Faculty Bibliography

BACKGROUND:Little is known about how dermatologists prescribe hormonal antiandrogen acne treatment (HAAT). OBJECTIVE:The aim of this study was to investigate dermatologists' HAAT-prescribing habits and HAAT's impact on systemic antibiotic use in women with acne. METHODS:We performed a retrospective study at an academic medical center of female patients receiving HAAT (combined oral contraceptive [COC], spironolactone) for acne from January 2005 to October 2015. Data from a control group of female acne patients who never received HAAT were also collected. RESULTS:A total of 672 female patients received HAAT. Out of all systemic medications for acne, antibiotics were used as first-line treatment in 39% of patients, COCs in 12%, and spironolactone in 21%. Mean antibiotic durations in patients who initiated HAAT for the first time at the study site (250.4 days) were significantly longer than in patients who received HAAT prior to presentation and continued HAAT at the study site (192.0 days) (p = 0.021). A statistically significant inverse association was found between HAAT use and mean antibiotic duration (p = 0.016). CONCLUSIONS:HAAT is not typically used as a first-line systemic therapy in women with acne. HAAT usage is associated with shorter cumulative antibiotic durations and early HAAT initiation can decrease systemic antibiotic use in acne treatment.

Iodinated contrast (IC) often is overlooked as a cause of delayed drug reactions. As a result, patients may continue to be readministered these agents, experiencing preventable morbidity. We report an illustrative case of a delayed cutaneous reaction to IC and review the literature on the epidemiology and management of this underrecognized phenomenon.

The utility of laser therapy is increasingly being recognized in the treatment of active acne vulgaris. We aimed to perform a narrative review of the medical literature on the use of laser therapy for the treatment of active acne vulgaris. We performed a PubMed literature search on September 1, 2016 using the search terms "active acne," "acne," "laser therapy," and "laser surgery." Case reports, case series, cohort, and controlled trials were included. Studies of lasers in the treatment of acne, including erbium glass, Nd:YAG, pulse dye laser (PDL), potassium titanyl phosphate (KTP) laser, and laser-based photodynamic therapy, have been published. While treatment of active acne with lasers has been successful, many studies are limited by small patient number and lack of control populations and comparison to standard therapies for active acne. Laser therapies are increasingly becoming part of or an adjunct to the medical treatment of active acne and are a useful treatment modality.

BACKGROUND: To some degree, acne vulgaris affects nearly every individual worldwide. Oral antibiotic therapy is routinely prescribed for the treatment of moderate to severe inflammatory acne; however, long-term use of oral antibiotics for acne may have unintended consequences. OBJECTIVE: The aim of this study was to provide a systematic evaluation of the scientific evidence on the efficacy and appropriate use of oral antibiotics in the treatment of acne. METHODS: A systematic search of MEDLINE was conducted to identify randomized controlled clinical trials, systematic reviews, and meta-analyses evaluating the efficacy of oral antibiotics for acne. Overall, 41 articles that examined oral antibiotics compared with placebo, another oral therapy, topical therapy, alternate dose, or duration were included in this study. RESULTS: Tetracyclines, macrolides, and trimethoprim/sulfamethoxazole are effective and safe in the treatment of moderate to severe inflammatory acne. Superior efficacy of one type or class of antibiotic could not be determined, therefore the choice of antibiotic is generally based on the side-effect profile. Although different dosing regimens have been studied, there is a lack of standardized comparator trials to determine optimal dosing and duration of each oral antibiotic used in acne. The combination of oral antibiotics with a topical therapy is superior to oral antibiotics alone. CONCLUSION: This article provides a systematic evaluation of the scientific evidence of the efficacy of oral antibiotics for acne. Due to heterogeneity in the design of the trials, there is insufficient evidence to support one type, dose, or duration of oral antibiotic over another in terms of efficacy; however, due to increasing resistance to antibiotics, dermatologists should heed consensus guidelines for their appropriate use.

Background: Relapse, even after HCT with myeloablative (MA) conditioning regimens for hematologic malignancies, remains the most common cause of failure. Older data suggests that higher dose TBI combined with chemotherapy may reduce disease relapse, however this benefit was offset by higher treatment related mortality (TRM) and hepatic sinusoidal obstructive syndrome (SOS). Radiotherapy techniques and supportive care have since improved. In the current transplant era we aimed to compare the outcomes of higher than standard (>12 Gy) dose TBI compared to standard dose TBI (12 Gy). Methods: We identified 2721 patients with AML (51%), MDS (4.5%), ALL (32%), CML (12.5%), between 18 and 60 years old, who underwent a MA HCT with cyclophosphamide (Cy)/TBI from an HLA-partially matched or fully matched donor between 2001 and 2013 from those patients reported to the CIBMTR. Patients who received radiation boost or an ex vivo T-cell depleted allograft were excluded. The cohort was divided into 3 groups based on TBI dose: Cy/TBI (12 Gy) [n= 1745], Cy/TBI (13-13.75 Gy) [n = 648] and Cy/TBI (14 Gy) [n = 328] according to the distribution of TBI doses. Results: Median ages of the cohorts were 39,39, and 43 years, respectively. Median follow-up of survivors was 71-73 [range 3-176] months across groups. The majority had a performance status that was >=90%. Median time from diagnosis to transplant was similar at 6-7 [range 1-310] months across cohorts. Relapse was the most common cause of death (40-55%) across cohorts, 14GyTBI group resulted in lower relapses (36%, 32% and 26% at 5 years, P <.001). Overall survival was similar across groups (42%, 40% and 45% at 5 years, P =.39). Multivariate analyses demonstrated that 14 Gy TBI was associated with lower relapse, higher risk of SOS but no difference in TRM and no improvement in overall mortality compared to 12 Gy TBI (Table 1). Conclusion: Cy/TBI with 14 Gy reduces relapse but increases organ toxicity, especially SOS, and did not result in survival benefit compared to Cy/TBI with standard MA dose of TBI (12 Gy) in this contemporary cohort

BACKGROUND: Lymphangitic streaking, characterized by linear erythema on the skin, is most commonly observed in the setting of bacterial infection. However, a number of nonbacterial causes can result in lymphangitic streaking. We sought to elucidate the nonbacterial causes of lymphangitic streaking that may mimic bacterial infection to broaden clinicians' differential diagnosis for patients presenting with lymphangitic streaking. METHODS: We performed a review of the literature, including all available reports pertaining to nonbacterial causes of lymphangitic streaking. RESULTS: Various nonbacterial causes can result in lymphangitic streaking, including viral and fungal infections, insect or spider bites, and iatrogenic etiologies. CONCLUSION: Awareness of potential nonbacterial causes of superficial lymphangitis is important to avoid misdiagnosis and delay the administration of appropriate care.