Use of an emollient as a steroid-sparing agent in the treatment of mild to moderate atopic dermatitis in children.

The effectiveness of an emollient as an adjunct to topical corticosteroid therapy for the treatment of mild to moderate atopic dermatitis was studied for 3 weeks in 25 children 3 to 15 years of age in comparison with corticosteroid therapy alone. The adjunctive regimen of a once-daily application each of hydrocortisone 2.5% cream and of a water-in-oil cream was equivalent in efficacy to the comparative regimen of twice-daily applications of hydrocortisone 2.5% cream. Both treatment regimens elicited significant improvement in skin condition by day 7 ( p < 0.005) and further significant improvement by day 14 (p < 0.005). No significant differences between the two treatment regimens were observed in the rates of improvement (p > 0.545) or in the reductions in mean lesion size (p > 0.98). No differences were observed in parental evaluations, except for ease of application where a slight preference was expressed for the hydrocortisone 2.5% cream preparation (p < 0.038). We conclude that emollient adjunctive therapy offers a steroid-sparing alternative to topical corticosteroids alone in the treatment of mild to moderate atopic dermatitis.

Definition and application of the discretionary screening indicators according to the National Cholesterol Education Program for Children and Adolescents.

OBJECTIVES: (1) To propose definitions for the discretionary screening indicators described by the National Cholesterol Education Program for Children and Adolescents (NCEP-Peds); (2) to examine the relative prevalence of major screening indicators (family history of premature heart disease and parental plasma cholesterol concentration > or = 6.21 mmol/L (240 mg/dl)) and discretionary screening indicators (excessive consumption of fat or cholesterol or both, smoking, diabetes, hypertension, and steroid use) in a family population; and (3) to evaluate the relative value of the major and the discretionary indicators in detecting high serum levels of low-density lipoprotein-cholesterol (LDL-C) (> or = 3.36 mmol/L (> or = 130 mg/dl)). DESIGN: Control cohort from a case-control study. SETTING: Lipid research clinic. PARTICIPANTS: White children and adolescents < 20 years of age from 232 nuclear families who participated in the Cincinnati Myocardial Infarction Hormone Study. MAIN OUTCOME MEASURES: (1) Number of children who have major and discretionary screening indicators; (2) sensitivity and specificity of the major and the discretionary screening indicators in identifying children with LDL-C concentrations > 3.36 mmol/L (130 mg/dl) (high LDL-C). RESULTS: With cutoff points of the 90th percentile for blood pressure, the 85th percentile for obesity, and the 80th percentile for dietary fat and cholesterol, and self-report for diabetes, smoking, and corticosteroid use, 54% of the 232 children in the cohort had one or more discretionary indicators. Additionally, applying the major screening indicators raised the percentage of children identified to 74%. Twenty-eight percent had both major and discretionary indicators. Having a discretionary screening indicator did not increase the probability of having a major indicator. Applying both discretionary and major screening indicators to the cohort identified 96% of the children who had a high concentration of LDL-C; 30% of the children with high LDL-C levels were discovered solely by the discretionary indicators. Similar sensitivity and specificity were noted between the major and the discretionary indicators. Children with high LDL-C concentrations were more likely to have multiple screening indicators. CONCLUSION: Discretionary and major screening indicators suggested by the National Cholesterol Education Program for Children and Adolescents identify different subsets of children at risk of having premature cardiovascular disease. Both major and discretionary indicators contribute to the identification of children with high LDL-C concentrations.

The new food label, type of fat, and consumer choice. A pilot study.

OBJECTIVES: To determine how frequently lay consumers evaluate both the front label of a product package and other nutritional information on the back label of the package; whether the nutritional descriptors on the front label that concern fat affect consumer choice; to what degree information on the back label redirects this choice; and how well consumers understand the percent daily value on the new food label. DESIGN: Preliminary cross-sectional survey. SETTING: General community and university setting. PARTICIPANTS: Volunteer sample of 200 men and women. METHODS/RESULTS: Participants were first asked to choose between two fabricated cookie packages, one with a "low fat" and the other with a "no saturated fat" front label. Eighty-four percent of participants made their product choice without turning the package to view the back label. Thirty-six percent chose the product with the low fat front label, while 64% chose the product with the no saturated fat front label. In contrast, when respondents were subsequently presented with two cake products that contained no front-label descriptors (which resulted in 100% of subjects turning the package to view the back label), 53% chose the product with a label indicating 6 g of total fat (none saturated), while 47% chose the product with a label indicating 4 g of total fat (all saturated). Thirty-two of the 94 respondents who chose the no saturated fat cookie (only viewing the front label and giving fat content as the reason for their choice) chose a cake product in which the fat was all saturated, based on back-label nutrition information. Finally, 56% of participants could not accurately use the new percent daily value component to calculate saturated fat content. CONCLUSIONS: The data from this pilot study suggest that consumers make product choices based on only viewing the front-label information; health claims on the front label that are related to fat do affect product choice; a choice made based on the information on the front label is potentially altered once the back label is viewed; and approximately one half of our population could not clearly understand the percent daily value. We conclude that current consumer choice may be overly influenced by industry-directed claims placed on the front of a product package.

Acne vulgaris in premenarchal girls. An early sign of puberty associated with rising levels of dehydroepiandrosterone.

BACKGROUND: This study examined the relationships of pubertal maturation and sex steroid hormones to the development of acne in young girls. Black (n = 317) and white (n = 306) premenarchal girls with a mean age of 9.97 +/- 0.62 years were evaluated for acne prevalence and severity, pubic hair and areolar maturation, and sex steroid hormone levels. RESULTS: Overall, 77.8% of the girls had some acne; of the whole group, 48.3% had only comedonal acne, 2.2% had only inflammatory acne, and 27.3% had both types. Although black girls matured at an earlier age than white girls, racial differences in acne were minimal when adjusted for pubertal maturation. Acne increased with advancing maturation; at Tanner pubic hair stages 1, 2, and 3, the prevalence of acne rose from 73.1% to 84.0% and to 90.6%, respectively. Acne lesion counts at seven facial locations revealed a predominance of midfacial acne on the middle aspect of the forehead, nose, and chin. Sex steroid hormone levels measured in 365 of the girls were found to increase significantly during maturation from prepuberty to early puberty. Testosterone-estrogen-binding globulin and the ratio of testosterone to estradiol decreased. In 118 prepubertal girls, estradiol, total and free testosterone, progesterone, testosterone to estradiol ratio, and testosterone-estrogen-binding globulin levels were no different whether in subjects with acne or without acne. However, the level of dehydroepiandrosterone sulfate, an androgen of adrenal origin, was significantly higher in prepubertal girls with acne. CONCLUSION: Acne, especially the comedonal type, can be the first sign of pubertal maturation in girls, even preceding pubic hair and areolar development. Concentration of dehydroepiandrosterone sulfate is significantly and specifically associated with the initiation of acne in young girls.