Psoriasis and hypertension severity: results from a case-control study.

BACKGROUND: Epidemiologic studies have provided new insights into the association between psoriasis and cardiovascular diseases. Previous population studies have examined hypertension frequency in psoriasis patients. However, the relationship between severity of hypertension and psoriasis has not been characterized. OBJECTIVE: We sought to investigate whether patients with psoriasis have more difficult-to-manage hypertension compared to non-psoriatic hypertensive patients. APPROACH: We performed a case-control study using the University of California Davis electronic medical records. The cases were defined as patients diagnosed with both psoriasis and hypertension, and controls were defined as patients with hypertension and without psoriasis. In this identified population, 835 cases were matched on age, sex, and body mass index (BMI) to 2418 control patients. KEY RESULTS: Treatment with multiple anti-hypertensives was significantly associated with the presence of psoriasis using univariate (p < 0.0001) and multivariable analysis, after adjusting for diabetes, hyperlipidemia, and race (p < 0.0001). Compared to hypertensive patients without psoriasis, psoriasis patients with hypertension were 5 times more likely to be on a monotherapy antihypertensive regimen (95% CI 3.607.05), 9.5 times more likely to be on dual antihypertensive therapy (95% CI 6.68-13.65), 16.5 times more likely to be on triple antihypertensive regimen (95% CI 11.01-24.84), and 19.9 times more likely to be on quadruple therapy or centrally-acting agent (95% CI 10.58-37.33) in multivariable analysis after adjusting for traditional cardiac risk factors. CONCLUSIONS: Psoriasis patients appear to have more difficult-to-control hypertension compared to non-psoriatic, hypertensive patients.

Vitamin E and allergic contact dermatitis.

Reports of vitamin E-induced allergic contact dermatitis (ACD) and frequent use of vitamin-E derivatives (tocopherol, tocopheryl linoleate, tocopherol acetate, etc) in skin care products deserves further investigation into tolerability and suitability of vitamin E in skin care preparations. A PubMed search was conducted to review the prevalence of vitamin E-induced ACD. It revealed 931 cases of vitamin E-induced ACD mainly from one large study. There were no reported deaths and only three patients required hospitalization for treatment. It appears that vitamin E-induced ACD is an uncommon phenomenon; incidence is low despite its widespread use in skin care products. Given its antioxidant and photoprotective properties, vitamin E should remain an ingredient in skin care products.

Drug samples in dermatology: special considerations and recommendations for the future.

BACKGROUND: The use of drug samples is a controversial issue in medicine. OBJECTIVE: We sought to determine the pros and cons of drug sampling, and how drug sampling in general medicine differs from dermatology. METHODS: Literature searches were conducted on PubMed, Google, and Yahoo!. Articles were found pertaining to drug sampling in general, and for dermatology specifically. RESULTS: Numerous pros and cons for drug sampling were found in the literature search. We divided these by cost-related issues, such as the industry-wide cost of sampling and the use of sampling to assist the underinsured and poor, and quality of care issues, such as adherence, patient education, and safety considerations. Articles also suggested that dermatology may differ from general medicine as topical treatments have fewer side effects, are more complicated to use, and come in different vehicles. LIMITATIONS: We identified few studies specifically focused on issues relevant to sampling in dermatology. CONCLUSION: There are strong arguments for and against drug sampling involving both cost and quality of care issues. Dermatology-specific medications clearly differ from oral medications in several regards. We ultimately conclude that the benefits of drug sampling outweigh the risks, but give recommendations on how drug sampling can be done ethically and effectively, including limiting personal use, not selling samples, properly documenting sample release, teaching patients about proper use, teaching students and residents ethical use of samples, working with pharmaceutical representatives in an ethical manner, prescribing the drug that is best for the patient, and securing samples appropriately to prevent theft and misuse.

Non-psoriatic dermatologic uses of monoclonal antibody therapy.

Monoclonal antibodies have been employed in the treatment of dermatologic disease for quite some time, primarily for psoriasis. Nevertheless, there are numerous case reports detailing successful and unsuccessful treatment of non-psoriatic dermatologic disease with these agents. In most cases, their use is off-label, as the FDA has approved monoclonal antibody use for only a few dermatologic diseases. The most commonly used monoclonal antibodies in dermatology are omalizumab, infliximab, rituximab, adalimumab, and efalizumab, and the disorders of interest include but are not limited to hidradenitis suppurativa, atopic dermatitis, pyoderma gangrenosum, and various blistering diseases. A review of these cases will hopefully encourage the use of monoclonal antibodies in dermatology via development of large, adequately powered clinical trials. This will hopefully result in FDA approval of monoclonal antibodies for a larger variety of recalcitrant, difficult-to-treat dermatologic illnesses.