ABSTRACT
The requirements of the iPLEDGE program place burdens on both patients with severe recalcitrant nodular acne and prescribers of isotretinoin. We sought to investigate the changes in dermatologists' acne treatment patterns due to the administrative burden of iPLEDGE by assessing whether dermatologists chose not to prescribe isotretinoin to appropriate patients because of the labor of iPLEDGE requirements. Additionally, we investigated the medications that were substituted for isotretinoin. An anonymous online survey was created and posted on a dermatology group on social media. The survey respondents (N=510) consisted of board-certified dermatologists across the United States and comprised a wide variety of ages and practice types. This survey ultimately highlighted the burden of iPLEDGE for American clinicians and the need for a more streamlined risk-management program. This program is deterring some US clinicians, especially those younger than 46 years, from prescribing isotretinoin and limiting patient access to an effective medication.
Subject(s)
Acne Vulgaris , Dermatologic Agents , Acne Vulgaris/drug therapy , Dermatologic Agents/therapeutic use , Dermatologists , Humans , Isotretinoin/adverse effects , Prescriptions , Surveys and Questionnaires , United StatesABSTRACT
BACKGROUND: Persulfate compounds are reactive oxidative agents increasingly recognized as contact allergens. OBJECTIVES: The aim of this study was to identify common consumer products containing persulfate compounds in the US market. METHODS: Five publicly accessible online ingredient repositories and searches of two large online retailers were used to identify persulfate-containing consumer products. RESULTS: We identified persulfates in 23 hair colouring products, 11 denture cleansers, 8 pool/hot-tub products, 3 paints, and 3 cleaning products. CONCLUSIONS: Clinicians assessing contact dermatitis should be aware of three primary categories of consumer products that contain persulfates: denture cleansers, hair colouring products, and nonchlorine hot-tub and pool shock.
Subject(s)
Dermatitis, Allergic Contact , Allergens/adverse effects , Dermatitis, Allergic Contact/etiology , HumansABSTRACT
Prurigo pigmentosa is a rare inflammatory cutaneous disorder associated with ketosis that resolves with reticulate hyperpigmentation. A 19-year-old man was admitted to the hospital with diabetic ketoacidosis. He also had developed reticulate papules coalescing into plaques over the posterior neck, back, and abdomen. Histopathological findings consistent with the clinical findings suggested the diagnosis of prurigo pigmentosa. After treatment with topical triamcinolone and oral doxycycline along with resolution of his ketosis after insulin administration, the patient's rash healed with reticulate hyperpigmentation.
Subject(s)
Diabetes Mellitus , Diabetic Ketoacidosis , Hyperpigmentation , Ketosis , Prurigo , Adult , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/diagnosis , Diabetic Ketoacidosis/drug therapy , Doxycycline/therapeutic use , Humans , Hyperpigmentation/complications , Hyperpigmentation/etiology , Ketosis/complications , Ketosis/drug therapy , Male , Prurigo/diagnosis , Prurigo/drug therapy , Prurigo/etiology , Young AdultABSTRACT
Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are life-threatening, cutaneous reactions often associated with culprit drugs. A growing body of knowledge has deepened our understanding of the pathophysiology and clarified mechanisms such as drug-specific cytotoxicity mediated by T-cells, genetic linkage with HLA and non-HLA genes, TCR restriction, and cytotoxicity mechanisms. Physicians should broadly consider the etiology of SJS/TEN in order to better understand treatment strategies as well as identify which patients may be at risk for developing this condition. Mechanisms for how radiotherapy and rare malignancies may contribute to the development of TEN and SJS have been proposed.
