New drugs, data and guidelines on acne and rosacea treatment were among the takeaways from days two and three of MauiDerm 2014. Presenters also described evidence-based suggestions for managing pigmentary disorders and updated information on infectious diseases.
Ted Rosen, M.D., professor of dermatology, Baylor College of Medicine, Houston, highlighted interesting findings in the infectious disease literature. He noted a retrospective study done between 1999 and 2010 in which 57,958 patients with herpes zoster were compared to a cohort of 231,832 individuals who did not have herpes zoster.
The researchers found a 25 percent higher likelihood that patients with herpes zoster would have acute coronary artery syndrome (ACS). The finding was statistically significant at both three months and one year. Dr. Rosen advised that if clinicians have a patient with herpes zoster, to warn the patient about the risks of ACS and review the symptoms.
Dr. Rosen also discussed a paper that he suggested dermatologists review if they practice in areas prone to flooding. A paper published in the International Journal of Dermatology in 2013 reviewed the literature related to flooding and skin disease. The paper categorized flood-related diseases into four groups: inflammatory skin diseases that may be aggravated in a flood, such as psoriasis and atopic dermatitis; skin infections, such as tinea pedis, cellulitis and Gas gangrene; traumatic wounds, such as lacerations, cuts, punctures, insect bites, animal bites; and miscellaneous skin disease. The paper offers guidance on early intervention, treatment and education.
Sheila Fallon Friedlander, M.D., University of California, San Diego, School of Medicine, quizzed attendees on situations in which clinicians would simply reassure a patient and parent, offer appropriate intervention, and provide immediate action.
Her first example was a case of molluscum contagiosum. She noted that it usually occurs in children up to 14 years old, but its highest incidence is in those ages 1 to 4 years, and it is associated with swimming and eczema. Although guidance from a Cochrane analysis suggests letting it heal on its own, it is likely patients won’t be pleased with that, Dr. Friedlander said, so it’s important to choose the appropriate strategy.
The recommendation is to use cantharidin 0.7 percent applied with a Q-tip directly to lesions with exception of those on the face and intertriginous areas. Patients should be advised to wash the cantharidin off after about four hours. It is not a treatment that should be offered to patients to take home and self-apply because it can cause serious side effects if misused, including lymphangitis, toxin shock syndrome, scarring and fatal poisoning.
George Martin, M.D., Dermatology and Laser Center of Maui, Kihei, Hawaii, suggested a method he strongly believes in, which is to obtain monochloroacetic acid crystals, fill a small clean biopsy container halfway, and then add half water. Apply the solution to the lesions with a toothpick, count to 60 and neutralize it with a wet paper towel.
With molluscum contagiosum, Dr. Friedlander noted that it is also important to recognize signs of BOTE (beginning of the end), which is the inflammatory phase of the disease and a sign it is on its way to self-resolution. Indications include:
- MC dermatitis
- Extreme induration and erythema
- Fluctuance, purulent exudate; abscess
Once inflammation occurs, the disease should resolve within three weeks to five months. Recognizing this, you can avoid unnecessary additional interventions. This stage should be distinguished from signs of cellulitis or lymphangitic streaking, in which case, you need to intervene.
Dr. Friedlander also highlighted signs of Kawasaki disease, which she said has been correlated with wind velocity. She referenced a paper published in the April 2012 issue of Nature, which notes a potential seasonal association. The number of cases is rising, particularly in Japan, Hawaii and San Diego, and the cases appear to be linked to wind currents coming from Central Asia, she explained. Dr. Friedlander advised attendees that if they notice characteristics of the disease to intervene immediately.