Emily Boozalis

Allergen of the Year alkyl glucoside is an ingredient in top-selling sunscreens and facial moisturizers

To the Editor: As eco-friendly consumerism gains popularity, cosmetic products are shifting to more sustainable, plant-based ingredients. Alkyl glucosides are 1 such biodegradable ingredient that is increasingly being used in cosmetic products. Alkyl glucosides are nonionic surfactants formed through the condensation of glucose with a fatty alcohol. These fatty alcohols are primarily derived from palm, coconut, and rapeseed oil. Alkyl glucosides are found in both rinse-off products (shower gels, shampoos, and hair dyes) and leave-on cosmetics (sunscreens, fragrances, moisturizers, and deodorants). Compared with harsher anionic surfactants such as sodium lauryl sulfate and sodium laureth sulfate, alkyl glucosides are considered to have lower irritancy and allergenicity. However, as the use of alkyl glucosides has increased in the past few decades, so have reports of allergic contact dermatitis (ACD) secondary to these products. Indeed, there have been 30 published reports of ACD to alkyl glucosides. The rate of positive patch test reactions to decyl glucoside—the prototype alkyl glucoside—has also increased from 1.3% in 2014 to 2.2% in 2016. For this reason, the American Contact Dermatitis Society recently named alkyl glucosides the 2017 Allergen of the Year.

Food and drug administration approval process for dermatology drugs in the United States

Abstract Aim: The purpose of this review is to elucidate the steps involved in the FDA’s approval of new dermatology drugs. Methods: To help illustrate the process of drug approval, we use examples from the recent approval of dupilumab (REGN668; Regeneron Pharmaceuticals). Results: In general, new dermatology drugs must undergo pre-clinical studies on non-human subjects and three phases of clinical trials in humans before undergoing review by the Food and Drug Administration (FDA). This review process involves an interdisciplinary team of scientists that determines if the drug should be brought to market based on its efficacy, risk-to-benefit ratio, and ability to be labeled. The team that specifically reviews dermatology drugs within the Center for Drug Evaluation and Research (CDER) at the FDA is the Division of Dermatologic and Dental Drug Products. Conclusions: The drug development process is enhanced by clinician input during all stages of development.

Itching at night: A review on reducing nocturnal pruritus in children

The most common causes of chronic nocturnal itching in children are atopic dermatitis and psoriasis, with lichen simplex chronicus and prurigo nodularis contributing to lesser degrees. Despite the prevalence of nocturnal itching, its pathophysiology remains poorly understood. The most troubling consequence of itching at night is poor quality of sleep. Poor sleep quality in children with nocturnal itching has been linked to adverse neurocognitive, behavioral, and physiologic outcomes, including poor performance in school, attention deficit hyperactivity disorder, short stature, hypertension, obesity, and impaired immune function. There is no consensus on the best management of nocturnal itching in children. We conducted a review of the literature evaluating the efficacy of various treatment options for children with chronic nocturnal pruritus. Our review found three recently conducted randomized controlled trials and one case report demonstrating the efficacy of topical corticosteroids, oral melatonin, and clonidine in reducing nocturnal itching or improving sleep quality in children with nocturnal pruritus. Future research is needed to elucidate the pathophysiology of nocturnal itching to best develop targeted, effective treatment strategies.

Morphea and systemic sclerosis are associated with an increased risk of melanoma and non-melanoma skin cancer

Communication Less educationz 1.4 (1.0-1.8) More educationx 1.4 (1.1-1.8) .41 0.13 .39 Age #65 y 1.4 (1.0-1.8) Age[65 y 1.4 (1.1-1.8) .64 e0.13 .36 Women 1.1 (1.0-1.5) Men 1.4 (1.1-1.8) .09 0.25 .08 Excellent/very goodk 1.2 (1.0-1.5) Good/fair/poork 1.6 (1.1-1.9) .01 0.25 .08 Complications Less education 1.8 (1.3-2.0) More education 2.0 (1.5-2.2) .19 0.25 .10 Age #65 y 2.0 (1.5-2.5) Age[65 y 1.8 (1.5-2.0) .03 e0.38 .01 Women 1.8 (1.5-2.2) Men 1.8 (1.5-2.2) .99 0.13 .40 Excellent/very good 1.8 (1.5-2.2) Good/fair/poor 1.8 (1.5-2.4) .71 0.13 .39 Facility Less education 1.4 (1.0-1.8) More education 1.6 (1.4-2.0) .30 0.2 .07 Age #65 y 1.6 (1.4-1.8) Age[65 y 1.4 (1.0-1.8) .20 e0.2 .052 Women 1.6 (1.2-1.8) Men 1.6 (1.2-1.8) .99 0 .99 Excellent/very good 1.4 (1.2-1.6) Good/fair/poor 1.8 (1.4-2.0) .01 0.4 .01 Courtesy Less education 1.2 (1.0-1.8) More education 1.4 (1.0-2.0) .32 0 .99 Age #65 y 1.6 (1.2-1.8) Age[65 y 1.2 (1.0-1.8) .04 e0.4 .01 Women 1.2 (1.0-1.6) Men 1.6 (1.0-1.8) .26 0.2 .18 Excellent/very good 1.2 (1.0-1.8) Good/fair/poor 1.6 (1.2-2.0) .05 0.2 .17

Selective serotonin reuptake inhibitors for the treatment of chronic pruritus

Chronic pruritus is defined as itch lasting 6u2009weeks or longer. Although chronic pruritus has a significant burden of disease, there are currently no FDA approved treatments specifically targeting p...

Clinical utility of marketing terms used for over-the-counter dermatologic products

Abstract Background: Cosmetic products are commonly marketed using dermatologic terms such as ‘hypoallergenic’, ‘non-comedogenic’, ‘fragrance-free’, etc. The clinical relevance of these claims can be confusing to both patients and clinicians. Methods: A systematic review was performed via a PubMed search of published articles from January 1985 to October 2017 to further describe and elucidate the clinical utility of a predefined list of common dermatologic terms used by pharmaceutical companies to market over-the-counter products. Results: The terms ‘fragrance-free’, ‘hypoallergenic’, ‘non-comedogenic’, and ‘oil-free’ on cosmetic product labels are not regulated by any governing body and provide varied clinical utility. Products labeled as having ‘natural ingredients’ are not necessarily safer or less irritating to patients with atopy or a history of allergic contact dermatitis. Despite the increasing popularity of ’paraben-free’ cosmetics, parabens are safe for patients in the quantities used in cosmetic products and can be safely used in patients who do not exhibit contact dermatitis to this preservative. Conclusion: A working knowledge of common cosmetic ingredients may help dermatologists to counsel patients on which products to avoid for their specific dermatologic conditions.

Oesophageal epidermal naevi as a feature of systematised epidermal naevus syndrome

Systematised epidermal naevi are hamartomas developing from neural ectoderm that can be quite extensive, typically with involvement of the face, neck, scalp, arms, legs and trunk. Involvement of the gastrointestinal tract is rare. We report on a 38‐year‐old Caucasian woman with systematised epidermal naevus syndrome who presented with previously undescribed involvement of the oesophagus, as well as the right side of her scalp, forehead, cheeks, chin, oral mucosa, neck, arms and trunk.