Jennifer Ornelas

Comparing the effect of bleach and water baths on skin barrier function in atopic dermatitis: a split-body randomized controlled trial†

DEAR EDITOR, Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with defective epidermal barrier function, characterized by decreased stratum corneum (SC) hydration, and increased transepidermal water loss (TEWL) and pH. Staphylococcus aureus skin colonization is present in nearly all cases of AD exacerbation and correlates with disease severity, suggesting an infection–inflammation cycle. The use of a sodium hypochlorite (bleach) bath alone and as an adjunct to intranasal mupirocin ointment is associated with a reduction in AD severity, and decreases annual skin infection cases 10-fold. In a Cochrane review on various interventions to reduce S. aureus colonization, including oral antibiotics, topical steroids and antibiotic ointments, only bleach bath showed a significant improvement in AD severity. Bleach bath appears to be a low-cost and effective adjuvant treatment for AD, and is recommended by the American Academy of Dermatology and American Academy of Allergy, Asthma and Immunology, particularly for patients with moderate-to-severe AD and frequent bacterial infections. Although bleach bath is generally well-tolerated, with no existing report on skin irritation, it may be difficult to convince patients and parents that a potential irritant is beneficial for the sensitive skin of patients with AD. The goal of this study was to compare the effect of bleach bath vs. water bath exposure on skin barrier function by measuring SC hydration, TEWL and pH in patients with AD and healthy subjects. The study was approved by the institutional review board of University of California, Davis (# 523979). The study was registered on ClinicalTrials.gov (NCT02594969). Ten patients with concurrent AD (mean age 26 3 years, range 12 0–45 0) and 10 healthy subjects (mean age 28 5 years, range 22 0– 34 0) were enrolled between 2014 and 2015. The entire study was performed at University of California, Davis. Demographic data are summarized in Table 1. Testing was conducted on the volar surfaces of the forearms, a commonly used study site for topical applications. AD severity was determined by the global eczema area severity index (EASI) and modified local EASI for upper limbs. Each patient served as their own control and a priori binary randomization was performed to determine which forearm would receive tap water or 0 005% dilute hypochlorite solution bath exposure. The randomization was performed prior to recruitment by the study coordinator, and stored in sealed envelopes that were not opened until the patient was recruited by the investigators. Participants remained blinded to the water or dilute hypochlorite immersion. Each arm was immersed for 10 min. None of the patients bathed or applied topical moisturizers or medications for 12 h prior to the study session. Skin barrier function parameters, including hydration (MoistureMeter SC; Delfin Technologies, Stamford, CT, U.S.A.), TEWL (Tewameter; Courage and Khazaka, Cologne, Germany) and pH (Dry Skin pH Meter; Hanna Instruments, Woonsocket, RI, U.S.A.), were measured at baseline, immediately postimmersion, and 15, 30 and 60 min postimmersion. Patients were asked to report skin discomfort, including itching, burning or pain during the 10-min immersion and throughout the postimmersion period. All recruited patients completed the study. A priori power analysis showed that evaluation of 10 patients with AD and 10 healthy controls would yield > 90% power at a = 0 05 to detect a difference of 15% in TEWL (primary end point) after bleach immersion compared with water immersion. Intraand interindividual comparisons were performed by ANOVA with a paired analysis performed for intraindividual comparisons.

Effect of Microneedle Pretreatment on Topical Anesthesia: A Randomized Clinical Trial

Effect of Microneedle Pretreatment on Topical Anesthesia: A Randomized Clinical Trial Microneedles are microscopic needles capable of creating microchannels through the stratum corneum to improve transdermal drug delivery.1-3 Microneedles have been shown1,2,4-6 to enhance the delivery of topical anesthetics with use of in vitro and animal models. In this split-body, randomized clinical trial, we investigated whether pretreatment with microneedles enhanced the anesthetic effect produced by topical lidocaine cream, 4%.

Use of the hCONSORT criteria as a reporting standard for herbal interventions for common dermatoses: a systematic review

The use of complementary and alternative medicine (CAM) is increasing in Western countries, including in the area of dermatology. However, Western healthcare providers have not integrated CAM into regular practice owing to a lack of reliable data supporting its use. To encourage high‐quality research related to the use of CAM and specifically herbal interventions, the CONsolidated Standards Of Reporting Trials (CONSORT) extension criteria on reporting herbal interventions (hCONSORT) were published in 2006.

A report of two patients with darier disease and hidradenitis suppurativa

We report two unique cases of patients with Darier disease and hidradenitis suppurativa. Although it is unknown whether there is a connection between the two diseases, it is possible that an interaction between sarcoendoplasmic reticulum calcium transport ATPase and Notch homolog 1, translocation‐associated (Drosophila) caused both diseases in these individuals.

Objective assessment of isotretinoin-associated cheilitis: Isotretinoin Cheilitis Grading Scale

Abstract Importance: Isotretinoin remains an effective treatment for severe acne. Despite its effectiveness, it includes many side effects, of which cheilitis is the most common. Objective: To develop an objective grading scale for assessment of isotretinoin-associated cheilitis. Design: Cross-sectional clinical grading study. Setting: UC Davis Dermatology clinic. Participants: Subjects were older than 18 years old and actively treated with oral isotretinoin. Exposures: Oral Isotretinoin. Main outcomes and measures: We developed an Isotretinoin Cheilitis Grading Scale (ICGS) incorporating the following four characteristics: erythema, scale/crust, fissures and inflammation of the commissures. Three board-certified dermatologists independently graded photographs of the subjects. Results: The Kendall’s coefficient of concordance (KCC) for the ICGS was 0.88 (p < 0.0001). The Kendall’s coefficient was ≥0.72 (p < 0.0001) for each of the four characteristics included in the grading scale. An image-based measurement for lip roughness statistically significantly correlated with the lip scale/crusting assessment (r = 0.52, p < 0.05). Conclusion and relevance: The ICGS is reproducible and relatively simple to use. It can be incorporated as an objective tool to aid in the assessment of isotretinoin associated cheilitis.

Cedarwood Oil as Complementary Treatment in Refractory Acne

Acne vulgaris is a widely prevalent chronic skin disease. Although multiple treatments are available, acne can sometimes be refractory to these treatments. The use of alternative medical therapies has increased within dermatology and for acne. This case report describes a patient in whom the addition of cedarwood oil was helpful in controlling acne.

International inter-rater agreement in scoring acne severity utilizing cloud-based image sharing of mobile phone photographs

Cloud‐based image sharing technology allows facilitated sharing of images. Cloud‐based image sharing technology has not been well‐studied for acne assessments or treatment preferences, among international evaluators. We evaluated inter‐rater variability of acne grading and treatment recommendations among an international group of dermatologists that assessed photographs.

Isotretinoin: controversies, facts, and recommendations

ABSTRACT Introduction: Since it was introduced to the market by Hoffman-La Roche (Roche) in 1982, isotretinoin has remained the most effective treatment for severe and recalcitrant acne. However, it has also been surrounded by controversy due to its teratogenicity and inconsistent associations with depression, suicidality, inflammatory bowel disease, increases in lipid levels, and elevated transaminases. Areas covered: In this article, we reviewed data regarding safety of isotretinoin and its association with these conditions. A thorough and comprehensive search on the topics was performed using pubmed and google scholar. Expert commentary: Despite common misperceptions, there is weak evidence for increased incidence of depression, suicidality, or inflammatory bowel disease with isotretinoin use. Furthermore, data indicates that transient increases in transaminases and lipid levels do not typically necessitate discontinuation of therapy. We hope to provide clinicians with information necessary to have meaningful discussions with patients regarding the safety and efficacy of isotretinoin.

The Role of Botanical Products in the Treatment of Alopecia

Alopecia, which is defined as the loss of hair from the body, encompasses a wide range of hair loss disorders, including alopecia areata and androgenetic alopecia. There is a growing use of botanical sources in dermatology. Accordingly the interest in the use of botanical and natural products for the treatment of alopecia is growing. Here we present a systematic review of natural and botanical products that have been examined as potential treatment options for alopecia. Our results yielded 13 studies that examined 11 different natural and botanical products for the potential treatment of alopecia areata. Studies pertaining to alopecia areata and androgenetic alopecia were found. These results are promising as they signal increasing investigation into the use of natural and botanical products for the treatment of alopecia.