Reviewing:
Pasternak B and Hviid A. JAMA 2010 Aug 25; 304:859
Mills JL and Carter TC. JAMA 2010 Aug 25; 304:905
First-trimester use of acyclovir was not associated with excess risk for major birth defects.
Monday, September 27, 2010
Sunday, September 26, 2010
Hand Foot Chemotherapy Induced Syndrome
Chemotherapy-induced acral erythema or palmoplantar erythrodysesthesia syndrome is a well-defined reaction to some of the chemotherapeutic agents such as methotrexate, cytarabine, doxorubicin, fluorouracil (5-FU), cytosine arabinoside and bleomycin.
More recently, HFS has been reported in association with regimens using targeted agents, in particular the multikinase inhibitors (MKI) sorafenib and sunitinib (1). The HFS associated with MKI has a different distribution and clinical appearance than the traditional disorder.
This reaction is characterized by symmetric, well-demarcated, painful erythema of the palms and soles, which may progress to desquamation or blisters.
It appears to be dose dependent. It is likely a direct toxic effect of the drug.
Tingling on the palms and soles is followed in a few days by painful, symmetric, well-defined swelling and erythema.
Histologically, the HFS is characterized by a toxic keratinocyte reaction. Furthermore, there is sub-basal edema with a tendency to bullae, dilated blood and lymph capillaries and usually only mild perivascular lymphocytic infiltration (2).
Depending on the severity, HFS requires dose reduction, interruption or switch in the antineoplastic chemotherapy (2-3).
(1) Degen A, Alter M, Satzger I, et al. The hand-foot-syndrome associated with medical tumor therapy- classification and management. J Dtsch Dermatol Ges. 2010 Sep; 8(9):652-61.
(2) Janusch M, Fischer M, Marsch WCh, et al. The hand-foot syndrome - a frequent secondary manifestation in antineoplastic chemotherapy. Eur J Dermatol. 2006 Sep-Oct; 16(5): 494-9.
(3) Habif TP. Clinical Dermatology. 5th edition. USA: Elsevier Science 2010.
More recently, HFS has been reported in association with regimens using targeted agents, in particular the multikinase inhibitors (MKI) sorafenib and sunitinib (1). The HFS associated with MKI has a different distribution and clinical appearance than the traditional disorder.
This reaction is characterized by symmetric, well-demarcated, painful erythema of the palms and soles, which may progress to desquamation or blisters.
It appears to be dose dependent. It is likely a direct toxic effect of the drug.
Tingling on the palms and soles is followed in a few days by painful, symmetric, well-defined swelling and erythema.
Histologically, the HFS is characterized by a toxic keratinocyte reaction. Furthermore, there is sub-basal edema with a tendency to bullae, dilated blood and lymph capillaries and usually only mild perivascular lymphocytic infiltration (2).
Depending on the severity, HFS requires dose reduction, interruption or switch in the antineoplastic chemotherapy (2-3).
(1) Degen A, Alter M, Satzger I, et al. The hand-foot-syndrome associated with medical tumor therapy- classification and management. J Dtsch Dermatol Ges. 2010 Sep; 8(9):652-61.
(2) Janusch M, Fischer M, Marsch WCh, et al. The hand-foot syndrome - a frequent secondary manifestation in antineoplastic chemotherapy. Eur J Dermatol. 2006 Sep-Oct; 16(5): 494-9.
(3) Habif TP. Clinical Dermatology. 5th edition. USA: Elsevier Science 2010.
Cryotherapy May Be Most Effective for Removal of Common Warts
Canadian Medical Association Journal, September 13 2010 (Published online)
A randomized controlled trial that compared the effectiveness of common wart treatments (Liq Nitrogen Vs Salicylic Acid) as well as a wait-and-see approach.
Introduction:
"Cryotherapy is widely used for the treatment of cutaneous warts in primary care"
"However, evidence favours salicylic acid application"
Method:
Between May 1, 2006, and January 26, 2007, all eligible patients with new cutaneous warts were recruited from 30 primary care practices in the Netherlands and were randomly assigned to 1 of 3 groups: cryotherapy with liquid nitrogen every 2 weeks, daily self-application of salicylic acid, or a wait-and-see approach.
The proportion of participants with cure of all warts at 13 weeks was the main study endpoint, and analysis was by intent-to-treat. Treatment adherence, adverse effects, and satisfaction with treatment were secondary endpoints. At 4, 13, and 26 weeks, research nurses evaluated outcomes during home visits.
Results:
Of the 250 participants, 122 (49%) were stratified into the common wart group and 128 (51%) into the plantar wart group.
Age range of the participants was 4 to 79 years.
At 13 weeks, 10 patients (4%) were lost to follow-up, and 240 were included in the analysis.
In the cryotherapy group, cure rate was 39(95% confidence interval [CI], 29% - 51%) vs 24% (95% CI, 16% - 35%) in the salicylic acid group and 16% (95% CI, 9.5% - 25%) in the wait-and-see group.
For participants with common warts (n = 116), these differences in efficacy were most pronounced. Cure rates were 49% with cryotherapy (95% CI, 34% - 64%), 15% with salicylic acid (95% CI, 7% - 30%), and 8% with the wait-and-see approach. The different treatments were not associated with significant differences in cure rates among participants with plantar warts (n = 124).
Limitation:
Limitations of this study include self-application of salicylic acid and lack of blinding of participants, family practices, and research nurses.
Conclusion:
"Although earlier evidence favoured salicylic acid application above cryotherapy, the present randomized controlled trial is the first that provides evidence to support the use of cryotherapy above salicylic acid, however, for common warts only,"
A randomized controlled trial that compared the effectiveness of common wart treatments (Liq Nitrogen Vs Salicylic Acid) as well as a wait-and-see approach.
Introduction:
"Cryotherapy is widely used for the treatment of cutaneous warts in primary care"
"However, evidence favours salicylic acid application"
Method:
Between May 1, 2006, and January 26, 2007, all eligible patients with new cutaneous warts were recruited from 30 primary care practices in the Netherlands and were randomly assigned to 1 of 3 groups: cryotherapy with liquid nitrogen every 2 weeks, daily self-application of salicylic acid, or a wait-and-see approach.
The proportion of participants with cure of all warts at 13 weeks was the main study endpoint, and analysis was by intent-to-treat. Treatment adherence, adverse effects, and satisfaction with treatment were secondary endpoints. At 4, 13, and 26 weeks, research nurses evaluated outcomes during home visits.
Results:
Of the 250 participants, 122 (49%) were stratified into the common wart group and 128 (51%) into the plantar wart group.
Age range of the participants was 4 to 79 years.
At 13 weeks, 10 patients (4%) were lost to follow-up, and 240 were included in the analysis.
In the cryotherapy group, cure rate was 39(95% confidence interval [CI], 29% - 51%) vs 24% (95% CI, 16% - 35%) in the salicylic acid group and 16% (95% CI, 9.5% - 25%) in the wait-and-see group.
For participants with common warts (n = 116), these differences in efficacy were most pronounced. Cure rates were 49% with cryotherapy (95% CI, 34% - 64%), 15% with salicylic acid (95% CI, 7% - 30%), and 8% with the wait-and-see approach. The different treatments were not associated with significant differences in cure rates among participants with plantar warts (n = 124).
Limitation:
Limitations of this study include self-application of salicylic acid and lack of blinding of participants, family practices, and research nurses.
Conclusion:
"Although earlier evidence favoured salicylic acid application above cryotherapy, the present randomized controlled trial is the first that provides evidence to support the use of cryotherapy above salicylic acid, however, for common warts only,"
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