Simple solution to prevent postoperative bleeding from paramidline forehead flap

Publication date: April 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 4
Author(s): Collin M. Blattner, Brandon Markus, William Lear

Table of Contents

Publication date: April 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 4

I pledge to prescribe ethically

Publication date: April 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 4
Author(s): Andrew Kelsey, Justin Finch, Jane M. Grant-Kels

Information for Readers

Publication date: April 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 4

CME examination

Publication date: April 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 4

Comorbidities in rosacea: A systematic review and update

Publication date: April 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 4
Author(s): Roger Haber, Maria El Gemayel
BackgroundRosacea is linked to abnormalities of cutaneous vasculature and dysregulation of the inflammatory response. Recent reports on rosacea have shown a significant association with cardiovascular, gastrointestinal, and psychiatric diseases, all of which may affect morbidity and mortality among these patients.ObjectiveTo review available data regarding comorbidities associated with rosacea, discuss their pathogenesis, and highlight the evaluation of affected patients.MethodsWe performed a complete and systematic literature review in PubMed/Medline, Embase, and the Cochrane Collaboration databases, searching for all articles on possible associated diseases that have been reported with rosacea, with no limits on publication date, participant age, sex, or nationality.ResultsA total of 29 studies were included in this systematic review, including 14 case-control, 8 cross-sectional, and 7 cohort studies. Statistically significant association with rosacea has been mostly demonstrated with depression (n = 117,848 patients), hypertension (n = 18,176), cardiovascular diseases (n = 9739), anxiety disorder (n = 9079), dyslipidemia (n = 7004), diabetes mellitus (n = 6306), migraine (n = 6136), rheumatoid arthritis (n = 4192), Helicobacter pylori infection (n = 1722), ulcerative colitis (n = 1424), and dementia (n = 1194).LimitationsLimitations included the accuracy of the published data, potential patient selection, and possible confounding factors. The true nature of the drawn correlations is uncertain, and causality cannot be established.ConclusionsRosacea is associated with a number of systemic disorders. Recognition of these conditions is critical to providing appropriate screening and management of affected patients.

JAAD Case Reports Article List

Publication date: April 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 4

Journal Based CME Instructions and Information

Publication date: April 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 4

Alopecia areata is a medical disease

Publication date: April 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 4
Author(s): Dorota Z. Korta, Angela M. Christiano, Wilma Bergfeld, Madeleine Duvic, Abby Ellison, Jennifer Fu, John E. Harris, Maria K. Hordinsky, Brett King, Dory Kranz, Julian Mackay-Wiggan, Amy McMichael, David A. Norris, Vera Price, Jerry Shapiro, Natasha Atanaskova Mesinkovska

Analysis of the patient experience measure

Publication date: April 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 4
Author(s): Nicholas Golda, Stephen Beeson, Nita Kohli, Brandon Merrill
Assessing the patient experience has been a component of national health care policy for years in various forms, and it is now incorporated into many areas affecting physician practice. This review will focus on the origin and importance of this measure and address its critiques. The evolution of the measure as it progressed from patient satisfaction to patient experience and the rationale behind this shift will be detailed, the thought process behind the measure as an indicator of a culture of patient-centeredness and quality rather than as strictly a score will be reviewed, and the various motivators for physicians to improve patient experience will be divided into extrinsic and intrinsic and discussed.

Editorial Board

Publication date: April 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 4

Answers to CME examination

Publication date: April 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 4

Topical calcipotriol before ablative fractional laser-assisted photodynamic therapy enhances treatment outcomes for actinic keratosis in Fitzpatrick grades III-V skin: A prospective randomized clinical trial

Publication date: April 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 4
Author(s): Jeong-Wan Seo, Ki-Hoon Song

Rituximab as first-line adjuvant therapy for pemphigus: Retrospective analysis of long-term outcomes at a single center

Publication date: April 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 4
Author(s): Keshavamurthy Vinay, Simone Cazzaniga, Kyle T. Amber, Laurence Feldmeyer, Luigi Naldi, Luca Borradori

Recommendations for improving the patient experience in specialty encounters

Publication date: April 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 4
Author(s): Nicholas Golda, Stephen Beeson, Nita Kohli, Brandon Merrill
The relationship between patient experience and health care quality has generated significant interest in the patient experience measure. However, it is challenging to find information on how to improve one's patient experience score because scientific data on this topic are weak or lacking, and suggestions provided by scoring vendors are often overgeneralized and not specialty-specific. This review will focus on the current state of evidence supporting factors influencing patient experience (both positive and negative) in outpatient specialist encounters that are applicable to general and surgical dermatology. The literature review includes research from multiple medical specialties. Identified studies were based on title and abstract and sourced from Medline, PubMed, and Scopus databases. Medical subject headings terms in PubMed and Ovid Medline included "dermatology/standards," "patient satisfaction," "surgery/standards," "physician-patient relations," "surgery," "practice management," "practice management, medical," "office management," "patient experience," "practice guidelines," "best practice," and "outpatient surgery." During this review, three main themes affecting the patient experience emerged: communication, time, and access. Of the three, communication appears to be the dominant theme affecting the patient experience measure.

CME examination

Publication date: April 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 4

Prescribing to save patients money: Ethical considerations

Publication date: April 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 4
Author(s): Shridat A. Jadoo, Jules B. Lipoff

Answers to CME examination

Publication date: April 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 4

All-cause mortality in patients with basal and squamous cell carcinoma: A systematic review and meta-analysis

Publication date: April 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 4
Author(s): Mackenzie R. Wehner, Wilmarie Cidre Serrano, Adi Nosrati, Patrick Michael Schoen, Mary-Margaret Chren, John Boscardin, Eleni Linos
BackgroundThere are varying reports of the association of basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC) with mortality.ObjectiveTo synthesize the available information on all-cause mortality after a diagnosis of BCC or SCC in the general population.MethodsWe searched PubMed (1966-present), Web of Science (1898-present), and Embase (1947-present) and hand-searched to identify additional records. All English articles that reported all-cause mortality in patients with BCC or SCC were eligible. We excluded case reports, case series, and studies in subpopulations of patients. Random effects model meta-analyses were performed separately for BCC and SCC.ResultsThe searches yielded 6538 articles, and 156 were assessed in a full-text review. Twelve studies met the inclusion criteria, and 4 were included in the meta-analysis (encompassing 464,230 patients with BCC and with 175,849 SCC), yielding summary relative mortalities of 0.92 (95% confidence interval, 0.83-1.02) in BCC and 1.25 (95% confidence interval, 1.17-1.32) in SCC.LimitationsOnly a minority of studies controlled for comorbidities. There was significant heterogeneity in meta-analysis (χ²P < .001, I² > 98%), but studies of SCC were qualitatively concordant: all showed statistically significant increased relative mortality.ConclusionsWe found that patients with SCC are at higher risk for death from any cause compared with the general population.

Omalizumab response in patients with chronic idiopathic urticaria: Insights from the XTEND-CIU study

Publication date: April 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 4
Author(s): Thomas B. Casale, Patrick H. Win, Jonathan A. Bernstein, Karin Rosén, Michael Holden, Ahmar Iqbal, Benjamin L. Trzaskoma, Ming Yang, Evgeniya N. Antonova, Thomas Murphy, Mark D. Scarupa, Howard Sofen, Allen Kaplan

Cover Image

The cover image, by Liya He et al., is based on the Original Article Successful treatment of chromoblastomycosis of 10-year duration due to Fonsecaea nubica, DOI: 10.1111/myc.12732.

Issue Information

Laws and their instances

Abstract

I present an argument for the view that laws ground their instances. I then outline two important consequences that follow if we accept the conclusion of this argument. First, the claim that laws ground their instances threatens to undermine a prominent recent attempt to make sense of the explanatory power of Humean laws by distinguishing between metaphysical and scientific explanation. And second, the claim that laws ground their instances gives rise to a novel argument against the view that grounding relations are metaphysically necessary.

I pledge to prescribe ethically

Throughout its existence, the US Food and Drug Administration has had to cope with various unexpected side effects of medications. Some of the most serious and detrimental to society involve irreparable harm to unborn fetuses. The use of thalidomide, and later isotretinoin, led to the implementation of a series of pregnancy prevention programs. The goal of these programs is to prevent fetal exposure to these medications. In 2002 the System to Manage Accutane Related Teratogenicity (SMART) program requiring physician education, informed consent, rigorous pregnancy testing, and restrictive dispensing policies was put in place.

Answers to CME examination

Alopecia areata is a medical disease

Alopecia areata (AA) is a common autoimmune disease characterized by nonscarring hair loss that affects all ages, both sexes, and all skin types. Despite significant advances in understanding the pathomechanism of the disease, the autoimmune comorbidities, and how quality of life (QoL) is affected, treatment for AA is still not considered medically necessary by many insurers and even some physicians.

Indentured servitude or junior faculty extension of a residency? An ethical evaluation of the 3 + 3 program structure

Despite a growing push by dermatology residencies for program graduates to pursue careers in academic dermatology, the vast majority of dermatology graduates work in private practice.1 In response to this, some programs have taken novel measures to increase the number of their graduates working in academics. Some of these programs involve combined internal medicine-dermatology residencies and extended research tracks and have been lauded for their ingenuity; others like the 3 + 3 program highlighted in this case scenario have caused concern amongst members of the dermatology community.

Iotaderma #290

Recommendations for improving the patient experience in specialty encounters

The relationship between patient experience and health care quality has generated significant interest in the patient experience measure. However, it is challenging to find information on how to improve one's patient experience score because scientific data on this topic are weak or lacking, and suggestions provided by scoring vendors are often overgeneralized and not specialty-specific. This review will focus on the current state of evidence supporting factors influencing patient experience (both positive and negative) in outpatient specialist encounters that are applicable to general and surgical dermatology.

Editorial Board

CME examination

Table of Contents

Simple solution to prevent postoperative bleeding from paramidline forehead flap

Patients who undergo a forehead flap reconstructive procedure often have postoperative bleeding from the flap's pedicle that necessitates physician intervention and causes significant patient distress. A safe, effective, low-cost, convenient, and reliable method to reduce this problem would be highly desired by reconstructive surgeons.

Information for Readers

Journal Based CME Instructions and Information

Dermatology Calendar

Answers to CME examination

JAAD Case Reports Article List

Correction of “sandwiching phenomenon” following horizontal mattress suture

Closure of surgical and traumatic defects under high amounts of tension often involves use of horizontal mattress sutures. When a horizontal mattress suture is performed, a "sandwiching phenomenon," in which the epidermal edges fail to meet, is often observed (Fig 1). It is often found in situations in which a large bite size is used to close a wound under tension; it results from unbalanced tension in the closure, in which the entire load of the closure is in the reticular dermis (Fig 2, A). This results in apposition of the deep tissues, but not of the papillary dermis or epidermis (Fig 2, B), which in turn results in a wound edge profile with exposed dermal edges "sandwiched" by epidermal edges.

Billing of botulinum toxin for hyperhidrosis: Ethical considerations

Severe hyperhidrosis has significant effects on a patient's daily life. Billing of botulinum toxin injections for this condition varies among practices, despite most insurance covering its use in patients who fail first-line therapies. Although many dermatologists bill insurance for qualified patients, others charge according to the fee schedule for cosmetic botulinum toxin injections, even if patients have insurance that covers the service.1

CME examination

Prescribing to save patients money: Ethical considerations

In offering treatment options to their patients, physicians should always consider safety and efficacy. However, it is also important for physicians to consider the cost of medications and the out-of-pocket expense to patients, regardless of whether prescribed for cosmetic, "lifestyle," or medical indications. The final cost for which patients are responsible is dependent on several factors, such as the manufacturer's wholesale price, drug formularies, tiers and contractual copays set by insurance companies, and individual pharmacy discounts.

Time-dependent changes in extra-domain A-fibronectin concentration and relative amounts of fibronectin-fibrin complexes in plasma of patients with peripheral arterial disease after endovascular revascularisation

Fibronectin (FN) may be involved in time- and stage-dependent and inter-related controlled processes of inflammation, coagulation, and wound healing accompanying peripheral arterial disease (PAD). In the present study, FN and FN-containing extra-domain A (EDA-FN), macromolecular FN-fibrin complexes, and FN monomer were analysed in the plasma of 142 PAD patients, including 37 patients with restenosis, for 37 months after revascularisation. FN concentration increased significantly in the plasma of PAD patients within 7 to 12 months after revascularisation, whereas the high concentration of EDA-FN was maintained up to 24 months, significantly higher in the group 7 to 12 months after revascularisation with recurrence of stenosis and lower in the PAD groups 1 to 3 months and 4 to 6 months after revascularisation with comorbid diabetes and ulceration, respectively. The relative amounts of FN-fibrin complexes up to 1600 kDa and FN monomer were significantly higher, within intervals of 4 to 24 months and 4 to 6 months after revascularisation, respectively. Moreover, the relative amounts of 750 to 1600 kDa FN-fibrin complexes within 13 to 24 months after revascularisation were higher in comparison with those in the group without restenosis. In conclusion, high levels of EDA-FN and FN-fibrin complexes could have potential diagnostic value in the management of PAD patients after revascularisation, predicting restenosis risk.

Combination of resveratrol-containing collagen with adipose stem cells for craniofacial tissue-engineering applications

Repair and regeneration of craniofacial tissues is particularly challenging because they comprise a complex structure of hard and soft tissues involved in intricate functions. This study combined collagen scaffolds and human adipose stem cells (hASCs) for oral mucosal and calvarial bone regeneration by using resveratrol (RSV), which affects the differentiation of mesenchymal stem cells. We have evaluated the effect of collagen scaffold-containing RSV (collagen/RSV) scaffolds both in vitro and in vivo for their wound healing and bone regeneration potential. Scanning electron microscopy and immunostaining results reveal that hASCs adhere well to and proliferate on both collagen scaffolds and collagen/RSV scaffolds. Oral mucosal lesion experiments demonstrated that the collagen/RSV scaffold is more effective in wound closure and contraction than the collagen scaffold. The micro-computed tomography (μCT) images of calvarial bone display regenerating bone in defects covered with hASCs on collagen/RSV scaffolds that are more visible than that in defects covered with hASCs on a collagen scaffolds. RSV was more effective at inducing hASC differentiation on the collagen scaffold, suggesting that collagen/RSV scaffolds can provide useful biological cues that stimulate craniofacial tissue formation.

Predicting the likelihood of venous leg ulcer recurrence: The diagnostic accuracy of a newly developed risk assessment tool

The aim of this study was to validate a newly developed tool for predicting the risk of recurrence within 12 months of a venous leg ulcer healing. Performance of the tool to predict recurrence within a 12-month period was assessed using Area Under the Receiver Operating Characteristic Curve (AUC) analysis. Multi-site retrospective and prospective longitudinal studies were undertaken to validate a risk assessment tool for the recurrence of venous leg ulcers within 12 months. In the retrospective study (n = 250), 55% of venous leg ulcers recurred within 12 months, and the risk assessment total score had excellent discrimination and goodness of fit with an AUC of 0.83 (95% CI, 0.76-0.90, P < .001). The prospective study (n = 143) observed that 50.4% (n = 63) of venous leg ulcers recurred within 12 months of healing. Participants were classified using the risk assessment tool as being at low risk (28%), moderate risk (59%), and high risk (13%); the proportion of wounds recurring at 12 months was 15%, 61%, and 67% for each group, respectively. Validation results indicated good discrimination and goodness of fit, with an AUC of 0.73 (95% CI, 0.64-0.82, P < .001). Validation of this risk assessment tool for the recurrence of venous leg ulcers provides clinicians with a resource to identify high-risk patients and to guide decisions on adjunctive, tailored interventions to address the specific risk factors to decrease the risk of recurrence.

Ozone therapy for the treatment of chronic wounds: A systematic review

Chronic wounds present a significant burden to the health care system and the patient. Ozone therapy has been proposed as a treatment for chronic wounds, potentially acting by eliciting mild oxidative stress or disinfection. The purpose of this systematic review is to evaluate the potential benefits and harms of ozone therapy as an advanced care intervention for chronic wounds. Studies were extracted from Google Scholar, PubMed, the Cochrane Library, and reference lists. General inclusion criteria included English-language randomised human trials reporting the use of ozone therapy in the topical treatment of chronic wounds. Primary outcome data included the extent of chronic wound healing, and secondary outcomes included adverse effects. Studies were assessed for level of bias and data quality. Nine studies (n = 453 patients) matched the inclusion criteria and underwent meta-analysis. Overall, there was a significant improvement in wound closure with ozone therapy. Results consistently favour the application of ozone as a treatment for chronic wounds; however, there is no conclusive evidence of ozone therapy as superior compared with standard treatments. Compared with standard care, ozone therapy as an advanced wound care treatment may improve the proportion of chronic wounds healed in a shorter amount of time, but further research is required.

Cover Image

The cover image, by G. Haymerle et al., is based on the Correspondence The effect of adjuvant radiotherapy on radial forearm free flap volume after soft palate reconstruction in 13 patients, DOI 10.1111/coa.13042.

Author Guidelines

Issue Information

Recent advancement in the mechanism of basophil activation

Basophils have been recognized as crucial players in allergic inflammation. Basophils have the potential to initiate and expand inflammation through the production of specific cytokines and proteases, and are associated with T helper 2 (Th2) immune responses. In addition, recent studies revealed the heterogeneity in basophil populations. Basophils have been clarified important roles in not only IgE-mediated allergic inflammation but also TSLP-mediated and IgE-independent inflammation. Moreover, basophils infiltrate in many human cutaneous diseases.

Sunscreen sun protection factor (SPF): Is higher better?

The harmful properties of sunlight are well known. Actinic keratoses occur nearly exclusively in chronically sun exposed skin. Nonmelanoma skin cancer, especially squamous cell carcinoma, is strongly linked to sun exposure. The International Agency for Research on Cancer (IARC) of the World Health Organization classifies sunlight as a Group I carcinogen.1 Sun exposure is also strongly associated with photoaging. It is estimated that 80% or more of the changes in the skin that occur over time are due to the extrinsic effects of sunlight.

Ixekizumab treatment shows a neutral impact on cardiovascular parameters in patients with moderate-to-severe plaque psoriasis: results from UNCOVER-1, -2, and -3

The impact of ixekizumab treatment for psoriasis on cardiovascular-related parameters in patients is unknown., Ixekizumab maintenance dosing (12-60-weeks) had a neutral impact on cardiovascular-related parameters (including total cholesterol, LDL-cholesterol, HDL-cholesterol, LDL/HDL, triglycerides), Ixekizumab's neutral impact on cardiovascular-related parameters should not alter decisions to treat with other medications/interventions targeting cardiovascular-related parameters.

Post-traumatic Reactions and Their Predictors among Workers Who Experienced Serious Violent Acts: Are There Sex Differences?

Abstract

Background

Serious violent acts (e.g. physical violence, robbery, sexual aggression and death threats) are among the most visible and notable examples of workplace violence. Although women are commonly found to be at higher risk for post-traumatic reactions following workplace violence, little is known as regards sex differences concerning the types of post-traumatic reactions and their predictors.

Objective

This study aimed to describe sex differences in the post-traumatic reactions of serious violent acts and the predictors of such reactions.

Methods

The study was conducted among a convenience sample of 2889 French-speaking workers from Quebec, Canada by using a self-administrated survey. Linear regression modelings and post-hoc comparisons of coefficients according to the sex of the respondents were used to achieve the objective.

Results

Preliminary results confirmed that while men are more exposed to violence at work, women experience a greater number of post-traumatic reactions. Women were more affected by flashbacks, avoidance, and hypervigilance than men. The results also showed that being victimized by a male aggressor was associated with a greater number of post-traumatic reactions for women, whereas being victimized by an insider (e.g. colleague, supervisor, employee) was associated with a greater number of post-traumatic reactions for both sexes.

Implications

These findings highlight the necessity to better consider sex as a potential determinant of mental health in studies on workplace violence.

Temporal dynamics of gut microbiota in triclocarban-exposed weaned rats

Abstract

Widely used as an antimicrobial in antibacterial bar soaps, triclocarban (3,4,4′-trichlorocarbanilide; TCC) is effective against Gram-positive bacteria but shows little efficacy against Gram-negative strains, potentially altering the composition of indigenous microflora within and on the human body. To date, the consequence of continuous or previous nonprescription antimicrobial exposure from compounds in personal care products on commensal microflora is still elusive. Previous research has shown that TCC exposure during gestation and lactation induced dysbiosis of gut microbial communities among exposed dams and neonates. However, the impact of antimicrobial exposure specifically after discontinuation of the use of TCC on the gut microbiota has not been investigated. In this study, weaned Sprague Dawley rats (postnatal day, PND 22) were provided ad lib access to TCC-supplemented diet (0.2% w/w or 0.5% w/w) for 4 weeks (phase I) followed by a 4-week washout period (phase II) to determine gut microflora changes both during continuous exposure to TCC and to determine the potential rebound following TCC withdrawal. Fecal samples were collected at baseline (PND 22) prior to TCC exposure and throughout phase I and phase II. The V4 region of 16S rDNA was sequenced from extracted total fecal DNA with the MiSeq platform. Exposure to both 0.2% w/w and 0.5% w/w TCC was sufficient to alter diversity of microbiota during phase I of treatment. This effect was further prolonged into phase II, even when TCC exposure was discontinued. Collectively, these data highlight the impact of both continuous and prior TCC exposure on gut microbial ecology and shed light onto the potential long-term health risk of daily nonprescription antimicrobial personal care product use.

A dose-finding study for hemoporfin in photodynamic therapy for port-wine stain: a multicenter randomized double-blind phase IIb trial

Abstract

Background/Purpose

Previous studies have shown that hemoporfin-mediated photodynamic therapy (PDT) was a treatment for port-wine stain (PWS). Our current study aimed to identify optimal hemoporfin dose.

Methods

A prospective, multicenter, double-blind, randomized clinical trial was conducted. Patients were assigned into low or high dose hemoporfin (2.5 mg/kg and 5 mg/kg intravenously, respectively), or control (placebo) group, at a rate of 2: 2: 1. Treatment efficacy was evaluated at week 8. Then, patients in control group were randomly assigned into either high or low dose hemoporfin group. Treatment reactions and adverse events were analyzed at week 16.

Results

A total of 100 patients (40, 40, 20 in low, high dose hemoporfin, and control group, respectively) were enrolled. Compared to low dose (40%) and control group (15%), a higher proportion of patients in high dose group (75%) had achieved skin lesion improvements. Treatment satisfactions were graded highest in high dose group. Compared to low dose group (14.3%), high dose group (46.0%) had more frequent skin hyperpigmentation, which disappeared 3 – 6 months after treatment. Other treatment reactions and adverse events were comparable between two groups.

Conclusions

PDT with 5 mg hemoporfin could be an effective and safe treatment for PWS.

This article is protected by copyright. All rights reserved.

Solar Urticaria in 145 patients: Assessment of Action Spectra and Impact on Quality of Life in adults and children

Abstract

Background

Solar urticaria (SU) is a rare chronic inducible urticaria triggered via uncharacterised chromophores. We detail responses of a large patient series to monochromator phototesting and broadband ultraviolet radiation (UVR); relationship to life quality is explored.

Methods

Retrospective review of all SU patients undergoing standardised diagnostic photoinvestigation at a specialist centre during 2000-2016. From 2011, patients completed dermatology life quality index (DLQI) questionnaires for the past week and year.

Results

In 145 patients (mean 35.8, range 3-69 years; 18 aged <18yrs; 100 female), combined phototesting with broadband UVR and monochromator sources successfully provoked 74.5% patients, with 65.6% provoked by broadband UVR alone and 57.9% by monochromated radiation alone. The narrow wavebands most frequently eliciting wheal and flare response were between 370-400nm, with 25% patients at 300±5nm, 53.6% at 320±10nm, 66.7% at 330±10nm, 77.4% at 350±20nm, 83.3% at 370±20nm, 86.9% at 400±20nm, 44% at 500±20nm, 17.8% at 600±20nm. In 62 patients, the DLQI revealed 56.1% had very to extremely large impact in the past week (all patients: mean score 11.1, range 0-29) rising to 69.8% for the past year (12.5, 0-30); adults and children were similarly affected. Patients with positive photoprovocation had higher DLQI score than those who were negative (DLQI for past week: mean 12.6 ± SEM 1.1 vs 4.6 ± 1.4, p<0.01).

Conclusion

SU is predominantly provoked by longer UVA-shorter visible radiation, which penetrates window-glass and where sunscreens are less effective; impact on life quality is considerable. Photoprotective agents effective against this spectrum are needed.

This article is protected by copyright. All rights reserved.

Sunburn at the seaside

Abstract

Background/purpose

The purpose of this paper is to estimate the contribution to our erythemal exposure at the coast of solar UV both reflected from, and transmitted into, the ocean.

Methods

The reflection of solar UV radiation from, and transmitted into, seawater were calculated using a numerical model under a number of atmospheric conditions in order to estimate erythemal exposure on the skin of supine/prone and ambulant people.

Results

The results were expressed as UV Indices. Even under the most extreme insolation with the sun directly overhead, where the ambient UV Index may be around 14, reflected UV from the ocean contributes an erythemal exposure to the skin equivalent to a UV Index of about 0.7. For typical ocean waters, with the sun high in the sky, the UV index within the water is about 7 at a depth of two meters.

Conclusion

Whilst our eyes often sense a high level of reflected sunlight from the ocean, especially when the sun is low in the sky, our skin does not share that experience. The reason people get sunburnt at the seaside has more to do with the absence of shade than with reflectance by the water surface or even beach sand.

This article is protected by copyright. All rights reserved.

Decrease in artificial tanning by French teenagers: 2011 – 2016

Abstract

Background

The major risk factor is exposure to solar and artificial ultraviolet radiation, in particular during childhood and adolescence. In France a law was restricted tanning-bed access to adults (≥18 years) since 1997.

Objective

To evaluate teenagers' artificial tanning behaviour in 2016 and to compare results with those obtained in a similar survey performed in 2011.

Methods

The SOLADO 2011 and 2016 surveys were conducted in a general school in Antony and a technical school in Fontenay-aux-Roses (Paris suburb).

Results

In 2016, 630 teenagers (mean age: 14.2 ± 1.9 y: Males/Females: 301/329) completed the questionnaire, 1.3% of teenagers reported using tanning beds, 1.1% tanning pills, and 8.9% tanning creams. Between 2011 and 2016, the use of tanning beds decreased from 1.4% to 0.7% in Antony (p=0.26) and from 9.5% to 4.8% in Fontenay-aux-Roses (p=0.01), and the use of tanning creams from 39.8% to 17.6% in Fontenay-aux-Rose (p=0.0007). The incidence of sunburn decreased from 60.5% to 54.0% in Antony (p=0.02) and from 55.4% to 42.4% in Fontenay-aux-Roses (p=0.05).

Conclusion

As compared to 2011, teenagers used artificial tanning methods less frequently in 2016. In particular, they used tanning beds less frequently, suggesting that the new stricter legislation has been effective.

This article is protected by copyright. All rights reserved.

Cutaneous carcinogenic risk evaluation in 375 patients treated with narrowband-UVB phototherapy

Abstract

Background

Narrowband-ultraviolet B (NB-UVB) is widely used for the treatment of several dermatological diseases. A cutaneous carcinogenic effect has been hypothesized, but not proved.

Methods

We retrospectively reviewed the data of patients treated with NB-UVB between January 1998 and December 2013 at the Dermatology Unit of our University Hospital, to evaluate the cutaneous carcinogenic risk of NB-UVB.

Results

375 patients were included, each receiving a mean follow-up of 6.9 years. Vitiligo and psoriasis were the most common diseases. 19 non-melanoma skin cancers (NMSCs) were diagnosed in 8 patients, after a mean latency of 5.2 years after the first radiation. No malignant melanoma (MM) was observed. The incidence rates of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) were 620.2/100 ̇000 p/y and 116.3/100 ̇000 p/y. NMSCs were more frequent in patients affected by psoriasis (p = 0.0232), with older age at the first radiation (mean = 68.8 years, p = 0.0001).

Conclusion

Despite the small number of patients and limited follow-up, our data suggest that NB-UVB may trigger cutaneous carcinogenesis, mainly in patients at risk for NMSCs, increasing their personal risk for single and multiple neoplasms, usually superficial BCCs. MM risk does not seem to be enhanced.

This article is protected by copyright. All rights reserved.

Phototherapy as a first line treatment for early stage mycosis fungoides: The results of a large retrospective analysis

Abstract

Background

Phototherapy is one of the main treatments for mycosis fungoides (MF). In this study, we analyzed the efficacy and safety of phototherapy as a first line treatment in patients with early stage disease.

Methods

We analyzed treatment outcomes in a group of 227 early stage patients. The chi-squared test, the parametric t-test and ANOVA test and the non-parametric tests of Mann-Whitney and Kruskal-Wallis were applied for data analysis.

Results

55.9% of patients treated with UVB-NB reached complete remission (CR), while analogue rates after PUVA treatment were 74.5% (p=0.015). Patients with patch-stage disease showed better response rates to PUVA compared to UVB-NB therapy (CRs 56.7% vs 91.3%, p<0.001). Regarding the latter, long lasting disease was proven as an independent negative prognostic factor for treatment outcome. Phototypes I and II were found to be favorable prognostic factors for patients treated with PUVA. Maintenance treatment did not alter final relapse rates but led to prolonged time to relapse compared to no-maintenance treated cases (19.5 months, vs 32.3, p<0.002).

Conclusion

Our analysis indicates that PUVA leads to better responses and longer relapse-free intervals both in patch and plaque stage disease. UVB-NB could be a valid therapeutic alternative for patients with recent disease presentation.

This article is protected by copyright. All rights reserved.

A review of methods for measuring microplastics in aquatic environments

Abstract

An increasing number of reports have been published concerning microplastic (MP) pollution in aquatic environments. Methods used in these studies continue to be updated and lack standardization, so that an up-to-date review pertaining methods for MP research is needed. This critical review examines the analytical methods, including sampling, identification, and quantitation, for MP research. Samples are generally collected from water, sediment, and biota gastrointestinal tract. Manta nets or trawls are prevalently used in surface water sampling, while direct shoveling or box-corer grab are commonly applied in sediment sampling. Microplastics in biota are generally obtained by dissecting organisms and separating livers, gills, and guts. Density separation is frequently chosen to separate MPs from sample matrices. Chemical digestion can dissolve other organic materials and isolate MPs for further identification. Visual sorting should be combined with chemical composition analysis to better identify the polymer type. Pyrolysis or thermal decomposition gas chromatography coupled with mass spectrometry, Fourier transform infrared spectroscopy, and Raman spectroscopy are currently the main technologies for MP identification. Units prevalently used to express MP abundance in water, sediment, and biota are "particles per m³," "particles per m²," and "particles per individual," respectively. As MP abundances often varied with the methods used, we recommend that analytical protocols of MPs should better be standardized and optimized. Despite the important progress in analysis of MPs, detection technologies for identifying nano-sized plastic particles are still lacking, and therefore should be developed swiftly.

Adsorption/desorption of arsenite and arsenate on chitosan and nanochitosan

Abstract

Equilibrium sorption studies of anionic species of arsenite, As(III) ions and arsenate As(V) ions onto two biosorbents, namely, chitosan and nanochitosan, have been investigated and compared. The results and trends in the sorption behavior are novel, and we have observed during the sorption process of the As(III) and As(V) on chitosan, a slow process of desorption occurred after an initial maximum adsorption capacity was achieved, before reaching a final but lower equilibrium adsorption capacity. The same desorption trend, however, is not observed on nanochitosan. The gradual desorption of As(III) and As(V) in the equilibrium sorption on chitosan is attributed to the different fractions of the dissociated forms of arsenic on the adsorbent surface and in solution and the extent of protonation of chitosan with the changing of solution pH during sorption. The change of solution pH during the sorption of arsenite ions on chitosan was also influenced by the interaction between the buffering effect of the arsenite species in the aqueous medium and the physical properties of chitosan. The final equilibrium adsorption capacity of chitosan for As(III) and As(V) was found to be around 500 and 8000 μg/g, respectively, whereas the capacities on nanochitosan are 6100 and 13,000 μg/g, respectively.

Pharmacological mechanisms underlying gastroprotective activities of binapthyl diselenide in Wistar rats

Abstract

Selenium (Se) is a dietary essential trace element with important biological roles. It is a nutrient related to the complex metabolic and enzymatic functions. Organoselenium compounds have been reported to have anti-ulcer activity and used as drug for the treatment of gastrointestinal disorders. The antiulcer activity of binapthyl diselenide (NapSe)2 was investigated in ethanol-induced gastric lesions in rats. A number of markers of oxidative stress were examined in rats stomach including thiobarbituric acid reactive species (TBARS), catalase (CAT), superoxide dismutase (SOD), non-protein thiol groups (NPSH) and ascorbic acid. (NapSe)2 was found to be significantly restoring the deficits in the antioxidant defense mechanisms (CAT, SOD, NPSH and ascorbic acid), and suppressed lipid peroxidation in rat stomach resulting from EtOH administration. It is experimentally concluded that ethanol exposure causes alterations in the antioxidant defense system and induces oxidative stress in rat stomach. These studies establish a promising foundation for investigating and understanding the beneficial effects of organoselenium compounds on human health. Moreover, (NaPSe)₂ deserves further investigation as a therapeutic and preventive agent against gastric ulcer in humans.

Science, Politics and the Production of Biological Knowledge: New Trends and Old Challenges

Abstract

In the history of biology, knowledge about human differences often has been produced through an interaction with politics and values assumed to be external to science. Two recent books—Jonathan Marks' Is Science Racist? and Maurizio Meloni's Political Biology—shed new light on this interplay. While Marks looks into the field of anthropology, Meloni offers a historiographical view on the soft-hard heredity debate. Based on these new contributions, this essay addresses a number of current ways in which society and science conceptualize human differences through categories like race, gender, and class. Especially, this refers to the separation of what is taken as natural and purportedly fixed, from what is cultural and changeable.

The Racialized Body of the Educator and the Ethic of Hospitality: The Potential for Social Justice Education Re-visited

Abstract

Derridean hospitality is seen to undergird ethical teacher–student interactions. However, hospitality is marked by three aporias that signal incommensurable and irreducible ways of being and responding that need to be held together in tension without eventual synthesis. Due to the sociopolitical materiality of race and the phenomenological difference that constitutes racialized bodies, educators of color in interaction with white students are called to live the aporetic tensions that characterize hospitality in distinctive ways that are not currently emphasized in the discourse on the educator's responsibility as it is informed by an ethic of hospitality. The asymmetrical nature of hospitality is reconfigured through the terms of eros and hospitality's link to education aimed at social justice is posited to be stronger than is currently suggested in the educational theory literature.

Factors determining the occurrence of anthropogenic materials in nests of the white stork Ciconia ciconia

Abstract

Birds have been using anthropogenic materials for nest construction for the past few decades. However, there is a trade-off between the use of new nesting material, which is often linked to greater breeding success, and the higher risk of nestling mortality due to entanglement or ingestion of debris. Here, we investigate the incorporation of anthropogenic materials into nests of the white stork Ciconia ciconia, based on a long-term study of a population in Western Poland. We recorded at least one item of debris in 50 and 42% of nests at the egg and nestling stages, respectively. More debris was found in nests located in territories with higher number of anthropogenic material in the surrounding environment. We found a relationship between the age of females, the number of debris in the area surrounding a nest, and the number of debris in the nest. We found no significant effect of the total number of debris in nests on clutch size, number of fledglings, or breeding success. Studies on the influence of the age and sex of individuals in understanding this behaviour and its drivers in bird populations should be continued.

Effects of a protein-free oat plantlet extract on microinflammation and skin barrier function in atopic dermatitis patients

Abstract

Atopic dermatitis (AD) is a common, highly pruritic, chronic inflammatory skin disease. Dysfunction of the epidermal barrier is witnessed by an increased transepidermal water loss in lesional and non-lesional AD skin. The inflammation in lesional AD skin is well characterized. Non-lesional skin of AD patients shows histological signs of a subclinical inflammation and a pro-inflammatory cytokine milieu. This microinflammation is present even in seemingly healed skin and must be taken into account regarding treatment of AD. Emollients provide a safe and effective method of skin barrier improvement, because they provide the skin with a source of exogenous lipids, thus improving its barrier function. The use of emollients is recommended for all AD patients irrespective of overall disease severity. Patients with moderate to severe AD should combine the emollients with a proactive therapy regimen of topical calcineurin inhibitors or topical corticosteroids. Skin areas affected by active eczema in flare should receive daily anti-inflammatory therapy first before introducing emollients, to induce rapid relief of skin lesions and pruritus. The microinflammation persisting in seemingly healed AD lesions should be addressed by a proactive treatment approach, consisting of minimal anti-inflammatory therapy and liberal, daily use of emollients. An emollient containing an extract of Rhealba oat plantlet has shown anti-inflammatory and barrier repairing properties, and was clinically tested in studies targeting the microinflammation in AD. All emollients based on Rhealba oat plantlet extract are free of oat protein, as the Rhealba extract is derived from the aerial parts of the oat plantlet and is unrelated to oatmeal proteins. The Rhealba oat plantlet extract is produced in a specific process, allowing the extraction of high levels of active principles such as flavonoids and saponins, whilst being virtually free of oat proteins to minimize the risk for allergic reactions.

Drop it like it’s HOT: a vicious regress for higher-order thought theories

Abstract

Higher-order thought (HOT) theories of consciousness attempt to explain what it takes for a mental state to be conscious, rather than unconscious, by means of a HOT that represents oneself as being in the state in question. Rosenthal (in: Liu, Perry (eds) Consciousness and the self: new essays, Cambridge University Press, Cambridge, 2011) stresses that the way we are aware of our own conscious states requires essentially indexical self-reference. The challenge for defenders of HOT theories is to show that there is a way to explain the required reference-fixing mechanisms that is compatible with the theory. According to Rosenthal, the reference to oneself as such is grounded in the disposition to identify the individual the HOT refers to as the individual who has that HOT. I argue that this leads to a vicious infinite regress on the more than plausible assumption that our cognitive capacities are limited. This leaves such theories without a foundation, since self-reference is thought essential to consciousness.

Sex-Specific Associations Between Complement Component 3 and Component 4 Levels and Metabolic Syndrome in an Adult Population

Metabolic Syndrome and Related Disorders, Ahead of Print.

The Effects of High-Protein and High-Monounsaturated Fat Meals on Postprandial Lipids, Lipoprotein Particle Numbers, Cytokines, and Leptin Responses in Overweight/Obese Subjects

Metabolic Syndrome and Related Disorders, Ahead of Print.

The big CGRP flood - sources, sinks and signalling sites in the trigeminovascular system

Calcitonin gene-related peptide (CGRP) has long been a focus of migraine research, since it turned out that inhibition of CGRP or CGRP receptors by antagonists or monoclonal IgG antibodies was therapeutic in f...

Longitudinal Associations between Respiratory Infections and Asthma in Young Children

Abstract

We examined temporal dependencies between repeated assessments of respiratory infections and asthma in children in the Leicester Respiratory Cohort, Leicestershire, UK. Asthma (doctor diagnosis, health care visits, wheeze frequency) and respiratory infections (cold duration and frequency, cough with colds, ear infections) in the previous 12 months were assessed repeatedly at ages 1, 4, and 6 years for children born between April 1996 and April 1997. We determined associations between contemporaneous and lagged measures of asthma and respiratory infections using structural equation modelling. In 1995 children, asthma was positively associated with contemporaneous infections. Asthma at age 6 was positively associated with asthma at age 4 (regression coefficient = 0.87; 95% CI 0.76, 0.97), but not with asthma at age 1 (-0.01; -0.14, 0.11). We found no evidence for direct protective effect of infections at age 1 on asthma either at age 4 (-0.20; -0.51, 0.10) or 6 (0.24; -0.04, 0.52). Adjusting for potential confounders did not qualitatively change those relationships. Our findings suggest that asthma at age 6 is directly influenced by asthma history and only indirectly if, at all, by earlier infection episodes. We found little support for a protective effect of preschool infections on asthma at early school age.

Timing of birth as an emergent risk factor for rotavirus hospitalization and vaccine performance in the post-vaccination era in the United States

Abstract

Rotavirus vaccines were introduced in the United States in 2006 and in the subsequent years have fundamentally altered seasonality and shifted disease from annual to biennial epidemics. We investigated whether season and year of birth have emerged as risk factors for rotavirus and affected vaccine performance. We constructed a retrospective birth cohort of US children <5 years using the 2001–2014 MarketScan Database. We evaluated the assocations of season of birth, even/odd year of birth and interactions with vaccination. We fit Cox proportional hazards models to estimate the hazard of rotavirus hospitalization by calendar year of birth, season of birth assessed for interaction with vaccination. After vaccine introduction, we observed monotonically decreasing rates of rotavirus hospitalization for each subsequent birth cohort, but a biennial incidence pattern by calendar year. In the post-vaccine period, children born odd calendar years had higher hazard of rotavirus hospitalization than even year births. Children born in winter had the highest hazard of hospitalization but also had the higher vaccine effectiveness than spring, summer or fall births. With the emergence of a strong biennial pattern of disease following vaccine introduction, the timing of a child's birth has become a risk factor for rotavirus.

TEACHING EPIDEMIOLOGY AT THE UNDERGRADUATE LEVEL: CONSIDERATIONS AND APPROACHES

Abstract

The rapid growth in undergraduate public health education has offered an increasing number of undergraduate students training in epidemiology. Epidemiology courses introduce undergraduate students to a population health perspective and provide opportunities for these students to build essential skills and competencies such as ethical reasoning, teamwork, comprehension of scientific methods, critical thinking, quantitative and information literacy, ability to analyze public health information, and effective writing and oral communication. Taking a varied approach and incorporating active learning and assessment strategies can help engage students in the material, improve comprehension of key concepts, and further develop key competencies. In this commentary, we present examples of how epidemiology may be taught in the undergraduate setting. Evaluation of these approaches and others would be a valuable next step.

Ammonia oxidation: Ecology, physiology, biochemistry and why they must all come together

Abstract

Ammonia oxidation is a fundamental core process in the global biogeochemical nitrogen cycle. Oxidation of ammonia (NH₃) to nitrite (NO₂⁻) is the first and rate-limiting step in nitrification and is carried out by distinct groups of microorganisms. Ammonia oxidation is essential for nutrient turnover in most terrestrial, aquatic and engineered ecosystems and plays a major role, both directly and indirectly, in greenhouse gas production and environmental damage. Although ammonia oxidation has been studied for over a century, this research field has been galvanised in the past decade by the surprising discoveries of novel ammonia oxidising microorganisms. This review reflects on the ammonia oxidation research to date and discusses the major gaps remaining in our knowledge of the biology of ammonia oxidation.

Salicylate induces reactive oxygen species and reduces UVC susceptibility in Staphylococcus aureus

Abstract

Present study demonstrates that growth of Staphylococcus aureus in the presence of salicylate reduces ultraviolet C (UVC)-induced cell death and increases the generation of reactive oxygen species (ROS). In addition, compounds that scavenge ROS (N-acetylcysteine, glutathione, catalase and superoxide dismutase) reverse the increased UVC survival induced by growth in the presence of salicylate, while ROS donors (tert-butylhydroperoxide, H₂O₂, and NaClO) enhance survival of salicylate challenged cultures. Collectively these findings suggest that ROS production induced by growth in the presence of salicylate protects S. aureus from UVC-induced cell death.

Interaction of enzymes of the tricarboxylic acid cycle in Bacillus subtilis and Escherichia coli: A comparative study

Abstract

We studied the interaction of the tricarboxylic acid cycle (TCA) enzymes citrate synthase, isocitrate dehydrogenase and malate dehydrogenase in the bacteria Bacillus subtilis and Escherichia coli in vivo. In B. subtilis the genes encoding citrate synthase, isocitrate dehydrogenase and malate dehydrogenase form an operon (citZ-icd-mdh) and predominantly are co-transcribed from a single promoter. In E. coli the corresponding genes gltA, icd and mdh do not form a transcription unit, are scattered around the chromosome and are expressed from different promoters. We found that co-transcription of genes and subsequent co-translation of the corresponding mRNAs promotes the formation of protein complexes and give support for the previous findings that in B. subtilis citrate synthase, isocitrate dehydrogenase and malate dehydrogenase form an enzyme complex (metabolon).

The Primary Biological Network of Bifidobacterium in the Gut

Abstract

Bacterial interactions in the biological network affect the growth of Bifidobacterium. In the present study, five habitats were constructed by changing animals, their health statuses and their diets. In each of these habitats, different networks of Bifidobacterium were outlined through correlation analysis of the 50 most dominant microbes. Thirty-eight bacterial genera directly correlated with the growth of Bifidobacterium, including 23 genera with a positive correlation and 15 genera with a negative correlation. This study presented, to our knowledge, a new biological network of rodent gut Bifidobacterium under various representative habitats. This study shows an in vivo network of Bifidobacterium, thereby contributing to constructing an in vitro network of Bifidobacterium for further studies.

Issue Information

“Interdigital pilonidal sinus in a hairdresser” a case report

Up-regulation of contractile endothelin receptors by airborne fine particulate matter in rat mesenteric arteries via activation of MAPK pathway

Abstract

Fine particle matters (PM_2.5) is a well-known risk factor for cardiovascular diseases. However, the underlying molecular mechanisms are largely unknown. Vascular hyper-reactivity plays an important roles in the pathogenesis of cardiovascular diseases. The present study was designed to investigate a hypothesis that PM_2.5 up-regulated endothelin receptors in mesenteric artery and the potential underlying mechanisms. Rat mesenteric arteries were cultured with PM_2.5. The artery contractile responses were recorded by a sensitive myograph. ET_B and ET_A receptor expressions of mRNA and protein were assessed by quantitative real-time PCR, Western blotting, and immunohistochemistry, respectively. Results showed that ET_B receptor agonist, sarafotoxin 6c induced a negligible contraction in fresh artery segments, while ET_A receptor agonist, ET-1 induced an obvious contraction. After organ culture, the contraction curve mediated by ET_B and ET_A receptors were shifted toward the left. PM_2.5 1.0 μg/ml cultured for 16 h further enhanced ET_B and ET_A receptor-mediated contractile responses with a markedly increased maximal contraction. The organ culture enhanced ET_B and ET_A receptor mRNA and protein levels from fresh arteries, which were further increased by PM_2.5. The U0126 (MEK/ERK1/2 inhibitor) and SB203580 (p38 inhibitor) significantly attenuated both organ cultured-induced and PM_2.5-induced up-regulation of ET_B receptor. U0126 also suppressed organ culture-increased and PM_2.5-increased expressions of ET_A receptor. SB203580 only suppressed PM_2.5-induced enhanced expressions of ET_A receptor In conclusion, airborne PM_2.5 up-regulates ET_B and ET_A receptors of mesenteric artery via p38 MAPK and MEK/ERK1/2 MAPK pathways.

High neutrophil-to-lymphocyte ratio before starting anti-PD1 immunotherapy predicts poor outcome in patients with metastatic melanoma

Publication date: Available online 12 March 2018
Source:Journal of the American Academy of Dermatology
Author(s): Margaux Garnier, Julia Zaragoza, Nathalie Bénéton, Guido Bens, Victoire Meurisse, Mahtab Samimi, Hervé Maillard, Laurent Machet

Clinical, dermoscopic and trichoscopic analysis of frontal fibrosing alopecia associated with acquired dermal macular hyperpigmentation: A cross sectional observational case-control study

Publication date: Available online 12 March 2018
Source:Journal of the American Academy of Dermatology
Author(s): Muthu Sendhil Kumaran, Muhammed Razmi T, Keshavamurthy Vinay, Davinder Parsad

Increased Topical Generic Prices by Manufacturers: An Isolated Trend or Worrisome Future?

Publication date: Available online 12 March 2018
Source:Journal of the American Academy of Dermatology
Author(s): Mehul D. Bhatt, Birju D. Bhatt, James T. Dorrian, Beth N. McLellan
BackgroundThere is limited data regarding generic medication prices. Recent studies have shown price changes at the retail level, but much is not known about the pharmaceutical supply chain or price changes at the manufacturer level.ObjectiveWe sought to examine the extent of price changes for topical generic medications.MethodsA comprehensive review of average wholesale prices (AWP) and manufacturers of topical generics and available corresponding branded medications was conducted for 2005 and 2016.ResultsA total of 51 topical chemical entities were examined. Between 2005 and 2016, the AWP of topical generics increased by 273% and the AWP of topical branded increased by 379%. The topical generic with the most price change increased by 2529%. Eight of the top twenty topical generics with the highest increase in AWP also had an increase in the number of manufacturers.LimitationsThese findings are not generalizable to medications used in other areas of medicineConclusionsTopical generic prices are rapidly increasing at the manufacturer level.