Web-based tailored intervention programs show considerable promise in effecting health-promoting behaviors and improving health outcomes across a variety of medical conditions and patient populations. This meta-analysis compares the effects of tailored versus nontailored web-based interventions on health behaviors and explores the influence of key moderators on treatment outcomes. Forty experimental and quasi-experimental studies (N =20,180) met criteria for inclusion and were analyzed using meta-analytic procedures. The findings indicated that web-based tailored interventions effected significantly greater improvement in health outcomes as compared with control conditions both at posttesting, d =.139 (95% CI = .111, .166, p <.001, k =40) and at follow-up, d =.158 (95% CI = .124, .192, p <.001, k =21). The authors found no evidence of publication bias. These results provided further support for the differential benefits of tailored web-based interventions over nontailored approaches. Analysis of participa...

/pdf/a-meta-analysis-of-web-delivered-tailored-health-behavior-f7hwkj1xdq.pdf

A meta-analysis of web-delivered tailored health behavior change interventions

Subcommittee Members: Dr. Alexander Nast, Berlin (Germany) Dr. Cristina Oprica, Stockholm (Sweden) Prof. Dr. Brigitte Dreno, Nantes (France) Mrs. Stefanie Rosumeck, Berlin (Germany) Dr. Vincenzo Bettoli, Ferrara (Italy) Prof. Dr. Berthold Rzany, Berlin (Germany) Prof. Dr. Klaus Degitz, Munich (Germany) Dr. Adel Sammain, Berlin (Germany) Mr. Ricardo Erdmann, Berlin (Germany) Dr. Thierry Simonart, Brussels (Belgium) Prof. Dr. Andrew Finlay, Cardiff (United Kingdom) Dr. Niels Kren Veien, Aalborg (Denmark) Prof. Dr. Ruta Ganceviciene, Vilnius (Lithuania) Dr. Maja Vurnek fivkovi , Zagreb (Croatia) Dr. Alison Layton, Harrogate (United Kingdom) Prof. Dr. Christos Zouboulis, Dessau (Germany) Dr. Jose Luis Lopez Estebaranz, Madrid (Spain) Prof. Dr. Falk Ochsendorf, Frankfurt (Germany) Prof. Dr. med. Harald Gollnick, Magdeburg (Germany)

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1468-3083.2011.04374.x

European Evidence‐based (S3) Guidelines for the Treatment of Acne

Background
Although acne vulgaris is a common skin disorder, limited epidemiological data exist specifically for European populations.

Objective
To determine the prevalence of self-reported acne among young people in Europe and evaluate the effect of lifestyle on acne.

Methods
We conducted a cross-sectional population-based online survey in representative samples of individuals aged 15–24 years in Belgium, Czech and Slovak Republics, France, Italy, Poland and Spain (n=10,521), identified by a quota sampling method based on age, geographic location, and socio-professional category.

Results
The overall adjusted prevalence of self-reported acne was 57.8% (95% confidence interval 56.9% to 58.7%). The rates per country ranged from 42.2% in Poland to 73.5% in the Czech and Slovak Republics. The prevalence of acne was highest at age 15–17 years and decreased with age. On multivariate analysis, a history of maternal or paternal acne was associated with an increased probability of having acne (odds ratio 3.077, 95% CI 2.743 to 3.451, and 2.700, 95% CI 2.391 to 3.049, respectively; both p<0.0001), as was the consumption of chocolate (OR 1.276, 95% CI 1.094 to 1.488, for quartile 4 versus quartile 1). Increasing age (OR 0.728, 95% CI 0.639 to 0.830 for age 21–24 years versus 15–17 years) and smoking tobacco (OR 0.705, 95% CI 0.616 to 0.807) were associated with a reduced probability of acne.

Conclusion
The overall prevalence of self-reported acne was high in adolescents/young adults in the European countries investigated. Heredity was the main risk factor for developing acne.

This article is protected by copyright. All rights reserved.

Acne prevalence and associations with lifestyle: a cross-sectional online survey of adolescents/young adults in 7 European countries

Treatment of acne with tea tree oil (melaleuca) products: A review of efficacy, tolerability and potential modes of action

BACKGROUND Acne vulgaris, a chronic inflammatory disease of the pilosebaceous unit associated with socialisation and mental health problems, may affect more than 80% of teenagers. Isotretinoin is the only drug that targets all primary causal factors of acne; however, it may cause adverse effects. OBJECTIVES To assess efficacy and safety of oral isotretinoin for acne vulgaris. SEARCH METHODS We searched the following databases up to July 2017: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO and LILACS. We updated this search in March 2018, but these results have not yet been incorporated in the review. We also searched five trial registries, checked the reference lists of retrieved studies for further references to relevant trials, and handsearched dermatology conference proceedings. A separate search for adverse effects of oral isotretinoin was undertaken in MEDLINE and Embase up to September 2013. SELECTION CRITERIA Randomised clinical trials (RCTs) of oral isotretinoin in participants with clinically diagnosed acne compared against placebo, any other systemic or topical active therapy, and itself in different formulation, doses, regimens, or course duration. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 31 RCTs, involving 3836 participants (12 to 55 years) with mild to severe acne. There were twice as many male participants as females.Most studies were undertaken in Asia, Europe, and North America. Outcomes were generally measured between eight to 32 weeks (mean 19.7 weeks) of therapy.Assessed comparisons included oral isotretinoin versus placebo or other treatments such as antibiotics. In addition, different doses, regimens, or formulations of oral isotretinoin were assessed, as well as oral isotretinoin with the addition of topical agents.Pharmaceutical companies funded 12 included trials. All, except three studies, had high risk of bias in at least one domain.Oral isotretinoin compared with oral antibiotics plus topical agentsThese studies included participants with moderate or severe acne and assessed outcomes immediately after 20 to 24 weeks of treatment (short-term). Three studies (400 participants) showed isotretinoin makes no difference in terms of decreasing trial investigator-assessed inflammatory lesion count (RR 1.01 95% CI 0.96 to 1.06), with only one serious adverse effect found, which was Stevens-Johnson syndrome in the isotretinoin group (RR 3.00, 95% CI 0.12 to 72.98). However, we are uncertain about these results as they were based on very low-quality evidence.Isotretinoin may slightly improve (by 15%) acne severity, assessed by physician's global evaluation (RR 1.15, 95% CI 1.00 to 1.32; 351 participants; 2 studies), but resulted in more less serious adverse effects (67% higher risk) (RR 1.67, 95% CI 1.42 to 1.98; 351 participants; 2 studies), such as dry lips/skin, cheilitis, vomiting, nausea (both outcomes, low-quality evidence).Different doses/therapeutic regimens of oral isotretinoinFor our primary efficacy outcome, we found three RCTs, but heterogeneity precluded meta-analysis. One study (154 participants) reported 79%, 80% and 84% decrease in total inflammatory lesion count after 20 weeks of 0.05, 0.1, or 0.2 mg/kg/d of oral isotretinoin for severe acne (low-quality evidence). Another trial (150 participants, severe acne) compared 0.1, 0.5, and 1 mg/kg/d oral isotretinoin for 20 weeks and, respectively, 58%, 80% and 90% of participants achieved 95% decrease in total inflammatory lesion count. One RCT, of participants with moderate acne, compared isotretinoin for 24 weeks at (a) continuous low dose (0.25 to 0.4 mg/kg/day), (b) continuous conventional dose (0.5 to 0.7 mg/kg/day), and (c) intermittent regimen (0.5 to 0.7 mg/kg/day, for one week in a month). Continuous low dose (MD 3.72 lesions; 95% CI 2.13 to 5.31; 40 participants; one study) and conventional dose (MD 3.87 lesions; 95% CI 2.31 to 5.43; 40 participants; one study) had a greater decrease in inflammatory lesion counts compared to intermittent treatment (all outcomes, low-quality evidence).Fourteen RCTs (906 participants, severe and moderate acne) reported that no serious adverse events were observed when comparing different doses/therapeutic regimens of oral isotretinoin during treatment (from 12 to 32 weeks) or follow-up after end of treatment (up to 48 weeks). Thirteen RCTs (858 participants) analysed frequency of less serious adverse effects, which included skin dryness, hair loss, and itching, but heterogeneity regarding the assessment of the outcome precluded data pooling; hence, there is uncertainty about the results (low- to very-low quality evidence, where assessed).Improvement in acne severity, assessed by physician's global evaluation, was not measured for this comparison.None of the included RCTs reported birth defects. AUTHORS' CONCLUSIONS Evidence was low-quality for most assessed outcomes.We are unsure if isotretinoin improves acne severity compared with standard oral antibiotic and topical treatment when assessed by a decrease in total inflammatory lesion count, but it may slightly improve physician-assessed acne severity. Only one serious adverse event was reported in the isotretinoin group, which means we are uncertain of the risk of serious adverse effects; however, isotretinoin may result in more minor adverse effects.Heterogeneity in the studies comparing different regimens, doses, or formulations of oral isotretinoin meant we were unable to undertake meta-analysis. Daily treatment may be more effective than treatment for one week each month. None of the studies in this comparison reported serious adverse effects, or measured improvement in acne severity assessed by physician's global evaluation. We are uncertain if there is a difference in number of minor adverse effects, such as skin dryness, between doses/regimens.Evidence quality was lessened due to imprecision and attrition bias. Further studies should ensure clearly reported long- and short-term standardised assessment of improvement in total inflammatory lesion counts, participant-reported outcomes, and full safety accounts. Oral isotretinoin for acne that has not responded to oral antibiotics plus topical agents needs further assessment, as well as different dose/regimens of oral isotretinoin in acne of all severities.

/pdf/oral-isotretinoin-for-acne-10i0cak6nv.pdf

Oral isotretinoin for acne

Health Disparities Among Different Ethnic and Racial Middle and High School Students in Sun Exposure Beliefs and Knowledge

No wonder it itches: quick bedside visualization of a scabies infestation using reflectance confocal microscopy.

A 5-month-old female with no significant past medical history and no contributory family history of skin diseases presented to the emergency department with 6 days of a worsening pruritic erythematous papular rash with tense bullae on hands and feet. There was no history of medication use, previous illness, or any systemic symptoms. Six days prior to admission the rash started on the dorsum of hands, soles of feet, neck, and chin, as multiple papules on an erythematous surface (Figures 1 and 2). She was seen by her primary care physician 5 days prior to admission where a preliminary diagnosis of Coxsackie virus infection (hand, foot, and mouth) was made. Four days prior to admission blisters then began to form on the dorsum of hands and soles of the feet (Figure 3). The lesions that developed on the torso and face began to have purulent yellow discharge. She was then sent to a hospital emergency room with a diagnosis of bullous impetigo and treatment was started with mupirocin ointment. While using mupirocin at home the mother also used cornstarch topically for 3 days but the rash continued to spread on the torso, to the superior aspect of the face, and perianal region. Soon blisters on the hands and the feet began to rupture. The patient’s mother then took her to a different hospital where a viral culture was done and subsequently found to be negative for varicella. She was then referred for admission to Bristol Meyers Squibb Children’s Hospital at Robert Wood Johnson University Hospital emergency unit.

A Case of Bullous Pemphigoid in an Infant

Paraneoplastic pemphigus without mucosal lesions in a patient with ovarian cancer.

We present a case of a 12-year-old girl born with congenital heart disease requiring transplantation at age two and age seven. She has been taking systemic immunosuppression with tacrolimus and low dose steroids since her initial transplant. While family history is unknown, her adoptive mother reports that she had atopic dermatitis since early childhood and had been using topical steroids and phototherapy without relief. She presented to our clinic in January of 2020 with a severe atopic dermatitis flare involving BSA of 80% with a calculated SCORAD of 73 (Figure 1). In coordination with the transplant team, we prescribed dupilumab starting in February 2020. The patient tolerated the initial two 200 mg injections supervised in clinic and continued with 200 mg every 2 weeks administered at home. On 12-week follow-up, the patient had near complete clearance (Figure 2). She denies any medication adverse effects. To our knowledge, we report the first adolescent immunosuppressed transplant recipient with concomitant severe AD successfully treated with dupilumab.

Dupilumab as treatment for atopic dermatitis in a pediatric heart transplant patient: A case report.

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