Epidermolysis bullosa is a rare blistering skin disorder that is challenging to manage because skin fragility and repeated wound healing cause itching, pain, limited mobility, and recurrent infections. Cannabidiol, an active cannabinoid found in cannabis, is postulated to have antiinflammatory and analgesic effects. We report 3 cases of self-initiated topical cannabidiol use in patients with epidermolysis bullosa in an observational study. One patient was weaned completely off oral opioid analgesics. All 3 reported faster wound healing, less blistering, and amelioration of pain with cannabidiol use. Although these results demonstrate promise, further randomized, double-blind clinical trials are necessary to provide scientific evidence of our observed benefits of cannabidiol for the treatment of epidermolysis bullosa.
Background/Objectives Social media use has been suggested to worsen psychiatric health among adolescents, especially those with visible skin lesions including acne. However, little is known about social media's impact on acne treatment. The purpose of the study sought to characterize the influence of social media use on acne treatment. Methods We conducted a cross‐sectional survey of West Virginia University ambulatory patients whose chief complaint was acne was conducted. The survey collected sociodemographics and queried whether individuals accessed social media for acne treatment advice or not, whether changes to acne care were made based on social media, and whether these changes aligned with the American Academy of Dermatology (AAD) clinical guidelines for acne management. Results Of 130 respondents, 45% consulted social media for acne treatment advice (54% of women vs 31% of men). 41% of adolescents and 51% of adults consulted social media. The most used platforms were YouTube and Instagram (58% each). Social media users often tried an OTC treatment (81%) or dietary modification (40%). However, only 31% of participants consulting social media made changes fully aligned with AAD clinical guidelines. Conclusions Social media‐influenced acne treatment advice is prevalent, especially among women, adolescents, and young adults. This treatment advice frequently does not align with AAD guidelines, with notably 40% of respondents choosing dietary modification for acne management. These results suggest that dermatologists should inquire about social media acne treatment advice and directly address misinformation.
Background Data on the impact of biologics and immunomodulators on CoVid-19 related outcomes remains scarce. Objective To determine whether patients on tumor necrosis factor inhibitor (TNFi) and/or methotrexate are at increased risk of CoVid-19 related outcomes. Methods In this large comparative cohort study, a real-time search and analysis were performed on adult patients diagnosed with CoVid-19 and treated with TNFi and/or methotrexate versus those not treated. Likelihood of hospitalization and mortality were compared between groups with and without propensity score matching for confounding factors. Results 53,511,836 unique patient records were analyzed, of which 32,076 (0.06%) had a CoVid-19-related diagnosis documented starting after January 20, 2020. 214 patients with CoVid-19 were identified with recent TNFi or methotrexate exposure compared to 31,862 patients with CoVid-19 without TNFi or methotrexate exposure. After propensity matching, likelihood of hospitalization and mortality were not significantly different between the treatment and non-treatment group (risk ratio 0.91, 95% confidence interval [CI] 0.68-1.22, p=0.5260; risk ratio 0.87, 95% CI 0.42-1.78, p=0.6958, respectively). Limitations All TNFi may not behave similarly. Conclusion Our study suggests that patients with recent TNFi and/or methotrexate exposure do not have increased hospitalization or mortality compared to CoVid-19 patients without recent TNFi and/or methotrexate exposure.
IMPORTANCE Current therapeutic options for patients with extracranial head and neck arteriovenous malformations are limited. Surgical intervention, such as sclerotherapy or resection, often result in rapid recurrence and progression of disease.OBJECTIVE To assess the efficacy and tolerability of sirolimus as an adjuvant therapy for endovascular embolization in the management of complicated extracranial head and neck arteriovenous malformations.DESIGN, SETTING, AND PARTICIPANTS This case series examined 6 patients with extracranial head and neck arteriovenous malformations treated from January 1, 2013, to December 31, 2017, at a multidisciplinary vascular anomalies clinic within Stanford Hospital and Clinics.INTERVENTION Initiation of sirolimus at least 1 month prior to endovascular embolization, targeting a trough level of 10 to 15 ng/mL throughout the course of the endovascular embolization series and continued for at least 1 month after the series.MAIN OUTCOMES AND MEASURES Clinical manifestations; disease progression and overall response to treatment were assessed via clinical evaluation and radiographic imaging.RESULTS All 6 patients (4 male and 2 female patients; mean age, 24.5 years [range, 9-44 years]) responded favorably to the combination of sirolimus therapy followed by endovascular embolization, and 4 patients exhibited a near-complete response. The median duration of follow-up was 19 months (range, 6-40 months). One patient discontinued sirolimus soon after embolization and experienced regrowth of the arteriovenous malformation after 1 year. Sirolimus was resumed, which has stabilized his disease for more than 2 years. Mild adverse effects were noted in 4 patients. The combination therapy was well tolerated in all patients. One patient developed skin ulceration after embolization and required surgical debridement. Another patient developed pulmonary microthrombi after embolization with cyanoacrylate glue that resolved with a brief course of anti-inflammatory therapy.CONCLUSIONS AND RELEVANCE Although further prospective trials are needed, this report suggests the benefit of a mammalian target of rapamycin inhibitor as an adjuvant therapy for surgical embolization of complex, extracranial head and neck arteriovenous malformations. The optimal dosing and therapeutic duration of sirolimus treatment before and after embolization remain to be determined.
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