Dermatopharmacology

FRIDAY, Oct. 11, 2024 (HealthDay News) -- Potential benzene exposure occurs as a result of benzoyl peroxide (BPO) drug product use, according to a study published online Oct. 7 in the Journal of Investigative Dermatology.The carcinogen benzene is a degradation product of BPO and has been reported to form when BPO drug products are incubated at body temperature and elevated temperatures, according to Kaury Kucera, Ph.D., from the Arnold &amp; Marie Schwartz College of Pharmacy and Health Sciences at Long Island University in Connecticut, and colleagues. Kucera and colleagues examined benzene concentrations detected in over-the-counter BPO products.The researchers found that benzene concentrations (0.16 to 35.30 ppm) were detected in 111 over-the-counter BPO drug products tested and maintained at room temperature. Stability testing of a prescription encapsulated BPO product resulted in no apparent benzene formation at 2 degrees Celsius and in high levels of benzene formation at 50 degrees Celsius. In face model experiments, detectable levels of benzene were found through evaporation, and considerable benzene formation occurred when exposed to ultraviolet light at levels below peak sunlight."The results presented here suggest that a substantial portion of the BPO acne treatment market currently contains unacceptably high levels of benzene in products sitting on the shelf and that stabilization techniques like encapsulation do not appear to prevent the formation of benzene in BPO drug products," the authors write. "In the interest of public health, further study and regulatory and industry actions, such as recalls, are warranted."Several authors disclosed ties to the pharmaceutical industry. The study was funded by Valisure.<a target="_blank" rel="noopener noreferrer" href="https://www.jidonline.org/article/S0022-202X(24)02155-9/fulltext">Abstract/Full Text</a>

Benzene concentrations detected in 111 over-the-counter BPO drug products that were tested, maintained at room temperature

Benzene Exposure Results From Benzoyl Peroxide Drug Product Use

THURSDAY, Jan. 25, 2024 (HealthDay News) -- From 2004 to 2019, there was an increase in isotretinoin use among girls and women of childbearing age in Germany, according to a study published online Jan. 25 in PLOS Medicine.Jonas Reinold, from the Leibniz Institute for Prevention Research and Epidemiology–BIPS in Bremen, Germany, and colleagues determined the age-standardized prevalence of isotretinoin use between 2004 and 2019 among girls and women aged 13 to 49 years using observational data from the German Pharmacoepidemiological Research Database. The number of exposed pregnancies was estimated by assessing whether there was prescription supply overlapping the beginning of pregnancy or a dispensation within the first eight weeks of pregnancy.The researchers found that from 2004 to 2019, there was an increase in the age-standardized prevalence of isotretinoin use, from 1.20 to 1.96 per 1,000 girls and women, respectively. A total of 178 pregnancies exposed to isotretinoin were identified in the base case analysis, with a doubling of the number per year during the study period. Among exposed pregnancies, at least 45 percent ended in an induced abortion. The number of exposed pregnancies varied from 172 to 375 in sensitivity analyses. Six of the live-born children had major congenital malformations."While our study was not designed to quantify risks, it was still striking that 13 live-born children classified as exposed to isotretinoin in early pregnancy in the base case or the sensitivity analyses had congenital malformations, six of them with major malformations," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004339">Abstract/Full Text</a>

In base case analysis, 178 pregnancies were exposed to isotretinoin, with a doubling of the number per year during the study period

2004 to 2019 Saw Increase in Isotretinoin Use in Girls, Women

WEDNESDAY, Dec. 20, 2023 (HealthDay News) -- The risk for osteoporosis and major osteoporotic fracture (MOF) is increased in association with long-term exposure to topical corticosteroids (TCSs), according to a study published online Dec. 20 in the Journal of the European Academy of Dermatology and Venereology.Bing-Jun Hsieh, from the National Taiwan University Hospital in Taipei, and colleagues examined the association of cumulative doses of TCSs of varying potency with osteoporosis and MOF using data from the Taiwan National Health Insurance Research Database. Cumulative TCS doses were calculated in different exposure periods; the potency was converted to prednisolone equivalent.A total of 129,682 osteoporosis cases and 34,999 MOF cases were selected from 2017 to 2020 and randomly matched to 518,728 and 139,996 controls by sex and age, respectively. The researchers identified clear dose-response relationships between long-term exposure to TCSs and osteoporosis and MOF. For osteoporosis, the adjusted odds ratios were 1.216, 1.260, and 1.341 for exposure to low, medium, and high cumulative TCS doses, respectively, compared with no TCSs, over five years. For MOF, the corresponding adjusted odds ratios were 1.118, 1.191, and 1.288. In a stratified analysis, higher odds ratios for osteoporosis and MOF were seen for women than men. Compared with other age groups, younger people (younger than 50 years) had the highest odds ratio for osteoporosis."High cumulative doses of TCSs should be used with caution, especially in susceptible populations," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://onlinelibrary.wiley.com/doi/10.1111/jdv.19697">Abstract/Full Text (subscription or payment may be required)</a>

Dose-response relationships identified between long-term exposure to TCSs and osteoporosis and major osteoporotic fracture

Osteoporosis Risk Increased With Long-Term Topical Corticosteroid Exposure

WEDNESDAY, July 5, 2023 (HealthDay News) -- Chemotherapy-induced adverse cutaneous drug reactions that mimic cellulitis, including those termed pseudocellulitis, do not meet criteria for other diagnoses, according to a review published online June 28 in JAMA Dermatology.Leah D. Kovacs, from the University of Washington School of Medicine in Seattle, and colleagues conducted a systematic review of case reports of patients with pseudocellulitis to characterize the various cellulitis-mimicking reactions caused by chemotherapeutic medications and understand how these reactions affect patient care. Data were obtained from 32 publications, representing 81 patients with pseudocellulitis.The researchers found that most of the 81 cases were associated with gemcitabine use, while pemetrexed use was reported less often. Thirty-nine cases were considered true chemotherapy-induced pseudocellulitis. These did not meet diagnostic criteria for any known diagnoses and resembled pseudocellulitis and were therefore described solely as pseudocellulitis. Sixty-seven and 36 percent of this group (26 and 14 patients) had been administered antibiotics before the correct diagnosis and experienced interruptions to their oncologic treatment plans, respectively."There is a need for a universally accepted definition of pseudocellulitis," the authors write. "A greater understanding of chemotherapy-induced pseudocellulitis would help to avoid oncologic interruptions and would promote antimicrobial stewardship."

Cases of true chemo-induced pseudocellulitis resembled infectious cellulitis; did not meet diagnostic criteria for known diagnoses

Chemotherapy-Induced Pseudocellulitis Described in Case Reports

In evidence-based clinical practice guidelines published online Aug. 17 in
 
 JAMA Dermatology
 
 , recommendations are presented for the safe and effective use of laser-assisted drug delivery (LADD).




 Jessica G. Labadie, M.D., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues developed recommendations for safe and effective use of LADD. Draft recommendations were informed by a systematic review and were refined through a Delphi survey, consensus meetings, and iterative review until unanimous consensus was achieved. A total of 48 published studies of ablative fractional LADD met inclusion criteria, and six publications of nonablative fractional LADD were included at the request of the expert panel.




 Thirty-four, 17, and three studies had low, moderate, and serious risk for bias, respectively. The researchers note that one of the key findings that informed the guidelines was that LADD is safe in adults and adolescents with all Fitzpatrick skin types and in immunosuppressed patients. LADD is effective for actinic keratosis, cutaneous squamous cell carcinoma in situ, actinic cheilitis, hypertrophic scars, and keloids; in addition, it is useful for epidermal and dermal analgesia. Application of heat, pressure, or occlusion or use of an aqueous drug solution may increase drug delivery. Laser settings should ensure that channel diameter is greater than the delivered molecule. Except with impaired wound healing, antibiotic prophylaxis is not recommended. When treating the face and genitalia, antiviral prophylaxis is not recommended; antifungal prophylaxis is not recommended.




 "As the standard of care continues to shift toward minimally invasive and individualized methods of drug delivery, LADD will play an important role," the authors write.




 Several authors disclosed financial ties to the pharmaceutical industry.




 <a class="rm-stats-tracked" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2795008" target="_blank">
 Abstract/Full Text (subscription or payment may be required)
 </a>

Key findings that informed guidelines include that LADD is safe for adults, adolescents, immunosuppressed patients

Guidance Developed for Use of Laser-Assisted Drug Delivery

In this episode of Cutaneous Miscellaneous, host Nicholas Brownstone, MD, welcomes David Osborne, PhD, an industry expert in topical drug formulation, for an in-depth discussion on formulations and compounding in dermatology.Dr Brownstone begins with a board review on the structure and function of the epidermis, covering the 5 layers of the skin and key cellular junctions, with mnemonic tips to aid retention.In the main segment, Drs Brownstone and Osborne explore the fundamentals of topical formulation, including principles of localized drug delivery, ingredient selection, and the role of Fick’s law in product diffusion. Dr Osborne shares insights on formulation challenges, selecting the right solvents and excipients, and key considerations such as ingredient stability, packaging, and accurate measurement of actives.The episode wraps up with practical pearls for dermatologists interested in product development, including which ingredients to avoid. Tune in for a high-yield, practical discussion!

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Benzene Exposure Results From Benzoyl Peroxide Drug Product Use

2004 to 2019 Saw Increase in Isotretinoin Use in Girls, Women

Osteoporosis Risk Increased With Long-Term Topical Corticosteroid Exposure