Studying dermatology extends beyond dermatology journals


Andrea Murina, MD: “We need to keep up with what other specialties are doing that affects us and our patients.”

Dermatology is served well by an extensive range of basic science and clinical journals. But not all studies that are relevant to dermatologists are published in dermatology journals. The wider world of medical publishing offers a broad array of topics, methods, analyses, and approaches that can inform dermatologic practice.

“Medical specialties have areas of shared practice gaps, areas where we can improve patient care based on new knowledge,” said Andrea Murina, MD, assistant professor of dermatology at Tulane University, New Orleans. “We can all use a look beyond the familiar dermatologic literature to advance our own knowledge of dermatology-related conditions. There is an important body of evidence-based literature relevant to dermatology that is published outside our own journals. We need to keep up with what other specialties are doing that affects us and our patients.”

Dr. Murina was course director August 20 for a focused look at the non-dermatologic literature during “What You Didn’t Hear at Your Last Journal Club: Highlights of Evidence-Based Medicine from Non-Dermatology Journals.” Some of the important studies she highlighted came from other medical specialty journals. All were based on solid medical evidence.

One of the most impactful was a look at the potential use of probiotics for eczema. A meta-analysis compared the number of eczemas that developed in children who were supplemented with probiotics in utero and during infancy versus controls.

“When all the data from studies were combined, eczema developed at a lower rate among children who were given the supplement compared to placebo,” Dr. Murina said. “Although there are currently no recommendations for the use of probiotics in pregnancy and infancy, the recent publication of several meta-analyses showing a positive effect, may lead to changes in future guidelines.”

Another small study investigated the use of oral nicotinamide for the prevention of non-melanoma skin cancer and showed a protective effect.

“This item first appeared as a poster at an oncology meeting,” Dr. Murina said. “Like a lot of dermatology-related studies published outside our own journals, this one was difficult to track down. There’s not enough evidence to recommend this to all of your patients with sun damage, but it’s the latest evidence we have and suggests a potentially useful course for more study.”

Occasionally, dermatology-related studies make headlines in the popular press for all the wrong reasons. There was a peak of interest in 2014 and early 2015 in two studies that linked both sildenafil and citrus juice with increased risk for melanoma. Both studies require further investigation to determine whether the associations are real or just the results of other lifestyle factors.

Follow-up data on PDE-5 inhibitors and melanoma found that there was, indeed, an apparent increase in risk for melanoma associated with a single prescription for erectile dysfunction drugs. However, men with six or more PDE-5 prescriptions did not show any increased risk.

“This is a good example of an observational study that needed follow-up studies to highlight possible bias,” Dr. Murina said. “Yes, there is an association, but the likelihood of cause and effect is remote at best because men who used PDE-5 inhibitors regularly did not show any increased risk. There are probably more lifestyle factors at work, not molecular mechanisms, that we should be concerned about.”

Another benefit of medical journals outside of dermatology includes the ability to perform high-quality studies with large numbers of patients, she said. A study in JAMA Ophthalmology evaluated more than 2,000 patients who had been on hydroxychloroquine for five years or longer and found that they have a small but clinically significant elevated risk of retinopathy of less than 2 percent. Even though this is not new information to dermatologists, the study is important because it helps quantify risk and better counsel patients about the likelihood of severe side effects.

“It is important to review clinically relevant, evidence-based literature that comes from specialties outside dermatology,” Dr. Murina said. “We can look at these studies and determine how to move forward, how to build on what others have done, and how to bring important outside information into our practices.”

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