PracticeUpdate Dermatology May 2019

CONFERENCE COVERAGE 26

Dr. Caitlyn Reed’s Take-Aways By Caitlyn T. Reed MD From Heidi Kong’s microbiome lecture:

• For clothing, she recommends sports bras, cotton or rayon fabrics (avoid polyester and lacy fabrics). She also recommends sweat-blotting bra liners. • For pain control, alternate bleach baths, epsom salt baths, and CBD oil/CBD balm/CBD bath bomb baths every 3 days. Atopic dermatitis: Dr. Peter Lio There is evidence for probiotic supplementation in pregnant women and babies, but this only seems to delay onset of atopic dermatitis rather than pre- venting it. There is no evidence for probiotics after disease onset. “Magic Cream” appears to work better for some patients than components separately for unknown reasons: • Betamethasone valerate 0.1% cream: 30 g • Mupirocin cream: 24 g • Vanicream: 400 g • Mix to a total mass of 454 g. No urea. Please do not substitute. • Apply to eczema areas at waking, 10:00 AM, 2:00 PM, and at bedtime for flares. ― ― Sunflower oil acts as an anti-inflammatory plus barrier repair and decreases lichenification. Coconut oil can decrease staph colonization by 95%. Dr. Lio recommends using either on babies as a massage. From comorbidities in psoriasis by Dr. Nehal Mehta and Dr. Ron Prussick • We should ask about symptoms of psoriatic arthritis at every appointment. • Psoriasis is an independent risk factor for non-al- coholic fatty liver disease. A low glycemic index diet and exercise can prevent NALFD even without weight loss. • Check vitamin D levels and correct if low. • Patients aged 40 to 50 years old with severe pso- riasis have twice the risk of myocardial infarction as healthy controls. • Psoriasis patients should have a cardiac screening every 5 years, even pediatric patients. This should include blood pressure, height and weight, fasting glucose, and cholesterol levels. From therapeutic and diagnostic and pearls • Pediatrics: Dr. Cynthia DeKlotz ― ― DeKlotz recommends warming wet wraps for patients with atopic dermatitis – can warm damp pajamas in the dryer or the microwave. ― ― Distraction can work better for pediatric patients than any form of anesthesia. www.practiceupdate.com/c/80879

While patients with atopic dermatitis typically have many different Staphyloccocus epidermidis strains within their microbiome, a single aureus strain tends to dominate, although strains vary a good deal among patients. This S. aureus strain multiplies greatly before and during an atopic dermatitis flare, termed the “clonal surge.” From the complementary, natural, and novel therapeutics lecture: Wound healing: Dr. Hadar Lev-Tov • Gotu kola cream, from the plant Centella asiatica , showed faster wound healing times versus silver sulfadiazine. • Curcumin can improve wound healing but has poor bioavailability. Dr. Lev-Tov recommends titrating slowly up to a dose of 4 g every 8 hours daily. • Honey works well for burns and post-op wounds. Hidradenitis suppurativa: Dr. Vivian Shi • Dr. Shi recommends oral zinc supplements (zinc picolinate preferred to zinc gluconate). Zinc can cause copper deficiency, and so she recommends a 10:1 zinc:copper dose. • Check vitamin D levels and replace if low. • Have the patient follow a diet free of Brewer’s yeast. Brewer’s yeast has been associated with earlier onset of disease and flares. • Refer patients early for weight-loss treatments, even bariatric surgery. She recommends the Med- iterranean diet and health and fitness coaching.

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