Background: With the introduction of IL12/23 therapy, and compared with a TNF-α agents, the comorbidity risk for MACE (acute myocardial infarction, acute cerebrovascular disease, and TIA) is not yet well delineated. The aim for this study was to explore this comparison using real world data.

Objectives A cleansing body wash containing diluted sodium hypochlorite (0.006% NaOCl) was evaluated for management of moderate-to-severe Staphylococcus aureus-colonized, atopic dermatitis in children. Methods A 6-week, prospective, open-label study was conducted with 50 evaluable participants (ages 6 months to 17 years) who had moderate-to-severe atopic dermatitis with S aureus skin colonization documented by culture. Participants were instructed to continue using their current medications while using the study product, 0.006% NaOCl body wash, once daily to affected areas for 6 weeks. Primary outcome measures were Investigator's Global Assessment, Eczema Area and Severity Index, and Body Surface Area scores. Secondary outcome measures were the Visual Analog Scale for pruritus, Family Dermatology Life Quality Index, and Patient Satisfaction Questionnaire for Problem Areas. A subject daily diary and a six-item subject questionnaire that provided information on preferences for bleach bath vs body wash were secondary outcome measures. Results Daily use of the 0.006% NaOCl body wash led to improvement for all outcome measures comparing baseline to 2-week and to 6-week evaluations. Of the 50 skin S aureus-positive subjects, 32/50 (64%) were still positive at 2 weeks. A 36.5% decrease in subject's daily record of topical corticosteroid application at end of study compared to baseline was found. Participant surveys indicated preferences for the body wash over bleach baths. Conclusions Sodium hypochlorite (NaOCl) body wash improved all outcome measures for moderate-to-severe S aureus-colonized AD in infants, children, and adolescents. The limited reduction in S aureus further suggests that sodium hypochlorite has ameliorative effects other than antimicrobial actions.

Although literature demonstrates a decreased risk of Alzheimer's disease (AD) in individuals with various cancers, including squamous cell cancers (SCC) and basal cell cancers (BCC) comprising non‐melanoma skin cancers (NMSC), there is a paucity of literature to substantiate an association between malignant melanoma (MM) and AD.

Journal of the European Academy of Dermatology and VenereologyVolume 31, Issue 7 p. e311-e312 Letter to the Editor Hidradenitis suppurativa association at the time of, or subsequent to, diagnosis of inflammatory bowel disease in a large U.S. patient population A. Cices, A. Cices Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USASearch for more papers by this authorE. Ibler, E. Ibler Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USASearch for more papers by this authorS. Majewski, S. Majewski Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USASearch for more papers by this authorT. Huynh, T. Huynh Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USASearch for more papers by this authorK.A. Sable, K.A. Sable Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USASearch for more papers by this authorJ. Brieva, J. Brieva Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USASearch for more papers by this authorD.P. West, D.P. West Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USASearch for more papers by this authorB. Nardone, Corresponding Author B. Nardone b-nardone@northwestern.edu Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USACorrespondence: B. Nardone. E-mail: b-nardone@northwestern.eduSearch for more papers by this author A. Cices, A. Cices Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USASearch for more papers by this authorE. Ibler, E. Ibler Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USASearch for more papers by this authorS. Majewski, S. Majewski Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USASearch for more papers by this authorT. Huynh, T. Huynh Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USASearch for more papers by this authorK.A. Sable, K.A. Sable Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USASearch for more papers by this authorJ. Brieva, J. Brieva Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USASearch for more papers by this authorD.P. West, D.P. West Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USASearch for more papers by this authorB. Nardone, Corresponding Author B. Nardone b-nardone@northwestern.edu Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USACorrespondence: B. Nardone. E-mail: b-nardone@northwestern.eduSearch for more papers by this author First published: 21 December 2016 https://doi.org/10.1111/jdv.14097Citations: 6Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume31, Issue7July 2017Pages e311-e312 RelatedInformation

Controversy exists about an association between angiotensin-converting-enzyme inhibitors (ACEIs), angiotensin-receptor blockers (ARBs), and thiazides (TZs) and the risk of malignant melanoma (MM), and non-melanoma skin cancer—basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).

Journal of the European Academy of Dermatology and VenereologyVolume 31, Issue 9 p. e397-e398 Letter to the Editor Multiple sclerosis association with psoriasis: a large U.S. population, single centre, retrospective cross-sectional study N. Guido, N. Guido Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611 USASearch for more papers by this authorA. Cices, A. Cices Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611 USASearch for more papers by this authorE. Ibler, E. Ibler Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611 USASearch for more papers by this authorT. Huynh, T. Huynh Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611 USASearch for more papers by this authorS. Majewski, S. Majewski Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611 USASearch for more papers by this authorK. Sable, K. Sable Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611 USASearch for more papers by this authorS.M. Rangel, S.M. Rangel Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611 USASearch for more papers by this authorD.P. West, D.P. West Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611 USASearch for more papers by this authorA.E. Laumann, A.E. Laumann Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611 USASearch for more papers by this authorB. Nardone, Corresponding Author B. Nardone b-nardone@northwestern.edu Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611 USACorrespondence: B. Nardone. E-mail: b-nardone@northwestern.eduSearch for more papers by this author N. Guido, N. Guido Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611 USASearch for more papers by this authorA. Cices, A. Cices Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611 USASearch for more papers by this authorE. Ibler, E. Ibler Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611 USASearch for more papers by this authorT. Huynh, T. Huynh Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611 USASearch for more papers by this authorS. Majewski, S. Majewski Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611 USASearch for more papers by this authorK. Sable, K. Sable Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611 USASearch for more papers by this authorS.M. Rangel, S.M. Rangel Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611 USASearch for more papers by this authorD.P. West, D.P. West Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611 USASearch for more papers by this authorA.E. Laumann, A.E. Laumann Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611 USASearch for more papers by this authorB. Nardone, Corresponding Author B. Nardone b-nardone@northwestern.edu Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair Street, Suite 1600, Chicago, IL, 60611 USACorrespondence: B. Nardone. E-mail: b-nardone@northwestern.eduSearch for more papers by this author First published: 10 March 2017 https://doi.org/10.1111/jdv.14205Citations: 14Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume31, Issue9September 2017Pages e397-e398 RelatedInformation

Systemic biologic and nonbiologic agents used to treat psoriasis may or may not contribute to serious infection (SI) risk. Safety data, particularly for biologic agents, and associated risk for SI, are scarce. The study's aim was to explore the risk for SI in psoriasis patients exposed to systemic biologic or nonbiologic agents.

Sex hormones are known to modulate immunity and influence the pathophysiology of numerous disorders. Yet the effect of fluctuating estrogen levels throughout a woman’s life on the level of psoriasis activity (LoPA) remains poorly elucidated. The aim of this study was to determine if the LoPA varied in females during pre-menopause compared to post-menopause. We searched a large urban academic center electronic medical record (EMR) repository (> 3 million individuals) for existing data (January 2001 to December 2014). Inclusion criteria included diagnosis of psoriasis (ICD-9 code: 696.1) at least 3 years prior to diagnosis of menopause (ICD-9 base code: 627) with at least a 3-year follow-up post-menopause. Systemic therapy for psoriasis was utilized to assess LoPA. Women who were exposed to systemic (oral or injectable) therapy were compared to women who had no exposure to systemic therapy. 51 adult women were included in the analyses. Post-menopause, 5.9% (N=3) of women improved their LoPA (changed from systemic therapy to no systemic therapy), 15.7% (N=8) showed worsening of LoPA (changed from no systemic therapy to systemic therapy), and 78.4% (N= 40) showed no difference for LoPA. These findings suggest that post-menopausal estrogen depletion appears to not be associated with a protective effect for women with pre-menopausal psoriasis. Given the long-standing history for gender bias in biomedical studies, further exploration of issues related to sex hormone activity and LoPA (including pregnancy state and hormone replacement therapy exposure) seems warranted.

Rosacea is a common inflammatory condition characterized by transient or persistent central facial erythema, telangiectasias, papules or pustules. Recently, an increased incidence of Parkinson’s disease (PD) in patients with rosacea has been reported within a large population. However, the association between rosacea and PD has not been well-characterized. We sought to determine if an association exists between rosacea and PD in a large, urban, single center, electronic medical record (EMR) repository by searching the Northwestern Medicine Enterprise Data Warehouse (NMEDW) (> 4 million patients) for patients data on those who had an in-person encounter between 2001 and March 2016 and with ≥1 year documentation of follow-up encounter. Of these, we selected all patients diagnosed with rosacea (ICD-9 codes: 372.31; 695.3, ICD-10 codes: L71.8; L71.9) and a subsequent diagnosis of PD (ICD-9 code: 332; ICD-10 code: G20). Patients diagnosed with PD prior to rosacea diagnosis were excluded. Data on age, gender and race were also collected. Adjusted odds ratio (OR) was obtained by using logistic regression analysis. A total of 803,005 patients were identified. 17,682 were diagnosed with rosacea, of which 47 were subsequently diagnosed with PD (mean age: 74.3 years, range 53-89; 24F/23M; 77% White). A significant association between rosacea and PD was detected in this population after adjusting for age, gender and race (OR = 1.7; 95%CI 1.27-2.28; p<0.001). These findings are supportive of a previously reported association between rosacea and PD. Further exploration of the association between these two conditions is essential to fully characterizing this important issue in order to optimally counsel patients.

Rosacea is a common inflammatory condition characterized by transient or persistent facial erythema, telangiectasias, papules and pustules, for which an association has been reported to exist with Parkinson's disease (PD). We used a large, urban, single center, electronic medical record repository by searching the Northwestern Medicine Enterprise Data Warehouse (NMEDW) (> 4 million patients) for this association. Patients were included if they had an in-person encounter (Jan 2001 to May 2016) and with 1 year documentation of follow-up. Of these, all patients diagnosed with rosacea (ICD-9 codes: 372.31; 695.3, ICD-10 codes: L71.8; L71.9) and with a subsequent diagnosis of PD (ICD-9 code: 332; ICD-10 code: G20) were selected. Data on age, gender, race and tetracycline class therapy were collected. Adjusted odds ratio (OR) was obtained by using logistic regression analysis. A total of 815,210 patients were detected. 18,066 were diagnosed with rosacea, of whom 51 were subsequently diagnosed with PD (mean age: 74.5 years, range 53-89). A significant association between rosacea and PD was detectable after adjusting for age, gender, race and tetracycline class therapy (OR =1.7; 95%CI 1.27-2.22; p<0.001). Moreover, the adjusted odds ratio among untreated patients was higher than for rosacea-treated patients (ORs: 1.64 vs 1.10) and PD remained significantly associated with rosacea for both groups, suggesting that rosacea is an independent factor in the development of PD. These findings warrant further exploration for the relevance of this association between the two disorders.

Clinical assessment of skin photosensitivity is subjectively determined by erythema and tanning responses to sunlight recalled by the subject, alternatively known as Fitzpatrick Skin Phototype (SPT). Responses may be unreliable due to recall bias, subjective bias by clinicians and subjects, and lack of cultural sensitivity of the questions. Analysis of red-green-blue (RGB) color spacing of digital images may provide an objective determination of SPT. This paper presents the studies to assess the melanin index (MI), as determined by RGB images obtained by both standard digital camera as well as by videodermoscope, and to correlate the MI with SPT based upon subjects’ verbal responses to standardized questions administered by a dermatologist. A sample of subjects representing all SPTs I–VI was selected. Both the digital camera and videodermoscope were calibrated at standard illumination, light source and white balance. Images of constitutive skin of the upper ventral arm were taken of each subject using both instruments. The studies showed that 58 subjects (20 M, 38 F) were enrolled in the study (mean age: 47 years; range: 20–89), stratified to skin phototype I–VI. MI obtained by using both digital camera and videodermoscope increased significantly as the SPT increased (p = 0.004 and p < 0.0001, respectively) and positively correlated with dermatologist-assessed SPT (Spearman correlation, r = 0.48 and r = 0.84, respectively). Digital imaging can quantify melanin content in order to quantitatively approximate skin pigmentation in all skin phototypes including Type VI skin. This methodology holds promise as a simple, non-invasive, rapid and objective approach to reliably determine skin phototype and, with further investigation, may prove to be both practical and useful in the prediction of skin cancer risk.

Aspirin use has been reported to be protective against development of several cancers. The aim of this study is to evaluate the association of aspirin use and melanoma in a large, urban, single academic center electronic medical record repository, the Northwestern Medicine Enterprise Data Warehouse (NMEDW) (>4.4 million patients, 01/2001 – 12/2015) to detect data for all patients, age 18-89, with a follow-up encounter ≥ 1 year. Aspirin exposure was ≥1 year with subsequent cutaneous melanoma diagnosis (ICD-9 172.0-172.9 and ICD-10:C43.0-C43.9), occurring ≥ 6 months after initial aspirin exposure. Data on age, gender, and race were collected. Adjusted Odds Ratio (OR) was determined per logistic regression analysis. The total study population consisted of 802,963 individuals. Of these, 7,227 aspirin users were detected, of whom 93 had a subsequent diagnosis of cutaneous melanoma (mean age 73.85 years, range 34-89; 64M/ 29F; 69% Caucasian). Median follow-up was 163 months (interquartile range (IQR) 134.5-177); length of exposure 36 months (IQR 21.5-66.5); time from first exposure to melanoma 69 months (IQR 32.5-86.5). After adjusting for age, race, and gender an increased risk for melanoma in aspirin-exposed patients (OR: 1.25; 95%CI 1.01-1.54; p=0.037) was detected. These findings serve to delineate the association between aspirin use and subsequent development of melanoma.

Hematopoietic stem cell transplant, a life-saving therapeutic option for some patients with malignant and non-malignant disease, may be complicated by a variety of cutaneous and systemic sequelae. Dermatologists are an integral part of the multidisciplinary effort involved in the care of stem cell transplant patients, as skin tissue may be the initial, and/or only, site of graft-versus-host disease (GVHD). Consequently, prompt diagnosis and treatment of cutaneous eruptions in the early post-transplant period may contribute to a reduction in morbidity and mortality. An important confounding issue is the clinical and histopathologic overlap of features among common cutaneous eruptions in stem cell transplant patients, with particular difficulties associated with differentiating GVHD from both cutaneous reactions to drugs (CRDs) as well as viral exanthema, including viral reactivation. We review challenges in the initial diagnosis of cutaneous eruptions following hematopoietic stem cell transplantation and provide an update on approaches to the differential diagnosis for GVHD, CRDs, and viral exanthema.

Psoriasis is a chronic inflammatory condition with several possible co-morbidities including multiple sclerosis (MS), however the associations between the two diseases has not been fully elucidated. We sought to determine if an association exists between psoriasis and MS in a large, urban, single center, electronic medical record (EMR) repository. We searched the Northwestern Medicine Enterprise Data Warehouse (NMEDW) (> 4 million patients), for data existing between January 2001 and December 2014, to detect all patients who were diagnosed with both psoriasis and MS (using ICD-9 codes 696.1 and 340, respectively). Data for age, gender, race, concomitant psoriatic arthropathy (ICD-9 code 696.0) and at least one prescription for a TNF-α agent were also collected. Adjusted odds ratio (OR) was obtained by using logistic regression analysis. Evaluable data existed for 667,480 individuals. 5,988 of these persons were ICD-9-coded as psoriasis, and 2,331 patients were coded as MS. Of these, 31 patients were diagnosed with both psoriasis and MS. A statistically significant association between psoriasis and MS was detected for this population after adjusting for confounding variables (OR=1.51; 95%CI 1.04 -2.19; p =0.02). These findings are strongly supportive of the prior reported association for MS and psoriasis. Of note, in our study population, exposure to a TNF-α agent did not confound the statistically significant association between MS and psoriasis, despite reported cases of demyelinating diseases with exposure to TNF-α blocking agent. Based on these findings, further exploration of the association between psoriasis and multiple sclerosis is warranted to ensure optimal therapeutic management for such patients, especially for those patients undergoing disease management with a biologic agent, given that both diseases may be managed with quite different targeted biologic agent therapy.

BACKGROUND:The popularity of active video games (AVGs) has skyrocketed over the last decade. However, research suggests that the most popular AVGs, which rely on synchronous integration between players' activity and game features, fail to promote physical activity outside of the game or for extended periods of engagement. This limitation has led researchers to consider AVGs that involve asynchronous integration of players' ongoing physical activity with game features. Rather than build an AVG de novo, we selected an established sedentary video game uniquely well suited for the incorporation of asynchronous activity: online fantasy sports.OBJECTIVE:The primary aim of this study was to explore the feasibility of a new asynchronous AVG-active fantasy sports-designed to promote physical activity.METHODS:We conducted two pilot studies of an active fantasy sports game designed to promote physical activity. Participants wore a low cost triaxial accelerometer and participated in an online fantasy baseball (Study 1, n=9, 13-weeks) or fantasy basketball (Study 2, n=10, 17-weeks) league. Privileges within the game were made contingent on meeting weekly physical activity goals (eg, averaging 10,000 steps/day).RESULTS:Across the two studies, the feasibility of integrating physical activity contingent features and privileges into online fantasy sports games was supported. Participants found the active fantasy sports game enjoyable, as or more enjoyable than traditional (sedentary) online fantasy sports (Study 1: t8=4.43, P<.01; Study 2: t9=2.09, P=.07). Participants in Study 1 increased their average steps/day, t8=2.63, P<.05, while participants in Study 2 maintained (ie, did not change) their activity, t9=1.57, P=.15). In postassessment interviews, social support within the game was cited as a key motivating factor for increasing physical activity.CONCLUSIONS:Preliminary evidence supports potential for the active fantasy sports system as a sustainable and scalable intervention for promoting adult physical activity.