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Erin M Warshaw

Publications and source records attributed to Erin M Warshaw.

At least 19 recordsLinked to original sources
PubMed2006

Results of a randomized, double-blind, vehicle-controlled efficacy trial of pimecrolimus cream 1% for the treatment of moderate to severe facial seborrheic dermatitis.

BACKGROUND: Seborrheic dermatitis is commonly treated with anti-inflammatory products, including topical corticosteroids. Pimecrolimus cream 1% also exerts anti-inflammatory activity by inhibiting T-cell cytokine production. OBJECTIVE: We sought to compare the efficacy and safety of twice-daily pimecrolimus for treatment of moderate to severe facial seborrheic dermatitis. METHODS: This double-blind, vehicle-controlled, 4-week trial randomized patients with seborrheic dermatitis to pimecrolimus or vehicle (1:1). Clinical assessments (erythema [0-3] and scaling [0-3] combined for a total area score [0-6]) were performed at weeks 0, 2, and 4. Inclusion criteria included total area score 4 or greater and erythema 2 or greater. The prespecified primary variable, change from baseline in total area score at week 4, was analyzed using a two-sample t test for intent-to-treat and per protocol populations. RESULTS: In all, 96 adults of mean age 59.6 years, 88.5% male, were randomized (n = 47 pimecrolimus; 49 vehicle). At week 4, the mean change from baseline in total area score was 3.7 versus 3.3 for pimecrolimus and vehicle groups, respectively (intent-to-treat: P = .1913; 95% confidence interval (CI) for difference [-0.195, 0.961]). Per protocol analysis (n = 41 pimecrolimus; 46 vehicle) indicated a significant difference between groups (mean change 3.9 pimecrolimus vs 3.2 vehicle; P = .0156; CI [0.129, 1.197]). The superiority of pimecrolimus was observed as early as week 2 (intent-to-treat: P = .0062; CI [0.132, 0.777]; per protocol: P = .0012; CI [0.410, 1.593]). No drug-related serious adverse events occurred. The most frequent drug-related adverse events were local, mild, and transient (pimecrolimus = 26%; vehicle = 12%). LIMITATIONS: Generalizability is limited by the elderly male study population. CONCLUSION: This study suggests that pimecrolimus cream 1% is an effective and well-tolerated treatment for moderate to severe facial seborrheic dermatitis.

Adult↗
PubMed2006

Cost-effectiveness of diagnostic tests for toenail onychomycosis: a repeated-measure, single-blinded, cross-sectional evaluation of 7 diagnostic tests.

OBJECTIVE: Our purpose was to estimate and compare the cost-effectiveness of the most commonly used diagnostic tests for onychomycosis: potassium hydroxide preparation (KOH), interpreted both by a dermatologist (KOH-CLINIC) and a laboratory technician (KOH-LAB); KOH with dimethyl sulfoxide (KOH-DMSO) and with chlorazol black E (KOH-CBE), interpreted by a dermatologist; culture using dermatophyte test medium, culture with Mycobiotic and Inhibitory Mold Agar (Cx); and histopathologic analysis using periodic acid-Schiff stain (PAS). METHODS: This was a repeated-measure, blinded, cross-sectional study conducted at the Minneapolis Veterans Affairs Medical Center. Inclusion criteria included: at least one toenail with 25% or more clinical disease, which was defined as subungual debris with onycholysis and/or onychauxis. Exclusion criteria included other nail dystrophies, use of oral antifungal medication for 2 months or longer within the past year, or topical ciclopirox lacquer within 6 weeks of enrollment. The main outcome measure was the cost-effectiveness (Medicare and non-Medicare costs) of 7 diagnostic tests. Sensitivity (at least 3 positive tests) was the unit of effectiveness. RESULTS: Two hundred four participants were enrolled; their average age was 69.5 years and 95.5% were male. PAS was the most sensitive test (98.8%); it was statistically significantly more sensitive than all other diagnostic tests except KOH-CBE (94.3%). Dermatophye test medium was the least sensitive test (57.3%). KOH-CBE was statistically significantly more cost effective than any other test, with the exception of KOH-CLINIC and KOH-LAB. PAS was the least cost effective. LIMITATIONS: Test specificities were not evaluated. CONCLUSION: KOH-CBE should be the test of choice for practitioners confident in interpreting KOH preparations because of its combination of high sensitivity and cost-effectiveness.

Aged↗
PubMed2006

Allergic contact dermatitis to cosmetics.

Cosmetics are used to enhance one's appearance and are used by women worldwide. This article reviews the epidemiology, clinical features, and management of cosmetic allergic contact dermatitis. Additionally, several important cosmetic-related allergens are discussed.

Allergens↗
PubMed2006

Pityriasis lichenoides and its subtypes.

Pityriasis lichenoides represents a unique group of inflammatory skin disorders that include pityriasis lichenoides et varioliformis acuta (PLEVA), febrile ulceronecrotic Mucha-Habermann disease (a subtype of PLEVA), and pityriasis lichenoides chronica. The history, epidemiology, clinical features, pathophysiology, and treatment of this group of conditions are reviewed in this manuscript.

Humans↗
PubMed2006

Diagnosing and managing cutaneous pigmented lesions: primary care physicians versus dermatologists.

BACKGROUND: Primary care physicians (PCPs) are often expected to screen for melanomas and refer patients with suspicious pigmented lesions to dermatologists. OBJECTIVE: To assess whether there is a difference between dermatologists and PCPs in accurately diagnosing melanoma and appropriately managing (based on decisions to refer/biopsy) suspicious pigmented lesions. DESIGN, PARTICIPANTS: A survey based on a random sample of 30 photographs of pigmented lesions with known pathology was administered to 101 dermatologists and 115 PCPs from October 2001 to January 2003. MEASUREMENTS: Likelihoods that a photographed lesion was melanoma and that the lesion should be biopsied/referred were scored on a 1 to 10 scale. Accuracy of melanoma diagnosis and appropriateness of pigmented lesion management were compared between dermatologists and PCPs by using the areas under (AUC) the receiver operating characteristic (ROC) curves. RESULTS: Dermatologists were superior to PCPs in diagnosing melanomas (AUC 0.89 vs 0.80, P<.001) and appropriately managing pigmented lesions (AUC .84 vs 0.76, P<.001). PCPs who tended to biopsy lesions themselves did better at managing pigmented lesions than PCPs who did not perform biopsies. Dermatology training during residency did not significantly improve the diagnostic accuracy of PCPs nor their management of pigmented lesions. CONCLUSIONS: Dermatologists have both better diagnostic accuracy and ability to manage pigmented lesions than PCPs. Yet, there is a shortage of dermatologists to meet the demand of accurate melanoma screening. More innovative strategies are needed to better train PCPs and enhance skin cancer screening.

Biopsy↗
PubMed2006

Dyshidrosis: epidemiology, clinical characteristics, and therapy.

Dyshidrosis is a common chronic dermatitis of the hands and feet that may cause significant physical discomfort, psychological distress, and occupational impairment. Topics reviewed in this article include epidemiology, clinical findings, quality of life, and therapeutic considerations. Dyshidrosis is often difficult to manage; therefore, extra attention is given in this review article to current treatment options.

Eczema, Dyshidrotic↗
PubMed2006

Cutaneous reactions to transdermal therapeutic systems.

Transdermal therapeutic systems have been increasingly used in the past two decades. However, cutaneous side effects are fairly common and may result in poor patient compliance. This review article summarizes the spectrum of reactions due to transdermal therapeutic systems and provides a current list of known allergens.

Administration, Cutaneous↗
PubMed2006

Optimizing reproducibility for clinical studies involving patch testing and application of topical preparations.

BACKGROUND: The reproducibility and consistency of patch-test techniques can be problematic, making controlled clinical trials of patch testing difficult. OBJECTIVE: To measure the accuracy and reproducibility of applying controlled quantities of petrolatum onto Finn Chambers. METHODS: Four dermatology nurses applied a total of 240 samples of white petrolatum, using three syringe sizes and types. Three different amounts of white petrolatum (0.02 mL, 0.05 mL, and the "usual" amount) were expressed onto previously weighed Finn Chambers, using three different syringe sizes (5 mL, 1 mL, and 0.5 mL), five times each on two separate days. RESULTS: The average weights of 0.05 mL of petrolatum expressed with each type of syringe (5 mL: 0.04252 g; 1 mL: 0.04084 g; and 0.5 mL: 0.04139 g) were not significantly different from each other in pairwise comparisons (p > .36) or from the "gold standard" expected value (0.04138 g, p > .72). The average weights of 0.02 mL of petrolatum expressed with two types of syringes (5 mL: 0.02138 g; 0.5 mL: 0.01778 g) were significantly different from each other (p = .0012), but neither differed significantly from the expected value (0.01655 g, p > .08). The variance due to the effect modifications of nurse, day, and interaction of nurse and day was statistically significant for measurements made with the 5 mL syringe but not for measurements made with the 1 mL or 0.5 mL syringe. CONCLUSION: The average amounts of petrolatum extruded from smaller syringes (0.5 mL and 1 mL) were less variable and more reproducible than those extruded from a 5 mL syringe.

Administration, Cutaneous↗
PubMed2006

Allergic contact dermatitis from mercapto compounds.

Despite being well-known allergens, mercaptobenzothiazole and its derivatives continue to be widely used in natural and synthetic rubber, in the mining industry, and in a variety of nonrubber products. The purpose of this article is to review the epidemiology and the clinical characteristics of allergic contact dermatitis from mercapto compounds.

Allergens↗
PubMed2006

Allergenicity and cross-reactivity of coconut oil derivatives: A double-blind randomized controlled pilot study.

BACKGROUND: Counseling of patients with cocamidopropyl betaine (CAPB) allergy is difficult because the cross-reactivity of CAPB with other coconut-derived surfactants, coconut oil, and coconut fatty acids is largely unknown. OBJECTIVE: To provide pilot data regarding the cross-reactivity and allergenicity of surfactants derived from coconut oil. METHODS: A randomized double-blind controlled pilot study of 10 control patients and 12 patients previously found to be allergic to CAPB. Eleven coconut-derived surfactants, as well as coconut oil and lauric acid, were applied in random order according to standardized patch-test procedures with readings at 48 and 92 hours. The primary outcome measure was the frequency of positive patch-test reactions to each allergen. RESULTS: Only 3 of the 12 patients with previous reactions to CAPB reacted on retesting, and all of these reactions were doubtful. Fifty-nine percent of the study patients had reactions to triethanolamine polyethylene glycol-3 (TEA-PEG-3) cocamide sulfate as compared to none of the controls (p = .005). CONCLUSIONS: Reactions to CAPB were only 25% reproducible. These results substantiate previous experience that doubtful and mild reactions to CAPB may represent irritant reactions as opposed to true allergic reactions. TEA-PEG-3 cocamide sulfate was the only agent that had a statistically significant higher rate of reactions in the study group as compared to the control group.

Adult↗
PubMed2005

Pulse versus continuous terbinafine for onychomycosis: a randomized, double-blind, controlled trial.

BACKGROUND: Effective treatments for onychomycosis are expensive. Previous studies suggest that less costly, pulsed doses of antifungal medications may be as effective as standard, continuous doses. Terbinafine is the current treatment of choice for toenail onychomycosis. OBJECTIVE: Our purpose was to determine whether pulse-dose terbinafine is as effective as standard continuous-dose terbinafine for treatment of toenail onychomycosis. METHODS: We conducted a double-blind, randomized, noninferiority, clinical intervention trial in the Minneapolis Veterans Affairs Medical Center. The main inclusion criteria for participants were a positive dermatophyte culture and at least 25% distal subungual clinical involvement. Six hundred eighteen volunteers were screened; 306 were randomized. Terbinafine, 250 mg daily for 3 months (continuous) or terbinafine, 500 mg daily for 1 week per month for 3 months (pulse) was administered. The primary outcome measure was mycological cure of the target toenail at 18 months. Secondary outcome measures included clinical cure and complete (clinical plus mycological) cure of the target toenail and complete cure of all 10 toenails. RESULTS: Results of an intent-to-treat analysis did not meet the prespecified criterion for noninferiority but did demonstrate the superiority of continuous-dose terbinafine for: mycological cure of the target toenail (70.9% [105/148] vs 58.7% [84/143]; P =.03, relative risk [RR] of 1.21 [95% confidence interval (CI), 1.02-1.43]); clinical cure of the target toenail (44.6% [66/148] vs 29.3% [42/143]; P =.007, RR =1.52 [95% CI, 1.11-2.07); complete cure of the target toenail (40.5% [60/148] vs 28.0% [40/143]; P =.02, RR=1.45 [95% CI, 1.04-2.01); and complete cure of all 10 toenails (25.2% [36/143] vs 14.7% [21/143]; P =.03, RR =1.71 [95% CI, 1.05-2.79). Tolerability of the regimens did not differ significantly between the groups (chi2 =1.63; P =.65). LIMITATIONS: The study population primarily consisted of older men with severe onychomycosis. CONCLUSIONS: This study demonstrated the superiority of continuous- over pulse-dose terbinafine. We also found this expensive therapy to be much less effective than previously believed, particularly for achieving complete cure of all 10 toenails.

Aged↗
PubMed2005

Prevention of onychomycosis reinfection for patients with complete cure of all 10 toenails: results of a double-blind, placebo-controlled, pilot study of prophylactic miconazole powder 2%.

The objective of this 2-year, double-blind, placebo-controlled, randomized trial involving 48 participants was to determine if biweekly miconazole powder prevents onychomycosis recurrence. Intent-to-treat analysis found no significant differences in mycologic, clinical, or complete onychomycosis reinfection rates or time to reinfection. Limitations include small sample size and dosing regimen.

Aged↗
PubMed2005

Benzyl alcohol allergy: importance of patch testing with personal products.

Benzyl alcohol is a weak sensitizer found in a wide array of plants and plant products, foods, cosmetics, and medications. Delayed contact dermatitis reactions as well as immediate, urticarial, and systemic reactions have been reported to occur with its use in these various formulations. We present the case of a woman with allergic contact dermatitis from benzyl alcohol and provide a brief review of allergy to this chemical.

Benzyl Alcohol↗
PubMed2005

Allergic contact dermatitis from propolis.

Propolis is commonly used in cosmetic and medicinal preparations because of its antiseptic, antiinflammatory, and anesthetic properties. Its therapeutic qualities have been well documented. However, 1.2 to 6.6% of patients who are patch-tested for dermatitis are sensitive to propolis. The main allergens are 3-methyl-2-butenyl caffeate and phenylethyl caffeate. Benzyl salicylate and benzyl cinnamate are less frequent sensitizers. Propolis is found in a number of "natural" products, including lip balms, cosmetics, lotions and ointments, shampoos, conditioners, and toothpastes. Dermatologists should consider patch testing with propolis in users of such remedies.

Anti-Infective Agents↗