geoffrey modest medical blogs

  Long-term potent topical corticosteroid use may be associated with increased risk of osteoporosis and fractures (see  osteoporosis topical steroids jamaderm2021  in dropbox, or  doi:10.1001/jamadermatol.2020.4968 )   Details: -- 723,251 Danish adults who were treated with potent or very potent topical corticosteroids (TCSs), from 2003-2018 -- mean age 53, 53% women, 20% from each of 5 defined SES groups, few comorbidities (cancer and diabetes 3% each, no comment on others) -- meds used: psych meds 11%, thiazides 9%, statins 8%, PPIs 7%, contraceptives 7% -- inhaled steroids 3%, systemic steroids 8% -- topical steroid doses were translated into equipotent doses of mometasone 1 mg/g -- all patients had used at least 200 g of mometasone cumulatively, based on filled prescriptions -- Main outcomes: diagnosis of osteoporosis (as inpatient or outpatient diagnosis) or major osteoporotic fracture (fracture the hip, distal forearm, vertebrae, or humerus)   Results...

Atopic dermatitis (AD) is pretty common in kids (up to 25%), typically occurring early on (45% of cases begin within first 6 months of life, 60% within first year), and 70% remit spontaneously by adolescence. In those with AD there are significant immunologic changes (increase in Th2 cells and decrease in Th1 cells in their skin, though there are differences in these T-cell subsets in the acute AD phase, with Th2 cells and their associated cytokines of IL-4, IL-5, IL-13 predominating, but in the chronic phase the Th1 cells and their associated  IFN- g , IL-5,IL-12 predominate. Vitamin D receptors are all over the body, including in the skin and in the immune system, and a small RCT in AD patients randomized to vitamin D 1,600 IU/d found clinical improvement after 60 days. The current study looked further into the immunologic changes and clinical effects of vitamin D supplementation in AD patients (see  vit d and atopic dermatitis kids int arch allergy 2015...