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NIHR Signal Dermoscopy plus visual inspection aids melanoma diagnosis
Dermoscopy, using a relatively cheap handheld magnifying device alongside naked eye observation, is more accurate in the diagnosis of melanoma than visual inspection alone. It can also provide a photographic record which can be used for reference during follow-up. This NIHR-funded review included 104 studies of skin lesions in the dermatology clinic that looked suspicious or were present in those at high risk of developing melanoma. Melanoma is a rare form of skin cancer. Inspection of the lesi...
NIHR Signal Several antibiotics appear effective against early-stage Lyme disease
Most cases of Lyme disease, which is an infection carried by ticks, can be easily managed if treated early using antibiotics, with choice of antibiotic agent having little bearing on success. This network meta-analysis suggests that when symptoms of the disease are confined to a localised skin infection, treatment failures are relatively infrequent, only 2% at 12 months. Effective antibiotics include penicillin V, doxycycline, azithromycin, cefuroxime, amoxicillin and ceftriaxone plus doxycycli...
NIHR Signal Adding emollients to the bath unlikely to help children with eczema
Adding emollients to children’s bath water does not significantly improve their eczema. Prescriptions should focus on emollients applied directly to the skin or used as a soap substitute. Using emollients to lock in moisture is the standard treatment for childhood eczema. These can be applied in a number of ways, but there is uncertainty surrounding their use as a bath additive. This NIHR-funded year-long trial included 482 children, mostly with mild eczema. It found there was little cha...
NIHR Signal Biological therapies for psoriasis do not increase serious infection risk
People with psoriasis who take an immune-modulating treatment are no more likely to get serious infections than people taking standard therapies. There are fears that these biological therapies raise the risk of serious infections and this has discouraged their use. They are recommended by NICE for moderate to severe psoriasis. Previous studies have reached conflicting conclusions, making it hard to advise on the true risk. This study used a large database of people with psoriasis from the UK ...
NIHR Signal Terbinafine is probably first choice oral drug for fungal toenail infection
The oral antifungal drug terbinafine appears to be slightly better than alternative ‘azole’ drugs for treating fungal toenail infection. Fifty-eight percent of people had a normal nail appearance after a treatment course compared with 47% taking ‘azoles’. Both drug classes were more effective than placebo and had similar side effects. Current guidelines recommend terbinafine or itraconazole as first-choice treatments, but consider terbinafine more effective. However, sys...
NIHR Signal Long-term antibiotics likely to reduce risk of recurrent cellulitis
Antibiotics may reduce the risk of leg cellulitis by about two thirds, in adults who have had at least two previous episodes, but only while they take the antibiotics. There is limited evidence measuring the efficacy of other forms of prevention. A review of five studies showed that the risk of developing repeated cellulitis was reduced in participants who were taking long-term (more than six months) penicillin or erythromycin, compared with a control group. Once the antibiotic course had finis...
NIHR Signal Heel casts do not improve heel ulcers in diabetes
Fibreglass casts moulded to the heel did not improve heel ulcers in people with diabetes when added to usual ulcer care. Ulcers healed within six months in 44% of people using casts compared with 37% without which was not a statistically significant difference. Foot ulcers are a common complication of diabetes, and heel ulcers are particularly difficult to treat. Based on the success of casts for treating ulcers elsewhere on the foot this trial was designed to test the effect and cost-effective...
NIHR Signal Molluscum contagiosum is best left to clear by itself
Molluscum contagiosum, the viral skin infection, is best left alone to heal by itself rather than being treated with medication, destructive treatments or creams. When comparing imiquimod (a skin cream that activates the immune system) with nothing, about 40% of people were clinically clear by 6 months in either group. Treatment increased the chance of severe adverse events such as irritation and scarring fourfold. The majority of other treatment comparisons were from studies judged by the auth...
NIHR Signal Silk clothing for children does not reduce objective measures of eczema severity
Six months of wearing special silk clothing had no effect on objective measures of child eczema severity, infection rates or medication use. Children and carers reported some small improvements in eczema severity on two scales but their awareness of the clothing worn by their child may have slightly influenced their judgment. Overall quality of life did not significantly improve. Specialist silk clothing is currently available on NHS prescription, but prior to this trial there was limited evide...
NIHR Signal Doxycycline may be a safer first option for treating a blistering skin condition
Doxycycline (an established antibiotic) may be a safer first option than the standard steroid treatment for people with the autoimmune skin condition bullous pemphigoid. The condition causes severe, itchy blistering. This NIHR-funded study showed that people started on doxycycline were 19% less likely to have severe, life-threatening or fatal events during the next 12 months than those who started a steroid (prednisolone). Blister control was considered acceptable for both treatments (74% treat...
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