Avascular necrosis of the hips following longterm use of clobetasol propionate

Predicting adverse drug reactions through interpretable deep learning framework

BACKGROUND

Adverse drug reactions (ADRs) are unintended and harmful reactions caused by normal uses of drugs. Predicting and preventing ADRs in the early stage of the drug development pipeline can help to enhance drug safety and reduce financial costs.

METHODS

In this paper, we developed machine learning models including a deep learning framework which can simultaneously predict ADRs and identify the molecular substructures associated with those ADRs without defining the substructures a-priori.

RESULTS

We evaluated the performance of our model with ten different state-of-the-art fingerprint models and found that neural fingerprints from the deep learning model outperformed all other methods in predicting ADRs. Via feature analysis on drug structures, we identified important molecular substructures that are associated with specific ADRs and assessed their associations via statistical analysis.

CONCLUSIONS

The deep learning model with feature analysis, substructure identification, and statistical assessment provides a promising solution for identifying risky components within molecular structures and can potentially help to improve drug safety evaluation.

Increased risk of avascular necrosis in patients with psoriatic disease: A nationwide population-based matched cohort study

BACKGROUND

Avascular necrosis (AVN) and psoriasis have some pathogenic mechanisms and associated conditions in common.

OBJECTIVE

To examine the association between psoriasis and AVN.

METHODS

This study used data from the Taiwan National Health Insurance Research Database for the period 2004-2006 and identified 28,268 patients with psoriasis, who were then matched for age and sex with 113,072 controls without psoriasis from the Taiwan Longitudinal Health Insurance Database 2000. Multivariate Cox proportional hazards models were used for the analysis.

RESULTS

The unadjusted risk of AVN was significantly higher for patients with psoriasis than for controls (hazard ratio [HR] 2.29) and remained significant after adjustment for other risk factors (adjusted HR 1.96; 95% confidence interval 1.62-2.38). The risk for AVN increased in relation to psoriasis severity and was higher for patients with psoriasis and arthritis than for patients without arthritis. The adjusted HRs were higher for male patients than for female patients and for patients younger than 30 years compared with older patients.

LIMITATIONS

We lacked information on daily tobacco use, alcohol consumption, and physical activity.

CONCLUSION

The risk for AVN increased with the disease severity of psoriasis.

Bone Complications of Corticosteroids

Background:

Systemic corticosteroids, a mainstay of treatment for severe dermatosis, are associated with systemic complications. Adverse effects of corticosteroids to bone represent a significant adverse effect that, is poorly understood and poorly managed.

Objectives:

The purpose of this article is to educate dermatologists to the current understanding of the pathogenesis, diagnosis, and treatment options available for bone complications of corticosteroids.

Results:

Virtually all patients chronically exposed to high-dose corticosteroid therapy lose bone mass and are at risk for osteoporotic fractures. In addition, osteonecrosis is an unpredictable complication of corticosteroid therapy that may occur with even low-dose corticosteroids.

Conclusion:

Optimal risk management of corticosteroid therapy includes understanding the risk factors associated with bone complications and improving communication with patients.

Osteonecrosis of the femoral head and glaucoma caused by topical corticosteroid application

A 37-year-old man was diagnosed with bilateral osteonecrosis of the femoral head (ONFH) and glaucoma. He had no risk factors for either ONFH or glaucoma, except for 24 years' continuous use of topical corticosteroid ointments for treating atopic dermatitis. We determined that the topical steroid had caused both the pathological conditions. It is necessary to recognize that continuous topical corticosteroid therapy may cause the same pathological conditions as those caused by the systemic administration of these agents.

Widespread use of toxic skin lightening compounds: medical and psychosocial aspects

Hyperpigmentation disorders and skin lightening treatments have a significant impact on the dermatologic, physiologic, psychologic, economic, social, and cultural aspects of life. Skin lightening compounds, such as hydroquinone and topical corticosteroids, are often used to treat hyperpigmentation disorders, such as melasma, or lighten skin for cosmetic purposes. Despite their established effectiveness, a multitude of dermatologic and systemic complications have been associated with these agents. Regulatory agencies have also recognized the adverse effects of skin lighteners and many countries around the world now forbid the production and sale of these compounds, although this prohibition has not significantly curtailed distribution. Dermatologists and users of cosmetic products should be aware of the various components in bleaching compounds, their potential adverse effects, and alternative options for skin lightening.

Steroid induced osteonecrosis: An analysis of steroid dosing risk

Osteonecrosis is a serious condition involving bone destruction that frequently requires surgical treatment to rebuild the joint. While there is an abundance of literature documenting corticosteroid related osteonecrosis, there is no consensus as to the relative risk of osteonecrosis after administration of steroids via parenteral, oral, topical, inhaled and other routes. This risk is an important prognostic indicator because identification and conservative intervention can potentially reduce morbidity associated with aggressive surgical treatment of osteonecrosis. This paper provides insight into establishing guidelines related to the risk of developing osteonecrosis as a result of corticosteroid use. Case studies, retrospective studies and prospective studies in humans on different corticosteroids and varied dosages were assessed. Most cases of osteonecrosis are secondary to systemically administered corticosteroids and/or high dose daily therapy, particularly in patients with underlying comorbidities including connective tissue diseases, hyperlipidemia, or previous trauma. Previous case reports of osteonecrosis related to inhaled or topical use of steroids are complicated by the fact that in the great majority of cases, the patients are also treated with systemic steroids prior to the development of osteonecrosis. Based on the literature, a set of recommendations regarding the risk of osteonecrosis in patients on steroids was formulated.

Osteonecrosis of the femoral head that developed after long-term topical steroid application

This is a report of a 52-year-old man who developed osteonecrosis of the femoral head (ONF) following long-term application of steroid for facial eczema. Before hip pain appeared, the patient had applied 2-3g/day of 0.05% clobetasol propionate for 2 years and 10 months. This steroid is classified as being in the strongest category. ONF was diagnosed based on radiographic and magnetic resonance imaging findings, and the patient received surgical treatment for both hips. ONF was also confirmed by pathological examination of a specimen obtained from the right femoral head during surgery. Because there were no risk factors for ONF besides topical steroid application, this case was considered as ONF associated with topical steroid. Even when steroids are for external use, their dosage and administration should be monitored, and the risk of ONF should also be considered.

Managing adults with atopic dermatitis

The majority of the patients with atopic dermatitis (AD) that dermatologists see present to us in childhood. For most patients there is a relatively limited period during which AD is a major influence on their lives. For some patients, however, AD behaves differently and also may cause significant trouble during adolescence and adult life. In this article, adult hood means from approximately puberty onward, but in addition to the issues relating to what amounts to a lifelong chronic disability, there are some points that need to be made about adolescents in particular.