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Medscape
44 minutes ago
- Medscape
Psoriasiform Dermatitis Risk in Children on TNFi Reviewed
TOPLINE: Older age at TNF alpha inhibitors initiation, a diagnosis of juvenile idiopathic arthritis (JIA), and concomitant immunomodulator use were associated with delayed onset of paradoxical psoriasiform dermatitis (PD) in children treated with TNFi, in a retrospective chart review. METHODOLOGY: Researchers conducted a retrospective chart review of 3418 patients receiving TNFi therapy for various conditions (including Crohn's disease, JIA, and ulcerative colitis) at Cincinnati Children's Hospital Medical Center, Cincinnati, from January 2018 to January 2023. Overall, 70 patients (2%) developed PD skin eruptions (52.9% women; 91.4% White; 5.7% Black; median age at TNFi initiation, 11.7 years; median age at PD onset, 13.6 years); 21.4% of patients were given concomitant immunomodulators; 94% of patients had PD at multiple sites. The median time from starting a TNFi to the onset of PD was 16.9 months. Treatments for PD included topical steroids (85.7%), systemic medications (15.4%), and nonsteroid topicals including tacrolimus, pimecrolimus, and calcipotriene (24.3%). PD outcomes and factors associated with its severity were evaluated. TAKEAWAY: PD rashes resolved in 32 patients (45.7%); the median time to resolution was 15.5 months. Most (71.4%) of those with PD had Crohn's disease, and infliximab (52.7%) and adalimumab (44.6%) were the most frequently used TNFi. The initial TNFi was discontinued in 40 patients (57.1%) because of PD in 23 (57.5) of those patients. Of these 40 patients, 12 (30%) switched to another TNFi with a 33% recurrence rate, while 25 (62.5%) switched to a different medication class with PD persisting in 36%. Girls were more likely to receive high-potency topical steroids, possibly indicating a difference in prescribing practices or worse disease. Onset of PD occurred later in patients with JIA (coefficient estimate [CE], 22.6 months; P = .02), those on concomitant immunomodulators (CE, 11.0; P = .04), or those who were older when the TNFi was started (CE, 2.4; P < .01). IN PRACTICE: 'Our study found that the diagnosis of JIA, older age at TNFi initiation, and concomitant immunomodulation are potential predictors of later PD onset,' the authors of the study concluded. 'Female sex may influence PD severity,' they added, 'but conflicting results and the retrospective design of this study call for additional research to better understand the factors contributing to PD severity in pediatrics.' SOURCE: This study was led by Muayad M. Shahin, University of Cincinnati College of Medicine, Cincinnati, and was published online on July 31, 2025, in Pediatric Dermatology. LIMITATIONS: The retrospective study design limited the availability of detailed morphologic descriptions. Additionally, multiple definitions of severe PD restricted analysis of risk factors across different outcome measures. DISCLOSURES: This research was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases Core Center and the University of Cincinnati Office of Research medical student summer research award, funded by the Stella and Carey Wamsley Charitable Trust. One author disclosed serving as a consultant for LEO Pharma. The other authors reported having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
44 minutes ago
- Medscape
Rural Parents See More Care Gaps and Delays After Pregnancy
TOPLINE: Parents in the year following birth residing in rural areas experienced more healthcare barriers, including reduced access to obstetric care and increased emergency department visits, than their urban counterparts. While infant care was similar between rural and urban areas, postpartum parents reported delays in medical care compared with their infants in both settings. METHODOLOGY: Researchers conducted a cross-sectional analysis using data from the National Health Interview Survey to examine rural-urban differences in healthcare access in postpartum parents and infants. They included nonpregnant women aged 18-49 years who had infants aged 1 year or younger. A total of 2019 postpartum parents (mean age, 27.1 years) and 2191 infants residing in rural areas, and 12,112 postpartum parents (mean age, 29.2 years) and 13,088 infants residing in urban areas were included in the study. Self-rated health was assessed on a five-point scale ranging from excellent to poor for both postpartum parents and infants. Healthcare utilization was evaluated based on the location where the care was received, the number of office or emergency department visits in the prior year, visits to specific clinicians, and the number of hospitalizations. Barriers to care were categorized into insurance coverage issues (such as gaps in coverage, losing coverage after pregnancy, or changes in care location) and reasons for delayed medical care. TAKEAWAY: Parents residing in rural areas were less likely to see an obstetrician-gynecologist (P = .002), visited the emergency department more frequently (P = .030), and had more hospitalizations (P = .041) than those residing in urban areas. Parents residing in rural areas experienced more disruptions in medical care, gaps in insurance coverage, and loss of Medicaid coverage after pregnancy than their urban counterparts. Delays in medical care were also more prevalent among parents residing in rural vs urban areas (20.3% vs 15.8%; P = .009); this pattern was not observed among infants. Among both rural and urban parent-infant dyads, adults were more likely to experience uninsurance and delayed medical care than their infants. Cost was a more common reason for delayed care among postpartum parents than among infants in the same household, regardless of where they lived. IN PRACTICE: 'Investments in rural health care infrastructure may support rural families,' the authors wrote. 'Integrating and incentivizing care for postpartum parents alongside their infants may address differential use and access to care in this critical period.' SOURCE: The study was led by Sara C. Handley, MD, MSCE, of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. It was published online on August 3, 2025, in The Journal of Rural Health. LIMITATIONS: The analysis did not include specific weighting to represent the US population of parent-infant dyads. The cross-sectional design did not specify the age of the infant, which could have affected the reported number of visits and limited comments on completeness of the care. DISCLOSURES: The study received support through grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the University of Minnesota Foundation Rural Health Research Center Fund, and the Federal Office of Rural Health Policy. The authors reported having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Yahoo
2 hours ago
- Yahoo
Importance of colorectal cancer screenings
NEW HAVEN, Conn. (WTNH) — Younger adults are facing a silent threat: colorectal cancer cases are on the rise, and experts say it's hitting harder and earlier than ever before. Madhavi Bhoomagoud, a Hartford HealthCare Digestive Health Institute gastroenterologist with Midstate Medical Center, spoke with News 8's Keith Kountz about the most common warning signs and symptoms of colorectal cancer that should never be ignored. She also explains what is behind the rise in colorectal cancer cases among younger adults, even those under age 45 who aren't eligible for screening yet. Watch the video above and visit or call 860-901-7008 for more information. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. Solve the daily Crossword
