Category: skin

Life expectancy with melanoma is greatly improved

kaitiscotland1 Comment
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Adapted from BMJ 28 Sept 2024

Melanoma rates show that there has been a decline in incidence in younger people. A study in Sweden indicates that rates continue to rise in those aged 50 to 59, and have been doing so since the 1990s. My comment: I wonder if this is to do with the increase in cheaper air travel since then? However in younger people aged 20 to 49, rates of new melanoma have been declining since 2015. Mortality has also been declining in younger people but not in the older age groups. Public campaigns stressing sun protection measures may be responsible.

Much improved treatment of melanoma, with “checkpoint inhibitor” treatments, are having a marked effect on survival rates of advanced melanoma. These treatments started in 2011. At that point, survival of advanced cases was only eleven months.

A study of 945 people with stage III or IV melanoma, randomised them to nivolumab plus ipilmumab or either drug plus placebo. Those who received both drugs did the best. The median survival with both drugs was 71.9 months. Ten year survival was 43%. With just one of the drugs, survival rates were 37% with nivolumab and 19% with ipilimumab.

NICE: Hydrogen peroxide for impetigo

kaitiscotland2 Comments

 Adapted from :NICE issues antimicrobial prescribing guidance for impetigo

curated by Pavankumar Kamat UK Medical News 28 Feb 2020

National Institute for Health and Care Excellence (NICE) recently published antimicrobial prescribing guidance which describes the antimicrobial strategy for adults, young people and children aged ≥72 hours with impetigo.

According to the new NICE guidance, GPs should prescribe topical hydrogen peroxide 1% instead of topical antibiotics for patients with localised non-bullous impetigo.
The guidance states that hydrogen peroxide 1% cream is as effective as topical antibiotics in patients with localised, non-bullous impetigo, provided they are not systemically unwell or at risk for complications.

If hydrogen peroxide 1% cream is not suitable or if symptoms have worsened or not improved, a short course of a topical antibiotic may be considered.
A topical or oral antibiotic is recommended for patients with widespread non-bullous impetigo, provided they are not systemically unwell or at risk for complications. Oral antibiotic treatment is recommended for patients who have bullous impetigo or if they are systemically unwell or at high risk for complications.
NICE does not recommend a combination of topical and oral antibiotic. There is no evidence that the combination works more effectively than a topical treatment alone.
The primary choice of topical antibiotic is fusidic acid 2%, and the secondary option is mupirocin 2%. The drug of choice for first-line oral antibiotic therapy is flucloxacillin, with clarithromycin and erythromycin (for pregnant women) as secondary choices.

References
Impetigo: antimicrobial prescribing: NICE guideline [NG153]. National Institute for Health and Care Excellence. 2020 February.

My comment: Impetigo is a common skin infection caused by staphloccus which tends to colonise up people’s noses. It spreads rapidly in the nursery and primary school environments. Previously it was treated with oral penicillin. Children are advised to stay off school to reduce spread. Any effective topical, non antibiotic treatment, is welcome as this will help reduce antibiotic resistance.