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March
2001
New
Medication Approved to Treat Eczema
Atopic dermatitis is a chronic, hereditary skin condition that
causes redness, itching, and oozing lesions. It mainly affects children
but can persist into adulthood. Doctors often prescribe oral or topical
corticosteroids for serious cases. But while steroids are very effective
at quieting inflammation, they can have adverse side effects. Steroid
creams may cause thinning of the skin and decreased collagen production,
while oral corticosteroids can have more serious adverse effects.
Now, dermatologists have high hopes for a new ointment, tacrolimus
(Protopic), which was recently approved by the FDA to treat moderate
to severe eczema in patients who cannot tolerate or are not adequately
helped by standard therapies. The FDA approved tacrolimus on the basis
of three 12-week studies that found 90% improvement in about one-third
of the patients who used the medication. Two additional one-year studies,
also considered by the FDA, found that adults who used the drug intermittently
over the course of the year had no adverse effects except temporary
burning and stinging. Because tacrolimus can increase sensitivity to
ultraviolet (UV) light, users should avoid sunlight, tanning beds,
and treatment with UVA or UVB light.
March 2001 Update
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Does
Aspirin Prevent Preeclampsia?
Preeclampsia, also known as toxemia, is a condition that
affects pregnant women and their unborn baby. It is characterized by
high blood pressure, water retention, and protein in the urine. The
condition, which usually occurs after the 5th month of pregnancy, can
lead to seizures, kidney and liver damage, slow fetal growth, and even
fetal or maternal death. Preeclampsia affects up to 8% of pregnancies,
and is responsible for 10-15% of maternal deaths. In the past decade,
several studies have looked at the effectiveness of aspirin in preventing
preeclampsia.
Early studies showed promising results. But larger, more recent studies
failed to show any benefit.
In an effort to reconcile these conflicting results, British researchers
reviewed several studies involving over 30,000 women who were at increased
risk for preeclampsia. (Risk factors include preexisting high blood pressure,
diabetes, a first pregnancy, pregnancy as a teenager or over the age
of 40, and pregnancy involving multiple fetuses.) The women had been
randomized to receive an antiplatelet drug (usually low-dose aspirin),
a placebo, or no antiplatelet medication.
The researchers concluded that aspirin reduced the risk of preeclampsia
by 15%. Their review also showed that aspirin decreased the risk of premature
births by 8% and the risk of stillbirths or newborn deaths by 14%. Based
on these results — acknowledged
by the researchers as showing only small to moderate benefits — the
researchers recommended the use of aspirin. Several issues including
the optimal dosage, the proper time to start treatment, and which women
are most likely to benefit, remain unresolved.
Despite the results of this review, some leading experts are unconvinced
that aspirin is effective at preventing preeclampsia. However, even
physicians who doubt aspirin's efficacy agree that at doses of less
than 80 milligrams per day, aspirin is not harmful. If your physician
prescribes aspirin to prevent preeclampsia, it may or may not be effective — but
in any case, it won't be harmful.
March 2001 Update
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Comparing
the Side Effects of Prostatectomy vs. Radiation Therapy
Prostate cancer is the most commonly diagnosed non-skin cancer among
men in the United States. When caught early, it is also among the most
treatable. Two of the more aggressive — and
common — methods
of treatment for early stage prostate cancer are radiation therapy and
surgery (radical prostatectomy) to remove the prostate gland. Although
both options have favorable outcomes, physicians have not reached a consensus
on which therapy is more effective. This means that men who are treated
with either surgery or radiation can usually expect to live for many
more years. The caveat is that they often have to live with the side
effects of their treatment. Deciding on a treatment option, then, becomes
a question of which side effects are more likely with each therapy, and
also which side effects are more tolerable to a particular patient.
A recent analysis of data from the Prostate Cancer Outcomes Study helps
to clarify this issue by comparing the side effects of the two therapies
in men between the ages of 55 and 74, two years after treatment. The
results showed that men in both treatment groups experienced significant
decreases in sexual function. Of the men in the surgery group, 80%
became impotent, compared to 62% of the men in the radiation group.
Age and status of sexual function prior to treatment affected these
outcomes. Twelve percent of the men who underwent surgery experienced
dripping or leaking urine, compared to only 2% of the men who had radiation
therapy. Few men in either group were bothered by bowel problems. Of
the men who were affected, however, radiation patients experienced
more diarrhea, bowel urgency, and painful hemorrhoids (33%, 30%, and
19%, respectively) compared to surgery patients (22%, 16%, and 10%).
Overall, this study showed that men who opt for surgery can expect
to have more urinary and sexual problems, while men who choose radiation
are more likely to suffer from bowel disturbances. A man's age and
initial health are also important factors in the development and duration
of long-term side effects from either treatment. Physicians and their
patients should use this information, as well as a discussion of the
patient's priorities, preferences, and concerns, to help decide which
treatment method is appropriate.
March 2001 Update
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Pneumonia:
How Long Before You Feel Better?
Pneumonia is a serious infection or inflammation of the lungs. Uncomplicated
pneumonia may be successfully treated with antibiotics in one or two
weeks, but many patients continue to experience the symptoms of pneumonia,
including cough, chest pain, fatigue, shortness of breath, and fever,
for some time after that. A team of Canadian researchers set out to
determine how long after treatment it should take for pneumonia patients
to be symptom-free.
The scientists asked a group of 535 adults who had undergone a course
of antibiotic treatment for pneumonia to complete questionnaires about
persisting symptoms at two and six weeks after the completion of their
treatment.
The average age of these patients was 62 years. Fifty-four percent
of the patients were admitted to the hospital for treatment of their
pneumonia, while a minority had a coexisting chronic illness such as
chronic obstructive pulmonary disease (26%), asthma (17%), or congestive
heart failure (12%).
At two weeks after therapy, 67% of patients reported fatigue, 56% were
coughing, 50% were short of breath, and 35% were producing sputum.
Six weeks after therapy, more than 60% of patients reported continuing
symptoms. Forty-five percent still had fatigue, 35% continued to cough,
and 16% had gastrointestinal symptoms. Older patients, those who were
sickest at onset of treatment, patients with chronic obstructive pulmonary
disease, and patients with asthma suffered the most persistent symptoms.
Although hospitalizations are shorter and antibiotic treatments briefer,
complete recovery still takes time. Pneumonia patients should be reassured
that a "normal" period of recuperation may vary from several
weeks to several months.
March 2001 Update
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