Efficacy of Water Aerobics for Overweight and Obese Hypertensive Women

SOURCE: Cunha R, Arsa G, Neves EB, et al. Water aerobics is followed by short-time and immediate systolic blood pressure reduction in overweight and obese hypertensive women. J Am Soc Hypertens 2016;10:570-577.

Clinicians sometimes are concerned about the effect of exercise on blood pressure in hypertensive patients, primarily because of a well-recognized post-exercise hypotension phenomenon that can occur. Typically, hypertensive patients experience greater degrees of hypotension than normotensive patients. There is a paucity of evidence about whether hypotension occurs with similar frequency, intensity, and duration after water aerobics as it does during exercise on land. An additional attractive feature of water aerobics is that overweight and obese subjects sustain less joint stress. Injuries associated with water aerobics are much less common than during land exercise.

In a small crossover study of overweight and obese hypertensive women (n = 18), participants were randomized to either water aerobics (performed at 70-75% of predicted maximum heart rate for 45 minutes) or control (sedentary pool-side participation). Blood pressure was measured at 10-minute intervals three times after the 45-minute interval of exercise (or sedentary activity). Participants then crossed over so that the previously sedentary group performed aerobic exercise, and vice versa.

In study subjects, post-exercise changes did not occur in diastolic blood pressure. Systolic blood pressure changes were small (1-3 mmHg decline) and not of clinical relevance. Clinicians who provide exercise advice to overweight and obese hypertensive patients should find some reassurance about the safety of aerobic exercise in this population.

Topicals for Atopic Dermatitis: Calcineurin Inhibitors vs. Corticosteroids

SOURCE: Broeders J, Ahmed Ali U, Fischer G. Systematic review and meta-analysis of randomized clinical trials (RCTs) comparing topical calcineurin inhibitors with topical corticosteroids for atopic dermatitis: A 15-year experience. J Am Acad Dermatol 2016;75:410-419.

Atopic dermatitis is a chronic disorder, usually beginning in childhood, that causes significant burden to patients because of unsightly dermatitis, pruritus, and lichenification. Unfortunately, there is no cure for atopic dermatitis; rather, numerous interventions are available to provide reduction in symptoms, or at least temporary periods of remission.

The mainstay of pharmacotherapy for atopic dermatitis has been topical corticosteroids for more than three decades. Although highly successful, concern about local cutaneous toxicity of topical corticosteroids, as well as the potential for systemic effects on the hypothalamic-pituitary-adrenal axis when a high-potency topical corticosteroid is used, has prompted exploration of alternative treatments. Within the past decade, topical calcineurin inhibitors (i.e., pimecrolimus, tacrolimus) have demonstrated efficacy for atopic dermatitis. Because of largely hypothetical concerns about immune dysregulation that might occur with topical calcineurin inhibitors (TCI), current guidelines reserve TCI for second-tier treatment, such as steroid-refractory atopic dermatitis or patients intolerant of topical corticosteroids. Broeders et al compared the efficacy of topical corticosteroids with TCI through a meta-analysis of 12 trials that compared topical corticosteroids to TCI (n = 6,954) in adults and children presenting with atopic dermatitis. Overall efficacy of TCI was slightly greater, but it caused higher rates of non-serious adverse events. The authors concluded that topical corticosteroids should remain the first-line treatment for atopic dermatitis.

What’s the Best Way to Remove a Tick?

SOURCE: Akin Belli A, Dervis E, Kar S, et al. Revisiting detachment techniques in human-biting ticks. J Am Acad Dermatol 2016;75:393-397.

Ticks transmit pathogens to victims around the globe. This particular data set was provided by a group of Turkish physicians, for whom the necessity to determine optimum tick removal technique was highlighted by a 2003 epidemic of tick-borne Crimean-Congo hemorrhagic fever that led to 300,000 tick-bite related admissions in one year.

Investigators studied four techniques — tweezers, freezing, lassoing, and card-detachment (a card with a narrow slit/channel into which a tick might be caught and removed) — among 160 patients presenting to the Dermatology Clinic at Haseki Training and Research Hospital (Istanbul). Except for the tweezer technique, all other methods were performed with commercial products specifically designed by the manufacturer to remove ticks.

There was great diversity in efficacy of tick removal, ranging from 0% (freezing), 7.5% (card-detachment technique), 47.5% (lassoing technique), and 82.5% (tweezers). The successful tweezer technique was simple: Grab the mouth parts, do not rotate, and pull off directly.