(BMJ)—A man in his 30s presented with a 3-month hx of an unusual odor from the armpits. On exam, axillary hair shafts were encircled by what appeared to be soft yellow-white material. Hair roots and adjacent skin weren't affected. Dermoscopy with polarized light showed yellowish-white creamy concretions adherent to several hair shafts. Under UV light, concretions exhibited green, purple, and red fluorescence. What's the dx?
poliosis
trichomycosis axillaris
white piedra
seborrheic dermatitis
You are correct. Findings represent an atypical example of trichomycosis axillaris, a superficial bacterial infection of axillary hair caused by corynebacterium, which usually fluoresces with pale yellow light under UV dermoscopy. The dx is usually made clinically, but bacterial culture can be used to confirm the causative bacteria. The condition mainly affects young adults, and risk factors include hyperhidrosis and living in areas with high humidity. Management includes shaving affected hair or using topical antibiotics.

BMJ 2023;382:e075704
Can you identify this pill?
droxidopa
hydroxyurea
fluvastatin
amoxicillin
You are correct. Droxidopa is used to treat symptomatic neurogenic orthostatic hypotension in adults.

As a reminder, you can use the Pill ID feature to identify a pill based on its imprint code or physical characteristics, including shape, color, and scoring. Find Pill ID in the epocrates app or on epocrates Web.
[Source: Pill ID]
(PubMed)—A 73-yo woman with hypertension, atrial fibrillation, hyperlipidemia, diabetes mellitus, and metastatic HR-positive, HER-2 negative breast cancer presented with general weakness and muscle pain in the lower extremities as well as brown-colored urine. Admission labs: Cr 2.06 mg/dL, GFR 14 mL/min, CPK 3070 U/L; U/A: moderate myoglobinuria.

The patient was diagnosed with acute kidney injury secondary to rhabdomyolysis.

Meds: apixaban, bisoprolol, insulin glargine, ribociclib, simvastatin, valsartan-hydrochlorothiazide.

What drug combo could have caused the rhabdomyolysis?
apixaban and valsartan
hydrochlorothiazide and simvastatin
ribociclib and simvastatin
You are correct. Ribociclib may increase simvastatin levels and the risk of rhabdomyolysis by strongly inhibiting CYP3A4. This combination is contraindicated.

More info is available, including the free full-text article PDF at PubMed Central.
Which of these strategies has NOT been proven to help with thinning/lackluster hair, brittle nails, or keeping skin smooth and healthy?
Taking collagen drinks and supplements to support skin, hair, and nail tissues
Quitting smoking
Limiting alcohol to two drinks or less a day for men and one drink or less in a day for women
Applying sunscreen daily and remembering to reapply every two hours
Following a healthy lifestyle, including eating a balanced diet that includes protein-rich foods
Wearing wide-brimmed or UV-protective hats and clothing when spending a lot of time in the sun
You are correct. At this time, there isn't enough medical evidence that taking collagen pills or consuming collagen drinks will make a difference in skin, hair, or nails.

A review and analysis of 19 studies, published in the International Journal of Dermatology, which had a total of 1,125 participants, found that those who used collagen supplements saw an improvement in the firmness, suppleness, and moisture content of the skin, with wrinkles appearing less noticeable. But it's unclear if these skin improvements were actually due to collagen since most of the trials used commercially available supplements that contained more than collagen: vitamins, minerals, antioxidants, coenzyme Q10, hyaluronic acid, and chondroitin sulfate were among the additional ingredients.

A few randomized, controlled trials have shown that drinking collagen supplements with high amounts of the peptides prolylhydroxyproline and hydroxyprolylglycine can improve skin moisture, elasticity, wrinkles, and roughness. But large, high-quality studies are needed to learn whether commercially available products are helpful and safe to use long-term.

Our bodies naturally produce collagen using the amino acids from protein-rich or collagen-rich foods like bone broth, meat, and fish. But aging, sun damage, smoking, and alcohol consumption all decrease collagen production so strategies to address such damage may be more effective than taking collagen supplements.

Source:
Patel, Payal and Makredes Senna, Maryanne. (2023, April 12). Harvard Health Publishing. Considering collagen drinks and supplements?
Which of these strategies has NOT been proven to help with thinning/lackluster hair, brittle nails, or keeping skin smooth and healthy?
Taking collagen drinks and supplements to support this major structural protein in our tissues.
For smokers: Quitting smoking.
Applying sunscreen daily and remembering to reapply every 2 hours.
Limiting alcohol to 2 drinks or less in a day for men or 1 drink or less in a day for women.
Wearing wide-brimmed or UV-protective hats and clothing when spending a lot of time in the sun.
Following a healthy lifestyle and eating a balanced diet that includes protein rich foods.
You are correct. At this time, there isn't enough medical evidence that taking collagen pills or consuming collagen drinks will make a difference in skin, hair, or nails.

A review and analysis of 19 studies, published in the International Journal of Dermatology, which had a total of 1,125 participants, found that those who used collagen supplements saw an improvement in the firmness, suppleness, and moisture content of the skin, with wrinkles appearing less noticeable. But it's unclear if these skin improvements were actually due to collagen since most of the trials used commercially available supplements that contained more than collagen: vitamins, minerals, antioxidants, coenzyme Q10, hyaluronic acid, and chondroitin sulfate were among the additional ingredients.

A few randomized, controlled trials have shown that drinking collagen supplements with high amounts of the peptides prolylhydroxyproline and hydroxyprolylglycine can improve skin moisture, elasticity, wrinkles, and roughness. But large, high-quality studies are needed to learn whether commercially available products are helpful and safe to use long-term.

Our bodies naturally produce collagen using the amino acids from protein-rich or collagen-rich foods like bone broth, meat, and fish. But aging, sun damage, smoking, and alcohol consumption all decrease collagen production so strategies to address such damage may be more effective than taking collagen supplements.

Source:
Patel, Payal and Makredes Senna, Maryanne. (2023, April 12). Harvard Health Publishing. Considering collagen drinks and supplements? https://www.health.harvard.edu/blog/considering-collagen-drinks-and-supplements-202304122911