Letters to the Editor
Management of Infantile Seborrheic Dermatitis
TO THE EDITOR: The article on seborrheic dermatitis in the July 1, 2006, issue of American Family Physician was an excellent review of a common topic.1 However, it is usually unnecessary to prescribe medications for cradle cap, which is a benign self-limited condition that generally resolves within six to eight weeks. Simple measures such as daily shampooing and application of olive or mineral oil will suffice to treat most infants with cradle cap. This first-line therapy limits the need for topical steroid medication and its risks, such as cutaneous atrophy.
In older children and adults, other nonpharmacologic measures that may be beneficial include limiting hair spray, gel, and sunlight exposure. Evidence supporting the effictiveness of a particular medication regimen should not cause physicians to de-emphasize simple lifestyle changes that also can assist in the management of a disease.
Author disclosure: Nothing to disclose.
REFERENCES
1. Schwartz RA, Janusz CA, Janniger CK. Seborrheic dermatitis: an overview. Am Fam Physician 2006;74:125-30.
Relationship Between Certain Medications and Cirrhosis
TO THE EDITOR: The article, "Cirrhosis and Chronic Liver Failure: Part 1. Diagnosis and Evaluation," in the September 1, 2006, issue of American Family Physician contains a listing of various causes of hepatic cirrhosis, including several medications.1 There are indeed older literature reports that describe severe fibrosis and even cirrhosis developing after prolonged exposure to alpha methyldopa (Aldomet), amiodarone (Cordarone), methotrexate, oxyphenisatin (Prulet; not available in the United States), perhexiline, and high-dose vitamin A.2 The authors could have added other medications, including nitrofurantoin (Furadantin), and drugs that have been associated with chronic cholestatic injury and biliary cirrhosis such as chlorpromazine (Thorazine), flucloxacillin, and thiabendazole (Mintezol).3 However, no causal relationship linking cirrhosis to isoniazid (INH)2 or troglitazone (Rezulin; not available in the United States)4 has been established.
In cases of medication use leading to acute liver failure with massive or submassive necrosis, collapse of the hepatic parenchyma has been at times confused with cirrhosis. Recovery from acute hepatocellular injury (as opposed to cholestasis) is thought to be complete without sequelae of chronic hepatitis or cirrhosis. In the case of troglitazone, progression of underlying steatohepatitis from diabetes is a much more plausible explanation for liver injury in patients who are receiving troglitazone and are subsequently diagnosed with cirrhosis or hepatic neoplasia.4,5 Finally, far from being considered "less common causes" of cirrhosis, the remaining drugs on the authors' list in Table 11 are rarely implicated.
Author disclosure: Dr. Lewis is a consultant for GlaxoSmithKline.
REFERENCES
1. Heidelbaugh JJ, Bruderly M. Cirrhosis and chronic liver failure: part I. Diagnosis and evaluation. Am Fam Physician 2006;74:756-62.
2. Lewis JH. Drug-induced liver disease. Med Clin North Am 2000;84:1275-311.
3. Mohi-ud-din R, Lewis JH. Drug- and chemical-induced cholestasis. Clin Liver Dis 2004;8:95-132.
4. Chojkier M. Troglitazone and liver injury: in search of answers. Hepatology 2005;41:237-46.
5. El-Serag HB, Tran T, Everhart JE. Diabetes increases the risk of chronic liver disease and hepatocellular carcinoma. Gastroenterology 2004;126:460-8.
The article "Using Pegylated Interferon and Ribavirin to Treat Patients with Chronic Hepatitis C" (August 15, 2005, page 655) contained several errors in Figure 2 on page 661. First, in the middle column, the text should have read as follows: "Viral load low but still detectable (more than a 100-fold drop): patient has reasonable odds of responding; continue treatment another 12 weeks and retest viral load. When viral load becomes undetectable, continue treatment for another 36 weeks." Second, an arrow should have pointed from this box of text to "At 24 weeks after completion of treatment, recheck for presence of viral RNA." Third, the right-hand column should have read: "Viral load undetectable: patient has an improved chance of sustained viral response; finish complete course of treatment." The online version of this article has been corrected and the corrected figure is reprinted below.
Treating Patients Who Have Chronic Hepatitis C with Pegylated Interferon and Ribavirin
Figure 2. Algorithm for treating patients who have chronic hepatitis C with pegylated interferon and ribavirin. (PCR = polymerase chain reaction)
Information from Fried MW, Shiffman ML, Reddy KR, Smith C, Marinos G, Goncales FL Jr, et al. Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med 2002;347:975-82.
Send letters to Kenny Lin, M.D., Assistant Editor, American Family Physician, e-mail: afplet@aafp.org. Letters submitted via regular mail should be sent to: 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-6272.
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