AFP Clinical Answers
Hirsutism, Amphetamines, COVID-19 Viral Shedding, Hand-Foot-and-Mouth Disease
Am Fam Physician. 2020 May 15;101(10):589.
What systemic treatments are effective for hirsutism in women?
Combined oral contraceptives are first-line therapy for women with hirsutism who are not trying to conceive and in whom cosmetic measures are ineffective. If patient-important hirsutism persists after six months of therapy with combined oral contraceptives, the addition of an antiandrogen should be considered. Gonadotropin-releasing hormone agonists should be avoided for the treatment of hirsutism except in patients with severe hyperandrogenism, in whom combined oral contraceptives and antiandrogens are ineffective. Insulin-lowering drugs are not recommended to treat hirsutism.
Are amphetamines safe and effective in adults with attention-deficit/hyperactivity disorder?
Amphetamines provide a clinician-rated 30% or greater reduction in attention-deficit/hyperactivity disorder symptoms when compared with placebo (number needed to treat = 5), according to one Cochrane review. Adverse effects leading to withdrawal included anxiety, depressed mood, nausea/vomiting, headache, fatigue, insomnia, increased blood pressure, flushing, and affective dullness. Most reported adverse effects are considered mild to moderate.
What is the existing research on viral shedding and antibody response in SARS-CoV-2?
On April 8, 2020, the National Academies Press published a rapid report on the duration of viral shedding and antibody response in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). They report that viral shedding occurs two to three days before the onset of symptoms, and the amount of shedding is greatest earlier in the illness. They found no correlation between coronavirus disease 2019 (COVID-19) severity and amount of shedding; however, patients with more severe disease shed for longer durations. The virus can be detected for up to one week after the resolution of symptoms, although they mention a single case of persistent shedding for 49 days. The report describes issues related to the accuracy of various tests and which viral antigen is used for antibody response. Their best “guesses” are that IgM can be detected a median of five days after onset of symptoms and IgG can be detected 10 to 18 days (median = 14) after symptom onset.
How should hand-foot-and-mouth disease be diagnosed and treated?
The diagnosis of hand-foot-and-mouth disease should be based on presentation of a maculopapular or papulovesicular rash on the hands and soles of the feet and painful oral ulcerations. Supportive care should be used to treat hand-foot-and-mouth disease. Weight-based acetaminophen or ibuprofen may be used to treat fever and pain, but oral lidocaine is not recommended. Handwashing decreases the risk of transmission.
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