IMPORTANCEStevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is known to cause multiple end-organ complications in its acute phase, but less is known about the long-term association with patients' mental health and quality of life.OBJECTIVE To examine the chronic physical and psychological sequelae affecting patients with SJS/TEN.

In light of recent warnings by the United States (US) Surgeon General and Centers for Disease Control (CDC) guidelines for recommending more prudent use of opioid narcotics, the search for a non-opioid alternative for aborting acute migraines is particularly relevant. The CDC also estimates the prevalence of opioid dependence may be as high as 26% among patients prescribed opioids for chronic pain, not due to cancer, in the primary care setting. Given such staggering data, it is imperative that we, as caretakers, not foster opioid dependence but rather continue to investigate non-opioid therapies for the management of acute migraines in the emergent care settings. Our literature review demonstrates that metoclopramide should be used more frequently as first-line therapy for an acute migraine over opioids. The use of opioids specifically has been discouraged as migraine treatment by the American Headache Society citing “insufficient evidence” as the main reason. Metoclopramide, specifically using the 10 mg dose, has been cited as “highly likely to be effective” by the same guidelines. Another major issue with opioids is the growing potential for abuse, thus minimizing the use of these drugs for only special circumstances would be beneficial overall.

Topical calcineurin inhibitors (TCI) are commonly used for atopic dermatitis and other inflammatory dermatoses. The U.S. Food and Drug Administration issued a black box warning in 2006 indicating a potential risk of malignancy with TCI use based primarily on case reports, animal studies, and systemic tacrolimus use in organ transplant recipients. Since then, large epidemiologic studies have examined the association between TCIs and cancer; we conducted this systematic review and meta-analysis of observational studies to synthesize the evidence. We searched Medline, Embase, and Web of Science from inception to August 2020. We included observational studies investigating the association between treatment with TCIs (tacrolimus, pimecrolimus) and development of cancer, with non-active or active comparators. A total of 8 cohort studies (408,366 treated participants, 1,764,313 non-active comparator controls, 1,067,280 controls using topical corticosteroids) and 3 case-control studies (3,898 cases and 14,026 cancer-free controls) were included. There was no association between TCI use and cancer overall compared to non-active comparators (relative risk (RR) 1.03, 95% confidence interval 0.92 to 1.16). Lymphoma risk was elevated with TCI use in studies with non-active (RR 1.86, 1.39 to 2.49) more than topical corticosteroid comparators (RR 1.35, 1.13 to 1.61), suggesting the relationship may be partly confounded by indication. No significant association was found between TCI use and skin cancer. In summary, we found TCI use to be associated with a modestly elevated risk of lymphoma but not with other cancers. Given the low absolute risk of lymphoma, patients and clinicians should be reassured by these findings.

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