DermatologistsBlog.com | Dermatology - Skin Care Reserch Interview by Dermatologists

DermatologistsBlog.com

Dermatology Research
Author Interviews
Updated January 5 2013

For Informational Purposes Only - Not for
1/5/13 Specific Medical Advice | Read more on

Medical Disclaimer | Terms and Conditions

• The contents of the Hemodialysis.com Site, such as text, graphics, images, and
other material contained on the Hemodialysis.com Site ("Content") are for
informational purposes only. The Content is not intended to be a substitute for
professional medical advice, diagnosis, or treatment. Always seek the advice of
your physician or other qualified health provider with any questions you may have
regarding a medical condition. Never disregard professional medical advice or
delay in seeking it because of something you have read on the Hemodialysis.com
Site!
• If you think you may have a medical emergency, call your doctor or 911
immediately. Hemodialysis.com does not recommend or endorse any specific
tests, physicians, products, procedures, opinions, or other information that may be
mentioned on the Site. Reliance on any information provided by Hemodialysis.com
or other Eminent Domains Inc (EDI) websites, EDI employees, others appearing on
the Site at the invitation of Hemodialysis.com or EDI, or other visitors to the Site is
solely at your own risk.
• The Site may contain health- or medical-related materials that are sexually explicit.
If you find these materials offensive, you may not want to use our Site. The Site
and the Content are provided on an "as is" basis.


Fingerprint Changes and Verification Failure Among Patients With Hand Dermatitis.
DermatologistsBlog.com Author Interview: Chew Kek Lee, MRCP(UK)

• DermatologistsBlog.com: What are the main findings of the study?
• Fingerprint verification failure is a significant problem affecting patients with hand dermatitis.
• A significantly higher proportion of patients had a history of fingerprint verification failure (odds ratio [OR], 8.81; 95%
CI, 3.51-22.13) compared with controls.The main fingerprint changes were fingerprint dystrophy (42.0%) and abnormal
white lines (79.5%). The number of abnormal white lines was significantly higher among the patients with hand dermatitis
compared with controls (P = .001). Among the patients with hand dermatitis, the odds of failing fingerprint verification with
fingerprint dystrophy was 4.01.

• DermatologistsBlog.com: Were any of the findings unexpected?
• The prevalence of fingerprint verification failure among patients with hand dermatitis was unexpectedly high. Besides
this, more controls compared to patients had abnormal white lines on their fingerprints. Although patients with atopic
dermatitis had been reported to have palmar hyperlinearity, patients with atopic dermatitis with hand dermatitis did not
have more abnormal white lines that may correspond to a higher degree of hyperlinearity on the thumbs.

• DermatologistsBlog.com: What should clinicians and patients take away from this study?
• Fingerprint verification failure is a significant and emerging problem among patients with hand dermatitis.
Therefore, problems with fingerprint verification should be actively sought for and anticipated in patients with hand
dermatitis.

• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?
• Researchers should investigate on treatments to reverse the verification problems in patients with hand dermatitis. Good
clinical tools should be developed to assist clinicians to identify patients at risk of verification failure.

• Citation:
• Fingerprint Changes and Verification Failure Among Patients With Hand Dermatitis.
• Lee CK, Chang CC, Johar A, Puwira O, Roshidah B.
• Arch Dermatol. 2012 Dec 17:1-6. doi: 10.1001/jamadermatol.2013.1425. [Epub ahead of print]

Watching reality television beauty shows is associated with tanning lamp use and
outdoor tanning among college students
DermatologistsBlog.com Author Interview: Joshua Fogel, PhD

• DermatologistsBlog.com What are the main findings of the study?
• Dr. Fogel: Young adult participants who watched reality television beauty shows were more likely to use tanning
lamps and to tan outdoors than those who did not watch reality television beauty shows.
• DermatologistsBlog.com Were any of the findings unexpected?
• Dr. Fogel: This was the direction of our study hypotheses. However, we did not know for sure if this pattern
would be true until after we analyzed the data. Surprisingly, in our analyses adjusting for a number of media
variables measuring identification with media characters, these media variables were not associated with tanning
lamp use or outdoor tanning.
• Dr. Fogel : As reality television show watching is very popular, clinicians should ask their young adult patients
about their tanning lamp use and outdoor tanning behavior.
• For those patients who use tanning lamps, they should be informed that it is a known risk factor for
cancer. Clinicians should also discuss the importance of minimizing outdoor tanning even with the use of
appropriate sun tan (sunscreen) products. Patients should realize that the television actors and personalities who
appear tanned and advocate tanning as a way of improving beauty is not a healthy lifestyle approach for one to
follow. It places one at risk for cancer.
• DermatologistsBlog.com What recommendations do you have for future research as a result of your study?
• Dr. Fogel: To study if particular reality television beauty shows are more or less associated with television viewers
engaging in tanning lamp use and outdoor tanning behavior.
• Citation:
• Watching reality television beauty shows is associated with tanning lamp use and outdoor tanning among college
students
• Joshua Fogel, Faye Krausz
Journal of the American Academy of Dermatology – 26 December 2012 (10.1016/j.jaad.2012.09.055)


A double-blind, randomized, placebo-controlled trial of adalimumab in the treatment of cutaneous sarcoidosis
DermatologistsBlog.com Authors’ Interview:
Joan Paul, MD, MPH | Robert J. Pariser, MD
Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia
Virginia Clinical Research Inc, Norfolk, Virginia

• DermatologistsBlog.com: What are the main findings of the study:
• The study provided fairly strong evidence that adalimumab at a dose of 40 mg per week for 12 weeks after
an 80 mg loading dose is more efficacious than placebo in improving the lesions of cutaneous sarcoidosis, as well
as the quality of life of these patients.
• DermatologistsBlog.com: Were any findings unexpected?
• The efficacy of adalimumab was not unexpected, given the anecdotal reports of its usefulness. The safety
of the treatment was also not unexpected, given the results of clinical trials for other conditions, such as
psoriasis. One notable, but not completely unexpected finding was the complete clearing of a patient who
ultimately was found to have received placebo treatment, emphasizing the importance of placebo-controlled trials
for conditions with unpredictable natural histories.
• DermatologistsBlog.com: What should clinicians and patients take away from this study.
• Adalimumab may reasonably be considered as a treatment option for patients with cutaneous sarcoidosis,
particularly for those patients with significant lesions that have not responded to more traditional treatments.
• Although small, this study is, to the authors’ best knowledge, the first placebo-controlled, blinded trial for
cutaneous sarcoidosis. Additional larger studies of this type are needed to establish truly evidence-based
treatment options for patients with this disease.

• Citation:
• A double-blind, randomized, placebo-controlled trial of adalimumab in the treatment of cutaneous sarcoidosis
• Robert J. Pariser, Joan Paul, Stefanie Hirano, Cyndi Torosky, Molly Smith
Journal of the American Academy of Dermatology – 02 January 2013 (10.1016/j.jaad.2012.10.056)


Risk of subsequent primary malignancies after dermatofibrosarcoma protuberans diagnosis: A national study
DermatologistsBlog.com Author Interview: David Kurlander, MS3
Case Western Reserve University School of Medicine, Cleveland, Ohio

• Our findings suggest that males and females with a dermatofibrosarcoma protuberans (DFSP) lesion are at increased risk of developing a second
primary DFSP lesion, compared to the general population.
• Additionally, females with DFSP are at increased risk of developing breast cancer, melanoma, and soft tissue cancers, and are at decreased risk of
colon cancer.

• Given that DFSP is such a rare cancer, literature search was more valuable than clinical experience in guiding expectations. Basic science studies and
case reports show mixed conclusions about the role of sex hormones and DFSP growth, but we were surprised to find that stratifying by gender led
to such drastic risk differences, and that females were at increased risk of cancers traditionally associated with female sex hormones.

• DermatologistsBlog.com: What should clinicians and patients take away from this study? 
• Although we do not have exact follow-up recommendations, clinicians and patients should be aware of an increased risk for the aforementioned
cancers. For dermatologists specifically, this means examining DFSP patients not only for local DFSP recurrence, which is very common, but also for
new primary lesions and primary melanomas.

• We are currently drafting a manuscript that examines survival of DFSP patients who develop second primary cancers.
• Additionally, further inquiry into the association of gender and DFSP development and proliferation could lend insight to pathogenesis and improved
treatment.

• Citation:
• Risk of subsequent primary malignancies after dermatofibrosarcoma protuberans diagnosis: A national study
• David E. Kurlander, Kathryn J. Martires, Yanwen Chen,
Jill S. Barnholtz-Sloan, Jeremy S. Bordeaux
• Journal of the American Academy of Dermatology – 26 December 2012 (10.1016/j.jaad.2012.10.040)


Selective Ablation of Ctip2/Bcl11b in Epidermal Keratinocytes Triggers Atopic Dermatitis-Like Skin Inflammatory Responses in
Adult Mice
DermatologistsBlog.com Author Interview: Arup Indra, Ph.D.
Associate Professor Department of Pharmaceutical Sciences, College of Pharmacy
Oregon State University-Oregon Health & Science University
Member, Environmental Health Science Center Corvallis, OR 97331 USA

• We demonstrated that keratinocytic ablation of Ctip2 (also known as Bcl11b) leads to atopic dermatitis (AD)-like skin inflammation, characterized by
alopecia, pruritus and scaling, as well as extensive infiltration of immune cells including T lymphocytes, mast cells and eosinophils. We observed
increased expression of T-helper 2 (Th2)-type cytokines and chemokines in the mutant skin, as well as systemic immune responses that share
similarity with human AD patients. Furthermore, we discovered that thymic stromal lymphopoietin (TSLP) expression was significantly upregulated in
the mutant epidermis as early as postnatal day 1 and ChIP assay revealed that TSLP is likely a direct transcriptional target of Ctip2 in epidermal
keratinocytes.

• We were not expecting to get such a massive cutaneous inflammation that would go systemic and display all the symptoms
that are very similar to human AD. The involvement of keratinocyte derived TSLP in AD pathogenesis is well documented from mouse and
human studies. But, the discovery of direct TSLP regulation by transcriptional regulator Ctip2 is unexpected as nothing much is known
about mechanisms of TSLP regulation epidermal keratinocytes. To our knowledge this so far the best genetically engineered mouse model
mimicking human AD.

• Our results establish an initiating role of epidermal TSLP in AD pathogenesis via a novel repressive regulatory mechanism enforced by Ctip2.
Therefore, loss of function mutation in Ctip2 locus could be a critical determinant in AD pathogenesis and can be useful for characterization of
specific AD-subtype.

• Use of this novel AD-model for better understanding the molecular mechanisms underlying AD-pathogenesis.
• The role of TSLP as a contributing factor in this process of cutaneous and systemic inflammation need to be elucidated. The present model can
be utilized as a in vivo tool for screening and validating new anti-inflammatory drugs identified from different sources that can be
effective in mitigating Th1/Th2 dependent inflammatory responses.
Citation:
• Wang Z, Zhang L-j, Guha G, Li S, Kyrylkova K, et al. (2012) Selective Ablation of Ctip2/Bcl11b in Epidermal Keratinocytes Triggers Atopic Dermatitis-
Like Skin Inflammatory Responses in Adult Mice. PLoS ONE 7(12): e51262. doi:10.1371/journal.pone.0051262


Is prevention of cancer by sun exposure more than just the effect of vitamin D?
A systematic review of epidemiological studies.
DermatologistsBlog.com Author Interview: Han van der Rhee
Department of Dermatology, Hagaziekenhuis, P.O. Box 40551, Leyweg 275, 2504 LN Den Haag, Zuid-Hollan
The Netherlands

• DermatologistsBlog.com: What are the main findings of the study
• We reviewed all published case control and cohort studies concerning colorectal-, prostate-, breast cancer, non-Hodgkin lymphoma (NHL) and both
sunlight and vitamin D.
• We found that almost all 40 epidemiological studies suggest that chronic (not intermittent) sun exposure is associated with a reduced risk of
colorectal-, breast-, prostate cancer and NHL. In colorectal- and to a lesser degree in breast cancer vitamin D levels were found to be inversely
associated with cancer risk. In prostate cancer and NHL, however, no associations were found. Other sunlight potentiated and vitamin D independent
pathways, such as immunosuppression and the influence on circadian rhythm, could play a role in the possible preventive effect of sunlight.

• No, in previous reviews (2006 and 2009) we more or less had the same results. In the meantime the evidence is getting more conclusive.
• However, for the discussion we reviewed all epidemiological studies on skin cancer and found that, in contrast with southern Europe, in northern
European countries like Belgium, The Netherlands, the UK and Scandinavia, chronic sun exposure is associated a significant lower risk of melanoma
and basal cell carcinoma.

• In the northern hemisphere above 50º NB avoidance of sunlight may have disadvantages for our health. We therefore think that, particularly in
countries with a moderate climate, intermitted sun exposure (and sunburn ) should on the one hand be discouraged, because of skin cancer
prevention, while on the other hand (moderate) chronic exposure possibly should be advised.

• More epidemiological data specifically on the association between latitude, skin type, sun exposure patterns and the risk of cancer, including skin
cancer, are needed to confirm our conclusions. In addition animal experiments could address these questions.

• Citation:
• Is prevention of cancer by sun exposure more than just the effect of vitamin D? A systematic review of epidemiological studies.
• van der Rhee H, Coebergh JW, de Vries E.
Department of Dermatology, Hagaziekenhuis
P.O. Box 40551, Leyweg 275, 2504 LN Den Haag, Zuid-Holland, The Netherlands
Eur J Cancer. 2012 Dec 10. pii: S0959-8049(12)00885-4. doi: 10.1016/j.ejca.2012.11.001.
[Epub ahead of print]


Effect of Nutrient Supplementation on Atopic Dermatitis in Children:
A Systematic Review of Probiotics, Prebiotics, Formula, and Fatty Acids.
DermatologistsBlog.com Author Interview: Negar Foolad BA

• On the basis of our systematic review, certain nutrient supplements may prevent the development of atopic dermatitis or diminish its severity
among infants and children younger than 3 years of age. More specifically, we found that supplementing with certain probiotics resulted in the
prevention and/or reduction in severity of atopic dermatitis. Based on our review, gamma-linolenic acid was shown to reduce the severity of atopic
dermatitis. Although prebiotics, certain hydrolyzed formulas, and black currant seed oil were all shown to prevent atopic dermatitis, more research is
needed.

• Yes, we were somewhat surprised to see the positive effects that these various nutrient supplements had on infant atopic dermatitis. Furthermore, it
was interesting to note that all of the randomized controlled trials and cohort studies in our systematic review; none took place in the United States
.
• Based on current literature, it appears that certain nutrient supplements may prevent the development of atopic dermatitis or diminish its severity
among infants and children. More specifically, probiotics were the most commonly studied nutrient. The earliest study took place in Finland in 2000.
Therefore, this is still a relatively new area of research and we still do not know the exact mechanisms associated with all of the supplements.
However, the lack of randomized controlled trials and cohort studies in the United States calls for additional research.

• Future research needs to illuminate mechanisms underlying the actions of nutritional supplementation on atopic dermatitis. There is a need for
longitudinal research, including follow-up studies. This type of research can confirm whether supplementation of infants and/or mothers can result in
lasting preventive effects. It would be interesting to see future studies evaluating various combinations of nutrient supplements. There may be
positive interactions and beneficial outcomes associated with this, and the development and/or amelioration of atopic dermatitis.

• Acknowledgement: I would like to thank Dr. Armstrong and the UC Davis Department of Dermatology for their guidance and support throughout
this process.
• Citation:
• Effect of Nutrient Supplementation on Atopic Dermatitis in Children: A Systematic Review of Probiotics, Prebiotics, Formula, and Fatty Acids.
• Foolad N, Brezinski EA, Chase EP, Armstrong AW.
Arch Dermatol. 2012 Dec 17:1-6. doi: 10.1001/jamadermatol.2013.1495. [Epub ahead of print]


Why is Melanoma Incidence Rate in Young Women Twice that of Young Men?
A unique gender difference in early onset melanoma implies that in addition to ultraviolet light exposure other causative factors are
important
DermatologistsBlog.com Author Interview: Feng Liu, PhD
Assistant Professional Researcher Department of Medicine
University of California Irvine Medical School Irvine, CA 92697

• The main finding of this study is that melanoma incidence rate in young women is twice that in young men, but non-melanoma skin cancer (NMSC)
does not exhibit the same trend. While it has been known that young women are at higher risk for melanoma, the reason was largely attributed to
UV radiation including sun-bed use. NMSC is known to be associated with UV radiation and most NMSC tumors carry UV-signature mutations, while
UV signature mutations in melanoma are less prevalent. Hence the different trend in age-specific incidence rate ratios (female/males) between
melanoma and NMSC suggests that melanoma in young age group in women may not be directly associated with UV radiation and/or that other
factors may a role in young women.
• Yes. As stated above it has been known that young women are more susceptible to melanoma than young men. But the comparison of the age-
specific rate ratios (female/male) between melanoma and NMSC was not made before, as NMSC data was not collected by US SEER 17 registries. We
utilized a relatively complete cancer registry database from Nordic Countries to make the comparison and found that the higher age-specific rate
ratio (female/male, age younger than 40 years old) is only observed in melanoma but not in NMSC.
• For doctors and patients, it may be helpful to understand that sun-damage is an accumulative process, whose adverse effect may show up many
years later (e.g., after 40 years of age). Hence it is very important to use sun screen and protective clothing whenever exposed to sun. However
early onset melanomas in young women may have additional etiological factors which may be related to female gender characteristics. Currently we
don’t know what these factors are, we are actively seeking an answer and hopefully will be able to provide further information in near future for
preventive purpose.
• Since large epidemiological studies have shown that estrogen, hormone replacement therapy, oral contraceptives and pregnancy basically do not
impact melanoma incidence rate, we are going to use a different approach to seek further explanations. The above mentioned studies made
comparisons between exposed groups and non-exposed groups but the study objectives in nature were all women. We will investigate the different
signal transduction pathways between men and women and hopefully will find the cause of the observed difference seen in our initial study.
• Acknowledgement:
• I’d like to take this interview chance to express my appreciation and thanks to Dr. Frank Meyskens and Dr. Hoda Anton-Culver, two great scientists
and mentors. Without their support this study would not be possible.
• Citation:
• A unique gender difference in early onset melanoma implies that in addition to ultraviolet light exposure other causative factors are important.
• Liu F, Bessonova L, Taylor TH, Ziogas A, Meyskens FL Jr, Anton-Culver H.
• Department of Medicine, University of California, Irvine, CA, USA; Department of Chao Family Comprehensive Cancer Center, University of California,
Irvine, CA, USA.
Pigment Cell Melanoma Res. 2012 Oct 24. doi: 10.1111/pcmr.12035. [Epub ahead of print]


Differential in situ expression of IL-17 in skin diseases
DermatologistsBlog.com Author Interview: Kilian Eyerich, MD, PhD
Specialist in Dermatology and scientist at the Department of Dermatology
and Allergology Biederstein, TU Munich and ZAUM
Center of Allergy and Environment, Germany

•
DermatologistsBlog.com: What are the main findings of the study?
• This study had a broad concept: although we know much about chemical structure, signal transduction, and effector functions of Interleukin-17, we
do not know in which dermatological diseases it is relevant. We wanted to identify skin diseases where a therapeutical intervention with the Th17
signaling cascade could be beneficial.

• We did not expect that not only lymphocytes express IL-17, but also granulocytes. Depending on the disease, granulocytes were an important source
of IL-17. We were also intrigued to see that skin diseases showed a characteristic pattern of IL-17+ lymphocytes or granulocytes in all investigated
patients. This study showed us that IL-17 seems to play an important role not only in inflammatory skin diseases such as psoriasis, but in many more
diseases with urgent need of efficient novel therapies.

• Fortunately, the IL-17 expression pattern is quite conserved within a disease. This means we can judge in what pathological skin condition
interference with the IL-17 pathway could be beneficial. In particular, we observed that in neutrophil dermatoses such as pyoderma
gangraenosum, vasculitis and Sweet´s syndrome as well as in the bullous autoimmune dermatoses pemphigus vulgaris and bullous pemphigoid a
great number of granulocytes produce IL-17 in the skin. Here, a direct neutralisation of IL-17 with biologic drugs in the pipeline or shortly before
approval seems promising. On the other hand, for example in fibrotic diseases blocking the more general IL-12p40 pathway with Ustekinumab could
be more beneficial.

• We identified a number of skin diseases where clinical studies with either anti-IL-12p40 or anti-IL-17 seem highly promising. From basic research
aspects, granulocytes as a source of IL-17 should be investigated in more detail.

• Citation:
• Differential in situ expression of IL-17 in skin diseases.
• Fischer-Stabauer M, Boehner A, Eyerich S, Carbone T, Traidl-Hoffmann C, Schmidt-Weber CB, Cavani A, Ring J, Hein R, Eyerich K.
• Department of Dermatology and Allergy.
Eur J Dermatol. 2012 Dec 5. [Epub ahead of print]


Dichlorophenol-containing pesticides and allergies: results from the US National Health and Nutrition Examination Survey
2005-2006
DermatologistsBlog.com Author Interview: Elina Jerschow, M.D., M.Sc., FACAAI
Albert Einstein College of Medicine Montefiore Medical Center
Assistant Professor of Medicine Director, Drug Desensitization Center
Allergy/ Immunology Division Bronx, New York

• We found an association between high levels of dichlorophenols in urine (defined as =/>75th
percentile in this population) and allergic sensitization to foods (measured by a blood test): people
with high dichlorophenol levels in urine were 80% more likely to be sensitized to foods.
• Yes, we were surprised to find that this association was only significant for sensitization to foods,
but not to aeroallergens.
• DermatologistsBlog.com What should clinicians and patients take away from this study?
• More studies would be needed to confirm these findings.
• DermatologistsBlog.com: What recommendations do you have for future research as a result of
your study?
• It would be nice to design a prospective study in populations who use different water sources and
differently processed crops: e.g., to compare people who use well water vs. who uses municipal
sources, possibly in farming vs. non-farming population.
• Citation:
• Dichlorophenol-containing pesticides and allergies: results from the US National Health and
Nutrition Examination Survey 2005-2006.
• Jerschow E, McGinn AP, de Vos G, Vernon N, Jariwala S, Hudes G, Rosenstreich D.
• Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
• Ann Allergy Asthma Immunol. 2012 Dec;109(6):420-5. doi: 10.1016/j.anai.2012.09.005.
Epub 2012 Oct 1.


Frequency of Excisions and Yields of Malignant Skin Tumors in a Population-Based Screening Intervention
of 360 288 Whole-Body Examinations
Dr. Annika Waldmann, PhD and Dr. Sandra Nolte, PhD
Institute for Cancer Epidemiology, University of Luebeck, Germany

• Introduction:
• The SCREEN project (Skin Cancer Screening Research to Provide Evidence for the Effectiveness of Screening) is one of the largest population-based
skin cancer screening interventions implemented world-wide. Data from this pilot project served as a base for the decision to implement a skin
cancer screening program at the national level in Germany in 2008. During the one-year project period, more than 85% of the population of the
federal-state of Schleswig-Holstein in Germany being 20 years were eligible for the screening. Overall, 98% of all dermatologists and ~64% of all
practice-based non-dermatologists in Schleswig-Holstein participated in the mandatory 8-hour training course and were allowed to screen persons
for skin cancer by means of a whole-body skin inspection.

• DermatologistsBlog.com :What are the main findings of the study?
• In total, 19% of all eligible inhabitants of Schleswig-Holstein participated in the SCREEN project and received a whole-body skin inspection. Of these,
15,983 screenees had an excision of at least one suspicious lesion (4.4% of all screenees). After histopathological examination, 3,103 malignant skin
lesions were confirmed in 2,911 screenees.
• Malignant melanomas (MM) were found in 858 persons, squamous cell carcinomas (SCC) in 392 persons, basal cell carcinomas (BCC) in 1,961
persons, and 165 persons had other forms of malignant skin tumors.
• In order to detect one skin cancer, 116 persons needed to be screened (NNS; Yield-S) and five persons needed to have an excision (NNE, Yield-E). The
yields varied with skin cancer type, age, and sex of the screenees.
• One in every 620 screenees (Yield-S) and one in every 28 person with an excision (Yield-E) was diagnosed with a melanoma. Yields were higher in
older men than in younger men, e.g. to find one MM more than 50 excisions were performed in men aged 20-34 years, while 20 excisions were
needed in men aged 65 years or older. Respective Yield-E’s were 1 in 41 young women and 1 in every 22 women aged 65+ years.
• To find one SCC, 920 persons needed to be screened (Yield-S) and 41 needed to have an excision (Yield-E). Again, yields differed with age and sex.
Only 14 women and 12 men aged 65 years and older needed to have an excision to find one SCC compared to 72 women and 48 men, respectively,
in the age-group 50-64 years (Yield-E).
• One in every 184 screenees (Yield-S) and one in every nine persons with an excision (Yield-E) was diagnosed with a BCC. Male screenees were more
likely to be diagnosed with BCC than female screenees (Yield-S in women: 1 in 252, Yield-S in men: 1 in 105). The overall Yield-E differed only slightly
with sex (Yield-E in women: 1 in 10; Yield-E in men: 1 in 7), while differences were higher for sex-specific age-group comparisons. In women aged 50-
64 years, eight excisions were needed, while in women aged 65 years or older four excisions needed to be performed to detect one BCC. In men, the
corresponding Yield-E’s were 1 in 7 and again 1 in 4.


Frequency of Excisions and Yields of Malignant Skin Tumors in a Population-Based Screening Intervention
of 360 288 Whole-Body Examinations
Dr. Annika Waldmann, PhD and Dr. Sandra Nolte, PhD
Institute for Cancer Epidemiology, University of Luebeck, Germany
(cont)

• DermatologistsBlog.com : Were any of the findings unexpected?
• The normal distribution (ratio) of incident melanomas to non-melanocytic skin cancer (NMSC) in Germany is 1 MM to 9 NMSC’s or 1 MM to 2 SCCs to
7 BCCs. In our study the distribution was as follows: 1 MM to 0.5 SCC to 2.3 BCCs. That is, a higher number of MM (n=858) in relation to NMSC was
detected. This fact may partly be explained by the mass media campaigns that preceded and accompanied the SCREEN project as it focused on MM
rather than NMSC. This campaign may have led to a higher participation of persons at increased risk for melanoma or with prevalent melanomas.
• As skin cancer becomes more common with increasing age, Yield-S must vary with age, under the precondition that an unselected proportion of the
population participated in the SCREEN project. However, the Yield-E should be relatively stable across the age-groups, under the assumption that
physicians are able to detect malignant lesions in young persons as accurately as in older persons. Thus, the low Yield-S’s in young screenees
compared to the high Yield-S’s in older persons were an unexpected finding. We cannot differentiate whether a high number of excisions was
conducted due to patients’ preferences or whether a high number of excisions was conducted due to physicians’ decisions who were concerned
about the safety especially of younger screenees, i.e. definitely rule out a malignancy that can only be confirmed by histopathological examination.

• DermatologistsBlog.com :What should clinicians and patients take away from this study?
• Population-based skin cancer screening is feasible. Non-dermatologists should be included to manage the high number of screenings being
conducted in such a setting. Even in young screenees a relevant number of melanomas, and to a lesser extent also NMSC, were found. Future efforts
should target physicians’ education with the aim to reduce the number of excisions in young persons – that is to optimize the ratio of tumor findings
to excisions (Yield-E).

• DermatologistsBlog.com : What recommendations do you have for future research as a result of your study?
• Future research could:

• (1) aim at answering the question why so many excisions were performed in young screenees, i.e. due to patient or physician preferences;
• (2) evaluate yields in persons at increased risk for skin cancer to explore the benefits of risk-group screening versus population-based screening.

• Citation:
• Frequency of Excisions and Yields of Malignant Skin Tumors in a Population-Based Screening Intervention of 360 288 Whole-Body Examinations
• Annika Waldmann, PhD; Sandra Nolte, PhD; Alan C. Geller, MPH, RN; Alexander Katalinic, MD; Martin A. Weinstock, MD, PhD; Beate Volkmer, PhD;
Ruediger Greinert, PhD; Eckhard W. Breitbart, MD
• Arch Dermatol. 2012;148(8):903-910. doi:10.1001/archdermatol.2012.893.


Evaluating facial pores and skin texture after low-energy nonablative fractional 1440-nm laser treatments
DermatologistsBlog.com Author Interview: Nazanin Saedi, MD
SkinCare Physicians, 1244 Boylston St, Chestnut Hill, MA 02467.

• Dr. Saedi: Clinical results of this study demonstrate that a low-energy, non-ablative fractionated
1440 nm laser is safe and effective in
reducing pore count, improving skin texture as well as improvement in overall facial appearance.
• Dr. Saedi: We expected these findings because many have noticed improvement in the appearance
of pores when treating with high energy fractionated devices.
• Dr. Saedi: Low energy level non-ablative fractionated devices are can improve the appearance of
pores. It is exciting because it is the first study
with objective data on pores.
• DermatologistsBlog.com : What recommendations do you have for future research as a result of
your study?
Dr. Saedi: We would recommend more long term follow-up to see if the results are sustainable for
a longer period of time. Also, it would be helpful
to have histology so that we have a better understanding of the exact mechanism.
• Citation:
• Evaluating facial pores and skin texture after low-energy nonablative fractional 1440-nm laser
treatments
• Nazanin Saedi, Kathleen Petrell, Kenneth Arndt, Jeffrey Dove
Journal of the American Academy of Dermatology – 24 October 2012 (10.1016/j.jaad.2012.08.041)


Food patch testing for irritable bowel syndrome
DermatologistsBlog.com Author Interview: Michael Stierstorfer, M.D.
East Penn Dermatology, P.C.

• DermatologistsBlog.com : What are the main findings of the study?
• Dr. Stierstorfer: Patch testing individuals with symptoms of irritable bowel syndrome (IBS) may detect foods and
food additives which, when avoided in the diet, may result in significant improvement in the IBS symptoms.
• Dr. Stierstorfer: The pathogenesis of IBS has been questioned recently as low grade inflammation of the lower GI
tract has been observed.
• The inflammation appears to alter motility and thus cause the IBS symptoms.
• The cause of the inflammation until now has been unknown. IgE testing is felt to not be worthwhile in these
individuals, so other sources of inflammation need to be investigated.
• Given that the immunologic system has full access to the GI tract, it seems logical that if foods can cause type 4
skin reactions, they should be able to elicit similar reactions in the GI tract.
• Dr. Stierstorfer: Foods and food additives that are known to cause allergic contact dermatitis should be suspected
as a possible cause for the symptoms of IBS.
• Comprehensive patch testing to these food allergens may help pinpoint a cause for IBS in some individuals.
• Dr. Stierstorfer: We patch tested to 40 foods and food additives and were able to help 27.5% of the 51 individuals
tested.
• Testing to a greater number of foods and food additives that are known to elicit allergic contact dermatitis may
help a larger percentage of patients with IBS.
• Citation:
• Food patch testing for irritable bowel syndrome
• Michael B. Stierstorfer, Christopher T. Sha, Marvin Sasson
Journal of the American Academy of Dermatology – 26 October 2012 (10.1016/j.jaad.2012.09.010)


Vitamin D Status and Skin Cancer Risk Independent of Time Outdoors
Vitamin D Status and Skin Cancer Risk Independent of Time Outdoors: 11-Year Prospective Study in an Australian Community
DermatologistsBlog.com Author Interview: Jolieke van der Pols, PhD
Cancer and Population Studies
Queensland Institute of Medical Research Brisbane QLD 4006 Australia

• We found that adults who had serum 25(OH)-vitamin D levels above 75 nmol/L (30 ng/mL) were more likely to develop melanoma and basal cell
carcinoma (BCC) in a subsequent 11-year follow-up period compared to adults whose serum 25(OH)-vitamin D levels were below 75 nmol/L (30
ng/mL).
• In contrast, the incidence of squamous cell carcinoma (SCC) tended to be lower in participants with serum levels above 75 nmol/L (30 ng/mL)
compared to those with lower levels.
• In these analyses we allowed for (adjusted for) all main skin cancer risk factors, such as skin colour, sunscreen use, personal and family history of skin
cancer, as well as long-term and recent measures of time spent outdoors.

• Our hypothesis was that higher levels of serum 25(OH)-vitamin D might be associated with reduced skin cancer risk, given that some experimental
studies indicate that vitamin D may reduce damage in the skin caused by ultraviolet light exposure.
• The findings for SCC did indeed suggest a protective association with vitamin D levels, although this was strictly not statistically significant.
• However, the findings for melanoma and BCC were in the opposite direction and clearly showed a higher incidence of these skin cancers in persons
with higher 25(OH)-vitamin D levels.

• Our findings indicate that the carcinogenic effect of high sun exposure is not counteracted by high vitamin D status.
Thus high sun exposure should be avoided as a means to achieve high vitamin D status.

• In terms of skin cancer we need to increase our understanding of how the epidemiology and risk factors differ between BCC, SCC, and melanoma.
• In terms of vitamin D we need more evidence from similar, prospective studies that have collected detailed data on skin cancer risk factors to
corroborate our findings.

• Citation:
• Vitamin D Status and Skin Cancer Risk Independent of Time Outdoors: 11-Year Prospective Study in an Australian Community
• Jolieke C van der Pols, Anne Russell, Ulrike Bauer, Rachel E Neale, Michael G Kimlin and Adèle C Green
Journal of Investigative Dermatology , (18 October 2012) | doi:10.1038/jid.2012.346


An ultraviolet-radiation-independent pathway to melanoma carcinogenesis in the red hair/fair skin background
DermatologistsBlog.com Author Interview: David E. Fisher MD, PhD
Edward Wigglesworth Professor & Chairman
Dept of Dermatology Director, Melanoma Program MGH Cancer Center
Director, Cutaneous Biology Research Center
Massachusetts General Hospital Harvard Medical School Boston, MA 02114

• Dr. Fisher: There appears to be a mechanism by which red-pigment (pheomelanin) is carcinogenic for melanoma formation, even independently of
UV irradiation. While this does not mean that UV is unimportant (we strongly believe that UV further worsens the effect), it suggests that UV
protection may not be sufficient to fully protect against melanoma.

• Dr. Fisher: Yes- we had expected that our study of melanoma formation using BRAF(V600E) oncogene in the redhead background would produce
benign nevi, as this gene typically does in black mice. We expected that UV irradiation would be required for melanoma formation, but were
surprised that melanomas arose spontaneously, suggesting that in the presence of the BRAF(V600E) gene there may be ongoing genomic alterations
which eventually produce melanoma formation— due to a UV independent activity of pheomelanin.

• Dr. Fisher: Firstly, we believe that UV protection remains as important as ever.
• While this study revealed a UV independent mechanism of melanoma formation, we suspect that UV may further amplify the effect.
• Therefore it is important for clinicians and patients to remain vigilant regarding UV protection.
• However we would add that even for people who are extremely careful with UV protection, it is important to be mindful of skin changes, because
this additional pathway towards melanoma formation might still occur. Such changes should be evaluated by an appropriate clinician.

• Dr. Fisher: We believe that the identification of this mechanism of melanoma formation, when better understood, may provide an opportunity for
novel preventative strategies.
• Our study suggested that reactive oxygen species may play a functional role in the carcinogenic process. While this may suggest that anti-oxidants
might one day prove beneficial, it is important to exercise caution until appropriate research is performed, because certain anti-oxidants may
inadvertently worsen oxidative damage. Hopefully future research will one day identify safe and effective prevention strategies, based upon
antagonizing this pigment-mediated pathway.

• Citation:
• Mitra D, et al “An ultraviolet-radiation-independent pathway to melanoma carcinogenesis in the red hair/fair skin background” Nature 2012;
DOI: 10.1038/nature11624.


Efficacy and safety of systemic methotrexate vs. acitretin in psoriasis patients with significant palmoplantar involvement: a
prospective, randomized study
DermatologistsBlog Author Interview: Dr A J Kanwar MD, FAMS, FRCP (London)
Prof and Head, Dept of Dermatology,
Venereology & Leprology PGIMER, Chandigarh

• DermatologistsBlog: What are the main findings of the study?
• Methotrexate at a dose of 0.4 mg/kg/wk was found to be more efficacious than acitretin 0.5 mg/kg/d for the
treatment of psoriasis with significant palmoplantar involvement.

• DermatologistsBlog: Were any of the findings unexpected?
• Yes. In two previous retrospective studies acitretin was found to be very efficacious but they had many limiting
factors as mentioned in the article. But according to our study the results are better with methotrexate.

• DermatologistsBlog: What should clinicians and patients take away from this study?
• Methotrexate is a highly efficacious systemic drug for treating psoriasis patients with significant palmoplantar
involvement.

• DermatologistsBlog: What recommendations do you have for future research as a result of your study?
• Methotrexate should be used as the first line systemic therapeutic agent for treatment of psoriasis patients
with significant palmoplantar involvement as it is highly efficacious and relatively inexpensive when compared to
acitretin.
• Citation:
• Efficacy and safety of systemic methotrexate vs. acitretin in psoriasis patients with significant palmoplantar
involvement: a prospective, randomized study
• Janagond AB, Kanwar AJ, Handa S.
• Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and
Research, Chandigarh 160012, India.
• J Eur Acad Dermatol Venereol. 2012 Oct 16. doi: 10.1111/jdv.12004. [Epub ahead of print]


Epigallocatechin-3-Gallate Improves Acne in Humans by Modulating Intracellular Molecular Targets and Inhibiting P. acnes
DermatologistsBlog.com: Author Interview: Dae Hun SUH, M.D., Ph.D.
Professor, Department of Dermatology
Seoul National University College of Medicine
Organizer, Asia-Pacific Acne Symposium

• DermatologistsBlog.com : What are the main findings of the study?
• In this study, we reported that Epigallocatechin-3-gallate (EGCG), the major polyphenol in green tea, has
therapeutic effects on acne by applying both experimental and clinical methods. In experimental methods, we
showed that EGCG displays apoptotic, sebosuppressive, and anti-inflammatory effects on human sebocytes, and
that it displays antibacterial effects on Propionibacterium acnes, findings that are, to our knowledge, previously
unreported. Our biochemical, genetic, and cellular studies further indicate that modulation of AMPK–SREBP-1 and
NF-kB/activator protein 1 (AP-1) signaling pathways mediates the sebosuppressive and anti-inflammatory effects
of EGCG, respectively.
• Subsequently, we confirmed its efficacy and safety in an 8-week randomized, split-face, clinical trial. Taken
together, these data demonstrate that EGCG modulates several key pathological factors of acne with very few,
relatively mild side effects, suggesting the possibility that EGCG may be effective in the treatment of acne.

• DermatologistsBlog.com : Were any of the findings unexpected?
• Most medical and surgical modalities developed so far to treat acne have demonstrated relatively modest efficacy,
presumably because of the inherent pathological complexity of the disease.
• Acne developments were critically related with four distinct processes as follows:
• (1) increased sebum production
• (2) altered keratinization of follicular keratinocytes,
• (3) activity of P. acnes, and
• (4) inflammation.
• Although we hypothesized that EGCG might have beneficial effects on some parts of this pathologic processes, we
didn’t even expect that it modulated all four pathological factors at molecular levels. Consistent with these results,
EGCG also have shown therapeutic effects on both inflammatory and non-inflammatory lesions with few, mild side
effects.


Epigallocatechin-3-Gallate Improves Acne in Humans by Modulating Intracellular Molecular Targets and Inhibiting P. acnes
DermatologistsBlog.com: Author Interview: Dae Hun SUH, M.D., Ph.D.
Professor, Department of Dermatology
Seoul National University College of Medicine
Organizer, Asia-Pacific Acne Symposium
(cont)

• DermatologistsBlog.com : What should clinicians and patients take away from this study?

• Clinically, only a few drugs target multiple pathological processes of acne and improve the condition effectively, but their use is accompanied by
potentially serious side effects. For example, one of the most effective treatments, isotretinoin, has serious side effects, including teratogenicity, liver
enzyme abnormalities, and dyslipidemia. Topical retinoids, currently considered as the first-line treatment of acne, may cause burning and irritation,
especially in the early stages of treatment.
• Our clinical trial revealed that 1 and 5% EGCG treatment significantly improves both inflammatory and non-inflammatory acne lesions with few, mild
side effects. Remarkably, the efficacies of EGCG in our study were better than those of a new compound product reported in recent large-scale
clinical trials with less side effects. Therefore, clinicians could recommend that patients apply green tea extract to their acne lesions as an alternative
therapy, especially for those suffering from possible side effects of current medications. Of course, further studies are definitely needed in the future.

• DermatologistsBlog.com : What recommendations do you have for future research as a result of your study?

• There is a clinical need for development of new acne medication. In this study, we showed that chemical components obtained from green tea could
play some important roles with minimal side effects. In fact, sixty one percent of total medications currently used originated from natural products.
• Aspirin, perhaps the most widely used antipyretic/analgesic agent, was developed from a natural product from willow bark. Furthermore, the
elucidation of the chemical structure of morphine (obtained from opium) led to the development of a range of new synthetic analgesics. Therefore, it
is reasonably expected that organic compounds extracted from natural compounds might interfere with target molecules associated with
pathogenesis of acne. To find and evaluate active ingredients in natural products objectively, quantitative and reliable methods are required to
evaluate effectiveness. In addition, these methods must be simple, economical, and efficient in examining small sample quantities with a precise,
reproducible manner. I strongly believe that these studies would yield valuable products that would have therapeutic effects not only for acne but
also for other skin diseases.

• Citation:
• Epigallocatechin-3-Gallate Improves Acne in Humans by Modulating Intracellular Molecular Targets and Inhibiting P. acnes.
• Yoon JY, Kwon HH, Min SU, Thiboutot DM, Suh DH.
• Acne Research Laboratory, Seoul National University Hospital, Seoul, South Korea.
J Invest Dermatol. 2012 Oct 25. doi: 10.1038/jid.2012.292. [Epub ahead of print]


Is skin self-examination for cutaneous melanoma detection still adequate? A retrospective study.
DermatologistsBlog.com Author Interview: Vincenzo De Giorgio, MD
Department of Dermatology, University of Florence, Florence, Italy.

I believe that the message of the skin self-examination has now been delivered to the majority of the population but it is not useful to
decrease the overall mortality of melanoma, as confirmed by the epidemiological study.
• We now have the tools to make the diagnosis for very early stage melanomas using dermatoscope, videodermatoscope or confocal
microscopy.
• I believe that it is unreasonable to ask a patient to look at his lesions in a hall of mirrors with the hope that he would recognize
and diagnose small and thin melanoma that would even be difficult for an expert dermatologist to diagnose.
• The important data that emerged from our study is that self-detection was associated with a greater probability of having a thick melanoma and,
therefore, a poor prognosis (OR 1.56).


• No, I was actually convinced that in order to make diagnosis of melanomas an early stage the ABCD rule was not sufficient because an in-situ or
thin melanoma is, clinically very similar to a mole, even for an expert dermatologist.
• A dermatological skin check should be recommended to all adult patients every year.
• In particular ,we should introduce a new message to encourage the high-risk patients, such as non-educated men over 50 years old, to have an
annual skin examination as a rule.
• This message could be helpful to further increase the prognosis of all kinds of
melanomas.
• I suggest to take in consideration that the self skin examination via the
ABCD rule is not be used to identify in-situ or thin melanomas.
• If further studies validate our result we will should discuss new guideline for
melanoma screening.
• Citation:
• Is skin self-examination for cutaneous melanoma detection still adequate? A retrospective study.
• De Giorgi V, Grazzini M, Rossari S, Gori A, Papi F, Scarfi F, Savarese I, Gandini S.
• Department of Dermatology, University of Florence, Florence, Italy.


Effect of Olive and Sunflower Seed Oil on the Adult Skin Barrier: Implications for Neonatal Skin Care
DermatologistsBlog.com Author Interview: Simon G. Danby, Ph.D.
Academic Unit of Dermatology Research, Department of Infection and Immunity, Faculty of Medicine, Dentistry and Health,
University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX, UK

• In contrast to sunflower seed oil, topical treatment with olive oil (6 drops, twice daily to the forearm) was found to significantly damage the structure
of the skins permeability barrier (the ‘skin barrier’) in adults.
• Subjects with a predisposition to a defective skin barrier (a history of atopic dermatitis, AD) were more susceptible to these negative effects.
• The development of a skin barrier defect is a key event in the development of AD, and the extent of the defect correlates with the severity of AD.
Damage to the skin barrier caused by the application of olive oil may therefore promote the development of, or exacerbate existing, AD. These
findings challenge the unfounded belief that all natural oils are beneficial for the skin and highlight the need for further research.
• Olive oil is widely recommended for the treatment of neonatal skin by healthcare professionals (Cooke et al., 2011), therefore it was surprising to
find such a negative affect on the skin barrier.
• There is of course no evidence to support this practice.
• Moreover earlier studies have reported negative effects associated with the application of olive oil to the skin. Indeed, oleic acid, a major constituent
of olive oil, is a well-studied skin penetration enhancer.
• The key message is to follow an evidenced-based approach to skincare.
Based on the results of this study the use of olive oil for the treatment of dry skin and infant massage should be discouraged.
• We should also be cautious about the topical use of sunflower seed oil. In this study we sourced sunflower seed oil with a very low oleic acid
content, however some varieties contain more oleic acid than olive oil.
• Furthermore all natural oils can contain small amounts of plant protein (depending on purity), which are potentially allergenic. The skin is an
important route of sensitization (Lack et al., 2003), therefore the potential for harm to ‘at risk’ neonates must be carefully considered.
• The next step is to undertake a randomized clinical trial to determine the effect of topical olive oil treatment in neonates from birth.
• Citation:
• Effect of Olive and Sunflower Seed Oil on the Adult Skin Barrier: Implications for Neonatal Skin Care.
• Danby SG, Alenezi T, Sultan A, Lavender T, Chittock J, Brown K, Cork MJ.
• Academic Unit of Dermatology Research, Department of Infection and Immunity, Faculty of Medicine, Dentistry and Health, University of Sheffield
Medical School, Sheffield, UK.
• Pediatr Dermatol. 2012 Sep 20. doi: 10.1111/j.1525-1470.2012.01865.x. [Epub ahead of print]


Triclosan exposure and allergic sensitization in Norwegian children
DermatologistsBlog.com: Author interview: Randi J Bertelsen PhD
Norwegian Institute of Public Health, Oslo, Norway

• DermatologistsBlog.com:What are the main findings of the study?
• Dr. Bertelsen: Response: We found that children with allergic sensitization and inflammation in the mucous lining of the nose, also known as rhinitis,
had higher levels of triclosan in urine than children without allergic sensitization and rhinitis.

• Dr. Bertelsen: Response: We were surprised that even though half of the children in the study had undetectable levels of triclosan in urine, some
children had very high levels which most likely would indicate several sources of exposure.

• Dr. Bertelsen: Response: For the majority of the population, the levels are so low that they are unlikely to be of concern. Due to concern about the
emergence of antibiotic-resistant bacteria, the Norwegian authorities have encouraged retailers and consumers for may years to avoid routine use of
products declared as antibacterial. Because of this, triclosan has now been phased out in many products in Norway. It is, however, believed that very
little actually goes through the skin, and that the mucosa in your mouth is where everything is absorbed, so triclosan-containing toothpaste and
mouthwash are likely to be important sources of exposure. By reading the label with ingredients, the consumers can easily avoid triclosan-containing
products.

• Dr. Bertelsen: Response: Since this is an observational study, we can only describe associations. Experimental models is important for understanding
the mechanism between triclosan and allergy development. It would also be interesting to know more about the sources of exposure; the Norwegian
children were 10 years of age, and many of the known sources of triclosan from cosmetic products would be expected to be more relevant for adult
populations.

• Citation:
• Triclosan exposure and allergic sensitization in Norwegian children
• Bertelsen RJ, Longnecker MP, Løvik M, Calafat AM, Carlsen K-H, London SJ, Lødrup Carlsen KC.
Allergy 2012; DOI: 10.1111/all.12058.


Incidence, Mortality, and Disease Associations of Pyoderma Gangrenosum in the United Kingdom: A
Retrospective Cohort Study
DermatologistsBlog.com Author Interview: Dr Sinead Langan
NIHR Clinician Scientist & Hon Consultant Dermatologist

• Pyoderma gangrenosum (PG) is a relatively rare disease; the standardised incidence of PG in the UK population is 0.63 (95% confidence interval 0.57
to 0.71) per 100,000 person-years.
• The risk of death in people with PG was three times higher than people of the same age and gender in the general population, 72% higher than
people with inflammatory bowel disease with a borderline increased risk compared to people of the same age and gender with rheumatoid arthritis.
• Frequently reported disease associations were present in a third of the individuals with PG, the majority having inflammatory bowel disease (20%)
with smaller numbers having rheumatoid arthritis (12%) and haematological disorders (4%).

• The increased mortality compared to inflammatory bowel disease controls and the borderline increase in mortality compared to rheumatoid arthritis
controls was unexpected and represents an important finding.
• The disease associations were less frequent than previously reported, which may reflect the presence of ascertainment bias in previous studies from
specialist centers.

• Pyoderma gangrenosum is a relatively rare but important disease, associated with significantly increased mortality, even compared to individuals
with rheumatoid arthritis or inflammatory bowel disease. Reasons for the increase in mortality are poorly understood and require further research.

• DermatologistsBlog.com What recommendations do you have for dermatology health care providers as a result of your study?
• This study provides the first population-based cohort study of PG.
• It gives really useful information on incidence, mortality rates, the validity of a PG diagnosis in GPRD (a UK general practice database) and disease
associations which will be extremely useful data for planning clinical care and clinical trials. More research is needed to understand factors which lead
to increased mortality in people with PG.
• Citation:
• Incidence, Mortality, and Disease Associations of Pyoderma Gangrenosum in the United Kingdom: A Retrospective Cohort Study
• Sinéad M Langan, Richard W Groves, Tim R Card and Martin C Gulliford
• Journal of Investigative Dermatology 132, 2166-2170 (September 2012) | doi:10.1038/jid.2012.130
• London School of Hygiene and Tropical Medicine and St John’s Institute of Dermatology,
Keppel Street, London, WC1E 7HT


Coin exposure may cause allergic nickel dermatitis: a review
DermatologistsBlog.com Author Interview Jacob P. Thyssen
Department of Dermato-Allergology, National Allergy Research Centre,
Copenhagen University Hospital Gentofte, DK-2900 Hellerup, Denmark

• Dr. Thyssen: This is an overview of experimental studies investigating nickel release from coins.
Furthermore, epidemiological studies and selected case reports are presented.
• DermatologistsBlog.com: What should clinicians and patients take away from this review?
• Dr. Thyssen: Despite consumer coin handling infrequently case nickel sensitization and dermatitis,
professional coin exposure does indeed cause morbidity.
• This should be considered in nickel allergic individuals who are in skin contact with coins, e.g.
cashiers.
• DermatologistsBlog.com: What recommendations do you have for future research as a result of
your study?
• Dr. Thyssen: Nickel release from new coins should be determined, and we recommend that mints
avoid nickel in future coin production.
• Citation:
• Coin exposure may cause allergic nickel dermatitis: a review.
• Thyssen JP, Gawkrodger DJ, White IR, Julander A, Menné T, Lidén C.
• Department of Dermato-Allergology, National Allergy Research Centre, Copenhagen University
Hospital Gentofte, DK-2900 Hellerup,Denmark Department of Dermatology, Royal Hallamshire
Hospital, Sheffield S10 2JF, UK Department of Cutaneous Allergy, St John’s Institute of Dermatology,
London SE1 7EH, UK Institute of Environmental Medicine, Karolinska Institutet, SE-171 77
Stockholm, Sweden.
• Contact Dermatitis. 2012 Jul 5. doi: 10.1111/j.1600-0536.2012.02127.x. [Epub ahead of print]


Recent skin self-examination and doctor visits in relation to melanoma risk and tumour depth
DermatologistsBlog.com Author Interview: Linda J. Titus, PhD
Yale University School of Medicine, PhD 1989
Connecticut College, MA 1983
Southern Connecticut State University, BA Section of Biostatistics & Epidemiology
Dartmouth Medical School One Medical Center Drive


• Dr. Titus: We found limited evidence that skin self-examination may reduce risk of melanoma, or risk of deeper tumors.
• The data also suggested that skin self-examination combined with a doctor visit may sharply reduce risk of melanoma.
• However, we did not see a dose response; that is, more frequent skin self-examinations did not result in a lower risk of melanoma.
• For this and other reasons, our findings may reflect confounding by “healthy” lifestyle behaviors.
For example, those who practice skin self-examination and regularly visit a doctor may also wear sun-protecting clothing.
Thus, although our findings are suggestive, they require verification by future studies before specific recommendations can be made.
• We also found that most melanomas are detected by laypersons, which has been seen in previous studies.
In our study, skin self-examination was also associated with self-detected tumors, but self-detected tumors were not shallower than tumors detected
by others. This may be due to delays in recognizing the tumor, or delays in seeing a dermatologist, or both.

• Dr. Titus: We did not find an advantage of having the melanoma detected by a physician, which has been shown in previous studies.
• This may reflect infrequent physician examinations, lack of skin examination during physician visits, or possibly lack of recognition of an early
melanoma.


• Dr. Titus: Melanoma occurs on the skin, giving us an opportunity for early detection.
• Laypersons and physicians alike should familiarize themselves with the characteristics of early melanomas.
Recognition of early melanoma is necessary before a benefit of skin examination can be realized.

• Dr. Titus: Future studies should assess the possible value of skin self-examination, with specific attention to the procedures involved and the
layperson’s knowledge of melanoma signs. In addition, future studies should carefully record the practices that lead to prevention or early detection.
• Citation:
• Titus, L.J., Clough-Gorr, K., Mackenzie, T.A., Perry, A., Spencer, S.K., Weiss, J., Abrahams-Gessel, S. and Ernstoff, M.S. (2012), Recent skin self-
examination and doctor visits in relation to melanoma risk and tumour depth. British Journal of Dermatology. doi: 10.1111/bjd.12003


Raf kinase inhibitor RKIP inhibits MDA-9/syntenin-mediated metastasis in melanoma.
DermatologistsBlog.com Author Interview: Dr. Paul B. Fisher, MPh, PhD
Professor and Chairman,Department of Human & Molecular Genetics
Director, VCU Institute of Molecular Medicine
VCU Massey Cancer Center Virginia Commonwealth University
School of Medicine Richmond, VA 23298-0033

• Dr. Fisher: Cancer metastasis, which is the ability of tumor cells to migrate from one site in the body and colonize in a distant region, represents a high priority area of research.
Moreover, the ability to control this process, which correlates with more than 90% of cancer-associated deaths, will have profound impact on the management of a patient’s cancer.
• Our research is focused on
• 1) elucidating the underlying genetic factors that mediate metastasis and
• 2) using this information to develop improved therapies to prevent this invariably fatal component of the neoplastic process. We previously identified a novel gene from human
melanoma cells, called melanoma differentiation associated gene-9 (also known as syntenin), mda-9/syntenin, that is a positive regulator of melanoma metastasis.
• In the present research, we document that a gene that can suppress cancer/metastasis (a tumor/metastasis suppressor gene), Raf kinase inhibitor (RKIP), can prevent metastasis by
directly affecting mda-9/syntenin changes in tumor cell signaling pathways.
• This is the first demonstration that targeting mda-9/syntenin using a genetic approach may provide a viable means of inhibiting metastasis in melanoma and in principal other
malignancies, since analysis of the human cancer genome indicates that MDA-9/syntenin is elevated in the majority of cancers, irrespective of anatomical site.
• We also demonstrate and inverse relationship between expression of MDA-9/syntenin and RKIP in advanced staged melanoma patient-derived clinical samples suggestion potential
applications for melanoma diagnosis and staging.
• Dr. Fisher: The present study tested a defined hypothesis that mda-9/syntenin is important in metastasis and blocking the action of this metastasis promoting gene using a genetic
inhibitor of metastasis, RKIP, would prevent metastasis.
• This hypothesis was validated and the results were expected. Mda-9/syntenin enhances expression of a transcription factor controlling other genes, NF-kB, which is inhibited by RKIP.
Inhibition occurs by physical interaction between MDA-9/syntenin protein and RKIP protein.
• Dr. Fisher: The present studies highlight an approach for preventing metastasis and indicate that this fatal process in cancer progression, at least with melanoma, can be inhibited.
Further studies are required to translate these preclinical studies into potential clinical trials to directly determine if targeting MDA-9/syntenin with RKIP or compounds that are RKIP
mimetics can prevent metastasis. Additionally, these two proteins could prove useful as biomarkers for diagnosing metastasis and for monitoring response to therapy, independent of
cancer type.
• Dr. Fisher: The major recommendations for future research are to develop innovative approaches to effectively deliver the therapeutic gene RKIP in a cancer-specific manner.
• In addition, it would be of value to develop small molecules that mimic RKIP and could be used as drugs to treat melanoma metastasis, and potentially other cancers.
• Citation:
• Raf kinase inhibitor RKIP inhibits MDA-9/syntenin-mediated metastasis in melanoma.
• Das SK, Bhutia SK, Sokhi UK, Azab B, Su ZZ, Boukerche H, Anwar T, Moen EL, Chatterjee D, Pellecchia M, Sarkar D, Fisher PB.
• Dept of Human and Molecular Genetics, Virginia Commonwealth University, School of Medicine.
Cancer Res. 2012 Oct 11. [Epub ahead of print]


Emotional benefit of cosmetic camouflage in the treatment of facial skin conditions
:personal experience and review
DermatologistsBlog.com Author Interview: Jason J. Emer, MD
Department of Dermatology, Mount Sinai School of Medicine,
5 East 98th St., 5th Floor, New York, NY

• Dr. Emer: This was not an official clinical trial but a review article demonstrating the published studies using cosmetic camouflage for medical therapy
— all of which showed excellent clinical results and improvement in the patients quality of life. with this paper we wanted to make aware the
potential benefit of using this type of therapy in conjunction with medical treatments; as our patients were extremely satisfied in the cases we
presented.

• Dr. Emer: No unexpected findings. In all cases our patients verbally expressed improvement in their quality of life, ease of use, and low financial
burden with the use of cosmetic camouflage. Further, they mentioned an improved physician-patient satisfaction from the mere offering of this
alternative therapy; as other physicians had not offered this to them in the past.

• All patients used this therapy in conjunction with their other medical treatments and had no adverse interactions.


• Dr. Emer: That cosmetic camouflage should be an alternative therapy that is offered to patients with cosmetically displeasing facial skin conditions
and that they can be used in conjunction with other prescription medical therapies with a low risk of adverse clinical effects or interactions.
• By offering non-traditional therapies, patients may be more likely to follow a treatment protocol as well help to strengthen the medical relationship
between the physician and patient.

• Dr. Emer: In the paper I discuss the need for studies demonstrating similar clinical results and/or less adverse reactions with the concomitant use of
this type of therapy (non-traditional, non-prescription) and prescription or procedural treatments.
• Emotional benefit of cosmetic camouflage in the treatment of facial skin conditions: personal experience and review
• Authors: Levy LL, Emer JJ
Department of Dermatology, Mount Sinai School of Medicine, New York, NY, USAPublished Date November 2012 Volume 2012:5 Pages 173 – 182
DOI: http://dx.doi.org/10.2147/CCID.S33860


Association of Pediatric Psoriasis Severity With Excess and Central Adiposity:
An International Cross-Sectional Study
DermatologistsBlog.com Author Interview: Amy S. Paller, MD
Walter J. Hamlin Professor and Chair Department of Dermatology of Pediatrics
Northwestern University’s Feinberg School of Medicine

• Dr. Paller: This major international study from 9 countries and 18 sites examined the association of
excess adiposity (overweight and obese as determined by BMI percentile) and central adiposity
(waist circumference percentile and waist-to-height ratio) with severity of pediatric psoriasis in 641
children and controls.
• Children with psoriasis were twice as likely as controls to be overweight or obese, regardless of the
severity of the psoriasis. The odds ratio of obesity in psoriatics vs. controls internationally was 4.3,
and was 7.6 in the U.S. group of children; the odds ratio of obesity was higher in severely affected
children (4.9) vs. children with mild psoriasis (3.6). Central adiposity, a strong indicator of
cardiovascular risk, was also significantly increased. Having a waist circumference of >90th
percentile occurred more than twice as often in children with psoriasis than controls, especially in
severe psoriatics and the significantly increased waist-to-height ratio was unaffected by severity.
Interestingly, there was no difference in either excess adiposity or central adiposity between
children with severe psoriasis at their worst, but mild at enrollment, and children who remained
severe at enrollment, suggesting that effective treatment does not affect adiposity.
• Dr. Paller: We were not surprised by the finding that children with psoriasis are heavier than
controls, but were intrigued by the extremely high odds ratios of the association and that severity
did not affect excess adiposity. Obviously, the clear association of psoriasis and central adiposity,
especially in children with severe psoriasis, further raises concern about the risk of cardiovascular
disease. We were also surprised and a bit discouraged that effective intervention did not affect
either excess or central adiposity in children with psoriasis.


Association of Pediatric Psoriasis Severity With Excess and Central Adiposity:
An International Cross-Sectional Study
DermatologistsBlog.com Author Interview: Amy S. Paller, MD
Walter J. Hamlin Professor and Chair Department of Dermatology of Pediatrics
Northwestern University’s Feinberg School of Medicine
(Cont)


• Dr. Paller: This study firmly cements the association of excess adiposity and central adiposity with pediatric
psoriasis of all severities and internationally. It reminds us to treat more than the skin lesions and, since altering
eating and exercise habits is much more effective if initiated early, to stress the importance of these lifestyle
changes in the group of children with psoriasis who are overweight.

• Dr. Paller: Clearly, longitudinal studies in affected children should be initiated to seek evidence of the development
of clinical and laboratory features of metabolic disease – and to assess how effective therapy of the psoriasis (vs.
of the excess adiposity) impacts their occurrence. One of the remaining questions is which comes first — the
adiposity or the psoriasis? We are actively pursuing the answer to this question in children, but a recent study
suggests that the psoriasis occurs in adults who are already overweight. In our study, approximately 30% of the
children had a first-degree relative with psoriasis; this provides an opportunity for dermatologists and primary
care physicians to counsel the entire family about a healthy lifestyle, with the possibility that prevention of excess
and central adiposity not only may improve cardiovascular health, but also may lower the risk of development or
severity of psoriasis. Finally, while there has been growing information about the genetics of psoriasis in the adult
population, there is little known about the genetics of pediatric psoriasis and how it may impact cardiovascular
risk factors; these studies should be initiated.

• Citation:
• Paller AS, Mercy K, Kwasny MJ, et al. Association of Pediatric Psoriasis Severity With Excess and Central Adiposity:
An International Cross-Sectional Study. Arch Dermatol. 2012;():1-11. doi:10.1001/jamadermatol.2013.1078.


Markers of circulating tumour cells in the peripheral blood of patients with melanoma
correlate with disease recurrence and progression.
DermatologistsBlog.com Author Interview: Dr. Mel ZIMAN PhD
Associate Professor, School of Medical Sciences
Edith Cowan University (ECU) Adjunct Senior Lecturer,University of Western Australia (UWA)
Perth, Western Australia

• Dr. Ziman: Research conducted in Western Australia and Boston U.S.A. looked at the role of circulating melanoma
cells in the blood of patients who had already been diagnosed with the disease, to determine whether these cells
relate to recurrence of the disease and treatment efficacy. The aim of the research was to identify those
subgroups of patients who are more likely to suffer disease recurrence or poor treatment outcomes, in order to
provide them with more targeted treatments at an earlier stage, which could improve survival rates. In a study
published in the British Journal of Dermatology, the researchers discovered the markers that can be used to
identify the tumour cells which make melanoma patients more likely to have their cancer spread or come back
following treatment. The study was conducted using the blood of 230 patients with both primary melanoma
(where it has not spread) and metastatic melanoma (spreading to other parts of the body), and compared with
the blood of 152 healthy controls.
• A test for the different genes produced by tumour cells was developed to identify those patients more likely to
have their cancer spread or come back following treatment. The researchers looked at five different markers of
these tumour cells. These markers are all found in melanoma tumour cells, of which there are some different
types.
• The presence and level of different genetic markers in the blood was shown to be useful in assessing a patient’s
disease spread, response to treatment, and risk of relapse.
• Dr. Ziman: Of the five markers we used, two were particularly helpful in determining disease progression and
recurrence. One of these ABCB5 is a melanoma stem cell marker. This has very important implications for
melanoma patients as the development of a minimally invasive method of measuring the frequency of melanoma
cells, and melanoma stem cells in particular, can be used to follow patient responses to current or novel and
emerging melanoma therapies. In turn this will help determine if a particular therapy is capable of eliminating the
aggressive cancer stem cell population required for the complete eradication of the cancer, potentially achieving a
cure.


Markers of circulating tumour cells in the peripheral blood of patients with melanoma
correlate with disease recurrence and progression.
DermatologistsBlog.com Author Interview: Dr. Mel ZIMAN PhD
Associate Professor, School of Medical Sciences
Edith Cowan University (ECU) Adjunct Senior Lecturer,University of Western Australia (UWA)
Perth, Western Australia
(cont)
• Dr. Ziman: The researchers found that the presence of these markers of tumour cells in a person’s blood does not necessarily correlate with disease
spread or recurrence, as these markers can still be present even when a patient is considered clinically disease free. It is in fact the behaviour and
characteristics (marker expression) of the circulating cells that is particularly important.
• The test can be used to assist clinicians to monitor patient progress after surgical removal of the tumour and during therapy.


• Dr. Ziman: Longitudinal studies are currently underway to substantiate our findings and to provide evidence of the efficacy of the blood markers of
melanoma in identifying those patients that are likely to suffer disease recurrence. The researchers have also published a study in the Journal of
Translational Medicine in which they show that circulating melanoma cells can be isolated from the blood of patients with early and late stage
melanoma and that the number of cells correlated with disease progression. This is not surprising as disease burden is likely to increase with
increase in disease stage. What is also required however is for researchers to determine the association between the characteristics of these cells
and disease progression and recurrence. We are vigorously pursuing this research and aim to provide a genetic profile of the circulating cells for each
patient that can be used to assist clinicians with the choice of therapy and then for monitoring response to therapy and resistance.
• Finally, while several studies are being undertaken to provide novel therapies for patients with melanoma, very few provide effective methods of
monitoring patient progress. Current monitoring of melanoma patients relies on expensive and /or invasive monitoring techniques. A blood test
that monitors patient progression and response to therapy would be relatively easy and inexpensive and could be utilized as a liquid biopsy. It is
anticipated that development of such a test could be a priority within the next few years.

• Citation:
• Markers of circulating tumour cells in the peripheral blood of patients with melanoma correlate with disease recurrence and progression.
• Reid AL, Millward M, Pearce R, Lee M, Frank MH, Ireland A, Monshizadeh L, Rai T, Heenan P, Medic S, Kumarasinghe P, Ziman M.
• School of Medical Sciences, Edith Cowan University, Perth, WA, Australia Department of Medicine School of Pathology and Laboratory Medicine,
University of Western Australia, Crawley, Australia Transplantation Research Center, Children’s Hospital Boston and Brigham & Women’s Hospital,
Harvard Medical School, Boston, MA 02115, U.S.A. St John of God, Dermatology, Perth, WA, Australia.


DermatologistsBlog.com | Dermatology - Skin Care Reserch Interview by Dermatologists

DermatologistsBlog.com | Dermatology - Skin Care Reserch Interview by Dermatologists

Recomendados

Recomendados

Mais conteúdo relacionado

Mais de Marie Benz MD FAAD

Mais de Marie Benz MD FAAD (20)

Último

Último (20)

DermatologistsBlog.com | Dermatology - Skin Care Reserch Interview by Dermatologists