Reuters (12/22, Rapaport) reported researchers found that “people who take a certain water pill [hydrochlorothiazide] prescribed to control fluid retention and treat high blood pressure may be more likely to get skin cancer than other individuals.” The article pointed out that the drug has previously been linked to an increased risk of sunburn, but the new research linked the common medication to basal cell carcinoma and squamous cell carcinoma. The findings were published in the Journal of the American Academy of Dermatology.
Reuters reports researchers used an enzyme solution “to change the pigmentation of skin cells in mice from very fair to dark, which protected their cells from the type of UV damage that can lead to skin cancer,” according to a study published in Cell Reports. The article suggests that in the future, people may “be able to get a tan without exposing their skin to the harmful ultraviolet (UV) radiation that’s responsible for skin cancers.” Also covering the story are BBC News (UK) and Popular Science.
The U.S. Food and Drug Administration (FDA) has issued a warning to providers and the public that unapproved versions of the dermal filler Juvederm are being sold and distributed illegally in the United States. According to the FDA Office of Health and Constituent Affairs, “Health care providers and consumers should avoid products labeled as Juvederm Ultra 2, 3 or 4, because these products are not approved by the FDA for use in the U.S., and their safety and effectiveness cannot be assured.”
When it comes to medical care, hoping for the best but preparing for the worst may be the best defense against adverse events. Read more on how to prevent and manage common adverse reactions in Dermatology World.
A recent study examined the risk of developing erectile dysfunction in men with benign prostatic hyperplasia or alopecia taking the 5-α reductase inhibitors finasteride and dutasteride.
Lauper shares her psoriasis story and encourages others to speak out
Throughout her 30-year career, Cyndi Lauper has inspired many people with her hit songs like “Girls Just Want to Have Fun” and “Time After Time.” Today, the Grammy, Tony and Emmy Award-winning singer, songwriter and actress shows her true colors for a different reason: She has psoriasis and is speaking out about the physical, social and emotional effects of this condition.
Lauper was on tour when psoriasis first flared on her scalp. She’d just dyed her hair and initially thought the sores on her head were some type of bug. A doctor confirmed it was scalp psoriasis.
Dermatology World (5/1, Carol) reports that “with the recent escalation of generic drug prices, dermatologists are finding themselves having to rethink some common treatment therapies, substituting them more often, and taking additional steps to assist their patients in obtaining the medications they need.” In the meantime, “the AAD staff and its Regulatory Policy Committee are conducting an environmental scan and analysis to define the problem, noted Adam Rubin, MD, committee chair.” The AAD is now “forming a Task Force on Drug Pricing and Drug Pricing Transparency to gather specific data about how this problem is affecting dermatology in particular.”
NBC News (3/5) reports on its website that “family practitioners, gynecologists and even dentists are getting into the cosmetic procedure business, and dermatologists say they’re seeing the side effects.” Several dermatologists “from around the country told NBC News that they’ve had to fix the mistakes of physicians who are dabbling in their specialty.” In a statement, the American Academy of Dermatology said, “A dermatologist is a licensed medical doctor and the only residency-trained physician fully educated in the science of cutaneous medicine, which includes medical and surgical conditions of the skin, hair, nails and mucous membranes.” An embedded video features a Today Show segment on the topic. AAD member Dr. Jerome Potozkin is featured in the story.
The NPR (3/5, Rutsch) “Shots” blog reports that research published in JAMA Dermatology indicates that individuals “with eczema missed 68 million work days in 2012.” Nearly “one-tenth of those were due to doctor appointments and other management of the disorder.” The majority “of the days were lost to health problems commonly associated with eczema, including allergies, asthma, heart disease or osteoporosis.” The researchers used data from the National Center for Health Statistics for the study.
HealthDay (3/5, Preidt) reports that the research “also found that adults with eczema were more likely to be unable to afford prescription medicines, or to delay care due to worries about costs.” Patients “were also more likely to experience delayed care because they could not get a medical appointment soon enough, reach a doctor’s office or had to wait too long to see a” physician.
The latest research confirms that there is no association between Isotretinoin( Accutane) use and inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease. Please read the article.
Isotretinoin Exposure and Risk of Inflammatory Bowel Disease
Adapted from a presentation by Margaret Lee, MD, PhD, at the 2014 National Eczema Association Patient Conference
Let’s Learn from Each Other
As a doctor, I learn continuously from my patients, and I know that all of my patients and families are unique. Each person is an individual; each family has their individual issues. But you are not alone. Birds of a feather who flock together are happier. You are fortunate to have a support organization like the National Eczema Association. Not all patients do.
I Can Relate
I’m sure many of you go to the doctor, and think, “You have perfect skin, so how do you know what it’s like to be itchy all the time?” I actually did grow up as an itchy kid. While I have not had the severity of full-body eczema that some patients suffer with, I relate to having really sensitive skin and contact allergies. Some of the tips that I’ve come up with to help patients with atopic dermatitis come from things that I have benefited from myself or would be willing to try.
NEA asked this question on Facebook recently: In order for prescription medications to be most effective, a proper bathing and moisturizing regimen is required. What’s your bathing and moisturizing routine? Here’s what people had to say:
SR: Try soaking in a bath for 20 minutes (lukewarm) then immediately apply a moisturizer before drying then allow your skin to air dry. Also fish oil, flax seed oil, any sort of anti-inflammatory oil is beneficial.
GM: Two baths, one in the morning and one before going to bed! I immediately apply a moisturizer followed by Aquaphor Healing Ointment. I apply Curél Itch Defense lotion 3x’s a day or as needed.
US News & World Report (12/18, Leonard) reports that research published “in JAMA Dermatology found that windshields used in airplanes are not strong enough to protect the inside of a plane from UV radiation.” The article points out that “the incidence of melanoma has continued to increase during the last four decades, according to the American Academy of Dermatology, though it is curable when it is detected early.”
HealthDay (12/18, Preidt) reports that the study found that “airline pilots get as much exposure to cancer-causing UV rays in an hourlong flight as they would during 20 minutes in a tanning bed.”
Much has been studied about how psoriasis results in increased expenses to patients from many cost sources, such as visit charges and other patient copayments. However, psoriasis treatments also results in travel costs and lost time, according to a recent study in Dermatology and Therapy.
For the study, the researchers set out to evaluate the multidimensional economic burden of psoriasis to patients. The study was based on 232 Finnish patients with psoriasis (n=199) or psoriatic arthritis (n=33) visiting a tertiary level dermatological clinic during a 1-year study period between October 1, 2009 and September 30, 2010.
The data were based on a patient questionnaire, clinical data from the medical records and reimbursement data from the Finnish Social Insurance Institution. Item costs were based on true costs charged from the patients and all time cost estimates were based on the Human Capital Approach method.
Results showed that total costs were higher for patients receiving traditional systemic medications or phototherapy than those not receiving such treatments.
Travel costs and travel time costs accounted for more than 60% of the costs of phototherapy. Skincare at home was time consuming and thus caused significant burden to patients. The majority of the visit costs arose from hospital visits and only a small proportion were attributed to visiting primary healthcare providers.
Overall, visit charges and other patient copayments were estimated to play a minor role in the total cost of psoriasis incurred by patients, while travel costs and lost time comprised the majority of the costs, which should not be omitted in future studies regarding costs of treatments, concluded researchers.
Mustonen A, Mattila K, Leino M, Koulu L, Tuominen R. Psoriasis causes significant economic burden to patients. Dermatol Ther (Heidelb). 2014;4(1):115-124.
Psoriasis, Uncontrolled Hypertension Linked- But Why?
(HealthDay News) — People with more severe cases of psoriasis may be at increased risk of uncontrolled hypertension, according to a study published online October 15 in JAMA Dermatology.
“We still don’t fully understand why we see a higher prevalence of cardiovascular risk factors in people with psoriasis,” study leader Junko Takeshita, MD, a clinical instructor of dermatology at the University of Pennsylvania in Philadelphia, told HealthDay. But, Takeshita said, chronic inflammation could be a common denominator.
The current findings are based on an electronic medical database that included 13,299 adults diagnosed with hypertension. Of those people, 1,322 also had psoriasis. Takeshita’s team found that among people with severe psoriasis (affecting more than 10% of their skin), almost 60% had uncontrolled hypertension (a reading of ≥140/90mmHg). What’s more, their odds of poorly controlled blood pressure were 48% higher, vs. people without psoriasis. Meanwhile, people with moderate psoriasis (at least 3% of the skin affected) had a 20% higher risk.
The researchers did consider other factors that affect blood pressure control, including people’s weight, smoking and drinking habits, and use of medications that can raise blood pressure. But psoriasis itself was still associated with a higher risk of uncontrolled hypertension. Takeshita agreed that the findings bring more awareness to the cardiovascular risks many people with psoriasis face. “Even among doctors, there’s still an under-recognition,” she said. A big question, Takeshita noted, is whether getting severe psoriasis under better control with medication can improve people’s cardiovascular health, too.
A study conducted in more than 100 schoolchildren found that daily treatment with a vitamin D supplement significantly reduced the symptoms of winter-related atopic dermatitis.
“While we don’t know the exact proportion of patients with atopic dermatitis whose symptoms worsen in the winter, the problem is common,” said Carlos Camargo, MD, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
“In this large group of patients, who probably had low levels of vitamin D, taking daily vitamin D supplements — which are inexpensive, safe and widely available — proved to be quite helpful.”
Atopic dermatitis is uncomfortable and makes patients more vulnerable to bacterial infection. Symptoms of the disorder are often worse during wintertime. While controlled administration of ultraviolet light, which can stimulate the production of vitamin D in the skin, is a common treatment for severe atopic dermatitis, the possibility that vitamin D deficiency contributes to the seasonal worsening of symptoms had received little consideration prior to this study.
The study included 107 children aged 2 to 17 years from 9 outpatient clinics in the capital city of Ulaanbaatar, Mongolia. The participants — all of whom had a history of atopic dermatitis symptoms worsening either during cold weather or around the transition from autumn to winter — were randomised to receive a daily vitamin D dose of 1000 IU or placebo in a double-blinded fashion.
Standard evaluations of atopic dermatitis symptoms were conducted at the outset of the trial and at the end of the month-long study period, and parents were also asked whether they saw any improvement in their child’s condition.
At the end of the month, children receiving the vitamin D supplement had an average 29% improvement on the primary assessment tool used, compared with 16 % improvement in the placebo group. Additional assessments — including the report from parents — also showed significantly greater improvement among children receiving vitamin D.
While data gathered at the outset of the study could not determine whether or not participating children were deficient in vitamin D, the authors noted that an even larger study of Ulaanbaatar children conducted at the same time found significant vitamin D deficiency in 98% of participants, supporting the probability that the children in this study were also deficient.
While future studies are needed to assess the value of vitamin D treatment in adults and in children with year-round symptoms, Dr. Camargo said that parents of children with symptoms that worsen in the winter should try a vitamin D supplement for a few weeks when symptoms flare to see if it helps.
SOURCE: Massachusetts General Hospital
The attached article confirms what Dermatologists have known for a long time- that good ,complete, thorough, regular screening for Melanoma increases the detection of thinner Melanomas. This results in more lives being saved as the thinner the Melanoma, the higher the chance that it can be removed completely, and therefore not spread and cause more serious problems.
Thicker Melanomas can be more serious and even fatal. If you are in a high risk group-someone with a previous history of Melanoma, and family history of Melanoma, large numbers of moles, history of other skin cancers, immune suppressed, fair skinned/ light haired/ blue eyed, frequent sunburns as a child/ teenager, outdoor occupation or a high amount of time in the sun, etc- it is IMPERATIVE that you get yearly skin exams- OR even more frequently if directed by your Dermatologist.
Please contact us with questions or to schedule an appointment.
There was wide coverage of the news that Merck & Co. on Thursday received FDA approval for a novel cancer medication called Keytruda (pembrolizumab), with major newspapers, news agencies and trade journals reporting. Many media outlets highlighted the significance of the medication, noting that Keytruda belongs to a new class of medications for treating advanced melanoma, using the body’s own immune system. The Wall Street Journal (9/5, Loftus, Subscription Publication) discusses the importance of the approval, noting that it is aimed at treating patients who have exhausted other therapies, including those people who did not respond adequately to Bristol-Myers Squibb Co.’s immunotherapy Yervoy (ipilimumab).
Writing about the mechanism of action of the new therapy, the New York Times (9/5, Pollack, Subscription Publication) reports that cancer researchers have been struggling to solve how cancerous cells manage “to evade the body’s immune system” and the “answer is that tumors activate brakes on the immune system, preventing it from attacking them.” The paper notes that Keytruda “is the first drug approved that inhibits the action of one of those brakes, a protein known as PD-1, or programmed death receptor 1.” The Times notes that the general approach could “work for many types of cancer, though so far the main successes in clinical trials have come against the deadly skin cancer melanoma, lung cancer and kidney cancer.”
Discussing the results of trials that facilitated the approval of the medicine, the Los Angeles Times (9/5, Healy) reports the FDA disclosed Keytruda “showed promising early results in 173 clinical trial participants with advanced melanoma whose disease progressed after prior treatment.” About a quarter who were given one of two doses of Keytruda “saw their tumors shrink.” According to the piece, “the effect lasted at least 1.4 to 8.5 months and continued beyond this period in most patients.”
According to Bloomberg News (9/5, Edney, Koons)melanoma “accounts for 2 percent of skin cancer cases and causes the majority of deaths from the disease,” including nearly 10,000 expected this year, citing the American Cancer Society. The article notes that the treatment “was approved under the FDA’s accelerated approval program,” but Merck will still have to show “the benefits through an improvement in survival or disease-related symptoms.”
The treatment, however, does not come cheap, with “early shipments” of Keytruda costing “$112,000 a year for an average patient,” and later versions reaching $150,000 a year, reports the Philadelphia Inquirer (9/5), citing Bernstein Research analyst Tim Anderson. In a note to clients Thursday Anderson expects “that Merck’s sales from Keytruda will be about $3.5 billion in 2020,” the paper adds.
The news was also covered by the AP (9/5, Johnson), Reuters (9/5), the Houston Chronicle (9/5), CNBC (9/5), Fox News (9/4), Forbes (9/4), HealthDay (9/5), MedPage Today (9/5), Medscape (9/5) and AFP (9/5).
Reuters (8/22, Beasley) reports that a study published Aug. 21 in the journal Preventing Chronic Disease found that according to survey data from the Centers for Disease Control and Prevention, high school students are using sunscreen less frequently, with the percentage dropping to 56.1 percent in 2011 from 67.7 percent in 2001.
The NBC News (8/22, Fox) website reports that “even though the federal government warns that indoor tanning raises skin cancer risk, more than 29 percent of white girls still used them in 2011.” Study author Corey Basch said “these findings indicate the need for prevention efforts aimed at adolescents to reduce risks for skin cancer.”
HealthDay (8/22, Reinberg) reports that “the reasons for the decreased use of sunscreen among teens aren’t clear, Basch said, but she thinks future research should focus on finding out why.” The Newark (NJ) Star-Ledger (8/22, O’Brien) also covers the story.
TIME (8/2, Vuillermoz) reports that, despite the fact that allergies to hair dye are “quite rare, affecting about one in 250,000 people,” the reaction can “prove to be just as serious as a nut or shellfish allergy.” Debra Jaliman, MD, a New York City-based dermatologist, says that “if you develop a severe allergy, you could get blisters and hives and, though rare, difficulty breathing similar to an anaphylactic reaction,” which can be fatal.
The attached article from the Journal of the American Academy of Dermatology confirms what seems logical. Melanoma patients who are closely monitored by their dermatologists will be diagnosed earlier , potentially saving lives. These patients tend to have melanoma in situ- a thinner melanoma, at time of first diagnosis. Thinner melanomas have a much better chance of complete cure and no further problems or issues.. Delay in diagnosis can lead to thicker and deeper melanomas, with potential for spread and possible death. We encourage all melanoma patients to be screened frequently, and others who have an increased number of moles/ growths to do the same. Please see the sites on our links page for more information on melanomas and skin cancer. You can also contact us for further information or to schedule an appointment.
It is well known that the rates of skin cancer in the United States have increased dramatically in recent decades, but a little known fact is that the rate of melanoma increase in Hispanics has risen 20% in the past two decades.
It is not entirely clear what is causing this increase, but it may be due to the misconception that people with darker skin are not at risk of developing skin cancer. Some studies suggest that there is also a lack of skin cancer education campaigns for Hispanics, and physicians may also be at fault for not emphasizing the danger to their Hispanic patients.
The following statistics may help to explain why we are seeing such an increase in skin cancer in our Hispanic patients:
The bottom line is that our Hispanic population needs to be more aware of the risk of skin cancer, and there needs to be more skin cancer education campaigns for the Hispanic community. One frightening statistic is that Hispanics with melanoma have poorer survival than non-Hispanic patients, quite likely due to being diagnosed at a later stage. A recent study showed that while melanoma diagnoses were late stage in 16% of white patients, the number jumped to 26% for Hispanics.
These findings underscore the urgency for year around sun protection, regular skin self-examinations, and annual visits to a dermatologist for everyone, no matter what their ethnicity or skin tone.
A recent study by the Centers for Disease Control found that in a given year, 30% of White female high school students engaged in indoor tanning at least once, and almost 17% did so at least ten times.
One out of four young White women in the age group 18-34 engaged in indoor tanning at least once in the previous 12 months and over 15% did so at least ten times.
So what does this mean in terms of skin cancer risk? Just one indoor UV tanning session
Here is a frightening statistic: more than 170,000 cases of non-melanoma skin cancer in the United States each year are linked to indoor tanning.
The take away message from this is that indoor tanning is dangerous, and if one really wants a tan it is better to use self-tanning lotions than to go into the tanning booths.