Reducing The Health Risks For Children From Ozone Layer Depletion

Looking at your shadow (the shorter it is, the more dangerous UV radiation is 1), and covering up with hats, sunglasses and sunscreen, are among the practical tips for children contained in a new guide on the ozone layer for primary school teachers.


The OzonAction Education Pack, launched globally today in English, French and Spanish, contains an entire teaching and learning programme, based on basic knowledge, practical skills and participation, to enable children to learn about simple solutions to protect the ozone layer and safely enjoy the sun.


"While we have hope that the atmosphere is healing and that the Montreal Protocol is working, we are still facing serious challenges," said Achim Steiner, UN Under-Secretary General and Executive Director of the United Nations Environment Programme (UNEP). "Children should be aware of the huge risks that a weakened ozone layer poses to human health and the environment and they must know that much remains to be done. We must give them the means to protect their own future, and education is certainly key in this regard," he said.


The pack, produced jointly by the United Nations Environment Programme (UNEP), the United Nations Educational, Scientific and Cultural Organization (UNESCO) and the World Health Organisation (WHO), has been released to co-incide with the International Day for the Preservation of the Ozone Layer on 16th of September. This year's theme is "Protect the Ozone Layer, Save Life on Earth".


"The OzonAction Education Pack will help schoolchildren to become aware of the simple protection steps that reduce solar UV health risks, and these become even more important as ozone layer depletion leads to intensified UV radiation on Earth," said Dr Anders Nordstr?m, Acting Director-General of WHO. "The severe health effects such as melanoma and other skin cancers are largely preventable through reduced sun exposure. UV protection thus becomes an important component of the global efforts towards cancer prevention." The ozone layer plays a crucial role in the protection of life on Earth from harmful effects of ultraviolet radiation. While some solar UV radiation is necessary for bone health and also may help to prevent certain chronic diseases, excessive sun exposure causes immediate and long-term health problems.


Sunburn - which can be severe and blistering - is an acute health problem, while skin cancer and cataract leading to blindness are the most severe long-term health effects. WHO estimates that about 1.5 million DALYs are lost every year due to excessive solar UV radiation. One DALY is equivalent to one lost year of life in full health.


The OzonAction Education Pack is also linked to the UN Decade of Education for Sustainable Development, which is led by UNESCO.


"The United Nations Decade of Education for Sustainable Development (2005-2014) aims to integrate the values inherent in sustainable development into all aspects of learning to encourage changes in behaviour which will enable a more viable and fairer society for everyone," said Ko?chiro Matsuura, Director-General of UNESCO. "During this Decade, education for sustainable development will help to make citizens better prepared to face the challenges of the present and the future, and to orient decision-makers in their efforts to create a viable world."


UNEP, UNESCO and WHO are jointly promoting the OzonAction Education Pack to countries around the world and encouraging Environment, Education and Health Ministries, schools and teachers to adopt it as part of the primary school curriculum.


The signing of the Montreal Protocol on Substances that Deplete the Ozone Layer on 16 September 1987 is now celebrated every year as the International Day for the Preservation of the Ozone Layer.


The development of the Education Pack was led by the OzonAction Branch in UNEP's Division of Technology, Industry and Economics and it was financially supported by the Multilateral Fund for the Implementation of the Montreal Protocol.

Phase III REGION-I Study Shows PEP005 (ingenol Mebutate) Gel 0.05% May Reduce Pre-Cancerous Skin Lesions In Patients With Actinic Keratosis

Specialty pharmaceutical company LEO Pharma announced that findings from a Phase III study evaluating PEP005 (ingenol mebutate) Gel 0.05% to treat actinic keratosis (AK), a common pre-cursor to skin cancer, were presented at the 68th Annual Meeting of the American Academy of Dermatology (AAD) (Scientific Session Poster Discussion: P105). Results from REGION-I demonstrated treatment with PEP005 Gel once daily for 2 consecutive days (n=117) on non-head locations resulted in significant clearance of AK lesions when compared with the vehicle or placebo (n=118). The study showed a 66.7% median reduction in the number of AK lesions, (p

PEP005 (ingenol mebutate) Gel at AAD


Phase II data evaluating the safety and efficacy of PEP005 in both head and non-head locations were included in AAD poster sessions:



-- Multicenter, randomized, double-blind, vehicle-controlled, dose-ranging study to evaluate the efficacy and safety of PEP005 (ingenol mebutate) Gel, 0.005%, 0.01%, and 0.015% when used to treat actinic keratoses (AK) on the head.(ii)


P2913: Electronic Poster



-- Multicenter, open-label, dose-area escalation, cohort study to evaluate the safety and tolerability of PEP005 (ingenol mebutate) Gel, 0.05% applied for 2 consecutive days to treatment area(s) of up to a total of 100 cm2 in patients with actinic keratoses (AK) on the extensor (dorsal aspect) forearm(s).(iii)


P2915: Electronic Poster


About REGION-I


REGION-I is a Phase III, multicenter, randomized, parallel-group, double-blind, vehicle-controlled study, evaluating the efficacy and safety of PEP005 (ingenol mebutate) Gel 0.05% once daily for 2 consecutive days (n=117) compared with vehicle (n=118) to treat patients with actinic keratoses on non-head locations. Eligible patients were randomized 1:1 to PEP005 Gel or vehicle, and were assessed for clearance on days 3, 8, 15, 29 and 57. The primary objective was to compare the efficacy, as measured by complete clearance, of PEP005 Gel with the vehicle. The secondary objective was the partial clearance of AK lesions. Safety was also assessed by the incidence rate of adverse events (AEs) serious AEs and AEs leading to discontinuation, as well as by the incidence rate and grade of Local Skin Responses (LSRs), pigmentation and scarring.(i)


About Actinic Keratosis


Actinic keratosis (AK), also known as solar keratosis or sun spots, is a common pre-cancerous skin condition caused by sun exposure which can develop into skin cancers if left untreated. The number of AK patients is both large and rapidly growing, and AK is a serious health problem. People with fair skin are more likely to develop AK and today it is estimated that 100 million people in the United States, European Union, Canada and Australia have the disease. Less than 10 million people are in treatment. The American Academy of Dermatology reports that 40 percent of all squamous cell carcinomas begin as AK.


About LEO Pharma


Founded more than 100 years ago, LEO Pharma is an independent, research-based specialty pharmaceutical company committed to the discovery and development of novel drugs for patients within the areas of Dermatology and Critical Care Medicine. With a strong portfolio of approved products including market leading topical psoriasis treatments TACLONEX®, TACLONEX® Scalp Topical Suspension, DOVONEX® Cream and DOVONEX® Scalp Solution and a robust pipeline of treatments in development for conditions including psoriasis, eczema and actinic (solar) keratosis, LEO Pharma is one of the leading dermatology companies in the U.S. and the world.


References


(i) Swanson N. Multicenter, randomized, parallel-group, double-blind, vehicle-controlled study to evaluate the efficacy and safety of PEP005 (ingenol mebutate) Gel, 0/05% in patients with actinic keratosis (AK) on non-head locations. 68th Annual Meeting of the American Academy of Dermatology. Poster session PD01 on Saturday, March 6, 2010 at 7:50 AM EST. Abstract P105.


(ii) Multicenter, randomized, double-blind, vehicle-controlled, dose-ranging study to evaluate the efficacy and safety of PEP005 (ingenol mebutate) Gel, 0.005%, 0.01%, and 0.015% when used to treat actinic keratoses (AK) on the head. Abstract 2913.


(iii) Multicenter, open-label, dose-area escalation, cohort study to evaluate the safety and tolerability of PEP005 (ingenol mebutate) Gel, 0.05% applied for 2 consecutive days to treatment area(s) of up to a total of 100 cm2 in patients with actinic keratoses (AK) on the extensor (dorsal aspect) forearm(s). Abstract 2915.

Latest Findings From Hair, Skin, Color And Shaving At AAAS Annual Meeting

P&G Beauty & Grooming scientists presented research at the AAAS Annual Meeting (Chicago, Feb. 12-16) that offers evidence of science's role in evolving beauty and grooming product efficacy. This year's meeting theme observes the 200th anniversary of Charles Darwin's birth, affording a unique perspective for examining the company's use of advanced science and technology to help individuals feel and look their best. Five studies--with subjects ranging from color optics to skin aging genomics to razor engineering--will be on display.



"The way people have managed their personal beauty and grooming routines continues to evolve, and scientists at P&G Beauty & Grooming are constantly driven to apply science insights to bring more advanced products to the market," said Steve Shiel, PhD, Associate Director, P&G Beauty & Grooming Science. "The AAAS Annual Meeting provides a premier forum for us to share insights with science peers and hear feedback that can lead to new hypothesis."



The following research summaries provide illustrations of the rigor brought to bear on product innovation at P&G Beauty & Grooming.



Color Science



More than Meets the Eye: The Science of Unique Skin Color and its Interaction with Cosmetic Foundation, Presented by Karen Kalla



The optics of human skin are well understood, including how the skin's chromophore layers (melanin, hemoglobin, and collagen) generate reflectance in specific regions of the visible spectrum. However, how these phenomenon vary across populations, impact skin defects (e.g. under eye circles, age spots) and can be predicted through light absorption and scattering principles (Kubelka Munk theory) are less well known. This poster outlines our combined understanding of these areas, and sets forth the scientific process involved in applying this knowledge to create better color foundation formulations to eliminate the problems of pasty or orange look on skin.



Genomics of Skin Aging



Genomic Analysis of the Anti-oxidant Capacity of Aging Skin, Presented by Rosemarie Osborne, PhD



Studies have established that environmental factors, such as UV light, trigger skin damage and photo-aging. And while the benefits of antioxidants in offsetting this damage have been documented, thorough understanding of skin's anti-oxidant response element (ARE) on a genomic level are key to the next generation of targeted prevention and reversal strategies. To uncover these insights, researchers analyzed gene expression patterns in sun-exposed and sun-protected old and young skin. The study results detail the genomic patterns found, including a pathway which found older, exposed skin having a dysregulated expression of ARE-related proteins, thus resulting in reduced defenses against oxidative damage, as compared to younger skin.



Stratum Corneum Lipid Metabolism Pathways Associated with Intrinsic and Extrinsic Aging, Presented by Rosemarie Osborne, PhD
















The same genomic study described above found new insights on the stratum corneum, the skin's barrier layer responsible for protecting against environmental assaults. Through a separate analysis, P&G Beauty & Grooming researchers gleaned vital genomic understandings of the respective roles of intrinsic and extrinsic aging in affecting the stratum corneum's ability to perform its core function. The same study analyzed this affect while adding the variable of a topical cosmetic compound, using human skin equivalents. The results demonstrated that the compound increased the expression of genes involved in lipid biosynthesis and metabolism of the stratum corneum, leading to new appreciation of its potential in improving barrier maintenance and repair.



Hair Science



Liquid Crystals for Surface Modifications of Colored Hair, Presented by Steve Shiel, PhD



Conventional oxidative hair color processes, such as bleaching, change the structure of hair fibers, removing more than 70 percent of the natural, hydrophobic protective layer after even a single coloring. This structural change inhibits hair's interaction with traditional, hydrophobic conditioning ingredients, such as dimethicone, leaving bleached hair in an unprotected state. To address this damage, P&G Beauty & Grooming scientists studied the effect of liquid crystal technology. Liquid crystals were found to significantly increase the hydrophobicity of the hair surface, enabling bleached hair to be conditioned with dimethicone. A description of this proprietary technology and its benefits to hair structure is presented.



Grooming Science



Innovations in Modern Blade and Razor Technology, Presented by Pamela Zupkosky



The modern five-blade razor is the product of years of research and technological advances. A five-blade razor is not a new idea, but it has taken almost 90 years to perfect the technology. Like all multi-blade razors, the five-blade razor improves the closeness of the shave through the "hysteresis effect," which results from a slight hair extension out of the follicle as the first blade engages and from the hair being cut further down the hair shaft by the subsequent blades. But the five-blade razor goes far beyond other multi-blade razors. P&G Beauty & Grooming scientists had to carefully optimize the inter-blade span and blade edge technology to ensure that closeness is complemented with excellent shaving comfort and rinsing properties.







About P&G Beauty & Grooming



P&G Beauty & Grooming has more than 1,800 scientists and technical employees working at 9 global technical centers with an unparalleled commitment to technology development. Company scientific efforts have resulted in over 10,000 active beauty and grooming patents. This allows P&G to develop products uniquely suited for different types of hair and skin, and tailored to different cultures and climates.

Location Of Plantar Ulcerations In Diabetic Patients Referred To A Department Of Veterans Affairs Podiatry Clinic

We described the location of foot ulcers through a chart review of diabetic patients in a Department of Veterans Affairs podiatry clinic and looked for connections between ulcer location and specific medical features.


We hypothesized that individuals with diabetes rarely have heel ulcers but that heel ulcers are directly related to peripheral neuropathy and diminished vascular function.


We found that patients with reduced vascular function were five times more likely to have heel ulcers than patients with adequate vascular function. The importance of understanding the risk factors for heel ulcers stems from a lack of available treatments. Further research should study the effectiveness of interventions for patients with reduced vascular status.


Download PDF file


About the Journal of Rehabilitation Research and Development


JRRD has been a leading research journal in the field of rehabilitation medicine and technology for more than 40 years. JRRD, a peer-reviewed, scientifically indexed journal, publishes original research papers, review articles, as well as clinical and technical commentary from U.S. and international researchers on all rehabilitation research disciplines. JRRD's mission is to responsibly evaluate and disseminate scientific research findings impacting the rehabilitative healthcare community.


Journal of Rehabilitation Research and Development

What Is Cellulite? What Causes Cellulite?

Cellulite is a term used to describe the dimpled appearance of skin caused by fat deposits that are just below the surface of the skin. It generally appears on skin in the abdomen, lower limbs, and pelvic region, and it usually occurs after puberty. Cellulite is also known as adiposis edematosa, dermopanniculosis deformans, status protrusus cutis, and gynoid lipodystrophy in the medical field and as orange peel syndrome, cottage cheese skin, hail damage, and the mattress phenomenon in colloquial language.


Cellulite is often classified using three grades. Grade 1 classification sees no clinical symptoms, but a microscopic examination of cells from the area detects underlying anatomical changes. Grade 2 cellulite requires the skin to show pallor (pastiness), be lower temperature, and have decreased elasticity in addition to anatomical changes noted by microscopic examinations. Grade 3 cellulite has visible roughness of the skin (like an orange peel) along with all grade 2 signs.
Cellulite occurs in both men and women, but it is much more common in women because they are more likely to have particular types of fat and connective tissue.
What causes cellulite?
The causes of cellulite are not well understood, but there are several theories that have been put forth as explanations. Among these are:

Hormonal factors - hormones likely play an important role in cellulite development. Many believe estrogen, insulin, noradrenaline, thyroid hormones, and prolactin are part of the cellulite production process.

Genetics - certain genes are required for cellulite development. Genes may predispose an individual to particular characteristics associated with cellulite, such as gender, race, slow metabolism, distribution of fat just underneath the skin, and circulatory insufficiency.

Diet - people who eat too much fat, carbohydrates, or salt and too little fiber are likely to have greater amounts of cellulite.

Lifestyle factors - cellulite may be more prevalent in smokers, those who do not exercise, and those who sit or stand in one position for long periods of time.

Clothing - underwear with tight elastic across the buttocks (limiting blood flow) may contribute to the formation of cellulite.

How can cellulite be removed?
There are several therapies that have been suggested to remove cellulite, but none have been supported in the scientific or medical literature.


Therapeutic methods that are physical or mechanical include pneumatic massages, massages that stimulate lymphatic flow, heat therapy, ultrasound, radio frequency therapy, magnetic therapy, radial waves therapy, Endermologie, and electrical stimulation. However, there is no solid evidence that these methods are effective.


A second class of cellulite removal strategies consists of drugs that are supposed to act on fatty tissues. There is a wide variation of pharmacological agents used, such as methylxanthines (caffeine and theobromine), pentoxifylline, beta-agonists and adrenaline, alpha-antagonists, amino acids, ginkgo biloba, rutin, and Indian chestnut among others. People with cellulite have tried to apply these agents topically, orally, or by injection, but none have been proved effective.















Some people with cellulite wear special clothing called compression garments to reduce the appearance of cellulite. These garments try to compress arteries and increase blood and lymph flow to reduce visual cellulite.



Cellulite reduction techniques such as liposuction and dieting actually do not remove cellulite. However, eating a healthful, balanced diet and exercising may be the best way to reduce the fat content in cells and reduce the appearance of cellulite.
How can cellulite be prevented?
Eating healthy, low fat foods such as fruits, vegetables, and fiber can help one to avoid cellulite. Similarly exercising regularly, maintaining a healthy weight, and reducing stress are recommended to prevent cellulite. In addition wearing thongs, boyshorts, or looser fitting undergarments can prevent cellulite that might form due to tight elastic.
News on Dermatology and Cosmetic Medicine
For the latest news and research on Dermatology and Cosmetic Medicine, and to sign up to newsletters or news alerts, please visit our Dermatology or our Cosmetic Medicine sections.
Video: New York Plastic Surgeon -Testing Cellulite Removal Products

Related articles

A Possible Cure For Unsightly Cellulite? Aesthetic Surgery Journal
Do Anti-Cellulite Creams Work?
Fat Melting Laser May Treat Cellulite, Heart Disease And Acne
Cellulite Found To Be Reduced By Weight Loss In Some Overweight Women
Dermatologists Debunk Myths, Offer Advice For Conditions That Hit Below The Belt
New Technologies Tighten Skin From Head To Toe Without Surgery
Caffeine's Use In Cosmetic Dermatology
Sources: National Health Service (NHS), UK, The Mayo Clinic, Wikipedia, HHS (Department of Health and Human Services USA), NIH (National Institutes of Health, USA).


Written by Peter Crosta M.A.


View drug information on Pentoxifylline.

New Generation Of Wound Care Products Providing Caregivers With Powerful Options

The introduction of new technologies and products for the treatment of acute and chronic wounds is providing caregivers with a set of powerful options that will have a profound effect on the field of wound management. These new treatment tools, which mimic the body's natural physiology and/or regenerative pathways, include tissue-engineered skin substitutes, regeneration matrices, and biologically active cellular therapies.


These emerging products will be competing in a worldwide market worth billions, and in which improvements in quality-of-life and treatment outcomes continue to be top healthcare industry initiatives. As further data on patient outcomes becomes available, the number of approved indications as well as third party payer acceptance for bioengineered wound care products and therapies will increase, driving growth to significant levels beginning in the latter part of the decade.


Bioengineered Wound Care, a recently released report, analyzes emerging therapeutics, market participants, and key regulatory and technology factors influencing this market and driving acceptance of these next-generation wound care technologies. It is available from Greystone Associates by visiting link.



About Greystone


Greystone Associates is a medical and healthcare technology consulting firm providing services in strategic planning, venture development, product commercialization, and technology and market assessment.


greystoneassociates

Help - But No Miracle Cure - For Receding Hairlines

It's undeniable. Your hair is thinning around the temples. One look at your older brother's receding hairline shows you what's likely ahead -- and you'd rather not go there. But is there any way to avoid a receding hairline?


Thinning hair is common for men and women. But contrary to the too-good-to-be-true promises in advertisements, there's typically no cure.


The best first step may be to talk with your doctor to determine what's causing the hair loss. If you have a common type of hair loss called androgenetic alopecia (al-o-PE-she-uh), medication and surgery options approved by the Food and Drug Administration (FDA) may help, according to the June issue of Mayo Clinic Health Letter.


Medications: Two FDA-approved medications are available. Their effectiveness varies with the extent of hair loss and individual response to the medication.


Minoxidil (Rogaine, others) -- These liquid products are available in nonprescription formulas and are applied directly to the scalp. Although only 7 percent of the men and women experience some hair regrowth, about 75 percent report significant slowing of hair loss.


Finasteride (Propecia) -- Approved for use by men only, this oral prescription medication acts by interfering with the hormone that normally shrinks hair follicles. Clinical trials show that about 75 percent of men using finasteride alone experience a slowdown in hair loss. Nearly half experienced some new hair growth.


Surgical options: If you have extensive hair loss, or medications prove unsuccessful, ask your doctor about surgical procedures.


Hair transplant -- This involves multiple surgeries where tiny micrografts of skin with one or two hairs are removed from the back of the scalp and implanted into bald areas or areas of thinning hair.


Scalp reduction -- The surgeon removes hairless scalp sections. In their place, areas of scalp with hair are pulled more closely together, reducing the bald surface.


Flap surgery -- This procedure involves folding and securing a section of the scalp with hair over an area of bald skin.


Hair transplants may be combined with other surgical approaches. Some who benefit from medications opt to have surgery done as well. Surgical procedures to address hair loss are generally costly and not covered by insurance.


Mayo Clinic

mayo/news


View drug information on Propecia.

Why Some Treatments Rescue Aging Skin

Fine wrinkles, deeper creases, saggy areas around the mouth and neck the sights in the mirror that make baby boomers wince are not inevitable. They result from a structural breakdown inside the skin that some existing treatments effectively counteract by stimulating the growth of new, youthful collagen, University of Michigan scientists say.


The researchers report an emerging picture of collagen collapse and possible renewal, based on more than a decade of studies, in the May issue of Archives of Dermatology.


The article draws on dozens of studies since the early 1990s, conducted primarily by U-M dermatologists, to explain why three types of available skin treatments are effective: topical retinoic acid, carbon dioxide laser resurfacing and injections of cross-linked hyaluronic acid.


These treatments all improve the skin's appearance and its ability to resist bruises and tears by stimulating new collagen. Collagen is a key supporting substance, plentiful in young skin, that's produced in the sub-surface layer of skin known as the dermis. The U-M findings show that the breakdown of the dermis' firm, youthful structure is a very important factor in skin aging a much more straightforward thing to fix than genetic factors that others theorize may be involved.


"Fibroblasts are not genetically shot," says John J. Voorhees, M.D., F.R.C.P., chair of the Department of Dermatology at the U-M Medical School and the article's senior author. Fibroblast cells in the skin are the key producers of collagen.


"We have shown that if you make more collagen go in, it provides an environment in which fibroblasts recover and make more collagen."


Voorhees and co-authors Gary J. Fisher, Ph.D., U-M professor of dermatology, and James Varani, Ph.D., U-M professor of microbiology and immunology and of pathology, hope the findings will help people make intelligent decisions amid the hype of the multi-billion-dollar anti-aging products industry. Fisher directs the U-M Photoaging and Aging Research Program.


"We want to educate clinicians about what's been found, and what it means in terms of how we may improve the appearance of people," says Voorhees, the Duncan and Ella Poth Distinguished Professor of Dermatology at U-M.


Young vs. old skin


Collagen formation and breakdown takes place in the dermis or inner skin the thicker, firm layer of skin that lies beneath the paper-thin outer skin or epidermis, much as a mattress lies beneath a sheet. Collagen consists of proteins that make up a supporting structure surrounding the skin cells. In youthful skin, collagen is firm, taut and abundant, like a new mattress. In older skin, the collagen structure begins to fall away, says Voorhees.


Just as a foam mattress over time becomes flatter in places and creased as its structure breaks down, aging skin begins to sag and wrinkle when its collagen is diminished and fragmented. The cycle of events involved in collagen loss is complicated.















As skin ages, reactive oxygen species, associated with many aspects of aging, lead to increased production of the enzyme collagenase, which breaks down collagen. Then fibroblasts, the critical players in firm, healthy skin, lose their normal stretched state. They collapse, and then more breakdown enzymes are produced. People in their 80s have four times more broken collagen than people in their 20s.


"What it's doing is dissolving your skin," Voorhees says. "What you've got is a vicious cycle. You have to interrupt it, or aging skin is just going downhill."


In the elderly, in whom the dermis has lost two-thirds or more of its youthful thickness through collagen loss, skin tears and bruises easily. Collagen-building interventions thus have potential for reducing basic health problems such as bed sores, in addition to improving appearance.


A growing body of evidence


The U-M researchers base their conclusions on past studies in which they have explored why certain anti-aging treatments are effective. A 2007 study looked at Restylane, marketed as a dermal filler, and found that injections of the product caused fibroblasts to stretch, promoting new collagen, and also limited the breakdown of collagen.


In another 2007 study, the U-M team tested lotions containing retinol, a form of Vitamin A found in many skin-care products, and found it significantly reduced wrinkles and skin roughness in elderly skin by promoting new collagen. Other U-M studies have shown why some laser treatments work and some less powerful ones do not. Carbon dioxide laser resurfacing is effective because it removes the aging dermis; in the three-week regrowth process, new, young collagen is produced.


Voorhees and his colleagues say they provide needed, independent research on the effectiveness of available and future treatments to counteract skin aging. They have no ties to the manufacturers of products they study. Funding has come from the National Institutes of Health and U-M.


University of Michigan Health System

2901 Hubbard St., Ste. 2400

Ann Arbor, MI 48109-2435

United States

med.umich

Uses For Botulinum Toxin - A Miracle Poison - Continue To Grow

First, it was infamous as a deadly form of food poison. Then, fame came as a temporary remedy for wrinkles. Now, botulinum toxin is considered the "miracle poison" and used for an increasing number of medical conditions.


The December issue of Mayo Clinic Health Letter covers how this drug works and its multiple and emerging applications.


Botulinum toxin blocks communication between nerves and muscles. Food poisoning occurs when large quantities are ingested, causing paralysis of the muscles that control breathing.


About 30 years ago, doctors found that injecting small amounts could safely immobilize muscle movements for as long as several months. The Food and Drug Administration has approved botulinum toxin to minimize fine facial wrinkles and to treat involuntary eyelid twitching and muscle contractions associated with crossed eyes. It can offer relief from sweating of the hands, feet and underarms and can help manage painful neck spasms (dystonia).


Other clinical uses include treating muscle conditions associated with cerebral palsy, multiple sclerosis, stroke and Parkinson's; and improving swallowing and speaking problems for people with vocal cord disorders.


Newer applications include facial scar healing and treatment for types of impaired bladder control. And the list goes on.


Results are mixed on whether botulinum toxin should have a role in headache management. For now, it isn't a first-line therapy for migraine but it may be a consideration for those who haven't had success with other treatment.


If you're considering a treatment that involves botulinum toxin, check to see that your doctor has considerable experience using the drug. Also check with your insurance company about coverage. The injections are costly and may not be covered.


Mayo Clinic

200 First St. SW

Rochester, MN 55902

United States

mayoclinic/

Over 70% Repigmentation Achieved In Patients With Stable Vitiligo

A high percentage of repigmentation is achieved in patients with stable vitiligo by noncultured epidermal cell transplantation, according to both subjective and objective evaluation methods.


In this soon to be published study in the journal "Dermatology", noncultured autologous melanocytes and keratinocytes were grafted in a hyaluronic-acid-enriched suspension on superficially laser-abraded vitiligo lesions in 40 patients with refractory stable vitiligo.


The repigmentation was evaluated 3-12 months after grafting using a digital image analysis system. Furthermore, the treatment was evaluated from the patients' point of view with the Dermatology Life Quality Index and a global assessment.



The mean percentage of repigmentation at the last follow-up visit was 72%; a repigmentation of more than 70% was observed in 62% of the patients. The best results were achieved in the neck and presternal regions.


All patients were satisfied with the achieved results, found it worthwhile to undergo the treatment and would choose to do so again.


About the S. KARGER AG


With over a century of experience in connecting the world of biomedical science, Karger publishes nearly 80 scientific, peer-reviewed journals and 150 serial and non-serial books and supplement issues annually for a global scientific readership.


karger

GlaxoSmithKline Announces Altargo® Receives Positive Opinion In Europe For Treatment Of Impetigo And Other Skin Infections

GlaxoSmithKline (GSK) today announced that its new, novel topical antibiotic ALTARGO® (retapamulin ointment, 1%) received a positive opinion from the European Committee for Human Medicinal Products (CHMP) for the treatment of impetigo and infected small lacerations, abrasions or sutured wounds. Impetigo is a superficial skin infection most commonly seen in children. The CHMP's positive opinion will now be proposed for final marketing approval by the European Commission.


"ALTARGO is predicted to have a valuable clinical role in treating uncomplicated skin infections," said Dr Lynn Marks, Senior Vice President, Infectious Diseases Medicines Development Centre at GSK. "By providing both efficacy and tolerability in a simple and short treatment regimen, ALTARGO is a favorable treatment option for patients and is an example of GSK's ongoing commitment to the management and treatment of infectious diseases."


ALTARGO will be used to treat bacterial infections most commonly caused by Staphylococcus aureus and Streptococcus pyogenes affecting small areas of skin. The impetigo indication is based primarily on the results of a double-blind, placebo-controlled clinical study demonstrating that the efficacy of ALTARGO was superior to placebo in adults and children. In a second pivotal study, ALTARGO was found to provide an effective course of therapy for impetigo compared to another commonly used topical antibiotic, fusidic acid. In two additional Phase III clinical trials, researchers examined the efficacy and safety of ALTARGO versus oral cephalexin for the treatment of infected abrasions, minor cuts and wounds in patients nine months of age and older.


GSK is committed to developing anti-infectives like ALTARGO. A significant need exists for new therapies because antibiotic resistance is at an increasingly high level. Retapamulin belongs to a new class of antibiotics called pleuromutilins and demonstrates a unique mode of action that is different from currently available antibiotics. Due to this unique mode of action, retapamulin exhibits a low potential for the development of resistance in vitro.


About Impetigo


Impetigo is a highly contagious bacterial infection of the top layers of the skin. It is most common among children two to six years of age. Cuts, scratches, insect bites or other dermatological conditions, notably eczema, can leave skin vulnerable to bacterial infection, especially with Staphylococcus aureus or group A Streptococcus. The infection causes sores which fill with pus before breaking open and producing the characteristic honey coloured or yellowish brown crusts. Impetigo can be spread by direct contact with wounds, sores or nasal discharge from an infected person, and scratching may facilitate the spread of the infection.















About ALTARGO


ALTARGO is a new antibiotic that belongs to a class of antibiotics called pleuromutilins and demonstrates a unique mode of action that is different from currently available antibiotics. ALTARGO is the first pleuromutilin to receive a positive opinion for use in humans. ALTARGO demonstrates no target-specific cross-resistance with other antimicrobial drugs, possesses excellent in vitro activity against bacteria that have become resistant to other classes of antibiotics, and exhibits a low potential for the development of resistance in vitro.


In these clinical studies in which a total of 2150 patients with superficial skin infections applied ALTARGO, the most commonly reported adverse reaction was application site irritation, which affected approximately 1% of patients.


About Pleuromutilins


Pleuromutilins represent a class of antibacterial agents that are potent and highly selective inhibitors of the bacterial protein synthesis machinery and, by virtue of their novel mechanism of action, possess excellent in vitro activity against bacteria that have become resistant to other classes of antibiotics.


About GlaxoSmithKline


GlaxoSmithKline has an established heritage in the development of novel anti-infectives to meet clinical needs. These products include the topical antibacterial agent Bactroban® (mupirocin) as well as the oral agent Augmentin® (amoxicillin/clavulanate potassium). These products have not only helped to widen the range of bacterial infections that can be successfully treated, but also to combat emerging bacterial resistance to existing agents. GSK is committed to the discovery, development, and commercialisation of innovative, potent antibacterials. Our approach includes in-house research using leading technologies, as well as actively seeking in-licensing opportunities and partnerships.


GSK, one of the world's leading research-based pharmaceutical and healthcare companies, is committed to improving the quality of human life by enabling people to do more, feel better and live longer. Additional information about GlaxoSmithKline can be found online at gsk.



View drug information on Augmentin; Bactroban Cream.

SkinMedica(R) Announces Commercial Launch Of Desonate(TM) (desonide) Gel 0.05 Percent With Patented Hydrogel Technology For Treatment Of Atopic Dermat

SkinMedica, Inc., a specialty
pharmaceutical company focused on developing, acquiring, and
commercializing products that treat dermatologic conditions and diseases
and improve the appearance of skin, today announced the commercial
availability of Desonate(TM) (desonide) Gel 0.05percent for treatment of
mild-to-moderate atopic dermatitis. Collaboratively developed by SkinMedica
and Dow Pharmaceutical Sciences, Inc., Desonate is a low-potency topical
steroid formulated in Dow's proprietary water-based Hydrogel vehicle.



Desonate, which has been approved by the U.S. Food and Drug
Administration (FDA) for the treatment of atopic dermatitis in patients
aged 3 months and older for up to four consecutive weeks, is an appropriate
therapy for both pediatric and adult patients. Formulated with desonide,
the leading low-potency corticosteroid used in dermatology, Desonate is the
first and only treatment for atopic dermatitis formulated with patented
Hydrogel Technology. The versatile formulation can be used on hair-bearing
and non-hair-bearing skin, and is free of alcohol, fragrance, or
surfactants that can be irritating or drying to the skin.



Desonate will be jointly promoted by SkinMedica and Galderma
Laboratories, L.P. SkinMedica will promote Desonate to the dermatology
market, while Galderma will promote Desonate to pediatricians via its
highly specialized pediatric sales force.



"The launch of Desonate provides great opportunities for SkinMedica and
our partners," said Rex Bright, President & CEO of SkinMedica. "We believe
the availability of an atopic dermatitis treatment utilizing Hydrogel
Technology fills an unmet need in dermatology. This new alcohol-free
Hydrogel formulation represents a novel addition to the therapeutic
armamentarium of low-potency steroids for the treatment of atopic
dermatitis. The Hydrogel molecule is specifically formulated to provide
effective therapy in a cosmetically acceptable, non-drying delivery
system."



"This is an exciting addition to the portfolio of products in our
pediatric division," said Albert Draaijer, President of Galderma U.S. "The
formulation is ideal for the pediatric patient. It incorporates what we
like to call 'Smart Science' in that it has the best of both worlds for the
patient -- an excellent cosmetically elegant vehicle, plus the proven
safety and efficacy of the desonide molecule. We are very pleased with the
potential that comes from this agreement with SkinMedica."



The efficacy and safety of Desonate was demonstrated in controlled
clinical trials, which assessed the product's ability to clear atopic
dermatitis symptoms in patients with mild-to-moderate disease. At the 65th
Annual Meeting of the American Academy of Dermatology (AAD) in Washington,
D.C. (February 2-6, 2007), clinical data supporting Desonate benefits were
unveiled.
















Scientific posters at AAD detailed (1) the safety and efficacy of
Desonate in two Phase III clinical trials; (2) the moisturizing qualities
of Hydrogel, as measured by reduced trans-epidermal water loss (TEWL); and
(3) patient preference for the Hydrogel vehicle versus other gel vehicles.
For a copy of these data, please call SkinMedica Customer Service at (877)
944-1412.



About Atopic Dermatitis



Atopic dermatitis affects more than 15 million patients, resulting in
rash, redness, swelling, crusting, and scaling of the skin. The disease
affects nearly 20% of infants and young children, some of which continue to
experience symptoms as adults. The exact cause is unknown; however,
genetics and environmental factors are considered key factors. Topical
corticosteroids are the "gold standard" of treatment for atopic dermatitis,
with more than $1 billion in prescriptions written annually by U.S.
physicians for inflammatory dermatoses.




Additional Information About Desonate



For information about Desonate, including its approved labeling, please
visit accessdata.fda/scripts/cder/drugsatfda/index.cfm.




About SkinMedica



SkinMedica is a privately held specialty pharmaceutical company
marketing both prescription and cosmeceutical dermatology products.
SkinMedica's Desonate(TM) (desonide) Gel 0.05% is indicated for the
treatment of mild-to-moderate atopic dermatitis; EpiQuin(R) Micro (4%
hydroquinone) cream is indicated for melasma and postinflammatory
hyperpigmentation; VANIQA(R) (eflornithine hydrochloride) Cream, 13.9%, is
the only FDA-approved prescription product for the treatment of unwanted
facial hair in women; and NeoBenz(R) Micro Cream and NeoBenz(R) Micro SD
(single dose) are the only benzoyl peroxide prescription products that
contain a patented gradual-release formulation of benzoyl peroxide to treat
acne. The company's full line of cosmeceutical products, which is sold
through physicians, includes TNS Recovery Complex(R) with NouriCel-MD(R) to
help improve the health and appearance of aging skin. SkinMedica is based
in Carlsbad, California. For more information, visit skinmedica.



About Galderma Laboratories, L.P.



Created in 1981 as a joint venture between Nestle and L'Oreal, Galderma
Laboratories is the number-one dermatology company in the world, according
to a recent IMS D-Class survey. With a worldwide presence in 65 countries,
over 1000 sales representatives, and one of the largest research facilities
dedicated to dermatology, Galderma provides innovative therapeutic skin
care solutions to meet the needs of dermatology patients and physicians.
The company is committed to improving the health of skin with an extensive
line of products that treat a range of skin care conditions, including
acne, rosacea, fungal nail infections, psoriasis, seborrheic dermatitis,
hyperpigmentation disorders, non-melanoma skin cancer, and photodamage.
With a new research lab in Sophia Antipolis, France, and the introduction
of exciting technology and products on the horizon, Galderma is poised to
continue making significant impact in dermatology treatment. For more
information, visit galdermaUSA.



Desonate(TM) is a trademark of SkinMedica, Inc.



SkinMedica(R), EpiQuin(R) Micro, NeoBenz(R) Micro, NouriCel-MD(R), TNS
Recovery Complex(R), and VANIQA(R) are registered trademarks of SkinMedica,
Inc.


SkinMedica, Inc.

skinmedica


View drug information on Desonate.

Smokers With Common Autoimmune Disorder At Higher Risk For Skin Damage

As if there weren't enough reasons to stop smoking, a team of researchers at the Research Institute of the McGill University Health Centre (RI-MUHC) have just found another. A study led by Dr. Christian A Pineau, Co-Director of the Lupus and Vasculitis clinic at the MUHC, has clearly linked skin damage and rashes to smoking in people with systemic lupus erythematosus (SLE). The study was published in a recent issue of the Journal of Rheumatology.



SLE is a long-term autoimmune disorder affecting about one in every 2000 people. About 90 per cent of SLE patients are women, many of them young. Symptoms are caused by an overactive immune system, and the disease can cause inflammation and damage in almost any organ system, including the skin.



"Up to 85 per cent of people with SLE develop skin involvement at some point," explains Dr. Pineau. "Our study shows that the risk of skin damage such as permanent hair loss and scarring from skin inflammation is significantly increased in smokers. So is the rate of active lupus rash."



While there is no cure for SLE, symptoms can be treated with drugs. "However, smoking may interfere with the effectiveness of some medications used to control skin disease in SLE," says Dr. Sasha Bernatsky, study co-author and physician in the MUHC's Rheumatology Division. "This may be part of the reason why smoking heightens skin damage in SLE.



"Even in healthy people, cigarette smoke has both immediate and long-term effects on the skin, its blood vessels and on hair follicles," she adds. "Exposure to tobacco promotes the release of cytokines - substances in the body that increase immune system activity and inflammation. In fact, some researchers believe that cigarette smoking is actually a risk factor for SLE in the first place."



The study underlines how vital it is for patients with SLE to remain smoke-free. "We already knew these people should not smoke, due to increased risk of adverse events like heart disease," Dr. Pineau says. "Now it appears we have another reason to emphasize smoking cessation. If we can convince people with SLE to stop smoking, we may be able to help them achieve better disease control, and better outcomes."



Dr. Christian A. Pineau is a researcher in the RI-MUHC Musculoskeletal Disorders Axis, as well as co-director of the Lupus and Vasculitis clinic at the MUHC. He is also the Rheumatology Program Director and Assistant Professor in the Department of Medicine at the McGill University Faculty of Medicine.



Dr. Sasha Bernatsky is a researcher in the RI-MUHC Musculoskeletal Disorders Axis, a physician in the Rheumatology Division and a member of the Clinical Epidemiology Division at the MUHC. She is also an Assistant Professor in the Department of Medicine and an Associate Member in the Department of Epidemiology, Biostatistics and Occupational Health at the McGill University Faculty of Medicine.

Good Belly Laughs Prescribed For Leg Ulcers

Forget technology. The best prescription for patients with venous leg ulcers is good quality nursing care - and the occasional belly laugh!



A five-year study led from the University of Leeds has shown that ultrasound therapy does nothing to speed up the healing process of leg ulceration - contrary to what had been expected. Traditional methods of nursing care, which are cheaper and easier to deliver, work just as well, the authors conclude.



"The 'healing energy' of low-dose ultrasound can make a difference to some medical conditions but with venous leg ulcers, this is simply not the case," said Professor Andrea Nelson from the University of Leeds' School of Healthcare, who led the study.



"The key to care with this group of patients is to stimulate blood flow back up the legs to the heart. The best way to do that is with compression bandages and support stockings - not 'magic wands' - coupled with advice on diet and exercise. Believe it or not, having a really hearty chuckle can help too. This is because laughing gets the diaphragm moving and this plays a vital part in moving blood around the body."



Venous leg ulcers are common in people with varicose veins or mobility problems whose 'muscle pumps' in the feet and calves struggle to drive blood up to the heart. These ulcers can be painful and unsightly, having a significant negative impact on health and quality of life.



Although most leg ulcers will clear up with good nursing care, a significant proportion of the lesions will take 12 months or longer to heal. The older and larger ulcers become the harder they are to get rid of, hence the search for solutions that could speed-up the healing process.



A number of small studies had suggested that ultrasound could be the answer. Professor Nelson (University of Leeds), working with colleagues from the Universities of York and Teeside, and many NHS Trusts, have now shown that this is not the case.



The researchers concentrated on 'hard to heal' ulcers that had not cleared up after six months or longer. Drawing on patients from across the UK and Ireland, they found that adding ultrasound to the standard approach to care - dressings and compression therapy - made no difference to the speed of healing or the chance of the ulcers coming back. Ultrasound also raised the cost of care per patient by almost ??200.



"Rising levels of obesity mean that the number of people who suffer from legs ulcers is likely to grow," Professor Nelson said. "We do need to find ways to helping those patients who ulcers won't go away, but our study shows that ultrasound is not the way to do that. We need to focus on what really matters, which is good quality nursing care. There really is no need for the NHS to provide district nurses with ultrasound machines. This would not be money well spent."


Notes:


The study was funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme (HTA).



Full details of the findings are published online in advance of publication in the British Medical Journal and Health Technology Assessment.



The paper: 'Use of weekly, low dose high frequency ultrasound for hard to heal venous leg ulcers: the VenUS III randomised control trial', is available online in advance of publication in the British Medical Journal (BMJ 2011;342:d1092).



The report: 'VenUS III: a randomised controlled trial of therapeutic ultrasound in the management of venous leg ulcers' is available online in advance of publication in Health Technology Assessment (DOI: 10.3310/hta15130).

The Choose Skin Health™ National Education Campaign Wants To "Sun Proof Your Community"

The Neutrogena® Choose Skin Health™ national education campaign today announced the Sun Proof Your Community contest, in partnership with the SHADE® Foundation of America, to help protect communities nationwide from the harmful effects of the sun. Sun Proof Your Community is a key element of the ongoing Choose Skin Health™ initiatives aimed at fighting the skin cancer epidemic by educating people on how to make positive changes in their sun behavior - from wearing sunscreen daily to seeking shade - 365 days a year. People can enter to win a sun shade covering for a school, park, playground or community space in their area by going to the Choose Skin Health™ Facebook page.


Many people don't realize that approximately 80 percent of sun exposure is incidental, meaning it happens unintentionally during everyday activities while walking a dog or when children are outside for recess.1 Moreover, Americans still believe dangerous myths when it comes to the sun, putting them at increased risk for skin cancer. A common myth is that people believe they don't need to protect themselves from the sun on cloudy days. Surprisingly, many states with the highest incidence rates of skin cancer are not typically viewed as "sunny locales," including Washington, Minnesota and Vermont.2 Even on a cloudy day, up to 80 percent of the sun's ultraviolet rays pass through the clouds.3 This is why it is crucial people nationwide, no matter where they live, protect themselves from the sun - 365 days a year. The Sun Proof Your Community contest will help five communities protect themselves from the sun, no matter where they are located, through the donation of a shade covering.


"As a melanoma survivor, I know first hand the importance of daily sun protection and the need for communities to have areas that provide adequate shade from the sun," said Shonda Schilling, Founder of the SHADE® Foundation of America. "We're proud to partner with Neutrogena® on their Choose Skin Health™ campaign to educate people on the dangers of the sun and to make shade coverings a reality for five communities," she said.


"Sun Proof Your Community" - Here's How To Enter:


To enter the Sun Proof Your Community contest, individuals or groups submit up to a 250-word essay on the Choose Skin Health™ Facebook page, explaining why a school, park, playground or community space in their area deserves to win a sun-shade covering. The call for entries will run from June 22, 2010 through July 20, 2010.


The top 10 finalists, as determined by Neutrogena® and the SHADE® Foundation of America, will be posted to the Choose Skin Health™ Facebook page for public voting. The five entries/locations with the highest number of votes will win a sun shade covering.


No purchase necessary to enter or win. Void where prohibited. Must be a legal resident of the 50 U.S. or D.C., 21 years of age or older. Contest starts 6/22/10 at 12:00 a.m. ET and ends 7/20/10 at 11:59 p.m. ET. Subject to Official Rules. Sponsor: Neutrogena Corporation.


1. American Academy of Pediatrics Web site. Last accessed June 15, 2010.



2. CDC Web site. Last accessed March 26, 2010.



3. AAD Web site. Last accessed March, 26, 2010.

Sun Safe Over Sun Tan - Australian Medical Association

Teenagers and young adults should ditch the trendy sun tan this summer and choose sun safety instead, according to the AMA.


AMA President, Dr Rosanna Capolingua, is warning young Australians not to put themselves at risk of skin cancer this summer through unsafe tanning.


"A summer tan may look attractive in a magazine but the reality is only ugly," Dr Capolingua said.


"Anyone can develop skin cancer or melanoma. Young people shouldn't feel that they are immune to the health risks of sun exposure.


"A lot of people spend time in the sun over Christmas and the New Year - at the beach, playing sport or at outdoor events - but we must not become complacent about the risk of skin cancer.


"Teenagers and young adults tend to have a false sense of security when it comes to sun exposure and their health - they assume skin cancer is something that happens to older people.


"The tragic story of Clare Oliver, who died earlier this year from melanoma, clearly shows young people are as much at risk as anyone else.


"Many young people think they need a golden tan to enjoy their summer holidays, but there is nothing attractive about sun damaged skin."


According to the Cancer Council, Australia has the highest rate of skin cancer in the world and melanoma is the most common cancer in people aged 15-39.


"There is no safe level of tanning. Everyone, no matter what their age or skin type, needs to take care when going out in the sun," Dr Capolingua said.


The Cancer Council recommends five steps to protect against skin cancer:


- wear sun-protective clothing that covers as much skin as possible,

- apply broad spectrum, water resistant SPF30+ sunscreen 20 minutes before sun exposure and every two hours afterwards,

- wear a hat that protects your face, head, neck and ears,

- seek shade whenever possible, and

- wear sunglasses to protect your eyes from glare.


Australian Medical Association

Having Severe Acne May Increase Suicide Risk

Individuals who suffer from severe acne are at an increased risk of attempting suicide, according to a paper published on bmj today.


The study also finds that an additional risk may be present during and up to one year after treatment with isotretinoin, a commonly prescribed drug for severe acne. However, the authors stress that this additional risk is most likely due to the acne itself, rather than the drug treatment.


Isotretinoin (commonly marketed as Roaccutane, Accutane, Amnesteem, Claravis, Clarus or Decutan) has been used to treat severe acne since the 1980s. The treatment can be effective but there have been reports linking isotretinoin to depression and suicidal behaviour. However studies have had conflicting results, say the authors.


With the hypothesis that acne sufferers are at a higher risk of suicide, regardless of whether they are on isotretinoin, Dr Anders Sundstrom and colleagues from the Karolinska Institute in Sweden, investigated suicide attempts before, during and after isotretinoin treatment for severe acne.


The authors assessed the data of individuals who had been prescribed isotretinoin from 1980 to 1989 and linked these to hospital discharge and cause of death registers from 1980 to 2001.


The data of 5,756 individuals were reviewed and 3,613 (63%) of them were male. The average age of men when they were first prescribed isotretinoin was 22 years and women were 27.


The results show that 128 patients were admitted to hospital following a suicide attempt. The authors also found that between one and three years before starting isotretinoin treatment the number of suicide attempts increased. However the risks were highest within six months after treatment ended.


Sundstrom and colleagues speculate that the increased risk after starting isotretinoin might be because patients whose acne and physical appearance improved following treatment were distraught if there was no improvement in their social life.


They believe it is impossible to say for certain that the continued rise in suicide risk "is due to the natural course of severe acne, or to negative effects of the treatment." They acknowledge that the increased risk could be "as a consequence of exposure to the drug" but believes "a more probable interpretation is that the underlying severe acne may best explain the raised risk."


The authors also stress that attempted suicide is an uncommon event - one first suicide attempt would equate to 2,300 individuals being on isotretinoin - and this assumes that the entire increase in risk was due to the drug, they say.


They conclude that "the most important proactive measure to be taken would be to closely monitor all patients' psychiatric status, not only during treatment, but also for at least a year after treatment with isotretinoin." In addition they say it is not only important to monitor the mental health status of patients receiving isotretinoin but also sufferers of severe acne who are not on treatment.


In an accompanying editorial, two senior researchers in Australia say that "it is difficult to tease out the relation between mental health and isotretinoin because acne itself is associated with psychiatric morbidity, including depression."


Parker Magin and John Sullivan say Sundstrom's research is important given the complexity of the issue and that it is essential that patients who are treated for acne with isotretinoin, especially perhaps those whose treatment is unsuccessful, need to be carefully monitored for depression and suicidal thoughts.


Click here to view paper

Click here to view editorial

Warning: New Skin Cancer Study Finds Outdoor Workers Are Less Likely To Get Screened For Skin Cancer

While occupational risks are
inherent in many jobs, workers who make a living toiling in the sun face an
increased threat of skin cancer from repeated overexposure to the sun's
harmful ultraviolet (UV) rays. Now, new research finds that workers who
need skin exams the most by nature of their occupation -- such as
construction, forestry, fishing and farming workers -- are the least likely
to get them.



In the study published online in the Journal of the American Academy of
Dermatology entitled "Reported skin cancer screening of U.S. adult
workers," dermatologist Robert S. Kirsner, MD, PhD, FAAD, professor and
vice chairman of the departments of dermatology and cutaneous surgery at
the University of Miami Miller School of Medicine in Miami, and his
colleagues used the National Health Interview Survey (NHIS) data from 2000
and 2005 to estimate the percentage of U.S. workers who had ever had a
thorough skin examination in their lifetime or during an appointment with a
primary health care provider in the past 12 months.



"Previous studies have shown that total-body screening examinations are
not frequently performed during routine health examinations by primary care
physicians, even among potentially high-risk populations," said Dr.
Kirsner. "As dermatologists, we know that the early detection of skin
cancer by routine skin examinations is crucial in successfully treating
this potentially life-threatening condition -- particularly for workers
routinely exposed to harmful ultraviolet light. This study shows that
workers who need careful monitoring for skin cancer due to the nature of
their jobs are less likely to receive skin exams than workers in low-risk
occupations."



Conducted by the National Center for Health Statistics (NCHS), the NHIS
is an annual, cross-sectional in-person household survey of U.S. workers.
In 2000 and 2005, the Cancer Control Module was included as part of the
NHIS and included questions on skin examinations that were administered to
19,702 and 18,422 employed participants, respectively. Questions included
"Have you ever had all of your skin from head to toe checked for cancer
either by a dermatologist or some other kind of doctor?" and "When did you
have your most recent skin exam?"



Dr. Kirsner explained that data of all participants who reported a
full-body skin examination were grouped into two categories -- those who
received a skin exam in the last 12 months and ever in their lifetime.
Workers also were asked about their sun-protection behavior, if they
reported going out in the sun for an hour or more, and, from their
responses, were classified as "sun exposed" for the purposes of the study.



In addition, detailed employment information was coded by occupation
and industry for all participants aged 18 years or older employed during
the time of the survey. Occupations were grouped into four standard
occupational categories -- white-collar workers; service workers; farming,
fishing, and forestry workers; and blue-collar workers. Workers were then
subsequently grouped into eight industrial sector classifications --
agriculture, forestry, and fishing; mining; construction; manufacturing;
wholesale and retail trade; transportation, warehousing, and utilities;
services; and health care and social assistance.
















"When we examined the data for the 38,124 total worker participants
interviewed from the 2000 and 2005 Cancer Control Supplements, we found
that the prevalence of both lifetime and 12-month skin examinations was
low," said Dr. Kirsner. "Only 15 percent of all U.S. workers reported ever
receiving a skin examination during their lifetime, and only 8 percent of
those who also had seen a health care provider in the past year reported
that they had received a skin exam during that time."



In addition, the data clearly showed that the rate of reporting skin
cancer screening was lowest for high-risk occupations most likely to
experience increased sun exposure. Specifically, in the 2000 and 2005
Cancer Control Modules, the prevalence of 12-month skin examinations among
those who had seen a physician in the past year was lowest among farm
workers (5.8 percent and 1.6 percent, respectively) and blue-collar workers
(3.9 percent and 4.9 percent, respectively).



"When we analyzed the data by industry sectors, we concluded that
agriculture, forestry, fishing, and construction workers reported the
lowest rate of skin exams in 2000," said Dr. Kirsner. "Although the number
of agriculture, forestry and fishing workers reporting a skin exam
increased from 2000 to 2005 -- from 4.2 percent to 13.6 percent -- the
prevalence of skin exams among construction workers stayed essentially the
same, from 5.2 percent to 5.6 percent."



Dr. Kirsner added that occupational groups at increased risk for
exposure to UV light on the job were less likely to have ever received a
skin examination in their lifetime than the average U.S. worker (15
percent). This included farm operators and managers (10 percent), farm
workers and other agricultural workers (7 percent), forestry and fishing
occupations (3 percent), construction and mining trades (8 percent), and
construction laborers (8 percent).



"Socioeconomic factors also were significant predictors of having a
skin exam in the past year," said Dr. Kirsner. "Specifically, younger black
or Hispanic women with no health insurance, who were service, farm or
blue-collar workers, and who did not use sun protection were the least
likely to report ever having been screened for skin cancer. All patients,
especially those that have occupations where they are exposed to UV light,
should request that their physician provide skin exams during their routine
exams."



"In addition, developing and implementing local community health fairs
that include screening programs targeting high-risk workers who are
reporting low skin examination rates could help reverse this alarming
trend," commented Dr. Kirsner. "One way to receive a free screening is
through the Academy's National Melanoma/Skin Cancer Screening Program,
where dermatologists volunteer to provide free skin cancer screenings in
their communities. The public can visit aad to find a free
skin cancer screening in their area."



For more information about skin cancer, please visit the SkinCancerNet
section on skincarephysicians, a Web site developed by
dermatologists that provides patients with up-to-date information on the
treatment and management of disorders of the skin, hair and nails.



Headquartered in Schaumburg, Ill., the American Academy of Dermatology
(Academy), founded in 1938, is the largest, most influential, and most
representative of all dermatologic associations. With a membership of more
than 15,000 physicians worldwide, the Academy is committed to: advancing
the diagnosis and medical, surgical and cosmetic treatment of the skin,
hair and nails; advocating high standards in clinical practice, education,
and research in dermatology; and supporting and enhancing patient care for
a lifetime of healthier skin, hair and nails.


American Academy of Dermatology

aad

Drink Green Tea, Prevent Skin Cancer

Green tea just keeps getting better. To add to the abundance of health-improving qualities of the beverage, UAB Researcher Santosh Katiyar, Ph.D., associate professor of dermatology, claims that it can reduce the risk of skin cancer. According to Katiyar, the rich tumor-inhibiting green tea polyphenols, which include the antioxidant, epigallocatechin-3-gallae (EGGCG), protect the skin from ultraviolet radiation-induced damage and prevent skin tumor formation. "Green tea prevents UV radiation induced suppression of the immune system, which has been considered a risk factor for the development of skin cancer," he said.


Katiyar's green tea research was most recently published in the May edition of the Journal of Nutritional Biochemistry and can be found online at sciencedirect. He has devoted the past 17 years to finding ways to prevent skin cancer. Grape and black raspberry consumption can also help prevent skin cancer, he said.


University of Alabama at Birmingham

701 20th St. S., AB 1320

Birmingham, AL 35294-0113

United States

main.uab

Dermatologists Can Help Separate Fact From Fiction For Sun Exposure, Sunscreen And Vitamin D

When it comes to vitamin D, consumers are bombarded with mixed messages about the best source for this essential nutrient. While some may argue that small doses of intentional sun exposure are safe, dermatologists point out that the risk of developing skin cancer from ultraviolet (UV) radiation far outweighs the benefit of stimulating vitamin D production particularly when enriched foods and supplements are safe and effective sources of this vitamin.


Speaking today at the American Academy of Dermatology's SKIN academy (Academy), Washington, D.C., dermatologist Elizabeth L. Tanzi, MD, FAAD, clinical faculty in the department of dermatology at Johns Hopkins Hospital Center in Baltimore, addressed common myths about sun exposure, sunscreen and vitamin D, and announced the Academy's increased recommendation on the minimum Sun Protection Factor (SPF) of sunscreen.


"Despite years of ongoing public education efforts on the dangers of UV radiation, a number of misconceptions remain as to how to best protect ourselves from this known carcinogen and whether or not we absolutely need sun exposure for vitamin D production," said Dr. Tanzi. "The fact is these myths are harmful because sun exposure is the leading cause of skin cancer, and the consequences of this misinformation could be potentially fatal."


Myth: Sun exposure is the best source of vitamin D.


Vitamin D is an essential nutrient that is vital for strong bones and a healthy immune system. Deficiency of vitamin D is associated with bone softening in adults, rickets in children and, more recently, with high blood pressure, arthritis, type I diabetes and certain cancers.


While UV radiation is one source of vitamin D, dermatologists argue that it is not the best source because the benefits of obtaining vitamin D through UV exposure cannot be separated from an increased risk of skin cancer. Instead, the Academy recommends that an adequate amount of vitamin D should be obtained from a healthy diet that includes foods naturally rich in vitamin D (e.g., dairy products and fish), foods/beverages fortified with vitamin D (e.g., fortified milk and fortified cereals), and/or vitamin D supplements.


"Although studies showing the benefits of increased vitamin D intake have caused some to propose 'sensible sun exposure' or intentional sun exposure as a cost-effective method for preventing vitamin D deficiency, increased sun exposure is not the answer," said Dr. Tanzi. "UV radiation is the most preventable risk factor for the development of skin cancer, which is the most common form of cancer in this country. There are more than an estimated 1 million new cases of skin cancer every year. Despite this fact, there remains a tremendous amount of misinformation about UV exposure especially in relation to vitamin D."















Myth: All sunscreens are created equal.


While on the surface most sunscreens may look the same, they are in fact quite different. One of the things that makes sunscreens different is the level of protection from UV exposure that they provide. Dr. Tanzi explained that a common misconception is that the SPF rates the degree of protection from both UVA rays (which pass through window glass, penetrate into the deepest layer of the skin and are associated with premature aging and melanoma) and UVB rays (the sun's burning rays, which are blocked by window glass, are the primary cause of sunburn, and also are linked with skin cancer). In fact, the SPF number on sunscreens only reflects the product's ability to deflect the sun's burning rays (or UVB). Sunscreens labeled broad-spectrum provide coverage against both UVA and UVB light.


"SPF may create a false sense of security about the level of protection a person is getting, because many sunscreens do not adequately protect against harmful UVA rays," said Dr. Tanzi. "The main challenge in providing effective protection from UVA rays is that traditional chemicals used in sunscreens that absorb UVA light degrade quickly and become ineffective."


Fortunately, there are ingredients that can be added to traditional sunscreen ingredients to keep them stable and provide broad-spectrum protection. For example, Dr. Tanzi noted that the ingredient oxybenzone can help stabilize avobenzone (one of the best absorbers of UVA rays that, while highly effective, breaks down quickly), which provides a longer duration of effective protection from UVA rays. Other effective ingredients that help provide broad-spectrum UV coverage include ecamsule, cinoxate, menthyl anthranilate, octyl methoxycinnamate, octyl salicylate, and sulisobenzone.


For those with sensitive skin, sunscreens with non-chemical ingredients work best and will prevent irritation. Dr. Tanzi said the ingredients zinc oxide and titanium dioxide provide both UVA and UVB protection.


Myth: Using a higher SPF will ensure you don't burn.


Dr. Tanzi explained that those who use sunscreen with a higher SPF may think they will not burn when exposed to UV light, but she said that is not true. In fact, actual sunscreen protection depends on many other factors including skin type, the amount and frequency of sunscreen application, and the impact of activities (such as swimming and sweating). As a result, sunburn can occur even when wearing a higher SPF sunscreen.


Another important factor Dr. Tanzi emphasized is that UVB protection does not increase proportionately with a designated SPF number. For example, an SPF of 30 screens 97 percent of UVB rays, while an SPF of 15 screens 93 percent of UVB rays and an SPF of 2 screens out 50 percent of UVB rays. However, not applying enough sunscreen or not covering all exposed areas may result in a lower SPF than the product contains.


"For adequate protection, sunscreens are best applied 15-30 minutes prior to going outside, approximately every two hours or immediately after swimming or sweating," said Dr. Tanzi. "Research demonstrates that most people only apply 25 to 50 percent of the recommended amount of sunscreen, which is one ounce for the entire body or enough to fill a shot glass. Therefore, if only half the proper amount of SPF 15 is applied, the SPF has been reduced to an SPF of approximately 5, which is then inadequate protection. "


To address the issue of people not using enough sunscreen or reapplying improperly, the Academy recently increased its recommended SPF to a minimum of 30 for proper sun protection. Dr. Tanzi said that while sunscreen is important to protect against skin cancer, it is only one part of what should be an overall sun-protection program. To minimize your risk of skin cancer, the Academy recommends that everyone Be Sun SmartSM :


-- Generously apply a broad-spectrum water-resistant sunscreen with a Sun Protection Factor (SPF) of at least 30 to all exposed skin. "Broad-spectrum" provides protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Re-apply approximately every two hours, even on cloudy days, and after swimming or sweating.


-- Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible.


-- Seek shade when appropriate, remembering that the sun's rays are strongest between 10 a.m. and 4 p.m. If your shadow is shorter than you are, seek shade.


-- Protect children from sun exposure by playing in the shade, using protective clothing, and applying sunscreen.


-- Use extra caution near water, snow and sand as they reflect the damaging rays of the sun which can increase your chance of sunburn.


-- Get vitamin D safely through a healthy diet that may include vitamin supplements. Don't seek the sun.


-- Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look like you've been in the sun, consider using a sunless self-tanning product, but continue to use sunscreen with it.


-- Check your birthday suit on your birthday. If you notice anything changing, growing, or bleeding on your skin, see a dermatologist. Skin cancer is very treatable when caught early.


Check the Academy's Web site (aad) for the latest list of sun protective products that meet the stringent, evidence-based criteria of the AAD SEAL OF RECOGNITION®.


For more information about skin cancer, please visit the "SkinCancerNet" section of skincarephysicians, a Web site developed by dermatologists that provides patients with up-to-date information on the treatment and management of disorders of the skin, hair and nails.


Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 16,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails.

Study Shows DuraPrep Solution May Be Superior To Chlorhexidine In Preventing Surgical-Site Infections

3M Health Care today announced the publication of a new independent study "Effects of Preoperative Skin Preparation on Postoperative Wound Infection Rates: A Prospective Study of 3 Skin Preparation Protocols," that compared the effects of three different skin preparation solutions on surgical-site infections. The study found that Iodophor-based skin preparation solutions, such as 3M™ DuraPrep™ Surgical Solution (Iodine Povacrylex [0.7% available Iodine] and Isopropyl Alcohol, 74% w/w) Patient Preoperative Skin Prep, may be superior to chlorhexidine in preventing surgical-site infections. Authored by Brian R. Swenson, MD, Robert G. Sawyer, MD, and colleagues from the University of Virginia Health System in Charlottesville, VA, the study appears in the October 2009 issue of the journal Infection Control and Hospital Epidemiology.


The study, which examined more than 3,200 general surgery patients during an 18-month period, was performed in concert with ongoing data collection for the American College of Surgeons' National Surgical Quality Improvement Project (NSQIP). This program, which employs a prospective, peer-controlled, validated database to quantify 30-day risk-adjusted surgical outcomes, is a tool to measure and report surgical quality and outcomes and is recognized by the Institutes of Medicine, the Joint Commission and the American Board of Surgery.


"The main findings of the study were somewhat unexpected. Based on data derived from central venous catheter insertions, we had thought that the infection rates would be lowest in the period where chlorhexidine was the preferred agent for skin preparation. This was not the case. If these findings are reproduced in a multicenter study, switching to iodine-based preparations on a broad basis could significantly reduce the huge morbidity and cost associated with surgical site infection in this country and abroad," said Robert G. Sawyer, M.D., Professor of Surgery and Public Health Science, Co-director Surgical Trauma Intensive Care Unit and Director of Surgical Nutrition Services at the University of Virginia Health System and co-author on the study.


"To date, there have only been limited studies comparing the impact of various skin preparation solutions on surgical-site infections. Previous studies examined only specific surgical sites or relied on less impactful surrogate endpoints such as microbial counts. Dr. Sawyer's study provided a broader assessment of general surgery patients and specifically examined means to reduce the risk of surgical-site infections," said Debra Rectenwald, Vice President and General Manager 3M Infection Prevention Division, 3M Health Care. "We are pleased that DuraPrep solution has been proven effective in the fight against surgical-site infections, and that hospitals, like the University of Virginia Health System, are updating their protocols to include its use."


This independent study was funded in part by an unrestricted educational grant from 3M Health Care.


About DuraPrep Solution


DuraPrep solution contains two active ingredients, isopropyl alcohol (74% w/w) for fast kill and iodine povacrylex (0.7% available iodine) for persistence. The performance of DuraPrep solution can be attributed to its unique film-forming properties which enable it to dry to a water-insoluble film. Under simulated surgical conditions, DuraPrep solution resisted removal by blood and saline compared to Betadine scrub and paint. DuraPrep solution keeps bacterial counts low for up to 48 hours and improves drape adhesion. Clinicians are provided with detailed information on how to use DuraPrep solution safely and effectively.


Source

3M Health Care

New Skin Disorder Caused By Mobile Phones Discovered - 'mobile Phone Dermatitis'

Doctors are being warned to be alert to a new allergic skin disorder, caused by mobile phones, according to the British Association of Dermatologists.


A new phenomenon called "mobile phone dermatitis" has been discovered, in which people who spend long periods of time on their mobile phone develop an allergic reaction to the phone's nickel surface.


The problem was identified in several published case reports of patients with unexplained rashes on their face and ear. Closer investigation revealed that the reaction was caused by nickel in the mobile phone handsets, where it is often found in the casing or buttons, particularly in the most fashionable models.


Now the British Association of Dermatologists is warning other doctors to be aware of the allergy, which is thought to be on the increase. Because the condition has only newly been identified, many cases may go unreported or untreated, which has prompted the scientists to share their findings.


Nickel allergy is the most common contact allergy in the UK and is thought to affect 30 percent of the population, with a rising incidence.* Women have a higher risk of developing mobile phone dermatitis, as they are more likely to have been previously sensitised to the metal following an allergic reaction to nickel-coated jewellery.


Dr Graham Lowe, from the British Association of Dermatologists, said: "The allergy results from frequent skin contact with nickel-containing objects. Prolonged or repetitive contact with a nickel-containing phone is more likely to cause a skin reaction in those who are allergic. If you have had a previous reaction to a nickel-coated belt-buckle or jewellery, for example, you are at greater risk of reacting to metal phones.


"In mobile phone dermatitis, the rash would typically occur on the cheek or ear, depending on where the metal part of the phone comes into contact with the skin. In theory it could even occur on the fingers if you spend a lot of time texting on metal menu buttons.


"It is worth doctors bearing this condition in mind if they see a patient with a rash on the cheek or ear that cannot otherwise be explained."


In a study published earlier this year, doctors in the US tested for nickel in 22 popular handsets from eight different manufacturers, and found it present in ten of them.??


Dr Lionel Bercovitch, one of the study's authors from Brown University, Rhode Island, said: "Nearly half of the phones we spot tested contained some free nickel. The menu buttons, decorative logos on the headsets and the metallic frames around the liquid crystal display (LCD) screens were the most common sites.. Those with the more fashionable designs often have metallic accents and are more likely to contain free nickel in their casings.


"Given the widespread use of cell phones, the presence of metal in the exterior casing of these phones and the high prevalence of nickel sensitization in the population, it is not surprising that cell phones can cause allergic contact dermatitis."















Several other cases have been reported, prompting the British Association of Dermatologists to share the research with other doctors. The association is advising anyone who develops a rash on their face which might be attributable to prolonged mobile phone use to seek advice from their doctor.


* "Genetic Factors in Nickel Allergy"; Journal of Investigative Dermatology (2004) 123, xxiv-xxv; doi:10.1111/j.0022-202X.2004.23508.x; Veronique Bataille, Genetic Epidemiology and Twin Research Unit, St Thomas Hospital, London, UK


Recent case reports of mobile phone dermatitis:


?? "Cellphone contact dermatitis with nickel allergy"; Lionel Bercovitch, MD* and John Luo; *Department of Dermatology, Warren Alpert Medical School of Brown University; Liberal Medical Education, Brown University, Providence, Rhode Island, USA.

CMAJ, January 1, 2008; 178 (1). doi:10.1503/cmaj.071233. cmaj.ca/cgi/content/full/178/1/23


"Mobile phone dermatitis: a modern presentation of contact allergy"; A. Waters, C.M. Green and S. Lewis-Jones; Ninewells Hospitall, Dundee, UK. Overview available in British Journal of Dermatology, BSPD abstracts 2008; Presented at British Society for Paediatric Dermatology Annual Symposium, November 2007.


"Cellular phone addiction and allergic contact dermatitis to nickel"; Contact Dermatitis

Volume 57 Issue 2, Pages 130 - 131; Cristina Livideanu 1 , Francoise Giordano-Labadie 1 Carle Paul 1; 1 University Paul-Sabatier, Department of Dermatology, Purpan University Hospital, Place du Dr Baylac Toulouse, France; 11 Jul 2007; www3.interscience.wiley/journal/117986581/abstract


"Mobile telephone as new source for nickel dermatitis"; Contact Dermatitis

Volume 56 Issue 2, Pages 113 - 113; Stefan W?¶hrl 1 , Tamara Jandl 1 , Georg Stingl 1 Tamar Kinaciyan 1; 1 Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna; 18 Jan 2007

www3.interscience.wiley/journal/117986455/abstract?CRETRY=1&SRETRY=0


The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease.


bad.uk

Red, White And Brown: Defining Characteristics Of Common Birthmarks Will Determine Type And Timing Of Treatment

Vascular birthmarks, which occur in nearly 10 percent of all infants at birth or within the first few weeks of life, can cause concern for parents particularly if they are large or in a cosmetically important area. The decision to treat a birthmark is one that parents should make with a dermatologist, who can determine the type of birthmark and whether or not it poses any potential risks in the future.


Speaking at the 69th Annual Meeting of the American Academy of Dermatology (Academy), dermatologist Sheila Fallon Friedlander, MD, FAAD, professor of clinical pediatrics and medicine at the University of California San Diego (UCSD) and section chief of pediatric dermatology at Rady Children's Hospital in San Diego, discussed which birthmarks should be treated in infancy and the most effective treatments for red, white and brown birthmarks.


"There are several different types of birthmarks, so it is important to determine the type of birthmark before considering any possible treatments," said Dr. Friedlander. "Most birthmarks pose no risks to infants and are best left untreated, but some can grow and potentially cause complications, particularly if they occur around the eyes, lips, nose or groin area. In addition, any lesion that has the potential to ulcerate should be monitored."


Infantile Hemangiomas: When Red Birthmarks Raise a Red Flag


The most common types of red birthmarks are known as infantile hemangiomas, which typically appear on the skin at birth or shortly thereafter as small strawberry-shaped bumps or flat spots. Infantile hemangiomas grow during the first two to six months of life, after which time they typically stop growing. Dermatologists can generally pinpoint how much skin will be affected by this type of birthmark by the time an infant is three or four months old. Dr. Friedlander emphasized that most infantile hemangiomas do not pose a problem to infants, but dermatologists can often provide useful information to families regarding the potential for problems by assessing the location of the birthmark and the degree to which it grows during the first few months of life.


"Over time, most infantile hemangiomas will disappear on their own, but there are instances where dermatologists will recommend treatment," said Dr. Friedlander. "For example, if an infantile hemangioma occurs around the eyes, it can obstruct and prevent normal visual development if left untreated, or, if they occur in the groin area, they can become inflamed and then cause pain to the child. Depending on their size, some facial birthmarks may leave behind a scar or saggy skin after they disappear. That is why it is often important for parents to consult a dermatologist as soon as their baby develops a birthmark, so it can be properly evaluated to determine if treatment is necessary."


Dr. Friedlander added that the presence of a large facial hemangioma is sometimes the first sign of a more serious disorder termed PHACES. In this disorder, a hemangioma occurs on the face which is broader and more likely to pose a problem that requires medical intervention. Because PHACES may be a sign of an underlying abnormality, including heart defects, eye abnormalities, blood vessel or brain problems, it also requires specialized evaluation and imaging.















There are times infantile hemangiomas require treatment, and if they do, there are several treatment options available. While systemic steroids and intralesional steroid therapy - where the treatment is injected directly in the birthmark - have been widely used, they may cause side effects that a dermatologist will need to discuss with parents prior to treatment. A recent breakthrough in the treatment of hemangiomas is the use of propranolol, a drug used to treat high blood pressure. This medication has recently been found to be very effective for preventing growth of and actually shrinking these lesions, but this medication also has potential side effects that can be serious and need to be monitored closely. Other effective treatments being used are topical medications and laser therapy.


Another common vascular birthmark that may require treatment is a port- wine stain. Unlike infantile hemangiomas, port-wine stains will slowly darken and thicken over time and will not resolve on their own. Characterized by a flat appearance with a pink, red, or purplish discoloration, port-wine stains commonly appear on the face and can affect a child physically and emotionally. Dr. Friedlander explained that port-wine stains can be associated with eye problems, including glaucoma, and seizure disorders. For this reason, infants with port-wine stains need to be evaluated in a timely manner.


"Because port-wine stains grow and thicken over time and will not go away, many parents opt to treat them early when children are small," said Dr. Friedlander. "While dermatologists have been using pulsed-dye lasers for decades to treat these types of birthmarks, different forms of laser therapy that penetrate more deeply - such as the Nd:YAG laser and the alexandrite long-pulsed laser - also are now being used with much success." Dr. Friedlander noted that laser therapy is usually started within the first six to 12 months of life, and approximately six to eight treatments are needed to obtain optimal results.


Dr. Friedlander added that new research is investigating the use of an oral medication, rapamycin, for treating port-wine stains in conjunction with laser therapy.


"This is an exciting potential treatment because it could help prevent the recurrence of the birthmarks that initially fade, but sometimes recur, when treated with the pulsed-dye laser," said Dr. Friedlander.


White Spots: A Cause for Concern?


While far less commonly noted at birth than red birthmarks, white birthmarks can appear as white spots in a raised or flat pattern on the skin. Dr. Friedlander noted that although white birthmarks are generally harmless, they can sometimes result in a permanent loss of pigmentation in the affected area. Some can grow and removal may be a consideration.


"Generally, a few white spots that are flat are not cause for concern. However, multiple white spots or lesions that are elevated or thick need to be evaluated by a dermatologist," said Dr. Friedlander, who added that removal by excision or the CO2 laser is sometimes used when white birthmarks require medical intervention, which is very rare.


Brown Birthmarks Linked to Melanoma


One type of brown mole that is present at birth is the congenital nevus. This type of brown birthmark results from an increased number of melanocyte cells (the pigment-producing cells of the body) and can develop into melanoma - the deadliest form of skin cancer. Most moles present at birth, particularly the small ones, have a very, very small risk of converting into melanoma. Dr. Friedlander explained that approximately 3 to 6 percent of very large congenital nevi can possibly develop a melanoma, but this percentage is quite controversial. Most moles never get bigger than two or three inches in diameter, but some larger lesions that grow and darken are hard to follow and pose a higher risk than smaller lesions. As such, Dr. Friedlander recommended that those moles deemed a higher risk for developing into melanoma should be followed closely or considered for surgical removal if possible, by a dermatologist.


Another brown birthmark that may be worrisome for families is a caf?© au lait birthmark. The term caf?© au lait is French for "coffee with milk," which refers to the light brown color of this flat type of birthmark. While these birthmarks may not be appealing visually, Dr. Friedlander added that they do not pose a medical concern unless there are multiple caf?© au lait birthmarks or a very large spot is present.


"If a patient has multiple caf?© au lait birthmarks, they need to be evaluated by a dermatologist for other associated conditions. In particular, the health care provider needs to rule out neurofibromatosis - a genetically inherited disorder in which the nerve tissues grow tumors," said Dr. Friedlander. "For patients who want to treat a cosmetically troublesome facial caf?© au lait birthmark, various lasers exist which can be useful."


Dr. Friedlander encouraged concerned parents of infants or children with birthmarks to see a dermatologist to rule out any underlying conditions or medical problems that could be linked to them.