The "A" Train

New Drug MAY Extend the Lives Of Melanoma Patients

Roche has conducted a Phase II clinical trial that shows the lives of melanoma patients can be extended several months on their new drug Avastin. http://www.reuters.com/article/healthNews/idUSTRE58K1KS20090921?feedType=RSS&feedName=healthNews&rpc=22&sp=true

Though this is a great step forward, death doesn't have to be an option when it comes to melanoma. The key is early detection. Everyone over the age of 45 needs to see a dermatologist (not their family physician) every year for a full body examination.

Lasers for Acne

As much as the laser community wants us to believe that lasers treat acne. The fact is the cost does not justify the result....However, that may change in the future.

http://www3.interscience.wiley.com/cgi-bin/fulltext/119408075/PDFSTART?CRETRY=1&SRETRY=0

Topical and oral treatments remain the best protocols for acne

http://atrain.typepad.com/atrain/2009/03/acne-now-classified-as-a-chronic-disease.html

Acne: Now Classified as a Chronic Disease

According to The Acne Global Alliance, acne is not classified as a chronic disease that needs appropriate diagnosis and long term strategies to effectively treat.

The Alliance says that acne effects 85% of the World's Population in the age of 12 to 24.

So how do you treat this disease? The Alliance recommends the following (and I am paraphrasing).

Mild Acne     - 1st Choice - Topical retinoid
                   - 2nd Choice - Azelaic acid, salicyclic acid, physical extraction
                   - Alternative for women - see 1st choice
                   - Maintenance - Topical retinoid

Moderate Acne     - 1st Choice - Topical retinoid + topical antimicrobial
                           - 2nd Choice - Azaelaic acid, physical extraction
                           - Alternative for women - see 1st choice
                           - Maintenance - Topical retinoid

Severe Acne     - 1st Choice - Oral antibiotic + topical retinoid and/or benzoyl peroxide
                       - 2nd Choice - No consensus among experts so they default to first choice and azelaic
                       - Alternative for women - Oral antiandrogen + Topical retinoid and/or topical                                                                           antimicrobial
                       -Maintenance - Topical retinoid and/or benzoyl peroxide

Disfiguring Acne  - 1st Choice - oral isotretinoin
                          - 2nd Choice - high dose oral antibiotic + topical retinoid and/or benzoyl peroxide
                          - Alternative for women - High dose oral antiandrogen + topical retinoid and/or                                                                            topical antimicrobial
                          - Maintenance - Topical retinoid and/or benzoyl peroxide

This is alot of information to digest, but the bottom line is that a topical retinoid is your best weapon when fighting acne.

Please do not use this information to self diagnose and treat your acne. But, use this information to talk to your dermatologist as the best ways to treat your condition.

I often hear from frusterated people that lament they have tried man of these therapies and are not getting results or that they cannot tolerate the retinoid. There is no one best way to treat everyone's acne, but requires a trial by fire mentality to best approach your condition. Your doctor has the insight and training to help your search for the best path to treatment....so, don't lose faith after a couple of visits!

Hair Cloning

Here is an article from London about researchers taking hair cells, cloning them and then injecting those cells into the scalp to grow hair. Sound far fetched, but if the results are true (to be released next year) then this could be a huge leap forward in curing baldness.

Steroid Phobia

If athlete's use steroids, they develop nasty cancers that make them pay in the long run. If you use a topical steroid, the same thing will happen, right? Not at all.

Physicians use topical steroids to treat eczema and psoriasis, but many people use nonprescription steroids for minor skin irritations, bug bites and rashes. We often recommend a 1% hydrocortisone for people that have flare ups due to retinoid use.

True, if you use topical corticosteroids in great doses over a prolonged period, the skin can atrophy and can cause adrenal suppression. If you read the warning labels on most of these preparations, one would think you are flirting with the disaster. Even physicians can add to this phobia by instructing you to apply "thinly and evenly" or "sparingly" over the skin. This implies that you are using a dangerous ointment and to be careful.

The reality is that there is little or no risk from using a topical steroid. Most all preparations have such a low concentration of the active ingredient that patients and physicians need not worry about the short term use of topical steroid.

Since most people are scared to use too much of the cream, they tend to under-treat the underlying problem which causes the patient to use the steroid longer than needed. You should apply a generous amount to the affected area.

Study summaries:

• In a systematic review of treatments for atopic eczema, randomized controlled trials of topical corticosteroids that specifically gathered data on skin thinning and suppression of the pituitary–adrenal axis failed to show evidence of harm – although the studies were short term Study Reference
• Two longer-term studies on intermittent use of the potent topical steroid, fluticasone (Brand name Cutivate), found no evidence of skin thinning after 4 months Study Reference and Study Reference
• A study of 35 children aged 0.7–18.7 years with a median of 6.9 years of corticosteroid treatment for atopic eczema found biochemical evidence of HPA axis suppression (decreased cortisol response) only in those using potent or very potent topical corticosteroids or those who had received corticosteroids from other routes (inhaled, intranasal or oral). Study reference
• Reassuring evidence about the effects of long-term use of corticosteroids on the HPA axis in patients with psoriasis comes from a study of 46 patients randomized to 0.25% desoximetasone or betamethasone 17-valerate (Brand name Diprosone). Patients applied their medication to psoriatic lesions on approximately one-third of their body. Plasma cortisol levels were reduced to below normal levels in nine patients using desoximetasone during the study, but in none of the betamethasone group. Levels returned to normal spontaneously in four of the desoximetasone group. In four other patients, plasma cortisol remained suppressed at the end of 5 months of continuous therapy, but returned to normal within 7 days of stopping treatment. Study reference.
• In a 3-week comparative study of 40 patients using 3.5 g of either 0.05% betamethasone dipropionate cream (brand name Diprosone) or 0.05% clobetasol-17-propionate (Brand name Temovate) ointment for treatment of moderate to severe psoriasis, temporary reversible suppression of the HPA axis (low morning cortisol) was seen in eight patients – three on betamethasone and five on clobetasol. Study reference.

Some topical corticosteroids (active ingredient) Brand Name

Nonprescription

• (hydrocortisone) Aveeno Anti-Itch cream, Cortaid, Cortizone 10

Prescription Low Strength

• (hydrocortisone) Cort-Dome cream, Dermacort cream, Hytone ointment,

Prescription Medium Strength

• (betamethasone dipropionate) Diprosone lotion
• (flurandrenolide) Cordran ointment
• (fluticasone propionate) Cutivate ointment
• (hydrocortisone valerate) Westcort cream
• (triamcinolone acetonide) Aristocort ointment, Kenalog cream

Prescription High Strength

• (betamethasone dipropionate) Diprosone lotion
• (fluocinonide)Lidex cream, Lidex ointment
• (triamcinolone acetonide) Kenalog ointment

Prescription Very High Strength

• (betamethasone dipropionate) Diprolene ointment
• (clobetasol propionate) Temovate ointment and cream

Sources for this posting come from Medline (requires registration)

Clothing for Contact Dermatitis Sufferers.

For people who suffer from contact dermatitis (or other skin diseases) have a difficult time finding clothing that they can wear. Even the softest cotton or the touch of a seam can cause great discomfort and irritation.

However, here is a UK company that has created silk undergarments that will protect these sufferers from their clothing. This is a wonderful idea whose time has come, but I am afraid that it is a little too expensive for us Americans. Hopefully the dollar will correct soon or the products will become available here which should help with the expense factor.

There are many styles and sizes to choose from and the company has clinical data to back up their claims. Check it out.

GP's Removing Skin Cancers

In most cases Basal Cell carcinomas are not lethal, however, great care needs to be taken to move these cancers. In an overall trend driven by reimbursers, general practitioners are starting to diagnose and remove benign skin cancers.

This study strongly suggests that GP's have a long way to go before they can effectively remove skin cancers.

My advice to the general public is to insist on seeing a dermatologist to have your skin cancers treated. My advice to the dermatologist is that this trend will continue because economics drive the industry. Please read this post for more insight.

AAD Seal of Approval for Sunscreens

More drama at the American Academy of Dermatology lately. The controversy as of late is whether or not the AAD should put its seal of approval on sunscreens or not. The crux of the matter is whether the AAD should accept money from the pharmaceutical/cosmeceutical industry in exchange for this seal. Some doctors feel that it may cloud the waters of the AAD's objectivty i.e. if they accept money from a manufacturer then the AAD may not criticize the manufacturer's other products.

• Some docs do not want a program at all.
• Other docs think the program should be free.
• A majority of the group wants the pay for placement program.

There are a couple of things that I would like to point out before I pass judgement.

• The AAD already accepts millions of dollars from the private industry in the form of endowments, advertising, sponsored studies etc.
• The AAD has a track record of being overzealous in their pusuit of ethical behavior in spite of the millions of dollars that they receive from industry.
• Over 70% of the public wants some kind of seal of approval from a trusted source. The public is confused and needs help on wading through the litany of marketing messages that the industry spews.
• It costs the academy a lot of money to create, maintain and oversee the program and to make this service free to the industry lowers the bar of acceptance and would utimately dilute the meaning of the seal of approval.

So, the public needs help from a trusted source, industry is willing to pay for the seal, and the AAD already accepts millions of dollars from industry...what's the problem here?

The Skin Cancer Foundation has a similar program which I highly recommend.

Medical vs. Cosmetic Dermatology - Missing the Boat

There has been a raging debate within the dermatology community whether or not "physicians" should embrace cosmetic practices and therapies. Dermatologist were the first to recognize the cosmetics trend, but they have been the last to join. Here is a link to a great article that highlights the schism. http://www.skinandaging.com/article/1804

However, it is apparent to me that the winner in this divide is the .... plastic surgeons. Where traditional doctors won't go, plastic surgeons have become marketing mavens. Now what do plastic surgeons know about skin care and therapies? They are highly trained surgeons, artists of their trade. Their training on skin care consists of one chapter in a multivolumn curriculum.

Recognizing that they didn't know much about skin care and therapies, they hired licensed estheticians to come into their practices and teach their patients the nuances of skin care. In my experience, plastic surgeons recruit and train the best skin care specialists in the industry and spend alot of money and time training them. Of all the trade shows and conferences we attend, I am always most impressed with the training done by the Society of Plastic Surgery and Skincare Specialists.

So here is the problem from my point of view. Dermatologist will not sanction an aesthetics group within the American Academy of Dermatology. There are alot of good aestheticians here in the US that work for dermatologists. The only sources of their education and training comes from the general aesthetics group, which lacks serious medical oversight and from product based training, which is biased at best.

The purpose of the aesthetian is to bridge the gap between what is learned in the medical community and the general public. Their purpose is not to provide general medical services. This is what concerns the medical dermatology community.

Therefore, until the dermatology community embraces the aestheticians and sanction their existence, the plastic surgeon will outmarket and out perform the cosmetic dermatologist all day long.

With the reimbursements coming from insurance companies and government sources diminishing everyday, you are going to see more general practitioners moving into the medical dermatology field. With the plastic surgeons poaching on the cosmetic side of things, I'm afraid dermatology may slowly dwindle away to insignificance. Unfortunately, cosmetic dermatology is the only segment of their practice that is making money. Therefore, in order to keep dermatology a strong and thriving discipline, they must embrace cosmetic dermatology in order to keep the medical aspects alive. If they don't do this, I'm afraid they are missing the boat completely. Their first step should be to sanction a licensed aesthetician's group within the AAD.

Primary Docs for Skin Care Advice?

Due to changes in the whole medical industry, more and more people are turning to their primary care physicians in order to get anti-aging skin care advice. Though the market is glut with dermatologists selling their own product lines, most dermatologist do not sell skin care products from their office. Therefore, other physicians are starting to fill the void.

Plastic surgeons were the first to notice the gap in skin care sales, but now general practitioners or moving in as well. However, knowledge on the best treatment protocols are cursory at best. However, here is a link to a great article in one of my favorite magazines Healthy Aging Magazine giving family docs a good overview on treating anti aging skin care concerns. The article is good read and not too technical.

Of course what do they recommend as the first line of defense for aging skin and acne? Retinoids of course. Now if we can get the general medical community on board, maybe the next step we can reach the skin care counter people at the major retailers and drugstores. I'm doubtlful, but ever so optimistic. :)