DermatologistsBlog.com October 2012

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DermatologistsBlog.com October 2012

  1. 1. DermatologistsBlog.com Dermatology Research Author Interviews Updated October 2012
  2. 2. Medical Disclaimer | Terms and Conditions• The contents of the Hemodialysis.com Site, such as text, graphics, images, and other material contained on the Hemodialysis.com Site ("Content") are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the Hemodialysis.com Site!• If you think you may have a medical emergency, call your doctor or 911 immediately. Hemodialysis.com does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. Reliance on any information provided by Hemodialysis.com or other Eminent Domains Inc (EDI) websites, EDI employees, others appearing on the Site at the invitation of Hemodialysis.com or EDI, or other visitors to the Site is solely at your own risk.• The Site may contain health- or medical-related materials that are sexually explicit. If you find these materials offensive, you may not want to use our Site. The Site and the Content are provided on an "as is" basis. Read more interviews on Hemodialysis.com
  3. 3. Safety of Quadrivalent Human Papillomavirus Vaccine Administered Routinely to Females DermatologistsBlog.com: Author Interview: Nicola Klein, MD, PhD• DermatologistsBlog.com: What are the main findings of the study?• This study of almost 200,000 females who received nearly 350,000 doses of the quadrivalent human papilloma virus (HPV4) vaccine found that immunization was associated with same-day syncope (fainting) and skin infections in the two weeks after vaccination.• The findings from this large, comprehensive study did not detect any evidence of serious safety concerns secondary to HPV4.• DermatologistsBlog.com: Were any of the findings unexpected?• The association between HPV4 and fainting (syncope) was not unexpected because immunization and injections in general have a known association with syncope (particularly in this age group).• A medical record review suggested that some of the cases of skin infection may have been local injection site reactions.• However, females who received HPV4 generally sought increased clinical care for skin conditions in the two weeks following vaccination.• Read the Rest of the Interview on DermatologistsBlog.com
  4. 4. Cutaneous manifestations of dabrafenib (GSK2118436): a selective inhibitor of mutant BRAF in patients with metastatic melanoma DermatologistsBlog.com Author Interview: Dr R.Anforth, BMed, BAppSc• DermatologistsBlog.com: What are the main findings of the study?• The new generation RAF inhibitor dabrafenib has a number of cutaneous side effects including cutaneous squamous cell carcinoma, verrucal keratosis, Grover’s disease and plantar hyperkeratosis.• Other less frequently seen cutaneous side effects include, hair loss or changes in colour (grey), follicular erythema, seborrheic keratosis, hyperkeratotic actinic keratosis, verruca vulgaris and epidermal cysts.• DermatologistsBlog.com Author Interview: Were any of the findings unexpected?• Verrucal keratosis is a new entity first described in this paper. Since then a number of other studies have been published commenting on its presence in patients taking either vemurafenib or dabrafenib. Its relationship as a possible precursor to cutaneous squamous cell carcinoma is still under investigation.• This was also the first time such a high frequency of Grover’s disease was reported, with up to 20% of the population affected.• Read the rest of the interview on DermatologistsBlog.com
  5. 5. Obesity, waist circumference, weight change, and the risk of psoriasis and psoriatic arthritis in US women DermatologistsBlog.com: Authors’ Interview: Sandeep Kumar, MD, Brigham and Women’s Hospital, Boston, MA• DermatologistsBlog.com: What are the main findings of the study?• Our study found that obesity was associated with an increased incident of psoriasis in older US women.• Also, higher body mass index (BMI) and weight gain represented the significant measures of obesity.• DermatologistsBlog.com: Were any of the findings unexpected?• Our study strengthens the observed association between psoriasis and obesity in a defined patient population.• Read the rest of the interview on DermatologistsBlog.com
  6. 6. Comparative Risk for Angioedema Associated With the Use of Drugs That Target the Renin-Angiotensin-Aldosterone System DermatologistsBlog.com: Author Interview: Sengwee Darren Toh, ScD• DermatologistsBlog.com: What are the main findings of the study?• We found that the risk for angioedema was about 3-fold higher among patients who used an ACE inhibitor or the direct renin inhibitor aliskiren, and approximately 16% greater among patients who used an angiotensin receptor blocker when compared with those who used a beta-blocker.• DermatologistsBlog.com: Were any of the findings unexpected?• The magnitude of the association between aliskiren and angioedema was somewhat unexpected, primarily because little was known about this possible association at the time of our analysis.• Read the Rest of the Interview on DermatologistsBlog.com
  7. 7. Propionibacterium acnes Bacteriophages Display Limited Genetic Diversity and Broad Killing Activity against Bacterial Skin Isolates. Robert L. Modlin, M.D. Professor and Chief of Dermatology Residency Program Director Laura Marinelli, Ph.D. UCLA Dermatology, BSRB 246• DermatologistsBlog.com: What are the main findings of the study?• In this study, we used high throughput DNA sequencing to compare the genomes of a population of P. acnes phages isolated from both healthy donors and those with acne.• We performed comparative genomic analyses and found that these phages are highly homogeneous and have a striking lack of genetic diversity.• This is surprising because it is very different than what has been observed for other groups of phages that infect a specific bacterial host (such as those that infect the bacteria that cause human TB), which are much more diverse and contain a number of different genetic types. For the P. acnes phages however, we only find one genetic type, suggesting a unique relationship between P. acnes bacteria and P. acnes phages within restricted environment of the human sebaceous follicle.• The limited diversity of the phage and the wide range of infectivity they display towards P. acnes isolates suggest that the phage or proteins from the phage could be used to develop a improved therapeutics for the treatment of acne.• Read the Rest of the Interview on DermatologistsBlog.com
  8. 8. Comparative Risk for Angioedema Associated With the Use of Drugs That Target the Renin- Angiotensin-Aldosterone System DermatologistsBlog.com: Author Interview: Sengwee Darren Toh, ScD• DermatologistsBlog.com: What are the main findings of the study?• We found that the risk for angioedema was about 3-fold higher among patients who used an ACE inhibitor or the direct renin inhibitor aliskiren, and approximately 16% greater among patients who used an angiotensin receptor blocker when compared with those who used a beta-blocker.• DermatologistsBlog.com: Were any of the findings unexpected?• The magnitude of the association between aliskiren and angioedema was somewhat unexpected, primarily because little was known about this possible association at the time of our analysis.• DermatologistsBlog.com: What should clinicians and patients take away from this study?• These drugs appear to have different risks for angioedema.• However, it is important to note that angioedema risk is one of the many factors that clinicians may consider when making treatment decisions, and that the absolute risk is quite low – about 1.8 per 1,000 ACEI inhibitor users, 0.6 per 1,000 angiotensin receptor blocker users, 1.4 per 1,000 aliskiren users, and 0.6 per 1,000 beta-blocker users in our population.• Read the Rest of the Interview on DermatologistsBlog.com
  9. 9. Psoriasis and the Risk of Diabetes Mellitus : A Systematic Review and Meta-analysis DermatologistsBlog.com Author Interview: April W. Armstrong, M.D., M.P.H.• DermatologistsBlog.com Author Interview : What are the main findings of the study?• Our research team found that psoriasis was associated with an increased prevalence and incidence of diabetes.• Specifically, among patients with psoriasis, there was a 59% increased prevalence of diabetes and a 27% increased risk of developing diabetes.• DermatologistsBlog.com Author Interview: Were any of the findings unexpected?• We found that the association between psoriasis and diabetes appears to be similar across diverse patient populations.• DermatologistsBlog.com Author Interview: What should clinicians and patients take away from this study?• Patients with psoriasis should be educated about the increased risk of developing diabetes. Additionally, physicians and clinicians should more closely screen psoriasis patients for diabetes and diabetes risk factors in order for the condition to be detected early.• Read the Rest of the Interview on DermatologistsBlog.com
  10. 10. Melanomas resist T-cell therapy through inflammation-induced reversible dedifferentiation DermatologistsBlog.com: Author Interview: Prof. Dr. med. Thomas Tüting• DermatologistsBlog.com: What is the background for your research project and what methods were used?• Approaches for adoptive T cell immunotherapy hold promise for the treatment of metastatic melanoma.• In our work we combined mouse models and tools of tumor biology and tumor immunology to experimentally study the interaction between tumor and immune cells in their natural microenvironment in an immunocompetent organism.• We first established an effective adoptive cell transfer therapy protocol with genetically engineered T cells recognizing the melanocyte-specific antigen gp100. This combination treatment regimen caused regression of established primary and metastatic melanomas. However, we frequently observed a tumor relapse following initial response and long-term remission. In our paper we now reported on the mechanisms underlying acquired therapy resistance.• DermatologistsBlog.com: What are the main findings of the study?• We found that tumor relapse after initially successful T cell immunotherapy involves a reversible adaptive process of de-differentiation driven by proinflammatory mediators such as TNF-α secreted by tumor-infiltrating immune cells in the tumor microenvironment. The immunoselection of tumor cell variants with persistent genetic loss of the antigen, as predicted by the immunoediting theory, is not a prerequisite for acquired therapy resistance• Read the Rest of the Interview on DermatologistsBlog.com
  11. 11. Elder abuse: Dermatologic clues and critical solutions DermatologistsBlog.com Author Interview: Eliot N. Mostow, MD, MPH Northeast Ohio Medical University, 157 W Cedar St, Suite 101, Akron, OH 44307.• DermatologistsBlog.com: What are the main findings of the study?• Elder abuse affects approximately 2% to 10% of older Americans. Unfortunately, it is often unrecognized and certainly underreported.• Dermatologists have a unique role in the detection and reporting of elder abuse.• DermatologistsBlog.com: Were any of the findings unexpected?• The most unexpected finding, and this was an early part of this work, was that there had never been any paper like this in the dermatology literature. While there were a number of studies related to skin findings that might suggest child abuse (or be confused with child abuse), this particular topic had been neglected.• This paper became possible because of the initial interest and hard work of Dr. Matt Palmer (he was a medical student at NEOMED as the paper was written) with guidance by Dr. Brodell and me.• Read the Rest of the Interview on DermatologistsBlog.com
  12. 12. Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis. DermatologistsBlog.com Author Interview: Dr. Eleni Linos MD• DermatologistsBlog.com: What are the main findings of the study?• Indoor tanning is linked to a higher risk of skin cancer, including basal and squamous cell cancers.• The risk is even higher when tanning beds are used in teenage years. We found that over170,000 new cases of skin cancer are attributed to tanning beds each year in the United States.• For teenagers, tanning beds increase the risk of basal cell cancer by 40% and they double the risk of squamous cell cancer• DermatologistsBlog.com: Were any of the findings unexpected?• We did not expect to see such high numbers of cases attributed to indoor tanning. Finding that hundreds of thousands of cases each year are potentially preventable was surprising but also an important result.• Read the Rest of the Interview on DermatologistsBlog.com
  13. 13. Solar UV radiation reduces the barrier function of human skin DermatologistsBlog.com Author Interview: Reinhold H. Dauskardt Ph.D• DermatologistsBlog.com : What are the main findings of the study?• Our research showed that UV B exposure causes a double threat to skin damage – not only does it reduce the strength of the critical outer barrier layer, the stratum corneum, but it also increases the stresses that exist in this barrier layer. So the stresses go up, and the strength comes down, and this leads to damage in the form of cracking and chapping of the skin. DermatologistsBlog.com : Were any of the findings unexpected?• We were on the one hand impressed by the resilience of skin to even large doses of damaging UV exposure, but on the other hand did not expect that the double effect involves not only a strength reduction, but an increase in the skin stress. Taken together these shown how skin can be damaged by solar UV exposure.• DermatologistsBlog.com : What should clinicians and patients take away from this study?• While moderate UV exposure in the solar spectrum is vital for vitamin D production, over-exposure not only increases the risk of skin cancer, but can lead to actual “mechanical” damage of skin – it can chap, crack and split as a result, all at the very least painful, and could lead to more serious infections once the barrier is compromised.• potentially preventable was surprising but also an important result.• Read the Rest of the Interview on DermatologistsBlog.com
  14. 14. Investigation of Hyfrecators and Their In Vitro Interference with Implantable Cardiac Devices DermatologistsBlog.com Author Interview: Christopher Weyer, DO• DermatologistsBlog.com: What are the main findings of the study?• The main overall finding is that using a hyfrecator in patients with implanted cardiac devices (pacemakers or defibrillators) is safe.• We found no interference with hyfrecators on the defibrillators tested.• We found limited interference with the pacemakers, but this was at a very close proximity to the device (1-3 cm). Clinically, that makes almost any surgery (except over the pacemaker) safe to use the hyfrecator.• DermatologistsBlog.com: Were any of the findings unexpected?• What surprised me the most was how minimal the interference of the hyfrecators tested was with the cardiac devices.• The project was initiated to test and create hyfrecator specific guidelines for safe use in patient’s implantable cardiac devices.• Before this, guidelines that existed were generalized for all electrosurgical devices, of which the hyfrecator was lumped into that group.• Read the Rest of the Interview on DermatologistsBlog.com
  15. 15. Risk of cancer among patients with herpes zoster infection: a population-based study. DermatologistsBlog.com Author Interview: Dr. Yi-Tsung Lin• DermatologistsBlog.com : What are the main findings of the study?• Our main findings is that herpes zoster is not associated with increased risk of cancer in the general population. Therefore, our findings do not support extensive investigations for occult cancer or enhanced surveillance for cancer in patients with herpes zoster.• DermatologistsBlog.com : Were any of the findings unexpected?• Survey for occult malignancy or enhanced surveillance for cancer after herpes zoster is common in some countries, such as Taiwan and Japan. The textbook of dermatology from Japan also suggested herpes zoster cases should be carefully observed for the possibility of occult malignancy or future diagnosis of cancer. Our findings provide the evidence that extensive cancer surveillance is unnecessary in patients with herpes zoster.• Read the Rest of the Interview on DermatologistsBlog.com
  16. 16. Prospective Registration and Outcome-Reporting Bias in Randomized Controlled Trials of Eczema Treatments: A Systematic Review. DermatologistsBlog.com Author Interview: Helen Nankervis• DermatologistsBlog.com What are the main findings of the study?• The study revealed that only 37 out of 109 (34%) eczema RCTs published in the 5 years from 2007 to 2011 had ever been registered on an approved clinical trials register.• Only 18 of the total of 109 RCTs (17%) had been ‘properly’ registered: i.e the trial had been registered before the trial end date and had nominated a primary outcome. This generous definition of ‘proper’ trial registration is not as strict as registration before trial recruitment commences which journals require in order to publish clinical trial papers. The number of trials being ‘properly’ registered and providing sufficient details of the primary outcome was not high enough to properly analyse the level of outcome reporting bias in eczema RCTs.• DermatologistsBlog.com: Were any of the findings unexpected?• We have originally estimated that the number of trials registered would be not more than half of the total number of trials, however, the low numbers were disappointing considering the generous definition of ‘properly’ registered we used for the study.• Read the Rest of the Interview on DermatologistsBlog.com
  17. 17. Loss of 5-Hydroxymethylcytosine Is an Epigenetic Hallmark of Melanoma DermatologistsBlog.com Author Interview: Christine Guo Lian MD• DermatologistsBlog.com : What are the main findings of the study?• Evidence demonstrates that epigenetic events, combined with genetic changes in the DNA sequence, play critical roles in the genesis of cancer. Our study demonstrates that genome-wide loss of 5-hydroxymethylcytosine (5-hmC) is an epigenetic hallmark in melanoma, a prototype of aggressive human cancer. In addition, our findings indicate that such epigenetic changes can be reversed in experimental animal models by re-introducing enzymatically active genes, i.e. TET2 and IDH2, thus replenishing the loss of 5-hmC. Thus, the findings open up a promising new area for cancer therapy that will rely on reversal of epigenetic changes underlying the malignant phenotype.• DermatologistsBlog.com : Were any of the findings unexpected?• The most exciting part about the findings is that, unlike genetic mutations, loss of this DNA tag (5- hmC) is potentially reversible (hence such changes are referred to as epigenetic). In fact, in our study we were able to demonstrate that melanoma growth in mouse and fish models could actually be slowed by restoring the 5-hmC tag to the DNA. In addition, this is the very first study to our knowledge in which whole genome-wide deep sequencing was applied to describe the 5-hmC landscape in cancer. To our surprise, the data show global 5-hmC and DNA methylation changes in many genes, not only at promoter region, but also at gene bodies.• Read the Rest of the Interview on DermatologistsBlog.com
  18. 18. Remission of psoriasis after allogeneic, but not autologous, hematopoietic stem-cell transplantation Author Interview: Benjamin H. Kaffenberger, MD, Dermatology• DermatologistsBlog.com: What are the main findings of the study?• We reviewed the literature for all cases of patients with psoriasis who then underwent hematopoietic stem cell transplantation.• Patients with a history of psoriasis that underwent stem cell transplantation appeared to have durable remission of their psoriasis after the transplant, if it was allogeneic. This is not surprising, but had been largely only published in single cases in the bone marrow transplant literature. Unfortunately, patients that underwent autologous transplantation did not have the same response. There was improvement of the psoriasis but the remission was not as long-lasting.• DermatologistsBlog.com: Were any of the findings unexpected?• It was surprising how few cases have been reported given the prevalence of psoriasis and the increasing prevalence of blood and marrow transplantation. I think that this demonstrates that there has largely been a disconnect between dermatologists and hospital based physicians such as hematologists, who do not see psoriasis as a systemic disease.• Autologous blood and marrow transplantation is being studied for other refractory autoimmune diseases such as SLE and scleroderma. It was a little surprising that patients with psoriasis relapsed so quickly.• Read the Rest of the Interview on DermatologistsBlog.com
  19. 19. Whey Protein Precipitating Moderate to Severe Acne Flares in 5 Teenaged Athletes DermatologistsBlog.com Author Interview: Nanette Silverberg, MD• DermatologistBlog.com: What are the main findings of the study?• In the August 2012 issue of Cutis, I had the great pleasure to publish an article on a trend in my practice of whey-protein induced flares of acne vulgaris in teenage males. The subject of diet and acne has been a controversial one. For many years we believed acne to be unrelated to foods and supplements; however, it is hard to ignore the fact that our teenage patients often have diets filled with fried foods and refined sugars.• In the past few years I have seen a group of teenage boys, ages 14-18 years, who were using whey protein supplements and experienced inflammatory and/ or cystic flares of their acne. Two boys were attempting to gain weight and three were football players for high school teams being encouraged to use the supplement. None of the boys were easily convinced to discontinue the supplements. When continuing whey protein supplementation, it was difficult to clear their acne. One boy would not discontinue supplements of whey protein until partway through his second course of isotretinoin. Stopping usage of whey protein helped four of the teenagers as soon as two weeks after discontinuation, but one could not stop and persisted in disease activity. Reintroduction retriggered acne in one athlete.• DermatologistBlog.com : Were any of the findings unexpected?• In 2011, Veith and Silverberg reviewed the published literature on acne and diet in Cutis (Veith WB, Read the Rest of the Interview on DermatologistsBlog.com
  20. 20. Narrowband ultraviolet B three times per week is more effective in treating vitamin D deficiency than 1600 IU oral vitamin D3 per day: a randomized clinical trial DermatologistsBlog.com Author Interview: Morten Bogh MD, PhD• DermatologistsBlog.com What are the main findings of the study?• Our study shows that full body narrowband UVB (NB-UVB) exposure 3 times per week is an effective treatment against vitamin D deficiency. Notably, we found a significantly greater increase in vitamin D (expressed as 25- hydroxyvitamin D3) in the NB-UVB treated group (from 19.2 to 75 nmol/L) compared to the oral vitamin D3 treated group (from 23.3 to 60.6 nmol/L), who had a daily oral intake of 40 µg vitamin D3. DermatologistsBlog.com Were any of the findings unexpected?• A limited number of studies have compared the effects of NB-UVB exposure with relatively low doses of oral vitamin D3 supplementation in the treatment of vitamin D deficiency. In our study, we compared the effects of NB-UVB exposure with a relatively high oral daily intake of 40 µg vitamin D3. Despite this, we found that the NB- UVB exposure was slightly more effective in treating vitamin D deficiency. This result was not expected.• DermatologistsBlog.com What should clinicians and patients take away from this study?• Patients with vitamin D deficiency deserves the most optimal treatment with either controlled NB-UVB exposure or oral vitamin D supplementation.• Controlled NB-UVB exposure is a safe procedure and the use of NB-UVB in the treatment of psoriasis has shown no increase in BCC, SCC or melanoma. In spite of this, I believe that most patients are sufficiently treated with oral vitamin D supplementation being both a safe and efficient treatment with low health-economic costs and without any known carcinogenic side-effects. However, their may be some groups of patients where controlled NB-UVB exposure can be used to treat vitamin D deficiency as a first choice treatment, for instance patients with poor gastrointestinal absorption, noncompliant patients or when there is a need for rapid replenishment.• Read the Rest of the Interview on DermatologistsBlog.com
  21. 21. ALDH1A Isozymes are Markers of Human Melanoma Stem Cells and Potential Therapeutic Targets. Author Interview: Mayumi Fujita, MD, PhD• DermatologistsBlog.com: What are the main findings of the study?• There are three major findings in this study:• 1) Aldehyde dehydrogenase (ALDH) – positive human melanoma cells are demonstrated to be cancer stem cells (CSCs), responsible for tumor initiation, propagation, resistance to treatment and tumor recurrence after treatment.• 2) ALDH1A isozymes (enzymes) contribute to the ALDH activity in human melanoma.• 3) ALDH isozymes are not only markers of CSCs but also therapeutic targets for human melanoma.• DermatologistsBlog.com Were any of the findings unexpected?• The existence of CSCs in human melanoma had been questioned because it was reported that most melanoma cells were tumorigenic. In this paper, we have confirmed that human melanoma tumors contain cells that fulfill the criteria for CSCs.• Read the Rest of the Interview on DermatologistsBlog.com

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