The Week
Taking a common antibiotic can help men resist the allure of attractive women, Nature reports. Researchers recruited 100 men and gave half of them a course of minocycline, an antibiotic used to treat acne that also appears to improve decision-making. Then they asked them to play a game of trust, in which the men had to decide how much money to give a women of varying attractiveness, knowing that some women could opt to keep it all while others would give back triple what they got. The men who weren't taking minocycline acted like typical men, giving more money to the women they considered highly attractive; the men on the antibiotic treated all the women the same. That suggests minocycline may disrupt the tendency of men to lavish attention and gifts on pretty women in order to seduce them and "increase the probability of producing attractive offspring," the study authors say. For unexplained reasons, minocycline seems to affect the brain, improving focus and mood.
Monday, October 21, 2013
Friday, October 18, 2013
Sleep deprivation linked to skin aging
Medical New Today
In a first-of-its-kind clinical trial, physician-scientists at University Hospitals (UH) Case Medical Center found that sleep quality impacts skin function and aging. The recently completed study, commissioned by Estee Lauder, demonstrated that poor sleepers had increased signs of skin aging and slower recovery from a variety of environmental stressors, such as disruption of the skin barrier or ultraviolet (UV) radiation. Poor sleepers also had worse assessment of their own skin and facial appearance.
The research team, led by Primary Investigator Elma Baron, MD, presented their data this spring at the International Investigative Dermatology Meeting in Edinburgh, Scotland in an abstract titled "Effects of Sleep Quality on Skin Aging and Function."
"Our study is the first to conclusively demonstrate that inadequate sleep is correlated with reduced skin health and accelerates skin aging. Sleep deprived women show signs of premature skin aging and a decrease in their skin's ability to recover after sun exposure," said Dr. Baron, Director of the Skin Study Center at UH Case Medical Center and Associate Professor of Dermatology at Case Western Reserve University School of Medicine. "Insufficient sleep has become a worldwide epidemic. While chronic sleep deprivation has been linked to medical problems such as obesity, diabetes, cancer and immune deficiency, its effects on skin function have previously been unknown."
Skin functions as an important barrier from external stressors such as environmental toxins and sun-induced DNA damage. The research team set out to determine if skin function and appearance is also impacted by sleep quality, which is vital to the growth and renewal of the body's immune and physiological systems.
The study involved 60 pre-menopausal women between the ages of 30 and 49, with half of participants falling into the poor quality sleep category. The classification was made on the basis of average duration of sleep and the Pittsburgh Sleep Quality Index, a standard questionnaire-based assessment of sleep quality. The study involved a visual skin evaluation and participation in several non-invasive skin challenge tests including UV light exposure and skin barrier disruption. Additionally, participants filled out a sleep log for one week to quantify sleep duration.
The researchers found statistically significant differences between good and poor quality sleepers. Using the SCINEXA skin aging scoring system, poor quality sleepers showed increased signs of intrinsic skin aging including fine lines, uneven pigmentation and slackening of skin and reduced elasticity. In this system, a higher score means a more aged appearance. The average score in the good quality sleepers was 2.2 versus 4.4 in poor quality sleepers. They found no significant difference between the groups in signs of extrinsic aging, which are attributed primarily to sun exposure, such as coarse wrinkles and sunburn freckles.
The researchers found that good quality sleepers recovered more efficiently from stressors to the skin. Recovery from sunburn was more sluggish in poor quality sleepers, with erythema (redness) remaining higher over 72 hours, indicating that inflammation is less efficiently resolved. A Transepidermal Water Loss (TEWL) test was used at various time points to determine the ability of the skin to serve as an effective barrier against moisture loss. In measurements 72 hours after a skin barrier stressor (tape-stripping), the recovery of good quality sleepers was 30% higher than poor quality sleepers (14% vs. -6%) demonstrating that they repair the damage more quickly.
Additionally, poor quality sleepers were significantly more likely to have a higher Body Mass Index (BMI). For example, 23% of good quality sleepers were obese compared to 44% of poor quality sleepers. Not surprisingly, self perception of attractiveness was significantly better in good quality sleepers (mean score of 21 on self evaluation) vs. poor quality sleepers (mean score of 18).
"This research shows for the first time, that poor sleep quality can accelerate signs of skin aging and weaken the skin's ability to repair itself at night," said Dr. Daniel Yarosh, Senior Vice President, Basic Science Research, R&D, at The Estée Lauder Companies. "These connections between sleep and skin aging, now supported with solid scientific data, will have a profound effect on how we study skin and its functions. We see these findings as yet another way we can direct our scientific research toward the real needs of our customers who want to look and feel their best."
In a first-of-its-kind clinical trial, physician-scientists at University Hospitals (UH) Case Medical Center found that sleep quality impacts skin function and aging. The recently completed study, commissioned by Estee Lauder, demonstrated that poor sleepers had increased signs of skin aging and slower recovery from a variety of environmental stressors, such as disruption of the skin barrier or ultraviolet (UV) radiation. Poor sleepers also had worse assessment of their own skin and facial appearance.
The research team, led by Primary Investigator Elma Baron, MD, presented their data this spring at the International Investigative Dermatology Meeting in Edinburgh, Scotland in an abstract titled "Effects of Sleep Quality on Skin Aging and Function."
"Our study is the first to conclusively demonstrate that inadequate sleep is correlated with reduced skin health and accelerates skin aging. Sleep deprived women show signs of premature skin aging and a decrease in their skin's ability to recover after sun exposure," said Dr. Baron, Director of the Skin Study Center at UH Case Medical Center and Associate Professor of Dermatology at Case Western Reserve University School of Medicine. "Insufficient sleep has become a worldwide epidemic. While chronic sleep deprivation has been linked to medical problems such as obesity, diabetes, cancer and immune deficiency, its effects on skin function have previously been unknown."
Skin functions as an important barrier from external stressors such as environmental toxins and sun-induced DNA damage. The research team set out to determine if skin function and appearance is also impacted by sleep quality, which is vital to the growth and renewal of the body's immune and physiological systems.
The study involved 60 pre-menopausal women between the ages of 30 and 49, with half of participants falling into the poor quality sleep category. The classification was made on the basis of average duration of sleep and the Pittsburgh Sleep Quality Index, a standard questionnaire-based assessment of sleep quality. The study involved a visual skin evaluation and participation in several non-invasive skin challenge tests including UV light exposure and skin barrier disruption. Additionally, participants filled out a sleep log for one week to quantify sleep duration.
The researchers found statistically significant differences between good and poor quality sleepers. Using the SCINEXA skin aging scoring system, poor quality sleepers showed increased signs of intrinsic skin aging including fine lines, uneven pigmentation and slackening of skin and reduced elasticity. In this system, a higher score means a more aged appearance. The average score in the good quality sleepers was 2.2 versus 4.4 in poor quality sleepers. They found no significant difference between the groups in signs of extrinsic aging, which are attributed primarily to sun exposure, such as coarse wrinkles and sunburn freckles.
The researchers found that good quality sleepers recovered more efficiently from stressors to the skin. Recovery from sunburn was more sluggish in poor quality sleepers, with erythema (redness) remaining higher over 72 hours, indicating that inflammation is less efficiently resolved. A Transepidermal Water Loss (TEWL) test was used at various time points to determine the ability of the skin to serve as an effective barrier against moisture loss. In measurements 72 hours after a skin barrier stressor (tape-stripping), the recovery of good quality sleepers was 30% higher than poor quality sleepers (14% vs. -6%) demonstrating that they repair the damage more quickly.
Additionally, poor quality sleepers were significantly more likely to have a higher Body Mass Index (BMI). For example, 23% of good quality sleepers were obese compared to 44% of poor quality sleepers. Not surprisingly, self perception of attractiveness was significantly better in good quality sleepers (mean score of 21 on self evaluation) vs. poor quality sleepers (mean score of 18).
"This research shows for the first time, that poor sleep quality can accelerate signs of skin aging and weaken the skin's ability to repair itself at night," said Dr. Daniel Yarosh, Senior Vice President, Basic Science Research, R&D, at The Estée Lauder Companies. "These connections between sleep and skin aging, now supported with solid scientific data, will have a profound effect on how we study skin and its functions. We see these findings as yet another way we can direct our scientific research toward the real needs of our customers who want to look and feel their best."
The Children and Suncreen Study
Archives of Dermatology
Childhood sun exposure is thought to be a key risk factor for future skin cancer development. Often used as a stand-alone primary prevention method, sunscreen is the most common form of sun protection used by children. Because there is a linear relationship between the thickness of sunscreen application and the sun protection factor (SPF), sunscreens may have an effectively lower SPF if applied in inadequate amounts. In this crossover study of children's use of 3 sunscreen dispenser types, Diaz et al demonstrate that children applied significantly more sunscreen when using a pump and a squeeze bottle compared with a roll-on. All sunscreens were applied at substantially less than the recommended thickness.
Childhood sun exposure is thought to be a key risk factor for future skin cancer development. Often used as a stand-alone primary prevention method, sunscreen is the most common form of sun protection used by children. Because there is a linear relationship between the thickness of sunscreen application and the sun protection factor (SPF), sunscreens may have an effectively lower SPF if applied in inadequate amounts. In this crossover study of children's use of 3 sunscreen dispenser types, Diaz et al demonstrate that children applied significantly more sunscreen when using a pump and a squeeze bottle compared with a roll-on. All sunscreens were applied at substantially less than the recommended thickness.
Wet Wipes Linked to contact dermatitis in children
Skin & Allergy News
MILWAUKEE – Despite extensive testing, seemingly innocuous wet wipes have been linked to allergic contact dermatitis in children.
The first reported case occurred in a healthy 8-year-old girl who presented with chronic, recalcitrant erythematous, eczematous patches and plaques with crusting and fissuring around the mouth and perianal area. She had been using wipes containing methylisothiazolinone (MI), without methylchloroisothiazolinone (MCI).
Within 22 months, an additional five children had been diagnosed with allergic contact dermatitis to MI in wet wipes, Dr. Mary Wu Chang and Ms. Radhika Nakrani reported at the annual meeting of the Society for Pediatric Dermatology.
All cases were confirmed on patch testing, and all patients had rapid, complete resolution within about 2 days after discontinuing use of the wipes. Ms. Nakrani also interviewed the parents to determine the type of wipes used, identified as Cottonelle and Huggies brands (both manufactured by Kimberly-Clark). The preservative MI was identified in these brands.
"This is going to explode," Dr. Chang, a pediatric dermatologist at the University of Connecticut, West Hartford, said in an interview. "There’s more marketing [of wipes] now for non–diaper wearing children, and older people use wipes out of convenience."
The case series was described as the first report of pediatric allergic contact dermatitis to MI in wet wipes in the United States.
Although the MCI/MI patch test (T.R.U.E. Test) detected contact allergy to MI in the six children, identifying MI contact sensitization may require specialized MI patch tests with higher concentrations of MI or the use of small squares of the wipes themselves, Dr. Chang observed. Patch testing containing 100 ppm of MCI/MI mixture consists of only 25 ppm of MI and may be inadequate to detect MI alone, missing 33%-60% of cases.
Acute contact dermatitis was suspected in the index case, when the 8-year-old girl presented to pediatric dermatology after suffering for 11 months. She was initially misdiagnosed with impetiginized eczema and had received numerous oral and topical corticosteroids and antibiotics, said Dr. Chang. Questioning revealed that the patient used wet wipes for toileting and facial cleansing, and the rash resolved after the wipes were discontinued. MI sensitivity was confirmed on patch testing. Ms. Nakrani also interviewed the parents to determine the type of wipes used, and the preservative MI was identified in these brands.
"Remember to ask about wet wipe use, even in individuals who do not wear diapers and even if the rash in on the face," Dr. Chang said.
In the five other cases, allergic reactions to MI in the wet wipes were misdiagnosed as impetigo, psoriasis, diaper dermatitis, or atopic dermatitis, and unsuccessfully treated with a multitude of medications including steroids, antifungals, and topical tacrolimus (Protopic). The children, aged 3-8 years, had experienced symptoms for 1-12 months, according to the authors, who earned top honors for their poster presentation at the meeting.
The index patient also suffered from chronic retroauricular dermatitis, which resolved after discontinuing a shampoo containing MI.
MI was named the 2013 contact allergen of the year by the American Contact Dermatitis Society. In another recent study, Australian researchers reported 23 reactions to MI from a variety of personal care products, including 7 cases of hand dermatitis in parents of young children that was caused by an allergic reaction to MI in baby wipes (Australas. J. Dermatol. 2013 May 29 [doi: 0.1111/ajd.12062]).
The preservative MI was previously used only in a 3:1 MCI/MI combination (Kathon CG) that is widely known to cause allergic contact dermatitis. In an attempt to minimize such reactions, MI has been used alone, explained Ms. Nakrani, a medical student at the University of Connecticut.
However, its permitted concentration has increased by more than 25 times – from 3.7 ppm to 100 ppm – because it was thought to be a weaker sensitizer than MCI, she said.
"Once we found out the culprit was MI in the wet wipes and instructed parents to read labels and avoid MI, parents became more vigilant about the other products they were using like shampoos and soaps, and it really turned things right around once they stopped using these products," Ms. Nakrani said. "One mom, very grateful that the rashes finally cleared, said her child was going to school and everyone thought it was contagious."
The investigators have not contacted Kimberly-Clark regarding their findings. Bob Brand, director of external communications for Kimberly-Clark, would not specifically say whether they had received complaints of allergic contact dermatitis to MI in their wet wipes, but said all of their products undergo a thorough safety review prior to commercialization.
"While we understand there might be concern regarding a potential reaction to one of our products, consumers can use our wipes with confidence and know that the concentration levels of MI in our products are considered safe and well within the recommended levels as established by scientific and regulatory bodies such as the Cosmetic Ingredient Review Expert Panel in the U.S.A. and the European Commission Scientific Committee on Consumer Safety," he told Skin & Allergy News.
The formulation of the wipes appears to vary by product. Ms. Dianna Kenneally, principal scientist, baby care scientific communication, for Procter & Gamble, said in a separate interview that Proctor & Gamble baby wipe brands do not contain MI.
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Communications About Family Members' Risk of Melanoma
Archives Of Dermatology
As many as 5% to 12% of patients with melanoma have a family history of the disease, and patients with a positive family history of melanoma should be observed closely because of their elevated risk. When the initial diagnosis of melanoma is made, dermatologists play a crucial role in communicating risk assessment to their patients and recommending that family members be screened.
As many as 5% to 12% of patients with melanoma have a family history of the disease, and patients with a positive family history of melanoma should be observed closely because of their elevated risk. When the initial diagnosis of melanoma is made, dermatologists play a crucial role in communicating risk assessment to their patients and recommending that family members be screened.
Thursday, July 18, 2013
Feet Home To More Than 100 Types of Fungus
From: Dermatology Daily
The Los Angeles Times (5/23, Netburn) reports, "At least 80 types of fungi reside on a typical person's heel, along with 60 between the toes and 40 on the toenail." In fact, "the feet are home to more than 100 types of fungus, more than any other area of the human body, according to a study published Wednesday by the journal Nature."
On it's "All Things Considered" program and on its "Shots" blog, NPR (5/22, Stein) reports that the "census of the fungi that inhabit different places on our skin" is "part of a big scientific push to better understand the microbes that live in and on our bodies. 'This is the first study of fungi, which are yeast and other molds that live on the human body,' says Julie Segre, of the National Human Genome Research Institute, who led the survey."
The NBC News (5/23, Fox) "The Body Odd" blog reports that "one family" of fungus called Malassezia "covers most of our bodies." HealthDay (5/23, Norton) reports, "The new study...took advantage of DNA-sequencing technology to analyze the fungi on 10 healthy volunteers' skin." Also covering the story are BBC News (5/23, Briggs) and Medscape (5/23, Laidman).
The Los Angeles Times (5/23, Netburn) reports, "At least 80 types of fungi reside on a typical person's heel, along with 60 between the toes and 40 on the toenail." In fact, "the feet are home to more than 100 types of fungus, more than any other area of the human body, according to a study published Wednesday by the journal Nature."
On it's "All Things Considered" program and on its "Shots" blog, NPR (5/22, Stein) reports that the "census of the fungi that inhabit different places on our skin" is "part of a big scientific push to better understand the microbes that live in and on our bodies. 'This is the first study of fungi, which are yeast and other molds that live on the human body,' says Julie Segre, of the National Human Genome Research Institute, who led the survey."
The NBC News (5/23, Fox) "The Body Odd" blog reports that "one family" of fungus called Malassezia "covers most of our bodies." HealthDay (5/23, Norton) reports, "The new study...took advantage of DNA-sequencing technology to analyze the fungi on 10 healthy volunteers' skin." Also covering the story are BBC News (5/23, Briggs) and Medscape (5/23, Laidman).
SELF Magazine Awards Glytone "Best Night Cream"
From: Practical Dermatology June 2013
Glytone won one of SELF Magazine's 14th annual Healthy Beauty Awards, landing the distinction of "Best Night Cream" 2013 for Glytone Anti-aging Night Cream. The publications surveyed more than 1,600 US readers on their favorite beauty products-based on products that deliver on their promise-in five different categories: Hair, Makeup, Face, Body, and Sun.
Glytone won one of SELF Magazine's 14th annual Healthy Beauty Awards, landing the distinction of "Best Night Cream" 2013 for Glytone Anti-aging Night Cream. The publications surveyed more than 1,600 US readers on their favorite beauty products-based on products that deliver on their promise-in five different categories: Hair, Makeup, Face, Body, and Sun.
Thursday, June 13, 2013
Skin Cancer Myths-And Facts
From: Skin Cancer Foundation Journal
Myth: Eighty percent of a person's lifelong sun exposure is acquired before age 18.
Fact: Actually, only about 23 percent of lifetime exposure occurs by age 18. You can-and should-protect yourself from the sun at every age.
Myth: Tanning at a salon is safer than tanning outdoors-it's a controlled does of radiation.
Fact: When compared to people who have never tanned indoors, indoor tanners have a higher risk of all skin cancers. A "controlled" dose of tanning lamp radiation provides as much as 12 times the annual ultraviolet A (UVA) dose tanners receive from sun exposure. Just one indoor tanning session increases users' chances of developing melanoma by 20 percent.
Myth: Ingredients in sunscreen can cause cancer.
Fact: Research shows that when used as directed, sunscreens are safe and effective.
Myth: The sun is the best way to obtain vitamin D.
Fact: Our bodies can produce some vitamin D following sun exposure. However, within as little as a few minutes, vitamin D manufacture reaches its maximum. Meanwhile, the sun is damaging your skin and immune system. Diet and supplements are the safest way to obtain vitamin D.
Myth: You can't sustain sun damage on a cloudy day.
Fact: Believe it or not, up to 80 percent of the sun's harmful UV rays can penetrate clouds and fog.
Myth: A "base tan" protects your skin from sunburn.
Fact: A tan is a sign of skin damage. Skin tans in response to UV damage to the skin's DNA; a tan is the skin's attempt to repair damage and prevent further injury. But imperfect repairs can eventually lead to skin cancer.
Myth: A high SPF is all that you need in a sunscreen.
Fact: A sunscreen's SPF (sun protection factor) indicates protection from UVB rays, but UVA protection is necessary, too. Apply a UVA- and UVB- screening/broad-spectrum sunscreen with an SPF of 15+ (or 30+ for extended outdoor activity).
Myth: People of color don't get skin cancer.
Fact: People of color are less likely to develop skin cancer than Caucasians, but they have a higher risk of dying from it. The dangerous and fast-spreading skin cancer acral lentiginous melanoma is more common among darker-skinned people. Whatever your skin color, protect yourself.
Myth: Windows protect us from the sun's ultraviolet rays.
Fact: While glass blocks most UVB rays, UVA radiation can get through. However, UVA-screening window film is also available.
Myth: Eighty percent of a person's lifelong sun exposure is acquired before age 18.
Fact: Actually, only about 23 percent of lifetime exposure occurs by age 18. You can-and should-protect yourself from the sun at every age.
Myth: Tanning at a salon is safer than tanning outdoors-it's a controlled does of radiation.
Fact: When compared to people who have never tanned indoors, indoor tanners have a higher risk of all skin cancers. A "controlled" dose of tanning lamp radiation provides as much as 12 times the annual ultraviolet A (UVA) dose tanners receive from sun exposure. Just one indoor tanning session increases users' chances of developing melanoma by 20 percent.
Myth: Ingredients in sunscreen can cause cancer.
Fact: Research shows that when used as directed, sunscreens are safe and effective.
Myth: The sun is the best way to obtain vitamin D.
Fact: Our bodies can produce some vitamin D following sun exposure. However, within as little as a few minutes, vitamin D manufacture reaches its maximum. Meanwhile, the sun is damaging your skin and immune system. Diet and supplements are the safest way to obtain vitamin D.
Myth: You can't sustain sun damage on a cloudy day.
Fact: Believe it or not, up to 80 percent of the sun's harmful UV rays can penetrate clouds and fog.
Myth: A "base tan" protects your skin from sunburn.
Fact: A tan is a sign of skin damage. Skin tans in response to UV damage to the skin's DNA; a tan is the skin's attempt to repair damage and prevent further injury. But imperfect repairs can eventually lead to skin cancer.
Myth: A high SPF is all that you need in a sunscreen.
Fact: A sunscreen's SPF (sun protection factor) indicates protection from UVB rays, but UVA protection is necessary, too. Apply a UVA- and UVB- screening/broad-spectrum sunscreen with an SPF of 15+ (or 30+ for extended outdoor activity).
Myth: People of color don't get skin cancer.
Fact: People of color are less likely to develop skin cancer than Caucasians, but they have a higher risk of dying from it. The dangerous and fast-spreading skin cancer acral lentiginous melanoma is more common among darker-skinned people. Whatever your skin color, protect yourself.
Myth: Windows protect us from the sun's ultraviolet rays.
Fact: While glass blocks most UVB rays, UVA radiation can get through. However, UVA-screening window film is also available.
Thursday, May 2, 2013
Cat Allergy vaccine effects persist at 2 years
From: SKNews April 2013
San Antonio-A short course of treatment with an investigational synthetic cat-peptide-antigen desensitizing vaccine, or Cat-PAD, results in a substantial and persistent reduction in cat allergy symptom scores, according to 2-year findings from a randomized controlled study involving 202 adults patients.
Participants in the phase II trial were initially randomized to receive eight 3-nmol intradermal doses at 2-week intervals, four 6-nmol doses at 4-week intervals, or placebo. At 1-year follow-up, the improvement in Total Rhinoconjunctivitis Symptom Score (TRSS) was significantly greater in the patients who received four doses of Circassia's Cat-PAD (ToleroMune Cat) than in patients who received the placebo (-7.1 points vs. -2.99 points), investigators reported online in the journal of Allergy and Clinical Immunology (2013;131:AB147[doi: 10.1016/j.jaci.2012.12.1185]).
Data from a 2-year follow-up study were reported by Rod P. Hafner, Pd.D., and his colleagues in a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Of 89 patients enrolled into the follow-up study, 50 returned at 2 years after the start of treatment, having received no additional treatment, for an environmental exposure chamber (EEC) challenge. The magnitude of difference from baseline in TRSS seen at 1 year in those who received four doses and those who received placebo was maintained at 2 years (-5.87 vs. -2.02 points) among those who initially received the four-dose regimen.
"Cat-PAD is the first in a new class of synthetic peptide immune-regulatory epitopes. The results from this study provide the first evidence that four doses of 6 nmol Cat-PAD over a 12-week period have a disease-modifying effect, with subjects showing sustained improvement at 2 years," the investigators wrote.
Study participants were aged 18-65 years with cat allergy who underwent a baseline EEC challenges at 18-22 weeks and at 100-104 weeks.
"Cat allergen was dispersed into the EEC to achieve a consistent mean level of approximately 50 ng Fel d1/m3, using a validated method," they explained, noting that TRSS was calculated at each EEC challenge based on self-scoring of four nasal symptoms (running nose, sneezing, blocked nose, itchy nose), and four ocular symptoms (itchy eyes, watery eyes, red eyes, sore eyes) on a scale of 0 to 3, every 30 minutes during the challenge.
Cat-PAD is a "potentially exciting new approach to cat allergy immunotherapy," the investigators said, noting that improvements in the TRSS seen in the initial phase II study and follow-up study represent a substantial improvement over numerous therapies investigated in the past, in symptom reduction.
In late 2012 the investigators began enrolling participants for a phase III study.
This study was funded by Circassia. Dr. Hafner is employed by Circassia.
San Antonio-A short course of treatment with an investigational synthetic cat-peptide-antigen desensitizing vaccine, or Cat-PAD, results in a substantial and persistent reduction in cat allergy symptom scores, according to 2-year findings from a randomized controlled study involving 202 adults patients.
Participants in the phase II trial were initially randomized to receive eight 3-nmol intradermal doses at 2-week intervals, four 6-nmol doses at 4-week intervals, or placebo. At 1-year follow-up, the improvement in Total Rhinoconjunctivitis Symptom Score (TRSS) was significantly greater in the patients who received four doses of Circassia's Cat-PAD (ToleroMune Cat) than in patients who received the placebo (-7.1 points vs. -2.99 points), investigators reported online in the journal of Allergy and Clinical Immunology (2013;131:AB147[doi: 10.1016/j.jaci.2012.12.1185]).
Data from a 2-year follow-up study were reported by Rod P. Hafner, Pd.D., and his colleagues in a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Of 89 patients enrolled into the follow-up study, 50 returned at 2 years after the start of treatment, having received no additional treatment, for an environmental exposure chamber (EEC) challenge. The magnitude of difference from baseline in TRSS seen at 1 year in those who received four doses and those who received placebo was maintained at 2 years (-5.87 vs. -2.02 points) among those who initially received the four-dose regimen.
"Cat-PAD is the first in a new class of synthetic peptide immune-regulatory epitopes. The results from this study provide the first evidence that four doses of 6 nmol Cat-PAD over a 12-week period have a disease-modifying effect, with subjects showing sustained improvement at 2 years," the investigators wrote.
Study participants were aged 18-65 years with cat allergy who underwent a baseline EEC challenges at 18-22 weeks and at 100-104 weeks.
"Cat allergen was dispersed into the EEC to achieve a consistent mean level of approximately 50 ng Fel d1/m3, using a validated method," they explained, noting that TRSS was calculated at each EEC challenge based on self-scoring of four nasal symptoms (running nose, sneezing, blocked nose, itchy nose), and four ocular symptoms (itchy eyes, watery eyes, red eyes, sore eyes) on a scale of 0 to 3, every 30 minutes during the challenge.
Cat-PAD is a "potentially exciting new approach to cat allergy immunotherapy," the investigators said, noting that improvements in the TRSS seen in the initial phase II study and follow-up study represent a substantial improvement over numerous therapies investigated in the past, in symptom reduction.
In late 2012 the investigators began enrolling participants for a phase III study.
This study was funded by Circassia. Dr. Hafner is employed by Circassia.
Monday, April 29, 2013
VZV Vaccination for the Prevention of Shingles
From: Practical Dermatology March 2013
Increasingly, there is interest in developing a vaccine that would prevent additional outbreaks of HSV among individuals who are already positive for HSV. The vaccine would presumably boost the patient's immunity to prevent subsequent outbreaks.
VZV Vaccine
The shingles vaccine is actually a concentrated form of the vaccine given to children for the prevention of chicken pox. In the original trials for the vaccine, all subjects were age 60 or older. Subjects received either active vaccine or placebo. There was a 51 percent reduction overall in the incidence of shingles among those in their 60's.
These findings would seem to support vaccination in younger elderly patients. For one, the risk of developing shingles increases with age. Furthermore, the vaccine seems to be potentially more effective in younger patients. Overall, there was a 2/3 reduction in the incidence of post-herpetic neuralgia among those subjects who received the vaccination but nonetheless developed shingles.
A subsequent study enrolled patients in their 50s and determined that the efficacy rate of the vaccine was about 70 percent. The vaccine (Zostavax, Merck and Co.) received FDA approval for use in individuals 50 or older.
When To Vaccinate
The average age of patients presenting in Dr. Trying's office with shingles is 51. This suggests that patients who receive the vaccination upon turning 50 may significantly reduce their risk for developing shingles. Increased age is a known risk factor for developing shingles. Although stress has frequently been identified as a risk factor, it appears that only significant, acute stress, such as the loss of a loved one, may be associated with shingles outbreak. Most recently, family history of shingles has emerged as a significant risk factor for developing shingles. Having a first-degree relative with shingles may double an individual's risk for developing shingles.
Vaccination is not recommended for an individual who has recently has shingles. However, individuals who had shingles some time in the past (approximately a decade or so), vaccination may prevent re-emergence of shingles.
Finally, patient recollection of a personal history of chicken pox is rarely reliable. Many individuals simply do not recall having chicken pox as children. Furthermore, many sero-positive patients say that their parents never acknowledged that the patient had chicken pox. Importantly, patients do not require an antibody test prior to receiving the VZV vaccine. Cost of the vaccine, which may not be covered by third-party payors, can remain a limiting factor.
Increasingly, there is interest in developing a vaccine that would prevent additional outbreaks of HSV among individuals who are already positive for HSV. The vaccine would presumably boost the patient's immunity to prevent subsequent outbreaks.
VZV Vaccine
The shingles vaccine is actually a concentrated form of the vaccine given to children for the prevention of chicken pox. In the original trials for the vaccine, all subjects were age 60 or older. Subjects received either active vaccine or placebo. There was a 51 percent reduction overall in the incidence of shingles among those in their 60's.
These findings would seem to support vaccination in younger elderly patients. For one, the risk of developing shingles increases with age. Furthermore, the vaccine seems to be potentially more effective in younger patients. Overall, there was a 2/3 reduction in the incidence of post-herpetic neuralgia among those subjects who received the vaccination but nonetheless developed shingles.
A subsequent study enrolled patients in their 50s and determined that the efficacy rate of the vaccine was about 70 percent. The vaccine (Zostavax, Merck and Co.) received FDA approval for use in individuals 50 or older.
When To Vaccinate
The average age of patients presenting in Dr. Trying's office with shingles is 51. This suggests that patients who receive the vaccination upon turning 50 may significantly reduce their risk for developing shingles. Increased age is a known risk factor for developing shingles. Although stress has frequently been identified as a risk factor, it appears that only significant, acute stress, such as the loss of a loved one, may be associated with shingles outbreak. Most recently, family history of shingles has emerged as a significant risk factor for developing shingles. Having a first-degree relative with shingles may double an individual's risk for developing shingles.
Vaccination is not recommended for an individual who has recently has shingles. However, individuals who had shingles some time in the past (approximately a decade or so), vaccination may prevent re-emergence of shingles.
Finally, patient recollection of a personal history of chicken pox is rarely reliable. Many individuals simply do not recall having chicken pox as children. Furthermore, many sero-positive patients say that their parents never acknowledged that the patient had chicken pox. Importantly, patients do not require an antibody test prior to receiving the VZV vaccine. Cost of the vaccine, which may not be covered by third-party payors, can remain a limiting factor.
UV Protection from the Patient's Perspective
From: Practical Dermatology March 2013
In a recent survey of American consumers, 86 percent of respondents said they know that sunscreen helps prevent skin cancer when used with other protection measures, yet the majority do not use sunscreen on a regular basis. Reasons consumers gave for not using sunscreen include not thinking about doing it (40 percent), believing that they do not stay out long enough in the sun to burn (44 percent), and having an aversion to sunscreen texture (51 percent).
Memorial Sloan Kettering's Steven Q. Wang, MD, Director of Dermatologic Surgery and Dermatology at Basking Ridge Dermatology, addressed consumer behaviors and strategies to increase UV avoidance. He, along with Stephen Dusza, PhD, conducted the study described above and has written extensively on sunscreen formulations and science. Ahead, he answers questions about UV avoidance and sunscreen formulation and use.
Q. You found that 86 percent of Americans understand the importance of sun protection, yet most don't use sunscreens or use them properly. Why do you think this is and how can this change?
"The public understands the need to use sunscreens and to limit UV exposure, but there is a gap," observes Dr.Wand. "The gap is in how they translate knowledge into motivation and motivation into behavior." He likens adoption of UV avoidance behavior to weight loss or smoking cessation. "People understand this is important, but they just cannot change their behaviors."
There are ways to support patients and facilitate change. "I encourage dermatologists to emphasize comprehensive photoprotective strategies," Dr. Wang says. He argues that the current emphasis on sunscreens, "puts the hierarchy of sun protection strategies in reverse." Over-dependence on sunscreens gives patients a false sense of security.
It is more important, he says, for patients to understand when and how they are exposed to UV radiation and how they can limit exposure through sun avoidance and physical protection strategies: staying out of the sun as much as possible, especially during midday hours, wearing protective hats and clothing, etc. When patients adopt these crucial strategies, then sunscreen becomes a secondary mode of defense to protect minimal exposure rather a first line of defense.
When patients adopt adequate UV avoidance strategies, then use of a daily sunscreen SPF 30 is probably sufficient for day-to-day use. Remind patients that windows block out UVB, Dr. Wang suggests.
Dermatologists should also, "Focus on the need for adequate application of sunscreens," Dr. Wang says. "Most people use about one-third the desired amount of sunscreen, which translates to about one-half or one-third the stated level of protection."
Q. Your research and other surveys have found that patients are concerned about the safety of sunscreen ingredients and the cosmetic elegance of formulations. What should dermatologists know about these topics?
"There have been some overblown concerns regarding sunscreen ingredients," Dr. Wang acknowledges. "Many people voice concern about oxybenzone," he says, noting that the degree of exposure needed to realize theoretical oxybenzone affects on human hormone levels are far above those achieved with normal sunscreen use. In fact, he says, it would take more than 270 years of consistent application to achieve problematic levels.
Additionally, fear of nanotechnology is also "not valid" according to Dr. Wang. Micronized or nanosized TiO and ZnO are important for cosmetic elegance of sunscreen formulations; compared to older, larger particle size formulations that tended to leave white residues on the skin. "Studies to date suggest that micronized and nanosized UV filters do not penetrate beyond the stratum corneum," he explains, meaning little to no risk of systemic exposure. Even if nanosized particles are deposited within the stratum corneum, constant shedding of the SC does not permit accumulation of material.
Furthermore, there are concerns that nanoparticle filters, upon exposure to UV, can generate damaging free radicals in the skin. Free radicals are associated with photoaging, immunosuppression, and photocarcinogenesis. It is shown that excess UVA irradiation and exposure to pollutants are themselves drivers of ROS-generation in human skin.
While in vitro studies using cell culture models did suggest a high level of ROS generation when non-organic nanosized filters were exposed to UV irradiation, subsequent in vitro studies have not borne out these findings. However, Dr. Wang says, most nanosized filters are coated to reduce reactivity and thus limit free-radical formation. Furthermore, the skin's natural antioxidant capacity can readily neutralize any ROS generated through enzymes and nonenzymatic molecules.
As an additional measure of protection, many sunscreen formulations now incorporate topical antioxidants, which may have the potential to diminish the ROS generated from exposure to UVA radiation. This antioxidant capacity may be especially important, given that most sunscreens tend to provide greater protection against UVB than UVA. Dr. Wang and colleagues recently have published on the use and benefits of topical antioxidants within sunscreen formulations, but he cautions that much depends on the quality of the finished product. Failure to provide sufficient concentrations of antioxidants or stable formulations will negate the benefit of the antioxidants.
Q. What are your recommendations for effectively educating patients about UV avoidance? How can this be achieved quickly in the average clinic visit?
"What I find helpful and what I encourage dermatologists to do is to give specific recommendations," Dr. Wang says. "Most people only want to hear what sunscreen and what SPF they should be using."
Dr. Wang also strongly encourages dermatology practices to develop a handout that lays out a specific, appropriate, comprehensive UV avoidance strategy "It is very important to have a sheet of instructions ready."
Specific product recommendations can be made on this handout. Of course, Dr. Wang says, give a few options across various price points, and encourage patients to seek out a product they like.
"Overall, I think US sunscreen manufactures have done a good job creating products for the American consumer," Dr. Wang says. But patients still have preferences. Common consumer complaints about sunscreen tend to focus on texture, which may be perceived as greasy to some. Formulations intended to be water resistant may have a sticky feel.
Q. What are remaining questions in the area of sunscreens?
The FDA is still trying to determine whether formulations should indicate a level of UVA protection and how to best accomplish this. There also remain questions about certain dosage forms, such as sprays. Under the current FDA proposed ruling, Dr. Wang notes,"wipes, powders, and washes cannot claim SPFs because they were deemed to not provide sufficient protection."
Sprays are popular due to their convenience, ease of application at certain anatomic sites, and the ease of use in children, who may not like creams or lotions. The challenge is in achieving adequate and consistent coverage, Dr. Wang says. Even if a spray is applied imperfectly, "it's better than nothing," he says.
There are methods to optimize use of sprays. One is to spray the product into the hand and then apply to the desired area, though this somewhat defeats the purpose of the spray, Dr. Wang admits. Alternatively, consumers should move the can slowly over the target area to ensure a good amount of coverage. The product should still be rubbed in by hand once on the skin.
In a recent survey of American consumers, 86 percent of respondents said they know that sunscreen helps prevent skin cancer when used with other protection measures, yet the majority do not use sunscreen on a regular basis. Reasons consumers gave for not using sunscreen include not thinking about doing it (40 percent), believing that they do not stay out long enough in the sun to burn (44 percent), and having an aversion to sunscreen texture (51 percent).
Memorial Sloan Kettering's Steven Q. Wang, MD, Director of Dermatologic Surgery and Dermatology at Basking Ridge Dermatology, addressed consumer behaviors and strategies to increase UV avoidance. He, along with Stephen Dusza, PhD, conducted the study described above and has written extensively on sunscreen formulations and science. Ahead, he answers questions about UV avoidance and sunscreen formulation and use.
Q. You found that 86 percent of Americans understand the importance of sun protection, yet most don't use sunscreens or use them properly. Why do you think this is and how can this change?
"The public understands the need to use sunscreens and to limit UV exposure, but there is a gap," observes Dr.Wand. "The gap is in how they translate knowledge into motivation and motivation into behavior." He likens adoption of UV avoidance behavior to weight loss or smoking cessation. "People understand this is important, but they just cannot change their behaviors."
There are ways to support patients and facilitate change. "I encourage dermatologists to emphasize comprehensive photoprotective strategies," Dr. Wang says. He argues that the current emphasis on sunscreens, "puts the hierarchy of sun protection strategies in reverse." Over-dependence on sunscreens gives patients a false sense of security.
It is more important, he says, for patients to understand when and how they are exposed to UV radiation and how they can limit exposure through sun avoidance and physical protection strategies: staying out of the sun as much as possible, especially during midday hours, wearing protective hats and clothing, etc. When patients adopt these crucial strategies, then sunscreen becomes a secondary mode of defense to protect minimal exposure rather a first line of defense.
When patients adopt adequate UV avoidance strategies, then use of a daily sunscreen SPF 30 is probably sufficient for day-to-day use. Remind patients that windows block out UVB, Dr. Wang suggests.
Dermatologists should also, "Focus on the need for adequate application of sunscreens," Dr. Wang says. "Most people use about one-third the desired amount of sunscreen, which translates to about one-half or one-third the stated level of protection."
Q. Your research and other surveys have found that patients are concerned about the safety of sunscreen ingredients and the cosmetic elegance of formulations. What should dermatologists know about these topics?
"There have been some overblown concerns regarding sunscreen ingredients," Dr. Wang acknowledges. "Many people voice concern about oxybenzone," he says, noting that the degree of exposure needed to realize theoretical oxybenzone affects on human hormone levels are far above those achieved with normal sunscreen use. In fact, he says, it would take more than 270 years of consistent application to achieve problematic levels.
Additionally, fear of nanotechnology is also "not valid" according to Dr. Wang. Micronized or nanosized TiO and ZnO are important for cosmetic elegance of sunscreen formulations; compared to older, larger particle size formulations that tended to leave white residues on the skin. "Studies to date suggest that micronized and nanosized UV filters do not penetrate beyond the stratum corneum," he explains, meaning little to no risk of systemic exposure. Even if nanosized particles are deposited within the stratum corneum, constant shedding of the SC does not permit accumulation of material.
Furthermore, there are concerns that nanoparticle filters, upon exposure to UV, can generate damaging free radicals in the skin. Free radicals are associated with photoaging, immunosuppression, and photocarcinogenesis. It is shown that excess UVA irradiation and exposure to pollutants are themselves drivers of ROS-generation in human skin.
While in vitro studies using cell culture models did suggest a high level of ROS generation when non-organic nanosized filters were exposed to UV irradiation, subsequent in vitro studies have not borne out these findings. However, Dr. Wang says, most nanosized filters are coated to reduce reactivity and thus limit free-radical formation. Furthermore, the skin's natural antioxidant capacity can readily neutralize any ROS generated through enzymes and nonenzymatic molecules.
As an additional measure of protection, many sunscreen formulations now incorporate topical antioxidants, which may have the potential to diminish the ROS generated from exposure to UVA radiation. This antioxidant capacity may be especially important, given that most sunscreens tend to provide greater protection against UVB than UVA. Dr. Wang and colleagues recently have published on the use and benefits of topical antioxidants within sunscreen formulations, but he cautions that much depends on the quality of the finished product. Failure to provide sufficient concentrations of antioxidants or stable formulations will negate the benefit of the antioxidants.
Q. What are your recommendations for effectively educating patients about UV avoidance? How can this be achieved quickly in the average clinic visit?
"What I find helpful and what I encourage dermatologists to do is to give specific recommendations," Dr. Wang says. "Most people only want to hear what sunscreen and what SPF they should be using."
Dr. Wang also strongly encourages dermatology practices to develop a handout that lays out a specific, appropriate, comprehensive UV avoidance strategy "It is very important to have a sheet of instructions ready."
Specific product recommendations can be made on this handout. Of course, Dr. Wang says, give a few options across various price points, and encourage patients to seek out a product they like.
"Overall, I think US sunscreen manufactures have done a good job creating products for the American consumer," Dr. Wang says. But patients still have preferences. Common consumer complaints about sunscreen tend to focus on texture, which may be perceived as greasy to some. Formulations intended to be water resistant may have a sticky feel.
Q. What are remaining questions in the area of sunscreens?
The FDA is still trying to determine whether formulations should indicate a level of UVA protection and how to best accomplish this. There also remain questions about certain dosage forms, such as sprays. Under the current FDA proposed ruling, Dr. Wang notes,"wipes, powders, and washes cannot claim SPFs because they were deemed to not provide sufficient protection."
Sprays are popular due to their convenience, ease of application at certain anatomic sites, and the ease of use in children, who may not like creams or lotions. The challenge is in achieving adequate and consistent coverage, Dr. Wang says. Even if a spray is applied imperfectly, "it's better than nothing," he says.
There are methods to optimize use of sprays. One is to spray the product into the hand and then apply to the desired area, though this somewhat defeats the purpose of the spray, Dr. Wang admits. Alternatively, consumers should move the can slowly over the target area to ensure a good amount of coverage. The product should still be rubbed in by hand once on the skin.
Friday, March 8, 2013
Survey: Women Want Youthful Skin Over Fancy Wardrobe
The Syneron Consumer Beauty Insights Survey of more than 1,000 women over age 25 reports that 79 percent prefer having youthful skin that would make them feel more confident than a designer wardrobe. Findings also show that only 8 percent of women are satisfied with their current appearance. In addition, 42 percent of women would be willing to have a surgical cosmetic procedure in the next five years and 63 percent would be open to a non-surgical procedure during this time. When it comes to non-surgical procedures, 70 percent of women would want to see a practice's before and after photos.
Melanoma Rates Up in US as Overall Cancer Incidence Falls
While incidence rates are declining for most types of cancer across the US, they are increasing for melanoma among both men and women, according to The American Cancer Society's annual Cancer Statistics report. As of 2009, the overall death rate for cancer in the US has declined 20 percent from its peak in 1991, which translates to roughly 1.2 million deaths avoided from cancer, 152,900 of these in 2009 alone. Death rates continue to decline for all four major cancer sites: lung, colon and rectum (colorectum), breast and prostate. Yet, melanoma remains one of four types of cancer (the others being liver, thyroid, and pancreas) that is increasing in both men and women, according to the report. The authors noted that while the broader drops are encouraging, further progress can be accelerated by applying existing cancer control knowledge across all segments of the population, with an emphasis on those groups in the lowest socioeconomic bracket and other underserved populations.
Thursday, March 7, 2013
Dermatologist Warns Gel Manicure Is A Cancer Risk
The Washington Times (3/7, Chasmar) reports Dr. Chris Adigun, a dermatologist at the New York University School of Medicine, in a recent article in the Journal of the American Academy of Dermatology, warned that "a rising fad of replacing traditional nail polish with quick-hardening gel may result in skin cancer, " due to the UV light needed to cure the gel. Dr. Adigun advised, "Moderation is the key when it comes to gel manicures," adding that he "advocates wearing hand sunscreen for women who get frequent gel manicures."
The New York Post (3/7, Stretten, Sutherland, Fagen) reports, "Another concern is that no one knows what is the proper dose of these harmful rays because the UV lamps are not regulated." Research published in JAMA Dermatology in 2009 said that "two middle-aged women, who did not have a history of skin cancer, developed tumors on their hands following exposure to UV nail light." In contrast, the "LED lamps are used in drying regular nail polish and don't pose a health risk because they don't emit ultraviolet radiation." An additional issue with the gel is that its durability means it can conceal nail brittleness, thinning, or cracking.
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