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.
Thursday, May 2, 2013
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.
Monday, October 29, 2012
New products
NEW products recommended and sold by Dr. Kelly Hood, M.D.:
La Roche Posay Anthelios sunscreen
Advanced patented sunscreen technologies in revolutionary textures. For over 15 years, La Roche-Posay has been at the forefront in advanced UV protection research. Anthelios, the La Roche-Posay suncare brand, is trusted and recognized by dermatologists worldwide, for providing advanced formulations in UVA & UVB protection.
NIA24 Niacin-Powered Skin Therapy
Products with hydroquinone and tretinoin for controlling brown spots and photodamage.
Glytone by Merz Aesthetics
Glytone wash and lotion, which contain alphahydroxy acids. Developed by experts in dermatology, Glytone® is ideal for the successful treatment of broad skin areas, fine to deep lines and lips and volume deficiencies.
Obagi Medical
An extensive line of clinically proven skin care systems and products designed to help you revitalize, enhance, and maintain beautiful skin for life.
Contact us today to schedule an appointment with Dr. Hood.
La Roche Posay Anthelios sunscreen
Advanced patented sunscreen technologies in revolutionary textures. For over 15 years, La Roche-Posay has been at the forefront in advanced UV protection research. Anthelios, the La Roche-Posay suncare brand, is trusted and recognized by dermatologists worldwide, for providing advanced formulations in UVA & UVB protection.
NIA24 Niacin-Powered Skin Therapy
Products with hydroquinone and tretinoin for controlling brown spots and photodamage.
Glytone by Merz Aesthetics
Glytone wash and lotion, which contain alphahydroxy acids. Developed by experts in dermatology, Glytone® is ideal for the successful treatment of broad skin areas, fine to deep lines and lips and volume deficiencies.
Obagi Medical
An extensive line of clinically proven skin care systems and products designed to help you revitalize, enhance, and maintain beautiful skin for life.
Contact us today to schedule an appointment with Dr. Hood.
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