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People with psoriasis an often distressing dermatological condition that causes lesions and red scaly patches on the skin are less likely to react to looks of disgust by others than people without the condition, new research has found.

University of Manchester scientists used magnetic resonance imaging (MRI) scans to compare the brains of 26 men, half of whom had chronic psoriasis. The researchers looked at the insular cortex a part of the brain triggered by both feelings and observations of disgust to see how participants responded to images of disgusted faces.

The study, published in the Journal of Investigative Dermatology, found that the volunteers with psoriasis had a much weaker response in their insular cortex than the healthy volunteers, suggesting they have developed a coping mechanism to protect themselves from adverse emotional responses to their condition by others.

“Psoriasis has a significant negative impact on the physical and psychological wellbeing of those affected but little is known about the neurocognitive mechanisms of how patients cope with the adverse social stigma associated with visible skin lesions,” said Dr Elise Kleyn, the dermatologist who carried out the research.

“We had previously shown that psoriasis patients commonly believe that they will be evaluated solely on the basis of their skin and so often avoid social situations they think will be stressful or humiliating as a coping mechanism.

“For this study we wanted to investigate whether the social impact of psoriasis is associated with altered cognitive processing in response to facial expressions of disgust by measuring brain activity in the insular cortex.

“We found a significantly reduced response in the insular cortex in the patients compared with the control volunteers when observing disgusted faces, but also that patients were half as likely to recognise that a face was expressing disgust. This was not the case for other facial expressions, such as fear.”

The research team, which was headed by worldrenowned dermatologist Professor Chris Griffiths, believe that one explanation for their findings is that psoriasis patients develop a coping mechanism to protect them from stressful emotional responses by blocking the processing of disgusted facial expressions encountered in others.

Dr Kleyn added “We believe that other stigmatising conditions, such as severe acne or scarring, may elicit similar findings, although further research is clearly needed. We think the insights provided by this study, however, could generate new strategies for managing stigmatising skin diseases.”

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Aeron Haworth

Eczema is a chronic skin disorder characterized by dry, itchy, scaly skin and rashes. It is commonly known as “the itch that rashes.” (1) While the exact cause of eczema is not known, it appears to result from a complex interaction of factors including personal and family genetics, immune response and environmental factors. (2)

Scratching the affected area can lead to more itch, redness, swelling, scaling, cracking, oozing clear fluid and, ultimately, crusting. (3) Eczema is a chronic condition characterized by itchy flares when the inflammation gets worse, and periods when the skin gets better, or entirely clears up, known as remission. (4)

Who gets eczema?

Eczema is one of the most common skin disorders in children, and its prevalence has increased steadily over the past several decades. (5) It is most common in people with a family history of eczema or other atopic disorders like asthma or hay fever. More than half of the children who develop eczema will continue to have it as adults. (6) In some children, the disorder goes away for a long time, only to reappear at puberty when hormones kick in, stress becomes more common and the use of irritating skin care products or cosmetics begins. (7)

Adult cases can be frequently tied to exposure in which the skin comes into contact with such things as toiletries containing alcohol, astringents or fragrances. Additional triggers include harsh detergents/soaps, abrasive clothing (wool or synthetics), dust or sand. (8)

More than 15 million people in the US suffer from some form or degree of eczema. (9) Recent data concludes that medical care costs can range from $580 to $1,250 per patient per year.

What causes eczema?

Researchers have been unable to pinpoint the exact cause of eczema, and experts believe that genetics, the immune system and environment play a role. (10) Stress and other emotional discord may make eczema worse, but they do not cause the disorder. (11)

If one or both parents have eczema or other disorders such as asthma or hay fever, their children are more likely to develop it. (12) In addition, about 75 percent of children with eczema also develop hay fever or asthma. (13)

Where does eczema occur?

The rashes that characterize eczema can occur on skin anywhere on the body, but most commonly develop on the face, inside the elbows, behind the knees and on the hands and feet. (14) Other areas of body affected by the disorder include the skin around the eyes. (15)

How is eczema treated?

Successful management of eczema involves educating patients and their families about eczema and reducing signs and symptoms. Long term care includes education, trigger avoidance, skin care, and treatment. (16)

The use of medication is largely dependent on the severity of the disorder and the response to lifestyle and environmental changes. The standard types of medication used to treat eczema have traditionally been topical corticosteroids. (17) Among the newer forms of treatment are prescription medications called topical calcineurin (calSEEnurin) inhibitors (TCIs). TCIs belong to a category of medicines called immunomodulators. (18) Scientists believe that TCIs target T cells in the skin which play a significant role in regulating some of the bodys immune responses. (19) Generally, physicians use TCIs if a topical corticosteroid is ineffective in controlling the disorder or when those treatments are not advisable. (20)

While topical corticosteroids are used first in the treatment of eczema, TCIs can provide effective second line therapy. Among the benefits of TCIs are that they can reduce eczema signs and symptoms and have been shown to be effective on sensitive areas. (21) TCIs have not been associated with certain side effects such as skin thinning, stretch marks, and growth suppression in children. (22)

The most common application side effects of TCIs include the sensation of burning or itching. (23) These occur at the beginning of treatment and tend to go away after a few days. Other side effects include flulike symptoms, headache, and skin redness. Drinking alcohol while using TCIs may cause the skin or face to become flushed or red and feel hot. (24) Skin infections should be cleared prior to treatment with TCIs, and there may be an increased risk of certain skin infections.

Important Information Patients Should Know About TCIs

The safety of using TCIs for a long period of time is not known. A very small number of people who have used TCIs have had cancer (for example, skin or lymphoma). However, a link with TCIs has not been shown. Because of this concern, patients should not use TCIs continuously for a long time or on a child under 2 years of age and should use TCIs only on areas of skin that have eczema. (25)

References

1. Eczema/Atopic Dermatitis, American Academy of Dermatology

2. Handout on Health Atopic Dermatitis. National Institute of Arthritis and Muscoskeletal and Skin

Diseases. NIH Publication No. 034272. Revised April 2003, page 3

3. NIH, ibid., page 3

4. NIH, ibid., page 4

5. Krakowski, Eichenfield, Management of Atopic Dermatitis in Pediatric Population, 2008

6. NIH, ibid., page 6

7. NIH, ibid., page 11

8. NIH, ibid., page 16

9. NIH, skincarephysicians.com/eczemanet/whatIs.html. Accessed April 20. Accessed April 20, 2009

10. NIH, skincarephysicians.com/eczemanet/whatIs.html. Accessed April 20. Accessed April 20, 2009

11. NIH, op. cit., page 6

12. NIH, op. cit., page 7

13. NIH, op. cit., page 6

14. NIH, op. cit., page 7

15. AAD, op. cit., page 1

16. NIH, op. cit., page 9

17. Krakowski, Eichenfield, Management of Atopic Dermatitis in Pediatric Population, 2008

18. NIH, op. cit., page 19

19. protopicla.com/professionals/Science+of+Protopic/Mechanism+of+action?_EN.htm. Accessed December 4, 2008.

20. nobelprize.org/educational_games/medicine/immunity/immunedetail.html. Accessed October 21, 2008.

21. Hanifin et al J Am Acad Dermatol 2001; Soter et al J Am Acad Dermatol 2001; Paller et al J Am< Acad Dermatol 2001

22. NIH, op. cit., page 19

23. NIH, op. cit., page 20

24. Protopic(R) (tacrolimus) Ointment full Prescribing Information, Deerfield, Ill., Astellas Pharma US, Inc. 2006

25. Protopic(R) (tacrolimus) Ointment full Prescribing Information, Deerfield, Ill., Astellas Pharma US, Inc. 2006

26. Protopic(R) (tacrolimus) Ointment full Prescribing Information, Deerfield, Ill., Astellas Pharma US, Inc. 2006

Hoag Memorial Hospital Presbyterian announced promising data from a clinical study showing patientspecific cancer vaccines derived from patients own cancer cells and immune cells were well tolerated and resulted in impressive longterm survival rates in patients with metastatic melanoma whose disease had been minimized by other therapies.

The study entitled “Phase II Trial of Dendritic Cells Loaded with Antigens from SelfRenewing, Proliferating Autologous Tumor Cells as PatientSpecific AntiTumor Vaccines in Patients with Metastatic Melanoma,” was published in the June 2009 issue of Cancer Biotherapy and Radiopharmaceuticals and was sponsored by Hoag Hospital Foundation.

“There is continued interest in developing new therapies for melanoma patients with recurrent or distant metastatic disease at the time of diagnosis because there are no systemic therapies that can be relied upon to cure them,” said Robert O. Dillman, M.D., F.A.C.P., executive medical and scientific director at the Hoag Cancer Center and lead investigator for the study. “Patients with metastatic melanoma are at high risk for additional metastases and death.”

During the study, 54 patients with regionally recurrent or distant metastatic melanoma were injected with a vaccine that included each patients own immune cells (dendritic cells) and 500 micrograms of granulocytecolony stimulating factor (GMCSF), an immune stimulator, three times a week and then monthly for five months for a total of up to eight injections. The patients dendritic cells were obtained from their peripheral blood and mixed with a cell culture of the patients own melanoma cells that had been selfrenewing and proliferating in the laboratory. The patientspecific vaccine is designed to stimulate the patients immune system to react against tumor stem cells or early progenitor cells that can create new depots of cancer throughout the body.

Data showed that the projected fiveyear survival rate is 54% at a median follow up of 4.5 years (range 2.4 to 7.4) for the 30 surviving patients. Although not a direct comparison, the results are superior to those observed following vaccination with irradiated tumor cells in 48 melanoma patients in a previous trial (64 vs. 31 months, p=.016). Eight patients in the dendritic cell vaccine study experienced remarkable longterm, progressionfree survival after completing the vaccine therapy, even though they had widely metastatic disease and/or repeated appearance of new metastases despite various therapies. The vaccine treatment was welltolerated, with most patients experiencing mild skin irritation and redness at the injection site.

“The oneyear and projected fiveyear survival rates of 85% and 54%, respectively, are remarkable for melanoma patients with documented metastatic disease,” said Dr. Dillman. “This study is extremely encouraging and shows the potential these types of personalized cancer vaccines have for patients diagnosed with metastatic melanoma.”

Source
Kelly Smith

KP is a genetic skin condition that affects 40 percent of the worlds population, often resulting in patches of dry skin, and little red bumps, on the arms and legs. KP is most prevalent in the teenage years but may continue throughout adulthood. There is no cure for Keratosis Pilaris.(1, 2)

Dr. Alan B. Fleischer, professor and chair of the department of dermatology at Wake Forest University School of Medicine, recommends keeping skin moisturized to help manage the dry skin associated with KP by using products containing lactic acid, such as AmLactin(R) or AmLactin XL(R).

About Keratosis Pilaris

There is no cure for Keratosis Pilaris (KP) and the cause remains unknown, however it tends to run in families.(2) People with KP may experience fleshcolored or red bumps around hair follicles on the upper arms, thighs, buttocks, and cheeks, extremely dry skin and, in some cases, itching.(1,2) It is important to be aware that other medical conditions can mimic KP, so people with these symptoms should visit a doctor to confirm a diagnosis.

Littleredbumps.com and The AmLactin(R) family of moisturizers are not intended to diagnose, treat, cure or prevent any medical condition. Some skin conditions may be worsened by moisturizers, so people should always follow their doctors skin care recommendations.

AmLactin(R)

The AmLactin(R) family of moisturizers are the number one dermatologist and podiatrist recommended brand of moisturizers (1,3,4) and are readily available without a prescription at fine retailers nationwide and online.

UpsherSmith

UpsherSmith Laboratories, Inc. is a rapidlygrowing pharmaceutical company that manufactures and markets both prescription and consumer products. UpsherSmith prides itself on providing safe, effective and economical therapies to the everchallenged healthcare environment.

(1) aad.org/public/publications/pamphlets/skin_dry.html

(2) Nili, A. Keratosis pilaris. September 2008

(3) Rough, Dry skin most recommended moisturizing product. Omnibus Study. Dermatology Times. 2008.

(4) Kloos Donoghue S. Podiatry management annual practice survey. Podiatry Management. February 2009.

Approximately twothirds of the 1.5 million Americans living with lupus will develop some type of skin disease. Lupus is an autoimmune disease in which the immune system is unbalanced causing it to become destructive to any organ and tissue in the body. Skin disease in lupus can cause rashes or sores (lesions), most of which will appear on sunexposed areas, such as a persons face, ears, neck, arms, and legs. In addition, 4070 percent of people with systemic lupus will find that their disease is made worse by exposure to ultraviolet (UV) rays from sunlight or artificial light. For this and other reasons, people with lupus are advised to take steps to protect themselves from exposure to UV light.

Summertime presents a challenge for people with lupus as vacations, leisure activities and household tasks can increase time outdoors, increasing risk of lupus flares. In addition, people with lupus are also at risk for other skin problems.

The Lupus Foundation of America website, lupus.org, will host a live chat, “Your Skin and Lupus,” on Wednesday, July 15, beginning at 300 p.m. Eastern Daylight Time (UTC 4). The guest expert will be Dr. Andrew Franks, Clinical Professor of Dermatology and the Director of the Connective Tissue Disease Section of The Skin and Cancer Unit at New York University Medical Center.

Dr. Franks is one of the few physicians in the country who hold board certification in dermatology, rheumatology, and internal medicine. Over the past twenty five years he has earned a distinct reputation in the area of “skin manifestations of autoimmune disease.”

Individuals can access the chat at the following URL lupus.org/newsite/pages/chat_login.html

Participants can submit questions during the course of the hourlong live chat, or in advance through the LFA website. A transcript of the chat will be posted within 24hours following the chat.

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Campaigning to tackle the massive problem of head lice.

Next Monday June 15th 2009, its the Department of Healths National Bug Busting Day. On this day, families everywhere are encouraged to check their hair for traces of head lice and their nits.

In support of this Department of Health incentive, The Hairforce are setting up a Head Lice Check & Clear Hotline for people to callin and listen to advice about checking and clearing hair. Its a process many parents are unfamiliar with, daunted and defeated by. Many dont even know what theyre looking for. The Hairforce are the UKs first head lice and nit clearing service with expert Lice Assassins who 100% guarantee to clear all lice infestations.

The Hairforce has a highly trained team of professional Lice Assassins who clear in the only trusted way by hand, without the use of any chemicals or treatments. They are armed too, with a set of fresh, disinfected equipment LeiceMeister nit combs, Lice hoovers, specialist lighting and magnifying visors. Throughout the process, children are kept comfy in specialist seating and entertained with the latest computer games and DVDs.

To help customers have a safe and fun summer in the sun, Rite Aid and The Skin Cancer Foundation are partnering to raise awareness and offer free information on the importance of smart skin care practices. A free skin care guide aimed to encourage customers to protect their skin this summer will be available at nearly 4,900 Rite Aid stores nationwide and online at riteaid.com starting May 31.

The 12page skin care guide contains information from The Skin Cancer Foundation on being proactive in preventing skin cancer, guidelines on how to use and choose sunscreen, and tips to avoid burning. Theres a section on how to protect the eyes with the proper sunglasses, as well as information on how different kinds of recreation call for different kinds of sun protection, such as sweatresistant or waterresistant sunscreens and a lip balm of at least SPF 15.

The guide includes the signs of skin cancer, how diabetes affects the skin, how to use sunscreens and cosmetics together, and how to keep skin healthy yearround with the use of sunscreen, exfoliation and hydration both on the surface with moisturizers and internally by drinking plenty of water. A simple quiz at riteaid.com/health/skin/ is designed to determine skin type and offers advice based on answers.

Also online at riteaid.com/health/skin/ is an interactive body map to track skin changes on a regular basis, a section about the differences between harmless spots and unusual growths that need immediate medical attention, and the facts about UVA/UVB protection.

Customers also can learn online or in all Rite Aid stores about how to get a free gift bag valued at $40, filled with popular skin care samples and coupons, with the purchase of $20 of specially marked skin care products.

Rite Aid pharmacists are specially trained to offer helpful information on proper skin protection options and always are available to answer questions on maintaining healthy skin while enjoying the outdoors. They also can counsel customers about certain medications that cause skin to burn more easily, a side effect called photosensitivity. Some commonly used medications, such as antibiotics, antihistamines, birth control pills and oral diabetes medications, require additional precautions to avoid sunburn, hives, rashes or other skin irritations.

Rite Aid also is participating for the second year in the The Skin Cancer Foundations Road to Healthy Skin Tour presented by AVEENO® and Rite Aid, making 80 stops across the country many of them local Rite Aid stores to provide early detection services to thousands of people. At each stop, local boardcertified dermatologists will conduct free fullbody skin cancer screenings on a 38foot customized RV in one of two private rooms. Educational materials that explain how to perform monthly skin checks at home and the proper ways to protect the skin from the sun on a daily basis also are provided, along with sunscreen samples, coupons and other useful information.

In 2008, the Road to Healthy Skin Tour traveled 17,650 miles making 81 stops. It attracted almost 7,000 visitors and screened more than 3,000. More than 3,200 suspicious markings were detected and 39 suspected cases of melanoma. For the tour schedule and other interactive features, visit riteaid.com/skintour.

Customers can check their local Rite Aid store for the new Rx Suncare line available only at Rite Aid and at riteaidonlinestore.com. This exclusive line of suncare products is competitive with national brands or items found at highend specialty retailers in terms of quality but priced much lower. Seven products carry the prestigious Skin Cancer Foundation Seal of Recommendation as an effective UV sunscreen with a sun protection factor (SPF) of SPF 30 to SPF 50 and antiaging vitamins. Items in the RX Suncare line are priced from $2.49 to $9.99 and are fragrance free, noncomedogenic (does not block pores), supplemented by antioxidant vitamins and provide stabilized broad spectrum protection. Among the products are those specially designed for kids, sports, an advanced protection continuous spray, burn relief mask and a lip balm.

According to The Skin Cancer Foundation, there are more cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon; in fact, one in five Americans will develop skin cancer in the course of a lifetime. Despite these staggering statistics, 40 percent of people admit that they never use sunscreen and only 11 percent use an SPF 15 or higher daily. The Skin Cancer Foundation, the only global organization solely devoted to preventing, detecting and treating skin cancer, reports the incidence of melanoma is increasing faster than that of almost any other cancer. For more skin cancer information visit skincancer.org.

Rite Aids focus on skin care is part of its yearlong commitment to health and wellness. Each year Rite Aid offers free information, answers and education on health and wellness topics including allergies, oral health, diabetes, weight management and heart health.

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Immigration officials held a cancer patient for four hours before they allowed him to enter the USA because one of his cancer drugs caused his fingerprints to disappear. His oncologist is now advising all cancer patients who are being treated with the commonly used drug, capecitabine, to carry a doctors letter with them if they want to travel to the USA.

The incident is highlighted in a letter to the cancer journal, Annals of Oncology [1], published online 27 May. According to the oncologist, several other cancer patients have reported loss of fingerprints on their blog sites, and some have also commented on similar problems entering the USA.

Dr EngHuat Tan, a senior consultant in the medical oncology department at the National Cancer Centre, Singapore, described how his patient, a 62yearold man, had head and neck cancer that had spread (metastatic nasopharyngeal carcinoma), but which had responded well to chemotherapy. To help prevent a recurrence of the cancer the patient was put on a maintenance dose of capecitabine, an antimetabolite drug.

Capecitabine is a common anticancer drug used in the treatment of a number of cancers such as head and neck cancers, breast, stomach and colorectal cancers. One of its adverse sideeffects can be handfoot syndrome; this is chronic inflammation of the palms or soles of the feet and the skin can peel, bleed and develop ulcers or blisters. “This can give rise to eradication of finger prints with time,” said Dr Tan.

The patient, Mr S, developed a mild case of handfoot syndrome, and because it was not affecting his daily life he was kept on a low dose of the drug.

“In December 2008, after more than three years of capecitabine, he went to the United States to visit his relatives,” wrote Dr Tan. “He was detained at the airport customs for four hours because the immigration officers could not detect his fingerprints. He was allowed to enter after the custom officers were satisfied that he was not a security threat. He was advised to travel with a letter from his oncologist stating his condition and the treatment he was receiving to account for his lack of fingerprints to facilitate his entry in future.”

Foreign visitors have been asked to provide fingerprints at USA airports for several years now, and the images are matched with millions of visa holders to detect whether the new visa applicant has a visa under a different name. “These fingerprints are also matched to a list of suspected criminals,” wrote Dr Tan.

Mr S was not aware that he had lost his fingerprints before he travelled.

Dr Tan concludes “In summary, patients taking longterm capecitabine may have problems with regards to fingerprint identification when they enter United States ports or other countries that require fingerprint identification and should be warned about this. It is uncertain when the onset of fingerprint loss will take place in susceptible patients who are taking capecitabine. However, it is possible that there may be a growing number of such patients as Mr S who may benefit from maintenance capecitabine for disseminated malignancy. These patients should prepare adequately before travelling to avert the inconvenience that Mr S was put through.”

Dr Tan said that he would recommend patients on capecitabine to carry a doctors letter with them. “My patient subsequently travelled again with a letter from us and he had fewer problems getting through.”

[1] Travel warning with capecitabine. Annals of Oncology. doi10.1093/annonc/mdp278
[2] Due to patient confidentiality it is not possible to identify Mr S.

Emma Mason Emma Mason