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Dermatology Research Author Interviews

Updated January 5 2013

1/5/13


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Fingerprint Changes and Verification Failure Among Patients With Hand Dermatitis.DermatologistsBlog.com Author Interview: Chew Kek Lee, MRCP(UK)

• DermatologistsBlog.com: What are the main findings of the study?• Fingerprint verification failure is a significant problem affecting patients with hand dermatitis. • A significantly higher proportion of patients had a history of fingerprint verification failure (odds ratio [OR], 8.81; 95% CI, 3.51-22.13)

compared with controls.The main fingerprint changes were fingerprint dystrophy (42.0%) and abnormal white lines (79.5%). The number of abnormal white lines was significantly higher among the patients with hand dermatitis compared with controls (P = .001). Among the patients with hand dermatitis, the odds of failing fingerprint verification with fingerprint dystrophy was 4.01.

• DermatologistsBlog.com: Were any of the findings unexpected?• The prevalence of fingerprint verification failure among patients with hand dermatitis was unexpectedly high. Besides this, more controls

compared to patients had abnormal white lines on their fingerprints. Although patients with atopic dermatitis had been reported to have palmar hyperlinearity, patients with atopic dermatitis with hand dermatitis did not have more abnormal white lines that may correspond to a higher degree of hyperlinearity on the thumbs.

• DermatologistsBlog.com: What should clinicians and patients take away from this study?• Fingerprint verification failure is a significant and emerging problem among patients with hand dermatitis. Therefore, problems with

fingerprint verification should be actively sought for and anticipated in patients with hand dermatitis.

• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?• Researchers should investigate on treatments to reverse the verification problems in patients with hand dermatitis. Good clinical tools

should be developed to assist clinicians to identify patients at risk of verification failure.

• Citation:• Fingerprint Changes and Verification Failure Among Patients With Hand Dermatitis.• Lee CK, Chang CC, Johar A, Puwira O, Roshidah B.• Arch Dermatol. 2012 Dec 17:1-6. doi: 10.1001/jamadermatol.2013.1425. [Epub ahead of print]

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Watching reality television beauty shows is associated with tanning lamp use and outdoor tanning among college studentsDermatologistsBlog.com Author Interview: Joshua Fogel, PhD

• DermatologistsBlog.com What are the main findings of the study?• Dr. Fogel: Young adult participants who watched reality television beauty shows were more likely to use tanning lamps

and to tan outdoors than those who did not watch reality television beauty shows. • DermatologistsBlog.com Were any of the findings unexpected?• Dr. Fogel: This was the direction of our study hypotheses. However, we did not know for sure if this pattern would be

true until after we analyzed the data. Surprisingly, in our analyses adjusting for a number of media variables measuring identification with media characters, these media variables were not associated with tanning lamp use or outdoor tanning.

• DermatologistsBlog.com: What should clinicians and patients take away from this study?• Dr. Fogel : As reality television show watching is very popular, clinicians should ask their young adult patients about their

tanning lamp use and outdoor tanning behavior.• For those patients who use tanning lamps, they should be informed that it is a known risk factor for cancer. Clinicians

should also discuss the importance of minimizing outdoor tanning even with the use of appropriate sun tan (sunscreen) products. Patients should realize that the television actors and personalities who appear tanned and advocate tanning as a way of improving beauty is not a healthy lifestyle approach for one to follow. It places one at risk for cancer.

• DermatologistsBlog.com What recommendations do you have for future research as a result of your study?• Dr. Fogel: To study if particular reality television beauty shows are more or less associated with television viewers

engaging in tanning lamp use and outdoor tanning behavior. • Citation: • Watching reality television beauty shows is associated with tanning lamp use and outdoor tanning among college

students • Joshua Fogel, Faye Krausz

Journal of the American Academy of Dermatology – 26 December 2012 (10.1016/j.jaad.2012.09.055)

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A double-blind, randomized, placebo-controlled trial of adalimumab in the treatment of cutaneous sarcoidosis DermatologistsBlog.com Authors’ Interview:Joan Paul, MD, MPH | Robert J. Pariser, MD

Department of Dermatology, Eastern Virginia Medical School, Norfolk, VirginiaVirginia Clinical Research Inc, Norfolk, Virginia

• DermatologistsBlog.com: What are the main findings of the study:• The study provided fairly strong evidence that adalimumab at a dose of 40 mg per week for 12 weeks after an

80 mg loading dose is more efficacious than placebo in improving the lesions of cutaneous sarcoidosis, as well as the quality of life of these patients.

• DermatologistsBlog.com: Were any findings unexpected?• The efficacy of adalimumab was not unexpected, given the anecdotal reports of its usefulness. The safety of

the treatment was also not unexpected, given the results of clinical trials for other conditions, such as psoriasis. One notable, but not completely unexpected finding was the complete clearing of a patient who ultimately was found to have received placebo treatment, emphasizing the importance of placebo-controlled trials for conditions with unpredictable natural histories.

• DermatologistsBlog.com: What should clinicians and patients take away from this study.• Adalimumab may reasonably be considered as a treatment option for patients with cutaneous sarcoidosis,

particularly for those patients with significant lesions that have not responded to more traditional treatments.• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?• Although small, this study is, to the authors’ best knowledge, the first placebo-controlled, blinded trial for

cutaneous sarcoidosis. Additional larger studies of this type are needed to establish truly evidence-based treatment options for patients with this disease.

• Citation:• A double-blind, randomized, placebo-controlled trial of adalimumab in the treatment of cutaneous sarcoidosis• Robert J. Pariser, Joan Paul, Stefanie Hirano, Cyndi Torosky, Molly Smith

Journal of the American Academy of Dermatology – 02 January 2013 (10.1016/j.jaad.2012.10.056)

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Risk of subsequent primary malignancies after dermatofibrosarcoma protuberans diagnosis: A national studyDermatologistsBlog.com Author Interview: David Kurlander, MS3

Case Western Reserve University School of Medicine, Cleveland, Ohio

• DermatologistsBlog.com: What are the main findings of the study?• Our findings suggest that males and females with a dermatofibrosarcoma protuberans (DFSP) lesion are at increased risk of developing a second

primary DFSP lesion, compared to the general population. • Additionally, females with DFSP are at increased risk of developing breast cancer, melanoma, and soft tissue cancers, and are at decreased risk of

colon cancer.

• DermatologistsBlog.com: Were any of the findings unexpected?• Given that DFSP is such a rare cancer, literature search was more valuable than clinical experience in guiding expectations. Basic science studies

and case reports show mixed conclusions about the role of sex hormones and DFSP growth, but we were surprised to find that stratifying by gender led to such drastic risk differences, and that females were at increased risk of cancers traditionally associated with female sex hormones.

• DermatologistsBlog.com: What should clinicians and patients take away from this study?• Although we do not have exact follow-up recommendations, clinicians and patients should be aware of an increased risk for the aforementioned

cancers. For dermatologists specifically, this means examining DFSP patients not only for local DFSP recurrence, which is very common, but also for new primary lesions and primary melanomas.

• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?• We are currently drafting a manuscript that examines survival of DFSP patients who develop second primary cancers. • Additionally, further inquiry into the association of gender and DFSP development and proliferation could lend insight to pathogenesis and

improved treatment.

• Citation:• Risk of subsequent primary malignancies after dermatofibrosarcoma protuberans diagnosis: A national study• David E. Kurlander, Kathryn J. Martires, Yanwen Chen,

Jill S. Barnholtz-Sloan, Jeremy S. Bordeaux• Journal of the American Academy of Dermatology – 26 December 2012 (10.1016/j.jaad.2012.10.040)

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Selective Ablation of Ctip2/Bcl11b in Epidermal Keratinocytes Triggers Atopic Dermatitis-Like Skin Inflammatory Responses in Adult Mice

DermatologistsBlog.com Author Interview: Arup Indra, Ph.D.Associate Professor Department of Pharmaceutical Sciences, College of PharmacyOregon State University-Oregon Health & Science UniversityMember

, Environmental Health Science Center Corvallis, OR 97331 USA

• DermatologistsBlog.com: What are the main findings of the study? • We demonstrated that keratinocytic ablation of Ctip2 (also known as Bcl11b) leads to atopic dermatitis (AD)-like skin inflammation, characterized by

alopecia, pruritus and scaling, as well as extensive infiltration of immune cells including T lymphocytes, mast cells and eosinophils. We observed increased expression of T-helper 2 (Th2)-type cytokines and chemokines in the mutant skin, as well as systemic immune responses that share similarity with human AD patients. Furthermore, we discovered that thymic stromal lymphopoietin (TSLP) expression was significantly upregulated in the mutant epidermis as early as postnatal day 1 and ChIP assay revealed that TSLP is likely a direct transcriptional target of Ctip2 in epidermal keratinocytes.

• DermatologistsBlog.com: Were any of the findings unexpected?• We were not expecting to get such a massive cutaneous inflammation that would go systemic and display all the symptoms that are very

similar to human AD. The involvement of keratinocyte derived TSLP in AD pathogenesis is well documented from mouse and human studies. But, the discovery of direct TSLP regulation by transcriptional regulator Ctip2 is unexpected as nothing much is known about mechanisms of TSLP regulation epidermal keratinocytes. To our knowledge this so far the best genetically engineered mouse model mimicking human AD.

• DermatologistsBlog.com: What should clinicians and patients take away from this study?• Our results establish an initiating role of epidermal TSLP in AD pathogenesis via a novel repressive regulatory mechanism enforced by Ctip2.

Therefore, loss of function mutation in Ctip2 locus could be a critical determinant in AD pathogenesis and can be useful for characterization of specific AD-subtype.

• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?• Use of this novel AD-model for better understanding the molecular mechanisms underlying AD-pathogenesis. • The role of TSLP as a contributing factor in this process of cutaneous and systemic inflammation need to be elucidated. The present model can

be utilized as a in vivo tool for screening and validating new anti-inflammatory drugs identified from different sources that can be effective in mitigating Th1/Th2 dependent inflammatory responses. Citation:

• Wang Z, Zhang L-j, Guha G, Li S, Kyrylkova K, et al. (2012) Selective Ablation of Ctip2/Bcl11b in Epidermal Keratinocytes Triggers Atopic Dermatitis-Like Skin Inflammatory Responses in Adult Mice. PLoS ONE 7(12): e51262. doi:10.1371/journal.pone.0051262

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Is prevention of cancer by sun exposure more than just the effect of vitamin D?A systematic review of epidemiological studies. DermatologistsBlog.com Author Interview: Han van der Rhee

Department of Dermatology, Hagaziekenhuis, P.O. Box 40551, Leyweg 275, 2504 LN Den Haag, Zuid-Hollan The Netherlands

• DermatologistsBlog.com: What are the main findings of the study• We reviewed all published case control and cohort studies concerning colorectal-, prostate-, breast cancer, non-Hodgkin lymphoma (NHL) and both sunlight

and vitamin D.• We found that almost all 40 epidemiological studies suggest that chronic (not intermittent) sun exposure is associated with a reduced risk of colorectal-,

breast-, prostate cancer and NHL. In colorectal- and to a lesser degree in breast cancer vitamin D levels were found to be inversely associated with cancer risk. In prostate cancer and NHL, however, no associations were found. Other sunlight potentiated and vitamin D independent pathways, such as immunosuppression and the influence on circadian rhythm, could play a role in the possible preventive effect of sunlight.

• DermatologistsBlog.com: Were any of the findings unexpected?• No, in previous reviews (2006 and 2009) we more or less had the same results. In the meantime the evidence is getting more conclusive.• However, for the discussion we reviewed all epidemiological studies on skin cancer and found that, in contrast with southern Europe, in northern European

countries like Belgium, The Netherlands, the UK and Scandinavia, chronic sun exposure is associated a significant lower risk of melanoma and basal cell carcinoma.

• DermatologistsBlog.com: What should clinicians and patients take away from this study?• In the northern hemisphere above 50º NB avoidance of sunlight may have disadvantages for our health. We therefore think that, particularly in countries with

a moderate climate, intermitted sun exposure (and sunburn ) should on the one hand be discouraged, because of skin cancer prevention, while on the other hand (moderate) chronic exposure possibly should be advised.

• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?• More epidemiological data specifically on the association between latitude, skin type, sun exposure patterns and the risk of cancer, including skin cancer, are

needed to confirm our conclusions. In addition animal experiments could address these questions.

• Citation:• Is prevention of cancer by sun exposure more than just the effect of vitamin D? A systematic review of epidemiological studies.• van der Rhee H, Coebergh JW, de Vries E.

Department of Dermatology, HagaziekenhuisP.O. Box 40551, Leyweg 275, 2504 LN Den Haag, Zuid-Holland, The NetherlandsEur J Cancer. 2012 Dec 10. pii: S0959-8049(12)00885-4. doi: 10.1016/j.ejca.2012.11.001. [Epub ahead of print]

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Effect of Nutrient Supplementation on Atopic Dermatitis in Children: A Systematic Review of Probiotics, Prebiotics, Formula, and Fatty Acids.DermatologistsBlog.com

Author Interview: Negar Foolad BA

• DermatologistsBlog.com: What are the main findings of the study?• On the basis of our systematic review, certain nutrient supplements may prevent the development of atopic dermatitis or diminish its severity among

infants and children younger than 3 years of age. More specifically, we found that supplementing with certain probiotics resulted in the prevention and/or reduction in severity of atopic dermatitis. Based on our review, gamma-linolenic acid was shown to reduce the severity of atopic dermatitis. Although prebiotics, certain hydrolyzed formulas, and black currant seed oil were all shown to prevent atopic dermatitis, more research is needed.

• DermatologistsBlog.com: Were any of the findings unexpected?• Yes, we were somewhat surprised to see the positive effects that these various nutrient supplements had on infant atopic dermatitis. Furthermore, it was

interesting to note that all of the randomized controlled trials and cohort studies in our systematic review; none took place in the United States.

• DermatologistsBlog.com: What should clinicians and patients take away from this study?• Based on current literature, it appears that certain nutrient supplements may prevent the development of atopic dermatitis or diminish its severity among

infants and children. More specifically, probiotics were the most commonly studied nutrient. The earliest study took place in Finland in 2000. Therefore, this is still a relatively new area of research and we still do not know the exact mechanisms associated with all of the supplements. However, the lack of randomized controlled trials and cohort studies in the United States calls for additional research.

• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study? • Future research needs to illuminate mechanisms underlying the actions of nutritional supplementation on atopic dermatitis. There is a need for

longitudinal research, including follow-up studies. This type of research can confirm whether supplementation of infants and/or mothers can result in lasting preventive effects. It would be interesting to see future studies evaluating various combinations of nutrient supplements. There may be positive interactions and beneficial outcomes associated with this, and the development and/or amelioration of atopic dermatitis.

• Acknowledgement: I would like to thank Dr. Armstrong and the UC Davis Department of Dermatology for their guidance and support throughout this process.

• Citation:• Effect of Nutrient Supplementation on Atopic Dermatitis in Children: A Systematic Review of Probiotics, Prebiotics, Formula, and Fatty Acids.• Foolad N, Brezinski EA, Chase EP, Armstrong AW.

Arch Dermatol. 2012 Dec 17:1-6. doi: 10.1001/jamadermatol.2013.1495. [Epub ahead of print]

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Why is Melanoma Incidence Rate in Young Women Twice that of Young Men?A unique gender difference in early onset melanoma implies that in addition to ultraviolet light exposure other causative factors are important

DermatologistsBlog.com Author Interview: Feng Liu, PhD Assistant Professional Researcher Department of Medicine University of California Irvine Medical School Irvine, CA 92697

• DermatologistsBlog.com: What are the main findings of the study?• The main finding of this study is that melanoma incidence rate in young women is twice that in young men, but non-melanoma skin cancer (NMSC) does not

exhibit the same trend. While it has been known that young women are at higher risk for melanoma, the reason was largely attributed to UV radiation including sun-bed use. NMSC is known to be associated with UV radiation and most NMSC tumors carry UV-signature mutations, while UV signature mutations in melanoma are less prevalent. Hence the different trend in age-specific incidence rate ratios (female/males) between melanoma and NMSC suggests that melanoma in young age group in women may not be directly associated with UV radiation and/or that other factors may a role in young women.

• DermatologistsBlog.com: Were any of the findings unexpected?• Yes. As stated above it has been known that young women are more susceptible to melanoma than young men. But the comparison of the age-specific rate ratios

(female/male) between melanoma and NMSC was not made before, as NMSC data was not collected by US SEER 17 registries. We utilized a relatively complete cancer registry database from Nordic Countries to make the comparison and found that the higher age-specific rate ratio (female/male, age younger than 40 years old) is only observed in melanoma but not in NMSC.

• DermatologistsBlog.com: What should clinicians and patients take away from this study?• For doctors and patients, it may be helpful to understand that sun-damage is an accumulative process, whose adverse effect may show up many years later (e.g.,

after 40 years of age). Hence it is very important to use sun screen and protective clothing whenever exposed to sun. However early onset melanomas in young women may have additional etiological factors which may be related to female gender characteristics. Currently we don’t know what these factors are, we are actively seeking an answer and hopefully will be able to provide further information in near future for preventive purpose.

• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?• Since large epidemiological studies have shown that estrogen, hormone replacement therapy, oral contraceptives and pregnancy basically do not impact

melanoma incidence rate, we are going to use a different approach to seek further explanations. The above mentioned studies made comparisons between exposed groups and non-exposed groups but the study objectives in nature were all women. We will investigate the different signal transduction pathways between men and women and hopefully will find the cause of the observed difference seen in our initial study.

• Acknowledgement:• I’d like to take this interview chance to express my appreciation and thanks to Dr. Frank Meyskens and Dr. Hoda Anton-Culver, two great scientists and mentors.

Without their support this study would not be possible. • Citation:• A unique gender difference in early onset melanoma implies that in addition to ultraviolet light exposure other causative factors are important.• Liu F, Bessonova L, Taylor TH, Ziogas A, Meyskens FL Jr, Anton-Culver H.• Department of Medicine, University of California, Irvine, CA, USA; Department of Chao Family Comprehensive Cancer Center, University of California, Irvine, CA,

USA.Pigment Cell Melanoma Res. 2012 Oct 24. doi: 10.1111/pcmr.12035. [Epub ahead of print]

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Differential in situ expression of IL-17 in skin diseasesDermatologistsBlog.com Author Interview: Kilian Eyerich, MD, PhDSpecialist in Dermatology and scientist at the Department of Dermatology and Allergology

Biederstein, TU Munich and ZAUM Center of Allergy and Environment, Germany

• DermatologistsBlog.com: What are the main findings of the study?

• This study had a broad concept: although we know much about chemical structure, signal transduction, and effector functions of Interleukin-17, we do not know in which dermatological diseases it is relevant. We wanted to identify skin diseases where a therapeutical intervention with the Th17 signaling cascade could be beneficial.

• DermatologistsBlog.com: Were any of the findings unexpected?• We did not expect that not only lymphocytes express IL-17, but also granulocytes. Depending on the disease, granulocytes were an important source of

IL-17. We were also intrigued to see that skin diseases showed a characteristic pattern of IL-17+ lymphocytes or granulocytes in all investigated patients. This study showed us that IL-17 seems to play an important role not only in inflammatory skin diseases such as psoriasis, but in many more diseases with urgent need of efficient novel therapies.

• DermatologistsBlog.com: What should clinicians and patients take away from this study?• Fortunately, the IL-17 expression pattern is quite conserved within a disease. This means we can judge in what pathological skin condition interference

with the IL-17 pathway could be beneficial. In particular, we observed that in neutrophil dermatoses such as pyoderma gangraenosum, vasculitis and Sweet´s syndrome as well as in the bullous autoimmune dermatoses pemphigus vulgaris and bullous pemphigoid a great number of granulocytes produce IL-17 in the skin. Here, a direct neutralisation of IL-17 with biologic drugs in the pipeline or shortly before approval seems promising. On the other hand, for example in fibrotic diseases blocking the more general IL-12p40 pathway with Ustekinumab could be more beneficial.

• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?• We identified a number of skin diseases where clinical studies with either anti-IL-12p40 or anti-IL-17 seem highly promising. From basic research

aspects, granulocytes as a source of IL-17 should be investigated in more detail.

• Citation:• Differential in situ expression of IL-17 in skin diseases.• Fischer-Stabauer M, Boehner A, Eyerich S, Carbone T, Traidl-Hoffmann C, Schmidt-Weber CB, Cavani A, Ring J, Hein R, Eyerich K.• Department of Dermatology and Allergy.

Eur J Dermatol. 2012 Dec 5. [Epub ahead of print]

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Dichlorophenol-containing pesticides and allergies: results from the US National Health and Nutrition Examination Survey 2005-2006

DermatologistsBlog.com Author Interview: Elina Jerschow, M.D., M.Sc., FACAAIAlbert Einstein College of Medicine Montefiore Medical CenterAssistant Professor of Medicine Director, Drug Desensitization Center

Allergy/ Immunology Division Bronx, New York

• DermatologistsBlog.com What are the main findings of the study?• We found an association between high levels of dichlorophenols in urine (defined as =/>75th percentile in this

population) and allergic sensitization to foods (measured by a blood test): people with high dichlorophenol levels in urine were 80% more likely to be sensitized to foods.

• DermatologistsBlog.com: Were any of the findings unexpected?• Yes, we were surprised to find that this association was only significant for sensitization to foods, but not to

aeroallergens.• DermatologistsBlog.com What should clinicians and patients take away from this study?• More studies would be needed to confirm these findings.• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?• It would be nice to design a prospective study in populations who use different water sources and differently

processed crops: e.g., to compare people who use well water vs. who uses municipal sources, possibly in farming vs. non-farming population.

• Citation:• Dichlorophenol-containing pesticides and allergies: results from the US National Health and Nutrition

Examination Survey 2005-2006.• Jerschow E, McGinn AP, de Vos G, Vernon N, Jariwala S, Hudes G, Rosenstreich D.• Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.• Ann Allergy Asthma Immunol. 2012 Dec;109(6):420-5. doi: 10.1016/j.anai.2012.09.005.

Epub 2012 Oct 1.

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Frequency of Excisions and Yields of Malignant Skin Tumors in a Population-Based Screening Intervention of 360 288 Whole-Body ExaminationsDermatologistsBlog.com Authors’ Interview:Dr. Annika Waldmann

, PhD and Dr. Sandra Nolte, PhDInstitute for Cancer Epidemiology, University of Luebeck, Germany

• Introduction:• The SCREEN project (Skin Cancer Screening Research to Provide Evidence for the Effectiveness of Screening) is one of the largest population-

based skin cancer screening interventions implemented world-wide. Data from this pilot project served as a base for the decision to implement a skin cancer screening program at the national level in Germany in 2008. During the one-year project period, more than 85% of the population of the federal-state of Schleswig-Holstein in Germany being 20 years were eligible for the screening. Overall, 98% of all dermatologists and ~64% of all practice-based non-dermatologists in Schleswig-Holstein participated in the mandatory 8-hour training course and were allowed to screen persons for skin cancer by means of a whole-body skin inspection.

• DermatologistsBlog.com :What are the main findings of the study?• In total, 19% of all eligible inhabitants of Schleswig-Holstein participated in the SCREEN project and received a whole-body skin inspection. Of

these, 15,983 screenees had an excision of at least one suspicious lesion (4.4% of all screenees). After histopathological examination, 3,103 malignant skin lesions were confirmed in 2,911 screenees.

• Malignant melanomas (MM) were found in 858 persons, squamous cell carcinomas (SCC) in 392 persons, basal cell carcinomas (BCC) in 1,961 persons, and 165 persons had other forms of malignant skin tumors.

• In order to detect one skin cancer, 116 persons needed to be screened (NNS; Yield-S) and five persons needed to have an excision (NNE, Yield-E). The yields varied with skin cancer type, age, and sex of the screenees.

• One in every 620 screenees (Yield-S) and one in every 28 person with an excision (Yield-E) was diagnosed with a melanoma. Yields were higher in older men than in younger men, e.g. to find one MM more than 50 excisions were performed in men aged 20-34 years, while 20 excisions were needed in men aged 65 years or older. Respective Yield-E’s were 1 in 41 young women and 1 in every 22 women aged 65+ years.

• To find one SCC, 920 persons needed to be screened (Yield-S) and 41 needed to have an excision (Yield-E). Again, yields differed with age and sex. Only 14 women and 12 men aged 65 years and older needed to have an excision to find one SCC compared to 72 women and 48 men, respectively, in the age-group 50-64 years (Yield-E).

• One in every 184 screenees (Yield-S) and one in every nine persons with an excision (Yield-E) was diagnosed with a BCC. Male screenees were more likely to be diagnosed with BCC than female screenees (Yield-S in women: 1 in 252, Yield-S in men: 1 in 105). The overall Yield-E differed only slightly with sex (Yield-E in women: 1 in 10; Yield-E in men: 1 in 7), while differences were higher for sex-specific age-group comparisons. In women aged 50-64 years, eight excisions were needed, while in women aged 65 years or older four excisions needed to be performed to detect one BCC. In men, the corresponding Yield-E’s were 1 in 7 and again 1 in 4.

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Frequency of Excisions and Yields of Malignant Skin Tumors in a Population-Based Screening Intervention of 360 288 Whole-Body ExaminationsDermatologistsBlog.com Authors’ Interview:Dr. Annika Waldmann, PhD and Dr. Sandra Nolte, PhDInstitute for Cancer Epidemiology, University of Luebeck, Germany (cont)

• DermatologistsBlog.com : Were any of the findings unexpected?• The normal distribution (ratio) of incident melanomas to non-melanocytic skin cancer (NMSC) in Germany is 1 MM to 9 NMSC’s or 1 MM to 2 SCCs to 7

BCCs. In our study the distribution was as follows: 1 MM to 0.5 SCC to 2.3 BCCs. That is, a higher number of MM (n=858) in relation to NMSC was detected. This fact may partly be explained by the mass media campaigns that preceded and accompanied the SCREEN project as it focused on MM rather than NMSC. This campaign may have led to a higher participation of persons at increased risk for melanoma or with prevalent melanomas.

• As skin cancer becomes more common with increasing age, Yield-S must vary with age, under the precondition that an unselected proportion of the population participated in the SCREEN project. However, the Yield-E should be relatively stable across the age-groups, under the assumption that physicians are able to detect malignant lesions in young persons as accurately as in older persons. Thus, the low Yield-S’s in young screenees compared to the high Yield-S’s in older persons were an unexpected finding. We cannot differentiate whether a high number of excisions was conducted due to patients’ preferences or whether a high number of excisions was conducted due to physicians’ decisions who were concerned about the safety especially of younger screenees, i.e. definitely rule out a malignancy that can only be confirmed by histopathological examination.

• DermatologistsBlog.com :What should clinicians and patients take away from this study?• Population-based skin cancer screening is feasible. Non-dermatologists should be included to manage the high number of screenings being conducted in

such a setting. Even in young screenees a relevant number of melanomas, and to a lesser extent also NMSC, were found. Future efforts should target physicians’ education with the aim to reduce the number of excisions in young persons – that is to optimize the ratio of tumor findings to excisions (Yield-E).

• DermatologistsBlog.com : What recommendations do you have for future research as a result of your study?• Future research could:

• (1) aim at answering the question why so many excisions were performed in young screenees, i.e. due to patient or physician preferences;• (2) evaluate yields in persons at increased risk for skin cancer to explore the benefits of risk-group screening versus population-based screening.

• Citation:• Frequency of Excisions and Yields of Malignant Skin Tumors in a Population-Based Screening Intervention of 360 288 Whole-Body Examinations• Annika Waldmann, PhD; Sandra Nolte, PhD; Alan C. Geller, MPH, RN; Alexander Katalinic, MD; Martin A. Weinstock, MD, PhD; Beate Volkmer, PhD;

Ruediger Greinert, PhD; Eckhard W. Breitbart, MD• Arch Dermatol. 2012;148(8):903-910. doi:10.1001/archdermatol.2012.893.

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Evaluating facial pores and skin texture after low-energy nonablative fractional 1440-nm laser treatmentsDermatologistsBlog.com Author Interview: Nazanin Saedi, MDSkinCare Physicians, 1244 Boylston St, Chestnut Hill, MA 02467.

• DermatologistsBlog.com What are the main findings of the study?• Dr. Saedi: Clinical results of this study demonstrate that a low-energy, non-ablative fractionated 1440 nm

laser is safe and effective inreducing pore count, improving skin texture as well as improvement in overall facial appearance.

• DermatologistsBlog.com: Were any of the findings unexpected?• Dr. Saedi: We expected these findings because many have noticed improvement in the appearance of pores

when treating with high energy fractionated devices.• DermatologistsBlog.com: What should clinicians and patients take away from this study?• Dr. Saedi: Low energy level non-ablative fractionated devices are can improve the appearance of pores. It is

exciting because it is the first studywith objective data on pores.

• DermatologistsBlog.com : What recommendations do you have for future research as a result of your study?Dr. Saedi: We would recommend more long term follow-up to see if the results are sustainable for a longer period of time. Also, it would be helpfulto have histology so that we have a better understanding of the exact mechanism.

• Citation:• Evaluating facial pores and skin texture after low-energy nonablative fractional 1440-nm laser treatments• Nazanin Saedi, Kathleen Petrell, Kenneth Arndt, Jeffrey Dove

Journal of the American Academy of Dermatology – 24 October 2012 (10.1016/j.jaad.2012.08.041)

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Food patch testing for irritable bowel syndromeDermatologistsBlog.com Author Interview: Michael Stierstorfer, M.D.East Penn Dermatology, P.C.

• DermatologistsBlog.com : What are the main findings of the study?• Dr. Stierstorfer: Patch testing individuals with symptoms of irritable bowel syndrome (IBS) may detect foods and food additives

which, when avoided in the diet, may result in significant improvement in the IBS symptoms.• DermatologistsBlog.com Were any of the findings unexpected?• Dr. Stierstorfer: The pathogenesis of IBS has been questioned recently as low grade inflammation of the lower GI tract has

been observed.• The inflammation appears to alter motility and thus cause the IBS symptoms.• The cause of the inflammation until now has been unknown. IgE testing is felt to not be worthwhile in these individuals, so

other sources of inflammation need to be investigated.• Given that the immunologic system has full access to the GI tract, it seems logical that if foods can cause type 4 skin reactions,

they should be able to elicit similar reactions in the GI tract.• DermatologistsBlog.com What should clinicians and patients take away from this study?• Dr. Stierstorfer: Foods and food additives that are known to cause allergic contact dermatitis should be suspected as a possible

cause for the symptoms of IBS.• Comprehensive patch testing to these food allergens may help pinpoint a cause for IBS in some individuals.• DermatologistsBlog.com What recommendations do you have for future research as a result of your study?• Dr. Stierstorfer: We patch tested to 40 foods and food additives and were able to help 27.5% of the 51 individuals tested.• Testing to a greater number of foods and food additives that are known to elicit allergic contact dermatitis may help a larger

percentage of patients with IBS.• Citation:• Food patch testing for irritable bowel syndrome• Michael B. Stierstorfer, Christopher T. Sha, Marvin Sasson

Journal of the American Academy of Dermatology – 26 October 2012 (10.1016/j.jaad.2012.09.010)

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Vitamin D Status and Skin Cancer Risk Independent of Time OutdoorsVitamin D Status and Skin Cancer Risk Independent of Time Outdoors: 11-Year Prospective Study in an Australian Community

DermatologistsBlog.com Author Interview: Jolieke van der Pols, PhDCancer and Population StudiesQueensland Institute of Medical Research Brisbane QLD 4006 Australia

• DermatologistsBlog.com: What are the main findings of the study?• We found that adults who had serum 25(OH)-vitamin D levels above 75 nmol/L (30 ng/mL) were more likely to develop melanoma and basal cell

carcinoma (BCC) in a subsequent 11-year follow-up period compared to adults whose serum 25(OH)-vitamin D levels were below 75 nmol/L (30 ng/mL).• In contrast, the incidence of squamous cell carcinoma (SCC) tended to be lower in participants with serum levels above 75 nmol/L (30 ng/mL) compared

to those with lower levels.• In these analyses we allowed for (adjusted for) all main skin cancer risk factors, such as skin colour, sunscreen use, personal and family history of skin

cancer, as well as long-term and recent measures of time spent outdoors.

• DermatologistsBlog.com: Were any of the findings unexpected?• Our hypothesis was that higher levels of serum 25(OH)-vitamin D might be associated with reduced skin cancer risk, given that some experimental studies

indicate that vitamin D may reduce damage in the skin caused by ultraviolet light exposure.• The findings for SCC did indeed suggest a protective association with vitamin D levels, although this was strictly not statistically significant.• However, the findings for melanoma and BCC were in the opposite direction and clearly showed a higher incidence of these skin cancers in persons with

higher 25(OH)-vitamin D levels.

• DermatologistsBlog.com: What should clinicians and patients take away from this study?• Our findings indicate that the carcinogenic effect of high sun exposure is not counteracted by high vitamin D status.

Thus high sun exposure should be avoided as a means to achieve high vitamin D status.

• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?• In terms of skin cancer we need to increase our understanding of how the epidemiology and risk factors differ between BCC, SCC, and melanoma.• In terms of vitamin D we need more evidence from similar, prospective studies that have collected detailed data on skin cancer risk factors to corroborate

our findings.

• Citation:• Vitamin D Status and Skin Cancer Risk Independent of Time Outdoors: 11-Year Prospective Study in an Australian Community• Jolieke C van der Pols, Anne Russell, Ulrike Bauer, Rachel E Neale, Michael G Kimlin and Adèle C Green

Journal of Investigative Dermatology , (18 October 2012) | doi:10.1038/jid.2012.346

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An ultraviolet-radiation-independent pathway to melanoma carcinogenesis in the red hair/fair skin backgroundDermatologistsBlog.com Author Interview: David E. Fisher MD, PhDEdward Wigglesworth Professor & ChairmanDept of

Dermatology Director, Melanoma Program MGH Cancer CenterDirector, Cutaneous Biology Research CenterMassachusetts General Hospital Harvard Medical School Boston, MA 02114

• DermatologistsBlog.com: What are the main findings of the study?• Dr. Fisher: There appears to be a mechanism by which red-pigment (pheomelanin) is carcinogenic for melanoma formation, even independently of UV

irradiation. While this does not mean that UV is unimportant (we strongly believe that UV further worsens the effect), it suggests that UV protection may not be sufficient to fully protect against melanoma.

• DermatologistsBlog.com: Were any of the findings unexpected?• Dr. Fisher: Yes- we had expected that our study of melanoma formation using BRAF(V600E) oncogene in the redhead background would produce benign

nevi, as this gene typically does in black mice. We expected that UV irradiation would be required for melanoma formation, but were surprised that melanomas arose spontaneously, suggesting that in the presence of the BRAF(V600E) gene there may be ongoing genomic alterations which eventually produce melanoma formation— due to a UV independent activity of pheomelanin.

• DermatologistsBlog.com: What should clinicians and patients take away from this study?• Dr. Fisher: Firstly, we believe that UV protection remains as important as ever.• While this study revealed a UV independent mechanism of melanoma formation, we suspect that UV may further amplify the effect.• Therefore it is important for clinicians and patients to remain vigilant regarding UV protection.• However we would add that even for people who are extremely careful with UV protection, it is important to be mindful of skin changes, because this

additional pathway towards melanoma formation might still occur. Such changes should be evaluated by an appropriate clinician.

• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?• Dr. Fisher: We believe that the identification of this mechanism of melanoma formation, when better understood, may provide an opportunity for novel

preventative strategies.• Our study suggested that reactive oxygen species may play a functional role in the carcinogenic process. While this may suggest that anti-oxidants might

one day prove beneficial, it is important to exercise caution until appropriate research is performed, because certain anti-oxidants may inadvertently worsen oxidative damage. Hopefully future research will one day identify safe and effective prevention strategies, based upon antagonizing this pigment-mediated pathway.

• Citation:• Mitra D, et al “An ultraviolet-radiation-independent pathway to melanoma carcinogenesis in the red hair/fair skin background” Nature 2012;

DOI: 10.1038/nature11624.

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Efficacy and safety of systemic methotrexate vs. acitretin in psoriasis patients with significant palmoplantar involvement: a prospective, randomized studyDermatologistsBlog Author Interview: Dr A J Kanwar MD, FAMS, FRCP (London)

Prof and Head, Dept of Dermatology,Venereology & Leprology PGIMER, Chandigarh

• DermatologistsBlog: What are the main findings of the study?• Methotrexate at a dose of 0.4 mg/kg/wk was found to be more efficacious than acitretin 0.5 mg/kg/d for the treatment

of psoriasis with significant palmoplantar involvement.

• DermatologistsBlog: Were any of the findings unexpected?• Yes. In two previous retrospective studies acitretin was found to be very efficacious but they had many limiting factors as

mentioned in the article. But according to our study the results are better with methotrexate.

• DermatologistsBlog: What should clinicians and patients take away from this study?• Methotrexate is a highly efficacious systemic drug for treating psoriasis patients with significant palmoplantar involvement.

• DermatologistsBlog: What recommendations do you have for future research as a result of your study?• Methotrexate should be used as the first line systemic therapeutic agent for treatment of psoriasis patients with significant

palmoplantar involvement as it is highly efficacious and relatively inexpensive when compared to acitretin.• Citation:• Efficacy and safety of systemic methotrexate vs. acitretin in psoriasis patients with significant palmoplantar involvement:

a prospective, randomized study• Janagond AB, Kanwar AJ, Handa S.• Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research,

Chandigarh 160012, India.• J Eur Acad Dermatol Venereol. 2012 Oct 16. doi: 10.1111/jdv.12004. [Epub ahead of print]

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Epigallocatechin-3-Gallate Improves Acne in Humans by Modulating Intracellular Molecular Targets and Inhibiting P. acnes DermatologistsBlog.com: Author Interview: Dae Hun SUH, M.D., Ph.D.Professor, Department of Dermatology

Seoul National University College of MedicineOrganizer, Asia-Pacific Acne Symposium

• DermatologistsBlog.com : What are the main findings of the study?• In this study, we reported that Epigallocatechin-3-gallate (EGCG), the major polyphenol in green tea, has therapeutic

effects on acne by applying both experimental and clinical methods. In experimental methods, we showed that EGCG displays apoptotic, sebosuppressive, and anti-inflammatory effects on human sebocytes, and that it displays antibacterial effects on Propionibacterium acnes, findings that are, to our knowledge, previously unreported. Our biochemical, genetic, and cellular studies further indicate that modulation of AMPK–SREBP-1 and NF-kB/activator protein 1 (AP-1) signaling pathways mediates the sebosuppressive and anti-inflammatory effects of EGCG, respectively.

• Subsequently, we confirmed its efficacy and safety in an 8-week randomized, split-face, clinical trial. Taken together, these data demonstrate that EGCG modulates several key pathological factors of acne with very few, relatively mild side effects, suggesting the possibility that EGCG may be effective in the treatment of acne.

• DermatologistsBlog.com : Were any of the findings unexpected?• Most medical and surgical modalities developed so far to treat acne have demonstrated relatively modest efficacy,

presumably because of the inherent pathological complexity of the disease.• Acne developments were critically related with four distinct processes as follows:• (1) increased sebum production• (2) altered keratinization of follicular keratinocytes,• (3) activity of P. acnes, and• (4) inflammation.• Although we hypothesized that EGCG might have beneficial effects on some parts of this pathologic processes, we didn’t

even expect that it modulated all four pathological factors at molecular levels. Consistent with these results, EGCG also have shown therapeutic effects on both inflammatory and non-inflammatory lesions with few, mild side effects.

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Epigallocatechin-3-Gallate Improves Acne in Humans by Modulating Intracellular Molecular Targets and Inhibiting P. acnes DermatologistsBlog.com: Author Interview: Dae Hun SUH, M.D., Ph.D.Professor, Department of Dermatology

Seoul National University College of MedicineOrganizer, Asia-Pacific Acne Symposium(cont)

• DermatologistsBlog.com : What should clinicians and patients take away from this study?

• Clinically, only a few drugs target multiple pathological processes of acne and improve the condition effectively, but their use is accompanied by potentially serious side effects. For example, one of the most effective treatments, isotretinoin, has serious side effects, including teratogenicity, liver enzyme abnormalities, and dyslipidemia. Topical retinoids, currently considered as the first-line treatment of acne, may cause burning and irritation, especially in the early stages of treatment.

• Our clinical trial revealed that 1 and 5% EGCG treatment significantly improves both inflammatory and non-inflammatory acne lesions with few, mild side effects. Remarkably, the efficacies of EGCG in our study were better than those of a new compound product reported in recent large-scale clinical trials with less side effects. Therefore, clinicians could recommend that patients apply green tea extract to their acne lesions as an alternative therapy, especially for those suffering from possible side effects of current medications. Of course, further studies are definitely needed in the future.

• DermatologistsBlog.com : What recommendations do you have for future research as a result of your study?

• There is a clinical need for development of new acne medication. In this study, we showed that chemical components obtained from green tea could play some important roles with minimal side effects. In fact, sixty one percent of total medications currently used originated from natural products.

• Aspirin, perhaps the most widely used antipyretic/analgesic agent, was developed from a natural product from willow bark. Furthermore, the elucidation of the chemical structure of morphine (obtained from opium) led to the development of a range of new synthetic analgesics. Therefore, it is reasonably expected that organic compounds extracted from natural compounds might interfere with target molecules associated with pathogenesis of acne. To find and evaluate active ingredients in natural products objectively, quantitative and reliable methods are required to evaluate effectiveness. In addition, these methods must be simple, economical, and efficient in examining small sample quantities with a precise, reproducible manner. I strongly believe that these studies would yield valuable products that would have therapeutic effects not only for acne but also for other skin diseases.

• Citation:• Epigallocatechin-3-Gallate Improves Acne in Humans by Modulating Intracellular Molecular Targets and Inhibiting P. acnes.• Yoon JY, Kwon HH, Min SU, Thiboutot DM, Suh DH.• Acne Research Laboratory, Seoul National University Hospital, Seoul, South Korea.

J Invest Dermatol. 2012 Oct 25. doi: 10.1038/jid.2012.292. [Epub ahead of print]

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Is skin self-examination for cutaneous melanoma detection still adequate? A retrospective study.DermatologistsBlog.com Author Interview: Vincenzo De Giorgio, MDDepartment of Dermatology, University of Florence, Florence, Italy.


I believe that the message of the skin self-examination has now been delivered to the majority of the population but it is not useful todecrease the overall mortality of melanoma, as confirmed by the epidemiological study.

• We now have the tools to make the diagnosis for very early stage melanomas using dermatoscope, videodermatoscope or confocalmicroscopy.

• I believe that it is unreasonable to ask a patient to look at his lesions in a hall of mirrors with the hope that he would recognizeand diagnose small and thin melanoma that would even be difficult for an expert dermatologist to diagnose.

• The important data that emerged from our study is that self-detection was associated with a greater probability of having a thick melanoma and, therefore, a poor prognosis (OR 1.56).

• DermatologistsBlog.com: Were any of the findings unexpected?

• No, I was actually convinced that in order to make diagnosis of melanomas an early stage the ABCD rule was not sufficient because an in-situ orthin melanoma is, clinically very similar to a mole, even for an expert dermatologist.

• DermatologistsBlog.com: What should clinicians and patients take away from this study?• A dermatological skin check should be recommended to all adult patients every year.• In particular ,we should introduce a new message to encourage the high-risk patients, such as non-educated men over 50 years old, to have an annual skin

examination as a rule.• This message could be helpful to further increase the prognosis of all kinds of

melanomas.• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?• I suggest to take in consideration that the self skin examination via the

ABCD rule is not be used to identify in-situ or thin melanomas.• If further studies validate our result we will should discuss new guideline for

melanoma screening.• Citation:• Is skin self-examination for cutaneous melanoma detection still adequate? A retrospective study.• De Giorgi V, Grazzini M, Rossari S, Gori A, Papi F, Scarfi F, Savarese I, Gandini S.• Department of Dermatology, University of Florence, Florence, Italy.

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Effect of Olive and Sunflower Seed Oil on the Adult Skin Barrier: Implications for Neonatal Skin CareDermatologistsBlog.com Author Interview: Simon G. Danby, Ph.D.

Academic Unit of Dermatology Research, Department of Infection and Immunity, Faculty of Medicine, Dentistry and Health,University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX, UK

• DermatologistsBlog.com: What are the main findings of the study?• In contrast to sunflower seed oil, topical treatment with olive oil (6 drops, twice daily to the forearm) was found to significantly damage the structure of

the skins permeability barrier (the ‘skin barrier’) in adults.• Subjects with a predisposition to a defective skin barrier (a history of atopic dermatitis, AD) were more susceptible to these negative effects.• The development of a skin barrier defect is a key event in the development of AD, and the extent of the defect correlates with the severity of AD. Damage

to the skin barrier caused by the application of olive oil may therefore promote the development of, or exacerbate existing, AD. These findings challenge the unfounded belief that all natural oils are beneficial for the skin and highlight the need for further research.

• DermatologistsBlog.com: Were any of the findings unexpected?• Olive oil is widely recommended for the treatment of neonatal skin by healthcare professionals (Cooke et al., 2011), therefore it was surprising to find

such a negative affect on the skin barrier.• There is of course no evidence to support this practice.• Moreover earlier studies have reported negative effects associated with the application of olive oil to the skin. Indeed, oleic acid, a major constituent of

olive oil, is a well-studied skin penetration enhancer.• DermatologistsBlog.com: What should clinicians and patients take away from this study?• The key message is to follow an evidenced-based approach to skincare.

Based on the results of this study the use of olive oil for the treatment of dry skin and infant massage should be discouraged.• We should also be cautious about the topical use of sunflower seed oil. In this study we sourced sunflower seed oil with a very low oleic acid content,

however some varieties contain more oleic acid than olive oil.• Furthermore all natural oils can contain small amounts of plant protein (depending on purity), which are potentially allergenic. The skin is an important

route of sensitization (Lack et al., 2003), therefore the potential for harm to ‘at risk’ neonates must be carefully considered.• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?• The next step is to undertake a randomized clinical trial to determine the effect of topical olive oil treatment in neonates from birth.• Citation:• Effect of Olive and Sunflower Seed Oil on the Adult Skin Barrier: Implications for Neonatal Skin Care.• Danby SG, Alenezi T, Sultan A, Lavender T, Chittock J, Brown K, Cork MJ.• Academic Unit of Dermatology Research, Department of Infection and Immunity, Faculty of Medicine, Dentistry and Health, University of Sheffield

Medical School, Sheffield, UK.• Pediatr Dermatol. 2012 Sep 20. doi: 10.1111/j.1525-1470.2012.01865.x. [Epub ahead of print]

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http://www.ncbi.nlm.nih.gov/pubmed/22995032


Triclosan exposure and allergic sensitization in Norwegian children DermatologistsBlog.com: Author interview: Randi J Bertelsen PhDNorwegian Institute of Public Health, Oslo, Norway

• DermatologistsBlog.com:What are the main findings of the study?• Dr. Bertelsen: Response: We found that children with allergic sensitization and inflammation in the mucous lining of the nose, also known as

rhinitis, had higher levels of triclosan in urine than children without allergic sensitization and rhinitis.

• DermatologistsBlog.com: Were any of the findings unexpected?• Dr. Bertelsen: Response: We were surprised that even though half of the children in the study had undetectable levels of triclosan in urine,

some children had very high levels which most likely would indicate several sources of exposure.

• DermatologistsBlog.com: What should clinicians and patients take away from this study?• Dr. Bertelsen: Response: For the majority of the population, the levels are so low that they are unlikely to be of concern. Due to concern

about the emergence of antibiotic-resistant bacteria, the Norwegian authorities have encouraged retailers and consumers for may years to avoid routine use of products declared as antibacterial. Because of this, triclosan has now been phased out in many products in Norway. It is, however, believed that very little actually goes through the skin, and that the mucosa in your mouth is where everything is absorbed, so triclosan-containing toothpaste and mouthwash are likely to be important sources of exposure. By reading the label with ingredients, the consumers can easily avoid triclosan-containing products.

• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?• Dr. Bertelsen: Response: Since this is an observational study, we can only describe associations. Experimental models is important for

understanding the mechanism between triclosan and allergy development. It would also be interesting to know more about the sources of exposure; the Norwegian children were 10 years of age, and many of the known sources of triclosan from cosmetic products would be expected to be more relevant for adult populations.

• Citation:• Triclosan exposure and allergic sensitization in Norwegian children• Bertelsen RJ, Longnecker MP, Løvik M, Calafat AM, Carlsen K-H, London SJ, Lødrup Carlsen KC.

Allergy 2012; DOI: 10.1111/all.12058.

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Incidence, Mortality, and Disease Associations of Pyoderma Gangrenosum in the United Kingdom: A Retrospective Cohort StudyDermatologistsBlog.com Author Interview: Dr Sinead

LanganNIHR Clinician Scientist & Hon Consultant Dermatologist

• DermatologistsBlog.com What are the main findings of the study?• Pyoderma gangrenosum (PG) is a relatively rare disease; the standardised incidence of PG in the UK population is 0.63 (95% confidence interval 0.57 to 0.71)

per 100,000 person-years.• The risk of death in people with PG was three times higher than people of the same age and gender in the general population, 72% higher than people with

inflammatory bowel disease with a borderline increased risk compared to people of the same age and gender with rheumatoid arthritis.• Frequently reported disease associations were present in a third of the individuals with PG, the majority having inflammatory bowel disease (20%) with smaller

numbers having rheumatoid arthritis (12%) and haematological disorders (4%).

• DermatologistsBlog.com Were any of the findings unexpected?• The increased mortality compared to inflammatory bowel disease controls and the borderline increase in mortality compared to rheumatoid arthritis controls

was unexpected and represents an important finding.• The disease associations were less frequent than previously reported, which may reflect the presence of ascertainment bias in previous studies from specialist

centers.

• DermatologistsBlog.com What should clinicians and patients take away from this study?• Pyoderma gangrenosum is a relatively rare but important disease, associated with significantly increased mortality, even compared to individuals with

rheumatoid arthritis or inflammatory bowel disease. Reasons for the increase in mortality are poorly understood and require further research.

• DermatologistsBlog.com What recommendations do you have for dermatology health care providers as a result of your study?• This study provides the first population-based cohort study of PG.• It gives really useful information on incidence, mortality rates, the validity of a PG diagnosis in GPRD (a UK general practice database) and disease associations

which will be extremely useful data for planning clinical care and clinical trials. More research is needed to understand factors which lead to increased mortality in people with PG.

• Citation:• Incidence, Mortality, and Disease Associations of Pyoderma Gangrenosum in the United Kingdom: A Retrospective Cohort Study• Sinéad M Langan, Richard W Groves, Tim R Card and Martin C Gulliford• Journal of Investigative Dermatology 132, 2166-2170 (September 2012) | doi:10.1038/jid.2012.130• London School of Hygiene and Tropical Medicine and St John’s Institute of Dermatology,

Keppel Street, London, WC1E 7HT

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Coin exposure may cause allergic nickel dermatitis: a reviewDermatologistsBlog.com Author Interview Jacob P. ThyssenDepartment of Dermato-Allergology, National Allergy Research Centre,

Copenhagen University Hospital Gentofte, DK-2900 Hellerup, Denmark

• DermatologistsBlog.com: What are the main findings of the study?• Dr. Thyssen: This is an overview of experimental studies investigating nickel release from coins.

Furthermore, epidemiological studies and selected case reports are presented.• DermatologistsBlog.com: What should clinicians and patients take away from this review?• Dr. Thyssen: Despite consumer coin handling infrequently case nickel sensitization and dermatitis,

professional coin exposure does indeed cause morbidity.• This should be considered in nickel allergic individuals who are in skin contact with coins, e.g. cashiers.• DermatologistsBlog.com: What recommendations do you have for future research as a result of your

study?• Dr. Thyssen: Nickel release from new coins should be determined, and we recommend that mints avoid

nickel in future coin production.• Citation:• Coin exposure may cause allergic nickel dermatitis: a review.• Thyssen JP, Gawkrodger DJ, White IR, Julander A, Menné T, Lidén C.• Department of Dermato-Allergology, National Allergy Research Centre, Copenhagen University Hospital

Gentofte, DK-2900 Hellerup,Denmark Department of Dermatology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK Department of Cutaneous Allergy, St John’s Institute of Dermatology, London SE1 7EH, UK Institute of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden.

• Contact Dermatitis. 2012 Jul 5. doi: 10.1111/j.1600-0536.2012.02127.x. [Epub ahead of print]

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Recent skin self-examination and doctor visits in relation to melanoma risk and tumour depthDermatologistsBlog.com Author Interview: Linda J. Titus, PhDYale University School of Medicine, PhD 1989Connecticut College, MA 1983

Southern Connecticut State University, BA Section of Biostatistics & EpidemiologyDartmouth Medical School One Medical Center Drive


• Dr. Titus: We found limited evidence that skin self-examination may reduce risk of melanoma, or risk of deeper tumors.• The data also suggested that skin self-examination combined with a doctor visit may sharply reduce risk of melanoma.• However, we did not see a dose response; that is, more frequent skin self-examinations did not result in a lower risk of melanoma.• For this and other reasons, our findings may reflect confounding by “healthy” lifestyle behaviors.

For example, those who practice skin self-examination and regularly visit a doctor may also wear sun-protecting clothing.Thus, although our findings are suggestive, they require verification by future studies before specific recommendations can be made.

• We also found that most melanomas are detected by laypersons, which has been seen in previous studies.In our study, skin self-examination was also associated with self-detected tumors, but self-detected tumors were not shallower than tumors detected by others. This may be due to delays in recognizing the tumor, or delays in seeing a dermatologist, or both.

• DermatologistsBlog.com: Were any of the findings unexpected?• Dr. Titus: We did not find an advantage of having the melanoma detected by a physician, which has been shown in previous studies.• This may reflect infrequent physician examinations, lack of skin examination during physician visits, or possibly lack of recognition of an early melanoma.

• DermatologistsBlog.com: What should clinicians and patients take away from this study?

• Dr. Titus: Melanoma occurs on the skin, giving us an opportunity for early detection.• Laypersons and physicians alike should familiarize themselves with the characteristics of early melanomas.

Recognition of early melanoma is necessary before a benefit of skin examination can be realized.• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?

• Dr. Titus: Future studies should assess the possible value of skin self-examination, with specific attention to the procedures involved and the layperson’s knowledge of melanoma signs. In addition, future studies should carefully record the practices that lead to prevention or early detection.

• Citation:• Titus, L.J., Clough-Gorr, K., Mackenzie, T.A., Perry, A., Spencer, S.K., Weiss, J., Abrahams-Gessel, S. and Ernstoff, M.S. (2012), Recent skin self-examination

and doctor visits in relation to melanoma risk and tumour depth. British Journal of Dermatology. doi: 10.1111/bjd.12003

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Raf kinase inhibitor RKIP inhibits MDA-9/syntenin-mediated metastasis in melanoma.DermatologistsBlog.com Author Interview: Dr. Paul B. Fisher, MPh, PhD

Professor and Chairman,Department of Human & Molecular GeneticsDirector, VCU Institute of Molecular Medicine

VCU Massey Cancer Center Virginia Commonwealth UniversitySchool of Medicine Richmond, VA 23298-0033

• DermatologistsBlog.com: What are the main findings of the study?• Dr. Fisher: Cancer metastasis, which is the ability of tumor cells to migrate from one site in the body and colonize in a distant region, represents a high priority area of research. Moreover,

the ability to control this process, which correlates with more than 90% of cancer-associated deaths, will have profound impact on the management of a patient’s cancer.• Our research is focused on• 1) elucidating the underlying genetic factors that mediate metastasis and• 2) using this information to develop improved therapies to prevent this invariably fatal component of the neoplastic process. We previously identified a novel gene from human melanoma

cells, called melanoma differentiation associated gene-9 (also known as syntenin), mda-9/syntenin, that is a positive regulator of melanoma metastasis.• In the present research, we document that a gene that can suppress cancer/metastasis (a tumor/metastasis suppressor gene), Raf kinase inhibitor (RKIP), can prevent metastasis by

directly affecting mda-9/syntenin changes in tumor cell signaling pathways.• This is the first demonstration that targeting mda-9/syntenin using a genetic approach may provide a viable means of inhibiting metastasis in melanoma and in principal other

malignancies, since analysis of the human cancer genome indicates that MDA-9/syntenin is elevated in the majority of cancers, irrespective of anatomical site.• We also demonstrate and inverse relationship between expression of MDA-9/syntenin and RKIP in advanced staged melanoma patient-derived clinical samples suggestion potential

applications for melanoma diagnosis and staging.• DermatologistsBlog.com: Were any of the findings unexpected?• Dr. Fisher: The present study tested a defined hypothesis that mda-9/syntenin is important in metastasis and blocking the action of this metastasis promoting gene using a genetic

inhibitor of metastasis, RKIP, would prevent metastasis.• This hypothesis was validated and the results were expected. Mda-9/syntenin enhances expression of a transcription factor controlling other genes, NF-kB, which is inhibited by RKIP.

Inhibition occurs by physical interaction between MDA-9/syntenin protein and RKIP protein.• DermatologistsBlog.com: What should clinicians and patients take away from this study?• Dr. Fisher: The present studies highlight an approach for preventing metastasis and indicate that this fatal process in cancer progression, at least with melanoma, can be inhibited. Further

studies are required to translate these preclinical studies into potential clinical trials to directly determine if targeting MDA-9/syntenin with RKIP or compounds that are RKIP mimetics can prevent metastasis. Additionally, these two proteins could prove useful as biomarkers for diagnosing metastasis and for monitoring response to therapy, independent of cancer type.

• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?• Dr. Fisher: The major recommendations for future research are to develop innovative approaches to effectively deliver the therapeutic gene RKIP in a cancer-specific manner.• In addition, it would be of value to develop small molecules that mimic RKIP and could be used as drugs to treat melanoma metastasis, and potentially other cancers.• Citation:• Raf kinase inhibitor RKIP inhibits MDA-9/syntenin-mediated metastasis in melanoma.• Das SK, Bhutia SK, Sokhi UK, Azab B, Su ZZ, Boukerche H, Anwar T, Moen EL, Chatterjee D, Pellecchia M, Sarkar D, Fisher PB.• Dept of Human and Molecular Genetics, Virginia Commonwealth University, School of Medicine.

Cancer Res. 2012 Oct 11. [Epub ahead of print]

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Emotional benefit of cosmetic camouflage in the treatment of facial skin conditions:personal experience and reviewDermatologistsBlog.com Author Interview: Jason J. Emer, MD

Department of Dermatology, Mount Sinai School of Medicine,5 East 98th St., 5th Floor, New York, NY

• DermatologistsBlog.com: What are the main findings of the study?• Dr. Emer: This was not an official clinical trial but a review article demonstrating the published studies using cosmetic camouflage for medical

therapy — all of which showed excellent clinical results and improvement in the patients quality of life. with this paper we wanted to make aware the potential benefit of using this type of therapy in conjunction with medical treatments; as our patients were extremely satisfied in the cases we presented.

• DermatologistsBlog.com: Were any of the findings unexpected?• Dr. Emer: No unexpected findings. In all cases our patients verbally expressed improvement in their quality of life, ease of use, and low financial

burden with the use of cosmetic camouflage. Further, they mentioned an improved physician-patient satisfaction from the mere offering of this alternative therapy; as other physicians had not offered this to them in the past.

• All patients used this therapy in conjunction with their other medical treatments and had no adverse interactions.

• DermatologistsBlog.com: What should clinicians and patients take away from this study?

• Dr. Emer: That cosmetic camouflage should be an alternative therapy that is offered to patients with cosmetically displeasing facial skin conditions and that they can be used in conjunction with other prescription medical therapies with a low risk of adverse clinical effects or interactions.

• By offering non-traditional therapies, patients may be more likely to follow a treatment protocol as well help to strengthen the medical relationship between the physician and patient.

• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?• Dr. Emer: In the paper I discuss the need for studies demonstrating similar clinical results and/or less adverse reactions with the concomitant use of

this type of therapy (non-traditional, non-prescription) and prescription or procedural treatments.• Emotional benefit of cosmetic camouflage in the treatment of facial skin conditions: personal experience and review• Authors: Levy LL, Emer JJ

Department of Dermatology, Mount Sinai School of Medicine, New York, NY, USAPublished Date November 2012 Volume 2012:5 Pages 173 – 182DOI: http://dx.doi.org/10.2147/CCID.S33860

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Association of Pediatric Psoriasis Severity With Excess and Central Adiposity:An International Cross-Sectional StudyDermatologistsBlog.com Author Interview: Amy S. Paller, MD

Walter J. Hamlin Professor and Chair Department of Dermatology of PediatricsNorthwestern University’s Feinberg School of Medicine

• DermatologistsBlog.com What are the main findings of the study?• Dr. Paller: This major international study from 9 countries and 18 sites examined the association of excess

adiposity (overweight and obese as determined by BMI percentile) and central adiposity (waist circumference percentile and waist-to-height ratio) with severity of pediatric psoriasis in 641 children and controls.

• Children with psoriasis were twice as likely as controls to be overweight or obese, regardless of the severity of the psoriasis. The odds ratio of obesity in psoriatics vs. controls internationally was 4.3, and was 7.6 in the U.S. group of children; the odds ratio of obesity was higher in severely affected children (4.9) vs. children with mild psoriasis (3.6). Central adiposity, a strong indicator of cardiovascular risk, was also significantly increased. Having a waist circumference of >90th percentile occurred more than twice as often in children with psoriasis than controls, especially in severe psoriatics and the significantly increased waist-to-height ratio was unaffected by severity. Interestingly, there was no difference in either excess adiposity or central adiposity between children with severe psoriasis at their worst, but mild at enrollment, and children who remained severe at enrollment, suggesting that effective treatment does not affect adiposity.

• DermatologistsBlog.com Were any of the findings unexpected?• Dr. Paller: We were not surprised by the finding that children with psoriasis are heavier than controls, but

were intrigued by the extremely high odds ratios of the association and that severity did not affect excess adiposity. Obviously, the clear association of psoriasis and central adiposity, especially in children with severe psoriasis, further raises concern about the risk of cardiovascular disease. We were also surprised and a bit discouraged that effective intervention did not affect either excess or central adiposity in children with psoriasis.

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Association of Pediatric Psoriasis Severity With Excess and Central Adiposity:An International Cross-Sectional StudyDermatologistsBlog.com Author Interview: Amy S. Paller, MD

Walter J. Hamlin Professor and Chair Department of Dermatology of PediatricsNorthwestern University’s Feinberg School of Medicine (Cont)

• DermatologistsBlog.com What should clinicians and patients take away from this study?

• Dr. Paller: This study firmly cements the association of excess adiposity and central adiposity with pediatric psoriasis of all severities and internationally. It reminds us to treat more than the skin lesions and, since altering eating and exercise habits is much more effective if initiated early, to stress the importance of these lifestyle changes in the group of children with psoriasis who are overweight.

• DermatologistsBlog.com What recommendations do you have for future research as a result of your study?• Dr. Paller: Clearly, longitudinal studies in affected children should be initiated to seek evidence of the development of

clinical and laboratory features of metabolic disease – and to assess how effective therapy of the psoriasis (vs. of the excess adiposity) impacts their occurrence. One of the remaining questions is which comes first — the adiposity or the psoriasis? We are actively pursuing the answer to this question in children, but a recent study suggests that the psoriasis occurs in adults who are already overweight. In our study, approximately 30% of the children had a first-degree relative with psoriasis; this provides an opportunity for dermatologists and primary care physicians to counsel the entire family about a healthy lifestyle, with the possibility that prevention of excess and central adiposity not only may improve cardiovascular health, but also may lower the risk of development or severity of psoriasis. Finally, while there has been growing information about the genetics of psoriasis in the adult population, there is little known about the genetics of pediatric psoriasis and how it may impact cardiovascular risk factors; these studies should be initiated.

• Citation:• Paller AS, Mercy K, Kwasny MJ, et al. Association of Pediatric Psoriasis Severity With Excess and Central Adiposity: An

International Cross-Sectional Study. Arch Dermatol. 2012;():1-11. doi:10.1001/jamadermatol.2013.1078.

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Markers of circulating tumour cells in the peripheral blood of patients with melanoma correlate with disease recurrence and progression.DermatologistsBlog.com Author Interview: Dr. Mel ZIMAN PhD

Associate Professor, School of Medical SciencesEdith Cowan University (ECU) Adjunct Senior Lecturer,University of Western Australia (UWA)Perth, Western Australia

• DermatologistsBlog.com: What are the main findings of the study?• Dr. Ziman: Research conducted in Western Australia and Boston U.S.A. looked at the role of circulating melanoma

cells in the blood of patients who had already been diagnosed with the disease, to determine whether these cells relate to recurrence of the disease and treatment efficacy. The aim of the research was to identify those subgroups of patients who are more likely to suffer disease recurrence or poor treatment outcomes, in order to provide them with more targeted treatments at an earlier stage, which could improve survival rates. In a study published in the British Journal of Dermatology, the researchers discovered the markers that can be used to identify the tumour cells which make melanoma patients more likely to have their cancer spread or come back following treatment. The study was conducted using the blood of 230 patients with both primary melanoma (where it has not spread) and metastatic melanoma (spreading to other parts of the body), and compared with the blood of 152 healthy controls.

• A test for the different genes produced by tumour cells was developed to identify those patients more likely to have their cancer spread or come back following treatment. The researchers looked at five different markers of these tumour cells. These markers are all found in melanoma tumour cells, of which there are some different types.

• The presence and level of different genetic markers in the blood was shown to be useful in assessing a patient’s disease spread, response to treatment, and risk of relapse.

• DermatologistsBlog.com: Were any of the findings unexpected?• Dr. Ziman: Of the five markers we used, two were particularly helpful in determining disease progression and

recurrence. One of these ABCB5 is a melanoma stem cell marker. This has very important implications for melanoma patients as the development of a minimally invasive method of measuring the frequency of melanoma cells, and melanoma stem cells in particular, can be used to follow patient responses to current or novel and emerging melanoma therapies. In turn this will help determine if a particular therapy is capable of eliminating the aggressive cancer stem cell population required for the complete eradication of the cancer, potentially achieving a cure.

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Markers of circulating tumour cells in the peripheral blood of patients with melanoma correlate with disease recurrence and progression.DermatologistsBlog.com Author Interview: Dr. Mel ZIMAN PhD

Associate Professor, School of Medical SciencesEdith Cowan University (ECU) Adjunct Senior Lecturer,University of Western Australia (UWA)Perth, Western Australia (cont)

• DermatologistsBlog.com: What should clinicians and patients take away from this study?• Dr. Ziman: The researchers found that the presence of these markers of tumour cells in a person’s blood does not necessarily correlate with

disease spread or recurrence, as these markers can still be present even when a patient is considered clinically disease free. It is in fact the behaviour and characteristics (marker expression) of the circulating cells that is particularly important.

• The test can be used to assist clinicians to monitor patient progress after surgical removal of the tumour and during therapy.

• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?

• Dr. Ziman: Longitudinal studies are currently underway to substantiate our findings and to provide evidence of the efficacy of the blood markers of melanoma in identifying those patients that are likely to suffer disease recurrence. The researchers have also published a study in the Journal of Translational Medicine in which they show that circulating melanoma cells can be isolated from the blood of patients with early and late stage melanoma and that the number of cells correlated with disease progression. This is not surprising as disease burden is likely to increase with increase in disease stage. What is also required however is for researchers to determine the association between the characteristics of these cells and disease progression and recurrence. We are vigorously pursuing this research and aim to provide a genetic profile of the circulating cells for each patient that can be used to assist clinicians with the choice of therapy and then for monitoring response to therapy and resistance.

• Finally, while several studies are being undertaken to provide novel therapies for patients with melanoma, very few provide effective methods of monitoring patient progress. Current monitoring of melanoma patients relies on expensive and /or invasive monitoring techniques. A blood test that monitors patient progression and response to therapy would be relatively easy and inexpensive and could be utilized as a liquid biopsy. It is anticipated that development of such a test could be a priority within the next few years.

• Citation:• Markers of circulating tumour cells in the peripheral blood of patients with melanoma correlate with disease recurrence and progression.• Reid AL, Millward M, Pearce R, Lee M, Frank MH, Ireland A, Monshizadeh L, Rai T, Heenan P, Medic S, Kumarasinghe P, Ziman M.• School of Medical Sciences, Edith Cowan University, Perth, WA, Australia Department of Medicine School of Pathology and Laboratory

Medicine, University of Western Australia, Crawley, Australia Transplantation Research Center, Children’s Hospital Boston and Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, U.S.A. St John of God, Dermatology, Perth, WA, Australia.

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Occupational dermatitis in hairdressers: do they claim workers’ compensation?DermatologistsBlog.com Author Interview: Dr Georgina Lyons MBBS41 Victoria Parade, Fitzroy, Vic. 3065, Australia

• DermatologistsBlog.com: What are the main findings of the study?• Dr. Lyons: Our findings suggest that claim rates reported in workers’

compensation datasets under-represent the true incidence of diagnosedOCD among hairdressers in Victoria, Australia, three-fold.Hairdressers may accept dermatitis as ‘part of the job’, be reluctantto complete compensation paperwork, or be unaware of theircompensation entitlements. Fear of job loss may also act as areporting disincentive. The median time off work for hairdressersfiling a workers’ compensation claim for OCD (four working weeks) washigher than for other workers (three working weeks), suggesting agreater severity of OCD in the hairdressers than in other workers.

• DermatologistsBlog.com: Were any of the findings unexpected?• Dr. Lyons: Hairdressers in the 15–24-year age group were significantly

over-represented in the claims data relative to the diagnosed diseasedata (p < 0.01), which may suggest a greater burden of disease in thisyounger subgroup and a healthy worker effect in the hairdressingtrade.

• DermatologistsBlog.com: What should clinicians and patients take away from this study?• Dr. Lyons: Hairdressers presenting with dermatitis should be patch tested.• Increased efforts are needed to reduce the incidence of occupational

contact dermatitis in hairdressers, and to ensure that hairdresserswith occupational contact dermatitis are aware of their compensationentitlements. Reliance on workers’ compensation data for diseasesurveillance may lead occupational health and safety regulators tounderestimate the magnitude of the problem of occupational contactdermatitis in the hairdressing profession.

• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?• Ongoing research into strategies for preventing and treating

occupational contact dermatitis in hairdressers, and identifyingbarriers to claiming workers’ compensation, is indicated.

• Citation:• Contact Dermatitis. 2012 Sep 7. doi: 10.1111/j.1600-0536.2012.02152.x. [Epub ahead of print]• Occupational dermatitis in hairdressers: do they claim workers’ compensation?• Lyons G, Keegel T, Palmer A, Nixon R.• Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation, 3053 Melbourne Australia Monash Centre for Occupational and Environmental Health, Monash

University, 3181 Melbourne, Australia McCaughey Centre, Melbourne School of Population Health, The University of Melbourne, 3181 Melbourne, Australia.

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Lipid profile in psoriasis patientsDermatologistsBlog.com Author Interview: Dr. Ramesh Marne BhatHOD, Dermatology, FMMCFormer Hon Gen Sec,IADVL, National(2010-12) IADVL Karnataka President (2011)

Department of Dermatology, Fr Muller Medical CollegeKankanady, Mangalore, India

• DermatologistsBlog.com: What are the main findings of your study?• Dr. Bhat: We found that the S. Triglyceride ane S. Cholesterol levels and S. LDL levels were elevated in

psoriasis patients though the results were notsignificant when compared with those of age and sex matched normal individuals.

• DermatologistsBlog.com: Where any of your findings surprising?• Dr. Bhat: The findings though not unexpected brought to our notice the varying conclusions from

various similar studies with respect to the lipid profile levels in psoriasis patients.• DermatologistsBlog.com: What should patients and clinicians take away from your study?• Dr. Bhat: Clinicians should be aware and anticipate the lipid abnormalities and cardiovascular

complications associated with the disease and educate and advice their patients about the same.• DermatologistsBlog.com: What future research would you recommend as a result of your study?• Dr. Bhat: More studies on the lipid profile in Psoriasis patients with bigger sample size and further

studies on associated metabolic syndrome andcardiovascular complications occurring in Psoriasis patients.

• Citation:• Lipid profile in psoriasis patients• Psoriasis: Targets and Therapy Published Date November 2012

Volume 2012:2 Pages 77 – 80 DOI: http://dx.doi.org/10.2147/PTT.S32539

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Analysis of sentinel lymph node positivity in patients with thin primary melanomaDermatologistsBlog.com Author Interview: Dr. Mohammed Kashani-Sabet, M.D.

Center for Melanoma Research and Treatment, 2340 Clay St, Second Floor, San Francisco, CA 94115.

• DermatologistsBlog.com : What are the main findings of the study?• Dr. Kashani-Sabet: The study identified that a combinatorial index of clinical and histological factors could predict

a higher prevalence of sentinel lymph node positivity in patients with thin melanoma (<1 mm, or T1).• In addition, the study demonstrated a significant prognostic impact for sentinel node status in patients with thin

melanoma.• DermatologistsBlog.com :Were any of the findings unexpected?• Dr. Kashani-Sabet : An unexpected finding was that none of the T1b-defining factors (ulceration, mitotic rate, or

Clark level) significantly predicted a higher rate of sentinel node positivity.• Rather, there were other factors that were significantly predictive of a higher rate of sentinel node metastasis.• DermatologistsBlog.com : What should clinicians and patients take away from this study?• Dr. Kashani-Sabet : Subsets of patients with T1 melanoma can be identified with a prevalence of lymph node

metastasis traditionally described for intermediate- or even high-risk melanoma. These results may assist in the identification and counseling of patients to undergo this procedure.

• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?• Dr. Kashani-Sabet : The predictive impact of the combinatorial index identified here needs to be confirmed in

independent data sets of T1 melanoma patients.• Citation:• Analysis of sentinel lymph node positivity in patients with thin primary melanoma• Suraj S. Venna, Suresh Thummala, Mehdi Nosrati, Stanley P. Leong, James R. Miller, Richard W. Sagebiel,

Mohammed Kashani-SabetJournal of the American Academy of Dermatology – 21 November 2012 (10.1016/j.jaad.2012.08.045)

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Patients labeled with delusions of parasitosis compose a heterogenous group: A retrospective study from a referral centerDermatologistsBlog.com Author Interview: Jason S. Reichenberg, MD, FAADProgram Director, Department of Dermatology

University of Texas Southwestern-AustinUniversity Medical Center Brackenridge Austin, Texas, USA

• DermatologistsBlog.com: What are the main findings of the study?• Dr. Reichenberg: We found that many of the patients who had been referred to our practice with a diagnosis of “Delusions of Parasitosis” had been misdiagnosed.• Many of them had other psychiatric disorders, and some actually had curable medical conditions. The referring physicians may have misinterpreted their bizarre

behavior as “delusional” and referred them to our practice.• We also found that a focus on the chief complaints of the patients and the use of patient-administered questionnaires could be time-saving and helpful in making a

diagnosis.• DermatologistsBlog.com: Were any of the findings unexpected?• Dr. Reichenberg: For nineteen of the patients in the study, no medical diagnosis could be found to explain their symptoms, and most of them met criteria for

somatoform disorder.• One patient dubbed herself the “princess and the pea.” Despite some of them having delusional thoughts, we began to treat these “princess and the pea” patients

with antidepressants, which improved their symptoms and quality of life dramatically. We were surprised to find that antidepressants would be so helpful and so well accepted by the patients.

• We were also surprised with how often these patients required the physician to involve the hospital’s legal services.Though no formal lawsuits were filed (thank goodness!), these complicated situations required a large investment of physician time to resolve.

• DermatologistsBlog.com: What should clinicians and patients take away from this study?• Dr. Reichenberg: Clinicians should be careful to label their patient as “delusional” before a detailed history and physical is performed.

The patient’s behavior may be explained by other medical or psychiatric conditions that can be more easily treated.• Clinicians can be somewhat reassured that it is normal to require multiple visits to obtain this information, and utilizing standardized questionnaires can save time.• Patients should be very specific in discussing their concerns with their physician. If they don’t know what is wrong with their skin, they should say so, and avoid

analogies that may be misunderstood to be delusional thoughts.• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?• Dr. Reichenberg: We wonder if patient-administered questionnaire tools can be developed specifically for busy dermatologists to expedite the reaching of an

appropriate diagnosis for these patients.• Citation:• Patients labeled with delusions of parasitosis compose a heterogenous group: A retrospective study from a referral center.• Reichenberg JS, Magid M, Jesser CA, Hall CS.• Department of Dermatology, University of Texas Southwestern-Austin Program, Austin, Texas.

J Am Acad Dermatol. 2012 Oct 8. pii: S0190-9622(12)00853-5. doi: 10.1016/j.jaad.2012.08.006. [Epub ahead of print

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Experience with the dermatology inpatient hospital service for adults: mayo clinic, 2000–2010DermatologistsBlog.com: Author Interview: Eoin Storan MB, BCh, BAO

• DermatologistsBlog.com: What are the main findings of the study?• A: Inpatient dermatology services have disappeared in many parts of the United States. Several factors have contributed to this decline, including advances in outpatient

therapy but also commercial restraints from insurance companies. In this study, we describe the activity of one of the few remaining dermatology inpatient hospital services in the U.S over an 11-year period, from 2000 to 2010. We looked at patient demographics, median length of stay and the main indications for admission. We also compared data from the first 5 years to the second 5 years to evaluate for any trends.

• In total, there were 2216 admissions over the 11-year period. Of the patients admitted, only 38.8% were from the local state of Minnesota; with the remainder being referred from across the United States and a small number being internationally referred. This strikingly high number of patients admitted from outside the local state of Minnesota implies that there is a demand for inpatient dermatology care and that patients are willing to travel for it.

• The commonest indication for admission was dermatitis (44.2%) followed by psoriasis (17.4%) and cutaneous T-cell lymphoma (9.2%). When we compared admissions from 2000 to mid-2005 to admissions from mid-2005 through 2010, there was a statistically significant reduction in the number of admissions over the two study periods, from 1260 to 956, in keeping with national trends. The median duration of admission decreased from 4 days to 3 days, possibly reflecting advances in therapy but also the availability of a dermatology day hospital at our institution. Many patients with extensive skin disease are transitioned from the inpatient service to lower intensity therapy at the dermatology day hospital once they began to improve and no longer require continuous care. Other statistically significant changes included a decrease in the number of admissions for psoriasis, falling by over half from 261 to 124 (P<.01).

• DermatologistsBlog.com: Were any of the findings unexpected?• A: There was a significant decline in the number of admissions for patients with psoriasis, falling by over half over the two study periods.• In the past, psoriasis was by far the most common indication for admission to dermatology inpatient centers, with patients frequently requiring admission to dermatology units

for several weeks. This reduction in the number of admissions for psoriasis likely reflects the more widespread use of biologic therapies and also possibly the local availability of outpatient Goeckerman therapy at our institution.

• DermatologistsBlog.com: What should clinicians and patients take away from this study?• The dermatology inpatient hospital service is an essential part of our armamentarium in caring for patients with severe skin disease.• It provides care for patients with a wide range of dermatologic conditions from many parts of the United States and further afield.• Overall numbers of patients admitted have diminished over the past decade, with a marked reduction in admissions for psoriasis, and patients tend to have a shorter hospital

stay. Nevertheless, a need and a demand still exist for a dermatology inpatient hospital service that provides care for patients with severe dermatologic disease.• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?• Potential areas for future research include evaluating disease response to inpatient care and the impact of inpatient care on patient quality of life.• Citation:• Experience with the dermatology inpatient hospital service for adults: mayo clinic, 2000-2010.• Storan ER, McEvoy MT, Wetter DA, El-Azhary RA, Bridges AG, Camilleri MJ, Davis MD.

Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota Department of Dermatology, Mayo Clinic, Rochester, Minnesota.• J Eur Acad Dermatol Venereol. 2012 Oct 16.

doi: 10.1111/jdv.12010.[Epub ahead of print]

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Association of Psoriasis with Stroke and Myocardial Infarction DermatologistsBlog.com Author Interview: Yonghong ZhangFirst author: Tian Xu | Corresponding author: Yonghong Zhang

Department of Epidemiology, School of Public Health, Medical College of Soochow University,Suzhou, Jiangsu Province 215123, China

• DermatologistsBlog.com: What are the main findings of the study?• We evaluate the association of psoriasis with stroke and myocardial infarction (MI) by conducting a meta-analysis of cohort studies.• Cohort studies were searched in MEDLINE (Pubmed) , EMBASE and Cochrane Library from their inception to March 2012.• Stroke and MI were considered as a composite endpoint. A random-effects model was used to calculate the overall combined risk estimates .• Seven cohort studies were included in the meta-analysis. The overall combined relative risk (95% confidence interval) for psoriasis and composite vascular endpoint was 1.2 (1.1, 1.31).• Subgroup analysis indicates that psoriasis significantly increases the risk of stroke (relative risk: 1.21 (95% confidence interval: 1.04 to 1.4)) and MI (relative risk: 1.22 (95% confidence interval: 1.05

to 1.42)) respectively. The Begg rank correlation test and Egger linear regression test indicated no evidence of publication bias among studies (Begg, p=0.466; Egger, p=0.155). The pooled analysis incorporating 3 hypothetical ones continued to show a statistically significant association (relative risk: 1.15 (95% confidence interval: 1.05-1.26)).

• DermatologistsBlog.com:Were any of the findings unexpected?• Psoriasis is a common chronic, immune-mediated disease that affects about 2% to 3% of the adult population, including 125 million persons worldwide. Psoriasis was previously believed to affect

only the skin, and in some patients, the joints.• However, recent evidence suggests that chronic psoriasis may lead to other diseases in which inflammation is important. Our meta-analysis also proved that psoriasis significantly increases the

risk of stroke and MI. Both these two vascular events share a common pathogenesis involving disrupted atherosclerotic plaque and intravascular thrombosis, which were closely related to inflammatory reaction.

• DermatologistsBlog.com: What should clinicians and patients take away from this study?• Our findings have important clinical implications. Psoriasis, which is not only a chronic inflammatory skin disease, is also likely to be an independent risk factor for cardiovascular and

cerebrovascular diseases.• Clinicians are advised to alert patients with psoriasis, particularly if their disease is severe, to have assessment and treatment of their cardiovascular and cerebrovascular risk factors as

recommended by current guidelines.

• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?• Our meta-analysis of cohort studies suggests that psoriasis significantly increases the risks of vascular events including stroke and MI.• This increase is probably independent of conventional cardiovascular risk factors. Further studies, including well-designed clinical trials, are warranted for a better understanding of the association

and to provide convincing evidence for clinical practice in stroke ⁄MI prevention.

• Citations• 1. Psoriasis statistics. National Psoriasis Foundation Web site. www.psoriasis.org/about/stats. June 16, 2008. • 2. Xu T, Zhang YH. Association of psoriasis with stroke and myocardial infarction: meta-analysis of cohort studies. Br J Dermatol 2012.• Funding sources This study was supported by the National Natural Science Foundation of China (Grant No. 30972531) and a Project of the Priority Academic Program Development of Jiangsu

Higher Education Institutions.• Conflicts of interest None declared.• Citation:• Xu, T. and Zhang, Y.-H. (2012), Association of psoriasis with stroke and myocardial infarction: meta-analysis of cohort studies. British Journal of Dermatology, 167: 1345–1350.

doi: 10.1111/bjd.12002

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Desmoplastic Malignant Melanoma: A Study of Ten Cases and Status of BRAF MutationDermatologistsBlog.com Author Interview: Pr Michel D’INCAN, MD, PhDDermatology CHU- Hôpital Estaing

1, place Lucie et Raymond AubracF-63003 Clermont-Ferrand cedex 01 France

• DermatologistsBlog.com: What are the main findings of the study?• Desmoplastic melanoma is a rare variant of spindle cell melanoma with a poor prognosis.• Delay to diagnosis is often long and misdiagnoses frequent. In this paper, we present characteristics and outcome of patients with

this melanoma subtype in a retrospective and single center series of 10 patients. V600E mutation of BRAF gene is a biomarker commonly checked in melanoma patients because it offers the possibility to treat them with vemurafenib, a new promising drug. Only one previously published study showed that this mutation is absent in desmoplastic melanoma. In our series, one patient harboured this mutation

• DermatologistsBlog.com: Were any of the findings unexpected?• Our data suggest that desmoplastic melanoma is a molecularly distinct form of melanoma in which mutation of the BRAF pathway

does not play a predominant role• DermatologistsBlog.com: What should clinicians and patients take away from this study?• First, our study showed that delay to diagnoses observed in desmoplastic melanoma may be due to atypical presentation of the

tumor (frequently non pigmented tumors, 80% of our cases) and pitfalls in pathological diagnosis are frequent : histological features may be confusing with sarcoma or other myxoid tumors that do not express HMB-45 like.

• Secondly, in spite of the low ratio of BRAF mutations in desmoplastic melanomas, it is worthy to check for V600 mutation in these patients because a small ratio of them could take benefit from vemurafenib use.

• DermatologistsBlog.com: What recommendations do you have for future research as a result of your study?• Our data, together with those published elsewhere, should encourage further research on genomic profile of this melanoma

variant.• Citation:• Desmoplastic Malignant Melanoma: A Study of Ten Cases and Status of BRAF Mutation.

Coupelon S, Franck F, Jarrousse AS, Déchelotte P, Souteyrand P, D’Incan M.Department of Dermatology, Université d’Auvergne, CHU, Clermont-Ferrand, France.Dermatology. 2012 Oct 24. [Epub ahead of print]

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