Tanning Tax Debate Emerging

A panel of 25 Congressional Representatives has proposed legislation (H.R. 2092) to repeal the tanning tax. The legislators say the tax is a burden on small business owners and hurts the economy. At the least, opponents of repeals say, elimination of the tax could risk public health. If repeal rekindles interest in a cosmetic surgery tax, it could spell problems for dermatologists confronted with a slow economic recovery. The American Academy of Dermatology Association (AADA) and the Dermatology Nurses' Association (DNA) are among groups publicly opposed to repeal.

In addition to voicing opposition to H.R. 2092, DNA also recently launched its newly redesigned website: dnanurse.org. New features include a Community tab, where members can submit and respond to blog posts, post documents, pose questions and polls to colleagues and create groups for networking purposes. Also new is a Career Center.

Prescription Assistance Programs Underway

Prescription drug assistance programs are now available to reduce health insurance co-payments for six primary dermatological brands from PharmaDerm. Under the programs, patients will pay $10-30 out-ofpocket for Adoxa 150mg (doxycycline capsules), Apexicon E (diflorasone diacetate USP 0.05% emollient) Cream, Cutivate (fluticasone propionate) Lotion 0.05%, Oxistat (oxiconazole nitrate) Cream 1% and Lotion 1%, Solaraze (diclofenac sodium) Gel 3%, and Veregen (sinecatechins) Ointment 15%. The programs reduce the patient's out-of-pocket costs through the use of Instant Savings Cards that can be obtained directly from a doctor's office. Patients present the card to their pharmacists.

Leukemia Drug May Be Beneficial for Some Melanomas

Imatinib (Gleevec, Novartis), an agent indicated for the treatment of leukemia, demonstrated significant activity in patients with metastatic melanoma harboring genetic c-Kit aberrations in a recent study (Journal of Clinical Oncology; 29(21): 2904-9). The phase II trial enrolled 43 patients with metastatic melanoma harboring c-Kit aberrations, each who received continuous dose of imatinib 400mg daily. Fifteen patients who experienced progression of disease escalated to 800mg/day. Results indicated that the rate of total disease control was 53.5 percent, with 23.3 percent and 30.2 percent achieving PR and SD, respectively. Median PFS and OS times for patients who had PR or SD versus disease progression were nine months versus 1.5 months and 15 months versus nine months. In addition, imatinib 400mg/d was well tolerated. Only one of 15 patients who received dose escalation to 800mg/d achieved SD.

Ipilimumab Approved in Europe

The European Commission approved ipilimumab (Yervoy, Bristol Myers Squibb) for the treatment of adult patients with previously-treated advanced melanoma. Yervoy showed long-term survival in the treatment of patients with advanced melanoma in a randomized, double-blind Phase III study published in the New England Journal of Medicine in June 2010 (see p. 37 for more information).

Data Support Hydroquinone Combination

New data presented at the World Congress of Dermatology suggests that hydroquinone 4% plus tretinoin 0.025% (NuDerm, Obagi) effectively decreases the severity of melasma, particularly in skin of color. Statistically significant benefits were seen in brown spots or discoloration, as well as in skin texture and fine lines and wrinkles. In addition, patients reported that the reduction in pigment discoloration actually decreased their self-consciousness by 60 percent and their feelings of overall unattractiveness by 45 percent. Moreover, 90 percent of patients reported that the combination treatment was more effective or much more effective than other medications they had used before.

Results from a new clinical 12-week study also presented at the World Congress of Dermatology evaluating prescription strength the Hydroquinone/LAscorbic Acid Treatment System (Obagi-C Rx, Obagi) for normal to oily skin found that the system provided improvement in overall facial appearance as well as increased patient satisfaction. The 34 participants in the study had a mean age of 32 years and exhibited minimal to mild photodamage. Of the 30 patients who completed the study, 100 percent of patients reported that the system was good, very good, or excellent compared with other skin treatments they had used before. In addition, statistically significant benefits were seen in hyperpigmentation and skin laxity as well as improved skin texture and fine lines and wrinkles. All of the patients were either satisfied or sery satisfied with their overall facial appearance.

Neurotrophins May Affect Development of Urticaria

New research appearing in Clinical & Experimental Allergy suggests that neurotrophins may play role in the pathophysiology of chronic spontaneous urticaria. For the study, researchers performed autologous serum skin tests in 50 adult patients with chronic spontaneous urticaria. They also analyzed BDNF serum levels by enzyme immunoassay in the 50 urticaria patients and 23 subjects with healthy skin. Additionally, they took skin biopsies from weals of eight of the patients with chronic spontaneous urticaria as well as from healthy skin of eight of the controls to evaluate the expression of BDNF and its receptors including tyrosine kinase (trk) B and panneurotrophin receptor p75NTR. For inclusion, chronic spontaneous urticaria was defined as recurrent weals for more than six weeks.

While BDNF serum levels were detectable in all subjects, these levels were significantly higher in patients with chronic spontaneous urticaria compared to non-atopic skin-healthy controls. Epidermal and dermal expression of BDNF and epidermal expression of p75NTR was significantly higher in patients with chronic spontaneous urticaria compared with controls. There was no difference with regard to the expression of trkB between the two groups. BDNF serum levels were not different between autologous serum skin test-positive and negative patients with chronic spontaneous urticaria.