Recent Developments

SYSTEM CHECK

Systemic glucocorticoid therapy may pose only minimal risks of adrenal insufficiency in the treatment of infantile hemangiomas, according to new research (Arch Dermatol 145: 262-266). Researchers studied 16 infants who received prompt adrenal axis evaluation after finishing glucocorticoid therapy, with a mean duration of treatment of 7.2 months. They found that only one of 16 infants had adrenal insufficiency following completion of therapy. Furthermore, this infant had resolution of his adrenal suppression when retested three months later. This evidence suggests that persistent adrenal suppression following steroid therapy does not appear to raise the risk of adrenal insufficiency and should not dissuade physicians from their use.

IT'S IN THE GENES
New research may have uncovered a new link between melanoma and genetics. According to a recent report (Cancer Cell), up to 70 percent of melanoma skin cancers may be triggered by a gene mutation that causes cells to become cancerous after excessive exposure to UV radiation. Scientists already knew the BRAD gene was frequently damaged in melanoma patients, but it was unclear if this was a cause or effect of the cancer. According to researchers, the discovery that genetic damage of BRAF is the first step in skin cancer development could eventually lead to better treatments for the disease.

BITING BACK
Dermatologists may be confronting more and more cases of a once-rare condition: bed bug bites. Responding to rising interest in and concern about bed-bugs, the Environmental Protection Agency hosted its first-ever summit on bed-bugs in April. According to ABC News, the two-day conference drew nearly 300 participants, who will provide the EPA with advice and recommendations for responding to the increasing reports of bed-bug bites in densely populated areas. Over the last 50 years, the EPA has pulled from the market various chemicals commonly used to treat mattresses and prevent bed-bugs out of concern for effects on the environment. But the summit may signal future action with regards to pesticides that may ward off the insects.

DOUBLE DUTY
For patients with chronic plaque psoriasis, pioglitazone (Actos) in combination with acitretin may offer a safe and effective alternative to currently available immunosuppressive agents (Arch Dermatol 145(4):387-93). Investigators randomly assigned 41 patients to receive either a daily 25mg dose of acitretin plus a daily 15mg dose of pioglitazone or a 25mg dose of acitretin plus a daily matching placebo. Results showed a clinical improvement in both groups. However, 42 percent of patients in the acitretin and pioglitazone group acheived PASI 75 at 12 weeks, compared with 23 percent of patients in the acitretin and placebo group. At week eight, two pioglitazone-treated patients (11 percent) had achieved PASI 75 compared with one patient (four percent) in the placebo group. Lesions were cleared or almost cleared in 37 percent of acitretin plus pioglitazone-treated patients and nine percent of acitretin plus placebo-treated patients. Finally, adverse events were seen in 15 patients in each group, with the majority reported as mild to moderate, including increased erythema, dry skin, dry mouth, thirst, and cheilitis, and one possibly unrelated episode of acute myocardial infarction in a woman in the acitretin plus placebo group after just five days of therapy.

DON'T SWEAT THE DERMATITIS
A novel aluminum chloride hexahydrate 15% (AC) gel containing salicylic acid (Hydrosal, Valeo) may be a suitable treatment option for patients recovering from irritant contact dermatitis from other topical formulations for hyperhidrosis (HH). In a presentation at the AAD Annual Meeting in San Francisco in March, Heather Woolery-Lloyd, MD described two cases in which patients with ICD to other HH therapies successfully used Hydrosal. The first patient had had a severe irritation of the axillae due to a 20% AC solution. After two months of therapy with aclometasone diproprionate alone, she switched to Hydrosal and reported good tolerability. A second patient with sub-optimal response to bolutilum toxin injections for palmar HH developed severe irritation from the regular use of 20% AC solution. At one week of therapy the patient reported improvement in HH, and at three months all symptoms of irritation had resolved. Hydrosal is now exclusively ditributed by Del-Ray Dermatologicals in the US.

PATH TO KNOWLEDGE
The College of American Pathologists has introduced an enhanced version of its educational program for dermatopathology. The program allows physicians to assess and improve their dermatopathology diagnostic skills with 10 clinically significant cases and allows participants to earn five CME credits, according to the College. It will also offer online whole slide imaging technology, simulating the use of a microscope and allowing the physician to scan through the field and change magnification. The program will be available in June.

• The American Acne & Rosacea Society in conjunction with the first annual national Acne Awareness Month will be providing a CME webinar opportunity for dermatologists in June. Through the webinars, dermatologists can discuss the safety and efficacy of various acne treatments, review the latests data on available therapies, and keep up-to-date on the latest guidelines on the management of acne.

WALKING FOR AWARENESS
The National Psoriasis Foundation is encouraging dermatologists and their staff to participate in the "Walk with Your Doc" program, a nationwide program designed to generate awareness about psoriasis and psoriatic arthritis. Physicians can form or join a team at one of 15 National Psoriasis Walk For Awareness events across the nation.

To learn more or to register for a walk near you, visit www.psoriasis.org/walk or call 800-723-9166.

UPCOMING EVENTS

• The American Society for Laser Medicine and Surgery (ASLMS) annual meeting will be held April 3 - 5, 2009 at National Harbor, MD. www.eshow2000.com/aslms/2009/
• International Society of Hair Restoration Surgery (ISHRS), will hold its 17th Annual Scientific Meeting July 22-26, 2009 in Amsterdam, The Netherlands. www.ishrs.org
• The Five Continent Congress on Lasers and Aesthetic Medicine will be held September 10-12, 2009 in Nice, France. www.5continent-congress.com