Recent Developments

Selling Psoriasis Online

Psoriasis patients may be particularly likely to acquire prescription medications via the Internet, according to a new study (J Euro Acad Dermatol Vener). French researchers investigated a variety of websites that are purported to offer psoriasis medications in order to evaluate whether psoriatic outpatients can buy the full range of psoriasis medications, including biological therapies, without a prescription, via the Internet. The website search was limited to a four-hour period, and all products had to be available for delivery in France, without a prescription, and be suitable for outpatient use. Using key words such as "psoriasis," "shopping," and "pharmacy" in major search engines such as Google and Yahoo, investigators identified 47 websites offering a total of 340 products, including some biologics. All treatments were available for purchase, with the exception of calcitriol and alefacept, with median prices being higher than the French price.

AK Cream Shows Promise
New data for a lower-concentration imiquimod product from Graceway (currently under FDA review) show that it is effective for treating AKs within a novel treatment paradigm. Results from the Phase III study demonstrated imiquimod 3.75%, administered daily during two two-week treatment cycles separated by a two-week non-treatment period, produced clearance rates for actinic keratosis superior to placebo.

According to Neil Swanson, MD, lead investigator of the study, dosing patterns with the currently available imiquimod 5% vary widely from prescriber to prescriber. One popular approach—applying imiquimod twice a week for eight weeks—can be a compliance challenge. The recently reported two-week courses are, "Easier for patients to rememberÉand easier for patients to comply with," he says. While many patients developed anticipated reactions to imiquimod therapy during the trial, such as erythema and inflammation, the degree of scaling, ulceration, and edema seemed to be decreased with the new formulation, Dr. Swanson notes. "In general it seemed to be tolerated by patients pretty well."

The new cream formulation may be especially well-suited for treatment of larger surface areas, Dr. Swanson says, to target multiple AKs and potentially treat pre-clinical lesions.

Natural Learning Initiative
A new online resource is available offering physicians detailed information on the science of natural ingredients in skincare. Launched and sponsored by Johnson & Johnson, the Active Naturals Institute (activenaturalinstitute.com gives physicians access to a "Library" that provides an indexed scientific review of new and existing natural ingredients and their applications in Dermatology, a "Laboratory" that explores the processes of their screening, validation and development, and an "Auditorium" with slide and video presentations.

New in Print
A new book for patients explores the social, psychological, cultural, environmental, and genetic components that affect the skin and how we understand it. Written by Robert Norman, DO, 100 Questions & Answers About Aging Skin answers questions about the best anti-aging products available, new advancements in the dermatology industry, and how to improve general skin health.

Another new book is now available free to dermatologists and residents. The Financial Fund of Knowledge and the white paper "Physician's Guide to Purchasing Disability Insurance" were written by Michael Reiman, a financial planner with Reiman Financial, which helps physicians and soon-to be medical school graduates with comprehensive financial planning, insurance needs, investment advice, and more. To obtain a free copy, email complete contact information to reiman@attentiongroup.com or visit www.reimanfinancial.com.

Nano-Technology Shows Promise
Speculation has grown in recent years about the role that nanotechnology may play in various dermatologic therapies, and the promise of the technology is becoming more clear as more data are revealed. At the Academy '09 meeting in Boston, two posters were presented on nanoemulsions used for the treatment of microbial skin infections, particularly acne vulgaris. NB-003 (NanoBio) is an antimicrobial oil-in-water emulsion with an average droplet diameter of ~200 nm and a composition that allows for selective penetration into the pilosebaceous unit, the site of acne pathogenesis. The technology is designed to preferentially target bacteria. In one study (P 106) NB-003 had relevant microbiological and bactericidal activity against a collection of recent clinical isolates of P. acnes, including multidrug-resistant strains. The other study (P 109) examined NB-003 in formulations containing benzoyl peroxide, finding that nanoemulsions with BPO have inherent anti-acne properties. These data suggest that nanoemulsions may soon play a greater role in acne therapy, researchers report.

Skin Cancer Patterns Emerging
Patients who have both basal cell carcinomas (BCC) and squamous cell carcinomas (SCC) may be at a lower risk of further BCC than patients with BCC exclusively (J Am Acad Dermatol 2009; 61:247-51). Researchers compared 1,040 patients who developed BCC alone with 140 who developed BCC and SCC. The annual rate of further BCC development was significantly higher in the BCC-only patients than it was in those with BCC/SCC. However, because the mean follow-up was 4.4 years in the BCC group and 7.5 years in the BCC/SCC group, researchers refined the results by examining rates over a five-year period in a subgroup of 174 BCC and 71 BCC/SCC patients. At the end of this follow-up period, 51.1 percent of the BCC-only and 74.6 percent of the BCC/SCC groups were free from a subsequent BCC. Further analysis, corrected for age at initial presentation, confirmed that patients with BCC/SCC were significantly less likely to develop additional BCC.

Update: Gardasil Safety
An analysis of adverse events reported following distribution of quadrivalent human papillomavirus recombinant vaccine (Gardasil, Merck) since 2006 indicates that adverse event rates were mostly consistent with pre-licensing data and expected background rates of other vaccines (JAMA, Aug 19). Last month's issue (vol. 6, no. 8, pp. 57-59) discussed the HPV vaccine, noting that some critics suspected higher than expected rates of adverse events. The current publication did find a slightly higher proportion of reports of fainting and blood clots, researchers report.

Botulinum Makeover
Following previous action to update safety information on botulinum toxin products in April—new boxed warnings caution that the effects of the botulinum toxin may spread from the area of injection to other areas of the body, causing symptoms similar to those of botulism—FDA last month announced changes to the established names of the respective drugs. The new established names are:

Botox (Allergan): onabotulinumtoxin A
Dysport (Medicis): abobotulinumtoxin A
Myobloc (Solstice): rimabotulinum toxin B

Cosmetic Dermatology Forum Announced
Dermatologists can get updates on the latest cosmetic interventions, practice management advice, and tips for successful patient management at the Cosmetic Surgery Forum 2009, a CME-accredited educational program jointly sponsored by Practical Dermatology, the Dulaney Foundation, and Cosmetic Surgery Forum, LLC. The program, Chaired by Joel Schlessinger, MD, will be held December 4 to 6 at the Palazzo Hotel in Las Vegas and is intended for dermatologists, cosmetic surgeons, and students in these fields.

For more information and to register, log on to cosmeticsurgeryforum.com. Discounted early registration ends October 31.