Recent Developments
More Than Skin Deep?
New research suggests that the development of
eczema goes deeper than epidermal barrier function.
Data indicate that a second skin barrier structure
consisting of cell-to-cell connections known as
tight junctions likely plays a role in the development
of eczema (Journal of Allergy and Clinical
Immunology). Researchers studied skin samples
from eczema patients and healthy individuals using
resistance and permeability tests. They discovered
that tight junctions, which act like a gate controlling
the passage of water and particles, were strong
and tight in healthy skin samples, but loose and
porous in the skin of eczema patients. On further
investigation, they found that a particular tight
junction protein, claudin-1, which determines the
strength and permeability of tight junctions in skin,
is significantly reduced in the skin of eczema
patients, but not in healthy individuals or individuals
with psoriasis. The researchers plan to investigate
the immunologic consequences of tight junction
disruption in the skin and whether there is a
relationship between barrier disruption and
patients' intractable itch.
Lice Treatment in the Pipeline
Current treatments for head lice tend to be limited,
but an investigational agent may soon be available to
treat dry hair and scalp in young and old patients.
Topaz announced the completion of two Phase 3
clinical trials studying the use of ivermectin topical
cream whose mechanism of action is through selectively
binding to certain ion channels present in the
invertebrate nerve and muscle cells. The studies
compared 0.5% ivermectin cream with vehicle in
patients six months of age and older. The primary
efficacy endpoint was achieving “lice free” status
within approximately 24 hours of application and
maintaining this status for at least 14 days after
application. Topaz plans to submit its NDA to the
FDA in 2011.
Heads Up
New data suggest that the two-compound scalp treatment
calcipotriol and betamethasone (Taclonex Scalp, Leo) has a rapid onset of action and yields significant
efficacy after just one week (Journal of the
European Academy of Dermatology & Venereology
25:1). Researchers analyzed pooled data from two
large pivotal phase 3 trials with 2,920 patients
receiving once-daily treatment for up to eight weeks
with either the two-compound scalp formulation,
betamethasone dipropionate, calcipotriol, or vehicle.
Findings show that 30.6 percent of patients who
were treated with the two-compound formulation
had absent or very mild disease after one week of
treatment, compared to 24.1 percent of those treated
with betamethasone, and 10 percent of those treated
with calcipotriol.
Supreme Court May Hear Case on
Side Effects of Generic Drugs
In the coming year, the US Supreme Court is expected
to decide whether generic drug companies could be
sued under state law over allegations that they failed
to provide adequate label warnings about side effects.
Controversy exists on the issue because the drugs in
questions have been approved the FDA and thus may
be subject to federal law. The Supreme Court decided
a related case involving the Wyeth anti-nausea drug
Phenergan in 2009, when it ruled that FDA regulations
do not protect pharmaceutical companies from
being sued under state law over drug labeling. The Court is expected to hear arguments in the generic
drug cases in March or April, with a decision likely
by the end of June, Reuters reports.
Botox May Improve QOL and Self Esteem
Patients who receive botulinum injections may
experience improved quality of life (QOL) and selfesteem,
according to a new study (Dermatologic
Surgery, November 2010). Researchers evaluated
100 patients who received treatment with botulinum
toxin A (BoNTA) or placebo saline. The
patients then completed a health outcomes survey
consisting of Quality of Life Enjoyment and
Satisfaction Questionnaire–Short Form and
Heatheron and Polivy State Self Esteem measurements
before injection and two weeks and three
months after injection. Statistically significant
improvements were observed in patients treated
with BoNTA in answers to QOL questions regarding
physical health, mood, household activities,
overall life satisfaction, body satisfaction, self-consciousness,
intellect, self-worth appearance, comprehension,
weight satisfaction, attractiveness, and
sense of well-being.
Systemic Psoriasis Therapies May be Under-used
A recent online survey of patients with moderate to
severe psoriasis reveals systemic therapies may be
underutilized, given the high rates of dissatisfaction
with topical therapies (International Journal of
Dermatology 49: 12). Patient awareness of available
treatment options ranged from 98 percent for prescription
topical agents to 75 percent for photo/light
therapy, and was less than 50 percent for prescription
oral (49 percent) and injectable (35 percent)
medications. Of the 514 patients surveyed, 92 percent
had been treated with and 61 percent were
currently taking prescription topical agents.
Photo/light therapy had been used by 38 percent
and was currently used by seven percent of respondents.
Prescribed oral medication had been taken
by 25 percent and was currently used by eight percent.
Few patients had been treated with injectables
in the past (10 percent) or currently (five percent).
Overall, 24 percent of respondents were very satisfied
with their current treatment. A total of 63 percents
of respondents taking injectables were very
satisfied, compared with 38 percent of those taking
prescribed oral medication and 21 percent of those
receiving photo/light therapy. The researchers indicated
that treatment satisfaction rates were overall
low, highlighting the need to ensure greater patient
education on and use of available therapeutic
options.
New Acne Findings in Women with PCOS
High serum dehydroepiandrosterone sulfate
(DHEAS) is associated with acne and a reduced
risk of abdominal obesity in women with polycystic
ovary syndrome (PCOS), new research suggests
(Human Reproduction, November 2010).
Researchers evaluated 318 consecutive untreated
Taiwanese women with PCOS, recording phenotypic
hyperandrogenism, BMI, waist circumference,
wait-to-hip ratios, lipid profiles, fasting glucose and
insulin levels, and hormone profiles. Women with
acne were younger, had higher serum DHEAS levels
and a lower BMI, but comparable serum testosterone
levels, compared with women without acne.
The aggravating effect of elevated DHEAS on the
risk of acne still exited after adjustment for age
and BMI. The DHEAS level was positively correlated
with the testosterone level, but inversely related
to waist circumference, wait-to-hip ratio, BMI, IR
index, low-density lipoprotein-cholesterol and
triglycerides.
Take a Supplement
Maintaining adequate levels of vitamin D while practicing photoprotection
to protect from skin cancer has developed into an
ongoing debate among various medical disciplines. A new review
suggests that while this is a valid concern, assessing vitamin D
status and administering vitamin D supplementation when needed
can mitigate it (Seminars in Cutaneous Medicine and Surgery
29: 3). The authors report that patients who took vitamin D oral
supplementation had greater serum 25(OH)D levels than those
who did not, whereas dietary intake through foods did not predict
25(OH)D levels. Nonetheless, there was still a high prevalence
of vitamin D insufficiency and deficiency in the patient
population, highlighting the importance of assessing vitamin D
status and recommending oral vitamin D supplementation when
indicated.
To Your Health?
Even moderate intake of non-light beer appears to increase a
woman's risk for psoriasis, data show (Arch Dermatol
146(12):1364-1369). Based on analysis of data from the Nurses'
Health Study II, which followed a cohort of 116,671 US women,
the multivariate relative risk of incident psoriasis among women
who have 2.3 drinks or more per week is 1.72 compared to nondrinkers.
Although consumption of five or more non-light beers
is associated with increased psoriasis risk, consumption of light
beer, red wine, white wine, and liquor is not significantly associated
with psoriasis risk.
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