Recent Developments

Evaluating Photography Techniques for Nevi Monitoring
A new comparative analysis found that total body (TB) photography may be a more effective method for monitoring high-risk patients than digital epiluminescence microscopy (DELM) (Dermatology Surgery). Researchers used TB photography on 1,076 patients, who were then monitored with photographs. The investigators noted that risk factors and median monitoring periods for these patients were comparable with those of patients previously monitored using DELM . In total, 275 biopsies were performed in 467 patients on follow-up visits. Of 12 melanomas detected on follow-up, five were invasive, five presented as changing lesions and two as new lesions, nine arose de novo, and the remainder were nevus derived. The researchers concluded that using TB photography to monitor at-risk patients was associated with lower biopsy rates and lower nevus-to-melanoma ratios than using DELM.

Nutrition/Psoriasis Link Explored
A new review suggests that nutritional supplementation may provide a viable treatment adjunct for patients with psoriasis (Clinics in Dermatology. 2010. 28; 6: 615-626). The article analyzed various trials and found that dual therapies of UVB and fish oil, retinoids and thiazolidinediones, and cyclosporine and a low-calorie diet were all effective treatments for patients with psoriasis. The article also reviewed the potential negative effect of alcohol and the potential positive affects of vitamin B12 selenium, retinoic acid metabolism-blocking agents, and a gluten-free diet on the skin disease.

Health Database Found to be a Valid Resource for Studying Psoriasis
A new study suggests that The Health Improvement Network (THIN) is a valid data resource for studying psoriasis (British Journal of Dermatology). Researchers conducted a cross-sectional study to determine if psoriasis prevalence in THIN is similar to expected. In addition, they created a cohort of 4,900 patients with a psoriasis diagnostic Read Code, and then surveyed GPs to confirm the diagnosis clinically. Psoriasis prevalence was 1.9 percent and showed the characteristic age distribution expected. In addition, questionnaires indicated that psoriasis diagnoses were confirmed in 90 percent of patients. Duration of disease in the database showed substantial agreement with physician query. GPs confirmed that the diagnosis was corroborated by a dermatologist in 91 percent of patients whose database records contained a dermatology referral code associated with a psoriasis code.

A New Combination For Vitiligo?
A new study suggests that topical tacrolimus, when combined with enothothelin may, may increase efficacy when used to treat vitiligo (British Journal of Dermatology). Investigating the mechanisms involved in follicular pigmentations induced by topical tacrolimus, researchers evaluated the maturation parameters of melanoblasts derived from neural crest cells in mice. Results showed that topical tacrolimus stimulated the expressions of protein kinase A, protein kinase C, and phosphorylaetd p38 mitogen-activated protein kinase. However, cell mobility, a parameter associated with melanoblast differentiation, was not enhanced by topical tacrolimus, nor was it by Endotheline-3. Combining ET-3 and topical tacrolimus stimulated cell mobility, leading researchers to conclude that a combination of the two may yield effective vitiligo treatment.

PAs Assisting Mohs Surgeons
Physicians are employing physician assistants to support Mohs micrographic surgery, a new survey suggests (Dermatologic Surgery. October 20, 2010). Researchers sent surveys to 576 fellows of the American College of Mohs Surgery in January 2009. Of the 143 who responded, 30.1 percent reported currently employing one or more PAs. Of that group, 34.9 percent reported that PAs in their practice perform preoperative consults, 58.1 percent reported that PAs perform postoperative follow-up, 41.9 percent reported that PAs were participating in some aspect of repairs, and 81.4 percent reported that PAs were seeing general dermatology patients, allowing the surgeon to concentrate on cancer patients.

Severe Acne Shown to Increase Risk of Suicide
A new study has concluded that suicidal behavior in individuals with severe acne is linked to the disease rather than treatment with isotretinoin (British Medical Journal. November 11, 2010). Investigators analyzed data from 5,756 individuals aged 15 to 49 who were prescribed isotretinoin for severe acne between 1980 and 1989. These data were then linked to data from hospital discharge and cause-ofdeath registers from 1980 to 2001. A total of 128 patients were admitted to the hospital for attempted suicide. The standardized incidence ratio was observed to be the number of suicides divided by the expected number of suicide attempts calculated up to three years before, during, and up to 15 years after the end of treatment.

During the year before treatment, the standardized incidence ratio for attempted suicide increased by 1.57 for all suicide attempted and 1.36 for first attempts only. The standardized incidence ratio during and up to six months after treatment was 1.78 for all attempts and 1.93 for first attempts. Three years after treatment stopped, the observed number of attempts was close to the expected number and remained so during 15 years of follow-up, with a standardized incidence ratio of 1.04 for all attempts and 0.97 for first attempts. The authors speculated that the risk of attempted suicide being highest within six month of treatment may be because patients whose acne and physical appearance improved after treatment were distraught if there was no improvement in their social life.