Tattoo Removal by Non-Physicians Poses Dangers
A new literature review examining the potential
risks and pitfalls of laser tattoo removal when performed
by non-physicians has identified four major
areas of risk (Journal of the European Academy of
Dermatology 24(7): 756-762). They are rare but
potentially severe allergic or toxic effects of
decomposition products of the tattoo pigments;
bodily harm caused by out-of-specification usage of
the laser devices; malignant disease that is
obscured within the area of a tattoo and requires
meticulous dermatological diagnosis; and insufficient
pre-operative consultation of patients about
the risks, side effects, and realistic expectations on
the therapeutic outcome. Thus, the researchers
conclude that laser tattoo removal by non-medical
professionals is unacceptable from the standpoint
of patient safety and suggest that lawsshould be in
place to ban the practice.
Data Support Tretinoin for Pre-Adolescent Acne
Topical tretinoin 0.04% microsphere gel (TMG)
pump appears to be safe and effective for pre-adolescent
acne, according to a study in Pediatrics
(125(6):e1316-23). The open-label study involved 40
patients eight to 12 years of age (with a mean age
of 10.7 years) with mild/moderate acne, defined by
the Evaluator's Global Severity Score (EGSS) values
between 2 and 3. The patients were given 0.04%
TMG for 12 weeks and were evaluated at baseline
and weeks 3, 6, and 12.
By week 12, mean EGSS value had decreased significantly from baseline (2.6 vs 2.1; P < .001). At week 12, 75 percent of cases were graded as almost clear or mild. The mean Alternative Evaluator's Global Severity Score value declined from 3.1 to 2.4 during the 12-week period (P < .001). The mean Investigator's Global Evaluation score was 3.39 at week 12, demonstrating moderate improvement of acne. Treatment was generally well tolerated.
Etanercept Safe for Pediatric Psoriasis
Etanercept provides “significant, sustained
improvement in disease severity and is well tolerated tolerated
in children eight years and younger with
severe plaque psoriasis,” according to a retrospective
analysis of previous data that was published in
the European Journal of Dermatology (125(6):e1316-
23). The sub-analysis looked at patients aged eight
to 17 years who received once-weekly subcutaneous
etanercept 0.8mg/kg (≤50mg) or placebo in
double-blind fashion for 12 weeks, followed by 24
weeks of open-label etanercept. At baseline, subjects,
95 of whom were randomized entanercept
while 97 received placebo, had 10 percent body
surface area and Psoriasis Area and Severity Index
(PASI) 12.
Researchers found that at week 12, “54.7 percent of subjects receiving etanercept versus 11.3 percent receiving placebo achieved 75 percent or greater improvement in PASI (PASI 75) compared with baseline (P < 0.001). PASI 50, PASI 90, and static Physician Global Assessment of psoriasis followed a similar pattern (P < 0.001).” Efficacy was sustained through Week 36 during the open-label phase. Etanercept, marketed as Enbrel (Amgen/Pfizer), is approved for moderate to severe plaque psoriasis in individuals 18 years of age and older who are candidates for systemic therapy or phototherapy. Its lone pediatric indication is polyarticular Juvenile Idiopathic Arthritis in patients two and older.
Protective Creams Benefit Some ICD Patients
Treatments designed to prevent occupational irritant
hand dermatitis (OIHD) appear to provide
some benefit according to a recent Cochrane
review (Schmitt, et al. The Cochrane Collaboration).
Data came from four randomized controlled trials
involving 894 subjects from different occupations.
Although “generally positive,” results did not reach
statistical significance, the authors say. They
encourage additional large, well-designed trials to
determine the benefit of barrier protection creams.
Negative Barrier Effects from TCIs?
New data suggest that topical calcineuron
inhibitors may disrupt the epidermal permeability
barrier and antimicrobial function (Journal of the European Academy of Dermatology, 24;(7)).
Investigators examined the effects of TCI treatment
for four days in hairless mice, finding that there
were decreases in epidermal lipid content, lamellar
body number and secretion, and lipid synthesisrelated
enzymes such as 3-hydroxy-3-methylglutaryl-
CoA reductase, serine-palmitoyl transferase
and fatty acid synthase, implying decreased lipid
synthesis. TCIs also suppressed expression of IL-1a
and antimicrobial peptides. Given that TCIs can
have negative effects on the skin barrier, the
researchers suggest co-treatment with a physiologic
lipid mixture, which helps to normalize barrier
homeostasis.
Rapid-Fire Combo
Topical calcipotriol/betamethasone in combination
with adalimumab may result in rapid early results,
but brings little added benefit after the first four
weeks of psoriasis treatment, according to the
results of a new study published in the British
Journal of Dermatology. Investigators conducted a
16-week, randomized, vehicle-controlled trial in
patients with moderate to severe psoriasis and previous
failure, intolerance, or contraindications to
two or more systemic treatments. All patients
receivbed adalimumab 80mg at week zero and
40mg every other week for 15 weeks, in addition
to topical calcipotriol/betamethasone or drug-free
vehicle applied once daily for four weeks and as
needed thereafter. PASI 75 response was initially
higher with the combination therapy as opposed to
adalimumab monotherapy at weeks two (14.8 percent
vs. 5.8 percent) and four (40.7 percent vs.
32.4 percent), but after week four the trend was
toward a higher response with adalimumab
monotherapy.
Data on Antibodies to Infliximab
Researchers recently shed light on the presence of
antibodies to infliximab in psoriatic patients (The
Journal of Dermatology, June 14 online). Fifteen
patients with psoriasis were treated with infliximab
(5mg/kg) every eight weeks after an initial
three-dose induction regimen. Researchers used an enzyme linked immunosorbent assay kit for analyzing
the presence of ATI in the sera, and found
that five patients developed ATI. They suggested
that monitoring for the induction of ATI and rescue
strategies should be developed to avoid or to
maintain a delay in ATI development.
More Evidence Suggests Tanning Addiction
Studies in recent years have indicated that those
who tan indoors often exhibit traits of addiction.
The newest publication to support this notion,
published in Clinical and Experimental Dermatology
(online June 7), found that a staggering 41 percent
of individuals who were surveyed and tan regularly
met criteria consistent with “tanning addictive
disorder,” with an additional 33 percent meeting
criteria for problematic tanning behavior.
Clarification
The June 2010 cover feature, “Mohs Micrographic Surgery: An
Update for the Clinician” (vol. 7, no. 6), neglected to mention
the American Society for Mohs Surgery (ASMS,
www.mohssurgery.org), a professional society of board certified
dermatologists who perform Mohs surgery. Most ASMS Fellows
receive training in Mohs surgery during a three year Dermatology
residency. ASMS Fellows may or may not have completed an extra
year of fellowship training in Mohs surgery. The Society currently
has 925 physician members.
The Society's stated mission is to improve physician performance and patient health through regular medical education courses with an emphasis on skin cancer, dermatologic surgery, and Mohs surgery. ASMS also provides political and professional advocacy for Mohs surgeons from a variety of Mohs training backgrounds, supports its members in the area of third-party reimbursement, professional credentialing, and other practice issues, and offers a range of ancillary products and services to assist members in establishing and maintaining their Mohs practices.
