Skin Cancer On the Rise
The number of non-melanoma skin cancers increased dramatically in the US from 1992 to 2006, according to a new study (Arch Dermatol. 2010;146:283-287). Researchers found that the overall number of procedures for NMSC among Medicare patients rose by 76 percent during that time, from 1,158,298 in 1992 to 2,048,517 in 2006. Incidence was observed by calculating the total number of approved skin cancer treatments in the Medicare total claims dataset. The majority of the skin cancers assessed in this study were keratinocyte carcinomas (i.e., basal cell or squamous cell carcinomas or squamous cell carcinoma in situ). However, procedures for other skin cancers, which occur in much smaller numbers—such as Merkel cell carcinoma, anneal carcinoma, and malignant melanoma in situ—were also included in the analysis.

Zyclara Data Published
Short-course topical imiquimod therapy appears safe and effective for the treatment of actinic keratoses (AK), according to data recently published in the Journal of the American Academy of Dermatology. Two publications reporting data from Phase III clinical trials demonstrate the benefits of imiquimod 3.75% (Zyclara, Graceway) and imiquimod 2.5% administered daily on either twoor three-week treatment cycles. With two two-week treatment cycles, imiquimod 3.75% produced a total reduction in AKs of 82 percent, while imiqimod 2.5% produced a total reduction of 72 percent, versus 25 percent for placebo. Complete clearance rates were 36 percent for the 3.75% formulation and 31 percent for the 2.5% formulation, versus six percent for placebo.

Results were similar for three-week cycles, with imiquimod 3.75% producing an 80 percent reduction in total AKs and a complete clearance rate of 34 percent and imiquimod 2.5% showing a total lesion reduction of 67 percent and complete clearance rate of 25 percent. Placebo yielded a 24 percent reduction in total AKs and complete clearance in six percent of cases. Rates of adverse events, rest periods, and local skin reactions were higher in the three-week cycle groups. An NDA submitted to FDA for imiquimod 3.75% under the two-week cycle was approved last month. Anthony Gaspari, MD, an investigator involved in the trials, notes that the two-week treatment cycles, “are much more intuitive and much easier for patients.” An important benefit of the newly approved 3.75% formulation of imiquimod is that it is intended for and has been shown suitable for application to the full face and/or scalp, providing a field effect, he says. Response is predictable, according to Dr. Gaspari, with the first round of treatment “highlighting” pre-clinical lesions, so that patients experience some mild erythema and an actual increase in total AK lesions. This is because, “the field treatment finds the lesions that you can't see,” he explains. However, Dr. Gaspari adds, “We don't anticipate that patients are going to need a rest period.”

Physicians Positive on Repair Cream
In an ongoing study of EpiCeram Emulsion (Promius Pharma) for the management of mild to moderate atopic dermatitis (AD), treating physicians report that they have been “satisfied” or “very satisfied” with results in 65 percent of cases. In 82 percent of cases, physicians were at least “somewhat satisfied.” Findings come from an interim analysis of data for100 patients enrolled in the EPIC trial (ultimate enrollment target is approximately 220 patients), an open-label, 21-day trial of subjects with mild to moderate atopic dermatitis using EpiCeram Emulsion twice daily alone or, at the patient's option, in combination with a topical steroid. Of patients treated thus far, 76 percent underwent EpiCeram monotherapy. Median age of subjects is 34 years.

Biomimetic Electricity Technology Unveiled
A novel technology that uses a complex of zinc and copper to produce and deliver electrical signals similar to the skin's natural bioelectricity appears to improve the signs of aging skin, according to data presented at the AAD Annual Meeting last month. Cytomymic, the patented technology found in Johnson & Johnson Consumer Companies, Inc. products, is thought to naturally stimulate intrinsic rejuvenation processes and accelerate cell activity, according to the company. The bi-mineral complex, when activated by moisture, functions as a mini-battery.

According to data presented in poster format, biomimetic electricity decreased inflammation by reducing the release of pro-inflammatory cytokines from activated human T-cells and inhibiting their release from keratinocytes and macrophages exposed to bacteria (P1618). Data also support the role of biomimetic electricity to improve skin elasticity and resilience (P1625) and reduce melanin deposition to lighten skin (P1621). In a 12-week placebo-controlled trial, 94 healthy females were randomized to use placebo gel, bi-mineral complex in activating moisturizer A, and bi-mineral complex in activating moisturizer B. Subjects applied the respective formulations twice daily to the full face and eye area, including eyelids. Beginning at week 2 and continuing through week 12, the bi-mineral complex-treated patients had clinically significant improvements, compared to placebo, in photoaging, radiance, fine lines, and lifting/firming (P304).

Psoriasis Patients Can Get Fit Online
To support psoriasis patients who want to improve their health, Centocor Ortho Biotech, Inc. and the National Psoriasis Foundation last month launched “Fit in Your Skin,” (www.fitinyourskin.com) a health and wellness program spearheaded by fitness expert Jackie Warner. Featuring exercise programs, nutrition and diet tips, healthy recipes, and resources to promote emotional wellbeing, the web-based program features a “team” of actual psoriasis patients striving to become healthier. Los Angeles based dermatologist Paul Yamauchi, MD is also involved in the program, which is intended for use by any interested patient. Participation in the program is free. Numerous features are available without registering, however, interested patients can register for free full program access, including a work-out program on DVD, along with regular nutrition and fitness tips.

CSF Accepting Resident Grant Applications, Abstracts
Grants covering airfare and hotel are available for 50 senior residents or fellows to attend the Cosmetic Surgery Forum (CSF) December 2-4, 2010 at the Palazzo, Las Vegas. To qualify for a grant, residents are invited to submit a 250-word abstract on an issue related to cosmetic surgery or general dermatology at the time of registration. Select abstracts may be published in Practical Dermatology, pending review and revision processes. Dr. Bill Danby (Adjunct Assistant Professor of Medicine (Dermatology) at Dartmouth Medical School) and Dr. Julie Ann Woodward (Chair, Duke University Oculoplastics Department) will chair this program. Grant applicants must register by Nov. 5 at www.CosmeticSurgeryForum.com/residents. Participation is limited and spots will be allocated based on time and quality of application.

In addition to the primary scientific sessions, the CSF program also includes resident-specific, hourlong sessions at the end of the day Friday and Saturday: 1.) Residents Injection Session - Fillers and Neurotoxins and 2.) Resident Presentations - Issues in Cosmetic Surgery and Dermatology.

Cosmetic Surgery Forum is a CME event jointly sponsored by Practical Dermatology and Cosmetic Surgery Forum, LLC. For information: CosmeticSurgeryForum.com

Steroids, Stem Cells, and Hemangiomas
New findings suggest that infantile hemangiomas originate from stem cells and that steroids target these stem cells specifically, revealing their mechanism of action and suggesting other possible ways to halt and shrink hemangiomas. Researchers further showed that steroids work by inhibiting hemangioma stem cells' ability to stimulate blood vessel growth, and that they do so by shutting down production of a specific factor called vascular endothelial growth factor (VEGF-A). VEGF is well known as a stimulator of angiogenesis (blood vessel growth) in cancer and age-related macular degeneration. Steroids usually result only in stabilization of hemangioma growth, and about 30 percent of hemangiomas don't respond to steroid treatment. Steroids also have side effects including facial swelling, hyperactivity, growth retardation, and increased blood pressure. Although the effects on appearance may seem minor, research indicates that a baby's physical appearance can interfere with maternal bonding, researcher shows.

The investigators also learned that when human hemangioma stem cells were pretreated with dexamethasone, then implanted in mice, the tumors that formed had far fewer blood vessels. Dexamethasone suppressed the stem cells' production of VEGF-A but did not suppress VEGF-A production by endothelial cells from the same h

emangioma. When VEGF-A production was suppressed in hemangioma stem cells using shRNA silencing, then implanted in the mice, there was an 89 percent reduction in vessel growth. VEGF-A was detected in actively growing hemangiomas, but not in regressing (involuting) hemangiomas.

Vitamin C Helps Acne
Vitamin C may play an important role in acne care, new findings suggest. Investigators evaluated the effects of Sodium L-ascorbyl-2-phosphate (APS), a vitamin C derivative for the treatment of acne and found that the agent demonstrated good efficacy. The study examined 50 patients who received APS 5% lotion or vehicle for 12 weeks using the Global Assessment Score, lesion counts, cutaneous tolerability, and adverse events. The APS 5% lotion demonstrated a statistically significant improvement when compared to vehicle in all parameters, while adverse events were similar to those for vehicle. They concluded that the lotion is an effective monotherapy for acne.