Hot Topics
A collection of our current Skin Hot Topics by Dr. Landow are available on this page.
While proponents of radiofrequency therapies claim they reliably produce collagen tightening and fewer wrinkles, the technology seems primitive and unlikely to restore a youthful appearing skin. Unfortunately many patients succumb to the marketing lure of Thermage and spend thousands of dollars for little if any noticeable benefit.
Excessive Sweating
Injections of Botox provide unsurpassed improvement for those suffering from excessive perspiration. Not only does the therapy dry the underarms but it also relieves uncontrollable sweating on the palms, soles and forehead. Botox also dramatically aids those with embarrassing wetness in the groin and about the anus.
And Another Use For Botox
Drooling in children and adults often results from neurologic disease. Among the frequent culprits are Parkinson's disease, stroke, cerebral palsy and mental retardation. Injection of Botox into the Parotid or submandibular salivary glands often alleviates this added burden more safely than any of the other available therapies.
Laser Hair Removal
Excessive and annoying dark hair may be successfully reduced by laser therapy. However the results may be less impressive and shorter in duration than once believed. Adding a topical prescription agent, Vaniqua, may significantly boost the outcome and hasten disappearance of unwanted hair.
Contour Thread
In our never ending uncritical embrace of beauty treatments, a number of people turn to "facial lifting" with barbed suture. Supposedly this minimally invasive therapy suspends the sagging tissues with a suture embedded under the skin. Unfortunately no long term safety data exist. When complications arise, significant facial asymmetry may result without a simple method of correcting the deformity.
Psoriasis
Individual responses to treatment with the expensive biologics such as Enbrel, Raptiva or Remicade vary significantly. For some the psoriasis miraculously disappears while inexplicably for others the skin's appearance remains unaltered. To some degree these differences involve genetic variations lurking silently in the DNA.
Melanoma
Current estimates suggest 2007 will bring slightly fewer than 60,000 new cases of invasive malignant melanoma with another 50,000 non-invasive tumors. While these numbers indicate a slight fall from the 2006 numbers, the death toll will continue to rise.
Screening routinely fails to improve the prognosis of this potentially fatal condition.
Screening for Melanoma
Reports indicate yearly melanoma screening may not be effective for the general population. Instead limiting evaluations to those at highest risk appears as a more prudent use of resources. Those most likely to benefit include men, those past age 50, people with a history of melanoma or a changing mole and individuals lacking a dermatologist.
Eyelash Lengthening
One of the newest fads includes a series of newly available cosmetic agents that promise to lengthen and thicken eyelashes. Most of these over-the-counter products contain a relative of the drops prescribed to lower the eye pressure in patients with glaucoma. While the compounds might be effective, persistent discoloration of the skin and eye frequently appear as unwanted side effects.
Sunscreens
In spite of public fascination with sunscreens as a simple and safe method of avoiding cancer and premature skin aging, our love remains unrequited. A recent petition filed by the Attorney General of Connecticut demands the FDA declare an end to the "false and misleading" advertising of these products by their manufacturers. Proof of benefit remains elusive.
Sunscreens II
A recent report from Australia may be the first to show that regular application of sunscreens might be of some benefit in the war against a limited variety of skin cancers. No conclusive evidence even hints that these products reduce the incidence of the two most well known skin cancers: melanomas or basal cell carcinomas. Sunscreens may possibly help protect against squamous cell carcinomas.
Accutane and Inflammatory Bowel Disease
Televised advertisements beckon former Accutane users suffering from colitis referred to as IBD to call for legal assistance. While initial reports hinted the much maligned acne drug might indeed be related to bowel problems, a more recent evaluation of the data questions whether the initial assessment grossly over-exaggerated the purported association.
Blood Thinners
Doctors routinely advise patients to discontinue blood thinners several days prior to surgical procedures. Accumulating evidence indicates this may be unnecessary for the vast majority of operations. Caution still may be appropriate for those beyond age 67, but for most others aspirin, coumadin and Plavix do not pose a great risk.
HPV and Cancer
Proteins produced by certain variants of the wart virus may predispose to cancer. Nowhere does this seem more clearly established than cancer of the cervix. Evidence now links betapapillomavirus, a subgroup of HPV, as a potentially commanding partner in non-melanoma skin cancer formation. Currently the strongest association appears to be with Actinic Keratoses, a forerunner of Squamous Cell Carcinoma.
All In Your Head?
Many individuals experience an undeniable desire to pick, scratch and gouge their skin to the point of mutilation. The underlying condition often appears to be a psychiatric malady known as Neurotic or Psychogenic Excoriations. Rather than suffering a primary disease of the skin, these individuals do best under the care of a mental health provider. Other commonly occurring conditions include depression, anxiety and impulse control disorder.
-->
A collection of our current Skin Hot Topics by Dr. Landow are available on this page.
August
Volume V, Number 8
Medical commentary on dermatology related subjects.
While proponents of radiofrequency therapies claim they reliably produce collagen tightening and fewer wrinkles, the technology seems primitive and unlikely to restore a youthful appearing skin. Unfortunately many patients succumb to the marketing lure of Thermage and spend thousands of dollars for little if any noticeable benefit.
Excessive Sweating
Injections of Botox provide unsurpassed improvement for those suffering from excessive perspiration. Not only does the therapy dry the underarms but it also relieves uncontrollable sweating on the palms, soles and forehead. Botox also dramatically aids those with embarrassing wetness in the groin and about the anus.
And Another Use For Botox
Drooling in children and adults often results from neurologic disease. Among the frequent culprits are Parkinson's disease, stroke, cerebral palsy and mental retardation. Injection of Botox into the Parotid or submandibular salivary glands often alleviates this added burden more safely than any of the other available therapies.
Laser Hair Removal
Excessive and annoying dark hair may be successfully reduced by laser therapy. However the results may be less impressive and shorter in duration than once believed. Adding a topical prescription agent, Vaniqua, may significantly boost the outcome and hasten disappearance of unwanted hair.
Contour Thread
In our never ending uncritical embrace of beauty treatments, a number of people turn to "facial lifting" with barbed suture. Supposedly this minimally invasive therapy suspends the sagging tissues with a suture embedded under the skin. Unfortunately no long term safety data exist. When complications arise, significant facial asymmetry may result without a simple method of correcting the deformity.
Psoriasis
Individual responses to treatment with the expensive biologics such as Enbrel, Raptiva or Remicade vary significantly. For some the psoriasis miraculously disappears while inexplicably for others the skin's appearance remains unaltered. To some degree these differences involve genetic variations lurking silently in the DNA.
Melanoma
Current estimates suggest 2007 will bring slightly fewer than 60,000 new cases of invasive malignant melanoma with another 50,000 non-invasive tumors. While these numbers indicate a slight fall from the 2006 numbers, the death toll will continue to rise.
Screening routinely fails to improve the prognosis of this potentially fatal condition.
Screening for Melanoma
Reports indicate yearly melanoma screening may not be effective for the general population. Instead limiting evaluations to those at highest risk appears as a more prudent use of resources. Those most likely to benefit include men, those past age 50, people with a history of melanoma or a changing mole and individuals lacking a dermatologist.
One of the newest fads includes a series of newly available cosmetic agents that promise to lengthen and thicken eyelashes. Most of these over-the-counter products contain a relative of the drops prescribed to lower the eye pressure in patients with glaucoma. While the compounds might be effective, persistent discoloration of the skin and eye frequently appear as unwanted side effects.
Sunscreens
In spite of public fascination with sunscreens as a simple and safe method of avoiding cancer and premature skin aging, our love remains unrequited. A recent petition filed by the Attorney General of Connecticut demands the FDA declare an end to the "false and misleading" advertising of these products by their manufacturers. Proof of benefit remains elusive.
Sunscreens II
A recent report from Australia may be the first to show that regular application of sunscreens might be of some benefit in the war against a limited variety of skin cancers. No conclusive evidence even hints that these products reduce the incidence of the two most well known skin cancers: melanomas or basal cell carcinomas. Sunscreens may possibly help protect against squamous cell carcinomas.
Accutane and Inflammatory Bowel Disease
Televised advertisements beckon former Accutane users suffering from colitis referred to as IBD to call for legal assistance. While initial reports hinted the much maligned acne drug might indeed be related to bowel problems, a more recent evaluation of the data questions whether the initial assessment grossly over-exaggerated the purported association.
Blood Thinners
Doctors routinely advise patients to discontinue blood thinners several days prior to surgical procedures. Accumulating evidence indicates this may be unnecessary for the vast majority of operations. Caution still may be appropriate for those beyond age 67, but for most others aspirin, coumadin and Plavix do not pose a great risk.
HPV and Cancer
Proteins produced by certain variants of the wart virus may predispose to cancer. Nowhere does this seem more clearly established than cancer of the cervix. Evidence now links betapapillomavirus, a subgroup of HPV, as a potentially commanding partner in non-melanoma skin cancer formation. Currently the strongest association appears to be with Actinic Keratoses, a forerunner of Squamous Cell Carcinoma.
All In Your Head?
Many individuals experience an undeniable desire to pick, scratch and gouge their skin to the point of mutilation. The underlying condition often appears to be a psychiatric malady known as Neurotic or Psychogenic Excoriations. Rather than suffering a primary disease of the skin, these individuals do best under the care of a mental health provider. Other commonly occurring conditions include depression, anxiety and impulse control disorder.
|
Dermatology Hot Topics September 2010 Sunscreens In spite of dedication to regular application of sunscreens the skin still appears to manufacture sufficient levels of vitamin D. Only the UVB rays entering the atmosphere between 10 am to 2 pm initiate synthesis of this important compound. Supposedly proper use of sunscreen totally blocks these rays. The conclusion: sunscreens fail to deliver as promised. Additionally use of these products fails to demonstrably reduce the incidence of skin cancer!!! Botox Children Controversy surrounding Botox for youngsters continues to stir emotions. Whether a 15 year old should opt for Botox injections remains an issue most properly addressed by parents, physicians and counselors. While the overwhelming majority of children are not candidates for therapy, certain exceptions exist. Included among the most frequent cosmetic problems arguing in favor of treatment are embarrassing, excessive sweating, temporo-mandibular joint dysfunction and certain congenital deformities. Toilet Paper Hazard Itching and redness about the personal area may be due to a contact allergy from a chemical in body wipes and moist towelettes. While more often used in children, an increasing number of adults opt for this method of personal cleansing. For those allergic to methlycholorisothiazoline or more simply MCI, the problem can be long-lasting, distressing and unnerving. For those with peri-anal itching, the possibility of this condition should be evaluated. Melanoma Continuing public service announcements bombarding the airways create the assumption that melanoma results from excessive sun exposure. Interesting recent reports now suggest the incidence of melanoma involving the female vulva may indeed be heightened in those who avoid sun exposure. Perhaps the explanation involves levels of vitamin D manufactured as a result of ultraviolet light impacting on the skin. Acne Acne remains the scourge of adolescence. Unfortunately therapy requires adherence to a relatively long-term treatment regimen lasting months to years and often involving pills and regular application of creams. However in our frenetic, fast paced society this meets with displeasure on the part of anxious patient and impatient parent. In spite of this, nature will not be hurried. Even Accutane requires 5 months of therapy without any guarantees of success. Body Odor Many more people complain of foul body or mouth odor than suffer any medical disorder. Now known as the Olfactory Reference Syndrome, affected individuals attempt to camouflage their perceived smell by applications of perfume, scented powders, toothpaste and mouth wash. Since no actual medical problem exists, none of these attempted home remedies improves the situation. According to experts, this condition belongs in the group of hallucination disorders and requires psychotropic medications. Stelara and Psoriasis A relatively new agent in the fight against psoriasis appears considerably more active than Enbrel, the largest selling biologic therapy for this disease. Benefits of Stelara include its safety, once every three month injection schedule rather than one or two shots each week and the lack of requirement for routine blood tests. Often within two months the skin begins to clear even in those resistant to Enbrel and topical salves Aquaporins? Few outside the arcane world of medical research have ever heard of aquaporins. Yet these relatively newly discovered chemicals involve themselves in water transport into and out of cells, cell migration and proliferation, metastasis and new blood vessel formation. They appear intimately involved in determining who develops dry skin and whether an individual either develops or resists the development of skin cancer. |
Safe Showers Warnings about contaminated drinking water in underdeveloped nations raise no special alarm. Interestingly few people realize the potential problem with bacterial colonization in their personal showers. A recent study evaluated showerheads from 9 metropolitan areas in the United States and found soil and water bacteria and biofilms in most of them. While healthy people may suffer little or no harm, those with impaired immunity may be exposed to potential disease causing organisms. Skin Disease in Older Individuals With advancing age the incidence of skin cancers and infections rises dramatically. Explaining why this situation exists remains the focus of intense investigation. New information suggests the white blood cells charged with maintaining skin health become progressively less functional as time passes. Interestingly they seem to lose their vitality principally in the skin yet retain their disease fighting capacity inside the body. This at least in part explains why those beyond age 70 seem at higher risk than those under age 40. Warts and Skin Cancer By itself ultraviolet light may not be sufficient to cause skin cancer. Another agent may be necessary to convert damage from excessive sun exposure into malignant disease. Accumulating research hints the wart virus may be the mechanism that translates sun bathing into skin cancer. This combination seems especially risky for those with compromised immune status - perhaps as the result of steroid use or anti-rejection medicines in transplant recipients. Tattoo Removal The ease with which tattoos can be eradicated depends on a number of factors. Contrary to popular belief, lasers neither totally nor painlessly remove vestiges of past indiscretions. Multiple sessions, often in excess of 10-12, with a variety of different lasers may be necessary to achieve partial success. Even after as much as a year of therapy and potentially thousands of dollars, pristine unblemished skin will not return. Perhaps temporary tattoos make more sense than permanent alternatives. Treating Skin Cancer Until now therapy for basal and squamous cell carcinomas involved either radiation therapy or traditional excision wtih suturing. We are now poised to enter an entirely new domain of targeted therapy where cancers are eliminated or even prevented by oral medicines. Recent publications demonstrate the ability of a hedgehog inhibitor, GDC-0449, to arrest or contain disseminated or aggressive localized non-melanoma skin cancer without the need for more traditional interventions. Hopefully this variety of agents will be available for use among the general public within the next several years. Cost remains an issue. Levulan The manufacturer of topical agent Levulan petitioned the FDA to allow this drug to be marketed as a skin cancer preventive. According to DUSA pharmaceuticals their drug must be applied to the skin and allowed to penetrate for at least an hour. Afterward exposure to blue light activates the drug and in the process creates an inflammatory reaction which destroys cells destined to become malignant. Concern exists about the ability of the topical liquid to perform as advertised. Botox Competition An alternative to Botox marketed as Dysport appears headed for weak runner up status. It offers nothing in excess of its more well know competitor and additionally suffers from anemic marketing. In early August, Merz Pharmaceuticals received FDA authorization for its agent Xeomin. Initially this drug will be targeted to people with eyelid muscle twitching or blepharospasm and neck muscle spasms. Ultimately the company's goal appears to compete in the cosmetic business against Botox. |