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.
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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.
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Dermatology Hot Topics March 2010 Botox and Migraines Migraine headaches plague at least 1 in 10 Americans striking somewhere in excess of 25 million. Arguments exist regarding the role of Botox injections in treating or preventing this condition. Contrary to original thoughts, it appears Botox provides dramatic improvement with injections limited to the standard locations used for cosmetic purposes. Formerly it was assumed the treatments needed to be directed at muscles along the side and back of the scalp. This appears to be false. However not all migraines improve with Botox. The best responders include those with crushing and viselike or eye-popping symptoms. Growing Old With age a number of skin changes seem inevitable. Among the most common are brownish, itchy, scaly spots that rise above the surface and are referred to as Seborrheic Keratoses. Ultimately these bedevil the majority of people past middle age and are generally mistaken for warts or moles. They commonly occur on the torso and occasionally the face or scalp. Two frequent variants include stucco keratoses that strike older men more often than women and principally target the area around the ankles and sometimes the wrists. Blacks and at times Hispanics and Asians develop wart-like growths about the cheeks. These Dermatosis Papulosis Nigra lesions often number in excess of 25 and remain asymptomatic but may be cosmetically troublesome. Sirtuins Calorie restricted mice live longer than those who consume more feed. From this simple fact, doctors discovered a class of proteins known as SIR2 which stands for silent mating type information regulator 2. These chemicals are involved in the process of energy generation within cells which means they control a laundry list of important functions ranging from aging to gene silencing, cell death and metabolism. Resveratrol, a chemical in red wine and grapes, also seems to activate these proteins. Researchers may have identified a chemical at least 1000 times as potent as resveratrol in stimulating this family of proteins. New investigations suggest applying sirtuin as a cream at 1% concentration improves skin function, protects against ultraviolet damage, provides extra hydration and protects against wrinkles. Skin Cancer Basal Cell Carcinoma still represents the most common malignancy in Americans. Generally thought to result after years of unprotected sun exposure, therapy for this tumor generally poses more inconvenience and scarring than the potential for complications. Preventing Basal Cell Carcinomas requires appropriate avoidance of excessive ultraviolet light. Perhaps the anti-arthritis drug Celebrex may offer another avenue to prevent or at least mitigate against some of the damage by strengthening underlying cell structures and reducing underlying solar damage. Preventing Genital Herpes According to advocates of condoms, these devices protect against spread of sexually transmitted disease. While the concept remains true, in practice the level of protection falls short of what most people believe at least with reference to minor venereal diseases such as warts, molluscum and herpes. For those who faithfully wear condoms during 100% of sexual encounters, the likelihood of acquiring disease falls by only 30% compared to those who never wear them. Use during half of all contacts reduces the risk of contagion by only 15%. On the other hand, consistent use prevents passage of HIV/AIDS by nearly 90%. Vitamin D and the Sun While sun exposure boosts the blood levels of Vitamin D, whether this represents an adequate method of assuring adequate amounts of the vitamin remains hotly contested. A recent evaluation questions how the body controls blood levels of this essential substance. It seems those simple assumptions that equate sun exposure with plentiful amounts of skin production of this vitamin maybe overly simplistic or totally inaccurate. Genetic control, skin pigment, ethnic background and latitude remain predominant contributors. Even hours in the sun without clothing during the winter months fail to ensure healthy levels of vitamin D. For most people, supplements rather than dietary intake seems necessary. |
Malignant Melanoma I The incidence of malignant melanoma appears to be steadily rising at a more rapid rate than almost any other cancer. Just this year researchers expect more than 68,000 individuals to develop the invasive form of the disease while another 53,000 will be diagnosed with a pre-invasive, more superficial type known as melanoma in situ. Melanoma remains the most common cancer in women between ages 25-29 and the most frequent cause of cancer related death in those aged 30-35. In spite of this, more than 92% of patients with melanoma will be cured by simple office surgery. Malignant Melanoma II Until recently all of the so-called miracles designed to treat melanoma once it spread beyond its original confines failed to provide any substantive advantages. Now a dramatic shift may be at hand. Working together with Roche, a small drug company Plexxikon reported dramatic improvements in patients with metastatic melanoma once considered at imminent risk of death. This drug known as PLX4032 inhibits the driving force behind half of all melanomas. Among those who tumors test positive for this genetic derangement, seemingly miraculous tumor reduction occurs without significant drug related toxicity. Malignant Melanoma III Patients with advanced melanoma are currently being accepted into studies sponsored by Roche involving what may be the most significant advance in the treatment of metastatic melanoma. Information regarding the current status of these protocols may be downloaded by searching Roche Clinical Trials and directing inquiries to the drug PLX4032 or Ro5185426. Acceptance requires specific tumor characteristics and not everyone will receive the drug. For more inquiries you may proceed to ClinicalTrials.gov at http://www.clinicaltrials.gov/ct2/results?term=plx4032. And Another Reason Not To Smoke Scientists investigating a possible link between cigarette smoking and hand eczema discovered a weak relationship may indeed exist. This seems especially true among light smokers. Several categories of eczema include allergic, irritant, wet-work associated and a genetic form known as atopic dermatitis. While previous studies questioned the validity of this interaction, it seems inherently possible that tobacco related toxins as well as reduced blood flow contribute to deterioration in the skin's protective capacity. This follows quite nicely with the well accepted role of cigarettes in predisposing to facial wrinkling especially in women. Vitamin D Low levels of vitamin D appear to be associated with a variety of health related concerns including an increased risk of cancer, heart disease and possibly even dementia. With so many poorly performed and uncontrolled studies, sorting out hype from reality remains difficult. As an example, a recent report claims that low levels of Vitamin D predispose to coronary vascular disease by increasing arterial calcification, stimulating smooth muscle proliferation and altering the internal chemical nature of the cells. The claim that low levels of Vitamin D increase the rate of sudden coronary death by 600% remains preposterous. Vitiligo During the spring and summer months, protection of the skin against harsh ultraviolet rays rises in importance. For those lacking normally functioning pigment cells, patches of the skin become white and more susceptible to developing skin tumors. Additionally these non-pigmented areas become more noticeable as the rest of the skin normally tans. This accentuates the diseased skin in a manner akin to high beams in the car irritating oncoming drivers only during the nighttime hours. While therapy for vitiligo requires devotion and considerable effort, successful repigmentation of the skin often rewards those willing to adhere to a treatment plan. Chronic Urticaria Most cases of hives or urticaria last less than one month before spontaneously resolving. Unfortunately a variant of this condition known as chronic urticaria may continue unabated for one to two years and result in itching and discomfort often little improved by current therapy. Only rarely will blood or allergy tests determine an explanation for this more protracted problem. At times the underlying culprit may be an infection or a so-called autoimmune disease where blood cells react to some unknown chemical in the skin. Stress, anxiety and depression not infrequently accompany the disease. Treatment involves a trial and error approach with the goal being reduction rather than elimination of symptoms. |