Author Interviews, Cancer Research, Dermatology, Race/Ethnic Diversity, UCSD / 24.03.2015

MedicalResearch.com Interview with: Arisa Ortiz, MD, FAAD Assistant Clinical Professor Director, Laser and Cosmetic Dermatology Senior author: Brian Jiang, MD and First author Tiffany Loh, BS Department of Dermatology UC San Diego Medical Research: What is the background for this study? What are the main findings? Response: Non-melanoma skin cancers (NMSCs) are the most common type of malignancy in the United States, affecting an estimated 3.5 million people each year. Previous perception has remained that skin cancer risk in Hispanics and Asians is lower than that of Caucasians. However, despite historically lower rates of skin cancer, in recent years, the incidence of skin cancer in these groups has reportedly been increasing in the United States. As Hispanics and Asians constitute two of the most rapidly expanding ethnic groups in the US, the rise in NMSCs in these populations is particularly concerning. The finding from our study were as follows: Hispanic patients were significantly younger than Caucasians and Asians (p=0.003, 0.023 respectively). The majority of Non-melanoma skin cancers in Caucasians occurred in men, while this gender ratio was reversed for both Hispanics and Asians. There were significantly more cases of Non-melanoma skin cancers occurring in the “central face” area in Hispanics. Race was not a significant predictor for specific NMSC type (BCC or SCC). (more…)
Author Interviews, Dermatology, Opiods / 24.03.2015

Madhulika A. Gupta MD University of Western OntarioMedicalResearch.com Interview with: Madhulika A. Gupta MD  University of Western Ontario Medical Research: What is the background for this study? What are the main findings? Dr. Gupta: Opioid (narcotic) analgesics (OA) are FDA-approved primarily for the symptomatic relief of pain in acute and chronic conditions. The prescription rates of Opioid analgesics in the US have increased significantly since 1989, and their possible inappropriate use has been declared a public health concern. We have recently reported (GuptaMA et al. J Dermatol Treat, 2014) that the use of Opioid analgesics in primarily skin disorders (with no reported non-dermatologic comorbidities) has increased from 1995-2010. Skin disorders are associated with psychiatric pathology in up to 30% of cases. Psychiatric disorders have been associated with an increased use of Opioid analgesics and other potentially addictive drugs. We examined psychiatric disorders, comorbidities and psychotropic drugs in patient visits with skin disorders and Opioid analgesics use (‘Skin Disorders+OA’). We examined nationally representative cross-sectional data collected between 1995-2010 by the NAMCS and NHAMCS. Up to 3 ICD9-CM diagnoses are coded for each patient visit; the following codes were used to create the ‘Skin Disorders’ variable: ICD9-CM codes 680-709 ‘Diseases of the Skin and Subcutaneous Tissue’ and ICD9-CM codes 172, 173, 216 and 232 for cutaneous malignancies. Ambulatory Care Drug Database System drug codes were used for creation of variables for Opioid analgesics and other psychotropics. (more…)
Author Interviews, Brigham & Women's - Harvard, Dermatology, JAMA / 22.03.2015

Dr. Arash Mostaghimi, MD, MPA Director of Dermatology Inpatient Service Brigham and Women’s Hospital Boston, MAMedicalResearch.com Interview with: Dr. Arash Mostaghimi, MD, MPA Director of Dermatology Inpatient Service Brigham and Women’s Hospital Boston, MA     Medical Research: What is the background for this study? What are the main findings? Dr. Mostaghimi: Spironolactone, a generic drug that’s been used in the clinic since 1959, is commonly prescribed for treating hormonal acne – acne that tends to affect the jaw line most commonly around the time of the month when a woman gets her period. The US Food and Drug Administration recommends frequent potassium monitoring in patients with heart failure who are taking spironolactone as a diuretic and antihypertensive treatment, but it’s been unclear if these guidelines should apply to healthy patients taking spironolactone for the treatment of acne, and, if so, how frequently such patients should have their potassium levels tested. My colleagues and I have found that for young, healthy women taking spironolactone to treat hormonal acne, potassium monitoring is an unnecessary health care expense. For the approximately 1,000 patients we studied, blood tests to monitor potassium levels did not change the course of treatment, but the tests cumulatively totaled up to $80,000. We suggest that routine potassium monitoring should no longer be recommended for this patient population in order to improve the patient care experience, decrease unnecessary office visits and reduce health care spending. (more…)
Author Interviews, Dermatology / 22.03.2015

MedicalResearch.com Interview with: Nicolette Farman MD Ph.D. Directeur de recherche Université Pierre et Marie Curie, Paris, France Centre de Recherche des Cordeliers Paris, France Medical Research: What is the background for this study? What are the main findings? Dr. Farman: I have been working for a long time on aldosterone, a steroid hormone that enhances renal sodium transport, thus regulating blood pressure levels. Importantly, excessive effects of the hormone can be blocked by a pharmacological agent (a blocker of the receptor of the hormone): spironolactone. This drug has been used for decades as an anti-hypertensive drug. We identified several tissues where the receptor for the hormone (the mineralocorticoid receptor, MR) is expressed, in addition to kidney cells. Unexpectedly we found the receptor to be present in the human epidermis, but its role there was ignored. We designed first a mouse model, and found that overexpression of the receptor leads to thin and fragile skin in mice, as observed in glucocorticoid-treated skin. We hypothetized that perhaps the glucocorticoids exhibit this deleterious side-effect because they could bind to the mineralocorticoid receptor. As a consequence, we argued that pharmacological blockade of the MR over the skin should limit this side-effect. We used human skin explants in culture, and treated them with a potent dermocorticoid (clobetasol) alone or together with spironolactone. After 5 days in culture, we saw that spironolactone could indeed limit the atrophy of the epidermis induced by the dermocorticoid. Then a clinical trial was performed in healthy volunteers, that confirmed the efficiency of topical spironolactone to limit glucocorticoid-induced atrophy. Although the effect is not full reversion, the benefit was there. This is why we propose now that this approach could bring benefit to patients, if our results are confirmed in patients with psoriasis or eczema, that receive a dermocorticoid cream or gel. (more…)
Author Interviews, Dermatology / 22.03.2015

MedicalResearch.com Interview with: Steven R. Feldman, M.D., Ph.D. Professor of Dermatology Wake Forest Baptist Medical Center Winston-Salem, NC Medical Research: What is the background for this study? What are the main findings? Response: Results show that introducing apremilast into the treatment pathway prior to biologics is cost-saving and confers a cost and quality of life benefit. Over 10 years, apremilast was estimated to provide an additional 0.74 years (5.00 vs. 4.26 years) in which patients achieved a 75% reduction from baseline in PASI score, compared to a pathway of biologics only. It was also found to be less costly, mainly due to less time spent on more expensive biologic therapy (costs reduced by $9,072.39 over 10 years). (more…)
Author Interviews, Dermatology, Infections, JAMA / 15.03.2015

MedicalResearch.com Interview with: Dr. Ana Ramírez-Boscá, MD Department of Dermatology and Clinical Research UnitDr. Ana Ramírez-Boscá, MD Department of Dermatology and Clinical Research Unit and Vicente Navarro-López, MD Clinical Research Unit and Infectious Diseases Unit Centro Dermatológico Estético, Alicante, SpainVicente Navarro-López, MD Clinical Research Unit and Infectious Diseases Unit Centro Dermatológico Estético, Alicante, Spain   MedicalResearch: What is the background for this study? What are the main findings? Response: Infections have been related with the pathogenesis of guttate psoriasis, however antibiotic treatment does not improve prognosis nor does it affect the evolution of the disease. The association between psoriasis and other infectious diseases has been reported as well, although in these cases there is scarce information on the causative microbial likely involved and the role of these bacteria in the pathogenesis of this skin disease. MedicalResearch: What are the main findings?  Response: Bacterial DNA may be detected in bloodstream of a significant proportion of patients with active plaque psoriasis. Increased levels of pro-inflammatory cytokines in patients with presence of bacterial DNA but not in patients without presence of bacterial genomic fragments suggest a role of bacterial DNA translocation in inducing an inflammatory response. (more…)
Author Interviews, Dermatology / 11.03.2015

MedicalResearch.com interview with: J. Kühnl, D. Roggenkamp, G. Neufang. Research & Development, Beiersdorf AG, Hamburg MedicalResearch:What is the background for this study? What are the main findings? Response: The skin is constantly challenged by environmental stressors that induce inflammatory processes, resulting in skin damage and –in the long term- consequently aging processes. UV-irradiation is an important exogeneous stressor. Even the best filter systems do not completely abolish the impact of UV radiation. For example, after application of a SPF50+ sun lotion, about 2% of UV-rays still reach the skin. However, the skin developed strategies to cope with exogenous stressors: Intracellular thiols quench harmful UV-derived free radicals and a multitude of detoxifying enzymes convert noxious compounds and metabolites into harmless species. We strived to specifically stimulate these cytoprotective cellular systems in order to tip the balance in favor of more robust skin cells. Previous studies showed that the root extract of the plant Glycyrrhiza inflata (Chinese Licorice) exhibits anti-inflammatory and anti-microbial effects. The major phenolic constituent of the licorice extract is Licochalcone A (LicA) and this compound is largely responsible for the beneficial effects. This was explained by LicA´s inhibitory effect on the pro-inflammatory transcription factor NFkB and its antioxidant properties. However, in this study, we could add another facet of LicA´s efficacy: by activating the transcription factor Nrf2, LicA stimulates the expression of cytoprotective enzymes such as heme oxygenase I and the key enzyme of glutathione synthesis, resulting in increased intracellular thiols concentrations. Consequently, when pre-incubated with LicA, isolated human skin cells were more robust against solar simulated light-induced cellular damage, indicated by a significantly decrease in the generation of free radicals in vitro. In a translational approach, we conducted a study with healthy volunteers demonstrating that the application of a lotion containing LicA-rich root extract on the inner forearms for two weeks protected the skin from UV-provoked oxidative stress. Thus the cellular effects of licorice are able to provide a protective shield from sun exposure, supporting and going beyond the action of sunscreens regarding sun protection. (more…)
Author Interviews, Dermatology, Melanoma / 06.03.2015

MedicalResearch.com Interview with: Alberto Pappo, M.D. Member, Oncology; Director, Solid Tumor Division St. Jude Children’s Research Hospital Medical Research: What is the background for this study? What are the main findings? Dr. Pappo: Researchers have identified three distinct subtypes of childhood and adolescent tumors of pigment-producing skin cells called melanocytes. The subtypes have different genetic alterations and often different outcomes for patients. The findings should aid efforts to improve diagnosis and treatment of melanoma, which is the most common skin cancer in children and adolescents. The study provides the most comprehensive analysis yet of the genetic alteration underlying pediatric melanoma, including the first genetic evidence that sun damage causes melanoma in children and adolescents as well as adults. Researchers used whole genome sequencing and other techniques to study the normal and cancer genomes of 23 young patients with a variety of melanocytic tumors, including conventional melanoma. Patients ranged in age from 9 months to 19 years old. The melanoma subtypes in this study included conventional melanoma, which scientists showed was the same disease in children, adolescents and adults. More than 90 percent of pediatric conventional melanoma had DNA changes linked to sun damage. (more…)
Author Interviews, Dermatology, Nature / 23.02.2015

Chwee Teck (C.T.) LIM PhD Provost’s Chair Professor, Deputy Head, Department of Biomedical Engineering & Department of Mechanical Engineering Principal Investigator, Mechanobiology Institute Faculty Fellow, Singapore-MIT Alliance for Research & Technology (SMART) National University of Singapore Faculty of Engineering, SingaporeMedicalResearch.com Interview with: Chwee Teck (C.T.) LIM PhD Provost’s Chair Professor, Deputy Head, Department of Biomedical Engineering & Department of Mechanical Engineering Principal Investigator, Mechanobiology Institute Faculty Fellow, Singapore-MIT Alliance for Research & Technology (SMART) National University of Singapore   Medical Research: What is the background for this study? What are the main findings? Professor Chwee Teck Lim: Epithelial cells have a natural tendency to close gaps and this feature plays a crucial role in many biological processes such as embryological development and wound healing. For example, skin does consist of epithelial cells that when wounded, will elicit closure to initiate healing.  How epithelial cells close such gaps has always fascinated researchers from across many disciplines. It is generally accepted that two major mechanisms exist that underlie such a closure. The first is a "cell-crawling" mechanism wherein cells at the edge of the gap actively send protrusions or lamellipodia and use them as footholds to migrate over the gap. However, such a migration requires that the gap is conducive for cells to attach and form adhesions or footholds. The second mechanism is based on a coordinated contraction of multiple bundles of cellular cytoskeletal components (bundles of actin) in a manner similar to that of a "purse-string". Despite many studies, it has always been difficult to understand and characterize these processes separately since most often they co-exist. In this study, we show that keratinocyte monolayers have a tendency to close circular non-adhesive gaps (gaps that have been coated with a polymer that does not allow cells to adhere or form foot-holds) through contraction of bundles of actin within cells at the edge of the gap. We find that such as closure is strongly affected by the size of the gap (gaps more than 150 um in diameter have a tendency to close only partially), curvature of the gap (gaps with high curvature show better closure), and strength of intercellular adhesion (poor intercellular adhesion completely inhibits closure of non-adhesive gaps). (more…)
Author Interviews, Dermatology, JAMA, Melanoma / 17.02.2015

MedicalResearch.com Interview with: Caroline Watts| PhD Candidate Cancer Epidemiology and Services Research | Sydney School of Public Health The University of Sydney MedicalResearch: What is the background for this study? What are the main findings? Response: A clinic for people at high risk of melanoma was established at the Royal Prince Alfred Hospital, Sydney in 2006 to look at the impact of surveillance regime which included regular full body skin examination supported by dermoscopy and total body photography at 6 monthly intervals. If a suspicious lesion was identified, the lesion was either removed or sequential digital dermoscopy was performed and the patient returned in 3 months for review. This study aimed to estimate the costs associated with surveillance in this type of specilaised clinic. The mean number of clinic visits per year was 2.7 (95% CI, 2.5-2.8) for surveillance and 3.8 (95% CI, 3.4-4.1) for patients requiring surgical excisions. The mean annual cost per patient to the health system was A $882 (95% CI, A $783-$982) (US $599 [95% CI, US $532-$665]) and mean annual societal cost per patient (excluding health system costs) was A $972 (95% CI, A $899-$1045) (US $660 [95% CI, US $611-$710). Diagnosis of melanoma or non-melanoma skin cancer and frequent excisions for benign lesions in a relatively small number of patients was responsible for skewed health system costs. (more…)
Author Interviews, Dermatology, Hand Washing, Occupational Health / 15.02.2015

MedicalResearch.com Interview with: Dr Jill Stocks PhD, Research Fellow Centre for Occupational and Environmental Health, Centre for Epidemiology; NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care Institute of Population Health, University of Manchester, UK. Medical Research: What is the background for this study? What are the main findings? Dr. Stocks: Reducing healthcare-associated infections has been a priority in the UK over recent decades; and this has been reflected in interventions and guidelines focussing on improving hygiene procedures. During 2004 to 2008 the Cleanyourhands campaign promoted hand hygiene in all NHS trusts. There was anecdotal evidence from dermatologists and occupational physicians that irritant contact dermatitis was on the increase in healthcare workers, and that it was caused by hand hygiene. We investigated whether or not there was an increase in the incidence of irritant contact dermatitis in healthcare workers due to hand hygiene or other types of hygiene coinciding with the interventions and guidelines promoting hygiene. We used reports made by dermatologists to the Occupational and Health reporting network, a voluntary surveillance scheme collecting reports of work-related ill-health. Trends in incidence of irritant contact dermatitis due to hygiene in healthcare workers were compared with trends in control groups (irritant contact dermatitis in workers with other jobs) using a quasi-experimental (interrupted time series) design. We found a 4.5 fold increase in irritant contact dermatitis due to hand hygiene and hygiene in general in healthcare workers between 1996 and 2012. The results also suggested a steepening of the increase in incidence during the rollout period of the Cleanyourhands campaign but the limitations of the data made this less clear cut. (more…)
Author Interviews, Dermatology, JAMA / 11.02.2015

Omar A. Ibrahimi, M.D., Ph.D Connecticut Skin Institute Founding Medical Director Stamford, CT 06905MedicalResearch.com Interview with: Omar A. Ibrahimi, M.D., Ph.D Connecticut Skin Institute Founding Medical Director Stamford, CT 06905 www.ctskindoc.com Medical Research: What is the background for this study? What are the main findings? Dr. Ibrahimi: The delivery of healthcare in a efficient and cost effective fashion is one of the largest themes in medicine today. Malpractice lawsuits have steadily increased with the cost of healthcare delivery. Mohs surgery involves the surgical removal, the tissue analysis and the reconstruction of a skin cancer all in a single visit that bundles multiple procedures in a cost effective manner that is proposed to be the gold standard for treating certain skin cancers. Information regarding malpractice involving Mohs surgery is lacking. The only previous study that has been done was a survey of Mohs surgeons looking at how many had been involved in lawsuits and the reasons for being involved. Our study examined a legal database to identify all the lawsuits involving Mohs surgery and skin cancer. We were surprised to find that the majority of lawsuits involved non-Mohs surgeons as the primary defendant, mostly due to a delay of or failure in diagnosis, cosmetic outcome issues, lack of informed consent, and a delay of or failure in referral to a Mohs surgeon. (more…)
Author Interviews, Dermatology, JAMA, OBGYNE, UC Davis / 05.02.2015

MedicalResearch.com Interview with: Dr. Eleanor B. Schwarz, M.D., M.S University of California, Davis Sacramento, CA MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Schwarz: The background for this study is that… Women treated with Isotretinoin receive a lot of scary information about this medication’s risk of causing birth defects, but few receive clear information on the most effective ways to protect themselves from undesired pregnancy and the risks of medication-induced birth defects. Our main finding is that women who spent less than a minute reviewing a simple information sheet were significantly more likely to be aware that some contraceptives are considerably more effective than others. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Schwarz: Clinicians who prescribe medications that can cause birth defects should make sure their patients are aware of the fact that women using a birth control pill are typically twenty times more likely to experience a contraceptive failure than those using a subdermal contraceptive implant (e.g. Nexplanon) or intrauterine contraceptive (e.g. Mirena, ParaGard). (more…)
Author Interviews, Dermatology, Diabetes / 04.02.2015

MedicalResearch.com Interview with: Mette Gyldenløve MD Gentofte Hospital, University of Copenhagen Denmark MedicalResearch: What is the background for this study? Dr. Gyldenløve: Epidemiological studies have shown that patients with psoriasis have increased risk of type 2 diabetes. The pathophysiology is largely unknown, but it is hypothesised that systemic inflammation causes insulin resistance, which is an early feature of type 2 diabetes. Insulin sensitivity has only been sparsely investigated in patients with psoriasis, and previous studies have used suboptimal methodology. The objective of the present study was to investigate, if patients with psoriasis exhibit impaired insulin sensitivity when assessed by the hyperinsulinaemic euglycaemic clamp technique (gold standard). MedicalResearch: What are the main findings? Dr. Gyldenløve: In this study we found that normal glucose-tolerant patients with moderate-to-severe psoriasis (n=16) had significantly reduced insulin sensitivity compared to age, gender, and body mass index (BMI)-matched, healthy control subjects (n=16). The two groups were similar with regard to age, gender, BMI, body composition, physical activity, fasting plasma glucose, and glycosylated haemoglobin. (more…)
Author Interviews, Dermatology, Education / 30.01.2015

Robert S. Kirsner, MD, PhD, FAAD Interim Chairman and Harvey Blank Professor in Dermatology, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine Director, University of Miami Hospital Wound Center Chief of Dermatology, University of Miami HospitalMedicalResearch.com Interview with: Robert S. Kirsner, MD, PhD, FAAD Interim Chairman and Harvey Blank Professor in Dermatology, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine Director, University of Miami Hospital Wound Center Chief of Dermatology, University of Miami Hospital Medical Research: What is the background for this study? What are the main findings? Dr. Kirsner: Psoriasis is common, affecting 7.5 million Americans. The major indication of psoriasis is chronic inflammation of the skin. It is characterized by disfiguring, scaling and erythematous plaques that may be painful or pruritic and may cause significant quality of life issues. Psoriasis may also cause joint pain and more recently has been associated with metabolic syndrome, diabetes, cardiovascular disease, dyslipidemia, hypertension and nonalcoholic fatty liver disease. Thus, patients may be physically and emotionally impacted by psoriasis. The American Academy of Dermatology (Academy) developed a Performance Improvement (PI) CME activity to enhance dermatologists’ care of psoriasis patients by allowing them to evaluate their practice using patient charts, utilize evidence-based strategies to overcome self-identified gaps, and then re-measure their performance using charts for patients seen after practice changes were implemented. It was found that the PI CME activity significantly improved dermatologists’ overall documentation of patient history, patient counseling for lifestyle behaviors and shared decision-making ability. For example, dermatologists who participated in and completed this PI CME activity improved practice performance by either inquiring about or documenting to a greater extent comorbidities (particularly cardiovascular disease), drug costs and interactions, patient preference, other medical problems, and severity of disease, resulting in an overall improvement in documented clinical behaviors. (more…)
Author Interviews, Dermatology, PLoS, Stem Cells / 29.01.2015

Alexey Terskikh, Ph.D. Associate Professor Department of Developmental and Stem Cell Biology Sanford-Burnham Medical Research Institute La Jolla, CAMedicalResearch.com Interview with: Alexey Terskikh, Ph.D. Associate Professor Department of Developmental and Stem Cell Biology Sanford-Burnham Medical Research Institute La Jolla, CA Medical Research: What is the background for this study? What are the main findings? Dr. Terskikh: Hair loss is a wide spread human condition with an unmet need for hair replacement. In the United States alone, over 40 million men and 21 million women are affected by hair loss. I have been interested in the differentiation of human pluripotent stem cells into various cell including neural crest cells. In-vivo neural crest cells give rise to a multitude of cell types, including dermal papilla cells, which populate the bulb of hair follicles and regulate hair growth. We have established new method to differentiate human pluripotent stem cells into dermal papilla-like (DP-like) cells, with a goal of inducing hair growth. To find out whether DP-like cells induce hair growth we transplanted these cells under the skin of mice (which have a small amounts of white hair) along with the skin cells from dark-haired mice. We observed the growth of new black hairs suggesting the induction of hair growth by transplanted human DP-like cells. (more…)
Allergies, Author Interviews, Dermatology / 25.01.2015

Dr. Alan Irvine, MD Professor in Dermatology Department of Clinical Medicine Trinity College DublinMedicalResearch.com Interview with: Dr. Alan Irvine, MD Professor in Dermatology Department of Clinical Medicine Trinity College Dublin   Medical Research: What is the background for this study? What are the main findings? Response: Atopic diseases include atopic dermatitis (AD, also know as eczema), food allergy, allergic rhinitis and asthma.  The prevalence of these diseases has increased in recent decades causing considerable morbidity in childhood. The putative “Atopic March” refers to the typical sequence of clinical manifestation of atopic disease, usually initiated by atopic dermatitis from early infancy. Parental atopy is an independent risk factor for development of atopic disease. The genetic mechanisms and inheritance pattern of atopic diseases are not fully elucidated but recent candidate gene studies and Genome Wide Association Studies (GWAS) have yielded some insights. The most widely replicated and most significant gene to influence atopic dermatitis is Filaggrin (FLG). Filaggrin is a filament binding protein in the stratum Corneum. FLG loss-of-function mutations (FLG mut) occur in 10% of Europeans, imparting an increased risk of atopic dermatitis, food allergy and asthma.  The overall increase in risk of atopic dermatitis conferred by a single FLG loss-of-function mutation is approximately 3.3, with a significant additional and independent effect conferred by intragenic copy number variations in FLG. Importantly FLG mutations increase the risk of developing asthma only in the presence of atopic dermatitis. While loss-of-function mutations in the skin barrier protein filaggrin (FLG) are a major risk for atopic dermatitis, the pathogenic sequence of disturbances in skin barrier function prior to or during the early development of atopic dermatitis is not fully understood. A more detailed understanding of these events is needed to develop a clearer picture of disease pathogenesis. A robust, non-invasive test to identify babies at high risk of atopic dermatitis would be important in planning early intervention and/or prevention studies. We found that raised transepidermal water loss at birth and at two months in asymptomatic infants predates the development of atopic dermatitis. This signal is independent of FLG status and parental atopy. (more…)
Author Interviews, Dermatology, HIV / 22.01.2015

MedicalResearch.com Interview with: Dr Sophie Grabar, MD, PhD Unité de Biostatistique et Epidémiologie (Aile B2-5ieme étage) Groupe Hospitalier Cochin Broca Hôtel-Dieu PARIS Medical Research: What is the background for this study? Dr. Grabar: We took advantage of a large cohort, the French Hospital on HIV-ANRS CO4 cohort, of more than 100 000 HIV-infected patients to study the incidence trends and risk factors of Herpes Zoster since the advent of cART (combination antiretroviral medications)that have been discrepantly reported in the literature. Also, because Herpes Zoster has been associated with Immune Reconstitution Inflammatory Syndrome, we studied the early impact of cART initiation on the risk of Herpes Zoster and finally evaluated the risk with regards to the risk in the general population that has never been reevaluated in recent years. Medical Research: What are the main findings? Dr. Grabar: We found that the incidence of Herpes Zoster has significantly declined with the arrival of cART and continue to decline probably owing to the immune recovery induced by cART. The risk in HIV-infected patients is globally 3-times higher to that of the general population, and 6-times higher between 15-45 years. Among cART naive patients, we found that the risk of Herpes Zoster increases in the first months of cART initiation but only moderately while it sharply decreases after 6 months of cART. (more…)
Author Interviews, Dermatology, Heart Disease / 18.01.2015

Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology, Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, IllinoisMedicalResearch.com Interview with: Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology, Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois Medical Research: What is the background for this study? What are the main findings? Dr. Silverberg: There is a growing body of literature supporting an association between psoriasis and increased cardiovascular risk. We hypothesized that these associations are not specific to psoriasis. Rather, they likely occur in other chronic inflammatory skin disorders, namely eczema. We studied two large-scale US population-based studies and found that adults with eczema were more likely to smoke cigarettes, drink alcohol and were less physically active. In turn, they also have higher rates of obesity, high blood pressure, prediabetes and type 2 diabetes and high cholesterol. Of note, eczema was associated with these disorders even after controlling for smoking, alcohol consumption and physical activity. This suggests that chronic inflammation and/or other factors related to eczema may also drive increased cardiovascular risk. (more…)
Author Interviews, Cancer Research, Dermatology / 13.01.2015

MedicalResearch.com Interview with : Cédric Blanpain, MD, PhD Professor of Stem Cell and Developmental Biology WELBIO, Interdisciplinary Research Institute (IRIBHM) Université Libre de Bruxelles Belgium MedicalResearch.com : What is the background for this study? What are the main findings? Dr. Blanpain: Squamous cell carcinoma (SCC) represents the second most frequent skin cancer with more than half million new patients affected every year in the world. Cancer stem cells (CSCs) are a population of cancer cells that have been described in many different cancers including skin SCCs and that feed tumor growth. These cells could be resistant to therapy thus being responsible for tumor relapse after therapy. However, still very little is known about the mechanisms that regulate Cancer stem cells functions. In a new study published and making the cover of Cell Stem Cell, researchers led by Pr. Cédric Blanpain, MD/PhD, professor and WELBIO investigator at the IRIBHM, Université libre de Bruxelles, Belgium, report the mechanisms regulating the different functions of Twist1 controlling skin tumour initiation, cancer stem cell function and tumor progression. Benjamin Beck and colleagues used state of the art genetic mouse models to dissect, the functional role and molecular mechanisms by which Twist1 controls tumor initiation, cancer stem cell function and tumor progression. In collaboration with Dr Sandrine Rorive and Pr Isabelle Salmon from the department of Pathology at the Erasme Hospital, ULB and the group of Jean-Christophe Marine (VIB, KUL Leuven), they demonstrated that while Twist1 is not expressed in the normal skin, Twist1 deletion prevents skin cancer formation demonstrating the essential role of Twist1 during tumorigenesis. The authors demonstrate that different levels of Twist1 are necessary for tumor initiation and progression. Low level of Twist1 is required for the initiation of benign tumors, while higher level of Twist1 is necessary for tumor progression. They also demonstrate that Twist1 is essential for tumor maintenance and the regulation of cancer stem cell function. The researchers also uncovered that the different functions of Twist1 are regulated by different molecular mechanisms, and identified a p53 independent role of Twist1 in regulating cancer stem cell functions. (more…)
Author Interviews, Dermatology, Infections, Pediatrics / 06.01.2015

Jonathan Olsen Institute of Primary Care and Public Health Cardiff University Heath Park CardiffMedicalResearch.com Interview with: Jonathan Olsen Institute of Primary Care and Public Health Cardiff University Heath Park Cardiff MedicalResearch: What is the background for this study? What are the main findings? Response: Molluscum Contagiosum is a common skin condition in children which has a prevalence of between 5.1% to 8% in children aged 14 years and under. Strikingly however, there is little epidemiological evidence describing the natural history, transmission between family members and impact upon quality of life of molluscum contagiosum. Our research aimed to address this gap in evidence by conducting a prospective cohort study of UK children recruited by clinical and self-referral using the validated Molluscum Contagiosum Diagnostic Tool for Parents (MCDTP). We recruited 306 children during 2013 and showed that on average lesions will last for 12 months, however 30% still had lesions at 18 months and 13% still had lesions at 24 months. Most children experienced only a small effect on their quality of life from the condition, however 1 in 10 experienced a large or very large impact on their quality of life. The condition was shown to be highly contagious with further transmission between children living in the same household as an index case shown in 40%. (more…)
Aging, Author Interviews, Dermatology / 03.01.2015

David Granville, BSc, PhD, FAHA Professor, University of British Columbia Scholar of the Royal Society of Canada Director, GEM Facility, Centre for Heart Lung Innovation, St. Paul's Hospital Founder and CSO, viDA Therapeutics, Inc. Vancouver, BC, CanadaMedicalResearch.com Interview with: David Granville, BSc, PhD, FAHA Professor, University of British Columbia Scholar of the Royal Society of Canada Director, GEM Facility, Centre for Heart Lung Innovation, St. Paul's Hospital Founder and CSO, viDA Therapeutics, Inc. Vancouver, BC, Canada Medical Research: What is the background for this study? What are the main findings? Dr. Granville: My background is in cardiovascular research. In particular, how age affects blood vessels and how age affects mechanisms of blood vessel and heart injury and repair. We became interested in skin aging during a study in which we were studying the role of a protein degrading enzyme known as Granzyme B in atherosclerosis (hardening of the arteries) and aging. In these studies, we were using a genetic mouse model that is prone to accelerated aging, and knocked out Granzyme B. Although we were initially focused on the blood vessels, we also found that Granzyme B-deficient mice exhibited younger-looking skin. As we started to look into this, we became aware that UV light can induce the skin cells to produce Granzyme B. As sunlight is believed to be responsible for 80-90% of preventable skin aging, we generated a solar-simulated light box (with the similar ratios of UVA/UVB to sunlight) to assess whether Granzyme B played a role in UV-induced skin aging (aka photoaging). We exposed the mice to repetitive, low dose UV three times per week for 20 weeks. After 20 weeks we observed that Granzyme B deficient mice exhibited fewer wrinkles. We then wanted to look histologically and biochemically into how Granzyme B was affecting skin morphology. Granzyme B deficient mice exhibited greater collagen density compared to mice that possessed Granzyme B. As we looked into the mechanism in more detail, we determined that Granzyme B was cleaving a protein known as decorin. Decorin is responsible for collagen fibrillogenesis and assembling collagen into tight bundles. Loss of decorin is associated with a loss of collagen tensile strength. Interestingly, decorin also protects collagen from destruction by a protein-degrading enzyme known as MMP1. We showed in the study that by breaking down decorin, Granzyme B renders collagen susceptible to MMP1-mediated degradation. In addition, we showed that Granzyme B-fragmentation of another protein, fibronectin, led to the upregulation of MMP1 in skin fibroblasts. In summary, the paper showed that UV induced Granzyme B expression in the skin and showed that this enzyme contributes to the breakdown of extracellular matrix proteins and formation of wrinkles. A link to the Aging Cell publication: http://onlinelibrary.wiley.com/doi/10.1111/acel.12298/pdf (more…)
Author Interviews, Dermatology, Smoking, Weight Research / 26.12.2014

MedicalResearch.com Interview with: Seong Jin Jo, MD, PhD Department of Dermatology Seoul National University College of Medicine Seoul Korea. Medical Research: What is the background for this study? What are the main findings? Response: Hair graying is a natural aging process, but some people develop hair graying in their youth. In this study of young Korean males, we found that obesity, smoking, and family history were significantly associated with premature hair graying. (more…)
Author Interviews, Blood Pressure - Hypertension, Case Western, Dermatology, JAMA, Weight Research / 26.12.2014

Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology, Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, IllinoisMedicalResearch.com Interview with: Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology, Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois Medical Research: What is the background for this study? Dr. Silverberg: Previous studies found associations between obesity and atopic dermatitis (AD). However, little was known about the association between AD and metabolic risk factors, such as central obesity and high blood pressure. (more…)
Author Interviews, Dermatology, JAMA, Melanoma, Occupational Health, UCSF / 18.12.2014

Martina Sanlorenzo, MD Department of Dermatology Mount Zion Cancer Research Center University of California, San FranciscoMedicalResearch.com Interview with: Martina Sanlorenzo, MD Department of Dermatology Mount Zion Cancer Research Center University of California, San Francisco Medical Research: What is the background for this study? Dr. Sanlorenzo: We recently performed a meta-analysis and found an increased risk of melanoma in pilots and cabin crew. One of the possible occupational hazards responsible for this risk is UV radiation. Medical Research: What are the main findings? Dr. Sanlorenzo: We performed UV measurements in airplane cockpits during flight and we found that windshields blocked UV-B but allowed UV-A transmission. We compared the UV-A dose in airplanes with the UV-A dose in tanning beds, whose use is a known risk factor for melanoma. Pilots flying for 56.6 minutes at 30,000 feet received the same amount of UV-A carcinogenic effective radiation of a 20-minute tanning beds session. (more…)
Author Interviews, CDC, Dermatology, Emergency Care, JAMA / 16.12.2014

Gery P. Guy Jr., PhD, MPH Health economist Division of Cancer Prevention and Control’s Epidemiology and Applied Research Branch CDCMedicalResearch.com Interview with: Gery P. Guy Jr., PhD, MPH Health economist Division of Cancer Prevention and Control’s Epidemiology and Applied Research Branch CDC Medical Research: What is the background for this study? What are the main findings? Dr. Guy: Indoor tanning exposes users to intense UV radiation and is associated with an increased risk of skin cancer. However, little is known about the more immediate adverse outcomes of indoor tanning. This study provides the first national estimates of visits to emergency departments related to indoor tanning. We examined cases from the Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS), a national probability sample of hospitals in the U.S. and its territories. Patient information is collected from each NEISS hospital for every emergency visit involving an injury associated with consumer products. From this sample, the total number of product-related injuries treated in hospital emergency rooms nationwide can be estimated. (more…)
Author Interviews, Dermatology, Nature, Sleep Disorders / 14.12.2014

Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology, Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, IllinoisMedicalResearch.com Interview with: Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology, Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois Medical Research: What is the background for this study? What are the main findings? Dr. Silverberg: Chronic itch related to childhood eczema has been shown to cause worsened sleep quality with shorter sleep duration, more frequent and prolonged awakening, and overall lower sleep efficiency. However, little is known about the sleep disturbances that occur in adults with eczema. (more…)
Author Interviews, Dermatology, Ebola / 01.12.2014

Victoria Vaughan Medical College of Georgia, Augusta, GeorgiaMedicalResearch.com Interview with: Victoria Vaughan Medical College of Georgia, Augusta, Georgia Medical Research: What is the background for this study? What are the main findings? Response: The Global Mortality of Skin Disease study compares age adjusted mortality of disease with skin manifestations between developing and developed countries for the years 1990 and 2010. The main findings were that mortality from infectious conditions was greater in the developing world while melanoma contributed to mortality in the developed world. Ebola Virus Disease has cutaneous manifestations and affects the developing world preferentially. As of November 27, 2014, the mortality in West Africa totals 5444 according to the CDC. However, the United States has had only two deaths from Ebola Virus Disease. (more…)
Author Interviews, Dermatology / 28.11.2014

Univ.-Prof. Dr. med. Tilo Biedermann Klinikdirektor Klinik und Poliklinik für Dermatologie und Allergologie der Technischen Universität München Biedersteinerstr. MünchenMedicalResearch.com Interview with: Univ.-Prof. Dr. med. Tilo Biedermann Klinikdirektor Klinik und Poliklinik für Dermatologie und Allergologie der Technischen Universität München Biedersteinerstr. München Medical Research: What is the background for this study? What are the main findings? Prof. Biedermann: The skin is constantly exposed to microbes and skin developed during evolution under the constant influence of microbes. Tightly regulated communication between microbes and the skin can be expected and levels of regulation still needed to be explored. We found that Gram-positive bacteria when sensed by one certain innate immune receptor (hetero dimer TLR 2-6 suppresses immunity both in animal models and in humans. Following the sensing of lipoproteins by toll like receptor 2-6) skin produces high levels of InterleukinL6 that induce the accumulation of so called myeloid-derived suppressor cells. These cells can be found in the blood but also migrate to the skin suppressing T-cell-immunity allowing infections to spread on the skin. (more…)