Author Interviews, Dermatology, Genetic Research / 28.05.2016
Genes That Activate Inflammation in Psoriasis Identified
MedicalResearch.com Interview with:
Ryuta Muromoto, Ph.D.
Department of Immunology,
Faculty of Pharmaceutical Sciences, Hokkaido University
Sapporo, Japan
MedicalResearch.com: What is the background for this study?
Dr. Muromoto: Psoriasis is an immune-mediated chronic inflammatory skin disorder that affects some 125 million people worldwide. It is characterized by itchy, scaly skin plaques. It has been known that a cytokine IL-17A, which is produced by immune cells, plays a central role in the development and maintenance of clinical features of psoriasis. IL-17A acts on keratinocytes and up-regulates anti-microbial peptides and a set of chemokines, that are important for immune cell infiltration. This immune cell feedback amplifies psoriatic inflammation. Also, other inflammatory cytokines such as TNF-alpha and interferon-gamma are up-regulated, and have been implicated in pathogenesis of psoriasis. So, the interplay between cytokines appears to be important for development of psoriasis through keratinocyte activation. In this study, we sought to clarify the actual role of IL-17A and its interplay with other cytokines in keratinocyte activation.
Dr. Jack Resneck[/caption]
Jack Resneck, Jr, MD
Professor and Vice-Chair of Dermatology
Core Faculty, Philip R. Lee Institute for Health Policy Studies
UCSF School of Medicine
MedicalResearch.com: What is the background for this study?
What are the main findings?
Dr. Resneck: Telemedicine, when done right, can improve access and offer convenience to patients. We have seen proven high-quality care in telemedicine services where patients are using digital platforms to communicate with their existing doctors who know them, and where doctors are getting teleconsultations from other specialists about their patients. But our study shows major quality problems with the rapidly growing corporate direct-to-consumer services where patients send consults via the web or phone apps to clinicians they don’t know.
Most of these sites aren’t giving patients a choice of the clinician who will care for them or disclosing the credentials of those clinicians – patients should know whether their rash is being cared for by a board-certified dermatologist, a pain management specialist, or a nurse practitioner who usually works in an emergency department. Some of these sites are even using doctors who aren’t licensed in the US. We also found that these sites were regularly missing important diagnoses, and prescribing medications without discussing risks and side-effects, putting patients at risk. We observed that if you upload photos of a highly contagious syphilis rash but state that you think you have psoriasis, most clinicians working for these direct-to-consumer sites will just agree with your self-diagnosis and prescribe psoriasis medications, leaving you with a contagious STD.
Perhaps the biggest problem with many of these sites is the lack of coordinating care for patients – most of them didn’t offer to send records to a patient’s existing local doctors. And when patients end up needing in-person care if their condition worsens, or they have a medication side-effect, those distant clinicians often don’t have local contacts, and are unable to facilitate needed appointments.
Dr. Uscher-Pines[/caption]
Lori Uscher-Pines, PhD
RAND Corporation
Arlington, Virginia
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Although many communities in the U.S. are underserved by dermatologists, access is particularly limited among Medicaid patients. Teledermatology may be one solution to improve access. Our goal with this study was to assess the effect of a novel teledermatology initiative on access to dermatologists among enrollees in a Medicaid Managed Care Plan in California’s Central Valley.
Among all patients who visited a dermatologist after the introduction of teledermatology from 2012-2014 (n=8614), 49% received care via teledermatology. Among patients newly enrolled in Medicaid following Medicaid expansion in 2014, 76% of those who visited a dermatologist received care via teledermatology. Patients of primary care practices that engaged in teledermatology had a 64% increase in the fraction of patients visiting a dermatologist (vs. 21% in other practices) (p<.01). Compared with in-person dermatology, teledermatology served more patients under age 17, male patients, nonwhite patients, and patients without comorbid conditions. Conditions managed across settings varied; teledermatology physicians were more likely to care for viral skin lesions and acne whereas in-person dermatologists were more likely to care for psoriasis and skin neoplasms.
Dr. Orit Markowitz[/caption]
Orit Markowitz, MD, FAAD
Director of Pigmented Lesions and Skin Cancer
Assistant Professor of Dermatology
Mount Sinai Medical Center, NY, NY
Director of Pigmented lesions clinic
Brooklyn VA, Brooklyn, NY
Adjunct Professor, Dermatology
SUNY Downstate Medical Center, Brooklyn, NY
Chief of Dermatology
Queens General Hospital, Jamaica, NY
MedicalResearch.com: How common is skin cancer? Is the incidence rising in US adults? Who is most at risk?
Dr. Markowitz: The annual incidence of skin cancer is more than breast, colon, lung, and prostate cancer combined. Of the 7 most common skin cancers in the US melanoma is the only one whose incidence is increasing. The highest risk group for skin cancer are fair skin, adults with a history of sun exposure.
Dr. Lazovich[/caption]
MedicalResearch.com Interview with:
DeAnn Lazovich, Ph.D.
Associate Professor
Division of Epidemiology and Community Health
University of Minnesota
Minneapolis, MN 55454
Medical Research: What is the background for this study? What are the main findings?
Dr. Lazovich: In Minnesota, as well as nationally, melanoma rates have been increasing more steeply in women than men younger than age 50 years since about the mid-1990s. Some have speculated that this could be due to women's indoor tanning use, as women use indoor tanning much more than men do. We had data on indoor 
Pritesh Karia[/caption]
MedicalResearch.com Interview with:
Tanning Bed CDC Image[/caption]
MedicalResearch.com Interview with:
Myra Sendelweck M.Eng
M.D. Candidate 2018 and
Robert Dellavalle, MD, PhD, MSPH
Chief, Dermatology Service Denver VA Medical Center Denver, CO
University of Colorado School of Medicine
MedicalResearch: What is the background for this study? What are the main findings?
Response: Indoor tanning has increasingly been recognized amongst providers as a public health concern. Recent literature suggests an association between indoor tanning and other risky health behaviors in adolescents.
We were intrigued by this association. We analyzed a survey of Colorado high school students and found that those who tanned were also more likely to use various substances, such as steroids, alcohol, marijuana, and illicit drugs. Tanners were over five times as likely to report steroid use!
Dr. Jung Min Bae[/caption]
MedicalResearch.com Interview with:
Jung Min Bae, MD, PhD
Department of Dermatology, St. Vincent's Hospital,
College of Medicine
The Catholic University of Korea,
Suwon Korea
Medical Research: What is the background for this study?
Response: Vitiligo is one of the major challenging skin diseases. Although a number of interventions have been done in the treatment of vitiligo, no definitive curative treatment exists. Narrowband ultraviolet B phototherapy is considered the mainstay of vitiligo treatment, and 308-nm excimer laser/light therapy has gained popularity for localized vitiligo. However, they are not effective in all patients with vitiligo, and the combination therapies with topical agents are widely applied to increase the response rates of these treatment modalities in clinical practice. We sought to compare the efficacy of excimer laser/light and topical agent combination therapy versus excimer laser/light monotherapy for vitiligo. We performed a systematic review and meta-analyses of randomized controlled trials in this subject.
Medical Research: What are the main findings?
Response: According to our study, the combination therapy of excimer laser/light and topical calcineurin inhibitors showed almost a two-fold increase in treatment success rate (≥75% repigmentation) compared to excimer laser/light monotherapy (relative risk 1.93). The combination therapy also reduced the treatment failure rate (<25% repigmentation) by almost half (relative risk 0.43). Addition of topical vitamin-D3 analogs or topical corticosteroids on excimer laser/light showed insufficient evidence to support their use in combination therapies yet. Considering the difficulites in complete recovery of vitiligo, the combination therapies enhancing the treatment response are promising.
Dr. Jason Lee[/caption]
MedicalResearch.com Interview with:
Jason B. Lee MD
Professor , Clinical Vice Chair
Department of Dermatology and Cutaneous Biology
Director, Jefferson Dermatopathology Center
Thomas Jefferson University
Philadelphia, Pennsylvania
Medical Research: What is the background for this study? What are the main findings?
Dr. Lee: When initially described, Clark et al. suggested that dysplastic nevi were intermediate lesions that lie biologically on a spectrum between benign and malignant. As such, they were to be histologically graded as mild, moderate, and severe (or a combination thereof), with mild presumably closer to benign and severe closer to malignant. In this paradigm, adopted by most dermatologists, these nevi are routinely excised based on histologic grading and margin status. Recent outcomes of follow-up and excision studies of dysplastic nevi suggest that they are over treated as there have been very low rates of melanoma on re-excision.
An alternative approach considers dysplastic or eponymously Clark nevi as common acquired nevi, typically in fair skin individuals, and rejects the entire notion that they are intermediate lesions as there exists no formal proof of their intermediate status. This approach omits grading and margin status entirely, providing the clinician an explicit recommendation for excision only for those cases of diagnostic uncertainty. In this study, excision recommendation rate of dysplastic/Clark nevi was determined along with analysis of excision outcomes in a laboratory where non-grading histologic diagnostic approach to these nevi has been adopted.
The excision recommendation rate, representing the diagnostic uncertainty rate, was 11.1%. Out of 80% of the cases returned for excision, only 2.0% of the cases were interpreted as melanoma on excision; all were in situ or thin melanomas. This excision rate is much lower than in prior reports, which vary from 22-52%, while still capturing melanomas within this subset of lesions.
Dr. Shinkai[/caption]
MedicalResearch.com Interview with:
Kanade Shinkai, MD PhD
Associate Professor of Clinical Dermatology
Director, Residency Program
Endowed Chair in Dermatology Medical Student Education
UCSF Department of Dermatology
San Francisco, CA 94115
Medical Research: What is the background for this study? What are the main findings?
Dr. Shinkai: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder in the United States that has important skin manifestations including acne, hair loss, hirsutism, and acanthosis nigricans. We performed a retrospective cross-sectional study of women referred to a multidisciplinary PCOS clinic at UCSF to determine whether skin findings and systemic associations differ between women who meet diagnostic criteria for PCOS versus those suspected of having PCOS but do not meet diagnostic criteria. We found that women with PCOS commonly have skin findings, however, present across a broad spectrum of cutaneous manifestations.
Comparing the skin findings in women who meet diagnostic criteria for PCOS with women who are suspected of having PCOS suggests that it can be very difficult to distinguish a patient with PCOS based on skin findings alone. Hirsutism and acanthosis nigricans are the most helpful findings to suggest 
Christie Riemer[/caption]
MedicalResearch.com Interview with:
Christie Riemer
MD Candidate-Class of 2016
Michigan State University
College of Human Medicine
Medical Research: What is the background for this study? What are the main findings?
Response: Online physician rating sites allow patients to recommend, grade, and publicly comment on physician performance. Despite increases in physician rating website popularity, little information exists regarding the online footprint of dermatologists. Many physicians also remain wary of these websites for fear of malicious reviews.
Our study aimed to investigate the patterns of dermatologist online ratings. We found the average ratings for dermatologists were high, >3.5 stars, on the top 5 websites (ZocDoc, Healthgrades, Yelp, RateMDs, and 
Dr. Chia-Yu Chu[/caption]
MedicalResearch.com Interview with:
Chia-Yu Chu, MD, PhD
Associate Professor, Department of Dermatology
National Taiwan University Hospital
Medical Research: What is the background for this study? What are the main findings?
Dr. Chia-Yu Chu: It has been well known that EGFR TKIs could cause skin toxicities (acneiform eruptions, pruritus, xerosis and paronychia). However, incidences of these skin toxicities have varied according to the different clinical trials, some of which even simply use “skin rash” instead of specific cutaneous findings in the reports.
Afatinib, in contrast to first generation EGFR TKIs like gefitinib and erlotinib, is a second generation EGFR TKI with irreversible inhibition to not only EGFR, but also HER2 and ErbB4. Whether afatinib cause more skin toxicities remained unknown.
Many of our patients received 2 or even 3 different EGFR TKIs with adequate drug exposure and washout period. Therefore, we had an opportunity to compare skin toxicities in “same patients” receiving different EGFR TKIs, and we found that around 30% of patients receiving afatinib developed paronychia whereas only 10% in gefetinib or erlotinib. This was the only significant difference between the 3 drugs. We also found afatinib treated patients needed significantly more dermatologic visits within 180 days of treatments and the reason was due to higher incidence of afatinib-related paronychia. Interestingly, regardless of causative agents, once skin toxicities developed they could be managed effectively in the same manners.
Dr. Susana Puig[/caption]
MedicalResearch.com Interview with:
Susana Puig MD PhD
Chief Dermatology Service
Research Director
"Melanoma: Imaging, genetics and immunology" at IDIBAPS
Consultant & Assistant Professor
Melanoma Unit, Dermatology Department
Hospital Clinic, University of Barcelona
Barcelona Spain
Medical Research: What is the background for this study? What are the main findings?
Dr. Puig: CDKN2A is the main high-penetrance melanoma susceptibility gene. A rare functional variant in MITF, p.E318K (rs149617956), has been identified as a moderate risk allele in melanoma susceptibility and also predisposes to renal cell carcinoma.
In this study MITF p.E318K was associated with an increased melanoma risk (OR=3.3, p<0.01), especially in patients with multiple primary melanoma (OR=4.5, p<0.01) and high nevi count (>200 nevi) (OR=8.4, p<0.01). Interestingly, two fast growing melanomas were detected among two MITF p.E318K carriers during dermatologic digital follow-up. Furthermore, we have detected a similar prevalence of MITF p.E318K in CDKN2A wild-type and mutated individuals.
Dr. Becevic[/caption]
MedicalResearch.com Interview with:
Mirna Becevic, PhD, MHA
Assistant Research Professor of Telemedicine
University of Missouri - Department of Dermatology
Missouri Telehealth Network
Medical Research: What is the background for this study? What are the main findings?
Dr. Becevic: The Missouri Telehealth Network (MTN) at the University of Missouri has been providing outpatient clinical services to rural Missourians since 1995. Over 29 specialties and subspecialties have been utilized to assist patients in 69 counties. We have learned a lot along the way, what works well and what does not, in terms of telehealth protocols, trainings, best practices, etc.
The MTN holds bi-annual two day training conference for new sites to share these experiences and provide hands-on training in telemedicine. Our main goal with this study was to reach all telehealth users on the Missouri Telehealth Network (patients, providers, and telehealth coordinators-patient presenters) and learn about their perceptions of and opinions regarding this form of health care delivery. We also wanted to evaluate the overall accessibility and discernment of the MTN by telehealth coordinators, since we felt that they might need to have continuous support in order to successfully manage their telehealth programs.
Our main findings indicated that all three surveyed groups had high satisfaction with telemedicine. Patients were confident in their doctors’ medical skills, and lack of physical contact was not viewed as a barrier. Telehealth providers thought telehealth was an effective tool for providing care at a distance, but indicated that they did not prefer telehealth over in-person visits.
Dr. Cleynen[/caption]
MedicalResearch.com Interview with:
Isabelle Cleynen PhD
University of Leuven
Medical Research: What is the background for this study? What are the main findings?
Dr. Cleynen : Ulcerative colitis and Crohn’s disease, together inflammatory bowel disease (IBD), are characterized by chronic inflammation of the gastrointestinal tract. Treatment for IBD usually involves drug therapy including anti-inflammatory drugs and immune system repressors, amongst which biologics as the anti-TNF antibodies used for patients with moderate to severe IBD. Although these TNF-blocking drugs are effective in many patients with immune-mediated disorders like psoriasis, rheumatoid arthritis and spondylarthropathies, and IBD, several case reports and series showed that some patients developed troubling skin problems (including psoriasis and eczema), causing them to stop the anti-TNF treatment. It is however not clear how often these skin problems develop in IBD patients treated with anti-TNF, and what could be the predisposing factors.
In a retrospective cohort of 917 
Prof. Chiang[/caption]
MedicalResearch.com Interview with:
Prof. Bor-Luen Chiang
Vice Superintendent, National Taiwan University Hospital
Professor of Graduate Institute of Clinical Medicine and Pediatrics
National Taiwan University
Attending Physician, Department of Medical research
National Taiwan University Hospital and
Yung-Sen Chang, MD MPH
Attending physician, Department of Pediatrics,
Taipei City Hospital Renai Br.
Adjunct Attending Physician, Department of Pediatrics
National Taiwan University Children’s Hospital
Adjunct Instructor, School of Medicine, National Yang-Ming University
Medical Research: What is the background for this study?
Prof. Chang: Sleep disturbance is a common disorder in the children with atopic dermatitis (AD) (reported in 47 to 60%), but no effective way of managing this problem had been established. In our preceding study, we found that lower nocturnal melatonin level was significantly associated with sleep disturbance in the patients with AD. Melatonin is a hormone secreted by the pineal gland which plays an important role in sleep regulation. In addition to sleep-inducing effects, melatonin also has anti-inflammatory and immunomodulatory properties which might be helpful for the management o fatopic dermatitis. Furthermore, melatonin has an excellent safety profile with minimal adverse effects, making it a good choice for children. Therefore, we aimed to evaluate whether melatonin is effective for improving the sleep problems and the dermatitis severity in children with 
Dr. Nagler[/caption]
MedicalResearch.com Interview with:
Arielle Nagler MD
Instructor, Department of Ronald O. Perelman Department of Dermatology
NYU Langone Medical Center
Medical Research: What are some of the best ways to keep our skin healthy?
Dr. Nagler: Sun protection is the single, most important step you can take to keep your skin healthy. Sun protection can help to prevent many of the signs of aging including wrinkles, changes in skin texture, and uneven pigmentation. Also sun protection has been shown to prevent certain types of skin cancer, which may save you from the distress and scarring of treatment. While we should all be careful in the sun, sun protection doesn’t mean that you have to avoid all outdoor activities and deprive yourself of outdoor fun. If you have any issues with your skin, or want more information, you might want to look into someone like this 
Dr. Silverberg[/caption]
MedicalResearch.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: We previously showed that adults with eczema are more likely to smoke cigarettes, drink alcohol and have sedentary lifestyle. We wondered whether chronic eczema might negatively impact upon other health behaviors, such as seeking preventive care and vaccinations. On the other hand, previous studies from our group and others found that both children and adults with eczema have a number of comorbid medical and mental health conditions. One potential reason for this is detection bias from since eczema patients are “plugged into” the healthcare system because of their skin disease, which allows them to be diagnosed more frequently with other health problems.
We sought to understand the routine and preventive healthcare behaviors of children and adults with eczema. We found that adults with eczema were more likely to be vaccinated for tetanus, influenza, hepatitis A and B viruses, human papilloma virus and pneumonia. Moreover, they were more likely to undergo age-appropriate health screenings, such as blood pressure and cholesterol checks, but not cancer screening. Adults with eczema were more likely to interact with a variety of general doctors and specialists.
Similarly, 
