Published by
Stanford Medicine

Category

Dermatology

Dermatology, In the News, Public Health

Don't feed the bedbugs: Tips for travelers

hotel bedHere’s something to think about before heading out for a summer weekend adventure: bedbugs. They still exist. And a new article from Wired offers a few practical tips to spot and avoid bringing home unwelcome guests.

From the piece (weigh the pros and cons of viewing “itch-inducing photos” before clicking the link below):

Tools you will need: A flashlight, or the flashlight feature of your phone. Use your phone to take photos of anything suspicious.

What you are looking for: Bedbugs hang out near their food source–you. After feeding, bed bugs poop, creating tell-tale brown stains of your clotted blood. You typically won’t see bugs — they are fairly tiny and can scurry quickly — but you will see these stains. You can find many itch-inducing photos here to help you know what to look for.

Author Gwen Pearson reminds readers that luggage is a popular mode of transportation for bedbugs, so stow your bags in the hotel room bathtub until the coast is clear. Check everything in sight. Sleep tight! And if you’ve made it through the night, check your sheets in the morning.

Previously: A (mostly bleak) bedbug updateWhy we worry about bedbugs and Image of the week: Bedbug
Photo by Simon Davison

Cancer, Dermatology, Events, Public Health, Stanford News

Free skin cancer screening being held Saturday

Free skin cancer screening being held Saturday

sunbatherScreening for skin cancer is advised for people with many moles or atypical moles, fair skin or a history of excessive sun exposure, a personal history of skin cancer or precancerous spots, or a parent or sibling who has had skin cancer. Each year, Stanford dermatologists offer a free screening for those in the local community, and this year’s event – being held tomorrow, May 31 – will offer more than the experienced eyes of skin clinicians.

Understanding that many people have concerns about one particular spot, the organizers are debuting a form of fast-track evaluation for just such concerns. During the Spot Check service, clinicians will use and study a new Stanford-developed smartphone-based device. As Justin Ko, MD, co-chief of medical dermatology at Stanford Hospital & Clinics, explained to me, “The device allows a user to capture clinical images of a skin lesion with their smartphone previously possible only with specialized, expensive devices typically used by dermatologists. We’ll be doing some studies to validate what we believe may well ‘democratize’ ability to capture and send medical-quality images of skin lesions by making this technology accessible and easy to use.”

The screening event (.pdf) will also include information on SUNSPORT, a collaboration of the Stanford Cancer Institute, the medical school’s Department of Dermatology, Stanford Athletics, and Stanford Hospital & Clinics, which provides student-athletes with information about their heightened risks for sun-related skin damage and works with the teams’ coaches and athletic trainers to reinforce skin-protection practices on a daily basis.

For local readers: The event runs from 8-11 AM at the Stanford Medicine Outpatient Center in Redwood City. Call (650) 723-6316 for more information.

Previously: Skin cancer images help people check skin more often and effectively, Working to protect athletes from sun dangersStanford clinic addresses cancer-related skin issuesAs summer heats up take steps to protect your skin and Man’s story shows how cancer screenings saves lives
Photo by Tom Godber

Dermatology, Health Costs, In the News, Research, Stanford News, Videos

Stanford dermatologist tackles free drug samples on NewsHour

Stanford dermatologist tackles free drug samples on NewsHour

Last week, my colleague reported on a new Stanford study showing that free drug samples lead to more expensive prescriptions. Over the weekend, dermatologist Al Lane, MD, senior author of the study, appeared on PBS NewsHour to discuss the implications of his findings. (He’s also quoted in a New York Times blog post on the research.) After mentioning that pharmaceutical companies spend more than $6 billion a year on sampling, he told NewsHour’s Hari Sreenivasan “that [this] cost eventually has to be paid by someone.” And he closes on a powerful note:

One of the focuses of our study was for the dermatologists to realize that although they think they’re helping the patients, they’re really being manipulated to write for more expensive medications with no proven benefit of those medications over the generic drugs.

Previously: Drug samples lead to more expensive prescriptions, Stanford study finds

Dermatology, Ethics, Health Costs, Research, Stanford News

Drug samples lead to more expensive prescriptions, Stanford study finds

Drug samples lead to more expensive prescriptions, Stanford study finds

drugs on money - big

It’s been years (fortunately) since I’ve needed a prescription for anything more than a simple antibiotic. But when I did, I remember I was always thankful on those occasions when my doctor offered a free sample of a medication to try before (or sometimes instead of) pulling out the prescription pad. I appreciated the chance to see if a medication would work for me, and I was happy for any opportunity to save myself (or, at times, my insurance company) a few dollars. The fact that the samples were invariably for drugs that were still on patent (known as brand name drugs or branded generics) to a particular company certainly escaped me.

Now, a study by Stanford dermatologist Al Lane, MD, highlights the dark side of such free samples, which are provided to doctors by the pharmaceutical companies who make the drugs. The research, along with an accompanying editorial, is published today in JAMA Dermatology. As Lane comments in my release on the work:

Physicians may not be aware of the cost difference between brand-name and generic drugs and patients may not realize that, by accepting samples, they could be unintentionally channeled into subsequently receiving a prescription for a more expensive medication.

Specifically, Lane and medical student Michael Hurley found that dermatologists with access to free drug samples wrote prescriptions for medications with a retail price of about twice that of prescriptions written by dermatologists without access to samples. All of the patients had the same first-time diagnosis of adult acne. The difference is nothing to sniff at – $465 for docs who accepted samples and about $200 for docs who did not. What’s more, the overall prescribing patterns of the two groups of physicians showed almost no overlap. Physicians without access to samples prescribed mainly generic drugs (83 percent of the time), whereas those with access to samples prescribed generics much less frequently (21 percent of the time). Only one drug of the top ten most commonly prescribed by physicians without access to samples even made it into the top ten list of physicians who did accept samples.

The distribution of free drug samples in this country is big business. It’s been estimated that pharmaceutical companies give away samples of medications with a retail value of about $16 billion every year. But many physicians feel the availability of samples doesn’t sway their prescribing choices, and instead feel the samples allow them more flexibility to treat their patients. Lane himself thought so, until Stanford Medicine prohibited physicians to accept samples or other industry gifts in 2006. As he explains in the release:

At one time, we at Stanford really felt that samples were a very important part of our practice. It seemed a good way to help poorer patients, who maybe couldn’t afford to pay for medications out-of-pocket, and we had the perception that this was very beneficial for patients. But the important question physicians should be asking themselves now is whether any potential, and as yet unproven, benefit in patient compliance, satisfaction or adherence is really worth the increased cost to patients and the health-care system.

Clearly Lane has had a change of heart, in part based on the data in the study. Now he’s hoping to get the word out to other physicians. He and Hurley conclude in the paper, “The negative consequences of free drug samples affect clinical practice on a national level, and policies should be in place to properly mitigate their inappropriate influence on prescribing patterns.”

Previously: Consumers’ behavior responsible for $163 billion in wasteful pharmacy-related costs and Stanford’s medical school expands its policy to limit industry access
Photo by StockMonkeys.com

Clinical Trials, Dermatology, Pediatrics, Research, Stanford News

Using Viagra to treat a rare childhood deformity: A research update

Using Viagra to treat a rare childhood deformity: A research update

Researchers at Lucile Packard Children’s Hospital Stanford are investigating a surprising treatment for a rare and potentially dangerous childhood deformity. As I’ve described previously, pediatric dermatologist Al Lane, MD, and his colleagues are studying the drug sildenafil – better known by its trade name, Viagra – as a treatment for lymphangioma. The condition, an overgrowth of the body’s lymph vessels, can cause disfigurement and even threaten children’s lives if the deformity impinges on essential body structures such as the airway.

“It can be lethal in 10 percent of people or more, and the problem is, we don’t know what’s the best treatment,” Lane told me.

Other treatments, such as surgery and sclerotherapy, are less effective than doctors would like: Afterward, the deformity often grows back.

A new publication from Lane’s team appeared this week in the Journal of the American Academy of Dermatology, reporting on the first seven patients to have their lymphangiomas treated with sildenafil. Though the idea of giving this drug to children might seem startling, it has a good safety profile and is already used in kids who have a form of high blood pressure in the lungs called pulmonary arterial hypertension. Lane realized that the medication might work for both PAH and lymphangioma when he treated a child with both conditions who was receiving the drug.

The new study shows mixed results. Six of the seven children responded to the medication, though not all responses were equally strong. One child’s deformity became worse while taking the drug. The team is now planning a larger, placebo-controlled, blinded study to investigate why they saw these differences.

“If we can identify which patients respond to sildenafil, we may get a better idea for the molecular mechanism of how it helps, and that could help us understand the disease more,” Lane said.

His team has applied for an orphan disease grant through the National Institutes of Health and the U.S. Food and Drug Administration and will find out in the fall if they’ve been funded.

Previously: Viagra may treat rare childhood deformity

Cancer, Dermatology, Parenting, Pediatrics, Research

Want teens to apply sunscreen regularly? Appeal to their vanity

tanning_021314When it comes to encouraging teenagers to take measures to reduce their risk of skin cancer, new research suggests parents and health educators should emphasize how ultraviolet light causes wrinkles and other signs of premature aging.

In the study, researchers recruited high-school students and randomly assigned them to two groups. One set of participants watched a health-based video that highlighted skin-cancer risks, while the other group viewed a video focusing on the cosmetic changes due to ultraviolet light. Students completed questionnaires demonstrating their knowledge about ultraviolet light and use of sun-protective behaviors before and after watching the videos. According to a University of Colorado Cancer Center release:

… despite knowing the skin cancer risk from ultraviolet exposure, the group that had watched the health-based video showed no statistically significant increase in their sun-protective behaviors. On the other hand, the group that had been shown the appearance-based video reported a dramatic increase in the use of sunscreen.

“For teenagers, telling them [ultraviolet] exposure will lead to skin cancer is not as effective as we would hope. If our endgame is to modify their behavior, we need to tailor our message in the right way and in this case the right way is by highlighting consequences to appearance rather than health. It’s important to address now – if we can help them start this behavior when younger, it can affect skin cancer risk when older,” [says study co-author April Armstrong, MD.]

Previously: Beat the heat – and protect your skin from the sun, As summer heats up take steps to protect your skin, How ultraviolet radiation changes the protective functions of human skin, Medical experts question the safety of spray-on tanning products and The importance of sunscreen in preventing skin cancer
Photo by David van der Mark

Cancer, Dermatology, Research, Stanford News

Humble anti-fungal pill appears to have a noble side-effect: treating skin cancer

Humble anti-fungal pill appears to have a noble side-effect: treating skin cancer

anti-fungal pill

Curing cancer isn’t cheap; developing new drugs comes with a multimillion-dollar price tag. Plus, there’s the rigmarole of animal testing, IRB reviews, FDA approval, and so on. What if you could just skip all of that, and get the drug to patients directly and at a lower price than an existing treatment option? You could, if you can successfully recycle a drug that’s already on the shelves at the pharmacy.

A few years ago, Stanford researchers led by Philip Beachy, PhD, got an inkling that a pink-and-blue capsule that removes unsightly toenail fungi also has a secret superpower: It might be able to treat skin cancer. The first set of clinical trials testing the effect of the oral pill, itraconazole, on skin cancer is the focus of a new study published online today.

Led by Stanford dermatologist and senior author Jean Tang, MD, PhD, the study shows proof of itraconazole’s ability to reduce tumor size and spread in patients with basal cell carcinoma, the most common type of skin cancer.

“We are shortcutting the [drug development] process,” says Tang, “by using a drug that’s already been around for 25 years and given to tens of thousands of people.”

From our press release on the study:

Itraconazole, which is prescribed for common fungal infections, kills fungal cells by blocking the production of a vital membrane component. In cancer cells, the drug appears to disable the Hedgehog signaling pathway — a cascade of cellular events triggered by the Hedgehog protein signal that is vital to cell growth and development.

Oral drugs for basal cell carcinoma are rare. These tumors are usually treated through radiation or cut out surgically. But surgery on advanced stage tumors may not always be effective and can greatly scar and disfigure patients.

Tang tested the drug itraconazole on 29 patients with a total of 101 tumors and found that it both blocked the Hedgehog pathway and reduced tumor size at the normally-prescribed anti-fungal dosage. As I describe in the release:

Patients were given itraconazole pills twice a day for a month. Another small group was given a lower dosage of itraconazole for a longer duration (an average of 10 weeks). In the first group, the drug reduced Hedgehog pathway activity by an average of 65 percent and tumor size by 24 percent. Patients in the second group, with lower itraconazole doses, showed similar reductions in tumor size.

And the best part? This medication is several times cheaper than vismodegib, the current and only go-to oral drug for basal cell carcinoma ($20 versus vismodegib’s $250 per day). It can also potentially treat tumors that are immune to vismodegib and other Hedgehog-pathway-blocking cancer drugs, says Beachy.

Ranjini Raghunath is a writing intern in the medical school’s Office of Communication & Public Affairs.

Previously: New skin cancer target identified by Stanford researchers, Funding basic science leads to clinical discoveries, eventually, Studies show new drug may treat and prevent basal cell carcinoma and Common drug might help prevent skin cancers
Photo by Worak

Autoimmune Disease, Chronic Disease, Dermatology

My two-decade battle with psoriasis

My two-decade battle with psoriasis

We’ve partnered with Inspire, a company that builds and manages online support communities for patients and caregivers, to launch a patient-focused series here on Scope. Once a month, patients affected by serious and often rare diseases share their unique stories; the latest comes from Alisha Bridges.

Psoriasis has affected every aspect and transition of life that I’ve encountered thus far. I’ve had the itchy, flaky, non-contagious autoimmune disease since I was 7 years old; I’m now 26. As I approach the 20-year anniversary of encountering the disease, I think of how my treatment has evolved, and as I reflect on the differences in treatment between then and now, it’s a Catch-22 in some ways.

It all started after a bad case of chicken pox. My scars weren’t healing correctly. They looked crusty and inflamed. After more than 90 percent of my body remained covered with this mysterious rash, my grandmother decided it was time for me to see the doctor, who diagnosed me with psoriasis. The positive side was that I had Medicaid as insurance, and it covered any and everything I needed. But unfortunately, due to my age, there weren’t many treatment options. From the age of seven to 19, I was prescribed an array of topical treatments and UVA light treatment, none of which were really effective in ridding me of psoriasis. The treatments just kept it at bay.

Once I went to college, treatment became more challenging. First, I went out of state for college, so the only time I could get treatment was when I came home for winter vacation. This particular treatment required me to stay in the hospital for three weeks, which was basically my entire winter break. Once I realized a treatment twice a year wasn’t going to be effective, my family attempted to find me a doctor near my school. The only caveat then was that Medicaid is state-to-state; therefore I was removed from hometown Michigan Medicaid and required to apply for Alabama Medicaid where I attended school. I wasn’t approved for Alabama Medicaid, though, which caused me to go essentially without insurance, aside from the simple coverage the school offered for emergencies.

After a few years of being in school without any insurance, I finally landed a job with coverage and started my routine doctor visits. This time I had more options. As a child I couldn’t consider biologic injections and oral medications, but as a working adult these options became available to me. The flip side was and remains that the medicine is harder to get because of high deductibles and regulations by insurance. I’ve also found that it’s harder to maintain insurance due to life situations such as layoffs or career changes.

There are vast differences between having this disease as a child through adulthood, yet there are a few similarities that I experienced in both phases of life. Doctors have fought to get me treatment no matter what age. As a teenager with severe psoriasis, doctors attempted to get me approved for Enbrel, which has only been authorized for adults over 18. I’ve even had doctors battle the insurance company to gain approval and decrease the cost of various medicines.

Though there have been many things that have changed there is one aspect of psoriasis that is too often neglected. From childhood until now there have been no coping strategies offered to me when dealing with this disease. Out of the approximately ten doctors I’ve seen in regards to my psoriasis, not one inquired on how the condition affected me psychologically. Although this disease appears to be a battle from the outside, the mental anguish faced as a psoriasis patient is life-altering and can even be virtually paralyzing. Patients need to know that there are other people in the world with this disease, and that there are resources outside of medicine to help them cope. Coping strategies are just as important as treatment. Although I have found organizations such as the National Psoriasis Foundation to help manage this disease, it wasn’t because of professional recommendation. I found them on my own at the age of 24.

I can only fathom how having support would have enhanced the overall quality of life for me if a doctor would have made me aware of these organizations at the age of seven. Although I have struggled to find a successful treatment, knowing that there’s support for the mental aspect of psoriasis will give me peace until a cure is found.

Now, psoriasis does not define me – I define it.

Alisha Bridges is the creator of Beingmeinmyownskin.com, where she blogs about life with psoriasis. She’s a community ambassador and volunteer for the National Psoriasis Foundation.

Aging, Cancer, Dermatology, Patient Care, Research, Science, Stanford News

Dilute bleach solution may combat skin damage and aging, according to Stanford study

Dilute bleach solution may combat skin damage and aging, according to Stanford study

3350877893_9d1db3abf3_zIs it time to put away your fancy skin creams and moisturizers? A study published today in the Journal of Clinical Investigation by Stanford pediatric dermatologist Thomas Leung, MD, PhD, and developmental biologist Seung Kim, MD, PhD, suggests that a dilute solution of sodium hypochlorite (you’ll know it better as the bleach you use for cleaning and disinfecting), inhibits an inflammatory pathway involved in skin damage and aging.

The researchers conducted their studies in mice, but it’s been known for decades that dilute bleach baths (roughly 0.005 percent, or one-fourth to one-half cup bleach in a bathtub of water) are an effective and inexpensive way to combat moderate to severe forms of eczema in human patients.

According to our release:

Leung and his colleagues knew that many skin disorders, including eczema and radiation dermatitis, have an inflammatory component. When the skin is damaged, immune cells rush to the site of the injury to protect against infection. Because inflammation itself can be harmful if it spirals out of control, the researchers wondered if the bleach (sodium hypochlorite) solution somehow played a role in blocking this response.

The researchers found that the bleach solution blocks the activation of a molecule called NF-kappaB, or NF-kB, that is involved in inflammation and aging. They collaborated with radiation oncologist Susan Knox, MD, to investigate potential clinical applications. From our release:

Radiation dermatitis is a common side effect of radiation therapy for cancer. While radiation therapy is directed at cancer cells inside the body, the normal skin in the radiation therapy field is also affected. Radiation therapy often causes a sunburn-like skin reaction. In some cases, these reactions can be quite painful and can require interrupting the radiation therapy course to allow the skin to heal before resuming treatment. However, prolonged treatment interruptions are undesirable.

“An effective way to prevent and treat radiation dermatitis would be of tremendous benefit to many patients receiving radiation therapy,” said Susan Knox, MD, PhD, associate professor of radiation oncology and study co-author.

The researchers tested the effect of daily, 30-minute bleach baths on laboratory mice with radiation dermatitis, and on healthy, but older mice. They found that animals bathed in the bleach experienced less severe skin damage and better healing and hair regrowth after radiation,  and the fragile skin of older animals grew thicker than control animals bathed in water. But don’t ditch the contents of your medicine cabinet just yet– mice aren’t exactly tiny people, and more research needs to be done.

The researchers are now considering clinical trials in humans, and they are also looking at other diseases that could be treated by dilute-bleach baths. “It’s possible that, in addition to being beneficial to radiation dermatitis, it could also aid in healing wounds like diabetic ulcers,” Leung said. “This is exciting because there are so few side effects to dilute bleach. We may have identified other ways to use hypochlorite to really help patients. It could be easy, safe and inexpensive.”

Previously: Master regulator for skin development identified by Stanford researchers
Photo by Shawn Campbell

Chronic Disease, Dermatology, Global Health, In the News, Infectious Disease, Public Health

Eradicating leprosy?

In this age of medical advancements it’s sometimes hard to believe that any disease we can treat could still persist. Here on Scope, we’ve discussed several such diseases that we can treat but can’t quite eradicate, such as malaria and leprosy. Leprosy, as my colleague explains, is an ancient disease that continues to thrive in the modern world even though an effective and free treatment is widely available to patients suffering from the disease.

If you’re slack-jawed in disbelief, you have good company. Yet, as incredible as this sounds, access to an effective and affordable treatment isn’t the only barrier to eradicating a disease. Yesterday, this article in The Economist Explains discusses some of the nuances to eradicating treatable diseases.

From The Economist:

A big obstacle to eradicating leprosy is the long delay between its onset and detection. It usually takes three to five years before the symptoms show up. In some cases the incubation period from infection to disease can be as long as 20 years. Leprosy attacks the skin and nerves, leaving behind scaly patches on the body. It looks like a skin disorder and can be easily misdiagnosed. Since many medical colleges do not stock infected skin smears, most doctors are not qualified to recognise it early on.

Eradication of leprosy would be a formidable task. Getting rid of other diseases (such as tuberculosis and malaria) would be a higher priority for most countries, since they kill huge numbers of people. Leprosy does not.

On a brighter note, the article points out that efforts to reduce the cases of leprosy and detect the disease earlier are still underway.

Previously: Leprosy in the modern worldAll in the family: Uncovering the genetic history of the world’s most lethal pathogensImage of the Week: Leprosy bacteria and interferon-beta and Tropical disease treatments need more randomized, controlled trials, say Stanford researchers

Stanford Medicine Resources: