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Dermatology

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

Aging, Dermatology, Genetics, Research, Stanford News

New study: Genes may affect skin youthfulness

New study: Genes may affect skin youthfulness

GEORGIA HEAT WAVE

Could the fountain of skin youth be found in your gene pool? Some older adults have skin that looks decades younger than their chronological age – yet, despite the identification of genes that promote overall youthfulness among centenarians, no genes that promote skin youthfulness in older individuals have been identified.

In an effort to explore the secrets that make some people’s skin look so good, Anne Lynn S. Chang, MD, a Stanford assistant professor of dermatology, and her colleagues here and at Albert Einstein College of Medicine studied a population of 1,000 genetically distinct older Ashkenazi-Jewish adults in New York – including hundreds of centenarians – that were part of Einstein’s LonGenity Database. In their study, the researchers examined the gene variants and environmental factors in this population, excluding those who reported having undergone facial cosmetic procedures or used topical anti-aging medication. A dermatologist blinded to the chronological age of participants then assessed all facial skin aging parameters.

Through their analysis, and after controlling for external factors that could affect facial skin appearance - including smoking history and skin cancer history – the investigators were able to identify candidate genes associated with youthful appearing facial skin. The team then replicated the work in a second and third validation group.

According to Chang, the genes associated with skin youthfulness in this study appeared to be distinct from the genes that have previously been associated with exceptional longevity. She also noted that the homogeneity of the gene pool in the Ashkenazi Jewish population ensured that the gene variants were not due to ethnic differences.

“These study findings suggest that healthy appearing skin may, in part, be inherited,” Chang told me. “The results may pave the way to enable a better understanding of the genetic basis of healthy skin.”

And as Chang’s co-author Nir Barzilai, MD, at Einstein noted, “The genetic variations we found that influence skin age may also shed light on how the body’s other organs age – and potentially point to a strategy to prevent aging and its diseases.”

Chang said studies are underway to understand the biologic mechanisms by which these gene variants act and whether any drugs or external agents might promote these mechanisms.

The work appears online in the Journal of Investigative Dermatology. Among Chang and Barzilai’s co-authors were Stanford’s Howard Chang, MD, PhD, and Gil Atzmon, PhD, and Aviv Bergman, PhD, both of Einstein.

Photo by ASSOCIATED PRESS

Cancer, Dermatology, Image of the Week, Public Health

Image of the Week: Ready for some football – and protected from the sun

Image of the Week: Ready for some football - and protected from the sun

SUNSPORT kids

Above is a shot of just a few of the Cardinal football fans who applied temporary tattoos – and plenty of sunscreen - from the SUNSPORT booth at the recent Stanford Football Open House. The Open House is an annual opportunity for fans to meet players and run through drills in Stanford Stadium, and SUNSPORT was there to help everyone play safely in the Palo Alto sun.

SUNSPORT, a collaboration of the Stanford Cancer Institute, the medical school’s Department of Dermatology, Stanford Athletics, and Stanford Hospital & Clinics, is Stanford’s first-in-the-nation program to provide sun-exposure education and protection strategies to outdoor athletes and fans. The program is profiled (.pdf) in the latest edition of Stanford Cancer Institute News.

Michael Claeys is the senior communications manager for the Stanford Cancer Institute.

Previously: Working to protect athletes from sun dangers and Image of the Week: Stanford SUNSPORT

Dermatology, In the News, Public Health

A link between early puberty and pre-teen acne?

acne This weekend, a story in USA Today connected the spots between two growing trends – the number of pre-teens with acne, and the number of kids who experience early puberty. From the article:

“It is common for 9- to 11-year-olds to have early acne, and sometimes this can be quite significant,” says Lawrence Eichenfield, chief of pediatric and adolescent dermatology at Rady Children’s Hospital in San Diego. The earlier onset of acne has been linked to the start of puberty at younger ages, he says.

Boys are experiencing puberty six months to two years earlier, according to a study last year in the journal Pediatricsand a 2010 study found that the percentage of girls who had breast development at ages 7 and 8 is greater than for girls born 10 to 30 years earlier.

Holly MacCormick is a writing intern in the medical school’s Office of Communication & Public Affairs. She is a graduate student in ecology and evolutionary biology at University of California-Santa Cruz.

Previously: Will eating candy or fatty foods cause acne?Natural product found in coconut oil, human milk could help fight acne and Can telemedicine work for dermatology patients?
Photo by rachel a. k.

Cancer, Dermatology, Public Health, Research

Skin cancer images help people check skin more often and effectively

Skin cancer images help people check skin more often and effectively

skin pointIf I told you that people are more inclined to look for something when they’ve actually seen what they’re looking for, you probably wouldn’t be that surprised. Yet, this is important information for medical professionals who want to motivate their patients to examine their own skin for signs of cancer. In new research, people who were shown images of skin cancer were more likely to examine their skin than people who’d only read about it.

Graduate student Jennifer E. McWhirter, BSc, and professor Laurie Hoffman-Goetz, PhD, MPH, of the University of Waterloo in Canada, wanted to know if text and photographic instructions were equally effective ways to prompt patients to check their own skin for  cancer. To test this, they culled through 5,330 peer-reviewed studies to find research projects that used photos as part of their educational materials on skin self-examinations. The results of their study (subscription required) appeared recently in the Journal of the American Academy of Dermatology.

The researchers found that patients who were shown images of skin cancer examined their skin more often, and were more adept at spotting suspicious-looking skin than patients who’d only read text descriptions of the how to check for skin cancer. Hoffman-Gotez explains why this might be, and the significance of the findings, in a university press release:

Visual images capture our attention and are persuasive. They also help us to learn and remember… Incorporating images into clinical practice when educating patients can be a powerful tool in the fight against skin cancer.

Holly MacCormick is a writing intern in the medical school’s Office of Communication & Public Affairs. She is a graduate student in ecology and evolutionary biology at University of California-Santa Cruz.

Previously: Working to protect athletes from sun dangersStanford clinic addresses cancer-related skin issuesAs summer heats up take steps to protect your skinMan’s story shows how cancer screenings saves livesNew research shows aspirin may cut melanoma riskNew skin cancer target identified by Stanford researchers and More evidence on the link between indoor tanning and cancers
Photo U.S. Department of Veteran’s Affairs

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