Dermatology

Compact fluorescent bulbs (often referred to as CFLs) burn less energy per unit of emitted light. That’s something pretty much everbody can agree on. But that’s about it.

As some readers may know, the U.S. government effectively banned the production of incandescent bulbs going forward by mandating energy-consumption standards no incandescent bulb is likely to meet. At least for the short term, this has tilted the playing field in favor of CFLs.

You either love the temperamental twisted tubes, presumably because they’re energy efficient, or hate them for any of a number of reasons. First, they’re expensive. Worse, because they contain mercury, CFLs have to be disposed of carefully – and should you, heaven forbid, drop one and have it smash into smithereens on the floor, the Environmental Protection Agency says you are supposed to open the windows immediately and clear the room.

I’ve got one in my kitchen. When I turn it on, it takes a while to warm up – and when it finally does, the light it gives off is, well, dirty. It’s depressing. I hate it.

Now, it turns out, there could be a medical reason to hate CFLs too: A recent study in the journal Photochemistry and Photobiology by researchers at the State University of New York, Stony Brook, indicates that, despite advocates’ claims to the contrary, these bulbs give off significant amounts of ultraviolet light, namely in the UVA and UVC range. The SUNY investigators explain that stresses introduced in the bulbs’ X-ray-absorbing coatings during the tubes’ manufacture cause minute cracks or lapses in those coatings:

Closer examination of some of these commercially available bulbs showed multiple defects in their coating, thus allowing UV-light emission. . . . These data are particularly disturbing as the UVC emission is even larger than ambient sunlight on a mountain.

To see if these emissions were physiologically harmful to human skin, the researchers used various biological assays on two kinds of human skin cells: keratinocytes and dermal fibroblasts. For example, the cells were exposed to CFLs so that they got the same UV doses a person’s skin would get from the bulbs after 45 hours at the typical working distance from a desk lamp. The damage to the cells was noticeable and was similar to the kind that occurs in the aging process. (It took only five hours at that distance from a CFL to get UV exposure exceeding recognized safety standards, the scientists noted.)

Ironically, adding either of two forms of titanium oxide (the chief UV-absorbing component of commercial sunscreens) to the skin cells made the damage that CFLs inflicted on them even worse.

Photo by Nioxxe

Your skincare regimen may protect you from sun damage or boast an advanced formula for wrinkle resistance, but what has it done for you genetically?

Ed Yong writes for The Scientist:

Researchers at Northwestern University have created small nanoparticles that can silence disease-related genes in skin cells after being applied via a cream or ointment.

Described today in the Proceedings of the National Academy of Sciences, the particles consist of small strands of RNA, densely packed around a gold core. They were 100 times more effective at shutting down a target gene than an alternative method using lipids to carry RNA into cells, and showed no harmful effects after weeks of use. With further testing and development, they could provide new ways of treating skin cancer, psoriasis, and other skin disorders caused by faulty or overactive genes.

Yong writes that existing pill or intravenous treatments targeting the genes involved in skin diseases may spread to internal organs, thus introducing harmful side effects.

Previously: What does nanotechnology bring to medicine? and Nanomedicine moves one step closer to reality

Your mother might have warned you about fungal infections and other horror stories from the pedicure chair. At least mine did. Being a ballet dancer, I wouldn’t set foot in a nail salon for years, not trusting anyone to treat my feet properly. I hoarded my hard-earned calluses and once even performed my own minor surgery, unsuccessfully, and vowed never again to take a sharp tool to my feet. I’ll spare you the gory details.

But for those who still enjoy indulging in a foot-pampering experience, U.S. New offers tips today for decreasing your risk of infection at the spa or considering taking your business to a podiatrist. Recommendations include avoiding razors (yes!) and skipping the popular fish pedicure. Also, beware soaking your feet:

For your part, hold off on the foot bath if you have any cuts, scrapes, scabs, bruises, or open sores on your legs or feet as broken skin eases the passage of germs into your body. The EPA and CDC also include bug bites on this list, which seems to ensure no one could ever possibly be fit for a pedicure, given the coinciding seasons of pedicures and bugs. Also, skip the pre-pedicure shave to avoid causing any nicks. The APMA [American Podiatric Medical Association] suggests scheduling your spa pedicure early in the morning, since “salon foot baths are typically cleanest earlier in the day.” [Hillary Brenner, DPM, a podiatric surgeon] advises patronizing nail salons that use disposable plastic bins inside the foot bath to lower your risk of infection.

Previously:Examining the effectiveness of hand sanitizers
Photo by Luiz Gustavo Leme

Medical experts have advised wearing sunscreen outdoors and staying out of tanning beds altogether to reduce preventable skin damage and other health risks. But those still aiming to look like the Bronze Idol from the 19th century ballet La Bayadère may also want to hold off on even a sunless tanning approach. Evidence suggests that spray tanning may not be a safe alternative to ultraviolet exposure.

Today, ABC News reports that spray tans’ active chemical, dihydroxyacetone (DHA), may damage DNA and cause genetic alterations. A literature review performed by six medical experts with expertise spanning dermatology, toxicology and pulmonary medicine has raised questions about the safety of DHA. The chemical was approved by the U.S. Food and Drug Administration in 1970s for external use; back then, it was tanning lotions, not sprays, that were ubiquitous.

Scientists worry that when sprayed without protecting body cavities and mucous membranes, the chemical could be inhaled, ingested, or absorbed through the skin into the bloodstream – all falling outside of the approved use of DHA and possibly making the body vulnerable to its harmful effects.

From today’s article:

[Rey Panettieri, MD], like all the experts ABC News consulted with, said more studies should be done. He emphasized the available scientific literature is limited. Still, he said, he has seen enough to say the warning signs of serious health concerns exist.

“These compounds in some cells could actually promote the development of cancers or malignancies,” he said, “and if that’s the case then we need to be wary of them.”

The full investigative report is worth a read.

Previously: Study shows link between indoor tanning and common skin cancer and Intense, rapid sun tanning may increase skin cancer risk
Photo by Dr Stephen Dann

Each year approximately 2.8 million people in the United States are diagnosed with basal cell carcinoma (BCC), the country’s most common form of cancer. New studies published today in the New England Journal of Medicine show the drug vismodegib (trade name: Erivedge) may help treat and prevent this type of skin cancer that is rarely fatal but potentially disfiguring.

Three papers, all with Stanford authors, demonstrate the effectiveness of vismodegib. The first U.S. Food and Drug Administration-approved drug in its class, vismodegib was shown in two of the studies to be effective in treating advanced or metastatic BCC tumors.

According to our release, one clinical trial, tested the use of vismodegib to treat patients who have Gorlin syndrome, which is characterized by tens to hundreds of BCC tumors. A second clinical trial tested the drug’s effectiveness in treating advanced basal cell carcinomas. From the release:

In the study of the drug’s effect on patients with Gorlin syndrome (also known as Basal Cell Nevus Syndrome) the researchers showed that subjects taking vismodegib developed an average of two new tumors per year, compared with 29 new tumors in subjects taking placebo. The drug is taken daily in a pill form. This investigator-initiated, double-blind placebo trial involved 41 patients with Gorlin syndrome and was stopped early due to the overwhelming effectiveness of vismodegib, the article states. It was considered unethical not to offer the drug to those participants taking a placebo.

…

The second of the three papers presents the findings from the phase-2 Genentech-sponsored clinical trial that were the basis for the FDA’s decision to allow vismodegib to be used to treat advanced forms of BCC in adults. The drug was successful 43 percent of the time in either complete or partial shrinkage of tumors in the 96 patients with advanced disease who participated in the trial, the study reports.

Researcher and author on two of the studies Anthony Oro, MD, PhD, professor of dermatology at Stanford, was most excited about having a treatment for many of his patients who are running out of options:

We now have a brand new class of drugs that can treat these cancers. As a dermatologist, this is exciting to see. There is nothing for these patients that works. Their cancers are often surgically inoperable.

Previously: Hope for basal cell carcinoma prevention? and Common drug might help prevent skin cancers

Don’t forget to wish your neighbors a happy Don’t Fry Day.

The National Council on Skin Cancer Prevention designated the Friday before Memorial Day as Don’t Fry Day to bring sun safety awareness to all swimmers, barbecue attendees, outdoor adventurists and other folks who are subject to ultraviolet (UV) rays from the sun. Overexposure to UV radiation is a major risk factor for most forms of skin cancer, the most common type of cancer in the United States.

The Council recommends these steps to stay safe:

Slip! Slop! Slap!…and Wrap when you’re outdoors — slip on a shirt, slop on broad spectrum sunscreen of SPF 30 or higher, slap on a wide-brimmed hat, and wrap on sunglasses. The best way to detect skin cancer early is to examine your skin regularly and recognize changes in moles and skin growths.

As previously reported on Scope, Stanford dermatologists will be hosting a free skin cancer screening on June 2 in Redwood City.

Previously: The importance of sunscreen in preventing skin cancer and Working to prevent melanoma
Photo by Vassil Tzvetanov

For those of us who live in climes with no shortage of sunny days, spending hours outdoors is a such given that we may forget - especially in the bliss of summer vacation - that it can be too much of a good thing. But Stanford’s dermatologists, about to host their annual free skin cancer screening on June 2, are quick with facts and figures about the risks of too much unprotected time in the sun.

In the latest issue of Inside Stanford Medicine and in the video above, we tell the story of Kelly Bathgate – a classic example of what doctors are seeing in rising numbers: a young woman with melanoma. In the last 30 years, the rate of melanoma in women under age 40 has risen 150 percent. 

So how can these cancers be prevented? Since sun exposure remains the single most predictive risk factor for development of skin cancer, protective steps aren’t extreme. As Stanford physician Sumaira Aasi, MD, told me:

We’re not asking people to get on a treadmill or not eat their favorite foods. We’re just recommending that people treat sunscreen like brushing their teeth or using deodorant don’t leave the house without it no matter what the weather is like.

Previously: Study shows link between indoor tanning and common skin cancer, Working to prevent melanoma, New law: No more tanning beds for California teens and Intense, rapid sun tanning may increase skin cancer risk

Physicians in rural areas in California are in short supply, and some fear the scarcity could grow more severe. But telemedicine might prove beneficial in these parts: Research has shown increased use could help reduce health disparities between rural and non-rural areas.

David J. Wong, MD, PhD, a Stanford dermatologist and cofounder and CEO of Direct Dermatology, stands among health-care providers working to increase the reach of telemedicine. His company brings medical dermatology expertise to poor and underserved populations in California to treat serious and even life-threatening conditions including melanoma, psoriasis and problems of the skin, hair, and nails.

A panelist at last week’s Healthcare Innovation Summit at Stanford, Wong believes a social mission driving a for-profit company can deliver healthy results. He discusses his company’s work and how it fits into broader efforts to improve rural medicine in a Stanford Graduate School of Business Q&A.

On explaining how Direct Dermatology visits work, he says:

The interaction is asynchronous. It’s not a live interactive visit over Web cams. A patient takes a picture of their skin problem, then sends in that picture along with their medical history. And then a dermatologist will review it, and send back a report and any prescriptions that are needed. We have a two-day turnaround. Dermatology is such a visually based specialty that dermatology consultation works well through images.

Later in the interview, he talks about how his work is relevant to other medical specialties:

While some specialties will always require some live interaction, nearly every specialty can provide better access, higher quality care and lower cost by integrating telemedicine in some fashion. Dermatology is a great one to start with as a proof of concept, because it is so visually based. But we believe similar concepts can be spread to other specialties.

In ophthalmology, for example, much of the exam is based on images of the retina. Cardiologists are looking at EKGs and echocardiograms. A lot of those types of images you’d have to first acquire at a lab or clinic, and then send them in. That being said, there is a growing number of home consumer appliances that will take your EKG, for example. And consumers will be soon able to send those in directly to their physicians.

A 2010 study showed that online dermatology visits, similar to those described by Wong, can be as effective as office visits and can save patients time.

Previously: Ask Stanford Med: Stefanos Zenios taking questions on health-care innovation and entrepreneurship, Phoning in your specialized medical tests and Can telemedicine work for dermatology patients?
Photo by mysiana

Squirming over the thought of tending to a pesky wound? Just hold still and relax: You could save yourself a painful manual scraping while creating jobs for industrious maggots.

The process of applying maggots to eat away necrotic tissue while leaving healthy skin intact isn’t new (the U.S. Food and Drug Administration approved the cleaning technique in 2004), but, as Booster Shots reports today, few clinical trials have been performed to test its efficacy.

New research, though, indicates maggots may provide an effective quick fix against infection, for those who can handle hosting a crawly crew:

Dr. Anne Dompmartin [MD, PhD] of the Centre Hospitalier Universitaire de Caen in France and her colleagues studied nonhealing wounds on the legs of 119 patients. Half the patients had their wounds debrided with a scalpel three times a week for two weeks. The remainder had maggots — the larvae of the fly Lucilia sericata — placed on the wound twice a week for two weeks. The maggots, 80 at a time, were sealed into a commercial plastic device that prevents them from escaping while allowing access to the wound.

The team reported in the Archives of Dermatology on Monday that wound healing at the end of eight days was significantly better in the group that was cleaned with the maggots. After 15 days, however, results from the two groups were indistinguishable. Pain was moderate in both groups. Both groups also reported a crawling sensation on their wound at day eight.

Previously: “Superbug” author discusses dangers, history and treatment of MRSA

As of January 1, minors in the Golden State are banned from indoor UV tanning. California is the first in the nation to restrict this artificial bronzing process for those 18-years-old and under, and 18 states are now considering a similar ban.

A USA Today story reports on the issue, with writer Tracy Lowe explaining that most states already require parental consent for teens who tan to use indoor UV facilities. But a complete ban for all minors is stronger, and something that many feel is important:

“As parents, we don’t provide permission slips to our children to smoke cigarettes or drink liquor,” [Maryland State Sen. Jamie] Raskin, a Democrat, said. “As a matter of public health, we should take electronic tanning devices off the table for children.”

As it turns out, tanning is also an important issue to Stanford experts. Susan Swetter, MD, professor of dermatology, and colleagues at the Stanford Cancer Institute, for example, have been vocal in their belief that tanning bed usage and other recreational tanning likely has contributed to a dramatic increase in melanoma cases among California girls and women. And melanoma is the deadliest type of skin cancer.

Previously: State Senator Ted Lieu weighs in on tanning-bed legislation, New law: No more tanning beds for California teens, A push to keep minors away from tanning beds, Intense, rapid sun tanning may increase skin cancer risk
Photo by joelogon