Dermatologists: Resources for Eczema Patients

Physicians and Health Care Providers: Have patients with eczema? 

We’re always here to help.

The National Eczema Association offers resources for you and your patients, all in one place.

Information You Can Trust.

• Patient Education Materials

• The Advocate, quarterly newsletter eInsights, electronic newsletter

• Tips from leading eczema experts

• The latest eczema research and treatment news

• National Eczema Association Seal  of Acceptance products

You Can Count On Us.

• Web: nationaleczema.org

• Phone: 415.499.3474 or 800.818.7546

• Email: info@nationaleczema.org

• Support groups nationwide

• Facebook: facebook.nationaleczema.org

• Online support community: community.nationaleczema.org

• National Patient Conference  & Kids Camp, June 2012 

Order Patient Education Materials

____ All About Atopic Dermatitis: $45/100 brochures

____ Atopic Dermatitis in Children: $45/100 brochures

____ Bathing & Moisturizing: $45/100 brochures

____ Hand Eczema: $45/100 brochures

____ Topical Corticosteroids: Myths & Facts: $45/100 brochures

____ Dermatitis Atópica (Spanish): $45/100 brochures

____ Starting From Scratch DVD: $20 each

MAIL ORDER FORM WITH CHECK

National Eczema Association
4460 Redwood Highway, Suite 16D San Rafael, CA 94903

FAX ORDER FORM 415.472.5345

ORDER ONLINE: nationaleczema.org

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National Eczema Association Patient Conference

National Eczema Association Patient Conference for Eczema Patients & Families 

In collaboration with

Emory University School of Medicine Department of Dermatology

Thursday, June 28 – Sunday, July 1, 2012

Westin Peachtree Plaza Hotel • Atlanta, GA

It’s a conference that changes lives!

The conference is for people of all ages who have eczema or care about someone who has eczema.  Participants gain knowledge on the most current medical treatments, skin management techniques, ongoing research in the field, and nationwide support activities.

The NEA Patient Conference provides an opportunity for people to interact with others who share the same challenges.

Attendees will:

 LEARN how to treat eczema more effectively

 RECEIVE answers to questions from world-renowned medical experts

 OBTAIN medical research updates

 CONNECT with others to exchange ideas, support and advice

 GAIN knowledge of products helpful to those with eczema

 INSPIRE others with tips and experience

o Three days: June 29 – July 1

o Supports children with eczema

o Cultivates self esteem and confidence

o Two groups: kids 5 -12 and teens 13 -17

o For youth with eczema, their siblings and friends

Conference registration:

conference.nationaleczema.org

For more information, contact the National Eczema Association (NEA):

info@nationaleczema.org

Phone: 415.499.3474

Toll free: 800.818.7546

National Eczema Association • 4460 Redwood Hwy, Suite 16D, San Rafael, CA 94903 • 415.499.3474 • nationaleczema.org 

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Genome-wide association study for Vitiligo

Genome-wide association analyses identify 13 new susceptibility loci for generalized vitiligo

Author Interview : Richard A. Spritz, M.D.

Professor and Director, Human Medical Genetics and Genomics Program

University of Colorado School of Medicine, Aurora, CO 80045 USA

What are the main findings of the study?

Dr. Richard Spritz and colleagues conducted a genome-wide association study of generalized vitiligo in Caucasians.

Meta-analysis of the new data combined with those from another genome-wide study they conducted previously identified 13 new vitiligo susceptibility genes.

Altogether, the more than 30 genes identified thus far account for 18 percent of the heritability of vitiligo. Most vitiligo susceptibility genes encode immunoregulatory proteins, consistent with autoimmune pathogenesis. Several others encode components of the melanosomes, and likely mediate autoimmune sensitization and targeting of melanocytes.

Were any of the findings unexpected?

An unexpected finding was association of vitiligo with the OCA2 gene, which is responsible for oculocutaneous albinism type 2, and encodes a melanosomal membrane protein. Association was found with the same SNPs that are associated with blue eyes in Caucasians, indicating that blue eyes would be less prevalent among vitiligo patients. The investigators surveyed 1206 Caucasian vitiligo patients and found that, indeed, the prevalence of blue eyes was greatly reduced.  These same SNPs are associated with increased risk of melanoma.

What should clinicians and patients take away from this study?

It is now clear that vitiligo is an autoimmune disease.

Many of the genes that are associated with vitiligo are also associated with other autoimmune diseases, explaining the increased prevalence of autoimmune thyroid disease (Hashimoto’s disease and Graves’ disease), type 1 diabetes, rheumatoid arthritis, psoriasis, lupus, and Addison’s disease in vitiligo patients and their close relatives.

What recommendations do you have for dermatology health care providers as a result of your study?

Dermatologists should  have a high index of suspicion of other autoimmune diseases in patients with vitiligo. Patients with vitiligo should be screened for autoimmune thyroid disease on a periodic basis.

Citation:

Genome-wide association analyses identify 13 new susceptibility loci for generalized vitiligo

Ying Jin, Stanca A Birlea, Pamela R Fain, Tracey M Ferrara, Songtao Ben, Sheri L Riccardi, Joanne B Cole, Katherine Gowan, Paulene J Holland, Dorothy C Bennett, Rosalie M Luiten, Albert Wolkerstorfer, J P Wietze van der Veen, Anke Hartmann, Saskia Eichner, Gerold Schuler, Nanja van Geel, Jo Lambert, E Helen Kemp, David J Gawkrodger, Anthony P Weetman, Alain Taïeb, Thomas Jouary, Khaled Ezzedine, Margaret R Wallace, Wayne T McCormack, Mauro Picardo, Giovanni Leone, Andreas Overbeck, Nanette B Silverberg & Richard A Spritz

Nature Genetics Published online: 06 May 2012 | doi:10.1038/ng.2272

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GSTP1 rs1695 polymorphism in Melanoma

Role of glutathione S-transferases in melanoma susceptibility:
association with GSTP1 rs1695 polymorphism

Author Interview: Gloria Ribas

Investigadora “FIS Miquel Servet”
Fundacion Investigacion Clinico de Valencia
Instituto de Investigacion Sanitaria INCLIVA
Av. Blasco Ibanez, 17 46010 Valencia

What are the main findings of the study?

Glutathione S-transferases (GSTs) GSTM1, GSTT1 and GSTP1 are multifunctional enzymes involved in the detoxification of a wide range of reactive oxygen species produced during melanin synthesis and oxidative stress processes.

GSTM1 and GSTT1 genes have copy number variants (null, 1 or 2 genotypes). Evaluating CNVs in this case-control study we did not detect differences in the number of copies and melanoma predisposition.

However, when we consider The GSTP1 polymorphism rs1695, which encodes the amino acid change p.Ile105Val, we indeed, detect association with malignant melanoma (MM) with odds ratio (OR): 1.32, 95% confidence interval (CI): 1.06–1.63] p-value <0.01.

This association is maintained in a multivariate analysis when other malignant melanoma risk factors are considered. In addition, we included in the study updated information on variants in MC1R gene. The results confirm the major role of MC1R in melanoma susceptibility.

Furthermore, individuals carrying one or two MC1R nonsynonymous changes and GSTP1 rs1695 rare allele had an increased risk of developing MM (OR: 3.34, 95% CI: 1.42–8.09 and OR: 20.42,95% CI: 2.80–417.42, respectively.

Were any of the findings unexpected?

Despite of GSTP1 having previously being related to some other cancers, its association to melanoma susceptibility has been shown for the first time.
In addition, we reported that, the GSTP1 SNP rs1695, which encodes the amino acid change p.Ile105Val, influences the penetrance of the best known MC1R risk genotypes.

What should clinicians and patients take away from this study?

The knowledge of the genetic background of each individual is becoming increasingly important in order to properly consider the risk of developing melanoma.

Genetic variations in the MC1R gene are the ones with major implications however, new variants such as rs1695 at the GSTP1 gene appear to contribute itself to the association and in addition increases to the overall risk when considered together with MC1R.

What recommendations do you have for dermatology health care providers as a result of your study?

Whenever it is possible to genotype the patients for variants associated to melanoma in distinct genes.

Citation:

Ibarrola-Villava, M., Martin-Gonzalez, M., Lazaro, P., Pizarro, A., Lluch, A. and Ribas, G. (2012), Role of glutathione S-transferases in melanoma susceptibility: association with GSTP1 rs1695 polymorphism. British Journal of Dermatology. doi: 10.1111/j.1365-2133.2012.10831.x

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Eye color may indicate risk for serious skin conditions

DENVER (May 6, 2012) – Eye color may be an indicator of whether a person is high-risk for certain serious skin conditions.

A study, led by the University of Colorado School of Medicine, shows people with blue eyes are less likely to have vitiligo. It then follows, according to scientists, that people with brown eyes may be less likely to have melanoma.

Vitiligo  is an autoimmune skin disease in which pigment loss results in irregular white patches of skin and hair. Melanoma is the most dangerous kind of skin cancer.

The study is published online by the journal Nature Genetics. It looked at almost 3,000 people with vitiligo of Non-Hispanic European ancestry, identifying 13 new genes that predispose to vitiligo.

Among the vitiligo patients, approximately 27 percent had blue/gray eyes, 43 percent had tan or brown eyes and 30 percent had green or hazel eyes, which is significantly different from the normal distribution of eye color where approximately 52 percent of Americans of Non-Hispanic European ancestry have blue/gray eyes, 22 percent have green/hazel eyes, and 27 percent have tan or brown eyes.

Richard Spritz, MD, is director of the Human Medical Genetics and Genomics Program at the CU School of Medicine, the coordinating center for the research. Spritz said the study primarily looked at vitiligo but also has implications for melanoma.

“Genetically, in some ways vitiligo and melanoma are polar opposites.

Some of the same genetic variations that make one more likely to have vitiligo make one less likely to have melanoma, and vice-versa,” said Spritz.

“Vitiligo is an autoimmune disease, in which a person’s immune system attacks their normal pigment cells. We think that vitiligo represents over-activity of a normal process by which one’s immune system searches out and destroys early cancerous melanoma cells.”

People with vitiligo are at higher risk for various other autoimmune diseases, such as thyroid disease, type 1 diabetes, rheumatoid arthritis and lupus.
Vitiligo patients’ close relatives also are at higher risk for these same diseases, even if they don’t have vitiligo. Spritz said this means there must be some genes that push towards these autoimmune diseases in general, while other genes and environmental triggers determine which autoimmune disease occurs and when. So, as scientists learn about the genetics of vitiligo, they also are learning about the genetics of these other autoimmune diseases.

###

The study was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health.

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Skin manifestations of athletes competing in the summer olympics

Skin Manifestations of Athletes Competing in the Summer Olympics:
What a Sports Medicine Physician Should Know.

Author Interview: Jacqueline De Luca MD

University of Hawaii Transitional Residency Program, Honolulu, HI, USA.

What are the main findings of the study?

Athletes competing in the summer Olympics are frequently affected with skin problems related to their sport of interest.

We addressed both common and more difficult to diagnose skin manifestations under the general categories of Endurance, Resistance, Team Sport, and Performing Arts.

We also subcategorized the different dermatoses as either traumatic, environmental, and infectious in etiology.

Were any of the findings unexpected?

We found that in a recent study of the 2004 Olympics, that the  most prevalent medical (non-traumatic) complaint was dermatological, totaling 16% of the total consultations.

We also found reports that eczema and atopy are actually more prevalent in the elite athlete population, and that these per-existing dermatoses can be further exacerbated by practice and competition.

What should clinicians and patients take away from this study?

We hoped to provide a review for sport’s medicine physicians so that athletes would have better preventative measures, be treated more promptly, and be allowed to return to competition earlier.

We also provided a list of potential treatments for each of the sports dermatoses, making sure  to also disclose treatments banned by the U.S. Anti-Doping Agency (USADA).

What recommendations do you have for dermatology health care providers as a result of your study?

Athletes are in a unique situation in that they are many times unable to remove themselves from their offending agent whether is be the sun, fungus, trauma, or even exercising in itself.

Promptly and acurately diagnosing and treating the athlete is of utmost importance given the potential time lost in training and competition that may result with delays.

Citation:

Skin manifestations of athletes competing in the summer olympics: what a sports medicine physician should know.

De Luca JF, Adams BB, Yosipovitch G.
Sports Med. 2012 May 1;42(5):399-413.
doi: 10.2165/11599050-000000000-00000.
University of Hawaii Transitional Residency Program, Honolulu, HI, USA.

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Superior Outcome of Women with Melanoma

Superior Outcome of Women With Stage I/II Cutaneous Melanoma: Pooled Analysis of Four European Organisation for Research and Treatment of Cancer Phase III Trials

Author Interview Arjen Joosse, Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherland

What are the main findings of the study?

The basic finding in the article is that women fare better than men when they are diagnosed with a localized melanoma, this being a melanoma which has not been metastasized to either lymph nodes or to other organs than the skin.

One could summarize the article with the conclusion that the advantage of women is approximately 30%. The 30% advantage applies to survival, thus women have a 30% better chance (hazard ratio) to survive their melanoma. It also applies to having a metastasis: women have a 30% lower chance to experience a metastasis to the lymph nodes and to other organs. The consistency of the finding is also reflected that it applies to different subgroups e.g. younger versus older patients, melanomas on the limbs and on the trunk, different subtypes such as nodular versus superficial spreading melanomas, and so on. Finally, in our analysis, women of pre- and postmenopausal age (<45 years and > 60 yrs) had an equal advantage over men of the same age. Therefore, the female hormones (which decline after menopause) do not seem to cause this female advantage.

Our main conclusion is that this advantage of 30% is probably caused by a biological difference across gender, as we adjusted for many factors which are related to behavior; such as tumor thickness and body site of the tumor. Also, the subgroup analysis suggests that behavior cannot fully explain the advantage for women.

For example, if earlier detection in females due to increased awareness is the causative factor (as suggested by Sondak and Berwick in the editorial), then we would expect this earlier detection to translate into thinner tumors in female, and when investigating the thinnest tumors, there would be no (or a considerably smaller) male disadvantage. This is not true; males fare worse in thicker and in thinner tumors, as well as for truncal and limb melanomas.

Were any of the findings unexpected?
 
The female advantage was known from the results of other studies.

However, we were surprised to see that the magnitude was so consistently 30% across different endpoints. Furthermore, in our article we also make a comparison to other large studies reporting gender hazard ratio’s, and we see the 30% magnitude again in all these studies. So it seems a very robust advantage for females across continents, subgroups, and different study designs.

What should clinicians and patients take away from this study? 

That male gender is a disadvantageous prognostic factor in melanoma, for which the explanation is yet unknown. We agree with Sondak and Berwick that due to incomplete data and understanding of the pathway, it is premature to have different treatment strategies for melanoma across gender. However, when seeing two melanoma patients in your clinic with equal tumor characteristics, one being male, one female, it might be useful to realize that the female patient has a 30% lower risk to metastasize or die from the disease. In the future, one could imagine that this leads to differences in follow-up after the diagnosis across gender. However, more research is needed.

What recommendations do you have for dermatology health care providers as a result of your study?

Our main message goes out to all the researchers working in the melanoma field, from bench to bedside: keep gender in mind. There is a “gender factor” which influences melanoma so profoundly that it results in this robust 30% female advantage. Unraveling the mechanism behind this phenomenon could be valuable to find new treatment strategies.

If researchers take gender into account of all their analyses, we moght stumble upon the explanation. Based on literature research, we suggest a few biological explanations in our article: recently, we published a review on gender differences in reactive oxygen species as a possible explanation for this gender difference in melanoma (Joosse et al, Pigment Cell Melanoma Research, june 2010).

Other explanations might relate to gender differences in vitamin D, male hormones or immune homeostasis.

Citation:

Superior Outcome of Women With Stage I/II Cutaneous Melanoma: Pooled Analysis of Four European Organisation for Research and Treatment of Cancer Phase III Trials

Arjen Joosse, Sandra Collette, Stefan Suciu, Tamar Nijsten, Ferdy Lejeune, Ulrich R. Kleeberg, Jan Willem W. Coebergh, Alexander M.M. Eggermont, and Esther de Vries

JCO JCO.2011.38.0584; published online on April 30, 2012;

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Keratoacanthoma: Clinical and histopathologic features of regression

Keratoacanthoma: Clinical and histopathologic features of regression

Author Interview: Christine J. Ko, MD,
333 Cedar St, PO Box 208059, New Haven, CT 06520

What are the main findings of the study?

Although keratoacanthoma may be a subtype of squamous cell carcinoma with a very good prognosis (spontaneous regression), and while keratoacanthoma can be histopathologically indistinguishable from squamous cell carcinoma, there are characteristic features of regressing keratocanthoma that do not mimic carcinoma.

Regression can be used as a “gold standard” for diagnosis of keratocanthoma; this requires clincial examination of a suspected keratoacanthoma at two different time points and assessing tumor flattening and shrinkage of diameter.

Patients are not always aware their tumors are smaller.

Regressing keratoacanthoma loses the glassy keratinocytes histopathologically but tends to retain a crateriform architecture.

Were any of the findings unexpected?

There is a diverse appearance histopathologically to regressing keratoacanthoma. 

Keratoacanthoma

Keratoacanthoma - Representative image from Armed Forces Institute of Pathology

What should clinicians and patients take away from this study?

If keratoacanthoma is suspected, evidence of regression can often be obtained by one month of follow-up.
What recommendations do you have for dermatology health care providers as a result of your study?

Keratoacanthoma is a distinctive tumor in its regressing phase.

Citation:

Keratoacanthoma: Clinical and histopathologic features of regression

Christine J. Ko, Jennifer M. McNiff, Marcus Bosenberg, Keith A. Choate
Journal of the American Academy of Dermatology – 23 April 2012 (10.1016/j.jaad.2012.02.041)

by on April 29, 2012  •  Permalink
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Effect of cosmetic ingredients as anticellulite agents

Effect of cosmetic ingredients as anticellulite agents:
synergistic action of actives with in vitro and in vivo efficacy

Author Interview: Tamara Al-Bader PhD

Oriflame Cosmetics AB
Oriflame Skin Research Institute, Stockholm, Sweden

What are the main findings of the study?

Our studies show the ability of cosmetic agents Furcellaria lumbricalis, Fucus vesiculosus, retinol, conjugated linoleic acid (CLA), and a glaucine mixture to stimulate lipolysis in human adipocytes and production of pro-collagen I by fibroblasts, in vitro.

The assessment of cellulite in vivo was performed by dermatological grading and ultrasound measurements.

Our clinical study demonstrated a significant improvement in cellulite grading by a dermatologist after 8 and 12 weeks vs. vehicle, and ultrasound imaging showed a significant decrease in fat thickness compared with placebo after 12 weeks.

Were any of the findings unexpected?

We observed in our lipolysis assays that the individual ingredients, algae (combined treatment of F. vesiculosus and F. lumbricalis), retinol, CLA, and an agent containing glaucine as the active ingredient, all were capable of inducing intracellular triglyceride hydrolysis leading to the eventual release of free extracellular glycerol.

However, surprisingly we discovered when all these ingredients were combined together in a treatment, a synergistic increase in glycerol release was observed in vitro, by mechanisms that are unknown as yet.

Our finding suggests that the combination of these ingredients can act as powerful mixture to stimulate fat breakdown.

Pooling this together with our collagen data, we observed that this potent cocktail of ingredients work together to act on both fat breakdown and dermal re-strengthening mechanisms.

What should clinicians and patients take away from this study?

Cellulite grading by a dermatologist showed that over the course of 12 weeks, statistically significant improvements in grading were observed on thighs treated with creams containing the cosmetic ingredients vs. thighs treated with the placebo.

This indicates that the active ingredients chosen for this study possess activities above the effects seen by the formulation alone.

What recommendations do you have for dermatology health care providers as a result of your study?

In addition to product treatment, the effects of massaging the skin is also thought to improve the appearance of cellulite by accelerating blood flow and preventing fibrosclerosis.

Citation:

Effect of cosmetic ingredients as anticellulite agents:
synergistic action of actives with in vitro and in vivo efficacy

Al-Bader T, Byrne A, Gillbro J, Mitarotonda A, Metois A,
Vial F, Rawlings AV, Laloeuf A.

Oriflame Cosmetics AB, Oriflame Skin Research Institute
Stockholm, Sweden.
J Cosmet Dermatol. 2012 Mar;11(1):17-26.
doi: 10.1111/j.1473-2165.2011.00594.x.

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Study finds Shingles (Herpes Zoster) Vaccine Safe

PASADENA, Calif. — The herpes zoster vaccine, also known as the shingles vaccine, is generally safe and well tolerated according to a Vaccine Safety Datalink study of 193,083 adults published online in the Journal of Internal Medicine.

More than 1 million people develop shingles every year in the United States. Shingles is a painful contagious rash caused by the dormant chickenpox virus which can reactivate and replicate, damaging the nerve system. The elderly are especially vulnerable because immunity against the virus that causes shingles declines with age.

The VSD project is a collaborative effort between the Centers for Disease Control and Prevention and integrated care organizations, including Kaiser Permanente. The VSD project monitors immunization safety and addresses the gaps in scientific knowledge about any rare and serious events that occur following immunization.

This study examined adverse events after the zoster vaccine was administered to 193,083 adults aged 50 and older from Jan. 1, 2007, to Dec. 31, 2008. Vaccination data were retrieved from electronic health records and collected from eight managed care organizations participating in the VSD project.

Researchers found a small increased risk of local reactions from 1 to 7 days after vaccination. These findings corroborate clinical trials of the vaccine in which there was evidence of a minor local reaction at the injection site in the form of redness and pain.

The study found no increased risk for cerebrovascular diseases; cardiovascular diseases; meningitis, encephalitis, and encephalopathy; Ramsay-Hunt syndrome; or Bell’s palsy.

“It’s good to know there is no serious adverse reaction to the zoster vaccine. The study supports the CDC’s Advisory Committee on Immunization Practices (ACIP) recommendation and reassures the general public that the vaccine is safe,” said study lead author Hung Fu Tseng, PhD, MPH, a research scientist with the Kaiser Permanente Southern California Department of Research & Evaluation in Pasadena, Calif.

The herpes zoster vaccine was licensed in 2006, but few people have been vaccinated, national data shows. The ACIP recommends the vaccine for healthy people ages 60 years and older. In 2011, the U.S. Food and Drug Administration approved the use of the herpes zoster vaccine in individuals 50 to 59 years of age. The study results released today provide important safety data for people in this age group as well as adults 60 and older.

This is the latest in a series of published Kaiser Permanente studies conducted to better understand vaccine effectiveness and safety. Among these studies were:

  • Dr. Tseng published a study last year in the journal Vaccine which found that administering both the pneumococcal and the herpes zoster vaccines at the same time is as beneficial as if they are administered separately.
  • In 2011, Dr. Tseng published a study in the Journal of the American Medical Associationwhich found that the shingles vaccine is associated with a 55 percent reduced risk of developing the disease.
  • Another study by Dr. Tseng in JAMA in 2010 found the pneumococcal pneumonia vaccination is not associated with a reduced risk of heart attacks or strokes in men.
  • Two Kaiser Permanente studies found that the combination vaccine for measles, mumps, rubella, and chickenpox is associated with double the risk of febrile seizures for 1- to 2-year-old children, compared to same-day administration of the separate vaccine for MMR (measles, mumps, rubella) and the varicella vaccine for chickenpox.
  • Other Kaiser Permanente studies found children of parents who refuse vaccines are nine times more likely to get chickenpox and 23 times more likely to get pertussis – commonly known as whooping cough — compared to fully immunized children.
  • Another study found that herpes zoster is very rare among children who have been vaccinated against chickenpox.

     ###

The Vaccine Safety Datalink Team authors included: Hung Fu Tseng, PhD, MPH, Steven J. Jacobsen, MD, PhD, Amy Liu, MS, Lina Sy, MPH, and S. Michael Marcy, MD, from the Kaiser Permanente Southern California Department of Research & Evaluation; Bruce Fireman (MA) and Roger Baxter (MD), from Kaiser Permanente Northern California, Vaccine Study Center; Sheila Weinmann (PhD) from Kaiser Permanente Northwest, Portland, Ore.; Matthew F. Daley (MD) from Kaiser Permanente Colorado, Denver; Eric Weintraub (MPH) and James Baggs (PhD), from the Centers for Disease Control and Prevention Immunization Safety Office, Atlanta; James Nordin (MD) from HealthPartners Research Foundation, Minneapolis, Minn.; and Lisa Jackson (MD, MPH) from Group Health Cooperative of Puget Sound, Seattle.

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