Page 1

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Improved clinical approach to Dx of hypertrophic discoid lupus Clinical practice

The Chronicle

of

& ALLERGY SKIN SKIN

Rosacea I

P RACTICAL T HERAPEUTICS and C LINICAL N EWS from the W ORLD of D ERMATOLOGY

n

M A RC H 2015

n SI 6 > C > C g E A 6 H B 9 : C 9 G >I>8 8 : AAH 8 6 wD G I = w= > A : 6 E E G 9 > 6 gC D H > H D ; 9 > H : by JOHN EVANS,

6 8 AA: D 6 6 H

:

yI D > 9 9 6 8 = ID

Assistant Editor, The Chronicle

All rights reserved. Chronicle Information Resources Ltd. Canada Post Canadian Publications Mail Sales Product Agreement Number 40016917

Emerging therapies

New clinical alternatives See page 4

HS significantly impacts patient quality of life: Canadian study Clinical practice

n GG : 6 I : G 6 w6 G : C : H H D ; HS C : : 9 : 9 I D > B E G D v: 9 > 6 gC D H > H , B 6 C 6 g: B : C I

H

by EMILY INNES,

Assistant Editor, The Chronicle

> 9 G 6 9 : C > I > H H J E E J G 6 I > v6 (HS) 8 6 C H > gC > ; > 8 6 C I A y 6 ; ; : 8 I 6 E 6 I > : C I ’H qJ 6 A > I y D ; A > ; : (QD L) 6 C 9 I = : 9 : gG : : D ; > B E 6 8 I 8 D G G : A 6 I : H w> I = I = : H : v: G > I y D ; I = : 8 D C 9 > I > D C , 6 8 8 D G 9 > C g I D I = : ; > C 9 > C gH D ; 6 C6 C 6 9 > 6 C H I J 9 y E J bA > H = : 9 D C A > C : > C I = : American Journal of Clinical Dermatology (F: b. 2015). F> ; I y-; > v: HS E 6 I > : C I H ; G D B 8 D B B J C > I y 9 : G B 6 I D A D gy 8 A > C > 8 H > C OC I 6 G > D 8 D B E A: I: 9 bD I = I= :

D: G B 6 I D A D gy L> ; : QJ 6 A > I y IC 9 : x (DLQI) 6 C 9 I = : S= D G I FD G B 36 V: G H > D C 2 (SF36v2). T= : G : H : 6 G 8 = : G H ;D J C 9 I= 6 I I= : B : 6 C DLQI H 8 D G : w6 H 10 ± 8.8, w= > 8 = > H : v: C = > g= : G I = 6 C Dr. Afsaneh Alavi B 6 C y H : G >D J H 9 : G B 6 I D A D g> 8 8 D C 9 > I > D C H . T= : 6 J I = D G H G : E D G I : 9 I = 6 I I = : SF-36v2 H 8 D G : H w: G : H > gC > ; > 8 6 C I A y G : 9 J 8 : 9

Oral small molecule new option for treatment of plaque psoriasis Therapies

n AE G : B > A 6 H I E G D v> 9 : H ; A : x> b> A > I y 6 H 8 A > C > 8 > 6 C H 8 D C H > 9 : G b: H I 8 = D > 8 : I D I G : 6 I I = : H : E 6 I > : C I H

H

by JOHN EVANS, Assistant Editor, The Chronicle

: 6 A I = C6 C 6 9 6 ’H H 6 ; : , : ; ; : 8 I > v: 6 C 9 E 6 I>: C IH 6 9 6 I : I D H : v: G : E A 6 qJ : E H D G T= : C : w ; D G B J A 6 I > D C

6 E IG: 9 : >6 H >H

E G D v6 A D ; D G 6 A 6 E G : B > A 6 H I G : E G : H : C I H 6 6 I B : C I D E I > D C I = 6 I w> A A g> v: 8 A > C > 8 > 6 C H 9 ; A : x> b> A > I y > C I = : I G : 6 I B : C I D ; B D 9 : G > H , H 6 y C6 C 6 9 > 6 C 9 : G B 6 I D A D g> H I H . Please turn to Apremilast page 16à

; D G bD I = E = yH > 8 6 A 6 C 9 B : C I 6 A = : 6 A I = . T= : 6 J I = D G H ; D J C 9 I = 6 I I = : H : v: G > I y D ; 9 > H : 6 H : , 6 H B : 6 H J G : 9 by HJ G A : y H I 6 g> C g 6 C 9 I = : C J B b: G D ; A : H > D C H , w: G : H > gC > ; > 8 6 C I A y 8 D G G : A 6 I : 9 w> I = I = : DLQI H 8 D G : H . P6 I > : C I H w> I = = > g= : G HJ G A : y H I 6 g> C g H 8 D G : H —> .: ., 6 H 8 D G : D ; III—= 6 9 I = : = > g= : H I DLQI H 8 D G : H .

Assessing impact on QoL DG . A; H 6 C : = AA 6 v> , w> I = I = D ; TD G D C I D ’H D: E 6 G I B : C I 9 > G : 8 I D G D ; I = : wD J C 9 = : H = > E 6 I WD B : C ’H CD A A : g: I = : H I J 9 y’H A : 6 9 6 J I = D G , H 6 w6 G : I = 6 I HS = 6 9 6 C E 6 I > : C I H ’ A > v: H , 6 C 9 w6 H E G

: UC > v: G H > I y D ; M: 9 > 8 > C : , 6 A > C g ; : A A D wHD H E > I 6 A 6 C 9 6 yH H = : w6 H >B E 6 8 I D C >B 6 G >Ay>C I: G -

Please turn to HS page 14à

n The Chronicle is committed to maintaining leadership in environmentally sustainable policies, and to encouraging the adoption of “green-aware” practices in healthcare. We invite your comments via e-mail, at: health@chronicle.org

B B J C D = >H ID 8 = : B >8 6 AAy B 6 E E > C g I = : 9 : C H > I y 6 C 9 9 > H I G > bJ I > D C D ; E A 6 H B 6 8 yI D > 9 9 : C 9 G > I > 8 8 : A A H (PDC) > H 6 v6 A J 6 bA : 9 > 6 gC D H I > 8 I D D A > C 8 6 H : H D ; H J H E : 8 I : 9 = yE : G I G D E = > 8 9 > H 8 D > 9 A J E J H : G yI = : B 6 I D H J H (HDLE), G : H : 6 G 8 = : G H ; G D B D6 A = D J H > : UC > v: G H > I y > C H6 A > ; 6 x G : E D G I > C 6 E 6 E : G E J bA > H = : 9 >C I= : Journal of Cutaneous Pathology (J6 C . 2015; 42(1):32R 38). HDLE “8 6 C H D B : I > B : H b: B > H I 6 k: C ; D G H qJ 6 B D J H 8 : A A 8 6 G 8 > C D B 6 D G 6 8 I > C > 8 k: G 6 I D H > H ,” H 6 yH DG . ND G : : C W6 A H = , 9 : G B 6 I D E 6 I = D A D g> H I 6 C 9 E G D ; : H H D G D ; E 6 I = D A D gy 6 I H6 A > ; 6 x’H C6 E > I 6 A D> H I G > 8 I H: 6 A I = AJ I = D G > I y 6 C 9 D6 A = D J H > : UC > v: G H > I y, 6 C 9 I = : H : C > D G 6 J I = D G D ; I = : H I J 9 y. “II > H H D B : I > B : H B > H I 6 k: C ; D G E G : -B 6 A > gC 6 C I D G B 6 A > gC 6 C I H k> C A : H > D C H .” R: 8 : C I A > I : G 6 I J G : = 6 H H = D wC PDCH = 6 v: 6 E 6 I = D A D g> 8 6 A H > gC > ; > 8 6 C 8 : > C 8 J I 6 C : D J H A J E J H : G yI = : B 6 I D H J H , 6 C 9 I = : 9 > H I G > bJ I > D C E 6 I I : G C H D ; PDCH >C 9 >;;: G : C I B 6 C >;: H I6 I>D C H D ; I= : 9 >H : 6 H : 6 G : >C ;D G B 6 I > v: . “T= > H > H I= : 8 6 H : >C 9 >H 8 D >9 AJ E J H 6 C 9 A J E J H E G D ; J C 9 J H ,” Dr. Noreen Walsh H 6 yH DG . W6 A H = . “B: 8 6 J H : [PDCH ] = 6 v: b: : C H = D wC I D b: D ; 9 > 6 gC D H I > 8 b: C : ; > I > C D I = : G I yE : H D ; 8 J I 6 C : D J H A J E J H , I I = D J g= I I = 6 I I = : y B > g= I 6 A H D b: D ; J H : > C = yE : G I G D E = > 8 A J E J H .” IC I = > H H I J 9 y, G : H : 6 G 8 = : G H J H : 9 CD123 6 C I > bD 9 y > B B J C D = > H I D 8 = : B > H I G y I D A 6 b: A I = : PDCH > C 27 I > H H J : H 6 B E A : H D ; HDLE, I 6 k: C ; G D B C > C : E 6 I > : C I H . T= : qJ 6 C I > I > : H D ; PDCH 6 C 9

Please turn to HDLE page 11à


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NEW CICAPLAST BAUME

B5

Cracks

With La Roche-Posay Thermal Spring Water

REPAIRING BALM Dry patches and chapping

Fragrance-free Paraben-free Lanolin-free

A COMPLETE FORMULA FOR DRY SKIN IRRITATIONS*

Cutaneous heating sensations

Panthenol 5% • Madecassoside • Copper • Zinc • Manganese • Shea Butter

1. Soothes and relieves dry skin areas

Infant redness

2. Repairs 3. Protects (Isolating texture for anti-bacterial adhesion)

Rough areas

Very good tolerance demonstrated on babies, children and adults. TESTED UNDER DERMATOLOGICAL AND PEDIATRIC CONTROL Intense dryness INGREDIENTS: AQUA • HYDROGENATED POLYISOBUTENE • DIMETHICONE • GLYCERIN • BUTYROSPERMUM PARKII BUTTER / SHEA BUTTER • PANTHENOL • BUTYLENE GLYCOL • ALUMINUM STARCH OCTENYLSUCCINATE • PROPANEDIOL • CETYLPEG / PPG-10 / 1 DIMETHICONE • TRISTEARIN • ZINC GLUCONATE • MADECASSOSIDE • MANGANESE GLUCONATE • MAGNESIUM SULFATE • DISODIUM EDTA • COPPER GLUCONATE • ACETYLATED GLYCOL STEARATE • POLYGLYCERYL-4 ISOSTEARATE • SODIUM BENZOATE • PHENOXYETHANOL • CHLORHEXIDINE DIGLUCONATE • CI 77891 / TITANIUM DIOXIDE.

La Roche-Posay. Committed to dermatology. * Due to dry skin.


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Vol. 21, No. 2

THE CHRONICLE of S K I N & A L L E R G Y

TOP of the MONTH

M6 G 8 = 2015 · 3

A Message from the Medical Editor

F

Cellular dermatofibromas should always be completely excised R> H kH H J 8 = 6 H 6 = > g= G 6 I : D ; G : 8 J G G: C 8 : 6 C 9 G6 G: G: E D GI: 9 8 6 H : H D ; B : I 6 H I 6 H : H w> I = b: C > gC 8 : A A J A 6 G 9 : G B 6 I D ; > bG D B 6 H , 6 H w: A A 6 H 6 A D w G > H k D ; B 6 A > gC 6 C I I G 6 C H ; D G B 6 I > D C , A : 6 9 8 A > C > 8 > 6 C I D J G g: 8 D B E A : I : : x8 > H > D C D ; I = : H : A : H > D C H . . . . . . . . . .6

Surveying the current dermatologic literature: Low-dose cyclosporine plus glucosamine for AD, and more THE CHRONICLE’H H : A : 8 I > D C D ; C D I 6 bA : 9 : v: A D E B : C I H > C 9 : G B 6 I D A D gy, w> I = 8 D B B : C I 6 G y E G D v> 9 : 9 by DG . K6 I > : B: A : zC 6 y, 8 A > C > 8 6 A > C H I G J 8 I D G > C I = : D: E 6 G I B : C I D ; D: G B 6 I D A D gy 6 C 9 Sk> C S8 > : C 8 : , UC > v: G H > I y D ; BG > I > H = CD A J B b> 6 , V6 C 8 D J v: G . . . . . . . . . . . 8

Changes called for in counselling process for patients on isotretinoin JAMA H I J 9 y ; > C 9 H I = 6 I w= > A : wD B : C J C 9 : G H I D D 9 I = : G > H kH D ; b: 8 D B > C g E G : gC 6 C I w= > A : D C > H D I G : I > C D > C , B D H I w: G : 8 D J C H : A A : 9 6 bD J I D G 6 A 8 D C I G 6 8 : E I > v: H bJ I 9 > 9 C D I G : 8 : > v: 6 9 : qJ 6 I : > C ; D G B 6 I > D C 6 bD J I D I = : G : ; ; : 8 I > v: ; D G B H D ; b> G I = 8 D C I G D A . . . . . . . . . . . .25

Chronicle Postgraduate Educational Supplement IC I = > H B D C I = ’H C= G D C > 8 A : PD H I gG 6 9 J 6 I : E9 J 8 6 I > D C 6 A SJ E E A : B : C I , G: G B 6 C G : H : 6 G 8 = : G H 6 H H : H H I = : 6 H H D 8 > 6 I > D C D ; v6 G > 6 I > D C > C I = : LAMA3 g: C : , : C 8 D 9 > C g I = : 6 A E = 6 8 = 6 > C D ; A 6 B > C > C 5, w> I = 6 I D E > 8 9 : G B 6 I > I > H > C 6 8 6 H : -8 D C I G D A H I J 9 y . . 21

D G I= D 6 II: C 9 H >D C H D ; D: G B 6 I D

Research

Skin patch for immunotherapy From the News Resources of The Chronicle

A b: I I : G G D J I : I D G : I G 6 > C I = : > B B J C : H yH I : B D ; E : D E A : w> I = ; D D 9 6 A A : G g> : H B 6 y b: I = G D J g= I = : H k> C , 6 8 8 D G 9 > C g I D ; > C 9 > C gH ; G D B G : H : 6 G 8 = : G H 6 I I = : J6 ; ; : FD D 9 AA A : G gy IC H I > I J I : 6 I I = : KG 6 v> H C= > A 9 G : C ’H HD H E > I 6 A 6 I MD J C I S> C 6 > > C N: w YD G k C> I y. IC 6 C 6 G I > 8 A : E J bA > H = : 9 D C A > C : > C H: 6 A I = D6 y (F: b. 23, 2015), H I J 9 y A : 6 9 DG . HJ g= S6 B E H D C , 9 > G : 8 I D G D ; I = : J6 ; ; : IC H I > I J I : , H 6 > 9 I = 6 I w= > A : I = : G : = 6 H b: : C E G D gG : H H > C I = : J H : D ; D G 6 A >B B J C D I= : G 6 E y ID : 6 H : E : 6 C J I 6 AA: G g> : H , I = : G 6 I : D ; 6 9 v: G H : G : 6 8 I > D C H = 6 H b: : C = > g= , 6 C 9 6 C D v: A H k> C E 6 I 8 = ; D G 9 : A > v: G > C g 8 D C I G D A A : 9 9 D H : H D ; 6 A A : G g: C H B 6 y b: H > gC > ; > 8 6 C I A y H 6 ; : G . CA > C > 8 6 A I G > 6 A 9 6 I 6 ; G D B I = : C : w > B B J C D I = : G 6 E y H k> C E 6 I 8 = , E G : H : C I : 9 6 I I = : AB : G > 8 6 C A8 6 9 : B y D ; AA A : G gy, AH I = B 6 , 6 C 9 IB B J C D A D gy H : H H > D C H > C F: bG J 6 G y, H J gg: H I H > C I G D 9 J 8 > C g I = : > B B J C : H yH I : B I D 6 A A : G -

g: C E G D I : > C H I = G D J g= I = : H k> C 8 6 C b: bD I = : ; ; : 8 I > v: 6 C 9 H 6 ; : G I = 6 C D G 6 A 6 9 B >C >H IG 6 I>D C . IC I = : I G > 6 A , = 6 A ; D ; 221 E 6 G I > 8 > E 6 C I H b: I w: : C I = : 6 g: H D ; H > x 6 C 9 55 y: 6 G H , 6 A A w> I = E : 6 C J I 6 A A : G gy, wD G : I = : C : w E 6 I 8 = ; D G D C : y: 6 G . By I = : : C 9 D ; I = : I G : 6 I B : C I E : G > D 9 , I = D H : E 6 I > : C I H w: G : 6 bA : I D I D A : G 6 I : 6 B > C > B J B D ; D C : gG 6 B D ; E : 6 C J I E G D I : > C —I = : : qJ > v6 A : C I D ; ; D J G E : 6 C J I H —w= > 8 = G : E G : H : C I : 9 6 E E G D x> B 6 I : A y 10 I > B : H I = : 6 B D J C I I = : y 8 D J A 9 I D A : G 6 I : 6 I I = : b: g> C C > C g D ; I = : I G > 6 A . ExI : C 9 : 9 E : G > D 9 H D ; w: 6 G > C g I = : E 6 I 8 = wD J A 9 A > k: A y E G D 9 J 8 : : v: C gG : 6 I : G > C 8 G : 6 H : H > C I D A : G 6 C 8 : . T= : > B E G D v: B : C I H D ; : v: C 6 H > C gA : y: 6 G D ; J H : 8 D J A 9 bG > C g H > gC > ; > 8 6 C I E : 6 8 : D ; B > C 9 I D I = D H : w> I = E : 6 C J I 6 A A : G g> : H , H 6 > 9 DG . S6 B E H D C , H > C 8 : I = : > C 8 G : 6 H : > C I D A : G 6 C 8 : wD J A 9 E G D I : 8 I I = : B ; G D B 6 8 8 > 9 : C I 6 A : xE D H J G : 6 I 6 E 6 G I y, ; D G : x6 B E A : , D G wD G G y 6 bD J I A 6 b: A H I = 6 I H 6 y V B 6 y 8 D C I 6 > C E : 6 C J I ’.

Subscriptions: $85.60 per year in Canada, $129.95 per year in all other countries. Single copies: $10.00 per issue (plus 13% HST).

March 2015 • Vol. 21 No. 2

Published eight times per year by the proprietor, Chronicle Information Resources Ltd., with offices at 555 Burnhamthorpe Road, Ste 306, Toronto, Ont. M9C 2Y3 Canada. Telephone: (416) 9162476; Facs. (416) 352-6199. E-mail: health@chronicle.org ISSN No. 1209-0581

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Ideas in the Service of Medicinesm Affiliated journals of the Chronicle Companies include The Chronicle of Cosmetic Medicine + Surgery, The Chronicle of Neurology & Psychiatry, Pediatric Chronicle, The Chronicle of Healthcare Marketing, Drug Rep Chronicle, and Linacre’s Books/Les Editions Linacre

H : D ; J H w= D w: G : 6 bA : I D I= : 6 C C J 6 A H 8 >: C I>;>8 H : H D ; I = : AB : G > 8 6 C A8 6 9 : B y A D gy > C S6 C FG 6 C 8 > H 8 D , > I w6 H G : 6 9 > A y 6 E E 6 G : C I I = 6 I C6 C 6 9 > 6 C H w: G : B 6 k> C g 6 = J g: > B E 6 8 I D C I = 6 I g6 I = : G > C g. F> G H I 6 C 9 ; D G : B D H I w6 H I = : g: C J > C : bJ zz 6 C 9 : x8 > I : B : C I 6 G D J C 9 I = : J E 8 D B > C g 23G 9 WD G A 9 CD C gG : H H D ; D: G B 6 I D A D gy > C V6 C 8 D J v: G , H 8 = : 9 J A : 9 ; D G JJ C : 8 I D 13, 2015. S: 8 D C 9 w6 H I = : H > gC > ; > 8 6 C I 8 D C I G > bJ I > D C C6 C 6 9 > 6 C H B 6 9 : D C I = : E D 9 > J B 6 I I = : AAD, w= : I = : G > I w6 H E G : H : C I > C g C D v: A 9 6 I 6 6 I 6 A 6 I : bG : 6 k> C g H : H H > D C D G B 6 k> C g 6 B 6 jD G 8 D C I G > bJ I > D C I D D C : D ; I = : w: A A -6 I I : C 9 : 9 H yB E D H > J B H . THE CHRONICLE OF SKIN & ALLERGY 6 AH D 8 D C I>C J : H ID 9 : B D C H IG 6 I: = D w C6 C 6 9 > 6 C 9 : G B 6 I D A D g> H I H 6 G : B 6 k> C g 6 B 6 jD G 8 D C I G > bJ I > D C I D I = : H E : 8 > 6 A A I y, w= : I = : G > C I = : 6 G : 6 D ; E : 9 > 6 I G > 8 9 : G B 6 I D A D gy w> I = I = : 9 : v: A D E B : C I D ; I = : C : w TD G D C I D E : 9 > 6 I G > 8 > I 8 = H 8 6 A : (H : : E 6 g: 16), D G D C I = : B : 9 > 8 6 A H > 9 : w> I = DG . A; H 6 C : = AA 6 v> E G : H : C I > C g H I J 9 y G : H J A I H I = 6 I = 6 v: = > g= A > g= I : 9 I= : IG J : >B E 6 8 I I= 6 I = > 9 G 6 9 : C > I > H H J E E J G 6 I > v6 = 6 H D C E 6 I > : C I H (H : : E 6 g: 1). DG . S= 6 C : S> A v: G = 6 H 6 ; : w E G 6 8 I > 8 6 A H J G g> 8 6 A I > E H I = 6 I w: G : E G : H : C I : 9 9 J G > C g I = : 2014 CDA. T= : H : > C 8 A J 9 :

Medical Editor

Wayne Gulliver,

MD, FRCPC

John P. Arlette, MD, FRCPC Benjamin Barankin, MD, FRCPC Marc Bourcier, MD, FRCPC Eric Goldstein, MD, FRCPC Peter Hull, MD, FRCPC Rod Kunynetz, MD, FRCPC Richard Langley, MD, FRCPC Danielle Marcoux, MD, FRCPC

Please turn to Message page 24à Editor, Cosmetic Dermatology MD, FRCPC

Sheldon V. Pollack,

R.A.W. Miller, MD, FRCPC H. Eileen Murray, MD, FRCPC Kim Papp, MD, FRCPC Yves Poulin, MD, FRCPC Melanie D. Pratt, MD, FRCPC Denis Sasseville, MD, FRCPC Jerry Tan, MD, FRCPC Ronald B. Vender, MD, FRCPC

Founding Editor Colin A. Ramsay, MD, FRCPC (1936-2003)

Publisher Mitchell Shannon Editorial Director R. Allan Ryan Senior Associate Editor Lynn Bradshaw Assistant Editors John Evans, Emily Innes

Sales & Marketing Sandi Leckie, RN Production and Circulation Cathy Dusome Comptroller Rose Arciero

Contacting The Chronicle

“OG 6 A 9 D H D E I>D C ;D 6 E E G : 8 >6 I: 6 C

>C G I= 9

g [D H D B >H 6 B 6

; 6 E G: B : E 6 I>: H A: H H I= y b: B D

>A6 C IH G: G:

H I]>H 6 B . SD B : E 6 I: C >C gD D E : C ID

D G : 8 D C v: C > : C I 6 I>: C IH B 6 y G A : H H > C v6 H > v: > I . . .”

Dr. Norman Wasel, assistant clinical professor of medicine, University of Alberta, Edmonton (see page 1)

n READER SERVICE: TD 8 = 6 C g: yD J G 6 9 9 G : H H , D G ; D G qJ : H I > D C H 6 bD J I yD J G G : 8 : > E I D ; I = : jD J G C 6 A , H : C 9 6 C : -B 6 > A I D = : 6 A I = @8 = G D C > 8 A : .D G g w> I = H J bj: 8 I A > C : “C> G 8 J A 6 I > D C ,” D G 8 6 A A 9 J G > C g bJ H > C : H H = D J G H 6 I 416.916.CHROC (2476), D G I D A A ; G : : 6 I 866.63.CHRON (24766). n LETTERS: W: w: A 8 D B : yD J G 8 D G G : H E D C 9 : C 8 : by B 6 > A , ; 6 x (416.352.6199), D G : -B 6 > A . K> C 9 A y J H : I = : 8 D -D G 9 > C 6 I : H A > H I : 9 6 bD v: . n ADVERTISING: FD G 8 J G G : C I G 6 I : H 6 C 9 9 6 I 6 , E A : 6 H : 8 D C I 6 8 I I = : E J bA > H = : G . n REPRINTS: T= : 8 D C I : C I D ; I = > H jD J G C 6 A > H 8 D E yG > g= I : 9 . PA : 6 H : 8 D C I 6 8 I M> I 8 = : A A S= 6 C C D C ; D G G : E G >C I >C ;D G B 6 I>D C .


Skin_March_2015,rar16_ms_9.1_rar1_Skin_March_2014,rar1.qxd 09/04/2015 12:26 PM Page 4

Lead article

4 · M6 G 8 = 2015

Clinical practice

THE CHRONICLE of SKIN & A L L E R G Y

Emerging therapies offer clinical alternatives for

Rosacea W

n TD E > 8 6 A > v: G B : 8 I > C 8 6 A A : 9 6 “g6 B : 8 = 6 C g: G ” > C I = : I G : 6 I B : C I D ; G D H 6 8 : 6 ; H = D wH A 6 H I > C g : ; ; : 8 I by LOUISE GAGNON,

Correspondent, The Chronicle

>I= I= : G : 8 : C I 6 E E G D v6 A D ; I D E > 8 6 A > v: G B : 8 I>C ;D G I= : IG: 6 IB : C I D ; G D H 6 8 : 6 by I = : U.S. FD D 9 6 C 9 DG J g A9 B > C > H I G 6 I > D C , 6 E E G D v6 A > C C6 C 6 9 6 w> A A 6 9 9 6 C D I = : G > C I : gG 6 A I D E > 8 6 A I = : G 6 E y C6 C 6 9 > 6 C 9 : G B 6 I D A D g> H I H 8 6 C E G : H 8 G > b: I D I = : > G E 6 I>: C IH .

“T= : : v: C I J 6 A 6 E E G D v6 A D ; I D E > 8 6 A > v: G B : 8 I > C w> A A b: 6 g6 B : 8 = 6 C g: G ,” H 6 yH DG . B: C j6 B > C B6 G 6 C k> C , 8 D ; D J C 9 : G D ; I = : TD G D C I D D: G B 6 I D A D gy C: C I G : . “Iv: G B : 8 I > C H : : B H I D b: B D G : : ; ; : 8 I > v: I = 6 C B : I G D C > 9 6 zD A : 6 C 9 6 z: A 6 > 8 6 8 > 9 ; D G E 6 E J A D E J H I J A 6 G G D H 6 8 : 6 . II > H v: G y : x8 > I > C g b: 8 6 J H : > v: G B : 8 I > C G : E G : H : C I H 6 w= D A : C : w 8 A 6 H H D ; B : 9 > 8 > C : . II [H J gg: H I H ] D: B D 9 : x > H E A 6 y> C g 6 b> g G D A : [> C I = : 9 : v: A D E B : C I D ; G D H 6 8 : 6 ].” TD E > 8 6 A > v: G B : 8 I > C 6 ; ; : 8 I H I = : D: B D 9 : x B > I : H I = 6 I 6 G : E G : H : C I > C I = : E > A D H : b6 8 : D J H J C > I H D ; E 6 I > : C I H w> I = G D H 6 8 : 6 . T= : G : = 6 H b: : C A > I : G 6 I J G : D C I = : D: B D 9 : x > C ; : H I 6 I > D C G : H E D C 9 > C g I D 6 C D G 6 A ; D G B J A 6 I > D C D ; > v: G B : 8 I > C 6 C 9 I D E > 8 6 A E : G B : I = G > C , bJ I A > I I A : D C I = : J H : D ; I D E > 8 6 A > v: G B : 8 I > C . More patients clear on ivermectin T= : 6 E E G D v6 A D ; > v: G B : 8 I > C w6 H b6 H : 9 D C P= 6 H : III I G > 6 A H , w= : G : > v: G B : 8 I > C 1% 8 G : 6 B w6 H 8 D B E 6 G : 9 I D

v: = > 8 A : . F> C 9 > C gH H = D w: 9 I = : G : w6 H 6 H I 6 I > H I > 8 6 A A y H > gC >;>8 6 C I 9 >;;: G : C 8 : ; 6 vD J G > C g E 6 I>: C IH w= D J H : 9 > v: G B : 8 I > C 1% > C I = : E : G 8 : C I 6 g: D ; E 6 I>: C IH w= D Dr. Benjamin w: G : 8 A : 6 G D G Barankin C : 6 G 8 A : 6 G 6 I 12 w: : kH D ; I = : G 6 E y. ExI : C H > D C H IJ 9 >: H D ; I= : IG >6 AH 8 D C 9 J 8 I: 9 ID : v6 A J 6 I : A D C gI: G B H 6 ;: Iy D ; > v: G B : 8 I > C H 6 w E 6 I>: C IH IG : 6 I: 9 Dr. Melinda w> I = v: = > 8 A : Gooderham H w> I 8 = : 9 I D 6 z: A 6 > 8 6 8 > 9 15% g: A . D6 I 6 6 AH D 9 : B D C H I G 6 I : 9 I= : G : w6 H 6 9 : 8 G : 6 H : 9 >C 8 >9 : C 8 : D ; G : A6 I: 9 6 9 v: G H : : v: C I H w> I = > v: G B : 8 I > C Dr. Lisa Kellett 8 D B E 6 G : 9 I D 6 z: A 6 > 8 6 8 > 9 15% g: A , 6 C 9 C D E 6 I>: C IH G : 8 : > v> C g > v: G B : 8 I > C 1% 8 G : 6 B 9 > H 8 D C I > C J : 9 : > I = : G H I J 9 y b: 8 6 J H : D ; 6 G : A 6 I : 9 6 9 v: G H : : v: C I . IC v: H I > g6 I D G gA D b6 A 6 H H : H H B : C I G 6 I > C gH H J E E D G I : 9 > v: G B : 8 I > C 1% 8 G : 6 B 6 H 6 I = : G 6 E y I = 6 I 8 6 C b: J H : 9 ; D G I = : A D C g-I : G B > C I = : I G : 6 I B : C I D ; E 6 E J A D E J H I J A 6 G G D H 6 8 : 6 (JDD 2014

ND v1; 13(11): 1380R 1386). OC : D ; I = : 6 I I G 6 8 I > v: 8 = 6 G 6 8 I: G >H I>8 H D ; ID E > 8 6 A > v: G B : 8 I > C > H >I = 6 H 6 A6 H I>C g : ; ; : 8 I b: yD C 9 I = : G 6 E y, DG . B6 G 6 C k> C H 6 > 9 . “II H : : B H I D = 6 v: Dr. Julia Carroll E G D E : G I>: H I= 6 I G : B >I I= : 8 D C 9 >I > D C .” DG . M: A > C 9 6 GD D 9 : G = 6 B , 6 9 : G B 6 I D A D g> H I , B : 9 >8 6 A 9 >G : 8 ID G D ; Sk> C C: C I G : ; D G D: G B 6 I D A D gy Dr. Ian Landells > C P: I : G bD G D J g= , OC I ., 6 C 9 6 8 A > C > 8 6 A I G > 6 A > C v: H I > g6 I D G , 6 gG : : 9 I = 6 I I = : b: C : ; > I w> I = > v: G B : 8 I > C J H : 6 E E : 6 G H I D : xI : C 9 b: yD C 9 I G : 6 I B : C I . “I I = > C k > I w> A A B 6 k: 6 b> g 9 > ; ; : G : C 8 : > C = D w w: I G : 6 I D J G E 6 I > : C I H ,” H 6 yH DG . GD D 9 : G = 6 B > C 6 C > C I : G v> : w. “Ev: C I = D J g= E 6 I > : C I H w: G : C D A D C g: G D C > I , I = : y 8 D C I > C J : 9 I D 9 D b: I I : G 6 ; I : G 6 8 I > v: I G : 6 I B : C I : C 9 : 9 . II H : : B H I D E J I E 6 I > : C I H > C I D G : B > H H > D C .”

Additional treatment options T= : 6 v6 > A 6 b> A > I y D ; bG > B D C > 9 > C : I 6 G I G 6 I : > H 6 “gD D 9 D E I > D C ” ; D G E 6 I > : C I H w= D = 6 v: G D H 6 8 : 6 6 C 9 H : : k 6 I D E > 8 6 A I = : G 6 E y I D I G : 6 I b6 8 kgG D J C 9 G : 9 C : H H b: ; D G : H E : 8 > ; > 8 D 8 8 6 H > D C H , : xE A 6 > C H DG . L> H 6 K: A A : I I , 6 9 : G B 6 I D A D g> H I 6 C 9 Please turn to Rosacea page 12à

E


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6 · M6 G 8 = 2015

Cellular dermatofibromas should be exised Clinical practice

n Ex8 > H > D C B 6 y G : 9 J 8 : E D I : C I > 6 A ; D G B 6 A > gC 6 C I I G 6 C H ; D G B 6 I > D C

W

v> 9 : 9 w> I = 6 C 6 E E D > C I B : C I w> I = > C 6 ; : w w: : kH 6 ; I : G H : : > C g I = : > G G : ; : G G > C g E = yH > 8 > 6 C , = : C D I : 9 . AC D I = : G E G 6 8 I > 8 : B 6 C 6 g: B : C I E : 6 G A > H I = 6 I = : C 9 : G B 6 I D A D g> H I H 6 G : ; 6 8 : 9 w> I = 6 9 : G B 6 I D A D g> H I H H = D J A 9 9 D 8 J B : C I b> D E H > : H by E 6 I > : C I w= D = 6 H 8 : A A J A 6 G 9 : G B 6 I D ; > bG D - D bI 6 > C > C g 9 > g> I 6 A E = D I D gG 6 E = H D ; H > I : H I = 6 I = 6 v: B 6 H , I = : y H = D J A 9 8 D B E A : I : A y : x8 > H : I = : b: : C b> D E H > : 9 . T= > H > H 6 w> H : E G 6 8 I > 8 : b: 8 6 J H : A : H > D C H , 6 8 8 D G 9 > C g I D 6 A : 8 I J G : G > C I = : ; 6 8 J A I y D ; I = : G : B 6 y b: 6 9 : A 6 y D ; H : v: G 6 A w: : kH > C I : G B H D ; B : 9 > 8 > C : 6 I I = : UC > v: G H > I y D ; M6 C > I D b6 > C W> C C > E : g. I = : b> D E H y G : H J A I H . T= : A D 8 6 I > D C D ; I = : b> D E H y, G> v> C g ; : A A D w 9 : G B 6 I D A D g> H I H I > E H D C g: C : G 6 A H J 8 = 6 H I = : H 8 6 A E , 6 C 9 8 = 6 G 6 8 I : G > H I > 8 H D ; I = : H k> C , 9 : G B 6 I D A D gy 6 I 6 E A : C 6 G y H : H H > D C 9 J G > C g I = : 6 C C J 6 A H J 8 = 6 H E = D I D 6 g> C g, B 6 y B 6 k: > 9 : C I > ; y> C g I = : B : : I > C g D ; I = : C6 C 6 9 > 6 C D: G B 6 I D A D gy AH H D 8 > 6 I > D C b> D E H > : 9 H > I : 6 8 = 6 A A : C g: 6 ; I : G 6 E : G > D 9 D ; I > B : . > C TD G D C I D , DG . S= 6 C : S> A v: G “YD J B 6 y C D I b: 6 bA : I D H : : I = : b> D E H y H > I : C D I : 9 I = 6 I I = : G : 6 G : G > H kH 6 H H D w: : kH A 6 I : G , 6 C 9 yD J B 6 y C D I kC D w w= : G : I D 8 > 6 I : 9 w> I = 8 : A A J A 6 G 9 : G B 6 I D ; > : x8 > H : > ; yD J C : : 9 I D ,” = : H 6 > 9 . “I; I = 6 v: 6 E = D I D bG D B 6 H , w= > 8 = 6 8 8 D J C I ; D G gG 6 E = D ; I = : b> D E H > : 9 H > I : , I kC D w : x6 8 I A y w= : G : 6 bD J I 5% D ; 8 J I 6 C : D J H 9 : G I D : x8 > H : .” B 6 I D ; > bG D B 6 H (Dermatol Surg D: G B 6 I D A D g> H I H 8 6 C C D I 6 H H J B : I = 6 I 6 b> D E H y 2008; 34(9):1264R 1271). I = 6 I H = D wH 6 C g> D ; > bG D B 6 H B : 6 C H 6 9 > 6 gC D H > H D ; “T= : G : 8 D B B : C 9 6 I > D C > H I J b: G D J H H 8 A : G D H > H , H 6 > 9 DG . S> A v: G . P6 I > : C I H 8 6 C Dr. Shane Silver I D 6 A w6 yH 8 D B E A : I : A y : x8 > H : = 6 v: 6 C g> D ; > bG D B 6 H D C b> D E H y, bJ I I = : 8 D G G : 8 I I = : A : H > D C ,” H 6 > 9 DG . S> A v: G . 9 > 6 gC D H > H B 6 y b: B> G I -HD gg-DJ b: SyC 9 G D B : . “T= : G : > H 6 = > g= G 6 I : D ; G : 8 J G G : C 8 : 6 C 9 G 6 G : G : E D G I “CA 6 H H > 8 6 A A y, B> G I -HD gg-DJ b: SyC 9 G D B : = 6 H : 9 8 6 H : H D ; B : I 6 H I 6 H : H w> I = b: C > gC 8 : A A J A 6 G 9 : G - 6 8 = G D 8 D G 9 D C H , ; > bG D ; D A A > 8 J A D B 6 H , 6 C 9 I G > 8 = D 9 > H 8 D B 6 I D ; > bG D B 6 H , 6 H w: A A 6 H 6 A D w G > H k D ; B 6 A > gC 6 C I B 6 H ,” H 6 > 9 DG . S> A v: G . “T= 6 I > H I = : I G > 6 9 . HD w: v: G , I G 6 C H ; D G B 6 I > D C ” (Am J Surg Pathol 2013; 6 A D I D ; E 6 I > : C I H w> I = B> G I -HD gg-DJ b: SyC 9 G D B : 37(4):484R 495). w> A A = 6 v: 6 C g> D ; > bG D B 6 H . f the patient does YD J B 6 y b> D E H y I wD D G DG . S> A v: G H 6 > 9 8 : A A J A 6 G 9 : G B 6 I D ; > bG D B 6 H , w= > 8 = 6 G : not get a [refer- I = G : : H > I : H , 6 C 9 I = : y w> A A 6 AH D G : ;: G G : 9 ID 6 H 8 J I6 jJ H I H = D w 6 C g> D ; > bG D B 6 H . ral] appointment, I; I = 6 I 9 D : H C ’I B 6 I 8 = 8 A > C C : D J H ; > bG D J H = > H I > D 8 yI D B 6 H , 6 G : 8 = 6 A A : C g> C g I D : x8 > H : , > 8 6 A A y, yD J H = D J A 9 I = > C k D ; you [the bJ I > I > H > B E : G 6 I > v: I = 6 I I = : y B> G I -HD gg-DJ b: dermatologist] are at risk b: G : B D v: 9 I D G : 9 J 8 : [SyC 9 G D B : ] 6 C 9 G : -b> D E E D I : C I > 6 A ; D G B 6 A > gC 6 C I H y. I; yD J H : : B 6 C y for litigation.” IG 6 C H ;D G B 6 I>D C . 6 C g> D ; > bG D B 6 H , 9 D C D I —Dr. Shane Silverq 6 H H J B : I = : E 6 I > : C I = 6 H “YD J B 6 y = 6 v: I D : x8 > H : I wD D G I = G : : I > B : H 6 C 9 J H : I J b: G D J H H 8 A : G D H > H .” w> 9 : B 6 G g> C H w= : C yD J 9 D ,” = : H 6 > 9 . DG . S> A v: G C D I : 9 = : = 6 H H : : C 6 bD J I 20 E 6 I > : C I H > C 6 9 : 8 6 9 : D ; E G 6 8 I > 8 : w= D = 6 v: ; > G H I H = D wC Square knot for closing wounds A E : 6 G A G : g6 G 9 > C g H J G g> 8 6 A I : 8 = C > qJ : > H I = : J H : D ; 6 C g> D ; > bG D B 6 H 6 C 9 w= D H : 9 > 6 gC D H > H w6 H B> G I HD gg-DJ b: SyC 9 G D B : . I = : H qJ 6 G : kC D I ; D G H J I J G > C g, H 6 > 9 DG . S> A v: G , w= D “II > H > B E D G I 6 C I I D G : 8 D gC > z: I = 6 I I = : H : G : 8 D B B : C 9 : 9 I wD I = G D wH D C I = : C : : 9 A : 9 G > v: G > C E 6 I > : C IH 6 G : 6 I G >H k;D G G : C 6 A 8 : AA 8 6 G 8 >C D B 6 ,E C : J D C : 9 >G : 8 I>D C , D C : I= G D w I= : D E E D H >I: , 6 C 9 I= : B D I = D G 6 x, 6 C 9 yD J w> A A = 6 v: I D > C v: H I > g6 I : ; D G ; > C 6 A I = G D w I = : H 6 B : w6 y 6 H I = : > C > I > 6 A 9 > G : 8 I > D C . IC I = 6 I ,” H 6 > 9 DG . S> A v: G . “YD J w> A A = 6 v: I D > C v: H I > g6 I : wD J C 9 H w> I = I : C H > D C , > C H I : 6 9 D ; 9 D > C g 6 H : 8 D C 9 ; 6 B > A y B : B b: G H 6 H w: A A .” I= G D w I= : D E E D H >I: 9 >G : 8 I>D C D ; I= : ;>G H I, 6 9 9 D C : P6 I > : C I H w= D G : E D G I I = 6 I I = : y = 6 v: 6 C > I 8 = y B D G : I= G D w >C I= : H 6 B : 9 >G : 8 I>D C H D I= : H J IJ G : 6 C J H ; D G 6 C : xI : C 9 : 9 9 J G 6 I > D C , H J 8 = 6 H B 6 C y w> A A H I 6 y > C E A 6 8 : 6 C 9 C D I A D D H : C . YD J 8 6 C I = : C y: 6 G H , 8 6 C b: 6 9 : qJ 6 I : A y I G : 6 I : 9 w> I = I D E > 8 6 A E G D 8 : : 9 w> I = I = : H : 8 D C 9 6 C 9 I = > G 9 I = G D w 6 H wD J A 9 H J 8 G 6 A ; 6 I : , H 6 > 9 DG . S> A v: G . C D G B 6 A A y b: 9 D C : I D 8 D B E A : I : I = : H qJ 6 G : kC D I . “M6 C y D ; J H E G : H 8 G > b: I D E > 8 6 A H I : G D > 9 H [I D OC : E G 6 8 I > 8 : B 6 C 6 g: B : C I I > E I = 6 I DG . S> A v: G I G : 6 I > I 8 = y 6 C J H ], 6 C 9 I = : A > I : G 6 I J G : H J gg: H I H J H > C g H = 6 G : 9 w> I = 8 D A A : 6 gJ : H > H I D = 6 v: E 6 I > : C I H 8 D C I 6 8 I B D 9 6 A > I > : H A > k: PUVA I = : G 6 E y 6 C 9 > C I G 6 A : H > D C 6 A I = : D ; ; > 8 : D ; I = : 9 : G B 6 I D A D g> H I I D : C H J G : I = 6 I 6 H I : G D > 9 H ,” H 6 > 9 DG . S> A v: G . “W= 6 I I ; > C 9 = : A E H w> I = G : ; : G G 6 A I D 6 C D I = : G E = yH > 8 > 6 C = 6 H b: : C B 6 9 : > ; E 6 I > : C I H w= D G : E D G I > I 8 = y 6 C J H > H I D E > 8 6 A H J 8 G 6 A E 6 I > : C I H 6 G : C D I E G D v> 9 : 9 6 C 6 E E D > C I B : C I w> I = > C ;6 I: . I I= >C k I= 6 I H J 8 G 6 A;6 I: = 6 H 6 E A6 8 : >C 9 : G B 6 D C : B D C I = D ; b: > C g G : ; : G G : 9 by 6 9 : G B 6 I D A D g> H I . I D A D gy, 6 C 9 I = 6 I > I = 6 H b: : C J C 9 : G J I > A > z: 9 .” “W= : I = : G I = : E 6 I > : C I > H b: > C g G : ; : G G : 9 ; D G DG . S> A v: G C D I : 9 I = : v6 G > : I y D ; J H : H ; D G H J 8 G 6 A 8 6 C 8 : G 8 6 G : , : C 9 D 8 G > C D A D gy D G w= 6 I : v: G I = : G : 6 ; 6 I : 8 > I : 9 > C I = : A > I : G 6 I J G : , H J 8 = 6 H b: > C g J H : 9 I D H D C , > I ’H 6 A w6 yH I = : G : ; : G G > C g E = yH > 8 > 6 C ’H G : H E D C H > IG : 6 I G 6 9 >6 I>D C 9 : G B 6 I>I>H , G 6 9 >6 I>D C E G D 8 I>I>H , 6 C 9 b> A > I y I D B 6 k: H J G : I = : 6 E E D > C I B : C I = 6 H b: : C v: C D J H A : g J A 8 : G H , 6 B D C g D I = : G 8 D C 9 > I > D C H . B 6 9 : ,” H 6 > 9 DG . S> A v: G . “I = 6 v: J H : 9 > I ; D G H : v: G : 9 > 6 E : G 9 : G B 6 I > I > H “I; I = : E 6 I > : C I 9 D : H C D I g: I 6 [G : ; : G G 6 A ] 6 E E D > C I - 6 C 9 H : v: G : E : G > 6 C 6 A E G J G > I J H w> I = : x8 D G > 6 I > D C H ,” B : C I , yD J [I = : 9 : G B 6 I D A D g> H I ] 6 G : 6 I G > H k ; D G A > I > g6 - H 6 > 9 DG . S> A v: G , w= D C D I : 9 = : I yE > 8 6 A A y J H : H 6 8 D C I > D C . I 6 A w6 yH 9 D 8 J B : C I > C B y 8 = 6 G I I = 6 I I = 6 v: 8 : C I G 6 I > D C D ; 8% H J 8 G 6 A ; 6 I : . 6 H k: 9 I = : E 6 I > : C I H I D 8 6 A A B : > ; I = : y 9 D C ’I = : 6 G OC : 9 D J bA : -bA > C 9 , G 6 C 9 D B > z: 9 I G > 6 A ; D J C 9 b6 8 k 6 bD J I 6 C 6 E E D > C I B : C I > C 6 bD J I I wD w: : kH .” I D E > 8 6 A H J 8 G 6 A ; 6 I : , 6 9 B > C > H I : G : 9 6 H 6 20% D > C I T= : C6 C 6 9 > 6 C M: 9 > 8 6 A PG D I : 8 I > v: AH H D 8 > 6 I > D C B : C I , w6 H H J E : G > D G I D I D E > 8 6 A z> C 8 D x> 9 : > C I = : H J E E D G I H I = > H E G 6 8 I > 8 : D ; 6 H k> C g E 6 I > : C I H I D ; D A A D w- B 6 C 6 g: B : C I D ; 9 > 6 E : G 9 : G B 6 I > I > H (Iranian J E w> I = I = : > G G : ; : G G > C g E = yH > 8 > 6 C > ; I = : y 6 G : C D I E G D - Journal of Dermatology 2012; 15:85R 88). by LOUISE GAGNON,

Correspondent, The Chronicle

“I

Indications and Clinical use: • CLINDOXYL® Gel (5% benzoyl peroxide, 1% clindamycin) and CLINDOXYL® ADV Gel (3% benzoyl peroxide, 1% clindamycin) are indicated in the topical treatment of moderate acne vulgaris characterized by the presence of comedones, papules and pustules. • Not indicated for the treatment of cystic acne • Not for use in children <12 years Contraindications: • Hypersensitivity to medications containing lincomycin • Patients with or with a history of regional enteritis, ulcerative colitis or antibiotic-induced colitis (including pseudomembranous colitis) Most serious warnings and precautions: • For external use only • Not for oral, ophthalmic or intravaginal use Other relevant warnings and precautions: • Concomitant topical acne treatments: not recommended because a possible cumulative irritancy effect may occur • May cause clostridium difficile-associated disease • Avoid contact with hair, fabrics, carpeting or other materials (may cause bleaching) • May cause increased sensitivity to sunlight; sunlamps should not be used and deliberate or prolonged exposure to sunlight should be avoided or minimized • Sunburns should be resolved prior to use • Avoid contact with the mouth, eyes, lips, other mucous membranes or areas of irritated or broken skin • Could cause gram-negative folliculitis • May cause skin adverse events including irritation (peeling, reddening, dryness, itching, stinging/burning) • Cross-resistance between clindamycin and lincomycin and resistance to clindamycin is often associated with inducible resistance to erythromycin • Safety and efficacy not established in patients <12 years of age or those >65 years of age • Caution in use with neuromuscular blocking agents, tretinoin, isotretinoin and tazarotene • Should not be used with erythromycin or topical sulphonamides • Should not be administered during pregnancy or lactation unless the expected benefits to the mother outweigh the potential risks to the fetus or the infant; if used during lactation, do not apply to the chest so as to avoid accidental ingestion by the infant Dosage and method of administration: • Gently apply once daily to lightly cover the entire affected areas of the face with a thin layer of gel • A pea-sized amount should be applied for each area of the face (e.g., forehead, chin, each cheek), then hands should be washed. Adverse drug reactions: • CLINDOXYL® ADV Gel: application site dermatitis (1%) and application site photosensitivity (1%) • CLINDOXYL® Gel: peeling (16.3%), erythema (7.6%), dryness (7%), burning (2.3%), pruritus (1.7%), mild application-site paraesthesia (<1%) and acne worsening (<1%). For more information: Please consult the product monograph at http:// webprod5.hc-sc.gc.ca/dpd-bdpp/index-eng.jsp for important information relating to contraindications, warnings and precautions, adverse reactions, drug interactions, dosing information and postmarket adverse drug reactions which have not been discussed in this piece. The product monograph is also available by calling 1-800-387-7374.

46076_TAB_Clindoxyl_ADV_Chron_E.indd 1

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3% benzoyl peroxide, 1% clindamycin

A proven treatment for moderate acne vulgaris Demonstrated excellent adverse event profile1 • Most frequently reported treatment-related adverse events were application site dermatitis (1%) and application site photosensitivity (1%) Stiefel, a GSK company, Mississauga (Ontario) L5N 6L4 © 2014

® CLINDOXYL is a registered trademark, used under license by GlaxoSmithKline Inc.

Reference: 1. CLINDOXYL® GEL / CLINDOXYL® ADV Gel Product Monograph. GlaxoSmithKline Inc., November 7, 2013.

Another option in the treatment of acne

If severe local irritation (e.g. severe erythema, severe dryness and itching, severe stinging/burning) develops, discontinue use and institute appropriate therapy.

Help them face their acne

82043 12/14


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Vol. 20, No. 5

8ツキ M6 G 8 = 2015

Surveying the current

Dermatologic literature Low-dose cyclosporine plus glucosamine for AD

SADBE an effective therapy for recalcitrant warts

THE CHRONICLE of S K I N & A L L E R G Y

CD B B : C I 6 G y > C I = > H : 9 > I > D C : Dr. Katie Beleznay, 8 A > C > 8 6 A > C H I G J 8 I D G > C I = : D: E 6 G I B : C I D ; D: G B 6 I D A D gy 6 C 9 Sk> C S8 > : C 8 : , UC > v: G H > I y D ; BG > I > H = CD A J B b> 6 , V6 C 8 D J v: G

Recently come across something from the peer-review literature that you consider to be interesting or impactful? Share it with your colleagues. E-mail your clippings, along with your comments, to: health@chronicle.org

D ; AD B 6 I > I > H (AD) 9 D : 8 D B E 6 G : 9 I D 8 y8 8 y8 A D H E D G > C : , G : H : 6 G 8 = COMBINATION

A

w-9 H C D AD H E : GH

D H : I 6 E D G >C G: E D

8 y8 A D E : 6 G : 6 AD G I >C

H E D G > C : 6 C 9 gA J 8 D H 6 B > C : I D > C 8 G : 6 H : : > I = : G 6 9 v: G H : C : , H D I = : 8 D B b> C 6 I > D C B 6 Dermatologic Therapy (J6 C

; D G B D 9 : G 6 I : I D H : v: G : 6 I D E > 8 9 : G : v: C I H D G H : G J B 8 y8 A D H E D G > C : A : v: A H y 6 A A D w ; D G A D C g-I : G B I G : 6 I B : C I w> I = ./F: b. 2015; 28(1):44-51).

FD A A D w> C g J E D C 6 E > A D I H I J 9 y I = 6 I ; D J C 9 > B E G D v: 9 D J I 8 D B : H ; G D B 8 D B b> C > C g I G : 6 I B : C I w> I = 8 y8 A D H E D G > C : 6 C 9 gA J 8 D H 6 B > C : ; D G AD I G : 6 I B : C I 8 D B E 6 G : 9 I D 8 y8 A D H E D G > C : 6 A D C : , I = : 6 J I = D G H 8 D C 9 J 8 I : 9 6 G 6 C 9 D B > z: 9 , E A 6 8 : bD -8 D C I G D A A : 9 6 C 9 9 D J bA : -bA > C 9 : 9 H I J 9 y I D : v6 A J 6 I : I = : H 6 ; : I y 6 C 9 : ; ; > 8 6 8 y D ; I = : 8 D B b> C 6 I > D C I G : 6 I B : C I > C B D 9 : G 6 I : I D H : v: G : AD vH . I = : B D C D I = : G 6 E y. P6 I > : C I H w> I = SCORAD > C 9 : x: H D ; 30 D G = > g= : G w: G : > C 8 A J 9 : 9 > C I = : H I J 9 y, 6 C 9 w: G : G 6 C 9 D B > z: 9 > C I D I wD : qJ 6 A I G : 6 I B : C I gG D J E H . GG D J E A G : 8 : > v: 9 8 y8 A D H E D G > C : 2 B g/kg 6 C 9 gA J 8 D H 6 B > C : 25 B g/kg, w= > A : gG D J E B G : 8 : > v: 9 I = : 8 y8 A D H E D G > C : 9 D H : 6 C 9 6 E A 6 8 : bD . T= : I G : 6 I B : C I E : G > D 9 w6 H : > g= I w: : kH , 6 C 9 SCORAD > C 9 > 8 : H , H : G J B A : v: A H D ; 8 = : B D k> C : A > g6 C 9 17 6 C 9 > C I : G A : J k> C (IL)-31, : D H > C D E = > A 8 D J C I H , 6 C 9 bA D D 9 8 y8 A D H E D G > C : A : v: A H w: G : B : 6 H J G : 9 b: ; D G : 6 C 9 6 ; I : G I = : I G : 6 I B : C I E : G > D 9 . T= : 19 E 6 I > : C I H > C gG D J E A = 6 9 H > gC > ; > 8 6 C I A y G : 9 J 8 : 9 SCORAD > C 9 > 8 : H E D H I -I G : 6 I B : C I , 6 C 9 6 H > gC > ; > 8 6 C I 8 D G G : A 6 I > D C b: I w: : C SCORAD 8 = 6 C g: H 6 C 9 8 = 6 C g: H > C 8 = : B D k> C : A > g6 C 9 17 H : G J B A : v: A H , I = D J g= C D I IL-31. 窶認or more information visit http://tinyurl.com/n6vv35j

Commentary: This study was performed on a relatively small sample size and more research needs to be done, but it does present interesting data supporting the efficacy of a combination of cyclosporine and glucosamine for treatment of moderate to severe atopic dermatitis. If a patient is requiring a systemic medication such as cyclosporine to treat AD it appears that low dose cyclosporine in combination with glucosamine may allow for longer-term use with improved results and no increase in the likelihood of adverse events versus cyclosporine alone.

S

(SADBE) I = : G 6 E y 6 E E : 6 G H I D b: bD I = H 6 ; : 6 C 9 : ; ; : 8 I > v: ; D G I = : I G : 6 I B : C I D ; G : 8 6 A 8 > I G 6 C I w6 G I H > C 8 = > A 9 G : C , 6 8 8 D G 9 > C g I D 6 H I J 9 y E J bA > H = : 9 > C Pediatric Dermatology (J6 C ./F: b. 2015; 32(1):85-90).. QUARIC ACID DIBUTYL ESTER

T= : 8 = 6 G I H D ; 72 E 6 I > : C I H , I G : 6 I : 9 J H > C g SADBE 6 I 6 E : 9 > 6 I G > 8 9 : G B 6 I D A D gy D J I E 6 I > : C I 8 A > C > 8 6 I I = : UC > v: G H > I y D ; ND G I = C6 G D A > C 6 6 I C= 6 E : A H> A A ; G D B JJ A y 2002 I D D: 8 . 2012, w: G : G : I G D H E : 8 I > v: A y G : v> : w: 9 , w> I = E 6 I > : C I H b: > C g ; D A A D w: 9 ; G D B H > x B D C I = H I D 11 y: 6 G H . T= : > C 8 A J 9 : 9 E 6 I > : C I H 6 A A = 6 9 v: G G J 8 6 : w= > 8 = = 6 9 ; 6 > A : 9 > C > I > 6 A I G : 6 I B : C I . AB D C g I = : E 6 G I > 8 > E 6 C I H , ; J A A A D C g-I : G B ; D A A D w-J E w6 H D bI 6 > C : 9 > C 48 E 6 I > : C I H ; ; D J G E 6 I > : C I H 9 > H 8 D C I > C J : 9 SADBE I G : 6 I B : C I 9 J : I D 6 9 v: G H : : ; ; : 8 I H . E; ; > 8 6 8 y D ; I = : SADBE I G : 6 I B : C I w6 H I = : E G > B 6 G y D J I 8 D B : B : 6 H J G : 9 , 6 C 9 9 6 I 6 D C 6 9 v: G H : : ; ; : 8 I H , 9 D H 6 g: H 6 9 B > C > H I : G : 9 , w6 G I I yE : , I = : E G : H : C 8 : D ; D I = : G 8 J I 6 C : D J H 9 > H : 6 H : , 6 C 9 > B B J C D H J E E G : H H > D C A : v: A w: G : 6 A H D G : 8 D G 9 : 9 . AB D C g I = : 48 E 6 I > : C I H w> I = 8 D B E A : I : I G : 6 I B : C I D J I 8 D B : 9 6 I 6 , 40 (83%) G : E D G I : 9 8 D B E A : I : w6 G I G : H D A J I > D C . SD B : 70% D ; E 6 I > : C I H J H : 9 6 B 6 x> B J B SADBE 8 D C 8 : C I G 6 I > D C D ; 0.4%, 6 C 9 60% D ; E 6 I > : C I H G : E D G I : 9 C D 6 9 v: G H : : ; ; : 8 I H . T= : B 6 jD G > I y D ; E 6 I > : C I H G : E D G I : 9 8 D B E A : I : G : H D A J I > D C D ; I = : > G w6 G I H , 6 C 9 C D 6 9 v: G H : : ; ; : 8 I H w> I = 9 D H 6 g: H 6 H = > g= 6 H 2% 9 6 > A y. 窶認or more information visit http://tinyurl.com/mkwkx8g

Commentary: This was a good retrospective chart review that builds on previous studies demonstrating the efficacy of SADBE. The findings show that SADBE is a safe and effective treatment for recalcitrant warts in children, even at higher concentrations than previously described.

Factors affecting sebum excretion rate in women

HANGES IN SLEEP PATTERN, FREE TESTOSTERONE LEVELS, AND

5-ALPHA-REDUCTASE TYPE 1 ACTIVITY 6 A A 6 E E : 6 G I D b: 6 H H D 8 > 6 I : 9 w> I = 8 = 6 C g: H > C H : bJ B : x8 G : I > D C > C wD B : C , E D I : C I > 6 A A y : xE A 6 > C > C g D bH : G v: 9 > C I : G -H J bj: 8 I v6 G > 6 b> A > I y > C H : bJ B : x8 G : I > D C G 6 I : (SER) b: I w: : C E 6 I > : C I v> H > I H > C 8 A > C > 8 6 A H I J 9 > : H , G : H : 6 G 8 = : G H G : E D G I > C Skin Research and Technology (F: b. 2015; 21(1):47-53)..

C

R: H : 6 G 8 = : G H I D D k SER B : 6 H 6 C 9 D C I = D H : v> H > I H 6 A H D : v6 A J 6 I : I J G : , H A : : E = 6 b> I H , 9 > : I , ; 6 8 > 6 A w6 H J bj: 8 I H ; : A A 6 H A : : E D C D6 y 0 6 C 9 = : 6 9 . SER 6 C 9 ; G : : I : H I D H I : G D C : A H J b-6 C 6 A yH > H E : G ; D G B : 9 D C B :

J G: B 9 H : H = >C 8 = 6 A : v: C 6 C

: C I H ; G D B I = : ; D G : = : 6 9 H D ; 40 = : 6 A I = y H J bj: 8 I H D C I wD D 8 8 6 H > D C H , H : v: C 9 6 yH 6 E 6 G I , G J B 6 C 9 G D g: C A : v: A H , 5-6 A E = 6 -G : 9 J 8 I 6 H : I yE : 1 g: C : : xE G : H H > D C , ; D G : = : 6 9 I : B E : G 6 g G D J I > C : , 6 C 9 UV : xE D H J G : . A E D H > I > v: 8 D G G : A 6 I > D C w6 H D bH : G v: 9 b: I w: : C I = : I > B : C g: H > C SER ; D G A : ; I (E =0.010; G =0.402) 6 C 9 G > g= I (E =0.002; G =0.467) H > 9 : D ; I = : ; D G : A H bD I = = 6 9 H > gC > ; > 8 6 C I > C v: G H : 8 D G G : A 6 I > D C H w> I = 5-6 A E = 6 -G : 9 J 8 I 6 H : I yE : 1 : xE G : H H > D C . 9 wD B : C H = D w: 9 I = 6 I I = : H : 8 D G G : A 6 I > D C H w: G : H > gC > ; > 8 6 C I D C A y ; D G wD B : C . 窶認or more information visit http://tinyurl.com/qzjj9ut

Commentary: This study presents interesting correlations but does not pinpoint causality or provide any actionable data. The study showed that variations in sleep patterns, free testosterone, and 5-alpha-reductase type 1 activity are associated with changes in sebum excretion in women but the same correlations were not observed in men. It would be interesting to see further research on the role of circadian rhythms on SER.


Skin_March_2015,rar16_ms_9.1_rar1_Skin_March_2014,rar1.qxd 09/04/2015 12:26 PM Page 9

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Skin_March_2015,rar16_ms_9.1_rar1_Skin_March_2014,rar1.qxd 09/04/2015 12:26 PM Page 10

V

10 · M6 G 8 = 2015

THE CHRONICLE of S K I N & A L L E R G Y

Morphea requires long-term follow-up Pediatrics

n DD C ’I G : ; : G I D 8 D C 9 > I > D C 6 H A D 8 6 A H 8 A : G D 9 : G B 6 D G H 8 A : G D 9 : G B 6 D ; 6 C y k> C 9 , 9 : G B 6 I D A D g> H I 6 9 v> H : H

W

by IAN J.S. MOORE,

Correspondent, The Chronicle

>B E D B D GE D G 6 C L6 wG 9 J G >C

= : C H E : 6 k> C g w> I = I= : E 6 G : C IH D ; E : 9 >6 IG >8 E 6 I>: C IH , >I >H G I 6 C I I D 6 vD > 9 G : ; : G G > C g I D = : 6 6 H AD 8 6 A H 8 A: G D 9 : G B 6 y D I = : G H 8 A : G D 9 : G B 6 , DG . : C 8 : A. S8 = 6 8 = C : G H 6 > 9 g 6 E G : H : C I6 I>D C 6 I I= :

AB : G > 8 6 C A8 6 9 : B y D ; D: G B 6 I D A D gy H : H H > D C H . “T= : G : 6 H D C w: w6 C I I D 6 vD > 9 G : ; : G G > C g I D B D G E = : 6 6 H H 8 A : G D 9 : G B 6 > H b: 8 6 J H : 6 ; I : G 6 C D ; ; > 8 : v> H > I I = : E 6 G : C I H D ; D J G E : 9 > 6 I G > 8 E 6 I > : C I H w> A A gD D C I D I = : IC I : G C : I , I = : y 6 G : gD > C g I D G : H : 6 G 8 = V H 8 A : G D 9 : G B 6 ’ 6 C 9 I = : y 6 G : gD > C g I D E 6 C > 8 ,” H 6 > 9 DG . S8 = 6 8 = C : G ,

: e l b a l i Now asveaveral copies e s a h c r u P as holiday gifts

9 >G : 8 ID G D ; E : 9 >6 IG >8 9 : G B 6 I D A D gy 6 I I = : UC > v: G H > I y D ; M> 6 B > H: 6 A I = SyH I : B . “JJ H I 8 6 A A > I B D G E = : 6 . II > H 6 gG : 6 I C 6 B : . II > H C D I H 8 A : G D 9 : G B 6 . AC 9 > I > H C D I gD > C g I D b: 8 D B : H 8 A : G D 9 : G B 6 .”

A number of formss MD G E = : 6 9 : v: A D E H > C 6 C J B b: G D ; ; D G B H , > C 8 A J 9 > C g bA 6 8 k,

AK THE M

gJ I I k: A D ;G D C I= : E 6 G 6 A>C : S8 = 6

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6 I: >9 6 I6 A A6 II -A > C

8 = “T= E = : 6 G: E y6 C 9 = : H 6 >9

, H J b-8 J I 6 C : D J H , A , E 6 C -H 8 A : G D I > 8 6 C 9 A>C : 6 G H 8 A: G D 9 : G B 6 , : G 9 > H I > C gJ > H = : 9 by : 6 G D G E 6 G 6 -B : 9 > 6 C D G bD I = , H 6 > 9 DG . C : G. : IG : 6 IB : C I D ; B D G qJ > G : H H yH I : B > 8 I = : G 6 A D C g-I : G B ; D A A D w-J E ,” .

T LOGIS O T A M R F A DE O G N I

O TTO E E R R The future, O M MO N I present and past K S ANN MMEEEETTSS A H H T T EE of skin therapy, as Y Y E E E E H TTH seen by a doctor at the forefront of all three phases

N ADDINON M T UAR MITCHELL SHAN T S . R Y D ORD B OREW F

Through his career (65-years-and-counting) as an international practitioner, educator, researcher, and public advocate of dermatology, Dr. Stuart Maddin has helped to lead the evolution of the specialty, from the front-lines. In his most recent contribution to medicine, Dr. Maddin provides through his memoirs a revealing look forward—and an intimate glimpse back—at a lifetime devoted to the study, care, consideration, and celebration of skin. Now readers of The Chronicle of Cosmetic Medicine + Surgery can purchase a copy of More to Skin Than Meets the Eye: The Making of a Dermatologist directly from Linacre's Books. This 292-page book, featuring dozens of candid photos, will make a perfect holiday gift for colleagues and patients. To place your order, using American Express, MasterCard or Visa, telephone toll-free 866-63-CHRON (24766), extension 106. Special price: $24.95, plus $1.25 GST and $3.80 P&P, for a total of $30.00.

For a preview of the book, visit www.drmaddin.com

L

INACRES

Toronto Buffalo, NY Stratford-u-Avon

“T= > H > H 6 9 > H D G 9 : G > C w= > 8 = I = : G : 8 6 C b: 6 C y C J B b: G D ; 8 : C I G 6 A C : G vD J H H yH I : B E G D bA : B H 6 C 9 D 8 J A 6 G E G D bA: B H ” DG . S8 = 6 8 = C : G 8 6 J I > D C : 9 I = 6 I “I; [I = : A > C : ] k: : E H gD > C g 9 D wC G > g= I I = G D J g= I = : G : H I D ; I = : ; 6 8 : yD J 6 G : gD > C g I D b: 9 : 6 A > C g E D I : C I > 6 A A y w> I = E G D bA: B H >C I= : C 6 H 6 A H IG J 8 IJ G : , I = : D G 6 A H I G J 8 I J G : , : I 8 .” MD G E = : 6 8 6 C b: qJ > : H 8 : C I , w= > 8 = w6 H I = : 8 6 H : D ; 6 C 18-y: 6 G -D A 9 -g> G A D G > g> C 6 A A y 9 > 6 gC D H : 9 w> I = k: A D > 9 6 A B D G E = : 6 ; > v: y: 6 G H : 6 G A > : G , w= D C D w 9 > H E A 6 y: 9 I wD : A D C g6 I : 9 E A 6 qJ : H 6 C 9 6 G : H I G > 8 I : 9 G 6 C g: D ; B D I > D C . DG . S8 = 6 8 = C : G 6 gG : : 9 w= : C D C : 8 D A A : 6 gJ : > C I = : 6 J 9 > : C 8 : H J gg: H I : 9 H yH I : B > 8 I= : G 6 E y 6 H I= : IG : 6 IB : C I 6 E E G D 6 8 = >C I= >H 8 6 H : . P= D I D I = : G 6 E y (UVA), I D E > 8 6 A 6 g: C I H (: B D A A > : C I H , H I: G D >9 H , 6 C 9 8 6 A8 >C : J G >C > C = > b> I D G H ), 6 C I > b> D I > 8 H 6 C 9 E = yH > 8 6 A I = : G 6 E y w: G : 6 B D C g I = : D I = : G H J gg: H I > D C H ; G D B 8 D A A : 6 gJ : H 6 H B D G E = : 6 I G : 6 I B : C I. “I 6 B gD > C g I D gD 6 I I = > H E D > C I > C I > B : w> I = B : I = D I G : x6 I: 6 C 9 E G : 9 C >H D C : 6 H I= : I G : 6 I B : C I D ; 8 = D > 8 : ,” I = : M> 6 B > 9 : G B 6 I D A D g> H I H 6 > 9 D ; = >H E G : ;: G G : 9 >C >I>6 A I= : G 6 E y ;D G I= >H E 6 I>: C I 6 C 9 H >B >A6 G 8 6 H : H .

Use treatments simultaneously DG . S8 = 6 8 = C : G G : E D G I : 9 I = 6 I >C = >H E G 6 8 I>8 : ,I= : E G D ID 8 D A >H I D E G : -H 8 G : : C I = : E 6 I > : C I w> I = I= : J H J 6 A I: H IH ,G : E : 6 I I: H I>C g ; D G 6 ; : w B D C I = H w= : C J H > C g B : I = D I G : x6 I : 6 C 9 I = : C I D b: g> C I = : G 6 E y w> I = bD I = B : 9 > 8 6 I > D C H [B : I = D I G : x6 I : 6 C 9 E G : 9 C >H D C : ] H >B J AI6 C : D J H A y. “I H I 6 G I I = : B : I = D I G : x6 I : 6 I 0.3 B g/kg 6 A A > C D C : 9 6 y, J H J 6 A A y > C 6 9 > v> 9 : 9 9 D H : . YD J 8 6 C gD 6 H = > g= 6 H 1 B g > ; yD J C : : 9 > I , bJ I B D H I A y yD J 9 D C ’I . W> I = I = : E G : 9 C > H D C : I gD w> I = 1 B g/kg 6 H = > g= 6 H 40 B g 6 C 9 I = : C 8 J I > I I D 6 B 6 x D ; 60 B g, : v: C > ; I’B 9 : 6 A > C g w> I = 6 100 k> A D k> 9 ,” = : H 6 > 9 . “V> I 6 B > C D, ; D A > 8 6 8 > 9 6 C 9 UVA 6 G : D 8 8 6 H > D C 6 A > C 8 A J H > D C H > C I D I = > H E G D I D 8 D A .” UVA 6 C 9 I 6 8 G D A > B J H 6 G : : ; ; : 8 I > v: > C B > A 9 ; D G B H D ; B D G E = : 6 , 6 8 8 D G 9 > C g I D H : v: G Please turn to next pageà


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Vol. 21, No. 2

THE CHRONICLE of S K I N & A L L E R G Y

6 A E A 6 8 : bD -8 D C I G D A A : 9 I G > 6 A H , DG . S8 “N: v: G H 6 y V GD D 9 -by: ’ I D E 6 I > : C I H ,” = : H 6 > 9 , G : ; : G G > C g I D D A D w-J E H I J 9 y, w= > 8 = ; D J C 9 9 > H : 6 89% D ; 27 E : 9 > 6 I G > 8 E 6 I > : C I H , E : > C 56% 6 C 9 6 I A : 6 H I D C : 6 J I D > B 26%. “R: B : B b: G H : v: G : B D G E = I : B > 8 I G : 6 I B : C I 6 C 9 A D C g-I : G B G: E : 6 I: 9 .

= 6 8 = C : G C D I: 9 yD J G B D G E = C : A D C g-I : G B H : E G D gG : H H > D C G B 6 C : C I H : qJ B J C : 9 >H : 6 H :

.

: 6 ;D A>C : A6 >C

: 6 G : qJ > G : H H yH ; D A A D w-J E ,” = :

AD treatment considerations DG . S8 = 6 8 = C : G H 6 > 9 I = 6 I 6 I D E > 8 9 : G B 6 A H D 6 8 = 6 A A : C g> C g 6 C 9 = J B bA > C g 8 6 ; ; : 8 I H 6 H B 6 C y 6 H 20% I D 25% D ; 8 g: C : G 6 A E D E J A 6 I > D C H D ; W: H I : G C EJ G D

6 I>I>H D C 9 >I = >A9 G : E : , J6

(AD) > H >D C I= 6 I C >C I= : E 6 C 6 C 9

I = : U.S., D ; I : C > C > I H G : H E > G 6 I D G y, 8 J I 6 C : D J H 6 C 9 g6 H IG D >C I: H I>C 6 A ;D G B H . “IC 8 6 H : H w= : G : AD ; A 6 G : H J E b6 9 A y > C 6 E 6 I > : C I w= D = 6 H b: : C H I 6 bA : ; D G B D C I = H D G 6 y: 6 G , D C : B > g= I w6 C I I D 8 D C H > 9 : G SI 6 E = . W: 9 D = 6 v: I D I = > C k 6 bD J I 8 D C I 6 8 I 9 : G B 6 I > I > H ; b: 8 6 J H : ; > v: E : G 8 : C I D ; 8 = > A 9 G : C [6 C 9 6 9 J A I H ] b: 8 D B : 6 A A : G g> 8 I D I = : 8 D G I > 8 D H I : G D > 9 w: J H : ; D G I = > H , bJ I I = > C k 6 bD J I SI 6 E = ; > G H I .” TD E > 8 6 A 6 C I > b> D I > 8 H , w: I wG 6 E H D ; : B D A A > : C I 6 C 9 H I : G D > 9 , bA : 6 8 = b6 I = H (D C : -qJ 6 G I : G 8 J E D ; bA : 6 8 = > C D C : ; D D I D ; w6 I : G > C I = : b6 I = I J b I = G : : I > B : H 6 w: : k), 6 C 9 g: A H 8 G J bH 6 G : 6 B D C g H : v: G 6 A AD I G : 6 I B : C I D E I>D C H . AD, DG . S8 = 6 8 = C : G : B E = 6 H > z: 9 , > H 6 8 D C 9 > I > D C I = 6 I 6 ; ; : 8 I H I = : ; 6 B > A y. IC B D 9 : G 6 I : 8 6 H : H , ; 6 B > A y

HDLE diagnosis can be difficult

Continued from page 1 I = : > G 9 > H I G > bJ I > D C E 6 I I : G C H > C I = : H 6 B E A : H w: G : 8 D B E 6 G : 9 I D I = D H : > C 6 I D I 6 A D ; 39 > C ; A 6 B B 6 I D G y 6 C 9 C : D E A 6 H I > 8 8 D C I G D A H 6 B E A : H I 6 k: C ; G D B 36 E 6 I>: C IH . PDC assessment can lead to improved diagnosis T= G : : 9 > 6 gC D H I > 8 E 6 G 6 B : I : G H D ; I = : PDCH w: G : : v6 A J 6 I : 9 : w= : I = : G I = : y G : E G : H : C I : 9 10% D G B D G : D ; I = : > C ; A 6 B B 6 I D G y > C ; > A I G 6 I : ; > ; I = : PDCH w: G : ; D J C 9 > C 8 A J H I : G H D ; 10 D G B D G : 8 : A A H ; 6 C 9 > ; I = : PDCH w: G : ; D J C 9 6 I I = : 9 : G B D : E > 9 : G B 6 A jJ C 8 I > D C . O; I = : I = G : : E 6 G 6 B : I : G H , I = : ; > G H I = 6 9 6 77% 9 > 6 gC D H I > 8 6 8 8 J G 6 8 y, I = : H : 8 D C 9 74%, 6 C 9 I = : I = > G 9 71%.

T= : H : ; > C 9 > C gH H = D J A 9 6 A A D w 8 A > C > 8 > 6 C H I D : xE : 8 I B D G : 6 8 8 J G 6 I : 9 > 6 gC D H : H D ; 8 J I 6 C : D J H A J E J H : G yI = : B 6 I D H J H ; G D B E 6 I = D A D g> H I H , H 6 yH DG . W6 A H = . “T= : 9 > 6 gC D H > H D ; = yE : G I G D E = > 8 A J E J H 8 6 C b: B 6 9 : w> I = D J I H I 6 > C > C g I = : PDCH , bJ I I = > H > H 6 C 6 9 jJ C 8 I I D 9 > 6 gC D H > H ,” H 6 yH DG . W6 A H = . “IC 6 C J C 8 : G I 6 > C 8 6 H : > I 8 6 C b: = : A E ; J A 6 C 9 8 A 6 G > ; y I = : 9 > 6 gC D H > H .” B: I I : G 9 > 6 gC D H > H B : 6 C H B D G : 6 8 8 J G 6 I : 6 C 9 B D G : I 6 G g: I : 9 I G : 6 I B : C I , w= > 8 = > H gD D 9 ; D G E 6 I > : C I H , H 6 yH DG . W6 A H = . “Obv> D J H A y > ; yD J 6 G : I G : 6 I > C g I = : wG D C g I = > C g > I > H C D I gD D 9 C : wH .”

M6 G 8 = 2015 · 11

B : B b: G H A D H : 6 E E G D x> B 6 I : A y D C : = D J G D G B D G : D ; H A : : E : 6 8 = 6 C 9 : v: G y C > g= I I = G D J g= D J I I = : y: 6 G . IC H : v: G : 8 6 H : H I = : A D H H 6 B D J C I H I D 90 B > C J I : H , D G B D G: .

Pleasant office visit may help to increase compliance potential DG . S8 = 6 8 = C : G 8 D C 8 A J 9 : 9 = > H E G : H : C I 6 I > D C by D ; ; : G > C g 6 E G 6 8 I > 8 6 A I > E D C 9 : 6 A > C g w> I = E : 9 > 6 I G > 8 E 6 I > : C I H , w= D = 6 v: H : G > D J H , H D B : I > B : H > C I G 6 8 I 6 bA : , H k> C 8 D C 9 > I > D C H . “II > H > B E D G I 6 C I I = 6 I yD J 6 H 6 8 A > C > 8 > 6 C I = > C k 6 bD J I H > B E A : I = > C gH I = 6 I B 6 k: 6 v> H > I I D I = : D ; ; > 8 : B D G : E A : 6 H 6 C I ; D G yD J , ; D G I = : 8 = > A 9 6 C 9 ; D G I = : ; 6 B > A y. I; 6 C D ; ; > 8 : v> H > I > H E A : 6 H 6 C I > I 6 9 9 H I D I = : A > k: A > = D D 9 D ; 8 D B E A > 6 C 8 : 6 C 9 b: I I : G D J I 8 D B : H w> I = I = : I G : 6 I B : C I ,” = : H 6 > 9 . IC DG . S8 = 6 8 = C : G ’H E G 6 8 I > 8 : , = : 6 A w6 yH gG : : I H I = : 8 = > A 9 ; > G H I by J H > C g = > H D G = : G ; > G H I C 6 B : . AH 6 C 6 9 9 : 9 w: A 8 D B : I D J 8 = , DG . S8 = 6 8 = C : G H B > A : H 6 C 9 H qJ 6 I H 9 D wC I D G : 6 8 = : y: A : v: A D ; = > H E : 9 > 6 I G > 8 E 6 I > : C I . H: I = : C : xI : C 9 H 6 E > C ky ; > C g: G I D “H = 6 k: = 6 C 9 H ” w> I = I = : E 6 I > : C I . I; I = : v> H > I > H I = : ; > G H I ; D G I = 6 I E 6 G I > 8 J A 6 G E 6 I > : C I , I = : C = : 6 H kH 6 bD J I = > H D G = : G B 6 > C A : > H J G : 6 8 I > v> I y, w= 6 I : v: G > I B 6 y b: H J 8 = 6 H H E D G I H , b6 A A : I , 8 = : H H B 6 I 8 = : H , : I 8 . 6 C 9 8 = 6 G I H I = : G : H E D C H : ; D G H J bH : qJ : C I v> H > I H . “IC I : G 6 8 I > C g w> I = I = : E 6 I > : C I D C A y I 6 k: H ; > v: D G I: C H : 8 D C 9 H 6 C 9 >I G : 6 AAy: C = 6 C 8 : H I= : G : A6 I>D C H = >E yD J = 6 v: w> I = I = : 8 = > A 9 . T6 k> C g I = : I > B : I D > C I : G 6 8 I w> I = 6 E : 9 > 6 I G > 8 E 6 I > : C I G : 6 A A y B 6 k: H I = : B ; : : A A > k: I = : y 6 G : 6 E : G H D C , C D I 6 E H D G > 6 I > 8 E A 6 qJ : ,” DG . S8 = 6 8 = C : G 8 D C 8 A J 9 : 9 .

Topical Minoxidil Foam 5% for Hair Regrowth in Males with Androgenetic Alopecia

Jerry Shapiro, MD, FRCPC  Clinical Professor  Department of Dermatology and Skin Science  University of British Columbia  Vancouver

Treatment: The dermatologist explained the condition to him and

discussed patient expectations of treatment outcome and realistic length of time to see results, as well as monitoring and follow-up of treatment. He was successfully treated with twice daily 5% minoxidil foam used as monotherapy (Fig. 2 and Fig. 3). The product was easy to use, did not drip and stayed localized in the area where it was applied.

Fig 1: Minoxidil 5% foam was demonstrated to significantly increase hair count versus placebo (Adapted from Olsen EA, et al)

Male pattern hair loss: Male androgenetic alopecia is a result of genetics and androgens.1,2 About half of the male population is genetically predisposed to show signs of male pattern hair loss, before the age of 50.1,21In male androgenetic alopecia there is a shortened hair cycle as the anagen phase is reduced.2 Therefore thinner, less pigmented hairs or vellus hairs, gradually replace the larger pigmented hairs.2 The emotional impact of male pattern hair loss is not to be underestimated by dermatologists, who are now able to offer effective early treatment.1,3 Minoxidil 5% foam for male androgenetic alopecia

Minoxidil is incorporated in a foam formulation, which is propylene glycol free.3 The foam is thermo-labile and breaks down rapidly as soon as it comes in contact with skin.3 The foam dries quickly and is aesthetically pleasing, leaving no sticky residue on the skin. The exact mechanism of action of minoxidil is unknown, but it is believed to work via vasodilation of the microcirculation around the hair follicles or by direct stimulation of the hair follicle cells to enter into a proliferative phase.4 When topically applied, 5% minoxidil induces telogen hairs to enter the anagen phase, prolonging anagen duration, increasing hair count and weight.3,4 Although uncommon, possible treatment side effects are irritation of the scalp, including dryness, scaling, itching and redness, usually caused by improper application of the topical.3 Application of topical minoxidil 5% foam* has been shown to promote hair regrowth.3 A doubleblind, placebo-controlled study in 352 men of 16 weeks duration

Fig 2: Before treatment with topical 5% minoxidil foam

Fig 3: After 16 weeks of treatment with topical 5% minoxidil foam

showed a 13.4% increase in target area hair count with minoxidil 5% foam compared to 3.4% with placebo (p<0.0001) (Fig. 1).3 Subjective assessment of improved hair loss condition by patients showed that 70.6% (p<0.0001) felt their hair loss had improved from baseline.3 At week 16, 143 subjects continued on an openlabel phase to collect 52 weeks of safety information, showing minoxidil 5% foam was well tolerated over a 52-week period.3 Patient case

The 30-year-old male presented with a four-year history of androgenetic alopecia on the vertex.

Profile: On physical examination, he has hair thinning with a widened part over the vertex. He has a family history of male pattern hair loss and mentioned that his father was already completely bald by the age of 36. He reported to be self-conscious about his thinning hair as he generally takes care of his appearance and doesn’t want to appear older than he is. He is a sales manager and is often meeting customers, making presentations and entertaining potential clients. The condition: He is aware that his male pattern hair loss is not a disease and that he is predisposed to this common cause of baldness.1 He is concerned about how he looks and wants to be proactive in trying to maintain his hair. After consulting a dermatologist, who is specialised in pattern hair loss, he was happy to start with topical treatment as the least invasive treatment.

Consider  Male androgenetic alopecia is a common cause of hair loss,

often starts in males in their twenties and has a significant emotional impact.  This propylene glycol free thermolabile, hydroethanolic formulation of minoxidil offers a new option for patients with androgenetic alopecia on the vertex.  This foam formulation is contraindicated in patients with hypertension, hair loss not due to hereditary factors or a compromised scalp (e.g., scalp with psoriasis, sunburn, otherwise broken or inflamed skin).4

*Rogaine 5% foam, Johnson & Johnson; for more information, see Product Monograph at http://www.jnjcanada.com/sites/www_jnjcanada_com/files/pdf/en/Rogaine.pdf.

References

Habif TP: Hair Diseases, in Clinical Dermatology a Color Guide to Diagnosis and Therapy; St. Louis, Mo: Mosby, Inc. 5th Edition, Chapter 24, Dec. 9, 2009. 2 Blumeyer A, Tosti A, Messenger A, Reygagne P, Del Marmol V, Spuls PI, et al: Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men. J Dtsch Dermatol Ges 2011; 9 Suppl 6:S1–57. 3 Olsen EA, Whiting D, Bergfeld W, Miller J, Hordinsky M, Wanser R, et al: A multicenter, randomized, placebo-controlled, double-blind clinical trial of a novel formulation of 5% minoxidil topical foam versus placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol 2007; 57:767–774. 4 ROGAINE Canadian Product Monograph. July 2014. 1

Editorial feature of The Chronicle of Skin & Allergy, March 2015, supported by a grant from Johnson & Johnson, which is not responsible for content


Gillette

Skin_March_2015,rar16_ms_9.1_rar1_Skin_March_2014,rar1.qxd 09/04/2015 12:26 PM Page 12

Atopic dermatitis research

12 · M6 G 8 = 2015

THE CHRONICLE of S K I N & A L L E R G Y

Rosacea: Emerging therapies offer clinical alternatives

Continued from page 4 B : 9 > 8 6 A 9 > G : 8 I D G 6 I DLK D C Av: C J : > C TD G D C I D . T= : G : H J A I H w> I = I = : I = : G 6 E y = 6 v: b: : C H D B : w= 6 I B > x: 9 , C D I : H DG . K: A A : I I . “I H J gg: H I I = 6 I E 6 I > : C I H 6 8 I J 6 A A y I G > 6 A > I H J H : b: ; D G : I = : y = 6 v: 6 C : v: C I I D H : : = D w I = : y G : H E D C 9 I D > I ,” H 6 yH DG . K: A A : I I . “BG > B D C > 9 > C : 8 6 C = : A E w> I = I = : G : 9 C : H H , bJ I I = : bA D D 9 v: H H : A H 8 6 C H I > A A b: H : : C . L> g= I H D J G 8 : H I 6 G g: I I = : bA D D 9 v: H H : A H , 6 C 9 I = : y 6 G : gD D 9 ; D G I = : G : 9 C : H H 6 H w: A A .” OC : G : I G D H E : 8 I > v: > C v: H I > g6 I > D C ; G D B KD G : 6 , w= > 8 = > C 8 A J 9 : 9 E 6 I > : C I H w> I = G D H 6 8 : 6 w= D w: G : C 6 > v: I D A 6 H : G I= : G 6 E y ;D G I= : >G G D H 6 8 : 6 , ;D J C 9 I= 6 I I = : J H : D ; > C I : C H : E J A H : 9 A > g= I (IPL) I D I G : 6 I : G yI = : B 6 I D I : A 6 C g> : 8 I 6 I > 8 G D H 6 8 : 6 B 6 y b: B D G : : ; ; : 8 I > v: > C E 6 I > : C I H w= D = 6 v: B D 9 : G 6 I : I D H : v: G : 9 > H : 6 H : 6 C 9 > C E 6 I > : C I H A : H H I = 6 C 40 y: 6 G H D ; 6 g: (Annals of Dermatology 2014 AJ g; 26(4):491R 495). IC 9 : : 9 , DG . B6 G 6 C k> C C D I : H I = 6 I

I: A6 : v> 9 H >C 8 gG D J

C g> : 8 I 6 H > 6 B 6 y “b: 8 D B : B D G : : C I ” w> I = I = : J H : D ; bG > B D C > 9 > C : : > I B 6 y b: B 6 H k: 9 by I = : b6 8 kC 9 G: 9 C : H H D ; GD H 6 8 : 6 . “II ’H > B E D G I 6 C I I D I G y > I D J I 6 C 9 H : : > ; > I wD G kH ; D G 6 E 6 I > : C I ,” = : H 6 yH . “P6 I > : C I H H = D J A 9 ; > G H I I G y J H > C g > I D C 6 w: : k: C 9 D G w= : C I = : y = 6 v: 6 9 6 y D ; 9 D wC I > B : I D B 6 k: H J G : I = : y 6 G : E A : 6 H : 9 w> I = I = : 8 D H B : I > 8 D J I 8 D B : .” T= : v6 H D 8 D C H I G > 8 I > v: : ; ; : 8 I D ; bG > B D C > 9 > C : > H I : B E D G 6 G y, w> I = I = : bG : 6 k9 D wC D ; bG > B D C > 9 > C : 8 6 J H > C g v6 H 8 J A 6 G bA D D 9 ; A D w I D G : I J G C I D C D G B 6 A , bJ I 9 6 I 6 H J gg: H I I = 6 I 52-w: : k J H : 8 6 C E G D 9 J 8 : 6 H J H I6 >C : 9 G : 9 J 8 I > D C > C : G yI = : B 6 . “T= : G : B 6 y b: E D I : C I > 6 A ; D G 8 = G D C > 8 > B E G D v: B : C I D ; G D H 6 8 : 6 [w> I = I = : J H : D ; bG > B D C > 9 > C : ],” E D > C I H D J I DG . B6 G 6 C k> C . A9 v: G H : : v: C I H G : E D G I : 9 w> I = I = : J H : D ; bG > B D C > 9 > C : > C 8 A J 9 : : G yI = : B 6 wD G H : I = 6 C b6 H : A > C : , E D E J A 6 G A y 9 : H 8 G > b: 9 6 H 6 “G : bD J C 9 ” E = : C D B : -

THERAPEUTIC INDEX

Canadian Dermatology Industry Association Corporate. . . . . . . . . . . . . 12 GlaxoSmithKline Spectro. . . . . . . . . . . . . 27 L`Oreal. La Roche Posay Cicaplast. . . . . . . . 2

Procter & Gamble Free and Gentle Fabric Care . . . . . 28 Gillette. . . . . . . . . . . . . 15 Venus Swirl. . . . . . . . . . . . . 5 Stiefel, a GSK Company Clindoxyl. . . . . . . . . . . . . 6-7, 9

C D C , ; A J H = > C g 6 C 9 bJ G C > C g. JJ H I 6 H H J C H 8 G : : C H = D J A 9 b: 6 E E A > : 9 : v: C A y, 8 D G G : 8 I 6 E E A > 8 6 I > D C D ; bG > B D C > 9 > C : > H C : 8 : H H 6 G y I D 6 8 = > : v: 6 9 : H > G : 9 G : H J A I . P6 I > : C I H 8 6 C ; > C 9 6 E E H D C I = : > G B D b> A : 9 : v> 8 : H I = 6 I 8 6 C > C H I G J 8 I I = : B D C I = : 8 D G G : 8 I 6 E E A > 8 6 I > D C D ; bG > B D C > 9 > C : I6 GIG6 I: .

Ocular rosacea FD G E 6 I > : C I H w> I = D 8 J A 6 G G D H 6 8 : 6 , H yH I : B > 8 I = : G 6 E y w> I = B D 9 > ; > : 9 G : A : 6 H : 9 D xy8 y8 A > C : > H 6 E G : ; : G G : 9 I = : G 6 E y, H 6 yH DG . B6 G 6 C k> C . “MD G : 9 : G B 6 I D A D g> H I H C : : 9 I D 6 H k E 6 I > : C I H > ; I = : y = 6 v: D 8 J A 6 G > C vD A v: B : C I ,” = : H 6 yH . “JJ H I A > k: w: 6 H k E 6 I > : C I H w> I = E H D G > 6 H > H > ; I = : y = 6 v: E H D G > 6 I > 8 6 G I = G > I > H , w: H = D J A 9 b: 6 H k> C g 6 A A D J G G D H 6 8 : 6 E 6 I > : C I H 6 bD J I D 8 J A 6 G > C vD A v: B : C I . UE I D 50 E : G 8 : C I = 6 v: D 8 J A 6 G > C vD A v: B : C I 6 C 9 9 D C ’I kC D w > I .” T= : G : = 6 H b: : C 6 “E 6 G 6 9 > gB H = >;I” >C I= : IG : 6 IB : C I D ; G D H 6 8 : 6 , w> I = I = : G : 8 D gC > I > D C I = 6 I > I ’H 6 8 = G D C > 8 9 > H : 6 H : , 6 8 8 D G 9 > C g I D DG . B6 G 6 C k> C . “FD G 8 = G D C > 8 8 D C 9 > I > D C H , yD J > 9 : 6 A A y 9 D C ’I w6 C I I D J H : ; J A A -9 D H : 6 C I > b> D I > 8 H ,” = : : xE A 6 > C H . “P6 I > : C I H 8 6 C 9 : v: A D E g6 H I G D > C I : H I > C 6 A J E H : I , I = : G : 6 G : y: 6 H I > C ; : 8 I > D C H > C ; : B 6 A : E 6 I > : C I H , 6 C 9 I = : G : 6 G : D C gD > C g 8 D C 8 : G C H 6 bD J I 6 C I > b> D I > 8 G : H > H I 6 C 8 : . II > H E G : ; : G 6 bA : I D J H : H D B : I = > C g I = 6 I = 6 H B D G : 6 C I > -> C ; A 6 B B 6 I D G y E G D E : G I > : H A > k: B D 9 > ; > : 9 G : A : 6 H : [H J b-6 C I > B > 8 G D b> 6 A 9 D H : ] 9 D xy8 y8 A > C : .” Ev: C w> I = I G : 6 I B : C I 8 = D > 8 : H A > k: bG > B D C > 9 > C : 6 C 9 B D 9 > ; > : 9 G : A : 6 H :

[H J b-6 C I > B > 8 G D b> 6 A 9 D H : ] 9 D xy8 y8 A > C : 6 C 9 : B : G g> C g I G : 6 I B : C I H A > k: > v: G B : 8 I > C , E G D E : G H k> C 8 6 G : > H 8 G J 8 > 6 A I D E G : v: C I > C g G D H 6 8 : 6 ; A 6 G : H , H 6 yH DG . I6 C L6 C 9 : A A H , 8 A > C > 8 6 A 8 = > : ; D ; I = : D> v> H > D C D ; D: G B 6 I D A D gy ; D G E6 H I : G C H: 6 A I = , B : 9 > 8 6 A 9 > G : 8 I D G (9 : G B 6 I D A D gy) 6 I N: xJ H CA > C > 8 6 A R: H : 6 G 8 = > C SI . JD = C ’H , N: w; D J C 9 A 6 C 9 , 6 C 9 8 A > C > 8 6 A 6 H H D 8 > 6 I : E G D ; : H H D G > C I = : F6 8 J A I y D ; M: 9 > 8 > C : 6 I M: B D G > 6 A UC > v: G H > I y > C SI . JD = C ’H . H: = 6 H ; D J C 9 I = 6 I 8 D J C H : A A > C g E 6 I > : C I H w> I = G D H 6 8 : 6 6 bD J I gD D 9 H k> C 8 6 G : 8 6 C H D B : I > B : H b: H J ; ; > 8 > : C I ; D G G D H 6 8 : 6 B 6 C 6 g: B : C I . “W: kC D w UV G 6 9 > 6 I > D C > H 6 8 6 J H : 6 C 9 6 I G > gg: G ,” H 6 yH DG . L6 C 9 : A A H . “OC : D ; I = : b> gg: H I H I : E H [I = 6 I E 6 I > : C I H 8 6 C I 6 k: ] > H I D w: 6 G H J C H 8 G : : C : v: G y 9 6 y. I = 6 v: = 6 9 E 6 I > : C I H H 6 y I = 6 I I = : > G G D H 6 8 : 6 > H J C 9 : G 8 D C I G D A b: 8 6 J H : I = : y w: 6 G H J C H 8 G : : C 9 6 > A y. W> I = 6 C y B : 9 >8 6 A 8 D C 9 >I>D C , I= : ;D J C 9 6 I>D C D ; IG : 6 IB : C I > H E G : v: C I > D C .”

Importance of sunscreen D: G B 6 I D A D g> H I H C : : 9 I D 6 H k E 6 I > : C I H 6 bD J I I = : > G J H : D ; H J C H 8 G : : C , ; D G E 6 I > : C I H w> I = G D H 6 8 : 6 B 6 y G : E D G I I = 6 I I = : > G 8 D C 9 > I > D C wD G H : C H w> I = H J C H 8 G : : C , 6 C 9 >; 8 = : B >8 6 A H J C H 8 G : : C H 6 G : b: > C g 6 E E A > : 9 , I = : > G : xE : G > : C 8 : > H H J E E D G I : 9 by : v> 9 : C 8 : , : xE A 6 > C H DG . JJ A > 6 C6 G G D A A , 8 D -9 > G : 8 I D G D ; CD B E 6 H H D: G B 6 I D A D gy > C TD G D C I D . “T= : 8 = : B > 8 6 A H J C H 8 G : : C H 8 D C v: G I UV G 6 9 > 6 I > D C > C I D = : 6 I , 6 C 9 6 A D I D ; E : D E A : ’H G D H 6 8 : 6 > H ; A 6 G : 9 by = : 6 I ,” H 6 yH DG . C6 G G D A A . “T= : y B 6 y I : A A yD J I = 6 I I = : y 8 6 C ’I J H : H J C H 8 G : : C H . RD H 6 8 : 6 E 6 I > : C I H 6 G : B J 8 = b: I I : G D ; ; w> I = 6 E = yH > 8 6 A bA D 8 k: G I = 6 I 8 D C I 6 > C H > C gG : 9 > : C I H A > k: I > I 6 C > J B 6 C 9 z> C 8 .” DG . C6 G G D A A 6 A H D H J gg: H I H = : G G D H 6 8 : 6 E 6 I > : C I H J H : g: C I A : 8 A : 6 C H : G H 6 C 9 H I 6 y 8 A : 6 G D ; H D 6 E . “SD 6 E > H 6 9 > G I y wD G 9 ; D G G D H 6 8 : 6 E 6 I > : C I H ,” H = : H 6 yH . OC : I = : G 6 E y I = 6 I DG . C6 G G D A A E G : H 8 G > b: H D ; ; -A 6 b: A ; D G = : G B 6 A : 6 C 9 ; : B 6 A : E 6 I > : C I H w> I = G D H 6 8 : 6 w= D 9 D C D I : xE : G > : C 8 : 6 gG : 6 I 9 : 6 A D ; > C ; A 6 B B 6 I > D C > H A D w-9 D H : > H D I G : I > C D > C . “II H = J I H 9 D wC I = : G D H 6 8 : 6 E 6 I = w6 y,” H 6 yH DG . C6 G G D A A . RD H 6 8 : 6 > H I yE > 8 6 A A y G : g6 G 9 : 9 6 H 6 8 D C 9 > I > D C I = 6 I 6 ; ; : 8 I H E 6 I > : C I H w= D 6 G : ; 6 > G : G > C 8 D B E A : x> D C , bJ I E 6 I > : C I H D ; 8 D A D J G 8 6 C 6 A H D : xE : G > : C 8 : G D H 6 8 : 6 . A U.S. > C v: H I > g6 I > D C A D D k> C g 6 I I = : E G : v6 A : C 8 : D ; G D H 6 8 : 6 > C H k> C D ; 8 D AD J G ;D J C 9 E 6 I>: C IH D ; 8 D AD J G G 6 G : Ay G : 8 : > v: 6 9 > 6 gC D H > H D ; G D H 6 8 : 6 : v: C w= : C I = : y E D H H : H H H yB E I D B H D ; I = : 8 D C 9 > I > D C (Dermatology Online Journal 2014 O8 I 15: 20(10)).

Non-proprietary and brand names of therapies: topical ivermectin 1% (not approved in Canada); brimonidine gel 0.33% (Onreltea, Galderma); subantimicrobial dose modified release doxycycline (Apprilon, Galderma).


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Irritation

Challenges of shaving in patients with skin prone to

W

hile the inflammatory skin condition pseudofolliculitis barbae can potentially lead to secondary infections, scarring and keloids, the condition is extremely preventable through changes in personal care practices—particularly those associated with shaving, according to a roundtable discussion held at Dermatology Update in Vancouver. Pseudofolliculitis barbae, or PFB, is characterized by papules, and occasionally pustules and hypertrophic scarring, that have typically developed in response to shaving, says Windsor, Ont. dermatologist Dr. Jerry Tan, Adjunct Professor at

Western University in London, Ont. “One of the features about psuedofolliculitis barbae is that there is a very clear diagnostic hallmark, which is ingrown hair,” says Dr. Tan. PREVENTING PFB The condition develops, Dr. Tan says, when the sharp edges of shaved hairs penetrate into the skin either extra-follicularly or trans-follicularly, triggering a foreign body reaction. Differences in hair and skin quality, and shaving behaviour all impact prevalence. Black males are the group that most commonly develop PFB, with 45% to 83% of this group encountering the issue, says Dr. Tan.1 That is due to hair that curls tightly which makes it more prone to becoming ingrown. PFB is also often seen in other men who shave, and in hirsute black women, Dr. Tan says. “If you compare scalp hair with facial hair, facial hair is thicker, there is more cuticle, and it is irregular in size. There is more variation in the shape,” says Dr. Richard Thomas,

a dermatologist in Vancouver and a Clinical Associate Professor at the

University of British Columbia. “Here you have this tough, hard hair in this viscoelastic matrix [the skin].” The hair grows in multiple directions from a surface that is both highly uneven topographically and richly ennervated, he notes. On the neck in particular, hair can grow in whorled patterns that make uniform cutting more difficult, says Dr. Tan. Irregular growth patterns, along with uneven hair crosssections, can result in hairs being pulled or twisted in their follicles. This can not only irritate the follicle, but torqued hairs may crack or split, creating additional sharp edges that can pierce the skin, he says. The skin around the hairs of the neck also tends to mound up, making it more vulnerable to being nicked by the shaving blade and becoming a further source of irritation, says Dr. Tan. Preventing PFB, then, is a matter of minimizing irritation and damage to the skin from shaving, says Dr. Thomas. “You have to cut the hair without damaging the skin. So in a sense, the whole concept is that we have to prepare the hair so it is optimal [for shaving], we have to protect the skin by preparing it, and we need to look after the skin barrier function longer-term.” Yet there is a wide variation in how men shave, and few follow best shaving practices, says Dr. Thomas. A U.K. study published in 2012 found a range of shaving strokes from 30 to 700, preparation time spent ranging from 10 to 100 seconds, and actual shaving time ranging from 30 to 1,000 seconds. The force used to hold the razor to the face also ranged from 0.5 N to 4.0 N.2

FIVE STEPS IN SHAVING PROCESS Proper shaving technique to minimize risk of PFB, nicks, and skin irritation in general is really a five-step process, says Dr. Thomas. These steps are: pre-shave preparation of the skin; the use of a hydrating shave gel to lift hairs and reduce friction; shaving with an effective razor system; immediate post-shave care with a humectant and emollients for soothing; and maintenance of the skin’s barrier by using a moisturizer. Pre-shave care includes freeing– but not plucking–ingrown hairs at the surface using a toothpick or similarly clean, blunt tool, and soaking the facial hair to soften it. “You need to keep the hair wet for two to four minutes,” says Dr. Thomas. “The keratin has a huge capacity to absorb water.” The force needed to cut hair can be reduced by as much as 40% by four minutes of water contact.3 This soaking can also be com-

Changes in shaving practice can reduce incidence of pseudofolliculitis barbae

3-BLADE VERSUS 5-BLADE RAZORS

More blades, spaced closer together, distribute the pressure more evenly onto the skin bined with an exfoliating cleanse. Not only does this remove debris that could impede the blade path, but exfoliating around the follicle exposes more of the hair shaft, helps it stand upright, and helps prevent skin interaction.4 A moisturizing gel is an effective way to maintain that hair hydration while also reducing razor to skin friction, Dr. Thomas says. For the shaving act itself, technique can make a significant difference. Shaving with the grain of the hair wherever possible, with smooth, even strokes is recommended, and stretching the skin, pressing the razor down or repeatedly shaving the same area in an attempt to achieve a closer or more thorough shave are all habits to be discouraged.3 IMPORTANT SKIN BENEFITS: PREPARATION AND A FIVE-BLADE RAZOR Gillette conducted a study in 90 African-American males comparing shaving with a three-blade razor and a standard skin care regimen to both a five-blade razor with the same regimen and a five-blade razor accompanied by a more advanced skin care regimen that included postshave moisturizing products, says Dr. Tan. Compared to the 30 participants in the three-blade control group, “the five-blade razor with the more conventional standard treatment had fewer ingrown hairs,” he says. “The last group, that had the [advanced skin care] products plus the five-blade razor, had fewer ingrown hairs, less itching, and better improvement in the Physician Global Assessment of their ingrown hairs.” Post-shaving moisturization with a product containing niacinimide has been shown in a randomized clinical trial to significantly improve trans-epidermal water loss compared to a placebo moisturizer, and this improvement in skin barrier function and skin moisturization was sustained with continued use of the regimen.3 “Anything that elevates the skin clearly gives a target for trauma,” says Dr. Thomas. So any skin condition that results in papules or pustules, such as acne, makes patients vulnerable to razor damage and skin

inflammation from shaving. Teaching good shaving practice will benefit these patients.

PSEUDOFOLLICULITIS BARBAE

Pseudofolliculitis barbae (PFB) is more prevalent in men with strongly curved beard hair.5 REFERENCES

1. Daniel A, et al: J Drugs Dermatol Apr. 2013; 12(4):410–418. 2. Cowley K, Vanoosthuyze K: Br J Dermatol Mar. 2012; 166 Suppl. 1:6– 12. 3. Ertel K, McFeat G: Blade Shaving. In: Cosmetic Dermatology: Products and Procedures (Draelos Z.D., ed.). Oxford: Blackwell Publishing, 2010; pp. 156–164. 4. Shiel S: Man in the mirror: research considerations for the care and appearance of men’s skin Br J Dermatol Mar. 2012; 166 Suppl 1. 5. Winter H, et al: J Invest Dermatol 2004 Mar; 122(3):652.

Supplement to The Chronicle of Skin & Allergy, March 2015. Chronicle is an independent medical news service that provides educational updates regarding medical developments around the world. Views expressed are those of the participants and do not necessarily reflect those of the publisher or sponsor. Support for distribution of this report was provided by Procter & Gamble through an unrestricted educational grant without conditions. Information provided in this report is not intended to serve as the sole basis for individual care. Printed in Canada for Chronicle Information Resources Ltd., 555 Burnhamthorpe Rd., Suite 306, Toronto, Ont. M9C 2Y3.Telephone 416.916.2476; facsimile 416.352.6199; e-mail: health@chronicle.org. Copyright 2015 by Chronicle Information Resources Ltd., except where noted. All rights reserved. Reproduction in any form is expressly prohibited without written permission of the publisher.


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HS greatly impacts patient’s quality of life, study reports

Continued from page 1 : H I : 9 > C ; > C 9 > C g D J I w= : G : > I G 6 C k: 9 > C I : G B H D ; D I = : G 9 : G B 6 I D A D g> 8 8 D C 9 > I > D C H . T= : QD L > B E 6 8 I ; D G HS “w6 H B J 8 = = > g= : G I = 6 C bJ A A D J H E : B E = > gD > 9 6 C 9 8 D C I 6 8 I 9 : G B 6 I > I > H . . . II w6 H B J 8 = = > g= : G I = 6 C 6 A D E : 8 > 6 . II w6 H H >B >A6 G ID 8 = G D C >8 J G I>8 6 G >6 6 C 9 w: kC D w = D w 8 = 6 A A : C g> C g I = 6 I [8 D C 9 > I > D C ] > H ,” H 6 > 9 DG . AA 6 v> . “II w6 H D C : D ; I = : = > g= : H I > C I : G B H D ; 8 D B B D C

9 : G B 6 I D A D gy 9 > H : 6 H : H . II w6 H : v: C = > g= : G I = 6 C E H D G > 6 H > H .” T= : E 6 I > : C I H G : E D G I : 9 I = 6 I HS > B E 6 8 I H I = : > G H D 8 > 6 A ; J C 8 I > D C > C g, I = : > G : B D I > D C 6 A G : A 6 I > D C H = > E H , 6 C 9 I = : > G E = yH > 8 6 A ; J C 8 I > D C > C g. HS, 6 8 8 D G 9 > C g I D DG . AA 6 v> , 8 6 J H : H E = yH > 8 6 A E 6 > C , w= > 8 = > B E 6 8 I H I = : > G 6 II: C 9 6 C 8 : 6 I I = : > G jD b 6 B D C gB 6 C yD I= : G 6 H E : 8 IH D ; I = : > G A > v: H . T= : A : H > D C H 6 G : 6 AH D D ;I: C AD 8 6 I: 9 >C 6 G : 6 H D ; I = : bD 9 y 8 D C H > 9 : G : 9 > C I > B 6 I :

E 6 G H B : 8 = 6 6 C D H D 8 G6 H H

IH . AA 6 G g: I= : >6 A B :

FJ G I = : G B D G : , “I = : C 9 I= : 8 D C I>C J D J H 9 >H D ; I = : A : H > D C w6 H G ;6 8 ID G I= 6 I 8 6 J H : 9 > H D A 6 I > D C 6 C 9 : B b6 G C I ,” H 6 > 9 DG . AA 6 v> .

More awareness of HS needed T= : 6 J I = D G H H I 6 I : 9 > C I = : H I J 9 y I = 6 I I = : y = D E : I = 6 I : H I 6 bA > H = > C g I = : bJ G 9 : C D ; 9 > H : 6 H : ; D G I = : > C 9 > v> 9 J 6 A 6 C 9 H D 8 > : I y w> A A A : 6 9 I D b: I I : G ; J C 9 > C g 6 C 9 gG : 6 I : G 6 w6 G : C : H H D ; HS. IC 6 9 > ; ; : G : C I H I J 9 y, H J b-

B > I I : 9 6 C 9 J C 9 : G G : v> : w ; D G E J bA > 8 6 I > D C , DG . AA 6 v> 6 C 9 = : G 8 D A A : 6 gJ : H ; D J C 9 I = 6 I 9 : G B 6 I D A D g> H I H 9 > 6 gC D H : 9 I= : B 6 jD G > I y D ; HS 8 6 H : H > C I = : H I J 9 y, 6 bD J I 70%. “T= : B 6 > C >H H J : >H I= 6 I I= : G : >H 6 C : : 9 ; D G G 6 > H > C g 6 w6 G : C : H H > C C D C 9 : G G B 6 I D A D g> H I H , E 6 G I > 8 J A 6 G A y E G > B 6 G y 8 6 G : 6 C 9 : B : G g: C 8 y E = yH > 8 > 6 C H ,” H = : H 6 > 9 . DG . AA 6 v> , : I 6 A , > C I = > H H : 8 D C 9 H I J 9 y, H = D w: 9 I = 6 I > I 8 6 C I 6 k: B 6 C y y: 6 G H ; D G E 6 I > : C I H

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I D G : 8 : > v: 6 9 > 6 gC D H > H D ; HS. P6 I > : C I H w> A A 8 D C I > C J D J H A y G : I J G C I D I = : : B : G g: C 8 y 9 : E 6 G I B : C I 6 C 9 b: I G : 6 I : 9 H yB E I D B 6 I > 8 6 A A y, H J 8 = 6 H 9 G 6 > C > C g I = : 6 bH 8 : H H : H D G 8 yH I H . IC I = : 8 J G G : C I H I J 9 y > C I = : C6 C 6 9 > 6 C E D E J A 6 I > D C , 6 AB D H I = 6 A; D ; E 6 I>: C IH = 6 9 ID w6 > I D C : I D ; > v: y: 6 G H I D G : 8 : > v: I = : > G 9 > 6 gC D H > H D ; HS 6 C 9 A D C g: G I = 6 C ; > v: y: 6 G H ; D G 40% D ; E 6 I > : C I H . “HS > H 6 H yH I : B > 8 9 > H : 6 H : , H D B D H I D ; I= : H : E 6 I>: C IH 9 D C D I jJ H I = 6 v: 8 J I 6 C : D J H E G : H : C I 6 I > D C H ,” H 6 > 9 DG . AA 6 v> . “HS = 6 H 6 H H D 8 > 6 I > D C w> I = B : I 6 bD A > 8 H yC 9 G D B : , PCOS [E D A y8 yH I > 8 D v6 G y H yC 9 G D B : ], 8 yH I H , 6 C 9 = yE : G 6 C 9 G D g: C > H B . II > H > B E D G I 6 C I I D 9 > 6 gC D H : I = : H : 8 6 H : H , C D I D C A y b: 8 6 J H : D ; I = : > G qJ 6 A > I y D ; A > ; : , bJ I b: 8 6 J H : D ; = D w > I 6 ; ; : 8 I H I = : > G = : 6 A I = .” DG . AA 6 v> C D I : 9 I = 6 I > I > H > B E D G I 6 C I I D = : > g= I : C 6 w6 G : C : H H D ; HS C D I D C A y 6 B D C g 9 > ; ; : G : C I E = yH > 8 > 6 C E D E J A 6 I > D C H I D 6 > 9 w> I = : 6 G A > : G 9 > 6 gC D H > H 6 C 9 > B E G D v: 9 B 6 C 6 g: B : C I , bJ I 6 A H D w> I = I = : g: C : G 6 A E J bA > 8 .

HS has stigma of association “HS = 6 H 6 H I > gB 6 > C I = : 8 D B B J C > I y b: 8 6 J H : A D I H D ; E : D E A: 6 H H J B : I= 6 I I= >H >H 9 J : ID E D D G = yg> : C : D G I = 6 I > I > H 6 H : xJ 6 A A y I G 6 C H B > I I : 9 9 > H : 6 H : . [P6 I > : C I H H D B : I > B : H ] 9 D C D I gD I D H : : k B : 9 > 8 6 A 6 9 v> 8 : 6 C 9 I = : y = > 9 : > I ,” H = : H 6 > 9 . AC D I = : G w6 y I D > B E G D v: QD L ; D G E 6 I > : C I H w> I = I = > H 8 D C 9 > I > D C , DG . AA 6 v> H 6 > 9 , wD J A 9 b: I D : H I 6 bA > H = HS 8 : C I G : H D ; : x8 : A A : C 8 : > C C6 C 6 9 6 I = 6 I wD J A 9 = 6 v: 6 8 8 : H H I D 9 : G B 6 I D A D g> H I H , : C 9 D 8 G > C D A D g> H I H , E H y8 = > 6 I G > H I H , 6 C 9 H J G g: D C H . “W: C : : 9 I D H I 6 G I I = > C k> C g 6 bD J I : H I 6 bA > H = > C g > C I : G 9 >H 8 >E A>C 6 G y I: 6 B H ;D G I= : H : E 6 I > : C I H ,” H = : H 6 > 9 . W= > A : C D H J 8 = 8 A > C > 8 y: I : x> H I H > C C6 C 6 9 6 , DG . AA 6 v> > H = D E : ; J A I = 6 I w> I = I = : B D G : G : 8 : C I I = : G 6 E > : H I = 6 I = 6 v: bG D J g= I 6 I I : C I > D C I D HS 6 C 9 I = : >C 8 G : 6 H : 9 6 B D J C I D ; A>I: G 6 IJ G : > C ND G I = AB : G > 8 6 D C I = : I D E > 8 B > g= I 8 D C v> C 8 : J C > v: G H > I > : H I D 9 : v: A D E HS 8 A > C > 8 H > C C6 C 6 9 6 . “FD G 6 A D C g I > B : , [HS] w6 H 6 C D G E = 6 C 9 > H : 6 H : ,” H = : H 6 > 9 . AC D I = : G G : 8 : C I G : 8 D gC > I > D C D ; I = : 8 D C 9 > I > D C w6 H I = : ; D G B 6 I > D C D ; T= : C6 C 6 9 > 6 C H> 9 G 6 9 : C > I > H SJ E E J G 6 I > v6 FD J C 9 6 I > D C > C O8 I . 2014. A8 8 D G 9 > C g I D DG . AA 6 v> , I = : C D I -; D G -E G D ; > I 8 D G E D G 6 I > D C w> A A b: 6 bA : I D E J H = ; D G gG : 6 I : G 6 w6 G : C : H H 6 C 9 ; J C 9 > C g.


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THE C

KI

ON

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Novel postburn pruritus scale introduced Clinical practice

n D: v: A D E : 9 > C TD G D C I D , ; D J G -E D > C I H 8 6 A : w> A A = : A E gG 6 9 : > I 8 = H : v: G > I y > C 8 = > A 9 G : C I D ; > v: y: 6 G H D ; 6 g:

R

by EMILY INNES,

Assistant Editor, The Chronicle

: H : 6 G 8 = : G H ; G D B T= : HD H E > I 6 A ; D G S> 8 k C= > A 9 G : C (S> 8 k K> 9 H ) 6 C 9 I = : HD A A 6 C 9 BA D D G v> : w K> 9 H R: = 6 b> A > I 6 I > D C HD H E > I 6 A > C TD G D C I D = 6 v: 9 : v: A D E : 9 6 C D v: A E D H I bJ G C E G J G > I J H H 8 6 A : 8 6 A A : 9 I = : TD G D C I D P: 9 > 6 I G > 8 II 8 = S8 6 A : . PJ bA > H = : 9 > C I = : Journal of Burn Care Research (AJ g. 4, 2014), I = : ; D J G -E D > C I H 8 6 A : —gG 6 9 : z: G D I D gG 6 9 : I = G : : —J H : H 9 : H 8 G > E I > D C H D ; b: = 6 v> D J G H I D = : A E 8 6 G : g> v: G H > 9 : C I > ; y I = : H : v: G > I y D ; > I 8 = > C bJ G C E 6 I > : C I H yD J C g: G I = 6 C ; > v: y: 6 G H D ; 6 g: . “WD G k> C g w> I = E = yH > 8 > 6 C H D C I = : E 6 > C H : G v> 8 : 6 C 9 w> I = bJ G C H J G g: D C H > I b: 8 6 B : 8 A : 6 G I = 6 I ; D A A D w> C g [I = : E 6 I > : C I ’H ] G : 8 D v: G y ; G D B bJ G C H I = : E G > C 8 > E A : H yB E I D B I = 6 I bD I = : G : 9 8 = > A 9 G : C B D G : w6 H C D I I = : E 6 > C bJ I I = : > I 8 = ; G D B I = : bJ G C ,” H 6 > 9 DG . TD b> 6 H Ev: G : I I , 6 H I 6 ; ; 6 C : H I = : H > D A D g> H I 6 I S> 8 k K> 9 H 6 C 9 I = : A : 6 9 > C v: H I > g6 I D G . “W= > A : w: = 6 v: J H : ; J A 6 C 9 G : A > 6 bA : H 8 6 A : H ; D G G 6 I > C g E 6 > C > C I = : C D C -v: G b6 A E D E J A 6 I > D C H w: 9 D C D I = 6 v: J H : ; J A G 6 I > C g H 8 6 A : H I D G 6 I : > I 8 = > C I = : C D C -v: G b6 A E D E J A 6 I > D C .”

Assessing degree of itch GG 6 9 : z: G D G : E G : H : C I H C D > I 8 = 6 C 9 6 I I = : D I = : G : C 9 D ; I = : H E : 8 I G J B , 6 gG 6 9 : I = G : : , I = : 8 = > A 9 B > g= I b: 8 G y> C g > C 8 D C H D A 6 bA y, = > I I > C g I = : 6 G : 6 , b> I > C g > I , 9 > H G J E I > C g I = : 9 G : H H > C g D G H k> C gG 6 ; I I D I = : E D > C I w= : G : ; J G I = : G H J G g: G y > H C : : 9 : 9 , 6 C 9 I = : y 8 6 C C D I b: 9 > H I G 6 8 I : 9 w> I = D I = : G 6 8 I > v> I > : H . IC gG 6 9 : D C : D G I wD , I = : B > A 9 G 6 C g: , I = : 8 = > A 9 B > g= I b: E 6 I I > C g 6 I I = : wD J C 9 , G J bb> C g 6 I I = : 6 G : 6 , y: I , w= > A : I = : y B 6 y b: E G : D 8 8 J E > : 9 w> I = I = : > I 8 = , > I > H E D H H > bA : I D 9 > H I G 6 8 I I = : B w> I = D I = : G 6 8 I > v> I > : H .

DG . Ev: G : I I , 6 C 6 H H > H I 6 C I E G D ; : H H D G > C I = : D: E 6 G I B : C I D ; AC : H I = : H > D A D gy 6 I I = : UC > v: G H > I y D ; TD G D C I D , H 6 > 9 E G > D G I D I = : 9 : v: A D E B : C I D ; I = : H 8 6 A : E = yH > 8 > 6 C H wD J A 9 wG > I : 9 D wC > C I = : 8 = 6 G I “B > A 9 > I 8 = > C : H H ” D G “H : v: G : > I 8 = > C : H H ” b6 H : 9 D C v> : w> C g I = : E 6 I > : C I ’H b: = 6 v> D J G H . “[T= 6 I B : I = D 9 ] > H ; > C : , 6 C 9 E = yH > 8 > 6 C H 6 C 9 C J G H : H 6 C 9 = : 6 A I = 8 6 G : E G D v> 9 : G H J H : I = : > G jJ 9 gB : C I 9 6 > A y I D 9 : H 8 G > b: w= : G : D C 6 H E : 8 I G J B D ; H yB E I D B 6 I D A D gy H D B : D C : J C ; D A 9 H . BJ I > ; w: 6 G : ID 9 G 6 wJ H : ;J A 8 D C 8 AJ H >D C H ;G D B 8 A>C >8 6 A G : H : 6 G 8 = > I > H H > gC > ; > 8 6 C I A y B D G : G D bJ H I > ; w: 8 6 C 9 D > I > C 6 8 D C H I 6 C I > v: B 6 C C : G ,” H 6 > 9 DG . Ev: G : I I . “[T= : C yD J 8 6 C ] H = D w I = 6 I 6 C 6 v: G 6 g: H 8 D G : = 6 H b: : C G : 9 J 8 : 9 by 6 E 6 G I > 8 J A 6 G > C I : G v: C I > D C D G w: 8 6 C 8 D B E 6 G : I wD > C I : G v: C I > D C H 6 C 9 H = D w I = 6 I I = : 6 v: G 6 g: H 8 D G : w> I = D C : > C I : G v: C I > D C w6 H A D w: G I = 6 C I = : D I = : G .”

Will help develop accepted treatment protocol UH > C g I = : H 8 6 A : , 6 8 8 D G 9 > C g I D DG . Ev: G : I I , 6 A H D E G D v> 9 : H 6 C D E E D G I J C > I y ; D G B D G : 8 D C H > H I : C I J H : D ; I = : G 6 E > : H 6 C 9 6 C 6 8 8 : E I : 9 E G D I D 8 D A . CJ G G : C I A y, DG . Ev: G : I I 6 C 9 I = : S> 8 k K> 9 H I : 6 B 6 G : G : 8 D B B : C 9 > C g I = 6 I 6 gG 6 9 : z: G D D G D C : > I 8 = b: I G : 6 I : 9 w> I = I D E > 8 6 A 8 G : 6 B H . A E 6 I > : C I G 6 C k: 9 w> I = 6 gG 6 9 : I wD > I 8 = 8 D J A 9 G : 8 : > v: B 6 H H 6 g: I = : G 6 E y, : B D A A > : C I 8 G : 6 B , D G E D H H > bA y D G 6 A B : 9 > 8 6 I > D C . I; I = : 8 6 G : g> v: G b: A > : v: H I = : E 6 I > : C I = 6 H 6 gG 6 9 : I = G : : > I 8 = I = : E G : H 8 G > b> C g E = yH > 8 > 6 C B > g= I w6 C I I D 8 D C H > 9 : G > C I G 6 v: C D J H E G : E 6 G 6 I > D C H , : C I : G 6 A E G : E 6 G 6 I > D C H , D G A6 H : G . N: w G : H : 6 G 8 = = 6 H ; D J C 9 I = 6 I “> ; yD J J H : A 6 H : G H D C bJ G C : 9 6 G : 6 H , I = : C I = : > I 8 = H yB E I D B H 9 > H 6 E E : 6 G

D v: G 6 H = D G I 8 D J G H : D ; I G : 6 I B : C I ,” H 6 > 9 DG . Ev: G : I I . T= : H 8 6 A : w6 H I : H I : 9 ; D G v6 A > 9 > I y 6 C 9 G : A > 6 b> A > I y by = 6 v> C g > I G : v> : w: 9 by : xE : G I H > C I = : ; > : A 9 , 8 D B E 6 G > C g > I I D 6 9 J A I H 8 6 A : H H > C 8 : I = : G : > H C D gD A 9 H I 6 C 9 6 G 9 , 6 C 9 by = 6 v> C g 9 > ; ; : G : C I = : 6 A I = 8 6 G : E G D v> 9 : G H J H : >I ID G 6 I: I= : H 6 B : E 6 I>: C I. “OJ G 9 6 I 6 w6 H D C A y E G : A > B > C 6 G y I D b: = D C : H I , w: 9 > 9 C D I 9 D 6 C yI = > C g G D bJ H I D G > C 6 B : I = D 9 D A D g> 8 6 A A y H D J C 9 w6 y. W: 9 > 9 > I > C 6 k> C 9 D ; G : 6 A wD G A 9 w6 y w= : G : w: jJ H I g6 v: I = : H 8 6 A : I D H D B : bJ G C 8 6 G : G H 6 C 9 6 H k: 9 I = : B I D = 6 v: 6 gD [6 I G 6 I > C g],” H 6 > 9 DG . Ev: G : I I .

Less laboratory monitoring T= : 8 6 G : G H w: G : 6 H k: 9 I D G : 8 D G 9 I = : E 6 I > : C I 6 G D J C 9 I = : H 6 B : I > B : , = D w: v: G , I = : G : w6 H C D 8 D C I G D A I D 6 8 8 D J C I ; D G I = : ; 6 8 I I = 6 I > ; I wD 9 > ; ; : G : C I J H : G H D ; I = : H 8 6 A : G : 8 D G 9 : 9 I = : H : v: G > I y 6 C = D J G 6 E 6 G I , I = : > I 8 = A : v: A B > g= I = 6 v: 6 A G : 6 9 y 8 = 6 C g: 9 . DG . Ev: G : I I H 6 > 9 I = 6 I I = D J g= > I B 6 y 6 E E : 6 G I = 6 I I = : G : 8 D G 9 : G H 6 G : g: I I > C g 9 > ; ; : G : C I G : H J A I H J H > C g I = : H 8 6 A : , > I 8 D J A 9 jJ H I b: I = 6 I I = : > I 8 = H : v: G > I y = 6 H gD C : 9 D wC D G >C 8 G : 6 H : 9 >C 6 H = D G I E : G >D 9 D ; I>B : . T= : H 8 6 A : > H H I > A A > C I = : E > A D I H I 6 g: D ; > B E A : B : C I 6 I > D C 6 C 9 DG . Ev: G : I I H 6 > 9 6 H E 6 G I D ; D C gD > C g G : H : 6 G 8 = I = : y 6 G : : C H J G > C g I = 6 I I = : > G B : I = D 9 D A D gy ; D G 8 D A A : 8 I > C g G : A > 6 b> A > I y 6 C 9 v6 A > 9 > I y 9 6 I 6 > H H D J C 9 . T= : H 8 6 A : = 6 H b: : C w: A A G : 8 : > v: 9 H D ; 6 G , 6 8 8 D G 9 > C g I D DG . Ev: G : I I . H: E G : H : C I : 9 I = : H 8 6 A : > C BD H I D C 9 J G > C g I = : AB : G > 8 6 C BJ G C AH H D 8 > 6 I > D C 6 C C J 6 A B : : I > C g 6 y: 6 G 6 gD 6 C 9 = : = 6 H H > C 8 : G : 8 : > v: 9 G : qJ : H I H ; D G > I I D b: > B E A : B : C I : 9 > C I D D I = : G 8 = > A 9 G : C ’H = D H E > I 6 A H . H: H 6 > 9 = : > H = D E > C g I = : H 8 6 A : > H 6 I D D A I = 6 I g: I H 9 > H H : B > C 6 I : 9 w: A A .

Oral apremilast a new treatment option for psoriasis

Continued from page 1 I= : ;>G H I D G 6 A E = D H E = D 9 >: H I: G 6 H : 4 (PDE4) > C = > b> I D G . “I; w: A D D k 6 I I = : : vD A J I > D C D ; E H D G > 6 H > H I G : 6 I B : C I , w: ’v: = 6 9 I D E > 8 6 A H , I6 G H ,6 B >C D E I: G >C ,6 C 9 E = D ID I= : G 6 E >: H . W: = 6 9 B : I = D I G : x6 I : > C I G D 9 J 8 : 9 B 6 C y y: 6 G H 6 gD 6 C 9 I = : C 8 y8 A D H E D G > C : 6 G D J C 9 20 y: 6 G H 6 gD . T= : C w: w: C I I D I = : b> D A D g> 8 H I = 6 I w: G : 9 : A > v: G : 9 > C > I > 6 A A y > C I G 6 v: C D J H A y 6 C 9 I = : C H J b8 J I 6 C : D J H A y,” H 6 yH DG . W6 yC : GJ A A > v: G , 6 SI . JD = C ’H N: w; D J C 9 A 6 C 9 6 C 9 L6 bG 6 9 D G -b6 H : 9 9 : G B 6 I D A D g> H I 6 C 9 PG D ; : H H D G D ; M: 9 > 8 > C : 6 I M: B D G > 6 A UC > v: G H > I y. “AC 9 C D w w: ’G : b6 8 k I D 6 C D G 6 A H B 6 A A B D A : 8 J A : .” T= : C : w E G D 9 J 8 I > H I = : ; > G H I D G 6 A A y 9 : A > v: G : 9 H B 6 A A B D A : 8 J A : I G : 6 I B : C I ; D G E H D G > 6 H > H H > C 8 : 8 y8 A D H E D G > C : w6 H > C I G D 9 J 8 : 9 I wD 9 : 8 6 9 : H 6 gD , H 6 yH DG . GJ A A > v: G . TD 9 6 I : I G > 6 A H D ; I = : C : w ; D G B J A 6 I > D C = 6 v: H = D wC > I = 6 H G : 6 H D C 6 bA : : ; ; > 8 6 8 y 6 C 9 6 v: G y gD D 9 H 6 ; : I y E G D ; > A : , 6 C 9 wD G kH G : 6 H D C 6 bA y w: A A ; D G 6 A A 6 H E : 8 I H D ; E H D G > 6 H > H — C 6 >AH ,H 8 6 AE ,6 C 9 E H D G >6 I>8 6 G I= G >I>H ,= : H 6 yH . AE E G D v6 A D ; I = : C : w ; D G B J A 6 I > D C w6 H A 6 G g: A y b6 H : 9 D C I wD B J A I > -8 : C I G : , G 6 C 9 D B > z: 9 , 9 D J bA : -bA > C 9 H I J 9 > : H (ESTEEM 1 6 C 9 2), w= > 8 = > C vD A v: 9

G D J g= A y 1,250 6 9 J A I H w> I = B D 9 : G 6 I : I D H : v: G : E A 6 qJ : E H D G > 6 H > H .

Less laboratory monitoring T= : D G 6 A ; D G B J A 6 I > D C D ; 6 E G : B > A 6 H I 6 E E : 6 G H I D b: 6 H : ; ; : 8 I > v: 6 H D G 6 A B : I = D I G : x6 I : , H 6 yH V6 C 8 D J v: G 9 : G B 6 I D A D g> H I DG . J6 H D C R> v: G H , 8 A > C > 8 6 A E G D ; : H H D G D ; 9 : G B 6 I D A D gy 6 C 9 6 E 6 H I 9 > G : 8 I D G D ; I = : 9 : G B 6 I D A D gy G : H > 9 : C 8 y I G 6 > C > C g E G D gG 6 B 6 I I = : UC > v: G H > I y D ; BG > I > H = CD A J B b> 6 . A9 v: G H : : v: C I H H : : B I D b: A > B > I : 9 , I D D , = : H 6 yH . UC A > k: D G 6 A B : I = D I G : x6 I : , D G 6 A 6 E G : B > A 6 H I 9 D : H C D I G : qJ > G : I = : H 6 B : A : v: A D ; A 6 b B D C > I D G > C g, H 6 yH DG . R> v: G H . “OG 6 A 9 D H > C g > H 6 B D G : 8 D C v: C > : C I D E I > D C ; D G H D B : E 6 I > : C I H ,” H 6 yH E9 B D C I D C 9 : G B 6 I D A D g> H I DG . ND G B 6 C W6 H : A , 6 H H > H I 6 C I 8 A > C > 8 6 A E G D ; : H H D G D ; B : 9 > 8 > C : 6 I I = : UC > v: G H > I y D ; AA b: G I 6 . “SD B : E 6 I > : C I H B 6 y 6 E E G : 8 > 6 I : I = > H 6 H A : H H I = G : 6 I : C > C g D G A : H H > C v6 H > v: 6 C 9 B 6 y b: B D G : D E : C I D [D G 6 A I = : G 6 E y] 6 H D E E D H : 9 I D D I = : G G D J I : H D ; 6 9 B > C > H I G 6 I > D C .” DG . W6 H : A H 6 yH = > H D wC E 6 I > : C I H D ; I : C H I 6 y 6 w6 G : D ; 9 : v: A D E B : C I H > C I G : 6 I B : C I D E I > D C H ;D G I= : >G 8 D C 9 >I>D C H , 6 C 9 I= : G : = 6 H b: : C 6 ; 6 > G b> I D ; > C I : G : H I > C D G 6 A 6 E G : B >A6 H I. “SD B : E 6 I > : C I H B 6 y v> : w > I 6 H 6 B D G : 8 D C v: C > : C I D E I > D C , D G 6 B D G :

Dr. Wayne Gulliver

Dr. Norman Wasel

6 8 8 : E I 6 bA : G D J I : D ; 6 9 B >C >H IG 6 I>D C . OI = : G E 6 I>: C IH B 6 y v> : w H J b8 J I6 C : D J H 6 H B D G: 8 D C v: C > : C I ,” = : H 6 yH . “II > H 6 gD D 9 Dr. Jason Rivers E A 6 8 : ; D G E = yH > 8 > 6 C H I D = 6 v: 6 9 > H 8 J H H > D C w> I = I = : E 6 I > : C I H . I 6 C I > 8 > E 6 I : I = 6 I E 6 I > : C I H w= D 6 G : 8 J G G : C I A y D C D G 6 A I G : 6 I B : C I H w> I = B : I = D I G : x6 I : 6 C 9 E : G = 6 E H B 6 y C D I b: 9 D > C g w: A A 6 G : gD > C g I D b: E 6 G I > 8 J A 6 G A y > C I : G : H I : 9 > C D G 6 A I G : 6 I B : C I w> I = 6 E G : B > A 6 H I , D G 6 A I : G C 6 I > v: A y E 6 I > : C I H w= D w: G : 8 D C H > 9 : G > C g B : I = D I G : x6 I : I = : G 6 E y bJ I ; D G w= D B B : I = D I G : x6 I : B 6 y b: 8 D C I G 6 > C 9 > 8 6 I : 9 B 6 y 6 A H D w6 C I I D g> v: 6 H : G > D J H A D D k 6 I 6 E G : B > A 6 H I .” RD J g= A y D C : -I = > G 9 D ; E 6 I > : C I H > C

I = : ESTEEM 1 I G > 6 A 6 8 = > : v: 9 PASI-75 8 A : 6 G 6 C 8 : . “FD G I = : E : D E A : w= D 9 D w: A A w> I = > I , I = : y 6 G : v: G y = 6 E E y w> I = > I , 6 C 9 > I > H B 6 > C I 6 > C : 9 . T= : G : > H A D C gI : G B 9 6 I 6 D J I I D 6 y: 6 G . W: ’v: gD I H D B : E : D E A : > C H I J 9 > : H , 6 C 9 I’v: = 6 9 H D B : : xE : G > : C 8 : w> I = > I > C 8 A > C > 8 6 A I G > 6 A H , I = 6 I 6 G : gD > C g I D b: D C I = : 9 G J g C D w ; D G 6 8 D J E A : D ; y: 6 G H ,” 6 9 9 H DG . GJ A A > v: G . P6 I > : C I H > C D C gD > C g : ; ; > 8 6 8 y H I J 9 > : H 6 G : b: > C g ; D A A D w: 9 D J I I D ; > v: y: 6 G H , = : H 6 yH . T= : B 6 > C A > B > I 6 I > D C D ; D G 6 A 6 E G : B >A6 H I 6 I I= >H I>B : >H I= : 8 D H I, H 6 yH DG . R> v: G H . II G : B 6 > C H I D b: H : : C w= : I = : G D G C D I E G D v> C 8 > 6 A ; D G B J A 6 G > : H w> A A E > 8 k J E I = : C : w ; D G B J A 6 I > D C ; D G G : > B bJ G H : B : C I . H6 v> C g 6 C D G 6 A PDE4 > C = > b> I D G g> v: H 8 A > C > 8 > 6 C H B D G : ; A : x> b> A > I y, H 6 yH DG . GJ A A > v: G . “FD G E 6 I > : C I H w= D = 6 v: ; 6 > A : 9 B 6 C y D I = : G 8 A 6 H H : H D ; 9 G J gH , > I > H 8 : G I 6 > C A y 6 C D E I > D C . AC 9 ; D G I = D H : w= D w6 C I 6 E > A A , > I > H 8 : G I 6 > C A y 6 C D E I > D C . IC I : G B H D ; H 6 ; : I y E G D ; > A : , > I B 6 y b: 6 E E : 6 A > C g I D 6 C J B b: G D ; E 6 I > : C I H . II > H H D B : I = > C g C : w, 6 C 9 H D B : I = > C g w: 6 G : v: G y = 6 E E y I D = 6 v: 6 H E 6 G I D ; D J G I = : G 6 E : J I > 8 6 G B 6 B : C I 6 G > J B .”

Non-proprietary and brand name of therapy: apremilast (Otezla, Celgene Corp.)


Skin_March_2015,rar16_ms_9.1_rar1_Skin_March_2014,rar1.qxd 09/04/2015 H&S_DU_02-11-15a_April_09_2015_Layout 1 09/04/2015 12:00 PM Page 1 12:26 PM Page 17

New treatment option for

seborrheic dermatitis of the scalp

A

lthough the pathogenesis of seborrheic dermatitis—one of the most common presentations in dermatology practice—is not completely understood, results from a recent clinical trial indicate therapy with an over-thecounter preparation can provide benefits to patients whose scalp, face and other body areas are affected by the disease. “The results from this study show that this hydro-alcoholicbased agent containing niacinamide, panthenol and caffeine can reduce dry skin appearance, improve skin barrier function, reduce inflammation and normalize epidermal differentiation. We can help our patients,” according to Dr. Loukia Mitsos, a Montreal dermatologist, who presented the results of the study during a podium session at Dermatology Update in Vancouver. Dr. Mitsos noted that seborrheic dermatitis is a troublesome, annoying condition for patients, who experience distressing yellow, white and grey skin flakes, pruritus, a feeling of tightness and, in many cases, erythema as well. She noted seborrheic dermatitis is a reaction to the Pityrosporum yeasts, Malasezzia furfur, Malassezia globosa, and Malassezia restricta, and reported new developments in the understanding and treatment of the condition. “What is very interesting now is that we have molecular markers we can quantify to see if with our treatments we are actually improving the inflammatory process,” she said. “Studies are also looking at improvement in barrier function by investigating transepidermal water loss and the presence of human serum albumin in the superficial stratum corneum.” She described the randomized, split-scalp clinical trial that evaluated the improvement in the dry scalp appearance of 36 males treated with a leave-on, hydro-alcoholic-based agent containing niacinamide, panthenol and caffeine (Head & Shoulders Full and Thick Advanced Hair Thickening Tonic, Procter & Gamble). Subjects with concomitant skin disease of the scalp were excluded from the study. Niacinamide, Dr. Mitsos said, is a Vitamin B3 compound that decreases inflammation and improves the skin’s moisturization by increasing fibrin in the skin barrier, and also by increasing high molecular weight keratins. Caffeine is a non-competitive selective phosphodiesterase inhibitor that increases cyclic AMP and also inhibits TNF-alpha. Panthenol, a pro-vitamin B5 humectant emollient, also plays a role by drawing in moisture and decreasing inflammation. Dr. Mitsos noted that subjects en-

Microscopic image of human seborrheic dermatitis of the scalp. Courtesy, Horoporo, licensed under CC by-SA 3,0

Leave-on hydro-alcoholic agent with niacinamide, panthenol and caffeine helps patients scaling, 6 (moderate scaling), 8 (heavy scalDivision of the scalp into 8 sections ing) and 10 (very heavy scaling). Improvement in barGrading scale: rier function 0 – no scaling was meas2 – slight scaling ured by trans4 – some scaling e p i d e r mal 6 – moderate scaling water loss 8 – heavy scaling (TEWL), and 10 – very heavy scaling the presence of human serBacon RA: J Dermatology Treat 2014 Jun; 25(3):232-236. um albumin biomarkers in rolled in the trial were screened via a the superficial stratum corneum. medical history questionnaire and The normalization of epidermal then assessed by qualified dandruff differentiation and inflammation graders, who used the Adherent was assessed by recording the level Scalp Flaking Score (ASFS) to quanof the IL-1ra:IL-1alpha ratio and the tify the severity of flaking on each level of involucrin, a keratinocyte ensubject’s scalp (Bacon RA, Mizoguchi velope protein biomarker, in the suH, Schwartz JR: Assessing therapeuperficial stratum corneum. tic effectiveness of scalp treatment for Compared to the results dandruff and seborrheic dermatitis, achieved using only the shampoo, Part 1: a reliable and relevant method the hair thickening and scalp treatbased upon the adherent scalp and ment significantly improved the dry flaking score (ASFS). J Dermatology skin appearance of the 36 subjects at Treat 2014; 25(3):232–236). weeks 2 and 3 of the study p<0.005 During a two-week pre-treat(Schwartz J: J Acta Derm Venereol ment period the subjects washed 2013; 93:131–137). their hair with a cosmetic shampoo, Measurements of transepiderand at baseline at the end of this pemal water loss (TEWL) at the same riod were required to have an ASFS weekly intervals also showed the of >/=24. The leave-on tonic was aphair thickening and scalp treatment plied each day for three weeks on the had also significantly improved skin right side or the left side of the scalp; barrier function. Human serum albuin each case, the location was determin (HSA) biomarker levels at week mined by randomization. 3 confirmed this finding. The same shampoo used in the The investigators utilized inpre-treatment phase of the study was volucrin to assess epidermal differused over the entire scalp again three entiation achieved through the use times each week. of the shampoo or hair thickening and scalp treatment agents. DifferWeekly evaluation entiation was found to be normalThe results were evaluated weekly, ized to a significant degree at both Dr. Mitsos said. The improvement in week 2 and week 3 when the hair dry skin appearance was assessed vithickening and scalp treatment was sually by experts, who recorded their used. findings using the ASFS score: 0 (no An improvement of more than scaling), 2 (slight scaling), 4 (some 20% was noted at week 2 and an im-

Adherent Scalp Flaking Score (ASFS) method to quantitate the flaking severity

provement of more than 30% was noted seven days later, compared to a normalization of 40% in epidermal differentiation with the shampoo. The hair thickening and scalp treatment also reduced inflammation on the scalp. The IL-1ra:IL1alpha ratio demonstrated that this reduction was significant at weeks 1, 2 and 3. “Use of this new scalp treatment significantly reduced the dry skin appearance of these subjects,” Dr.

on the scalps Mitsos said. “It also reduced inflammation of the scalp, improved skin barrier function and normalized the epidermal differentiation in each of the 36 subjects.”

Therapeutic option Available as an OTC product, the new Head & Shoulders Full & Thick Advanced Hair Thickening Tonic offers patients and physicians another preventive and therapeutic option to the list of prescription medications available to manage the various forms of seborrheic dermatitis. The therapeutic armamentarium for seborrheic dermatitis includes antifungals (miconazole, ketoconazole), topical corticosteroids (fluocinolone, triamcinolone, hydrocortisone) and keratolytics such as topical urea. Antihistamines may also be used to relieve pruritus. Some dermatologists also favour photodynamic therapy with UV-A and UV-B laser or red and blue LED light to halt growth of the Malassezia fungi. Supplement to The Chronicle of Skin

& Allergy, March 2015. Chronicle is an independent medical news service that provides educational updates regarding medical developments around the world. Views expressed are those of the participants and do not necessarily reflect those of the publisher or sponsor. Support for distribution of this report was provided by Procter & Gamble through an unrestricted educational grant without conditions. Information provided in this report is not intended to serve as the sole basis for individual care. Printed in Canada for Chronicle Information Resources Ltd., 555 Burnhamthorpe Rd., Suite 306, Toronto, Ont. M9C 2Y3.Telephone 416.916.2476; facsimile 416.352.6199; e-mail: health@chronicle.org. Copyright 2015 by Chronicle Information Resources Ltd., except where noted. All rights reserved. Reproduction in any form is expressly prohibited without written permission of the publisher.


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Melanoma research

THE CHRONICLE of S K I N & A L L E R G Y

Melanoma in situ

Research

Electroporation + PDT

Research

n BD D H I I D 9 G J g 6 bH D G E I > D C 6 > 9 H : ; ; > 8 6 8 y From the News Resources of The Chronicle

n LD C g-I : G B

From the News Resources of The Chronicle

P= D I D 9 yC 6 B > 8 I = : G 6 E y, H J E E D G I : 9 by : A : 8 I G D E D G 6 I > D C , 6 E E : 6 G H I D : ; ; > 8 > : C I A y > C 9 J 8 : 6 E D E I D H > H > C bD I = B : A 6 C D I > 8 6 C 9 6 B : A 6 C D I > 8 B : A 6 C D B 6 8 : A A H , G : H : 6 G 8 = : G H G : E D G I D C A > C : > C Melanoma Research (M6 G . 9, 2015). T= : 6 J I = D G H C D I : I = 6 I E = D I D 9 yC 6 B > 8 I = : G 6 E y = 6 H b: : C 8 D C H > 9 : G : 9 > C : ; ; : 8 I > v: ; D G I = : I G : 6 I B : C I D ; B : A 6 C D B 6 9 J : I D 8 D B E : I > I > v: 6 bH D G E I > D C A > g= I D ; I = : w6 v: A : C gI = J H : 9 I D : x8 > I : I = : E = D I D H : C H > I > z: G . T= : y H D J g= I I D : xE A D G : I = : E D H H > b> A > I y I = 6 I I = : : ; ; > 8 6 8 y D ; E = D I D 9 yC 6 B > 8 I = : G 6 E y 6 g6 > C H I B : A 6 C D B 6 8 D J A 9 b: > B E G D v: 9 I = G D J g= I = : J H : D ; : A : 8 I G D E D G 6 I > D C I D > B E G D v: I G 6 C H E D G I D ; 6 E = D I D H : C H > I > z: G I = G D J g= I G 6 C H > : C I E D G : H > C I = : 8 : A A B : B bG 6 C : . TD I : H I I = > H = yE D I = : H > H , I = : 8 D B b> C 6 I > D C D ; : A : 8 I G D E D G 6 I > D C 6 C 9 E = D I D 9 yC 6 B > 8 I = : G 6 E y J H > C g I = : E = D I D H : C H > I > z: G E = D I D ; G > C w6 H I : H I : 9 > C v> I G D D C I wD = J B 6 C B : A 6 C D B 6 8 : A A A > C : H : B : A 6 C D I > 8 B : A 6 C D B 6 (M: W), 6 C 9 6 B : A 6 C D I > 8 B : A 6 C D B 6 (C32). HJ B 6 C k: G 6 I > C D 8 yI : H (H6 C6 T) w: G : J H : 9 ; D G 8 D C I G D A : xE : G > B : C I H . R: H : 6 G 8 = : G H B : 6 H J G : 9 E = D I D H : C H > I > z: G 9 > H I G > bJ I > D C , E : G ; D G B : 9 8 A D C > C g : ; ; > 8 6 8 y I : H I H 6 C 9 8 D B : I 6 H H 6 yH , 6 C 9 6 H H : H H : 9 6 E D E I D I > 8 E G D I : > C H , 6 H w: A A 6 H 9 : I : G B > C > C g B : A 6 C > C A : v: A H bD I = b: ; D G : 6 C 9 6 ; I : G 6 9 B > C > H I : G > C g E = D I D 9 yC 6 B > 8 I = : G 6 E y. T= : > G ; > C 9 > C gH H = D w: 9 I = 6 I : A : 8 I G D E D G 6 I > D C 9 > 9 : ; ; : 8 I > v: A y H J E E D G I I = : E = D I D 9 yC 6 B > 8 I = : G 6 E y.

MIS EXCISION MARGINS SHOULD BE GREATER THAN 3 MM F6 8 > A > I > : H J H > C g w> 9 : A D 8 6 A : x8 > H > D C D G H I 6 g: 9 : x8 > H > D C ; D G B : A 6 C D B 6 > C H > I J (MIS) H = D J A 9 b: J H > C g 6 = > H I D A D g> 8 6 A B 6 G g> C gG : 6 I : G I = 6 C 3.0 B B > C D G 9 : G I D 6 8 = > : v: 6 A D w G : 8 J G G : C 8 : G 6 I : , 6 8 8 D G 9 > C g I D G : H : 6 G 8 = E J bA > H = : 9 > C Plastic and Reconstructive Surgery: Global Open (M6 G . 6, 2015; 3(2):: 201). TD 6 H H : H H I = : G : A 6 I > D C b: I w: : C = > H I D A D g> 8 6 A : x8 > H > D C B 6 G g> C H D ; MIS 6 C 9 G : 8 J G G : C 8 : 6 C 9 E G D gG : H H > D C I D > C v6 H > v: 9 > H : 6 H : , I = : 6 J I = D G H 6 C 6 A yz: 9 6 A A E 6 I > : C I H > C I = : > G 8 A > C > 8 w= D = 6 9 MIS : x8 > H : 9 by w> 9 : A D 8 6 A : x8 > H > D C D G H I 6 g: 9 : x8 > H > D C ; G D B D: 8 . 2008 I D J6 C . 2014. D6 I 6 g6 I = : G : 9 > C I = : E G D H E : 8 I > v: 9 6 I 6 b6 H : > C 8 A J 9 : 9 E 6 I > : C I 9 : B D gG 6 E = > 8 H , I = : 6 C 6 I D B > 8 6 A H > I : H D ; I = : A : H > D C H , H J bI yE : D ; B : A 6 C D B 6 , = > H I D A D g> 8 6 A : x8 > H > D C B 6 G g> C , 6 C 9 9 > H : 6 H : G : 8 J G G : C 8 : . AB D C g I = : 410 E 6 I > : C I H > C 8 A J 9 : 9 , I = : B 6 jD G > I y (79%) D ; : x8 > H : 9 MIS w: G : A : C I > gD B 6 A > gC 6 H J bI yE : . T= : 6 v: G 6 g: = > H I D A D g> 8 6 A : x8 > H > D C B 6 G g> C w6 H 3.7 B B , 6 C 9 w> I = 6 B : 9 > 6 C ; D A A D w-J E D ; 23 B D C I = H I = : G : 8 J G G : C 8 : G 6 I : w6 H 2.2%—C > C : D ; I = : 410 E 6 I > : C I H . T= : G : w: G : H > B > A 6 G G : 8 J G G : C 8 : G 6 I : H H : : C b: I w: : C A : C I > gD B 6 A > gC 6 (2.3%) 6 C 9 C D C -A : C I > gD MIS (1.2%, E =0.69). AB D C g I = : A : H > D C H I = 6 I G : 8 J G G : 9 , I = : B : 6 C : x8 > H > D C B 6 G g> C w6 H 1.9 B B , 8 D B E 6 G : 9 I D 3.8 B B > C I = D H : I = 6 I 9 > 9 C D I G : D 8 8 J G . Ov: G 6 A A , I = : G 6 I : D ; MIS G : 8 J G G : C 8 : w= : G : I = : B 6 G g> C w6 H 3.0 B B D G A : H H w6 H 3.8%, 8 D B E 6 G : 9 I D jJ H I 0.5% 6 B D C g I = D H : w> I = B 6 G g> C H A 6 G g: G I = 6 C 3.0 B B (E =0.03). OC : D ; I = : MIS I = 6 I G : 8 J G G : 9 9 > 9 H D 6 H > C v6 H > v: 9 > H : 6 H : .

H J G v: > A A 6 C 8 : v6 A J 6 bA :

F> C 9 > C gH D ; 6 = > g= A D C g-I : G B G > H k D ; H J bH : qJ : C I B : A 6 C D B 6 > C 6 B : A 6 C D B 6 > C H > I J 8 D = D G I H J gg: H I I = 6 I A D C g-I : G B H J G v: > A A 6 C 8 : D ; E 6 I > : C I H 9 > 6 gC D H : 9 w> I = B : A 6 C D B 6 > C H > I J 8 6 C b: D ; b: C : ; > I , G : H : 6 G 8 = : G H G : E D G I D C A > C : > C Journal of the American Academy of Dermatology (M6 G . 11, 2015). TD 8 D B E 6 G : I = : G > H k D ; H J bH : qJ : C I B : A 6 C D B 6 > C E 6 I > : C I H w= D H : ; > G H I 8 6 C 8 : G w6 H B : A 6 C D B 6 > C H > I J I D I = D H : w= D H : ; > G H I 8 6 C 8 : G w6 H > C v6 H > v: B : A 6 C D B 6 , > C v: H I > g6 I D G H > 9 : C I > ; > : 9 E 6 I > : C I H ; 6 A A > C g > C I D I = : H : I wD 8 6 I : gD G > : H ; G D B I = : SJ G v: > A A 6 C 8 : , EE > 9 : B > D A D gy, 6 C 9 EC 9 R: H J A I H (SEER) E G D gG 6 B ; G D B 1973 I D 2011, 6 C 9 : v6 A J 6 I : 9 I = : I wD 8 D = D G I H J H > C g CD x E G D E D G I > D C 6 A = 6 z6 G 9 H B D 9 : A H . T= : y ; D J C 9 I = 6 I I = : B : A 6 C D B 6 > C H > I J 8 D = D G I w6 H B D G : A > k: A y I = 6 C I = : > C v6 H > v: B : A 6 C D B 6 8 D = D G I I D 9 : v: A D E H J bH : qJ : C I B : A 6 C D B 6 D ; 6 C y H I 6 g: 6 ; I : G I wD y: 6 G H , H J bH : qJ : C I > C v6 H > v: B : A 6 C D B 6 6 6 ; I : G 10 y: 6 G H , 6 C 9 H J bH : qJ : C I B : A 6 C D B 6 > C H > I J 6 I 6 A A I = : I > B : E D > C I H (E <0.001, E =0.003, E <0.001, G : H E : 8 I > v: A y). T= : 6 J I = D G H 9 D C D I : I = 6 I I = : > G ; > C 9 > C gH B 6 y b: 6 ; ; : 8 I : 9 by J C 9 : G G : E D G I > C g D ; B : A 6 C D B 6 (: H E : 8 > 6 A A y B : A 6 C D B 6 > C H > I J ), 6 C 9 6 A D H H D ; E 6 I > : C I H ; G D B I = : SEER G : g> H I G y 6 G : 6 G : H J A I > C g > C J C G : E D G I : 9 H J bH : qJ : C I B : A 6 C D B 6 H .

Melanoma update

BRAF MUTATION DOES NOT SPEED MELANOMA TUMOUR GROWTH T= : E G : H : C 8 : D ; 6 BRAF B J I 6 I > D C 9 D : H C D I 6 E E : 6 G ID E GD 9 J 8 : B D G: G 6 E > 9 I J B D J G gG D wI = > C B : A 6 C D B 6 , bJ I > H 6 H H D 8 > 6 I : 9 w> I = E D D G : G B : A 6 C D B 6 -H E : 8 > ; > 8 H J G v> v6 A (MSS) > C E 6 I > : C I H w> I = : 6 G A y-H I 6 g: 9 > H : 6 H : , G : H : 6 G 8 = : G H G : E D G I D C A > C : > C The British Journal of Dermatology (M6 G . 5, 2015). A E G D H E : 8 I > v: 8 D = D G I D ; 196 E 6 I > : C I H w> I = H I 6 g: I I D III E G > B 6 G y 8 J I 6 C : D J H B : A 6 C D B 6 w: G : ; D A A D w: 9 ; D G 6 B : 9 > 6 C D ; 92 B D C I = H , E G : -9 6 I > C g I = : > C H I > I J I > D C D ; BRAF > C = > b> I D G I = : G 6 E y. R: H : 6 G 8 = : G H 8 D G G : A 6 I : 9 8 A > C > 8 D E 6 I = D A D g> 8 6 A v6 G > 6 bA : H w> I = B J I 6 I > D C H I 6 I J H , 6 C 9 : H I > B 6 I : 9 MSS = 6 z6 G 9 G 6 I > D H . SD B : 77 I J B D J G H (39%) = 6 9 I = : V600E v6 G > 6 C I D ; I = : BRAF g: C : , 10 (5%) BRAF V600K, 6 C 9 33 (17%) NRAS. T= : BRAF V600E B J I 6 C I B : A 6 C D B 6 H I : C 9 : 9 I D gG D w B D G : H A D wA y, 6 C 9 w: G : 6 H H D 8 > 6 I : 9 w> I = B D G : ; 6 vD J G 6 bA : 8 A > C > 8 6 A 8 = 6 G 6 8 I : G > H I > 8 H I = 6 C BRAF V600K, NRAS B J I 6 C I , D G BRAF/NRAS WT I J B D J G H (0.12 B B /B D , 0.61 B B /B D , 0.36 B B /B D = , 6 C 9 0.23 B B /B D G : H E : 8 I > v: A y, E =0.05). T= : G : w: G : 39 B : A 6 C D B 6 9 : 6 I = H , 6 C 9 BRAF B J I 6 C I B : A 6 C D B 6 H w: G : 6 H H D 8 > 6 I : 9 w> I = E D D G : G MSS > C H I 6 g: I-III 9 > H : 6 H : (HR=2.60, 95% CI 1.20, 5.63, E =0.02) 6 C 9 H I 6 g: I-II 9 > H : 6 H : (HR=3.39 95% CI 1.12, 10.22, E =0.03) w= : C D I = : G E G D gC D H I > 8 v6 G > 6 bA : H w: G : 6 9 jJ H I : 9 ; D G . BRAF V600E B J I 6 C I B : A 6 C D B 6 H w: G : H I G D C gA y (HR=3.89 95% CI 1.67, 9.09 E =0.002) 6 H H D 8 > 6 I : 9 w> I = MSS, > C 9 : E : C 9 : C I D ; A : H > D C I = > 8 kC : H H D G C D 9 6 A H I 6 I J H . BRAF V600K B J I 6 C I I J B D J G H w: G : C D I (HR=1.19 95% CI 0.36, 3.92, E =0.77).

ACCEPTABLE TOXICITY FOR BRAF INHIBITOR/RADIOTHERAPY CD C 8 D B > I 6 C I BRAF > C = > b> I D G I = : G 6 E y 6 C 9 G 6 9 >D I= : G 6 E y >C B : A6 C D B 6 E 6 I > : C I H 9 D : H 6 E E : 6 G ; : 6 H > bA : w> I = > C 8 G : 6 H : H > C I D x> 8 > I y w> I = > C 6 8 8 : E I 6 bA : A > B > I H , G : H : 6 G 8 = : G H G : E D G I D C A > C : > C Annals of Oncology (M6 G . 11, 2015). A I D I 6 A D ; 161 B : A 6 C D B 6 E 6 I > : C I H ; G D B 11 H k> C 8 6 G : 8 : C I G : H > C EJ G D E : w: G : > C 8 A J 9 : 9 . P6 I > : C I H w: G : : v6 A J 6 I : 9 ; D G 6 8 J I : 6 C 9 A 6 I : I D x> 8 > I y. SD B : 70 8 D C H : 8 J I > v: E 6 I > : C I H G : 8 : > v: 9 86 H : G > : H D ; G 6 9 > D I = : G 6 A y, 6 A D C g w> I = BRAF > C = > b> I D G I = : G 6 E y. BA D D 9 H 6 B E A : H ; G D B 35 E 6 I > : C I H J C 9 : G w: C I G 6 9 > D H : C H > I > v> I y I : H I > C g v> 6 ; A J D G : H 8 : C 8 : -> C -H > I J -= ybG > 9 > z6 I > D C D ; 8 = G D B D H D B 6 A bG : 6 kH 6 ; I : G : x v> vD > G G 6 9 > 6 I > D C . T= : G 6 I : D ; 6 8 J I : G 6 9 > D 9 : G B 6 I > I > H =2° w6 H 36% > C E 6 I > : C I H w> I = 8 D C 8 D B > I 6 C I BRAF > C = > b> I D G I = : G 6 E y 6 C 9 G 6 9 > D I = : G 6 E y. FD A A > 8 J A 6 G 8 yH I > 8 E G D A > ; : G 6 I > D C w6 H H : : C > C 13% D ; 6 A A G 6 9 > D I = : G 6 E > : H . H: 6 G > C g 9 > H D G 9 : G H B 6 9 : J E 4% D ; C D C -H k> C I D x> 8 > I > : H H : : C , 6 C 9 9 yH E = 6 g> 6 2%. R6 I : H D ; G 6 9 > D 9 : G B 6 I > I > H =2° E D H I w= D A : -bG 6 > C G 6 9 > D I = : G 6 E y w: G : 44% ; D G E 6 I > : C I H D C BRAF > C = > b> I D G I = : G 6 E y, 6 C 9 8% ; D G I = D H : C D I (E <0.001). CD C 8 D B > I 6 C I v: B J G 6 ; : C > b IG : 6 IB : C I 6 AH D E G D 9 J 8 : 9 G 6 9 >D 9 : G B 6 I > I > H =2° B D G : ; G : qJ : C I A y I = 6 C 9 6 bG 6 ; : C > b I G : 6 I B : C I (40% vH . 26%, E =0.07). T= : 6 C 6 A yH > H D ; 8 = G D B D H D B 6 A bG : 6 kH : x v> vD 6 A H D H = D w: 9 H > gC > ; > 8 6 C I G 6 9 > D H : C H > I > v> I y > C 8 G : 6 H : ; D G v: B J G 6 ; : C > b E 6 I > : C I H (E =0.004) 6 C 9 I = D H : w= D H w> I 8 = : 9 ; G D B v: B J G 6 ; : C > b I D 9 6 bG 6 ; : C > b (E =0.002), bJ I C D I I = D H : D C 9 6 bG 6 ; : C > b D C A y. ND I D x> 8 > I > : H w: G : G : E D G I : 9 6 ; I : G H I : G : D I 6 8 I > 8 IG: 6 IB : C I.

ALTERNATE ANGIOGENESIS IN RESPONSE TO ANTI-VEGF TX AC I > -VEGF I G : 6 I B : C I H > C B : A 6 C D B 6 6 E E : 6 G I D E G D 9 J 8 : 6 H : A : 8 I > v: E G : H H J G : ; D G 6 9 6 E I > v: G : H > H I 6 C 8 : , : C 8 D J G 6 g> C g I = : 9 : v: A D E B : C I D ; H I : B -A > k: 8 6 C 8 : G 8 : A A H I = 6 I 6 > 9 > C 6 C g> D g: C : H > H , 6 ; > C 9 > C g I = 6 I B 6 y > C ; D G B I = : 9 : H > gC D ; 8 D B b> C 6 I > D C I = : G 6 E > : H , 6 8 8 D G 9 > C g I D 6 E 6 E : G E J bA > H = : 9 D C A > C : > C Cancer Research (M6 G . 13, 2015). T= : 6 J I = D G H J H : 9 6 A D H H -D ; -; J C 8 I > D C 6 C 6 A yH > H J H > C g E A 6 H B > 9 -b6 H : 9 H = RNA I D : x6 B > C : 6 9 6 E I > v: G : H E D C H : ID VEGF-A > C = > b> I > D C . TJ B D J G x: C D gG 6 ; I H w= > 8 = > C > I > 6 A A y G : H E D C 9 : 9 I D I = : > C = > b> I > D C J C 9 : G w: C I 6 C 6 9 6 E I 6 I > D C > C v> vD , w= > 8 = A : 9 I D 6 C 6 8 qJ > G : 9 G : H > H I 6 C 8 : . VEGF-A bA D 8 k6 9 : w6 H ; D J C 9 I D b: 6 H H D 8 > 6 I : 9 w> I = HIF-16 : xE G : H H > D C , 6 C 9 6 C > C 8 G : 6 H : > C CD144+ v6 H 8 J A D g: C > 8 B > B > 8 G y (VM). T= > H A : 9 I D I = : 9 : v: A D E B : C I D ; 8 = 6 C C : A H w= > 8 = 9 > H E A 6 y: 9 T> : -1 6 C 9 MMP-2 J E G : gJ A 6 I > D C . CD133+ 6 C 9 CD271+ B : A 6 C D B 6 H I : B -A > k: 8 : A A H (MSLC) 6 8 8 J B J A 6 I : 9 > C I = : E : G > v6 H 8 J A 6 G C > 8 = : . HD w: v: G , x: C D gG 6 ; I H ; G D B B : A 6 C D B 6 8 : A A E D E J A 6 I > D C H I = 6 I w: G : > C I G > C H > 8 6 A A y G : H > H I 6 C I I D VEGF-A bA D 8 k6 9 : 9 >9 C D I H = D w 6 C y D ; I= : H : ;: 6 I J G : H 8 D B E 6 G : 9 I D C D C -I 6 G g: I 8 D C I G D A H . T= : 6 J I = D G H 8 D C 8 A J 9 : I = 6 I B : A 6 C D B 6 H I = 6 I H I 6 G I D J I H : C H > I > v: I D VEGF-A bA D 8 k6 9 : 6 9 D E I VM 6 H 6 C 6 A I : G C 6 I : 6 C g> D g: C > 8 H I G 6 I : gy 6 H 6 ; D G B D ; 6 9 6 E I > v: G : H > H I 6 C 8 : , : C G > 8 = > C g I = : E : G > v6 H 8 J A 6 G C > 8 = : ; D G MSLC 9 : E D H > I > D C v> 6 6 C HIF-16 -9 : E : C 9 : C I E G D 8 : H H . M: A 6 C D B 6 H > C = : G : C I A y G : H > H I 6 C I I D VEGF-A bA D 8 k6 9 : 9 D C D I H = D w I = > H 8 D B E : C H 6 I D G y H J G v> v6 A B : 8 = 6 C > H B .


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Hydrophobically-modified polymers containing cleanser applied for facial acne demonstrated improved mildness and skin barrier integrity in a female with sensitive skin Acne Vulgaris: Acne vulgaris is an inflammatory disorder of pilosebaceous units, with characteristic lesions.1 Underlying barrier dysfunction plays a crucial role in triggering the pathogenic pathway leading to acne.1 Research has shown that acne pathophysiology is more complex and interrelated with p. acnes contributing to inflammation by direct and indirect mechanisms.1,2 Multiple therapies are available such as systemic and topical retinoids, antibacterials, systemic and topical antibiotics, and benzoyl peroxide (BPO) and combination products.2 Cleansing of Cleansers for acne vulgaris: The purpose for skin cleansing is to reduce sebum and exogenous contaminants and to control the skin microbiome. The surfactants in cleansers solubilize hydrophobic materials into the aqueous phase and enable their subsequent removal from the skin surface.6,7 In addition to providing skin hygiene, surfactants can also extract skin components during cleansing and remain in the stratum corneum after rinsing.5–7 These side effects disrupt stratum corneum structure and degrade its barrier properties. 3–7 Hydrophobically-modified polymers have been introduced to create skin compatible cleansing systems.6,7 It has been shown that low molecular weight hydrophobically-modified polymers are effective at associating surfactants.5–7 At the presence of these polymers, surfactants assemble into larger, more stable structures, which are less likely to penetrate the skin. 6,7 The cleansing* system, composed of a lower concentration of free surfactant micelles as well as polymer-surfactant complexes, have been shown to maintain the integrity of the skin barrier (Fig 1).5– 7,8 A significant improvement (p<0.05 vs. placebo) in skin barrier integrity (as measured via TEWL) and cleanser irritation potential (p<0.05) for the HMP containing cleanser, was observed after four consecutive 24-hour patch exposures to a diluted cleanser solution.8 When used in acne after an eight-week treatment period, the numbers of inflammatory and non-inflammatory lesions had decreased together with the inflammatory reactions, as assessed by histopathologic examination.5

the facial skin in acne is a necessary measure together with the use of moisturizers containing Julia Carroll, MD, FRCPC SPF.1–3 Surfactants within cleanser formulations are useful to solubilize and remove unwanted substances from the skin surface.3–5 However, the interaction of surfactants with components of the stratum corneum can also cause deleterious effects, which can lead to skin barrier dysfunction, erythema and dryness.3–5

Patient case: Female teenager with sensitive skin who has regular flare-ups of mild to moderate acne Profile: The 16-year-old girl has sensitive skin. She has regular flare-ups of mild to moderate facial acne (Fig 2). She is concerned and insecure about her appearance and has difficulties interacting with her peers, especially with boys in her school. The condition: Her facial skin is prone to sub-acute and chronic inflammation, dryness, peeling, and irritation resulting from acne therapy and the cleansers she had used previously. Her adherence to treatment is poor as a result of cutaneous intolerance to acne therapy and a lack of successful outcomes of previous treatments. Moreover, she prefers to use a cleanser that is foaming and gives a clean feeling after use. Treatment: The approach should include education on the cause of acne and education on treatment options. She was offered a simpli-

Fig 1: Skin Barrier Integrity comparing the HMP-containing cleanser with a frequently used commercially available skin cleanser6

fied, well-tolerated treatment regimen with a combined topical retinoid/antibiotic. For successful adjunctive therapy, a gentle foaming cleanser with hydrophobically-modified polymers and an SPF moisturizer** was used. Consider:

 The use of the gentle cleanser to maintain the integrity of the skin barrier that is already compromised by acne

 Discuss patient expectations of treatment results as well as monitoring and follow-up of treatment and adjunct therapy to achieve compliance and good patient outcomes

There is a significant improvement (p<0.05 vs. placebo) in skin barrier integrity (as measured via TEWL) for the HMP containing cleanser, after four consecutive 24-hour patch exposures to a diluted cleanser solution.

References 1. Thiboutot D, Gollnick H, Bettoli V, Dreno B, Kang S, Leyden JJ, et al: New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group. J Am Acad Dermatol 2009; 60(5):S1–50. 2. Del Rosso JQ, Kircik L: The sequence of inflammation, relevant biomarkers, and the pathogenesis of acne vulgaris: what does recent research say and what does it mean to the clinician? J Dmgs. Dermatol 2013; 12(suppl 8):s109–115. Fig 2: Acne patient case: 3. Draelos Z, Hornby S, Walters RM, Appa Y: Hydrophobically modified Teenager with sensitive skin and polymers can minimize skin irritation potential caused by surfactantregular flare-ups of mild to moderbased cleansers. J Cosmet Dermatol 2013 Dec; 12(4):314–321. ate acne 4. Draelos ZD: The effect of a daily facial cleanser for normal to oily skin on the skin barrier of subjects with acne. Cutis 2006 Jul; 78(1 Suppl):34–40. 5. Choi YS, Suh HS, Yoon MY, Min SU, Kim JS, Jung JY, Lee DH, Suh DH.: A study of the efficacy of cleansers for acne vulgaris. J Dermatology Treat 2010 May; 21(3):201–205. 6. Walters RM, Fevola MJ, Gandolfi L, Librizzi JJ, Tamareselvy K, Tierney NK: Polymer-surfactant self-assembly for the design of mild skin cleansers. Polymeric Materials: Science & Engineering 2011; 105(6):697–698. 7. Hornby S, Walters R, Kamath Y, Appa Y: Reduction in skin barrier perturbation by hydrophobically modified polymers. J Am Acad Dermatol 2011; 64(2):AB25. 8. Tierney N, et al: Cleansers with hydrophobically-modified polymers demonstrate Improved mildness and skin barrier integrity. J Am Acad Dermatol Feb. 2011; 64(2, supplement 1):p. AB72.

Editorial feature supported by an unrestricted grant from Johnson & Johnson Inc., who are not responsible for content. *Neutrogena NEUTROGENA® Ultra Gentle Daily Cleanser, **Neutrogena NEUTROGENA® HEALTHY DEFENSE® Daily Moisturizer/SPF 30/45Healthy Defense, Johnson & Johnson Inc.


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POSTGRADUATE EDUCATIONAL SUPPLEMENT Chronicle

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Association of variation in the LAMA3 gene, encoding the alpha-chain of laminin5, with atopic dermatitis in a German case-control cohort Susanne Stemmler,1 Qumar Parwez,2 Elisabeth Petrasch-Parwez,3 Joerg T Epplen,1,4 and Sabine Hoffjan1,*

from 1Department of Human Genetics, Ruhr-University, Universitätsstrasse 150, 44801 Bochum, Germany, 2Private medical practice, Gladbeck, Germany, 3Department of Neuroanatomy and Molecular Brain Research, Ruhr-University Bochum, Bochum, Germany, 4Faculty of Health, Witten/Herdecke University, Witten, Germany. *Corresponding author.

ABSTRACT

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disorder caused by complex interaction of genetic and environmental factors. Besides mutations in the filaggrin gene, leading to impaired skin barrier function, variation in genes encoding additional skin proteins has been suggested to contribute to disease risk. Laminin 5, playing an important role in skin integrity, is composed of three subunits encoded by the LAMA3, LAMB3 and LAMC2 genes in which biallelic mutations cause epidermolysis bullosa junctionalis. We aimed at evaluating the role of variation in the LAMA3, LAMB3 and LAMC2 genes for AD pathogenesis. Methods: A total of 29 single nucleotide polymorphisms (SNPs) were genotyped in the three genes in a German AD case–control cohort comprising 470 unrelated AD patients and 320 non-atopic controls by means of restriction enzyme digestion. Allele, genotype and haplotype frequencies were compared between cases and controls using chi-square testing and the Haploview software. Results: Several SNPs in the LAMA3 gene showed significant association with AD in our cohort (p<0.01), while we did not detect association with variations in the LAMB3 and LAMC2 genes. Haplotype analysis additionally revealed several significantly associated haplotypes in the LAMA3 gene. Due to extensive linkage disequilibrium, though, we were not able to further differentiate the specific disease causing variation(s) in this region. Conclusions: We established the LAMA3 gene as novel potential susceptibility gene for AD. Additional studies in independent cohorts are needed to replicate these results.

A

BACKGROUND

topic dermatitis (AD) is a chronic inflammatory skin disorder caused by complex interaction between genetic and environmental factors.1 Besides the dysregulated immune mechanisms that have long been suspected to play a major role for AD pathogenesis, the impact of an intact skin barrier in the protection against AD has gained increasing attention over the recent years. 2 In particular, the role of filaggrin, a major

Reprinted with permission from: Stemmler, et al: BMC Dermatology 2014; 14:17. © 2014 Stemmler, et al; licensee BioMed Central Ltd. http://www.biomedcentral.com/1471-5945/14/17

structural protein in the stratum corneum of the epidermis, has been extensively studied. Mutations in the FLG gene, located in the epidermal differentiation complex (EDC) on chromosome 1q21,3 have consistently been associated with early-onset persistent AD. 4 It could be demonstrated that FLG mutations constitute the most significant known risk factor for AD development so far. 5 However, impaired skin barrier function has also been shown in AD patients without FLG mutations,6 suggesting that variation in genes encoding additional skin proteins may play a role in AD pathogenesis. Laminin 5 is another protein that plays an important role for skin integrity.7 It is comprised of three dif-

ferent subunits, built by the LAMA3 (alpha-3), LAMB3 (beta-3) and LAMC2 (gamma-2) polypeptide chains. Laminin 5 (also called laminin-332) is involved in connecting dermis and epidermis and induces adhesion, spreading and migration of human keratinocytes.8 The three polypeptide chains are encoded by the LAMA3, LAMB3 and LAMC2 genes on chromosomes 18q11.2, 1q32.2 and 1q25.3, resp. 9 Biallelic mutations in each of these three genes are known to cause epidermolysis bullosa junctionalis, a severe (type Herlitz) or less severe (type Non-Herlitz) skin disorder characterized by blisters and erosions of the skin.10 Furthermore, laminin 5 synthesis is elevated during acute wound healing in healthy individuals.11 Given the important role of mutations in skin barrier proteins in AD pathogenesis, we hypothesized that variation in one or more of the laminin 5 subunits may also confer risk for AD. Therefore, we evaluated 29 single nucleotide polymorphisms (SNPs) in the three genes in a German AD case–control cohort and present first evidence that the LAMA3 gene may be a novel susceptibility gene for AD.

METHODS Subjects

A total of 470 unrelated patients with AD with a mean age of 19±15 years (median 11 years) were recruited by a consultant specialist for AD (Q.P., Gladbeck, Germany) as described previously. 12 AD diagnosis was established based on the criteria by Hanifin and Rajka. 13 Since the risk remains very high for primarily asymptomatic children to develop an allergic disease during childhood or even adulthood,14,15 we chose to use non-allergic adults as a control group. Therefore, 320 individuals of at least 40 years of age (mean age 62±11 years, median 63 years) that had neither self-reported allergies or allergic symptoms nor first degree relatives with allergic diseases were recruited in the same private practice as the patients. The controls further underwent clinical examination in order to exclude symptoms of AD, asthma or allergic rhinitis (see12). All participants were Germans of European ancestry and gave informed consent prior to enrolment. The Declaration of Helsinki protocols were followed and the study was approved by the Ethics Committee of the RuhrUniversity Bochum. Genotyping DNA of AD patients and controls was extracted as described before. 16 We selected 29 SNPs in the three genes (17 in the LAMA3 gene, eight in LAMB3, and four in LAMC2) that represented the haplotype block structures accord-

ing to HapMap. 17 Genotyping was performed by polymerase chain reaction (PCR) followed by restriction enzyme digestion. PCR was done in a total volume of 10 µl, containing 40 ng DNA, 200 mmol of each dNTP, 1.5-3 mmol MgCl2, 5 pmol of each primer, and 0.5 U Taq-DNA-polymerase (Genecraft, Münster, Germany) on the RoboCycler or Biometra T cycler (Stratagene, Heidelberg, Germany and Biometra GmbH, Göttingen, Germany, respectively). After two initial cycles at 6° C and 3°C above the annealing temperature, 28 to 32 cycles of 95°C (30 sec), annealing temperature (30 sec) and 72°C (30 sec) were run. PCR products were subsequently digested with the respective restriction enzyme, the fragments separated on 2.5% to 3.5% agarose gels in 1xTBE buffer (30 to 60 min, 200 V) and visualized with ethidium bromide (0.5% [w/v]). Additional information about primer sequences, PCR conditions and restriction enzymes is summarized in Additional file 1. (http://www.biomedcentral.com/ content/supplementary/1471-5945-1417-s1.docx) Statistics

Genotype and allele frequencies were compared between AD patients and controls according to the X2 method; the significance threshold was set at p<0.05. We evaluated every SNP for deviations from Hardy-Weinberg equilibrium (HWE) using the deFinetti program. 18 The program Haploview 4.019 was used to estimate haplotype frequencies and test for haplotypic association. We applied Bonferroni correction for multiple tests; however, since this approach has been controversially discussed for genetic case– control studies,20 especially if several tightly linked SNPs within one gene are analysed as in the present study, we also present the uncorrected p-values and discuss them as hypothesisgenerating.

RESULTS

All 29 SNPs showed genotypic distributions according to HWE. Of the 17 SNPs chosen for the LAMA3 gene, 10 showed significant associations (p<0.01 in the uncorrected analysis) with AD in the present cohort. The most significant results that also survived Bonferroni correction were obtained for rs8083184 and rs1711450, both located in the promoter region of LAMA3 (p=0.0003, pcorr=0.0087, Table 1; full genotype data is presented in Additional file 2 http://www.biomedcentral.com/content/supplementary/1471-5945-14-17-s2.doc). A high degree of linkage disequilibrium (LD) was observed for the SNPs in the LAMA3 gene region (Figure 1). Significant association extended into the 5' region of LAMA3, including rs1613739 which is located in the


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POSTGRADUATE EDUCATIONAL SUPPLEMENT neighbouring ANKRD29 gene. Two other SNPs in ANKRD29 (rs7238623 and rs8096061), however, did not show significant association results. Haplotype analyses revealed the existence of two haploblocks (Figure 1) with a common haplotype in block 1 that was highly significantly associated with AD (61.9% in cases vs. 51.1% in controls, p=2.94Ă&#x2014;10-5, Table 2). In the LAMB3 gene, neither single SNP nor haplotype analyses revealed significant association with AD in the present cohort (Table 1; haplotype data not shown). In LAMC2, no single SNP showed association with AD; however, haplotype analyses revealed the existence of a rare protective haplotype (4% in cases vs. 6.9% in controls, p=0.01; Table 3).

Table 1: Allele frequencies of LAMA3, LAMB3 and LAMC2 polymorphisms in AD patients and controls

DISCUSSION

To our knowledge, this is the first report of an association of AD with variation in the LAMA3 gene, encoding the alpha-chain of laminin 5. In a well-characterized German caseâ&#x20AC;&#x201C;control cohort, we found significant association of both allelic and haplotypic frequencies in this gene with AD, suggesting that it may constitute a novel susceptibility gene for this frequent skin disease. Of the 19 SNPs evaluated across the LAMA3 gene, 10 showed genotypic or allelic association with AD at p<0.01 (uncorrected values). Due to the extensive LD evident at the LAMA3 locus we were not able to further differentiate the specific disease causing variation(s) in this region. Significant association extended into the 5' neighbouring gene ANKRD29, but additional SNPs in this gene did not show association with AD. The biological function of ANKRD29, encoding the ankyrin repeat domain-containing protein 29, is not yet known; however, for another protein of the same family, ANKRD17, a role in anti-bacterial innate immune pathways has been suggested. 21 For the gene located 3' of LAMA3 (TTC39C), encoding the tetratricopeptide repeat protein 39C, the biological function is not yet clear either, and since the most significant results for LAMA3 were at the 5' end of this large gene, we did not evaluate additional SNPs in the TTC39C gene. Taken together, even though we cannot exclude that the observed association with AD may be due to LD with a susceptibility variant in another gene in this region, our data highly points to LAMA3 as susceptibility gene for AD in the 18q11.2 region. SNPs in the genes encoding the beta- and gamma-chains of laminin 5, on the other hand, did not show convincing evidence for association with AD in this analysis. However, haplotype analysis suggested the existence of a rare protective haplotype in LAMC2. The main role of laminin 5 in normal tissues is the maintenance of epithelial-mesenchymal cohesion in tissues exposed to external forces, such as skin and stratified squamous mucosa.22 Genetic variation in laminin 5 components may thus contribute to reduced

Figure 1:

Haploblock structure of the LAMA3 region as revealed by Haploview 4.0.15 *SNPs associated with AD at p<0.01 (uncorrected values) **SNPs associated with AD at p<0.001 (uncorrected values).

skin integrity and barrier function, as has been observed for FLG mutations,5 even though the exact underlying mechanisms still have to be elucidated. In each of the three genes analysed here, rare null mutations are known to

cause epidermolysis bullosa junctionalis, a severe autosomal recessive skin disorder characterized by the development of blisters and skin erosions in response to minor injury or friction.10 In contrast, we observed association of

common variation in LAMA3 with the common complex disorder AD. This phenomenon is in line with findings for the SPINK5 gene, in which null mutations cause autosomal recessive Netherton syndrome while common


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variations have been associated with AD.23 Our association results further contribute to the hypothesis that an intact skin barrier function plays a key part in AD pathogenesis. Additional to the established role of FLG mutations, 24 associations with some other skin-related genes have been described recently. For example, mutations in the claudin-1 gene (CLDN1), encoding a major tight junction protein in the granular layer of the epidermis, were associated with AD in North American cohorts of both European and African American origin.25 Further, polymorphisms near the OVOL1 and ACTL9 genes, both involved in epidermal proliferation and differentiation, showed genome-wide significant association with AD in a large meta-analysis of GWAS data, including 5,606 AD patients and 20,565 controls.26 In a study cohort comprising AD patients from Germany, Poland and the Czech Republic, a 24-bp deletion in the gene encoding small proline-rich protein 3 (SPRR3), located within the EDC, was significantly associated with disease risk.27 On the other hand, a deletion of the cornified envelope 3B and 3C genes within in the EDC was not associated with AD in a European cohort.28 All of these results still await replication in independent cohorts. Altogether, though, evidence is accumulating that additional genes involved in epidermal differentiation and stability may be important for AD pathogenesis. We are conscious of the fact that the cohort sizes of the present study are comparatively small so that the statistical power is only moderate. Furthermore, only two SNPs in LAMA3 results remained significant after strict Bonferroni correction for multiple testing, leaving open the risk for false-positive results. However, the Bonferroni correction has been controversially discussed for genetic caseâ&#x20AC;&#x201C;control studies,20 especially if several tightly linked SNPs within one gene are analysed, as was the case in the present study. Therefore, we regard the results as hypothesis-generating and strongly encourage replication in additional cohorts.

Table 2: Frequencies and p-values of LAMA3 haplotypes in AD patients and controls

Table 3: Frequncies and p-values of LAMC2 haplotypes in AD patients and controls

CONCLUSIONS

We presented initial evidence for association of LAMA3 variation with AD, suggesting that variation in this gene may contribute to skin fragility and impaired barrier function underlying AD pathogenesis. Additional studies in independent populations as well as functional analyses of the associated variations appear warranted to replicate or extend these findings, since the genetic risk factors for AD might be increasingly included into prognostic and therapeutic strategies in the future. In more detail, an integrated approach including genotypic and phenotypic information as well as genetic and biological biomarkers has been proposed for example to identify

patients who are prone to develop persistent AD and/ or additional asthma and start early intervention. 29 Further, therapeutic strategies targeting the skin barrier function are already under way.30 Thus, elucidating the complex genetic background of AD is essential for paving the way toward a more individualized therapy in the future.

ABBREVIATIONS

AD: Atopic dermatitis; EDC: Epidermal differentiation complex; HWE: Hardy-Weinberg equilibrium; LD: Linkage disequilibrium; SNP:

Single nucleotide polymorphism.

COMPETING INTERESTS

The authors declare that they have no competing interests.

AUTHORSâ&#x20AC;&#x2122; CONTRIBUTIONS

SS was in charge of study design and statistical analysis and drafted the manuscript. QP and EPP were involved in patient recruitment and helped to draft the manuscript. JTE and SH conceived of the study, participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.

ACKNOWLEDGEMENTS We thank Maike Kallenbach, Natascha Wirkus, Monika Harazin and Katharina Batzke for technical assistance and the patients for their cooperation in this study.

REFERENCES

1. Holloway JW, Yang IA, Holgate ST: Genetics of allergic disease. J Allergy Clin Immunol 2010; 125:S81S94. 2. Boguniewicz M, Leung DY: Atopic dermatitis: a disease of altered skin barrier and immune dysregulation. Immunol Rev 2011; 242:233-246.


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Agenda MAY 2015

3. Kypriotou M, Huber M, Hohl D: The human epidermal differentiation complex: cornified envelope precursors, S100 proteins and the ‘fused genes’ family. Exp Dermatol 2012; 21:643-649. 4. Irvine AD, McLean WH, Leung DY: Filaggrin mutations associated with skin and allergic diseases. N Engl J Med 2011; 365:1315-1327. 5. McAleer MA, Irvine AD: The multifunctional role of filaggrin in allergic skin disease. J Allergy Clin Immunol 2013; 131:280-291. 6. Jakasa I, Koster ES, Calkoen F, McLean WH, Campbell LE, Bos JD, Verberk MM, Kezic S: Skin barrier function in healthy subjects and patients with atopic dermatitis in relation to filaggrin loss-of-function mutations. J Invest Dermatol 2011; 131:540-542. 7. Nishiyama T, Amano S, Tsunenaga M, Kadoya K, Takeda A, Adachi E, Burgeson RE: The importance of laminin 5 in the dermal-epidermal basement membrane. J Dermatol Sci 2000; 24(Suppl 1):S51S59. 8. Schneider H, Muhle C, Pacho F: Biological function of laminin-5 and pathogenic impact of its deficiency. Eur J Cell Biol 2007; 86:701717. 9. Akutsu N, Amano S, Nishiyama T: Quantitative analysis of laminin 5 gene expression in human keratinocytes. Exp Dermatol 2005; 14:329-335. 10. Kiritsi D, Has C, BrucknerTuderman L: Laminin 332 in junctional epidermolysis bullosa. Cell Adh Migr 2013; 7:135-141. 11. Amano S, Akutsu N, Ogura Y, Nishiyama T: Increase of laminin 5 synthesis in human keratinocytes by acute wound fluid, inflammatory cytokines and growth factors, and lysophospholipids. Br J Dermatol 2004; 151:961-970. 12. Macaluso F, Nothnagel M, Parwez Q, Petrasch-Parwez E, Bechara FG, Epplen JT, Hoffjan S: Polymorphisms in NACHT-LRR (NLR) genes in atopic dermatitis. Exp Dermatol 2007; 16:692-698. 13. Hanifin JM, Rajka G: Diagnostic features of atopic dermatitis. Acta Derm Venereol 1980; 92:44-47. 14. Bel EH: Clinical phenotypes of asthma. Curr Opin Pulm Med 2004; 10:44-50. 15. De Marco R, Locatelli F, Cerveri I, Bugiani M, Marinoni A, Giammanco G: Incidence and remission of asthma: a retrospective study on the natural history of asthma in Italy. J Allergy Clin Immunol 2002; 110:228-235. 16. Miller SA, Dykes DD, Polesky HF: A simple salting out procedure for extracting DNA from human nucleated cells. Nucleic Acids Res 1988; 16:1215. 17. International HapMap Consortium: The International HapMap Project. Nature 2003; 426:789-796. 18. DeFinetti test for Hardy-Weinberg equilibrium. 19. Barrett JC: Haploview: Visualization and analysis of SNP genotype data. Cold Spring Harb

Protoc 2009; pdb ip71. 20. Boehringer S, Epplen JT, Krawczak M: Genetic association studies of bronchial asthma–a need for Bonferroni correction? Hum Genet 2000; 107:197. 21. Menning M, Kufer TA: A role for the Ankyrin repeat containing protein Ankrd17 in Nod1- and Nod2mediated inflammatory responses. FEBS Lett 2013; 587:2137-2142. 22. Rousselle P, Beck K: Laminin 332 processing impacts cellular behavior. Cell Adh Migr 2013; 7:122-134. 23. Norgett EE, Kelsell DP: SPINK5: both rare and common skin disease. Trends Mol Med 2002; 8:7. 24. McLean WH, Irvine AD: Heritable filaggrin disorders: the paradigm of atopic dermatitis. J Invest Dermatol 2012; 132:E20-E21. 25. De Benedetto A, Rafaels NM, McGirt LY, Ivanov AI, Georas SN, Cheadle C, Berger AE, Zhang K, Vidyasagar S, Yoshida T, Boguniewicz M, Hata T, Schneider LC, Hanifin JM, Gallo RL, Novak N, Weidinger S, Beaty TH, Leung DY, Barnes KC, Beck LA: Tight junction defects in patients with atopic dermatitis. J Allergy Clin Immunol 2010; 127:773-786. 26. Paternoster L, Standl M, Chen CM, Ramasamy A, Bonnelykke K, Duijts L, Ferreira MA, Alves AC, Thyssen JP, Albrecht E, Baurecht H, Feenstra B, Sleiman PM, Hysi P, Warrington NM, Curjuric I, Myhre R, Curtin JA, Groen-Blokhuis MM, Kerkhof M, Sääf A, Franke A, Ellinghaus D, Fölster-Holst R, Dermitzakis E, Montgomery SB, Prokisch H, Heim K, Hartikainen AL, Pouta A, et al: Meta-analysis of genome-wide association studies identifies three new risk loci for atopic dermatitis. Nat Genet 2012; 44:187-192. 27. Marenholz I, Rivera VA, EsparzaGordillo J, Bauerfeind A, LeeKirsch MA, Ciechanowicz A, Kurek M, Piskackova T, Macek M, Lee YA: Association screening in the Epidermal Differentiation Complex (EDC) identifies an SPRR3 repeat number variant as a risk factor for eczema. J Invest Dermatol 2011; 131:1644-1649. 28. Bergboer JG, Zeeuwen PL, Irvine AD, Weidinger S, Giardina E, Novelli G, Den Heijer M, Rodriguez E, Illig T, RiveiraMunoz E, Campbell LE, Tyson J, Dannhauser EN, O'Regan GM, Galli E, Klopp N, Koppelman GH, Novak N, Estivill X, McLean WH, Postma DS, Armour JA, Schalkwijk J: Deletion of Late Cornified Envelope 3B and 3C genes is not associated with atopic dermatitis. J Invest Dermatol 2010; 130:20572061. 29. Bieber T, Cork M, Reitamo S: Atopic dermatitis: a candidate for disease-modifying strategy. Allergy 2012; 67:969-975. 30. Heimall J, Spergel JM: Filaggrin mutations and atopy: consequences for future therapeutics. Expert Rev Clin Immunol 2012; 8:189-197.

6-9 2015 Annual Meeting of the Society for Investigational Dermatology Atlanta

Contact: Jim Rumsey ¶ Tel: 216-579-9300 ¶ Fax: 216-579-9333 ¶ Email: sid@sidnet.org ¶ Website: http://www.sidnet.org/annualmeeting

12-23 North American Clinical Dermatology Society 56th Annual Meeting

Reykjavik, Iceland; Amsterdam, The Netherlands; Copenhagen, Norway Contact: Dr. Judith Koperski ¶ Tel: 85-85-580-677 ¶ Fax: 85-85-583-077 ¶ Email: jakoperski@yahoo.com ¶ Website: www.nacds.com

JUNE 2015

8–13 23rd World Congress of Dermatology Vancouver

Contact: Secretariat ¶ Tel: 604-738-8600 ¶ Fax: 604-738-8697 ¶ Email: info@derm2015.org ¶ Website: www.derm2015.org

18-21 Practical Dermatology and Dermopathology Symposium Vail, Colo.

Contact: Bronwen Beaudoin ¶ Tel: 781-793-0088 ¶ Email: bbeaudoin@mdmeetingdesigns.com ¶ Website: http://http//www.dermpath.com/newsevents/calendar/practical-dermatology-and-dermatopathlogy-symposium-registernow

22-24 The 4th International Conference and Expo on Cosmetology & Trichology Philadelphia

Contact: Secretariat ¶ Email: cosmetology.conference@omicsonline.us ¶ Website: http://cosmetology-trichology.conferenceseries.com/

JULY 2015

9-12 41st Annual Meeting of The Society for Pediatric Dermatology Boston

Contact: Kent Lindeman ¶ Tel: 317-202-0224 ¶ Email: info@pedsderm.net ¶ Website: http://www.pedsderm.net/sections/meetings_dates.php

13-15 The 5th International Conference on Clinical & Experimental Dermatology New Orleans

Contact: Secretariat ¶ Email: dermatology@omicsgroup.com ¶ Website: http://dermatology.conferenceseries.com/

SEPTEMBER 2015

2015 Wound Care & Limb Preservation Symposium: The 10th Annual Meeting Coconut Grove, Fla.

Contact: Secretariat ¶ Email: cme@baptisthealth.net ¶ Website: http://cme.baptisthealth.net/wound/pages/index.aspx

Message from the Medical Editor Continu I = : B 3 6 C 6 g: B : C I D C > C page w> 9 : : x8ed> H >from D ; ; > bG D J H = > H I > D 8 yI D B 6 6 C 9 J H > C g B : 9 > 8 6 A E = D I D gG 6 E = y ; D G A : H > D C A D 8 6 I > D C (H : : E 6 g: 6). A 8 D J E A: D ; D I= : G 6 G I>8 A: H D ; C D I : D C I = : 8 D v: G D ; I = > H > H H J : > C 8 A J 9 : 6 G : E D G t about oral apremi-

last for the treatment of psoriasis, which was approved by Health Canada in December, 2014. This newly available therapy is having a positive impact on the way dermatologists manage psoriasis. Another excellent piece of Canadian research comes from our dermatopathology colleagues in Halifax who have identified that plasmacytoid dendritic cells are helpful in the diagnosis of hypertrophic DLE.

This finding is not only useful in the pathological diagnosis of the disease, but gives us insight into the immunopathogenesis which could potentially lead to new targeted therapies for this form of cutaneous lupus, which is a significant diagnostic and therapeutic challenge. Like all Canadian dermatologists, we are looking forward to the World Congress of Dermatology in Vancouver from June 8 to 13, 2015 where we will be pleased to observe the ongoing achievements of our friends and colleagues, both past and present, being showcased to the world.

—Wayne P. Gulliver, MD, FRCPC Medical Editor


Skin_March_2015,rar16_ms_9.1_rar1_Skin_March_2014,rar1.qxd 09/04/2015 12:26 PM Page 25

THE CHRONICLE of S K I N & A L L E R G Y

Vol. 21, No. 2

M6 G 8 = 2015 · 25

Changes to isotretinoin prescribing needed Clinical practice

n R: 8 D B B : C 9 6 I > D C ; D G H > C gA : , : ; ; : 8 I > v: b> G I = 8 D C I G D A B : I = D 9 B > g= I > B E G D v: 8 D C I G 6 8 : E I > v: 8 D B E A > 6 C 8 : 6 C 6 9 > 6 C 6 C 9 AB : G > 8 6 C 9 : G B 6 I D A D g> H I H 6 C 9 E : 9 > 6 I G > 8 > 6 C H 6 G : 8 6 A A > C g ; D G 8 = 6 C g: H I D E D A > 8 >: H H J G G D J C 9 >C g I= : E G : H 8 G >E I>D C D ; > H D I G : I > C D > C ; D G H : v: G : G : 8 6 A 8 > I G 6 C I 6 8 C : b: 8 6 J H : H D B : wD B : C 8 D C I > C J : I D b: 8 D B : E G : gC 6 C I w= > A : I 6 k> C g I = : I : G 6 I D g: C > 8 9 G J g, 6 8 8 D G 9 > C g I D G : 8 : C I A > I : G 6 I J G : E J bA > H = : 9 D C I = : H J bj: 8 I . A H I J 9 y E J bA > H = : 9 > C AE G . 2014 > C JAMA Dermatology (150(4):366R 371) G : H : 6 G 8 = : 9 I = : 8 D J C H : A A > C g E G D 8 : H H wD B : C > C I = : U.S. G : 8 : > v: w= : C jD > C > C g > PLEDGE—I = : E G : gC 6 C 8 y E G : v: C I > D C E G D gG 6 B wD B : C > C I = 6 I 8 D J C I G y 6 G : G : qJ > G : 9 I D I 6 k: b: ; D G : I= : y 8 6 C b: E G : H 8 G > b: 9 >H D IG : I>C D >C . T= : G : H : 6 G 8 = : G H 6 I I = : UC > v: G H > I y D ; P> I I H bJ G g= ; D J C 9 I = 6 I 6 gG D J E D ; 16 wD B : C J H >C g >H D IG : I>C D >C 8 A: 6 G Ay J C 9 : G H I D D 9 I = : G > H kH D ; g: I I > C g Dr. Laura Korb Ferris E G : gC 6 C I w= > A : I 6 k> C g I = : 9 G J g, bJ I I = 6 I ; : w w: G : > C ; D G B : 9 6 bD J I = > g= A y : ; ; : 8 I > v: B : I = D 9 H D ; 8 D C I G 6 8 : E I > D C H J 8 = 6 H H J b9 : G B 6 A >B E A6 C IH D G >C IG 6 J I: G >C : 9 : v> 8 : H (IUDH ). MD H I D ; I = : 8 D J C H : AA>C g I= : wD B : C G : 8 : > v: 9 w: G : 6 bD J I D G 6 A 8 D C I G 6 8 : E I > v: H . T= : 6 J I = D G H 8 D C 8 A J 9 : 9 I = 6 I Dr. Gideon Koren “I = : > PLEDGE E G D gG 6 B > C 8 G : 6 H : H 6 C x> : I y 6 bD J I > H D I G : I > C D > C B D G : I = 6 C > I = : A E H wD B : C ; : : A E G D I : 8 I : 9 ; G D B I = : I : G 6 I D g: C > 8 G > H kH D ; > H D I G : I > C D > C .” > PLEDGE w6 H > C I G D 9 J 8 : 9 > C 2006 by I = : U.S. FD D 9 6 C 9 DG J g A9 B > C > H I G 6 I > D C (FDA) 6 C 9 > I G : qJ > G : H E 6 I > : C I H I 6 k> C g I = : 9 G J g I D J H : I wD ; D G B H D ; b> G I = 8 D C I G D A , = 6 v: I wD C : g6 I > v: E G : gC 6 C 8 y I : H I G : H J A I H b: ; D G : H I 6 G I > C g 6 C > H D I G : I > C D > C G : g> B : C , 6 C 9 I D I 6 k: 6 E G : gC 6 C 8 y I : H I : v: G y B D C I = w= > A : D C I = : I = : G 6 E y. AA A E 6 I > : C I H I 6 k> C g I = : B : 9 > 8 6 I > D C 6 C 9 I = : > G E = 6 G B 6 8 > H I H 6 G : G : g> H I : G : 9 > C 6 8 : C I G 6 A 9 6 I 6 b6 H : . Intrauterine devices, subdermal implants alternatives “T= : D C : I = > C g I = 6 I I wD J A 9 H 6 y w> I = > PA : 9 g: > H I = 6 I by G : qJ > G > C g I wD ; D G B H yD J 6 G : 6 A B D H I 6 A w6 yH E J I I > C g I = : wD B : C > C 6 E D H > I > D C D ; H 6 y> C g V y: H I w> A A J H : 8 D C 9 D B H ’ 6 C 9 I = D H : 6 G : 6 H H D 8 > 6 I : 9 w> I = 6 v: G y = > g= G 6 I : D ; C D C -8 D B E A > 6 C 8 : ,” H 6 > 9 DG . L6 J G 6 KD G b F: G G > H , 6 9 : G B 6 I D A D g> H I E G 6 8 I > 8 > C g > C P> I I H bJ G g= 6 C 9 D C : D ; I = : 6 J I = D G H D ; I = : H I J 9 y. “I I = > C k > ; yD J g6 v: wD B : C I = : D E I > D C D ; J H > C g D C : ; D G B D ; = > g= A y : ; ; : 8 I > v: 8 D C I G 6 8 : E I > D C I = 6 I > H J H : G > C 9 : E : C 9 : C I , B : 6 C > C g 6 C IUD D G 6 H J b9 : G B 6 A > B E A 6 C I , 6 C 9 > ; yD J 6 G : D C I = > H D C : J H : G > C 9 : E : C 9 : C I , = > g= A y : ; ; : 8 I > v: ; D G B D ; b> G I = 8 D C I G D A w: wD C ’I G : qJ > G : yD J I D b: D C I wD [; D G B H D ; b> G I = 8 D C I G D A ], 6 C 9 I = 6 I B > g= I 6 8 I J 6 A A y : C 8 D J G 6 g: wD B : C I D J H : I = : H : B J 8 = B D G : : ; ; : 8 I > v: ; D G B H D ; 8 D C I G 6 8 : E I > D C > C H I : 6 9 D ; 8 = D D H > C g I wD A : H H -: ; ; : 8 I > v: B : I = D 9 H .” DG . F: G G > H w6 H > C vD A v: 9 > C 6 C D I = : G H I J 9 y w= : G : H = : 6 C 9 = : G 8 D A A : 6 gJ : H : x6 B > C : 9 I = : 8 D C I G 6 8 : E I > v: H : A : 8 I > D C D ; 75 wD B : C D C > H D I G : I > C D > C 6 C 9 I = : > G 8 D B E A > 6 C 8 : G 6 I : (Journal of American Academy of Dermatology J6 C . 2014; 70(1):55R 59).

T= : > C v: H I > g6 I D G H ; D J C 9 I = 6 I 21 E 6 I > : C I H (28%) H : A : 8 I : 9 6 bH I > C : C 8 : 6 H I = : > G E G > B 6 G y B : 6 C H D ; E G : gC 6 C 8 y E G : v: C I > D C : v: C I = D J g= ; D J G (19%) > C I = 6 I gG D J E D ; E 6 I > : C I H w: G : H : xJ 6 A A y 6 8 I > v: 9 J G > C g I G : 6 I B : C I . CD C 9 D B H (35, 90%) 6 C 9 D G 6 A 8 D C I G 6 8 : E I > v: E > A A H (18, 46%) w: G : I= : B D H I J H : 9 D E I>D C H D ; H : xJ 6 A A y 6 8 I > v: wD B : C . Tw: A v: wD B : C (31%) 6 9 B > I I : 9 I D = 6 v> C g >C I: G 8 D J G H : 6 I A: 6 H I D C 8 : J H >C g D C : D G ; : w: G ; D G B H D ; 8 D C IG 6 8 : E I>D C — > C 8 A J 9 > C g D C : w= D G : E D G I: 9 8 D B E A: I: Ay J C E G D I: 8 I: 9 >C I: G 8 D J G H : . AB D C g H : xJ 6 A A y 6 8 I > v: D G 6 A 8 D C I G 6 8 : E I > v: E > A A J H : G H , 7 (39%) G : E D G I : 9 B > H H > C g D C : D G B D G : E > A A H > C I = : E G : v> D J H B D C I = . S> C 8 : 6 bH I > C : C 8 : > H D C A y 6 A A D w: 9 ; D G > PLEDGE > C : x8 : E I > D C 6 A 8 > G 8 J B H I 6 C 8 : , DG . F: G G > H H 6 yH I = 6 I 9 : G B 6 I D A D g> H I H H = D J A 9 b: = 6 v> C g B D G : > C -9 : E I = 8 D C v: G H 6 I > D C H 6 bD J I 8 D C I G 6 8 : E I > v: H w> I = I = : > G E 6 I>: C IH .

Dermatologists need to be more rigorous “I I = > C k > I bG > C gH 6 I I : C I > D C I D I = : ; 6 8 I I = 6 I w: , 6 H 9 : G B 6 I D A D g> H I H , C : : 9 I D b: 6 A > I I A : B D G : G > gD G D J H > C 6 E E A y> C g I = 6 I H I 6 C 9 6 G 9 ,” H 6 > 9 DG . F: G G > H . “I I = > C k I = 6 I w= : C w: 8 = D H : I D = 6 v: 6 wD B 6 C J H : 6 bH I > C : C 8 : 6 H 6 B : I = D 9 w: G : 6 A A y C : : 9 I D = 6 v: 6 9 > ; ; > 8 J A I 8 D C v: G H 6 I > D C D ; [6 H k> C g] V w= y 6 G : yD J 8 = D D H > C g 6 bH I > C : C 8 : , = 6 v: yD J : v: G b: : C H : xJ 6 A A y 6 8 I > v: ’ “I I = > C k : v: C > ; I = : y = 6 v: C : v: G b: : C H : xJ 6 A A y 6 8 I > v: > I > H > B E D G I 6 C I I D bG > C g J E I = : > H H J : I = 6 I > ; I = : y 9 D b: 8 D B : H : xJ 6 A A y 6 8 I > v: D G > ; I = : y I = > C k I = 6 I I = : y B 6 y b: 8 D B : H : xJ 6 A A y 6 8 I > v: , I = : y C : : 9 I D B 6 k: H J G : I = : y I 6 A k I D J H 6 C 9 I = 6 I I = : y 6 G : 6 8 I > v: A y D C I wD ; D G B H D ; b> G I = 8 D C I G D A .” DG . F: G G > H H 6 > 9 > I > H > B E D G I 6 C I ; D G E = yH > 8 > 6 C H I D 6 A H D G : 8 D gC > z: I = 6 I 6 A I = D J g= E 6 I > : C I H B 6 y H 6 y I = : y 6 G : J H > C g I wD ; D G B H , I = : y B 6 y b: J H > C g I = : B > C 8 D C H > H I : C I A y b: 8 6 J H : = J B 6 C : G G D G > H > C : v> I 6 bA : . S= : H 6 > 9 > I > H > B E D G I 6 C I I = 6 I 9 : G B 6 I D A D g> H I H H = D J A 9 = 6 v: I = : D E I > D C D ; G : 8 D B B : C 9 > C g B D G : : ; ; : 8 I > v: ; D G B H D ; b> G I = 8 D C I G D A I = 6 I 9 D C D I G : qJ > G : = J B 6 C 6 8 I>D C . “II 9 D : H C ’I B : 6 C I = 6 I [9 : G B 6 I D A D g> H I H ] = 6 v: I D b: I = : D C : H I D > C H : G I I = : IUD D G > B E A 6 C I , bJ I [I = : y H = D J A 9 ] G : ; : G I = : E 6 I > : C I I D 6 H E : 8 > 6 A > H I w= D > H 8 D B ; D G I 6 bA : 8 D J C H : A A > C g 6 bD J I 6 C 9 E G D v> 9 > C g I = : H : = > g= A y : ; ; : 8 I > v: ; D G B H D ; 8 D C I G 6 8 : E I > D C . II > H > B E D G I6 C I I= 6 I E 6 I>: C IH J C 9 : G H I6 C 9 I= : H : G >D J H 8 D C H : qJ : C 8 : H D ; b: 8 D B > C g E G : gC 6 C I w= > A : D C > H D I G : I > C D > C , 6 C 9 I = 6 I > I > H = 6 G 9 I D b: 100 E : G 8 : C I 8 D B E A > 6 C I w> I = b> G I = 8 D C I G D A E > A A H 6 C 9 /D G 8 D C 9 D B H ,” H 6 > 9 DG . F: G G > H . C6 C 6 9 6 9 D : H C D I G : qJ > G : E 6 I > : C I H I D jD > C I = : > PLEDGE E G D gG 6 B . IC H I : 6 9 > I ; D A A D wH I = : E G : H 8 G > b> C g G : qJ > G : B : C I H > C I G D 9 J 8 : 9 by > H D I G : I > C D > C B 6 C J ; 6 8 I J G : G RD 8 = : 6 C 9 I = : U.S. FDA > C 1988—I = : R: I > C D > 9 PG : gC 6 C 8 y PG : v: C I > D C PG D gG 6 B . T= > H E G D gG 6 B G : qJ > G : H wD B : C I D H > gC 6 wG > I I : C 6 gG : : B : C I I D J H : I wD B : I = D 9 H D ; 8 D C I G 6 8 : E I > D C 6 C 9 I D = 6 v: 6 B D C I = A y E G : gC 6 C 8 y I : H I . DG . G> 9 : D C KD G : C , 6 E G D ; : H H D G > C I = : D: E 6 G I B : C I

D ; P6 : 9 > 6 I G > 8 H C D I H J G E G >H : 9 H I J 9 > : H . H: H ; G D B wD B : C > C I = : E G D gG 6

6 I I = : UC > v: G H > I y D ; TD G D C I D , H 6 yH = : > H by I = : ; > C 9 > C gH ; G D B I = : H : AB : G > 8 6 C 6 > 9 = : 8 D C I > C J : H I D H : : b> G I = 9 : ; : 8 I H w= D gD I E G : gC 6 C I w= > A : D C > H D I G : I > C D > C B 8 6 A A : 9 MD I = : G > H k I = 6 I = : 9 > G : 8 I H 6 I T= : HD H E > I 6 A ; D G S> 8 k C= > A 9 G : C > C TD G D C I D . “T= : ; 6 8 I I = 6 I w: 8 D C I>C J : ID H : : I= D H : k> 9 H I = 6 I w> A A b: B 6 A ;D G B : 9 ;D G A>;: . . . >H v: G y 8 D C 8 : G C > C g. II B : 6 C H I = 6 I w= 6 I : v: G > H b: > C g 9 D C : > H C D I : C D J g= 6 C 9 > H C D I H J ; ; > 8 > : C I A y : ; ; : 8 I > v: ,” H 6 > 9 DG . KD G : C . “I I = > C k I = 6 I H: 6 A I = C6 C 6 9 6 H = D J A9 G : v> : w I = : ID E >8 >C 6 B J 8 = B D G : H : G > D J H B 6 C C : G .” IC 2013, DG . KD G : C 6 C 9 = > H 8 D A A : 6 gJ : H G : v> : w: 9 I = : I D E > 8 > C The Canadian Medical Association Journal (M6 G . 19, 2013; 185(5):411R 413) w= : G : I = : y E G D v> 9 : 9 H J gg: H I > D C H ; D G 6 v6 G > : I y D ; 6 E E G D 6 8 = : H I = 6 I 8 D J A 9 G : 9 J 8 : I = : G 6 I : D ; E G : gC 6 C 8 > : H ; D G wD B : C I 6 k> C g > H D I G : I > C D > C .

Image © Alexdans | Dreamstime.com

C

by EMILY INNES,

Assistant Editor, The Chronicle

Multiple approaches needed to address problem “PG : v: C I > C g ; : I 6 A : xE D H J G : I D > H D I G : I > C D > C G : qJ > G : H > C I : G v: C I > D C 6 I B J A I > E A : A : v: A H ,” H I 6 I : 9 I = : 6 J I = D G H D ; I = 6 I E 6 E : G . “IC 6 9 9 > I > D C I D I = : E G D gG 6 B H 8 J G G : C I A y > C E A 6 8 : , D I = : G D E I > D C H ; D G H yH I : B > C I : G v: C I > D C > C 8 A J 9 : b6 C C > C g D C A > C : H 6 A : H D ; > H D I G : I > C D > C , 6 H w: A A 6 H B 6 C 9 6 I D G y D C A > C : 8 : G I > ; > 8 6 I > D C E G D gG 6 B H ; D G I = : E = yH > 8 > 6 C H 6 C 9 E = 6 G B 6 8 > H I H E G D v> 9 > C g I = : 9 G J g I = 6 I > C 8 A J 9 : : 9 J 8 6 I > D C 6 bD J I 8 D C I G 6 8 : E I > v: B : I = D 9 H 6 C 9 I = : 9 G J g’H I = : G 6 E : J I > 8 6 C 9 ; : I D I D x> 8 : ; ; : 8 I H .” DG . KD G : C H 6 > 9 8 D J G H : H 6 G : B 6 C 9 6 I D G y ; D G E = yH > 8 > 6 C H > C C6 C 6 9 6 w= D w6 C I I D E G : H 8 G > b: B : I = 6 9 D C : b: 8 6 J H : D ; I = : H : G > D J H C : H H D ; I = : 9 G J g. “H: G : I = : H : v: G > I y > H C D I I D I = : E 6 I > : C I bJ I I D = : G 8 = > A 9 ,” = : H 6 >9 . IH D I G : I > C D > C J H : 9 I D b: D C A y H D A 9 by RD 8 = : , = D w: v: G , I = : G : 6 G : C D w B 6 C y bG 6 C 9 H 6 C 9 g: C : G > 8 v: G H > D C H . T= : I = : G 6 E y 8 6 C 6 A H D b: E J G 8 = 6 H : 9 D v: G I = : IC I : G C : I , w= > 8 = DG . KD G : C H 6 yH = 6 H G : 9 J 8 : 9 G : gJ A 6 I > D C 6 C 9 G : qJ > G : B : C I H ; D G E 6 I > : C I H I D 6 gG : : I D J H > C g b> G I = 8 D C I G D A . T= > H > H w= y I = : 6 J I = D G H G : 8 D B B : C 9 I = 6 I I = : H 6 A : D ; I = : 9 G J g b: b6 C C : 9 D C A>C : . R: g6 G 9 > C g I = : G : 8 : C I U.S. H I J 9 > : H , DG . KD G : C H 6 yH = : 6 gG : : H I = 6 I E 6 I > : C I H H = D J A 9 C D I b: G : qJ > G : 9 I D J H : I wD b> G I = 8 D C I G D A H , bJ I G 6 I = : G D C : = > g= A y : ; ; : 8 I > v: ; D G B . DG . KD G : C H 6 > 9 = : > H 9 > H 6 E E D > C I : 9 I = : gD v: G C B : C I = 6 H C D I G : H E D C 9 : 9 ID I= : H IJ 9 >: H 6 C 9 E 6 E : G H D C I = : H J bj: 8 I by 8 = 6 C g> C g 8 J G G : C I E D A > 8 > : H . “W: H : : > I 6 A D I 6 C 9 w: wG > I : 6 bD J I > I , w: H = D J I 6 H B J 8 = 6 H w: 8 6 C , bJ I G : 6 A A y I = : D C A y > C 9 > v> 9 J 6 A H I = 6 I G : 6 A A y 8 D C I G D A I = : 6 g: C 9 6 > H I = : G : gJ A 6 I D G , b: 8 6 J H : I = : y 8 6 C [B 6 k: ] 6 C y G J A : .” FD G B D G : >C ;D G B 6 I>D C , E A: 6 H : v> H > I : = I I E ://D w.A y/vLJ A Y D G = I I E ://D w.A y/vLJ J z Non-proprietary and brand names of therapies: isotretinoin (Accutane, Roche Canada; Clarus, Mylan Pharmaceuticals ULC; Epuris, Cipher Pharmaceuticals Inc.).


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INVESTIGATING NOTCH SIGNALLING IN CYLD-DEFECTIVE TUMOURS

D > C v: H I > g6 I : I = : ; J C 8 I > D C D ; I = : J b> qJ > I > C = y9 G D A 6 H : CYLD, 6 8 yA > C 9 G D B 6 I D H > H g: C : E G D 9 J 8 I , G : H : 6 G 8 = : G H J H : 9 6 E G D I : D B > 8 H 6 E E G D 6 8 = I D > 9 : C I > ; y E G D I : > C H I = 6 I > C I : G 6 8 I w> I = CYLD, 6 C 9 > 9 : C I > ; > : 9 I = : J b> qJ > I > C A > g6 H : : C zyB : MIB2. MIB2 > H > C vD A v: 9 w> I = ND I 8 = H > gC 6 A A > C g. W= : C CYLD 6 C 9 MIB2 w: G : 8 D -: xE G : H H : 9 , I = : G : w6 H 6 C D bH : G v: 9 H I 6 b> A > z6 I > D C D ; BIB2 E G D I : > C A : v: A H , 6 C 9 I = > H 8 D -: xE G : H H > D C w6 H 6 H H D 8 > 6 I : 9 w> I = G : 9 J 8 : 9 A : v: A H D ; I = : A > g6 C 9 JAG2, > B E A > 8 6 I : 9 > C ND I 8 = H > gC 6 A A > C g. OC I = : D I = : G = 6 C 9 , J H > C g H > RNA I D H > A : C 8 : CYLD G : H J A I : 9 > C bD I = > C 8 G : 6 H : 9 : xE G : H H > D C D ; JAG2 6 C 9 J E G : gJ A 6 I D C D ; ND I 8 = H > gC 6 A A > C g. W= : C I = : y A D D k: 9 6 I ND I 8 = E 6 I = w6 y 6 8 I > v> I y > C H k> C I J B D J G H D ; E 6 I > : C I H w> I = g: G B A > C : CYLD B J I 6 I > D C H , G : H : 6 G 8 = : G H ; D J C 9 JAG2 E G D I : > C A : v: A H 6 C 9 ND I 8 = I 6 G g: I g: C : H J E G : gJ A 6 I : 9 . RUN2 1 w6 H D v: G : xE G : H H : 9 > C CYLD 9 : ; : 8 I > v: I J B D J G 8 : A A H . AH w: A A , E G > B 6 G y 8 : A A 8 J A I J G : H ; G D B CYLD 9 : ; : 8 I > v: I J B D J G H = 6 9 G : 9 J 8 : 9 v> 6 b> A > I y w= : C : xE D H : 9 I D ND I 8 = -I 6 G g: I > C g y-H : 8 G : I 6 H : > C = > b> I D G H . T= : > C v: H I > g6 I D G H 8 D C 8 A J 9 : I = : H : ; > C 9 > C gH H = D w 6 C D C 8 D g: C > 8 9 : E : C 9 : C 8 y D C ND I 8 = H > gC 6 A A > C g > C E 6 I > : C I H w> I = CYLD 9 : ; : 8 I > v: I J B D J G H , w= > 8 = B 6 y 6 A H D H J gg: H I C D v: A I = : G 6 E : J I > 8 6 E E G D 6 8 = : H . Rajan N, Elliott RJR, Smith A, et al: The cylindromatosis gene product, CYLD, interacts with MIB2 to regulate notch signalling, in Oncotarget (Nov. 03, 2014; 5(23):12126-12140).

W

ANTI-DRUG ANTIBODIES AFFECTED BY TREATMENT PATTERNS, ETHNICITY

= > A : I = : 9 : v: A D E B : C I D ; 6 C I > -9 G J g 6 C I > bD 9 > : H 6 g6 > C H I 6 b> D A D g> 8 9 G J g > H kC D wC I D b: 6 H H D 8 > 6 I : 9 w> I = G : 9 J 8 : 9 8 A > C > 8 6 A : ; ; > 8 6 8 y, I = : > B B J C D g: C > 8 > I y D ; I = : H : 9 G J gH v6 G > : H C D I D C A y b: I w: : C 9 G J gH , bJ I 6 A H D b: I w: : C 9 > H : 6 H : H 6 C 9 E 6 I > : C I : I = C > 8 > I > : H . TD : v6 A J 6 I : E G : 9 > 8 I D G H ; D G 6 C I > -6 9 6 A > B J B 6 b 6 C I > bD 9 y (AAA) ; D G B 6 I > D C > C C= > C : H : E H D G > 6 H > H E 6 I > : C I H 6 C 9 I = : 8 A > C > 8 6 A 8 D C H : qJ : C 8 : H D ; I = : ; D G B 6 I > D C D ; I = D H : 6 C I > bD 9 > : H , G : H : 6 G 8 = : G H A D D k: 9 6 I G > H k ; 6 8 I D G H 6 C 9 9 > ; ; : G : C 8 : H > C PASI 75 G : H E D C H : G 6 I : H > C 53 E 6 I > : C I H . P6 I > : C I H w> I = AAA = 6 9 H > gC > ; > 8 6 C I A y A D w: G PASI 75 G : H E D C H : G 6 I : H (44.4% vH . 88.5%; E =0.001). S> gC > ; > 8 6 C I A y A D w: G I G D J g= 8 D C 8 : C I G 6 I > D C H D ; 6 9 6 A > B J B 6 b w: G : H : : C > C E 6 I > : C I H w> I = AAA 6 H w: A A . TG : 6 I B : C I > C I : G G J E I > D C , A D w I G D J g= 6 9 6 A > B J B 6 b 8 D C 8 : C I G 6 I > D C , A 6 8 k D ; 8 D C 8 D B > I 6 C I B : I = D I G : x6 I : J H : , 6 C 9 H w> I 8 = > C g b: I w: : C b> D A D g> 8 H w: G : 6 A A 6 H H D 8 > 6 I : 9 w> I = 6 = > g= : G AAA I > I G : . T= : G : H : 6 G 8 = : G H 8 D C 8 A J 9 : I = 6 I I = : b> D A D g> 8 I G : 6 I B : C I E 6 I I : G C > B E 6 8 I H AAA ; D G B 6 I > D C G > H k, 6 C 9 I = G D J g= I = 6 I G : 9 J 8 : 9 6 9 6 A > B J B 6 b : ; ; > 8 6 8 y. Chiu HY, Wang TS, Chan CC, et al: Risk factor analysis for the immunogenicity of adalimumab associated with decreased clinical response in Chinese patients with psoriasis, in Acta Dermato-Venereologica (in the Feb. 12, 2015 online edition).

Diagnostic Quiz

A. Morbillivirus measles B. Parvovirus B19 C. Human herpesvirus type 7

THE EDITORS invite your participation in this regular feature of the journal. Please send all images and correspondence to: Medical Editor, The Chronicle of Skin & Allergy 555 Burnhamthorpe Road, Suite 306, Toronto, Ont. M9C 2Y3. Telephone: (416) 916-2476 E-mail: health@chronicle.org

What THE LAY PRESS is saying about . . .

THE BENEFITS OF COFFEE DG > C k> C g ; D J G 8 J E H D ; 8 D ; ; : : 6 9 6 y B 6 y E G D I : 8 I 6 g6 > C H I H k> C 8 6 C 8 : G , G : E D G I H The Telegraph (J6 C . 21, 2015). A H I J 9 y E J bA > H = : 9 > C I = : Journal of the National Cancer Institute (J6 C . 2015; 107(2): 9 jJ 421) H J G v: y: 9 B D G : I = 6 C 447,000 > C 9 > v> 9 J 6 A H > C I = : U.S. ; D G 6 C 6 v: G 6 g: D ; 10 y: 6 G H . IC I = : H I J 9 > : 9 E D E J A 6 I > D C , 9 G > C k> C g 8 D ; ; : : w6 H 6 H H D 8 > 6 I : 9 w> I = 6 9 : 8 G : 6 H : 9 G > H k D ; 9 : v: A D E > C g B : A 6 C D B 6 . DG > C k> C g ; D J G D G B D G : 8 J E H E : G 9 6 y w6 H 6 H H D 8 > 6 I : 9 w> I = 6 20% 9 : 8 G : 6 H : > C G > H k. T= : C : w ; > C 9 > C gH bJ > A 9 D C E G > D G G : H : 6 G 8 = E J bA > H = : 9 > C 2007 by DG . EG C : H I Ab: A D ; W6 yC : SI 6 I : UC > v: G H > I y > C D: I G D > I , I = : C : wH D J I A : I G: E D GI: 9 . P6 G I > 8 > E 6 C I H w= D G : E D G I : 9 I = : y 9 G 6 C k 9 : 8 6 ;;: >C 6 I: 9 8 D ;;: : 9 >9 C D I 6 E E : 6 G ID H : : 6 C y G : 9 J 8 I>D C >C I= : G > H k D ; B : A 6 C D B 6 , 6 8 8 D G 9 > C g I D The Telegraph. HD w: v: G I = : C : wH D J I A : I C D I : 9 I = 6 I I = : H I J 9 y’H 6 J I = D G H H J gg: H I ; J G I = : G > C v: H I > g6 I > D C > H C : : 9 : 9 > C I D I = > H E D I : C I > 6 A E G D I : 8 I > v: : ; ; : 8 I , E 6 G I > 8 J A 6 G A y 6 H I = : U.K.’H N6 I > D C 6 A H: 6 A I = S: G v> 8 : 8 6 J I > D C H 6 g6 > C H I = > g= 8 6 ; ; : > C : > C I 6 k: .

ISOTRETINOIN, BIRTH CONTROL A C : w H I J 9 y G : v: 6 A H I = 6 I yD J C g wD B : C b: > C g I G : 6 I : 9 ; D G 6 8 C : w> I = > H D I G : I > C D > C D ; I : C G : 8 : > v: > C 6 9 : qJ 6 I : > C ; D G B 6 I > D C D C b> G I = 8 D C I G D A B : I = D 9 H , Fox News G : E D G I : 9 D C F: b. 12, 2015. S: C > D G H I J 9 y 6 J I = D G DG . EA : 6 C D G B. S8 = w6 G z D ; I = : UC > v: G H > I y D ; C6 A > ; D G C > 6 , D6 v> H , H 6 > 9 I = 6 I 9 : G B 6 I D A D g> H I H 6 G : D ; I : C I = : ; > G H I H D J G 8 : D ; b> G I = 8 D C I G D A : 9 J 8 6 I > D C ; D G yD J C g wD B : C w> I = H : v: G : 6 8 C : . T= : H I J 9 y 6 J I = D G H H J G v: y: 9 wD B : C D ; 8 = > A 9 b: 6 G > C g 6 g: , 6 H k> C g qJ : H I > D C H 6 bD J I kC D wA : 9 g: D ; : > g= I 9 > ; ; : G : C I 8 D C I G 6 8 : E I > v: B : I = D 9 H 6 C 9 I = : > G : ; ; : 8 I > v: C : H H . P6 G I > 8 > E 6 C I H I = : C G : v> : w: 9 6 C > C ; D G B 6 I > D C H = : : I 6 C 9 9 > 9 I = : H J G v: y 6 g6 > C , FD x G : E D G I H . OC ; > G H I I 6 k> C g I = : H J G v: y, B D H I D v: G : H I > B 6 I : 9 I = : : ; ; : 8 I > v: C : H H D ; b> G I = 8 D C I G D A E > A A H , > C j: 8 I > D C H , 6 C 9 8 D C 9 D B H . OC : -I = > G 9 = 6 9 C D I = : 6 G 9 D ; 8 D C I G 6 8 : E I > v: > B E A 6 C I H 6 C 9 16% w: G : J C 6 w6 G : D ; > C I G 6 J I : G > C : 9 : v> 8 : H . A; I : G G : 6 9 >C g I= : >C ;D G B 6 I>D C H = : : I ;D G 6 C 6 v: G 6 g: D ; D C : B > C J I : , I = : > G H J G v: y H 8 D G : H D C I= : H : 8 D C 9 6 II: B E I > C 8 G : 6 H : 9 by 6 A B D H I : v: G y B : 6 H J G : . DG . S8 = w6 G z H 6 > 9 I= : 8 J G G : C I > H D I G : I > C D > C > PA : 9 g: E 6 8 k: I > H D J I D ; 9 6 I : , 6 C 9 H = D J A 9 b: J E 9 6 I : 9 I D ; D 8 J H D C 8 D C IG 6 8 : E I>D C B : I= D 9 H I= : E 6 I>: C I 8 6 C C D I ; D G g: I I D J H : , H J 8 = 6 H > C I G 6 J I : G > C : 9 : v> 8 : H 6 C 9 > C j: 8 I > D C H .

Image courtesy: http://ow.ly/JEzsD

T

Research of Note

THE CHRONICLE of S K I N & A L L E R G Y

HEALING WOUNDS WITH FISH? AE E A y> C g 8 D A A 6 g: C 9 : G > v: 9 ; G D B I = : H k> C D ; I > A 6 E > 6 ; > H = B 6 y b: 6 gG : 6 I w6 y I D H E : : 9 J E wD J C 9 = : 6 A > C g 6 8 8 D G 9 > C g I D 6 I : 6 B D ; C= > C : H : G : H : 6 G 8 = : G H , G : E D G I H Scientific American (F: b. 18, 2015, D C A > C : ). T= : G : H : 6 G 8 = : G H A D D k: 9 6 I I = : ; > H = H k> C E G D I : > C 6 H 6 C 6 A I : G C 6 I > v: I D B 6 B B 6 A > 6 C E G D I : > C b: 8 6 J H : D ; I = : I = : D G : I > 8 6 A A y A D w: G G > H k D ; 9 > H : 6 H : I G 6 C H B > H H > D C , I = : C : wH D J I A : I G : E D G I H . AH w: A A , I > A 6 E > 6 > H 6 C 6 bJ C 9 6 C I H D J G 8 : ; D G 8 D A A 6 g: C . A; I : G : xI G 6 8 I > C g I = : 8 D A A 6 g: C , I = : G : H : 6 G 8 = I : 6 B ; G D B I = : S= 6 C g= 6 > J> 6 D I D C g UC > v: G H > I y S8 = D D A D ; M: 9 > 8 > C : ; D J C 9 > I = 6 9 I = : G > g= I E = yH > 8 6 A E G D E : G I > : H ; D G J H : > C wD J C 9 = : 6 A > C g, 6 C 9 9 > 9 C D I 8 6 J H : 6 C >B B J C : G : H E D C H : >C G 6 I H . W= : C I : H I : 9 D C H k> C wD J C 9 H > C G 6 I H , I = : wD J C 9 H = : 6 A : 9 ; 6 H I : G I = 6 C D C J C I G : 6 I : 9 G 6 I H D G G 6 I H I G : 6 I : 9 w> I = 6 A g> C 6 I : 9 G : H H > C gH . G> J H : E E : TG D C 8 > , 6 b> D B 6 I : G > 6 A H : xE : G I 6 I I = : UC > v: G H > I y D ; L: : 9 H , I D A 9 I = : C : wH D J I A : I I = 6 I I = : = > g= 6 v6 > A 6 b> A > I y D ; I = : H I6 G I>C gB 6 I: G >6 A 6 C 9 E D I: C I>6 A >B E A>8 6 I > D C H ; D G 8 D H I -: ; ; : 8 I > v: C : H H > C 8 = G D C > 8 wD J C 9 8 6 G : w: G : : x8 > I > C g. “G> v: C I = : D J I H I 6 C 9 > C g > C v> vD 9 6 I 6 , > I wD J A 9 b: > C I : G : H I > C g I D H : : = D w I = : H k> C G : g: C : G 6 I > D C E D I : C I > 6 A D ; I = > H B 6 I : G > 6 A 8 D B E 6 G : 9 w> I = I = 6 I D ; 6 8 D B B : G 8 > 6 A A y 6 v6 > A 6 bA : 8 D A A 6 g: C b6 H : 9 wD J C 9 9 G : H H > C g,” TG D C 8 > H 6 > 9 .

Correct answer: Morbillivirus measles

Journal Club

26 · M6 G 8 = 2015

REACTIONS TO PRESERVATIVE T= : G : > H > C 8 G : 6 H > C g 6 w6 G : C : H H 6 C 9 8 D C 8 : G C 6 bD J I I = : E G : H : G v6 I > v: B : I = yA > H D I = > 6 zD A > C D C : (MI) > C E : G H D C 6 A 8 6 G : E G D 9 J 8 I H A : 6 9 > C g I D 6 A A : G g> 8 H : C H > I > z6 I > D C , > C E 6 G I —E 6 G 6 9 D x> 8 6 A A y— b: 8 6 J H : B 6 C y B 6 C J ; 6 8 I J G : G H 6 G : H w> I 8 = > C g I D MI ; G D B D I = : G E G : H : G v6 I > v: H H J 8 = 6 H E 6 G 6 b: C H , G : E D G I H The New York Times (J6 C . 23, 2015). M6 jD G 8 D C H J B : G E G D 9 J 8 I 8 D B E 6 C > : H , > C 8 A J 9 > C g K> B b: G A y-CA 6 G k, JD = C H D C & JD = C H D C 6 C 9 UC > A : v: G , = 6 v: b: gJ C G : B D v> C g MI ; G D B A D I > D C H 6 C 9 w> E : H . “W= : C E : D E A : 6 G : : xE D H : 9 D C 6 9 6 > A y b6 H > H I D MI, w: I = > C k I = : G 6 I : H D ; H : C H > I > z6 I > D C 6 G : gD > C g J E ,” DG . BG J 8 : A. BG D 9 , E G : H > 9 : C I -: A : 8 I D ; I = : AB : G > 8 6 C CD C I 6 8 I D: G B 6 I > I > H SD 8 > : I y, I D A 9 I = : C : wH D J I A : I . A A 6 8 k D ; 6 w6 G : C : H H 6 B D C g I = : E J bA > 8 6 C 9 9 D 8 I D G H D ; I = : E D I : C I > 6 A 6 A A : G g> 8 H : C H > I > z6 I > D C > H 6 C > H H J : , DG . BG D 9 H 6 > 9 , : v: C I = D J g= MI w6 H I = : H D 8 > : I y’H 6 A A : G g: C D ; I = : y: 6 G > C 2013. BJ I I = : G : 6 G : D C A y H D B 6 C y E G : H : G v6 I > v: H 6 E E G D v: 9 ; D G J H : > C E : GH D C 6 A 8 6 G: E GD 9 J 8 IH , 6 C 9 8 D C H J B : G E G : H H J G : —C D I C : 8 : H H 6 G > A y H J E E D G I : 9 by H 8 > : C 8 : —= 6 H A > B > I : 9 I = : E 6 A : I I : D ; E G : H : G v6 I > v: H E G D 9 J 8 I B 6 C J ; 6 8 I J G : G H 8 6 C J H : , L> C 9 6 LD G : I z, I = : 8 = > : ; I D x> 8 D A D g> H I ; D G I = : P: G H D C 6 A C6 G : PG D 9 J 8 I H CD J C 8 > A , 6 C > C 9 J H I G y I G 6 9 : gG D J E , I D A 9 I = : Times. Department Editor: John Evans


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The Chronicle of Skin & Allergy March 2015  

The Chronicle of Skin & Allergy March 2015

The Chronicle of Skin & Allergy March 2015  

The Chronicle of Skin & Allergy March 2015

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