User login
Nicotinamide Prevents Actinic Keratoses, Basal Cell Carcinomas, and Squamous Cell Carcinomas
Chen et al (N Engl J Med. 2015;373:1618-1626) performed a multicenter, phase 3, double-blind, randomized, placebo-controlled trial. Results demonstrated that nicotinamide effectively decreased the rates of new nonmelanoma skin cancers (NMSCs) and actinic keratoses (AKs) in high-risk patients who had at least 2 histologically confirmed NMSCs in the last 5 years. In comparison to participants who received placebo, individuals who received nicotinamide 500 mg twice daily during the 12-month study (branded with a predictive acronym ONTRAC [oral nicotinamide to reduce actinic cancer]) had reduced rates of AKs of up to 20%, basal cell carcinomas of 20%, squamous cell carcinomas of 30%, and NMSCs of 23%. However, the effect of nicotinamide on NMSCs was not maintained at evaluation 6 months after discontinuation; the number of basal cell carcinomas was similar, and the number of squamous cell carcinomas was greater in participants who received nicotinamide in comparison to individuals who received placebo.
What’s the issue?
The risk for skin cancer is increased by UV radiation that damages DNA, suppresses cutaneous immunity, and inhibits DNA repair by depleting cellular adenosine triphosphate. Nicotinamide, an amide form of vitamin B3, has been demonstrated to not only reduce UV radiation–induced immunosuppression but also to prevent UV radiation–induced adenosine triphosphate depletion and glycolic blockade. Nicotinamide, which is classified as a food additive, also has neuroprotective and antioxidant functions and reduces pigmentation, wrinkles, and sebum production. Although oral nicotinamide has been demonstrated to reduce NMSCs and AKs, topical application has been shown to improve many skin conditions such as acne, atopic dermatitis, isoniazid-induced pellagra, and rosacea.
In contrast to nicotinic acid (niacin), nicotinamide is not associated with headaches, hypotension, flushing, itching, or vasodilatation. At high oral doses, side effects of nicotinamide that have been hypothesized or observed in animals, humans, or both have included the development of Parkinson disease, insulin sensitivity and diabetes mellitus, and liver toxicity. Although there are no reports in humans of growth retardation, teratogenicity, or oncogenicity, Rolfe (J Cosmet Dermatol. 2014;13:324-328) discussed that fetal blood levels of nicotinamide are greater than corresponding maternal blood levels because it is able to cross the placenta. However, according to Chen et al, no clinically significant between-group differences were found with respect to the number or types of adverse events that occurred in the placebo participants and the individuals who received 1000 mg daily of nicotinamide. Chen et al implied that there were additional benefits in the recipients of nicotinamide with regards to cognitive function and transepidermal water loss.
Perhaps all patients with a history of AKs, basal cell carcinomas, or squamous cell carcinomas should receive lifelong nicotinamide. Also, it might be reasonable to consider that all individuals older than 18 years who are not pregnant or breastfeeding with increased sun exposure but no history of AKs or NMSC add nicotinamide to their daily diets as a proactive measure for chemoprevention. Would you suggest nicotinamide to your patients?
Chen et al (N Engl J Med. 2015;373:1618-1626) performed a multicenter, phase 3, double-blind, randomized, placebo-controlled trial. Results demonstrated that nicotinamide effectively decreased the rates of new nonmelanoma skin cancers (NMSCs) and actinic keratoses (AKs) in high-risk patients who had at least 2 histologically confirmed NMSCs in the last 5 years. In comparison to participants who received placebo, individuals who received nicotinamide 500 mg twice daily during the 12-month study (branded with a predictive acronym ONTRAC [oral nicotinamide to reduce actinic cancer]) had reduced rates of AKs of up to 20%, basal cell carcinomas of 20%, squamous cell carcinomas of 30%, and NMSCs of 23%. However, the effect of nicotinamide on NMSCs was not maintained at evaluation 6 months after discontinuation; the number of basal cell carcinomas was similar, and the number of squamous cell carcinomas was greater in participants who received nicotinamide in comparison to individuals who received placebo.
What’s the issue?
The risk for skin cancer is increased by UV radiation that damages DNA, suppresses cutaneous immunity, and inhibits DNA repair by depleting cellular adenosine triphosphate. Nicotinamide, an amide form of vitamin B3, has been demonstrated to not only reduce UV radiation–induced immunosuppression but also to prevent UV radiation–induced adenosine triphosphate depletion and glycolic blockade. Nicotinamide, which is classified as a food additive, also has neuroprotective and antioxidant functions and reduces pigmentation, wrinkles, and sebum production. Although oral nicotinamide has been demonstrated to reduce NMSCs and AKs, topical application has been shown to improve many skin conditions such as acne, atopic dermatitis, isoniazid-induced pellagra, and rosacea.
In contrast to nicotinic acid (niacin), nicotinamide is not associated with headaches, hypotension, flushing, itching, or vasodilatation. At high oral doses, side effects of nicotinamide that have been hypothesized or observed in animals, humans, or both have included the development of Parkinson disease, insulin sensitivity and diabetes mellitus, and liver toxicity. Although there are no reports in humans of growth retardation, teratogenicity, or oncogenicity, Rolfe (J Cosmet Dermatol. 2014;13:324-328) discussed that fetal blood levels of nicotinamide are greater than corresponding maternal blood levels because it is able to cross the placenta. However, according to Chen et al, no clinically significant between-group differences were found with respect to the number or types of adverse events that occurred in the placebo participants and the individuals who received 1000 mg daily of nicotinamide. Chen et al implied that there were additional benefits in the recipients of nicotinamide with regards to cognitive function and transepidermal water loss.
Perhaps all patients with a history of AKs, basal cell carcinomas, or squamous cell carcinomas should receive lifelong nicotinamide. Also, it might be reasonable to consider that all individuals older than 18 years who are not pregnant or breastfeeding with increased sun exposure but no history of AKs or NMSC add nicotinamide to their daily diets as a proactive measure for chemoprevention. Would you suggest nicotinamide to your patients?
Chen et al (N Engl J Med. 2015;373:1618-1626) performed a multicenter, phase 3, double-blind, randomized, placebo-controlled trial. Results demonstrated that nicotinamide effectively decreased the rates of new nonmelanoma skin cancers (NMSCs) and actinic keratoses (AKs) in high-risk patients who had at least 2 histologically confirmed NMSCs in the last 5 years. In comparison to participants who received placebo, individuals who received nicotinamide 500 mg twice daily during the 12-month study (branded with a predictive acronym ONTRAC [oral nicotinamide to reduce actinic cancer]) had reduced rates of AKs of up to 20%, basal cell carcinomas of 20%, squamous cell carcinomas of 30%, and NMSCs of 23%. However, the effect of nicotinamide on NMSCs was not maintained at evaluation 6 months after discontinuation; the number of basal cell carcinomas was similar, and the number of squamous cell carcinomas was greater in participants who received nicotinamide in comparison to individuals who received placebo.
What’s the issue?
The risk for skin cancer is increased by UV radiation that damages DNA, suppresses cutaneous immunity, and inhibits DNA repair by depleting cellular adenosine triphosphate. Nicotinamide, an amide form of vitamin B3, has been demonstrated to not only reduce UV radiation–induced immunosuppression but also to prevent UV radiation–induced adenosine triphosphate depletion and glycolic blockade. Nicotinamide, which is classified as a food additive, also has neuroprotective and antioxidant functions and reduces pigmentation, wrinkles, and sebum production. Although oral nicotinamide has been demonstrated to reduce NMSCs and AKs, topical application has been shown to improve many skin conditions such as acne, atopic dermatitis, isoniazid-induced pellagra, and rosacea.
In contrast to nicotinic acid (niacin), nicotinamide is not associated with headaches, hypotension, flushing, itching, or vasodilatation. At high oral doses, side effects of nicotinamide that have been hypothesized or observed in animals, humans, or both have included the development of Parkinson disease, insulin sensitivity and diabetes mellitus, and liver toxicity. Although there are no reports in humans of growth retardation, teratogenicity, or oncogenicity, Rolfe (J Cosmet Dermatol. 2014;13:324-328) discussed that fetal blood levels of nicotinamide are greater than corresponding maternal blood levels because it is able to cross the placenta. However, according to Chen et al, no clinically significant between-group differences were found with respect to the number or types of adverse events that occurred in the placebo participants and the individuals who received 1000 mg daily of nicotinamide. Chen et al implied that there were additional benefits in the recipients of nicotinamide with regards to cognitive function and transepidermal water loss.
Perhaps all patients with a history of AKs, basal cell carcinomas, or squamous cell carcinomas should receive lifelong nicotinamide. Also, it might be reasonable to consider that all individuals older than 18 years who are not pregnant or breastfeeding with increased sun exposure but no history of AKs or NMSC add nicotinamide to their daily diets as a proactive measure for chemoprevention. Would you suggest nicotinamide to your patients?
Dermatologists Need To “Stand Up” For Themselves
Sedentary living, supported by the number of hours spent sitting at work and at home each day, has been associated with increased risk for cardiovascular disease, diabetes, and premature mortality. Buckley et al (Br J Sports Med. 2015;49:1357-1362) provided guidelines for employers regarding interventions that may promote the avoidance of prolonged periods of sedentary work in a consensus statement that was commissioned by Public Health England and the Active Working Community Interest Company (who launched the Get Britain Standing campaign). The authors recommended initially aiming to accumulate at least 2 hours of standing and light activity (such as walking around the office) during work hours, with the eventual goal of 4 hours per day; however, they also cautioned that this positive adaptive process may lead to musculoskeletal sensations and fatigue in some individuals who may not be accustomed to standing-based work.
Buckley et al also suggested that employers should encourage goal that promote good health, such as improving nutrition and reducing alcohol consumption, smoking, and stress. Additionally, the authors highly recommended adjustable desk stations that allow employees to alternate between standing and seated work. Finally, Buckley et al commented that prolonged static standing postures, similar to prolonged static seated positions, also should be avoided.
Buckley et al also noted that workplaces that have initiated these interventions have seen improvement in cardiometabolic, musculoskeletal, and mental health risks in employees. Additionally, the productivity, quality, and efficiency of the work improved and employees experienced a greater sense of collaboration. Incorporating interventions to eliminate sitting for prolonged periods in the workplace resulted in cost savings for health services for both the employees and the employer in the groups studied by Buckley et al.
What’s the Issue?
Like other physicians and health care providers, dermatologists may be working longer hours, dealing with increased administrative demands that require electronic or hand-written documentation, and spending more time sitting each day to accomplish activities that do not involve direct patient care. Incorporating planned periods of activity (eg, standing breaks) in the workday for both themselves and their office personnel may be an effective intervention for dermatologists to use to avoid sitting for prolonged periods of time. Additionally, changing the ergonomic design of the office and workstations with adjustable desks and counter tops that allow employees to alternate between sitting and standing may encourage staff to not only become less sedentary but possibly more productive as well. Is it time for dermatologists to “stand up” for themselves?
Sedentary living, supported by the number of hours spent sitting at work and at home each day, has been associated with increased risk for cardiovascular disease, diabetes, and premature mortality. Buckley et al (Br J Sports Med. 2015;49:1357-1362) provided guidelines for employers regarding interventions that may promote the avoidance of prolonged periods of sedentary work in a consensus statement that was commissioned by Public Health England and the Active Working Community Interest Company (who launched the Get Britain Standing campaign). The authors recommended initially aiming to accumulate at least 2 hours of standing and light activity (such as walking around the office) during work hours, with the eventual goal of 4 hours per day; however, they also cautioned that this positive adaptive process may lead to musculoskeletal sensations and fatigue in some individuals who may not be accustomed to standing-based work.
Buckley et al also suggested that employers should encourage goal that promote good health, such as improving nutrition and reducing alcohol consumption, smoking, and stress. Additionally, the authors highly recommended adjustable desk stations that allow employees to alternate between standing and seated work. Finally, Buckley et al commented that prolonged static standing postures, similar to prolonged static seated positions, also should be avoided.
Buckley et al also noted that workplaces that have initiated these interventions have seen improvement in cardiometabolic, musculoskeletal, and mental health risks in employees. Additionally, the productivity, quality, and efficiency of the work improved and employees experienced a greater sense of collaboration. Incorporating interventions to eliminate sitting for prolonged periods in the workplace resulted in cost savings for health services for both the employees and the employer in the groups studied by Buckley et al.
What’s the Issue?
Like other physicians and health care providers, dermatologists may be working longer hours, dealing with increased administrative demands that require electronic or hand-written documentation, and spending more time sitting each day to accomplish activities that do not involve direct patient care. Incorporating planned periods of activity (eg, standing breaks) in the workday for both themselves and their office personnel may be an effective intervention for dermatologists to use to avoid sitting for prolonged periods of time. Additionally, changing the ergonomic design of the office and workstations with adjustable desks and counter tops that allow employees to alternate between sitting and standing may encourage staff to not only become less sedentary but possibly more productive as well. Is it time for dermatologists to “stand up” for themselves?
Sedentary living, supported by the number of hours spent sitting at work and at home each day, has been associated with increased risk for cardiovascular disease, diabetes, and premature mortality. Buckley et al (Br J Sports Med. 2015;49:1357-1362) provided guidelines for employers regarding interventions that may promote the avoidance of prolonged periods of sedentary work in a consensus statement that was commissioned by Public Health England and the Active Working Community Interest Company (who launched the Get Britain Standing campaign). The authors recommended initially aiming to accumulate at least 2 hours of standing and light activity (such as walking around the office) during work hours, with the eventual goal of 4 hours per day; however, they also cautioned that this positive adaptive process may lead to musculoskeletal sensations and fatigue in some individuals who may not be accustomed to standing-based work.
Buckley et al also suggested that employers should encourage goal that promote good health, such as improving nutrition and reducing alcohol consumption, smoking, and stress. Additionally, the authors highly recommended adjustable desk stations that allow employees to alternate between standing and seated work. Finally, Buckley et al commented that prolonged static standing postures, similar to prolonged static seated positions, also should be avoided.
Buckley et al also noted that workplaces that have initiated these interventions have seen improvement in cardiometabolic, musculoskeletal, and mental health risks in employees. Additionally, the productivity, quality, and efficiency of the work improved and employees experienced a greater sense of collaboration. Incorporating interventions to eliminate sitting for prolonged periods in the workplace resulted in cost savings for health services for both the employees and the employer in the groups studied by Buckley et al.
What’s the Issue?
Like other physicians and health care providers, dermatologists may be working longer hours, dealing with increased administrative demands that require electronic or hand-written documentation, and spending more time sitting each day to accomplish activities that do not involve direct patient care. Incorporating planned periods of activity (eg, standing breaks) in the workday for both themselves and their office personnel may be an effective intervention for dermatologists to use to avoid sitting for prolonged periods of time. Additionally, changing the ergonomic design of the office and workstations with adjustable desks and counter tops that allow employees to alternate between sitting and standing may encourage staff to not only become less sedentary but possibly more productive as well. Is it time for dermatologists to “stand up” for themselves?
An Ancient Recipe to Cure a Modern Pathogen
At the Society for General Microbiology Annual Conference (March 30–April 2, 2015), Harrison et al presented a paper describing their experience with a 1000-year-old antimicrobial remedy with antistaphylococcal activity (S19We1006). The unique team of investigators—consisting of an expert in Viking studies and 3 microbiologists from the University of Nottingham, England, and another microbiologist who performs mouse model studies from Texas Tech University (Lubbock, Texas)—pooled their talents to reconstruct and test an ancient recipe for treating eyelash follicle infection. The potion not only killed methicillin-resistant Staphylococcus aureus (MRSA) grown in established biofilms but also performed as good, if not better, than the conventional antibiotics on MRSA-infected skin wounds in mice.
“Take cropleek and garlic, of both equal quantities, pound them well together . . . take wine and bullocks gall, mix with the leek . . . let it stand 9 days in the brass vessel” is an excerpt of the recipe for treatment of a sty from the 9th century Anglo-Saxon text Bald’s Leechbook (translated from Old English). The modern day chefs cooked their potion using: (1) 2 Allium species (equal amounts of garlic and either leek or onion, finely chopped and crushed in a mortar for 2 minutes), (2) wine (add 25 mL [0.87 fl oz] of an organic vintage from a historic English vineyard near Glastonbury), (3) bullock gall (dissolve bile from a cow’s stomach in distilled water), and (4) brass (glass bottles with squares of brass sheets immersed in the mixture were used because a brass vessel would be not only hard to sterilize but also expensive). After brewing (in the “brass vessel”), the solution was purified by straining it and left to chill at 4oC for 9 days before the mixture was used.
What’s the issue?
Advances in technology provide the opportunity to create new medical treatments. However, efficacious therapies may remain hidden in ancient texts, waiting to be discovered. Historic Chinese literature has been the source for modern day drugs such as artemisinin for Plasmodium falciparum malaria. The ancient recipe in Bald’s Leechbook may be the next major advance in the topical management of MRSA. I anticipate, in the future, that physicians may be prescribing “Bald’s potion” to treat impetigo. What do you think?
We want to know your views! Tell us what you think.
Suggested Readings
- AncientBiotics—a medieval remedy for modern day superbugs [news release]? United Kingdom: The University of Nottingham; March 30, 2015. http://www.nottingham.ac.uk/news/pressreleases/2015/march/ancientbiotics---a-medieval-remedy-for-modern-day-superbugs.aspx. Accessed August 12, 2015.
- Feilden T. 1,000-year-old onion and garlic eye remedy kills MRSA. BBC News. March 30, 2015. http://www.bbc.com/news/uk-england-nottinghamshire-32117815. Accessed August 12, 2015.
- Wilson C. Anglo-Saxon remedy kills hospital superbug MRSA. New Scientist. March 30, 2015. http://www.newscientist.com/article/dn27263-anglosaxon-remedy-kills-hospital-superbug-mrsa.html#.VTPpsqazDzl. Accessed August 12, 2015.
At the Society for General Microbiology Annual Conference (March 30–April 2, 2015), Harrison et al presented a paper describing their experience with a 1000-year-old antimicrobial remedy with antistaphylococcal activity (S19We1006). The unique team of investigators—consisting of an expert in Viking studies and 3 microbiologists from the University of Nottingham, England, and another microbiologist who performs mouse model studies from Texas Tech University (Lubbock, Texas)—pooled their talents to reconstruct and test an ancient recipe for treating eyelash follicle infection. The potion not only killed methicillin-resistant Staphylococcus aureus (MRSA) grown in established biofilms but also performed as good, if not better, than the conventional antibiotics on MRSA-infected skin wounds in mice.
“Take cropleek and garlic, of both equal quantities, pound them well together . . . take wine and bullocks gall, mix with the leek . . . let it stand 9 days in the brass vessel” is an excerpt of the recipe for treatment of a sty from the 9th century Anglo-Saxon text Bald’s Leechbook (translated from Old English). The modern day chefs cooked their potion using: (1) 2 Allium species (equal amounts of garlic and either leek or onion, finely chopped and crushed in a mortar for 2 minutes), (2) wine (add 25 mL [0.87 fl oz] of an organic vintage from a historic English vineyard near Glastonbury), (3) bullock gall (dissolve bile from a cow’s stomach in distilled water), and (4) brass (glass bottles with squares of brass sheets immersed in the mixture were used because a brass vessel would be not only hard to sterilize but also expensive). After brewing (in the “brass vessel”), the solution was purified by straining it and left to chill at 4oC for 9 days before the mixture was used.
What’s the issue?
Advances in technology provide the opportunity to create new medical treatments. However, efficacious therapies may remain hidden in ancient texts, waiting to be discovered. Historic Chinese literature has been the source for modern day drugs such as artemisinin for Plasmodium falciparum malaria. The ancient recipe in Bald’s Leechbook may be the next major advance in the topical management of MRSA. I anticipate, in the future, that physicians may be prescribing “Bald’s potion” to treat impetigo. What do you think?
We want to know your views! Tell us what you think.
Suggested Readings
- AncientBiotics—a medieval remedy for modern day superbugs [news release]? United Kingdom: The University of Nottingham; March 30, 2015. http://www.nottingham.ac.uk/news/pressreleases/2015/march/ancientbiotics---a-medieval-remedy-for-modern-day-superbugs.aspx. Accessed August 12, 2015.
- Feilden T. 1,000-year-old onion and garlic eye remedy kills MRSA. BBC News. March 30, 2015. http://www.bbc.com/news/uk-england-nottinghamshire-32117815. Accessed August 12, 2015.
- Wilson C. Anglo-Saxon remedy kills hospital superbug MRSA. New Scientist. March 30, 2015. http://www.newscientist.com/article/dn27263-anglosaxon-remedy-kills-hospital-superbug-mrsa.html#.VTPpsqazDzl. Accessed August 12, 2015.
At the Society for General Microbiology Annual Conference (March 30–April 2, 2015), Harrison et al presented a paper describing their experience with a 1000-year-old antimicrobial remedy with antistaphylococcal activity (S19We1006). The unique team of investigators—consisting of an expert in Viking studies and 3 microbiologists from the University of Nottingham, England, and another microbiologist who performs mouse model studies from Texas Tech University (Lubbock, Texas)—pooled their talents to reconstruct and test an ancient recipe for treating eyelash follicle infection. The potion not only killed methicillin-resistant Staphylococcus aureus (MRSA) grown in established biofilms but also performed as good, if not better, than the conventional antibiotics on MRSA-infected skin wounds in mice.
“Take cropleek and garlic, of both equal quantities, pound them well together . . . take wine and bullocks gall, mix with the leek . . . let it stand 9 days in the brass vessel” is an excerpt of the recipe for treatment of a sty from the 9th century Anglo-Saxon text Bald’s Leechbook (translated from Old English). The modern day chefs cooked their potion using: (1) 2 Allium species (equal amounts of garlic and either leek or onion, finely chopped and crushed in a mortar for 2 minutes), (2) wine (add 25 mL [0.87 fl oz] of an organic vintage from a historic English vineyard near Glastonbury), (3) bullock gall (dissolve bile from a cow’s stomach in distilled water), and (4) brass (glass bottles with squares of brass sheets immersed in the mixture were used because a brass vessel would be not only hard to sterilize but also expensive). After brewing (in the “brass vessel”), the solution was purified by straining it and left to chill at 4oC for 9 days before the mixture was used.
What’s the issue?
Advances in technology provide the opportunity to create new medical treatments. However, efficacious therapies may remain hidden in ancient texts, waiting to be discovered. Historic Chinese literature has been the source for modern day drugs such as artemisinin for Plasmodium falciparum malaria. The ancient recipe in Bald’s Leechbook may be the next major advance in the topical management of MRSA. I anticipate, in the future, that physicians may be prescribing “Bald’s potion” to treat impetigo. What do you think?
We want to know your views! Tell us what you think.
Suggested Readings
- AncientBiotics—a medieval remedy for modern day superbugs [news release]? United Kingdom: The University of Nottingham; March 30, 2015. http://www.nottingham.ac.uk/news/pressreleases/2015/march/ancientbiotics---a-medieval-remedy-for-modern-day-superbugs.aspx. Accessed August 12, 2015.
- Feilden T. 1,000-year-old onion and garlic eye remedy kills MRSA. BBC News. March 30, 2015. http://www.bbc.com/news/uk-england-nottinghamshire-32117815. Accessed August 12, 2015.
- Wilson C. Anglo-Saxon remedy kills hospital superbug MRSA. New Scientist. March 30, 2015. http://www.newscientist.com/article/dn27263-anglosaxon-remedy-kills-hospital-superbug-mrsa.html#.VTPpsqazDzl. Accessed August 12, 2015.
Coffee Each Day Keeps the Melanoma Away
“An apple a day keeps the doctor away,” and coffee each day keeps the melanoma away. A recent analysis of data by Loftfield et al from a food frequency questionnaire published online on January 20 in the Journal of the National Cancer Institute demonstrated that caffeinated coffee intake was inversely associated with melanoma. Specifically, consuming 4 or more cups of caffeinated coffee each day was found to decrease the risk for melanoma by 20%.
The authors’ reference groups were derived from a National Institutes of Health–AARP prospective cohort diet and health study that commenced in 1995 to 1996 and concluded on December 31, 2006. They observed that the lower risk for melanoma was only associated with caffeinated coffee. Unexpectedly, they also observed that caffeinated coffee drinking only decreased the risk for melanoma but not melanoma in situ.
There is scientific evidence that coffee has a role in decreasing UVB-induced carcinogenesis. Caffeine (both orally and topically) inhibits UVB-induced carcinogenesis by absorbing UV radiation. Also, 5-O-caffeoylquinic acid (the major chlorogenic acid in coffee) and its metabolite caffeic acid inhibit cyclooxygenase 2 expression, which is overexpressed in human melanoma cells and in response to UVB exposure. In addition to caffeine, coffee also contains several bioactive compounds: diterpenes, polyphenols, and trigonelline. Topical diterpenes inhibit inflammation in epidermal cells. During coffee roasting, trigonelline generates nicotinic acid and nicotinamide, both of which are protective against UVB-induced skin carcinogenesis in mice and UVB-induced immunosuppression in both humans and mice.
What’s the issue?
According to an article in The Washington Post, the “apple” adage originated in the 1860s; the original phrase was “Eat an apple on going to bed, and you’ll keep the doctor from earning his bread,” which evolved to “An apple a day, no doctor to pay,” then “An apple a day sends the doctor away” before the current version was first used in 1922. As one who enjoys having a cup of caffeinated coffee next to my computer in the office or at home, I can easily welcome the prospect of a few additional cups each day to prevent melanoma. And, as advocates for a possible benefit to our patients’ better health, should we should provide complimentary caffeinated coffee in our office waiting rooms to encourage our dermatology patients to decrease their risk for developing melanoma?
“An apple a day keeps the doctor away,” and coffee each day keeps the melanoma away. A recent analysis of data by Loftfield et al from a food frequency questionnaire published online on January 20 in the Journal of the National Cancer Institute demonstrated that caffeinated coffee intake was inversely associated with melanoma. Specifically, consuming 4 or more cups of caffeinated coffee each day was found to decrease the risk for melanoma by 20%.
The authors’ reference groups were derived from a National Institutes of Health–AARP prospective cohort diet and health study that commenced in 1995 to 1996 and concluded on December 31, 2006. They observed that the lower risk for melanoma was only associated with caffeinated coffee. Unexpectedly, they also observed that caffeinated coffee drinking only decreased the risk for melanoma but not melanoma in situ.
There is scientific evidence that coffee has a role in decreasing UVB-induced carcinogenesis. Caffeine (both orally and topically) inhibits UVB-induced carcinogenesis by absorbing UV radiation. Also, 5-O-caffeoylquinic acid (the major chlorogenic acid in coffee) and its metabolite caffeic acid inhibit cyclooxygenase 2 expression, which is overexpressed in human melanoma cells and in response to UVB exposure. In addition to caffeine, coffee also contains several bioactive compounds: diterpenes, polyphenols, and trigonelline. Topical diterpenes inhibit inflammation in epidermal cells. During coffee roasting, trigonelline generates nicotinic acid and nicotinamide, both of which are protective against UVB-induced skin carcinogenesis in mice and UVB-induced immunosuppression in both humans and mice.
What’s the issue?
According to an article in The Washington Post, the “apple” adage originated in the 1860s; the original phrase was “Eat an apple on going to bed, and you’ll keep the doctor from earning his bread,” which evolved to “An apple a day, no doctor to pay,” then “An apple a day sends the doctor away” before the current version was first used in 1922. As one who enjoys having a cup of caffeinated coffee next to my computer in the office or at home, I can easily welcome the prospect of a few additional cups each day to prevent melanoma. And, as advocates for a possible benefit to our patients’ better health, should we should provide complimentary caffeinated coffee in our office waiting rooms to encourage our dermatology patients to decrease their risk for developing melanoma?
“An apple a day keeps the doctor away,” and coffee each day keeps the melanoma away. A recent analysis of data by Loftfield et al from a food frequency questionnaire published online on January 20 in the Journal of the National Cancer Institute demonstrated that caffeinated coffee intake was inversely associated with melanoma. Specifically, consuming 4 or more cups of caffeinated coffee each day was found to decrease the risk for melanoma by 20%.
The authors’ reference groups were derived from a National Institutes of Health–AARP prospective cohort diet and health study that commenced in 1995 to 1996 and concluded on December 31, 2006. They observed that the lower risk for melanoma was only associated with caffeinated coffee. Unexpectedly, they also observed that caffeinated coffee drinking only decreased the risk for melanoma but not melanoma in situ.
There is scientific evidence that coffee has a role in decreasing UVB-induced carcinogenesis. Caffeine (both orally and topically) inhibits UVB-induced carcinogenesis by absorbing UV radiation. Also, 5-O-caffeoylquinic acid (the major chlorogenic acid in coffee) and its metabolite caffeic acid inhibit cyclooxygenase 2 expression, which is overexpressed in human melanoma cells and in response to UVB exposure. In addition to caffeine, coffee also contains several bioactive compounds: diterpenes, polyphenols, and trigonelline. Topical diterpenes inhibit inflammation in epidermal cells. During coffee roasting, trigonelline generates nicotinic acid and nicotinamide, both of which are protective against UVB-induced skin carcinogenesis in mice and UVB-induced immunosuppression in both humans and mice.
What’s the issue?
According to an article in The Washington Post, the “apple” adage originated in the 1860s; the original phrase was “Eat an apple on going to bed, and you’ll keep the doctor from earning his bread,” which evolved to “An apple a day, no doctor to pay,” then “An apple a day sends the doctor away” before the current version was first used in 1922. As one who enjoys having a cup of caffeinated coffee next to my computer in the office or at home, I can easily welcome the prospect of a few additional cups each day to prevent melanoma. And, as advocates for a possible benefit to our patients’ better health, should we should provide complimentary caffeinated coffee in our office waiting rooms to encourage our dermatology patients to decrease their risk for developing melanoma?
Prevention of Potential Infection Transmission: No Coat, No Tie, No Handshake, Please!
Do you greet your patients when you enter the examination room in your office or their room in the hospital? “Of course I do,” most physicians reply. And, do you shake hands? If your answer is yes, should you? Perhaps a fist bump would be a more hygienic alternative.
Mela and Whitworth (Am J Infect Control. 2014;42:916-917) demonstrated that “dap greetings” such as the high five and the fist bump dramatically reduced the transfer of bacteria during greeting exchange compared with the traditional handshake. Transmission of bacteria during the handshake was influenced not only by the large contact area but also the duration of the activity and the strength of the grip. Specifically, they observed the following about bacterial transfer: (1) it positively correlated with the area of contact made during the greeting, (2) it increased for greetings lasting longer than 3 seconds (handshakes and prolonged fist bumps), and (3) it was greater following handshakes with a strong grip as compared to those with a moderate-strength grip.
What’s the issue?
The potential spread of infection by physicians to their patients is an issue of concern. The transmission of health care–associated microorganisms by fomites in the hospital environment may contribute to this problem. Indeed, contaminated apparel of health care personnel may result in cross-transmission of bacteria.
A physician’s attire is influenced by culture and tradition. Many medical schools still conduct “white coat ceremonies” for their students to acknowledge the beginning of clinical training. However, physicians’ white coats may increase nosocomial infection transmission. It was shown that 91.3% of swabs taken from the cuffs and pocket mouths of white coats worn by physicians at an acute care hospital had bacterial contamination (World Health Popul. 2010;11:44-54).
Another potential vector for the transmission of infections by physicians is the necktie. Bacteria often colonize the neckties of health care workers; therefore, they can become a source of nosocomial infections in hospitalized individuals. Perhaps physicians, while providing patient care in a clinical setting, should not only hang up their white coats but also abandon their neckties in an effort to keep their patients safe.
Now, in addition to the physician’s attire, it has been shown that the physical interaction during the initial moments of the physician-patient encounter also may have the potential to transmit infectious organisms directly between 2 individuals. Indeed, an increased risk for infection transmission may be associated with the greeting type (particularly, the handshake), the greeting longevity (often >3 seconds), and the greeting contact force (eg, a strong grip). Therefore, following the salutation with patients, perhaps physicians should consider a fist bump instead of a handshake.
We want to know your views! Tell us what you think.
Suggested Readings
- Abuannadi M, O’Keefe JH, Brewer J. Neckties for physicians: yes? no? maybe? Mo Med. 2010;107:366-367.
- Bearman G, Bryant K, Leekha S, et al. Healthcare personnel attire in non-operating-room settings. Infect Control Hosp Epidemiol. 2014;35:107-121.
- Bi G, Wilson AB. Deadly ties and the rise of multi-drug resistant infections: a case for a new health care practitioner hygienic dress code. Independent Democratic Conference. https://www.yumpu.com/en/document/view/24854102/deadly-ties-and-the-rise-of-multi-drug-resistant-infections-a-case-. Published May 2011. Accessed March 12, 2015.
Do you greet your patients when you enter the examination room in your office or their room in the hospital? “Of course I do,” most physicians reply. And, do you shake hands? If your answer is yes, should you? Perhaps a fist bump would be a more hygienic alternative.
Mela and Whitworth (Am J Infect Control. 2014;42:916-917) demonstrated that “dap greetings” such as the high five and the fist bump dramatically reduced the transfer of bacteria during greeting exchange compared with the traditional handshake. Transmission of bacteria during the handshake was influenced not only by the large contact area but also the duration of the activity and the strength of the grip. Specifically, they observed the following about bacterial transfer: (1) it positively correlated with the area of contact made during the greeting, (2) it increased for greetings lasting longer than 3 seconds (handshakes and prolonged fist bumps), and (3) it was greater following handshakes with a strong grip as compared to those with a moderate-strength grip.
What’s the issue?
The potential spread of infection by physicians to their patients is an issue of concern. The transmission of health care–associated microorganisms by fomites in the hospital environment may contribute to this problem. Indeed, contaminated apparel of health care personnel may result in cross-transmission of bacteria.
A physician’s attire is influenced by culture and tradition. Many medical schools still conduct “white coat ceremonies” for their students to acknowledge the beginning of clinical training. However, physicians’ white coats may increase nosocomial infection transmission. It was shown that 91.3% of swabs taken from the cuffs and pocket mouths of white coats worn by physicians at an acute care hospital had bacterial contamination (World Health Popul. 2010;11:44-54).
Another potential vector for the transmission of infections by physicians is the necktie. Bacteria often colonize the neckties of health care workers; therefore, they can become a source of nosocomial infections in hospitalized individuals. Perhaps physicians, while providing patient care in a clinical setting, should not only hang up their white coats but also abandon their neckties in an effort to keep their patients safe.
Now, in addition to the physician’s attire, it has been shown that the physical interaction during the initial moments of the physician-patient encounter also may have the potential to transmit infectious organisms directly between 2 individuals. Indeed, an increased risk for infection transmission may be associated with the greeting type (particularly, the handshake), the greeting longevity (often >3 seconds), and the greeting contact force (eg, a strong grip). Therefore, following the salutation with patients, perhaps physicians should consider a fist bump instead of a handshake.
We want to know your views! Tell us what you think.
Suggested Readings
- Abuannadi M, O’Keefe JH, Brewer J. Neckties for physicians: yes? no? maybe? Mo Med. 2010;107:366-367.
- Bearman G, Bryant K, Leekha S, et al. Healthcare personnel attire in non-operating-room settings. Infect Control Hosp Epidemiol. 2014;35:107-121.
- Bi G, Wilson AB. Deadly ties and the rise of multi-drug resistant infections: a case for a new health care practitioner hygienic dress code. Independent Democratic Conference. https://www.yumpu.com/en/document/view/24854102/deadly-ties-and-the-rise-of-multi-drug-resistant-infections-a-case-. Published May 2011. Accessed March 12, 2015.
Do you greet your patients when you enter the examination room in your office or their room in the hospital? “Of course I do,” most physicians reply. And, do you shake hands? If your answer is yes, should you? Perhaps a fist bump would be a more hygienic alternative.
Mela and Whitworth (Am J Infect Control. 2014;42:916-917) demonstrated that “dap greetings” such as the high five and the fist bump dramatically reduced the transfer of bacteria during greeting exchange compared with the traditional handshake. Transmission of bacteria during the handshake was influenced not only by the large contact area but also the duration of the activity and the strength of the grip. Specifically, they observed the following about bacterial transfer: (1) it positively correlated with the area of contact made during the greeting, (2) it increased for greetings lasting longer than 3 seconds (handshakes and prolonged fist bumps), and (3) it was greater following handshakes with a strong grip as compared to those with a moderate-strength grip.
What’s the issue?
The potential spread of infection by physicians to their patients is an issue of concern. The transmission of health care–associated microorganisms by fomites in the hospital environment may contribute to this problem. Indeed, contaminated apparel of health care personnel may result in cross-transmission of bacteria.
A physician’s attire is influenced by culture and tradition. Many medical schools still conduct “white coat ceremonies” for their students to acknowledge the beginning of clinical training. However, physicians’ white coats may increase nosocomial infection transmission. It was shown that 91.3% of swabs taken from the cuffs and pocket mouths of white coats worn by physicians at an acute care hospital had bacterial contamination (World Health Popul. 2010;11:44-54).
Another potential vector for the transmission of infections by physicians is the necktie. Bacteria often colonize the neckties of health care workers; therefore, they can become a source of nosocomial infections in hospitalized individuals. Perhaps physicians, while providing patient care in a clinical setting, should not only hang up their white coats but also abandon their neckties in an effort to keep their patients safe.
Now, in addition to the physician’s attire, it has been shown that the physical interaction during the initial moments of the physician-patient encounter also may have the potential to transmit infectious organisms directly between 2 individuals. Indeed, an increased risk for infection transmission may be associated with the greeting type (particularly, the handshake), the greeting longevity (often >3 seconds), and the greeting contact force (eg, a strong grip). Therefore, following the salutation with patients, perhaps physicians should consider a fist bump instead of a handshake.
We want to know your views! Tell us what you think.
Suggested Readings
- Abuannadi M, O’Keefe JH, Brewer J. Neckties for physicians: yes? no? maybe? Mo Med. 2010;107:366-367.
- Bearman G, Bryant K, Leekha S, et al. Healthcare personnel attire in non-operating-room settings. Infect Control Hosp Epidemiol. 2014;35:107-121.
- Bi G, Wilson AB. Deadly ties and the rise of multi-drug resistant infections: a case for a new health care practitioner hygienic dress code. Independent Democratic Conference. https://www.yumpu.com/en/document/view/24854102/deadly-ties-and-the-rise-of-multi-drug-resistant-infections-a-case-. Published May 2011. Accessed March 12, 2015.
Does Your Dermatology Center Need a Dermatoscenter?
There are anecdotal reports of dogs detecting melanoma and studies of canines being able to not only detect but also distinguish cancer from noncancer. Analysis of volatile compounds or metabolites from exhaled human breath and excreted urine also has been shown to differentiate between patients with certain cancers and healthy individuals. In addition, investigators have demonstrated that melanoma tissue has a volatile profile that is distinct from healthy nonneoplastic skin and nevi.
Abaffy et al (Metabolomics. 2013;9:998-1008) conducted a study that gives further support to the potential for analyzing volatile organic compounds as biomarkers of melanoma. They used the headspace solid phase microextraction method followed by gas chromatography and mass spectrometry to compare the volatile metabolic profiles of melanoma and nonneoplastic healthy-appearing adjacent skin from the same patient. They discovered increased levels of lauric acid (C12:0) and palmitic acid (C16:0) in melanoma and they postulated that the increased levels of these fatty acids were due to cancer-associated upregulation of de novo lipid synthesis.
What’s the issue?
In the 1980s, nail fold capillary microscopy using an ophthalmoscope was occasionally performed to evaluate for disease-associated vascular changes in patients who were being evaluated for connective tissue disorders. Within 2 decades, a dermoscope to assist in the evaluation of not only nail folds but also pigmented and other lesions replaced the ophthalmoscope. The US Food and Drug Administration recently approved a software-driven optical imaging and data analysis device that can be used to obtain additional information to assist the clinician in making a decision whether to biopsy a pigmented lesion.
As our ability to develop more sensitive and specific methods to diagnose melanoma and differentiate it from benign lesions advances, our approach to the evaluation of patients with pigmented lesions shall continue to be modified. Based on the detection of melanoma-associated volatile organic compounds coupled with their potential use as readily accessible tumor-related biomarkers, it is reasonable to speculate: (1) that a handheld office-based device, a dermatoscenter, that can identify melanoma-induced volatile tumor markers shall be developed to evaluate whether pigmented lesions are malignant or benign, and (2) that this device will eventually become an integral component of the dermatologist’s diagnostic armamentarium. Does your dermatology center need a dermatoscenter?
There are anecdotal reports of dogs detecting melanoma and studies of canines being able to not only detect but also distinguish cancer from noncancer. Analysis of volatile compounds or metabolites from exhaled human breath and excreted urine also has been shown to differentiate between patients with certain cancers and healthy individuals. In addition, investigators have demonstrated that melanoma tissue has a volatile profile that is distinct from healthy nonneoplastic skin and nevi.
Abaffy et al (Metabolomics. 2013;9:998-1008) conducted a study that gives further support to the potential for analyzing volatile organic compounds as biomarkers of melanoma. They used the headspace solid phase microextraction method followed by gas chromatography and mass spectrometry to compare the volatile metabolic profiles of melanoma and nonneoplastic healthy-appearing adjacent skin from the same patient. They discovered increased levels of lauric acid (C12:0) and palmitic acid (C16:0) in melanoma and they postulated that the increased levels of these fatty acids were due to cancer-associated upregulation of de novo lipid synthesis.
What’s the issue?
In the 1980s, nail fold capillary microscopy using an ophthalmoscope was occasionally performed to evaluate for disease-associated vascular changes in patients who were being evaluated for connective tissue disorders. Within 2 decades, a dermoscope to assist in the evaluation of not only nail folds but also pigmented and other lesions replaced the ophthalmoscope. The US Food and Drug Administration recently approved a software-driven optical imaging and data analysis device that can be used to obtain additional information to assist the clinician in making a decision whether to biopsy a pigmented lesion.
As our ability to develop more sensitive and specific methods to diagnose melanoma and differentiate it from benign lesions advances, our approach to the evaluation of patients with pigmented lesions shall continue to be modified. Based on the detection of melanoma-associated volatile organic compounds coupled with their potential use as readily accessible tumor-related biomarkers, it is reasonable to speculate: (1) that a handheld office-based device, a dermatoscenter, that can identify melanoma-induced volatile tumor markers shall be developed to evaluate whether pigmented lesions are malignant or benign, and (2) that this device will eventually become an integral component of the dermatologist’s diagnostic armamentarium. Does your dermatology center need a dermatoscenter?
There are anecdotal reports of dogs detecting melanoma and studies of canines being able to not only detect but also distinguish cancer from noncancer. Analysis of volatile compounds or metabolites from exhaled human breath and excreted urine also has been shown to differentiate between patients with certain cancers and healthy individuals. In addition, investigators have demonstrated that melanoma tissue has a volatile profile that is distinct from healthy nonneoplastic skin and nevi.
Abaffy et al (Metabolomics. 2013;9:998-1008) conducted a study that gives further support to the potential for analyzing volatile organic compounds as biomarkers of melanoma. They used the headspace solid phase microextraction method followed by gas chromatography and mass spectrometry to compare the volatile metabolic profiles of melanoma and nonneoplastic healthy-appearing adjacent skin from the same patient. They discovered increased levels of lauric acid (C12:0) and palmitic acid (C16:0) in melanoma and they postulated that the increased levels of these fatty acids were due to cancer-associated upregulation of de novo lipid synthesis.
What’s the issue?
In the 1980s, nail fold capillary microscopy using an ophthalmoscope was occasionally performed to evaluate for disease-associated vascular changes in patients who were being evaluated for connective tissue disorders. Within 2 decades, a dermoscope to assist in the evaluation of not only nail folds but also pigmented and other lesions replaced the ophthalmoscope. The US Food and Drug Administration recently approved a software-driven optical imaging and data analysis device that can be used to obtain additional information to assist the clinician in making a decision whether to biopsy a pigmented lesion.
As our ability to develop more sensitive and specific methods to diagnose melanoma and differentiate it from benign lesions advances, our approach to the evaluation of patients with pigmented lesions shall continue to be modified. Based on the detection of melanoma-associated volatile organic compounds coupled with their potential use as readily accessible tumor-related biomarkers, it is reasonable to speculate: (1) that a handheld office-based device, a dermatoscenter, that can identify melanoma-induced volatile tumor markers shall be developed to evaluate whether pigmented lesions are malignant or benign, and (2) that this device will eventually become an integral component of the dermatologist’s diagnostic armamentarium. Does your dermatology center need a dermatoscenter?
Old Concept, New Drug: Topical Application of Systemic Antineoplastic Agent to Treat Skin Cancer
In a June 29 article published online in Molecular Carcinogenesis, Fenton et al demonstrated that topical dasatinib treatment of UVB-exposed SKH1 hairless mice reduced the total tumor burden (ie, benign tumors, atypical benign tumors, squamous cell carcinomas) per mouse.
Dasatinib is a tyrosine kinase inhibitor currently used to treat imatinib-resistant chronic myeloid leukemia and Philadelphia chromosome positive acute lymphoblastic leukemia. Its mechanism of action is to block the activity of tyrosine kinases by attaching to their adenosine triphosphate–binding site. It can inhibit the activity of the following tyrosine kinases: Src family kinases (SFK), break point cluster region-Abelson (Bcr-Abl), Ephrin type-A receptor 2 (EphA2), platelet-derived growth factor receptor, and mast/stem cell factor receptor (also called CD117 or c-Kit).
Src family kinases are associated with transformation of cells and progression of cancer. Elevated Src family kinases activity is present in the majority of human carcinomas.
Fyn, a nonreceptor tyrosine kinase, is a member of the Src family kinases. Cell growth, cell migration, and protein kinase B (Akt)–mediated inhibition of apoptosis are influenced by Fyn activity. In addition, Fyn activity is overexpressed in cutaneous squamous cell carcinoma.
In conclusion, dasatinib—an Src family kinases inhibitor—was able to inhibit Fyn activity and thereby reduce UV-induced skin carcinogenesis.
What’s the issue?
In 1962, Falkson and Schulz (Br J Dermatol. 1962;74:229-236) noted not only inflammation and subsequent resolution of actinic keratoses after exposure to sunlight in a woman with colon cancer being treated with systemic 5-fluorouracil but also several other patients whose keratoses were seen to disappear during therapy without preceding erythema. Omura and Torre (JAMA. 1969;208:150-151) confirmed these observations in a woman with breast cancer whose actinic keratoses became inflamed after receiving intravenous 5-fluorouracil and subsequently faded. The route of drug administration was modified and 5-fluorouracil was applied topically. Today topical 5-fluorouracil is still used for the treatment of actinic keratoses.
Topical application of nitrogen mustard is used in the treatment of cutaneous T-cell lymphoma. In addition, intralesional administration of systemic antineoplastic agents has been used to treat cutaneous neoplasms: methotrexate for keratoacanthomas and rituximab for primary cutaneous B-cell lymphomas.
The Fenton et al study suggests that topical dasatinib may be a potential therapeutic intervention for the treatment of cutaneous squamous cell carcinoma. The investigators not only demonstrate laboratory data from mouse studies but also provide a potential molecular mechanism for drug-associated tumor suppression. Indeed, dasatinib solution, dasatinib cream, or both may be the next innovative therapy for the suppression of cutaneous squamous cell carcinoma in organ transplant and immunocompromised patients and for the potential management of this skin cancer in immunocompetent individuals. What do you think?
In a June 29 article published online in Molecular Carcinogenesis, Fenton et al demonstrated that topical dasatinib treatment of UVB-exposed SKH1 hairless mice reduced the total tumor burden (ie, benign tumors, atypical benign tumors, squamous cell carcinomas) per mouse.
Dasatinib is a tyrosine kinase inhibitor currently used to treat imatinib-resistant chronic myeloid leukemia and Philadelphia chromosome positive acute lymphoblastic leukemia. Its mechanism of action is to block the activity of tyrosine kinases by attaching to their adenosine triphosphate–binding site. It can inhibit the activity of the following tyrosine kinases: Src family kinases (SFK), break point cluster region-Abelson (Bcr-Abl), Ephrin type-A receptor 2 (EphA2), platelet-derived growth factor receptor, and mast/stem cell factor receptor (also called CD117 or c-Kit).
Src family kinases are associated with transformation of cells and progression of cancer. Elevated Src family kinases activity is present in the majority of human carcinomas.
Fyn, a nonreceptor tyrosine kinase, is a member of the Src family kinases. Cell growth, cell migration, and protein kinase B (Akt)–mediated inhibition of apoptosis are influenced by Fyn activity. In addition, Fyn activity is overexpressed in cutaneous squamous cell carcinoma.
In conclusion, dasatinib—an Src family kinases inhibitor—was able to inhibit Fyn activity and thereby reduce UV-induced skin carcinogenesis.
What’s the issue?
In 1962, Falkson and Schulz (Br J Dermatol. 1962;74:229-236) noted not only inflammation and subsequent resolution of actinic keratoses after exposure to sunlight in a woman with colon cancer being treated with systemic 5-fluorouracil but also several other patients whose keratoses were seen to disappear during therapy without preceding erythema. Omura and Torre (JAMA. 1969;208:150-151) confirmed these observations in a woman with breast cancer whose actinic keratoses became inflamed after receiving intravenous 5-fluorouracil and subsequently faded. The route of drug administration was modified and 5-fluorouracil was applied topically. Today topical 5-fluorouracil is still used for the treatment of actinic keratoses.
Topical application of nitrogen mustard is used in the treatment of cutaneous T-cell lymphoma. In addition, intralesional administration of systemic antineoplastic agents has been used to treat cutaneous neoplasms: methotrexate for keratoacanthomas and rituximab for primary cutaneous B-cell lymphomas.
The Fenton et al study suggests that topical dasatinib may be a potential therapeutic intervention for the treatment of cutaneous squamous cell carcinoma. The investigators not only demonstrate laboratory data from mouse studies but also provide a potential molecular mechanism for drug-associated tumor suppression. Indeed, dasatinib solution, dasatinib cream, or both may be the next innovative therapy for the suppression of cutaneous squamous cell carcinoma in organ transplant and immunocompromised patients and for the potential management of this skin cancer in immunocompetent individuals. What do you think?
In a June 29 article published online in Molecular Carcinogenesis, Fenton et al demonstrated that topical dasatinib treatment of UVB-exposed SKH1 hairless mice reduced the total tumor burden (ie, benign tumors, atypical benign tumors, squamous cell carcinomas) per mouse.
Dasatinib is a tyrosine kinase inhibitor currently used to treat imatinib-resistant chronic myeloid leukemia and Philadelphia chromosome positive acute lymphoblastic leukemia. Its mechanism of action is to block the activity of tyrosine kinases by attaching to their adenosine triphosphate–binding site. It can inhibit the activity of the following tyrosine kinases: Src family kinases (SFK), break point cluster region-Abelson (Bcr-Abl), Ephrin type-A receptor 2 (EphA2), platelet-derived growth factor receptor, and mast/stem cell factor receptor (also called CD117 or c-Kit).
Src family kinases are associated with transformation of cells and progression of cancer. Elevated Src family kinases activity is present in the majority of human carcinomas.
Fyn, a nonreceptor tyrosine kinase, is a member of the Src family kinases. Cell growth, cell migration, and protein kinase B (Akt)–mediated inhibition of apoptosis are influenced by Fyn activity. In addition, Fyn activity is overexpressed in cutaneous squamous cell carcinoma.
In conclusion, dasatinib—an Src family kinases inhibitor—was able to inhibit Fyn activity and thereby reduce UV-induced skin carcinogenesis.
What’s the issue?
In 1962, Falkson and Schulz (Br J Dermatol. 1962;74:229-236) noted not only inflammation and subsequent resolution of actinic keratoses after exposure to sunlight in a woman with colon cancer being treated with systemic 5-fluorouracil but also several other patients whose keratoses were seen to disappear during therapy without preceding erythema. Omura and Torre (JAMA. 1969;208:150-151) confirmed these observations in a woman with breast cancer whose actinic keratoses became inflamed after receiving intravenous 5-fluorouracil and subsequently faded. The route of drug administration was modified and 5-fluorouracil was applied topically. Today topical 5-fluorouracil is still used for the treatment of actinic keratoses.
Topical application of nitrogen mustard is used in the treatment of cutaneous T-cell lymphoma. In addition, intralesional administration of systemic antineoplastic agents has been used to treat cutaneous neoplasms: methotrexate for keratoacanthomas and rituximab for primary cutaneous B-cell lymphomas.
The Fenton et al study suggests that topical dasatinib may be a potential therapeutic intervention for the treatment of cutaneous squamous cell carcinoma. The investigators not only demonstrate laboratory data from mouse studies but also provide a potential molecular mechanism for drug-associated tumor suppression. Indeed, dasatinib solution, dasatinib cream, or both may be the next innovative therapy for the suppression of cutaneous squamous cell carcinoma in organ transplant and immunocompromised patients and for the potential management of this skin cancer in immunocompetent individuals. What do you think?
Bedside Teaching Rounds: An Essential Component of Dermatology Training!
Educating medical students incorporates not only classroom instruction but also bedside teaching. However, in a recent article McGee (JAMA. 2014;311:1971-1972) commented that “teachers spend less than 25% of their teaching time at the bedside.” Therefore, he reconsidered how to routinely incorporate bedside teaching rounds.
McGee recommended that the oral presentation of the patient be brief. He also commented that the subjects best suited for bedside teaching are those who focus on communication, professionalism, and clinical skills. In contrast, complex discussions of pathophysiology and treatment are more appropriate for the classroom. He suggested that the teacher compose and memorize minilectures to use during rounds at the bedside.
In addition, McGee “celebrate[d] the triumphs of bedside examination” by providing 3 personal examples in which patient evaluation at the bedside trumped technology. It is noteworthy but not unexpected that all of the patients had systemic conditions for which the cutaneous findings, in concert with other nondermatologic features, helped to establish the diagnosis. The cases included patients who either had subacute bacterial endocarditis with splinter hemorrhages, reactive arthritis with psoriasiform lesions on the soles of the feet and penis, or hereditary hemorrhagic telangiectasia with pallor and matlike telangiectases on the fingertips and lower lip.
I fondly remember that during my residency a group of no fewer than 15 to 20 individuals—not only the entire dermatology department but also the medical students on their dermatology clerkship; other clinicians attending the weekly Grand Rounds; and medicine, pediatric, or surgery residents who joined the group—ambulated through the floors of the hospital visiting several patients in their rooms. Bedside teaching gave those who were present the opportunity to observe cutaneous manifestations of systemic diseases. It also allowed for the discovery of clinical observations, such as the linear tongue fissures of herpetic geometric glossitis in immunocompromised patients with oral herpes simplex virus infection.
What’s the issue?
Is teaching at the bedside an activity destined for extinction? Is this time-honored classical method of training, since the days of Sir William Olser at Johns Hopkins Hospital in Baltimore, Maryland, becoming an educational artifact of only historic significance?
Unfortunately, there are several barriers to bedside teaching. For example, insufficient time to teach is a major problem. In addition, many diagnoses require ancillary technology such as an electrocardiogram or roentgenogram.
However, there are definite benefits of bedside teaching rounds. This activity can help to calm patients. Teaching at the bedside also provides the mentee with an opportunity to not only see their mentors interact with patients but also to learn physical diagnosis and embrace the concept that patients are unique individuals and not merely abstract diseases or cases. Additionally, bedside teaching provides an opportunity for many patients who derive personal gratification by being able to help in the education of others.
Teaching dermatology often involves the mentor instructing the mentee, either during an encounter with the patient, shortly after they evaluate the patient together, or both.
Dermatology training conferences and society meetings often incorporate patient viewing and discussion. Indeed, bedside teaching and its equivalent when evaluating and treating patients in the office has been and continues to be an integral aspect of dermatology training.
Educating medical students incorporates not only classroom instruction but also bedside teaching. However, in a recent article McGee (JAMA. 2014;311:1971-1972) commented that “teachers spend less than 25% of their teaching time at the bedside.” Therefore, he reconsidered how to routinely incorporate bedside teaching rounds.
McGee recommended that the oral presentation of the patient be brief. He also commented that the subjects best suited for bedside teaching are those who focus on communication, professionalism, and clinical skills. In contrast, complex discussions of pathophysiology and treatment are more appropriate for the classroom. He suggested that the teacher compose and memorize minilectures to use during rounds at the bedside.
In addition, McGee “celebrate[d] the triumphs of bedside examination” by providing 3 personal examples in which patient evaluation at the bedside trumped technology. It is noteworthy but not unexpected that all of the patients had systemic conditions for which the cutaneous findings, in concert with other nondermatologic features, helped to establish the diagnosis. The cases included patients who either had subacute bacterial endocarditis with splinter hemorrhages, reactive arthritis with psoriasiform lesions on the soles of the feet and penis, or hereditary hemorrhagic telangiectasia with pallor and matlike telangiectases on the fingertips and lower lip.
I fondly remember that during my residency a group of no fewer than 15 to 20 individuals—not only the entire dermatology department but also the medical students on their dermatology clerkship; other clinicians attending the weekly Grand Rounds; and medicine, pediatric, or surgery residents who joined the group—ambulated through the floors of the hospital visiting several patients in their rooms. Bedside teaching gave those who were present the opportunity to observe cutaneous manifestations of systemic diseases. It also allowed for the discovery of clinical observations, such as the linear tongue fissures of herpetic geometric glossitis in immunocompromised patients with oral herpes simplex virus infection.
What’s the issue?
Is teaching at the bedside an activity destined for extinction? Is this time-honored classical method of training, since the days of Sir William Olser at Johns Hopkins Hospital in Baltimore, Maryland, becoming an educational artifact of only historic significance?
Unfortunately, there are several barriers to bedside teaching. For example, insufficient time to teach is a major problem. In addition, many diagnoses require ancillary technology such as an electrocardiogram or roentgenogram.
However, there are definite benefits of bedside teaching rounds. This activity can help to calm patients. Teaching at the bedside also provides the mentee with an opportunity to not only see their mentors interact with patients but also to learn physical diagnosis and embrace the concept that patients are unique individuals and not merely abstract diseases or cases. Additionally, bedside teaching provides an opportunity for many patients who derive personal gratification by being able to help in the education of others.
Teaching dermatology often involves the mentor instructing the mentee, either during an encounter with the patient, shortly after they evaluate the patient together, or both.
Dermatology training conferences and society meetings often incorporate patient viewing and discussion. Indeed, bedside teaching and its equivalent when evaluating and treating patients in the office has been and continues to be an integral aspect of dermatology training.
Educating medical students incorporates not only classroom instruction but also bedside teaching. However, in a recent article McGee (JAMA. 2014;311:1971-1972) commented that “teachers spend less than 25% of their teaching time at the bedside.” Therefore, he reconsidered how to routinely incorporate bedside teaching rounds.
McGee recommended that the oral presentation of the patient be brief. He also commented that the subjects best suited for bedside teaching are those who focus on communication, professionalism, and clinical skills. In contrast, complex discussions of pathophysiology and treatment are more appropriate for the classroom. He suggested that the teacher compose and memorize minilectures to use during rounds at the bedside.
In addition, McGee “celebrate[d] the triumphs of bedside examination” by providing 3 personal examples in which patient evaluation at the bedside trumped technology. It is noteworthy but not unexpected that all of the patients had systemic conditions for which the cutaneous findings, in concert with other nondermatologic features, helped to establish the diagnosis. The cases included patients who either had subacute bacterial endocarditis with splinter hemorrhages, reactive arthritis with psoriasiform lesions on the soles of the feet and penis, or hereditary hemorrhagic telangiectasia with pallor and matlike telangiectases on the fingertips and lower lip.
I fondly remember that during my residency a group of no fewer than 15 to 20 individuals—not only the entire dermatology department but also the medical students on their dermatology clerkship; other clinicians attending the weekly Grand Rounds; and medicine, pediatric, or surgery residents who joined the group—ambulated through the floors of the hospital visiting several patients in their rooms. Bedside teaching gave those who were present the opportunity to observe cutaneous manifestations of systemic diseases. It also allowed for the discovery of clinical observations, such as the linear tongue fissures of herpetic geometric glossitis in immunocompromised patients with oral herpes simplex virus infection.
What’s the issue?
Is teaching at the bedside an activity destined for extinction? Is this time-honored classical method of training, since the days of Sir William Olser at Johns Hopkins Hospital in Baltimore, Maryland, becoming an educational artifact of only historic significance?
Unfortunately, there are several barriers to bedside teaching. For example, insufficient time to teach is a major problem. In addition, many diagnoses require ancillary technology such as an electrocardiogram or roentgenogram.
However, there are definite benefits of bedside teaching rounds. This activity can help to calm patients. Teaching at the bedside also provides the mentee with an opportunity to not only see their mentors interact with patients but also to learn physical diagnosis and embrace the concept that patients are unique individuals and not merely abstract diseases or cases. Additionally, bedside teaching provides an opportunity for many patients who derive personal gratification by being able to help in the education of others.
Teaching dermatology often involves the mentor instructing the mentee, either during an encounter with the patient, shortly after they evaluate the patient together, or both.
Dermatology training conferences and society meetings often incorporate patient viewing and discussion. Indeed, bedside teaching and its equivalent when evaluating and treating patients in the office has been and continues to be an integral aspect of dermatology training.
Is There a Potential Benefit of Expressive Writing for Dermatology Patients?
A diagnosis of a chronic and/or serious medical condition can be a traumatic experience. Patients may experience not only intrusive thoughts but also avoidance behaviors. The affected individuals can express these trauma-associated symptoms as depression, fatigue, and sleep disturbance.
Milbury et al (J Clin Oncol. 2014;32:663-670) included 277 patients who had been diagnosed with renal cell carcinoma in a study to evaluate if writing about their deepest thoughts and feelings regarding their cancer (expressive writing) offered a quality-of-life benefit compared to writing about neutral topics (neutral writing). They found that expressive writing not only reduced the patients’ cancer-related symptoms but also improved their physical functioning.
What’s the issue?
Many of the conditions that affect dermatology patients are chronic, serious, or both. For example, psoriasis is a chronic skin condition with the potential for serious associated rheumatologic or metabolic sequelae. In addition, skin malignancies (eg, basal cell carcinoma, squamous cell carcinoma, malignant melanoma) and cutaneous lymphoma (eg, mycosis fungoides) are conditions that require chronic surveillance and possibly may have serious consequences.
Expressive writing for dermatology patients might result in remarkable improvement in emotional and physical health. Perhaps dermatologists should recommend this intervention for their patients.
A diagnosis of a chronic and/or serious medical condition can be a traumatic experience. Patients may experience not only intrusive thoughts but also avoidance behaviors. The affected individuals can express these trauma-associated symptoms as depression, fatigue, and sleep disturbance.
Milbury et al (J Clin Oncol. 2014;32:663-670) included 277 patients who had been diagnosed with renal cell carcinoma in a study to evaluate if writing about their deepest thoughts and feelings regarding their cancer (expressive writing) offered a quality-of-life benefit compared to writing about neutral topics (neutral writing). They found that expressive writing not only reduced the patients’ cancer-related symptoms but also improved their physical functioning.
What’s the issue?
Many of the conditions that affect dermatology patients are chronic, serious, or both. For example, psoriasis is a chronic skin condition with the potential for serious associated rheumatologic or metabolic sequelae. In addition, skin malignancies (eg, basal cell carcinoma, squamous cell carcinoma, malignant melanoma) and cutaneous lymphoma (eg, mycosis fungoides) are conditions that require chronic surveillance and possibly may have serious consequences.
Expressive writing for dermatology patients might result in remarkable improvement in emotional and physical health. Perhaps dermatologists should recommend this intervention for their patients.
A diagnosis of a chronic and/or serious medical condition can be a traumatic experience. Patients may experience not only intrusive thoughts but also avoidance behaviors. The affected individuals can express these trauma-associated symptoms as depression, fatigue, and sleep disturbance.
Milbury et al (J Clin Oncol. 2014;32:663-670) included 277 patients who had been diagnosed with renal cell carcinoma in a study to evaluate if writing about their deepest thoughts and feelings regarding their cancer (expressive writing) offered a quality-of-life benefit compared to writing about neutral topics (neutral writing). They found that expressive writing not only reduced the patients’ cancer-related symptoms but also improved their physical functioning.
What’s the issue?
Many of the conditions that affect dermatology patients are chronic, serious, or both. For example, psoriasis is a chronic skin condition with the potential for serious associated rheumatologic or metabolic sequelae. In addition, skin malignancies (eg, basal cell carcinoma, squamous cell carcinoma, malignant melanoma) and cutaneous lymphoma (eg, mycosis fungoides) are conditions that require chronic surveillance and possibly may have serious consequences.
Expressive writing for dermatology patients might result in remarkable improvement in emotional and physical health. Perhaps dermatologists should recommend this intervention for their patients.
Increased Risk for Melanoma in Men With Prostate Cancer: Implications for Clinical Practice?
Prostate tumorigenesis is related to sex hormones, particularly androgens. It also has been suggested that melanoma may be androgen dependent. Postulated mechanisms of pathogenesis include androgen level imbalance (for which early evidence may present as severe teenaged acne), chromosome telomere length alteration (for which increased risk for melanoma is associated with long telomeres), and host immune response modification.
In a December 2013 article published in the Journal of Clinical Oncology, Li et al (2013;31:4394-4399) confirmed that a personal history of prostate cancer was associated with an increased risk for subsequent melanoma. Among patients with prostate cancer whose median age at diagnosis was 68 years or younger, a higher hazard ratio of melanoma was noted. Also, similar to prostate cancer, they observed a positive association between melanoma risk and severe teenaged acne defined by the use of tetracycline for 4 or more years.
What’s the issue?
Are there clinical implications to the confirmation that there is an increased risk for patients with prostate cancer to subsequently develop melanoma? Specifically, should there be increased surveillance for melanoma in these individuals? Perhaps it would be reasonable to regularly perform a complete skin examination in all patients with a history of prostate cancer, especially men who had prostate cancer diagnosed before 68 years of age.
Prostate tumorigenesis is related to sex hormones, particularly androgens. It also has been suggested that melanoma may be androgen dependent. Postulated mechanisms of pathogenesis include androgen level imbalance (for which early evidence may present as severe teenaged acne), chromosome telomere length alteration (for which increased risk for melanoma is associated with long telomeres), and host immune response modification.
In a December 2013 article published in the Journal of Clinical Oncology, Li et al (2013;31:4394-4399) confirmed that a personal history of prostate cancer was associated with an increased risk for subsequent melanoma. Among patients with prostate cancer whose median age at diagnosis was 68 years or younger, a higher hazard ratio of melanoma was noted. Also, similar to prostate cancer, they observed a positive association between melanoma risk and severe teenaged acne defined by the use of tetracycline for 4 or more years.
What’s the issue?
Are there clinical implications to the confirmation that there is an increased risk for patients with prostate cancer to subsequently develop melanoma? Specifically, should there be increased surveillance for melanoma in these individuals? Perhaps it would be reasonable to regularly perform a complete skin examination in all patients with a history of prostate cancer, especially men who had prostate cancer diagnosed before 68 years of age.
Prostate tumorigenesis is related to sex hormones, particularly androgens. It also has been suggested that melanoma may be androgen dependent. Postulated mechanisms of pathogenesis include androgen level imbalance (for which early evidence may present as severe teenaged acne), chromosome telomere length alteration (for which increased risk for melanoma is associated with long telomeres), and host immune response modification.
In a December 2013 article published in the Journal of Clinical Oncology, Li et al (2013;31:4394-4399) confirmed that a personal history of prostate cancer was associated with an increased risk for subsequent melanoma. Among patients with prostate cancer whose median age at diagnosis was 68 years or younger, a higher hazard ratio of melanoma was noted. Also, similar to prostate cancer, they observed a positive association between melanoma risk and severe teenaged acne defined by the use of tetracycline for 4 or more years.
What’s the issue?
Are there clinical implications to the confirmation that there is an increased risk for patients with prostate cancer to subsequently develop melanoma? Specifically, should there be increased surveillance for melanoma in these individuals? Perhaps it would be reasonable to regularly perform a complete skin examination in all patients with a history of prostate cancer, especially men who had prostate cancer diagnosed before 68 years of age.
