Biologic therapy with or without topical treatment in psoriasis: what does the current evidence say?

Biologic therapy represents a relatively new class of drugs which have revolutionized the treatment of psoriasis and are used with increasing frequency in order to control this chronic, systemic inflammatory disease. However, it is unclear what role there is for combination therapy of biologics with traditional topical agents. The purpose of this article is to assess the literature on the role of topical agents as adjuvants to biological treatments in the treatment of psoriasis and identify areas for further research. A MEDLINE search was performed in order to identify English-language publications from 1996 to 2014 examining combination biologic therapy with topical medications in the treatment of psoriasis. Data from these clinical studies are summarized and the outcomes are discussed. In general, the addition of adjuvant topical therapy to systemic biologic therapy allowed for a reduction in dosage and side effects of both agents, maintenance of initial response to biologics, treatment of recalcitrant lesions in partial responders, and potential acceleration of response to biologic therapies. The current data, though limited, suggest that using topical therapies as adjunct treatment to biologics is a well tolerated and effective means of controlling psoriasis and improving quality of life for patients. However, the treating physician should remain attentive to signs of adverse events and seek opportunities to reduce the dose or treatment frequency during chronic use.

Ablative fractionated CO2 resurfacing yields excellent result for severely atrophic traumatic scar on the face.

Ablative fractionated resurfacing has gained significant traction as an effective treatment for acne, burn, traumatic, and surgical scars over recent years. We report a case of a severely depressed, atrophic scar on the cheek of a middle aged woman treated with a 10,600 nm factionated CO2 laser. Serial treatments were performed, resulting in marked improvement in scar contour, texture, and overall cosmesis. Our report highlights the utility of ablative fractionated resurfacing for the treatment of post-traumatic, atrophic scars on the face.

Paraneoplastic pityriasis rubra pilaris as the presenting manifestation of metastatic squamous cell carcinoma.

Pityriasis rubra pilaris (PRP) is a rare idiopathic papulosquamous eruption. Few cases of PRP have been reported in association with malignancies. We report a case of an 83-year-old Caucasian male who presented with recalcitrant paraneoplastic PRP as the presenting manifestation of metastatic squamous cell carcinoma with unknown primary. Treatment with chemotherapy and radiation led to temporary radiologic and symptomatic regression of the cancer as well as resolution of cutaneous findings. This suggests a direct relationship between the PRP and the underlying malignancy in this patient. This case highlights a rare, but important phenomenon in which PRP may act as a harbinger for underlying malignancy.

Dermatology education and the Internet: traditional and cutting-edge resources.

BACKGROUND: The number and variety of dermatological medical resources available online has grown exponentially over the past decade. Internet-based resources allow for immediate and easy access to information for both medical education and reference purposes. Although clinicians continue to turn to the Internet for clinical information and still images, tech-savvy medical students are currently accessing a variety of exciting new resources, including discussion boards, wikis, streaming video, podcasts, journal clubs, online communities, and interactive diagnostic experiences to augment their medical education. OBJECTIVE: The objective of this study was to identify traditional and cutting-edge online dermatology resources. METHODS: We present a sampling of the top dermatology Internet resources, as assessed by a group of medical students in our university dermatology research lab. These resources were ranked by using a matrix derived from the Silberg Criteria, which assessed authorship, attribution, disclosure, currency, and content. Results indicate comparable ranking and approval of cutting-edge resources as traditional online sources. The ranked resources in each category are provided with URLs for readers' use. CONCLUSIONS: These cutting-edge online dermatology resources represent excellent sources for continuing education for students and clinicians alike. Resources such as these likely represent the future of medical education, as they allow for self-directed and supplementary education as well as remote access.

Ellagic acid inhibits melanoma growth in vitro.

Ellagic is a polyphenolic compound with anti-fibrotic and antioxidant properties, and exhibits antitumor properties against various cancer cells in vitro. There are few studies, however, which examine the effects of ellagic acid on melanoma. In the present study, we observe effects of ellagic acid on melanoma cells in vitro. Three metastatic melanoma cell lines (1205Lu, WM852c and A375) were examined to determine the effects of ellagic acid on melanoma cell viability, cell-cycle, apoptosis, NF-κß activity, and IL-1ß & IL-8 secretion. Cell viability assays demonstrated that ellagic acid possesses an inhibitory effect on cell proliferation at concentrations between 25 and 100 µM. In addition, ellagic acid promoted G1 cell cycle arrest, increased levels of apoptosis and decreased synthesis of IL-1ß and IL-8 in melanoma cells. Ellagic acid also decreased NF-κß activity, suggesting at least one potential mechanism by which ellagic acid may exert its effects in melanoma cells. Our findings support further investigation into prospective roles for ellagic acid as a therapeutic, adjuvant, or preventive agent for melanoma.

Nutrition and melanoma prevention.

Melanoma has continued to rise in incidence despite public efforts to promote sun protection behaviors. Because sunscreen use does not completely prevent skin cancer induced by ultraviolet radiation, additional chemopreventive methods for protecting against and reversing the effects of ultraviolet photodamage need evaluation. Recent years have brought increased interest in dietary factors, such as natural botanicals and vitamins, for the prevention of melanoma. This contribution provides a narrative review of the relevant, nutrition-related literature found by searching the keywords "melanoma chemoprevention," "nutrition and melanoma," "dietary botanicals and melanoma prevention," "green tea and melanoma," "vitamin D and melanoma," and "vitamin E and melanoma" in the PubMed database. Although randomized controlled trials of humans are lacking, basic science and epidemiologic studies show promising benefits of many natural products in chemoprevention for melanoma. Future studies, hopefully, will yield concrete answers and clarify the role of commonly available dietary nutrients in melanoma chemoprevention.

Nuclear variants of bone morphogenetic proteins.

BACKGROUND: Bone morphogenetic proteins (BMPs) contribute to many different aspects of development including mesoderm formation, heart development, neurogenesis, skeletal development, and axis formation. They have previously been recognized only as secreted growth factors, but the present study detected Bmp2, Bmp4, and Gdf5/CDMP1 in the nuclei of cultured cells using immunocytochemistry and immunoblotting of nuclear extracts. RESULTS: In all three proteins, a bipartite nuclear localization signal (NLS) was found to overlap the site at which the proproteins are cleaved to release the mature growth factors from the propeptides. Mutational analyses indicated that the nuclear variants of these three proteins are produced by initiating translation from downstream alternative start codons. The resulting proteins lack N-terminal signal peptides and are therefore translated in the cytoplasm rather than the endoplasmic reticulum, thus avoiding proteolytic processing in the secretory pathway. Instead, the uncleaved proteins (designated nBmp2, nBmp4, and nGdf5) containing the intact NLSs are translocated to the nucleus. Immunostaining of endogenous nBmp2 in cultured cells demonstrated that the amount of nBmp2 as well as its nuclear/cytoplasmic distribution differs between cells that are in M-phase versus other phases of the cell cycle. CONCLUSIONS: The observation that nBmp2 localization varies throughout the cell cycle, as well as the conservation of a nuclear localization mechanism among three different BMP family members, suggests that these novel nuclear variants of BMP family proteins play an important functional role in the cell.

Human research review committee requirements in medical journals.

PURPOSE: Independent ethical review committees safeguard participants in human research. The purpose of this study was to describe the current ethical guidelines for human research requirements in the Instructions to Authors of the English language medical journals previously studied in 1995. METHODS: The instructions to authors of English language medicine journals from the Abridged Index Medicus were searched for any policies regarding guidance on the ethical treatment of human subjects in research. RESULTS: More medical journals require independent ethics committee approval of human research now [84/101 (83%)] than 10 years ago [48/102 (47%) (P < 0.001)], and most journals continue to require that this disclosure appear in the manuscript [71/84 (85%) vs. then 37/48 (77%) (P=0.29)]. Fewer medical journal instructions to authors provide no ethical guidelines for human research now [8/101 (8%)] than 10 years ago [25/102 (24%) (P < 0.001)]. No journal required submission of the study approval letter or of the approved protocol. CONCLUSIONS: Although medicine journals increasingly require disclosure statements of independent ethics committee approval for human research, they fail to verify such approval beyond taking authors for their word.

Youth at risk: identifying correlates of violence in Bolivia.

BACKGROUND: Although violence is one of the leading causes of mortality worldwide, in Latin America the prevalence of violence and factors associated with violent behavior among youth are largely unknown. OBJECTIVE: We describe the prevalence of carrying a weapon among Bolivian adolescent males and identify risk factors associated with weapon carrying. METHODS: The Youth Risk Behavior Survey was administered to a sample of teenagers 13-18 years of age (394 males and 182 females) from randomly selected schools in La Paz, Bolivia. The study is limited to males because of the small sample size for females. Frequencies and chi-square tests were calculated and logistic regression was used to identify factors associated with carrying a weapon in the past 30 days. RESULTS: Among the sample population, one-quarter of adolescent boys reported carrying a weapon in the previous 30 days. Ever having used cigarettes was the risk factor most strongly associated with weapon carrying. Additional risk factors included having participated in a physical fight, having used cocaine, and sniffing glue or other inhalants. CONCLUSION: Our results showed a link between weapon carrying and other risk behaviors, including smoking, drug use and fighting. Understanding the factors associated with carrying weapons among youth is an essential step in determining which risk behaviors should be included in comprehensive programs focused on youth violence prevention.