Sun safety: how to protect your child from the greatest cause of skin cancer

It is well known that exposure to UV radiation from the sun or indoor tanning devices is a primary cause of skin cancer - the most common form of cancer in the US. What appears to be less well known is the risk UV radiation can pose to children, with a recent survey revealing that 1 in 5 parents are unaware that their children's skin is sensitive to the sun.

Sun protection is a key factor for reducing skin cancer risk.

According to Dr. Lisa Chipps, assistant clinical professor of the David Geffen School of Medicine at the University of California-Los Angeles (UCLA), director of dermatologic surgery at Harbor-UCLA Medical Center, skin cancer is primarily viewed as a disease of adulthood, meaning many parents may not consider their child is at risk.

"However," Dr. Chipps told, "melanoma accounts for up to 3% of pediatric cancers and 6% of cancer cases in teens 15-19 years old."

There is currently no registry or database that tracks cases of skin cancer among children in the US, but a 2013 study published in the journal Pediatrics found the rate of melanoma - the deadliest form of skin cancer - rose 2% annually among children aged 0-19 between 1973 and 2009.

Though a diagnosis of skin cancer is rare during childhood, excessive sun exposure at a young age can increase the risk of skin cancer later in life. Last year, MNT reported on a study revealing that multiple sunburns during adolescence can raise the risk of melanoma by 80%.

"Overexposure to the sun and sunburns that happen during childhood are important and preventable risk factors for developing skin cancer as an adult," says Dawn Holman, a behavioral scientist in the Division of Cancer Prevention and Control at the Centers for Disease Control and Prevention (CDC), told MNT. "This is why it's so important for us all to use sun protection at every age."

However, as the aforementioned survey revealed, many parents seem to be unaware that the sun poses a risk to their child's skin. That same survey - conducted by Nivea Sun - also found that more than half of parents are unaware that multiple sunburns cause long-lasting damage to their child's skin, while 77% do not think pink or sore skin necessarily indicates sun damage.

In this Spotlight, we look at the best ways to protect children of all ages against the damaging effects of UV (ultraviolet) radiation and look at ways to overcome some of the major challenges that threaten children's sun safety.

Shade is the best sun protection for infants

According to the Skin Cancer Foundation, infants aged 6 months and under should be kept out of direct sunlight. This is because they have low levels of melanin in their skin - the substance that gives pigment to the skin, hair and eyes and protects against the sun - meaning they are very sensitive to UV radiation.

As such, the Skin Cancer Foundation recommend that parents take their infant for walks in a stroller with a sun-protective cover before 10 am and after 4 pm - when UV radiation is lowest.

"The best protection is to keep your baby in the shade," says Dr. Hari Cheryl Sachs.

Infants should be dressed in lightweight clothing that covers the arms and legs, and their face neck and ears should be protected with a wide-brimmed hat or bonnet.

When an infant is traveling in a vehicle, it is wise to cover the windows with removable mesh window shields or UV window film to reduce sun exposure.

While sunscreen is regarded as a key form of sun protection, it is not recommended for use on infants under the age of 6 months.

"Babies' skin is less mature compared to adults, and infants have a higher surface-area to body-weight ratio compared to older children and adults," explains Dr. Hari Cheryl Sachs, a pediatrician at the Food and Drug Administration (FDA). "Both these factors mean that an infant's exposure to the chemicals in sunscreens may be much greater, increasing the risk of side effects from the sunscreen."

"The best protection is to keep your baby in the shade, if possible," she adds. "If there's no natural shade, create your own with an umbrella or the canopy of the stroller."

If it is not possible to protect an infant from the sun with protective clothing or shade, sunscreen may be applied on the advice if a pediatrician.

It is safe to use sunscreen in babies aged 6-12 months, according to the Skin Cancer Foundation, who note that a broad-spectrum sunscreen with a minimum sun protection factor (SPF) of 15 should be applied.

Wearing protective clothing and seeking shade are still key factors for protecting a baby against the sun; sunscreen should be applied on areas that are not covered - such as the hands and face - 30 minutes before sun exposure and reapplied every 2 hours after swimming or sweating.

Children aged 6 months and older should also wear wraparound sunglasses that block 99-100% of UV radiation.

The challenges of sun protection in toddlers

As a child grows, protecting them against the sun can become more difficult. They are more likely to be exposed to sunlight by playing outdoors, and they are also more likely to disobey requests to wear a hat or sunglasses.

In 2004, Dr. Lori Steinberg Benjes, a dermatologist in Cambridge, MA, led a study published in JAMA Dermatology that looked at rates of sun protection among children aged 6 and 18 months.

The results revealed that while 22% of children experienced tanned or sunburnt skin at the age of 6 months, this figure rose to 54% at 18 months. The researchers claim one reason for this is due to the difficulties parents face in controlling their children as they reach toddler age.

"Keeping babies out of the sun is often manageable, but consistent, effective sun protection of toddlers requires more effort and is more challenging," Dr. Benjes notes.

The study also revealed that while there was a higher incidence of tanned and sunburnt skin among children aged 18 months, the use of sunscreen increased. This, the team says, indicates that parents fail to action other sun-protection methods.

"Parents need to understand that sunscreen is only one vital line of defense in sun protection," says Dr. Perry Robins, president of the Skin Cancer Foundation, adding:

"Strategies such as seeking shade and dressing children in sun-protective clothing are just as important and can't be abandoned in the second year, since sunscreen cannot keep all of the sun's rays away from the skin. Teaching these techniques early to children can leave them with sun safety habits that will help prevent skin cancer later in life."

Schools: a help or hindrance to sun safety?

For school-age children, the rules for sun protection remain the same; they should use sunscreen, wear protective clothing and seek shade when UV radiation is at its strongest, which is normally around midday.

Of course, parents have a lot to think about when they are getting their child ready for school, which means they may be less likely to focus on sun protection.

"Getting a few kids ready for school in the morning involves making breakfasts, packing lunches, choosing outfits, finding shoes/homework/backpacks, so yes, sometimes parents slack on the sunscreen," Dr. Chipps told.

The Skin Cancer Foundation say schools can be a hindrance to sun safety, but they can also play an important role in increasing sun safety.

She does, however, provide a useful tip to help combat this problem: "As a parent, I advise making sunscreen part of the childrens' daily morning routine. I keep the sunscreen on the bathroom counter so my kids can apply it when they brush their teeth and comb their hair."

But how can parents ensure their children receive adequate sun protection when they are at school and out of their sight?

According to the Skin Cancer Foundation, sometimes schools can be the "biggest block" to children's sun safety. "Many schools see sunscreen as a medicine, and require either written permission to use it, or require that the school nurse apply it," they note. "Many schools also ban the wearing of hats and sunglasses during school hours, including recess."

The Foundation recommend parents talk to their child's school to find out what their policy is on sun safety. If the school is not doing enough to protect children, they recommend alerting other parents and getting them involved in encouraging the school to take action.

Schools, however, can also play an important role in increasing children's sun safety. "Evidence suggests that sun-safety interventions in child care centers, elementary schools and middle schools are effective in increasing children's use of sun protection," says Holman.

Such interventions - detailed in The Community Guide from the Community Preventive Services Task Force - include educating children about the risks of UV radiation and what can be done to protect against them, as well as implementing activities designed to influence children's, teachers' and parents' behaviors and attitudes toward sun safety.

"In addition," added Holman, "the public health community can work with partners to ensure parents have the information they need to keep their families sun-safe and that other community sectors - such as those working at schools and outdoor recreational settings - have the tools they need to support sun-safety."

Teens and tanning

We all know what it's like to be a teenager. It is a time when you may feel pressured to look a certain way and conform to common perceptions of what is attractive. For many teens - particularly girls - attractiveness means having tanned skin.

What many people - both teenagers and adults - fail to realize is that any form of tan is a reflection of skin damage. The skin turns brown because of an increase in melanin production in an attempt to protect it from further damage.

But many individuals - particularly teens - put their desire for a tan over the associated health risks. In a Spotlight investigating the dangers of UV exposure last year, Tim Turnham, executive director of the Melanoma Research Foundation, told us:

"Despite elevated awareness of the dangers of UV radiation, people still choose to ignore the dangers in the pursuit of what they consider to be a 'healthy tan.' This is particularly an issue among young people who tend to ignore health risks in favor of enhancing their social status and popularity. We know that tanning appeals to people who are interested in being included, and this is a primary driver for teens - being part of the 'in' crowd."

Unfortunately, the desire for being part of the "in" crowd pushes many teenagers toward indoor tanning. According to the American Academy of Dermatology, around 17% of teenagers have reported using a tanning bed at some point in their lives.

Indoor tanning can dramatically raise the risk of skin cancer - with the rays that tanning devices emit being around 10-15 times stronger than those given off by the midday sun.

A 2014 study estimated that each year, around 400,000 cases of skin cancer in the US may be related to indoor tanning, while a study reported by MNT last year linked the use of tanning beds in teenagers to greater risk of basal cell carcinoma (BCC) - the most common skin cancer in the US.

The dangers of indoor tanning have hit the headlines recently after a 29-year-old woman shared a picture of wounds caused by treatment for skin cancer. Tawny Willoughby, from Kentucky, was first diagnosed with BCC aged 21 - a diagnosis she puts down to her excessive sunbed use as a teenager.

"If anyone needs a little motivation to not lay in the tanning bed and sun here ya go! This is what skin cancer treatment can look like," she wrote alongside her posted picture. "Wear sunscreen and get a spray tan. You only get one skin and you should take care of it."

A spray tan is certainly a healthier alternative to using indoor tanning devices for those who yearn for a golden glow, though it should be noted that a spray tan does not protect the skin against the sun. The use of sunscreen is still required. Another alternative is tanning lotions, some of which have an SPF of 15 and above.

As well as the use of sunscreen, it is recommended that teenagers also seek shade during midday hours and wear sun-protective clothing. If your teen complains that such clothing isn't fashionable, try to find items that are more stylish that still cover them up - like a pretty sarong for a teenage girl, for example.

But of course, one of the best ways to encourage sun safety in children - no matter what their age - is to lead by example. As the Skin Cancer Foundation say:

"The most important thing to remember when thinking about sun protection is this: you are your children's role model. Be sure to let them see you protecting yourself from the sun. If you have great skin, so will they."

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In Xenograft Model, Spread Of Human Melanoma Cells Correlates With Clinical Outcomes In Patients

UT Southwestern Medical Center scientists led by Dr. Sean Morrison, director of the Children's Medical Center Research Institute at UT Southwestern, have developed an innovative model for predicting the progression of skin cancer in patients.

In a new study published in Science Translational Medicine, Stage III human melanoma cells from 20 patients were implanted into specially selected mice with compromised immune systems. Using this xenograft model, in which tissue is transplanted from one species to another, the institute's team observed reproducible differences in the rate at which the cancer spread in the mice, or metastasized, that correlated with clinical outcomes in patients.

Dr. Morrison said human melanomas that metastasized efficiently in the mice eventually progressed to advanced, Stage IV disease in patients - spreading to distant organs, such as the brain, liver, or lungs. When the melanoma did not metastasize efficiently in the mice, it also did not form distant metastases in patients.

This xenograft model will make it possible to study the mechanisms that regulate disease progression and distant metastasis of melanomas in patients. The researchers said they hope that their system will lead to new prognostic markers that identify patients at highest risk of disease progression as well as new therapies.

"We believe this is the only time in cancer biology that anyone has developed a xenograft model in which disease progression correlates with what happens in the patient," said Dr. Morrison, senior author of the investigation and a Howard Hughes Medical Institute investigator at UT Southwestern. "The highly immune-compromised state of the mice makes it possible to observe the metastasis of human melanomas, and to study intrinsic differences among melanomas in their metastatic potential."

Previous studies of cancer metastasis were limited by a lack of workable models in which scientists could study the progression of a patient's cancer cells in laboratory animals in a way that correlated with clinical outcomes, he said.

But such correlation was clear in this study by the research institute, an innovative collaboration that melds the leading clinical resources of Children's Medical Center with the outstanding research resources of UT Southwestern. Melanomas that spread slowly and could not be detected in the blood of mice did not form distant tumors within 22 months in patients. Melanomas that spread rapidly in mice did form distant tumors in patients within the same time frame, giving rise to circulating melanoma cells in the blood of the mice. This finding suggests that entry of melanoma cells into the blood is a step that limits the rate of distant metastasis.

"Ultimately we want to identify new drug targets," Dr. Morrison said. "There are promising ideas coming out of this work that we hope will lead to clinical trials in melanoma."

The research arose from the Morrison laboratory's innovative techniques for studying neural crest stem cells - work that was recognized in 2004 with a Presidential Early Career Award for Scientists and Engineers. Neural crest stem cells make melanocytes, a type of cell that can mutate into melanoma if exposed, for example, to excessive sunlight.

The Children's Research Institute focuses on the interface of stem cell biology, cancer, and metabolism and will eventually include approximately 150 scientists in 15 laboratories. The work of Dr. Morrison, who also leads the Hamon Laboratory for Stem Cell and Cancer Biology, focuses on adult stem cell biology and cancers of the blood, nervous system, and skin.

"We're trying to do transformational science that not only changes scientific fields, but also creates new strategies for treating diseases," Dr. Morrison said. "The goal is for our work to have a direct impact on the patient."

Other UTSW researchers involved in the study were Drs. Elena Piskounova and Ugur Eskiocak, both postdoctoral researchers in the Children's Research Institute. This work originated with lead author Dr. Elsa Quintana and Dr. Mark Shackleton in Dr. Morrison's former lab at the University of Michigan. Other key collaborators from the University of Michigan were Dr. Douglas R. Fullen, director of dermatopathology, and Dr. Timothy Johnson, director of the Multidisciplinary Melanoma Clinic.

"This animal model offers unprecedented opportunities for discovery efforts that could be translated into patient care," Dr. Johnson said. "Dr. Morrison and I share a core mission to effectively treat melanoma, and that shared belief is the basis of the past, present, and future collaboration between UT Southwestern and the University of Michigan."

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What are Blackheads? How to Get Rid of Blackheads

A blackhead, or open comedo is a wide opening on the skin with a blackened mass of skin debris covering the opening. Despite their name, some blackheads can be yellowish in color. A comedo is a widened hair follicle which is filled with skin debris (keratin squamae), bacteria and oil (sebum).

A closed comedo is a whitehead, while an open comedo is a blackhead. the plural of "comedo" is comedomes".

Blackheads are said to be the first stage of acne. They form before bacteria invade the pores of the patient's skin. A blackhead can develop into a pimple, which is also known as a papule or pustule.

Blackheads, and acne in general, usually develop after puberty, when hormone levels surge and reach the skin. The presence of higher levels of hormones in the skin triggers the stimulation of the sebaceous glands, which produce oily substances. The sebaceous glands produce too much oil in the pores, which accumulates and gets stuck. When the occluded oil is exposed to air it becomes black.

Several conditions and circumstances can cause blackheads, or make them worse, such as the use of topical oils and make up. Blackheads can affect people with any type of skin, but are generally more common in those with oily skin.



Blackheads on a man's nose

What are the causes of blackheads

The overproduction of oil is the main cause of the emergence of blackheads. This is likely to occur in a high proportion of humans during puberty. Spikes in hormone production can result in the high levels of DHT (dihydrotestosterone), a hormone which triggers overactivity in the oil glands, resulting in clogged pores.

Clean skin - if the skin is not cleaned properly, more blackheads can appear, especially during those milestones in life when they are more prevalent, such as puberty. Improperly cleaned skin makes it more likely that dead skin cells build up within the pores. The pore openings can become clogged, which accelerates the build up of oil inside - thus causing blackheads to form. However, many experts warn that dirt does not cause blackheads to form - which frequently confuses and frustrates patients. Blackheads are caused by oxidized oil, not dirt, experts add. Over-cleaning the skin can lead to irritation.

In some cases, blackheads can emerge if moisturizers, sun screens, make up, or foundations are overused.

In the majority of cases, blackhead susceptibility is not heredity, with the exception of some severe acnes.

Food does not cause acne - although parents and grandparents commonly tell their teenage offspring not to eat chocolates and greasy foods, because they think they encourage the formation of acne - they do not cause blackheads or make them worse. Some studies have pointed towards a link between some dairy products and acne, but the evidence is not compelling.

Stress - stress does not directly affect blackhead occurrence. However, stress and anxiety can cause people to pick at their blackheads and acne, which may make them worse. Put simply, the behaviors resulting from stress and anxiety may worsen acne symptoms, but not the stress/anxiety itself.

What are the treatment options for blackheads

Hormonal treatments - contraceptives have often been used for the treatment of blackheads and acne, often with good results.

Cleaning the skin - clean your face with a good cleanser, ideally, one for oily skin, such as a salicylic acid cleanser.

Medications - adapalene is a third-generation topical retinoid, used mainly in the treatment of mild to moderate acne. Many patients with blackheads have had good results. In the USA adapalene is available under brand name Differin, in three preparations - 0.1% cream, 0.1% gel, and 0.3% gel. Since 2010, it has also been available in the USA under the generic name Teva, (0.1% gel). Only the 0.1% cream and 0.1% gel forms are available in Europe.

UV exposure - exposing the skin to sunlight or ultra-violet light encourages it to peel, which helps unblock pores. Sunbathing or using sunbeds may help. However, it is important to discuss this with your doctor. Exposing skin to sunlight, if overdone, also raises the risk of burning and developing skin cancer.

Hair - greasy hair touching the face of your skin can spread infection and in some cases encourage the spread of blackheads and acne. Keeping your hair away from your face may help keep blackheads to a minimum.

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Looking Older? How Square Is Your Jaw Line?

Your face may be giving away your age, and it has nothing to do with wrinkles, sagging skin or droopy eyelids. A study in January's Plastic and Reconstructive Surgery(R) (PRS), the official medical journal of the American Society of Plastic Surgeons (ASPS), found that as we age, the lower jaw continues to grow, creating a more square jaw line, ultimately making people appear older.

"The shape of the lower jaw plays an important role in the perception of youth and can be a tell-tale sign of someone's age," said Joel Pessa, MD, ASPS Member Surgeon and study co-author. "Across the board in many cultures, the smaller and more curved a man or woman's jaw line, the younger looking they appear."

The authors studied radiographic images of 16 patients (eight men and eight women) taken at youth (mean age 16 years old) and maturity (mean age 56 years old). They discovered the lower jaw in both men and women continued to grow with age, creating a larger, squarer jaw line.

According to the study, soft-tissue procedures, such as a facelift, can create the illusion of a smaller lower jaw and may enhance a more youthful appearance.

More than 104,000 facelifts were performed in 2006, according to ASPS statistics.

Visit http://www.plasticsurgery.org for referrals to ASPS Member Surgeons and to learn more about cosmetic and reconstructive plastic surgery.

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 6,000 members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 90 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

American Society of Plastic Surgeons
http://www.plasticsurgery.org

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LATISSE™ - New Prescription Product Increases Length, Thickness And Darkness Of Eyelashes

Allergan, Inc. (NYSE: AGN) today announced the U.S. Food and Drug Administration (FDA) has approved LATISSE™ (bimatoprost ophthalmic solution) 0.03% as a novel treatment for hypotrichosis of the eyelashes. Eyelash hypotrichosis is another name for having inadequate or not enough eyelashes. LATISSE™ is the first and only science-based treatment approved by the FDA to enhance eyelash prominence as measured by increases in length, thickness and darkness of eyelashes.

"LATISSE™ fulfills a significant and previously unmet need in the medical aesthetic marketplace with a product approved by the FDA that increases the growth of eyelashes, making them longer, thicker and darker," said Scott Whitcup, M.D., Allergan's Executive Vice President of Research and Development. "As the global leader in medical aesthetics, LATISSE™ exemplifies our continuing commitment to developing innovative treatments that are studied in well-controlled clinical trials, manufactured to pharmaceutical standards, appropriately labeled for use, and available to consumers as a prescription product."

Available only through a doctor, LATISSE™ is a once-daily prescription treatment applied to the base of the upper eyelashes with a sterile, single-use-per-eye disposable applicator. LATISSE™ users can expect to experience longer, fuller and darker eyelashes in as little as eight weeks, with full results in 16 weeks. To maintain effect, continued treatment with LATISSE™ is required. If use of LATISSE™ is discontinued, eyelashes will gradually return to where they were prior to treatment over a period of weeks to months (average eyelash hair cycle).

Similar to Allergan's other medical aesthetic offerings, the benefits of LATISSE™ are derived from scientific evidence, its quality formulation, and medical origin. LATISSE™ was clinically tested in a pivotal Phase III, multi-center, double-masked, placebo-controlled study to assess its safety and efficacy in which all endpoints (improved eyelash prominence, length, thickness and darkness) were met. In addition, like BOTOX® (botulinum toxin type A), which was first approved by the FDA as a medical treatment for eye disorders and was later found to have an aesthetic benefit, bimatoprost, the active ingredient in LATISSE™, was first approved in 2001 as a medical product to lower intraocular pressure in people with open-angle glaucoma or ocular hypertension. Patients treated with bimatoprost for this specific eye condition experienced eyelash growth as a side effect. The long-term safety of bimatoprost for therapeutic use has been recognized by the medical community and well established based on use in 32 clinical trials involving more than 5,700 glaucoma patients and more than 13 years of clinical trial experience. Given the existing and substantial clinical and post-marketing safety data with bimatoprost solution 0.03%, coupled with the positive results from the Phase III LATISSE™ study, LATISSE™ provides patients a clinically meaningful aesthetic benefit with a favorable safety profile.


Bimatoprost is the active pharmaceutical ingredient in the formulation of LATISSE™ and is a structural prostaglandin analog, a lipid compound derived from fatty acids designed to bind to prostaglandin (PG) receptors. PG receptors are present in hair, particularly in the dermal papilla and outer root sheath. Although the precise mechanism of action is unknown, PG receptors are thought to be involved in the development and regrowth of the hair follicle,1 by increasing the percent of hairs in, and the duration of, the anagen or growth phase.

"As an oculoplastic surgeon who has treated both medical eye conditions as well as aesthetic needs, I have extensive knowledge of and experience with the established therapeutic safety profile for bimatoprost," said Steven Fagien, M.D., F.A.C.S., in private practice at Aesthetic Eyelid Plastic Surgery in Boca Raton, Florida, and LATISSE™ clinical investigator. "In the clinical study with LATISSE™, I observed statistically significant differences in eyelash growth and resulting patient satisfaction. Now that LATISSE™ is FDA approved, I look forward to prescribing it to my patients who will enjoy the benefits of more prominent eyelashes while I remain confident in the treatment's favorable safety profile."

LATISSE™ will be available in the United States by prescription only and is subject to all U.S. guidelines applicable to dispensing a prescription product. Based on today's FDA approval, Allergan expects to launch the product nationwide in the first quarter of 2009. Doctors and consumers are encouraged to visit http://www.latisse.com for further product and prescribing information.

Allergan estimates global peak sales of LATISSE™ could exceed $500 million per year. As the exclusive U.S. and foreign patent owner, Allergan obtains the rights to the use of bimatoprost and other prostaglandins and prostaglandin analogs as a treatment to stimulate eyelash growth.

LATISSE™ Clinical Development Program

In the pivotal Phase III study, 278 healthy adult patients with no active ocular disease and with baseline minimal or moderate eyelash prominence were randomized to apply either LATISSE™ or vehicle to both upper eyelid margins once daily for 16 weeks. The primary efficacy endpoint was overall eyelash prominence at the end of the 16-week treatment period as measured by a ≥1-grade improvement on a 4-point Global Eyelash Assessment Scale. Secondary efficacy endpoints were eyelash length, thickness, and darkness as determined by Digital Image Analysis of patient photographs taken in a standardized manner.

All of the endpoints in the LATISSE™ pivotal trial were met. By the end of the 16-week treatment period, patients treated with LATISSE™ experienced statistically significant greater improvement (p < 0.0001 for each endpoint) than those in the vehicle group in the measurements of eyelash prominence, length, thickness and darkness. LATISSE™ was also well tolerated with the most commonly reported adverse events being non-serious and cosmetic in nature. Common adverse events observed in the clinical trial included eye redness (3.6%), itchy eyes (3.6%) and skin hyperpigmentation (2.9%).

Important LATISSE™ Safety Information

LATISSE™ solution is intended for use on the skin of the upper eyelid margins at the base of the eyelashes. DO NOT APPLY to the lower eyelid. If you are using LUMIGAN® or other products in the same class for elevated intraocular pressure (IOP), or if you have a history of abnormal IOP, you should only use LATISSE™ under the close supervision of your doctor.

LATISSE™ use may cause darkening of the eyelid skin which may be reversible. Although not reported in clinical studies, LATISSE™ use may also cause increased brown pigmentation of the colored part of the eye which is likely to be permanent.

It is possible for hair growth to occur in other areas of your skin that LATISSE™ frequently touches. Any excess solution outside the upper eyelid margin should be blotted with a tissue or other absorbent material to reduce the chance of this from happening. It is also possible for a difference in eyelash length, thickness, fullness, pigmentation, number of eyelash hairs, and/or direction of eyelash growth to occur between eyes. These differences, should they occur, will usually go away if you stop using LATISSE™.

The most common side effects after using LATISSE™ solution are an itching sensation in the eyes and/or eye redness. This was reported in approximately 4% of patients. LATISSE™ solution may cause other less common side effects which typically occur on the skin close to where LATISSE™ is applied, or in the eyes. These include skin darkening, eye irritation, dryness of the eyes, and redness of the eyelids.

If you develop a new ocular condition (e.g., trauma or infection), experience a sudden decrease in visual acuity, have ocular surgery, or develop any ocular reactions, particularly conjunctivitis and eyelid reactions, you should immediately seek your doctor's advice concerning the continued use of LATISSE™ solution.

Full prescribing information is available at http://www.latisse.com.

Important BOTOX® and BOTOX® Cosmetic (Botulinum Toxin Type A) Information

BOTOX® is approved for the treatment of cervical dystonia in adults to decrease the severity of abnormal head position and neck pain associated with cervical dystonia.

BOTOX® is approved for the treatment of strabismus and blepharospasm associated with dystonia, including benign essential blepharospasm or VII nerve disorders in patients 12 years of age and above.

The efficacy of BOTOX® treatment in deviations over 50 prism diopters, in restrictive strabismus, in Duane's syndrome with lateral rectus weakness, and in secondary strabismus caused by prior surgical over-recession of the antagonist has not been established. BOTOX® is ineffective in chronic paralytic strabismus except when used in conjunction with surgical repair to reduce antagonist contracture.

And BOTOX® is approved for the treatment of severe primary axillary hyperhidrosis that is inadequately managed with topical agents.

BOTOX® Cosmetic is approved for the temporary treatment of moderate to severe frown lines between the brows in people ages 18 - 65.

Important Safety Information

Who should not be treated with BOTOX® and BOTOX® Cosmetic

BOTOX® injections should not be given to people who have an infection where the physician proposes to inject. They should not be given to people who are known to be sensitive to any ingredient in the BOTOX® product.

Warnings

Serious heart problems and serious allergic reactions have been reported rarely. If you think you're having an allergic reaction or other reaction, such as difficulty swallowing, speaking, or breathing, call your doctor immediately.

Patients with certain neuromuscular disorders such as ALS, myasthenia gravis, or Lambert-Eaton syndrome may be at increased risk of serious side effects.

Patients with neuromuscular disorders may be at increased risk of clinically significant systemic effects including severe dysphagia (difficulty swallowing) and respiratory compromise from typical doses of BOTOX® and BOTOX® Cosmetic.

Dysphagia (difficulty swallowing) is a commonly reported adverse event following treatment of cervical dystonia patients with all botulinum toxins. In these patients, there are reports of rare cases of dysphagia severe enough to warrant the insertion of a gastric feeding tube.

Precautions

Patients or caregivers should be advised to seek immediate medical attention if swallowing, speech, or respiratory disorders arise.

Side Effects

Localized pain, infection, inflammation, tenderness, swelling, redness and/or bruising may be associated with the injection.

In cervical dystonia, the most common side effects following injection include difficulty swallowing (19%), upper respiratory infection (12%), neck pain (11%), and headache (11%).

In blepharospasm, the most common side effects following injection include ptosis (20.8%), inflammation of the cornea (6.3%), and eye dryness (6.3%).

In strabismus, the most common side effects following injection include ptosis (15.7%) and vertical deviation (16.9%).

In severe primary axillary hyperhidrosis, the most common side effects (3-10% of patients) include injection-site pain and bleeding, non-underarm sweating, infection, sore throat, flu, headache, fever, neck or back pain, itching and anxiety.

The most common side effects following BOTOX® Cosmetic injections include temporary eyelid droop and nausea.

Please see full product information at http://www.botox.com and http://www.botoxcosmetic.com.

Forward-Looking Statements
This press release contains "forward-looking statements," including the statements by Dr. Whitcup, Dr. Fagien and other statements regarding the safety, effectiveness, approval and market potential associated with LATISSE™, BOTOX® and BOTOX® Cosmetic. These statements are based on current expectations of future events. If underlying assumptions prove inaccurate or unknown risks or uncertainties materialize, actual results could vary materially from Allergan's expectations and projections. Risks and uncertainties include, among other things, general industry, biologic and pharmaceutical market conditions; technological advances and patents attained by competitors; challenges inherent in the research and development and regulatory processes; inconsistency of treatment results among patients; potential difficulties in manufacturing; general economic conditions; and governmental laws and regulations affecting domestic and foreign operations. Allergan expressly disclaims any intent or obligation to update these forward-looking statements except as required by law. Additional information concerning these and other risk factors can be found in press releases issued by Allergan, as well as Allergan's public periodic filings with the Securities and Exchange Commission, including the discussion under the heading "Risk Factors" in Allergan's 2007 Form 10-K and subsequently filed Forms 10-Q.

About Allergan, Inc.

Founded in 1950, Allergan, Inc., with headquarters in Irvine, California, is a multi-specialty health care company that discovers, develops and commercializes innovative pharmaceuticals, biologics and medical devices that enable people to live life to its greatest potential - to see more clearly, move more freely, express themselves more fully. The Company employs more than 8,500 people worldwide and operates state-of-the-art R&D facilities and world-class manufacturing plants. In addition to its discovery-to-development research organization, Allergan has global marketing and sales capabilities with a presence in more than 100 countries.

Allergan Medical, a division of Allergan, Inc., offers the most comprehensive, science-based, aesthetic product offerings under its Total Facial Rejuvenation™ portfolio, including BOTOX® Cosmetic; hyaluronic acid and collagen-based dermal fillers; and physician-dispensed skin care products. Allergan Medical also offers the industry's widest range of silicone gel-filled and saline-filled breast implant options for reconstructive and aesthetic breast surgery, and leading minimally invasive devices for obesity intervention treatment.

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Child's Allergy Risk Higher If Parent Of Same Sex Has It

Researchers have discovered an interesting fact about the genetic basis of childhood allergic diseases: a child is more likely to have a particular allergy if his or her same-sex parent has it.

So for example, a girl's chance of having asthma is higher if her mother has it, and a boy's is higher if his father has it.

And the same appears to be true of eczema and other childhood allergies.

This is the conclusion of a study by Professor Hasan Arshad, a consultant in allergy and immunology at Southampton General Hospital, and colleagues, that is published in the August issue of The Journal of Allergy and Clinical Immunology.

What The Researchers Did

For the study, the researchers used data from the Isle of Wight (IOW) Birth Cohort Study, which collected information on just under 1,500 children that were followed up to the age of 18. During that time, the children were examined at age 1, 2, 4, 10 and 18.

The Isle of Wight, which lies off the South coast of England, is ideal for carrying out long-term prospective epidemiological studies because it has a stable resident population, so most of the participants did not move away during the course of the study, and were thus available for follow-up.

Arshad was one of the initiators of the The IOW cohort study, which was set up with the aim of prospectively studying a whole population (about 130,000 people live on the IOW) for the development of asthma and allergic diseases and identify any relevant genetic and environmental risk factors.

The data on the cohort contains detailed information on heredity and environmental exposures, collected from birth and updated at each follow-up, where detailed questionnaires were completed with the parents for each child, about asthma and any other allergies, for example eczema and rhinitis.

At ages 4, 10, and 18, the children also underwent skin prick tests to 14 common food and airborne allergens.

Other examinations included spirometry and bronchial provocation tests, and collected blood samples to measure Immunoglobulin E (IgE) at ages 10 and 18. IgE is an antibody that is often screened for in testing for allergies.

The parents also underwent assessments. For example, shortly after the children in the cohort were born, the researchers found out whether his or her parents had allergies, and the mother's IgE level was also measured.

What They Found

When they analyzed the results the researchers found that maternal asthma was tied to asthma in girls but not to boys, and paternal asthma was linked to asthma in boys but not to girls.

They found the same pattern for eczema: if a child's mother had eczema, then the chances of the child having it was higher if it was a girl but not a boy, and if the father had it, the chance was higher for his son but not his daughter.

Similar patterns were found for other allergies, as the authors explain:

"Similar trends were observed when the effect of maternal and paternal allergic disease was assessed for childhood atopy and when maternal total IgE levels were related to total IgE levels in children at ages 10 and 18 years."

Possible Implications

The authors suggest the findings may change the way childhood allergies are assessed and prevented. For instance, in diagnosis, it may be useful to find out the allergy history of the mother in girl patients and of the father in boy patients.

The study may also open new avenues for studying sex-dependent effects in hereditary diseases, with the prospect one day of finding ways to prevent them.

The National Institutes of Health in the US funded the study.

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Device Dries Lice And Nits Out Of Hair

If you want to rid your children of lice and nits and don't want to use chemicals, a hairdryer-type device may be just what you are looking for. Use it on your child for 30-minutes and he/she will be infestation free, say the makers of the LouseBuster, Larada Sciences. The makers stress that their device dries the bugs out, it does not heat them. You should not try doing this at home with your hairdryer.

You can read about this in the journal Pediatrics.

Larada Sciences says the LouseBuster should be on the market within the next two years.

Currently, there are various ways of treating headlice, chemical shampoos among them. However, there is evidence that the lice are developing resistance to them. Special combs can also be effective, but the user has to follow the instructions carefully - many people don't.

Dr Dale Clayton, who co-invented the LouseBuster, stressed that it does not work by heating the nits and lice out, "We don't want kids getting burned by parents who think it is the heat. This thing is actually cooler than a hairdryer, but requires twice as much airflow, and the special hand piece is critical because, unless you expose the roots of the hair, it doesn't work. It's difficult to do that with a regular comb."

The new 30-minute treatment has been shown to eliminate 80% of lice and 98% of nits. The researchers said there was no evidence of any side-effects from this treatment.

What are Lice and Nits

The singular of Lice is Louse (one louse, two lice). The eggs of lice are called Nits. Lice are tiny, light-brown insects, they live on the human scalp. They suck blood from the scalp. They lay their greyish eggs, which stick firmly onto the shaft of your hair, very close to the scalp. The eggs hatch after about one week. As lice can start laying eggs when they are just two weeks' old, it is not long before a person has hundreds of them on his/her head (an infestation).

Lice, unlike fleas, do not jump. They go from one head to another when the two heads are touching each other (they walk over).

Lice need the warmth of the scalp to survive, that is why combs and brushes do not have live lice.

The word LOUSY, as in "I have a lousy teacher", comes from the meaning 'infested with lice'.

"An Effective Nonchemical Treatment for Head Lice: A Lot of Hot Air"
Click here to see abstract online

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New Study Demonstrates Dietary Supplement Lutein Increases Skin Hydration, Elasticity And Lipid Levels

Highlights from a new clinical study presented today at the "Beyond Beauty Paris" conference in France provide compelling evidence that lutein, a dietary nutrient available as a supplement and long-known for its effectiveness in promoting eye health, also provides specific skin health benefits. These include increasing the hydration, elasticity and superficial lipids of the skin, while decreasing the oxidation - a process that causes degradation - of those beneficial skin lipids.

Topline results of the study, presented by Dr. Pierfrancesco Morganti, professor of applied cosmetic dermatology at the University of Naples, on behalf of the research team, indicated that lutein and its associated molecule zeaxanthin, when taken daily as a 10 mg oral lutein supplement, increased skin hydration by 38 percent, skin elasticity by 8 percent and the level of superficial lipids present in the skin by 33 percent after adjustments for placebo. Results also showed that lutein decreased oxidation of those beneficial lipids by 55 percent after adjustment for placebo.

The study further demonstrated that the combination of oral and topical administration of lutein/zeaxanthin provided even more powerful improvements, increasing skin hydration by 60 percent, skin elasticity by 20 percent and the amount of superficial lipids present in the skin by 50 percent after adjustment for placebo, all while decreasing the oxidation of those beneficial lipids by 64 percent.

Lutein, a nutrient naturally found in dark green leafy vegetables like spinach, kale and collard greens, as well as broccoli, corn and egg yolks, is present in tissues in the eye, blood serum, skin, cervix, brain and breast. It is not produced by the human body and thus must be ingested daily through food or taken as a supplement.

The study, entitled "Clinical Evidence for Lutein and Zeaxanthin in Skin Health, Part 1: Comparison of Placebo, Oral, Topical and Combined Oral/Topical Xanthophyll Treatments," was conducted in Italy on female subjects, age 25-50, over a 12-week period. The test product utilized in the study contained FloraGLO(R) Lutein, manufactured by Kemin Health, L.C., of Des Moines Iowa. It was administered daily at 10 mg (oral supplementation) and 50 ppm (topical formulation) to subjects in the study's different test groups.

"This is the first study to determine the impact of lutein/zeaxanthin alone on the human skin," said Richard L. ("Dick") Roberts, Ph.D., senior manager of scientific affairs for Kemin Health, the leading manufacturer of lutein. "It provides strong new evidence of lutein's positive role in promoting skin health and appearance by increasing hydration, elasticity and lipid content."

"This research underscores the importance of thinking about skin health and beauty from the 'inside out,'" said Bruce Katz, M.D., a dermatologist and director of the JUVA Skin & Laser Center in New York, who is working with Kemin to educate consumers on the role of nutrition as part of a total skin health and beauty regimen. "The benefits of taking lutein daily will be of great interest to people who are looking for new ways to improve the hydration and elasticity of their skin and help reduce the appearance of premature aging."

The new study adds to an existing body of research that suggests lutein, when taken on a daily basis, may help bolster the skin's natural antioxidant defense system, helping to protect skin from potentially damaging effects of sun and artificial light exposure.

About Kemin

A nutritional ingredient manufacturer, Kemin is committed to improving the nutrition of the world with functional products that deliver maximum efficacy through superior chemistry. FloraGLO(R) Lutein is the world's leading patented, purified lutein. Products with FloraGLO(R) Lutein contain the same lutein naturally found in dark green leafy vegetables as well as eggs. Studies indicate daily lutein intake of 6 mg to 10 mg may be beneficial.

A Kemin-affiliated company, Kemin Health is ISO 9001:2000 certified and headquartered in Des Moines, Iowa, USA. Kemin has manufacturing facilities in Iowa, Texas, Belgium, India, Singapore, China and Thailand. To learn more visit http://www.luteininfo.com or http://www.kemin.com.

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What Is Hair Loss (Alopecia)? What Is Baldness?

The word alopecia refers to any type of hair loss, thinning hair or baldness in any hairy region of the body. Baldness tends to be a more specific term among lay people, as it usually refers to hair loss on the scalp - however, it can mean hair loss in any part of the body. Alopecia areata means "hair loss in areas". In the majority of cases hair loss is a normal process of aging, and not a disease. Because it is not seen as life-threatening to doctors it is often disregarded. This is unfortunate because hair loss can cause serious distress in some people, with some far reaching psychological effects. In some cases hair loss may be a consequence of some medical treatment, especially cancer treatment drugs - when the hair loss is generally temporary.

There are several types of alopecia, below is a list of the main types:

Alopecia areata - hair loss occurring in patches anywhere on the body. Hair is lost from some or all areas of the body, generally from the scalp. As it causes bald spots on the scalp, especially during its early phase, it is sometimes referred to as "spot baldness". A small proportion of alopecia areata cases spread to the whole scalp, or even the entire body. Approximately 0.1% to 0.2% of all humans are affected. It occurs in both men and women, but more commonly among women.

Most people who develop alopecia areata are apparently healthy and have no skin problems. When it does occur, it tends to start during the late teenage years, early childhood, or early adulthood. However, it can strike at any age.

Alopecia areata is not contagious. It is more commonly found among people who have close family member who have/had it. People who have a close relative with some kind of autoimmune disease are more likely to develop alopecia areata. That is why most experts believe it is an autoimmune disease - a disease where the body attacks good parts of the body as if they were foreign undesirable objects, such as some bacteria or viruses; in this case the body is attacking its own hair follicles. Studies indicate that T cell lymphocytes cluster around attacked follicles, causing inflammation and hair loss. Scientists say something, combined with hereditary factors, trigger the condition - we do not know what that something is, although some suspect it may be emotional stress or a pathogen. A pathogen is a disease-producing agent, e.g. a virus, bacterium or other microorganism. A study found that there is a close relationship between infection outbreaks on teeth and the presence of alopecia areata.

Symptoms usually appear as small, soft, bald patches. They may be of various shapes, but are generally round or oval. The scalp and beard are the most commonly affected areas; but can occur in any hairy part of the body. The patient may feel tingling, or even some slight pain in affected areas. Some parts of the body may experience hair re-growth while others will not. It can go into remission for long or short periods, and even forever (gets better and never comes back).

When the hair falls out on the scalp it tends to do so over a short period, and more so on one side than the other.

People with this type of alopecia also have "exclamation point hairs" - hairs that become narrower along the length of the strand closer to the base.

Alopecia totalis - total hair loss of the scalp. This could happen rapidly, or from progression of alopecia areata. Experts are not sure what causes it, but know that it is an autoimmune disorder. Although many believe mental stress is a contributory factor, a sizeable number of people with alopecia totalis lead relatively stress-free lives.

This type of alopecia may be an intermediary condition between Alopecia areata and Alopecia Universalis (total body hair loss). It usually emerges as a fairly sudden total scalp hair loss, or more gradual. When it is gradual it tends to be a development from alopecia areata.

The majority of sufferers are either children or young adults under 40. However alopecia totalis can affect people of any age. The patient's nails may also become ridged, pitted or brittle in appearance.

Alopecia universalis - all hair is lost throughout the body. It generally involves rapid loss of hair, including eyebrows and eyelashes. Experts consider it to be the most severe form of alopecia areata. It affects approximately 1 in every 100,000 people in North America and Western Europe. It is an autoimmune condition.

Alopecia barbae - loss of facial hear. Barbae comes from Latin and refers to the bearded area of the face. It does, in fact, affect both men and women. However, it is of more interest to men as only men are generally bothered by it.

Alopecia mucinosa - also referred to as follicular mucinosis. It is an inflammatory condition of both the hair follicle and sebaceous glands (pilosebaceous unit) which can result in scarring as well as non-scarring hair loss. Severity of scarring indicates how advanced the disease is. There is mucin around hair follicles when examined under the microscope. Mucins appear like stringy, clear or whitish gunk in the skin, and are made up mostly of hyaluronic acid - this is a normal component of the ground substance surrounding collagen of the dermis (part of the skin).

Alopecia mucinosa generally affects the face, neck, and scalp, but can affect any part of the body.

Alopecia mucinosa can be one of three types: 1. Primary and acute disorder - this affects children and teenagers (Pinkus type). 2. Primary and chronic disorder - this occurs in people over 40. 3. Secondary disorder - this is associated with benign (non-cancerous) or malignant (cancerous) skin disease.

Experts are not sure why it occurs, but it is seen as an autoimmune disease. Early signs include raised spots (follicular papules) which appear in reddened plaques or patches, about 2.5 centimeters in diameter, but they can be bigger. Some patients may start with one or more lesions, while others may have a single lesion that develops to multiple lesions over several weeks or months. The affected follicles will commonly result in hair loss.

If treated early enough it is reversible - hair will grow back. In more severe cases hair will not grow back, even after the disease has cleared up.

Androgenetic alopecia (male pattern hair loss) - this is also known as male pattern baldness. The hair gradually thins out, to an almost transparent state. It can affect both men and women. Experts say this type of alopecia is most likely to be hereditary - the person can inherit from either the mother or the father. Androgens means hormones. This type of alopecia is the type most lay people refer to when talking about balding.

Male pattern baldness usually starts with a receding hairline, and/or hair loss on the top of the head.

The person has a genetically determined sensitivity to the effects of DHT (dihydrotestosterone). Experts believe DHT shortens the growth phase (anagen phase) of the hair cycle, causing miniaturization of the follicles, resulting in finer hair. DHT production is regulated by 5-alpha reductase, an enzyme. DHT exists in several tissues of the body, including the scalp.

About 50% of men are affected by this type of hair loss at some time in their lives. Men of Chinese or Japanese ancestry are less likely to be affected.

A Chinese study found that men who smoked were more prone to age-related hair loss.

A study identified two genetic variants in Caucasians that together produce an astounding sevenfold increase in the risk of male pattern baldness.

Adrogenetic alopecia (female pattern hair loss) - this is also known as female pattern baldness. Women have a higher risk of female pattern baldness when they undergo hormonal changes during the menopause. The hair on the head is thinner, while facial hair may be coarser. Although new hair is not produced, the follicles are still alive. This suggests that hair regrowth is possible.

Generally, female pattern baldness is different from male pattern baldness. The woman will experience hair thinning all over the head, but will not usually lose her frontal hairline (it will not recede). Loss of hair on the crown may be moderate, but his hardly ever progresses to total or near baldness. Women can lose hair for other reasons than female pattern baldness:

• Teologen effluvium (temporary shedding of hair)
• The hair may breaks after styling treatments, or the twisting and pulling of hair
• Alopecia areata
• Some skin diseases
• Iron deficiency
• Hormonal problems
• Underactive thyroid
• Vitamin deficiency

Traction alopecia - this refers to hair loss as a result of too much pulling or tension on the hair shafts - usually the result of some hair styles. This type of alopecia is more commonly found among women. If the traction alopecia is prolonged the person's hair, where lost, may never come back.

Very tight ponytails, braids, or pigtails may cause traction alopecia if the person frequently uses them. Toy dogs whose owners use barrettes to keep hair out of their faces may also develop this type of alopecia.

Anagen effluvium - generally brought on by the use of chemotherapy or radiotherapy to treat cancer. Hair loss starts off as patchy, and then becomes total. Fortunately, in the vast majority of cases, as soon as the treatment is stopped the hair comes back within about six or so months. Some other medications can also cause hair loss. Compulsive hair pulling can also cause this type of hair loss, as well as poisoning from toxic plants, and some other diseases.

Anagen effluvium is caused by sudden, profound disturbances to the matrix cells of the hair follicles.

Telogen effluvium - more than normal amounts of hair fall out. It is characterized by excessive and early entry of hairs into the telogen phase (resting phase). This is a temporary condition - the hair comes back. It is thought to be caused by marked emotional or physiological stressful events that may result in an alteration of the normal hair cycle. The events may include childbirth, chronic illness, major surgery, anemia, crash diets, severe emotional disorders, or drugs.

What are the treatments for alopecia?

If the hair loss is caused by an infection or a condition, treating that infection/condition may prevent further hair loss, and in many cases re-growth will occur.

Male-pattern baldness treatment

• Finasteride - this works by preventing the hormone testosterone converting to the hormone DHT (dihydrotestosterone) which causes hair follicles to shrink. Finasteride effectively brings back normal hair size (from being very fine hair). According the National Health Service, UK, two-thirds of males who are given finasteride experience some hair regrowth. However, even among the other third who experience no regrowth, most stop becoming balder. The effects of finasteride are not evident for at least four months. If the patient stops taking finasteride the balding process will resume. About 1 in every 50 men who take finasteride experiences a loss of libido (sex drive).


• Minoxidil - this is available as a lotion. The person rubs it into the scalp on a daily basis. In the UK, and most other countries it is available over-the-counter (no prescription needed). About 15% of men who use it experience hair regrowth, while half of all men notice that the balding process stops. For about 32% of all men, minoxidil has no effect at all. It is only after four months of daily applications that those who do benefit from minoxidil notice it. If treatment is stopped the balding process will resume. Side effects are uncommon.


• Laser phototherapy - a controlled clinical trial proved the clinical efficacy and safety of a laser phototherapy device for treating hereditary hair loss.


• Dermabrasion gel - scientists have found a way to make the skin of laboratory mice give have fully working hair follicles complete with new hair by using a protein that stimulates follicle generating genes in skin cells under wound conditions.

Female-pattern baldness treatment

The only effective medication for women with female-pattern baldness is minoxidil. About 20% to 25% of UK women who take it experience hair regrowth, while the majority finds the treatment stops or slows the loss of hair. Other treatments include hair transplants, wigs, hair weaving, changes in hairstyle, plastic surgery (scalp reduction).

Alopecia areata treatment

There is no current reliable, safe, effective, long term treatment for alopecia areata, a study showed. Fortunately, about 80% of cases resolve themselves after a year without treatment and hair grows back. Therefore, watchful waiting may be the best initial strategy. If it does not resolve itself, some treatments are possible:

• Steroid injections - effective when the patient has small patches. A steroid solution is injected straight into the scalp, several times. The steroid stops the immune system from attacking hair follicles. After about four weeks this treatment may stimulate regrowth. Treatment might be repeated every few months. With some patients alopecia returns some time after treatment is stopped, while with others the regrowth is permanent.


• Topical steroids (creams and ointments) and steroid tablets - although these medications are widely prescribed for alopecia areata treatment, their long-term benefits are not clear. It seems there is a chance hair will regrow. Side effects become more common the longer the patient takes the steroid tablets or creams/ointments; they may include diabetes and stomach ulcers. Some patients experience itching, and sometimes hair growth in other areas.


• Minoxidil - applied in lotion form to the scalp every day, this treatment can stimulate hair growth. Benefits, if they do appear, do so after about two or three months. In the UK they are not recommended for people under the age of 16.


• Immunotherapy - this is the most effective treatment for total hair loss. DPCP (diphencyprone) is applied to the bald skin. The patient applies the chemical solution once a week, and the dosage is stronger each time. The DPCP generally causes an allergic reaction and the patient will develop mild dermatitis (mild eczema). Hair starts to regrow after about three months among patients who respond. Some patients may have a severe skin reaction. This can be dealt with by reducing the rate of dosage increase. A very small percentage of patients may develop vitiligo (patchy colored skin). Most patients find that hair continues falling out after treatment is stopped.


• Dithranol cream - this treatment is much less popular than immunotherapy because it is less effective and there is a greater risk of causing a skin reaction and itchiness. It can also stain the scalp and hair.


• UV light treatment - the patient is given about two to three sessions of light therapy each week. This is usually done in a hospital. After about 12 months patients may see some good results. It is not very popular as response rates are not so good.


• Tattooing the eyebrows - this is known as dermatography.


• Alternative therapies - alternative therapists commonly offer aromatherapy, massage, or acupuncture for alopecia treatment. Not enough studies exist to determine how effective these treatments are.

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Cream Makes Skin Produce Sunless Tan

A cream which has been shown to trigger the skin to produce a tan without direct exposure to sunlight has been developed by scientists at the Dana-Farber Cancer Institute and Children's Hospital Boston, USA. Studies on genetically engineered, fair-skinned, red-haired mice, were successful.

You can read about this experiment in the journal Nature.

The mice were genetically engineered to have a disorder called xeroderma pigmentosum, their skin behaves in a similar way to skin of fair-skinned and/or red-haired people who do not tan, but burn when exposed to UV radiation (sunlight). The cells in their skin can't repair DNA damage caused by radiation.

The cream makes the skin behave as if it were hit by the sun's ultraviolet light. Fair-skinned people, as well as people with red hair, do not tan properly. They have a MC1R defect, a receptor which when triggered produces pigmentation. This defect means lower production of cAMP, a chemical which stimulates the melanocytes to produce pigmentation. In simple terms, this means that these people do not tan - they burn when exposed to sunlight. Many people with this rare genetic disorder have to stay in indoors while the sun is shining.

The more your skin is burned when exposed to sunlight the higher your chances are of developing skin cancer.

The scientists applied a cream, which contained Forskolin, a chemical from the Forskohli plant, a tropical mint plant from India, to the skin of the mice. Forskolin is known to raise cAMP levels. The mice's skin got darker as a result - they developed a tan. The scientists found that the tan looked virtually identical to the tan achieved from exposure to the sun.

If human skin reacts in the same way to this cream, it will mean that fair-skinned and/or red haired people can be triggered to produce the same pigmentation.

Apart from developing a sunless sun tan, the cream also seems to protect the skin better from exposure to UV light, meaning better protection from skin cancer.

Whether or not this cream can benefit humans in the same way as the genetically-engineered mice remains to be seen. Human skin is much thicker than the skin of mice. The cream needs to penetrate deeply enough to trigger the production of pigments.

Dr David Fisher, team leader, said "These studies suggest that a drug-induced rescue of the tanning mechanism may correspondingly rescue at least some aspect of skin cancer protection. Such sunless tanning may also dissuade sun-seeking behaviours, which undoubtedly contribute significantly to high skin cancer incidence."

Topical drug rescue strategy and skin protection based on the role of Mc1r in UV-induced tanning

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Steroids For Treatment Of Sudden Hearing Loss

Sudden sensorineural hearing loss (SSNHL) can occur suddenly in one ear, and generally within three days, cause a 30+ decibel (dB) hearing loss at three consecutive frequencies. The cause for this disorder is unclear, but research has indicated that viral infection, vascular compromise, and immunologic diseases could be key reasons for this hearing disorder. A few celebrities have reported experiencing sudden hearing loss. In recent years, radio personality Rush Limbaugh and Rapper Foxy Brown both reported experiencing sudden hearing loss.

Treatment of SSNHL remains controversial. Different approaches such as steroids, vasodilator, antiviral agents, diuretics, and low-salt diets have been suggested. Nevertheless, spontaneous recovery rate without treatment ranges from 30 to 60 percent, most resolving within two weeks after onset.

As a result of its anti-inflammatory effect, high-dosage systemic steroid therapy is currently the mainstay of the treatment for SSNHL. Despite oral or intravenous steroid therapy for two weeks, approximately 30-50 percent of patients show no response. Animal studies have found that intratympanic steroid injections, introducing steroids through the tympanic membrane, results in reduced systemic steroid toxicity and higher perilymph steroid level selectively. Past research has focused on use of these injections as a secondary-line therapy in SSNHL refractory cases. Other clinicians promote its use as first-line therapy in all SSNHL cases. Nevertheless, few controlled studies have been published comparing the results between intratympanic steroid treatment and other approaches.

A New Study

A new study evaluates the effect of intratympanic steroid injections in patients with SSNHL after failure to respond to systemic steroid treatment. Patients who refused this regimen were used as controls in this research. The authors of "Intratympanic Steroids for Treatment of Sudden Hearing Loss After Failure of Intravenous Therapy," are Guillermo Plaza MD PhD, from the Otolaryngology Department, Hospital de Fuenlabrada, and Carlos Herr�iz MD PhD, with the Otolaryngology Department, Fundaci�n Hospital Alcorc�n, both in Madrid, Spain. Their findings are being presented at the 110th Annual Meeting & OTO EXPO of the American Academy of Otolaryngology-Head and Neck Surgery Foundation, being held September 17-20, 2006, at the Metro Toronto Convention Centre, Toronto, Canada.

Methodology

From January 2000 to December 2004, a non-randomized prospective clinical trial was conducted for 50 patients diagnosed with unilateral (affecting one ear) SSNHL due to unknown reasons. All patients underwent a complete clinical history, physical and audiologic examination, syphilis serology, autoimmune antibody test, and magnetic resonance imaging, producing negative results. Patients were excluded if SSNHL might be caused by trauma, Meniere's disease, tumors, or autoimmune diseases. Also, those cases that were treated later than 30 days after onset of SSNHL were also excluded.


All cases were intravenously treated, with 120 mg of methlyprednisolone per day, for five days. Rest, stop smoking, and low-salt diet were also advised. Although antiviral agents or diuretic were not included in the standard protocol, intravenous pentoxyphylline was sometimes used with the steroids. After five days of intravenous treatment, pure-tone audiometry and speech discrimination tests (SDT) were performed. Pure-tone average (PTA) was calculated as the average of the thresholds at 0.5, 1, 2 and 3 kHz.

After this period of intravenous therapy, failures (18 cases) were offered intratympanic steroid treatment. Nine patients refused, and were treated with oral steroid tapering during 15 days. They were considered as internal controls, whereas the other nine patients received three weekly intratympanic injections of methylprednisolone. Intratympanic steroid treatment was started 5-7 days after onset of conservative treatment.

Pure-tone audiometry and SDT were performed just before each injection, and one week, one month and six months after the last injection. In the control group that refused intratympanic treatment, pure-tone audiometry and SDT were performed one month and six months after onset. Recovery of hearing was defined as improvement of more than 15 dBs in PTA or an increase in speech discrimination score (SDS) of 15 percent or more. Threshold differences were also analyzed at each frequency in PTA. Side effects and subjective symptoms were also recorded.

Results

The average age of the study patients the patients was 52.0 � 15.8 years. Male to female ratio was 22:28. Time of onset to start of intravenous therapy averaged 5.6 � 7.7 days. Tinnitus was present in 58 percent of the cases, whereas vertigo presented in 24 percent. Thirty-two percent of cases had hypertension, and 14 percent had diabetes mellitus. Initial hearing impairment was average 76.5 � 21.2 dB PTA, and 38 � 12 percent.

After standard intravenous treatment, hearing improvement of 15 dB or more in PTA was noted in 32 cases (64 percent). In these responders, the mean improvement of the value of PTAs before and after intravenous treatment was 35.0 � 16.56 dB. For the 18 failures, nine patients accepted intratympanic treatment, and were enrolled in the treatment group, whereas the other nine served as internal controls. There were no statistical differences in age, sex ratio, time of onset to therapy, presence of vertigo and tinnitus, initial hearing level, and final hearing level after intravenous treatment between the two groups.

In the treatment group, hearing improvement of 15 dB or more in PTA was noted in five cases (55 percent). The mean value of PTA before and one month after intratympanic injections treatment were 73.3 � 20.8 dB and 40.2 � 17.3 dB, respectively, so that an improvement in mean PTA after intratympanic treatment was 33 � 12.55 dB.

Conclusions

This non-randomized prospective clinical trial shows that intratympanic methylprednisolone significantly improved the outcome of SSNHL after intravenous steroid treatment. As previously reported, intratympanic steroids actually are an effective and safe therapy in SSNHL cases that are refractory to standard treatment.

The researchers suggest that the number of injections, the type of steroid, and the most adequate doses must be defined in randomized prospective clinical trials. Also, these randomized studies will allow establishing an evidence-based treatment for idiopathic SSNHL. These trials should also evaluate outcomes after initial therapy for SSNHL comparing steroids that are administrated systemically or by intratympanic injections.

American Academy of Otolaryngology Head and Neck Surgery (AAOHNS)

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