Psoriasis Drug OK for Long-term Use

Patients who used the psoriasis drug Enbrel for more than a year had no more adverse effects than patients taking a placebo, a new study found.

And most patients showed an improvement in their psoriasis, according to the study. Enbrel had previously been shown to be safe and effective when used over a short period of time, but the question remained whether long-term use of the drug would be safe.

"This drug is safe for long-term use," said lead author Dr. Stephen Tyring, a clinical professor of dermatology at the University of Texas Health Science Center at Houston. "During 96 weeks of follow-up, both the safety and efficacy of the drug were very good."

Enbrel (etanercept) is a drug that blocks tumor necrosis factor, a pro-inflammatory cytokine. People with an immune disease, such as psoriasis, have too much tumor necrosis factor (TNF) in their bodies. Enbrel reduces the amount of TNF to normal levels, but it can also lower the ability of the immune system to fight infections.

In the trial, Tyring's team randomly assigned 618 people with psoriasis to 12 weeks of treatment with Enbrel or a placebo. The patents received 50 milligrams of Enbrel twice a week. After the initial 12 weeks of treatment, 591 patients from both groups continued to receive Enbrel for 84 weeks.

The study researchers found that people receiving Enbrel or a placebo had a similar number of adverse reactions, including serious infections. "There was not a problem with increased infections or any other adverse events in using the drug for the long term, and this is at the higher dosage of 100 milligrams a week," Trying said.

What's more, by the end of the trial, the psoriasis had improved at least 75 percent for 51.1 percent of the original Enbrel group and 51.6 percent of the original placebo group.

The findings are published in the June issue of the Archives of Dermatology.

Tyring noted that Enbrel is not usually used alone, as it was in this trial, but in combination with other drugs, such as creams, as well as with light therapy. "So, in real life, we see better results," he said.

The main drawback to long-term Enbrel treatment is cost, Tyring said. "Like all five biological treatments for psoriasis, Enbrel is expensive, and if the patient doesn't have insurance, it is difficult to keep using this dosage and perhaps even a lower dosage," he said.

According to the National Psoriasis Foundation, Enbrel can cost $10,000 to $25,000 a year or more, depending on the dose and how often it is taken.

One skin disease expert agreed that long-term use of Enbrel is safe and effective, even at the higher dose.

"Physicians would love to use the drug this way," said Dr. Jeffrey M. Weinberg, director of the clinical research center in the department of dermatology at St. Luke's-Roosevelt Hospital Center, in New York City. "The limiting factor is cost," he added.

Some patients do well on 50 milligrams a week, Weinberg said. "But many people do better at the higher dose, especially those who weigh more," he said. "About 40 percent of patients would benefit from the higher dose."

By Steven Reinberg, HealthDay News, June 19, 2007

University Reports Retinol Reduces Wrinkles

The University of Michigan Medical School recently reported that retinol reduces the fine lines and wrinkles associated with natural aging.

UV Exposure Throughout Life May Influence Skin Cancer Risk

Overall exposure to the sun's ultraviolet (UV) rays in childhood, not just sunburns, may be a major factor influencing a person's risk for skin cancer later in life, suggest initial results of research looking at the interaction of genes and UV exposure in 214 people with melanoma, the most deadly form of skin cancer.

Dr. Nancy Thomas, a dermatologist at the University of North Carolina, used satellite data to track average UV radiation in the towns and states where the patients lived at different times of their lives, the Associated Press reported.

She and her colleagues found that the patients who'd experienced the highest UV exposure by age 20 had the highest number of melanoma-related BRAF gene mutations. The same patients also had the most moles, another important risk factor for melanoma.

More research is needed, but Thomas suggested that rapidly growing skin on young people may be especially vulnerable to damage from UV rays, the AP reported.

In related news, the U.S. Food and Drug Administration is putting the finishing touches to new rules for sunscreen ratings. Currently, sun protection factor (SPF) ratings tell consumers only how well a sunscreen protects against UV-B rays that cause sunburn.

The agency wants the SPF ratings to also include how well sunscreens protect against UV-A rays that cause cancer and wrinkles, the AP reported. The proposed changes should be introduced within the next few weeks, but are subject to a public comment period before they take effect.

HealthDay News, June 11, 2007

Protein May Predict Melanoma's Recurrence

Melanoma patients with higher levels of a protein called S-100 in their blood may run a higher risk of having the potentially deadly skin cancer return, a new study says.

The study tested serum samples from 103 patients who were treated with high-dose interferon, a standard therapy for melanoma; the patients had been treated eight years earlier, on average. The disease recurred in 64 of the patients within an average of 30 months. When the researchers examined levels of S-100 in the serum samples, they found that the higher the level of the protein, the greater likelihood the patient's disease had returned.

"Melanoma patients who initially respond well to treatment with interferon are at high risk of their cancer recurring," said Dr. John Kirkwood, principal investigator of the study and a professor of medicine at the University of Pittsburgh School of Medicine and director of the school's Melanoma Center. "We know that only 30 percent of these patients benefit from treatment long-term. The goal of our study was to identify better predictors of who will benefit most from treatment with interferon and who is most at risk of their cancer returning."

The study also found that patients who survived longer showed increased evidence of an autoimmune response to treatment with interferon.

The study findings were to be presented Saturday at the annual meeting of the American Society of Clinical Oncology, in Chicago.

"With further study, we hope to learn more about the role of S-100 in melanoma survival," said Joseph Stuckert, a medical student at the University of Pittsburgh School of Medicine who was to present the study at the meeting. "S-100 may be an important key to better stratifying patients into those more or less likely to relapse."

The next step in the research, Stuckert said, is to identify factors that may make patients more likely to develop autoimmunity and to further examine the role of S-100 as a potential biomarker for melanoma.

Malignant melanoma is one of the deadliest forms of skin cancer. Nearly 60,000 new cases of melanoma are expected in 2007, and 8,100 deaths are expected to occur.

The study was funded by a grant from the U.S. National Cancer Institute.

HealthDay News, June 2, 2007

Triple Threat: The Three Keys to Fighting Aging Skin

By Diana L. Howard, PhD

Teach your clients about the three biochemical reactions that cause aging skin.

Immune System Dysfunction Pinpointed in Melanoma Cases

U.S. researchers say they've spotted a key immune system dysfunction in patients with melanoma skin cancer.

A team at Stanford University School of Medicine, in California, found that the immune cells in most melanoma patients fail to respond properly to a molecule called interferon, which normally activates the immune system. This failure to respond to interferon means that the immune cells don't fight off melanoma.

The findings, published in the May issue of the journal Public Library of Science-Medicine, could help in the development of new treatments for melanoma.

Melanoma will kill about 16 percent of the 47,700 people in the United States expected to be diagnosed with this form of skin cancer this year.

These findings help explain why a common melanoma treatment involving prolonged exposure to interferon sometimes helps melanoma patients, said senior author Dr. Peter Lee, associate professor of medicine.

"Doctors knew it worked in some people but didn't know why," Lee said in a prepared statement. This study suggests that prolonged interferon treatment may work by overcoming the immune system's inability to respond to interferon.

Previous research has found that cancer patients often have immune system problems, but, until now, scientists didn't know which genes or pathways were at the root of the trouble. Identification of this interferon response disruption may boost efforts to develop vaccines for different types of cancer, the Stanford researchers said.

"We think this is a dominant way that immune dysfunction occurs in people with cancer," Lee said

HealthDay News, May 14, 2007

Tea May Lower Skin Cancer Risk

People who unwind with a cup of tea every night may have a lower risk of two common forms of skin cancer, new research suggests.

In a study of nearly 2,200 adults, researchers found that tea drinkers had a lower risk of developing squamous cell or basal cell carcinoma, the two most common forms of skin cancer.

Men and women who had ever been regular tea drinkers -- having one or more cups a day -- were 20 percent to 30 percent less likely to develop the cancers than those who didn't drink tea.

The effect was even stronger among study participants who'd been tea fans for decades, as well as those who regularly had at least two cups a day, according to findings published in the Journal of the American Academy of Dermatology.

However, the findings do not mean it's okay to bake in the sun as long as you have a cup of tea afterward. The researchers found no evidence that tea drinking lowered skin cancer risk in people who'd accumulated painful sunburns in the past.

Nor did the study look at the relationship between tea drinking and malignant melanoma, the least common but most deadly form of skin cancer.

Still, the findings support the theory that tea antioxidants may limit the damage UV radiation inflicts on the skin, according to the study authors, led by Dr. Judy R. Rees of Dartmouth Medical School in Lebanon, New Hampshire.

In particular, a tea antioxidant known as EGCG has been shown to reduce burning on UV-exposed skin.

The current findings are based on interviews with 770 New Hampshire residents with basal cell carcinoma, 696 with squamous cell carcinoma, and 715 cancer-free men and women the same age.

Tea consumption was linked to a lower skin cancer risk, even with factors such as age, skin type and history of severe burns considered. However, tea drinkers who'd suffered multiple painful burns in the past did not have a lower risk of skin cancer.

It's possible, the researchers explain, that the antioxidants in tea are enough to limit skin damage caused by moderate sun exposure, but not the "more extreme" effects of sun exposure, such as cancer-promoting damage to the DNA in skin cells.

SOURCE: Journal of the American Academy of Dermatology, May 2007.

HealthDay News, May 4, 2007

Less Sun a Better Bet Than Sunscreens

Sun worshippers won't want to hear it, but a new study says the best way to protect against cancer-causing ultraviolet rays is to avoid direct sunlight and wear protective clothing to keep exposure to a minimum.

Sunscreens are a poor second choice, but they're better than nothing, said the Swiss dermatologists who did the study.

The findings take on added urgency for residents of the northern hemisphere, where summer is approaching with its promise of long, lazy days spent at the beach or other outdoor play spots.

"Wearing sun-protective clothes and a hat and reducing sun exposure to a minimum should be preferred to sunscreens," Dr. Stephan Lautenschlager, of the Outpatient Clinic of Dermatology at Triemli Hospital in Zurich, wrote in the May 3 online edition of The Lancet.

But, this advice is felt to be "unacceptable in our global, outdoor society and sunscreens could become the predominant mode of sun protection for various societal reasons, for example healthiness of a tan, relaxation in the sun," the study authors added. "Nevertheless, sunscreens should not be abused in an attempt to increase time in the sun to a maximum."

One expert agrees with the recommendation.

"I am a proponent of the approach advocated by the [American] Cancer Society," said Dr. Martin Weinstock, a professor of dermatology at Brown University and chairman of the American Cancer Society's skin cancer advisory group. "It's called Slip-Slop-Slap. Slip on a shirt, slop on sunscreen, slap on a hat. That's the way to be safe during outdoor activities."

According to Lautenschlager's group, the type of clothing you wear can make a big difference in sun protection factor (SPF). For example, tightly woven, thick garments made of denim, wool or polyester offer the best protection, while cotton, linen and acetate are much less effective, they noted.

In terms of sunscreens, there are two kinds -- inorganic and organic. Inorganic sunscreens work by scattering UV light using zinc or titanium oxides. This type of sunscreen is well tolerated by the skin and produces few allergic effects. It is recommended for children, the study authors said.

Organic sunscreens absorb the UV rays, and are made up of complex organic molecules that are "photoprotective." Organic screens should be put on 15 to 30 minutes before going out in the sun.

And waterproof or water-resistant sunscreens should be used to reduce the need for reapplication after swimming followed by toweling, friction with clothing or sand, and sweating, Lautenschlager's group noted.

Weinstock thinks that SPF factor is the most important consideration when choosing a sunscreen. "I recommend SPF 30 or greater," he said.

Lautenschlager's group warned that while studies have found that sunscreens protect against acute UV skin damage and nonmelanoma skin cancers, it's not clear whether they help protect against melanoma, the most dangerous form of skin cancer.

"The population has to be advised how to best make use of sunscreens," the authors wrote. "The application of a liberal quantity of sunscreen is, by far, the most important factor for effectiveness of the sunscreen, followed by the uniformity of application and the specific absorption spectrum of the agent used."

Dr. Doris Day, a dermatologist at Lenox Hill Hospital in New York City, offers another safety rule to minimize your exposure to UV rays.

"There is a nice rule -- called the shadow rule -- that is very useful," Day said in a statement. "The shorter your shadow, the more dangerous the rays of the sun. So, for example, at noon when the sun is highest, you have little to no shadow, and that is the best time to try to stay indoors or in the shade."

Skin cancer -- including melanoma and nonmelanoma malignancies -- is the most common of all cancers, accounting for about half of all cancers. An estimated one million cases of nonmelanoma skin cancers are diagnosed annually in the United States. Most are basal cell -- about 800,000 to 900,000. Squamous cell cancer occurs less often -- perhaps 200,000 to 300,000 cases annually. People do not often die of these cancers. About 1,000 to 2,000 people die of nonmelanoma skin cancer each year in the United States, according to the American Cancer Society.

Melanoma, on the other hand, causes most skin cancer deaths, even though it accounts for just 3 percent of all skin cancer cases. The American Cancer Society estimates there will be 59,940 new cases of melanoma in the United States this year, and about 8,110 people will die of the disease.

HealthDay News, May 3, 2006.