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A new combination treatment offers hope to people who have the blistering, potentially fatal skin disease known as pemphigus vulgaris.
By combining the cancer-fighting drug rituximab with intravenous immune globulin, Harvard doctors have discovered a therapy that can effectively treat people with cases of pemphigus vulgaris that haven't responded to other treatments.
"We got a home run with this combination," said study co-author Dr. Marshall Posner, medical director of the head and neck oncology program at the Dana-Farber Cancer Institute and Harvard Medical School.
"These patients were extremely ill and on multiple medications," he said. "This therapy resulted in complete eradication of the disease for nine patients." The remaining two patients in the study required additional doses of the treatment before they, too, went into remission. All of those involved in the study had sustained remissions, some as long as 37 months, by the end of the study.
Results of the study are published in the Oct. 26 issue of the New England Journal of Medicine.
Pemphigus vulgaris is a rare autoimmune disease that causes the skin cells to stop adhering to one another. Blisters and lesions form, usually beginning in the mouth and then spreading to the skin.
"Before the discovery of corticosteroids, it was fatal within five years. People lost the surface of their skin, and died horrible deaths," explained Dr. John Stanley, chairman of the department of dermatology at the University of Pennsylvania School of Medicine. "This is an instructive disease about the power of the immune system. While it's usually used for good, it can actually destroy you."
Stanley co-authored a review article in the same issue of the journal about pemphigus and other dermatological diseases.
Currently, the first line of treatment for this devastating skin condition is prednisone, a corticosteroid. While it's often an effective treatment, it has numerous side effects that can be serious, so people generally can't stay on high doses for a long time. Other medications used are immune-suppressing agents that also carry the risk of serious side effects, such as infection.
Posner said most deaths from pemphigus occur as a result of immune-system suppression. But without suppressing the immune system, people with pemphigus would continue to develop blisters and erosions in their skin, giving bacteria an easy entry into the body.
Another treatment option is intravenous immune globulin. This option is usually reserved for those who don't respond to the other treatment options. Stanley said scientists aren't sure how this therapy works, but it may be that it replaces the immune-system antibodies that are attacking the skin cells with healthy antibodies.
For most people, these treatments options have proved lifesaving, and people with the disease often do well, said Stanley.
However, there are people who don't respond to any of the currently available treatments. And, the 11 people treated in the new Harvard study fell into that category. None of the available treatments had worked for them, and the disease was covering more than 30 percent of their body's surface area.
Each study volunteer received two cycles of rituximab weekly for three weeks. During the fourth week, they received a dose of intravenous immune globulin. Then, they received monthly infusions of both rituximab and IV immune globulin for four months.
During the initial treatment, nine of the 11 study participants went into remission for an average of 32 months. The remaining two required additional treatments about six months after treatment, but subsequently went back into remission.
While previous research on rituximab has sometimes found serious side effects, such as allergic reaction, Posner said there were virtually no side effects seen in this trial.
He said he thinks this drug combination would likely be helpful in less severe cases of pemphigus vulgaris, and he added that it could potentially be useful for treating other autoimmune diseases, such as rheumatoid arthritis, systemic lupus and type 1 diabetes.
"This therapy offers hope for this disease, and it could lead the way to treatment for other diseases that have a big impact on people's lives -- it needs to be investigated in other diseases so we can see how it works in other situations," Posner said.
Stanley said he doubted that rituximab would become a first-line treatment for pemphigus vulgaris anytime soon because the medication is quite costly and insurance companies would likely balk at paying for an expensive drug that isn't FDA approved specifically for treating pemphigus. The problem, he added, is that because pemphigus is so rare, it would be difficult to conduct a large enough trial to get such approval.
But, Posner suggested that while the rituximab/immune globulin combination treatment is more expensive initially, a cost analysis comparing all of the costs, including hospitalizations, might find the combination treatment is the cheaper alternative in the long run.
By Serena Gordon, HealthDay Reporter, October 26, 2006
By: Heather Woolery-Lloyd, MD
Discover the unique skin care challenges of various ethnic skin types and about some treatment options.
The FDA has approved a new drug to treat a rare and slow-growing type of skin cancer.
The agency approved Zolinza capsules for the treatment of cutaneous T-cell lymphoma (CTCL), a type of lymphoma that affects the skin.
The drug is approved for treatment when the disease gets worse, persists, or comes back during or after treatment with other medicines.
Researchers say about three in a million people are diagnosed with the skin cancer each year, mostly middle-aged men.
Zolinza was approved as part of FDA's Orphan Drug program, which offers companies financial incentives to develop medicines for diseases that affect fewer than 200,000 Americans a year.
Benefits and Risks
The safety and effectiveness of Zolinza were evaluated in two clinical trials involving 107 people with CTCL, who received the drug after their disease came back or other treatments had failed.
Of patients receiving the drug, 30% saw improvement, with the benefit lasting an average of 168 days.
The most common serious side effects of Zolinza were blood clots in the lungs (pulmonary embolism), dehydration, deep vein thrombosis (blood clots in deep veins) and anemia.
Other side effects included diarrhea, nausea, anorexia, vomiting, constipation, fatigue, chills, and taste disorders.
The drug has not been studied in pregnant women, but animal studies suggest Zolinza may harm the fetus if used during pregnancy.
Zolinza is manufactured by Pantheon Inc. for Merck & Co. Inc.
By Jennifer Warner, WebMD Medical News, October 11, 2006
Women's skin ages faster than men's, suggests a study that used an experimental laser device to measure skin damage.
Researchers in Germany used the device to determine collagen and elastin levels beneath the skin's surface. Collagen and elastin are the proteins responsible for the elasticity, tone, and texture of skin, and levels typically decline with age.
There is no good way to assess skin, as measured by collagen and elastin composition, short of removing skin and analyzing it in a lab.
The laser procedure shows promise for making the process a whole lot simpler. That could one day help consumers better evaluate the effectiveness of the antiaging skin products they buy, researcher Martin Johannes Koehler, of Germany's Schiller University, tells WebMD.
"Some cosmetics are thought to change the content of collagen to the skin, but until now to measure that you had to cut out a piece of skin," he says.
Multiphoton Laser Imaging
The search for a noninvasive test to measure damage to the skin from sun exposure and aging is the Holy Grail of the cosmetics industry.
But proving that a skin cream that promises to turn back the clock really is worth $100 an ounce is only one potential application for the experimental laser technique, Koehler says.
It may also prove useful for evaluating skin diseases like that seen in, which is a serious autoimmune disease, as well as a skin complication that can occur in transplant recipients, known as graft vs. host disease.
Koehler and colleagues used the technique, called multiphoton laser imaging, on the inner forearms of seven women and 11 men between the ages of 21 and 84.
The researchers used the information gathered from the imaging to develop an aging index of the dermis, an inner layer of the skin. Skin aging was more evident in women than in men of similar age. It was most marked in older women who had been through.
The researchers wrote that menopause-related declines in the sex hormones estrogen and progesterone might explain this acceleration in skin aging.
More Study Needed
But they added that more research is needed to confirm the finding that men and women's skin ages at different rates. The researchers also note that studies comparing their aging index measurements need to be compared to established measures such as skin surface hydration and wrinkle number and depth.
The study is published in the Oct. 1 issue of the journal Optics Letters.
Cosmetic dermatologist Eliot Battle, MD, tells WebMD that the laser procedure is one of several promising experimental techniques that could help clinicians more easily diagnose and treat skin diseases.
"Diagnostic tools like this have been used in every area of medicine, but they are only beginning to be used in dermatology," he says. "This [technique] is an attempt to use the latest and greatest in laser imaging, but much more research is needed. This is just the very beginning of what could be an exciting journey."
SOURCES: Koehler, M.J. Optical Letters, Oct. 1, 2006; vol 31: pp 2879-2881. Martin Johannes Koehler, department of dermatology and allergology, Friedrich Schiller University, Jena, Germany. Eliot Battle Jr., MD, cosmetic dermatologist and laser surgeon, Cultura Cosmetics Medical Spa, Washington, D.C.
By Salynn Boyles, WebMD, October 4, 2006
An antibiotic-resistant acne germ can spread among family members, Swedish researchers find.
The germ is Propionibacterium acnes. Skin colonized by P. acnes tends to erupt into the blotches and pustules of acne. Since the 1960s, doctors have fought P. acnes with antibiotics. The bug fought back. It's now common to find P. acnes strains resistant to several common antibiotics.
Doctors hoped that the only people carrying the drug-resistant acne bugs would be patients on long-term antibiotic therapy. That isn't the case, find Carl Eric Nord, MD, PhD, and colleagues at Karolinska Institute in Stockholm, Sweden.
Nord and colleagues took skin samples from 10 acne patients, all on antibiotic therapy, and from two close family contacts of each patient. Twelve healthy, acne-free volunteers -- who were not taking antibiotics and did not have family members with acne -- served as a comparison group.
Nord and colleagues found that nearly half of the family members carried drug-resistant acne bacteria on their skin. Genetic analysis showed that these family members carried the same strain of P. acnes as the acne patient among them.
The good news is that the family members fought off the drug-resistant germs -- but only after the acne patient in their family stopped using antibiotics.
On the other hand, you apparently can't avoid drug-resistant acne germs by avoiding people with acne. A third of the healthy comparison group also carried drug-resistant P. acnes on their skin.
Nord reported the findings at last week's 46th Interscience Conference on Antimicrobial Agents and Chemotherapy, held Sept. 27-30 in San Francisco.
SOURCES: 46th Interscience Conference on Antimicrobial Agents and Chemotherapy, San Francisco, Sept. 27-30, 2006.
By Daniel DeNoon, WebMD, October 2, 2006
"Easy on the mind" rather than "easy on the eyes" may be a better way to describe something that’s beautiful, according to a new study.
Researchers found objects and animals that conform to a prototype rather than deviate from it are easier for the brain to process and, therefore, are perceived as more pleasing to the eye.
"What you like is a function of what your mind has been trained on," says researcher Piotr Winkielman of the University of California, San Diego, in a news release. "A stimulus becomes attractive if it falls into the average of what you've seen and is therefore simple for your brain to process. In our experiments, we show that we can make an arbitrary pattern likeable just by preparing the mind to recognize it quickly."
Researchers say the findings build a phenomenon known as "beauty-in-averageness effect," which was discovered in the late 1800s. The theory holds that prototypical images are rated as more beautiful or appealing than variations of the same thing.
To test the theory, researchers had groups of students undergo different experiments. In one experiment, a group of students were presented prototypes of random groupings of dots. Then distortions of the dots in these prototypes were created and presented to the students.
In a second experiment, a group of students rated the attractiveness of random dot patterns and those that conformed to common geometric patterns, like a diamond or square.
The results, published in Psychological Science, showed that the participants categorized patterns quicker and rated them as more attractive when they were closer to their respective prototypes.
A third experiment had students looking at dots also, but this time also examined cheek muscle for smiling action and brow muscle for frowning action.
Researchers also found that the less time it took participants to classify a pattern, the more attractive they found it.
"This parsimonious explanation," says Winkielman, "accounts for cultural differences in beauty -- and historical differences in beauty as well -- because beauty basically depends on what you've been exposed to and what is therefore easy on your mind."
SOURCES: Winkielman, P. Psychological Science, September 2006; vol 17: pp 799-806. News release, University of California, San Diego.
By Jennifer Warner, WebMD, September 29, 2006
Melanoma surgery may get more aggressive to help plan treatment and ultimately improve survival.
A study and editorial in The New England Journal of Medicine support checking the "sentinel" lymph node near melanoma for signs of.
Melanoma is the most serious type of, with more than 53,600 new cases per year diagnosed in the U.S., according to the National Cancer Institute.
The body's lymph system makes, stores, and carries white blood cells that fight infections and other diseases. Lymph nodes are part of the lymph system; they're clustered around the body.
Cancer can spread to lymph nodes. It usually first shows up in one or two "sentinel" nodes that are closest to the cancer site.
In sentinel lymph node biopsy, doctors surgically check the sentinel lymph node or nodes for signs of cancer.
If the biopsy shows cancer in the sentinel node or nodes, that means cancer has spread beyond its original location and would be more likely to be in the other lymph nodes in the area. Sentinel node biopsies are also used with other types of cancer, including.
Sentinel Node Study
The new study comes from researchers including Donald Morton, MD, of the John Wayne Cancer Institute at Saint John's Health Center in Santa Monica, Calif.
Morton's team studied 1,269 people who had surgery to remove isolated skin melanomas of medium thickness.
The researchers randomly assigned 60% of the patients to get sentinel node biopsy. Patients with cancerous sentinel nodes had all the other lymph nodes near the sentinel nodes removed.
The remaining 40% of the patients got careful checkups every few months, without sentinel node biopsy. They kept all of their lymph nodes unless doctors suspected cancer's spread, which happened months or even years later.
Why not just automatically remove all lymph nodes closest to a melanoma? Doing so could have complications and offers no advantage if those nodes are cancer-free.
The researchers followed the patients for five years.
During that time, the overall survival rate between the two groups was similar (around 87%).
But there was an important exception for patients with cancerous lymph nodes.
Of the patients who got sentinel node biopsies that showed cancerous sentinel nodes and had their nearby lymph nodes immediately removed, 72% were alive five years later.
But the five-year survival rate was much lower -- 52% -- for patients with cancerous lymph nodes that were spotted later because they didn't get sentinel lymph node biopsy.
In patients with skin melanomas of medium thickness, sentinel node biopsy "should be preferred to observation," write Morton and colleagues.
That conclusion is "convincing" and "justified," based on the study's results, write editorialists Charles Balch, MD, and Natale Cascinelli, MD.
Balch works in Baltimore, Md., at the Johns Hopkins Medical Institutions. Cascinelli works at the National Tumor Institute in Milan, Italy.
SOURCES: Morton, D. The New England Journal of Medicine, Sept. 28, 2006; vol 355: pp 1307-1317. Balch, C. The New England Journal of Medicine, Sept. 28, 2006; vol 355: pp 1370-1371. National Cancer Institute: "What You Need to Know About Melanoma."
By Mirandi Hitti, WebMD, September 27, 2006
By Judi Bailey
Learn more about identifying this disorder and helping clients who demonstrate its symptoms.
Fair-skinned people who yearn for a suntan -- even though they know it's hopeless and unhealthy -- may one day have cause for celebration.
Harvard scientists have discovered new information about how the skin tans or -- in the case of fair-skinned people -- stubbornly refuses to tan due to a genetic defect. Using a skin treatment, they have turned pale skin dark, while also protecting it from ultraviolet-induced.
"Darkening a person's skin may mimic the protective benefit seen in people who otherwise make a large amount of pigment," says researcher David E. Fisher, MD, PhD, director of the Melanoma Program at Dana Farber Cancer Institute in Boston. And that could translate into a reduction in the toll of the potentially deadly skin cancer melanoma, expected to be diagnosed this year in 62,000 people in the U.S. and to result in 8,000 deaths, according to American Cancer Society projections.
The study appears in the Sept. 21 edition of the journal Nature. Fisher cautions that the study was done only in animals. Using a topical cream instead of the sun's rays, Fisher's team was able to switch on the tanning mechanism in the skin cells of fair-skinned mice, turning them into olive-skinned animals. "This has not been demonstrated in people and there is a lot that needs to be proven before it's ready for even a first attempt in clinical subjects," Fisher says.
Even so, the study was called intriguing by Meenhard Herlyn, DVM, PhD, a tumor biologist at The Wistar Institute, a research center on the campus of the University of Pennsylvania. "What he clearly has shown is ... you can induce a pigmentation, tanning, and the purpose is that people who are very susceptible to skin cancer, including melanoma, can be protected."
By Kathleen Doheny, WebMD, September 20, 2006
Rates of eczema and hay fever in the United Kingdom appear to have stabilized, after charting a steady rise over recent decades.
However, the study also found that rates of systemic allergic reactions -- including the severe condition known as anaphylaxis -- have surged in the past 20 years.
The researchers analyzed data gathered from numerous sources: national surveys, primary care doctors, prescription and hospital admission records, and death records.
Over the past three decades, diagnoses of allergic rhinitis and eczema in children have tripled, but there appears to have been a recent decrease in the prevalence of symptoms. Hospital admissions for eczema have stabilized since 1995, the researchers found, while admissions for allergic rhinitis have decreased to about 40 percent of their 1990 levels.
Between 1971 and 1991, the number of consultations with family doctors about hay fever increased by 260 percent and by 150 percent for eczema. However, these rates have stabilized in the past 10 years, the study said.
Hospital admissions for anaphylaxis have soared by 700 percent, for food allergy by 500 percent, and for the skin allergy urticaria by 100 percent.
Prescriptions for all types of allergies have increased since 1991.
The researchers said that some of the trends could be related to changes in medical practice and care but could also be explained by changes in the sources of allergic disease.
The study was published in the current issue of Thorax.
HealthDay News, September 7, 2006