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Oct
27
2006

New Study Finds Allergy-Like Reaction May Trigger Rosacea Bumps and Pimples

The bumps (papules) and pimples (pustules) of rosacea, a poorly-understood facial disorder affecting an estimated 14 million Americans, may be the result of an allergy-like reaction to environmental and emotional triggers, according to new study results presented at the National Rosacea Society (NRS) research workshop during the annual meeting of the Society for Investigative Dermatology and reported in Rosacea Review.

"We are very excited about these findings because they may provide the basis for improving the treatment and management of this condition," said Dr. Richard Gallo, chief of the division of dermatology at the University of California-San Diego and lead investigator of the NRS-funded study. "By defining the process leading to the inflammation, new medications might be developed to block these effects."

Dr. Gallo explained that when the normal immune system is faced with any of a broad range of potential dangers—such as sun exposure, emotional stress, heat and spicy foods, among many others—receptors recognize potential threats and protect the body by prompting the production of protective substances that isolate and neutralize any harmful effects. With rosacea, however, these protective substances turn the body on itself like overzealous guards, leading to inflammation.

Using advanced mass spectrometry technology to analyze the biochemical composition of proteins in rosacea patients, the researchers discovered an abnormality in the production of protective molecules known as cathelicidins, Dr. Gallo said. In normal patients, the cathelicidins are found in a form that is inactive and would not lead to bumps and pimples. In rosacea patients, the forms of cathelicidins are different and lead to skin inflammation. The cause of this abnormality in cathelicidins seems to be due to an equally important problem in rosacea—an overabundance of yet another substance, called kallikrein, which can spur dormant cathelicidins into action.

"It appears that the combination of these two substances at abnormally high levels is a double whammy for rosacea patients," Dr. Gallo noted.

The researchers recently completed the picture when they were able to demonstrate that this process is linked to the actual formation of rosacea signs and symptoms. The skin of mice injected with the cathelicidins found in rosacea patients showed a dramatic inflammatory response—including bumps and pimples—while mice injected with normal cathelicidins showed no inflammation, either visually or under a microscope.

"The next step is to test these findings in human subjects through various therapeutic interventions," Dr. Gallo said. "As we gain a thorough understanding in humans, we can look for new medications that block this process in order to treat or prevent the inflammation associated with rosacea."

Rosacea is a chronic disorder that primarily affects the cheeks, nose, chin or forehead, and is often characterized by flare-ups and remissions. It typically begins as a flushing or redness that comes and goes, and visible blood vessels may also appear. Inflammatory bumps and pimples often develop, and in severe cases, the nose may become swollen and enlarged from excess tissue.

In addition to long-term medical therapy to bring the condition under control and maintain remission, patients are advised to keep a diary to identify and avoid lifestyle and environmental factors that may affect their individual cases. Some of the most common rosacea triggers include sun exposure, emotional stress, hot or cold weather, wind, heavy exercise, alcohol, hot baths and spicy foods.

Oct
26
2006

Dual Drug Therapy Effective Against Pemphigus Vulgaris

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

Oct
24
2006

Ethnic Skin Care

By: Heather Woolery-Lloyd, MD

Discover the unique skin care challenges of various ethnic skin types and about some treatment options.

Oct
20
2006

New Study Indicates Massage Reduces Hand Arthritis Pain

Massage therapy is effective in reducing hand pain and increasing grip strength, according to a new study funded by Biotone and conducted by the Touch Research Institutes (TRI) at the University of Miami School of Medicine in Miami, Fla.

Arthritis is a systemic inflammatory disease, frequently located in the small joints of the hands. It affects the active, working-age population as well as the elderly, causing pain, activity limitations, and a lower quality of life. Many daily activities, for example, require considerable hand strength, such as opening doors, opening jar lids, lifting and carrying items. Hand strength in patients with arthritis is 75 percent lower than in healthy patients.

“While massage therapy has decreased pain in several pain syndromes, including fibromyalgia, lower back pain and migraine, this is the first report of pain reduction in hand arthritis following massage therapy,” said Dr. Tiffany Field, TRI director. “Up to now, many other interventions to alleviate hand pain have been tried -- medications, physical therapy and various forms of exercise. The results of this study are very encouraging for the application of massage therapy as a complementary alternative treatment for hand arthritis.”

Under the study, 22 adults ranging in age from 20 to 65 with wrist/hand arthritis were randomly assigned to a massage therapy or a standard treatment control group. The massage therapy group received massage on the affected wrist/hand once a week for a four-week period and also conducted self-massage on the wrist/hand at home daily. Biotone Polar Lotion was used in the massage therapy. The standard treatment control group did not receive massage therapy during the study. 

The massage therapy group had lower anxiety and depressed mood scores after the first and last sessions, and by the end of the study reported less pain and greater grip strength. The massage therapy group showed greater improvement than the standard treatment control group on all of these measures across the study period.

“Biotone continues to fund research regarding the different effects of massage therapy on consumer's health and well being," said Jean Shea, Biotone founder and CEO. “The arthritis, breast cancer and back pain studies we funded all have shown positive results that are very encouraging. Our research studies, in addition to the many others being conducted worldwide, provide increased awareness and acceptance of massage therapy as an effective complementary alternative treatment."

Biotone is supporting two research projects through the Massage Therapy Foundation for 2006. The research studies involve therapeutic massage for pediatric burn survivors and the effects of five minute foot massages on pediatric Intensive Care Unit patients. More information will be available soon.

Oct
18
2006

BLS, NCLE Offer Unified Safety Officer Program

The Board of Laser Safety (BLS)/The National Council on Laser Excellence (NCLE) now offer a collaborative, unified Certified Medical Laser Safety Officer program (CMLSO) to promote overall acceptance of laser certifications. To contact the BLS, call 407-380-1553. For the NCLE, call 614-883-1739.

Oct
09
2006

Black Tea Eases Stress

Black tea eases stress by lowering blood levels of the stress hormone cortisol, says a British study in the journal Psychopharmacology.

The six-week study of 75 people found that those who drank black tea were able to de-stress more quickly than those who drank a caffeinated tea substitute, BBC News reported.

The participants were assigned challenging tasks while their cortisol, blood pressure, blood platelet, and self-rated levels of stress were measured by the researchers. During these tasks, both groups of study participants experienced large increases in blood pressure, heart rate, and self-rated levels of stress.

However, 50 minutes after the stressful tasks, cortisol levels dropped by an average of 47 percent among those who drank black tea and 27 percent among those who drank the tea substitute.

The study also found that the tea drinkers had lower blood platelet activation, which is associated with blood clotting and heart-attack risk, BBC News reported.

It's unclear which ingredients in black tea help reduce stress, the University College London researchers said.

HealthDay News, October 6, 2006

Oct
06
2006

U.S. Companies Embrace Wellness Programs

To arrest rising health-care costs, a growing number of U.S. employers are expanding workplace "wellness" initiatives. Providing workers with tools and incentives to improve their health, the thinking goes, will reduce medical-care costs and boost worker productivity.

Experts say it's a trend that bodes well for employees who are motivated to lose weight, quit smoking, manage a chronic condition or just stay fit.

"Pretty clearly, employers have realized that if they're going to manage benefit costs and manage work loss, they need to get at the underlying health drivers of that -- employee health -- and get at the root causes of health-care utilization and health-care expenditures," said Bruce Kelley, practice leader for data services in the Minneapolis office of Watson Wyatt Worldwide, a human resources consulting firm.

According to Kelley, employers have been investing much more heavily in wellness services in the last few years. "I've been consulting in this area for 20 years," he noted, "and I've never seen as much activity among employers as I've seen just in the last few years."

Wellness is a broad term that describes the panoply of health-management services that companies offer, from onsite fitness centers and smoking-cessation classes to health-risk appraisals and disease-management programs.

Survey data show that more large employers are offering programs to improve employee health and productivity. Seventy-five percent offered a "health promotion" program in 2005 or 2006, up from 56 percent in 2003, according to survey results released last December by Watson Wyatt and the National Business Group on Health.

Nearly three out of four employers (72 percent) are sponsoring health-risk appraisals to measure individual employees' health risks and behaviors. And 40 percent are engaging "personal health coaches," health professionals who can help, say, an employee with diabetes manage their diet, exercise and drug regimens.

At the same time, corporate America and public health leaders are grappling to understand which particular interventions or combinations of programs and incentives yield the greatest return on investment.

"There has not been a tremendous amount of high quality research in this area," said Doug Evans, director of the Center for Health Promotion Research at RTI International, a nonprofit research institute based in Research Triangle Park, N.C.

But there are a number of efforts under way to learn what works. The U.S. Centers for Disease Control and Prevention, for one, is sponsoring a series of studies to evaluate worksite efforts to prevent and control obesity.

In one study, published in the September/October 2005 issue of the American Journal of Health Promotion, CDC and RTI researchers found that obesity boosts employers' costs, including medical expenditures and absenteeism, by $460 to $2,500 per obese employee per year. They estimated that the cost of obesity at a firm with 1,000 employees is about $285,000 per year.

In March, the National Business Group on Health issued 10 recommendations for promoting prevention in the workplace. Overall, it concluded that without the support of top-level management, companies cannot convey "the importance to employees of caring for themselves."

Some employers are using incentives to get workers on the wellness bandwagon. You might qualify for a lower health insurance premium, say, if you stop smoking, or you could earn a $25 gift certificate for completing a health-risk appraisal.

The use of incentives will continue, Evans predicted. However, he believes employers must do a better job of promoting the benefits of health, much like anti-tobacco advocates did by portraying a non-smoking lifestyle as cool, hip and fun.

"Maybe that kind of technique can be effective in obesity," he offered. "Can you make it cool to be healthy weight and not to be fat?"

More information

Arkansas Gov. Mike Huckabee, chairman of the National Governors Association, is encouraging all Americans to live healthy lifestyles through a national campaign, Healthy America: Wellness Where We Live, Work and Learn.

By Karen Pallerito, HealthDay News, October 5, 2006

Oct
03
2006

Drug-resistant Acne Runs in the Family

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

Sep
27
2006

Compulsive Skin Picking

By Judi Bailey

Learn more about identifying this disorder and helping clients who demonstrate its symptoms.

Sep
27
2006

Cornelia Day Resort Welcomed Chiva-Som Therapists

Cornelia Day Resort in New York welcomed two Chiva-Som therapists from Hua Hin, Thailand, for a special promotional week in which clients could experience authentic Thai massages. 866-663-1700