Are you itching to know what might be causing your skin rash?  If you have eczema or dermatitis, you might be allergic to something your skin has come in contact with.  Sometimes the allergen is fairly obvious, such as if you got exposed to poison ivy.  Many times however which chemical allergens are involved is not obvious.  Since avoidance of the allergens can often result in significant improvement or clearing of the rash, finding out what you might be allergic to is important.  The allergen testing process is called patch testing.  It is different from the scratch and prick testing that allergists do.

Patch testing involves having panels of allergens applied to the skin of your back and taped in place.  They are left in place for two days.  The tapes are then removed and a first reading is done.  A second reading is done a day or two later because the reaction is often delayed. During the patch testing process you cannot get your back wet.  After the second reading, you will receive a printout listing any allergens and what products would be safe to use. 

After you begin avoiding your allergens, the allergen you already have bound to your skin will slowly be shed, usually over 6 to 8 weeks, and you may begin to notice improvement or clearing of your dermatitis type rash. You will remain allergic to those allergens and will have to continue to avoid them.  For many people the relief obtained is significant and lasting.

by:Philip Shenefelt, MD

Dr. Shenefelt is Professor and Dermatologist at USF Health and actively see patients at the Morsani Center for Advanced Health Care on the USF campus and also at the USF Health Davis Island location. For appointments call 813-974-4744

The Gustavus Adolphus College Board of Trustees has established an award in honor of the college’s Sesquicentennial anniversary to recognize individuals who have made a significant difference in the life of the college.

The award, called “The Sesquicentennial Award,” acknowledges and pays tribute to living alumni, parents, friends, and retired faculty and staff who:

Through actions in their personal or professional lives, have advanced the status of Gustavus as a premier liberal arts college; Set a new precedent in the ways they supported and advanced the mission of the college as an institution dedicated to preparing students “for fulfilling lives of leadership and service in society”and/or have brought particular dignity or honor to the college.

On Thursday, February 9^th the President of Gustavus Adolphus College, Jack R. Ohle awarded Neil Alan Fenske, MD the Gustavus Sesquicentennial Award.  The presentation and event took place at Malio’s in Tampa.

Neil Alan Fenske, MD is the Professor and Chairman of the Department of Dermatology and Cutaneous Surgery at the University of South Florida, Morsani College of Medicine.   813-974-4744 for appointments

Visit dermforthenonderm.com to register

Mary Ruth Buchness, MD
Arch Dermatol. 2011;147(11):1282. doi:10.1001/archdermatol.2011.322

Bedi MK, Shenefelt PD. Herbal therapy in dermatology. Arch Dermatol. 2002;138(2):232-242.

In this article, Bedi and Shenefelt present a comprehensive review of evidence-based uses of herbs in dermatology. Consumers are increasingly interested in treatment with “natural” remedies either because of the failure of conventional therapy or because of the belief that natural treatments lead to fewer adverse effects. By disease, the authors list the herbal treatments that have been studied in humans and animals, effective doses, hypothesized mechanism of action, and potential adverse effects. In a second section, they review cutaneous and systemic adverse effects, including fatalities, that can occur with the use of herbal treatments for dermatologic diseases as well as drug-herb interactions.

Unfortunately, Bedi and Shenefelt’s excellent review article cannot serve as an herbal treatment formulary because herbal treatments are considered to be dietary supplements, not drugs, by the Food and Drug Administration and therefore are not regulated or standardized. This lack of regulation puts the practitioner in the difficult position of knowing what may be effective without knowing where to send the patient to get it. In the analysis of various herbal products, not only has the active ingredient been found to be absent in some brands, but, in some cases, the product itself has been found to be adulterated with prescription medications or heavy metals. In the end, the article serves as a caveat against choosing natural over pharmaceutical treatment.

Genetech has submitted a New Drug Application for vismodegib to the U.S. Food and Drug Administration (FDA) for the treatment of people with advanced basal cell carcinoma (BCC) for whom surgery is considered inappropriate. BCC is the most common type of skin cancer which affects thousands of people each year. Most BCCs are easily treated through surgery. However, if left untreated, they can become very large and difficult to treat by standard means. Rarely, BCCs may even metastasize. Currently, there are limited treatment options once BCC reaches an advanced stage.
Research has shown that mutations in the Hedgehog pathway are implicated in most BCCs. These mutations activate the Hedgehog pathway and promote growth of cancer cells. Vismodegib is an inhibitor of the Hedgehog pathway.
In the ERIVANCE trial, 104 patients with locally advanced or metastatic BCC were treated with 150mg of vismodegib orally. A clinical benefit was noted in 75% of patients: tumors shrank or did not enlarge. The most common drug-related adverse events were muscle spasms, hair loss, altered taste sensation, weight loss, fatigue, nausea, decreased appetite and diarrhea. Four patients experience severe adverse events thought to be related to vismodegib.
It is important to note that vismodegib did not cure any patients but does offer some hope for treatment of these otherwise debilitating cancers. Early detection is key in preventing these cancers from growing to an advanced stage. Early detection can be facilitated by examining your skin monthly for any new or suspicious growths such as ones that change color, size, shape, bleed, or are symptomatic. Some BCCs can be difficult to detect or may not arouse your suspicion which is why it is important to be examined by a dermatologist at least once a year.
For more information, patients can contact the Genentech clinical trial call center at 888-662-6728.

by: Basil S. Cherpelis, M.D.

Twenty-four USF Health physicians are among the top 1 percent of physicians in the entire country, according to Top Doctors, a recently published list from U.S. News & World Report and Castle Connolly, publisher of America’s Top Doctors.

U.S. News & World Report recently released its list of the Top Doctors – one of many much anticipated rankings the magazine publishes each year – and USF Health physicians make up nearly half of the Tampa Bay area physicians deemed to be among the top 1 percent of physicians in the United States.

Top Doctors is a compilation that includes more than 27,000 physicians from across the country. All of these physicians are considered by fellow physicians to be the best in their specialties and determined by U.S. News to be in the top 10 percent in their region. From that overall list, U.S. News had a committee of medical experts look closer at the group to determine which ones warrant being considered among the top 1 percent of the nearly 800,000 physicians in the country.

Here’s how the list panned out locally for USF Health. Searching the online U.S. News list for all physicians within 25 miles of zip code 33612, 572 names came up. Of those, 80 are on the USF faculty, or 14 percent. Also within that list of 572, there are 53 in the Tampa Bay area making the list’s separate designation of being among the top 1 percent in the country in his or her specialty. Of those 53 local physicians, 24 are at USF, or 45 percent.

U.S. News Top Doctors was developed in collaboration with Castle Connolly Medical Ltd., publisher of America’s Top Doctors® and other guides, and was built upon data from Castle Connolly’s Top Doctors™. Castle Connolly bases its Top Doctors selections on nominations submitted by other doctors and reviewed by its physician-led research team.

Tops Doctors at USF Health are:
Top 1% in the nation
Bandyk, Dennis, MD Vascular Surgeon
Cruse, C. Wayne, MD Plastic Surgeon
Diamond, Frank B., MD Pediatric Endocrinologist
Djulbegovic, Benjamin, MD/PhD Hematologist
Emmanuel, Patricia, MD Pediatric Infectious Disease Specialist
Estores, David S., MD Gastroenterologist
Fenske, Neil A., MD Dermatologist
Freeman, Thomas, MD Neurosurgeon
Goldman, Allan L., MD Pulmonologist
Hess, J. Bruce, MD Ophthalmologist
Ledford, Dennis, MD Allergist-Immunologist
Lockey, Richard, MD Allergist-Immunologist
Lockhart, Jorge L., MD Urologist
Marcet, Jorge E., MD Colon and Rectal Surgeon
McCaffrey, Thomas V., MD ENT-Otolaryngologist
Nicosia, Santo, MD Pathologist
Paidas, Charles N., MD Pediatric Surgeon
Powers, Pauline, MD Psychiatrist
Sleasman, John W., MD Pediatric Allergist-Immunologist
Smith, David J., Jr., MD Plastic Surgeon
Smith, Paul D., MD Plastic Surgeon
Sutphen, Rebecca, MD Clinical Geneticist
Tebbi, Cameron, MD Pediatric Hematologist-Oncologist
Van Loveren, Harry, MD Neurosurgeon

Top 10% in the nation
Abel, Naomi, MD Physiatrist
Albrink, Michael H., MD Surgeon
Anderson, William M., MD Pulmonologist
Baran, Gregg, MD Diagnostic Radiologist
Baumann, Shelly, MD Diagnostic Radiologist
Belsole, Robert John, MD Hand Surgeon
Brady, Patrick G., MD Gastroenterologist
Brownlee, Harrison J., Jr., MD Family Medicine Doctor
Bruder, Karen, MD Obstetrician-Gynecologist
Carrion, Rafael, MD Urologist
Dabrow, Sharon, MD Pediatrician
Drucker, Mitchell, MD Ophthalmologist
Fernandez, Francisco, MD Psychiatrist
Flannery, Michael, MD Internist
Greenberg, Mark S., MD Neurosurgeon
Groden, Lewis, MD Ophthalmologist
Haubner, Laura, MD Neonatalogist
Hauser, Robert A., MD Neurologist
Homan, Edward, Jr., MD Orthopedic Surgeon
Klasko, Stephen, MD Obstetrician-Gynecologist
Leffers, David, MD Orthopedic Surgeon
Lien, Mary H., MD Dermatologist
Lynch, Catherine, MD Obstetrician-Gynecologist
Mamel, Jay J., MD Gastroenterologist
Martinez, Carlos R., MD Diagnostic Radiologist
Mayer, James C., MD Obstetrician-Gynecologist
Mendellblatt, Frank, MD Ophthalmologist
Miguel, Rafael, MD Anesthesiologist
Morrison, Anthony D., MD Endocrinologist
Nelson, Robert M., MD Neonatalogist
Ordorica, Raul C., MD Urologist
Panzarino, Valerie M., MD Pediatric Nephrologist
Parsons, Anna, MD Obstetrician-Gynecologist
Parsons, Michael, MD Perinatologist
Pavan, Peter, MD Ophthalmologist
Perlman, Sharon, MD Nephrologist
Pinkas, Haim, MD Gastroenterologist
Plosker, Shayne M., MD Reproductive Endocrinologist
Ridley, Marion B., MD ENT-Otolaryngologist
Rifkin, Stephen, MD Nephrologist
Saba, Hussain, MD/PhD Hematologist
Schnapf, Bruce, DO Pediatric Pulmonologist
Seleznick, Mitchel, MD Internist
Shames, Murray, MD Vascular Surgeon
Shenefelt, Philip D., MD Dermatologist
Shulman, Dorothy, MD Pediatric Endocrinologist
Smith, Donald A., MD Neurosurgeon
Solomon, David Allan, MD Pulmonologist
Spellacy, William, MD Obstetrician-Gynecologist
Stromquist, Philip S., MD Interventional Cardiologist
Takagishi, Jennifer C., MD Pediatrician
Winters, Paul R., MD Neurologist
Woodard, Laurie, MD Family Medicine Doctor

PHYSICIAN SPOTLIGHT: Neil A. Fenske, MD Chairman, Department of Dermatology & Cutaneous Surgery, USFCOM, Tampa
Some might think that growing up “dirt poor” on a farm in Blue Earth, Minn. would be a liability. But Neil Fenske treasures it as a character-building experience that allows him to appreciate how far he has come in life.

“I’m a guy who came up the hard way,” said Fenske, chairman of the Department of Dermatology & Cutaneous Surgery at the University of South Florida College of Medicine in Tampa. “I had to carve, scratch, dig and cajole. That’s not a complaint. It has made me stronger, Fenske said.

Written by Robin McClain MSN, ARNP, FP-C

Over the last decade severe acne has been linked to dairy intake such as milk, breakfast drinks, sherbet, and cheeses. What should teens and parents do with this information? Should teens stop drinking milk and eating dairy products that are good for their health, growth and development? The answer is no.

First, thing you must know is that diary has shown to make acne more severe but, does not cause acne. A study from the Journal of the American Academy of Dermatology in February 2005 analyzed responses from 47,355 married female nurses who drank more than three servings of any type of milk per day. Twenty-two percent of the women were more likely to report having had severe acne than those who drank only one (or less) servings of milk per week. Those who consumed two or more glasses of skim milk daily were forty-four percent more likely to have been diagnosed with severe acne as teenagers. Then in May of 2008 the Journal of the American Academy of Dermatology published a study that found amongst boys who drank skim milk tended to have more severe acne. These findings suggested that skim milk contains hormonal constituents or factors that might influence endogenous hormones in sufficient quantities to have biological effects in patients that lead to increased severity of acne. We know that whey is found in higher concentrations in skim milk, which maybe the substance to blame in causing acne to worsen. Also, milk contains androgen hormones or better known as testosterone, which have been linked to the formation of acne breakout. The reason teenagers are more prone to acne breakouts is due to increased levels of testosterone that causes a chain reaction that stimulates the oil gland to secrete more oil possibly leading to increase acne outbreaks. If all of the above was not enough, dairy farmers are actually injecting genetically-engineered bovine growth hormones (rBGH) into their cows to increase milk production. This growth hormone has been possibly linked to acne and cancer as well.  

It is hard to come to the conclusion that we should stop drinking milk or ingesting diary to minimize acne outbreaks, when the studies are so limited and the exact reasons why diary has this effect is unknown. Let alone diary can be very beneficial to our bodies in so many other ways.  We need to remember people react differently to milk and dairy. And just because one drinks milk or eats diary does not mean that person will get an acne outbreak.

Long story short, if you are worried that milk and diary may be playing a role in your acne getting worse try soy or organic milk. It is typically pesticide, antibiotic, and injected hormone free but there will still be natural hormones in the milk and less in soy milk. Stay away from products high in whey such as fat-free or skim milk, or pasteurized processed cheese.

Dermatologists and medical providers cannot say for sure, what role dairy truly has on acne. However, if you are struggling with acne, it probably would not hurt to limit milk and dairy for a while and see if your skin improves.