Dr. Christopher Nelson will be speaking on New Advancements in the Treatment of Psoriasis this December 17, 2013 at 6:30pm. Please join us by signing up through www.tgh.org/che.htm
TAMPA – The broad expanse of 63-year-old Richard Partyka’s back is a rough neighborhood, covered with scar tissue from his many run-ins with with Dr. Christopher Nelson.
“These are where he had spots cut out. This was the melanoma,” said Dr. Nelson, USF’s director of dermatology research clinic, pointing out the healed incisions on Partyka’s freckled skin.
Aside from logging hundreds of hours at the beach as a youth, Partyka was at risk for skin cancer for another reason. His mother died of metastatic, or spreading, melanoma.
“She had a mole in the back of her calf about the size of a fingernail. It began to bleed. Two and a half months later, she was gone at age 50,” said Partyka.
Skin cancer research has found ways to slow the spread of highly malignant cancers like melanoma. But Dr. Nelson far prefers catching cancer early through regular exams. And while melanomas are rare, squamous cell and basal cell cancers are common and more closely correlated to how much time you’ve spent under the burning rays of the sun.
Doctors believe sun exposure accumulates in the body over a lifetime. That means sunburns you suffered when you were in high school increase your risk of skin cancer today.
One of the hurdles people of all ages need to overcome is modesty. One third of melanomas occur on non-sun exposed skin.
“So when you go in to get looked at, take off all your clothes. Don’t be shy. We’ve seen it all” said Dr. Nelson.
Until further notice Richard Partyka will be in for an exam every three months.
Go to abcactionnews.com/skincancer to find out where you can get free skin cancer screenings.
We’ve also posted some very personal stories from our team about why this is so important.
And we’re taking your questions about skin cancer to the experts on “Melanoma Monday.” Representatives from Baycare, Moffitt, Florida Hospital Tampa and USF Health will be taking your calls and online questions. That’s Monday May 6 on ABC Action News at noon.
“We have more women with adult acne than we do have teenagers in our practice,” says Dermatologist Dr. Victoria Cirillo. “It’s because the hormone levels are changing very quickly and in large numbers, they start to switch.”
The fix is just as complex as the cause. The reality is, no two cases are the same.
“Acne is a devastating disease on one’s self image, whether you’re a kid, or an adult,” explains Dr. Neil Fenske, a dermatologist with TGH/USF Health. “It destroys them emotionally, they feel bad, they don’t want to go out.”
Adult acne can be triggered by chronic stress, hormone changes, and pores that grow sensitive as we age.
“A small percentage get acne for the first time after age 25,” Fenske explains. “Adult acne is actually more difficult to treat than adolescent acne for reasons we quit don’t understand.”
He says acne tends to be a more stubborn problem in adults.
“It’s usually more inflammatory, more cystic, more located on the chin area and lower cheeks, and much more likely to result in scarring because scarring occurs in chronic inflammation, and this is a much more chronic disease in adults,” he said.
Prescriptions like Retinae, Differin and other topicals and antibiotics are improved so even the most sensitive skin can tolerate them.
Some patients benefit from 20- minute treatments under red and blue LED lights.
Others receive treatments that can clear up the face: sessions that include chemical peels, microdermabrasion, and a suctioning session. It can reduce acne in just six months.
“This loosens up the skin so that way, when I go over with the microderm, I physically see dead skin coming off, it’s unbelievable,” explains skin therapist Lauren Menig.
As always, talk with your dermatologist about which treatments are right for your skin.
Living with psoriasis can be difficult and uncomfortable. There are many treatment options available including topical steroid creams, oral medications, and light therapy treatments. All of these treatments work well but have various side effects. There is another option for treating psoriasis: the eximer laser.
This treatment delivers 308-nm ultraviolet light to localized affected skin to help control mild to moderate psoriasis without harming the surrounding healthy skin. This targeted laser treatment is similar to traditional light therapy treatments but works in fewer sessions and is good for hard-to-treat areas such as the scalp, elbows, hands, knees, and feet. This high-dose therapy can effectively treat stubborn plaques, even those that have not responded to other treatments modalities. Patients typically undergo 2-3 treatments a week with 48 hours in between treatments. Noticeable improvement may be seen in as few as 6-10 treatments depending on the severity of the affected skin.
Advantages to this laser treatment include short and painless treatments, extended remission, favorable insurance coverage, and no creams or lotions are required. Although side effects are minimal, they can include itching, hyperpigmentation, burning and blistering at the treated locations. Due to the targeted nature of this treatment, only affected skin is treated. This may reduce the risk of premature aging that is seen with traditional phototherapy. The lack of systemic side effects caused from oral medications and lack of skin thinning, bruising, and stretch marks from topical steroids makes this a more favorable treatment option for patients with psoriasis.
There are many options available when it comes to treating psoriasis. Laser treatments can be very effective but may not be appropriate for everyone with psoriasis. You should discuss this option with your dermatologist to see if it’s right for you.
by:Robin Moran, Dermatology PA-C, USF Health Dermatology and Cutaneous Surgery.
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
Gustuvas Sesquicentennial Award
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 9th 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
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.