Tag Archives: AAD

You Asked For It: Top Five Dermatology Videos of 2011

What were dermatologists watching on YouTube from Global Medical News Network in 2011?  Here’s the top five countdown.

5.     New Drugs Help Melanoma Patients Live Longer: Dr. Lynn Schuchter puts the studies, which were presented at the 2011 ASCO Annual Meeting in Chicago, in perspective and offers advice to oncologists. For more, visit www.oncologypractice.com.

4.     Laviv May Offer Longer-Term Acne Scarring Tx: Azficel-T, an autologous cellular product, produced significant improvement in acne scarring, compared with placebo, according to new study results reported at the annual meeting of the American Society for Dermatologic Surgery. Laviv was approved by the FDA earlier this year for treating wrinkles. This video features an interview with Dr. Girish Munavalli.

3.     How to ID and Treat Fire Ant Bites : Dr. Ronald Rapini talks about recognizing and treating fire ant bites.

2.     Eczema and Food Allergies Often Go Hand and Hand: Dr. Lawrence Eichenfield talks about atopic dermatitis, food allergies, and national guidelines.

Drum roll please…

1.     Gel Nail Polish: The Painted Truth: Dr. Richard K. Scher talks about the dangers of gel nail polish and gives tips to share with patients on how to have a safe experience at the nail salon.

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Video of the Week: Could Skin Biopsy Detect Mitral Valve Prolapse?

Researchers at the University of Miami reported at the annual meeting of the American Academy of Dermatology that elevations of certain substances in the skin could be a sign of severe mitral valve prolapse. Along with ecocardiograms, skin biopsy could help save lives by preventing the sudden death of patients who have the condition.

Our reporter Damian McNamara talked with Dr. Paolo Romanelli about a small study of eight patients with severe mitral valve prolapse and six control individuals. All participants had skin biopsies. The investigators found patients with severe mitral valve prolapse had elevated levels of mucins/proteoglycans in the skin. It may be that a skin biopsy and evaluation of these substances can help prevent sudden deaths due to severe mitral valve prolapse.

To read more news from the annual AAD meeting, visit Skin & Allergy News.

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Are Psoriasis Patients Better Off With Biologics?

That’s the question Dr. Kenneth Gordon of the Pritzker School at the University of Chicago posed to colleagues at the American Academy of Dermatology’s annual meeting in New Orleans.  It was not meant to be rhetorical.

Given the huge pressure to use the new therapies – from patients, pharmaceutical manufacturers, and in some cases, the dermatologist’s own desire to use what appears to be the latest and greatest – there are a lot of potential costs.

Via Flickr Creative Commons user walknboston

The drugs, which include Amevive (alefacept), Enbrel (etanercept), Humira (adalimumab), Remicade (infliximab), and Stelara (ustekinumab), are hugely expensive (for a list of these drugs and their mechanisms, go here). Plus, there is a human cost – many of these biologics have the potential to cause infections, demyelinating disorders like multiple sclerosis, and cancer.

Psoriasis is a lifelong disease, and thus, therapies are taken more or less for life, noted Dr. Gordon, who also heads dermatology at the Northshore University Health System. But what is known about the long term safety of these biologics? There is little-to-no data beyond trial periods of 12-24 weeks in psoriasis patients. And although some of the drugs have been studied for longer in rheumatoid arthritis, Dr. Gordon said that it is not instructional to extrapolate the data to psoriasis.

When the first biologic came on the market in 2003, there was a great deal of excitement, he said.  At that time, at least half of patients he treated were on methotrexate.

In his presentation, Dr. Gordon delved through the available data on efficacy and long term safety of older therapies like methotrexate, acitretin, and cyclosporine, and compared that to the biologics’ track record.  So far, though there’s a big gap between knowledge and use for both the older and newer therapies.

What he concluded was that for moderate-to-severe patients, biologics probably pack a more powerful punch.  Methotrexate is still a first-line choice for many psoriasis patients in his practice who are not as ill, but he says he still thinks of the drug as having had its heyday in the 1970s.

Where do biologics fit in your practice? Have your patients been better off since the advent of the therapies?

— Alicia Ault (on Twitter @aliciaault)

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Video of the Week: Propranolol and Hemangiomas at AAD

Over the past several years, the blood pressure drug propranolol has engendered a lot of excitment as a treatment for infantile hemangiomas.  While the drug has shown impressive results, caution is still needed, Dr. Sheila Fallon Friedlander told our reporter Naseem Miller at the annual meeting of the American Academy of Dermatology in New Orleans.

There are still many unknowns, such as the proper dosage, length of treatment and the mechanism of action, according to Dr. Friedlander, who is professor of clinical pediatrics and medicine at the University of California, San Diego, and section chief of pediatric dermatology at Rady Children’s Hospital in San Diego.

To find out more, read the story at Skin & Allergy News, where you can also read the latest news from the AAD meeting.

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Dermatologists in NOLA? … Eat!

Any dermatologist whose appetite is more than skin-deep is going to L-O-V-E next week’s American Academy of Dermatology meeting. New Orleans and food. They go together like fried chicken and waffles, praline bacon and stuffed French toast, beignets and chicory coffee.

Hot beignets are just a healthy jog away. Photo by Flickr user jyshun

Although there’s no shortage of tables in the Big Easy, reservations could be in short supply by now, with thousands of docs ready to pounce on the city’s specialties. So be a smart tourist and get on the phone, or hit opentable.com and line up your plan of attack. 

Breakfast

Most derms are probably going to hit the AAD’s breakfast tables before hitting the morning sessions. But if you just can’t take one more muffin-and-coffee meal, consider the following: 

Cafe du Monde. Do we really need to talk about this spot? Just do it.  It’s easy to incorporate into an early morning jog and the jog back eliminates any guilt (and all calories) about downing two or three sofa-pillow-sized pieces of fried dough.

You also might want to hop on the St. Charles Streetcar and head up to the white-colonnaded Camellia  Grill. The streetcar ride is a pleasure in itself, a leisurely trip through a grand old neighborhood of enormous moss-draped live oaks, Audubon Park, and some incredible old homes. Get off at Carrollton Avenue and open the door on the past – a long lunch counter served by (mostly) men in white uniforms and bow ties. Banter with the grill cooks and enjoy an enormous plate of eggs, waffles, French toast, or omelets. Since Camellia serves breakfast all day, you can still enjoy the experience at night, with the added bonus of a piece of pecan pie grilled in butter. Or what the heck – just have that pie for breakfast (626 South Carrollton Ave.; 504-866-9573).

Brunch

Brunch at the Court of Two Sisters in the French Quarter is a frustrating mix of dreamlike atmosphere in a vine-draped courtyard, and throngs of hung-over tourists lining up at the trough, um,  buffet line. The food is decent, but the courtyard not quite as lovely in February as it is in June. And, well, it can be a mob scene (613 Royal St. 504-522-7261).

How about a real surprise – something elegant, discreet, and lovely in the racy French Quarter? For about $60, you can listen to soft jazz and blues by the James Rivers Movement and relax in the Roosevelt  Hotel’s velvety Blue Room. For that price , you’ll get endless champagne and mimosas, one entrée off the brunch menu (anything from eggs Sardou to prime rib), and access to buffet of gumbo, chilled seafood, and a dessert table of mini-pastries, speciality cakes, and bananas foster – flamed tableside. For cool cocktails and hot jazz, check out the hotel’s Sazarac Bar, decked out in devilish red velvet for a devilish evening out. (123 Baronne St.; 504-648-1200).

Oysters

I know, I know – everyone will tell that Acme is THE place to go. But while 50 people are shivering in the outside line, facing an hour wait, you can saunter right across the street to Felix’s,  grab a bar stool, and have them shuck you out a dozen fresh, sweet oysters for $10.75. Manager Adrian Zado assured me that Louisiana oysters are still coming in, although the beds around the mouth of the Mississippi remain off-line. “Some were shut down for protection,” because authorities didn’t know how oily oysters would affect diner safety. Other beds died off when the state released more fresh water into the gulf to try to keep oil offshore. Slip  in on a Wednesday from 5-10 p.m., and you’ll get a free beer (the local Amber Abita is great) with every dozen oysters, although I like mine with one of those cute demi-bottles of champagne (739 Iberville St.; 504-522-4440).

Lunch and Dinner

Mother’s, close to the convention center, is a controversial place. Tourists love it because it’s in all the books. Locals come for a few specific things –the roast beef with debris particularly. But mostly it’s a long wait in a lunch line, followed by big servings of mediocre food (401 Poydras St.; 504- 523-9656).

Both Antoine’ s and Galatoire’s are old NOLA institutions, these two grand monsieur of the French Quarter offer a similar experience – a time trip back to the genteel era of ladies with feathery hats and the men who coddle them. Antoine’s  is the elder brother, established in 1840; Galatoire’s a mere 106-year-old. Antoine’s is heavily French-influenced; Galatoire’s proudly claims “The menu doesn’t change.” Aficionados of lighter, New American-style cuisine might be disappointed in the presentation and the flavors, but both draw devotees of these classic dishes (Antoine’s: 713 Saint Louis St., [504] 581-4422; Galatoire’s:  209 Bourbon St., [504] 525-2021).

In the Commercial District, my favorite place is still Herbsaint. It’s small, with a vest-pocket-sized bar, but survived Hurricane Katrina with most of its well-loved offerings, and some darn good new ones. My favorite meal? Shrimp and grits with Tasso ham, any of the pork dishes (the menu changes seasonally), and, for dessert, the brown sugar banana tart with fleur de sel caramel. Reservations all gone? Try the tart anyway; the recipe appeared a few years ago in Bon Appetite (701 St. Charles Ave.; 504-524-4114).

If you want to venture uptown, Brigtsen’s  is a great bet. Housed in a charming turn-of-the century wooden home, it serves up Creole classics with a little modern twist. Anything with pork, quail, or rabbit is a can’t miss (especially the panéed rabbit and spinach with the Creole mustard sauce). The “Shell Beach Diet” gives you six different little seafood  jewels, for $32. And what’s not to like about banana bread pudding with banana custard sauce? (723 Dante St.; (504) 861-7610).

For a local’s take on food, I turned to my colleague Alicia Ault, who has a long-standing love affair and virtual residency with NOLA. Here’s what she had to say:

Dick & Jenny’s has  become somewhat well-known over the years, and a big plus is that they are open on Mondays – there are few fine dining establishments open on either Sunday or Monday (4501 Tchoupitoulas St.; 504-894-9880).

Three Muses.  A new-ish place on Frenchmen Street, very small, good chef, has music sometimes. Small plates-type food. It’s getting a lot of hipster buzz  (536 Frenchmen St.; 504-298-TRIO).

Patois.  This is an old New Orleans place, too, also  uptown.  Fabulous food, almost impossible to  get in. Alicia – is that a challenge (6078 Laurel St.; 504-895-9441)?

Boucherie.   In the Carrollton area, it features very highly rated New American/New Orleans food, farm-to-table stuff. I can never get in here, partly because it’s small. And I’m  talking even when there’s nothing special going on in town (8115 Jeanette St.; 504- 862-5514).

Coquette. Fabulous cocktails (I had bacon-infused bourbon), some outside tables, nice atmosphere, very good food (2800 Magazine St.; 504-265-0421).

Ralph’s on the Park. A Brennan’s restaurant, Ralph’s is a locals-type special-occasion place on City Park. Service and food are great. A $35 three-course pre-theater menu and a $19 two-course lunch are on offer (900 City Park Ave.; 504-488-1000).

Ye Olde College Inn. Very solid New Orleans food with a noisy, party-type atmosphere. Locals love this place, and I end up eating here a lot because it’s easy and not too expensive (3000 S Carrollton Ave.; 504-866-3683). Also it’s right next to the Rock ‘N Bowl   so you can eat and then stumble over for music.

Well, that’s it. And now I’m calling my editor to complain because I’m being sent to cover a stroke meeting in L.A. next week – instead of delicious NOLA.

— Michele G. Sullivan (on Twitter @MGSullivan)

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Doomsday 2010: Shall the MRSA Inherit the Earth?

And thus spoke Dr. Rosen, as he read from the Book of Doom:

“The Archangel FDA shall fix upon the antibiotic pipeline a seal. And the seal shall be unbroken by any, be they monolithic pharmaceutical company or earnest researcher. And the pipeline shall narrow ever more, until I say unto you, it shall be easier for a camel to pass through the eye of a needle than for a new antibiotic to pass through the sealed pipeline.”

Klebsiella pneumonia dressed for battle (Electron microscopy property of the U.S. Federal Government; accessories by Michele Sullivan)

Normally a jovial and witty speaker, Dr. Theodore Rosen assumed a peculiar air during a talk at the summer meeting of the American Academy of Dermatology —a nearly indefinable mixture of gravitas and utter befuddlement. He agrees wholeheartedly with the new prudence of the Food and Drug Administration with regard to approving the vast majority of medications. Most of the time. But desperate times call for desperate measures.

And, according to Dr. Rosen, chief of the dermatology clinic at the Houston Veterans Administration and professor of dermatology at the Baylor College of Medicine, desperate times are upon us.

“We are being bombarded every year by increasingly resistant bacteria,” Dr. Rosen told me. “Some of these are relatively trivial, some are really bad—like MRSA—and some are wreaking havoc.”

So what’s the FDA doing about it? Not a whole lot, Dr. Rosen contends.

The agency’s exacting standards hamper research, he says.  Noninferiority trials are standard for proving antibiotic efficacy, but there doesn’t seem to be any standard about just how noninferior the new drug has to be against its gold standard comparator. Is it 12%? 10%? Is it a moving target? Does it depend on the pair of drugs being compared?

There seem to be more questions than answers. But the result  is that FDA has only approved one new antibiotic – televancin—since 2007.  And there’s just no assurance that this will be sufficient. A  quick Google search of resistant bacteria reads like a marquee of summer horror flicks (if you’re geeky enough).

Top billing has to go to NDM-1, New Delhi metallo-β-lactamase 1, which has conferred multidrug-resistance to Escherichia coli and Klebsiella pneumoniae in India, Pakistan, and the U.K.  The bugs were highly resistant to all antibiotics except tigecycline and colistin.

Plagued by the Middle Ages? Yes, the disease that killed more than 200 million folks way back when is still alive and kicking – stronger than ever. Far from geezing, Yersina pestis has acquired a bagful of new tricks, including resistance to at least eight antimicrobials, among them streptomycin, tetracycline, and chloramphenicol. “Do we really want to let this genie out of the bag?” Dr. Rosen asked.

According to the World Health Organization, 2008 saw 9.5 million new tuberculosis cases and nearly 2 million deaths. About 150,000 deaths were due to multi-drug resistant strains; the bugs have been spotted in 58 countries.

In just one New York City hospital, 432 ceftazidime-resistant Klebsiella pneumoniae cases were found during a 19-month study period—17% of all the Klebsiella infections. The spike occurred in tandem with a ceftazidime war against multidrug resistant Acinetobater infections in the same institution.

Another jolly article confirms one of Dr. Rosen’s scariest points – not only are the stronger Klebsiellae adapting to our stronger antibiotics, they’re sharing that knowledge with their lowly E. coli cousins.

Slow as it may be to respond, this crisis is not solely of FDA’s making. Farmers, patients, and physicians each play key roles. Food animals are pumped full of antibiotics from conception until slaughter, providing a fast track for bacterial evolution. The fittest bugs survive and spread to farm workers, and even to the groundwater that sustains us all.

Patients remain notoriously unreliable when it comes to antibiotics, from nervous mamas demanding amoxicillin for baby’s every cough, to grownups who, feeling better after half a scrip, hoard the rest against a future bout of illness.

Docs are culpable as well, especially dermatologists Dr. Rosen said. “We treat acne and rosacea with antibiotics forever, instead of moving on as quickly as possible to topical therapies.”

FDA needs to quickly come to grips with the global rise of drug-resistant microbes, Dr. Rosen said. An overhaul of profit-driven animal husbandry is way overdue. On a more human scale, physicians need to keep pounding away at their patients to use antibiotics wisely and only as prescribed.

“And we need to listen to our own preaching, too,” he said. “It’s time to get real.”

—Michele G. Sullivan (on Twitter, @MGSullivan)
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