Los extremos son malos...

Mucho sol es malo, pero muy poco también nos indica un estudio hecho en Suecia.

Avoiding Sun as Dangerous as Smoking

Marcia Frellick

March 23, 2016

 

Nonsmokers who stayed out of the sun had a life expectancy similar to smokers who soaked up the most rays, according to researchers who studied nearly 30,000 Swedish women over 20 years.

This indicates that avoiding the sun "is a risk factor for death of a similar magnitude as smoking," write the authors of the article, published March 21 in the Journal of Internal Medicine. Compared with those with the highest sun exposure, life expectancy for those who avoided sun dropped by 0.6 to 2.1 years.

Pelle Lindqvist, MD, of Karolinska University Hospital in Huddinge, Sweden, and colleagues found that women who seek out the sun were generally at lower risk for cardiovascular disease (CVD) and noncancer/non-CVD diseases such as diabetes, multiple sclerosis, and pulmonary diseases, than those who avoided sun exposure.

And one of the strengths of the study was that results were dose-specific — sunshine benefits went up with amount of exposure.

The researchers acknowledge that longer life expectancy for sunbathers seems paradoxical to the common thinking that sun exposure increases risk for skin cancer.

"We did find an increased risk of...skin cancer. However, the skin cancers that occurred in those exposing themselves to the sun had better prognosis," Dr Lindqvist said.

Some Daily Exposure Important for Health

Given these findings, he told Medscape Medical News, women should not overexpose themselves to sun, but underexposure may be even more dangerous than people think.

"We know in our population, there are three big lifestyle factors [that endanger health]: smoking, being overweight, and inactivity," he said. "Now we know there is a fourth — avoiding sun exposure."

Sweden's restrictive guidance against sun exposure over the past 4 decades may be particularly ill-advised, the study finds, in a country where the maximum UV index is low (< 3) for up to 9 months out of the year.

Use of sunscreen is also widely misunderstood in the country and elsewhere, Dr Lindqvist said.

"If you're using it to be out longer in the sun, you're using it in the wrong manner," he said. However, "If you are stuck on a boat and have to be out, it's probably better to have sunscreen than not to have it."

Women with more pigmentation would be particularly well-served to stop avoiding sunshine, he said, adding that many people in India, for instance, follow guidelines like those in Sweden to avoid sun year round.

And because melanomas are rare among women with darker skin, benefit goes up in those populations when weighing sun exposure's risk against benefits, Dr Lindqvist said.

Age and Smoking Habits

The researchers studied sun exposure as a risk factor for all-cause mortality for 29,518 women with no history of malignancy in a prospective 20-year follow-up of the Melanoma in Southern Sweden cohort.

The women were recruited from 1990 to 1992 when they were 25 to 64 years old. Detailed information was available at baseline on sun-exposure habits and potential confounders such as marital status, education level, smoking, alcohol consumption, and number of births.

When smoking was factored in, even smokers at approximately 60 years of age with the most active sun-exposure habits had a 2-year longer life expectancy during the study period compared with smokers who avoided sun exposure, the researchers note.

The authors do, however, acknowledge some major limitations. Among them, it was impossible to differentiate between active sun-exposure habits and a healthy lifestyle, and they did not have access to exercise data.

Role of Vitamin D Still in Question 

The results add to the longstanding debate on the role of vitamin D in health and the amount of it people need, but this study doesn't resolve the question.

"Whether the positive effect of sun exposure demonstrated in this observational study is mediated by vitamin D, another mechanism related to ultraviolet radiation, or by unmeasured bias cannot be determined. Therefore, additional research is warranted," the authors write.

"From Irish studies we know that vitamin D deficiency makes melanomas more malignant," Dr Lindqvist said.

"This is in agreement with our results; melanomas of [those not exposed] to the sun had a worse prognosis."

This study was supported by the Clintec at the Karolinska Institute; ALF (Faculty of Medicine, Lund University, Region Skane); the Swedish Cancer Society; and the Swedish Medical Research Council. Funding was also received from Lund University Hospital; the Gustav V Jubilee Fund; the Gunnar Nilsson Foundation; the Kamprad Foundation; and the European Research Council. The authors declared no relevant financial relationships. 

J Intern Med. Published online March 16, 2016.

Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

4000-1054

2208-8206

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Psoriasis aumenta el riesgo de cancer en general, y entre más severa, más riesgo.

The Risk of Cancer in Patients with Psoriasis 

JAMA Dermatol; 2016 Mar; Fuxench, Shin, et al

MARCH 23, 2016

The link between psoriasis and cancer was small but present in a population cohort study involving more than 1.1 million individuals. The correlation was primarily due to nonmelanoma skin cancer, lymphoma, and lung cancer. 

Participants had no history of HIV, cancer, organ transplants, albinism, or xeroderma pigmentosum at baseline. They had either moderate-to-severe (n=12,290) or mild (n=198,366) psoriasis, or served as controls (n=937,716). 

Among the results:

• Patients with moderate-to-severe psoriasis were 89% more likely to develop lymphoma, compared with 31% for those with mild disease and 34% for controls. 

• Those with moderate-to-severe psoriasis were 61% more likely to develop NMSC, compared with 9% for mild disease and 12% for controls. 

• Those with moderate-to-severe psoriasis were 62% more likely to develop lung cancer, compared with 12% for those with mild disease and 15% for controls.  

• In all 3 groups the risk for any cancer excluding NMSC was roughly the same. 

• No links were observed in breast, colon, or prostate cancer, or leukemia.

Citation: Fuxench Z, Shin D, Beatty A, Gelfand J. The risk of cancer in patients with psoriasis: A population-based cohort

 study in the Health Improvement Network. JAMA Dermatol. 2016;152(3)282-290. doi:10.1001/jamadermatol.2015.4847.

Nevus de Sutton y Vitiligo, Simbióticos y Dermatitis Atópico.

Does Childhood Vitiligo Differ When Halo Nevi Are Present?

Vitiligo, characterized by depigmented patches due to loss of melanocytes, affects up to 4% of individuals worldwide. Childhood vitiligo differs from adult vitiligo regarding higher prevalence of segmental disease, history of atopy, and family history of autoimmune disease. Halo nevi (HN) — nevi with an acquired depigmented peripheral zone (see NEJM JW Dermatol Nov 2012 and Am Acad Dermatol 2012; 67:582) that occur in 1% of the general population, usually on the trunk — are more common in vitiligo patients than in the general population and are considerably more common in children with vitiligo than in adults.

These authors retrospectively reviewed charts at an academic pediatric dermatology unit to characterize childhood vitiligo with and without associated HN. Over a 24-year period, 208 children presented with vitiligo, 55 (26%) of whom had HN. Children with vitiligo-associated HN were more likely to be male (62%; P= 0.03) and older at presentation than those with vitiligo alone (5.8 vs. 7.3 years; P= 0.01).

Children with vitiligo-associated HN were more likely to have the generalized vitiligo subtype. No between-group differences were observed in body surface area affected or family history of vitiligo or autoimmune diseases. Patients with HN were no more likely to develop new vitiligo over a mean of 1.9 years, and there were no significant differences in repigmentation.

Editor Disclosures at Time of Publication

• Disclosures for Mary Wu Chang, MD at time of publication Consultant / Advisory board Pierre Fabre; Valeant Speaker's bureau Pierre Fabre

The Value of Synbiotics in Atopic Dermatitis  : Dermatology News

February 24, 2016

Synbiotics can be used to treat atopic dermatitis, particularly those with mixed strains of bacteria, according to a meta-analysis of 8 studies involving nearly 1,700 children. 

Investigators analyzed the SCORAD index in 6 treatment studies involving 369 children, and the relative risk of atopic dermatitis in 2 prevention trials involving 1,320 children. 

In the treatment studies:

• Change in SCORAD index in those treated with synbiotics at 8 weeks was −6.56.  

• Heterogeneity was significant.  

• Significant effect was seen only when using mixed strains of bacteria (average score difference -7.32), and when used in children aged 1 year or older (average score difference -7.37). 

In the prevention studies, those taking synbiotics were 56% less likely than those taking placebo to develop atopic dermatitis. 

Citation: Chang Y, Trivedi M, Jha A, Lin Y, Dimaano L, Garcia-Romero. Synbiotics for prevention and treatment of atopic dermatitis: A meta-analysis of randomized clinical trials. [Published online ahead of print January 25, 2016]. JAMA Pediatr. doi:10.1001/jamapediatrics.2015.3943.

Articulos varios... Protecció solar en niños e ivermectina vs metronidazol gel..

Effective Sun Safety in Children: A Randomized Controlled Trial of a Multicomponent Program

Improving sun-protective behaviors in children may minimize sun damage and reduce skin cancer risks later in life. Investigators performed a randomized, controlled clinical trial that included 300 pediatric patients (ages 2–6) and their caregiver; 51% were randomized to receive a read-along book, a swim shirt, and weekly text-messaged questions about sun protection that elicited a yes/no response from caregivers: ("During the past week, did your child wear a hat?"). The control group (49%) received information typically given at a well-child visit.

Caregivers were surveyed about sun exposures and sun irritation/burn at baseline and at 4-week follow-up. Spectrophotometric melanin measurements of the outer upper arm (under the shirt sleeve) were performed at baseline and at 4 weeks. Caregivers received a $20 gift card at baseline and $50 gift card at study completion. The intervention group had significantly higher scores related to sun-protective behaviors and did not have increased melanin levels on the upper arm. The control group had significantly increased melanin levels on the arm. The authors conclude that this multicomponent intervention program led to increased sun-protective behaviors.

Editor Disclosures at Time of Publication

• Disclosures for Mary Wu Chang, MD at time of publication Consultant / Advisory board Pierre Fabre; Valeant Speaker's bureau Pierre Fabre

Metronidazole vs. Ivermectin

Topical metronidazole 0.75% cream (MET) twice daily and ivermectin 1% cream daily (IVER) both effectively treat the papulopustular component of rosacea. Is one better at producing remissions? Investigators conducted a 36-week, randomized, parallel group phase III study to find out.

They enrolled 399 patients who had been judged clear or almost clear (Investigators Global Assessment [IGA] score, 0 or 1) after 16 weeks of treatment in an earlier, phase III, investigator-blinded, randomized, parallel group study showing superiority of IVER for reducing papule and pustule counts (P<0.001). These patients now stopped treatment. If recurring papules and pustules warranted an IGA score of ≤2, patients resumed their original topical treatment until remission was again obtained. Primary endpoints were relapse rate and days to first relapse.

The median number of days to first relapse was higher in IVER recipients (median, 115 days; 95% confidence interval, 113–165 days) than in MET recipients (median, 85 days; 95% CI, 85–113 days). The relapse rate by study end at 36 weeks was lower for IVER recipients (62.7%) than MET recipients (68.4%). No serious adverse treatment-related events were recorded.

Editor Disclosures at Time of Publication

• Disclosures for Mark V. Dahl, MD at time of publication Consultant / Advisory board Ulthera, Inc.; AuBio LifeSciences, LLC; Paris Therapeutics EquityElorac, Inc.; Makucell, Inc.; Paris Therapeutics Editorial boards UpToDateLeadership positions in professional societies National Rosacea Society (Chairman, Medical Board)

Plaquinol a veces no funciona, medir niveles.

March 17, 2016

Hydroxychloroquine Blood Levels May Be Helpful in Patients with "Antimalarial-Resistant" Cutaneous Lupus Erythematosus

Jeffrey P. Callen, MD reviewing  Chasset F et al.  J Am Acad Dermatol 2016 Apr. 

Increasing the hydroxychloroquine dose to achieve adequate levels produced clinical response.

Hydroxychloroquine is standard therapy for patients with cutaneous lupus erythematous (CLE), but up to a third of patients appear to be refractory to this agent. Blood levels of hydroxychloroquine are measurable; levels below 750 ng/mL are considered inadequate.

These authors measured blood levels in patients with antimalarial-resistant CLE. Among 74 refractory patients, 36 (49%) had blood levels below 750 ng/mL. Investigators raised the daily hydroxychloroquine dose in 34 of these patients to obtain adequate blood levels, and measured clinical disease using a validated score (CLASI) before and after the intervention. The patients included had a mixture of clinical disease, including discoid LE, subacute CLE, indeterminate disease, chilblains, and lupus panniculitis. Half of the patients were tobacco smokers.

When patients achieved adequate hydroxychloroquine blood levels, their clinical disease responded. Even among smokers, increased dosing produced response. In most instances, daily dosing was able to be reduced to levels compatible with long-term ocular safety.

COMMENT

Despite a small cohort of patients, some with rarer cutaneous manifestations, the findings have important aspects. First, simply measuring hydroxychloroquine levels can identify noncompliant patients and lead to better patient education. Second, increasing the hydroxychloroquine dose to achieve adequate levels produced clinical response and might avoid agents with more potential toxicity. Third, it seems that the daily dosage can eventually be decreased for safer use. The authors note the small number of patients, but it might also have been better to include only patients with DLE and SCLE.

EDITOR DISCLOSURES AT TIME OF PUBLICATION

• Disclosures for Jeffrey P. Callen, MD at time of publicationConsultant / Advisory boardXOMA; Eli Lilly; CelgeneEquityVarious trust accountsEditorial boardsJAMA Dermatology; UpToDateLeadership positions in professional societiesAssociation of Professors of Dermatology (President-Elect)

CITATION(S):

1. Chasset F et al. The effect of increasing the dose of hydroxychloroquine (HCQ) in patients with refractory cutaneous lupus erythematosus (CLE): An open-label prospective pilot study. J Am Acad Dermatol 2016 Apr; 74:693. (http://dx.doi.org/10.1016/j.jaad.2015.09.064)

- See more at: http://www.jwatch.org/na40514/2016/03/17/hydroxychloroquine-blood-levels-may-be-helpful-patients?query=etoc_jwderm&jwd=000100713143&jspc=D#sthash.EV0km7gc.dpuf

Por fin me encontré el articulo del porque la N-acetilcisteina en enfermedades compulsivas...

Trichotillomania: N-Acetylcysteine Shows Promise

This readily available glutamate modulator provided significant improvement in 56% of patients with alopecia caused by compulsive hair pulling.

Trichotillomania is a greatly underrecognized, poorly understood disorder characterized by alopecia caused by hair pulling. Selective serotonin reuptake inhibitors, clomipramine, and behavioral modification have been used but with mixed success.

Glutamatergic dysfunction has been implicated in the pathogenesis of obsessive-compulsive disorder, a disease with a suggested neurobiological link to trichotillomania. N-acetylcysteine (NAC) is an amino acid that modulates the glutamatergic pathway by increasing extracellular glutamate in the nucleus accumbens. NAC has been previously shown to decrease compulsive gambling and cocaine addiction.

Investigators performed a double-blind, placebo-controlled study of NAC treatment for trichotillomania. Fifty patients, aged 18 to 65, with a primary diagnosis of trichotillomania were randomized to receive 1200 mg NAC or placebo every day for 6 weeks. At week 6, if trichotillomania persisted, the dose was increased to 2400 mg/day or a matching increase in placebo pills; 88% of the placebo group and 72% of the treatment group received the dose increase. Patients were evaluated every 3 weeks for 12 weeks; 88% of both groups completed the study.

Patients receiving NAC had significantly greater reductions in hair-pulling symptoms as measured by the Massachusetts General Hospital Hair Pulling Scale (P<0.001) and the Psychiatric Institute Trichotillomania Scale (P=0.001). Fifty-six percent of treatment recipients were "much" or "very much" improved at study completion, compared with 16% of those taking placebo. Significant improvement was observed by 9 weeks of treatment. Although NAC has been known to cause headache, pruritus, flatulence, increased blood pressure, and fatigue, no adverse effects were noted in this study.

Regarding the 44% of treated patients whose symptoms did not improve, the authors hypothesize that trichotillomania represents a heterogeneous disease with different subtypes, some of which may respond better to glutamatergic agents, or may require higher dosages, than others.

Comment: Although long-term follow-up is lacking, the data are promising. The 56% rate of response is similar to rates achieved with other methods. The treatment is inexpensive, readily available in health food stores, and appears to be well tolerated. Further study is warranted to validate safety and efficacy and to determine optimum dosing schedules. A pediatric trial is now under way. Research may lead to a better understanding of the pathophysiology of impulsive-compulsive neurocircuitry and discover better treatments for this distressing condition.

— Mary Wu Chang, MD

Published in Journal Watch Dermatology November 13, 2009

Citation(s):

Grant JE et al. N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: A double-blind, placebo-controlled study. Arch Gen Psychiatry 2009 Jul; 66:756.

Tantos cosméticos no son buenos, debemos seleccionar...

Teen girls see big drop in chemical exposure with switch in cosmetics.

The results, published Monday, March 7, 2016 in the journal Environmental Health Perspectives, came from a study of 100 Latina teenagers participating in the Health and Environmental Research on Makeup of Salinas Adolescents (HERMOSA) study.

HERMOSA is a community-university collaboration between UC Berkeley, Clinica de Salud del Valle de Salinas, and a team of youth researchers from the CHAMACOS Youth Council, a project to involve young people in public health and the environment.

Researchers provided teen study participants with personal care products labeled free of chemicals such as phthalates, parabens, triclosan and oxybenzone. Such chemicals are widely used in personal care products, including cosmetics, fragrance, hair products, soaps and sunscreens, and have been shown in animal studies to interfere with the body's endocrine system.

"Because women are the primary consumers of many personal care products, they may be disproportionately exposed to these chemicals," said study lead author Kim Harley, associate director of the UC Berkeley Center for Environmental Research and Children's Health. "Teen girls may be at particular risk since it's a time of rapid reproductive development, and research has suggested that they use more personal care products per day than the average adult woman."

Analysis of urine samples before and after a three-day trial in which the participants used the lower- chemical products found significant drops in levels of these chemicals in the body. Metabolites of diethyl phthalate, commonly used in fragrances, decreased 27 percent by the end of the trial period. Methyl and propyl parabens, used as preservatives in cosmetics, dropped 44 and 45 percent respectively. Both triclosan, found in antibacterial soaps and some brands of toothpaste, and benzophenone-3 (BP-3), found in some sunscreens under the name oxybenzone, fell 36 percent.

Surprisingly, there was a small increase in concentrations in two less common parabens. Those levels were small and could have been caused by accidental contamination or a substitution not listed on the labels, the study authors said.

Kimberly Parra, study co-director, said it was important to involve local youth in the design and implementation of the study.

"The results of the study are particularly interesting on a scientific level, but the fact that high school students led the study set a new path to engaging youth to learn about science and how it can be used to improve the health of their communities," she said. "After learning of the results, the youth took it upon themselves to educate friends and community members, and presented their cause to legislatures in Sacramento."

The CHAMACOS Youth Council included 12 local high school students who helped design and carry out the study. One teen researcher, Salinas native and study co-author Maritza Cárdenas, is now a UC Berkeley undergraduate majoring in molecular and cell biology.

"One of the goals of our study was to create awareness among the participants of the chemicals found in everyday products, to help make people more conscious about what they're using," said Cárdenas. "Seeing the drop in chemical levels after just three days shows that simple actions can be taken, such as choosing products with fewer chemicals, and make a difference."

The researchers noted that cosmetics and personal care products are not well-regulated in this country, and that getting data about health effects from exposure, particularly long-term ones, is difficult. But they say there is growing evidence linking endocrine-disrupting chemicals to neurobehavioral problems, obesity and cancer cell growth.

"We know enough to be concerned about teen girls' exposure to these chemicals. Sometimes it's worth taking a precautionary approach, especially if there are easy changes people can make in the products they buy," said Harley.

Cárdenas said the research findings have already influenced the products she buys for herself.

"Personally, since the study, I've tried to use more organic products," she said. "It's hard, especially as a college student who doesn't have a lot of money. You tend to just get what's on sale. But I've decided to splurge more on products with fewer chemicals because of the effect in the future. And if you can't make the best choice when you're buying because of cost, you can at least try to limit the use of the products you do buy."

The above post is reprinted from materials provided by University of California - Berkeley. The original item was written by Sarah Yang. Note: Materials may be edited for content and length.