In brief

Saliva protein speeds healing
Licking one's wounds may be the best way to heal them, according to the results of an in vitro study. Researchers in the Netherlands have identified a small protein in human saliva, histatin, that greatly speeds up healing. Inner cheek epithelial cells were cultured and an artificial wound made in the centre by scratching some of the cells away. The cells were then bathed in isotonic fluid or human saliva. After 16 hours, the saliva-treated wound was almost completely closed, whereas a substantial part of the isotonic fluid treated wound was still open. After splitting the saliva into components and testing each using the wound model, histatin was found to be responsible.
Oudhoff MJ, Bolscher JG, Nazmi K et al. FASEB J 2008; doi: 10.1096/fj.08-112003.

Bullous pemphigoid incidence increases
Incidences of bullous pemphigoid and pemphigus vulgaris are rising in the UK, a retrospective historical cohort study has found. Researchers examined computerised medical records from the health improvement network and identified 869 people with bullous pemphigoid and 138 with pemphigus vulgaris. Median age at presentation was 80 years for bullous pemphigoid and 71 for pemphigus vulgaris, with 61 and 66 per cent of patients, respectively, being female. Average yearly increase in incidence was 17 per cent for bullous pemphigoid and 11 per cent for pemphigus vulgaris. The researchers also found that the risk of death, compared with controls, was twice as high for bullous pemphigoid and three times greater for pemphigus vulgaris.
Langan SM, Smeeth L, Hubbard R et al. BMJ 2008; 337: a180

Biological treatments in plaque psoriasis
The efficacy of biological treatments for plaque psoriasis has been ranked by US researchers. They reviewed 16 studies comprising a total of 7,931 patients. All four biological treatments used in the trials - alefacept (not available in the UK), efalizumab, etanercept and infliximab - were found to be efficacious. However, efficacy in terms of Psoriasis Area and Severity Index 75 achievement after 10-14 weeks of treatment was graded, with infliximab being most effective compared with placebo, followed by etanercept, then efalizumab and alefacept. On pooling safety data, the researchers found a previously unreported increased risk of adverse events for alefacept, efalizumab and infliximab.
Brimhall AK, King LN, Licciardone JC et al. Br J Dermatol 2008; 159(2): 274-85

Staph aureus in atopic eczema
A Cochrane review has failed to find clear evidence of benefit for interventions to reduce Staphylococcus aureus in people with atopic eczema. Researchers included 21 studies (1,018 patients) covering seven treatment categories. Oral antibiotics were not associated with benefit in non-infected or infected eczema and no benefit was found for antibacterial soaps or bath additives, or for topical antibiotics/antiseptics. Adding antibiotics to topical corticosteroids reduced numbers of Staph aureus in four trials (n = 302), but there was no evidence of clinical benefit in nine trials (n = 677). However, the researchers say this does not necessarily mean these antimicrobial interventions do not work, because the studies were small and poorly reported. Further large studies with long-term outcomes are urgently required, they conclude.
Birnie AJ, Bath-Hextall FJ, Ravenscroft JC, Williams HC. Cochrane Database Syst Rev 2008; 3: CD003871

Psoriasis and pulmonary hypertension
Psoriasis may be associated with pulmonary hypertension, researchers in Turkey suggest. They examined 47 patients with psoriasis and 20 healthy people aged a mean 36 years, using transthoracic echocardiography. Mild pulmonary hypertension (30-40mmHg) occurred more frequently in psoriasis patients (31.9 v 0 per cent, P = 0.003). Patients with psoriasis also had significantly longer pulse wave mitral Doppler deceleration and isovolumetric relaxation times. The researchers conclude that echocardiographic follow-up of psoriasis patients may therefore be important.
Gunes Y, Tuncer M, Calka O et al. Arch Dermatol Res 2008; 300(8): 435-40

Excision of malignant melanoma
There is no evidence that excision of malignant melanoma in general practice is managed poorly or has a worse prognosis, a study undertaken in North Wales has shown. An analysis of data from the North Wales Melanoma Database found 578 cases diagnosed between 1993 and 2001. Median Breslow thickness was 1.10mm. Ninety-five lesions (16 per cent) were removed in general practice, of which 49 (52 per cent) were referred to hospital. There were no differences in quality of excision between general practice and hospital. Time to diagnosis was shorter overall for general practice excisions (median 12 v 41 days, P <0.001).
Neal RD, Cannings-John R, Hood K et al. Fam Pract 2008; 25: 221-7

Treatment for atopic dermatitis
Intermittent treatment of atopic dermatitis (AD) with a topical calcineurin inhibitor can help to prevent relapse and ensure fewer flare-ups, according to the results of a double-blind randomised, controlled trial. Adult and paediatric patients with moderate to severe AD who were clear of disease after up to 16 weeks of treatment with tacrolimus ointment were randomised to three times weekly treatment with tacrolimus ointment (0.03% or 0.1%; 125 patients) or vehicle (72 patients) for 40 weeks. The mean number of flare-free treatment days was 177 for tacrolimus and 134 for vehicle. Median time to first relapse was 169 days for tacrolimus and 43 for vehicle.
Breneman D, Fleischer AB, Abramovits W et al. J Am Acad Dermatol 2008; 58(6): 990-9

Addiction to tanning
More than a quarter of people at one university in the US have been found to be addicted to tanning, in an online survey. Of the 400 students and other volunteers surveyed at Virginia Commonwealth University in Richmond, Virginia, 27 per cent were classified as 'tanning dependent', showing symptoms similar to those seen in alcohol and drug addiction. Almost 40 per cent of those surveyed had used tanning booths and mean age at first use was 17 years, which the researchers found 'alarming'. The researchers also found that people addicted to tanning were more likely to be thin and to smoke cigarettes.
Heckman CJ, Egleston BL, Wilson DB, Ingersoll KS. Am J Health Behav 2008; 32(5): 451-64.

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