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GPs with an interest in dermatology review the latest papers of significance from research teams across the world.

Psoriasis: some women may need psychological treatment
Psoriasis: some women may need psychological treatment

Psychological therapy in skin disease
By Sanjay Tandy
Women with skin conditions such as acne and psoriasis should be offered psychological treatment as part of their management of skin problems, Australian researchers say.
The research team found that symptoms of depression and stress occurred more frequently among patients with skin problems. For this study, 6,630 women aged 22-27 years were asked how often they had experienced skin problems in the past 12 months. Those who responded 'sometimes' or 'often' were defined as having skin problems.
The women were then asked to complete a questionnaire for signs of depression and asked if they had experienced panic attacks. The researchers also checked for other depression risk factors, including chronic conditions such as heart disease and diabetes, as well as alcohol use, obesity and use of the combined oral contraceptive pill.
Overall, 24.2 per cent of the women reported having skin problems. Women with skin problems had the highest levels of stress and depression, but no link was found between skin problems and anxiety attacks.
The research team, led by Dr Parker Magin from the University of Newcastle in New South Wales, concluded that the study provided strong evidence for depressive symptoms and stress-causing skin conditions.
They add that the findings may have considerable clinical implications for psychological interventions in the management of patients with skin disease.
Magin P, Sibbritt D, Bailey K. The relationship between psychiatric illnesses and skin disease. A longitudinal analysis of young Australian women. Arch Dermatol 2009; 145(8): 896-902

Psoriasis therapies and cancer risk
Many of the treatment options for moderate to severe psoriasis may increase the risk of cancer, according to a review of published evidence. The authors found that long-term PUVA therapy was associated with an increased risk of cutaneous squamous cell carcinoma and malignant melanoma, and that methotrexate, ciclosporin and mycophenolate mofetil could be associated with an increased risk of lymphoproliferative disorders during treatment. The risk associated with biologics was unclear, but most studies suggested TNF-blockers could slightly increase the risk of cancer. The researchers conclude that patient counselling and selection, and clinical follow-up are needed to maximise patient safety.
Patel RV, Clark LN, Lebwohl M et al. J Am Acad Dermatol 2009; 60: 1001-17

Diabetes and postoperative infection
Patients with diabetes have a greater risk of postoperative infection following skin surgery, a study has shown. In the five-year prospective observational study, 7,224 lesions were excised from 4,197 patients by one surgeon in southern Australia; 4.7 per cent of the patients had diabetes. Infection incidence was significantly higher in those with diabetes (4.2 per cent, 23 out of 551) than in those without (2.0 per cent, 135 out of 6,673). Non-infective complications were similar in both groups, at 1.8 per cent. The researchers suggest that clinicians might consider antibiotic prophylaxis in patients with diabetes who are facing high-risk skin surgery.
Dixon AJ, Dixon MP, Dixon JB. Dermatol Surg 2009; 35: 1035-40

GPs' role in melanoma follow-up
GP-led melanoma follow-up is feasible and GPs are willing to provide it, a small study has found. Researchers at the University of Aberdeen interviewed 17 GPs currently delivering routine follow-up for people with cutaneous malignant melanoma. The responses showed that GP-led follow-up worked well from the GPs' perspective. The GPs believed they were well equipped and supported, and recognised they were freeing up hospital consultant time. They also felt that patients appreciated the convenience of GP-led follow-up. However, a robust recall system, initial training with regular refreshers and effective consultant back-up were cited as vital parts of a successful long-term programme.
Murchie P, Delaney EK, Campbell NC et al. Fam Pract 2009; 26: 317-24

Itching as a guide to UVB therapy
Prevalence of itching and scratching in psoriasis can indicate how many UVB irradiation sessions are likely to be needed to achieve clearance, researchers in The Netherlands say. Patients referred for UVB phototherapy were randomised to a suberythematogenic or an erythematogenic irradiation regimen. Among the 77 patients who achieved clearance, levels of itching and scratching were positively correlated with the number of irradiation sessions needed to achieve this. The correlation remained significant after controlling for various factors including the irradiation scheme used, cumulative UVB dose and lifestyle factors.
Evers AW, Kleinpenning MM, Smits T et al. Br J Dermatol 2009; 161; 542-6

Antioxidants and melanoma risk
Antioxidants taken in nutritional doses do not increase melanoma risk, the results of a population-based prospective study suggest. Recent research (SUVIMAX study) reported a fourfold higher melanoma risk in women taking a supplement with nutritionally appropriate doses of antioxidants. This latest study examined melanoma risk in 69,671 men and women who self-reported intake of multivitamins and supplemental antioxidants, including selenium and beta carotene, over the previous 10 years. After adjusting for melanoma risk factors, there was no significant association between melanoma risk in women or men and multivitamin use, or supplemental beta carotene or selenium at doses comparable to the SUVIMAX study.
Asgari MM, Maruti SS, Kushi LH et al. Arch Dermatol 2009; 145: 879-82

Squamous cell carcinoma
A virus may play a part in the pathogenesis of squamous cell carcinoma (SCC), according to US researchers. Tissue samples from 58 people with SCC were examined. The researchers identified a virus that had first been discovered last year in patients with Merkel cell carcinoma, in 36 per cent of the patients and in 15 per cent of the tumours tested. Furthermore, the virus found in tumour cells had a mutation that could enable the viral DNA to integrate into the DNA of the host cell. The researchers cite this as indirect evidence that the virus might have a role in causing some cases of SCC.
Dworkin AM, Tseng SY, Allain DC et al. J Invest Dermatol 2009; doi:10.1038/jid.2009.183

Quality of life in patients with skin disease
A novel visual tool for assessing health-related quality of life in people with dermatological disease has been validated in an open longitudinal study of 227 dermatology inpatients. Study participants completed the PRISM (Pictorial Representation of Illness and Self Measure) tool, and the Dermatology Life Quality Index (DLQI) and Skindex-29 questionnaires at admission and discharge. PRISM scores correlated well with those from the Skindex-29 and DLQI questionnaires. The highest correlations between PRISM and Skindex-29 were for dermatitis and leg ulcers, and between PRISM and DLQI for psoriasis and tumours. The researchers say that free-text answers in the PRISM tool allow for assessment of individual information and potentially customised therapeutic approaches.
Muhleisen B, Buchi S, Schmidhauser S et al. Arch Dermatol 2009; 145: 774-80

Vitamin C may improve wound healing
The protective properties of vitamin C have been studied in human skin cells by researchers in Portugal. They investigated which genes were activated in human dermal fibroblasts as a result of sustained exposure to a vitamin C derivative, ascorbic acid 2-phosphate. The results showed that vitamin C may improve wound healing by stimulating fibroblast division and promoting fibroblast migration into the wounded area. Vitamin C could also protect the skin by increasing the capacity of fibroblasts to repair potentially mutagenic DNA lesions. The results will be of interest to the cosmetics industry, but may also benefit research aimed at prevention and treatment of skin lesions.
Duarte TL, Cooke MS, Jones GD. Free Radic Biol Med 2009; 46: 78-87

More effective antibiotics
US researchers have discovered a mechanism that could make existing antibiotics more effective. The researchers, from the NYU School of Medicine in New York, found that eliminating nitric oxide rendered antibiotics more potent at lower, less toxic doses.
Science Online 2009,

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