Belaray Dermatology - Jericho, Plainview, Long Island, NY

So reads the headline published in the LONDON (Reuters) in an article by Michael Kahn, discussing a publication by Johan Moan in PNAS, titled “Addressing the health benefits and risks, involving vitamin D or skin cancer, of increased sun exposure” Abstract Free Full Text

This is an eye catching headline, and thought provoking paper - but both are somewhat misleading. In this paper, Johan Moan and colleagues have suggested a slight relationship between the prognosis of some cancers and latitude. That is to say, for some times of cancer, you might be expected to live a little longer if you reside closer to the equator.

The researchers take this discovery and run with ideas and possible explanations. They suggest that patients closer to the equator get more sun, and the sun is responsible for making Vitamin D in the skin. They further suggest that low levels of Vitamin D may put you at risk for not doing as well with some types of cancer.

What is notable here are several things that the researchers have not demonstrated. For example, the researchers have not shown that there is a difference in the level of Vitamin D at different latitudes. Certainly one would expect that if exposed to more sunlight, an individual will produce more Vitamin D. However, Vitamin D also is introduced into our body by the things we eat. Vitamin D is readily supplemented in milk, yogurt, margarine, oil spreads, breakfast cereal, pastries, and bread. It is naturally found in fish, fish oils, mushrooms, and eggs. Several previous studies have looked at Vitamin D levels in different countries, and it is not generally believed by scientists that there is any difference in Vitamin D levels at different latitudes.

Of note, the researchers also present data in their paper that suggests that there is a higher likelihood of developing colon, lung, prostate, and of course melanoma in patients living closer to the equator. This finding was not made much mention of in either the original article, nor the newspaper coverage.

In summary, Vitamin D is an interesting compound that we need to learn more about… but this paper falls far short of the headline it was given “More sun is healthy.” For now, we suggest you stick to your sunblock and hats!

Researchers in Canada looked at 153 YouTube videos about vaccination and immunization. They found that over half of the videos published childhood, flu and HPV vaccines in a negative or ambiguous light. Forty-five of them contradict recommendations contained in the Canadian Immunization Guide (2006).  Videos that portray vaccinations in a negative light receive significantly more traffic than those that portray them in a positive light

Since YouTube is increasingly a resource people consult for health information, it is concerning that a significant amount of immunization content contradicts the nation’s reference standard.

On a review of dermatology related YouTube videos, we have found the helpful mixed with the bizarre.  What we also found surprising was the amount of dermatology related YouTube videos that were an advertisement.  For example, we refer you to an earlier blog where we suggest you visit this YouTube video that teaches you how to do a self skin examination.  What we did not mention is that we were surprised how difficult it was to find a video that we thought was helpful on the topic.  We spent our time screening YouTube to bring you content that we thought was worthy of your time.  But isn’t that what doctors are supposed to do?

YouTube is simply a venue for information… as is the radio, newspaper, magazine, and TV.  It is a venue that allows syndication of the people… and is filled with helpful, as well as silly, commercialized, bogus, exaggerated, biased, and simply incorrect content – mirroring every branch of the media.  I doubt that the ‘anti-vaccination’ YouTube popularity will result  in a public health crisis.  It is likely a curiosity amongst viewers, and it is being viewed because it is a different viewpoint than you will get when you visit your physician. 

What would we like to see?  Dermatology residency programs should consider taking the initiative to fill YouTube with helpful content that patients and colleagues will find enjoyable to watch.  And while they are at it… they should make it their responsibility to correct, update, and monitor other public sources like wikipedia.  As respectable organizations begin to take the lead in bringing trustworthy, reliable, informative, and interesting content to viewers, we will all be better off.

“YouTube as a Source of Information on Immunization: A Content Analysis”
Jennifer Keelan, PhD, Vera Pavri-Garcia, PhD, George Tomlinson, PhD, Kumanan Wilson, MSc, MD
JAMA Vol. 298 No. 21, December 5, 2007

We wanted to share with you an important study from the American Journal of Medicine: “ Smoking cessation may be a potentially important target for the prevention and management of psoriasis.”

In this study, researchers have shown that current, past, as well as cumulative levels of smoking, are associated with an increased risk of psoriasis.  And the more you smoke…. the higher your risk.  Prenatal exposure, and second hand smoke also put you at risk.  They have also shown that the risk decreases to nearly baseline levels after 20 years of abstinence. 

This adds one more important reason to consider quiting.  We know that quitting can be very difficult, and if you feel ready to quit you should speak with your internist for help.  There are many tools available to help you break this addictive habit.

A recent article published in Preventive Medicine titled “ Is ultraviolet B irradiance inversely associated with incidence rates of endometrial cancer: an ecological study of 107 countries” suggests that the sun may lower the risk of endometrial cancer.

In this study, researches tried to relate the incidence of endometrial cancer in 107 countries to a long list of variables.  After reviewing the data, they found a higher incidence of endometrial cancer in populations with low UVB irradiance, high intake of energy from animal sources, per capita health expenditure, and proportion of population overweight.

What does this mean?  I’m not sure.  This type of research is great at asking questions, but it rarely gives us any answers.  Any conclusions from this point are quite speculative.  The authors have suggested that the sun may reduce the risk of endometrial cancer, or perhaps those with low Vitamin D have a higher risk of endometrial cancer.  Perhaps a future study will look at this, by reviewing the incidence of endometrial cancer in patients with Vitamin D deficiency?  Or by looking at the risk of endometrial cancer in patients who have had long-term phototherapy?    Or maybe UV exposure has nothing at all to do with endometrial cancer… but is related to another variable that was not analyzed?  For example, perhaps those who live in an area with high incidence of UV, and from wealthy economies (spending more per-capita on health care) are more likely to use sunscreen?  Does sunscreen put one at risk then for endometrial cancer?  Or… maybe populations with low UV exposure are exposed to a carcinogen in winter that warmer climates avoid?  Perhaps endometrial cancer risk increases by relaxing in-front of a fireplace?  Or, perhaps, those in the Northern climates eat more meat, are more likely to be obese, and consume less fish, fruits and vegetables - and UV exposure has nothing at all to do with it. 

The bottom line is that this is an interesting study,  but drawing the conclusion that sun lowers the risk of endometrial cancer is misleading, and premature.  It is interesting that the authors did not title the article “Eating meat may increase the risk of Endometrial Cancer….” or  “Obesity may increase the risk of Endometrial Cancer.” 

FYI: Here are some excellent dietary sources of vitamin D:

• Fish liver oil
• Fatty fish (ie: salmon, catfish, mackerel, sardines, tuna, eel)
• Mushrooms
• Eggs
• Many other foods are fortified with Vitamin D, including milk, cereal, and yogurt.

Several stories appeared in the news regarding Age Intervention Eyelash.  Here is the scoop:

U.S. marshals on Friday seized 12,682 applicator tubes of a cosmetic called Age Intervention Eyelash, which the FDA claims is being marketed as an unapproved and misbranded drug.  The FDA suggests that this product may harm some users’ vision.  The product, promoted as increasing eyelash growth, is sold and distributed by San Jose, California-based Jan Marini Skin Research, Inc (JMSR).  Though this sounds like it was an action packed day for U.S. marshals - things probably went pretty smoothly since the product has been off the market for more than one year and the company was storing the old product for disposition at the FDA’s direction for 14 months. 

Why all the fuss?  Part of the problem is JMSR’s claim that Age Intervention Eyelash will increase eyelash growth. Making a claim that a product will have a specific effect -like increasing eyelash growth- means that Age Intervention Eyelash is a drug.  Before a new drug product may be legally marketed, it must be shown to be safe and effective, and approved by FDA. Age Intervention Eyelash was not put through these rigorous (and expensive) tests.

The articles in several papers focused on the accused wrongdoing JMSR is involved with, by bringing a product with claims to market hat did not go through the FDA process.  What was not reported is the question of potential legitimacy of these claims.

The product in question contained bimatoprost, an active ingredient in an FDA-approved drug to treat elevated intraocular pressure (elevated pressure inside the eye).  Bimatoprost, a prostaglandin analogue, is marketed as Lumigan.  There are other medications in this class, Travoprost (Travatan), and Latanoprost (Xalatan).  All of these medications have been shown to have the side effect of increasing hair growth.  In fact, Murray Johnstone, an ophthalmologist from Seattle Washington, filed a patent in 1999 Patent 6,262,105 after he noticed this effect in several of his patients who were using one of these eye drops on just one side.  Since then, there have been several papers in the medical literature discussing the use of these products for enhancing hair growth.  Some subsequent studies have suggested that Travoprost is the best at inducing hair to grow, but more research needs to be done.

Even though Age Intervention Eyelash is off the market, if you have a problem with eyebrow or eyelash growth you may want to ask your doctor about your options.  Though it is against FDA regulation for Jan Marini Skin Research to market a drug in a cosmetic package without rigorous testing, your physician may be able to prescribe for you a product like Travoprost to use topically to the areas you need hair to grow one or two times per day.  Every treatment has potential side effects, and you should discuss these with your doctor.  Of note…. the newspaper articles failed to mention the most common side effect.  When this medication is used in the eye, it has been may make your iris (the colored part of your eye) turn permanently darker in color.  It is not clear what the risk of this side effect is if the medication is used on eyelashes or eyebrows.  In addition, using this medication would not be recommended for patients who already take this type of eye drop to manage glaucoma.  With this medicine… more can be less, and may result in inadequate control of glaucoma.

JMSR reformulated its eyelash product in late 2006 to eliminate the marketing claims and the ingredient questioned by the FDA. JMSR’s new Age Intervention Eyelash Conditioner does not contain bimatoprost or any other prescription drug ingredient.  In this new cosmetic product, there is no “active ingredient” that has been disclosed that has been scientifically shown to increase hair growth.  Age Intervention Eyelash Conditioner is not intended to stop, prevent, cure, relieve, reverse or reduce eyelash loss or to promote the growth of eyelashes.  So if you just want thicker appearing lashes, you may enjoy Age Intervention Eyelash Conditioner as a high end mascara.  If you have a problem with lashes not growing… you will need to talk to your doctor – and bring a copy of this article.

The Answer: Maybe 

A study published in The Proceedings of the National Academy of Sciences has found that an extract from three-day-old broccoli sprouts, sulforaphane, rubbed on skin produces significant long-lasting protection against the burns caused by ultraviolet radiation.  The extract may work by provoking an increase in a protective enzyme produced by the skin cells. This reaction requires days to develop, but it continues to work after the substance is washed off.

Though it is too soon to start rubbing broccoli sprouts on our skin before a venture to the beach, we are excited to see further research on the topic.  In addition, it is interesting to consider what other human organs might be protected by this or similar compounds.

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Long Island Students Diagonosed With Staph Infection

You have read about antibiotic-resistant bacterial infections in our school systems in Newsday, the NY Times, and heard it on the TV & radio.  Such infections became a concern following the death this month of a Virginia high school senior who was diagnosed with it.  Since all of the publicity, we have had many patients visiting the office worried that they have been infected.

We wanted to share some tips with you, and help you better understand how to prevent methicillin-resistant Staphylococcus aureus, or M-R-S-A infections.

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The rates of skin cancer are on the rise, and both primary care doctors and dermatologists are taking note.  One in five Americans will develop a skin cancer, and every hour someone is dying of a melanoma.  These are alarming statistics, and were the topic of conversation at Huntington Hospital after Dr. Jeffrey Ellis presented a dermatologists perspective on the identification, and management of skin cancer.

“It is well know that the biggest risk of skin cancer,” said Ellis “is overexposure to UV rays from the sun.  Most of us will try to protect ourselves if we go to the beach, but few realize how much little bits of sun exposure add up.  In fact one week worth of casual sun exposure, like going to the car or supermarket, is equivalent to a solid hour at the beach!”  Ellis emphasizes the importance of wearing a broad brimmed hat and broad spectrum sunscreen daily.  He recommends to his patients that sunscreen use become part of the morning ritual, which should be applied just after you brush your teeth.

UV rays from the sun or tanning beds do not only increase the risk of skin cancer, but it also makes us look older. The UV rays are responsible for loss of tissue elasticity and the development of wrinkles and age spots.  Dr. Ellis offers this advice; “It doesn’t matter if your goal is to look younger, or to avoid skin cancer.  Protect yourself from UV rays, and you will be better off.”

Keloids, the overgrowth of scar tissue, can be found in up to 1 of every 5 Blacks, Hispanics, and Asians.  They normally begin after trauma such as ear piercing.  Treatment of keloids is fraught with challenges, as they often recur after conventional surgery – sometimes larger than before.  At the 2007 Florida Society of Dermatologic Surgeons - Annual Meeting, Dr. Jeffrey Ellis has presented a new technique for the treatment of keloids using Radiosurgery with promising results.

            “Keloids are very common, and we have tried to treat them with everything from traditional excision, pressure earrings, creams, injections, to silicone sheeting,” Ellis said.  “The use of Radiosurgery to treat keloids is a new approach, and we are very excited by the results so far.”  In Ellis’s pilot study, he used the Ellman Surgitron Dual Frequency device to carefully excise a series of earlobe keloids. 

Ellis chose to use the Ellman device due to it’s ability to meticulously sculpt tissue, while providing minimal trauma.  It utilizes a special high frequency of 4.0MHz which minimizes heat dissipation and thus scarring.  “One of the biggest problems with conventional surgery when excising a keloid,” Ellis says “is that trauma and tissue injury is inherent in the procedure.  This serves as a seed for a new keloid to grow in place of the old… sometimes a larger and more aggressive one.”  With Ellis’s new technique, tissue trauma at the time of excision is minimized, offering a better chance of long term cure.  And the results so far are very promising.