Damian McNamara

MIAMI — A topical tocopheryl phosphate complex effectively reduced problems associated with sensitive skin and shaving-induced irritation in a study of 28 Hispanic, Asian, and other participants.

Tocopheryl phosphate occurs naturally and is found in many animal and plant species, Roger McMullen, Ph.D., said at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research.

The livers of rats, guinea pigs, and chickens, and the adipose tissue of guinea pigs, rats, and humans contain tocopheryl phosphate. It is also found in wheat germ oil, butter, cheddar cheese, olive oil, and chocolate, said Dr. McMullen, a researcher at International Specialty Products in Wayne, N.J.

Researchers studied a lipophilic tocopheryl phosphate complex (Vital ET, International Specialty Products) for relief of sensitive and/or irritated skin since it had demonstrated efficacy in previous studies.

Tocopheryl phosphate inhibited inflammatory and proliferative pathways in previous animal studies.

The substance "also provides protection against oxidative stress, but not through a free radical scavenging mechanism," said Dr. McMullen, who presented findings of the current study on behalf of David J. Moore, Ph.D., a senior science fellow at International Specialty Products.

There are many skin care products on the global market that contain Vital ET, Dr. Moore said in an interview after the meeting.

The researchers assessed the ability of the lipophilic tocopheryl phosphate complex to relieve symptoms of skin sensitive to shaving in Hispanic, Asian, and other study participants.

They applied a balm containing 2% tocopheryl phosphate once daily for 4 weeks. There were 13 men who shaved their faces daily and 15 women who shaved their legs every other day. There were four Hispanic and seven Asian participants.

Erythema, folliculitis, tactile roughness, dryness, skin clarity, and nicks and cuts were clinically graded at baseline. A board-certified dermatologist then rated these parameters at week 2 and week 4. Participants also scored any burning, stinging, itching, or tightness.

"All objective and subjective graded parameters of irritated or sensitive skin were significantly improved compared to baseline. The very significant efficacy for all clinically graded parameters at 2 and 4 weeks … was delivered in a real skin care formulation," Dr. McMullen said at the meeting, which was also sponsored by Howard University.

"We were not surprised, as this was our third clinical study with Vital ET and both previous studies had demonstrated significant efficacy in mitigating skin irritation," Dr. Moore said.

The previous research involved treatment of UV-induced erythema or acne with the product applied in a simple gel formulation, he noted.

In the current study, erythema improved from a mean score of 5 at baseline to a mean of 2 after 2 weeks and a mean of 1 after 4 weeks. These improvements were observed in all study participants, said Dr. McMullen.

Similarly, improvements in skin clarity were observed at 2 weeks and 4 weeks, compared with baseline, in all participants. In addition, "there was a big drop in folliculitis from baseline to 2 weeks," he said.

"We are currently conducting human ex vivo skin studies at ISP Global Skin Research in Nice, France, to further understand the biologic activity of Vital ET in skin," Dr. Moore said. Researchers are assessing its protective effect on Langerhans cells and its role in protecting the skin from glycation stress.

"After this work is complete, we expect to conduct further human clinical studies," he said.

An Asian patient with shaving-induced irritation is shown before using a skin balm containing tocopheryl phosphate complex.

The patient is shown 2 weeks after daily treatment with the skin care formulation. Skin improvements were observed in all study patients. Photos courtesy Dr. David J. Moore

MIAMI — A topical tocopheryl phosphate complex effectively reduced problems associated with sensitive skin and shaving-induced irritation in a study of 28 Hispanic, Asian, and other participants.

Tocopheryl phosphate occurs naturally and is found in many animal and plant species, Roger McMullen, Ph.D., said at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research.

The livers of rats, guinea pigs, and chickens, and the adipose tissue of guinea pigs, rats, and humans contain tocopheryl phosphate. It is also found in wheat germ oil, butter, cheddar cheese, olive oil, and chocolate, said Dr. McMullen, a researcher at International Specialty Products in Wayne, N.J.

Researchers studied a lipophilic tocopheryl phosphate complex (Vital ET, International Specialty Products) for relief of sensitive and/or irritated skin since it had demonstrated efficacy in previous studies.

Tocopheryl phosphate inhibited inflammatory and proliferative pathways in previous animal studies.

The substance "also provides protection against oxidative stress, but not through a free radical scavenging mechanism," said Dr. McMullen, who presented findings of the current study on behalf of David J. Moore, Ph.D., a senior science fellow at International Specialty Products.

There are many skin care products on the global market that contain Vital ET, Dr. Moore said in an interview after the meeting.

The researchers assessed the ability of the lipophilic tocopheryl phosphate complex to relieve symptoms of skin sensitive to shaving in Hispanic, Asian, and other study participants.

They applied a balm containing 2% tocopheryl phosphate once daily for 4 weeks. There were 13 men who shaved their faces daily and 15 women who shaved their legs every other day. There were four Hispanic and seven Asian participants.

Erythema, folliculitis, tactile roughness, dryness, skin clarity, and nicks and cuts were clinically graded at baseline. A board-certified dermatologist then rated these parameters at week 2 and week 4. Participants also scored any burning, stinging, itching, or tightness.

"All objective and subjective graded parameters of irritated or sensitive skin were significantly improved compared to baseline. The very significant efficacy for all clinically graded parameters at 2 and 4 weeks … was delivered in a real skin care formulation," Dr. McMullen said at the meeting, which was also sponsored by Howard University.

"We were not surprised, as this was our third clinical study with Vital ET and both previous studies had demonstrated significant efficacy in mitigating skin irritation," Dr. Moore said.

The previous research involved treatment of UV-induced erythema or acne with the product applied in a simple gel formulation, he noted.

In the current study, erythema improved from a mean score of 5 at baseline to a mean of 2 after 2 weeks and a mean of 1 after 4 weeks. These improvements were observed in all study participants, said Dr. McMullen.

Similarly, improvements in skin clarity were observed at 2 weeks and 4 weeks, compared with baseline, in all participants. In addition, "there was a big drop in folliculitis from baseline to 2 weeks," he said.

"We are currently conducting human ex vivo skin studies at ISP Global Skin Research in Nice, France, to further understand the biologic activity of Vital ET in skin," Dr. Moore said. Researchers are assessing its protective effect on Langerhans cells and its role in protecting the skin from glycation stress.

"After this work is complete, we expect to conduct further human clinical studies," he said.

An Asian patient with shaving-induced irritation is shown before using a skin balm containing tocopheryl phosphate complex.

The patient is shown 2 weeks after daily treatment with the skin care formulation. Skin improvements were observed in all study patients. Photos courtesy Dr. David J. Moore

MIAMI — A topical tocopheryl phosphate complex effectively reduced problems associated with sensitive skin and shaving-induced irritation in a study of 28 Hispanic, Asian, and other participants.

Tocopheryl phosphate occurs naturally and is found in many animal and plant species, Roger McMullen, Ph.D., said at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research.

The livers of rats, guinea pigs, and chickens, and the adipose tissue of guinea pigs, rats, and humans contain tocopheryl phosphate. It is also found in wheat germ oil, butter, cheddar cheese, olive oil, and chocolate, said Dr. McMullen, a researcher at International Specialty Products in Wayne, N.J.

Researchers studied a lipophilic tocopheryl phosphate complex (Vital ET, International Specialty Products) for relief of sensitive and/or irritated skin since it had demonstrated efficacy in previous studies.

Tocopheryl phosphate inhibited inflammatory and proliferative pathways in previous animal studies.

The substance "also provides protection against oxidative stress, but not through a free radical scavenging mechanism," said Dr. McMullen, who presented findings of the current study on behalf of David J. Moore, Ph.D., a senior science fellow at International Specialty Products.

There are many skin care products on the global market that contain Vital ET, Dr. Moore said in an interview after the meeting.

The researchers assessed the ability of the lipophilic tocopheryl phosphate complex to relieve symptoms of skin sensitive to shaving in Hispanic, Asian, and other study participants.

They applied a balm containing 2% tocopheryl phosphate once daily for 4 weeks. There were 13 men who shaved their faces daily and 15 women who shaved their legs every other day. There were four Hispanic and seven Asian participants.

Erythema, folliculitis, tactile roughness, dryness, skin clarity, and nicks and cuts were clinically graded at baseline. A board-certified dermatologist then rated these parameters at week 2 and week 4. Participants also scored any burning, stinging, itching, or tightness.

"All objective and subjective graded parameters of irritated or sensitive skin were significantly improved compared to baseline. The very significant efficacy for all clinically graded parameters at 2 and 4 weeks … was delivered in a real skin care formulation," Dr. McMullen said at the meeting, which was also sponsored by Howard University.

"We were not surprised, as this was our third clinical study with Vital ET and both previous studies had demonstrated significant efficacy in mitigating skin irritation," Dr. Moore said.

The previous research involved treatment of UV-induced erythema or acne with the product applied in a simple gel formulation, he noted.

In the current study, erythema improved from a mean score of 5 at baseline to a mean of 2 after 2 weeks and a mean of 1 after 4 weeks. These improvements were observed in all study participants, said Dr. McMullen.

Similarly, improvements in skin clarity were observed at 2 weeks and 4 weeks, compared with baseline, in all participants. In addition, "there was a big drop in folliculitis from baseline to 2 weeks," he said.

"We are currently conducting human ex vivo skin studies at ISP Global Skin Research in Nice, France, to further understand the biologic activity of Vital ET in skin," Dr. Moore said. Researchers are assessing its protective effect on Langerhans cells and its role in protecting the skin from glycation stress.

"After this work is complete, we expect to conduct further human clinical studies," he said.

An Asian patient with shaving-induced irritation is shown before using a skin balm containing tocopheryl phosphate complex.

The patient is shown 2 weeks after daily treatment with the skin care formulation. Skin improvements were observed in all study patients. Photos courtesy Dr. David J. Moore

MIAMI — Although some skin features vary by ethnicity and with age, researchers found no significant seasonal differences in skin smoothness or dryness between African American, Chinese, white, or Hispanic women. In a second comparison, color heterogeneity and yellowness were the primary skin differences among these ethnic groups.

"There is a paucity of data when it comes to trying to quantify properties of ethnic skin," Felicia Dixon, Ph.D., said at an international symposium sponsored by the L'Oréal Institute for Ethnic Hair and Skin Research.

The investigators studied 214 women aged 18-87 years in the summer of 2004 and again, 6 months later, in the winter of 2005. There were 91 African American, 47 Chinese, 41 white, and 35 Hispanic women.

"There are drastic changes in temperature in Chicago between summer and winter, while humidity is about the same," said Dr. Dixon, a researcher at L'Oréal USA Inc. in Chicago. She presented the results for Stephane Diridollou, Ph.D., also of L'Oréal USA, who was unable to attend the meeting.

The researchers compared skin microrelief, dryness features, mechanical properties, and sebum function between groups. They also looked for differences in the epidermis, subepidermal nonechogenic band, papillary dermis, and dermis.

Microrelief and dryness were measured using a SkinChip sensor (jointly developed by L'Oréal and STMicroelectronics). This device features about 92,000 microsensors in a sensor slightly larger than a penny. The image analysis software quantified skin smoothness and dryness at three sites—the cheek and dorsal and ventral sides of the arm.

The ventral arm sites were smoother than the dorsal sites during both seasons, and the dorsal skin became rougher from summer to winter. "Yes, in winter, there was an increase in dryness of the skin at the three sites. But there were more changes on the dorsal arm and cheek versus the ventral arm, related to exposure to the elements," Dr. Dixon said.

The seasonal differences in dryness were not statistically significant between groups. "All ethnic groups seem to respond the same way," she said at the meeting, which was also sponsored by Howard University.

With aging, white women showed more changes in microrelief, elasticity, and skin structures. These changes were not observed among African American women. "It's not lost on this audience that black women tend to age well, so to speak," Dr. Dixon said. "What was unique for the African American women was the uneven skin tone as a function of age."

In a second comparison, Jean Paul de Rigal, Ph.D., and his associates assessed 387 women for skin color and color heterogeneity. They compared 122 African Americans, 120 Chinese, 81 whites, and 64 Hispanics aged 20-90 years.

Any differences in forehead or cheek color characteristics were detected using standardized whole face images taken with the L'Oréal Chromasphere. The device diffuses light in a spherical manner around the face and allows for precise color measurements without any shadows, said Dr. de Rigal, a research engineer at L'Oréal Inc. in Chevilly-Larue, France.

Skin color heterogeneity was highest among African American and Hispanic women. On the forehead, color heterogeneity decreased from African American to white participants, "with Chinese and Hispanic women in between, and more or less identical," Dr. de Rigal said. For all women, there was lower color heterogeneity on the forehead, compared with the cheeks. Again, African Americans displayed the most color heterogeneity on the cheek area, followed by Hispanics.

The redness component of skin did not vary significantly between groups. The yellow component, however, did vary by ethnicity. Yellowness was higher in Hispanic and Chinese skin, compared with African American and white skin.

MIAMI — Although some skin features vary by ethnicity and with age, researchers found no significant seasonal differences in skin smoothness or dryness between African American, Chinese, white, or Hispanic women. In a second comparison, color heterogeneity and yellowness were the primary skin differences among these ethnic groups.

"There is a paucity of data when it comes to trying to quantify properties of ethnic skin," Felicia Dixon, Ph.D., said at an international symposium sponsored by the L'Oréal Institute for Ethnic Hair and Skin Research.

The investigators studied 214 women aged 18-87 years in the summer of 2004 and again, 6 months later, in the winter of 2005. There were 91 African American, 47 Chinese, 41 white, and 35 Hispanic women.

"There are drastic changes in temperature in Chicago between summer and winter, while humidity is about the same," said Dr. Dixon, a researcher at L'Oréal USA Inc. in Chicago. She presented the results for Stephane Diridollou, Ph.D., also of L'Oréal USA, who was unable to attend the meeting.

The researchers compared skin microrelief, dryness features, mechanical properties, and sebum function between groups. They also looked for differences in the epidermis, subepidermal nonechogenic band, papillary dermis, and dermis.

Microrelief and dryness were measured using a SkinChip sensor (jointly developed by L'Oréal and STMicroelectronics). This device features about 92,000 microsensors in a sensor slightly larger than a penny. The image analysis software quantified skin smoothness and dryness at three sites—the cheek and dorsal and ventral sides of the arm.

The ventral arm sites were smoother than the dorsal sites during both seasons, and the dorsal skin became rougher from summer to winter. "Yes, in winter, there was an increase in dryness of the skin at the three sites. But there were more changes on the dorsal arm and cheek versus the ventral arm, related to exposure to the elements," Dr. Dixon said.

The seasonal differences in dryness were not statistically significant between groups. "All ethnic groups seem to respond the same way," she said at the meeting, which was also sponsored by Howard University.

With aging, white women showed more changes in microrelief, elasticity, and skin structures. These changes were not observed among African American women. "It's not lost on this audience that black women tend to age well, so to speak," Dr. Dixon said. "What was unique for the African American women was the uneven skin tone as a function of age."

In a second comparison, Jean Paul de Rigal, Ph.D., and his associates assessed 387 women for skin color and color heterogeneity. They compared 122 African Americans, 120 Chinese, 81 whites, and 64 Hispanics aged 20-90 years.

Any differences in forehead or cheek color characteristics were detected using standardized whole face images taken with the L'Oréal Chromasphere. The device diffuses light in a spherical manner around the face and allows for precise color measurements without any shadows, said Dr. de Rigal, a research engineer at L'Oréal Inc. in Chevilly-Larue, France.

Skin color heterogeneity was highest among African American and Hispanic women. On the forehead, color heterogeneity decreased from African American to white participants, "with Chinese and Hispanic women in between, and more or less identical," Dr. de Rigal said. For all women, there was lower color heterogeneity on the forehead, compared with the cheeks. Again, African Americans displayed the most color heterogeneity on the cheek area, followed by Hispanics.

The redness component of skin did not vary significantly between groups. The yellow component, however, did vary by ethnicity. Yellowness was higher in Hispanic and Chinese skin, compared with African American and white skin.

MIAMI — Although some skin features vary by ethnicity and with age, researchers found no significant seasonal differences in skin smoothness or dryness between African American, Chinese, white, or Hispanic women. In a second comparison, color heterogeneity and yellowness were the primary skin differences among these ethnic groups.

"There is a paucity of data when it comes to trying to quantify properties of ethnic skin," Felicia Dixon, Ph.D., said at an international symposium sponsored by the L'Oréal Institute for Ethnic Hair and Skin Research.

The investigators studied 214 women aged 18-87 years in the summer of 2004 and again, 6 months later, in the winter of 2005. There were 91 African American, 47 Chinese, 41 white, and 35 Hispanic women.

"There are drastic changes in temperature in Chicago between summer and winter, while humidity is about the same," said Dr. Dixon, a researcher at L'Oréal USA Inc. in Chicago. She presented the results for Stephane Diridollou, Ph.D., also of L'Oréal USA, who was unable to attend the meeting.

The researchers compared skin microrelief, dryness features, mechanical properties, and sebum function between groups. They also looked for differences in the epidermis, subepidermal nonechogenic band, papillary dermis, and dermis.

Microrelief and dryness were measured using a SkinChip sensor (jointly developed by L'Oréal and STMicroelectronics). This device features about 92,000 microsensors in a sensor slightly larger than a penny. The image analysis software quantified skin smoothness and dryness at three sites—the cheek and dorsal and ventral sides of the arm.

The ventral arm sites were smoother than the dorsal sites during both seasons, and the dorsal skin became rougher from summer to winter. "Yes, in winter, there was an increase in dryness of the skin at the three sites. But there were more changes on the dorsal arm and cheek versus the ventral arm, related to exposure to the elements," Dr. Dixon said.

The seasonal differences in dryness were not statistically significant between groups. "All ethnic groups seem to respond the same way," she said at the meeting, which was also sponsored by Howard University.

With aging, white women showed more changes in microrelief, elasticity, and skin structures. These changes were not observed among African American women. "It's not lost on this audience that black women tend to age well, so to speak," Dr. Dixon said. "What was unique for the African American women was the uneven skin tone as a function of age."

In a second comparison, Jean Paul de Rigal, Ph.D., and his associates assessed 387 women for skin color and color heterogeneity. They compared 122 African Americans, 120 Chinese, 81 whites, and 64 Hispanics aged 20-90 years.

Any differences in forehead or cheek color characteristics were detected using standardized whole face images taken with the L'Oréal Chromasphere. The device diffuses light in a spherical manner around the face and allows for precise color measurements without any shadows, said Dr. de Rigal, a research engineer at L'Oréal Inc. in Chevilly-Larue, France.

Skin color heterogeneity was highest among African American and Hispanic women. On the forehead, color heterogeneity decreased from African American to white participants, "with Chinese and Hispanic women in between, and more or less identical," Dr. de Rigal said. For all women, there was lower color heterogeneity on the forehead, compared with the cheeks. Again, African Americans displayed the most color heterogeneity on the cheek area, followed by Hispanics.

The redness component of skin did not vary significantly between groups. The yellow component, however, did vary by ethnicity. Yellowness was higher in Hispanic and Chinese skin, compared with African American and white skin.

MIAMI — Unique structural and functional differences between the skin of black and white patients might help explain differences in the top five dermatology diagnoses for each ethnicity.

"As diversity increases in the U.S., understanding these differences becomes important," said Dr. Amanda B. Sergay, a third-year dermatology resident at St. Luke's-Roosevelt Hospital Center in New York City.

Dr. Sergay and her associates, including principal investigator Dr. Andrew F. Alexis, retrospectively compared the diagnostic codes for 1,074 black and white patient visits treated at the Skin of Color Center at St. Luke's-Roosevelt Hospital Center, New York City, from August 2004 to July 2005. When ethnicity was unclear, the patient's own description was used.

Prior to this study, the most recent survey of cutaneous diseases in black Americans was published more than 2 decades ago (Cutis 1983;32:388-90), Dr. Sergay said during a presentation at an international symposium sponsored by L'Oreal Institute for Ethnic Hair and Skin Research. "The survey highlights the variability in skin disorders for which individuals of different racial/ethnic groups present to a dermatologist."

Acne vulgaris was the most common diagnosis in both groups (ICD-9 code 706.1). "The pathophysiology of acne is not thought to differ between races or ethnicities," she said at the symposium, which was also sponsored by Howard University.

Acne and dyschromia (code 709.09) are so common that they accounted for almost 50% of black patient visits (Cutis, in press: November 2007). Black patients also were commonly diagnosed with contact dermatitis and other eczema, unspecified cause (code 692.9), alopecia (code 704.0), and seborrheic dermatitis (code 690.1).

After acne vulgaris, the most common diagnoses in white patients were a lesion of unspecified behavior (code 238.2), benign neoplasm of the skin of the trunk (code 216.5), contact dermatitis or other eczema, and psoriasis (696.1).

Dyschromia and alopecia made the top 5 list for black patients but did not appear among the top 10 diagnoses for white patients, Dr. Sergay commented.

The dyschromia diagnoses included postinflammatory hyperpigmentation and melasma. "Postinflammatory hyperpigmentation is a common sequela of cutaneous injury or irritation in skin of color," Dr. Sergay said. Postinflammatory hyperpigmentation can also result from pseudofolliculitis barbae, which is more common among black patients because of structural differences in the hair follicle and shaft compared with white patients.

Fewer elastic fibers in black skin to anchor hair follicles to dermis might partially explain the higher incidence of alopecia among black patients (Dermatol. Clin. 1988;6:271-81). Chemical and physical hair care practices may also contribute. Other possible explanations are the significantly lower total hair density and number of hair follicles among black patients, compared with white patients (Dermatol. Clin. 2003;21:595-600; Arch. Dermatol. 1999;135:656-8).

Racial variations in skin physiology may lead to differences in eczema prevalence, Dr. Sergay said. Black skin, for example, typically features a greater number of stratum corneum layers. "There is no consensus, however, about the propensity to develop eczema and race or ethnicity."

The single-center source of information is a limitation of the study, as well as potential selection bias from participating physicians, Dr. Sergay said. In addition, categorization of patient ethnicity by a physician or assistant is less reliable than self-reporting.

Melasma is one of the dyschromia diagnoses. Dyschromia and acne accounted for almost half of all black patient visits.

Lower total hair density and number of hair follicles might explain the higher incidence of alopecia in black patients. Photos courtesy Dr. Pearl E. Grimes

MIAMI — Unique structural and functional differences between the skin of black and white patients might help explain differences in the top five dermatology diagnoses for each ethnicity.

"As diversity increases in the U.S., understanding these differences becomes important," said Dr. Amanda B. Sergay, a third-year dermatology resident at St. Luke's-Roosevelt Hospital Center in New York City.

Dr. Sergay and her associates, including principal investigator Dr. Andrew F. Alexis, retrospectively compared the diagnostic codes for 1,074 black and white patient visits treated at the Skin of Color Center at St. Luke's-Roosevelt Hospital Center, New York City, from August 2004 to July 2005. When ethnicity was unclear, the patient's own description was used.

Prior to this study, the most recent survey of cutaneous diseases in black Americans was published more than 2 decades ago (Cutis 1983;32:388-90), Dr. Sergay said during a presentation at an international symposium sponsored by L'Oreal Institute for Ethnic Hair and Skin Research. "The survey highlights the variability in skin disorders for which individuals of different racial/ethnic groups present to a dermatologist."

Acne vulgaris was the most common diagnosis in both groups (ICD-9 code 706.1). "The pathophysiology of acne is not thought to differ between races or ethnicities," she said at the symposium, which was also sponsored by Howard University.

Acne and dyschromia (code 709.09) are so common that they accounted for almost 50% of black patient visits (Cutis, in press: November 2007). Black patients also were commonly diagnosed with contact dermatitis and other eczema, unspecified cause (code 692.9), alopecia (code 704.0), and seborrheic dermatitis (code 690.1).

After acne vulgaris, the most common diagnoses in white patients were a lesion of unspecified behavior (code 238.2), benign neoplasm of the skin of the trunk (code 216.5), contact dermatitis or other eczema, and psoriasis (696.1).

Dyschromia and alopecia made the top 5 list for black patients but did not appear among the top 10 diagnoses for white patients, Dr. Sergay commented.

The dyschromia diagnoses included postinflammatory hyperpigmentation and melasma. "Postinflammatory hyperpigmentation is a common sequela of cutaneous injury or irritation in skin of color," Dr. Sergay said. Postinflammatory hyperpigmentation can also result from pseudofolliculitis barbae, which is more common among black patients because of structural differences in the hair follicle and shaft compared with white patients.

Fewer elastic fibers in black skin to anchor hair follicles to dermis might partially explain the higher incidence of alopecia among black patients (Dermatol. Clin. 1988;6:271-81). Chemical and physical hair care practices may also contribute. Other possible explanations are the significantly lower total hair density and number of hair follicles among black patients, compared with white patients (Dermatol. Clin. 2003;21:595-600; Arch. Dermatol. 1999;135:656-8).

Racial variations in skin physiology may lead to differences in eczema prevalence, Dr. Sergay said. Black skin, for example, typically features a greater number of stratum corneum layers. "There is no consensus, however, about the propensity to develop eczema and race or ethnicity."

The single-center source of information is a limitation of the study, as well as potential selection bias from participating physicians, Dr. Sergay said. In addition, categorization of patient ethnicity by a physician or assistant is less reliable than self-reporting.

Melasma is one of the dyschromia diagnoses. Dyschromia and acne accounted for almost half of all black patient visits.

Lower total hair density and number of hair follicles might explain the higher incidence of alopecia in black patients. Photos courtesy Dr. Pearl E. Grimes

MIAMI — Unique structural and functional differences between the skin of black and white patients might help explain differences in the top five dermatology diagnoses for each ethnicity.

"As diversity increases in the U.S., understanding these differences becomes important," said Dr. Amanda B. Sergay, a third-year dermatology resident at St. Luke's-Roosevelt Hospital Center in New York City.

Dr. Sergay and her associates, including principal investigator Dr. Andrew F. Alexis, retrospectively compared the diagnostic codes for 1,074 black and white patient visits treated at the Skin of Color Center at St. Luke's-Roosevelt Hospital Center, New York City, from August 2004 to July 2005. When ethnicity was unclear, the patient's own description was used.

Prior to this study, the most recent survey of cutaneous diseases in black Americans was published more than 2 decades ago (Cutis 1983;32:388-90), Dr. Sergay said during a presentation at an international symposium sponsored by L'Oreal Institute for Ethnic Hair and Skin Research. "The survey highlights the variability in skin disorders for which individuals of different racial/ethnic groups present to a dermatologist."

Acne vulgaris was the most common diagnosis in both groups (ICD-9 code 706.1). "The pathophysiology of acne is not thought to differ between races or ethnicities," she said at the symposium, which was also sponsored by Howard University.

Acne and dyschromia (code 709.09) are so common that they accounted for almost 50% of black patient visits (Cutis, in press: November 2007). Black patients also were commonly diagnosed with contact dermatitis and other eczema, unspecified cause (code 692.9), alopecia (code 704.0), and seborrheic dermatitis (code 690.1).

After acne vulgaris, the most common diagnoses in white patients were a lesion of unspecified behavior (code 238.2), benign neoplasm of the skin of the trunk (code 216.5), contact dermatitis or other eczema, and psoriasis (696.1).

Dyschromia and alopecia made the top 5 list for black patients but did not appear among the top 10 diagnoses for white patients, Dr. Sergay commented.

The dyschromia diagnoses included postinflammatory hyperpigmentation and melasma. "Postinflammatory hyperpigmentation is a common sequela of cutaneous injury or irritation in skin of color," Dr. Sergay said. Postinflammatory hyperpigmentation can also result from pseudofolliculitis barbae, which is more common among black patients because of structural differences in the hair follicle and shaft compared with white patients.

Fewer elastic fibers in black skin to anchor hair follicles to dermis might partially explain the higher incidence of alopecia among black patients (Dermatol. Clin. 1988;6:271-81). Chemical and physical hair care practices may also contribute. Other possible explanations are the significantly lower total hair density and number of hair follicles among black patients, compared with white patients (Dermatol. Clin. 2003;21:595-600; Arch. Dermatol. 1999;135:656-8).

Racial variations in skin physiology may lead to differences in eczema prevalence, Dr. Sergay said. Black skin, for example, typically features a greater number of stratum corneum layers. "There is no consensus, however, about the propensity to develop eczema and race or ethnicity."

The single-center source of information is a limitation of the study, as well as potential selection bias from participating physicians, Dr. Sergay said. In addition, categorization of patient ethnicity by a physician or assistant is less reliable than self-reporting.

Melasma is one of the dyschromia diagnoses. Dyschromia and acne accounted for almost half of all black patient visits.

Lower total hair density and number of hair follicles might explain the higher incidence of alopecia in black patients. Photos courtesy Dr. Pearl E. Grimes

Biologic treatment of rheumatoid arthritis patients has spurred an increase in melanoma and other skin cancers but not malignancies other than those of the skin, according to an observational study of 13,001 patients, reported Dr. Frederick Wolfe, a rheumatologist at the National Data Bank for Rheumatic Diseases, and the University of Kansas, Wichita, and his colleague, Kaleb Michaud, Ph.D., of the University of Nebraska, Omaha

Extrapolating from previous data in immunosuppressed transplantation patients, some have theorized that immunosuppression from biologics would increase the risk of cancer database (Arthr. Rheum. 2007;56:2886-95).

The hypothesis gained some credence when a meta-analysis found a 3.3-fold increased risk of malignancy in general among transplantation recipients who were treated with infliximab or adalimumab, compared with those who received nonbiologic therapy (JAMA 2006;295:2275-85).

Findings from studies in patients taking biologic agents for rheumatoid arthritis conflict, however.

An observational study using the Swedish inpatient registry found cancer risks "largely similar" between 4,160 patients treated with a tumor necrosis factor (TNF) antagonist, compared with 53,067 other rheumatoid arthritis patients not treated with such an agent (Ann. Rheum. Dis. 2005;64:1421-6).

To address this discrepancy, Dr. Wolfe and Dr. Michaud studied 13,001 rheumatoid arthritis patients who were included in the National Data Bank for Rheumatic Diseases.

In an assessment of the national rheumatoid arthritis database sample only, risk of melanoma (odds ratio, 2.3) and nonmelanotic skin cancer (OR, 1.5) increased among those ever treated with a biologic, compared with the others.

These associations were consistent across the different agents in the biologics class. A total of 4,277 patients (33%) received infliximab; 3,011 received etanercept (23%); 763 received adalimumab (6%); and 319 received anakinra (3%) in the study.

Cancer incidence was based on self-reports from semiannual questionnaires.

Researchers compared their specific cancer rates with a comparison population from the Surveillance, Epidemiology, and End Results (SEER) database.

The overall cancer rate did not differ between rheumatoid arthritis patients and SEER database participants (standardized incidence ratio [SIR] = 1.0). "This result is substantially different from the OR of 3.3 noted by Bongartz et al. [above] in their meta-analysis of clinical trials," the authors wrote.

The mean duration of any type of biologic therapy was 3 years, which the authors of the current study cited as a possible limitation. However, Dr. Wolfe and Dr. Michaud wrote, "true associations are usually seen within this time frame, since post-transplantation studies have shown increased risk after the first year of treatment."

Melanoma (SIR, 1.7) and lymphoma (SIR, 1.7) occurred more often in the rheumatoid arthritis database versus the SEER database participants. Rates of lung cancer and bladder cancer were not statistically different between groups. Some cancer rates were lower among rheumatoid arthritis patients, including breast cancer (SIR, 0.8) and colon cancer (SIR, 0.5), compared with the comparison group.

"In summary, biologic therapy is associated with increased risk for skin cancers, but not for solid tumors or lymphoproliferative malignancies."

During the period when these data were collected, the National Data Bank for Rheumatic Diseases received funding from Abbott, Amgen, Bristol-Myers Squibb, Centocor, Merck, Pfizer, and Wyeth-Australia. Centocor reviewed the completed manuscript.

Biologic treatment of rheumatoid arthritis patients has spurred an increase in melanoma and other skin cancers but not malignancies other than those of the skin, according to an observational study of 13,001 patients, reported Dr. Frederick Wolfe, a rheumatologist at the National Data Bank for Rheumatic Diseases, and the University of Kansas, Wichita, and his colleague, Kaleb Michaud, Ph.D., of the University of Nebraska, Omaha

Extrapolating from previous data in immunosuppressed transplantation patients, some have theorized that immunosuppression from biologics would increase the risk of cancer database (Arthr. Rheum. 2007;56:2886-95).

The hypothesis gained some credence when a meta-analysis found a 3.3-fold increased risk of malignancy in general among transplantation recipients who were treated with infliximab or adalimumab, compared with those who received nonbiologic therapy (JAMA 2006;295:2275-85).

Findings from studies in patients taking biologic agents for rheumatoid arthritis conflict, however.

An observational study using the Swedish inpatient registry found cancer risks "largely similar" between 4,160 patients treated with a tumor necrosis factor (TNF) antagonist, compared with 53,067 other rheumatoid arthritis patients not treated with such an agent (Ann. Rheum. Dis. 2005;64:1421-6).

To address this discrepancy, Dr. Wolfe and Dr. Michaud studied 13,001 rheumatoid arthritis patients who were included in the National Data Bank for Rheumatic Diseases.

In an assessment of the national rheumatoid arthritis database sample only, risk of melanoma (odds ratio, 2.3) and nonmelanotic skin cancer (OR, 1.5) increased among those ever treated with a biologic, compared with the others.

These associations were consistent across the different agents in the biologics class. A total of 4,277 patients (33%) received infliximab; 3,011 received etanercept (23%); 763 received adalimumab (6%); and 319 received anakinra (3%) in the study.

Cancer incidence was based on self-reports from semiannual questionnaires.

Researchers compared their specific cancer rates with a comparison population from the Surveillance, Epidemiology, and End Results (SEER) database.

The overall cancer rate did not differ between rheumatoid arthritis patients and SEER database participants (standardized incidence ratio [SIR] = 1.0). "This result is substantially different from the OR of 3.3 noted by Bongartz et al. [above] in their meta-analysis of clinical trials," the authors wrote.

The mean duration of any type of biologic therapy was 3 years, which the authors of the current study cited as a possible limitation. However, Dr. Wolfe and Dr. Michaud wrote, "true associations are usually seen within this time frame, since post-transplantation studies have shown increased risk after the first year of treatment."

Melanoma (SIR, 1.7) and lymphoma (SIR, 1.7) occurred more often in the rheumatoid arthritis database versus the SEER database participants. Rates of lung cancer and bladder cancer were not statistically different between groups. Some cancer rates were lower among rheumatoid arthritis patients, including breast cancer (SIR, 0.8) and colon cancer (SIR, 0.5), compared with the comparison group.

"In summary, biologic therapy is associated with increased risk for skin cancers, but not for solid tumors or lymphoproliferative malignancies."

During the period when these data were collected, the National Data Bank for Rheumatic Diseases received funding from Abbott, Amgen, Bristol-Myers Squibb, Centocor, Merck, Pfizer, and Wyeth-Australia. Centocor reviewed the completed manuscript.

Biologic treatment of rheumatoid arthritis patients has spurred an increase in melanoma and other skin cancers but not malignancies other than those of the skin, according to an observational study of 13,001 patients, reported Dr. Frederick Wolfe, a rheumatologist at the National Data Bank for Rheumatic Diseases, and the University of Kansas, Wichita, and his colleague, Kaleb Michaud, Ph.D., of the University of Nebraska, Omaha

Extrapolating from previous data in immunosuppressed transplantation patients, some have theorized that immunosuppression from biologics would increase the risk of cancer database (Arthr. Rheum. 2007;56:2886-95).

The hypothesis gained some credence when a meta-analysis found a 3.3-fold increased risk of malignancy in general among transplantation recipients who were treated with infliximab or adalimumab, compared with those who received nonbiologic therapy (JAMA 2006;295:2275-85).

Findings from studies in patients taking biologic agents for rheumatoid arthritis conflict, however.

An observational study using the Swedish inpatient registry found cancer risks "largely similar" between 4,160 patients treated with a tumor necrosis factor (TNF) antagonist, compared with 53,067 other rheumatoid arthritis patients not treated with such an agent (Ann. Rheum. Dis. 2005;64:1421-6).

To address this discrepancy, Dr. Wolfe and Dr. Michaud studied 13,001 rheumatoid arthritis patients who were included in the National Data Bank for Rheumatic Diseases.

In an assessment of the national rheumatoid arthritis database sample only, risk of melanoma (odds ratio, 2.3) and nonmelanotic skin cancer (OR, 1.5) increased among those ever treated with a biologic, compared with the others.

These associations were consistent across the different agents in the biologics class. A total of 4,277 patients (33%) received infliximab; 3,011 received etanercept (23%); 763 received adalimumab (6%); and 319 received anakinra (3%) in the study.

Cancer incidence was based on self-reports from semiannual questionnaires.

Researchers compared their specific cancer rates with a comparison population from the Surveillance, Epidemiology, and End Results (SEER) database.

The overall cancer rate did not differ between rheumatoid arthritis patients and SEER database participants (standardized incidence ratio [SIR] = 1.0). "This result is substantially different from the OR of 3.3 noted by Bongartz et al. [above] in their meta-analysis of clinical trials," the authors wrote.

The mean duration of any type of biologic therapy was 3 years, which the authors of the current study cited as a possible limitation. However, Dr. Wolfe and Dr. Michaud wrote, "true associations are usually seen within this time frame, since post-transplantation studies have shown increased risk after the first year of treatment."

Melanoma (SIR, 1.7) and lymphoma (SIR, 1.7) occurred more often in the rheumatoid arthritis database versus the SEER database participants. Rates of lung cancer and bladder cancer were not statistically different between groups. Some cancer rates were lower among rheumatoid arthritis patients, including breast cancer (SIR, 0.8) and colon cancer (SIR, 0.5), compared with the comparison group.

"In summary, biologic therapy is associated with increased risk for skin cancers, but not for solid tumors or lymphoproliferative malignancies."

During the period when these data were collected, the National Data Bank for Rheumatic Diseases received funding from Abbott, Amgen, Bristol-Myers Squibb, Centocor, Merck, Pfizer, and Wyeth-Australia. Centocor reviewed the completed manuscript.

MIAMI — Laser treatment improved dermatosis papulosa nigra with efficacy comparable to standard electrodesiccation, according to rater assessments in a randomized, split-face pilot study of skin types IV-VI.

Subjective ratings, however, revealed a trend toward better efficacy with the laser treatment (Aura KTP [potassium titanyl phosphate], Laserscope) after 8 weeks, Dr. Roopal V. Kundu said at an international symposium sponsored by the L'Oréal Institute for Ethnic Hair and Skin Research.

"Both treatment modalities were quite efficacious; however, the KTP laser was probably preferable for patient comfort and tolerability," she said.

Dermatosis papulosa nigra (DPN) are superficial and hyperpigmented papules that occur on the head and neck of patients with darker skin. They tend to grow in size over time and do not resolve. Although benign, "they are cosmetically displeasing and psychologically distressing to many of our patients," said Dr. Kundu, who is with the department of dermatology at Northwestern University, Chicago, and has no financial disclosure regarding the KTP laser.

"The important point for dermatologists is we have a wonderful opportunity to educate patients with DPNs. Tell them they are not moles, that they are benign and have no malignant potential," she said.

Conventional treatment includes cryotherapy, snip excision, curettage, or electrodesiccation of each lesion. These approaches, however, increase the risk of pain and hypopigmentation, especially in darker skin.

All 14 participants were adults with clinically diagnosed DPN and skin types IV-VI. There were 11 women and 3 men with a mean age of 52 years. At baseline and 4 weeks, each received electrodesiccation to half of their face and KTP laser treatment to the other half. The laser was set to 15 J/cm2, 5 pulses per second repetition, and a 1-cm spot size.

A dermatologist blinded to the regimen rated left- and right-side photographs at week 8. Efficacy was rated as a score of 1-4, with each number representing a 25% clinical improvement over baseline. About 60% of photographs demonstrated a 75%-100% improvement, so the raters found no statistically significant difference between treatments.

"There was a notable improvement for both KTP laser treatment and electrodesiccation at week 8," Dr. Kundu said at the meeting, which was also sponsored by Howard University.

Participants were asked to report adverse events, treatment satisfaction, and cosmetic outcome up to week 8. They used a 1-5 rating scale, with 1 representing "not at all" and 5 "very much." There was a trend toward KTP laser treatment being more effective than electrodesiccation. In addition, there was significantly "less pain and discomfort with the KTP laser," Dr. Kundu said.

MIAMI — Laser treatment improved dermatosis papulosa nigra with efficacy comparable to standard electrodesiccation, according to rater assessments in a randomized, split-face pilot study of skin types IV-VI.

Subjective ratings, however, revealed a trend toward better efficacy with the laser treatment (Aura KTP [potassium titanyl phosphate], Laserscope) after 8 weeks, Dr. Roopal V. Kundu said at an international symposium sponsored by the L'Oréal Institute for Ethnic Hair and Skin Research.

"Both treatment modalities were quite efficacious; however, the KTP laser was probably preferable for patient comfort and tolerability," she said.

Dermatosis papulosa nigra (DPN) are superficial and hyperpigmented papules that occur on the head and neck of patients with darker skin. They tend to grow in size over time and do not resolve. Although benign, "they are cosmetically displeasing and psychologically distressing to many of our patients," said Dr. Kundu, who is with the department of dermatology at Northwestern University, Chicago, and has no financial disclosure regarding the KTP laser.

"The important point for dermatologists is we have a wonderful opportunity to educate patients with DPNs. Tell them they are not moles, that they are benign and have no malignant potential," she said.

Conventional treatment includes cryotherapy, snip excision, curettage, or electrodesiccation of each lesion. These approaches, however, increase the risk of pain and hypopigmentation, especially in darker skin.

All 14 participants were adults with clinically diagnosed DPN and skin types IV-VI. There were 11 women and 3 men with a mean age of 52 years. At baseline and 4 weeks, each received electrodesiccation to half of their face and KTP laser treatment to the other half. The laser was set to 15 J/cm2, 5 pulses per second repetition, and a 1-cm spot size.

A dermatologist blinded to the regimen rated left- and right-side photographs at week 8. Efficacy was rated as a score of 1-4, with each number representing a 25% clinical improvement over baseline. About 60% of photographs demonstrated a 75%-100% improvement, so the raters found no statistically significant difference between treatments.

"There was a notable improvement for both KTP laser treatment and electrodesiccation at week 8," Dr. Kundu said at the meeting, which was also sponsored by Howard University.

Participants were asked to report adverse events, treatment satisfaction, and cosmetic outcome up to week 8. They used a 1-5 rating scale, with 1 representing "not at all" and 5 "very much." There was a trend toward KTP laser treatment being more effective than electrodesiccation. In addition, there was significantly "less pain and discomfort with the KTP laser," Dr. Kundu said.

MIAMI — Laser treatment improved dermatosis papulosa nigra with efficacy comparable to standard electrodesiccation, according to rater assessments in a randomized, split-face pilot study of skin types IV-VI.

Subjective ratings, however, revealed a trend toward better efficacy with the laser treatment (Aura KTP [potassium titanyl phosphate], Laserscope) after 8 weeks, Dr. Roopal V. Kundu said at an international symposium sponsored by the L'Oréal Institute for Ethnic Hair and Skin Research.

"Both treatment modalities were quite efficacious; however, the KTP laser was probably preferable for patient comfort and tolerability," she said.

Dermatosis papulosa nigra (DPN) are superficial and hyperpigmented papules that occur on the head and neck of patients with darker skin. They tend to grow in size over time and do not resolve. Although benign, "they are cosmetically displeasing and psychologically distressing to many of our patients," said Dr. Kundu, who is with the department of dermatology at Northwestern University, Chicago, and has no financial disclosure regarding the KTP laser.

"The important point for dermatologists is we have a wonderful opportunity to educate patients with DPNs. Tell them they are not moles, that they are benign and have no malignant potential," she said.

Conventional treatment includes cryotherapy, snip excision, curettage, or electrodesiccation of each lesion. These approaches, however, increase the risk of pain and hypopigmentation, especially in darker skin.

All 14 participants were adults with clinically diagnosed DPN and skin types IV-VI. There were 11 women and 3 men with a mean age of 52 years. At baseline and 4 weeks, each received electrodesiccation to half of their face and KTP laser treatment to the other half. The laser was set to 15 J/cm2, 5 pulses per second repetition, and a 1-cm spot size.

A dermatologist blinded to the regimen rated left- and right-side photographs at week 8. Efficacy was rated as a score of 1-4, with each number representing a 25% clinical improvement over baseline. About 60% of photographs demonstrated a 75%-100% improvement, so the raters found no statistically significant difference between treatments.

"There was a notable improvement for both KTP laser treatment and electrodesiccation at week 8," Dr. Kundu said at the meeting, which was also sponsored by Howard University.

Participants were asked to report adverse events, treatment satisfaction, and cosmetic outcome up to week 8. They used a 1-5 rating scale, with 1 representing "not at all" and 5 "very much." There was a trend toward KTP laser treatment being more effective than electrodesiccation. In addition, there was significantly "less pain and discomfort with the KTP laser," Dr. Kundu said.

MIAMI — Nonablative fractional resurfacing with an erbium-doped 1,550-nm laser device can safely and effectively improve acne scarring among patients with skin types IV-VI, Dr. Wendy E. Roberts said at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research.

"Treatment of acne scars with ablative lasers in skin types IV-VI has been limited because of hypopigmentation and depigmentation risks," she said. This significant risk of hypopigmentation, in particular, has limited laser resurfacing for distensible and nondistensible acne scars in skin types other than I-III.

In search of better results, researchers assessed nonablative fractional photothermolysis in 40 patients with skin types IV through VI. Dr. Roberts presented the findings on behalf of the lead investigator, Dr. Vic A. Narurkar, a dermatologist in San Francisco who was unable to attend the meeting.

"This study was motivated by the fact that most laser and light-based technologies are risky in skin types IV-VI, especially for hypopigmentation. And if they are safe, they are generally ineffective," Dr. Narurkar said in a follow-up interview.

Dr. Narurkar and his associates, Dr. Joely Kaufman and Dr. Zakia Rahman, enrolled patients with moderate to severe acne scarring from three clinical sites. Presentations included distensible, nondistensible, ice pick, and box-type scars. Participants were treated with an erbium-doped 1,550-nm Fraxel laser (Reliant Technologies) at 4- to 6-week intervals.

"Resurfacing, particularly for acne scars, has, until the development of the Fraxel laser, not been a viable option for darker skin with traditional lasers," said Dr. Narurkar, who is a consultant for Reliant. Dr. Roberts reported no conflict of interest related to the company.

A nontreating physician scored photographs taken at baseline and at 6 months or longer after completion of the three to five treatment sessions. Every participant showed some improvement, so there were no patients classified as grade 0 (no improvement). Six percent were grade 1 (up to 25% improvement); 34% were grade 2 (26%-50%); 42% were grade 3 (51%-75%); and 18% were grade 4 (76% or greater).

"The majority of patients showed a 50% or greater improvement in acne scars," said Dr. Roberts, a dermatologist in Rancho Mirage, Calif., who also is with the department of medicine at Loma Linda (Calif.) University Medical Center.

Because of the risk of adverse events, use of nonablative fractional resurfacing can be more challenging for patients with ethnic skin. "You really have to not know what you are doing with this to cause any damage in skin types I-III. But it does get tricky in skin types IV-VI. If your laser settings are not conservative, you can get edema and postinflammatory hyperpigmentation," Dr. Roberts said at the meeting, which was also sponsored by Howard University.

In the study, 22% of patients experienced transient postinflammatory hyperpigmentation (PIH) and 28% had acne flares. "We can work through the flares and treat the PIH," Dr. Roberts said. "There was no hypopigmentation, which is quite remarkable."

"We were most impressed with the fact that there were no permanent adverse effects, and even the postinflammatory hyperpigmentation eventually resolved," Dr. Narurkar said. "Future studies include the use of pre- and posttreatment regimens for Fraxel to speed up the recovery and reduce both PIH and acne flares."

A patient is shown at baseline (left) and after undergoing five treatments with an erbium-doped 1,550-nm laser. Photos courtesy Dr. Zakia Rahman

MIAMI — Nonablative fractional resurfacing with an erbium-doped 1,550-nm laser device can safely and effectively improve acne scarring among patients with skin types IV-VI, Dr. Wendy E. Roberts said at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research.

"Treatment of acne scars with ablative lasers in skin types IV-VI has been limited because of hypopigmentation and depigmentation risks," she said. This significant risk of hypopigmentation, in particular, has limited laser resurfacing for distensible and nondistensible acne scars in skin types other than I-III.

In search of better results, researchers assessed nonablative fractional photothermolysis in 40 patients with skin types IV through VI. Dr. Roberts presented the findings on behalf of the lead investigator, Dr. Vic A. Narurkar, a dermatologist in San Francisco who was unable to attend the meeting.

"This study was motivated by the fact that most laser and light-based technologies are risky in skin types IV-VI, especially for hypopigmentation. And if they are safe, they are generally ineffective," Dr. Narurkar said in a follow-up interview.

Dr. Narurkar and his associates, Dr. Joely Kaufman and Dr. Zakia Rahman, enrolled patients with moderate to severe acne scarring from three clinical sites. Presentations included distensible, nondistensible, ice pick, and box-type scars. Participants were treated with an erbium-doped 1,550-nm Fraxel laser (Reliant Technologies) at 4- to 6-week intervals.

"Resurfacing, particularly for acne scars, has, until the development of the Fraxel laser, not been a viable option for darker skin with traditional lasers," said Dr. Narurkar, who is a consultant for Reliant. Dr. Roberts reported no conflict of interest related to the company.

A nontreating physician scored photographs taken at baseline and at 6 months or longer after completion of the three to five treatment sessions. Every participant showed some improvement, so there were no patients classified as grade 0 (no improvement). Six percent were grade 1 (up to 25% improvement); 34% were grade 2 (26%-50%); 42% were grade 3 (51%-75%); and 18% were grade 4 (76% or greater).

"The majority of patients showed a 50% or greater improvement in acne scars," said Dr. Roberts, a dermatologist in Rancho Mirage, Calif., who also is with the department of medicine at Loma Linda (Calif.) University Medical Center.

Because of the risk of adverse events, use of nonablative fractional resurfacing can be more challenging for patients with ethnic skin. "You really have to not know what you are doing with this to cause any damage in skin types I-III. But it does get tricky in skin types IV-VI. If your laser settings are not conservative, you can get edema and postinflammatory hyperpigmentation," Dr. Roberts said at the meeting, which was also sponsored by Howard University.

In the study, 22% of patients experienced transient postinflammatory hyperpigmentation (PIH) and 28% had acne flares. "We can work through the flares and treat the PIH," Dr. Roberts said. "There was no hypopigmentation, which is quite remarkable."

"We were most impressed with the fact that there were no permanent adverse effects, and even the postinflammatory hyperpigmentation eventually resolved," Dr. Narurkar said. "Future studies include the use of pre- and posttreatment regimens for Fraxel to speed up the recovery and reduce both PIH and acne flares."

A patient is shown at baseline (left) and after undergoing five treatments with an erbium-doped 1,550-nm laser. Photos courtesy Dr. Zakia Rahman

MIAMI — Nonablative fractional resurfacing with an erbium-doped 1,550-nm laser device can safely and effectively improve acne scarring among patients with skin types IV-VI, Dr. Wendy E. Roberts said at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research.

"Treatment of acne scars with ablative lasers in skin types IV-VI has been limited because of hypopigmentation and depigmentation risks," she said. This significant risk of hypopigmentation, in particular, has limited laser resurfacing for distensible and nondistensible acne scars in skin types other than I-III.

In search of better results, researchers assessed nonablative fractional photothermolysis in 40 patients with skin types IV through VI. Dr. Roberts presented the findings on behalf of the lead investigator, Dr. Vic A. Narurkar, a dermatologist in San Francisco who was unable to attend the meeting.

"This study was motivated by the fact that most laser and light-based technologies are risky in skin types IV-VI, especially for hypopigmentation. And if they are safe, they are generally ineffective," Dr. Narurkar said in a follow-up interview.

Dr. Narurkar and his associates, Dr. Joely Kaufman and Dr. Zakia Rahman, enrolled patients with moderate to severe acne scarring from three clinical sites. Presentations included distensible, nondistensible, ice pick, and box-type scars. Participants were treated with an erbium-doped 1,550-nm Fraxel laser (Reliant Technologies) at 4- to 6-week intervals.

"Resurfacing, particularly for acne scars, has, until the development of the Fraxel laser, not been a viable option for darker skin with traditional lasers," said Dr. Narurkar, who is a consultant for Reliant. Dr. Roberts reported no conflict of interest related to the company.

A nontreating physician scored photographs taken at baseline and at 6 months or longer after completion of the three to five treatment sessions. Every participant showed some improvement, so there were no patients classified as grade 0 (no improvement). Six percent were grade 1 (up to 25% improvement); 34% were grade 2 (26%-50%); 42% were grade 3 (51%-75%); and 18% were grade 4 (76% or greater).

"The majority of patients showed a 50% or greater improvement in acne scars," said Dr. Roberts, a dermatologist in Rancho Mirage, Calif., who also is with the department of medicine at Loma Linda (Calif.) University Medical Center.

Because of the risk of adverse events, use of nonablative fractional resurfacing can be more challenging for patients with ethnic skin. "You really have to not know what you are doing with this to cause any damage in skin types I-III. But it does get tricky in skin types IV-VI. If your laser settings are not conservative, you can get edema and postinflammatory hyperpigmentation," Dr. Roberts said at the meeting, which was also sponsored by Howard University.

In the study, 22% of patients experienced transient postinflammatory hyperpigmentation (PIH) and 28% had acne flares. "We can work through the flares and treat the PIH," Dr. Roberts said. "There was no hypopigmentation, which is quite remarkable."

"We were most impressed with the fact that there were no permanent adverse effects, and even the postinflammatory hyperpigmentation eventually resolved," Dr. Narurkar said. "Future studies include the use of pre- and posttreatment regimens for Fraxel to speed up the recovery and reduce both PIH and acne flares."

A patient is shown at baseline (left) and after undergoing five treatments with an erbium-doped 1,550-nm laser. Photos courtesy Dr. Zakia Rahman

HOLLYWOOD, FLA. — Reconstructive surgery for pelvic organ prolapse not only improves physical distress but can significantly improve a woman's body image and depressive symptoms, according to results of a prospective, case-control study.

“Body image can be used as an indicator of quality of life after reconstructive surgery,” said Dr. Jerry L. Lowder of the division of urogynecology and pelvic reconstructive surgery at the University of Pittsburgh Medical Center.

Body image is a neuropsychiatric construct, and dissatisfaction with body image is associated with anxiety and depression, he said. “Prolapse is a disfiguring disorder of the urogenital tract that is often hidden” but could still have negative effects on body image.

Dr. Lowder and his associates hypothesized that reconstructive surgery would improve body image scores. They enrolled 85 sexually active women over age 40 who were planning surgery to correct stage II or greater prolapse. A total of 57 participants had complete data at 6 months and were assessed further.

Participants had a variety of surgery types. “Surgical choice was not part of the design,” Dr. Lowder said at the annual meeting of the American Urogynecologic Society. A total of 42 of the 57 patients (74%) had sacral colpopexy; 7 (12%) had uterosacral suspension; 6 (11%) had total vaginal mesh placed; and 2 (3%) had posterior colporrhaphy.

The mean age of patients was 60 years, and mean body mass index was 28 kg/m

Prolapse stage significantly improved according to standard Pelvic Organ Prolapse Quantitative (POP-Q) examinations at baseline and at 6 months. Initial prolapse improved from an average stage III to stage I at 6 months.

The researchers assessed other effects of the surgery using questionnaires at baseline and follow-up.

For example, the women had a significant improvement on the Body Exposure in Sexual Activities Questionnaire (BESAQ), a 28-item “prolapse-specific body image proxy,” Dr. Lowder said. Scores range from 0 to 112, with a lower result representing a better body image. Mean scores changed from 41 at baseline to 34 at 6 months.

Patients also self-administered the Body Image Quality of Life Inventory (BIQLI), a 19-item general body image questionnaire. Results are expressed within a range of -3 to +3, with a higher score translating to a better body image. The scores went from a mean 0.9 at baseline to 1.2 at 6 months, which was not a significant difference.

There were, however, significant improvements in symptoms on both the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) by 6 months. The median PFDI score decreased from 282 at baseline to 45 at 6 months. The median PFIQ score improved from 212 at baseline to 22 at follow-up.

Significant improvements also were demonstrated with the Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ-12). Results went from a mean 32 at baseline to 35 at 6 months. Similarly, the median scores on the Patient Health Questionnaire (PHQ-9) improved from 3 at baseline to 2 at follow-up.

Reports of depressive symptoms improved as well following reconstructive surgery. Patients had a mean of 14 moderate to severe depressive symptoms preoperatively,” Dr. Lowder said. “There were a mean of five moderate to severe depressive symptoms postoperatively without a change in treatment.”

HOLLYWOOD, FLA. — Reconstructive surgery for pelvic organ prolapse not only improves physical distress but can significantly improve a woman's body image and depressive symptoms, according to results of a prospective, case-control study.

“Body image can be used as an indicator of quality of life after reconstructive surgery,” said Dr. Jerry L. Lowder of the division of urogynecology and pelvic reconstructive surgery at the University of Pittsburgh Medical Center.

Body image is a neuropsychiatric construct, and dissatisfaction with body image is associated with anxiety and depression, he said. “Prolapse is a disfiguring disorder of the urogenital tract that is often hidden” but could still have negative effects on body image.

Dr. Lowder and his associates hypothesized that reconstructive surgery would improve body image scores. They enrolled 85 sexually active women over age 40 who were planning surgery to correct stage II or greater prolapse. A total of 57 participants had complete data at 6 months and were assessed further.

Participants had a variety of surgery types. “Surgical choice was not part of the design,” Dr. Lowder said at the annual meeting of the American Urogynecologic Society. A total of 42 of the 57 patients (74%) had sacral colpopexy; 7 (12%) had uterosacral suspension; 6 (11%) had total vaginal mesh placed; and 2 (3%) had posterior colporrhaphy.

The mean age of patients was 60 years, and mean body mass index was 28 kg/m

Prolapse stage significantly improved according to standard Pelvic Organ Prolapse Quantitative (POP-Q) examinations at baseline and at 6 months. Initial prolapse improved from an average stage III to stage I at 6 months.

The researchers assessed other effects of the surgery using questionnaires at baseline and follow-up.

For example, the women had a significant improvement on the Body Exposure in Sexual Activities Questionnaire (BESAQ), a 28-item “prolapse-specific body image proxy,” Dr. Lowder said. Scores range from 0 to 112, with a lower result representing a better body image. Mean scores changed from 41 at baseline to 34 at 6 months.

Patients also self-administered the Body Image Quality of Life Inventory (BIQLI), a 19-item general body image questionnaire. Results are expressed within a range of -3 to +3, with a higher score translating to a better body image. The scores went from a mean 0.9 at baseline to 1.2 at 6 months, which was not a significant difference.

There were, however, significant improvements in symptoms on both the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) by 6 months. The median PFDI score decreased from 282 at baseline to 45 at 6 months. The median PFIQ score improved from 212 at baseline to 22 at follow-up.

Significant improvements also were demonstrated with the Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ-12). Results went from a mean 32 at baseline to 35 at 6 months. Similarly, the median scores on the Patient Health Questionnaire (PHQ-9) improved from 3 at baseline to 2 at follow-up.

Reports of depressive symptoms improved as well following reconstructive surgery. Patients had a mean of 14 moderate to severe depressive symptoms preoperatively,” Dr. Lowder said. “There were a mean of five moderate to severe depressive symptoms postoperatively without a change in treatment.”

HOLLYWOOD, FLA. — Reconstructive surgery for pelvic organ prolapse not only improves physical distress but can significantly improve a woman's body image and depressive symptoms, according to results of a prospective, case-control study.

“Body image can be used as an indicator of quality of life after reconstructive surgery,” said Dr. Jerry L. Lowder of the division of urogynecology and pelvic reconstructive surgery at the University of Pittsburgh Medical Center.

Body image is a neuropsychiatric construct, and dissatisfaction with body image is associated with anxiety and depression, he said. “Prolapse is a disfiguring disorder of the urogenital tract that is often hidden” but could still have negative effects on body image.

Dr. Lowder and his associates hypothesized that reconstructive surgery would improve body image scores. They enrolled 85 sexually active women over age 40 who were planning surgery to correct stage II or greater prolapse. A total of 57 participants had complete data at 6 months and were assessed further.

Participants had a variety of surgery types. “Surgical choice was not part of the design,” Dr. Lowder said at the annual meeting of the American Urogynecologic Society. A total of 42 of the 57 patients (74%) had sacral colpopexy; 7 (12%) had uterosacral suspension; 6 (11%) had total vaginal mesh placed; and 2 (3%) had posterior colporrhaphy.

The mean age of patients was 60 years, and mean body mass index was 28 kg/m

Prolapse stage significantly improved according to standard Pelvic Organ Prolapse Quantitative (POP-Q) examinations at baseline and at 6 months. Initial prolapse improved from an average stage III to stage I at 6 months.

The researchers assessed other effects of the surgery using questionnaires at baseline and follow-up.

For example, the women had a significant improvement on the Body Exposure in Sexual Activities Questionnaire (BESAQ), a 28-item “prolapse-specific body image proxy,” Dr. Lowder said. Scores range from 0 to 112, with a lower result representing a better body image. Mean scores changed from 41 at baseline to 34 at 6 months.

Patients also self-administered the Body Image Quality of Life Inventory (BIQLI), a 19-item general body image questionnaire. Results are expressed within a range of -3 to +3, with a higher score translating to a better body image. The scores went from a mean 0.9 at baseline to 1.2 at 6 months, which was not a significant difference.

There were, however, significant improvements in symptoms on both the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) by 6 months. The median PFDI score decreased from 282 at baseline to 45 at 6 months. The median PFIQ score improved from 212 at baseline to 22 at follow-up.

Significant improvements also were demonstrated with the Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ-12). Results went from a mean 32 at baseline to 35 at 6 months. Similarly, the median scores on the Patient Health Questionnaire (PHQ-9) improved from 3 at baseline to 2 at follow-up.

Reports of depressive symptoms improved as well following reconstructive surgery. Patients had a mean of 14 moderate to severe depressive symptoms preoperatively,” Dr. Lowder said. “There were a mean of five moderate to severe depressive symptoms postoperatively without a change in treatment.”

HOLLYWOOD, FLA. — Although most primary care physicians recognize the importance of diagnosis and treatment of urinary incontinence, routine screening is not always done, according to survey results presented at the annual meeting of the American Urogynecologic Society.

Although “98% of primary care physicians consider screening somewhat or very important, only 60% screen their patients all [or most] of the time,” Dr. Gunhilde M. Buchsbaum said.

Dr. Buchsbaum and her associates mailed a survey to 1,466 primary care physicians practicing in Monroe County, New York state, to determine perceptions and practices regarding urinary incontinence screening. Of the 554 responses, 43% were from internists, 28% from family physicians, 23% from obstetricians and gynecologists, and 6% from geriatricians. The majority of the respondents (65%) were 35–54 years old; 61% were men, and 83% were white. A total of 58% were in private practice.

“We asked about their overall perception of the importance of urinary incontinence screening,” said Dr. Buchsbaum, director of urogynecology and reconstructive pelvic surgery at the University of Rochester (N.Y.) Medical Center.

A total of 42% felt that such screening was “very important,” and another 56% replied it was “somewhat important.” Broken down by specialty, the following perceived screening as “very important”: 63% of geriatricians, 58% of ob.gyns., 43% of internists, and 30% of family physicians.

The researchers asked how routinely these primary care physicians screen for urinary incontinence. A total of 18% replied “always,” 42% said “most of the time,” 26% replied “occasionally,” and 14% indicated they “rarely or never” screen their patients.

The propensity to screen varied by specialty as well, with ob.gyns. and geriatricians more likely to report screening all or most of the time, compared with internists and family physicians.

Among physicians not routinely screening, time constraints were cited by 38% as the primary reason. Another 27% cited reimbursement concerns, 23% pointed to a lack of support staff, and 12% indicated they would not know what to do about a positive result, Dr. Buchsbaum said.

Physician comfort with diagnosis of urinary incontinence and use of conservative management were associated with higher screening rates, she said. Ob.gyns. and geriatricians more often said they were “very comfortable” or “somewhat comfortable” with diagnosis, compared with internists and family physicians.

Physicians were asked about additional education regarding urinary incontinence. Overall, 75% indicated they wanted to learn more, particularly those younger than 35 years and those who had been in practice for less than 10 years. “Although many are interested in learning more about urinary incontinence, only 35% feel it [screening] will alter their practice,” Dr. Buchsbaum said.

Based on these findings, the researchers suggested that continuing medical education programs on urinary incontinence for primary care physicians be targeted in particular at younger and less-experienced physicians.

HOLLYWOOD, FLA. — Although most primary care physicians recognize the importance of diagnosis and treatment of urinary incontinence, routine screening is not always done, according to survey results presented at the annual meeting of the American Urogynecologic Society.

Although “98% of primary care physicians consider screening somewhat or very important, only 60% screen their patients all [or most] of the time,” Dr. Gunhilde M. Buchsbaum said.

Dr. Buchsbaum and her associates mailed a survey to 1,466 primary care physicians practicing in Monroe County, New York state, to determine perceptions and practices regarding urinary incontinence screening. Of the 554 responses, 43% were from internists, 28% from family physicians, 23% from obstetricians and gynecologists, and 6% from geriatricians. The majority of the respondents (65%) were 35–54 years old; 61% were men, and 83% were white. A total of 58% were in private practice.

“We asked about their overall perception of the importance of urinary incontinence screening,” said Dr. Buchsbaum, director of urogynecology and reconstructive pelvic surgery at the University of Rochester (N.Y.) Medical Center.

A total of 42% felt that such screening was “very important,” and another 56% replied it was “somewhat important.” Broken down by specialty, the following perceived screening as “very important”: 63% of geriatricians, 58% of ob.gyns., 43% of internists, and 30% of family physicians.

The researchers asked how routinely these primary care physicians screen for urinary incontinence. A total of 18% replied “always,” 42% said “most of the time,” 26% replied “occasionally,” and 14% indicated they “rarely or never” screen their patients.

The propensity to screen varied by specialty as well, with ob.gyns. and geriatricians more likely to report screening all or most of the time, compared with internists and family physicians.

Among physicians not routinely screening, time constraints were cited by 38% as the primary reason. Another 27% cited reimbursement concerns, 23% pointed to a lack of support staff, and 12% indicated they would not know what to do about a positive result, Dr. Buchsbaum said.

Physician comfort with diagnosis of urinary incontinence and use of conservative management were associated with higher screening rates, she said. Ob.gyns. and geriatricians more often said they were “very comfortable” or “somewhat comfortable” with diagnosis, compared with internists and family physicians.

Physicians were asked about additional education regarding urinary incontinence. Overall, 75% indicated they wanted to learn more, particularly those younger than 35 years and those who had been in practice for less than 10 years. “Although many are interested in learning more about urinary incontinence, only 35% feel it [screening] will alter their practice,” Dr. Buchsbaum said.

Based on these findings, the researchers suggested that continuing medical education programs on urinary incontinence for primary care physicians be targeted in particular at younger and less-experienced physicians.

HOLLYWOOD, FLA. — Although most primary care physicians recognize the importance of diagnosis and treatment of urinary incontinence, routine screening is not always done, according to survey results presented at the annual meeting of the American Urogynecologic Society.

Although “98% of primary care physicians consider screening somewhat or very important, only 60% screen their patients all [or most] of the time,” Dr. Gunhilde M. Buchsbaum said.

Dr. Buchsbaum and her associates mailed a survey to 1,466 primary care physicians practicing in Monroe County, New York state, to determine perceptions and practices regarding urinary incontinence screening. Of the 554 responses, 43% were from internists, 28% from family physicians, 23% from obstetricians and gynecologists, and 6% from geriatricians. The majority of the respondents (65%) were 35–54 years old; 61% were men, and 83% were white. A total of 58% were in private practice.

“We asked about their overall perception of the importance of urinary incontinence screening,” said Dr. Buchsbaum, director of urogynecology and reconstructive pelvic surgery at the University of Rochester (N.Y.) Medical Center.

A total of 42% felt that such screening was “very important,” and another 56% replied it was “somewhat important.” Broken down by specialty, the following perceived screening as “very important”: 63% of geriatricians, 58% of ob.gyns., 43% of internists, and 30% of family physicians.

The researchers asked how routinely these primary care physicians screen for urinary incontinence. A total of 18% replied “always,” 42% said “most of the time,” 26% replied “occasionally,” and 14% indicated they “rarely or never” screen their patients.

The propensity to screen varied by specialty as well, with ob.gyns. and geriatricians more likely to report screening all or most of the time, compared with internists and family physicians.

Among physicians not routinely screening, time constraints were cited by 38% as the primary reason. Another 27% cited reimbursement concerns, 23% pointed to a lack of support staff, and 12% indicated they would not know what to do about a positive result, Dr. Buchsbaum said.

Physician comfort with diagnosis of urinary incontinence and use of conservative management were associated with higher screening rates, she said. Ob.gyns. and geriatricians more often said they were “very comfortable” or “somewhat comfortable” with diagnosis, compared with internists and family physicians.

Physicians were asked about additional education regarding urinary incontinence. Overall, 75% indicated they wanted to learn more, particularly those younger than 35 years and those who had been in practice for less than 10 years. “Although many are interested in learning more about urinary incontinence, only 35% feel it [screening] will alter their practice,” Dr. Buchsbaum said.

Based on these findings, the researchers suggested that continuing medical education programs on urinary incontinence for primary care physicians be targeted in particular at younger and less-experienced physicians.

MIAMI BEACH – Inadequate informed consent places physicians prescribing lamotrigine at increased risk of malpractice liability, Dr. Neelam Varshney suggested.

Given that, it is important to inform patients about the risk of a rare but life-threatening rash that can develop with lamotrigine, Dr. Varshney said in a poster presented at the annual meeting of the American Academy of Psychiatry and the Law.

In an interview, Dr. Varshney pointed out that although such cases are rare, these rashes can progress to Stevens-Johnson syndrome or to toxic epidermal necrolysis.

Severe rashes can result in hospitalization, permanent disability, or even death. “That is why it is so important to give adequate informed consent,” said Dr. Varshney, a resident in the department of psychiatry at Elmhurst (N.Y.) Hospital.

It is a good idea to have solid therapeutic rapport for explaining everything to the patient, including risks and benefits. Also, it is important to remind patients of the risk throughout treatment. “Informed consent is not just given on the first visit,” she said.

Some physicians have suggested showing pictures of the rash to patients, but Dr. Varshney said she thinks doing this is unnecessary.

When prescribed as adjunctive therapy for epilepsy, the incidence of severe rash is about 0.8% among patients younger than 16 years and 0.3% among adults, according to a black box warning on the product's label. In clinical trials of adults with bipolar and other mood disorders, the rate of serious rash was 0.08% with monotherapy and 0.13% when used as adjunctive therapy.

MIAMI BEACH – Inadequate informed consent places physicians prescribing lamotrigine at increased risk of malpractice liability, Dr. Neelam Varshney suggested.

Given that, it is important to inform patients about the risk of a rare but life-threatening rash that can develop with lamotrigine, Dr. Varshney said in a poster presented at the annual meeting of the American Academy of Psychiatry and the Law.

In an interview, Dr. Varshney pointed out that although such cases are rare, these rashes can progress to Stevens-Johnson syndrome or to toxic epidermal necrolysis.

Severe rashes can result in hospitalization, permanent disability, or even death. “That is why it is so important to give adequate informed consent,” said Dr. Varshney, a resident in the department of psychiatry at Elmhurst (N.Y.) Hospital.

It is a good idea to have solid therapeutic rapport for explaining everything to the patient, including risks and benefits. Also, it is important to remind patients of the risk throughout treatment. “Informed consent is not just given on the first visit,” she said.

Some physicians have suggested showing pictures of the rash to patients, but Dr. Varshney said she thinks doing this is unnecessary.

When prescribed as adjunctive therapy for epilepsy, the incidence of severe rash is about 0.8% among patients younger than 16 years and 0.3% among adults, according to a black box warning on the product's label. In clinical trials of adults with bipolar and other mood disorders, the rate of serious rash was 0.08% with monotherapy and 0.13% when used as adjunctive therapy.

MIAMI BEACH – Inadequate informed consent places physicians prescribing lamotrigine at increased risk of malpractice liability, Dr. Neelam Varshney suggested.

Given that, it is important to inform patients about the risk of a rare but life-threatening rash that can develop with lamotrigine, Dr. Varshney said in a poster presented at the annual meeting of the American Academy of Psychiatry and the Law.

In an interview, Dr. Varshney pointed out that although such cases are rare, these rashes can progress to Stevens-Johnson syndrome or to toxic epidermal necrolysis.

Severe rashes can result in hospitalization, permanent disability, or even death. “That is why it is so important to give adequate informed consent,” said Dr. Varshney, a resident in the department of psychiatry at Elmhurst (N.Y.) Hospital.

It is a good idea to have solid therapeutic rapport for explaining everything to the patient, including risks and benefits. Also, it is important to remind patients of the risk throughout treatment. “Informed consent is not just given on the first visit,” she said.

Some physicians have suggested showing pictures of the rash to patients, but Dr. Varshney said she thinks doing this is unnecessary.

When prescribed as adjunctive therapy for epilepsy, the incidence of severe rash is about 0.8% among patients younger than 16 years and 0.3% among adults, according to a black box warning on the product's label. In clinical trials of adults with bipolar and other mood disorders, the rate of serious rash was 0.08% with monotherapy and 0.13% when used as adjunctive therapy.

BIRMINGHAM, ENGLAND – Metabolic changes in the basal ganglia that can be detected with magnetic resonance spectroscopy may precede irreversible changes from neuropsychiatric lupus, according to a pilot study.

“Why look at basal ganglia? They are highly prone to hypoxic damage and have recently been linked with the frontal lobe regarding cognitive function,” Dr. Pamela L. Peterson said at the annual meeting of the British Society for Rheumatology. In Parkinson disease “and other diseases, there is increasing recognition of the role of basal ganglia.”

There are at least four circuits that link the basal ganglia to the cerebral cortex. Although less common, movement disorders are a well-accepted complication of neuropsychiatric systemic lupus erythematosus (NPSLE) and may be mediated by the basal ganglia, said Dr. Peterson, a rheumatology fellow at St. George's Hospital, London.

Clinicians more commonly order MRI scans to detect abnormalities in the periventricular region and subcortical white matter of patients with NPSLE. However, magnetic resonance spectroscopy of the basal ganglia might prove to be useful for earlier clinical intervention,

“Magnetic resonance spectroscopy is noninvasive, cheap, and easily added to an MRI protocol,” Dr. Peterson said.

Preliminary findings of the study are based on 24 patients who have NPSLE, 8 patients with active lupus but without neurologic symptoms, and 4 healthy controls. Participants are recruited for the ongoing study from St. George's University of London; St. Thomas' Hospital, London; and University College London. The age range is 17–54 years.

Blood tests indicated absolute concentrations of N-acetylaspartate (NAA), choline, creatine, and myoinositol. The metabolite NAA is a marker for neuronal loss or dysfunction, Dr. Peterson said. Study participants had a combination of MRI, magnetic resonance spectroscopy, and diffusion tensor imaging, as well as an interview, clinical assessment, and psychometric testing.

The researchers found a statistically significant correlation between decreases in NAA in the basal ganglia and frontal white matter. Also, levels were significantly lower in these regions, compared with healthy controls. “There was a step-wise deterioration in NAA with worsening neurologic effects,” Dr. Peterson said.

Participants with non-neuropsychiatric lupus also had decreases in the metabolite, but the reductions were not significantly different, compared with controls.

“This correlation may simply indicate a global reduction of NAA in patients with NPSLE or it may reflect abnormalities in the circuits connecting the frontal white matter with the basal ganglia,” the researchers noted. NPSLE may alter the cortical striatal fibers that connect basal ganglia and frontal lobe, Dr. Peterson added.

Although the pilot data from the study included only magnetic resonance spectroscopy findings, Dr. Peterson said changes in myoinositol in these two regions also appear to be correlated. In addition, initial psychometry results suggest “a possible relationship between NAA reduction in the basal ganglia and processing speed.”

“My results are tentative. This is a small data set,” Dr. Peterson said. “We want bigger numbers in the future.”

BIRMINGHAM, ENGLAND – Metabolic changes in the basal ganglia that can be detected with magnetic resonance spectroscopy may precede irreversible changes from neuropsychiatric lupus, according to a pilot study.

“Why look at basal ganglia? They are highly prone to hypoxic damage and have recently been linked with the frontal lobe regarding cognitive function,” Dr. Pamela L. Peterson said at the annual meeting of the British Society for Rheumatology. In Parkinson disease “and other diseases, there is increasing recognition of the role of basal ganglia.”

There are at least four circuits that link the basal ganglia to the cerebral cortex. Although less common, movement disorders are a well-accepted complication of neuropsychiatric systemic lupus erythematosus (NPSLE) and may be mediated by the basal ganglia, said Dr. Peterson, a rheumatology fellow at St. George's Hospital, London.

Clinicians more commonly order MRI scans to detect abnormalities in the periventricular region and subcortical white matter of patients with NPSLE. However, magnetic resonance spectroscopy of the basal ganglia might prove to be useful for earlier clinical intervention,

“Magnetic resonance spectroscopy is noninvasive, cheap, and easily added to an MRI protocol,” Dr. Peterson said.

Preliminary findings of the study are based on 24 patients who have NPSLE, 8 patients with active lupus but without neurologic symptoms, and 4 healthy controls. Participants are recruited for the ongoing study from St. George's University of London; St. Thomas' Hospital, London; and University College London. The age range is 17–54 years.

Blood tests indicated absolute concentrations of N-acetylaspartate (NAA), choline, creatine, and myoinositol. The metabolite NAA is a marker for neuronal loss or dysfunction, Dr. Peterson said. Study participants had a combination of MRI, magnetic resonance spectroscopy, and diffusion tensor imaging, as well as an interview, clinical assessment, and psychometric testing.

The researchers found a statistically significant correlation between decreases in NAA in the basal ganglia and frontal white matter. Also, levels were significantly lower in these regions, compared with healthy controls. “There was a step-wise deterioration in NAA with worsening neurologic effects,” Dr. Peterson said.

Participants with non-neuropsychiatric lupus also had decreases in the metabolite, but the reductions were not significantly different, compared with controls.

“This correlation may simply indicate a global reduction of NAA in patients with NPSLE or it may reflect abnormalities in the circuits connecting the frontal white matter with the basal ganglia,” the researchers noted. NPSLE may alter the cortical striatal fibers that connect basal ganglia and frontal lobe, Dr. Peterson added.

Although the pilot data from the study included only magnetic resonance spectroscopy findings, Dr. Peterson said changes in myoinositol in these two regions also appear to be correlated. In addition, initial psychometry results suggest “a possible relationship between NAA reduction in the basal ganglia and processing speed.”

“My results are tentative. This is a small data set,” Dr. Peterson said. “We want bigger numbers in the future.”

BIRMINGHAM, ENGLAND – Metabolic changes in the basal ganglia that can be detected with magnetic resonance spectroscopy may precede irreversible changes from neuropsychiatric lupus, according to a pilot study.

“Why look at basal ganglia? They are highly prone to hypoxic damage and have recently been linked with the frontal lobe regarding cognitive function,” Dr. Pamela L. Peterson said at the annual meeting of the British Society for Rheumatology. In Parkinson disease “and other diseases, there is increasing recognition of the role of basal ganglia.”

There are at least four circuits that link the basal ganglia to the cerebral cortex. Although less common, movement disorders are a well-accepted complication of neuropsychiatric systemic lupus erythematosus (NPSLE) and may be mediated by the basal ganglia, said Dr. Peterson, a rheumatology fellow at St. George's Hospital, London.

Clinicians more commonly order MRI scans to detect abnormalities in the periventricular region and subcortical white matter of patients with NPSLE. However, magnetic resonance spectroscopy of the basal ganglia might prove to be useful for earlier clinical intervention,

“Magnetic resonance spectroscopy is noninvasive, cheap, and easily added to an MRI protocol,” Dr. Peterson said.

Preliminary findings of the study are based on 24 patients who have NPSLE, 8 patients with active lupus but without neurologic symptoms, and 4 healthy controls. Participants are recruited for the ongoing study from St. George's University of London; St. Thomas' Hospital, London; and University College London. The age range is 17–54 years.

Blood tests indicated absolute concentrations of N-acetylaspartate (NAA), choline, creatine, and myoinositol. The metabolite NAA is a marker for neuronal loss or dysfunction, Dr. Peterson said. Study participants had a combination of MRI, magnetic resonance spectroscopy, and diffusion tensor imaging, as well as an interview, clinical assessment, and psychometric testing.

The researchers found a statistically significant correlation between decreases in NAA in the basal ganglia and frontal white matter. Also, levels were significantly lower in these regions, compared with healthy controls. “There was a step-wise deterioration in NAA with worsening neurologic effects,” Dr. Peterson said.

Participants with non-neuropsychiatric lupus also had decreases in the metabolite, but the reductions were not significantly different, compared with controls.

“This correlation may simply indicate a global reduction of NAA in patients with NPSLE or it may reflect abnormalities in the circuits connecting the frontal white matter with the basal ganglia,” the researchers noted. NPSLE may alter the cortical striatal fibers that connect basal ganglia and frontal lobe, Dr. Peterson added.

Although the pilot data from the study included only magnetic resonance spectroscopy findings, Dr. Peterson said changes in myoinositol in these two regions also appear to be correlated. In addition, initial psychometry results suggest “a possible relationship between NAA reduction in the basal ganglia and processing speed.”

“My results are tentative. This is a small data set,” Dr. Peterson said. “We want bigger numbers in the future.”