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Psoriasis
Evaluating besttherapiesforpregnant women,pediatric patients
Some treatmentsfor adults withpsoriasis can also beoptions for childrenand adolescents
by LYNN BRADSHAW
Senior Associate Editor, The Chronicle
A
lthough research is lackingconcerning the best treat-ment options for pediatricpatients with psoriasis and women with psoriasis who would like tostart a family, it’s clear that the dis-ease often negatively affects thequality of patients’ lives and clini-cians have a duty to provide them with the best possible treatment,according to Dr. Bruce Strober.
Pediatric psoriasis patients
“I disagree that the average onsetage of psoriasis is 28 years of age,because I have found that a num-ber of people have reported theirpsoriasis started as a child,” saidDr. Strober, assistant professor,Department of Dermatology atNYU, Langone Medical Center inNew York during a presentation atmini Dermatology Update inToronto.“Really, I think there is a lotgoing on that we are not diagnosingas psoriasis under the age of 18.Maybe pediatricians called iteczema. Maybe it is mild andignored by parents.”Dr. Strober highlighted that pso-riasis is a concern among pediatricpatients and must not be ignored.During his presentation, he posed aquestion to the audience: Shouldtreatment options for children beprioritized differently than those foradults?Dr. Strober admitted that thereis really no right answer to thequestion, and that all clinicianshave their treatment style and pref-
Please turn to
Psoriasis
page
13
study of generalized vitiligo inCaucasians of European descentmainly turned up previously-described associations withimmune-related genes, Dr. Richard A. Spritz of the University of Coloradoin Aurora, and colleagues reported.However, the association withthe TYR genetic locus (p=1.60x10-18)came as a surprise, “though probably it should not have been in retro-spect,” Dr. Spritz said in an interview.
P
RACTICAL
T
HERAPEUTICS
an
C
LINICAL
N
EWS
 from the
 W 
ORLD
of 
D
ERMATOLOGY 
I
 J
UNE
2010
by CRYSTAL PFEND
Special to The Chronicle
A
n unexpected genetic linkbetween the hair and skinpigmentation disorder vitiligo and malignant melanomamay have implications for treat-ment of both, researchers report-ed online in the
 New England  Journal of Medicine
.The genome-wide association
Genetics
 Vitiligo shares roots withskin cancer, say researchers
Genetic inquiry finds vitiligo associated with major alleles of melanoma
of&
ALLERGY
SKINSKIN
The Chronicle
Eczema
 Alitretinoin a new option forchronic hand eczema patients
Condition often seen in daily practice
by IAN J.S. MOORE,
Correspondent, The Chronicle
A
new oral formulation of tretinoin—as a once-daily therapy for patients with severe, chronic hand eczema who areunresponsive to corticosteroids—is now available. Alitretinoin was approved for use in Canada earlier this year, and isexpected to be available for prescription sometime this summer,after the manufacturer, Basilea Pharmaceutica, reaches an agree-ment on price with the Patented Medicine Prices Review Board(PMPRB).
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TANNING ISSUES
• 11
CDA working with legislators to implementage limits on tanning parlour patrons
ACD
12
 Patch tests useful for Dx of  eczematous disease, says the University of Ottawa’s Dr. Melanie Pratt
The Chronicle
NSIDE
Please turn to
Chronic hand eczema
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28
This gene encodes tyrosinase,the key enzyme in melanocytes thatsynthesizesmelanin and thatis the major tar-get of autoim-munity in gener-alized vitiligo.This pro- vides an impor-tant insight intothe pathogenesisof vitiligo andmay point to targets for treatment of the disease, which affects 0.5% to
Please turn to
Vitiligo
page
9
Update
on
See page 4
 Ref 
 
ined therapies att
 
 racting new patient
 
 s
Dr. Richard Spritz
Cosmetic
dermato
 
logy
 
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T
HE
C
HRONICLE
of 
SKIN & ALLERGY 
 Vol. 16, No. 4
 June 2010 ·
3
 A 
Message
from the
Medical Editor
C
anadian dermatologists contin-ue to impress and inspire meevery time I am asked to reviewcutting edge articles for T
HE
C
HRONICLE
. Within the world's dermatology community Canadiandermatologists interms of numbers areless than 1% (mostlikely less than 0.1%)but continue to beover-represented inour contribution on the world stage. Whether it be enrolling disproportion-ately high numbers of high quality patients to the first head-to-head bio-logic trial of ustekinumab versus etan-ercept, or helping with trials workingtoward novel therapeutics such asalitretinoin for hand eczema,Canadian dermatologists are up tothe challenge in continuing to be asignificant force within the world’sclinical trials community. We alsomake significant impact in the globalarena in many other areas includingcontact dermatitis, wound care, andcosmetic dermatology to name a few.Our association, the CDA, isanother shining example to the worldof the leadership we display. One of the best examples is the CDA’s Sun Awareness Program. It is truly amodel for dermatology associations worldwide and if we are successful inpassing the “Skin Cancer Prevention Act” (see report on page 11), we will
UBC professor
Dr. John Hill has identified high levels of the enzymemyeloperoxidase as a important predictor of cardiovascular death.
CAD
 Key predictor for CV death found 
TOP
ofthe
MONTH
CDA working with legislators toimplement new age limits andother restrictions on patrons oftanning parlours in Canada
Meanwhile, the World HealthOrganization elevates tanningdevice risk to other known cancer-causing agents, such as as ciga-rettes and mustard gas. . . . . . . .
11
Acne: Online followup for patientswith acne just as effective asconventional consultation
 Also: Laser, retinaldehyde combina-tion shown to improve acnerosacea, and tretinoin microspheregel safe and effective for the treat-ment of acne vulgaris in eight- to 12- year-olds.. . . . . . . . . . . . . . . . . . .
14
Burn treatment: In children, 70%of burns are scalds, in adults, 70%are typically flame burns
One of the biggest advances in thecare of patients with burn woundsis the development of dressingsimpregnated with silver, which donot have to be changed as fre-quently. . . . . . . . . . . . . . . . . . . . .
18
Chronicle PostgraduateEducational Supplement
In this issue’s PostgraduateEducational Supplement,C
HRONICLE
guest authors from theUniversity of Cologne investigatenew understandings of cell matrixinteractions in dermal repair andscarring . . . . . . . . . . . . . . . . . . . .
21
“The proposed private members’ bill for improved warnings and labels on tanning beds iscertainly a move in the right direction and we definitely support this bill.”
Dr. Cheryl Rosen, chief of dermatology, Toronto Western Hospitaland national director of the CDA’s Sun Awareness Program
(see page 11)
 A high level of myeloperoxidase hasbeen found to be a key predictor of car-diovascular death, according to a study out of the University of BritishColumbia’s department of pathology and laboratory science and theProvidence Heart and Lung Institute,published in the
 Journal of the American College of Cardiology
“We hope that the discovery of newmarkers of cardiovascular risk will helpidentify specific patients who couldbenefit from more aggressive treatmentstrategies,” said associate professor Dr. John Hill, the lead investigator who co- wrote the article with PhD studentClaire Heslop and professor Dr. JiriFrohlich.Data was collected from the med-ical records and blood samples of con-senting patients with coronary artery disease (CAD). The records covered a13-year period.The study determined that CADpatients with higher levels of the enzymemyeloperoxidase experience twice themortality rate than those with lower rates.The enzyme is associated with oxidativestress, which damages arterial tissue.CAD is the cause of over 160,000hospitalizations in Canada each year.One-quarter of those hospitalized die.Bobbe Wood, president and CEOof the Heart and Stroke Foundation of B.C. & Yukon, said he was proud tosupport these researchers. Wood added “since almost 40,000deaths occur in Canada each year due toCAD, it’s crucial to focus on better meth-ods to treat such a devastating healthproblem.”
From the News Resources of The Chronicle
Published eight times per year bythe proprietor,
ChronicleInformation Resources Ltd.
, withoffices at 555 Burnhamthorpe Road,Ste 306, Toronto, Ont. M9C 2Y3Canada. Telephone: (416) 916-2476; Facs. (416) 352-6199.E-mail: health@chronicle.orgISSN No. 1209-0581Contents ©
ChronicleInformation Resources Ltd.
, 2010except where noted.
 All rights reserved worldwide.
The Publisher prohibits reproduc-tion in any form, including print,broadcast, and electronic, without written permissions.Printed in Canada.
The Chronicleof Skin & Allergy
is a Canadianpublication. The Publisher certifiesthat advertising placed in this pub-lication meets Revenue Canadarequirements for tax deductibility.Subscriptions: $85.60 per year inCanada, $129.95 per year in allother countries. Single copies:$10.00 per issue (plus 5% GST).Canada Post Canadian PublicationsMail Sales Product AgreementNumber 40016917. Please forwardall correspondence on circulationmatters to: The Chronicle of Skin & Allergy, 555 Burnhamthorpe Road,Ste 306, Toronto, Ont. M9C 2Y3
Ideas in the Service of Medicine
sm
Affiliated journals ofthe ChronicleCompanies include
 Dental Chronicle,The Chronicle of  Neurology & Psychiatry, TheChronicle of Urology & Sexual  Medicine, The Chronicle of  Healthcare Marketing, Drug RepChronicle, and Linacre’s Books/Les Editions Linacre
June 2010
• Vol. 16 No. 4
Medical Editor
Wayne Gulliver,
MD, FRCPCEditor, Cosmetic Dermatology
Sheldon V. Pollack,
MD, FRCPC
Publisher
Mitchell Shannon
Editorial Director
R. Allan Ryan
Senior Associate Editor Assistant Editor
Lynn Bradshaw
Production and Circulation
Josh LongCathy Dusome
Comptroller
Rose Arciero
Founding Editor
Colin A. Ramsay,
MD, FRCPC
(1936-2003)
John P. Arlette,
MD, FRCPC
Benjamin Barankin,
MD,FRCPC
Marc Bourcier,
MD,FRCPC
W. Alan Dodd,
MD, FRCPC
Eric Goldstein,
MD, FRCPC
Peter Hull,
MD, FRCPC
Rod Kunynetz,
MD, FRCPC
Richard Langley,
MD, FRCPC
Danielle Marcoux,
MD, FRCPC
R.A.W. Miller,
MD, FRCPC
H. Eileen Murray,
MD, FRCPC
Kim Papp,
MD, FRCPC
Yves Poulin,
MD, FRCPC
Melanie D. Pratt,
MD, FRCPC
Denis Sasseville,
MD, FRCPC
Jerry Tan,
MD, FRCPC
Ronald B. Vender,
MD, FRCPC
Contacting
The Chronicle
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Please turn to
Message
page
36
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