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Clinical Rounds

SKIN & ALLERGY NEWS • January 2007

Psychology, OTCs Help Solve Many Skin Problems
BY ROBERT FINN

San Francisco Bureau

M O N T E R E Y , C A L I F . — An understanding of patient psychology and a familiarity with over-the-counter preparations can aid the diagnosis and treatment of several dermatologic conditions, said Dr. John A. Lenahan said at the annual meeting of the Pacific Dermatologic Association. When patients complain of intense pruritus, Dr. Lenahan of the University of California, San Francisco, asks them, “ ‘Is your itch driving you crazy?’ If they answer yes to that, 95% of the time they itch, what they have is scabies.” Scabies mites are nocturnal, and their activity keeps patients awake. This sleep disruption may be responsible for the extra psychological edge to the scabies itch, Dr. Lenahan claims, well beyond the itching one sees with hepatitis, lymphomas, or drug reactions.

Patients often stop treating their hand dermatitis when it appears to be healed. Dr. Lenahan shows patients a poster with the cross-sectional view of the layers of the skin. Although the stratum corneum forms the actual skin barrier, he tells patients that it’s the stratum lucidum—which has a waxy, white appearance in the poster—that needs to heal. He explains it takes 6-8 weeks after hands apStaphylococcus pear normal for aureus bacteria that layer to reshould be treated externally, as well turn, so they need as with a systemic to continue protective measures antibiotic. from the effects of water for at least DR. LENAHAN that long. When the patient presents with staph furuncles, recognize that Staphylococcus aureus bacteria can reside in many areas of the skin, and these areas should be treated externally as well as with a systemic antibiotic. Dr. Lenahan suggests treating the inside of the nose and other skin folds with Bactroban and having patients shower with Hibiclens chlorhexidine soap. This alone won’t clear the in-

fection, but if you treat the sites externally for about 6 weeks, the patients will have fewer problems. “If they’ve had this a long time, probably their spouse is also contaminated,” and should be treated as well, he said. Systemic antibiotics may cause diarrhea, and probiotics offer a good solution. Dr. Lenahan recommends Bio-K+, each dose of which contains at least 50 billion live lactobacilli that can help restore intestinal flora. For patients with nail ridges, find a glass

slide and use the edge of the slide to file the ridges down. Within seconds every single ridge on their fingernail will disappear. Afterward, wrap the slide in tissue paper and hand it to the patient. “They think you’ve given them one of the best tools ever,” he said. Liquid nitrogen, an excellent treatment for warts, is often painful. To reduce pain, treat patients with L-M-X-5, a 5% lidocaine gel, immediately after freezing the warts. Dr. Lenahan said he had no conflicts of interest related to his presentation. ■

Bias Sways Expert Evaluation Of Some Cosmetic Procedures
B Y T I M O T H Y F. K I R N

Sacramento Bureau

BRIEF SUMMARY OF PRESCRIBING INFORMATION
TM

For Topical Dermatological Use Only

Rx only

Indication For Use MimyX Cream is indicated to manage and relieve the burning and itching experienced with various types of dermatoses, including atopic dermatitis, allergic contact dermatitis and radiation dermatitis. MimyX Cream helps to relieve dry, waxy skin by maintaining a moist wound & skin environment, which is beneficial to the healing process. Contraindications MimyX Cream is contraindicated in persons with a known hypersensitivity to any of the components of the formulation. Warnings In radiation therapy, MimyX Cream may be applied as indicated by the treating Radiation Oncologist. Do not apply 4 hours prior to a radiation session. Precautions and Observations - MimyX Cream is for external use only. - MimyX Cream does not contain a sunscreen and should not be used prior to extended exposure to the sun. - If clinical signs of infection are present, appropriate treatment should be initiated; use of MimyX Cream may be continued during the anti-infective therapy. - If the condition does not improve within 10 – 14 days, consult a physician. - Keep this and other similar products out of the reach of children. - MimyX Cream may dissolve fuchsin when this dye is used to define the margins of the radiation fields to be treated. HOW SUPPLIED MimyXTM Cream is available in a 70 gram tube, NDC 0145-4200-01. Store at 15°C to 30°C (59°F to 86°F). Do not freeze. Stiefel Laboratories, Inc. Coral Gables, FL 33134 826801-0905

P A L M D E S E R T , C A L I F . — A new study indicates that investigator bias of cosmetic procedure trial results, including blinding and prejudice about the value of the procedure performed, renders those results largely unreliable, Dr. David F. Horne said at the annual meeting of the American Society for Dermatologic Surgery. Dr. Horne presented data from his study of 10 patients who had a Food and Drug Administration–approved, noninvasive cosmetic device treatment (which he did not disclose), and then were evaluated four times by different dermatologists. The study showed that the evaluations differed depending on the evaluator bias, and that when 4 of 10 of those dermatologists were blinded to whether the photographs they were shown were taken before or after the procedure, they could not tell which was the before or the after photo 44% of the time, said Dr. Horne, a dermatologist in Boston. The study’s subjects were photographed before the procedure and 6 months afterward. The pairs of photographs were then given to 10 dermatologists expert in that procedure for a standard evaluation with an improvement scale. The dermatologists were identified and grouped based on atti-

tude toward the procedure: enthusiastic (four), ambivalent (four), or doubtful (two). When the enthusiasts saw the before and after photographs in an unblinded fashion (so they knew which photographs were before and which after), there was agreement among them, and they judged an improvement of more than 25% in most patients, with a greater than 50% improvement in two individuals. When the doubters saw the same photographs in an unblinded fashion, there was little agreement. While they generally said that most patients showed up to 25% improvement, they also said there were clearly nonresponders. Ambivalent dermatologists who saw the photographs in an unblinded fashion also determined that there were nonresponders, but overall agreed that most patients showed up to 25% improvement. Three months earlier, the ambivalent group saw the same photographs in a blinded fashion, so that they did not know before from after, and there was less agreement. They did agree that there was no improvement or that the patients were actually worse afterward, Dr. Horne said. “Blinding expert evaluators to the preand posttreatment status of standardized photographs may have significant effects on the perceived efficacy of a procedure or device,” he said. ■

Beauty Is Truly in the Eye of the Beholder
L A S V E G A S — Age and gender influence opinions on what makes a face beautiful, a recent study showed. Dr. David W. Kim and his associates at the University of California, San Francisco, photographed the faces of four women— two white women aged 30 and 60 years, and two Asian women aged 30 and 60 years—and used a computer program to modify three aspects of their faces. They created five eyebrow shapes, six nasolabial angles, and five nasal tip widths. Eyebrows with the most lateral apex were rated as the least attractive by 171 volunteers. The most attractive eyebrows were those with the apex just short of that. A moderate nasolabial angle and narrower nasal tip generally were preferred, Dr. Kim said at an international symposium sponsored by the American Academy of Facial Plastic and Reconstructive Surgery. The ethnicity of the models or the observers did not affect ratings, with one exception: the narrowest nasal tip was deemed unnatural in the younger white model. However, the sex of observers made a difference, with females preferring a lateral apex to the eyebrow and males preferring a central apex. The age of the model and of the observer affected scoring. A more lateral eyebrow apex was preferred in the younger models, but a more central apex was considered more attractive in the older models. “Standardized guidelines of facial aesthetic beauty cannot be applied universally,” Dr. Kim said.
—Sherry Boschert

Rx only - Prescription Medical Device: Federal Law restricts this device to sale by or on the order of a physician.

REFERENCES: 1. Del Rosso JQ, Bikowski J, Hawkes S, Sanglay L. Use of a palmitoylethanolamide-containing non-steroidal cream for the treatment of atopic dermatitis: impact on the duration of and time between flares. Presented at: 2006 Meeting of the American Academy of Dermatology; July 2006; San Diego, Calif. Poster 505. 2. Data on file. [TTF clinical results and protocol], August C. Stiefel Research Institute, Inc. MimyX is a registered trademark of Stiefel Laboratories, Inc., and Research in Dermatology is also a trademark of Stiefel Laboratories, Inc.