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How to manage sensitive skin in a polluted environment
4517
5172
How to improve sun protection counseling in a primary care setting Dhwani Mehta, MD, Henry Ford Hospital; Regina O’Brien, MD, Presence Resurrection Medical Center; Laurie Kohen, MD, Henry Ford Hospital
How Viagra may cause melanoma: A histopathologic study providing a potential physiological/etiopathological mechanism W. Clark Lambert, MD, Rutgers New Jersey Medical School, Department of Dermatology and Pathology and Laboratory Medicine; Muriel Lambert, PhD, Rutgers New Jersey Medical School; Christina Ring, BS, Rutgers New Jersey Medical School; Claude Gagna, PhD, New York Institute of Technology; Robert Schwartz, MD, Rutgers New Jersey Medical School, Department of Dermatology Objective: To identify cases of melanoma with closely associated, markedly dilated, thin-walled vessels and to define the relationship to Viagra use.
Skin cancer is a significant public health concern in the United States as there continues to be an increasing number of cancers annually. Ultraviolet exposure is linked to the risk of developing skin cancer, but only a little more than half of the American practice sun protection. While many studies have shown that counseling can increase patient knowledge about sun protection, the counseling rate by physicians can be very low, especially in a primary care setting. Given that majority of the patients in this nation will likely see a primary care doctor before a dermatologist, we sought to see the rate at which a primary care physician provides counseling about sun protection. A survey was sent to primary care doctors and dermatologists in the Detroit and Ann Arbor area. Survey results showed that primary care doctors counsel significantly less than dermatologists. Also, primary care doctors are less likely to perform a full skin exam or use sunscreen themselves. Based on the results of the study, we were able to identify the barriers to primary care doctors performing counseling. We followed up our survey by providing educational intervention to the participating internal medicine doctors in the form of a lecture and an informative email. These doctors took the survey again after the intervention. Post-intervention survey results showed that doctors who participated in the intervention were more likely to wear sunscreen during the winter and were more accurate in counseling their patients on reapplication of sunscreen. Although statistically insignificant, post-intervention doctors trended towards being more comfortable providing information on sun protection and higher frequency of counseling their patients on sun exposure, sun protection, and tanning bed use. Based on our study results we conclude that primary care physicians need to be educated on how to provide better sun-protection counseling. Interventions such as lectures and emails may be helpful, but future studies with higher power are needed to further investigate these interventions.
Methods: Following initial observation by one of us (WCL), that certain melanomas showed a striking dilatation of closely associated thin-walled vessels, a review of 50 sequential cases of melanomas in the dermatopathology laboratory at Rutgers New Jersey Medical School was performed. Particular attention was paid to dilatation of closely associated thin-walled vessels. Results: Four cases were identified with markedly dilated closely associated thinwalled vessels. All four were difficult to classify, best fitting into the categories of superficial spreading melanoma (in vertical growth phase) vs nodular melanoma. In two of the cases, the patients had volunteered use of sildenafil (Viagra) over several years. Interestingly, both of these cases showed a striking evidence of invasion into these dilated vessels. Limitations: Limited sample size. Strengths: Well-documented use of Viagra. Direct histopathological documentation. Conclusion: A physiologic/etiopathological link between use of Viagra and melanoma is indicated on histology. Commercial support: None identified.
Commercial support: None identified.
4588 How to manage sensitive skin in a polluted environment Sophie Seite, PhD, La Roche-Posay; Dominique Moyal, PhD, La RochePosay; Muriel Bayer-Vanmoen, PharmD, L’Oreal; Dang Man Pham, PhD, L’Oreal; Gabrielle Sore, PharmD, L’Oreal Introduction: Pollution is a major concern in big cities. Most pollution studies have focused on the related side effects to the pulmonary and cardiovascular systems. More recently, however, epidemiological and mechanistic studies suggest that air pollution can also have a negative impact on the integrity of the skin. Pollution can result in aggravated skin sensitivity and reactivity. It has been determined that particulate matter can generate reactive oxygen species, leading to lipid and protein oxidation that can induce up-regulation of proinflammatory mediators. A harmful synergy between UV (particularly UVA) radiation and pollution was also observed. The objective of this study was to evaluate the efficiency of a skin care product routine to reduce the reactivity to pollution of women having sensitive skin in a polluted environment. Methods: 53 Chinese women from 35 to 63 years old with sensitive skin according to a standardized questionnaire and having a positive stinging test (10% Lactic acid solution) score were recruited. Repeated applications for 4 weeks in a highly polluted environment in Shanghai (China) of a mild cleanser to remove the particles without damaging the skin barrier, a face care developed for sensitive skin (containing Neurosensine and LRP thermal spring water) and a daily sun care with high UVB and UVA protection level were performed. At T0 and T4 weeks, evaluations were done: stinging test, cutaneous functional signs (stinging, burning, discomfort), clinical signs by dermatologic scores (erythema, dryness, desquamation), and self-assessment of skin sensitivity and reaction to triggering factors. Lastly, expression of carbonyl proteins was analyzed from D-squames (tape stripping). Results: The skin care product routine significantly reduced the facial stinging test score (-29.1%), pruritus, discomfort, tugging feeling, and the physical signs (-100% dryness, -69% roughness). Self-assessment demonstrated a decrease of skin sensitivity feeling and decrease of skin reactivity to triggering factors. There was a significant decrease of the carbonyl proteins after 4 weeks of routine use, showing less oxidative stress. Conclusion: This study demonstrated in a polluted environment the interest of using adapted products to reduce skin sensitivity. These products were developed to remove the pollution particles without damaging the skin barrier, to reinforce the skin barrier, decrease the skin inflammation and to protect against the UV/ pollution damaging effect. Commercial support: Cost of poster covered by La Roche-Posay.
AB158
J AM ACAD DERMATOL
5681
Human nasal myiasis caused by Oestrus ovis in the highlands of Cusco, Peru: Report of a case and review of the literature Paige Hoyer, BS, The University of Texas Medical Branch at Galveston; Robert Williams, BS, The University of Texas Medical Branch at Galveston; Miguel Cabada, BS, The University of Texas Medical Branch at Galveston Cutaneous myiasis is the most prevalent form and furuncular lesions are a relatively common dermatologic condition reported in travelers returning from South America and Africa. Less commonly, infestation can occur in body cavities with mucosal surfaces including the eyes, nose, and mouth. Oestrus ovis generally causes ophthalmo-myiasis in humans, an infestation of the soft-tissue in the orbit. Cavitary myiasis, especially O ovis infestation, is rare in humans. We present a case of a 56year-old male who presented in Cusco, Peru with nasal pruritus and congestion for 2 months. He reported a muco-sanguinolent secretion from his left nostril after waking up and sneezing white ‘‘cottony’’ material. The patient admitted sporadic exposure to livestock, specifically sheep. The material was collected and identified as an O ovis fly larvae. No bone erosion was evident on CT scan of the head and endoscopic evaluation of the sinuses did not reveal additional larvae. Cavitary myiasis most often causes a mild self-limited illness, but infestation and inflammation can result in significant damage to the surrounding structures. Nonetheless, infestation of the mucosal cavities can pose a diagnostic challenge to physicians unaware of this condition. Commercial support: None identified.
JUNE 2017
5172
How to improve sun protection counseling in a primary care setting Dhwani Mehta, MD, Henry Ford Hospital; Regina O’Brien, MD, Presence Resurrection Medical Center; Laurie Kohen, MD, Henry Ford Hospital
How Viagra may cause melanoma: A histopathologic study providing a potential physiological/etiopathological mechanism W. Clark Lambert, MD, Rutgers New Jersey Medical School, Department of Dermatology and Pathology and Laboratory Medicine; Muriel Lambert, PhD, Rutgers New Jersey Medical School; Christina Ring, BS, Rutgers New Jersey Medical School; Claude Gagna, PhD, New York Institute of Technology; Robert Schwartz, MD, Rutgers New Jersey Medical School, Department of Dermatology Objective: To identify cases of melanoma with closely associated, markedly dilated, thin-walled vessels and to define the relationship to Viagra use.
Skin cancer is a significant public health concern in the United States as there continues to be an increasing number of cancers annually. Ultraviolet exposure is linked to the risk of developing skin cancer, but only a little more than half of the American practice sun protection. While many studies have shown that counseling can increase patient knowledge about sun protection, the counseling rate by physicians can be very low, especially in a primary care setting. Given that majority of the patients in this nation will likely see a primary care doctor before a dermatologist, we sought to see the rate at which a primary care physician provides counseling about sun protection. A survey was sent to primary care doctors and dermatologists in the Detroit and Ann Arbor area. Survey results showed that primary care doctors counsel significantly less than dermatologists. Also, primary care doctors are less likely to perform a full skin exam or use sunscreen themselves. Based on the results of the study, we were able to identify the barriers to primary care doctors performing counseling. We followed up our survey by providing educational intervention to the participating internal medicine doctors in the form of a lecture and an informative email. These doctors took the survey again after the intervention. Post-intervention survey results showed that doctors who participated in the intervention were more likely to wear sunscreen during the winter and were more accurate in counseling their patients on reapplication of sunscreen. Although statistically insignificant, post-intervention doctors trended towards being more comfortable providing information on sun protection and higher frequency of counseling their patients on sun exposure, sun protection, and tanning bed use. Based on our study results we conclude that primary care physicians need to be educated on how to provide better sun-protection counseling. Interventions such as lectures and emails may be helpful, but future studies with higher power are needed to further investigate these interventions.
Methods: Following initial observation by one of us (WCL), that certain melanomas showed a striking dilatation of closely associated thin-walled vessels, a review of 50 sequential cases of melanomas in the dermatopathology laboratory at Rutgers New Jersey Medical School was performed. Particular attention was paid to dilatation of closely associated thin-walled vessels. Results: Four cases were identified with markedly dilated closely associated thinwalled vessels. All four were difficult to classify, best fitting into the categories of superficial spreading melanoma (in vertical growth phase) vs nodular melanoma. In two of the cases, the patients had volunteered use of sildenafil (Viagra) over several years. Interestingly, both of these cases showed a striking evidence of invasion into these dilated vessels. Limitations: Limited sample size. Strengths: Well-documented use of Viagra. Direct histopathological documentation. Conclusion: A physiologic/etiopathological link between use of Viagra and melanoma is indicated on histology. Commercial support: None identified.
Commercial support: None identified.
4588 How to manage sensitive skin in a polluted environment Sophie Seite, PhD, La Roche-Posay; Dominique Moyal, PhD, La RochePosay; Muriel Bayer-Vanmoen, PharmD, L’Oreal; Dang Man Pham, PhD, L’Oreal; Gabrielle Sore, PharmD, L’Oreal Introduction: Pollution is a major concern in big cities. Most pollution studies have focused on the related side effects to the pulmonary and cardiovascular systems. More recently, however, epidemiological and mechanistic studies suggest that air pollution can also have a negative impact on the integrity of the skin. Pollution can result in aggravated skin sensitivity and reactivity. It has been determined that particulate matter can generate reactive oxygen species, leading to lipid and protein oxidation that can induce up-regulation of proinflammatory mediators. A harmful synergy between UV (particularly UVA) radiation and pollution was also observed. The objective of this study was to evaluate the efficiency of a skin care product routine to reduce the reactivity to pollution of women having sensitive skin in a polluted environment. Methods: 53 Chinese women from 35 to 63 years old with sensitive skin according to a standardized questionnaire and having a positive stinging test (10% Lactic acid solution) score were recruited. Repeated applications for 4 weeks in a highly polluted environment in Shanghai (China) of a mild cleanser to remove the particles without damaging the skin barrier, a face care developed for sensitive skin (containing Neurosensine and LRP thermal spring water) and a daily sun care with high UVB and UVA protection level were performed. At T0 and T4 weeks, evaluations were done: stinging test, cutaneous functional signs (stinging, burning, discomfort), clinical signs by dermatologic scores (erythema, dryness, desquamation), and self-assessment of skin sensitivity and reaction to triggering factors. Lastly, expression of carbonyl proteins was analyzed from D-squames (tape stripping). Results: The skin care product routine significantly reduced the facial stinging test score (-29.1%), pruritus, discomfort, tugging feeling, and the physical signs (-100% dryness, -69% roughness). Self-assessment demonstrated a decrease of skin sensitivity feeling and decrease of skin reactivity to triggering factors. There was a significant decrease of the carbonyl proteins after 4 weeks of routine use, showing less oxidative stress. Conclusion: This study demonstrated in a polluted environment the interest of using adapted products to reduce skin sensitivity. These products were developed to remove the pollution particles without damaging the skin barrier, to reinforce the skin barrier, decrease the skin inflammation and to protect against the UV/ pollution damaging effect. Commercial support: Cost of poster covered by La Roche-Posay.
AB158
J AM ACAD DERMATOL
5681
Human nasal myiasis caused by Oestrus ovis in the highlands of Cusco, Peru: Report of a case and review of the literature Paige Hoyer, BS, The University of Texas Medical Branch at Galveston; Robert Williams, BS, The University of Texas Medical Branch at Galveston; Miguel Cabada, BS, The University of Texas Medical Branch at Galveston Cutaneous myiasis is the most prevalent form and furuncular lesions are a relatively common dermatologic condition reported in travelers returning from South America and Africa. Less commonly, infestation can occur in body cavities with mucosal surfaces including the eyes, nose, and mouth. Oestrus ovis generally causes ophthalmo-myiasis in humans, an infestation of the soft-tissue in the orbit. Cavitary myiasis, especially O ovis infestation, is rare in humans. We present a case of a 56year-old male who presented in Cusco, Peru with nasal pruritus and congestion for 2 months. He reported a muco-sanguinolent secretion from his left nostril after waking up and sneezing white ‘‘cottony’’ material. The patient admitted sporadic exposure to livestock, specifically sheep. The material was collected and identified as an O ovis fly larvae. No bone erosion was evident on CT scan of the head and endoscopic evaluation of the sinuses did not reveal additional larvae. Cavitary myiasis most often causes a mild self-limited illness, but infestation and inflammation can result in significant damage to the surrounding structures. Nonetheless, infestation of the mucosal cavities can pose a diagnostic challenge to physicians unaware of this condition. Commercial support: None identified.
JUNE 2017