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Public education: An approach
Editorial Public education: An approach Skin cancer awareness project using the solar meter
The public is becoming more aware of health and its correlation to fitness. The attitude of selfhelp and self-education is in vogue. One critical area to help educate the public and reduce and prevent problems is in mass media education about the sun's ultraviolet radiation and its damaging effects. Local dermatologists became aware of this factor in 1977-1978 when the National Cancer Institute did a survey of eight cities (Seattle, Minneapolis-St. Paul, Detroit, Utah [state}, San Francisco, New Orleans, New Mexico [state], and Atlanta), showing that Atlanta had the highest rate of skin cancer of those areas studied-393.8 per 100,000.' The Department of Dermatology at Emory University believed it to be prudent at that time for us to initiate some form of an educational program locally. After many alternative considerations, we decided to use the Berger sunburn ultraviolet meter as our central focal point. 2 The project was funded by local dermatologists, pharmaceutical company support, and the Department of Dermatology. The sunburn meter was chosen for specific reasons. The Berger ultraviolet meter has a spectral response that resembles the skin's erythema action spectrum (Fig. 1). This response is therefore wavelength-dependent and cannot give absolute energy measurements. It is accurate at a small zenith-mornings and evenings. It is thereby indicative of the skin's general erythema response and therefore uses a general term, the sunburn unit. This unit is defined as a minimal erythema dose (MED) on an average untanned skin, at sea level, with an overhead sun in a clear sky, and a stratospheric ozone of 2 to 6 mm thickness. Using the data from the meter, we have been able to calculate units in half-hour measurements with approximately 440 U equaling one sunburn unit or MED in Atlanta. The data are listed in
676
1.00 8 6 4
Human skin action spectrum (Best fit)
2
(/)
;t::
c:
::J
.. Q)
>
III Q)
ex:
0.10 8 6 4 2
0.01 8 6 4 2
0.001 8 6 4 2
275 300 325 350 375
Wavelength, nm Fig. 1. Sunburning ultraviolet meter.
Table 1. It is important to notice from Table I that on standard time (add 1 hour for daylight saving time; DST) high noon in Atlanta is at 12:29 and the highest unit readings are around 12:30 (1 :30 DST). It is also important to note that the sun intensity is high in Atlanta from 10 A.M. until 5 P.M.; not the 10 to 2 P.M. we seem to believe as dogma from the past. This is based on the observation that the units measured at 10 and 17 (5 P,M.) are almost the same. An education program was developed around the meter, converting the units into the sunburn index This is done by taking the units as times (Table in Table I per half hour and dividing by 440 U to get one MED. This information is given daily to the national weather service, which has been very helpful in putting it out on our local weather Na-
II'.
Volume 14 Number 4
The solar meter 677
April, 1986
Table I. Atlanta, GA, Department of Dermatology-year, 1983; month, July; standard time Hour
Meter units measured
Hour
Meter units measured
0-30 to 6-0 6-30 7-0 8-0 8-30 9-0 9-30 10-0 10-30 11-0 11-30 12-0 12-30 13-0
000 002 006 046 086 142 211 290 374 464 551 60 671 699
13-30 14-0 14-30 15-0 15-30 16-0 16-30 17-0 17-30 18-0 18-30 19-0 20-0 21-0 to 24-0
705 688 656 597 519 428 336 253 184 122 073 037 004 000
Table II. Sunburn index in minutes Standard time Date
10 A.M.
12 noon
2 P.M.
4 P.M.
May 27-June 2
46* 44 44 42 43
23 22 22 21 22
22 20 20 20 21
29 34 31 31 31
June June June June
3-9 10-16 17-23 24-30
*Measurement in minutes to get a MED on untanned skin.
tional Oceanic and Atmospheric Administration (NOAA) wire for all to use locally if they desire, from Memorial Day to Labor Day. Since the start of the program, the local paper has included the 2 P.M. time in its weather page daily. Numerous television and radio stations periodically use the data to tell the public how long they may stay out before damage tends to accumulate to get a MED. The shortcomings of the time measurement, such as a cloudy or rainy day, are important. Individual variations such as skin type or sun-induced skin thickness and tan will change the MED. 3 To simplify the sun exposure risk so that the public could understand it better, the program started in 1985 at the University of Alabama used a degree of danger range, low (below 400 U), medium (450-600 U), high (600-800 U), and dangerous (800 + U). * *Sams WM (University of Alabama): Personal communication, July
7, 1985.
As one can see, there is no absolute guideline that will apply to everyone's skin, but the principle of all of this is not to use the times as absolutes, but to use the times as a general educational tool to teach the public about ultraviolet damage caused by the sun. If you hear about, read about, and talk about sun ultraviolet damage enough, you will soon begin to think that maybe there is some factual information one should believe in the presentations. This has been the case with our program. The first year we started, we had national coverage; every year since, we have had local, state, and national coverage. The local community, Atlanta Dermatological Association, Emory University, and the University of Georgia have all been asked for talks, interviews, and programs about the meter, sun ultraviolet damage, sunscreens, prevention, and skin cancer. 4 We have helped set up programs since we started in other states and for-
678
Journal of the American Academy of Dermatology
Dobes
SUNLIGHT SUNSCREENS and SKIN CANCER
SKIN CANCER IN ATIANrA
SUN INTENSITY INDEX
Atlanta has one of the highest Incidences of skin cancer In the nation, according to the National Cancer Institute, which conducted a survey of eight major metropolitan U.S. cities. The survey showed that Atlanta had an incidence of 393 squamous cell or basal cell cancers per 100,000 at risk population, I.e., those affair complexion. This data is frightening In that It shows an Increase in the incidence of skin cancer as well as a very high local occurrence rate. This Is probably due to the Scottish, Irish, fair-skinned descent of much of the Atlanta population, but also may 1>< partly accounted for by the higher elevation of the city. For this reason, people who live In this area are much more al risk of developing skin cancer and should 1>< extremely cautious In avoiding sun damage.
The Sun Intensity Index Is a measurement of the ultraviolet light which shines on Atlanta. The figures used to calculate the Sun Intensily Index are derived from past years' accumulation of data of ultraviolet light durtng a penod of time in Ihal month In Alianta. These figures are then used to calculate the amount of sunlight 1\ takes for a nontanned, fair-skinned individual to get red. The Sun Intensity Index Is given out by many of the media (newspapers, radio, and television stations) throughoUI this area and Is extremely helpful In predicting how long an Individual can safely stay In the sun before damage begins. The Index Is calculated for clear days; cloud cover affecls the time slgnUicanliy, as does the utilization of sunscreens, which will Increase one's tolerance of sun exposure markedly.
SUNSCREEN PROTECTIVE FACTOR (SPF)
SOlAR METER READINGS
The SPF refers to the multiple of allowable sun exposure with a sunscreen applied (0 the skin as compared to no sunscreen applied to the sl
Atlanta Dermatological Association
FREQUENnY ASKED QUESTIONS • How proiectiue is a sun tan?
OUf best evidence 10 date fndlcates that a sun Ian of· fel'S no more protection than 2 or 3 SPF. It has been
wet! documented that although one may have a tan. radiatiQn damage still accumulates through the tan, To acquirE a tan one must accumulate sun ex-
posure Which wlll hurt the skIn. For this reason, just
lyIng In the sun or using
1>
ell
tanning parlor, booth or
• Are there any other topleal treatments that may reduce aging and wrinkling, or prevent ft, such as C
these provide any benefit,
whQtsoever~
In preven-
ting aging or v.n:lnkling, However, sInce chronic sun
exposure may accelerate wrinkling and aging of Ihe skin, the Judicious use of .sunscreens vJould seem In~
dlcaled.
During the summer months the Nallonal Weather Service transmits a reading gathered from Emory University's Solar MeIer, which Is given out at 10 a.m., 12 noon, 2 p.m.. and 4 p.m. Each of the readings Is the measure of time thallt would take untanned skin to turn red. This, In essence, Is the amount o( time It takes (or a fair complexioned Individual, on exposure at lhet time, to expenence sun damage. (Examples: Middle of the month readings during July 1983 were: 10 a.m.-43 minutes, 12 noon-21 minutes, 2 p.m,-20 minutes, 4 p.m.-31 minutes). As one can see from typica' readings, II fakes very little outdoor exposure to accumulate damage. The benefit of using sunscreens at all times Is evident.
Your dermatologist may be consulted regarding the choice of a sunscreen. There is no one
sunscreen Ihat fJls everyone. Some Individuals may be allergic to certain ingredients in a sunscreen, and some sunscreens may be acne
producing. No prescription Is necessary even for the sunscreens with a 15 SPF. In fact, since each of the prolective ingredients In a given sunscreen blocks only a portion of the sunburn rays, all of the higher SPF sunscreens contain two or more
agents, In order to protect against a wider range of
the ultraviolet light spectrum. But use a sunscreen! II has been shown thaI the average person gets only 15% of his annual ultraviolet exposure on vacations. It is the steady exposure to low doses of ultraviolet light that appears to pose the greatest threat of causing skin cancers.
• How pro/ecllveIs Zinc Oxide? Zinc Oxide has been shown to have a protective factor of only 5 to 7! and If il is wiped off in an area, the protective factor 15 tOlally lost. Baby all offers no protection.
• Which Is the best sunscreen? The firs! consideration In selecting a sunscreen 15 the SPF. The SPF on a given sunscreen may be any
number from 2 to 15 (some sunscreens c1atm a
higher SPF than 15, but there Is no evidence of any
additional benefit derived (rom any product Wfth an
SPF greater than 15). Many people choose a
sunscreen with a low SPF because they would like
to have some protectfon but sUI[ gel a tan. (I should be noled thai some tanning will take place even
through a sunscreen with an SPP of 15. Therefore, sll)ce one may still develop that "healthy glow'l even wllh the use of a sunscreen, bUI help to prevenl damage to the skin II) the form of sunburn, skin cancer, premature aging tmd wrinklln9, there Is no good reason not to use a sunscreen,
Atlanta Dermatological Association
Fig. 2. Six-page informational pamphlet from the Atlanta Dermatological Association,
Volume 14 Number 4 April, 1986
The solar meter 679
eign countries and have even helped local South Florida school boards to have education topics about sun exposure in the classrooms. This type of program can be set up anywhere, and with the interest and help of local media coverage the process of educating the public is expedited. Support and help by local dermatologic societies and their members by use of informational pamphlets, as shown in Fig. 2 from the Atlanta Dermatological Association, are beneficial. The solar meter and the sunburn index are good foundations on which to base a program. They are much like the pollution index-the more you hear about it, the more you believe it may be for real! National programs, such as the Melanoma Skin Cancer Detection Week, are essential, but the continued momentum must come from local programs, local projects, local health fair clinics, and
local exposure, which will benefit the local patient and will also benefit the local dermatologic community. Requests for information about the meter and program organization should be forwarded to: William L. Dobes, M.D., 478 Peachtree S1., N.E., Atlanta, GA 30308. REFERENCES 1. Scotto J, Fears TR, Fraumeni F J r: Incidence of nonmelanoma skin cancer in the United States: Publication No. (NIH) 82-2433. Bethesda, 1981, U.S. Department of Health and Human Services. 2. Berger DS, Urbach F: A climatology of sunburning ultraviolet radiation. Photochem PhotobioI35:187-192, [982. 3. Morison WL: What is the function of melanin. Arch Dermatol 121:1160-1163, 1985. 4. Dobes WL: Sun damage to the skin: Aging, wrinkling, and cancer. Med Assoc Oa 1:496-498, 1984.
ABSTRACTS Psoriasis, alcohol, and liver disease Chaput J-C, Poynard T, Naveau S, et al: Br Med J 291:25, 1985 Psoriasis and alcohol consumption were noted among 1,987 subjects admitted between November 1981 and November 1983. No patient was treated with methotrexate. There were 639 subjects who had drunk more than 50 gm (mean, 120 gm) alcohol daily for at ieast 5 years. Ten of the 1,348 nondrinkers (0.7%) had psoriasis compared with thirtyfour of the 639 drinkers (5.3%; p < 0.001). J. Graham Smith. Jr.. M.D.
HTLV-III antibodies in drug addicts in Spain Rodrigo 1M, Serra MA, Aguilar E, et al: Lancet 2: 156-157, 1985 In Spain as in the United States and the United Kingdom, prevalence of antibodies to HTLV-III in drug addicts has increased. HTLV-III seropositivity was 0% in 1983 among addicts with less than a 20-month history of addiction, rising to 50% in 1984. Addicts for periods longer than 65 months had a 20% incidence in 1983 and 64% in 1984. Thus, the increased seropositivity to HTLV-1lI antibodies in Spain is related to duration of drug addiction and has been increasing as in other countries. J. Graham Smith. Jr., M.D.
Inoculation of cryptococcosis without transmission of the acquired immunodeficiency syndrome Glaser JB, Garden A: N Engl ] Med 313:266, 1985 A 24-year old medical student developed cryptococcosis of the thumb following an accidental needlestick with blood from a patient with cryptococcal fungemia and a positive HTLV-IlI serologic test. This is the second report of transmission of an infectious agent, the previous one being hepatitis B, but not HTLV-111, after percutaneous exposure. There is also one previous report of seroconversion with HTLV-IIl following inoculation of a small amount of blood. J. Graham Smith, Jr., M.D.
Is localised scleroderma A Borrelia infection? Aberer E, Neumann R, Stanek K: Lancet 2:278, 1985 Sera from ten patients with morphea were tested for antibodies against Borrelia burgdOlj'eri. Sera from forty-four patients with noninfectious dermatologic diseases served as controls. Five of the patients with long-standing morphea had antibodies. Of the five patients whose test results were negative, three had received high-dose penicillin. All forty-four control samples were negative. J. Graham Smith, Jr., M.D.
The public is becoming more aware of health and its correlation to fitness. The attitude of selfhelp and self-education is in vogue. One critical area to help educate the public and reduce and prevent problems is in mass media education about the sun's ultraviolet radiation and its damaging effects. Local dermatologists became aware of this factor in 1977-1978 when the National Cancer Institute did a survey of eight cities (Seattle, Minneapolis-St. Paul, Detroit, Utah [state}, San Francisco, New Orleans, New Mexico [state], and Atlanta), showing that Atlanta had the highest rate of skin cancer of those areas studied-393.8 per 100,000.' The Department of Dermatology at Emory University believed it to be prudent at that time for us to initiate some form of an educational program locally. After many alternative considerations, we decided to use the Berger sunburn ultraviolet meter as our central focal point. 2 The project was funded by local dermatologists, pharmaceutical company support, and the Department of Dermatology. The sunburn meter was chosen for specific reasons. The Berger ultraviolet meter has a spectral response that resembles the skin's erythema action spectrum (Fig. 1). This response is therefore wavelength-dependent and cannot give absolute energy measurements. It is accurate at a small zenith-mornings and evenings. It is thereby indicative of the skin's general erythema response and therefore uses a general term, the sunburn unit. This unit is defined as a minimal erythema dose (MED) on an average untanned skin, at sea level, with an overhead sun in a clear sky, and a stratospheric ozone of 2 to 6 mm thickness. Using the data from the meter, we have been able to calculate units in half-hour measurements with approximately 440 U equaling one sunburn unit or MED in Atlanta. The data are listed in
676
1.00 8 6 4
Human skin action spectrum (Best fit)
2
(/)
;t::
c:
::J
.. Q)
>
III Q)
ex:
0.10 8 6 4 2
0.01 8 6 4 2
0.001 8 6 4 2
275 300 325 350 375
Wavelength, nm Fig. 1. Sunburning ultraviolet meter.
Table 1. It is important to notice from Table I that on standard time (add 1 hour for daylight saving time; DST) high noon in Atlanta is at 12:29 and the highest unit readings are around 12:30 (1 :30 DST). It is also important to note that the sun intensity is high in Atlanta from 10 A.M. until 5 P.M.; not the 10 to 2 P.M. we seem to believe as dogma from the past. This is based on the observation that the units measured at 10 and 17 (5 P,M.) are almost the same. An education program was developed around the meter, converting the units into the sunburn index This is done by taking the units as times (Table in Table I per half hour and dividing by 440 U to get one MED. This information is given daily to the national weather service, which has been very helpful in putting it out on our local weather Na-
II'.
Volume 14 Number 4
The solar meter 677
April, 1986
Table I. Atlanta, GA, Department of Dermatology-year, 1983; month, July; standard time Hour
Meter units measured
Hour
Meter units measured
0-30 to 6-0 6-30 7-0 8-0 8-30 9-0 9-30 10-0 10-30 11-0 11-30 12-0 12-30 13-0
000 002 006 046 086 142 211 290 374 464 551 60 671 699
13-30 14-0 14-30 15-0 15-30 16-0 16-30 17-0 17-30 18-0 18-30 19-0 20-0 21-0 to 24-0
705 688 656 597 519 428 336 253 184 122 073 037 004 000
Table II. Sunburn index in minutes Standard time Date
10 A.M.
12 noon
2 P.M.
4 P.M.
May 27-June 2
46* 44 44 42 43
23 22 22 21 22
22 20 20 20 21
29 34 31 31 31
June June June June
3-9 10-16 17-23 24-30
*Measurement in minutes to get a MED on untanned skin.
tional Oceanic and Atmospheric Administration (NOAA) wire for all to use locally if they desire, from Memorial Day to Labor Day. Since the start of the program, the local paper has included the 2 P.M. time in its weather page daily. Numerous television and radio stations periodically use the data to tell the public how long they may stay out before damage tends to accumulate to get a MED. The shortcomings of the time measurement, such as a cloudy or rainy day, are important. Individual variations such as skin type or sun-induced skin thickness and tan will change the MED. 3 To simplify the sun exposure risk so that the public could understand it better, the program started in 1985 at the University of Alabama used a degree of danger range, low (below 400 U), medium (450-600 U), high (600-800 U), and dangerous (800 + U). * *Sams WM (University of Alabama): Personal communication, July
7, 1985.
As one can see, there is no absolute guideline that will apply to everyone's skin, but the principle of all of this is not to use the times as absolutes, but to use the times as a general educational tool to teach the public about ultraviolet damage caused by the sun. If you hear about, read about, and talk about sun ultraviolet damage enough, you will soon begin to think that maybe there is some factual information one should believe in the presentations. This has been the case with our program. The first year we started, we had national coverage; every year since, we have had local, state, and national coverage. The local community, Atlanta Dermatological Association, Emory University, and the University of Georgia have all been asked for talks, interviews, and programs about the meter, sun ultraviolet damage, sunscreens, prevention, and skin cancer. 4 We have helped set up programs since we started in other states and for-
678
Journal of the American Academy of Dermatology
Dobes
SUNLIGHT SUNSCREENS and SKIN CANCER
SKIN CANCER IN ATIANrA
SUN INTENSITY INDEX
Atlanta has one of the highest Incidences of skin cancer In the nation, according to the National Cancer Institute, which conducted a survey of eight major metropolitan U.S. cities. The survey showed that Atlanta had an incidence of 393 squamous cell or basal cell cancers per 100,000 at risk population, I.e., those affair complexion. This data is frightening In that It shows an Increase in the incidence of skin cancer as well as a very high local occurrence rate. This Is probably due to the Scottish, Irish, fair-skinned descent of much of the Atlanta population, but also may 1>< partly accounted for by the higher elevation of the city. For this reason, people who live In this area are much more al risk of developing skin cancer and should 1>< extremely cautious In avoiding sun damage.
The Sun Intensity Index Is a measurement of the ultraviolet light which shines on Atlanta. The figures used to calculate the Sun Intensily Index are derived from past years' accumulation of data of ultraviolet light durtng a penod of time in Ihal month In Alianta. These figures are then used to calculate the amount of sunlight 1\ takes for a nontanned, fair-skinned individual to get red. The Sun Intensity Index Is given out by many of the media (newspapers, radio, and television stations) throughoUI this area and Is extremely helpful In predicting how long an Individual can safely stay In the sun before damage begins. The Index Is calculated for clear days; cloud cover affecls the time slgnUicanliy, as does the utilization of sunscreens, which will Increase one's tolerance of sun exposure markedly.
SUNSCREEN PROTECTIVE FACTOR (SPF)
SOlAR METER READINGS
The SPF refers to the multiple of allowable sun exposure with a sunscreen applied (0 the skin as compared to no sunscreen applied to the sl
Atlanta Dermatological Association
FREQUENnY ASKED QUESTIONS • How proiectiue is a sun tan?
OUf best evidence 10 date fndlcates that a sun Ian of· fel'S no more protection than 2 or 3 SPF. It has been
wet! documented that although one may have a tan. radiatiQn damage still accumulates through the tan, To acquirE a tan one must accumulate sun ex-
posure Which wlll hurt the skIn. For this reason, just
lyIng In the sun or using
1>
ell
tanning parlor, booth or
• Are there any other topleal treatments that may reduce aging and wrinkling, or prevent ft, such as C
these provide any benefit,
whQtsoever~
In preven-
ting aging or v.n:lnkling, However, sInce chronic sun
exposure may accelerate wrinkling and aging of Ihe skin, the Judicious use of .sunscreens vJould seem In~
dlcaled.
During the summer months the Nallonal Weather Service transmits a reading gathered from Emory University's Solar MeIer, which Is given out at 10 a.m., 12 noon, 2 p.m.. and 4 p.m. Each of the readings Is the measure of time thallt would take untanned skin to turn red. This, In essence, Is the amount o( time It takes (or a fair complexioned Individual, on exposure at lhet time, to expenence sun damage. (Examples: Middle of the month readings during July 1983 were: 10 a.m.-43 minutes, 12 noon-21 minutes, 2 p.m,-20 minutes, 4 p.m.-31 minutes). As one can see from typica' readings, II fakes very little outdoor exposure to accumulate damage. The benefit of using sunscreens at all times Is evident.
Your dermatologist may be consulted regarding the choice of a sunscreen. There is no one
sunscreen Ihat fJls everyone. Some Individuals may be allergic to certain ingredients in a sunscreen, and some sunscreens may be acne
producing. No prescription Is necessary even for the sunscreens with a 15 SPF. In fact, since each of the prolective ingredients In a given sunscreen blocks only a portion of the sunburn rays, all of the higher SPF sunscreens contain two or more
agents, In order to protect against a wider range of
the ultraviolet light spectrum. But use a sunscreen! II has been shown thaI the average person gets only 15% of his annual ultraviolet exposure on vacations. It is the steady exposure to low doses of ultraviolet light that appears to pose the greatest threat of causing skin cancers.
• How pro/ecllveIs Zinc Oxide? Zinc Oxide has been shown to have a protective factor of only 5 to 7! and If il is wiped off in an area, the protective factor 15 tOlally lost. Baby all offers no protection.
• Which Is the best sunscreen? The firs! consideration In selecting a sunscreen 15 the SPF. The SPF on a given sunscreen may be any
number from 2 to 15 (some sunscreens c1atm a
higher SPF than 15, but there Is no evidence of any
additional benefit derived (rom any product Wfth an
SPF greater than 15). Many people choose a
sunscreen with a low SPF because they would like
to have some protectfon but sUI[ gel a tan. (I should be noled thai some tanning will take place even
through a sunscreen with an SPP of 15. Therefore, sll)ce one may still develop that "healthy glow'l even wllh the use of a sunscreen, bUI help to prevenl damage to the skin II) the form of sunburn, skin cancer, premature aging tmd wrinklln9, there Is no good reason not to use a sunscreen,
Atlanta Dermatological Association
Fig. 2. Six-page informational pamphlet from the Atlanta Dermatological Association,
Volume 14 Number 4 April, 1986
The solar meter 679
eign countries and have even helped local South Florida school boards to have education topics about sun exposure in the classrooms. This type of program can be set up anywhere, and with the interest and help of local media coverage the process of educating the public is expedited. Support and help by local dermatologic societies and their members by use of informational pamphlets, as shown in Fig. 2 from the Atlanta Dermatological Association, are beneficial. The solar meter and the sunburn index are good foundations on which to base a program. They are much like the pollution index-the more you hear about it, the more you believe it may be for real! National programs, such as the Melanoma Skin Cancer Detection Week, are essential, but the continued momentum must come from local programs, local projects, local health fair clinics, and
local exposure, which will benefit the local patient and will also benefit the local dermatologic community. Requests for information about the meter and program organization should be forwarded to: William L. Dobes, M.D., 478 Peachtree S1., N.E., Atlanta, GA 30308. REFERENCES 1. Scotto J, Fears TR, Fraumeni F J r: Incidence of nonmelanoma skin cancer in the United States: Publication No. (NIH) 82-2433. Bethesda, 1981, U.S. Department of Health and Human Services. 2. Berger DS, Urbach F: A climatology of sunburning ultraviolet radiation. Photochem PhotobioI35:187-192, [982. 3. Morison WL: What is the function of melanin. Arch Dermatol 121:1160-1163, 1985. 4. Dobes WL: Sun damage to the skin: Aging, wrinkling, and cancer. Med Assoc Oa 1:496-498, 1984.
ABSTRACTS Psoriasis, alcohol, and liver disease Chaput J-C, Poynard T, Naveau S, et al: Br Med J 291:25, 1985 Psoriasis and alcohol consumption were noted among 1,987 subjects admitted between November 1981 and November 1983. No patient was treated with methotrexate. There were 639 subjects who had drunk more than 50 gm (mean, 120 gm) alcohol daily for at ieast 5 years. Ten of the 1,348 nondrinkers (0.7%) had psoriasis compared with thirtyfour of the 639 drinkers (5.3%; p < 0.001). J. Graham Smith. Jr.. M.D.
HTLV-III antibodies in drug addicts in Spain Rodrigo 1M, Serra MA, Aguilar E, et al: Lancet 2: 156-157, 1985 In Spain as in the United States and the United Kingdom, prevalence of antibodies to HTLV-III in drug addicts has increased. HTLV-III seropositivity was 0% in 1983 among addicts with less than a 20-month history of addiction, rising to 50% in 1984. Addicts for periods longer than 65 months had a 20% incidence in 1983 and 64% in 1984. Thus, the increased seropositivity to HTLV-1lI antibodies in Spain is related to duration of drug addiction and has been increasing as in other countries. J. Graham Smith. Jr., M.D.
Inoculation of cryptococcosis without transmission of the acquired immunodeficiency syndrome Glaser JB, Garden A: N Engl ] Med 313:266, 1985 A 24-year old medical student developed cryptococcosis of the thumb following an accidental needlestick with blood from a patient with cryptococcal fungemia and a positive HTLV-IlI serologic test. This is the second report of transmission of an infectious agent, the previous one being hepatitis B, but not HTLV-111, after percutaneous exposure. There is also one previous report of seroconversion with HTLV-IIl following inoculation of a small amount of blood. J. Graham Smith, Jr., M.D.
Is localised scleroderma A Borrelia infection? Aberer E, Neumann R, Stanek K: Lancet 2:278, 1985 Sera from ten patients with morphea were tested for antibodies against Borrelia burgdOlj'eri. Sera from forty-four patients with noninfectious dermatologic diseases served as controls. Five of the patients with long-standing morphea had antibodies. Of the five patients whose test results were negative, three had received high-dose penicillin. All forty-four control samples were negative. J. Graham Smith, Jr., M.D.