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Radiotherapy in dermatology: How past practices influence current uses
1085
362
Past and contemporary myths and misconceptions of oculocutaneous albinism in Africa Christopher Chu, Baylor College of Medicine, Houston, TX, United States; Harry Dao, MD, Baylor College of Medicine, Houston, TX, United States
Spiritual and religious aspects of skin and skin disorders Philip Shenefelt, MD, University of South Florida, Tampa, FL, United States
Albinism is couched in mystery in African countries. While albinism’s prevalence worldwide is around 1:20,000, consanguineous marriages in Africa have led to much higher rates, with prevalence as high as 1:4000 in Zimbabwe and 1:1429 in Tanzania. A survey in 2008 by Lund on children with albinism revealed that views on albinism in Africa are heavily intertwined with culture and superstition. The majority of the 138 children with albinism surveyed did not understand their condition; only 15 out of 138 children with albinism suggested a biologic reason. Others believed that their condition was the result of God, the devil, or witchery. While some beliefs are benign, other superstitions have proven more dangerous. In Tanzania, witchdoctors have spread the myth that individuals with albinism and their body parts have superpowers. Fishermen use nets woven from albino hair believing these nets will catch more fish. Witch doctors use body parts from afflicted individuals as ingredient in potions or as a trinket for jewelry to bring good fortune and wealth to those who possess them. In 2007, over seventy documented cases of albino killings had been reported. By 2013, there were a reported 207 killings of albinos by ‘‘albino hunters.’’ Currently, up to $75,000 may be offered for a set of arms, legs, ears, and genitals from an individual with albinism. Other dangerous misconceptions of albinism include the belief that the mother was impregnated by a white man, or that the devil replaced the child with an albino. Others may believe albinism is contagious. As a result of these beliefs, both the mother and the child are often marginalized. Children with albinism are ridiculed, beaten, avoided by peers, and even denied the visitation of family members at work. One particular damaging misconception is that albinism is due to a lack of sun. Albino children find themselves placed outside to become accustomed to the sun and adults with albinism are encouraged to work outdoors as frequently as possible, further increasing their risk of skin cancer. Given the frequency of OCA in Africa, dermatologist may frequently encounter a person with albinism from Africa. By understanding the myths surrounding albinism and the persecution of albinism in Africa, clinicians may be able to better counsel, comprehend, and treat both the individual with the condition and the family; as family support is a key factor in determining the future mortality or morbidity of the afflicted child.
Skin and skin disorders have had spiritual dimensions since ancient times. Skin, hair, and nails are visible to self and others and touchable by self and others. The skin is a major sense organ. Skin also expresses emotions detectable by others through pallor, coldness, ‘‘goose bumps,’’ redness, warmth, or sweating. Spiritual and religious significances of skin are revealed through how much of the skin has been and continues to be covered with what kind of coverings, scalp and beard hair cutting, shaving, and styling, skin, nail and hair coloring and decorating, tattooing, and intentional scarring of skin. Persons with visible skin disorders have often been stigmatized or even treated as outcasts. Shamans and other spiritual and religious healers have brought about healing of skin disorders through spiritual means. Spiritual and religious interactions with various skin disorders such as psoriasis, leprosy, and vitiligo are discussed. Religious aspects of skin and skin diseases are evaluated for several major religions. Commercial support: None identified.
Commercial support: None identified.
1800
Radiotherapy in dermatology: How past practices influence current uses Robert Griffith, MD, University of Miami Miller School of Medicine, Miami, FL, United States; Brian Simmons, University of Miami Miller School of Medicine, Miami, FL, United States; Leyre Falto-Aizpurua, MD, University of Miami Miller School of Medicine, Miami, FL, United States; Keyvan Nouri, MD, University of Miami Miller School of Medicine, Miami, FL, United States Since its discovery 120 years ago, ionizing radiation has played a role in the treatment of cutaneous disease. Soon after its introduction as a medical therapy, radiation was found to improve hypertrichosis and a number of inflammatory skin conditions. In larger doses, radiotherapy was used to cure tumors of the skin. In the first 50 years after its introduction, radiotherapy was frequently used to treat acne vulgaris, tinea capitis, and plantar warts. However, long-term adverse effects, such as chronic dermatitis, skin ulcers, and cutaneous malignancy began to appear in patients treated with radiation. At the same time, various alternative treatment options became available for the skin diseases for which radiation therapy had been used. Consequently, the use of radiotherapy for benign cutaneous disease began to fall out of favor among dermatologists. Today, alternative treatment options have in large part supplanted the use of radiation therapy in dermatology. However, ionizing radiation remains an excellent therapeutic alternative for the treatment of cutaneous malignancies. This presentation will trace the use of radiation therapy in dermatology over time. By understanding the history of radiotherapy for the treatment of cutaneous diseases, clinicians may be able to better understand the advantages and disadvantages of ionizing radiation therapy and its current role in dermatology.
The history of skin cancer Leyre Falto-Aizpurua, MD, Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine, Miami, FL, United States; Robert Griffith, MD, Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine, Miami, FL, United States; Brian Simmons, Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine, Miami, FL, United States; Keyvan Nouri, MD, Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine, Miami, FL, United States The first descriptions of cancer are documented in Egyptian papyri dating 2500 BC. Hippocrates described nonulcer and ulcer forming tumors, which he named carcinos (Greek for crab) as these tumors had finger-like projections resembling a crab. Celsus later used the Latin term for crab, cancer, to refer to tumors. The term oncology comes from oncos (Greek for swelling), which Galen used to describe tumors. In the 19th century, scientific oncology proliferated with the introduction of the modern microscope. Laennac made the first description of melanoma in 1804, Jacob of basal cell carcinoma in 1827, and Bowen of squamous cell carcinoma in situ in 1912. Virchow, the founder of cellular pathology, provided the basics for modern cancer pathology as he demonstrated that cancer cells derived from other cells. He also hypothesized that chronic radiation caused cancer. A group of experiments performed by dermatologists, physicists and other medical scientists between the 19th and 20th century demonstrated that skin cancers were induced by UV radiation and that skin pigmentation had a protective effect from radiation. They also demonstrated that certain chemicals could potentiate skin damage and skin cancer formation, while other chemicals could block radiation and protect the skin. It was in 1928 that the first sunscreen became available. Although it was known that UV radiation could cause skin cancer, it was not until the 1940s that its damage to nucleic acids became evident. Furthermore, in the 1970s oncogenes and tumor suppressor genes were discovered as important gene families related to cancer development. Since the 16th century, cancers were treated with surgery as long as the tumor was localized. Mohs revolutionized skin cancer surgery in the 1930s, which method remains vital to the treatment of skin cancers today. Medical noninvasive treatment options became possible due to innovations in molecular biology in the 1960s. Photodynamic therapy and lasers were also added to the armamentarium for the treatment of actinic keratosis and cutaneous cancers. In 2012, vismodegib was approved for the treatment of metastasized or advanced basal cell carcinomas. Thanks to these discoveries, advancements in technology and the rapid evolution of molecular biology, today we have a greater comprehension of the pathophysiology of skin cancers and are able to prevent, appropriately diagnose and treat cutaneous malignancies.
Commercial support: None identified.
Commercial support: None identified.
1992
MAY 2015
J AM ACAD DERMATOL
AB27
362
Past and contemporary myths and misconceptions of oculocutaneous albinism in Africa Christopher Chu, Baylor College of Medicine, Houston, TX, United States; Harry Dao, MD, Baylor College of Medicine, Houston, TX, United States
Spiritual and religious aspects of skin and skin disorders Philip Shenefelt, MD, University of South Florida, Tampa, FL, United States
Albinism is couched in mystery in African countries. While albinism’s prevalence worldwide is around 1:20,000, consanguineous marriages in Africa have led to much higher rates, with prevalence as high as 1:4000 in Zimbabwe and 1:1429 in Tanzania. A survey in 2008 by Lund on children with albinism revealed that views on albinism in Africa are heavily intertwined with culture and superstition. The majority of the 138 children with albinism surveyed did not understand their condition; only 15 out of 138 children with albinism suggested a biologic reason. Others believed that their condition was the result of God, the devil, or witchery. While some beliefs are benign, other superstitions have proven more dangerous. In Tanzania, witchdoctors have spread the myth that individuals with albinism and their body parts have superpowers. Fishermen use nets woven from albino hair believing these nets will catch more fish. Witch doctors use body parts from afflicted individuals as ingredient in potions or as a trinket for jewelry to bring good fortune and wealth to those who possess them. In 2007, over seventy documented cases of albino killings had been reported. By 2013, there were a reported 207 killings of albinos by ‘‘albino hunters.’’ Currently, up to $75,000 may be offered for a set of arms, legs, ears, and genitals from an individual with albinism. Other dangerous misconceptions of albinism include the belief that the mother was impregnated by a white man, or that the devil replaced the child with an albino. Others may believe albinism is contagious. As a result of these beliefs, both the mother and the child are often marginalized. Children with albinism are ridiculed, beaten, avoided by peers, and even denied the visitation of family members at work. One particular damaging misconception is that albinism is due to a lack of sun. Albino children find themselves placed outside to become accustomed to the sun and adults with albinism are encouraged to work outdoors as frequently as possible, further increasing their risk of skin cancer. Given the frequency of OCA in Africa, dermatologist may frequently encounter a person with albinism from Africa. By understanding the myths surrounding albinism and the persecution of albinism in Africa, clinicians may be able to better counsel, comprehend, and treat both the individual with the condition and the family; as family support is a key factor in determining the future mortality or morbidity of the afflicted child.
Skin and skin disorders have had spiritual dimensions since ancient times. Skin, hair, and nails are visible to self and others and touchable by self and others. The skin is a major sense organ. Skin also expresses emotions detectable by others through pallor, coldness, ‘‘goose bumps,’’ redness, warmth, or sweating. Spiritual and religious significances of skin are revealed through how much of the skin has been and continues to be covered with what kind of coverings, scalp and beard hair cutting, shaving, and styling, skin, nail and hair coloring and decorating, tattooing, and intentional scarring of skin. Persons with visible skin disorders have often been stigmatized or even treated as outcasts. Shamans and other spiritual and religious healers have brought about healing of skin disorders through spiritual means. Spiritual and religious interactions with various skin disorders such as psoriasis, leprosy, and vitiligo are discussed. Religious aspects of skin and skin diseases are evaluated for several major religions. Commercial support: None identified.
Commercial support: None identified.
1800
Radiotherapy in dermatology: How past practices influence current uses Robert Griffith, MD, University of Miami Miller School of Medicine, Miami, FL, United States; Brian Simmons, University of Miami Miller School of Medicine, Miami, FL, United States; Leyre Falto-Aizpurua, MD, University of Miami Miller School of Medicine, Miami, FL, United States; Keyvan Nouri, MD, University of Miami Miller School of Medicine, Miami, FL, United States Since its discovery 120 years ago, ionizing radiation has played a role in the treatment of cutaneous disease. Soon after its introduction as a medical therapy, radiation was found to improve hypertrichosis and a number of inflammatory skin conditions. In larger doses, radiotherapy was used to cure tumors of the skin. In the first 50 years after its introduction, radiotherapy was frequently used to treat acne vulgaris, tinea capitis, and plantar warts. However, long-term adverse effects, such as chronic dermatitis, skin ulcers, and cutaneous malignancy began to appear in patients treated with radiation. At the same time, various alternative treatment options became available for the skin diseases for which radiation therapy had been used. Consequently, the use of radiotherapy for benign cutaneous disease began to fall out of favor among dermatologists. Today, alternative treatment options have in large part supplanted the use of radiation therapy in dermatology. However, ionizing radiation remains an excellent therapeutic alternative for the treatment of cutaneous malignancies. This presentation will trace the use of radiation therapy in dermatology over time. By understanding the history of radiotherapy for the treatment of cutaneous diseases, clinicians may be able to better understand the advantages and disadvantages of ionizing radiation therapy and its current role in dermatology.
The history of skin cancer Leyre Falto-Aizpurua, MD, Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine, Miami, FL, United States; Robert Griffith, MD, Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine, Miami, FL, United States; Brian Simmons, Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine, Miami, FL, United States; Keyvan Nouri, MD, Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine, Miami, FL, United States The first descriptions of cancer are documented in Egyptian papyri dating 2500 BC. Hippocrates described nonulcer and ulcer forming tumors, which he named carcinos (Greek for crab) as these tumors had finger-like projections resembling a crab. Celsus later used the Latin term for crab, cancer, to refer to tumors. The term oncology comes from oncos (Greek for swelling), which Galen used to describe tumors. In the 19th century, scientific oncology proliferated with the introduction of the modern microscope. Laennac made the first description of melanoma in 1804, Jacob of basal cell carcinoma in 1827, and Bowen of squamous cell carcinoma in situ in 1912. Virchow, the founder of cellular pathology, provided the basics for modern cancer pathology as he demonstrated that cancer cells derived from other cells. He also hypothesized that chronic radiation caused cancer. A group of experiments performed by dermatologists, physicists and other medical scientists between the 19th and 20th century demonstrated that skin cancers were induced by UV radiation and that skin pigmentation had a protective effect from radiation. They also demonstrated that certain chemicals could potentiate skin damage and skin cancer formation, while other chemicals could block radiation and protect the skin. It was in 1928 that the first sunscreen became available. Although it was known that UV radiation could cause skin cancer, it was not until the 1940s that its damage to nucleic acids became evident. Furthermore, in the 1970s oncogenes and tumor suppressor genes were discovered as important gene families related to cancer development. Since the 16th century, cancers were treated with surgery as long as the tumor was localized. Mohs revolutionized skin cancer surgery in the 1930s, which method remains vital to the treatment of skin cancers today. Medical noninvasive treatment options became possible due to innovations in molecular biology in the 1960s. Photodynamic therapy and lasers were also added to the armamentarium for the treatment of actinic keratosis and cutaneous cancers. In 2012, vismodegib was approved for the treatment of metastasized or advanced basal cell carcinomas. Thanks to these discoveries, advancements in technology and the rapid evolution of molecular biology, today we have a greater comprehension of the pathophysiology of skin cancers and are able to prevent, appropriately diagnose and treat cutaneous malignancies.
Commercial support: None identified.
Commercial support: None identified.
1992
MAY 2015
J AM ACAD DERMATOL
AB27