- Email: [email protected]
Sun protection fun: An educational outreach initiative by a dermatology interest group
Letters 1091
J AM ACAD DERMATOL VOLUME 57, NUMBER 6
fistulae, and draining sinuses located in the intertriginous regions. Each patient was required to have 12 total lesions at baseline. Only 2 of the 5 patients completed a full 12-week course of therapy. Regardless, none of the patients derived clinical benefit from the therapy (Table I). Specifically, patient 1 experienced a worsening of disease that required antibiotic therapy and withdrew from the study after 8 weeks of treatment. Patient 2 displayed a worsening of disease activity through 12 weeks of therapy. Approximately 12 weeks after her last efalizumab injection she was given the diagnosis of ductal carcinoma of her left breast and underwent a lumpectomy. We assessed the malignancy as possibly related to the study medication. No other treatment for the malignancy was required. Patient 3 received one efalizumab injection but was lost to follow-up. Patient 4 received a complete 12 weeks of treatment and displayed no improvement in her condition. Patient 5 was hospitalized overnight for a severe migraine headache one day after her first injection of efalizumab. She had a long history of migraine activity that was well-controlled before the study. She continued to experience headaches daily after her hospital discharge, yet elected to continue on the study, receiving two more doses of efalizumab before deciding to withdraw from study because of continuing headaches that resolved after discontinuing efalizumab. None of the 5 patients displayed either an abnormality or significant alteration in any laboratory value. Hidradenitis suppurativa is a chronic, inflammatory disease of the apocrine sweat glands, primarily affecting the intertriginous areas. Severe, refractory disease often requires surgical management, systemic corticosteroids, or other immunosuppressive therapies. Systemic retinoids have been helpful in some patients, but remission is infrequent. Safer, effective, and long-term therapies currently are under examination. For example, an examination of finasteride showed promise in a small pilot study.1 Tumor necrosis factor-a-inhibiting medications such as infliximab, adalimumab, and etanercept also have been reported to successfully treat hidradenitis
NOTES
suppurativa.2-4 Most recently, short-contact aminolevulinic acid-photodynamic therapy therapy using a blue light for activation has been reported as effective.5 Our study demonstrates that efalizumab may be ineffective in the treatment of women with severe, treatment-refractory hidradenitis suppurativa. The negative results of this study may indicate that the pathophysiology of hidradenitis suppurativa is not dependent on either T-cell activation or T-cell migration to sites of inflammation. But the small population of patients enrolled and treated necessarily limits any definitive conclusions about the origin of this complex disease. Bruce E. Strober, MD, PhD, Carolyn Kim, MD, and Kimberly Siu, MD Department of Dermatology, New York University School of Medicine Genentech Inc provided the medication efalizumab and partially funded the study. Disclosure: Dr Strober has acted as a speaker, advisor, consultant, and/or investigator for Abbott, Amgen, Astellas, Genentech, Centocor, Novo Nordisk, and Wyeth. Drs Kim and Siu have no conflicts of interest to declare. Reprints not available from the author. Correspondence to: Bruce E. Strober, MD, PhD E-mail: [email protected] REFERENCES 1. Joseph MA, Jayaseelan E, Ganapathi B, Stephen J. Hidradenitis suppurativa treated with finasteride. J Dermatol Treat 2005; 16:75-8. 2. Rosi YL, Lowe L, Kang S. Treatment of hidradenitis suppurativa with infliximab in a patient with Crohn’s disease. J Dermatol Treat 2005;16:58-61. 3. Cusack C, Buckley C. Etanercept: effective in the management of hidradenitis suppurativa. Br J Dermatol 2006;154:726-9. 4. Moul DK, Korman NJ. Severe hidradenitis suppurativa treated with adalimumab. Arch Dermatol 2006;142:1110-2. 5. Gold M, Bridges TM, Bradshaw VL, Boring M. ALA-PDT and blue light therapy for hidradenitis suppurativa. J Drugs Dermatol 2004;3(1 Suppl):S32-5. doi:10.1016/j.jaad.2007.07.032
& COMMENTS
Sun protection fun: An educational outreach initiative by a dermatology interest group To the Editor: We read with interest the study by Irwin et al1 regarding the SkinSAT program, which
educates middle- and high-school students about sun protection and acne. We agree on the difficulty in conveying the importance of daily sun protection for skin cancer prevention to the general public, and
1092 Letters
J AM ACAD DERMATOL DECEMBER 2007
Fig 1. A bracelet, made using ultraviolet (UV) lightsensitive beads, shown activated by sunlight.
have found a greater challenge in educating children and adolescents. Because individuals in these age groups often have increased concerns with their appearances, we found this integrated approach of presenting sun-protective measures alongside acne information to be interesting and innovative. As the incidence of skin cancer continues to increase yearly, we strongly agree with the authors’ assertion on the need for more educational outreach programs to reinforce the importance of sun protection. To address this tremendous need of widespread awareness regarding skin cancer prevention in south Florida, the University of Miami Miller School of Medicine’s Dermatology Interest Group developed an educational outreach program entitled ‘‘Sun Protection Fun’’ in the fall of 2006. This program is an ongoing community service initiative aimed at educating elementary schooleaged students on the harmful effects of the sun. A detailed overview of SPF can be found at the following link: http:// dermatology.med.miami.edu/education_SPF.asp. Our program begins with a multimedia PowerPoint (Microsoft, Redmond, Wash) presentation, which assesses the students’ current knowledge and behaviors and shares important facts and recommendations regarding sun damage and protection. A video is then shown demonstrating children experimenting with sunscreen effectiveness.2 An interactive session follows with a segment in which a volunteer student is dressed up by his or her newly educated peers for a fun day at the beach using sun-safe props. The program concludes with an arts and crafts activity completed in small groups in which the dermatology interest group medical students help the elementary students make bracelets using ultraviolet (UV) lightesensitive beads (Fig 1). These special beads remain clear indoors, but change color (activate) in the presence of UV light, which serves as a reminder of the importance of sun protection. This informal interactive
time provides a forum for addressing any remaining questions and reinforcing key concepts from the presentation. Knowing how difficult it can be to capture the attention of young students on such an important topic, we purposely incorporated activities that conveyed the same important message through a variety of learning styles approaches. More than 300 elementary students have participated in our program, with feedback from the teachers being, for example, that the program ‘‘was very informative to the students and myself about what damage the sun can do to your skin.’’ In addition, although the children have continued to exhibit sun-safety practices (eg, wearing their UV lightesensitive bracelets) 5 months after our presentation, we do acknowledge the need for a formal evaluation of this program, including outcome measures (ie, fewer sunburns and increased sunscreen use). We share our outreach program on skin health and sun protection to promote similar programs to SkinSAT and Sun Protection Fun and make an impact in early education. Rajiv I. Nijhawan, BS, Shalu S. Patel, BS, Sarah Stechschulte, BA, and Sharon E. Jacob, MD Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida Supported by a University of Miami Alumni Association John K. Robinson Grant. Conflicts of interest: None declared. Reprint requests: Sharon E. Jacob, MD, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1259 NW 14 St, Cedars Medical Center, South Bldg, Suite L, Miami, FL 33125 E-mail: [email protected] REFERENCES 1. Irwin B, Mauriello D, Hemminger L, Pappert A, Kimball AB. Skin sun-acne tutorial evaluation among middle- and high-school students in central New Jersey. J Am Acad Dermatol 2007;56: 407-12. 2. DragonflyTV: Body and Brain. Sunscreen by Aaron and Justin [videotape]. PBS Kids; 2006. Available at: http://pbskids.org/ dragonflytv/show/sunscreen.html. Accessed June 25, 2007. doi:10.1016/j.jaad.2007.08.006
Dietary fat, fiber, and acne vulgaris To the Editor: I read with great interest the recent article by Smith et al.1 Based on a controlled dietary intervention study, this group makes a strong argument for nutritional factors being of relevance in
J AM ACAD DERMATOL VOLUME 57, NUMBER 6
fistulae, and draining sinuses located in the intertriginous regions. Each patient was required to have 12 total lesions at baseline. Only 2 of the 5 patients completed a full 12-week course of therapy. Regardless, none of the patients derived clinical benefit from the therapy (Table I). Specifically, patient 1 experienced a worsening of disease that required antibiotic therapy and withdrew from the study after 8 weeks of treatment. Patient 2 displayed a worsening of disease activity through 12 weeks of therapy. Approximately 12 weeks after her last efalizumab injection she was given the diagnosis of ductal carcinoma of her left breast and underwent a lumpectomy. We assessed the malignancy as possibly related to the study medication. No other treatment for the malignancy was required. Patient 3 received one efalizumab injection but was lost to follow-up. Patient 4 received a complete 12 weeks of treatment and displayed no improvement in her condition. Patient 5 was hospitalized overnight for a severe migraine headache one day after her first injection of efalizumab. She had a long history of migraine activity that was well-controlled before the study. She continued to experience headaches daily after her hospital discharge, yet elected to continue on the study, receiving two more doses of efalizumab before deciding to withdraw from study because of continuing headaches that resolved after discontinuing efalizumab. None of the 5 patients displayed either an abnormality or significant alteration in any laboratory value. Hidradenitis suppurativa is a chronic, inflammatory disease of the apocrine sweat glands, primarily affecting the intertriginous areas. Severe, refractory disease often requires surgical management, systemic corticosteroids, or other immunosuppressive therapies. Systemic retinoids have been helpful in some patients, but remission is infrequent. Safer, effective, and long-term therapies currently are under examination. For example, an examination of finasteride showed promise in a small pilot study.1 Tumor necrosis factor-a-inhibiting medications such as infliximab, adalimumab, and etanercept also have been reported to successfully treat hidradenitis
NOTES
suppurativa.2-4 Most recently, short-contact aminolevulinic acid-photodynamic therapy therapy using a blue light for activation has been reported as effective.5 Our study demonstrates that efalizumab may be ineffective in the treatment of women with severe, treatment-refractory hidradenitis suppurativa. The negative results of this study may indicate that the pathophysiology of hidradenitis suppurativa is not dependent on either T-cell activation or T-cell migration to sites of inflammation. But the small population of patients enrolled and treated necessarily limits any definitive conclusions about the origin of this complex disease. Bruce E. Strober, MD, PhD, Carolyn Kim, MD, and Kimberly Siu, MD Department of Dermatology, New York University School of Medicine Genentech Inc provided the medication efalizumab and partially funded the study. Disclosure: Dr Strober has acted as a speaker, advisor, consultant, and/or investigator for Abbott, Amgen, Astellas, Genentech, Centocor, Novo Nordisk, and Wyeth. Drs Kim and Siu have no conflicts of interest to declare. Reprints not available from the author. Correspondence to: Bruce E. Strober, MD, PhD E-mail: [email protected] REFERENCES 1. Joseph MA, Jayaseelan E, Ganapathi B, Stephen J. Hidradenitis suppurativa treated with finasteride. J Dermatol Treat 2005; 16:75-8. 2. Rosi YL, Lowe L, Kang S. Treatment of hidradenitis suppurativa with infliximab in a patient with Crohn’s disease. J Dermatol Treat 2005;16:58-61. 3. Cusack C, Buckley C. Etanercept: effective in the management of hidradenitis suppurativa. Br J Dermatol 2006;154:726-9. 4. Moul DK, Korman NJ. Severe hidradenitis suppurativa treated with adalimumab. Arch Dermatol 2006;142:1110-2. 5. Gold M, Bridges TM, Bradshaw VL, Boring M. ALA-PDT and blue light therapy for hidradenitis suppurativa. J Drugs Dermatol 2004;3(1 Suppl):S32-5. doi:10.1016/j.jaad.2007.07.032
& COMMENTS
Sun protection fun: An educational outreach initiative by a dermatology interest group To the Editor: We read with interest the study by Irwin et al1 regarding the SkinSAT program, which
educates middle- and high-school students about sun protection and acne. We agree on the difficulty in conveying the importance of daily sun protection for skin cancer prevention to the general public, and
1092 Letters
J AM ACAD DERMATOL DECEMBER 2007
Fig 1. A bracelet, made using ultraviolet (UV) lightsensitive beads, shown activated by sunlight.
have found a greater challenge in educating children and adolescents. Because individuals in these age groups often have increased concerns with their appearances, we found this integrated approach of presenting sun-protective measures alongside acne information to be interesting and innovative. As the incidence of skin cancer continues to increase yearly, we strongly agree with the authors’ assertion on the need for more educational outreach programs to reinforce the importance of sun protection. To address this tremendous need of widespread awareness regarding skin cancer prevention in south Florida, the University of Miami Miller School of Medicine’s Dermatology Interest Group developed an educational outreach program entitled ‘‘Sun Protection Fun’’ in the fall of 2006. This program is an ongoing community service initiative aimed at educating elementary schooleaged students on the harmful effects of the sun. A detailed overview of SPF can be found at the following link: http:// dermatology.med.miami.edu/education_SPF.asp. Our program begins with a multimedia PowerPoint (Microsoft, Redmond, Wash) presentation, which assesses the students’ current knowledge and behaviors and shares important facts and recommendations regarding sun damage and protection. A video is then shown demonstrating children experimenting with sunscreen effectiveness.2 An interactive session follows with a segment in which a volunteer student is dressed up by his or her newly educated peers for a fun day at the beach using sun-safe props. The program concludes with an arts and crafts activity completed in small groups in which the dermatology interest group medical students help the elementary students make bracelets using ultraviolet (UV) lightesensitive beads (Fig 1). These special beads remain clear indoors, but change color (activate) in the presence of UV light, which serves as a reminder of the importance of sun protection. This informal interactive
time provides a forum for addressing any remaining questions and reinforcing key concepts from the presentation. Knowing how difficult it can be to capture the attention of young students on such an important topic, we purposely incorporated activities that conveyed the same important message through a variety of learning styles approaches. More than 300 elementary students have participated in our program, with feedback from the teachers being, for example, that the program ‘‘was very informative to the students and myself about what damage the sun can do to your skin.’’ In addition, although the children have continued to exhibit sun-safety practices (eg, wearing their UV lightesensitive bracelets) 5 months after our presentation, we do acknowledge the need for a formal evaluation of this program, including outcome measures (ie, fewer sunburns and increased sunscreen use). We share our outreach program on skin health and sun protection to promote similar programs to SkinSAT and Sun Protection Fun and make an impact in early education. Rajiv I. Nijhawan, BS, Shalu S. Patel, BS, Sarah Stechschulte, BA, and Sharon E. Jacob, MD Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida Supported by a University of Miami Alumni Association John K. Robinson Grant. Conflicts of interest: None declared. Reprint requests: Sharon E. Jacob, MD, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1259 NW 14 St, Cedars Medical Center, South Bldg, Suite L, Miami, FL 33125 E-mail: [email protected] REFERENCES 1. Irwin B, Mauriello D, Hemminger L, Pappert A, Kimball AB. Skin sun-acne tutorial evaluation among middle- and high-school students in central New Jersey. J Am Acad Dermatol 2007;56: 407-12. 2. DragonflyTV: Body and Brain. Sunscreen by Aaron and Justin [videotape]. PBS Kids; 2006. Available at: http://pbskids.org/ dragonflytv/show/sunscreen.html. Accessed June 25, 2007. doi:10.1016/j.jaad.2007.08.006
Dietary fat, fiber, and acne vulgaris To the Editor: I read with great interest the recent article by Smith et al.1 Based on a controlled dietary intervention study, this group makes a strong argument for nutritional factors being of relevance in