- Email: [email protected]
Vitamin D and sunscreens
Ab# 159-02
Ab# 159-04
ORAL RETINOIDS: THEN AND NOW Barbara Reed, MD, Clin Assoc Prof Derm, University of Colorado, Denver, CO, United States The purpose of this talk is to discuss patient safety and regulatory issues of oral retinoids. The first oral retinoid, isotretinoin, was approved for use in 1982, revolutionizing the treatment of severe, cystic acne. Since that time, other oral retinoids including acitretin, bexarotene, and tazarotene have been documented to ameliorate dermatologic and oncologic conditions as well. Patient safety concerns, including teratogenicity and depression, have been factors in determining risk management regulations by the US Food and Drug Administration. History, background, and present status of these regulations will be discussed.
TOP TEN VULVAR TRAPS Lynne Margesson, MD, FRCPC, Departments of Obstetrics and Gynecology and Medicine, Dartmouth Medical School, Hanover, NH, United States Vulvar disorders are missed all too commonly. They are either not seen or not recognized by caregivers. The vulva is not easily viewed and is seldom part of a ‘‘complete’’ skin examination. This is because of time constraints, patient modesty, and even denial of problems in an area of ongoing taboo and lack of confident expertise on the part of the caregivers. Complicating matters further, the appearance of dermatoses on the genital skin is often non-specific, making diagnosis more difficult. In dermatologic training and even in gynecology, the vulva is neglected. It is a small town that everyone passes through and no one notices! Patients usually have no education about this area. To them it is often unpleasant, damp and ‘‘down there.’’ They cannot see it and they sometimes do not want to even touch it. They are embarrassed to tell their caregivers that they have a ‘‘problem.’’ Compounding the situation is the difficulty of finding experienced caregivers for diagnosis and treatment. This presentation is a brief overview of traps to avoid in managing the commonest vulvar diseases.
Nothing to disclose.
Nothing to disclose.
Ab# 159-03 VITAMIN D AND SUNSCREENS Marianne O’Donoghue, MD, Rush University Medical Center, Chicago, IL, United States In December of 2003, Michael Holick, MD wrote an editorial in the Mayo Clinic Proceedings concerning vitamin D deficiency. In this article he strongly criticized dermatologists for advising their patients to use sunscreen at all times. He felt that the original safety records for vitamin D and sunscreens from xeroderma pigmentosa patients did not represent the norm. In May, in that same journal, Holick stated ‘‘that sunphobic propaganda from the American Academy of Dermatology and affiliated nonprofit, sunscreen industry-sponsored organizations such as the Skin Alliance has resulted in a resurgence of vitamin D deficiency in both children and adults throughout the United States.’’1 Mark Dahl, MD responded to that article in May 2004 in the Proceedings. Holick had advised judicious daily exposures to sunlight to prevent vitamin D deficiency. Dr Dahl believes that ‘‘every photon hitting the skin could produce a photomutation leading to skin cancer.’’ Plotnikoff and Quigley published an article in the Mayo Clin Proc in December 2003 entitled ‘‘Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain.’’ In this article, 100% of African Americans, East Africans, Hispanics, and American Indians in their Minnesota-based study had deficient levels and vitamin D. Tangpricha et al reported 32% of healthy young white men and women in Boston aged l8 to 29 years were vitamin D-deficient at the end of winter. There is a valid concern for hypovitaminosis D in all ages, especially those patients prone to osteoporosis. When skin is exposed to sufficient UVB, the hormonal cascade for endogenous production of vitamin D is activated. The prohormone 7dehydrocholesterol is converted into pre-vitamin D3 which is chemically altered by the skin’s temperature into cholecalciferol. Cholecalciferol is transported in the blood and is cleared from the blood by the liver, where it is converted into 25hydroxycholecalciferol. This is converted into calcitriol. This vitamin D analogue serves to elevate the plasma concentrations of calcium and phosphorus and in a feedback loop with the parathyroid glands prevents parathyroid hormone (PTH) from increasing osteoclastic action which would lead to the release of calcium from the bones to the serum. Besides osteoporosis and osteomalacia, vitamin D may have a role is controlling hypertension, and it may act as a tumor suppressant in breast, colorectal, and prostate cancers.Dietary supplementation, especially in whole milk, has helped control ricketts. Most adults are not large milk drinkers, and skimmed milk does not supply as much vitamin D as whole milk. It may be wise for our patients to take supplemental vitamin D along with using their sunscreen. To correct a deficiency the dose of vitamin D is 50,000 IU weekly for 8 weeks, than once or twice per month for maintenance.
MARCH 2005
Ab# 159-05
J AM ACAD DERMATOL
AB15
Ab# 159-04
ORAL RETINOIDS: THEN AND NOW Barbara Reed, MD, Clin Assoc Prof Derm, University of Colorado, Denver, CO, United States The purpose of this talk is to discuss patient safety and regulatory issues of oral retinoids. The first oral retinoid, isotretinoin, was approved for use in 1982, revolutionizing the treatment of severe, cystic acne. Since that time, other oral retinoids including acitretin, bexarotene, and tazarotene have been documented to ameliorate dermatologic and oncologic conditions as well. Patient safety concerns, including teratogenicity and depression, have been factors in determining risk management regulations by the US Food and Drug Administration. History, background, and present status of these regulations will be discussed.
TOP TEN VULVAR TRAPS Lynne Margesson, MD, FRCPC, Departments of Obstetrics and Gynecology and Medicine, Dartmouth Medical School, Hanover, NH, United States Vulvar disorders are missed all too commonly. They are either not seen or not recognized by caregivers. The vulva is not easily viewed and is seldom part of a ‘‘complete’’ skin examination. This is because of time constraints, patient modesty, and even denial of problems in an area of ongoing taboo and lack of confident expertise on the part of the caregivers. Complicating matters further, the appearance of dermatoses on the genital skin is often non-specific, making diagnosis more difficult. In dermatologic training and even in gynecology, the vulva is neglected. It is a small town that everyone passes through and no one notices! Patients usually have no education about this area. To them it is often unpleasant, damp and ‘‘down there.’’ They cannot see it and they sometimes do not want to even touch it. They are embarrassed to tell their caregivers that they have a ‘‘problem.’’ Compounding the situation is the difficulty of finding experienced caregivers for diagnosis and treatment. This presentation is a brief overview of traps to avoid in managing the commonest vulvar diseases.
Nothing to disclose.
Nothing to disclose.
Ab# 159-03 VITAMIN D AND SUNSCREENS Marianne O’Donoghue, MD, Rush University Medical Center, Chicago, IL, United States In December of 2003, Michael Holick, MD wrote an editorial in the Mayo Clinic Proceedings concerning vitamin D deficiency. In this article he strongly criticized dermatologists for advising their patients to use sunscreen at all times. He felt that the original safety records for vitamin D and sunscreens from xeroderma pigmentosa patients did not represent the norm. In May, in that same journal, Holick stated ‘‘that sunphobic propaganda from the American Academy of Dermatology and affiliated nonprofit, sunscreen industry-sponsored organizations such as the Skin Alliance has resulted in a resurgence of vitamin D deficiency in both children and adults throughout the United States.’’1 Mark Dahl, MD responded to that article in May 2004 in the Proceedings. Holick had advised judicious daily exposures to sunlight to prevent vitamin D deficiency. Dr Dahl believes that ‘‘every photon hitting the skin could produce a photomutation leading to skin cancer.’’ Plotnikoff and Quigley published an article in the Mayo Clin Proc in December 2003 entitled ‘‘Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain.’’ In this article, 100% of African Americans, East Africans, Hispanics, and American Indians in their Minnesota-based study had deficient levels and vitamin D. Tangpricha et al reported 32% of healthy young white men and women in Boston aged l8 to 29 years were vitamin D-deficient at the end of winter. There is a valid concern for hypovitaminosis D in all ages, especially those patients prone to osteoporosis. When skin is exposed to sufficient UVB, the hormonal cascade for endogenous production of vitamin D is activated. The prohormone 7dehydrocholesterol is converted into pre-vitamin D3 which is chemically altered by the skin’s temperature into cholecalciferol. Cholecalciferol is transported in the blood and is cleared from the blood by the liver, where it is converted into 25hydroxycholecalciferol. This is converted into calcitriol. This vitamin D analogue serves to elevate the plasma concentrations of calcium and phosphorus and in a feedback loop with the parathyroid glands prevents parathyroid hormone (PTH) from increasing osteoclastic action which would lead to the release of calcium from the bones to the serum. Besides osteoporosis and osteomalacia, vitamin D may have a role is controlling hypertension, and it may act as a tumor suppressant in breast, colorectal, and prostate cancers.Dietary supplementation, especially in whole milk, has helped control ricketts. Most adults are not large milk drinkers, and skimmed milk does not supply as much vitamin D as whole milk. It may be wise for our patients to take supplemental vitamin D along with using their sunscreen. To correct a deficiency the dose of vitamin D is 50,000 IU weekly for 8 weeks, than once or twice per month for maintenance.
MARCH 2005
Ab# 159-05
J AM ACAD DERMATOL
AB15