The Chronicle of Skin & Allergy Mar. 2015

C l i n i c a l p r a c t i c e

Improved clinicalapproach to Dxof hypertrophicdiscoid lupusn SI 6 > C > C g� E A 6 H B 6 8 yI D > 99 : C 9 G > I > 8 � 8 : A A H � 8 6 A A : 9 � 6wD G I = w= > A : � 6 E E G D 6 8 = � I D9 > 6 gC D H > H � D ; � 9 > H : 6 H :by JOHN EVANS,Assistant Editor, The Chronicle

IB B J C D = > H I D 8 = : B > 8 6 A A y � B 6 E -E > C g� I = : � 9 : C H > I y� 6 C 9 � 9 > H I G > bJ I > D CD ; � E A 6 H B 6 8 yI D > 9 � 9 : C 9 G > I > 8 � 8 : A A H

(PDC)� > H � 6 � v6 A J 6 bA : � 9 > 6 gC D H I > 8 � I D D A � > C8 6 H : H � D ; � H J H E : 8 I : 9 � = yE : G I G D E = > 8 � 9 > H -8 D > 9 � A J E J H � : G y I = : B 6 I D H J H � (HDLE),G : H : 6 G 8 = : G H � ; G D B � D6 A = D J H > : � UC > v: G H > I y> C � H6 A > ; 6 x� G : E D G I � > C � 6 � E 6 E : G � E J bA > H = : 9> C � I = : � Journal of CutaneousPathology (J6 C .� 2015;� 42(1):32R 38).

HDLE� “8 6 C � H D B : I > B : H � b: � B > H I 6 k-: C � ; D G � H qJ 6 B D J H � 8 : A A � 8 6 G 8 > C D B 6 � D G6 8 I > C > 8 � k : G 6 I D H > H ,” � H 6 y H � DG . � ND G : : CW6 A H = ,� 9 : G B 6 I D E 6 I = D A D g> H I � 6 C 9 � E G D -; : H H D G � D ; � E 6 I = D A D gy� 6 I � H6 A > ; 6 x’H � C6 E > I 6 AD > H I G > 8 I � H : 6 A I = � A J I = D G > I y � 6 C 9D6 A = D J H > : � UC > v: G H > I y,� 6 C 9 � I = : � H : C > D G6 J I = D G � D ; � I = : � H I J 9 y.� “II � > H � H D B : I > B : HB > H I 6 k: C � ; D G � E G : -B 6 A > gC 6 C I � D G � B 6 A > g-C 6 C I � H k> C � A : H > D C H .”

R: 8 : C I � A > I : G 6 I J G : � = 6 H � H = D wC � PDCH= 6 v: � 6 � E 6 I = D A D g> 8 6 A � H > gC > ; > 8 6 C 8 : � > C8 J I 6 C : D J H � A J E J H � : G yI = : B 6 I D H J H ,� 6 C 9I = : � 9 > H I G > b J I > D CE 6 I I : G C H � D ; � PDCH> C � 9 > ; ; : G : C I � B 6 C > -; : H I 6 I > D C H � D ; � I = :9 > H : 6 H : � 6 G : � > C ; D G -B 6 I > v : . � “T = > H � > HI = : � 8 6 H : � > C � 9 > H -8 D > 9 � A J E J H � 6 C 9A J E J H � E G D ; J C 9 J H ,”H 6 y H � D G . � W6 A H = .“B: 8 6 J H : � [PDCH ]= 6 v: � b: : C � H = D wC � I D � b: � D ; � 9 > 6 gC D H I > 8b: C : ; > I � > C � D I = : G � I yE : H � D ; � 8 J I 6 C : D J HA J E J H ,� I� I = D J g= I � I = 6 I � I = : y� B > g= I � 6 A H Db: � D ; � J H : � > C � = yE : G I G D E = > 8 � A J E J H .”

I C � I = > H � H I J 9 y, � G : H : 6 G 8 = : G H � J H : 9CD123� 6 C I > bD 9 y� > B B J C D = > H I D 8 = : B -> H I G y � I D � A 6 b: A � I = : � PDCH � > C � 27� I > H H J :H 6 B E A : H � D ; � HDLE,� I 6 k: C � ; G D B � C > C :E 6 I > : C I H .� T= : � qJ 6 C I > I > : H � D ; � PDCH � 6 C 9

Please turn to HDLE page 11à

D: G B 6 I D A D gy� L> ; : � QJ 6 A > I y� I C 9 : x(DLQI)� 6 C 9 � I = : � S = D G I � F D G B � 36V: G H > D C � 2� (SF-36v2). � T = :G : H : 6 G 8 = : G H; D J C 9 � I = 6 II = : � B : 6 CDLQI� H 8 D G :w6 H � 10� ±� 8.8,w= > 8 = � > H � : v: C= > g = : G � I = 6 CB 6 C y� H : G > D J H9 : G B 6 I D A D g > 8 � 8 D C 9 > I > D C H . � T = :6 J I = D G H � G : E D G I : 9 � I = 6 I � I = : � SF-36v2H 8 D G : H � w: G : � H > gC > ; > 8 6 C I A y� G : 9 J 8 : 9

PRACTICAL THERAPEUTICS and CLINICAL NEWS from the WORLD of DERMATOLOGY n MARCH 2015

by EMILY INNES,Assistant Editor, The Chronicle

H> 9 G 6 9 : C > I > H � H J E E J G 6 I > v 6(HS)� 8 6 C � H > g C > ; > 8 6 C I A y6 ; ; : 8 I � 6 � E 6 I > : C I ’H � qJ 6 A > I y� D ;

A > ; : � (QD L)� 6 C 9 � I = : � 9 : gG : : � D ; � > B E 6 8 I8 D G G : A 6 I : H � w> I = � I = : � H : v: G > I y� D ; � I = :8 D C 9 > I > D C ,� 6 8 8 D G 9 > C g� I D � I = : � ; > C 9 > C gHD ; � 6 � C 6 C 6 9 > 6 C � H I J 9 y � E J b A > H = : 9D C A > C : � > C � I = : � American Journal ofClinical Dermatology (F: b.� 2015).�

F> ; I y-; > v: � HS� E 6 I > : C I H � ; G D B � 8 D B -B J C > I y � 9 : G B 6 I D A D gy � 8 A > C > 8 H � > CO C I 6 G > D � 8 D B E A : I : 9 � b D I = � I = :


HS significantly impacts patientquality of life: Canadian studynGG : 6 I : G � 6 w6 G : C : H H � D ; � HS� C : : 9 : 9 � I D � > B E G D v: � 9 > 6 gC D H > H ,� B 6 C 6 g: B : C I

o f & A L L E R G YSKINSKINThe Chronicle

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; D G � bD I = � E = yH > 8 6 A � 6 C 9 � B : C I 6 A � = : 6 A I = .�T= : � 6 J I = D G H � ; D J C 9 � I = 6 I � I = : � H : v: G > -

I y� D ; � 9 > H : 6 H : ,� 6 H � B : 6 H J G : 9 � by� HJ G A : yH I 6 g> C g� 6 C 9 � I = : � C J B b: G � D ; � A : H > D C H ,w: G : � H > gC > ; > 8 6 C I A y� 8 D G G : A 6 I : 9 � w> I = � I = :DLQI� H 8 D G : H . � P 6 I > : C I H � w> I = � = > g = : GHJ G A : y� H I 6 g> C g� H 8 D G : H —> .: .,� 6 � H 8 D G : � D ;III—= 6 9 � I = : � = > g= : H I � DLQI� H 8 D G : H .�

Assessing impact on QoLDG .� A; H 6 C : = � AA 6 v> ,� w> I = � I = : � UC > v: G H > I yD ; � TD G D C I D ’H � D: E 6 G I B : C I � D ; � M: 9 > 8 > C : ,9 > G : 8 I D G � D ; � I = : � wD J C 9 � = : 6 A > C g� ; : A A D w-H = > E � 6 I � WD B : C ’H � CD A A : g: � HD H E > I 6 A � 6 C 9I = : � H I J 9 y’H � A : 6 9 � 6 J I = D G ,� H 6 yH � H = : � w6 H6 w 6 G : � I = 6 I � HS � = 6 9 � 6 C � > B E 6 8 I � D CE 6 I > : C I H ’� A > v: H ,� 6 C 9 � w6 H � E G > B 6 G > A y� > C I : G -

Please turn to HS page 14à

n The Chronicle is committed tomaintaining leadership in envi-ronmentally sustainable poli-cies, and to encouraging theadoption of “green-aware” prac-tices in healthcare. We inviteyour comments via e-mail, at:[email protected]

T h e r a p i e s

Oral small molecule new optionfor treatment of plaque psoriasisnAE G : B > A 6 H I � E G D v> 9 : H � ; A : x> b> A > I y� 6 H � 8 A > C > 8 > 6 C H8 D C H > 9 : G � b: H I � 8 = D > 8 : � I D � I G : 6 I � I = : H : � E 6 I > : C I Hby JOHN EVANS, Assistant Editor, The Chronicle

H : 6 A I = � C6 C 6 9 6 ’H � 6 E E G D v6 A � D ; � D G 6 A � 6 E G : B > A 6 H I � G : E G : H : C I H � 6H 6 ; : ,� : ; ; : 8 I > v: � I G : 6 I B : C I � D E I > D C � I = 6 I � w> A A � g> v: � 8 A > C > 8 > 6 C H6 C 9 � E 6 I > : C I H � 6 9 9 : 9 � ; A : x> b> A > I y� > C � I = : � I G : 6 I B : C I � D ; � B D 9 : G -

6 I : � I D � H : v: G : � E A 6 qJ : � E H D G > 6 H > H ,� H 6 y� C6 C 6 9 > 6 C � 9 : G B 6 I D A D g> H I H .T= : � C : w� ; D G B J A 6 I > D C � > H Please turn to Apremilast page 16à

Dr. Afsaneh Alavi

Dr. Noreen Walsh

RosaceaEmergingtherapies

New clinicalalternatives

See page 4

Skin_March_2015,rar16_ms_9.1_rar1_Skin_March_2014,rar1.qxd 09/04/2015 12:25 PM Page 1

NEWCICAPLAST BAUME B5With La Roche-Posay Thermal Spring Water

REPAIRING BALM

A COMPLETE FORMULA FOR DRY SKIN IRRITATIONS*

Panthenol 5% • Madecassoside • Copper • Zinc • Manganese• Shea Butter

INGREDIENTS: AQUA • HYDROGENATED POLYISOBUTENE • DIMETHICONE • GLYCERIN • BUTYROSPERMUM PARKII BUTTER / SHEA BUTTER • PANTHENOL • BUTYLENE GLYCOL • ALUMINUM STARCH OCTENYLSUCCINATE • PROPANEDIOL • CETYLPEG / PPG-10 / 1 DIMETHICONE • TRISTEARIN • ZINC GLUCONATE • MADECASSOSIDE • MANGANESE GLUCONATE • MAGNESIUM SULFATE • DISODIUM EDTA • COPPER GLUCONATE • ACETYLATED GLYCOL STEARATE • POLYGLYCERYL-4 ISOSTEARATE • SODIUM BENZOATE • PHENOXYETHANOL • CHLORHEXIDINE DIGLUCONATE • CI 77891 / TITANIUM DIOXIDE.

* Due to dry skin.

1. Soothes and relieves dry skin areas

2. Repairs

3. Protects (Isolating texture for anti-bacterial adhesion)

Very good tolerance demonstrated on babies, children and adults.TESTED UNDER DERMATOLOGICAL AND PEDIATRIC CONTROL

Fragrance-freeParaben-freeLanolin-free

Dry patchesand chapping

Infantredness

Roughareas

Intensedryness

Cutaneousheating

sensations

Cracks

La Roche-Posay. Committed to dermatology.


THE CHRONICLE of SKIN & ALLERGY

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �Vol. 21, No. 2 M6 G 8 = � 2015� ·� 3

R e s e a r c h

Skin patch for immunotherapy

TOP ofthe MONTH

Cellular dermatofibromas shouldalways be completely excisedR> H kH � H J 8 = � 6 H � 6 � = > g= � G 6 I : � D ; � G : 8 J G -G : C 8 : � 6 C 9 � G 6 G : � G : E D G I : 9 � 8 6 H : H � D ;B : I 6 H I 6 H : H � w> I = � b: C > gC � 8 : A A J A 6 G � 9 : G -B 6 I D ; > bG D B 6 H ,� 6 H � w: A A � 6 H � 6 � A D w� G > H kD ; � B 6 A > gC 6 C I � I G 6 C H ; D G B 6 I > D C , � A : 6 98 A > C > 8 > 6 C � I D � J G g: � 8 D B E A : I : � : x8 > H > D CD ; � I = : H : � A : H > D C H . � . � . � . � . � . � . � . � . � .6

Surveying the current dermatologicliterature: Low-dose cyclosporineplus glucosamine for AD, and more THE CHRONICLE’H � H : A : 8 I > D C � D ; � C D I 6 bA :9 : v: A D E B : C I H � > C � 9 : G B 6 I D A D gy,� w> I =8 D B B : C I 6 G y� E G D v> 9 : 9 � by� DG .� K6 I > :B: A : zC 6 y,� 8 A > C > 8 6 A � > C H I G J 8 I D G � > C � I = :D : E 6 G I B : C I � D ; � D : G B 6 I D A D gy� 6 C 9Sk> C � S8 > : C 8 : , � UC > v: G H > I y� D ; � BG > I > H =CD A J B b> 6 ,� V6 C 8 D J v: G .� .� .� .� .� .� .� .� .� .� .� 8

Changes called for in counsellingprocess for patients on isotretinoinJAMA H I J 9 y� ; > C 9 H � I = 6 I � w= > A : � wD B : CJ C 9 : G H I D D 9 � I = : � G > H kH � D ; � b: 8 D B > C gE G : gC 6 C I � w= > A : � D C � > H D I G : I > C D > C ,� B D H Iw: G : � 8 D J C H : A A : 9 � 6 bD J I � D G 6 A � 8 D C I G 6 -8 : E I > v: H � bJ I � 9 > 9 � C D I � G : 8 : > v: � 6 9 : qJ 6 I :> C ; D G B 6 I > D C � 6 bD J I � D I = : G � : ; ; : 8 I > v :; D G B H � D ; � b> G I = � 8 D C I G D A .� .� .� .� .� .� .� .� .� .� .� .25

Chronicle Postgraduate Educational SupplementI C � I = > H � B D C I = ’ H � C = G D C > 8 A : � P D H I �-gG 6 9 J 6 I : � E9 J 8 6 I > D C 6 A � SJ E E A : B : C I ,G : G B 6 C � G : H : 6 G 8 = : G H � 6 H H : H H � I = :6 H H D 8 > 6 I > D C � D ; � v 6 G > 6 I > D C � > C � I = :LAMA3� g: C : ,� : C 8 D 9 > C g� I = : � 6 A E = 6 -8 = 6 > C � D ; � A 6 B > C > C 5,� w> I = � 6 I D E > 8 � 9 : G -B 6 I > I > H � > C � 6 � 8 6 H : -8 D C I G D A � H I J 9 y� .� . 21

“OG 6 A � 9 D H > C g� [D ; � 6 E G : B > A 6 H I ]� > H � 6 � B D G : � 8 D C v: C > : C ID E I > D C � ; D G � H D B : � E 6 I > : C I H .� SD B : � E 6 I > : C I H � B 6 y

6 E E G : 8 > 6 I : � I = > H � 6 H � A : H H � I = G : 6 I : C > C g� D G � A : H H � > C v6 H > v:6 C 9 � B 6 y� b: � B D G : � D E : C � I D � > I � .� .� .”

Dr. Norman Wasel, assistant clinical professor of medicine,University of Alberta, Edmonton (see page 1)

A� b: I I : G � G D J I : � I D � G : I G 6 > C � I = : � > B B J C :H yH I : B � D ; � E : D E A : � w> I = � ; D D 9 � 6 A A : G g> : HB 6 y� b: � I = G D J g= � I = : � H k> C ,� 6 8 8 D G 9 > C g� I D; > C 9 > C gH � ; G D B � G : H : 6 G 8 = : G H � 6 I � I = : � J6 ; ; :FD D 9 � AA A : G gy� I C H I > I J I : � 6 I � I = : � KG 6 v> HC= > A 9 G : C ’H � HD H E > I 6 A � 6 I � MD J C I � S> C 6 > � > CN: w� YD G k� C> I y.

IC � 6 C � 6 G I > 8 A : � E J bA > H = : 9 � D C A > C : � > CH: 6 A I = D6 y� (F: b.� 23,� 2015),� H I J 9 y� A : 6 9DG . � HJ g= � S6 B E H D C , � 9 > G : 8 I D G � D ; � I = :J6 ; ; : � I C H I > I J I : , � H 6 > 9 � I = 6 I � w= > A : � I = : G := 6 H � b: : C � E G D gG : H H � > C � I = : � J H : � D ; � D G 6 A> B B J C D I = : G 6 E y� I D � : 6 H : � E : 6 C J I � 6 A A : G -g> : H ,� I = : � G 6 I : � D ; � 6 9 v: G H : � G : 6 8 I > D C H � = 6 Hb: : C � = > g= ,� 6 C 9 � 6 � C D v: A � H k> C � E 6 I 8 = � ; D G9 : A > v: G > C g� 8 D C I G D A A : 9 � 9 D H : H � D ; � 6 A A : G -g: C H � B 6 y� b: � H > gC > ; > 8 6 C I A y� H 6 ; : G .

CA > C > 8 6 A � I G > 6 A � 9 6 I 6 � ; G D B � I = : � C : w> B B J C D I = : G 6 E y� H k> C � E 6 I 8 = ,� E G : H : C I -: 9 � 6 I � I = : � A B : G > 8 6 C � A 8 6 9 : B y � D ;A A A : G gy, � AH I = B 6 , � 6 C 9 � I B B J C D A D gyH : H H > D C H � > C � F: bG J 6 G y,� H J gg: H I H � > C I G D -9 J 8 > C g� I = : � > B B J C : � H yH I : B � I D � 6 A A : G -

g: C � E G D I : > C H � I = G D J g= � I = : � H k> C � 8 6 C � b:b D I = � : ; ; : 8 I > v : � 6 C 9 � H 6 ; : G � I = 6 C � D G 6 A6 9 B > C > H I G 6 I > D C .�

IC � I = : � I G > 6 A ,� = 6 A ; � D ; � 221� E 6 G I > 8 > E 6 C I Hb: I w: : C � I = : � 6 g: H � D ; � H > x� 6 C 9 � 55� y: 6 G H ,6 A A � w> I = � E : 6 C J I � 6 A A : G gy,� wD G : � I = : � C : wE 6 I 8 = � ; D G � D C : � y: 6 G .� By� I = : � : C 9 � D ; � I = :I G : 6 I B : C I � E : G > D 9 ,� I = D H : � E 6 I > : C I H � w: G :6 bA : � I D � I D A : G 6 I : � 6 � B > C > B J B � D ; � D C :gG 6 B � D ; � E : 6 C J I � E G D I : > C —I = : � : qJ > v6 -A : C I � D ; � ; D J G � E : 6 C J I H —w= > 8 = � G : E G : H : C I -: 9 � 6 E E G D x> B 6 I : A y� 10� I > B : H � I = : � 6 B D J C II = : y� 8 D J A 9 � I D A : G 6 I : � 6 I � I = : � b: g> C C > C g� D ;I = : � I G > 6 A .� ExI : C 9 : 9 � E : G > D 9 H � D ; � w: 6 G > C gI = : � E 6 I 8 = � wD J A 9 � A > k: A y� E G D 9 J 8 : � : v: CgG : 6 I : G � > C 8 G : 6 H : H � > C � I D A : G 6 C 8 : .�

T= : � > B E G D v: B : C I H � D ; � : v: C � 6 � H > C -gA : � y: 6 G � D ; � J H : � 8 D J A 9 � bG > C g� H > gC > ; > 8 6 C IE : 6 8 : � D ; � B > C 9 � I D � I = D H : � w> I = � E : 6 C J I6 A A : G g> : H ,� H 6 > 9 � DG .� S6 B E H D C ,� H > C 8 : � I = :> C 8 G : 6 H : � > C � I D A : G 6 C 8 : � wD J A 9 � E G D I : 8 II = : B � ; G D B � 6 8 8 > 9 : C I 6 A � : xE D H J G : � 6 I � 6E 6 G I y, � ; D G � : x6 B E A : , � D G � wD G G y� 6 bD J IA 6 b: A H � I = 6 I � H 6 y� V B 6 y� 8 D C I 6 > C � E : 6 C J I ’.

From the News Resources of The Chronicle

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Neurology & Psychiatry, PediatricChronicle, The Chronicle ofHealthcare Marketing, Drug RepChronicle, and Linacre’s Books/LesEditions Linacre

March 2015 • Vol. 21 No. 2

Medical EditorWayne Gulliver, MD, FRCPC

Editor, Cosmetic DermatologySheldon V. Pollack, MD, FRCPC

Publisher Mitchell ShannonEditorial Director R. Allan Ryan

Senior Associate Editor Lynn BradshawAssistant Editors John Evans, Emily Innes

Production and Circulation Cathy Dusome

Sales & Marketing Sandi Leckie, RN

Founding Editor Colin A. Ramsay, MD, FRCPC (1936-2003)

John P. Arlette, MD, FRCPC

Benjamin Barankin, MD, FRCPC

Marc Bourcier, MD, FRCPC

Eric Goldstein, MD, FRCPC

Peter Hull, MD, FRCPC

Rod Kunynetz, MD, FRCPC

Richard Langley, MD, FRCPC

Danielle Marcoux, MD, FRCPC

R.A.W. Miller, MD, FRCPC

H. Eileen Murray, MD, FRCPC

Kim Papp, MD, FRCPC

Yves Poulin, MD, FRCPC

Melanie D. Pratt, MD, FRCPC

Denis Sasseville, MD, FRCPC

Jerry Tan, MD, FRCPC

Ronald B. Vender, MD, FRCPC

Contacting The Chroniclen READER SERVICE: TD � 8 = 6 C g: � yD J G � 6 9 9 G : H H ,� D G

; D G � qJ : H I > D C H � 6 bD J I � yD J G � G : 8 : > E I � D ; � I = : � jD J G C 6 A ,H : C 9 � 6 C � : -B 6 > A � I D � = : 6 A I = @8 = G D C > 8 A : .D G g� w> I =H J bj: 8 I � A > C : � “C> G 8 J A 6 I > D C ,”� D G � 8 6 A A � 9 J G > C g� bJ H > -C : H H � = D J G H � 6 I � 416.916.CHROC � (2476),� D G � I D A A -; G : : � 6 I � 866.63.CHRON� (24766).

n LETTERS: W: � w: A 8 D B : � yD J G � 8 D G G : H E D C 9 : C 8 :by� B 6 > A ,� ; 6 x� (416.352.6199),� D G � : -B 6 > A .� K> C 9 A yJ H : � I = : � 8 D -D G 9 > C 6 I : H � A > H I : 9 � 6 bD v: .

n ADVERTISING: FD G � 8 J G G : C I � G 6 I : H � 6 C 9 � 9 6 I 6 ,E A : 6 H : � 8 D C I 6 8 I � I = : � E J bA > H = : G .

n REPRINTS: T= : � 8 D C I : C I � D ; � I = > H � jD J G C 6 A � > H � 8 D E y-G > g= I : 9 .� PA : 6 H : � 8 D C I 6 8 I � M> I 8 = : A A � S= 6 C C D C � ; D GG : E G > C I � > C ; D G B 6 I > D C .

Comptroller Rose Arciero

A Message from theMedical Editor

FD G � I = D H : � D ; � J H � w= D � w: G : � 6 bA : � I D6 I I : C 9 � I = : � 6 C C J 6 A � H 8 > : C I > ; > 8 � H : H -H > D C H � D ; � I = : � AB : G > 8 6 C � A8 6 9 : B y

D ; � D: G B 6 I D A D gy� > C � S6 C � FG 6 C 8 > H 8 D , � > Iw6 H � G : 6 9 > A y� 6 E E 6 G : C II = 6 I � C6 C 6 9 > 6 C H � w: G :B 6 k> C g� 6 � = J g: � > B E 6 8 ID C � I = 6 I � g6 I = : G > C g.� F> G H I6 C 9 � ; D G : B D H I � w6 H � I = :g : C J > C : � b J zz � 6 C 9: x 8 > I : B : C I � 6 G D J C 9I = : � J E 8 D B > C g � 23 G 9

WD G A 9 � CD C gG : H H � D ; � D: G B 6 I D A D gy� > CV6 C 8 D J v: G ,� H 8 = : 9 J A : 9 � ; D G � JJ C : � 8� I D13,� 2015.� S: 8 D C 9 � w6 H � I = : � H > gC > ; > 8 6 C I8 D C I G > bJ I > D C � C6 C 6 9 > 6 C H � B 6 9 : � D C � I = :E D 9 > J B � 6 I � I = : � AAD,� w= : I = : G � > I � w6 HE G : H : C I > C g� C D v: A � 9 6 I 6 � 6 I � 6 � A 6 I : � bG : 6 k-> C g� H : H H > D C � D G � B 6 k> C g� 6 � B 6 jD G � 8 D C I G > -bJ I > D C � I D � D C : � D ; � I = : � w: A A - 6 I I : C 9 : 9H yB E D H > J B H .

THE CHRONICLE OF SKIN &� ALLERGY6 A H D � 8 D C I > C J : H � I D � 9 : B D C H I G 6 I : � = D wC6 C 6 9 > 6 C � 9 : G B 6 I D A D g> H I H � 6 G : � B 6 k> C g6 � B 6 jD G � 8 D C I G > bJ I > D C � I D � I = : � H E : 8 > 6 A A -I y,� w= : I = : G � > C � I = : � 6 G : 6 � D ; � E : 9 > 6 I G > 89 : G B 6 I D A D gy� w> I = � I = : � 9 : v: A D E B : C ID ; � I = : � C : w� TD G D C I D � E : 9 > 6 I G > 8 � > I 8 =H 8 6 A : � (H : : � E 6 g: � 16),� D G � D C � I = : � B : 9 -> 8 6 A � H > 9 : � w> I = � DG .� A; H 6 C : = � AA 6 v> � E G : -H : C I > C g� H I J 9 y� G : H J A I H � I = 6 I � = 6 v: � = > g= -A > g = I : 9 � I = : � I G J : � > B E 6 8 I � I = 6 I= > 9 G 6 9 : C > I > H � H J E E J G 6 I > v 6 � = 6 H � D CE 6 I > : C I H � (H : : � E 6 g: � 1).

DG .� S= 6 C : � S> A v: G � = 6 H � 6 � ; : w� E G 6 8 I > -8 6 A � H J G g> 8 6 A � I > E H � I = 6 I � w: G : � E G : H : C I : 99 J G > C g� I = : � 2014� CDA.� T= : H : � > C 8 A J 9 :

Please turn to Message page 24à

NEWCICAPLAST BAUME B5With La Roche-Posay Thermal Spring Water

REPAIRING BALM

A COMPLETE FORMULA FOR DRY SKIN IRRITATIONS*

Panthenol 5% • Madecassoside • Copper • Zinc • Manganese• Shea Butter

INGREDIENTS: AQUA • HYDROGENATED POLYISOBUTENE • DIMETHICONE • GLYCERIN • BUTYROSPERMUM PARKII BUTTER / SHEA BUTTER • PANTHENOL • BUTYLENE GLYCOL • ALUMINUM STARCH OCTENYLSUCCINATE • PROPANEDIOL • CETYLPEG / PPG-10 / 1 DIMETHICONE • TRISTEARIN • ZINC GLUCONATE • MADECASSOSIDE • MANGANESE GLUCONATE • MAGNESIUM SULFATE • DISODIUM EDTA • COPPER GLUCONATE • ACETYLATED GLYCOL STEARATE • POLYGLYCERYL-4 ISOSTEARATE • SODIUM BENZOATE • PHENOXYETHANOL • CHLORHEXIDINE DIGLUCONATE • CI 77891 / TITANIUM DIOXIDE.

* Due to dry skin.

1. Soothes and relieves dry skin areas

2. Repairs

3. Protects (Isolating texture for anti-bacterial adhesion)

Very good tolerance demonstrated on babies, children and adults.TESTED UNDER DERMATOLOGICAL AND PEDIATRIC CONTROL

Fragrance-freeParaben-freeLanolin-free

Dry patchesand chapping

Infantredness

Roughareas

Intensedryness

Cutaneousheating

sensations

Cracks

La Roche-Posay. Committed to dermatology.


by LOUISE GAGNON,Correspondent, The Chronicle

4 · M6 G 8 = � 2015

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �Lead article THE CHRONICLE of SKIN & ALLERGY

* vs. Embrace † vs. 3 blades on Venus Original

© 2014 P&G www.gillettevenus.ca

Contours better* to tricky areas for a fl awless shave

5 Contour blades are 6X more fl exible†

Water-activated MoistureGlide serum for incredible glide

MicroFine comb guides hair to the blades that capture virtually every hair

Gillette Venus, the #1 selling female razor brand in the world, introduces NEW Venus Swirl, a razor that sets a new standard in shaving. Designed by women for women, Venus Swirl combines the innovative four-way movement of FlexiBall technology and Gillette’s most advanced blades.

EASY MANEUVERABILITY. EASY CONTROL.


n TD E > 8 6 A � > v: G B : 8 I > C � 8 6 A A : 9 � 6 � “g6 B : � 8 = 6 C g: G ”� > C � I = : � I G : 6 I B : C I � D ; � G D H 6 8 : 6 ;� H = D wH � A 6 H I > C g� : ; ; : 8 I

W> I = � I = : � G : 8 : C I6 E E G D v 6 A � D ;I D E � > 8 6 A � > v : G -B : 8 I > C � ; D G � I = :I G : 6 I B : C I � D ;

G D H 6 8 : 6 � by� I = : � U.S.� FD D 96 C 9 � DG J g� A9 B > C > H I G 6 I > D C ,6 E E G D v6 A � > C � C6 C 6 9 6 � w> A A � 6 9 96 C D I = : G � > C I : gG 6 A � I D E > 8 6 A � I = : G -6 E y� C6 C 6 9 > 6 C � 9 : G B 6 I D A D -g> H I H � 8 6 C � E G : H 8 G > b: � I D � I = : > GE 6 I > : C I H .

“T= : � : v: C I J 6 A � 6 E E G D v6 A � D ; � I D E > 8 6 A> v: G B : 8 I > C � w> A A � b: � 6 � g6 B : � 8 = 6 C g: G ,”H 6 y H � D G . � B : C j 6 B > C � B 6 G 6 C k > C , 8 D -; D J C 9 : G � D ; � I = : � TD G D C I D � D: G B 6 I D A D gyC: C I G : . � “Iv : G B : 8 I > C � H : : B H � I D � b :B D G : � : ; ; : 8 I > v: � I = 6 C � B : I G D C > 9 6 z D A :6 C 9 � 6 z: A 6 > 8 � 6 8 > 9 � ; D G � E 6 E J A D E J H I J A 6 GG D H 6 8 : 6 . � II � > H � v: G y� : x8 > I > C g� b: 8 6 J H :> v: G B : 8 I > C � G : E G : H : C I H � 6 � w= D A : � C : w8 A 6 H H � D ; � B : 9 > 8 > C : . � I I � [ H J gg : H I H ]D: B D 9 : x� > H � E A 6 y> C g� 6 � b> g� G D A : � [> C � I = :9 : v: A D E B : C I � D ; � G D H 6 8 : 6 ].”

TD E > 8 6 A � > v : G B : 8 I > C � 6 ; ; : 8 I H � I = :D: B D 9 : x� B > I : H � I = 6 I � 6 G : � E G : H : C I � > C � I = :E > A D H : b6 8 : D J H � J C > I H � D ; � E 6 I > : C I H � w> I =G D H 6 8 : 6 .� T= : G : � = 6 H � b: : C � A > I : G 6 I J G : � D CI = : � D: B D 9 : x� > C ; : H I 6 I > D C � G : H E D C 9 > C gI D � 6 C � D G 6 A � ; D G B J A 6 I > D C � D ; � > v: G B : 8 I > C6 C 9 � I D E > 8 6 A � E : G B : I = G > C ,� bJ I � A > I I A : � D CI = : � J H : � D ; � I D E > 8 6 A � > v: G B : 8 I > C .�

More patients clear on ivermectinT= : � 6 E E G D v 6 A � D ; � > v : G B : 8 I > C � w 6 Hb6 H : 9 � D C � P= 6 H : � III� I G > 6 A H ,� w= : G : � > v: G -B : 8 I > C � 1%� 8 G : 6 B � w6 H � 8 D B E 6 G : 9 � I D

v: = > 8 A : .� F> C 9 > C gH � H = D w: 9 � I = : G : � w6 H � 6H I 6 I > H I > 8 6 A A y � H > g-C > ; > 8 6 C I � 9 > ; ; : G -: C 8 : � ; 6 v D J G > C gE 6 I > : C I H � w = DJ H : 9 � > v: G B : 8 I > C1%� > C � I = : � E : G -8 : C I 6 g : � D ;E 6 I > : C I H � w = Dw : G : � 8 A : 6 G � D GC : 6 G � 8 A : 6 G � 6 I � 12w: : kH � D ; � I = : G 6 -E y. � Ex I : C H > D CH I J 9 > : H � D ; � I = : � I G > -6 A H � 8 D C 9 J 8 I : 9 � I D: v 6 A J 6 I : � A D C g-I : G B � H 6 ; : I y � D ;> v : G B : 8 I > C � H 6 wE 6 I > : C I H � I G : 6 I : 9w > I = � v : = > 8 A :H w> I 8 = : 9 � I D � 6 z: -A 6 > 8 � 6 8 > 9 � 15%� g: A .�

D 6 I 6 � 6 A H D9 : B D C H I G 6 I : 9I = : G : � w 6 H � 69 : 8 G : 6 H : 9 � > C 8 > -9 : C 8 : � D ; � G : A 6 I : 96 9 v : G H : � : v : C I Hw > I = � > v : G B : 8 I > C8 D B E 6 G : 9 � I D � 6 z: -A 6 > 8 � 6 8 > 9 � 15%� g: A ,6 C 9 � C D � E 6 I > : C I HG : 8 : > v> C g� > v: G B : 8 I > C � 1%� 8 G : 6 B � 9 > H -8 D C I > C J : 9 � : > I = : G � H I J 9 y� b: 8 6 J H : � D ; � 6G : A 6 I : 9 � 6 9 v: G H : � : v: C I .

I C v : H I > g 6 I D G � g A D b6 A � 6 H H : H H B : C IG 6 I > C g H � H J E E D G I : 9 � > v : G B : 8 I > C � 1%8 G : 6 B � 6 H � 6 � I = : G 6 E y� I = 6 I � 8 6 C � b: � J H : 9; D G � I = : � A D C g-I : G B � > C � I = : � I G : 6 I B : C I � D ;E 6 E J A D E J H I J A 6 G � G D H 6 8 : 6 � (JDD 2014

ND v1;� 13(11):� 1380R 1386).OC : � D ; � I = :

6 I I G 6 8 I > v : � 8 = 6 G -6 8 I : G > H I > 8 H � D ; � I D E -> 8 6 A � > v: G B : 8 I > C � > H> I � = 6 H � 6 � A 6 H I > C g: ; ; : 8 I � b : y D C 9I = : G 6 E y, � D G .B6 G 6 C k> C � H 6 > 9 .� “IIH : : B H � I D � = 6 v :E G D E : G I > : H � I = 6 IG : B > I � I = : � 8 D C 9 > -I > D C .”�

D G . � M: A > C 9 6G D D 9 : G = 6 B , � 69 : G B 6 I D A D g > H I ,B : 9 > 8 6 A � 9 > G : 8 I D GD ; � Sk > C � C : C I G :; D G � D: G B 6 I D A D gy> C � P: I : G bD G D J g= ,OC I .,� 6 C 9 � 6 � 8 A > C > -8 6 A � I G > 6 A � > C v : H I > -

g6 I D G , � 6 gG : : 9 � I = 6 I � I = : � b: C : ; > I � w> I => v : G B : 8 I > C � J H : � 6 E E : 6 G H � I D � : x I : C 9b: yD C 9 � I G : 6 I B : C I .

“I� I = > C k� > I � w> A A � B 6 k: � 6 � b> g� 9 > ; ; : G -: C 8 : � > C � = D w� w: � I G : 6 I � D J G � E 6 I > : C I H ,”H 6 yH � DG .� GD D 9 : G = 6 B � > C � 6 C � > C I : G v> : w.“Ev : C � I = D J g = � E 6 I > : C I H � w : G : � C DA D C g: G � D C � > I ,� I = : y� 8 D C I > C J : 9 � I D � 9 D � b: I -I : G � 6 ; I : G � 6 8 I > v: � I G : 6 I B : C I � : C 9 : 9 . � I IH : : B H � I D � E J I � E 6 I > : C I H � > C I D � G : B > H H > D C .”

Additional treatment optionsT= : � 6 v6 > A 6 b> A > I y� D ; � bG > B D C > 9 > C : � I 6 G -I G 6 I : � > H � 6 � “gD D 9 � D E I > D C ”� ; D G � E 6 I > : C I Hw= D � = 6 v: � G D H 6 8 : 6 � 6 C 9 � H : : k� 6 � I D E > 8 6 AI = : G 6 E y� I D � I G : 6 I � b6 8 kgG D J C 9 � G : 9 C : H Hb: ; D G : � H E : 8 > ; > 8 � D 8 8 6 H > D C H , � : xE A 6 > C HDG .� L> H 6 � K: A A : I I ,� 6 � 9 : G B 6 I D A D g> H I � 6 C 9

Dr. BenjaminBarankin

Dr. Julia Carroll

Dr. Ian LandellsDr. MelindaGooderham

Dr. Lisa Kellett

Please turn to Rosacea page 12à

Emerging therapies offerclinical alternatives for

Rosacea


* vs. Embrace † vs. 3 blades on Venus Original

© 2014 P&G www.gillettevenus.ca

Contours better* to tricky areas for a fl awless shave

5 Contour blades are 6X more fl exible†

Water-activated MoistureGlide serum for incredible glide

MicroFine comb guides hair to the blades that capture virtually every hair

Gillette Venus, the #1 selling female razor brand in the world, introduces NEW Venus Swirl, a razor that sets a new standard in shaving. Designed by women for women, Venus Swirl combines the innovative four-way movement of FlexiBall technology and Gillette’s most advanced blades.

EASY MANEUVERABILITY. EASY CONTROL.


Another option in the treatment of acne

Help them face their acne

A proven treatment for moderate acne vulgaris

Demonstrated excellent adverse event profi le1

• Most frequently reported treatment-related adverse events were application site dermatitis (1%) and application site photosensitivity (1%)

If severe local irritation (e.g. severe erythema, severe dryness and itching, severe stinging/burning) develops, discontinue use and institute appropriate therapy.

3% benzoyl peroxide, 1% clindamycin

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46076_TAB_Clindoxyl_ADV_Chron_E.indd 2 2015-02-11 4:26 PM

by LOUISE GAGNON,Correspondent, The Chronicle

W= : C � 9 : G B 6 I D A D g> H I H � 6 G : � ; 6 8 : 9 � w> I = � 6E 6 I > : C I � w= D � = 6 H � 8 : A A J A 6 G � 9 : G B 6 I D ; > bG D -B 6 H ,� I = : y� H = D J A 9 � 8 D B E A : I : A y� : x8 > H : � I = :

A : H > D C H ,� 6 8 8 D G 9 > C g� I D � 6 � A : 8 I J G : G � > C � I = : � ; 6 8 J A I y� D ;B : 9 > 8 > C : � 6 I � I = : � UC > v: G H > I y� D ; � M6 C > I D b6 � > C � W> C C > E : g.

G> v> C g� ; : A A D w� 9 : G B 6 I D A D g> H I H � I > E H � D C � g: C : G 6 A9 : G B 6 I D A D gy� 6 I � 6 � E A : C 6 G y� H : H H > D C � 9 J G > C g� I = : � 6 C C J 6 AB : : I > C g� D ; � I = : � C6 C 6 9 > 6 C � D: G B 6 I D A D gy� AH H D 8 > 6 I > D C> C � TD G D C I D , � DG .� S= 6 C : � S> A v: GC D I : 9 � I = 6 I � I = : G : � 6 G : � G > H kH � 6 H H D -8 > 6 I : 9 � w> I = � 8 : A A J A 6 G � 9 : G B 6 I D ; > -bG D B 6 H , � w= > 8 = � 6 8 8 D J C I � ; D G6 bD J I � 5%� D ; � 8 J I 6 C : D J H � 9 : G -B 6 I D ; > bG D B 6 H � (Dermatol Surg2008;� 34(9):1264R 1271).

“T= : � G : 8 D B B : C 9 6 I > D C � > HI D � 6 A w6 yH � 8 D B E A : I : A y� : x8 > H :I = : � A : H > D C ,” � H 6 > 9 � D G . � S > A v : G .“T= : G : � > H � 6 � = > g= � G 6 I : � D ; � G : 8 J G G : C 8 : � 6 C 9 � G 6 G : � G : E D G I -: 9 � 8 6 H : H � D ; � B : I 6 H I 6 H : H � w> I = � b: C > gC � 8 : A A J A 6 G � 9 : G -B 6 I D ; > bG D B 6 H ,� 6 H � w: A A � 6 H � 6 � A D w� G > H k� D ; � B 6 A > gC 6 C II G 6 C H ; D G B 6 I > D C ” � (Am J Surg Pathol 2013;37(4):484R 495).

DG . � S > A v : G � H 6 > 9 � 8 : A A J A 6 G9 : G B 6 I D ; > bG D B 6 H ,� w= > 8 = � 6 G :6 A H D � G : ; : G G : 9 � I D � 6 H � 8 J I 6 -C : D J H � ; > bG D J H � = > H I > D 8 yI D B 6 H ,6 G : � 8 = 6 A A : C g > C g � I D � : x 8 > H : ,bJ I � > I � > H � > B E : G 6 I > v: � I = 6 I � I = : yb : � G : B D v : 9 � I D � G : 9 J 8 :E D I : C I > 6 A � ; D G � B 6 A > g C 6 C II G 6 C H ; D G B 6 I > D C .

“YD J � B 6 y� = 6 v: � I D � : x8 > H :I wD � D G � I = G : : � I > B : H � 6 C 9 � J H :w> 9 : � B 6 G g> C H � w= : C � yD J � 9 D ,”� = : � H 6 > 9 .

Square knot for closing woundsA� E : 6 G A � G : g6 G 9 > C g� H J G g> 8 6 A � I : 8 = C > qJ : � > H � I = : � J H : � D ;I = : � H qJ 6 G : � kC D I � ; D G � H J I J G > C g,� H 6 > 9 � DG .� S> A v: G ,� w= DG : 8 D B B : C 9 : 9 � I wD � I = G D wH � D C � I = : � C : : 9 A : � 9 G > v: G � > CD C : � 9 > G : 8 I > D C ,� D C : � I = G D w� I = : � D E E D H > I : ,� 6 C 9 � I = :; > C 6 A � I = G D w� I = : � H 6 B : � w6 y� 6 H � I = : � > C > I > 6 A � 9 > G : 8 I > D C .� ICwD J C 9 H � w> I = � I : C H > D C ,� > C H I : 6 9 � D ; � 9 D > C g� 6 � H : 8 D C 9I = G D w� I = : � D E E D H > I : � 9 > G : 8 I > D C � D ; � I = : � ; > G H I ,� 6 9 9 � D C :B D G : � I = G D w� > C � I = : � H 6 B : � 9 > G : 8 I > D C � H D � I = : � H J I J G :w> A A � H I 6 y� > C � E A 6 8 : � 6 C 9 � C D I � A D D H : C .� YD J � 8 6 C � I = : CE G D 8 : : 9 � w> I = � I = : � H : 8 D C 9 � 6 C 9 � I = > G 9 � I = G D w� 6 H � wD J A 9C D G B 6 A A y� b: � 9 D C : � I D � 8 D B E A : I : � I = : � H qJ 6 G : � kC D I .

OC : � E G 6 8 I > 8 : � B 6 C 6 g: B : C I � I > E � I = 6 I � DG .� S> A v: GH = 6 G : 9 � w> I = � 8 D A A : 6 gJ : H � > H � I D � = 6 v: � E 6 I > : C I H � 8 D C I 6 8 II = : � D ; ; > 8 : � D ; � I = : � 9 : G B 6 I D A D g> H I � I D � : C H J G : � I = 6 I � 6G : ; : G G 6 A � I D � 6 C D I = : G � E = yH > 8 > 6 C � = 6 H � b: : C � B 6 9 : � > ;E 6 I > : C I H � 6 G : � C D I � E G D v> 9 : 9 � 6 C � 6 E E D > C I B : C I � w> I = > CD C : � B D C I = � D ; � b: > C g� G : ; : G G : 9 � by� 6 � 9 : G B 6 I D A D g> H I .

“W= : I = : G � I = : � E 6 I > : C I � > H � b: > C g� G : ; : G G : 9 � ; D G8 6 C 8 : G � 8 6 G : ,� : C 9 D 8 G > C D A D gy� D G � w= 6 I : v: G � I = : � G : 6 -H D C ,� > I ’H � 6 A w6 yH � I = : � G : ; : G G > C g� E = yH > 8 > 6 C ’H � G : H E D C H > -b> A > I y� I D � B 6 k: � H J G : � I = : � 6 E E D > C I B : C I � = 6 H � b: : CB 6 9 : ,”� H 6 > 9 � DG .� S> A v: G .

“I; � I = : � E 6 I > : C I � 9 D : H � C D I � g: I � 6 � [G : ; : G G 6 A ]� 6 E E D > C I -B : C I ,� yD J � [I = : � 9 : G B 6 I D A D g> H I ]� 6 G : � 6 I � G > H k� ; D G � A > I > g6 -I > D C .� I� 6 A w6 yH � 9 D 8 J B : C I � > C � B y� 8 = 6 G I � I = 6 I � I� = 6 v:6 H k: 9 � I = : � E 6 I > : C I H � I D � 8 6 A A � B : � > ; � I = : y� 9 D C ’I � = : 6 Gb6 8 k� 6 bD J I � 6 C � 6 E E D > C I B : C I � > C � 6 bD J I � I wD � w: : kH .”

T= : � C6 C 6 9 > 6 C � M: 9 > 8 6 A � PG D I : 8 I > v: � AH H D 8 > 6 I > D CH J E E D G I H � I = > H � E G 6 8 I > 8 : � D ; � 6 H k> C g� E 6 I > : C I H � I D � ; D A A D w-J E � w> I = � I = : > G � G : ; : G G > C g� E = yH > 8 > 6 C � > ; � I = : y� 6 G : � C D I � E G D -

v> 9 : 9 � w> I = � 6 C � 6 E E D > C I B : C I � w> I = > C � 6 � ; : w� w: : kH6 ; I : G � H : : > C g� I = : > G � G : ; : G G > C g� E = yH > 8 > 6 C ,� = : � C D I : 9 .

AC D I = : G � E G 6 8 I > 8 : � B 6 C 6 g: B : C I � E : 6 G A � > H � I = 6 I9 : G B 6 I D A D g > H I H � H = D J A 9 � 9 D 8 J B : C I � b > D E H > : H � byD bI 6 > C > C g� 9 > g> I 6 A � E = D I D gG 6 E = H � D ; � H > I : H � I = 6 I � = 6 v:b: : C � b> D E H > : 9 .� T= > H � > H � 6 � w> H : � E G 6 8 I > 8 : � b: 8 6 J H :I = : G : � B 6 y� b: � 6 � 9 : A 6 y� D ; � H : v: G 6 A � w: : kH � > C � I : G B H � D ;I = : � b> D E H y� G : H J A I H . � T= : � A D 8 6 I > D C � D ; � I = : � b> D E H y,H J 8 = � 6 H � I = : � H 8 6 A E ,� 6 C 9 � 8 = 6 G 6 8 I : G > H I > 8 H � D ; � I = : � H k> C ,H J 8 = � 6 H � E = D I D 6 g> C g,� B 6 y� B 6 k: � > 9 : C I > ; y> C g� I = :b> D E H > : 9 � H > I : � 6 � 8 = 6 A A : C g: � 6 ; I : G � 6 � E : G > D 9 � D ; � I > B : .

“YD J � B 6 y� C D I � b: � 6 bA : � I D � H : : � I = : � b> D E H y� H > I :w: : kH � A 6 I : G , � 6 C 9 � yD J � B 6 y� C D I � kC D w� w= : G : � I D: x8 > H : � > ; � yD J � C : : 9 � I D ,”� = : � H 6 > 9 .� “I; � I� = 6 v: � 6 � E = D I D -gG 6 E = � D ; � I = : � b> D E H > : 9 � H > I : ,� I� kC D w� : x6 8 I A y� w= : G :I D � : x8 > H : .”

D: G B 6 I D A D g> H I H � 8 6 C C D I � 6 H H J B : � I = 6 I � 6 � b> D E H yI = 6 I � H = D wH � 6 C g> D ; > bG D B 6 H � B : 6 C H � 6 � 9 > 6 gC D H > H � D ;I J b: G D J H � H 8 A : G D H > H , � H 6 > 9 � DG .� S> A v: G .� P6 I > : C I H � 8 6 C= 6 v: � 6 C g> D ; > bG D B 6 H � D C � b> D E H y,� bJ I � I = : � 8 D G G : 8 I9 > 6 gC D H > H � B 6 y� b: � B> G I -HD gg-DJ b: � SyC 9 G D B : .

“CA 6 H H > 8 6 A A y,� B> G I -HD gg-DJ b: � SyC 9 G D B : � = 6 H6 8 = G D 8 D G 9 D C H ,� ; > bG D ; D A A > 8 J A D B 6 H ,� 6 C 9 � I G > 8 = D 9 > H 8 D -B 6 H ,”� H 6 > 9 � DG .� S> A v: G .� “T= 6 I � > H � I = : � I G > 6 9 .� HD w: v: G ,6 � A D I � D ; � E 6 I > : C I H � w> I = � B> G I -HD gg-DJ b: � SyC 9 G D B :

w> A A � = 6 v: � 6 C g> D ; > bG D B 6 H .YD J � B 6 y � b> D E H y � I wD � D GI = G : : � H > I : H ,� 6 C 9 � I = : y� w> A AjJ H I � H = D w� 6 C g> D ; > bG D B 6 H .I; � I = 6 I � 9 D : H C ’I � B 6 I 8 = � 8 A > C -> 8 6 A A y,� yD J � H = D J A 9 � I = > C k� D ;B > G I - H D g g - D J b :[SyC 9 G D B : ]� 6 C 9 � G : -b> D E -H y. � I ; � y D J � H : : � B 6 C y6 C g > D ; > b G D B 6 H , � 9 D � C D I6 H H J B : � I = : � E 6 I > : C I � = 6 H

I J b: G D J H � H 8 A : G D H > H .”DG .� S> A v: G � C D I : 9 � = : � = 6 H � H : : C � 6 bD J I � 20� E 6 I > : C I H

> C � 6 � 9 : 8 6 9 : � D ; � E G 6 8 I > 8 : � w= D � = 6 v: � ; > G H I � H = D wC6 C g> D ; > bG D B 6 H � 6 C 9 � w= D H : � 9 > 6 gC D H > H � w6 H � B> G I -HD gg-DJ b: � SyC 9 G D B : .

“I I � > H � > B E D G I 6 C I � I D � G : 8 D g C > z : � I = 6 I � I = : H :E 6 I > : C I H � 6 G : � 6 I � G > H k� ; D G � G : C 6 A � 8 : A A � 8 6 G 8 > C D B 6 ,� E C : J -B D I = D G 6 x,� 6 C 9 � yD J � w> A A � = 6 v: � I D � > C v: H I > g6 I : � ; D GI = 6 I ,”� H 6 > 9 � DG .� S> A v: G .� “YD J � w> A A � = 6 v: � I D � > C v: H I > g6 I :; 6 B > A y� B : B b: G H � 6 H � w: A A .”

P6 I > : C I H � w= D � G : E D G I � I = 6 I � I = : y� = 6 v: � 6 C � > I 8 = y6 C J H � ; D G � 6 C � : xI : C 9 : 9 � 9 J G 6 I > D C , � H J 8 = � 6 H � B 6 C yy: 6 G H , � 8 6 C � b: � 6 9 : qJ 6 I : A y � I G : 6 I : 9 � w> I = � I D E > 8 6 AH J 8 G 6 A ; 6 I : ,� H 6 > 9 � DG .� S> A v: G .

“M6 C y� D ; � J H � E G : H 8 G > b: � I D E > 8 6 A � H I : G D > 9 H � [ I DI G : 6 I � > I 8 = y� 6 C J H ],� 6 C 9 � I = : � A > I : G 6 I J G : � H J gg: H I H � J H > C gB D 9 6 A > I > : H � A > k: � PUVA� I = : G 6 E y� 6 C 9 � > C I G 6 A : H > D C 6 AH I : G D > 9 H ,”� H 6 > 9 � DG .� S> A v: G .� “W= 6 I � I� ; > C 9 � = : A E H � w> I =E 6 I > : C I H � w= D � G : E D G I � > I 8 = y� 6 C J H � > H � I D E > 8 6 A � H J 8 G 6 A -; 6 I : .� I� I = > C k� I = 6 I � H J 8 G 6 A ; 6 I : � = 6 H � 6 � E A 6 8 : � > C � 9 : G B 6 -I D A D gy,� 6 C 9 � I = 6 I � > I � = 6 H � b: : C � J C 9 : G J I > A > z: 9 .”

DG .� S> A v: G � C D I : 9 � I = : � v6 G > : I y� D ; � J H : H � ; D G � H J 8 G 6 A -; 6 I : � 8 > I : 9 � > C � I = : � A > I : G 6 I J G : ,� H J 8 = � 6 H � b: > C g� J H : 9 � I DI G : 6 I � G 6 9 > 6 I > D C � 9 : G B 6 I > I > H ,� G 6 9 > 6 I > D C � E G D 8 I > I > H ,� 6 C 9v: C D J H � A : g� J A 8 : G H ,� 6 B D C g� D I = : G � 8 D C 9 > I > D C H .

“I� = 6 v: � J H : 9 � > I � ; D G � H : v: G : � 9 > 6 E : G � 9 : G B 6 I > I > H6 C 9 � H : v: G : � E : G > 6 C 6 A � E G J G > I J H � w> I = � : x8 D G > 6 I > D C H ,”H 6 > 9 � DG .� S> A v: G ,� w= D � C D I : 9 � = : � I yE > 8 6 A A y� J H : H � 6 � 8 D C -8 : C I G 6 I > D C � D ; � 8%� H J 8 G 6 A ; 6 I : .

OC : � 9 D J bA : -bA > C 9 , � G 6 C 9 D B > z : 9 � I G > 6 A � ; D J C 9I D E > 8 6 A � H J 8 G 6 A ; 6 I : , � 6 9 B > C > H I : G : 9 � 6 H � 6 � 20%� D > C I -B : C I ,� w6 H � H J E : G > D G � I D � I D E > 8 6 A � z> C 8 � D x> 9 : � > C � I = :B 6 C 6 g : B : C I � D ; � 9 > 6 E : G � 9 : G B 6 I > I > H � (IranianJournal of Dermatology 2012;� 15:85R 88).

6 ·� M6 G 8 = � 2015


Cellular dermatofibromas should be exisedn Ex8 > H > D C � B 6 y� G : 9 J 8 : � E D I : C I > 6 A � ; D G � B 6 A > gC 6 C I � I G 6 C H ; D G B 6 I > D C

Indications and Clinical use:• CLINDOXYL® Gel (5% benzoyl peroxide, 1%

clindamycin) and CLINDOXYL® ADV Gel (3% benzoyl peroxide, 1% clindamycin) are indicated in the topical treatment of moderate acne vulgaris characterized by the presence of comedones, papules and pustules.

• Not indicated for the treatment of cystic acne• Not for use in children <12 years

Contraindications:• Hypersensitivity to medications containing

lincomycin• Patients with or with a history of regional

enteritis, ulcerative colitis or antibiotic-induced colitis (including pseudomembranous colitis)

Most serious warnings and precautions:• For external use only • Not for oral, ophthalmic or intravaginal use

Other relevant warnings and precautions:• Concomitant topical acne treatments: not

recommended because a possible cumulative irritancy effect may occur

• May cause clostridium difficile-associated disease • Avoid contact with hair, fabrics, carpeting or

other materials (may cause bleaching)• May cause increased sensitivity to sunlight;

sunlamps should not be used and deliberate or prolonged exposure to sunlight should be avoided or minimized

• Sunburns should be resolved prior to use• Avoid contact with the mouth, eyes, lips, other

mucous membranes or areas of irritated or broken skin

• Could cause gram-negative folliculitis• May cause skin adverse events including

irritation (peeling, reddening, dryness, itching, stinging/burning)

• Cross-resistance between clindamycin and lincomycin and resistance to clindamycin is often associated with inducible resistance to erythromycin

• Safety and efficacy not established in patients <12 years of age or those >65 years of age

• Caution in use with neuromuscular blocking agents, tretinoin, isotretinoin and tazarotene

• Should not be used with erythromycin or topical sulphonamides

• Should not be administered during pregnancy or lactation unless the expected benefits to the mother outweigh the potential risks to the fetus or the infant; if used during lactation, do not apply to the chest so as to avoid accidental ingestion by the infant

Dosage and method of administration: • Gently apply once daily to lightly cover the entire affected areas of the face with a thin layer of gel

• A pea-sized amount should be applied for each area of the face (e.g., forehead, chin, each cheek), then hands should be washed.

Adverse drug reactions:• CLINDOXYL® ADV Gel: application site dermatitis (1%) and application site photosensitivity (1%)

• CLINDOXYL® Gel: peeling (16.3%), erythema (7.6%), dryness (7%), burning (2.3%), pruritus (1.7%), mild application-site paraesthesia (<1%) and acne worsening (<1%).

For more information: Please consult the product monograph at http://webprod5.hc-sc.gc.ca/dpd-bdpp/index-eng.jsp for important information relating to contraindi ca-tions, warnings and precautions, adverse reactions, drug interactions, dosing information and post-market adverse drug reactions which have not been discussed in this piece. The product monograph is also available by calling 1-800-387-7374.


Dr. Shane Silver

“If the patient doesnot get a [refer-ral] appointment,

you [thedermatologist] are at risk

for litigation.”—Dr. Shane Silverq


Another option in the treatment of acne


A proven treatment for moderate acne vulgaris

Demonstrated excellent adverse event profi le1

• Most frequently reported treatment-related adverse events were application site dermatitis (1%) and application site photosensitivity (1%)

If severe local irritation (e.g. severe erythema, severe dryness and itching, severe stinging/burning) develops, discontinue use and institute appropriate therapy.

3% benzoyl peroxide, 1% clindamycin

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You can choose which CLINDOXYL® is suitable for your patients.

No two faces are alike.

CLINDOXYL® Gel 5% benzoyl peroxide, 1% clindamycin

CLINDOXYL® ADV Gel 3% benzoyl peroxide, 1% clindamycin


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Low-dosecyclosporine plusglucosamine for AD

ACOMBINATION D ; � A D w-9 D H : � 8 y8 A D H E D G > C : � 6 C 9 � gA J 8 D H 6 B > C : � ; D G � B D 9 : G 6 I : � I D � H : v: G : � 6 I D E > 8 � 9 : G -B 6 I > I > H � (AD)� 9 D : H � C D I � 6 E E : 6 G � I D � > C 8 G : 6 H : � : > I = : G � 6 9 v: G H : � : v: C I H � D G � H : G J B � 8 y8 A D H E D G > C : � A : v: A H8 D B E 6 G : 9 � I D � 8 y8 A D H E D G > C : � 6 A D C : ,� H D � I = : � 8 D B b> C 6 I > D C � B 6 y� 6 A A D w� ; D G � A D C g-I : G B � I G : 6 I B : C I � w> I =

8 y8 A D H E D G > C : ,� G : H : 6 G 8 = : G H � G : E D G I � > C � Dermatologic Therapy (J6 C ./F: b.� 2015;� 28(1):44-51).FD A A D w> C g� J E � D C � 6 � E > A D I � H I J 9 y� I = 6 I � ; D J C 9 � > B E G D v: 9 � D J I 8 D B : H � ; G D B � 8 D B b> C > C g� I G : 6 I B : C I � w> I = � 8 y8 A D H E D G > C : � 6 C 9

gA J 8 D H 6 B > C : � ; D G � AD� I G : 6 I B : C I � 8 D B E 6 G : 9 � I D � 8 y8 A D H E D G > C : � 6 A D C : ,� I = : � 6 J I = D G H � 8 D C 9 J 8 I : 9 � 6 � G 6 C 9 D B > z: 9 ,� E A 6 8 : bD -8 D C -I G D A A : 9 � 6 C 9 � 9 D J bA : -bA > C 9 : 9 � H I J 9 y� I D � : v6 A J 6 I : � I = : � H 6 ; : I y� 6 C 9 � : ; ; > 8 6 8 y� D ; � I = : � 8 D B b> C 6 I > D C � I G : 6 I B : C I � > C � B D 9 : G 6 I : � I DH : v: G : � AD� vH .� I = : � B D C D I = : G 6 E y.� P6 I > : C I H � w> I = � SCORAD� > C 9 : x: H � D ; � 30� D G � = > g= : G � w: G : � > C 8 A J 9 : 9 � > C � I = : � H I J 9 y,� 6 C 9 � w: G :G 6 C 9 D B > z: 9 � > C I D � I wD � : qJ 6 A � I G : 6 I B : C I � gG D J E H .� GG D J E � A� G : 8 : > v: 9 � 8 y8 A D H E D G > C : � 2� B g/kg� 6 C 9 � gA J 8 D H 6 B > C : � 25� B g/kg,w= > A : � gG D J E � B� G : 8 : > v: 9 � I = : � 8 y8 A D H E D G > C : � 9 D H : � 6 C 9 � 6 � E A 6 8 : bD .� T= : � I G : 6 I B : C I � E : G > D 9 � w6 H � : > g= I � w: : kH ,� 6 C 9 � SCORAD> C 9 > 8 : H ,� H : G J B � A : v: A H � D ; � 8 = : B D k> C : � A > g6 C 9 � 17� 6 C 9 � > C I : G A : J k> C (IL)-31,� : D H > C D E = > A � 8 D J C I H ,� 6 C 9 � bA D D 9 � 8 y8 A D H E D G > C : � A : v: A Hw: G : � B : 6 H J G : 9 � b: ; D G : � 6 C 9 � 6 ; I : G � I = : � I G : 6 I B : C I � E : G > D 9 .� T= : � 19� E 6 I > : C I H � > C � gG D J E � A� = 6 9 � H > gC > ; > 8 6 C I A y� G : 9 J 8 : 9 � SCORAD> C 9 > 8 : H � E D H I -I G : 6 I B : C I ,� 6 C 9 � 6 � H > gC > ; > 8 6 C I � 8 D G G : A 6 I > D C � b: I w: : C � SCORAD� 8 = 6 C g: H � 6 C 9 � 8 = 6 C g: H � > C � 8 = : B D k> C : � A > g6 C 9 � 17H : G J B � A : v: A H ,� I = D J g= � C D I � IL-31. —For more information visit http://tinyurl.com/n6vv35j

Commentary: This study was performed on a relatively small sample size and more research needs to be done, but itdoes present interesting data supporting the efficacy of a combination of cyclosporine and glucosamine for treatmentof moderate to severe atopic dermatitis. If a patient is requiring a systemic medication such as cyclosporine to treat ADit appears that low dose cyclosporine in combination with glucosamine may allow for longer-term use with improvedresults and no increase in the likelihood of adverse events versus cyclosporine alone.

SADBE an effectivetherapy for recalcitrant warts

SQUARIC ACID DIBUTYL ESTER (SADBE)� I = : G 6 E y� 6 E E : 6 G H � I D � b: � bD I = � H 6 ; : � 6 C 9 � : ; ; : 8 I > v: � ; D G � I = : � I G : 6 I -B : C I � D ; � G : 8 6 A 8 > I G 6 C I � w6 G I H � > C � 8 = > A 9 G : C ,� 6 8 8 D G 9 > C g� I D � 6 � H I J 9 y� E J bA > H = : 9 � > C � Pediatric Dermatology(J6 C ./F: b.� 2015;� 32(1):85-90)..

T= : � 8 = 6 G I H � D ; � 72� E 6 I > : C I H ,� I G : 6 I : 9 � J H > C g� SADBE� 6 I � 6 � E : 9 > 6 I G > 8 � 9 : G B 6 I D A D gy� D J I E 6 I > : C I � 8 A > C > 8 � 6 I � I = : � UC > v: G H > I y� D ;ND G I = � C6 G D A > C 6 � 6 I � C= 6 E : A � H> A A � ; G D B � JJ A y� 2002� I D � D: 8 .� 2012,� w: G : � G : I G D H E : 8 I > v: A y� G : v> : w: 9 ,� w> I = � E 6 I > : C I H � b: > C g� ; D A A D w: 9; G D B � H > x� B D C I = H � I D � 11� y: 6 G H .� T= : � > C 8 A J 9 : 9 � E 6 I > : C I H � 6 A A � = 6 9 � v: G G J 8 6 : � w= > 8 = � = 6 9 � ; 6 > A : 9 � > C > I > 6 A � I G : 6 I B : C I .� AB D C g� I = : � E 6 G -I > 8 > E 6 C I H ,� ; J A A � A D C g-I : G B � ; D A A D w-J E � w6 H � D bI 6 > C : 9 � > C � 48� E 6 I > : C I H ;� � ; D J G � E 6 I > : C I H � 9 > H 8 D C I > C J : 9 � SADBE� I G : 6 I B : C I � 9 J : � I D6 9 v: G H : � : ; ; : 8 I H .� E; ; > 8 6 8 y� D ; � I = : � SADBE� I G : 6 I B : C I � w6 H � I = : � E G > B 6 G y� D J I 8 D B : � B : 6 H J G : 9 ,� 6 C 9 � 9 6 I 6 � D C � 6 9 v: G H : � : ; ; : 8 I H ,9 D H 6 g: H � 6 9 B > C > H I : G : 9 ,� w6 G I � I yE : ,� I = : � E G : H : C 8 : � D ; � D I = : G � 8 J I 6 C : D J H � 9 > H : 6 H : ,� 6 C 9 � > B B J C D H J E E G : H H > D C � A : v: A � w: G : � 6 A H DG : 8 D G 9 : 9 .� AB D C g� I = : � 48� E 6 I > : C I H � w> I = � 8 D B E A : I : � I G : 6 I B : C I � D J I 8 D B : � 9 6 I 6 ,� 40� (83%)� G : E D G I : 9 � 8 D B E A : I : � w6 G I � G : H D A J I > D C .SD B : � 70%� D ; � E 6 I > : C I H � J H : 9 � 6 � B 6 x> B J B � SADBE� 8 D C 8 : C I G 6 I > D C � D ; � 0.4%,� 6 C 9 � 60%� D ; � E 6 I > : C I H � G : E D G I : 9 � C D � 6 9 v: G H :: ; ; : 8 I H .� T= : � B 6 jD G > I y� D ; � E 6 I > : C I H � G : E D G I : 9 � 8 D B E A : I : � G : H D A J I > D C � D ; � I = : > G � w6 G I H ,� 6 C 9 � C D � 6 9 v: G H : � : ; ; : 8 I H � w> I = � 9 D H 6 g: H � 6 H= > g= � 6 H � 2%� 9 6 > A y. —For more information visit http://tinyurl.com/mkwkx8g

Commentary: This was a good retrospective chart review that builds on previous studies demonstrating the efficacy ofSADBE. The findings show that SADBE is a safe and effective treatment for recalcitrant warts in children, even at higherconcentrations than previously described.

Factors affectingsebum excretionrate in women

CHANGES IN SLEEP PATTERN,� FREE TESTOSTERONE LEVELS,� AND 5-ALPHA-REDUCTASE TYPE 1� ACTIVITY 6 A A � 6 E E : 6 GI D � b: � 6 H H D 8 > 6 I : 9 � w> I = � 8 = 6 C g: H � > C � H : bJ B � : x8 G : I > D C � > C � wD B : C ,� E D I : C I > 6 A A y� : xE A 6 > C > C g� D bH : G v: 9> C I : G -H J bj: 8 I � v6 G > 6 b> A > I y� > C � H : bJ B � : x8 G : I > D C � G 6 I : � (SER)� b: I w: : C � E 6 I > : C I � v> H > I H � > C � 8 A > C > 8 6 A � H I J 9 > : H ,

G : H : 6 G 8 = : G H � G : E D G I � > C � Skin Research and Technology (F: b.� 2015;� 21(1):47-53)..R: H : 6 G 8 = : G H � I D D k� SER� B : 6 H J G : B : C I H � ; G D B � I = : � ; D G : = : 6 9 H � D ; � 40� = : 6 A I = y� H J bj: 8 I H � D C � I wD � D 8 8 6 H > D C H ,� H : v: C � 9 6 yH � 6 E 6 G I ,

6 C 9 � D C � I = D H : � v> H > I H � 6 A H D � : v6 A J 6 I : 9 � H : G J B � 6 C 9 G D g: C � A : v: A H ,� 5-6 A E = 6 -G : 9 J 8 I 6 H : � I yE : � 1� g: C : � : xE G : H H > D C ,� ; D G : = : 6 9 � I : B E : G 6 -I J G : ,� H A : : E � = 6 b> I H ,� 9 > : I ,� ; 6 8 > 6 A � w6 H = > C g� G D J I > C : ,� 6 C 9 � UV� : xE D H J G : .� A� E D H > I > v: � 8 D G G : A 6 I > D C � w6 H � D bH : G v: 9 � b: I w: : C � I = : � I > B :H J bj: 8 I H � ; : A A � 6 H A : : E � D C � D6 y� 0� 6 C 9 � 8 = 6 C g: H � > C � SER� ; D G � A : ; I � (E =0.010;� G =0.402)� 6 C 9 � G > g= I � (E =0.002;� G =0.467)� H > 9 : � D ; � I = : � ; D G : -= : 6 9 .� SER� 6 C 9 � ; G : : � I : H I D H I : G D C : � A : v: A H � bD I = � = 6 9 � H > gC > ; > 8 6 C I � > C v: G H : � 8 D G G : A 6 I > D C H � w> I = � 5-6 A E = 6 -G : 9 J 8 I 6 H : � I yE : � 1� : xE G : H H > D C .A� H J b-6 C 6 A yH > H � E : G ; D G B : 9 � D C � B : C � 6 C 9 � wD B : C � H = D w: 9 � I = 6 I � I = : H : � 8 D G G : A 6 I > D C H � w: G : � H > gC > ; > 8 6 C I � D C A y� ; D G � wD B : C .

—For more information visit http://tinyurl.com/qzjj9ut

Commentary: This study presents interesting correlations but does not pinpoint causality or provide any actionabledata. The study showed that variations in sleep patterns, free testosterone, and 5-alpha-reductase type 1 activity areassociated with changes in sebum excretion in women but the same correlations were not observed in men. It wouldbe interesting to see further research on the role of circadian rhythms on SER.

Surveying the current

Dermatologic literature

Recently come across something from the peer-review literature that you consider to be interesting or impactful? Share it with your colleagues. E-mail your clippings, along with your comments, to: [email protected]

8·� M6 G 8 = � 2015� �

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �Vol. 20, No. 5 THE CHRONICLE of SKIN & ALLERGY

CD B B : C I 6 G y� > C � I = > H � : 9 > I > D C :� Dr. Katie Beleznay,�8 A > C > 8 6 A � > C H I G J 8 I D G � > C � I = : � D: E 6 G I B : C I � D ; � D: G B 6 I D A D gy� 6 C 9 � Sk> C � S8 > : C 8 : ,

UC > v: G H > I y� D ; � BG > I > H = � CD A J B b> 6 ,� V6 C 8 D J v: G


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� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �V THE CHRONICLE of SKIN & ALLERGY

by IAN J.S. MOORE,Correspondent, The Chronicle

W= : C � H E : 6 k> C g� w> I =I = : � E 6 G : C I H � D ; � E : 9 > -6 I G > 8 � E 6 I > : C I H , � > I � > H

> B E D G I 6 C I � I D � 6 vD > 9 � G : ; : G G > C g� I DB D G E = : 6 � 6 H � A D 8 6 A � H 8 A : G D 9 : G B 6D G � 6 C y� D I = : G � H 8 A : G D 9 : G B 6 ,� DG .L6 wG : C 8 : � A.� S8 = 6 8 = C : G � H 6 > 99 J G > C g� 6 � E G : H : C I 6 I > D C � 6 I � I = :

A B : G > 8 6 C � A 8 6 9 : B y � D ;D: G B 6 I D A D gy� H : H H > D C H .

“T= : � G : 6 H D C � w: � w6 C I � I D6 vD > 9 � G : ; : G G > C g� I D � B D G E = : 6 � 6 HH 8 A : G D 9 : G B 6 � > H � b: 8 6 J H : � 6 ; I : G6 C � D ; ; > 8 : � v> H > I � I = : � E 6 G : C I H � D ;D J G � E : 9 > 6 I G > 8 � E 6 I > : C I H � w> A A � gDD C I D � I = : � I C I : G C : I , � I = : y � 6 G :gD > C g� I D � G : H : 6 G 8 = � V H 8 A : G D 9 : G -B 6 ’ � 6 C 9 � I = : y � 6 G : � g D > C g � I DE 6 C > 8 ,”� H 6 > 9 � DG . � S8 = 6 8 = C : G ,

9 > G : 8 I D G � D ; � E : 9 > 6 I G > 8 � 9 : G B 6 -I D A D gy � 6 I � I = : � U C > v : G H > I y � D ;M> 6 B > � H: 6 A I = � SyH I : B .

“JJ H I � 8 6 A A � > I � B D G E = : 6 .� II � > H6 � gG : 6 I � C 6 B : .� II � > H � C D I � H 8 A : G D -9 : G B 6 .� AC 9 � > I � > H � C D I � gD > C g� I Db: 8 D B : � H 8 A : G D 9 : G B 6 .”

A number of formssMD G E = : 6 � 9 : v: A D E H � > C � 6 � C J B -b: G � D ; � ; D G B H ,� > C 8 A J 9 > C g� bA 6 8 k,

g J I I 6 I : , � H J b- 8 J I 6 C : D J H ,k : A D > 9 6 A , � E 6 C - H 8 A : G D I > 8 � 6 C 9; G D C I 6 A � A > C : 6 G � H 8 A : G D 9 : G B 6 ,I = : � A 6 I I : G � 9 > H I > C g J > H = : 9 � byE 6 G 6 - A > C : 6 G � D G � E 6 G 6 - B : 9 > 6 CA > C : H � D G � b D I = , � H 6 > 9 � D G .S8 = 6 8 = C : G .�

“T= : � I G : 6 I B : C I � D ; � B D G -E = : 6 � G : qJ > G : H � H yH I : B > 8 � I = : G 6 -E y� 6 C 9 � A D C g-I : G B � ; D A A D w-J E ,”= : � H 6 > 9 .

“T = > H � > H � 6 � 9 > H D G 9 : G � > Cw= > 8 = � I = : G : � 8 6 C � b: � 6 C y� C J B -b: G � D ; � 8 : C I G 6 A � C : G vD J H � H yH I : BE G D b A : B H � 6 C 9 � D 8 J A 6 G � E G D b-A : B H ”�

DG .� S8 = 6 8 = C : G � 8 6 J I > D C : 9I = 6 I � “I; � [I = : � A > C : ]� k: : E H � gD > C g9 D wC � G > g= I � I = G D J g= � I = : � G : H I � D ;I = : � ; 6 8 : � yD J � 6 G : � gD > C g� I D � b:9 : 6 A > C g� E D I : C I > 6 A A y� w> I = � E G D b-A : B H � > C � I = : � C 6 H 6 A � H I G J 8 I J G : ,I = : � D G 6 A � H I G J 8 I J G : ,� : I 8 .”

MD G E = : 6 � 8 6 C � b : � q J > : H -8 : C I ,� w= > 8 = � w6 H � I = : � 8 6 H : � D ;6 C � 18-y: 6 G - D A 9 -g> G A � D G > g> C 6 A A y9 > 6 gC D H : 9 � w> I = � k: A D > 9 6 A � B D G -E = : 6 � ; > v: � y: 6 G H � : 6 G A > : G , � w= DC D w� 9 > H E A 6 y: 9 � I wD � : A D C g6 I : 9E A 6 q J : H � 6 C 9 � 6 � G : H I G > 8 I : 9G 6 C g: � D ; � B D I > D C .� �

D G . � S 8 = 6 8 = C : G � 6 g G : : 9w= : C � D C : � 8 D A A : 6 g J : � > C � I = :6 J 9 > : C 8 : � H J gg: H I : 9 � H yH I : B > 8I = : G 6 E y � 6 H � I = : � I G : 6 I B : C I6 E E G D 6 8 = � > C � I = > H � 8 6 H : .�

P= D I D I = : G 6 E y� (UVA),� I D E > -8 6 A � 6 g : C I H � ( : B D A A > : C I H ,H I : G D > 9 H , � 6 C 9 � 8 6 A 8 > C : J G > C> C = > b > I D G H ), � 6 C I > b > D I > 8 H � 6 C 9E = yH > 8 6 A � I = : G 6 E y� w: G : � 6 B D C gI = : � D I = : G � H J gg: H I > D C H � ; G D B8 D A A : 6 gJ : H � 6 H � B D G E = : 6 � I G : 6 I -B : C I .

“I� 6 B � gD > C g� I D � gD � 6 I � I = > HE D > C I � > C � I > B : � w> I = � B : I = D I G : x-6 I : � 6 C 9 � E G : 9 C > H D C : � 6 H � I = :I G : 6 I B : C I � D ; � 8 = D > 8 : ,” � I = :M> 6 B > � 9 : G B 6 I D A D g> H I � H 6 > 9 � D ;= > H � E G : ; : G G : 9 � > C > I > 6 A � I = : G 6 E y; D G � I = > H � E 6 I > : C I � 6 C 9 � H > B > A 6 G8 6 H : H .�

Use treatments simultaneouslyDG .� S8 = 6 8 = C : G � G : E D G I : 9 � I = 6 I> C � = > H � E G 6 8 I > 8 : ,� I = : � E G D I D 8 D A � > HI D � E G : -H 8 G : : C � I = : � E 6 I > : C I � w> I =I = : � J H J 6 A � I : H I H ,� G : E : 6 I � I : H I > C g; D G � 6 � ; : w� B D C I = H � w= : C � J H > C gB : I = D I G : x 6 I : � 6 C 9 � I = : C � I Db : g > C � I = : G 6 E y � w > I = � b D I =B : 9 > 8 6 I > D C H � [ B : I = D I G : x 6 I :6 C 9 � E G : 9 C > H D C : ] � H > B J A I 6 C : -D J H A y.�

“I� H I 6 G I � I = : � B : I = D I G : x6 I :6 I � 0.3� B g/kg� 6 A A � > C � D C : � 9 6 y,J H J 6 A A y� > C � 6 � 9 > v> 9 : 9 � 9 D H : .� YD J8 6 C � gD � 6 H � = > g= � 6 H � 1� B g� > ; � yD JC : : 9 � > I ,� bJ I � B D H I A y� yD J � 9 D C ’I .W> I = � I = : � E G : 9 C > H D C : � I� gD � w> I =1� B g/kg� 6 H � = > g= � 6 H � 40� B g� 6 C 9I = : C � 8 J I � > I � I D � 6 � B 6 x� D ; � 60� B g,: v: C � > ; � I’B � 9 : 6 A > C g� w> I = � 6 � 100k> A D � k> 9 ,”� = : � H 6 > 9 .

“V> I 6 B > C � D,� ; D A > 8 � 6 8 > 9 � 6 C 9UVA� 6 G : � D 8 8 6 H > D C 6 A � > C 8 A J -H > D C H � > C I D � I = > H � E G D I D 8 D A .”

UVA� 6 C 9 � I 6 8 G D A > B J H � 6 G :: ; ; : 8 I > v : � > C � B > A 9 � ; D G B H � D ;B D G E = : 6 ,� 6 8 8 D G 9 > C g� I D � H : v: G -

MORE TO

SKINTHAN MEETS

THE EYE

MORE TO

SKINTHAN MEETS

THE EYE

THE MAKING OF A DERMATOLOGIST

FOREWORD BY MITCHELL SHANNON

DR. STUART MADDIN

Through his career (65-years-and-counting) as an international practitioner, educator, researcher, and

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consideration, and celebration of skin.

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P e d i a t r i c s

Morphea requires long-term follow-upnDD C ’I � G : ; : G � I D � 8 D C 9 > I > D C � 6 H � A D 8 6 A � H 8 A : G D 9 : G B 6 � D G � H 8 A : G D 9 : G B 6 � D ; � 6 C y� k> C 9 ,� 9 : G B 6 I D A D g> H I � 6 9 v> H : H

Please turn to next pageà


Male pattern hair loss: Male androgenetic alopecia is a resultof genetics and androgens.1,2 About half of the male population isgenetically predisposed to show signs of male pattern hair loss,before the age of 50.1,21In male androgenetic alopecia there is ashortened hair cycle as the anagen phase is reduced.2 Thereforethinner, less pigmented hairs or vellus hairs, gradually replace thelarger pigmented hairs.2 The emotional impact of male pattern hairloss is not to be underestimated by dermatologists, who are nowable to offer effective early treatment.1,3

Minoxidil 5% foam for male androgenetic alopecia Minoxidil is incorporated in a foam formulation, which is propyleneglycol free.3 The foam is thermo-labile and breaks down rapidly assoon as it comes in contact with skin.3 The foam dries quickly andis aesthetically pleasing, leaving no sticky residue on the skin. Theexact mechanism of action of minoxidil is unknown, but it is be-lieved to work via vasodilation of the microcirculation around thehair follicles or by direct stimulation of the hair follicle cells toenter into a proliferative phase.4 When topically applied, 5% minox-idil induces telogen hairs to enter the anagen phase, prolonginganagen duration, increasing hair count and weight.3,4 Although un-common, possible treatment side effects are irritation of the scalp,including dryness, scaling, itching and redness, usually caused byimproper application of the topical.3 Application of topical minoxi-dil 5% foam* has been shown to promote hair regrowth.3 A double-blind, placebo-controlled study in 352 men of 16 weeks duration

showed a 13.4% increase in target area hair count with minoxidil5% foam compared to 3.4% with placebo (p<0.0001) (Fig. 1).3

Subjective assessment of improved hair loss condition by patientsshowed that 70.6% (p<0.0001) felt their hair loss had improvedfrom baseline.3 At week 16, 143 subjects continued on an open-label phase to collect 52 weeks of safety information, showing mi-noxidil 5% foam was well tolerated over a 52-week period.3

Patient caseThe 30-year-old male presented with a four-year history of andro-genetic alopecia on the vertex.

Profile: On physical examination, he has hair thinning with awidened part over the vertex. He has a family history of male patternhair loss and mentioned that his father was already completely bald bythe age of 36. He reported to be self-conscious about his thinning hairas he generally takes care of his appearance and doesn’t want to ap-pear older than he is. He is a sales manager and is often meeting cus-tomers, making presentations and entertaining potential clients.

The condition: He is aware that his male pattern hair loss is nota disease and that he is predisposed to this common cause ofbaldness.1 He is concerned about how he looks and wants to beproactive in trying to maintain his hair. After consulting a dermatol-ogist, who is specialised in pattern hair loss, he was happy to startwith topical treatment as the least invasive treatment.

Treatment: The dermatologist explained the condition to him anddiscussed patient expectations of treatment outcome and realisticlength of time to see results, as well as monitoring and follow-up oftreatment.

He was successfully treated with twice daily 5% minoxidilfoam used as monotherapy (Fig. 2 and Fig. 3). The product waseasy to use, did not drip and stayed localized in the area where itwas applied.

Consider � Male androgenetic alopecia is a common cause of hair loss,

often starts in males in their twenties and has a significantemotional impact.

� This propylene glycol free thermolabile, hydroethanolic formu-lation of minoxidil offers a new option for patients with andro-genetic alopecia on the vertex.

� This foam formulation is contraindicated in patients with hyper-tension, hair loss not due to hereditary factors or a compro-mised scalp (e.g., scalp with psoriasis, sunburn, otherwisebroken or inflamed skin).4

*Rogaine 5% foam, Johnson & Johnson; for more information, seeProduct Monograph at http://www.jnjcanada.com/sites/www_jnj-canada_com/files/pdf/en/Rogaine.pdf.

References1 Habif TP: Hair Diseases, in Clinical Dermatology a Color Guide to

Diagnosis and Therapy; St. Louis, Mo: Mosby, Inc. 5th Edition,Chapter 24, Dec. 9, 2009.

2 Blumeyer A, Tosti A, Messenger A, Reygagne P, Del Marmol V,Spuls PI, et al: Evidence-based (S3) guideline for the treat-ment of androgenetic alopecia in women and in men. J DtschDermatol Ges 2011; 9 Suppl 6:S1–57.

3 Olsen EA, Whiting D, Bergfeld W, Miller J, Hordinsky M, WanserR, et al: A multicenter, randomized, placebo-controlled, dou-ble-blind clinical trial of a novel formulation of 5% minoxidiltopical foam versus placebo in the treatment of androgeneticalopecia in men. J Am Acad Dermatol 2007; 57:767–774.

4 ROGAINE Canadian Product Monograph. July 2014.

TTooppiiccaall Minoxidil Foam 5% ffoorr HHaaiirr RReeggrroowwtthh iinn MMaalleess wwiitthh AAnnddrrooggeenneettiicc AAllooppeecciiaaJerry Shapiro, MD, FRCPC � Clinical Professor � Department of Dermatology and Skin Science � University of British Columbia � Vancouver

Editorial feature of The Chronicle of Skin & Allergy, March 2015, supported by a grant from Johnson & Johnson, which is not responsible for content

Fig 1: Minoxidil 5% foam was demonstrated to signif-icantly increase hair count versus placebo (Adapted fromOlsen EA, et al)

Fig 2: Before treatmentwith topical 5% minoxidilfoam

Fig 3: After 16 weeks oftreatment with topical5% minoxidil foam

6 A � E A 6 8 : bD -8 D C I G D A A : 9 � I G > 6 A H ,� DG .� S8 = 6 8 = C : G � C D I : 9 .“N : v : G � H 6 y � V G D D 9 -by : ’ � I D � y D J G � B D G E = : 6

E 6 I > : C I H ,”� = : � H 6 > 9 ,� G : ; : G G > C g� I D � D C : � A D C g-I : G B � ; D A -A D w-J E � H I J 9 y,� w= > 8 = � ; D J C 9 � 9 > H : 6 H : � E G D gG : H H > D C � > C89%� D ; � 27� E : 9 > 6 I G > 8 � E 6 I > : C I H ,� E : G B 6 C : C I � H : qJ : A 6> C � 56%� 6 C 9 � 6 I � A : 6 H I � D C : � 6 J I D > B B J C : � 9 > H : 6 H : � > C26%.�

“R: B : B b : G � H : v : G : � B D G E = : 6 � G : q J > G : H � H y H -I : B > 8 � I G : 6 I B : C I � 6 C 9 � A D C g- I : G B � ; D A A D w-J E ,” � = :G : E : 6 I : 9 .�

AD treatment considerationsDG .� S8 = 6 8 = C : G � H 6 > 9 � I = 6 I � 6 I D E > 8 � 9 : G B 6 I > I > H � (AD)� > H6 A H D � 6 � 8 = 6 A A : C g> C g� 6 C 9 � = J B bA > C g� 8 D C 9 > I > D C � I = 6 I6 ; ; : 8 I H � 6 H � B 6 C y� 6 H � 20%� I D � 25%� D ; � 8 = > A 9 G : C � > C � I = :g: C : G 6 A � E D E J A 6 I > D C H � D ; � W: H I : G C � EJ G D E : ,� J6 E 6 C � 6 C 9

I = : � U.S.,� D ; I : C � > C � > I H � G : H E > G 6 I D G y,� 8 J I 6 C : D J H � 6 C 9 � g6 H -I G D > C I : H I > C 6 A � ; D G B H .�

“IC � 8 6 H : H � w= : G : � AD� ; A 6 G : H � J E � b6 9 A y� > C � 6 � E 6 I > : C Iw= D � = 6 H � b: : C � H I 6 bA : � ; D G � B D C I = H � D G � 6 � y: 6 G ,� D C : � B > g= Iw6 C I � I D � 8 D C H > 9 : G � SI 6 E = .� W: � 9 D � = 6 v: � I D � I = > C k� 6 bD J I8 D C I 6 8 I � 9 : G B 6 I > I > H ;� b: 8 6 J H : � ; > v: � E : G � 8 : C I � D ; � 8 = > A 9 G : C[6 C 9 � 6 9 J A I H ]� b: 8 D B : � 6 A A : G g> 8 � I D � I = : � 8 D G I > 8 D H I : G D > 9 � w:J H : � ; D G � I = > H ,� bJ I � I = > C k� 6 bD J I � SI 6 E = � ; > G H I .”

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AD,� DG .� S8 = 6 8 = C : G � : B E = 6 H > z: 9 ,� > H � 6 � 8 D C 9 > I > D CI = 6 I � 6 ; ; : 8 I H � I = : � ; 6 B > A y.� IC � B D 9 : G 6 I : � 8 6 H : H ,� ; 6 B > A y

B : B b: G H � A D H : � 6 E E G D x> B 6 I : A y� D C : � = D J G � D G � B D G : � D ;H A : : E � : 6 8 = � 6 C 9 � : v: G y� C > g= I � I = G D J g= D J I � I = : � y: 6 G .� ICH : v: G : � 8 6 H : H � I = : � A D H H � 6 B D J C I H � I D � 90� B > C J I : H ,� D GB D G : .�

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IC � DG .� S8 = 6 8 = C : G ’H � E G 6 8 I > 8 : ,� = : � 6 A w6 yH � gG : : I HI = : � 8 = > A 9 � ; > G H I � by� J H > C g� = > H � D G � = : G � ; > G H I � C 6 B : .� AH � 6 C6 9 9 : 9 � w: A 8 D B : � I D J 8 = ,� DG .� S8 = 6 8 = C : G � H B > A : H � 6 C 9H qJ 6 I H � 9 D wC � I D � G : 6 8 = � : y: � A : v: A � D ; � = > H � E : 9 > 6 I G > 8E 6 I > : C I .� H: � I = : C � : xI : C 9 H � 6 � E > C ky� ; > C g: G � I D � “H = 6 k:= 6 C 9 H ”� w> I = � I = : � E 6 I > : C I .

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“IC I : G 6 8 I > C g� w> I = � I = : � E 6 I > : C I � D C A y� I 6 k: H � ; > v: � D GI : C � H : 8 D C 9 H � 6 C 9 � > I � G : 6 A A y� : C = 6 C 8 : H � I = : � G : A 6 I > D C H = > EyD J � = 6 v: � w> I = � I = : � 8 = > A 9 .� T6 k> C g� I = : � I > B : � I D � > C I : G 6 8 Iw> I = � 6 � E : 9 > 6 I G > 8 � E 6 I > : C I � G : 6 A A y� B 6 k: H � I = : B � ; : : A � A > k:I = : y � 6 G : � 6 � E : G H D C , � C D I � 6 � E H D G > 6 I > 8 � E A 6 q J : ,” � DG .S8 = 6 8 = C : G � 8 D C 8 A J 9 : 9 .

I = : > G � 9 > H I G > bJ I > D C � E 6 I I : G C H � > C � I = : � H 6 B E A : H � w: G :8 D B E 6 G : 9 � I D � I = D H : � > C � 6 � I D I 6 A � D � ; 39� > C ; A 6 B B 6 I D G y6 C 9 � C : D E A 6 H I > 8 � 8 D C I G D A � H 6 B E A : H � I 6 k : C � ; G D B � 36E 6 I > : C I H .

PDC assessment can lead to improved diagnosisT= G : : � 9 > 6 gC D H I > 8 � E 6 G 6 B : I : G H � D ; � I = : � PDCH � w: G :: v 6 A J 6 I : 9 : � w= : I = : G � I = : y � G : E G : H : C I : 9 � 10%� D GB D G : � D ; � I = : � > C ; A 6 B B 6 I D G y� > C ; > A I G 6 I : ; � > ; � I = : � PDCHw: G : � ; D J C 9 � > C � 8 A J H I : G H � D ; � 10� D G � B D G : � 8 : A A H ;� 6 C 9 � > ;I = : � PDCH � w: G : � ; D J C 9 � 6 I � I = : � 9 : G B D : E > 9 : G B 6 AjJ C 8 I > D C .� O; � I = : � I = G : : � E 6 G 6 B : I : G H ,� I = : � ; > G H I � = 6 9 � 677%� 9 > 6 gC D H I > 8 � 6 8 8 J G 6 8 y,� I = : � H : 8 D C 9 � 74%,� 6 C 9I = : � I = > G 9 � 71%.

T= : H : � ; > C 9 > C g H � H = D J A 9 � 6 A A D w � 8 A > C > 8 > 6 C H � I D: x E : 8 I � B D G : � 6 8 8 J G 6 I : � 9 > 6 g C D H : H � D ; � 8 J I 6 C : D J HA J E J H � : G yI = : B 6 I D H J H � ; G D B � E 6 I = D A D g> H I H , � H 6 yH � DG .W6 A H = .�

“T= : � 9 > 6 gC D H > H � D ; � = yE : G I G D E = > 8 � A J E J H � 8 6 C � b:B 6 9 : � w> I = D J I � H I 6 > C > C g� I = : � PDCH ,� bJ I � I = > H � > H � 6 C6 9 jJ C 8 I � I D � 9 > 6 gC D H > H ,”� H 6 yH � DG .� W6 A H = .� “IC � 6 C � J C 8 : G -I 6 > C � 8 6 H : � > I � 8 6 C � b: � = : A E ; J A � 6 C 9 � 8 A 6 G > ; y� I = : � 9 > 6 gC D -H > H .”

B: I I : G � 9 > 6 gC D H > H � B : 6 C H � B D G : � 6 8 8 J G 6 I : � 6 C 9B D G : � I 6 G g : I : 9 � I G : 6 I B : C I , � w = > 8 = � > H � g D D 9 � ; D GE 6 I > : C I H ,� H 6 yH � DG .� W6 A H = .

“Obv> D J H A y� > ; � yD J � 6 G : � I G : 6 I > C g� I = : � wG D C g� I = > C g� > I> H � C D I � gD D 9 � C : wH .”

HDLE diagnosis can be difficultContinued from page 1


� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �Vol. 21, No. 2 M6 G 8 = � 2015� ·� 11


While the inflammatory skincondition pseudofolliculi-tis barbae can potentially

lead to secondary infections, scar-ring and keloids, the condition is ex-tremely preventable throughchanges in personal care prac-tices—particularly those associatedwith shaving, according to a round-table discussion held at DermatologyUpdate in Vancouver.

Pseudofolliculitis barbae, or PFB,is characterized by papules, and oc-casionally pustules and hypertrophicscarring, that have typically devel-oped in response to shaving, saysWindsor, Ont. dermatologist Dr.Jerry Tan, Adjunct Professor at

Western University in London, Ont.“One of the features about psuedo-folliculitis barbae is that there is avery clear diagnostic hallmark,which is ingrown hair,” says Dr. Tan.

PREVENTING PFBThe condition develops, Dr. Tan says,when the sharp edges of shavedhairs penetrate into the skin eitherextra-follicularly or trans-follicularly,triggering a foreign body reaction.Differences in hair and skin quality,and shaving behaviour all impactprevalence.

Black males are the group thatmost commonly develop PFB, with45% to 83% of this group encounter-ing the issue, says Dr. Tan.1 That isdue to hair that curls tightly whichmakes it more prone to becoming in-grown. PFB is also often seen inother men who shave, and in hirsuteblack women, Dr. Tan says.

“If you compare scalp hair withfacial hair, facial hair is thicker, thereis more cuticle, and it is irregular insize. There is more variation in theshape,” says Dr. Richard Thomas,

a dermatologist in Vancouver and aClinical Associate Professor at the

University of British Columbia. “Hereyou have this tough, hard hair in thisviscoelastic matrix [the skin].” Thehair grows in multiple directionsfrom a surface that is both highly un-even topographically and richly en-nervated, he notes.

On the neck in particular, haircan grow in whorled patterns thatmake uniform cutting more difficult,says Dr. Tan. Irregular growth pat-terns, along with uneven hair cross-sections, can result in hairs beingpulled or twisted in their follicles.This can not only irritate the follicle,but torqued hairs may crack or split,creating additional sharp edges thatcan pierce the skin, he says. The skinaround the hairs of the neck alsotends to mound up, making it morevulnerable to being nicked by theshaving blade and becoming a fur-ther source of irritation, says Dr. Tan.

Preventing PFB, then, is a matterof minimizing irritation and damageto the skin from shaving, says Dr.Thomas. “You have to cut the hairwithout damaging the skin. So in asense, the whole concept is that wehave to prepare the hair so it is opti-mal [for shaving], we have to protectthe skin by preparing it, and weneed to look after the skin barrierfunction longer-term.”

Yet there is a wide variation inhow men shave, and few follow bestshaving practices, says Dr. Thomas. AU.K. study published in 2012 found arange of shaving strokes from 30 to700, preparation time spent rangingfrom 10 to 100 seconds, and actualshaving time ranging from 30 to1,000 seconds. The force used tohold the razor to the face also rangedfrom 0.5 N to 4.0 N.2

FIVE STEPS IN SHAVING PROCESSProper shaving technique to mini-mize risk of PFB, nicks, and skin irri-tation in general is really a five-stepprocess, says Dr. Thomas. Thesesteps are: pre-shave preparation ofthe skin; the use of a hydrating shavegel to lift hairs and reduce friction;shaving with an effective razor sys-tem; immediate post-shave care witha humectant and emollients forsoothing; and maintenance of theskin’s barrier by using a moisturizer.

Pre-shave care includes freeing–but not plucking–ingrown hairs atthe surface using a toothpick or simi-larly clean, blunt tool, and soakingthe facial hair to soften it. “You needto keep the hair wet for two to fourminutes,” says Dr. Thomas. “The ker-atin has a huge capacity to absorbwater.” The force needed to cut haircan be reduced by as much as 40%by four minutes of water contact.3

This soaking can also be com-

bined with an exfoliating cleanse.Not only does this remove debris thatcould impede the blade path, butexfoliating around the follicle ex-poses more of the hair shaft, helps itstand upright, and helps prevent skininteraction.4

A moisturizing gel is an effectiveway to maintain that hair hydrationwhile also reducing razor to skin fric-tion, Dr. Thomas says.

For the shaving act itself, tech-nique can make a significant differ-ence. Shaving with the grain of thehair wherever possible, with smooth,even strokes is recommended, andstretching the skin, pressing the razordown or repeatedly shaving the samearea in an attempt to achieve a closeror more thorough shave are all habitsto be discouraged.3

IMPORTANT SKIN BENEFITS: PREPARATIONAND A FIVE-BLADE RAZORGillette conducted a study in 90African-American males comparingshaving with a three-blade razor anda standard skin care regimen to botha five-blade razor with the same reg-imen and a five-blade razor accom-panied by a more advanced skincare regimen that included post-shave moisturizing products, says Dr.Tan. Compared to the 30 partici-pants in the three-blade controlgroup, “the five-blade razor with themore conventional standard treat-ment had fewer ingrown hairs,” hesays. “The last group, that had the[advanced skin care] products plusthe five-blade razor, had fewer in-grown hairs, less itching, and betterimprovement in the Physician GlobalAssessment of their ingrown hairs.”

Post-shaving moisturization with aproduct containing niacinimide hasbeen shown in a randomized clinicaltrial to significantly improve trans-epi-dermal water loss compared to aplacebo moisturizer, and this im-provement in skin barrier functionand skin moisturization was sustainedwith continued use of the regimen.3

“Anything that elevates the skinclearly gives a target for trauma,”says Dr. Thomas. So any skin condi-tion that results in papules or pus-tules, such as acne, makes patientsvulnerable to razor damage and skin

inflammation from shaving. Teachinggood shaving practice will benefitthese patients.

REFERENCES1. Daniel A, et al: J Drugs Dermatol Apr.

2013; 12(4):410–418.2. Cowley K, Vanoosthuyze K: Br J Der-

matol Mar. 2012; 166 Suppl. 1:6–12.

3. Ertel K, McFeat G: Blade Shaving. In:Cosmetic Dermatology: Productsand Procedures (Draelos Z.D., ed.).Oxford: Blackwell Publishing, 2010;pp. 156–164.

4. Shiel S: Man in the mirror: researchconsiderations for the care and ap-pearance of men’s skin Br J Derma-tol Mar. 2012; 166 Suppl 1.

5. Winter H, et al: J Invest Dermatol 2004Mar; 122(3):652.

Supplement to The Chronicle of Skin & Allergy,March 2015. Chronicle is an independent medicalnews service that provides educational updatesregarding medical developments around theworld. Views expressed are those of the partici-pants and do not necessarily reflect those of thepublisher or sponsor.

Support for distribution of this report wasprovided by Procter & Gamble through an unre-stricted educational grant without conditions. In-formation provided in this report is not intendedto serve as the sole basis for individual care.

Printed in Canada for Chronicle Informa-tion Resources Ltd., 555 Burnhamthorpe Rd.,Suite 306, Toronto, Ont. M9C 2Y3.Telephone416.916.2476; facsimile 416.352.6199; e-mail:[email protected]. Copyright 2015 by Chroni-cle Information Resources Ltd., except wherenoted. All rights reserved. Reproduction in anyform is expressly prohibited without written per-mission of the publisher.

IrritationChallenges of shaving in patients with skin prone to

Changes in shaving practice can reduce incidence of pseudofolliculitis barbae

PSEUDOFOLLICULITIS BARBAE

3-BLADE VERSUS 5-BLADE RAZORS

Pseudofolliculitis barbae (PFB) is more prevalentin men with strongly curved beard hair.5

More blades, spaced closer together, distribute the pressure more evenly onto the skin

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I : A 6 C g > : 8 I 6 H > 6 � B 6 y � “b: 8 D B : � B D G :: v> 9 : C I ”� w> I = � I = : � J H : � D ; � bG > B D C > 9 > C :H > C 8 : � > I � B 6 y� b: � B 6 H k: 9 � by� I = : � b6 8 k-gG D J C 9 � G : 9 C : H H � D ; � G D H 6 8 : 6 .�

“II ’H � > B E D G I 6 C I � I D � I G y� > I � D J I � 6 C 9 � H : :> ; � > I � wD G k H � ; D G � 6 � E 6 I > : C I ,” � = : � H 6 y H .“P6 I > : C I H � H = D J A 9 � ; > G H I � I G y� J H > C g� > I � D C � 6w: : k: C 9 � D G � w= : C � I = : y� = 6 v: � 6 � 9 6 y� D ;9 D w C I > B : � I D � B 6 k : � H J G : � I = : y � 6 G :E A : 6 H : 9 � w> I = � I = : � 8 D H B : I > 8 � D J I 8 D B : .”

T= : � v6 H D 8 D C H I G > 8 I > v: � : ; ; : 8 I � D ; � bG > -B D C > 9 > C : � > H � I : B E D G 6 G y , � w > I = � I = :bG : 6 k9 D wC � D ; � bG > B D C > 9 > C : � 8 6 J H > C gv6 H 8 J A 6 G � bA D D 9 � ; A D w� I D � G : I J G C � I D � C D G -B 6 A , � bJ I � 9 6 I 6 � H J gg: H I � I = 6 I � 52-w: : kJ H : � 8 6 C � E G D 9 J 8 : � 6 � H J H I 6 > C : 9 � G : 9 J 8 -I > D C � > C � : G yI = : B 6 .

“T = : G : � B 6 y � b : � E D I : C I > 6 A � ; D G8 = G D C > 8 � > B E G D v : B : C I � D ; � G D H 6 8 : 6[w> I = � I = : � J H : � D ; � bG > B D C > 9 > C : ],”� E D > C I HD J I � DG .� B6 G 6 C k> C .

A9 v: G H : � : v: C I H � G : E D G I : 9 � w> I = � I = :J H : � D ; � bG > B D C > 9 > C : � > C 8 A J 9 : � : G yI = : B 6w D G H : � I = 6 C � b 6 H : A > C : , � E D E J A 6 G A y9 : H 8 G > b: 9 � 6 H � 6 � “G : bD J C 9 ”� E = : C D B : -

C D C , � ; A J H = > C g � 6 C 9 � b J G C > C g. � J J H I � 6 HH J C H 8 G : : C � H = D J A 9 � b: � 6 E E A > : 9 � : v: C A y,8 D G G : 8 I � 6 E E A > 8 6 I > D C � D ; � bG > B D C > 9 > C : � > HC : 8 : H H 6 G y� I D � 6 8 = > : v: � 6 � 9 : H > G : 9 � G : H J A I .P6 I > : C I H � 8 6 C � ; > C 9 � 6 E E H � D C � I = : > G � B D b> A :9 : v> 8 : H � I = 6 I � 8 6 C � > C H I G J 8 I � I = : B � D C � I = :8 D G G : 8 I � 6 E E A > 8 6 I > D C � D ; � b G > B D C > 9 > C :I 6 G I G 6 I : .

Ocular rosaceaFD G � E 6 I > : C I H � w> I = � D 8 J A 6 G � G D H 6 8 : 6 ,� H yH -I : B > 8 � I = : G 6 E y� w> I = � B D 9 > ; > : 9 � G : A : 6 H :9 D xy8 y8 A > C : � > H � 6 � E G : ; : G G : 9 � I = : G 6 E y,H 6 yH � DG .� B6 G 6 C k> C .� “MD G : � 9 : G B 6 I D A D -g> H I H � C : : 9 � I D � 6 H k� E 6 I > : C I H � > ; � I = : y� = 6 v:D 8 J A 6 G � > C vD A v: B : C I ,”� = : � H 6 yH . � “JJ H IA > k: � w: � 6 H k� E 6 I > : C I H � w> I = � E H D G > 6 H > H � > ;I = : y � = 6 v : � E H D G > 6 I > 8 � 6 G I = G > I > H , � w :H = D J A 9 � b : � 6 H k > C g � 6 A A � D J G � G D H 6 8 : 6E 6 I > : C I H � 6 bD J I � D 8 J A 6 G � > C v D A v: B : C I .UE � I D � 50� E : G � 8 : C I � = 6 v: � D 8 J A 6 G � > C vD A v: -B : C I � 6 C 9 � 9 D C ’I � kC D w� > I .”

T = : G : � = 6 H � b : : C � 6 � “ E 6 G 6 9 > g BH = > ; I ” � > C � I = : � I G : 6 I B : C I � D ; � G D H 6 8 : 6 ,w> I = � I = : � G : 8 D gC > I > D C � I = 6 I � > I ’H � 6 � 8 = G D C > 89 > H : 6 H : ,� 6 8 8 D G 9 > C g� I D � DG .� B6 G 6 C k> C .

“FD G � 8 = G D C > 8 � 8 D C 9 > I > D C H ,� yD J � > 9 : -6 A A y� 9 D C ’I � w6 C I � I D � J H : � ; J A A -9 D H : � 6 C I > b> -D I > 8 H ,” � = : � : x E A 6 > C H . � “P6 I > : C I H � 8 6 C9 : v: A D E � g6 H I G D > C I : H I > C 6 A � J E H : I ,� I = : G :6 G : � y : 6 H I � > C ; : 8 I > D C H � > C � ; : B 6 A :E 6 I > : C I H ,� 6 C 9 � I = : G : � 6 G : � D C gD > C g� 8 D C -8 : G C H � 6 bD J I � 6 C I > b> D I > 8 � G : H > H I 6 C 8 : .� II � > HE G : ; : G 6 bA : � I D � J H : � H D B : I = > C g� I = 6 I � = 6 HB D G : � 6 C I > - > C ; A 6 B B 6 I D G y � E G D E : G I > : HA > k: � B D 9 > ; > : 9 � G : A : 6 H : � [H J b-6 C I > B > 8 G D -b> 6 A � 9 D H : ]� 9 D xy8 y8 A > C : .”

Ev: C � w> I = � I G : 6 I B : C I � 8 = D > 8 : H � A > k:bG > B D C > 9 > C : � 6 C 9 � B D 9 > ; > : 9 � G : A : 6 H :

[H J b-6 C I > B > 8 G D b> 6 A � 9 D H : ]� 9 D xy8 y8 A > C :6 C 9 � : B : G g> C g� I G : 6 I B : C I H � A > k: � > v : G -B : 8 I > C ,� E G D E : G � H k> C � 8 6 G : � > H � 8 G J 8 > 6 A � I DE G : v: C I > C g� G D H 6 8 : 6 � ; A 6 G : H ,� H 6 yH � DG .� I6 CL6 C 9 : A A H ,� 8 A > C > 8 6 A � 8 = > : ; � D ; � I = : � D> v> H > D CD ; � D: G B 6 I D A D gy� ; D G � E6 H I : G C � H: 6 A I = ,B : 9 > 8 6 A � 9 > G : 8 I D G � ( 9 : G B 6 I D A D gy)� 6 IN: xJ H � CA > C > 8 6 A � R: H : 6 G 8 = � > C � SI .� JD = C ’H ,N: w; D J C 9 A 6 C 9 ,� 6 C 9 � 8 A > C > 8 6 A � 6 H H D 8 > 6 I :E G D ; : H H D G � > C � I = : � F6 8 J A I y� D ; � M: 9 > 8 > C :6 I � M: B D G > 6 A � UC > v: G H > I y� > C � SI .� JD = C ’H .H : � = 6 H � ; D J C 9 � I = 6 I � 8 D J C H : A A > C gE 6 I > : C I H � w> I = � G D H 6 8 : 6 � 6 bD J I � gD D 9 � H k> C8 6 G : � 8 6 C � H D B : I > B : H � b: � H J ; ; > 8 > : C I � ; D GG D H 6 8 : 6 � B 6 C 6 g: B : C I .

“W: � kC D w� UV� G 6 9 > 6 I > D C � > H � 6 � 8 6 J H :6 C 9 � 6 � I G > gg: G ,”� H 6 yH � DG .� L6 C 9 : A A H .� “OC :D ; � I = : � b> gg: H I � H I : E H � [I = 6 I � E 6 I > : C I H � 8 6 CI 6 k: ]� > H � I D � w: 6 G � H J C H 8 G : : C � : v: G y� 9 6 y.� I= 6 v : � = 6 9 � E 6 I > : C I H � H 6 y � I = 6 I � I = : > GG D H 6 8 : 6 � > H � J C 9 : G � 8 D C I G D A � b: 8 6 J H : � I = : yw: 6 G � H J C H 8 G : : C � 9 6 > A y.� W> I = � 6 C y� B : 9 -> 8 6 A � 8 D C 9 > I > D C ,� I = : � ; D J C 9 6 I > D C � D ; � I G : 6 I -B : C I � > H � E G : v: C I > D C .”

Importance of sunscreenD: G B 6 I D A D g> H I H � C : : 9 � I D � 6 H k� E 6 I > : C I H6 b D J I � I = : > G � J H : � D ; � H J C H 8 G : : C , � ; D GE 6 I > : C I H � w> I = � G D H 6 8 : 6 � B 6 y� G : E D G I � I = 6 II = : > G � 8 D C 9 > I > D C � wD G H : C H � w> I = � H J C -H 8 G : : C , � 6 C 9 � > ; � 8 = : B > 8 6 A � H J C H 8 G : : C H6 G : � b: > C g� 6 E E A > : 9 ,� I = : > G � : xE : G > : C 8 : � > HH J E E D G I : 9 � by� : v> 9 : C 8 : ,� : xE A 6 > C H � DG .JJ A > 6 � C6 G G D A A ,� 8 D -9 > G : 8 I D G � D ; � CD B E 6 H HD: G B 6 I D A D gy� > C � TD G D C I D .

“T= : � 8 = : B > 8 6 A � H J C H 8 G : : C H � 8 D C -v: G I � UV� G 6 9 > 6 I > D C � > C I D � = : 6 I ,� 6 C 9 � 6 � A D ID ; � E : D E A : ’H � G D H 6 8 : 6 � > H � ; A 6 G : 9 � by� = : 6 I ,”H 6 yH � DG .� C6 G G D A A . � “T= : y� B 6 y� I : A A � yD JI = 6 I � I = : y � 8 6 C ’ I � J H : � H J C H 8 G : : C H .RD H 6 8 : 6 � E 6 I > : C I H � 6 G : � B J 8 = � b: I I : G � D ; ;w> I = � 6 � E = yH > 8 6 A � bA D 8 k: G � I = 6 I � 8 D C I 6 > C H> C gG : 9 > : C I H � A > k: � I > I 6 C > J B � 6 C 9 � z> C 8 .”

D G . � C 6 G G D A A � 6 A H D � H J gg : H I H � = : GG D H 6 8 : 6 � E 6 I > : C I H � J H : � g: C I A : � 8 A : 6 C H : G H6 C 9 � H I 6 y� 8 A : 6 G � D ; � H D 6 E .� “SD 6 E � > H � 6 � 9 > G I ywD G 9 � ; D G � G D H 6 8 : 6 � E 6 I > : C I H ,”� H = : � H 6 yH .

OC : � I = : G 6 E y� I = 6 I � DG .� C6 G G D A A � E G : -H 8 G > b : H � D ; ; - A 6 b : A � ; D G � = : G � B 6 A : � 6 C 9; : B 6 A : � E 6 I > : C I H � w> I = � G D H 6 8 : 6 � w= D � 9 DC D I � : xE : G > : C 8 : � 6 � gG : 6 I � 9 : 6 A � D ; � > C ; A 6 B -B 6 I > D C � > H � A D w-9 D H : � > H D I G : I > C D > C . � “IIH = J I H � 9 D wC � I = : � G D H 6 8 : 6 � E 6 I = w6 y,”H 6 yH � DG .� C6 G G D A A .

RD H 6 8 : 6 � > H � I yE > 8 6 A A y� G : g6 G 9 : 9 � 6 H � 68 D C 9 > I > D C � I = 6 I � 6 ; ; : 8 I H � E 6 I > : C I H � w= D6 G : � ; 6 > G : G � > C � 8 D B E A : x> D C ,� bJ I � E 6 I > : C I HD ; � 8 D A D J G � 8 6 C � 6 A H D � : x E : G > : C 8 :G D H 6 8 : 6 .� A� U.S.� > C v: H I > g6 I > D C � A D D k> C g6 I � I = : � E G : v6 A : C 8 : � D ; � G D H 6 8 : 6 � > C � H k> C � D ;8 D A D J G � ; D J C 9 � E 6 I > : C I H � D ; � 8 D A D J G � G 6 G : A yG : 8 : > v: � 6 � 9 > 6 gC D H > H � D ; � G D H 6 8 : 6 � : v: Cw= : C � I = : y� E D H H : H H � H yB E I D B H � D ; � I = :8 D C 9 > I > D C � (Dermatology OnlineJournal 2014� O8 I � 15:� 20(10)).

Non-proprietary and brand names oftherapies: topical ivermectin 1% (notapproved in Canada); brimonidinegel 0.33% (Onreltea, Galderma); sub-antimicrobial dose modified releasedoxycycline (Apprilon, Galderma).

Rosacea: Emerging therapies offer clinical alternativesContinued from page 4

Canadian DermatologyIndustry Association

Corporate. . . . . . . . . . . . . 12

GlaxoSmithKlineSpectro. . . . . . . . . . . . . 27

L`Oreal.La Roche Posay Cicaplast. . . . . . . . 2

Procter & GambleFree and Gentle Fabric Care . . . . . 28

Gillette. . . . . . . . . . . . . 15Venus Swirl. . . . . . . . . . . . . 5

Stiefel,a GSK Company

Clindoxyl. . . . . . . . . . . . . 6-7, 9

THERAPEUTIC INDEX


While the inflammatory skincondition pseudofolliculi-tis barbae can potentially

lead to secondary infections, scar-ring and keloids, the condition is ex-tremely preventable throughchanges in personal care prac-tices—particularly those associatedwith shaving, according to a round-table discussion held at DermatologyUpdate in Vancouver.

Pseudofolliculitis barbae, or PFB,is characterized by papules, and oc-casionally pustules and hypertrophicscarring, that have typically devel-oped in response to shaving, saysWindsor, Ont. dermatologist Dr.Jerry Tan, Adjunct Professor at

Western University in London, Ont.“One of the features about psuedo-folliculitis barbae is that there is avery clear diagnostic hallmark,which is ingrown hair,” says Dr. Tan.

PREVENTING PFBThe condition develops, Dr. Tan says,when the sharp edges of shavedhairs penetrate into the skin eitherextra-follicularly or trans-follicularly,triggering a foreign body reaction.Differences in hair and skin quality,and shaving behaviour all impactprevalence.

Black males are the group thatmost commonly develop PFB, with45% to 83% of this group encounter-ing the issue, says Dr. Tan.1 That isdue to hair that curls tightly whichmakes it more prone to becoming in-grown. PFB is also often seen inother men who shave, and in hirsuteblack women, Dr. Tan says.

“If you compare scalp hair withfacial hair, facial hair is thicker, thereis more cuticle, and it is irregular insize. There is more variation in theshape,” says Dr. Richard Thomas,

a dermatologist in Vancouver and aClinical Associate Professor at the

University of British Columbia. “Hereyou have this tough, hard hair in thisviscoelastic matrix [the skin].” Thehair grows in multiple directionsfrom a surface that is both highly un-even topographically and richly en-nervated, he notes.

On the neck in particular, haircan grow in whorled patterns thatmake uniform cutting more difficult,says Dr. Tan. Irregular growth pat-terns, along with uneven hair cross-sections, can result in hairs beingpulled or twisted in their follicles.This can not only irritate the follicle,but torqued hairs may crack or split,creating additional sharp edges thatcan pierce the skin, he says. The skinaround the hairs of the neck alsotends to mound up, making it morevulnerable to being nicked by theshaving blade and becoming a fur-ther source of irritation, says Dr. Tan.

Preventing PFB, then, is a matterof minimizing irritation and damageto the skin from shaving, says Dr.Thomas. “You have to cut the hairwithout damaging the skin. So in asense, the whole concept is that wehave to prepare the hair so it is opti-mal [for shaving], we have to protectthe skin by preparing it, and weneed to look after the skin barrierfunction longer-term.”

Yet there is a wide variation inhow men shave, and few follow bestshaving practices, says Dr. Thomas. AU.K. study published in 2012 found arange of shaving strokes from 30 to700, preparation time spent rangingfrom 10 to 100 seconds, and actualshaving time ranging from 30 to1,000 seconds. The force used tohold the razor to the face also rangedfrom 0.5 N to 4.0 N.2

FIVE STEPS IN SHAVING PROCESSProper shaving technique to mini-mize risk of PFB, nicks, and skin irri-tation in general is really a five-stepprocess, says Dr. Thomas. Thesesteps are: pre-shave preparation ofthe skin; the use of a hydrating shavegel to lift hairs and reduce friction;shaving with an effective razor sys-tem; immediate post-shave care witha humectant and emollients forsoothing; and maintenance of theskin’s barrier by using a moisturizer.

Pre-shave care includes freeing–but not plucking–ingrown hairs atthe surface using a toothpick or simi-larly clean, blunt tool, and soakingthe facial hair to soften it. “You needto keep the hair wet for two to fourminutes,” says Dr. Thomas. “The ker-atin has a huge capacity to absorbwater.” The force needed to cut haircan be reduced by as much as 40%by four minutes of water contact.3

This soaking can also be com-

bined with an exfoliating cleanse.Not only does this remove debris thatcould impede the blade path, butexfoliating around the follicle ex-poses more of the hair shaft, helps itstand upright, and helps prevent skininteraction.4

A moisturizing gel is an effectiveway to maintain that hair hydrationwhile also reducing razor to skin fric-tion, Dr. Thomas says.

For the shaving act itself, tech-nique can make a significant differ-ence. Shaving with the grain of thehair wherever possible, with smooth,even strokes is recommended, andstretching the skin, pressing the razordown or repeatedly shaving the samearea in an attempt to achieve a closeror more thorough shave are all habitsto be discouraged.3

IMPORTANT SKIN BENEFITS: PREPARATIONAND A FIVE-BLADE RAZORGillette conducted a study in 90African-American males comparingshaving with a three-blade razor anda standard skin care regimen to botha five-blade razor with the same reg-imen and a five-blade razor accom-panied by a more advanced skincare regimen that included post-shave moisturizing products, says Dr.Tan. Compared to the 30 partici-pants in the three-blade controlgroup, “the five-blade razor with themore conventional standard treat-ment had fewer ingrown hairs,” hesays. “The last group, that had the[advanced skin care] products plusthe five-blade razor, had fewer in-grown hairs, less itching, and betterimprovement in the Physician GlobalAssessment of their ingrown hairs.”

Post-shaving moisturization with aproduct containing niacinimide hasbeen shown in a randomized clinicaltrial to significantly improve trans-epi-dermal water loss compared to aplacebo moisturizer, and this im-provement in skin barrier functionand skin moisturization was sustainedwith continued use of the regimen.3

“Anything that elevates the skinclearly gives a target for trauma,”says Dr. Thomas. So any skin condi-tion that results in papules or pus-tules, such as acne, makes patientsvulnerable to razor damage and skin

inflammation from shaving. Teachinggood shaving practice will benefitthese patients.

REFERENCES1. Daniel A, et al: J Drugs Dermatol Apr.

2013; 12(4):410–418.2. Cowley K, Vanoosthuyze K: Br J Der-

matol Mar. 2012; 166 Suppl. 1:6–12.

3. Ertel K, McFeat G: Blade Shaving. In:Cosmetic Dermatology: Productsand Procedures (Draelos Z.D., ed.).Oxford: Blackwell Publishing, 2010;pp. 156–164.

4. Shiel S: Man in the mirror: researchconsiderations for the care and ap-pearance of men’s skin Br J Derma-tol Mar. 2012; 166 Suppl 1.

5. Winter H, et al: J Invest Dermatol 2004Mar; 122(3):652.

Supplement to The Chronicle of Skin & Allergy,March 2015. Chronicle is an independent medicalnews service that provides educational updatesregarding medical developments around theworld. Views expressed are those of the partici-pants and do not necessarily reflect those of thepublisher or sponsor.

Support for distribution of this report wasprovided by Procter & Gamble through an unre-stricted educational grant without conditions. In-formation provided in this report is not intendedto serve as the sole basis for individual care.

Printed in Canada for Chronicle Informa-tion Resources Ltd., 555 Burnhamthorpe Rd.,Suite 306, Toronto, Ont. M9C 2Y3.Telephone416.916.2476; facsimile 416.352.6199; e-mail:[email protected]. Copyright 2015 by Chroni-cle Information Resources Ltd., except wherenoted. All rights reserved. Reproduction in anyform is expressly prohibited without written per-mission of the publisher.

IrritationCChhaalllleennggeess ooff sshhaavviinngg in patients with skin prone to

Changes in shaving practice can reduce incidence of pseudofolliculitis barbae

PSEUDOFOLLICULITIS BARBAE

3-BLADE VERSUS 5-BLADE RAZORS

Pseudofolliculitis barbae (PFB) is more prevalentin men with strongly curved beard hair.5

More blades, spaced closer together, distribute the pressure more evenly onto the skin

Gillette custom 2014_02-27-2015_Layout 1 27/02/2015 10:26 AM Page 1Skin_March_2015,rar16_ms_9.1_rar1_Skin_March_2014,rar1.qxd 09/04/2015 12:26 PM Page 13

14 ·� � M6 G 8 = � 2015


: H I : 9 � > C � ; > C 9 > C g� D J I � w= : G : � > IG 6 C k: 9 � > C � I : G B H � D ; � D I = : G � 9 : G -B 6 I D A D g> 8 � 8 D C 9 > I > D C H .�

T = : � QD L� > B E 6 8 I � ; D G � HS“w6 H � B J 8 = � = > g= : G � I = 6 C � bJ A -A D J H � E : B E = > gD > 9 � 6 C 9 � 8 D C I 6 8 I9 : G B 6 I > I > H � . � . � . � I I � w6 H � B J 8 == > g= : G � I = 6 C � 6 A D E : 8 > 6 . � II � w6 HH > B > A 6 G � I D � 8 = G D C > 8 � J G I > 8 6 G > 66 C 9 � w: � kC D w� = D w� 8 = 6 A A : C g-> C g� I = 6 I � [8 D C 9 > I > D C ]� > H ,”� H 6 > 9DG .� AA 6 v> .� “II � w6 H � D C : � D ; � I = := > g= : H I � > C � I : G B H � D ; � 8 D B B D C

9 : G B 6 I D A D gy� 9 > H : 6 H : H .� II � w6 H: v: C � = > g= : G � I = 6 C � E H D G > 6 H > H .”

T= : � E 6 I > : C I H � G : E D G I : 9 � I = 6 IHS� > B E 6 8 I H � I = : > G � H D 8 > 6 A � ; J C 8 -I > D C > C g,� I = : > G � : B D I > D C 6 A � G : A 6 -I > D C H = > E H , � 6 C 9 � I = : > G � E = yH > 8 6 A; J C 8 I > D C > C g.� HS,� 6 8 8 D G 9 > C g� I DD G . � A A 6 v > , � 8 6 J H : H � E = y H > 8 6 AE 6 > C , � w = > 8 = � > B E 6 8 I H � I = : > G6 I I : C 9 6 C 8 : � 6 I � I = : > G � j D b6 B D C g� B 6 C y� D I = : G � 6 H E : 8 I H � D ;I = : > G � A > v : H . � T = : � A : H > D C H � 6 G :6 A H D � D ; I : C � A D 8 6 I : 9 � > C � 6 G : 6 H � D ;I = : � bD 9 y� 8 D C H > 9 : G : 9 � > C I > B 6 I :

E 6 G I H . � F J G I = : G B D G : , � “ I = :H B : A A � 6 C 9 � I = : � 8 D C I > C J D J H � 9 > H -8 = 6 G g : � D ; � I = : � A : H > D C � w 6 H6 C D I = : G � ; 6 8 I D G � I = 6 I � 8 6 J H : 9H D 8 > 6 A � > H D A 6 I > D C � 6 C 9 � : B b6 G -G 6 H H B : C I ,”� H 6 > 9 � DG .� AA 6 v> .

More awareness of HS neededT= : � 6 J I = D G H � H I 6 I : 9 � > C � I = : � H I J 9 yI = 6 I � I = : y� = D E : � I = 6 I � : H I 6 bA > H = -> C g� I = : � bJ G 9 : C � D ; � 9 > H : 6 H : � ; D GI = : � > C 9 > v> 9 J 6 A � 6 C 9 � H D 8 > : I y� w> A AA : 6 9 � I D � b : I I : G � ; J C 9 > C g � 6 C 9gG : 6 I : G � 6 w6 G : C : H H � D ; � HS.�

IC � 6 � 9 > ; ; : G : C I � H I J 9 y,� H J b-

B > I I : 9 � 6 C 9 � J C 9 : G � G : v> : w� ; D GE J bA > 8 6 I > D C ,� DG .� AA 6 v> � 6 C 9 � = : G8 D A A : 6 gJ : H � ; D J C 9 � I = 6 I � 9 : G B 6 -I D A D g > H I H � 9 > 6 g C D H : 9 � I = :B 6 j D G > I y � D ; � HS� 8 6 H : H � > C � I = :H I J 9 y,� 6 bD J I � 70%.� “T= : � B 6 > C> H H J : � > H � I = 6 I � I = : G : � > H � 6 � C : : 9; D G � G 6 > H > C g� 6 w6 G : C : H H � > C � C D C -9 : G G B 6 I D A D g> H I H , � E 6 G I > 8 J A 6 G A yE G > B 6 G y� 8 6 G : � 6 C 9 � : B : G g: C 8 yE = yH > 8 > 6 C H ,”� H = : � H 6 > 9 .�

DG .� AA 6 v> ,� : I � 6 A ,� > C � I = > H � H : 8 -D C 9 � H I J 9 y,� H = D w: 9 � I = 6 I � > I � 8 6 CI 6 k: � B 6 C y� y: 6 G H � ; D G � E 6 I > : C I H

I D � G : 8 : > v: � 6 � 9 > 6 gC D H > H � D ; � HS.P 6 I > : C I H � w > A A � 8 D C I > C J D J H A yG : I J G C � I D � I = : � : B : G g : C 8 y9 : E 6 G I B : C I � 6 C 9 � b : � I G : 6 I : 9H y B E I D B 6 I > 8 6 A A y , � H J 8 = � 6 H9 G 6 > C > C g � I = : � 6 b H 8 : H H : H � D G8 yH I H .� IC � I = : � 8 J G G : C I � H I J 9 y� > CI = : � C 6 C 6 9 > 6 C � E D E J A 6 I > D C ,6 A B D H I � = 6 A ; � D ; � E 6 I > : C I H � = 6 9 � I Dw 6 > I � D C : � I D � ; > v : � y : 6 G H � I DG : 8 : > v: � I = : > G � 9 > 6 gC D H > H � D ; � HS6 C 9 � A D C g: G � I = 6 C � ; > v: � y: 6 G H � ; D G40%� D ; � E 6 I > : C I H .

“HS� > H � 6 � H yH I : B > 8 � 9 > H : 6 H : ,H D � B D H I � D ; � I = : H : � E 6 I > : C I H � 9 DC D I � jJ H I � = 6 v: � 8 J I 6 C : D J H � E G : -H : C I 6 I > D C H ,”� H 6 > 9 � DG .� AA 6 v> .� “HS= 6 H � 6 H H D 8 > 6 I > D C � w> I = � B : I 6 bD A > 8H yC 9 G D B : , � PCOS� [E D A y8 yH I > 8D v6 G y� H yC 9 G D B : ],� 8 yH I H , � 6 C 9= yE : G 6 C 9 G D g: C > H B .� II � > H � > B E D G -I 6 C I � I D � 9 > 6 gC D H : � I = : H : � 8 6 H : H ,C D I � D C A y� b: 8 6 J H : � D ; � I = : > G � qJ 6 A > -I y� D ; � A > ; : ,� bJ I � b: 8 6 J H : � D ; � = D w� > I6 ; ; : 8 I H � I = : > G � = : 6 A I = .”

DG . � AA 6 v> � C D I : 9 � I = 6 I � > I � > H> B E D G I 6 C I � I D � = : > g= I : C � 6 w6 G : -C : H H � D ; � HS� C D I � D C A y� 6 B D C g� 9 > ; -; : G : C I � E = yH > 8 > 6 C � E D E J A 6 I > D C H � I D6 > 9 � w> I = � : 6 G A > : G � 9 > 6 gC D H > H � 6 C 9> B E G D v: 9 � B 6 C 6 g: B : C I , � bJ I6 A H D � w> I = � I = : � g: C : G 6 A � E J bA > 8 .�

HS has stigma of association“HS� = 6 H � 6 � H I > gB 6 � > C � I = : � 8 D B -B J C > I y� b: 8 6 J H : � A D I H � D ; � E : D -E A : � 6 H H J B : � I = 6 I � I = > H � > H � 9 J : � I DE D D G � = yg> : C : � D G � I = 6 I � > I � > H � 6H : xJ 6 A A y� I G 6 C H B > I I : 9 � 9 > H : 6 H : .[P6 I > : C I H � H D B : I > B : H ]� 9 D � C D Ig D � I D � H : : k � B : 9 > 8 6 A � 6 9 v > 8 :6 C 9 � I = : y� = > 9 : � > I ,”� H = : � H 6 > 9 .�

AC D I = : G � w6 y� I D � > B E G D v:QD L� ; D G � E 6 I > : C I H � w> I = � I = > H � 8 D C -9 > I > D C ,� DG .� AA 6 v> � H 6 > 9 ,� wD J A 9 � b:I D � : H I 6 b A > H = � HS� 8 : C I G : H � D ;: x 8 : A A : C 8 : � > C � C 6 C 6 9 6 � I = 6 IwD J A 9 � = 6 v: � 6 8 8 : H H � I D � 9 : G B 6 -I D A D g > H I H , � : C 9 D 8 G > C D A D g > H I H ,E H y8 = > 6 I G > H I H ,� 6 C 9 � H J G g: D C H .

“W: � C : : 9 � I D � H I 6 G I � I = > C k-> C g� 6 bD J I � : H I 6 bA > H = > C g� > C I : G -9 > H 8 > E A > C 6 G y� I : 6 B H � ; D G � I = : H :E 6 I > : C I H ,”� H = : � H 6 > 9 .�

W= > A : � C D � H J 8 = � 8 A > C > 8 � y: I: x> H I H � > C � C6 C 6 9 6 ,� DG .� AA 6 v> � > H= D E : ; J A � I = 6 I � w> I = � I = : � B D G :G : 8 : C I � I = : G 6 E > : H � I = 6 I � = 6 v :bG D J g= I � 6 I I : C I > D C � I D � HS� 6 C 9 � I = :> C 8 G : 6 H : 9 � 6 B D J C I � D ; � A > I : G 6 I J G :> C � ND G I = � AB : G > 8 6 � D C � I = : � I D E > 8B > g= I � 8 D C v> C 8 : � J C > v: G H > I > : H � I D9 : v: A D E � HS� 8 A > C > 8 H � > C � C6 C 6 9 6 .

“FD G � 6 � A D C g� I > B : ,� [HS]� w6 H6 C � D G E = 6 C � 9 > H : 6 H : ,”� H = : � H 6 > 9 .�

AC D I = : G � G : 8 : C I � G : 8 D gC > -I > D C � D ; � I = : � 8 D C 9 > I > D C � w6 H � I = :; D G B 6 I > D C � D ; � T = : � C6 C 6 9 > 6 CH > 9 G 6 9 : C > I > H � S J E E J G 6 I > v 6F D J C 9 6 I > D C � > C � O 8 I . � 2014.A8 8 D G 9 > C g � I D � D G . � A A 6 v > , � I = :C D I -; D G -E G D ; > I � 8 D G E D G 6 I > D C � w> A Ab: � 6 b A : � I D � E J H = � ; D G � g G : 6 I : G6 w6 G : C : H H � 6 C 9 � ; J C 9 > C g.�

TThhee CChhrroonniicclleehhaass llaannddeedd oonnyyoouurr mmoobbiilleepphhoonnee

TTeexxtt ffoollllooww sskkiinncchhrroonniiccllee ttoo 2211221122iinn CCaannaaddaa ((oorr ttoo 4400440044 iinn tthhee UUSSAA))ffoorr uupp--ttoo--tthhee--sseeccoonndd uuppddaatteess ffrroommtthhee wwoorrlldd ooff cclliinniiccaall ddeerrmmaattoollooggyy,,aanndd ttoo pprreevviieeww aarrttiicclleess ffrroomm uupp--ccoommiinngg eeddiittiioonnss ooff TThhee CChhrroonniiccllee ooff SSkkiinn && AAlllleerrggyy..

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HS greatly impacts patient’s quality of life, study reportsContinued from page 1

ON SENSITIVE SK

IN

* Among fusion razors.† Versus Gillette Fusion ProGlide.

© 2014 P&G www.gillette.ca

RECOMMEND GILLETTE FUSION PROGLIDE WITH FLEXBALL TECHNOLOGY FOR YOUR PATIENTS WITH SENSITIVE SKIN.

Gillette Fusion ProGlide with FlexBall Technology responds to contours for maximum contact* and gets virtually every hair. The new razor is specifi cally designed to respond to the contours of a man’s face, allowing for maximum contact on the curves.† The result is a completely upgraded shaving experience that is kinder and gentler to every man’s face.



� � � �Atopic dermatitis research M6 G 8 = � 2015� � ·� 15

ON SENSITIVE SK

IN

* Among fusion razors.† Versus Gillette Fusion ProGlide.

© 2014 P&G www.gillette.ca

RECOMMEND GILLETTE FUSION PROGLIDE WITH FLEXBALL TECHNOLOGY FOR YOUR PATIENTS WITH SENSITIVE SKIN.

Gillette Fusion ProGlide with FlexBall Technology responds to contours for maximum contact* and gets virtually every hair. The new razor is specifi cally designed to respond to the contours of a man’s face, allowing for maximum contact on the curves.† The result is a completely upgraded shaving experience that is kinder and gentler to every man’s face.


16 ·� � M6 G 8 = � 2015


I = : � ; > G H I � D G 6 A � E = D H E = D 9 > : H I : G 6 H : � 4(PDE4)� > C = > b> I D G .�

“I; � w: � A D D k� 6 I � I = : � : vD A J I > D C � D ; � E H D -G > 6 H > H � I G : 6 I B : C I ,� w: ’v: � = 6 9 � I D E > 8 6 A H ,I 6 G H ,� 6 B > C D E I : G > C ,� 6 C 9 � E = D I D I = : G 6 E > : H .W: � = 6 9 � B : I = D I G : x 6 I : � > C I G D 9 J 8 : 9B 6 C y� y: 6 G H � 6 gD � 6 C 9 � I = : C � 8 y8 A D H E D G > C :6 G D J C 9 � 20� y: 6 G H � 6 gD .� T= : C � w: � w: C I � I DI = : � b> D A D g> 8 H � I = 6 I � w: G : � 9 : A > v: G : 9 � > C > -I > 6 A A y� > C I G 6 v: C D J H A y� 6 C 9 � I = : C � H J b8 J I 6 -C : D J H A y,”� H 6 yH � DG .� W6 yC : � GJ A A > v: G ,� 6S I . � J D = C ’ H � N : w; D J C 9 A 6 C 9 � 6 C 9L 6 bG 6 9 D G -b6 H : 9 � 9 : G B 6 I D A D g > H I � 6 C 9PG D ; : H H D G � D ; � M: 9 > 8 > C : � 6 I � M: B D G > 6 AUC > v: G H > I y.� “AC 9 � C D w� w: ’G : � b6 8 k� I D � 6 CD G 6 A � H B 6 A A � B D A : 8 J A : .”

T= : � C : w� E G D 9 J 8 I � > H � I = : � ; > G H I � D G 6 A -A y � 9 : A > v : G : 9 � H B 6 A A � B D A : 8 J A : � I G : 6 I -B : C I � ; D G � E H D G > 6 H > H � H > C 8 : � 8 y8 A D H E D G > C :w6 H � > C I G D 9 J 8 : 9 � I wD � 9 : 8 6 9 : H � 6 g D ,H 6 yH � DG .� GJ A A > v: G .� TD � 9 6 I : � I G > 6 A H � D ; � I = :C : w� ; D G B J A 6 I > D C � = 6 v: � H = D wC � > I � = 6 HG : 6 H D C 6 bA : � : ; ; > 8 6 8 y� 6 C 9 � 6 � v: G y� gD D 9H 6 ; : I y� E G D ; > A : ,� 6 C 9 � wD G kH � G : 6 H D C 6 bA yw: A A � ; D G � 6 A A � 6 H E : 8 I H � D ; � E H D G > 6 H > H —C 6 > A H ,� H 8 6 A E ,� 6 C 9 � E H D G > 6 I > 8 � 6 G I = G > I > H ,� = :H 6 yH .

AE E G D v6 A � D ; � I = : � C : w� ; D G B J A 6 I > D Cw6 H � A 6 G g: A y� b6 H : 9 � D C � I wD � B J A I > -8 : C -I G : ,� G 6 C 9 D B > z: 9 ,� 9 D J bA : -bA > C 9 � H I J 9 > : H(ESTEEM� 1� 6 C 9 � 2),� w= > 8 = � > C v D A v : 9

G D J g= A y� 1,250� 6 9 J A I H � w> I = � B D 9 : G 6 I : � I DH : v: G : � E A 6 qJ : � E H D G > 6 H > H .

Less laboratory monitoringT= : � D G 6 A � ; D G B J A 6 I > D C � D ; � 6 E G : B > A 6 H I6 E E : 6 G H � I D � b : � 6 H � : ; ; : 8 I > v : � 6 H � D G 6 AB : I = D I G : x6 I : ,� H 6 yH � V6 C 8 D J v: G � 9 : G B 6 -I D A D g> H I � DG .� J6 H D C � R> v: G H ,� 8 A > C > 8 6 A � E G D -; : H H D G � D ; � 9 : G B 6 I D A D gy� 6 C 9 � 6 � E 6 H I � 9 > G : 8 -I D G � D ; � I = : � 9 : G B 6 I D A D gy� G : H > 9 : C 8 y� I G 6 > C -> C g� E G D gG 6 B � 6 I � I = : � UC > v: G H > I y� D ; � BG > I > H =CD A J B b> 6 .� A9 v: G H : � : v: C I H � H : : B � I D � b:A > B > I : 9 , � I D D , � = : � H 6 y H . � U C A > k : � D G 6 AB : I = D I G : x6 I : ,� D G 6 A � 6 E G : B > A 6 H I � 9 D : H � C D IG : qJ > G : � I = : � H 6 B : � A : v: A � D ; � A 6 b� B D C > I D G -> C g,� H 6 yH � DG .� R> v: G H .�

“OG 6 A � 9 D H > C g� > H � 6 � B D G : � 8 D C v: C > : C ID E I > D C � ; D G � H D B : � E 6 I > : C I H ,” � H 6 y HE9 B D C I D C � 9 : G B 6 I D A D g> H I � DG .� ND G B 6 CW6 H : A ,� 6 H H > H I 6 C I � 8 A > C > 8 6 A � E G D ; : H H D G � D ;B : 9 > 8 > C : � 6 I � I = : � UC > v: G H > I y� D ; � AA b: G I 6 .

“SD B : � E 6 I > : C I H � B 6 y� 6 E E G : 8 > 6 I :I = > H � 6 H � A : H H � I = G : 6 I : C > C g� D G � A : H H � > C v6 H > v:6 C 9 � B 6 y� b: � B D G : � D E : C � I D � [D G 6 A � I = : G 6 -E y] � 6 H � D E E D H : 9 � I D � D I = : G � G D J I : H � D ;6 9 B > C > H I G 6 I > D C .”� DG . � W6 H : A � H 6 y H � = > HD w C � E 6 I > : C I H � D ; I : C � H I 6 y � 6 w 6 G : � D ;9 : v: A D E B : C I H � > C � I G : 6 I B : C I � D E I > D C H; D G � I = : > G � 8 D C 9 > I > D C H , � 6 C 9 � I = : G : � = 6 Hb : : C � 6 � ; 6 > G � b > I � D ; � > C I : G : H I � > C � D G 6 A6 E G : B > A 6 H I .

“SD B : � E 6 I > : C I H � B 6 y� v> : w� > I � 6 H � 6B D G : � 8 D C v: C > : C I � D E I > D C , � D G � 6 � B D G :

6 8 8 : E I 6 bA : � G D J I :D ; � 6 9 B > C > H I G 6 I > D C .O I = : G � E 6 I > : C I HB 6 y � v> : w� H J b8 J -I 6 C : D J H � 6 H � B D G :8 D C v : C > : C I ,” � = :H 6 yH .

“I I � > H � 6 � g D D 9E A 6 8 : � ; D G � � E = y H > -8 > 6 C H � I D � = 6 v: � 6 � 9 > H -

8 J H H > D C � w> I = � I = : � E 6 I > : C I H .� I� 6 C I > 8 > E 6 I :I = 6 I � E 6 I > : C I H � w= D � 6 G : � 8 J G G : C I A y� D C � D G 6 AI G : 6 I B : C I H � w> I = � B : I = D I G : x6 I : � 6 C 9 � E : G -= 6 E H � B 6 y� C D I � b: � 9 D > C g� w: A A � 6 G : � gD > C gI D � b: � E 6 G I > 8 J A 6 G A y � > C I : G : H I : 9 � > C � D G 6 AI G : 6 I B : C I � w> I = � 6 E G : B > A 6 H I ,� D G � 6 A I : G C 6 -I > v: A y� E 6 I > : C I H � w= D � w: G : � 8 D C H > 9 : G > C gB : I = D I G : x6 I : � I = : G 6 E y� bJ I � ; D G � w= D BB : I = D I G : x6 I : � B 6 y� b: � 8 D C I G 6 > C 9 > 8 6 I : 9B 6 y� 6 A H D � w6 C I � I D � g> v: � 6 � H : G > D J H � A D D k� 6 I6 E G : B > A 6 H I .”

RD J g= A y� D C : - I = > G 9 � D ; � E 6 I > : C I H � > C

I = : � ESTEEM� 1� I G > 6 A � 6 8 = > : v: 9 � PASI-758 A : 6 G 6 C 8 : . � “FD G � I = : � E : D E A : � w= D � 9 Dw: A A � w> I = � > I ,� I = : y� 6 G : � v: G y� = 6 E E y� w> I => I ,� 6 C 9 � > I � > H � B 6 > C I 6 > C : 9 .� T= : G : � > H � A D C g-I : G B � 9 6 I 6 � D J I � I D � 6 � y : 6 G . � W: ’v: � gD IH D B : � E : D E A : � > C � H I J 9 > : H ,� 6 C 9 � I’v: � = 6 9H D B : � : xE : G > : C 8 : � w> I = � > I � > C � 8 A > C > 8 6 A � I G > -6 A H ,� I = 6 I � 6 G : � gD > C g� I D � b: � D C � I = : � 9 G J gC D w� ; D G � 6 � 8 D J E A : � D ; � y: 6 G H ,”� 6 9 9 H � DG .GJ A A > v: G .� P6 I > : C I H � > C � D C gD > C g� : ; ; > 8 6 8 yH I J 9 > : H � 6 G : � b: > C g� ; D A A D w: 9 � D J I � I D � ; > v:y: 6 G H ,� = : � H 6 yH .�

T = : � B 6 > C � A > B > I 6 I > D C � D ; � D G 6 A6 E G : B > A 6 H I � 6 I � I = > H � I > B : � > H � I = : � 8 D H I ,H 6 yH � DG .� R> v: G H .� II � G : B 6 > C H � I D � b: � H : : Cw= : I = : G � D G � C D I � E G D v> C 8 > 6 A � ; D G B J A 6 G > : Hw> A A � E > 8 k� J E � I = : � C : w� ; D G B J A 6 I > D C � ; D GG : > B bJ G H : B : C I .

H 6 v > C g � 6 C � D G 6 A � PDE4� > C = > b > I D Gg> v: H � 8 A > C > 8 > 6 C H � B D G : � ; A : x> b> A > I y,� H 6 yHDG .� GJ A A > v: G .� “FD G � E 6 I > : C I H � w= D � = 6 v:; 6 > A : 9 � B 6 C y� D I = : G � 8 A 6 H H : H � D ; � 9 G J gH ,� > I � > H8 : G I 6 > C A y� 6 C � D E I > D C .� AC 9 � ; D G � I = D H : � w= Dw6 C I � 6 � E > A A ,� > I � > H � 8 : G I 6 > C A y� 6 C � D E I > D C .� ICI : G B H � D ; � H 6 ; : I y � E G D ; > A : , � > I � B 6 y � b :6 E E : 6 A > C g� I D � 6 � C J B b: G � D ; � E 6 I > : C I H .� II � > HH D B : I = > C g� C : w,� 6 C 9 � H D B : I = > C g� w:6 G : � v: G y� = 6 E E y� I D � = 6 v: � 6 H � E 6 G I � D ; � D J GI = : G 6 E : J I > 8 � 6 G B 6 B : C I 6 G > J B .”

Non-proprietary and brand name oftherapy: apremilast (Otezla, CelgeneCorp.)

Although the pathogenesisof seborrheic dermati-tis—one of the most com-

mon presentations in derm -at ology practice—is not com-pletely understood, results froma recent clinical trial indicatetherapy with an over-the-counter preparation can providebenefits to patients whose scalp,face and other body areas are af-fected by the disease.

“The results from this studyshow that this hydro-alcoholic-based agent containing niaci-namide, panthenol and caffeinecan reduce dry skin appearance,improve skin barrier function,reduce inflammation and nor-malize epidermal differentiation.

We can helpour patients,”according to Dr.Loukia Mitsos, aMontreal derma-tologist, who pre-sented the results

of the study during a podium sessionat Dermatology Update in Vancou-ver.

Dr. Mitsos noted that seborrheicdermatitis is a troublesome, annoy-ing condition for patients, who expe-rience distressing yellow, white andgrey skin flakes, pruritus, a feeling oftightness and, in many cases, ery-thema as well.

She noted seborrheic dermatitis isa reaction to the Pityrosporum yeasts,Malasezzia furfur, Malassezia globosa,and Malas sezia restricta, and reportednew developments in the understand-ing and treatment of the condition.

“What is very interesting now isthat we have molecular markers wecan quantify to see if with our treat-ments we are actually improving theinflammatory process,” she said.

“Studies are also looking at im-provement in barrier function by in-vestigating transepidermal waterloss and the presence of humanserum albumin in the superficialstratum corneum.”

She described the randomized,split-scalp clinical trial that evaluatedthe improvement in the dry scalp ap-pearance of 36 males treated with aleave-on, hydro-alcoholic-based agentcontaining niacinamide, panthenoland caffeine (Head & Shoulders Fulland Thick Advanced Hair ThickeningTonic, Procter & Gamble). Subjectswith concomitant skin disease of thescalp were excluded from the study.

Niacinamide, Dr. Mitsos said, is aVitamin B3 compound that decreasesinflammation and improves the skin’smoisturization by increasing fibrin inthe skin barrier, and also by increas-ing high molecular weight keratins.

Caffeine is a non-competitive se-lective phosphodiesterase inhibitor thatincreases cyclic AMP and also inhibitsTNF-alpha. Panthenol, a pro-vitaminB5 humectant emollient, also plays arole by drawing in moisture and de-creasing inflammation.

Dr. Mitsos noted that subjects en-

rolled in the trial were screened via amedical history questionnaire andthen assessed by qualified dandruffgraders, who used the AdherentScalp Flaking Score (ASFS) to quan-tify the severity of flaking on eachsubject’s scalp (Bacon RA, MizoguchiH, Schwartz JR: Assessing therapeu-tic effectiveness of scalp treatment fordandruff and seborrheic dermatitis,Part 1: a reliable and relevant methodbased upon the adherent scalp andflaking score (ASFS). J DermatologyTreat 2014; 25(3):232–236).

During a two-week pre-treat-ment period the subjects washedtheir hair with a cosmetic shampoo,and at baseline at the end of this pe-riod were required to have an ASFSof >/=24. The leave-on tonic was ap-plied each day for three weeks on theright side or the left side of the scalp;in each case, the location was deter-mined by randomization.

The same shampoo used in thepre-treatment phase of the study wasused over the entire scalp again threetimes each week.

Weekly evaluationThe results were evaluated weekly,Dr. Mitsos said. The improvement indry skin appearance was assessed vi-sually by experts, who recorded theirfindings using the ASFS score: 0 (noscaling), 2 (slight scaling), 4 (some

scaling, 6( m o d e r a t escaling), 8(heavy scal-ing) and 10(very heavyscaling).

Improve-ment in bar-rier functionwas meas-ured by trans -e p i d e r m a lwater loss(TEWL), andthe presenceof human ser -um albuminbiomarkers in

the superficial stratum corneum.The normalization of epidermal

differentiation and inflammationwas assessed by recording the levelof the IL-1ra:IL-1alpha ratio and thelevel of involucrin, a keratinocyte en-velope protein biomarker, in the su-perficial stratum corneum.

Compared to the resultsachieved using only the shampoo,the hair thickening and scalp treat-ment significantly improved the dryskin appearance of the 36 subjects atweeks 2 and 3 of the study p<0.005(Schwartz J: J Acta Derm Venereol2013; 93:131–137).

Measurements of transepider-mal water loss (TEWL) at the sameweekly intervals also showed thehair thickening and scalp treatmenthad also significantly improved skinbarrier function. Human serum albu-min (HSA) biomarker levels at week3 confirmed this finding.

The investigators utilized in-volucrin to assess epidermal differ-entiation achieved through the useof the shampoo or hair thickeningand scalp treatment agents. Differ-entiation was found to be normal-ized to a significant degree at bothweek 2 and week 3 when the hairthickening and scalp treatment wasused.

An improvement of more than20% was noted at week 2 and an im-

provement ofmore than 30%was noted sevendays later, com-pared to a nor-malization of 40%in epidermal dif-ferentiation withthe shampoo.

The hair thick-ening and scalptreatment also re-duced inflamma-tion on the scalp.The IL-1ra:IL-1alpha ratio demo-nstrated that thisreduction was sig-nificant at weeks 1,2 and 3.

“Use of thisnew scalp treat-ment significantlyreduced the dryskin appearance

on the scalps of these subjects,” Dr.Mitsos said.

“It also reduced inflammation ofthe scalp, improved skin barrier func-tion and normalized the epidermal dif-ferentiation in each of the 36 subjects.”

Therapeutic optionAvailable as an OTC product, thenew Head & Shoulders Full & ThickAdvanced Hair Thickening Tonicoffers patients and physicians an-other preventive and therapeuticoption to the list of prescriptionmedications available to manage thevarious forms of seborrheic der-matitis.

The therapeutic armamentariumfor seborrheic dermatitis includes an-tifungals (miconazole, ketoconazole),topical corticosteroids (fluocinolone,triamcinolone, hydrocortisone) andkeratolytics such as topical urea. An-tihistamines may also be used to re-lieve pruritus.

Some dermatologists also favourphotodynamic therapy with UV-Aand UV-B laser or red and blue LEDlight to halt growth of the Malasseziafungi.

Supplement to The Chronicle of Skin& Allergy, March 2015. Chronicle is anindependent medical news service thatprovides educational updates regardingmedical developments around the world.Views expressed are those of the partici-pants and do not necessarily reflect thoseof the publisher or sponsor.

Support for distribution of this re-port was provided by Procter & Gamblethrough an unrestricted educationalgrant without conditions. Informationprovided in this report is not intendedto serve as the sole basis for individualcare.

Printed in Canada for ChronicleInformation Resources Ltd., 555 Burn-hamthorpe Rd., Suite 306, Toronto,Ont. M9C 2Y3.Telephone416.916.2476; facsimile 416.352.6199;e-mail: [email protected]. Copyright2015 by Chronicle Information Re-sources Ltd., except where noted. Allrights reserved. Reproduction in anyform is expressly prohibited withoutwritten permission of the publisher.

Leave-on hydro-alcoholic agent with niacinamide, panthenol and caffeine helps patients

Microscopicimage ofhuman sebor-rheic dermatitisof the scalp.Courtesy, Horo-poro, licensedunder CC by-SA3,0

Adherent Scalp Flaking Score (ASFS) method to quantitate the ,aking severity

Grading scale:0 – no scaling2 – slight scaling4 – some scaling6 – moderate scaling8 – heavy scaling10 – very heavy scaling

Division of the scalp into 8 sections

Bacon RA: J Dermatology Treat 2014 Jun; 25(3):232-236.

New treatment option forseborrheic dermatitis of the scalp

H&S_DU_02-11-15a_April_09_2015_Layout 1 09/04/2015 12:00 PM Page 1

Oral apremilast a new treatment option for psoriasisContinued from page 1


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“[T= 6 I � B : I = D 9 ] � > H � ; > C : , � 6 C 9 � E = y H > 8 > 6 C H � 6 C 9C J G H : H � 6 C 9 � = : 6 A I = 8 6 G : � E G D v> 9 : G H � J H : � I = : > G � j J 9 g-B : C I � 9 6 > A y� I D � 9 : H 8 G > b: � w= : G : � D C � 6 � H E : 8 I G J B � D ;H yB E I D B 6 I D A D gy� H D B : D C : � J C ; D A 9 H .� BJ I � > ; � w: � 6 G :I D � 9 G 6 w� J H : ; J A � 8 D C 8 A J H > D C H � ; G D B � 8 A > C > 8 6 A � G : H : 6 G 8 => I � > H � H > gC > ; > 8 6 C I A y� B D G : � G D bJ H I � > ; � w: � 8 6 C � 9 D � > I � > C � 68 D C H I 6 C I > v: � B 6 C C : G ,”� H 6 > 9 � DG .� Ev: G : I I .� “[T= : C � yD J8 6 C ] � H = D w � I = 6 I � 6 C � 6 v : G 6 g : � H 8 D G : � = 6 H � b : : CG : 9 J 8 : 9 � by� 6 � E 6 G I > 8 J A 6 G � > C I : G v : C I > D C � D G � w: � 8 6 C8 D B E 6 G : � I wD � > C I : G v : C I > D C H � 6 C 9 � H = D w� I = 6 I � I = :6 v: G 6 g: � H 8 D G : � w> I = � D C : � > C I : G v: C I > D C � w6 H � A D w: GI = 6 C � I = : � D I = : G .”�

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by� = 6 v> C g� > I � G : v> : w: 9 � by� : xE : G I H � > C � I = : � ; > : A 9 ,� 8 D B -E 6 G > C g� > I � I D � 6 9 J A I � H 8 6 A : H � H > C 8 : � I = : G : � > H � C D � gD A 9 � H I 6 C -9 6 G 9 ,� 6 C 9 � by� = 6 v> C g� 9 > ; ; : G : C I � = : 6 A I = � 8 6 G : � E G D v> 9 : G HJ H : � > I � I D � G 6 I : � I = : � H 6 B : � E 6 I > : C I .�

“OJ G � 9 6 I 6 � w6 H � D C A y� E G : A > B > C 6 G y� I D � b: � = D C : H I ,w: � 9 > 9 � C D I � 9 D � 6 C yI = > C g� G D bJ H I � D G � > C � 6 � B : I = D 9 D A D g> -8 6 A A y� H D J C 9 � w6 y.� W: � 9 > 9 � > I � > C � 6 � k> C 9 � D ; � G : 6 A � wD G A 9w6 y� w= : G : � w: � jJ H I � g6 v: � I = : � H 8 6 A : � I D � H D B : � bJ G C8 6 G : G H � 6 C 9 � 6 H k: 9 � I = : B � I D � = 6 v: � 6 � gD � [6 I � G 6 I > C g],”H 6 > 9 � DG .� Ev: G : I I .�

Less laboratory monitoringT= : � 8 6 G : G H � w: G : � 6 H k: 9 � I D � G : 8 D G 9 � I = : � E 6 I > : C I � 6 G D J C 9I = : � H 6 B : � I > B : ,� = D w: v: G ,� I = : G : � w6 H � C D � 8 D C I G D A � I D6 8 8 D J C I � ; D G � I = : � ; 6 8 I � I = 6 I � > ; � I wD � 9 > ; ; : G : C I � J H : G H � D ; � I = :H 8 6 A : � G : 8 D G 9 : 9 � I = : � H : v: G > I y� 6 C � = D J G � 6 E 6 G I ,� I = : � > I 8 =A : v: A � B > g= I � = 6 v: � 6 A G : 6 9 y� 8 = 6 C g: 9 .� DG .� Ev: G : I I � H 6 > 9I = 6 I � I = D J g= � > I � B 6 y� 6 E E : 6 G � I = 6 I � I = : � G : 8 D G 9 : G H � 6 G :g: I I > C g� 9 > ; ; : G : C I � G : H J A I H � J H > C g� I = : � H 8 6 A : ,� > I � 8 D J A 9 � jJ H Ib : � I = 6 I � I = : � > I 8 = � H : v : G > I y � = 6 H � g D C : � 9 D w C � D G> C 8 G : 6 H : 9 � > C � 6 � H = D G I � E : G > D 9 � D ; � I > B : .

T= : � H 8 6 A : � > H � H I > A A � > C � I = : � E > A D I � H I 6 g: � D ; � > B E A : B : C -I 6 I > D C � 6 C 9 � D G . � Ev : G : I I � H 6 > 9 � 6 H � E 6 G I � D ; � D C g D > C gG : H : 6 G 8 = � I = : y� 6 G : � : C H J G > C g� I = 6 I � I = : > G � B : I = D 9 D A D gy; D G � 8 D A A : 8 I > C g� G : A > 6 b> A > I y� 6 C 9 � v6 A > 9 > I y� 9 6 I 6 � > H � H D J C 9 .�

T = : � H 8 6 A : � = 6 H � b : : C � w : A A � G : 8 : > v : 9 � H D � ; 6 G ,6 8 8 D G 9 > C g� I D � DG .� Ev: G : I I .� H: � E G : H : C I : 9 � I = : � H 8 6 A : � > CB D H I D C � 9 J G > C g � I = : � A B : G > 8 6 C � B J G C � A H H D 8 > 6 I > D C6 C C J 6 A � B : : I > C g � 6 � y : 6 G � 6 g D � 6 C 9 � = : � = 6 H � H > C 8 :G : 8 : > v: 9 � G : qJ : H I H � ; D G � > I � I D � b: � > B E A : B : C I : 9 � > C I DD I = : G � 8 = > A 9 G : C ’H � = D H E > I 6 A H .� H: � H 6 > 9 � = : � > H � = D E > C g� I = :H 8 6 A : � > H � 6 � I D D A � I = 6 I � g: I H � 9 > H H : B > C 6 I : 9 � w: A A .


Novel postburn pruritus scale introducedn D: v: A D E : 9 � > C � TD G D C I D ,� ; D J G -E D > C I � H 8 6 A : � w> A A � = : A E � gG 6 9 : � > I 8 = � H : v: G > I y� > C � 8 = > A 9 G : C � I D � ; > v: � y: 6 G H � D ; � 6 g:

Dr. Jason Rivers

Dr. WayneGulliver

Dr. NormanWasel


Although the pathogenesisof seborrheic dermati-tis—one of the most com-

mon presentations in derm -at ology practice—is not com-pletely understood, results froma recent clinical trial indicatetherapy with an over-the-counter preparation can providebenefits to patients whose scalp,face and other body areas are af-fected by the disease.

“The results from this studyshow that this hydro-alcoholic-based agent containing niaci-namide, panthenol and caffeinecan reduce dry skin appearance,improve skin barrier function,reduce inflammation and nor-malize epidermal differentiation.

We can helpour patients,”according to Dr.Loukia Mitsos, aMontreal derma-tologist, who pre-sented the results

of the study during a podium sessionat Dermatology Update in Vancou-ver.

Dr. Mitsos noted that seborrheicdermatitis is a troublesome, annoy-ing condition for patients, who expe-rience distressing yellow, white andgrey skin flakes, pruritus, a feeling oftightness and, in many cases, ery-thema as well.

She noted seborrheic dermatitis isa reaction to the Pityrosporum yeasts,Malasezzia furfur, Malassezia globosa,and Malas sezia restricta, and reportednew developments in the understand-ing and treatment of the condition.

“What is very interesting now isthat we have molecular markers wecan quantify to see if with our treat-ments we are actually improving theinflammatory process,” she said.

“Studies are also looking at im-provement in barrier function by in-vestigating transepidermal waterloss and the presence of humanserum albumin in the superficialstratum corneum.”

She described the randomized,split-scalp clinical trial that evaluatedthe improvement in the dry scalp ap-pearance of 36 males treated with aleave-on, hydro-alcoholic-based agentcontaining niacinamide, panthenoland caffeine (Head & Shoulders Fulland Thick Advanced Hair ThickeningTonic, Procter & Gamble). Subjectswith concomitant skin disease of thescalp were excluded from the study.

Niacinamide, Dr. Mitsos said, is aVitamin B3 compound that decreasesinflammation and improves the skin’smoisturization by increasing fibrin inthe skin barrier, and also by increas-ing high molecular weight keratins.

Caffeine is a non-competitive se-lective phosphodiesterase inhibitor thatincreases cyclic AMP and also inhibitsTNF-alpha. Panthenol, a pro-vitaminB5 humectant emollient, also plays arole by drawing in moisture and de-creasing inflammation.

Dr. Mitsos noted that subjects en-

rolled in the trial were screened via amedical history questionnaire andthen assessed by qualified dandruffgraders, who used the AdherentScalp Flaking Score (ASFS) to quan-tify the severity of flaking on eachsubject’s scalp (Bacon RA, MizoguchiH, Schwartz JR: Assessing therapeu-tic effectiveness of scalp treatment fordandruff and seborrheic dermatitis,Part 1: a reliable and relevant methodbased upon the adherent scalp andflaking score (ASFS). J DermatologyTreat 2014; 25(3):232–236).

During a two-week pre-treat-ment period the subjects washedtheir hair with a cosmetic shampoo,and at baseline at the end of this pe-riod were required to have an ASFSof >/=24. The leave-on tonic was ap-plied each day for three weeks on theright side or the left side of the scalp;in each case, the location was deter-mined by randomization.

The same shampoo used in thepre-treatment phase of the study wasused over the entire scalp again threetimes each week.

Weekly evaluationThe results were evaluated weekly,Dr. Mitsos said. The improvement indry skin appearance was assessed vi-sually by experts, who recorded theirfindings using the ASFS score: 0 (noscaling), 2 (slight scaling), 4 (some

scaling, 6( m o d e r a t escaling), 8(heavy scal-ing) and 10(very heavyscaling).

Improve-ment in bar-rier functionwas meas-ured by trans -e p i d e r m a lwater loss(TEWL), andthe presenceof human ser -um albuminbiomarkers in

the superficial stratum corneum.The normalization of epidermal

differentiation and inflammationwas assessed by recording the levelof the IL-1ra:IL-1alpha ratio and thelevel of involucrin, a keratinocyte en-velope protein biomarker, in the su-perficial stratum corneum.

Compared to the resultsachieved using only the shampoo,the hair thickening and scalp treat-ment significantly improved the dryskin appearance of the 36 subjects atweeks 2 and 3 of the study p<0.005(Schwartz J: J Acta Derm Venereol2013; 93:131–137).

Measurements of transepider-mal water loss (TEWL) at the sameweekly intervals also showed thehair thickening and scalp treatmenthad also significantly improved skinbarrier function. Human serum albu-min (HSA) biomarker levels at week3 confirmed this finding.

The investigators utilized in-volucrin to assess epidermal differ-entiation achieved through the useof the shampoo or hair thickeningand scalp treatment agents. Differ-entiation was found to be normal-ized to a significant degree at bothweek 2 and week 3 when the hairthickening and scalp treatment wasused.

An improvement of more than20% was noted at week 2 and an im-

provement ofmore than 30%was noted sevendays later, com-pared to a nor-malization of 40%in epidermal dif-ferentiation withthe shampoo.

The hair thick-ening and scalptreatment also re-duced inflamma-tion on the scalp.The IL-1ra:IL-1alpha ratio demo-nstrated that thisreduction was sig-nificant at weeks 1,2 and 3.

“Use of thisnew scalp treat-ment significantlyreduced the dryskin appearance

on the scalps of these subjects,” Dr.Mitsos said.

“It also reduced inflammation ofthe scalp, improved skin barrier func-tion and normalized the epidermal dif-ferentiation in each of the 36 subjects.”

Therapeutic optionAvailable as an OTC product, thenew Head & Shoulders Full & ThickAdvanced Hair Thickening Tonicoffers patients and physicians an-other preventive and therapeuticoption to the list of prescriptionmedications available to manage thevarious forms of seborrheic der-matitis.

The therapeutic armamentariumfor seborrheic dermatitis includes an-tifungals (miconazole, ketoconazole),topical corticosteroids (fluocinolone,triamcinolone, hydrocortisone) andkeratolytics such as topical urea. An-tihistamines may also be used to re-lieve pruritus.

Some dermatologists also favourphotodynamic therapy with UV-Aand UV-B laser or red and blue LEDlight to halt growth of the Malasseziafungi.

Supplement to The Chronicle of Skin& Allergy, March 2015. Chronicle is anindependent medical news service thatprovides educational updates regardingmedical developments around the world.Views expressed are those of the partici-pants and do not necessarily reflect thoseof the publisher or sponsor.

Support for distribution of this re-port was provided by Procter & Gamblethrough an unrestricted educationalgrant without conditions. Informationprovided in this report is not intendedto serve as the sole basis for individualcare.

Printed in Canada for ChronicleInformation Resources Ltd., 555 Burn-hamthorpe Rd., Suite 306, Toronto,Ont. M9C 2Y3.Telephone416.916.2476; facsimile 416.352.6199;e-mail: [email protected]. Copyright2015 by Chronicle Information Re-sources Ltd., except where noted. Allrights reserved. Reproduction in anyform is expressly prohibited withoutwritten permission of the publisher.

Leave-on hydro-alcoholic agent with niacinamide, panthenol and caffeine helps patients

Microscopicimage ofhuman sebor-rheic dermatitisof the scalp.Courtesy, Horo-poro, licensedunder CC by-SA3,0

Adherent Scalp Flaking Score (ASFS) method to quantitate the ,aking severity

Grading scale:0 – no scaling2 – slight scaling4 – some scaling6 – moderate scaling8 – heavy scaling10 – very heavy scaling

Division of the scalp into 8 sections

Bacon RA: J Dermatology Treat 2014 Jun; 25(3):232-236.

New treatment option forseborrheic dermatitis of the scalp

H&S_DU_02-11-15a_April_09_2015_Layout 1 09/04/2015 12:00 PM Page 1Skin_March_2015,rar16_ms_9.1_rar1_Skin_March_2014,rar1.qxd 09/04/2015 12:26 PM Page 17

Hydrophobically-modified polymers containing cleanser

applied for facial acne demonstrated improved mildness and skinbarrier integrity in a female with sensitive skin

Cleansers for acne vulgaris: The

purpose for skin cleansing is to

reduce sebum and exogenous

contaminants and to control the

skin microbiome. The surfactants

in cleansers solubilize hydropho-

bic materials into the aqueous

phase and enable their subse-

quent removal from the skin sur-

face.6,7 In addition to providing

skin hygiene, surfactants can also

extract skin components during

cleansing and remain in the stra-

tum corneum after rinsing.5–7

These side effects disrupt stra-

tum corneum structure and de-

grade its barrier properties. 3–7

Hydrophobically-modified poly-

mers have been introduced to

create skin compatible cleansing

systems.6,7 It has been shown that

low molecular weight hydropho-

bically-modified polymers are ef-

fective at associating

surfactants.5–7 At the presence of

these polymers, surfactants as-

semble into larger, more stable

structures, which are less likely to

penetrate the skin. 6,7 The cleans-

ing* system, composed of a

lower concentration of free sur-

factant micelles as well as poly-

mer-surfactant complexes, have

been shown to maintain the in-

tegrity of the skin barrier (Fig 1).5–

7,8 A significant improve ment

(p<0.05 vs. placebo) in skin bar-

rier integrity (as measured via

TEWL) and cleanser irritation po-

tential (p<0.05) for the HMP con-

taining cleanser, was observed

after four consecutive 24-hour

patch ex posures to a diluted

cleanser solution.8 When used in

acne after an eight-week treat-

ment period, the numbers of in-

flammatory and

non-inflam matory lesions had de-

creased together with the inflam-

matory reactions, as assessed by

histopathologic examination.5

Acne Vulgaris: Acne vulgaris is an inflammatory disorder of pi-

losebaceous units, with characteristic lesions.1 Underlying barrier

dysfunction plays a crucial role in triggering the pathogenic

pathway leading to acne.1 Research has shown that acne patho-

physiology is more complex and interrelated with p. acnes con-

tributing to inflammation by direct and indirect mechanisms.1,2

Multiple therapies are available such as systemic and topical

retinoids, antibacterials, systemic and topical antibiotics, and

benzoyl peroxide (BPO) and combination products.2 Cleansing of

the facial skin in acne is a neces-

sary measure together with the

use of moisturizers containing

SPF.1–3 Surfactants within

cleanser formulations are useful

to solubilize and remove unwanted substances from the skin sur-

face.3–5 However, the interaction of surfactants with components

of the stratum corneum can also cause deleterious effects, which

can lead to skin barrier dysfunction, erythema and dryness.3–5

Patient case: Female teenager with sensitive skin who has regular flare-ups of mild to moderate acne

Profile: The 16-year-old girl has sensitive skin. She has regular flare-ups of mild to moderate facial acne (Fig

2). She is concerned and insecure about her appearance and has difficulties interacting with her peers, espe-

cially with boys in her school.

The condition: Her facial skin is prone to sub-acute and chronic inflammation, dryness, peeling, and irritation

resulting from acne therapy and the cleansers she had used previously. Her adherence to treatment is poor

as a result of cutaneous intolerance to acne therapy and a lack of successful outcomes of previous treat-

ments. Moreover, she prefers to use a cleanser that is foaming and gives a clean feeling after use.

Treatment: The approach should include edu-

cation on the cause of acne and education on

treatment options. She was offered a simpli-

fied, well-tolerated treatment regimen with a

combined topical retinoid/antibiotic. For suc-

cessful adjunctive therapy, a gentle foaming

cleanser with hydrophobically-modified poly-

mers and an SPF moisturizer** was used.

Consider:

� The use of the gentle cleanser to maintain

the integrity of the skin barrier that is al-

ready compromised by acne

� Discuss patient expectations of treatment re-

sults as well as monitoring and follow-up of

treatment and adjunct therapy to achieve

compliance and good patient outcomes

References

1. Thiboutot D, Gollnick H, Bettoli V, Dreno B, Kang S, Leyden JJ, et al:

New insights into the management of acne: an update from the

Global Alliance to Improve Outcomes in Acne group. J Am Acad

Dermatol 2009; 60(5):S1–50.

2. Del Rosso JQ, Kircik L: The sequence of inflammation, relevant bio-

markers, and the pathogenesis of acne vulgaris: what does recent

research say and what does it mean to the clinician? J Dmgs. Der-

matol 2013; 12(suppl 8):s109–115.

3. Draelos Z, Hornby S, Walters RM, Appa Y: Hydrophobically modified

polymers can minimize skin irritation potential caused by surfactant-

based cleansers. J Cosmet Dermatol 2013 Dec; 12(4):314–321.

4. Draelos ZD: The effect of a daily facial cleanser for normal to oily skin

on the skin barrier of subjects with acne. Cutis 2006 Jul; 78(1

Suppl):34–40.

5. Choi YS, Suh HS, Yoon MY, Min SU, Kim JS, Jung JY, Lee DH, Suh DH.: A study of the efficacy of cleansers

for acne vulgaris. J Dermatology Treat 2010 May; 21(3):201–205.

6. Walters RM, Fevola MJ, Gandolfi L, Librizzi JJ, Tamareselvy K, Tierney NK: Polymer-surfactant self-assem-

bly for the design of mild skin cleansers. Polymeric Materials: Science & Engineering 2011; 105(6):697–698.

7. Hornby S, Walters R, Kamath Y, Appa Y: Reduction in skin barrier perturbation by hydrophobically modi-

fied polymers. J Am Acad Dermatol 2011; 64(2):AB25.

8. Tierney N, et al: Cleansers with hydrophobically-modified polymers demonstrate Improved mildness and

skin barrier integrity. J Am Acad Dermatol Feb. 2011; 64(2, supplement 1):p. AB72.

Editorial feature supported by an unrestricted grant from Johnson & Johnson Inc., who are not responsible for content.

*Neutrogena NEUTROGENA® Ultra Gentle Daily Cleanser, **Neutrogena NEUTROGENA® HEALTHY DEFENSE® Daily Moisturizer/SPF 30/45Healthy Defense,Johnson & Johnson Inc.

Fig 1: Skin Barrier Integrity comparing the HMP-containingcleanser with a frequently used commercially available skincleanser6

There is a significant improvement (p<0.05 vs. placebo) inskin barrier integrity (as measured via TEWL) for the HMPcontaining cleanser, after four consecutive 24-hour patchexposures to a diluted cleanser solution.

Fig 2: Acne patient case: Teenager with sensitive skin andregular flare-ups of mild to moder-ate acne

Julia Carroll, MD, FRCPC

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From the News Resources of The Chronicle

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AB D C g� I = : � 410� E 6 I > : C I H � > C 8 A J 9 : 9 ,I = : � B 6 j D G > I y � (79%)� D ; � : x8 > H : 9 � MISw: G : � A : C I > gD � B 6 A > gC 6 � H J bI yE : .� T= :6 v: G 6 g: � = > H I D A D g> 8 6 A � : x8 > H > D C � B 6 G g> Cw6 H � 3.7� B B ,� 6 C 9 � w> I = � 6 � B : 9 > 6 C � ; D A -A D w-J E � D ; � 23� B D C I = H � I = : � G : 8 J G G : C 8 :G 6 I : � w6 H � 2.2%—C > C : � D ; � I = : � 410E 6 I > : C I H . � T= : G : � w: G : � H > B > A 6 G � G : 8 J G -G : C 8 : � G 6 I : H � H : : C � b: I w: : C � A : C I > g DB 6 A > gC 6 � (2.3%)� 6 C 9 � C D C -A : C I > gD � MIS(1.2%,� E =0.69).� AB D C g� I = : � A : H > D C HI = 6 I � G : 8 J G G : 9 ,� I = : � B : 6 C � : x8 > H > D C � B 6 G -g> C � w6 H � 1.9� B B ,� 8 D B E 6 G : 9 � I D � 3.8� B B> C � I = D H : � I = 6 I � 9 > 9 � C D I � G : D 8 8 J G .� Ov: G 6 A A ,I = : � G 6 I : � D ; � MIS� G : 8 J G G : C 8 : � w= : G : � I = :B 6 G g> C � w6 H � 3.0� B B � D G � A : H H � w6 H � 3.8%,8 D B E 6 G : 9 � I D � jJ H I � 0.5%� 6 B D C g� I = D H :w> I = � B 6 G g > C H � A 6 G g : G � I = 6 C � 3.0� B B( E =0.03). � OC : � D ; � I = : � MIS� I = 6 IG : 8 J G G : 9 � 9 > 9 � H D � 6 H � > C v6 H > v: � 9 > H : 6 H : .

BRAF MUTATION DOES NOT SPEEDMELANOMA TUMOUR GROWTHT= : � E G : H : C 8 : � D ; � 6 � BRAF� B J I 6 I > D C9 D : H � C D I � 6 E E : 6 G � I D � E G D 9 J 8 : � B D G :G 6 E > 9 � I J B D J G � gG D wI = � > C � B : A 6 C D B 6 ,bJ I � > H � 6 H H D 8 > 6 I : 9 � w> I = � E D D G : GB : A 6 C D B 6 -H E : 8 > ; > 8 � H J G v> v6 A � (MSS)� > CE 6 I > : C I H � w> I = � : 6 G A y- H I 6 g : � 9 > H : 6 H : ,G : H : 6 G 8 = : G H � G : E D G I � D C A > C : � > C � The BritishJournal of Dermatology (M6 G .� 5,� 2015).�

A� E G D H E : 8 I > v : � 8 D = D G I � D ; � 196E 6 I > : C I H � w> I = � H I 6 g: � I � I D � III� E G > B 6 G y8 J I 6 C : D J H � B : A 6 C D B 6 � w: G : � ; D A A D w: 9; D G � 6 � B : 9 > 6 C � D ; � 92� B D C I = H ,� E G : -9 6 I > C gI = : � > C H I > I J I > D C � D ; � BRAF� > C = > b> I D G � I = : G 6 -E y.� R: H : 6 G 8 = : G H � 8 D G G : A 6 I : 9 � 8 A > C > 8 D -E 6 I = D A D g> 8 6 A � v6 G > 6 bA : H � w> I = � B J I 6 I > D CH I 6 I J H , � 6 C 9 � : H I > B 6 I : 9 � MSS� = 6 z 6 G 9G 6 I > D H .� SD B : � 77� I J B D J G H � (39%)� = 6 9I = : � V600E� v6 G > 6 C I � D ; � I = : � BRAF� g: C : ,� 10(5%)� BRAF� V600K,� 6 C 9 � 33� (17%)NRAS.� T= : � BRAF� V600E� B J I 6 C IB : A 6 C D B 6 H � I : C 9 : 9 � I D � g G D w� B D G :H A D wA y, � 6 C 9 � w: G : � 6 H H D 8 > 6 I : 9 � w> I =B D G : � ; 6 vD J G 6 bA : � 8 A > C > 8 6 A � 8 = 6 G 6 8 I : G > H -I > 8 H � I = 6 C � BRAF� V600K,� NRAS� B J I 6 C I ,D G � BRAF/NRAS� WT� I J B D J G H � (0.12B B /B D ,� 0.61� B B /B D ,� 0.36� B B /B D = ,6 C 9 � 0.23� B B / B D � � G : H E : 8 I > v : A y,E =0.05).� T= : G : � w: G : � 39� B : A 6 C D B 69 : 6 I = H ,� 6 C 9 � BRAF� B J I 6 C I � B : A 6 C D B 6 Hw: G : � 6 H H D 8 > 6 I : 9 � w> I = � E D D G : G � MSS� > CH I 6 g: � I-III� 9 > H : 6 H : � (HR=2.60,� 95%� CI1.20,� 5.63,� E =0.02)� 6 C 9 � H I 6 g: � I-II� 9 > H -: 6 H : � (HR=3.39� 95%� CI� 1.12,� 10.22,E =0.03)� w= : C � D I = : G � E G D gC D H I > 8 � v6 G > -6 bA : H � w: G : � 6 9 jJ H I : 9 � ; D G .� BRAF� V600EB J I 6 C I � B : A 6 C D B 6 H � w: G : � H I G D C g A y(HR=3.89� 95%� CI� 1.67,� 9.09� E =0.002)6 H H D 8 > 6 I : 9 � w> I = � MSS,� > C 9 : E : C 9 : C I � D ;A : H > D C � I = > 8 kC : H H � D G � C D 9 6 A � H I 6 I J H .� BRAFV600K� B J I 6 C I � I J B D J G H � w: G : � C D I(HR=1.19� 95%� CI� 0.36,� 3.92,� E =0.77).

ACCEPTABLE TOXICITY FOR BRAFINHIBITOR/RADIOTHERAPYCD C 8 D B > I 6 C I � BRAF� > C = > b> I D G � I = : G 6 E y6 C 9 � G 6 9 > D I = : G 6 E y � > C � B : A 6 C D B 6E 6 I > : C I H � 9 D : H � 6 E E : 6 G � ; : 6 H > bA : � w> I => C 8 G : 6 H : H � > C � I D x> 8 > I y� w> I = > C � 6 8 8 : E I -6 bA : � A > B > I H ,� G : H : 6 G 8 = : G H � G : E D G I � D C A > C :> C � Annals of Oncology (M6 G .� 11,� 2015).

A� I D I 6 A � D ; � 161� B : A 6 C D B 6 � E 6 I > : C I H; G D B � 11� H k> C � 8 6 G : � 8 : C I G : H � > C � EJ G D E :w: G : � > C 8 A J 9 : 9 .� P6 I > : C I H � w: G : � : v6 A J 6 I -: 9 � ; D G � 6 8 J I : � 6 C 9 � A 6 I : � I D x> 8 > I y.� SD B : � 708 D C H : 8 J I > v : � E 6 I > : C I H � G : 8 : > v : 9 � 86H : G > : H � D ; � G 6 9 > D I = : G 6 A y, � 6 A D C g � w> I =BRAF� > C = > b> I D G � I = : G 6 E y.� BA D D 9 � H 6 B -E A : H � ; G D B � 35 � E 6 I > : C I H � J C 9 : G w: C IG 6 9 > D H : C H > I > v> I y� I : H I > C g� v> 6 � ; A J D G : H -8 : C 8 : -> C -H > I J -= ybG > 9 > z6 I > D C � D ; � 8 = G D B D -H D B 6 A � bG : 6 kH � 6 ; I : G � : x� v> vD � > G G 6 9 > 6 I > D C .T= : � G 6 I : � D ; � 6 8 J I : � G 6 9 > D 9 : G B 6 I > I > H � =2°w6 H � 36%� > C � E 6 I > : C I H � w> I = � 8 D C 8 D B > I 6 C IBRAF� > C = > b> I D G � I = : G 6 E y� 6 C 9 � G 6 9 > D I = : G -6 E y.� FD A A > 8 J A 6 G � 8 yH I > 8 � E G D A > ; : G 6 I > D C � w6 HH : : C � > C � 13%� D ; � 6 A A � G 6 9 > D I = : G 6 E > : H .H: 6 G > C g � 9 > H D G 9 : G H � B 6 9 : � J E � 4%� D ;C D C -H k> C � I D x> 8 > I > : H � H : : C ,� 6 C 9 � 9 yH E = 6 -g> 6 � 2%.� R6 I : H � D ; � G 6 9 > D 9 : G B 6 I > I > H � =2°E D H I � w= D A : -bG 6 > C � G 6 9 > D � I = : G 6 E y� w: G :44%� ; D G � E 6 I > : C I H � D C � BRAF� > C = > b> I D GI = : G 6 E y, � 6 C 9 � 8%� ; D G � I = D H : � C D I(E <0.001).� CD C 8 D B > I 6 C I � v: B J G 6 ; : C > bI G : 6 I B : C I � 6 A H D � E G D 9 J 8 : 9 � G 6 9 > D 9 : G -B 6 I > I > H � =2°� B D G : � ; G : q J : C I A y � I = 6 C9 6 bG 6 ; : C > b� I G : 6 I B : C I � (40%� vH .� 26%,E =0.07).� T= : � 6 C 6 A yH > H � D ; � 8 = G D B D H D -B 6 A � bG : 6 kH � : x� v> vD � 6 A H D � H = D w: 9 � H > g-C > ; > 8 6 C I � G 6 9 > D H : C H > I > v> I y� > C 8 G : 6 H : � ; D Gv: B J G 6 ; : C > b� E 6 I > : C I H � (E =0.004)� 6 C 9I = D H : � w= D � H w> I 8 = : 9 � ; G D B � v : B J -G 6 ; : C > b� I D � 9 6 bG 6 ; : C > b� (E =0.002),� bJ IC D I � I = D H : � D C � 9 6 bG 6 ; : C > b� D C A y.� ND � I D x> -8 > I > : H � w: G : � G : E D G I : 9 � 6 ; I : G � H I : G : D I 6 8 I > 8I G : 6 I B : C I .

ALTERNATE ANGIOGENESIS INRESPONSE TO ANTI-VEGF TX AC I > -VEGF� I G : 6 I B : C I H � > C � B : A 6 C D B 66 E E : 6 G � I D � E G D 9 J 8 : � 6 � H : A : 8 I > v: � E G : H -H J G : � ; D G � 6 9 6 E I > v: � G : H > H I 6 C 8 : ,� : C 8 D J G -6 g> C g� I = : � 9 : v: A D E B : C I � D ; � H I : B -A > k:8 6 C 8 : G � 8 : A A H � I = 6 I � 6 > 9 � > C � 6 C g> D g: C : H > H ,6 � ; > C 9 > C g� I = 6 I � B 6 y� > C ; D G B � I = : � 9 : H > gCD ; � 8 D B b> C 6 I > D C � I = : G 6 E > : H ,� 6 8 8 D G 9 > C gI D � 6 � E 6 E : G � E J b A > H = : 9 � D C A > C : � > CCancer Research (M6 G .� 13,� 2015).

T= : � 6 J I = D G H � J H : 9 � 6 � A D H H -D ; -; J C 8 -I > D C � 6 C 6 A y H > H � J H > C g � E A 6 H B > 9 -b6 H : 9H = RNA� I D � : x6 B > C : � 6 9 6 E I > v: � G : H E D C H :I D � VEGF-A� > C = > b > I > D C . � T J B D J Gx: C D gG 6 ; I H � w= > 8 = � > C > I > 6 A A y� G : H E D C 9 : 9I D � I = : � > C = > b> I > D C � J C 9 : G w: C I � 6 C � 6 9 6 E I 6 -I > D C � > C � v> vD ,� w= > 8 = � A : 9 � I D � 6 C � 6 8 qJ > G : 9G : H > H I 6 C 8 : . � VEGF-A� bA D 8 k 6 9 : � w6 H; D J C 9 � I D � b: � 6 H H D 8 > 6 I : 9 � w> I = � HIF-16: x E G : H H > D C , � 6 C 9 � 6 C � > C 8 G : 6 H : � > CCD144+� v6 H 8 J A D g: C > 8 � B > B > 8 G y� (VM).T= > H � A : 9 � I D � I = : � 9 : v: A D E B : C I � D ; � 8 = 6 C -C : A H � w= > 8 = � 9 > H E A 6 y: 9 � T> : -1� 6 C 9 � MMP-2J E G : gJ A 6 I > D C .� CD133+� 6 C 9 � CD271+B : A 6 C D B 6 � H I : B - A > k: � 8 : A A H � (MSLC)6 8 8 J B J A 6 I : 9 � > C � I = : � E : G > v 6 H 8 J A 6 GC > 8 = : . � HD w: v : G , � x : C D g G 6 ; I H � ; G D BB : A 6 C D B 6 � 8 : A A � E D E J A 6 I > D C H � I = 6 I � w: G :> C I G > C H > 8 6 A A y� G : H > H I 6 C I � I D � VEGF-A� bA D 8 k-6 9 : � 9 > 9 � C D I � H = D w� 6 C y� D ; � I = : H : � ; : 6 -I J G : H � 8 D B E 6 G : 9 � I D � C D C -I 6 G g: I � 8 D C I G D A H .

T = : � 6 J I = D G H � 8 D C 8 A J 9 : � I = 6 IB : A 6 C D B 6 H � I = 6 I � H I 6 G I � D J I � H : C H > I > v: � I DVEGF-A� bA D 8 k6 9 : � 6 9 D E I � VM� 6 H � 6 C6 A I : G C 6 I : � 6 C g> D g: C > 8 � H I G 6 I : gy� 6 H � 6 � ; D G BD ; � 6 9 6 E I > v: � G : H > H I 6 C 8 : ,� : C G > 8 = > C g� I = :E : G > v6 H 8 J A 6 G � C > 8 = : � ; D G � MSLC� 9 : E D H > -I > D C � v> 6 � 6 C � HIF-16 -9 : E : C 9 : C I � E G D 8 : H H .M: A 6 C D B 6 H � > C = : G : C I A y � G : H > H I 6 C I � I DVEGF-A� bA D 8 k6 9 : � 9 D � C D I � H = D w� I = > H8 D B E : C H 6 I D G y� H J G v> v6 A � B : 8 = 6 C > H B .


Hydrophobically-modified polymers containing cleanser

applied for facial acne demonstrated improved mildness and skinbarrier integrity in a female with sensitive skin

Cleansers for acne vulgaris: The

purpose for skin cleansing is to

reduce sebum and exogenous

contaminants and to control the

skin microbiome. The surfactants

in cleansers solubilize hydropho-

bic materials into the aqueous

phase and enable their subse-

quent removal from the skin sur-

face.6,7 In addition to providing

skin hygiene, surfactants can also

extract skin components during

cleansing and remain in the stra-

tum corneum after rinsing.5–7

These side effects disrupt stra-

tum corneum structure and de-

grade its barrier properties. 3–7

Hydrophobically-modified poly-

mers have been introduced to

create skin compatible cleansing

systems.6,7 It has been shown that

low molecular weight hydropho-

bically-modified polymers are ef-

fective at associating

surfactants.5–7 At the presence of

these polymers, surfactants as-

semble into larger, more stable

structures, which are less likely to

penetrate the skin. 6,7 The cleans-

ing* system, composed of a

lower concentration of free sur-

factant micelles as well as poly-

mer-surfactant complexes, have

been shown to maintain the in-

tegrity of the skin barrier (Fig 1).5–

7,8 A significant improve ment

(p<0.05 vs. placebo) in skin bar-

rier integrity (as measured via

TEWL) and cleanser irritation po-

tential (p<0.05) for the HMP con-

taining cleanser, was observed

after four consecutive 24-hour

patch ex posures to a diluted

cleanser solution.8 When used in

acne after an eight-week treat-

ment period, the numbers of in-

flammatory and

non-inflam matory lesions had de-

creased together with the inflam-

matory reactions, as assessed by

histopathologic examination.5

Acne Vulgaris: Acne vulgaris is an inflammatory disorder of pi-

losebaceous units, with characteristic lesions.1 Underlying barrier

dysfunction plays a crucial role in triggering the pathogenic

pathway leading to acne.1 Research has shown that acne patho-

physiology is more complex and interrelated with p. acnes con-

tributing to inflammation by direct and indirect mechanisms.1,2

Multiple therapies are available such as systemic and topical

retinoids, antibacterials, systemic and topical antibiotics, and

benzoyl peroxide (BPO) and combination products.2 Cleansing of

the facial skin in acne is a neces-

sary measure together with the

use of moisturizers containing

SPF.1–3 Surfactants within

cleanser formulations are useful

to solubilize and remove unwanted substances from the skin sur-

face.3–5 However, the interaction of surfactants with components

of the stratum corneum can also cause deleterious effects, which

can lead to skin barrier dysfunction, erythema and dryness.3–5

Patient case: Female teenager with sensitive skin who has regular flare-ups of mild to moderate acne

PPrrooffiillee:: The 16-year-old girl has sensitive skin. She has regular flare-ups of mild to moderate facial acne (Fig

2). She is concerned and insecure about her appearance and has difficulties interacting with her peers, espe-

cially with boys in her school.

The condition: Her facial skin is prone to sub-acute and chronic inflammation, dryness, peeling, and irritation

resulting from acne therapy and the cleansers she had used previously. Her adherence to treatment is poor

as a result of cutaneous intolerance to acne therapy and a lack of successful outcomes of previous treat-

ments. Moreover, she prefers to use a cleanser that is foaming and gives a clean feeling after use.

Treatment: The approach should include edu-

cation on the cause of acne and education on

treatment options. She was offered a simpli-

fied, well-tolerated treatment regimen with a

combined topical retinoid/antibiotic. For suc-

cessful adjunctive therapy, a gentle foaming

cleanser with hydrophobically-modified poly-

mers and an SPF moisturizer** was used.

Consider:

� The use of the gentle cleanser to maintain

the integrity of the skin barrier that is al-

ready compromised by acne

� Discuss patient expectations of treatment re-

sults as well as monitoring and follow-up of

treatment and adjunct therapy to achieve

compliance and good patient outcomes

References

1. Thiboutot D, Gollnick H, Bettoli V, Dreno B, Kang S, Leyden JJ, et al:

New insights into the management of acne: an update from the

Global Alliance to Improve Outcomes in Acne group. J Am Acad

Dermatol 2009; 60(5):S1–50.

2. Del Rosso JQ, Kircik L: The sequence of inflammation, relevant bio-

markers, and the pathogenesis of acne vulgaris: what does recent

research say and what does it mean to the clinician? J Dmgs. Der-

matol 2013; 12(suppl 8):s109–115.

3. Draelos Z, Hornby S, Walters RM, Appa Y: Hydrophobically modified

polymers can minimize skin irritation potential caused by surfactant-

based cleansers. J Cosmet Dermatol 2013 Dec; 12(4):314–321.

4. Draelos ZD: The effect of a daily facial cleanser for normal to oily skin

on the skin barrier of subjects with acne. Cutis 2006 Jul; 78(1

Suppl):34–40.

5. Choi YS, Suh HS, Yoon MY, Min SU, Kim JS, Jung JY, Lee DH, Suh DH.: A study of the efficacy of cleansers

for acne vulgaris. J Dermatology Treat 2010 May; 21(3):201–205.

6. Walters RM, Fevola MJ, Gandolfi L, Librizzi JJ, Tamareselvy K, Tierney NK: Polymer-surfactant self-assem-

bly for the design of mild skin cleansers. Polymeric Materials: Science & Engineering 2011; 105(6):697–698.

7. Hornby S, Walters R, Kamath Y, Appa Y: Reduction in skin barrier perturbation by hydrophobically modi-

fied polymers. J Am Acad Dermatol 2011; 64(2):AB25.

8. Tierney N, et al: Cleansers with hydrophobically-modified polymers demonstrate Improved mildness and

skin barrier integrity. J Am Acad Dermatol Feb. 2011; 64(2, supplement 1):p. AB72.

Editorial feature supported by an unrestricted grant from Johnson & Johnson Inc., who are not responsible for content.

*Neutrogena NEUTROGENA® Ultra Gentle Daily Cleanser, **Neutrogena NEUTROGENA® HEALTHY DEFENSE® Daily Moisturizer/SPF 30/45Healthy Defense,Johnson & Johnson Inc.

Fig 1: SSkkiinn BBaarrrriieerr IInntteeggrriittyy ccoommppaarriinngg tthhee HHMMPP--ccoonnttaaiinniinnggcclleeaannsseerr wwiitthh aa ffrreeqquueennttllyy uusseedd ccoommmmeerrcciiaallllyy aavvaaiillaabbllee sskkiinncclleeaannsseerr66

TThheerree iiss aa ssiiggnniiffiiccaanntt iimmpprroovveemmeenntt ((pp<<00..0055 vvss.. ppllaacceebboo)) iinnsskkiinn bbaarrrriieerr iinntteeggrriittyy ((aass mmeeaassuurreedd vviiaa TTEEWWLL)) ffoorr tthhee HHMMPPccoonnttaaiinniinngg cclleeaannsseerr,, aafftteerr ffoouurr ccoonnsseeccuuttiivvee 2244--hhoouurr ppaattcchheexxppoossuurreess ttoo aa ddiilluutteedd cclleeaannsseerr ssoolluuttiioonn..

Fig 2: AAccnnee ppaattiieenntt ccaassee:: TTeeeennaaggeerr wwiitthh sseennssiittiivvee sskkiinn aannddrreegguullaarr ffllaarree--uuppss ooff mmiilldd ttoo mmooddeerr--aattee aaccnnee

Julia Carroll, MD, FRCPC


House


BACKGROUND

Atopic dermatitis (AD) is achronic inflammatory skindisorder caused by complexinteraction between geneticand environmental factors.1

Besides the dysregulatedimmune mechanisms that have longbeen suspected to play a major role forAD pathogenesis, the impact of anintact skin barrier in the protectionagainst AD has gained increasingattention over the recent years.2 Inparticular, the role of filaggrin, a major

structural protein in the stratumcorneum of the epidermis, has beenextensively studied. Mutations in theFLG gene, located in the epidermal dif-ferentiation complex (EDC) on chro-mosome 1q21,3 have consistently beenassociated with early-onset persistentAD.4 It could be demonstrated thatFLG mutations constitute the most sig-nificant known risk factor for ADdevelopment so far.5 However,impaired skin barrier function has alsobeen shown in AD patients withoutFLG mutations,6 suggesting that varia-tion in genes encoding additional skinproteins may play a role in AD patho-genesis.

Laminin 5 is another protein thatplays an important role for skinintegrity.7 It is comprised of three dif-

ferent subunits, built by the LAMA3(alpha-3), LAMB3 (beta-3) and LAMC2(gamma-2) polypeptide chains.Laminin 5 (also called laminin-332) isinvolved in connecting dermis andepidermis and induces adhesion,spreading and migration of humankeratinocytes.8 The three polypeptidechains are encoded by the LAMA3,LAMB3 and LAMC2 genes on chromo-somes 18q11.2, 1q32.2 and 1q25.3,resp.9 Biallelic mutations in each ofthese three genes are known to causeepidermolysis bullosa junctionalis, asevere (type Herlitz) or less severe(type Non-Herlitz) skin disorder char-acterized by blisters and erosions ofthe skin.10 Furthermore, laminin 5 syn-thesis is elevated during acute woundhealing in healthy individuals.11

Given the important role of muta-tions in skin barrier proteins in ADpathogenesis, we hypothesized thatvariation in one or more of thelaminin 5 subunits may also conferrisk for AD. Therefore, we evaluated29 single nucleotide polymorphisms(SNPs) in the three genes in a GermanAD case–control cohort and presentfirst evidence that the LAMA3 genemay be a novel susceptibility gene forAD.

METHODS Subjects

A total of 470 unrelated patients withAD with a mean age of 19±15 years(median 11 years) were recruited by aconsultant specialist for AD (Q.P.,Gladbeck, Germany) as described pre-viously.12 AD diagnosis was estab-lished based on the criteria by Hanifinand Rajka.13 Since the risk remainsvery high for primarily asymptomaticchildren to develop an allergic diseaseduring childhood or even adult-hood,14,15 we chose to use non-allergicadults as a control group. Therefore,320 individuals of at least 40 years ofage (mean age 62±11 years, median 63years) that had neither self-reportedallergies or allergic symptoms nor firstdegree relatives with allergic diseaseswere recruited in the same privatepractice as the patients. The controlsfurther underwent clinical examinationin order to exclude symptoms of AD,asthma or allergic rhinitis (see12). Allparticipants were Germans ofEuropean ancestry and gave informedconsent prior to enrolment. TheDeclaration of Helsinki protocols werefollowed and the study was approvedby the Ethics Committee of the Ruhr-University Bochum.

Genotyping

DNA of AD patients and controls wasextracted as described before.16 Weselected 29 SNPs in the three genes (17in the LAMA3 gene, eight in LAMB3,and four in LAMC2) that representedthe haplotype block structures accord-

ing to HapMap.17 Genotyping wasperformed by polymerase chain reac-tion (PCR) followed by restrictionenzyme digestion. PCR was done in atotal volume of 10 µl, containing 40 ngDNA, 200 mmol of each dNTP, 1.5-3mmol MgCl2, 5 pmol of each primer,and 0.5 U Taq-DNA-polymerase(Genecraft, Münster, Germany) on theRoboCycler or Biometra T cycler(Stratagene, Heidelberg, Germany andBiometra GmbH, Göttingen, Germany,respectively). After two initial cycles at6° C and 3°C above the annealing tem-perature, 28 to 32 cycles of 95°C (30sec), annealing temperature (30 sec)and 72°C (30 sec) were run. PCR prod-ucts were subsequently digested withthe respective restriction enzyme, thefragments separated on 2.5% to 3.5%agarose gels in 1xTBE buffer (30 to 60min, 200 V) and visualized with ethidi-um bromide (0.5% [w/v]). Additionalinformation about primer sequences,PCR conditions and restrictionenzymes is summarized in Additionalfile 1. (http://www.biomedcentral.com/content/supplementary/1471-5945-14-17-s1.docx)

Statistics

Genotype and allele frequencies werecompared between AD patients andcontrols according to the X2 method;the significance threshold was set atp<0.05. We evaluated every SNP fordeviations from Hardy-Weinbergequilibrium (HWE) using the deFinettiprogram.18 The program Haploview4.019 was used to estimate haplotypefrequencies and test for haplotypicassociation. We applied Bonferronicorrection for multiple tests; however,since this approach has been contro-versially discussed for genetic case–control studies,20 especially if severaltightly linked SNPs within one geneare analysed as in the present study,we also present the uncorrected p-val-ues and discuss them as hypothesis-generating.

RESULTS All 29 SNPs showed genotypic distrib-utions according to HWE. Of the 17SNPs chosen for the LAMA3 gene, 10showed significant associations(p<0.01 in the uncorrected analysis)with AD in the present cohort. Themost significant results that also sur-vived Bonferroni correction wereobtained for rs8083184 and rs1711450,both located in the promoter region ofLAMA3 (p=0.0003, pcorr=0.0087,Table 1; full genotype data is presentedin Additional file 2 http://www.bio-medcentral.com/content/supplemen-tary/1471-5945-14-17-s2.doc). A highdegree of linkage disequilibrium (LD)was observed for the SNPs in theLAMA3 gene region (Figure 1).Significant association extended intothe 5' region of LAMA3, includingrs1613739 which is located in the

POSTGRADUATEEDUCATIONAL SUPPLEMENTAssociation of variationin the LAMA3 gene, encoding

the alpha-chain oflaminin5, with

atopic dermatitis in aGerman case-control

cohortSusanne Stemmler,1 Qumar Parwez,2 Elisabeth

Petrasch-Parwez,3 Joerg T Epplen,1,4and Sabine Hoffjan1,*

from 1Department of Human Genetics, Ruhr-University, Universitätsstrasse 150, 44801Bochum, Germany, 2Private medical practice, Gladbeck, Germany, 3Department ofNeuroanatomy and Molecular Brain Research, Ruhr-University Bochum, Bochum,

Germany, 4Faculty of Health, Witten/Herdecke University, Witten, Germany.*Corresponding author.

ABSTRACTBackground: Atopic dermatitis (AD) is a chronic inflammatory skin disordercaused by complex interaction of genetic and environmental factors. Besidesmutations in the filaggrin gene, leading to impaired skin barrier function, varia-tion in genes encoding additional skin proteins has been suggested to contributeto disease risk. Laminin 5, playing an important role in skin integrity, is com-posed of three subunits encoded by the LAMA3, LAMB3 and LAMC2 genes inwhich biallelic mutations cause epidermolysis bullosa junctionalis. We aimed atevaluating the role of variation in the LAMA3, LAMB3 and LAMC2 genes for ADpathogenesis.Methods: A total of 29 single nucleotide polymorphisms (SNPs) were genotypedin the three genes in a German AD case–control cohort comprising 470 unrelatedAD patients and 320 non-atopic controls by means of restriction enzyme diges-tion. Allele, genotype and haplotype frequencies were compared between casesand controls using chi-square testing and the Haploview software.Results: Several SNPs in the LAMA3 gene showed significant association withAD in our cohort (p<0.01), while we did not detect association with variations inthe LAMB3 and LAMC2 genes. Haplotype analysis additionally revealed severalsignificantly associated haplotypes in the LAMA3 gene. Due to extensive linkagedisequilibrium, though, we were not able to further differentiate the specific dis-ease causing variation(s) in this region.Conclusions: We established the LAMA3 gene as novel potential susceptibilitygene for AD. Additional studies in independent cohorts are needed to replicatethese results.

Chro

nicle

Reprinted with permission from: Stemmler, et al: BMC Dermatology 2014;14:17. © 2014 Stemmler, et al; licenseeBioMed Central Ltd. http://www.biomed-central.com/1471-5945/14/17


POSTGRADUATE EDUCATIONAL SUPPLEMENTneighbouring ANKRD29 gene. Twoother SNPs in ANKRD29 (rs7238623 andrs8096061), however, did not show sig-nificant association results. Haplotypeanalyses revealed the existence of twohaploblocks (Figure 1) with a commonhaplotype in block 1 that was highlysignificantly associated with AD (61.9%in cases vs. 51.1% in controls,p=2.94×10-5, Table 2).

In the LAMB3 gene, neither singleSNP nor haplotype analyses revealedsignificant association with AD in thepresent cohort (Table 1; haplotype datanot shown). In LAMC2, no single SNPshowed association with AD; however,haplotype analyses revealed the exis-tence of a rare protective haplotype (4%in cases vs. 6.9% in controls, p=0.01;Table 3).

DISCUSSIONTo our knowledge, this is the firstreport of an association of AD with vari-ation in the LAMA3 gene, encoding thealpha-chain of laminin 5. In a well-char-acterized German case–control cohort,we found significant association of bothallelic and haplotypic frequencies in thisgene with AD, suggesting that it mayconstitute a novel susceptibility gene forthis frequent skin disease.

Of the 19 SNPs evaluated acrossthe LAMA3 gene, 10 showed genotypicor allelic association with AD at p<0.01(uncorrected values). Due to the exten-sive LD evident at the LAMA3 locuswe were not able to further differenti-ate the specific disease causing varia-tion(s) in this region. Significant associ-ation extended into the 5' neighbour-ing gene ANKRD29, but additionalSNPs in this gene did not show associ-ation with AD. The biological functionof ANKRD29, encoding the ankyrinrepeat domain-containing protein 29, isnot yet known; however, for anotherprotein of the same family, ANKRD17,a role in anti-bacterial innate immunepathways has been suggested.21 Forthe gene located 3' of LAMA3(TTC39C), encoding the tetratricopep-tide repeat protein 39C, the biologicalfunction is not yet clear either, andsince the most significant results forLAMA3 were at the 5' end of this largegene, we did not evaluate additionalSNPs in the TTC39C gene. Takentogether, even though we cannotexclude that the observed associationwith AD may be due to LD with a sus-ceptibility variant in another gene inthis region, our data highly points toLAMA3 as susceptibility gene for AD inthe 18q11.2 region. SNPs in the genesencoding the beta- and gamma-chainsof laminin 5, on the other hand, didnot show convincing evidence for asso-ciation with AD in this analysis.However, haplotype analysis suggest-ed the existence of a rare protectivehaplotype in LAMC2.

The main role of laminin 5 in nor-mal tissues is the maintenance ofepithelial-mesenchymal cohesion in tis-sues exposed to external forces, such asskin and stratified squamous mucosa.22

Genetic variation in laminin 5 compo-nents may thus contribute to reduced

skin integrity and barrier function, ashas been observed for FLG mutations,5

even though the exact underlyingmechanisms still have to be elucidated.In each of the three genes analysedhere, rare null mutations are known to

cause epidermolysis bullosa junction-alis, a severe autosomal recessive skindisorder characterized by the develop-ment of blisters and skin erosions inresponse to minor injury or friction.10

In contrast, we observed association of

common variation in LAMA3 with thecommon complex disorder AD. Thisphenomenon is in line with findings forthe SPINK5 gene, in which null muta-tions cause autosomal recessiveNetherton syndrome while common

Table 1: Allele frequencies of LAMA3, LAMB3 and LAMC2 polymorphisms in AD patients and controls

Figure 1:

Haploblock structure of the LAMA3 region as revealed by Haploview 4.0.15 *SNPs associated with AD at p<0.01(uncorrected values) **SNPs associated with AD at p<0.001 (uncorrected values).


variations have been associated withAD.23

Our association results further con-tribute to the hypothesis that an intactskin barrier function plays a key part inAD pathogenesis. Additional to theestablished role of FLG mutations,24

associations with some other skin-relat-ed genes have been described recently.For example, mutations in the claudin-1gene (CLDN1), encoding a major tightjunction protein in the granular layer ofthe epidermis, were associated with ADin North American cohorts of bothEuropean and African Americanorigin.25

Further, polymorphisms near theOVOL1 and ACTL9 genes, bothinvolved in epidermal proliferation anddifferentiation, showed genome-widesignificant association with AD in alarge meta-analysis of GWAS data,including 5,606 AD patients and 20,565controls.26

In a study cohort comprising ADpatients from Germany, Poland and theCzech Republic, a 24-bp deletion in thegene encoding small proline-rich pro-tein 3 (SPRR3), located within the EDC,was significantly associated with dis-ease risk.27 On the other hand, a dele-tion of the cornified envelope 3B and3C genes within in the EDC was notassociated with AD in a Europeancohort.28 All of these results still awaitreplication in independent cohorts.Altogether, though, evidence is accu-mulating that additional genesinvolved in epidermal differentiationand stability may be important for ADpathogenesis.

We are conscious of the fact thatthe cohort sizes of the present study arecomparatively small so that the statisti-cal power is only moderate.Furthermore, only two SNPs in LAMA3results remained significant after strictBonferroni correction for multiple test-ing, leaving open the risk for false-posi-tive results. However, the Bonferronicorrection has been controversially dis-cussed for genetic case–control stud-ies,20 especially if several tightly linkedSNPs within one gene are analysed, aswas the case in the present study.Therefore, we regard the results ashypothesis-generating and stronglyencourage replication in additionalcohorts.

CONCLUSIONS We presented initial evidence for asso-ciation of LAMA3 variation with AD,suggesting that variation in this genemay contribute to skin fragility andimpaired barrier function underlyingAD pathogenesis. Additional studiesin independent populations as well asfunctional analyses of the associatedvariations appear warranted to repli-cate or extend these findings, since thegenetic risk factors for AD might beincreasingly included into prognosticand therapeutic strategies in thefuture. In more detail, an integratedapproach including genotypic andphenotypic information as well asgenetic and biological biomarkers hasbeen proposed for example to identify

patients who are prone to developpersistent AD and/ or additional asth-ma and start early intervention.29

Further, therapeutic strategies target-ing the skin barrier function arealready under way.30 Thus, elucidat-ing the complex genetic backgroundof AD is essential for paving the waytoward a more individualized therapyin the future.

ABBREVIATIONSAD: Atopic dermatitis; EDC:Epidermal differentiation complex;HWE: Hardy-Weinberg equilibrium;LD: Linkage disequilibrium; SNP:

Single nucleotide polymorphism.

COMPETING INTERESTS The authors declare that they have nocompeting interests.

AUTHORS’ CONTRIBUTIONSSS was in charge of study design andstatistical analysis and drafted the man-uscript. QP and EPP were involved inpatient recruitment and helped to draftthe manuscript. JTE and SH conceivedof the study, participated in its designand coordination and helped to draftthe manuscript. All authors read andapproved the final manuscript.

ACKNOWLEDGEMENTS We thank Maike Kallenbach, NataschaWirkus, Monika Harazin and KatharinaBatzke for technical assistance and thepatients for their cooperation in thisstudy.

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Table 2: Frequencies and p-values of LAMA3 haplotypes in AD patients and controls

Table 3: Frequncies and p-values of LAMC2 haplotypes in AD patients and controls


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5. McAleer MA, Irvine AD: The multi-functional role of filaggrin in aller-gic skin disease. J Allergy ClinImmunol 2013; 131:280-291.

6. Jakasa I, Koster ES, Calkoen F,McLean WH, Campbell LE, BosJD, Verberk MM, Kezic S: Skinbarrier function in healthy subjectsand patients with atopic dermatitisin relation to filaggrin loss-of-func-tion mutations. J Invest Dermatol2011; 131:540-542.

7. Nishiyama T, Amano S, TsunenagaM, Kadoya K, Takeda A, AdachiE, Burgeson RE: The importanceof laminin 5 in the dermal-epider-mal basement membrane. JDermatol Sci 2000; 24(Suppl 1):S51-S59.

8. Schneider H, Muhle C, Pacho F:Biological function of laminin-5and pathogenic impact of its defi-ciency. Eur J Cell Biol 2007; 86:701-717.

9. Akutsu N, Amano S, Nishiyama T:Quantitative analysis of laminin 5gene expression in human ker-atinocytes. Exp Dermatol 2005;14:329-335.

10. Kiritsi D, Has C, Bruckner-Tuderman L: Laminin 332 in junc-tional epidermolysis bullosa. CellAdh Migr 2013; 7:135-141.

11. Amano S, Akutsu N, Ogura Y,Nishiyama T: Increase of laminin 5synthesis in human keratinocytesby acute wound fluid, inflammato-ry cytokines and growth factors,and lysophospholipids. Br JDermatol 2004; 151:961-970.

12. Macaluso F, Nothnagel M, ParwezQ, Petrasch-Parwez E, Bechara FG,Epplen JT, Hoffjan S:Polymorphisms in NACHT-LRR(NLR) genes in atopic dermatitis.Exp Dermatol 2007; 16:692-698.

13. Hanifin JM, Rajka G: Diagnosticfeatures of atopic dermatitis. ActaDerm Venereol 1980; 92:44-47.

14. Bel EH: Clinical phenotypes of asth-ma. Curr Opin Pulm Med 2004;10:44-50.

15. De Marco R, Locatelli F, Cerveri I,Bugiani M, Marinoni A,Giammanco G: Incidence andremission of asthma: a retrospec-tive study on the natural history ofasthma in Italy. J Allergy ClinImmunol 2002; 110:228-235.

16. Miller SA, Dykes DD, Polesky HF: Asimple salting out procedure forextracting DNA from humannucleated cells. Nucleic Acids Res1988; 16:1215.

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Agenda MAY 2015

6-9 2015 Annual Meeting of the Society forInvestigational Dermatology

AtlantaContact: Jim Rumsey ¶ Tel: 216-579-9300 ¶ Fax: 216-579-9333 ¶ Email:[email protected] ¶ Website: http://www.sidnet.org/annualmeeting

12-23 North American Clinical Dermatology Society56th Annual Meeting

Reykjavik, Iceland; Amsterdam, The Netherlands; Copenhagen, NorwayContact: Dr. Judith Koperski ¶ Tel: 85-85-580-677 ¶ Fax: 85-85-583-077 ¶ Email:[email protected] ¶ Website: www.nacds.com

JUNE 2015 8–13 23rd World Congress of Dermatology

VancouverContact: Secretariat ¶ Tel: 604-738-8600 ¶ Fax: 604-738-8697 ¶ Email:[email protected] ¶ Website: www.derm2015.org

18-21 Practical Dermatology andDermopathology Symposium

Vail, Colo.Contact: Bronwen Beaudoin ¶ Tel: 781-793-0088 ¶ Email: [email protected] ¶ Website: http://http//www.dermpath.com/news-events/calendar/practical-dermatology-and-dermatopathlogy-symposium-register-now

22-24 The 4th International Conference and Expoon Cosmetology & Trichology

PhiladelphiaContact: Secretariat ¶ Email: [email protected] ¶ Website:http://cosmetology-trichology.conferenceseries.com/

JULY 20159-12 41st Annual Meeting of The Society for

Pediatric DermatologyBoston

Contact: Kent Lindeman ¶ Tel: 317-202-0224 ¶ Email: [email protected] ¶Website: http://www.pedsderm.net/sections/meetings_dates.php

13-15 The 5th International Conference onClinical & Experimental Dermatology

New OrleansContact: Secretariat ¶ Email: [email protected] ¶ Website: http://der-matology.conferenceseries.com/

SEPTEMBER 20152015 Wound Care & Limb Preservation Symposium:

The 10th Annual MeetingCoconut Grove, Fla.

Contact: Secretariat ¶ Email: [email protected] ¶ Website: http://cme.bap-tisthealth.net/wound/pages/index.aspx

w> 9 : � : x8 > H > D C � > C � I = : � B 6 C 6 g: B : C ID ; � ; > bG D J H � = > H I > D 8 yI D B 6 � 6 C 9 � J H > C gB : 9 > 8 6 A � E = D I D g G 6 E = y � ; D G � A : H > D CA D 8 6 I > D C � (H : : � E 6 g: � 6).

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Another excellent piece ofCanadian research comes from ourdermatopathology colleagues inHalifax who have identified that plas-macytoid dendritic cells are helpful inthe diagnosis of hypertrophic DLE.

This finding is not only useful in thepathological diagnosis of the disease,but gives us insight into theimmunopathogenesis which couldpotentially lead to new targeted ther-apies for this form of cutaneouslupus, which is a significant diagnos-tic and therapeutic challenge.

Like all Canadian dermatologists,we are looking forward to the WorldCongress of Dermatology inVancouver from June 8 to 13, 2015where we will be pleased to observethe ongoing achievements of ourfriends and colleagues, both past andpresent, being showcased to theworld.—Wayne P. Gulliver, MD, FRCPC

Medical Editor

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T= : � 6 J I = D G H � 8 D C 8 A J 9 : 9 � I = 6 I“I = : � > PLEDGE� E G D gG 6 B � > C 8 G : 6 H -: H � 6 C x > : I y � 6 b D J I � > H D I G : I > C D > CB D G : � I = 6 C � > I � = : A E H � wD B : C � ; : : A � E G D I : 8 I : 9 � ; G D B � I = :I : G 6 I D g: C > 8 � G > H kH � D ; � > H D I G : I > C D > C .”

> PLEDGE� w6 H � > C I G D 9 J 8 : 9 � > C � 2006� by� I = : � U.S.F D D 9 � 6 C 9 � D G J g � A 9 B > C > H I G 6 I > D C � (FDA) � 6 C 9 � > IG : qJ > G : H � E 6 I > : C I H � I 6 k> C g� I = : � 9 G J g� I D � J H : � I wD � ; D G B HD ; � b> G I = � 8 D C I G D A ,� = 6 v: � I wD � C : g6 I > v: � E G : gC 6 C 8 y� I : H IG : H J A I H � b: ; D G : � H I 6 G I > C g� 6 C � > H D I G : I > C D > C � G : g> B : C ,� 6 C 9I D � I 6 k: � 6 � E G : gC 6 C 8 y� I : H I � : v: G y� B D C I = � w= > A : � D C � I = :I = : G 6 E y.� AA A � E 6 I > : C I H � I 6 k> C g� I = : � B : 9 > 8 6 I > D C � 6 C 9I = : > G � E = 6 G B 6 8 > H I H � 6 G : � G : g> H I : G : 9 � > C � 6 � 8 : C I G 6 A � 9 6 I 6 -b6 H : .

Intrauterine devices, subdermal implants alternatives“T= : � D C : � I = > C g� I = 6 I � I� wD J A 9 � H 6 y� w> I = � > PA : 9 g: � > H � I = 6 Iby� G : q J > G > C g � I wD � ; D G B H � y D J � 6 G : � 6 A B D H I � 6 A w6 y HE J I I > C g� I = : � wD B : C � > C � 6 � E D H > I > D C � D ; � H 6 y> C g� V y: H � I� w> A AJ H : � 8 D C 9 D B H ’� 6 C 9 � I = D H : � 6 G : � 6 H H D 8 > 6 I : 9 � w> I = � 6 � v: G y= > g= � G 6 I : � D ; � C D C -8 D B E A > 6 C 8 : ,”� H 6 > 9 � DG .� L6 J G 6 � KD G bF: G G > H ,� 6 � 9 : G B 6 I D A D g> H I � E G 6 8 I > 8 > C g� > C � P> I I H bJ G g= � 6 C 9D C : � D ; � I = : � 6 J I = D G H � D ; � I = : � H I J 9 y.�

“I� I = > C k� > ; � yD J � g6 v: � wD B : C � I = : � D E I > D C � D ; � J H > C gD C : � ; D G B � D ; � = > g= A y� : ; ; : 8 I > v: � 8 D C I G 6 8 : E I > D C � I = 6 I � > HJ H : G � > C 9 : E : C 9 : C I ,� B : 6 C > C g� 6 C � IUD� D G � 6 � H J b9 : G B 6 A> B E A 6 C I ,� 6 C 9 � > ; � yD J � 6 G : � D C � I = > H � D C : � J H : G � > C 9 : E : C -9 : C I , � = > g = A y � : ; ; : 8 I > v : � ; D G B � D ; � b > G I = � 8 D C I G D A � w:wD C ’I � G : qJ > G : � yD J � I D � b: � D C � I wD � [; D G B H � D ; � b> G I = � 8 D C -I G D A ],� 6 C 9 � I = 6 I � B > g= I � 6 8 I J 6 A A y� : C 8 D J G 6 g: � wD B : C � I DJ H : � I = : H : � B J 8 = � B D G : � : ; ; : 8 I > v: � ; D G B H � D ; � 8 D C I G 6 -8 : E I > D C � > C H I : 6 9 � D ; � 8 = D D H > C g � I wD � A : H H - : ; ; : 8 I > v :B : I = D 9 H .”

DG .� F: G G > H � w6 H � > C vD A v: 9 � > C � 6 C D I = : G � H I J 9 y� w= : G :H = : � 6 C 9 � = : G � 8 D A A : 6 gJ : H � : x6 B > C : 9 � I = : � 8 D C I G 6 8 : E -I > v: � H : A : 8 I > D C � D ; � 75� wD B : C � D C � > H D I G : I > C D > C � 6 C 9 � I = : > G8 D B E A > 6 C 8 : � G 6 I : � (Journal of American Academy ofDermatology J6 C .� 2014;� 70(1):55R 59).

T= : � > C v: H I > g6 I D G H � ; D J C 9 � I = 6 I � 21� E 6 I > : C I H � (28%)H : A : 8 I : 9 � 6 b H I > C : C 8 : � 6 H � I = : > G � E G > B 6 G y � B : 6 C H � D ;E G : gC 6 C 8 y� E G : v: C I > D C � : v: C � I = D J g= � ; D J G � (19%)� > CI = 6 I � gG D J E � D ; � E 6 I > : C I H � w: G : � H : xJ 6 A A y� 6 8 I > v: � 9 J G > C gI G : 6 I B : C I .� CD C 9 D B H � (35,� 90%)� 6 C 9 � D G 6 A � 8 D C I G 6 8 : E -I > v: � E > A A H � (18,� 46%)w: G : � I = : � B D H IJ H : 9 � D E I > D C H � D ;H : x J 6 A A y � 6 8 I > v :w D B : C . � Tw: A v :w D B : C � (31%)6 9 B > I I : 9 � I D � = 6 v> C g> C I : G 8 D J G H : � 6 I � A : 6 H ID C 8 : � J H > C g� D C : � D G; : w : G � ; D G B H � D ;8 D C I G 6 8 : E I > D C —> C 8 A J 9 > C g� D C : � w= DG : E D G I : 9 � 8 D B -E A : I : A y� J C E G D I : 8 I -: 9 � > C I : G 8 D J G H : .A B D C g � H : x J 6 A A y6 8 I > v: � D G 6 A � 8 D C I G 6 8 : E I > v: � E > A A � J H : G H ,� 7� (39%)� G : E D G I -: 9 � B > H H > C g� D C : � D G � B D G : � E > A A H � > C � I = : � E G : v> D J H � B D C I = .

S> C 8 : � 6 bH I > C : C 8 : � > H � D C A y� 6 A A D w: 9 � ; D G � > PLEDGE> C � : x8 : E I > D C 6 A � 8 > G 8 J B H I 6 C 8 : , � DG .� F: G G > H � H 6 yH � I = 6 I9 : G B 6 I D A D g> H I H � H = D J A 9 � b: � = 6 v> C g� B D G : � > C - 9 : E I =8 D C v : G H 6 I > D C H � 6 b D J I � 8 D C I G 6 8 : E I > v : H � w> I = � I = : > GE 6 I > : C I H .

Dermatologists need to be more rigorous“I� I = > C k� > I � bG > C gH � 6 I I : C I > D C � I D � I = : � ; 6 8 I � I = 6 I � w: ,� 6 H9 : G B 6 I D A D g> H I H ,� C : : 9 � I D � b: � 6 � A > I I A : � B D G : � G > gD G D J H � > C6 E E A y> C g� I = 6 I � H I 6 C 9 6 G 9 ,”� H 6 > 9 � DG .� F: G G > H .� “I� I = > C k� I = 6 Iw= : C � w: � 8 = D H : � I D � = 6 v: � 6 � wD B 6 C � J H : � 6 bH I > C : C 8 :6 H � 6 � B : I = D 9 � w: � G : 6 A A y� C : : 9 � I D � = 6 v: � 6 � 9 > ; ; > 8 J A I � 8 D C -v: G H 6 I > D C � D ; � [6 H k> C g]� V w= y� 6 G : � yD J � 8 = D D H > C g� 6 bH I > -C : C 8 : ,� = 6 v: � yD J � : v: G � b: : C � H : xJ 6 A A y� 6 8 I > v: � ’

“I� I = > C k� : v: C � > ; � I = : y� = 6 v: � C : v: G � b: : C � H : xJ 6 A A y6 8 I > v: � > I � > H � > B E D G I 6 C I � I D � bG > C g� J E � I = : � > H H J : � I = 6 I � > ;I = : y� 9 D � b: 8 D B : � H : xJ 6 A A y� 6 8 I > v: � D G � > ; � I = : y� I = > C k� I = 6 II = : y� B 6 y� b: 8 D B : � H : xJ 6 A A y� 6 8 I > v: , � I = : y� C : : 9 � I DB 6 k: � H J G : � I = : y� I 6 A k� I D � J H � 6 C 9 � I = 6 I � I = : y� 6 G : � 6 8 I > v: A yD C � I wD � ; D G B H � D ; � b> G I = � 8 D C I G D A .”

DG .� F: G G > H � H 6 > 9 � > I � > H � > B E D G I 6 C I � ; D G � E = yH > 8 > 6 C H � I D6 A H D � G : 8 D gC > z: � I = 6 I � 6 A I = D J g= � E 6 I > : C I H � B 6 y� H 6 y� I = : y6 G : � J H > C g � I wD � ; D G B H , � I = : y � B 6 y � b : � J H > C g � I = : B> C 8 D C H > H I : C I A y� b: 8 6 J H : � = J B 6 C � : G G D G � > H � > C : v> I 6 bA : .S= : � H 6 > 9 � > I � > H � > B E D G I 6 C I � I = 6 I � 9 : G B 6 I D A D g> H I H � H = D J A 9= 6 v: � I = : � D E I > D C � D ; � G : 8 D B B : C 9 > C g� B D G : � : ; ; : 8 I > v:; D G B H � D ; � b> G I = � 8 D C I G D A � I = 6 I � 9 D � C D I � G : qJ > G : � = J B 6 C6 8 I > D C .

“II � 9 D : H C ’I � B : 6 C � I = 6 I � [9 : G B 6 I D A D g> H I H ]� = 6 v: � I Db: � I = : � D C : H � I D � > C H : G I � I = : � IUD� D G � > B E A 6 C I ,� bJ I � [I = : yH = D J A 9 ]� G : ; : G � I = : � E 6 I > : C I � I D � 6 � H E : 8 > 6 A > H I � w= D � > H � 8 D B -; D G I 6 bA : � 8 D J C H : A A > C g � 6 bD J I � 6 C 9 � E G D v > 9 > C g � I = : H := > g= A y� : ; ; : 8 I > v: � ; D G B H � D ; � 8 D C I G 6 8 : E I > D C .� II � > H � > B E D G -I 6 C I � I = 6 I � E 6 I > : C I H � J C 9 : G H I 6 C 9 � I = : � H : G > D J H � 8 D C H : -q J : C 8 : H � D ; � b : 8 D B > C g � E G : g C 6 C I � w = > A : � D C> H D I G : I > C D > C ,� 6 C 9 � I = 6 I � > I � > H � = 6 G 9 � I D � b: � 100� E : G � 8 : C I8 D B E A > 6 C I � w> I = � b> G I = � 8 D C I G D A � E > A A H � 6 C 9 /D G � 8 D C 9 D B H ,”H 6 > 9 � DG .� F: G G > H .

C6 C 6 9 6 � 9 D : H � C D I � G : qJ > G : � E 6 I > : C I H � I D � j D > C � I = :> PLEDGE� E G D gG 6 B .� IC H I : 6 9 � > I � ; D A A D wH � I = : � E G : H 8 G > b-> C g� G : qJ > G : B : C I H � > C I G D 9 J 8 : 9 � by� > H D I G : I > C D > C � B 6 C J -; 6 8 I J G : G � R D 8 = : � 6 C 9 � I = : � U.S. � FDA� > C � 1988—I = :R: I > C D > 9 � PG : gC 6 C 8 y� PG : v: C I > D C � PG D gG 6 B .� T= > H � E G D -gG 6 B � G : qJ > G : H � wD B : C � I D � H > gC � 6 � wG > I I : C � 6 gG : : B : C II D � J H : � I wD � B : I = D 9 H � D ; � 8 D C I G 6 8 : E I > D C � 6 C 9 � I D � = 6 v: � 6B D C I = A y� E G : gC 6 C 8 y� I : H I .

DG .� G> 9 : D C � KD G : C ,� 6 � E G D ; : H H D G � > C � I = : � D: E 6 G I B : C I

D ; � P6 : 9 > 6 I G > 8 H � 6 I � I = : � UC > v: G H > I y� D ; � TD G D C I D ,� H 6 yH � = : � > HC D I � H J G E G > H : 9 � by� I = : � ; > C 9 > C gH � ; G D B � I = : H : � AB : G > 8 6 CH I J 9 > : H .� H: � H 6 > 9 � = : � 8 D C I > C J : H � I D � H : : � b> G I = � 9 : ; : 8 I H; G D B � wD B : C � w= D � gD I � E G : gC 6 C I � w= > A : � D C � > H D I G : I > C D > C> C � I = : � E G D gG 6 B � 8 6 A A : 9 � MD I = : G > H k� I = 6 I � = : � 9 > G : 8 I H � 6 I

T = : � HD H E > I 6 A � ; D G � S > 8 kC= > A 9 G : C � > C � TD G D C I D .

“T= : � ; 6 8 I � I = 6 I � w:8 D C I > C J : � I D � H : : � I = D H :k> 9 H � I = 6 I � w> A A � b: � B 6 A -; D G B : 9 � ; D G � A > ; : � . � . � . � > Hv : G y � 8 D C 8 : G C > C g. � I IB : 6 C H � I = 6 I � w= 6 I : v : G> H � b : > C g � 9 D C : � > H � C D I: C D J g= � 6 C 9 � > H � C D I � H J ; -; > 8 > : C I A y � : ; ; : 8 I > v : ,”H 6 > 9 � DG .� KD G : C .� “I� I = > C kI = 6 I � H : 6 A I = � C 6 C 6 9 6H = D J A 9 � G : v > : w � I = :I D E > 8 � > C � 6 � B J 8 = � B D G :H : G > D J H � B 6 C C : G .”

IC � 2013,� DG .� KD G : C � 6 C 9 � = > H � 8 D A A : 6 gJ : H � G : v> : w: 9I = : � I D E > 8 � > C � The Canadian Medical AssociationJournal (M6 G .� 19,� 2013;� 185(5):411R 413)� w= : G : � I = : yE G D v> 9 : 9 � H J gg: H I > D C H � ; D G � 6 � v6 G > : I y� D ; � 6 E E G D 6 8 = : HI = 6 I � 8 D J A 9 � G : 9 J 8 : � I = : � G 6 I : � D ; � E G : g C 6 C 8 > : H � ; D GwD B : C � I 6 k> C g� > H D I G : I > C D > C .

Multiple approaches needed to address problem“PG : v: C I > C g� ; : I 6 A � : xE D H J G : � I D � > H D I G : I > C D > C � G : qJ > G : H> C I : G v: C I > D C � 6 I � B J A I > E A : � A : v: A H ,”� H I 6 I : 9 � I = : � 6 J I = D G HD ; � I = 6 I � E 6 E : G . � “IC � 6 9 9 > I > D C � I D � I = : � E G D gG 6 B H � 8 J G -G : C I A y� > C � E A 6 8 : ,� D I = : G � D E I > D C H � ; D G � H yH I : B � > C I : G v: C -I > D C � > C 8 A J 9 : � b6 C C > C g� D C A > C : � H 6 A : H � D ; � > H D I G : I > C D > C ,6 H � w: A A � 6 H � B 6 C 9 6 I D G y � D C A > C : � 8 : G I > ; > 8 6 I > D C � E G D -gG 6 B H � ; D G � I = : � E = yH > 8 > 6 C H � 6 C 9 � E = 6 G B 6 8 > H I H � E G D v> 9 -> C g� I = : � 9 G J g� I = 6 I � > C 8 A J 9 : � : 9 J 8 6 I > D C � 6 bD J I � 8 D C I G 6 -8 : E I > v: � B : I = D 9 H � 6 C 9 � I = : � 9 G J g’H � I = : G 6 E : J I > 8 � 6 C 9; : I D I D x> 8 � : ; ; : 8 I H .”

DG .� KD G : C � H 6 > 9 � 8 D J G H : H � 6 G : � B 6 C 9 6 I D G y� ; D G � E = yH > -8 > 6 C H � > C � C6 C 6 9 6 � w= D � w6 C I � I D � E G : H 8 G > b: � B : I = 6 9 D C :b: 8 6 J H : � D ; � I = : � H : G > D J H C : H H � D ; � I = : � 9 G J g.� “H: G : � I = :H : v: G > I y� > H � C D I � I D � I = : � E 6 I > : C I � bJ I � I D � = : G � 8 = > A 9 ,”� = :H 6 > 9 .

I H D I G : I > C D > C � J H : 9 � I D � b: � D C A y � H D A 9 � by� RD 8 = : ,= D w: v: G ,� I = : G : � 6 G : � C D w� B 6 C y� bG 6 C 9 H � 6 C 9 � g: C : G > 8v: G H > D C H .� T= : � I = : G 6 E y� 8 6 C � 6 A H D � b: � E J G 8 = 6 H : 9 � D v: GI = : � I C I : G C : I , � w= > 8 = � DG .� KD G : C � H 6 yH � = 6 H � G : 9 J 8 : 9G : gJ A 6 I > D C � 6 C 9 � G : qJ > G : B : C I H � ; D G � E 6 I > : C I H � I D � 6 gG : :I D � J H > C g� b> G I = � 8 D C I G D A .� T= > H � > H � w= y� I = : � 6 J I = D G H � G : 8 -D B B : C 9 � I = 6 I � I = : � H 6 A : � D ; � I = : � 9 G J g � b : � b 6 C C : 9D C A > C : .

R: g6 G 9 > C g� I = : � G : 8 : C I � U.S.� H I J 9 > : H , � DG .� KD G : CH 6 yH � = : � 6 gG : : H � I = 6 I � E 6 I > : C I H � H = D J A 9 � C D I � b: � G : qJ > G : 9I D � J H : � I wD � b> G I = � 8 D C I G D A H , � bJ I � G 6 I = : G � D C : � = > g= A y: ; ; : 8 I > v: � ; D G B .

DG .� KD G : C � H 6 > 9 � = : � > H � 9 > H 6 E E D > C I : 9 � I = : � gD v: G C -B : C I � = 6 H � C D I � G : H E D C 9 : 9 � I D � I = : � H I J 9 > : H � 6 C 9 � E 6 E : G HD C � I = : � H J bj: 8 I � by� 8 = 6 C g> C g� 8 J G G : C I � E D A > 8 > : H .

“W: � H : : � > I � 6 � A D I � 6 C 9 � w: � wG > I : � 6 bD J I � > I ,� w: � H = D J I6 H � B J 8 = � 6 H � w: � 8 6 C ,� bJ I � G : 6 A A y� I = : � D C A y� > C 9 > v> 9 J 6 A HI = 6 I � G : 6 A A y � 8 D C I G D A � I = : � 6 g : C 9 6 � > H � I = : � G : g J A 6 I D G ,b: 8 6 J H : � I = : y� 8 6 C � [B 6 k: ]� 6 C y� G J A : .”

F D G � B D G : � > C ; D G B 6 I > D C , � E A : 6 H : � v > H > I := I I E ://D w.A y/vLJ A Y� D G � = I I E ://D w.A y/vLJ J z

Non-proprietary and brand names of therapies:isotretinoin (Accutane, Roche Canada; Clarus,Mylan Pharmaceuticals ULC; Epuris, CipherPharmaceuticals Inc.).

Dr. Laura KorbFerris

Dr. Gideon Koren

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THE BENEFITS OF COFFEEDG > C k> C g� ; D J G � 8 J E H � D ; � 8 D ; ; : : � 6 � 9 6 yB 6 y � E G D I : 8 I � 6 g 6 > C H I � H k > C � 8 6 C 8 : G ,G : E D G I H � The Telegraph (J6 C . � 21,2015).

A� H I J 9 y� E J bA > H = : 9 � > C � I = : � Journalof the National Cancer Institute (J6 C .2015;� 107(2):� 9 jJ 421)� H J G v: y: 9 � B D G :I = 6 C � 447,000� > C 9 > v> 9 J 6 A H � > C � I = : � U.S.; D G � 6 C � 6 v : G 6 g: � D ; � 10� y: 6 G H . � I C � I = :H I J 9 > : 9 � E D E J A 6 I > D C ,� 9 G > C k> C g� 8 D ; ; : :w6 H � 6 H H D 8 > 6 I : 9 � w> I = � 6 � 9 : 8 G : 6 H : 9G > H k � D ; � 9 : v : A D E > C g � B : A 6 C D B 6 .DG > C k> C g� ; D J G � D G � B D G : � 8 J E H � E : G � 9 6 yw6 H � 6 H H D 8 > 6 I : 9 � w> I = � 6 � 20%� 9 : 8 G : 6 H :> C � G > H k.

T= : � C : w� ; > C 9 > C gH � bJ > A 9 � D C � E G > D GG : H : 6 G 8 = � E J bA > H = : 9 � > C � 2007� by� DG .E G C : H I � Ab : A � D ; � W6 y C : � S I 6 I :UC > v: G H > I y� > C � D: I G D > I ,� I = : � C : wH � D J I A : IG : E D G I : 9 .

P6 G I > 8 > E 6 C I H � w= D � G : E D G I : 9 � I = : y9 G 6 C k� 9 : 8 6 ; ; : > C 6 I : 9 � 8 D ; ; : : � 9 > 9 � C D I6 E E : 6 G � I D � H : : � 6 C y� G : 9 J 8 I > D C � > C � I = :G > H k� D ; � B : A 6 C D B 6 ,� 6 8 8 D G 9 > C g� I D � TheTelegraph.� HD w: v: G � I = : � C : wH � D J I A : IC D I : 9 � I = 6 I � I = : � H I J 9 y’H � 6 J I = D G H � H J g-g: H I � ; J G I = : G � > C v: H I > g6 I > D C � > H � C : : 9 : 9> C I D � I = > H � E D I : C I > 6 A � E G D I : 8 I > v: � : ; ; : 8 I ,E 6 G I > 8 J A 6 G A y � 6 H � I = : � U.K.’H � N6 I > D C 6 AH: 6 A I = � S: G v> 8 : � 8 6 J I > D C H � 6 g6 > C H I � = > g=8 6 ; ; : > C : � > C I 6 k: .

ISOTRETINOIN, BIRTH CONTROLA� C : w � H I J 9 y � G : v : 6 A H � I = 6 I � y D J C gwD B : C � b: > C g� I G : 6 I : 9 � ; D G � 6 8 C : � w> I => H D I G : I > C D > C � D ; I : C � G : 8 : > v : � > C 6 9 : -qJ 6 I : � > C ; D G B 6 I > D C � D C � b> G I = � 8 D C I G D AB : I = D 9 H , � Fox News G : E D G I : 9 � D CF: b.� 12,� 2015.

S: C > D G � H I J 9 y� 6 J I = D G � DG .� EA : 6 C D GB. � S 8 = w 6 G z � D ; � I = : � U C > v : G H > I y � D ;C6 A > ; D G C > 6 ,� D6 v> H ,� H 6 > 9 � I = 6 I � 9 : G B 6 I D A -D g> H I H � 6 G : � D ; I : C � I = : � ; > G H I � H D J G 8 : � D ;b> G I = � 8 D C I G D A � : 9 J 8 6 I > D C � ; D G � y D J C gwD B : C � w> I = � H : v: G : � 6 8 C : .

T = : � H I J 9 y � 6 J I = D G H � H J G v : y : 9wD B : C � D ; � 8 = > A 9 b: 6 G > C g� 6 g: ,� 6 H k> C gqJ : H I > D C H � 6 bD J I � kC D wA : 9 g: � D ; � : > g= I9 > ; ; : G : C I � 8 D C I G 6 8 : E I > v: � B : I = D 9 H � 6 C 9I = : > G � : ; ; : 8 I > v: C : H H .� P6 G I > 8 > E 6 C I H � I = : CG : v> : w: 9 � 6 C � > C ; D G B 6 I > D C � H = : : I � 6 C 99 > 9 � I = : � H J G v: y� 6 g6 > C ,� FD x� G : E D G I H .

OC � ; > G H I � I 6 k> C g� I = : � H J G v: y,� B D H ID v: G : H I > B 6 I : 9 � I = : � : ; ; : 8 I > v: C : H H � D ;b> G I = � 8 D C I G D A � E > A A H ,� > C j: 8 I > D C H ,� 6 C 9 � 8 D C -9 D B H . � OC : - I = > G 9 � = 6 9 � C D I � = : 6 G 9 � D ;8 D C I G 6 8 : E I > v: � > B E A 6 C I H � 6 C 9 � 16%� w: G :J C 6 w6 G : � D ; � > C I G 6 J I : G > C : � 9 : v> 8 : H .� A; I : GG : 6 9 > C g� I = : � > C ; D G B 6 I > D C � H = : : I � ; D G � 6 C6 v: G 6 g: � D ; � D C : � B > C J I : ,� I = : > G � H J G v: yH 8 D G : H � D C � I = : � H : 8 D C 9 � 6 I I : B E I> C 8 G : 6 H : 9 � by� 6 A B D H I � : v: G y� B : 6 H J G : .D G . � S 8 = w6 G z � H 6 > 9 � I = : � 8 J G G : C I> H D I G : I > C D > C � > PA : 9 g: � E 6 8 k: I � > H � D J I � D ;9 6 I : ,� 6 C 9 � H = D J A 9 � b: � J E 9 6 I : 9 � I D � ; D 8 J HD C � 8 D C I G 6 8 : E I > D C � B : I = D 9 H � I = : � E 6 I > : C I8 6 C C D I � ; D G g : I � I D � J H : , � H J 8 = � 6 H> C I G 6 J I : G > C : � 9 : v> 8 : H � 6 C 9 � > C j: 8 I > D C H .

HEALING WOUNDS WITH FISH? AE E A y> C g� 8 D A A 6 g: C � 9 : G > v: 9 � ; G D B � I = :H k> C � D ; � I > A 6 E > 6 � ; > H = � B 6 y� b: � 6 � gG : 6 Iw 6 y � I D � H E : : 9 � J E � w D J C 9 � = : 6 A > C g6 8 8 D G 9 > C g � I D � 6 � I : 6 B � D ; � C = > C : H :G : H : 6 G 8 = : G H , � G : E D G I H � ScientificAmerican (F: b.� 18,� 2015,� D C A > C : ).

T= : � G : H : 6 G 8 = : G H � A D D k: 9 � 6 I � I = :; > H = � H k> C � E G D I : > C � 6 H � 6 C � 6 A I : G C 6 I > v: � I DB 6 B B 6 A > 6 C � E G D I : > C � b: 8 6 J H : � D ; � I = :I = : D G : I > 8 6 A A y� A D w: G � G > H k� D ; � 9 > H : 6 H :I G 6 C H B > H H > D C , � I = : � C : w H � D J I A : IG : E D G I H .� AH � w: A A ,� I > A 6 E > 6 � > H � 6 C � 6 bJ C -9 6 C I � H D J G 8 : � ; D G � 8 D A A 6 g : C . � A ; I : G: xI G 6 8 I > C g� I = : � 8 D A A 6 g: C ,� I = : � G : H : 6 G 8 =I : 6 B � ; G D B � I = : � S = 6 C g = 6 > � J > 6 D I D C gUC > v: G H > I y� S8 = D D A � D ; � M: 9 > 8 > C : � ; D J C 9> I � = 6 9 � I = : � G > g= I � E = yH > 8 6 A � E G D E : G I > : H; D G � J H : � > C � wD J C 9 � = : 6 A > C g,� 6 C 9 � 9 > 9C D I � 8 6 J H : � 6 C � > B B J C : � G : H E D C H : � > CG 6 I H .� W= : C � I : H I : 9 � D C � H k> C � wD J C 9 H � > CG 6 I H ,� I = : � wD J C 9 H � = : 6 A : 9 � ; 6 H I : G � I = 6 CD C � J C I G : 6 I : 9 � G 6 I H � D G � G 6 I H � I G : 6 I : 9 � w> I =6 A g> C 6 I : � 9 G : H H > C gH .� G> J H : E E : � TG D C 8 > ,6 � b > D B 6 I : G > 6 A H � : x E : G I � 6 I � I = :UC > v: G H > I y� D ; � L: : 9 H , � I D A 9 � I = : � C : wHD J I A : I � I = 6 I � I = : � = > g= � 6 v6 > A 6 b> A > I y� D ; � I = :H I 6 G I > C g� B 6 I : G > 6 A � 6 C 9 � E D I : C I > 6 A � > B E A > -8 6 I > D C H � ; D G � 8 D H I - : ; ; : 8 I > v : C : H H � > C8 = G D C > 8 � wD J C 9 � 8 6 G : � w: G : � : x8 > I > C g.“G> v: C � I = : � D J I H I 6 C 9 > C g� > C � v> vD � 9 6 I 6 ,> I � wD J A 9 � b: � > C I : G : H I > C g� I D � H : : � = D wI = : � H k> C � G : g: C : G 6 I > D C � E D I : C I > 6 A � D ;I = > H � B 6 I : G > 6 A � 8 D B E 6 G : 9 � w> I = � I = 6 I � D ;6 � 8 D B B : G 8 > 6 A A y� 6 v6 > A 6 bA : � 8 D A A 6 g: C -b6 H : 9 � wD J C 9 � 9 G : H H > C g,”� TG D C 8 > � H 6 > 9 .�

REACTIONS TO PRESERVATIVET= : G : � > H � > C 8 G : 6 H > C g� 6 w6 G : C : H H � 6 C 98 D C 8 : G C � 6 b D J I � I = : � E G : H : G v 6 I > v :B : I = yA > H D I = > 6 zD A > C D C : � (MI)� > C � E : G H D C -6 A � 8 6 G : � E G D 9 J 8 I H � A : 6 9 > C g� I D � 6 A A : G g> 8H : C H > I > z6 I > D C ,� > C � E 6 G I —E 6 G 6 9 D x> 8 6 A A y—b: 8 6 J H : � B 6 C y � B 6 C J ; 6 8 I J G : G H � 6 G :H w> I 8 = > C g� I D � MI� ; G D B � D I = : G � E G : H : G v6 -I > v: H � H J 8 = � 6 H � E 6 G 6 b: C H ,� G : E D G I H � TheNew York Times (J6 C .� 23,� 2015).

M6 jD G � 8 D C H J B : G � E G D 9 J 8 I � 8 D B -E 6 C > : H , � > C 8 A J 9 > C g K> B b: G A y-CA 6 G k,JD = C H D C � &� JD = C H D C 6 C 9 � UC > A : v: G ,= 6 v : � b : g J C � G : B D v > C g � MI � ; G D BA D I > D C H � 6 C 9 � w> E : H . � “W= : C � E : D E A :6 G : � : xE D H : 9 � D C � 6 � 9 6 > A y� b6 H > H � I D � MI,w: � I = > C k� I = : � G 6 I : H � D ; � H : C H > I > z6 I > D C6 G : � g D > C g � J E ,”� DG . � BG J 8 : � A.� BG D 9 ,E G : H > 9 : C I - : A : 8 I � D ; � I = : � A B : G > 8 6 CCD C I 6 8 I D: G B 6 I > I > H SD 8 > : I y,� I D A 9 � I = :C : wH � D J I A : I . � A� A 6 8 k� D ; � 6 w6 G : C : H H6 B D C g� I = : � E J bA > 8 � 6 C 9 � 9 D 8 I D G H � D ; � I = :E D I : C I > 6 A � 6 A A : G g> 8 � H : C H > I > z6 I > D C � > H � 6 C> H H J : ,� DG .� BG D 9 � H 6 > 9 ,� : v: C � I = D J g= � MIw6 H � I = : � H D 8 > : I y’H � 6 A A : G g: C � D ; � I = : � y: 6 G> C � 2013.� BJ I � I = : G : � 6 G : � D C A y� H D � B 6 C yE G : H : G v 6 I > v : H � 6 E E G D v : 9 � ; D G � J H : � > CE : G H D C 6 A � 8 6 G : � E G D 9 J 8 I H , � 6 C 9 � 8 D C -H J B : G � E G : H H J G : —C D I � C : 8 : H H 6 G > A yH J E E D G I : 9 � by� H 8 > : C 8 : —= 6 H � A > B > I : 9I = : � E 6 A : I I : � D ; � E G : H : G v6 I > v: H � E G D 9 J 8 IB 6 C J ; 6 8 I J G : G H � 8 6 C � J H : , � L > C 9 6LD G : I z,� I = : � 8 = > : ; � I D x> 8 D A D g> H I � ; D G � I = :P: G H D C 6 A � C6 G : � PG D 9 J 8 I H � CD J C 8 > A ,� 6 C> C 9 J H I G y� I G 6 9 : � gG D J E ,� I D A 9 � I = : � Times.

Research of NoteINVESTIGATING NOTCH SIGNALLING IN CYLD-DEFECTIVE TUMOURS

TD � > C v: H I > g6 I : � I = : � ; J C 8 I > D C � D ; � I = : � J b> qJ > I > C � = y9 G D A 6 H : � CYLD,� 6 � 8 yA > C 9 G D B 6 I D H > H � g: C :E G D 9 J 8 I ,� G : H : 6 G 8 = : G H � J H : 9 � 6 � E G D I : D B > 8 H � 6 E E G D 6 8 = � I D � > 9 : C I > ; y� E G D I : > C H � I = 6 I � > C I : G 6 8 I � w> I =CYLD,� 6 C 9 � > 9 : C I > ; > : 9 � I = : � J b> qJ > I > C � A > g6 H : � : C zyB : � MIB2.� MIB2� > H � > C vD A v: 9 � w> I = � ND I 8 =

H > gC 6 A A > C g.� W= : C � CYLD� 6 C 9 � MIB2� w: G : � 8 D -: xE G : H H : 9 ,� I = : G : � w6 H � 6 C � D bH : G v: 9 � H I 6 b> A > z6 I > D C � D ;BIB2� E G D I : > C � A : v: A H ,� 6 C 9 � I = > H � 8 D -: xE G : H H > D C � w6 H � 6 H H D 8 > 6 I : 9 � w> I = � G : 9 J 8 : 9 � A : v: A H � D ; � I = : � A > g6 C 9JAG2,� > B E A > 8 6 I : 9 � > C � ND I 8 = � H > gC 6 A A > C g.� OC � I = : � D I = : G � = 6 C 9 ,� J H > C g� H > RNA� I D � H > A : C 8 : � CYLD� G : H J A I : 9> C � bD I = � > C 8 G : 6 H : 9 � : xE G : H H > D C � D ; � JAG2� 6 C 9 � J E G : gJ A 6 I D C � D ; � ND I 8 = � H > gC 6 A A > C g.� W= : C � I = : y� A D D k: 9 � 6 IND I 8 = � E 6 I = w6 y� 6 8 I > v> I y� > C � H k> C � I J B D J G H � D ; � E 6 I > : C I H � w> I = � g: G B A > C : � CYLD B J I 6 I > D C H ,� G : H : 6 G 8 = : G H; D J C 9 � JAG2� E G D I : > C � A : v: A H � 6 C 9 � ND I 8 = � I 6 G g: I � g: C : H � J E G : gJ A 6 I : 9 .� RUN2 1� w6 H � D v: G : xE G : H H : 9 � > CCYLD� 9 : ; : 8 I > v: � I J B D J G � 8 : A A H .� AH � w: A A ,� E G > B 6 G y� 8 : A A � 8 J A I J G : H � ; G D B � CYLD� 9 : ; : 8 I > v: � I J B D J G H � = 6 9G : 9 J 8 : 9 � v> 6 b> A > I y� w= : C � : xE D H : 9 � I D � ND I 8 = -I 6 G g: I > C g� y-H : 8 G : I 6 H : � > C = > b> I D G H .� T= : � > C v: H I > g6 I D G H � 8 D C -8 A J 9 : � I = : H : � ; > C 9 > C gH � H = D w� 6 C � D C 8 D g: C > 8 � 9 : E : C 9 : C 8 y� D C � ND I 8 = � H > gC 6 A A > C g� > C � E 6 I > : C I H � w> I = � CYLD9 : ; : 8 I > v: � I J B D J G H ,� w= > 8 = � B 6 y� 6 A H D � H J gg: H I � C D v: A � I = : G 6 E : J I > 8 � 6 E E G D 6 8 = : H .Rajan N, Elliott RJR, Smith A, et al: The cylindromatosis gene product, CYLD, interacts with MIB2 to

regulate notch signalling, in Oncotarget (Nov. 03, 2014; 5(23):12126-12140).

ANTI-DRUG ANTIBODIES AFFECTED BY TREATMENT PATTERNS, ETHNICITY

W= > A : � I = : � 9 : v: A D E B : C I � D ; � 6 C I > -9 G J g� 6 C I > bD 9 > : H � 6 g6 > C H I � 6 � b> D A D g> 8 � 9 G J g� > H � kC D wC � I D � b:6 H H D 8 > 6 I : 9 � w> I = � G : 9 J 8 : 9 � 8 A > C > 8 6 A � : ; ; > 8 6 8 y,� I = : � > B B J C D g: C > 8 > I y� D ; � I = : H : � 9 G J gH � v6 G > : HC D I � D C A y� b: I w: : C � 9 G J gH ,� bJ I � 6 A H D � b: I w: : C � 9 > H : 6 H : H � 6 C 9 � E 6 I > : C I � : I = C > 8 > I > : H .� TD � : v6 A J -

6 I : � E G : 9 > 8 I D G H � ; D G � 6 C I > -6 9 6 A > B J B 6 b� 6 C I > bD 9 y� (AAA)� ; D G B 6 I > D C � > C � C= > C : H : � E H D G > 6 H > H � E 6 I > : C I H � 6 C 9I = : � 8 A > C > 8 6 A � 8 D C H : qJ : C 8 : H � D ; � I = : � ; D G B 6 I > D C � D ; � I = D H : � 6 C I > bD 9 > : H ,� G : H : 6 G 8 = : G H � A D D k: 9 � 6 I � G > H k� ; 6 8 -I D G H � 6 C 9 � 9 > ; ; : G : C 8 : H � > C � PASI� 75� G : H E D C H : � G 6 I : H � > C � 53� E 6 I > : C I H .� P6 I > : C I H � w> I = � AAA� = 6 9 � H > gC > ; > 8 6 C I A yA D w: G � PASI� 75� G : H E D C H : � G 6 I : H � (44.4%� vH .� 88.5%;� E =0.001).� S> gC > ; > 8 6 C I A y� A D w: G � I G D J g= � 8 D C 8 : C I G 6 -I > D C H � D ; � 6 9 6 A > B J B 6 b� w: G : � H : : C � > C � E 6 I > : C I H � w> I = � AAA� 6 H � w: A A .� TG : 6 I B : C I � > C I : G G J E I > D C , � A D wI G D J g= � 6 9 6 A > B J B 6 b� 8 D C 8 : C I G 6 I > D C , � A 6 8 k� D ; � 8 D C 8 D B > I 6 C I � B : I = D I G : x6 I : � J H : , � 6 C 9 � H w> I 8 = > C gb: I w: : C � b> D A D g> 8 H � w: G : � 6 A A � 6 H H D 8 > 6 I : 9 � w> I = � 6 � = > g= : G � AAA� I > I G : .� T= : � G : H : 6 G 8 = : G H � 8 D C 8 A J 9 : � I = 6 II = : � b> D A D g> 8 � I G : 6 I B : C I � E 6 I I : G C � > B E 6 8 I H � AAA� ; D G B 6 I > D C � G > H k,� 6 C 9 � I = G D J g= � I = 6 I � G : 9 J 8 : 9 � 6 9 6 A > -B J B 6 b� : ; ; > 8 6 8 y.

Chiu HY, Wang TS, Chan CC, et al: Risk factor analysis for the immunogenicity of adalimumabassociated with decreased clinical response in Chinese patients with psoriasis,

in Acta Dermato-Venereologica (in the Feb. 12, 2015 online edition).

What THE LAY PRESS is saying about . . .

Department Editor: John Evans

Diagnostic Quiz

A. Morbillivirus measlesB. Parvovirus B19

C. Human herpesvirus type 7

THE EDITORS invite your participation in thisregular feature of the journal.Please send all images and

correspondence to:Medical Editor,

The Chronicle of Skin & Allergy555 Burnhamthorpe Road, Suite 306,

Toronto, Ont. M9C 2Y3.Telephone: (416) 916-2476E-mail: [email protected]

Correct answer: Morbillivirus measles

26 ·� M6 G 8 = � 2015�

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The Chronicle of Skin & Allergy Mar. 2015