Skin Deep - Clinical & Cosmetic Dermatology Blog

Skin Deep is a blog for dermatologists and skin care professionals with focus on theoretical, cosmetic and aesthetic dermatology. This blog is associated with ‘Dermatologists Sans Borders’ one of the largest curated groups of skin care professionals on facebook. If you are looking for non-technical information, please visit http://skinhelpdesk.com


Big Bang Theory

This is a theoretic exploration of a product that promises to reverse the greying of hair. Special thanks to Dr. Ranju for bringing up this topic in the Dermatologists facebook group and to Dr Bina for sending me the details. We shall avoid using the trade names and shall refer to the product as 'The Bang'. Please follow this convention, if you comment on this post.

3D rendered animation of the structure of the ...
3D rendered animation of the structure of the Melanotan II peptide molecule. (Full size) (Photo credit: Wikipedia)
First of all 'The Bang' is from a cosmetic company and it is unlikely to be approved by regulatory bodies as a drug. (The cynic in me is awake already :)

3D rendered animation of the structure of the ...
3D rendered animation of the structure of the afamelanotide peptide molecule. (Full size) (Photo credit: Wikipedia)
Let me start with a little bit of history. MC1R ligands (like the bangs) are the focus of active research. The most noteworthy molecule in this group is the Afamelanotide that is being developed by Clinuvel Pharmaceuticals as melanotan. The primary use for melanotan is to produce a protective tan prior to intense sun exposure. It is being developed as an injection and a subcutaneous implant.

Due to some inconsistency in the regulatory process, a number of products with similar structure are 'legally sold' over the internet as a natural tanning product. There are reports of darkening and increase in size of moles following the use of these products, but the risk of carcinogenesis has been ruled out.

Read more about this story here.

English: Picture to illustrate bangs
English: Picture to illustrate bangs (Photo credit: Wikipedia)
I checked their patent (filed on May 10, 2005 and approved on Aug 21, 2008) and found that the core structure is similar to Afamelanotide. Peptides may have similar active site with vastly different sequence for the rest of the chain.

To sum up the history, the concept of a biomimetic MC1R ligand that darkens hair is good. I shall critically evaluate their promotional material in the next post after a couple of days. In the meantime, if you have it from Dermacon Ahmedabad, do a critical evaluation yourself.

Read Part 2 here on monday morning.

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Fractional Q-switched Laser

Ref: The efficacy in melasma treatment using a 1410 nm fractional photothermolysis laser Wanitphakdeedecha 2013 Journal of the European Academy of Dermatology and Venereology Wiley Online Library (abstract)

The above article promotes 1410 nm fractional laser as a temporary effective procedure in the treatment of melasma. The key word is 'temporary'. Like most clinical trials for melasma interventions, the followup period is (?intentionally) kept low. In this case the authors have accepted this limitation in the conclusion.

Fun with an Argon-ion and a He-Ne laser. Most ...
Fun with an Argon-ion and a He-Ne laser. Most of these photos are from around 2000-2001. (Photo credit: Wikipedia)
What interested me more in this study is the incidental finding. Fractional laser at low coverage (5%) is better than more coverage. This is probably because of the reduced risk of post inflammatory pigmentation a common problem with darker skin types and more intense laser platforms like the Q-switched ones.

I was wondering whether a fractional q-switched technology would be better for the treatment of melasma. I did a google search and found such a system actually exists. The manufacturer says their Q-switched fractional technology is unique in the world. (They all do, but the claim may be true in this case). In line with my blogging convention, I cannot reveal the name of the platform, but the readers can easily find it by googling "fractional q switched laser".

I am just curious to know whether anyone has practical experience with this platform. Please do comment  if you have, referring to the platform by the acronym 'fqsl'.

On a lighter note, acronyms can be tricky sometimes. I have a medical/dental PG entrance site called docpg.co.in which has a category called Frequently Unanswered Questions. No, I do not use any acronym for that :)

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How do you examine bromhidrosis?

Ref: One million Brits can 'dump their deodorants': 
http://www.nhs.uk/news/2013/01January/Pages/One-million-Brits-can-dump-their-deodorants.aspx


Bromhidrosis or body odour is a fairly common condition presenting to a dermatologist. But how do you examine your patient to confirm your diagnosis of bromhidrosis?

verschiedene Deodorants
verschiedene Deodorants (Photo credit: Wikipedia)
A MRC sponsored study conducted in the university of Bristol, suggests that you should look into their ears! A particular SNP (Single Neucleotide Polymorphism) in the ABCC11 gene gives rise to both wet ear wax and odourous sweat. Apparently there is no other known genetic association for odourous sweat.

There is no mention of whether it involves apocrine or eccrine sweat glands or both. Besides this is an incidental finding on a cohort for a different purpose. The article also makes a bizarre claim that at least 80% of deodorant use is probably unnecessary. Well, do you use deodorant, because you have body odour?


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Skin Renewal Growth Factors

Colourful Spin
Colourful Spin (Photo credit: beapen)
In my series on PRP (sorry for going back to PRP again), I said that a non-specific concoction of platelet derived growth factors (PDGFs) are unlikely to have a beneficial cosmetic outcome. A new study from Taiwan (Reference and link below) strengthen my point.

The authors seem to have come up with 'skin renewal growth factors' that stimulates fibroblast proliferation and inhibits keratinocytes and melanocytes. Inhibition of keratinocytes and melanocytes would reduce the risk of acanthosis nigricans and pigmentation as I postulated.

I do not have access to the full article, so I am little skeptical. Besides the preparation is of porcine origin.

However the study corroborates my view that, to assess the cosmetic effects of a growth factor mixture, you have to evaluate its effect on fibroblasts, keratinocytes and melanocytes and not just any one cell line.

Ref: (abstract) http://online.liebertpub.com/doi/abs/10.1089/rej.2012.1345
Kuo-Hsien Wang, Yo-Ping G. Wu, Wen-Cheng Lo. An Ideal Preparation for Dermal Regeneration: Skin Renewal Growth Factors, the Growth Factor Composites from Porcine Platelets. Rejuvenation Research, Vol. 15, No. 6. (December 2012), pp. 613-623.
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Axillary hyperpigmentation

Ref: http://dx.doi.org/10.2147/CCID.S39246 (link to access full text)

Castanedo-Cazares, Juan Pablo; Lárraga-Piñones, Gabryela et.al. Topical niacinamide 4% and desonide 0.05% for treatment of axillary hyperpigmentation: a randomized, double-blind, placebo-controlled study. Clinical, cosmetic and investigational dermatology, Vol. 6, (2013)


The above article describes the use of topical niacinamide and topical desonide in axillary hyperpigmentation from the Dovepress journal: Clinical, Cosmetic and Investigational Dermatology. Axillary hyperpigmentation is considered a cosmetic condition in this part of the world, except in conditions like acanthosis nigricans or axillary freckling. I generally view studies on cosmetic condition with skepticism even when it involves non-cosmetic interventions. But there are few factors that sets this study apart from the rest of the genre.

English: Region of the left axilla. Note the p...
English: Region of the left axilla. Note the presence of characteristic brown-grayish maculae following the Lines of Blaschko. (Photo credit: Wikipedia)
This controlled trial is registered on the US National Institutes of Health Clinical Trial Register. Two departments (Dermatology and Pathology) are involved in the study. The study is of high quality and probably the first to evaluate post inflammatory hyperpigmentation (PIH) at the histological level as they have included histological changes as secondary outcome.

The authors have demonstrated basement membrane disruption in PIH that improves with anti-inflammatory interventions like desonide and niacinamide. They have also found that PIH is associated with increase in melanin but WITHOUT any increase in melanocytes. Both these findings have clinical relevance.

Somehow 'incontinentia pigmenti' was used as a synonym for pigmentary  incontinence. Incontinentia Pigmenti is an inherited developmental defect of the skin and cannot be used as a synonym for the histological finding of pigmentary incontinence characterised by release of melanin pigment in the dermis.

Niacinamide and desonide have different mechanism of action and are compatible. Can both be combined as a treatment for axillary hyperpigmentation? I shall try to add the protocol to the Dermatology Post graduate thesis topics wiki. Please add your ideas to the wiki too. If colorimetry is beyond the scope of PG thesis, feel free to use my online colorimetry from digital photographs!

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Does your face cream make you fat?!

Pink in honor of breast cancer awareness programs
Pink in honor of breast cancer awareness programs (Photo credit: beapen)
Long term readers of my blog would know me as an anti-sunscreen and anti-fairness guy. I have seen a sunscreen that claimed to be paraben-free on the pack with three parabens listed in the ingredients list. Parabens are ubiquitous cosmetic preservatives but known to have a low but significant association with breast cancer.  But a recent finding would make products with paraben even more disagreeable to cosmetic users. A study showed that parabens have adipogenic potential, or in other words it can increase body fat! This potential increases with the length of alkyl chain making ethyl paraben more adipogenic than methyl paraben. Aromatic chain further augments this property making benzyl paraben the most adipogenic paraben.
Parabéns, Fâ!
Parabéns, Fâ! (Photo credit: Daniel F. Pigatto)

I don't know how the main stream cosmetic industry is going to counter this. But if you don't have a weighing scale near your mirror, don't say I didn't warn you!

The article is here: http://www.ncbi.nlm.nih.gov/pubmed/22956630

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Dapsone and Eosinophils

After the series on PRP, I shall dedicate the next few posts to showcase the practical utilities of DermKnowledgeBASE (DKB). But DKB is still in its infancy and may greatly benefit from your expertise. Do take a look, if you have not done so before.

Tabletas de Dapsona 50mg
Tabletas de Dapsona 50mg (Photo credit: Wikipedia)
Today we shall try to find the answers to two common questions commonly asked during dermatology PG exam.

What are the dermatological indications of Dapsone?

What are the dermatological conditions associated with an eosinophilic infiltrate?

1. To query DKB please visit http://dermbase.gulfdoctor.net (Opens in a new window)
2. Click on 'Query Builder' You can see the button in the first row below the title.
3. Leave the first (left) field blank. Choose 'has intervention' from the drop down menu. Enter 'Dapsone' in the right column and click Submit.

Voila! The list should be in front of your eyes.

Image of an eosinophil
Image of an eosinophil (Photo credit: Wikipedia)
To find conditions with eosinophilic infiltrate, repeat steps (1) and (2) as above.

3. Leave the first (left) field blank. Choose 'has feature' from the drop down menu (default option). Enter 'Eosinophilic' in the right column and click Submit.

Remember that the list you see is self learnt by the system. Curators may be able to remove wrong entries and add missed ones. If you want to join DKB as a curator please let me know.

BTW, If you are too lazy, you can use the links below for a direct link to the list for Dapsone and Eosinophilic! In the next few posts I shall discuss how to do more complicated queries on DKB. Till then feel free to experiment to your heart's content.


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About Me

As a Dermatologist and Informatician my research mainly involves application of bioinformatics techniques and tools in dermatological conditions. However my research interests are varied and I have publications in areas ranging from artificial intelligence, sequence analysis, systems biology, ontology development, microarray analysis, immunology, computational biology and clinical dermatology. I am also interested in eHealth, Health Informatics and Health Policy.

Address

Bell Raj Eapen
Hamilton, ON
Canada