Women With Breast Cancer Have Less Dermatitis When Treated With IMRT

Daily Science Journal (Oct. 30, 2007) — All women treated with radiation therapy for breast cancer are at risk of developing dermatitis--a sometimes-painful skin condition caused by radiation as it makes its way through the skin to the tumor area and tissue within the breast. But researchers at Fox Chase Cancer Center say women being treated with IMRT (intensity-modulated radiation therapy) are less likely to have serious dermatitis.

A reddening of the skin, dermatitis is often likened to a bad sunburn. It can begin in the first weeks of treatment as mild redness, dryness or itching of the skin and progress to a more intense skin reaction by the last week of radiation. When dermatitis is acute and severe, causing peeling, it is can be extremely painful, interfering with normal life activities and sometimes interrupting treatment.

"Dermatitis is a major quality-of-life concern," said Gary Freedman, M.D., a radiation oncologist at Fox Chase Cancer Center who studies the side effects of breast cancer treatment. "It can be so painful that wearing a bra or snug-fitting clothing isn't possible. In the most severe cases, the skin will actually bleed or be at risk of infection."

Freedman says IMRT can reduce the risk of dermatitis. IMRT allows the radiation to be distributed in more beams across the skin, avoiding the full-on assault of conventional radiation.

In this study, Freedman and his colleagues looked at the records of 804 consecutive patients with early-stage breast cancer. The women were treated with breast-conserving surgery and radiation therapy between 2001 and 2006.

In the earlier part of the study period, women were treated with conventional radiation therapy (n=405). Later in the study period, women were primarily treated with IMRT (n=399).

Of those treated with IMRT, 48 percent had grade 0/1 dermatitis and 52 percent had grade 2/3. Of those treated with conventional radiation, 25 percent had grade 0/1 dermatitis and 75 percent had grade 2/3.

"In addition to statistically fewer patients with serious dermatitis, women treated with IMRT who developed dermatitis had it for a shorter time period than those treated with conventional radiation," added Freedman. "These benefits were shown in all patients regardless of breast size."

He concluded, "This study confirms our current practice of recommending IMRT for all patients. The study seeks to provide further evidence for patients, physicians and insurance companies that IMRT should be standard practice."

The research was presented October 28, 2007 at the American Society for Therapeutic Radiology and Oncology's 49th Annual Meeting in Los Angeles.

Fox Chase Cancer Center was founded in 1904 in Philadelphia as the nation's first cancer hospital. In 1974, Fox Chase became one of the first institutions designated as a National Cancer Institute Comprehensive Cancer Center. Fox Chase conducts basic, clinical, population and translational research; programs of cancer prevention, detection and treatment; and community outreach. For more information about Fox Chase activities, visit the Center's web site at http://www.fccc.edu or call 1-888-FOX CHASE.

Adapted from materials provided by Fox Chase Cancer Center, via EurekAlert!, a service of AAAS.

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New Skin-healing Chemicals, Green Tea And The 'Asian Paradox'

Daily Science Journal (Aug. 30, 2007) — Researchers have made synthetic lipids called pseudoceramides that are involved in skin cell growth and could be used in treating skin diseases in which skin cells grow abnormally.

Ceramides are lipids found in the outermost skin layer called the stratum corneum, which is made of dead skin cells and mainly serves as a physical barrier. Ceramides' main biological function is to control how skin cells grow and differentiate -- a process through which skin cells become specialized.

Scientists have created in the laboratory synthetic ceramides, called pseudoceramides, to treat skin diseases such as atopic dermatitis, a form of eczema characterized by red, flaky and very itchy skin; psoriasis, a disease that causes red scaly patches on the skin; and glucocorticoid-induced epidermal atrophy, in which the skin shrinks due to skin cell loss.

Jeung-Hoon Lee and colleagues have developed a new series of pseudoceramides and examined their effects on skin cells. They found that three pseudoceramides called K6PC-4, K6PC-5, and K6PC-9 significantly increased the amount of proteins produced when skin cells differentiate. These results were obtained both on cultured skin cells and on a reconstituted epidermis. K6PC-4, K6PC-5, and K6PC-9 may be used to treat skin diseases arising from abnormal growth of skin cells, the scientists concluded.

Article: "Novel synthetic ceramide derivatives increase intracellular calcium levels and promote epidermal keratinocyte differentiation," by Yoo Bin Kwon, Chang Deok Kim, Jong-Kyung Youm, Hyung Sub Gwak, Byeong Deog Park, Seung Hun Lee, Saewha Jeon, Bo Joong Kim, Young-Joon Seo, Jang-Kyu Park, and Jeung-Hoon Lee

Adapted from materials provided by American Society for Biochemistry and Molecular Biology, via EurekAlert!, a service of AAAS.

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Green Tea And The 'Asian Paradox'

There is a lower incidence of cardiovascular disease and cancer in Asia where people smoke heavily, which may be accounted for by high consumption of tea, particularly green tea, according to a review article published by a Yale School of Medicine researcher.

"We do not yet have a full explanation for the 'Asian paradox,' which refers to the very low incidence of both heart disease and cancer in Asia, even though consumption of cigarettes is greater than in most other countries," said Bauer Sumpio, M.D., professor and Chief of Vascular Surgery in the Department of Surgery. "But we now have some theories."

Sumpio, the lead author of the review in the Journal of the American College of Surgeons, said he and his colleagues reviewed more than 100 experimental and clinical studies about green tea in writing the article.

He said one theory is that the average 1.2 liters of green tea consumed daily by many people in Asia offers the anti-oxidant protective effects of the polyphenolic EGCG. EGCG may prevent LDL oxidation, which has been shown to play a key role in the pathophysiology of arteriosclerosis. EGCG also reduces the amount of platelet aggregation, regulates lipids, and promotes proliferation and migration of smooth muscle cells, which are all factors in reducing cardiovascular disease, he said.

Sumpio said other reports show that EGCG prevents growth of certain tumors. Tea, according to studies, also can improve gastrointestinal function, alcohol metabolism, kidney, liver and pancreatic function, protect skin and eyes and alleviate arthritis. Tea has been used in managing and preventing allergies, diabetes, bacterial and viral infections, cavities, reduce or cure diseases with an inflammatory component and improve neurologic and psychological health.

"More studies are necessary to fully elucidate and better understand green tea's method of action, particularly at the cellular level," Sumpio said. "The evidence is strong that green tea consumption is a useful dietary habit to lower the risk for, as well as treat, a number of chronic diseases. Certainly, however, smoking cessation is the best way to prevent cardiovascular disease and cancer."

Reference: Journal of the American College of Surgeons 202: 813-825 (May 2006)

Adapted from materials provided by Yale University.

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Combination Of Limes, Sun Can Result In 'Margarita Dermatitis'

Daily Science Journal (Aug. 16, 2007) — Adding a slice of lime to a favorite summer drink is nice to cool off with, but it could leave your skin burning, say dermatologists at Baylor College of Medicine in Houston.

The condition, called phytophotodermatitis, happens when a certain plant compound comes in contact with the skin, making that one area light sensitive. During the summer, lime juice is the common cause for this condition, which is why some doctors call it 'margarita dermatitis.'

"The reaction usually looks like a sunburn, or a poison ivy rash, with redness and sometimes swelling and blistering," says Dr. Rajani Katta, associate professor of dermatology at BCM. "It can be itchy and painful, and leave behind skin discoloration."

The photosensitizing compound is also found in plants such as celery, parsley and even Queen Anne's Lace. Exposure can come from fruit drippings, scratches from branches or airborne particles.

"It's not just the plant that causes the condition," Katta said. "The skin must be exposed to both the plant compound and the sun."

Treatment is similar to treating a poison ivy rash. Cool compresses and hydrocortisone creams along with oral antihistamines are used. Severe cases could require steroid pills.

"This is a common condition, but most cases are mild and people usually won't head to the doctor," Katta said. "I find patients are more bothered by the discoloration left behind rather than the inflamed area."

Preventative action is best. Be aware of what plant products you come in contact with and wash the area thoroughly before going out in the sun. As always, make sure to apply sunscreen and stay in shaded areas to maintain good skin health.

Adapted from materials provided by Baylor College of Medicine.

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Green Tea Holds Promise As New Treatment For Inflammatory Skin Diseases, Tea Extracts Help Treat Damaged Skin In Cancer Patients

Daily Science Journal (Aug. 7, 2007) — Green tea could hold promise as a new treatment for skin disorders such as psoriasis and dandruff, Medical College of Georgia researchers say.

Dr Hsu says, "There are no cures for autoimmune diseases. But it is possible that this is a non-toxic way to regulate them. We need further study -- on humans -- to determine the full effects." (Credit: Medical College of Georgia)

Researchers studied an animal model for inflammatory skin diseases, which are often characterized by patches of dry, red, flaky skin caused by the inflammation and overproduction of skin cells. Those treated with green tea showed slower growth of skin cells and the presence of a gene that regulates the cells' life cycles.

"Psoriasis, an autoimmune disease, causes the skin to become thicker because the growth of skin cells is out of control," says Dr. Stephen Hsu, an oral biologist in the MCG School of Dentistry and lead investigator on the study published in the Aug. 18 edition of Experimental Dermatology. "In psoriasis, immune cells, which usually protect against infection, instead trigger the release of cytokines, which causes inflammation and the overproduction of skin cells."

Other autoimmune diseases with similar side effects include lupus, which can lead to skin lesions, and dandruff.

Green tea, already shown to suppress inflammation, helps by regulating the expression of Caspase-14, a protein in genes that regulates the life cycle of a skin cell.

"That marker guides cells by telling them when to differentiate, die off and form a skin barrier," Dr. Hsu says. "In people with psoriasis, that process is interrupted and the skin cells don't die before more are created and the resulting lesions form."

Animal models treated with green tea also showed reduced levels of proliferating cell nuclear antigen, a gene expressed when skin cells multiply. In psoriasis, the gene is over-expressed and speeds production of skin cells.

"Before treatment, the antigen, PCNA, was present in all layers of the skin," Dr. Hsu says. "Typically, PCNA is only found in the basal layer, the innermost layer where skin cells continually divide and new cells push the older ones to the skin surface, where they eventually slough off. After being treated with green tea, the animal models showed near-normal levels of PCNA in only the basal layers."

This research is important because some treatments for psoriasis and dandruff can have dangerous side effects, he says.

"The traditional treatment of ultraviolet light and medication, while it can control the lesions and be used long term, may cause squamous cell carcinoma – the second most common form of skin cancer," Dr. Hsu says. "Some of the most effective anti-dandruff shampoos also have carcinogens in them. While the U.S. Food and Drug Administration allows that in small amounts, the bottom line is that we don't know the long-term effects of using those products continuously."

Green tea, which is plant-derived, may be an alternative, he says. But scientists must work to overcome some barriers with the treatment.

The chemicals in green tea are so active that they are oxidized too quickly when mixed with other ingredients. They also dissolve in water, which cannot penetrate the skin's barrier.

Researchers are looking for a balanced formula that can dissolve in fats, which can permeate the skin, Dr. Hsu says.

Adapted from materials provided by Medical College of Georgia.

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Tea Extracts Help Treat Damaged Skin In Cancer Patients

Tea extracts work as an effective treatment for patients who suffer from damaged skin following radiation treatment for cancer. Researchers show that this might partly be due to the anti-inflammatory properties of tea.

In a study published in the open access journal BMC Medicine, researchers show that tea acts at the cellular level, by inhibiting inflammatory pathways, to reduce inflammation. They also show that tea extracts reduce the duration of radiation-induced skin damage by up to 10 days in patients who received radiation treatment.

Frank Pajonk, from the University of California in Los Angeles, USA, and colleagues from the University of Freiburg, Germany, studied the effects of green tea and black tea extracts on patients who had been treated with radiotherapy, which can damage the skin. The authors then analysed the effects of the same tea extracts on human and mouse white blood cells in culture.

Pajonk et al. find that tea extracts reduce the duration of skin toxicity following radiotherapy by 5 to 10 days. Green tea extracts are more effective than black tea extracts in some patients. Pajonk et al. also show that tea extracts reduce the release of pro-inflammatory cytokines, such as IL-1beta, IL-6, IL-8, TNFalpha and PGE2, in human white blood cells in culture, with green tea having higher anti-inflammatory properties than black tea. Both black tea and green tea inhibit one major inflammatory pathway in mouse white blood cells.

Pajonk et al. add that tea's high content of polyphenols is likely to be responsible for its high anti-inflammatory activity, but that other pathways are probably involved in its clinical effectiveness.

Adapted from materials provided by BioMed Central, via EurekAlert!, a service of AAAS.

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The Elderberry Way To Perfect Skin

Daily Science Journal (Jul. 6, 2007) — Forget expensive moisturisers and cosmetic surgery, a compound found in the humble elderberry could give a natural boost to skin.

In the first study of its kind, researchers will explore whether the skin's condition is improved by a compound which gives berries their vibrant colour (called 'anthocyanin'). (Credit: iStockphoto)

In the first study of its kind, a team of researchers led by Prof Aedin Cassidy at the University of East Anglia and Dr Paul Kroon at the Institute of Food Research, will explore whether the skin's condition is improved by a compound which gives berries their vibrant colour (called 'anthocyanin').

In a 12-week trial starting in September, post-menopausal women will consume either extracts from elderberries or placebo capsules, and will have their skin's structure and appearance measured with state-of-the-art equipment used by experts in skin science. At the same time, researchers will also test whether the elderberry extract can reduce risk factors for heart disease.

"We already know that a healthy diet can help protect against heart disease and skin damage, and that a mixture of similar food components have been shown to improve the skin's structure. There is also evidence that the active components have anti-inflammatory properties, which may be important in helping people stay healthy," said UEA's Dr Peter Curtis who is leading the project.

"If the results of our study are positive, it may lead to innovations in skin health products and may also give us vital information about diets which promote healthier hearts."

Adapted from materials provided by University of East Anglia.

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Innovative Treatment For Migraines Combines Botox And Surgery

Daily Science Journal (Jun. 19, 2007) — Five years ago, Sharon Schafer Bennett suffered from migraines so severe that the headaches disrupted her life, kept her from seeking a job and interfered with participation in her children's daily activities.

Plastic surgeon Dr. Jeffrey Janis marks a site that, using the anti-wrinkle drug Botox, pinpointed a muscle later removed to help relieve Sharon Schafer Bennett's severe migraines. (Credit: Image courtesy of UT Southwestern Medical Center)

Now, thanks to an innovative surgical technique performed by a UT Southwestern Medical Center plastic surgeon who helped pioneer the procedure, the frequency and intensity of Mrs. Bennett's migraines have diminished dramatically -- from two to three per week to an occasional one every few months.

The technique -- performed by a handful of plastic surgeons in the U.S. -- includes using the anti-wrinkle drug Botox to pinpoint which of several specific muscles in the forehead, back of the head or temple areas may be serving as "trigger points" to compress, irritate or entrap nerves that could be causing the migraine. Because Botox temporarily paralyzes muscles, usually for about three months, it can be used as a "litmus test" or "marker" to see if headaches go away or become less intense while the Botox's effects last, said Dr. Jeffrey Janis, assistant professor of plastic surgery.

If the Botox is successful in preventing migraines or lessening their severity, then surgery to remove the targeted muscle is likely to accomplish the same result, but on a more long-term and possibly permanent basis, he said.

For Mrs. Bennett, the surgery proved to be life-altering.

"I can't even begin to tell you what a change this has made in my life," said Mrs. Bennett, 45, a Houston-area resident. "For the first time in years, I can live like a normal human being and do all the normal 'mom' and 'wife' things that the migraines physically prevented me from doing. My family thinks it's great because they don't have to put their lives on hold numerous times a week because of my migraines. I'm also going back to school to get a second degree, something I could never have considered before."

Dr. Janis said: "Many neurologists are using Botox to treat migraines, but they are making the injections in a 'headband-like' circle around the forehead, temple and skull. They are not looking at finding the specific location of the headache's trigger point. While patients may get temporary relief, after the Botox wears off they will have to go back and get more injections or continue medications for migraines.

"It's like a math equation. I will inject the Botox into one trigger point at a time and leave the others alone. The Botox is used as a diagnostic test to determine what trigger point is causing the problem. If patients get a benefit from the Botox, they likely will get a benefit from the surgery. If there's no benefit from the Botox, then there won't be a benefit from the surgery."

Dr. Janis began collaborating more than five years ago with Dr. Bahman Guyuron, a plastic surgeon at Case Western Reserve University and the first to explore using surgery to relieve migraines, following the revelation by several of his patients that their migraines had disappeared after they had cosmetic brow lifts. Dr. Janis has assisted his colleague by performing anatomical studies on cadavers to explore the nerves and pathways that might cause migraines. Together they have identified four specific trigger points and developed a treatment algorithm that includes using Botox prior to deciding whether to perform surgery.

During the past several years, numerous peer-reviewed articles have been published in Plastic & Reconstructive Surgery detailing their research efforts and the researchers have presented the technique at professional meetings of plastic surgeons.

Approximately 28 million Americans, 75 percent of those women, suffer from migraines, according to the National Institutes of Health. For employers, that translates into an estimated 157 million lost workdays annually.

"A migraine is something you can't explain to someone who hasn't had one," said Mrs. Bennett, who began suffering monthly migraines as a teenager. As she grew older, the headaches become more frequent and unpredictable. "They were messing up my life. I couldn't make any commitments or plan activities for my kids. This surgery has made a huge difference in my life. It's awesome."

Dr. Janis only sees patients who have been diagnosed with recurring migraines by a neurologist and have tried other treatments that have failed.

"Plastic surgeons are not in the business of diagnosing and treating headaches," he said. "This is a novel method of treatment that is proving to be effective and potentially more long lasting than other things used before. But it is still in its infancy."

Adapted from materials provided by UT Southwestern Medical Center.

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