September 2008
MELANOMA TEST
Some years ago, I remember attending a meeting of the Society of Investigative Dermatology in Washington. I sat listening to a distinguished research scientist talk about hereditary melanoma. In his talk he discussed the p16 gene and its role in suppressing melanoma. When this gene goes astray, we lose our protection against both melanoma and pancreatic cancer. Testing for this genetic mutation seemed theoretical and far in the future.
Little did I know then that this test would be made available to every dermatologist in a simple and easy manner. All it takes is small tube of blood. The Melaris test can identify the p16 gene mutation. The test can be done for the whole gene or that part which might be mutated. If you have a mutation in this gene, your parents, your children, and your brothers and sisters have up to a 50% chance that they too possess the same mutation. It is recommended that those who have a history of melanoma and pancreatic cancer in a family or two or more melanomas in an individual or family and a relative with the p16 gene mutation be tested.
DIET AND ACNE
The role of diet as a cause of acne has been rooted in controversy. Now the pendulum may be swinging back to those who claim its importance.
A few years back an enterprising and perhaps vacation-seeking dermatologist journeyed to a Pacific Island where the teenage natives were known to be blessed with blemish-free skin. He exchanged their tuber-laden diet for typical American fare. Sure enough their faces began to erupt like the volcanoes of the neighboring Pacific isles.
Now comes the second of two studies by an Australian scientist, Robyn Smith, demonstrating that a high-glycemic diet worsens acne. Foods that produce a high-glycemic load, or high levels of blood sugar (glucose)—such as white bread, potatoes, cake—tend to release a rapid surge in blood sugar. Conversely, other carbs, such as high-fiber cereal or beans, create a more gradual change and are regarded to bear a low-glycemic index.
A high-glycemic diet requires higher insulin levels. Higher insulin levels lead to increased androgen availability (androgens being a leading culprit in acne) and the production of an acne-producing insulin-like growth factor. Dr. Smith’s studies have shown that a low-glycemic diet leads to a major reduction in acne lesions. So maybe it is better to hold off on that extra slice of pizza or piece of chocolate cake after all.
PORE SIZE
One of the more frequent questions I am asked is whether anything can be done to shrink pore sizes. The bigger the pore, the smaller the hair but the larger the oil gland. That is why even the hairiest of men grow nothing much on their inner cheeks. That also explains why we are oilier in the central portion of the face. It further elucidates a popular and clever advertising gimmick of a few decades ago: a treatment for combination skin—which approximately 80% of us have to an extent.
But can those with large pores have their pore sizes shrunk? I hate to be ambiguous, but the answer is yes and no. You cannot change the pore size any more than you can change the actual color of your hair. While you make adjustments to the pore through various cleansing rituals and treatments, you are stuck with your pore size the same way you can color your hair but not alter the inner root sheath which donates the pigment that gives it its color.
So which treatment do I recommend? It is called the deep-pore cleanser. Few if any dermatologists have the time or inclination to perform these treatments. This is an area that a good aesthetician can come to the fore. Though time consuming, a deep pore cleansing will not only keep your pores clean and fresh, but will temporarily shrink your pore size. By expunging keratin, dirt, and sebum, the deep-pore cleansing allows the pore to relax and shrink in size. An added benefit is that it will reduce, though not eliminate, acne flare-ups and give the skin a good clean glow.
Most aestheticians will use a combination of steam, masks, and extractions. A good, experienced aesthetician will not need to pick, probe, and dig. In fact, in most states it is illegal for a non-physician to penetrate the skin. Done correctly a deep pore cleansing should be a pleasant, non-painful, and of course dermatologically therapeutic experience. In my next column I will make recommendations on topical creams to keep pores clean and clear.
PEPPER FOR VITILIGO
Compounds derived from black pepper show the potential to treat vitiligo, one of the more disfiguring skin conditions known. In vitiligo the body mysteriously loses pigment. Most experts feel vitiligo results when the body attacks its own melanocytes, the cells that produce pigment. Michael Jackson is the world’s most famous vitiligo patient.
Treatment for vitiligo has been at best spotty. While the Eximer laser may be a superior treatment for resistant vitiligo, often the results are only partially effective and the patient is left with a mottled appearance.
Along comes that condiment so loved by waiters everywhere, black pepper. It seems that piperine, a chemical found in black pepper, can stimulate the proliferation of melanocytes. When piperine is applied to a poorly pigmented mouse model, hopefully mice not inhabiting any of the restaurants I haunt, a light, even pigmentation was produced.
When ultraviolet light was added, the results were even more impressive as the skin grew darker and lacked any of the patchiness caused by ultraviolet light alone. If similar results are obtained in humans and proved to be safe, there is the promise of far superior results than are currently available.
VA. BEACH FIGHTS WARTS
A local pharmaceutical company, Dalos Biopharma, has come out with an intriguing and most effective product called Poxiderm. When a dermatologist is asked for the bane of his existence, he would probably reply warts. Some might answer molluscum contagiousum. These pesky, little, shiny dome-shaped lesions like to flock around the face and trunk in children and the lower abdomen and privates of young adults. In the latter it can be a sexually transmitted disease. Like warts they are caused by a virus. In the case of MC the virus is a hardy one and resists the sun and drying, making it all the more communicable.
Dalos has developed a powerful new weapon in the fight against both conditions. Well, not exactly new since it is derived from a plant found in the Amazon. The active ingredient is a phytochemical which has anti-pox virus activity. Perhaps, its earliest users were the South American Indians who would rub it on their bodies to protect themselves from the smallpox that was decimating the native population.
So far I have used Poxiderm on ten patients and am happy to report that the response has been excellent. Of course, I use every wart and MC fighter at my disposal, but Poxiderm has been a great adjunctive therapy. Its pleased me and my patients, and I think we should be proud that such a superior product is originating in Virginia Beach.
ULTIMATE FILLER
Instead of injecting a material—hyaluronic acid or collagen—into your skin, how about your physician injecting your own skin cells and encouraging them to multiply? That is the rationale behind the Isolagen process. In this technique a biopsy is taken from behind the ear, the specimen is sent off to a laboratory, and the individual’s fibroblasts are harvested, grown, and then sent back. These fibroblasts are injected back into the skin, where the busy little cells produce collagen, elastin, and other components of the skin’s dermis. This gives a full natural appearance, and it is thought the new wrinkle-ablated look can last ten years, maybe longer.
Hopes for this process received a major boost a few weeks ago when it was reported that a recently completed study demonstrated that this process performed significantly better than placebo. This was a Phase III FDA trial, part of which was performed in Virginia Beach at the Institute for Anti-Aging Research. The company plans to file for FDA approval soon and hopes to begin marketing its revolutionary product in 2010.
While the results may be superior to its present filler competitors—and certainly the concept of receiving one’s own cells is compelling, the technology involved will be quite labor and technologically intensive. I would assume that this will make the procedure quite pricey.
This article was written by Dr. Arnold Oppenheim, M.D. for the Tidewater Women – September 2008 Edition.
