Jack L. Lesher

Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. A randomized controlled trial. Nutritional Prevention of Cancer Study Group.

OBJECTIVE To determine whether a nutritional supplement of selenium will decrease the incidence of cancer. DESIGN A multicenter, double-blind, randomized, placebo-controlled cancer prevention trial. SETTING Seven dermatology clinics in the eastern United States. PATIENTS A total of 1312 patients (mean age, 63 years; range, 18-80 years) with a history of basal cell or squamous cell carcinomas of the skin were randomized from 1983 through 1991. Patients were treated for a mean (SD) of 4.5 (2.8) years and had a total follow-up of 6.4 (2.0) years. INTERVENTIONS Oral administration of 200 microg of selenium per day or placebo. MAIN OUTCOME MEASURES The primary end points for the trial were the incidences of basal and squamous cell carcinomas of the skin. The secondary end points, established in 1990, were all-cause mortality and total cancer mortality, total cancer incidence, and the incidences of lung, prostate, and colorectal cancers. RESULTS After a total follow-up of 8271 person-years, selenium treatment did not significantly affect the incidence of basal cell or squamous cell skin cancer. There were 377 new cases of basal cell skin cancer among patients in the selenium group and 350 cases among the control group (relative risk [RR], 1.10; 95% confidence interval [CI], 0.95-1.28), and 218 new squamous cell skin cancers in the selenium group and 190 cases among the controls (RR, 1.14; 95% CI, 0.93-1.39). Analysis of secondary end points revealed that, compared with controls, patients treated with selenium had a nonsignificant reduction in all-cause mortality (108 deaths in the selenium group and 129 deaths in the control group [RR; 0.83; 95% CI, 0.63-1.08]) and significant reductions in total cancer mortality (29 deaths in the selenium treatment group and 57 deaths in controls [RR, 0.50; 95% CI, 0.31-0.80]), total cancer incidence (77 cancers in the selenium group and 119 in controls [RR, 0.63; 95% CI, 0.47-0.85]), and incidences of lung, colorectal, and prostate cancers. Primarily because of the apparent reductions in total cancer mortality and total cancer incidence in the selenium group, the blinded phase of the trial was stopped early. No cases of selenium toxicity occurred. CONCLUSIONS Selenium treatment did not protect against development of basal or squamous cell carcinomas of the skin. However, results from secondary end-point analyses support the hypothesis that supplemental selenium may reduce the incidence of, and mortality from, carcinomas of several sites. These effects of selenium require confirmation in an independent trial of appropriate design before new public health recommendations regarding selenium supplementation can be made

Telemedicine evaluation of cutaneous diseases: a blinded comparative study.

BACKGROUND Numerous telemedicine programs have been created in the United States, but studies documenting the fidelity and effectiveness of telemedicine for evaluation of skin diseases are lacking. OBJECTIVE We attempted to determine the percentage of encounters in which two different dermatologists, one using telemedicine and one on-site, could independently arrive at the same primary diagnosis. METHODS Two clinical telemedicine sites linked through the Georgia Statewide Telemedicine Program were used in this study of 60 patients with skin problems. One dermatologist evaluated the patients on telemedicine (interactive television) and a second then took the patients into a separate examination room and evaluated them on-site. Each investigator recorded their diagnoses with no discussion with each other. As a control group, the investigators independently and in a blinded fashion (to each others diagnoses) recorded diagnoses for a group of patients from a third dermatologists clinic. Raw data were evaluated and classified by this third dermatologist who assigned diagnoses to categories of complete agreement, partial agreement, or disagreement. RESULTS There were no significant differences with regard to disagreement. However, there was a higher probability of complete agreement between the two dermatologists when each examined the patient on-site and in person than when one evaluated the patient on telemedicine and one examined the patient on-site and in person. CONCLUSION Our results suggest that telemedicine is an effective means of diagnosing cutaneous diseases. However, because partial interobserver agreement on diagnoses was greater for the telemedicine group than for the control group (p < 0.05), it is likely that optimum use of medical assistants at the remote site will be necessary to increase the likelihood of complete agreement on diagnoses among dermatologists using interactive television.

Ocular rosacea : Signs, symptoms, and tear studies before and after treatment with doxycycline

OBJECTIVE To examine ocular signs, symptoms, and results of tear analysis in patients with cutaneous rosacea before, during, and after doxycycline therapy. DESIGN Before-after trial. SETTING General community. PATIENTS OR OTHER PARTICIPANTS Thirty-nine patients with cutaneous rosacea underwent dermatologic and ocular examinations, testing of tear break-up time, and Schirmer testing at baseline and 4, 8, and 12 weeks. Six patients did not complete the study. Baseline tear break-up time and results of Schirmer test were compared with those of 13 patients without rosacea who were matched for age and sex. INTERVENTION Patients with rosacea were given doxycycline, 100 mg daily for 12 weeks. MAIN OUTCOME MEASURE Statistically significant (P, .05) improvement in tear break-up time. RESULT The most frequent ocular symptoms were dryness, itching, blurred vision, and photosensitivity, all of which improved significantly with treatment. All patients had signs of ocular disease, most commonly erythema and telangiectasia, meibomian gland dysfunction, and ciliary base injection. Significant improvement (P,.05) for scales, erythema and telangiectasia, ciliary base injection, bulbar injection, papillary hypertrophy, and punctate epithelial erosions was seen. Average tear break-up time for the patients with rosacea was 5.7 seconds, which improved to 10.8 seconds after 12 weeks of treatment (P = .007). Baseline tear break-up time was significantly lower than for the comparison group of normal subjects (P = .001). There was no correlation between severity of cutaneous disease and ocular disease. CONCLUSIONS All patients with cutaneous rosacea had some degree of ocular involvement. Tear break-up time is abnormal in patients with rosacea. Ocular erythema and telangiectasia, meibomian gland dysfunction, and short tear break-up time in patients with cutaneous rosacea are indicators of ocular rosacea. Doxycycline, 100 mg daily, will improve ocular disease and increase the tear break-up time.

Efficacy of topical isotretinoin 0.05% gel in acne vulgaris: Results of a multicenter, double-blind investigation

Two hundred sixty-eight patients with mild to moderate acne vulgaris completed a multicenter, double-blind, controlled study comparing isotretinoin 0.05% gel with its vehicle. Patients were treated twice daily for up to 14 weeks. Efficacy was measured by counting facial inflammatory and noninflammatory lesions and by grading acne severity initially and at 2- to 3-week intervals throughout the study. The isotretinoin 0.05% gel proved to be statistically more effective than vehicle in reducing inflammatory lesions after 5 weeks and in reducing noninflammatory lesions and acne severity grade after 8 weeks. Except for two patients who dropped out because of irritation, isotretinoin 0.05% gel was well tolerated.

Oral therapy of common superficial fungal infections of the skin

Although superficial fungal infections of the skin often respond to topical agents, systemic therapy is sometimes necessary. This article gives a review of the effectiveness of the oral antifungal agents fluconazole, itraconazole, and terbinafine in the treatment of pityriasis versicolor, tinea corporis/cruris, and tinea pedis. Four hundred milligrams fluconazole as a single dose and 200 mg itraconazole daily for 5 to 7 days were effective in the treatment of pityriasis versicolor; terbinafine taken orally appears to be ineffective in pityriasis versicolor. Tinea corporis and tinea cruris were effectively treated by 50 to 100 mg fluconazole daily or 150 mg once weekly for 2 to 3 weeks, by 100 mg itraconazole daily for 2 weeks or 200 mg daily for 7 days, and by 250 mg terbinafine daily for 1 to 2 weeks. Tinea pedis has been effectively treated with pulse doses of 150 mg fluconazole once weekly, with 100 mg itraconazole daily for 2 weeks or 400 mg daily for 1 week, and with 250 mg terbinafine daily for 2 weeks.

Cytomegalovirus infections and the skin

Cytomegalovirus has received renewed recognition as a pathogen in recent years. This article emphasizes the cutaneous manifestations of cytomegalovirus infection.

Rapidly progressive CD8-positive cutaneous T-cell lymphoma with tongue involvement

Cutaneous T-cell lymphoma rarely involves the oral cavity. We describe the histological and immunological findings of a rapidly progressive CD8+ cutaneous T-cell lymphoma involving the tongue. Involvement of the oral cavity usually indicates a poor prognosis. Cases of cutaneous T-cell lymphoma with oral involvement as reported in the English-language literature are reviewed and discussed.

Antifungal agents in dermatology

Development of new antifungal agents has increased significantly over the past two decades, with recent advances reflecting interest in synthetic agents as opposed to antibiotics. We review the various antifungal medications in use or under development, beginning with a discussion of over-the-counter agents, antibiotics, and older azole compounds and ending with an evaluation of newer azoles and the new class of antifungals, the allylamines.

The effect of sunless tanning on behavior in the sun: a pilot study.

Background: In the United States, indoor tanning is a booming industry and contributes to the ultraviolet light (UVL) burden that ultimately leads to skin cancer. “Sunless” tanning methods that avoid UVL exposure may represent a safe alternative. However, the effects of sunless tanning methods on ultraviolet light-related behaviors have never been investigated. Methods: Anonymous survey of 121 individuals who underwent a spray-on sunless tanning treatment between February and May 2004. Results: Women completed 107 surveys. Men completed 14 surveys. The majority of individuals reported that they had not or would not change their time spent outdoors or their sunscreen use as a result of undergoing sunless tanning. However, 73% of individuals who had used UVL tanning beds said they had decreased or would decrease their UVL tanning bed use. Conclusion: Sunless tanning is associated with a self-reported decrease in traditional UVL tanning bed use among tanning bed users. Physicians should advocate the use of sunless tanning to their patients who use traditional UVL tanning beds as a means of decreasing their UVL exposure and cancer risk.

An evaluation of a 2% erythromycin ointment in the topical therapy of acne vulgaris

Two hundred eight patients completed a 12-week, multicenter, double-blind, controlled study comparing a 2% erythromycin ointment to its vehicle. Patients were evaluated by inflammatory lesion counts and Cook acne severity grade at the initial visit and at weeks 2, 4, 8, 10, and 12. The 2% erythromycin ointment proved to be statistically more effective than the vehicle in reducing lesion counts and acne severity grade at weeks 4, 8, 10, and 12. The ointment caused few side effects and was well tolerated by most patients.