Sunil Kalia

New concepts in antimalarial use and mode of action in dermatology.

ABSTRACT:  Although chloroquine, hydroxychloroquine and quinacrine were originally developed for the treatment of malaria, these medications have been used to treat skin disease for over 50 years. Recent clinical data have confirmed the usefulness of these medications for the treatment of lupus erythematosus. Current research has further enhanced our understanding of the pharmacologic mechanisms of action of these drugs involving inhibition of endosomal toll‐like receptor (TLR) signaling limiting B cell and dendritic cell activation. With this understanding, the use of these medications in dermatology is broadening. This article highlights the different antimalarials used within dermatology through their pharmacologic properties and mechanism of action, as well as indicating their clinical uses. In addition, contraindications, adverse effects, and possible drug interactions of antimalarials are reviewed.

Polarization speckle imaging as a potential technique for in vivo skin cancer detection

Abstract. Skin cancer is the most common cancer in the Western world. In order to accurately detect the disease, especially malignant melanoma—the most fatal form of skin cancer—at an early stage when the prognosis is excellent, there is an urgent need to develop noninvasive early detection methods. We believe that polarization speckle patterns, defined as a spatial distribution of depolarization ratio of traditional speckle patterns, can be an important tool for skin cancer detection. To demonstrate our technique, we conduct a large in vivo clinical study of 214 skin lesions, and show that statistical moments of the polarization speckle pattern could differentiate different types of skin lesions, including three common types of skin cancers, malignant melanoma, squamous cell carcinoma, basal cell carcinoma, and two benign lesions, melanocytic nevus and seborrheic keratoses. In particular, the fourth order moment achieves better or similar sensitivity and specificity than many well-known and accepted optical techniques used to differentiate melanoma and seborrheic keratosis.

Hyperhidrosis prevalence and demographical characteristics in dermatology outpatients in Shanghai and Vancouver

Background There is a wide variation in the reported prevalence of primary hyperhidrosis in the literature. Further, it is unknown if primary hyperhidrosis is a lifelong condition, or if demographical factors influence hyperhidrosis prevalence. Objectives This study aims to examine the prevalence of hyperhidrosis in multiple ethnic groups from two ethnically diverse cities and to determine if the prevalence of primary hyperhidrosis changes according to age, gender, ethnicity, body mass index, and geographical locations. Methods In total, 1010 consecutive subjects attending dermatology outpatient clinics in Shanghai Skin Disease Hospital and 1018 subjects in Skin Care Center of Vancouver General Hospital were invited to fill out a questionnaire on their presenting concerns, demographical information, and sweating symptoms. The subjects were then classified to have primary hyperhidrosis using the criteria of International Hyperhidrosis Society, late-onset hyperhidrosis, or no-hyperhidrosis. The prevalence of primary HH and late-onset HH was calculated for the entire study population and in subgroups stratified according to age of examination, sex, ethnicity, presenting diagnosis, body mass index, and specific study cities. Multivariate logistic regression analyses were performed to assess the impact of these factors on HH prevalence. Results The prevalence of primary hyperhidrosis is very similar in Shanghai and in Vancouver, at 14.5% and 12.3% respectively. In addition, 4.0% of subjects in Shanghai and 4.4% subjects in Vancouver suffer from late-onset HH. Primary HH has highest prevalence in those younger than 30 years of age, decreasing dramatically in later years. Caucasian subjects are at least 2.5 times more likely to develop axillary hyperhidrosis compared to Chinese subjects. Obesity does not have much influence on primary HH presentation, although it does increase significantly the development of late-onset HH. Finally, there is no major difference of hyperhidrosis between Chinese subjects in Shanghai and Vancouver. Limitations The data were gathered according to patients’ self-reports only and the sample size was relatively small in some groups after stratification for gender, ethnicity and age. Conclusion Prevalence of primary HH and late-onset HH is similar in dermatology outpatients independent of geographical locations. However, certain specific HH subtypes can show great variations according to ethnicity, age, body mass index and sex.

The Burden of Skin Disease in the United States and Canada

The burden of skin disease is a crucial indicator of the impact of skin disease in the general population. Despite many documented attempts in the literature to quantify independent parameters of skin disease burden, strides towards more comprehensive estimations have mainly arisen in the last decade. Utilizing the World Health Organization breakdown of disease burden, the literature was surveyed and summarized in respect to the classification, epidemiology, quality of life, and costs associated with skin disease.

Trends in Non-Melanoma Skin Cancer (Basal Cell Carcinoma and Squamous Cell Carcinoma) in Canada A Descriptive Analysis of Available Data

Background: Despite its increased incidence and status as the most prevalent cancer in Canada, there is a paucity of epidemiological data on non-melanoma skin cancer (NMSC). Objective: To assess trends of keratinocyte carcinomas (KC) in Canada over 5 decades. Methods: Articles published from 1960 to 2015 on NMSC in Canada were identified through MEDLINE. Six articles met our search criteria. Results: Overall, KC has increased. However, the rate of increase in the past decade has slowed down and decreased in younger age cohorts. Men had higher incidences of KC. In both sexes, the basal cell carcinoma and squamous cell carcinoma ratio was ≥2.5:1. Keratinocyte carcinomas were most commonly located on the head and neck, and increasing rates are occurring on the trunk. Limitations: The methods of registering skin cancer cases vary among different provinces. Conclusion: Keratinocyte carcinomas incidence is overall increasing; however, there may be evidence that the incidence is leveling off and decreasing in younger age cohorts.

Outdoor Workers' Use of Sun Protection at Work and Leisure

Background Outdoor workers are at risk of high ultraviolet radiation exposure, and may have difficulty using sun protection. The objectives were to determine the prevalence of sun protection behaviors in a sample of outdoor construction workers, and to assess which factors predict better sun protection practices. Methods Participants were recruited via construction unions. Workers answered a questionnaire on demographics, skin cancer risk, sun protection behaviors, and job. Sun protection behavior scores (from questions on sunscreen use, sleeved shirt, hat, shade seeking, sunglasses) were calculated by converting Likert-scale answers to scores from 0 to 4, and taking the mean (separately for work and leisure). Determinants of sun protection behavior scores were examined for work and leisure using generalized linear models. Results Seventy-seven workers had complete questionnaire data (participation 98%). Sun protection behaviors used most often were hats (79% often/always) and sleeved shirts (82% often/always); least prevalent were shade-seeking (8% often/always) and sunscreen (29% often/always). For both work and leisure scores, the strongest predictor was skin type, with fairer-skinned individuals having higher sun protection behavior scores. Workers had higher scores at work than on weekends. Workplaces that required hats and sleeved shirts for safety purposes had higher protection behavior scores. Conclusion This high-participation rate cohort helps characterize sun protection behaviors among outdoor workers. Workers practiced better sun protection at work than on weekends, suggesting that workplace policies supportive of sun protection could be useful for skin cancer prevention in the construction industry.

Assessment of the feasibility of using sunlight exposure to obtain the recommended level of vitamin D in Canada.

BACKGROUND Endogenous vitamin D synthesis can be affected by a number of variables, including skin colour, amount of skin exposed and levels of ultraviolet radiation. The objective of this study was to assess the feasibility of using only sunlight exposure in Canada to meet the daily recommended level of vitamin D, given differences in these variables and adherence to guidelines for sun protection. METHODS Ultraviolet index data for 13 Canadian sites were obtained from Environment Canada. The sun exposure times required to synthesize 1000 IU of vitamin D in fair- and dark-skinned people who exposed either 1/4 or 1/8 of their body surface area to the sun were calculated for each hour of the year. These times were then classified according to whether the ultraviolet index was 3 or more (when sun protection is advised) or less than 3. RESULTS During the fall and winter months and in the more northern sites, ultraviolet radiation levels were too low for all skin types to use sun exposure alone to obtain enough vitamin D within one time period. The required exposure time became longer when a smaller surface area was exposed. For people with darker skin, it can be difficult even in the summer to find opportunities outside of when sun protection is advised to use sunlight to obtain the recommended dose of vitamin D. INTERPRETATION Although sun exposure is an important source of vitamin D, Canadians should look to other safe sources to meet the bodys vitamin D requirements throughout the year.

Persistent polymorphous light eruption after ultraviolet A1 phototherapy

Polymorphous light eruption (PMLE) is the most common photodermatosis and is characterized by the development of a pruritic skin eruption within a few hours to days after sun or artificial light exposure. The eruption usually takes up to two weeks to resolve in the absence of further ultraviolet radiation. PMLE has been reported as a side effect of ultraviolet A1 (UVA1) therapy but characteristics of the eruption, especially the duration until resolution after treatment, has not been described. A 37‐year‐old female developed an unusually persistent PMLE that lasted for 5 weeks after completion of UVA1 phototherapy.

Using Raman Spectroscopy to Detect and Diagnose Skin Cancer In Vivo

Raman spectroscopy provides a noninvasive bedside tool that captures unique optical signals via molecular vibrations in tissue samples. Raman theory was discovered at the beginning of the twentieth century, but it was not until the past few decades that it has been used to differentiate skin neoplasms. We provide a brief description of Raman spectroscopy for in vivo skin cancer diagnosis, including the physical principles underlying Raman spectroscopy, its advantages, typical spectra of skin pathologies, and its clinical application for aiding skin cancer diagnosis.

Utilizing Electromagnetic Radiation for Hair Growth: A Critical Review of Phototrichogenesis

Hair loss has a high prevalence in the general population and can have significant medical and psychological sequelae. Pattern hair loss and alopecia areata represent the major reasons patients present to dermatologists in relation to hair loss. Because conventional treatment options are generally incompletely effective, novel methods for hair grown induction are being developed. The role of using electromagnetic radiation, including low-level laser therapy for the management of hair loss through phototrichogenesis, is reviewed in this article.