Dermatology News

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'Skin Protection in the Sunshine'

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From our Aesthetics nurse
At Dr Ashworth's private practice we have introduced a new aesthetics clinic in association with our expert nurse. The latest treatment and sure to be hitting the headlines soon is

'cleavage lips'.

Research has found that we find people more attractive when they have a slight dimple in the centre of the lower lip, this look can be achieved by introducing a small amount of dermal filler into specific regions in the lip.
To book an appointment with our aesthetic nurse for this or any aesthetic treatment, please visit our clinic page.

Mobile mole checker
A new service that we are piloting in the south Manchester and Cheshire areas.
If you have a new or changing mole, our mobile agent will visit you at your convenience to photograph your mole/moles using a Dermascope, a special camera lens used to magnify the mole. This shows the structure and colour not apparent to the naked eye. This picture is then emailed to our specialist, Consultant Dermatologist, Dr John Ashworth, for his expert opinion.
The report and any recommendations will be emailed or posted to you usually the next day, with a preferred time of 3 days.
The cost for one mole to be photographed is £30.00, and £10.00 per mole thereafter and the appointment should take no longer than 10 minutes.
If you would like to use this service please email mobilemolechecker@yahoo.co.uk

What does this mean? .organising a prescription when the patient is not physically present at a face to face consultation with the doctor - probably the commonest form is the ubiquitous "repeat prescription" from the GP - a national scandal costing the NHS billions - promoting unnecessary medical treatments and sometimes lifelong unnecessary drug therapies with all the hazards that entails.
Is this dangerous?  no, not with the correct precautions; questions about allergy; a common sense approach; etc etc - how often does your GP (or often a stand in or new GP) adequately pore back through your notes to check for any past interaction or problem - answer:  hardly ever because they just don't have the time.
What happens in other countries? you can walk into a chemist shop and simply buy medications with or often without an authorisation from a medical doctor - a typical example would be simple antibiotics?? - this is especially so for repeat and commonly prescribed items.
Why cant we do this in the UK? it is probably safer to discuss with a doctor - but have you tried recently to have a "discussion" with your GP about the rational for taking all the medications you are on and any possible interactions?? You must be joking !? - also in the UK we have a big brother attitude - doctors like to be in control - they don't like patients doing there own thing - and there is some rationale for this - another reason is economic - there is rationing and rationalisation of NHS drugs because the prescription charge does not cover the true cost.
Why is BOTOX a restricted prescription item? - because it is a poisonous chemical and should not be injected without due care and consideration - things can go wrong with BOTOX injections - but to be honest, only very very rarely and usually completely reversible and non-serious - the medical establishment probably has a slight downer on cosmetic treatments and there may be something of a witch hunt scenario here.
Are there other examples of 'cosmetic' drugs being restricted in terms of easy access? yes, the commonest in dermatology is Roaccutane a very good and extremely powerful acne treatment - your GP cannot prescribe this - only a hospital specialist and therefore there is restricted access because we are about 130 Consultant Dermatologists short in the UK - Roaccutane was initially (like all new drugs) a research only medication but is now mainstream but has never had the restriction lifted for no really valid reason - GPs commonly prescribe far more dangerous drugs with no restriction - perhaps 'cosmetic' and dermatological problems are a special case in the UK - perhaps we are not allowed to want to look good - a little like Austin Powers' in the Bond spoof movies ??
My Conclusion? In my opinion a satisfactory remote assessment is every bit as good as a rushed face to face assessment in many cases.

John Ashworth Consultant Dermatologist GMC 2488929.

Even common disorders can look very different in darker skinned patients compared with white skin patients. Dermatology is a voluntary subject in many Medical Schools – therefore many GP’s have had zero or close to zero training in Dermatology. Given these two compounding facts, it is hardly surprising that if you have pigmented skin and you attend your GP for a skin disorder you might get significantly short changed in terms of the expertise and opinion you receive. GP’s can refer on to experts Dermatologists and if you are worried you should ask for a referral or use the online consultation facility on this website for advice from myself. I will be producing a some helpful information on this subject over the next few days for any GP's who would like some direction, please request information via the contact page.

A small but very highly selected range of

skin care products

is now available only through this website.

Professor Kligman, a well respected research dermatologist in the USA, has developed treatment with a vitamin-A related product previously developed for its benefits in acne sufferers. The data relates to about forty patients and is said to show benefits in the treatment of cellulite. We have not yet seen the actual scientific paper which relates to this finding (so far all I have been able to find is general press information). This is a tremendously interesting area and if validated, will undoubtedly be of great interest. I will attempt to find out more about this and come back to you as soon as possible. Please revisit soon. Alternatively, if you have further information yourself please e-mail me (see home page).

April 2000: Brit Med Journal, London.

NHS Faces Possible Further Payouts.

NHS NEGLIGENCE BILL MAY SOAR In the British Medical Journal dated April 1st 2000, details are given of a court judgment last week ruling that certain claims should be increased by a third from their previous maximum. Most cases of birth damage with cerebral palsy may come under the ruling. The rulings do not necessarily indicate that lifetime living expenses for such patients will also increase but it seems likely that these awards will follow suit. Something else interesting is tied in with this problem. It would appear that the payments received by patients receiving such awards are related to the likely investment income return on their award and thereby the ability of the award to care for that patient throughout their expected life span. It would appear that the returns from investment income are considered to be dropping and therefore an award expected to care for a patient throughout their life might need to substantially increase. Major increases in payments like this will have a significant impact on NHS resources.

April 2000: Brit Med Journal, London.

Cancer Figures Improve

A recent article from the British Medical Journal dated April 1st 2000 has studied the number of deaths from all cancers occurring within five years of diagnosis in England and Wales. The periods 1981-1985 were compared with 1986-1990 [Comment: the term "five year survival" is commonly used in medicine and refers to the percentage number of patients diagnosed with cancer surviving for the following five years. It is for this reason that by convention we often refer to five year figures and that explains why they have been studied like this here]. The results showed that 1.5 million adults were diagnosed with 47 different cancers during these periods of time. There was a reduction of cancer deaths in 1986-1990 compared with the previous five years and the total number of reduced deaths was 17,041 which represents a figure of 3.3%. The vast majority of these reductions were achieved in just 5 out of the 47 different types of cancer and these 5 cancers were - female breast cancer, cancer of the colon, cancer of the rectum, cancer of the bladder and MELANOMA OF THE SKIN. The largest proportionate increase in improvement was in MELANOMA (link skin cancer info). Unfortunately there were very little improvements in other common cancers like lung, prostate and stomach, which remain a major problem.

July 25 1999: Sunday Times, London.

Stem Cell ResearchGrows New Nose.

Stem cells are cells cultured from a fertilised embryo within 7 days of fertilisation. These cells are capable of dividing into any cell type in the body depending upon how they are stimulated. In theory these cells can be used to produce literally any kind of body tissue. Maybe even whole organs can be produced which might be manipulated in such a way that transplantation without tissue rejection seems a possibility. In the view of some people this is potentially the greatest step in medical science. In other people's eyes this is fiddling where humans were not meant to fiddle - firstly living human tissue (the fertilised foetus) is being manipulated and many will be destroyed - secondly are these advances really going to improve the global state of mankind and his illnesses or is this technology simply going to provide a few rich countries with the potential for unlimited hair transplantation, bigger breasts, larger genitals, etc.

Additional Comments:

A rather morbid picture of a new "nose" is shown. This was grown on a matrix of artificial fibres but the living tissue is human tissue. My own view of this research is that growing tissue has never been a problem for scientists - the problem for medicine has always been stopping tissue (e.g. cancerous tissue) from further growth. Until we are able to stop unwanted tissue growth this type of area is fraught with danger. In addition there is the question of foetal manipulation and destruction.

Acta Dermato-venereologica (A major medical skin science journal from Stockholm, Sweden).

Basal Cell Carcinoma (Rodent Ulcer) New Non-Surgical Treatment Success Long Term Follow Up.

In the Swedish Journal Acta Dermato Venereologica 119 patient with rodent ulcers (basal cell carcinomas, BCCs) were treated with PHOTO DYNAMIC THERAPY (PDT). This treatment consists of the application of a cream to the tumor for about 2 hours and then a powerful beam of light is shone on the surface. The tumor cells take up chemicals from the cream and the chemicals are activated by the light so that they destroy the cells. Usually there is no surgery involved but a number of patients have the surface of the tumor shaved away first to assist penetration of the cream. After 1 year follow up over 90% had a good outcome and many had no sign of recurrence.

Additional Comments:

This is great news for rodent ulcer (BCC) sufferers especially those with multiple small lesions where repeated surgery would be very troublesome. If this type of treatment can be further refined the benefits should be huge.

from the LANCET, London

CHEMICAL IN CHINESE HERBAL MEDICINE LINKED TO SERIOUS KIDNEY FAILURE

Two patients have been reported in whom severe renal failure (necessitating dialysis) has occurred following the use of Chinese herbal medicine in the treatment of skin disease. This trouble has been previously reported in Belgian patients about 3 years ago.
COMMENT: herbal and other "natural" remedies are not without their own problems. Any medication taken internally should be supervised by medical doctor.

In a journal called Dermatology (the official journal of the Swiss and Belgian Dermatology Societies) there is a study of vitiligo written from India. 1000 patients were treated with mini-punch skin grafts where small pieces of normal skin are transplanted onto the vitiligo skin (i.e. the skin where there is no pigmentation). The theory is that the pigment cells (melanocytes) in the normal skin will spread their pigment outward into the surrounding skin affected by vitiligo. Approximately 69% of treatments achieved over 90% repigmentation in the affected sites. Unfortunately there were a lot of side effects including abnormal elevation of the skin grafts at the transplant sites (33%), an exaggerated polka dotted appearance at the treated sites (44%), uneven pigmentation (24%), etc.

COMMENT: This incidence of side effects unfortunately very much reduces the impact that this kind of treatment is likely to make upon vitiligo sufferers. Perhaps with further refinement, melanocyte transplantation in one form or another will eventually give good results but I think this type of work still needs much more research.

Archives of Dermatology 1999; 135: 574-580, edited Boston, USA.

Tacrolimus is a drug which suppresses the immune system and therefore in theory should be helpful for a wide variety of skin diseases (psoriasis, eczema, etc.). Tacrolimus is used in the prevention of organ graft rejection. This is a similar history to Cyclosporin which also started its medical life as an organ-rejection suppresser but later was found to be very helpful in skin disease. Hopefully Tacrolimus will prove to be equally helpful in some patients. The types of condition reviewed in this article are psoriasis, Behcet's disease, pyoderma gangrenosum (all three of these were treated by systemic administration). Atopic dermatitis and alopecia areata have been treated by skin surface applications with some suggestion of success.

COMMENT: It is early days as yet with respect to the skin development of this drug but the future looks very promising.

Archives of Dermatology 1999; 135: 391-397

COMPARISONS OF ERBIUM AND CARBON DIOXIDE LASERS IN WRINKLE TREATMENT

Twenty-one patients were treated for wrinkles around the eyes with Erbium laser to one side of the face and carbon dioxide laser to the other side. Both systems were effective. The carbon dioxide laser tended to be slightly more effective but this could be counteracted by treating more intensively with the Erbium laser. The overall outcomes were very similar for both systems.

COMMENT: The more established carbon dioxide laser system tends to be slightly more powerful and therefore if it is passed over the skin less often it should be able to achieve the same gentle results that the Erbium laser achieves. Conversely, if the Erbium laser is passed over the skin more often then it should be able to achieve the same results as the carbon dioxide laser. There does not seem to be a great deal to choose between the two systems.

Sunday Times, London August 8th 1999

London doctors try to produce cancer-free children.

Research at University College Hospital, London, is attempting to screen in-vitro fertilised embryos for a variety of genetic disorders. Two cells are removed from the embryo (which at this early stage comprises less than 20 cells total) and the doctors predict the outcome of the "pregnancy". The theoretical aim appears to be reduction in the likelihood of inherited cancer syndromes. The practicalities presumably mean that only embryos which are screen "negative" will be implanted and other embryos will be destroyed. The article does not give statistical information about how accurate the predictive value of these tests are.

COMMENT: This type of research should eventually be able to allow parents to screen embryos for the likely (not definite) development of some hereditary cancerous processes. One of the disorders mentioned in the article - neurofibromatosis - in fact only leads to cancerous developments in a relatively small number of sufferers. Most sufferers have much less serious trouble and many sufferers live their entire lives unaware that they have anything the matter with them. This type of technique moves us still closer to the day where selectivity will be available regarding a variety of genetic outcomes in our "children".

A significant step has been taken along the line of transplantation of animal organs into humans. Cloned piglets with a specific gene inactivation for alpha-1:3 galactosyltransferase are seen as a significant step forward. This particular gene inactivation prevents pig cells producing a specific sugar group which is readily recognised by the human immune system as foreign thereby triggering a rejection response. It is thought that about 180,000 people around the world require organ transplantation but only about 1:3 of them will ever actually receive an organ because of the wide divergence between supply and demand. Various corporations are interested in the concept of xenographs (which means transplantation from one animal species to another) to satisfy this demand. It is thought that this ability to clone piglets will prove to be a small but significant step forward along this road.