Download Chemical - Cleveland Clinic

410851Clinic_dv
5/27/04
9:45 PM
Page 1
Help For “Turkey Necks” And “Double Chins”
“Psoriasis Update”
continued from page 1
ACHIEVE A MORE YOUTHFUL LOOK WITH LIPOSUCTION
CLEVELAND CLINIC
I
f you’re bothered by sagging jowls
or a double chin, and not quite
ready for — or interested in —
a full facelift, consider the advantages
of liposuction. Advances in cosmetic
surgery allow Cleveland Clinic dermatologic surgeons to reshape the neck
and lower face to achieve a more
youthful appearance.
Called tumescent liposuction,
the procedure is a safe and effective
approach to removing excess fat from
the chin and neck, say Cleveland
Clinic dermatologic surgeons Teri
McGillis, M.D., and Rebecca Tung,
M.D. “Both the treatment time and
recovery are quick, and patients report
excellent results,” says Dr. McGillis.
CALLED TUMESCENT
LIPOSUCTION, THE
PROCEDURE IS A SAFE
AND EFFECTIVE
APPROACH TO
REMOVING EXCESS
FAT FROM THE CHIN
AND NECK
Ideal candidates must have good
skin and muscle tone, and be in good
overall physical health. During the initial consultation, a thorough medical
history will be taken and a physical
examination will be performed.
At The Cleveland Clinic, boardcertified surgeons in both the
Rebecca Tung,
M.D.
Teri McGillis,
M.D.
Dermatology and Plastic Surgery
departments are trained in and
routinely perform liposuction.
Generally, Clinic plastic surgeons treat
more complex cases using general
anesthesia, and the dermatologic
surgeons treat patients using the
tumescent technique.
The tumescent technique involves
injecting a dilute solution of local anesthesia to the area of excess fat. “The
anesthetic solution not only aids in
breaking up fat deposits, but it also
helps minimize trauma to surrounding
tissue, and reduces post-operative
swelling and pain,” reports Dr. Tung.
The procedure is performed using
a suction pump attached to a small
stainless steel instrument called a
cannula. The cannula is inserted into
fatty areas between skin and muscle
through a small incision, typically in
the crease under the chin. The cannula
removes localized accumulations of
fat, resulting in an improved contour.
According to a study published
in Dermatologic Surgery in December
2002, liposuction using the tumescent
liposuction technique is safe — particularly when performed in an office
setting by an experienced, board-certified physician. Tumescent liposuction
is performed using only local anesthesia. No sedative or general anesthesia
is used, which helps speed recovery
and reduce the risks of surgery.
Order Your Free Video
“Medical Miracles: New Frontiers in Research”
recently aired on WKYC TV 3. Among other things,
viewers learned how researchers are using knowledge
about bone loss in space to manage osteoporosis, and
how a new drug helps patients with macular degeneration to see again. Viewers witnessed the latest in
stem cell research, and saw how researchers are
working to both improve kidney dialysis and avoid
kidney failure. For a free copy of the video, call
216/444-8919 or 800/545-7718.
The procedure takes about 11⁄2
hours, and patients are able to return
home within an hour after the procedure. Patients wear a supportive chin
strap for several days and can resume
social activities or work immediately
thereafter.
To schedule a consultation at the
Cleveland Clinic’s main campus, call
216/444-5724 or 800/223-2273,
ext. 45724. For an appointment at the
Beachwood Family Health Center, call
216/839-3870.
flu, but the reactions diminished over time.
Treatment with Raptiva, which is in the form
of a weekly injection, must continue indefinitely to maintain improvement. Patients can
learn to administer Raptiva at home.
ENBREL (etanercept), a drug approved
to treat rheumatoid arthritis, juvenile
rheumatoid arthritis, psoriatic arthritis and
ankylosing spondylitis, may be an effective
treatment for moderate to severe plaque psoriasis, for which it was just FDA-approved.
Roughly 1 million of the 7 million people in
the United States with psoriasis have moderate to severe plague psoriasis. People with
psoriatic arthritis achieved considerable relief
from symptoms of the disease, as well as
significant reduction of skin psoriasis.
Treatment is self-injection.
Enbrel works by inhibiting the action
of a cytokine called tumor necrosis factor
(TNF) alpha, which is overproduced in the
fluid responsible for lubricating the joints
(synovial fluid) and skin of people with
psoriasis and psoriatic arthritis.
TNF-alpha promotes inflammation,
which leads to painful damage of the joints
and connective tissue, as well as contributes
to development of lesions on the skin. When
Enbrel binds to TNF, the latter becomes
biologically inactive, reducing inflammation.
Skin Smart / W14
9500 Euclid Avenue, Cleveland, OH 44195
REMICADE (infliximab), a drug
already approved to treat rheumatoid
arthritis and Crohn’s disease (a type of
inflammatory bowel disease), has shown
promise in treating patients with psoriasis.
In a clinical study, Remicade improved
symptoms in 88 percent of patients receiving the highest dose of the drug. Remicade
is an antibody used to block the protein
that causes inflammation. Remicade is in
Phase III clinical trials
HUMIRA (adalimumab), another
tumor necrosis factor inhibitor, also is
being tested in clinical trials for treating
psoriasis and psoriatic arthritis. Humira
has already been FDA-approved for treating moderate to severe active rheumatoid
arthritis. The current clinical trial is a
randomized, multicenter, Phase II trial to
assess safety and efficacy in adult patients
with moderate to severe chronic-plaque
psoriasis.
If you suffer from psoriasis and traditional therapies haven’t worked well for
you, call your dermatologist to discuss the
possibility of using biologic therapies. For
an appointment, call 216/444-5725 or
800/223-2273, ext. 45725.
MAIN LOCATION .....216/444-5725
Cleveland Clinic Family Health Centers
offer dermatology services close to home.
Beachwood ...........216/839-3870
Chagrin Falls ........440/247-4404
Elyria.....................440/366-8822
Independence........216/986-4000
Strongsville ...........440/878-2500
Willoughby Hills...440/943-2500
Wooster .................330/287-4960
Visit our Web site at
www.clevelandclinic.org/dermatology
skInsmArt
Psoriasis Update:
New Drugs Bring New Hope
A
Summer 2004
Skin Smart is published by the Division of
Marketing to provide up-to-date information about
The Cleveland Clinic Foundation and its programs
and services. The information contained in Skin
Smart is for educational purposes only and should
not be relied upon as medical advice. It has not
been designed to replace a physician’s medical
assessment and medical judgment.
Editor: Laura Malee Greenwald
Art Director: Doug Crouch
Jonelle
McDonnell, M.D.
ccording to the American Academy of Dermatology, more than 7 million
people in the United States have psoriasis, with an estimated 150,000
new cases appearing annually. Several new medications to treat psoriasis
are on the market, waiting for FDA approval or in clinical trials. All are biologic
therapies, which halt the activity
of T-cells, a type of white
blood cell. T-cells trigger
immune responses,
and, when mistakenly
activated, they can
stimulate the development of symptoms
associated with any
number of autoimmune
disorders, like psoriasis
and psoriatic arthritis.
According to Cleveland
Clinic dermatologist Jonelle
McDonnell, M.D., biologic
therapies are the “latest and greatest.”
Biologic therapies are very specific and target the underlying problem causing
psoriasis, rather than suppressing other immune functions that are unrelated
to the disease. Also, biologic therapies tend to be well tolerated by patients and
are convenient.
AMEVIVE (alefacept) is a new treatment option for adults with moderate to
severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy. It is the first biologic drug to be approved by the FDA for the treatment
of adults with moderate to severe plaque psoriasis. Amevive is given through
injection by your health care professional once a week for 12 weeks. Results can
improve after a second course of treatment.
RAPTIVA (efalizumab), like Amevive, works by blocking T-cells that cause the
development and maintenance of psoriasis plaques. FDA approval was received in
October 2003. The drug offers continuous control of chronic moderate to severe
psoriasis. In clinical trials prior to FDA approval, between 18 percent and 37 percent of patients experienced at least a 75 percent reduction in symptoms after 12
weeks of treatment. Adverse reactions were mild to moderate and similar to the
continued on back cover
410851Clinic_dv
5/27/04
9:45 PM
Page 2
Managing Serious Acne With Accutane
Rejuvenate Your Skin, Quickly and Safely
Schedule a Skin Cancer Screening Today
MAY IS NATIONAL MELANOMA / SKIN CANCER DETECTION AND PREVENTION MONTH
F
or most people, dealing with a
blackhead here or a whitehead
there is manageable. But when
acne is severe, it can leave many scars
– physical, social and psychological.
The good news is that severe acne can
be managed successfully with Accutane.
Divya
Singh-Behl, M.D.
Accutane (isotretinoin) has revolutionized the treatment of acne in the
last 25 years, says Cleveland Clinic
dermatologist Divya Singh-Behl, M.D.
“Accutane is a synthetic retinoid and
belongs to the vitamin A family of
molecules. It is a potent drug and
should be reserved for treatment of
severe nodulocystic acne or acne that
is resistant to conventional therapy.”
A number of side effects are
associated with Accutane; most serious
is its potential to cause severe birth
defects in pregnant women receiving
therapy. “Accutane should not be used
in women trying to conceive, or who
are pregnant or nursing,” cautions
Dr. Singh-Behl.
!
A
In 1998, the U.S. FDA issued a warning regarding a possible increased risk
of depression and suicidal thoughts associated with Accutane use. However,
there has been no conclusive evidence to support that theory.
The most common side effect of Accutane is dryness of the skin and
mucosal membranes (mouth, lips, eyes). Other less common side effects include
headaches, thinning hair, changes in blood profile, muscle aches, nausea and
vomiting. For most patients, side effects are tolerable and are not a reason to
discontinue therapy.
Typically a patient is on a course for an average of five to six months.
Regularly scheduled follow-ups with a physician to monitor side effects are
needed while on Accutane. Baseline and repeat blood work, enzyme-profile testing, and pregnancy testing in women should be performed. It is imperative that
women of childbearing potential follow the pregnancy-prevention guidelines
while on therapy and for at least one month after discontinuation, adds Dr.
Singh-Behl.
After a course of Accutane, no long-term adverse effects have been noted
in fetal development. To date, no effects on male fertility have been noted.
“Accutane is the most effective drug available for treating acne, achieving
greater than 95 percent clearing of nodulocystic acne, as well as long-term clearing,” notes Dr. Singh-Behl. “Although side effects may be noted during therapy,
they are reversible once treatment is discontinued.”
For an appointment at the Clinic’s main campus, call 216/444-5725 or
800/223-2273, ext. 45725. For an appointment at the Beachwood Family
Health Center, call 216/839-3870.
Accutane: Safety First
All users, prescribers and dispensers of Accutane must now
enroll in a national registry to help prevent pregnancy among women
using this powerful acne drug. Accutane can cause severe birth
defects if a woman using the drug becomes pregnant. Through the
registry, women can only get their monthly supply of Accutane by
having a negative pregnancy test. They also are instructed to use
two forms of contraception while taking Accutane. Cleveland Clinic
dermatologist Wilma Bergfeld, M.D., served on the advisory panel
that made the recommendations to the U.S. FDA.
re fine lines or minor blemishes
troubling you? If so, a simple
outpatient procedure can deliver
smoother, healthier-looking skin in less than
an hour.
Called microdermabrasion, the procedure is a noninvasive way to safely and
effectively treat superficial sun damage and
skin irregularities, such as fine lines, blotchy
patches and minor blemishes.
“Microdermabrasion works well on age
spots, small scars and uneven pigmentation,”
explains James Sherer, P.A., a physician assistant with the Cleveland Clinic’s Department
of Dermatology. “It also can help thicken
collagen, which is important in maintaining
youthful-looking skin.”
The procedure involves the use of a fine
crystal spray, which gently removes the very
top layer of skin, comprised mostly of dead
skin cells. The result is skin that is rejuvenated and refreshed.
Microdermabrasion works best on
younger skin and is not recommended for
moderate or deep wrinkles or significant
facial aging or sun damage, explains Mr.
Sherer. For severe wrinkles and acne scars,
he recommends a chemical peel or laser
treatment.
A typical microdermabrasion on facial
skin takes between 20 and 30 minutes. If the
neck and upper chest area are included, the
treatment may take up to an hour. “For best
results, most patients need about four to
eight treatments, roughly two weeks apart,”
says Mr. Sherer.
Side effects are minimal. Some patients,
particularly those who are fair-skinned, experience slight redness that usually disappears
after about an hour. There is no recovery
time, and patients immediately can return
to their activities.
If you’re interested in microdermabrasion, schedule an appointment with our
dermatology office. One of our dermatologists or skin care specialists will work with
you to determine a specific plan based on
your skin type, condition and expectations.
For an appointment at the Clinic’s main
campus, call 216/444-5724 or 800/223-2273,
ext. 45724. For an appointment at the
Beachwood Family Health Center, call
216/839-3870.
T
HOW ALDARA WORKS
The cream works by stimulating the
body’s own immune system to fight off skin
cancer. According to the cream’s manufacturer, 3M Pharmaceuticals, the majority
of patients treated with Aldara achieved
Clinic’s Dermatology Department for a
skin cancer screening. For most people, a professional screening should be
performed yearly.
Dermatologists at The Cleveland
Clinic will inspect your skin and may
monitor suspicious growths, moles or
sores over time using photographs. A
photographic record is a reliable way
to scrutinize changes in your skin.
For an appointment, call
216/444-5725 or 800/223-2273,
ext. 45725.
Additionally, very few patients reported pain
with using the cream.
AKs can also be treated with surgery,
photodynamic therapy, cryotherapy (freezing
using liquid nitrogen) or topical chemotherapy applied directly to the lesion. Chemical
peels and superficial laser ablation also have been used to
treat lesions.
THE BEST DEFENSE
AGAINST AKS —AND SKIN
WHO GETS AKS
Because AKs are caused
by
excessive
sun exposure, they
CANCER IN GENERAL IS
most commonly are found among
LIMITING SUN EXPOSURE
people who spend or have spent
a good deal of time outdoors.
People with fair complexions
75 percent or more clearance of AK
are at a higher risk.
lesions and nearly half experienced comOf course, the best defense against
plete clearance in clinical trials.
AKs—and skin cancer in general—is limiting
The most frequently reported side
sun exposure.
effects were local skin reactions, like flakFor more information or an appointing, dryness, scabbing, swelling, and
ment, call 216/444-5725 or 800/223-2273,
itching or burning at the application site.
ext. 45725.
Only 2 percent of patients stopped using
the cream due to adverse skin reactions.
—
.
Quick Facts
ABOUT MELANOMA
■
■
■
■
Protect YOUR SKIN!
A
New Treatment For Precancerous Skin Lesions
he latest treatment for the most
common pre-cancerous skin lesions,
known as actinic keratoses, is
Aldara (imiquimod) cream (5%). This topical
prescription cream is the first immune
response modifier to be approved
by the U.S. FDA for the
treatment of actinic keratosis in adults.
Caused by excessive exposure to the
sun, actinic keratoses
(AKs) are red, scaly
patches found most
often on the face and
scalp. If left untreated,
5 percent to 15 percent of AKs
will develop into squamous cell carcinomas.
Because this type of skin cancer poses a definite risk of spreading to other areas of the
body, including lymph nodes, it is important
to identify and treat AKs early.
N
early half of all new cancers
are skin cancers, according to
the American Academy of
Dermatology. But you can prevent skin
cancer by avoiding the No. 1 culprit:
sun exposure. (See below for tips.)
While that’s sometimes easier
said than done, consider the value of
routine skin cancer screenings: Early
detection of skin cancer is crucial
to cure.
At home, try to regularly inspect
your body for any skin changes. You
also can make an appointment at the
voiding sun exposure doesn’t mean you have to stay indoors
while the sun is shining. The tips below will help you enjoy the
beautiful outdoors while keeping your skin safe from harmful
UVA and UVB rays.
■ Use a sunscreen with a Sun Protective Factor (SPF) of 15 or
higher—30 or 45. “Broad spectrum” sunscreen will block both UVA
and UVB radiation. Look for ingredients such as titanium dioxide,
parsol, zinc oxide or Z-Cote on the label; these products block the
most UV light.
■ Wear a wide-brimmed hat to shade the face, neck and ears. Avoid
straw hats, which offer no protection.
■ Make sure your sunglasses have a UVA/UVB coating; this will help
prevent retinal melanomas.
■ Consider wearing specially formulated sun-protective gear. Sun
Precautions (sunprecautions.com or 800/882-7860) and Sunday
Afternoons (sundayafternoons.com or 888/874-2642) offer sunprotective clothing, hats, swimwear and more.
■ Try Rit Sun Guard Laundry Treatment UV Protectant. Added
to your regular wash, it coats your clothing with SPF 30 sun
protectant that will last through 20 additional washings.
■
■
■
Malignant melanoma is a skin cancer that arises
from the skin’s pigment cells called melanocytes.
The incidence of skin cancer in the United States
is on the rise, and the number of new cases of
melanoma—the deadliest form of skin cancer—
has more than doubled in the past 20 years.
Melanoma appears as a pre-existing mole that
changes, or as a new mole on clear skin. Keep in
mind that not all moles are in plain sight. For
example, moles can form in the mucous membranes of the mouth.
More than 80 percent of skin cancer deaths are
from melanoma.
When melanoma is detected at its earliest stage, it
is highly curable.
Proper sun protection and skin self-examinations
are crucial for the prevention and early detection
of melanoma.
Risk factors for melanoma include a personal
history of many moles (more than 25); large
moles (larger than 6 mm or the size of a pencil
eraser); atypical or unusual looking moles; fair
skin; light eye or hair color; family history of
melanoma; intense sun exposure with blistering
sunburns as a child or adult; tanning salon
usage; and sun sensitivity.
Know your skin, and be familiar with your moles,
birthmarks and other marks. Look for any new
or unusual changes in your skin. Finally, use the
ABCDs of melanoma (below) as a guide when
checking your skin. If you have a mole or a growth
that is suspicious, have it evaluated by a dermatologist without delay!
A
B
C
D
symmetry - The shape of one half doesn’t
match the other.
order - Edges that are ragged and blurred.
MELANOMA CLINIC
If you have or suspect you have melanoma, you can access specialty
care at the Cleveland Clinic Cancer Center’s Melanoma Clinic. Your physician can refer you to the Melanoma Clinic, or you can call 216/444-7923
or 800/862-7798 for an appointment.
olor - Uneven shades of brown, black,
tan, and sometimes patches of red,
blue, or white.
iameter - The width is greater than onequarter inch (size of a pencil eraser, though
some melanomas may be smaller).
For a free fact sheet on melanoma, call 216/4448919 or 800/545-7718.
410851Clinic_dv
5/27/04
9:45 PM
Page 2
Managing Serious Acne With Accutane
Rejuvenate Your Skin, Quickly and Safely
Schedule a Skin Cancer Screening Today
MAY IS NATIONAL MELANOMA / SKIN CANCER DETECTION AND PREVENTION MONTH
F
or most people, dealing with a
blackhead here or a whitehead
there is manageable. But when
acne is severe, it can leave many scars
– physical, social and psychological.
The good news is that severe acne can
be managed successfully with Accutane.
Divya
Singh-Behl, M.D.
Accutane (isotretinoin) has revolutionized the treatment of acne in the
last 25 years, says Cleveland Clinic
dermatologist Divya Singh-Behl, M.D.
“Accutane is a synthetic retinoid and
belongs to the vitamin A family of
molecules. It is a potent drug and
should be reserved for treatment of
severe nodulocystic acne or acne that
is resistant to conventional therapy.”
A number of side effects are
associated with Accutane; most serious
is its potential to cause severe birth
defects in pregnant women receiving
therapy. “Accutane should not be used
in women trying to conceive, or who
are pregnant or nursing,” cautions
Dr. Singh-Behl.
!
A
In 1998, the U.S. FDA issued a warning regarding a possible increased risk
of depression and suicidal thoughts associated with Accutane use. However,
there has been no conclusive evidence to support that theory.
The most common side effect of Accutane is dryness of the skin and
mucosal membranes (mouth, lips, eyes). Other less common side effects include
headaches, thinning hair, changes in blood profile, muscle aches, nausea and
vomiting. For most patients, side effects are tolerable and are not a reason to
discontinue therapy.
Typically a patient is on a course for an average of five to six months.
Regularly scheduled follow-ups with a physician to monitor side effects are
needed while on Accutane. Baseline and repeat blood work, enzyme-profile testing, and pregnancy testing in women should be performed. It is imperative that
women of childbearing potential follow the pregnancy-prevention guidelines
while on therapy and for at least one month after discontinuation, adds Dr.
Singh-Behl.
After a course of Accutane, no long-term adverse effects have been noted
in fetal development. To date, no effects on male fertility have been noted.
“Accutane is the most effective drug available for treating acne, achieving
greater than 95 percent clearing of nodulocystic acne, as well as long-term clearing,” notes Dr. Singh-Behl. “Although side effects may be noted during therapy,
they are reversible once treatment is discontinued.”
For an appointment at the Clinic’s main campus, call 216/444-5725 or
800/223-2273, ext. 45725. For an appointment at the Beachwood Family
Health Center, call 216/839-3870.
Accutane: Safety First
All users, prescribers and dispensers of Accutane must now
enroll in a national registry to help prevent pregnancy among women
using this powerful acne drug. Accutane can cause severe birth
defects if a woman using the drug becomes pregnant. Through the
registry, women can only get their monthly supply of Accutane by
having a negative pregnancy test. They also are instructed to use
two forms of contraception while taking Accutane. Cleveland Clinic
dermatologist Wilma Bergfeld, M.D., served on the advisory panel
that made the recommendations to the U.S. FDA.
re fine lines or minor blemishes
troubling you? If so, a simple
outpatient procedure can deliver
smoother, healthier-looking skin in less than
an hour.
Called microdermabrasion, the procedure is a noninvasive way to safely and
effectively treat superficial sun damage and
skin irregularities, such as fine lines, blotchy
patches and minor blemishes.
“Microdermabrasion works well on age
spots, small scars and uneven pigmentation,”
explains James Sherer, P.A., a physician assistant with the Cleveland Clinic’s Department
of Dermatology. “It also can help thicken
collagen, which is important in maintaining
youthful-looking skin.”
The procedure involves the use of a fine
crystal spray, which gently removes the very
top layer of skin, comprised mostly of dead
skin cells. The result is skin that is rejuvenated and refreshed.
Microdermabrasion works best on
younger skin and is not recommended for
moderate or deep wrinkles or significant
facial aging or sun damage, explains Mr.
Sherer. For severe wrinkles and acne scars,
he recommends a chemical peel or laser
treatment.
A typical microdermabrasion on facial
skin takes between 20 and 30 minutes. If the
neck and upper chest area are included, the
treatment may take up to an hour. “For best
results, most patients need about four to
eight treatments, roughly two weeks apart,”
says Mr. Sherer.
Side effects are minimal. Some patients,
particularly those who are fair-skinned, experience slight redness that usually disappears
after about an hour. There is no recovery
time, and patients immediately can return
to their activities.
If you’re interested in microdermabrasion, schedule an appointment with our
dermatology office. One of our dermatologists or skin care specialists will work with
you to determine a specific plan based on
your skin type, condition and expectations.
For an appointment at the Clinic’s main
campus, call 216/444-5724 or 800/223-2273,
ext. 45724. For an appointment at the
Beachwood Family Health Center, call
216/839-3870.
T
HOW ALDARA WORKS
The cream works by stimulating the
body’s own immune system to fight off skin
cancer. According to the cream’s manufacturer, 3M Pharmaceuticals, the majority
of patients treated with Aldara achieved
Clinic’s Dermatology Department for a
skin cancer screening. For most people, a professional screening should be
performed yearly.
Dermatologists at The Cleveland
Clinic will inspect your skin and may
monitor suspicious growths, moles or
sores over time using photographs. A
photographic record is a reliable way
to scrutinize changes in your skin.
For an appointment, call
216/444-5725 or 800/223-2273,
ext. 45725.
Additionally, very few patients reported pain
with using the cream.
AKs can also be treated with surgery,
photodynamic therapy, cryotherapy (freezing
using liquid nitrogen) or topical chemotherapy applied directly to the lesion. Chemical
peels and superficial laser ablation also have been used to
treat lesions.
THE BEST DEFENSE
AGAINST AKS —AND SKIN
WHO GETS AKS
Because AKs are caused
by
excessive
sun exposure, they
CANCER IN GENERAL IS
most commonly are found among
LIMITING SUN EXPOSURE
people who spend or have spent
a good deal of time outdoors.
People with fair complexions
75 percent or more clearance of AK
are at a higher risk.
lesions and nearly half experienced comOf course, the best defense against
plete clearance in clinical trials.
AKs—and skin cancer in general—is limiting
The most frequently reported side
sun exposure.
effects were local skin reactions, like flakFor more information or an appointing, dryness, scabbing, swelling, and
ment, call 216/444-5725 or 800/223-2273,
itching or burning at the application site.
ext. 45725.
Only 2 percent of patients stopped using
the cream due to adverse skin reactions.
—
.
Quick Facts
ABOUT MELANOMA
■
■
■
■
Protect YOUR SKIN!
A
New Treatment For Precancerous Skin Lesions
he latest treatment for the most
common pre-cancerous skin lesions,
known as actinic keratoses, is
Aldara (imiquimod) cream (5%). This topical
prescription cream is the first immune
response modifier to be approved
by the U.S. FDA for the
treatment of actinic keratosis in adults.
Caused by excessive exposure to the
sun, actinic keratoses
(AKs) are red, scaly
patches found most
often on the face and
scalp. If left untreated,
5 percent to 15 percent of AKs
will develop into squamous cell carcinomas.
Because this type of skin cancer poses a definite risk of spreading to other areas of the
body, including lymph nodes, it is important
to identify and treat AKs early.
N
early half of all new cancers
are skin cancers, according to
the American Academy of
Dermatology. But you can prevent skin
cancer by avoiding the No. 1 culprit:
sun exposure. (See below for tips.)
While that’s sometimes easier
said than done, consider the value of
routine skin cancer screenings: Early
detection of skin cancer is crucial
to cure.
At home, try to regularly inspect
your body for any skin changes. You
also can make an appointment at the
voiding sun exposure doesn’t mean you have to stay indoors
while the sun is shining. The tips below will help you enjoy the
beautiful outdoors while keeping your skin safe from harmful
UVA and UVB rays.
■ Use a sunscreen with a Sun Protective Factor (SPF) of 15 or
higher—30 or 45. “Broad spectrum” sunscreen will block both UVA
and UVB radiation. Look for ingredients such as titanium dioxide,
parsol, zinc oxide or Z-Cote on the label; these products block the
most UV light.
■ Wear a wide-brimmed hat to shade the face, neck and ears. Avoid
straw hats, which offer no protection.
■ Make sure your sunglasses have a UVA/UVB coating; this will help
prevent retinal melanomas.
■ Consider wearing specially formulated sun-protective gear. Sun
Precautions (sunprecautions.com or 800/882-7860) and Sunday
Afternoons (sundayafternoons.com or 888/874-2642) offer sunprotective clothing, hats, swimwear and more.
■ Try Rit Sun Guard Laundry Treatment UV Protectant. Added
to your regular wash, it coats your clothing with SPF 30 sun
protectant that will last through 20 additional washings.
■
■
■
Malignant melanoma is a skin cancer that arises
from the skin’s pigment cells called melanocytes.
The incidence of skin cancer in the United States
is on the rise, and the number of new cases of
melanoma—the deadliest form of skin cancer—
has more than doubled in the past 20 years.
Melanoma appears as a pre-existing mole that
changes, or as a new mole on clear skin. Keep in
mind that not all moles are in plain sight. For
example, moles can form in the mucous membranes of the mouth.
More than 80 percent of skin cancer deaths are
from melanoma.
When melanoma is detected at its earliest stage, it
is highly curable.
Proper sun protection and skin self-examinations
are crucial for the prevention and early detection
of melanoma.
Risk factors for melanoma include a personal
history of many moles (more than 25); large
moles (larger than 6 mm or the size of a pencil
eraser); atypical or unusual looking moles; fair
skin; light eye or hair color; family history of
melanoma; intense sun exposure with blistering
sunburns as a child or adult; tanning salon
usage; and sun sensitivity.
Know your skin, and be familiar with your moles,
birthmarks and other marks. Look for any new
or unusual changes in your skin. Finally, use the
ABCDs of melanoma (below) as a guide when
checking your skin. If you have a mole or a growth
that is suspicious, have it evaluated by a dermatologist without delay!
A
B
C
D
symmetry - The shape of one half doesn’t
match the other.
order - Edges that are ragged and blurred.
MELANOMA CLINIC
If you have or suspect you have melanoma, you can access specialty
care at the Cleveland Clinic Cancer Center’s Melanoma Clinic. Your physician can refer you to the Melanoma Clinic, or you can call 216/444-7923
or 800/862-7798 for an appointment.
olor - Uneven shades of brown, black,
tan, and sometimes patches of red,
blue, or white.
iameter - The width is greater than onequarter inch (size of a pencil eraser, though
some melanomas may be smaller).
For a free fact sheet on melanoma, call 216/4448919 or 800/545-7718.
410851Clinic_dv
5/27/04
9:45 PM
Page 2
Managing Serious Acne With Accutane
Rejuvenate Your Skin, Quickly and Safely
Schedule a Skin Cancer Screening Today
MAY IS NATIONAL MELANOMA / SKIN CANCER DETECTION AND PREVENTION MONTH
F
or most people, dealing with a
blackhead here or a whitehead
there is manageable. But when
acne is severe, it can leave many scars
– physical, social and psychological.
The good news is that severe acne can
be managed successfully with Accutane.
Divya
Singh-Behl, M.D.
Accutane (isotretinoin) has revolutionized the treatment of acne in the
last 25 years, says Cleveland Clinic
dermatologist Divya Singh-Behl, M.D.
“Accutane is a synthetic retinoid and
belongs to the vitamin A family of
molecules. It is a potent drug and
should be reserved for treatment of
severe nodulocystic acne or acne that
is resistant to conventional therapy.”
A number of side effects are
associated with Accutane; most serious
is its potential to cause severe birth
defects in pregnant women receiving
therapy. “Accutane should not be used
in women trying to conceive, or who
are pregnant or nursing,” cautions
Dr. Singh-Behl.
!
A
In 1998, the U.S. FDA issued a warning regarding a possible increased risk
of depression and suicidal thoughts associated with Accutane use. However,
there has been no conclusive evidence to support that theory.
The most common side effect of Accutane is dryness of the skin and
mucosal membranes (mouth, lips, eyes). Other less common side effects include
headaches, thinning hair, changes in blood profile, muscle aches, nausea and
vomiting. For most patients, side effects are tolerable and are not a reason to
discontinue therapy.
Typically a patient is on a course for an average of five to six months.
Regularly scheduled follow-ups with a physician to monitor side effects are
needed while on Accutane. Baseline and repeat blood work, enzyme-profile testing, and pregnancy testing in women should be performed. It is imperative that
women of childbearing potential follow the pregnancy-prevention guidelines
while on therapy and for at least one month after discontinuation, adds Dr.
Singh-Behl.
After a course of Accutane, no long-term adverse effects have been noted
in fetal development. To date, no effects on male fertility have been noted.
“Accutane is the most effective drug available for treating acne, achieving
greater than 95 percent clearing of nodulocystic acne, as well as long-term clearing,” notes Dr. Singh-Behl. “Although side effects may be noted during therapy,
they are reversible once treatment is discontinued.”
For an appointment at the Clinic’s main campus, call 216/444-5725 or
800/223-2273, ext. 45725. For an appointment at the Beachwood Family
Health Center, call 216/839-3870.
Accutane: Safety First
All users, prescribers and dispensers of Accutane must now
enroll in a national registry to help prevent pregnancy among women
using this powerful acne drug. Accutane can cause severe birth
defects if a woman using the drug becomes pregnant. Through the
registry, women can only get their monthly supply of Accutane by
having a negative pregnancy test. They also are instructed to use
two forms of contraception while taking Accutane. Cleveland Clinic
dermatologist Wilma Bergfeld, M.D., served on the advisory panel
that made the recommendations to the U.S. FDA.
re fine lines or minor blemishes
troubling you? If so, a simple
outpatient procedure can deliver
smoother, healthier-looking skin in less than
an hour.
Called microdermabrasion, the procedure is a noninvasive way to safely and
effectively treat superficial sun damage and
skin irregularities, such as fine lines, blotchy
patches and minor blemishes.
“Microdermabrasion works well on age
spots, small scars and uneven pigmentation,”
explains James Sherer, P.A., a physician assistant with the Cleveland Clinic’s Department
of Dermatology. “It also can help thicken
collagen, which is important in maintaining
youthful-looking skin.”
The procedure involves the use of a fine
crystal spray, which gently removes the very
top layer of skin, comprised mostly of dead
skin cells. The result is skin that is rejuvenated and refreshed.
Microdermabrasion works best on
younger skin and is not recommended for
moderate or deep wrinkles or significant
facial aging or sun damage, explains Mr.
Sherer. For severe wrinkles and acne scars,
he recommends a chemical peel or laser
treatment.
A typical microdermabrasion on facial
skin takes between 20 and 30 minutes. If the
neck and upper chest area are included, the
treatment may take up to an hour. “For best
results, most patients need about four to
eight treatments, roughly two weeks apart,”
says Mr. Sherer.
Side effects are minimal. Some patients,
particularly those who are fair-skinned, experience slight redness that usually disappears
after about an hour. There is no recovery
time, and patients immediately can return
to their activities.
If you’re interested in microdermabrasion, schedule an appointment with our
dermatology office. One of our dermatologists or skin care specialists will work with
you to determine a specific plan based on
your skin type, condition and expectations.
For an appointment at the Clinic’s main
campus, call 216/444-5724 or 800/223-2273,
ext. 45724. For an appointment at the
Beachwood Family Health Center, call
216/839-3870.
T
HOW ALDARA WORKS
The cream works by stimulating the
body’s own immune system to fight off skin
cancer. According to the cream’s manufacturer, 3M Pharmaceuticals, the majority
of patients treated with Aldara achieved
Clinic’s Dermatology Department for a
skin cancer screening. For most people, a professional screening should be
performed yearly.
Dermatologists at The Cleveland
Clinic will inspect your skin and may
monitor suspicious growths, moles or
sores over time using photographs. A
photographic record is a reliable way
to scrutinize changes in your skin.
For an appointment, call
216/444-5725 or 800/223-2273,
ext. 45725.
Additionally, very few patients reported pain
with using the cream.
AKs can also be treated with surgery,
photodynamic therapy, cryotherapy (freezing
using liquid nitrogen) or topical chemotherapy applied directly to the lesion. Chemical
peels and superficial laser ablation also have been used to
treat lesions.
THE BEST DEFENSE
AGAINST AKS —AND SKIN
WHO GETS AKS
Because AKs are caused
by
excessive
sun exposure, they
CANCER IN GENERAL IS
most commonly are found among
LIMITING SUN EXPOSURE
people who spend or have spent
a good deal of time outdoors.
People with fair complexions
75 percent or more clearance of AK
are at a higher risk.
lesions and nearly half experienced comOf course, the best defense against
plete clearance in clinical trials.
AKs—and skin cancer in general—is limiting
The most frequently reported side
sun exposure.
effects were local skin reactions, like flakFor more information or an appointing, dryness, scabbing, swelling, and
ment, call 216/444-5725 or 800/223-2273,
itching or burning at the application site.
ext. 45725.
Only 2 percent of patients stopped using
the cream due to adverse skin reactions.
—
.
Quick Facts
ABOUT MELANOMA
■
■
■
■
Protect YOUR SKIN!
A
New Treatment For Precancerous Skin Lesions
he latest treatment for the most
common pre-cancerous skin lesions,
known as actinic keratoses, is
Aldara (imiquimod) cream (5%). This topical
prescription cream is the first immune
response modifier to be approved
by the U.S. FDA for the
treatment of actinic keratosis in adults.
Caused by excessive exposure to the
sun, actinic keratoses
(AKs) are red, scaly
patches found most
often on the face and
scalp. If left untreated,
5 percent to 15 percent of AKs
will develop into squamous cell carcinomas.
Because this type of skin cancer poses a definite risk of spreading to other areas of the
body, including lymph nodes, it is important
to identify and treat AKs early.
N
early half of all new cancers
are skin cancers, according to
the American Academy of
Dermatology. But you can prevent skin
cancer by avoiding the No. 1 culprit:
sun exposure. (See below for tips.)
While that’s sometimes easier
said than done, consider the value of
routine skin cancer screenings: Early
detection of skin cancer is crucial
to cure.
At home, try to regularly inspect
your body for any skin changes. You
also can make an appointment at the
voiding sun exposure doesn’t mean you have to stay indoors
while the sun is shining. The tips below will help you enjoy the
beautiful outdoors while keeping your skin safe from harmful
UVA and UVB rays.
■ Use a sunscreen with a Sun Protective Factor (SPF) of 15 or
higher—30 or 45. “Broad spectrum” sunscreen will block both UVA
and UVB radiation. Look for ingredients such as titanium dioxide,
parsol, zinc oxide or Z-Cote on the label; these products block the
most UV light.
■ Wear a wide-brimmed hat to shade the face, neck and ears. Avoid
straw hats, which offer no protection.
■ Make sure your sunglasses have a UVA/UVB coating; this will help
prevent retinal melanomas.
■ Consider wearing specially formulated sun-protective gear. Sun
Precautions (sunprecautions.com or 800/882-7860) and Sunday
Afternoons (sundayafternoons.com or 888/874-2642) offer sunprotective clothing, hats, swimwear and more.
■ Try Rit Sun Guard Laundry Treatment UV Protectant. Added
to your regular wash, it coats your clothing with SPF 30 sun
protectant that will last through 20 additional washings.
■
■
■
Malignant melanoma is a skin cancer that arises
from the skin’s pigment cells called melanocytes.
The incidence of skin cancer in the United States
is on the rise, and the number of new cases of
melanoma—the deadliest form of skin cancer—
has more than doubled in the past 20 years.
Melanoma appears as a pre-existing mole that
changes, or as a new mole on clear skin. Keep in
mind that not all moles are in plain sight. For
example, moles can form in the mucous membranes of the mouth.
More than 80 percent of skin cancer deaths are
from melanoma.
When melanoma is detected at its earliest stage, it
is highly curable.
Proper sun protection and skin self-examinations
are crucial for the prevention and early detection
of melanoma.
Risk factors for melanoma include a personal
history of many moles (more than 25); large
moles (larger than 6 mm or the size of a pencil
eraser); atypical or unusual looking moles; fair
skin; light eye or hair color; family history of
melanoma; intense sun exposure with blistering
sunburns as a child or adult; tanning salon
usage; and sun sensitivity.
Know your skin, and be familiar with your moles,
birthmarks and other marks. Look for any new
or unusual changes in your skin. Finally, use the
ABCDs of melanoma (below) as a guide when
checking your skin. If you have a mole or a growth
that is suspicious, have it evaluated by a dermatologist without delay!
A
B
C
D
symmetry - The shape of one half doesn’t
match the other.
order - Edges that are ragged and blurred.
MELANOMA CLINIC
If you have or suspect you have melanoma, you can access specialty
care at the Cleveland Clinic Cancer Center’s Melanoma Clinic. Your physician can refer you to the Melanoma Clinic, or you can call 216/444-7923
or 800/862-7798 for an appointment.
olor - Uneven shades of brown, black,
tan, and sometimes patches of red,
blue, or white.
iameter - The width is greater than onequarter inch (size of a pencil eraser, though
some melanomas may be smaller).
For a free fact sheet on melanoma, call 216/4448919 or 800/545-7718.
410851Clinic_dv
5/27/04
9:45 PM
Page 1
Help For “Turkey Necks” And “Double Chins”
“Psoriasis Update”
continued from page 1
ACHIEVE A MORE YOUTHFUL LOOK WITH LIPOSUCTION
CLEVELAND CLINIC
I
f you’re bothered by sagging jowls
or a double chin, and not quite
ready for — or interested in —
a full facelift, consider the advantages
of liposuction. Advances in cosmetic
surgery allow Cleveland Clinic dermatologic surgeons to reshape the neck
and lower face to achieve a more
youthful appearance.
Called tumescent liposuction,
the procedure is a safe and effective
approach to removing excess fat from
the chin and neck, say Cleveland
Clinic dermatologic surgeons Teri
McGillis, M.D., and Rebecca Tung,
M.D. “Both the treatment time and
recovery are quick, and patients report
excellent results,” says Dr. McGillis.
CALLED TUMESCENT
LIPOSUCTION, THE
PROCEDURE IS A SAFE
AND EFFECTIVE
APPROACH TO
REMOVING EXCESS
FAT FROM THE CHIN
AND NECK
Ideal candidates must have good
skin and muscle tone, and be in good
overall physical health. During the initial consultation, a thorough medical
history will be taken and a physical
examination will be performed.
At The Cleveland Clinic, boardcertified surgeons in both the
Rebecca Tung,
M.D.
Teri McGillis,
M.D.
Dermatology and Plastic Surgery
departments are trained in and
routinely perform liposuction.
Generally, Clinic plastic surgeons treat
more complex cases using general
anesthesia, and the dermatologic
surgeons treat patients using the
tumescent technique.
The tumescent technique involves
injecting a dilute solution of local anesthesia to the area of excess fat. “The
anesthetic solution not only aids in
breaking up fat deposits, but it also
helps minimize trauma to surrounding
tissue, and reduces post-operative
swelling and pain,” reports Dr. Tung.
The procedure is performed using
a suction pump attached to a small
stainless steel instrument called a
cannula. The cannula is inserted into
fatty areas between skin and muscle
through a small incision, typically in
the crease under the chin. The cannula
removes localized accumulations of
fat, resulting in an improved contour.
According to a study published
in Dermatologic Surgery in December
2002, liposuction using the tumescent
liposuction technique is safe — particularly when performed in an office
setting by an experienced, board-certified physician. Tumescent liposuction
is performed using only local anesthesia. No sedative or general anesthesia
is used, which helps speed recovery
and reduce the risks of surgery.
Order Your Free Video
“Medical Miracles: New Frontiers in Research”
recently aired on WKYC TV 3. Among other things,
viewers learned how researchers are using knowledge
about bone loss in space to manage osteoporosis, and
how a new drug helps patients with macular degeneration to see again. Viewers witnessed the latest in
stem cell research, and saw how researchers are
working to both improve kidney dialysis and avoid
kidney failure. For a free copy of the video, call
216/444-8919 or 800/545-7718.
The procedure takes about 11⁄2
hours, and patients are able to return
home within an hour after the procedure. Patients wear a supportive chin
strap for several days and can resume
social activities or work immediately
thereafter.
To schedule a consultation at the
Cleveland Clinic’s main campus, call
216/444-5724 or 800/223-2273,
ext. 45724. For an appointment at the
Beachwood Family Health Center, call
216/839-3870.
flu, but the reactions diminished over time.
Treatment with Raptiva, which is in the form
of a weekly injection, must continue indefinitely to maintain improvement. Patients can
learn to administer Raptiva at home.
ENBREL (etanercept), a drug approved
to treat rheumatoid arthritis, juvenile
rheumatoid arthritis, psoriatic arthritis and
ankylosing spondylitis, may be an effective
treatment for moderate to severe plaque psoriasis, for which it was just FDA-approved.
Roughly 1 million of the 7 million people in
the United States with psoriasis have moderate to severe plague psoriasis. People with
psoriatic arthritis achieved considerable relief
from symptoms of the disease, as well as
significant reduction of skin psoriasis.
Treatment is self-injection.
Enbrel works by inhibiting the action
of a cytokine called tumor necrosis factor
(TNF) alpha, which is overproduced in the
fluid responsible for lubricating the joints
(synovial fluid) and skin of people with
psoriasis and psoriatic arthritis.
TNF-alpha promotes inflammation,
which leads to painful damage of the joints
and connective tissue, as well as contributes
to development of lesions on the skin. When
Enbrel binds to TNF, the latter becomes
biologically inactive, reducing inflammation.
Skin Smart / W14
9500 Euclid Avenue, Cleveland, OH 44195
REMICADE (infliximab), a drug
already approved to treat rheumatoid
arthritis and Crohn’s disease (a type of
inflammatory bowel disease), has shown
promise in treating patients with psoriasis.
In a clinical study, Remicade improved
symptoms in 88 percent of patients receiving the highest dose of the drug. Remicade
is an antibody used to block the protein
that causes inflammation. Remicade is in
Phase III clinical trials
HUMIRA (adalimumab), another
tumor necrosis factor inhibitor, also is
being tested in clinical trials for treating
psoriasis and psoriatic arthritis. Humira
has already been FDA-approved for treating moderate to severe active rheumatoid
arthritis. The current clinical trial is a
randomized, multicenter, Phase II trial to
assess safety and efficacy in adult patients
with moderate to severe chronic-plaque
psoriasis.
If you suffer from psoriasis and traditional therapies haven’t worked well for
you, call your dermatologist to discuss the
possibility of using biologic therapies. For
an appointment, call 216/444-5725 or
800/223-2273, ext. 45725.
MAIN LOCATION .....216/444-5725
Cleveland Clinic Family Health Centers
offer dermatology services close to home.
Beachwood ...........216/839-3870
Chagrin Falls ........440/247-4404
Elyria.....................440/366-8822
Independence........216/986-4000
Strongsville ...........440/878-2500
Willoughby Hills...440/943-2500
Wooster .................330/287-4960
Visit our Web site at
www.clevelandclinic.org/dermatology
skInsmArt
Psoriasis Update:
New Drugs Bring New Hope
A
Summer 2004
Skin Smart is published by the Division of
Marketing to provide up-to-date information about
The Cleveland Clinic Foundation and its programs
and services. The information contained in Skin
Smart is for educational purposes only and should
not be relied upon as medical advice. It has not
been designed to replace a physician’s medical
assessment and medical judgment.
Editor: Laura Malee Greenwald
Art Director: Doug Crouch
Jonelle
McDonnell, M.D.
ccording to the American Academy of Dermatology, more than 7 million
people in the United States have psoriasis, with an estimated 150,000
new cases appearing annually. Several new medications to treat psoriasis
are on the market, waiting for FDA approval or in clinical trials. All are biologic
therapies, which halt the activity
of T-cells, a type of white
blood cell. T-cells trigger
immune responses,
and, when mistakenly
activated, they can
stimulate the development of symptoms
associated with any
number of autoimmune
disorders, like psoriasis
and psoriatic arthritis.
According to Cleveland
Clinic dermatologist Jonelle
McDonnell, M.D., biologic
therapies are the “latest and greatest.”
Biologic therapies are very specific and target the underlying problem causing
psoriasis, rather than suppressing other immune functions that are unrelated
to the disease. Also, biologic therapies tend to be well tolerated by patients and
are convenient.
AMEVIVE (alefacept) is a new treatment option for adults with moderate to
severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy. It is the first biologic drug to be approved by the FDA for the treatment
of adults with moderate to severe plaque psoriasis. Amevive is given through
injection by your health care professional once a week for 12 weeks. Results can
improve after a second course of treatment.
RAPTIVA (efalizumab), like Amevive, works by blocking T-cells that cause the
development and maintenance of psoriasis plaques. FDA approval was received in
October 2003. The drug offers continuous control of chronic moderate to severe
psoriasis. In clinical trials prior to FDA approval, between 18 percent and 37 percent of patients experienced at least a 75 percent reduction in symptoms after 12
weeks of treatment. Adverse reactions were mild to moderate and similar to the
continued on back cover
410851Clinic_dv
5/27/04
9:45 PM
Page 1
Help For “Turkey Necks” And “Double Chins”
“Psoriasis Update”
continued from page 1
ACHIEVE A MORE YOUTHFUL LOOK WITH LIPOSUCTION
CLEVELAND CLINIC
I
f you’re bothered by sagging jowls
or a double chin, and not quite
ready for — or interested in —
a full facelift, consider the advantages
of liposuction. Advances in cosmetic
surgery allow Cleveland Clinic dermatologic surgeons to reshape the neck
and lower face to achieve a more
youthful appearance.
Called tumescent liposuction,
the procedure is a safe and effective
approach to removing excess fat from
the chin and neck, say Cleveland
Clinic dermatologic surgeons Teri
McGillis, M.D., and Rebecca Tung,
M.D. “Both the treatment time and
recovery are quick, and patients report
excellent results,” says Dr. McGillis.
CALLED TUMESCENT
LIPOSUCTION, THE
PROCEDURE IS A SAFE
AND EFFECTIVE
APPROACH TO
REMOVING EXCESS
FAT FROM THE CHIN
AND NECK
Ideal candidates must have good
skin and muscle tone, and be in good
overall physical health. During the initial consultation, a thorough medical
history will be taken and a physical
examination will be performed.
At The Cleveland Clinic, boardcertified surgeons in both the
Rebecca Tung,
M.D.
Teri McGillis,
M.D.
Dermatology and Plastic Surgery
departments are trained in and
routinely perform liposuction.
Generally, Clinic plastic surgeons treat
more complex cases using general
anesthesia, and the dermatologic
surgeons treat patients using the
tumescent technique.
The tumescent technique involves
injecting a dilute solution of local anesthesia to the area of excess fat. “The
anesthetic solution not only aids in
breaking up fat deposits, but it also
helps minimize trauma to surrounding
tissue, and reduces post-operative
swelling and pain,” reports Dr. Tung.
The procedure is performed using
a suction pump attached to a small
stainless steel instrument called a
cannula. The cannula is inserted into
fatty areas between skin and muscle
through a small incision, typically in
the crease under the chin. The cannula
removes localized accumulations of
fat, resulting in an improved contour.
According to a study published
in Dermatologic Surgery in December
2002, liposuction using the tumescent
liposuction technique is safe — particularly when performed in an office
setting by an experienced, board-certified physician. Tumescent liposuction
is performed using only local anesthesia. No sedative or general anesthesia
is used, which helps speed recovery
and reduce the risks of surgery.
Order Your Free Video
“Medical Miracles: New Frontiers in Research”
recently aired on WKYC TV 3. Among other things,
viewers learned how researchers are using knowledge
about bone loss in space to manage osteoporosis, and
how a new drug helps patients with macular degeneration to see again. Viewers witnessed the latest in
stem cell research, and saw how researchers are
working to both improve kidney dialysis and avoid
kidney failure. For a free copy of the video, call
216/444-8919 or 800/545-7718.
The procedure takes about 11⁄2
hours, and patients are able to return
home within an hour after the procedure. Patients wear a supportive chin
strap for several days and can resume
social activities or work immediately
thereafter.
To schedule a consultation at the
Cleveland Clinic’s main campus, call
216/444-5724 or 800/223-2273,
ext. 45724. For an appointment at the
Beachwood Family Health Center, call
216/839-3870.
flu, but the reactions diminished over time.
Treatment with Raptiva, which is in the form
of a weekly injection, must continue indefinitely to maintain improvement. Patients can
learn to administer Raptiva at home.
ENBREL (etanercept), a drug approved
to treat rheumatoid arthritis, juvenile
rheumatoid arthritis, psoriatic arthritis and
ankylosing spondylitis, may be an effective
treatment for moderate to severe plaque psoriasis, for which it was just FDA-approved.
Roughly 1 million of the 7 million people in
the United States with psoriasis have moderate to severe plague psoriasis. People with
psoriatic arthritis achieved considerable relief
from symptoms of the disease, as well as
significant reduction of skin psoriasis.
Treatment is self-injection.
Enbrel works by inhibiting the action
of a cytokine called tumor necrosis factor
(TNF) alpha, which is overproduced in the
fluid responsible for lubricating the joints
(synovial fluid) and skin of people with
psoriasis and psoriatic arthritis.
TNF-alpha promotes inflammation,
which leads to painful damage of the joints
and connective tissue, as well as contributes
to development of lesions on the skin. When
Enbrel binds to TNF, the latter becomes
biologically inactive, reducing inflammation.
Skin Smart / W14
9500 Euclid Avenue, Cleveland, OH 44195
REMICADE (infliximab), a drug
already approved to treat rheumatoid
arthritis and Crohn’s disease (a type of
inflammatory bowel disease), has shown
promise in treating patients with psoriasis.
In a clinical study, Remicade improved
symptoms in 88 percent of patients receiving the highest dose of the drug. Remicade
is an antibody used to block the protein
that causes inflammation. Remicade is in
Phase III clinical trials
HUMIRA (adalimumab), another
tumor necrosis factor inhibitor, also is
being tested in clinical trials for treating
psoriasis and psoriatic arthritis. Humira
has already been FDA-approved for treating moderate to severe active rheumatoid
arthritis. The current clinical trial is a
randomized, multicenter, Phase II trial to
assess safety and efficacy in adult patients
with moderate to severe chronic-plaque
psoriasis.
If you suffer from psoriasis and traditional therapies haven’t worked well for
you, call your dermatologist to discuss the
possibility of using biologic therapies. For
an appointment, call 216/444-5725 or
800/223-2273, ext. 45725.
MAIN LOCATION .....216/444-5725
Cleveland Clinic Family Health Centers
offer dermatology services close to home.
Beachwood ...........216/839-3870
Chagrin Falls ........440/247-4404
Elyria.....................440/366-8822
Independence........216/986-4000
Strongsville ...........440/878-2500
Willoughby Hills...440/943-2500
Wooster .................330/287-4960
Visit our Web site at
www.clevelandclinic.org/dermatology
skInsmArt
Psoriasis Update:
New Drugs Bring New Hope
A
Summer 2004
Skin Smart is published by the Division of
Marketing to provide up-to-date information about
The Cleveland Clinic Foundation and its programs
and services. The information contained in Skin
Smart is for educational purposes only and should
not be relied upon as medical advice. It has not
been designed to replace a physician’s medical
assessment and medical judgment.
Editor: Laura Malee Greenwald
Art Director: Doug Crouch
Jonelle
McDonnell, M.D.
ccording to the American Academy of Dermatology, more than 7 million
people in the United States have psoriasis, with an estimated 150,000
new cases appearing annually. Several new medications to treat psoriasis
are on the market, waiting for FDA approval or in clinical trials. All are biologic
therapies, which halt the activity
of T-cells, a type of white
blood cell. T-cells trigger
immune responses,
and, when mistakenly
activated, they can
stimulate the development of symptoms
associated with any
number of autoimmune
disorders, like psoriasis
and psoriatic arthritis.
According to Cleveland
Clinic dermatologist Jonelle
McDonnell, M.D., biologic
therapies are the “latest and greatest.”
Biologic therapies are very specific and target the underlying problem causing
psoriasis, rather than suppressing other immune functions that are unrelated
to the disease. Also, biologic therapies tend to be well tolerated by patients and
are convenient.
AMEVIVE (alefacept) is a new treatment option for adults with moderate to
severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy. It is the first biologic drug to be approved by the FDA for the treatment
of adults with moderate to severe plaque psoriasis. Amevive is given through
injection by your health care professional once a week for 12 weeks. Results can
improve after a second course of treatment.
RAPTIVA (efalizumab), like Amevive, works by blocking T-cells that cause the
development and maintenance of psoriasis plaques. FDA approval was received in
October 2003. The drug offers continuous control of chronic moderate to severe
psoriasis. In clinical trials prior to FDA approval, between 18 percent and 37 percent of patients experienced at least a 75 percent reduction in symptoms after 12
weeks of treatment. Adverse reactions were mild to moderate and similar to the
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