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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 continued on back cover