Complementary and Alternative Medicine in Dermatology

According to survey data, 35-69% of patients with skin disease have used complementary and alternative medicine (CAM) in their lifetime. A literature search on this subject reveals a number of studies on the efficacy of CAM treatment for dermatologic conditions, as well as a number of articles showing the growing prevalence of CAM use amongst patients suffering from these conditions. Given the consensus amongst these articles that dermatologists require increased education on CAM, this paper presents an overview of some of the most widely used systems of alternative medicine to serve as a tool for practicing dermatologists. Specifically, the history and theory behind psychocutaneous therapies, traditional Chinese medicine (including acupuncture), homeopathy, and Ayurvedic medicine will be described, along with current evidence for their efficacy and reports of their adverse effects. The authors conclude that more evidence and better studies are needed for each of the major CAM modalities before they may be considered as independent therapeutic options. Moreover, given the shortage of evidence supporting the efficacy and safety of CAM, dermatologists should obtain a thorough history of CAM use from their patients. In general, ingestible substances including most homeopathic, Ayurvedic, and traditional Chinese medicine herbal formulations that are not US FDA regulated should be viewed with caution as they may cause severe adverse effects such as arsenicosis and hepatotoxicity. On the other hand, less invasive techniques such as acupuncture and psychocutaneous therapies may be more acceptable given their low-risk profile. Ultimately, until the availability of more sound data, these treatments should primarily be used in combination with conventional treatment and rarely independently.     

Evaluation of techniques used to estimate cortical feature maps

Functional properties of neurons are often distributed nonrandomly within a cortical area and form topographic maps that reveal insights into neuronal organization and interconnection. Some functional maps, such as in visual cortex, are fairly straightforward to discern with a variety of techniques, while other maps, such as in auditory cortex, have resisted easy characterization. In order to determine appropriate protocols for establishing accurate functional maps in auditory cortex, artificial topographic maps were probed under various conditions, and the accuracy of estimates formed from the actual maps was quantified. Under these conditions, low-complexity maps such as sound frequency can be estimated accurately with as few as 25 total samples (e.g., electrode penetrations or imaging pixels) if neural responses are averaged together. More samples are required to achieve the highest estimation accuracy for higher complexity maps, and averaging improves map estimate accuracy even more than increasing sampling density. Undersampling without averaging can result in misleading map estimates, while undersampling with averaging can lead to the false conclusion of no map when one actually exists. Uniform sample spacing only slightly improves map estimation over nonuniform sample spacing typical of serial electrode penetrations. Tessellation plots commonly used to visualize maps estimated using nonuniform sampling are always inferior to linearly interpolated estimates, although differences are slight at higher sampling densities. Within primary auditory cortex, then, multiunit sampling with at least 100 samples would likely result in reasonable feature map estimates for all but the highest complexity maps and the highest variability that might be expected.     

Part 1 of a 4-part series Facial Cosmetics: Trends and Alternatives: Data from the American Contact Alternatives Group

Objective: To provide updated data on usage of ingredients that are common potential contact allergens in several categories of facial cosmetics. To identify useful alternative products with few or no common contact allergens. Design: In November 2009, the full ingredient lists of 5,416 skin, hair, and cosmetic products marketed by the CVS pharmacy chain were copied from CVS.com into Microsoft Word format for analysis. Computer searches were made in Microsoft Word using search/replace and sorting functions to accurately identify the presence of specific allergens in each website product. Measurements: Percentages of American Contact Alternatives Group core series allergens were calculated. Results: The usage of American Contact Alternatives Group core series allergens in facial cosmetics is reported along with suitable alternative products for individuals with contact allergy. Conclusion: Data on allergen usage and alternatives for facial cosmetics is not widely published. This article reviews some of the common potential allergens in facial cosmetics, including blushers and bronzers, concealers, eyeliners, eyeshadows, foundations, loose and pressed powders, and mascaras. Suitable available alternative products for patients with contact allergy are listed.     

Lean and obese Zucker rats exhibit different patterns of p70s6 kinase regulation in the tibialis anterior muscle in response to high‐force muscle contraction

Increased phosphorylation of the 70‐kDa ribosomal S6 kinase (p70S6k) signaling is strongly correlated with the degree of muscle adaptation following exercise. Herein we compare the phosphorylation of p70S6k, Akt, and mammalian target of rapamycin (mTOR) in the tibialis anterior (TA) muscles of lean and obese Zucker rats following a bout of eccentric exercise. Exercise increased p70S6k (Thr389) phosphorylation immediately after (33.3 ± 7.2%) and during [1 h (24.0 ± 14.9%) and 3 h (24.6 ± 11.3%)] recovery in the lean TA and at 3 h (33.5 ± 8.0%) in the obese TA Zucker rats. mTOR (Ser2448) phosphorylation was elevated in the lean TA immediately after exercise (96.5 ± 40.3%) but remained unaltered in the obese TA. Exercise increased Akt (Thr308) and Akt (Ser473) phosphorylation in the lean but not the obese TA. These results suggest that insulin resistance is associated with alterations in the ability of muscle to activate p70S6k signaling following an acute bout of exercise. Muscle Nerve 39: 503–511 2009     

Diet and Dermatology: The Role of Dietary Intervention in Skin Disease

For decades, it was thought that many common dermatological conditions had no relationship to diet. Studies from recent years, however, have made it clear that diet may influence outcome. In this review, the authors focus on conditions for which the role of diet has traditionally been an underappreciated aspect of therapy. In some cases, dietary interventions may influence the course of the skin disease, as in acne. In others, dietary change may serve as one aspect of prevention, such as in skin cancer and aging of the skin. In others, dermatological disease may be linked to systemic disease, and dietary changes may affect health outcomes, as in psoriasis. Lastly, systemic medications prescribed for dermatological disease, such as steroids, are known to raise the risk of other diseases, and dietary change may reduce this risk.Patients often seek dietary advice from their dermatologist, as they frequently link many of their health problems, including diseases of the skin, to their diet. While some of these concerns are unfounded, research has uncovered significant evidence that dietary considerations may be important in some dermatological conditions.While a number of well-known conditions are linked to diet, such as food allergies and dermatitis herpetiformis, in this review, the authors focus on conditions for which the role of diet has traditionally been an underappreciated aspect of therapy. In some cases, dietary interventions may influence the course of the skin disease, as in acne. In others, dietary change may serve as one aspect of prevention, such as in skin cancer and aging of the skin. In others, dermatological disease may be linked to systemic disease, and dietary changes may affect health outcomes, as in psoriasis. Lastly, systemic medications prescribed for dermatological disease, such as steroids, are known to raise the risk of other diseases, and dietary change may reduce this risk.In this article, the authors review studies that have examined the link between diet and dermatology. Many patients come in with questions due to misconceptions that they themselves have developed or due to information they have received from friends, family members, or the media. Dermatologists must take the lead in providing clear, well-substantiated dietary recommendations to their patients.     

Novel variant p.(Ala102Thr) in SDHB causes mitochondrial complex II deficiency: Case report and review of the literature

Leigh syndrome is a clinically and radiologically heterogeneous condition with approximately 75 genes, nuclear and mitochondrial, known to be implicated in its pathogenesis. Leigh syndrome due to complex II deficiency constitutes 2% to 7% of these cases. Previously, nine individuals with Leigh syndrome have been reported with pathogenic variants in SDHB, which encodes for the iron–sulfur cluster subunit of mitochondrial respiratory chain complex II. The proband presented with Leigh syndrome. Exome sequencing revealed a homozygous missense variant p.(Ala102Thr) in SDHB. In silico protein modeling of the wild-type and mutant proteins showed potentially decreased protein stability. We hereby report another individual with Leigh syndrome due to SDHB-related mitochondrial complex II deficiency and review the phenotype and genotype associated with this condition.     

The SMAD-binding domain of SKI: a hotspot for de novo mutations causing Shprintzen–Goldberg syndrome

Shprintzen–Goldberg syndrome (SGS) is a rare, systemic connective tissue disorder characterized by craniofacial, skeletal, and cardiovascular manifestations that show a significant overlap with the features observed in the Marfan (MFS) and Loeys–Dietz syndrome (LDS). A distinguishing observation in SGS patients is the presence of intellectual disability, although not all patients in this series present this finding. Recently, SGS was shown to be due to mutations in the SKI gene, encoding the oncoprotein SKI, a repressor of TGFβ activity. Here, we report eight recurrent and three novel SKI mutations in eleven SGS patients. All were heterozygous missense mutations located in the R-SMAD binding domain, except for one novel in-frame deletion affecting the DHD domain. Adding our new findings to the existing data clearly reveals a mutational hotspot, with 73% (24 out of 33) of the hitherto described unrelated patients having mutations in a stretch of five SKI residues (from p.(Ser31) to p.(Pro35)). This implicates that the initial molecular testing could be focused on mutation analysis of the first half of exon 1 of SKI. As the majority of the known mutations are located in the R-SMAD binding domain of SKI, our study further emphasizes the importance of TGFβ signaling in the pathogenesis of SGS.