Tan by Needle?

Hans Reuchlin, a friend with Type I/II skin, alerted us to a recent letter in the BMJ which draws attention to the unlicensed use of melanotrophic peptides for recreational tanning: "Change in moles linked to use of unlicensed "sun tan jab"

The letter describes two women who were also sunbed users who presented with "rapidly pigmenting naevi and intense tan. Both patients had also subcutaneously injected Melanotan I and II obtained for self administration from the internet shortly before their moles changed."

Some of these products are purported to have aphrodisiac and positive erectile effects which will add to their illicit use one suspects. This is an emerging story. Stay tuned.

It reminds one of the book, Black Like Me by John Howard Griffith. The urban legend that Griffith died of melanoma is apparently erroneous.

Witness to History by Brenda Dintiman

We had mixed feelings about dealing with the crowds and cold to go and witness the swearing in of the president. Yet, our friends, Caroline and Charles, were visiting from North Carolina and they were determined to be there. I wasn't sure if Teddy would want to go but as Caroline said, "This is historic and he needs to be there with you." It was the first election that my daughter, Christine had voted in and the first time in my life that I felt passionate about voting.

We rode on the crowded Metro and became anxious as the announcer told us which stops were closed or overwhelmed with crowds. People tried to push on to the already full train as we got close to the Clarendon and Rosslyn Station and that was a little scary. They were affable and festive, however, singing and talking to each other and full of excitement. We got off four stops before the Capitol and were resigned to just be near a JumboTron screen to watch. We walked with thousands of people peacefully down 18th Street to the reflecting pool and then to the Washington monument. College kids were carrying signs; parents were walking with children and whole families were excitedly strolling together.

As we looked down the mall past the first JumboTron over the sea of people waving flags and saw the Capitol at the end, we felt emotional anticipating what was about to happen. For me it was a significant historic moment since I grew up in Richmond, Virginia the capital of the Confederacy and we were about to watch the swearing in of our first African-American president. We felt proud to witness the "peaceful transition of power" that makes our country unique.

People cheered and clapped for President Obama. I felt that this was a sign that regardless of one’s heritage and ethnic background our country gives us all opportunities to succeed and even become the President of the United States.

Unfortunately, some people booed ex-president Bush which offended us since regardless of one’s political beliefs he had served our country for eight years. Yet again, this symbolizes our country's freedom of speech.

I am happy that we braved the crowds and am still in awe of witnessing this historic event. The joyous energy of the crowds has given me a renewed faith in our country's ability to heal and to recover from these difficult economic times.

Brenda Dintiman is a dermatologist in Northern Virginia. She is the founder of Fair Oaks Skin Care Center in Fairfax, Virginia. You can reach her at: Email.

Voices of Psoriasis

Patient Voices is a section in the NY Times that allows patients to speak candidly about their disease -- usually there are six patients and they speak for from 30 seconds for a child to around 90 seconds for an adult. This week's topic is psoriasis.

"About 15 years ago, a dermatologist diagnosed my psoriasis and said to me “Congratulations, you have a new hobby.” Was she right!" This is an excerpt from a fine piece on psoriasis that appeared on Jan 15, 2009 in the NY Times.

Short intro to Voices of Psoriasis

Audio of seven patients

Perhaps, the most eloquent voice on psoriasis is that of John Updike. His essay "From the Diary of a Leper" appeared in the New Yorker Magazine almost 30 years ago. It is well worth reading and can be found in Problems and Other Stories (London: Deutsch, 1980), p. 187; and is quoted in John Updike, Self-Consciousness: Memoirs (London: Penguin, 1990).

An essay The Thick-Skinned Art of John Updike: 'From the Journal of a Leper' can be accessed online and is a good discussion of the impact of skin disease on those afflicted.

Love those long lashes...

who's your dermatologist?

"Allergan, the company that turned an obscure muscle paralyzer for eyelid spasms, Botox, into a blockbuster wrinkle smoother, hopes to perform cosmetic alchemy yet again. At the end of the month, the company plans to introduce Latisse, the first federally approved prescription drug for growing longer, lusher lashes."
So begins an amazing front page article in the NY Times today.

When I first entered dermatology, back in the Pleistocene no patient ever asked about moisturizers, anti-wrinkle creams, fillers, and on and on. Sadly, these hold no interest for me and I realize that I am a curmudgeon deserving of the title "Dinosaur" -- or perhaps "Dermosaur."

"Allergan plans to introduce Latisse this month, primarily to cosmetic doctors like dermatologists. Some women who have already tried Latisse are fans.

“People would say to me ‘Are you wearing false eyelashes?’ — even my own mother asked,” said Cindy Ross, vice president for sales at Young Pharmaceuticals in Wethersfield, Conn., who participated in the Latisse clinical trial."

Stay tuned, but pleas don't refer any of these patients to the Dino-Dermo Centre at which I work.

The Pharmacopeia

I often think of this quote when I see patients bringing in bags of medications: "I firmly believe that if the whole materia medica, as now used, could be sunk to the bottom of the sea, it would be all the better for mankind,--and all the worse for the fishes." (In an Address delivered by Oliver Wendell Holmes.before the Massachusetts Medical Society in 1860 ) Matters are not that different today (DJE)

The patient is a disabled woman I saw today who told me that her acne scars reminded her of manholes. She bought all of these products to help improve her appearance. I quoted Holmes to her and she was amused. She agreed to be photographed for my partners in crime.

[Strangely, each time this is quoted, it changes a bit. The original, I think, is in "The Autocrat of the Breakfast Table."]

Acne by Danielle Ofri

In case some of you may have missed this fine essay which appeared in the Annals of Internal Medicine we have posted it here. It begins:

"A young Navajo woman files silently into my office, making no eye contact. As she slips into the chair, errant strands of black hair spill across her face. Through the breaches, I catch glimpses of her rich dark skin riddled with the pockmarks of severe acne. Violently swollen pustules and angry red craters contort the architecture of her face. Her shoulders slope into her slight body, as if afraid to claim too much territory on their own. She contemplates the linoleum wordlessly. I am almost afraid to interrupt."

For full article, email DJE or find it at: Acne/Ofri