Advances in Cosmetic and Medical Dermatology

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This activity is supported by an educational grant from Dermik Laboratories, a business of sano3 -aventis U.S. LLC, and Stiefel Laboratories, Inc. ® THE DERMAT OLOGY REPORT | Spr ing 200 8 1 VOLUME 2 NUMBER 1 | SPRING 200 8 Selected Reports from the 4 th Annual Advances in Cosmetic and Medical Dermatology Meeting , Wailea, Maui, Hawaii George M.

Martin, MD, Guest Editor Dermat ology The REPORT ology ology 3 Introduction George M. Martin, MD Maui, Hawaii 4 Advances in Rosacea and Acne Vulgaris Evans C. Bailey, MD, PhD University of Michigan Medical Center, Ann Arbor, Michigan 8 Chemoprevention: Current Treatments and Future Directions Christy B.

Doherty, MD Baylor College of Medicine, Houston, Texas 16 Evolving Concepts in the Immunology of Cutaneous Diseases Scott N. Isenhath, MD Oregon Health & Science University, Portland, Oregon 19 Psoriasis Update 2008 Scott N. Isenhath, MD Oregon Health & Science University, Portland, Oregon 25 Botulinum Toxins and Fillers: What, Where, and How?

# omas T. Su, MD, PhD David Ge' en School of Medicine at UCLA, Los Angeles, California 33 Atopic Dermatitis: Current Concepts Wynnis L. Tom, MD Rady Children 9s Hospital and University of California, San Diego, San Diego, California 36 The Top 10 ... more. less.

Pediatric Dermatologic Disorders Wynnis L. Tom, MD Rady Children 9s Hospital and University of California, San Diego, San Diego, California 40 Cosmeceuticals: From Topical Antioxidants to Peptides Ruth Ann Vleugels, MD Harvard Medical School, Boston, Massachusetts 46 CME Post Test and Evaluation 2 THE DERMAT OLOGY REPORT | Volume 2 Number 1 About This CME Activity Rationale and Purpose Dermatologic diseases range from annoying rashes to potentially life-threatening skin infec- tions and malignant melanoma. This issue of The Dermatology Report is based on the 4 th annual Advances in Cosmetic and Medical Dermatol- ogy meeting, held in Wailea, Maui, Hawaii, from February 25 to March 1, 2008. It takes a close look at the molecular mechanisms leading to many common skin diseases and oJ ers current recommendations for their management. Ex- perts at the meeting discussed the inG uence of a newly discovered T-cell pathway involved in the pathogenesis of psoriasis and psoriatic arthritis and of proteolytically processed peptides in rosacea. Recent data on the pathogenesis and management of pediatric skin disorders were also presented. Combining diJ erent drug classes is providing excellent results in the treatment of acne vulgaris, psoriasis, and nonmelanoma skin cancer, among other skin diseases. More knowledge about the pathogenesis of atopic dermatitis is leading to better topical and sys- temic treatments. Finally, experts in the F eld of cosmeceuticals shared their insights and methodology for providing patients with the best aesthetic results with the most safety. The articles in this issue, written from the academic perspective of physicians in training at leading medical institutions, summarize the im- port of these new F ndings and place them into clinical context. This activity has been developed and approved by a planning committee of na- tionally recognized thought leaders, under the direction of Beam Institute, to meet a perceived educational need to provide dermatologists and other physicians with strategies to help them perform their medical roles. Learning Objectives After reading this issue of The Dermatology Report, participants in this educational activity should be able to: " DiJ erentiate between acne vulgaris and rosacea and describe their management. " Describe the detection of nonmelanoma skin cancers and their treatment. " Review the role of biologic agents in the treatment of psoriasis and psoriatic arthritis. " Recount the 10 most common pediatric skin disorders and their management. " Discuss the pathogenesis of atopic dermatitis and the therapeutic options available. " Review the role of antimicrobial peptides in the etiology and development of psoriasis and rosacea. " Describe the appropriate use of botulinum toxins and dermal F llers. " Compare available cosmeceuticals for ease of administration and aesthetic results and discuss their uses in clinical practice. Target Audience Dermatologists and other physicians signiF cant- ly involved in the diagnosis and management of skin disorders and diseases should F nd partici- pating in this educational activity valuable. Accreditation This activity has been planned and implemented in accor- dance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Beam Institute and Direct One Communications, Inc. Beam Institute is accredited by the ACCME to provide continu- ing medical education for physicians. Faculty Disclosures In compliance with the ACCME 9s Standards for Commercial Support, any person who was in a position to control the content of this CME activ- ity was required to disclose all relevant F nancial relationships that created conG icts of interest. Beam Institute has identiF ed and resolved all conG icts of interest prior to the publication of this educational activity. All faculty have been oJ ered a modest honorarium for their participa- tion in this activity. George M. Martin, MD, a Board-certiF ed special- ist in dermatology and internal medicine, is in private practice in Maui, Hawaii. He is a speaker for and consultant to DUSA Pharmaceuticals, Inc. and Dermik Laboratories, a business of sanoF - aventis U.S. LLC. Evans C. Bailey, MD, PhD, Chief Resident, Depart- ment of Dermatology, University of Michigan Medical Center, Ann Arbor, Michigan, has noth- ing to disclose. Christy B. Doherty, MD, a Medical Resident in Dermatology at Baylor College of Medicine, Houston, Texas, has nothing to disclose. Scott N. Isenhath, MD, Chief Resident in the Department of Dermatology, Oregon Health & Science University, Portland, Oregon, has noth- ing to disclose. Thomas T. Su, MD, PhD, a STAR Resident in Dermatology at the David GeJ en School of Medicine at UCLA, Los Angeles, California, has nothing to disclose. Wynnis L. Tom, MD, Clinical Fellow in Pediatric and Adolescent Dermatology at Rady Children 9s Hospital and University of California, San Diego, San Diego, California, has nothing to disclose. Ruth Ann Vleugels, MD, Chief Resident in Der- matology at Harvard Medical School, Boston, Massachusetts, has nothing to disclose. Continuing Education Credit The Beam Institute designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits " . Physicians should only claim credit commensurate with the extent of their partici- pation in the activity. Disclaimer This activity is an independent educational activity under the direction of Beam Institute. The activity was planned and implemented in accordance with the Essential Areas and policies of the ACCME, the Ethical Opinions/Guidelines of the American Medical Association, the US Food and Drug Administration, the OK ce of In- spector General of the US Department of Health and Human Services, and the Pharmaceutical Research and Manufacturers of America Code on Interactions With Healthcare Professionals, thus assuring the highest degree of independence, fair balance, scientiF c rigor, and objectivity. However, the planning committee, faculty, Beam Institute, Dermik Laboratories, sanoF -aventis U.S. LLC, Stiefel Laboratories, Inc., and Direct One Communications, Inc. shall in no way be liable for the currency of information or for any errors, omissions, or inaccuracies in this activity. Discussions concerning drugs, dosages, and procedures may reG ect the clinical experience of the planning committee or they may be derived from the professional literature or other sources and may suggest uses that are investigational in nature and not approved labeling or indications. Participants in this activity are encouraged to refer to primary references or full prescribing information resources. The opinions and recommendations presented herein are those of the faculty and do not neces- sarily reG ect the views of the provider, producer, or grantors. Copyright Copyright owned by Direct One Communica- tions, Inc. © Copyright 2008, Direct One Com- munications, Inc. Contact Information We would like to hear your comments regard- ing this or other educational activities provided by Beam Institute. In addition, suggestions for future activities are welcome. Contact us at: Director of Continuing Education Beam Institute 11 West 19 th Street, 3 rd Floor New York, NY 10011 Phone: 888-618-5781 / Fax: 212-600-3050 E-mail: beaminstitute@cmp.com Activity release date: June 20, 2008 Expiration date: June 30, 2009 CME Post Test and Evaluation 46 THE DERMAT OLOGY REPORT | Volume 2 Number 1 1. Which of the following statements about cathelicidin is true? a. It is a member of a family of antimicrobial peptides against bacteria, fungi, and viruses. b. It is expressed in melanocytes, saliva, and sweat, where it exerts its antimicrobial eP ects. c. It inhibits angiogenesis and inO ammation and promotes dermal matrix remodeling. d. All of the above. 2. LL-37 is a topical photosensitizing agent that is incorporated into epidermal cells and sebaceous glands and causes intracellular accumulation of the photoactive heme precursor protoporphyrin IX. a. True b. False 3. Imiquimod has been approved by the US Food and Drug Administration (FDA) to treat: a. Squamous cell carcinoma b. Squamous cell carcinoma in situ c. SuperN cial basal cell carcinoma d. All of the above 4. R e FDA-approved protocol for photodynamic therapy in treating nonhyperkeratotic actinic keratoses includes a 14- to 18-hour incubation of 5-aminolevulinic acid solution on the skin followed by exposure to _________ for 1,000 seconds. a. Visible red light b. Pulsed-light laser c. Visible blue light d. Intense pulse laser 5. A major antimicrobial peptide family in the skin that is released rapidly upon injury to and/or infection of the skin and disrupts the microbial cell membrane is the: a. Cecropins b. Cathelicidins c. Beta-defensins d. Penaeidins 6. Which of the following statements about rosacea is true? a. AP ected patients express abnormally low levels of LL-37 in their facial skin. b. AP ected patients harbor proteolytically processed LL-37 peptides that are diP erent from those of persons having normal skin. c. R e presence of an elevated stratum corneum tryptic enzyme level alone is suQ cient to produce the inO am- mation of rosacea. d. R e presence of an elevated LL-37 level alone is suQ cient to produce the inO ammation of rosacea. 7. R e biologic agents ustekinumab and ABT-874 target T cells and the inO ammatory process of psoriasis, in particular, the p40 subunit of: a. Interleukin (IL)-17 and IL-23 b. IL-12 and IL-23 c. IL-12 and IL-17 d. IL-12, IL-17, and IL-23 8. A tumor necrosis factor (TNF)- ± inhibitor that blocks interaction between TNF- ± and the p55 and p75 cell- surface receptors that recently was approved by the FDA for treatment of psoriasis is: a. Adalimumab b. Alefacept c. Efalizumab d. Ustekinumab 9. Patients who exhibit eyelid hooding and use their frontalis muscle to compensate for this eP ect are not candidates for treatment with botulinum toxin. a. True b. False 10. R e only nonresorbable dermal N ller used to correct facial lines and wrinkles is: a. Calcium hydroxylapatite b. Poly-L-lactic acid c. Polymethylmethacrylate d. Silicone CME Post Test Using these pages as a worksheet, select the best answer to each question based on your reading of the articles in this issue o f T e Dermatology Report , Report Report then complete the evaluation on page 48 and see the instructions below it to obtain CME credit. CME Post Test and Evaluation THE DERMAT OLOGY REPORT | Spring 200 8 47 11. In comparative studies, which of the following has been proven to be signiN cantly more eP ective against atopic dermatitis than are the others and, therefore, is recommended as N rst-line therapy? a. Azathioprine b. Methotrexate c. Efalizumab d. None of the above 12. A pediatric skin condition most commonly caused by Epstein-Barr virus in the United States is: a. Kawasaki 9s disease b. Gianotti-Crosti syndrome c. Erythema infectiosum d. Pityriasis rosea 13. A key feature of Kawasaki 9s disease is: a. Conjunctival discharge or exudate b. Depressed erythrocyte sedimentation rate c. Redness and desquamation of the perineal area that occurs before acral locations are aP ected d. Fever of at least 10 days and pelvic lymphadenopathy 14. A randomized, investigator-blinded, parallel study of 77 female subjects found that which product produced the best investigator- and subject-reported results when treating moderate-to-severe glabellar rhytides? a. Hydroderm" b. StriVectin-SD® c. Botulinum toxin type A injection d. Placebo injection 15. R e anticarcinogenic eP ects of green tea are particularly attributed to the extract epigallocatechin 3-gallate. a. True b. False CME Post Test and Evaluation 48 THE DERMAT OLOGY REPORT | Volume 2 Number 1 Instructions for Obtaining CME Credit To receive CME credit for this free educational activity and a certiN cate from Beam Institute: " Study the educational material presented in this issue of T e Dermatology Report. " Using pages 46 347 as a worksheet, answer all of the post-test questions based on the content of the articles. " Visit www. The DermatologyReport . com on the Web by June 30, 2009, select this issue of T e Dermatology Report, and click cCME Post Test d to open a window into Beam Institute 9s Web site. " Complete the Beam Institute enrollment form, enter your post-test answers from the worksheet on pages 46 3 4 7 , and respond to all of the questions on the evaluation form, then click the cSubmit d button. R e full text of each article may be accessed on the R eDermatologyReport . com Web site, should you need to refer to it again. " If you answer correctly at least 12 (80%) of the 15 post-test questions, you will immediately receive credit for this educational activity and can access your certiN cate online by clicking cView/Print CertiN cate d on the acknowledgment page. R e certiN cate may be printed out by using the Print button or selecting Print on the File menu of your Web browser. Your candid and thorough completion of this evaluation will help Beam Institute improve the quality of its CME/CE activities. R ank you for your participation. Strongly agree Agree Disagree 1. As a result of this activity & a. I have a better appreciation of the diP erences between acne vulgaris, Q Q Q rosacea, and other common skin disorders and their management. b. I have a greater understanding of the diagnosis and treatment of Q Q Q psoriasis and nonmelanoma skin cancers. c. I am more knowledgeable about both biologic and nonbiologic agents Q Q Q useful in the treatment of a variety of skin disorders and diseases. d. I am more familiar with the clinical applications of botulinum toxins, Q Q Q dermal N llers, and various cosmeceuticals. Strongly agree Agree Disagree 2. I found the content of this educational activity & a. Clearly written and well organized. Q Q Q b. Accurate and timely. Q Q Q c. Related to its overall objectives. Q Q Q d. Free from commercial bias. Q Q Q e. Relevant to my own clinical practice. Q Q Q Yes No Don 9t know 3. Did the information you received from this CME activity: a. ConN rm the way you currently manage your patients? Q Q Q b. Suggest new options for managing your patients that you might apply Q Q Q in the future? Patient Board CME management review credit 4. I used the information in this issue for & (check all that apply) Q Q Q 5. Approximately how long (in minutes) did it take you to complete this activity, minutes including this evaluation? E valuation

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