Stelara (ustekinumab) and Remicade (infliximab) are effective if Enbrel (etanercept) stops working in psoriasis

About 7.5 million Americans suffer from psoriasis, a lifelong disorder characterized by inflammation of skin and, often, the joints.

Stelara, Remicade, and Enbrel are all biologics -- drugs made of genetically engineered proteins -- that are generally used to treat patients who aren't responding to traditional therapies such as light therapy and methotrexate.

Remicade and Enbrel both block tumor necrosis factor-alpha (TNF-alpha), a chemical produced by immune cells that fuels inflammation, much like gas on a fire. Stelara targets two proteins, interleukin 12 and interleukin 23, that also drive the inflammatory process.

References:
Study Shows Stelara and Remicade Are Both Effective if Enbrel Stops Working. WebMD, 2010.

Image source: Crystal structure of human IL-12, Wikipedia, public domain.

Non-surgical Baldness Treatments Rated Ineffective by Most Patients

Only 27% of men who used Propecia (finasteride) said it was “very” effective. Finasteride is a 5-alpha reductase inhibitor used to treat prostate enlargement symptoms and baldness. Finasteride has 2 trade names: Propecia for baldness and Proscar for BPH.

Over-the-counter minoxidil (Rogaine) is applied directly to the scalp and is the only hair regrowth drug approved for use by women. Just 4% of respondents said it was very effective, with 43% of users saying it was not effective at all.

Only 2% of men surveyed underwent hair transplants; but of these, 49% were either very or completely satisfied with the results of their surgery, the poll shows.


Minoxodil - Costco.

References:
Survey: Most Baldness Treatments Don't Work. WebMD.
Widely used baldness drug finasteride (Propecia) boosts hair growth in men, but 1 in 80 may develop ED http://goo.gl/6lmd

Experts Answers on Alopecia and Hair Loss - NYTimes.com http://goo.gl/Oplfw

Drugs that "shrink prostate" and treat baldness (5-alpha-reductase inhibitors) may have sexual side effects that persist after stopping them, WebMD, 2011.

Image source: Finasteride, Wikipedia, public domain.

Comments from Facebook:

"Ah... so you are supposed to rub it on the scalp... I've been drinking it all these years, no wonder it has had no effect"

Sunscreen with high SPF needed at high altitudes: 8-10% increase in sun exposure for every thousand feet of elevation

Golfers playing in Vail, Colorado, at 2500 meters (roughly 8200 feet) above sea level, got significantly more burn protection from sunscreen with a sun protection factor (SPF) of 70+ compared to one with an SPF of 15.

There is 8-10 percent increase in sun exposure for every thousand feet of elevation. In the summertime, you can get anywhere from 40 percent to 50 percent greater sun intensity than at sea level.

References:
Sunscreen with high SPF needed at high altitudes, Reuters.

What sunscreen to use for children?

Study confirms sunscreen prevents melanoma http://goo.gl/16Vqd

Can You Get Sunburned Through a Car Window? http://goo.gl/M7Fwv - No, but penetrating UVA rays may be related to left-sided skin cancers.

Related:

Melanoma - JAMA Patient Page illustrates the ABCDE of diagnosis, 2011.

Image source: Amazon, for illustration only, not a suggestion to buy any products.

Eating chocolate with high flavanol levels can protect the skin from UV light

Cocoa beans fresh from the tree are exceptionally rich in flavanols. Unfortunately, during conventional chocolate making, this high antioxidant capacity is greatly reduced due to manufacturing processes.

The researchers evaluated the photoprotective potential of chocolate consumption, comparing:

- conventional dark chocolate
- specially produced chocolate with preserved high flavanol (HF) levels.

A double-blind in vivo study in 30 healthy subjects was conducted, 15 subjects were randomly assigned to either a high flavanol (HF) or low flavanol (LF) chocolate group and consumed a 20 g portion of their allocated chocolate daily.

The minimal erythema dose (MED) was assessed at baseline and after 12 weeks.

In the high flavanol (HF) chocolate group the mean MED more than doubled after 12 weeks of chocolate consumption, while in the LF chocolate group, the MED remained without significant change.

The authors concluded that regular consumption of a chocolate rich in flavanols confers significant photoprotection and can thus be effective at protecting human skin from harmful UV effects. However, conventional chocolate has no such effect.


Video: Chocolate Rain by Tay Zonday.

References:
Eating chocolate can significantly protect the skin from UV light. Williams S, Tamburic S, Lally C. J Cosmet Dermatol. 2009 Sep;8(3):169-73.
Link via @DrShock.

Photo Essay: Making Chocolate in Belize http://goo.gl/2DPi
Image source: Wikipedia.

Related:

Times have changed

@ConanOBrien:

http://twitpic.com/17lx53 - I no longer have health care. Could someone show this to a dermatologist and get back to me?

@pyknosis:

I'm a hematologist, not a dermatologist, but looking at that, I give you 7 months. Don't worry. That's a really long time.

That's just good humor, as Happy Hospitalist likes to say.