Proton Pump Inhibitors Increasing Skin Aging?

Skin aging has long been important to human beings and in recent years this field has received tremendous attention by both researchers and the general population. Cutaneous aging includes two distinct phenomena, intrinsic aging and photoaging, and is characterized mainly by the loss of collagen fibers from dermis.

PPI's (by inhibiting the stomach's hydrochloric acid secretion) raise the pH of the stomach juices and surrounding environs to a markedly more alkaline milieu.... and increase intralysosomal (inside the lysosome) pH. By changing the original acid base balance to a more basic medium TGFB secretion is decreased and lysyl oxidase which needs copper to do its job in cross linking collagen to make new skin can't do it's enzymatic best because it may not get the "copper on demand" it requires even though the supply is there.

With this new information on how proton pump inhibitors can accentuate skin aging, they should no longer be viewed as a safe first line therapy for acid reflux.It has been known for some time that PPI's prevent the absorption of certain vitamins (specifically B12)and minerals (specifically calcium) promoting osteoporosis. What we tend to forget is that they primarily prevent normal digestive processes from occurring leading to a myriad of gastrointestinal problems, physician visits and other prescription drug usage with their attendant side effects.

Unsupervised Physician Extenders Are a Key Malpractice Concern

Dr. Goldberg was recently interviewed by Denise Napoli of Skin & Allergy News magazine. Here is the published May, 2010 article in its entirety.

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Improper use of "physician extenders," a lack of informed consent, and patient dissatisfaction are some of the top reasons why patients sue, and all are easily preventable, according to Dr. David J. Goldberg.

The first - the use of unsupervised or improperly trained physician assistants, nurse practitioners, or other physician extenders - hits home for many dermatologists. According to the American Academy of Dermatology, in 2010, 36% of physicians will use NPs and PAs in their practice, up from 30% in 2007 and 20% in 2002, Dr. Goldberg said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation in Santa Monica, Calif. "NPs and PAs who work for core physicians are clearly the most qualified nonphysicians to perform these procedures," said Dr. Goldberg, director of dermatologic laser research at Mount Sinai School of Medicine, New York. Many have received cosmetic training through the Aesthetic Extender Symposium (www.aestheticextendersymposium.com), he said.

However, there are still risks. A 2006 American Society for Dermatologic Surgery survey found that 51% of ASDS members reported seeing nonphysician, nonsupervised physician-extender complications in their practice, with the two most common being misdiagnosed skin cancer and scarring following dermatologic procedures.

"If the [physician extender] is sued, so will be the provider who is affiliated with the PE," said Dr. Goldberg, who also is on the faculty of Fordham University School of Law in New York.

Poorly informed or uninformed consent is another moneymaker for medical malpractice lawyers in the field of dermatology, according to Dr. Goldberg. "Because dermatologists tend to see large numbers of patients, there is a tendency to be overwhelmed by the paperwork associated with quality informed consent," he said.

One procedure to be especially careful about is botulinum toxin type A injections - there were 2,464,123 in 2008, according to the American Society for Aesthetic Plastic Surgery. The black box warning on Botox reads "swallowing and breathing difficulties can be life threatening and there have been reports of death."

Dr. Goldberg encouraged physicians to instruct patients to read the warning on botulinum toxin "each and every time" they receive it. He also encouraged discussion about these risks and the procedure's other rare but potential side effects, including generalized muscle weakness, diplopia, ptosis, dysphagia, dysphonia, dysarthria, and urinary incontinence.

He noted that many of these potential complications have never been reported with the cosmetic use of botulinum toxin.

Finally, Dr. Goldberg said that dermatologists can keep legal troubles at bay simply by keeping patients happy. He cited a 2006 retrospective chart study of all patients who received botulinum toxin injections over a 2-year period at a private dermatology clinic. The retention rate was 55%. However, the "institution of a 2-week posttreatment evaluation increased the retention rate from 55% to 67%," said Dr. Goldberg (Dermatol. Surg. 2006;32:212-5).

"Probably more important in keeping patients happy - and keeping them coming back - is to communicate with patients," he advised. "Treat each patient as if they are special. Pay total attention to their concerns. They will appreciate your one-on-one interaction with them."

Dr. Goldberg is a founding director of the Aesthetic Extended Symposium. SDEF and this news organization are owned by Elsevier.

Using Light-Activated Technologies for Battlefield Injuries

A recent research study by the Air Force Office of Scientific Research shows that conventional sutures as well as glues and staples used to repair wounds in the skin or to reconnect nerves, blood vessels, tendons and corneal incisions, can be replaced with Photochemical Tissue Bonding. According to Dr. Irene Kochevar (Massachusetts General Hospital Wellman Center researcher and Harvard Med School professor), "We have demonstrated that this technology is very helpful in medicine for the Air Force because it produces better healing and functional outcomes than the same wounds that were treated with conventional materials.”

Bonding (aka nanosutures) is achieved when a dye is applied to the wound, after which the wound is exposed to green light for a brief time. The dye absorbs the light and then proceeds to molecularly bond proteins on the surface of the tissues. "No glues, proteins or other materials are used that might stimulate an inflammatory response," said Kochevar. "An immediate, water-tight seal is formed between the tissue surfaces leading to reduced inflammation in the near term and better scar formation in the long term."

Researchers plan to continue to assess the efficacy of this new technology, particularly as to how it might be made even more effective in the field. If all goes well, they hope to create a shorter treatment time and an even stronger bond. "We are approaching this challenge by identifying the basic molecular mechanisms responsible for light-activated crosslinking," she said. "We believe that this information will show us how to improve the efficiency and effectiveness of the nanosuturing technology on the battlefield."

Valeant Pharma to Purchase Vital Science Corp

According to a Socaltech.com report, Valeant Pharmaceuticals (VRX.N) will purchase Vital Science Corp., a Toronto-based manufacturer of over-the-counter dermatology products in the 2^nd quarter of 2010. They have recently acquired two other dermatology firms, both in Brazil. One of the firms, a private Brazilian company focusing on branded generics and OTC products, reported annual sales in the 49 million Brazilian reals range (about 26.7 million dollars US) with an average compounded growth of 15% per year. Purchase price for this company is reported to be approximately 56 million US$ and will be consummated in the 2^nd quarter of 2010.

"This latest transaction, along with Valeant's acquisition of Instituto Terapeutico Delta Ltda last month, will be our second acquisition in Brazil this year," stated J. Michael Pearson, chairman and chief executive officer. "We see strong synergies between these two acquisitions and our current operations in Brazil and believe that the combination of all three businesses will provide Valeant with expanded opportunities for growth in Brazil and enhance our Latin American franchise. This new business operation has had product sales that have grown in excess of 30% over the last year, while also achieving operating margins greater than 20%. Incorporating our new, state-of-the-art manufacturing plant in Indaiatuba will also provide us the ability to achieve significant growth and synergies across all three businesses."

The company has been on a shopping spree over the past few years, with purchases in 2009 of EMO-FARM, Mexico’s Tecnofarma S.A. de C.V. (Tecnofarma); Private Formula Holdings International Pty Limited (PFI) in Australia; Canadian skincare firm, Laboratoire Dr. Renaud and another US company. Last May, Valeant bought trademarks, inventory and intellectual property for dermatology products that were sold in New Zealand and Australia.

Valeant Pharmaceuticals International (Valeant) is a multinational specialty pharmaceutical company that develops, manufactures and markets pharmaceutical products. Their specialty pharmaceutical and over-the-counter (OTC) products are marketed under brand names and sold in the US, Canada, Australia and New Zealand. Valeant also has branded generic and OTC operations in Europe and Latin America, which focus on pharmaceutical products that are bioequivalent to original products and are marketed under company brand names. The Company’s product portfolio consists of 380 products with approximately 2,000 stock keeping units. The Company’s products are sold through three segments: Specialty Pharmaceuticals, Branded Generics/Europe and Branded Generics/Latin America.