EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, NOVEMBER 17, 2003
To contact Joel M. Gelfand, M.D., call Susan Winston at 215/349-8368.

PSORIASIS MAY INCREASE RISK FOR CERTAIN CANCERS

CHICAGO—Patients with the skin disease psoriasis may be at an increased risk for developing lymphoma, according to an article in the November issue of The Archives of Dermatology, one of the JAMA/Archives journals.

Psoriasis is a common skin disease characterized by patches of thickened, red and scaly skin, usually on the torso or arms, and can be painful and disfiguring in some cases. According to the article, psoriasis affects about 1 percent to 2 percent of the population. Previous research has shown that people with psoriasis may be at an increased risk for developing lymphoma - a group of cancers affecting the lymph tissues found mainly in the lymph nodes and spleen.

Joel M. Gelfand, M.D., of the University of Pennsylvania, Philadelphia, and colleagues investigated whether the rate of lymphoma in patients with a history of psoriasis is different from the rate of lymphoma in patients without psoriasis.

The researchers studied a random sample of 10 percent of patients 65 years or older (2,718 patients with psoriasis; 105,203 without) who were registered with a general practitioner who contributed to the General Practice Research Database (GPRD) between 1988 and 1996. The GPRD was established in the United Kingdom in 1987 and is a medical record database that holds data on more than 8 million patients including information on diagnoses and medications. The median follow-up time for the patients was 46 months (the median is the middle value; half the patients follow-up times were longer than 46 months, half were shorter than 46 months).

During the study period, the authors identified 276 lymphomas. "Patients with psoriasis had an almost 3-fold increased rate of lymphoma compared with patients without psoriasis," the authors write. "Patients 65 years or older who had psoriasis developed an additional 122 lymphomas per 100,000 patients annually."

After reviewing the medical records of patients with psoriasis who had lymphoma, the researchers found that "all patients with psoriasis who developed systemic lymphoma were treated with medications consistent with psoriasis and had outcomes consistent with the diagnosis of lymphoma (e.g. referral to an oncology service)."

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, NOVEMBER 17, 2003
To contact Boni E. Elewski, M.D., call Hank Black 205/934-3884.

NEW TREATMENT APPEARS EFFECTIVE FOR ROSACEA

CHICAGO—Application of a new formulation of azelaic acid gel to the face reduces the redness and lesions associated with rosacea better than a commonly used treatment (metronidazole gel), according to an article in the November issue of The Archives of Dermatology, one of the JAMA/Archives journals.

Rosacea is a chronic skin condition characterized by red, flaky patches on the nose and cheeks and sometimes accompanied by lesions that appear similar to small pimples. According to the article, rosacea usually fist appears in people between the ages of 30 and 60 years. Rosacea seems to respond well to topical antimicrobial treatments (creams or gels that kill microorganisms like bacteria), although the mechanisms behind this are not well understood, especially because no microorganisms have been identified as causes of rosacea. Azelaic acid and metronidazole are two antimicrobial preparations used to treat acne, and have also been observed to reduce skin conditions associated with rosacea. A new product containing 15 percent azelaic acid has been formulated specifically to treat rosacea.

Boni E. Elewski, M.D., of the University of Alabama at Birmingham, and colleagues conducted a randomized, double-blind study to compare the new 15 percent azelaic acid gel (Finacea; Berlex Laboratories, Inc., Montville, N.J.) with 0.75 percent metronidazole gel (MetroGel; Galderma Laboratories LP, Fort Worth, Tex.) in treating patients with rosacea. The researchers randomly assigned 251 patients (aged 18 years or older) to use either azelaic acid gel (n=124) or metronidazole gel (n=127). The patients applied the gels to the affected areas twice a day for 15 weeks. Participants enrolled in the study between October 29, 2001 and January 31, 2002.

The researchers found that the azelaic acid gel was better than metronidazole gel at reducing the number of lesions associated with rosacea. Fifty-six percent of patients in the azelaic acid gel group experienced a reduction in redness vs. 42 percent of the metronidazole gel group. The researchers also found that the effectiveness of the metronidazole gel seemed to plateau after 8 weeks, while patients in the azelaic acid gel group showed continuous improvement over 15 weeks.

The researchers conclude: "Results showed that azelaic acid gel was consistently superior to metronidazole gel in improving principal signs of rosacea (for example, reducing inflammatory papules and pustules and reducing erythema [redness] intensity). In addition, azelaic acid gel was superior to metronidazole gel in improving or resolving rosacea signs as measured by two distinct investigators' assessments."

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, NOVEMBER 17, 2003
To contact Sandro Sorbi, M.D., e-mail sorbi{at}unifi.it.

RESEARCHERS DESCRIBE NOVEL GENE MUTATIONS ASSOCIATED WITH ALZHEIMER DISEASE

CHICAGO—Three mutations in genes associated with Alzheimer disease (AD) are described by researchers in the November issue of The Archives of Neurology, one of the JAMA/Archives journals.

Alzheimer disease (AD) is a complex neurodegenerative disorder often affecting the elderly and characterized by gradual loss of memory and cognitive decline, according to the article. AD is often accompanied by a buildup of certain proteins or plaques in the brain. Since 1991, the results of genetic studies have led to the identification of gene mutations and variations that can either cause AD or increase the risk for developing the disease. Familial Alzheimer disease (FAD), which accounts for approximately 5 percent to 10 percent of all cases of AD, has been found to influenced by mutations on genes coding for presenilin. Presenilin is a protein that has been associated with plaque formation.

Sandro Sorbi, M.D., of the University of Florence, Italy and colleagues obtained DNA samples from 45 individuals with FAD. Participants were outpatients from the neurology departments at the Universities of Florence and Parma, and the Santa Maria Nuova Hospital in Reggio Emilia, Italy. The authors conducted genetic studies to screen certain genes for mutations associated with FAD.

The researchers identified several families carrying presenilin mutations. They found one presenilin gene mutation associated with variable age of onset AD (from 35 to 85 years old) in one family, and found two new presenilin gene mutations associated with early onset AD at age 49 to 54 years old in two other unrelated Italian families.

"In conclusion, results of this study confirm and extend the concept that the clinical manifestation of PS1 and PS2 [presenilin genes] mutations may be typical for AD and more similar to other dementias," write the authors.

EMBARGOED UNTIL 3 P.M. (CT), NOVEMBER 17, 2003
To contact Wallace K. Dyer II, M.D., call Sarah Goodwin at 404/727-3366. To contact editorialist Keith A. LaFerriere, M.D., e-mail klaf1{at}sbcglobal.net.

SURGICALLY PLACED "SLING" REDUCES SIGNS OF AGING IN THE NECK

CHICAGO—A thin, plastic "sling" surgically placed under the skin beneath the skin and jaws helps reduce the saggy appearance of the neck that results from aging, according to an article in the November/December issue of The Archives of Facial Plastic Surgery, one of the JAMA/Archives journals.

According to the article, aging is often accompanied by changes in the face and neck, including loss of elasticity in the skin and an increase in the amount of fat in the neck, causing it to sag. Part of the reason the neck begins to droop is because the underlying muscle that acts as a kind of "sling" has stretched over time and can no longer support the tissues under the chin. Several plastic surgery procedures have been used to combat the signs of aging in the face and neck area, including face lifts and liposuction.

Wallace K. Dyer II, M.D., and Arvind Prabhat, M.D., of Emory University School of Medicine, Atlanta, investigated the use of an artificial plastic sling to help lift the tissues under the chin to give a more youthful appearance. The permanent sling - a narrow strip of polytetrafluoroethylene (a kind of plastic) - is surgically attached under the skin and is positioned beginning behind one earlobe, extends below the jaw and chin and ends behind the other earlobe.

The researchers implanted the sling in 100 patients when they underwent various other plastic surgery procedures to rejuventate the neck (including liposuction and skin tightening) between October 1996 and December 1998 (88 women; average age 54 years old). The average follow-up for the patients was about three years.