A novel patient-administered treatment for malignant and pre-malignant skin lesions

It is a well established fact that the incidence of sun-related skin damage (photo-ageing) and neoplastic transformation (photo-carcinogenesis) has progressively increased in recent decades as a result of cultural and occupational trends leading to increased sun exposure and use of sunbeds, particularly in Caucasian populations. Reference to a topical immune response modulator known as Imiquimod (Aldara™).peer-reviewe

The adverse effects of the sun on the skin : a review

Solar radiation causes a variety of biologic effects in the skin which are predominantly harmful. The only recognised beneficial effect is that of endogenous photosynthesis of vitamin D from its precursors in the skin, the importance of which is greatly diminished by a well balanced diet. Acute excessive exposure to ultraviolet radiation (UVR) causes sunburn, whereas chronic overexposure is responsible for the process of photo ageing and skin cancer. This sun related degenerative process and neoplastic transformation may be effectively minimised by an increased public awareness of the harmful effect of the sun.peer-reviewe

Sun awareness and sun protection among persons attending dermatology clinics in Malta

On a global level, public awareness of the harmful effects of the sun on the skin, namely skin cancer and photo ageing, has gradually increased largely as a result of ongoing public educational campaigns. In order to assess the current level of knowledge of sun-related skin damage, and to evaluate sun protection habits among Maltese persons (aged 16-50 years) attending dermatology clinics in 3 local hospitals, we undertook a questionnaire survey. A total of 333 valid completed questionnaires were available for evaluation. The vast majority of respondents were aware that exposure to the sun causes skin cancer (93%) and skin ageing (85%). In addition, 69% of the respondents knew that skin cancer can kill. Overall however, this high level of sun awareness is not being translated into safe practice. Occupational sun exposure is substantially greater in men. Notwithstanding this trend men use sunscreens far less than women when out in the sun both at work and during leisure. Pursuing outdoor leisure activities including going to the beach during hours of peak sunshine in spring and summer is popular. The general level of sun protection during leisure is unacceptably low. The media are considered to be by far the most influential source of information on the subject of the sun and the skin. The results of this survey can be used to guide future sun awareness campaigns to focus on issues and population subgroups that need most emphasis.peer-reviewe

Acne Vulgaris in Malta : a dermatologist's perspective

Acne vulgaris is an inflammatory disease of the pilosebaceous units characterized by oily skin, and the formation of comedones, papulopustules, and less frequently nodulo-cystic lesions. Permanent scarring which may have profound negative psychosocial effects in the short and long term is a real risk. Varying degrees of acne affects at least 85% of 16 year old boys and girls, with a tendency towards natural resolution by the age of 2s2. Acne may less commonly affect older age groups, particularly in females. Exacerbating factors include psychological stress, pre-menstrual state, and oily applications including cosmetics. The alleged role of diet constitutes a common misconception among acne sufferers. An extensive array of topical and oral medications are nowadays available for effectively treating acne of any severity 3. Treatment needs to be tailored according to the type and severity of the acne, and must be administered with the least possible delay if scarring is to be minimized or prevented. Other than the mild forms of acne which may respond to over the counter (OTC) applications, acne treatment falls squarely within the competence of the prescribing physician. Health education can go a long way towards helping the public to better understand this common affliction, and to provide general guidance that will in turn aid to keep acne related morbidity to the lowest acceptable levels.peer-reviewe

Getting to grips with Urticaria

Urticaria is indeed a common dermatological affliction, which imparts a considerable degree of distress on the sufferer. Its clinical spectrum comprises urticarial wea ls (superficial dermal swellings), angio-oedema (deeper swellings), and the dreaded but fortunately rare anaphylaxis. Acute urticaria (lasting up to 6 weeks) is commoner in children, whereas chronic urticaria (which lasts anything from 6 weeks to several years) is commoner in adults. The underlying key patho- physiological event is the degranulation of mast cells and basophils, leading to the release of multiple mediators, the most important of which being histamine. Cellular degranulation may be triggered off either via an immunulogical process (IgE mediated) or directly (non- immunological). The released histamine binds to cutaneous histamine receptors producing the swelling, erythema, and itch. The aim of treatment is simply to suppress the symptoms until the disease process burns out.peer-reviewe

'Food allergy / intolerance testing' in dermatology : science or hype?

Food allergies are becoming an increasingly recognized clinical problem and patients frequently ask if their health complaints are related to their diet. There has been a recent phenomenon of food allergy or intolerance testing leading to dietary alterations and restrictions. This article gives a brief overview of the latest evidence and current guidelines for proper diagnosis and management. A distinction between food allergies and food intolerance or sensitivity should be made. It focuses on the association of the common skin conditions: eczema, acne and urticaria, to food and whether dietary changes are indicated. The currently available tests and their appropriateness are also discussed.peer-reviewe

Trends in sun exposure awareness and protection practices in Malta : 1999-2004

Rising skin cancer incidence rates have led to sun awareness campaigns in Malta since the early 1990s. The aim of this study is to assess the impact of these campaigns by analysing trends in sun exposure-related knowledge and behaviour amongst the Maltese people. A total of 559 Maltese pedestrians aged 16-50 years were interviewed in 1999. The same questionnaire was used to interview 304 pedestrians in 2004. More people admitted spending leisure time outdoors during peak sunshine hours in 2004 than in 1999 (85.9% vs 62.4%, p<0.001). There was a drop in people regularly wearing a hat during outdoor leisure activities from 32.4% to 18.4% (p<0.001), and from 37.5% to 9.3% (p<0.001) during outdoor work activities. Rates of regular sunscreen use remained constant at about 50% using it for outdoor leisure activities, but dropped from 25.0% to 9.3% for outdoor work (p=0.02). In 2004, 96.1% of participants having children aged less than 12 years stated that they regularly used sunscreen on their children (87.0% in 1999, p=0.01), while 66.2% said that their children regularly wore a hat (78.4% in 1999, p=0.05). More people were regarding a suntan as unhealthy in 2004 than in 1999 (62.8% versus 37.0%, p<0.001). The mass media remained the most important source of health information.peer-reviewe

Treatment of psoriasis with biologic agents in Malta

Introduction: Biologic therapy has revolutionalised the treatment of moderate to severe psoriasis leading to improved clinical outcomes and quality of life scores. This study aims to determine current biologic use in psoriatic patients at our Dermatology department at Sir Paul Boffa hospital, Malta. Method: All patients who were administered biologic therapy for psoriasis in Malta until the end of 2014 were included. Data included demographic details, disease duration and severity, biologic use and duration, previously attempted treatments, side effects, early and late response to biologic using Psoriasis Area Severity Index (PASI) scores and Dermatology Life Quality index (DLQI) scores. Results: A total of 36 patients were started on a biologic between 2009 and 2014 for psoriasis (M:25, F:11) with a mean age of 46.9 years. These included etanercept (n=22), infliximab (n=8), adalimumab (n=4) and ustekinumab (n=2). Secondary failure was the main reason why biologics were stopped and switched. Most patients had an improvement in their PASI scores after 2 to 4 weeks of starting the biologic and had a PASI 90 score improvement. All patients had more than a 5 point improvement in DLQI score. Discussion: Biologic use in our department is on the increase. Our patients had considerable improvements in their PASI and DLQI scores. Secondary failures have occurred usually after 2 to 4 years and switching has yielded positive results. Biologics are expensive drugs and recently we have switched to cheaper biosimilars. Doctors should be aware of the treatment options available for psoriasis patients, their possible side effects and when to refer to our department. In most cases a satisfactory response can be achieved.peer-reviewe

Prevelance of Tinea Pedis and Onychomycosis in Malta : the Achilles project

The Achilles project was set up because of the general poor awareness of foot disease, espe- cially of fungal foot infections. Foot diseases are often not viewed as a real problem, and the general public has limited knowledge of them. Most previous studies have involved small and specific population groups, such as school children, subjects visiting swimming baths, populations with specific occupations, or patients with underlying diseases like diabetes. Moreo- ver, patients often had to diagnose the condition themselves. The results of these self-assess- ments, was an underestimation of the prevalence of foot infections. (1, 2) The Achilles project was the largest epidemiological study ever to be carried out on foot health in Europe and other countries, related to the part of the body below the Achilles heel (e.g. foot, toes, toenails). Started in 1998, the aim of the project was to gain a better understanding of diseases affecting the feet and their prevalence among different patient groups with a view to improve the timely diagnosis and optimal treatment of this significant medical problem. The project also allowed an insight to be gained into the predisposing factors and quality of life in a large population, and to generate clinical data from a sample of the population. The data also served as the basis for epidemiological studies, allowing both medical professionals and pa- tients to benefit from this knowledge. The ultimate goal is therefore to increase the chance for timely diagnosis and treatment of foot disorders. Several European countries, including Austria, Belgium, the Czech Republic, Germany, Greece, Hungary, Italy, Luxembourg, the Netherlands, Portugal, Poland, Russia, Slovakia, Slovenia, Spain, Sweden, Switzerland and the United Kingdom (UK), have thus far participated in this foot-screening project, which was endorsed by the European Academy of Dermatology and Venerology (EADV) and the European Nail Society. Following the example of these countries, in 1999 Malta, Jordan and Cyprus implemented the Achilles project.peer-reviewe

Rituximab : a novel treatment for Pemphigus in Malta

Until recently, the main treatment for pemphigus has been systemic corticosteroids, usually administered at high doses with consequent side-effects. Lately, the biological agent rituximab has been introduced as an effective treatment for this condition. This article describes seven cases of pemphigus successfully treated with rituximab in Malta and discusses the benefits and drawbacks of this novel treatment modality.peer-reviewe