Stem Cells From Fat Might Improve Plastic Surgery

By Amy Norton
HealthDay Reporter

THURSDAY, Sept. 26 (HealthDay News) -- Using people's own stem cells from their body fat could aid in plastic surgery procedures such as post-cancer breast reconstruction, a small, preliminary study suggests.

The study, published in the Sept. 28 issue of The Lancet, looked at whether stem cells might improve the current technique of "lipofilling" -- where fat is removed via liposuction from one part of the body, purified, then injected into another area of the body.

Doctors use lipofilling in cosmetic procedures to create smoother skin or fuller lips. But it also has a range of medical uses. Fat injections can help reshape the breasts in women having reconstruction after breast cancer surgery. They can also be used in correcting facial deformities caused by an injury or congenital defect, or helping certain burn injuries heal.

The problem is that transferred fat often doesn't last, explained lead researcher Dr. Stig-Frederik Kolle.

"It's unpredictable," said Kolle, of the plastic surgery department at Copenhagen University Hospital in Denmark. "And you often have to repeat the procedure to get a [satisfactory] result."

So Kolle's team tested a different approach: Take stem cells from people's body fat and use them to "enrich" the fat tissue being transplanted from one body area to another. Stem cells are primitive cells that develop into more mature ones.

The researchers recruited 10 healthy volunteers who underwent liposuction to have fat taken from the abdomen. The fat was then purified and injected into the volunteers' upper arms. In one arm, the fat transplant was enriched with stem cells; the other arm received a traditional transplant.

After about four months, the researchers took MRI images of the fat transplants, then removed them. It turned out that the stem cell-enriched transplants had retained about 81 percent of their initial volume, on average -- compared with only 16 percent among the stem cell-free transplants.

Dr. J. Peter Rubin, chair of plastic surgery at the University of Pittsburgh Medical Center, said the study is "very" important.

"We've known that this works in animals. What's been missing is good data on humans," said Rubin, co-author of an editorial accompanying the study.

These early results offer a "proof of principle," and need to be followed up with clinical trials of actual patients, rather than healthy volunteers, Rubin said.

One question is whether the transplanted fat will hold up over the long term, experts say. "We have no reason to believe that it won't last," Kolle said, but it still needs to be shown in studies.

And why do the added stem cells help? It's not clear, said Kolle. One possibility is that they spur the growth of small blood vessels and give the transplanted fat a better blood supply. The stem cells may also develop into mature fat cells, or send out "signals" that cause other cells -- such as fat or blood vessel cells -- to increase in number.

As for safety, Kolle and Rubin said there is a theoretical concern in using stem cell-enriched fat in women who've been treated for breast cancer. Some of the benefits of stem cells -- such as releasing "growth factors" that stimulate other cells -- could potentially feed a breast cancer recurrence.

"There's no evidence to suggest that this is true," Rubin said. But it is a possibility that everyone should be aware of, he added.

Kolle agreed. "We need to move forward carefully," he said.

Even if stem cell-enriched fat transplants prove safe and long lasting, there will be practical hurdles, since the approach would add costs and complexity. Kolle said the process of harvesting the stem cells, then growing and expanding them in cultures, is actually relatively simple -- but the facilities have to be in place.

"No, not every center will be able to do this," he said.

Still, editorial author Rubin said that new technology is needed. Breast reconstruction, he noted, has been done by the same methods for decades. It's possible, said Rubin, that stem cells could help allow some women to have reconstruction done solely via fat injections -- without the major surgery or implants used now.

The current study was funded by the Danish Cancer Society. None of the researchers reports any financial conflicts of interest. Rubin has submitted a patent application for an instrument that harvests body-fat tissue.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Stig-Frederik Trojahn Kolle, M.D., department of plastic surgery, Copenhagen University Hospital, Copenhagen, Denmark; J. Peter Rubin, M.D., chair, department of plastic surgery, University of Pittsburgh Medical Center; Sept. 28, 2013, The Lancet

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Health Tip: Troubled by an Ingrown Toenail?

(HealthDay News) -- An ingrown toenail occurs when a toenail, usually one that's trimmed too short, begins to grow into the toe's skin.

The American Academy of Orthopaedic Surgeons says symptoms of an ingrown toenail include:

A toe that feels hard to the touch, and appears swollen.Pain, soreness or tenderness in the toe.Redness on the toe.Signs of infection around the nail, including visible pus.Skin growing over the nail.

-- Diana Kohnle
Copyright © 2013 HealthDay. All rights reserved.

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Atlanta Women Offers Hope for Those With Psoriasis

By Serena Gordon
HealthDay Reporter

FRIDAY, Sept. 13 (HealthDay News) -- Alisha Bridges spent most of her life covering up and hiding. She didn't want the world to see the scaly patches of psoriasis that cover a significant portion of her body.

She's tried almost every treatment that's out there, with varying degrees of success, she said. Topical corticosteroids tend to work best for her, but because they can be used for only limited periods of time, she tries to restrict their use to when she has a special occasion coming up and as warmer weather approaches.

As much as 90 percent of her body is often covered with psoriasis, Bridges said.

She was only 7 years old when she was diagnosed with the autoimmune skin disease after a bout of chickenpox. Bridges said she's spent most of her life worried that people would stare, or that they'd think she had something that was contagious.

"I was hiding and being ashamed -- I was my own worst enemy," admitted Bridges, who just turned 26.

But then she started blogging about what it's like to live with psoriasis, and people took notice. She was invited to the National Psoriasis Foundation meeting in Washington D.C., where she attended a number of workshops, including one on using social media to raise awareness and connect with others.

Since then, she's been busy raising awareness through Facebook and Twitter, and she's continued to blog about living with psoriasis. She's also become a National Psoriasis Foundation community ambassador.

"Finding support is imperative in the battle with psoriasis," Bridges said. "It's so important to know that you're not alone -- that other people are also dealing with this. And, don't be afraid to speak out. When you start talking about it, people are more understanding than you expect them to be. The majority of people don't know what psoriasis is, but many are open to hearing more about it."

Support groups, she said, are great places to learn about what works and what doesn't for psoriasis, and to pick up tips -- like learning to be persistent and patient with your medication.

"Sometimes treatment won't work until months later, so you have to be persistent in using them, even when you don't see results right away," she said.

Bridges also recommends getting comfortable with your disease.

"No matter what you show of your psoriasis, talk about it until you're comfortable with it," she said. "It's a process that takes time. Three years ago, I didn't talk about it at all. Now, I'm working on exposing my psoriasis," Bridges explained.

"I won't say I'm comfortable enough to go to the grocery store in shorts just yet," she said with a laugh, "but I'm working on it."

Copyright © 2013 HealthDay. All rights reserved. SOURCE: Alisha Bridges, National Psoriasis Foundation community ambassador, Atlanta

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Treatment Options Expand for Psoriasis Patients

By Serena Gordon
HealthDay Reporter

FRIDAY, Sept. 13 (HealthDay News) -- For the legions of Americans living with the red, scaly patches of psoriasis, doctors have good news.

"We are at a point where we can help almost anyone, and we can do it fairly safely," said Dr. Mark Lebwohl, who chairs the National Psoriasis Foundation's medical board. "If you have psoriasis, there's usually a treatment out there that will make you better."

Some 7.5 million people in the United States have the autoimmune disease, yet it's unknown to millions of others.

The telltale scaly patches often occur on the outside of the elbows, knees and scalp, but they can appear anywhere on the skin and may itch, sting or burn. Some people with psoriasis also develop psoriatic arthritis, which causes stiffness, pain, throbbing, swelling and tenderness in one or more joints.

Symptoms vary from person to person, as does severity of the disease. Some people are affected mildly, while others have signs of the disease over most of their body.

But Lebwohl said there are more treatment options available today than ever before, and more are on the way. "We have medicines that are pretty safe and incredibly effective for the large majority of patients," he said.

For most people, the first line of treatment is a topical medication. Topical corticosteroids are probably the most common first treatment, he said, and they often work very well but are prone to such side effects as thinning skin and stretch marks.

Dr. Janet Lin, a dermatologist at Mercy Medical Center in Baltimore, also noted that people can develop a resistance to topical corticosteroids, which means the medication won't work any longer.

Another topical treatment is a class of medications known as vitamin D analogues, which Lin said "help normalize the growth of the skin cells, and they don't have the side effects of corticosteroids." Examples are calcipotriol, calcitriol and tacalcitol.

Two other topical formulations approved for psoriasis treatment are salicylic acid and coal tar, according to the foundation.

Lin said that steroids injected into areas with psoriasis patches can help thin out the scales, but they can be used only in limited areas.

Light therapy can also help people with psoriasis. "There are certain wavelengths in the UVA and UVB spectrum that help suppress inflammation," she said. The problem with light therapy, though, is that it must be administered in a doctor's office two to three times a week, which makes it inconvenient.

Oral medications also are available and are often the first ones tried for widespread psoriasis. "If someone is covered from head to toe with psoriasis," Lebwohl said, "it's useless to try topical treatments."

Examples of oral medications are acitretin, cyclosporine and methotrexate. He said that most insurance companies prefer that people start with methotrexate because it's effective and considerably less expensive than some of the alternative treatments. Most oral drugs, however, are not considered advisable for use by women during their childbearing years.

The newest and perhaps most helpful drugs for people with psoriasis are called biologics and include such drugs as Enbrel, Humira, Remicade and Stelara. They work by suppressing certain parts of the immune system, and are given by injection or intravenously, Lebwohl said. Because they affect the immune system, however, they carry some increased risks.

"People usually do very well on these medications," Lin said, but she added that "they may see an increase in colds or in infections like strep throat."

For people with psoriatic arthritis, Lebwohl said, methotrexate and most of the biologics are the preferred treatments.

Many people end up using a combination of medications -- a biologic and topical corticosteroids, for instance.

Even more options are in the treatment pipeline.

Lebwohl said there are "at least two pills on the near horizon, and at least five new biologics in the works." And, according to the foundation, more oral medications and new topical treatments are currently being tested in clinical trials.

"There are good medications to control psoriasis, but there's no cure yet," Lin said, but she added that, with all the new medications in development, there's reason to be hopeful.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Mark Lebwohl, M.D., chairman, medical board, National Psoriasis Foundation, and Sol and Ciara Kest professor and chairman of dermatology, Icahn School of Medicine at Mount Sinai, New York City; Janet Lin, M.D., dermatologist, Mercy Medical Center, Baltimore

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Psychological effects of acne

The physical symptoms of acne are generally obvious to anyone who sees them. Painful-looking, blotchy red patches of skin which can, if left untreated, lead to breakage of the skin and aggravated problems are a common symptom of acne vulgaris. What people looking from the outside often don’t see is the severe mental and emotional torment that can be caused by acne. As it is well established that acne affects predominantly teenage victims – who are already at a stage in their life when they are most emotionally insecure – the importance of tackling it as early and as effectively as possible is clear.

The reasons for acne having such a profound psychological effect are easy to see. During our teenage years we experience a very pronounced surge in hormones which affects almost everything about us. We grow in height, our voices change, and as puberty takes its effect our bodies change beyond all recognition. In addition to this our minds change considerably too, as we become acutely aware of our burgeoning sexuality and that of our peers. It is a pressurised time for anyone, and adding the self-esteem problems generated by acne means it is hardly a surprise that it is seen as a cause of teenage depression.

There have been studies which point to a link between acne and problems as severe as suicide. Problem acne can be so profoundly affecting for an individual that they feel there is no prospect of ever being happy. If necessary, it can be helpful to have counselling alongside whatever acne treatment you decide on.

Acne Treatment

It is fair to say that the list of possible treatments for acne stretches a long distance when written on paper, and some of the treatments listed would be as effective if that is where they remained. Acne treatment, and any other kind of medical treatment for a skin condition, will always be a potentially lucrative market because of the large numbers of people with skin conditions, who are keen to get rid of their blemishes by one means or another. Many of the products available for treatment of acne or other skin conditions, however, are at best temporarily or superficially effective. Those which are powerfully effective are more likely to have side-effects, leaving the sufferer with a choice between ineffective and detrimental.

It seems clear that prevention of acne is considerably better and more reliable than any known cure. This prevention depends on a system that does not merely treat symptoms, but combats the underlying root causes of the skin condition. Anti-inflammatory medication, for example, will prevent the skin from becoming reddened and blotchy. Hormone supplements which level out the amount of testosterone – frequently overproduced in acne sufferers – are also beneficial. Other treatments have differing effects but, taken in combination, the overall effect can be to deal with each of the separate problems which together cause acne blemishes to appear on the skin. There are other measures which can be taken – not least dietary changes and washing regimes – to produce a holistic acne prevention system. Treating the problem globally in this way is perhaps the best bet for long-term effectiveness.