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Meet Steve T. Anderson, PA-C!

Steve received his bachelor of science in exercise physiology from Brigham Young University. He then went on to receive his master of medical science degree and physician assistant diploma from Emory University School of Medicine in Atlanta, Georgia. During his undergraduate studies, Steve worked as a rehabilitation therapist in the cardiac rehabilitation department at Utah Valley Regional Medical Center. After earning his PA and master’s degree he worked in family practice and urgent care in both Wyoming and California. He recently returned to Utah to work at Alpine Dermatology. Steve is a board certified physician assistant and is a fellow of the American Academy of Physician Assistants, the Utah Academy of Physician Assistants, and the Society of Dermatology Physician Assistants.

During his time in California, Steve was a member of the National Health Service Corps and worked in a remote location in the Tahoe National Forest, providing health care to the people of rural Sierra County. He has been a medical provider at county jails in California and Wyoming, and now in Utah.

Steve is a native of southwest Wyoming and enjoys all things recreational and outdoors with his family. He served a mission for The Church of Jesus Christ of Latter-day Saints in Sydney, Australia. Steve now lives with his wife and two children in Highland, Utah.

Blue light special: ALA-PDT safe and effective tool for treating acne lesions

Brooklyn, N.Y. — Recent research has shown that ALA-PDT using blue light is a safe and effective treatment for acne vulgaris.

ALA (Levulan) is absorbed by the skin and changes into a compound that is sensitive to light. ALA-PDT is a combination of a topical solution followed by exposure to blue light from the Blue Light Photodynamic Therapy Illuminator (BLU-U)
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The combination of ALA and PDT is believed to preferentially target Propionibacterium acnes (P.acnes) and sebaceous glands. Research
Wei-Li Lee, Ph.D., director of research, department of dermatology at the State University of New York (SUNY)-Downstate, Brooklyn, N.Y., and colleagues conducted an in vitro study to investigate the effects of ALA-PDT on cytokine production in cultured keratinocytes.
If complexity of a cytokine network’s regulation is an index of its biological importance, then IL-1 ranks as an extraordinarily important cytokine.

Skin is unique in that a significant reservoir of pre-formed IL-1 alpha exists in epidermis in situ. Both intact epidermis and stratum corneum contain significant IL-1 bioactivity, leading to the concept that epidermis is a shield of sequestered IL-1 surrounding the host, waiting to be released upon injury.

External stimuli, such as wounding, burns, UV radiation or chemical insults, along with internal stimuli such as local cytokine release from stimulated leukocytes, can induce the release of IL-1 for local or systemic delivery.

"The expression of cytokines such as IL-1 alpha plays a critical role in the development of inflammation and results in the expression of dermal and vascular adhesion molecules, chemoattraction of inflammatory cells, and stimulation of other mediators of inflammation," Dr. Lee Ph.D. tells Dermatology Times.

In vitro experiments
In the in vitro experiments, immortalized keratinocytes (hTERT cells. Rheinwald Lab) and primary keratinocytes (NHEK – normal human epithelial keratinocytes) were used. They were grown to subconfluence and treated with several concentrations of ALA ranging from 1 mM to 0.1 nM before being illuminated with narrow band blue light (NBBL at 405-420 nm) and/or treated with cytokines such as IFN-gamma (5-10 U/ml) and TNF-alpha (2.5-25ng/ml).

Efforts were made to mimic the therapeutic milieu of clinical trials, including exposure to ALA, incubation time, and dose used for NBBL exposure. ELISA was performed to detect pro-inflammatory cytokines IL-1 alpha and ICAM-1.

Results
Study results showed that treatment with ALA or BL alone is not cytotoxic to NHEK and hTERT keratinocytes. However, the combination of ALA with cytokines (IFN-gamma, TNF-alpha) caused cell death ranging from 27 to 48 percent. Adding NBBL to ALA and cytokines produced increased cell death ranging from 56 to 62 percent.
Based on MTT assays, all tested concentrations of ALA were equivalently cytotoxic.
The ELISA data demonstrated that ALA up-regulated the IL-1 alpha level whereas NBBL reduced the IL-1 alpha level; induction of IL-1 alpha by ALA with or without NBBL is not significantly dose-dependent. NBBL decreased IL-1alpha production when used alone (Shnitkind & Lee, J Drugs Derm 2006 5 (7): 605); this suppressive effect was lost when used in combination with ALA or with both ALA and cytokines (IFN-gamma + TNF-alpha).

Comparison
Comparison of IL-1 alpha production in NHEK and hTERT cells showed that the magnitude of up-regulation is higher in hTERT. When ALA was added to cytokines/NBBL treated cells, there was about a twofold increase in IL-1 alpha in NHEK cells and an up to five-fold increase production of IL-1 alpha in hTERT cells. The authors also noted that ICAM-1 upregulation was similar to IL-1 alpha.
The department of dermatology at SUNY-Downstate was one of the multicenter sites selected to study the effect of ALA-PDT therapy in treating patients (248 subjects) with moderate-to-severe acne.

Adverse Effects
According to Dr. Lee, side effects such as burning, stinging, and redness have been reported and are probably related to the cell cytotoxicity and increased IL-1 alpha level in the epidermis. Post-treatment efficacy evaluations show that patients remain well controlled up to three months following their last treatment.

"Though there is still some fine-tuning that needs to be done with ALA-PDT in the treatment of acne, this line of therapy is very important in light of the current and increasing worry clinicians have with prolonged use of systemic antibiotics and the risks of isotretinoin therapy.

"Acne therapy with ALA-PDT offers a different treatment approach and a possible treatment solution, especially for inflammatory acne,” Dr. Lee says.

Men, Young And Unmarried Ignore Skin Cancer Warnings

Men are twice as likely as women to not protect their skin in the sun, despite more men dying from melanoma than women, according to research due to be released at the British Association of Dermatologists annual conference in Glasgow next month.
The shocking survey of 1213 adults formed part of the Northern Ireland Omnibus Survey published in September 2008, a regular survey of the lifestyle and views of the people of Northern Ireland*.
It also found that people in their teens and early twenties are less likely than any other age group to use sun protection, despite increasing numbers of melanoma being diagnosed in this age group. One in ten people surveyed (10%) take no protective measures at all against sun exposure (compared to 8% in 2000). Men (14% vs. 7% women), unmarried people (13% vs. 8%), those with no children (11% vs. 9%) and those in their teens and early twenties (12%) are among the worst offenders.
Most people surveyed (70%) use sunscreen as their primary method of sun protection, despite warnings from dermatologists that shade and clothing should be the first line of defence against sun damage, with sunscreen offering additional protection. Of respondents who use sunscreen, almost one in three (30%) use a low protection sunscreen of below SPF 15. This is an improvement from 57% in the same survey carried out in 2000 but is still concerning as the British Association of Dermatologists recommends that people use a high protection sunscreen of at least SPF 30.
Only a quarter of respondents (24%) protect their skin by seeking shade during the middle of the day, with a similar number (23%) covering up in the sun. Worryingly both methods are less popular in 2008 than they were in 2000. Those most likely to protect their skin with clothing and shade fell into the 45 to 64 year and over-65 age groups. Women are more likely to use shade than men (29% vs. 18%), as are married people compared to unmarried people (26% vs. 19%), and those with children compared to those with no children (25% vs. 23%).
Sunscreen use is greatest among those aged 25 to 44 (77%), women (76% vs. 63%), married people (75% vs. 67%) and people with children (76% vs. 65%). Interestingly, although men are less likely to use sunscreen than women, those that do are more likely to use a SPF of 15 or over (73% vs. 68%).Dr Rhonda Boyle, Dermatologist at Royal Victoria Hospital, Belfast, and one of the study's authors, said: "Unfortunately the results of this survey demonstrate that, despite public health campaigns, the use of sun protection and attitudes to sun safety in Northern Ireland remain concerning."
Nina Goad of the British Association of Dermatologists said: "Sunscreen seems to be the preferred way of protecting the skin, but it seems that many people may be forgetting to cover up and seek shade in the sun. "It is worrying that people in their teens and early twenties are the least likely of any age group to protect their skin in the sun. This may be due to the prevailing fashion for tanned skin, but I would have hoped that young people would be more likely to use self tan products to get a bronzed look, rather than risking skin cancer. It may be that as people get older and start to see the visible sun damage on their skin, including wrinkles, they then take steps to protect themselves. "It is really interesting that unmarried people and those without children take the least care in the sun - it would be worth examining what the obstacles are for these people, and perhaps we need to look at tailoring our prevention campaigns for specific audiences in the future." The incidence of malignant melanoma in Northern Ireland (NI) has increased more than three fold since the 1970's with an almost parallel rise in melanoma-related deaths. Summary of results
Age-
Those aged below 25 are more likely than other age groups to use no sun protection at all (12% of this age group) - Sunscreen use is highest in the 25 to 44 year age group (77%)- Use of clothing and shade to protect skin is highest in those aged 45 and over.
Sex-
Women are more likely than men to use sunscreen (76% vs. 63%) and to protect the skin with shade (29% vs. 18%). - Men are twice as likely as women to use no sun protection at all (14% vs. 7%)- Although fewer men than women use sunscreen, those that do are more likely to use a SPF of 15 or over (73% vs. 68%).
Marital status and children
Married people are more likely than unmarried people to heed sun safety advice, as are people with children compared to those with no children: - Those who are unmarried are more likely than married people to use no sun protection (clothing, shade or sunscreen) at all (13% vs. 8%)- People with no children are more likely to not use any sun protection (clothing, shade or sunscreen) than those with children (11% vs. 9%)- Married people are more likely to use sunscreen than unmarried people (75% vs. 67%), as are subjects with children compared to those with no children (76% vs. 65%).
Choice of sun protection-
70% use sunscreen as their primary method of sun protection. - Of those who use sunscreen only 70% use a SPF of 15 or over. - Only a quarter of respondents (24%) protect their skin by seeking shade during the middle of the day, with a similar number (23%) covering up in the sun. - Notably one in ten people (10%) take no protective measures at all against sun exposure.
Facts about skin cancer-
There are three main types of skin cancer: malignant melanoma - the deadliest but least common, squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). - BCC and SCC are collectively known as 'non-melanoma skin cancer'. BCC is the most common skin cancer. - In the UK, more than 100,000 new cases of skin cancer are diagnosed annually, making it the most common cancer. Of these, more than 10,000 are melanoma. - There are over 2,300 deaths from skin cancer annually in the UK. - The annual incidence of melanoma worldwide is increasing faster than that of any other cancer. - In just 30 years, cases of melanoma across Great Britain have quadrupled in men and tripled in women. - Melanoma is more common in women than men, but there is a faster rate of increase in men and more men die from the disease, possibly due to late detection. - In as many as 4 out of 5 cases, skin cancer is preventable, so follow the British Association of Dermatologists' sun safety tips:

You don't have to avoid the sun all year, and some sunshine can be good for you as it helps the body to produce vitamin D, but taking a few steps when out and about in the summer sun or when on a sunshine holiday will help to protect you from sunburn and the risk of skin cancer, particularly if you are pale skinned. - Protect the skin with clothing, including a hat, T shirt and UV protective sunglasses - Spend time in the shade between 11am and 3pm when it's sunny - Use a sunscreen of at least SPF 30 (SPF 50 for children or people with pale skin) which also has high UVA protection- Keep babies and young children out of direct sunlight - The British Association of Dermatologists recommends that you tell your doctor about any changes to a mole - if your GP is concerned about your skin, make sure you see a Consultant Dermatologist (on the GMC register of specialists), the most expert person to diagnose a skin cancer. Your GP can refer you via the NHS.

Sunscreens should not be used as an alternative to clothing and shade, rather they offer additional protection. No sunscreen will provide 100% protection.