Skin and Connective Tissue

The skin is the largest organ in the body — both in weight and in surface area — and separates the body's internal environment from the external environment. The skin has many diverse roles. It acts as a channel of communication with the outside world; protects the body from water loss; uses specialized pigment cells, called melanocytes, to protect the body from ultraviolet radiation; participates in calcium homeostasis by contributing to the body's supply of vitamin D; and helps regulate body temperature and metabolism.

Elastic tissues such as the skin require a strong and resilient structural framework. This framework is called the extracellular matrix, or connective tissue. The orientation of the connective tissues — adipose (fat cells), cartilage, bone, tendons, and ligaments — found beneath the skin are also key for tissue appearance and function. All connective tissue is composed of three major classes of biomolecules: structural proteins (collagen and elastin), specialized proteins (fibrillin, fibronectin, and laminin), and proteoglycans.

Some skin and connective tissue diseases, such as those discussed in this section of genes and disease, are due strictly to genetic inheritance, while others do not have specific gene abnormalities as their sole cause. Many features of skin and connective tissue disorders overlap with each other, and with other disorders, even though they have unique genetic causes.

 

Misoprostol

 

Misoprostol is a drug that is FDA-approved in the United States for the prevention of NSAID-induced gastric ulcers. It is also used (and approved in other countries) to induce labor and as an abortifacient. It was invented and marketed by G.D. Searle & Company (now Pfizer) under the trade name Cytotec, but other brand-name and generic formulations are now available as well.

Chemically, misoprostol is a synthetic prostaglandin E₁ (PGE₁) analogue.

 

Indicated use

Misoprostol stimulates increased secretion of the protective mucus that lines the gastrointestinal tract and increases mucosal blood flow, thereby increasing mucosal integrity. It is sometimes co-prescribed with non-steroidal anti-inflammatory drugs to prevent their common adverse effect of gastric ulceration

Off label uses

Obstetric and gynecological

Labor Induction

Misoprostol is commonly prescribed off-label to cause birth induction by uterine contractions and the ripening (effacement or thinning) of the cervix. Misoprostol is highly effective and much less expensive than pitocin and dinoprostone, the FDA-approved drugs for medically necessary labor induction. Trial meta-analysis by the Cochrane Collaboration demonstrates no difference in efficacy or side effects between inductions undertaken with dinoprostone or misoprostol.

Concern has been expressed about the overuse or misuse of misoprostol for labor induction. High doses can cause uterine rupture (especially in women who have previously had a caesarean section), fetal death and severe fetal brain damage, according to a CBS Evening News story by correspondent Sharyn Alfonsi. All induction agents cause uterine contractions – this can affect the blood supply to the fetus, especially if contractions become very frequent. Induction agents therefore need to be used with great care and with close fetal monitoring. One of the problems with induction using prostaglandins (either cervidil or misoprostol) is that once given, the process is difficult to reverse. In contrast, Pitocin (oxytocin, a hormone that also causes contractions) has a half-life of about 10 minutes and is administered via intravenous drip, which can be stopped immediately in the event of adverse reaction, according to a Salon.com webzine article by midwife Ina May Gaskin. A clinical trial is currently underway to establish a controlled delivery method for misoprostol.

The manufacturers of misoprostol have never sought to license misoprostol for labor induction. Recently, however, generic forms of misoprostol have become available, and it is now licensed for labor induction in Egypt and Brazil, and a licensed induction product is expected in the UK in 2008.

The American College of Obstetricians and Gynecologists advocates misoprostol for labor inductions, and it is on the WHO essential drug list for labour induction. Other agencies await more evidence as to its safety, including obstetric organizations in Britain, Canada and Scandinavia, according to a Midwifery Today magazine article by neonatologist Marsden Wagner.

Abortion

Misoprostol is one of the drugs used for medical abortions. In many countries it is used in conjunction with mifepristone (RU-486). After mifepristone is taken orally, misoprostol is taken 24–72 hours later causing the expulsion of the fetus and associated matter in approximately 92% of the cases. No large studies have established a protocol for the use of misoprostol alone, and the range of efficacy is 65%–93% depending on sample size, gestational age, and other test variables; Misoprostol alone may be more effective in earlier gestation. The side effects associated with the misoprostol-only regimen are generally much more severe than those associated with the combined regimens. Misoprostol is used for self-induced abortions in Brazil, where black market prices exceed US $100 per dose. Illegal medically-unsupervised misoprostol abortions in Brazil are associated with a lower complication rate than other forms of illegal self-induced abortion, but are still associated with a higher complication rate than legal, medically supervised surgical and chemical abortions. Failed misoprostol abortions are associated with birth defects in some cases. Poor immigrant populations in New York have also been observed to use self-administered misoprostol to induce abortions, as this method is much cheaper than a surgical abortion.

Misoprostol is sometimes used to treat early fetal death in the absence of spontaneous miscarriage, but further research is needed to establish a a safe, effective protocol. It can also be used to dilate the cervix in preparation for a surgical abortion. Misoprostol is also used to prevent and treat post-partum hemorrhage, but it has more side effects and is less effective than oxytocin for this purpose.

 

Symptoms of skin cancer

 

Following is a list of symptoms of skin cancer...

Most basal cell and squamous cell skin cancers can be cured if found and treated early.

A change on the skin is the most common sign of skin cancer. This may be a new growth, a sore that doesn't heal, or a change in an old growth. Not all skin cancers look the same. Skin changes to watch for:

• Small, smooth, shiny, pale, or waxy lump

• Firm, red lump

• Sore or lump that bleeds or develops a crust or a scab

• Flat red spot that is rough, dry, or scaly and may become itchy or tender

• Red or brown patch that is rough and scaly

Sometimes skin cancer is painful, but usually it is not.

Checking your skin for new growths or other changes is a good idea. Keep in mind that changes are not a sure sign of skin cancer. Still, you should report any changes to your health care provider right away. You may need to see a doctor who has special training in the diagnosis and treatment of skin problems.

This is a copy of the original http://www.cancer.gov/cancertopics/wyntk/skin/page6

 

Understanding Skin Cancer

Skin cancer begins in cells, the building blocks that make up the skin. Normally, skin cells grow and divide to form new cells. Every day skin cells grow old and die, and new cells take their place.

Sometimes, this orderly process goes wrong. New cells form when the skin does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.

Growths or tumors can be benign or malignant.

• Benign growths are not cancer:
  • Benign growths are rarely life-threatening.
  • Generally, benign growths can be removed. They usually do not grow back.
  • Cells from benign growths do not invade the tissues around them.
  • Cells from benign growths do not spread to other parts of the body.
• Malignant growths are cancer:
  • Malignant growths are generally more serious than benign growths. They may be life-threatening. However, the two most common types of skin cancer cause only about one out of every thousand deaths from cancer.
  • Malignant growths often can be removed. But sometimes they grow back.
  • Cells from malignant growths can invade and damage nearby tissues and organs.
  • Cells from some malignant growths can spread to other parts of the body. The spread of cancer is called metastasis.

Types of Skin Cancer

Skin cancers are named for the type of cells that become cancerous.

The two most common types of skin cancer are basal cell cancer and squamous cell cancer. These cancers usually form on the head, face, neck, hands, and arms. These areas are exposed to the sun. But skin cancer can occur anywhere.

• Basal cell skin cancer grows slowly. It usually occurs on areas of the skin that have been in the sun. It is most common on the face. Basal cell cancer rarely spreads to other parts of the body.
• Squamous cell skin cancer also occurs on parts of the skin that have been in the sun. But it also may be in places that are not in the sun. Squamous cell cancer sometimes spreads to lymph nodes and organs inside the body.

If skin cancer spreads from its original place to another part of the body, the new growth has the same kind of abnormal cells and the same name as the primary growth. It is still called skin cancer.

 

Skin Cancer

What is skin cancer?

Cancer that forms in tissues of the skin. When cancer forms in cells that make pigment, it is called melanoma. When cancer forms in cells that do not make pigment it may begin in basal cells (small, round cells in the base of the outer layer of skin) or squamous cells (flat cells that form the surface of the skin). Both types of skin cancer usually occur in skin that has been exposed to sunlight, such as the skin on the face, neck, hands, and arms.

Estimated new cases and deaths from skin (nonmelanoma) cancer in the United States in 2007:

  New cases: more than 1,000,000
  Deaths: less than 2,000

Source: http://www.cancer.gov

 

 

Methotrexate

Methotrexate may cause very serious side effects. Some side effects of methotrexate may cause death. You should only use methotrexate to treat life-threatening cancer, or certain other conditions that are very severe and that cannot be treated with other medications. Talk to your doctor about the risks of taking methotrexate for your condition.

Tell your doctor if you have or have ever had excess fluid in your stomach area or in the space around your lungs and if you have or have ever had kidney disease. Also tell your doctor if you are taking aspirin or other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) or are being treated with radiation therapy. These conditions and treatments may increase the risk that you will develop serious side effects of methotrexate. Your doctor will monitor you more carefully and may need to change the doses of your medications.

Methotrexate may cause liver damage. Tell your doctor if you are taking any of the following medications: acitretin (Soriatane), azathioprine (Imuran), isotretinoin (Accutane), sulfasalazine (Azulfidine), or tretinoin (Vesanoid), Tell your doctor if you drink or have ever drunk large amounts of alcohol and if you have or have ever had liver disease, Your doctor may tell you that you should not take methotrexate unless you have a life-threatening cancer. Also tell your doctor if you have diabetes. Do not drink alcohol while you are taking methotrexate. Call your doctor immediately if you experience any of the following symptoms: nausea, extreme tiredness, lack of energy, loss of appetite, pain in the upper right part of the stomach, yellowing of the skin or eyes, or flu-like symptoms.

Methotrexate may cause lung damage. Tell your doctor if you have or have ever had lung disease. Call your doctor immediately if you experience any of the following symptoms: dry cough, fever, or shortness of breath.

Methotrexate may cause kidney damage. Be sure to drink plenty of fluids during your treatment with methotrexate, especially if you exercise or are physically active. Call your doctor if you think you might be dehydrated (do not have enough fluid in your body). You may become dehydrated if you sweat excessively or if you vomit, have diarrhea, or have a fever.

Methotrexate may cause a decrease in the number of blood cells made by your bone marrow. Tell your doctor if you have or have ever had a low blood count (decrease in the number of blood cells in your body), anemia (red blood cells do not bring enough oxygen to all parts of the body), or any other problem with your blood cells. Your doctor may tell you not to take methotrexate unless you have a life-threatening cancer. Call your doctor immediately if you experience any of the following symptoms: sore throat, chills, fever, or other signs of infection; unusual bruising or bleeding; excessive tiredness; weakness; pale skin; dizziness; confusion; fast heartbeat; shortness of breath; or difficulty falling asleep or staying asleep.

Methotrexate may cause damage to your intestines. Tell your doctor if you have or have ever had stomach ulcers or ulcerative colitis (condition in which part or all of the lining of the intestine is swollen or worn away). If you develop sores in your mouth or diarrhea, stop taking methotrexate and call your doctor immediately.

Methotrexate may cause a severe rash that may be life-threatening. If you develop a rash, blisters, or a fever, call your doctor immediately.

Methotrexate may decrease the activity of your immune system, and you may develop serious infections. Tell your doctor if you have any type of infection and if you have or have ever had any condition that affects your immune system such as human immunodeficiency syndrome (HIV) or acquired immunodeficiency syndrome (AIDS). Your doctor may tell you that you should not take methotrexate unless you have a life-threatening cancer. If you experience signs of infection such as a sore throat, cough, fever, or chills, call your doctor immediately.

Taking methotrexate may increase the risk that you will develop lymphoma (cancer that begins in the cells of the immune system). If you do develop lymphoma, it might go away without treatment when you stop taking methotrexate, or it might need to be treated with chemotherapy.

If you are taking methotrexate to treat cancer, you may develop certain complications as methotrexate works to destroy the cancer cells. Your doctor will monitor you carefully and treat these complications if they occur.

Keep all appointments with your doctor and the laboratory. Your doctor will order lab tests before, during, and after your treatment to check your body's response to methotrexate and to treat side effects before they become severe.

Women who are taking methotrexate, or whose male partners are taking methotrexate are less likely to become pregnant than women who are not taking methotrexate or whose partners are not taking the medication. However, you should not assume that you or your partner cannot become pregnant while you are taking methotrexate. Tell your doctor if you or your partner is pregnant or plan to become pregnant. If you are female, you will need to take a pregnancy test before you begin taking methotrexate. Use a reliable method of birth control so that you or your partner will not become pregnant during or shortly after your treatment. If you are male, you and your female partner should continue to use birth control for 3 months after you stop taking methotrexate. If you are female, you should continue to use birth control until you have had one menstrual period that began after you stopped taking methotrexate. If you or your partner become pregnant, call your doctor immediately. Methotrexate may harm the fetus.