Skin deep newsletter, autumn 2015

Autumn 2015– News and information from the Department of Dermatology Letter from our Chairman
"If I have seen further, it is by standing on the
UConn Dermatology
shoulders of giants." – Isaac Newton, 1676.
granD roUnDs, 8 am
Over 35 years Dr. Jane Grant-Kels has built a city in Farmington. Avenues October 7, November 4
glowing and skyscrapers soaring, the city that is the UConn Department of and December 2
Dermatology teems vibrantly. So how to better this metropolis? Dermatology Waiting Room
21 South Rd., 2nd Floor,

Our department already has 22 faculty, 9 residents and over 100 staff dedicated to providing the best and most comprehensive dermatologic care. Be it cutaneous malignancy, inflammation or UConn Dermatology
cosmesis, there is no skin disorder of which we are fearful. Yet, in spite of our great capabilities, we JoUrnal ClUb, 12:15 pm
face many challenges. October 21 and 28, November 18 and
25, and December 16 and 23
Dermatology Conference Room

Healthcare delivery in the U.S. is rapidly changing in ways that will require our Department 21 South Rd., 2nd Floor,
to shoulder a larger burden. Patient numbers are plentiful and growing, and wait times for appointments are often long. Thankfully, the UConn Health Center has sanctioned our hiring of new dermatologists and mid-level providers to help address the growing need. Further, satellite HartforD psoriasis netWork
offices have been created in Canton and Storrs, with ample room for the addition of more providers meetings, 7 pm to 8:45 pm
at these sites. While not fully eliminating the problem of extended wait times, the expansion of our October 8, November 12
practitioner corps should help.
and December 10
The Newington Lucy Robin
Welles Library

Additionally, we will broaden our mission to address difficult-to-treat dermatologic cases 95 Center St. Newington, CT
by growing the number of our specialty clinics. In addition to clinics dedicated to pediatric RSVP to register or for questions:
dermatology, cutaneous lymphoma, and pigmented lesions we will add sessions focused on Marjorie: 860-888-6669 or Missy:
psoriasis and psoriatic arthritis (co-managed by a rheumatologist), and immunosuppression (transplant)-related cutaneous disease. Finally, we will expand our use of teledermatology to accommodate patients and practices in distant locales. We update our Calendar and events Ultimately, UConn Dermatology should remain a glowing city of confident referral, willingly on a regular basis. to submit an event applying the latest therapies to the toughest skin-related challenges. We hope to increase our or for more information, feel free to already regional and national recognition as a leader in full-spectrum dermatologic care and ContaCt our main line at - Bruce Strober, MD, PhD

Latest News.
size, location and appearance of skin teledermatologists and clinic-based lesions will be taken with a digital dermatologist is around 80-90%; camera. In addition, depending on the - Management planned accuracy for feature of skin problems, amplified teledermatologists was rated 78.8% photos under special fluorescence or/ compared with 83.4% for in-person and polarized light using a dermatologists with no significant dermatoscope need to be taken. The statistical difference and was considered clinical photos together with relevant clinical history will be sent via secured - Patient satisfaction surveys and those transmission by a referring physician or of referring providers varies between in some cases patients themselves to 70-90% in most studies. Studies on the consulting physician. The quality of life, clinical outcomes and dermatologist will evaluate the patient financial analysis all generate very based on the clinical photos and positive and promising results indicating available clinical information. The teledermatology is a reliable alternative consultation will be sent back to the way of offering cost-effective referring physician to discuss with the dermatology care to patients.
patient. In live-interactive telecommunication, video conferences Teledermatology is still relatively new in will be set up for the patient, the the field and has shown to be fast referring physician and consulting growing in the last few years. There are challenges that are unique for What is teledermatology?
dermatologist at the same time, The dermatologist will then be able to view teledermatology: Teledermatology is a subspecialty in the and evaluate skin problems via - Suboptimal photos and incomplete medical field of dermatology and live-interactive video. history can impede accurate diagnosis, probably one of the most common - no real-time interaction in applications of telemedicine and store-and-forward teledermatology may e-health. In teledermatology, The benefits and challenges of
pose a challenge for patient-physician telecommunication technologies are communication or delay of feedback, used to exchange medical information - Uncertainty on insurance policy causes and provide dermatology service over a Teledermatology provides many doubts among providers, etc. distance using audio, visual and data benefits to patients and primary care With more study and research on communication. Dermatology is providers. It offers an alternative teledermatology as well as more particularly suited to the use of cost-effective and easy-to-access way of advanced telecommunication advanced communication technologies care compared to conventional care. technology, there will be many and the internet for delivery of care, With a shortage of dermatologists, promising improvement and develop- given that dermatology is one of the especially the lack of dermatology ment in the near future.
most visual medical specialties. By using access in many rural or under served advanced communication technologies, populations, teledermatology dermatologists are able to widen their significantly shortens the waiting period Teledermatology at UConn Health
reach to patients in a cost-effective with more predictable fast patient access, decrease patient costs for Our department started the travelling, missed work days, etc. In teledermatology service this year. We addition, teledermatology, since it's offer both store-and-forward and How teledermatology service is pro-
often coordinated through the patients' live-video teledermatology. Our pilot primary care providers, offers great projects with Community Health opportunity for coordinated care among Network and the Department of Teledermatology specialty care is physicians as well as the medical educa- Correctional Service, have proven to be generally delivered via tion for primary care physicians. More- very successful with high satisfaction store-and-forward communications or over, it also helps triage more urgent, from patients and referring physicians. by live-interactive video complicated, and serious medical Patients with the Community Health communications. In teledermatology, problems into a fast-track of diagnostic Network across Connecticut and part of store-and-forward communication procedures, medical treatment and Maine, who otherwise were unable to typically refers to the sending or surgery that avoids delay from long- get dermatology service for months, are forwarding of digital images and waiting time for in-person evaluated and treated in days without associated patient data to the traveling. Patients who need diagnostic dermatologist for viewing, evaluating or treatment procedures were put into a and providing consultation. For The experience of patients and referring fast-track for clinic visits. Given positive live-interactive teledermatology, providers through teledermatology are experiences, plans for expanding the providers and patients interact via live positive, based on research done so far. service to more health networks and video-conferencing. For Studies on comparing teledermatology clinics are underway. Our department is video-conferencing, a variety of (both store-and-forward and committed to providing easy access and hardware attachments may be utilized live-interactive) with conventional good quality care to our patients across to enhance the consultation. In in-person visits have shown: Connecticut.
store-and-forward teledermatology, - diagnostic reliability which was mea- high-quality photos best reflecting the sured by complete agreement among

A Wrinkle in Time? products. However, over-the-counter cosmeceuticals aren't regulated by the FDA and may have unpredictable - Andrew Kim MD, PGY 3 efficacy. Those seeking a stronger and more consistent product may find benefit from using prescription retinoids such as tretinoin (Retin-A® or Renova®).
Repetitive facial movements can contribute to permanent
facial wrinkles. The most popular and well known among the neurotoxins is onabotulinumtoxin A (Botox®). Strategic injections of these products into key muscles soften up lines by relaxing the muscles that make our wrinkles more prominent. The effects of these treatments take about a week to take effect and last on average for 3 months.
"What can I do about my wrinkles?", is a common
Injectable soft-tissue fillers are used for deeper, coarser question we hear from many of our patients. As part of wrinkles or loss in volume. There are a wide variety of the normal aging process, we lose the natural elasticity in products available for cosmetic use, so careful selection our skin as the collagen and elastin is broken down over among the choices with a provider familiar with them time. It's hard to not walk down the cosmetics aisle of needs to be done according to your goals. Most any local store and be overwhelmed by the multitude of injectable fillers are temporary and last on average from products with promises to erase our wrinkles. Outlined 6 months to 2 years.
below are a few of the methods we discuss with our patients concerned about their skin.
Chemical Peels & Dermabrasion
A variety of peels of different strength are available for the treatment of chronic photoaging. These products Chronic exposure to UV light accelerates the photoaging dissolve away the top layer of skin and cause controlled process, so the best strategy is prevention, prevention, damage to the deeper layers in order to stimulate and prevention! Using a good sunscreen with a SPF of collagen production in the skin. Dermabrasion works by 30 or higher on a daily basis (with reapplications at least a similar method except the process is achieved with a every 2 hours when outdoors for extended periods) can fine abrasive substance instead of a chemical.
greatly reduce our exposure to the harmful effects of UV light. Many studies have also implicated smoking as a factor leading to accelerated skin aging. Other factors such as routine moisturization, sleeping position (avoid- Another alternative to chemical peels or dermabrasion, ing those that lead to "sleep lines"), and avoiding several different types of laser treatment can be used to repetitive facial movements (such as squinting) can help cause controlled skin damage and stimulate collagen slow the development of permanent wrinkles.
production. Lasers needing a longer recovery time tend to give more significant results, though they need to be balanced with their side effects.
Various over-the-counter preparations containing retinols or alpha-hydroxy-acids (AHA) are formulated to help smooth out skin texture and have been shown to have some efficacy. These formulations tend to be milder and less irritating to the skin than prescription-based

Who we are
Department News!!!
Jun Lu, MD
Bruce Strober, MD, PhD is our Interim Chairman for
Dr. Lu joined our department in 2010. She received her medical degree from the department. We wish him much success in his new China Medical University. She later pur- position! Dr. Strober will still continue to sued a postdoctoral research fellowship see his patients as scheduled. at the Mayo Clinic in Rochester, MN where she studied immunotherapy for melanoma and psoriasis mouse model. She con-tinued there to completed her medicine Jane Grant-Kels, MD has been nominated as one of
internship and dermatology residency. the AMA Women Physicians Section (WPS) Dr. Lu's academic interests include general dermatology, connective tissue disease, autoimmune Inspirational Physicians. The Inspirational Physician bullous disease, teledermatology and clinical trials. She's been program is designed to recognize physicians who have actively involved in clinical trials on new psoriasis therapy and contributed to the achievements of women in the also initiated a teledermatology service with the Community Health Network which successfully provides easy and quick medical profession. Congratulations to Dr. Grant-Kels! access to dermatology service for patients across Connecticut Congratulations to Allen Meckowski on earning the
Andrew Kim, MD PGY 3
HUSKY HERO Award this past May here at UConn
Dr. Kim is currently one of our second Health! Allen is our Clinical Coordinator in the year dermatology residents. He obtained his B.A. from Brown University prior to Farmington Office and we are very proud of his attending the University of Massachusetts accomplishments here in the Dermatology department. Medical School. Dr. Kim additionally spent a year as a clinical research fellow at UT Southwestern Medical Center coordinating clinical trials prior to completing his intern year in internal medicine at Lenox Hill TELL FAMILY MEMBERS AND
Hospital in New York City. His professional interests include FRIENDS ABOUT
autoimmune connective tissue disorders, medical photography, and procedural dermatology.
With offices in Farmington, Canton and Southington, Rachel Rose
our highly experienced and board certified faculty and Executive Assistant
providers will provide you, your family and friends with Rachel has been with the Department excellent health care. Call for an appointment today. since 2011 and is the Executive Assistant to the Chair. In addition to serving as the main administrative support person to the Chair and Vice Chair, she carries out many non-clinical administrative functions For more information or to schedule
for the physicians in the Department. an appointment, please contact:
These include handling travel authorizations and booking UConn Dermatology Associates
travel, processing reimbursements, and scheduling academic 21 South Road, Second Floor
meetings and appointments. She also assists the Clinical Trials Farmington, CT 06030-6231
Office with patient stipends and transfer vouchers. Main Line: 860-679-4600 Web:



C O N T E N T S Useful contact numbers Reporting of infectious disease or an outbreak of infection Infection - its causes and spread Standard precautions Management of sharps and the prevention of sharps injuries Decontamination of medical equipment/devices Cleaning of nebulising equipment Cleaning and storage of suction equipment Environmental cleaning Disposal of clinical waste


TRENDS in Pharmacological Sciences The Akt–GSK-3 signaling cascade inthe actions of dopamine Jean-Martin Beaulieu, Raul R. Gainetdinov and Marc G. Caron Department of Cell Biology, Duke University Medical Center, Durham, NC 27710, USA Drugs that act on dopamine neurotransmission are in a diminution of PKA activity D2-class important tools for the management of multiple neurop-