Treating Wrinkles

Look after your skin

Your skin works hard to keep you healthy, and you can return the favour by taking care of it. Here are some tips to help you keep your skin looking and feeling good.

Skin is made up of an outer layer, the epidermis, and a layer of soft tissue underneath called the dermis. The epidermis constantly grows up towards the outer surface of the skin and sheds dead cells.

The skin acts as a barrier to protect our body from the environment. It also regulates temperature and detects and fights off infections. Nerves in the skin let us feel things such as touch. The skin is one of the biggest and most complex organs of the body, and contains hair follicles, oil glands, sweat glands, nerves and blood vessels.

Hermione Lawson of the British Skin Foundation says: "If you look after your skin, it will be able to do its job better. There are a number of ways you can protect your skin to maintain health." 

Sun care

Sunlight contains ultraviolet (UV) rays, which are the main cause of skin ageing and can cause skin cancer. It's important to protect skin against sun damage at any age, but take special care with babies, children and young people. A blistering sunburn before the age of 20 may double the risk of malignant melanoma, the most serious type of skin cancer.

To protect yourself, spend time in the shade between 11am and 3pm, cover up with clothing, hat and sunglasses, and use suncream with a sun protection factor (SPF) of at least 15. 

You need to spend some time in sunlight so your body can make vitamin D, which is essential for healthy bones. To find out more about balancing the need for getting vitamin D and protecting your skin from sun damage, see how to get vitamin D from sunlight.

Smoking

"Strong evidence links smoking to ageing of the skin, and it's one of the main environmental factors in premature skin ageing," says Lawson. "It causes wrinkles and a leathery complexion, which makes the skin look old before it should."

It is thought smoking reduces the skin's natural elasticity by causing the breakdown of collagen and reducing collagen production (collagen is a protein that supports skin strength).

Collagen naturally degrades as we get older, leading to the formation of wrinkles. Smoking makes this happen sooner. "Smoking also causes the tiny blood vessels in the skin to constrict, reducing the supply of oxygen to the skin," says Lawson.

Get help to stop smoking.

Alcohol

When you drink alcohol, your body and skin can become dehydrated, leaving the skin looking older and tired. "Drink plenty of water to avoid drying out your skin," says Lawson. When you're drinking alcohol, try to drink within recommended limits and have a non-alcoholic drink, such as soda water or fruit juice, between alcoholic drinks.

Facts from the British Association of Dermatologists
The average adult has 21 sq ft (2 sq m) of skin.

On average, each square half-inch of skin contains:

  • 10 hairs
  • 5 sebaceous (oil) glands
  • 100 sweat glands
  • 3.2ft (1m) of tiny blood vessels

Keeping skin clean

Washing the skin can help prevent smells and infections, but too much washing or using harsh soaps can wash away the natural oils we need to keep our skin healthy. Use mild soaps or bath oils.  

"Moisturising protects your skin from the elements as well as preventing it from drying," says Lawson. "An expensive moisturiser is not necessarily more effective than a cheaper one. It all comes down to personal preference."

If you have dry skin, don't use harsh, alcohol-based products as these can irritate skin and dry it out. If you have oily skin, avoid oil-based products and choose water-based ones instead.

People who work in jobs where they frequently have to put their hands in water or come into contact with certain chemicals can sometimes experience inflammation and itchiness on their hands. This is known as contact dermatitis or contact eczema. A doctor can advise on treatment, which usually includes special creams.

Sleep

Don't let late nights ruin your skin. "If you're deprived of sleep, this will make your skin look older and tired," says Lawson. "It can also cause anxiety, irritation and depression. This can cause more sleeplessness and the cycle continues. Make sure you get enough sleep to keep your skin looking healthy."

If you wear make-up, always wash it off before going to bed to reduce the risk of bacteria building up on your skin.

Feeling stressed can disrupt sleeping patterns, which can leave you looking tired and feeling run-down and irritable. Consider taking up an activity, such as running, swimming or yoga.

"Regular exercise is a great outlet for stress," says Lawson. "This leaves the skin looking and feeling vibrant."

How to apply sunscreen

An expert explains why it is important to protect your skin from sunburn to help avoid skin cancer. She also gives advice on how to apply sunscreen correctly and what to look out for when buying sun cream.

Page last reviewed: 22/06/2014

Next review due: 22/06/2016

Source: NHS Choices, UK

Botox injection 'leads to rejection'

Muscle-freezing botox injections have grown in popularity

"Botox can lose you your friends,” according to the Metro, which said that the anti-wrinkle injections could “damage your social life and emotions”. According to the newspaper, using the popular cosmetic jab could make users “take longer to frown or look sad” and that they “may be unable to show empathy when told of the death of a friend”.

The small study behind this and other news reports found that people who have had Botox treatment for frown lines read angry and sad sentences slower after treatment than before it. Conversely, the treatment had no effect on the reading speed of happy sentences.

Overall, it is questionable whether these findings, based on reading speed, can be interpreted to imply that a volunteer’s emotional processing was different before and after treatment. What is more certain is that this study does not provide evidence that people who have Botox will lose their friends, as many media reports have implied.

Where did the story come from?

The study was carried out by Dr David Havas and colleagues from the University of Wisconsin-Madison, Arizona State University and the University of Chicago. The US study was funded by the National Science Foundation, National Institute of Mental Health and Research to Prevent Blindness. The study is available prior to full publication in the peer-reviewed medical journal Psychological Science.

Newspapers have generally overstated the findings of this study. This research provides no evidence that people who have Botox treatment have fewer friends or a poorer social life.

What kind of research was this?

This observational study looked at a theoretical measure of emotional response time in 41 healthy people who received Botox injections for the first time. Researchers observed the time the group took to read sentences describing angry, happy and sad situations before and after Botox treatment for frown lines. The researchers say that by measuring the change in reading times, they could comment on how Botox affects processing of angry, happy and sad sentences.

What did the research involve?

The 41 female participants were recruited through cosmetic surgery clinics. They were given $50 towards the cost of their treatment for participation in two study sessions. In the first session, immediately before their Botox treatment, the women were given 20 happy, 20 sad and 20 angry sentences to read on a computer. They were instructed to press a key on the keyboard when they had finished reading the sentence. Some sentences were followed by a yes or no question, which the researchers say was inserted to encourage comprehension.

A second study session was scheduled for two weeks after the Botox treatment, in which the participants read 60 remaining sentences. At each session, the last 16 participants also completed a questionnaire that assessed their positive and negative emotions.

The researchers used a technique called regression analysis to assess the contribution of different factors to reading time, namely in which session a question was asked and the emotion it reflected. The researchers also undertook a separate analysis to determine whether treatment-related anxiety might be responsible for any change in the way the sentences were read.

What were the basic results?

The study found that, on average, overall reading times were longer for angry sentences than for happy or sad ones. Response time was also linked to both session number and the sentence emotion, suggesting that performance was different before and after the Botox treatment.

Angry and sad sentence reading times increased by about 0.2 to 0.3 seconds following Botox treatment. There was no difference in happy sentence reading time. Pre-treatment anxiety was not significantly related to the change in reading times between the sessions.

The researchers discuss reasons why Botox may affect the processing of emotions, drawing on the findings of other researchers, both in animal and human studies.

How did the researchers interpret the results?

The researchers concluded that their study shows that paralysis of facial muscles “selectively hinders emotional language processing”. They say that the reading time of sentences was increased if the sentiment they conveyed would usually be expressed using the muscles paralysed by Botox.

Conclusion

This small observational study measured reading time which, the researchers say, is a proxy for emotional processing. They say that previous research has linked the ability to interpret a negative emotion, such as sadness and anger, to the ability to physically express the emotion facially. Based on this theory, they investigated whether the interpretation of these negative emotions was affected if physical expression was paralysed by Botox.

Overall, this research has some limitation, principally the assumption by the researchers that reading time is the same as emotional processing. It is not clear that this has been conclusively established by previous studies. Other points to consider when interpreting these findings include the small sample size and the potential for unmeasured confounders, which may have affected the outcome. Equally, while the researchers attempted to rule out pre-treatment anxiety as a cause of faster reading times before treatment, other emotions may have been at play that would be difficult to measure.

The findings of this research have been overstated by the media. The researchers say that their study “raises questions about the effects of Botox on […] emotional reactivity”, whereas news coverage interpreted this to suggest that Botox could damage personal relationships. Such claims seem unfounded given that the research did not assess sociability or popularity of the participants (either before or after treatment), nor did it ask other people to rate the facial expressions of the people treated with Botox.

Analysis by Bazian

Edited by NHS Choices

Botox eases urinary incontinence

Botox can ease incontinence by freezing bladder muscles

Botox injections may help women with urinary incontinence, The Daily Telegraph has today reported. The newspaper said that injecting the muscle-freezing toxin into the wall of the bladder can have a long-lasting impact on overactive bladder syndrome, a major cause of incontinence.

The newspaper’s story is based on a UK medical trial that investigated whether the paralysing properties of botox were effective at reducing the symptoms such as frequently using the toilet, feeling an urgent need to urinate, and leakage in patients with overactive bladder syndrome.

The trial featured 240 women who had not responded to medical treatments for overactive balder syndrome. The researchers found that women who received the botox injection experienced these symptoms significantly less frequently than women who received a dummy injection of saltwater. However, women given botox were more likely to get urinary tract infections.

The results of the study indicate that botox may be effective in treating a common and upsetting health condition. However, if it does get adopted into use in this way there are several other treatment options (including lifestyle measures, bladder training exercises and medication that would be considered first. Botox may be considered as an option only if these treatments fail, and the benefits would have to be considered in relation to its potential harms.

Where did the story come from?

The study was carried out by researchers from the University of Leicester and was funded by the Moulton Charitable Trust and the women’s health charity Wellbeing of Women.

The study was published in the peer-reviewed medical journal European Urology.

The Telegraph covered this study appropriately, covering the study size and design, as well as the treatment benefits and harms.

What kind of research was this?

While it is hard to gauge the true scale of the problem, research suggests that around 13% of women in the UK may have some form of urinary incontinence. Although many conditions and factors can cause urinary incontinence, one major cause is overactive bladder syndrome. The condition is marked by uncontrolled contraction of the bladder that results in an urgent need to pass urine. While this can lead women to need the toilet frequently, some also experience a form of leakage called urge incontinence.

An overactive bladder can be a cause of urge incontinence, which is when urine leaks at the same time or just after you feel an intense urge to pass urine. Urge incontinence differs from stress incontinence, where the pelvic floor muscles are too weak to prevent urination. This causes urine to leak when your bladder is placed under pressure from actions such as coughing or laughing.

This was a placebo-controlled randomised controlled trial that examined the effectiveness and safety of using botulinum toxin (botox) as a treatment for overactive bladder syndrome. A randomised controlled trial is the best way to measure the effectiveness of a treatment, as the randomisation process helps to ensure that any patient characteristics that may influence the outcome have an equal chance of appearing in either treatment group. This allows researchers to be confident that any observed effect is due to the treatment under study.

What did the research involve?

The researchers enrolled 240 women with bladder muscle overactivity, or overactive bladder syndrome, that had not responded to previous treatment. The women were randomly allocated injections of either Botulinum toxin A (botox) or placebo (saltwater) into the wall of the bladder. Women with another common type of incontinence, stress incontinence, were not included in the study.

The participants kept a diary over three days, recording the number of times they:

  • emptied their bladder
  • felt an urgent need to empty their bladder
  • experienced an unintentional passing of urine (or leakage)

The women also completed a questionnaire that assessed their quality of life, as overactive bladder syndrome often has a significant negative impact on patient quality of life.

The researchers conducted follow-up sessions with the women on average at six weeks, three months and six months after treatment. They assessed differences in the frequency of the above three symptoms between the two treatment groups. They also compared quality of life scores, treatment complications and time until troubling symptoms returned between the two groups.

The researchers used appropriate statistical methods to assess differences in frequency of symptoms between the two groups.

What were the basic results?

There were 122 women allocated to the botox treatment group and 118 women allocated to the placebo group.

The researchers compared the outcomes in the botox and placebo groups at the six-month follow-up. They found that in any 24-hour period women in the botox group:

  • emptied their bladders less often: 8.33 times versus 9.67 times, a difference of 1.34 (95% confidence interval [CI] 1.00 to 2.33, p=0.0001)
  • experienced fewer leakage episodes: 1.67 versus 6.00, a difference of 4.33 episodes (95% CI 3.33 to 5.67, p<0.0001)
  • experienced fewer episodes of urgency to urinate: 3.83 versus 6.33, a difference of 2.50 episodes (95% CI 1.33 to 3.33, p<0.0001)

Almost a one-third of women in the botox group (31.3%) developed bladder control (or continence) following their treatment, compared to 12.0% in the placebo group (Odds Ratio [OR] 3.12, 95% CI 1.49 to 6.52, p=0.002).

However, urinary tract infection was reported at least once during six months by a one-third of women in the botox treatment group, compared to 10% in the placebo group (OR 3.68, 95% CI 1.72 to 8.25, p=0.0003).

Those given botox also reported greater difficulty emptying their bladders, which required self-catheterisation to remove their urine: 16% of the botox group compared to 4% of the placebo group (OR 4.87, 95% CI 1.52 to 20.33, p=0.003).

How did the researchers interpret the results?

The researchers concluded that injections of botulinum toxin A into the bladder wall is an effective and safe treatment for overactive bladder syndrome in women who have not responded to previous treatment.

Conclusion

Urinary incontinence can be a distressing and problematic condition, and although we cannot be sure of the number of people affected, research suggests it is surprisingly common.

While there is a range of potential treatments and ways to manage urinary incontinence (including medication, bladder training, lifestyle changes and surgery) not all people respond to them, and they can have problems. This randomised controlled trial provided good evidence that botox injections may be a useful treatment option for women with incontinence due to overactive bladder syndrome that has proven difficult to treat with other methods.

The researchers say that the relief of symptoms reported by the participants was considerably better than those who used oral anticholinergic drugs. These drugs act on the nerve supply to the bladder and are the standard medical treatment used for this condition. They add that other randomised controlled trials have reported similar effects.

The researchers say that since they designed their trial, other studies have published results that support using a lower recommended dose of botox for this type of treatment. Therefore, it is unclear if the same results would be found at this reduced dose. They also say that their study recruited participants with severe cases of overactive bladder syndrome, and that it is unclear if the treatment would be as effective in less severe cases.

It is important to note that the study participants did not have stress incontinence, which is a common cause of urinary incontinence. Therefore, the results of this study cannot be generalised to all women with symptoms of overactive bladder or incontinence, but can only be applied to those with diagnosed overactive bladder syndrome (or detrusor overactivity).

Botox is not routinely used by the NHS in this way, but if it were then it would probably be considered as an option only among women who have required specialist referral for their condition. This would be given after they had tried other treatment options first, which may include lifestyle measures and bladder training exercises in addition to oral medications. If these treatments fail, the benefits of botox would have to be considered in relation to its potential harms.

Analysis by Bazian

Edited by NHS Choices

Could Botox be used to treat severe asthma?

Tuesday March 25 2014

Botox can cause a localised temporary paralysis

Botox – not just for wrinkles

“Botox is commonly used to smooth out wrinkles, but new research suggests it could be used to help asthma sufferers,” the Mail Online reports.

While early results seem encouraging, the research being reported on is still at proof of concept stage.

For most people, asthma can be controlled using conventional treatments such as inhalers. However, some people's asthma symptoms are resistant to treatment (intractable).

The researchers make the case that abnormal vocal cord movement, caused by muscle spasms, may be responsible for some of these intractable asthma cases.

So they tested Botox (botulinum toxin) – a powerful neurotoxin that can cause temporary partial paralysis – on 11 people with severe intractable asthma who had abnormal vocal cord movements that had failed to respond to speech therapy.

After injecting a course of Botox into their vocal cords, participants reported better asthma control, and airway size at the level of the vocal cords was increased. However, there were no changes in measures of lung function.

While the results seem promising it is important to point out that there was no control group in this small study. So any improvement in symptoms could be due to the placebo effect.

As the treatment appears to be relatively safe it should lead to further randomised controlled trials, which will help assess whether a placebo effect influenced the results.

Botox – handle with care

Botox, aka botulinum toxin, is only safe in minute doses. Above a certain level it is extremely deadly.

It is estimated that a teaspoon of botulinum toxin is enough to kill the entire population of India (1.2 billion people).

Where did the story come from?

The study was carried out by researchers from Monash University in Australia. It was funded by Monash Medical Centre. 

The study was published in the peer-reviewed journal Respirology.

The results of this study were poorly reported by the Mail Online. The story headline read “injections into the vocal cords proven to help patients breathe”. Although the study did find that people reported better asthma control, there were no improvements in lung function after the treatment.

In addition, as the study was not a randomised controlled trial, it cannot prove that the improvements in asthma control were due to the injections.

Finally, the article appears to have been “cut in half” as it has no proper ending and just peters out.

What kind of research was this?

This study was a case-series of 11 people who still had severe asthma symptoms despite optimised treatment and who had abnormal vocal cord movement which was not improved by speech therapy.

All 11 were treated with vocal cord injections of Botox. The researchers wanted to see whether Botox is an effective treatment that improves asthma control.

A small study like this, often referred to as a phase I trial, can provide some indication of whether Botox may be a safe and effective treatment. However a randomised controlled trial is required to determine whether any improvements seen are actually due to the treatment and are not just due to people reporting improved symptoms because they have been treated (the placebo effect).

What did the research involve?

The study involved 11 people who had severe asthma symptoms despite optimised treatment and who had abnormal vocal cord movement which was not improved by speech therapy. They were treated with Botox injections into one of their vocal cords. If people didn’t have improved symptoms they were given additional injections.

After treatment, response was assessed using the following:

  • asthma control test scores – a self-reported “scorecard” that is based on the severity and frequency of symptoms (minimum five points for poor control, maximum 25 points for good control)
  • spirometry (where the amount and/or speed of air that can be inhaled or exhaled is measured)
  • measuring vocal cord narrowing using computerised tomography (CT) scans, where a series of X-rays are taken to create a detailed image of the larynx

The researchers also collected information on any side-effects that were experienced by the participants.

What were the basic results?

Four people had a single Botox injection, and the other seven received repeat injections, with two people receiving four injections. In total, 24 injections were given.

Asthma control test scores one month after each injection were significantly improved, from an average of 9.1 before treatment to 13.5 after treatment. The researchers state that changes of three or more on this score are clinically important.

Airway size was measured by computerised tomography in 10 patients. Some patients had received multiple injections when it was measured. Compared to before treatment, the amount of time the airway was narrowed below the lower limit of normal significantly improved from 39.4% to 17.6%.

There was no change in lung function as assessed by spirometry.

Side effects were noted after 17 of the 24 injections. Dysphonia (voice disorder) occurred after 16 injections and lasted for up to six weeks in five of the cases, though they were still able to have normal conversations. Dysphagia (difficulty swallowing) was reported after six of the 24 injections. All cases were categorised as ‘mild’.

One person with severe asthma required hospital admission and steroids after having the injection under general anaesthetic. The study fails to make clear whether this was due to an adverse reaction to the Botox or to the general anaesthetic (or to something else entirely).

How did the researchers interpret the results?

The researchers conclude that “although a placebo effect cannot be ruled out, local injection of botulinum toxin may be an effective treatment for intractable asthma associated with abnormal vocal cord movement. Further mechanistic studies and a double-blind randomised controlled trial of botulinum toxin treatment are merited.”

Conclusion

This small study involved 11 people who had severe asthma symptoms despite optimised treatment and who had abnormal vocal cord movement which was not improved by speech therapy. The results suggest that Botox injections into one of the vocal cords improved asthma control and the airway size at the level of the vocal cords was increased. However, there were no changes in measures of lung function.

As the researchers point out, this study was not controlled or blinded and a placebo effect cannot be excluded.

It is also not known how long any effect would last, as participants were only assessed for one to three months after treatment.

It is also currently unclear how common the problem of abnormal vocal cord movements is in people with poorly controlled asthma.

In conclusion, although Botox could be a promising treatment for people with asthma who also have abnormal vocal cord movement, further randomised controlled trials are needed.

If you do feel that your asthma symptoms are poorly controlled then speak to your GP or the doctor in charge of your care. There are a range of treatments that may be of benefit.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Analysis by Bazian

Edited by NHS Choices

Botox may be useful in treating stomach cancers

Thursday August 21 2014

Botox is an extremely powerful toxin that can only be safely used in small doses

Botox can block nerve signals

"Botox may have cancer fighting role," BBC News reports after research involving mice found using Botox to block nerve signals to the stomach may help slow the growth of stomach cancers. Botox, short for botulinum toxin, is a powerful neurotoxin that can block nerve signals.

The researchers studied genetically modified mice designed to develop stomach cancer as they grew older.

They found that mice treated with Botox injections had improved survival rates, because the cancer spread at a reduced rate or was prevented from developing in the first place.

Cutting the nerve supply to the stomach during an operation called a vagotomy had a similar effect.

In mice that had already developed stomach cancer, Botox injections reduced cancer growth and improved survival rates when combined with chemotherapy.

Further studies of human stomach cancer samples confirmed the finding that nerves play a role in tumour growth.

An early-phase human trial is now underway in Norway to determine the safety of such a procedure and to work out how many people would need to be treated in trials, to see whether the treatment is effective.

Botox: not just for wrinkles

Botulinum toxin is a toxin produced by the bacterium Clostridium botulinum and is thought to be the most powerful toxin on the planet. It is estimated that a single gram of Botox would be enough to kill one million people, though it is safe to use in very small doses.

Aside from its cosmetic uses, Botox is useful medically, as it can help relax muscles and block nerve signals. This means it has a wide range of potential applications, from treating excessive sweating to uncontrollable muscle contractions (dystonia) and migraines.

Where did the story come from?

The study was carried out by researchers from the Norwegian University of Science and Technology in Trondheim, Columbia University College of Physicians and Surgeons in New York, and universities and institutes of technology in Boston, Germany and Japan.

It was funded by the Research Council of Norway, the Norwegian University of Science and Technology, St Olav's University Hospital, the Central Norway Regional Health Authority, the US National Institutes of Health, the Clyde Wu Family Foundation, the Mitsukoshi Health and Welfare Foundation, the Japan Society for the Promotion of Science Postdoctoral Fellowships for Research Abroad, the Uehara Memorial Foundation, the European Union Seventh Framework Programme, the Max Eder Program of the Deutsche Krebshilfe and the German Research Foundation.

The study was published in the peer-reviewed medical journal Science Translational Medicine.

The study was reported accurately by the UK media, making it clear that this potential treatment is not yet available and will take years to assess its potential.

What kind of research was this?

This research was a collection of experiments on mice and studies of human tissue samples. Previous research had shown that cutting the main nerve to the stomach (vagus) in a procedure called a vagotomy reduces the thickness of the stomach wall and decreases cell division.

Another research study found people who had a vagotomy had a 50% reduced risk of developing stomach cancer 10 to 20 years later. The researchers wanted to see if targeting the nerve would reduce stomach cancer growth.

What did the research involve?

Genetically modified mice designed to develop stomach cancer by 12 months of age were studied to see if there was a link between the density of nerves and stomach cancer.

One of four different types of operation was then performed on the vagus nerve of 107 genetically modified mice at the age of six months to see if this made a difference in the development of stomach cancer. This was either:

  • a sham operation
  • pyloroplasty (PP) – surgery to widen the valve at the bottom of the stomach so the stomach can empty food more easily
  • bilateral vagotomy with pyloroplasty (VTPP) – cutting both sections of the vagus nerve and widening the valve
  • anterior unilateral vagotomy (UVT) – cutting just the front section of the vagus nerve

The researchers then performed a Botox procedure on another set of mice by injecting the anterior vagus nerve (front section) when they were six months old to see if this reduced the development of stomach cancer.

To see if cutting or injecting the nerve had any effect after stomach cancer had developed, the researchers performed UVT on mice aged 8, 10 or 12 months and compared their survival rate with mice who had not had the intervention.

They then injected Botox into the stomach cancer of mice aged 12 months and looked at the subsequent cancer growth. They also compared survival rates for chemotherapy with saline injection, chemotherapy with Botox and chemotherapy with UVT.

The researchers then examined human stomach samples from 137 people who had undergone an operation for stomach cancer, to look at how active the nerves were in the sections of cancer compared with normal tissue.

They also compared tissue samples of 37 people who had already had an operation for stomach cancer, but then developed stomach cancer in the base portion of the stomach. The vagus nerve had been cut in 13 of these people.

What were the basic results?

The genetically modified mice mostly developed stomach cancer in the section of the stomach that had the highest density of nerves.

Cutting the vagus nerve supply reduced the incidence of tumours developing. The percentage of mice that had tumours six months after the operation was:

  • 78% after the sham surgery
  • 86% after PP
  • 17% after VTPP
  • 14% in the front section of the stomach (where the nerve had been cut) and 76% in the back section (where the vagus nerve was still intact) after UVT

Six months after the Botox injection into the anterior vagus nerve, the mice still developed stomach cancer. However, the size of the tumour and number of dividing cancer cells in the front section of the stomach was less than half that of the back section.

In mice that had already developed stomach cancer, the normal survival rate was 53% by 18 months, but this was increased by the UVT to:

  • 71% if the UVT was performed at 8 months
  • 64% if the UVT was performed at 10 months
  • 67% if the UVT was performed at 12 months

Botox injection into the stomach tumours of mice reduced the growth by roughly half. Botox and chemotherapy improved mouse survival compared with chemotherapy on its own, as did UVT and chemotherapy.

In the human samples, there was evidence of increased nerve activity in the cancer sections of tissue compared with the normal tissues. This was higher in more advanced tumours.

All 24 people who had not had the vagus nerve cut developed stomach cancer in the base, as well as the remaining front and back sections of the stomach. Only one of the 13 people who had had the vagus nerve cut developed cancer in the front or back section of the stomach, suggesting that the nerve needed to be intact for cancer to develop.

How did the researchers interpret the results?

The researchers say that their "finding that nerves play an important role in cancer initiation and progression highlights a component of the tumour microenvironment contributing to the cancer stem cell niche.

"The data strongly supports the notion that denervation and cholinergic antagonism, in combination with other therapies, could represent a viable approach for the treatment of gastric cancer and possibly other solid malignancies."

Conclusion

These laboratory experiments show that nerves have a role in the development and advancement of stomach cancer. The early experiments in mice found that stopping the nervous supply by either cutting the vagus nerve or injecting it with Botox improved survival rates and reduced cancer growth.

The Botox injections were not performed on any humans in this study. However, an early-phase clinical trial in humans with inoperable stomach cancer began in Norway in January 2013, with the results expected in 2016.

This will determine the safety of such a procedure and work out the number of people who would need to be treated in a larger controlled trial to see whether the treatment is effective.

You can reduce your risk of stomach cancer by quitting smoking if you smoke and moderating your consumption of salt and smoked meats, such as pastrami.

Stomach cancer has also been linked to a chronic infection by H. pylori bacteria, a common cause of stomach ulcers.

If you find yourself having persistent bouts of indigestion or stomach pain, you should contact your GP for advice. The symptoms could be caused by a H. pylori infection, which is relatively straightforward to treat.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Analysis by Bazian

Edited by NHS Choices

 Cancer Cream and Wrinkles

Researchers claim that “a cream used to treat early signs of skin cancer can erase wrinkles and make skin look younger,” the Daily Mail reported. It said that the cream, used to treat a form of pre-cancer called actinic keratoses, could also reverse signs of ageing.

The cream was tested on 21 healthy people between the ages of 56 and 85. All of them experienced irritation with red, scaly skin at the beginning of the treatment, but after ten weeks they rated their skin as improved. This result was also confirmed through clinical assessment.

The researchers say that many people would find the cream’s side effects unacceptable if used for cosmetic purposes. As the Daily Mail said, the volunteers’ skin looked like “raw hamburger meat” during therapy. The researchers say that the cream’s restorative effects may be seen as an additional benefit for people with actinic keratoses and could give them extra motivation to undergo the treatment.

Where did the story come from?

This research was carried out by Dr Dana L Sachs and colleagues from dermatology departments at the University of Michigan and Johns Hopkins University. The study was supported by Valeant Pharmaceuticals International, the maker of the cream being studied. The study was published in the peer-reviewed medical journal Archives of Dermatology.

What kind of scientific study was this?

The study investigated what effects a course of skin cream for treating actinic keratoses would have on the wrinkles, texture and pigmentation of the skin. Actinic keratoses (also known as solar keratosis) are thick, scaly or crusty patches on the skin that are caused by exposure to sunlight. They are most common in fair-skinned people and those who have been frequently exposed to the sun. While they are usually harmless, actinic keratoses sometimes develop into a type of skin cancer called squamous cell carcinoma.

The cream investigated by this study contains the chemical fluorouracil, which is usually used to treat cancers of the colon, head and neck, pancreas and other organs. Since 1963, it has been used in creams to treat actinic keratoses.

In this case series, the researchers enrolled 13 men and eight women in a 24-week study. All the volunteers were between 56 and 85 years of age with moderate to severe sun damage and actinic keratoses on the face. The volunteers needed to be in general good health and willing to have skin biopsies taken from the face. They could not be pregnant, breast-feeding or have a history of allergy to any ingredients of the cream.

All volunteers were given the same 5% cream to be applied to the whole of the face twice a day to for two weeks. The study was an open-label study with no control group for comparison. All participants knew they were getting the active cream.

The researchers measured the cream’s effects with before-and-after photos of the volunteers’ faces, close-up photos of any actinic keratoses, and 3mm punch biopsy specimens of sun-damaged skin from behind the ears and forehead. The biopsies were repeated at two weeks (24 hours after the last cream was applied), four weeks, 10 weeks and 24 weeks. Various molecular markers of inflammation and protein levels in the skin were estimated from the tissue samples.

The volunteers’ skin was clinically assessed at the same intervals using scores for a global assessment of overall photoageing severity, coarse wrinkling, fine wrinkling, dark spots, mottled hyperpigmentation, sallowness and tactile roughness. The researchers counted the actinic keratoses at the beginning of the study and at subsequent visits. They asked the volunteers to complete a questionnaire at 10 weeks.

What were the results of the study?

The researchers reported that the day after the final fluorouracil treatment was applied, there were significant increases in the molecular markers of inflammation and cellular damage. At week four, there was evidence of increases in the production of procollagen (a forerunner to collagen).

Actinic keratoses and photoaging were improved and this was statistically significant. Most patients rated photoaging as improved and said they would be willing to have the therapy again.

What interpretations did the researchers draw from these results?

The researchers say that the fluorouracil cream applied to the face causes skin injury, which leads to healing and then skin remodelling, resulting in improved appearance. They suggest that this mechanism is “reminiscent of that seen with laser treatment of photoageing”.

What does the NHS Knowledge Service make of this study?

This study has shown that some molecular changes attributed to this cream are linked to a sequence of events that results in improved skin appearance. Although the subjective improvements in appearance have been observed by people using this cream before, this study has clarified how these improvements occurs. There are some notes of caution:

Overall, this small study improves our understanding of the repair mechanisms in sun-damaged skin in people over 50. The results do not suggest that the cream should be routinely used for cosmetic purposes as its side effects are considerable. The researchers say that the cream’s restorative effects may be seen by people with actinic keratoses as an additional benefit and give them extra motivation to undergo the treatment. They also say that while the cream may be cheaper than laser treatment, many people would not think that the cream’s side effects and length of treatment were acceptable, and it may not achieve the same degree of improvement as laser treatment.

Analysis by Bazian

Edited by NHS Choices