Mobile & the skin

2. Dr.Arwa M HassanAssist.Prof of DermatologyTanta University Mobile & the skin

3. Mobile and the skin • Physiological functions of human body are regulated by electric currents. Therefore, is not surprising that placing human body within electromagnetic field, of sufficient strength, may affect physiological processes.

4. Mobile and the skin • Mobile phone radiation and health effects have been studied, especially following the enormous increase in the use of mobile phone throughout the world (as of June 2009, there were more than 4.3 billion users worldwide.

5. Mobile electromagnetic field • In the 1980s, the analogue Nordic Mobile Telephone or NMT system was used, which emitted a continuous radio frequency radiation of 902.5 MHz • In the early 1990s, the digital Global System for Mobile Communication or GSM system was introduced with a 902.4-MHz electromagnetic field at a pulse frequency of 217 Hz. • In the meantime, the Digital Cellular System (DCS) or GSM 1800 cellular phones have been developed that emit at 1,800 MHz.

6. Electromagnetic Field

7. Basic changes Chemical Histological Protein expression physiological

8. Chemical changes • MDA and hydroxyproline levels and activities of CAT and GSH-Px were increased significantly in the IR group compared to the control group . • SOD activity was decreased significantly in the IR group . • These results suggest that rats irradiated with 900 MHz suffer from increased fibrosis and lipid peroxidation (LPO).

9. physiological changes • Mobile phone users often complain about burning sensations or a heating of the ear region. • The thermal insulation and the electrical power dissipation led to statistically significant rises in the skin temperature, while the RF exposure did not. • Significant increase in skin temperature of the nostril and occipital area on the same side as the telephone as well as a tendency for higher nasal NO levels . • No changes on the opposite side to the mobile phone or on using earpiece

10. physiological changes Heat generation and the activation of the inducible form of nitric oxide (NO) synthase may be possible causes of the biological effects of EMF exposure . Non-ionizing electromagnetic radiations, emitted by a cellular phone, modify cutaneous blood flow. Further studies are needed to study the long-term effects of mobile phone use and the relation among NO production, vasodilation, and temperature.

11. Histolopathologic changes • Effect of GSM-900 and -1800 signals on the skin of hairless rats. 1-2 hours after acute exposures • Effect of GSM-900 and -1800 signals on the skin of hairless rats. II: 12-week chronic exposures The results of these 2 studies do not demonstrate major histological variations in the skin of hairless rats exposed to RFR used in mobile telephony (GSM-900 or -1800). Int rad biology2006

12. Histopathologic changes • In the IR group,increased thickness of stratum corneum, atrophy of epidermis, papillamatosis, basal cell proliferation, hypergranulosis and capillary proliferation, impairment in collagen tissue distribution and separation of collagen bundles in dermiswere all observed compared to the control group.

13. Effect of cellular phone. R. F on human skin fibroblasts • Human skin fibroblasts were exposed to global system for mobile communication (GSM) cellular phone radiofrequency for1 h. • GSM exposure induced alterations in cell morphology and increased the expression of mitogenic signal transduction genes (e.g., MAP kinase kinase 3, G2/mitotic-specific cyclin G1), cell growth inhibitors (e.g., transforming growth factor-beta), and genes controlling apoptosis (e.g., bax).

14. Effect of cellular phone. R. F on human skin fibroblasts • A significant increase in DNA synthesis and intracellular mitogenic second messenger formation matched the high expression of MAP kinase family genes. • These findings show that these electromagnetic fields have significant biological effects on human skin fibroblasts. They alter their gene expression and morphology. • Department of Human Anatomy, Histology and Forensic Medicine, University of Firenze, Italy.

15. Protein Expression Profile Proteomics screening is valid method for search for identification of the proteins responding to mobile phone radiation. The number of the statistically significantly affected proteins appears to be similar in human skin and on cellular (Endothelial cell line) study. BMC Genomics. 2008.Finland • Mobile phone radiation might alter protein expression in human skin. Physiological significance of this change is not known and requires further study. Larger human volunteer study will be needed to confirm results of this pilot study.

16. Mobile And The Skin Case Reports

17. Cellular and cordless telephones and basal cell carcinoma: a casereport During a 1-yr period, a 50-yr-old man had developed 6 basal cell skin cancer lesions on his scalp and face, 5 of which were localized on the right side of his head. The man had used an analog cellular telephone during 1987-1992; after 1992, he used a digital cellular telephone. In addition, he had used a cordless telephone since 1997. He always placed a phone on his right ear during phone calls. The right side of this individual's head contained 5 of the 6 tumors that eventually developed. 2003 Jun;58(6):380-2. Department of Oncology, University Hospital, Orebro, Sweden.

18. Tumourogenesis. • RFR exposures did not significantly enhance skin tumourigenesis. However, there is slightly accelerated tumour development that may warrant further evaluation. • Int J Radiat Biol. 2003 Apr

19. Mobile phone dermatitis • The problem was identified in several published case reports of patients with unexplained rashes on their face and ear. • Closer investigation revealed that the reaction was caused by nickel in the mobile phone handsets, where it is often found in the casing or buttons .

20. Mobile phone dermatitis • The rash would typically occur on the cheek or ear, depending on where the metal part of the phone comes into contact with the skin. In theory it could even occur on the fingers if you spend a lot of time texting on metal menu buttons. "It is worth doctors bearing this condition in mind if they see a patient with a rash on the cheek or ear that cannot otherwise be explained."

23. Spot tests for free nickel were performed by adding a dimethylglyoxime and ammonium hydroxide solution to a cotton-tipped applicator and then rubbing the applicator on areas of cell phones likely to have skin contact. A pink color on the applicator tip indicates the presence of free nickel (left).

24. Mobile phone dermatitis • Women have a higher risk of developing mobile phone dermatitis, as they are more likely to have been previously sensitized to the metal following an allergic reaction to nickel-coated jewellery. • Prolonged or repetitive contact with a nickel-containing phone is more likely to cause a skin reaction in those who are allergic.

25. Mobile phone dermatitis • Contact dermatitis 2009 Mobile phones are now covered by the European Union Nickel Directive • Clin Exp Dermatol 2009 Preauricular eczema: a sign of cellular phone dermatitis. • Cutis 2009 Nickel-induced facial dermatitis: adolescents beware of the cell phone • Australian J Dermatol 2010 Feb Nickel allergy presenting as mobile phone contact dermatitis.

26. Allergic responses • Exposure to frequently ringing mobile phones enhanced allergic responses with a concomitant increased release of substance P, vasoactive intestinal peptide and nerve growth factor.

27. The 'PDA nail' • All-in-one devices with mobile phone, web browser, and organizer are now owned by over 6 million people and their popularity is increasing. These devices are often called personal digital assistants (PDAs). • The use of PDAs is associated with exposure of distal thumbs and nails to repeated pressure with a frequency of up to a few thousand times per hour and several tens of thousands of times per day.

28. The 'PDA nail' Two cases of median nail plate dystrophy after 4-8 months of habitual PDA use. One patient also developed thumb nail psoriasis and paronychia. All symptoms resolved a few months after discontinuing PDA use. • Biomechanical stress resulting from overuse of PDAs may result in various types of nail dystrophy. • The general term 'PDA nails‘ was suggested for these nail abnormalities. Am J Clin Dermatol. 2009

29. Blackberry-induced hand-foot skin reaction to sunitinib (HFSR) Sunitinib is an orally administered small molecule that was approved by the FDA in January 2006 as monotherapy for the treatment of patients with advanced renal cell carcinoma (RCC) and patients with gastrointestinal stromal tumor after disease progression on or intolerance to imatinib mesylate...

30. Blackberry-induced hand-foot skin reaction to sunitinib(HFSR) 48-year-old woman with a history of metastatic colorectal cancer treated with single-agent sunitinib who developed pain and tenderness in areas of friction secondary to Blackberry use, and was diagnosed with trauma-induced hand-foot skin reaction (HFSR) secondary to sunitinib therapy. • Invest New Drugs ,2009

31. So , is the mobile always harmful ? NO,IT IS NOT

32. Mobile teledermatology • with dermatology being a visual profession, mobile teledermatology is perhaps the most recent development in this field. • Mobile teledermatology may provide a service aimed toward management of patients with emergent skin disease or for follow-up with patients requiring systemic treatment.

33. Store-and-forward teledermatology(SAFT) • Store and forward and real time or videoconferences are the two types of teledermatology services practiced. • Advances in information technology, electronic instruments and biotechnology have revolutionized and brought changes in SAFT. • Cellular phone, digital camera, personal digital assistants, Wi-Fi, Wi-Max and computer- aided-design software are incorporated to deliver the quality health care to remote geographic regions.

34. Store-and-forward teledermatology(SAFT • Health care providers in rural areas are the 'eyes' for the consultants. Consultants to guide them should have a rapid periodic audit of visual parameters and dimensions of lesions. • Advances in 1) capture, store and transfer of images. 2) Computer Aided measurements of generalized and localized lesions and 3) the integration model to meet all the above two requirements in a centralized location. This process enables diagnosis, management, periodic assessment and complete follow-up care to achieve patient and physician satisfaction.

35. Mobile teledermoscopy • Mobile teledermoscopy is the combination of such approaches enabling transfer of images captured with cellular phones coupled with a pocket dermatoscope . • Mobile teledermoscopy enables rapid transmission of dermoscopic images via e-mail or specific web-application .

36. Mobile teledermoscopy • Mobile teledermatology and teledermoscopy may be implemented as a triage or screening tool for malignant tumors to facilitate early detection and diagnosis, which is crucial for improved patient outcomes. • Mobile teledermoscopy--melanoma diagnosis by one click? Semin cut med and surg 2009

37. Self-management of psoriasis • Patients themselves can acquire health parameters and take photos of their psoriasis lesions. • The data are sent to a monitoring centre, where they are provided to the patients' physician who returns a feed-back message. • The system is currently tested in a study with 20 patients. Preliminary results prove the feasibility and usability of such a system and indicate that it is useful for optimizing psoriasis-therapy. 2008,2009

38. Telemedical wound care • Leg ulcers are an important cost factor in health care systems. It has been shown that a telemedical wound care consultation can improve quality of care and help reduce costs. Int Wound J. 2008

39. Improving patient attendance • The ease with which large numbers of messages can be customized and sent by SMS text messaging, along with its availability and comparatively low cost, suggest it may be a suitable means of improving patient attendance.

40. NOW, WHAT DO YOU THINK ? Mobile Phone is A FRIEND OR AN ENEMY ?

41. SMS • For a dermatologist mobile could be a friend as it Improves your connection with your patients and your professors. HOWEVER • Remember If you have had a previous reaction to a nickel-coated object, you are at greater risk of reacting to metal phones. • Also , habitual users of PDAs may develop traumatic nail dystrophy. So, don’t over use it.

42. Thank you