Editor's Message: NSF: Learning the Latest About An Emerging Disorder - Larisa Hubbs, Executive Editor Larisa Hubbs, Executive Editor        Within the past 8 years, a new cutaneous fibrosing disorder has emerged — one that is still fraught with some mystery.        Nephrogenic systemic fibrosis received its official name in 2005. This month, we offer continuing medical education on this topic. Authors Sarah N. Walsh, M.D., and Omar P. Sangüeza, M.D., write about what is known about this condition to date. Who Is Most At Risk?        As the authors note in the article, “it has been well established that those at greatest risk are patients with chronic kidney disease or end-stage renal disease (ESRD) — particularly those with a glomerular filtration rate of <30 ml/min/1.73 m2 as well as those receiving peritoneal dialysis (even more so than hemodialysis).” Yet, not all patients are affected, and sometimes the disease progresses rapidly — other times not. What Triggers This Disease? Intracellular particles of gadolinium, a chemical that is used as an MRI contrast agent and has also been detected in the skin of patients with nephrogenic fibrosing dermopathy/ nephrogenic systemic fibrosis. Image courtesy of Whit High, M.D.        As noted on the International Center for Nephrogenic Fibrosing Dermopathy Research (www.pathmax.com/dermweb), “specific triggers for the development of NSF are still being investigated. Recent reports have strongly correlated the development of NSF with exposure to gadolinium-containing MRI contrast agents.”        Last July we reported about this link in our cover story, “Better Understanding the Chemicals That Surround Us,” by Mari Paz Castanedo-Tardan, M.D., Adnan Nasir, M.D., Ph.D., and Sharon E. Jacob M.D. (www.skinandaging.com/article/7428).        In this article, new research had been reported by Whit High, M.D., that “gadolinium deposition has been identified and quantified in the affected skin of patients with NSF. In other cases, the gadolinium has appeared entrapped within the intracellular lysosomes.” In addition, Dr. High noted, “While aqueous ionic chemistry may be involved in early transmetallation reactions, nanoparticle-sized conglomerations of this toxic metal could alter cytokine production within fibrocytes or other infiltrating cells, such as circulating fibroblasts.”        Some mysteries still exist about this disease, but this month’s CME will bring you up to date on what all is known about this emerging condition. Read the CME activity beginning on page 34, and then complete the test and evaluation on pages 40 and 41. Larisa Hubbs Executive Editor lhubbs@hmpcommunications.com   Skin & Aging - ISSN: 1096-0120 - Volume 16 - Issue 6 - June 2008 - Pages: 8 - 8