(Note: This topical medication will be available by prescription-only in mid-2012.)

The "nit" or egg of head lice on a hair shaft

Sklice is approved for use in children 6 months of age and older and is used in a single 10-minute application of the lotion, without nit combing. 

The ability to kill the nits without being combed out of the hair is a unique quality of Sklice lotion.

The benefits of this new treatment will be clear to any parent, teacher, or school administrator who has had to deal with the “epidemic” of head lice in recent years.

Treatment options available to date for head lice have included over-the-counter medications Rid© and Nix© and prescription-only medications Kwell© and Ovide©. These treatments normally require repeat treatments after 7-10 days and intensive nit combing.

Nit combing is painstaking and time intensive so it is often not performed or performed improperly. In fact, insufficient nit combing has been responsible for failed treatments and further spreading of head lice in family and schools.  This has lead to a rise in the availability of “nit-picking” services, but incidence of head lice in schools has continued to increase each year.

Each year in the U.S. head lice infest an estimated 6 to 12 million children aged 3 to 11 years. Some studies suggest that girls get head lice more often than boys, probably due to more frequent head-to-head contact. Estimates for direct and indirect costs, which include millions of lost school days and lost work for parents, are as high as $1 billion dollars.

Now with the arrival of Sklice there may be a more effective treatment option that parents and school administrators can be confident that works (or at least until the head lice build up resistance to this anti-parasitic agent).

The FDA approval of Sklice Lotion was based on results of two randomized, double-blind phase 3 clinical trials that compared Sklice Lotion with a placebo in nearly 800 patients.  The majority of Sklice-treated patients were lice-free without any nit combing after two weeks.

Sklice was well-tolerated with fewer than 1% of patients experienced adverse events, which included conjunctivitis, ocular hyperemia, eye irritation, dandruff, dry skin and skin-burning sensation.

Sklice lotion contains ivermectin, an antiparasitic medication, that blocks cellular activity of  nerve and muscle cells found in insects, but not in mammals. Ivermectin is the same active ingredient used since 1987 in oral form to treat river blindness (onchocerciasis). More than one billion treatments of ivermectin tablets have been administered worldwide. Sklice will, however, use a topical form of ivermectin specially formulated for use on the scalp and hair.

Professor Nelson Novick, M.D., Dermatologist

Nelson Lee Novick, M.D., New York City dermatologist and Clinical Professor of Dermatology at Mt. Sinai School of Medicine, provides his clinical perspective on cosmeceuticals and some of the newest ingredients used in these anti-aging treatments.

Cosmeceuticals ingredient may be categorized as follows

• Antioxidants that reduce the harmful effects of free radicals that damage skin cells
• Peptides that are small proteins that stimulate the production of collagen and thicken the skin.
• Growth factors that serve as chemical messengers between cells to increase production of collagen and elastin.

Dr. Nelson Novick provides comments on specific anti-aging ingredients that have become available in recent years.

Vitamin B5, better known as panthenol, has been found to be effective in promoting wound healing when used in concentrations of at least 5%. Panthenol has been getting quite a bit of play recently as an additive in antiaging skin care cosmetics.

Vitamin B3, niacinamide, is another vitamin newcomer to the skin care playing field. Studies have suggested that it suppresses skin cancer production by ultraviolet light, particuarly the UV-B rays that lead to sunburn. Niacinamide also appears to promote a gentle exfoliation and smoothing of the skin. However, unlike alpha hydroxyacids (glycolic acid), it does so without provoking irritation. For this reason, it is being tested in individuals with very sensitive skin and in patients with rosacea.

Vitamin K, phytonedione, in a topical 5% formulation, is intended for treating dead-end vessels, “broken” blood vessels (telangiectasias) and to protect the vascular integrity of the tiny, coiled vessels in the dermis. It is also purported to possess some anti-inflammatory properties. Although the benefits of topical vitamin K await confirmation in large controlled studies, significant anecdotal evidence suggests that daily applications may be helpful for speeding the resolution of skin bruising from a variety of causes, including photodamage; for reducing the redness associated with rosacea; for diminishing the appearance of facial spider veins; and for lightening dark circles under the eyes.

Antioxidant Vitamin E is certainly no newcomer to topical preparations. However, more recently it has been increasingly touted for its  free-radical scavenging, antioxidant capabilities, and its ability to protect cell membranes and thus prevent cell destruction. Alpha-tocopherol is the most active biologic form of  vitamin E.Reports in the cosmetic literature suggest that the use of alpha-tocopherol in concentrations of between 5-8% can smoothe skin roughness and diminish fine wrinkling. At the same time, vitamin E is a well known cause of contact allergic dermatitis and a trigger of acne, all of which leaves the place of this vitamin in skin rejuvenation open to question.

Alpha lipoic acid is one of the newest and most post antioxidants to come along. In topical preparations, it is rapidly absorbed down to the subcutaneous fat layer. It possesses anti-inflammatory properties and in 3% concentrations has been demonstrated in preliminary work at least to diminish fine wrinkles, presumably by stimulating the synthesis of collagen.

Coenzyme Q10 (CoQ10), also known as ubiquinone, and idebenone, its chemical relative, may increase the the production of collagen when applied to the skin. In one small study, these properties  translated into reduction of fine lines and smoothing of surface irregularities. Coenzyme Q10 has the added benefits of being non irritating, even for sensitive skin.

About Dr. Nelson Novick

Nelson Lee Novick, M.D. is a Clinical Professor of Dermatology at Mount Sinai School of Medicine in New York City, an Attending Physician, and a former OPD Clinic Chief within the department of dermatology of the Medical Center. He is board certified both in internal medicine and dermatology and is a Fellow of the American Academy of Dermatology (FAAD) and a Fellow of the American Academy of Cosmetic Surgery (FAACS).

Dr. Novick’s biography has been included in Who’s Who in America for more than two decades, and he has been listed in Consumer Research Council of America’s Guide to America’s Top Physicians–2003-2006 and Guide To America’s Top Dermatologists–2007-2008. He has received awards for Excellence in Teaching; Outstanding Patient Care; and the American Academy of Dermatology’s prestigious Leadership Circle Award.

Dr. Nelson Novick is in private practice in New York City at 500 East 85th St., Suite P-1, New York, New York 10028.

Call 212-772-9300 to make an appointment with Dr. Novick.

Eliot Mostow, M.D, Akron Dermatologist

Dermatologist Dr. Eliot Mostow of Akron Dermatology in Akron, Ohio provides his clinical perspective on Laser Hair Removal and its role as a treatment option for the removal of unwanted hair.

According to Dr. Mostow, “almost everyone has unwanted hair somewhere on their body. Unfortunately, traditional hair removal routines can be tedious, painful and expensive over time. Laser hair removal can remove unwanted hair faster and more effectively than traditional methods.”

To eliminate hair, the laser emits gentle pulses of energy that pass through the skin to the hair follicle. This energy is then absorbed into the hair follicle to destroy it so that is unlikely to grow there again. The laser treatment causes only minimal discomfort.

Typically patients will see results in 4 – 6 treatments, though this number will vary based upon skin tone, hair color and several other factors.

According to Dr. Mostow, results of laser hair removal depend on several factors, including hair color, hair thickness, skin color and the body area being treated.

About Dr. Eliot Mostow and Akron Dermatology

Eliot Mostow, MD., MPH., is a board-certified dermatologist and currently Head of the Dermatology Section at Northeast Ohio University College of Medicine (NEOUCOM) and on the clinical faculty at Case Western University Department of Dermatology.

Dr. Mostow received his medical training at Ohio State University College of Medicine and his Masters in Public Health (MPH) at Johns Hopkins School of Hygiene and Public Health. He completed his dermatology residency at the University of Michigan and was Assistant Professor Clinical Medicine at the University of Pittsburgh prior to becoming Professor and Chair of the Dermatology section at Northeastern Ohio University College of Medicine (NEOUCOM). Dr. Mostow also served as President of the Cleveland Dermatological Society from 2006 to 2008.

Dr. Mostow is in private practice at Akron Dermatology at 566 White Pond Drive, Suite E Akron, Ohio  44320.

To make an appointment with Eliot Mostow, M.D. or another dermatology professional at Akron Dermatology, please contact the office at (330) 535-7100 or email info@akronderm.com.

Selim Benbadis, M.D., Epileptologist

Epilepsy surgery is a an important treatment options for those with epilepsy when anti-epileptic medications (anticonvulsants) fail to control the seizures. More than 100,000 people in the U.S. may be candidates for epilepsy surgery, but only about 3,000 epilepsy surgeries are performed each year, indicating a great need for more information epilepsy surgery.

Dr. Selim Benbadis, neurologist and Director of the Comprehensive Epilepsy Program at the University of South Florida (USF), provides an overview of epilepsy surgery, its role in treating recurrent seizures and how it is performed.

“Overall, (anti-epileptic) medications work for about 70% of patients with epilepsy. When they do not work, surgery is a well-accepted option for some types of epilepsy”, stated Dr. Benbadis.

If a person with epilepsy fails to achieve sufficient seizure control after trying 2 different medications, the chances of controlling the seizures with a 3rd medication are less then 20%.  If 3 or more medications have been attempted and failed to provide seizure control, then the chance of future success with any additional anticonvulsant medication is less then 10%. Thus, according to Dr. Benbadis “if 3 (anti-epileptic) medications have been tried without success, it is reasonable (and advisable) to look into the possibility of epilepsy surgery.”

According to Dr. Benbadis, about 70% of patients who have epilepsy become seizure free following epilepsy surgery. However, in some circumstances, the chances of becoming seizure free are higher (>90%), and this can usually be predicted based on the results of the tests performed prior to serugery.. For example, in cases where the results of EEG-video monitoring and MRI are in agreement, over 90% of patients become seizure-free with a temporal lobectomy. Some patients get off medications, while others may have to continue to take medication.

When surgery is considered, a complex evaluation is performed to make sure that the operation will 1) improve the seizures, and 2) not cause damage to essential functions (for example movements, speech, memory). Tests include prolonged video-EEG monitoring, brain imaging (Head MRI) and other brain function tests, such as the Wada test. Like other complex operations such as organ transplants, epilepsy surgery involves a whole team of different specialists. It is directed by a neurologist specializing in epilepsy (an “epileptologist”), with the input from other specialists including neuroradiologist, neuropsychologist, and of course neurosurgeon.

About Dr. Selim Benbadis

Dr. Selim Benbadis, M.D., FAAN, is Professor of Neurology, Departments of Neurology and Neurosurgery, University of South Florida and Director of the Comprehensive Epilepsy Program. Dr. Benbadis also serves as an attending neurologist at Tampa General Hospital, James A. Haley V.A. Hospital and Moffitt Cancer Center.

The goal of the Comprehensive Epilepsy Program and the University of South Florida is to provide the most advanced care for patients with seizures, and especially seizures that are difficult to control.

The Epilepsy Program meets and exceeds the guidelines for a fourth (highest) level medical and surgical epilepsy center, based on guidelines established by the National Association of Epilepsy Centers. The USF/TGH Epilepsy Program is one of only four centers in the state of Florida, and the only one in West Central Florida, with this level of expertise.

With over 50 epilepsy surgeries per year since 2003, the Comprehensive Epilepsy Program  is now the highest volume surgical epilepsy center in Florida.

Dr. Benbadis and the Comprehensive Epilepsy Program are located in Tampa, Florida. To make an appointment with Dr. Benbadis, or to consider an evaluation, contact The Comprehensive Epilepsy Comprehensive Epilepsy Program and Clinical Neurophysiology Laboratory at (813) 259-0892.

Matthew Kniss, M.D., Neurologist at Lincoln Neurology

Meralgia paresthetica is a neurologic condition that results in tingling, numbness and burning pain in the outer part of the thigh.

The neurologists of Neurology Associates in Lincoln, Nebraska provide their patients with a helpful summary of this condition and possible treatment options.

According to the neurologist “Meralgia paresthetica occurs when the lateral femoral cutaneous nerve — a nerve that supplies sensation to the surface of your upper thigh — becomes compressed, or pinched.”

This is more likely to occur in individuals who are overweight, pregnancy or have been diagnosed with diabetes.

According to Neurology Associates, “treatment for meralgia paresthetica focuses on relieving compression of the nerve, which may include self-care measures, such as wearing looser clothing or losing weight. If necessary, corticosteroid injections or medications (anticonvulsants) amy be indicated.

About Neurology Associates

The physicians of Neurology Associates are Board-Certified Neurologists with the American Board of Psychiatry and Neurology, and members of the American Academy of Neurology.  A neurologist is a physician who has specialized in medical training in disorders affecting the nervous system, including the brain, spinal cord, peripheral nerves and muscles.

Physicians include Lewiston Birkmann, M.D., James Bobenhouse, M.D., Brian Boes, M.D., Matthew Kniss, M.D., and Gary Pattee, M.D.

To make an appointment with one of the physicians at Neurology Associate, please call (402) 483-7226. Fax: (402) 483-5440

Neurology Associates is located at2631 S. 70th Street, Lincoln, Nebraska.

Erivedge is the first FDA-approved medicine for people with this form of cancer

Erivedge is a prescribed for use once-a-day by people with basal cell carcinoma that has spread elsewhere in the body or who are not candidates for the surgery or radiation treatment ordinarily used to treat this form of skin cancer.

In a story published in the New York Times, the wholesale price of Erivedge will be $7,500 a month, or about $75,000 for the 10-month course of treatment that was typical in the clinical trial.

The FDA announced that the approval was based on an analysis of 96 patients in a clinical trial with locally advanced or metastatic basal cell carcinoma. In the study, Erivedge shrank the tumors in 30% of those with metastatic cancer and shrank or eliminated tumors in 43% of patients with locally advanced cancer.

The approval by the FDA followed a priority review program that provides for expedited review of drugs perceived to represent major therapeutic advances. The active ingredient of Erivedge, vismodegib, stops the “hedgehog signal” that is required for the growth of basal cell skin cells.

Erivedge is being made available with a important safety warning. This “black box” warning points out that Erivedge cannot be used by women who are pregnant because it may lead to the death of the baby (stillbirth) or cause severe birth defects.

For females who can become pregnant:

• You should talk with your healthcare provider about the risks of Erivedge to your unborn child.
• Your healthcare provider should do a pregnancy test within 7 days before you start taking Erivedge to find out if you are pregnant.
• In order to avoid pregnancy, you should start using highly effective birth control before you start Erivedge, and continue to use highly effective birth control during treatment, and for 7 months after your last dose of Erivedge. Talk with your healthcare provider about what birth control method is right for you during this time.
• Talk to your healthcare provider right away if you have unprotected sex or if you think that your birth control has failed.
• Tell your healthcare provider right away if you become pregnant or think that you may be pregnant.

For males:

• You should always use a condom with a spermicide, even if you have had a vasectomy, during sex with female partners while you are taking Erivedge and for 2 months after your last dose to protect your female partner from being exposed to Erivedge.
• Tell your healthcare provider right away if your partner becomes pregnant or thinks she is pregnant while you are taking Erivedge.

“Stelara appears to be an excellent new option for moderate-to-severe psoriasis, offering patients who have failed other treatments new hope, and offering the most convenient option yet for treating severe disease,” according to Steven Feldman, M.D., dermatologist and Professor of Pathology and Dermatology at Wake Forest Univeristy Baptist Medical Center. “The primary benefits are high efficacy and, so far, good safety (measured over about 2 years of use). In addition, the drug is injected at baseline, a month later, then only once every 3 months, so it doesn’t require many injections. Being the newest of our options, we don’t yet have as much safety data as we do for other drugs, so we don’t have quite the same confidence in what the long term safety will be.”

Dr. Steven Feldman, Dermatologist, Psoriasis Expert

Results of a clinical trial published in the medical journal Lancet showed that the active ingredient of Stelara, ustekinumab, reduced the severity of plaque psoriasis by 75% in as many as 76% of patients treated. As many as 42% of treated patients saw a reduction of 90% in the severity of their psoriasis. Side effects were generally mild, though experts say additional studies will be required before long-term safety can be determined.

Stelara is given twice in the first month, followed by dosing just four times per year. The relatively long duration of relief between treatments (only 5 doses per year) is perceived by some as one of the benefits. Stelara also has a unique mechanism of action by selectively targeting immune system signals called “cytokines” that are resonsible for the inflammation seen with psoriasis, specifically interleukin-12 (IL-12) and interleukin 23 (IL-23). Other biologics regulate different immune system components, such as T-cells or tumor necrosis factor (TNF).

About Dr. Steven Feldman

Steven Feldman, M.D. is a renowned psoriasis expert having authored multiple clinical studied regarding psoriasis and has served as a member of the Medical Board of the National Psoriasis Foundation (NPF). Dr. Feldman chairs that board’s Subcommittee on Education.  He also serves as the Director of the Foundation’s Chief Resident’s Meeting on psoriasis treatment.

Dr. Feldman also serves as Chief Medical Editor of Skin & Aging magazine, a professional publication for dermatologists, and is the founder of DrScore, a service that provides doctor ratings based on patient satisfaction surveys.

Picato Gel is the first topical therapy to effectively treat actinic keratoses in just two or three days.

Mark Lebwohl, Dermatologist and Picato Gel Study Investigator

Dr. Mark Lebwohl, M.D., chairman, Department of Dermatology, Mount Sinai Medical Center in  New York City and investigator of one of the clinical studies of ingenol mebutate commented in a statement for the Skin Cancer Foundation that “what makes this new solution particularly exciting is the two or three day course of treatment.”

The active ingredient, ingenol mebutate, is derived from the sap of a plant called “radium weed” (Euphorbia peplus). It is thought that the chemical ingenol causes the death of abnormal skin cells, but the mechanism of action isn’t fully understood.

The 0.015% formulation of Picato was approved for the treatment of lesions on the face and scalp once daily for 3 consecutive days. The 0.05% formulation (stronger concentration) was cleared for once daily treatment of the trunk and extremities for 3 consecutive days.

The four different phase III clinical studies performed on ingenol mebutate reported that a significantly higher proportion of those treated with Picato gel showed complete clearance of AKs when compared to placebo.

“Cryotherapy (freezing of the skin lesion) has been the gold standard for actinic keratosis for some time, with topical agents also used over a period of weeks to months,” said Neil Swanson, M.D., Department Chairman and Professor of Dermatology at OHSU and principal investigator of one of the clinical studies (REGION-I) in a press release published by the manufacturer LEO pharmaceuticals. Dr. Swanson added that “Findings from the REGION-I study suggest that PEP005, a topical Gel administered over just two days, may provide a safe and effective alternative to current therapies.”

In the face and scalp studies, the complete clearance rates were 37% and 47%, vs. 2% and 5% for controls. Partial clearance rates came in at 60% and 68%, vs. 7% and 8% for vehicle controls.

The most common side effects following the use of Picato Gel were local skin reactions (redness, irritation), and  pain and itching at the application site.

Actinic Keratoses (“solar keratoses”) are precancerous skin lesions that may appear as scaly or crusty growths (lesions). AKs are caused by overexposure to the ultraviolet rays (UV-rays) of the sun. AKs usually appear on sun-exposed areas such as the face, bald scalp, lips, and the back of the hands. If left untreated, actinic keratoses can become a type of skin cancer called squamous cell carcinoma.

According to Dr. Mark Lebwohl of Mt. Sinai “Since there is no way to predict which actinic keratosis will advance to skin cancer, early detection and treatment of (AK) lesions are critical,”

Patrick Killian, M.D., Dermatologist and Mohs Surgeon

Patrick Killian, M.D., Mohs Cancer Surgeon at Trillium Creek Dermatology & Surgery Center describes the benefits of Mohs surgery for the treatment of skin cancer, and what to expect from the procedure.

Skin cancer is the most common from of human cancer. There are three major types of skin cancer; basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma. Basal cell carcinoma and squamous cell carcinoma are the most common types of skin cancer. They are referred to as “nonmelanoma skin cancer”  to differentiate them from melanoma, the most serious form of cancer that can metastasize (or spread) throughout our body.

According to Dr. Killian, “with Mohs surgery, 100% of the specimen is examined, which explains why Mohs surgery results in much higher cure rates than other forms of surgery. This differs from a standard surgical excision when the pathologist slices the specimen vertically, like a loaf of bread. Using this technique, the pathologist is only sampling the margins of the tissue, so only 1%  of the specimen is being examined.”

Processing the skin sample during Mohs Surgery takes about 1 to 1.5 hours. Once the sample is processed, it is examined under the microscope to check multiple sections, making sure all of the cancerous cells have been removed. If cancerous cells are still present, the Mohs surgeon must go back and remove more tissue until the margins are clear upon examination. Once the margins are clear, the wound is sutured and dressed and you are given complete home care instructions. The average time spent at the clinic by a Mohs patient is 2-6 hours, depending on the case.

According to Dr. Killian, “because Mohs surgery removes the smallest amount of tissue possible, the size of your scar is minimized. Also, more importantly, all cancerous cells have been removed.”

About Dr. Patrick Killian

After obtaining his Doctorate from Ohio State University College of Medicine in 1999, Dr. Killian quickly joined the American Academy of Dermatology, the Ohio Dermatological Association and the Central Ohio Dermatological Society.

Dr. Killian served as a resident in the Division of Dermatology at Ohio State University and completed a fellowship in Mohs Micrographic Surgery in 2004 at the Skin Cancer Center in Cincinnati, Ohio.

A noted authority on Mohs Surgery, Dr. Killian has authored several publications and lectures to colleagues on a variety of dermatology topics. He has received many honors including Salutatorian at University of Notre Dame where he received his undergraduate degree, and honors standing throughout medical school.

Dr. Killian is a Cleveland area dermatologist in private practice in Medina, Ohio.

Call the Mohs Skin Cancer Center at 330.721.9990 to schedule an appointment with Dr. Killian or another dermatologist at Trillium Creek Dermatology and Skin Surgery Center.

The Mohs Skin Cancer Center is located at 5783 Wooster Pike, Medina, Ohio 44256.

Jeffrey S. Dover, Boston Area Dermatologist

“We have had excellent results with Latisse® thus far”, says Dr. Dover. “Bimatoprost (the active ingredient of Latisse®) was first used to treat glaucoma as an eye drop medication and a beneficial side effects that was noted was increased eyelash length and thickness.”

“Painted on the upper eyelash in a very large study, it increased the length of eyelashes an average of 30% and doubled their thickness. Most of the individuals in the study were very pleased with the outcome.”

“Patients have been uniformly very pleased,” said Dr. Dover. “Their lashes get longer and thicker and become much more appealing looking. Only approved for use to help to thicken eyebrows we have treated a few patients who have thin eyebrows and they so far been quite please with the results.”

When treating eyelashes, Latisse® is applied to the upper eyelashes only. It should not be applied directly into the eye. It takes about 8 weeks to notice results and it can take up to sixteen weeks to see the full effect of the medication. When you stop using Latisse the eyelashes eventually go back to the way they were prior to treatment.

” I think it is a wonderful new addition to our options for so many women in America whose eyelashes are not quite as thick as they would like,” said Dr. Jeffrey Dover.

About Dr. Jeffrey Dover

Dr. Dover received his dermatology training at the University of Toronto followed by research fellowships at St. John’s Hospital for Diseases of the Skin at the University of London in London, England, and a two-year photomedicine fellowship at the Beth Israel Hospital and the Massachusetts General Hospital of Harvard Medical School. Dr. Dover is a former Associate Professor of Dermatology at Harvard Medical School, was Chief of Dermatology at the New England Deaconess Hospital for over ten years and also Associate Chairman of Dermatology at Beth Israel Deaconess Medical Center. He is Associate Clinical Professor of Dermatology, at Yale University School of Medicine, and Adjunct Professor of Medicine (Dermatology) at Dartmouth Medical School. A Boston dermatologist, and director of SkinCare Physicians, Dr. Dover’s research interests are lasers in medicine, cosmetic surgery and medical education.

Dr. Dover is the author of over 350 scientific publications. He has co-authored and edited over 30 textbooks. Many of these books are on cutaneous laser surgery and cosmetic surgery. He is founding editor of Journal Watch for Dermatology, produced by the publishers of the New England Journal of Medicine.

Dr. Dover is immediate past president of the American Society of Dermatologic Surgery, and vice president of the American Society of Lasers in Medicine and Surgery. He is past president of the New England Dermatological Society and organizes and directs numerous medical conferences, including the annual Controversies in Cutaneous Laser and Cosmetic Surgery Symposium along with Dr. Arndt.

Dr. Dover, creator of Skin Effects, the skin care line available at CVS Pharmacy nationwide and author of the “Youth Equation – Take 10 years off your face”

Dr. Dover is in private practice in the Boston area at Skin Care Physicians of Chestnut Hill. To make an appointment with Dr. Jeffrey Dover or one of his colleagues call (617) 731-1600, or visit the practice Website.

Skin Care Physicians of Chestnut Hill is located at 1244 Boylston Street (Route 9) Chestnut Hill, Massachusetts 02467. Fax: (617) 731-1601