bluuebunny/crossref_metadata_2025 huggingface dataset:
An Early Selective Medline: Henry Stelwagon's 1916 Textbook of Dermatology
Authors: Jackson Robert
Published: March 2015

Background:

With the rapidly increasing amount of surgical and laser knowledge that has to be learned, we run the risk of not spending enough educational efforts on the morphologic findings on which the specialty of dermatology is based.

Objective:

To briefly review and evaluate a 1916 dermatology text by Henry Stelwagon.

Conclusion:

This text has excellent clinical descriptions of diseases. As a bonus, we can find a succinct summary of the world literature up to 1916 on each topic presented.
Pachydermodactyly: Case Report and Review of the Literature
Authors: Al Hammadi Anwar , Hakim Miriam
Published: March 2015

Background:

Pachydermodactyly is a benign form of digital fibromatosis usually presenting in male adolescent patients as asymptomatic nodules on the lateral aspects of the proximal interphalangeal joints of the fingers. It is commonly misdiagnosed as a juvenile rheumatologic condition.

Objective and Conclusion:

Recognition of the features of this disease will assist dermatologists and rheumatologists in making the diagnosis of this rare condition.
Topical Tacrolimus in the Treatment of Erosive Pustular Dermatosis of the Scalp
Authors: Cenkowski Marta J. , Silver Shane
Published: March 2015

Background:

Erosive pustular dermatosis of the scalp (EPDS) is a rare condition characterized by chronic, sterile, pustular erosions leading to scarring alopecia. Although the etiology is unknown, it appears to be associated with ultraviolet light exposure and trauma. Histologic findings include nonspecific atrophy of the epidermis and chronic inflammation.

Case History:

A 71-year-old female presented with a 1-year history of a boggy, erythematous, friable plaque on the vertex of her scalp. A diagnosis of EPDS was made based on presentation, negative cultures, and histologic findings. Initial therapy with intralesional and topical steroids and oral antibiotics resolved the inflamed plaques; however, steroid-induced atrophy became prominent after 5 months of use. The treatment was discontinued, resulting in recurrence of disease. Topical tacrolimus 0.1% ointment was initiated, which has been successfully controlling the lesions with reversal of skin atrophy and clinical evidence of hair growth.

Conclusion:

This is the fourth reported case of the successful treatment of EPDS with topical tacrolimus for the resolution of atrophy and the prevention of relapse of inflammation. Although its long-term use warrants close follow-up for side effects, tacrolimus may constitute a novel therapeutic option for the treatment of EPDS.
Histologic Spectrum of Melanocytic Nevi Removed from Patients > 60 Years of Age
Authors: Martinka Magda , Bruecks Andrea K. , Trotter Martin J.
Published: March 2015

Background:

The histology of melanocytic nevi removed from older patients often differs from that of nevi from younger adults. According to the literature, the most common nevus in older individuals is the intradermal nevus, and purely junctional nevi are rare and should alert the pathologist to a possible melanoma precursor.

Objective:

To evaluate the histologic features of melanocytic nevi removed from patients > 60 year of age.

Methods:

Biopsies of nevi ( N = 215) from 172 patients > 60 years (mean age 69 ± 7 years) were examined retrospectively by three dermatopathologists, a consensus diagnosis was rendered, and the spectrum of histologic features was documented.

Results:

Junctional melanocytic nevi were frequently diagnosed in older patients (21% of cases) and a lentiginous, often heavily pigmented growth pattern was common (12% of nevi). Severely atypical (dysplastic) changes were found in 6% of nevi removed from older patients.

Conclusions:

We conclude that benign junctional nevi are relatively common in older patients and that a lentiginous, heavily pigmented growth pattern, traditionally associated with younger individuals, is often seen in both junctional and compound nevi in this older age group. This pattern must be differentiated from dysplastic nevus and melanoma in situ, which they may clinically resemble.
Should We Consider Hypohidrotic Ectodermal Dysplasia as a Possible Risk Factor for Malignant Melanoma?
Authors: Gregoriou Stamatis , Rigopoulos Dimitris , Vergou Theognosia , Korfitis Chrysovalantis , Menegakis George , Kontochristopoulos George
Published: March 2015

Background:

Hypohidrotic ectodermal dysplasia (HED) is a rare multisystem disorder that typically affects hair, teeth, nails, and sweat glands in combination with abnormalities of ectodermal originated tissues.

Objective:

To raise the issue of whether heightened awareness is required in the follow-up of pigmented lesions in patients with HED.

Methods/Results:

Two patients with HED are reported. The first had a history of two malignant melanomas, whereas the second presented with a novel malignant melanoma.

Conclusion:

Although a prospective epidemiologic study to determine the incidence of malignant melanoma in patients with HED is virtually impossible and the probable pathogenesis warrants further investigation, these two case reports, in conjunction with other recent reports associating other ectodermal dysplasias with malignant melanoma, suggest that heightened awareness might be prudent in the follow-up of pigmented lesions in patients with HED.
Development and Validation of a Comprehensive Acne Severity Scale
Authors: Tan Jerry K.L. , Tang Jing , Fung Karen , Gupta Aditya K. , Thomas D. Richard , Sapra Sheetal , Lynde Charles , Poulin Yves , Gulliver Wayne , Sebaldt Rolf J.
Published: March 2015

Background:

Although more than 25 acne grading systems exist, only 2 are inclusive of truncal acne. There is neither a gold standard nor a consistently used standardized system.

Purpose:

Our purpose was to develop and validate an acne grading system incorporating severity at the face, chest, and back.

Methods:

We developed a comprehensive acne severity scale (CASS) by modifying a preexisting facial acne scale, the Investigator Global Assessment, to include truncal acne. The validity and responsiveness of CASS grades were correlated with Leeds scores at baseline and after 6 months of standard acne treatment.

Results:

Spearman correlations were significant between Leeds and CASS grades for the face (0.823), chest (0.854), and back (0.872), respectively ( p < .001). After 6 months of therapy, changes in these scores were also significantly correlated ( p < .001) at all three sites.

Conclusion:

Concurrent validity of CASS is demonstrated by a very strong correlation with Leeds grading. CASS is simpler to use than the Leeds system and more appropriate for translation of research trial results to clinical practice.
Gianotti-Crosti Syndrome in Two Adult Patients
Authors: Ting Patricia T. , Barankin Benjamin , Dytoc Marlene T.
Published: March 2015

Background:

Gianotti-Crosti syndrome was first described in Italy by Gianotti in 1955. It is considered a benign, self-limited exanthem that occurs in younger children. Adult cases are rare.

Objective:

We report two cases of Gianotti-Crosti syndrome in a previously healthy 37-year old Asian and 21-year old Caucasian female.

Methods/Results:

Histopathological analysis of 4-mm punch biopsies from the upper extremity of both patients revealed an interstitial dermatitis with mild to moderate perivascular lymphocytic infiltrate and occasional scattered eosinophils in the superficial and mid-dermis. Clinicopathological correlation was consistent with Gianotti-Crosti syndrome.

Conclusion:

Since both patients experienced significant pruritus, patient 1 was initially treated with a high potency topical corticosteroid followed by a two-week course of oral prednisone and patient 2 was treated with a potent topical corticosteroid. Both patients were asymptomatic at follow-up 3 to 4 weeks after their initial presentation.
North American Efficacy and Safety of a Novel Pediculicide Rinse, Isopropyl Myristate 50% (Resultz)
Authors: Kaul Nalini , Palma Kathleen G. , Silagy Stewart S. , Goodman J. John , Toole Jack
Published: March 2015

Background:

Head lice infestations are a major nuisance in school-aged children and are a worldwide public health problem. There are growing concerns about the effectiveness of current treatments owing to increasing resistance, safety, and patient noncompliance. A safe, easy to use, effective alternative is needed.

Objective:

A pediculicide rinse, 50% isopropyl myristate (IPM), was assessed in two phase 2 trials conducted in North America. The first trial was a nonrandomized (proof of concept) trial without a comparator conducted in Winnipeg, Canada. The second trial, conducted in the United States, was an evaluator-blinded, randomized superiority trial comparing 50% IPM rinse with a positive control (RID; pyrethrin 0.33%, piperonyl butoxide 4%). The primary end points were to determine the safety and efficacy of 50% IPM as a pediculicide rinse.

Methods:

Subjects meeting inclusion criteria were enrolled in the above-mentioned trials with efficacy end points 7 and 14 days post-treatment. Subjects were also evaluated on days 0, 7, 14, and 21 for the presence of erythema and edema using the Modified Draize Scale. Other comments associated with the safety evaluation (ie, pruritus) were collected.

Results:

IPM was found to be effective in the proof of concept study and comparator trial using a positive control. IPM was also well tolerated, with minimal adverse events. All adverse events were mild, resolving by completion of the study.

Conclusion:

Data suggest that IPM is a safe and effective therapy for the treatment of head lice in children and adults. IPM's mechanical mechanism of action makes development of lice resistance unlikely.
Case Report of Primary Rectal Melanoma and Review of the Etiology of Melanoma
Authors: Fratesi Lauren , Alhusayen Raed , Walker James
Published: March 2015

Background:

Primary rectal melanoma is a very rare and aggressive malignancy. It is defined as melanoma arising in the rectal mucosa, more than 4 cm from the anal verge.

Objective:

A case of primary rectal melanoma is reported, and the theories of the etiology of melanoma are reviewed.

Methods and Results:

This article reports a case of a 75-year-old woman who presented with lower gastrointestinal bleeding and abdominal discomfort. A polyp was removed from the low-lying rectum during colonoscopy. After immunohistochemical staining and microscopic examination, it was diagnosed as melanoma.

Conclusion:

In light of primary melanoma in sun-shielded regions such as the rectum, theories of causation other than sun exposure merit consideration. Factors such as genetics, immunosuppression, and virus infections, as well as ultraviolet radiation, may play a role in the etiology of melanoma.
Dermatologic Immune Restoration Syndrome: Report of Five Cases from a Tertiary Care Center in North India
Authors: Handa Sanjeev , Narang Tarun , Wanchu Ajay
Published: March 2015

Background:

Dermatologic conditions are often an early clue to human immunodeficiency virus (HIV) infection. As the disease progresses and the host immunity fails, patients may develop a number of skin conditions. At this point, they have a dominant T helper 2 immunologic response. After the initiation of antiretroviral therapy, the T helper 1 response is restored, and some skin problems, paradoxically, make their appearance then.

Conclusion:

Herpes zoster, mucocutaneous herpes, eosinophilic folliculitis, and mycobacterial infections have been known to occur at this stage. This may be because immune restoration of a host's immunity causes recognition of silent or latent infection and results in development of the condition. We report five cases that were seen at our center during a 2-year period.
Asymptomatic Palmar Pits: Clinical Evaluation of Six Cases and Review of the Literature
Authors: De Dipankar , Narang Tarun , Dogra Sunil , Kanwar Amrinder J.
Published: March 2015

Background:

Palmar pits are intriguing and are found in association with diverse dermatologic conditions. Some are innocuous, whereas others have sinister implications.

Objective:

Six cases of asymptomatic palmar pits are described, and the literature is reviewed in brief. Method and Results: Of the six patients, five were male and one was female, with a mean age of 63.5 years. In all six patients, the palmar pits were noticed incidentally during a cutaneous examination for some other unrelated dermatoses, except in one in whom the pits were the reason for visiting a dermatologist. The number of pits varied from one to nine. Dupuytren contracture was observed in five patients. Sole involvement was seen in only one patient. None had overlying hyperkeratosis or associated symptoms relating to palmar pits.

Conclusions:

Palmar pits may have sinister implications in conditions such as nevoid basal cell carcinoma syndrome or Cowden syndrome. The association of palmar pits and Dupuytren contracture seems to be common but is underreported. Palmar pits may be the clinical cutaneous sign of systemic diseases and may sometimes provide a diagnostic clue to other dermatoses. This report emphasizes the significance of the art of clinical observation in dermatology.
Cutaneous Myiasis from Panama, South America: Case Report and Review
Authors: Ting Patricia T. , Barankin Benjamin
Published: March 2015

Background:

Myiasis is a cutaneous infestation with larvae of Diptera, the two-winged arthropod order. Eggs and/or larvae are transmitted directly from the environment or via arthropod vectors. Larvae are able to burrow into the dermis of intact skin or external body orifices. Three clinical variants of myiasis are furuncular, migratory (creeping), and infestation of wounds.

Methods:

A 35-year-old male presented with a 1-month history of worsening furuncles on the left knee and posterior thigh following his return from Panama, South America. Clinical examination revealed tender 6 cm and 2 cm erythematous to violaceous furuncles with surrounding desquamation and central puncta draining serosanguinous fluid. Five-millimeter punch biopsies and tissue swabs were performed.

Results:

All larvae were of the Dermatobia hominis species. The patient was empirically treated with cephalexin and ciprofloxacin for secondary bacterial cellulitis. Tissue swabs later cultured group B streptococcus. A tetanus booster was recommended.

Conclusion:

This case report describes a relatively rare cutaneous infestation with D. hominis, a Central and South American endemic larva of the human botfly. Increasing trends toward immigration and global travel to tropical and subtropic areas will likely increase the frequency of encounters with such parasitic cutaneous infestations in North American outpatient dermatology clinics.
Uncommon Flexural Presentation of Darier Disease
Authors: De Dipankar , Kanwar Amrinder J. , Saikia Uma Nahar
Published: March 2015

Background:

Darier disease is an autosomal dominant skin disorder characterized by keratotic papules, focal loss of adhesion, and abnormal keratinization. Several clinical variants of Darier disease have been described. Predominant flexural distribution of lesions in Darier disease is uncommon.

Objective:

We report a sporadic case of Darier disease in which the lesions were strictly localized to the flexures. We also briefly review the differential diagnoses of such atypical localization.

Methods and Results:

A 26-year-old female presented with erythematous and hyperpigmented papular lesions localized to flexures for 4 months. The skin of the other areas, hairs, nails, and mucosa was normal. Histopathologic examination revealed suprabasal acantholysis along with dyskeratotic keratinocytes, consistent with Darier disease.

Conclusion:

Physicians should be aware of such atypical localizations and should consider the diagnosis of flexural Darier disease along with more common clinical conditions with flexural localization, such as Hailey-Hailey disease and occasionally Grover disease.
Divergence of Demographic Factors Associated with Clinical Severity Compared with Quality of Life Impact in Acne
Authors: Tan Jerry K.L. , Li Yudi , Fung Karen , Gupta Aditya K. , Thomas D. Richard , Sapra Sheetal , Lynde Charles , Poulin Yves , Gulliver Wayne , Sebaldt Rolf J.
Published: March 2015

Background:

Previous smaller studies suggest that age, gender, and duration of acne may individually be associated with clinical acne severity and quality of life (QoL) impact.

Objective:

Our purpose was to concurrently evaluate the association of demographic factors with clinical acne severity and with QoL impact.

Methods:

Clinical acne severity was assessed using the Investigators Global Assessment, whereas QoL impact was evaluated by the patient-completed Acne-QoL. These outcomes were correlated with sociodemographic variables, including age, gender, and duration of acne.

Results:

In 862 acne patients, clinical severity was associated with younger age, male gender, and shorter acne duration (1–5 years). In contrast, greater impact on QoL was associated with older age, female gender, and longer acne duration (> 5 years).

Conclusions:

Clinical and QoL measures each differentiate between groups of patients most severely affected by acne. Our findings reinforce the imperative for clinicians to use both measures for comprehensive patient management.

Limitations:

Study limitations include referral population of acne patients and the restriction of outcome measures to facial acne.
Efficacy and Tolerability of Topical Tacrolimus Ointment for the Treatment of Male Genital Psoriasis
Authors: Bissonnette Robert , Nigen Simon , Bolduc Chantal
Published: March 2015

Background:

Genital psoriasis is difficult to treat and has a significant psychological impact on affected patients.

Objective:

To study the safety and efficacy of topical tacrolimus ointment in male patients with genital psoriasis.

Methods:

This was an open-label study in 12 male patients with genital psoriasis. Patients received topical tacrolimus 0.1% ointment twice daily for 8 weeks followed by a 4-week observational period. Efficacy was assessed by a modification of the Psoriasis Area and Severity Index (PASI) scale adapted for genital psoriasis (male genital PASI). Severity was also evaluated individually for the glans, shaft of the penis, and scrotum.

Results:

Male genital PASI decreased from a mean score of 15.8 at baseline to 1.2 at week 8 ( p < .001). Psoriasis severity also improved significantly for the glans, shaft of the penis, and scrotum evaluated individually. Tacrolimus 0.1% ointment was very well tolerated, with only mild pruritus or burning sensation of limited duration reported.

Conclusions:

Topical tacrolimus ointment appears very efficacious and well tolerated in male patients with genital psoriasis.
Leprosy: Ongoing Medical and Social Struggle in Vietnam
Authors: Nguyen Nhiem , Nguyen Thang Tat , Phan Hai Hong , Tran Tinh Tam
Published: March 2015

Background:

Until recently, leprosy had been prominent in 33 countries worldwide, and Vietnam was ranked among the top 14 endemic countries.

Objective:

The leprosy situation in Vietnam was reviewed as a sample of the worldwide ongoing medical and social struggle to assess the need for continued support for leprosy control activities and for social programs of integration of leprosy victims into the community.

Methods:

A search was conducted of official Vietnamese publications, World Health Organization documents, major electronic databases, and popular leprosy Web sites; as well, notes from visits to local leprosy clinics and interviews with health workers were checked.

Results:

Important achievements were realized through national determination and international collaboration. In contrast with the impressive performance statistics at the national level, and despite strong government efforts for leprosy control, the results obtained at the province-city and district-commune levels still exhibit deficiencies in case detection, treatment, and socioeconomic integration of leprosy victims.

Conclusion:

The struggle to eliminate such a complex and destructive infectious disease as leprosy does not end with the cure. Deep-seated medical and social problems remain. These problems are best solved through community-based approaches.
Dermal Skin Template for the Management of Multiple Cutaneous Leiomyomas
Authors: Gravvanis Andreas , Kakagia Despoina , Papadopoulos Stefanos , Tsoutsos Dimosthenis
Published: March 2015

Background:

Multiple leiomyomas are rare benign tumors of the skin, originating from the arrector pili muscle, and usually appear as painful nodules. Several pharmacologic agents have been used with some success to reduce pain and discomfort since surgery may be an impractical approach owing to the extent of the disease.

Objective:

This article reports on a patient with multiple cutaneous leiomyomas of the upper limb who was managed by a method not previously reported for leiomyomas.

Method:

The management involved total surgical resection of the defect and immediate reconstruction with the Integra artificial dermal template (Integra LifeSciences Corp., Plainsboro, NJ).

Results:

With this treatment, the patient was totally relieved from the pain, and optimal functional and esthetic results were achieved.

Conclusion:

Complete surgical resection of multiple cutaneous leiomyomas prevented the disease's recurrence. The immediate reconstruction of the resultant full-thickness defect with artificial dermis ensured uneventful wound healing, resulting in optimal functional and esthetic outcome and total relief from leiomyoma-associated discomfort.
Incidence of Cutaneous Malignant Melanoma in the Ottawa Region: 1996 to 2006
Authors: Nevins Tara , Su Yinghua , Doucette Steven , Kanigsberg Nordau
Published: March 2015

Background:

The incidence rates of invasive primary cutaneous malignant melanoma in Canada have shown a gradual tapering in recent years, after decades of increases. This trend suggests that the incidence of melanoma in Canada is stabilizing; however, knowledge of the recent trend for both in situ and invasive tumors was lacking.

Objective:

The purpose of this study was to examine the temporal trend of both in situ and invasive melanoma within the Ottawa region over a 10-year period.

Methods:

The histopathology of cutaneous melanomas diagnosed in the Ottawa region was obtained for the years 1996, 2001, and 2006 from the main diagnostic centers servicing the area; however, not all melanomas have been accounted for. All rates are expressed per 100,000 population per year.

Results:

Melanoma incidence decreased between 1996 and 2001 (–3.83) and increased between 2001 and 2006 (+7.46; p ≤ .05). This increase is mainly attributable to in situ melanoma (+5.49; p ≤ .05). There has been no statistically significant change in invasive melanoma.

Conclusions:

Invasive melanoma incidence in the Ottawa region remained stable, whereas in situ melanoma incidence increased.
Acral, Pure Cutaneous, Self-Healing, Late-Onset, Cellulitis-Like Langerhans Cell Histiocytosis
Authors: Sharma Prafulla Kumar , Sabhnani Sunil , Bhardwaj Minakshi , Kar Hemanta Kumar
Published: March 2015

Background:

An unusual and not yet reported clinical presentation of pure cutaneous Langerhans cell histiocytosis (LCH) that was a diagnostic dilemma.

Objective:

To bring to light the newer presentation of this disease.

Method:

The case was managed on clinical grounds initially as cellulitis. However, after the investigations and confirmation of the diagnosis, she was managed symptomatically.

Results:

Pure cutaneous LCH may manifest in early adulthood with features of cellulitis, erythematous edematous vesicular plaques, and nodules distributed in the flexural acral areas.

Conclusion:

Pure cutaneous LCH may have an acute late onset with unusual morphology as cellulitis, inverse acral distribution, and self-healing.
Occurrence of Plantar Pustular Psoriasis during Treatment with Infliximab
Authors: English Penny Lovell , Vender Ronald
Published: March 2015

Background:

Pustular psoriasis is an uncommon form of psoriasis that often affects areas of the hands and feet. It typically manifests as small pustules that develop within erythematous areas of the palms and soles. Infliximab, a tumor necrosis factor inhibitor, can be used to treat pustular psoriasis. Infliximab can also be effective in the treatment of various other disorders, including plaque-type psoriasis, psoriatic arthritis, Crohn disease, rheumatoid arthritis, and ankylosing spondylitis.

Objective:

We present a case of a young woman developing pustular psoriasis for the first time despite being on infliximab treatment for Crohn disease.

Results:

Infliximab has been successful in the treatment of pustular psoriasis. In rare cases, plaque psoriasis appears for the first time during infliximab treatment for other disorders, such as Crohn disease.

Conclusion:

Plantar pustular psoriasis occurring for the first time during infliximab treatment is an uncommon occurrence.
Results of Patch Testing in Patients Diagnosed with Oral Lichen Planus
Authors: Lomaga Mark A. , Polak Shely , Grushka Miriam , Walsh Scott
Published: March 2015

Background:

Oral lichenoid lesions (OLLs) resemble oral lichen planus (OLP) but develop secondary to various underlying causes. The role of contact allergy in precipitating and/or perpetuating OLL is well documented but remains controversial.

Objective:

To help elucidate the association of contact allergy and OLL, we reviewed patch-test readings in patients diagnosed with OLP-like lesions.

Methods:

We retrospectively reviewed patients diagnosed with OLP-like lesions who had patch tests performed between January 1, 2006, and December 31, 2007.

Results:

Patch tests were performed on 24 patients with a histopathologic and/or clinical diagnosis of OLP. Of these, 16 (67%) had positive patch-test readings. At least eight (50%) of these patients had clinically relevant reactions. Ten of the 16 patients (63%) had reactions to metals. In most of these patients, troublesome areas tended to localize adjacent to metallic dental restorations. Of the nine patients (56%) who had reactions to fragrances, flavorings, gallates, and/or diallyl disulfide, the majority improved after avoiding these allergens.

Conclusion:

Our findings support the notion that contact allergy may underlie the pathogenesis of OLL and that allergen avoidance may result in amelioration of disease.
Biologics in the Treatment of Psoriasis: Clinical and Economic Overview
Authors: Poulin Yves , Langley Richard , Teixeira Henrique D. , Martel Marie-Josée , Cheung Sun
Published: March 2015

Background:

The use of biologic medications for psoriasis is a recent therapeutic advance.

Objective:

To review clinical and economic data for biologic therapies in the treatment of chronic plaque psoriasis.

Methods:

Published meta-analyses and additional literature review identified randomized controlled trials. Analyses included the number needed to treat (NNT), the cost in Canadian dollars for the first year of treatment per the Canadian product monograph, and the estimated cost per responder achieving a 75% reduction in Psoriasis Area and Severity Index score (PASI 75).

Results:

Pooled NNTs were 1.3 (infliximab), 1.5 (ustekinumab 90 mg), 1.6 (adalimumab and ustekinumab 45 mg), 2.3 (etanercept), 4.1 (efalizumab), and 5.6 (alefacept). The annual treatment cost per patient was $19,825 to $37,600. The cost per patient achieving a PASI 75 response at 12 weeks ranged from $8,330 (adalimumab) to $71,371 (alefacept).

Conclusion:

This analysis suggests favorable cost and benefits of biologic psoriasis therapies, particularly adalimumab, infliximab, and ustekinumab.
Psoriasis Comorbidities
Authors: Guenther Lyn , Gulliver Wayne
Published: March 2015

Psoriasis has been associated with a number of behavioral and systemic comorbidities, including psoriatic arthritis, anxiety, depression, obesity, hypertension, diabetes mellitus, hyperlipidemia, metabolic syndrome, smoking, cardiovascular disease, alcoholism, Crohn's disease, lymphoma, and multiple sclerosis. Many of these conditions have a similar immunologic pathogeneses. Canadian and international studies have not only confirmed the presence of these comorbidities but also have demonstrated that patients with psoriasis have a significantly reduced life span. Given that patients with psoriasis are often unaware of their comorbidities, they should be screened for these conditions and treated if required by their dermatologist and/or primary care physician. It is important to keep in mind that the comorbidities and drugs used to treat them have an impact on the choice of anti-psoriatic treatment. In addition, comorbidities often preclude the use of traditional systemic agents. Recent studies have demonstrated that patients with preexisting comorbidities can be safely and effectively treated with biologic therapy. Furthermore, literature is evolving to suggest that better control of psoriasis might decrease cardiovascular mortality and prolong life.
Efficacy Outcomes in Patients Using Alefacept in the AWARE Study
Authors: Landells Ian , Searles Gordon , Bissonnette Robert , Shear Neil H. , Vender Ronald , Lui Harvey
Published: March 2015

Background:

Alefacept has demonstrated efficacy in clinical trials of patients with chronic plaque psoriasis, either as monotherapy or combined with other treatment modalities such as phototherapy.

Objective:

AWARE (Amevive Wisdom Acquired from Real-World Evidence) is a multicenter, observational, phase IV Canadian registry of psoriasis patients treated with alefacept.

Methods:

Patients with chronic plaque psoriasis were treated with at least one course of alefacept, either alone or added on to their existing antipsoriatic treatment regimen. Each course of alefacept was followed by a period of at least 12 weeks off treatment. Efficacy outcomes included physicians' and patients' assessments of response at week 18, as well as change in percent body surface area (BSA) involvement with psoriasis. The time to retreatment was assessed in patients receiving a second course of alefacept during at least 60 weeks of prospective follow-up.

Results:

The majority of patients received alefacept in combination with other antipsoriatic therapies. Physicians' and patients' assessments of response at 18 weeks showed that 42% and 41% of patients, respectively, had a “cleared to marked response” and a further 42% had a “moderate to some response.” Among those patients whose psoriasis was moderately controlled or not controlled at baseline, 49 to 51% and 33 to 36%, respectively, improved to “cleared to marked response” at 18 weeks. A substantial shift in percent BSA involvement with psoriasis was observed at 18 weeks, with 55% of patients having a BSA involvement of < 10% at week 18 compared to only 20% having this level of BSA involvement at baseline. The mean time to retreatment among the 60% of patients who received a second course of alefacept was 19.3 weeks (range 2–47 weeks).

Conclusion:

A single course of alefacept therapy improved outcomes in this broad population of real-world chronic plaque psoriasis patients.

Study Limitations:

The limitations of this study include its nonrandomized, noncontrolled, noncomparative design, which allowed multiple different treatment approaches across all patients. The rating scales used in this study have not been previously validated, and ranges were assigned to baseline control and response data that are not specifically defined. Clinicians did not receive specific training in using these scales; therefore, interrater variability could not be assessed.
Utility of an Interferon-γ Release Assay for Latent Tuberculosis Diagnosis in a Case of Bullous Pemphigoid
Authors: Goodfellow Alfred , Keeling Douglas N. , Hayes Robert C. , Webster Duncan
Published: March 2015

Background:

With increasing use of immunosuppressive therapy, including tumor necrosis factor a inhibitors, there is concern about infectious complications, including reactivation of latent Mycobacterium tuberculosis infection. Routine testing prior to administration of systemic immunosuppression includes the tuberculin skin test, which lacks sensitivity and specificity and may be difficult to interpret in the presence of extensive cutaneous disease. Treatment of individuals with latent tuberculosis infection is recommended when immunosuppressive medications are to be employed.

Observations:

We report a case in which a diagnosis of latent tuberculosis infection in a patient with extensive bullous pemphigoid was clarified by the use of an interferon-γ release assay after equivocal tuberculin skin test results.

Conclusion:

Interferon-γ release assays are useful adjuncts to the tuberculin skin test in the diagnosis of latent tuberculosis infection in the setting of extensive cutaneous disease.
Work-Related Lost Productivity and Its Economic Impact on Canadian Patients with Moderate to Severe Psoriasis
Authors: Chan Brian , Hales Brigette , Shear Neil , Ho Vincent , Lynde Charles , Poulin Yves , Mittmann Nicole
Published: March 2015

Background:

Psoriasis impacts many different areas of a patient's life, including work productivity. There is no information regarding lost productivity owing to psoriasis in a Canadian population.

Objective:

The objective of this study was to determine the lost productivity of Canadian patients with moderate to severe psoriasis.

Methods:

Seventy-nine consecutive Canadian dermatology patients were interviewed and completed the Work Productivity and Activity Impairment Questionnaire (WPAIQ).

Results:

On average, 2.2 hours (± 5.6 hours) were lost from work per week owing to psoriasis-related events. Absence from work may result in lost mean patient wages of C$2,270.84 per person per year. Total lost wages owing to moderate to severe psoriasis may cost up to approximately $749 million for all moderate to severe psoriasis patients in Canada.

Conclusion:

The results from our study indicate that moderate to severe psoriasis may have a substantial impact on the work productivity of patients with this disease.
Dermoscopy in Pigmented Squamous Cell Carcinoma
Authors: de Giorgi Vincenzo , Alfaioli Barbara , Papi Federica , Janowska Agata , Grazzini Marta , Lotti Torello , Massi Daniela
Published: March 2015

Background:

The diagnosis of squamous cell carcinoma (SCC) is, generally, a clinical diagnosis, but in some cases, when the lesion is pigmented, as in our case, the differential diagnosis between pigmented SCC and other pigmented skin lesions, in particular melanocytic lesions, is difficult. Dermoscopy may improve the early diagnosis of SCC and thus play a role in its preoperative classification. However, its potential role has been hampered so far by the fact that little is known about the dermoscopic features of pigmented SCC.

Objective:

We report the case of a rare pigmented SCC dermoscopically mimicking a melanocytic lesion whose dermoscopic features have been investigated.

Conclusion:

On the basis of the literature and our experience, pigmented SCC can present dermoscopic features typical of melanocytic lesions, such as radial streaks, globules, and homogeneous blue pigmentation, and can lead dermatologists to diagnostic errors.
Skin and Soft Tissue Abscess: 1 Year's Experience
Authors: Nalmas Sandhya , Bishburg Eliahu , Shah Monica , Chan Trini
Published: March 2015

Background:

The incidence of skin and soft tissue abscesses (SSTAs) has increased owing to the emergence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). Some of these patients are treated as outpatients (OPs) and some as inpatients (IPs).

Objective:

To review the microbiology and clinical features of SSTAs and the clinical parameters that may have influenced clinicians to treat patients as IPs.

Methods:

The study was conducted in a 673-bed teaching hospital between January and December 2005. A retrospective chart review of patients identified from a microbiology culture log was conducted. Data were collected for demographics, underlying disease, SSTA number and site, recurrence rates, and clinical presentation.

Results:

One hundred thirty-eight patients were identified; 76 (55%) were female, with a mean age of 42 years (range 18–80 years); 76 (55.5%) had no underlying disease, 27 (19.6%) had diabetes, 20 (14.5%) had human immunodeficiency virus (HIV) infection, and 13 (9.4%) were intravenous drug users. Common SSTA sites involved were the perineal area (43; 31.2%), upper extremities (35; 25.4%), lower extremities (19; 13.8%), head and neck (14; 10.1%), chest (13; 9.4%), and abdomen (8; 5.8%).

Conclusions:

CA-MRSA was the most commonly isolated organism overall and in patients treated as OPs. The decision to treat SSTA patients as IPs seems to be influenced by SSTA number and site and the presence of fever at presentation. SSTA number and site (variables that led to the decision to treat patients as IPs) were confirmed by demonstrating statistical significance in the analysis between the IP and OP groups, but the other determinant of admission, the presence of fever at presentation, was based on chart review statements and not confirmed by statistical analysis between the IP and OP groups.
Tonsil Metastasis from Cutaneous Melanoma: First Clinical Sign of Recurrence after Complete Lymph Node Dissection
Authors: Cecchi Roberto , Pavesi Mario , Calamandrei Pierantonio , Rapicano Valentina , De Gaudio Cataldo
Published: March 2015

Background:

The development of melanoma metastasis to the palatine tonsil is a very rare event, generally associated with advanced-stage disease and poor prognosis.

Case Presentation:

A 29-year-old man presented with a melanoma metastasis to the right palatine tonsil 6 months after the surgical excision of an ulcerated nodular melanoma (tumor thickness 1.8 mm, Clark level IV) on the left shoulder. A metastatic sentinel lymph node had been removed from the left axilla, and a subsequent complete lymph node dissection had disclosed no further metastatic lymph nodes. Although staging tests had revealed multiple visceral metastases, a palliative tonsillectomy was performed. The patient died of metastases 5 months later.

Conclusion:

The case presentation suggests that careful examination of the head and neck should be part of the routine follow-up visit in all melanoma patients.
Detection of Occult Melanoma by Preoperative Positron Emission Tomography–Computed Tomography and Intraoperative Ultrasonography
Authors: Shoo Brenda A. , Kangelaris Gerald , Callen Peter W. , Kashani-Sabet Mohammed , Leong Stanley P.L.
Published: March 2015

Background:

18F-Fluorodeoxyglucose positron emission tomography–computed tomography (PET-CT) has become a common imaging modality for detecting metastatic melanoma. However, the identification of lesions intraoperatively can be difficult.

Objective/Methods:

We describe an innovative multimodality approach to tumor localization using preoperative PET-CT and intraoperative ultrasonography and describe cases in which this technique was used.

Results:

The use of these two modalities together enabled resection of multiple occult metastatic lesions in the patients presented.

Conclusion:

The use of this multimodality approach will be important in ensuring that all known metastatic disease sites are resected and represents an important concept in the setting of metastatic melanoma resection.
Nevus Spilus and Melanoma: Case Report and Review of the Literature
Authors: Corradin Maria Teresa , Zattra Edoardo , Fiorentino Renzo , Alaibac Mauro , Belloni-Fortina Anna
Published: March 2015

Background:

Nevus spilus is characterized by a pigmented patch with scattered flat or maculopapular speckles. Nevus spilus was first described by Burkley in 1842. Since then, this lesion has been widely debated in the literature, particularly for the possible occurrence of melanoma within the lesion.

Objective:

We describe the case of a 65-year-old female presenting with a nodular achromic melanoma that occurred within a nevus spilus on the left thigh.

Conclusion:

Our observation is consistent with the idea that this entity in some circumstances may have the ability to evolve into a malignant melanoma.
Antepartum Intravenous Immunoglobulin Therapy in Refractory Pemphigoid Gestationis: Case Report and Literature Review
Authors: Doiron Philip , Pratt Melanie
Published: March 2015

Background:

Pemphigoid gestationis is an autoimmune blistering disease affecting pregnant women. Treatment often consists of topical corticosteroids, oral antihistamines, and oral prednisone followed by immunosuppressants. Refractory cases in antepartum patients present a particular therapeutic challenge as the majority of second-line agents are contraindicated until the patient has delivered.

Objective:

The following report describes the case of a 34-year-old woman pregnant for the third time at 16 weeks' gestation. Her previous two pregnancies were complicated by pemphigoid gestationis but were successfully managed with oral prednisone and topical agents. During her third pregnancy, the initial lesions were controlled with oral prednisone, but attempts to decrease her dose resulted in disease flare.

Conclusion:

Monthly infusions of intravenous immunoglobulin (40 g intravenously for 3 consecutive days for 120 g total) proved to be successful in reducing the dose of oral prednisone required to maintain disease remission. A healthy baby was delivered at 37.5 weeks.
Lupus Vulgaris Occurring in a Locus Minoris Resistentiae
Authors: Long Richard , Beatch Anita , Lee Mao-Cheng , Cheung-Lee Melody , Wasel Norman
Published: March 2015

Background:

The pathogenesis of lupus vulgaris, a form of cutaneous tuberculosis, is not always clear, especially in patients who do not have coexistent extracutaneous tuberculosis and in patients with single lesions.

Objectives:

To report a case of lupus vulgaris in a locus minoris resistentiae (a site of reduced resistance) and to use a unique set of clinical circumstances and laboratory tests to reconstruct the pathogenesis of the lesion and the response to treatment.

Conclusion:

Lupus vulgaris can occur in a locus minoris resistentiae; local trauma and possibly other factors, such as increased temperature, topical corticosteroids, and the virulence of the infecting strain, may facilitate the growth of Mycobacterium tuberculosis present at a locus minoris resistentiae as a result of a silent bacillemia.
Long-Term Evolution of Cytophagic Histiocytic Panniculitis
Authors: Fernández Raquel Rios , Rubio José-Luis Callejas , Cano Daniel Sánchez , Vicent Juan-Ramón Dominguez , Solano Juan Linares , Centeno Norberto Ortego
Published: March 2015

Background:

Cytophagic histiocytic panniculitis is a disorder manifested by multiple subcutaneous nodules, characterized by lobular panniculitis, and occasionally accompanied by severe systemic manifestations, which require an aggressive medical approach. Several case reports with a good response to immunosuppressive therapy in the acute phase can be found in the literature.

Objective and Conclusion:

Nevertheless, the long-term evolution of this entity has not been described yet, nor have precise recommendations regarding the most adequate posology and duration of therapy. We report the result of switching from a long-term cyclosporine therapy to tacrolimus in a patient with a severe form of cytophagic histiocytic panniculitis.
Permanent Alopecia following Cranial Irradiation in a Child
Authors: Al-Mohanna Hind , Al-Khenaizan Sultan
Published: March 2015

Background:

Cranial irradiation is commonly used in childhood leukemia, with many potential cutaneous adverse effects. Radiation-induced permanent alopecia owing to scalp fibrosis is a rare but disturbing side effect.

Objective and Conclusion:

Here we report a Saudi boy with acute T-cell lymphoblastic leukemia who developed radiation-induced cicatricial alopecia. Topical treatment using minoxidil solution was tried but was ineffective.
Are Excipients Really Inert Ingredients? A Review of Adverse Reactions to Excipients in Oral Dermatologic Medications in Canada
Authors: Noiles Kristin , Vender Ronald
Published: March 2015

Background:

Whereas several literature reviews have discussed the role of excipients in drug-related reactions, no article has focused specifically on those found in oral dermatologic medications.

Methods:

The Compendium of Pharmaceuticals and Specialties (CPS) was used to reference the inert ingredients found in oral dermatologic medications. An extensive literature review was subsequently conducted using PubMed and MEDLINE to document adverse reactions to these excipients.

Results:

Sixty-three oral dermatologie medications were reviewed. Lactose was commonly used as a filler. Several medications indicated that they were dye, tartrazine, or gluten free. Three medications were found to contain soybean oil and one was found to contain peanut oil.

Conclusions:

Although there are documented reactions to excipients in other products in the literature, few reports outline reactions to excipients in oral dermatologie medications. Whether this low frequency is accurate or whether it is due to a lack of reporting remains unknown. If the latter reasoning is correct, dermatologists must be more aware of these possible reactions. This article serves as a reference guide for dermatologists to aid in prescribing medications to individuals with known sensitivities and to assist in working up patients with suspected reactions to inert ingredients.
Pyrethroid Pediculicide Resistance of Head Lice in Canada Evaluated by Serial Invasive Signal Amplification Reaction
Authors: Marcoux Danielle , Palma Kathleen G. , Kaul Nalini , Hodgdon Hilliary , Van Geest Andrea , Previte Dominic J. , Abou-Elghar Gamal Elsayed , Yoon Kyong Sup , Clark J. Marshall
Published: March 2015

Background:

Most people in the United States and Canada with pediculosis will be treated with neurotoxic pediculicides containing pyrethrins or pyrethroids. Their widespread use led to significant resistance reported from various countries. Although treatment failures are frequently observed in Canada, the resistance frequency to pyrethroid pediculicide of human head lice (Pediculus humanus capitis) has not been determined.

Objective:

To determine the knockdown resistance ( kdr) allele frequency in human head louse populations in Canada.

Methods:

Patients infested with Pediculus humanus capitis, aged 4 to 65 years, residents of Ontario, Quebec, and British Columbia, were participants. Head lice were collected by combing and picking the enrolled subjects' hair. Lice were analyzed by serial invasive signal amplification reaction (SISAR) for genotyping the T917I mutation of lice indicating permethrin resistance. The permethrin-resistant kdr allele (R allele) frequency could then be evaluated in the head lice collected in Canada.

Results:

Of the head louse populations analyzed, 133 of 137 (97.1%) had a resistant (R) allele frequency, whereas only 4 of 137 (2.9%) had a susceptible (S) allele frequency.

Conclusions:

The 97.1% resistant (R) allele frequency in head lice from Canada could explain the treatment failures encountered with pyrethrin and pyrethroid pediculicide treatments in Canadian populations infested with Pediculus humanus capitis as the latter will not be eliminated by those pediculicides.