bluuebunny/crossref_metadata_2025 huggingface dataset:
Hepatic Safety of Itraconazole
Authors: Gupta Aditya K. , Chwetzoff Elisabeth , Del Rosso James , Baran Robert
Published: July 2017

Background:

As the use of the newer oral antifungal agents for the treatment of superficial fungal infections becomes more widespread, the issue of safety surrounding their use is becoming an increasingly important consideration. Itraconazole is effective and well tolerated, with most side effects being minor and reversible. The most common adverse events are gastrointestinal upset, headache, and transient skin reaction. There have also been rare reports of hepatitis.

Objective:

To assess the hepatic safety of pulse and continuous itraconazole in the treatment of onychomycosis.

Methods:

An analysis was performed on all itraconazole clinical trials sponsored by Janssen Research Foundation in the treatment of onychomycosis, where there was an assessment of laboratory safety. A review of the published literature was also undertaken to assess the hepatic safety of itraconazole in common practice.

Results:

The data indicate that itraconazole pulse treatment is safe, with no significant differences in the number of code 4 abnormalities (baseline value is in the normal range and at least two values, or the last testing in the observation period, exceed twice the upper limit of normal) in the liver function parameters studied: alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, and total bilirubin. The incidence of all the code 4 abnormalities was below 2%. In the literature there are reports of symptomatic hepatitis with itraconazole continuous therapy but no published report of symptomatic hepatotoxicity using the pulse regimen.

Conclusions:

Itraconazole pulse therapy for onychomycosis appears to be safe, especially from the perspective of potential liver damage. In the itraconazole package insert liver function tests are recommended for patients receiving continuous itraconazole for periods of time exceeding 1 month. There is no such monitoring requirement for the pulse regimen unless the patient has a history of underlying hepatic disease, the liver function tests are abnormal at baseline, or at any time that there is the development of signs or symptoms suggestive of liver dysfunction.
Granuloma Gluteale Adultorum Associated with Use of Topical Benzocaine Preparations: Case Report and Literature Review
Authors: Dytoc Marlene T. , Fiorillo Loretta , Liao Janice , Krol Alfons L.
Published: July 2017

Background:

Granuloma gluteale infantum is a skin disorder of controversial etiology manifested clinically by oval reddish-purple granulomatous nodules on the gluteal surfaces and groin areas of infants. Similar granulomas are noted in adults and the elderly and are referred to as granuloma gluteale adultorum and diaper area granuloma of the aged, respectively. Occlusion from diapers, paper napkins, plastic pants, detergents, starch, powder, halogenated steroids, candidal infection, and urine and feces are postulated as possible etiologies.

Objective:

We report a case of a 40-year-old woman presenting with a 3-year history of multiple, painful, closely set, red-purple, oval, smooth, firm papules and nodules in the genitocrural area. The development of the lesions was associated with prolonged use of topical benzocaine. Histology of the lesions was consistent with granuloma gluteale infantum. Gram stain and culture of representative tissue did not demonstrate bacterial or fungal organisms. The lesions significantly improved with discontinuation of topical benzocaine. Patch testing of skin to determine allergic contact hypersensitivity to benzocaine was negative.

Conclusion:

We propose that topical benzocaine preparations may play a role in the pathogenesis of granuloma gluteale adultorum, independent of contact sensitization to benzocaine.
Rare Presentations of Basal Cell Carcinoma
Authors: Nouri Keyvan , Romanelli Paolo , Trent Jennifer T. , Javid Roya , Jimenez Gloria
Published: July 2017

Background:

Even though basal cell carcinomas (BCC) are the most common skin cancers in the world, they rarely appear in the African–American, Hispanic, and Asian populations. BCCs most commonly present on the head and neck of elderly, light-skinned individuals who have received an excessive amount of sun exposure. However, it has been hypothesized that the development of BCCs in unusual populations is a result of an alteration in tumor surveillance or an impairment in cellular immunity.

Objective:

We present two cases of BCC, one in an Asian woman and one in an African–American woman. Neither of these patients had any history of genodermatoses or were immunocompromised.

Conclusion:

BCCs can occur in Asian and African–American patients. Clinicians should include the diagnosis of BCC in their differential for these patients despite their rare presentations.
The Genes and Genetics of Malignant Melanoma
Authors: Gibbs Peter , Brady Benjamin M. R. , Robinson William A.
Published: July 2017

Background:

Population-based studies have identified several clinical variables associated with an increased risk of developing cutaneous melanoma that include phenotype, amount of and response to sun exposure, and family history. However, these observations are of limited relevance to clinical practice as the risk associated with each factor is individually modest and the characteristics of these variables lack precision when applied to a particular individual.

Objective:

To review the literature regarding recent advances made in the understanding of the genes and genetics of clinical variables associated with an increased risk of melanoma.

Conclusion:

Variants of the MC1R (melanocortin-1 receptor) have been identified as major determinants of high-risk phenotypes, such as red hair and pale skin, and the ability to tan in response to UV exposure. Several studies also suggest that such variants may increase melanoma risk independent of their contribution to phenotype. A strong genetic basis for both nevus density and size has been demonstrated and the link between nevi and the development of MM has become better defined. Finally, germline defects in several genes involved in cell cycle regulation, namely, p16 and CDK4, have been demonstrated in many familial melanoma kindreds. This progress has introduced the prospect of genetic testing as a means of identifying a limited number of high-risk individuals who can be targeted with regular screening and education regarding UV exposure and skin self-examination. Ultimately, through rational genetic therapy targeted to correcting the underlying molecular defect, altering the natural history of melanoma development may be possible.
HLA Haplotypes and Class II Molecular Alleles in Argentinian Patients with Pemphigus Vulgaris
Authors: Glorio Roberto , Costa Graciela Rodriguez , Haas Roxana , Gruber Mijail , Fainboim Leonardo , Woscoff Alberto
Published: July 2017

Background:

Pemphigus is a group of chronic blistering autoimmune diseases of which pemphigus vulgaris (PV) is the more frequent clinical form. The association of PV with the HLA serotypes suggests that there is a genetic predisposition to the disease.

Objectives:

To determine the frequency of class I and class II HLA antigens and the allelic variants of the class II HLA antigens, DR and DQ, in patients with PV and to determine the relative risk.

Methods:

An observational, prospective, transverse, and controlled study carried out between 1995 and 1999. Forty-seven patients with a diagnosis of PV and a control sampling of 199 unselected individuals from the same ethnic group were included. The HLA alleles were determined by polymerase chain reaction.

Results:

No significant associations were detected between HLA A, B, or C and our patients. The DR and DQ molecular alleles positively associated with PV were two different haplotypes: DRβ1* 0402/DQβ1* 0302 and DRβ1* 1401/DQβ1* 0503.

Conclusions:

In patients with the haplotype DRβ1* 0402/DQβ1* 0302 the affectation of 10%–30% of the corporal surface prevailed (ACS). In patients with DRβ1* 1401/DRQβ1* 0503, involvement of <10% of the ACS prevailed.
A 10-Year Prospective Study of Patients with Skin Cancer
Authors: Czarnecki D. , Sutton Tina , Czarnecki C. , Culjak G.
Published: July 2017

Background and Objective:

To determine the incidence of new skin cancer formation in people who have had a nonmelanoma skin cancer (NMSC) removed.

Methods:

A prospective study of Australian outpatients with histologically confirmed nonmelanoma skin cancer (NMSC).

Results:

Four hundred eighty-one patients were entered in the study and 300 were followed for at least 10 years. Another skin cancer developed in 67.8% and multiple skin cancers (three or more) in 51.8%. A logistical regression analysis found that the main risk factors for new skin cancer formation were male sex and if the patient had multiple skin cancers. A squamous cell carcinoma (SCC) developed in 36% during the study and a melanoma in 4.7% of men and 2.1% of women. Men who had a NMSC were 8 times more likely than the general population to develop a melanoma while women with NMSC were 4 times more likely. Three patients died of metastatic SCC and one of metastatic melanoma during the followup period. A multivariate analysis showed that multiple skin cancer formation was the main risk factor for SCC or melanoma formation.

Conclusion:

Patients with NMSC require careful followup as they have an increased risk of new cancer formation. Those with multiple skin cancer merit particularly careful followup as all develop another NMSC within 10 years and have a significantly increased risk of developing SCC or melanoma.
The Changing Face of Canadian Dermatology
Authors: Marcoux Danielle , Gratton David
Published: July 2017

Background:

In 1986, Cosmair Canada, agent of the L'Oréal Group, sponsored a survey among Canadian dermatologists to measure the perceptions, attitudes, expectations, and needs of dermatologists regarding cosmetology. Fifteen years later, a new survey among Canadian dermatologists, again sponsored by L'Oréal, tries to capture the evolution and new trends.

Objectives:

This survey tries to capture the perceptions, attitudes, and expectations of Canadian dermatologists regarding cosmetology.

Methods:

A questionnaire was sent to 394 members of the Canadian Dermatology Association; 99 responded (25%). The questionnaire, had 21 questions regarding cosmetology, future trends in Canadian dermatology, and how dermatologists acquire the information required for their practice.

Results:

More than ever, dermatologists are asked to deal with maintaining healthy, youthful skin. Cosmetology is a greater part of everyday practice. Laser and cosmetic dermatology will become more important in the future.

Conclusions:

Dermatologists are asked to provide information on the maintenance of healthy, young-looking skin and feel they need more information relating to cosmetology.
Nonpsoriatic Uses of Calcipotriol
Authors: Gupta Aditya K. , Browne Melanie , Bluhm Robyn
Published: July 2017

Background:

Calcipotriol is a synthetic vitamin D3 analog that binds to vitamin D receptors in epidermal cells. In vitro studies have shown that calcipotriol stimulates terminal cell differentiation and has antiproliferative effects. In vivo, calcipotriol has been shown to reduce the number of cycling epidermal cells. Calcipotriol also has less effect on calcium metabolism than calcitriol, which is the natural, bioactive, 1,25-dihydroxyvitamin D3.

Objective:

These properties make calcipotriol an ideal candidate for the topical treatment of hyperproliferative skin disorders. While it has been approved for topical use in psoriasis, its potential for use in other dermatological disorders has not yet been fully investigated.

Conclusion:

This survey of the literature suggests that calcipotriol may show promise in the treatment of other conditions involving abnormal keratinization and hyperproliferation of epidermal cells. While some of these disorders are rare, and therefore difficult to study, further study into the nonpsoriatic uses of calcipotriol may be rewarding.
NSAIDs in Dermatologic Therapy: Review and Preview
Authors: Friedman Edward S. , LaNatra Nicole , Stiller Matthew J.
Published: July 2017

Background:

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been an important therapy in the treatment of a large number of cutaneous pathologies for more than three decades.

Objective:

In this retrospective review, we document the use of NSAIDs in more than 15 common and uncommon dermatoses, including acne, psoriasis, sunburn, erythema nodosum, cryoglobulinemia, Sweet's syndrome, systemic mastocytosis, as well as urticarial, livedoid, and nodular vasculitis. NSAIDs act mainly by inhibiting prostaglandin synthesis by the cyclooxygenase (COX) pathway.

Conclusion:

Recent studies link prostaglandin to cutaneous carcinogenesis, thus expanding the dermatologic use of NSAIDs. They may be effective in the treatment and prevention of non-melanoma skin cancer, and specific COX-2 inhibitors promise safer, broader, long-term use of these pharmacologically innovative drugs.
Long-Term Safety of Spironolactone in Acne: Results of an 8-Year Followup Study
Authors: Shaw James C. , White Lucile E.
Published: July 2017

Background:

Spironolactone has been used for over 20 years as an antiandrogen in the treatment of acne and hirsutism. No long-term studies of the safety of spironolactone used in this manner have been published. We present a study of the long-term safety and tolerance of spironolactone in 91 women with acne who were followed for up to 8 years.

Methods:

A survey questionnaire was sent to 210 patients, and a comparison chart review of all patients to whom the survey was sent was made.

Results:

Ninety-one completed surveys were analyzed, comprising 506 person-years of followup and 200 person-years of spironolactone exposure. Mean treatment length was 28.5 months (range = 0.5–122 months). During the 8-year followup period, there were no cases of serious illness attributable to spironolactone use. Side effects were present in 59% and resulted in cessation of the drug in 15%. Diuretic effect and menstrual irregularities were the most common adverse effects.

Conclusions:

After 200 person-years of exposure to spironolactone and 506 person-years of followup over 8 years, no serious illnesses thought to be attributed to spironolactone were reported. The long-term use of spironolactone in the treatment of acne in women appears to be safe. Side effects, however, are common, although not usually a cause for stopping the drug.
Imiquimod: A Review
Authors: Gupta Aditya K. , Browne Melanie , Bluhm Robyn
Published: July 2017

Background and Objective:

Imiquimod (Aldara) is an immune response modifier used primarily to treat anogenital warts. Imiquimod induces cytokines and enhances cell-mediated cytolytic antiviral activity in vivo. It exhibits antiviral and antitumor effects; however, it does not exhibit direct antiviral effects in vitro. By inducing cytokines, such as interferon A, imiquimod stimulates both the innate immune response and the cellular arm of acquired immunity. Currently, imiquimod is approved for use in the treatment of external genital and perianal warts in adults.

Conclusion:

Beyond its established use, there are case reports and preliminary studies suggesting the effectiveness of imiquimod 5% cream in the treatment of nongenital human papillomavirus warts, molluscum contagiosum, actinic keratosis, basal cell carcinoma, squamous cell carcinoma, Bowen's disease, nongenital human papillomavirus infection, and vulvar intraepithelial neoplasia.
The Efficacy and Tolerability of Clobetasol Propionate Foam 0.05% in the Treatment of Mild to Moderate Plaque-Type Psoriasis of Nonscalp Regions
Authors: Gottlieb Alice B. , Ford Rosanne Odom , Spellman Mary C.
Published: July 2017

Background:

Clobetasol propionate foam 0.05% (Connetics Corporation, Palo Alto, CA) is approved by the United States Food and Drug Administration for the treatment of corticosteroid-responsive scalp dermatoses, but there is only limited data available for its efficacy and tolerability in treating dermatoses which affect nonscalp sites.

Objective:

The efficacy and tolerability of clobetasol propionate foam (clobetasol foam) in treating psoriatic lesions at nonscalp sites was evaluated in a multicenter, randomized, double-blinded, placebo-controlled study of 279 patients with mild to moderate plaque-type psoriasis.

Methods:

The patients applied clobetasol foam or placebo to the psoriatic lesions twice daily for two weeks. In addition to receiving clinical evaluations, the study patients completed a questionnaire evaluating various characteristics of the foam formulation, including their preference for its use and their projected likelihood to comply with similar therapy in a nonstudy environment.

Results:

At Week 2 (or end of treatment), 68% (94/139) of patients who received clobetasol foam had a Physician's Static Global Assessment score of 0 (clear, except for minor residual discoloration) or 1 (majority of lesions have individual scores for plaque thickness, erythema, and scaling that averages 1). This was significantly more than the 21% (30/140) observed in the placebo group ( P < 0.0001). Similar results were obtained for the Patient's Global Assessment score at Week 2 and in changes (from Baseline to Week 2) in the scores for the signs of psoriasis at a target lesion and for pruritus. Adverse effects were generally limited to mild and transient burning or other application site reactions in only a few patients in each treatment group. In the patient's poststudy questionnaire (completed at Week 2, or end of treatment) a majority of patients rated the characteristics of the foam formulation very highly. The patients ranked the foam formulation as superior to other topical formulations based on factors impacting their quality of life and indicated they would be more likely to comply with a recommended course of therapy with the foam formulation than with other topical formulations.

Conclusion:

Clobetasol propionate foam 0.05% is safe and effective for the treatment of plaque-type psoriasis on scalp and nonscalp areas, when applied twice daily for two weeks. As it is understood that patient dissatisfaction with select topical formulations affects their compliance with therapy, which necessarily affects the effectiveness of the therapy, the results of the patient's poststudy questionnaire suggest that there are multiple and integrated benefits for the use of clobetasol foam in the treatment of psoriasis of nonscalp sites.
Innovative Therapies in Wound Healing
Authors: Shen John T. , Falanga Vincent
Published: July 2017

Background:

Apligraf is a bioengineered skin product composed of neonatal fibroblasts and keratinocytes. The FDA has approved Apligraf for the treatment of chronic venous ulcers and diabetic ulcers.

Objective:

We review the development of bioengineered skin, examine the cellular activities of various growth factors that may facilitate wound healing, and discuss the results of clinical trials with a particular construct, Apligraf, as proof of principle.

Conclusion:

Bioengineered skin acts as a “smart” delivery system for growth factors and other stimulatory substances. Not only does it present a novel treatment for chronic and diabetic ulcers, but it could also be considered for application to other types of acute wounds.
Subacute Cutaneous Lupus Erythematosus Induced by Nifedipine
Authors: Gubinelli Emanuela , Cocuroccia Barbara , Girolomoni Giampiero
Published: July 2017

Background:

Subacute cutaneous lupus erythematosus (SCLE) has been reported to be associated with the use of several drugs, including thiazides, terbinafine, and, rarely, calcium channel blockers.

Objective:

A case of SCLE induced by nifedipine is presented.

Methods and Results:

A 48-year-old white woman developed a papulosquamous and annular eruption in sun-exposed areas during the summer. The patient was taking nifedipine for essential hypertension for four years. Serology showed the presence of antinuclear and anti-Ro/SSA as well as antihistone antibodies. Histopathologic and immunopathologic (granular IgM deposits at the dermoepidermal junction) findings confirmed the diagnosis of SCLE. Nifedipine discontinuation led to rapid improvement with almost complete resolution of skin lesions in one month in the absence of active treatment. Reduction of antinuclear, anti-Ro/SSA, and antihistone antibody levels was documented after six months.

Conclusion:

Nifedipine can cause SCLE after a long period of administration. Antihistone antibodies may be associated with drug-induced SCLE.
Characterizing Anxiety in Melanoma Patients
Authors: Missiha Sharif B. , Solish Nowell , From Lynn
Published: July 2017

Background:

Over half of melanoma patients experience significantly elevated anxiety levels leading to psychological distress and delays in diagnosis and treatment.

Objective:

To identify melanoma patients likely to experience high levels of anxiety, we characterized the contributing factors and coping strategies and investigated potential anxiety-alleviating interventions.

Method:

Surveys were sent to 94 melanoma patients at Women's College Hospital's Pigmented Lesion Clinic assessing self-reported anxiety, contributing factors, coping strategies, and potential assisting services.

Results:

Risk factors for anxiety include female gender ( p = 0.002) and increasing age ( p = 0.004) but not melanoma depth. Major factors contributing to anxiety are prognosis, fear of death, and the attitude of the diagnosing doctor. Major coping strategies include family support, doctor assistance, and self-distraction. Potentially useful services for decreasing anxiety include the provision of detailed information pamphlets.

Conclusion:

Melanoma patients likely to experience high anxiety can be predicted and managed in ways that minimize the distress experienced.
Multiple, Clustered Dermatofibroma: A Rare Clinical Variant of Dermatofibroma
Authors: Soon Seaver L. , Howard Amy K. , Washington Carl V.
Published: July 2017

Background:

Although patients with one to two dermatofibromas are common, cases of “multiple” dermatofibromas (more than 15 lesions) are rare and may occur in the context of altered or normal immune function. Patients with multiple dermatofibromas clustered in one anatomic area, by contrast, are strikingly rare.

Objective:

The aim of our study was to present an additional case of multiple, clustered dermatofibroma (MCDF) and to summarize the literature concerning this entity.

Methods:

We performed a MEDLINE (1960–2001) database search using keywords “dermatofibroma” AND “clustered” OR “agminated” OR “grouped.”

Results:

Five case reports were identified using this search strategy. These cases demonstrated substantial similarity in clinical features and behavior, specifically, the presence of pruritic symptoms, no clear inciting incident, an early active growth phase followed by stabilization, predilection for the lower extremity, and no report of sarcomatous transformation.

Conclusion:

Despite an active early growth phase, MCDF appears to follow a benign clinical course, with no report of sarcomatous transformation at up to 20 years followup.
A Case of Familial Psoriasis with Predominant Hand Involvement
Authors: Gottlieb Alice B. , Weisfelner Michelle E.
Published: July 2017

Psoriasis has been recognized as a familial disease with a polygenic inheritance. A case is reported of a father and four of his seven children with plaque psoriasis localized to the hands. The other three children are not afflicted by psoriasis. All patients developed psoriasis at 5 years of age. Only one member of this family has involvement in an area other than the hands. This case illustrates some of the complexities of the genetics of psoriasis.
Axillary Hidradenitis Suppurativa: A Further Option for Surgical Treatment
Authors: Altmann S. , Fansa H. , Schneider W.
Published: July 2017

Background:

Hidradenitis suppurativa is a chronic inflammatory disease of the cutis with furuncles, fistulas, and abscesses. The disease is mostly located in groin and axilla. As conservative treatment can usually not prevent recurrence, surgical treatment is the method of choice.

Methods:

We report on 20 patients with axillary hidradenitis suppurativa. The inflammatory region was excised in a rhomboid shape and immediately covered with a transposition flap according to Limberg. Postoperatively, all patients received antibiotic treatment and immobilization of the arm. Physiotherapy started after 2 weeks.

Results:

No flap complications occurred. The functional and aesthetic results were very satisfactory. Movement of shoulder showed no restrictions. A recurrence with single fistulas was seen in 3 patients.

Conclusions:

Conservative treatment of hidradenitis suppurativa is followed by a high rate of recurrence. Only radical debridement offers a cure. The therapy of choice is the radical excision of the affected region and immediate coverage with a flap. Open granulation or split skin grafting often results in a prolonged hospitalization, higher morbidity, and functional problems. Thus, open granulation is inferior to primary closure by a transposition flap. Using the Limberg flap, the donor site is allowed to be closed primarily.
Scar Area and Cosmetic Outcome after Circular and Elliptical Excision of Small Skin Lesions
Authors: Ek Lorens , Högstedt Benkt , Herrström Per
Published: July 2017

Background:

Cutaneous surgery for removal of small skin tumors is usually performed as elliptical excision. There is some indication that circular excisions could result in cosmetically more favorable scars and should therefore be considered as an alternative method.

Objective:

The aim of this study was to compare circular and elliptical excisions with respect to scar area and cosmetic result.

Methods:

Fifty-six operations were performed, 27 elliptical and 29 circular. The cosmetic results were determined as patient's opinion by questionnaire and assessment of photo slides by three independent observers. Also, scar areas were measured by computer program.

Results:

The scar area was significantly smaller after circular excisions compared with elliptical excisions after 6 and 12 months of observation ( p = 0.005 and p = 0.001, respectively). The assessment of cosmetic results by the patients did not differ between the two groups ( p = 0.44), while the independent observers slightly favored the cosmetic outcome of elliptical scars ( p = 0.03). When analyzing only excisions without complications, there was no difference in cosmetic results between the two groups.

Conclusion:

Circular excisions seemed to cause smaller scars and equal cosmetic results compared with traditional elliptical excisions and could therefore be an alternative method for small skin excisions on the trunk and extremities.
Fixed Drug Eruption Due to Influenza Vaccine
Authors: Al-Mutairi N. , Al-Fouzan A. , Nour-Eldin Osama
Published: July 2017

Two females, one 28 years old and the other 32 years old, developed dusky red macules with pain and a burning sensation within 24 hours of receiving influenza vaccine. One patient had blisters within the lesion. A clinical diagnosis of fixed drug eruption (FDE) due to influenza vaccine was made. Histopathology was consistent with the diagnosis of FDE. The lesions subsided within 2 weeks of topical corticosteroid treatment. The diagnosis was confirmed by topical provocation test with influenza vaccine. A Medline search revealed these cases to be the second report of this kind of reaction due to influenza vaccine.
Chondroid Syringoma with Small Tubular Lumina
Authors: Radhi J. M.
Published: July 2017

Background:

Chondroid syringoma or mixed tumor of the skin is a rare epithelial tumor with eccrine differentiation. The variant with small tubular lumina is extremely uncommon.

Objective:

Chondroid syringoma is usually present as a single subcutaneous nodule. This report describes a man with multiple scalp lesions exhibiting features of chondroid syringoma with small tubular lumina.

Methods:

A Pathological examination of surgically resected multiple scalp nodules was carried out by routine histology and immunohistochemistry. The following antibodies were found: cytokeratin, epithelial membrane antigen, and vimentin.

Results:

Microscopic findings revealed multiple chondroid syringoma with small tubular lumina. The tumor cells were positive for high- and low-molecular-weight keratin, epithelial membrane antigen, and vimentin.

Conclusion:

This is the first report of multiple chondroid syringoma with small tubular lumina.
Early Detection of Skin Cancer by Family Physicians: A Pilot Project
Authors: de Gannes Gillian C. , Ip Janet L. , Martinka Magdalena , Crawford Richard I. , Rivers Jason K.
Published: July 2017

Background:

Malignant melanoma is rising quickly in incidence and mortality rates. Family physicians (FPs) have been reported to lack confidence in diagnosing skin cancers. Objective: The aim of this study was to determine whether an educational intervention can improve FPs' abilities to diagnose skin cancers.

Methods:

The design was a prospective, randomized trial which included a skin cancer questionnaire, a video intervention, and a skin biopsy review.

Results:

Pre-intervention, FPs answered 57% of the questions correctly on the skin cancer questionnaire. Post-intervention, the video intervention group scored higher than did the control group. The video intervention group removed 10% fewer benign lesions and almost 3 times more malignant lesions compared with their pre-intervention biopsy rate. No findings were statistically significant.

Conclusion:

An educational intervention may improve FPs' knowledge and diagnosis of skin cancer. Our results may guide future studies with larger sample sizes in developing a skin cancer continuing medical education (CME) course for FPs.
HPV Typing in Brazilian Patients witn Epidermodysplasia Verruciformis: High Prevalence of EV-HPV 25
Authors: de Oliveira Walmar Roncalli P. , He Qin , Rady Peter L. , Hughes Thomas K. , Neto Cyro Festa , Rivitti Evandro A. , Tyring Stephen K.
Published: July 2017

Background:

Epidermodysplasia verruciformis is a rare genetic disorder characterized by development of lesions associated with HPV#5 or HPV#8 in early childhood; malignant transformation occurs in approximately half of individuals during adulthood.

Objective:

Our goal was to study the presence and spectrum of EV-HPV types in Brazilian EV patients, a population that had never been studied in this regard. Patients and MethodsForty-one biopsies from different lesions (benign and skin tumors) and one biopsy from clinically normal skin from each of 20 Brazilian patients with EV were studied for HPV typing using nested PCR.

Results:

EV-HPV DNA was detected in all 41 skin lesions of the patients and was also identified in specimens considered as normal skin from 8 patients (40%). In this study HPV-EV 25 was the most prevalent (70%), and HPV 14d (67%) was highly associated with malignant lesions.

Conclusion:

EV-HPV 25 was the most prevalent in our study. The noteworthy association of EV-HPV type 14d with skin cancers suggests its possible oncogenic role in malignant transformation in this population.
Nail Psoriasis: Combined Therapy with Systemic Cyclosporin and Topical Calcipotriol
Authors: Feliciani Claudio , Zampetti Anna , Forleo Pietro , Cerritelli Luca , Amerio Paolo , Proietto Gianluca , Tulli Antonio , Amerio Pierluigi
Published: July 2017

Background:

Nail psoriasis is a common problem in psoriatic patients and often it is difficult to cure. Several treatments have been proposed in the last decade using new molecules like vitamin-D analog and/or immunosuppressive drugs both systemically and locally.

Objective:

Our goal was to evaluate a combination of cyclosporin and topical calcipotriol cream versus cyclosporin alone in a matched group of patients treated with cyclosporin alone.

Method:

Fifty-four patients affected by severe psoriasis and nail involvement were selected and matched for severity of nail involvement, sex, age, and cyclosporin dosage. Group A included 21 patients treated with cyclosporin alone (3.5 mg/kg/day) for three months. Group B included 33 patients treated with the same cyclosporin dosage plus, for the same time, topical application of calcipotriol cream twice a day. Evaluation for clinical improvement was the personal feeling of the patient after three months, while clinical appearance of the lesions was evaluated by the same dermatologist using digital pictures and who was blind as to the treatment of the patient. A score ranging from + to +++ was used in order to evaluate the improvement, and data were statistically evaluated with the Wilcoxon test.

Results:

Both cyclosporin alone and a combination of cyclosporin with topical calcipotriol twice a day were useful for treating nail psoriasis after three months of therapy although the combined therapy showed a better overall result in both mild and severe nail psoriasis. Improvement of the clinical appearance of the nail lesions was seen in about 79% of patients in group B ( p ≤ 0.0004) versus about 47% of patients in group A ( p ≤ 0.15). Conclusionsln patients with severe involvement of nail psoriasis we suggest the use of a combination of topical calcipotriol twice a day with systemic treatment such as cyclosporine.
Nipple and Areolar Eczema in the Breastfeeding Woman
Authors: Barankin Benjamin , Gross M. Shirley
Published: July 2017

Eczema of the nipple and areola can occasionally develop in the breastfeeding patient and is associated with sore, burning, and painful areolae and nipples. Management includes elimination of any precipitating allergens and irritants and the judicious use of appropriate topical corticosteroid preparations. Patients must also be offered effective pain control and support. The proper diagnosis and management of eczema of the nipple and areola in breastfeeding patients will prevent premature and iatrogenic weaning.
Abdominal Elephantiasis: A Case Report
Authors: Hanna Dominique , Cloutier Richard , Lapointe Roch , Desgagné Antoine
Published: July 2017

Background:

Elephantiasis is a well-known condition in dermatology usually affecting the legs and external genitalia. It is characterized by chronic inflammation and obstruction of the lymphatic channels and by hypertrophy of the skin and subcutaneous tissues. The etiology is either idiopathic or caused by a variety of conditions such as chronic filarial disease, leprosy, leishmaniasis, and chronic recurrent cellulites. ObjectiveElephantiasis of the abdominal wall is very rare. A complete review of the English and French literature showed only two cases reported in 1966 and 1973, respectively. We report a third case of abdominal elephantiasis and we briefly review this entity.

Methods:

We present the case of a 51-year-old woman who had progressively developed an enormous pediculated abdominal mass hanging down her knees. The skin was thickened, hyperpigmented, and fissured. She had a history of multiple abdominal cellulites. ResultsShe underwent an abdominal lipectomy. Histopathology of the specimen confirmed the diagnosis of abdominal elephantiasis.

Conclusion:

Abdominal elephantiasis is a rare disease that represents end-stage failure of lymph drainage. Lipectomy should be considered in the management of this condition.
Treatment of Chronic Nonhealing Leg Ulceration with Gaseous Nitric Oxide: A Case Study
Authors: Miller Chris C. , Miller Minna K. , Ghaffari Abdi , Kunimoto Brian
Published: July 2017

Background:

Despite the best clinical practice, chronic nonhealing ulcers of the lower extremities present a significant challenge. Nitric oxide (NO) has been shown to play a significant role in biological functions including wound healing and as an antimicrobial agent in nonspecific immune response.

Objective:

Our goal was to study the effect of gaseous NO (gNO) administered directly to a two-year-old nonhealing chronic venous ulcer in a 55-year-old male presenting with a 30-year history of severe venous disease.

Methods:

gNO (200 ppm) was applied to the lower extremity using a delivery system connected to a “single patient use” plastic boot, at 1.0 L/min.

Results:

The patient received an average of 8.1-h treatments for 14 consecutive nights. On day 0 the wound was malodorous and covered by bacterial biofilm with little healthy granulation tissue present. Following 3 days of gNO treatment, healthy granulation tissue was noted with absence of malodorous odor. At day 14, the ulcer was significantly reduced in size ( p = 0.014) and almost completely reepithelialized. Day 10 post-treatment did not reveal any deterioration in healing. Six weeks later, the wound was 90% healed. At 26 weeks post gNO discontinuation, the ulcer was completely healed.

Conclusions:

This single case study demonstrated that gNO as a topical agent was well tolerated by the patient without any report of discomfort or side effect. The result of wound healing was very promising and warrants future exploration.
Integrating Biologic Agents into Management of Moderate-to-Severe Psoriasis: A Consensus of the Canadian Psoriasis Expert Panel
Authors: Guenther Lyn , Langley Richard G , Shear Neil H. , Bissonnette Robert , Ho Vincent , Lynde Charles , Murray Eileen , Papp Kim , Poulin Yves , Zip Catherine
Published: July 2017

Background:

Approximately 2% of people worldwide have psoriasis, with as many as 1 million people with psoriasis in Canada alone.1,2 The severity of psoriasis ranges from mild to severe. It can lead to substantial morbidity and psychological stress and have a profound negative impact on patient quality of life.3,4 Although available therapies reduce therapies reduce the extent and severity of the disease and improve quality of life,3 reports have indicated a patient preference for more aggressive therapy and a dissatisfaction with the effectiveness of current treatment options.5

Objective:

A Canadian Expert Panel, comprising Canadian dermatologists, convened in Toronto on 27 February 2004 to reach a consensus on unmet needs of patients treated with current therapies and how to include the pending biologic agents in and improve the current treatment algorithm for moderate-to-severe psoriasis. Current treatment recommendations suggest a stepwise strategy starting with topical agents followed by phototherapy and then systemic agents.3,6,7 The Panel evaluated the appropriate positioning of the biologic agents, once approved by Health Canada, for the treatment of moderate-to-severe psoriasis.

Methods:

The Panel reviewed available evidence and quality of these data on current therapies and from randomized, controlled clinical trials.8–14 Subsequently, consensus was achieved by small-group workshops followed by plenary discussion.

Results:

The Panel determined that biologic agents are an important addition to therapies currently available for moderate-to-severe psoriasis and proposed an alternative treatment algorithm to the current step wise paradigm.

Conclusion:

The Panel recommended a new treatment algorithm for moderate-to-severe psoriasis whereby all appropriate treatment options, including biologic agents, are considered together and patients' specific characteristics and needs are taken into account when selecting the most appropriate treatment option.
Cutaneous Effects of Smoking
Authors: Freiman Anatoli , Bird Garrett , Metelitsa Andrei I. , Barankin Benjamin , Lauzon Gilles J.
Published: July 2017

Background:

Cigarette smoking is the single biggest preventable cause of death and disability in developed countries and is a significant public health concern. While known to be strongly associated with a number of cardiovascular and pulmonary diseases and cancers, smoking also leads to a variety of cutaneous manifestations.

Objective:

This article reviews the effects of cigarette smoking on the skin and its appendages.

Methods:

A literature review was based on a MEDLINE search (1966–2004) for English-language articles using the MeSH terms cutaneous, dermatology, tobacco, skin, and smoking. An additional search was subsequently undertaken for articles related to smoking and associated mucocutanous diseases, with the focus on pathogenesis and epidemiologic data. Articles presenting the highest level of evidence and latest reports were preferentially selected.

Results:

Smoking is strongly associated with numerous dermatologic conditions including poor wound healing, wrinkling and premature skin aging, squamous cell carcinoma, psoriasis, hidradenitis suppurativa, hair loss, oral cancers, and other oral conditions. In addition, it has an impact on the skin lesions observed in diabetes, lupus, and AIDS. The evidence linking smoking and melanoma, eczema, and acne is inconclusive. Anecdotal data exist on the possible protective effects of smoking in oral/genital aphthosis of Behçet's disease, herpes labialis, pyoderma gangrenosum, acral melanoma, and Kaposi's sarcoma in AIDS patients.

Conclusions:

An appreciation of the adverse cutaneous consequences of smoking is important. Dermatologists can play an integral role in promoting smoking cessation by providing expert opinion and educating the public on the deleterious effects of smoking on the skin.
Kikuchi—Fujimoto's Necrotizing Lymphadenitis in Association with Discoid Lupus Erthematosus: A Case Report
Authors: Silver Shane G. , Hong H. Chih-Ho , Ting Patricia T. , Ball Nigel J.
Published: July 2017

Background:

Kikuchi–Fujimoto's necrotizing lymphadenitis (KFNL) is a rare, benign, self-limited condition characterized by constitutional symptoms, lymphadenopathy, and skin lesions.

Objective:

We report a case of KFNL in a 43-year-old East Indian woman with a ten-year history of discoid lupus erythematosus (DLE) of the scalp and a three-month history of a erythematous plaque on the left nasal bridge, cervical lymphadenopathy, and fever. Skin biopsy samples were taken from the face and lymph node.

Results:

Histopathological examination of the skin revealed a mixed infiltrate of inflammatory cells, nuclear dust, and histiocytes phagocytosing nuclear debris in the reticular dermis. The lymph node showed interfollicular liquefactive necrosis, immunoblasts, and a similar cellular infiltrate as the skin. The non-necrotic areas demonstrated follicular hyperplasia. These pathological changes are associated with a diagnosis of KFNL.

Conclusions:

KFNL is reported in association with systemic lupus erythematosus, but only two other cases of systemic KFNL in association with DLE exist in the literature. This case is unique in that the patient presented with cutaneous and systemic KFNL in the setting of longstanding DLE.
The Remittive Effects of Alefacept
Authors: Krueger Gerald G.
Published: July 2017

The duration of response to treatment with alefacept has been assessed in patients with moderate to severe chronic plaque psoriasis who responded to alefacept therapy in phase 2 and phase 3 clinical studies. In a phase 2 trial, duration of response was based on time to retreatment with alefacept. In two phase 3 studies, the more objective measure of maintenance of a ≥50% reduction from baseline Psoriasis Area and Severity Index (PASI 50) was used. Two patient subsets were analyzed: (1) those who achieved a PASI 75 at any time during the trials and (2) those who achieved a Physician Global Assessment of “clear” or “almost clear” at any time during the trials. Regardless of the criterion used or the route of alefacept administration (intravenous or intramuscular), the median duration of response to alefacept therapy ranged from 7 to 10 months across the three studies. Alefacept is a remittive therapy for psoriasis.
Reduction of Melanogenic Activity and Responsiveness to α-Melanocyte-Stimulating Hormone during Serial Passage of Melanoma Cells
Authors: Park Hee-Young , Gilchrest Barbara A.
Published: July 2017

Background:

Murine melanoma cells such as Cloudman S91 or B16 mouse melanoma cells have been used extensively to study mechanisms involved in pigmentation because these cells have tyrosinase, the key enzyme in pigmentation, and produce pigment. We have observed that serial passaged S91 cells tend to decrease their basal pigment content and to lose their responsiveness to α-melanocyte-stimulating hormone (α-MSH).

Objective:

Because this reduction of melanogenic capacity is a widely acknowledged but virtually unstudied characteristic of both human and murine melanoma cell lines in culture, we wished to document and quantify the phenomenon.

Methods:

Commercially attained S91 melanoma cells were serially passaged. Basal pigmentation as well as α-MSH responsiveness and expression of protein kinase C-beta (PKC-β) were assessed.

Results:

S91 cells progressively lost their basal pigmentation under standardized conventional conditions of culture, from an initial melanin content of 20 ± 4 pg/cell content to 12 ± 5 pg/cell within 70 population doublings (16 passages) and to 4.5 ± 6 pg/cell, a level at or below the detectable level of our melanin assay, by 110 population doublings (28 passages). When responsiveness to α-MSH was assessed, a 6-day treatment with 10−6M α-MSH initially induced the pigment content four-fold from 20 ± 4 to 82 ± 2 pg/cell. In contrast, after 110 population doublings, identical treatment with α-MSH induced pigment content less than two-fold from 4.5 ± 6 to 7.5 ± 2 pg/cell. PKC-β expression was readily detected by immunofluorescence in early passage pigmented cells, but not in late passage nonpigmented cells.

Conclusion:

These results confirm that while murine melanoma cells are a useful model system for pigmentation studies, it is important to monitor changes in the cells' basal abilities to pigment and to respond to exogenous pigment-inducing factors. They further suggest that factors in the culture environment or the internal milieu of melanoma cells exposed to continuous mitogenic stimulation inhibit melanogenesis. One candidate mechanism is down regulation of PKC-β.
Informed Patient Decision Making and the Use of Prescription Medications: A Canadian Dermatologic Perspective
Authors: Singer Michael I. , Shear Neil H.
Published: July 2017

Background:

Informed consent is a potentially beneficial component of medical practice and a basic obligation of physician to patient. Society, in general, and the courts, in particular, have increasingly emphasized the principles of individual autonomy and patient rights, and they have begun to more rigorously require physicians to inform and consult with patients before initiating treatments. Nevertheless, the lack of sufficient information disclosure to patients has become an increasingly common allegation in legal actions against physicians. It has been shown that physicians' understanding of what constitutes informed consent is not always equivalent to the legal definition. While informed consent is generally applied in investigative medical research and before surgical and other invasive procedures, general medicine and dermatology patients do not commonly undergo a process of informed and formal decision making before commencing therapy with sometimes potent medications that often have potentially serious side effects.

Objective:

The purpose of this article is to explore and clarify the legal concept of informed consent as it applies to the use of prescription medications and to offer dermatologists a strategy to make drug use safer, both medically and legally.

Conclusion:

In light of recent legal trends including the proclamation of the Ontario Consent to Treatment Act, as well as the application of the “learned intermediary” rule in cases of medical negligence involving lack of drug risk disclosure, Canadian health care practitioners are well advised to become familiar with the concept of informed consent and how it applies to prescription medications.