bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of Cytomegalovirus Replication in Alopecia Areata Pathogenesis
Authors: Offidani Annamaria , Amerio Paolo , Bernardini Maria Luisa , Feliciani Claudio , Bossi Guido
Published: July 2017

Background:

Cytomegalovirus (CMV) infection has been correlated with various autoimmune disorders. Using molecular biology techniques, DNA sequences of CMV have been reported in paraffin sections of alopecia areata (AA) lesions. Reactivation of the CMV infection has been postulated as one of the pathogenic mechanisms in AA. Other studies, using different techniques however have demonstrated no correlation between CMV and AA.

Objectives:

This study was to clarify the role of CMV infection and to demonstrate the absence of replication of other autoimmune diseases-related herpes virus (EBV) in the pathogenesis of AA.

Methods:

After extraction of mRNA from tissue samples of a patient with active patchy AA, reverse transcriptase-polymerase chain reaction was carried out using primers specific for some viral members of the β-herpes viridae family (CMV, EBV, HSV).

Results:

No replication of the CMV or other β-herpes viridae has been detected in any of the samples collected.

Conclusions:

The results strongly support the hypothesis that CMV is not the triggering factor in AA, neither as a re-activator of the immune response nor as a trigger of the autoimmunity. No other herpes virus is implicated in the pathogenesis of this disease.
Isotretinoin Use in Acne: Prospective Evaluation of Adverse Events
Authors: Hull Peter R. , Demkiw-Bartel Coby
Published: July 2017

Background:

Isotretinoin is an effective treatment for severe acne. Although the spectrum of side effects has been well documented, the changing incidence of such side effects over the course of treatment has not been studied in detail.

Objectives:

The purpose of our study was to examine a group of patients monthly over their course of treatment and prospectively document the side effects experienced.

Methods:

Over the period between January 1991 and July 1996, 124 courses of treatment with isotretinoin for severe acne were followed. The patients were treated for 4 months at a dose of 1 mg per kg body weight. A questionnaire was administered monthly, inquiring specifically about side effects known to be associated with isotretinoin. Any additional side effects were also noted.

Results:

The majority of patients experienced persistent dryness of lips. Dry eyes affected 40% of patients; this continued throughout treatment in 25%. Contact lens wearers were more likely to develop conjunctivitis. Lower back pain was reported early in about 30% of patients and fewer than 10% of patients would develop it later in the course of treatment. Arthralgia was noted in 16.5% of patients at the first visit and there was little change with ongoing treatment. Hair loss was experienced in a small percentage but was rarely noted on more than one occasion. Headaches occurred in less than 10% and were occasionally severe, but most often intermittent and recorded at a single visit. Depression occurred in 4% of patients and tended to persist throughout the treatment. All these patients completed the full course of treatment.

Conclusion:

This prospective analysis has shown that patients treated with isotretinoin experienced a predictable series of side effects. Some occurred fleetingly, but several persisted for the duration of treatment.
Long-Term Hair Removal Using a 3-Millisecond Alexandrite Laser
Authors: Laughlin Sharyn A. , Dudley Denis K.
Published: July 2017

Background:

Laser epilation is now used widely as a clinical alternative to electrolysis for the removal of unwanted hair. All of the laser systems presently being used produce a reliable temporary hair loss by inducing telogen. Most of the published studies use follow-up periods of 6 months or less after the last treatment and cannot address the issue of permanency. Since many patients desire permanent hair loss, there is a need for specific information on the exact benefits and limitations of each particular system.

Objective:

The purpose of this study was to assess the degree of hair loss attained by a single treatment with a 3-msec alexandrite laser. A designated period for follow-up was used to address the issue of long-term benefits.

Methods:

A single treatment was carried out on 25 study sites with a 3-msec alexandrite laser at 755 nm using fluences of 30 to 50 joules/cm2. Hair counts were obtained manually by two independent observers marking terminal hairs under magnification. The counts were repeated using photographic images and the average of the four readings taken. The degree of hair loss was calculated at a time after treatment equal to one complete growth cycle for the particular anatomic site. A second measurement was obtained at a time equal to one growth cycle plus 6 months to determine whether any hair loss had remained stable.

Results:

The average hair loss at the first follow-up time was 43%, with 60% of sites showing a hair loss of >30%. The hair loss remained stable and the reduction in hair density at both designated times was statistically significant (p < .05).

Conclusion:

A normal-mode alexandrite laser achieves a long-term alopecia and may result in a permanent loss of terminal hair after one treatment at fluences of 30 to 50 joules/cm2.
Chronic Urticaria: A Canadian Perspective on Patterns and Practical Management Strategies
Authors: Sharma Jasdeep K. , Miller Robert , Murray Scott
Published: July 2017

Background:

Chronic urticaria is a common condition and is a source of great frustration to patients. It has been suggested that there may be differences among physicians in their approach to this common clinical entity.

Objective and Method:

A questionnaire was distributed Canada-wide to allergists, dermatologists, and a selection of practitioners with an interest in alternative medicine. The survey included questions on demographics, epidemiology, causative factors, diagnostic methods, therapeutic strategies, follow-up advice, and efficacy of therapies, with emphasis on personal experience.

Results:

The response rates of allergists and dermatologists were 31% and 36%, respectively. There was wide representation from all regions of Canada and from physicians from all age groups, both genders, different types of practice, and years in practice. The reported incidence per month was 13 and 4 patients for allergists and dermatologists, respectively. The prevalence was 199 and 44 patients by allergists and dermatologists, respectively. Comparison of causative factors showed differences in the experiences of the two groups. Diagnostic investigations were requested in a similar pattern with respect to timing. The specific tests ordered by the groups showing statistical difference were complete blood count (CBC), differential, C4 complement, antinuclear antibodies, and IgE antibody assay. Allergists chose the skin prick test (100%) as the most important allergy test. Dermatologists ranked skin prick (50%), radioallergosorbent test (RAST) (20%), and skin patch (30%) as the most important tests. The top six choices of pharmaceutical therapies chosen by the groups were similar, but in a slightly different order. The responders ranked their personal selection of antihistamines according to effectiveness. Hydroxyzine (Atarax®) and cetirizine (Reactine®, Allegra®) were selected as first and second most effective agents by both groups. The results also show effective experience by both groups with nonsedating and sedating antihistamines. Also, doxepin, ketotifen, and cimetidine are used frequently by both groups. The experience of dermatologists in Canada with respect to other modalities including psoralen ultraviolet A (PUVA) therapy, danazol, chelation, calcium channel blockers, and acyclovir is limited and efficacy is ranked either neutral or ineffective. Allergists reported even less experience with these therapies.

Conclusion:

Allergists and dermatologists across Canada show interesting similarities and differences in their practical approach to the management of chronic urticaria. With the sharing of this information, these two specialties will be better equipped to effectively manage patients suffering from chronic urticaria.
Trichophyton Rubrum Tinea Capitis in an 85-Year-Old Woman
Authors: Bargman Howard
Published: July 2017

Background:

Tinea capitis is a worldwide problem and occurs most commonly in young children. Certain common fungal types are most often recognized as the responsible infecting organism.

Objective:

This article presents the case of an elderly woman with tinea capitis caused by a fungal organism that rarely infects hair. A review of the world literature provides evidence of only a few other similar cases.

Conclusions: Trichophyton rubrum

causing tinea capitis in adults is a rare but now increasingly recognized entity. This possibility should be kept in mind when caring for adults with nonhealing scalp conditions.
Histopathologic Findings in the Alopecia Associated with Vogt-Koyanagi-Harada Disease
Authors: DiPreta Edward A. , Smith Kathleen J. , Williams John , Skelton Henry
Published: July 2017

Background:

Vogt-Koyanagi-Harada (VKH) disease is a rare autoimmune disease primarily involving pigmented structures. The commonly associated alopecia usually precedes leukodermic changes seen in the hair and skin.

Objective:

We present a 46-year-old oriental woman with VKH disease who developed diffuse alopecia followed by the regrowth of nonpigmented hairs. The biopsy specimens showed a peribulbar mononuclear infiltrate with increased telogen/catagemanagen follicles. The most prominent additional histologic finding was melanin pigment release from the matrix into the dermal papillae, fibrous tracks, and surrounding perifollicular sheaths. The peribulbar mononuclear cells showed diffuse immunohistochemical staining of approximately 80 to 90% of the cells for CD3, CD45RO. More than 50% of the mononuclear cells showed positive staining for CD4, whereas approximately 10 to 20% showed staining for TIA with TIA+ cells within the follicular epithelium.

Conclusion:

Although the histologic features seen in the alopecia associated with VKH are consistent with alopecia areata, the prominent pigment release does suggest that the prime target are the melanocytes and that keratinocytes may be secondarily involved.
Treatment of Self-Mutilation with Olanzapine
Authors: Garnis-Jones Sylvia , Collins Stephen , Rosenthal Donald
Published: July 2017

Background:

Self-mutilation or dermatitis artefacta is a facet of a much broader spectrum of factitial disease. Three nonpsychotic patients with self-mutilation are presented in this article who were successfully treated with low dose olanzapine when all other modalities of therapy had failed, including trials with numerous antidepressants and antipsychotics.

Objective:

The patients were simultaneously evaluated and treated by a dermatologist and a psychiatrist who run the psychodermatology or consultation-liaison clinic based at McMaster University. After dermatologic conditions had been excluded as a cause of the clinical findings, olanzapine was prescribed on a trial basis due to its low risk of parkinsonian side-effects and its antihistaminic properties.

Conclusions:

The excellent clinical response of the patients can be attributed to the low side-effect profile of the drug but also to the anti-impulsive effect which stems not only from antihistaminic properties but also from its anti-dopamine and serotonin-blocking action.
Cutaneous Reactions Associated with Vitamin K1
Authors: Wilkins Karl , DeKoven Joel , Assaad Dalai
Published: July 2017

Background:

Vitamin K1 (phytonadione) is a fat-soluble, naturally occurring vitamin used to treat certain coagulation disorders. A review of the adverse cutaneous reactions to Vitamin K1 is important because this diagnosis can be easily overlooked. This is due to their low incidence and because the presentation and morphology can vary considerably.

Objective:

The objective of this article is to summarize the different morphologies, the natural history, and the treatment of the cutaneous reactions reported to Vitamin K1

Methods:

A case of a patient who developed a localized eczematous plaque at the site of a vitamin K1 injection is outlined. A review of the English medical literature focused on the adverse cutaneous reactions associated with intramuscular or subcutaneous use of vitamin K1

Results:

Our patient developed a localized eczematous reaction to subcutaneous vitamin K1 The eruption developed within 7 days of her dose of vitamin K1 The eruption persisted for 18 months despite treatment with topical and intralesional steroids. There are three distinct types of cutaneous reactions to vitamin K1 localized eczematous, localized morphea-form, and, very rarely, diffuse maculopapular eruption. The eczematous type (32 cases) appears at the site of injection, and the median number of days between injection and appearance of the eruption is 13 days. The dose range required to initiate the reaction is broad (10 to 410 mg). Thirteen of 32 cases took more than 2 months to resolve. The morphea-form type (7 cases) is a localized morphea-form patch that appears at the site of injection. The average delay before presentation of morphea-form changes was 8.5 months (range: 5 weeks-1.5 years). The dose range is broad (30–2080 mg), and the prognosis for resolution very poor.

Conclusion:

The diagnosis of an adverse cutaneous reaction to vitamin K can be made if the possibility is considered. Many of these reactions are very slow to clear up and some may persist as a chronic sclerodermoid change. Managing these reactions may be frustrating for both the patient and the clinician.
Scanning Electron Microscopy of Adult Head Lice (Pediculus Humanus Capitis) with Focus on Clinical Implications
Authors: Burkhart Craig N. , Burkhart Craig G. , Gunning William T.
Published: July 2017

Background:

The incidence of head lice infestations in North America is escalating with an estimated 12 million cases of head lice per year despite the existence of insecticidal therapies.

Objective:

To evaluate certain characteristics of the human head louse, including their chitinous structure, nymphal developmental stages, legs with claw adaptations, antennae with sensory perceptions, and spiracles by which oxygen exchange occurs, for assessment of possible means to control the spread and growth of this insect.

Methods:

Scanning electron-microscopic examination of head lice was performed.

Results:

Newer treatments of head lice must acknowledge defense mechanisms that are based on anatomic structure and physiologic characteristics, details of louse transmission, and the insects' ability to ‘resurrect’ after sham death.

Conclusions:

An understanding of lice entomology is essential in the pursuit of novel means to control the lice epidemic.
Transmittance Properties of Flurandrenolide Tape for Psoriasis: Helpful Adjunct to Phototherapy
Authors: Setaluri Vijay , Clark Adele R. , Feldman Steven R.
Published: July 2017

Background:

Flurandrenolide tape is a valuable agent in the treatment of lichen simplex chronicus and in psoriasis. The corticosteroid is helpful for reducing the symptoms and induration of the lichen simplex chronicus lesion, and occlusion of the lesion with the tape reduces the patient's opportunity to rub and scratch the affected area.

Objective:

The purpose of this study was to determine to what extent flurandrenolide tape may block ultraviolet (UV) light and interfere with phototherapy of psoriasis.

Methods:

Flurandrenolide tape was applied to quartz spectroscopy cuvettes, and the absorption spectrum was determined using a Beckman DU-600 spectrophotometer. The effect of the tape on UV light transmission was also determined using our UVA-UVB office phototherapy unit.

Results:

Flurandrenolide tape has considerable UV absorption in the UVC range with less absorption in the UVB and UVA range. The transmittance is greater (less absorption) with longer wavelengths. There was greater UV absorption in the UVB range than in the UVA range.

Conclusion:

Although flurandrenolide tape may be left in place during PUVA therapy, adjustment of UV dose or removal of the tape is probably needed during UVB phototherapy.
Clinical Evidence of Lice Resistance to Over-the-Counter Products
Authors: Burkhart Craig G. , Burkhart Craig N.
Published: July 2017

Background:

Over-the-counter insecticidal solutions continue to be the mainstream treatment for most cases of head lice. Recorded insecticidal activity 15 years ago was at 100%, with ovicidal kill at 80%. Recently scattered accounts of possible resistance have surfaced.

Objective:

This article is to document the general consensus that head lice are becoming resistant to standard over-the-counter therapies.

Methods:

Direct testing of lethality of adult lice with permethrin and pyrethroid was assessed.

Results:

Present over-the-counter products proved to be successful in only 9 of 32 head lice tested (28% insecticidal activity).

Conclusions:

Our series of cases further documents that over-the-counter head lice preparations no longer achieve high levels of insecticidal activity, suggesting increased resistance to these insecticides.
Male Paget's Disease of the Breast
Authors: Hayes Robert , Cummings Brian , Miller Robert A.W. , Guha Ashim K.
Published: July 2017

Background:

Paget's disease is an extremely rare condition of the male breast that presents as an eczematous change of the nipple and areola. It is almost always associated with an underlying intraductal carcinoma.

Objective:

A case of Paget's disease of the male breast with extension into adnexal structures is reported.

Materials and Methods:

A MEDLINE search for cases of Paget's disease of the male breast was performed and the cases were reviewed. The following antibodies were used in immunohistochemical staining: Rabbit Anti-Human c-erbB-2 Oncoprotein, monoclonal Mouse Anti-Human Estrogen Receptor (IgGl, kappa), and monoclonal Mouse Anti-Human Progesterone Receptor (Clone PgR 636).

Results:

This is only the 43rd histologically proven case of Paget's disease of the male breast in the world literature and, to our knowledge, the first to document extension of Paget's cells into adnexal structures, including eccrine glands.

Conclusion:

Mammary Paget's disease is a rare phenomenon among men.
Serum Sickness
Authors: Jackson Robert
Published: July 2017

Background:

In the late 19th and early 20th century there was much interest in understanding the reactions to diphtheria antitoxin and the horse serum in which it was produced and administered.

Objective:

Pirquet and Schick reported on their studies of these reactions; particularly the differences in the reaction of those patients who had only one injection, and those who had a re-injection.

Conclusion:

Pirquet and Schick concluded that “due to a single injection of horse serum a change takes place in the reaction of the human organism to the re-introduction of the same substance.” This change, Pirquet in a 1906 article, called allergy.
Photodynamic Therapy with 5-Aminolevulinic Acid Induces Apoptosis and Caspase Activation in Malignant T Cells
Authors: Gad Faten , Viau Gilles , Bousbira Michele , Bertrand Richard , Bissonnette Robert
Published: July 2017

Background:

Preliminary studies have suggested that photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA) can improve psoriasis and mycosis fungoides, two diseases where normal or malignant T cells play a central role.

Objectives:

To determine if ALA-PDT induces apoptosis and caspase activation in Jurkat cells, a malignant T-cell line.

Methods:

Jurkat cells were incubated with ALA in the presence of [14C]-thymidine followed by red light exposure. DNA fragmentation was measured 24 hours later with a DNA elution assay. The influence on DNA fragmentation of ALA concentration, time between ALA addition and light exposure, as well as light fluence were studied. The occurrence of oligonucleosome-sized DNA fragmentation was also studied with DNA electrophoresis. Caspase-3-like activity was monitored by measuring Ac-DEVD-AMC hydrolysis.

Results:

DNA fragmentation as high as 88% was observed 24 hours after ALA-PDT. The percentage of DNA fragmentation increased with increasing doses of ALA, red light fluence, as well as longer incubation time with ALA. DNA fragmentation was observed as early as 3 hours after ALA-PDT. The presence of apoptosis after ALA-PDT was confirmed by DNA electrophoresis. An increase in caspase-3-like activities was detected following ALA-PDT.

Conclusion:

ALA-PDT induces apoptosis and caspase-3-like activation in Jurkat cells.
The Efficacy and Safely of a Combination Benzoyl Peroxide/Clindamycin Topical Gel Compared with Benzoyl Peroxide Alone and a Benzoyl Peroxide/Erythromycin Combination Product
Authors: den Ley James J. , Hickman Janet G. , Jarratt Michael T. , Stewart Daniel M. , Levy Sharon F.
Published: July 2017

Background:

Topical clindamycin and benzoyl peroxide have each demonstrated clinical efficacy in the treatment of acne vulgaris. When used in tandem, they promise greater efficacy than either individual agent through their antibacterial and anti-inflammatory effects.

Objective:

To determine the efficacy and safety of combination benzoyl peroxide/clindamycin compared with benzoyl peroxide or benzoyl peroxide/erythromycin in the treatment of acne.

Methods:

In this randomized, 10-week, multicenter, single-blind trial, 492 patients with moderate to moderately severe acne were treated twice daily with 5% benzoyl peroxide/1% clindamycin, 5% benzoyl peroxide, or 5% benzoyl peroxide/3% erythromycin and assessed every 2 weeks.

Results:

Compared with benzoyl peroxide, benzoyl peroxide/clindamycin demonstrated significantly greater reductions in inflammatory lesions ( p = 0.04) and significantly greater overall improvement as assessed by physicians (p ⩽ 0.04) and patients ( p ≤ 0.001). Benzoyl peroxide/clindamycin demonstrated a nonsignificant trend for greater efficacy compared to benzoyl peroxide/erythromycin. Dry skin was the most frequent (⩽7.3%) adverse event with all three therapies.

Conclusion:

Benzoyl peroxide/clindamycin demonstrated improved efficacy and similar tolerability to benzoyl peroxide used alone and was similar to benzoyl peroxide/erythromycin, making this combination product an effective alternative antimicrobial therapy for acne.
A Skin Moisturizing Cream Containing Quaternium-18-Bentonite Effectively Improves Chronic Hand Dermatitis
Authors: Fowler Joseph F.
Published: July 2017

Background:

Irritant and allergic hand dermatitis is difficult to control in individuals who are unable to avoid causative exposures. Effectiveness of “protective” creams has been poor.

Objective:

To determine if hand dermatitis, primarily of an occupational nature, could be improved by the use of a newly developed moisturizing cream containing Quaternium-18-Bentonite.

Methods:

Adult male and female subjects with chronic hand dermatitis felt to be either allergic, irritant, or combined in nature, after a 2-week observation period, were given the study cream for routine application. At 2, 4, and 8 weeks, the investigator and the subject evaluated the skin parameters, including redness, scaling, fissuring, blistering, and pruritus, on a numerical scale. A global evaluation was also performed. Photographs were taken at each visit. Use of topical corticosteroids was recorded. No systemic therapies other than antihistamines were allowed.

Results:

Thirty-seven subjects were enrolled in the study and 33 completed it. The physician's and the subject's initial global evaluations averaged 6.0 and 5.8, respectively (0–10 scale). The final scores were 2.9 and 2.8, respectively, an improvement of 50% (p < 0.001). Topical corticosteroid usage was reduced in 29 of 33 subjects. Fifteen of 35 had a final score of 0–2, indicating complete or almost complete clearing. Only 10, including 2 of the dropouts, failed to show improvement. No adverse effects were noted.

Comment:

This moisturizing cream significantly improved chronic hand dermatitis in a majority of individuals with previously uncontrolled dermatitis despite continuing in their regular occupation.
Dermatologists and Allergists Have Far More Experience and Use More Complex Treatment Regimens in the Treatment of Atopic Dermatitis Than other Physicians
Authors: Henderson Robert L. , Fleischer Alan B. , Feldman Steven R.
Published: July 2017

Background:

Atopic dermatitis (AD) is a prevalent skin condition, especially in the pediatric population. Whereas it has been shown that dermatologists prefer using more intensive therapy for AD than generalists, actual drug utilization has not been quantified.

Objective:

The purpose of this study is to characterize visits for and treatment of AD in the office-based setting.

Methods:

National Ambulatory Medical Care Survey data from 1990 to 1997 was analyzed to determine the use of topical corticosteroids (including their relative potencies), oral antibiotics, and oral antihistamines in the treatment of AD.

Results:

There were an estimated 900,000 outpatient visits per year for AD. If in some visits to generalists the diagnosis for AD was miscoded as contact dermatitis, there may have been as many as 3 million outpatient visits per year for AD. Topical corticosteroids were used in 67% of visits with a mean potency rank of 4.5 (4.3, 4.8 95% CI). Dermatologists saw 48% of all visits for AD (63 yearly visits/physician) and allergists saw 10% of visits (30 yearly visits/physician). Other physicians saw from 0.1 to 2 yearly visits per physician. Dermatologists were the most likely to use topical corticosteroids (81% of visits) and high-potency corticosteroid agents (22% of visits). Dermatologists and allergists were the only physicians to prescribe ultrahigh-potent corticosteroid agents (12% and 9% of visits, respectively) and were more likely than other physicians to use multiple-agent regimens (21% and 27% of visits treated with a corticosteroid agent, respectively).

Conclusions:

Dermatologists and allergists have more expertise in the management of AD than other physicians, as suggested by their higher per capita visits and greater use of complex topical corticosteroid regimens.
Genital Lentigines in a 6-Year-Old Boy with a Family History of Cowden's Disease: Clinical and Genetic Evidence of the Linkage between Bannayan–Riley–Ruvacalba Syndrome and Cowden's Disease
Authors: Blum Robin R. , Rahimizadeh Afshin , Kardon Nataline , Lebwohl Mark , Wei Huachen
Published: July 2017

Background:

In 1997, it was reported that a PTEN gene deletion, a common genetic mutation in Cowden's disease (CD), was identified in a patient with Bannayan–Riley–Ruvacalba (BRR), suggesting that the two diseases were allelic. However, the clinical overlap between the two diseases has largely remained unclear.

Objective:

To confirm the genetic and clinical association in a family segregating both CD and BRR.

Methods:

Clinical evaluation and genetic analysis using a denaturing gradient gel electrophoresis (DGGE), temporal temperature gradient electrophoresis (TTGE), and DNA sequencing techniques.

Results:

Our patient presents with typical BRR clinical manifestations, including multiple lentigines on his penis, while his mother presents with typical manifestations of CD, including multiple malignancies. Genetic analyses of leukocytes from the patient and his mother showed mutations in exon 8 that was identified as the presumably truncating mutation R335X.

Conclusion:

This report provides clinical evidence that both BRR and CD are closely related and confirms the PTEN gene mutation in BRR and CD patients segregating in the same family, thus confirming the genetic linkage between the two genodermatoses.
Peroxisomes in Dermatology. Part I
Authors: Smith Kathleen J. , Dipreta Edward , Skelton Henry
Published: July 2017

Background:

Peroxisomes are small cellular organelles that were almost ignored for years because they were believed to play only a minor role in cellular functions. However, it is now known that peroxisomes play an important role in regulating cellular proliferation and differentiation as well as in the modulation of inflammatory mediators. In addition, peroxisomes have broad effects on the metabolism of lipids, hormones, and xenobiotics. Through their effects on lipid metabolism, peroxisomes also affect cellular membranes and adipocyte formation, as well as insulin sensitivity, and peroxisomes play a role in aging and tumorigenesis through their effects on oxidative stress.

Objective:

To review genetically determined peroxisomal disorders, especially those that particularly affect the skin, and some recent information on the specific genetic defects that lead to some of these disorders. In addition, we present some of the emerging knowledge of peroxisomal proliferator activator receptors (PPARs) and how ligands for mese receptors modulate different peroxisomal functions. We also present information on how the discovery of PPARs, and the broad and diverse group of ligands that activate these members of the superfamily of nuclear binding transcription factors, has led to development of new drugs that modulate the function of peroxisomes.

Conclusion:

PPAR expression and ligand modulation within the skin have shown potential uses for these ligands in a number of inflammatory cutaneous disorders, including acne vulgaris, cutaneous disorders with barrier dysfunction, cutaneous effects of aging, and poor wound healing associated with altered signal transduction, as well as for side effects induced by the metabolic dysregulation of other drugs.
Ultraviolet Light (UV) Regulation of the TNF Family Decoy Receptors DcR2 and DcR3 in Human Keratinocytes
Authors: Maeda Tomoko , Hao Chunhai , Tron Victor A.
Published: July 2017

Background:

Several additional members of the tumor necrosis factor (TNF) receptor family were recently identified. The existence of such receptors, which may play distinct and unique regulatory roles, suggests that complex regulatory mechanisms are involved in apoptosis.

Objective:

This study examines the expression of several members of the TNF receptor family in human keratinocytes exposed to ultraviolet B (UVB) irradiation.

Methods:

Human keratinocytes were exposed to increasing doses of UVB, total RNA was harvested, and a quantitative RNase protection assay was performed.

Results:

Decoy receptor-3 (DcR3), a nonfunctional receptor that binds to Fas ligand (FasL), was constitutively expressed at high level in keratinocytes but decreased rapidly in cells exposed to UVB. Decoy receptor-2 (DcR2), a nonfunctional receptor that binds to TNF-related apoptosis-inducing ligand (TRAIL)/APO-2L, showed the opposite expression pattern. DcR2 was undetectable in unirradiated keratinocytes and was markedly up-regulated after exposure to UVB. Although the response showed significant delays at higher UVB doses, the patterns observed for DcR3 and DcR2 were consistent in this set of experiments.

Conclusion:

We conclude that UVB regulates expression of these two TNF decoy receptors in keratinocytes. This pathway may represent a novel mechanism for regulation of apoptosis in the skin.
Betamethasone Valerate Foam for Treatment of Nonscalp Psoriasis
Authors: Stein Linda F. , Sherr Amelia , Solodkina Galina , Gottlieb Alice B. , Chaudhari Umesh
Published: July 2017

Background:

Although betamethasone valerate (BMV) foam, 0.12% (Luxiq™, Connectics Corporation, Palo Alto, CA) is approved by the Food and Drug Administration for the treatment of corticosteroid-responsive scalp dermatoses, no data are available for its use on nonscalp psoriasis.

Objective:

We evaluated the safety and efficacy of BMV foam in treating psoriatic lesions at nonscalp sites.

Methods:

We conducted a randomized, double-blind, placebo-controlled, paired-comparison, split-body study of 40 patients with mild to moderate plaque-type psoriasis. Patients applied BMV foam and placebo foam twice daily for 12 weeks.

Results:

At the end of the treatment period, 70% of patients had greater than 50% improvement of lesions on their active foam-treated side compared with 24% of patients with similar improvement on their placebo foam-treated side. Adverse effects were limited to temporary stinging, burning, or itching in several patients. Three patients (7.5%) withdrew because of stinging or itching.

Conclusions:

The results indicate that BMV foam is effective against nonscalp psoriasis. Twice-daily applications are well tolerated, compliance exceeds 90%, cosmetic characteristics are acceptable, and the medication may reduce the need for multiple prescriptions.
Human Papillomavirus, Smoking, and Cancer
Authors: Moore Todd O. , Moore Angela Yen , Carrasco Daniel , Vander Straten Melody , Arany Istvan , Au William , Tyring Stephen K.
Published: July 2017

Background:

The effect of smoking on human papillomavirus (HPV) activity and subsequent dysplasia and neoplasia remains controversial

Objective:

To determine any reported effects of smoking on either HPV activity or HPV-related dysplasia/cancer using retrospective analysis of the literature from 1966 through 1998 via Toxline and PubMed to search for “smoking,” “papillomavirus,” and “cancer.”

Conclusion:

Several recent large studies demonstrated that smoking was associated with a greater incidence of cervical, vulvar, penile, anal, oral, and head and neck cancer in a dose-dependent fashion, while other studies did not show any correlation between smoking and cervical dysplasia after multivariate adjustment. Recent studies have also indicated that smoking may be more closely related to high-grade lesions of the cervix and vulva. These data provide evidence of an association between HPV, smoking, and cancer. Progression of dysplasia likewise seems to be associated with smoking. Several groups have attempted to discern whether the connection between smoking and cervical cancer is from local immunosuppression and/or from direct carcinogenic effects.
Dural Melanoma Associated with Ocular Melanosis and Multiple Blue Nevi
Authors: Rivers Jason K. , Bhayana Shelly , Martinka Magda
Published: July 2017

Background:

Primary meningeal melanomas of the central nervous system (CNS) are a rare malignant process with the majority originating from the leptomeninges. Primary dural melanomas have been reported to occur in isolation or in conjunction with Nevus of Ota. The association of primary dural melanoma with multiple cutaneous blue nevi has not been reported previously.

Objective:

To describe a case of a 41-year-old Asian woman patient with a primary dural melanoma that arose in association with ocular melanosis and multiple cutaneous blue nevi. The patient is alive almost more than 8 years after subtotal and subsequent total resection of her primary tumor. Primary dural melanomas, Nevus of Ota, and blue nevi are discussed in relation to their coexistence and potential for intracranial melanoma.

Conclusion:

CNS melanoma is regarded as an extremely aggressive disease with poor prognosis. This case and previous reports of dural melanomas occurring in isolation or with Nevus of Ota have demonstrated relatively prolonged survival after surgical intervention. We conclude that dural melanomas are less aggressive tumors requiring surgical extirpation only.
Bullous Pilomatricoma: A Report of Clinical and Pathologic Findings and Review of Dermal Bullous Disorders
Authors: Weichert Gabriele E. , Bush Kevin L. , Crawford Richard I.
Published: July 2017

Background:

Pilomatricoma is a common benign adnexal tumor differentiating toward elements of the hair matrix and shaft. It typically presents as a solitary, deep, dermal nodule. We describe a case of a pilomatricoma with the unusual feature of a thick-walled dermal bulla overlying the tumor.

Objective:

We describe a case of bullous pilomatricoma and discuss the potential etiology of the bullous feature of the lesion.

Methods:

This article includes a case report and a literature review.

Conclusions:

Bullous pilomatricoma has rarely been described. A common pathological feature in this type of pilomatricoma is the presence of dilated lymphatics. Bullous morphea associated with dermal lymphatic dilation has also been described. In both bullous pilomatricoma and morphea, it is possible that individual pathological features of the lesion lead to obstruction and congestion of the dermal lymphatics thereby inducing enough dilation and edema to form a dermal bulla.

Antécédents:

Le pilomatrixome (épithéliome calcifiant de Malherbe) est une tumeur annexielle bénigne qui ressemble aux éléments de la matrice et de la tige pilaires. Il se manifeste typiquement par un nodule sous-cutané solitaire. Nous rapportons un cas de pilomatrixome présentant la caractéristique inhabituelle d'une bulle dermique à paroi épaisse située au-dessus de la tumeur.

Objectifs:

Décrire un cas de pilomatrixome bulleux et présenter l'étiologie potentielle d'une telle manifestation.

Méthodes:

Cet article comporte une étude de cas ainsi qu'une revue de la littérature.

Conclusion:

Le pilomatrixome bulleux a rarement été décrit. La dilatation des vaisseaux lymphatiques constitue une manifestation pathologique fréquente de cette forme de pilomatrixome. La morphée bulleuse a également été associée à une dilatation de vaisseaux lymphatiques. Il est possible que les caractéristiques pathologiques individuelles des lésions du pilomatrixome bulleux et de la morphée entraînent une obstruction et une congestion des vaisseaux lymphatiques, provoquant ainsi une dilatation et un œdème suffisamment importants pour former une bulle.
Development of Cutaneous Sarcoidosis in a Patient with Chronic Hepatitis C Treated with Interferon Alpha 2b
Authors: Neglia Vicenta , Sookoian Silvia , Herrera Micaela , AbeIdaño Alejandra , Kien Maria Cristina , Chouela Edgardo , Frider Bernardo
Published: July 2017

Background:

Sarcoidosis is a multisystemic granulomatous disorder of unknown etiology that most commonly affects young adults. A probable induction of sarcoidosis by interferons (IFN) has been published. To this date, few cases of cutaneous sarcoidosis in patients with chronic hepatitis C under interferon treatment have been reported.

Objective:

We describe a 50-year-old woman with chronic hepatitis C who developed lesions of cutaneous sarcoidosis three months after IFN treatment.

Conclusions:

The possible role of INF therapy in the development of cutaneous sarcoidosis in a patient with chronic hepatitis C should be considered.
Herpetic Folliculitis
Authors: Al-Dhafiri Shehab A. M. , Molinari Raynald
Published: July 2017

Background:

Although herpetic skin infection is very common, herpetic folliculitis is infrequently reported in the literature. It has varied presentations, some of which are clinically atypical requiring histopathological confirmation of follicular involvement.

Objective:

We describe an otherwise healthy young adult male with extensive herpetic sycosis of the beard area, which is a variant of herpetic folliculitis. The diagnosis was confirmed by typical herpetic cytopathic changes in Tzanck smear and positive viral culture for HSV-1.

Method:

This article includes a case report and a literature review of herpetic (simplex and varicella/zoster) folliculitis.

Conclusions:

More cases of herpetic folliculitis should be reported to improve our understanding of this disease entity. Physicians should consider herpetic or other viral etiology in patients with folliculitis even if they were healthy, especially if they show resistance to antibacterial and antifungal therapy.
Keratoelastoidosis Marginalis
Authors: Mengesha Yebabe M. , Kayal John D. , Swerlick Robert A.
Published: July 2017

Background:

Keratoelastoidosis marginalis is a rare disease that is a variant of solar elastosis. Long-term ultraviolet radiation exposure and chronic trauma secondary to manual labor are considered to be inciting factors.

Objective:

To outline the clinical and histological features of this disorder.

Methods:

We report two cases and review the literature.

Results:

Both patients had persistence of their disease despite multiple topical treatment regimens.

Conclusion:

Keratoelastoidosis marginalis is a chronic and progressive disease that is difficult to treat. The differential includes focal acral hyperkeratosis and acrokeratoelastoidosis.
A Listing of Skin Conditions Exhibiting the Koebner and Pseudo-Koebner Phenomena with Eliciting Stimuli
Authors: Rubin Adam I. , Stiller Matthew J.
Published: July 2017

Background:

The Koebner phenomenon was first described in 1872. It occurs after a variety of traumatic insults. New examples of koebnerization are reported each decade.

Objective:

We have compiled, for the first time in the dermatologic literature, an extensive list of the cutaneous diseases reported to demonstrate koebnerization, correlated in each case with the precise source of trauma. Cutaneous diseases reported to show a pseudo-Koebner phenomenon and the corresponding mechanism of trauma are also detailed.

Methods:

A search and review of the English language literature on MEDLINE was made to identify cutaneous diseases exhibiting the Koebner phenomenon and the correlated mechanism of trauma.

Results:

Results of our efforts are cataloged in table format.

Conclusion:

We present an extensive list of cutaneous diseases reported to exhibit the Koebner and pseudo-Koebner phenomena, correlating each entry with the mechanism of trauma.
A Clinical Evaluation of Tazarotene 0.1% Gel, with and without a High- or Mid-High-Potency Corticosteroid, in Patients with Stable Plaque Psoriasis
Authors: Green Lawrence , Sadoff Wendy
Published: July 2017

Background:

Several clinical trials have established the benefit of using a topical corticosteroid in conjunction with tazarotene gel in the treatment of plaque psoriasis. However, there is little information comparing the relative benefits of different corticosteroids, or different formulations of corticosteroids, when used adjunctively with tazarotene.

Objective:

This study was designed to compare the clinical benefits achieved with each of six commonly prescribed high- or mid-high-potency corticosteroid creams and ointments applied in conjunction with tazarotene 0.1% gel in the treatment of patients with stable plaque psoriasis.

Methods:

A 12-week, multicenter, investigator-masked, randomized, parallel-group study was performed with more than 200 patients who were randomly assigned to regimens of tazarotene 0.1% gel alone, tazarotene plus a high-potency topical corticosteroid (fluocinonide 0.05% ointment, mometasone furoate 0.1% ointment, or diflorasone diacetate 0.05% ointment), or tazarotene plus a mid-high-potency topical corticosteroid (betamethasone dipropionate 0.05% cream, fluticasone propionate 0.005% ointment, or diflorasone diacetate 0.05% cream). All medications were to be applied once daily: corticosteroids in the morning, tazarotene gel in the evening. At assessment visits, physicians made an overall evaluation of the patient's psoriasis and graded global improvement, plaque elevation, scaling, erythema, and pruritus. Patients also rated their treatment in terms of efficacy, tolerability, and satisfaction.

Results:

The best-performing steroid was betamethasone dipropionate 0.05% cream (a mid-high-potency steroid), followed by mometasone furoate 0.1% ointment (a high-potency steroid) and diflorasone diacetate 0.05% ointment (a high-potency steroid). Maximum improvements were achieved within 8 weeks. The best-tolerated regimen was tazarotene plus mometasone furoate 0.1% ointment and the optimal balance between efficacy and tolerability was achieved with this regimen.

Conclusion:

Some steroids are considerably more effective than others in optimizing the efficacy and tolerability of tazarotene therapy. With a suitable combination regimen, the duration of initial therapy (before maintenance therapy is started) need not be prolonged.
Chronic Pruritus Associated with Helicobacter Pylori
Authors: Kandyil Roshini , Satya Nadia S. , Swerlick Robert A.
Published: July 2017

Background:

Helicobacter pylori is an established cause of gastritis and has been implicated in extradigestive diseases.

Objective:

To investigate the role of H. pylori in patients with unexplained refractory pruritus.

Methods:

Ten patients with severe pruritus unresponsive to conventional therapy were evaluated for active H. pylori infection by H. pylori serology followed by either esophagogastroduodenoscopy (EGD) or urea breath test. Of the 10 patients, 8 were found to have active infection. All 10 received anti- H. pylori antibiotic therapy and were reevaluated for relief of pruritus.

Results:

Of 8 patients with active H. pylori infection, 87.5% (7/8) had some type of pruritus relief after triple therapy. Of these, 62.5% (5/8) had complete relief and 25% (2/8) had temporary relief of pruritus. The remaining 12.5% (1/8) did not respond. Two control patients without active H. pylori infection had no relief of pruritus with therapy.

Conclusions:

We have identified a population of patients with refractory pruritus and active H. pylori infection whose pruritus resolved after eradication of H. pylori.
Transformation in Mycosis Fungoides: The Role of Methotrexate
Authors: Abd-El-Baki Jasmin , Demierre Marie-France , Li Ning , Foss Francine M.
Published: July 2017

Background:

Large cell transformation in patients with mycosis fungoides (MF) has been well reported in the literature. Although the risk factors have not been clearly elucidated, advanced stage seems to be associated with a higher incidence of transformation. Because MF is a rare disorder, little is known about the influence of other factors such as immunosuppressive therapy in the occurrence of transformation.

Objective:

We questioned the role of methotrexate (MTX) in the transformation of MF to large cell lymphoma (LCL).

Methods:

We identified all patients with MF who were registered in our cutaneous lymphoma database. Transformation was defined by the presence of large cells exceeding 25% of the infiltrate in at least one skin biopsy. In one patient, we followed the histologic, immunophenotypic, and genotypic changes taking place as transformation occurred.

Results:

A total of 134 patients with MF were identified. Of 21 patients who received MTX, 3 transformed, and of the 113 patients in the non-MTX group, only 2 transformed. The incidence of transformation in the patients who received MTX was significantly higher than in those who did not receive the drug (14.3% vs. 1.8%; p = 0.03). This significance was maintained, even after controlling for stage and sex. For one patient who transformed, we demonstrated an identical dominant T-cell clone in all skin specimens, including the large cell lymphoma.

Conclusion:

Our results demonstrate a significant association between MTX exposure and transformation to LCL in patients with MF. In light of the small sample size, short followup of patients, and the inherent tendency of mycosis fungoides to transform, the role for MTX in transformation is unproven and needs to be confirmed in a multicenter study.
Acute Generalized Exanthematous Pustulosis Induced by Oral Fluconazole
Authors: Alsadhan A. , Taher M. , Krol A.
Published: July 2017

Background:

Acute generalized exanthematous pustulosis (AGEP) is a generalized, nonfollicular, pustular eruption of the skin associated with fever and leukocytosis. The cause of AGEP has mainly been attributed to drugs.

Objective:

We report a unique case of AGEP in a 75-year-old male caused by oral fluconazole. We include clinical as well as histological illustrations of our case.

Conclusion:

Based on a current literature search using the MEDLINE electronic database, this is the first reported case of AGEP arising from use of oral fluconazole. The clinical presentation, clinical course, and histology are consistent with prior reports of AGEP resulting from other drugs. AGEP should be considered a possible complication of oral fluconazole treatment.