bluuebunny/crossref_metadata_2025 huggingface dataset:
Dermatologic Manifestations of Sjögren Syndrome
Authors: Kittridge Ashley , Routhouska Shannon B. , Korman Neil J.
Published: March 2015

Background:

Sjögren syndrome (SS) is a chronic autoimmune inflammatory disease that involves primarily the exocrine glands, resulting in their functional impairment. SS typically presents as dry eyes (xerophthalmia) and dry mouth (xerostomia). This process can manifest either as the independent phenomenon of primary SS or as secondary SS when found in the context of another autoimmune process, most commonly rheumatoid arthritis or systemic lupus erythematosus. Nearly half of the patients with SS develop cutaneous manifestations, which may include dry skin (xeroderma), palpable and nonpalpable purpura, and/or urticaria-like lesions. These cutaneous manifestations have been underemphasized because they are often overshadowed by the more prominent sicca symptoms. However, certain skin findings are of paramount clinical and prognostic importance as they confer an increased risk for the development of life-threatening conditions, including multisystem vasculitis and non-Hodgkin lymphoma.

Objective and Conclusions:

In this review, the cutaneous manifestations of primary SS are discussed, with an emphasis on those findings that portend an increased risk of mortality.

Antécédent:

Le syndrome de Sjögren (SS) est une maladie autoimmune inflammatoire chronique qui affecte principalement les glandes exocrines, menant à leur incapacité fonctionnelle. SS se caractérise typiquement par une xérophtalmie (sècheresse des yeux) et une xérostomie (bouche sèche). Ces symptômes peuvent apparaître en tant que manifestations indépendantes du SS primaire ou comme SS secondaire, c'est-à-dire comme conséquence d'une autre affection autoimmune, le plus souvent l'arthrite rhumatoïde, ou le lupus érythémateux systémique. Près de la moitié des patients présente des manifestations cutanées de la maladie, dont une peau sèche (xérodermie) et des lésions palpables ou non de purpura ou ressemblant à l'urticaire. Ces manifestations cutanées n'ont pas été suffisamment soulignées car elles sont souvent éclipsées par des symptômes plus notables de la maladie. Toutefois, certaines manifestations cutanées sont d'une grande importance dans le diagnostic clinique et dans le pronostic, car elles représentent une indication d'un risque plus élevé de développer une maladie mortelle telle que la vascularite multisystémique et le lymphome non hodgkinien.
Novel Case of Generalized Multinucleate Cell Angiohistiocytoma
Authors: O'Blenes Catherine A.E. , Walsh Noreen M.G. , Green Peter J. , Tremaine Robert D.L.
Published: March 2015

Background:

Multinucleate cell angiohistiocytoma is a rare benign fibrohistiocytic and vascular proliferation, typically characterized by the development of solitary papules, in an acral distribution in otherwise healthy late middle-aged to elderly women.

Objective:

Our objectives are to present a novel case of generalized multinucleate cell angiohistiocytoma and to review the current literature regarding the clinical and histologic findings in this condition, as well as its potential causes and treatments.

Observations:

We describe a 35-year-old man who presented with generalized asymptomatic firm violaceous papules. Histopathology revealed dermal vascular proliferation; a perivascular infiltrate of lymphocytes, histiocytes, neutrophils, and plasma cells; thickened surrounding collagen bundles; and characteristic multinucleate cells with scalloped borders.

Conclusion:

Our patient is one of three patients reported to date with generalized lesions of multinucleate cell angiohistiocytoma who were all in a younger age group (20–40 years old) than previously reported for solitary lesions.
Treatment Decision Needs of Psoriasis Patients: Cross-sectional Survey
Authors: Tan Jerry , Stacey Dawn , Fung Karen , Barankin Benjamin , Bissonnette Robert , Gulliver Wayne , Lui Harvey , Shear Neil , Jackson Christine , Zhang Xuemao
Published: March 2015

Background:

Informed shared decision making is a mutual process engaging both doctor and patient and informed by best medical evidence and patient values and preferences.

Objective:

Our aim was to identify the needs of psoriasis patients in decisions on selecting treatment.

Methods:

Psoriasis subjects participated in an online survey on decisional role, postdecisional conflict, and treatment awareness.

Results:

Of 2,622 people invited to participate, 248 completed surveys. Their most recent treatment decision was either made by subjects alone (42%) or physicians alone (28%) or was shared (29%). Subjects perceived that their doctors lacked time to stay abreast of treatments, to provide counseling, and to access appropriate treatments. Deficiencies most frequently identified were information on options, clarification of values, access to physicians, and decision-making skills. Those with a body surface area (BSA) ≥ 3% more frequently indicated that having the skill or ability to make treatment decisions was important.

Limitations:

The limitations of this study include sampling, recall, and reporting bias. Percent BSA was not verified.

Conclusions:

The multiple deficiencies in support of psoriasis patients in treatment decisions may preclude informed shared decision making.
Digital Mucous Cysts
Authors: Li Kayi , Barankin Benjamin
Published: March 2015

Background:

Digital mucous cyst (DMC) is a common benign condition, but consensus has not been reached regarding its pathogenesis and treatment.

Objective:

This review provides a concise overview of DMCs.

Methods:

The review presents the literature pertaining to the etiology, pathogenesis, classification, clinical features, epidemiology, differential diagnoses, diagnosis, and management of DMCs.

Results:

DMCs have a predilection for middle-aged patients, a good prognosis, and a high recurrence rate. DMCs may occur in one of three locations on the distal digit. They arise owing to a metaplastic or degenerative process. Preexisting osteoarthritis is common and may be an etiologic factor in patients with DMCs. A number of conservative and surgical treatments are available depending on the structures and locations involved.

Conclusion:

Studies with greater sample size and longer follow-up would enrich current knowledge of the benefits, recurrences, and complications for each treatment modality.
Sebaceous Carcinoma Associated with Seborrheic Keratosis
Authors: Tsai Tsung-Ming , Wu Yu-Hung , Yang Kuo-Chia , Yang Chia-Yi , Tsai Tsung-Hua , Chan Jung-Yi
Published: March 2015

Background:

The association of a seborrheic keratosis with other common cutaneous neoplasms such as basal cell carcinoma and Bowen disease has been reported, but the association between a seborrheic keratotis and a malignant neoplasm with sebaceous differentiation is very unusual.

Objective:

We present a case of two contiguous neoplasms, a seborrheic keratosis and a sebaceous carcinoma, and discuss the possibility of malignant change in a seborrheic keratosis as an explanation for the findings.

Methods and Results:

A 57-year-old man presented with an asymptomatic tumor on the skin of his abdomen that was composed of two separate but contiguous lesions. The central lesion, about 0.9 cm in diameter, was nodular, irregular, and reddish and was surrounded by a blackish lesion about 3 cm in greatest dimension. Histopathologic examination revealed that the plaque was composed of two different adjacent tumors, including a central portion showing findings consistent with a sebaceous carcinoma and a peripheral part showing a seborrheic keratosis.

Conclusion:

Although the association is likely to be a coincidence and probably represents a collision tumor, the possibility that the sebaceous carcinoma represents malignant degeneration of the seborrheic keratosis cannot be entirely excluded.
ICOS Gene Polymorphism May Be Associated with Pemphigus
Authors: Narbutt Joanna , Lesiak Aleksandra , Klich Izabela , Torzecka Jolanta Dorota , Sysa-Jedrzejowska Anna , Młynarski Wojciech
Published: March 2015

Background:

Pemphigus is an autoimmune blistering disease mediated by circulating IgG autoantibodies directed against desmogleins 3 and/or 1. As pemphigus is a T cell–mediated disease, one may assume that genetically determined disregulation of costimulatory signal may be involved in its pathogenesis.

Objective:

The aim of the present study was to evaluate the relationship between polymorphisms in genes encoding costimulatory receptors, CTLA4 and ICOS, and pemphigus in the Polish population.

Methods:

The study included 54 patients with pemphigus: 40 with pemphigus vulgaris (PV) and 14 with pemphigus foliaceus (PF). Additionally, 176 healthy unrelated blood donors served as controls. +49A/G CTLA4 and IVS1+173 ICOS polymorphisms were identified using a modified polymerase chain reaction–restriction fragment-length polymorphism.

Results:

Analysis of the frequency of genotypes and alleles of +49A/G CTLA4 gene polymorphism showed no statistically significant differences between the PV and PF patients and the controls. The distribution of genotypes in IVS1+173 ICOS polymorphisms was significantly different in both PV ( p < .01) and PF ( p = .0004) patients when compared to controls. The carriers of the allele C were more frequent in PV or PF in comparison with the control group ( p < .001 for both groups).

Conclusions:

Our results suggest that genetically determined abnormal function of costimulatory receptors in T cells may be associated with the pathogenesis of pemphigus.
Psoriasis and Multiple Sclerosis: Is There a Link?
Authors: Kwok Tiffany , Loo Wei Jing , Guenther Lyn
Published: March 2015

Background:

Psoriasis and multiple sclerosis (MS) are both autoimmune T cell-mediated diseases. Some case series have suggested an association.

Objective:

To investigate the potential relationship between psoriasis and MS based on a systematic review of the literature.

Methods:

Medline, Cochrane Library, and EMBASE searches were performed.

Results:

T-helper 17 cells are involved in the pathogenesis of both psoriasis and MS. Both conditions have been associated with interleukin-23 receptor (IL23R) polymorphisms. Studies have reported psoriasis in 0.41 to 7.7% of individuals with MS. A higher rate of psoriasis compared to controls was noted in a few small MS cohorts, but the number of cases was too small to draw any firm conclusions. In two studies, including a large Canadian study of 5,031 patients with MS, there was no increased prevalence of psoriasis in patients over the control population. Family members of individuals with MS do not appear to be at increased risk for psoriasis in these studies. Psoriasis has developed during treatment for MS, and MS has developed during treatment for psoriasis.

Conclusion:

Although there are some common genetic linkages in psoriasis and MS, psoriasis does not appear to be more common in patients with MS or their relatives.
Drug-Induced Lichenoid Dermatitis with Histopathologic Features of Mycosis Fungoides in a Patient with Psoriasis
Authors: Wu Jane , Vender Ronald , Jambrosic Jadranka
Published: March 2015

Background:

With recent advancements in the understanding of psoriasis, treatment has evolved toward more targeted therapy in the form of biologics. Although generally safe and well tolerated, various adverse reactions may occur with the use of biologics.

Objectives:

The objective of this article is to present a case of a biologic-induced drug eruption initially presenting with histopathologic features of mycosis fungoides (MF).

Methods and Results:

A 47-year-old male presented with an extensive erythematous macular eruption approximately 14 hours after a single dose of etanercept. Histopathology initially revealed a lichenoid dermatitis with features of MF, but immunohistopathology later refuted the presence of MF.

Conclusions:

It is important for clinicians to be aware that adverse cutaneous reactions with biologic therapy may initially present with histopathologic features of MF.
Pretibial Angioplasia: A Novel Entity Encompassing the Clinical Features of Necrobiosis Lipoidica and the Histopathology of Venous Insufficiency
Authors: Mistry Nisha , Hong H. Chih-ho , Crawford Richard I.
Published: March 2015

Background:

Necrobiosis lipoidica (NL) presents clinically as waxy yellow-brown plaques, commonly on the shins. Venous insufficiency also involves the legs; however, it has distinct clinical and pathologic features.

Objective:

We present a series of eight patients who had lesions that clinically resembled NL but on pathology showed features resembling venous insufficiency.

Methods:

Between 1997 and 2008, eight patients were identified at St. Paul's Hospital, Vancouver, to have had skin lesions clinically diagnosed as NL, or a similar morphologic entity, but showing histopathologic features resembling venous insufficiency on biopsy. The clinical records and pathology reports of these patients were reviewed.

Results:

The patients' ages ranged from 39 to 73 years. Only one patient was female. Members of the group held diagnoses of diabetes, renal failure, or venous or arterial disease. All patients had lesions on the legs, most on the anterior aspect. The clinical diagnosis was generally NL; other clinical impressions included lichen planus, morphea, and Kaposi sarcoma. All patients had features on pathology resembling venous insufficiency and no features of NL.

Conclusion:

We propose that this unique combination of clinical features of NL and histopathologic features resembling venous insufficiency represents a novel entity for which we propose the name pretibial angioplasia.
5-Year Review of a Unique Multidisciplinary Nonmelanoma Skin Cancer Clinic
Authors: Culleton Shaelyn , Breen Dale , Assaad Dalal , Zhang Liying , Balogh Judith , Tsao May , Kamra Juhu , Czarnota Greg , Antonyshyn Oleh , Fialkov Jeffery , Barnes Elizabeth
Published: March 2015

Background:

A multidisciplinary nonmelanoma skin cancer (NMSC) clinic is held weekly at our center, where all new patients are jointly assessed by dermatology/dermatopathology, radiation oncology, and plastic surgery. A new patient database was established in 2004. The purpose of this study was to provide a preliminary report on the patients seen in the NMSC clinic and the treatment recommendations rendered.

Methods:

The new patient database was reviewed from January 2004 to December 2008, and patient demographics, tumor characteristics, and treatment recommendations were extracted. Cochran-Mantel-Harnszel (CMH) testing and chi-square analysis were used to detect any associations or relationships between variables within the database. A p value of less than .05 was considered significant.

Results:

During the 5-year study period, 2,146 new patients were seen in the NMSC clinic. The majority of patients presented with basal cell carcinoma (64%) or squamous cell carcinoma (22%), with a median tumor size of 1 to 2 cm (range 0 to #x003E; 9 cm). Tumors were located in the head and neck region (80%), extremities (14%), and torso (6%). Previous treatment included biopsy only (62%), surgery (20%), electrodesiccation and curettage (11%), topical imiquimod (3%), and radiotherapy (1%). Treatment recommendations included surgery (55%) (with either simple excision [31%] or excision with margin control under frozen-section guidance [24%]), radiotherapy (19%), topical imiquimod (10%), observation (7%), and electrodesiccation and curettage (4%).

Conclusions:

The NMSC clinic at our center sees a high volume of patients who benefit from the multidisciplinary assessment provided. Treatment recommendations were based on patient and disease characteristics as well as patient preference.
Psoriasis Treatment Patterns of Dermatologists in Northeast Ohio
Authors: Grozdev Ivan , Cao Lauren , Kavlick Kathleen , Brodell Robert T. , Mostow Eliot N. , Korman Neil J.
Published: March 2015

Aim:

To describe the psoriasis treatment patterns of community-based dermatologists in northeast Ohio.

Materials and Methods:

A prospective cross-sectional survey was performed among dermatologists in northeast Ohio. The survey was initiated by the Murdough Family Center for Psoriasis and members of LIFEDERMNET (Leaders Initiative For Excellence In Dermatology Network). A questionnaire was sent to all community-based dermatologists in northeast Ohio.

Results:

Forty-seven of 145 questionnaires were returned and analyzed. The annual mean number of psoriasis patients seen in the community-based dermatology practices was 250, representing approximately 4% of the total patients seen. Among the systemic treatment options for psoriasis, each of the following was used at least once to treat a patient with psoriasis in the previous year by the following percentage of community-based dermatology practices: methotrexate, 72%; acitretin, 68%; biologics, 66%; phototherapy, 55%; cyclosporine, 36%; and the excimer laser, 28%.

Conclusion:

Our findings demonstrate that dermatologists in northeast Ohio use both systemic and biologic agents for the treatment of patients with psoriasis.
Erythema Multiforme Major Associated with CMV Infection in an Immunocompetent Patient
Authors: Vitiello Magalys , Echeverria Begoña , Elgart George , Kerdel Francisco
Published: March 2015

Background:

Cytomegalovirus (CMV) infection usually remains asymptomatic in immunocompetent adults, and few cases of complicated disease in nonimmunosuppressed patients have been reported. Erythema multiforme (EM), an acute and self-limiting skin eruption characterized by a typical targetoid lesion that may also affect the mucosa, is a hypersensitivity reaction that usually occurs after herpes simplex virus infection or use of certain drugs and resolves without complications in healthy individuals. To our knowledge, CMV infection has been associated with EM in only six patients.

Objective:

We present a case of an EM caused by CMV infection in a 35-year-old nonimmunosuppressed patient who was successfully treated with ganciclovir.

Conclusion:

Our report, like other similar reports found in the literature, suggests that CMV can trigger EM in apparently healthy individuals. Intravenous ganciclovir appears to be a good treatment option in these cases.
Functions and Uses of Immunohistochemical Stains in Cutaneous Infiltrates of Hematopoietic Origin: A Review for the Practicing Dermatologist
Authors: Chisholm Cary , Cockerell Clay J.
Published: March 2015

Background:

Immunohistochemical stains, particularly those for cutaneous lymphomas, have similar-sounding names, which may lead to confusion among dermatologists who are not well versed in the terminology of the tools used for pathologic diagnosis. Also aiding in this is the fact that some familiar stains are constantly investigated for novel utility in different tumors, and a plethora of new stains regularly emerge in the peer-reviewed literature.

Objective:

To review the major stains encountered in dermatopathologic reports for cutaneous lymphomas. A select number of other stains are reviewed that are either new and under investigation in several cutaneous processes or have a new use described in recent reports.

Methods:

The peer-reviewed literature was searched and analyzed for the accepted purposes of using these markers.

Results:

All pertinent findings for these immunostains are reported with the purpose of educating the dermatology community.

Conclusion:

This review serves as a reference to clarify potentially confusing immunohistochemical stains.
Multiple Symmetric Lipomatosis
Authors: da Silva Rodrigo Gomes , Bragança Renan Detoffol , Costa Carolina Ribeiro , de Melo Lorena Torres , Telles Rosa Weiss , Silva Luciana Costa
Published: March 2015

Background:

Multiple symmetric lipomatosis (MSL) is a relatively uncommon entity of unknown etiology characterized by symmetrically subcutaneous accumulation of nonencapsulated adipose tissue. Approximately 200 to 300 cases have been published.

Objectives:

The aims of this article are to report the case of a 58-year-old Brazilian patient with MSL and provide a comprehensive overview of the current concepts concerning this disease.

Methods:

Our search yielded 28 articles on MSL, including case reports and reviews of the literature.

Results:

MSL predominantly affects Mediterranean males with a history of chronic alcohol abuse. It is usually asymptomatic and may be associated with diabetes mellitus, hyperlipidemia, hyperuricemia, macrocytic anemia, and oral cancer. Surgical resection is the best treatment option.

Conclusion:

The case reported is a classic presentation of MSL; however, it is particularly uncommon owing to the association with immune thrombocytopenic purpura. This association has been described only once in the medical literature.
Bullous Scabies Simulating Pemphigoid
Authors: Stan T. Roxana , Piaserico Stefano , Bordignon Matteo , Salmaso Roberto , Zattra Edoardo , Alaibac Mauro
Published: March 2015

Background:

Scabies is a contagious infestation affecting subjects of all ages, races, and social conditions.

Objective:

We report a case of a 79-year-old man who developed a bullous pemphigoid-like eruption. He presented to our unit 4 months after the onset of symptoms. An autoimmune bullous disease was suspected. Direct immunofluorescence on a skin specimen and anti-desmoglein 1, anti-desmoglein 3, and anti-bullous pemphigoid antigen 180 were negative. Surprisingly, the histology of a skin lesion demonstrated the presence of scabies, which was successfully treated with benzyl benzoate 20%.

Conclusion:

The diagnosis of bullous scabies should be considered for any bullous eruptions accompanied by papules and itching resistant to steroid treatment and with negative immunopathologic findings.
Annular Elastolytic Giant Cell Granuloma Associated with Temporal Arteritis Leading to Blindness
Authors: Shoimer Ilya , Wismer Judy
Published: March 2015

Background:

Annular elastolytic giant cell granuloma (AEGCG) is a rare granulomatous disorder characterized by giant cells in the dermis phagocytosing damaged elastin fragments.

Objective:

We report a case of a 71-year-old man presenting with erythematous plaques in predominantly sun-exposed areas.

Method:

A diagnosis of AEGCG was made based on the clinical and histologic picture, and treatment with systemic steroids was initiated. However, while tapering the steroid dose, the patient developed a radiating headache that progressed to temporal arteritis and eventual blindness in the right eye.

Conclusion:

There have been only two previous case reports presenting an association between AEGCG and temporal arteritis. This report explores AEGCG and its possible relationship to temporal arteritis along with possible treatment regimens cited in the current literature.
Unusual Case of Proximal Calciphylaxis without Renal Failure
Authors: Stanciu Monica , Gagné-Henley Angélique , Thérien Geneviève
Published: March 2015

Background:

Calciphylaxis is a rare syndrome of vascular calcification with subsequent cutaneous and tissue necrosis. It usually manifests as a complication of end-stage renal failure, affecting 1 to 4% of long-term dialysis patients. Very exceptionally, it can occur without chronic renal failure.

Objective:

The goal of this study was to discuss an exceptional case of extensive calciphylaxis in the absence of chronic renal failure and its successful management.

Methods:

We present a case of a 31-year-old woman with extensive proximal, ulcerated calciphylaxis without associated chronic renal failure. Our patient had quite a few risk factors associated with the pathogenesis of calciphylaxis, such as obesity, malnutrition, and a transient episode of acute renal failure.

Results:

She was successfully treated with sodium thiosulfate, extensive wound débridement (more than 30% total body surface), and subsequent skin grafts. The patient has miraculously survived this often fatal condition.

Conclusion:

Calciphylaxis can occur even in the absence of chronic renal failure. This often fatal condition can be managed successfully with a combination of aggressive wound control and the fairly newly described sodium thiosulfate therapy.
Fibroblast Growth Factor-Binding Protein Facilitates the Growth and Migration of Skin-Derived Precursors
Authors: Huang Yong , Qi Shao-Hai , Shu Bin , Chen Lei , Xie Ju-Lin , Xu Ying-Bin , Liu Xu-Sheng
Published: March 2015

Background:

Fibroblast growth factors (FGFs) are important regulators of cell proliferation, migration, and differentiation during wound healing. FGF-binding protein (FGF-BP) plays a critical role in activating FGFs by releasing them from the extracellular matrix. Although previous studies have demonstrated a pivotal role for FGF-BP in wound healing and angiogenesis, little is known about the biologic effects of FGF-BP on skin stem cells that contribute to wound healing.

Objective:

To investigate the effects of FGF-BP on the growth and migration of skin-derived precursors (SKPs).

Methods:

FGF-BP was titrated to determine the optimal concentration that maximally stimulated cell proliferation. Cellular phenotype and telomerase activity were compared in the presence and absence of FGF-BP. The effect of FGF-BP on cell migration was observed by intravenously transplanting SKPs to adult mice.

Results:

Cell proliferation was maximally stimulated by FGF-BP at a concentration of 10 ng/mL without changing the intrinsic characteristics of SKPs. Low levels of telomerase activity were detected, and FGF-BP decreased the rate at which telomerase activity was downregulated. In vivo, FGF-BP remarkably enhanced the migration of SKPs to skin lesion sites.

Conclusion:

FGF-BP exerts a positive effect on the growth and migration of SKPs, suggesting a potential role for SKPs in wound healing.
Calcific Uremic Arteriolopathy Treated with Cinacalcet, Paricalcitol, and Autologous Growth Factors
Authors: Kakagia Despoina , Kriki Pelagia , Thodis Elias , Roumeliotis Athanasios , Vargemezis Vassilios
Published: March 2015

Background:

Calcific uremic arteriolopathy is an uncommon cutaneous ischemic necrotizing disease, most commonly associated with renal disease and hyperparathyroidism, bearing a high mortality rate.

Objective and Method:

A case of a 57-year-old female renal patient with hyperparathyroidism who was successfully treated with combined paricalcitol and cinacalcet systemically, while autologous growth factors were locally applied, is herein presented.

Result and Conclusion:

The combination of cinacalcet and paricalcitol is a reliable alternative to parathyroidectomy in patients with calcific uremic arteriolopathy and hyperparathyroidism. Meticulous débridement of necrotic tissues is essential and application of autologous growth factors promotes healing.
Likelihood of Dermatology Patients to Inquire about Sun Protection Measures during a Regular Clinic Visit
Authors: Jung Gordon W. , Senthilselvan Ambikaipakan , Salopek Thomas G.
Published: March 2015

Background:

Health information-seeking behavior refers to ways individuals acquire health information. Few studies demonstrate its association with skin cancer.

Objectives:

To determine the likelihood of patients to inquire about sun protection methods from dermatologists and whether such knowledge will affect their preventive behaviors.

Methods:

Over a 2-month period, 396 dermatology patients completed a survey assessing their sun awareness knowledge and inquiry about sun protection measures. Features associated with increased skin cancer risk were correlated with patients' inquiry about sun protection information and their future intentions to practice safe sun behavior.

Results:

One in seven patients (13.8%) inquired about sun protection measures. Patients with features known to be associated with increased skin cancer risk infrequently inquired about sun protection methods (4.5–23.8%). Post–physician counseling, patients with previous sun awareness education had a greater intention to use sunscreen routinely (41.4% vs 28.3%, p = .01), avoid the sun (31.2% vs 18.2%, p = .004), and wear sun-protective clothing (32.5% vs 23.2%., p = .05).

Conclusion:

Patients' desire for medical information from physicians does not translate efficiently into seeking sun awareness information from dermatologists. Dermatologists should play a greater proactive role in skin cancer prevention through initiation of regular personalized discussions on sun awareness issues.
Giant Dermoid Cyst of the Lower Limb: Presentation of a Rare Case
Authors: Iconomou Thomais , Zapantioti Polyxeni , Kakagia Despoina , Kyriopoulos Eugene , Papaliodi Eugene , Tsoutsos Dimosthenis
Published: March 2015

Background:

Dermoid cysts are unusual neoplasms that often present in childhood and are usually located in the head and neck region.

Objective and Method:

We describe a rare case of a giant dermoid cyst of congenital inclusion type located at the lower extremity of a young male. Preoperative imaging studies were performed for evaluation of the mass.

Result:

The cyst was surgically removed, and histopathologic examination confirmed the diagnosis.

Conclusion:

Dermoid cysts rarely appear in the lower extremity and must be included in the differential diagnosis of cystic lesions of the lower limb.
The Fusiform Skin Excision: One Recipe for Success
Authors: Kraft John , Murray Christian A.
Published: March 2015

The fusiform skin excision is commonly performed by dermatologists. This brief review presents a stepwise approach to this procedure and discusses recent evidence related to dermatologic minor surgery.

Les dermatologues pratiquent couramment l'excision fusiforme de la peau. Ce bref compte rendu présente une approche par étapes de cette intervention et une discussion sur les données récentes relatives aux petites chirurgies dermatologiques.
Techniques to Minimize the Pain of Injected Local Anesthetic
Authors: Baibergenova Akerke , Murray Christian A.
Published: March 2015

The process of injecting local anesthetic still often remains the most uncomfortable part of dermatologic surgery for patients. This review discusses strategies that may be used to reduce this discomfort.

Le processus d'injection d'un anesthésique local demeure souvent l'aspect le plus désagréable de la chirurgie dermatologique pour les patients. Ce compte rendu contient une discussion des stratégies que l'on peut utiliser pour réduire cet inconfort.
Methotrexate-Induced Cutaneous Ulcers in a Nonpsoriatic Patient: Case Report and Review of the Literature
Authors: Kurian Anil , Haber Richard
Published: March 2015

Background:

Methotrexate is a mainstay of treatment for autoimmune conditions such as rheumatoid arthritis and psoriasis. Methotrexate has numerous potential side effects and, in rare circumstances, can lead to cutaneous ulceration. Methotrexate can cause skin ulceration, and stopping this medication can lead to complete healing of the ulcerated lesion.

Observations:

A 67-year-old man with rheumatoid arthritis on long-term methotrexate therapy presented to hospital with ulcers on his hands, elbows, and lower extremities. He had no history of psoriasis. Shortly after admission, the patient was noted to have pancytopenia. A bone marrow biopsy showed a hypocellular marrow. Both the cutaneous ulcers and the hypocellular marrow were thought to be induced by methotrexate. The ulcerated areas were biopsied, and histopathology showed no evidence of vasculitis. After 1 month of rehabilitative skin care, the patient's ulcers healed almost completely and his bone marrow suppression recovered.

Conclusion:

We report the fifth case of methotrexate-induced cutaneous ulceration in a nonpsoriatic patient and review the literature on this unusual drug reaction. Methotrexate can induce cutaneous ulceration in nonpsoriatic patients and should be considered a potential cause of ulceration in patients treated with this antimitotic agent.
Multiple Cutaneous Granular Cell Tumors: Case Report of a 19-Year-Old African American Female
Authors: Henry Matthew , Perry Adam
Published: March 2015

Background and Objective:

This is a somewhat rare case of a 19-year-old African American female with multiple cutaneous granular cell tumors. Granular cell tumors are of neural origin, except in rare cases, and are considered benign, with a low incidence of malignancy. The clinical presentation varies greatly, but these tumors are most commonly painful and slow growing, with two-thirds occurring on the head and neck. Patients are most commonly in their second to fourth decades of life, two-thirds are black, and two-thirds are women. Granular cell tumors are diagnosed by the characteristic pathologic findings of polygonal cells with eosinophilic granular cytoplasm.

Conclusion:

These tumors are most commonly singular but can be multiple in 10 to 15% of patients. Older patient age, rapid growth or enlargement, and a history of local recurrence should raise concern for malignant behavior. The distribution and family history in this case are suggestive of possible mosaicism.
Phototherapy in Psoriasis: A Review of Mechanisms of Action
Authors: Wong Tami , Hsu Leon , Liao Wilson
Published: March 2015

Background:

Phototherapy is one of the most efficacious treatment options for psoriasis. New, emerging studies are beginning to define the biologic mechanisms by which phototherapy improves psoriasis.

Methods:

To provide an overview of the mechanisms thought to be responsible for the therapeutic effects of phototherapy, a review was performed on all relevant published studies in the Medline database from January 1, 1985, to August 15, 2011.

Findings:

Four categories of action were proposed in the literature to describe the effects of phototherapy in psoriasis: (1) alteration of the cytokine profile, (2) induction of apoptosis, (3) promotion of immunosuppression, and (4) all other mechanisms.

Conclusions:

Phototherapy acts through a combination of pathways to confer therapeutic benefits in psoriasis, and these different modalities may help explain its particular usefulness in treating this cutaneous disease.
Examining the Relationship between Alopecia Areata, Androgenetic Alopecia, and Emotional Intelligence
Authors: Monselise Assaf , Bar-On Reuven , Chan Lisa , Leibushor Naama , McElwee Kevin , Shapiro Jerry
Published: March 2015

Background:

Emotional stress has been associated with the development of alopecia areata (AA) and androgenetic alopecia (AGA). Emotional intelligence (EI), a component of general intelligence, is thought to govern the recognition, expression, and control of stress and other emotions. People with low EI are unable to adequately control stress in everyday life.

Objective:

To investigate EI differences between AA and AGA patients and a control population.

Methods:

Thirty-five AGA patients and 42 AA patients, with patchy ( n = 28), ophiasis ( n = 5), totalis ( n = 5), and universalis ( n = 4) distribution of hair loss, completed a 133-item Emotional Quotient-Inventory (EQ-I) psychometric assessment. Scores were compared between AA, AGA, and 77 control subjects obtained from the North American normative population sample on which the psychometric instrument was normed.

Results:

Statistically significant differences were found in EI between AA patients and controls with the EQ-I Stress Tolerance scale ( p = .005). AGA patients also differed significantly from the controls but to a lesser degree compared toAA patients. In overall EI, there were no apparent differences between AGA and AA patients.

Conclusions:

AA and AGA patients exhibit a mild depressive reaction to their condition, with AA patients demonstrating a significantly stronger deficiency in coping with stress than AGA patients. The data support a psychosomatic contribution to AA. Referral of patients for EI assessment and psychosocial counseling could help reduce stress.
Teaching Dermatology to Internal Medicine Residents: Needs Assessment Survey and Possible Directions
Authors: Drucker Aaron M. , Cavalcanti Rodrigo B. , Wong Brian M. , Walsh Scott R.A.
Published: March 2015

Background:

Internal medicine trainees receive limited teaching and training in dermatology and may feel inadequately prepared to assess and manage patients with dermatologic complaints. No study to date has assessed the needs of internal medicine trainees in Canada with regard to dermatology teaching.

Objective:

To determine internal medicine residents' comfort in assessing and managing dermatologic issues and their educational needs in dermatology.

Methods:

An electronic survey was conducted of first-, second-, and third-year internal medicine residents at the University of Toronto.

Results:

Fifty-four of 186 internal medicine trainees responded to our survey (response rate = 29%). Each respondent did not answer every question. Residents were generally uncomfortable or very uncomfortable assessing and managing dermatologic issues in the emergency department (40 of 47, 85%), ward or intensive care unit (39 of 47, 83%), and ambulatory clinic (40 of 47, 85%). Residents thought that various clinical and didactic dermatology exposures would be useful to their training as internists. Case-based teaching and ambulatory clinical rotations were felt to be particularly valuable. Additionally, 38 of 46 (83%) respondents wanted to learn how to perform punch biopsies.

Conclusions:

An effort should be made to increase the availability of relevant dermatology teaching and clinical exposures for internal medicine residents.
Familial Pityriasis Rubra Pilaris: Case Report and Review
Authors: Mercer Joshua M. , Pushpanthan Chitra , Anandakrishnan Canagasundrum , Landells Ian D.R.
Published: March 2015

Background:

Pityriasis rubra pilaris (PRP) is a rare dermatosis of unknown etiology. Most cases of PRP are sporadic; however, rare cases of familial PRP have been reported.

Objectives:

To present a case of PRP inherited in an autosomal dominant (AD) fashion and to evaluate the current literature on familial PRP and formulate a comprehensive, up-to-date summary of this rare condition.

Methods:

PubMed was used to conduct a search for articles pertaining to familial PRP published through May 2011.

Results:

The first documented case was published in 1910, and 36 subsequent familial cases of PRP have been reported. Familial PRP typically presents very early in childhood, has a gradual onset, and persists throughout life. Given the rarity of this subtype, determining the best therapy has been a challenge. In the pediatric population, a conservative treatment approach, including topical therapy, is frequently used, whereas systemic treatments are reserved for patients with a severe disease that is refractory to therapy.

Conclusion:

Rare cases of PRP inherited in an AD fashion have been described and tend to have a chronic clinical course and are treatment refractory. Therefore, the awareness of familial PRP is important for early and accurate diagnosis and administration of appropriate therapy.
In Vivo Reflectance Confocal Microscopy of Halo Nevus
Authors: Schwartz Rodrigo J. , Vera Karla , Navarrete Nelson , Lobos Pedro
Published: March 2015

Background:

RCM (reflectance confocal microscopy) is a noninvasive, high-resolution technology that has been proven to improve the diagnostic accuracy over clinical examination in several skin diseases.

Objective:

The aim of this article is to describe the morphologic features of halo nevi (HN) observed with RCM and correlate them with their dermoscopic characteristics.

Method:

Nine patients with the clinical diagnosis of HN were assessed with RCM. A second assessment was performed up to 12 months later. Dermoscopic global patterns were obtained and correlated with the RCM findings.

Results:

In five (55.6%) cases, pagetoid cells were observed. Nonedged dermal papilla and junctional thickening were found in three (33%) cases. Nucleated cells in the dermal papillae and plump bright cells were observed in seven (77.8%) and six (66.7%) cases, respectively.

Conclusion:

Our study shows that HN observed by RCM can show atypical features that overlap with those observed on atypical melanocytic lesions and malignant melanoma.
Degree of Histologic Inflammation in Lupus Erythematosus and Direct Immunofluorescence Results: Red and Inflamed Lesions Do Not Increase the Chances of Getting a Bright Band
Authors: Hung Tawny , Crawford Richard Ian , Martinka Magdalena
Published: March 2015

Background:

In the diagnostic work-up of lupus erythematosus (LE), direct immunofluoresence (DIF) examination could be helpful. Classically, clinically red lesions are targeted by clinicians in the hope of yielding an informative DIF result. However, the investigative correlation between the degree of inflammation and DIF positivity has never been published in the literature.

Objective:

In this study, we sought to discover if histologically inflamed lesions correlated with DIF positivity results.

Method:

We studied 112 lesions histologically consistent with LE and correlated the degree of histologic inflammation on the DIF hematoxylin and eosin-stained biopsy with DIF positivity. The degree and location of the inflammation, as well as the involvement of the dermoepidermal interface, were documented.

Results:

A positive lupus band test was defined as the presence of either (1) granular IgG alone ± other immunoglobulins and/or C3 or (2) granular IgM or Ig A plus other immunoglobulins ± C3. Fifty-four of 112 (48%) cases had positive DIF (DIF+) results, 26 of 112 (23%) had negative DIF (DIF-) results, and 32 of 112 (29%) had nonspecific DIF patterns. Of the DIF+ cases, 41 of 54 (76%) showed some degree of inflammation, whereas 25 of 26 (96%) DIF- cases had inflammation ( p − .60). Most of the biopsies in the study (85%) were inflamed, but the degree and location of the inflammation had no influence on DIF+ results. The intensity of the DIF+ band further failed to show any relationship with the degree of inflammation.

Conclusion:

The level of inflammatory activity in a clinical lesion fails to correlate with DIF positivity. Furthermore, other common histopathologic findings of LE are not predictive of DIF results.
Therapy of Ulcerated Hemangiomas
Authors: McCuaig Catherine C. , Cohen Lynn , Powell Julie , Hatami Afshin , Marcoux Danielle , Maari Catherine , Caouette-Laberge Louise , Bortoluzzi Patricia , Ondrejchak Sandra , Dubois Josée
Published: March 2015

Background:

Cutaneous ulceration is the most common complication of infantile hemangiomas (IHs) seen in a pediatric dermatology practice.

Objective:

The most effective treatments in our experience are compared to those in the current literature.

Methods:

The study was a retrospective chart review of therapy of 169 ulcerated IHs at a tertiary care pediatric hospital and a literature review.

Results:

Combination therapy was the rule. Local wound care was required in all, pain management in 72%, pulsed dye laser in 42%, infection control in 38%, diminution of the hemangioma through systemic therapy in 36%, and suppression of bleeding in 2%.

Limitations:

A retrospective review compared to a case-control study has inherent bias. In addition, our cases were all at a tertiary referral center.

Conclusion:

All ulcerated IHs benefit from local barrier creams or dressings. Pulsed dye laser, antibiotics, topical morphine 0.1% in hydrogel, topical becaplermin, and, most importantly, systemic therapy (especially propranolol) to reduce the hemangioma may be useful.
Understanding and Assessing Potential Serious Adverse Events: A Practical Approach to Understanding the Benefits and Harm of Psoriasis Treatments
Authors: Papp Kim , Guenther Lyn , Shear Neil , Binder Carin , Tan Jerry , Lynde Charles , Gulliver Wayne , Stang Paul
Published: March 2015

Background:

Any therapeutic intervention carries with it the potential for benefit and harm. Generally, benefit is far more common than risk; however, risk aversion drives many of the treatment decisions made by patients and their physicians.

Objective:

To provide guidelines to help clinicians improve their understanding of causality and the interpretation of harm.

Methods:

A group of dermatologists involved in data safety monitoring boards, clinical trial investigators, and a clinical epidemiologist identified the need for practical advice on how to understand and explain causality and harm and combined to share their knowledge.

Results:

An explanation of how data are collected and the environment that shapes the data seen by clinicians is presented. The article spans an overview of the regulatory environment that informs trial design for regulatory approval to a description of types of designs that inform safety and techniques, such as the rule of three, to provide guidance to clinicians in interpreting the data.

Conclusion:

Communicating the potential for harm to patients is critical. Placing the potential for rare and serious risks into perspective for the patient is as important as discussing the potential benefits of medication.
Reactive Arthritis in India: A Dermatologists' Perspective
Authors: Kanwar Amrinder J. , Mahajan Rahul
Published: March 2015

Background:

The mucocutaneous lesions in Reiter syndrome (RS) or reactive arthritis are seen quite frequently.

Materials and Methods:

The case records of patients admitted with the diagnosis of RS from January 2006 to December 2010 were reviewed. Data regarding the demographic details; course of musculoskeletal, mucocutaneous, and ophthalmic involvement; body surface area affected; morphology of lesions; investigations undertaken; and treatment instituted were recorded. Based on these, the disease was classified as complete or incomplete RS.

Results:

The case records of 11 patients were evaluated. There were seven males and four females. Only two patients had complete RS, whereas nine patients had incomplete RS. Arthritis and mucocutaneous involvement were seen in all 11 patients, whereas preceding urethritis/dysentery was seen in 4 patients and eye symptoms in 4 patients. Enthesitis was seen in eight patients (72.7%). Circinate balanitis/vulvitis was present in six patients and keratoderma blenorrhagicum in eight patients. The most frequent radiologic finding was juxta-articular osteopenia in eight patients.

Conclusion:

RS may not show the typical triad in all cases, although musculoskeletal disease is seen in a significant proportion of patients. In the absence of typical signs and symptoms, cutaneous manifestations may help establish the diagnosis of RS.
Ingenol Mebutate: A Promising Treatment for Actinic Keratoses and Nonmelanoma Skin Cancers
Authors: Gupta Aditya K. , Paquet Maryse
Published: March 2015

Background:

A new treatment for actinic keratoses, ingenol mebutate, was recently approved by the US Food and Drug Administration.

Objective:

To review the mechanisms of action, efficacy and safety data, and practical recommendations for ingenol mebutate.

Methods:

The PubMed and clinicaltrials.gov databases were searched in March/April 2012 using the terms PEP005, ingenol mebutate, and ingenol 3-angelate. The abstracts from the Annual Scientific Meeting of the Australian College of Dermatologists (2009–2011) and the Annual Meeting of the American Academy of Dermatology (2009–2012) were also searched.

Results:

Due to its multiple mechanisms of action, ingenol mebutate treatment resulted in short- and long-term efficacy similar to other topical treatments for actinic keratoses in a shorter period of 2 or 3 days. This short therapy would reduce the duration of adverse events. Premarketing trials for treatment of nonmelanoma skin cancers also showed promising results for ingenol mebutate.

Conclusion:

Ingenol mebutate is a convenient, safe, and effective intervention for precancerous and cancerous skin conditions.