bluuebunny/crossref_metadata_2025 huggingface dataset:
Environmentally Friendly Drilling Systems Scorecard
Authors: Wilcox A. , Haut R. , Williams T.
Published: March 2015

With increasing O&G exploration and production activities taking place, there are various concerns about how environmental issues are being addressed. Industry is making great strides in the protection of the environment, however challenges still exist. Matters involving air, water, site, waste management, biodiversity, and community disturbances potentially alarm citizens who may not understand that numerous environmentally friendlier technologies and practices are currently being developed and used to address such areas. Several operators go beyond what is required, taking steps to lessen impacts.

The Environmentally Friendly Drilling (EFD) Program provides unbiased science to identify and demonstrate technologies and practices designed to address environmental and societal issues. The EFD Scorecard was created as a voluntary, consensus-based tool that measures how industry addresses these issues. It has been tested on various sites in different ecosystems across North America. These review processes helped identify additional attributes to consider, ensuring all relevant information is being examined.

The Scorecard methodology is designed to document how issues affecting stakeholders are being addressed. The intended result is to provide an adaptive ecosystem services management tool to assist operating companies in planning and implementing good practices. It can be used to objectively assess operators’ environmental performance. Industry can gain powerful insight in relaying their efforts at addressing environmental issues throughout E&P operations. As oil and gas activity continues to grow, a tool to measure and share the performance and commitment of operators can help allay unease about transparency. Benchmarking best management practices in action and making such data available can also provide the necessary improvement in communication with all stakeholders.

This paper will describe a tool for operators to help improve communication with all stakeholders and assist in ongoing relationships with regulators. Whereas the O&G industry has fallen short on remaining in touch with the communities surrounding operations, the EFD Scorecard will provide the unbiased data in understandable and approachable terminology that has been vetted by industry, environmental groups, academia and NGO's. Communicating the measures taken by industry in terms relevant to all stakeholders is crucial to earning not only a license to operate, but also, an invitation to operate.
Balanced Materiality: A Practical Approach to Determining Sustainability Priorities
Authors: Krembs M. , Cort T.
Published: March 2015

Materiality is a fundamental principle in sustainability and corporate social responsibility (CSR) to determine those issues that are significant enough to companies, investors and other stakeholders to warrant investment, management and disclosure. Exploration and Production (E&P) companies are at various stages of development in the application of materiality tools to support non-financial reporting. This paper describes background on this developing area of practice and a practical approach to materiality taken by one company in the E&P sector. Specifically, we provide first-hand knowledge and guidance for developing a materiality process that adheres to company risk assessment principles, investor and community expectations, and company values and commitments. The approach also integrates mechanisms to incorporate external expert feedback and criteria from leading standards for disclosure such as the Global Reporting Initiative (GRI) G4 Guidelines and the Sustainability Accounting Standards Board (SASB) E&P sustainability accounting standard.
Pili Bigemini and Terminal Hair Growth Induced by Low-Fluence Alexandrite Laser Hair Removal
Authors: Bukhari Iqbal A.
Published: March 2015

Background:

Different types of lasers are used in the removal of undesirable hair by targeting the hair follicles, with the melanin pigment acting as the chromophore, and through the mechanism of selective photothermolysis.

Objectives:

This report documents an unusual increase in terminal hair growth after alexandrite laser hair removal in three female patients.

Conclusion:

Excessive hair growth after alexandrite laser hair removal must be listed as one of the complications resulting from the use of a laser with a fluence that is too low and can possibly be prevented if we use higher energy to fully destroy the hair follicles, with consideration given to the skin type and an effective cooling system.
Treatment of Nail Bed Defects with Hard Palate Mucosal Grafts
Authors: Fernández-Mejía Silvia , Domínguez-Cherit Judith , Pichardo-Velázquez Patricia , González-Olvera Sergio
Published: March 2015

Background:

Nail bed defects produce a nail plate dystrophy that is permanent and presents important cosmetic problems. To correct the defect, we used a hard palate mucosal graft. This is a procedure with encouraging outcomes for nail bed scars.

Objective:

To show our initial experience with the hard palate mucosal graft technique for correcting nail dystrophy or permanent onycholysis secondary to a nail bed scar.

Methods:

This was a prospective, longitudinal, descriptive, observational study. We included five patients with a traumatic nail bed scar and one patient with congenital dystrophy. Seven nails were treated using a hard palate mucosal graft.

Results:

All repaired nails had a good outcome, with excellent growth and improvement in nail dystrophy. The patients had surgical recovery in 2 weeks and tolerable pain.

Conclusions:

This is a relatively easy procedure for experienced surgeons to correct nail dystrophy secondary to a nail bed scar, with good to excellent results.
Modified Dermoscopic Algorithm for the Differentiation between Melanocytic and Nonmelanocytic Skin Tumors
Authors: Blum Andreas , Clemens Jennifer , Argenziano Giuseppe
Published: March 2015

Background:

The use of dermoscopy (dermatoscopy, epiluminescence microscopy, surface microscopy) improves the clinical diagnostic accuracy of skin tumors by applying different algorithms or scores. The first step in the dermoscopic evaluation is the differentiation between melanocytic and nonmelanocytic skin tumors.

Objective:

To evaluate the diagnostic accuracy of the established dermoscopic algorithm (EDA) and the modified dermoscopic algorithm (MDA) for melanocytic versus nonmelanocytic skin tumors.

Methods:

Two hundred forty-nine patients with melanocytic and nonmelanocytic skin lesions were included. Dermoscopic images of the tumors were taken with 10-fold magnification, followed by surgery and histopathology at the departments of Dermatology at the universities of Tuebingen, in Germany, and Naples, in Italy. Each lesion was classified using the EDA and MDA. In the MDA, accessory nipples and dermatofibromas were considered in particular.

Results:

With the EDA, 225 of 249 (90.4%) skin tumors were correctly classified in one of the six groups. With the MDA, 237 of 249 (95.2%) were correctly classified. Improvement was achieved in 12 (4.8%) better classified skin tumors. In both algorithms, no melanoma was classified as a nonmalignant melanocytic tumor. All melanomas were classified in the group of melanocytic tumors and one melanoma was classified in the group of basal cell carcinomas.

Conclusion:

Both dermoscopic algorithms for the differentiation between melanocytic and nonmelanocytic skin tumors were simple and effective when applied step by step. The MDA is an improvement on the EDA with the classification of accessory nipples and dermatofibromas.
Dermatitis Artefacta
Authors: Kwon Eun Ji , Dans Michael , Koblenzer Caroline S. , Elenitsas Rosalie , James William D.
Published: March 2015

Background:

Dermatitis artefacta (DA) is difficult to diagnose by clinical findings alone. Histopathologic analysis may rule out organic disorders and in some cases establish, in conjunction with microanalytic techniques, a definite diagnosis.

Objective:

We report a young woman with DA in the form of recurrent abscesses whose diagnosis was aided by the identification of subcutaneous foreign material through histologic and microanalytic methods.

Methods:

Histologic examination showed foreign body giant cell reaction with polarizable material, which was identified as cellulose by energy dispersive x-ray analysis and Fourier transform infrared spectrometry.

Results:

Self-injection of exogenous matter was suspected. Referral to an expert in psychodermatology resulted in the diagnosis of multiple psychiatric comorbidities commonly associated with DA. Initiation of antidepressants resulted in marked improvement in her skin disease, as well as her mood and affect.

Conclusion:

We emphasize the importance of interdisciplinary collaboration between dermatologists, dermatopathologists, and mental health professionals in the management of DA.
Classification and Prevalence of Pigmented Lesions in Patients with Total-Body Photographs at High Risk of Developing Melanoma
Authors: Menon Kavita , Dusza Stephen W. , Marghoob Ashfaq A. , Halpern Allan C. , Nehal Kishwer S.
Published: March 2015

Background:

The classification of many pigmented lesions is not well defined, and an association with melanoma has not been established.

Objective:

To better define the spectrum of pigmented lesions (excluding common and dysplastic nevi) and explore links to melanoma.

Methods:

Retrospective review of patients with total-body digital photographs at high risk of developing melanoma from the Memorial Sloan-Kettering Cancer Center Dermatology Service.

Results:

Among 598 patients, 7.7% had café au lait spots, 2.8% had nevi spilus, 2.3% had congenital nevus–like nevi, 2% had “other” lesions, 1.2% had segmental speckled lentiginous nevi, and 1% had agminated nevi. There was no statistical difference in the prevalence rates of these pigmented lesions in patients with or without a history of melanoma or > 100 nevi.

Conclusions:

A wide range of pigmented lesions require further classification and study to explore possible links to melanoma.
Mexoryl: Broad-Spectrum Ultraviolet a Photoprotection
Authors: Guenther Lyn , Lynde Charles W. , Zip Catherine
Published: March 2015

The deleterious effects of long-wave (320–400 nm) ultraviolet (UV) radiation on human skin have been recognized for decades. Human exposure to UV radiation may induce skin pigmentation and sunburn, cutaneous connective tissue alterations (photoaging), immunosuppression, and the development of skin cancers. Public awareness campaigns on the need for photoprotection advocate the regular use of sunscreens. Consumer demand and an expanding knowledge of the adverse effects of UV exposure have fueled the continual development of novel sunscreen formulations. Two organic UV filters, terephthlylidene dicamphor sulphonic acid (Mexoryl SX, L'Oréal, Paris, France) and drometrizole trisiloxane (Mexoryl XL, L'Oréal), provide effective protection from UV irradiation and offer improved safety profiles in terms of protection from UVA radiation. This article details the photoprotective benefits of Mexoryl SX and Mexoryl XL.
Cutaneous Lupus Erythematosus Limited to the Site of a Laceration
Authors: Timani Shereen , Mutasim Diya F.
Published: March 2015

Background:

Cutaneous lupus erythematosus is known to occur at sites of trauma or inflammation of the skin, including sites of tattoo, frostbite, herpes zoster scar, burn scar, and implantation by windshield glass.

Objective:

We report a 32-year-old white man who developed cutaneous lupus erythematosus at the site of a laceration. The diagnosis was confirmed by histologic and immunofluorescence examination. The patient responded to intralesional corticosteroid and hydroxychloroquine therapy.

Conclusion:

Lupus erythematosus may be induced by trauma.
Prognostic Significance of Vascularity in Cutaneous Melanoma: Pilot Study Using in Vivo Confocal Scanning Laser Microscopy
Authors: Humphrey Shannon , Walsh Noreen M. , Delaney Laura , Propperova Iva , Langley Richard G. B.
Published: March 2015

Background:

Tumor vascularity may be of strong prognostic significance in cutaneous melanoma. We are the first to use a novel, noninvasive, in vivo confocal scanning laser microscope (CSLM) to evaluate vascularity in cutaneous melanoma.

Objective:

Our purpose was to apply a CSLM to assess vascularity in melanoma and to evaluate the prognostic significance of these findings.

Methods:

Patients with a suspicious pigmented lesion were prospectively recruited to undergo CSLM prior to skin biopsy, and those diagnosed with melanoma were included in this study. A blinded observer graded tumor vascularity from still digital CSLM images. The CSLM vascularity grading was correlated to tumor thickness and ulceration as a proxy for clinical prognosis.

Results:

Sixty-six patients and 67 lesions underwent imaging with CSLM. Eleven patients were diagnosed with melanoma, including six in situ and five invasive melanomas. Prominent vascularity was observed in all advanced melanomas. There was an overall increase in mean tumor thickness between the absent (x = 0.315 mm) to prominent (x = 1.51 mm) categories.

Conclusion:

In this pilot study, vascularity was readily detected in cutaneous melanomas using CSLM. Prominent vascularity was observed in patients with advanced cutaneous melanomas. Our preliminary results are encouraging and indicate potential for the use of CSLM to assess vascularity in cutaneous melanoma, with potential prognostic and therapeutic implications.
Randomized Controlled Study of Electrochemotherapy in the Local Treatment of Skin Metastases of Melanoma
Authors: Gaudy Cardine , Richard Marie-Aleth , Folchetti Gilles , Bonerandi Jean Jacques , Grob Jean-Jacques
Published: March 2015

Background:

Electrochemotherapy (ECT) combines intralesional injections of bleomycin with electroporation (EP), which permeabilizes tumor cells and thus increases the bleomycin efficacy at the tumor site.

Objective:

To assess whether EP therapy improves the local control of skin metastases of melanoma by intralesional bleomycin. The secondary objective was to evaluate tolerance of the treatments.

Patients:

Patients with at least two measurable skin metastases of melanoma that were previously untreated, either in stage III with in-transit melanoma skin metastases or stage IV with no efficacy of systemic chemotherapy on these metastases.

Design:

A prospective internally controlled study with randomization of melanoma skin metastases in each individual to intralesional injections of bleomycin alone or to intralesional injections of bleomycin with EP. The primary end point was the rate of complete local response per treated melanoma skin metastasis at week 12, and the secondary end point was tolerance.

Results:

Fifty-four melanoma skin metastases were treated in 12 patients (8 stage IV patients under chemotherapy and 4 stage III patients free of other treatment). A local complete response was obtained in 36% (11 of 30) of melanoma skin metastases treated with bleomycin + EP and only in 8% (2 of 24) of melanoma skin metastases treated with bleomycin alone ( p = .016). In the per protocol population, complete response was obtained in 74% (17 of 23) and 13% (2 of 15) of the lesions treated, respectively ( p = .017). All patients (12 of 12) reported discomfort during the EP procedure, including local pain for 9 patients (75%) at the treatment site and muscle spasm with myoclonia in 3 cases (25%). No clinical or biologic systemic toxicity was noticed.

Conclusions:

EP increases the effect of intralesional bleomycin and improves the rate of local control in melanoma skin metastases without inducing a more systemic effect. This local treatment could be useful in a palliative strategy in patients with melanoma skin metastases.
Perianal Paget's Disease
Authors: Zibly Zion , Haik Josefh , Khaikin Marat , Barshack Iris , Zmora Oded
Published: March 2015

Background:

Perianal Pa get's disease is an uncommon intraepithelial neoplasm that involves areas affluent with apocrine glands, most frequently in the female external genitalia, but may also affect the perianal region.

Objective:

We present the pathologic and clinical management of a case of Paget's disease involving the perianal region, in which diagnosis was delayed for 8 years.

Conclusions:

The importance of a high index of suspicion for early diagnosis is emphasized, which should be followed by aggressive surgical treatment with wide excision and local reconstruction.
Bilateral Extensive Periorbital Milia en Plaque Treated with Electrodesiccation
Authors: Al-Mutairi Nawaf , Joshi Arun
Published: March 2015

Background:

Milia en plaque (MEP) is a rare form of milia. Only 25 cases of this rare condition have been reported to date ( MEDLINE search). Only one previous case of MEP has been treated with electrodesiccation.

Objective:

To report a new case of this rare condition and present the outcome with electrodesiccation.

Conclusion:

The case is being reported here to highlight the features of this rare but now well-recognized dermatologic condition, which has been reported increasingly in the recent past, to discuss the various treatments tried, and to share our experience of treating patients with the simple, inexpensive, easily available, and nonsophisticated office procedure of electrodesiccation.
Lipolysis of Lipomas in Patients with Familial Multiple Lipomatosis: An Ultrasonography-Controlled Trial
Authors: Bechara Falk Georges , Sand Michael , Sand Daniel , Rotterdam Sebastian , Stücker Markus , Altmeyer Peter , Hoffmann Klaus
Published: March 2015

Background:

Surgery of multiple lipomas, as in patients with familial multiple lipomatosis, is often limited by poor aesthetic outcome owing to extensive scarring. For this reason, phosphatidylcholine (PDC) has been widely used to treat areas of localized fat accumulation. However, no reports of lipoma therapy with intralesional application of PDC, that is, injection lipolysis, have been published to date.

Objective:

To investigate whether injection lipolysis with PDC is an effective therapeutic option for patients with multiple lipomas.

Methods:

Thirty lipomas in 10 patients were sonographically measured prior to treatment. Four injections at intervals of 6 to 8 weeks were done. Sonographic measurements of lipoma size were repeated before each injection. Side effects, a pain score using a visual analogue scale, and patient satisfaction were noted. In one lipoma, histologic changes after lipolysis are described.

Results:

After four injections, a significant reduction in size of 45.8% was achieved. No complete elimination was seen in any lipoma. Histology showed a mild granulomatous septal panniculitis. Hematoma occurred in eight cases (27%). Four patients described pain on pressure for 3 days after injection. No severe side effects or systemic reactions were observed.

Conclusion:

Although surgery is the gold standard for lipoma therapy, injection lipolysis with PDC can also significantly reduce lipoma size. Complete elimination was not observed in any lipoma. Given that this was a short-term study, long-lasting therapeutic effects and possible recurrence of lipoma cannot be evaluated.
Dermatologic Signs
Authors: Freiman Anatoli , Kalia Sunil , O'Brien Elizabeth A.
Published: March 2015

Background:

Dermatology signs serve as important clues to primary skin disorders and internal conditions.

Objective and Methods:

To highlight major cutaneous signs based on a MEDLINE literature search from 1966 to March 2006.

Results and Conclusions:

A multitude of signs exist in dermatology. Appreciation and knowledge of cutaneous signs will enhance the care of patients with dermatologic manifestations.
Predominant Dermoscopic Patterns Observed among Nevi
Authors: Scope Alon , Burroni Marco , Agero Anna Liza Chan , Benvenuto-Andrade Cristiane , Dusza Stephen W. , Rubegni Pietro , Bono Riccardo , Dell'Eva Giordana , Salaro Cristina , Marghoob Ashfaq A.
Published: March 2015

Background:

It has been clinically observed that patients' “normal” moles resemble each other. Whether this concept is applicable to dermoscopic practice has not been sufficiently studied.

Objective:

To investigate whether physicians evaluating dermoscopic images would identify common dermoscopic profiles of nevi within individual patients.

Methods:

Images of 205 nevi belonging to 18 patients were evaluated by 2 dermatologists for dermoscopic global pattern, color, and specific structures. We defined dermoscopic patterns as dominant if seen in ≥ 40% of the patient's nevi; a minor pattern was defined as 20 to 39%.

Results:

A dominant pattern was seen in 15 patients (83%). In 13 (72%) of the patients, ≥ 80% of the nevi were classified into one, two, or three global patterns. The reticular global pattern was the most prevalent dominant pattern, seen in 9 patients (50%); the homogeneous pattern was the most prevalent minor pattern, seen in 16 patients (89%).

Conclusion:

Individuals tend to have one to three predominant dermoscopic nevus global patterns.
XP-828L in the Treatment of Mild to Moderate Psoriasis: Randomized, Double-Blind, Placebo-Controlled Study
Authors: Poulin Yves , Bissonnette Robert , Juneau Christina , Cantin Kim , Drouin Rejean , Poubelle Patrice E.
Published: March 2015

Background:

XP-828L, a protein extract obtained from sweet whey, has demonstrated potential benefit for the treatment of mild to moderate psoriasis in an open-label study.

Objective:

To study in a randomized, double-blind, placebo-controlled study the safety and efficacy of XP-828L in the treatment of mild to moderate psoriasis.

Design:

XP-828L 5 g/d (group A, n = 42) or placebo (group B, n = 42) was given orally for 56 days followed by XP-828L 5 g/d in group A and by XP-828L 10 g/d in group B for an additional 56 days.

Results:

Patients receiving XP-828L 5 g/d for 56 days had an improved Physician's Global Assessment (PGA) score compared with patients under placebo ( p < .05). Considering the data of group A only, the PGA score improved from day 1 to day 56 ( p < .01); the Psoriasis Area and Severity Index score improved as well, but to a lesser extent ( p < .05).

Conclusion:

Oral administration of 5 g/d XP-828L compared with a placebo significantly improved the PGA score of patients with mild to moderate psoriasis.
Treatment of Mycosis Fungoides: Overview
Authors: Freiman Anatoli , Sasseville Denis
Published: March 2015

Background:

Mycosis fungoides (MF) is the most common clinicopathologic subtype of primary cutaneous T-cell lymphoma.

Objective:

The therapy of MF is highlighted in this overview.

Results and Conclusions:

Skin-directed MF therapies include topical corticosteroids, nitrogen mustard, carmustine (BCNU), topical bexarotene gel, imiquimod cream, radiotherapy, total skin electron beam therapy, and phototherapy. Systemic therapies include extracorporeal photopheresis, interferon, oral bexarotene, denileukin diftitox, monoclonal antibodies and cytokine therapy, and other systemic chemotherapy. Finally, some investigative therapeutic modalities are presented.
Are Narrow-Band Ultraviolet B Home Units a Viable Option for Continuous or Maintenance Therapy of Photoresponsive Diseases?
Authors: Haykal Kay-Anne , DesGroseilliers Jean-Pierre
Published: March 2015

Background:

Phototherapy is an effective treatment for several photoresponsive diseases. Many patients are unable to attend hospital-based treatment and prefer home phototherapy.

Objectives:

The purpose of this study is to survey patients who were prescribed home phototherapy to determine the viability of narrow-band ultraviolet B home units in the continuous or maintenance treatment of photoresponsive diseases.

Methods:

A patient questionnaire was prepared focusing on different areas of interest: the reason for choosing home therapy, appropriate teaching, previous medical treatment, present exposure therapy, improvement of the condition, side effects, regular dermatologic follow-ups, and the effectiveness of this approach. Twenty-seven patients who attended the photodermatology clinics at the Sisters of Charity of Ottawa Health Service at the Elisabeth Bruyère Health Centre in Ottawa and the Ottawa Hospital Civic Campus were contacted, and they completed a questionnaire by telephone or electronic mail.

Results:

Twenty-five patients completed the questionnaire. One refused to participate, and one was out of the country. The main reasons for choosing home phototherapy were time (40%), travel expenses (25%), difficulty with work schedule (17%), and recommendation by a physician (6%). Other reasons included loss of earnings, personal stress, knowledge that the disease recurs when phototherapy is discontinued, moving from the city, personal stress, and the convenience of being at home. Regarding the effectiveness of the home phototherapy, 24 patients (96%) viewed the home unit approach to be effective. All patients agreed that they would continue the treatment; they would repeat it, and they would recommend it. Few patients reported side effects, such as erythema (36%), blisters (1%), pruritus (8%), and dryness (1%). Fourteen patients (56%) reported not experiencing any side effects.

Conclusion:

Narrow-band ultraviolet B home phototherapy was found to be an effective form of maintenance therapy for photoresponsive diseases. It is safe and presents few side effects when patients receive appropriate guidelines, teaching, and follow-ups.
Review of Treatment for Onychomycosis: Consideration for Special Populations
Authors: Barber Kirk , Claveau Joël , Thomas Richard
Published: March 2015

This article provides a brief discussion of onychomycosis treatment in special populations such as children, the elderly, and patients with diabetes, human immunodeficiency virus (HIV), or Down syndrome. These subjects are generally not included in clinical trials, and few data on antifungal therapy are available in the literature. Issues with onychomycosis infection and treatment affecting each group are discussed, and where treatment reports exist, efficacy and safety data are presented. The discussion is restricted to agents approved for use in onychomycosis in Canada: oral terbinafine, oral itraconazole, and ciclopirox 8% nail lacquer. Although sparse, the literature demonstrates that onychomycosis therapies can be used safely and effectively in these special populations, although it is likely that the appropriateness of such treatment would have to be assessed on a case-by-case basis. Typically, oral medications are used reluctantly in these groups as the potential for adverse liver or kidney effects and medication interactions may be significant. Ciclopirox nail lacquer has recently become available for use and may offer an alternative to oral therapy in the future for mild to moderate cases of onychomycosis; however, the efficacy in these patients has not typically been reported. It remains to be seen what impact this medication will have for special populations. More knowledge of treatment in special populations must be accumulated in the literature before more formal treatment guidelines may be formulated.
Brief Treatment Guide for Onychomycosis
Authors: Poulin Yves , Thomas Richard , Gupta Aditya K.
Published: March 2015

Most onychomycosis infections result from dermatophyte organisms and present as distal lateral subungual onychomycosis (DLSO). Mild to moderate infections may be effectively treated with topical lacquer medications; however, there is no general consensus on what constitutes mild infection. In general, mild infections involve relatively small areas of the nail plate without infection of the nail matrix or lunula. Characteristics such as nail thickness, the number of nails affected, and the degree of onycholysis will also be taken into account in the categorization of nail severity and may increase the severity to moderate or severe even where nail plate area involvement is low. Similarly, although an infection may be mild, for patients with underlying health issues such as diabetes or immunodeficiency, oral therapy may be recommended as it typically provides the higher treatment efficacy required by these conditions. Severe infections may be treated with oral antifungal agents or combinations of oral agents and oral antifungals or oral and topical lacquer antifungals. Débridement is a technique that may be used in nearly any degree of infection to aid treatment efficacy by reducing the burden of fungal infection. Other treatment issues discussed include superficial white onychomycosis, nondermatophyte mold infection, and infection prophylaxis. Treatment is discussed considering a dermatophyte infection of DLSO presentation, unless otherwise stated. Infections should be confirmed by laboratory culture to eliminate any other diagnosis. Therapy recommendations concentrate on those agents approved in Canada for onychomycosis: oral terbinafine, oral itraconazole, and ciclopirox 8% nail lacquer.
Pharmacoeconomic Assessment of Ciclopirox Topical Solution, 8%, Oral Terbinafine, and Oral Itraconazole for Onychomycosis
Authors: Gupta Aditya K. , Lynde Charles W. , Barber Kirk
Published: March 2015

Most pharmacoeconomic data available for antifungal agents are based on US or European cost parameters. Similar data have not been reported in a Canadian health care system. A pharmacoeconomic analysis was performed considering the costs of drug acquisition and medical management, which were representative of the Canadian health care system, for each of the therapies approved for use in toenail onychomycosis in Canada: continuous oral terbinafine, oral pulse itraconazole, and topical ciclopirox 8% nail lacquer. A survey of provincial fee schedules was conducted to determine the representative costs of parameters relating to onychomycosis treatment, such as consultation visit cost, return visit cost, mycology testing, liver function testing, and complete blood count analysis. Manufacturers' costs were used to calculate representative drug acquisition costs. Meta-analysis was used to determine the average mycologic cure rates of each therapy, and the medical literature was consulted to determine the relapse rates for each therapy. Ciclopirox nail lacquer had the lowest drug acquisition costs compared with continuous terbinafine and pulse itraconazole ($197.89 vs $311.39 and $323.40, respectively). Using the pharmacoeconomic model with three 1-year treatment phases, in which failures or relapses were re-treated with the primary drug, the expected cost per patient was $601.52 with ciclopirox nail lacquer, $746.72 with oral terbinafine, and $938.42 with itraconazole. The main analysis assumed that two bottles of ciclopirox nail lacquer were required per treatment. The cost for the ciclopirox lacquer exceeded continuous terbinafine but remained lower than pulse itraconazole when three bottles of ciclopirox nail lacquer were considered in the calculation of cost per mycological cure. A variety of relapse rates were tested, and ciclopirox using two or fewer bottles remained cost-effective compared with continuous terbinafine or pulse itraconazole, regardless of the relapse rate. Where three bottles are required, the cost-effectiveness of ciclopirox nail lacquer is less than that of continuous terbinafine but more cost-effective than that of pulse itraconazole.
Biologic Therapeutics in the Treatment of Psoriasis. Part 1: Review
Authors: Langley Richard G. , Gupta Aditya K. , Cherman Andrea M. , Inniss Kimberley A.
Published: March 2015

Background:

Psoriasis is a chronic inflammatory skin disease principally mediated by activated T cells, which release proinflammatory cytokines with reactive epidermal changes in the skin, producing the characteristic lesions of psoriasis. New research into possible treatment options has been inspired by increased understanding of the pathophysiology of psoriasis and advances in immunology and molecular biology permitting the development of targeted, highly active biologic agents.

Objective:

The aim of this article is to review the efficacy and safety of five biologic therapeutics in the treatment of moderate to severe psoriasis and to provide practical guidelines for integration of these agents in the management of psoriasis.

Methods:

We searched MEDLINE (1966–2005) for articles containing the key words: alefacept, efalizumab, etanercept, infliximab, and adalimumab and searched recent conference abstracts.

Results:

Emerging immunotherapeutic agents (fusion proteins, recombinant cytokines, fusion toxins, or antibodies) target T cells or cytokines responsible for plaque formation that is characteristic of psoriasis. Alefacept is the first biologic to be approved in both the United States and Canada. More recently, efalizumab and etanercept and infliximab have been approved in the United States and Canada for plaque-type psoriasis. Adalimumab is currently in phase III clinical trials.

Conclusion:

These novel biologics offer an intriguing and effective treatment option for patients with moderate to severe psoriasis.
Cutaneous Sarcoidosis Successfully Treated with Alefacept
Authors: Garcia-Zuazaga Jorge , Korman Neil J.
Published: March 2015

Background:

Sarcoidosis is a systemic granulomatous disease of unknown etiology that affects multiple organ systems, including the pulmonary, lymphatic, skeletal, and integumentary systems. Improved understanding of the intrinsic immunology and molecular biology in sarcoidosis can be applied to the treatment of this disease. Alefacept is a human fusion protein consisting of the extracellular domain of leukocyte function-associated antigen 3 fused with the Fc portion of human immunoglobulin G1. It works by blocking the interaction between antigen-presenting cells and T cells to inhibit activation and by inducing apoptosis of CD4+ T cells. In this case report, we describe a 46-year-old patient with recalcitrant lupus pernio who was successfully treated with alefacept.

Objective:

To determine whether T-cell inhibition, specifically the use of alefacept, may be used to treat a patient with recalcitrant cutaneous sarcoidosis.

Methods:

Case report.

Results:

There was a modest clinical improvement after 8 weeks of intramuscular injections of alefacept.

Conclusion:

This case report provides further evidence of successful treatment of sarcoidosis with biologic agents directed against T-lymphocyte activation.
Lack of Significant Skeletal Changes after Long-Term, Low-Dose Retinoid Therapy: Case Report and Review of the Literature
Authors: Halverstam Caroline P. , Zeichner Joshua , Lebwohl Mark
Published: March 2015

Background:

Long-term systemic retinoid therapy has been associated with skeletal side effects. There have been reports of diffuse idiopathic skeletal hyperostosis (DISH) syndrome, calcification of ligaments, and osteoporosis, as well as premature fusion of epiphyses and modeling abnormalities of long bones, occurring in patients on chronic high-dose isotretinoin, etretinate, and acitretin therapy. Low-dose acitretin has been used for many years as monotherapy or in combination with other systemic therapies for psoriasis. Evidence to date suggests that the frequency of symptomatic bony effects is quite low in these patients.

Objective:

To present the radiologic findings of a patient on long-term, low-dose acitretin and etretinate and to review the literature on the radiologic evidence of skeletal side effects during retinoid therapy.

Methods:

Case report and literature search.

Results:

A patient on low-dose acitretin had no significant radiologic abnormalities associated with retinoid use after 9 years of treatment. A review of the literature revealed conflicting reports on the incidence of radiologic abnormalities in patients on retinoid treatment.

Conclusion:

The evidence to date does not substantiate a clear link between radiologic skeletal abnormalities and long-term, low-dose acitretin or etretinate therapy.
Cutaneous Rosai-Dorfman Disease: Comprehensive Review of Cases Reported in the Medical Literature since 1990 and Presentation of an Illustrative Case
Authors: Frater John L. , Maddox Jessica S. , Obadiah Joseph M. , Hurley M. Yadira
Published: March 2015

Background:

The latest comprehensive review of primary cutaneous Rosai-Dorfman disease was published as part of an exhaustive survey of sinus histiocytosis with massive lymphadenopathy in 1990. Since then, much progress has been made in the understanding of malignant lymphoma and benign disorders of lymphoid and histiocytic origin.

Objective:

We reviewed cases of primary cutaneous Rosai-Dorfman disease published since 1990 and discuss their clinical and pathologic features, comparing them with cases of systemic Rosai-Dorfman disease.

Methods:

We conducted a search of the National Library of Medicine PubMed database for cases of cutaneous Rosai-Dorfman disease reported in the English-language medical literature since February 1990.

Results:

We identified 72 patients with cutaneous Rosai-Dorfman (female to male ratio 1:0.5). The gross appearance and number or distribution of lesions were highly variable. Abnormal laboratory data included peripheral blood cytopenias (10 patients) and increased gammaglobulin fraction (10 patients). The response to treatment was variable.

Conclusion:

Purely cutaneous disease without the characteristic lymphadenopathy is rare but has been increasingly reported in the literature. Compared with patients with systemic Rosai-Dorfman disease, patients with primary cutaneous Rosai-Dorfman disease are older, women are more commonly affected, and whites are more likely than blacks to be afflicted.
Efficacy of Etanercept in the Management of Plaque Psoriasis and Psoriatic Arthritis
Authors: Poulin Yves , Gupta Aditya K. , Amiss John D.
Published: March 2015

Etanercept is a fully human dimeric fusion protein that reversibly binds tumor necrosis factor α. The first approved indication for etanercept was for the treatment of rheumatoid arthritis. It has also been shown to be highly efficacious in numerous large-scale trials for the treatment of plaque psoriasis; this indication was approved in Canada, the United States, and Europe. The recommended dosing of etanercept for plaque psoriasis is 50 mg twice weekly for 12 weeks, followed by a maintenance dose of 50 mg per week. Etanercept given at 50 mg twice weekly for 12 weeks significantly improved plaque psoriasis, as assessed by the Psoriasis Area and Severity Index (PASI), in which 75% reduction in PASI scores (PASI 75) has been the gold standard for judging effective therapy. Dosing given for 12 weeks produced PASI 75 rates of 47 to 49% in the phase 3 clinical trials. Longer treatment periods at this dosage have been investigated, from 24 to 48 weeks, with PASI 75 increasing to 63%. The importance of quality of life for psoriasis patients has been the focus of recent trials, and etanercept has been shown significant improvement in quality of life measures. Interim results from a phase 3b study suggest that etanercept may help reduce the burden of health care resources use by psoriatics. Etanercept has also shown efficacy in nail psoriasis. Case reports indicate that etanercept may be useful in psoriatic erythroderma, pustular psoriasis, guttate psoriasis, and palmopustular psoriasis. Etanercept is an effective biologic agent currently approved for the management of plaque psoriasis and psoriatic arthritis.
Challenges and Solutions in Selecting Systemic Antipsoriatic Agents
Authors: Tan Jerry K.L.
Published: March 2015

More than nine treatment options are available in Canada for moderate to severe psoriasis vulgaris. The process of deciding on optimal systemic antipsoriatic therapy for individual patients is dependent on multiple factors, including medical contraindications, the risks and benefits of treatment, and patient values and preferences. This article addresses current challenges faced by both dermatologists and their patients in the process of selecting systemic antipsoriatic therapy. Informed shared decision making is a useful relational model to describe the interaction between dermatologists and psoriasis patients in the selection of best systemic antipsoriatic treatment. There are no systematic reviews inclusive of the spectrum of treatment options for moderate to severe psoriasis, including biologics. Current guidelines of care are of varying quality and provide disparate and conflicting recommendations. Shortcomings in facilitating informed choice include inadequate training, skills, and resources. There is an urgent need for a high-quality systematic review of systemic antipsoriatic agents that includes the biologics. The evidence from such a document can form the basis for rational clinical guidelines and policy and can provide the foundation for educational and counseling tools. Furthermore, to facilitate dialogue and values-based informed choice, the use of decision aids for patients may be useful in selection of the most appropriate therapy.
Socioeconomic Status and The Prevalence of Melanoma in Ontario, Canada
Authors: Haider Aamir , Mamdani Muhammad , Shear Neil H.
Published: March 2015

Objective:

To determine if an association exists between the prevalence of melanoma and socioeconomic status based on income gradients in a large population of over 12 million people in Ontario, Canada.

Methods:

A population-based cross-sectional study using administrative health care databases was conducted. Individuals were divided into five income quintiles based on median neighborhood household income. A Mantel-Haenszel extension test was used to assess whether there was a gradient in the prevalence of melanoma across income groups. Multivariate logistic regression was used to determine if median neighborhood income predicted the prevalence of a melanoma, independent of gender, age, and urban-rural residence status.

Results:

The study cohort consisted of 14,623 patients with melanoma. Between the lowest income group of $37,637 and the highest income group of $84,162, the prevalence of melanoma increased by 225%. Our study also identified an association between melanoma prevalence and rural residence. The overall prevalence rate was 30% ( p < .01) higher in rural areas compared with urban areas.

Conclusion:

A higher socioeconomic status and rural versus urban residence status appear to be significant risk factors for the development of melanoma in Ontario.
Surgical Treatment of Facial Cutis Verticis Gyrata with Direct Excision
Authors: Beier Justus P. , Kneser Ulrich , Horch Raymund E.
Published: March 2015

Background:

Cutis verticis gyrata (CVG) is a rare deformity of the skin presenting with thick gyrated folds and ridges, involving predominantly parts of the head and the face.

Objective:

We report on aspects of the surgical treatment of facial CVG based on our experiences with four patients, who had developed a progressive and enormous thickening and an extraordinary strong gyration of the facial skin.

Methods:

A single or staged repeated straightforward surgical treatment with direct excision of abundant and thickened gyriform folds, in one case accomplished by an upper face-lift, was performed.

Results:

Direct excision within the lines of tension resulted in a major reduction of the facial skin distortion, a reduced scalp, and facial skin thickening and avoided maceration in all four patients. The quality of life was considerably improved in all patients.

Conclusion:

Direct excision of gyriform skin is a successful surgical approach to the rare skin deformity of CVG.
Perifolliculitis Capitis Abscedens et Suffodiens in an 18-Year-Old Aboriginal Canadian Patient: Case Report and Review of the Literature
Authors: Varshney Nishi , Al Hammadi Anwar , Sam Hakeem , Watters A. Kevin
Published: March 2015

Background:

Perifolliculitis capitis abscedens et suffodiens (PCAS) is a suppurative process that involves the scalp, eventually resulting in extensive scarring and irreversible alopecia. This condition often presents in males of African American origin.

Objective:

This article describes the clinical presentation, diagnosis, and treatment of an Aboriginal Canadian male suffering from PCAS. A literature review on the etiology, pathology, differential diagnosis, and management is also discussed.

Conclusion:

Careful analysis of the pathology and clinical presentation can aid in the timely diagnosis and management of this challenging condition. The clinician dealing with patients suffering from PCAS has several treatment options available to help successfully manage patients with straightforward or recalcitrant disease.
Weight of Decision-Making Impairs Clinical Assessment of Melanocytic Lesions
Authors: Gächter Tamara , Mühleisen Beda , Schärer Leo , Dummer Reinhard , Burg Günter , Hofbauer Günther F.L.
Published: March 2015

Background and Objective:

We studied the weight of decision-making on clinical assessment of melanocytic lesions judging benign, atypical, and malignant lesions; common mistakes; and total removal rates, comparing dermatologists with nondermatologists.

Methods:

Of 11,246 histopathology specimens, 3,768 had a clinical assessment of melanocytic lesions. Histopathologic diagnosis served as the gold standard.

Results:

Benign nevi were assessed most accurately (77%). Dermatologists assessed benign nevi better (p < .0001). The accuracy of clinical assessment in atypical nevi and melanoma was lower (23% and 42%, respectively). Seborrheic keratosis was the most common mistaken diagnosis. Complete removal of clinically benign nevi, atypical nevi, and melanoma was 84%, 90%, and 89%. Decision-making impaired clinical assessement of melanocytic lesions by 5% for dermatologists and 9% for nondermatologists.

Conclusion:

The accuracy of clinical assessment of melanocytic lesions is high for benign nevi, with dermatologists outperforming nondermatologists. Clinicians overestimated malignant potential. Complete removal was more frequent in suspicious lesions. Clinical decision-making impaired assessment by 5 to 9%.
Jean Darier and His Précis
Authors: Jackson Robert
Published: March 2015

Background:

Many dermatologists know the name Jean Darier. Few are familiar with his accomplishments. The contemporary dermatology scene, with its emphasis on surgery and laser, is in danger of forgetting its roots in living gross pathology.

Objective:

To describe in summary form Darier's excellent dermatology text, Precis de Dermatologie, with particular emphasis on its organization and morphologic approach to skin disease.

Conclusion:

Knowledge in some areas of dermatology has increased manyfold since Darier's Précis was first published. This does not apply to current clinical descriptions of disease found in many current texts and journal articles. A study of Darier's Précis would be an excellent start to reinvigorate morphologic knowledge in dermatology.
Treatment of Focal Hyperhidrosis
Authors: Murray Christian A. , Cohen Joel L. , Solish Nowell
Published: March 2015

Background:

Focal hyperhidrosis is not rare, affecting over 2.5% of the population. This condition is often socially and professionally debilitating, leading to significant quality of life impairment. It most commonly involves the axillae, palms, soles, and face.

Objective:

To review hyperhidrosis and discuss and compare the treatment options currently available.

Conclusions:

Topical or systemic therapies may be helpful for patients with mild disease. Invasive surgical options, although often effective, are limited by complications. More recently, botulinum toxin injection has proven to be a safe and successful treatment for hyperhidrosis and results in high patient satisfaction. Botulinum toxin A (Botox, Allergan Inc., Irvine, CA) is currently approved in the United States, Canada, the United Kingdom, and many other countries for the treatment of axillary hyperhidrosis and is routinely used off-label for other anatomic sites.