bluuebunny/crossref_metadata_2025 huggingface dataset:
Central Centrifugal Cicatricial Alopecia: Retrospective Chart Review
Authors: Shah Sejal K. , Alexis Andrew F.
Published: March 2015

Background:

Few studies have investigated central centrifugal cicatricial alopecia (CCCA). Thus, our understanding of CCCA is largely based on anecdotal evidence.

Objective:

The purpose of this study was to investigate clinical characteristics and hair care practices in CCCA patients.

Methods:

We conducted a single-center retrospective chart review of patients with a clinicopathologic diagnosis of CCCA.

Results:

Medical records of 69 patients were reviewed. Of these, 97% were female. The mean ages at onset and presentation were 38.2 and 42.4 years, respectively. All subjects for whom hair care data were available had used a traumatic practice at least once, the most common being chemical relaxer. Family history data were available for 27 subjects (39%). Of these, 56% had a positive family history of hair loss. Seborrheic dermatitis was the leading concurrent diagnosis.

Limitations:

Limitations include lack of a control group, retrospective design, and selection bias.

Conclusions:

Our results confirm that CCCA primarily affects adult women of African descent. The majority of patients presented several years after onset, suggesting that efforts to encourage earlier diagnosis are warranted. Although the role of hair care remains unclear, traumatic practices were reported in all patients in our study for whom hair care was documented.
Permanent Poliosis following Repetitive Plucking in an Adolescent
Authors: Tan Cheng , Zhu Wen-Yuan
Published: March 2015

Background and Objective:

Poliosis is an inherited or acquired loss of pigment from a group of closely positioned hair follicles characterized by a patch of white hair. It is commonly seen in vitiligo, piebaldism, Waardenburg syndrome, Vogt-Koyanagi-Harada syndrome, Griscelli syndrome, and Apert syndrome. We investigated a male manifesting poliosis on the chin after repetitive plucking.

Conclusion:

To our knowledge, poliosis induced by repeated plucking has never been documented.
Tenascin-C Expression in Papulosquamous Disorders Other than Psoriasis in Pediatric Patients: An Epiphenomenon?
Authors: Afsar F. Sule , Aktas Safiye , Diniz Gulden
Published: March 2015

Background:

Tenascin-C is a large extracellular matrix protein that is expressed in the basal membrane zone during embryonic development, tissue repair, and oncogenesis. In vitro studies suggest that proliferating epithelium induces the production of tenascin-C by mesenchymal cells.

Objective:

Our goal was to compare the expression of tenascin-C in psoriasis with other papulosquamous disorders of the skin in pediatric patients.

Methods:

The study was conducted on skin biopsy samples of 37 patients with psoriasis or other papulosquamous disorders. Of the 37 skin biopsy samples, 17 (45.9%) were diagnosed as psoriasis and 20 (54.1%) were diagnosed as other papulosquamous disorders histopathologically, and the expression of tenascin-C was evaluated immunohistochemically.

Results:

Tenascin-C expression was seen in the dermis of lesional tissues or epidermal keratinocytes in 1 (5.8%) of the 17 biopsy samples diagnosed as psoriasis and 15 (75.0%) of the 20 biopsy samples diagnosed as other papulosquamous disorders ( p = .001).

Conclusion:

Tenascin-C expression was not found to be a staining characteristic of psoriasis lesions. But the significant staining intensity of the tenascin-C expression in other papulosquamous disorders suggests that tenascin-C expression might be an epiphenomenon in the papulosquamous disorders other than psoriasis immunohistochemically.

Antécédents:

La ténascine-C est une grande protéine de la matrice extracellulaire qui est exprimée dans la membrane basale durant le développement embryonnaire, le processus de réparation des tissus, et l'oncogenèse. Les études in vitro suggèrent que la prolifération épithéliale cause la production de la ténascine-C par les cellules mésenchymateuses.
Successful Treatment of Atrophic Scars from Cutaneous Leishmaniasis Using a Fractional Laser
Authors: AlGhamdi Khalid M.
Published: March 2015

Background:

Cutaneous leishmaniasis can lead to unsightly atrophic scars, which have limited treatment options. There is a scarcity of literature on its treatment modalities. Fractional lasers have been successfully used in treating a variety of skin conditions with minimal downtime and side effects.

Methods:

We report a successful treatment of a 25-year-old female patient with an atrophic scar from cutaneous leishmaniasis on the nose with a fractional laser (Fraxel Re:store SR 1500). Ten treatment sessions were performed at a pulse energy of 45 to 70 mJ. The treatment response was assessed by comparing pre- and posttreatment clinical photographs.

Results:

After three sessions, the patient observed 40% improvement. More than 90% improvement was noticed after the tenth session. No significant adverse effects were noted. The improvement was persistent at the 3-month follow-up.

Conclusion:

The excellent improvement in this patient should encourage further studies to achieve more efficacy and optimize the treatment parameters.
Practical Techniques to Enhance the Safety of Health Care Workers in Office-Based Surgery
Authors: AlGhamdi Khalid M. , AlKhodair Rayan A.
Published: March 2015

Background:

Office-based surgery is commonly practiced in different specialties for a variety of procedures. During these procedures, the health care worker (HCW) is exposed to a large number of pathogens that can be bloodborne, including the hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). These pathogens can be transmitted through needlesticks or sharp injuries to intact skin or by backsplash of contaminated body fluids onto mucous membranes or injured skin.

Objectives and Conclusions:

This article reviews the published techniques designed to protect the HCW from such hazards. These techniques are classified into preoperative, intraoperative, and postoperative. Preoperative measures include general protective measures, organization of the surgical field, and consideration of alternative treatments in high-risk patients. Intraoperative techniques deal with safe handling and transferring of sharp instruments, working without using sharps, and protection from backspray injuries. Postoperative measures address proper disposal of used sharps.
HIV Dermatology in Canada: Cutaneous Disease Burden and Demographic Characteristics of a Specialized Urban Practice
Authors: Shapero Jonathan L. , Leslie Jasmine , de Gannes Gillian C.
Published: March 2015

Background:

The introduction of antiretroviral therapies has changed the pattern of cutaneous disease in individuals infected with human immunodeficiency virus (HIV).

Objective:

To assess demographic characteristics, severity of immunosuppression, and frequency of dermatologic disorders in patients presenting to a Canadian specialized HIV dermatology practice.

Methods:

A cross-sectional study was performed of 183 consecutive outpatient and inpatient consultations to a single HIV dermatology practice from January 2007 to December 2008.

Results:

One hundred sixty-three (88%) patients were male, with an average age of 45. Forty-six patients were not on antiretroviral therapy. Verruca was the most common diagnosis, seen in 29 patients, followed by dermatophyte infection, seen in 27. Patients with a low CD4 count ( p = .0001) and a high viral load ( p = .0043) were more likely to present with an HIV-specific dermatosis.

Conclusion:

Cutaneous infections were the most common diagnoses in this cross section. Classic HIV dermatoses were seen more frequently in those with more advanced disease owing to HIV infection.
Compliance with Self-Examination Surveillance in Patients with Melanoma and Atypical Moles: An Anonymous Questionnaire Study
Authors: Hull Peter R. , Piemontesi Nicholas G. , Lichtenwald Jessica
Published: March 2015

Background:

Regular skin self-examination is suggested as a means to detect melanomas at an early stage and thus improve prognosis. Compliance, however, has seldom been assessed in a routine clinical setting and anonymously.

Objectives:

To assess compliance with self-examination in patients with either a previous melanoma or atypical moles (dysplastic nevi) and to examine the perceived utility of supplied photographs.

Methods:

An anonymous questionnaire was sent to all patients seen with either a melanoma or atypical moles between the years 1995 and 2005. The melanoma cohort consisted of 143 patients. There were 440 patients with atypical moles.

Results:

Replies to the questionnaire were received from 94 of the melanoma patients and from 185 patients in the atypical mole cohort. Only 22% (12) in the melanoma group performed a total skin examination monthly. Fewer than 10% of those with atypical moles did a monthly skin examination, but about half of the patients examined their entire skin more than once a year.

Conclusion:

Self-examination is practiced in the majority of patients with either a previous melanoma or atypical moles. Those doing this on a regular monthly basis are a small minority.
Collagen Triple Helix Repeat Containing 1 Promotes Melanoma Cell Adhesion and Survival
Authors: Ip Wency , Wellman-Labadie Olivier , Tang Liren , Su Mingwan , Yu Richard , Dutz Jan , Wang Yuzhuo , Huang Shengquan , Zhang Xuejun , Huang Changzheng , Zhou Youwen
Published: March 2015

Background:

The extracellular protein collagen triple helix repeat containing 1 (CTHRC1) is aberrantly upregulated in melanoma and most human solid cancers. However, its role in cancer remains unknown.

Objective:

In this study, we investigated the functional impact of CTHRC1 on melanoma cells in vitro.

Methods:

Stable clones of cultured melanoma cells expressing different amounts of CTHRC1 protein were generated and evaluated to characterize their growth, survival, and attachment ability as well as their sensitivity to chemotherapy.

Results:

In cultured MMAN and MMRU melanoma cells, increased expression of CTHRC1 protein resulted in morphologic cell changes, enhanced cell adhesion to culture surfaces, increased cell proliferation, and decreased apoptosis. Furthermore, decreased CTHRC1 expression through antisense inhibition enhanced temozolomide sensitivity.

Conclusion:

CTHRC1 expression influences cellular processes, including cell adhesion and survival. Additionally, CTHRC1 inhibition may represent a potential method for decreasing melanoma resistance to conventional chemotherapy.
Treatment of Acral Persistent Papular Mucinosis with Electrocoagulation
Authors: Jorge Flávia André , Cortez Tatiana Mimura , Mendes Fabiana Guadalini , Marques Mariângela Esther Alencar , Miot Hélio Amante
Published: March 2015

Background:

Acral persistent papular mucinosis is a rare localized form of lichen myxedematosus with few case reports and no documented therapeutic options.

Objective:

To report full resolution of acral persistent papular mucinosis after electrocoagulation.

Methods:

Case report of a 51-year-old white female diagnosed with an acral persistent papular mucinosis. The clinical and histopathologic features, treatment provided, and response to treatment are detailed.

Results:

Acral persistent papular mucinosis presented as multiple asymptomatic normochromic papules on the wrists. Treatment with topical and intralesional steroids was unsatisfactory. Gentle electrocoagulation led to complete resolution of the lesions and negligible scarring. The favorable results remained for 6 months of follow-up, and no new lesions have emerged.

Conclusion:

Our case of acral persistent papular mucinosis was successfully treated with electrocoagulation and long-lasting, excellent cosmetic results.
Degos Disease with Dermatomyositis-like Phenomenon: A Diagnostic Dilemma and a Therapeutic Challenge
Authors: Gupta Suruchi , Dogra Sunil , Saikia Uma Nahar , Yadav Savita , Kanwar Amrinder J.
Published: March 2015

Background:

Degos disease is a type of vasculopathy characterized by progressive occlusion of small-sized blood vessels primarily involving the skin, gastrointestinal system, and central nervous system as well as various other systems. Owing to the rarity of the condition, the diagnosis is often a challenge; consequently, management is even more difficult owing to the paucity of experience and literature for the effective treatment of this entity.

Case Presentation:

We report a case of a 50-year-old male patient with classic skin lesions and rapidly progressive fatal clinical course involving multiple organs associated with dermatomyositis-like features. Therapeutic challenge in such a case of secondary Degos disease with multiorgan dysfunction is discussed.

Conclusion:

Secondary Degos disease with underlying multisystem dysfunction is a rapidly fatal disease. The patient must be thoroughly investigated to watch for systemic involvement and aggressively treated preferably with antiplatelet drugs and immunosuppresants so as to moderate the severity of the disease. Corticosteroids are best avoided to prevent gastrointestinal perforation.
A Rare Tumor of the Face: Malignant Nodular Hidradenoma with Dermoscopic Features Mimicking Amelanotic Melanoma
Authors: Bakar Özgür , Ince Umit
Published: March 2015

Background:

Sweat gland neoplasms are rare neoplasms with less known dermoscopic features.

Observations:

By applying dermoscopy, we identified some common vascular features that have been defined for amelanotic melanoma such as hairpin vessels, dotted vessels, linear irregular vessels, glomerular vessels, and milky-red areas.

Conclusion:

Polymorphic vascular structures can also be seen in eccrine neoplasms. Further evaluations should be done to differentiate and identify the common dermoscopic features of other sweat gland tumors.
Canadian Guidelines for the Management of Plaque Psoriasis: Overview
Authors: Papp Kim , Gulliver Wayne , Lynde Charles , Poulin Yves , Ashkenas John
Published: March 2015

New clinical treatment guidelines for plaque psoriasis, written by a panel of 16 Canadian dermatologists, were recently published online. These Canadian Guidelines for the Management of Plaque Psoriasis are evidence based and free of any influence from corporate sponsors and have been endorsed by the Canadian Dermatology Association (CDA). The Guidelines offer treatment recommendations for mild and moderate to severe body psoriasis, as well as for psoriasis affecting specific areas of the skin, such as the facial, flexural, and genital areas; nails; scalp; and palms and soles. The present overview describes the genesis and contents of the Guidelines, which are available in full through the CDA at (English) or (French).
Treatment of Mycosis Fungoides with Bexarotene Results in Remission of Diffuse Plane Xanthomas
Authors: Gregoriou Stamatis , Rigopoulos Dimitris , Stamou Christos , Nikolaou Vasiliki , Kontochristopoulos George
Published: March 2015

Background:

Cutaneous xanthomas develop as a result of intracellular and dermal deposition of lipids in either hyper- or normolipidemic patients. Plane xanthomas may signal the presence of an underlying monoclonal gammopathy, chronic myelomonocytic leukemia, or cutaneous T-cell lymphoma. Investigators have suggested that xanthomatized T cells may result in induction of plane xanthomas.

Methods:

We report the case of a patient with mycosis fungoides (MF) and plane xanthomas who was treated with bexarotene for his MF.

Results:

Significant improvement in the clinical signs of MF was observed within 3 months. We also observed a substantial regression of the xanthomas after 5 months of treatment. Complete clinical remission of both the MF and xanthomas was obtained after 6 months. The patient was still free of xanthomas after 3 years of follow-up.

Conclusion:

Bexarotene led to the clearing of the cutaneous lesions of cutaneous T-cell lymphoma and plane xanthomas. This may be due to an effect of bexarotene on the aberrant T cells that may cause xanthomatization.
Plasmapheresis and Steroid Treatment of Levamisole-Induced Vasculopathy and Associated Skin Necrosis in Crack/Cocaine Users
Authors: Pavenski Katerina , Vandenberghe Hilde , Jakubovic Henry , Adam David N. , Garvey Bernadette , Streutker Catherine J.
Published: March 2015

Background:

Levamisole was removed from the market due to complications of agranulocytosis and skin necrosis. Levamisole has been reported in a high proportion of seized cocaine in North America and has been associated with multiple cases of skin necrosis.

Objective:

We report three cases of levamisole/cocaine-induced skin necrosis who responded to treatment with plasmapheresis and immunosuppression.

Results:

Three patients presented with painful necrotic skin lesions on the ears, cheeks, breasts, and buttocks. The extremities were involved in two patients and the upper respiratory tract mucosa in one patient. All had markers of immune activation, with elevated C-reactive protein, antinuclear antibody, and perinuclear antineutrophil cytoplasmic antibody. Skin biopsy in all cases revealed a mixed pattern of thrombosis and vasculitis within dermal vessels, with overlying ischemic ulceration of skin and soft tissues. One patient required extensive debridement of the skin and soft tissue of the calves and also had respiratory involvement. All patients were treated with plasmapheresis and immunosuppression with rapid stabilization and/or improvement of the lesions.

Conclusion:

Levamisole is frequently added to crack/cocaine; we report three patients who developed vascular lesions and skin necrosis after using cocaine/levamisole. These improved with plasmapheresis and immunosuppression as well as abstention from the drugs; one patient with severe disease required debridement and skin grafting.
Treatment of Large Xanthelasma Palpebrarums with Full-Thickness Skin Grafts Obtained by Blepharoplasty
Authors: Kose Rustu
Published: March 2015

Purpose:

The treatment of large xanthelasma palpebrarum cases in patients whose lesions could not be closed primarily is reported. All lesions were repaired with full-thickness skin grafts obtained by blepharoplasty of the same upper eyelid. Patient satisfaction, complications, and recurrence rates were investigated.

Methods:

Sixteen patients were treated between 2007 and 2012. Bilateral upper eyelids were involved in all patients. Twenty-six large xanthelasma palpebrarum lesions were treated using this method. All lesions were located in the medial canthus of the upper eyelid.

Results:

The patients were followed up for 6 months to 5 years (mean 3 years). No patients developed complications or required revision surgery. All patients had normally positioned upper eyelids and were satisfied with the aesthetic outcome. Two patients had mild hyperpigmentation at the graft site.

Conclusions:

The results of this study suggest that large xanthelasma palpebrarum defects that are not primarily closed after excision should be repaired with full-thickness skin grafts harvested from the lateral aspect of the same upper eyelid. Moreover, good patient satisfaction can be achieved when blepharoplasty of the upper eyelid is performed concurrently in patients who are middle-aged or older.
Squamous Cell Carcinoma Developing after CO2 Laser Resurfacing
Authors: Nicoli Fabio , Balzani Alberto , Gentile Pietro , Lazzeri Davide , Di Pasquali Camilla , Nicoli Marzia , Bocchini Ilaria , Cervelli Valerio
Published: March 2015

Background:

Skin resurfacing with the carbon dioxide (CO2) laser is currently a popular means of improving rhytides and scars and has been reported useful in the treatment for photodamaged skin, including precancerous and benign skin lesions, as well as superficial benign pigmented lesions.

Methods:

We describe a 68-year-old man who developed rapid squamous cell carcinoma (SCC) on the resurfaced areas 3 weeks following CO2 laser resurfacing.

Results:

Rapid occurrence of SCC should be considered a rare complication, and we recommend carefully considering CO2 laser resurfacing after excision of an SCC and surveying any cancer recurrences.

Conclusions:

We report a rare complication of CO2 laser resurfacing. This report suggests that additional work in this area is warranted.
Sanitization of Contaminated Footwear from Onychomycosis Patients Using Ozone Gas: A Novel Adjunct Therapy for Treating Onychomycosis and Tinea Pedis?
Authors: Gupta Aditya K. , Brintnell William C.
Published: March 2015

Background:

Ozone gas possesses antimicrobial properties against bacteria, viruses, and yeasts. Previously, we demonstrated the efficacy of ozone in killing ATCC strains of the dermatophyte fungi Trichophyton rubrum and Trichophyton mentagrophytes.

Objective:

To test the efficacy of ozone gas in sanitizing onychomycosis patient footwear contaminated with fungal material as a means of minimizing the risk of reinfection.

Methods:

Swabs of footwear from onychomycosis patients were cultured prior to and after ozone exposure to test the ability of ozone to sanitize these items.

Results:

We identified contamination of footwear from most onychomycosis patients, a potential source of reinfection in these individuals. Furthermore, ozone gas was effective in sanitizing contaminated footwear.

Conclusion:

Ozone gas is effective in sanitizing footwear and represents a novel adjunct therapy to be used in conjunction with antifungal medications and/or devices to better treat onychomycosis and tinea pedis patients in both the short and the long term.
Friction-Induced Pagetoid Dyskeratosis
Authors: Al-Mohammedi Faisal , de Cannes Gillian C. , Crawford Richard I.
Published: March 2015

Background:

Pagetoid dyskeratosis (PD) is characterized by pale cells within the epidermis resembling those of Paget disease. These cells have been seen as an incidental finding in a variety of benign papules most commonly located in intertriginous areas. The lesion is considered a reactive process in which a small proportion of the normal population of keratinocytes is altered. Among the triggers for this lesion, friction has been suggested; however, a direct cause-and-effect relationship has not yet been reported.

Results:

We confirmed the relationship between PD and friction in a biopsy taken from a 19-year-old woman who presented with clinical features indicating exogenously induced bullae and erosions and consented to a biopsy of a lesion immediately after its induction, demonstrating combined features of PD and friction bulla.
Effect of Age at Onset on Disease Characteristics in Vitiligo
Authors: Kanwar Amrinder J. , Mahajan Rahul , Parsad Davinder
Published: March 2015

Background:

Vitiligo is a multifactorial disease in which genetic, immunologic, and environmental factors play an important part. Late-onset vitiligo is a poorly defined entity.

Materials and Methods:

Case records of patients who attended the pigmentary clinic at our institute from January 2001 to December 2010 were reviewed. Patients with a diagnosis of vitiligo were analyzed with respect to their demographic characteristics with special reference to their age at onset.

Results:

Patients with disease onset after 30 years had a significantly higher association with precipitating factors such as trauma, stress, and drugs in comparison with early-onset vitiligo ( p < .004). However, the difference did not reach statistical significance when these factors were analyzed individually. There was a significantly higher association with other nonautoimmune diseases ( p = .05), a higher incidence of positive family history ( p < .0001), and a higher association with leukotrichia ( p < .002) in late-onset disease. Early-onset nonsegmental vitiligo was associated with a higher incidence of photosensitivity and pruritus compared to early-onset segmental vitiligo.

Conclusion:

Late-onset vitiligo has certain distinguishing features compared to early-onset vitiligo.
Doxycycline-Induced Cutaneous Inflammation with Systemic Symptoms in a Patient with Acne Vulgaris
Authors: Weinstein Miriam , Laxer Ronald , Debosz Joanna , Somers Gino
Published: March 2015

Background:

Doxycycline is a commonly prescribed antibiotic for the treatment of acne vulgaris. Often preferred to other tetracyclines due to a safer and milder side-effect profile, doxycycline is more frequently prescribed as a treatment of this common condition.

Objective:

To present a case report of a young patient who developed skin eruptions over the extremities; myalgias; fatigue; swelling involving the face, hands, and feet; headache; and mood changes after 2 years of using doxycycline. She promptly developed similar symptoms after a rechallenge with doxycycline 1 year later.

Results/Conclusion:

This important finding will make practitioners more vigilant to the side effects of this medication despite its current safety profile and regardless of the time that a patient is using it.
Recurrences of Dermatophyte Toenail Onychomycosis during Long-Term Follow-up after Successful Treatments with Mono- and Combined Therapy of Terbinafine and Itraconazole
Authors: Gupta Aditya K. , Cooper Elizabeth A. , Paquet Maryse
Published: March 2015

Background:

The influence of dosing regimens on the recurrence rates of onychomycosis has not been investigated.

Objective:

To compare recurrence rates for toenail dermatophyte onychomycosis between four dosing regimens.

Methods:

A prospective, investigator-blinded, long-term follow-up (1.25 to 7 years postenrolment) study of the following regimens was undertaken with or without booster therapy at week 36: overlapping continuous itraconazole and terbinafine (COMBO), continuous terbinafine (CTERB), intermittent terbinafine (TOT), and pulsed itraconazole (III).

Results:

One hundred six mycologically and 43 completely cured participants at week 48 were included. Recurrence rates (RR) for mycologically and completely cured participants were respectively termed mycologic recurrence (MRR) and complete cure recurrence (CRR) rates. No statistically significant difference was detected between the four regimens for the two rates. However, lower MRRs were obtained for CTERB (32%) and TOT (36%) compared to III (59%) and COMBO (57%). When participants who received booster therapy were excluded from the analysis, the MRR was lower for CTERB (21%) compared to TOT (39%).

Conclusions:

Itraconazole therapy was associated with higher RRs than terbinafine therapy. Combined therapy did not reduce the RRs compared to monotherapies. A difference might exist between continuous and intermittent antifungal regimens, but additional randomized clinical trials are needed for confirmation.
Lymphangiosarcoma of the Scalp
Authors: Mamelak Adam J. , Collie Megan R.V. , Kroll Ryan , Hanson Miriam L. , Harris Howard M.
Published: March 2015

Background:

Lymphangiosarcoma is a rare, aggressive malignancy that originates from the endothelial cells lining lymphatic vessels and carries an extremely poor prognosis. Its clinical and histologic features are often indistinguishable from angiosarcoma.

Objective:

We sought to better characterize the clinical and histologic features of lymphangiosarcoma.

Methods:

Case report and review of the literature.

Results:

A number of immunohistochemical markers, including Von Willebrand factor, Ulex europaeus agglutinin 1, CD31, VEGFR-3, D2-40, Prox-1, can be used to help differentiate lymphatic from vascular tissue.

Conclusions:

Recent characterization of several new biologic markers has allowed greater differentiation between these tumors and may provide new therapeutic targets for treatment.
Bullous Pemphigoid Associated with Acquired Hemophilia A: A Rare Association of Autoimmune Disease
Authors: AlJasser Mohammed I. , Sladden Chris , Crawford Richard I. , Au Sheila
Published: March 2015

Background:

Acquired hemophilia (AH) is a rare autoimmune disease with an annual incidence of one per million and has a mortality rate of up to 22%. It is caused by the development of autoantibodies against factor VIII. Approximately half of the reported cases are associated with autoimmune disorders, pregnancy, malignancies, and adverse drug reactions. Autoimmune diseases are the most frequently associated disorders and include rheumatoid arthritis, systemic lupus erythematosus, cryoglobulinemia, pemphigus vulgaris, and bullous pemphigoid. There are a few reports of acquired hemophilia and bullous pemphigoid in the literature.

Method:

We report a 73-year-old male who presented with cutaneous blistering, upper gastrointestinal bleeding, and hemoptysis. He later developed right flank pain secondary to a retroperitoneal hematoma. He had a prolonged partial thromboplastin time, a low factor VIII level, and a high factor VIII inhibitor level, all consistent with acquired hemophilia. Skin biopsies were diagnostic for bullous pemphigoid.

Results:

He was treated successfully with prednisone, cyclophosphamide, rituximab, and intravenous immunoglobulin.
Unilateral Hand Allergic Contact Dermatitis due to Occupational Exposure
Authors: Mussani Farheen , DeKoven Joel G.
Published: March 2015

Background and Objective:

Hand dermatitis is the most common subtype of occupation-related skin disease. Regardless of its underlying cause, hand dermatitis results in significant impairment and a negative impact on quality of life. Any case of unilateral hand dermatitis should have a high index of suspicion for an allergic contact dermatitis.

Conclusion:

We report two cases of unilateral hand dermatitis. The first case is a 53-year-old female with a unilateral dermatitis of the left hand. The second case is a 53-year-old male with dermatitis of the right hand. Both cases highlight an interesting presentation of unilateral hand allergic contact dermatitis secondary to an occupational exposure.
Compliance with Tap Water Iontophoresis in Patients with Palmoplantar Hyperhidrosis
Authors: Özcan Deren , Güleç A. Tülin
Published: March 2015

Background:

Patients tend to be noncompliant with tap water iontophoresis (TWI), which is an effective treatment option for palmoplantar hyperhidrosis.

Objective:

To investigate compliance with TWI in patients with palmoplantar hyperhidrosis and identify the factors limiting its utility.

Methods:

The medical data of 22 patients treated with TWI for palmoplantar hyperhidrosis were collected. A telephone inquiry questioning overall satisfaction with the treatment and the reasons for discontinuation was conducted.

Results:

Sixteen patients completed the initial treatment period, and all responded well to the therapy. Eight patients started on the maintenance treatment, five of whom gave up before completing five sessions. The reasons for discontinuation were a lack of time in 12 patients, switching to home therapy in 3 patients, and side effects in 1 patient.

Conclusion:

Patients with palmoplantar hyperhidrosis are noncompliant with TWI, mainly due to a lack of time. They should be well informed before therapy and be encouraged to have a home device for maintenance.
Improved Decisional Conflict and Preparedness for Decision Making Using a Patient Decision Aid for Treatment Selection in Psoriasis: A Pilot Study
Authors: Tan Jerry , Wolfe Barat
Published: March 2015

Background:

We developed a patient decision aid (pDA) to assist psoriasis patients in treatment decisions.

Objective:

This pilot study evaluated the pDA in patient knowledge, decisional conflict, and preparation for decision making.

Methods:

Newly referred psoriasis patients in a private dermatology office completed self-administered surveys at three time points: before (visit 1) and on two occasions after provision of the pDA (visit 2 up to 2 weeks after visit 1; visit 3 up to 6 weeks after visit 1). The survey included questions regarding knowledge of psoriasis and its treatment and validated questionnaires on decisional conflict and preparation for decision making.

Results:

Ten psoriasis patients participated (seven men, three women; mean age 45.7 years), with a mean age of 11.4 years since diagnosis. Improvement by visit 3 was observed for knowledge ( p = .06), reduced decisional conflict ( p ≤ .001), and preparation for decision making ( p ≤ .05). Patients tended to self-select treatment appropriate to the level of psoriasis severity.

Conclusion:

This pilot study of the pDA showed improved patient knowledge of psoriasis and its treatments, reduced decisional conflict, and increased patient preparation for decision making.

Limitations:

This small study was not randomized and did not have a comparator arm.
Mosaic Generalized Neurofibromatosis 1: Report of Two Cases
Authors: Hardin Jori , Behm Allan , Haber Richard M.
Published: March 2015

Background:

We report two cases of mosaic generalized neurofibromatosis 1 (NF1) and review the history of the classification of segmental neurofibromatosis (SNF; Ricardi type NF-V). Somatic mutations giving rise to limited disease, such as segmental neurofibromatosis are manifestations of mosaicism. If the mutation occurs before tissue differentiation, the clinical phenotype will be generalized disease. Mutations that occur later in development give rise to disease that is confined to a single region.

Objectives:

Segmental neurofibromatosis is caused by a somatic mutation of neurofibromatosis type 1, and should not be regarded as a distinct entity from neurofibromatosis 1. Cases previously referred to as unilateral or bilateral segmental neurofibromatosis are now best referred to as mosaic generalized or mosaic localized neurofibromatosis 1.
Cytomegalovirus Retinitis: A Rare but Preventable Cause of Blindness in Dermatology Patients
Authors: Laws Philip M. , Kingston Timothy P. , Walsh Scott , Shear Neil H.
Published: March 2015

Importance:

Dermatologists are using an increasing range of immunomodulatory therapies to treat an expanding number of skin diseases. Complications of therapy are broad and include infection. Cytomegalovirus (CMV) retinitis has not been reported in association with dermatologic disease.

Observations:

We report two cases of CMV retinitis associated with immunosuppression for eczema and pemphigus vulgaris. In both cases, patients were receiving corticosteroid and a second-line immunosuppressive agent (cyclosporine or mycophenolate mofetil). Disease presented in both patients with painless visual loss.

Conclusions and Relevance:

Patients receiving immunosuppressive therapy should be monitored for blurred vision, floaters, or visual loss and referred for urgent assessment to ensure accurate diagnosis and prompt treatment of possible CMV retinitis.
A Consensus on Acne Management Focused on Specific Patient Features
Authors: Lynde Charles , Tan Jerry , Andriessen Anneke , Barankin Benjamin , Dutil Maha , Gilbert Martin , Hong Chih-ho , Humphrey Shannon , Rochette Linda , Toole Jack , Thomas Richard , Vender Ronald , Wiseman Marni , Zip Catherine
Published: March 2015

Background:

Most treatment guidelines for acne are based on clinical severity. Our objective was to expand that approach to one that also comprised individualized patient features: a case-based approach.

Methods:

An expert panel of Canadian dermatologists was established to develop demographic and clinical features considered to be particularly important in acne treatment selection. A nominal group consensus process was used for inclusion of features and corresponding appropriate treatments.

Results:

Consensus was achieved on the following statements: follicular epithelial dysfunction contributes to acne pathogenesis; inflammation from underlying disease(s) or prior treatment may impact further patient management; management focusing on specific patient features and on addressing psychosocial factors, including impact on quality of life, may improve treatment adherence and outcomes; and case-based scenarios are a practical approach to illustrate the effect of these factors. To address the latter, eight case profiles were developed.

Conclusions:

Management of acne should be based on multifactorial considerations beyond clinically determined acne severity and should include patient-reported impact, gender, skin sensitivity (including preexisting dermatoses), and phototype.
Association between Skin Conditions and Depressive Disorders in Community-Dwelling Older Adults
Authors: Guerra Samantha Gontijo , Préville Michel , Vasiliadis Helen-Maria , Berbiche Djamal
Published: March 2015

Background:

Depression is frequently observed in dermatologic patients. However, the association between depressive disorders and skin conditions has rarely been explored through population-based studies, especially within older-adult populations.

Objective:

To test this association in a representative sample of an older-adult population.

Methods:

Data came from the Survey on the Health of the Elderly (Enquête sur la Santé des Aînés [ESA]), a longitudinal survey conducted in Quebec among 2,811 older adults. Cross-lagged panel models were used to simultaneously examine cross-sectional and longitudinal relationships between the presence of skin conditions and depressive disorders.

Results:

The prevalence of skin conditions was 13%, and the prevalence of depressive disorders among participants presenting with skin conditions was 11%. Our results indicated significant cross-sectional correlation ( ζ = 0.20) between skin conditions and depressive disorders, but no longitudinal association was observed.

Conclusion:

Our results reinforce the hypothesis that skin conditions and depressive disorders are concurrently associated in older adults. However, no evidence of the predictive effect of skin problems on depression (and vice versa) was found in our community sample. Despite the deleterious effect of the coexistence of these problems in older adults, studies are lacking. This article highlights the importance of this issue and emphasizes the need for further research on this topic.
Effect of Oral Isotretinoin Treatment on Retinal Nerve Fiber Layer Thickness
Authors: Ucak Haydar , Aykut Veysel , Ozturk Savas , Cicek Demet , Erden Ilker , Demir Betul
Published: March 2015

Background:

Oral isotretinoin treatment can cause ocular side effects.

Objective:

This study was performed to detect possible toxic effects of oral isotretinoin treatment on the retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL).

Methods:

The study population consisted of 54 eyes of 27 patients with nodulocystic acne who used oral isotretinoin (Roaccutane) treatment. Macular GCL and peripapillary RNFL thickness measurements were performed using spectral domain optical coherence tomography (OCT) before and after therapy.

Results:

Before and after treatment, a complete ophthalmologic examination was normal in all eyes. However, posttreatment lower temporal (TL) values were significantly lower (76.80 ± 16.31) than pretreatment TL values (84.96 ± 24.83) ( p = .02). There was no statistically significant difference in the other OCT values, upper temporal, superotemporal, superonasal, upper nasal, lower nasal, inferonasal, and inferotemporal ( p = .35, p = .40, p = .56, p = .95, p = .94, p = .93, p = .61, respectively). Also, there was no statistically significant difference between the right and left eyes and between genders for all parameters ( p > .05).

Conclusion:

The use of oral isotretinoin treatment has increased in recent years. In addition, oral isotretinoin treatment has a broad adverse effect potential on the ocular system. The measurement of RNFL thickness, especially TL thickness, by OCT may be useful for detecting the possible toxic effect of oral isotretinoin therapy on RNFL.
Comparing Demographic Characteristics and Adverse Event Rates at Two Dermatologic Surgery Practices
Authors: O'Neill Jenna L. , Shutty Brandon , Lee Yun Sun , Solomon James A. , Patel Nikita , Davis Scott A. , Taheri Arash , Huang Karen E. , Landis Erin T. , Robins Douglas N. , Williford Philip M. , Feldman Steven R. , Pearce Daniel J.
Published: March 2015

Background:

Patient demographics and operative techniques may contribute to adverse events after surgeries.

Objective:

To identify differences in adverse event rates between different dermatologic surgery centers and potential contributing features affecting these rates.

Methods:

Data regarding demographics, procedure type, and adverse events were collected at two dermatologic surgery centers.

Results:

The most common adverse event at both sites was infection: 2.1% at site 1 versus 0.5% at site 2 ( p < .001). Using multivariate logistic regression, procedure type (Mohs surgery), geographic location (being at site 1), older age, and anatomic location of surgery were associated with a higher risk of infection.

Conclusion:

Adverse event rate appears to correlate with patient demographics, procedure type, and setting of surgery more than use of prophylactic antibiotics. Identification of differences in adverse event rates and potential contributing variables at different practices may allow for identification of opportunities to prevent adverse events.
Cutaneous Polyarteritis Nodosa Sine Nodosa
Authors: Merman Erica , Rosen Cheryl , Ghazarian Danny , Habeeb Ayman Al , Siddha Sanjay
Published: March 2015

Background and Objective:

Cutaneous polyarteritis nodosa, a form of vasculitis affecting the small to medium sized arteries, most commonly presents as tender subcutaneous nodules over the lower legs and feet. Other features include livedo reticularis, skin ulcers and tender indurated plaques.

Conclusion:

We report a 51-year old woman with a primarily livedo reticularis presentation of cutaneous polyarteritis nodosa without a nodular component.
Successful Treatment of Atrophic Facial Leishmaniasis Scars by CO2 Fractional Laser
Authors: AlGhamdi Khalid , Khurrum Huma
Published: March 2015

Background:

A permanent, unpleasant atrophic leishmaniasis scar is a potentially disfiguring condition that causes social stigma with limited treatment choices. Fractionated carbon dioxide (CO2) laser resurfacing is expected to be a safe and effective treatment for leishmaniasis scars.

Objective:

To assess the safety and efficacy of ablative fractional resurfacing (AFR) with a CO2 laser for facial leishmaniasis atrophic scars.

Methods:

Eleven patients (five males, age 18–47 years) underwent the fractional CO2 laser procedure. The mean duration for scars was 18.3 years. Three to five treatment sessions with the fractional laser eCO2 (10,600 nm, Lutronic Corporation, Gyeonggi-do, Korea) were performed for each patient, at 2-month intervals, under topical anesthesia. Two passes (with tip type 120, density 150 spots/cm2 in static mode, and peak power of 30 watts) were performed on each leishmaniasis scar. Pulse energies ranged between 100 and 140 mJ. Posttreatment improvements in texture, atrophy, and overall satisfaction with appearance were graded on a quartile scale 1 month after the second session and 3 months after the final session. Scar improvement was graded using a 4-point score with a maximum score of 20.

Results:

At the 3-month posttreatment follow-up, all subjects were rated as having at least 50% improvement in texture, atrophy, borders, and overall appearance of scars. The median score of improvement was 18 of 20 (range 11–19). Mild postinflammatory hyperpigmentation was the only adverse effect, observed in 18% (2 of 11) of subjects. After the procedure, moderate to severe erythema and edema typically resolved within 24 to 48 hours. No additional adverse effects were observed.

Conclusion:

Fractional CO2 resurfacing represents a safe, effective, and well-tolerated potential treatment for atrophic facial leishmaniasis scars in ethnic skin.
Hypopigmented Segmental Darier Disease
Authors: Morin Catherine Besner , Netchiporouk Elena , Billick Robin C. , Srolovitz Herbert D. , Roshdy Osama
Published: March 2015

Background:

Darier disease is a genodermatosis caused by a mutation in the ATP2A2 gene. It classically presents as hyperkeratotic greasy papules in a seborrheic distribution. Several variants have been reported, notably the hypopigmented variant, which predominantly targets dark-skinned individuals, and a segmental variant that often follows the lines of Blaschko.

Methods:

We report a case of a 41-year-old African-Canadian female with a long-standing history of macular hypopigmented pruritic eruption following the lines of Blaschko on her back. The eruption was persistent and recalcitrant to various treatments. Dyskeratosis with corps ronds and grains, acantholysis, and parakeratosis were observed on histopathology. Those findings were consistent with the diagnosis of segmental hypopigmented Darier disease.

Results and conclusions:

To our knowledge, this is the first case reporting a combined segmental and hypopigmented variant of Darier disease. We further present a literature review for hypopigmented and segmental variants of Darier disease.
A Clinicopathologic Review of a Case Series of Dermatofibrosarcoma Protuberans with Fibrosarcomatous Differentiation
Authors: Kuzel Paul , Mahmood Muhammad N. , Metelitsa Andrei I. , Salopek Thomas G.
Published: March 2015

Background:

Dermatofibrosarcoma protuberans with fibrosarcomatous differentiation (DFSP-FS) is a rare variant of DFSP with a more aggressive clinical course, characterized by higher rates of local recurrence, metastasis, and death.

Methods:

We conducted a clinicopathologic review of all DFSP-FS cases that occurred in Alberta, Canada, from 1997 to 2007.

Results:

Of the 75 DFSP cases reviewed, 4 demonstrated fibrosarcomatous differentiation. Three patients were female and one was male, and the age range was 25 to 76 years. Three tumors invaded to skeletal muscle, whereas one invaded to subcutaneous tissue only. Although perineural invasion was noted in all four cases, none exhibited lymphovascular space invasion. One local recurrence developed, and two of four tumors metastasized. Metastasis was associated with tumor size, tumor necrosis, grenz zone involvement, ulceration, thickness, and tumor grade. One patient died within 5 years of diagnosis.

Conclusion:

DFSP-FS represents a more aggressive subtype of DFSP. Several features of DFSP-FS may impart a higher risk of metastasis.
Polysensitization in Recurrent Lip Dermatitis
Authors: Fraser Kathleen , Pratt Melanie
Published: March 2015

Background:

In allergic contact dermatitis (ACD), polysensitization consists of positive patch test reactions to three or more unrelated allergens.

Objective:

The purpose of this case report is to document a 27-year-old female with recurrent lip dermatitis, polysensitization, and reactions to a number of clinically relevant exposures.

Methods:

Patch testing results revealed positive reactions to tixocortol-21-pivalate (3+), lanolin (3+), neomycin (3+), nickel (1+), hydroxyethyl methylacrylate (3+), bacitracin (3+), and abitol (3+).

Results:

The patient had seven positive reactions, meeting the criteria for polysensitization. Of known clinical relevance, the patient had applied lanolin-containing lip balms and hydrocortisone- and bacitracin-containing products to the lips, all of which she was strongly reactive to on patch testing.

Conclusion:

Polysensitization occurs when three or more unrelated allergens are positive on patch testing. This case highlights the importance of considering polysensitization in ACD as numerous allergens that were positive on patch testing were clinically relevant.
Periungual Eccrine Poroma
Authors: Fierro-Arias Leonel , Calderón Luz , Peniche-Castellanos Amelia , Mercadillo-Pérez Patricia
Published: March 2015

Background:

Eccrine poroma is a rare, benign skin appendage tumor originating from the intraepidermal portion of the eccrine sweat duct, which typically occurs on the sides and soles of the feet. Nonetheless, eccrine poroma may be found in any skin area bearing sweat glands.

Objective:

Herein we report a case of an eccrine poroma in an unusual location, the surgical management of the condition, and follow-up processes.