bluuebunny/crossref_metadata_2025 huggingface dataset:
Alopecia Areata following Adalimumab
Authors: Kirshen Carly , Kanigsberg Nordau
Published: March 2015

Background:

Alopecia areata is a nonscarring hair loss characterized by well-circumscribed patchy areas, most often on the scalp. The inflammatory cytokine tumor necrosis factor alpha (TNF-α), has been connected with the development of alopecia areata in vivo; thus, the TNF-α inhibitors have been cited as possible treatments for this autoimmune condition.

Objective:

We report a case of alopecia areata that developed in a 52-year-old woman who was recently started on adalimumab for treatment of her psoriatic arthritis.

Results:

We discuss the previously published cases in the literature linking alopecia areata to TNF-α inhibitor administration. Our case is the first report of a new-onset alopecia areata following adalimumab.

Conclusions:

Even though TNF-α is implicated in causing alopecia areata, TNF-α inhibitors have paradoxically been associated with new cases of alopecia areata. It is possible that TNF-α may not be involved in the pathogenesis of alopecia areata, as in vitro studies have suggested.
Are All Seborrheic Keratoses Benign? Review of the Typical Lesion and Its Variants
Authors: Noiles Kristin , Vender Ronald
Published: March 2015

Background:

Seborrheic keratosis (SK) is one of the more common benign epidermal neoplasms seen in adult and middle-aged patients.

Objective:

As little is written in the literature about the variants of SK, this article aims to categorize and discuss the different subtypes and their important associations.

Methods:

An in-depth literature search using OVID Medline and PubMed was conducted to classify the various subtypes of SK. Clinical variants were photographed and used to help document the subtypes. The pathology is described for each.

Results:

Six subtypes of SK were identified: dermatosis papulosa nigra, stucco keratosis, inverted follicular keratosis, large cell acanthoma, lichenoid keratosis, and flat seborrheic keratosis. Although the etiology and pathogenesis of SKs are still largely debatable, several underlying mechanisms and contributing factors have been identified. All subtypes represent benign lesions, and treatment is usually done for cosmetic reasons. Several of the subtypes may act as cutaneous markers for internal malignancy and should be monitored closely for any atypical changes.

Conclusion:

Although all subtypes of SK are benign, their association with other malignant lesions and ability to serve as cutaneous markers of internal malignancy emphasize the importance of correctly identifying all variants.
Use of Biologic Therapeutics in Difficult-to-Treat Psoriasis
Authors: Lynde Charles
Published: March 2015

Background:

A need for improved psoriasis management drove the development of four biologicals now approved for use in moderate to severe psoriasis: alefacept, efalizumab, etanercept, and infliximab.

Objective:

This review compares the recommended and practical use of biologicals in “difficult-to-treat” psoriasis. Difficult-to-treat patients, a subpopulation of particular interest to caregivers and regulators, are those for whom conventional options are unavailable, contraindicated, intolerable, or ineffective.

Conclusions:

Despite guidance recommending that biologicals be considered among first-line antipsoriasis treatments, formulary inclusion may be influenced by the biologicals' success in controlling difficult-to-treat psoriasis. Findings from the Clinical Experience Acquired with Raptiva (CLEAR) randomized controlled trial (RCT) established efalizumab's equal efficacy in difficult-to-treat and moderate to severe psoriasis. The CLEAR data were cited in support of a regulatory recommendation to include efalizumab in Canadian provincial formularies. For some other biologicals, evidence regarding efficacy in difficult-to-treat psoriasis remains equivocal. Additional RCTs are needed to define appropriate roles for specific biologicals in difficult-to-treat patients.
Acantholytic Dermatosis of the Crural Folds with ATP2C1 Mutation is a Possible Variant of Hailey-Hailey Disease
Authors: Lipoff Jules B. , Mudgil Adarsh V. , Young Saryna , Chu Paul , Cohen Steven R.
Published: March 2015

Background:

We describe a patient with acantholytic dermatosis of the crural folds (ADCF) that was misdiagnosed and treated as condyloma acuminata for 13 years. After many skin biopsies consistently showed epidermal acantholysis and negative human papillomavirus serotyping excluded condyloma acuminata, a diagnosis of ADCF was considered most likely.

Objective and Conclusion:

Acitretin effectively suppressed the symptomatic hyperkeratosis. Subsequent genetic testing revealed a deletion in the ATP2C1 gene that led us to conclude that this case of ADCF is probably a variant of familial benign chronic pemphigus (Hailey-Hailey disease).
Management of Malignant Melanoma: Best Practices
Authors: Smylie Michael , Claveau Joël , Alanen Kenneth , Taillefer Raymond , George Ralph , Wong Ralph , Mason Warren P.
Published: March 2015

Background:

Melanoma is a commonly occurring cancer in Canada, with an estimated age-standardized incidence of 10 to 13 per 100,000. An estimated 4,300 new cases were diagnosed, and there were 880 reported deaths in 2005.

Objective and Conclusion:

The Canadian Expert Panel on Malignant Melanoma has developed best practices to improve the management of malignant melanoma. Sections include recommendations on primary diagnosis, dermatopathologic assessment, and reporting; use of preoperative lymphoscintigraphy and an intraoperative gamma probe to map and biopsy the sentinel lymph node; indications for surgical resection, sentinel node biopsy, and surgery for advanced disease; use of interferon-α adjuvant therapy and treatment options for stage IV disease; and management of central nervous system metastases.
Rigorous Vibrio vulnificus Soft Tissue Infection of the Lower Leg in a Renal Transplant Patient Managed by Vacuum Therapy and Autologous Growth Factors
Authors: Thodis Elias , Kriki Pelagia , Kakagia Despoina , Passadakis Ploumis , Theodoridis Marios , Mourvati Euthymia , Vargemezis Vassilios
Published: March 2015

Background:

Vibrio vulnificus is a gram-negative marine bacterium that grows well in coastal waters. It is an opportunistic pathogen that can cause serious life-threatening infections in patients with certain health conditions. Vibrio-induced wound infections in immunosuppressed patients are difficult to treat because the healing process may be significantly delayed. Reconstructive surgery may not be successful in early treatment as skin grafts are likely to fail, and there may be increased morbidity of donor sites of grafts or flaps.

Objective:

Herein a case of septicemia and wound necrosis owing to V. vulnificus wound infection in a renal transplant patient is reported.

Method:

To conservatively yet adequately débride the wound bed, stimulate angiogenesis, and accelerate granulation, vacuum-assisted closure was employed. Granulation was further enhanced by autologous platelet concentrate spray, which has also been reported to increase the epithelialization rate.

Result:

Complete epithelialization of the wound was achieved 4 weeks after completion of treatment.

Conclusion:

Noninvasive advanced modalities may be employed to successfully treat infectious soft tissue deficits in immunocompromised patients.
Etiologic Aspects and Prognostic Factors of Patients with Chronic Urticaria: Nonrandomized, Prospective, Descriptive Study
Authors: Gregoriou Stamatis , Rigopoulos Dimitrios , Katsambas Andreas , Katsarou Alexandra , Papaioannou Dimitrios , Gkouvi Aikaterini , Kontochristopoulos George , Danopoulou Ifigenia , Stavrianeas Nikolaos , Kalogeromitros Dimitris
Published: March 2015

Background:

Studies investigating etiologic factors in chronic urticaria are based on small populations of a few hundred patients. In addition, data on prognostic factors of the disorder are scarce.

Objective:

To investigate the etiologic and prognostic factors of chronic urticaria on a large population referred to tertiary specialized hospital departments.

Methods:

The study investigated 2,523 patients with chronic urticaria and a negative autologous serum skin test using anamnesis, and the literature suggested laboratory tests for etiologic factors of the disorder. The patients were prescribed cetirizine 10 mg daily plus treatment of any underlying disorders illuminated by the laboratory investigation. The rescue medicine was loratadine 10 mg. The patients were evaluated every 3 months. Comparative statistical methods were used to evaluate the prognostic factors having an impact on the duration of the disorder until resolution of symptoms.

Results:

Etiologic factors of chronic urticaria-angioedema were identified in 38.7% of the patients. Physical urticarias had a prevalence of 17.1% in the population under study. Other common etiologic factors identified included infection (7.7%) and autoimmune thyropathy (7.3%). Multiple regression analysis showed that female gender, long duration of the disorder at the initial examination, the presence of angioedema, and physical urticarias are associated with worse prognosis of the disorder, whereas increased self-reported stress and psychiatric disease had no impact on the course of the disorder.

Conclusion:

A detailed medical history and selective laboratory tests can illuminate etiologic factors in less than 40% of patients with chronic urticaria. Prognostic factors identified to impact the natural history of the disorder could be helpful when designing studies assessing the efficacy of therapeutic agents for chronic urticaria.
Juvenile-Onset Hypopigmented Mycosis Fungoides Mimicking Vitiligo
Authors: Ngo Jennifer T. , Trotter Martin J. , Haber Richard M.
Published: March 2015

Background:

Mycosis fungoides (MF) is the most common form of cutaneous T-cell lymphoma and typically affects older adults. It is estimated that less than 5% of MF cases are of juvenile onset. An uncommon hypopigmented variant of MF exists, which has been more commonly observed in dark-skinned individuals and predominantly in juvenile-onset cases.

Methods:

We describe an 8-year-old otherwise healthy Hispanic male who, by 6 months of age, had developed asymptomatic hypopigmented patches on the lower legs, thighs, and buttocks, which have evolved over the past 7 years. This condition had previously been misdiagnosed as vitiligo. Recent immunohistologic and molecular biology studies are consistent with MF.

Results and Conclusions:

Given that hypopigmented MF is an uncommon condition, it may not be clinically suspected in the pediatric population. Histopathologic, immunophenotypic, and/or molecular biologic studies are sometimes equivocal, with findings similar to inflammatory dermatoses or autoimmune vitiligo, which may initially lead to a misdiagnosis, as in this patient's case.
Gnatophyma and Otophyma
Authors: Ezra Navid , Greco Joseph F. , Haley Jennifer C. , Chiu Melvin W.
Published: March 2015

Background:

Phymas are slowly progressive, disfiguring disorders of the face and ears that represent the end stage of rosacea. The most common phyma is rhinophyma, yet similar swellings may occur on the chin (gnatophyma), forehead (metophyma), one or both ears (otophyma), and eyelids (blepharophyma).

Objective: Unlike rhinophyma, otophyma is rarely seen. We report two rare phymas:

a case of gnatophyma and a case of otophyma.

Methods:

A 56-year-old African American man presented with a history of bumps on his chin that had begun about 7 years earlier. Physical examination was remarkable for lobulated plaques on the chin, coalescing into hypertrophic nodules and dilated pores. A 73-year-old African American male presented with bilateral cauliflower-like earlobe growths for the past 17 years.

Results:

A skin biopsy was performed for each patient demonstrating cystic follicular dilatation with keratin plugging, dermal scarring, psoriasiform epidermal hyperplasia, and chronic inflammation of some of the follicles.

Conclusion:

This case report describes a relatively rare gnatophyma and otophyma. Surgical management is well accepted as the best mode of therapy to treat rhinophyma and is becoming a first-line treatment for all phymas.
Targeting the Interleukin-12/23 Cytokine Family in the Treatment of Psoriatic Disease
Authors: Shear Neil H. , Prinz Jörg , Papp Kim , Langley Richard G.B. , Gulliver Wayne P.
Published: March 2015

Psoriasis is a complex systemic immune inflammatory disease whose burden of disease includes poorer quality of life, a high prevalence of serious comorbidities, and a potentially decreased life span—hence the continued need to search for new treatment options. ABT-874 (Abbott Laboratories, Saint-Laurent, QC,) and ustekinumab (CNTO 1275, Ortho Biotech, Toronto, ON) are two monoclonal antibodies against interleukins 12 and 23 (IL-12/23), key mediators of T-cell differentiation in the pathogenesis of psoriasis. The results of a 12-week, phase II, dose-finding study of ABT-874 have been encouraging. More recently, level 1 evidence has emerged for ustekinumab in two placebo-controlled phase III trials, PHOENIX 1 and PHOENIX 2; therapeutic responses to ustekinumab have been maintained up to 76 weeks of follow-up, and quality of life has significantly improved with ustekinumab. Both agents produced few and mild adverse events, and the rates of serious infections and cancers were very low and similar to those of placebo. These promising results strongly confirm the central role of IL-12/23 in psoriasis and its importance as a therapeutic target.
Adalimumab in the Treatment of Psoriasis: Pooled Efficacy and Safety Results from Three Pivotal Studies
Authors: Papp Kim , Okun Martin , Vender Ronald
Published: March 2015

Background:

Adalimumab, a fully human monoclonal antibody, binds to and neutralizes tumor necrosis factor.

Objective:

To provide an integrated review of efficacy and safety from adalimumab clinical trials in psoriasis.

Methods:

Pooled analyses were conducted of three placebo-controlled clinical trials of adalimumab (40 mg every other week) in psoriasis patients. The primary efficacy measure was the Psoriasis Area Severity Index (PASI). The Physician's Global Assessment (PGA) was also assessed.

Results:

At Week 16, mean percentage PASI improvement was 78.3% for adalimumab-treated patients versus 15.1% for placebo-treated patients. A PGA of “Clear” or “Minimal” was achieved in 63.4% of adalimumab-treated patients versus 5.1% of placebo-treated patients. The response to adalimumab was rapid, with significant improvements for adalimumab-treated patients in most efficacy measures by Week 4. Adverse event incidence was similar between treatment groups and consistent with adalimumab safety profiles in other indications.

Conclusion:

Adalimumab improved psoriasis and was generally safe and well-tolerated.
Practical Aspects of Prescribing a Biologic
Authors: Poulin Yves , Bourcier Marc
Published: March 2015

As the use of biologic agents for treatment of psoriasis becomes more common, practitioners need to be aware of the unique concerns and procedures required when prescribing biologics. This article describes the clinical and laboratory assessments that should occur before starting a biologic treatment, as well as the contraindications to consider for patients who might be candidates for biologic treatment. Important-treatment monitoring issues for safe and effective use of biologics in patients with psoriasis are also discussed.
Psoriatic Nail Disease: Quality of Life and Treatment
Authors: Gupta Aditya K. , Cooper Elizabeth A.
Published: March 2015

Nail psoriasis is common among patients with plaque psoriasis or psoriatic arthritis and has a detrimental effect on quality of life. However, there are currently no standardized therapeutic regimens for nail psoriasis. Traditional treatments for nail psoriasis, which include topical, intralesional, and oral therapies, may be time-consuming, painful, or unsafe when administered long term. Biologic therapies have demonstrated efficacy for plaque psoriasis and psoriatic arthritis; these therapies may be particularly promising for the treatment of nail psoriasis as both groups of patients have an elevated incidence of nail dystrophy. The biologic therapies adalimumab, alefacept, efalizumab, etanercept, and infliximab have demonstrated clinically important nail psoriasis improvements using the Nail Psoriasis Severity Index, a helpful tool that, upon validation, will allow comparison across treatments and trials. Large-scale, long-term trials using standardized outcome measures are needed to further evaluate biologic therapies for the treatment of nail psoriasis.
The AWARE Study: Methodology and Baseline Characteristics
Authors: Bissonnette Robert , Searles Gordon , Landells Ian , Shear Neil H. , Papp Kim , Lui Harvey , Gulliver Wayne P.F. , Lynde Charles
Published: March 2015

Background:

Alefacept was the first biologic therapy approved by Health Canada for the treatment of moderate to severe chronic plaque psoriasis and is used either alone or as part of combination therapy.

Objective:

AWARE (Amevive Wisdom Acquired from Real-World Evidence) is a multicenter, observational phase IV Canadian study of psoriasis patients treated with alefacept. This study's main goals were to develop a shared, real-time, national clinical database to support best practice and optimize the care of patients receiving alefacept and to gain an understanding of how alefacept is used in Canadian clinical practice. Baseline patient demographic data are described herein.

Methods:

Patients with chronic plaque psoriasis were enrolled from 37 clinics across Canada. Subjects received at least one course of alefacept treatment followed by a period of at least 12 weeks off treatment and were prospectively followed for at least 60 weeks. Baseline assessments included patient demographics, relevant medical history, psoriasis and treatment history, reasons for initiating alefacept, enrolling physician's initial alefacept treatment plan and strategy, percent body surface area (BSA) involvement with psoriasis, and physician's baseline assessment of disease control. Subsequent assessments at each follow-up visit included the patient's response and the physician's assessment.

Results:

A total of 426 adult patients with predominantly chronic plaque psoriasis, with or without other types of psoriasis, were enrolled into the AWARE registry. Patients generally had moderate to severe psoriasis, with more than half (55.8%) having little or no disease control at baseline as assessed by their clinician, and 77% had > 10% BSA involvement with psoriasis. All patients in the AWARE patient population were receiving one or more treatments for psoriasis prior to or at the time of enrolment, and the majority continued to receive concomitant treatments at the time of study enrolment.

Conclusion:

The AWARE registry enrolled a broad group of real-world patients with chronic plaque psoriasis treated with alefacept in clinical practices across Canada.
Patterns of Combination Therapy with Alefacept for the Treatment of Psoriasis in Canada in the AWARE Study
Authors: Searles Gordon , Bissonnette Robert , Landells Ian , Shear Neil H. , Papp Kim , Lui Harvey
Published: March 2015

Background:

Evidence from clinical trials supports the use of alefacept for the treatment of patients with chronic plaque psoriasis, either as monotherapy or combined with other treatment modalities.

Objective:

AWARE (Amevive Wisdom Acquired from Real-World Evidence) is a multicenter, observational, phase IV Canadian registry of psoriasis patients treated with alefacept.

Methods:

Patients with chronic plaque psoriasis were treated with at least one course of alefacept treatment followed by a period of at least 12 weeks off-treatment. The use of combination therapy with alefacept in a real-world population of psoriasis patients is presented here, including the types of psoriasis therapies received by patients at the time of enrolment, reasons for initiating alefacept, and discontinuation or dosage reduction of concomitant therapy.

Results:

The majority of patients were receiving other antipsoriatic therapies at the time of enrolment into the AWARE study, most commonly topical therapy, systemic agents, or phototherapy. Most patients were receiving monotherapy prior to the initiation of alefacept. There was little change in the use of topical therapies with alefacept at 24 weeks, whereas a substantial proportion of patients were able to reduce or discontinue concomitant systemic therapies and/or phototherapy. The use of combination therapy regimens was relatively consistent across the country and by age groups, although younger patients were prescribed systemic agents more often than older patients.

Conclusion:

Alefacept is commonly added to other antipsoriatic therapies in a broad population of real-world chronic plaque psoriasis patients in Canada and may allow for dosage reduction or discontinuation of concomitant systemic agents or phototherapy.
Update on Alefacept Safety
Authors: Wexler Denise , Searles Gordon , Landells Ian , Shear Neil H. , Bissonnette Robert , Papp Kim , Poulin Yves , Langley Richard , Gulliver Wayne P.S.
Published: March 2015

Background:

Alefacept has been demonstrated in clinical trials to be an effective, safe, and well-tolerated treatment strategy when used alone or in combination with other antipsoriatic therapies in patients with chronic plaque psoriasis.

Objective:

AWARE (Amevive Wisdom Acquired from Real-World Evidence) is a multicenter, observational, Canadian phase IV registry evaluating the efficacy and safety of alefacept, alone or in combination with other antipsoriatic therapies, in patients with psoriasis.

Methods:

Patients with chronic plaque psoriasis were treated with at least one course of alefacept followed by an off-treatment period, typically lasting 12 or more weeks. Prospective follow-up was at least 60 weeks, depending on when patients presented for retreatment. Safety data collected throughout the study included the incidence of serious adverse events (SAEs), dosing suspensions, and withdrawals owing to adverse events.

Results:

Twelve SAEs were reported in psoriasis patients treated with at least one course of alefacept, with only one considered to be possibly related to the study drug. Approximately one-quarter of patients missed at least one dose of alefacept during the course of the study. A total of 291 doses of alefacept were missed, representing almost 4% of the total doses administered in this group of patients. Low CD4+ count was the most frequent reason for missed doses; however, no patient had persistently low CD4+ counts requiring permanent discontinuation of alefacept treatment. Seven patients in the AWARE registry discontinued treatment with alefacept, with the most common reason being patient request.

Conclusion:

The AWARE study supports the safety of alefacept used alone or in combination with other antipsoriatic therapies, in a broad population of real-world chronic plaque psoriasis patients in Canada.
Cutaneous Protothecosis following a Tape-Stripping Injury
Authors: Humphrey Shannon , Martinka Magdalena , Lui Harvey
Published: March 2015

Background:

Prototheca species are ubiquitous achlorophyllic algae that can, in rare instances, manifest as cutaneous infection in humans at sites of traumatic inoculation into the skin.

Objectives:

We report a 77-year-old man who developed cutaneous protothecosis at the site of an iatrogenic tape-stripping type injury. The diagnosis was confirmed by histologic examination and tissue culture. The patient responded completely to a 17-week course of oral fluconazole.

Conclusion:

Cutaneous protothecosis can present clinically as nonspecific indolent inflammatory plaques that require skin biopsy for definitive diagnosis.
Epidermodysplasia Verruciformis Associated with Myelodysplastic Syndrome: An Intriguing Association
Authors: Oliveira Walmar R. , Ferreira Gustavo N. , Rady Peter L. , Festa Cyro , Tyring Stephen K.
Published: March 2015

Background:

Epidermodysplasia verruciformis (EV) is a rare genodermatosis characterized by massive infection with human papillomaviruses (HPVs) and development of skin cancer. Myelodysplastic syndromes (MDSs) are a group of chronic conditions that involve dysplastic hematopoiesis, peripheral blood cytopenias, and a high incidence of progression into leukemia.

Methods:

We describe the intriguing association of these two premalignant conditions (EV and MDS) in one patient. These diagnoses were confirmed by histopathologic examination and cytogenetic abnormalities of bone marrow cells.

Results:

The patient presented initially with clinical features typical of EV and impairment of cell-mediated immunity. In the skin lesions, HPVs 23 and 25 were identified by nested polymerase chain reaction. Six years later, he had recurrent episodes of mucosal bleeding with fever, weakness, and fatigue. At this time, severe refractory anemia and neutropenia were observed, and bone marrow smears showed hypercellularity with abnormal dysplastic megakaryocytes. The cytogenetic pattern showed abnormalities involving trisomy of chromosomes 8 and 21. The patient received a diagnosis of the indolent subtype of MDS.

Conclusions:

Through the observation of our patient and review of the literature, we hypothesized that the pathomechanisms, including the role of oncogenes and cytokines, are connected to the progression to malignancy in these settings.
Coexisting Tattoo Pigment and Metastatic Melanoma in the Same Sentinel Lymph Node
Authors: Jaigirdar Adnan A. , Yeh Michael W. , Sharifi Emile , Browne L. Walden , Leong Stanley P.L.
Published: March 2015

Background:

The principle of sentinel lymph node states that metastatic melanoma spreads in a predictable sequential fashion from the primary site to the regional lymph node basin.

Objective and Conclusion:

Reports show that melanoma and tattoo pigment can be in the same regional lymph node basin on gross evaluation. We present two cases of melanoma arising within the setting of a tattoo where the sentinel lymph node contained both pigmented histiocytes and metastatic melanoma on gross inspection and histopathology.
Elastosis Perforans Serpignosa: Treatment with Liquid Nitrogen Cryotherapy and Review of the Literature
Authors: Humphrey Shannon , Hemmati Iman , Randhawa Roop , Crawford Richard I. , Hong Chih-ho
Published: March 2015

Background:

Elastosis perforans serpiginosa (EPS) is a rare skin disease in which abnormal elastic tissue fibers, other connective tissue elements, and cellular debris are expelled from the papillary dermis via transepithelial elimination. It is characterized by an eruption of small grouped hyperkeratotic papules in a serpiginous arrangement. This condition presents a therapeutic challenge as many treatments have been reported with inconsistent efficacy.

Methods:

This article reports a case of a 13-year-old male who presented to our outpatient clinic with a 1-year history of facial lesions showing multiple annular keratotic plaques with slight central atrophy.

Conclusion:

We report a case of EPS treated successfully with liquid nitrogen cryotherapy. Liquid nitrogen cryotherapy is well tolerated, with few side effects, and can be considered in the management of EPS.
Meyerson Phenomenon
Authors: Loh James , Kenny Patrick
Published: March 2015

Background:

Meyerson phenomenon is an uncommon clinical condition that is characterized by an eczematous halo surrounding a preexisting melanocytic nevus and numerous other lesions. The etiology of this condition is unknown. We suggest that the mechanism is due to the interaction between CD4 T lymphocytes and increased expression of intercellular cell adhesion molecule 1 (ICAM-1).

Objective:

This article provides a concise overview of Meyerson phenomenon.

Methods and Results:

We present the case of a 37-year-old female with an inflamed nevus located on her thigh from no evident cause. Her condition resolved with surgical excision of the nevus. Histopathology of the specimen demonstrated spongiosis and lymphocytic infiltrate with eosinophils, which confirmed the diagnosis of Meyerson phenomenon.

Conclusion:

Meyerson phenomenon can resolve spontaneously or with treatment of either topical steroids or surgical excision. The main concern with benign lesions presenting with inflammation is malignant transformation; thus, clinicians need to be more aware of Meyerson phenomenon.
A Canadian Self-Administered Online Survey to Evaluate the Impact of Moderate-to-Severe Psoriasis among Patients
Authors: Wasel Norman , Poulin Yves , Andrew Robin , Chan Daphne , Fraquelli Elisa , Papp Kim
Published: March 2015

Background:

Few population studies of individuals living with psoriasis have been performed in Canada.

Objective:

The objective of this survey was to understand the severity and impact of psoriasis on the lives of Canadian patients.

Methods:

An online survey was conducted using a consumer panel. Eligible subjects reported a diagnosis of psoriasis and provided a self-reported level of severity. In addition, subjects had to either (a) have psoriasis covering at least 3% of their body surface area; (b) have psoriasis on a sensitive area of the body; or (c) be currently undergoing treatment for their psoriasis with systemic medication and/or phototherapy.

Results:

A total of 514 panelists met the inclusion criteria and completed the survey. Current moderate, severe, or very severe psoriasis was reported by 65% of respondents. Nearly all subjects (96%) had psoriasis affecting a sensitive area of the body. At the time of the survey, 18% were taking systemic medication and/or phototherapy. Comorbidities, such as obesity and high blood pressure, were highly prevalent, with 75% of respondents reporting at least one other diagnosis. Data from the SF-8 and Dermatology Life Quality Index instruments indicated that psoriasis negatively impacted quality of life.

Conclusion:

Moderate-to-severe psoriasis places a burden on Canadian patients, some of whom may be receiving suboptimal treatment or treatment not appropriate for the severity of their condition.
Exacerbation of Darier Disease by Lithium Carbonate
Authors: Ngo Jennifer , Haber Richard
Published: March 2015

Introduction:

Darier disease (DD) and Hailey-Hailey disease (HHD) are rare autosomal dominantly inherited genodermatoses with mutations in the respective genes, ATP2A2 and ATP2C1, that encode the respective calcium adenosine triphosphatases SERCA2 and PMRI/SPCA1. Lithium is an effective therapy used in psychiatry as prophylaxis against recurrent mania and to treat acute schizoaffective, impulsive, and alcoholic disorders.

Methods:

We discuss a patient with DD who claimed that her skin condition had flared after she was administered lithium therapy for bipolar disorder.

Discussion and Conclusions:

DD may flare after lithium therapy, an association that has rarely been reported. Not uncommonly, DD has been observed to coexist with affective disorders, with reports of the bipolar disorder susceptibility locus cosegregating with a separate DD gene. A mechanism by which lithium worsens disease has recently been studied in rats. DD's coexistence with affective disorders and the mechanisms by which lithium may cause exacerbation of DD and HHD are reviewed.
Ultraviolet Light-Induced Leukoderma of the Scalp Associated with Androgenetic Alopecia: Senescent Actinic Depigmentation of the Scalp
Authors: Verma Shyam B. , Wollina Uwe
Published: March 2015

Background:

Human scalp skin is normally protected from sunlight and ultraviolet radiation by the presence of hair. When hair loss occurs, for example, in androgenetic alopecia, this protective factor declines.

Objective:

We report a series of 10 type IV and V skin patients with a male predominance (60–85 years). All patients suffered from androgenetic alopecia starting from the age of around 40 to 45 years. They all noticed asymptomatic, well-defined, depigmented macules, which were seen only in areas that have been afflicted by androgenetic alopecia. The depigmented macules remain within the confines of the hair margin. There has been no depigmented lesion elsewhere on the body. The patients did not report any association with any drug that they may have started taking. There is no history of vitiligo in these patients or their families. Biopsy samples taken from three of the patients showed solar elastosis.

Conclusions:

The entity of ultraviolet-induced scalp leukoderma and androgenetic alopecia has not been acknowledged in dermatology textbooks but needs consideration for its importance in differential diagnoses. The term senescent actinic depigmentation of the scalp is suggested.
The Burden of Psoriasis and Barriers to Satisfactory Care: Results from a Canadian Patient Survey
Authors: Mahler Ronald , Jackson Christine , Ijacu Horia
Published: March 2015

Background:

The physical, mental, social, and financial burdens experienced by Canadians with psoriasis are relatively unexplored.

Objective:

To gain an understanding of the impact of psoriasis on Canadians.

Methods:

An online survey, “Stand Up and Speak Out,” was provided to Psoriasis Education Program users who had given consent to be contacted.

Results:

Ninety-five percent of respondents had moderate to severe psoriasis, a high proportion relative to similar studies. Respondents reported medical and psychological comorbidities, with prevalence up to fourfold higher than Canadian background rates. Respondents also reported reduced income and increased unemployment, at levels that increased with psoriasis severity. Use of biologics was associated with high levels of satisfaction relative to other treatment options. However, biologic use was not uniform but was strongly correlated with insured status and annual income.

Conclusion:

In this severely affected population of Canadians with psoriasis, the physical, mental, social, and financial burden of disease was high.
Canadian Case Report of Erythema Nodosum Leprosum Successfully Treated with Prednisone and Thalidomide
Authors: Saber Mélissa , Bourassa-Fulop Caroline , Bouffard Danielle , Provost Nathalie
Published: March 2015

Background:

Erythema nodosum leprosum (ENL) is a disease rarely encountered in Canada. It is characterized by multiple remissions and recurrences, often requires long-term treatment, and can result in debilitating sequelae.

Objective:

To promote rapid recognition and adequate therapy for ENL.

Methods:

Case report of a 39-year-old man diagnosed with an ENL. The clinical and histopathologic features, treatment provided, and response to treatment are detailed in this article.

Results:

ENL presented itself as painful cutaneous lesions on the face and limbs, bilateral paresthesia of the fourth and fifth fingers, and systemic symptoms. Prednisone 40 mg daily for a week and then 60 mg daily for another week reduced the lesions by 80% and the pain by 50%. Although prednisone 60 mg daily was continued for one more week and then stopped, thalidomide was started at a dose of 300 mg daily for 4 weeks and then reduced gradually, which led to complete resolution.

Conclusion:

At the 7½-month follow-up, the patient remained completely asymptomatic.
Drug-Induced Hepatitis and Lupus during Infliximab Treatment for Psoriasis: Case Report and Literature Review
Authors: Poulin Yves , Thérien Geneviève
Published: March 2015

Background:

Infliximab (IFX) can induce elevation of hepatic aminotransferase levels. Hepatitis has been reported in patients treated with IFX and with risk factors such as viral hepatitis, alcohol intake, or concomitant use of hepatotoxic drugs. Liver disorders occurring in a patient without risk factors have rarely been reported, and liver biopsies to substantiate the liver changes have very rarely been described. The presence of lupus-like symptoms with newly positive antinuclear antibodies (ANAs), sometimes with double-stranded deoxyribonucleic acid (DNA) antibodies, has also been reported with IFX. Only a few articles have reported in detail these types of adverse events in patients with psoriasis. To our knowledge, the combination of lupus-like symptoms with simultaneous occurrence of a biopsy-proven hepatitis has not been reported with the use of IFX for psoriasis.

Objective:

Description of a case of drug-induced hepatitis in a patient with concurrent clinical and serologic features of lupus induced by IFX.

Methods:

We present the case of a 40-year-old woman with psoriasis who developed a biopsy-proven drug-induced hepatitis and concurrent lupus symptoms with positive ANAs while under IFX treatment. A review of related publications is presented.

Conclusion:

The clinician must be aware of uncommon side effects of IFX, such as liver anomalies and development of autoantibodies. Liver enzymes should be monitored regularly, and ANAs should be checked if liver enzymes are increasing and in the presence of lupus symptoms.
The Green Monster: Stokes's 1944 Modern Clinical Syphilology
Authors: Jackson Robert
Published: March 2015

Background:

There is much information on the life and accomplishments of John Hinchman Stokes (1885–1961), the dermatologist and syphilologist. There is little detailed information on his 1944 classic text on syphilis, Modern Clinical Syphilology.

Objective:

To review and critique this book.

Methods:

A careful review of the book, his life, and the accomplishments that were undertaken in relation to the age in which he lived.

Results:

The book is indeed a goldmine of information of all aspects of syphilis from pre–World War I (1905) until the late (1944) World War II era.

Conclusion:

The factors that make it a classic are as follows: (1) the disease had a specific cause; (2) Stokes's 25-year obsession with the disease; (3) there was no effective simple cure for most of the time he was studying it; (4) Stokes was an obsessive, intelligent, well-trained physician; (5) he lived in a well-developed, reasonably stable country; and (6) he was able to see how the disease could be adequately treated with penicillin and compare these events with those in the prepenicillin era.
Updated Review of the Pathogenesis and Management of Merkel Cell Carcinoma
Authors: Zampetti Anna , Feliciani Claudio , Massi Guido , Tulli Antonello
Published: March 2015

Background:

Merkel cell carcinoma is a rare, aggressive, malignant cutaneous tumor of the elderly or immunosuppressed individuals that usually appears on sun-exposed areas of the body. Its pathogenesis is still debated, and, currently, no standardized treatment exists.

Objective:

To provide a current updated review of the most relevant data concerning the pathogenesis and management of Merkel cell carcinoma.

Methods:

Using relevant MeSH terms, we performed a review of the literature on these subjects from 1980 to June 2009.

Results and Conclusion:

The current management of Merkel cell carcinoma is based on surgical excision as the majority of patients present with localized disease, whereas up to 30% have regional lymph node metastases. In these cases, the best outcome is achieved with multidisciplinary management that includes radiotherapy. Chemotherapy is part of the treatment in advanced cases and is mandatory for distant metastatis. Given that a recent work showed the presence of a previously unknown polyomavirus, which the authors called Merkel cell polyomavirus, the therapeutical approach to Merkel cell carcinoma could be reconsidered in the future.
Psoriasis Care: New and Emerging Pharmacologic Trends
Authors: Papp Kim A. , Carey Wayne
Published: March 2015

Background:

The first Canadian Guidelines for the Management of Plaque Psoriasis were recently published, reflecting an evidence-based analysis of psoriasis therapies available in Canada. The guidelines advocate patient-centered psoriasis care in which physicians explore appropriate options to find safe therapies that patients will adhere to and be satisfied with over the long term.

Objective:

To update the discussion in the guidelines regarding new and emerging therapies and trends in psoriasis clinical research.

Methods:

Searches of Medline and clinicaltrials.gov were undertaken to identify new and emerging psoriasis therapies as of March 2009.

Results:

Since May 2008, when published evidence was evaluated for the guidelines, one new drug, ustekinumab, has been approved for moderate to severe psoriasis. New formulations and combinations of existing drugs are expected to reach the Canadian market shortly. Novel agents continue to move through clinical development.

Conclusion:

With the introduction and removal of antipsoriatic therapies from the Canadian market, the therapeutic landscape continues to shift. An increasing number of head-to-head comparisons and the reporting of ambitious treatment outcomes will simplify physicians' evaluation of treatment options. Recognition of quality of life as a key goal of psoriasis treatment is another hopeful trend, consistent with the principles of patient-centered care.
Skin Disease and Stigma in Emerging Adulthood: Impact on Healthy Development
Authors: Roosta Neda , Black David S. , Peng David , Riley Lee W.
Published: March 2015

Background:

Visible skin disorders can limit healthy psychosocial development in several domains owing to the stigma these disorders create.

Objective:

To assess if emerging adults with acne and eczema perceive stigma in diverse developmental domains resulting from their visible skin conditions.

Methods:

A convenience sample of 336 emerging adults attending a diverse public university in northern California completed a Web-based survey. Multivariate modeling was used to determine if eczema and acne result in perceived stigma.

Results:

The mean (SD) age of respondents was 20.1(1.5) years; most were white (43.2%) and female (62.5%). Almost half (47%) reported acne and 16.4% reported eczema. The likelihood of experiencing perceived stigma was 1.6 (95% CI 1.13–2.27, p < .001) times higher for those with eczema compared to those without eczema, and the likelihood of experiencing perceived stigma was 3.19 (95% CI 2.41–4.22, p < .0001) times higher for those with acne compared to those without acne.

Conclusions:

Our findings indicate that emerging adults perceive stigma as a result of their acne and eczema in several important developmental domains. The results suggest that acne may have a stronger relationship with perceived stigma than eczema, perhaps owing to its greater visibility on the body. University-based activities are recommended to support those with skin disease.
Epidemiology of Moderate-to-Severe Plaque Psoriasis in a Canadian Surveyed Population
Authors: Papp Kim , Valenzuela Fernando , Poulin Yves , Bernstein Geula , Wasel Norman
Published: March 2015

Background:

Limited data are available on the epidemiologic features of psoriasis in Canada.

Objective:

To investigate the epidemiologic features and burden of moderate-to-severe psoriasis in a Canadian population.

Methods:

An online survey was conducted using a consumer panel. Eligible respondents indicated a diagnosis of psoriasis and plaque-type psoriasis of at least moderate severity. Eligibility was validated according to self-reported body surface area (BSA) involvement, sensitive areas affected, and/or current treatment.

Results:

Of the 514 respondents who completed the survey, 62% estimated a BSA involvement of ≥ 3% within the past 5 years. Onset of psoriasis occurred earlier in females than in males. Nail involvement was more commonly reported in individuals with psoriatic arthritis compared to those without. Several symptoms were more likely described as “constantly” or “near constantly” experienced by females than by males. Comorbidities commonly reported were hypertension, dyslipidemia, and overweight or obesity.

Conclusions:

The findings are consistent with a substantial burden attributed to moderate-to-severe plaque psoriasis in a Canadian population.
Pyogenic Granuloma of the Foot with Satellitosis: A Role for Conservative Management
Authors: Bacher Janice , Assaad Dalal , Adam David N.
Published: March 2015

Background:

Pyogenic granuloma (PG) with satellitosis is a rare phenomenon that typically occurs in children and teenagers. It can be seen after excision or trauma to the original lesion.

Objective:

The aim is to review an atypical case of PG with satellitosis and to highlight a conservative approach to management.

Methods:

This article includes a case report of a 48-year-old woman developing PG with satellitosis in her right foot and includes a review of the literature.

Results:

There are few cases of PG with satellitosis in the literature. Our patient differs from most given her age and the location of the lesions. She was managed differently with a conservative observational approach, and, over time, her symptoms abated.

Conclusion:

PG with satellitosis can occur in varying patient populations with varying presentations. Although several treatment options exist, managing patients conservatively should be considered an approach to management. Early investigations should be conducted to rule out more sinister items in the differential diagnosis.
Effects of Avotermin (Transforming Growth Factor β3) in a Clinically Relevant Pig Model of Long, Full-Thickness Incisional Wounds
Authors: Laverty Hugh G. , Occleston Nick L. , Johnson Mark , Little John , Jones Richard , Fairlamb David , Ferguson Mark W.J. , O'Kane Sharon
Published: March 2015

Background:

The pig is an accepted species for evaluating the safety of molecules in dermal wound healing indications; however, the sizes of wounds assessed have not always been comparable to large incisions encountered clinically.

Objective:

To develop a clinically relevant model of incisional wounding in the Göttingen minipig for assessing the safety and tolerance of compounds in development to improve scarring.

Methods:

Intradermal avotermin (recombinant transforming growth factor β3 [TGFβ3]) up to 6,000 ng/100μL was administered twice to 20 cm full-thickness incisions.

Results:

Incisions were well tolerated in the minipig. Avotermin treatment was not associated with adverse changes in a range of clinical parameters, including wound healing and strength. Plasma TGFβ3 levels were transient with ≈0.1% bioavailability.

Conclusion:

A clinically relevant model of long, full-thickness, sutured surgical incisions in the minipig is achievable. Avotermin is well tolerated in this model and does not adversely affect normal wound healing at levels that significantly exceed those doses to be used clinically in humans.
Health-Related Quality of Life in Patients with Psoriasis
Authors: Jankovic Slavenka , Raznatovic Milena , Marinkovic Jelena , Jankovic Janko , Kocev Nikola , Tomic-Spiric Vesna , Vasiljevic Nadja
Published: March 2015

Background:

Psoriasis is a chronic skin disease that has a significant impact on patients' lives.

Objective:

The purpose of the study was to assess factors that might influence the health-related quality of life (HRQoL) of patients with psoriasis.

Methods:

We conducted a cross-sectional study of 110 outpatients with psoriasis. To assess the HRQoL, The Short Form 36 Health Survey (SF-36) and Skindex-29 were administered. Stressful life events during the last 12 months were assessed with Paykel's Interview for Recent Life Events.

Results:

HRQoL was significantly more impaired in older patients, those with age at onset of 40 years or more, who had a positive family history and who experienced stressful life events in the 12 months preceding the interview. Sex and clinical severity were not significantly related to patients' HRQoL.

Conclusion:

Psoriasis patients have poorer HRQoL than the general population. This study supports the decision to use both generic and skin-specific instruments to assess the impact of psoriasis on HRQoL.