bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanism of Action, Pharmacokinetics, and Drug Interactions of Etanercept in Dermatology
Authors: Papp Kim A. , Keystone Edward C. , Shear Neil H.
Published: March 2015

Etanercept, a dimeric soluble form of the p75 tumor necrosis factor (TNF) receptor, has been shown to be efficacious for the treatment of psoriatic arthritis and moderate to severe chronic plaque psoriasis, as well as rheumatoid arthritis, juvenile rheumatoid arthritis, and ankylosing spondylitis. In this article, we review the mechanism of action, pharmacokinetics, and drug interactions of etanercept. Differences between etanercept and other anti-TNF antagonists with respect to membrane binding, the effect on T lymphocytes, the effect on the blood-brain barrier, adverse event profiles, and disease efficacy are also discussed.
An Erythrodermic Variant of Pemphigus Foliaceus with Puzzling Histologic and Immunopathologic Features
Authors: Peterson Jennifer D. , Worobec Sophie M. , Chan Lawrence S.
Published: March 2015

Background:

Pemphigus foliaceus is an autoimmune blistering disorder that affects the skin owing to autoantibodies against desmoglein 1.

Methods:

We employed clinical, histologic, immunopathologic, and serum laboratory studies to investigate a case of an erythrodermic variant of pemphigus foliaceus in an elderly man following treatment with bisoprolol-hydrochlorothiazide.

Results:

Early histopathology revealed psoriasiform dermatitis, but later biopsies showed subcorneal and granular layer separation with neutrophilic infiltrate. Direct immunofluorescence showed intercellular deposits of immunoglobulin G throughout the epidermis, granular staining of C3 along the basement membrane zone, and fibrin and C3 deposition around the blood vessels. Indirect immunofluorescence on monkey esophagus showed a titer of greater than 1:1,280. Indirect immunofluorescence on rat bladder, antinuclear antibody, lupus panel, and kidney function panel were all negative.

Conclusion:

There are no reports in the literature of pemphigus foliaceus being induced by bisoprolol, but reports exist of propanolol resulting in drug-induced pemphigus foliaceus.
Observations on the Procedural Aspects and Health Effects of Scarification in Sub-Saharan Africa
Authors: Ayeni Olubimpe A. , Ayeni Olubukunola O. , Jackson Robert
Published: March 2015

Background:

Scarification involves cutting or making an incision into the skin and then allowing the wound to heal, leaving a permanent scar. The purpose of this article is to examine the origins of scarification and its social and medical significance in sub-Saharan Africa.

Methods:

We conducted a computerized search in the MEDLINE electronic database with combinations of the following terms: scarification, tribal marks, keloid, hypertrophic scar, Africa, and sub-Saharan Africa. Inclusion criteria were studies published in English involving human participants. We reviewed the bibliography of each article that met our inclusion criteria for additional relevant studies. We abstracted data on the historical, social, and medical aspects of scarification from eligible studies.

Results:

This review of scarification in sub-Saharan Africa highlights the complex interplay that exists between biology and society. Photographs, artwork, and literary descriptions reveal that scarification results in hypertrophic or atrophic scars, although these types of scars are often mistakenly referred to as keloids. In terms of the procedural aspects of scarification, specific tools and substances were consistently used by various ethnic groups. Although much is known about the history of scarification as a form of identification in Africa, it appears that the practice also had medical applications. Scarification was used to treat conditions such as epilepsy, although it was also known to exacerbate conditions such as sarcoidosis, lichen planus, and psoriasis. Evolving cultural beliefs, in addition to the association of scarification with an increased risk of contracting hepatitis B and human immunodeficiency virus (HIV), are contemporary threats to this long-standing practice.

Conclusions:

Given the remarkably consistent appearance of scars that are described in the literature and depicted in images, scarification does not appear to be a random or accidental occurrence. Instead, it is a deliberate attempt to reproduce a custom that has been perfected after many years of practice in sub-Saharan Africa.
Efficacy of Imiquimod as an Adjunct to Cryotherapy for Actinic Keratoses
Authors: Tan Jerry K.L. , Thomas D. Richard , Poulin Yves , Maddin Frances , Tang Jing
Published: March 2015

Background:

Cryotherapy is the standard of care for clinically apparent (target) actinic keratoses (AKs). Topical imiquimod may reduce initially inapparent or subclinical AKs.

Objective:

We evaluated the potential of topical imiquimod to decrease subclinical AKs after cryotherapy of target AKs.

Methods:

A randomized trial of imiquimod or vehicle twice weekly for 8 weeks following 3- to 5-second cryotherapy of target AKs within a 50 cm2 field at the face or scalp was conducted. Efficacy outcomes included clearance of target, subclinical, and total AKs and proportions clear of AKs. Subjects with residual AKs were offered cryotherapy and open-label imiquimod twice weekly for 8 weeks.

Results:

Sixty-three subjects completed the randomized phase. At 12 weeks, target AK clearance was similar for imiquimod and vehicle (79% vs 76%), but fewer total AKs were noted for imiquimod (78 vs 116). This was due to a progressive reduction in subclinical AKs with imiquimod compared with a progressive increase with vehicle. More subjects treated with imiquimod achieved clearance of subclinical (58% vs 34%; p = .06) and total (23% vs 9%; p = .21) AKs.

Conclusion:

Imiquimod postcryotherapy may increase clearance of subclinical and total AKs and proportions of subjects clear at 3 months. These findings require confirmation in larger controlled trials powered for statistical significance.
Cost Comparisons of Managing Complex Facial Basal Cell Carcinoma: Canadian Study
Authors: Lear William , Mittmann Nicole , Barnes Elizabeth , Breen Dale , Murray Christian
Published: March 2015

Background:

Basal cell carcinoma (BCC) is the most common human malignancy and accounts for over 60,000 new cases of cancer in Canada annually. Although expensive to the health care system, no Canadian studies have reported the costs involved in management. This study calculated the costs of managing high-risk BCCs using radiotherapy (RT) and Mohs micrographic surgery (MMS).

Methods:

Forty-nine consecutive complex BCC cases presenting to a skin cancer referral center were collected prospectively. All were located on the head and neck and were either recurrent disease or located in “at risk” sites such as the eye, ear, lip, or nose. All patients underwent MMS. A radiation oncologist reviewed each case retrospectively. The costs of MMS were the actual costs of the procedure, with an additional amount added to account for the technical costs of the surgery. The costs of RT included physician fees and technical fees. A sensitivity analysis was performed using known recurrence rates from the medical literature.

Results:

Five patients were excluded from the comparative analysis because radiation was not recommended (age < 50 years or radiation would overlap with a previous radiation field). The direct cost of treating a patient with a single BCC was $871 (range $630–1, 159) using MMS and $3,625 (range $3,430–3,971) using RT. The costs were significantly higher for patients with multiple tumors with both modalities ( p = .02 for both). The direct costs of a “5-year cure” were $952 (range $644–1,647) for MMS and $3,758 (range $3,564–4,675) for RT.

Conclusions:

This study attempted to document the costs associated with two well-recognized and effective methods of treating complex BCC in Ontario. Subgroup analysis revealed independent associations between aggressive histology, larger size, and complexity of surgical closure with higher costs. Although we did notice a trend toward greater costs in patients with recurrent disease, in males, younger patients, and tumors present for > 1 year, these did not reach significance within our sample size. Despite the limitation that treatment costs may be center and provincially dependent, we hope this preliminary report will initiate further study into comparing Canadian costs of managing skin cancer.
ISA247: Quality of Life Results from a Phase II, Randomized, Placebo-Controlled Study
Authors: Gupta Aditya K. , Langley Richard G. , Lynde Charles , Barber Kirk , Gulliver Wayne , Lauzon Gilles , Aspeslet Launa J. , Foster Robert T. , Huizinga Robert B. , Yatscoff Randall W.
Published: March 2015

Background:

Psoriasis is a chronic skin condition that can negatively affect a patient's quality of life (QoL), often hindering social functioning. ISA247, a novel psoriatic agent, has shown clinical efficacy in moderate to severe psoriasis sufferers, but its effect on QoL is currently not reported.

Objective:

The objective of this study was to assess the effect of ISA247 on the QoL in patients with stable, plaque-type psoriasis.

Methods:

A phase II, randomized, double-blind, placebo-controlled, parallel-group, multicenter study assessed the effects of ISA247 doses of 0.5 mg/kg/d ( n = 77) or 1.5 mg/kg/d ( n = 83) compared with placebo ( n = 41) for 12 weeks. QoL was assessed using the Dermatology Life Quality Index (DLQI) and Psoriasis Disability Index (PDI) scales.

Results:

ISA247 treatment (pooled groups) significantly improved QoL scores as assessed by both the DLQI and the PDI compared with those receiving placebo ( p < .05). Treatment with the higher dose of 1.5 mg/kg/d demonstrated a significantly greater response to many of the QoL scales compared with the 0.5 mg/kg/d group ( p < .05).

Conclusions:

ISA247 appears to improve the QoL while also providing effective treatment for chronic, moderate to severe, plaque-type psoriasis.
Cutaneous Granulomas with Predominantly CD8+ Lymphocytic Infiltrate in a Child with Severe Combined Immunodeficiency
Authors: Gregoriou Stamatis , Trimis Georgios , Charissi Christina , Kalogeromitros Dimitris , Stefanaki Kalliopi , Rigopoulos Dimitris
Published: March 2015

Background:

Combined immunodeficiency disorders comprise a heterogeneous group of diseases characterized by both humoral and cell-mediated immunodeficiency. Cutaneous granulomas manifestations in children with combined immunodeficiency are rare.

Objective:

We report the case of a 6-year-old boy who presented with disseminated cutaneous granulomas and a history of multiple infections.

Methods and Results:

Laboratory evaluation revealed severe combined immunodeficiency, and deoxyribonucleic acid (DNA) analysis confirmed mutations on a gene of chromosome 19 that encodes an enzyme called Janus kinase 3 (Jak-3). Immunohistochemistry revealed expression of CD8+ in the perivascular lymphocytic infiltrate

Conclusion:

Disseminated granulomatous lesions in children with a history of frequent infections should prompt the clinician to initiate detailed immunocompetence evaluation as they might prove to be the first manifestation of immunologic impairment.
Practical Understanding of Mean Percent Psoriasis Area and Severity Index Reduction for Biologics
Authors: English Penny Lovell , Vender Ronald
Published: March 2015

Background:

Psoriasis in clinical trials is often measured by the Psoriasis Area and Severity Index (PASI). This measurement is well understood by clinical trialists and many dermatologists but rarely by patients and some clinicians. Patients may not understand their chance of improvement based on a PASI-50 or PASI-75 value (50 or 75% improvement in PASI score). They would better understand a PASI average presented as the mean percent improvement in the PASI score from baseline.

Objective and Conclusion:

This article simplifies these terms of reduction from baseline in PASI scores as related to treatment with biologic agents. This may be more meaningful for patients and clinicians when discussing their average chance of improvement.
A Young Man with Fever and Skin Nodules
Authors: Lomaga Mark A. , Walsh Scott
Published: March 2015

Background:

There are two rare variants of cutaneous T-cell lymphoma (CTCL) that primarily involve the subcutis. These include subcutaneous panniculitis-like T-cell lymphoma (SPTL) and cutaneous γ/δ T-cell lymphoma.

Objective:

This case report describes the clinical presentation, diagnosis, and treatment of a young man with probable SPTL. A review of recent literature outlining the differences between SPTL and cutaneous γ/δ T-cell lymphoma is discussed.

Conclusion:

The differential diagnosis in patients presenting with subcutaneous nodules and constitutional symptoms should include CTCL.
Generalized Eruptive Histiocytoma Treated with Isotretinoin
Authors: Kwinter Jennifer , DeKoven Joel
Published: March 2015

Background:

Generalized eruptive histiocytoma (GEH) is a rare, benign non-Langerhans cell histiocytosis characterized by widespread and symmetric skin-colored to blue-red papules on the trunk and proximal extremities affecting mainly adults. GEH is associated with a self-limiting course lasting from 1 month to over 12 years, and the lesions typically resolve spontaneously; therefore, reports of potential therapies for GEH are lacking.

Objective:

We report for the first time the use of isotretinoin in the treatment of GEH. An otherwise healthy 53-year-old female with a 3-month history of GEH had resolution of lesions without further development of new lesions over 8 months of treatment with isotretinoin, although, eventually, lesions began to recur.

Conclusion:

Although there has been success with isotretinoin in the management of Rosai-Dorfman disease and Langerhans cell histiocytosis, further investigation is needed to delineate the exact mechanism of action and future role of isotretinoin in the management of GEH.
Vincristine and Corticosteroids as First-Line Treatment of Kasabach-Merritt Syndrome in Kaposiform Hemangioendothelioma
Authors: Drucker Aaron M. , Pope Elena , Mahant Sanjay , Weinstein Miriam
Published: March 2015

Background:

Historically, patients with the consumptive coagulopathy Kasabach-Merritt syndrome (KMS) have been treated with systemic corticosteroids as first-line therapy, but many patients do not respond. Recently, there have been increasing reports of the use of the chemotherapeutic drug vincristine in these patients.

Objective:

To report a case of a newborn with a kaposiform hemangioendothelioma (KHE) of the right leg associated with KMS treated successfully with vincristine and oral corticosteroids.

Methods:

The patient's chart and the literature on the subject were reviewed using Medline and PubMed.

Results:

Treatment with vincristine and corticosteroids lead to sustained shrinking of the tumor and correction of the thrombocytopenia and coagulopathy through 1 year of age. We believe this is the first report in the North American literature of corticosteroids and vincristine being used concomitantly as first-line therapy for KHE with KMS.

Conclusion:

Vincristine and corticosteroids should be considered first-line treatment for KMS.
Erosive Pustular Dermatosis of the Leg: An Overlooked Entity?
Authors: Seckin Dilek , Gurbuz Oya , Demirkesen Cuyan
Published: March 2015

Background:

Erosive pustular dermatosis is a distinctive clinical entity that has been described on either the scalp or legs. Chronic, shallow erosions covered by yellow crusts develop in atrophic or fibrotic skin. The scalp is the most commonly encountered localization, whereas erosive pustular dermatosis of the leg has also been reported in several cases. The histopathologic picture is nonspecific, and the disease is usually considered as a diagnosis of exclusion.

Objective and Conclusion:

We report two patients with erosive pustular dermatosis of the leg who were unresponsive to antibacterial and antifungal medications but were successfully treated with systemic steroids in combination with topical pimecrolimus in one of them and topical clobetasol in the other. The condition is simply overlooked, which accounts for its rare description in literature.
Coexistence of Acral Syringomas and Multiple Trichoepitheliomas on the Face
Authors: Balci Didem Didar , Atik Esin , Altintas Suleyman
Published: March 2015

Background:

An extremely rare variant of syringoma is an acral form, which affects the upper extremities as an isolated finding. The acral syringomas may also be associated with syringomas on the feet or usual distribution around the eyelids. Of the eight previously documented cases of acral syringomas, all were located on the dorsal aspect of the upper extremities (fingers, hand, wrist, or forearm) dominantly.

Objective:

We report a 41-year-old woman who presented with multiple flesh-colored to reddish brown papules on the inner aspect of the forearms and many pearly, small papules on the periorbital regions.

Results:

The clinical picture and histopathology indicated the coexistence of acral syringomas and multiple trichoepitheliomas on the face.

Conclusion:

To the best of our knowledge, this is the first case of acral syringomas coexisting with multiple trichoepitheliomas.
Nail Psoriasis and Biologics
Authors: Noiles Kristin , Vender Ronald
Published: March 2015

Background:

Since the advent of biologic therapies for psoriasis, reports of efficacy in nail psoriasis have appeared in the literature and at international conferences with increasing frequency.

Objective:

This article aims to review the existing literature on the use of biologics in the treatment of nail psoriasis.

Methods:

An extensive literature review was conducted using OVID Medline. Studies examining the efficacy of biologics in the treatment of nail psoriasis were documented.

Results:

A literature review revealed few clinical trials specifically concentrating on nail psoriasis; however, nails have been assessed in larger clinical trials for cutaneous psoriasis. A large, multicenter, phase III, double-blind, placebo-controlled study of infliximab administered as a brief induction regimen at weeks 0, 2, and 6 followed by a single infusion every 8 weeks revealed statistically significant mean percent improvement in the Nail Psoriasis Severity Index (NAPSI) score over placebo at both week 10 (26.8% vs −7.7%, respectively; p < .001) and week 24 (57.2% vs −4.1%, respectively; p < .001). For other biologics, evidence has thus far been largely anecdotal, appearing as either case studies or extracted secondarily from open-label prospective trials in plaque psoriasis or psoriatic arthritis.

Conclusion:

Infliximab appears to be the most effective treatment for nail psoriasis to date.
Compatibility of Tacrolimus Ointment with Corticosteroid Ointments of Varying Potencies
Authors: Pappas Lisa , Kiss Alex , Levitt Jacob
Published: March 2015

Background:

Tacrolimus is often coadministered with various topical corticosteroids in the treatment of steroid-responsive dermatoses; however, the stability of these products in combination has not been examined extensively.

Objective:

To assess the in vitro compatibility of three tacrolimus-corticosteroid ointment combinations compared with unmixed controls.

Methods:

Tacrolimus-clobetasol propionate, tacrolimus-desoximetasone, and tacrolimus-hydrocortisone-17-valerate ointment combinations were prepared, stored with unmixed ointments at three temperature/humidity conditions, and evaluated for stability at days 0, 1, 2, 7, 14, and 28 via reverse-phase high-performance liquid chromatography.

Results:

There was no significant difference in the rate of drug degradation in mixed and unmixed ointments over time or across temperatures for tacrolimus (time p = .94; temperature p = .44), clobetasol (time p = .98, temperature p = .30), desoximetasone (time p = .98; temperature p = .94), or hydrocortisone-17-valerate (time p = .87, temperature p = .36).

Limitations:

This study did not examine the compatibility of tacrolimus with nonointment formulations.

Conclusion:

Tacrolimus-clobetasol propionate (superpotent), tacrolimus-desoximetasone (high potent), and tacrolimus-hydrocortisone-17-valerate (midpotent) ointment combinations are chemically compatible for at least 4 weeks.
Chronic Actinic Dermatitis: Clinical Cases, Diagnostic Workup, and Therapeutic Management
Authors: Beach Renée A. , Pratt Melanie D.
Published: March 2015

Background:

We report four cases of chronic actinic dermatitis (CAD) occurring in middle-aged men with significant outdoor exposure.

Objective:

The aim of this report is to show the spectrum of presentations of patients with CAD and to outline the proper diagnostic workup of these individuals.

Methods:

Phototesting was performed to determine the minimal erythema doses to ultraviolet (UV)A (315–400 nm) and UVB (280–315 nm) and photopatch testing and patch testing for each individual with the North American Contact Dermatitis Group Standard series and the Chemotechnique Plant series, supplemented by the Hausen Plant series and the patients' own products.

Results:

All patients were men, over 45 years, who worked outdoors or had outdoor hobbies. Two had a past known history of allergic contact dermatitis. Two had atopic dermatitis. Three had positive reactions to Compositae plants and sesquiterpene lactone; one had a reaction to lichen acid mix. All had photocontact dermatitis or contact dermatitis to sunscreen chemicals, including benzophenone 3 (oxybenzone), butyl methoxydibenzoylmethane (avobenzone), and ethylhexyl methoxycinnamate (octinoxate). All reacted to fragrance mix; two reacted to balsam of Peru and two to colophony. All had biopsies showing an eczematous pattern.

Conclusion:

CAD is persistent, with a classic presentation, and requires a specific diagnostic workup. Effective therapeutic options exist for patients with CAD.
Familial Coexisting and Colocalized Psoriasis and Vitiligo Responding to Alefacept
Authors: Al-Mutairi Nawaf , Al-Doukhi Azari
Published: March 2015

Background:

Psoriasis is an immune-mediated, chronic, inflammatory disease that significantly impairs both physical and emotional aspects of an individual's quality of life. Vitiligo leads to depigmentation of skin, in which some or all melanocytes in the interfollicular epidermis and occasionally those in the hair follicles are selectively destroyed. The coexistence of the two disorders is rarely seen.

Objective:

To report two cases of the rare coexistence of psoriasis and vitiligo in a family.

Methods:

After providing informed written consent, both patients were given alefacept 15 mg/kg weekly injections for 12 weeks. The patients were monitored both clinically and with all relevant laboratory investigations. These patients were then followed up once a month for 2 years.

Results:

Treatment with alefacept led to complete clearance of vitiligo along with the expected improvement in psoriasis. In the 2-year follow-up, vitiligo did not recur, although psoriasis relapsed and was appropriately treated.

Conclusion:

Use of alefacept in vitiligo may turn out to be a possible novel off-label treatment option in vitiligo. But the results need to be reproduced in larger studies
Contact Sensitivity to Aluminum
Authors: Brodbaker Elliott , Pratt Melanie
Published: March 2015

Purpose:

To report two cases of aluminum contact dermatitis caused by different sources.

Methods:

Two patients were patch-tested for suspected contact sensitivities.

Results:

The results of patch testing revealed aluminum contact dermatitis reactions in both patients.

Conclusion:

Aluminum contact dermatitis is a rare finding with many possible etiologies. One should consider aluminum sensitivity when all patch test sites are positive when using aluminum Finn Chambers.
Spiradenocarcinoma Arising from a Spiradenocylindroma: Unusual Case with Lymphoepithelioma-Like Areas
Authors: Chetty Runjan , Perez-Ordonez Bayardo , Gilbert Ralph , Pagedar Nitin A. , Waldron John , Ghazarian Danny
Published: March 2015

Background:

Hybrid skin adnexal tumors are common, and spiradenocylindroma is well described.

Objective:

However, malignant transformation in this setting is infrequent, especially resemblance to lymphoepithelioma-like carcinoma of skin, which is not associated with Epstein-Barr virus.

Methods:

A 65-year-old female presented with ataxia and a skin nodule composed of a hybrid adnexal tumor (spiradenoma and cylindroma) that transitioned into an undifferentiated carcinoma with attendant lymphocytes and plasma cells. There was widespread dissemination of the undifferentiated component to regional neck lymph nodes.

Results:

The undifferentiated component resembled a lymphoepithelioma-like carcinoma and showed focal evidence of tubular and squamous differentiation. The tumor was Epstein-Barr encoded RNAs (EBER) negative by in situ hybridization. No evidence of neuroendocrine differentiation was seen in the tumor, despite the patient having symptoms of paraneoplastic ataxia that improved after surgery.

Conclusion:

This case highlights the transition of a benign hybrid tumor (spiradenocylindroma) into a spiradenocarcinoma that resembled lymphoepithelioma-like carcinoma of skin. It also highlights two unusual features: widespread lymph node dissemination and presentation with paraneoplastic syndrome-associated ataxia.
Verrucous Hemangioma: A Challenging Vascular Lesion
Authors: Lara-Corrales Irene , Somers Gino R. , Ho Nhung
Published: March 2015

Background:

We present a case of a 13-year-old girl with a congenital vascular lesion in her right ankle.

Results and Conclusions:

Clinical and pathologic examinations led to the diagnosis of a verrucous hemangioma, a distinct, uncommon vascular lesion. The appearance of verrucous hemangiomas evolves with time and may represent a diagnostic challenge. We present this case report and a review of the literature.
Fact or Fiction: Does the Non-HIV/AIDS: Immunosuppressed Patient Need Pneumocystis Jiroveci Pneumonia Prophylaxis? An Updated Literature Review
Authors: Grewal Parbeer , Brassard Alain
Published: March 2015

Background:

Pneumocystis jiroveci pneumonia (PJP) is a potentially fatal fungal infection occurring in immunocompromised patients.

Objective:

To determine whether PJP prophylaxis is required in the non-human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) immunocompromised patient and, if so, the optimal prophylactic therapy.

Methods:

A thorough literature review, with the appropriate MeSH terms, was conducted using PubMed, Medline, and The Cochrane Database. A number of cases describing PJP in patients with various systemic diseases and immunosuppressive medications, along with a Cochrane review, were highlighted.

Results:

Although there are a number of case reports in the literature, the only collagen vascular disease with an increased incidence of PJP is Wegener granulomatosis. Oral trimethoprim-sulfamethoxazole continues to be the prophylaxis of choice for PJP.

Conclusion:

There is currently no evidence to recommend PJP prophylaxis in the non-HIV/AIDS immunocompromised population. If physicians do decide to use prophylaxis, they should always weigh the benefits with the potential risks. Further studies are needed to better quantify the risks of PJP with immunosuppressive medications.
Evaluation of a Telehealth Clinic as a Means to Facilitate Dermatologic Consultation: Pilot Project to Assess the Efficiency and Experience of Teledermatology Used in a Primary Care Network
Authors: Ludwick David A. , Lortie Charles , Doucette John , Rao Jaggi , Samoil-Schelstraete Christine
Published: March 2015

Background:

Primary care offices spend considerable time coordinating the specialist referral process. Patients experience long wait times for consultation and intervention.

Objective:

To determine if telehealth combined with interdisciplinary team–based care can reduce wait times for dermatologic consultation while making the consultation process easier for physicians.

Methods:

Retrospective chart reviews as well as patient, referring physician, nonreferring physician, clinic physician, nurse, and teledermatologist interviews were used to evaluate the clinic. A comparative immersion approach generated themes from field notes. Wait times, appointment times, and encounter durations were measured.

Results:

Twenty-eight patients were seen (23 had previous specialist referral experience) within 1 week of referral compared to a wait period of 104 days for conventional referral. Patients requiring intervention were treated within 1 week of their initial appointment. Referring practitioners were concerned that they would lose control of patients' care. An easier referral process and faster intakes met physician expectations.

Conclusions:

Teledermatology improves the timeliness of appointments. Patients forgo face-to-face appointments if alternatives are available sooner. Physicians are concerned about their own liability if dermatologists do not assess the patient in person but will refer through teledermatology when patients are seen faster and they remain in control of the care process.
The Case for Early Detection of Melanoma
Authors: Rivers Jason K. , Wulkan Sarah
Published: March 2015

Background and Objective:

The incidence and mortality from melanoma continue to rise worldwide. Unfortunately, there is still no consistently effective treatment for metastatic disease. The fact that survival for melanoma has increased dramatically over the last 30 years highlights the importance of early detection of this malignancy.

Conclusion:

With continued public education and the advent of new technologies, it is hoped that we will be able to improve on what has been accomplished to date to reduce the health burden of melanoma even further. This article reviews issues related to patient and physician detection of melanoma and highlights newer technologies being used for this purpose.
Type I Pityriasis Rubra Pilaris: Upregulation of Tumor Necrosis Factor α and Response to Adalimumab Therapy
Authors: Zhang Yao-Hua , Zhou Youwen , Ball Nigel , Su Ming-Wan , Xu Jin-Hua , Zheng Zhi-Zhong
Published: March 2015

Background:

Pityriasis rubra pilaris (PRP) has unknown etiology and is often refractory to conventional therapies.

Objective:

To document a PRP patient's response to adalimumab therapy and to highlight the potential role of tumor necrosis factor (TNF) in the development of PRP skin lesions.

Methods:

A patient received adalimumab therapy at standard dosing intervals. In addition, the messenger ribonucleic acid (mRNA) of TNF in the lesional and perilesional normal skin was quantified in two patients with PRP.

Results:

The patient responded to adalimumab therapy and achieved clinical remission by 4 months. There was a significant elevation of TNF mRNA in the lesional skin of PRP.

Conclusion:

TNF upregulation is detected in PRP lesional skin, consistent with the observed clinical efficacy of TNF blockade for the treatment of PRP.
The Amazing Vanishing Canadian Dermatologist: Results from the 2006 Canadian Dermatology Association Member Survey
Authors: Chow Eunice Y. , Searles Gordon E.
Published: March 2015

Background:

The 2006 Canadian Dermatology Association (CDA) member survey tracked the Canadian dermatology workforce. Information on use of nondermatologist extenders, impact of financial burden on practice style, and wait times was collected in the survey.

Objective:

To survey Canadian dermatologists for specialty-specific physician resource information including demographics, workload, and future career plans and compare it to results from the 2001 survey. In addition, to explore three other areas not covered in the previous survey: patient access to dermatologic care through wait times, the use of nondermatologist extenders, and potential impact of educational financial debt on practice styles.

Methods:

CDA members in 2006 were surveyed by mail. Follow-up mailings were done for nonresponders. Survey results were compared to those of the 2001 survey.

Results:

Thirty-six percent (216 of 602) of Canadian dermatologists responded (70% in 2001). The national distribution was identical between surveys. The median age increased to 55 years; two-thirds of dermatologists are male. The median retirement age remained at 65 years. There was a shift from rural to urban practice locations; 78% practice in private offices. Three-fifths of dermatologists do mainly medical dermatology, a decrease between surveys. Pediatric dermatology decreased 10%, whereas surgical dermatology increased 52% between surveys. Fewer practitioners perform noninsured services, and half as many perform research or hospital consultations or teach medical students. Financial debt burden had no impact on selection of practice style. Median wait times for nonurgent consultations doubled from 5 to 10 weeks; follow-up visits increased from 4 to 5 weeks; noninsured consultations increased from 4 to 5 weeks. The national median wait time for a third available consultation appointment was 42 days (range 7–161 days). Seventeen percent of dermatologists reported using nondermatologist extenders. Training programs produce only 60% of new practitioners needed to replace retirees over the next 5 years. Existing training programs are at full capacity, and only the creation of new programs can expand training capacity.

Conclusions:

Although the face of Canadian dermatology shows a productive specialty committed to patient care, teaching, and research, the demographics of the Canadian baby boom generation will have a major negative impact on the effectiveness of Canadian dermatology in the service of the Canadian population. The attrition rate predicted in the 2001 survey and validated by the 2006 survey spotlights the critical imperative for the specialty to adapt to the future of a shrinking workforce in the face of expanding demand for its services.
Recurrent Bullous Scabies
Authors: Serra David , Reis José Pedro , Mariano Angelina , Machado Álvaro , Figueiredo Américo
Published: March 2015

Background:

Scabies is a common infestation that usually presents as a pruriginous eruption consisting of erythematous papules, nodules, and excoriations. Diagnosis relies mostly on clinical features, including the identification of scabietic burrows. Several atypical clinical manifestations have been reported; bullous presentations are particularly rare and intriguing.

Objective:

A case of recurrent bullous scabies is reported.

Methods and Results:

An 87-year-old institutionalized woman developed a pruriginous eruption that mimicked bullous pemphigoid. Histopathologic examination revealed blistering at the subepidermal level and a mixed inflammatory infiltrate with numerous eosinophils. Scabies mites were identified on dermoscopy and on skin scrapings, allowing a diagnosis of bullous scabies. Despite effective treatment with topical lindane, failure to control scabies in her institution led to recurrences of her peculiar blistering infestation. Immunofluorescence studies were always negative.

Conclusions:

These observations underscore the mite's role in the pathogenesis of blister formation and illustrate current challenges in scabies' diagnosis and management.
Chronic Cutaneous Graft-versus-Host Disease Manifesting as Calcinosis Cutis Universalis on a Background of Widespread Sclerodermatoid Changes
Authors: Man Jeremy , Kalisiak Michal , Birchall Iain W.J. , Salopek Thomas G.
Published: March 2015

Background:

The cutaneous manifestations of graft-versus-host disease (GVHD) can be classified into acute and chronic forms. Acute GVHD is defined as a skin eruption that manifests within 100 days of transplantation, whereas chronic GVHD refers to cutaneous changes that appear 100 days or more posttransplantation.

Objective:

Although most chronic forms fall within lichenoid and sclerodermoid forms, there is a multitude of less common presentations. These include xerosis, follicular prominence, ichthyosis, and pityriasis rosea–like, eczematous, or psoriasiform lesions.

Conclusions:

We report a previously unreported manifestation of chronic cutaneous GVHD, specifically calcinosis cutis universalis on a background of sclerodermoid changes.
Development and Validation of a Scale for Acne Scar Severity (SCAR-S) of the Face and Trunk
Authors: Tan Jerry K.L. , Tang Jing , Fung Karen , Gupta Aditya K. , Thomas D. Richard , Sapra Sheetal , Lynde Charles , Poulin Yves , Gulliver Wayne , Sebaldt Rolf J.
Published: March 2015

Background:

Scarring is an important component of overall acne severity, but there are no global scales for its evaluation inclusive of the face and trunk.

Objective:

Our objective was to develop a global scale for acne scar severity inclusive of the trunk and the face.

Methods:

A six-category global severity scale (SCAR-S) was developed for assessment of acne scarring at each of the face, chest, and back. We evaluated SCAR-S against acne severity and patient-reported scar severity.

Results:

Of 973 subjects, 73% reported acne scarring. Self-assessment of scarring was associated with facial SCAR-S and overall SCAR-S scores ( p < .001, r = .31 and .30, respectively). Acne scarring was observed at the face in 87%, the back in 51%, and the chest in 38%. Clinically relevant scarring (mild or greater) at each of these regions was 55%, 24%, and 14%, respectively. Acne severity correlated with SCAR-S ( p < .001) for the back ( r = .612), the chest ( r = .548), and the face ( r = .514). Acne duration correlated with patient-reported severity of scarring ( r = .244) and overall SCAR-S scores ( r = .152). Clinically relevant scarring increased with acne duration.

Conclusion:

SCAR-S is a practical, validated, global system for acne scar evaluation and is clinically relevant in overall severity grading of acne.
Acute Generalized Exanthematous Pustulosis in a Patient after Stem Cell Transplantation
Authors: Cetkovská Petra , Benáková Nina
Published: March 2015

Background:

A severe generalized pustular eruption occurred several months after allogeneic hematopoietic stem cell transplantation for multiple myeloma in a patient being treated with antibiotics for respiratory infection. Neither he nor his donor had a history of psoriasis.

Methods:

The patient was treated with drug withdrawal and administration of cyclosporine and methylprednisolone without improvement; later, acitretin and methylprednisolone were used successfully. The eruption slowly subsided, and therapy was discontinued. Four months later, the patient experienced a recurrent severe pustular eruption associated with fever and leukocytosis, and the same treatment was used successfully again.

Results and Conclusion:

The patient has not experienced relapses in the ensuing 3 years. Acute generalized exanthematous pustulosis is a rare cutaneous adverse reaction triggered most commonly by drugs with a tendency to resolve spontaneously. The surprisingly prolonged, refractory, and relapsing course of the eruption in our patient might be due to the immune alteration and the polypharmacologic therapy after stem cell transplantation.

Antécédents:

Une éruption pustulaire généralisée aiguë s'est produite chez un patient traité aux antibiotiques contre une infection respiratoire, plusieurs mois après une allogreffe de cellules souches hématopoïétiques pour myélome multiple. Ni le patient ni le donneur n'ont des antécédents de psoriasis.
Progressive Mucinous Histiocytosis: Importance of Electron Microscopy to Confirm Diagnosis
Authors: Hemmati Iman , McLeod W. Alastair , Crawford Richard I.
Published: March 2015

Background:

Progressive mucinous histiocytosis (PMH) is a benign, non-Langerhans cell histiocytosis with characteristic ultrastructural features that can be used for diagnosis. Once an important tool in dermatologic diagnosis, electron microscopy has been largely replaced by immunohistochemistry and immunofluorescence techniques today. However, electron microscopy occasionally still plays a crucial role in the diagnosis of dermatologic conditions. We report a case of PMH as an example of a dermatologic disorder that requires electron microscopy for its diagnosis.

Methods:

A 60-year-old woman presented to our clinic with a history of small, sharply demarcated, skin-colored papules ranging from 2 to 5 mm in diameter distributed over the arms, forearms, and dorsal hands. The results of light microscopy, immunohistochemical studies, and clinical examination were inconclusive. Another biopsy for electron microscopy showed the characteristic features of PMH.

Conclusion:

This case demonstrates that a dermatopathology service still needs to have access to electron microscopy for diagnostic purposes to successfully diagnose a small number of rare conditions.
Chemical Leukoderma Induced by Herbal Oils
Authors: Ghosh Sudip Kumar , Bandyopadhyay Debabrata
Published: March 2015

Background:

Chemical leukoderma (CL) may result from repeated exposure to specific chemical compounds such as industrial chemicals, cosmetics, and personal articles. The incidence of CL is reportedly increasing rapidly in developing countries.

Objective:

Two cases of chemical leukoderma arising out of use of herbal oils on the scalp and breasts are described.

Conclusion:

We emphasize the importance of a detailed history regarding possible exposure to chemical agents in patients with depigmented lesions, mainly in adults.
Anatomic Location of Basal Cell Carcinomas May Favor Certain Histologic Subtypes
Authors: Betti Roberto , Radaelli Giovanni , Bombonato Caterina , Crosti Carlo , Cerri Amilcare , Menni Silvano
Published: March 2015

Background:

Differences in age, site, and subtype exist in basal cell carcinoma (BCC).

Objective:

To evaluate whether an independent association exists between the anatomic location and the histologic subtype of BCC.

Materials and Methods:

A series of 3,254 BCCs was examined. The location was the head/neck ( n = 1,766), limbs ( n = 362), trunk ( n = 1,113), or genitals ( n = 13). Subtype was classified as superficial, nodular, micronodular, morpheic-infiltrative, or fibroepithelial.

Results:

Prevalence of BCCs on the head/neck or chest/abdomen increased with age ( p < .001). The prevalence of superficial subtype decreased with age ( p < .0001), whereas the prevalence on nodular subtype increased ( p < .0001). Subtype was associated with location ( p < .0001). The prevalence of superficial subtype was lower among BCCs on the head/neck than other locations (24.9% vs 64.4%, OR 0.18, 95% CI 0.16–0.21). The prevalence of nodular or morpheic/infiltrative subtype was higher among BCCs on the head/neck than other locations, that is, 57.1% versus 29.2%, OR 3.23, 95% CI 2.79 to 3.74 (nodular) and 16.1% versus 4.0%, OR 4.56, 95% CI 3.42 to 6.08 (morpheic/infiltrative).

Conclusion:

Anatomic location and subtype of BCC were associated with age, but the anatomic location was the only independent predictor of histologic subtype. Although a bias by referral patterns may not be excluded, the results suggest that the anatomic location may favor the development of particular BCC subtypes.
Short-Scar Surgical Approach for the Treatment of Glomus Tumor of the Digit
Authors: Cigna Emanuele , Palumbo Francesca , De Santo Liliana , Zampieri Andrea Edoardo , Soda Giuseppe
Published: March 2015

Background:

A glomus tumor is a biologically benign neoplasm. The traditional surgical approach to treat this tumor boasts the lowest recurrence rates but may cause nail deformities.

Objective:

A short-scar surgical approach was applied, with the aim of preserving the aesthetics of the nail.

Methods:

Between January 1999 and January 2009, 25 patients who underwent surgery for a glomus tumor were included in the study. All patients underwent radical resection with three different surgical approaches based on the location of the tumor.

Results:

All patients who were operated on had complete regression of pain immediately after surgery and at postsurgery follow-ups.

Conclusion:

The treatment of glomus tumors consists of surgical excision, which is successful if properly executed. Excision of sensitive afferent nervous fibers is a prerequisite to achieve regression of pain. A short-scar surgical approach ensures complete eradication of the tumor and preservation of nail aesthetics.
The Origins of Western Dermatology
Authors: Ross J. Barrie
Published: March 2015

Objective:

On the premise that historical background makes the present more understandable, this review covers the origins of Western dermatology from its Greek and Roman origins through the Middle Ages to the defining moments in the late eighteenth century.

Background and Conclusion:

The development of major European centers at this time became the background for future centers in the eastern United States in the midnineteenth century and, finally, to the West Coast of the United States and Canada by the midtwentieth century.
Canadian Hand Dermatitis Management Guidelines
Authors: Lynde Charles , Guenther Lyn , Diepgen Thomas L. , Sasseville Denis , Poulin Yves , Gulliver Wayne , Agner Tove , Barber Kirk , Bissonnette Robert , Ho Vincent , Shear Neil H. , Toole Jack
Published: March 2015

Background:

Hand dermatitis (HD) is one of the most common skin conditions; however, it is not a homogeneous disease entity. The severity of HD may range from very mild cases to severe chronic forms, which may result in prolonged disability and, occasionally, refractory HD. Chronic hand dermatitis (CHD) is associated with a high health- economic burden and significant loss of quality of life.

Objective:

Although numerous treatment options are available, the management of CHD is often difficult and unsatisfactory. There is a paucity of well-designed, randomized, controlled clinical trials in support of the efficacy of established treatment modalities.

Conclusion:

These guidelines cover the epidemiology, burden, quality of life, etiology, diagnosis, classification, and prevention of HD and provide guidance on management using an approach that is as evidence based as possible.
Long-Term Prognosis and Comorbidities Associated with Psoriasis in the Newfoundland and Labrador Founder Population
Authors: Gulliver Wayne P. , MacDonald Don , Gladney Neil , Alaghehbandan Reza , Rahman Proton , Baker K. Adam
Published: March 2015

Background:

Psoriasis is a common chronic immune-mediated inflammatory disorder of the skin with several associated comorbidities.

Objective:

To assess the prevalence of comorbidities in a cohort of psoriasis patients within the Canadian province of Newfoundland and Labrador (NL).

Methods:

This cross-sectional observational study investigated hospital-coded comorbidities associated with psoriasis in comparison to the general NL hospitalized population.

Results:

Patients died significantly younger than the general population, with patients having an earlier disease onset (≤ 25 years) dying at a younger age than those with a later onset (> 25 years; 59.3 vs 71.2; p = .001). Patients were hospitalized more frequently for several system disorders than the general population, and a potential association was observed between prognostic factors such as age at onset, disease severity, and HLA-Cw6 genotype and certain comorbid conditions.

Conclusion:

This study supports an association between psoriasis and other conditions, such as circulatory and endocrine diseases.