bluuebunny/crossref_metadata_2025 huggingface dataset:
Itraconazole and Terbinafine Treatment of Some Nondermatophyte Molds Causing Onychomycosis of the Toes and a Review of the Literature
Authors: Gupta Aditya K. , Gregurek-Novak Teodora , Konnikov Nellie , Lynde Charles W. , Hofstader Sophie , Summerbell Richard C.
Published: July 2017

Background:

Onychomycosis may be caused by dermatophytes (which form the majority of organisms), Candida species, and nondermatophyte molds.

Objective:

To evaluate the efficacy and safety of itraconazole and terbinafine in the treatment of some nondermatophyte molds that cause toe onychomycosis and to review the literature on the treatment of nondermatophyte mold toe onychomycosis using the oral antifungal agents.

Patients and Methods:

Patients with nondermatophyte mold toe onychomycosis were treated in an open, prospective manner with either itraconazole (pulse) or terbinafine therapy. In each instance, light microscopic examination was consistent with the diagnosis of a nondermatophyte mold. For each patient, mycological evaluation of the target nail resulted in 3 or more successive cultures yielding growth of the mold alone.

Results:

All 15 patients had onychomycosis of the toes which was of the distal and lateral type. The patients were treated with itraconazole given as the standard 3 pulses with additional pulses administered depending upon the response exhibited by the toe onychomycosis in the patient. Similarly, terbinafine was given for 12 weeks with additional therapy administered as dictated by the response. Efficacy parameters were mycological cure (MC) and clinical cure (CC). Mycological cure was negative light microscopic examination (KOH) and culture. Clinical cure was the appearance of a completely normal-looking nail. At month 12 from the start of treatment, the response was as follows: Scopulariopsis brevicaulis: itraconazole (MC 4/4, CC 2/4) and terbinafine (MC 0/1, CC 0/1), Fusarium species: itraconazole (MC 1/1, CC 1/1) and terbinafine (MC 0/1, CC 0/1), Aspergillus species: itraconazole (MC 5/6, CC 3/6), Alternaría alternata: itraconazole (MC 0/1, CC 0/1), and Onychocola canadensis: itraconazole (MC 1/1, CC 0/1). There were no significant clinical or laboratory adverse effects.

Conclusions:

In the present series itraconazole demonstrated efficacy against onychomycosis of the toenails caused by 5. brevicaulis and Aspergillus species. A review of the literature confirms our experience with itraconazole and further suggests that terbinafine may also demonstrate efficacy against cases of S. brevicaulis and Aspergillus toe onychomycosis. Additionally, reports in the literature suggest that pedal onychomycosis caused by Fusarium species may also show response to itraconazole and terbinafine. For the other species, there are fewer data, making it difficult to draw conclusions.
Microscopic Acanthosis Nigricans in Type 2 Diabetes
Authors: McManus R. M. , Gottschalk R. , Alanen K. , Shum D. T. , Grundy P.
Published: July 2017

Background:

Acanthosis nigricans (AN) has been associated with insulin resistance. Individuals with type 2 diabetes are insulin-resistant and, therefore, could be expected to manifest AN. However, the prevalence and predictors of AN are unknown in this population.

Objective:

An outpatient population with Type 2 diabetes (DM) was compared with matched controls (C) for microscopic and clinical AN along with measurement of body habitus, insulin, glucose, and androgen levels.

Methods:

Twenty-four individuals with DM (12M, 12F) from a tertiary care center were compared with 24 C (12M, 12F). Fasting glucose, insulin, sex hormone binding globulin, androstenedione, dihydroepiandrosterone sulfate, and testosterone were measured. Height, weight, waist/hip measures, and a clinical survey for acanthosis were recorded. A 2-mm skin biopsy from midaxilla of the nondominant arm was taken for pathological review.

Results:

C and DM were matched for age and body mass index (BMI). Prevalence of microscopic AN in C was 12% (3/24) and in DM was 21% (5/24; NS). In C, AN was predicted by waist, waist/hip ratio, and fasting insulin measures, while none of the variables examined was predicative of AN in DM.

Conclusions:

Microscopic acanthosis nigricans was found in similar numbers of people with DM when compared with C. Fasting insulin levels most strongly predicted the presence of AN in C, while no significant predictors of AN were found in the population with DM.
Are Cutaneous Reactions to Fly Larvae Mediated by CD4+, TIA+ NK1.1 T Cells?
Authors: Norwood Christopher , Smith Kathleen J. , Neafie Ronald , Skelton Henry
Published: July 2017

Background:

Although there have been reports of fly larvae in wounds and as isolated primary infestations, there have been only rare reports documenting reactions to the larvae within the skin in humans and animals. There have been no reports documenting the histopathologic and immunohistochemical characteristics of the inflammatory infiltrate.

Objective:

We present a patient who developed local pruritus, erythema, and swelling approximately three weeks after infestation by a fly larva within the scalp. Histopathologically the biopsy site showed a mixed infiltrate containing lymphoid cells and numerous eosinophils. Immunohistochemical stains showed predominantly CD4+ T cells expressing an αβ T-cell receptor (TCR) of which approximately 30% coexpressed T-cell intracellular antigen (TIA) and CD56. In addition, there were approximately 5% of these CD4+ T cells which coexpressed CD30.

Conclusions:

Histopathologic and immunohistochemical findings are consistent with an effector cell population of cytotoxic CD4+ T cells that produce a T-helper 2 cytokine pattern. The phenotype of this subset of T cells is unique and among its characteristics is that antigens—usually nonprotein antigens—are presented to these CD4+, TIA+ natural killer (NK)1.1T cells by CD1d molecules.
Pyogenic Granuloma: Pyogenic Again? Association between Pyogenic Granuloma and Bartonella
Authors: Lee Joyce , Lynde Charles
Published: July 2017

Background:

Pyogenic granulomas (PG) are benign vascular lesions which were thought to have an infectious etiology, yet none has been found. Bacillary angiomatosis (BA), which presents as disseminated vascular lesions in immunosuppressed patients, and verruga peruana (VP), which presents as crops of vascular nodules in immunocompetent persons, are caused by infection with Bartonella. Thus, the question was raised whether Bartonella could be associated with the development of PG, also a vasoproliferative lesion like BA and VP. The objective of this study was to determine through a case-control study whether such an association exists.

Methods:

Patients who presented with PG and age and sex-matched controls with capillary hemangiomas and senile (cherry) angiomas were tested for serum IgG antibodies against Bartonella using an immunofluorescence antibody method. The prevalence of positive serology was compared between the groups.

Results:

Twenty PG patients and 20 control patients with hemangiomas or angiomas were studied. Six out of 20 PG patients tested positive (30%), while none of the 20 control patients tested positive (0%). The difference between the proportions of seropositivity in the two groups reached statistical significance ( p = 0.02, df= 1).

Conclusions:

Pyogenic granuloma patients were determined to have a statistically higher prevalence of Bartonella seropositivity compared with control patients. Further studies are needed to confirm the association and establish a possible etiological link. Such an association could have potential therapeutic importance. A nonsurgical approach with antibiotics may be possible and may decrease the recurrence rate and occurrence of satellite lesions.
Attitudes of Female Patients regarding Oral Contraceptives for Treatment of Acne
Authors: Tan Jerry K. L. , Vasey Kirsten , Fung Karen Y.
Published: July 2017

Background:

Two hormonal agents with contraceptive properties are currently indicated in Canada for treatment of acne.

Objective:

The purpose of this study was to determine the attitudes and concerns of female patients regarding the use of hormonal agents and oral contraceptives in treatment of acne.

Methods:

A self-completed questionnaire was administered to all female acne patients of a community-based dermatologist over a 10-week period between June and August 1999. Statistical analysis was performed by chi-square testing at the 5% significance level.

Results:

Eighty-six percent recognized that oral contraceptives (“birth control pills”) were also used as a treatment for acne and 60% were willing to use this form of treatment. The most common concern regarding the use of oral contraceptives were side effects (80%). Younger patients were seven times more likely to be concerned about potential disapproval or misunderstanding on the part of others regarding the use of these medications ( p ∼ 0.01).

Conclusion:

Female acne patients recognize that oral contraceptives are useful in treatment of acne. Although side effects of these medications are of general concern, social disapproval is of particular concern to younger patients.
Review of Ivermectin in Scabies
Authors: Vaidhyanathan Usha
Published: July 2017

Background:

Currently available topical medications for scabies are messy and need prolonged application. This leads to poor patient adherence. Emerging drug resistance to topical scabicides has made eradication of scabies difficult.

Objective:

Availability of an effective oral scabicidal agent, ivermectin (Ivm), opens a new era in the management of scabies. This review summarizes the published literature on the use of ivermectin in the treatment of scabies.

Conclusion:

A single oral dose of ivermectin of 200 μg/kg body weight is very effective in the treatment of human scabies. A second dose 7–10 days later substantially improves the cure rate. This suggests that ivermectin may not be effective against all the stages in the life cycle of the parasite. Endemic and epidemic scabies in institutions are better treated with Ivm. Crusted scabies ideally should be treated with a combination of Ivm and topical scabicides. Other standard measures and precautions should be taken. Additional controlled studies using a higher single oral dose or using parenteral or topical forms of Ivm are needed. The safety of Ivm in children less than 5 years old and in pregnant women has to be established. The U.S. FDA has not yet approved the drug for the treatment of human scabies.
Perianal Basal Cell Carcinoma
Authors: Damin Daniel C. , Rosito Mario A. , Gus Pedro , Tarta Claudio , Weindorfer Marcos , Burger Marcos B. , Cartell Andre
Published: July 2017

Background:

A case of basal cell carcinoma (BCC) of the perianal region is reported. This tumor is extremely rare in this location and behaves rather innocently.

Objective:

Clinical and histopathologic characteristics of perianal BCC, as well as the choices of treatment, are outlined.

Conclusion:

The tumor should be histologically distinguished from basaloid carcinoma of the anus, which is much more aggressive and metastasizes early, thus requiring a different therapy.
A Review of Antibiotics in Dermatology
Authors: Carrasco Daniel A. , Vander Straten Melody , Tyring Stephen K.
Published: July 2017

Background:

Since the early 1930s when antibiotics were first introduced, they have revolutionized the way physicians treat infections. Skin conditions from acne to leprosy, which were once shunned by society, are now easily treated with oral antibiotics.

Objective:

Antibiotics are chemicals derived from bacteria and fungi that uniquely have antibacterial action. The most notable example is penicillin, which is derived from a mold. With hundreds of antibiotics available to the practicing physician, improper use of these drugs has become widespread and expensive and has spawned resistant strains. For the dermatologist, antibiotics are vital weapons in the drug armamentarium for treating various skin conditions.

Conclusion:

This review explores the newest and most common oral, parenteral, and topical antibiotics used in dermatology, their indications, adverse effects, dosage, and spectrum of activity. Furthermore, systemic antibacterial prophylaxis and vaccines pertinent to dermatology are discussed. The penicillins, cephalosporins, tetracyclines, macrolides, fluoroquinolones, sulfonamides, aminoglycosides, lincosamides, folate inhibitors, and a new synthetic class of drugs, the oxazolidinones, are reviewed. These antibiotics are used to treat a variety of organisms.
The Skin in Pregnancy
Authors: Barankin Benjamin , Silver Shane G. , Carruthers Alastair
Published: July 2017

Background:

Physiologic skin changes are common during pregnancy due to a temporary shift in hormonal, metabolic, and immunologic factors. Physicians may mistake normal skin changes in pregnancy as pathologic change within the skin, and so an appreciation of the common and less common skin manifestations will assist in appropriate patient care.

Objective:

This review highlights the normal physiologic skin changes in pregnancy, which include pigmentary changes, changes to the hair and nails, alterations in glandular activity, vascular and hematological changes, cutaneous tumors, and mucous membrane changes.

Conclusion:

Physiologic changes to the skin in pregnancy can be complex and confusing. Pregnancy can be a stressful time for women so it is imperative that physicians be aware of the normal skin changes during pregnancy in order to prevent unnecessary investigations and treatments.
Randomized Placebo-Controlled Trial of Metronidazole 1 % Cream with Sunscreen SPF 15 in Treatment of Rosacea
Authors: Tan J. K. L. , Girard C. , Krol A. , Murray H. E. , Papp K. A. , Poulin Y. , Chin D. A. , Jeandupeux D.
Published: July 2017

Background:

Rosacea is a photoaggravated dermatosis responsive to treatment with topical and oral antibiotics. A formulation combining metronidazole 1% cream with sunscreen SPF 15 was developed for the treatment of rosacea. Objective: The objective of this study was to determine the safety and efficacy of a formulation combining metronidazole 1% cream with sunscreen SPF 15 in the treatment of moderate to severe rosacea.

Methods:

One hundred and twenty patients with moderate to severe rosacea were enrolled for a randomized, placebo-controlled (vehicle containing sunscreen with SPF 15), double-blind study. Study cream was applied twice daily to the entire face over a 12-week period.

Results:

Treatment with metronidazole 1% cream with sunscreen SPF 15 resulted in significant improvement ( p < 0.05) in inflammatory lesion count, erythema and telangiectasiae scores, and investigator and patient global assessment scores compared with baseline and placebo. Adverse reactions related to study medication were typically mild, occurred at the site of application, and were reversible. There was no difference between the safety profiles of metronidazole 1% cream with sunscreen SPF 15 and placebo.

Conclusions:

The combined topical formulation of metronidazole 1% cream with sunscreen SPF 15 was an effective, well-tolerated topical agent for the treatment of moderate to severe rosacea.
Squamous Cell Carcinoma in Recessive Dystrophic Epidermolysis Bullosa, Presenting as an Ulcer That Appears to Be Filled with Granulation Tissue
Authors: Kalisiak Michal S. , Edwards David , Lin Andrew N.
Published: July 2017

Background:

Cutaneous squamous cell carcinoma (SCCA) is an important cause of death in patients with the severe form of recessive dystrophic epidermolysis bullosa (RDEB). These cancers often present with features that are different from those of actinically induced SCCA.

Objective:

To emphasize the unusual features with which SCCA can present in RDEB and discuss early recognition of such cancers.

Methods:

We present the case of a patient with RDEB who developed a cutaneous ulcer that appeared to be filled with heaped-up granulation tissue. Biopsy, however, showed moderately differentiated squamous cell carcinoma.

Results:

The patient underwent wide surgical excision of the cancer, with split-thickness skin graft. She has remained disease-free three years later.

Conclusion:

In patients with RDEB, any ulcer that appears to be filled with heaped-up granulation tissue should be biopsied to rule out SCCA.
Antihistamines in the Treatment of Atopic Dermatitis
Authors: Herman Sari M. , Vender Ronald B.
Published: July 2017

Background:

Atopic dermatitis (AD) is an inflammatory skin disorder that is exceedingly challenging to treat. A prominent feature of AD is chronic pruritus. Early evidence suggested that pruritus in AD was partially due to mast cell release of histamine. Conversely, recent studies do not validate the role of histamine in the pathogenesis of pruritus. Conventional management continues to include the wide use of antihistamines to treat the persistent itch, however, there is an urgent need for therapy which will reduce the severity of pruritus for these patients.

Objective:

To review the evidence in the literature for the use of antihistamines in the treatment of atopic dermatitis.

Methods:

A MEDLINE search (1966–2002) was performed to obtain studies examining the use of antihistamines in the treatment of atopic dermatitis. Search terms included: atopic dermatitis; eczema; antihistamines; azatadine; brompheniramine; cetirizine; chlorpheniramine; clemastine; cyclizine; cyproheptadine; desloratadine; diphenhydramine; fexofenadine; hydroxyzine; loratadine; meclizine; promethazine; trimeprazine. Further references were gathered from these publications.

Results:

Historically, antihistamines have been used in the treatment of AD. However, this review shows that the evidence for its use is inconclusive. At present, several antihistamines continue to provide relief of pruritus by central sedation, and they can also be used therapeutically for concomitant allergic conditions associated with AD. More clinical trials examining the therapeutic efficacy of antihistamines, especially with the newer nonsedating antihistamines, are necessary to elucidate their role in the treatment of AD.

Conclusion:

Dermatologists require additional evidence regarding the efficacy of antihistamines and their mechanism of action in the treatment of AD to enhance patient care.
Enhancing Skin Self-Examination with Imaging: Evaluation of a Mole-Mapping Program
Authors: Weinstock M. A. , Nguyen F. Q. , Martin R. A.
Published: July 2017

Background:

To enhance early detection of melanoma with thorough skin self-examination, we have enrolled patients in a mole-mapping program that uses digital imaging of the skin.

Objective:

The goal of our study was to evaluate the impact of participation in the mole-mapping program on performance of thorough skin self-examination.

Methods:

The study was carried out by telephone survey of 64 program participants, using self-report to assess impact.

Results:

Participants were generally satisfied and found the program useful and effective; 97% would recommend it. Almost half (45%) of those who were not performing thorough skin self-examination before participation reported performing it after receiving their images. After participation, a partner such as a spouse or friend was more commonly assisting in these examinations. We also noted a correlation (of borderline statistical significance) between sun protection and performance of self-examination, and differences among different definitions of thorough skin self-examination.

Conclusion:

Interventions centered around imaging have the potential to substantially enhance and encourage the performance of thorough skin self-examination for the early detection of melanoma.
An Unusual Case of Calciphylaxis
Authors: Kouba David J. , Owens Nicole M. , Barrett Terry L. , Laman Susan D.
Published: July 2017

Background:

Cutaneous calciphylaxis is a rare disorder that occurs most frequently in patients with end-stage renal disease (ESRD), those on hemodialysis, and renal transplant recipients. It is frequently associated with hyperparathyroidism and a markedly elevated calcium–phosphate product, and it carries a high mortality rate. The usual clinical presentation is of painful, stellate necrosis of the thighs or buttocks, often in the setting of livedo reticularis. Death usually results from septicemia.

Objective:

This report documents an unusual case of recurrent, self-limiting calciphylaxis in the setting of a patient with ESRD and discusses the clinical and pathologic features of this potentially very fatal disorder.

Methods and Remits:

A 52-year-old woman presented with a greater than one-year history of relapsing and remitting, exquisitely painful, necrotic, numular plaques on the abdomen, breast, and arm. This patient had a markedly elevated calcium–phosphate product and parathyroid hormone level. The diagnosis of calciphylaxis was made by wedge biopsy of the most recent plaque, revealing calcification of medium-sized subcutaneous vessels and lobular capillaries with associated epidermal necrosis.

Conclusions:

This case demonstrates an unusual clinical variant of calciphylaxis that presented without the characteristic stellate necrosis or livedo reticularis that normally marks this condition and spontaneous resolution without incurring septicemia. Regardless of morphology, calciphylaxis should be considered in the differential diagnosis of painful, necrotic lesions occurring in the setting of ESRD.
Multiple Large-Surface Photodynamic Therapy Sessions with Topical or Systemic Aminolevulinic Acid and Blue Light in UV-Exposed Hairless Mice
Authors: Liu Younan , Viau Gilles , Bissonnette Robert
Published: July 2017

Background:

The use of photodynamic therapy (PDT) with topical aminolevulinic acid (ALA) on large skin surfaces has recently been reported for patients with multiple actinic keratoses.

Objective:

The current study compared the ability of topical and systemic ALA–PDT as well as topical ALA–PDT with blue light to delay the appearance of UV-induced skin cancer using the hairless mouse as a model.

Methods:

Groups of hairless mice were exposed daily to UV radiation and weekly to ALA–PDT. Tumor-free survival was compared for mice exposed to UV and treated weekly with ALA–PDT and mice exposed only to UV radiation.

Results:

Weekly topical or systemic ALA–PDT was able to delay the induction of skin tumors. A significant difference in tumor-free survival was also observed for both actinic keratoses and invasive squamous cell carcinoma in mice treated weekly with topical ALA–PDT performed with blue light. This was observed even when weekly ALA–PDT was started after 8 weeks of UV exposure.

Conclusion:

Large-surface topical ALA–PDT with blue light can delay the appearance of UV-induced actinic keratoses and squamous cell carcinoma in hairless mice.
Understanding the New Clinical Landscape for Psoriasis: A Comparative Review of Biologics
Authors: Sauder Daniel N. , Mamelak Adam J.
Published: July 2017

Background:

Encouraging results from clinical trials suggest that biologic therapies are effective treatments for psoriasis.

Objective:

The aim of our study was to evaluate the scientific evidence for the efficacy and safety of biologic drugs for psoriasis.

Methods:

The studies reviewed include data on the biologies alefacept, efalizumab, etanercept, and infliximab. This article reviews all data published in the dermatology literature listed in the MEDLINE database, as well as data presented as abstracts and posters at dermatology society meetings, including the annual meetings of the American Academy of Dermatology.

Results:

The majority of the studies used an improvement from baseline of 75% or more in the psoriasis area and severity index (PASI 75) as the primary measure of efficacy.

Conclusions:

Overall, biologics represent an important addition to the psoriatic therapies and have a great impact on the disease course and life quality of those afflicted with psoriasis.
Prednicarbate (Dermatop®): Profile of a Corticosteroid
Authors: Gupta Aditya K. , Chow Melody
Published: July 2017

Background:

Topical steroids have been a popular choice for treating various cutaneous disorders; however, the potential for significant local and systemic adverse events, like skin atrophy and hypothalamic–pituitary–adrenal (HPA) axis suppression, has limited their use.

Objective:

This article reviews the topical steroid prednicarbate through its mechanism of action, clinical efficacy, and adverse events profile.

Methods:

Published literature containing the word “prednicarbate” was examined and summarized.

Results:

Prednicarbate is a nonhalogenated, double-ester derivative of prednisolone that has been used in the treatment of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses such as atopic dermatitis. It has a favorable benefit–risk ratio, low skin atrophy potential, and high anti-inflammatory action.

Conclusion:

These characteristics make prednicarbate an ideal alternative agent for children, elderly patients, and those who require long-term intermittent treatment.
Segmental Neurofibromatosis Follows Blaschko's Lines or Dermatomes Depending on the Cell Line Affected: Case Report and Literature Review
Authors: Redlick Fara P. , Shaw James C.
Published: July 2017

Background:

Segmental neurofibromatosis type 1 (NF-1) has the characteristic features of generalized NF-1 but is isolated to a particular segment of the body. Segmental NF-1 results from a postzygotic mutation during embryogenesis in the NF-1 gene on chromosome 17. The embryologic timing of the mutation and cell types affected predict the clinical phenotype.

Objective:

We present a case of a 52-year-old woman with segmental neurofibromas isolated to the right cheek and neck. We review the recent literature on the genetic and cellular differences between the various clinical manifestations of segmental NF-1.

Methods:

A MEDLINE search for cases of segmental neurofibromatosis was conducted.

Results:

In patients with segmental NF-1 presenting as neurofibromas-only, the distribution follows a neural distribution in dermatomes because the genetic mutation appears to be limited to Schwann cells. In patients with pigmentary changes only, the NF-1 mutation has been shown to occur in fibroblasts and the distribution tends to follow the lines of Blaschko.

Conclusion:

Our patient's neurofibromas were secondary to a postzygotic mutation in the NF-1 gene of neural crest–derived cells. This mutation most likely occurred later in embryogenesis in cells that had already differentiated to Schwann cells and were committed to the dermatomal distribution of the right neck and cheek region (C2).
When Genetics Gets under Your Skin
Authors: Bale Sherri J.
Published: July 2017

Background:

Only recently has the advent of the use of modern statistical and molecular genetic techniques begun to increase our understanding of the study of dermatology and skin biology.

Objective:

This paper will briefly outline several statistical techniques that are used in genetic studies of skin disease by reviewing these techniques, the types of questions that can be answered using them, and issues that should be considered in evaluating and interpreting papers that use them.

Methods:

A discussion of association studies, segregation analyses, and linkage analyses with respect to skin diseases is presented.

Results:

Association studies can be used to identify both genetic and environmental risk factors for disease. Segregation analyses are used to identify the underlying mechanism for disease aggregation in families. Linkage analysis is used to map disease genes to chromosomes.

Conclusion:

Dermatologists should be familiar with the types of genetic questions that can be answered with each technique, and should remain aware of the limitations in interpretation.
Mohs' Micrographic Surgery in Canada: Current Pattern of Practice
Authors: Berg Daniel , Carruthers J. Alastair , Warshawski Laurence M.
Published: July 2017

Background:

Nonmelanoma skin cancers are the commonest human malignancies. Mohs' micrographic surgery is an important treatment for difficult nonmelanoma skin cancers. Little data exist on the use of this technique in Canada.

Objective:

Our study was to document the modern practice pattern of Mohs' micrographic surgery, with an evaluation of the types of tumours treated and the disposition of patients following tumour excision.

Methods:

Data were collected prospectively on 410 patients who received Mohs' micrographie surgery for 464 skin cancers at the University of British Columbia.

Results:

Eighty-one percent of defects were dealt with immediately by the micrographie surgeon with local flaps, skin grafts, primary closure, or healing by secondary intention. Nineteen percent were referred out for repair. Almost all cases referred out had pre-arrangements for repair within 24 hours.

Conclusions:

In a modern micrographie surgery unit, most patients are managed as outpatients in one setting, and delayed reconstructions are uncommon. Using a multidisciplinary approach, patients requiring referral are usually repaired within 24 hours by a consultant surgeon who is already aware of the patient.
Immunotherapy of Psoriasis
Authors: Bhushan Monica , Craven Nicholas M. , Griffiths Christopher E.M.
Published: July 2017

Background:

Psoriasis is a common inflammatory skin disease, characterized by epidermal keratinocyte hyperproliferation and an inflammatory infiltrate. Current research indicates that epidermal hyperproliferation is, in part, dependent upon the milieu of cytokines and growth factors produced chiefly by T cells within the infiltrate and that the T cells play a central role in the pathogenesis of psoriasis.

Objective:

Recent developments in the treatment of psoriasis are discussed in the context of current understanding of the pathogenesis of this condition.

Conclusion:

Significant advances are being made in the treatment directed against these specific immunologic aberrations. Efficacy of immunosuppressive agents such as cyclosporine, FK506 (tacrolimus), anti-CD4 monoclonal antibodies, and IL-2 fusion-toxin in the treatment of psoriasis underscore its probable immune basis. Highly specific treatment directed against cytokines, angiogenesis, and adhesion molecules remains experimental, but shows promise for safer systemic treatment in the future.
Effects of Serum from Normal and Psoriatic Subjects on the Proliferation of Fibroblasts from Involved and Uninvolved Skin of Psoriatic Patients
Authors: Krueger Gerald G. , Jorgensen Cynthia M.
Published: July 2017

Background:

A framework hypothesis for the pathogenesis of psoriasis states that “there is an aberration throughout the skin of patients with psoriasis that is modified to disease expression by circulating factors.”

Objective:

A question to emerge from this hypothesis concerns whether fibroblasts could be more central to the aberration than other cells of the skin? This article focuses on the modulation of growth of fibroblasts from uninvolved and involved sites of patients with psoriasis as a function of the type of serum in which they are grown.

Methods:

Fibroblasts were generated from normal subjects and from involved and uninvolved sites of six untreated psoriatic subjects and their growth in vitro was assessed as a function of the type of serum (fetal bovine serum, normal human serum, and serum from psoriatic subjects) in which they are grown.

Results:

The data show (a) that fibroblasts from psoriatic subjects, especially from uninvolved sites, have an inherent capacity to proliferate at an enhanced rate relative to normal fibroblasts; (b) that this enhanced proliferation can be augmented by normal human serum and to a greater degree by serum from psoriatic subjects; (c) that ≈ 40% of the enhanced proliferation is secondary to the psoriasis serum phenotype; (d) that ≈ 30% of enhanced proliferation is secondary to the psoriasis fibroblast phenotype; and (e) that the magnitude of these features are independent of the severity of psoriasis, as assessed at the time of donation of biopsies for generation of test fibroblasts or of blood for serum.

Conclusion:

These data support the hypothesis that there is an aberration throughout the skin of patients with psoriasis (enhanced proliferation of fibroblasts in vitro, especially from uninvolved sites) that is modified by circulating factors (serum).
Calcipotriol in the Treatment of Psoriasis of Limited Severity: Pharmacoeconomic Evaluation
Authors: Oh Paul I. , Gupta Aditya K. , Einarson Thomas R. , Maerov Phillip , Shear Neil H.
Published: July 2017

Background:

Calcipotriol (calcipotriene) is a vitamin-D3 analogue that has recently become available in North America for the treatment of psoriasis.

Objective:

To perform a pharmacoeconomic analysis to determine the cost-effectiveness from a government payer perspective of calcipotriol compared with medium- to high-potency steroids in the management of plaque-type psoriasis of limited severity.

Methods:

A stepwise analysis was performed. Relevant clinical algorithms were developed after a thorough literature review and input from a clinical panel. A meta-analysis of 31 clinical trials was performed to determine efficacy rates. Costs and resource estimates were obtained from formularies, physician responses, and the literature. Utility values (ratings of health states) were obtained through interviews with 30 patients. Three different decision analytic models reflecting different clinical scenarios in psoriasis management were developed. Total expected costs of therapy including drugs, physician visits, and treatment of failures, and the total Quality Adjusted Life Years (QALYs) for each strategy were calculated. Extensive sensitivity analyses were carried out to explore uncertainty in the parameter estimates entered into the models.

Results:

In the comparison of drug acquisition cost and efficacy, the incremental cost per cure was $414 using a 6-week course of calcipotriol compared with betamethasone valerate. The cost-utility analyses demonstrated that when calcipotriol was used as a second-line therapy to betamethasone valerate, it was as cost-effective as, if not more cost-effective than, clobetasol propionate used for 4 to 6 weeks. Also, when calcipotriol was used as a primary therapy in patients who had failed prior therapies, it was an attractive alternate compared to betamethasone dipropionate and fluocinonide.

Conclusion:

Calcipotriol is a relatively new addition to the topical therapies available to treat psoriasis. In general, tolerability and efficacy are similar to those of topical corticosteroids. In the treatment of psoriatic patients with limited plaque disease, calcipotriol, as a second-line treatment to betamethasone valerate, is a cost-effective alternative to medium- to high-potency corticosteroids.
Pyoderma Gangrenosum and IgA Myeloma
Authors: Jackson J. Mark , Collen Jeffrey P.
Published: July 2017

Background:

Pyoderma gangrenosum (PG) is an uncommon condition that is associated with a systemic disease in 50% of patients. The condition may be associated with a monoclonal gammopathy, usually of the IgA type. It is rare for PG to be associated with multiple myeloma.

Observations:

We report the case of an 83-year-old man with PG associated with an IgA myeloma. The myeloma was discovered after the diagnosis of PG had been made. This is the 22nd case of multiple myeloma associated with PG, and only the 14th case of PG with an IgA myeloma.

Conclusions:

We should be aware of the potential association of multiple myeloma with PG, and consider doing a serum protein electrophoresis in the evaluation of patients with PG.
Calciphylaxis: Pathogenesis and Therapy
Authors: Worth Richard L.
Published: July 2017

Background:

Calciphylaxis is a rare, painful and debilitating disease in which calcification of the skin and subcutaneous tissues or of internal organs can lead to skin necrosis, discolouration, and other skin lesions. The typical patient has end-stage renal disease (ESRD) and hyperparathyroidism. Selye originally characterized this syndrome in rats and distinguished it from other syndromes of abnormal calcification by the following sequence: sensitizers, latent period, and challengers. There has been recent debate regarding misdiagnosis and failure to differentiate this category of patients even in clinical studies.

Objective:

In this article the clinical manifestations of calciphylaxis are described; the importance of distinguishing this condition from other calcification syndromes is explained; risk factors, sensitizers, and challenges are reviewed; treatments of choice are discussed; and the merits of parathyroidectomy are evaluated.

Conclusion:

It is important to consider calciphylaxis in a differential diagnosis of calcification syndromes and in treating patients with ESRD and hyperparathyroidism, because early diagnosis and treatment can interrrupt the progression of the disease process; the disease is painful and debilitating; and inappropriate treatment such as corticosteroid administration may aggravate the condition. Skin biopsy is an important diagnostic tool when the condition is suspected. Parathyroidectomy may be justified because the untreated disease itself has significant rates of morbidity and mortality and because this treatment occasionally leads to dramatic clinical improvement.
p53-Dependent Regulation of Nucleotide Excision Repair in Murine Epidermis in vivo
Authors: Tron Victor A. , Trotter Martin J. , Ishikawa Takatoshi , Ho Vincent C. , Li Gang
Published: July 2017

Background:

p53 protects the integrity of the genome by inducing programed cell death or by promoting DNA repair. We have previously shown that loss or mutation of p53 leads to reduced DNA repair in keratinocytes.

Objective:

The hypothesis that p53 regulates repair of ultraviolet light-induced epidermal DNA damage in vivo was tested in mice.

Methods:

An immunohistochemical assay for pyrimidine dimers and 6–4 photoproducts was performed on ultraviolet-irradiated skin from p53 null (−/−) and wild type (+/+) mice. Immunostaining for photoproducts was quantified using computer-assisted imaging. The level of DNA repair was then expressed as the percentage of positive cells remaining as compared to the zero hour time point.

Results:

p53+/+ mouse skin exposed to 1000 J/m2 retained ≈ 25% of epidermal cyclobutane dimers at 48 h, whereas approximately 50% remained in p53−/− cells. Using the same UV dose, p53+/+ mice retained 20% of detectable 6–4 photoproducts by 24 h, whereas about 50% remained in epidermal cells of p53-deficient mice.

Conclusion:

Using in situ labelling of UV-damaged cells, we confirm our earlier conclusion that p53 regulates DNA repair within the epidermis after exposure to UV light.
Cutaneous Cryptococcosis Mimicking Basal Cell Carcinoma in a Patient with AIDS
Authors: Ingleton Rosemarie , Koestenblatt Evelyn , Don Philip , Levy Howard , Szaniawski Wojciech , Weinberg Jeffrey M.
Published: July 2017

Background:

Cryptococcosis is an opportunistic infection caused by the encapsulated yeast Cryptococcus neoformans. This ubiquitous organism has emerged as a frequent finding in immunosuppressed patients, especially those with underlying malignancies, organ transplants, and the acquired immune deficiency syndrome (AIDS). Cutaneous manifestations of cryptococcosis occur in 10 to 15% of patients having systemic involvement. These skin lesions may simulate a variety of different disease entities.

Methods:

A case of crytococcosis mimicking a basal cell carcinoma is the subject of a case report presentation.

Results:

A case of cutaneous cryptococcosis mimicking basal cell carcinoma occurred in a patient with AIDS, who did not appear to have dissemination, but was treated aggressively to stem possible occult systemic disease.

Conclusion:

Cutaneous crytococcosis may mimic other dermatologic disorders.
Modification of LC Phenotype and Suppression of Contact Hypersensitivity Response by Stress
Authors: Hosoi Junichi , Tsuchiya Toru , Denda Mitsuhiro , Ashida Yutaka , Takashima Akira , Granstein Richard D. , Koyama Junichi
Published: July 2017

Background:

Stress is thought to exacerbate a number of diseases, some of which are skin disorders. Epidermal Langerhans' cells play a major role in cutaneous immune reactions.

Objective:

The effects of two types of stress on the cutaneous immune system were to be assessed in mice.

Methods:

Mice received stress by immobilization or housing at various population densities. Epidermal sheets were stained for I-A molecules (a member of class II major histocompatibility complex) and analyzed with a confocal-laser-scanning microscope. Contact hypersensitivity reaction to 2,4,6-trinitrochlorobenzene was elicited in mouse ears.

Results:

The cell density, intensity of I-A expression, and number of dendrites were decreased as the population density increased. Elicitation of contact hypersensitivity was suppressed in mice that received either population or immobilization stress. Increased I-A expression and number of dendrites were observed in adrenalectomized compared to sham-operated mice. The population-dependent suppression of contact hypersensitivity reaction was not observed in adrenalectomized mice. After incubation with serum from mice that received either immobilization stress or population stress, the expression of I-A molecules on a XS52 Langerhans' cell-like cell line was reduced.

Conclusion:

Stress affected the cutaneous immune system. There were indications that adrenergic hormones played a role in the regulation of the system.
Large Datasets: Common Uses and Caveats
Authors: Safavi Kayvon , Weinstock Martin A.
Published: July 2017

Background:

Increasingly, large collections of pre-existing data are being used to analyze the occurrence, burden, and health care resources directed to the management of various skin diseases.

Objective:

This article discusses a number of different types of large datasets along with their common uses. Various concerns about the use of this information are also discussed.

Conclusion:

Although large datasets provide significant statistical power with readily available data, there are significant concerns, particularly regarding data quality and statistical analysis. Readers need to be aware of how an investigator has addressed these issues. Furthermore, the profession needs to be cognizant of very legitimate public concerns regarding confidentiality of personal information.
Minocycline-Lnduced Cutaneous Pigmentation
Authors: Wasel Norman R. , Schloss Eric H. , Lin Andrew N.
Published: July 2017

Background:

Minocycline-induced cutaneous pigmentation is an adverse effect that may be more common than is generally realized. It is usually reported in patients undergoing chronic minocycline therapy for acne vulgaris.

Objective:

The case of a 69-year-old woman taking minocycline for rheumatoid arthritis is presented, and its differential diagnosis discussed in order to characterize the clinical features of minocycline-induced cutaneous pigmentation.

Conclusion:

Patients undergoing minocycline therapy for rheumatoid arthritis may develop bluish-grey pigmentation over the legs and forearms.
Gene Therapy and Dermatology: More Than Just Skin Deep
Authors: Somani Ally-Khan , Esmail Najwa , Siminovitch Katherine A.
Published: July 2017

Background:

Recent advances in the molecular characterization of dermatologic disease have substantively augmented the understanding of the pathogenetic processes underlying disorders of the skin. This new knowledge coupled with progress in gene delivery technologies has paved the way for introducing cutaneous gene therapy into the dermatologic therapeutic armamentorium.

Objective:

This review article includes an overview of the current strategies for delivery of gene therapy with an emphasis on the potential role of cutaneous gene delivery in the treatment of skin and systemic diseases.

Conclusions:

Accessibility for gene delivery, clinical evaluation, and topical modulation of gene expression render the skin a very attractive tissue for therapeutic gene delivery. However, there are several key hurdles to be overcome before cutaneous gene therapy becomes a viable clinical option. These include difficulties in inducing sustained expression of the desired gene in vivo, the challenge of targeting genes to long-lived stem cells, and the difficulty in achieving specific and uniform transfer to different compartments of the skin. However, these problems are not insurmountable and will likely be resolved in conjunction with ongoing advances in delineating gene expression profiles and other molecular properties of the skin, strategies for stem cell isolation, and improved approaches to regulating gene delivery and expression. These advances should create the framework for translating the enormous potential of cutaneous gene therapy into the clinical arena and, thereby, substantively improving the management of both cutaneous and systemic disease.
Malignant Melanoma Arising from Nevi, p53, p16, and Bcl-2: Expression in Benign versus Malignant Components
Authors: Radhi Jasim M.
Published: July 2017

Background:

The etiology of malignant melanoma has been the subject of much study. Tumour suppressor genes p53 and pl6 and the antiapoptotic, Bcl-2, are implicated in the development and progression of malignant melanoma.

Objective:

To compare the expression of p53, pl6, and the Bcl-2 genes in both benign and malignant components of malignant melanoma arising from pre-existing nevocellular nevi.

Methods:

Twenty cases of malignant melanoma arising from pre-existing nevi were selected and studied by immuno-histochemistry for the expression of p53 (D07) CDK4I/MTS-1/INK ←4, which detects both wild and mutant type, pl6 CDK4I/MTS-1/INK ←4, and Bcl-2 using an avidin-biotin technique on formalin-fixed, paraffin-embedded sections.

Results:

Fifteen cases demonstrated p53 immunoreactivity in the malignant components ranging from 5 to 20% with no expression being seen in the benign components. The pl6 gene showed strong nuclear reactivity in the benign components of 14 cases and weak reaction in 6 cases; the malignant components expressed weak nuclear staining in 18 cases and cytoplasmic staining in all cases. The Bcl-2 gene was expressed strongly to moderately in benign components and weakly in malignant components of nine cases, and was negative in 11 cases.

Conclusion:

Immunostaining for p53 is expressed only in the malignant component, whereas p16 and Bcl-2 showed decreased staining and a different pattern in malignant compared with benign components. These findings suggest that expression and alterations in the subcellular localization of the cell cycle regulators may contribute to the mechanism of tumourigenesis.
Interferon-Induced Cutaneous Necrosis
Authors: Sasseville Denis , Ghamdi Walid Al , Khenaizan Sultan Al
Published: July 2017

Background:

Due to advances in recombinant DNA technology, interferons are now readily available and are frequently used in all branches of medicine. These potent biologic response modifiers carry a number of systemic and local side effects. These cytokines are usually administered subcutaneously, and recent studies have described the occurrence of inflammation or necrosis at the site of injection.

Objective:

We report a case of cutaneous necrosis at the sites of interferon injections in a 35-year-old man treated for chronic myeloid leukemia with high, daily doses of interferon alfa. In addition, we review the existing literature on interferon-induced cutaneous necrosis and discuss preventive strategies.

Conclusion:

Cutaneous inflammation or necrosis at interferon injection sites is not uncommon. Although interferon beta-lb is most commonly responsible for this complication, it is now increasingly reported with interferon alfa. It appears to be secondary to the proinflammatory effects of these cytokines or to their unmasking of a subtle hyper-coagulable state.
Information Technology and the New Information Order
Authors: Hamelink Cees J.
Published: July 2017

In the present debate on a new international information order the North-South transfer of information technology is a crucial issue. This article explores the implications for the South.