bluuebunny/crossref_metadata_2025 huggingface dataset:
Invasive Trichophyton Rubrum Infection Occurring with Infliximab and Long-Term Prednisone Treatment
Authors: Lowther Abigail L. , Somani Ally-Khan , Camouse Melissa , Florentino Frances T. , Somach Stephen C.
Published: March 2015

Background:

A 64-year-old woman presented with erythematous plaques, tender nodules, and pustules of the dorsal right hand and both legs following long-term treatment with systemic steroids and infliximab. Skin biopsy demonstrated dermal inflammation with foci of necrosis and multinucleated giant cells containing fungal spores. Tissue culture grew Trichophyton rubrum.

Objective:

To report a case that demonstrates the pathophysiology of invasive T. rubrum infection, the mechanisms of action and uses of tumor necrosis factor α (TNF-α)-inhibiting drugs, and how these drugs may increase patients' risk of invasive dermatophytosis.

Conclusion:

Dermatophytes such as T. rubrum rarely cause invasive disease. This unusual presentation of invasive T. rubrum occurred with immunosuppression by infliximab and systemic steroids. Patients should have a thorough examination for signs of latent infection before TNF-α inhibitors are prescribed, including inspection of the skin and nails for signs of dermatophytosis.
Incidence of Nonmelanoma Skin Cancer in New Brunswick, Canada, 1992 to 2001
Authors: Hayes Robert C. , Leonfellner Suzanne , Pilgrim Wilfred , Liu Jian , Keeling Douglas N.
Published: March 2015

Background:

Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), collectively referred to as nonmelanoma skin cancer (NMSC), cause significant morbidity and generate a substantial cost to the health care system. Canadian data on the incidence of NMSC are lacking.

Objective:

To study the incidence and characteristics of NMSC in New Brunswick, Canada (population 729,498 people in 2001), by using the Provincial Cancer Registry.

Method:

Data were obtained from 1992 to 2001 from the New Brunswick Provincial Cancer Registry, to which reporting of all cancers is mandatory. Multiple tumors of a given histologic type are recorded only once in the registry per individual per lifetime. A descriptive analysis of incidence rates of BCC and invasive SCC of the skin was performed in relation to gender, age, and anatomic location. The main outcome measures were the age- and sex-specific incidence rates of BCC and SCC. Age standardization was performed using the Canadian, US, and world standard populations.

Results:

When adjusted to the world standard population, the age-standardized incidence rates (ASIRs) per 100,000 population for BCC from 1992 through 2001 were 87 for males and 68 for females. For invasive SCC, the ASIRs per 100,000 population were 34 for males and 16 for females. There was an increasing incidence trend for both BCC and invasive SCC over the 10-year study period, with minimal change in the incidence of SCC in women. The overall ratio of BCC to invasive SCC in the population was 2.8 to 1. The approximate lifetime probabilities of developing BCC and invasive SCC were 13% and 5%, respectively.

Conclusions:

The incidence of NMSC in the province of New Brunswick is similar to that reported from 1973 through 1987 in the province of British Columbia, higher than those reported in most parts of Europe, and lower than all published rates in the United States and Australia. Owing to the inability of the registry to account for tumor multiplicity, the actual annual number of all NMSC lesions in this population is likely much higher.
Primary Cutaneous Eosinophil-Rich Anaplastic Large Cell Lymphoma: Report of an Unusual Case and Literature Review
Authors: Bittencourt Achiléa L. , Rothers Silene , Boente Paulo , Santos Roberto
Published: March 2015

Background:

Cutaneous, neutrophil-rich anaplastic large cell lymphoma (ALCL) is an uncommon variant of ALCL that may be confused with inflammatory dermatoses.

Objective and methods:

We describe an eosinophil-rich variant of ALCL occurring on the left ear without systemic involvement. The lesion had inflammatory characteristics, which led initially to a histological diagnosis of an inflammatory process. Two months later, a second biopsy diagnosed eosinophil-rich variant of ALCL. The patient underwent radiation therapy, but due to the extensive deformation and mutilation of the ear, the patient elected to have the ear amputated. We discuss the clinicopathological findings and the differential diagnosis

Conclusions:

To the best of our knowledge, the occurrence of a cutaneous, eosinophil-rich variant of ALCL has not been previously reported. It is important to alert pathologists to this variant of ALCL so that this possibility may be considered in the early differential diagnosis of inflammatory cutaneous conditions.
Endothelin-3 Is Produced by Metastatic Melanoma Cells and Promotes Melanoma Cell Survival
Authors: Tang Liren , Su Mingwan , Zhang Yi , Ip Wency , Martinka Magdalena , Huang Changzheng , Zhou Youwen
Published: March 2015

Background:

Endothelin-3 (ET-3) is an essential paracrine factor for the proliferation, migration, and survival of embryonic melanocytes during fetal development. Its expression is tightly regulated, being completely turned off in adult skin.

Objective:

In this study, results are presented that demonstrate abnormal expression of ET-3 by metastatic melanoma cells in both tissue biopsies and cell culture. Further, in vitro experiments showed that metastatic melanoma cells have the capacity to respond to ET-3 stimulation by increasing survival.

Conclusion:

Therefore, an abnormal autocrine stimulation pathway involving ET-3 is present in metastatic melanoma cells. Blocking this signal transduction pathway may prove useful for the treatment of metastatic melanoma.
Localized Lepromatous Leprosy in Household Contact of Multibacillary Disease
Authors: Narang Tarun , Dogra Sunil , Kaur Inderjeet
Published: March 2015

Background:

Lepromatous leprosy (LL) is a generalized disease, usually with numerous papules, nodules, or plaques containing abundant Mycobacterium leprae and affecting wide areas of the skin.

Aim:

To report on an LL patient presenting with two lesions on the face and to discuss its epidemiologic significance in the current context of leprosy elimination.

Methods:

A 52-year-old housewife presented to our department with erythematous lesions over her face for 2 months. Her husband and son were treated for multibacillary leprosy 15 years previously. An infiltrated erythematous nodule was located over the right supraorbital area, and a single papule was present on the right eyelid. The rest of the examination was normal.

Results:

A slit skin smear from the lesion revealed a bacillary index of 6+ and a morphologic index of 6%. A skin biopsy showed atrophic epidermis with an underlying clear grenz zone; the dermis showed massive infiltration of foamy macrophages, filled with bacilli and a few lymphocytes.

Conclusions:

The presentation of LL or borderline lepromatous leprosy (BL) as a single cutaneous lesion (or localized lesions) is a rare presentation of multibacillary disease, and such cases can be undertreated. This case also highlights the need to further explore the role of immunoprophylaxis or chemoprophylaxis in the contacts of multibacillary cases.
Side Effects of Short-Term Oral Corticosteroids
Authors: Richards Robert N.
Published: March 2015

Background:

Physicians frequently prescribe short-term corticosteroids (CSs) to treat acute and self-limiting diseases. Standard texts and articles do not usually discuss the possible, although infrequent, risks of short-term CSs.

Objective:

To demonstrate that side effects, although uncommon, can occur with short-term CSs and that these can occasionally be serious.

Methods:

Medline peer review literature in English (1985–2006) was searched to identify the potential risks of CSs. Standard textbooks of dermatology, gastroenterology, ophthalmology, pharmacology, respirology, and rheumatology were reviewed. Because the results showed some factual discordance and a dearth of precise data, the results for each body system were reviewed with two relevant clinical specialists at North York General Hospital (with at least 20 years' experience). Further information was obtained from a questionnaire of 200 physicians in North York General Hospital and by feedback from an additional 100 physicians during a presentation of this material at the American Academy of Dermatology.

Results:

Short-term CSs are generally safe, but there have been numerous reports of associated avascular necrosis and a few cases of fatal varicella-zoster in immunocompetent patients. Severe mood changes and psychotic reactions rarely occur unpredictably with short-term CSs. These events are rare, and most treatments with short-term CSs are problem free.

Conclusions:

Problems are infrequent, but patients must be informed of all material risks and treatment options. Thorough chart documentation is required, and patient consent must be given. CS doses should be as low as possible, and CS courses should be as infrequent and as short as possible. The literature reviewed in this article clearly indicates that a short course of CS of 1 week, in the absence of specific contraindications, is unlikely to be harmful (psychotic or prepsychotic episodes possibly excepted).
Improvement in Both Raynaud Disease and Hyperhidrosis in Response to Botulinum Toxin Type a Treatment.
Authors: Kossintseva Irèn , Barankin Benjamin
Published: March 2015

Background:

A patient with concurrent Raynaud disease presented for Hyperhidrosis of the axillae and palms. After a positive response to botulinum toxin type A (BoNTA) for axillary hyperhidrosis, she returned requesting palmar treatment.

Objectives:

Our goal was to investigate the effect of BoNTA on Raynaud disease in concurrent hyperhidrosis with respect to color change, swelling, and digital pain.

Methods:

The patient had treatment with 100 units of BoNTA to one hand at first, with the other being a negative control, followed by treatment of the second hand 1 week later.

Results:

After the injection into the first palm, the patient demonstrated an 85% reduction in palmar hyperhidrosis and a significant improvement in her Raynaud symptoms. Specifically, the BoNTA-treated hand had reduced swelling, color change, and pain, whereas the untreated control hand remained affected. After the second hand was treated, it, too, demonstrated the same positive results.

Conclusions:

Our case report of concurrent Raynaud disease and palmar hyperhidrosis shows significant improvement in both conditions to BoNTA administration. The physiology is multifactorial and relates to BoNTA's effect on acetylcholine, noradrenaline, substance P, calcitonin gene-related peptide, and glutamate release from nerve terminals. These results present an encouraging novel treatment option in dermatology for patients with Raynaud disease.
Desmoplastic Squamous Cell Carcinoma: Case Presentation and Literature Review
Authors: Seal Alex , Zloty David
Published: March 2015

Background:

Desmoplastic squamous cell carcinoma (DSCC) is a variant of squamous cell carcinoma (SCC) with aggressive histologic and clinical features. DSCC has a 6 to 10 times higher rate of both local recurrence and metastatic spread compared with well-differentiated SCC. Clinical estimation of tumor margins can grossly underestimate both the depth and the peripheral extent of the tumor. Surgery with intraoperative margin control has been recommended. In many cases, postoperative radiotherapy or prophylactic lymph node dissection may be required.

Case Presentation:

A 71-year-old man with a biopsy positive for DSCC involving the left postauricular area was treated with nine-stage Mohs micrographic surgery before the tumor margins were negative.

Conclusion:

There are minimal reports in the literature pertaining to the presentation and treatment of DSCC; therefore, definitive conclusions are difficult. The depth of tumor penetration and peripheral spread of the DSCC presented in this case, however, supports the need for aggressive surgical excision, preferably with intraoperative margin control. To maximize the chance of cure, physicians must be aware of the distinct clinical and histologic features of DSCC and the aggressive treatment required.
Canaries in the Mineshaft: The Dermatology Workforce Shortage in Eastern Ontario
Authors: Heughan Caroline , Kanigsberg Nordau , Amdemichael Esiahas , Fergusson Dean , Ammerman Darcy
Published: March 2015

Background:

The number of dermatology residency positions in Canada has not reflected the growing workforce shortage. Until 2005, all dermatology residents at the University of Ottawa were committed to return to their funding area at the completion of their training. This has left Eastern Ontario with a critical shortage of dermatologists.

Objective:

To survey dermatologists practicing in Eastern Ontario to understand the basis of the workforce shortage and outlook for the future.

Methods:

Mailed surveys sent in 1999, 2003, and 2006 to all dermatologists in Eastern Ontario requesting demographic information, workload data, and future career plans.

Results:

There was a 100% response rate in each survey year. Between 1999 and 2006, the total number of practicing dermatologists decreased from 26 to 23, whereas the average age increased from 51.4 to 57.4 years. The waiting time to see new and returning patients increased, from 5.8 to 18.5 weeks and 4.9 to 11.8 weeks, respectively. Ten of the 23 dermatologists practicing in 2006 plan to retire within the next 5 years.

Conclusions:

The inadequate supply of dermatologists in Eastern Ontario will increasingly threaten patient care. This emphasizes the need for additional funding for dermatology training positions, continued mentorship, and improved dermatology training for nondermatologists.
Coverage of Exposed Bones and Joints in Critically Ill Patients: Lower Extremity Salvage with Topical Negative Pressure Therapy
Authors: Horch Raymund E. , Dragu Adrian , Lang Werner , Banwell Paul , Leffler Mareike , Grimm Andreas , Bach Alexander D. , Uder Michael , Kneser Ulrich
Published: March 2015

Background:

Soft tissue defects of the limb with exposure of tendons and bones in critically ill patients usually lead to extremity amputation. A potential treatment with topical negative pressure may allow split-thickness skin grafting to the bone, which leads to limb salvage.

Materials and Methods:

We report on 21 multimorbid patients, 46 to 80 years of age, with severe lower limb soft tissue loss and infection with exposed bone following débridement with critical limb ischemia. Attempts to salvage the extremities were undertaken with repeated surgical débridement followed by vacuum-assisted closure therapy and subsequent split-thickness skin grafting procedures.

Results:

Infection control and limb salvage were achieved in all cases with multiple débridements, topical negative pressure therapy, and skin grafts. In all patients, the exposure of tendons and bones was reversible by this strategy without a free flap transfer.

Discussion:

The patients described in this study were severely compromised by systemic and vascular disorders, so extremity amputation had been considered owing to the overall condition and the exposure of tendons and bones. Since it was possible to salvage the affected limbs with this straightforward and simple procedure, this type of treatment should be considered as a last attempt to prevent amputation.
Surgical Management of Chest Wall Tuberculosis
Authors: Gözübüyük Alper , Özpolat Berkant , Gürkök Sedat , Çaylak Hasan , Yücel Orhan , Kavaklı Kuthan , Dakak Mehmet , Genç Onur
Published: March 2015

Objective:

Tuberculosis remains one of the most fatal diseases in the world. Extrapulmonary tuberculosis increases in parallel fashion with the rise of incidence of pulmonary tuberculosis. Tuberculosis of the chest wall is rare.

Methods:

Our study retrospectively evaluated 10 patients with tuberculosis of the chest wall who were treated with surgery in addition to antituberculous chemotherapy in the last 8 years. Seven of the lesions were located on the anterior chest wall, and three of the lesions were on the lateral chest wall.

Results:

Surgical therapy consisted of evacuation of the cold abscess material from the cavities and wide débridement of the soft tissue planes in all patients. Partial rib resections were performed in six patients owing to costal or chondral involvement.

Conclusions:

Chest wall tuberculosis must be considered in the differential diagnosis of chest wall lesions, especially in endemic areas.
Clinical Efficacy of 25% l-Ascorbic Acid (C'ensil) in the Treatment of Melasma
Authors: Hwang Seon-Wook , Oh Doo-Jin , Lee Deborah , Kim Jung-Wook , Park Sung-Wook
Published: March 2015

Background:

l-Ascorbic acid is used to treat melasma; however, it is quickly oxidized in aqueous solutions. Thus, C'ensil, a formulation containing 25% l-ascorbic acid and a chemical penetration enhancer, was created to promote the penetration of l-ascorbic acid into the skin.

Objective:

To evaluate the efficacy of C'ensil in patients with melasma.

Methods:

Forty subjects with melasma were treated with C'ensil during an open-label trial over a period of 16 weeks. Each subject's skin pigmentation was assessed every 4 weeks using the Melasma Area and Severity Index (MASI) and mexameter score. In addition, transepidermal water loss, skin dryness and irritation, and quality of life (Melasma Quality of Life Scale [MelasQoL]) were evaluated.

Results:

After 16 weeks, a significant decrease was noted in the degree of pigmentation based on the patients' MASI and mexameter scores. MelasQoL scores also decreased, indicating an increase in the subjects' quality of life.

Conclusion:

Our data indicate that C'ensil is an effective treatment modality for melasma.
Prevalence of Non–Organ-Specific Autoantibodies in Patients with Pemphigus Vulgaris
Authors: Blondin David A. , Zhang Zuhui , Shideler Karalee K. , Hou Haiyan , Fritzler Marvin J. , Mydlarski P. Régine
Published: March 2015

Background:

Pemphigus vulgaris (PV) is a potentially life-threatening, organ-specific, autoimmune, blistering disease of the skin and mucous membranes. Although several reports suggest an association between pemphigus and other autoimmune connective tissue disorders, studies that measure non–organ-specific autoantibodies are lacking.

Objective:

To evaluate the prevalence of antinuclear antibodies (ANA), anti–double-stranded DNA (anti-dsDNA) antibodies, and antibodies against extractable nuclear antigens (ENAs) in PV patients.

Methods:

Serum samples were obtained from 59 PV patients and 50 healthy controls. Indirect immunofluorescence assays containing human epithelial cell substrates (HEp-2) and Crithidia luciliae were used to detect ANA and anti-dsDNA antibodies, respectively. A multiplexed addressable laser bead immunoassay was employed to measure autoantibodies to: Smith (Sm), ribonucleoprotein (RNP), Sjögren syndrome B (SSB/La), Sjögren syndrome A (SSA/Ro), histidyl transfer ribonucleic acid synthetase (Jo-1), topoisomerase I (Scl-70), and ribosome-P (Ribo-P) antigens.

Results:

Positive ANAs were obtained in 22 of 59 (37.3%) PV patients compared with 4 of 50 (8.0%) healthy controls ( p ≤ .01). In both the patient and control populations, anti-dsDNA antibodies were absent. Antibodies against the ENAs were present in 1 of 59 (1.7%) PV patients compared with 0 of 50 (0%) controls. In the single ENA-positive PV patient, antibodies to SSB/La (1.7%) and SSA/Ro (1.7%) were detected.

Conclusions:

Non–organ-specific autoantibodies are prevalent in the PV population. As ANAs are detected in over one-third of PV patients, clinicians should screen for signs and symptoms of other connective tissue disease. Correlative clinical studies are warranted to determine the diagnostic, prognostic, and therapeutic significance of these findings.
Solving Acne Inversa (Hidradenitis Suppurativa) in Crohn Disease with Buried Chip Skin Grafts
Authors: Bleiziffer Oliver , Dragu Adrian , Kneser Ulrich , Horch Raymund E.
Published: March 2015

Background:

Acne inversa is a progressive chronic inflammatory disease associated with abscess and fistula formation and subsequent scarring. In recent years, an increasing number of reports have been published about acne inversa and concomitantly occurring Crohn disease. Extensive anogenitoperineal soft tissue defects represent an enormous challenge to therapy. Common treatment strategies of reconstructive surgery such as local flaps, free flaps, or split-thickness skin grafts are frequently problematic and associated with poor outcomes.

Objective:

The aim of this case report is to demonstrate the clinical problem of extensive anogenitoperineal soft tissue defects and to present a surgical technique that can be successfully used in such difficult cases.

Methods:

In both cases, extensive excision of the affected areas was carried out down to the gluteal muscles followed by intramuscular grafting of buried skin chip grafts.

Results:

In both cases, the final postoperative results after numerous surgeries were very good, with complete wound closure resulting in complete recovery and social reintegration.

Conclusion:

The technique of buried skin chip grafting has long been ignored since split-thickness skin grafting and different techniques of flap coverage evolved, but it may constitute a highly efficient treatment strategy in challenging reconstructive situations.
Results of a Survey regarding Perioperative Antiseptic Practices
Authors: Eisen Daniel B. , Warshawski Laurence , Zloty David , Azari Rahman
Published: March 2015

Background:

Currently, there are many options available for perioperative antiseptic techniques for cutaneous surgery. However, there is a paucity of scientific evidence available to suggest which techniques are worthwhile and which are not.

Objectives:

To determine if there is any consensus among dermatologic surgeons as to which perioperative techniques are being used and which are not.

Methods:

A questionnaire regarding perioperative techniques was mailed to the 641 members of the American College of Mohs Surgery (ACMS).

Results:

Forty-one percent of those queried returned the questionnaire within the allotted time. Surgical caps and booties were the least used antiseptic techniques. Respondents tended to use antiseptic techniques less often for less invasive procedures and more often for more invasive procedures. Few people used surgical caps, surgical gowns, or booties for any procedure.

Conclusions:

Many traditional perioperative antiseptic techniques are not being performed by respondents. Calculated infection rates are very low for all queried procedures.
Successful Treatment of Hidradenitis Suppurativa with Infliximab in a Patient Who Failed to Respond to Etanercept
Authors: Poulin Yves
Published: March 2015

Background:

Hidradenitis suppurativa (HS) is a devastating chronic scarring disease of the axillae, groins, and submammary tissue occurring predominantly in women, with onset at puberty. Multiple treatments have been attempted, with limited success. The association of HS with Crohn disease, psoriasis (PSO), and pyoderma gangrenosum, as well as the seronegative arthropathies, suggests a common immunopathogenesis and has motivated attempts at treatment with anti-tumor necrosis factor (TNF)-α agents, already demonstrated to be efficacious in major inflammatory diseases.

Objective:

To report on the clinical evolution of a patient with HS and PSO treated with infliximab who had failed to respond to etanercept and to discuss the possible mechanism responsible for the outcome.

Methods:

We describe the medical history, diagnostic tests, and clinical evolution of a 25-year-old woman with HS and psoriasis treated with infliximab.

Results:

The patient demonstrated a rapid and complete response with infliximab for the HS and PSO, sustained for 24 months.

Conclusion:

The success of anti-TNF agents such as infliximab in managing HS offers a new therapeutic option and supports an underlying immunologic basis for the disease. The differential response to HS observed with infliximab and etanercept in this patient could be related to differences in structure, binding specificities, or gene suppression.
Safety of Conventional Systemic Agents and Biologic Agents in the Treatment of Psoriasis
Authors: Bissonnette Robert , Ho Vincent , Langley Richard G.
Published: March 2015

For many years, the mainstays of psoriasis therapy were conventional oral immunosuppressants (eg, cyclosporine and methotrexate) and retinoids. Recently, six biologic agents were approved for the treatment of psoriasis in Canada and the United States: alefacept, efalizumab, etanercept, infliximab, adalimumab, and ustekinumab. Biologic agents exert their therapeutic effect in psoriasis through inhibition of various pathways. Although these treatments are new to the management of psoriasis, many have been used in other disease states, such as rheumatoid arthritis, psoriatic arthritis, and Crohn's disease. Long-term safety data are available from the treatment of these diseases. Both conventional and biologic treatments are effective in the treatment of psoriasis, but they are associated with serious adverse events, ranging from organ toxicity to serious infections, birth defects, and malignancies. This article reviews the safety profiles of both classes of treatments.
A Wolf in Sheep's Disguise: Rhabdomyosarcoma Misdiagnosed as Infantile Hemangioma
Authors: Al-Mubarak Luluah , Al-Khenaizan Sultan
Published: March 2015

Background:

Rhabdomyosarcomas are a heterogeneous group of malignant tumors representing the most common soft tissue sarcoma of childhood. A delay in diagnosis is not uncommon.

Objective:

To report a boy with paranasal rhabdomyosarcoma who was misdiagnosed and treated for infantile hemangioma.

Methods and Results:

A 2-year-old Saudi boy who presented with a progressively increasing nasal mass for 18 months was misdiagnosed and treated for infantile hemangioma at an outside hospital. Histopathologic examination revealed paranasal rhabdomyosarcoma.

Conclusion:

We review some clinical clues that can alert the physician to malignant childhood tumors. We also review management options for childhood rhabdomyosarcoma.
Effect of Quality of Life Impact and Clinical Severity on Adherence to Topical Acne Treatment
Authors: Tan Jerry K.L. , Balagurusamy Madhan , Fung Karen , Gupta Aditya K. , Thomas D. Richard , Sapra Sheetal , Lynde Charles , Poulin Yves , Gulliver Wayne , Sebaldt Rolf J.
Published: March 2015

Background:

Topical medications are the most commonly prescribed treatments for acne patients. However, adherence to these treatments and possible associations with clinical severity and quality of life (QoL) impact are unclear.

Purpose:

We evaluated the association between sociodemographic factors, clinical severity, and QoL impact and adherence to topical acne treatments.

Methods:

This was an observational study of acne patients referred for usual care to community-based dermatologists. Adherence was assessed with questionnaires after 2 months of acne therapy. The associations of adherence with factors of interest were evaluated by chi-square analysis and Spearman rank correlation.

Results:

In 152 acne patients treated with topical medications, low adherence was observed in 26%, medium in 49%, and high in 24%. Age, gender, duration of acne, education level, third-party drug plan coverage, smoking history, recreational drug use, ingestion of alcohol, and number of prescribed topical agents were not significantly associated with adherence. Adherence was significantly positively correlated with QoL impact ( r = .24, p = .003), with the role-emotional and self-perception domains having the highest correlations. In contrast, adherence was weakly negatively correlated with facial acne severity ( r = .16, p = .047).

Limitations:

This study focused on facial acne, and adherence was based on patient reporting.

Conclusions:

Adherence to topical acne therapy increases with impact on QoL but decreases with increasing acne severity.
Aphthous Vulvar Ulcers in Adolescent Girls: Case Report and Review of the Literature
Authors: Lai Kimberly , Lambert Emily , Mercurio Mary Gail
Published: March 2015

Background:

Aphthous vulvar ulcers are painful ulcerations on the genital mucosa frequently accompanied by systemic symptoms. They are most commonly reported in young women and adolescents without a history of sexual contact. Diagnosis is made by exclusion of more common causes, and treatment for this self-limited condition is mainly symptomatic.

Objective:

Clinicians should be aware of this rare condition to avoid misdiagnoses and unwarranted investigations into sexual abuse or false accusations of sexual activity.

Methods:

We report a case of an 11-year-old girl with systemic symptoms and vulvar ulcers of unknown etiology.

Results:

The patient's illness was consistent with previous reports that vulvar ulcers can occur without sexual transmission or a documented infectious cause.

Conclusion:

A lack of general knowledge regarding this entity may lead to its exclusion from the differential diagnosis of vulvar ulcers in this patient population. Aphthous ulcers should be strongly considered in any adolescent with vulvar ulcers.
The Burden of Psoriasis in Canada: Insights from the p

S

oriasis

K

nowledge

IN

Canada (SKIN) Survey
Authors: Lynde Charles W. , Poulin Yves , Guenther Lyn , Jackson Christine
Published: March 2015

Background:

Although some data addressing the burden of illness associated with psoriasis and psoriatic arthritis (PsA) have been reported for American and European patient populations, similar data have been lacking for Canadians with these diseases.

Objective:

We sought to characterize the natural history of disease in a sample of Canadians with a history of moderate to severe psoriasis, with or without diagnosed PsA or other recognized comorbid conditions, and to identify factors that influenced their perception of psoriasis as a problem in their daily lives.

Methods:

A nationwide telephone survey, pSoriasis Knowledge IN Canada (SKIN), was conducted between April 30 and June 2, 2007, on 500 people who indicated that they had been diagnosed with psoriasis and that their skin lesions had at some time affected an area at least as large as three palms of their hand (3% of body surface area [BSA]).

Results:

The mean age at diagnosis for psoriasis among SKIN survey respondents was 28 years, with 31% (155 of 500) indicating that they developed the disease prior to age 18 years. At the time of the survey, 54% (269 of 500) of respondents were experiencing lesions affecting a BSA equivalent to at least three palms (3%). In response to questions on the burden of illness, 35% (176 of 500) of respondents indicated that they considered psoriasis to be a substantial problem in their daily life. Both affected BSA at the time of the survey and self-reported extent of skin involvement at the height of the condition (BSAmax) correlated with the perception of psoriasis as a substantial problem. Other subpopulations in which psoriasis was commonly identified as a substantial problem included women and individuals with diagnosed PsA. Whereas 18% (88 of 500) of respondents were diagnosed with PsA, the number who reported joint pain or stiffness was substantially higher (51%; 256 of 500), suggesting that some respondents may have had incipient or undiagnosed PsA.

Conclusions:

This survey reveals that psoriasis, PsA, and their associated comorbidities impose a severe burden on the daily lives of Canadians with a history of moderate to severe psoriasis.
Ethyl Chloride Spray for Sensory Relief for Botulinum Toxin Injections of the Hands and Feet
Authors: Richards Robert N.
Published: March 2015

Background:

Botulinum toxin injections are effective in the treatment of palmar and plantar hyperhidrosis, but discomfort has limited its use.

Objective:

To study the use of ethyl chloride medium-stream spray in reducing injection discomfort.

Methods:

We used ethyl chloride medium-stream spray, in conjunction with precooling by frozen ice packs, in our No Sweat Clinic for our most recent 51 consecutive cases of botulinum toxin injection.

Results:

Ethyl chloride spray greatly facilitated the injection procedure, and all patients completed the injections without hesitation or delay.

Conclusion:

Ethyl chloride medium-stream spray, in conjunction with precooling by frozen ice packs, is highly effective in reducing painful injection sensations. Its use is safe, economical, and easy to learn and does not require special equipment.
Postinflammatory Hyperpigmentation
Authors: Taylor Susan , Grimes Pearl , Lim Joyce , Im Sungbin , Lui Harvey
Published: March 2015

Background:

Postinflammatory hyperpigmentation (PIH) commonly occurs in Fitzpatrick skin types III to VI and can have a considerable impact on quality of life. The majority of cases will improve spontaneously, but this can take months or even years to resolve and in some cases can be permanent. Treatment maybe prolonged, lasting 6 to 12 months or longer for adequate restoration of normal pigmentation.

Objective:

To review the etiology, pathogenesis, and current therapy options for patients with PIH.

Methods:

This review is the outcome of a workshop that discussed literature reports of research and developments in the treatment of PIH and associated disease and current clinical practice.

Results:

Combination products containing hydroquinone and retinoids appear to be the most beneficial treatment options, although there are few evidence-based studies for PIH.

Conclusion:

More randomized controlled clinical studies in large numbers of PIH patients are needed to provide standardized measurable outcomes in this indication.
Update on Intralesional Steroid: Focus on Dermatoses
Authors: Richards Robert N.
Published: March 2015

Background:

Intralesional steroid (ILS; usually triamcinolone acetonide) is commonly used, and the literature contains much information about its use in keloids, hemangiomas, and alopecia areata. Little has been written about its use in inflammatory dermatoses such as psoriasis and localized dermatitis since the 1960s, the conditions for which it was originallymost studied and used.

Objective:

To clarify the use of ILS and to encourage its use in psoriasis and localized dermatitis.

Methods:

Medline peer-reviewed literature in English (1956–2008) was searched for the use of ILS in all skin diseases. Six standard textbooks of dermatology were reviewed. Information as to how they used ILS was obtained from a questionnaire completed by 33 dermatologists and from personal discussions with 15 other dermatologists. Additional information was obtained from 40 years of personal ILS use and from observation of 42 dermatologists working intermittently in our office over the past 25 years. ILS product package inserts and company drug monographs were reviewed.

Results:

ILS is used by most dermatologists, but there are considerable divergences in technique and dosing. Current textbooks contain little on its use in psoriasis and localized dermatitis. There have been no clinical studies since the 1960s, and their end points and descriptions were somewhat vague by today's standards. Product package inserts are dated and not helpful. Nevertheless, the use of ILS is safe and economical, and the original authors and our office have found it consistently to be virtually 100% effective at 2.5 mg/mL in small plaques of psoriasis on the trunk and limbs and highly effective in localized dermatitis (such as lichen simplex chronicus, prurigo nodularis, and nonspecific eczema). Clinical studies indicate that we can safely increase our ILS from the usual 3 cc (7.5 mg) to 6 cc (15 mg) or even to 8 cc (20 mg) for patients over 50 kg every 3 to 4 weeks. Serum cortisol can be performed if there are concerns about adrenal suppression, with use in periorbital hemangiomas and with intranasal ILS. Blindness (from central artery occlusion) was reported with injections of ILS around the eyes wih older products during the early development stages; and more recently with the use of ILS for periorbital hemangiomas and with ILS used intranasally. It has never been reported with low pressure injections of ILS using triamcinalone acetonide at 2.5 mg around the eyes.

Limitations:

No formal clinical studies since the 1960s. Poor statistical end points.

Conclusions:

ILS at 2.5 mg/cc is safe, economical, and effective and its greater use should be encouraged in inflammatory dermatoses such as psoriasis and localized dermatitis. Further well-designed research would be helpful.
Cost Comparison of Psoriasis Treatments
Authors: Mikhael Dalia , Babcock Kelly , DesGroseilliers Jean-Pierre
Published: March 2015

Background:

Knowledge of the cost of various psoriasis therapeutic options is essential to the prescribing clinician.

Objective:

To compare the cost of various psoriasis treatments over a 10-year period in the province of Ontario, Canada.

Methods:

We used a hypothetical patient with plaque-type psoriasis of moderate severity with a Psoriasis Area and Severity Index of 10, body surface area of 20%, and no joint involvement. The costs to treat this hypothetical patient with different therapeutic regimens were compared in this study.

Results:

In a 60 kg patient, alefacept was the most costly form of therapy, based on two 12-week treatments per year, followed by infliximab 5 mg/kg. In a 90 kg patient, infliximab 5 mg/kg was the most costly, followed by alefacept. The least costly treatment was ultraviolet B phototherapy.

Conclusion:

With the knowledge of these data, informed prescribing by the dermatologist may reduce the financial burden to the patient, the provincial health care system, and insurance companies.
Mycosis Fungoides in the Pediatric Population: Report from an International Childhood Registry of Cutaneous Lymphoma
Authors: Pope Elena , Weitzman Sheila , Ngan Bo , Walsh Scott , Morel Kimberly , Williams Judith , Stein Sarah , Garzon Maria , Knobler Elizabeth , Lieber Colette , Turchan Kirsten , Wargon Orli , Tsuchiya Arline
Published: March 2015

Background/Objectives:

There are limited data on the clinical presentation and progression of pediatric cutaneous lymphoma. This study focuses on the clinical characteristics of pediatric patients with mycosis fungoides (MF).

Materials and Methods:

This descriptive study presents clinical characteristics of 22 pediatric patients with MF, enrolled in the international Childhood Registry for Cutaneous Lymphomas (CRCL).

Results:

The mean ages at onset and at diagnosis were 7.5 (SD 3.8 years) years and 9.9 (SD 3.4) years, respectively. The most common MF presentation was patch stage (68%), followed by hypopigmentation (59%) and plaque stage disease (50%). Epidermotropism and lymphocytic atypia were the most common pathologic features, found in 89% and 85%, respectively. Cerebriform nuclei were noted in 42%, and Pautrier microabscesses were seen in 16% of cases. A cytotoxic pattern was more commonly seen (67% vs 33%), and clonality was detected in 21% (3 of 14) of patients. All patients presented with early-stage disease and received skin-directed therapy (topical steroids, 73%; light therapy, 54%; or combination therapy, 35%).

Conclusions:

Pediatric patients with MF present in the first decade of life, with early-stage disease and unusual forms such as hypopigmented variant. Further patient enrolment will provide information regarding natural history, treatment response, and overall prognosis of pediatric cutaneous T-cell lymphoma (CTCL).
Giant Cutaneous Plasmacytoma of the Sacrococcygeal Region
Authors: Ioannidis Orestis , Kakoutis Emmanouil , Varnalidis Ioannis , Tamouridis George , Chatzichristou Aristidis , Tzarou Valasia , Makrantonakis Nikolaos
Published: March 2015

Background:

Cutaneous plasmacytoma is a very rare manifestation of extramedullary plasmacytoma, with only 32 cases having been reported so far in the last 60 years. Extramedullary plasmacytoma is a plasma cell tumor that involves soft tissues, without any signs of systemic spread of multiple myeloma or bone marrow involvement. The cutaneous lesions usually range in diameter from 1 to 5 cm and can be treated with radiotherapy or surgical excision.

Objective and Conclusion:

We present a case of a giant cutaneous plasmacytoma of the sacrococcygeal region with a diameter of 12 cm that was treated with surgical excision.
Children with Atopic Dermatitis Do Not Have More Anxiety or Different Cortisol Levels Compared with Normal Children
Authors: Afsar F. Sule , Isleten Figen , Sonmez Nihal
Published: March 2015

Background:

The hypothalamic-pituitary-adrenal axis has an important immunoregulatory role under stress, and stressmediated anxiety has been reported to be associated with alterations in immune functions and attenuated cortisol levels in atopic dermatitis (AD) patients.

Objective:

We investigated serum basal cortisol and anxiety levels in pediatric AD patients and compared them with those of controls.

Methods:

Basal serum cortisol levels were measured in 36 pediatric AD patients (aged 9–16 years) and 36 control subjects (aged 9–15 years). Anxiety was assessed by the trait anxiety subscale (TAI-C) of the State-Trait Anxiety Inventory for Children. The severity of AD was assessed by the objective severity scoring of AD (SCORing Atopic Dermatitis [SCORAD]).

Results:

Data analysis showed no statistical difference for the basal serum cortisol levels ( p = .383) and the TAI-C ( p = .730) between the two groups. No significant correlation was found between the basal cortisol values and the TAI-C scores in the AD group ( p = .290). The SCORAD index was correlated with the TAI-C scores ( p < .05) but not correlated with the basal serum cortisol values in AD patients ( p = .06).

Conclusion:

Children with AD do not have more anxiety or different cortisol levels when compared with normal children, but the severe symptomatology of AD itself may cause anxiety levels to increase in children with AD.
Naturally Occurring Isohexenylnaphthazarins and Wound Healing: Experimental Study in Dogs
Authors: Karayannopoulou Maria , Loukopoulos Panagiotis , Papazoglou Lysimachos G. , Tsioli Vassiliki , Anagnostou Tilemahos L. , Assaloumidis Nikolaos , Constantinidis Theodocos C. , Assimopoulou Andceana N. , Kaldrymidou Eleni , Papageorgiou Vassilios P.
Published: March 2015

Background:

The healing efficacy of isohexenylnaphthazarins (IHN) has been well proved on chronic or contaminated wounds.

Objective:

To evaluate the wound healing activity of an experimental ointment containing IHN on acute and noncontaminated wounds in dogs. Methods: In each of six beagle dogs, four full-thickness skin defects were created bilaterally: one 2 × 2 cm defect on the lateral aspect of each arm for subjective evaluation, laser Doppler flowmetry (LDF), and planimetry and three 1.5 × 1.5 cm defects on opposite sides of the dorsal midline for histologic evaluation. Wounds on the left were treated with an ointment based on IHN and on the right with another based on petroleum jelly (Vaseline) and beeswax.

Results:

Wound size decreased significantly in both sides. The significantly increased percentage of epithelialization was higher ( p = .0274) in the petroleum jelly–treated wounds on day 20. Tissue perfusion (LDF) increased significantly bilaterally in the center of the wound but only in the IHN-treated side cranial to the wound. Histologically, angiogenesis was significantly higher ( p = .0431) on day 5 in the IHN-treated wounds compared with the petroleum jelly–treated wounds. Collagen production increased significantly bilaterally.

Conclusion:

The IHN-based ointment promoted some of the proliferative processes, but it did not enhance the overall wound healing of acute, surgically created wounds in dogs.
Frontal Fibrosing Alopecia: To Treat or Not to Treat?
Authors: Rallis Eustathios , Gregoriou Stamatis , Christofidou Eleftheria , Rigopoulos Dimitrios
Published: March 2015

Background:

Published studies have evaluated a variety of therapeutic agents in frontal fibrosing alopecia (FFA); however, data on whether fibrosis is already established when the patients initially present are scarce.

Objective:

To identify the prevalence of active disease in patients initially diagnosed with FFA and to evaluate the efficacy of therapeutic agents suggested in the medical literature. Patients/Methods: Eighteen postmenopausal women with FFA presented at the outpatient clinic of our hospital from June 2003 to August 2007. Five patients who also presented with androgenetic alopecia were treated with finasteride 2.5 mg/d plus minoxidil 5% for 12 months. One patient with a rapidly regressing disease received systemic corticosteroids. The remaining 12 patients were divided into two groups: 6 patients received topical clobetasol 0.05% solution once daily for 6 months and the rest received no treatment.

Results:

Thirteen of 18 patients presented with stable disease. No significant improvement was observed in any of the patients.

Conclusion:

To date, there is no effective treatment proven with an appropriate level of evidence in the management of FFA. Exclusion criteria in future clinical studies should take into account patients presenting with stable disease. What needs to be established is whether treatment can halt or slow the progression of active disease.
Statins and “Chameleon-Like” Cutaneous Eruptions: Simvastatin-Induced Acral Cutaneous Vesiculobullous and Pustular Eruption in a 70-Year-Old Man
Authors: Adams Amy E. , Bobrove Arthur M. , Gilliam Anita C.
Published: March 2015

Background:

The statin medications for lowering of blood cholesterol can be associated with cutaneous lichenoid reactions but also a variety of other adverse cutaneous eruptions, including Stevens-Johnson syndrome, toxic epidermolytic necrolysis, porphyria cutanea tarda, linear IgA bullous dermatosis, and reaction patterns (lupus and dermatomyositis-like and pustular). Cutaneous eruptions (“eczema” in the product literature) owing to simvastatin are reported in approximately 1.5% individuals compared with placebo.

Objective:

To correlate the clinical and microscopic features of an unusual vesiculobullous reaction to simvastatin.

Methods:

Retrospective analysis of clinical information and skin biopsies.

Results:

We present the case of a 70-year-old man with chronic vesiculobullous and pustular annular lesions on distal arms, legs, hands, and feet for 2 years. The eruption was recalcitrant to potent topical corticosteroids. Multiple biopsies at different times showed a spongiotic and lichenoid hypersensitivity reaction resembling contact dermatitis, purpuric drug eruption, and pustular folliculitis. The common themes in the histopathology were spongiosis with microvesiculation, focal lichenoid infiltrates, dermal hemorrhage, and chronic superficial inflammatory cell infiltrates with eosinophils. The eruption began when simvastatin was started, improved when it was stopped, recurred with rechallenge, and cleared when simvastatin was discontinued.

Conclusions:

Acral cutaneous vesiculobullous eruption is an uncommon adverse drug eruption due to simvastatin, one of many different patterns possible. A high level of suspicion for an unexplained cutaneous eruption in an older individual on statins is important to identification of the disorder and discontinuation of the offending medication.