bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary Cutaneous Folliculotropic and Lymphohistiocytic Anaplastic Large Cell Lymphoma
Authors: Bittencourt Achiléa L. , de Oliveira Rodrigo Ferreira , Santos Jussamara Brito
Published: March 2015

Background:

Primary cutaneous anaplastic large cell lymphoma (PC-ALCL) is a T-cell lymphoma that presents in the skin and consists of CD30+ anaplastic large lymphocytes with abundant cytoplasm and pleomorphic nuclei. In addition to the classic variant, several other histologic patterns of ALCL have been identified, among them the lymphohistiocytic variant.

Objective and Methods:

We describe a case of the lymphohistiocytic variant of PC-ALCL with a marked follicular involvement. The lesion appeared as a single nodule in the face that completely regressed following biopsy. A diffuse infiltration of lymphocytes and macrophages was seen in the dermis associated with hypertrophied hair follicles, follicular mucinosis, and marked folliculotropism, leading to follicular disruption. Cohesive groups of CD30+ large, atypical lymphocytes with a high proliferative index were seen focally. The patient was followed up for 41 months, during which time no relapses occurred.

Conclusions:

This case shows that PC-ALCL may present with different histologic features, including a follicular variant, that may mimic both benign and malignant conditions.
Versatile Punch Surgery
Authors: AlGhamdi Khalid M. , AlEnazi Madallah M.
Published: March 2015

Background:

Punch instrument is a circular blade that can be used for many diagnostic and therapeutic purposes in different medical and surgical specialties. Punch surgery (or biopsy) is achieved by using this versatile punch blade under local anesthesia. Basic punch surgery is quick and easy to learn. Complications such as bleeding and infection are minimal. Diagnostic punch surgery can obtain a part of or whole skin lesion for histologic examination. In addition to the skin, nail and mucous membrane tissue can be obtained by punch biopsy. Interestingly, punch biopsy can be used as an adjunctive to fine-needle aspiration to establish the diagnosis of tumors of solid organ such as the breast. Diagnostic punch surgery can be modified to overcome certain problems. The split-punch technique helps avoid crushing the tissue punch when trying to divide it for different examinations. The double-trephine punch facilitates obtaining subcutaneous tissue without the need for full elliptical excision. The string-of-beads technique obviates the need for dissection of tissue into pieces. In other nondermatology and dermatology conditions, such as nerve pathology, arteriosclerosis, melanoma mapping, and eyelid tumors, the diagnosis can be enhanced with the use of punch surgery. Therapeutic punch surgery can be used for excision of unwanted lesions such as nevi, as well as pathologic bone and cartilage tissues. Punch grafting is used in vitiligo surgery and hair transplantion. Punch evacuative surgery can help in the evacuation of unwanted tissue or materials such as lipoma, subungual hematoma, scrotal calcinosis, pseudocyst of the auricle, pilar cyst, and others. Reconstructive punch surgery includes correction of ear lobe defects and acne scars. Enhancement of wound healing can be achieved by use of the punch; therefore, it can help nonhealing ulcers.
Promising Results from a Pilot Study on Compression Treatment of Ear Keloids
Authors: Hassel Jessica C. , Löser Christoph , Koenen Wolfgang , Kreuter Alexander , Hassel Alexander J.
Published: March 2015

Background:

Ear keloids continue to be a therapeutic challenge.

Objective:

To evaluate the clinical success of a modified “oyster splint technique.”

Methods:

Ten patients with an ear keloid agreed to receive the compression therapy. After surgical removal, a compressive device made of acrylic resin was applied on top of a silicone gel sheet and patients were asked to wear the splint 23 hours a day for at least 8 months. If the scar showed a tendency to grow, corticosteroids were injected intralesionally. In addition to recurrence rate, other parameters and wearing times were obtained by an interview.

Results:

Two of 10 patients experienced a recurrence in a mean follow-up period of 18.2 months (range 4–44 months). The daily wearing time of the compression splint was critical for the success of the treatment ( p = .022). The splint had to be worn at least 10 hours a day for a minimum of 8 months to prevent recurrence. However, the need for additional intralesional steroid injections was significantly lower in patients wearing the splint for more than 20 hours per day ( p = .048). The splint treatment was painless for 80% of patients. The therapeutic result was given a median mark of 1.75 (1 = best, 6 = worst).

Conclusion:

Although it requires considerable time and effort, the technique seems to be a promising therapy.
The Electronic Psoriasis and Arthritis Screening Questionnaire (ePASQ): A Sensitive and Specific Tool to Diagnose Psoriatic Arthritis Patients
Authors: Khraishi Majed , Mong Jonathan , Mugford Gerry , Landells Ian
Published: March 2015

Background:

We report on an electronic version of the Psoriatic Arthritis Screening Questionnaire (ePASQ), a sensitive and specific tool for diagnosis of psoriatic arthritis (PsA) in patients with plaque psoriasis.

Objective:

To validate the ePASQ against the original paper version.

Method:

The ePASQ scores 15 points on 10 weighted questions and a 68-joint diagram. Data were collected from a prospective cohort of 42 patients with early PsA meeting the Classification Criteria for Psoriatic Arthritis (CASPAR) criteria and from 12 plaque psoriasis patients without PsA.

Results:

The receiver operating characteristic curves for the ePASQ group yielded an optimal 97.62% sensitivity and 75.00% specificity, for a cutoff score of 7. A cutoff point of 8 yielded 88.10% sensitivity and 75.00% specificity. Concordance of the paper and electronic scores was very high.

Conclusion:

The ePASQ is a sensitive and specific tool to screen for PsA. The simple electronic administration and automatic scoring minimize clinician involvement and increase the potential for wider distribution.
Teaching Dermatology to Canadian Undergraduate Medical Students
Authors: Kirshen Carly , Shoimer Ilya , Wismer Judy , DesGroseilliers Jean-Pierre , Lui Harvey
Published: March 2015

Background:

The Canadian dermatology undergraduate curriculum was reviewed in 1983, 1987, and 1996. All surveys revealed the limited amount of time dedicated to dermatology in the undergraduate curriculum.

Objective:

This survey was designed to obtain current information regarding undergraduate dermatology teaching in Canadian medical schools.

Methods:

A survey was sent electronically to all undergraduate dermatology curriculum coordinators at each of the 17 Canadian medical schools.

Results:

Between 1996 and 2008, the average number of hours of dermatology teaching has increased by 7 hours to 20.5 ± 17.2 hours. Again, most of the teaching is performed in the preclinical years. The majority of schools would like to have more time dedicated to dermatology teaching; however, many schools cited a restriction in the number of dermatology faculty members, with an average of 7.8 ± 7 dermatologists, as a barrier to education delivery.

Conclusion:

It is important to have dermatology included throughout the undergraduate medical curriculum because most dermatologic problems are seen by nondermatologists. Respondents at each school believed that there may be value in moving toward a national strategy for dermatology curriculum changes, and this can ensure both uniformity and consistency within Canada.
Break Dancing: A New Risk Factor for Scarring Hair Loss
Authors: Monselise Assaf , Chan Lisa J.Y. , Shapiro Jerry
Published: March 2015

Background:

We report on a first case of lichen planopilaris (LPP) mimicking androgenetic alopecia (AGA) in an individual who has been break-dancing on his head for many years. LPP is an autoimmune inflammatory scalp condition that when left untreated can result in scarring and irreversible hair loss. The etiology of LPP is unknown. Different treatment modalities are used for LPP and AGA.

Objective:

To increase the awareness of physicians to the possibility of scarring hair loss (LPP) presenting like AGA.

Results:

Scalp examination showed scarring patches of hair loss. A scalp biopsy confirmed the diagnosis of LPP.

Conclusion:

Chronic scalp trauma due to break dancing may be a trigger for LPP. A meticulous scalp examination should be performed before making a diagnosis of nonscarring conditions of hair loss such as AGA. Early recognition of LPP and appropriate treatment are important before scarring and irreversible hair loss ensue.
A Refresher on Herpes Zoster, Current Status on Vaccination, and the Role of the Dermatologist
Authors: Guenther Lyn C. , Lynde Charles W.
Published: March 2015

Background:

Herpes zoster (HZ) and postherpetic neuralgia (PHN) have a significant impact on quality of life. PHN is often chronic and difficult to treat. Dermatologists have always been involved in making the diagnosis of these conditions and, most recently, teaching the need for early antiviral therapy.

Objective:

With the introduction of a new vaccine, HZ and its difficult-to-treat complication PHN can be prevented or minimized. Preventive medicine is important and has been supported by dermatologists with sun safety programs. Patients receiving biologics are at increased risk of developing zoster.

Conclusion:

Dermatologists should embrace zoster vaccination and recommend routine vaccination of immunocompetent individuals > age 60 years, as well as patients of any age who are starting immunosuppressants, including biologics. Given that individuals over age 50 years are at risk for PHN and studies have shown that the vaccine's immunogenicity and safety are maintained in individuals age 50 to 59 years, vaccination in this age group may be considered. Some dermatologists may consider vaccinating their own patients, but most will likely recommend that vaccination be performed by their patients' primary care physicians.
Kaposi Sarcoma of the Penis in an HIV-Negative Patient
Authors: Cecchi Roberto , Troiano Michela , Ghilardi Maurizia , Bartoli Laura
Published: March 2015

Background:

The penis is an unusual site of presentation for Kaposi sarcoma, especially in immunocompetent patients.

Case Presentation:

A 52-year-old human immunodeficiency virus (HIV)-seronegative man presented with a reddish, 8 mm in diameter nodule on the glans penis near the coronal sulcus. Histopathology after excision of the lesion was consistent with Kaposi sarcoma. No other cutaneous or mucosal manifestations were present. After a follow-up period of 2 years, no recurrence was observed.

Conclusion:

This unusual case suggests that Kaposi sarcoma should be considered in the differential diagnosis of macular, papular, and nodular lesions involving the penis.
Cutaneous Manifestations of Modern Technology Use
Authors: Li Kayi , Barankin Benjamin
Published: March 2015

Background:

Modern-age technology is increasingly implicated in traditional dermatologic conditions.

Objective:

This review provides a concise overview of the cutaneous manifestations from modern technology use.

Methods:

We describe a case of laptop computer–induced erythema ab igne and provide a review of the literature pertaining to the etiology, clinical features, diagnosis, and management of reported cases of dermatoses resulting from the use of modern technology.

Results:

Sources of modern technology implicated in the reported cases include video games, laptop computers, personal computers and accessories, and smart and cellular phones. These presentations have primarily been localized to the extremities, particularly the hands and face. Diagnoses were associated with trauma or repetitive strain, irritant contact dermatitis, or allergic contact sensitivities. Removal of the offending agent was most often described as effective in symptom resolution.

Conclusion:

It is important to consider modern-age sources as part of the index of suspicion for diagnosing traditional dermatologic conditions. These manifestations will likely increase over time with the pervasive popularity and use of modern technology. Early recognition of the offending agent will be beneficial in differentiating the etiology for effective management.
Facial Nerve Danger Zone in Dermatologic Surgery: Temporal Branch
Authors: Dahlke Erin , Murray Christian A.
Published: March 2015

Background:

The principal function of cranial nerve 7 (CN VII), the facial nerve, is to provide motor innervation to the muscles of facial expression. The temporal branch of the facial nerve primarily innervates the frontalis muscle, which raises the eyebrow.

Objective:

To present a case that illustrates the importance of facial nerve anatomy to skin surgery practice.

Conclusion:

The relevant surgical anatomy of the temporal branch is reviewed, as well as clinical practice points around nerve damage in skin surgery.
A Challenging Case of Multiply Recurrent Nasal Basal Cell Carcinoma
Authors: Mohammed Fazilat , Solish Nowell , Murray Christian A.
Published: March 2015

Background:

Basal cell carcinoma (BCC) is the most common human malignancy worldwide and represents a significant cost to health care systems. Most cases occur on the head and neck, and many are successfully treated with relatively simple measures. However, if high-risk or complicated cases are not treated effectively, they may result in considerable disfigurement or morbidity. We report on a patient with a complex nasal basal cell carcinoma (BCC) that failed multiple treatments by electrodesiccation and curettage (EDC). Management strategies for primary and recurrent BCC, including EDC, standard excision, Mohs micrographic surgery (MMS), and radiation therapy, are discussed. This case required extensive resection, and we review the literature for predictive factors of significant subclinical spread.

Objective:

To present a complex case that illustrates the management options of high-risk, recurrent BCC of the head and neck.

Materials and Methods:

Case report and review of the literature.

Results:

MMS offers the lowest recurrence rate in the treatment of recurrent BCC in surgical candidates. A validated risk scale may predict subclinical spread in patients with BCC of the head and neck.

Conclusions:

BCC can progress to locally advanced disease, necessitating definitive treatment. EDC performed by an experienced dermatologist may offer cure rates comparable to those of surgery in lower-risk BCC. However, in higher-risk tumors, such as recurrent or larger lesions, methods that ensure clear margins should be considered first line, especially in sensitive locations. The routine use of a validated risk scale can better prepare patients and dermatologists for potentially extensive resections. In cases with risk of extensive involvement, strategies to clearly communicate options and progress at all stages of the process should be available.
Support Needed to Involve Psoriasis Patients in Treatment Decisions: Survey of Dermatologists
Authors: Tan Jerry , Stacey Dawn , Barankin Benjamin , Bissonnette Robert , Gulliver Wayne , Lui Harvey , Shear Neil , Bhatti Shahid
Published: March 2015

Background:

Little is known about the interaction between dermatologists and their patients in facilitating treatment decisions for psoriasis.

Purpose:

Our objective was to determine dermatologists' perceptions of the needs of psoriasis patients in treatment decisions.

Methods:

Dermatologists were invited to complete an 18-item online survey on the treatment of psoriasis, including questions on decision-making roles, factors they considered important to patients in treatment decisions, and patients' needs for decision support.

Results:

Seventy dermatologists completed the survey (15% response rate). The highest rated factors in decision making were access to physicians for discussion (86%) and information about the risks and benefits (80%); the latter was more frequently reported by those ≥ 50 years ( p = .021). Treatment-specific factors of greatest importance were side-effect profile (87%) and cost (80%). Potential hindrances were patient misconceptions about disease, inadequate patient education materials, patient indecision, and inadequate physician time.

Conclusion:

Although dermatologists consider accessibility to dermatologists and information on treatment risk and benefits to be important in treatment decision making, they report time with patients and educational materials to be inadequate.

Limitations:

The small sample size may limit the generalizability of our findings.
Worsening of Vitiligo and Onset of New Psoriasiform Dermatitis following Treatment with Infliximab
Authors: AlGhamdi Khalid M. , Khurrum Huma , Rikabi Ammar
Published: March 2015

Background:

Vitiligo is a depigmentation disorder caused by melanocyte destruction that possibly results from an autoimmune mechanism. Psoriasis is an immune-mediated, chronic, inflammatory dermatosis. Although tumor necrosis factor α antagonists (anti-TNF-α), such as infliximab, are effective in treating psoriasis, many cases reported in the literature indicate that psoriasis might also be induced by treatment with infliximab. Some studies also suggest that TNF-α antagonists might be an effective treatment for vitiligo because the disorder is characterized by increased levels of TNF-α, indicating that it might play a role in the pathogenesis of this disease.

Objective:

We report a case of psoriasiform dermatitis with vacuolar interface reaction that occurred after infliximab therapy in a patient with vitiligo.

Method:

A 17-year-old male patient with vitiligo vulgaris was treated with an intravenous infusion of 5 mg/kg of infliximab at 0, 2, and 6 weeks and then once every 6 weeks over a span of 6 months. The patient was monitored both clinically and with laboratory investigations. He had no personal or family history of psoriasis. He tolerated the treatment well, without side effects. However, he developed a biopsy-proven psoriasiform lesion for the first time 4 months after he completed his sixth dose of infliximab. His vitiligo also worsened.

Conclusion:

This case report shows that infliximab given for vitiligo did not improve the disorder and that the vitiligo actually progressed. Moreover, psoriasiform lesions developed after this therapy. Further studies are needed to identify the effects of infliximab in patients with vitiligo.
Early Surgical Excision of Giant Congenital Hemangiomas of the Scalp in Newborns: Clinical Indications and Reconstructive Aspects
Authors: Santecchia Luigino , Valassina Maria Francesca Bianciardi , Maggiulli Federica , Spuntarelli Giorgio , De Vito Rita , Zama Mario
Published: March 2015

Background:

Infantile hemangioma is the most common vascular tumor in newborns, with an incidence from 12 to 23% among preterm infants with low weight at birth and a female to male ratio of 3:1. The head and neck is the most frequently affected area (60%), and the scalp is a typical site for such large lesions.

Objective:

We describe some clinical and medical aspects in comparison with the surgical approach to giant infantile hemangioma of the scalp.

Methods:

The indications to treatment are discussed. An outcome basis evaluation, by reviewing some clinical cases, is provided to help readers better understand when and how to undergo surgery safely.

Conclusion:

Early excision of huge infantile hemangioma of the scalp is the treatment of choice if feasible within 5 months of age.
Successful Intravenous Immunoglobulin Treatment of Atypical Lichen Myxedematosus Associated with Hypothyroidism and Central Nervous System Involvement: Case Report and Discussion of the Literature
Authors: Macnab Magnus , Kenny Patrick
Published: March 2015

Background:

Lichen myxedematosus (LM) is a rare idiopathic disorder characterized by papules, plaques, and/or nodules in the skin secondary to mucin deposition and variable dermal fibrosis in the absence of thyroid disease. Case reports are the predominant literature on LM due to its rarity, and the data are limited regarding the disease. No standard treatment regimen exists, and the response to treatment varies.

Objective:

This report adds to the limited literature on atypical LM associated with thyroid dysfunction and contributes to the growing body of evidence supporting intravenous immunoglobulin (IVIg) as effective therapy for extensive cases.

Methods and Results:

We report an unusual case of atypical LM associated with hypothyroidism, central nervous system (CNS) disturbances, and atrial fibrillation in a 64-year-old male. The patient experienced remarkable improvement within 3 months of beginning IVIg treatment; however, he required repeat therapy due to the recurrence of CNS symptoms 3 months after treatment.

Conclusion:

We agree with previous authors that thyroid dysfunction alone should not preclude a diagnosis of LM. Additionally, we contribute to the increasing evidence of IVIg being an effective treatment, particularly in the setting of systemic complications or acute worsening of LM.
Examining the Risk of Cardiovascular Disease in Patients with Psoriasis: A Critical Review
Authors: Papp Kim , Poulin Yves , Vieira Andrew
Published: March 2015

Background:

Increased prevalence of cardiovascular disease (CVD) in psoriasis patients could be due to a greater prevalence of traditional cardiovascular (CV) risk factors or increased inflammatory disease burden.

Objective:

To critically evaluate evidence on the etiology and magnitude of CV risk in psoriasis patients.

Methods:

A total of 497 articles were identified for review through a PubMed search using the terms “CVD and psoriasis”; 43 were selected. Data measuring the risk of comorbidities and CV risk factors in psoriasis were retrieved.

Results:

Psoriasis patients have an increased prevalence of CV risk factors. Evidence suggests an increased risk of CV morbidity and mortality associated with psoriasis itself. Risk estimates vary across studies (OR range 1.13–6.48), possibly due to heterogeneous study design and incomplete data.

Conclusion:

Although additional data are required, increased awareness of the association of psoriasis with CV risk factors could lead to early diagnosis and treatment of comorbidities, with resultant improvement in morbidity and mortality.
The Pathogenesis of Vitiligo
Authors: Malhotra Neel , Dytoc Marlene
Published: March 2015

Background:

Vitiligo is a commonly encountered pigmentary disorder. Numerous studies and investigations from all over the world have attempted to determine the mechanisms behind this disease; however, the pathogenesis of vitiligo remains elusive.

Objective:

In this comprehensive review article, we present the findings behind the five overarching theories of what causes this disfiguring and psychologically debilitating disease.

Method:

We begin our discussion with the role of genetic predisposition and move onward to the neural theory first proposed in the 1950s. Next we discuss the autoimmune hypothesis, followed by the reactive oxygen species model, and conclude by describing the findings of the more recent melanocytorrhagy hypothesis.

Conclusion:

Although the exact pathogenesis of vitiligo is uncertain, each of these theories likely plays a role. Understanding each theory would pave the way for therapeutic advances for this disease.
Surface Anatomy of the Nose for the Dermatologist
Authors: Chia Justin , Archibald Jason , Murray Christian
Published: March 2015

Expert diagnosis of cutaneous pathology requires precise anatomic description. This brief report will review the clinically relevant surface anatomy of the nose.
Prospective, Randomized, Open-Label Trial Comparing the Safety, Efficacy, and Tolerability of an Acne Treatment Regimen with and without a Probiotic Supplement and Minocycline in Subjects with Mild to Moderate Acne
Authors: Jung Gordon W. , Tse Jennifer E. , Guiha Isabella , Rao Jaggi
Published: March 2015

Background:

Systemic antibiotics are an effective treatment for acne vulgaris. However, intolerable side effects may invariably occur.

Objective:

To determine whether probiotics reduce the side effects imparted by systemic antibiotics while working synergistically with the latter in treating inflammatory acne.

Methods:

Forty-five 18- to 35-year-old females were randomly assigned to one of three arms in this prospective, open-label study. Group A received probiotic supplementation, whereas group B received only minocycline. Group C was treated with both probiotic and minocycline. Clinical and subjective assessments were completed at baseline and during the 2-, 4-, 8-, and 12-week follow-up visits.

Results:

All patients demonstrated a significant improvement in total lesion count 4 weeks after treatment initiation ( p < .001), with continued improvement seen with each subsequent follow-up visit ( p < .01). At the 8- and 12-week follow-up visits, group C had a significant decrease in total lesion count versus groups A ( p < .001) and B ( p < .01). Two patients (13%) from group B failed to complete the study secondary to vaginal candidiasis.

Conclusion:

Probiotics may be considered a therapeutic option or adjunct for acne vulgaris by providing a synergistic antiinflammatory effect with systemic antibiotics while also reducing potential adverse events secondary to chronic antibiotic use.
Familial Eruptive Syringomas: Case Report and Review of the Literature
Authors: Lau Jenny , Haber Richard M.
Published: March 2015

Background:

Syringomas are benign neoplasms of eccrine origin. A clinical variant is eruptive syringomas, which presents as firm, smooth, yellow to pigmented papules that appear as successive crops on the neck, axillae, chest, abdomen, and/or periumbilical region. To our knowledge, there are only 10 published reports of familial eruptive syringomas. Herein we describe the eleventh report of familial eruptive syringomas, review the literature on this unusual presentation, and suggest a novel classification of familial syringomas based on our literature review.

Observations:

We report two cases of eruptive syringoma within a family. Eruptive syringomas were widely distributed on the trunk of a healthy 16-year-old female and her 19-year-old brother. Both the 19-year-old man and his mother also had infraorbital syringomas.

Conclusion:

Familial eruptive syringomas are a rare clinical entity that is likely autosomal dominantly inherited. Future reports of this unusual condition may provide further insight into the etiology of familial syringomas, and genetic analysis of cases may enable the causative gene mutation to be determined.
Radiation- and Chemotherapy-Induced Permanent Alopecia: Case Series
Authors: Haider Mansoor , Hamadah Issam , Almutawa Abdulmonem
Published: March 2015

Background:

Radiation- and chemotherapy-induced alopecia is mostly temporary. However, permanent scalp alopecia is reported, albeit infrequently.

Objective:

The objective of this observational case series was to determine the kind and doses of chemotherapeutic agents and radiation in inducing permanent alopecia of the scalp.

Methods and Results:

Eleven patients referred to our department over a period of 3 years for permanent alopecia after chemotherapy/radiotherapy or combination therapy were included. A detailed medical and therapeutic history was obtained from each patient and from medical records. Photography was done, and the scalp biopsies were taken. Patients were divided into three groups according to the type of therapy. The first group received conditioning chemotherapy prior to bone marrow transplantation. The second group had radiation for brain tumors, and the third group received both.

Conclusion:

A comprehensive multicenter and multidisciplinary study is required to determine the definite causative agents, doses, and other cofactors that induce permanent alopecia following chemotherapy/radiotherapy, as well as the means to avoid this distressing outcome in surviving patients.
One-Year, Multicenter, Open-Label, Single-Arm Study Evaluating the Safety and Effectiveness of Etanercept for the Treatment of Moderate-to-Severe Plaque Psoriasis in a Canadian Population
Authors: Vender Ronald , Lynde Charles , Gilbert Martin , Ho Vincent , Sapra Sheetal , Poulin-Costello Melanie
Published: March 2015

Background:

Although etanercept is well tolerated and effective in moderate-to-severe plaque psoriasis, data are limited in Canadian practice settings.

Objective:

To assess the effectiveness and safety of etanercept in Canadian patients with moderate-to-severe plaque psoriasis (Physician Global Assessment [PGA] ≥ 3) in routine practice.

Methods:

A 1-year, multicenter, open-label trial of 246 patients enrolled from March 2006 to July 2009 was conducted. Patients received etanercept 50 mg subcutaneously twice weekly for 3 months and then 50 mg once weekly for 9 months. The primary end point was the proportion of patients achieving a PGA score ≤ 2 at month 12. Secondary end points included the proportion of patients achieving PGA score ≤ 2 at months 3, 6, and 9 and change from baseline at month 12 for Patient Global Assessment (PtGA), body surface area, and Dermatology Life Quality Index (DLQI). Adverse events were reported.

Results:

At month 12, 73.5% (95% CI 67.2–79.1) achieved a PGA score ≤ 2. The response was similar regardless of the previous response to systemic or phototherapy. The proportion of patients achieving this score improved from 2.2% (95% CI 0.3–4.2) at baseline to 73.5% (95% CI 67.2–79.1) at 12 months. At 12 months, patients with a DLQI score of 0 or ≥ 5-point improvement was 28.8% (95% CI 22.9–34.7) and 47.3% (95% CI 40.8–53.9), respectively. No new safety signals were reported.

Conclusion:

The majority of this Canadian population demonstrated a meaningful improvement in PGA and DLQI scores over 1 year.
Vulvar Sarcoidosis: Case Report and Review of the Literature
Authors: Vera Caridad , Funaro Deana , Bouffard Danielle
Published: March 2015

Background:

Sarcoidosis is a multisystemic disorder of unknown etiology that can affect multiple organs, including the lungs, skin, and eyes. Vulvar sarcoidosis has anecdotally been reported.

Objective:

The aim of this article is to describe a case of vulvar sarcoidosis and review the few cases that have been reported.

Methods:

We report the case of a 39-year-old woman who presented to the dermatologist with a 2-year history of vulvar pruritus.

Results:

Examination revealed infiltrated plaques on the vulva and perianal region. The biopsy demonstrated well-defined, nonnecrotizing granulomas in the dermis. Further investigation revealed hilar adenopathy consistent with sarcoidosis. The patient responded well to topical corticosteroids.

Conclusion:

In the presence of granulomatous lesions of the genital region, infectious causes, foreign body reaction, Crohn disease, and sarcoidosis should be part of the differential diagnosis.
Low-Dose Oral Mini-Pulse Dexamethasone Therapy in Progressive Unstable Vitiligo
Authors: Kanwar Amrinder J. , Mahajan Rahul , Parsad Davinder
Published: March 2015

Background:

The course of vitiligo is unpredictable. If the disease is spreading rapidly, the progression can be controlled with the use of systemic steroids daily or in pulsed form. The present study was planned to assess the efficacy of low-dose dexamethasone oral mini-pulse therapy in progressive unstable vitiligo.

Materials and Methods:

In this retrospective study, the case records of patients with vitiligo during the period from January 2006 to December 2010 were studied. Patients who had progressive unstable disease were included. These patients were administered oral dexamethasone 2.5 mg per day on 2 consecutive days after breakfast in a week. The patients were asked to come for regular follow-up to assess the arrest of disease activity, relapse of disease activity, and adverse effects.

Results:

A total of 444 patients were analyzed. In 408 (91.8%) patients, arrest of disease activity was achieved at a mean duration of 13.2 ± 3.1 weeks. In addition, some repigmentation of the lesions was seen in all patients after a mean of 16.1 ± 5.9 weeks. During the follow-up, 50 of 408 (12.25%) patients experienced one or two episodes of relapse in disease activity, which were treated with reinstitution of low-dose dexamethasone oral mini-pulse therapy. The mean disease-free survival (DFS) until the first relapse was 55.7 ± 26.7 weeks, and the mean DFS until the second relapse was 43.8 ± 7.2 weeks. Adverse reactions such as weight gain, lethargy, and acneiform eruptions were observed in 41 (9.2%) patients.

Conclusion:

Low-dose oral mini-pulse dexamethasone therapy is a good option for arresting progressive unstable vitiligo with minimal adverse effects.
Skin Manifestations of Outpatient Adverse Drug Events in the United States: A National Analysis
Authors: Koelblinger Peter , Dabade Tushar S. , Gustafson Cheryl J. , Davis Scott A. , Yentzer Brad A. , Kiracofe Elizabeth A. , Feldman Steven R.
Published: March 2015

Background:

Cutaneous reactions to drugs are among the most common clinical manifestations of adverse drug events (ADEs); however, data on outpatient cutaneous adverse drug events (CADEs) are limited.

Purpose:

To provide national estimates of outpatient CADEs and determine their most frequent causes.

Methods:

Outpatient CADEs recorded in the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) between 1995 and 2005 were analyzed. The national incidence of outpatient CADEs in those seeking medical attention in the United States was estimated, and the common medication classes implicated with CADEs were identified.

Results:

There were a mean annual total of 635,982 CADE-related visits, resulting in an annual incidence of 2.26 CADEs per 1,000 persons. Patients took an average of 2.2 medications in addition to the one causing the CADE. The incidence of CADEs increased with age, with a peak in the age group from 70 to 79 years. The medications most frequently causing a CADE were antimicrobial agents. Dermatitis and urticaria were the two main types of skin reactions reported.

Conclusions:

CADEs occur less frequently in outpatients than in inpatients and result in few hospital admissions. Physicians must be particularly cognizant of the occurrence of CADEs when prescribing antimicrobial agents.
Incontinentia Pigmenti in an XY Boy: Case Report and Review of the Literature
Authors: Mullan Erin , Barbarian Mher , Trakadis Yannis , Moroz Brenda
Published: March 2015

Background:

Incontinentia pigmenti (IP) is a rare genetic skin disorder with X-linked dominant inheritance and a characteristic sequence of cutaneous manifestations, which is regarded as lethal in XY males.

Objective:

To report a case of a surviving XY male with the common IKBKG (NEMO) gene deletion confirming IP.

Methods and Results:

A newborn XY male with suspected IP underwent a skin biopsy on affected tissue for histopathology. Molecular genetic testing was also performed on the specimen and revealed the common IKBKG gene deletion with a pattern suggestive of somatic mosaicism. Our findings are aligned with a PubMed literature review for XY males with IP and documented IKBKG mutation. We determined that only 10 such genetically proven cases have been reported, including our case.

Conclusion:

Although relatively rare, cases of IP in XY males with the common NEMO mutation have likely been underreported due to the unavailability of appropriate testing in the past. Karyotype and molecular testing should be considered when clinical suspicion of IP arises for a male patient.
Multiple Primary Cutaneous Plasmacytomas: An Unusual Presentation
Authors: Uçmak Derya , Akkurt Zeynep Meltem , Türkçü Gül , Harman Mehmet , Dal Mehmet Sinan , Uçmak Feyzullah
Published: March 2015

Background:

Extramedullary plasmacytoma of the skin, a rare type of cutaneous B-cell lymphoma, is characterized by clonal proliferation of plasma cells primarily in the skin without evidence of multiple myeloma. Only about 30 cases with extramedullary plasmacytoma of the skin are reported in the literature.

Case Report:

An 82-year-old male patient presented to our clinic with complaints of asymptomatic red nodular swelling and pain in the anterior chest wall. A dermatologic examination revealed multiple nodular lesions of varying sizes with a hard smooth surface and vivid red color. Serum protein and immunoglobulin electrophoresis, skeletal radiography, and bone marrow biopsy showed normal results in this patient. Here a rare case of multiple primary plasmacytoma localizing in the skin is reported.
Off-Label Uses of Topical Vitamin D in Dermatology: A Systematic Review
Authors: Wat Heidi , Dytoc Marlene
Published: March 2015

Background:

Topical vitamin D is approved by the US Food and Drug Administration for the treatment of psoriasis but is also used off-label in the treatment of a variety of cutaneous diseases despite a lack of evidence-based guidelines.

Objective:

The objective of this study was to provide evidence-based clinical guidelines for the off-label use of topical vitamin D in the treatment of dermatologic disease.

Methods:

A systematic literature review was conducted via the MEDLINE, Embase, and CENTRAL databases for off-label uses of topical vitamin D analogues in the treatment of dermatologic disease other than psoriasis. The data were synthesized, and evidence-based recommendations were rendered according to the highest level of evidence available.

Results:

A total of 165 articles met the inclusion criteria. A moderate to strong recommendation was given for the use of topical vitamin D in combination with corticosteroids and phototherapy in vitiligo and as monotherapy for various ichthyoses, morphea, pityriasis alba, prurigo nodularis, and polymorphous light eruption. There is evidence showing that topical vitamin D is ineffective in the treatment of actinic keratosis, seborrheic keratosis, lichen planus, seborrheic dermatitis, alopecia areata, chemotherapy-induced alopecia, and hypertrophic scars.

Conclusion:

Topical vitamin D analogues have an important role in the off-label treatment of dermatologic disease, but higher quality studies are still required.
Treatment of Molluscum Contagiosum in Adult, Pediatric, and Immunodeficient Populations
Authors: Nguyen Harrison P. , Franz Eric , Stiegel Kelly R. , Hsu Sylvia , Tyring Stephen K.
Published: March 2015

Background:

Molluscum contagiosum is a viral infection of the skin that is widely considered to be a self-resolving disease that can be treated with benign neglect. However, the clinical reality is that the disease can vary widely by anatomic site and by recalcitrance to treatment and remains a significant cause of morbidity worldwide.

Objective:

The purpose of this review was to compile an updated resource for clinicians that addresses the management of the broad spectrum of molluscum cases that may be encountered.

Methods:

A comprehensive PubMed search was performed to identify publications on the treatment of molluscum infection, including presentations that may be rare or difficult.

Results:

The specific clinical scenario of molluscum must be considered when selecting the optimal therapy because certain treatments can be more effective for specific patient subpopulations.

Conclusion:

Further attention must be directed toward standardizing treatment for molluscum infection based on patient age and immune status.
Periorbital Surface Anatomy for the Dermatologist
Authors: Lynde Carrie , Gunton Lara , Weinberg Tessa , Murray Christian
Published: March 2015

Background:

Optimal management of skin pathology demands accurate anatomic description, especially in the orbit and periorbital region.

Case Report:

This brief article reviews the clinically important surface anatomy of the orbit and periorbital region for the dermatologist.
Establishing Tension-Free Direct Wound Closure Using the Viscoelastic Properties of the Skin
Authors: Al-Benna Sammy
Published: March 2015

Background:

Establishing tension-free direct wound closure is important for optimal postsurgical wound healing. Direct closure should not be forced by raising wound tension.

Objective:

The aim of this article is to review the viscoelastic properties of skin and describe tension-relieving techniques to aid optimal wound closure.
Atypical Fibroxanthoma Arising in a Scar of Discoid Lupus Erythematosus
Authors: De Francesco Vincenzo , Errichetti Enzo , Pegolo Enrico , Stinco Giuseppe
Published: March 2015

Background:

Malignant change in the scars of discoid lupus erythematosus (DLE) is a well-known event. In most cases, tumors are of epithelial origin, particularly squamous cell carcinomas and, less frequently, basal cell carcinomas and keratoacanthomas. The onset of soft tissue sarcomas in a DLE scar is a very rare event, however, because only one case of malignant fibrous histiocytoma has been described in the literature.

Objective:

We describe the first documented report of atypical fibroxanthoma (AFX) arising in an old scar of DLE.

Results:

Although we cannot exclude an accidental association between AFX and DLE, our case emphasizes that patients with DLE may develop AFX in the context of an old scar.

Conclusion:

Our finding further underlines the importance of strict and long-term surveillance of people with DLE to identify and remove eventual tumors at an early stage.
Trends in the Association between Pyoderma Gangrenosum and Autoimmune Hepatitis: Case Report and Review of the Literature
Authors: Wat Heidi , Haber Richard M.
Published: March 2015

Background:

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis commonly associated with underlying systemic illness, typically of autoimmune origin. The association of PG with autoimmune hepatitis (AIH) has been reported but remains poorly recognized.

Observations:

We describe a case of PG manifesting 5 years following the diagnosis of AIH and conduct a literature review to determine the significance of this association. We identified a predisposition for young females and a tendency for PG to arise 4 to 12 years after the diagnosis of AIH during a period of disease quiescence. Additionally, fulminant hepatitis as the initial presentation of AIH appears to be a risk factor in the subsequent development of PG.

Conclusions:

These observations may provide important clues for the pathogenesis of PG in the context of AIH. Recognition of this association has important implications for dermatologists in the evaluation, workup, and management of patients with a history of AIH and suspected PG.
Catastrophic Wounds
Authors: Kunimoto Brian T.
Published: March 2015

Background:

This article summarizes information presented at the Wound Healing Subspecialty Symposium of the Annual Conference of the Canadian Dermatology Association held in Ottawa in June 2012.

Objective:

To provide continuing medical education on wound healing for dermatologists.

Methods:

A review of the pertinent literature was performed by the author in order to prepare the lecture and subsequent article.

Results:

The review found that necrotizing faciitis, hypertensive ulceration, antiphospholipid syndrome and α1-antitrypsin syndrome are entities that contribute to catastrophic wounds seen in wound healing clinics and in private offices.

Conclusion:

It is most important to have a high index of suspicion for these four conditions because early diagnosis can be life-***saving with necrotizing faciitis, pain-relieving in ulcers caused by hypertension, and antiphospholipid syndrome, and can result in early treatment in α1-antitrypsin deficiency.
Peripheral Neuropathy for Dermatologists: What If Not Diabetic Neuropathy?
Authors: Kwok Tiffany , Ting Patricia T. , Wong Eric K. , Brassard Alain
Published: March 2015

Background:

Patients with cutaneous manifestations associated with peripheral neuropathy often present to the dermatologist's office.

Objective/Methods:

This article outlines a practical approach for obtaining the history, performing a screening physical examination, and ordering initial diagnostic testing to diagnose the cause of nondiabetic neuropathy. When to refer for neurologic consultation and principles of management of neuropathic pain and neuropathy-related ulcers are also discussed.

Results:

Cutaneous manifestations of peripheral neuropathy may be secondary to a medical condition predisposing the patient to neuropathy or a manifestation of neuropathy itself. In the latter category, skin affected by neuropathy may show characteristics of xerosis, anhidrosis, rubor, edema, callus, ulceration, muscle wasting, and foot deformity. Most often these findings occur in association with diabetic neuropathy; however, many other infectious, inflammatory, metabolic, paraneoplastic, hereditary, and medication- or toxin-related causes should be considered. The treatment of cutaneous manifestations of neuropathy includes pressure downloading, control of edema, and optimal ulcer and neuropathic pain management.

Conclusion:

It is important for dermatologists to have a basic approach to neuropathy in patients with related skin disease. Referral to Neurology is warranted when basic workup for reversible causes is negative or for any severe, rapidly progressive symptoms.
Trichodysplasia Spinulosa in a Renal Transplant Patient
Authors: Laroche Alexandre , Allard Catherine , Chababi-Atallah Myrna , Masse Mélanie , Bertrand Janie
Published: March 2015

Background:

Trichodysplasia spinulosa (TS) is a rare skin affection seen in immunocompromised patients, mainly those with solid organ tranplants.

Objective:

To report a case of a patient with classic clinical and pathologic findings for the disease so that physicians caring for this population are aware of the clinical presentation.

Method:

We report the case of a female patient we saw at our clinic with a diagnosis of TS.

Results:

The diagnosis of TS was confirmed by pathologic findings.

Conclusion:

TS should be considered in any immunocompromised patient with a papular facial eruption reminiscent of acne vulgaris and with keratotic spiny papules as a distinctive feature.
Trichodysplasia Spinulosa: Rare Presentation of Polyomavirus Infection in Immunocompromised Patients
Authors: Kirchhof Mark G. , Shojania Kam , Hull Mark W. , Crawford Richard I. , Au Sheila
Published: March 2015

Background:

Trichodysplasia spinulosa (TS) is a rare, striking, folliculocentric papular eruption seen exclusively in immunosuppressed patients. The eruption can be disfiguring, associated with leonine faces and alopecia. TS is caused by a polyomavirus, identified as trichodysplasia spinulosa polyomavirus (TSPyV). Few reports exist in the literature, and support for treatment options is sparse.

Method and Results:

We report a patient with TS with underlying lupus nephropathy and renal transplant–associated immunosuppression. Diagnosis was confirmed by biopsy and pathognomonic histologic findings in the context of her extensive, spiculated monomorphous papules. With a biopsy-confirmed diagnosis, oral valganciclovir was prescribed, and the patient showed marked skin texture improvement and hair regrowth.

Conclusion:

The continued reporting of cases of TS will improve clinical identification of this condition and provide better information regarding treatment and long-term consequences.