bluuebunny/crossref_metadata_2025 huggingface dataset:
Acrokeratosis Paraneoplastica (Bazex Syndrome) Presenting in a Patient with Metastatic Breast Carcinoma: Possible Etiologic Role of Zinc
Authors: Taher Muba , Grewal Parbeer , Gunn Beth , Tonkin Katia , Lauzon Gilles
Published: March 2015

Background:

Bazex syndrome (acrokeratosis paraneoplastica) is a rare paraneoplastic syndrome that usually occurs in males over 40 years old and is particularly associated with squamous cell carcinoma of the upper aerodigestive tract and adenopathy above the diaphragm.

Objective:

The objectives of our article are (1) to describe a unique case of acrokeratosis paraneoplastica and (2) to review the current literature regarding skin findings, commonly associated neoplasms, and treatment options relative to this condition.

Patient:

We describe a 68-year-old female with lobular breast carcinoma, complicated by local and distant recurrences, who presented with a 1-year history of prominent acral skin and nail changes.

Results:

Our patient's clinical skin findings improved significantly following treatment and partial remission of her underlying malignancy.

Conclusions:

Our patient represents one of few females described with this syndrome, which is especially rare in association with lobular breast carcinoma. Further, the patient's presentation is unique as she was discovered to demonstrate laboratory findings consistent with coexistent porphyria cutanea tarda and relative zinc deficiency.
Open-Label Study of Valacyclovir 1.5 g Twice Daily for the Treatment of Uncomplicated Herpes Zoster in Immunocompetent Patients 18 Years of Age or Older
Authors: Madkan Vandana K. , Arora Anita , Babb-Tarbox Michelle , Aboutlabeti Sina , Tyring Stephen
Published: March 2015

Background:

Herpes zoster (shingles) is a common disease caused by a reactivation of the latent varicella-zoster virus (chickenpox), which resides in the dorsal root ganglia. Valacyclovir HCI, the L-valyl ester of acyclovir, is an antiviral drug that is used to accelerate the resolution of the herpes zoster rash and associated pain and reduce the duration of postherpetic neuralgia.

Objective:

To demonstrate the safety and efficacy of oral valacyclovir 1.5 g twice daily (bid) for the treatment of uncomplicated herpes zoster in immunocompetent patients over 18 years of age. The dosing schedule of bid versus three times daily is desirable for enhancing patient compliance and to subsequently reduce the incidence of viral resistance.

Methods:

One treatment group of 125 patients was administered oral valacyclovir 1.5 g bid for 7 days. Administration of the first dose occurred within 72 hours after onset of rash. Patients were seen and assessed for cutaneous healing, zoster-associated pain (ZAP), and/or zoster-associated abnormal sensations (ZAAS). Patients under 50 years of age were followed for 4 weeks and patients 50 years of age and older were followed for a total of 24 weeks. Patients ≥ 50 years were also asked to record a daily diary on pain and abnormal sensations throughout the 24-week study period. Responses to resource use and quality of life questions were also collected. Safety was monitored by means of routine hematologic and biochemical assessments and reporting of adverse experiences.

Results:

Data from this study were compared with historical control groups both for three times daily antiviral therapy and for placebo. The results showed that twice-daily dosing was as safe and effective as three times daily dosing for the reduction of ZAP and ZAAS. Adverse-effect profiles were similar between the two different regimens, and both treatment groups showed better outcomes than the historical placebo group. Because it is standard of care to administer antivirals for the treatment of acute herpes zoster, a placebo-controlled trial is not possible, necessitating the use of historical controls.

Conclusion:

Oral valacyclovir 1.5 g bid is safe and effective for the treatment of uncomplicated herpes zoster in immunocompetent patients over 18 years of age. Twice-daily dosing may help increase patient compliance and therefore increase the effectiveness of treatment of the acute herpes zoster rash and the prevention of ZAP.
Hidradenitis Suppurativa in 64 Female Patients: Retrospective Study Comparing Oral Antibiotics and Antiandrogen Therapy
Authors: Kraft John N. , Searles Gordon E.
Published: March 2015

Background:

Hidradenitis suppurativa (HS) is a recurrent disease confined to apocrine gland-bearing areas causing painful, deep-seated lesions and draining sinus tracts. Uniformly effective therapy is lacking. Improvements in current medical management strategies are needed.

Objective:

We sought to determine the success rate for a variety of treatments in our female HS patients and whether androgen-related tests can predict a response to antiandrogen therapy. As HS has been linked to a hyperandrogen state, we sought to determine if it is also associated with polycystic ovary syndrome (PCOS).

Methods:

A retrospective chart review was performed examining hormonal profiles and the response to a variety of treatments in female patients with HS.

Results:

Sixty-four female HS patients were identified (mean age 33 years). Antiandrogen therapy was superior to oral antibiotic therapy (55% vs 26%) based on a two-sample, two-sided, t-test statistic (p < .04). The prevalence of PCOS among our study patients in whom androgen markers were available was 8 of 21 (38.1%), and even if taken over all study patients, not necessarily investigated for PCOS, the prevalence was 8 of 64 (12.5%). This reflects a greater than expected prevalence among all women (10%).

Conclusion:

As a proof-of-concept study, despite limitations inherent in a retrospective chart review, there is sufficient signal to suggest that a hormonal manipulation approach to therapy should be considered in all women presenting with HS. Female patients presenting with HS should prompt investigations for underlying PCOS and insulin resistance.
Time to Diagnosis of Melanoma: Same Trend in Different Continents
Authors: Blum Andreas , Ingvar Christian , Avramidis Michelle , von Kannen Andreas , Menzies Scott W. , Olsson Håkan , Rezze Gisele G. , Wennberg Ann-Marie , Westerhoff Karin
Published: March 2015

Background:

Patients and physicians both play an important role in the diagnosis of malignant melanoma.

Objective:

The purpose of this study was to assess important factors of delay in diagnosis at different centers and on three continents.

Methods:

Between October 2001 and October 2002, patients with histologically confirmed invasive melanoma were included in the study and given an established questionnaire. Recorded patients and tumor characteristics included age, sex, anatomic location, Breslow thickness, patients' awareness of the lesion and time with suspicion, and physicians' time (delay) before the operation.

Results:

The study included 985 patients (486 males, 499 females): 253 from Germany, 464 from Sweden, 58 from Brazil, and 210 from Australia. More females detected their lesions by themselves. The change to a darker color (21 %) and enlargement of the area of the lesion (19%) were the major signs. The highest knowledge among patients that early detection may improve the outcome was found in Sweden and Australia. At each center, the media (newspaper, magazine, radio, and television) provided the best sources of information about melanoma. Twenty to 33% of all physicians initially consulted missed the melanoma diagnosis, independent of their specialty.

Conclusions:

There are still factors for the delay in melanoma diagnosis in different countries and continents, but the differences are rather small. The results should be included in planning prevention campaigns in this specific field and in the education of medical students, physicians of all specialties, and other health professionals.
Open-Label, Single-Center, Safety Dose Escalation Trial of Alefacept for the Treatment of Moderate to Severe Chronic Plaque Psoriasis
Authors: Moul Danielle K. , Routhouska Shannon B. , Korman Neil J.
Published: March 2015

Background:

Alefacept (Amevive) is a fully human LFA-3/IgG1 fusion protein with a dual mechanism of action inhibiting T-cell activation and selectively reducing memory T cells. Alefacept is currently approved as a 12-week course of weekly 15 mg intramuscular (IM) injections for the treatment of adults with moderate to severe chronic plaque psoriasis. In clinical trials using the currently approved dosing regimen, 33% and 57% of patients achieved a 75% or greater or 50% or greater reduction in Psoriasis Area and Severity Index score (PASI 75 and PASI 50), respectively, after one course of alefacept.

Objective:

To evaluate the tolerability and efficacy of alefacept 15 mg IM weekly for 6 weeks followed by alefacept 30 mg IM weekly for 6 weeks.

Design:

Open-label, single-center, dose escalation study of alefacept.

Patients:

Adult patients with chronic plaque psoriasis involving a minimum body surface area of 10% and with a minimum PASI of 12.

Intervention:

Patients were treated with alefacept 15 mg IM for 6 weeks followed by alefacept 30 mg IM for an additional 6 weeks; doses were held for CD4 counts < 200 cells/mm3 or evidence of a clinically significant infection.

Main Outcome Measure:

Efficacy was evaluated by PASI and Physician Global Assessment (PGA) at baseline, week 7, and 2, 6, 12, and 24 weeks post-treatment.

Results:

Sixteen patients were enrolled; at 6 weeks post-treatment, the PASI mean reduction was 39%, with continued improvement to 46% at 12 weeks post-treatment. The PASI 90, PASI 75, and PASI 50 responses at 12 weeks post-treatment were 6% (1 of 16), 13% (2 of 16), and 38% (6 of 16), respectively; 12% (2 of 16) of patients achieved a PGA of clear to almost clear at 12 weeks post-treatment. The overall PASI 75 and PASI 50 responses were 19% (3 of 16) and 38% (6 of 16), respectively.

Conclusion:

The treatment regimen of alefacept 15 mg IM for 6 weeks followed by alefacept 30 mg IM for 6 weeks was well tolerated by our patients. There was no increased incidence of infections when patients were treated with alefacept 30 mg compared with the 15 mg dose. The increased dose of alefacept 30 mg for the last 6 weeks of a 12-week course did not appear to yield a higher efficacy rate compared with historical controls.
Overexpression of p27KIP1 in Seborrheic Keratosis
Authors: Bruecks Andrea K. , Kalia Sunil , Trotter Martin J.
Published: March 2015

Background:

The pathogenesis of seborrheic keratosis (SK) is not well understood. SKs are slow growing, but the details of cell cycle control in these lesions are not known. We hypothesized that cyclin-dependent kinase inhibitors would be strongly expressed in SKs and that the proliferation rate would be low.

Objectives:

To quantify the expression of Ki67, p16INK4a, p21WAF1, and p27KIP1 in SK.

Methods:

We assessed acanthotic SKs ( n = 10) and irritated SKs ( n = 10) for Ki67, p16INK4a, p21WAF1, and p27KIP1 expression using immunohistochemistry.

Results:

For nonirritated acanthotic pattern SKs, the Ki67 index was 3.4% (range 0.6–6.5%), confirming a low proliferation rate. The p16INK4A index was 6.0% (range 0–16%), and the p21WAF1 index was 4.8% (range 0–25%). p27KIP1 was strongly and diffusely expressed in all SKs, with a labeling index of 78% (range 75–85%). The labeling indices were similar in irritated SK lesions with a slightly increased proliferation rate and corresponding decrease in p27KIP1 expression.

Conclusions:

We conclude that in SKs, strong expression of the cyclin-dependent kinase inhibitor p27KIP1 appears to be a major mechanism controlling keratinocyte proliferation.
Alefacept is Safe and Efficacious in the Treatment of Palmar Plantar Pustulosis
Authors: Guenther Lyn C.
Published: March 2015

Background:

Alefacept blocks T-cell activation and induces apoptosis of memory T cells. It improves psoriasis vulgaris and may induce prolonged remissions. Experience with alefacept in palmar plantar pustulosis (PPP) is limited.

Objective:

The objective of the study was to observe the effectiveness and safety of alefacept in the treatment of PPP.

Methods:

Alefacept was administered weekly for 16 weeks by intramuscular (IM) injection of 15 mg to 15 patients with moderate to very severe PPP. Patients were followed for an additional 12 weeks.

Results:

Four weeks after 16 weeks of treatment, there was a 49.6% reduction in the Palmoplantar Pustulosis Psoriasis Area and Severity Index (PPPASI) and a 38.6% and a 64.5% reduction in total and fresh pustules, respectively. Eight weeks after dosing, 53.3% achieved PPPASI 50, 26.7% achieved PPPASI 75, and one patient was clear. The mean percent reduction in total pustules and fresh pustules was 46.1% and 61.2%, respectively; 73% had no pain, 53% had no itching, and 80% had no functional impairment. The palms responded better than the soles.

Conclusions:

This pilot showed that 16 weeks of once-weekly alefacept 15 mg IM was safe, led to improvement in PPP in all 15 treated patients, and induced a remission in one patient. Larger double-blind studies are warranted.
Association between Proliferative Scars and In-Stent Restenosis
Authors: Ozdol Cagdas , Turhan Sibel , Tulunay Cansin , Altin A. Timucin , Atmaca Yusuf , Candemir Basar , Erol Cetin
Published: March 2015

Background:

Keloid and hypertrophic scars are two types of proliferative scars at sites of cutaneous injury that form as a result of an abnormal wound-healing process. Proliferative scar formation after skin injury and restenosis after coronary stenting have common features. The aim of this study was to investigate the association of proliferative scars with coronary stent restenosis.

Methods:

Patients with previous open heart surgery with median sternotomy who had coronary stenting after the surgery and were admitted for control angiography were included in the study. The patients were divided into two groups according to the presence or absence of proliferative scars. The primary end point was the incidence of angiographic restenosis in patient groups.

Results:

The study group consisted of 80 patients (64 men; mean age 64 ± 9 years). Twenty-three patients (29%) have a proliferative scar. In general, two groups were comparable with regard to baseline lipid profiles, demographics, and cardiovascular risk factors. Restenosis was significantly more prevalent in patients with proliferative scars than with controls ( p = .04). By multivariate logistic regression analysis, stent length (odds ratio [OR] 1.12, p = .005), diabetes (OR 3.3, p = .03), and proliferative scar (OR 4.2, p = .02) independently predicted in-stent restenosis.

Conclusion:

The findings of this study suggest that patients with proliferative scars may have a higher risk of in-stent restenosis.
Secondary Syphilis Presenting as Annular Lichenoid Plaques on the Scrotum
Authors: Narang Tarun , De Dipankar , Dogra Sunil , Kanwar Amrinder Jit , Saikia Uma Nahar
Published: March 2015

Background:

Secondary syphilis can have protean clinical manifestations and can present with unusual lesions, which may go unrecognized.

Methods:

We report two cases of secondary syphilis with annular lichenoid plaques on the scrotum associated with generalized lymphadenopathy, fever, and malaise.

Results and conclusions:

The serology revealed a reactive Venereal Disease Research Laboratory test and a positive Treponema pallidum hemagglutination assay. The human immunodeficiency virus (HIV) serology was nonreactive. The lesions cleared with a single dose of benzathine penicillin, 2.4 million units, given intramuscularly. The presentations of syphilis, often described as “x201C;the great imitator,” can be varied and atypical. Increased clinical vigilance and awareness of the varied modes of presentation are needed to prevent missing this highly treatable, potentially serious condition.
Unusual Presentations of Molluscum Contagiosum
Authors: Al-Mutairi Nawaf
Published: March 2015

Background:

Molluscum contagiosum is a common viral skin infection. Unusual presentations of this condition among immunocompetent individuals have rarely been reported.

Objective:

To highlight atypical clinical presentations of molluscum contagiosum in immunocompetent individuals.

Methods and Results:

An analysis of all cases of molluscum contagiosum with unusual presentation seen over a period of 2 years in the Farwaniya Department of Dermatology was conducted. Four patients (two males, two females), aged 13 to 35 years, with atypical molluscum contagiosum were encountered. Diagnosis was confirmed histopathologically. All of them were healthy, immunocompetent individuals without any underlying skin condition, except one who had preceding hand dermatitis. Clinical clues that could be helpful in making a diagnosis of molluscum contagiosum with an atypical presentation were looked for.

Conclusion:

A histopathologic examination may be necessary to make the diagnosis.
Incidence and Mortality Data from Cutaneous Melanoma in Trentino: Registry-Based Study
Authors: Boi Sebastiana , Cristofolini Mario , Micciolo Rocco , Polla Enzo , Piffer Silvano , Gentilini Maria
Published: March 2015

Background:

The province of Trento has been the target of health campaigns for early diagnosis of cutaneous melanoma for 30 years.

Objective:

To evaluate incidence and mortality data of skin melanoma in the province from January 1992 to December 2001.

Methods:

The study is based on the provincial skin cancer registry and the regional mortality registry. Standardized incidence and mortality rates were computed, and time trends were evaluated. Incidence rates were modeled using Poisson regression.

Results:

Five hundred fifty-four melanomas were diagnosed (226 in males and 328 in females). No period effect was revealed. Incidence rates in females were about 1.24 times those in males. No significant trend in mortality rates was observed.

Conclusion:

We examined incidence and mortality data of cutaneous melanoma during a 10-year period and failed to find any significant trend. It seems we have reached a plateau after many years of continuous, intensive health campaigns.
Naftifine: A Review
Authors: Gupta Aditya K. , Ryder Jennifer E. , Cooper Elizabeth A.
Published: March 2015

Background:

Naftifine is a topical allylamine that is effective and safe in the management of superficial dermatomycoses. Naftifine is fungicidal in vitro against a broad spectrum of dermatophyte fungi and provides good activity against Candida and Aspergillus species. It is also effective against gram-negative and gram-positive bacteria.

Objective:

To provide a review of the pharmacologic properties and clinical efficacy of topical naftifine preparations.

Methods:

A review of the medical literature was performed using PubMed (1965–2006) using the search term “naftifine.” All available English-language articles discussing the pharmacology and clinical use of naftifine were reviewed for the article.

Results:

Naftifine causes interruption of fungal ergosterol synthesis and accumulation of squalene in fungal organisms. Naftifine also has demonstrated anti-inflammatory properties such as a reduction in superoxide production and a reduction in polymorphonuclear leukocyte chemotaxis/endothelial adhesion. Naftifine has shown good efficacy and safety for a variety of conditions and is a useful treatment that provides both antifungal action and relief of inflammatory signs and symptoms. Few adverse events have been noted with naftifine use, the most frequent being mild and transient burning, stinging, or itching in the application area.

Conclusion:

Naftifine remains a reliable multifunctional agent for a variety of superficial infections.
Dermatologic Manifestations of Underlying Infectious Disease among Illicit Injection-Drug Users
Authors: Blondin David , Crawford Richard I. , Kerr Thomas , Zhang Ruth , Tyndall Mark W. , Montaner Julio S. , Wood Evan
Published: March 2015

Background:

Drug use patterns and serious bloodborne infections commonly have dermatologic manifestations among illicit injection-drug users (IDUs).

Objective:

To assess how self-reported skin conditions of IDUs may correlate with underlying infectious diseases after adjustment for drug use patterns.

Methods:

Prospective analysis of factors associated with self-reports of skin rashes, cellulitis, oral lesions, and lymphadenopathy obtained from 1,065 IDUs enrolled in a large cohort study. Variables potentially associated with each outcome were evaluated using multivariate generalized estimating equations.

Results:

In multivariate analyses, drug use patterns were associated with cellulitis, whereas human immunodeficiency virus (HIV) infection and hepatitis C (HCV) were not. HCV infection was independently associated with skin rashes (odds ratio [OR] 1.85; 95% Cl 1.17–2.94). HIV infection was independently associated with lymphadenopathy (OR 2.00; 95% CI 1.52–2.63), skin rash (OR 2.12; 95% CI 1.57–2.86), and oral lesions (OR 14.95; 95% CI 9.41–23.76).

Conclusions:

Self-reports of IDUs, which could easily be obtained as part of a functional inquiry in a clinical setting, correlate with specific drug use patterns and underlying bloodborne infections.
Hand Rejuvenation Using Intense Pulsed Light
Authors: Goldman Alberto , Prati Clarissa , Rossato Flávia
Published: March 2015

Background:

The aging of the hands is typically characterized by wrinkles, skin thinning, and solar lentigines. The search for effective treatments has led to the use of laser and intense pulsed light (IPL) technologies.

Objective:

To assess the effectiveness of an IPL device for the improvement of dyspigmentation and overall skin quality on the dorsa of the hands.

Methods:

Twenty-three patients with sun damage and solar lentigines on the dorsal hands were treated with four IPL sessions at 3- to 4-week intervals. Prior to treatment, photographs were taken and informed consent was obtained. Pre- and post-treatment photography and investigator clinical assessment and patient questionnaires were collected for data analysis.

Results:

After four treatment sessions, good to excellent results in the improvement in solar lentigines and skin quality were assessed by investigators in 100% of the cases and in 86.94% (20 of 23 subjects) by patient self-assessments. No significant side effects were observed.

Conclusion:

IPL is an effective and safe treatment option to improve solar lentigines and skin texture for hand rejuvenation.
Onycholysis Associated with Capecitabine in Patients with Breast Cancer
Authors: Hogeling Marcia , Howard Jessica , Kanigsberg Nordau , Finkelstein Harvey
Published: March 2015

Background:

Onycholysis, which is separation of the nail plate from the nail bed at its distal and lateral attachments, can cause pain and impair function and is a well-known side effect of traditional chemotherapeutic agents.

Objectives:

We present two cases of onycholysis associated with capecitabine in women with advanced breast cancer, who were initially referred for evaluation of onychomycosis and review the literature on capecitabine.

Conclusion:

Owing to the increased frequency of use of capecitabine for different cancers, physicians should be aware of this side effect.
Measurement of Utility in Nonmelanoma Skin Cancer
Authors: Lear William , Akeroyd Jennifer Ellen , Mittmann Nicole , Murray Christian
Published: March 2015

Background:

Quality of life is an important variable in assessing the impact of a condition on patients. The current literature shows a minimal effect of nonmelanoma skin cancer (NMSC) on patients' quality of life. This contrasts with our own experience. Given this disparity, we sought to perform an additional study in this area. Past studies have used multiattribute methods to assess quality of life. In contrast, the present study uses health utility methods, which rate a patient's quality of life from 0 to 1, with 1 representing perfect health.

Methods:

Forty-one patients were guided through two standardized scenarios using a standard gamble process with a trained interviewer. Health utility scores were determined for both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) using various NMSC treatment modalities.

Results:

All patients had health utility scores of 0.99 or higher. The standard gamble method showed no statistically significant differences in health utility scores for any treatment scenario for BCC or SCC using raw data comparisons. However, a modified standard gamble approach showed significantly higher health utility scores for both BCC and SCC treated using surgical modalities.

Conclusion:

Using the standard gamble health utility method in patients with BCC or SCC, it appears that these tumors have a minimal impact on the quality of life in the present study group. However, the results may simply reflect the poor sensitivity of the standard gamble health utility method to accurately assess quality of life changes in patients with NMSC. A modification of the standard gamble method did show that patients with NMSC associated surgical treatments with a better health outcome. New outcome measures need to be devised to accurately assess the toll of NMSC on patients.
Long-Term Management of Generalized Pustular Psoriasis with Infliximab: Case Series
Authors: Routhouska Shannon B. , Sheth Pranav B. , Korman Neil J.
Published: March 2015

Background:

Infliximab, a tumor necrosis factor α antagonist, has recently been shown to be successful for the short-term treatment of generalized pustular psoriasis (GPP) in multiple case reports.

Objective:

The goal of this case series was to assess the efficacy of the longer-term management of GPP with infliximab.

Methods:

Three patients with severe GPP were followed to assess the efficacy of long-term treatment with infliximab.

Results:

Infliximab therapy was more efficacious with infusion every 6 to 8 weeks in combination with methotrexate.

Conclusion:

Infliximab may be efficacious for some patients for the long-term management of GPP. Maintaining a strict infliximab infusion schedule and concomitant methotrexate therapy may decrease infusion reactions and increase efficacy.
Angioma Serpiginosum with Linear Distribution: Case Report and Review of the Literature
Authors: Kalisiak Mike S. , Haber Richard M.
Published: March 2015

Background:

Angioma serpiginosum is a vascular anomaly that classically presents in childhood and predominantly affects females.

Objective:

To present a case of a young woman with linear distribution of angioma serpiginosum and review the common clinical characteristics and presentation of this condition.

Methods:

Case report with skin biopsies and dermoscopic findings.

Results:

A clinical examination revealed numerous irregular punctate red macules in a linear distribution over the right arm. On dermoscopy, the lesions appeared as multiple sharply demarcated red lagoons. The histopathologic findings of dilated blood vessels in the papillary dermis with absence of other changes confirmed the diagnosis of angioma serpiginosum.

Conclusion:

Angioma serpiginosum is a rare entity that can be distinguished by clinical and histopathologic examinations. Lack of recognition of this condition may lead to unnecessary investigations and delayed treatment.
Effects of Basic Fibroblast Growth Factors on Hypertrophic Scarring in a Rabbit Ear Model
Authors: Xie Julin , Qi Shaohai , Xu Yingbin , Tang Jingming , Li Tianzeng , Liu Xusheng , Shu Bin , Liang HuiZhen , Huang Bing
Published: March 2015

Background:

Basic fibroblast growth factor (bFGF) was clinically proven to accelerate acute and chronic wound healing. Accelerated wound healing may lead to improved scarring. These studies suggested a possible antiscarring effect of bFGF during wound healing. Little was known about the precise pathologic mechanisms of bFGF on scarring formation.

Aims:

The aim of this study was to investigate the effect of bFGF on hypertrophic scarring in a rabbit ear model and clarify the mechanism of bFGF on scar treatment.

Methods:

The rabbit model of hypertrophic scarring was created and received of a low- or high-dose topical treatment three times daily for 1, 2, or 3 months. Then we examined the changes in the macroscopic and histopathologic characteristics of the scars. The expression of collagen, α1β2 integrin, and matrix metalloproteinase 1 (MMP-1) was studied by applying reverse transcriptase-polymerase chain reaction, enzyme-linked immunosorbent assay, and Western blotting.

Result:

High-dose bFGF remarkably alleviated the scar in the rabbit ear model and decreased collagen type I expression. Further study revealed that bFGF remarkably enhanced MMP-1 and decreased α1β2 integrin expression.

Conclusion:

This study supports the hypothesis that bFGF exerted a net negative effect on collagen remodeling, therefore suggesting a potential antiscarring role.
Diagnosis and Follow-Up of Keratoacanthoma-Like Lesions: Clinical-Histologic Study of 43 Cases
Authors: Magalhães Renata Ferreira , Cruvinel Gabriela Torres , Cintra Geórgia Fontes , Cintra Maria Letícia , Ismael Ana Paula Palu Baltieri , de Moraes Aparecida Machado
Published: March 2015

Background:

Keratoacanthoma (KA) is easily confused with squamous cell carcinoma (SCC) on a clinical or a histopathologic basis. However, KA undergoes spontaneous regression, whereas SCC does not.

Objective:

Our objective was to study the histopathologic features associated with clinical regression in KA-like lesions to support the therapeutic option.

Methods:

Forty-three biopsies of KA-like lesions were taken at patient admission. One month later, surgical excision was performed in 18 growing lesions. Regressing lesions were left untreated. Classic histopathologic features and diagnosis were blindly recorded in both biopsies and surgical specimens.

Results:

On a clinical and a histologic basis, 32 lesions were assessed as KA and 11 as SCC. Features that indicated malignancy were observed in both groups, but the probability of SCC was 31 times higher in tumors with five or more of such features. Several of the histologically atypical lesions were found to regress.

Conclusion:

SCCs and KAs have more pathologic similarities than differences, especially in the proliferative phase. The combination of the most useful features did not allow the nosologic diagnosis in difficult cases but helped. Differential diagnosis was easier to determine after the 1-month follow up. Complete surgical excision should be indicated in nonregressing and growing lesions.
Repair of the Philtrum: An Illustrative Case Series
Authors: Housman Tamara Salam , Berg Daniel , Most Sam P. , Odland Peter B. , Stoddard Earl
Published: March 2015

Background:

Distortion of the philtrum, which lends considerable symmetry to the midface, leads to a poor esthetic outcome.

Objective:

This case series describes reconstructive approaches to six philtral defects after Mohs micrographic surgery. Reconstructive approaches including advancement flaps, full-thickness skin grafts, and second-intention healing are illustrated. Postoperative complications included graft hypertrophy, irregularity of the graft surface, graft color mismatch, tenderness, and slight eclabium, which improved with dermabrasion or intralesional triamcinolone.

Conclusion:

The reasonable success of full-thickness skin grafts demonstrated here provides an additional approach to philtral repairs, especially when combined with traditional advancement flaps.
Open-Label Study to Assess the Safety and Efficacy of Imiquimod 5% Cream Applied Once Daily Three Times per Week in Cycles for Treatment of Actinic Keratoses on the Head
Authors: Rivers Jason K. , Rosoph Les , Provost Nathalie , Bissonnette Robert
Published: March 2015

Background:

Local skin reactions are common during imiquimod treatment of actinic keratosis (AK). Cyclical application of imiquimod may improve tolerability while maintaining efficacy.

Objective:

To assess the tolerability of imiquimod and clearance rate of AK lesions after imiquimod application.

Methods:

Imiquimod 5% cream was administered three times per week for 4 weeks followed by 4 weeks of rest (cycle 1) to AK lesions on the head. If AK lesions remained visible at the end of cycle 1, a second treatment cycle was instituted.

Results:

Fifty percent (30 of 60) of patients experienced complete clearance of AK lesions, and 75% (30 of 40) of patients experienced partial clearance of AK lesions after imiquimod treatment at the end of cycle 2. Moreover, 77% of patients who achieved complete clearance had no visible AK lesions 12 weeks post-treatment. Imiquimod was well tolerated.

Conclusion:

Imiquimod cycle therapy may be a safe and effective treatment option for AK lesions.
Melanonychia Following Mohs Surgery for Recurrent Squamous Cell Carcinoma in Situ of the Nail Bed
Authors: Lipoff Jules B. , Scope Alon , Busam Klaus J. , Nehal Kishwer S.
Published: March 2015

Background:

Longitudinal melanonychia (LM) is characterized by the appearance of a longitudinal pigmented band in the nail plate. Melanonychia can occur from many causes, including racial predisposition, trauma, drugs, pregnancy, Addison disease, Peutz-Jeghers syndrome, Laugier-Hunziker syndrome, Bowen disease, onychomycosis, benign nail matrix nevi, and melanoma.

Objective:

We present a case of diffuse melanonychia developing several months following Mohs surgery for a human papillomavirus-induced recurrent squamous cell carcinoma in situ of the nail bed.

Conclusions:

This case illustrates the diagnostic dilemma in determining the etiology of the melanonychia and considers the differential diagnosis.
Successful Treatment of Chronic Decubitus Ulcer with 0.1% Dirhamnolipid Ointment
Authors: Piljac Ante , Stipčević Tamara , Piljac-Žegarac Jasenka , Piljac Goran
Published: March 2015

Background:

Previous investigations of the biologic activities of dirhamnolipid α-L-rhamnopyranosyl-(1–2)α-L-rhamnopyranosyl-3-hydroxydecanoyl-3–hydroxydecanoic acid have demonstrated that it could be a novel therapeutic agent for wound healing and various immunologic and dermatologic conditions.

Objective:

The aim of this article is to report the successful treatment of a decubitus ulcer with dirhamnolipid.

Methods:

The patient was a 90-year-old woman who developed a decubitus ulcer on her right buttock. The patient was initially treated by a standard procedure using pressure reduction, wound management, surgical intervention, and nutrition. The open, full-thickness wound progressed to a size of 10 × 7 cm, with evidence of tissue deterioration. The draining ulcer reached a dimension of 1 × 1.5 × 3 cm. The 0.1% dirhamnolipid ointment was administered at regular intervals, three times daily, by applying a thin layer of ointment directly to the wound area. Photographs were taken at regular 5-day intervals.

Results:

The standard therapy gave no improvement. Subsequently, therapy with topical dirhamnolipid ointment resulted in a completely healed wound on day 48 of the treatment.

Conclusion:

This case demonstrates that application of dirhamnolipid resulted in the healing of a chronic decubitus ulcer in an elderly, debilitated patient and might be a useful therapy to improve healing of decubitus ulcers.
Treatment of Vitiligo with Narrow-Band Ultraviolet B: Advantages and Disadvantages
Authors: Abdulla Sonya J. , DesGroseilliers J.P.
Published: March 2015

Background:

Narrow-band ultraviolet B (NB-UVB) therapy for vitiligo is increasingly used in patients who are unresponsive to other forms of therapy.

Objective:

This study measures levels of patient and physician satisfaction and the associated advantages and disadvantages of NB-UVB.

Methods:

A retrospective chart review was conducted of the first 50 patients with vitiligo treated at the Photoderm Clinic in Ottawa, Ontario. Data were obtained from digital photographs and patient charts (n = 50).

Results:

Percent repigmentation of the face and body was very good compared with the hands and feet (poor = 0-< 33%; good = 33-< 66%; very good = ≥ 66%). The physician and patients were satisfied with results achieved with NB-UVB therapy (very good [VG]: medical doctor [MD] 49% [95% CI 35–63], patient [Pt] 51% [95% CI 37–65]; good [G]: MD 24% [95% CI 12–36], Pt 22% [95% CI 10–34]).

Conclusion:

NB-UVB therapy is an effective treatment for vitiligo (ie, VG, repigmentation ≥ 66%) that leads to high levels of patient and physician treatment-related satisfaction. Although there are disadvantages to NB-UVB therapy, the advantages outweigh the drawbacks. An objective evaluation such as the Vitiligo Area Scoring Index (VASI) is necessary to validate these findings. Additional limitations include those inherent in retrospective study design.
Psychopharmacology in Psychodermatology
Authors: Shukla Rahul , Sasseville Denis
Published: March 2015

Background:

The management of psychodermatologic disease often involves the use of psychotropics by dermatologists. A general approach to the psychopharmacologic management of psychodermatological disease may be of assistance to the dermatologist.

Objective:

We review and provide a current psychopharmacologically based approach to management of common psychopathologies associated with psychodermatologic disorders, common side effects, and potential drug interactions that may occur with selected psychotropics.

Methods:

Using relevant MeSH terms, we performed a review of the literature from 1980 to 2006.

Results and Conclusions:

Effective psychopharmacologic management of psychodermatologic disease involves identifying and basing treatment on the associated psychopathology; familiarity with a variety of psychotropic agents, including antidepressants, anxiolytics, and antipsychotics; and the involvement of a psychiatrist when possible.
Efficacy of a Day-Care Program in the Treatment of Psoriasis
Authors: Zhang Junling , Adam David N. , Stebbing Elaine , Gerbrandt Judith , Lui Harvey , Shapiro Jerry , Zhou Youwen
Published: March 2015

Background:

Few data exist documenting the effectiveness of psoriasis day-care treatment programs (PDTPs) using standardized efficacy measurements.

Objectives:

We sought to analyze the efficacy of a PDTP using the Psoriasis Area and Severity Index (PASI).

Methods:

A retrospective review was performed on 132 patients treated at our PDTP. Sufficient data existed to permit PASI analysis using a simplified method for a representative subgroup of 64 patients, who formed the study population. Patients received phototherapy and topical treatments over 2 weeks. The outcome measures included a baseline and day 11 PASI, a physician global assessment (PGA), and adverse events reported by the patients.

Results:

Mean baseline PASI was 13.6 ( N = 64), with a 59.6% reduction by day 11. A PASI reduction of ≥ 50% was seen in 75% of patients, with 30% of patients achieving ≥ 75% reduction of PASI. Day 11 PGA demonstrated a 69.9% improvement.

Conclusion:

With a reduction in PASI of 59.6% at 11 days, our PDTP, with phototherapy and topical agents, seems to be a rapid and effective therapy for psoriasis.
Results of Radiation Therapy for Treatment of Classic Kaposi Sarcoma
Authors: Hauerstock David , Gerstein William , Vuong Te
Published: March 2015

Background:

Classic Kaposi sarcoma (CKS) is a vascular neoplasm that primarily affects men of Mediterranean and Ashkenazi Jewish descent. A variety of therapeutic options exist, and choice of treatment depends on clinical form and stage, as well as lesion location and size; options include surgical excision, intralesional interferon α-2b, local or extended field radiotherapy, and chemotherapy.

Objective:

The aim of this study was to review the outcome of radiation therapy in the treatment of CKS at a single institution.

Methods:

This retrospective study reviewed patients who receive radiation therapy for histologically confirmed CKS between 1994 and 2006.

Results:

Sixteen patients were reviewed; the mean age at diagnosis was 74 years, and 13 patients were male. Fifteen patients (94%) presented with leg lesions, and two patients (12.5%) presented with arm lesions. The most commonly prescribed radiation dose was 30 Gy in 15 daily fractions of 2 Gy. All lesions responded to treatment, with a complete response rate of 88% and a partial response rate of 12%. Toxicity was limited to grade I dermatitis (four patients) and grade II dermatitis (two patients).

Conclusion:

Radiation therapy is an effective treatment modality for CKS and is associated with minimal toxicity.
Tanning Behavior of London-Area Youth
Authors: Gordon Danielle , Guenther Lyn
Published: March 2015

Background:

The World Health Organization recommends that tanning parlors not be used by individuals under age 18 years. The impact of self-tanners on tanning parlor and sunscreen use by Canadian teens is unknown.

Objective:

To determine teens' use of, knowledge of, attitudes toward, and behavior regarding tanning parlors, self-tanning products, and sunscreen.

Methods:

Self-report questionnaire of grade 10 students in Thames Valley district, Ontario.

Results:

Indoor tanning parlors were used by 14%, self-tanners by 28%, and sunscreen daily or most days by 36%. Use was more common in females. There was a strong association between parental and child use of tanning parlors and use of self-tanners. Sixty-two percent believe that self-tanners give adequate photoprotection.

Conclusions:

Further education is required to address teen tanning parlor use, infrequent sunscreen use, and lack of knowledge about the safety of tanning parlors and self-tanning products.
Skin Thickening in a Hemodialysis Patient: A Case of Nephrogenic Fibrosing Dermopathy
Authors: Al Habeeb Ayman , Partington Sara , Rosenthal Donald , Salama Samih
Published: March 2015

Background:

Nephrogenic fibrosing dermopathy (NFD), a rare fibrosing condition of the skin, occurs in patients with renal failure. Worldwide, 215 cases have been reported, but none of them are from Canada.

Case Report:

A 71-year-old woman with hypertensive vasculopathy and renal failure, hypothyroidism, deep vein thrombosis, and a previous abdominal aneurysm repair presented with the rapid development of indurated skin over her arms and legs. These skin changes developed 5 months after starting hemodialysis.

Biopsy Results:

Skin biopsies demonstrated thickened collagen bundles in the dermis with extension into the subcutaneous tissue and minimal increased mucin production. There were increased fibroblastic cells that were immunohistochemically CD34 positive.

Conclusions:

This patient has the clinical and pathologic features of NFD. Interestingly, this patient had a history of vein thrombosis and vascular surgery, emphasizing the possible role these features may play as instigators of fibrosis in this disease.
Exacerbation of Psoriasis under Efalizumab Therapy
Authors: Rallis Efstathios , Verros Constantinos , Karanikola Evmorfia , Valaskatzi Argyro , Papaconstantis Markos
Published: March 2015

Background:

Efalizumab is a recombinant humanized IgG1-κ isotype monoclonal antibody that binds to CD11a, inhibiting T-cell activation. It has been approved for the treatment of moderate to severe plaque psoriasis. Efalizumab has been associated with the development of skin eruptions during the administration period, and this probably represents the potential psoriasis events observed during its administration.

Objective:

We report a case of exacerbation of psoriasis under efalizumab administration. A reversible increase in lymphocyte count with normal total white blood cell count was also noticed.

Conclusion:

Larger series are probably needed to establish clinical and histopathologic criteria and to determine the terminology used regarding the psoriasis adverse events seen with efalizumab treatment.
Granulomatous Periorificial Dermatitis: A Variant of Granulomatous Rosacea in Children?
Authors: Lucas Chere R. , Korman Neil J. , Gilliam Anita C.
Published: March 2015

Background:

We report a case of granulomatous periorificial dermatitis (GPD). A 13-year-old Jamaican boy presented with pink to flesh-colored perioral and periocular papules that erupted during a summer visit to Jamaica. The child was initially diagnosed with sarcoidosis and treated with oral corticosteroids, but the eruption recurred 2 years later. He was referred to Dermatology. Biopsy of one of the facial papules revealed a dense granulomatous infiltrate with surrounding prominent lymphocytes. A diagnosis of GPD was made.

Objective and Conclusion:

Also known as facial Afro-Caribbean childhood eruption (FACE), GPD occurs in prepubertal children. It can be confused with sarcoidosis, infection, and granulomatous rosacea but contains lymphocytes around the granulomas and lacks the systemic involvement seen in sarcoidosis. Cultures are invariably negative. The histologic features of GPD and granulomatous rosacea can be identical, and certain treatments may exacerbate the condition, highlighting the importance of clinical correlation. The correct diagnosis is important to minimize treatment as GPD is ultimately self-limited.
Nevus Spilus with Synchronous Melanomas: Case Report and Literature Review
Authors: Meguerditchian Ari-Nareg , Cheney Richard T. , Kane John M.
Published: March 2015

Background:

Nevus spilus is a rare, acquired, and often large cutaneous lesion consisting of a light brown background macule containing varying numbers of small darker macular or papular areas.

Objective:

Nevus spilus may contain dysplastic melanocytic elements, and there are also reports of melanoma arising from nevus spilus. However, the absolute risk for malignant transformation is not well defined.

Conclusion:

We discuss a case of synchronous melanomas arising from a nevus spilus and potential management recommendations based on a review of the pertinent literature.
Attenuation of α1 Collagen Production with Antisense Ribonucleic Acid in Cultured Hypertrophic Scar Fibroblasts
Authors: Ju-lin Xie , Shao-hai Qi , Tian-zeng Li , Chao-quan Luo , Hou-dong Li , Ying-bin Xu , Xu-sheng Liu , Bin Shu , Huizhen Liang , Yong Huang
Published: March 2015

Background:

It has been demonstrated that hypertrophic scar fibroblasts (HSFs) overexpress collagen messenger ribonucleic acid (mRNA) and protein, especially α1 collagen. Antisense nucleic acids are effective in inhibiting harmful or uncontrolled gene expression, suggesting that antisense ribonucleic acid (RNA) can effectively downregulate the expression of α1 collagen gene and attenuate the scars.

Aims:

This study was conducted to observe the effect of recombinant plasmid pREP9-COL1 on α1 collagen expression in HSFs and clarify the prospect of antisense RNA on scar treatment.

Methods:

The α1 collagen gene fragment including the region of 5′ UTR to exon (229 bp) was cloned in the eukaryotic expression plasmid pREP9 in the antisense orientation relative to the RSV-LTR promoter to reconstruct the pREP9- COL1 plasmid. Then it was transferred into HSFs through lipofectamine. The expression of α1 collagen was examined by immunostaining, reverse-transcriptase polymerase chain reaction, and Western blots.

Results:

The recombinant plasmid pREP9-COL1 with a correct sequence was constructed successfully; pREP9-COL1 consistently inhibited human α1 collagen gene expression at both mRNA and protein levels.

Conclusions:

Antisense RNA was effective in downregulating α1 collagen expression of HSFs. Therefore, this approach offered a prospect of scar treatment by attenuation of α1 collagen production with antisense RNA.