bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antihistamines in the Treatment of Atopic Dermatitis
Authors: Herman Sari M. , Vender Ronald B. 
Published: July 2017

Background: Atopic dermatitis (AD) is an inflammatory skin disorder that is exceedingly challenging to treat. A prominent feature of AD is chronic pruritus. Early evidence suggested that pruritus in AD was partially due to mast cell release of histamine. Conversely, recent studies do not validate the role of histamine in the pathogenesis of pruritus. Conventional management continues to include the wide use of antihistamines to treat the persistent itch, however, there is an urgent need for therapy which will reduce the severity of pruritus for these patients. Objective: To review the evidence in the literature for the use of antihistamines in the treatment of atopic dermatitis. Methods: A MEDLINE search (1966–2002) was performed to obtain studies examining the use of antihistamines in the treatment of atopic dermatitis. Search terms included: atopic dermatitis; eczema; antihistamines; azatadine; brompheniramine; cetirizine; chlorpheniramine; clemastine; cyclizine; cyproheptadine; desloratadine; diphenhydramine; fexofenadine; hydroxyzine; loratadine; meclizine; promethazine; trimeprazine. Further references were gathered from these publications. Results: Historically, antihistamines have been used in the treatment of AD. However, this review shows that the evidence for its use is inconclusive. At present, several antihistamines continue to provide relief of pruritus by central sedation, and they can also be used therapeutically for concomitant allergic conditions associated with AD. More clinical trials examining the therapeutic efficacy of antihistamines, especially with the newer nonsedating antihistamines, are necessary to elucidate their role in the treatment of AD. Conclusion: Dermatologists require additional evidence regarding the efficacy of antihistamines and their mechanism of action in the treatment of AD to enhance patient care.
Enhancing Skin Self-Examination with Imaging: Evaluation of a Mole-Mapping Program
Authors: Weinstock M. A. , Nguyen F. Q. , Martin R. A. 
Published: July 2017

Background: To enhance early detection of melanoma with thorough skin self-examination, we have enrolled patients in a mole-mapping program that uses digital imaging of the skin. Objective: The goal of our study was to evaluate the impact of participation in the mole-mapping program on performance of thorough skin self-examination. Methods: The study was carried out by telephone survey of 64 program participants, using self-report to assess impact. Results: Participants were generally satisfied and found the program useful and effective; 97% would recommend it. Almost half (45%) of those who were not performing thorough skin self-examination before participation reported performing it after receiving their images. After participation, a partner such as a spouse or friend was more commonly assisting in these examinations. We also noted a correlation (of borderline statistical significance) between sun protection and performance of self-examination, and differences among different definitions of thorough skin self-examination. Conclusion: Interventions centered around imaging have the potential to substantially enhance and encourage the performance of thorough skin self-examination for the early detection of melanoma.
An Unusual Case of Calciphylaxis
Authors: Kouba David J. , Owens Nicole M. , Barrett Terry L. , Laman Susan D. 
Published: July 2017

Background: Cutaneous calciphylaxis is a rare disorder that occurs most frequently in patients with end-stage renal disease (ESRD), those on hemodialysis, and renal transplant recipients. It is frequently associated with hyperparathyroidism and a markedly elevated calcium–phosphate product, and it carries a high mortality rate. The usual clinical presentation is of painful, stellate necrosis of the thighs or buttocks, often in the setting of livedo reticularis. Death usually results from septicemia. Objective: This report documents an unusual case of recurrent, self-limiting calciphylaxis in the setting of a patient with ESRD and discusses the clinical and pathologic features of this potentially very fatal disorder. Methods and Remits: A 52-year-old woman presented with a greater than one-year history of relapsing and remitting, exquisitely painful, necrotic, numular plaques on the abdomen, breast, and arm. This patient had a markedly elevated calcium–phosphate product and parathyroid hormone level. The diagnosis of calciphylaxis was made by wedge biopsy of the most recent plaque, revealing calcification of medium-sized subcutaneous vessels and lobular capillaries with associated epidermal necrosis. Conclusions: This case demonstrates an unusual clinical variant of calciphylaxis that presented without the characteristic stellate necrosis or livedo reticularis that normally marks this condition and spontaneous resolution without incurring septicemia. Regardless of morphology, calciphylaxis should be considered in the differential diagnosis of painful, necrotic lesions occurring in the setting of ESRD.
Multiple Large-Surface Photodynamic Therapy Sessions with Topical or Systemic Aminolevulinic Acid and Blue Light in UV-Exposed Hairless Mice
Authors: Liu Younan , Viau Gilles , Bissonnette Robert 
Published: July 2017

Background: The use of photodynamic therapy (PDT) with topical aminolevulinic acid (ALA) on large skin surfaces has recently been reported for patients with multiple actinic keratoses. Objective: The current study compared the ability of topical and systemic ALA–PDT as well as topical ALA–PDT with blue light to delay the appearance of UV-induced skin cancer using the hairless mouse as a model. Methods: Groups of hairless mice were exposed daily to UV radiation and weekly to ALA–PDT. Tumor-free survival was compared for mice exposed to UV and treated weekly with ALA–PDT and mice exposed only to UV radiation. Results: Weekly topical or systemic ALA–PDT was able to delay the induction of skin tumors. A significant difference in tumor-free survival was also observed for both actinic keratoses and invasive squamous cell carcinoma in mice treated weekly with topical ALA–PDT performed with blue light. This was observed even when weekly ALA–PDT was started after 8 weeks of UV exposure. Conclusion: Large-surface topical ALA–PDT with blue light can delay the appearance of UV-induced actinic keratoses and squamous cell carcinoma in hairless mice.
Understanding the New Clinical Landscape for Psoriasis: A Comparative Review of Biologics
Authors: Sauder Daniel N. , Mamelak Adam J. 
Published: July 2017

Background: Encouraging results from clinical trials suggest that biologic therapies are effective treatments for psoriasis. Objective: The aim of our study was to evaluate the scientific evidence for the efficacy and safety of biologic drugs for psoriasis. Methods: The studies reviewed include data on the biologies alefacept, efalizumab, etanercept, and infliximab. This article reviews all data published in the dermatology literature listed in the MEDLINE database, as well as data presented as abstracts and posters at dermatology society meetings, including the annual meetings of the American Academy of Dermatology. Results: The majority of the studies used an improvement from baseline of 75% or more in the psoriasis area and severity index (PASI 75) as the primary measure of efficacy. Conclusions: Overall, biologics represent an important addition to the psoriatic therapies and have a great impact on the disease course and life quality of those afflicted with psoriasis.
Prednicarbate (Dermatop®): Profile of a Corticosteroid
Authors: Gupta Aditya K. , Chow Melody 
Published: July 2017

Background: Topical steroids have been a popular choice for treating various cutaneous disorders; however, the potential for significant local and systemic adverse events, like skin atrophy and hypothalamic–pituitary–adrenal (HPA) axis suppression, has limited their use. Objective: This article reviews the topical steroid prednicarbate through its mechanism of action, clinical efficacy, and adverse events profile. Methods: Published literature containing the word “prednicarbate” was examined and summarized. Results: Prednicarbate is a nonhalogenated, double-ester derivative of prednisolone that has been used in the treatment of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses such as atopic dermatitis. It has a favorable benefit–risk ratio, low skin atrophy potential, and high anti-inflammatory action. Conclusion: These characteristics make prednicarbate an ideal alternative agent for children, elderly patients, and those who require long-term intermittent treatment.
Segmental Neurofibromatosis Follows Blaschko's Lines or Dermatomes Depending on the Cell Line Affected: Case Report and Literature Review
Authors: Redlick Fara P. , Shaw James C. 
Published: July 2017

Background: Segmental neurofibromatosis type 1 (NF-1) has the characteristic features of generalized NF-1 but is isolated to a particular segment of the body. Segmental NF-1 results from a postzygotic mutation during embryogenesis in the NF-1 gene on chromosome 17. The embryologic timing of the mutation and cell types affected predict the clinical phenotype. Objective: We present a case of a 52-year-old woman with segmental neurofibromas isolated to the right cheek and neck. We review the recent literature on the genetic and cellular differences between the various clinical manifestations of segmental NF-1. Methods: A MEDLINE search for cases of segmental neurofibromatosis was conducted. Results: In patients with segmental NF-1 presenting as neurofibromas-only, the distribution follows a neural distribution in dermatomes because the genetic mutation appears to be limited to Schwann cells. In patients with pigmentary changes only, the NF-1 mutation has been shown to occur in fibroblasts and the distribution tends to follow the lines of Blaschko. Conclusion: Our patient's neurofibromas were secondary to a postzygotic mutation in the NF-1 gene of neural crest–derived cells. This mutation most likely occurred later in embryogenesis in cells that had already differentiated to Schwann cells and were committed to the dermatomal distribution of the right neck and cheek region (C2).
When Genetics Gets under Your Skin
Authors: Bale Sherri J. 
Published: July 2017

Background: Only recently has the advent of the use of modern statistical and molecular genetic techniques begun to increase our understanding of the study of dermatology and skin biology. Objective: This paper will briefly outline several statistical techniques that are used in genetic studies of skin disease by reviewing these techniques, the types of questions that can be answered using them, and issues that should be considered in evaluating and interpreting papers that use them. Methods: A discussion of association studies, segregation analyses, and linkage analyses with respect to skin diseases is presented. Results: Association studies can be used to identify both genetic and environmental risk factors for disease. Segregation analyses are used to identify the underlying mechanism for disease aggregation in families. Linkage analysis is used to map disease genes to chromosomes. Conclusion: Dermatologists should be familiar with the types of genetic questions that can be answered with each technique, and should remain aware of the limitations in interpretation.
Mohs' Micrographic Surgery in Canada: Current Pattern of Practice
Authors: Berg Daniel , Carruthers J. Alastair , Warshawski Laurence M. 
Published: July 2017

Background: Nonmelanoma skin cancers are the commonest human malignancies. Mohs' micrographic surgery is an important treatment for difficult nonmelanoma skin cancers. Little data exist on the use of this technique in Canada. Objective: Our study was to document the modern practice pattern of Mohs' micrographic surgery, with an evaluation of the types of tumours treated and the disposition of patients following tumour excision. Methods: Data were collected prospectively on 410 patients who received Mohs' micrographie surgery for 464 skin cancers at the University of British Columbia. Results: Eighty-one percent of defects were dealt with immediately by the micrographie surgeon with local flaps, skin grafts, primary closure, or healing by secondary intention. Nineteen percent were referred out for repair. Almost all cases referred out had pre-arrangements for repair within 24 hours. Conclusions: In a modern micrographie surgery unit, most patients are managed as outpatients in one setting, and delayed reconstructions are uncommon. Using a multidisciplinary approach, patients requiring referral are usually repaired within 24 hours by a consultant surgeon who is already aware of the patient.
Immunotherapy of Psoriasis
Authors: Bhushan Monica , Craven Nicholas M. , Griffiths Christopher E.M. 
Published: July 2017

Background: Psoriasis is a common inflammatory skin disease, characterized by epidermal keratinocyte hyperproliferation and an inflammatory infiltrate. Current research indicates that epidermal hyperproliferation is, in part, dependent upon the milieu of cytokines and growth factors produced chiefly by T cells within the infiltrate and that the T cells play a central role in the pathogenesis of psoriasis. Objective: Recent developments in the treatment of psoriasis are discussed in the context of current understanding of the pathogenesis of this condition. Conclusion: Significant advances are being made in the treatment directed against these specific immunologic aberrations. Efficacy of immunosuppressive agents such as cyclosporine, FK506 (tacrolimus), anti-CD4 monoclonal antibodies, and IL-2 fusion-toxin in the treatment of psoriasis underscore its probable immune basis. Highly specific treatment directed against cytokines, angiogenesis, and adhesion molecules remains experimental, but shows promise for safer systemic treatment in the future.
Effects of Serum from Normal and Psoriatic Subjects on the Proliferation of Fibroblasts from Involved and Uninvolved Skin of Psoriatic Patients
Authors: Krueger Gerald G. , Jorgensen Cynthia M. 
Published: July 2017

Background: A framework hypothesis for the pathogenesis of psoriasis states that “there is an aberration throughout the skin of patients with psoriasis that is modified to disease expression by circulating factors.” Objective: A question to emerge from this hypothesis concerns whether fibroblasts could be more central to the aberration than other cells of the skin? This article focuses on the modulation of growth of fibroblasts from uninvolved and involved sites of patients with psoriasis as a function of the type of serum in which they are grown. Methods: Fibroblasts were generated from normal subjects and from involved and uninvolved sites of six untreated psoriatic subjects and their growth in vitro was assessed as a function of the type of serum (fetal bovine serum, normal human serum, and serum from psoriatic subjects) in which they are grown. Results: The data show (a) that fibroblasts from psoriatic subjects, especially from uninvolved sites, have an inherent capacity to proliferate at an enhanced rate relative to normal fibroblasts; (b) that this enhanced proliferation can be augmented by normal human serum and to a greater degree by serum from psoriatic subjects; (c) that ≈ 40% of the enhanced proliferation is secondary to the psoriasis serum phenotype; (d) that ≈ 30% of enhanced proliferation is secondary to the psoriasis fibroblast phenotype; and (e) that the magnitude of these features are independent of the severity of psoriasis, as assessed at the time of donation of biopsies for generation of test fibroblasts or of blood for serum. Conclusion: These data support the hypothesis that there is an aberration throughout the skin of patients with psoriasis (enhanced proliferation of fibroblasts in vitro, especially from uninvolved sites) that is modified by circulating factors (serum).
Calcipotriol in the Treatment of Psoriasis of Limited Severity: Pharmacoeconomic Evaluation
Authors: Oh Paul I. , Gupta Aditya K. , Einarson Thomas R. , Maerov Phillip , Shear Neil H. 
Published: July 2017

Background: Calcipotriol (calcipotriene) is a vitamin-D3 analogue that has recently become available in North America for the treatment of psoriasis. Objective: To perform a pharmacoeconomic analysis to determine the cost-effectiveness from a government payer perspective of calcipotriol compared with medium- to high-potency steroids in the management of plaque-type psoriasis of limited severity. Methods: A stepwise analysis was performed. Relevant clinical algorithms were developed after a thorough literature review and input from a clinical panel. A meta-analysis of 31 clinical trials was performed to determine efficacy rates. Costs and resource estimates were obtained from formularies, physician responses, and the literature. Utility values (ratings of health states) were obtained through interviews with 30 patients. Three different decision analytic models reflecting different clinical scenarios in psoriasis management were developed. Total expected costs of therapy including drugs, physician visits, and treatment of failures, and the total Quality Adjusted Life Years (QALYs) for each strategy were calculated. Extensive sensitivity analyses were carried out to explore uncertainty in the parameter estimates entered into the models. Results: In the comparison of drug acquisition cost and efficacy, the incremental cost per cure was $414 using a 6-week course of calcipotriol compared with betamethasone valerate. The cost-utility analyses demonstrated that when calcipotriol was used as a second-line therapy to betamethasone valerate, it was as cost-effective as, if not more cost-effective than, clobetasol propionate used for 4 to 6 weeks. Also, when calcipotriol was used as a primary therapy in patients who had failed prior therapies, it was an attractive alternate compared to betamethasone dipropionate and fluocinonide. Conclusion: Calcipotriol is a relatively new addition to the topical therapies available to treat psoriasis. In general, tolerability and efficacy are similar to those of topical corticosteroids. In the treatment of psoriatic patients with limited plaque disease, calcipotriol, as a second-line treatment to betamethasone valerate, is a cost-effective alternative to medium- to high-potency corticosteroids.
Pyoderma Gangrenosum and IgA Myeloma
Authors: Jackson J. Mark , Collen Jeffrey P. 
Published: July 2017

Background: Pyoderma gangrenosum (PG) is an uncommon condition that is associated with a systemic disease in 50% of patients. The condition may be associated with a monoclonal gammopathy, usually of the IgA type. It is rare for PG to be associated with multiple myeloma. Observations: We report the case of an 83-year-old man with PG associated with an IgA myeloma. The myeloma was discovered after the diagnosis of PG had been made. This is the 22nd case of multiple myeloma associated with PG, and only the 14th case of PG with an IgA myeloma. Conclusions: We should be aware of the potential association of multiple myeloma with PG, and consider doing a serum protein electrophoresis in the evaluation of patients with PG.
Calciphylaxis: Pathogenesis and Therapy
Authors: Worth Richard L. 
Published: July 2017

Background: Calciphylaxis is a rare, painful and debilitating disease in which calcification of the skin and subcutaneous tissues or of internal organs can lead to skin necrosis, discolouration, and other skin lesions. The typical patient has end-stage renal disease (ESRD) and hyperparathyroidism. Selye originally characterized this syndrome in rats and distinguished it from other syndromes of abnormal calcification by the following sequence: sensitizers, latent period, and challengers. There has been recent debate regarding misdiagnosis and failure to differentiate this category of patients even in clinical studies. Objective: In this article the clinical manifestations of calciphylaxis are described; the importance of distinguishing this condition from other calcification syndromes is explained; risk factors, sensitizers, and challenges are reviewed; treatments of choice are discussed; and the merits of parathyroidectomy are evaluated. Conclusion: It is important to consider calciphylaxis in a differential diagnosis of calcification syndromes and in treating patients with ESRD and hyperparathyroidism, because early diagnosis and treatment can interrrupt the progression of the disease process; the disease is painful and debilitating; and inappropriate treatment such as corticosteroid administration may aggravate the condition. Skin biopsy is an important diagnostic tool when the condition is suspected. Parathyroidectomy may be justified because the untreated disease itself has significant rates of morbidity and mortality and because this treatment occasionally leads to dramatic clinical improvement.
p53-Dependent Regulation of Nucleotide Excision Repair in Murine Epidermis in vivo
Authors: Tron Victor A. , Trotter Martin J. , Ishikawa Takatoshi , Ho Vincent C. , Li Gang 
Published: July 2017

Background: p53 protects the integrity of the genome by inducing programed cell death or by promoting DNA repair. We have previously shown that loss or mutation of p53 leads to reduced DNA repair in keratinocytes. Objective: The hypothesis that p53 regulates repair of ultraviolet light-induced epidermal DNA damage in vivo was tested in mice. Methods: An immunohistochemical assay for pyrimidine dimers and 6–4 photoproducts was performed on ultraviolet-irradiated skin from p53 null (−/−) and wild type (+/+) mice. Immunostaining for photoproducts was quantified using computer-assisted imaging. The level of DNA repair was then expressed as the percentage of positive cells remaining as compared to the zero hour time point. Results: p53+/+ mouse skin exposed to 1000 J/m2 retained ≈ 25% of epidermal cyclobutane dimers at 48 h, whereas approximately 50% remained in p53−/− cells. Using the same UV dose, p53+/+ mice retained 20% of detectable 6–4 photoproducts by 24 h, whereas about 50% remained in epidermal cells of p53-deficient mice. Conclusion: Using in situ labelling of UV-damaged cells, we confirm our earlier conclusion that p53 regulates DNA repair within the epidermis after exposure to UV light.
Cutaneous Cryptococcosis Mimicking Basal Cell Carcinoma in a Patient with AIDS
Authors: Ingleton Rosemarie , Koestenblatt Evelyn , Don Philip , Levy Howard , Szaniawski Wojciech , Weinberg Jeffrey M. 
Published: July 2017

Background: Cryptococcosis is an opportunistic infection caused by the encapsulated yeast Cryptococcus neoformans. This ubiquitous organism has emerged as a frequent finding in immunosuppressed patients, especially those with underlying malignancies, organ transplants, and the acquired immune deficiency syndrome (AIDS). Cutaneous manifestations of cryptococcosis occur in 10 to 15% of patients having systemic involvement. These skin lesions may simulate a variety of different disease entities. Methods: A case of crytococcosis mimicking a basal cell carcinoma is the subject of a case report presentation. Results: A case of cutaneous cryptococcosis mimicking basal cell carcinoma occurred in a patient with AIDS, who did not appear to have dissemination, but was treated aggressively to stem possible occult systemic disease. Conclusion: Cutaneous crytococcosis may mimic other dermatologic disorders.