bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cutaneous Effects of Smoking
Authors: Freiman Anatoli , Bird Garrett , Metelitsa Andrei I. , Barankin Benjamin , Lauzon Gilles J. 
Published: July 2017

Background: Cigarette smoking is the single biggest preventable cause of death and disability in developed countries and is a significant public health concern. While known to be strongly associated with a number of cardiovascular and pulmonary diseases and cancers, smoking also leads to a variety of cutaneous manifestations. Objective: This article reviews the effects of cigarette smoking on the skin and its appendages. Methods: A literature review was based on a MEDLINE search (1966–2004) for English-language articles using the MeSH terms cutaneous, dermatology, tobacco, skin, and smoking. An additional search was subsequently undertaken for articles related to smoking and associated mucocutanous diseases, with the focus on pathogenesis and epidemiologic data. Articles presenting the highest level of evidence and latest reports were preferentially selected. Results: Smoking is strongly associated with numerous dermatologic conditions including poor wound healing, wrinkling and premature skin aging, squamous cell carcinoma, psoriasis, hidradenitis suppurativa, hair loss, oral cancers, and other oral conditions. In addition, it has an impact on the skin lesions observed in diabetes, lupus, and AIDS. The evidence linking smoking and melanoma, eczema, and acne is inconclusive. Anecdotal data exist on the possible protective effects of smoking in oral/genital aphthosis of Behçet's disease, herpes labialis, pyoderma gangrenosum, acral melanoma, and Kaposi's sarcoma in AIDS patients. Conclusions: An appreciation of the adverse cutaneous consequences of smoking is important. Dermatologists can play an integral role in promoting smoking cessation by providing expert opinion and educating the public on the deleterious effects of smoking on the skin.
Kikuchi—Fujimoto's Necrotizing Lymphadenitis in Association with Discoid Lupus Erthematosus: A Case Report
Authors: Silver Shane G. , Hong H. Chih-Ho , Ting Patricia T. , Ball Nigel J. 
Published: July 2017

Background: Kikuchi–Fujimoto's necrotizing lymphadenitis (KFNL) is a rare, benign, self-limited condition characterized by constitutional symptoms, lymphadenopathy, and skin lesions. Objective: We report a case of KFNL in a 43-year-old East Indian woman with a ten-year history of discoid lupus erythematosus (DLE) of the scalp and a three-month history of a erythematous plaque on the left nasal bridge, cervical lymphadenopathy, and fever. Skin biopsy samples were taken from the face and lymph node. Results: Histopathological examination of the skin revealed a mixed infiltrate of inflammatory cells, nuclear dust, and histiocytes phagocytosing nuclear debris in the reticular dermis. The lymph node showed interfollicular liquefactive necrosis, immunoblasts, and a similar cellular infiltrate as the skin. The non-necrotic areas demonstrated follicular hyperplasia. These pathological changes are associated with a diagnosis of KFNL. Conclusions: KFNL is reported in association with systemic lupus erythematosus, but only two other cases of systemic KFNL in association with DLE exist in the literature. This case is unique in that the patient presented with cutaneous and systemic KFNL in the setting of longstanding DLE.
Reduction of Melanogenic Activity and Responsiveness to α-Melanocyte-Stimulating Hormone during Serial Passage of Melanoma Cells
Authors: Park Hee-Young , Gilchrest Barbara A. 
Published: July 2017

Background: Murine melanoma cells such as Cloudman S91 or B16 mouse melanoma cells have been used extensively to study mechanisms involved in pigmentation because these cells have tyrosinase, the key enzyme in pigmentation, and produce pigment. We have observed that serial passaged S91 cells tend to decrease their basal pigment content and to lose their responsiveness to α-melanocyte-stimulating hormone (α-MSH). Objective: Because this reduction of melanogenic capacity is a widely acknowledged but virtually unstudied characteristic of both human and murine melanoma cell lines in culture, we wished to document and quantify the phenomenon. Methods: Commercially attained S91 melanoma cells were serially passaged. Basal pigmentation as well as α-MSH responsiveness and expression of protein kinase C-beta (PKC-β) were assessed. Results: S91 cells progressively lost their basal pigmentation under standardized conventional conditions of culture, from an initial melanin content of 20 ± 4 pg/cell content to 12 ± 5 pg/cell within 70 population doublings (16 passages) and to 4.5 ± 6 pg/cell, a level at or below the detectable level of our melanin assay, by 110 population doublings (28 passages). When responsiveness to α-MSH was assessed, a 6-day treatment with 10−6M α-MSH initially induced the pigment content four-fold from 20 ± 4 to 82 ± 2 pg/cell. In contrast, after 110 population doublings, identical treatment with α-MSH induced pigment content less than two-fold from 4.5 ± 6 to 7.5 ± 2 pg/cell. PKC-β expression was readily detected by immunofluorescence in early passage pigmented cells, but not in late passage nonpigmented cells. Conclusion: These results confirm that while murine melanoma cells are a useful model system for pigmentation studies, it is important to monitor changes in the cells' basal abilities to pigment and to respond to exogenous pigment-inducing factors. They further suggest that factors in the culture environment or the internal milieu of melanoma cells exposed to continuous mitogenic stimulation inhibit melanogenesis. One candidate mechanism is down regulation of PKC-β.
Informed Patient Decision Making and the Use of Prescription Medications: A Canadian Dermatologic Perspective
Authors: Singer Michael I. , Shear Neil H. 
Published: July 2017

Background: Informed consent is a potentially beneficial component of medical practice and a basic obligation of physician to patient. Society, in general, and the courts, in particular, have increasingly emphasized the principles of individual autonomy and patient rights, and they have begun to more rigorously require physicians to inform and consult with patients before initiating treatments. Nevertheless, the lack of sufficient information disclosure to patients has become an increasingly common allegation in legal actions against physicians. It has been shown that physicians' understanding of what constitutes informed consent is not always equivalent to the legal definition. While informed consent is generally applied in investigative medical research and before surgical and other invasive procedures, general medicine and dermatology patients do not commonly undergo a process of informed and formal decision making before commencing therapy with sometimes potent medications that often have potentially serious side effects. Objective: The purpose of this article is to explore and clarify the legal concept of informed consent as it applies to the use of prescription medications and to offer dermatologists a strategy to make drug use safer, both medically and legally. Conclusion: In light of recent legal trends including the proclamation of the Ontario Consent to Treatment Act, as well as the application of the “learned intermediary” rule in cases of medical negligence involving lack of drug risk disclosure, Canadian health care practitioners are well advised to become familiar with the concept of informed consent and how it applies to prescription medications.
When Studies are in Error: Basic Statistical Vocabulary Needed to Understand Clinical Studies
Authors: Weinstock Martin A. 
Published: July 2017

Background: Accurate understanding of certain basic statistical terms and principles is key to critical appraisal of published literature. Objective: This review describes type I error, type II error, null hypothesis, p value, statistical significance, a, two-tailed and one-tailed tests, effect size, alternate hypothesis, statistical power, β, publication bias, confidence interval, standard error, and standard deviation, while including examples from reports of dermatologic studies. Conclusion: The application of the results of published studies to individual patients should be informed by an understanding of certain basic statistical concepts.
Elastophagocytosis: A Clue to the Diagnosis of GM-CSF-Induced Dermatosis
Authors: Zalka Alicia D. , Ryan Anna Sarno , Worobec Sophie M. , Scott Glynis A. 
Published: July 2017

Background: Granulocyte-macrophage colony-stimulating factor (GM-CSF) is a cytokine used to stimulate the production of leukocytes and monocytes in neutropenic patients. Cutaneous reactions to GM-CSF are relatively common. However, documentation of the histologic features of GM-CSF-induced dermatoses has only been reported in nine patients. We previously reported three patients with GM-CSF dermatoses, all of whom demonstrated enlarged macrophages in the dermis. Biopsies from two of the patients showed intracytoplasmic elastin fragments in dermal macrophages consistent with GM-CSF's documented ability to increase phagocytic activity of macrophages in vitro. Objective: The objective of the present report is to present an additional case of GM-CSF-induced dermatoses and to document the apparent ability of this cytokine to induce phagocytosis of elastin fragments by macrophages. Methods and Results: The patient received GM-CSF to stimulate bone marrow recovery after a bone marrow transplant. He developed a diffuse macular papular rash that on biopsy revealed enlarged dermal macrophages with prominent intracytoplasmic elastin fragments. Conclusions: Elastophagocytosis by activated macrophages is a common finding in GM-CSF-induced dermatoses and is a relatively specific clue to the diagnosis of this disorder.
Foreign Body Granulomatous Reaction Presenting as Systemic Sarcoidosis: A Case Report with Energy-Dispersive Spectroscopy Analysis
Authors: Singer Michael , Srolovitz Herb , Bullick Robin , Dufresne André 
Published: July 2017

Background: Sarcoidosis is an immune-mediated idiopathic disorder and is generally thought to be a diagnosis of exclusion. Although researchers have looked at viruses, mycobacteria, and certain chemicals as possible triggers, the initiating antigen remains unidentified. Observations: A 41-year-old black male metal-worker previously diagnosed with systemic sarcoidosis presented with a 6-month history of recurrent, sometimes tender, skin nodules on the lower legs. Chest film, gallium scan, and angiotensin-converting enzyme (ACE) level results supported a diagnosis of systemic sarcoidosis. A biopsy of a lower extremity skin nodule showed confluent non-necrotizing granulomas with irregular birefringent particles in giant cells in a fibrous tissue background suggestive of a silica nodule. Review of a previous bronchial biopsy showed similar foreign body granulomas. Energy-dispersive spectroscopy (EDS) analysis of skin and lung tissue revealed mainly silica, clay (kaolinite), chromium, and aluminum particles that were consistent with the patient's occupational exposure. Conclusions: ACE level and gallium scan may not be specific for sarcoidosis. In certain occupational settings, EDS analysis should be considered before a diagnosis of sarcoidosis is made. This case may provide insight into the etiology of certain presentations labelled as sarcoidosis.
Trichothiodystrophy: Current Concepts
Authors: Price Vera H. 
Published: July 2017

Background: Trichothiodystrophy (TTD) is a rare, autosomal recessive disorder in which the hair identifies a group of genetic disorders with deficient high-sulfur matrix proteins, and a defect in excision repair of ultraviolet damage in fibroblasts of most patients. TTD patients may be grouped as follows: (1) the major group with defects in the excision repair cross-complementing gene ERCC2, the gene for xeroderma pigmentosum group D (XP-D); (2) those with defects in ERCC3, the gene for XP-B; and (3) those with a repair defect distinct from those in XP-D and XP-B. In contrast to XP patients, TTD patients have no increased frequency of skin cancers. Objective: The article explains the relationship of TTD and XP and helps clarify why TTD patients with defects in the same gene(s) as those with XP do not have increased skin cancers. Methods: Methods include biochemical studies, mutational analysis, and genomic sequence analysis of cell lines from skin biopsies of TTD and XP patients. Results: The ERCC2 gene is a component of the TFIIH complex which controls two distinct DNA-metabolizing processes, transcription initiation and nucleotide excision repair. Conclusion: In TTD, the major defect is in transcription initiation, whereas in XP-D, DNA repair is primarily altered.
Bone Complications of Corticosteroids
Authors: Lester Robert S. 
Published: July 2017

Background: Systemic corticosteroids, a mainstay of treatment for severe dermatosis, are associated with systemic complications. Adverse effects of corticosteroids to bone represent a significant adverse effect that, is poorly understood and poorly managed. Objectives: The purpose of this article is to educate dermatologists to the current understanding of the pathogenesis, diagnosis, and treatment options available for bone complications of corticosteroids. Results: Virtually all patients chronically exposed to high-dose corticosteroid therapy lose bone mass and are at risk for osteoporotic fractures. In addition, osteonecrosis is an unpredictable complication of corticosteroid therapy that may occur with even low-dose corticosteroids. Conclusion: Optimal risk management of corticosteroid therapy includes understanding the risk factors associated with bone complications and improving communication with patients.
Immunosuppressive and Cytotoxic Drugs in Dermatology: A Practical Overview and Personal Perspective
Authors: Callen Jeffrey P. 
Published: July 2017

Background: Cytotoxic/immunosuppressive drugs are regularly used to treat proliferative diseases of the skin and immunologically mediated inflammatory disorders. Objective: The rational use of cytotoxic/immunosuppressive drugs, which depends on the proper selection of both the patient and the drug, is discussed. Conclusion: Methotrexate, azathioprine, cyclophosphamide, chlorambucil, cyclosporine, and other related drugs have potential benefits in the treatment of severe recalcitrant cutaneous disease. Patients may survive otherwise fatal disorders, or may improve their life-style and become productive again. However, the beneficial effect of these agents is achieved when the blood level is at or near toxic level. Thus, the prescribing physician should have a familiarity with the potential toxicities and a knowledge of proper monitoring techniques.
Differential Induction of IL-12 p40 and IL-10 mRNA in Human Langerhans' Cells and Keratinocytes by in Vivo Occlusion, Vehicle, and All-TRANS Retinoic Acid
Authors: Chen Guofen , Kang Kefei , Kang Sewon , Rook Alain H. , Kubin Marek , Voorhees John J. , Cooper Kevin D. 
Published: July 2017

Background: Hydration and pharmacologic manipulation of the skin may have immunomodulatory effects. For instance, retinoic acid (RA) in vivo upregulates antigen-presenting cell (APC) activity of Langerhans' cells (LC). Objective: Our study was to determine whether RA increases LC APC activity via alteration of the potent immunoregulatory and reciprocally acting cytokines, IL-12 and IL-10. Methods: 0.1% RA and vehicle solvent only (V) as a control were applied under occlusion on the skin of normal volunteers. Freshly selected CD1a+ LC and keratinocytes from keratome were subject to semiquantitative determination of IL-12 p40 and IL-10 mRNA levels. IL-12 p40 protein was measured by radioimmunoassay. Results: Occlusion alone and open vehicle alone did not induce LC immunoregulatory cytokines; LCs demonstrated significant induction of IL-12 p40 mRNA, when the vehicle was occluded for 48 hours and, to a lesser extent, IL-10 as well. IL-12 p40 mRNA could be further induced by RA-LC at the 20-hour time point; however, IL-10 mRNA was induced at the 48-hour time point. Neither occlusion nor RA significantly induced IL-12 p40 or IL-10 mRNA in CD1a keratinocytes at any time points. Conclusion: A tight reciprocal regulation of IL-10 and IL-12 is present in LCs and is consistent with the initial, but self-limited, inflammatory effect of occlusion and topical retinoids.
Anatomic Distribution of Cutaneous Melanomas and Painful Sunburns in Adults
Authors: Wasti Qasim H. , Kopf Alfred W. , Marghoob Ashfaq A. , Stefanato Catherine M. , Romero Judith B. , Rao Babar K. , Bart Robert S. 
Published: July 2017

Background: Data show that intermittent painful sunburns are an important causative factor for cutaneous malignant melanoma. Objective: This study was undertaken to determine whether the differences in the anatomic distribution of melanomas in men, compared to women, could be accounted for by the distribution of sunburns and whether the high incidence of melanomas on the lower extremities of women is associated with the distribution of sunburns. Methods: One hundred and fifty nonmelanoma patients, men and women aged 20 to 60 years, recalled having painful sunburns within the previous 6 months. The locations of the sunburns were indicated on body surface diagrams. The locations of 1168 melanomas as recorded in the NYU-Melanoma Cooperative Group data base were plotted on anatomic diagrams. The anatomic distribution of melanomas and of sunburns for men and women were compared. Results: There was no statistically significant difference in the distribution of sunburns on any anatomic location in men as compared to women. However, there was a disproportionately high number of melanomas on the backs of men and on the legs of women. In both men and women, there was a significant difference between the anatomic distribution of painful sunburns and melanomas. Conclusion: Since the anatomic distribution of painful sunburns is similar in men and women, whereas the anatomic distribution of melanomas differ, it would appear that factors in addition to sunburns in adults account for the differences in the anatomic distribution of melanomas in men and women.
Epithelioid Sarcoma Presenting as a Benign Foot Ulcer
Authors: Tsao Hensin , Pennella Raffaele , Stiller Matthew J. 
Published: July 2017

Background: Epithelioid sarcomas are rare mesenchymal tumours that infrequently present to dermatologists. The often banal spindle and polygonal cell histology can mimic granulomas. Objective: Our aim is to raise the clinician's awareness of a potentially devastating malignancy that can remain unsuspected. Method: We present a case of an epithelioid sarcoma that was misdiagnosed as a benign foot ulcer and treated as such for nearly half a year. An uncertain histology further delayed definitive treatment. At the time of surgery, the tumour had infiltrated deeply. Conclusion: The often nondescript clinical and histologic nature of epithelioid sarcomas demands a high level of vigilance on the part of the clinician.
Genetic Studies in Skin Disorders, No. 1: Hair Today—Hair Tomorrow
Authors: Bale Sherri J. 
Published: July 2017

Background: A high-profile genetics journal published an article describing the mapping of a gene for the X-linked dominant disorder congenital generalized hypertrichosis. Objective: This article evaluates the data presented by Figuera et al. in their linkage-mapping study. Methods: The size of the candidate region defined by Figuera et al., the power of the data to identify candidate loci within the region, and the usefulness of the results for clinicians are evaluated. Results: The candidate region identified by Figuera et al. is extremely large, and these results will not be clinically useful. Conclusion: Despite what may have been presented in the lay press, identification of the gene for congenital generalized hypertrichosis is not imminent.
Rarity of Human Papillomavirus in Nonmelanoma Skin Cancer among Immunocompetent Patients
Authors: Karagas M.R. , Spencer S.K. , Weinstock Martin A. , Kuypers J. , Koff M. , Greenberg E.R. 
Published: July 2017

Background: The role of human papillomavirus (HPV) in nonmelanoma skin cancer (NMSC) among immunocompentent individuals is not well understood. Objective: We tested for the presence of HPV DNA in NMSC of immunocompetent patients from New England. Methods: Biopsies taken from 59 patients were reviewed histopathologically. A segment of the biopsy and scrapings from a site remote from the skin lesion were analyzed for HPV using a standardized polymerase chain reaction (PCR) DNA amplification assay. Results: Of 55 evaluable samples, 21 were histologically confirmed squamous cell carcinomas (SCC), 25 were basal cell carcinomas (BCC), and nine had other diagnoses. Two samples were HPV-positive (3.6%): a basal cell carcinoma of the forehead and a squamous cell carcinoma of the thumbnail bed. Type analysis of these samples revealed HPV 16 from both lesions. Conclusion: The HPV DNA is not commonly detected in NMSCs of immunocompetent patients using standard laboratory techniques. It is possible, however, that a wider range of HPV types could be detected using more sensitive assays; this warrants further investigation.
Defined System to Assess the in Vitro Induction of a Psoriasis Phenotype on Normal Keratinocytes by Fibroblasts from Psoriatic Subjects
Authors: Krueger Gerald G. , Jorgensen Cynthia M. 
Published: July 2017

Background: Research has shown that involved as well as uninvolved skin of psoriatic subjects have an inherent defect that manifests, at a minimum, as nonapparent epidermal hyperplasia. Fibroblasts have been shown to regulate epidermal proliferation and differentiation; furthermore, fibroblasts from patients with psoriasis have altered growth, response, and mediator release when compared with normal. Objective: We conjectured that it might be possible to generate the enhanced epidermal proliferation inherent to psoriatic skin in vitro using a defined interactive culture system with cellular components from the skin of normal and psoriatic subjects. Methods: To reduce the variables whereby fibroblasts stimulate keratinocyte proliferation in vitro, a system was developed that does not permit direct contact between keratinocytes and fibroblasts, but does permit the exchange of media and mediators as well as an assessment of keratinocyte growth as a function of time. Fibroblasts from involved and uninvolved sites from biopsies of seven untreated psoriatic subjects were assessed for their effect on the growth of keratinocytes from normal subjects. Results: Analysis shows that five of seven fibroblast sources from involved sites and six of seven from uninvolved sites of psoriatic subjects induce normal keratinocytes to display enhanced outgrowth. Three of 14 fibroblast sources consistently do not induce this change. Fibroblasts from uninvolved sources are particularly effective, with a mean of 40 ± 8% (SD) more growth than with normal fibroblasts. Conclusion: It is concluded that fibroblasts from psoriatics can induce the phenotype of increased epidermal proliferation on normal keratinocytes via a soluble mediator in a defined system.
Current Thoughts on the Use of Methotrexate in Patients with Psoriasis
Authors: Rosenthal Donald , Guenther Lyn , Kelly James 
Published: July 2017

Background: There are many problems associated with the use of methotrexate in the treatment of psoriasis. Objective: We will attempt to assist the clinician in resolving some of these problems. Methods: This article is a summary of a Round Table Discussion on methotrexate held at the Canadian Dermatology Association meeting at Whistler, BC, July 1995; of a Continuing Medical Education meeting on methotrexate at Langdon Hall, Cambridge, ON, May 1996; and our review of the pertinent literature. Results: We recommend routine folic acid supplementation in patients receiving methotrexate. A baseline pretreatment liver biopsy is probably not indicated in patients without clinical or laboratory evidence of liver disease; and patients on 15 mg or less of methotrexate per week with normal liver function may not need liver biopsy. Conclusion: Liver biopsy of patients on methotrexate for psoriasis may not be necessary.