bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pyoderma Gangrenosum in a Patient with Essential Thrombocythemia
Authors: King Kim W. , Murray Alexander 
Published: July 2017

Background: Pyoderma gangrenosum is an uncommon ulcerative condition associated with inflammatory bowel disease, arthritis, and hematologic disease. We report a patient with essential thrombocythemia and pyoderma gangrenosum. Objective: This article is a review of the associations between pyoderma gangrenosum and other diseases. Results: There have been two previous reports of patients with pyoderma gangrenosum and essential thrombocythemia. Conclusion: There may be a possible association between pyoderma gangrenosum and essential thrombocythemia. The diagnosis of pyoderma gangrenosum should be considered in patients with essential thrombocythemia and cutaneous ulcers.
Rapid Aggressive Soft-Tissue Necrosis after Beetle Bite Can Be Treated by Radical Necrectomy and Vacuum Suction-Assisted Closure
Authors: von Goßler Celia M. E. , Horch Raymond E. 
Published: July 2017

Background: The substance cantharidin, which is produced by a type of beetle, rapidly penetrates the epidermis and can cause severe toxicities such as skin necrosis. Optimal treatment for necrotic beetle bites has not been well defined. Conservative management has been advocated but the hospital stays are long and long-term morbidity may result, especially in multimorbid patients. Objective: The value of aggressive surgical management of such necrotizing diseases using newly developed surgical tools is compared to the traditional more conservative approach. Results: We present the case of a multimorbid 60-year-old man with a rapidly progressive necrosis of the medial thigh (measuring 30 × 15 cm), acquired during a stay in Western Africa after being bitten by a beetle of the species Cantharide. The patient was treated with radical surgical debridement and continuous elimination of the wound fluid by permanent computer-controlled negative pressure with a vacuum-assisted wound-closure device. This led to the sudden relief of both local and systemic symptoms and allowed extremely early wound closure. Conclusions: Comparing literature data with the course of this combined treatment, we strongly suggest an early aggressive management with complete radical excision of necrotic tissue, conditioning of the wound bed by temporary suction-assisted vacuum closure and subsequent skin grafting with continued vacuum application. This treatment leads to immediate relief of pain and enhanced healing of this lesion even in the condition of immunosuppression in the elderly.
Effects of a Sun Protection Program Targeting Elementary School Children and Their Parents
Authors: Barankin Benjamin , Liu Kimberly , Howard John , Guenther Lyn 
Published: July 2017

Background: Excessive sun exposure in childhood is considered a risk factor for later development of skin cancer, so sun awareness programs targeting children have been developed. Objective: To assess the benefits of involving parents at home in the sun protection program received by their children at school. Method: The existing “Sun and the Skin” program was enhanced in two ways. Parents were educated both about their child's program and with supplemental information. Also, sunscreen was distributed to each child. Results: Certain methods of sun protection, particularly the use of sunscreen, are being practiced by the majority of children, while others, such as protective clothing, have not been readily adopted. The enhanced group of students showed improvement over control and standard groups in their attitude toward tanning. There is a need for teachers to remind their students to practice protective measures. Conclusions: While a sun-awareness curriculum has been shown to be beneficial for elementary school children, the adjunct of parental and school involvement in this process can improve the results and ultimately decrease the risk of skin cancer in the children.
Changes in Patient Perception and Behavior following Mohs Micrographic Surgery
Authors: Maser Elana , Berg Daniel , Solish Nowell 
Published: July 2017

Background: Mohs micrographic surgery (MMS) is used for the removal of difficult or recurrent skin cancer. Little is known about the behavioral changes of patients who have undergone this procedure. Objective: This study was conducted to document patients' long-term psychological and behavioral changes following AIMS. Methods: A survey was mailed to a sample of 260 persons who underwent the Mohs procedure in 1997. It included questions on sunscreen use, level of anxiety about cancer, patient confidence in MMS, and changes in high-risk habits. Results: The study included 214 patients who responded to our mailed questionnaire. Trends showed an increase in some but not all preventative measures taken to avoid skin cancer recurrence post-MMS. Other healthy lifestyle changes, such as decreased cigarette smoking, were not noted. Conclusion: Mohs micrographic surgery has an impact on some aspects of patients' health-related behavior, especially skin cancer prevention. Other aspects which are not affected may be targets for extra patient education.
Olanzapine May Be an Effective Adjunctive Therapy in the Management of Acne Excoriée: A Case Report
Authors: Gupta Madhulika A. , Gupta Aditya K. 
Published: July 2017

Background: The self-inflicted dermatoses such as acne excoriée and neurotic excoriations are often chronic, recurring, and resistant to standard dermatologic therapies. Objective: We present a 28-year-old woman with longstanding acne excoriée, whose acne started at age 14 years and was followed by acne excoriée at age 16 years. The patient reported that her acne and self-excoriative behavior were exacerbated by psychological stress. The previously treatment-resistant acne excoriée responded favorably to treatment with the atypical antipsychotic agent olanzapine. Methods: The patient was started on olanzapine 2.5 mg at bedtime. Results: After 4 weeks of therapy with olanzapine she reported a significant decline in her self-excoriative behavior which was associated with an improvement in her acne excoriée. The patient used the olanzapine 2.5 mg for 6 months, during which time she also entered psychotherapy in order to deal with some psychosocial stressors that were exacerbating her self-excoriative behavior. The patient has not experienced a recurrence in her self-excoriative behavior or acne excoriée for 4 months after discontinuing the olanzapine. Conclusion: Olanzapine may prove to be a useful adjunctive therapy in some self-induced dermatoses including acne excoriée.
One-Year Followup on the Impact of a Sun Awareness Curriculum on Medical Students' Knowledge, Attitudes, and Behavior
Authors: Liu Kimberly E. , Barankin Benjamin , Howard John , Guenther Lyn C. 
Published: July 2017

Background: A one-week sun awareness curriculum was developed at the University of Western Ontario to educate first-year medical students on skin cancer risks and prevention. Objective: To assess the retention of knowledge, attitudes, and behavioral practices one year after receiving education in sun awareness. Method: Three surveys were administered: before, immediately after the sun awareness teaching, and one year later. Actual practiced behavior in the past year was compared with the intended behavior. Results: Half as many sunburns were reported in the year following the sun awareness curriculum compared with the previous year. Medical students demonstrated a good retention of the knowledge learned a year earlier. However, many students still believed that a tanned appearance looks healthy. While there was intent to adopt more healthy behavior after the curriculum, the actual behavior practiced varied. Conclusions: An undergraduate medical curriculum on sun awareness can be effective in improving the knowledge, attitudes, and behaviors of future physicians.
Itraconazole and Terbinafine Treatment of Some Nondermatophyte Molds Causing Onychomycosis of the Toes and a Review of the Literature
Authors: Gupta Aditya K. , Gregurek-Novak Teodora , Konnikov Nellie , Lynde Charles W. , Hofstader Sophie , Summerbell Richard C. 
Published: July 2017

Background: Onychomycosis may be caused by dermatophytes (which form the majority of organisms), Candida species, and nondermatophyte molds. Objective: To evaluate the efficacy and safety of itraconazole and terbinafine in the treatment of some nondermatophyte molds that cause toe onychomycosis and to review the literature on the treatment of nondermatophyte mold toe onychomycosis using the oral antifungal agents. Patients and Methods: Patients with nondermatophyte mold toe onychomycosis were treated in an open, prospective manner with either itraconazole (pulse) or terbinafine therapy. In each instance, light microscopic examination was consistent with the diagnosis of a nondermatophyte mold. For each patient, mycological evaluation of the target nail resulted in 3 or more successive cultures yielding growth of the mold alone. Results: All 15 patients had onychomycosis of the toes which was of the distal and lateral type. The patients were treated with itraconazole given as the standard 3 pulses with additional pulses administered depending upon the response exhibited by the toe onychomycosis in the patient. Similarly, terbinafine was given for 12 weeks with additional therapy administered as dictated by the response. Efficacy parameters were mycological cure (MC) and clinical cure (CC). Mycological cure was negative light microscopic examination (KOH) and culture. Clinical cure was the appearance of a completely normal-looking nail. At month 12 from the start of treatment, the response was as follows: Scopulariopsis brevicaulis: itraconazole (MC 4/4, CC 2/4) and terbinafine (MC 0/1, CC 0/1), Fusarium species: itraconazole (MC 1/1, CC 1/1) and terbinafine (MC 0/1, CC 0/1), Aspergillus species: itraconazole (MC 5/6, CC 3/6), Alternaría alternata: itraconazole (MC 0/1, CC 0/1), and Onychocola canadensis: itraconazole (MC 1/1, CC 0/1). There were no significant clinical or laboratory adverse effects. Conclusions: In the present series itraconazole demonstrated efficacy against onychomycosis of the toenails caused by 5. brevicaulis and Aspergillus species. A review of the literature confirms our experience with itraconazole and further suggests that terbinafine may also demonstrate efficacy against cases of S. brevicaulis and Aspergillus toe onychomycosis. Additionally, reports in the literature suggest that pedal onychomycosis caused by Fusarium species may also show response to itraconazole and terbinafine. For the other species, there are fewer data, making it difficult to draw conclusions.
Microscopic Acanthosis Nigricans in Type 2 Diabetes
Authors: McManus R. M. , Gottschalk R. , Alanen K. , Shum D. T. , Grundy P. 
Published: July 2017

Background: Acanthosis nigricans (AN) has been associated with insulin resistance. Individuals with type 2 diabetes are insulin-resistant and, therefore, could be expected to manifest AN. However, the prevalence and predictors of AN are unknown in this population. Objective: An outpatient population with Type 2 diabetes (DM) was compared with matched controls (C) for microscopic and clinical AN along with measurement of body habitus, insulin, glucose, and androgen levels. Methods: Twenty-four individuals with DM (12M, 12F) from a tertiary care center were compared with 24 C (12M, 12F). Fasting glucose, insulin, sex hormone binding globulin, androstenedione, dihydroepiandrosterone sulfate, and testosterone were measured. Height, weight, waist/hip measures, and a clinical survey for acanthosis were recorded. A 2-mm skin biopsy from midaxilla of the nondominant arm was taken for pathological review. Results: C and DM were matched for age and body mass index (BMI). Prevalence of microscopic AN in C was 12% (3/24) and in DM was 21% (5/24; NS). In C, AN was predicted by waist, waist/hip ratio, and fasting insulin measures, while none of the variables examined was predicative of AN in DM. Conclusions: Microscopic acanthosis nigricans was found in similar numbers of people with DM when compared with C. Fasting insulin levels most strongly predicted the presence of AN in C, while no significant predictors of AN were found in the population with DM.
Are Cutaneous Reactions to Fly Larvae Mediated by CD4+, TIA+ NK1.1 T Cells?
Authors: Norwood Christopher , Smith Kathleen J. , Neafie Ronald , Skelton Henry 
Published: July 2017

Background: Although there have been reports of fly larvae in wounds and as isolated primary infestations, there have been only rare reports documenting reactions to the larvae within the skin in humans and animals. There have been no reports documenting the histopathologic and immunohistochemical characteristics of the inflammatory infiltrate. Objective: We present a patient who developed local pruritus, erythema, and swelling approximately three weeks after infestation by a fly larva within the scalp. Histopathologically the biopsy site showed a mixed infiltrate containing lymphoid cells and numerous eosinophils. Immunohistochemical stains showed predominantly CD4+ T cells expressing an αβ T-cell receptor (TCR) of which approximately 30% coexpressed T-cell intracellular antigen (TIA) and CD56. In addition, there were approximately 5% of these CD4+ T cells which coexpressed CD30. Conclusions: Histopathologic and immunohistochemical findings are consistent with an effector cell population of cytotoxic CD4+ T cells that produce a T-helper 2 cytokine pattern. The phenotype of this subset of T cells is unique and among its characteristics is that antigens—usually nonprotein antigens—are presented to these CD4+, TIA+ natural killer (NK)1.1T cells by CD1d molecules.
Pyogenic Granuloma: Pyogenic Again? Association between Pyogenic Granuloma and Bartonella
Authors: Lee Joyce , Lynde Charles 
Published: July 2017

Background: Pyogenic granulomas (PG) are benign vascular lesions which were thought to have an infectious etiology, yet none has been found. Bacillary angiomatosis (BA), which presents as disseminated vascular lesions in immunosuppressed patients, and verruga peruana (VP), which presents as crops of vascular nodules in immunocompetent persons, are caused by infection with Bartonella. Thus, the question was raised whether Bartonella could be associated with the development of PG, also a vasoproliferative lesion like BA and VP. The objective of this study was to determine through a case-control study whether such an association exists. Methods: Patients who presented with PG and age and sex-matched controls with capillary hemangiomas and senile (cherry) angiomas were tested for serum IgG antibodies against Bartonella using an immunofluorescence antibody method. The prevalence of positive serology was compared between the groups. Results: Twenty PG patients and 20 control patients with hemangiomas or angiomas were studied. Six out of 20 PG patients tested positive (30%), while none of the 20 control patients tested positive (0%). The difference between the proportions of seropositivity in the two groups reached statistical significance ( p = 0.02, df= 1). Conclusions: Pyogenic granuloma patients were determined to have a statistically higher prevalence of Bartonella seropositivity compared with control patients. Further studies are needed to confirm the association and establish a possible etiological link. Such an association could have potential therapeutic importance. A nonsurgical approach with antibiotics may be possible and may decrease the recurrence rate and occurrence of satellite lesions.
Attitudes of Female Patients regarding Oral Contraceptives for Treatment of Acne
Authors: Tan Jerry K. L. , Vasey Kirsten , Fung Karen Y. 
Published: July 2017

Background: Two hormonal agents with contraceptive properties are currently indicated in Canada for treatment of acne. Objective: The purpose of this study was to determine the attitudes and concerns of female patients regarding the use of hormonal agents and oral contraceptives in treatment of acne. Methods: A self-completed questionnaire was administered to all female acne patients of a community-based dermatologist over a 10-week period between June and August 1999. Statistical analysis was performed by chi-square testing at the 5% significance level. Results: Eighty-six percent recognized that oral contraceptives (“birth control pills”) were also used as a treatment for acne and 60% were willing to use this form of treatment. The most common concern regarding the use of oral contraceptives were side effects (80%). Younger patients were seven times more likely to be concerned about potential disapproval or misunderstanding on the part of others regarding the use of these medications ( p ∼ 0.01). Conclusion: Female acne patients recognize that oral contraceptives are useful in treatment of acne. Although side effects of these medications are of general concern, social disapproval is of particular concern to younger patients.
Review of Ivermectin in Scabies
Authors: Vaidhyanathan Usha 
Published: July 2017

Background: Currently available topical medications for scabies are messy and need prolonged application. This leads to poor patient adherence. Emerging drug resistance to topical scabicides has made eradication of scabies difficult. Objective: Availability of an effective oral scabicidal agent, ivermectin (Ivm), opens a new era in the management of scabies. This review summarizes the published literature on the use of ivermectin in the treatment of scabies. Conclusion: A single oral dose of ivermectin of 200 μg/kg body weight is very effective in the treatment of human scabies. A second dose 7–10 days later substantially improves the cure rate. This suggests that ivermectin may not be effective against all the stages in the life cycle of the parasite. Endemic and epidemic scabies in institutions are better treated with Ivm. Crusted scabies ideally should be treated with a combination of Ivm and topical scabicides. Other standard measures and precautions should be taken. Additional controlled studies using a higher single oral dose or using parenteral or topical forms of Ivm are needed. The safety of Ivm in children less than 5 years old and in pregnant women has to be established. The U.S. FDA has not yet approved the drug for the treatment of human scabies.
Perianal Basal Cell Carcinoma
Authors: Damin Daniel C. , Rosito Mario A. , Gus Pedro , Tarta Claudio , Weindorfer Marcos , Burger Marcos B. , Cartell Andre 
Published: July 2017

Background: A case of basal cell carcinoma (BCC) of the perianal region is reported. This tumor is extremely rare in this location and behaves rather innocently. Objective: Clinical and histopathologic characteristics of perianal BCC, as well as the choices of treatment, are outlined. Conclusion: The tumor should be histologically distinguished from basaloid carcinoma of the anus, which is much more aggressive and metastasizes early, thus requiring a different therapy.
A Review of Antibiotics in Dermatology
Authors: Carrasco Daniel A. , Vander Straten Melody , Tyring Stephen K. 
Published: July 2017

Background: Since the early 1930s when antibiotics were first introduced, they have revolutionized the way physicians treat infections. Skin conditions from acne to leprosy, which were once shunned by society, are now easily treated with oral antibiotics. Objective: Antibiotics are chemicals derived from bacteria and fungi that uniquely have antibacterial action. The most notable example is penicillin, which is derived from a mold. With hundreds of antibiotics available to the practicing physician, improper use of these drugs has become widespread and expensive and has spawned resistant strains. For the dermatologist, antibiotics are vital weapons in the drug armamentarium for treating various skin conditions. Conclusion: This review explores the newest and most common oral, parenteral, and topical antibiotics used in dermatology, their indications, adverse effects, dosage, and spectrum of activity. Furthermore, systemic antibacterial prophylaxis and vaccines pertinent to dermatology are discussed. The penicillins, cephalosporins, tetracyclines, macrolides, fluoroquinolones, sulfonamides, aminoglycosides, lincosamides, folate inhibitors, and a new synthetic class of drugs, the oxazolidinones, are reviewed. These antibiotics are used to treat a variety of organisms.
The Skin in Pregnancy
Authors: Barankin Benjamin , Silver Shane G. , Carruthers Alastair 
Published: July 2017

Background: Physiologic skin changes are common during pregnancy due to a temporary shift in hormonal, metabolic, and immunologic factors. Physicians may mistake normal skin changes in pregnancy as pathologic change within the skin, and so an appreciation of the common and less common skin manifestations will assist in appropriate patient care. Objective: This review highlights the normal physiologic skin changes in pregnancy, which include pigmentary changes, changes to the hair and nails, alterations in glandular activity, vascular and hematological changes, cutaneous tumors, and mucous membrane changes. Conclusion: Physiologic changes to the skin in pregnancy can be complex and confusing. Pregnancy can be a stressful time for women so it is imperative that physicians be aware of the normal skin changes during pregnancy in order to prevent unnecessary investigations and treatments.
Randomized Placebo-Controlled Trial of Metronidazole 1 % Cream with Sunscreen SPF 15 in Treatment of Rosacea
Authors: Tan J. K. L. , Girard C. , Krol A. , Murray H. E. , Papp K. A. , Poulin Y. , Chin D. A. , Jeandupeux D. 
Published: July 2017

Background: Rosacea is a photoaggravated dermatosis responsive to treatment with topical and oral antibiotics. A formulation combining metronidazole 1% cream with sunscreen SPF 15 was developed for the treatment of rosacea. Objective: The objective of this study was to determine the safety and efficacy of a formulation combining metronidazole 1% cream with sunscreen SPF 15 in the treatment of moderate to severe rosacea. Methods: One hundred and twenty patients with moderate to severe rosacea were enrolled for a randomized, placebo-controlled (vehicle containing sunscreen with SPF 15), double-blind study. Study cream was applied twice daily to the entire face over a 12-week period. Results: Treatment with metronidazole 1% cream with sunscreen SPF 15 resulted in significant improvement ( p < 0.05) in inflammatory lesion count, erythema and telangiectasiae scores, and investigator and patient global assessment scores compared with baseline and placebo. Adverse reactions related to study medication were typically mild, occurred at the site of application, and were reversible. There was no difference between the safety profiles of metronidazole 1% cream with sunscreen SPF 15 and placebo. Conclusions: The combined topical formulation of metronidazole 1% cream with sunscreen SPF 15 was an effective, well-tolerated topical agent for the treatment of moderate to severe rosacea.
Squamous Cell Carcinoma in Recessive Dystrophic Epidermolysis Bullosa, Presenting as an Ulcer That Appears to Be Filled with Granulation Tissue
Authors: Kalisiak Michal S. , Edwards David , Lin Andrew N. 
Published: July 2017

Background: Cutaneous squamous cell carcinoma (SCCA) is an important cause of death in patients with the severe form of recessive dystrophic epidermolysis bullosa (RDEB). These cancers often present with features that are different from those of actinically induced SCCA. Objective: To emphasize the unusual features with which SCCA can present in RDEB and discuss early recognition of such cancers. Methods: We present the case of a patient with RDEB who developed a cutaneous ulcer that appeared to be filled with heaped-up granulation tissue. Biopsy, however, showed moderately differentiated squamous cell carcinoma. Results: The patient underwent wide surgical excision of the cancer, with split-thickness skin graft. She has remained disease-free three years later. Conclusion: In patients with RDEB, any ulcer that appears to be filled with heaped-up granulation tissue should be biopsied to rule out SCCA.