bluuebunny/crossref_metadata_2025_split huggingface dataset:
Imiquimod: A Review
Authors: Gupta Aditya K. , Browne Melanie , Bluhm Robyn 
Published: July 2017

Background and Objective: Imiquimod (Aldara) is an immune response modifier used primarily to treat anogenital warts. Imiquimod induces cytokines and enhances cell-mediated cytolytic antiviral activity in vivo. It exhibits antiviral and antitumor effects; however, it does not exhibit direct antiviral effects in vitro. By inducing cytokines, such as interferon A, imiquimod stimulates both the innate immune response and the cellular arm of acquired immunity. Currently, imiquimod is approved for use in the treatment of external genital and perianal warts in adults. Conclusion: Beyond its established use, there are case reports and preliminary studies suggesting the effectiveness of imiquimod 5% cream in the treatment of nongenital human papillomavirus warts, molluscum contagiosum, actinic keratosis, basal cell carcinoma, squamous cell carcinoma, Bowen's disease, nongenital human papillomavirus infection, and vulvar intraepithelial neoplasia.
The Efficacy and Tolerability of Clobetasol Propionate Foam 0.05% in the Treatment of Mild to Moderate Plaque-Type Psoriasis of Nonscalp Regions
Authors: Gottlieb Alice B. , Ford Rosanne Odom , Spellman Mary C. 
Published: July 2017

Background: Clobetasol propionate foam 0.05% (Connetics Corporation, Palo Alto, CA) is approved by the United States Food and Drug Administration for the treatment of corticosteroid-responsive scalp dermatoses, but there is only limited data available for its efficacy and tolerability in treating dermatoses which affect nonscalp sites. Objective: The efficacy and tolerability of clobetasol propionate foam (clobetasol foam) in treating psoriatic lesions at nonscalp sites was evaluated in a multicenter, randomized, double-blinded, placebo-controlled study of 279 patients with mild to moderate plaque-type psoriasis. Methods: The patients applied clobetasol foam or placebo to the psoriatic lesions twice daily for two weeks. In addition to receiving clinical evaluations, the study patients completed a questionnaire evaluating various characteristics of the foam formulation, including their preference for its use and their projected likelihood to comply with similar therapy in a nonstudy environment. Results: At Week 2 (or end of treatment), 68% (94/139) of patients who received clobetasol foam had a Physician's Static Global Assessment score of 0 (clear, except for minor residual discoloration) or 1 (majority of lesions have individual scores for plaque thickness, erythema, and scaling that averages 1). This was significantly more than the 21% (30/140) observed in the placebo group ( P < 0.0001). Similar results were obtained for the Patient's Global Assessment score at Week 2 and in changes (from Baseline to Week 2) in the scores for the signs of psoriasis at a target lesion and for pruritus. Adverse effects were generally limited to mild and transient burning or other application site reactions in only a few patients in each treatment group. In the patient's poststudy questionnaire (completed at Week 2, or end of treatment) a majority of patients rated the characteristics of the foam formulation very highly. The patients ranked the foam formulation as superior to other topical formulations based on factors impacting their quality of life and indicated they would be more likely to comply with a recommended course of therapy with the foam formulation than with other topical formulations. Conclusion: Clobetasol propionate foam 0.05% is safe and effective for the treatment of plaque-type psoriasis on scalp and nonscalp areas, when applied twice daily for two weeks. As it is understood that patient dissatisfaction with select topical formulations affects their compliance with therapy, which necessarily affects the effectiveness of the therapy, the results of the patient's poststudy questionnaire suggest that there are multiple and integrated benefits for the use of clobetasol foam in the treatment of psoriasis of nonscalp sites.
Innovative Therapies in Wound Healing
Authors: Shen John T. , Falanga Vincent 
Published: July 2017

Background: Apligraf is a bioengineered skin product composed of neonatal fibroblasts and keratinocytes. The FDA has approved Apligraf for the treatment of chronic venous ulcers and diabetic ulcers. Objective: We review the development of bioengineered skin, examine the cellular activities of various growth factors that may facilitate wound healing, and discuss the results of clinical trials with a particular construct, Apligraf, as proof of principle. Conclusion: Bioengineered skin acts as a “smart” delivery system for growth factors and other stimulatory substances. Not only does it present a novel treatment for chronic and diabetic ulcers, but it could also be considered for application to other types of acute wounds.
Subacute Cutaneous Lupus Erythematosus Induced by Nifedipine
Authors: Gubinelli Emanuela , Cocuroccia Barbara , Girolomoni Giampiero 
Published: July 2017

Background: Subacute cutaneous lupus erythematosus (SCLE) has been reported to be associated with the use of several drugs, including thiazides, terbinafine, and, rarely, calcium channel blockers. Objective: A case of SCLE induced by nifedipine is presented. Methods and Results: A 48-year-old white woman developed a papulosquamous and annular eruption in sun-exposed areas during the summer. The patient was taking nifedipine for essential hypertension for four years. Serology showed the presence of antinuclear and anti-Ro/SSA as well as antihistone antibodies. Histopathologic and immunopathologic (granular IgM deposits at the dermoepidermal junction) findings confirmed the diagnosis of SCLE. Nifedipine discontinuation led to rapid improvement with almost complete resolution of skin lesions in one month in the absence of active treatment. Reduction of antinuclear, anti-Ro/SSA, and antihistone antibody levels was documented after six months. Conclusion: Nifedipine can cause SCLE after a long period of administration. Antihistone antibodies may be associated with drug-induced SCLE.
Characterizing Anxiety in Melanoma Patients
Authors: Missiha Sharif B. , Solish Nowell , From Lynn 
Published: July 2017

Background: Over half of melanoma patients experience significantly elevated anxiety levels leading to psychological distress and delays in diagnosis and treatment. Objective: To identify melanoma patients likely to experience high levels of anxiety, we characterized the contributing factors and coping strategies and investigated potential anxiety-alleviating interventions. Method: Surveys were sent to 94 melanoma patients at Women's College Hospital's Pigmented Lesion Clinic assessing self-reported anxiety, contributing factors, coping strategies, and potential assisting services. Results: Risk factors for anxiety include female gender ( p = 0.002) and increasing age ( p = 0.004) but not melanoma depth. Major factors contributing to anxiety are prognosis, fear of death, and the attitude of the diagnosing doctor. Major coping strategies include family support, doctor assistance, and self-distraction. Potentially useful services for decreasing anxiety include the provision of detailed information pamphlets. Conclusion: Melanoma patients likely to experience high anxiety can be predicted and managed in ways that minimize the distress experienced.
Multiple, Clustered Dermatofibroma: A Rare Clinical Variant of Dermatofibroma
Authors: Soon Seaver L. , Howard Amy K. , Washington Carl V. 
Published: July 2017

Background: Although patients with one to two dermatofibromas are common, cases of “multiple” dermatofibromas (more than 15 lesions) are rare and may occur in the context of altered or normal immune function. Patients with multiple dermatofibromas clustered in one anatomic area, by contrast, are strikingly rare. Objective: The aim of our study was to present an additional case of multiple, clustered dermatofibroma (MCDF) and to summarize the literature concerning this entity. Methods: We performed a MEDLINE (1960–2001) database search using keywords “dermatofibroma” AND “clustered” OR “agminated” OR “grouped.” Results: Five case reports were identified using this search strategy. These cases demonstrated substantial similarity in clinical features and behavior, specifically, the presence of pruritic symptoms, no clear inciting incident, an early active growth phase followed by stabilization, predilection for the lower extremity, and no report of sarcomatous transformation. Conclusion: Despite an active early growth phase, MCDF appears to follow a benign clinical course, with no report of sarcomatous transformation at up to 20 years followup.
Axillary Hidradenitis Suppurativa: A Further Option for Surgical Treatment
Authors: Altmann S. , Fansa H. , Schneider W. 
Published: July 2017

Background: Hidradenitis suppurativa is a chronic inflammatory disease of the cutis with furuncles, fistulas, and abscesses. The disease is mostly located in groin and axilla. As conservative treatment can usually not prevent recurrence, surgical treatment is the method of choice. Methods: We report on 20 patients with axillary hidradenitis suppurativa. The inflammatory region was excised in a rhomboid shape and immediately covered with a transposition flap according to Limberg. Postoperatively, all patients received antibiotic treatment and immobilization of the arm. Physiotherapy started after 2 weeks. Results: No flap complications occurred. The functional and aesthetic results were very satisfactory. Movement of shoulder showed no restrictions. A recurrence with single fistulas was seen in 3 patients. Conclusions: Conservative treatment of hidradenitis suppurativa is followed by a high rate of recurrence. Only radical debridement offers a cure. The therapy of choice is the radical excision of the affected region and immediate coverage with a flap. Open granulation or split skin grafting often results in a prolonged hospitalization, higher morbidity, and functional problems. Thus, open granulation is inferior to primary closure by a transposition flap. Using the Limberg flap, the donor site is allowed to be closed primarily.
Scar Area and Cosmetic Outcome after Circular and Elliptical Excision of Small Skin Lesions
Authors: Ek Lorens , Högstedt Benkt , Herrström Per 
Published: July 2017

Background: Cutaneous surgery for removal of small skin tumors is usually performed as elliptical excision. There is some indication that circular excisions could result in cosmetically more favorable scars and should therefore be considered as an alternative method. Objective: The aim of this study was to compare circular and elliptical excisions with respect to scar area and cosmetic result. Methods: Fifty-six operations were performed, 27 elliptical and 29 circular. The cosmetic results were determined as patient's opinion by questionnaire and assessment of photo slides by three independent observers. Also, scar areas were measured by computer program. Results: The scar area was significantly smaller after circular excisions compared with elliptical excisions after 6 and 12 months of observation ( p = 0.005 and p = 0.001, respectively). The assessment of cosmetic results by the patients did not differ between the two groups ( p = 0.44), while the independent observers slightly favored the cosmetic outcome of elliptical scars ( p = 0.03). When analyzing only excisions without complications, there was no difference in cosmetic results between the two groups. Conclusion: Circular excisions seemed to cause smaller scars and equal cosmetic results compared with traditional elliptical excisions and could therefore be an alternative method for small skin excisions on the trunk and extremities.
Chondroid Syringoma with Small Tubular Lumina
Authors: Radhi J. M. 
Published: July 2017

Background: Chondroid syringoma or mixed tumor of the skin is a rare epithelial tumor with eccrine differentiation. The variant with small tubular lumina is extremely uncommon. Objective: Chondroid syringoma is usually present as a single subcutaneous nodule. This report describes a man with multiple scalp lesions exhibiting features of chondroid syringoma with small tubular lumina. Methods: A Pathological examination of surgically resected multiple scalp nodules was carried out by routine histology and immunohistochemistry. The following antibodies were found: cytokeratin, epithelial membrane antigen, and vimentin. Results: Microscopic findings revealed multiple chondroid syringoma with small tubular lumina. The tumor cells were positive for high- and low-molecular-weight keratin, epithelial membrane antigen, and vimentin. Conclusion: This is the first report of multiple chondroid syringoma with small tubular lumina.
Early Detection of Skin Cancer by Family Physicians: A Pilot Project
Authors: de Gannes Gillian C. , Ip Janet L. , Martinka Magdalena , Crawford Richard I. , Rivers Jason K. 
Published: July 2017

Background: Malignant melanoma is rising quickly in incidence and mortality rates. Family physicians (FPs) have been reported to lack confidence in diagnosing skin cancers. Objective: The aim of this study was to determine whether an educational intervention can improve FPs' abilities to diagnose skin cancers. Methods: The design was a prospective, randomized trial which included a skin cancer questionnaire, a video intervention, and a skin biopsy review. Results: Pre-intervention, FPs answered 57% of the questions correctly on the skin cancer questionnaire. Post-intervention, the video intervention group scored higher than did the control group. The video intervention group removed 10% fewer benign lesions and almost 3 times more malignant lesions compared with their pre-intervention biopsy rate. No findings were statistically significant. Conclusion: An educational intervention may improve FPs' knowledge and diagnosis of skin cancer. Our results may guide future studies with larger sample sizes in developing a skin cancer continuing medical education (CME) course for FPs.
HPV Typing in Brazilian Patients witn Epidermodysplasia Verruciformis: High Prevalence of EV-HPV 25
Authors: de Oliveira Walmar Roncalli P. , He Qin , Rady Peter L. , Hughes Thomas K. , Neto Cyro Festa , Rivitti Evandro A. , Tyring Stephen K. 
Published: July 2017

Background: Epidermodysplasia verruciformis is a rare genetic disorder characterized by development of lesions associated with HPV#5 or HPV#8 in early childhood; malignant transformation occurs in approximately half of individuals during adulthood. Objective: Our goal was to study the presence and spectrum of EV-HPV types in Brazilian EV patients, a population that had never been studied in this regard. Patients and MethodsForty-one biopsies from different lesions (benign and skin tumors) and one biopsy from clinically normal skin from each of 20 Brazilian patients with EV were studied for HPV typing using nested PCR. Results: EV-HPV DNA was detected in all 41 skin lesions of the patients and was also identified in specimens considered as normal skin from 8 patients (40%). In this study HPV-EV 25 was the most prevalent (70%), and HPV 14d (67%) was highly associated with malignant lesions. Conclusion: EV-HPV 25 was the most prevalent in our study. The noteworthy association of EV-HPV type 14d with skin cancers suggests its possible oncogenic role in malignant transformation in this population.
Nail Psoriasis: Combined Therapy with Systemic Cyclosporin and Topical Calcipotriol
Authors: Feliciani Claudio , Zampetti Anna , Forleo Pietro , Cerritelli Luca , Amerio Paolo , Proietto Gianluca , Tulli Antonio , Amerio Pierluigi 
Published: July 2017

Background: Nail psoriasis is a common problem in psoriatic patients and often it is difficult to cure. Several treatments have been proposed in the last decade using new molecules like vitamin-D analog and/or immunosuppressive drugs both systemically and locally. Objective: Our goal was to evaluate a combination of cyclosporin and topical calcipotriol cream versus cyclosporin alone in a matched group of patients treated with cyclosporin alone. Method: Fifty-four patients affected by severe psoriasis and nail involvement were selected and matched for severity of nail involvement, sex, age, and cyclosporin dosage. Group A included 21 patients treated with cyclosporin alone (3.5 mg/kg/day) for three months. Group B included 33 patients treated with the same cyclosporin dosage plus, for the same time, topical application of calcipotriol cream twice a day. Evaluation for clinical improvement was the personal feeling of the patient after three months, while clinical appearance of the lesions was evaluated by the same dermatologist using digital pictures and who was blind as to the treatment of the patient. A score ranging from + to +++ was used in order to evaluate the improvement, and data were statistically evaluated with the Wilcoxon test. Results: Both cyclosporin alone and a combination of cyclosporin with topical calcipotriol twice a day were useful for treating nail psoriasis after three months of therapy although the combined therapy showed a better overall result in both mild and severe nail psoriasis. Improvement of the clinical appearance of the nail lesions was seen in about 79% of patients in group B ( p ≤ 0.0004) versus about 47% of patients in group A ( p ≤ 0.15). Conclusionsln patients with severe involvement of nail psoriasis we suggest the use of a combination of topical calcipotriol twice a day with systemic treatment such as cyclosporine.
Abdominal Elephantiasis: A Case Report
Authors: Hanna Dominique , Cloutier Richard , Lapointe Roch , Desgagné Antoine 
Published: July 2017

Background: Elephantiasis is a well-known condition in dermatology usually affecting the legs and external genitalia. It is characterized by chronic inflammation and obstruction of the lymphatic channels and by hypertrophy of the skin and subcutaneous tissues. The etiology is either idiopathic or caused by a variety of conditions such as chronic filarial disease, leprosy, leishmaniasis, and chronic recurrent cellulites. ObjectiveElephantiasis of the abdominal wall is very rare. A complete review of the English and French literature showed only two cases reported in 1966 and 1973, respectively. We report a third case of abdominal elephantiasis and we briefly review this entity. Methods: We present the case of a 51-year-old woman who had progressively developed an enormous pediculated abdominal mass hanging down her knees. The skin was thickened, hyperpigmented, and fissured. She had a history of multiple abdominal cellulites. ResultsShe underwent an abdominal lipectomy. Histopathology of the specimen confirmed the diagnosis of abdominal elephantiasis. Conclusion: Abdominal elephantiasis is a rare disease that represents end-stage failure of lymph drainage. Lipectomy should be considered in the management of this condition.
Treatment of Chronic Nonhealing Leg Ulceration with Gaseous Nitric Oxide: A Case Study
Authors: Miller Chris C. , Miller Minna K. , Ghaffari Abdi , Kunimoto Brian 
Published: July 2017

Background: Despite the best clinical practice, chronic nonhealing ulcers of the lower extremities present a significant challenge. Nitric oxide (NO) has been shown to play a significant role in biological functions including wound healing and as an antimicrobial agent in nonspecific immune response. Objective: Our goal was to study the effect of gaseous NO (gNO) administered directly to a two-year-old nonhealing chronic venous ulcer in a 55-year-old male presenting with a 30-year history of severe venous disease. Methods: gNO (200 ppm) was applied to the lower extremity using a delivery system connected to a “single patient use” plastic boot, at 1.0 L/min. Results: The patient received an average of 8.1-h treatments for 14 consecutive nights. On day 0 the wound was malodorous and covered by bacterial biofilm with little healthy granulation tissue present. Following 3 days of gNO treatment, healthy granulation tissue was noted with absence of malodorous odor. At day 14, the ulcer was significantly reduced in size ( p = 0.014) and almost completely reepithelialized. Day 10 post-treatment did not reveal any deterioration in healing. Six weeks later, the wound was 90% healed. At 26 weeks post gNO discontinuation, the ulcer was completely healed. Conclusions: This single case study demonstrated that gNO as a topical agent was well tolerated by the patient without any report of discomfort or side effect. The result of wound healing was very promising and warrants future exploration.
Integrating Biologic Agents into Management of Moderate-to-Severe Psoriasis: A Consensus of the Canadian Psoriasis Expert Panel
Authors: Guenther Lyn , Langley Richard G , Shear Neil H. , Bissonnette Robert , Ho Vincent , Lynde Charles , Murray Eileen , Papp Kim , Poulin Yves , Zip Catherine 
Published: July 2017

Background: Approximately 2% of people worldwide have psoriasis, with as many as 1 million people with psoriasis in Canada alone.1,2 The severity of psoriasis ranges from mild to severe. It can lead to substantial morbidity and psychological stress and have a profound negative impact on patient quality of life.3,4 Although available therapies reduce therapies reduce the extent and severity of the disease and improve quality of life,3 reports have indicated a patient preference for more aggressive therapy and a dissatisfaction with the effectiveness of current treatment options.5 Objective: A Canadian Expert Panel, comprising Canadian dermatologists, convened in Toronto on 27 February 2004 to reach a consensus on unmet needs of patients treated with current therapies and how to include the pending biologic agents in and improve the current treatment algorithm for moderate-to-severe psoriasis. Current treatment recommendations suggest a stepwise strategy starting with topical agents followed by phototherapy and then systemic agents.3,6,7 The Panel evaluated the appropriate positioning of the biologic agents, once approved by Health Canada, for the treatment of moderate-to-severe psoriasis. Methods: The Panel reviewed available evidence and quality of these data on current therapies and from randomized, controlled clinical trials.8–14 Subsequently, consensus was achieved by small-group workshops followed by plenary discussion. Results: The Panel determined that biologic agents are an important addition to therapies currently available for moderate-to-severe psoriasis and proposed an alternative treatment algorithm to the current step wise paradigm. Conclusion: The Panel recommended a new treatment algorithm for moderate-to-severe psoriasis whereby all appropriate treatment options, including biologic agents, are considered together and patients' specific characteristics and needs are taken into account when selecting the most appropriate treatment option.