bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pyodermatitis—Pyostomatitis Vegetans: Two Cases and a Review of the Literature
Authors: Nigen Simon , Poulin Yves , Rochette Linda , Lévesque Marie–Hélène , Gagné Éric 
Published: July 2017

Background: Pyodermatitis–pyostomatitis vegetans (PD–PSV) is a rare vegetating, pustular, eosinophilic, mucocutaneous dermatosis characterized by mucocutaneous lesions of the genital, axillary, and oral regions, as well as on the scalp. Objective: We report two patients who were diagnosed with PD–PSV. The published cases of this rare disorder are reviewed. Results: The first patient presented with vegetating pustular plaques of the scalp, vulva, and mouth. The second patient initially showed pustules on fingers and then on toes. Vulva and mouth were later involved. There was no gastrointestinal involvement in either case. In both cases, histology revealed eosinophilic spongiosis with eosinophilic microabscesses and pseudoepitheliomatous hyperplasia. Direct immunofluorescence was negative. Conclusion: Pyodermatitis–pyostomatitis vegetans is a rare disorder of unknown cause. It bears similarities to pemphigus vegetans but histology, direct immunofluorescence, and clinical history show the differences. Response to treatment is generally rapid. In several reported cases, an inflammatory gastrointestinal disorder is found in association with the mucocutaneous signs.
Safety and Efficacy of Tacrolimus Ointment 0.1% (Protopic™) in Atopic Dermatitis: A Canadian Open-Label Multicenter Study
Authors: Tan Jerry , Langley Richard 
Published: July 2017

Background: Most previously published trials of topical tacrolimus in atopic dermatitis were of relatively short duration and comprised a limited population with moderate-to-severe disease. Objective: The goal of the study was to evaluate the safety and efficacy over a 6-month period of tacrolimus 0.1% ointment in children and adults with a broader severity spectrum of atopic dermatitis. Methods: An open-label multicenter trial in patients 2 years and older was used. Primary safety and tolerability assessments included skin infection and application site adverse events. Efficacy parameters were body surface area involvement, pruritus score, and overall reponse. Results: There were 240 patients recruited at 23 study sites. Significant improvement from baseline was noted for all efficacy endpoints in both pediatric and adult patients. Skin infections occurred in 26% of patients. Burning sensation with product application, reported by 38% of patients, was transient and of mild-to-moderate severity in the majority. Conclusion: Tacrolimus 0.1% ointment was safe, well tolerated, and efficacious in treatment of atopic dermatitis in children and adults over six months.
Successful Treatment of von Zumbusch Pustular Psoriasis with Infliximab
Authors: Trent Jennifer T. , Kerdel Francisco A. 
Published: July 2017

Background: Von Zumbusch pustular psoriasis is a severe, generalized form of psoriasis. Patients may also suffer from systemic complications, such as fever, arthropathy, congestive heart failure, and infections, which can ultimately prove fatal. Generalized pustular psoriasis can often be recalcitrant, making treatment difficult. Objective: The purpose of this study was to demonstrate the efficacy of infliximab in treating generalized pustular psoriasis. Methods: Four consecutively admitted patients with generalized pustular psoriasis were treated with infliximab 5 mg/kg intravenous infusion. ResultsAfter treatment with infliximab, white blood cell count, sedimentation rate, C-reactive protein, and vital signs normalized in all 4 patients within 24 h of the infusion. PASI scores on discharge had improved in all 4 patients. Conclusion: All 4 patients with generalized pustular psoriasis had rapid and positive responses to infliximab without any significant side effects. This experience adds support to the use of infliximab for generalized pustular psoriasis.
Impact of Melanoma Diagnosis on Sun-Awareness and Protection: Efficacy of Education Campaigns in a High-Risk Population
Authors: Freiman Anatoli , Yu John , Loutfi Antoine , Wang Beatrice 
Published: July 2017

Background: Malignant melanoma is a significant cause of morbidity and mortality worldwide. Sun-awareness campaigns increase public knowledge but may not translate into behavioral changes in practice, which is particularly alarming when reported for individuals in high-risk groups. In particular, patients diagnosed with melanoma are at increased risk of developing subsequent primary melanomas compared with the general population. Objectives: The study was undertaken (1) to assess whether patients with known risk factors for developing melanoma had been exposed to preventative campaign messages prior to their diagnosis, (2) to quantify whether the diagnosis of melanoma changed sun-related attitudes and behavior, and (3) to assess the adequacy of sun-related advice given to patients with melanoma, as well as their compliance with the advice. Methods: Using an anonymous questionnaire, 217 patients previously diagnosed with melanoma were interviewed on the source and frequency of received sun-related advice, as well as on their knowledge, attitudes, and behavior toward sun protection before and after the diagnosis. Results: The number of patients who reported receiving sun-related advice after being diagnosed with melanoma increased by 36% (52% pre-vs. 88% postDiagnosis), with advice being given more frequently and more often by a physician (19% pre- vs. 49% postdiagnosis). Furthermore, sun-related attitudes and behavioral practices were positively altered. Yet, patients with known risk factors were not preferentially targeted for advice before their diagnosis. Conclusions: The diagnosis of melanoma leads to increased sunwareness and protection. While dermatologists should continue their efforts to promote and reinforce sun-awareness in patients with melanoma, additional emphasis on preventative targeting of high-risk individuals would be of marked benefit in decreasing the overall incidence of melanoma. Non-dermatologists, such as family physicians, can be key players in this preventative campign, and can be educated to recognize and educate patients at risk, as well as direct them to be followed under dermatology care.
Patient Satisfaction with Psoriasis Therapies: An Update and Introduction to Biologic Therapy
Authors: Finlay Andrew Y. , Ortonne Jean-Paul 
Published: July 2017

Background: Psoriasis is a chronic, immune-mediated skin condition that often requires lifelong treatment. Many patients report dissatisfaction with traditional nonbiologic therapies because they are ineffective for their psoriasis, are associated with side effects, or impact negatively on quality of life. Objectives: The aim of this article is to review the effect on patient quality of life of traditional nonbiologic psoriasis therapies and to discuss the impact of biologic psoriasis therapies on patient satisfaction. Methods: A review of the literature is presented. Results: Traditional nonbiologic psoriasis therapies can negatively impact quality of life due to a variety of factors including inconvenience and toxicity. Biologic agents have been developed that target the immunopathogenesis of psoriasis. Based on favorable efficacy and safety results in clinical trials, some of these agents are now approved for clinical use. Evidence suggests that patients receiving biologic therapies experience significant improvements in health-related quality of life. Conclusion: Biologic agents offer new hope for patients with psoriasis that their chronic condition can be controlled in a manner that improves their quality of life and may lead to high levels of satisfaction with their treatment.
Stephen Rothman's Text on Physiology and Biochemistry of the Skin
Authors: Jackson Robert 
Published: July 2017

Background: Forty-nine years ago the first complete and authoritative English text on the physiology and biochemistry of the skin was published by Stephen Rothman, an early basic researcher in dermatology. Objective: The purpose of the article is to learn more about Stephen Rothman and his 1954 text, to learn more about what was known and not known then, to learn more about what was considered significant, and to learn more about what was popular at that time. Conclusion: Considering the techniques available and the knowledge base, Rothman's 1954 text shows that basic dermatology research 50 years ago had developed to a reasonably sophisticated degree.
Cost Effectiveness of Elidel in the Management of Patients with Atopic Dermatitis in Canada
Authors: Coyle Douglas , Barbeau Martin 
Published: July 2017

Background: With increasing pressure on health care resources, it is necessary to demonstrate that new treatments are both effective and cost effective. ObjectiveThe purpose of this study was to assess the cost effectiveness of pimecrolimus (Elidel) compared to usual therapy in the treatment of both adults and children with atopic eczema in Canada. Methods: Analysis was performed using a decision model which estimated the incremental cost per quality adjusted life year (QALY) gained from both a societal and health care perspective. Results: For children, Elidel leads an incremental cost per QALY of $38,000 from a societal perspective. For adults, the incremental cost per QALY was $35,000. Conclusion: Elidel will lead to an overall increase in costs but with an improvement in clinical outcomes. The cost effectiveness ratios for Elidel were consistently below $50,000 per QALY gained. Given previous funding decisions in Canada, Elidel may be considered a cost-effective use of health care resources.
Photosensitivity to Exogenous Agents
Authors: Lankerani Lela , Baron Elma D. 
Published: July 2017

Objective: To better understand cutaneous photosensitivity reactions, a review of its etiologic factors, clinical characteristics, pathogenesis, and treatment modalities was undertaken. Methods: Articles discussing the above aspects of phototoxic and photoallergic reactions were used to demonstrate what is currently known about photoinduced reactions and how to treat them. Results: Upon interaction of solar UV radiation with the chemical that is present in significant levels on the skin, one of two known reactions may occur in susceptible patients: a phototoxicity and/or photoallergy. Phototoxic and photoallergic reactions can be diagnosed separately on the basis of pathogenesis, clinical characteristics, and histology. Examples of drugs capable of inducing a phototoxic reaction include amiodarone, retinoids, nonsteroidal antiinflammatory agents, diuretics, and antibiotics. Substances known to cause a photoallergic response are fragrances, sunscreens, topical antimicrobials, NSAID, and psychiatric medications, such as chlorpromezine. Conclusion: Photoinduced reactions produced by exogenous chemicals are common skin disorders. Definitive therapy requires identifying and removing the offending agent, either the photosensitizing chemical or light. The use of fully protective clothing and a sunscreen of high SPF are important measures when light exposure is inevitable.
An Unusual Cause of Refractive Chronic Bilateral Leg Ulceration
Authors: Sabet Laila M. , Wexler Denise , Salama Samih , Gan Bing Siang 
Published: July 2017

Background: Ulceration of the lower extremities is a common disorder that can be very painful. It occurs most frequently in the elderly population as a result of venous hypertension. We report an unusual case of a 32-year-old man with an 11-year history of extensive, painful, bilateral leg ulcers resistant to conventional treatment necessitating above-knee amputation of the left leg. Eventually, the patient was treated with prednisone, which led to almost complete healing of the ulcers of the right leg. Objective: The objective of this report is to discuss a rare cause of chronic bilateral leg ulceration. Methods: Detailed histopathologic examination showed a complex pattern of overlapping features of several specific dermatologic conditions, including necrobiosis lipoidica (NL), necrobiotic xanthogranuloma (NXG), and the destructive form of granuloma annulare (GA). Conclusion: The characteristics of our patient suggest a variant of a cutaneous necrobiotic disorder that has not been previously reported. When clinicians are confronted with recalcitrant ulcerations in the lower extremity, this group of disorders should be considered in the differential diagnosis.
Metastatic Zosteriform Squamous Cell Carcinoma in an Immunocompetent Patient
Authors: Cohen Joel L. , Barankin Benjamin , Zloty David M. , Mikhail George R. 
Published: July 2017

Background: Although described in several reports of internal malignancies metastasizing to the skin, zosteriform metastases have been reported in only two cases of cutaneous squamous cell carcinoma (SCC). In both of these reports, the patients were immunosuppressed related to renal transplantation. Objective: We present a case of an immunocompetent patient with zosteriform metastases originating from a recurrent cutaneous SCC. The lesions were present along the maxillary division of the trigeminal nerve. Methods: Biopsies from eight lesions were studied using hematoxylin and eosin (H&E) and with immunohistochemistry. Results: Neural involvement was detected in H&E preparations before and during excision of the metastatic nodules by Mohs micrographic surgery. The tumor cells reacted with antikeratin antibodies. The patient has had no evidence of recurrence or metastases 30 months following surgery. Conclusion: To our knowledge, this is the first case of cutaneous SCC with zosteriform metastases in a patient with an intact immune system. SCC should be included in the differential diagnosis of lesions presenting in a dermatomal distribution.
Gene Therapy: Recent Advances and Applications in Dermatology
Authors: Hope Michael J. 
Published: July 2017

Background: Gene therapy is an innovative and exciting new branch of medicine. Despite the fact that a human disease has yet to be cured using this therapeutic approach, numerous clinical trials are taking place around the world based on encouraging preclinical data. Objective: The aim of this review is to bring the reader up to date with this rapidly advancing field and to highlight the technical advances that must occur before gene therapy will become common practice in dermatology. Methods: The current level of gene delivery technology restricts the applications. The advantages and disadvantages of viral and nonviral gene delivery systems are discussed. Results: Considerable advances are being made in the areas of cancer immunotherapy and vaccines. Of particular importance to the treatment of skin diseases will be the isolation and ex vivo manipulation of epidermal stem cells, the development of skin-specific regulatory sequences for gene expression, and the formulation of gene delivery systems suitable for systemic administration. Conclusions: In general, skin and keratinocytes are considered to be good targets for gene transfer applications, and several diseases have been identified as potential candidates for treatment in the near future.
Cold-Induced Skin Disorders
Authors: Kim H.L. , Bo-Abbas Y. , Guenther Lyn C. 
Published: July 2017

Background: Humans are commonly exposed to extremes in temperature. Fortunately, our skin behaves as an anatomic and physiologic barrier during these periods. Exposure to cold temperatures may result in a variety of symptoms and disorders. Objective: Our current understanding of the pathophysiology, clinical presentation, and therapies of cold-induced skin disorders are reviewed. Methods: Studies, reviews, and book chapters that contained information on cold-induced skin disorders were reviewed. Conclusion: Cold-induced skin disorders are a heterogeneous group of disorders that cause great morbidity, particularly in cold climates. These entities can be classified as physiologic or pathologic responses to freezing or nonfreezing cold exposure.
Assessing Scientific Data: The Case-Control Study as it Applies to Dermatology Part 1: The Case-Control Method
Authors: Heacock Helen J. , Rivers Jason K. 
Published: July 2017

Background: Epidemiology is integral to medical research. To keep abreast of medical advances related to the specialty, dermatologists need a sound understanding of epidemiologic principles. Objective: The purpose of this article is to introduce the case-control study design in the context of dermatology. Topics covered include subject selection, exposure assessment, and data analysis. Conclusions: The case-control design is applicable to dermatology research. This method is especially relevant for rare diseases or those with a long latency period.
Systematized Epidermal Nevus Associated with Neurofibromatosis Type 1
Authors: Meyerson Mitchell S. , Kelly Lesa , Don Philip , Gropper Charles 
Published: July 2017

Background: Epidermal nevi are hamartomatous, closely set, usually verrucous papules that may coalesce to form papillomatous plaques. A linear configuration is common. A systematized epidermal nevus has a diffuse or extensive distribution and, at times, can be associated with internal abnormalities and malignancies. Neurofibromatosis 1 (NF1) is an autosomal dominant disorder characterized by neurofibromas, café-au-lait macules, and axillary freckling. NF1 can also be associated with systemic abnormalities and neoplasms. Objective: Our aim was to determine if there is an association between epidermal nevi and NF1. Methods: A patient with both NF1 and a systematized epidermal nevus underwent physical examination, skin biopsies, ophthalmologic and neurologic examinations, laboratory analysis, chest and lumbosacral spine films, computed tomographic scan of the head, and renal sonogram. Results: Our patient fulfilled the criteria for NF1 and had epidermal nevi. This is, to our knowledge, the first report of NF1 and a systematized epidermal nevus appearing in the same patient. NF1 and epidermal nevi have been shown to have specific gene defects on different chromosomes. Conclusion: It is most probable that the simultaneous occurrence of NF1 and epidermal nevi is a sporadic event.
Informed Patient Decision Making: Cyclosporine and Skin Disease
Authors: Singer Michael I. , Sauder Daniel N. , Shear Neil H. 
Published: July 2017

Background: Informed patient decision making and consent before medical treatment is a medicolegal requirement that may be beneficial to patients and physicians. Certain medications such as cyclosporine (Neoral®) have important potential risks that patients need to understand before they begin treatment. Objective: Documentation of an informed decision-making and consent process for use of the drug cyclosporine in dermatology patients is promoted and encouraged. Methods: A sample information sheet and consent form to be used by patients and physicians before and during use of the drug cyclosporine are provided.
Neoral® in the Treatment of Psoriasis: Consensus Treatment Guidelines
Authors: Ho Vincent , Cloutier M.A. Richard , Gratton David , Gulliver Wayne , Lauzon Gilles J. , Papp Kim , Sauder Daniel N. 
Published: July 2017

Background: The efficacy of cyclosporine in the treatment of psoriasis is well-recognized. A new microemulsion formulation of cyclosporine, Neoral®, has become available and will replace the original formulation, Sandimmune®. Objectives: In view of the new clinical experience with Neoral and changes in clinical practice, an expert panel was convened to review the treatment guidelines and make new recommendations for its use in the treatment of psoriasis. Results: Compared with the original formulation, Neoral is more rapidly absorbed and there is less intra- and interpatient variation in bioavailability. In clinical trials, Neoral had a faster onset of action than Sandimmune at equal doses; efficacy and safety profiles were comparable. Conclusion: Neoral is indicated in patients with severe psoriasis in whom systemic therapy is justified. Careful baseline clinical and laboratory evaluation is mandatory prior to initiation of Neoral therapy. The therapeutic goal is to maintain substantial improvement with the lowest possible dose of cyclosporine. If possible, intermittent therapy is preferable. Guidelines for monitoring and management of adverse effects are presented.
Fusidic Acid in Acne Fulminans
Authors: Hatami Afshin , Raymond Giles P. 
Published: July 2017

Background: Acne fulminans (AF) is a rare subtype of acne, a common inflammatory disease of the pilosebaceous unit that can be triggered by the administration of systemic isotretinoin. Objective: The purpose of this article is to report the beneficial response to systemic fusidic acid in a case of AF. Methods and Results: This report documents the use and results of systemic isotretinoin, systemic corticosteroid, and systemic fusidic acid in an unusual case of AF. Conclusion: The use of systemic fusidic acid is recommended as a possible alternative to the therapeutic arsenal for AF.
Effect of Occlusion on Cell Proliferation during Epidermal Healing
Authors: Levine Richard , Agren Magnus S. , Mertz Patricia M. 
Published: July 2017

Background: Occlusive dressings influence epithelization of superficial wounds by some unknown mechanism(s). Objective: The effects of occlusion on epidermal cell proliferation in two types of wounds were examined. Methods: Partial-thickness wounds and tape-stripped skin wounds were compared. An immunohistochemical technique, employing PC10 — a monoclonal antibody against proliferating cell nuclear antigen (PCNA) — was applied to formalin-fixed, paraffin-embedded porcine tissue sections. Results: The number of PC10-positive cells was low during the migratory phase, then increased to a peak of proliferation 2 to 3 days after resurfacing. An overall increased proliferative response (mean = 21%) was seen in occluded compared to control partial-thickness wounds (day 10 postoperatively); an opposite effect of occlusion on epidermal proliferation was seen in tape-stripped skin. Occlusion decreased the proliferative response (mean = 42%) compared to air-exposure. Conclusion: Occlusion increased epidermal cell proliferation in wounds (where the entire surface epithelium and papillary dermis was removed), whereas an opposite effect was seen in tape-stripped skin from which only the stratum corneum had been removed.
Assessing Incidence Rates and Secular Trends in Nonmelanocytic Skin Cancer: Which Method is Best?
Authors: Gallagher Richard P. , Lee Tim 
Published: July 2017

Background: Evaluating the incidence of nonmelanocytic skin cancers in white populations and assessing the direction and strength of secular trends in these cancers have become important issues to dermatologists, oncologists, health policy analysts, and health care funders. Objective: The objective of this paper is to evaluate the three principal methods used to assess incidence rates and secular trends. Conclusions: Each of the three methods has strengths and weaknesses. An understanding of these will enable proper assessment of the value and significance of findings presented in the literature.
Onycholysis and Thyroid Disease: Report of Three Cases
Authors: Nakatsui Thomas , Lin Andrew N. 
Published: July 2017

Background: Onycholysis is a common disorder with many causes. It is known to be associated with thyroid disease (especially hyperthyroidism), but physicians probably do not routinely screen for underlying thyroid disease. Objective: To study the association of onycholysis and thyroid disease. Methods: We report three patients with onycholysis who were investigated for thyroid disease. Results: In two patients, onycholysis was the presenting sign of previously undiagnosed hypothyroidism, whereas the third developed onycholysis while undergoing therapy for hypothyroidism. Conclusions: These three cases appear to suggest that patients with unexplained onycholysis should be screened for asymptomatic thyroid disease.