bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mycophenolate Mofetil (CellCept®) for Psoriasis: A Two-Center, Prospective, Open-Label Clinical Trial
Authors: Zhou Youwen , Rosenthal Don , Dutz Jan , Ho Vincent 
Published: July 2017

Background: Mycophenolate mofetil (MMF) is an immune suppressant that selectively inhibits activated lymphocytes. Its usefulness in treating psoriasis has not been systematically investigated. Objective: To evaluate efficacy and safety of MMF as a monotherapy for psoriasis. Methods: This is a two-center, prospective, open-label clinical trial. Results: Twenty-three patients with moderate to severe psoriasis [mean psoriasis area and severity index (PASI) of 21.7] were treated with MMF 2–3 g/day for 12 weeks. Eighteen patients completed the study. The PASI was reduced by 24% ( p < 0.001) at 6 weeks, and by 47% ( p < 0.001) at 12 weeks. At the end of the treatment phase, 77% of the patients had significant reduction of PASI while 22% did not respond. The treatment was well tolerated. Five patients experienced mild nausea. One patient each had periorbital edema and pruritus. One patient had transient leukopenia. Conclusion: In this noncontrolled trial, the majority of patients with moderate to severe psoriasis responded to mycophenolate mofetil monotherapy with few adverse events. A randomized, controlled trial should be considered to confirm the usefulness of MMF as a monotherapy for psoriasis.
Trends in Invasive Cutaneous Melanoma in Saskatchewan 1970–1999
Authors: Ulmer Marcie J. , Tonita Jon M. , Hull Peter R. 
Published: July 2017

Background: Melanoma incidence rates have increased dramatically in white populations worldwide during the past several decades. A more modest increase has been observed for melanoma-related mortality. Cause-specific and disease-free survivals are related to tumor characteristics, gender, age, and possibly anatomic site. It is difficult to accurately assess these trends without information on tumor thickness that is often unavailable. Objective: This study determines trends in melanoma incidence, mortality, and survival in Saskatchewan for a 30-year period, incorporating analysis of tumor thickness. Methods: Information about cases of primary cutaneous melanoma for the 30-year period 1970–1999 was obtained from the population-based Saskatchewan Cancer Registry. A 50% random sample of charts was reviewed to collect information about Breslow depth, Clark level, and other demographic data not available from the Registry. Multivariate regression analysis was used to determine the significance of prognostic factors on incidence and five-year relative survival rates. Results: The number of patients registered increased dramatically during the study period. The increase was greatest for thin lesions in all age groups. Anatomic site varied by gender. Head and neck tumors showed continual increase in risk with increasing age. Mortality rates in females have been stable over time but increased for males in the 1990s. The prognostic factors that predicted excess mortality at five years were tumor thickness, Clark level, and gender. Conclusion: The observed increase in melanoma appears to be real and not the result of increased surveillance or screening. Tumor characteristics (Breslow depth, Clark level) and gender were significant prognostic indicators of five-year excess mortality.
Treatment of Onychomycosis: Pros and Cons of Antifungal Agents
Authors: Gupta Aditya K. , Ryder Jennifer E. , Skinner Alayne R. 
Published: July 2017

Background: Antifungal agents are beneficial in the treatment of onychomycosis in the general population, as well as in children, the elderly, and immunocompromised individuals. Special patient populations can be more difficult to treat due to such factors as drug interactions with concomitant medications, adverse events, and poor compliance. In addition, there is limited information about the use of antifungal agents in special populations, e.g., children. Objective: The pros and cons of oral and topical antifungal agents are discussed, with focus on special patient populations. Methods: We searched MedLine (1966 to April 2003) for clinical studies evaluating the efficacy of oral and topical antifungal agents to treat onychomycosis. The key words used in conjunction with “onychomycosis” include: “terbinafine,” “itraconazole,” “fluconazole,” “amorolfine nail lacquer,” “ciclopirox nail lacquer,” “HIV,” “transplant patients,” “diabetes,” “children,” and “elderly.” Studies were excluded if published in a language other than English. Results: Studies have shown that antifungal agents can be of benefit in treating the elderly, children, and immunocompromised individuals (e.g., transplant patients, Down's patients, HIV patients, and diabetics) with onychomycosis. Conclusion: The treatment modality of onychomycosis in special patient populations should take into account the clinical presentation of the onychomycosis, the causative organism, patient and physician preference, the concomitant medications that the patient is on, and the potential for adverse events for that patient if antifungal therapy is undertaken.
Scabies by Kenneth Mellanby
Authors: Jackson Robert 
Published: July 2017

Background: Epidemics of scabies are often associated with wars or other times of social upheaval. This was particularly evident during the Second World War when it was estimated that there were one to two million patients with scabies in Great Britain. Objective: This article reviews the work of the zoologist Kenneth Mellanby of England and evaluates his contribution to our knowledge of the diagnosis and treatment of scabies in the Second World War. Conclusion: Using humans, Mellanby studied the transmission and treatment of this disease. Among his contributions were knowledge of how many mites the average patient had, and where they were located. He clearly noted and described that the scabies rash was not limited to the location of the mites on the body; he attributed the rash in areas with no mites to “a true sensitization.” He found that “fomites were not the major method of transmissions.”
A Review of the Use of Infliximab to Manage Cutaneous Dermatoses
Authors: Gupta Aditya K. , Skinner Alayne R. 
Published: July 2017

Background: Infliximab is a chimeric monoclonal antibody that binds specifically to human tumor necrosis factor-alpha (TNF-α), decreasing the effect of the cytokine in inflammatory diseases. Objective: The aim of this study was to review the efficacy and safety of infliximab in the treatment of dermatological diseases. Methods: A MEDLINE search (1966–January 2003), using the keyword “infliximab” was performed to find relevant articles pertaining to the use of infliximab in dermatology. Results: Infliximab has been used in the following dermatological diseases: psoriasis, Behçet's disease, graft versus host disease, hidradenitis suppurativa, panniculitis, pyoderma gangrenosum, SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome, sarcoidosis, subcorneal pustular dermatosis, Sweet's syndrome, toxic epidermal necrolysis, and Wegener's granulomatosis. There is a generally good safety profile for infliximab, which is similar to that when it is used to treat Crohn's disease and rheumatoid arthritis. Conclusion: Although not approved for use in dermatological diseases, there have been numerous reports of the efficacy of infliximab in cutaneous inflammatory diseases. The most promise lies in those diseases that have increased amounts of TNF-α in the cutaneous lesions, such as psoriasis.
Topical Therapy for Peristomal Pyoderma Gangrenosum
Authors: Nybaek Hanne , Olsen A. G. , Karlsmark T. , Jemec G. B. E. 
Published: July 2017

Background: Pyoderma gangrenosum (PG) is an uncommon condition. Literature on the management of peristomal PG (PPG) is sparse. In the absence of randomized controlled trials the reporting of case series is potentially helpful to the management of this uncommon disease. Objective: In this study we report our experience with topical corticosteroid therapy for 14 consecutive cases of PPG. Methods: A clinical diagnosis PPG was made by a trained dermatologist using the appropriate investigations where necessary. Results: The majority of the cases presented were managed with simple topical corticosteroids, occasionally in combination with a change of dressing. In 8/14 (57%) cases ulcer resolution was achieved within 3 months with topical treatment alone or topical treatment plus a change of dressing to a silicone-based product applied directly to the wound under the normal base plate of the stoma bag. Conclusion: Our experience suggests that a significant proportion of PPG can be managed by topical treatment alone. The simple topical treatment allows the patient to continue use of stoma care products while minimizing the potential for side effects.
Viral and Nonviral Uses of Imiquimod: A Review
Authors: Gupta Aditya K. , Cherman Andrea M. , Tyring Stephen K. 
Published: July 2017

Background: Imiquimod is a topical immunomodulator that is indicated for the treatment of external genital and perianal warts. This drug has been recently approved for the treatment of actinic keratoses and superficial basal cell carcinoma. There is a growing body of evidence for its effectiveness in treating a variety of other skin conditions. Objective: This review examines the role of imiquimod 5% cream in the treatment of skin diseases such as actinic keratoses, basal cell carcinoma, Bowen's disease, lentigo maligna, and extramammary Paget's disease. Methods: Published literature containing the words “Imiquimod” or “Aldara” was reviewed and summarized. Results: This agent has demonstrated indirect antiviral and antitumor effects in animal models. Although the exact mechanism of action is unknown, imiquimod is an agonist for toll-like receptor (TLR) 7 and is thought to act by inducing cytokines, such as interferon alpha (IFN-α), interleukin-12 (IL-12), and tumor necrosis factor alpha (TNF-α). These cytokines trigger the immune system to recognize the presence of a viral infection or tumor and the associated lesion is ultimately eradicated. Side effects are generally well tolerated with local skin reactions reported most frequently. Conclusion: Imiquimod has been shown to be a safe and effective treatment for a variety of skin conditions.
Epidermodysplasia Verruciformis in Two Half Brothers with HIV Infection
Authors: Hu Weimin , Nuovo Gerard , Willen Marlene , Somach Stephen 
Published: July 2017

Background: Epidermodysplasia verruciformis (EV) is a rare disorder characterized by widespread flat and common Verrucae. From 25% to 50% of EV cases are inherited, usually with an autosomal recessive pattern. An X-linked inheritance has also been reported. Many EV patients have a cellular immunity defect. HIV-associated lesions have been found to contain HPV-5, HPV-8, and HPV-20. Objective: We describe two HIV-positive Hispanic maternal half brothers who presented with asymptomatic polyangular papules and plaques on the face, trunk, and extremities and which first appeared 4–5 years prior. The histopathology is consistent with EV. HPV-8 was detected by in situ hybridization. The patients were treated with topical imiquimod for two months without improvement. Conclusion: To our knowledge, this is the first reported case of epidermodysplasia verruciformis in HIV-positive pediatric patients.
The Frequent Use of Oral Retinoids in Combination with other Treatments for Psoriasis: A Retrospective Analysis
Authors: Hu Judy , Balkrishnan Rajesh , Camacho Fabian , Lang Wei , Pearce Daniel J. , Fleischer Alan B. , Feldman Steven R. 
Published: July 2017

Background: Combination treatment in psoriasis may be common, logical, and appropriate, even if not well tested or well documented by clinical trials. While oral retinoids such as acitretin can be used as monotherapy, efficacy can be further augmented by combination use with other agents. Similarly, because of its safety profile, acitretin can be added in low doses to help patients who have not achieved adequate control with other psoriasis treatments. Objective: The purpose of this study was to assess how oral retinoids are used in combination with other drugs to treat psoriasis. Methods: We assessed the use of acitretin and other oral retinoids for the treatment of psoriasis using two sources of information: nationally representative survey data from the National Ambulatory Medical Care Survey (NAMCS) and local data obtained by chart review of 518 patients seen in a university dermatology clinic. Results: In the NAMCS, oral retinoids were prescribed with other psoriasis medications at 71% of visits. In the chart review, combination use was even more frequent (96% of subjects were on combination treatment) and included combinations of acitretin with topicals, phototherapy, and other systemic treatments. Adverse events were reported in 53% of patients treated with acitretin, although none were severe. Conclusion: Use of acitretin in combination with many other psoriasis treatments is a common practice. Mucocutaneous side effects of oral retinoids are common but with appropriate dosing are generally mild.
Esophageal Stricture in a Patient with Epidermolysis Bullosa Acquisita: Endoscopic and Medical Management
Authors: Lazas Donald J. , James William D. , Yancey Kim B. , Kikendall James W. , Wong Roy K. H. 
Published: July 2017

Background: This 40-year-old man with extensive and severe epidermolysis bullosa acquisita (EBA) developed an esophageal stricture that caused dysphagia and limited his nutritional intake. Objective: The purpose of the evaluation and management was to relieve the symptomatic obstruction so that he could better swallow food and medications. Methods: Endoscopic visualization of the stricture allowed for balloon dilation to be effected. The radial forces applied probably allowed for a less traumatic intervention than the linear shearing forces of bougienage. Results: The stricture widened and immediately provided less dysphagia and better tolerance in ingesting food. Medical treatment with sucralfate, known to bind to and protect ulcer bases, also improved his symptoms. Conclusions: Esophageal strictures are relatively uncommon in patients with EBA; however, when faced with a stricture in this or other scarring bullous diseases that affect the esophagus, endoscopic balloon dilation combined with postprocedure sucralfate offers improvement with advantages over older methods of intervention.
Nasal Reconstruction with an Elongated Right Paramedian Flap after Maxillectomy for Basal Cell Carcinoma
Authors: Camacho Francisco M. , Moreno Jose C. , Rodriguez-Adrados Felipe 
Published: July 2017

Background: An extensive basal cell carcinoma that reached the maxillary sinus was removed. In the first reconstructive stage, we closed the primary defect on the sinus with a rotation-transposition flap. The distal portion of the flap necrosed, producing a defect in the nasolabial fold that left the sinus open and caused upward retraction of the upper lip. Objective: The defect of the nasolabial fold had to be corrected and the sinus closed; in a later stage, the retractile scar that appeared on the upper lip also needed correction. Methods: We used a delayed, elongated, right paramedian flap to correct the defect on the nasolabial fold and to close the sinus. We then corrected the retractile scar on the upper lip with a V-Y advancement flap. Results: The defect was closed without complications and the V-Y flap worked in returning the upper lip to its anatomic position. Conclusion: The midforehead flap is best for the reconstruction of the tip and the alar areas of the nose, including the near nasolabial fold. The V-Y advancement flap is an easy flap that allows one to correct retractions around the facial orifices. In dermatologie surgery, the final results must be as esthetic as possible.
Contact Dermatitis to Polysporin® Masquerading as a Delayed-Type Hypersensitivity Response to Dye Pigment
Authors: Bellman Betty , Brandt Fredric S. 
Published: July 2017

Background: A 15-year-old Hispanic adolescent with multiple amateur India ink tattoos developed a recurrent, eczematous pruritic eruption several weeks after each treatment with the Q-switched ruby laser. Objective: To determine if the patient was having an allergic reaction to tattoo dye pigment or an allergic contact dermatitis. Methods: Open- and closed-patch testing was performed to Polysporin® ointment, which revealed a 2+ vesicular reaction. Conclusion: Delayed-type hypersensitivity responses to contact allergens can very closely mimic the less common allergic reactions to dye pigment from tattoos. Open- and closed-patch testing to topical medications should be performed on any patient suspected of having an allergic reaction to tattoo dye pigment.
Primary Systemic Amyloidosis
Authors: Levesque Marte-Hélène , Doré Normand , Marion Alain , Cadotte Marcel 
Published: July 2017

Background: Primary systemic amyloidosis is a rare disease with multiorgan involvement including the skin. Because of the nonspecific and variable presenting symptoms and signs, this condition usually follows a long course before the correct diagnosis is established. Fortunately, skin manifestations contribute greatly in revealing the disease and determining the amyloidosis type. Objective: This article reports a case of primary systemic amyloidosis mimicking nodular primary localized cutaneous amyloidosis of the legs. We describe our systemic findings and the investigation procedure to classify and characterize the amyloidosis type. Methods and Results: After histologic studies revealed amyloid substance in the skin nodules of our 82-year-old patient, she was hospitalized for an appropriate systemic evaluation of this condition and associated medical problems. The investigation included biochemical, immunologic, radiologic, pathologic, and histochemical methods. Conclusion: This case of primary systemic amyloidosis, simulating a localized cutaneous form with nodular lesions, demonstrates the importance of the distinction between both entities. In fact, the management and prognosis will vary significantly.
Effect of Nitroglycerin Ointment on Psoriatic Plaques
Authors: Morhenn Vera B. 
Published: July 2017

Background: Nitric oxide is thought to play a major role in a number of inflammatory diseases. Psoriasis is a common inflammatory disease of the skin. Objective: To determine the effect of nitric oxide on psoriasis, nitroglycerin that is converted into nitric oxide in human skin was applied to psoriatic plaques. Methods: Nine individuals with chronic plaque-type psoriasis were treated with nitroglycerin ointment for 6 weeks. Results: The plaque of one individual improved with the application of nitroglycerin. By contrast, one individual's nitroglycerin-treated plaque improved dramatically about 6 weeks after cessation of treatment. On the other hand, the plaques of five individuals worsened with nitroglycerin treatment. Moreover, in one individual, the nitroglycerin-treated plaque increased in size, whereas the placebo-treated plaque improved slightly. Conclusion: Nitroglycerin ointment and, by extension, nitric oxide, may affect both the initiation and resolution of psoriasis.
Development of Diagnostic Criteria for Common Warts (Verrucae Vulgaris)
Authors: Young Richard , Kilkenny Monique , Jolley Damien , Marks Robin 
Published: July 2017

Background: Warts are common skin conditions. In most instances, their diagnosis by medical practitioners is a subjective or intuitive decision. Objective: To develop and assess a minimum set of diagnostic criteria for diagnosis of common warts. Methods: Patients with warts and other lesions were recruited. The lesions were diagnosed by the key dermatologist, whose diagnosis was used as the gold standard. They were then examined by two independent medical practitioners, who used a checklist of diagnostic criteria to determine whether the lesions had any or all of the characteristics. A minimum set of diagnostic criteria for common warts was then derived using logistic regression. Results: The diagnostic criteria were: site of wart (elbow, finger, or knee), flesh colour, hyperkeratosis, and discrete margin. Conclusion: Further studies are needed to compare these diagnostic criteria with the medical practitioners' intuitive diagnosis.
When Subjects are Not Randomly Assigned: The Cohort Approach
Authors: Karagas Margaret R. 
Published: July 2017

Background: Cohort studies are often used to answer clinical and etiologic questions. Objective: This article is to provide an overview of the basic concepts of cohort studies that are pertinent to the evaluation of the published literature. Methods: Fundamental principles, methods of assessing exposure and outcome status, choice of a comparison group, and statistical methods used in cohort studies are reviewed. Studies focusing on skin neoplasms are used as examples. Results: Methods used in cohort studies are similar to those used in clinical trials. One of the distinguishing features is that the exposure (e.g., treatment) is observed rather than assigned by the study investigators. Therefore, an effort must be made to ensure comparability between exposed and unexposed groups. Conclusion: Cohort studies have provided valuable clinical and etiologic information, but the strengths and limitations of this approach need to be recognized when evaluating the literature.
Distinctive Dermatoscopic Features of Acral Lentiginous Melanoma in Situ from Plantar Melanocytic Nevi and Their Histopathologic Correlation
Authors: Kawabata Yasuhiro , Tamaki Kunihiko 
Published: July 2017

Background: An acral lentiginous melanoma in situ on the sole is often difficult to differentiate with the naked eye from an acquired plantar melanocytic nevus. Recent technical advances in epiluminescence microscopy have contributed to the differentiation of these two pigmented skin lesions. Objective: In this study, the correlation between dermatoscopic and histopathologic findings of acral lentiginous melanoma in situ on the sole are compared to those of acquired plantar melanocytic nevi. Methods: Three acral lentiginous melanomas in situ on the sole, and two cases of acral lentiginous melanoma were compared with 50 acquired plantar melanocytic nevi by means of dermatoscopy and histopathology. Results: The dermatoscopic surface profiles of acquired melanocytic nevi were composed of linear pigmentation accentuated mainly on the sulcus superficialis. Histologically, some areas of the sulcus superficialis corresponded to rete ridges of the epidermis, and nests of nevus cells were also often located there. In contrast, the acral lentiginous melanomas in situ showed diffuse, irregularly shaped pigmentation distributed in a disorderly fashion over the entire surface. Histologically, isolated areas of proliferation and small nest formations of atypical melanocytes were irregularly distributed in the epidermis. Conclusion: A distinctive dermatoscopic feature of acral lentiginous melanoma in situ is diffuse and irregular pigmentation over the entire surface of the lesion. This feature is helpful for differentiating acral lentiginous melanoma in situ from acquired plantar melanocytic nevi.