bluuebunny/crossref_metadata_2025_split huggingface dataset:
One-Year, Multicenter, Open-Label, Single-Arm Study Evaluating the Safety and Effectiveness of Etanercept for the Treatment of Moderate-to-Severe Plaque Psoriasis in a Canadian Population
Authors: Vender Ronald , Lynde Charles , Gilbert Martin , Ho Vincent , Sapra Sheetal , Poulin-Costello Melanie 
Published: March 2015

Background: Although etanercept is well tolerated and effective in moderate-to-severe plaque psoriasis, data are limited in Canadian practice settings. Objective: To assess the effectiveness and safety of etanercept in Canadian patients with moderate-to-severe plaque psoriasis (Physician Global Assessment [PGA] ≥ 3) in routine practice. Methods: A 1-year, multicenter, open-label trial of 246 patients enrolled from March 2006 to July 2009 was conducted. Patients received etanercept 50 mg subcutaneously twice weekly for 3 months and then 50 mg once weekly for 9 months. The primary end point was the proportion of patients achieving a PGA score ≤ 2 at month 12. Secondary end points included the proportion of patients achieving PGA score ≤ 2 at months 3, 6, and 9 and change from baseline at month 12 for Patient Global Assessment (PtGA), body surface area, and Dermatology Life Quality Index (DLQI). Adverse events were reported. Results: At month 12, 73.5% (95% CI 67.2–79.1) achieved a PGA score ≤ 2. The response was similar regardless of the previous response to systemic or phototherapy. The proportion of patients achieving this score improved from 2.2% (95% CI 0.3–4.2) at baseline to 73.5% (95% CI 67.2–79.1) at 12 months. At 12 months, patients with a DLQI score of 0 or ≥ 5-point improvement was 28.8% (95% CI 22.9–34.7) and 47.3% (95% CI 40.8–53.9), respectively. No new safety signals were reported. Conclusion: The majority of this Canadian population demonstrated a meaningful improvement in PGA and DLQI scores over 1 year.
Vulvar Sarcoidosis: Case Report and Review of the Literature
Authors: Vera Caridad , Funaro Deana , Bouffard Danielle 
Published: March 2015

Background: Sarcoidosis is a multisystemic disorder of unknown etiology that can affect multiple organs, including the lungs, skin, and eyes. Vulvar sarcoidosis has anecdotally been reported. Objective: The aim of this article is to describe a case of vulvar sarcoidosis and review the few cases that have been reported. Methods: We report the case of a 39-year-old woman who presented to the dermatologist with a 2-year history of vulvar pruritus. Results: Examination revealed infiltrated plaques on the vulva and perianal region. The biopsy demonstrated well-defined, nonnecrotizing granulomas in the dermis. Further investigation revealed hilar adenopathy consistent with sarcoidosis. The patient responded well to topical corticosteroids. Conclusion: In the presence of granulomatous lesions of the genital region, infectious causes, foreign body reaction, Crohn disease, and sarcoidosis should be part of the differential diagnosis.
Low-Dose Oral Mini-Pulse Dexamethasone Therapy in Progressive Unstable Vitiligo
Authors: Kanwar Amrinder J. , Mahajan Rahul , Parsad Davinder 
Published: March 2015

Background: The course of vitiligo is unpredictable. If the disease is spreading rapidly, the progression can be controlled with the use of systemic steroids daily or in pulsed form. The present study was planned to assess the efficacy of low-dose dexamethasone oral mini-pulse therapy in progressive unstable vitiligo. Materials and Methods: In this retrospective study, the case records of patients with vitiligo during the period from January 2006 to December 2010 were studied. Patients who had progressive unstable disease were included. These patients were administered oral dexamethasone 2.5 mg per day on 2 consecutive days after breakfast in a week. The patients were asked to come for regular follow-up to assess the arrest of disease activity, relapse of disease activity, and adverse effects. Results: A total of 444 patients were analyzed. In 408 (91.8%) patients, arrest of disease activity was achieved at a mean duration of 13.2 ± 3.1 weeks. In addition, some repigmentation of the lesions was seen in all patients after a mean of 16.1 ± 5.9 weeks. During the follow-up, 50 of 408 (12.25%) patients experienced one or two episodes of relapse in disease activity, which were treated with reinstitution of low-dose dexamethasone oral mini-pulse therapy. The mean disease-free survival (DFS) until the first relapse was 55.7 ± 26.7 weeks, and the mean DFS until the second relapse was 43.8 ± 7.2 weeks. Adverse reactions such as weight gain, lethargy, and acneiform eruptions were observed in 41 (9.2%) patients. Conclusion: Low-dose oral mini-pulse dexamethasone therapy is a good option for arresting progressive unstable vitiligo with minimal adverse effects.
Skin Manifestations of Outpatient Adverse Drug Events in the United States: A National Analysis
Authors: Koelblinger Peter , Dabade Tushar S. , Gustafson Cheryl J. , Davis Scott A. , Yentzer Brad A. , Kiracofe Elizabeth A. , Feldman Steven R. 
Published: March 2015

Background: Cutaneous reactions to drugs are among the most common clinical manifestations of adverse drug events (ADEs); however, data on outpatient cutaneous adverse drug events (CADEs) are limited. Purpose: To provide national estimates of outpatient CADEs and determine their most frequent causes. Methods: Outpatient CADEs recorded in the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) between 1995 and 2005 were analyzed. The national incidence of outpatient CADEs in those seeking medical attention in the United States was estimated, and the common medication classes implicated with CADEs were identified. Results: There were a mean annual total of 635,982 CADE-related visits, resulting in an annual incidence of 2.26 CADEs per 1,000 persons. Patients took an average of 2.2 medications in addition to the one causing the CADE. The incidence of CADEs increased with age, with a peak in the age group from 70 to 79 years. The medications most frequently causing a CADE were antimicrobial agents. Dermatitis and urticaria were the two main types of skin reactions reported. Conclusions: CADEs occur less frequently in outpatients than in inpatients and result in few hospital admissions. Physicians must be particularly cognizant of the occurrence of CADEs when prescribing antimicrobial agents.
Incontinentia Pigmenti in an XY Boy: Case Report and Review of the Literature
Authors: Mullan Erin , Barbarian Mher , Trakadis Yannis , Moroz Brenda 
Published: March 2015

Background: Incontinentia pigmenti (IP) is a rare genetic skin disorder with X-linked dominant inheritance and a characteristic sequence of cutaneous manifestations, which is regarded as lethal in XY males. Objective: To report a case of a surviving XY male with the common IKBKG (NEMO) gene deletion confirming IP. Methods and Results: A newborn XY male with suspected IP underwent a skin biopsy on affected tissue for histopathology. Molecular genetic testing was also performed on the specimen and revealed the common IKBKG gene deletion with a pattern suggestive of somatic mosaicism. Our findings are aligned with a PubMed literature review for XY males with IP and documented IKBKG mutation. We determined that only 10 such genetically proven cases have been reported, including our case. Conclusion: Although relatively rare, cases of IP in XY males with the common NEMO mutation have likely been underreported due to the unavailability of appropriate testing in the past. Karyotype and molecular testing should be considered when clinical suspicion of IP arises for a male patient.
Multiple Primary Cutaneous Plasmacytomas: An Unusual Presentation
Authors: Uçmak Derya , Akkurt Zeynep Meltem , Türkçü Gül , Harman Mehmet , Dal Mehmet Sinan , Uçmak Feyzullah 
Published: March 2015

Background: Extramedullary plasmacytoma of the skin, a rare type of cutaneous B-cell lymphoma, is characterized by clonal proliferation of plasma cells primarily in the skin without evidence of multiple myeloma. Only about 30 cases with extramedullary plasmacytoma of the skin are reported in the literature. Case Report: An 82-year-old male patient presented to our clinic with complaints of asymptomatic red nodular swelling and pain in the anterior chest wall. A dermatologic examination revealed multiple nodular lesions of varying sizes with a hard smooth surface and vivid red color. Serum protein and immunoglobulin electrophoresis, skeletal radiography, and bone marrow biopsy showed normal results in this patient. Here a rare case of multiple primary plasmacytoma localizing in the skin is reported.
Off-Label Uses of Topical Vitamin D in Dermatology: A Systematic Review
Authors: Wat Heidi , Dytoc Marlene 
Published: March 2015

Background: Topical vitamin D is approved by the US Food and Drug Administration for the treatment of psoriasis but is also used off-label in the treatment of a variety of cutaneous diseases despite a lack of evidence-based guidelines. Objective: The objective of this study was to provide evidence-based clinical guidelines for the off-label use of topical vitamin D in the treatment of dermatologic disease. Methods: A systematic literature review was conducted via the MEDLINE, Embase, and CENTRAL databases for off-label uses of topical vitamin D analogues in the treatment of dermatologic disease other than psoriasis. The data were synthesized, and evidence-based recommendations were rendered according to the highest level of evidence available. Results: A total of 165 articles met the inclusion criteria. A moderate to strong recommendation was given for the use of topical vitamin D in combination with corticosteroids and phototherapy in vitiligo and as monotherapy for various ichthyoses, morphea, pityriasis alba, prurigo nodularis, and polymorphous light eruption. There is evidence showing that topical vitamin D is ineffective in the treatment of actinic keratosis, seborrheic keratosis, lichen planus, seborrheic dermatitis, alopecia areata, chemotherapy-induced alopecia, and hypertrophic scars. Conclusion: Topical vitamin D analogues have an important role in the off-label treatment of dermatologic disease, but higher quality studies are still required.
Treatment of Molluscum Contagiosum in Adult, Pediatric, and Immunodeficient Populations
Authors: Nguyen Harrison P. , Franz Eric , Stiegel Kelly R. , Hsu Sylvia , Tyring Stephen K. 
Published: March 2015

Background: Molluscum contagiosum is a viral infection of the skin that is widely considered to be a self-resolving disease that can be treated with benign neglect. However, the clinical reality is that the disease can vary widely by anatomic site and by recalcitrance to treatment and remains a significant cause of morbidity worldwide. Objective: The purpose of this review was to compile an updated resource for clinicians that addresses the management of the broad spectrum of molluscum cases that may be encountered. Methods: A comprehensive PubMed search was performed to identify publications on the treatment of molluscum infection, including presentations that may be rare or difficult. Results: The specific clinical scenario of molluscum must be considered when selecting the optimal therapy because certain treatments can be more effective for specific patient subpopulations. Conclusion: Further attention must be directed toward standardizing treatment for molluscum infection based on patient age and immune status.
Establishing Tension-Free Direct Wound Closure Using the Viscoelastic Properties of the Skin
Authors: Al-Benna Sammy 
Published: March 2015

Background: Establishing tension-free direct wound closure is important for optimal postsurgical wound healing. Direct closure should not be forced by raising wound tension. Objective: The aim of this article is to review the viscoelastic properties of skin and describe tension-relieving techniques to aid optimal wound closure.
Atypical Fibroxanthoma Arising in a Scar of Discoid Lupus Erythematosus
Authors: De Francesco Vincenzo , Errichetti Enzo , Pegolo Enrico , Stinco Giuseppe 
Published: March 2015

Background: Malignant change in the scars of discoid lupus erythematosus (DLE) is a well-known event. In most cases, tumors are of epithelial origin, particularly squamous cell carcinomas and, less frequently, basal cell carcinomas and keratoacanthomas. The onset of soft tissue sarcomas in a DLE scar is a very rare event, however, because only one case of malignant fibrous histiocytoma has been described in the literature. Objective: We describe the first documented report of atypical fibroxanthoma (AFX) arising in an old scar of DLE. Results: Although we cannot exclude an accidental association between AFX and DLE, our case emphasizes that patients with DLE may develop AFX in the context of an old scar. Conclusion: Our finding further underlines the importance of strict and long-term surveillance of people with DLE to identify and remove eventual tumors at an early stage.
Trends in the Association between Pyoderma Gangrenosum and Autoimmune Hepatitis: Case Report and Review of the Literature
Authors: Wat Heidi , Haber Richard M. 
Published: March 2015

Background: Pyoderma gangrenosum (PG) is a neutrophilic dermatosis commonly associated with underlying systemic illness, typically of autoimmune origin. The association of PG with autoimmune hepatitis (AIH) has been reported but remains poorly recognized. Observations: We describe a case of PG manifesting 5 years following the diagnosis of AIH and conduct a literature review to determine the significance of this association. We identified a predisposition for young females and a tendency for PG to arise 4 to 12 years after the diagnosis of AIH during a period of disease quiescence. Additionally, fulminant hepatitis as the initial presentation of AIH appears to be a risk factor in the subsequent development of PG. Conclusions: These observations may provide important clues for the pathogenesis of PG in the context of AIH. Recognition of this association has important implications for dermatologists in the evaluation, workup, and management of patients with a history of AIH and suspected PG.
Catastrophic Wounds
Authors: Kunimoto Brian T. 
Published: March 2015

Background: This article summarizes information presented at the Wound Healing Subspecialty Symposium of the Annual Conference of the Canadian Dermatology Association held in Ottawa in June 2012. Objective: To provide continuing medical education on wound healing for dermatologists. Methods: A review of the pertinent literature was performed by the author in order to prepare the lecture and subsequent article. Results: The review found that necrotizing faciitis, hypertensive ulceration, antiphospholipid syndrome and α1-antitrypsin syndrome are entities that contribute to catastrophic wounds seen in wound healing clinics and in private offices. Conclusion: It is most important to have a high index of suspicion for these four conditions because early diagnosis can be life-***saving with necrotizing faciitis, pain-relieving in ulcers caused by hypertension, and antiphospholipid syndrome, and can result in early treatment in α1-antitrypsin deficiency.
Peripheral Neuropathy for Dermatologists: What If Not Diabetic Neuropathy?
Authors: Kwok Tiffany , Ting Patricia T. , Wong Eric K. , Brassard Alain 
Published: March 2015

Background: Patients with cutaneous manifestations associated with peripheral neuropathy often present to the dermatologist's office. Objective/Methods: This article outlines a practical approach for obtaining the history, performing a screening physical examination, and ordering initial diagnostic testing to diagnose the cause of nondiabetic neuropathy. When to refer for neurologic consultation and principles of management of neuropathic pain and neuropathy-related ulcers are also discussed. Results: Cutaneous manifestations of peripheral neuropathy may be secondary to a medical condition predisposing the patient to neuropathy or a manifestation of neuropathy itself. In the latter category, skin affected by neuropathy may show characteristics of xerosis, anhidrosis, rubor, edema, callus, ulceration, muscle wasting, and foot deformity. Most often these findings occur in association with diabetic neuropathy; however, many other infectious, inflammatory, metabolic, paraneoplastic, hereditary, and medication- or toxin-related causes should be considered. The treatment of cutaneous manifestations of neuropathy includes pressure downloading, control of edema, and optimal ulcer and neuropathic pain management. Conclusion: It is important for dermatologists to have a basic approach to neuropathy in patients with related skin disease. Referral to Neurology is warranted when basic workup for reversible causes is negative or for any severe, rapidly progressive symptoms.
Trichodysplasia Spinulosa in a Renal Transplant Patient
Authors: Laroche Alexandre , Allard Catherine , Chababi-Atallah Myrna , Masse Mélanie , Bertrand Janie 
Published: March 2015

Background: Trichodysplasia spinulosa (TS) is a rare skin affection seen in immunocompromised patients, mainly those with solid organ tranplants. Objective: To report a case of a patient with classic clinical and pathologic findings for the disease so that physicians caring for this population are aware of the clinical presentation. Method: We report the case of a female patient we saw at our clinic with a diagnosis of TS. Results: The diagnosis of TS was confirmed by pathologic findings. Conclusion: TS should be considered in any immunocompromised patient with a papular facial eruption reminiscent of acne vulgaris and with keratotic spiny papules as a distinctive feature.
Trichodysplasia Spinulosa: Rare Presentation of Polyomavirus Infection in Immunocompromised Patients
Authors: Kirchhof Mark G. , Shojania Kam , Hull Mark W. , Crawford Richard I. , Au Sheila 
Published: March 2015

Background: Trichodysplasia spinulosa (TS) is a rare, striking, folliculocentric papular eruption seen exclusively in immunosuppressed patients. The eruption can be disfiguring, associated with leonine faces and alopecia. TS is caused by a polyomavirus, identified as trichodysplasia spinulosa polyomavirus (TSPyV). Few reports exist in the literature, and support for treatment options is sparse. Method and Results: We report a patient with TS with underlying lupus nephropathy and renal transplant–associated immunosuppression. Diagnosis was confirmed by biopsy and pathognomonic histologic findings in the context of her extensive, spiculated monomorphous papules. With a biopsy-confirmed diagnosis, oral valganciclovir was prescribed, and the patient showed marked skin texture improvement and hair regrowth. Conclusion: The continued reporting of cases of TS will improve clinical identification of this condition and provide better information regarding treatment and long-term consequences.
Network Meta-analysis of Treatments for Chronic Plaque Psoriasis in Canada
Authors: Gupta Aditya K. , Daigle Deanne , Lyons Danika C.A. 
Published: March 2015

Background: Psoriasis affects approximately 500,000 Canadians. Eight treatments are currently licensed for chronic plaque psoriasis in Canada. Objective: To compare the efficacy of systemic treatments for chronic plaque psoriasis for the outcome > 75% reduction in the Psoriasis Area and Severity Index (PASI) using network meta-analysis. Methods: PubMed and clinicaltrials.gov databases were searched up until October 15, 2013, for phase III clinical trials. A consistency model based on a random-effects bayesian statistical framework was used to compare the rates of > 75% PASI reduction across trials. Results: Twenty-one studies were included in the network analysis. Infliximab had significantly greater odds of producing > 75% reduction in the PASI compared to all treatments. All treatments conferred greater odds of > 75% PASI reduction compared to placebo. Conclusion: Although infliximab had the highest efficacy relative to other systemic treatments for psoriasis, adverse effects, cost, and patient preferences should also be considered when deciding on treatment.
Fatal Case of Vulvar Pyoderma Gangrenosum with Pulmonary Involvement: Case Presentation and Literature Review
Authors: Mercer Joshua M. , Kuzel Paul , Mahmood Muhammad N. , Brassard Alain 
Published: March 2015

Introduction: We report a case of a 61-year-old woman with locally destructive vulvar pyoderma gangrenosum (PG) with pulmonary involvement who was refractory to numerous systemic therapies and developed complications resulting in her demise. Objective: To report a rare case of treatment-resistant vulvar PG with pulmonary involvement that proved to be fatal. Methods: PubMed was used to search for other reports that discuss PG, or more specifically perigenital PG, with pulmonary involvement. Results and Conclusion: A thorough review of the literature revealed 33 cases of PG with pulmonary involvement, with only 4 involving the perigenital region. We report the second case of a female with vulvar PG and pulmonary involvement. In contrast to the first case described, our patient did not respond to systemic therapy, and, ultimately, her disease was fatal. It is hoped that with continued documentation of this rare and potentially lethal presentation of PG, physicians will determine more effective treatments.
Mucocutaneous Manifestations of Inflammatory Bowel Disease in Turkey
Authors: Demir Filiz Topaloǧlu , Kocatürk Emek , Yorulmaz Elif , Adali Gupse , Kavala Mukaddes 
Published: March 2015

Background: Mucocutaneous manifestations of inflammatory bowel diseases are relatively common; the mean incidence is around 10% at the time of diagnosis. However, during follow-up, an increased variety of skin lesions, granulomatous cutaneous disease, reactive skin eruptions, nutritional defiencies, and other associated conditions may develop. Objective: The objective of this study was to evaluate the prevalence of the mucocutaneous manifestations and their association with gender, duration of disease, arthritis, location of the bowel disease, and disease activity. Methods: Fifty-six patients with ulcerative colitis (UC) and 36 patients with Crohn disease (CD) who were in follow-up in the Istanbul Medeniyet University Göztepe Training and Research Hospital Department of Gastroenterology were included in the study. Whole-body dermatologic examinations were performed for all patients, and patient files were evaluated for mucocutaneous manifestations. Results: Of the 92 patients, 49 (53.26%) presented with at least one mucocutaneous manifestation (58.9% of patients with UC and 44.4% of patients with CD). Of these, 38 (41.3%) had at least one reactive skin eruption. Aphthous stomatitis was noted in 33 patients (35.86%) and became the most common mucocutaneous manifestation. Granulomatous cutaneous diseases were detected in 18 patients (19.57%), and none of the patients had a nutritional deficiency–associated skin condition. Only 3 patients (3.26%) had erythema nodosum and 2 patients (2.17%) had pyoderma gangrenosum. Conclusions: We found that mucocutaneous manifestations of inflammatory bowel diseases are more common than thought and are more common in UC than in CD. No association was detected between mucocutaneous manifestions and gender, duration of disease, arthritis, location of the bowel disease, and activity of the disease.