bluuebunny/crossref_metadata_2025_split huggingface dataset:
Familial Pityriasis Rubra Pilaris: Case Report and Review
Authors: Mercer Joshua M. , Pushpanthan Chitra , Anandakrishnan Canagasundrum , Landells Ian D.R. 
Published: March 2015

Background: Pityriasis rubra pilaris (PRP) is a rare dermatosis of unknown etiology. Most cases of PRP are sporadic; however, rare cases of familial PRP have been reported. Objectives: To present a case of PRP inherited in an autosomal dominant (AD) fashion and to evaluate the current literature on familial PRP and formulate a comprehensive, up-to-date summary of this rare condition. Methods: PubMed was used to conduct a search for articles pertaining to familial PRP published through May 2011. Results: The first documented case was published in 1910, and 36 subsequent familial cases of PRP have been reported. Familial PRP typically presents very early in childhood, has a gradual onset, and persists throughout life. Given the rarity of this subtype, determining the best therapy has been a challenge. In the pediatric population, a conservative treatment approach, including topical therapy, is frequently used, whereas systemic treatments are reserved for patients with a severe disease that is refractory to therapy. Conclusion: Rare cases of PRP inherited in an AD fashion have been described and tend to have a chronic clinical course and are treatment refractory. Therefore, the awareness of familial PRP is important for early and accurate diagnosis and administration of appropriate therapy.
In Vivo Reflectance Confocal Microscopy of Halo Nevus
Authors: Schwartz Rodrigo J. , Vera Karla , Navarrete Nelson , Lobos Pedro 
Published: March 2015

Background: RCM (reflectance confocal microscopy) is a noninvasive, high-resolution technology that has been proven to improve the diagnostic accuracy over clinical examination in several skin diseases. Objective: The aim of this article is to describe the morphologic features of halo nevi (HN) observed with RCM and correlate them with their dermoscopic characteristics. Method: Nine patients with the clinical diagnosis of HN were assessed with RCM. A second assessment was performed up to 12 months later. Dermoscopic global patterns were obtained and correlated with the RCM findings. Results: In five (55.6%) cases, pagetoid cells were observed. Nonedged dermal papilla and junctional thickening were found in three (33%) cases. Nucleated cells in the dermal papillae and plump bright cells were observed in seven (77.8%) and six (66.7%) cases, respectively. Conclusion: Our study shows that HN observed by RCM can show atypical features that overlap with those observed on atypical melanocytic lesions and malignant melanoma.
Degree of Histologic Inflammation in Lupus Erythematosus and Direct Immunofluorescence Results: Red and Inflamed Lesions Do Not Increase the Chances of Getting a Bright Band
Authors: Hung Tawny , Crawford Richard Ian , Martinka Magdalena 
Published: March 2015

Background: In the diagnostic work-up of lupus erythematosus (LE), direct immunofluoresence (DIF) examination could be helpful. Classically, clinically red lesions are targeted by clinicians in the hope of yielding an informative DIF result. However, the investigative correlation between the degree of inflammation and DIF positivity has never been published in the literature. Objective: In this study, we sought to discover if histologically inflamed lesions correlated with DIF positivity results. Method: We studied 112 lesions histologically consistent with LE and correlated the degree of histologic inflammation on the DIF hematoxylin and eosin-stained biopsy with DIF positivity. The degree and location of the inflammation, as well as the involvement of the dermoepidermal interface, were documented. Results: A positive lupus band test was defined as the presence of either (1) granular IgG alone ± other immunoglobulins and/or C3 or (2) granular IgM or Ig A plus other immunoglobulins ± C3. Fifty-four of 112 (48%) cases had positive DIF (DIF+) results, 26 of 112 (23%) had negative DIF (DIF-) results, and 32 of 112 (29%) had nonspecific DIF patterns. Of the DIF+ cases, 41 of 54 (76%) showed some degree of inflammation, whereas 25 of 26 (96%) DIF- cases had inflammation ( p − .60). Most of the biopsies in the study (85%) were inflamed, but the degree and location of the inflammation had no influence on DIF+ results. The intensity of the DIF+ band further failed to show any relationship with the degree of inflammation. Conclusion: The level of inflammatory activity in a clinical lesion fails to correlate with DIF positivity. Furthermore, other common histopathologic findings of LE are not predictive of DIF results.
Therapy of Ulcerated Hemangiomas
Authors: McCuaig Catherine C. , Cohen Lynn , Powell Julie , Hatami Afshin , Marcoux Danielle , Maari Catherine , Caouette-Laberge Louise , Bortoluzzi Patricia , Ondrejchak Sandra , Dubois Josée 
Published: March 2015

Background: Cutaneous ulceration is the most common complication of infantile hemangiomas (IHs) seen in a pediatric dermatology practice. Objective: The most effective treatments in our experience are compared to those in the current literature. Methods: The study was a retrospective chart review of therapy of 169 ulcerated IHs at a tertiary care pediatric hospital and a literature review. Results: Combination therapy was the rule. Local wound care was required in all, pain management in 72%, pulsed dye laser in 42%, infection control in 38%, diminution of the hemangioma through systemic therapy in 36%, and suppression of bleeding in 2%. Limitations: A retrospective review compared to a case-control study has inherent bias. In addition, our cases were all at a tertiary referral center. Conclusion: All ulcerated IHs benefit from local barrier creams or dressings. Pulsed dye laser, antibiotics, topical morphine 0.1% in hydrogel, topical becaplermin, and, most importantly, systemic therapy (especially propranolol) to reduce the hemangioma may be useful.
Understanding and Assessing Potential Serious Adverse Events: A Practical Approach to Understanding the Benefits and Harm of Psoriasis Treatments
Authors: Papp Kim , Guenther Lyn , Shear Neil , Binder Carin , Tan Jerry , Lynde Charles , Gulliver Wayne , Stang Paul 
Published: March 2015

Background: Any therapeutic intervention carries with it the potential for benefit and harm. Generally, benefit is far more common than risk; however, risk aversion drives many of the treatment decisions made by patients and their physicians. Objective: To provide guidelines to help clinicians improve their understanding of causality and the interpretation of harm. Methods: A group of dermatologists involved in data safety monitoring boards, clinical trial investigators, and a clinical epidemiologist identified the need for practical advice on how to understand and explain causality and harm and combined to share their knowledge. Results: An explanation of how data are collected and the environment that shapes the data seen by clinicians is presented. The article spans an overview of the regulatory environment that informs trial design for regulatory approval to a description of types of designs that inform safety and techniques, such as the rule of three, to provide guidance to clinicians in interpreting the data. Conclusion: Communicating the potential for harm to patients is critical. Placing the potential for rare and serious risks into perspective for the patient is as important as discussing the potential benefits of medication.
Reactive Arthritis in India: A Dermatologists' Perspective
Authors: Kanwar Amrinder J. , Mahajan Rahul 
Published: March 2015

Background: The mucocutaneous lesions in Reiter syndrome (RS) or reactive arthritis are seen quite frequently. Materials and Methods: The case records of patients admitted with the diagnosis of RS from January 2006 to December 2010 were reviewed. Data regarding the demographic details; course of musculoskeletal, mucocutaneous, and ophthalmic involvement; body surface area affected; morphology of lesions; investigations undertaken; and treatment instituted were recorded. Based on these, the disease was classified as complete or incomplete RS. Results: The case records of 11 patients were evaluated. There were seven males and four females. Only two patients had complete RS, whereas nine patients had incomplete RS. Arthritis and mucocutaneous involvement were seen in all 11 patients, whereas preceding urethritis/dysentery was seen in 4 patients and eye symptoms in 4 patients. Enthesitis was seen in eight patients (72.7%). Circinate balanitis/vulvitis was present in six patients and keratoderma blenorrhagicum in eight patients. The most frequent radiologic finding was juxta-articular osteopenia in eight patients. Conclusion: RS may not show the typical triad in all cases, although musculoskeletal disease is seen in a significant proportion of patients. In the absence of typical signs and symptoms, cutaneous manifestations may help establish the diagnosis of RS.
Ingenol Mebutate: A Promising Treatment for Actinic Keratoses and Nonmelanoma Skin Cancers
Authors: Gupta Aditya K. , Paquet Maryse 
Published: March 2015

Background: A new treatment for actinic keratoses, ingenol mebutate, was recently approved by the US Food and Drug Administration. Objective: To review the mechanisms of action, efficacy and safety data, and practical recommendations for ingenol mebutate. Methods: The PubMed and clinicaltrials.gov databases were searched in March/April 2012 using the terms PEP005, ingenol mebutate, and ingenol 3-angelate. The abstracts from the Annual Scientific Meeting of the Australian College of Dermatologists (2009–2011) and the Annual Meeting of the American Academy of Dermatology (2009–2012) were also searched. Results: Due to its multiple mechanisms of action, ingenol mebutate treatment resulted in short- and long-term efficacy similar to other topical treatments for actinic keratoses in a shorter period of 2 or 3 days. This short therapy would reduce the duration of adverse events. Premarketing trials for treatment of nonmelanoma skin cancers also showed promising results for ingenol mebutate. Conclusion: Ingenol mebutate is a convenient, safe, and effective intervention for precancerous and cancerous skin conditions.
Allergic Contact Dermatitis to Medical Equipment in a Non-Health Care Worker Caring for a Disabled Spouse
Authors: Shoimer Ilya , Pratt Melanie 
Published: March 2015

Background: Allergic contact dermatitis (ACD) to rubber accelerators is a common occurrence, especially in health care workers, but the risks in family caregivers are not as well documented. Objective: To document a case of a 66-year-old woman who developed recurrent, extensive flares of ACD from contact with rubber accelerators through caregiving. Method and Results: Patch testing revealed a positive reaction to two common rubber accelerators: carba mix (3+) and thiuram mix (3+). The patient described caring for her disabled husband, which involved handling rubberized medical equipment. Conclusion: Physicians should appreciate ACD in non-health care workers caused by rubber accelerators found in medical equipment. Individuals providing care for sick or elderly relatives should be further questioned on exposure to a hospital environment and contact with medical equipment.
The Care Triangle: Determining the Gaps in the Management of Atopic Dermatitis
Authors: O'Toole Ashley , Thomas Bjorn , Thomas Richard 
Published: March 2015

Background: Atopic dermatitis (AD) is a chronic, relapsing, intensely pruritic dermatosis that usually affects infants, children, and young adults. The treatment of AD entails an individualized regimen that depends on the age of the patient, the stage and variety of lesions present, the sites and extent of involvement, the presence of infection, and the previous response to treatment. Objectives: To identify the evidence surrounding potential strategies for closing these gaps—ultimately improving the quality of care, the care process itself, and patient outcomes—and to encourage discussions that help develop tools to bridge the gap between suggested therapy and what is done by the patient. Methods: Review of the literature including searches on PubMed Central and Medline and in seminal dermatology texts. Results: There are several disconnections between the evidence-based guidelines in the management of AD, what the individual dermatologist recommends, and what the patient does. Conclusion: Applying the concept of the care triangle requires a balance of evidence-based medicine, the physician's experiences and the patient's needs and expectations in the decisions surrounding appropriate management of the disease.
Systematic Review of Systemic Treatments for Tinea Versicolor and Evidence-Based Dosing Regimen Recommendations
Authors: Gupta Aditya K. , Lane Danielle , Paquet Maryse 
Published: March 2015

Background: Extensive or recurrent tinea versicolor (TV) can be treated with systemic antifungal therapies, but no dosing regimens have been approved for this indication. Objective: To provide evidence-based recommendations for dosing regimens. Methods: A systematic literature search was performed to identify trials reporting mycologic cure. All trials were included and assessed for quality. Correlation and statistical analyses were used to evaluate the effects of different dosing regimen parameters on efficacy. Results: Fifty-seven trials investigating itraconazole, ketoconazole, fluconazole, and pramiconazole were included. Cumulative dose, treatment duration, and daily/weekly concentrations were shown to significantly influence mycologic cure rates for ketoconazole and pramiconazole but not for itraconazole and fluconazole. Conclusion: Based on the efficacy evidence and potential safety concerns, this review supports the following dosing regimens: 200 mg/d for 5 or 7 days of itraconazole, 300 mg/wk for 2 weeks of fluconazole, and 200 mg/d for 2 days of pramiconazole.
Extraordinary Giant Basal Cell Carcinoma with Full-Thickness Infiltration of the Abdominal Wall: Single-Staged Resection and Simultaneous Reconstruction
Authors: Pierer Gerhard , Pülzl Petra , Deluca Jenny , Müller Hansgeorg , Zelger Bernhard , Putzer Daniel , Eisendle Klaus 
Published: March 2015

Background: Basal cell carcinoma (BCC) is the most frequent form of invasive skin cancer. BCCs usually show a slow progression and rarely metastasize; however, around 1% achieve a “giant” size, larger than 5 cm in diameter. Rarely, BCCs larger than 20 cm are reported in the literature. Objective: We report a case of a giant BCC, measuring 25 × 13 × 5 cm, involving the abdominal wall. The article describes the curative surgical procedure, which resulted in an excellent aesthetic result.
Rapid and Easy Diagnosis of Netherton Syndrome with Dermoscopy
Authors: Akkurt Zeynep Meltem , Tuncel Tuba , Ayhan Erhan , Uçmak Derya , Uluca Ünal , Uçak Haydar 
Published: March 2015

Background: Netherton syndrome is a rare autosomal recessive disease demonstrating ichthyosis linearis circumflexa, atopic findings, and hair shaft anomalies. Trichorrhexis invaginata is the pathognomonic hair shaft anomaly seen in this syndrome. Objective: In recent years, hair shaft anomalies have been described as “matchstick” and “golf tee” signs. We present a patient with Netherton syndrome diagnosed by the presence of matchstick and golf tee hairs in addition to trichorrhexis invaginata.
Acute Rhabdomyolysis as a Complication of Interferon Treatment for Stage IIIc Melanoma
Authors: Gavigan Geneviève , McEvoy Alana , Young Vince 
Published: March 2015

Background: Interferon alfa-2b is a treatment option for select patients with stage 3 melanoma. Objective: To highlight the potential complication of acute rhabdomyolysis from interferon alfa-2b in this patient population. Methods: We present a case of a 63-year-old female with stage IIIc melanoma who developed acute rhabdomyolysis after completing 2 of 4 weeks of induction with high-dose interferon alfa-2b. She recovered after hydration with intravenous fluids and discontinuation of interferon alfa-2b. Results: Review of the literature revealed eight cases of reported rhabdomyolysis triggered by interferon use, including four cases of melanoma. Conclusion: In patients treated with interferon, especially at high doses, screening for creatine kinase and myoglobinuria should be performed if the patient develops symptoms suggestive of acute rhabdomyolysis.
Successful Treatment of Calciphylaxis with Intravenous Sodium Thiosulfate in a Nonuremic Patient: Case Report and Review of Therapy Side Effects
Authors: Fernandes Carolina , Maynard Bruno , Hanna Dominique 
Published: March 2015

Background: Calciphylaxis is a life-threatening condition traditionally observed in patients with end-stage renal disease. Cases of nonuremic calciphylaxis have also been reported, but data on this rare condition are mainly empirical. Objectives: To present a case of severe nonuremic calciphylaxis treated with intravenous sodium thiosulfate (IV STS) and to assess the implications of this treatment. Methods: Case report and review of the literature. Results: A nonuremic patient diagnosed with distal calciphylaxis was started on IV STS after a 12-month nonresponse to conventional therapy. On week 12, the patient requested palliative care, given her many side effects (transient severe nausea and significant electrolyte imbalance). Pain subsided after 14 weeks, and complete wound healing was observed after 6 months. Conclusion: Based on this case report, IV STS can improve refractory calciphylaxis in nonuremic patients. However, literature on the subject remains scarce. Careful monitoring for adverse transient side effects is advised.
Cutaneous Adverse Events during Vemurafenib Therapy
Authors: Chandrakumar Shivani Felicia , Yeung Jensen 
Published: March 2015

Background: Vemurafenib, an oral agent that selectively targets the BRAF V600E mutation, has recently emerged as the mainstay of treatment in patients with BRAF-positive stage IV melanoma. A spectrum of cutaneous adverse events has been associated with vemurafenib, ranging from benign rashes to malignant side effects such as keratoacanthoma and squamous cell carcinoma. Objective: In this article, we review clinical data regarding the frequency and severity of the common dermatologic side effects associated with vemurafenib; case series and noncontrolled studies evaluating the safety of vemurafenib therapy are used to further characterize these adverse events. Conclusion: Benign vemurafenib-induced side effects generally tend not to be severe or life threatening, with most patients managed by dose interruptions, dose reductions, or topical therapies. Squamous cell carcinomas and keratoacanthomas associated with vemurafenib therapy are easily treated by simple excision of the lesion without discontinuation of vemurafenib. Thus, awareness of potential adverse events coupled with routine dermatologic assessment and timely management will allow for optimal therapeutic benefit in patients receiving vemurafenib therapy.
Hyperglycemia following Intralesional Corticosteroid Injection in a Patient with Type I Diabetes Mellitus
Authors: Fleming Patrick , Drazek Leah , Shaw James C. 
Published: March 2015

Case Report: A 36-year-old woman with well-controlled type 1 diabetes mellitus reported hyperglycemia (plasma glucose peaked at 21.3 mmol/L) after her first injection with intralesional triamcinolone acetonide for alopecia areata. Conclusion: Intralesional corticosteroids are used to maximize local effect while presumably minimizing systemic complications. This adverse effect is an important consideration when treating patients with insulin-dependent diabetes mellitus, and it would be reasonable to counsel patients of such a possibility.
Facial Reconstruction following Mohs Micrographic Surgery: A Report of 622 Cases
Authors: Grosfeld Eline C. , Smit Jeroen M. , Krekels Gertruud A. , van Rappard Julien H.A. , Hoogbergen Maarten M. 
Published: March 2015

Background: Around 100 to 200 patients undergo surgical reconstruction every year at our department of plastic and reconstructive surgery after Mohs micrographic surgery for nonmelanoma skin cancer. Objective: The aim of this report is to provide an overview of the type of facial reconstructions performed and investigate whether we achieved increased, definitive closure rates of the defect on the day of the excision after further improving the collaboration between the involved departments. Methods: All patients who underwent facial reconstruction at the Department of Plastic and Reconstructive Surgery following Mohs micrographic surgery between January 2006 and January 2011 were retrospectively systematically reviewed. Results: A total of 564 patients with 622 defects were identified. The different reconstructions used per aesthetic unit are described. The number of cases in which a reconstruction was performed on the same day as the resection significantly increased from 31 to 81% ( p < .001). Conclusion: Facial reconstruction following Mohs micrographic surgery is challenging. The type of reconstruction used depends on the type of defect and patient characteristics. A structured multidisciplinary approach improves the process from defect to reconstruction and can facilitate referrals.
Erythema Induratum: Case Series Illustrating the Utility of the Interferon-γ Release Assay in Determining the Association with Tuberculosis
Authors: Prajapati Vimal , Steed McKay , Grewal Parbeer , Mahmood Muhammad N. , Verma Geetika , Brassard Alain 
Published: March 2015

Background: The interferon-γ release assay (IGRA) is a novel method for detecting previous sensitization to tuberculosis (TB). Despite having several advantages over the tuberculin skin test (TST), including higher specificity and no influence from past bacille Calmette-Guérin (BCG) exposure, there are a limited number of reports describing its application in patients with erythema induratum (EI)/nodular vasculitis (NV), which is usually but not always related to TB. Objectives: The aim of our case series was to evaluate the usefulness of the IGRA for determining a TB association in patients with EI/NV. Methods: Retrospective chart reviews were conducted on four patients diagnosed with EI/NV at our institution in whom an IGRA had been performed. Results: All four subjects had positive TST results. The IGRA was also positive and therefore supported a link with TB in two cases. One patient responded completely to anti-TB therapy, whereas the second was lost to follow-up. Both cases unrelated to TB, by virtue of negative IGRAs, demonstrated complete response to immunosuppressive therapy (methotrexate), with one individual having failed anti-TB therapy first. Conclusion: Our case series highlights the utility of the IGRA for establishing a TB association in patients with EI/NV. Although limited by a small sample size, we propose adjunctive use of this test at the time of EI/NV diagnosis, especially in the setting of previous BCG exposure, so that management can be tailored according to whether an underlying relationship with TB exists.
Wound Bed Preparation 2012
Authors: Sibbald R. Gary , Goodman Laurie , Reneeka Persaud 
Published: March 2015

Background: The concept of wound bed preparation is a holistic approach to wound diagnosis and treatment of the cause, patient-centered concerns and optimizing the components of local wound care (débridement, infection and persistent infection, moisture balance) before edge effect for healable but stalled chronic wounds. This article has introduced the concepts of healable, nonhealable and maintenance wounds. Additionally, clinical criteria (mnemonic NERDS and STONEES) are provided on the use of topical agents for critical colonization or systemic antimicrobials for deep and surrounding infection. Objective: To present a holistic, evidence-informed approach to chronic wound care management. Methods: This article reviews the scientific evidence base, and forms an expert consensus of key opinion leaders to the Wound Bed Preparation model. Results and Conclusion: This article provides clinicians with evidence-informed wound caring approaches translating the evidence base into practice.