bluuebunny/crossref_metadata_2025_split huggingface dataset:
Generalized Eruptive Histiocytoma Treated with Isotretinoin
Authors: Kwinter Jennifer , DeKoven Joel 
Published: March 2015

Background: Generalized eruptive histiocytoma (GEH) is a rare, benign non-Langerhans cell histiocytosis characterized by widespread and symmetric skin-colored to blue-red papules on the trunk and proximal extremities affecting mainly adults. GEH is associated with a self-limiting course lasting from 1 month to over 12 years, and the lesions typically resolve spontaneously; therefore, reports of potential therapies for GEH are lacking. Objective: We report for the first time the use of isotretinoin in the treatment of GEH. An otherwise healthy 53-year-old female with a 3-month history of GEH had resolution of lesions without further development of new lesions over 8 months of treatment with isotretinoin, although, eventually, lesions began to recur. Conclusion: Although there has been success with isotretinoin in the management of Rosai-Dorfman disease and Langerhans cell histiocytosis, further investigation is needed to delineate the exact mechanism of action and future role of isotretinoin in the management of GEH.
Vincristine and Corticosteroids as First-Line Treatment of Kasabach-Merritt Syndrome in Kaposiform Hemangioendothelioma
Authors: Drucker Aaron M. , Pope Elena , Mahant Sanjay , Weinstein Miriam 
Published: March 2015

Background: Historically, patients with the consumptive coagulopathy Kasabach-Merritt syndrome (KMS) have been treated with systemic corticosteroids as first-line therapy, but many patients do not respond. Recently, there have been increasing reports of the use of the chemotherapeutic drug vincristine in these patients. Objective: To report a case of a newborn with a kaposiform hemangioendothelioma (KHE) of the right leg associated with KMS treated successfully with vincristine and oral corticosteroids. Methods: The patient's chart and the literature on the subject were reviewed using Medline and PubMed. Results: Treatment with vincristine and corticosteroids lead to sustained shrinking of the tumor and correction of the thrombocytopenia and coagulopathy through 1 year of age. We believe this is the first report in the North American literature of corticosteroids and vincristine being used concomitantly as first-line therapy for KHE with KMS. Conclusion: Vincristine and corticosteroids should be considered first-line treatment for KMS.
Erosive Pustular Dermatosis of the Leg: An Overlooked Entity?
Authors: Seckin Dilek , Gurbuz Oya , Demirkesen Cuyan 
Published: March 2015

Background: Erosive pustular dermatosis is a distinctive clinical entity that has been described on either the scalp or legs. Chronic, shallow erosions covered by yellow crusts develop in atrophic or fibrotic skin. The scalp is the most commonly encountered localization, whereas erosive pustular dermatosis of the leg has also been reported in several cases. The histopathologic picture is nonspecific, and the disease is usually considered as a diagnosis of exclusion. Objective and Conclusion: We report two patients with erosive pustular dermatosis of the leg who were unresponsive to antibacterial and antifungal medications but were successfully treated with systemic steroids in combination with topical pimecrolimus in one of them and topical clobetasol in the other. The condition is simply overlooked, which accounts for its rare description in literature.
Coexistence of Acral Syringomas and Multiple Trichoepitheliomas on the Face
Authors: Balci Didem Didar , Atik Esin , Altintas Suleyman 
Published: March 2015

Background: An extremely rare variant of syringoma is an acral form, which affects the upper extremities as an isolated finding. The acral syringomas may also be associated with syringomas on the feet or usual distribution around the eyelids. Of the eight previously documented cases of acral syringomas, all were located on the dorsal aspect of the upper extremities (fingers, hand, wrist, or forearm) dominantly. Objective: We report a 41-year-old woman who presented with multiple flesh-colored to reddish brown papules on the inner aspect of the forearms and many pearly, small papules on the periorbital regions. Results: The clinical picture and histopathology indicated the coexistence of acral syringomas and multiple trichoepitheliomas on the face. Conclusion: To the best of our knowledge, this is the first case of acral syringomas coexisting with multiple trichoepitheliomas.
Nail Psoriasis and Biologics
Authors: Noiles Kristin , Vender Ronald 
Published: March 2015

Background: Since the advent of biologic therapies for psoriasis, reports of efficacy in nail psoriasis have appeared in the literature and at international conferences with increasing frequency. Objective: This article aims to review the existing literature on the use of biologics in the treatment of nail psoriasis. Methods: An extensive literature review was conducted using OVID Medline. Studies examining the efficacy of biologics in the treatment of nail psoriasis were documented. Results: A literature review revealed few clinical trials specifically concentrating on nail psoriasis; however, nails have been assessed in larger clinical trials for cutaneous psoriasis. A large, multicenter, phase III, double-blind, placebo-controlled study of infliximab administered as a brief induction regimen at weeks 0, 2, and 6 followed by a single infusion every 8 weeks revealed statistically significant mean percent improvement in the Nail Psoriasis Severity Index (NAPSI) score over placebo at both week 10 (26.8% vs −7.7%, respectively; p < .001) and week 24 (57.2% vs −4.1%, respectively; p < .001). For other biologics, evidence has thus far been largely anecdotal, appearing as either case studies or extracted secondarily from open-label prospective trials in plaque psoriasis or psoriatic arthritis. Conclusion: Infliximab appears to be the most effective treatment for nail psoriasis to date.
Compatibility of Tacrolimus Ointment with Corticosteroid Ointments of Varying Potencies
Authors: Pappas Lisa , Kiss Alex , Levitt Jacob 
Published: March 2015

Background: Tacrolimus is often coadministered with various topical corticosteroids in the treatment of steroid-responsive dermatoses; however, the stability of these products in combination has not been examined extensively. Objective: To assess the in vitro compatibility of three tacrolimus-corticosteroid ointment combinations compared with unmixed controls. Methods: Tacrolimus-clobetasol propionate, tacrolimus-desoximetasone, and tacrolimus-hydrocortisone-17-valerate ointment combinations were prepared, stored with unmixed ointments at three temperature/humidity conditions, and evaluated for stability at days 0, 1, 2, 7, 14, and 28 via reverse-phase high-performance liquid chromatography. Results: There was no significant difference in the rate of drug degradation in mixed and unmixed ointments over time or across temperatures for tacrolimus (time p = .94; temperature p = .44), clobetasol (time p = .98, temperature p = .30), desoximetasone (time p = .98; temperature p = .94), or hydrocortisone-17-valerate (time p = .87, temperature p = .36). Limitations: This study did not examine the compatibility of tacrolimus with nonointment formulations. Conclusion: Tacrolimus-clobetasol propionate (superpotent), tacrolimus-desoximetasone (high potent), and tacrolimus-hydrocortisone-17-valerate (midpotent) ointment combinations are chemically compatible for at least 4 weeks.
Chronic Actinic Dermatitis: Clinical Cases, Diagnostic Workup, and Therapeutic Management
Authors: Beach Renée A. , Pratt Melanie D. 
Published: March 2015

Background: We report four cases of chronic actinic dermatitis (CAD) occurring in middle-aged men with significant outdoor exposure. Objective: The aim of this report is to show the spectrum of presentations of patients with CAD and to outline the proper diagnostic workup of these individuals. Methods: Phototesting was performed to determine the minimal erythema doses to ultraviolet (UV)A (315–400 nm) and UVB (280–315 nm) and photopatch testing and patch testing for each individual with the North American Contact Dermatitis Group Standard series and the Chemotechnique Plant series, supplemented by the Hausen Plant series and the patients' own products. Results: All patients were men, over 45 years, who worked outdoors or had outdoor hobbies. Two had a past known history of allergic contact dermatitis. Two had atopic dermatitis. Three had positive reactions to Compositae plants and sesquiterpene lactone; one had a reaction to lichen acid mix. All had photocontact dermatitis or contact dermatitis to sunscreen chemicals, including benzophenone 3 (oxybenzone), butyl methoxydibenzoylmethane (avobenzone), and ethylhexyl methoxycinnamate (octinoxate). All reacted to fragrance mix; two reacted to balsam of Peru and two to colophony. All had biopsies showing an eczematous pattern. Conclusion: CAD is persistent, with a classic presentation, and requires a specific diagnostic workup. Effective therapeutic options exist for patients with CAD.
Familial Coexisting and Colocalized Psoriasis and Vitiligo Responding to Alefacept
Authors: Al-Mutairi Nawaf , Al-Doukhi Azari 
Published: March 2015

Background: Psoriasis is an immune-mediated, chronic, inflammatory disease that significantly impairs both physical and emotional aspects of an individual's quality of life. Vitiligo leads to depigmentation of skin, in which some or all melanocytes in the interfollicular epidermis and occasionally those in the hair follicles are selectively destroyed. The coexistence of the two disorders is rarely seen. Objective: To report two cases of the rare coexistence of psoriasis and vitiligo in a family. Methods: After providing informed written consent, both patients were given alefacept 15 mg/kg weekly injections for 12 weeks. The patients were monitored both clinically and with all relevant laboratory investigations. These patients were then followed up once a month for 2 years. Results: Treatment with alefacept led to complete clearance of vitiligo along with the expected improvement in psoriasis. In the 2-year follow-up, vitiligo did not recur, although psoriasis relapsed and was appropriately treated. Conclusion: Use of alefacept in vitiligo may turn out to be a possible novel off-label treatment option in vitiligo. But the results need to be reproduced in larger studies
Contact Sensitivity to Aluminum
Authors: Brodbaker Elliott , Pratt Melanie 
Published: March 2015

Purpose: To report two cases of aluminum contact dermatitis caused by different sources. Methods: Two patients were patch-tested for suspected contact sensitivities. Results: The results of patch testing revealed aluminum contact dermatitis reactions in both patients. Conclusion: Aluminum contact dermatitis is a rare finding with many possible etiologies. One should consider aluminum sensitivity when all patch test sites are positive when using aluminum Finn Chambers.
Spiradenocarcinoma Arising from a Spiradenocylindroma: Unusual Case with Lymphoepithelioma-Like Areas
Authors: Chetty Runjan , Perez-Ordonez Bayardo , Gilbert Ralph , Pagedar Nitin A. , Waldron John , Ghazarian Danny 
Published: March 2015

Background: Hybrid skin adnexal tumors are common, and spiradenocylindroma is well described. Objective: However, malignant transformation in this setting is infrequent, especially resemblance to lymphoepithelioma-like carcinoma of skin, which is not associated with Epstein-Barr virus. Methods: A 65-year-old female presented with ataxia and a skin nodule composed of a hybrid adnexal tumor (spiradenoma and cylindroma) that transitioned into an undifferentiated carcinoma with attendant lymphocytes and plasma cells. There was widespread dissemination of the undifferentiated component to regional neck lymph nodes. Results: The undifferentiated component resembled a lymphoepithelioma-like carcinoma and showed focal evidence of tubular and squamous differentiation. The tumor was Epstein-Barr encoded RNAs (EBER) negative by in situ hybridization. No evidence of neuroendocrine differentiation was seen in the tumor, despite the patient having symptoms of paraneoplastic ataxia that improved after surgery. Conclusion: This case highlights the transition of a benign hybrid tumor (spiradenocylindroma) into a spiradenocarcinoma that resembled lymphoepithelioma-like carcinoma of skin. It also highlights two unusual features: widespread lymph node dissemination and presentation with paraneoplastic syndrome-associated ataxia.
Verrucous Hemangioma: A Challenging Vascular Lesion
Authors: Lara-Corrales Irene , Somers Gino R. , Ho Nhung 
Published: March 2015

Background: We present a case of a 13-year-old girl with a congenital vascular lesion in her right ankle. Results and Conclusions: Clinical and pathologic examinations led to the diagnosis of a verrucous hemangioma, a distinct, uncommon vascular lesion. The appearance of verrucous hemangiomas evolves with time and may represent a diagnostic challenge. We present this case report and a review of the literature.
Fact or Fiction: Does the Non-HIV/AIDS: Immunosuppressed Patient Need Pneumocystis Jiroveci Pneumonia Prophylaxis? An Updated Literature Review
Authors: Grewal Parbeer , Brassard Alain 
Published: March 2015

Background: Pneumocystis jiroveci pneumonia (PJP) is a potentially fatal fungal infection occurring in immunocompromised patients. Objective: To determine whether PJP prophylaxis is required in the non-human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) immunocompromised patient and, if so, the optimal prophylactic therapy. Methods: A thorough literature review, with the appropriate MeSH terms, was conducted using PubMed, Medline, and The Cochrane Database. A number of cases describing PJP in patients with various systemic diseases and immunosuppressive medications, along with a Cochrane review, were highlighted. Results: Although there are a number of case reports in the literature, the only collagen vascular disease with an increased incidence of PJP is Wegener granulomatosis. Oral trimethoprim-sulfamethoxazole continues to be the prophylaxis of choice for PJP. Conclusion: There is currently no evidence to recommend PJP prophylaxis in the non-HIV/AIDS immunocompromised population. If physicians do decide to use prophylaxis, they should always weigh the benefits with the potential risks. Further studies are needed to better quantify the risks of PJP with immunosuppressive medications.
Evaluation of a Telehealth Clinic as a Means to Facilitate Dermatologic Consultation: Pilot Project to Assess the Efficiency and Experience of Teledermatology Used in a Primary Care Network
Authors: Ludwick David A. , Lortie Charles , Doucette John , Rao Jaggi , Samoil-Schelstraete Christine 
Published: March 2015

Background: Primary care offices spend considerable time coordinating the specialist referral process. Patients experience long wait times for consultation and intervention. Objective: To determine if telehealth combined with interdisciplinary team–based care can reduce wait times for dermatologic consultation while making the consultation process easier for physicians. Methods: Retrospective chart reviews as well as patient, referring physician, nonreferring physician, clinic physician, nurse, and teledermatologist interviews were used to evaluate the clinic. A comparative immersion approach generated themes from field notes. Wait times, appointment times, and encounter durations were measured. Results: Twenty-eight patients were seen (23 had previous specialist referral experience) within 1 week of referral compared to a wait period of 104 days for conventional referral. Patients requiring intervention were treated within 1 week of their initial appointment. Referring practitioners were concerned that they would lose control of patients' care. An easier referral process and faster intakes met physician expectations. Conclusions: Teledermatology improves the timeliness of appointments. Patients forgo face-to-face appointments if alternatives are available sooner. Physicians are concerned about their own liability if dermatologists do not assess the patient in person but will refer through teledermatology when patients are seen faster and they remain in control of the care process.
The Case for Early Detection of Melanoma
Authors: Rivers Jason K. , Wulkan Sarah 
Published: March 2015

Background and Objective: The incidence and mortality from melanoma continue to rise worldwide. Unfortunately, there is still no consistently effective treatment for metastatic disease. The fact that survival for melanoma has increased dramatically over the last 30 years highlights the importance of early detection of this malignancy. Conclusion: With continued public education and the advent of new technologies, it is hoped that we will be able to improve on what has been accomplished to date to reduce the health burden of melanoma even further. This article reviews issues related to patient and physician detection of melanoma and highlights newer technologies being used for this purpose.
Type I Pityriasis Rubra Pilaris: Upregulation of Tumor Necrosis Factor α and Response to Adalimumab Therapy
Authors: Zhang Yao-Hua , Zhou Youwen , Ball Nigel , Su Ming-Wan , Xu Jin-Hua , Zheng Zhi-Zhong 
Published: March 2015

Background: Pityriasis rubra pilaris (PRP) has unknown etiology and is often refractory to conventional therapies. Objective: To document a PRP patient's response to adalimumab therapy and to highlight the potential role of tumor necrosis factor (TNF) in the development of PRP skin lesions. Methods: A patient received adalimumab therapy at standard dosing intervals. In addition, the messenger ribonucleic acid (mRNA) of TNF in the lesional and perilesional normal skin was quantified in two patients with PRP. Results: The patient responded to adalimumab therapy and achieved clinical remission by 4 months. There was a significant elevation of TNF mRNA in the lesional skin of PRP. Conclusion: TNF upregulation is detected in PRP lesional skin, consistent with the observed clinical efficacy of TNF blockade for the treatment of PRP.
The Amazing Vanishing Canadian Dermatologist: Results from the 2006 Canadian Dermatology Association Member Survey
Authors: Chow Eunice Y. , Searles Gordon E. 
Published: March 2015

Background: The 2006 Canadian Dermatology Association (CDA) member survey tracked the Canadian dermatology workforce. Information on use of nondermatologist extenders, impact of financial burden on practice style, and wait times was collected in the survey. Objective: To survey Canadian dermatologists for specialty-specific physician resource information including demographics, workload, and future career plans and compare it to results from the 2001 survey. In addition, to explore three other areas not covered in the previous survey: patient access to dermatologic care through wait times, the use of nondermatologist extenders, and potential impact of educational financial debt on practice styles. Methods: CDA members in 2006 were surveyed by mail. Follow-up mailings were done for nonresponders. Survey results were compared to those of the 2001 survey. Results: Thirty-six percent (216 of 602) of Canadian dermatologists responded (70% in 2001). The national distribution was identical between surveys. The median age increased to 55 years; two-thirds of dermatologists are male. The median retirement age remained at 65 years. There was a shift from rural to urban practice locations; 78% practice in private offices. Three-fifths of dermatologists do mainly medical dermatology, a decrease between surveys. Pediatric dermatology decreased 10%, whereas surgical dermatology increased 52% between surveys. Fewer practitioners perform noninsured services, and half as many perform research or hospital consultations or teach medical students. Financial debt burden had no impact on selection of practice style. Median wait times for nonurgent consultations doubled from 5 to 10 weeks; follow-up visits increased from 4 to 5 weeks; noninsured consultations increased from 4 to 5 weeks. The national median wait time for a third available consultation appointment was 42 days (range 7–161 days). Seventeen percent of dermatologists reported using nondermatologist extenders. Training programs produce only 60% of new practitioners needed to replace retirees over the next 5 years. Existing training programs are at full capacity, and only the creation of new programs can expand training capacity. Conclusions: Although the face of Canadian dermatology shows a productive specialty committed to patient care, teaching, and research, the demographics of the Canadian baby boom generation will have a major negative impact on the effectiveness of Canadian dermatology in the service of the Canadian population. The attrition rate predicted in the 2001 survey and validated by the 2006 survey spotlights the critical imperative for the specialty to adapt to the future of a shrinking workforce in the face of expanding demand for its services.
Recurrent Bullous Scabies
Authors: Serra David , Reis José Pedro , Mariano Angelina , Machado Álvaro , Figueiredo Américo 
Published: March 2015

Background: Scabies is a common infestation that usually presents as a pruriginous eruption consisting of erythematous papules, nodules, and excoriations. Diagnosis relies mostly on clinical features, including the identification of scabietic burrows. Several atypical clinical manifestations have been reported; bullous presentations are particularly rare and intriguing. Objective: A case of recurrent bullous scabies is reported. Methods and Results: An 87-year-old institutionalized woman developed a pruriginous eruption that mimicked bullous pemphigoid. Histopathologic examination revealed blistering at the subepidermal level and a mixed inflammatory infiltrate with numerous eosinophils. Scabies mites were identified on dermoscopy and on skin scrapings, allowing a diagnosis of bullous scabies. Despite effective treatment with topical lindane, failure to control scabies in her institution led to recurrences of her peculiar blistering infestation. Immunofluorescence studies were always negative. Conclusions: These observations underscore the mite's role in the pathogenesis of blister formation and illustrate current challenges in scabies' diagnosis and management.
Chronic Cutaneous Graft-versus-Host Disease Manifesting as Calcinosis Cutis Universalis on a Background of Widespread Sclerodermatoid Changes
Authors: Man Jeremy , Kalisiak Michal , Birchall Iain W.J. , Salopek Thomas G. 
Published: March 2015

Background: The cutaneous manifestations of graft-versus-host disease (GVHD) can be classified into acute and chronic forms. Acute GVHD is defined as a skin eruption that manifests within 100 days of transplantation, whereas chronic GVHD refers to cutaneous changes that appear 100 days or more posttransplantation. Objective: Although most chronic forms fall within lichenoid and sclerodermoid forms, there is a multitude of less common presentations. These include xerosis, follicular prominence, ichthyosis, and pityriasis rosea–like, eczematous, or psoriasiform lesions. Conclusions: We report a previously unreported manifestation of chronic cutaneous GVHD, specifically calcinosis cutis universalis on a background of sclerodermoid changes.