bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cutaneous Reaction to Drugs Used for Erectile Dysfunction: Case Report and Review of the Literature
Authors: Beach Renee A. , Murphy Frank , Vender Ronald B. 
Published: March 2015

Background: In the past 9 years, drugs for erectile dysfunction (ED) have been increasingly prescribed for men with erectile difficulty. These drugs, phosphodiesterase 5 (PDE5) inhibitors, help men with ED obtain and sustain an erection, improving both sexual function and sexual performance satisfaction. However, these drugs contain side effects. Objectives: A 56-year-old man developed an erythematous, circle-shaped lesion on his penis. The lesion was recurrent, with evidence of desquamation. The aim was to determine the source of the recurrent lesion based on its morphology and the patient's verbal history. Results: A clinical diagnosis of fixed drug eruption owing to use of the PDE5 inhibitor tadalafil (Cialis) was made. He was not rechallenged with the drug. However, he experienced a subsequent recurrence of the eruption on inadvertent rechallenge. Conclusions: We believe this case to be the first report of this type of reaction owing to tadalafil. Therefore, fixed drug eruption is a newly observable side effect of this drug.
Linear Lichen Planopilaris of the Trunk: First Report of a Case
Authors: Baker Kristi , Pehr Kevin 
Published: March 2015

Background: Lichen planopilaris (LPP) is believed to be a follicular variant of lichen planus that affects pilosebaceous units, mainly of the scalp. An extremely rare variant of LPP is a linear form, which follows the lines of Blaschko. Of the five previously documented cases of linear LPP, all were limited to the face. Objective: We report the case of a 34-year-old male who presented with a nonpruritic eruption on the trunk consisting of erythematous, keratotic, folliculocentric papules following Blaschko's lines. Results: Biopsy revealed lichenoid and interface dermatitis involving the basilar epidermis and hair follicles, as well as apoptotic keratinocytes, consistent with LPP. Conclusion: This represents the first documented case of LPP, following the Blaschko's lines, in a nonfacial distribution.
Outbreak of Acupuncture-Associated Cutaneous Mycobacterium Abscessus Infections
Authors: Tang Patrick , Walsh Scott , Murray Christian , Alterman Cecilia , Varia Monali , Broukhanski George , Chedore Pamela , DeKoven Joel , Assaad Dalai , Gold Wayne L. , Ghazarian Danny , Finkelstein Michael , Pritchard Marjolyn , Yaffe Barbara , Jamieson Frances , Henry Bonnie , Phillips Elizabeth 
Published: March 2015

Background: Cutaneous atypical mycobacterial infections have been increasingly described in association with cosmetic and alternative procedures. Objective: We report an outbreak of acupuncture-associated mycobacteriosis. Between April and December 2002, 32 patients developed cutaneous mycobacteriosis after visiting an acupuncture practice in Toronto, Canada. Results: Of 23 patients whose lesions were biopsied, 6 (26.1%) had culture-confirmed infection with Mycobacterium abscessus. These isolates were genetically indistinguishable by amplified fragment length polymorphism. The median incubation period was 1 month. Of 24 patients for whom clinical information was available, 23 (95.8%) had resolution of their infection. All patients developed residual scarring or hyperpigmentation. Conclusion: Nontuberculous mycobacteria should be recognized as an emerging, but preventable, cause of acupuncture-associated infections.
Dermatologic Treatment during Pregnancy: Practical Overview
Authors: Al Hammadi Anwar , Al-Haddab Mohammed , Sasseville Denis 
Published: March 2015

Background: This article provides a practical overview of dermatologic medication use in pregnancy. Objective: The therapeutics of the following common dermatoses are reviewed: acne, psoriasis, and bacterial, fungal, viral, and parasitic infections. Antipruritic, analgesic, and topical anesthetic use in pregnancy is reviewed as well. Conclusions: At the end, the reader is challenged with a series of applied clinical scenarios that highlight the presented material and provide information on additional important medications.
Reliability of Dermatologists in Acne Lesion Counts and Global Assessments
Authors: Tan Jerry K.L. , Fung Karen , Bulger Lynne 
Published: March 2015

Background: There is a paucity of data on the reliability of dermatologists in acne lesion counting and global severity assessments. The effects of training and practice on reliability are also uncertain. The objective of this study was to determine the reliability of these outcome measurements when performed by trained dermatologists. Methods: Eleven dermatologists were divided into two groups that evaluated the same six acne subjects twice on the same day. A training session was provided either after (group A) or before (group B) the first patient evaluation sessions. Reliability of raters in lesion counting and global severity assessment was determined by calculation of intraclass correlation coefficients (ICCs). ICC values close to 1.0 indicate excellent reliability, whereas values less than 0.75 are considered unacceptable. Results: Intrarater ICCs ranged from 0.37 to 0.99 for noninflammatory lesions, 0.26 to 0.97 for inflammatory lesions, and 0.56 to 0.83 for global assessments for group A (trained after); corresponding values for group B (trained before) were 0.84 to 0.98, 0.61 to 0.95, and 0.43 to 0.91. ICC values ≥ 0.75 for all three outcome parameters were observed in one of six group A and three of five group B raters. Interrater ICCs for groups A and B after the first evaluation session were 0.17 versus 0.68 for noninflammatory counts, 0.84 versus 0.72 for inflammatory counts, and 0.71 versus 0.65 for global assessments, respectively. Corresponding values after session 2 were 0.79 and 0.77 for noninflammatory, 0.81 and 0.90 for inflammatory, and 0.61 and 0.77 for global assessments. Conclusion: Dermatologists tended to be reliable in acne lesion counting but somewhat less so in global assessments. Training tended to improve group reliability in noninflammatory lesion counts and increased the proportion of raters with good reliability in all three outcome measures. Practice enhanced reliability in all outcome measurements.
Effect of Intravenous Immunoglobulin on Prednisone Dose in Patients with Pemphigus Vulgaris
Authors: Mittmann Nicole , Chan Brian , Knowles Sandra , Mydlarski P. Régine , Cosentino Lidia , Shear Neil 
Published: March 2015

Background: Current therapeutic options for the treatment of pemphigus vulgaris (PV) are prednisone and immunosuppressants. Patients unresponsive to high-dose systemic corticosteroids and conventional immunosuppressants may respond to intravenous immunoglobulin (IVIG). Objective: The primary outcome was the change in prednisone dose at 6 months and 1 year post-IVIG administration. Methods: A retrospective chart review of PV patients treated at Sunnybrook and Women's College Health Sciences Centre between January 1999 and October 2004 was conducted. Demographic information, corticosteroid and IVIG use, dosage, and the timing of administration for all patients were obtained. Results: Eight PV patients, mean age of 50 years (± 14.7 years), were reviewed. There was a significant decrease in mean prednisone dose at 6 months (45%) and 12 months (71%) compared with the mean dose at the start of treatment ( p < .05). Limitations: Concomitant medication use may influence results. Conclusion: This study demonstrates that IVIG can lower prednisone doses in PV patients.
Cutaneous Metastases from Non-Small Cell Lung Cancer
Authors: Alkhayat Hana , Hong Chih-ho 
Published: March 2015

Background: Cutaneous metastases are an uncommon phenomenon that occurs in a few patients with metastatic disease. Early recognition of a cutaneous metastasis is important as it may be the presenting sign of an underlying malignancy. These metastases usually indicate advanced disease and carry a poor prognosis. Objectives: We present two cases with cutaneous metastasis from primary non-small cell lung cancer. We seek to familiarize dermatologists with the unusual presentations of cutaneous metastases. Conclusion: In our two cases, the diagnosis of the metastatic cutaneous lesion ultimately led to the correct diagnosis of an underlying malignancy.
Expression of Endothelins and Their Receptors in Nonmelanoma Skin Cancers
Authors: Zhang Yi , Tang Liren , Su Mingwan , Eisen Daniel , Zloty David , Warshawski Lawrence , Zhou Youwen 
Published: March 2015

Background: Endothelins are paracrine peptides with growth-promoting and vasoactive functions for a variety of cell types. Elevated activation of the endothelin signaling pathway induces cell proliferation and/or survival and is implicated in a variety of malignancies. Increased endothelin 1 was described in solar lentigines in previous reports, raising the possibility that the endothelin pathway may be of significance in keratinocyte proliferation-related disorders. However, detailed investigation on endothelins in skin malignancies is lacking. Objectives: This study aims to survey the expression of endothelins and their receptors in keratinocyte-derived benign and malignant tumors of the skin and to test the effects of endothelin inhibitors on the growth and survival of cultured keratinocytes. Methods: Quantitative polymerase chain reaction was used to measure the level of gene transcription of three endothelins (ET-1, −2, and −3) and two endothelin receptors (ETRA and ETRB). The genes with significant messenger ribonucleic acid (mRNA) expression abnormalities were confirmed with immunohistochemical analysis to examine expression differences at the protein levels. To analyze the effect of endothelin inhibitors on the keratinocyte growth and survival, keratinocytes were cultured in the presence of various concentrations of endothelin inhibitors and subjected to tetrazolium bromide assay to quantify the cell numbers over time. Results: ET-1 mRNA was found to be significantly up-regulated in seborrheic keratosis and basal cell carcinoma. However, no significant expression increase was found in actinic keratosis, Bowen's disease, or squamous cell carcinoma. Immunohistochemical analysis of ET-1 peptide confirmed increased expression. In cultured keratinocytes, peptide inhibitors of the endothelin pathway resulted in a marked reduction in cell survival. Conclusion: The endothelin signaling pathway, especially ET-1, is activated in basoloid keratinocyte neoplasms of the skin, such as basal cell carcinoma and seborrheic keratosis. Blockade of this pathway can reduce cell survival in vitro. Therefore, endothelin inhibitors potentially offer a novel method for the treatment of some keratinocyte-derived skin tumors.
Susceptibility of Staphylococcus aureus to Fusidic Acid: Canadian Data
Authors: Rennie Robert P. 
Published: March 2015

Background: Ongoing antimicrobial surveillance is important to ensure proper management of infectious diseases. There are inherent issues in estimating the relevant incidence of antimicrobial resistance from surveillance data and special issues for topical preparations. Objective: To perform semiannual surveillance of fusidic acid susceptibility of Staphylocccus aureus strains in a Canadian tertiary care hospital. Methods: S. aureus strains were collected twice yearly from routine cultures. Routine antimicrobial susceptibility testing was performed by an automated method. Fusidic acid susceptibility testing was performed by disk diffusion. Results: Between 1999 and 2005, 2,302 S. aureus strains were tested, of which 240 were methicillin resistant (MRSA). Among all strains tested, 65 (2.8%) were resistant to fusidic acid. Ten of the MRSA strains (4.2%) were resistant to fusidic acid. Although from different patients, these were shown to be part of a hospital outbreak and were epidemiologically linked. Conclusions: There has been no trend toward increasing fusidic acid resistance in our hospital over this period.
An Erythrodermic Variant of Pemphigus Foliaceus with Puzzling Histologic and Immunopathologic Features
Authors: Peterson Jennifer D. , Worobec Sophie M. , Chan Lawrence S. 
Published: March 2015

Background: Pemphigus foliaceus is an autoimmune blistering disorder that affects the skin owing to autoantibodies against desmoglein 1. Methods: We employed clinical, histologic, immunopathologic, and serum laboratory studies to investigate a case of an erythrodermic variant of pemphigus foliaceus in an elderly man following treatment with bisoprolol-hydrochlorothiazide. Results: Early histopathology revealed psoriasiform dermatitis, but later biopsies showed subcorneal and granular layer separation with neutrophilic infiltrate. Direct immunofluorescence showed intercellular deposits of immunoglobulin G throughout the epidermis, granular staining of C3 along the basement membrane zone, and fibrin and C3 deposition around the blood vessels. Indirect immunofluorescence on monkey esophagus showed a titer of greater than 1:1,280. Indirect immunofluorescence on rat bladder, antinuclear antibody, lupus panel, and kidney function panel were all negative. Conclusion: There are no reports in the literature of pemphigus foliaceus being induced by bisoprolol, but reports exist of propanolol resulting in drug-induced pemphigus foliaceus.
Observations on the Procedural Aspects and Health Effects of Scarification in Sub-Saharan Africa
Authors: Ayeni Olubimpe A. , Ayeni Olubukunola O. , Jackson Robert 
Published: March 2015

Background: Scarification involves cutting or making an incision into the skin and then allowing the wound to heal, leaving a permanent scar. The purpose of this article is to examine the origins of scarification and its social and medical significance in sub-Saharan Africa. Methods: We conducted a computerized search in the MEDLINE electronic database with combinations of the following terms: scarification, tribal marks, keloid, hypertrophic scar, Africa, and sub-Saharan Africa. Inclusion criteria were studies published in English involving human participants. We reviewed the bibliography of each article that met our inclusion criteria for additional relevant studies. We abstracted data on the historical, social, and medical aspects of scarification from eligible studies. Results: This review of scarification in sub-Saharan Africa highlights the complex interplay that exists between biology and society. Photographs, artwork, and literary descriptions reveal that scarification results in hypertrophic or atrophic scars, although these types of scars are often mistakenly referred to as keloids. In terms of the procedural aspects of scarification, specific tools and substances were consistently used by various ethnic groups. Although much is known about the history of scarification as a form of identification in Africa, it appears that the practice also had medical applications. Scarification was used to treat conditions such as epilepsy, although it was also known to exacerbate conditions such as sarcoidosis, lichen planus, and psoriasis. Evolving cultural beliefs, in addition to the association of scarification with an increased risk of contracting hepatitis B and human immunodeficiency virus (HIV), are contemporary threats to this long-standing practice. Conclusions: Given the remarkably consistent appearance of scars that are described in the literature and depicted in images, scarification does not appear to be a random or accidental occurrence. Instead, it is a deliberate attempt to reproduce a custom that has been perfected after many years of practice in sub-Saharan Africa.
Efficacy of Imiquimod as an Adjunct to Cryotherapy for Actinic Keratoses
Authors: Tan Jerry K.L. , Thomas D. Richard , Poulin Yves , Maddin Frances , Tang Jing 
Published: March 2015

Background: Cryotherapy is the standard of care for clinically apparent (target) actinic keratoses (AKs). Topical imiquimod may reduce initially inapparent or subclinical AKs. Objective: We evaluated the potential of topical imiquimod to decrease subclinical AKs after cryotherapy of target AKs. Methods: A randomized trial of imiquimod or vehicle twice weekly for 8 weeks following 3- to 5-second cryotherapy of target AKs within a 50 cm2 field at the face or scalp was conducted. Efficacy outcomes included clearance of target, subclinical, and total AKs and proportions clear of AKs. Subjects with residual AKs were offered cryotherapy and open-label imiquimod twice weekly for 8 weeks. Results: Sixty-three subjects completed the randomized phase. At 12 weeks, target AK clearance was similar for imiquimod and vehicle (79% vs 76%), but fewer total AKs were noted for imiquimod (78 vs 116). This was due to a progressive reduction in subclinical AKs with imiquimod compared with a progressive increase with vehicle. More subjects treated with imiquimod achieved clearance of subclinical (58% vs 34%; p = .06) and total (23% vs 9%; p = .21) AKs. Conclusion: Imiquimod postcryotherapy may increase clearance of subclinical and total AKs and proportions of subjects clear at 3 months. These findings require confirmation in larger controlled trials powered for statistical significance.
Cost Comparisons of Managing Complex Facial Basal Cell Carcinoma: Canadian Study
Authors: Lear William , Mittmann Nicole , Barnes Elizabeth , Breen Dale , Murray Christian 
Published: March 2015

Background: Basal cell carcinoma (BCC) is the most common human malignancy and accounts for over 60,000 new cases of cancer in Canada annually. Although expensive to the health care system, no Canadian studies have reported the costs involved in management. This study calculated the costs of managing high-risk BCCs using radiotherapy (RT) and Mohs micrographic surgery (MMS). Methods: Forty-nine consecutive complex BCC cases presenting to a skin cancer referral center were collected prospectively. All were located on the head and neck and were either recurrent disease or located in “at risk” sites such as the eye, ear, lip, or nose. All patients underwent MMS. A radiation oncologist reviewed each case retrospectively. The costs of MMS were the actual costs of the procedure, with an additional amount added to account for the technical costs of the surgery. The costs of RT included physician fees and technical fees. A sensitivity analysis was performed using known recurrence rates from the medical literature. Results: Five patients were excluded from the comparative analysis because radiation was not recommended (age < 50 years or radiation would overlap with a previous radiation field). The direct cost of treating a patient with a single BCC was $871 (range $630–1, 159) using MMS and $3,625 (range $3,430–3,971) using RT. The costs were significantly higher for patients with multiple tumors with both modalities ( p = .02 for both). The direct costs of a “5-year cure” were $952 (range $644–1,647) for MMS and $3,758 (range $3,564–4,675) for RT. Conclusions: This study attempted to document the costs associated with two well-recognized and effective methods of treating complex BCC in Ontario. Subgroup analysis revealed independent associations between aggressive histology, larger size, and complexity of surgical closure with higher costs. Although we did notice a trend toward greater costs in patients with recurrent disease, in males, younger patients, and tumors present for > 1 year, these did not reach significance within our sample size. Despite the limitation that treatment costs may be center and provincially dependent, we hope this preliminary report will initiate further study into comparing Canadian costs of managing skin cancer.
ISA247: Quality of Life Results from a Phase II, Randomized, Placebo-Controlled Study
Authors: Gupta Aditya K. , Langley Richard G. , Lynde Charles , Barber Kirk , Gulliver Wayne , Lauzon Gilles , Aspeslet Launa J. , Foster Robert T. , Huizinga Robert B. , Yatscoff Randall W. 
Published: March 2015

Background: Psoriasis is a chronic skin condition that can negatively affect a patient's quality of life (QoL), often hindering social functioning. ISA247, a novel psoriatic agent, has shown clinical efficacy in moderate to severe psoriasis sufferers, but its effect on QoL is currently not reported. Objective: The objective of this study was to assess the effect of ISA247 on the QoL in patients with stable, plaque-type psoriasis. Methods: A phase II, randomized, double-blind, placebo-controlled, parallel-group, multicenter study assessed the effects of ISA247 doses of 0.5 mg/kg/d ( n = 77) or 1.5 mg/kg/d ( n = 83) compared with placebo ( n = 41) for 12 weeks. QoL was assessed using the Dermatology Life Quality Index (DLQI) and Psoriasis Disability Index (PDI) scales. Results: ISA247 treatment (pooled groups) significantly improved QoL scores as assessed by both the DLQI and the PDI compared with those receiving placebo ( p < .05). Treatment with the higher dose of 1.5 mg/kg/d demonstrated a significantly greater response to many of the QoL scales compared with the 0.5 mg/kg/d group ( p < .05). Conclusions: ISA247 appears to improve the QoL while also providing effective treatment for chronic, moderate to severe, plaque-type psoriasis.
Cutaneous Granulomas with Predominantly CD8+ Lymphocytic Infiltrate in a Child with Severe Combined Immunodeficiency
Authors: Gregoriou Stamatis , Trimis Georgios , Charissi Christina , Kalogeromitros Dimitris , Stefanaki Kalliopi , Rigopoulos Dimitris 
Published: March 2015

Background: Combined immunodeficiency disorders comprise a heterogeneous group of diseases characterized by both humoral and cell-mediated immunodeficiency. Cutaneous granulomas manifestations in children with combined immunodeficiency are rare. Objective: We report the case of a 6-year-old boy who presented with disseminated cutaneous granulomas and a history of multiple infections. Methods and Results: Laboratory evaluation revealed severe combined immunodeficiency, and deoxyribonucleic acid (DNA) analysis confirmed mutations on a gene of chromosome 19 that encodes an enzyme called Janus kinase 3 (Jak-3). Immunohistochemistry revealed expression of CD8+ in the perivascular lymphocytic infiltrate Conclusion: Disseminated granulomatous lesions in children with a history of frequent infections should prompt the clinician to initiate detailed immunocompetence evaluation as they might prove to be the first manifestation of immunologic impairment.
Practical Understanding of Mean Percent Psoriasis Area and Severity Index Reduction for Biologics
Authors: English Penny Lovell , Vender Ronald 
Published: March 2015

Background: Psoriasis in clinical trials is often measured by the Psoriasis Area and Severity Index (PASI). This measurement is well understood by clinical trialists and many dermatologists but rarely by patients and some clinicians. Patients may not understand their chance of improvement based on a PASI-50 or PASI-75 value (50 or 75% improvement in PASI score). They would better understand a PASI average presented as the mean percent improvement in the PASI score from baseline. Objective and Conclusion: This article simplifies these terms of reduction from baseline in PASI scores as related to treatment with biologic agents. This may be more meaningful for patients and clinicians when discussing their average chance of improvement.
A Young Man with Fever and Skin Nodules
Authors: Lomaga Mark A. , Walsh Scott 
Published: March 2015

Background: There are two rare variants of cutaneous T-cell lymphoma (CTCL) that primarily involve the subcutis. These include subcutaneous panniculitis-like T-cell lymphoma (SPTL) and cutaneous γ/δ T-cell lymphoma. Objective: This case report describes the clinical presentation, diagnosis, and treatment of a young man with probable SPTL. A review of recent literature outlining the differences between SPTL and cutaneous γ/δ T-cell lymphoma is discussed. Conclusion: The differential diagnosis in patients presenting with subcutaneous nodules and constitutional symptoms should include CTCL.