bluuebunny/crossref_metadata_2025_split huggingface dataset:
Miliarial Gout (A New Entity)
Authors: Shukla Rahul , Vender Ronald B. , Alhabeeb Ayman , Salama Samih , Murphy Frank 
Published: March 2015

Background: Tophaceous gout typically presents as a subcutaneous, nodular collection of monosodium urate crystals sharply circumscribed from surrounding tissues. Although intradermal cutaneous manifestations of gout have been described, no reported cases of miliarial gout remain. Objective: We describe the first known presentation of miliarial gout and list other uncommon cutaneous manifestations of gouty tophi. The treatment of miliarial gout is discussed, as well as risk factors predisposing an individual to the development of intradermal tophi. Results: Miliarial gout is an intradermal phenomenon consisting of multiple tiny papules containing material of a white to cream color scattered on an erythematous base that responds to allopurinol administration. Risk factors predisposing an individual to the development of intradermal gout include renal insufficiency, hypertension, chronic diuretic therapy, long duration of disease, and lack of consistent use of urate-lowering therapy. Conclusion: Miliarial gout is a unique intradermal manifestation of tophaceous gout.
Invasive Trichophyton Rubrum Infection Occurring with Infliximab and Long-Term Prednisone Treatment
Authors: Lowther Abigail L. , Somani Ally-Khan , Camouse Melissa , Florentino Frances T. , Somach Stephen C. 
Published: March 2015

Background: A 64-year-old woman presented with erythematous plaques, tender nodules, and pustules of the dorsal right hand and both legs following long-term treatment with systemic steroids and infliximab. Skin biopsy demonstrated dermal inflammation with foci of necrosis and multinucleated giant cells containing fungal spores. Tissue culture grew Trichophyton rubrum. Objective: To report a case that demonstrates the pathophysiology of invasive T. rubrum infection, the mechanisms of action and uses of tumor necrosis factor α (TNF-α)-inhibiting drugs, and how these drugs may increase patients' risk of invasive dermatophytosis. Conclusion: Dermatophytes such as T. rubrum rarely cause invasive disease. This unusual presentation of invasive T. rubrum occurred with immunosuppression by infliximab and systemic steroids. Patients should have a thorough examination for signs of latent infection before TNF-α inhibitors are prescribed, including inspection of the skin and nails for signs of dermatophytosis.
Incidence of Nonmelanoma Skin Cancer in New Brunswick, Canada, 1992 to 2001
Authors: Hayes Robert C. , Leonfellner Suzanne , Pilgrim Wilfred , Liu Jian , Keeling Douglas N. 
Published: March 2015

Background: Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), collectively referred to as nonmelanoma skin cancer (NMSC), cause significant morbidity and generate a substantial cost to the health care system. Canadian data on the incidence of NMSC are lacking. Objective: To study the incidence and characteristics of NMSC in New Brunswick, Canada (population 729,498 people in 2001), by using the Provincial Cancer Registry. Method: Data were obtained from 1992 to 2001 from the New Brunswick Provincial Cancer Registry, to which reporting of all cancers is mandatory. Multiple tumors of a given histologic type are recorded only once in the registry per individual per lifetime. A descriptive analysis of incidence rates of BCC and invasive SCC of the skin was performed in relation to gender, age, and anatomic location. The main outcome measures were the age- and sex-specific incidence rates of BCC and SCC. Age standardization was performed using the Canadian, US, and world standard populations. Results: When adjusted to the world standard population, the age-standardized incidence rates (ASIRs) per 100,000 population for BCC from 1992 through 2001 were 87 for males and 68 for females. For invasive SCC, the ASIRs per 100,000 population were 34 for males and 16 for females. There was an increasing incidence trend for both BCC and invasive SCC over the 10-year study period, with minimal change in the incidence of SCC in women. The overall ratio of BCC to invasive SCC in the population was 2.8 to 1. The approximate lifetime probabilities of developing BCC and invasive SCC were 13% and 5%, respectively. Conclusions: The incidence of NMSC in the province of New Brunswick is similar to that reported from 1973 through 1987 in the province of British Columbia, higher than those reported in most parts of Europe, and lower than all published rates in the United States and Australia. Owing to the inability of the registry to account for tumor multiplicity, the actual annual number of all NMSC lesions in this population is likely much higher.
Primary Cutaneous Eosinophil-Rich Anaplastic Large Cell Lymphoma: Report of an Unusual Case and Literature Review
Authors: Bittencourt Achiléa L. , Rothers Silene , Boente Paulo , Santos Roberto 
Published: March 2015

Background: Cutaneous, neutrophil-rich anaplastic large cell lymphoma (ALCL) is an uncommon variant of ALCL that may be confused with inflammatory dermatoses. Objective and methods: We describe an eosinophil-rich variant of ALCL occurring on the left ear without systemic involvement. The lesion had inflammatory characteristics, which led initially to a histological diagnosis of an inflammatory process. Two months later, a second biopsy diagnosed eosinophil-rich variant of ALCL. The patient underwent radiation therapy, but due to the extensive deformation and mutilation of the ear, the patient elected to have the ear amputated. We discuss the clinicopathological findings and the differential diagnosis Conclusions: To the best of our knowledge, the occurrence of a cutaneous, eosinophil-rich variant of ALCL has not been previously reported. It is important to alert pathologists to this variant of ALCL so that this possibility may be considered in the early differential diagnosis of inflammatory cutaneous conditions.
Endothelin-3 Is Produced by Metastatic Melanoma Cells and Promotes Melanoma Cell Survival
Authors: Tang Liren , Su Mingwan , Zhang Yi , Ip Wency , Martinka Magdalena , Huang Changzheng , Zhou Youwen 
Published: March 2015

Background: Endothelin-3 (ET-3) is an essential paracrine factor for the proliferation, migration, and survival of embryonic melanocytes during fetal development. Its expression is tightly regulated, being completely turned off in adult skin. Objective: In this study, results are presented that demonstrate abnormal expression of ET-3 by metastatic melanoma cells in both tissue biopsies and cell culture. Further, in vitro experiments showed that metastatic melanoma cells have the capacity to respond to ET-3 stimulation by increasing survival. Conclusion: Therefore, an abnormal autocrine stimulation pathway involving ET-3 is present in metastatic melanoma cells. Blocking this signal transduction pathway may prove useful for the treatment of metastatic melanoma.
Localized Lepromatous Leprosy in Household Contact of Multibacillary Disease
Authors: Narang Tarun , Dogra Sunil , Kaur Inderjeet 
Published: March 2015

Background: Lepromatous leprosy (LL) is a generalized disease, usually with numerous papules, nodules, or plaques containing abundant Mycobacterium leprae and affecting wide areas of the skin. Aim: To report on an LL patient presenting with two lesions on the face and to discuss its epidemiologic significance in the current context of leprosy elimination. Methods: A 52-year-old housewife presented to our department with erythematous lesions over her face for 2 months. Her husband and son were treated for multibacillary leprosy 15 years previously. An infiltrated erythematous nodule was located over the right supraorbital area, and a single papule was present on the right eyelid. The rest of the examination was normal. Results: A slit skin smear from the lesion revealed a bacillary index of 6+ and a morphologic index of 6%. A skin biopsy showed atrophic epidermis with an underlying clear grenz zone; the dermis showed massive infiltration of foamy macrophages, filled with bacilli and a few lymphocytes. Conclusions: The presentation of LL or borderline lepromatous leprosy (BL) as a single cutaneous lesion (or localized lesions) is a rare presentation of multibacillary disease, and such cases can be undertreated. This case also highlights the need to further explore the role of immunoprophylaxis or chemoprophylaxis in the contacts of multibacillary cases.
Side Effects of Short-Term Oral Corticosteroids
Authors: Richards Robert N. 
Published: March 2015

Background: Physicians frequently prescribe short-term corticosteroids (CSs) to treat acute and self-limiting diseases. Standard texts and articles do not usually discuss the possible, although infrequent, risks of short-term CSs. Objective: To demonstrate that side effects, although uncommon, can occur with short-term CSs and that these can occasionally be serious. Methods: Medline peer review literature in English (1985–2006) was searched to identify the potential risks of CSs. Standard textbooks of dermatology, gastroenterology, ophthalmology, pharmacology, respirology, and rheumatology were reviewed. Because the results showed some factual discordance and a dearth of precise data, the results for each body system were reviewed with two relevant clinical specialists at North York General Hospital (with at least 20 years' experience). Further information was obtained from a questionnaire of 200 physicians in North York General Hospital and by feedback from an additional 100 physicians during a presentation of this material at the American Academy of Dermatology. Results: Short-term CSs are generally safe, but there have been numerous reports of associated avascular necrosis and a few cases of fatal varicella-zoster in immunocompetent patients. Severe mood changes and psychotic reactions rarely occur unpredictably with short-term CSs. These events are rare, and most treatments with short-term CSs are problem free. Conclusions: Problems are infrequent, but patients must be informed of all material risks and treatment options. Thorough chart documentation is required, and patient consent must be given. CS doses should be as low as possible, and CS courses should be as infrequent and as short as possible. The literature reviewed in this article clearly indicates that a short course of CS of 1 week, in the absence of specific contraindications, is unlikely to be harmful (psychotic or prepsychotic episodes possibly excepted).
Improvement in Both Raynaud Disease and Hyperhidrosis in Response to Botulinum Toxin Type a Treatment.
Authors: Kossintseva Irèn , Barankin Benjamin 
Published: March 2015

Background: A patient with concurrent Raynaud disease presented for Hyperhidrosis of the axillae and palms. After a positive response to botulinum toxin type A (BoNTA) for axillary hyperhidrosis, she returned requesting palmar treatment. Objectives: Our goal was to investigate the effect of BoNTA on Raynaud disease in concurrent hyperhidrosis with respect to color change, swelling, and digital pain. Methods: The patient had treatment with 100 units of BoNTA to one hand at first, with the other being a negative control, followed by treatment of the second hand 1 week later. Results: After the injection into the first palm, the patient demonstrated an 85% reduction in palmar hyperhidrosis and a significant improvement in her Raynaud symptoms. Specifically, the BoNTA-treated hand had reduced swelling, color change, and pain, whereas the untreated control hand remained affected. After the second hand was treated, it, too, demonstrated the same positive results. Conclusions: Our case report of concurrent Raynaud disease and palmar hyperhidrosis shows significant improvement in both conditions to BoNTA administration. The physiology is multifactorial and relates to BoNTA's effect on acetylcholine, noradrenaline, substance P, calcitonin gene-related peptide, and glutamate release from nerve terminals. These results present an encouraging novel treatment option in dermatology for patients with Raynaud disease.
Desmoplastic Squamous Cell Carcinoma: Case Presentation and Literature Review
Authors: Seal Alex , Zloty David 
Published: March 2015

Background: Desmoplastic squamous cell carcinoma (DSCC) is a variant of squamous cell carcinoma (SCC) with aggressive histologic and clinical features. DSCC has a 6 to 10 times higher rate of both local recurrence and metastatic spread compared with well-differentiated SCC. Clinical estimation of tumor margins can grossly underestimate both the depth and the peripheral extent of the tumor. Surgery with intraoperative margin control has been recommended. In many cases, postoperative radiotherapy or prophylactic lymph node dissection may be required. Case Presentation: A 71-year-old man with a biopsy positive for DSCC involving the left postauricular area was treated with nine-stage Mohs micrographic surgery before the tumor margins were negative. Conclusion: There are minimal reports in the literature pertaining to the presentation and treatment of DSCC; therefore, definitive conclusions are difficult. The depth of tumor penetration and peripheral spread of the DSCC presented in this case, however, supports the need for aggressive surgical excision, preferably with intraoperative margin control. To maximize the chance of cure, physicians must be aware of the distinct clinical and histologic features of DSCC and the aggressive treatment required.
Canaries in the Mineshaft: The Dermatology Workforce Shortage in Eastern Ontario
Authors: Heughan Caroline , Kanigsberg Nordau , Amdemichael Esiahas , Fergusson Dean , Ammerman Darcy 
Published: March 2015

Background: The number of dermatology residency positions in Canada has not reflected the growing workforce shortage. Until 2005, all dermatology residents at the University of Ottawa were committed to return to their funding area at the completion of their training. This has left Eastern Ontario with a critical shortage of dermatologists. Objective: To survey dermatologists practicing in Eastern Ontario to understand the basis of the workforce shortage and outlook for the future. Methods: Mailed surveys sent in 1999, 2003, and 2006 to all dermatologists in Eastern Ontario requesting demographic information, workload data, and future career plans. Results: There was a 100% response rate in each survey year. Between 1999 and 2006, the total number of practicing dermatologists decreased from 26 to 23, whereas the average age increased from 51.4 to 57.4 years. The waiting time to see new and returning patients increased, from 5.8 to 18.5 weeks and 4.9 to 11.8 weeks, respectively. Ten of the 23 dermatologists practicing in 2006 plan to retire within the next 5 years. Conclusions: The inadequate supply of dermatologists in Eastern Ontario will increasingly threaten patient care. This emphasizes the need for additional funding for dermatology training positions, continued mentorship, and improved dermatology training for nondermatologists.
Coverage of Exposed Bones and Joints in Critically Ill Patients: Lower Extremity Salvage with Topical Negative Pressure Therapy
Authors: Horch Raymund E. , Dragu Adrian , Lang Werner , Banwell Paul , Leffler Mareike , Grimm Andreas , Bach Alexander D. , Uder Michael , Kneser Ulrich 
Published: March 2015

Background: Soft tissue defects of the limb with exposure of tendons and bones in critically ill patients usually lead to extremity amputation. A potential treatment with topical negative pressure may allow split-thickness skin grafting to the bone, which leads to limb salvage. Materials and Methods: We report on 21 multimorbid patients, 46 to 80 years of age, with severe lower limb soft tissue loss and infection with exposed bone following débridement with critical limb ischemia. Attempts to salvage the extremities were undertaken with repeated surgical débridement followed by vacuum-assisted closure therapy and subsequent split-thickness skin grafting procedures. Results: Infection control and limb salvage were achieved in all cases with multiple débridements, topical negative pressure therapy, and skin grafts. In all patients, the exposure of tendons and bones was reversible by this strategy without a free flap transfer. Discussion: The patients described in this study were severely compromised by systemic and vascular disorders, so extremity amputation had been considered owing to the overall condition and the exposure of tendons and bones. Since it was possible to salvage the affected limbs with this straightforward and simple procedure, this type of treatment should be considered as a last attempt to prevent amputation.
Surgical Management of Chest Wall Tuberculosis
Authors: Gözübüyük Alper , Özpolat Berkant , Gürkök Sedat , Çaylak Hasan , Yücel Orhan , Kavaklı Kuthan , Dakak Mehmet , Genç Onur 
Published: March 2015

Objective: Tuberculosis remains one of the most fatal diseases in the world. Extrapulmonary tuberculosis increases in parallel fashion with the rise of incidence of pulmonary tuberculosis. Tuberculosis of the chest wall is rare. Methods: Our study retrospectively evaluated 10 patients with tuberculosis of the chest wall who were treated with surgery in addition to antituberculous chemotherapy in the last 8 years. Seven of the lesions were located on the anterior chest wall, and three of the lesions were on the lateral chest wall. Results: Surgical therapy consisted of evacuation of the cold abscess material from the cavities and wide débridement of the soft tissue planes in all patients. Partial rib resections were performed in six patients owing to costal or chondral involvement. Conclusions: Chest wall tuberculosis must be considered in the differential diagnosis of chest wall lesions, especially in endemic areas.
Clinical Efficacy of 25% l-Ascorbic Acid (C'ensil) in the Treatment of Melasma
Authors: Hwang Seon-Wook , Oh Doo-Jin , Lee Deborah , Kim Jung-Wook , Park Sung-Wook 
Published: March 2015

Background: l-Ascorbic acid is used to treat melasma; however, it is quickly oxidized in aqueous solutions. Thus, C'ensil, a formulation containing 25% l-ascorbic acid and a chemical penetration enhancer, was created to promote the penetration of l-ascorbic acid into the skin. Objective: To evaluate the efficacy of C'ensil in patients with melasma. Methods: Forty subjects with melasma were treated with C'ensil during an open-label trial over a period of 16 weeks. Each subject's skin pigmentation was assessed every 4 weeks using the Melasma Area and Severity Index (MASI) and mexameter score. In addition, transepidermal water loss, skin dryness and irritation, and quality of life (Melasma Quality of Life Scale [MelasQoL]) were evaluated. Results: After 16 weeks, a significant decrease was noted in the degree of pigmentation based on the patients' MASI and mexameter scores. MelasQoL scores also decreased, indicating an increase in the subjects' quality of life. Conclusion: Our data indicate that C'ensil is an effective treatment modality for melasma.
Prevalence of Non–Organ-Specific Autoantibodies in Patients with Pemphigus Vulgaris
Authors: Blondin David A. , Zhang Zuhui , Shideler Karalee K. , Hou Haiyan , Fritzler Marvin J. , Mydlarski P. Régine 
Published: March 2015

Background: Pemphigus vulgaris (PV) is a potentially life-threatening, organ-specific, autoimmune, blistering disease of the skin and mucous membranes. Although several reports suggest an association between pemphigus and other autoimmune connective tissue disorders, studies that measure non–organ-specific autoantibodies are lacking. Objective: To evaluate the prevalence of antinuclear antibodies (ANA), anti–double-stranded DNA (anti-dsDNA) antibodies, and antibodies against extractable nuclear antigens (ENAs) in PV patients. Methods: Serum samples were obtained from 59 PV patients and 50 healthy controls. Indirect immunofluorescence assays containing human epithelial cell substrates (HEp-2) and Crithidia luciliae were used to detect ANA and anti-dsDNA antibodies, respectively. A multiplexed addressable laser bead immunoassay was employed to measure autoantibodies to: Smith (Sm), ribonucleoprotein (RNP), Sjögren syndrome B (SSB/La), Sjögren syndrome A (SSA/Ro), histidyl transfer ribonucleic acid synthetase (Jo-1), topoisomerase I (Scl-70), and ribosome-P (Ribo-P) antigens. Results: Positive ANAs were obtained in 22 of 59 (37.3%) PV patients compared with 4 of 50 (8.0%) healthy controls ( p ≤ .01). In both the patient and control populations, anti-dsDNA antibodies were absent. Antibodies against the ENAs were present in 1 of 59 (1.7%) PV patients compared with 0 of 50 (0%) controls. In the single ENA-positive PV patient, antibodies to SSB/La (1.7%) and SSA/Ro (1.7%) were detected. Conclusions: Non–organ-specific autoantibodies are prevalent in the PV population. As ANAs are detected in over one-third of PV patients, clinicians should screen for signs and symptoms of other connective tissue disease. Correlative clinical studies are warranted to determine the diagnostic, prognostic, and therapeutic significance of these findings.
Solving Acne Inversa (Hidradenitis Suppurativa) in Crohn Disease with Buried Chip Skin Grafts
Authors: Bleiziffer Oliver , Dragu Adrian , Kneser Ulrich , Horch Raymund E. 
Published: March 2015

Background: Acne inversa is a progressive chronic inflammatory disease associated with abscess and fistula formation and subsequent scarring. In recent years, an increasing number of reports have been published about acne inversa and concomitantly occurring Crohn disease. Extensive anogenitoperineal soft tissue defects represent an enormous challenge to therapy. Common treatment strategies of reconstructive surgery such as local flaps, free flaps, or split-thickness skin grafts are frequently problematic and associated with poor outcomes. Objective: The aim of this case report is to demonstrate the clinical problem of extensive anogenitoperineal soft tissue defects and to present a surgical technique that can be successfully used in such difficult cases. Methods: In both cases, extensive excision of the affected areas was carried out down to the gluteal muscles followed by intramuscular grafting of buried skin chip grafts. Results: In both cases, the final postoperative results after numerous surgeries were very good, with complete wound closure resulting in complete recovery and social reintegration. Conclusion: The technique of buried skin chip grafting has long been ignored since split-thickness skin grafting and different techniques of flap coverage evolved, but it may constitute a highly efficient treatment strategy in challenging reconstructive situations.
Results of a Survey regarding Perioperative Antiseptic Practices
Authors: Eisen Daniel B. , Warshawski Laurence , Zloty David , Azari Rahman 
Published: March 2015

Background: Currently, there are many options available for perioperative antiseptic techniques for cutaneous surgery. However, there is a paucity of scientific evidence available to suggest which techniques are worthwhile and which are not. Objectives: To determine if there is any consensus among dermatologic surgeons as to which perioperative techniques are being used and which are not. Methods: A questionnaire regarding perioperative techniques was mailed to the 641 members of the American College of Mohs Surgery (ACMS). Results: Forty-one percent of those queried returned the questionnaire within the allotted time. Surgical caps and booties were the least used antiseptic techniques. Respondents tended to use antiseptic techniques less often for less invasive procedures and more often for more invasive procedures. Few people used surgical caps, surgical gowns, or booties for any procedure. Conclusions: Many traditional perioperative antiseptic techniques are not being performed by respondents. Calculated infection rates are very low for all queried procedures.