bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are All Seborrheic Keratoses Benign? Review of the Typical Lesion and Its Variants
Authors: Noiles Kristin , Vender Ronald 
Published: March 2015

Background: Seborrheic keratosis (SK) is one of the more common benign epidermal neoplasms seen in adult and middle-aged patients. Objective: As little is written in the literature about the variants of SK, this article aims to categorize and discuss the different subtypes and their important associations. Methods: An in-depth literature search using OVID Medline and PubMed was conducted to classify the various subtypes of SK. Clinical variants were photographed and used to help document the subtypes. The pathology is described for each. Results: Six subtypes of SK were identified: dermatosis papulosa nigra, stucco keratosis, inverted follicular keratosis, large cell acanthoma, lichenoid keratosis, and flat seborrheic keratosis. Although the etiology and pathogenesis of SKs are still largely debatable, several underlying mechanisms and contributing factors have been identified. All subtypes represent benign lesions, and treatment is usually done for cosmetic reasons. Several of the subtypes may act as cutaneous markers for internal malignancy and should be monitored closely for any atypical changes. Conclusion: Although all subtypes of SK are benign, their association with other malignant lesions and ability to serve as cutaneous markers of internal malignancy emphasize the importance of correctly identifying all variants.
Use of Biologic Therapeutics in Difficult-to-Treat Psoriasis
Authors: Lynde Charles 
Published: March 2015

Background: A need for improved psoriasis management drove the development of four biologicals now approved for use in moderate to severe psoriasis: alefacept, efalizumab, etanercept, and infliximab. Objective: This review compares the recommended and practical use of biologicals in “difficult-to-treat” psoriasis. Difficult-to-treat patients, a subpopulation of particular interest to caregivers and regulators, are those for whom conventional options are unavailable, contraindicated, intolerable, or ineffective. Conclusions: Despite guidance recommending that biologicals be considered among first-line antipsoriasis treatments, formulary inclusion may be influenced by the biologicals' success in controlling difficult-to-treat psoriasis. Findings from the Clinical Experience Acquired with Raptiva (CLEAR) randomized controlled trial (RCT) established efalizumab's equal efficacy in difficult-to-treat and moderate to severe psoriasis. The CLEAR data were cited in support of a regulatory recommendation to include efalizumab in Canadian provincial formularies. For some other biologicals, evidence regarding efficacy in difficult-to-treat psoriasis remains equivocal. Additional RCTs are needed to define appropriate roles for specific biologicals in difficult-to-treat patients.
Acantholytic Dermatosis of the Crural Folds with ATP2C1 Mutation is a Possible Variant of Hailey-Hailey Disease
Authors: Lipoff Jules B. , Mudgil Adarsh V. , Young Saryna , Chu Paul , Cohen Steven R. 
Published: March 2015

Background: We describe a patient with acantholytic dermatosis of the crural folds (ADCF) that was misdiagnosed and treated as condyloma acuminata for 13 years. After many skin biopsies consistently showed epidermal acantholysis and negative human papillomavirus serotyping excluded condyloma acuminata, a diagnosis of ADCF was considered most likely. Objective and Conclusion: Acitretin effectively suppressed the symptomatic hyperkeratosis. Subsequent genetic testing revealed a deletion in the ATP2C1 gene that led us to conclude that this case of ADCF is probably a variant of familial benign chronic pemphigus (Hailey-Hailey disease).
Management of Malignant Melanoma: Best Practices
Authors: Smylie Michael , Claveau Joël , Alanen Kenneth , Taillefer Raymond , George Ralph , Wong Ralph , Mason Warren P. 
Published: March 2015

Background: Melanoma is a commonly occurring cancer in Canada, with an estimated age-standardized incidence of 10 to 13 per 100,000. An estimated 4,300 new cases were diagnosed, and there were 880 reported deaths in 2005. Objective and Conclusion: The Canadian Expert Panel on Malignant Melanoma has developed best practices to improve the management of malignant melanoma. Sections include recommendations on primary diagnosis, dermatopathologic assessment, and reporting; use of preoperative lymphoscintigraphy and an intraoperative gamma probe to map and biopsy the sentinel lymph node; indications for surgical resection, sentinel node biopsy, and surgery for advanced disease; use of interferon-α adjuvant therapy and treatment options for stage IV disease; and management of central nervous system metastases.
Rigorous Vibrio vulnificus Soft Tissue Infection of the Lower Leg in a Renal Transplant Patient Managed by Vacuum Therapy and Autologous Growth Factors
Authors: Thodis Elias , Kriki Pelagia , Kakagia Despoina , Passadakis Ploumis , Theodoridis Marios , Mourvati Euthymia , Vargemezis Vassilios 
Published: March 2015

Background: Vibrio vulnificus is a gram-negative marine bacterium that grows well in coastal waters. It is an opportunistic pathogen that can cause serious life-threatening infections in patients with certain health conditions. Vibrio-induced wound infections in immunosuppressed patients are difficult to treat because the healing process may be significantly delayed. Reconstructive surgery may not be successful in early treatment as skin grafts are likely to fail, and there may be increased morbidity of donor sites of grafts or flaps. Objective: Herein a case of septicemia and wound necrosis owing to V. vulnificus wound infection in a renal transplant patient is reported. Method: To conservatively yet adequately débride the wound bed, stimulate angiogenesis, and accelerate granulation, vacuum-assisted closure was employed. Granulation was further enhanced by autologous platelet concentrate spray, which has also been reported to increase the epithelialization rate. Result: Complete epithelialization of the wound was achieved 4 weeks after completion of treatment. Conclusion: Noninvasive advanced modalities may be employed to successfully treat infectious soft tissue deficits in immunocompromised patients.
Etiologic Aspects and Prognostic Factors of Patients with Chronic Urticaria: Nonrandomized, Prospective, Descriptive Study
Authors: Gregoriou Stamatis , Rigopoulos Dimitrios , Katsambas Andreas , Katsarou Alexandra , Papaioannou Dimitrios , Gkouvi Aikaterini , Kontochristopoulos George , Danopoulou Ifigenia , Stavrianeas Nikolaos , Kalogeromitros Dimitris 
Published: March 2015

Background: Studies investigating etiologic factors in chronic urticaria are based on small populations of a few hundred patients. In addition, data on prognostic factors of the disorder are scarce. Objective: To investigate the etiologic and prognostic factors of chronic urticaria on a large population referred to tertiary specialized hospital departments. Methods: The study investigated 2,523 patients with chronic urticaria and a negative autologous serum skin test using anamnesis, and the literature suggested laboratory tests for etiologic factors of the disorder. The patients were prescribed cetirizine 10 mg daily plus treatment of any underlying disorders illuminated by the laboratory investigation. The rescue medicine was loratadine 10 mg. The patients were evaluated every 3 months. Comparative statistical methods were used to evaluate the prognostic factors having an impact on the duration of the disorder until resolution of symptoms. Results: Etiologic factors of chronic urticaria-angioedema were identified in 38.7% of the patients. Physical urticarias had a prevalence of 17.1% in the population under study. Other common etiologic factors identified included infection (7.7%) and autoimmune thyropathy (7.3%). Multiple regression analysis showed that female gender, long duration of the disorder at the initial examination, the presence of angioedema, and physical urticarias are associated with worse prognosis of the disorder, whereas increased self-reported stress and psychiatric disease had no impact on the course of the disorder. Conclusion: A detailed medical history and selective laboratory tests can illuminate etiologic factors in less than 40% of patients with chronic urticaria. Prognostic factors identified to impact the natural history of the disorder could be helpful when designing studies assessing the efficacy of therapeutic agents for chronic urticaria.
Juvenile-Onset Hypopigmented Mycosis Fungoides Mimicking Vitiligo
Authors: Ngo Jennifer T. , Trotter Martin J. , Haber Richard M. 
Published: March 2015

Background: Mycosis fungoides (MF) is the most common form of cutaneous T-cell lymphoma and typically affects older adults. It is estimated that less than 5% of MF cases are of juvenile onset. An uncommon hypopigmented variant of MF exists, which has been more commonly observed in dark-skinned individuals and predominantly in juvenile-onset cases. Methods: We describe an 8-year-old otherwise healthy Hispanic male who, by 6 months of age, had developed asymptomatic hypopigmented patches on the lower legs, thighs, and buttocks, which have evolved over the past 7 years. This condition had previously been misdiagnosed as vitiligo. Recent immunohistologic and molecular biology studies are consistent with MF. Results and Conclusions: Given that hypopigmented MF is an uncommon condition, it may not be clinically suspected in the pediatric population. Histopathologic, immunophenotypic, and/or molecular biologic studies are sometimes equivocal, with findings similar to inflammatory dermatoses or autoimmune vitiligo, which may initially lead to a misdiagnosis, as in this patient's case.
Gnatophyma and Otophyma
Authors: Ezra Navid , Greco Joseph F. , Haley Jennifer C. , Chiu Melvin W. 
Published: March 2015

Background: Phymas are slowly progressive, disfiguring disorders of the face and ears that represent the end stage of rosacea. The most common phyma is rhinophyma, yet similar swellings may occur on the chin (gnatophyma), forehead (metophyma), one or both ears (otophyma), and eyelids (blepharophyma). Objective: Unlike rhinophyma, otophyma is rarely seen. We report two rare phymas: a case of gnatophyma and a case of otophyma. Methods: A 56-year-old African American man presented with a history of bumps on his chin that had begun about 7 years earlier. Physical examination was remarkable for lobulated plaques on the chin, coalescing into hypertrophic nodules and dilated pores. A 73-year-old African American male presented with bilateral cauliflower-like earlobe growths for the past 17 years. Results: A skin biopsy was performed for each patient demonstrating cystic follicular dilatation with keratin plugging, dermal scarring, psoriasiform epidermal hyperplasia, and chronic inflammation of some of the follicles. Conclusion: This case report describes a relatively rare gnatophyma and otophyma. Surgical management is well accepted as the best mode of therapy to treat rhinophyma and is becoming a first-line treatment for all phymas.
Adalimumab in the Treatment of Psoriasis: Pooled Efficacy and Safety Results from Three Pivotal Studies
Authors: Papp Kim , Okun Martin , Vender Ronald 
Published: March 2015

Background: Adalimumab, a fully human monoclonal antibody, binds to and neutralizes tumor necrosis factor. Objective: To provide an integrated review of efficacy and safety from adalimumab clinical trials in psoriasis. Methods: Pooled analyses were conducted of three placebo-controlled clinical trials of adalimumab (40 mg every other week) in psoriasis patients. The primary efficacy measure was the Psoriasis Area Severity Index (PASI). The Physician's Global Assessment (PGA) was also assessed. Results: At Week 16, mean percentage PASI improvement was 78.3% for adalimumab-treated patients versus 15.1% for placebo-treated patients. A PGA of “Clear” or “Minimal” was achieved in 63.4% of adalimumab-treated patients versus 5.1% of placebo-treated patients. The response to adalimumab was rapid, with significant improvements for adalimumab-treated patients in most efficacy measures by Week 4. Adverse event incidence was similar between treatment groups and consistent with adalimumab safety profiles in other indications. Conclusion: Adalimumab improved psoriasis and was generally safe and well-tolerated.
The AWARE Study: Methodology and Baseline Characteristics
Authors: Bissonnette Robert , Searles Gordon , Landells Ian , Shear Neil H. , Papp Kim , Lui Harvey , Gulliver Wayne P.F. , Lynde Charles 
Published: March 2015

Background: Alefacept was the first biologic therapy approved by Health Canada for the treatment of moderate to severe chronic plaque psoriasis and is used either alone or as part of combination therapy. Objective: AWARE (Amevive Wisdom Acquired from Real-World Evidence) is a multicenter, observational phase IV Canadian study of psoriasis patients treated with alefacept. This study's main goals were to develop a shared, real-time, national clinical database to support best practice and optimize the care of patients receiving alefacept and to gain an understanding of how alefacept is used in Canadian clinical practice. Baseline patient demographic data are described herein. Methods: Patients with chronic plaque psoriasis were enrolled from 37 clinics across Canada. Subjects received at least one course of alefacept treatment followed by a period of at least 12 weeks off treatment and were prospectively followed for at least 60 weeks. Baseline assessments included patient demographics, relevant medical history, psoriasis and treatment history, reasons for initiating alefacept, enrolling physician's initial alefacept treatment plan and strategy, percent body surface area (BSA) involvement with psoriasis, and physician's baseline assessment of disease control. Subsequent assessments at each follow-up visit included the patient's response and the physician's assessment. Results: A total of 426 adult patients with predominantly chronic plaque psoriasis, with or without other types of psoriasis, were enrolled into the AWARE registry. Patients generally had moderate to severe psoriasis, with more than half (55.8%) having little or no disease control at baseline as assessed by their clinician, and 77% had > 10% BSA involvement with psoriasis. All patients in the AWARE patient population were receiving one or more treatments for psoriasis prior to or at the time of enrolment, and the majority continued to receive concomitant treatments at the time of study enrolment. Conclusion: The AWARE registry enrolled a broad group of real-world patients with chronic plaque psoriasis treated with alefacept in clinical practices across Canada.
Patterns of Combination Therapy with Alefacept for the Treatment of Psoriasis in Canada in the AWARE Study
Authors: Searles Gordon , Bissonnette Robert , Landells Ian , Shear Neil H. , Papp Kim , Lui Harvey 
Published: March 2015

Background: Evidence from clinical trials supports the use of alefacept for the treatment of patients with chronic plaque psoriasis, either as monotherapy or combined with other treatment modalities. Objective: AWARE (Amevive Wisdom Acquired from Real-World Evidence) is a multicenter, observational, phase IV Canadian registry of psoriasis patients treated with alefacept. Methods: Patients with chronic plaque psoriasis were treated with at least one course of alefacept treatment followed by a period of at least 12 weeks off-treatment. The use of combination therapy with alefacept in a real-world population of psoriasis patients is presented here, including the types of psoriasis therapies received by patients at the time of enrolment, reasons for initiating alefacept, and discontinuation or dosage reduction of concomitant therapy. Results: The majority of patients were receiving other antipsoriatic therapies at the time of enrolment into the AWARE study, most commonly topical therapy, systemic agents, or phototherapy. Most patients were receiving monotherapy prior to the initiation of alefacept. There was little change in the use of topical therapies with alefacept at 24 weeks, whereas a substantial proportion of patients were able to reduce or discontinue concomitant systemic therapies and/or phototherapy. The use of combination therapy regimens was relatively consistent across the country and by age groups, although younger patients were prescribed systemic agents more often than older patients. Conclusion: Alefacept is commonly added to other antipsoriatic therapies in a broad population of real-world chronic plaque psoriasis patients in Canada and may allow for dosage reduction or discontinuation of concomitant systemic agents or phototherapy.
Update on Alefacept Safety
Authors: Wexler Denise , Searles Gordon , Landells Ian , Shear Neil H. , Bissonnette Robert , Papp Kim , Poulin Yves , Langley Richard , Gulliver Wayne P.S. 
Published: March 2015

Background: Alefacept has been demonstrated in clinical trials to be an effective, safe, and well-tolerated treatment strategy when used alone or in combination with other antipsoriatic therapies in patients with chronic plaque psoriasis. Objective: AWARE (Amevive Wisdom Acquired from Real-World Evidence) is a multicenter, observational, Canadian phase IV registry evaluating the efficacy and safety of alefacept, alone or in combination with other antipsoriatic therapies, in patients with psoriasis. Methods: Patients with chronic plaque psoriasis were treated with at least one course of alefacept followed by an off-treatment period, typically lasting 12 or more weeks. Prospective follow-up was at least 60 weeks, depending on when patients presented for retreatment. Safety data collected throughout the study included the incidence of serious adverse events (SAEs), dosing suspensions, and withdrawals owing to adverse events. Results: Twelve SAEs were reported in psoriasis patients treated with at least one course of alefacept, with only one considered to be possibly related to the study drug. Approximately one-quarter of patients missed at least one dose of alefacept during the course of the study. A total of 291 doses of alefacept were missed, representing almost 4% of the total doses administered in this group of patients. Low CD4+ count was the most frequent reason for missed doses; however, no patient had persistently low CD4+ counts requiring permanent discontinuation of alefacept treatment. Seven patients in the AWARE registry discontinued treatment with alefacept, with the most common reason being patient request. Conclusion: The AWARE study supports the safety of alefacept used alone or in combination with other antipsoriatic therapies, in a broad population of real-world chronic plaque psoriasis patients in Canada.
Cutaneous Protothecosis following a Tape-Stripping Injury
Authors: Humphrey Shannon , Martinka Magdalena , Lui Harvey 
Published: March 2015

Background: Prototheca species are ubiquitous achlorophyllic algae that can, in rare instances, manifest as cutaneous infection in humans at sites of traumatic inoculation into the skin. Objectives: We report a 77-year-old man who developed cutaneous protothecosis at the site of an iatrogenic tape-stripping type injury. The diagnosis was confirmed by histologic examination and tissue culture. The patient responded completely to a 17-week course of oral fluconazole. Conclusion: Cutaneous protothecosis can present clinically as nonspecific indolent inflammatory plaques that require skin biopsy for definitive diagnosis.
Epidermodysplasia Verruciformis Associated with Myelodysplastic Syndrome: An Intriguing Association
Authors: Oliveira Walmar R. , Ferreira Gustavo N. , Rady Peter L. , Festa Cyro , Tyring Stephen K. 
Published: March 2015

Background: Epidermodysplasia verruciformis (EV) is a rare genodermatosis characterized by massive infection with human papillomaviruses (HPVs) and development of skin cancer. Myelodysplastic syndromes (MDSs) are a group of chronic conditions that involve dysplastic hematopoiesis, peripheral blood cytopenias, and a high incidence of progression into leukemia. Methods: We describe the intriguing association of these two premalignant conditions (EV and MDS) in one patient. These diagnoses were confirmed by histopathologic examination and cytogenetic abnormalities of bone marrow cells. Results: The patient presented initially with clinical features typical of EV and impairment of cell-mediated immunity. In the skin lesions, HPVs 23 and 25 were identified by nested polymerase chain reaction. Six years later, he had recurrent episodes of mucosal bleeding with fever, weakness, and fatigue. At this time, severe refractory anemia and neutropenia were observed, and bone marrow smears showed hypercellularity with abnormal dysplastic megakaryocytes. The cytogenetic pattern showed abnormalities involving trisomy of chromosomes 8 and 21. The patient received a diagnosis of the indolent subtype of MDS. Conclusions: Through the observation of our patient and review of the literature, we hypothesized that the pathomechanisms, including the role of oncogenes and cytokines, are connected to the progression to malignancy in these settings.
Coexisting Tattoo Pigment and Metastatic Melanoma in the Same Sentinel Lymph Node
Authors: Jaigirdar Adnan A. , Yeh Michael W. , Sharifi Emile , Browne L. Walden , Leong Stanley P.L. 
Published: March 2015

Background: The principle of sentinel lymph node states that metastatic melanoma spreads in a predictable sequential fashion from the primary site to the regional lymph node basin. Objective and Conclusion: Reports show that melanoma and tattoo pigment can be in the same regional lymph node basin on gross evaluation. We present two cases of melanoma arising within the setting of a tattoo where the sentinel lymph node contained both pigmented histiocytes and metastatic melanoma on gross inspection and histopathology.
Elastosis Perforans Serpignosa: Treatment with Liquid Nitrogen Cryotherapy and Review of the Literature
Authors: Humphrey Shannon , Hemmati Iman , Randhawa Roop , Crawford Richard I. , Hong Chih-ho 
Published: March 2015

Background: Elastosis perforans serpiginosa (EPS) is a rare skin disease in which abnormal elastic tissue fibers, other connective tissue elements, and cellular debris are expelled from the papillary dermis via transepithelial elimination. It is characterized by an eruption of small grouped hyperkeratotic papules in a serpiginous arrangement. This condition presents a therapeutic challenge as many treatments have been reported with inconsistent efficacy. Methods: This article reports a case of a 13-year-old male who presented to our outpatient clinic with a 1-year history of facial lesions showing multiple annular keratotic plaques with slight central atrophy. Conclusion: We report a case of EPS treated successfully with liquid nitrogen cryotherapy. Liquid nitrogen cryotherapy is well tolerated, with few side effects, and can be considered in the management of EPS.
Meyerson Phenomenon
Authors: Loh James , Kenny Patrick 
Published: March 2015

Background: Meyerson phenomenon is an uncommon clinical condition that is characterized by an eczematous halo surrounding a preexisting melanocytic nevus and numerous other lesions. The etiology of this condition is unknown. We suggest that the mechanism is due to the interaction between CD4 T lymphocytes and increased expression of intercellular cell adhesion molecule 1 (ICAM-1). Objective: This article provides a concise overview of Meyerson phenomenon. Methods and Results: We present the case of a 37-year-old female with an inflamed nevus located on her thigh from no evident cause. Her condition resolved with surgical excision of the nevus. Histopathology of the specimen demonstrated spongiosis and lymphocytic infiltrate with eosinophils, which confirmed the diagnosis of Meyerson phenomenon. Conclusion: Meyerson phenomenon can resolve spontaneously or with treatment of either topical steroids or surgical excision. The main concern with benign lesions presenting with inflammation is malignant transformation; thus, clinicians need to be more aware of Meyerson phenomenon.