bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recurrences of Dermatophyte Toenail Onychomycosis during Long-Term Follow-up after Successful Treatments with Mono- and Combined Therapy of Terbinafine and Itraconazole
Authors: Gupta Aditya K. , Cooper Elizabeth A. , Paquet Maryse 
Published: March 2015

Background: The influence of dosing regimens on the recurrence rates of onychomycosis has not been investigated. Objective: To compare recurrence rates for toenail dermatophyte onychomycosis between four dosing regimens. Methods: A prospective, investigator-blinded, long-term follow-up (1.25 to 7 years postenrolment) study of the following regimens was undertaken with or without booster therapy at week 36: overlapping continuous itraconazole and terbinafine (COMBO), continuous terbinafine (CTERB), intermittent terbinafine (TOT), and pulsed itraconazole (III). Results: One hundred six mycologically and 43 completely cured participants at week 48 were included. Recurrence rates (RR) for mycologically and completely cured participants were respectively termed mycologic recurrence (MRR) and complete cure recurrence (CRR) rates. No statistically significant difference was detected between the four regimens for the two rates. However, lower MRRs were obtained for CTERB (32%) and TOT (36%) compared to III (59%) and COMBO (57%). When participants who received booster therapy were excluded from the analysis, the MRR was lower for CTERB (21%) compared to TOT (39%). Conclusions: Itraconazole therapy was associated with higher RRs than terbinafine therapy. Combined therapy did not reduce the RRs compared to monotherapies. A difference might exist between continuous and intermittent antifungal regimens, but additional randomized clinical trials are needed for confirmation.
Lymphangiosarcoma of the Scalp
Authors: Mamelak Adam J. , Collie Megan R.V. , Kroll Ryan , Hanson Miriam L. , Harris Howard M. 
Published: March 2015

Background: Lymphangiosarcoma is a rare, aggressive malignancy that originates from the endothelial cells lining lymphatic vessels and carries an extremely poor prognosis. Its clinical and histologic features are often indistinguishable from angiosarcoma. Objective: We sought to better characterize the clinical and histologic features of lymphangiosarcoma. Methods: Case report and review of the literature. Results: A number of immunohistochemical markers, including Von Willebrand factor, Ulex europaeus agglutinin 1, CD31, VEGFR-3, D2-40, Prox-1, can be used to help differentiate lymphatic from vascular tissue. Conclusions: Recent characterization of several new biologic markers has allowed greater differentiation between these tumors and may provide new therapeutic targets for treatment.
Bullous Pemphigoid Associated with Acquired Hemophilia A: A Rare Association of Autoimmune Disease
Authors: AlJasser Mohammed I. , Sladden Chris , Crawford Richard I. , Au Sheila 
Published: March 2015

Background: Acquired hemophilia (AH) is a rare autoimmune disease with an annual incidence of one per million and has a mortality rate of up to 22%. It is caused by the development of autoantibodies against factor VIII. Approximately half of the reported cases are associated with autoimmune disorders, pregnancy, malignancies, and adverse drug reactions. Autoimmune diseases are the most frequently associated disorders and include rheumatoid arthritis, systemic lupus erythematosus, cryoglobulinemia, pemphigus vulgaris, and bullous pemphigoid. There are a few reports of acquired hemophilia and bullous pemphigoid in the literature. Method: We report a 73-year-old male who presented with cutaneous blistering, upper gastrointestinal bleeding, and hemoptysis. He later developed right flank pain secondary to a retroperitoneal hematoma. He had a prolonged partial thromboplastin time, a low factor VIII level, and a high factor VIII inhibitor level, all consistent with acquired hemophilia. Skin biopsies were diagnostic for bullous pemphigoid. Results: He was treated successfully with prednisone, cyclophosphamide, rituximab, and intravenous immunoglobulin.
Unilateral Hand Allergic Contact Dermatitis due to Occupational Exposure
Authors: Mussani Farheen , DeKoven Joel G. 
Published: March 2015

Background and Objective: Hand dermatitis is the most common subtype of occupation-related skin disease. Regardless of its underlying cause, hand dermatitis results in significant impairment and a negative impact on quality of life. Any case of unilateral hand dermatitis should have a high index of suspicion for an allergic contact dermatitis. Conclusion: We report two cases of unilateral hand dermatitis. The first case is a 53-year-old female with a unilateral dermatitis of the left hand. The second case is a 53-year-old male with dermatitis of the right hand. Both cases highlight an interesting presentation of unilateral hand allergic contact dermatitis secondary to an occupational exposure.
Compliance with Tap Water Iontophoresis in Patients with Palmoplantar Hyperhidrosis
Authors: Özcan Deren , Güleç A. Tülin 
Published: March 2015

Background: Patients tend to be noncompliant with tap water iontophoresis (TWI), which is an effective treatment option for palmoplantar hyperhidrosis. Objective: To investigate compliance with TWI in patients with palmoplantar hyperhidrosis and identify the factors limiting its utility. Methods: The medical data of 22 patients treated with TWI for palmoplantar hyperhidrosis were collected. A telephone inquiry questioning overall satisfaction with the treatment and the reasons for discontinuation was conducted. Results: Sixteen patients completed the initial treatment period, and all responded well to the therapy. Eight patients started on the maintenance treatment, five of whom gave up before completing five sessions. The reasons for discontinuation were a lack of time in 12 patients, switching to home therapy in 3 patients, and side effects in 1 patient. Conclusion: Patients with palmoplantar hyperhidrosis are noncompliant with TWI, mainly due to a lack of time. They should be well informed before therapy and be encouraged to have a home device for maintenance.
Improved Decisional Conflict and Preparedness for Decision Making Using a Patient Decision Aid for Treatment Selection in Psoriasis: A Pilot Study
Authors: Tan Jerry , Wolfe Barat 
Published: March 2015

Background: We developed a patient decision aid (pDA) to assist psoriasis patients in treatment decisions. Objective: This pilot study evaluated the pDA in patient knowledge, decisional conflict, and preparation for decision making. Methods: Newly referred psoriasis patients in a private dermatology office completed self-administered surveys at three time points: before (visit 1) and on two occasions after provision of the pDA (visit 2 up to 2 weeks after visit 1; visit 3 up to 6 weeks after visit 1). The survey included questions regarding knowledge of psoriasis and its treatment and validated questionnaires on decisional conflict and preparation for decision making. Results: Ten psoriasis patients participated (seven men, three women; mean age 45.7 years), with a mean age of 11.4 years since diagnosis. Improvement by visit 3 was observed for knowledge ( p = .06), reduced decisional conflict ( p ≤ .001), and preparation for decision making ( p ≤ .05). Patients tended to self-select treatment appropriate to the level of psoriasis severity. Conclusion: This pilot study of the pDA showed improved patient knowledge of psoriasis and its treatments, reduced decisional conflict, and increased patient preparation for decision making. Limitations: This small study was not randomized and did not have a comparator arm.
Mosaic Generalized Neurofibromatosis 1: Report of Two Cases
Authors: Hardin Jori , Behm Allan , Haber Richard M. 
Published: March 2015

Background: We report two cases of mosaic generalized neurofibromatosis 1 (NF1) and review the history of the classification of segmental neurofibromatosis (SNF; Ricardi type NF-V). Somatic mutations giving rise to limited disease, such as segmental neurofibromatosis are manifestations of mosaicism. If the mutation occurs before tissue differentiation, the clinical phenotype will be generalized disease. Mutations that occur later in development give rise to disease that is confined to a single region. Objectives: Segmental neurofibromatosis is caused by a somatic mutation of neurofibromatosis type 1, and should not be regarded as a distinct entity from neurofibromatosis 1. Cases previously referred to as unilateral or bilateral segmental neurofibromatosis are now best referred to as mosaic generalized or mosaic localized neurofibromatosis 1.
Cytomegalovirus Retinitis: A Rare but Preventable Cause of Blindness in Dermatology Patients
Authors: Laws Philip M. , Kingston Timothy P. , Walsh Scott , Shear Neil H. 
Published: March 2015

Importance: Dermatologists are using an increasing range of immunomodulatory therapies to treat an expanding number of skin diseases. Complications of therapy are broad and include infection. Cytomegalovirus (CMV) retinitis has not been reported in association with dermatologic disease. Observations: We report two cases of CMV retinitis associated with immunosuppression for eczema and pemphigus vulgaris. In both cases, patients were receiving corticosteroid and a second-line immunosuppressive agent (cyclosporine or mycophenolate mofetil). Disease presented in both patients with painless visual loss. Conclusions and Relevance: Patients receiving immunosuppressive therapy should be monitored for blurred vision, floaters, or visual loss and referred for urgent assessment to ensure accurate diagnosis and prompt treatment of possible CMV retinitis.
A Consensus on Acne Management Focused on Specific Patient Features
Authors: Lynde Charles , Tan Jerry , Andriessen Anneke , Barankin Benjamin , Dutil Maha , Gilbert Martin , Hong Chih-ho , Humphrey Shannon , Rochette Linda , Toole Jack , Thomas Richard , Vender Ronald , Wiseman Marni , Zip Catherine 
Published: March 2015

Background: Most treatment guidelines for acne are based on clinical severity. Our objective was to expand that approach to one that also comprised individualized patient features: a case-based approach. Methods: An expert panel of Canadian dermatologists was established to develop demographic and clinical features considered to be particularly important in acne treatment selection. A nominal group consensus process was used for inclusion of features and corresponding appropriate treatments. Results: Consensus was achieved on the following statements: follicular epithelial dysfunction contributes to acne pathogenesis; inflammation from underlying disease(s) or prior treatment may impact further patient management; management focusing on specific patient features and on addressing psychosocial factors, including impact on quality of life, may improve treatment adherence and outcomes; and case-based scenarios are a practical approach to illustrate the effect of these factors. To address the latter, eight case profiles were developed. Conclusions: Management of acne should be based on multifactorial considerations beyond clinically determined acne severity and should include patient-reported impact, gender, skin sensitivity (including preexisting dermatoses), and phototype.
Association between Skin Conditions and Depressive Disorders in Community-Dwelling Older Adults
Authors: Guerra Samantha Gontijo , Préville Michel , Vasiliadis Helen-Maria , Berbiche Djamal 
Published: March 2015

Background: Depression is frequently observed in dermatologic patients. However, the association between depressive disorders and skin conditions has rarely been explored through population-based studies, especially within older-adult populations. Objective: To test this association in a representative sample of an older-adult population. Methods: Data came from the Survey on the Health of the Elderly (Enquête sur la Santé des Aînés [ESA]), a longitudinal survey conducted in Quebec among 2,811 older adults. Cross-lagged panel models were used to simultaneously examine cross-sectional and longitudinal relationships between the presence of skin conditions and depressive disorders. Results: The prevalence of skin conditions was 13%, and the prevalence of depressive disorders among participants presenting with skin conditions was 11%. Our results indicated significant cross-sectional correlation ( ζ = 0.20) between skin conditions and depressive disorders, but no longitudinal association was observed. Conclusion: Our results reinforce the hypothesis that skin conditions and depressive disorders are concurrently associated in older adults. However, no evidence of the predictive effect of skin problems on depression (and vice versa) was found in our community sample. Despite the deleterious effect of the coexistence of these problems in older adults, studies are lacking. This article highlights the importance of this issue and emphasizes the need for further research on this topic.
Effect of Oral Isotretinoin Treatment on Retinal Nerve Fiber Layer Thickness
Authors: Ucak Haydar , Aykut Veysel , Ozturk Savas , Cicek Demet , Erden Ilker , Demir Betul 
Published: March 2015

Background: Oral isotretinoin treatment can cause ocular side effects. Objective: This study was performed to detect possible toxic effects of oral isotretinoin treatment on the retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL). Methods: The study population consisted of 54 eyes of 27 patients with nodulocystic acne who used oral isotretinoin (Roaccutane) treatment. Macular GCL and peripapillary RNFL thickness measurements were performed using spectral domain optical coherence tomography (OCT) before and after therapy. Results: Before and after treatment, a complete ophthalmologic examination was normal in all eyes. However, posttreatment lower temporal (TL) values were significantly lower (76.80 ± 16.31) than pretreatment TL values (84.96 ± 24.83) ( p = .02). There was no statistically significant difference in the other OCT values, upper temporal, superotemporal, superonasal, upper nasal, lower nasal, inferonasal, and inferotemporal ( p = .35, p = .40, p = .56, p = .95, p = .94, p = .93, p = .61, respectively). Also, there was no statistically significant difference between the right and left eyes and between genders for all parameters ( p > .05). Conclusion: The use of oral isotretinoin treatment has increased in recent years. In addition, oral isotretinoin treatment has a broad adverse effect potential on the ocular system. The measurement of RNFL thickness, especially TL thickness, by OCT may be useful for detecting the possible toxic effect of oral isotretinoin therapy on RNFL.
Comparing Demographic Characteristics and Adverse Event Rates at Two Dermatologic Surgery Practices
Authors: O'Neill Jenna L. , Shutty Brandon , Lee Yun Sun , Solomon James A. , Patel Nikita , Davis Scott A. , Taheri Arash , Huang Karen E. , Landis Erin T. , Robins Douglas N. , Williford Philip M. , Feldman Steven R. , Pearce Daniel J. 
Published: March 2015

Background: Patient demographics and operative techniques may contribute to adverse events after surgeries. Objective: To identify differences in adverse event rates between different dermatologic surgery centers and potential contributing features affecting these rates. Methods: Data regarding demographics, procedure type, and adverse events were collected at two dermatologic surgery centers. Results: The most common adverse event at both sites was infection: 2.1% at site 1 versus 0.5% at site 2 ( p < .001). Using multivariate logistic regression, procedure type (Mohs surgery), geographic location (being at site 1), older age, and anatomic location of surgery were associated with a higher risk of infection. Conclusion: Adverse event rate appears to correlate with patient demographics, procedure type, and setting of surgery more than use of prophylactic antibiotics. Identification of differences in adverse event rates and potential contributing variables at different practices may allow for identification of opportunities to prevent adverse events.
Cutaneous Polyarteritis Nodosa Sine Nodosa
Authors: Merman Erica , Rosen Cheryl , Ghazarian Danny , Habeeb Ayman Al , Siddha Sanjay 
Published: March 2015

Background and Objective: Cutaneous polyarteritis nodosa, a form of vasculitis affecting the small to medium sized arteries, most commonly presents as tender subcutaneous nodules over the lower legs and feet. Other features include livedo reticularis, skin ulcers and tender indurated plaques. Conclusion: We report a 51-year old woman with a primarily livedo reticularis presentation of cutaneous polyarteritis nodosa without a nodular component.
Successful Treatment of Atrophic Facial Leishmaniasis Scars by CO2 Fractional Laser
Authors: AlGhamdi Khalid , Khurrum Huma 
Published: March 2015

Background: A permanent, unpleasant atrophic leishmaniasis scar is a potentially disfiguring condition that causes social stigma with limited treatment choices. Fractionated carbon dioxide (CO2) laser resurfacing is expected to be a safe and effective treatment for leishmaniasis scars. Objective: To assess the safety and efficacy of ablative fractional resurfacing (AFR) with a CO2 laser for facial leishmaniasis atrophic scars. Methods: Eleven patients (five males, age 18–47 years) underwent the fractional CO2 laser procedure. The mean duration for scars was 18.3 years. Three to five treatment sessions with the fractional laser eCO2 (10,600 nm, Lutronic Corporation, Gyeonggi-do, Korea) were performed for each patient, at 2-month intervals, under topical anesthesia. Two passes (with tip type 120, density 150 spots/cm2 in static mode, and peak power of 30 watts) were performed on each leishmaniasis scar. Pulse energies ranged between 100 and 140 mJ. Posttreatment improvements in texture, atrophy, and overall satisfaction with appearance were graded on a quartile scale 1 month after the second session and 3 months after the final session. Scar improvement was graded using a 4-point score with a maximum score of 20. Results: At the 3-month posttreatment follow-up, all subjects were rated as having at least 50% improvement in texture, atrophy, borders, and overall appearance of scars. The median score of improvement was 18 of 20 (range 11–19). Mild postinflammatory hyperpigmentation was the only adverse effect, observed in 18% (2 of 11) of subjects. After the procedure, moderate to severe erythema and edema typically resolved within 24 to 48 hours. No additional adverse effects were observed. Conclusion: Fractional CO2 resurfacing represents a safe, effective, and well-tolerated potential treatment for atrophic facial leishmaniasis scars in ethnic skin.
Hypopigmented Segmental Darier Disease
Authors: Morin Catherine Besner , Netchiporouk Elena , Billick Robin C. , Srolovitz Herbert D. , Roshdy Osama 
Published: March 2015

Background: Darier disease is a genodermatosis caused by a mutation in the ATP2A2 gene. It classically presents as hyperkeratotic greasy papules in a seborrheic distribution. Several variants have been reported, notably the hypopigmented variant, which predominantly targets dark-skinned individuals, and a segmental variant that often follows the lines of Blaschko. Methods: We report a case of a 41-year-old African-Canadian female with a long-standing history of macular hypopigmented pruritic eruption following the lines of Blaschko on her back. The eruption was persistent and recalcitrant to various treatments. Dyskeratosis with corps ronds and grains, acantholysis, and parakeratosis were observed on histopathology. Those findings were consistent with the diagnosis of segmental hypopigmented Darier disease. Results and conclusions: To our knowledge, this is the first case reporting a combined segmental and hypopigmented variant of Darier disease. We further present a literature review for hypopigmented and segmental variants of Darier disease.
A Clinicopathologic Review of a Case Series of Dermatofibrosarcoma Protuberans with Fibrosarcomatous Differentiation
Authors: Kuzel Paul , Mahmood Muhammad N. , Metelitsa Andrei I. , Salopek Thomas G. 
Published: March 2015

Background: Dermatofibrosarcoma protuberans with fibrosarcomatous differentiation (DFSP-FS) is a rare variant of DFSP with a more aggressive clinical course, characterized by higher rates of local recurrence, metastasis, and death. Methods: We conducted a clinicopathologic review of all DFSP-FS cases that occurred in Alberta, Canada, from 1997 to 2007. Results: Of the 75 DFSP cases reviewed, 4 demonstrated fibrosarcomatous differentiation. Three patients were female and one was male, and the age range was 25 to 76 years. Three tumors invaded to skeletal muscle, whereas one invaded to subcutaneous tissue only. Although perineural invasion was noted in all four cases, none exhibited lymphovascular space invasion. One local recurrence developed, and two of four tumors metastasized. Metastasis was associated with tumor size, tumor necrosis, grenz zone involvement, ulceration, thickness, and tumor grade. One patient died within 5 years of diagnosis. Conclusion: DFSP-FS represents a more aggressive subtype of DFSP. Several features of DFSP-FS may impart a higher risk of metastasis.
Polysensitization in Recurrent Lip Dermatitis
Authors: Fraser Kathleen , Pratt Melanie 
Published: March 2015

Background: In allergic contact dermatitis (ACD), polysensitization consists of positive patch test reactions to three or more unrelated allergens. Objective: The purpose of this case report is to document a 27-year-old female with recurrent lip dermatitis, polysensitization, and reactions to a number of clinically relevant exposures. Methods: Patch testing results revealed positive reactions to tixocortol-21-pivalate (3+), lanolin (3+), neomycin (3+), nickel (1+), hydroxyethyl methylacrylate (3+), bacitracin (3+), and abitol (3+). Results: The patient had seven positive reactions, meeting the criteria for polysensitization. Of known clinical relevance, the patient had applied lanolin-containing lip balms and hydrocortisone- and bacitracin-containing products to the lips, all of which she was strongly reactive to on patch testing. Conclusion: Polysensitization occurs when three or more unrelated allergens are positive on patch testing. This case highlights the importance of considering polysensitization in ACD as numerous allergens that were positive on patch testing were clinically relevant.
Periungual Eccrine Poroma
Authors: Fierro-Arias Leonel , Calderón Luz , Peniche-Castellanos Amelia , Mercadillo-Pérez Patricia 
Published: March 2015

Background: Eccrine poroma is a rare, benign skin appendage tumor originating from the intraepidermal portion of the eccrine sweat duct, which typically occurs on the sides and soles of the feet. Nonetheless, eccrine poroma may be found in any skin area bearing sweat glands. Objective: Herein we report a case of an eccrine poroma in an unusual location, the surgical management of the condition, and follow-up processes.