bluuebunny/crossref_metadata_2025_split huggingface dataset:
Asymptomatic Palmar Pits: Clinical Evaluation of Six Cases and Review of the Literature
Authors: De Dipankar , Narang Tarun , Dogra Sunil , Kanwar Amrinder J. 
Published: March 2015

Background: Palmar pits are intriguing and are found in association with diverse dermatologic conditions. Some are innocuous, whereas others have sinister implications. Objective: Six cases of asymptomatic palmar pits are described, and the literature is reviewed in brief. Method and Results: Of the six patients, five were male and one was female, with a mean age of 63.5 years. In all six patients, the palmar pits were noticed incidentally during a cutaneous examination for some other unrelated dermatoses, except in one in whom the pits were the reason for visiting a dermatologist. The number of pits varied from one to nine. Dupuytren contracture was observed in five patients. Sole involvement was seen in only one patient. None had overlying hyperkeratosis or associated symptoms relating to palmar pits. Conclusions: Palmar pits may have sinister implications in conditions such as nevoid basal cell carcinoma syndrome or Cowden syndrome. The association of palmar pits and Dupuytren contracture seems to be common but is underreported. Palmar pits may be the clinical cutaneous sign of systemic diseases and may sometimes provide a diagnostic clue to other dermatoses. This report emphasizes the significance of the art of clinical observation in dermatology.
Cutaneous Myiasis from Panama, South America: Case Report and Review
Authors: Ting Patricia T. , Barankin Benjamin 
Published: March 2015

Background: Myiasis is a cutaneous infestation with larvae of Diptera, the two-winged arthropod order. Eggs and/or larvae are transmitted directly from the environment or via arthropod vectors. Larvae are able to burrow into the dermis of intact skin or external body orifices. Three clinical variants of myiasis are furuncular, migratory (creeping), and infestation of wounds. Methods: A 35-year-old male presented with a 1-month history of worsening furuncles on the left knee and posterior thigh following his return from Panama, South America. Clinical examination revealed tender 6 cm and 2 cm erythematous to violaceous furuncles with surrounding desquamation and central puncta draining serosanguinous fluid. Five-millimeter punch biopsies and tissue swabs were performed. Results: All larvae were of the Dermatobia hominis species. The patient was empirically treated with cephalexin and ciprofloxacin for secondary bacterial cellulitis. Tissue swabs later cultured group B streptococcus. A tetanus booster was recommended. Conclusion: This case report describes a relatively rare cutaneous infestation with D. hominis, a Central and South American endemic larva of the human botfly. Increasing trends toward immigration and global travel to tropical and subtropic areas will likely increase the frequency of encounters with such parasitic cutaneous infestations in North American outpatient dermatology clinics.
Uncommon Flexural Presentation of Darier Disease
Authors: De Dipankar , Kanwar Amrinder J. , Saikia Uma Nahar 
Published: March 2015

Background: Darier disease is an autosomal dominant skin disorder characterized by keratotic papules, focal loss of adhesion, and abnormal keratinization. Several clinical variants of Darier disease have been described. Predominant flexural distribution of lesions in Darier disease is uncommon. Objective: We report a sporadic case of Darier disease in which the lesions were strictly localized to the flexures. We also briefly review the differential diagnoses of such atypical localization. Methods and Results: A 26-year-old female presented with erythematous and hyperpigmented papular lesions localized to flexures for 4 months. The skin of the other areas, hairs, nails, and mucosa was normal. Histopathologic examination revealed suprabasal acantholysis along with dyskeratotic keratinocytes, consistent with Darier disease. Conclusion: Physicians should be aware of such atypical localizations and should consider the diagnosis of flexural Darier disease along with more common clinical conditions with flexural localization, such as Hailey-Hailey disease and occasionally Grover disease.
Divergence of Demographic Factors Associated with Clinical Severity Compared with Quality of Life Impact in Acne
Authors: Tan Jerry K.L. , Li Yudi , Fung Karen , Gupta Aditya K. , Thomas D. Richard , Sapra Sheetal , Lynde Charles , Poulin Yves , Gulliver Wayne , Sebaldt Rolf J. 
Published: March 2015

Background: Previous smaller studies suggest that age, gender, and duration of acne may individually be associated with clinical acne severity and quality of life (QoL) impact. Objective: Our purpose was to concurrently evaluate the association of demographic factors with clinical acne severity and with QoL impact. Methods: Clinical acne severity was assessed using the Investigators Global Assessment, whereas QoL impact was evaluated by the patient-completed Acne-QoL. These outcomes were correlated with sociodemographic variables, including age, gender, and duration of acne. Results: In 862 acne patients, clinical severity was associated with younger age, male gender, and shorter acne duration (1–5 years). In contrast, greater impact on QoL was associated with older age, female gender, and longer acne duration (> 5 years). Conclusions: Clinical and QoL measures each differentiate between groups of patients most severely affected by acne. Our findings reinforce the imperative for clinicians to use both measures for comprehensive patient management. Limitations: Study limitations include referral population of acne patients and the restriction of outcome measures to facial acne.
Efficacy and Tolerability of Topical Tacrolimus Ointment for the Treatment of Male Genital Psoriasis
Authors: Bissonnette Robert , Nigen Simon , Bolduc Chantal 
Published: March 2015

Background: Genital psoriasis is difficult to treat and has a significant psychological impact on affected patients. Objective: To study the safety and efficacy of topical tacrolimus ointment in male patients with genital psoriasis. Methods: This was an open-label study in 12 male patients with genital psoriasis. Patients received topical tacrolimus 0.1% ointment twice daily for 8 weeks followed by a 4-week observational period. Efficacy was assessed by a modification of the Psoriasis Area and Severity Index (PASI) scale adapted for genital psoriasis (male genital PASI). Severity was also evaluated individually for the glans, shaft of the penis, and scrotum. Results: Male genital PASI decreased from a mean score of 15.8 at baseline to 1.2 at week 8 ( p < .001). Psoriasis severity also improved significantly for the glans, shaft of the penis, and scrotum evaluated individually. Tacrolimus 0.1% ointment was very well tolerated, with only mild pruritus or burning sensation of limited duration reported. Conclusions: Topical tacrolimus ointment appears very efficacious and well tolerated in male patients with genital psoriasis.
Leprosy: Ongoing Medical and Social Struggle in Vietnam
Authors: Nguyen Nhiem , Nguyen Thang Tat , Phan Hai Hong , Tran Tinh Tam 
Published: March 2015

Background: Until recently, leprosy had been prominent in 33 countries worldwide, and Vietnam was ranked among the top 14 endemic countries. Objective: The leprosy situation in Vietnam was reviewed as a sample of the worldwide ongoing medical and social struggle to assess the need for continued support for leprosy control activities and for social programs of integration of leprosy victims into the community. Methods: A search was conducted of official Vietnamese publications, World Health Organization documents, major electronic databases, and popular leprosy Web sites; as well, notes from visits to local leprosy clinics and interviews with health workers were checked. Results: Important achievements were realized through national determination and international collaboration. In contrast with the impressive performance statistics at the national level, and despite strong government efforts for leprosy control, the results obtained at the province-city and district-commune levels still exhibit deficiencies in case detection, treatment, and socioeconomic integration of leprosy victims. Conclusion: The struggle to eliminate such a complex and destructive infectious disease as leprosy does not end with the cure. Deep-seated medical and social problems remain. These problems are best solved through community-based approaches.
Dermal Skin Template for the Management of Multiple Cutaneous Leiomyomas
Authors: Gravvanis Andreas , Kakagia Despoina , Papadopoulos Stefanos , Tsoutsos Dimosthenis 
Published: March 2015

Background: Multiple leiomyomas are rare benign tumors of the skin, originating from the arrector pili muscle, and usually appear as painful nodules. Several pharmacologic agents have been used with some success to reduce pain and discomfort since surgery may be an impractical approach owing to the extent of the disease. Objective: This article reports on a patient with multiple cutaneous leiomyomas of the upper limb who was managed by a method not previously reported for leiomyomas. Method: The management involved total surgical resection of the defect and immediate reconstruction with the Integra artificial dermal template (Integra LifeSciences Corp., Plainsboro, NJ). Results: With this treatment, the patient was totally relieved from the pain, and optimal functional and esthetic results were achieved. Conclusion: Complete surgical resection of multiple cutaneous leiomyomas prevented the disease's recurrence. The immediate reconstruction of the resultant full-thickness defect with artificial dermis ensured uneventful wound healing, resulting in optimal functional and esthetic outcome and total relief from leiomyoma-associated discomfort.
Incidence of Cutaneous Malignant Melanoma in the Ottawa Region: 1996 to 2006
Authors: Nevins Tara , Su Yinghua , Doucette Steven , Kanigsberg Nordau 
Published: March 2015

Background: The incidence rates of invasive primary cutaneous malignant melanoma in Canada have shown a gradual tapering in recent years, after decades of increases. This trend suggests that the incidence of melanoma in Canada is stabilizing; however, knowledge of the recent trend for both in situ and invasive tumors was lacking. Objective: The purpose of this study was to examine the temporal trend of both in situ and invasive melanoma within the Ottawa region over a 10-year period. Methods: The histopathology of cutaneous melanomas diagnosed in the Ottawa region was obtained for the years 1996, 2001, and 2006 from the main diagnostic centers servicing the area; however, not all melanomas have been accounted for. All rates are expressed per 100,000 population per year. Results: Melanoma incidence decreased between 1996 and 2001 (–3.83) and increased between 2001 and 2006 (+7.46; p ≤ .05). This increase is mainly attributable to in situ melanoma (+5.49; p ≤ .05). There has been no statistically significant change in invasive melanoma. Conclusions: Invasive melanoma incidence in the Ottawa region remained stable, whereas in situ melanoma incidence increased.
Acral, Pure Cutaneous, Self-Healing, Late-Onset, Cellulitis-Like Langerhans Cell Histiocytosis
Authors: Sharma Prafulla Kumar , Sabhnani Sunil , Bhardwaj Minakshi , Kar Hemanta Kumar 
Published: March 2015

Background: An unusual and not yet reported clinical presentation of pure cutaneous Langerhans cell histiocytosis (LCH) that was a diagnostic dilemma. Objective: To bring to light the newer presentation of this disease. Method: The case was managed on clinical grounds initially as cellulitis. However, after the investigations and confirmation of the diagnosis, she was managed symptomatically. Results: Pure cutaneous LCH may manifest in early adulthood with features of cellulitis, erythematous edematous vesicular plaques, and nodules distributed in the flexural acral areas. Conclusion: Pure cutaneous LCH may have an acute late onset with unusual morphology as cellulitis, inverse acral distribution, and self-healing.
Occurrence of Plantar Pustular Psoriasis during Treatment with Infliximab
Authors: English Penny Lovell , Vender Ronald 
Published: March 2015

Background: Pustular psoriasis is an uncommon form of psoriasis that often affects areas of the hands and feet. It typically manifests as small pustules that develop within erythematous areas of the palms and soles. Infliximab, a tumor necrosis factor inhibitor, can be used to treat pustular psoriasis. Infliximab can also be effective in the treatment of various other disorders, including plaque-type psoriasis, psoriatic arthritis, Crohn disease, rheumatoid arthritis, and ankylosing spondylitis. Objective: We present a case of a young woman developing pustular psoriasis for the first time despite being on infliximab treatment for Crohn disease. Results: Infliximab has been successful in the treatment of pustular psoriasis. In rare cases, plaque psoriasis appears for the first time during infliximab treatment for other disorders, such as Crohn disease. Conclusion: Plantar pustular psoriasis occurring for the first time during infliximab treatment is an uncommon occurrence.
Results of Patch Testing in Patients Diagnosed with Oral Lichen Planus
Authors: Lomaga Mark A. , Polak Shely , Grushka Miriam , Walsh Scott 
Published: March 2015

Background: Oral lichenoid lesions (OLLs) resemble oral lichen planus (OLP) but develop secondary to various underlying causes. The role of contact allergy in precipitating and/or perpetuating OLL is well documented but remains controversial. Objective: To help elucidate the association of contact allergy and OLL, we reviewed patch-test readings in patients diagnosed with OLP-like lesions. Methods: We retrospectively reviewed patients diagnosed with OLP-like lesions who had patch tests performed between January 1, 2006, and December 31, 2007. Results: Patch tests were performed on 24 patients with a histopathologic and/or clinical diagnosis of OLP. Of these, 16 (67%) had positive patch-test readings. At least eight (50%) of these patients had clinically relevant reactions. Ten of the 16 patients (63%) had reactions to metals. In most of these patients, troublesome areas tended to localize adjacent to metallic dental restorations. Of the nine patients (56%) who had reactions to fragrances, flavorings, gallates, and/or diallyl disulfide, the majority improved after avoiding these allergens. Conclusion: Our findings support the notion that contact allergy may underlie the pathogenesis of OLL and that allergen avoidance may result in amelioration of disease.
Biologics in the Treatment of Psoriasis: Clinical and Economic Overview
Authors: Poulin Yves , Langley Richard , Teixeira Henrique D. , Martel Marie-Josée , Cheung Sun 
Published: March 2015

Background: The use of biologic medications for psoriasis is a recent therapeutic advance. Objective: To review clinical and economic data for biologic therapies in the treatment of chronic plaque psoriasis. Methods: Published meta-analyses and additional literature review identified randomized controlled trials. Analyses included the number needed to treat (NNT), the cost in Canadian dollars for the first year of treatment per the Canadian product monograph, and the estimated cost per responder achieving a 75% reduction in Psoriasis Area and Severity Index score (PASI 75). Results: Pooled NNTs were 1.3 (infliximab), 1.5 (ustekinumab 90 mg), 1.6 (adalimumab and ustekinumab 45 mg), 2.3 (etanercept), 4.1 (efalizumab), and 5.6 (alefacept). The annual treatment cost per patient was $19,825 to $37,600. The cost per patient achieving a PASI 75 response at 12 weeks ranged from $8,330 (adalimumab) to $71,371 (alefacept). Conclusion: This analysis suggests favorable cost and benefits of biologic psoriasis therapies, particularly adalimumab, infliximab, and ustekinumab.
Efficacy Outcomes in Patients Using Alefacept in the AWARE Study
Authors: Landells Ian , Searles Gordon , Bissonnette Robert , Shear Neil H. , Vender Ronald , Lui Harvey 
Published: March 2015

Background: Alefacept has demonstrated efficacy in clinical trials of patients with chronic plaque psoriasis, either as monotherapy or combined with other treatment modalities such as phototherapy. 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, either alone or added on to their existing antipsoriatic treatment regimen. Each course of alefacept was followed by a period of at least 12 weeks off treatment. Efficacy outcomes included physicians' and patients' assessments of response at week 18, as well as change in percent body surface area (BSA) involvement with psoriasis. The time to retreatment was assessed in patients receiving a second course of alefacept during at least 60 weeks of prospective follow-up. Results: The majority of patients received alefacept in combination with other antipsoriatic therapies. Physicians' and patients' assessments of response at 18 weeks showed that 42% and 41% of patients, respectively, had a “cleared to marked response” and a further 42% had a “moderate to some response.” Among those patients whose psoriasis was moderately controlled or not controlled at baseline, 49 to 51% and 33 to 36%, respectively, improved to “cleared to marked response” at 18 weeks. A substantial shift in percent BSA involvement with psoriasis was observed at 18 weeks, with 55% of patients having a BSA involvement of < 10% at week 18 compared to only 20% having this level of BSA involvement at baseline. The mean time to retreatment among the 60% of patients who received a second course of alefacept was 19.3 weeks (range 2–47 weeks). Conclusion: A single course of alefacept therapy improved outcomes in this broad population of real-world chronic plaque psoriasis patients. Study Limitations: The limitations of this study include its nonrandomized, noncontrolled, noncomparative design, which allowed multiple different treatment approaches across all patients. The rating scales used in this study have not been previously validated, and ranges were assigned to baseline control and response data that are not specifically defined. Clinicians did not receive specific training in using these scales; therefore, interrater variability could not be assessed.
Utility of an Interferon-γ Release Assay for Latent Tuberculosis Diagnosis in a Case of Bullous Pemphigoid
Authors: Goodfellow Alfred , Keeling Douglas N. , Hayes Robert C. , Webster Duncan 
Published: March 2015

Background: With increasing use of immunosuppressive therapy, including tumor necrosis factor a inhibitors, there is concern about infectious complications, including reactivation of latent Mycobacterium tuberculosis infection. Routine testing prior to administration of systemic immunosuppression includes the tuberculin skin test, which lacks sensitivity and specificity and may be difficult to interpret in the presence of extensive cutaneous disease. Treatment of individuals with latent tuberculosis infection is recommended when immunosuppressive medications are to be employed. Observations: We report a case in which a diagnosis of latent tuberculosis infection in a patient with extensive bullous pemphigoid was clarified by the use of an interferon-γ release assay after equivocal tuberculin skin test results. Conclusion: Interferon-γ release assays are useful adjuncts to the tuberculin skin test in the diagnosis of latent tuberculosis infection in the setting of extensive cutaneous disease.
Work-Related Lost Productivity and Its Economic Impact on Canadian Patients with Moderate to Severe Psoriasis
Authors: Chan Brian , Hales Brigette , Shear Neil , Ho Vincent , Lynde Charles , Poulin Yves , Mittmann Nicole 
Published: March 2015

Background: Psoriasis impacts many different areas of a patient's life, including work productivity. There is no information regarding lost productivity owing to psoriasis in a Canadian population. Objective: The objective of this study was to determine the lost productivity of Canadian patients with moderate to severe psoriasis. Methods: Seventy-nine consecutive Canadian dermatology patients were interviewed and completed the Work Productivity and Activity Impairment Questionnaire (WPAIQ). Results: On average, 2.2 hours (± 5.6 hours) were lost from work per week owing to psoriasis-related events. Absence from work may result in lost mean patient wages of C$2,270.84 per person per year. Total lost wages owing to moderate to severe psoriasis may cost up to approximately $749 million for all moderate to severe psoriasis patients in Canada. Conclusion: The results from our study indicate that moderate to severe psoriasis may have a substantial impact on the work productivity of patients with this disease.
Dermoscopy in Pigmented Squamous Cell Carcinoma
Authors: de Giorgi Vincenzo , Alfaioli Barbara , Papi Federica , Janowska Agata , Grazzini Marta , Lotti Torello , Massi Daniela 
Published: March 2015

Background: The diagnosis of squamous cell carcinoma (SCC) is, generally, a clinical diagnosis, but in some cases, when the lesion is pigmented, as in our case, the differential diagnosis between pigmented SCC and other pigmented skin lesions, in particular melanocytic lesions, is difficult. Dermoscopy may improve the early diagnosis of SCC and thus play a role in its preoperative classification. However, its potential role has been hampered so far by the fact that little is known about the dermoscopic features of pigmented SCC. Objective: We report the case of a rare pigmented SCC dermoscopically mimicking a melanocytic lesion whose dermoscopic features have been investigated. Conclusion: On the basis of the literature and our experience, pigmented SCC can present dermoscopic features typical of melanocytic lesions, such as radial streaks, globules, and homogeneous blue pigmentation, and can lead dermatologists to diagnostic errors.
Skin and Soft Tissue Abscess: 1 Year's Experience
Authors: Nalmas Sandhya , Bishburg Eliahu , Shah Monica , Chan Trini 
Published: March 2015

Background: The incidence of skin and soft tissue abscesses (SSTAs) has increased owing to the emergence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). Some of these patients are treated as outpatients (OPs) and some as inpatients (IPs). Objective: To review the microbiology and clinical features of SSTAs and the clinical parameters that may have influenced clinicians to treat patients as IPs. Methods: The study was conducted in a 673-bed teaching hospital between January and December 2005. A retrospective chart review of patients identified from a microbiology culture log was conducted. Data were collected for demographics, underlying disease, SSTA number and site, recurrence rates, and clinical presentation. Results: One hundred thirty-eight patients were identified; 76 (55%) were female, with a mean age of 42 years (range 18–80 years); 76 (55.5%) had no underlying disease, 27 (19.6%) had diabetes, 20 (14.5%) had human immunodeficiency virus (HIV) infection, and 13 (9.4%) were intravenous drug users. Common SSTA sites involved were the perineal area (43; 31.2%), upper extremities (35; 25.4%), lower extremities (19; 13.8%), head and neck (14; 10.1%), chest (13; 9.4%), and abdomen (8; 5.8%). Conclusions: CA-MRSA was the most commonly isolated organism overall and in patients treated as OPs. The decision to treat SSTA patients as IPs seems to be influenced by SSTA number and site and the presence of fever at presentation. SSTA number and site (variables that led to the decision to treat patients as IPs) were confirmed by demonstrating statistical significance in the analysis between the IP and OP groups, but the other determinant of admission, the presence of fever at presentation, was based on chart review statements and not confirmed by statistical analysis between the IP and OP groups.