bluuebunny/crossref_metadata_2025_split huggingface dataset:
Successful Treatment of Hidradenitis Suppurativa with Infliximab in a Patient Who Failed to Respond to Etanercept
Authors: Poulin Yves 
Published: March 2015

Background: Hidradenitis suppurativa (HS) is a devastating chronic scarring disease of the axillae, groins, and submammary tissue occurring predominantly in women, with onset at puberty. Multiple treatments have been attempted, with limited success. The association of HS with Crohn disease, psoriasis (PSO), and pyoderma gangrenosum, as well as the seronegative arthropathies, suggests a common immunopathogenesis and has motivated attempts at treatment with anti-tumor necrosis factor (TNF)-α agents, already demonstrated to be efficacious in major inflammatory diseases. Objective: To report on the clinical evolution of a patient with HS and PSO treated with infliximab who had failed to respond to etanercept and to discuss the possible mechanism responsible for the outcome. Methods: We describe the medical history, diagnostic tests, and clinical evolution of a 25-year-old woman with HS and psoriasis treated with infliximab. Results: The patient demonstrated a rapid and complete response with infliximab for the HS and PSO, sustained for 24 months. Conclusion: The success of anti-TNF agents such as infliximab in managing HS offers a new therapeutic option and supports an underlying immunologic basis for the disease. The differential response to HS observed with infliximab and etanercept in this patient could be related to differences in structure, binding specificities, or gene suppression.
A Wolf in Sheep's Disguise: Rhabdomyosarcoma Misdiagnosed as Infantile Hemangioma
Authors: Al-Mubarak Luluah , Al-Khenaizan Sultan 
Published: March 2015

Background: Rhabdomyosarcomas are a heterogeneous group of malignant tumors representing the most common soft tissue sarcoma of childhood. A delay in diagnosis is not uncommon. Objective: To report a boy with paranasal rhabdomyosarcoma who was misdiagnosed and treated for infantile hemangioma. Methods and Results: A 2-year-old Saudi boy who presented with a progressively increasing nasal mass for 18 months was misdiagnosed and treated for infantile hemangioma at an outside hospital. Histopathologic examination revealed paranasal rhabdomyosarcoma. Conclusion: We review some clinical clues that can alert the physician to malignant childhood tumors. We also review management options for childhood rhabdomyosarcoma.
Effect of Quality of Life Impact and Clinical Severity on Adherence to Topical Acne Treatment
Authors: Tan Jerry K.L. , Balagurusamy Madhan , Fung Karen , Gupta Aditya K. , Thomas D. Richard , Sapra Sheetal , Lynde Charles , Poulin Yves , Gulliver Wayne , Sebaldt Rolf J. 
Published: March 2015

Background: Topical medications are the most commonly prescribed treatments for acne patients. However, adherence to these treatments and possible associations with clinical severity and quality of life (QoL) impact are unclear. Purpose: We evaluated the association between sociodemographic factors, clinical severity, and QoL impact and adherence to topical acne treatments. Methods: This was an observational study of acne patients referred for usual care to community-based dermatologists. Adherence was assessed with questionnaires after 2 months of acne therapy. The associations of adherence with factors of interest were evaluated by chi-square analysis and Spearman rank correlation. Results: In 152 acne patients treated with topical medications, low adherence was observed in 26%, medium in 49%, and high in 24%. Age, gender, duration of acne, education level, third-party drug plan coverage, smoking history, recreational drug use, ingestion of alcohol, and number of prescribed topical agents were not significantly associated with adherence. Adherence was significantly positively correlated with QoL impact ( r = .24, p = .003), with the role-emotional and self-perception domains having the highest correlations. In contrast, adherence was weakly negatively correlated with facial acne severity ( r = .16, p = .047). Limitations: This study focused on facial acne, and adherence was based on patient reporting. Conclusions: Adherence to topical acne therapy increases with impact on QoL but decreases with increasing acne severity.
Aphthous Vulvar Ulcers in Adolescent Girls: Case Report and Review of the Literature
Authors: Lai Kimberly , Lambert Emily , Mercurio Mary Gail 
Published: March 2015

Background: Aphthous vulvar ulcers are painful ulcerations on the genital mucosa frequently accompanied by systemic symptoms. They are most commonly reported in young women and adolescents without a history of sexual contact. Diagnosis is made by exclusion of more common causes, and treatment for this self-limited condition is mainly symptomatic. Objective: Clinicians should be aware of this rare condition to avoid misdiagnoses and unwarranted investigations into sexual abuse or false accusations of sexual activity. Methods: We report a case of an 11-year-old girl with systemic symptoms and vulvar ulcers of unknown etiology. Results: The patient's illness was consistent with previous reports that vulvar ulcers can occur without sexual transmission or a documented infectious cause. Conclusion: A lack of general knowledge regarding this entity may lead to its exclusion from the differential diagnosis of vulvar ulcers in this patient population. Aphthous ulcers should be strongly considered in any adolescent with vulvar ulcers.
The Burden of Psoriasis in Canada: Insights from the p

S

oriasis

K

nowledge

IN

Canada (SKIN) Survey
Authors: Lynde Charles W. , Poulin Yves , Guenther Lyn , Jackson Christine 
Published: March 2015

Background: Although some data addressing the burden of illness associated with psoriasis and psoriatic arthritis (PsA) have been reported for American and European patient populations, similar data have been lacking for Canadians with these diseases. Objective: We sought to characterize the natural history of disease in a sample of Canadians with a history of moderate to severe psoriasis, with or without diagnosed PsA or other recognized comorbid conditions, and to identify factors that influenced their perception of psoriasis as a problem in their daily lives. Methods: A nationwide telephone survey, pSoriasis Knowledge IN Canada (SKIN), was conducted between April 30 and June 2, 2007, on 500 people who indicated that they had been diagnosed with psoriasis and that their skin lesions had at some time affected an area at least as large as three palms of their hand (3% of body surface area [BSA]). Results: The mean age at diagnosis for psoriasis among SKIN survey respondents was 28 years, with 31% (155 of 500) indicating that they developed the disease prior to age 18 years. At the time of the survey, 54% (269 of 500) of respondents were experiencing lesions affecting a BSA equivalent to at least three palms (3%). In response to questions on the burden of illness, 35% (176 of 500) of respondents indicated that they considered psoriasis to be a substantial problem in their daily life. Both affected BSA at the time of the survey and self-reported extent of skin involvement at the height of the condition (BSAmax) correlated with the perception of psoriasis as a substantial problem. Other subpopulations in which psoriasis was commonly identified as a substantial problem included women and individuals with diagnosed PsA. Whereas 18% (88 of 500) of respondents were diagnosed with PsA, the number who reported joint pain or stiffness was substantially higher (51%; 256 of 500), suggesting that some respondents may have had incipient or undiagnosed PsA. Conclusions: This survey reveals that psoriasis, PsA, and their associated comorbidities impose a severe burden on the daily lives of Canadians with a history of moderate to severe psoriasis.
Ethyl Chloride Spray for Sensory Relief for Botulinum Toxin Injections of the Hands and Feet
Authors: Richards Robert N. 
Published: March 2015

Background: Botulinum toxin injections are effective in the treatment of palmar and plantar hyperhidrosis, but discomfort has limited its use. Objective: To study the use of ethyl chloride medium-stream spray in reducing injection discomfort. Methods: We used ethyl chloride medium-stream spray, in conjunction with precooling by frozen ice packs, in our No Sweat Clinic for our most recent 51 consecutive cases of botulinum toxin injection. Results: Ethyl chloride spray greatly facilitated the injection procedure, and all patients completed the injections without hesitation or delay. Conclusion: Ethyl chloride medium-stream spray, in conjunction with precooling by frozen ice packs, is highly effective in reducing painful injection sensations. Its use is safe, economical, and easy to learn and does not require special equipment.
Postinflammatory Hyperpigmentation
Authors: Taylor Susan , Grimes Pearl , Lim Joyce , Im Sungbin , Lui Harvey 
Published: March 2015

Background: Postinflammatory hyperpigmentation (PIH) commonly occurs in Fitzpatrick skin types III to VI and can have a considerable impact on quality of life. The majority of cases will improve spontaneously, but this can take months or even years to resolve and in some cases can be permanent. Treatment maybe prolonged, lasting 6 to 12 months or longer for adequate restoration of normal pigmentation. Objective: To review the etiology, pathogenesis, and current therapy options for patients with PIH. Methods: This review is the outcome of a workshop that discussed literature reports of research and developments in the treatment of PIH and associated disease and current clinical practice. Results: Combination products containing hydroquinone and retinoids appear to be the most beneficial treatment options, although there are few evidence-based studies for PIH. Conclusion: More randomized controlled clinical studies in large numbers of PIH patients are needed to provide standardized measurable outcomes in this indication.
Update on Intralesional Steroid: Focus on Dermatoses
Authors: Richards Robert N. 
Published: March 2015

Background: Intralesional steroid (ILS; usually triamcinolone acetonide) is commonly used, and the literature contains much information about its use in keloids, hemangiomas, and alopecia areata. Little has been written about its use in inflammatory dermatoses such as psoriasis and localized dermatitis since the 1960s, the conditions for which it was originallymost studied and used. Objective: To clarify the use of ILS and to encourage its use in psoriasis and localized dermatitis. Methods: Medline peer-reviewed literature in English (1956–2008) was searched for the use of ILS in all skin diseases. Six standard textbooks of dermatology were reviewed. Information as to how they used ILS was obtained from a questionnaire completed by 33 dermatologists and from personal discussions with 15 other dermatologists. Additional information was obtained from 40 years of personal ILS use and from observation of 42 dermatologists working intermittently in our office over the past 25 years. ILS product package inserts and company drug monographs were reviewed. Results: ILS is used by most dermatologists, but there are considerable divergences in technique and dosing. Current textbooks contain little on its use in psoriasis and localized dermatitis. There have been no clinical studies since the 1960s, and their end points and descriptions were somewhat vague by today's standards. Product package inserts are dated and not helpful. Nevertheless, the use of ILS is safe and economical, and the original authors and our office have found it consistently to be virtually 100% effective at 2.5 mg/mL in small plaques of psoriasis on the trunk and limbs and highly effective in localized dermatitis (such as lichen simplex chronicus, prurigo nodularis, and nonspecific eczema). Clinical studies indicate that we can safely increase our ILS from the usual 3 cc (7.5 mg) to 6 cc (15 mg) or even to 8 cc (20 mg) for patients over 50 kg every 3 to 4 weeks. Serum cortisol can be performed if there are concerns about adrenal suppression, with use in periorbital hemangiomas and with intranasal ILS. Blindness (from central artery occlusion) was reported with injections of ILS around the eyes wih older products during the early development stages; and more recently with the use of ILS for periorbital hemangiomas and with ILS used intranasally. It has never been reported with low pressure injections of ILS using triamcinalone acetonide at 2.5 mg around the eyes. Limitations: No formal clinical studies since the 1960s. Poor statistical end points. Conclusions: ILS at 2.5 mg/cc is safe, economical, and effective and its greater use should be encouraged in inflammatory dermatoses such as psoriasis and localized dermatitis. Further well-designed research would be helpful.
Cost Comparison of Psoriasis Treatments
Authors: Mikhael Dalia , Babcock Kelly , DesGroseilliers Jean-Pierre 
Published: March 2015

Background: Knowledge of the cost of various psoriasis therapeutic options is essential to the prescribing clinician. Objective: To compare the cost of various psoriasis treatments over a 10-year period in the province of Ontario, Canada. Methods: We used a hypothetical patient with plaque-type psoriasis of moderate severity with a Psoriasis Area and Severity Index of 10, body surface area of 20%, and no joint involvement. The costs to treat this hypothetical patient with different therapeutic regimens were compared in this study. Results: In a 60 kg patient, alefacept was the most costly form of therapy, based on two 12-week treatments per year, followed by infliximab 5 mg/kg. In a 90 kg patient, infliximab 5 mg/kg was the most costly, followed by alefacept. The least costly treatment was ultraviolet B phototherapy. Conclusion: With the knowledge of these data, informed prescribing by the dermatologist may reduce the financial burden to the patient, the provincial health care system, and insurance companies.
Mycosis Fungoides in the Pediatric Population: Report from an International Childhood Registry of Cutaneous Lymphoma
Authors: Pope Elena , Weitzman Sheila , Ngan Bo , Walsh Scott , Morel Kimberly , Williams Judith , Stein Sarah , Garzon Maria , Knobler Elizabeth , Lieber Colette , Turchan Kirsten , Wargon Orli , Tsuchiya Arline 
Published: March 2015

Background/Objectives: There are limited data on the clinical presentation and progression of pediatric cutaneous lymphoma. This study focuses on the clinical characteristics of pediatric patients with mycosis fungoides (MF). Materials and Methods: This descriptive study presents clinical characteristics of 22 pediatric patients with MF, enrolled in the international Childhood Registry for Cutaneous Lymphomas (CRCL). Results: The mean ages at onset and at diagnosis were 7.5 (SD 3.8 years) years and 9.9 (SD 3.4) years, respectively. The most common MF presentation was patch stage (68%), followed by hypopigmentation (59%) and plaque stage disease (50%). Epidermotropism and lymphocytic atypia were the most common pathologic features, found in 89% and 85%, respectively. Cerebriform nuclei were noted in 42%, and Pautrier microabscesses were seen in 16% of cases. A cytotoxic pattern was more commonly seen (67% vs 33%), and clonality was detected in 21% (3 of 14) of patients. All patients presented with early-stage disease and received skin-directed therapy (topical steroids, 73%; light therapy, 54%; or combination therapy, 35%). Conclusions: Pediatric patients with MF present in the first decade of life, with early-stage disease and unusual forms such as hypopigmented variant. Further patient enrolment will provide information regarding natural history, treatment response, and overall prognosis of pediatric cutaneous T-cell lymphoma (CTCL).
Giant Cutaneous Plasmacytoma of the Sacrococcygeal Region
Authors: Ioannidis Orestis , Kakoutis Emmanouil , Varnalidis Ioannis , Tamouridis George , Chatzichristou Aristidis , Tzarou Valasia , Makrantonakis Nikolaos 
Published: March 2015

Background: Cutaneous plasmacytoma is a very rare manifestation of extramedullary plasmacytoma, with only 32 cases having been reported so far in the last 60 years. Extramedullary plasmacytoma is a plasma cell tumor that involves soft tissues, without any signs of systemic spread of multiple myeloma or bone marrow involvement. The cutaneous lesions usually range in diameter from 1 to 5 cm and can be treated with radiotherapy or surgical excision. Objective and Conclusion: We present a case of a giant cutaneous plasmacytoma of the sacrococcygeal region with a diameter of 12 cm that was treated with surgical excision.
Children with Atopic Dermatitis Do Not Have More Anxiety or Different Cortisol Levels Compared with Normal Children
Authors: Afsar F. Sule , Isleten Figen , Sonmez Nihal 
Published: March 2015

Background: The hypothalamic-pituitary-adrenal axis has an important immunoregulatory role under stress, and stressmediated anxiety has been reported to be associated with alterations in immune functions and attenuated cortisol levels in atopic dermatitis (AD) patients. Objective: We investigated serum basal cortisol and anxiety levels in pediatric AD patients and compared them with those of controls. Methods: Basal serum cortisol levels were measured in 36 pediatric AD patients (aged 9–16 years) and 36 control subjects (aged 9–15 years). Anxiety was assessed by the trait anxiety subscale (TAI-C) of the State-Trait Anxiety Inventory for Children. The severity of AD was assessed by the objective severity scoring of AD (SCORing Atopic Dermatitis [SCORAD]). Results: Data analysis showed no statistical difference for the basal serum cortisol levels ( p = .383) and the TAI-C ( p = .730) between the two groups. No significant correlation was found between the basal cortisol values and the TAI-C scores in the AD group ( p = .290). The SCORAD index was correlated with the TAI-C scores ( p < .05) but not correlated with the basal serum cortisol values in AD patients ( p = .06). Conclusion: Children with AD do not have more anxiety or different cortisol levels when compared with normal children, but the severe symptomatology of AD itself may cause anxiety levels to increase in children with AD.
Naturally Occurring Isohexenylnaphthazarins and Wound Healing: Experimental Study in Dogs
Authors: Karayannopoulou Maria , Loukopoulos Panagiotis , Papazoglou Lysimachos G. , Tsioli Vassiliki , Anagnostou Tilemahos L. , Assaloumidis Nikolaos , Constantinidis Theodocos C. , Assimopoulou Andceana N. , Kaldrymidou Eleni , Papageorgiou Vassilios P. 
Published: March 2015

Background: The healing efficacy of isohexenylnaphthazarins (IHN) has been well proved on chronic or contaminated wounds. Objective: To evaluate the wound healing activity of an experimental ointment containing IHN on acute and noncontaminated wounds in dogs. Methods: In each of six beagle dogs, four full-thickness skin defects were created bilaterally: one 2 × 2 cm defect on the lateral aspect of each arm for subjective evaluation, laser Doppler flowmetry (LDF), and planimetry and three 1.5 × 1.5 cm defects on opposite sides of the dorsal midline for histologic evaluation. Wounds on the left were treated with an ointment based on IHN and on the right with another based on petroleum jelly (Vaseline) and beeswax. Results: Wound size decreased significantly in both sides. The significantly increased percentage of epithelialization was higher ( p = .0274) in the petroleum jelly–treated wounds on day 20. Tissue perfusion (LDF) increased significantly bilaterally in the center of the wound but only in the IHN-treated side cranial to the wound. Histologically, angiogenesis was significantly higher ( p = .0431) on day 5 in the IHN-treated wounds compared with the petroleum jelly–treated wounds. Collagen production increased significantly bilaterally. Conclusion: The IHN-based ointment promoted some of the proliferative processes, but it did not enhance the overall wound healing of acute, surgically created wounds in dogs.
Frontal Fibrosing Alopecia: To Treat or Not to Treat?
Authors: Rallis Eustathios , Gregoriou Stamatis , Christofidou Eleftheria , Rigopoulos Dimitrios 
Published: March 2015

Background: Published studies have evaluated a variety of therapeutic agents in frontal fibrosing alopecia (FFA); however, data on whether fibrosis is already established when the patients initially present are scarce. Objective: To identify the prevalence of active disease in patients initially diagnosed with FFA and to evaluate the efficacy of therapeutic agents suggested in the medical literature. Patients/Methods: Eighteen postmenopausal women with FFA presented at the outpatient clinic of our hospital from June 2003 to August 2007. Five patients who also presented with androgenetic alopecia were treated with finasteride 2.5 mg/d plus minoxidil 5% for 12 months. One patient with a rapidly regressing disease received systemic corticosteroids. The remaining 12 patients were divided into two groups: 6 patients received topical clobetasol 0.05% solution once daily for 6 months and the rest received no treatment. Results: Thirteen of 18 patients presented with stable disease. No significant improvement was observed in any of the patients. Conclusion: To date, there is no effective treatment proven with an appropriate level of evidence in the management of FFA. Exclusion criteria in future clinical studies should take into account patients presenting with stable disease. What needs to be established is whether treatment can halt or slow the progression of active disease.
Statins and “Chameleon-Like” Cutaneous Eruptions: Simvastatin-Induced Acral Cutaneous Vesiculobullous and Pustular Eruption in a 70-Year-Old Man
Authors: Adams Amy E. , Bobrove Arthur M. , Gilliam Anita C. 
Published: March 2015

Background: The statin medications for lowering of blood cholesterol can be associated with cutaneous lichenoid reactions but also a variety of other adverse cutaneous eruptions, including Stevens-Johnson syndrome, toxic epidermolytic necrolysis, porphyria cutanea tarda, linear IgA bullous dermatosis, and reaction patterns (lupus and dermatomyositis-like and pustular). Cutaneous eruptions (“eczema” in the product literature) owing to simvastatin are reported in approximately 1.5% individuals compared with placebo. Objective: To correlate the clinical and microscopic features of an unusual vesiculobullous reaction to simvastatin. Methods: Retrospective analysis of clinical information and skin biopsies. Results: We present the case of a 70-year-old man with chronic vesiculobullous and pustular annular lesions on distal arms, legs, hands, and feet for 2 years. The eruption was recalcitrant to potent topical corticosteroids. Multiple biopsies at different times showed a spongiotic and lichenoid hypersensitivity reaction resembling contact dermatitis, purpuric drug eruption, and pustular folliculitis. The common themes in the histopathology were spongiosis with microvesiculation, focal lichenoid infiltrates, dermal hemorrhage, and chronic superficial inflammatory cell infiltrates with eosinophils. The eruption began when simvastatin was started, improved when it was stopped, recurred with rechallenge, and cleared when simvastatin was discontinued. Conclusions: Acral cutaneous vesiculobullous eruption is an uncommon adverse drug eruption due to simvastatin, one of many different patterns possible. A high level of suspicion for an unexplained cutaneous eruption in an older individual on statins is important to identification of the disorder and discontinuation of the offending medication.