Dermatologic Therapy via MedWorm.com

Intralesional vincristine combined with cryotherapy for recalcitrant verrucas

Dermatologic Therapy — Sat, 30 Apr 2011 23:00:00 +0100

ABSTRACTVerrucas are often recalcitrant to conventional cryotherapy. Since 1970, intralesional bleomycin has been used off‐label by dermatologists. But in some cases, the results of intralesional bleomycin were disappointing. Vincristine is a well‐known vinca alkaloid antiblastic drug that has been used for treating hematological neoplasm and nephroblastomas. It was reported good efficacy of intralesional vincristine for treating nodular lesion in classic Kaposi sarcoma. Its use in epithelial neoplasm and Kaposi sarcoma may support its efficacy in recalcitrant verrucas. The three patients selected for the study presented severe verrucas on foot, and they had already undergone cryotherapy several times and there was no improvement. They got intralesional vincristine injection on their v...

Lupoid leishmaniasis of the nose responding well to cryotherapy

Dermatologic Therapy — Sat, 30 Apr 2011 23:00:00 +0100

(Source: Dermatologic Therapy)

Imiquimod 5% cream for the treatment of nasal lesion of metastatic renal cell carcinoma

Dermatologic Therapy — Sat, 30 Apr 2011 23:00:00 +0100

ABSTRACTMany reports have shown the efficacy of topical imiquimod in patients with skin carcinoma. This effect is based on the activity of imiquimod as an immune‐response modifier. The present authors hypothesized that this agent could also be used to treat skin metastatic lesion from renal cell carcinoma. The present authors report the case of a 54‐year‐old man who presented with a metastasis renal cell carcinoma lesion on his nose. He had a history of right nephrectomy performed 4 years previously. The present authors started him on topical treatment with imiquimod 5% cream three times a week for his nose lesion. A reduction of the lesion was observed after 2 months, and during the following 12 months no sign of recurrence was observed. (Source: Dermatologic Therapy)

Histopathology of alopecia areata, acute and chronic: Why is it important to the clinician?

Dermatologic Therapy — Sat, 30 Apr 2011 23:00:00 +0100

ABSTRACTAlopecia areata (AA) is often easy to diagnose but a scalp biopsy for horizontal sectioning is routine in this research clinic. The characteristic histological feature of AA is the peribulbar and intrabulbar mononuclear cell infiltrate, which occurs in the acute stage of the disease but may be absent in biopsies taken at a later stage. AA evolves through acute, subacute, chronic, and recovery phases. Increased numbers of terminal catagen and telogen hairs are found in the acute and perhaps subacute stages with increased numbers of miniaturized, vellus‐like hairs in the subacute and chronic stages. Thus, it is important for clinicians and pathologists to recognize the different phases of AA, so that in the absence of the classic findings of a peribulbar lymphocytic infiltrate, a d...

Treatment of alopecia areata: “What is new on the horizon?”

Dermatologic Therapy — Sat, 30 Apr 2011 23:00:00 +0100

ABSTRACTNew drug treatment opportunities based on the results of a genome‐wide association study, which implicate T cell and natural killer (NK)‐cell activation pathways, are leading to new approaches in future clinical trials of alopecia areata. Special attention is being given to the UL 16‐binding protein (ULBP3) gene cluster on chromosome 6q25, as these genes make the NKG2D‐activating ligand or signal that can trigger the NKG2D receptor, initiating an autoimmune response. A greater expression of ULBP3 has also been found in hair follicles in scalp biopsy specimens from patients with active disease. It is now postulated that the characteristic T cell “swarm of bees” infiltrate seen in alopecia areata is the result of T cells being attracted to the hair follicle by NKG2D‐act...

Topical and intralesional therapies for alopecia areata

Dermatologic Therapy — Sat, 30 Apr 2011 23:00:00 +0100

This article will review the available topical and intralesional agents that are used in the treatment of alopecia areata and suggest a management approach based on the age of the patient and extent of the disease. (Source: Dermatologic Therapy)

Alopecia areata: Clinical presentation, diagnosis, and unusual cases

Dermatologic Therapy — Sat, 30 Apr 2011 23:00:00 +0100

ABSTRACTAlopecia areata (AA) is a nonscarring hair loss disorder with a 2% lifetime risk. Most patients are below 30 years old. Clinical types include patchy AA, AA reticularis, diffuse AA, AA ophiasis, AA sisiapho, and perinevoid AA. Besides scalp and body hair, the eyebrows, eyelashes, and nails can be affected. The disorder may be circumscribed, total (scalp hair loss), and universal (loss of all hairs). Atopy, autoimmune thyroid disease, and vitiligo are more commonly associated. The course of the disease is unpredictable. However, early, long‐lasting, and severe cases have a less favorable prognosis. The clinical diagnosis is made by the aspect of hairless patches with a normal skin and preserved follicular ostia. Exclamations mark hairs and a positive pull test signal activity. D...

Etiopathogenesis of alopecia areata: Why do our patients get it?

Dermatologic Therapy — Sat, 30 Apr 2011 23:00:00 +0100

This article provides some insights into the etiopathogenesis of AA and why some people develop it. The current knowledge on the pathogenesis of AA is summarized and some of the recent hypotheses and studies on AA are presented to allow for a fuller understanding of the possible biological mechanisms of AA. (Source: Dermatologic Therapy)

The genetics of alopecia areata: What's new and how will it help our patients?

Dermatologic Therapy — Sat, 30 Apr 2011 23:00:00 +0100

ABSTRACTIn the United States, alopecia areata (AA) is the most prevalent autoimmune disease, affecting approximately 5.3 million people, including males and females of all ages and across all ethnic groups. AA affects more individuals than most other autoimmune diseases combined, and yet despite its prevalence, there is little information on the underlying pathogenesis and there are currently no evidence‐based treatments available to treat or cure this disease. Genetics has provided a valuable tool for gaining insight into disease pathology. We recently completed the first genome‐wide association study (GWAS) in AA and successfully identified at least eight regions in the genome with evidence for association to AA. Importantly, this work identifies a discrete set of genes, some of whic...

Systemic treatment for alopecia areata

Dermatologic Therapy — Sat, 30 Apr 2011 23:00:00 +0100

ABSTRACTOf the world population, 1.7% is suffering from alopecia areata at some point in their lives. The exact etiology of this disease is still unknown, and the course of the disease is unpredictable. Effective treatments, especially for severe multifocal alopecia areata, alopecia areata totalis, and alopecia areata universalis, are lacking. The present article will discuss side effects and relapse rates of different systemic agents for treatment of severe and rapid progressive alopecia areata. (Source: Dermatologic Therapy)

Investigative guidelines for alopecia areata

Dermatologic Therapy — Sat, 30 Apr 2011 23:00:00 +0100

This report will give both the investigator and clinician guidelines for clinical trial design that will take into account variables known to effect efficacy results such as baseline severity, pattern, and duration of hair loss, age of the subject, and concomitant conditions that may impact on potential regrowth. Reliable methods of assessment of efficacy and response criteria that will enable direct comparison of results between agents will also be discussed. (Source: Dermatologic Therapy)

Camouflage technique for alopecia areata: What is a patient to do?

Dermatologic Therapy — Sat, 30 Apr 2011 23:00:00 +0100

This article discusses the currently available options for those who wish to pursue camouflage of hair loss involving the scalp, eyebrows, and eyelashes. (Source: Dermatologic Therapy)

Alopecia areata: Support groups and meetings – how can it help your patient?

Dermatologic Therapy — Sat, 30 Apr 2011 23:00:00 +0100

ABSTRACTMany people with alopecia areata find the fellowship of the support groups provides them with the help they need to cope. They find that they are not alone, how others have coped, what doctors and treatments have been tried, and what the results have been. The National Alopecia Areata Foundation offers support groups throughout the world to refer patients. (Source: Dermatologic Therapy)

Dermatologic therapy: Alopecia areata update

Dermatologic Therapy — Sat, 30 Apr 2011 23:00:00 +0100

(Source: Dermatologic Therapy)

THERAPEUTIC HOTLINE: Genetic variations in the androgen receptor gene and finasteride response in women with androgenetic alopecia mediated by epigenetics

Dermatologic Therapy — Tue, 01 Mar 2011 00:00:00 +0100

ABSTRACTWhen studies of postmenopausal women with hair loss failed to reveal a response to the 5 alpha reductase inhibitor, finasteride, researchers began to question the existence of androgenetic alopecia in women and renamed the clinical entity female pattern hair loss. However, recently published reports of finasteride response in some women with hair loss suggest that an androgenic mechanism is mediating response in this group. Variant repeat nucleotide sequences in exon 1 of the androgen receptor (AR) gene have been shown to determine androgen sensitivity in a variety of androgenic conditions in men and women. In an effort to identify whether this AR variant may help determine which women are likely to respond to finasteride therapy, a pilot study was undertaken. In our 6‐month pilo...

THERAPEUTIC HOTLINE: Does isotretinoin have effect on vitamin D physiology and bone metabolism in acne patients?

Dermatologic Therapy — Tue, 01 Mar 2011 00:00:00 +0100

ABSTRACTIsotretinoin is an effective therapy for severe nodulocystic acne. Several experimental studies suggest that it may have an effect on vitamin D physiology. In the present study, the authors aimed to investigate the effect of isotretinoin treatment on the metabolism of vitamin D in acne patients. A prospective analysis of 50 consecutive acne patients who were treated with isotretinoin for 3 months was done. Before and after 3 months of treatment, 25 hydroxy vitamin D, 1,25 dihydroxy vitamin D, and bone alkaline phosphatase, calcium, phosphate, and parathormone levels were measured. The 25 hydroxy vitamin D and serum calcium levels decreased significantly (p < 0.0001, p < 0.05, respectively), whereas 1,25 dihydroxy vitamin D, parathormone, and bone alkaline phosphatase levels i...

THERAPEUTIC HOTLINE: Abatacept: our experience of use in two patients with refractory psoriasis and psoriatic arthritis

Dermatologic Therapy — Tue, 01 Mar 2011 00:00:00 +0100

ABSTRACTThe B7 family of molecules on antigen presenting cells (APCs) regulate T cell activation. They deliver stimulatory signals through CD28 and inhibitory signals through CD152, or cytotoxic T lymphocyte‐associated antigen‐4 (CTLA‐4). CTLA4Ig (abatacept) is a soluble chimeric protein consisting of the extracellular domain of human CD152 linked to the modified Fc portion of human IgG1. By binding to B7‐1 (CD80) and B7‐2 (CD86) molecules on APCs, CTLA4Ig blocks the CD28‐mediated costimulatory signal for T cell activation. Success with abatacept has been noted in psoriasis. Abatacept was administered to two patients with refractory psoriasis and psoriatic arthritis after the patients had failed all conventional treatment methods. Both patients experienced very brief improvemen...

THERAPEUTIC HOTLINE: Treatment of pityriasis rubra pilaris with etanercept

Dermatologic Therapy — Tue, 01 Mar 2011 00:00:00 +0100

ABSTRACTPityriasis rubra pilaris (PRP) or Devergie's disease is a chronic and rare papulosquamous disorder of unknown etiology characterized by reddish orange scaly plaques, palmoplantar keratoderma, and keratotic follicular papules. The present authors report a case of a 30‐year‐old woman with clinical and histologic signs of PRP (type I adult onset, Griffith's classification). After a few unsuccessful treatments, the present authors chose to start etanercept. Total clearing of the lesions was achieved 5 months after starting the drug. Etanercept is a TNF‐α inhibitor, and today it is largely used in the treatment of several dermatological diseases through blockage of the inflammatory cytokine. The true mechanism of action in PRP remains to be explained; however, the favorable resul...

Diagnosis and treatment of the neutrophilic dermatoses (pyoderma gangrenosum, Sweet's syndrome)

Dermatologic Therapy — Tue, 01 Mar 2011 00:00:00 +0100

ABSTRACTNeutrophilic dermatoses include a spectrum of disorders with similar histologic appearance and pathologic processes. Clinically, however, they have different physical manifestations and associations. This group includes two diseases for which dermatologists are commonly consulted in the hospital, namely pyoderma gangrenosum and acute febrile neutrophilic dermatosis, or Sweet's syndrome. Evaluation is challenging, and many therapeutic approaches have been described for both. The previously reported diagnostic criteria, physical descriptions, differential diagnosis, workup, and treatment options are reviewed. A practical approach to pyoderma gangrenosum and Sweet's syndrome for the provider is described. (Source: Dermatologic Therapy)

Cutaneous community‐acquired and hospital‐acquired methicillin‐resistant Staphylococcus aureus

Dermatologic Therapy — Tue, 01 Mar 2011 00:00:00 +0100

ABSTRACTThe clinical presentation of methicillin‐resistant Staphylococcus aureus (MRSA) infection ranges from asymptomatic colonization to cutaneous and invasive involvement. This review discusses the cutaneous presentations of community‐acquired MRSA (CA‐MRSA) and hospital‐acquired MRSA (HA‐MRSA) that one may encounter in the hospital or outpatient setting. Cutaneous CA‐MRSA and HA‐MRSA are often clinically indistinguishable, although they have different epidemiologic profiles and virulence factors. Bacterial culture is necessary for diagnosis and guides treatment, as infection with CA‐MRSA and HA‐MRSA require distinct clinical management. Guidelines for surgical interventions and antibiotic treatment of CA‐MRSA and HA‐MRSA will be discussed. Strategies for MRSA deco...

Calciphylaxis

Dermatologic Therapy — Tue, 01 Mar 2011 00:00:00 +0100

ABSTRACTCalciphylaxis is a disease in which metastatic calcification affects small‐ and medium‐sized vessels resulting in significant dermatologic manifestations. Lesions typically occur over areas of high fat content and progress to black leathery eschars. Calciphylaxis is associated with intense pain and markedly increased risk of infection, often leading to sepsis requiring hospitalization. Diagnosis is made by clinical history and skin biopsy. Management of calciphylaxis is interdisciplinary, emphasizing factors such as primary prevention, proper wound care, pain control, and hormone and mineral balance. Although calciphylaxis carries a high mortality rate, symptomatic treatment has shown promise as a method for controlling disease progression. (Source: Dermatologic Therapy)

Inpatient management of atopic dermatitis

Dermatologic Therapy — Tue, 01 Mar 2011 00:00:00 +0100

This article will review the indications for inpatient management of AD and the therapies that can be used to acutely manage severe disease and associated complications. (Source: Dermatologic Therapy)

Approach to the neonate with ecchymoses and crusts

Dermatologic Therapy — Tue, 01 Mar 2011 00:00:00 +0100

ABSTRACTPremature and systemically ill infants have a high risk of developing dermatologic infectious complications, displaying the consequences of skin barrier immaturity. Opportunistic infections are an increasing concern in neonates, with cutaneous fungal infections (Aspergillus, Rhizopus, Mucor, Fusarium) observed more commonly as pathogens. Neonates are especially susceptible due to stresses of the perinatal transition to ex‐utero life, stratum corneum immaturity, and medical intervention during early life including intravenous catheters, non‐sterile adhesive dressings, broad spectrum antibiotic use, and systemic corticosteroids for lung disease. Cutaneous presentations of these infections encompass a broad set of morphologies: papules, vesicles, pustules, ecchymoses, and necrotic...

Cellulitis: diagnosis and management

Dermatologic Therapy — Tue, 01 Mar 2011 00:00:00 +0100

ABSTRACTCellulitis is an acute infection of the dermal and subcutaneous layers of the skin, often occurring after a local skin trauma. It is a common diagnosis in both inpatient and outpatient dermatology, as well as in the primary care setting. Cellulitis classically presents with erythema, swelling, warmth, and tenderness over the affected area. There are many other dermatologic diseases, which can present with similar findings, highlighting the need to consider a broad differential diagnosis. Some of the most common mimics of cellulitis include venous stasis dermatitis, contact dermatitis, deep vein thrombosis, and panniculitis. History, local characteristics of the affected area, systemic signs, laboratory tests, and, in some cases, skin biopsy can be helpful in confirming the correct ...

Cutaneous graft‐versus‐host disease: rationales and treatment options

Dermatologic Therapy — Tue, 01 Mar 2011 00:00:00 +0100

ABSTRACTThe treatment of cutaneous graft‐versus‐host disease (GVHD) is one of the most challenging clinical scenarios in a dermatological practice. Given the significant risk of morbidity and mortality in this patient group, it is important for a dermatologist to understand the pathophysiology of GVHD, as well as their role within a multidisciplinary practice where many immunosuppressants are prescribed. A significant proportion of the patients with GVHD will require a combination treatment regimen in order to stem the progression of their disease. In this review, the stages, type of GVHD and treatment options are reviewed for the dermatologist. (Source: Dermatologic Therapy)

Stevens–Johnson syndrome and toxic epidermal necrolysis: a review of treatment options

Dermatologic Therapy — Tue, 01 Mar 2011 00:00:00 +0100

ABSTRACTStevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous reactions that are medication‐induced in most instances. While the clinical manifestations of SJS and TEN are well‐defined, the optimal treatment for these disorders is not. Case reports have shown benefit with the use of a variety of agents including tumor necrosis factor‐alpha inhibitors and cyclophosphamide, whereas thalidomide was associated with an increased mortality. Plasmapheresis and cyclosporine have also demonstrated efficacy anecdotally, albeit with an even smaller number of cases in the literature. Most of the reporting has focused on the use of systemic corticosteroids and intravenous immunoglobulin (IVIG) for these severe reactions. The majority of studies analyzing the u...

Approach to the hospitalized patient with targetoid lesions

Dermatologic Therapy — Tue, 01 Mar 2011 00:00:00 +0100

This article focuses on a practical approach to the patient with targetoid lesions. The discussion focuses on differentiating erythema multiforme from Stevens–Johnson syndrome and toxic epidermal necrolysis. In addition, the article offers a concise review of the broader differential diagnosis of targetoid lesions including ecthyma gangrenosum, fixed drug eruption, erythema multiforme‐like drug reaction, vasculitis, acute hemorrhagic edema of infancy, erythema chronicum migrans, connective tissue diseases, and blistering diseases. (Source: Dermatologic Therapy)

An approach to the hospitalized patient with urticaria and fever

Dermatologic Therapy — Tue, 01 Mar 2011 00:00:00 +0100

ABSTRACTUrticaria is a common skin disorder with a long differential diagnosis. Most cases are readily treated symptomatically and have no systemic implications. However, a number of diseases and syndromes, including vasculitides, immunologic disorders, infectious diseases, hematologic diseases, and autoinflammatory syndromes, can present with urticaria and systemic symptoms, which may lead to hospitalization of the patient. These urticarial syndromes are important to recognize as they often have significant health implications. A comprehensive history and physical exam is important in distinguishing cases of simple urticaria from these syndromes. The presence of atypical wheals, systemic symptoms such as fever or arthralgia, and a lack of response to antihistamine therapy are important di...

Approach to the patient with autoimmune mucocutaneous blistering diseases

Dermatologic Therapy — Tue, 01 Mar 2011 00:00:00 +0100

This article will discuss the diagnosis and available treatments of the major AMBDs. There are very few case‐controlled studies regarding the treatments of these diseases. Most of the treatments used for these diseases are based on anecdotal reports. Hence, a synopsis of the conventional treatments and some brief recommendations will also be discussed. A brief discussion regarding “rescue” therapies that have been used for those patients with more recalcitrant cases of AMBD will also be presented. (Source: Dermatologic Therapy)

An approach to the patient with retiform purpura

Dermatologic Therapy — Tue, 01 Mar 2011 00:00:00 +0100

ABSTRACTRetiform purpura consists of branching purpuric lesions caused by a complete blockage of blood flow in the dermal and subcutaneous vasculature. The differential diagnosis for retiform purpura is broad, including vasculitides of the small and medium vessels as well as microvascular occlusion due to thrombotic, infectious, and embolic phenomena. Determining the etiology of this important dermatologic sign can be a diagnostic challenge; however, an organized approach can improve the speed and accuracy of diagnosis and identify an effective treatment. This review focuses on early recognition, evaluation, and treatment of hospitalized patients with retiform purpura. Specifically, vasculitis, protein C and S deficiencies, heparin necrosis, warfarin necrosis, antiphospholipid antibody syn...

INTRODUCTION: Why perform inpatient consultations?

Dermatologic Therapy — Tue, 01 Mar 2011 00:00:00 +0100

(Source: Dermatologic Therapy)

Chondrodermatitis nodularis chronica helicis and photodynamic therapy: a new therapeutic option?

Dermatologic Therapy — Sat, 01 Jan 2011 00:00:00 +0100

ABSTRACTChondrodermatitis nodularis chronica helicis (CNCH) is a fairly frequent disorder of unknown etiology. Although the elective therapy is surgery, local application of topical steroids, antibiotic ointments, intralesional injection of collagen, cryotherapy, curettage followed by diathermy, and CO2 laser treatment have also been proposed. The aim of the study was to test the utility of photodynamic therapy (PDT) for CNCH. Two patients with painful CNCH underwent PDT with a 635 nm light source for 20 minutes (70 J/cm2) after application of cream containing 20% 5‐aminolevulinic acid (5‐ALA) and occlusion for 3 hours. The lesions decreased considerably in size and pain ceased within a few weeks. The results suggest that this method can be useful for treating CNCH, especially in p...

Intradermal injection of PPD as a novel approach of immunotherapy in anogenital warts in pregnant women

Dermatologic Therapy — Sat, 01 Jan 2011 00:00:00 +0100

ABSTRACTImmunotherapy for treatment of recalcitrant warts was used through different modalities including intralesional injection of purified protein derivative (PPD), which is an extract of Mycobacterium tuberculosis, used for testing exposure to tuberculin protein, either from a previous vaccination or from the environment. This method is used to evaluate the efficacy of a new approach of intradermal injection of PPD in the treatment of anogenital warts in pregnant women. A total of 40 pregnant women, aged 20–35 years, and presented with anogenital warts were enrolled in this study. Human papillomavirus (HPV) typing was done using the GP5+/GP6+ PCR assay. The patients were treated with weekly injections of PPD given intradermally in the forearms, and evaluated for the response regularl...

Improvement of ulcerative pyoderma gangrenosum with hyperbaric oxygen therapy

Dermatologic Therapy — Sat, 01 Jan 2011 00:00:00 +0100

In this report, we present the results of intensive hyperbaric oxygen (HBO) therapy in a 62‐year‐old Greek woman who had been diagnosed with ulcerative PG two years ago, but had been resistant to other therapies. (Source: Dermatologic Therapy)

Candida parapsilosis infection following the electrosurgery procedure

Dermatologic Therapy — Sat, 01 Jan 2011 00:00:00 +0100

We report a case of a patient in whom a C. parapsilosis infection occurred as a complication following a minor electrocoagulation procedure. Because all obtained laboratory findings were nonspecific, the infection could be properly diagnosed only through cultures from the skin lesion. (Source: Dermatologic Therapy)

Novel method of minimally invasive removal of large lipoma after laser lipolysis with 980 nm diode laser

Dermatologic Therapy — Sat, 01 Jan 2011 00:00:00 +0100

This report describes step‐by‐step removal of a large lipoma located on the back, as well as a review of currently employed techniques for minimally invasive treatment of lipomas. (Source: Dermatologic Therapy)

Ultrasound‐guided drainage of a seroma following tumescent liposuction

Dermatologic Therapy — Sat, 01 Jan 2011 00:00:00 +0100

We present a case of seroma formation following liposuction, with a subsequent step‐by‐step technical description of ultrasound‐guided drainage of the seroma. Utilization of ultrasound provides a safe, effective method for aspirating seromas, allowing for accurate visualization and delineation of the seroma margins, proper needle placement, and monitoring of progress. It is a simple and useful tool in postprocedural management of patients undergoing liposuction. (Source: Dermatologic Therapy)

Vertical Vector Face Lift

Dermatologic Therapy — Sat, 01 Jan 2011 00:00:00 +0100

ABSTRACTFacial rejuvenation using local anesthesia has evolved in the past decade as a safer option for patients seeking fewer complications and minimal downtime. Mini‐ and short‐scar face lifts using more conservative incision lengths and extent of undermining can be effective in the younger patient with lower face laxity and minimal loose, elastotic neck skin. By incorporating both an anterior and posterior approach and using an incision length between the mini and more traditional face lift, the Vertical Vector Face Lift can achieve longer‐lasting and natural results with lesser cost and risk. Submentoplasty and liposuction of the neck and jawline, fundamental components of the vertical vector face lift, act synergistically with superficial musculoaponeurotic system plication to r...

Laser hair removal

Dermatologic Therapy — Sat, 01 Jan 2011 00:00:00 +0100

ABSTRACTThe extended theory of selective photothermolysis enables the laser surgeon to target and destroy hair follicles, thereby leading to hair removal. Today, laser hair removal (LHR) is the most commonly requested cosmetic procedure in the world and is routinely performed by dermatologists, other physicians, and non‐physician personnel with variable efficacy. The ideal candidate for LHR is fair skinned with dark terminal hair; however, LHR can today be successfully performed in all skin types. Knowledge of hair follicle anatomy and physiology, proper patient selection and preoperative preparation, principles of laser safety, familiarity with the various laser/light devices, and a thorough understanding of laser–tissue interactions are vital to optimizing treatment efficacy while mi...

MAL‐PDT for difficult to treat nonmelanoma skin cancer

Dermatologic Therapy — Sat, 01 Jan 2011 00:00:00 +0100

ABSTRACTWith an incidence of over 3.5 million nonmelanoma skin cancers (NMSCs) per year in the United States, there is an increasing need for effective, cost‐effective treatments for NMSC. When surgical excision is impractical or not feasible, methyl aminolevulinate photodynamic therapy (MAL‐PDT) has demonstrated consistently high long‐term cure rates ranging from 70–90%, with superior cosmetic outcomes compared with other treatment modalities. With the exception of invasive squamous cell carcinoma, MAL‐PDT has been successful in treating all types of NMSC, especially in patients with multiple comorbidities, field cancerization, and lesions in cosmetically sensitive locations. Herein, a step‐by‐step description of the procedure for MAL‐PDT is provided, followed by a review ...

Soft‐tissue augmentation with hyaluronic acid and calcium hydroxyl apatite fillers

Dermatologic Therapy — Sat, 01 Jan 2011 00:00:00 +0100

ABSTRACTSoft‐tissue augmentation with hyaluronic acid and calcium hydroxyl apatite are among the most widely used minimally invasive cosmetic treatments for the correction of contour deficiencies and wrinkles of the face without the risk, recovery time, and expense of a major surgery. Training and experience in the art and science of fillers is essential for the successful creation of a more youthful and natural appearance. An understanding of the different products, the injection techniques, the indications, and the potential complications of each filler are paramount to success. (Source: Dermatologic Therapy)

Ablative fractional CO2 resurfacing for photoaging of the hands: pilot study of 10 patients

Dermatologic Therapy — Sat, 01 Jan 2011 00:00:00 +0100

ABSTRACTExtrinsic aging of the hands involves alterations in pigmentation, wrinkling, and texture as a result of chronic ultraviolet and environmental exposures. Inherent tissue properties of the skin of the dorsal hand have made it challenging to safely and effectively improve all three parameters of photoaging with a single device. Recent successes with non‐ablative fractional lasers on the hands, as well as success of ablative fractional lasers on the neck and chest, raise the question of potential efficacy of ablative lasers for photorejuvenation of the hands. This was a prospective pilot study of ablative fractional CO2 laser in 10 participants, each receiving three treatments to one hand at 4–6‐week intervals. Subjective assessments by investigator and participants were perform...

Botulinum toxin type A for aging face and aesthetic uses

Dermatologic Therapy — Sat, 01 Jan 2011 00:00:00 +0100

This article also covers the main indications of botulinum neurotoxin type A for aging face and other aesthetic uses, as well as some possible adverse reactions and their management. (Source: Dermatologic Therapy)

Fractionated CO2 laser skin rejuvenation

Dermatologic Therapy — Sat, 01 Jan 2011 00:00:00 +0100

The objective of the study was to review the literature of non‐ablative fractional laser (NAFL) and ablative fractional laser (AFL) resurfacing for the treatment of photoaging. This is a review of the Medline literature evaluating NAFL and AFL for photoaging. Review of the literature supports the use of NAFL and AFL as safe and effective treatments for photoaging. It is likely that the controlled, limited dermal heating of fractional resurfacing initiates a cascade of events in which normalization of the collagenesis/collagenolysis cycle occurs. The advent of fractionated resurfacing for the treatment of photoaging is a significant advance over ablative laser resurfacing treatments, which were complicated by prolonged erythema, delayed onset hypopigmentation, and scarring. (Source: Derma...

Rejuvenation of the neck with liposuction and ancillary techniques

Dermatologic Therapy — Sat, 01 Jan 2011 00:00:00 +0100

This article will review all aspects of neck liposuction, including neck and lower face anatomy, proper patient selection and evaluation, necessary equipment, as well as all peri‐procedural management. An in‐depth discussion of administration of tumescent local anesthesia and proper liposuction technique is also included. Lastly, a number of ancillary techniques to further enhance the appearance of the neck including laser lipolysis, fractional ablative CO2 resurfacing, and treatment of platysmal banding will be briefly discussed. (Source: Dermatologic Therapy)

Facial volume restoration of the aging face with poly‐l‐lactic acid

Dermatologic Therapy — Sat, 01 Jan 2011 00:00:00 +0100

ABSTRACTThe purpose of this article is to discuss current techniques used with poly‐l‐lactic acid to safely and effectively address changes observed in the aging face. Several important points deserve mention. First, this unique agent is not a filler but a stimulator of the host's own collagen, which then acts to volumize tissue in a gradual, progressive, and predictable manner. The technical differences between the use of biostimulatory agents and replacement fillers are simple and straightforward, but are critically important to the safe and successful use of these products and will be reviewed in detail. Second, in addition to gains in technical insights that have improved our understanding of how to use the product to best advantage, where to use the product to best advantage in fa...

In‐office cosmetic procedures

Dermatologic Therapy — Sat, 01 Jan 2011 00:00:00 +0100

(Source: Dermatologic Therapy)

THERAPEUTIC HOTLINE: An alternative adjuvant treatment after ear keloid excision using a custom‐made methyl methacrylate stent

Dermatologic Therapy — Mon, 01 Nov 2010 00:00:00 +0100

ABSTRACTThe efficacy of most pressure devices developed for treatment of ear keloids is limited by the insufficient control of the applied pressure, sometimes causing pain and repeated bleeding with a subsequently increased risk of infections and cosmetic problems. The present study aims to describe the efficacy of the custom‐made methyl methacrylate stent in patients that were surgically treated for ear keloids and afterward underwent pressure therapy. The recurrence rate of the ear keloids was evaluated after at least 12 months. Adjuvant treatment with the methyl methacrylate stent resulted in an 83% success rate in our experience with 23 patients that completed the intended therapeutic duration of 18 months. No cases of severe complications were seen during or after the treatment. Fur...

THERAPEUTIC HOTLINE: Successful treatment of Morbihan's disease with oral prednisolone and doxycycline

Dermatologic Therapy — Mon, 01 Nov 2010 00:00:00 +0100

We report a case of a 45‐year‐old male with no previous history of rosacea who developed bilateral periorbital swelling associated with facial erythema and edema that responded to a combination of oral corticosteroids and doxycycline. Biopsy revealed changes of granulomatous rosacea. (Source: Dermatologic Therapy)

THERAPEUTIC HOTLINE: Primary cutaneous CD4 + small/medium‐sized pleomorphic T cell lymphoma coexisting with myelodysplastic syndrome transforming into chronic myelomonocytic leukemia successfully treated with cyclophosphamide

Dermatologic Therapy — Mon, 01 Nov 2010 00:00:00 +0100

We report a case of primary cutaneous CD4 + small/medium‐sized pleomorphic T cell lymphoma accompanied with myelodysplastic syndrome successfully treated with cyclophosphamide.It seems that cyclophosphamide as a single‐agent chemotherapy in patients with disseminated lesions might be safe and quite effective therapeutic option. (Source: Dermatologic Therapy)

Diagnosis and treatment of cutaneous paraneoplastic disorders

Dermatologic Therapy — Mon, 01 Nov 2010 00:00:00 +0100

ABSTRACTThe skin plays a critical role in the detection of internal malignances. Cutaneous signs of these disorders afford clinicians opportunities for early diagnosis and treatment. We aim to succinctly review the recognition, diagnosis, and treatment of selected cutaneous paraneoplastic diseases. Skin disorders that may be associated with paraneoplastic syndromes include: cutaneous metastases, tripe palms, Sweet's syndrome, glucagonoma, Paget's disease and extramammary Paget's disease, acanthosis nigricans, Birt‐Hogg‐Dube syndrome, basal cell nevus syndrome, Bazex syndrome (acrokeratosis paraneoplastica), carcinoid syndrome, Cowden's disease(multiple hamartoma syndrome), dermatomyositis, erythema gyratum repens, ichthyosis aquisita, von Recklinghausen's disease, pityriasis rotunda, p...

Electrochemotherapy for cutaneous and subcutaneous tumor lesions: a novel therapeutic approach

Dermatologic Therapy — Mon, 01 Nov 2010 00:00:00 +0100

ABSTRACTElectroporation uses pulsed, high‐intensity electric fields to temporarily increase cell membrane permeability by creation of pores, through which small molecules, such as chemotherapeutic agents, can diffuse inside cells before they reseal. The combination of electroporation with the administration of otherwise low‐permeant cytotoxic drugs is known as electrochemotherapy (ECT). The two most commonly used drugs are bleomycin and cisplatin. ECT has already been proven to be effective in diverse tumor histotypes, including melanoma and basal and squamous cell carcinoma, Kaposi sarcoma, and breast cancer, also in those cases nonresponding to classical chemotherapies or other loco‐regional treatment modalities, with a good safety profile. ECT can be proposed as loco‐regional th...

Skin manifestations of hormone‐secreting tumors

Dermatologic Therapy — Mon, 01 Nov 2010 00:00:00 +0100

ABSTRACTEndocrine and metabolic diseases, besides affecting other organs, can result in changes in cutaneous function and morphology and can lead to a complex symptomatology. Dermatologists may see some of these skin lesions first, either before the endocrinologist, or even after the internist or specialist has missed the right diagnosis. Because some skin lesions might reflect a life‐threatening endocrine or metabolic disorder, identifying the underlying disorder is very important, so that patients can receive corrective rather than symptomatic treatment.In this issue, we will review various hormone‐secreting tumors, including pituitary disorders (Cushing's syndrome and acromegaly), hyperthyroidism, glucagonoma, carcinoid syndrome, mastocytosis, and hyperandrogenism. We will focus on ...

Inherited syndromes

Dermatologic Therapy — Mon, 01 Nov 2010 00:00:00 +0100

This article succinctly reviews the dermatologic, clinical, and laboratory findings associated with genodermatoses that have associated internal malignancies. Appropriate treatment and screening recommendations are explored. (Source: Dermatologic Therapy)

Paraneoplastic vasculitis and paraneoplastic vascular syndromes

Dermatologic Therapy — Mon, 01 Nov 2010 00:00:00 +0100

ABSTRACTParaneoplastic syndromes are localized or diffuse pathologic manifestations that may occur in subjects affected by neoplastic diseases, even occult ones.Among the many clinical manifestations of paraneoplastic syndromes, cutaneous ones are quite common. It is estimated that skin manifestations may represent the very first diagnostic sign of a neoplastic disease in about 1% of patients.Many paraneoplastic syndromes with skin manifestations are caused by vascular alterations. In case of solid tumors, migrant thrombophlebitis and blood hypercoagulability can be seen, whereas in case of hematological neoplasms, vasculitis, and erythromelalgia can occur.Paraneoplastic vasculitis and paraneoplastic vascular syndromes are challenging issues in dermatology and general medicine. The present...

Chronic pruritus: a paraneoplastic sign

Dermatologic Therapy — Mon, 01 Nov 2010 00:00:00 +0100

ABSTRACTChronic itch could be a presenting sign of malignancy. Pruritus of lymphoma is the common prototype of paraneoplastic itch and can precede other clinical signs by weeks and months. Paraneoplastic pruritus has also been associated with solid tumors and is an important clinical symptom in paraneoplastic skin diseases such as erythroderma, Grovers disease, malignant acanthosis nigricans, generalized granuloma annulare, Bazex syndrome, and dermatomyositis. In any case with high index of suspicion a thorough work‐up is required. This review highlights the association between itch and malignancy and presents new findings related to pathophysiological mechanisms and the treatment of itch associated with malignancy. Combinative therapies reducing itch sensitization and transmission using...

Cutaneous manifestations of breast carcinoma

Dermatologic Therapy — Mon, 01 Nov 2010 00:00:00 +0100

ABSTRACTThe incidence of breast carcinoma cutaneous manifestation in patients with breast carcinoma is 23.9%. The most common sites of breast carcinoma cutaneous manifestation are the chest wall and abdomen, but they can occur at the extremities and in the head/neck region. Due the high incidence of breast carcinoma, these cutaneous manifestations are the most common metastases seen by dermatologists.In clinical practice, cutaneous metastases show a wide range of clinical manifestations. Nodules are the most common presentation, but several other patterns are described below. (Source: Dermatologic Therapy)

Cutaneous metastases from internal malignancies

Dermatologic Therapy — Mon, 01 Nov 2010 00:00:00 +0100

This article itemizes clinical presentations according to organ systems, specific features, and differential diagnoses. In general, the survival turned out to be less than 12 months. But incremental awareness of cutaneous metastases proclaims this paradigm insufficient. Although excision is the local treatment of choice, investigations attempt to propose tumor‐specific chemotherapeutic/immunological approaches. This paper endeavors to critically review the state of the art concerning the clinic, prognosis, and therapeutic concepts. (Source: Dermatologic Therapy)

INTRODUCTION: Diagnosis and treatment of cutaneous paraneoplastic disorders

Dermatologic Therapy — Mon, 01 Nov 2010 00:00:00 +0100

(Source: Dermatologic Therapy)

THERAPEUTIC HOTLINE: The effectiveness of intense pulsed light for possible Riehl's melanosis

Dermatologic Therapy — Tue, 31 Aug 2010 23:00:00 +0100

(Source: Dermatologic Therapy)

THERAPEUTIC HOTLINE: Alefacept in the treatment of hyperkeratotic palmoplantar psoriasis

Dermatologic Therapy — Tue, 31 Aug 2010 23:00:00 +0100

ABSTRACT (Source: Dermatologic Therapy)

THERAPEUTIC HOTLINE: A rare vandetanib‐induced photo‐allergic drug eruption

Dermatologic Therapy — Tue, 31 Aug 2010 23:00:00 +0100

ABSTRACT (Source: Dermatologic Therapy)

THERAPEUTIC HOTLINE: Effectiveness of the association of cetirizine and topical steroids in lichen planus pilaris – an open‐label clinical trial

Dermatologic Therapy — Tue, 31 Aug 2010 23:00:00 +0100

ABSTRACT (Source: Dermatologic Therapy)

THERAPEUTIC HOTLINE: Treatment of androgenic alopecia with finasteride may result in a high grade prostate cancer in patients: fact or fiction?

Dermatologic Therapy — Tue, 31 Aug 2010 23:00:00 +0100

ABSTRACT (Source: Dermatologic Therapy)

THERAPEUTIC HOTLINE: Infliximab for treatment of resistant pyoderma gangrenosum associated with ulcerative colitis and psoriasis. A case report

Dermatologic Therapy — Tue, 31 Aug 2010 23:00:00 +0100

ABSTRACT (Source: Dermatologic Therapy)

Lipschutz ulcers: evaluation and management of acute genital ulcers in women

Dermatologic Therapy — Tue, 31 Aug 2010 23:00:00 +0100

ABSTRACT (Source: Dermatologic Therapy)

Vulval lichen sclerosus and lichen planus

Dermatologic Therapy — Tue, 31 Aug 2010 23:00:00 +0100

ABSTRACT (Source: Dermatologic Therapy)

Atrophic vaginitis

Dermatologic Therapy — Tue, 31 Aug 2010 23:00:00 +0100

ABSTRACT (Source: Dermatologic Therapy)

Chronic vulvar pain from a physical therapy perspective

Dermatologic Therapy — Tue, 31 Aug 2010 23:00:00 +0100

ABSTRACT (Source: Dermatologic Therapy)

Approach to the diagnosis and treatment of vulvar pain

Dermatologic Therapy — Tue, 31 Aug 2010 23:00:00 +0100

ABSTRACT (Source: Dermatologic Therapy)

Medical and surgical approaches to vulvar intraepithelial neoplasia

Dermatologic Therapy — Tue, 31 Aug 2010 23:00:00 +0100

ABSTRACT (Source: Dermatologic Therapy)

An overview of human papillomavirus infection for the dermatologist: disease, diagnosis, management, and prevention

Dermatologic Therapy — Tue, 31 Aug 2010 23:00:00 +0100

ABSTRACT (Source: Dermatologic Therapy)

Pigmented vulvar lesions

Dermatologic Therapy — Tue, 31 Aug 2010 23:00:00 +0100

ABSTRACT (Source: Dermatologic Therapy)

Approach to the patient with vulvovaginal complaints

Dermatologic Therapy — Tue, 31 Aug 2010 23:00:00 +0100

ABSTRACT (Source: Dermatologic Therapy)

INTRODUCTION: The diagnosis and treatment of vulvar and vaginal disorders

Dermatologic Therapy — Tue, 31 Aug 2010 23:00:00 +0100

(Source: Dermatologic Therapy)

Erratum

Dermatologic Therapy — Tue, 27 Jul 2010 23:00:00 +0100

(Source: Dermatologic Therapy)

A large scale analytical study on efficacy of different photo(chemo)therapeutic modalities in the treatment of psoriasis, vitiligo and mycosis fungoides

Dermatologic Therapy — Tue, 27 Jul 2010 23:00:00 +0100

The objectives are to determine which photo (chemo) therapeutic modality could achieve the best response in the treatment of psoriasis, vitiligo, and MF. The design used in this study is retrospective analytical study. The study included 745 patients' records; 293 with psoriasis, 309 with vitiligo, and 143 with early MF, treated in the Phototherapy Unit, Dermatology Department, Kasr El-Aini Hospital, Cairo University by either psoralen and ultraviolet A (PUVA), narrow band ultraviolet B (NB-UVB), psoralen and narrow band UVB (P-NBUVB), broad band UVB (BB-UVB), or broad band UVA ([Beta][Beta]-UVA). Data were retrieved from the computer database of the unit and statistically analyzed. In psoriasis, oral and topical PUVA and NB-UVB were found to be equally effective, whereas oral PUVA had sig...

Extramammary Paget's disease treated with topical imiquimod 5% cream

Dermatologic Therapy — Tue, 27 Jul 2010 23:00:00 +0100

We present two cases of EMPD in Asian skin treated successfully with topical imiquimod 5% cream. (Source: Dermatologic Therapy)

High-dose immunoglobulines and extracorporeal photochemotherapy in the treatment of febrile ulceronecrotic Mucha-Habermann disease

Dermatologic Therapy — Tue, 27 Jul 2010 23:00:00 +0100

We report a case of a 23-year-old man with a steroid-resistant FUMHD treated by intravenous immunoglobulins (IVIG) combined with methotrexate. Only one case of FUMHD treated by IVIG has been reported to date in literature. Also in our case, IVIG proved to be effective in inducing a dramatic improvement of ulceration and in arresting the appearance of new lesions. Moreover, in our experience we decided to perform a maintenance treatment with extracorporeal photochemotherapy (ECP), to the best of our knowledge not previously used in the treatment of pityriasis lichenoides et varioliformis acuta. ECP, which involves extracorporeal exposure of peripheral blood mononuclear cells to photo-activated 8-methoxypsoralen, induces an immunological reaction against auto-reactive T cell clones, without ...

An observational study of methionine-bound zinc with antioxidants for mild to moderate acne vulgaris

Dermatologic Therapy — Tue, 27 Jul 2010 23:00:00 +0100

The objectives of this study are to explore the efficacy, safety, and tolerability of APC in acne patients with mild to moderate facial acne vulgaris. In this exploratory trial, 48 patients were treated with oral APC thrice a day for 3 months followed by a 4-week treatment-free period. At the end of treatment (Week 12), there was a statistically significant improvement in the global acne count (p < 0.05), which began after 8 weeks (p < 0.05). Almost 79% (38/48) of the patients had 80[ndash]100% improvement. There was a significant reduction in pustules (8 weeks (p < 0.05) and 12 weeks (p < 0.001)), and papules and closed comedones (8 weeks (p < 0.05) and 12 weeks (p < 0.001)). Only two patients had side effects. The current data indicate that treatment with oral APC thrice daily for 12 wee...

Complete resolution of recalcitrant periungual/subungual wart with recovery of normal nail following "prick" method of administration of bleomycin 1%

Dermatologic Therapy — Tue, 27 Jul 2010 23:00:00 +0100

We report a case of 14 year old girl with recalcitrant subungual wart which responded dramatically to bleomycin with normal nail regrowth. (Source: Dermatologic Therapy)

Efficacy of a new fractional CO2 laser in the treatment of photodamage and acne scarring

Dermatologic Therapy — Tue, 27 Jul 2010 23:00:00 +0100

This study evaluates the efficacy and safety of a novel fractional CO2 laser device for improving facial rhytids, hyperpigmentation, enlarged pores, skin laxity, and acne scarring. Subjects (n= 15) were treated three to five times at 3-week intervals. Biopsy specimens were used to evaluate healing response and neocollagenesis. Clinical improvement was rated on a quartile rating scale from digital photographs. Subject discomfort during treatment was evaluated on a scale of 0 to 5. Fourteen subjects who completed the study achieved good to excellent improvement in overall appearance, with 60% rated excellent. Improvement in photodamage was good to excellent in 92% of subjects, and reduction in rhytids was good to excellent in 85%. A total of 79% of subjects achieved good to excellent improve...

Cytophagic histiocytic panniculitis and hemophagocytic lymphohistiocytosis: an overview

Dermatologic Therapy — Tue, 27 Jul 2010 23:00:00 +0100

Cytophagic histiocytic panniculitis (CHP) is a rare panniculitis that is associated with systemic features including fevers, hepatosplenomegaly, lymphadenopathy, pancytopenia, hepatic abnormalities, hypertriglyceridemia, and coagulopathy without an elevated erythrocyte sedimentation rate. The panniculitis lesions show adipose tissue lymphocytic and histiocytic infiltration along with hemophagocytosis, which may also appear in bone marrow, spleen, lymph nodes, and liver. Patients may have a rapidly fatal disease course, a longer disease course with intermittent remissions and exacerbations for many years prior to death, or a nonfatal acute or intermittent course responsive to treatment. The cytophagocytic disorder in these patients is a hemophagocytic lymphohistiocytosis (HLH), similar to t...

Lipodermatosclerosis

Dermatologic Therapy — Tue, 27 Jul 2010 23:00:00 +0100

The most commonly recognized form of lipodermatosclerosis (LDS), chronic LDS presents with induration and hyperpigmentation of the skin involving the one or both of the lower legs in a characteristic "inverted champagne bottle" appearance. Associated with venous insufficiency, LDS is most common in middle aged women. In addition to chronic LDS, an acute form may also occur and is often misdiagnosed as cellulitis, inflammatory morphea, or erythema nodosum. The "acute" refers to the symptoms present that are exquisite pain. Treatment of LDS is based on the clinical presentation with compression therapy as the mainstay of treatment if tolerated. For acute LDS, patients often cannot tolerate compression therapy due to pain. We advise the use of fibrinolytic therapy, if available, until the pat...

Metabolic panniculitis: alpha-1 antitrypsin deficiency panniculitis and pancreatic panniculitis

Dermatologic Therapy — Tue, 27 Jul 2010 23:00:00 +0100

Panniculitis can be the initial presentation of both alpha-1 antitrypsin deficiency and pancreatic disease. They can both present with abscess-like draining nodules, but may present like other forms of panniculitis with erythematous nodules. It is important to consider these in the differential diagnosis of patients presenting with panniculitis. Alpha-1 antitrypsin deficiency is a relatively common disorder mainly affecting the lungs and liver. It frequently goes undiagnosed, yet critical interventions can be made to minimize disease progression. Panniculitis associated with alpha-1 antitrypsin deficiency can be difficult to treat. Pancreatic panniculitis occurs in less than 3% of patients with underlying pancreatic disease and is often associated with arthritis. Diagnosis and treatment of...

Panniculitis in childhood

Dermatologic Therapy — Tue, 27 Jul 2010 23:00:00 +0100

Panniculitis refers to disorders with inflammation of the subcutaneous fat. Such inflammation can be primary or can be a reaction pattern induced by a systemic process. Some types of panniculitis are seen more commonly or exclusively in children. These include erythema nodosum, subcutaneous fat necrosis of the newborn, sclerema neonatorum, poststeroid panniculitis, and cold panniculitis. The most typical clinical finding is tender, erythematous subcutaneous nodules. Clinical clues can aid in the diagnosis of the panniculitides, but pathology is often necessary to confirm the diagnosis. In general, the pediatric panniculitides are treated with supportive care and management of any underlying disorders, but certain types such as infectious panniculitis and malignancy-related panniculitis req...

Subcutaneous lymphoma and related conditions

Dermatologic Therapy — Tue, 27 Jul 2010 23:00:00 +0100

A variety of lymphoma entities can involve the subcutaneous tissue. The term subcutaneous panniculitis-like T cell lymphoma is now solely utilized for primary cutaneous CD8+ lymphomas expressing the [alpha][beta] T cell receptor heterodimer. This condition is generally responsive to treatment; however, the development of the hemophagocytic syndrome is a poor prognostic indicator. Overlapping features with lupus panniculitis has been observed, and cases with ambiguous pathology may be classified as atypical lobular lymphocytic panniculitis. These ambiguous cases often respond to systemic steroids or methotrexate. Overall, this condition follows an indolent course; however, evolution into frank lymphomas in some cases reflects the diagnostic difficulties of these conditions. Gamma-delta lymp...

Connective tissue panniculitis: lupus panniculitis, dermatomyositis, morphea/scleroderma

Dermatologic Therapy — Tue, 27 Jul 2010 23:00:00 +0100

Panniculitis is an uncommon cutaneous manifestation of connective tissue diseases. Our discussion will include panniculitis occurring in the setting of lupus erythematosus, dermatomyositis, and scleroderma/morphea. These subtypes of panniculitis are unified by an active inflammatory stage of the disease that can progress to develop scarring, atrophy, and calcifications. Treatment is most effective if initiated during the active phase of the disease and often requires systemic therapy because of the location of the inflammation. Antimalarials are the initial treatment of choice for most cases of lupus erythematosus panniculitis, whereas corticosteroids in combination with other steroid-sparing immunosuppressive agents are the first-line treatment for panniculitis in patients with dermatomyo...

Infection and panniculitis

Dermatologic Therapy — Tue, 27 Jul 2010 23:00:00 +0100

Infection-induced panniculitis may result from a number of microbes including bacteria, fungi, and parasites. Viruses have also been implicated as a cause. This type of panniculitis can occur as a primary infection by direct inoculation of infectious microorganisms into the subcutaneous tissue, or secondarily via microbial hematogenous dissemination with subsequent infection of the subcutaneous tissue. Panniculitis is rarely viewed solely in terms of infectious causes. Also, subcutaneous infections are infrequently viewed in terms of infection-induced panniculitis but rather as cutaneous infections with subcutaneous involvement. Little information exists specifically on the subject of infection-induced panniculitis outside of the realm of case reports and case series. In this review, the p...

Erythema nodosum and erythema induratum (nodular vasculitis): diagnosis and management

Dermatologic Therapy — Tue, 27 Jul 2010 23:00:00 +0100

Erythema nodosum is the most common type of panniculitis; it may be due to a variety of underlying infectious or otherwise antigenic stimuli. The pathogenesis remains to be elucidated, but both neutrophilic inflammation and granulomatous inflammation are implicated. Beyond treating underlying triggers, therapeutic options consist mainly of nonsteroidal anti-inflammatory drugs, symptomatic care, potassium iodide, and colchicine. Erythema induratum (nodular vasculitis) is a related but distinctly different clinicopathologic reaction pattern of the subcutaneous fat. It is classically caused by an antigenic stimulus from Mycobacterium tuberculosis but may be associated with several other underlying disorders. After appropriate antimicrobial treatment in tuberculous cases, therapy for erythema ...

High‐dose immunoglobulines and extracorporeal photochemotherapy in the treatment of febrile ulceronecrotic Mucha‐Habermann disease

Dermatologic Therapy — Wed, 30 Jun 2010 23:00:00 +0100

ABSTRACT (Source: Dermatologic Therapy)

An observational study of methionine‐bound zinc with antioxidants for mild to moderate acne vulgaris

Dermatologic Therapy — Wed, 30 Jun 2010 23:00:00 +0100

ABSTRACT (Source: Dermatologic Therapy)

Complete resolution of recalcitrant periungual/subungual wart with recovery of normal nail following “prick” method of administration of bleomycin 1%

Dermatologic Therapy — Wed, 30 Jun 2010 23:00:00 +0100

ABSTRACT (Source: Dermatologic Therapy)

Metabolic panniculitis: alpha‐1 antitrypsin deficiency panniculitis and pancreatic panniculitis

Dermatologic Therapy — Wed, 30 Jun 2010 23:00:00 +0100

ABSTRACT (Source: Dermatologic Therapy)

Panniculitis

Dermatologic Therapy — Wed, 30 Jun 2010 23:00:00 +0100

(Source: Dermatologic Therapy)

Diffuse cutaneous calculi (subepidermal calcified nodules): Case study

Dermatologic Therapy — Wed, 19 May 2010 23:00:00 +0100

Four forms of calcinosis cutis exist: metastatic calcinosis, dystrophic calcinosis, idiopathic calcinosis, and subepidermal calcified nodules, usually referred to as cutaneous calculi because single, small, raised, hard nodules are present. Occasionally, there are two or three nodules, and in some instances there are numerous or even innumerable nodules. Most patients are children, but in some patients, a nodule is present already at birth or does not appear until about adult life; in some instances, the surface of the nodule is verrucous, but it may be smooth. The most common location of the nodule is the face. A 12-year-old Yemeni child patient presented with warty, hard- and smooth-surface, white, and small and large non-itchy numerous nodules in the face and in the four extremities, wh...

The efficacy of nicotinamide gel 4% as an adjuvant therapy in the treatment of cutaneous erosions of pemphigus vulgaris

Dermatologic Therapy — Wed, 19 May 2010 23:00:00 +0100

This study was conducted to evaluate the clinical effectiveness of nicotinamide gel in the treatment of skin lesions of PV. In a double-blind, placebo-controlled study, eight PV patients with a total of 60 skin lesions were treated by either nicotinamide or placebo gel. After 30 days of treatment, epithelialization index of the two groups was compared. The mean of the epithelialization index in skin lesions that received nicotinamide was significantly higher than that of the placebo group (26 vs. [ndash]5.8, p < 0.001). Our results were suggestive that nicotinamide gel can effectively be used as an adjunctive treatment for PV lesions. (Source: Dermatologic Therapy)

Oral minocycline in the treatment of vitiligo – A preliminary study

Dermatologic Therapy — Wed, 19 May 2010 23:00:00 +0100

For effective treatment of vitiligo, it is as important to arrest the progression of the disease, as it is to induce repigmentation. Epidermal oxidative stress has been documented in vitiligo patients, and there is much support for a free-radical-mediated damage as an initial pathogenic event in melanocyte degeneration in vitiligo. Minocycline possesses a wide repertoire of anti-inflammatory, immunomodulatory, and free-radical scavenging actions in addition to their well-characterized antimicrobial effects. Recently, it has been shown that minocycline can rescue melanocytes from oxidative stress in vitro. Minocycline 100 mg was tried in this study to elucidate its role in arresting disease activity. Thirty-two patients with gradually progressive (slow spreading) vitiligo were enrolled in t...

Treatment of recalcitrant Darier's disease with electron beam therapy

Dermatologic Therapy — Wed, 19 May 2010 23:00:00 +0100

Darier's disease (DD) is difficult to treat and has no cure. Although many modalities have been investigated, treatment options to date are largely unsatisfactory. Side-effect profiles have limited the use of many of these therapies, as has their ability to target only limited areas of disease. Furthermore, the effectiveness of most available treatments seems to be highly individualized, varying with disease severity and offering little alteration in the natural course of the disease. The present study reports a case of severe DD that was poorly responsive to known therapeutic modalities but responded to electron beam radiotherapy, and recommends this therapeutic modality for localized areas of severe, recalcitrant symptomatic disease. (Source: Dermatologic Therapy)

A 14-year-old girl with multiple, firm, dome-shaped eroded nodules and itching on the limbs

Dermatologic Therapy — Wed, 19 May 2010 23:00:00 +0100

The standard treatment of prurigo nodularis (PN) includes antihistamines, ultraviolet light, and topical and systemic corticosteroids; unfortunately, PN is notoriously resistant to the conventional therapy. Herewith is described one case of PN, which was initialized with herose as the first-line therapy resulting in complete clinical clearance. Results of follow-up examinations from 2005 to 2009 showed no evidence of recurrence. Findings indicate that herose monotherapy is a potentially promising therapeutic options for PN. (Source: Dermatologic Therapy)

Burning mouth syndrome

Dermatologic Therapy — Wed, 19 May 2010 23:00:00 +0100

(BMS) is a chronic condition characterized by burning of the oral mucosa, with or without dysgeusia and xerostomia, in the setting of no underlying systemic disease or identifiable abnormalities on physical examination or laboratory testing. BMS disproportionately affects postmenopausal women. The pathophysiology of the disease is unknown; no single treatment has proven universally successful. In light of these shortcomings, having a practical approach to the evaluation and management of patients with BMS can improve both patient quality of life and physician satisfaction. (Source: Dermatologic Therapy)

Aphthous ulcers

Dermatologic Therapy — Wed, 19 May 2010 23:00:00 +0100

This article will summarize the differential diagnosis of aphthous ulceration, with emphasis on a practical guide for the management of recurrent aphthous ulceration, including topical and systemic therapy. (Source: Dermatologic Therapy)

The management of mucous membrane pemphigoid and pemphigus

Dermatologic Therapy — Wed, 19 May 2010 23:00:00 +0100

Mucous membrane pemphigoid and pemphigus vulgaris are autoimmune blistering disorders in which many similar drugs and therapeutic strategies are utilized. In general, localized disease can be treated with topical agents. In contrast, patients with more severe and progressive disease usually require a combination of systemic corticosteroids and immunosuppressive medications. Oral corticosteroids, adjuvant immunosuppressive agents, antibiotics such as dapsone and immunomodulatory procedures like intravenous immunoglobulin are the main therapeutic agents used in treating these two disorders. Much of the morbidity and mortality associated with these disorders are related to the sites involved and to the drugs used for therapy. Treatment should be individualized based on severity, extent, and r...

Lichen planus and lichenoid reactions of the oral mucosa

Dermatologic Therapy — Wed, 19 May 2010 23:00:00 +0100

Oral lichenoid reactions represent a common end point in response to extrinsic agents (drugs, allergens), altered self-antigens, or superantigens. Oral lichen planus, a common and under-recognized inflammatory disorder, shares many clinical and histopathological features with oral lichenoid drug reaction and oral lichenoid contact reaction. Clinical presentation can vary from asymptomatic white reticular striae to painful erythema and erosions. Cutaneous and additional mucosal involvement is common. Delay in diagnosis of extraoral mucocutaneous lichen planus (LP) results in conjunctival scarring; vaginal stenosis; vulvar destruction; and stricture of the esophagus, urethra, and external auditory meatus. Although the etiology of LP is idiopathic, oral lichenoid reactions may be caused by me...

Fungal infections of the mucous membrane

Dermatologic Therapy — Wed, 19 May 2010 23:00:00 +0100

A clinical review of three potentially severe fungal diseases, which are characterized in many cases by mucosal involvement, is presented. They are paracoccidioidomycosis, histoplasmosis, and mucormycosis. Mucosal involvement for paracoccidioidomycosis and rhinocerebral mucormycosis is frequent. Thus, oral involvement may provide early clue for diagnosis. In paracoccidioidomycosis, the mucosal lesion classically shows superficial ulcers with granular appearance and hemorrhagic points, usually on lips, palate, and jugal mucosa. In mucormycosis, necrosis of the palate followed for purulent discharge is a hallmark of rhinocerebral disease. Treatment with amphotericin B desoxycholate or the new second-generation triazoles is highly efficacious. (Source: Dermatologic Therapy)

Oral candidiasis and angular cheilitis

Dermatologic Therapy — Wed, 19 May 2010 23:00:00 +0100

Candidiasis, an often encountered oral disease, has been increasing in frequency. Most commonly caused by the overgrowth of Candida albicans, oral candidiasis can be divided into several categories including acute and chronic forms, and angular cheilitis. Risk factors for the development of oral candidiasis include immunosuppression, wearing of dentures, pharmacotherapeutics, smoking, infancy and old age, endocrine dysfunction, and decreased salivation. Oral candidiasis may be asymptomatic. More frequently, however, it is physically uncomfortable, and the patient may complain of burning mouth, dysgeusia, dysphagia, anorexia, and weight loss, leading to nutritional deficiency and impaired quality of life. A plethora of antifungal treatments are available. The overall prognosis of oral candi...

Melanin-associated pigmented lesions of the oral mucosa: presentation, differential diagnosis, and treatment

Dermatologic Therapy — Wed, 19 May 2010 23:00:00 +0100

This article will focus on the most common oral melanocytic lesions, along with mimics. (Source: Dermatologic Therapy)

The art and science of oral examination

Dermatologic Therapy — Wed, 19 May 2010 23:00:00 +0100

Performing an accurate oral examination is an integral part of a complete dermatological evaluation. As dermatologists, we are frequently asked to assess and treat numerous oral pathologies, which include, but are not limited to, normal variants, infections, ulcers, granulomas, lymphomas, as well as primary and metastatic tumors of the mouth and lips. The oral mucosa can be the window through which one can see and make numerous systemic diagnoses. Some clinicians are apprehensive about performing this evaluation, or feel that this examination is outside of their realm of expertise. These concerns may reflect limited exposure and education during training. Therefore, this article aimed to educate the readers on how to complete an oral examination, demonstrate normal variants, and highlight ...

The diagnosis and treatment of oral mucosal lesions

Dermatologic Therapy — Fri, 30 Apr 2010 23:00:00 +0100

(Source: Dermatologic Therapy)

Juvenile psoriatic arthritis and comorbidities: report of a case associated with enthesitis and celiac disease

Dermatologic Therapy — Sun, 04 Apr 2010 23:00:00 +0100

The present authors report the case of a 9-year-old boy affected by psoriasis, juvenile psoriatic arthritis, enthesitis, and celiac disease. The signs and symptoms of the different comorbitities appeared at different times in the clinical history, complicating the overall diagnostic and therapeutic procedures. Cooperation between dermatologists and rheumatologist is mandatory in similar cases, where sophisticated technology and teams with specialized and integrated knowledge are required. (Source: Dermatologic Therapy)

Discoid chronic lupus erythematosus at the site of a previously healed cutaneous leishmaniasis: an example of isotopic response

Dermatologic Therapy — Sun, 04 Apr 2010 23:00:00 +0100

We report here the case of a 38-year-old woman who referred to us for an infiltrated, red-brownish plaque localized on her left cheek. The patient had been treated for a cutaneous leishmaniasis, confirmed by the histologic examination, localized at the same site. She was completely healed after an appropriate local and systemic treatment. She experienced the occurrence of the new plaque at the site of the previously healed cutaneous leishmaniasis three month later. Histologic examination and laboratory tests were consistent with a diagnosis of discoid cutaneous chronic lupus erythematosus. Treatment with hydroxychloroquine, topical clobetasol and topical tretinoin resulted in flattening and clearing of the lesion. Our case is the first case of isotopic response where a discoid chronic lupu...

Necrotizing vasculitis in a patient affected by autoimmune hyperthyroidism treated with propylthiouracil

Dermatologic Therapy — Sun, 04 Apr 2010 23:00:00 +0100

Necrotizing vasculitis is a complex phenomenon because of an inflammation of small and larger vessels with polymorph infiltration within the vessel walls and leukocytoclasis, occurring in several autoimmune diseases. Propylthiouracil (PTU) is a medication commonly used to treat hyperthyroidism, but it is associated with various rare side effects, such as antineutrophil cytoplasm antibody-positive vasculitis. In the last decades, multiple cases of PTU causing antineutrophilic cytoplasmic antibody have been reported, some of them fatal. The present authors report the case of a 34-year-old Caucasian female affected by autoimmune hyperthyroidism treated with PTU, presenting an antineutrophil cytoplasm antibody-positive necrotizing vasculitis, with high levels of anticardiolipin antibodies that...

Dermo quiz: the illness and death of Anna Maria Lodovica de' Medici, Palatine Electress (1667–1743)

Dermatologic Therapy — Sun, 04 Apr 2010 23:00:00 +0100

According to the unpublished documents, preserved in the Archives, the authors provide a possible explanation of the disease of the Anna Maria Lodovica de' Medici, the last descendent of the famous Florentine dynasty, suggesting that she could not have suffered from breast cancer, as it was claimed, but that she could have contracted syphilis. The opportunity to exhume her corpse in the frame of the Medici Project will supply evidence for this interpretation. (Source: Dermatologic Therapy)

Therapeutic Hotline: Ulcerative lichen planus – treatment challenges

Dermatologic Therapy — Thu, 25 Mar 2010 00:00:00 +0100

Ulcerative lichen planus of the sole is an unusual variant of lichen planus, with only a few reported cases in the literature. The present authors present the case of a 77-year-old woman with relapsing erosive lichen planus of the feet with large, ill-defined and painful ulcers of the soles, which were present for 24 months and made her walking almost impossible. Ulcerative lichen planus is remarkably known as unresponsive to usual local and systemic therapies, and the cutaneous plantar lesions are even more difficult to treat. In our patient, we achieved very good results with topically applied tacrolimus ointment 0.1%, twice a day. The pain disappeared at the end of the first week of treatment, and after 4 weeks, the ulcerations were 95% epithelized, and the patient was able to walk with...

Therapeutic Hotline: Re-induction may be useful to manage psoriasis relapse during long-term maintenance treatment with infliximab: a retrospective analysis

Dermatologic Therapy — Thu, 25 Mar 2010 00:00:00 +0100

We report our cumulative experience on the use of infliximab re-induction in patients whose psoriasis relapsed during long-term maintenance treatment with infliximab. From September 2005 to January 2009, 22 patients required re-induction because of a relapse of their psoriasis. Re-induction was effective in restoring response in most patients and was well tolerated in all cases, without occurrence of serious or unexpected adverse events. (Source: Dermatologic Therapy)

Therapeutic Hotline: Treatment of prurigo nodularis and lichen simplex chronicus with gabapentin

Dermatologic Therapy — Thu, 25 Mar 2010 00:00:00 +0100

Psychocutaneous conditions are frequently encountered in dermatology practice. Prurigo nodularis and lichen simplex chronicus are two frustrating conditions that are classified in this category. They are often refractory to classical treatment with topical corticosteroids and antihistamines. Severe, generalized exacerbations require systemic therapy. Phototherapy, erythromycine, retinoids, cyclosporine, azathiopurine, naltrexone, and psychopharmacologic agents (pimozide, selective serotonin reuptake inhibitor antidepressants) were tried with some success. Here five cases with lichen simplex chronicus and four cases with prurigo nodularis, who responded well to gabapentin, are presented. (Source: Dermatologic Therapy)

Can early treatment with biologicals modify the natural history of comorbidities?

Dermatologic Therapy — Thu, 25 Mar 2010 00:00:00 +0100

This article briefly reviews the current literature, evaluating possible effects of anti-TNF drugs on the natural history of psoriasis comorbidities. Although further studies are needed, noteworthy considerations can be drawn. (Source: Dermatologic Therapy)

Psoriasis: depression, anxiety, smoking, and drinking habits

Dermatologic Therapy — Thu, 25 Mar 2010 00:00:00 +0100

Psoriasis is a chronic disease that can negatively impact many aspects of quality of life. Patients with psoriasis may suffer from pain and discomfort from the disease as well as psychological and social difficulties including stigmatization, embarrassment, and social inhibition. Anxiety, depression, smoking, and alcohol abuse have been found to have a higher prevalence among psoriasis patients than healthy controls. These comorbidities have also been found to have a directly negative impact on psoriasis. Awareness of the relationship between psoriasis, psychiatric disorders, and substance abuse is important for dermatologists, as these comorbidities can lead to poor compliance and treatment outcomes. (Source: Dermatologic Therapy)

Psoriasis and serum lipid abnormalities

Dermatologic Therapy — Thu, 25 Mar 2010 00:00:00 +0100

(Source: Dermatologic Therapy)

Psoriasis, the liver, and the gastrointestinal tract

Dermatologic Therapy — Thu, 25 Mar 2010 00:00:00 +0100

Psoriasis is a common chronic inflammatory, immune-mediated skin disease that is frequently associated with comorbidities including psoriatic arthropathy, chronic inflammatory bowel diseases, and cardio-metabolic disorders. In particular, nonalcoholic fatty liver disease affects about half of patients, Crohn's disease 0.5% and celiac disease 0.2[ndash]4.3% of patients with psoriasis. Some shared genetic traits as well as common inflammatory pathways may underlie these associations. The presence of comorbidities has important implications in the global approach to patients. In particular, traditional systemic antipsoriatic agents could negatively affect cardio-metabolic comorbidities as well as nonalcoholic fatty liver disease and may have important interactions with drugs commonly used by ...

Psoriasis and body mass index

Dermatologic Therapy — Thu, 25 Mar 2010 00:00:00 +0100

Recently, it has emerged a strong association between increased adiposity, obesity, and psoriasis. Body Mass Index (BMI) is a simple index of weight-for-height that is commonly used to classify underweight, overweight and obesity in adults. Psoriasis has also been associated with systemic obesity-related disorders including type 2 diabetes, hypertension, ischemic heart disease, and combined hyperlipidemia, as a part of metabolic syndrome. Not only the obesity may be associated with higher psoriasis incidence and activity, and prevalence of obesity-related syndromes, but it may also influence the therapeutic approach to disease and the clinical response to systemic treatment. Consequently, the approach of the experienced dermatologist will take into account all the aspects of the patient cl...

Psoriasis and cardiovascular disease

Dermatologic Therapy — Thu, 25 Mar 2010 00:00:00 +0100

Current epidemiological data support the association between psoriasis and cardiovascular (CV) risk, in apparent correlation with psoriasis severity. Although less unanimously, evidence of an increased prevalence of CV diseases among psoriasis patients has been reported, including ischemic heart disease, cerebrovascular, peripheral vascular and heart structural disorders. In particular, various studies showed a correlation between psoriasis and major CV events (i.e., myocardial infarction, stroke), while others investigated subclinical changes of blood vessels, such as intima-media thickness increase, arterial stiffness and coronary artery calcification. A series of different mechanisms, like traditional CV risk or iatrogenic risk factors, inflammation, hemostasis dysregulation, hyperhomoc...

Psoriasis and the metabolic syndrome

Dermatologic Therapy — Thu, 25 Mar 2010 00:00:00 +0100

Psoriasis is an inflammatory, immune-mediated cutaneous disorder that has recently been recognized as systemic disease that is associated with multiple comorbidities such as depression, obesity, and the metabolic syndrome. The metabolic syndrome is the constellation of abdominal obesity, dyslipidemia, hypertension and insulin resistance, and presence of the metabolic syndrome significantly increases a patient's risk for cardiovascular disease, stroke and type 2 diabetes. Recent studies have found that psoriasis patients are at increased risk for metabolic syndrome as well as the individual components of metabolic syndrome, and the two diseases appear linked through a common mechanism of inflammation. Speculation exists as to whether this association is causative or whether it is the result...

Psoriatic arthritis

Dermatologic Therapy — Thu, 25 Mar 2010 00:00:00 +0100

(PSA) is an entity of inflammatory joint disease associated with psoriasis. PSA belongs to the heterogeneous group of seronegative spondylarthropathies. Both peripheral joints and axial skeleton can be affected in a characteristic pattern. In addition to that, enthesitis and dactylitis are important extracutaneous manifestations. Uveitis anterior is temporarily seen in about one quarter of PSA patients. There is a closer relationship of nail and joint disease. This review provides data on drug and physical treatment options. In particular DMARDS and inhibitors of tumor necrosis factor [alpha] are established therapies with importance for quality of life and long term outcome. New drugs are tested in various trials. (Source: Dermatologic Therapy)

The concept of psoriatic disease: Can cutaneous psoriasis any longer be separated by the systemic comorbidities?

Dermatologic Therapy — Thu, 25 Mar 2010 00:00:00 +0100

Psoriasis is a general inflammatory status in which the skin is usually visibly involved. Recent papers show that several comorbidities, including psoriatic arthritis, metabolic syndrome, cancer, osteoporosis, cardiovascular disease, chronic inflammatory bowel disease etc., are significantly associated with psoriasis. Detecting association between psoriasis and comorbidities, properly evaluate confounders and make a correct distinction among absolute risk, relative risk and clinical relevance is mandatory, before embracing the fact the psoriasis is, in fact, a complex and common international disease. (Source: Dermatologic Therapy)

Epidemiology of comorbidities in psoriasis

Dermatologic Therapy — Thu, 25 Mar 2010 00:00:00 +0100

Epidemiological studies have shown that, in patients with psoriasis, associated disorders may occur more frequently than expected. Such comorbidities include, among others, psoriatic arthritis, inflammatory bowel disease, obesity, diabetes, cardiovascular disease, several cancer types, and depression. Comorbidities often become clinically manifest years after onset of psoriasis and tend to be more frequently seen in severe disease. (Source: Dermatologic Therapy)

Genetic variations associated with psoriasis and psoriatic arthritis found by genome-wide association

Dermatologic Therapy — Thu, 25 Mar 2010 00:00:00 +0100

Psoriasis and psoriatic arthritis are immune disorders with a complex polygenic basis. HLA-Cw6, which lies in the major histocompatibility region on chromosome 6, is considered the major genetic determinant of psoriasis. Recent genome-wide association studies have identified new variants outside of the MHC with relevance to the immunology of psoriasis. Variants in or near genes that encode subunits of cytokines (IL12B, IL23A) or cytokine receptors (IL23R) are interesting given that the gene product of IL12B, p40, is the target of a recently approved monoclonal antibody therapy for psoriasis (ustekinumab). Association with psoriasis and psoriatic arthritis has been found in TNFAIP3 and TNFIP1, ubiquitin ligases in the NF-[kappa]B pathway, and IL13, a Th2 cytokine. Copy number variation of h...

Matrix metalloproteinases 2 and 9, and extracellular matrix in Kaposi's sarcoma

Dermatologic Therapy — Mon, 01 Mar 2010 00:00:00 +0100

Matrix metalloproteinases (MMPs) are associated with Kaposi's sarcoma (KS) tumorigenesis and may contribute to the mechanism of KS invasive growth. To date, only a few MMPs have been studied in KS lesions, and exactly which MMPs are involved in KS development and progression remains unanswered. However, MMPs 2 and 9 have been associated with different phases of angiogenesis, but their role in the proteolytic modification of the extracellular matrix has not been investigated. The results of this study confirm that MMPs, specifically MMP-2 and MMP-9, can contribute to angiogenesis by disrupting the vessel basement membrane and other extracellular matrix barriers, and enabling endothelial cells migration through the surrounding tissues. (Source: Dermatologic Therapy)

Something new under the sun in the field of psoriasis?

Dermatologic Therapy — Mon, 01 Mar 2010 00:00:00 +0100

(Source: Dermatologic Therapy)

Topical Boswellic acids for treatment of photoaged skin

Dermatologic Therapy — Tue, 19 Jan 2010 00:00:00 +0100

Boswellic acids (BAs) are pentacyclic triterpenes extracted from the gum resins of the tropical tree Boswellia serrata. They are orally administered in traditional Indian medicine for the treatment of several inflammatory disease and cancer because of their anti-inflammatory and immunomodulatory activities as well as stimulatory effects on fibroblasts. The present authors have investigated efficacy, tolerability, and safety of a base cream containing 0.5% BAs in the treatment of clinical manifestations of photoaging of facial skin with a randomized, double-blind, placebo-controlled, split-face study. Fifteen female volunteers applied the creams with or without BAs on the half sides of the face once daily for 30 days. Significant improvements of the Dover's global score for photoaging, tact...

Treatment of disseminated granuloma annulare with allopurinol: case report

Dermatologic Therapy — Tue, 19 Jan 2010 00:00:00 +0100

Granuloma annulare (GA) is a rare disease characterized by granulomatous inflammation of the dermis. A variant form of the disease, disseminated granuloma annulare (DGA), can be observed in about 15% of affected patients. Localized GA is likely to resolve spontaneously within months or a few years, whereas DGA can persist for decades. Various therapies have been suggested in these cases, but none of them has been demonstrated to be consistently efficacious. Allopurinol has been successfully used in granulomatous diseases such as sarcoidosis or reactions to polymethylmethacrylate spheres; therefore, we decided to evaluate the possible efficacy of this drug in three patients with long-lasting, therapy-resistant DGA. (Source: Dermatologic Therapy)

Eccrine syringofibroadenoma radiation treatment of an unusual presentation

Dermatologic Therapy — Tue, 19 Jan 2010 00:00:00 +0100

Benign skin diseases have seldom been treated with radiotherapy, unless resistant to other treatments. Eccrine syringofibroadenoma (ESFA) is a rare benign eccrine tumor. ESFA very rarely presents bilateral lesions, and seldom a nonsurgical treatment has been proposed. An exceptional case of bilateral ESFA of the foot is presented; radiotherapy was effective in treating both lesions with good cosmetic results. (Source: Dermatologic Therapy)

Correlation between BMI and PASI in patients affected by moderate to severe psoriasis undergoing biological therapy

Dermatologic Therapy — Tue, 19 Jan 2010 00:00:00 +0100

Obesity is common in psoriatic patients, and it has been shown to be important for many aspects of the condition. In particular, low-calorie diets can improve the symptoms and response to treatment in pustular psoriasis. The present study investigates the influence of body-weight alteration on the disease's clinical manifestations in moderate to severe psoriasis patients treated with biological drugs. Finally, the influence of a caloric restriction was assessed. This observational transversal study enrolled 33 patients attending our Severe Psoriasis Outpatient Clinic, who were treated with biological drugs. Body Mass Index (BMI) was used as a diagnostic indicator of being overweight and of obesity. Waist circumference was also measured. Body weight and Psoriasis Area Severity Index (PASI) ...

Cost-effectiveness analysis of TNF-α blockers for the treatment of chronic plaque psoriasis in the perspective of the Italian health-care system

Dermatologic Therapy — Tue, 19 Jan 2010 00:00:00 +0100

The objectives of this study was to perform a cost-effectiveness analysis of infliximab compared with other anti-tumor necrosis factor-[alpha] agents for the treatment of psoriasis in Italy. The incremental cost-effectiveness ratio per patients achieving at least 75% improvement in the psoriasis area and severity index assessed over 24- and 48[ndash]50-week periods was calculated. Efficacy data were drawn from randomized controlled trials when available or from open label studies. Considering patients achieving psoriasis area and severity index at week 24 and 48[ndash]50, infliximab was dominant (more effective and less costly) over etanercept given at 50 mg twice weekly. In contrast, infliximab was not dominant over etanercept at other dosages or over adalimumab. When considering the impa...

Combined treatment of Favre-Racouchot syndrome with a superpulsed carbon dioxide laser: report of 50 cases

Dermatologic Therapy — Tue, 19 Jan 2010 00:00:00 +0100

Nodular elastosis with cysts and comedones also known as Favre-Racouchot syndrome frequently occurs on actinically damaged skin of middle-aged or elderly Caucasian subjects. The disease usually affects simmetrically the skin mainly around the orbits. Treatment in the past has not been entirely satisfactory. Treatment of 50 patients with a superpulsed carbon dioxide laser in order to vaporize epidermis followed by extraction of cystic and comedonic material using soft pressure with a pair of forceps. Laser treatment was performed without previous topical or intralesional anesthetics because no pain was reported using the described laser parameters. Our combined therapeutic approach was safe and effective in all the patients, guaranteeing an excellent cosmetic result. The combined technique ...

Unusual presentation of tuberculosis in an infliximab-treated patient – which is the correct TB screening before starting a biologic?

Dermatologic Therapy — Fri, 01 Jan 2010 00:00:00 +0100

We report the case of a psoriatic patient, who, despite a negative screening for infection by M. tuberculosis including both tuberculin skin test (TST) and chest X-ray, developed after 4 months of infliximab treatment, a severe pulmonary, lymphnodal and intestinal tuberculosis during infliximab treatment. (Source: Dermatologic Therapy)

Original Article: Compounding dermatologic preparations in developing countries

Dermatologic Therapy — Wed, 04 Nov 2009 00:00:00 +0100

Access to medications and their proper use are essential in developing countries. An interdisciplinary team of dermatologists and pharmacists created a master list of preparations useful for treating the most common dermatologic disorders in tropical and equatorial areas. The first pilot project was done at Cardinal Leger Hospital in Leogane, Haiti. Training was given to local staff at that hospital in 2005. Four years later, the clinic continues to prepare and offer, at a reasonable price, drugs that the population needs. (Source: Dermatologic Therapy)

Original Article: Superficial cutaneous fungal infections in tropical countries

Dermatologic Therapy — Wed, 04 Nov 2009 00:00:00 +0100

Superficial fungal infections represent an important cause of morbidity for people worldwide, particularly in the tropics. Fungal infections affect the skin, hair, or the nails, and tend to thrive in the heat and humidity of tropical countries. Because of environmental and cultural factors unique to the tropics, the causative organisms and presentation of these infections may differ from those in industrialized countries. Treatment options include topical and systemic therapy. However, social and socioeconomic factors in developing tropical countries may necessitate different treatment approaches to achieve success. (Source: Dermatologic Therapy)

Imported tropical diseases

Dermatologic Therapy — Wed, 04 Nov 2009 00:00:00 +0100

are among the top three leading causes for morbidity and may affect up to 8% of returning travelers. Because the spectrum of dermatological manifestations seen in travelers is broad, it can be challenging for physicians to recognize and treat such conditions in a timely and efficient manner. Therefore, the present review highlights common imported tropical diseases with a focus on treatment regimens. Specifically, cutaneous larva migrans, myiasis, swimmer's itch, mycetoma, Chagas disease, and leishmaniasis are discussed. As awareness increases among travelers, immigrants, and health care providers regarding imported tropical diseases, early intervention and proper diagnosis can ensue, thus reducing morbidity and mortality in affected individuals. (Source: Dermatologic Therapy)

Treatment of leprosy/Hansen's disease in the early 21st century

Dermatologic Therapy — Wed, 04 Nov 2009 00:00:00 +0100

Leprosy, or Hansen's disease (HD), is caused by Mycobacterium leprae, a slowly dividing mycobacterium that has evolved to be an intracellular parasite, causing skin lesions and nerve damage. Less than 5% of people exposed to M. leprae develop clinical disease. Host cell-mediated resistance determines whether an individual will develop paucibacillary or multibacillary disease. Hansen's disease is a worldwide disease with about 150 new cases reported annually in the United States. Effective anti-mycobacterial treatments are available, and many patients experience severe reversal and erythema nodosum leprosum reactions that also require treatment. Leprosy has been the target of a World Health Organization multiple drug therapy campaign to eliminate it as a national public health problem in me...

Cutaneous ectoparasites

Dermatologic Therapy — Wed, 04 Nov 2009 00:00:00 +0100

Parasites inhabit many places in the world. Some of these can inhabit the human skin or body. Many of these have been eradicated in the developed countries but persist in some tropical environments that are fun places to visit. Visitors can bring such parasites home with them such as scabies, cutaneous larva migrans, tungiasis and myiasis. Their clinical manifestations and treatment are presented for physicians evaluating and treating travelers from exotic places. (Source: Dermatologic Therapy)

Cutaneous and mucocutaneous leishmaniasis

Dermatologic Therapy — Wed, 04 Nov 2009 00:00:00 +0100

Leishmaniasis is a cluster of diseases caused by protozoa in the genus Leishmania. There are three basic clinical forms: cutaneous, mucocutaneous, and visceral leishmaniasis. The present review focuses on the diagnosis and treatment of cutaneous and mucocutaneous leishmaniasis. Characteristics of both the human host and the parasite species influence the clinical disease manifestations that range from asymptomatic exposure, to self-healing skin ulcers, to life-threatening widespread destructive ulcerations. Whether through medical treatment or through spontaneous resolution, skin ulcerations generally result in disfiguring scars with significant social and economic impact. Tests to confirm the diagnosis should be performed on patients who have recently visited endemic areas and have skin o...

Filariasis: diagnosis and treatment

Dermatologic Therapy — Wed, 04 Nov 2009 00:00:00 +0100

Filariasis is an infectious disease of the lymphatics and subcutaneous tissues caused by nematodes or filariae. Carried by mosquito vectors, this disease causes millions of people to suffer from lymphedema and elephantiasis, characteristics of filariasis infection. This disease can be diagnosed through the identification of microfilariae in blood or skin samples, antigen detection, radiographic imaging, or polymerase chain reaction. Mass drug administration by the World Health Organization has helped to diminish the incidence of filariasis. However, continued research on new drugs and vaccinations will be needed to control and reduce the microfilarial levels in the human population. (Source: Dermatologic Therapy)

Scabies and pyodermas – diagnosis and treatment

Dermatologic Therapy — Wed, 04 Nov 2009 00:00:00 +0100

Scabies and pyodermas are two of the commonest skin infections in tropical settings. They affect large numbers of people, particularly children, and account for a large burden of disease for peripheral health care teams. Despite this there have been significant advances in our knowledge of these diseases, their impact and their management. However there is a need to evaluate these developments in this specific setting, tropical health and in the context of communities with limited resources. This section will describe these advances and the challenges that remain. (Source: Dermatologic Therapy)

Cutaneous leishmaniasis treated with itraconazole

Dermatologic Therapy — Tue, 03 Nov 2009 00:00:00 +0100

We report a case of cutaneous Leishmaniasis in a young girl successfully treated with itraconazole. (Source: Dermatologic Therapy)

An overview of delayed pressure urticaria with special emphasis on pathogenesis and treatment

Dermatologic Therapy — Tue, 03 Nov 2009 00:00:00 +0100

Delayed pressure urticaria (DPU) is a physical urticaria characterized by the development of deep swellings at sites of pressure application on the skin. Etiopathogenesis of DPU is still unknown, although the available evidence suggests the involvement of mast cells through non-immunologic mechanisms and the role of several mediators beyond histamine, such as proinflammatory cytokines. The management of DPU is complex, also considering that prevention is very difficult and DPU frequently coexists with chronic "idiopathic" urticaria. Moreover, H1-antihistamines, which are the mainstay of treatment for common urticaria, usually provide less satisfactory results as compared with other urticarias. Therefore, numerous treatment alternatives have been proposed for severe refractory cases, such a...

Ultrasound evaluation of clobetasol propionate 0.05% foam application in psoriatic and healthy skin: a pilot study

Dermatologic Therapy — Tue, 03 Nov 2009 00:00:00 +0100

The aim of the present study was to evaluate through ultrasound imaging the response to treatment of twice and once daily application of clobetasol propionate 0.05% foam on psoriatic skin as well as the atrophogenic potential of once daily application of the foam on healthy skin. The study included a total of 40 participants, 30 affected by Psoriasis vulgaris and 10 healthy volunteers. Patients with psoriasis were branched in two groups of 15 subjects: in the first group, clobetasol propionate 0.05% foam was applied twice daily for up to 2 weeks on targeted plaques, in the second group, it was applied once daily for up to 4 weeks. Ten healthy adult volunteers were instructed to apply the foam to a 4 × 4 cm area on the volar aspect of the forearm once daily for 4 weeks. Ultrasound evaluati...

Treatment of erythrodermic psoriasis in HCV+ patient with adalimumab

Dermatologic Therapy — Tue, 03 Nov 2009 00:00:00 +0100

Erythrodermic psoriasis is a severe and disabling variant of psoriasis. The authors present the case of a 48-year-old man with psoriasis and hemophilia presented with a history of hepatitis C virus (HCV) infection treated with pegylated interferon alpha-2a and ribavirin therapy. At the end of antiviral therapy, skin manifestation progressively worsened, becoming erythrodermic, with lack of efficacy of steroid therapy. The authors decided to start biological therapy with induction dose of adalimumab (Humira, Abbott Laboratories, Abbott Park, Chicago, IL) 80 mg at Week 0 and 40 mg weekly. In our case, this resulted in a highly effective and safe treatment. (Source: Dermatologic Therapy)

Fractional CO2 laser: a novel therapeutic device upon photobiomodulation of tissue remodeling and cytokine pathway of tissue repair

Dermatologic Therapy — Tue, 03 Nov 2009 00:00:00 +0100

Minimally ablative fractional laser devices have gained acceptance as a preferred method for skin resurfacing. Notable improvements in facial rhytides, photodamage, acne scarring, and skin laxity have been reported. The aim of the present work was to compare how different CO2 laser fluences, by modulating the secretory pathway of cytokines, are able to influence the wound-healing process, and how these fluences are associated with different clinical results. Eighteen patients, all with photodamaged skin, were treated using a fractional CO2 laser (SmartXide DOT, Deka M.E.L.A., Florence, Italy) with varying laser fluences (2.07, 2.77, and 4.15 J/cm2). An immunocytochemical study was performed at defined end points in order to obtain information about specific cytokines of the microenvironmen...

Tropical dermatology and medicine

Dermatologic Therapy — Sun, 01 Nov 2009 00:00:00 +0100

(Source: Dermatologic Therapy)