Showing papers in "Journal of The American Academy of Dermatology in 2007"
TL;DR: Topical photodynamic therapy (PDT) is used to treat nonmelanoma skin cancers, such as actinic keratoses, Bowen's disease, and basal cell carcinoma (superficial and nodular) as mentioned in this paper.
Abstract: Topical photodynamic therapy (PDT) is used to treat nonmelanoma skin cancers, such as actinic keratoses, Bowen's disease, and basal cell carcinoma (superficial and nodular). This article presents up-to-date, practical, evidence-based recommendations on the use of topical PDT using 5-aminolevulinic acid or methyl aminolevulinate for the treatment (and prevention) of nonmelanoma skin cancers. A systematic literature review was conducted (using MEDLINE), and recommendations were made on the basis of the quality of evidence for efficacy, safety/tolerability, cosmetic outcome, and patient satisfaction/preference. Topical PDT is highly effective in the treatment of actinic keratoses, Bowen's disease, superficial and thin nodular basal cell carcinomas, with cosmesis typically superior to that achieved with existing standard therapies. PDT may also be a means of preventing certain nonmelanoma skin cancers in immunosuppressed patients.
560 citations
TL;DR: The detection of gadolinium within tissue of NSF patients is supportive of an epidemiologic association between exposure to gadolinia-containing contrast material and development of disease.
Abstract: Background Nephrogenic systemic fibrosis (NSF) is a disease of unknown etiology that affects a subset of patients with renal insufficiency. Recent publications suggested an association between exposure to gadolinium-containing contrast agents and subsequent development of NSF. We sought to detect gadolinium within the skin and soft tissue of patients with NSF who were exposed to gadolinium-based contrast. Methods Paraffin-embedded skin and soft tissue from NSF patients exposed to gadolinium, and from negative controls, was provided by the NSF Registry (New Haven, Conn). The tissue was searched for metals using a field emission scanning electron microscope that was equipped with energy dispersive spectroscopy. The presence of gadolinium and other metals was verified through identification of unique and requisite X-ray emission spectra. Results Gadolinium was detected in 4 of 13 tissue specimens from 7 patients with documented NSF who were exposed to gadolinium-based radiographic contrast. No gadolinium was detected in a paraffin-embedded specimen from a negative control. Based upon the known exposure history of patients with detectable gadolinium, a tissue residence time of 4 to 11 months was observed. Limitations As this was a pilot investigation, only a single control specimen and a single histological section from each block of tissue were utilized. Conclusion In this pilot investigation, gadolinium was detected in the tissue of a number of patients with NSF. Although neither dispositive of a pathophysiologic mechanism, nor proof of causation, the detection of gadolinium within tissue of NSF patients is supportive of an epidemiologic association between exposure to gadolinium-containing contrast material and development of disease.
539 citations
TL;DR: Through week 50, PASI responses were better maintained with continuous compared with intermittent therapy within each dose, and with 5 mg/kg compared with 3mg/kg continuous therapy.
Abstract: Background Previous studies of infliximab in psoriasis have demonstrated rapid improvement with induction therapy and sustained response with regularly administered maintenance therapy. Objective The efficacy and safety of continuous (every–8-week) and intermittent (as-needed) maintenance regimens were compared. Methods Patients with moderate-to-severe psoriasis (n = 835) were randomized to induction therapy (weeks 0, 2, and 6) with infliximab 3 mg/kg or 5 mg/kg or placebo. Infliximab-treated patients were randomized again at week 14 to continuous or intermittent maintenance regimens at their induction dose. Results At week 10, 75.5% and 70.3% of patients in the infliximab 5 mg/kg and 3 mg/kg groups, respectively, achieved PASI 75; 45.2% and 37.1% achieved PASI 90 (vs 1.9% [PASI 75] and 0.5% [PASI 90] for placebo; P Limitations Longer term (>1 year) maintenance therapy and further study of infliximab serum concentrations over this period, in both PASI 75 responders and non-responders, would be preferable. Conclusions Through week 50, response was best maintained with continuous infliximab therapy. Infliximab was generally well-tolerated in most patients.
489 citations
TL;DR: The epidemiology, pathogenesis, and diagnostic features of HSV infections are reviewed, providing the clinician with an up-to-date understanding of the available management strategies for mucocutaneous HSV-induced disease.
Abstract: Eight of the more than 80 known herpesviruses are human pathogens. Human herpes simplex virus (HSV) is a contagious infection with a large reservoir in the general population. It has a potential for significant complications in the immunocompromised host. In addition, psychological distress caused by the negative stigma associated with genital herpes and visible facial lesions in those experiencing frequent outbreaks renders it a challenging clinical dilemma. This article reviews the epidemiology, pathogenesis, and diagnostic features of HSV infections, providing the clinician with an up-to-date understanding of the available management strategies for mucocutaneous HSV-induced disease.
457 citations
Roy J. and Lucille A. Carver College of Medicine1, Wake Forest University2, University of Pennsylvania3, Cincinnati Children's Hospital Medical Center4, SUNY Downstate Medical Center5, Saint Louis University6, Penn State Milton S. Hershey Medical Center7, Anacor Pharmaceuticals Inc.8, American Academy of Dermatology9
TL;DR: The ultimate judgment regarding the propriety of any specific therapy must be made by the physician and the patient in light of all the circumstances presented by the individual patient.
Abstract: Disclaimer Adherence to these guidelines will not ensure successful treatment in every situation. Furthermore, these guidelines should not be deemed inclusive of all proper methods of care or exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific therapy must be made by the physician and the patient in light of all the circumstances presented by the individual patient.
447 citations
TL;DR: The purpose of this article is to highlight the association between obesity and dermatologic conditions, and to formulate a pathophysiology-based treatment strategy for obesity-associated dermatoses.
Abstract: Obesity is widely recognized as an epidemic in the Western world; however, the impact of obesity on the skin has received minimal attention. The purpose of this article is to highlight the association between obesity and dermatologic conditions. We review the impact of obesity on the skin, including skin physiology, skin manifestations of obesity, and dermatologic diseases aggravated by obesity. Obesity is responsible for changes in skin barrier function, sebaceous glands and sebum production, sweat glands, lymphatics, collagen structure and function, wound healing, microcirculation and macrocirculation, and subcutaneous fat. Moreover, obesity is implicated in a wide spectrum of dermatologic diseases, including acanthosis nigricans, acrochordons, keratosis pilaris, hyperandrogenism and hirsutism, striae distensae, adiposis dolorosa, and fat redistribution, lymphedema, chronic venous insufficiency, plantar hyperkeratosis, cellulitis, skin infections, hidradenitis suppurativa, psoriasis, insulin resistance syndrome, and tophaceous gout. We review the clinical features, evidence for association with obesity, and management of these various dermatoses and highlight the profound impact of obesity in clinical dermatology. Learning objective After completing this learning activity, participants should be aware of obesity-associated changes in skin physiology, skin manifestations of obesity, and dermatologic diseases aggravated by obesity, and be able to formulate a pathophysiology-based treatment strategy for obesity-associated dermatoses.
426 citations
TL;DR: In this article, the authors conducted a retrospective study of 64 patients with calciphylaxis (including 49 dialysis patients age and sex-matched to 98 dialysis controls) and found an estimated 1-year survival rate of 61.6% was observed for 17 patients receiving surgical debridement compared with 27.4% for the 46 who did not.
Abstract: Background Calciphylaxis is characterized by ischemic cutaneous ulceration, high mortality, and ineffective treatment. Methods We conducted a retrospective study of 64 patients with calciphylaxis (including 49 dialysis patients age- and sex-matched to 98 dialysis controls). Results The estimated 1-year survival rate of calciphylaxis was 45.8%. Risk factors for calciphylaxis included obesity, liver disease, systemic corticosteroid use, calcium-phosphate product more than 70 mg 2 /dL 2 , and serum aluminum greater than 25 ng/mL. Survival rates were similar for 16 patients who received parathyroidectomy and 47 who did not. An estimated 1-year survival rate of 61.6% was observed for 17 patients receiving surgical debridement compared with 27.4% for the 46 who did not ( P = .008). Limitations The study was limited by its retrospective design and there was no control group for the 15 nondialysis cases. Conclusions Calciphylaxis is multifactorial and usually fatal. Prevention of calciphylaxis may include correction of risk factors identified in this study. Surgical debridement was associated with improved survival, but parathyroidectomy was not.
420 citations
TL;DR: The recent observations suggest a likely mechanism for the initial dermal manifestations of this gadolinium toxicity and a likely pathogenesis of this entity.
Abstract: There is growing recognition of the association between the use of gadolinium-containing radiocontrast agents for magnetic resonance imaging and the serious dermal and systemic disease nephrogenic fibrosing dermopathy/nephrogenic systemic fibrosis (NFD/NSF). The pathogenesis of this entity remains unclear; however, our recent observations suggest a likely mechanism for the initial dermal manifestations of this gadolinium toxicity.
371 citations
TL;DR: The normal anatomy and embryology of the nail unit is discussed as well as the current understanding of the pathogenesis of the disease, which provides an extensive review of the existing literature with respect to psoriatic nail therapy.
Abstract: Psoriasis is a chronic skin disease that affects millions of people throughout the world Even though cutaneous signs and symptoms are the most common clinical manifestations, the nails can be involved in up to 50% of cases, and their involvement remains an important yet often overlooked aspect of the disease There is a broad spectrum of nail dystrophies associated with psoriasis, ranging from the common pitting and loosening of the nail plate to the less frequent discoloration and splinter hemorrhages seen in the nail bed This article discusses the normal anatomy and embryology of the nail unit as well as the current understanding of the pathogenesis of the disease It also provides an extensive review of the existing literature with respect to psoriatic nail therapy Although there have been many recent advances in the treatment of the cutaneous form of the disease—most notably in the field of immunotherapies—the options for nail psoriasis are far more limited While a number of treatment alternatives currently exist for nail disease, the general paucity of clear evidence regarding these choices often makes it difficult to select the most efficient, safe, and optimal treatment for the patient Even though the current literature has shown some support for the use of topical, intralesional, radiation, systemic, and combination therapies for nail psoriasis, the available studies lack sufficient power to extrapolate a standardized therapeutic regimen Therefore, until better-documented evidence validating the treatment options emerges within the literature, clinicians and patients are left with a vague and relatively unproven approach to psoriatic nail disease
369 citations
TL;DR: Recent data concerning clinical presentation, pathogenesis and treatment of TEN is reviewed, with evidence suggesting that combination therapies may be of value and anecdotal or based on observational or retrospective studies.
Abstract: Toxic epidermal necrolysis (TEN) is an unpredictable, life-threatening drug reaction associated with a 30% mortality. Massive keratinocyte apoptosis is the hallmark of TEN. Cytotoxic T lymphocytes appear to be the main effector cells and there is experimental evidence for involvement of both the Fas-Fas ligand and perforin/granzyme pathways. Optimal treatment for these patients remains to be clarified. Discontinuation of the offending drug and prompt referral to a burn unit are generally agreed upon steps. Beyond that, however, considerable controversy exists. Evidence both pro and con exists for the use of IVIG, systemic corticosteroid, and other measures. There is also evidence suggesting that combination therapies may be of value. All the clinical data, however, is anecdotal or based on observational or retrospective studies. Definitive answers are not yet available. Given the rarity of TEN and the large number of patients required for a study to be statistically meaningful, placebo controlled trials are logistically difficult to accomplish. The absence of an animal model further hampers research into this condition. This article reviews recent data concerning clinical presentation, pathogenesis and treatment of TEN. Learning objectives At the conclusion of this learning activity, participants should have acquired a more comprehensive knowledge of our current understanding of the classification, clinical presentation, etiology, pathophysiology, prognosis, and treatment of TEN.
357 citations
TL;DR: Quality of life impact in hidradenitis was much greater than that of several other dermatologic conditions and this hospital-based population may not be representative.
Abstract: Objective We sought to determine quality of life impairment in hidradenitis suppurativa. Methods Questionnaires were administered to 61 patients. Results Quality of life impact in hidradenitis was much greater than that of several other dermatologic conditions. Limitation This hospital-based population may not be representative. Conclusion Hidradenitis is one of the most distressing conditions observed in dermatology.
TL;DR: The most recent significant advances in the diagnosis and genetics of TSC are highlighted, along with a discussion on the limitations and the usefulness of the revised 1998 clinical criteria for the tuberous sclerosis complex.
Abstract: Tuberous sclerosis complex (TSC) is an autosomal dominant multisystem neurocutaneous syndrome characterized by the development of multiple hamartomas distributed throughout the body, skin, brain, heart, kidneys, liver, and lungs. Two-thirds of patients represent sporadic mutations. The classic triad is seizures, mental retardation, and cutaneous angiofibromas. However, the full triad occurs in only 29% of patients; 6% of them lack all three of them. Two tumor suppressor genes responsible for TSC have been identified: TSC1 gene on chromosome 9 and TSC2 on chromosome 16. This article highlights the most recent significant advances in the diagnosis and genetics of TSC, along with a discussion on the limitations and the usefulness of the revised 1998 clinical criteria for the tuberous sclerosis complex. The "ash leaf" macule often comes in other shapes, such as round; most are polygonal, usually 0.5 cm to 2.0 cm in diameter, resembling a thumbprint. Since the death of its describer, Thomas Fitzpatrick, we call each a "Fitzpatrick patch." Special attention is paid in this work to TSC treatment options, including therapeutic trials with rapamycin, also known as sirolimus. Learning objective After completing this learning activity, participants should familiar with tuberous sclerosis complex, its cutaneous signs and systemic findings stratified by patient age, its genetics, and the potential for meaningful therapeutic intervention.
TL;DR: In this paper, the authors presented a learning activity to understand the different types of cutaneous vascular malformations, and the importance of proper diagnosis of these lesions, and to direct correct management and treatment.
Abstract: Cutaneous vascular malformations are rare disorders representing errors in vascular development. These lesions occur much less commonly but are often confused with the common infantile hemangioma. It is important to properly diagnose vascular malformations because of their distinct differences in morbidity, prognosis and treatment. Vascular malformations may be associated with underlying disease or systemic anomalies. Several of these syndromes are well defined and can often be distinguished on the basis of the flow characteristics of the associated vascular malformation. Learning objective At the completion of this learning activity, participants should have a better understanding of the different types of cutaneous vascular malformations. Because of the importance of proper diagnosis of these lesions, participants should also be better able to direct correct management and treatment.
TL;DR: Participants should recognize groups at high risk for community-acquired methicillin-resistant Staphylococcus aureus infections and manage these infections appropriately.
Abstract: Published data confirm that community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections are increasing in incidence in both urban and rural settings. The statistical risk is higher for athletes, military personnel, prison inmates, intravenous drug abusers, the homeless, children in daycare, and certain Native American groups, but the infections are by no means restricted to these populations. Roughly 85% of the infections involve the skin and subcutaneous tissue, with the most common presentations being an abscess or folliculitis. The typical associated gene cassette is quite small and codes only for methicillin resistance. Abscesses generally respond to drainage. Learning objective At the conclusion of this learning activity, participants should recognize groups at high risk for community-acquired MSRA infections and manage these infections appropriately.
TL;DR: In this paper, the relationship between UVB exposure and 25-hydroxyvitamin D (25-OH-D) concentrations as a function of skin pigmentation was defined.
Abstract: Background Ultraviolet (UV)-B light increases vitamin D levels, but the dose response and the effect of skin pigmentation have not been well characterized. Objective We sought to define the relationship between UVB exposure and 25-hydroxyvitamin D (25-OH-D) concentrations as a function of skin pigmentation. Methods Seventy two participants with various skin tones had 90% of their skin exposed to UVB light (20-80 mJ/cm 2 ) 3 times a week for 4 weeks. Serum 25-OH-D was measured weekly. Results Eighty percent of the variation in treatment response was explained by UVB dose and skin tone. Therapeutically important changes in 25-OH-D were achieved with minimal tanning. Limitations Four weeks was not long enough to reach a steady state at the higher dose rates. Conclusions The response of 25-OH-D levels to UVB light is dependent on skin pigmentation and the amount of UVB given, and useful increases in vitamin D status can be achieved by defined UVB doses small enough to produce only minimal tanning.
TL;DR: In this paper, the authors provide an overview of zinc metabolism and a description of inherited and acquired zinc deficiency, which is made by way of clinical presentation together with histopathology and laboratory tests.
Abstract: Acrodermatitis enteropathica is a rare autosomal recessive disorder of zinc deficiency. The genetic defect has been mapped to 8q24 and the defective gene identified as SLC39A4, which encodes the zinc transporter Zip4. The diagnosis is made by way of clinical presentation together with histopathology and laboratory tests. Here we provide an overview of zinc metabolism and a description of inherited and acquired zinc deficiency.
TL;DR: This study supports previous reports for an association between psoriasis and atherosclerosis and psOriasis and diabetes and supports selection bias that may occur due to the possibility that reporting of both psor infection and associated illnesses is higher in individuals who are seeking medical care.
Abstract: Background Previous reports demonstrated an association between psoriasis and other diseases including heart failure and diabetes mellitus. Objectives Our aim was to describe the association between psoriasis, diabetes mellitus, and atherosclerosis in Israel. Methods A cross-sectional study was performed utilizing the database of Maccabi Healthcare Services (MHS), a large health provider organization in Israel. Case patients were defined as subjects who were diagnosed with psoriasis. Patients with diabetes and atherosclerosis were identified by using the MHS diabetes and cardiovascular registries, respectively. The control group included MHS enrollees without psoriasis. The proportion of diabetes and atherosclerosis among case and control groups was compared. Chi-square tests were used to compare categorical parameters. Logistic regression models were used for multivariate analyses. Results The study included 46,095 patients with psoriasis (case patients) and 1,579,037 subjects without psoriasis (control patients). The age-adjusted proportion of diabetes was significantly higher in psoriasis patients as compared with the control group (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.1-1.48). The age-adjusted proportion of atherosclerosis was significantly higher in psoriasis patients as compared with the control group (OR 1.28, 95% CI 1.04-1.59). In patients with psoriasis, a multivariate logistic regression model demonstrated an association between diabetes and the multiple use of very potent topical steroids ( P P P Limitations Our study was based on a computerized database. The diagnosis of psoriasis was based on digitally transmitted data. Therefore overestimation (false-positive cases) and underestimation (false-negative cases) of psoriasis patients may exist, thereby being a source for information bias. A second limitation is selection bias that may occur due to the possibility that reporting of both psoriasis and associated illnesses is higher in individuals who are seeking medical care. A third limitation concerns the causal effect between occurrence of psoriasis and atherosclerosis or diabetes. The dataset of MHS records diagnoses only from 1997 and does not record the date of disease onset. Conclusions Our study supports previous reports for an association between psoriasis and atherosclerosis and psoriasis and diabetes. Further study is needed to support this observation.
TL;DR: The purpose of this review is to highlight the recent advances in the mechanism of action of menthol and to provide an overview of its dermatologic applications.
Abstract: Menthol is a naturally occurring cyclic terpene alcohol of plant origin, which has been used since antiquity for medicinal purposes. Its use in dermatology is ubiquitous, where it is frequently part of topical antipruritic, antiseptic, analgesic, and cooling formulations. Despite its widespread use, it was only recently that the mechanism by which menthol elicits the same cool sensation as low temperature was elucidated upon, with the discovery of the TRPM8 receptor. Although almost 5 years have passed since the discovery of this receptor, many dermatologists are still unaware of menthol's underlying target. The purpose of this review is to highlight the recent advances in the mechanism of action of menthol and to provide an overview of its dermatologic applications.
TL;DR: Primary mucosal melanomas are rare, biologically aggressive neoplasms and most afflicted individuals harbor micrometastatic disease and experience a course characterized by multiple local recurrences before the clinical development of distant disease.
Abstract: Primary mucosal melanomas are rare, biologically aggressive neoplasms. The distribution of head and neck, female genital tract, anal/rectal, and urinary tract sites is 55.4%, 18.0%, 23.8%, and 2.8%, respectively. The median age at presentation is the seventh decade, and women are given the diagnosis more frequently than men. Unfortunately, most afflicted individuals harbor micrometastatic disease and experience a course characterized by multiple local recurrences before the clinical development of distant disease. Approximately a third of patients have nodal involvement at presentation, and the overall 5-year survival is only 25%. Despite aggressive surgical resection and a multitude of adjuvant treatments, the prognosis remains grave. Early detection, which is difficult because of the occult anatomic locations in which these tumors occur, allows the best hope for cure.
TL;DR: This suggests nutrition-related lifestyle factors play a role in acne pathogenesis, and the role of weight loss in the overall treatment effect is not preclude.
Abstract: Background No previous study has sought to examine the influence of dietary composition on acne vulgaris. Objective We sought to compare the effect of an experimental low glycemic–load diet with a conventional high glycemic–load diet on clinical and endocrine aspects of acne vulgaris. Methods A total of 43 male patients with acne completed a 12-week, parallel, dietary intervention study with investigator-masked dermatology assessments. Primary outcomes measures were changes in lesion counts, sex hormone binding globulin, free androgen index, insulin-like growth factor-I, and insulin-like growth factor binding proteins. Results At 12 weeks, total lesion counts had decreased more in the experimental group (−21.9 [95% confidence interval, −26.8 to −19.0]) compared with the control group (−13.8 [−19.1 to −8.5], P = .01). The experimental diet also reduced weight ( P = .001), reduced the free androgen index ( P = .04), and increased insulin-like growth factor binding protein-1 ( P = .001) when compared with a high glycemic–load diet. Limitations We could not preclude the role of weight loss in the overall treatment effect. Conclusion This suggests nutrition-related lifestyle factors play a role in acne pathogenesis. However, these preliminary findings should be confirmed by similar studies.
TL;DR: En coup de sabre morphea and Parry-Romberg syndrome frequently coexist and are likely both variants of morphea, and the efficacy of antimalarial agents and methotrexate in the treatment of these diseases remains unclear.
Abstract: Background The relationship between en coup de sabre morphea and Parry-Romberg syndrome is unclear, and not much is known regarding their demographic and clinical characteristics or the efficacy of the treatments that are used. Objective The purpose of this study was to describe demographic data, clinical features, and medications used in a large cohort of patients with en coup de sabre morphea and Parry-Romberg syndrome. Methods A retrospective review of patients diagnosed with en coup de sabre morphea or Parry-Romberg syndrome at the Mayo Clinic from 1984 to 2004 was conducted. Demographic data, examination findings, and treatments were noted. Results We identified 54 patients who met criteria for inclusion in the study. Twenty-six patients (48%) had en coup de sabre morphea, 13 (24%) had Parry-Romberg syndrome, and 15 (28%) had both. Disease was present bilaterally in 7.4% of patients. Thirteen percent of all patients in the study group had seizures. Of patients who received treatment, most were treated with antimalarial agents (57.1%) or methotrexate (28.6%). Limitations The study design was that of a retrospective review at a tertiary care center with referral bias. There were also limitations present because of the inherent nature of the diseases studied. Conclusion En coup de sabre morphea and Parry-Romberg syndrome frequently coexist and are likely both variants of morphea. Bilateral disease is more common than previously reported. The efficacy of antimalarials and methotrexate in the treatment of these diseases remains unclear.
TL;DR: The racial differences in the incidence of DFSP are significant, and the cause is unknown, and epidemiologic investigation using population-based data is important to better understand this disorder.
Abstract: Background The epidemiology of dermatofibrosarcoma protuberans (DFSP) has not been studied in detail. Objective We sought to describe patterns of DFSP incidence and survival in the United States. Methods Data were obtained from 9 population-based cancer registries of the Surveillance, Epidemiology, and End Results Program for 1973 to 2002. Results DFSP overall annual incidence was 4.2 per million. Incidence increased by 43% (3.1-4.4 per million per year) during the study period, but this increase was restricted to whites. Annual incidence among blacks (6.5 per million) was almost double the incidence among whites (3.9 per million; P P = .052, 95% confidence interval of difference –0.002 to 0.60), except among the elderly. Relative 5-year survival was 99.2% (95% confidence interval 98.3-100%). Limitations The Surveillance, Epidemiology, and End Results Program lacks independent verification of diagnoses and case detail. Conclusions The racial differences in the incidence of DFSP are significant, and the cause is unknown. Previous literature had suggested that men were more frequently affected, which was not true in our data. The tumor rarely results in death. Epidemiologic investigation using population-based data is important to better understand this disorder.
TL;DR: In this paper, a new algorithm for non-invasive diagnosis of nail pigmentation using dermoscopy has been proposed to reduce the number of unnecessary surgeries and to choose the most adequate biopsy technique.
Abstract: Longitudinal pigmentation of the nail is very common. The differential diagnosis varies from subungual hematoma, to a fungal infection, to a melanocytic lesion (lentigo, nevus melanoma, etc.) to others. Often, dermatologists do not feel at ease with these pathologies and management is often not clear. In many cases, a biopsy is not helpful because an inadequate technique was chosen. The use of noninvasive techniques such as dermoscopy has been described to be useful for the preoperative evaluation and the management decision. Using these technique, one will be able to reduce the number of unnecessary surgeries and to choose the most adequate biopsy technique. In this article, we will review the management, including diagnosis as well as differential diagnosis of nail pigmentations and propose a new algorithm for the non invasive diagnosis of nail pigmentation.
TL;DR: Participants should be aware of the most recent melanoma epidemiologic data, both in the United States and internationally; worldwide early detection and screening programs; clinical strategies to recognize and improve the detection of early melanoma; the latest technologies for early detection of melan cancer; and public and professional education programs designed to enhance early detection.
Abstract: In the past 5 years, there have been notable strides toward the earlier recognition and discovery of melanoma, including new technologies to complement and augment the clinical examination and new insights to help clinicians recognize early melanoma. However, incidence and mortality rates throughout most of the developed world have risen over the past 25 years, while education and screening, potentially the best means for reducing the disease, continue to be severely underutilized. Much progress needs to be made to reach middle-aged and older men and persons of lower socioeconomic status who suffer a disproportionate burden of death from melanoma. Worldwide melanoma control must also be a priority, and comprehensive educational and screening programs should be directed to Northern Ireland and a number of Eastern European nations, whose 5-year survival rates range between 53% and 60%, mirroring those of the United States and Australia more than 40 years ago. Learning objective After completing this learning activity, participants should be aware of the most recent melanoma epidemiologic data, both in the United States and internationally; worldwide early detection and screening programs; clinical strategies to recognize and improve the detection of early melanoma; the latest technologies for early detection of melanoma; and public and professional education programs designed to enhance early detection.
TL;DR: Adherence to topical medications is very poor in a clinic population of children with atopic dermatitis, and office visits are one means to increase adherence.
Abstract: Background Atopic dermatitis is a common problem for which topical agents are the primary treatment When topical medications fail, further therapy may include systemic agents with the potential for greater toxicity Adherence to topical treatment of atopic dermatitis has not been well characterized Poor adherence to topical medication could account for failure of topical therapy Purpose To determine adherence to topical treatment in patients with atopic dermatitis Methods Thirty-seven children were given 01% triamcinolone ointment and were counseled to use it twice daily They were told to return in 4 weeks, at which time they were told to continue treatment for another 4 weeks Electronic monitors were used to measure adherence over the entire 8 week study Patients were not informed of the compliance monitoring until the end of the study Results Twenty-six patients completed 8 weeks of treatment Mean adherence from the baseline to the end of the study was 32% Adherence was higher on or near office visit days and subsequently decreased rapidly Limitations This study was limited by the large number of subjects who failed to return for follow-up appointments or withdrew from the study Conclusions Adherence to topical medications is very poor in a clinic population of children with atopic dermatitis Office visits are one means to increase adherence If adherence to topical treatment can be improved, exposure to more costly and potentially toxic systemic agents may be avoidable
TL;DR: With effective management of these side effects, dermatologists can play an integral role in facilitating compliance with anti-EGFR therapy and aid with effective oncologic management.
Abstract: The growing investigation and use of epidermal growth factor receptor (EGFR) inhibitors in anticancer therapy has been motivated by their specificity for EGFR, which improves their ability to target cancer cells and enhances their safety profile compared with many other conventional chemotherapeutic agents. However, their growing use has been accompanied by an increasing incidence of cutaneous toxicities, which can cause serious discomfort and be disabling. This review illustrates the common cutaneous side effects seen in patients receiving EGFR inhibitors and discusses various options for management. With effective management of these side effects, dermatologists can play an integral role in facilitating compliance with anti-EGFR therapy and aid with effective oncologic management.
TL;DR: In this paper, the relationship between perception of skin condition and homogeneity of color/chromophore distribution was studied, showing that skin color homogeneity, driven by melanin and hemoglobin distribution, influences perception of age, attractiveness, healthiness, youthfulness, and biological age.
Abstract: Background Evolutionary psychology suggests that skin signals aspects of mate value, yet only limited empirical evidence exists for this assertion. Objectives We sought to study the relationship between perception of skin condition and homogeneity of color/chromophore distribution. Methods Cropped skin cheek images from 170 girls and women (11-76 years) were blind-rated for attractiveness, healthiness, youthfulness, and biological age by 353 participants. These skin images and corresponding melanin/hemoglobin concentration maps were analyzed objectively for homogeneity. Results Homogeneity of unprocessed images correlated positively with perceived attractiveness, healthiness, and youthfulness (all r > 0.40; P r = −0.45; P r = 0.92, 0.68; P r = −0.32, −0.38; P Limitations Female skin only was studied. Conclusions Skin color homogeneity, driven by melanin and hemoglobin distribution, influences perception of age, attractiveness, health, and youth.
TL;DR: The CASH algorithm can distinguish melanoma from melanocytic nevi with sensitivity and specificity comparable with other algorithms, and its intraobserver and interobserver correlations are warranted.
Abstract: Background The color, architecture, symmetry, and homogeneity (CASH) algorithm for dermoscopy includes a feature not used in prior algorithms, namely, architecture. Architectural order/disorder is derived from current concepts regarding the biology of benign versus malignant melanocytic neoplasms. Objective We sought to evaluate the accuracy of the CASH algorithm. Methods A total CASH score (TCS) was calculated for dermoscopic images of 325 melanocytic neoplasms. Sensitivity, specificity, diagnostic accuracy, and receiver operating characteristic curve analyses were performed by comparing the TCS with the histopathologic diagnoses for all lesions. Results The mean TCS was 12.28 for melanoma, 7.62 for dysplastic nevi, and 5.24 for nondysplastic nevi. These differences were statistically significant ( P Limitations This is a single-evaluator pilot study. Additional studies are needed to verify the CASH algorithm. Conclusions The CASH algorithm can distinguish melanoma from melanocytic nevi with sensitivity and specificity comparable with other algorithms. Further study is warranted to determine its intraobserver and interobserver correlations.
TL;DR: The PASE questionnaire is a self-administered tool that can be used to screen for PsA among patients with psoriasis and can distinguish between symptoms of PsA and osteoarthritis.
Abstract: Results: A total of 69 participants with known psoriasis and PsA before the initiation of systemic therapy were screened with PASE after institutional review board approval. The average age was 51 years, and 51% of the participants were female. A total of 25% (17/69) were diagnosed with PsA in this study, and 37% (24/69) were diagnosed with osteoarthritis. Patients with concomitant PsA and osteoarthritis were excluded. PASE total scores ranged from 23 to 68 (possible range, 15-75). In patients with PsA, the median total score was 53 (25th and 75th percentiles, 49 and 63, respectively) and 39 (25th and 75th percentiles, 28 and 47) in non-PsA patients (P \ .001). Median PASE total score for osteoarthritis patients was 43 (25th and 75th percentiles, 37 and 51) and significantly different to PsA patient total median scores (P = .002). Using receiver operator curves, we determined that PASE total score $47 was able to distinguish PsA from non-PsA patients with 82% sensitivity and 73% specificity. Limitations: PASE is a screening tool for PsA and does not replace a comprehensive musculoskeletal evaluation by a rheumatologist. Conclusion: The PASE questionnaire is a self-administered tool that can be used to screen for PsA among patients with psoriasis. PASE can distinguish between symptoms of PsA and osteoarthritis. A larger study is needed to validate PASE in dermatology clinics in the community. ( J Am Acad Dermatol 2007;57:581-7.)
TL;DR: Standard DS with a handheld DS is a useful tool for diagnosing scabies, with high sensitivity, even in inexperienced hands, and greatly enhances clinical skills for making treatment decisions.
Abstract: Background Scabies is a contagious skin infestation caused by the human mite Sarcoptes scabiei . The usual reference method for definitive diagnosis is ex vivo identification of the mite with microscopic examination of skin scrapings. We compared diagnostic accuracy of in vivo dermoscopic (DS) mite identification using a pocket handheld low-magnification DS with the reference method. Methods We conducted a prospective, nonrandomized, evaluator-blinded, noninferiority study to compare sensitivities (main outcome) and other diagnostic properties of DS and microscopic examination of skin scrapings. Among 756 patients with a presumptive diagnosis of scabies consulting in one center, 238 were sequentially submitted to the two diagnostic procedures. Three dermoscopists (one expert, two inexperienced) were involved. Diagnostic strategies using clinical skills only, DS results, and a combination of both were compared. Results Sensitivities were 91% (95% confidence interval: 86-96) for DS and 90% (95% confidence interval: 85-96) for microscopic examination of skin scrapings ( P = .005 for noninferiority). Specificities were 86% (95% confidence interval: 80-92) for DS and 100% (by definition) for microscopic examination of skin scrapings. DS sensitivities were similar for the expert and inexperienced dermoscopists, whereas differences were observed in specificities. However, diagnostic accuracy of inexperienced dermoscopists steadily increased during the study. Compared with clinical-based, DS-based treatment decision rule minimized the number of false-positive and false–negative findings, whereas a treatment decision rule based on combination of clinical presumption and DS result drastically reduced the number of patients with scabies left untreated. Limitations There is no definitive standard for ruling out the diagnosis of scabies. Conclusions Standard DS with a handheld DS is a useful tool for diagnosing scabies, with high sensitivity, even in inexperienced hands. It greatly enhances clinical skills for making treatment decisions.