... 2017 American Academy of Dermatology. All rights reserved. Reproduction or republication strictly prohibited without prior written permission. ... 2017 American Academy of Dermatology. All rights reserved. Reproduction or republication strictly prohibited without prior written permission.
The practice of behavioral dermatology encompasses the management of any dermatologic condition for which there is a substantial behavioral or emotional component. Commonly recognized behavioral dermatoses such as acral lick dermatitis, psychogenic alopecia, and hyperesthesia are syndromes rather than discrete diagnoses. Successful patient management is dependent upon integrating physiological, social, and environmental factors which contribute to the clinical manifestation of behavioral dermatoses.
Sica, P A
Being able to recognize and treat a dermatologic emergency is extremely important to the primary care physician. This ability is very rewarding for the patient and gratifying to the physician. In this article, some of the more commonly encountered emergencies are discussed.
White, Stephen D
Donkeys (Equus asinus) are a species used throughout the world primarily as beasts of burden, but occasionally for other functions, as a meat source or as pets. Although closely related to other equids, they have some unique features of their own with regard to dermatologic disease. This article highlights some of the various dermatoses seen or reported in donkeys, as well as some comparisons with horses when prevalence, presentation, or treatment may differ.
Fox, Lindy P
Inpatient dermatology is emerging as a distinct dermatology subspecialty where dermatologists specialize in caring for patients hospitalized with skin disease. While the main focus of inpatient dermatology is the delivery of top-quality and timely dermatologic care to patients in the hospital setting, the practice of hospital-based dermatology has many additional components that are critical to its success.
Biesbroeck, Lauren K; Shinohara, Michi M
Dermatology consultation can improve diagnostic accuracy in the hospitalized patient with cutaneous disease. Dermatology consultation can streamline and improve treatment plans, and potentially lead to cost savings. Dermatology consultants can be a valuable resource for education for trainees, patients, and families. Inpatient consultative dermatology spans a breadth of conditions, including inflammatory dermatoses,infectious processes, adverse medication reactions, and neoplastic disorders, many of which can be diagnosed based on dermatologic examination alone, but when necessary, bedside skin biopsies can contribute important diagnostic information.
Arora, Gp Capt Sandeep
Evolutionarily, man is a terrestrial mammal, adapted to land. Aviation and now space/microgravity environment, hence, pose new challenges to our physiology. Exposure to these changes affects the human body in acute and chronic settings. Since skin reflects our mental and physical well-being, any change/side effects of this environment shall be detected on the skin. Aerospace industry offers a unique environment with a blend of all possible occupational disorders, encompassing all systems of the body, particularly the skin. Aerospace dermatologists in the near future shall be called upon for their expertise as we continue to push human physiological boundaries with faster and more powerful military aircraft and look to colonize space stations and other planets. Microgravity living shall push dermatology into its next big leap-space, the final frontier. This article discusses the physiological effects of this environment on skin, effect of common dermatoses in aerospace environment, effect of microgravity on skin, and occupational hazards of this industry.
Arora, Gp Capt Sandeep
Evolutionarily, man is a terrestrial mammal, adapted to land. Aviation and now space/microgravity environment, hence, pose new challenges to our physiology. Exposure to these changes affects the human body in acute and chronic settings. Since skin reflects our mental and physical well-being, any change/side effects of this environment shall be detected on the skin. Aerospace industry offers a unique environment with a blend of all possible occupational disorders, encompassing all systems of the body, particularly the skin. Aerospace dermatologists in the near future shall be called upon for their expertise as we continue to push human physiological boundaries with faster and more powerful military aircraft and look to colonize space stations and other planets. Microgravity living shall push dermatology into its next big leap-space, the final frontier. This article discusses the physiological effects of this environment on skin, effect of common dermatoses in aerospace environment, effect of microgravity on skin, and occupational hazards of this industry. PMID:28216729
Usatine, Richard P; Sandy, Natasha
Life-threatening dermatologic conditions include Rocky Mountain spotted fever; necrotizing fasciitis; toxic epidermal necrolysis; and Stevens-Johnson syndrome. Rocky Mountain spotted fever is the most common rickettsial disease in the United States, with an overall mortality rate of 5 to 10 percent. Classic symptoms include fever, headache, and rash in a patient with a history of tick bite or exposure. Doxycycline is the first-line treatment. Necrotizing fasciitis is a rapidly progressive infection of the deep fascia, with necrosis of the subcutaneous tissues. It usually occurs after surgery or trauma. Patients have erythema and pain out of proportion to the physical findings. Immediate surgical debridement and antibiotic therapy should be initiated. Stevens-Johnson syndrome and toxic epidermal necrolysis are acute hypersensitivity cutaneous reactions. Stevens-Johnson syndrome is characterized by target lesions with central dusky purpura or a central bulla. Toxic epidermal necrolysis is a more severe reaction with full-thickness epidermal necrosis and exfoliation. Most cases of Stevens-Johnson syndrome and toxic epidermal necrolysis are drug induced. The causative drug should be discontinued immediately, and the patient should be hospitalized for supportive care.
Hoch, Heather E.; Busse, Kristine L.; Dellavalle, Robert P.
Summary Health care consumers increasingly confront and collaborate with their medical providers. We describe consumer success in other medical fields and in dermatology, especially dermatologic disease advocacy and improving dermatologist-patient interactions. PMID:19254661
Karimkhani, Chante; Connett, Jessica; Boyers, Lindsay; Quest, Tyler; Dellavalle, Robert P
The novel photo-sharing social networking platform, Instagram, has an impressive following of 75 million daily users, with a predominantly younger and female demographic. This study investigated the presence of dermatology-related content on Instagram. The most popular professional dermatological organizations, dermatology journals, and dermatology related patient advocate groups on Facebook and Twitter, determined from a prior study, were searched for established profiles on Instagram. In addition, dermatology-related terms (i.e. dermatology, dermatologist, alopecia, eczema, melanoma, psoriasis, and skin cancer) and dermatology-related hashtags (i.e. #dermatology, #dermatologist, #melanoma, #acne, #psoriasis, and #alopecia) were searched. None of the top ten dermatological journals or professional dermatological organizations were found on Instagram. Although only one of the top ten patient advocate groups related to dermatology conditions, Melanoma Research Foundation, had an Instagram presence, there were many private offices, cosmetic products, and some patient advocacy groups. This novel social networking platform could grant dermatology journals and other professional organizations a unique opportunity to reach younger demographic populations, particularly women, with the potential for true educational and life-changing impact.
Urpe, Mauro; Pallanti, Stefano; Lotti, Torello
Psychosomatics describes any aspect of dermatology with psychologic or psychiatric elements. Dermatologists know that a significant proportion of their practice involves patients for whom psychologic elements either partially or sometimes entirely dominate their presenting chief complaints. This article explores the role of psychosomatic factors in dermatologic disorders. The authors discuss the clinical interface between psychiatry, psychology and dermatology and the interpretation of possible relationships between cutaneous diseases, the role of the mind, and psychotherapeutic interventions.
Stephens, John B; Raimer, Sharon S; Wagner, Richard F
Acting internships are an important component of modern day medical school curriculum. Several specialties outside of internal medicine now offer acting internship experiences to fourth year medical students. We have found that a dermatology acting internship is a valuable experience for fourth year medical students who are interested in pursuing a residency in dermatology. Our experience with the dermatology acting internship over the 2010-2011 academic year is described.
Madke, Bhushan; Nayak, Chitra
Clinical signs reflect the sheer and close observatory quality of an astute physician. Many new dermatological signs both in clinical and diagnostic aspects of various dermatoses are being reported and no single book on dermatology literature gives a comprehensive list of these “signs” and postgraduate students in dermatology finds it difficult to have access to the description, as most of these resident doctor do not have access to the said journal articles. “Signs” commonly found in dermatologic literature with a brief discussion and explanation is reviewed in this paper. PMID:23189246
Jindal, Nidhi; Jindal, Pooja; Kumar, Jeevan; Gupta, Sanjeev; Jain, VK
The world of Dermatology is flooded with inflexions among clinical conditions and signs and syndromes; making it interesting, but a tougher subject to remember. Signs and syndromes have always fascinated residents, but simultaneously burdened their minds, as these attractive names are difficult to remember. This work was undertaken to review dermatological conditions and signs based on commonly encountered daily words and objects like animals, etc. Fifty dermatological conditions were found to be based on animal eponyms. For example, the usage of animal terminology in dermatology like leonine facies is present in leprosy, sarcoidosis, mycosis fungoides (MF), and airborne contact dermatitis (ABCD). PMID:25484417
Hassan, Iffat; Dorjay, Konchok; Anwar, Parvaiz
The use of thalidomide in relation to dermatology is well- known and enough data is available in the literature about various aspects of thalidomide. Despite being an interesting and useful drug for many dermatoses, it is associated with many health hazards including the birth defects, phocomelia. We hereby present a comprehensive review about thalidomide and its application in dermatology. PMID:25814738
Ro, B I
The Korean Dermatological Association (KDA) was founded on October 27, 1945. The first annual meeting was held on November 15, 1947, and meetings have been held twice a year since 1975. The KDA 50th Annual Spring Meeting was on April 15-16, 1998. Korean Journal of Dermatology, the official journal of the KDA, was first published in 1960 and has been published bimonthly since 1978. Annals of Dermatology (Seoul), the English journal, was first published in 1989 and has been published quarterly since 1995. The American residency and specialty board system was introduced in 1954. Board specialty examination of dermatology candidates by the KDA requires four years of residency. Three hundred and twenty residents are now in the training course in the fifty-nine resident training approved hospitals this year. KDA has seven regional dermatological societies; Seoul, Pusan, Taegu, Honam, Chungchong, Jeonbuk, and Kangwon. KDA has had eleven research subcommittees since 1981. There are two associated societies of the KDA; the Korean Society for Investigative Dermatology was founded in 1991, and the Korean Society for Medical Mycology was founded in 1994. The Korea-Japan Joint Meeting of Dermatology has been held every two years since 1979 and the Korea-China Joint Meeting of Dermatology and Mycology has been held since 1996. About three hundred papers were presented at the 49th Annual Autumn Meeting on October 21-23, 1997. These included special lectures, invited lectures, educational lectures, oral presentations, and posters. About five hundred dermatologists participated in that meeting. KDA joined the International League of Dermatological Societies in 1973 with forty-seven members. There are around 1200 members of the KDA including 320 residents in 1998.
As both a dermatology resident and yoga instructor, I find the potential correlation between the 2 disciplines to be interesting and a growing topic of attention in the media today. With the rising trend of practicing yoga, which encompasses physical postures, breathing exercises, and meditation or mindfulness, it is inevitable that patients will inquire about the benefits of yoga in managing dermatologic problems. In this column, I will discuss the dermatologic manifestations of stress as well as the known health benefits of yoga as described in the literature so that residents may offer an objective opinion about yoga in response to patient inquiries.
Keen, Mohammad Abid; Hassan, Iffat
Vitamin E is an important fat-soluble antioxidant and has been in use for more than 50 years in dermatology. It is an important ingredient in many cosmetic products. It protects the skin from various deleterious effects due to solar radiation by acting as a free-radical scavenger. Experimental studies suggest that vitamin E has antitumorigenic and photoprotective properties. There is a paucity of controlled clinical studies providing a rationale for well-defined dosages and clinical indications of vitamin E usage in dermatological practice. The aim of this article is to review the cosmetic as well as clinical implications of vitamin E in dermatology. PMID:27559512
Palmeiro, Brian S
Cyclosporine is an immunomodulatory medication that is efficacious and approved for atopic dermatitis in dogs and allergic dermatitis in cats; it has also been used to successfully manage a variety of immune-mediated dermatoses in dogs and cats. This article reviews the use of cyclosporine in veterinary dermatology including its mechanism of action, pharmacokinetics, drug interactions, side effects, and relevant clinical updates. Dermatologic indications including atopic/allergic dermatitis, perianal fistulas, sebaceous adenitis, and other immune-mediated skin diseases are discussed.
Bubna, Aditya Kumar
Aspirin has been one of the oldest drugs in the field of medicine, with a wide range of applications. In dermatology, aspirin has shown benefit in a variety of disorders. Recently, reduction of melanoma risk with aspirin has been demonstrated. Although an analgesic to begin with, aspirin has come a long way; after cardiology, it is now found to be useful even in dermatology. PMID:26753146
García-Martínez, F J; Muñoz-Garza, F Z; Hernández-Martín, A
Cutaneous ultrasound is particularly useful in pediatric dermatology to diagnose numerous diseases without the need to use invasive tests. The present articles reviews some frequent dermatological entities in children whose study can be simplified through cutaneous ultrasound. This article also provides practical recommendations reported in the literature that may facilitate ultrasound examination, with special mention of benign tumoural disease, both congenital and acquired, and vascular anomalies.
Szymanczyk, Jacek; Nowakowski, Wlodzimierz; Golebiowska, Aleksandra; Michalska, I.; Mindak, Marek K.
Almost every laser for medical applications was first tried in dermatology. The efficiency of YAG, CO2, and Argon lasers on this area and their potential advantages over conventional methods were mostly evaluated by cosmetic effect of laser therapy. The indications for different laser treatment in such dermatological cases as: angiomas, telangiectasias, pigmented lesions, nevus flammeus congenitus, deep cavernous angiomas, skin neoplasms and condylomata acuminata are discussed in this paper and the results of the laser therapy are also presented.
Ashack, Kurt A; Burton, Kyle A; Dellavalle, Robert P
Doximity, currently the largest online social networking service for United States (US) health care professionals and medical students, provides a wide variety of content to a large audience. In fact, its database includes 1,078,305 physicians in the US. It is therefore important to evaluate this content from time to time. Our objective is to analyze both the residency rankings and news content presented in Doximity, with respect to dermatology. The study compared the residency rankings created by Doximity to another dermatology residency ranking system that used a different algorithm. In terms of dermatology content, seven dermatology-related search terms were entered into the Doximity search query and data was collected on the first 20 "relevant" articles. Our study evaluated a total of 140 articles. The search term "skin cancer" yielded the most articles totaling 6,001. Informative articles were the most common type of article for each content item searched except for "dermatology", yielding research articles as the most common content type (70%). The search term "melanoma awareness" had the largest number of shares (19,032). In comparing dermatology residency rankings on Doximity with another ranking system that accounted for scholarly achievement, there was 50% overlap. In conclusion, it is vital to evaluate content on social media websites that are utilized by US medical students and health care professionals. We hope this information presented provides an up-to-date analysis on the quality of one particular social media platform.
Desai, Samir P.
For decades, it was thought that many common dermatological conditions had no relationship to diet. Studies from recent years, however, have made it clear that diet may influence outcome. In this review, the authors focus on conditions for which the role of diet has traditionally been an underappreciated aspect of therapy. In some cases, dietary interventions may influence the course of the skin disease, as in acne. In others, dietary change may serve as one aspect of prevention, such as in skin cancer and aging of the skin. In others, dermatological disease may be linked to systemic disease, and dietary changes may affect health outcomes, as in psoriasis. Lastly, systemic medications prescribed for dermatological disease, such as steroids, are known to raise the risk of other diseases, and dietary change may reduce this risk. PMID:25053983
Sgantzos, Markos; Tsoucalas, Gregory; Karamanou, Marianna; Giatsiou, Styliani; Tsoukalas, Ioannis; Androutsos, George
Hippocrates of Kos is well known in medicine, but his contributions to pediatric dermatology have not previously been examined. A systematic study of Corpus Hippocraticum was undertaken to document references of clinical and historical importance of pediatric dermatology. In Corpus Hippocraticum, a variety of skin diseases are described, along with proposed treatments. Hippocrates rejected the theory of the punishment of the Greek gods and supported the concept that dermatologic diseases resulted from a loss of balance in the body humors. Many of the terms that Hippocrates and his pupils used are still being used today. Moreover, he probably provided one of the first descriptions of skin findings in smallpox, Henoch-Schönlein purpura (also known as anaphylactoid purpura, purpura rheumatica, allergic purpura), and meningococcal septicemia.
Feinberg, Arthur N; Shwayder, Tor A
This dermatology article serves as a quick reference for the physician treating adolescents. We first review the diagnostic approach to a dermatologic problem: configuration, color, pattern, and distribution. The next section discusses diagnosis and management of the most common clinical situations encountered in everyday practice, including skin infections, infestations, dermatitis, hypersensitivity reactions, and papulosquamous disorders. The following section covers conditions that should be managed with the help of a dermatologist, including difficult acute situations such as Stevens-Johnson syndrome, toxic epidermal necrolysis, and necrotizing fasciitis; other chronic situations, including refractory common conditions such as acne and psoriasis, are also considered. We then discuss conditions that should be managed exclusively by a dermatologist, including malignancies, bullous disorders, and less common types of ichthyosis. The final section alerts the physician to dermatologic conditions that may be manifestations of other disorders, necessitating appropriate referral to a different specialist. Examples are immunologic and endocrine disorders, inflammatory bowel disease, collagen vascular disease, and malignancies.
Metz, Brandie J
Due to many factors, including parental anxiety, a child's inability to understand the necessity of a procedure and a child's unwillingness to cooperate, it can be much more challenging to perform dermatologic procedures in children. This article reviews pre-procedural preparation of patients and parents, techniques for minimizing injection-related pain and optimal timing of surgical intervention. The risks and benefits of general anesthesia in the setting of pediatric dermatologic procedures are discussed. Additionally, the surgical approach to a few specific types of birthmarks is addressed.
Regular analysis of the major journals in dermatology and paediatrics has been used to select forty articles which are representative of the past year in paediatric dermatology. This selection is not exhaustive but rather reflects the interests of the author and also the dominant topics in paediatric dermatology in 2013-2014.
Nijhawan, Rajiv I; Mazza, Joni M; Silverberg, Nanette B
Variability exists in pediatric dermatology education for dermatology residents. We sought to formally assess the pediatric dermatology curriculum and experience in a dermatology residency program. Three unique surveys were developed for dermatology residents, residency program directors, and pediatric dermatology fellowship program directors. The surveys consisted of questions pertaining to residency program characteristics. Sixty-three graduating third-year residents, 51 residency program directors, and 18 pediatric dermatology fellowship program directors responded. Residents in programs with one or more full-time pediatric dermatologist were more likely to feel very competent treating children and were more likely to be somewhat or extremely satisfied with their pediatric curriculums than residents in programs with no full-time pediatric dermatologist (50.0% vs 5.9%, p = 0.002, and 85.3% vs 52.9%, p < 0.001, respectively). Residents in programs with no full-time pediatric dermatologist were the only residents who were somewhat or extremely dissatisfied with their pediatric training. Residency program directors were more satisfied with their curriculums when there was one or more pediatric dermatologist on staff (p < 0.01). Residents in programs with pediatric dermatology fellowships were much more likely to report being extremely satisfied than residents in programs without a pediatric dermatology fellowship (83.3% vs 21.2%; p < 0.001). The results of this survey support the need for dermatology residency programs to continue to strengthen their pediatric dermatology curriculums, especially through the recruitment of full-time pediatric dermatologists.
Laniosz, Valerie; Wetter, David A; Godar, Desiree A
The aim of this study was to determine the common dermatologic diagnoses and skin-related symptoms in a cohort of patients with fibromyalgia seen in a tertiary referral center. A retrospective chart review was performed of all patients with a fibromyalgia diagnosis from January 1 to December 31, 2008, whose diagnosis was confirmed in the Fibromyalgia and Chronic Fatigue Clinic at Mayo Clinic in Rochester, Minnesota. Charts were reviewed for dermatologic conditions and cutaneous symptoms. Demographic and clinical data were collected to assess the frequency of skin-related issues in patients with fibromyalgia. Of 2,233 patients screened, 845 patients met the inclusion criteria of having a confirmed diagnosis of fibromyalgia. Among these fibromyalgia patients, various dermatologic conditions and cutaneous problems were identified, including hyperhidrosis in 270 (32.0 %), burning sensation of the skin or mucous membranes in 29 (3.4 %), and various unusual cutaneous sensations in 14 (1.7 %). Pruritus without identified cause was noted by 28 patients (3.3 %), with another 16 patients (1.9 %) reporting neurotic excoriations, prurigo nodules, or lichen simplex chronicus. Some form of dermatitis other than neurodermatitis was found in 77 patients (9.1 %). Patients with fibromyalgia may have skin-related symptoms associated with their fibromyalgia. No single dermatologic diagnosis appears to be overrepresented in this population, with the exception of a subjective increase in sweating.
Shenoy, Chetana; Shenoy, Manjunath Mala; Rao, Gururaja K.
Dyslipidemias are one of the common metabolic disorders. A link between dermatological disorders like psoriasis and dyslipidemia has been established in the recent past. Many dermatological disorders could have a systemic inflammatory component which explains such association. Chronic inflammatory dermatological disorders could also have other metabolic imbalances that may contribute to dyslipidemia. Presence of such abnormal metabolism may justify routine screening of these disorders for associated dyslipidemia and other metabolic abnormalities and early treatment of such comorbidities to improve quality of life. Some of the drugs used by dermatologists such as retinoids are also likely to be a cause of dyslipidemia. Hence, it is imperative that the dermatologists obtain scientific knowledge on the underlying mechanisms involved in dyslipidemia and understand when to intervene with therapies. A systematic review of the English language literature was done by using Google Scholar and PubMed. In this review, attempts are made to list the dermatological disorders associated with dyslipidemia; to simplify the understanding of underlying mechanisms; and to give a brief idea about the interventions. PMID:26713286
Metaphors have always played a role in the medical tradition and in dermatology too. Beyond their initially playful aspect, metaphors offer a way of rapidly identifying a lesion and of linking it to one or more diseases. They also play a role in the education of medical students and residents by making it easier to memorise different diseases. Herein we discuss "animal" metaphors.
Abstract: Allergists/immunologists see patients with a variety of skin disorders. Some, such as atopic and allergic contact dermatitis, are caused by abnormal immunologic reactions, whereas others, such as seborrheic dermatitis or rosacea, lack an immunologic basis. This review summarizes a select group of dermatologic problems commonly encountered by an allergist/immunologist. PMID:23268431
Adya, Keshavmurthy A.; Inamadar, Arun C.; Palit, Aparna
Many paradoxical phenomena related to clinical, immunological, and therapeutic dermatology have been described. While some of them can be explained logically, the cause for others can only be speculated. Whenever encountered in clinical practice, background knowledge of such paradoxes may be useful to the clinician. PMID:23741675
Stern, E B; Callinan, N; Hank, M; Lewis, E J; Schousboe, J T; Ytterberg, S R
Occupational therapists are expanding their use of custom and commercial soft splints fabricated from neoprene (polychloroprene), but little has been written regarding dermatological issues associated with this material. Skin contact with neoprene poses two dermatological risks: allergic contact dermatitis (ACD) and miliaria rubra (i.e., prickly heat). Allergic reaction to neoprene is generally ascribed to the accelerants used to manufacture the man-made rubber, specifically thiourea compounds and mercaptobenzothiazole (MBT). Symptoms of neoprene-related ACD include itching, skin eruptions, swelling, and hemorrhages into the skin. Miliaria rubra creates small, red, elevated, inflammatory papules and a tingling, burning sensation. Although neoprene hypersensitivity is rare, its incidence may grow as neoprene becomes a more commonly used material. It is recommended that therapists screen patients for a history of dermatological reactions to neoprene or other materials containing thiourea compounds or MBT and educate patients to discontinue splint use if dermatological symptoms develop. Therapists are also encouraged to notify splint manufacturers regarding all ACD reactions.
Pazyar, Nader; Feily, Amir; Kazerouni, Afshin
The purpose of this brief review is to summarize all in vitro, in vivo, and controlled clinical trials on green tea preparations and their uses in dermatology. An extensive literature search was carried out to identify in vivo and in vitro studies as well as clinical trials. Twenty studies were assessed and the results suggest that oral administration of green tea can be effective in the scavenging of free radicals, cancer prevention, hair loss, and skin aging plus protection against the adverse effects associated with psoralen-UV-A therapy. Topical application of green tea extract should be potentially effective for atopic dermatitis, acne vulgaris, rosacea, androgenetic alopecia, hirsutism, keloids, genital warts, cutaneous leishmaniasis, and candidiosis. There are promising results with the use of green tea for several dermatologic conditions; however, the efficacy of oral and topical green tea has not always been confirmed.
Petrof, Gabriela; Abdul-Wahab, Alya; McGrath, John A.
Harnessing the regenerative capacity of keratinocytes and fibroblasts from human skin has created new opportunities to develop cell-based therapies for patients. Cultured cells and bioengineered skin products are being used to treat patients with inherited and acquired skin disorders associated with defective skin, and further clinical trials of new products are in progress. The capacity of extracutaneous sources of cells such as bone marrow is also being investigated for its plasticity in regenerating skin, and new strategies, such as the derivation of inducible pluripotent stem cells, also hold great promise for future cell therapies in dermatology. This article reviews some of the preclinical and clinical studies and future directions relating to cell therapy in dermatology, particularly for inherited skin diseases associated with fragile skin and poor wound healing. PMID:24890834
Noé, C; Pelletier-Aouizerate, M; Cartier, H
The use in dermatology of light-emitting diodes (LEDs) continues to be surrounded by controversy. This is due mainly to poor knowledge of the physicochemical phases of a wide range of devices that are difficult to compare to one another, and also to divergences between irrefutable published evidence either at the level of in vitro studies or at the cellular level, and discordant clinical results in a variety of different indications: rejuvenation, acne, wound healing, leg ulcers, and cutaneous inflammatory or autoimmune processes. Therapeutic LEDs can emit wavelengths ranging from the ultraviolet, through visible light, to the near infrared (247-1300 nm), but only certain bands have so far demonstrated any real value. We feel certain that if this article remains factual, then readers will have a different, or at least more nuanced, opinion concerning the use of such LED devices in dermatology.
Wollina, Uwe; Goldman, Alberto; Berger, Uwe; Abdel-Naser, Mohammed Badawy
The field of esthetic and cosmetic dermatology has gained remarkable interest all over the world. The major advantage of recent years is the high scientific levels of the most significant new developments in techniques and pharmacotherapy and other nonsurgical approaches. The present paper reviews selected fields of interest under this view. Sexual hormones are involved in the aging process of men and women. Skin function, in particular the epidermal barrier, is affected by a loss of endocrine activity. Hormone replacement therapy has only recently been introduced in treatment of aging males. This is an area of gender-medicine in dermatology with a strong well-aging attempt. Botulinum toxin therapy for hyperfunctional lines has become not only well-established but evidence-based medicine on its highest level. Recent advantages were gained in objective evaluation and monitoring the effect. Digital imaging techniques with various facets have been introduced to assess the achievements of treatment in the most objective way. This may become an example for other techniques as peeling, laser therapy, or radiofrequency in esthetic and cosmetic dermatology. Botulinum toxin has become a valuable tool for brow lifts. Details of the technique are discussed. Cellulite is a strongly female gender-related condition. During the past decades numerous treatments had been recommended but only recently a more critical scientific approach led to improvements in therapy of this common and disfiguring condition. Three major approaches are developed: (a) skin loosing with techniques such as subcision, (b) skin tightening with radiofrequency and other approaches, and (c) improving circulation in blood and lymphatic microvasculature using both physical treatments and pharmacotherapy. The last two chapters are devoted to body sculpturing by lipotransfer and lipolysis. Lipotransfer for facial or body sculpturing has a history of about 100 years. Nevertheless, recently the role of adult stem
Holmes, John; Welzel, Julia
OCT is increasingly interesting for non-invasive skin imaging in Dermatology. Due to its resolution and imaging depth, OCT is already routinely established for diagnosis of nonmelanoma skin cancer, whereas for pigmented lesions, the resolution is still not high enough. OCT has also a high value for monitoring of treatment effects, for example to control healing after non-surgical topical treatment of basal cell carcinomas. In summary, there are several indications for applications of OCT to image skin diseases, and its importance will grow in the future due to further technical developments like speckle variance OCT.
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Matz, Hagit; Orion, Edith; Wolf, Ronni
Balneotherapy and spa therapy emerged as an important treatment modality in the 1800s, first in Europe and then in the United States. Balneotherapy involves immersion of the patient in mineral water baths or pools. Today, water therapy is being practiced in many countries. Examples of unique and special places for balneotherapy are the Dead Sea in Israel, the Kangal hot spring in Turkey, and the Blue Lagoon in Iceland. Bathing in water with a high salt concentration is safe, effective, and pleasant for healing and recovery. This approach needs no chemicals or potentially harmful drugs. There are almost no side effects during and after treatment, and there is a very low risk to the patient's general health and well-being. Mineral waters and muds are commonly used for the treatment of various dermatologic conditions. The major dermatologic diseases that are frequently treated by balneotherapy with a high rate of success are psoriasis and atopic dermatitis. The mechanisms by which broad spectrums of diseases are alleviated by spa therapy have not been fully elucidated. They probably incorporate chemical, thermal, mechanical, and immunomodulatory effects. The major importance of balneotherapy and spa therapy both individually and as complements to other therapies lies in their potential effectiveness after standard medical treatments have failed to give comfort to these patients.
Ceburkov, O; Gollnick, H
Application of non-ionising radiation with or without photosensitizers is rather common in dermatology. Though the method itself was described in ancient times, its routine use in medicine based on scientific research started in the second half of the 20th century. Light can be used in three different patterns: phototherapy (UV-A or UV-B light), photochemotherapy (combination of psoralens with UV-A light) and photodynamic therapy (combination of photosensitizers with UV- and/or visible light). The following article deals with the photodynamic therapy or PDT. Using PDT implies the understanding of light dosimetry and calculation of light dose using different light sources and photosensitizers. The number of PDT sensitisers under investigation is rapidly increasing. The PDT itself, being a relatively new modality, quickly spreads its list of applications covering new indications in different areas of medicine. Though the main part of this list is made up of dermatological conditions, the use of PDT in other disciplines is also discussed to make dermatologists familiar with different aspects of the issue. PDT, like any treatment modality, has its benefits and adverse effects. The future of PDT is closely related to teamwork in physical, biochemical and clinical research which could provide better understanding of underlying mechanisms and help to create protocols for higher therapeutic efficacy.
Antonio, João Roberto; Antônio, Carlos Roberto; Cardeal, Izabela Lídia Soares; Ballavenuto, Julia Maria Avelino; Oliveira, João Rodrigo
The scientific community and general public have been exposed to a series of achievements attributed to a new area of knowledge: Nanotechnology. Both abroad and in Brazil, funding agencies have launched programs aimed at encouraging this type of research. Indeed, for many who come into contact with this subject it will be clear the key role that chemical knowledge will play in the evolution of this subject. And even more, will see that it is a science in which the basic structure is formed by distilling different areas of inter-and multidisciplinary knowledge along the lines of new paradigms. In this article, we attempt to clarify the foundations of nanotechnology, and demonstrate their contribution to new advances in dermatology as well as medicine in general. Nanotechnology is clearly the future. PMID:24626657
Mathias, C. G. Toby; Maibach, Howard I.
Because large surface areas of the skin are exposed directly to the environment, skin is an organ particularly vulnerable to occupationally induced disease. Statistics show that, excluding accidental injury, nearly half of all occupational illnesses occur in this organ; a fourth of all workers suffering from occupational skin disease lose an average of 10 to 12 workdays. The constant evolution of new industrial chemicals and methods of manufacture continue to bring new skin hazards and disease into the workplace. Occupational health physicians and practitioners, who usually have minimal training in dermatology, must diagnose and treat unfamiliar diseases in a setting of even less familiar, often overwhelming, technology. A thorough understanding of cutaneous defense mechanisms, clinical patterns of occupational skin disease and methods for establishing accurate diagnoses is essential. PMID:6219498
Harth, Wolfgang; Hermes, Barbara; Freudenmann, Roland W
Delusional parasitosis (DP) is the most frequent delusional disorder in dermatology. In DP there is a fixed belief of a usually skin-related invasion or infestation by a number of alleged infectious species (usually parasites and bacteria), whose identity has varied over the decades. Since 2002 worldwide an increasing number of patients have complained of unverifiable fibers and filaments in or on the skin, associated with numerous nonspecific complaints (arthralgias, altered cognitive function and extreme fatigue). This entity has been named "Morgellons disease" by the patients themselves, although medical evidence for its existence is lacking. As an example, we discuss a 55-year-old woman who complained of Morgellons disease and was treated as if she had DP. Currently the delusional assumption of infestation with Morgellons should be considered as a new type of DP with some kind of inanimate material. We therefore recommend in case of DP including Morgellons the use of the broader term "delusional infestation".
Smith, Derek R
Although the fields of bibliometrics and citation analysis have existed for many years, relatively few studies have specifically focused on the dermatological literature. This article reviews citation-based research in the dermatology journals, with a particular interest in manuscripts that have included Contact Dermatitis as part of their analysis. Overall, it can be seen that the rise of bibliometrics during the mid-20th century and its subsequent application to dermatology has provided an interesting insight into the progression of research within our discipline. Further investigation of citation trends and top-cited papers in skin research periodicals would certainly help complement the current body of knowledge.
Aquino, Lisa L; Wen, Ge; Wu, Jashin J
Unlike many other adult specialties, US News & World Report does not rank dermatology residency programs annually. We conducted a study to rank individual US dermatology residency programs based on set criteria. For each residency program, data from 2008 related to a number of factors were collected, including annual amount of National Institutes of Health (NIH) and Dermatology Foundation (DF) funding received; number of publications from full-time faculty members; number of faculty lectures given at 5 annual society meetings; and number of full-time faculty members who were on the editorial boards of 6 dermatology journals with the highest impact factors. Most of the data were obtained through extensive Internet searches, and missing data were obtained by contacting individual residency programs. The programs were ranked based on the prior factors according to a weighted ranking algorithm. A list of overall rankings also was created.
... 000 per recipient for research relevant to dermatologic surgery and/or cutaneous oncology. Proposals for board-directed research topics, evidence-based medicine, comparative efficacy research, quality studies or patient ...
García Hidalgo, Linda
Obesity is a health problem of considerable magnitude in the Western world. Dermatological changes have been reported in patients with obesity, including: acanthosis nigricans and skin tags (due to insulin resistance); hyperandrogenism; striae due to over extension; stasis pigmentation due to peripheral vascular disease; lymphedema; pathologies associated with augmented folds; morphologic changes in the foot anatomy due to excess load; and complications that may arise from hospitalization. Acanthosis nigricans plaques can be managed by improved control of hyperinsulinemia; the vitamin D3 analog calcipitriol has also been shown to be effective. Skin tags can be removed by snipping with curved scissors, by cryotherapy or by electrodesiccation. Hyperandrogenism, a result of increased production of endogenous androgens due to increased volumes of adipose tissue (which synthesizes testosterone) and hyperinsulinemia (which increases the production of ovarian androgens) needs to be carefully assessed to ensure disorders such as virilizing tumors and congenital adrenal hyperplasia are treated appropriately. Treatment of hyperandrogenism should be centred on controlling insulin levels; weight loss, oral contraceptive and antiandrogenic therapies are also possible treatment options. The etiology of striae distensae, also known as stretch marks, is yet to be defined and treatment options are unsatisfactory at present; striae rubra and alba have been treated with a pulsed dye laser with marginal success. The relationship between obesity and varicose veins is controversial; symptoms are best prevented by the use of elastic stockings. Itching and inflammation associated with stasis pigmentation, the result of red blood cells escaping into the tissues, can be treated with corticosteroids. Lymphedema is associated with dilatation of tissue channels, reduced tissue oxygenation and provides a culture medium for bacterial growth. Lymphedema treatment is directed towards reducing the
Takac, S; Stojanović, S; Muhi, B
The authors review their experiences with the use of carbon-dioxide (CO2) lasers in dermatological surgery in a group of 3000 patients, with a total number of 3920 tumorous skin lesions, during a three-year period. The word LASER is an acronym for L-ight A-mplification by S-timulated E-mission of R-adiation. It must be pointed out that it is electromagnetic radiation, not X-irradiation. In regard to the spectrum laser light is between infrared and ultraviolet light, mainly in the visible spectrum, so its application does not produce new generations of iatrogenic malignancies as in the case of ionizing radiation. The laser is a new scalpel which differs from the metal surgical scalpel (also called "optical knife" and "light scalpel"). In the conclusion authors state that using (CO2) complete success was achieved in treatment of the following skin lesions: common viral warts, senile keratosis, seborrhoeic keratosis, plantar viral warts, papillomas, capillary telangiectasias of the face, hemangiomas, juvenile viral warts of the face, ingrown nails, condyloma acuminata, pendular fibromas, xanthelasmas, atheromas, pyogenic granulomas, keratoacanthomas, tattooed skin and basocellular epitheliomas.
Cevirgen Cemil, Bengu; Keseroglu, Havva Ozge; Kaya Akis, Havva
Many advances in dermatology have been made in recent years. In the present review article, newly described disorders from the last six years are presented in detail. We divided these reports into different sections, including syndromes, autoinflammatory diseases, tumors, and unclassified disease. Syndromes included are “circumferential skin creases Kunze type” and “unusual type of pachyonychia congenita or a new syndrome”; autoinflammatory diseases include “chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome,” “pyoderma gangrenosum, acne, and hidradenitis suppurativa (PASH) syndrome,” and “pyogenic arthritis, pyoderma gangrenosum, acne, and hidradenitis suppurativa (PAPASH) syndrome”; tumors include “acquired reactive digital fibroma,” “onychocytic matricoma and onychocytic carcinoma,” “infundibulocystic nail bed squamous cell carcinoma,” and “acral histiocytic nodules”; unclassified disorders include “saurian papulosis,” “symmetrical acrokeratoderma,” “confetti-like macular atrophy,” and “skin spicules,” “erythema papulosa semicircularis recidivans.” PMID:25243162
Olek-Hrab, Karolina; Karczewski, Jacek; Teresiak-Mikołajczak, Ewa; Adamski, Zygmunt
Over the last decade the availability of biological drugs for the treatment of psoriasis vulgaris, psoriatic arthritis and many other inflammatory diseases has revolutionized the treatment of these diseases around the world. Due to the high cost of therapy, the search has started for biosimilars. In dermatology the greatest interest in biosimilar medicines concerns inhibitors of tumor necrosis factor a (TNF-α), for use in the treatment of psoriasis vulgaris and psoriatic arthritis (infliximab, etanercept, adalimumab). The most important element of the safety of biologicals is their immunogenicity. Therefore, when discussing biosimilars, attention needs to be paid to the dangers of their immune activity. In view of the fact that the drugs contain and aggregates, produced by living organisms or cultures of living cells, they cannot be compared in any way to low molecular weight synthetic generics (called generics). Biosimilars are authorized for use in patients and treated as equivalent to the reference medicine only after passing a number of studies and assessments. As it is well known, the development of medicine and pharmacology is extremely intense, and the market in biological medicine is developing much faster than that of all other drugs, which underlines their important role in modern medicine. Currently, the subject of biosimilars is one of the most important challenges and topics of discussion around the world, including pharmacovigilance and legal and economic regulatory standards. It seems inevitable that biosimilar products will be introduced for the treatment of diseases with indications corresponding to the original product on which they are based. PMID:26759547
Del Río, E
Even before dermatology was born as a specialty at the beginning of the 19th century, most skin lesions and dermatoses tended to be treated by surgeons rather than physicians. After medicine and surgery were unified into a single discipline and dermatology emerged as a modern specialty, this relationship became blurred and Spanish dermatologists leaned more towards medicine than surgery. Then improvements in surgical techniques, knowledge of antiseptic and aseptic procedures, the development and introduction of anesthesia, and the greater interest in micrographic approaches led to the rediscovery and almost complete rebirth of this old surgical tradition in the second half of the 19th century. In Spain, dermatologic surgery as such did not really exist until the first third of the 20th century, when Enrique Alvarez Sainz de Aja and Vicente Gimeno emerged as the main exponents of this discipline. Of these 2, Alvarez Sainz de Aja drawing on his previous experience as a general surgeon and obstetrician was the better practitioner of the incipient dermatologic surgery. The other, Gimeno, wrote an interesting booklet on dermatologic surgery that was published in 1923 and that formed the basis of his inaugural speech to the Spanish Royal National Academy of Medicine.
McCann, Sue A.; Chase, Allister Benjamin; Tawa, Marianne C.
ABSTRACT Mycosis fungoides is the most common form of cutaneous T-cell lymphoma. Stage IA and IB mycosis fungoides cutaneous T-cell lymphoma can be effectively controlled by skin-directed therapies such as the mechlorethamine gel approved by the Food and Drug Administration. Dermatology nurses play a key role in promoting good patient compliance through patient education about mycosis fungoides cutaneous T-cell lymphoma disease, proper administration of mechlorethamine gel, and connecting patients with patient assistance programs or other supportive services. This article provides the dermatology nurse with a background about early-stage mycosis fungoides cutaneous T-cell lymphoma, skin-directed treatment options, questions that a patient may ask about mycosis fungoides cutaneous T-cell lymphoma and mechlorethamine gel, and patient education tools such as questions dermatology nurses may ask of their patients and a patient handout outlining mechlorethamine gel administration.
Has, Cristina; Sitaru, Cassian
Groundbreaking advances on the molecular and cellular physiological and physiopathological skin processes, including the complete sequencing of the genome of several species and the increased availability of gene-modified organisms, paved the way to firmly establishing molecular approaches and methods in experimental, translational, and clinical dermatology. As a result, newly developed experimental ex vivo assays and animal models prove exquisite tools for addressing fundamental physiological cutaneous processes and pathogenic mechanisms of skin diseases. A plethora of new findings that were generated using these experimental tools serve as a strong basis for intense translational research efforts aiming at developing new, specific, and sensitive diagnostic tests and efficient "personalized" therapies with less side-effects. Consequently, a broad array of molecular diagnostic tests and therapies for a wide spectrum of skin diseases ranging from genodermatoses through skin neoplasms, allergy, inflammatory and autoimmune diseases, are already routinely used in the clinical dermatology practice. This article highlights several major developments in molecular experimental and clinical dermatology.
Lakshmi, Dammaningala Venkataramaiah; Shilpa, Kanathur; Nataraja, Holavanahally Veerabhadrappa; Divya, Kallapa Gorur
Nose is the most prominent part of the mid-face and has important physiological, aesthetic and psychological functions. Skin diseases on the nose are commonly seen by dermatologists, otorhinolaryngologists, and plastic surgeons. Because of its exposed, highly visible localization, lesions on the skin of the nose are often noticed by patients themselves, typically very early in the course of the disease. Similarly, the dermatological lexicon is well known with descriptive terminologies, synonyms, acronyms, eponyms, toponyms, misnomers. We have tried to compile the anatomical applications of nose in cosmetology and dermatosurgery subspecialities with nasal eponyms and signs encountered in clinical dermatology that would be helpful for residents. PMID:27057038
Topical therapy in dermatology is often perplexing to nondermatologists. They have been taught by several clinicians how to treat a dermatologic case and in addition have been besieged by drug company personnel and by colorful journal advertisements on the virtues of preparations which should readily clear any rash. All these approaches usually lead to a hit or miss result. This presentation discusses a simple approach to skin eruptions, basing the treatment on the stage of the disorder rather than on the cause. ImagesFig. 1Fig. 2Fig. 3 PMID:21286146
In 2013, news from research has clearly shown that dermatology is bound to occupy a more important place in fundamental research. Among these evidences are an increasing number of papers devoted to "Skin" in journals with the highest impact factors and the excellence of the scientific program of the International Investigative Dermatology Meeting held in May in Edinburgh. This paper outlines a selection of scientific works published between September 2012 and August 2013 or presented as communications at the IID Meeting. This selection was made based on the quality of methods used by the authors to obtain results, and on the impact of these scientific results in terms of pathophysiological and therapeutical advances.
Park, Kelly K
Postresidency fellowship training options exist for graduating dermatology residents. Formal subspecialty fellowship programs are offered in dermatopathology, pediatric dermatology, micrographic surgery and dermatologic oncology (procedural dermatology), and cosmetic dermatologic surgery. There also are a number of fellowships offered at certain institutions for those interested in more specific subspecialties or academia. This guide serves to assist dermatology residents in learning more about fellowship opportunities.
Zimmermann, Corinne; Huang, Jennifer T.; Buzney, Elizabeth A.
In 2014 the Museum of Fine Arts Boston and Harvard Medical School began a partnership focused on building visual literacy skills for dermatology residents in the Harvard Combined Dermatology Residency Program. "Refining the Eye: Art and Dermatology", a four session workshop, took place in the museum's galleries and utilized the Visual…
Savitha, Somaiah A; Sacchidanand, Sarvajnamurthy A; Gowda, Shilpa K
The name of a condition in dermatology, gives a clue regarding the clinical feature, etiology, or histopathology of the disease. A disease might have been termed wrongly due to its resemblance to another known condition. Misnomers often mislead a physician regarding the etiology or histopathology of the condition. Here is a list of misnomers, with explanation, and the appropriate name in parentheses. PMID:24249901
Boyers, Lindsay N; Quest, Tyler; Karimkhani, Chante; Connett, Jessica; Dellavalle, Robert P
YouTube, reaches upwards of six billion users on a monthly basis and is a unique source of information distribution and communication. Although the influence of YouTube on personal health decision-making is well established, this study assessed the type of content and viewership on a broad scope of dermatology related content on YouTube. Select terms (i.e. dermatology, sun protection, skin cancer, skin cancer awareness, and skin conditions) were searched on YouTube. Overall, the results included 100 videos with over 47 million viewers. Advocacy was the most prevalent content type at 24% of the total search results. These 100 videos were "shared" a total of 101,173 times and have driven 6,325 subscriptions to distinct YouTube user pages. Of the total videos, 35% were uploaded by or featured an MD/DO/PhD in dermatology or other specialty/field, 2% FNP/PA, 1% RN, and 62% other. As one of the most trafficked global sites on the Internet, YouTube is a valuable resource for dermatologists, physicians in other specialties, and the general public to share their dermatology-related content and gain subscribers. However, challenges of accessing and determining evidence-based data remain an issue.
Ogawa, Sachiko; Isogawa, Naoyuki; Ushiro, Shin; Ayuzawa, Junko; Furue, Masutaka
Health-care safety management has recently been highlighted for patient safety. However, specialist-based risks in clinical settings have hardly been discussed in Japan so far. A review of dermatological legal claims may delineate these risks. This study examined court precedents from the databases "Courts in Japan" and LEX/DB. Thirty-four dermatology-related civil cases were found from 1968-2006. Of the 34 cases, 32 (94%) were judged and two (6%) were retried. Of these 32 cases, 11 (34%) were appealed to higher courts. Among the 34 litigations, the defendants of eight (23%) were dermatology specialists, 20 (59%) were non-dermatologists and six (18%) of unknown specialty. The defendants' negligence was determined at either level in court in 25 of the 34 cases. The negligence in these 25 cases was categorized into five groups: (i) delayed diagnosis (none); (ii) complication during diagnosis procedure (one, 4%); (iii) inappropriate treatment (nine, 36%); (iv) complication during treatment procedure (10, 40%); and (v) insufficient informed consent (five, 20%). The present study may help to improve strategies for health-care safety management in the dermatological field in Japan.
Sun, Natalie Z; Fox, Lindy P
The question of what makes a successful dermatology hospitalist has risen to the forefront due to the rapidly increasing number of these providers. Inpatient dermatology fellowships have formed as a direct consequence. Though mostly in their infancy, these programs have primary or secondary goals to train providers in the dermatologic care of the hospitalized patient. This article presents a brief synopsis of the history of traditional hospitalist fellowships and extrapolates these findings to existing hospitalist dermatology fellowships. As more of these programs arise, these fellowships are poised to revolutionize dermatologic inpatient care from a systems perspective.
Hanke, C William; Moy, Ronald L; Roenigk, Randall K; Roenigk, Henry H; Spencer, James M; Tierney, Emily P; Bartus, Cynthia L; Bernstein, Robert M; Brown, Marc D; Busso, Mariano; Carruthers, Alastair; Carruthers, Jean; Ibrahimi, Omar A; Kauvar, Arielle N B; Kent, Kathryn M; Krueger, Nils; Landau, Marina; Leonard, Aimee L; Mandy, Stephen H; Rohrer, Thomas E; Sadick, Neil S; Wiest, Luitgard G
An article titled "Current issues in dermatologic office-based surgery" was published in the JAAD in October 1999 (volume 41, issue 4, pp. 624-634). The article was developed by the Joint American Academy of Dermatology/American Society for Dermatologic Surgery Liaison Committee. A number of subjects were addressed in the article including surgical training program requirements for dermatology residents and selected advances in dermatologic surgery that had been pioneered by dermatologists. The article concluded with sections on credentialing, privileging, and accreditation of office-based surgical facilities. Much has changed since 1999, including more stringent requirements for surgical training during dermatology residency, and the establishment of 57 accredited Procedural Dermatology Fellowship Training Programs. All of these changes have been overseen and approved by the Residency Review Committee for Dermatology and the Accreditation Committee for Graduate Medical Education. The fertile academic environment of academic training programs with interaction between established dermatologic surgeons and fellows, as well as the inquisitive nature of many of our colleagues, has led to the numerous major advances in dermatologic surgery, which are described herein.
Bunick, Christopher G.; Aasi, Sumaira Z.
The ability to recognize, manage, and, most importantly, prevent hemorrhagic complications is critical to performing dermatologic procedures that have safe and high quality outcomes. This article reviews the preoperative, intraoperative, and postoperative factors and patient dynamics that are central to preventing such an adverse outcome. Specifically, the role that anticoagulants and antiplatelet agents, hypertension, and other medical conditions play in the development of postoperative hemorrhage are discussed. In addition, this article provides practical guidelines on managing bleeding during and after surgery. PMID:22515669
George, Dean D; Wainwright, Brent D
Both patients and medical professionals are increasingly accessing the Internet for health information. Today's Web enables features that facilitate information sharing in a social and collaborative manner, thus transforming the way we access data and communicate with our patients and colleagues. The visual nature of the field of dermatology lends itself to the use of the Internet for reference and educational purposes. To generate a list of Web sites commonly used by academic dermatologists, the authors polled the Accreditation Council for Graduate Medical Education Dermatology Program Directors for their top 3 Web resources. The purpose of this article is to identify resources used by dermatologists as well as patients and examine factors that can influence Internet search results. Concerns regarding professionalism in the era of social media are also explored. As the volume of health information on the Internet continues to increase, it is essential for physicians to be aware of what is available in cyberspace. Reference and learning tools for the physician, learning and support tools for the patient, and physician Internet presence are key aspects of modern dermatology practice.
Bernstein, Joseph A.; Didier, Peter J.
In general, veterinary dermatologists do not have extensive clinical experience of nonhuman primate (NHP) dermatoses. The bulk of the published literature does not provide an organized evidence-based approach to the NHP dermatologic case. The veterinary dermatologist is left to extract information from both human and veterinary dermatology, an approach that can be problematic as it forces the clinician to make diagnostic and therapeutic decisions based on two very disparate bodies of literature. A more cohesive approach to NHP dermatology – without relying on assumptions that NHP pathology most commonly behaves similarly to other veterinary and human disease – is required. This review of the dermatology of NHP species includes discussions of primary dermatoses, as well as diseases where dermatologic signs represent a significant secondary component, provides a first step towards encouraging the veterinary community to study and report the dermatologic diseases of nonhuman primates. PMID:19490576
Basavaraj, K. H.; Navya, M. A; Rashmi, R.
Skin is an organ that has a primary function in tactile receptivity and reacts directly upon emotional stimuli. Dermatological practice involves a psychosomatic dimension. A relationship between psychological factors and skin diseases has long been hypothesized. Psychodermatology addresses the interaction between mind and skin. It is divided into three categories according to the relationship between skin diseases and mental disorders. This article reviews different dermatological conditions under each of the three categories namely psychosomatic disorders, dermatological conditions due to primary and secondary psychiatric disorders. Dermatological conditions resulting from psychiatric conditions like stress/depression and those caused by psychiatric disorders are discussed. This review intends to present the relationship between the ‘skin’ and the ‘mind’ specifically from the dermatology point of view. The effects on the quality of life as a result of psychodermatological conditions are highlighted. A multidisciplinary approach for treatment from both dermatologic and psychiatric viewpoints are suggested. PMID:21180416
Hammer, U; Boy, D; Rothaupt, D; Büttner, A
The external examination after death requires knowledge in forensics/pathology, dermatology, as well as associated diseases and age-related alterations of the skin. This article highlights some findings with forensic evidence versus dermatological findings. The lectures in forensic medicine should be structured interdisciplinarily, especially to dermatology, internal medicine, surgery, pathology, and toxicology in order to train the overlapping skills required for external and internal postmortem examinations.
Gomes, Rafael Tomaz; Tiberto, Larissa Rezende; Bello, Viviane Nardin Monte; Lima, Margarete Aparecida Jacometo; Nai, Gisele Alborghetti; de Abreu, Marilda Aparecida Milanez Morgado
Despite advances in diagnosis and treatment, infective endocarditis still shows considerable morbidity and mortality rates. The dermatological examination in patients with suspected infective endocarditis may prove very useful, as it might reveal suggestive abnormalities of this disease, such as Osler’s nodes and Janeway lesions. Osler’s nodes are painful, purple nodular lesions, usually found on the tips of fingers and toes. Janeway lesions, in turn, are painless erythematous macules that usually affect palms and soles. We report a case of infective endocarditis and highlight the importance of skin examination as a very important element in the presumptive diagnosis of infective endocarditis. PMID:28300907
The years 2014-2015 have been rich in paediatric dermatology news in varied areas. Randomized controlled trials including children have been performed, especially in the fields of vascular anomalies, infectiology and immuno-allergology; new classifications and guidelines have been established; scientific research has made new discoveries, including the molecular basis of pediatric nevi and melanoma; epidemiologic works on risk factors have highlighted the need for dermatologists to be aware of prevention (sun prevention but also obesity); and finally, the many publications have taken into account psychological issues in children, such as quality of life, pain, observance or acceptance.
Jovanović, Marina; Golušin, Zoran
The purpose of this study was to review currently available literature data concerning pathomechanisms of action, indications, treatment efficacy, as well as side effects of nonsteroidal immunomodulators used in dermatology, primarily for the treatment of allergic dermatoses. MEDLINE search was undertaken using the key words “Topical Immunomodulators, Dermatology and Allergy”. Full articles, and nothing but full articles, were used. PMID:27144167
Activated intracellular signaling pathways based on mutations in oncogenes and tumor suppressor genes play an important role in a variety of malignant tumors. In dermatology, such mutations have been identified in melanoma, basal cell carcinoma and squamous cell carcinoma. These have partly led to the establishment of new, targeted therapies. Treatment successes have been particularly impressive for melanoma with small molecule inhibitors directed against the mutated BRAF oncogene and in basal cell carcinoma with inhibitors directed against the hedgehog signaling pathway. New sequencing technologies, in particular next generation sequencing, have led to a better and more comprehensive understanding of malignant tumors. This approach confirmed the pathogenic role of BRAF, NRAS and MAP kinase pathways for melanoma. At the same time, a series of further interesting target molecules with oncogenic mutations such as ERBB4, GRIN2A, GRM3, PREX2, RAC1 and TP53 were identified. New aspects have recently been shown for squamous cell carcinoma by detection of mutations in the NOTCH signaling pathway. A better understanding of the pathogenesis of these and other tumors should lead to improved and maybe even individualized treatment. The current developments in dermatological oncogenetics based on the new sequencing technologies are reviewed.
DeLouise, Lisa A.
What are nanoparticles and why are they important in dermatology? These questions are addressed by highlighting recent developments in the nanotechnology field that have increased the potential for intentional and unintended nanoparticle skin exposure. The role of environmental factors in the interaction of nanoparticles with skin and the potential mechanisms by which nanoparticles may influence skin response to environmental factors are discussed. Trends emerging from recent literature suggest that the positive benefit of engineered nanoparticles for use in cosmetics and as tools for understanding skin biology and curing skin disease, out weigh potential toxicity concerns. Discoveries reported in this journal are highlighted. This review begins with a general introduction to the field of nanotechnology and nanomedicine. This is followed by a discussion of the current state of understanding of nanoparticle skin penetration and their use in three different therapeutic applications. Challenges that must be overcome to derive clinical benefit from the application of nanotechnology to skin are discussed last, providing perspective on the significant opportunity that exists for future studies in investigative dermatology. PMID:22217738
DeLouise, Lisa A
What are nanoparticles and why are they important in dermatology? These questions are addressed by highlighting recent developments in the nanotechnology field that have increased the potential for intentional and unintentional nanoparticle skin exposure. The role of environmental factors in the interaction of nanoparticles with skin and the potential mechanisms by which nanoparticles may influence skin response to environmental factors are discussed. Trends emerging from recent literature suggest that the positive benefit of engineered nanoparticles for use in cosmetics and as tools for understanding skin biology and curing skin disease outweigh potential toxicity concerns. Discoveries reported in this journal are highlighted. This review begins with a general introduction to the field of nanotechnology and nanomedicine. This is followed by a discussion of the current state of understanding of nanoparticle skin penetration and their use in three therapeutic applications. Challenges that must be overcome to derive clinical benefit from the application of nanotechnology to skin are discussed last, providing perspective on the significant opportunity that exists for future studies in investigative dermatology.
Chowdhury, Satyendra Nath; Podder, Indrasish; Saha, Abanti; Bandyopadhyay, Debabrata
Background: Dermatology is primarily considered to be an outpatient-centered specialty. However, several inpatient admissions to other specialties require dermatologic consultation for optimum management. Aims: To analyze the causes of inpatient dermatology referrals, departments sending referrals, and impact of dermatology consultation on patient management. Materials and Methods: We conducted a cross-sectional study by analyzing the records of 486 patient referrals over a 4-year period. The demographic details, specialties requesting consultation, cause of referral, and dermatological advice have been recorded and analyzed. Results: Dermatology consultation changed the dermatologic diagnosis and treatment of almost two-thirds of patients. General medicine requested the maximum number of referrals, “skin rash” being the most common cause for referral. Accurate diagnosis on referrals was provided by only 30.2% of nondermatologists. Common dermatological disorders were often misdiagnosed by these physicians, and dermatology referrals had significant impact on the diagnosis and subsequent management of these patients. Conclusion: While dermatologic referral leads to improved patient care, there is a need for better training of nondermatologists enabling them to recognize and treat common dermatoses. PMID:28216722
The main selected articles in pediatric dermatology covered the following topics: development and maturation of the epidermal barrier in the neonate, iatrogenic events in the neonatal ICU, diagnostic value of minor birthmarks, complications, risk factors and treatment of hemangiomas, coagulopathy in venous malformations, epidemiology and dermoscopy of congenital and acquired melanocytic nevi in childhood, growth of the body surface area, new pathogenic concepts and treatment in atopic dermatitis, the impact of filaggrin deficiency, hereditary factors in Kawasaki disease, severe and drug resistant cases, management of juvenile dermatomyositis, treatment of childhood psoriasis with biologics, the new classification of epidermolysis bullosa and therapeutic approach with cell therapy, neurological impairment in xeroderma pigmentosum, behavioural anomalies in X-linked ichthyosis, guidelines for neurofibromatosis type I, the genetics of an hereditary hypotrichosis, infantile acne, rosacea in childhood, mast cell disease management and, last but not least, treatment of hair lice with silicone.
Gelmetti, Carlo; Frasin, Adina; Restano, Lucia
Although clinical trials for new drugs are often limited in children because of safety concerns or restrictions, new therapies or novel strategies with old drugs have recently expanded dermatologic armamentarium for pediatric patients. Oral propranolol is currently the first choice in the treatment of alarming infantile hemangiomas. In atopic dermatitis, proactive strategy with topical calcineurin inhibitors can safely prevent disease exacerbation. Tacrolimus, in particular, is also useful for the treatment of vitiligo occurring in sensitive areas such as the eyelids. Among biologic drugs, use of etanercept is safe and efficient in children and adolescents with moderate-to-severe plaque psoriasis. Engineered tissues with special antimicrobial properties (silver-coated fabrics or engineered silk) are now used to treat eczema and fungal diseases in children. In athlete's foot, the use of 5-finger socks can also be helpful.
Surjana, Devita; Damian, Diona L
Nicotinamide (the amide form of vitamin B3) has been used in dermatology for more than 40 years for a diverse range of conditions including acne, rosacea, autoimmune bullous dermatoses, and now the treatment and prevention of photoaging and photoimmunosuppression. The broad clinical effects of nicotinamide may be explained by its role as a cellular energy precursor, a modulator of inflammatory cytokines, and an inhibitor of the nuclear enzyme poly(adenosine diphosphate-ribose) polymerase-1, which plays a significant role in DNA repair, maintenance ofgenomic stability, and cellular response to injury including inflammation and apoptosis. This review outlines the use of nicotinamide for inflammatory dermatoses and photoaging and focuses on its emerging role in photoprotection.
A review of the medical literature and of the regulatory agencies website was performed to identify new information about dermatological therapy from October 2006 to October 2007. Care was taken to prioritize results from randomized controlled trials and epidemiological studies of acceptable methodology. In the last year, significant advances have been made in the field of psoriasis, pemphigus, prevention of infection with oncogenic papillomaviruses, leg ulcers, evaluation of lasers and photodynamic therapy. The availability of biological agents for the treatment of psoriasis, auto-immune disease and skin cancer will certainly induce major changes in our therapeutic strategies in the near future. The dermatologist needs to keep-up with new therapies in order to address the therapeutic needs of patients with skin diseases.
Danis, Judit; Forczek, Erzsébet; Bari, Ferenc
Technological advances in the fields of information and telecommunication technologies have affected the health care system in the last decades, and lead to the emergence of a new discipline: telemedicine. The appearance and rise of internet and smart phones induced a rapid progression in telemedicine. Several new applications and mobile devices are published every hour even for medical purposes. Parallel to these changes in the technical fields, medical literature about telemedicine has grown rapidly. Due to its visual nature, dermatology is ideally suited to benefit from this new technology and teledermatology became one of the most dynamically evolving fields of telemedicine by now. Teledermatology is not routinely practiced in Hungary yet, however, it promises the health care system to become better, cheaper and faster, but we have to take notice on the experience and problems faced in teledermatologic applications so far, summarized in this review.
Wozel, Gottfried; Blasum, Christian
Dapsone (4,4'-diaminodiphenylsulfone) is an aniline derivative belonging to the group of synthetic sulfones. In 1937 against the background of sulfonamide era the microbial activity of dapsone has been discovered. Shortly thereafter, the use of dapsone to treat non-pathogen-caused diseases revealed alternate antiinflammatory mechanisms that initially were elucidated by inflammatory animal models. Thus, dapsone clearly has dual functions of both: antimicrobial/antiprotozoal effects and anti-inflammatory features similarly to non-steroidal anti-inflammatory drugs. The latter capabilities primarily were used in treating chronic inflammatory disorders. Dapsone has been investigated predominantly by in vitro methods aiming to get more insights into the effect of dapsone to inflammatory effector cells, cytokines, and/or mediators, such as cellular toxic oxygen metabolism, myoloperoxidase-/halogenid system, adhesion molecules, chemotaxis, membrane-associated phospholipids, prostaglandins, leukotrienes, interleukin-8, tumor necrosis factor α, lymphocyte functions, and tumor growth. Moreover, attention has been paid to mechanisms by which dapsone mediates effects in more complex settings like impact of lifespan, stroke, glioblastoma, or as anticonvulsive agent. Additionally, there are some dermatological investigations in human being using dapsone and its metabolites (e.g., leukotriene B4-induced chemotaxis, ultraviolet-induced erythema). It could be established that dapsone metabolites by their own have anti-inflammatory properties. Pharmacology and mechanisms of action are determining factors for clinical use of dapsone chiefly in neutrophilic and/or eosinophilic dermatoses and in chronic disorders outside the field of dermatology. The steroid-sparing effect of dapsone is useful for numerous clinical entities. Future avenues of investigations will provide more information on this fascinating and essential agent.
Collison, Daniel W
Clarence S. Livingood and his mentors, Pillsbury and Sulzberger, wrote the Manual of Dermatology, a book that was the dermatologic handbook of choice for thousands of medical officers in World War II. By virtue of its wide distribution among a variety of physicians practicing in the medical boom of the 40s, 50s, and 60s, this book (and its formulary) was one of the most influential dermatologic texts of the 20th century. Livingood would repeat the strategies employed in writing this book over and over in his long career advancing dermatology among American medical specialties.
Martires, Kathryn J; Aquino, Lisa L; Wu, Jashin J
Although prior studies have examined methods by which to recruit and retain academic dermatologists, few have examined factors that are important for developing academic leaders in dermatology. This study sought to examine characteristics of dermatology residency programs that affect the odds of producing department or division chairs/chiefs and program directors (PDs). Data regarding program size, faculty, grants, alumni residency program attended, lectures, and publications for all accredited US dermatology residency programs were collected. Of the 103 programs examined, 46% had graduated at least 1 chair/chief, and 53% had graduated at least 1 PD. Results emphasize that faculty guidance and research may represent modifiable factors by which a dermatology residency program can increase its graduation of academic leaders.
Fogel, Alexander L; Teng, Joyce M C
Social media is predicted to become increasingly important in dermatology because of its potential to serve as a platform for public health campaigns, aid in participant recruitment for clinical trials, increase public engagement in health care, and facilitate scientific discourse. No study of social media use in pediatric dermatology has been performed, so we analyzed the use of the seven leading social media platforms in pediatric dermatology, with a focus on patient advocacy groups, professional societies, research journals, and research institutions. We observed that 89% of patient advocacy groups, 100% of professional societies, 62.5% of research journals, and 0% of academic pediatric dermatology departments maintained one or more social media accounts. Our observations suggest that all stakeholder groups, and in particular members of the research community, have the potential to further their engagement, connections, and communications through social media.
Hassan, Iffat; Dorjay, Konchok; Anwar, Parvaiz
Pentoxifylline is a methyl-xanthine derivative with many anti inflammatory effects. Pentoxifylline has been found to be effective for many dermatological as well as non-dermatological conditions. It has been used both as primary drug as well as adjuvant and is a safe and relatively cost-effective alternative drug. In this article, we review the literature and highlight various important aspects of pentoxifylline. PMID:25396144
Cardili, Renata Nahas; Roselino, Ana Maria
Discrepancies in the terminology of elementary lesions persist when texts from Dermatology and Semiology books are compared, which can cause some confusion in both the teaching of undergraduate medical students and the learning acquired by professionals in the field. This review aims to compare and clarify the differences in the description of elementary lesions by many authors, used as references for specialists in dermatology. PMID:27828637
Puberty is a period of life between childhood and adulthood. It is characterized by many changes in morphology and appearance of the body (biological maturation), in the psyche – development of personality (psychological maturation), and in the attitude towards one's own and the opposite sex (psychosexual maturation), and in the social role (social maturation). Dermatological problems of adolescence are mainly related to fluctuations in hormone levels, mainly androgens. They include acne, hair problems and excessive sweating. Acne vulgaris is the most frequently diagnosed dermatosis in patients aged between 11 and 30 years. It is believed that it affects about 80% of persons in this age group or even, taking into account lesions of low intensity, 100% of young people. Excessive sweating is a condition characterised by excessive production of sweat, resulting from high activity of sweat glands. The sweat glands are localised in almost all areas of the body surface but on the hands, feet, armpits and around the groin they are found at the highest density. Seborrhoeic dermatitis of the scalp is a chronic, relapsing, inflammatory dermatosis, which currently affects about 5% of the population. It affects mostly young people, particularly men. PMID:24278071
Ochsendorf, Falk R
The antimalarials chloroquine and hydroxychloroquine have been used for the treatment of inflammatory diseases for more than 60 years. Even today new indications evolve due to the complex mode of action of these compounds. Due to the fear of side effects, especially irreversible retinopathy, their use is often limited. These side-effects, however, are a consequence of excessive daily dosages. An effective, safe therapy needs correct dosing, i. e. adherence to maximal daily dosages of 3.5(-4) mg chloroquine or 6(-6.5) mg hydroxychloroquine per kilogram ideal body weight. If the actual body weight is lower than the ideal body weight, this actual weight is used for the calculation of the dosage. Observing these limits allows a rather safe therapy of the diseases like lupus erythematosus, REM syndrome, porphyria cutanea tarda (2 × 125 mg chloroquine/week), cutaneous sarcoidosis and dermatomyositis. If standard therapies fail, then antimalarials can be tried to treat Sjögren syndrome, granuloma annulare or erosive lichen planus. If therapy fails, either can be combined with quinacrine to increase their effectiveness. Chloroquine and hydroxychloroquine are indispensable and well-tolerated essential drugs in dermatology and especially suited as part of a combination scheme, for example with corticosteroids, as they act synergistically and reduce side-effects.
Dermatological research is more and more productive and its level higher and higher. Choosing the most significant articles is difficult. Mast cell plays a role in the initiation of inflammation and therefore in poorer healing. Keratinocytes derive from stem cells and progenitors, which are independent. They can be activated directly by heat through sensory proteins at their surface. The cutaneous nervous system has an organization similar to that of the most complex sensory organs. In psoriasis, denervation induces a significant plaque regression. The cerebral integration of skin appearance modulates the skin reactivity to histamine. Pruritus is linked to specific receptors in the skin, which give specific projections into the brain and are histamine-dependent or not. Atopic dermatitis may be linked to the nonspecific activation of Th2 immune system, particularly to abnormalities of the skin barrier. Skin bacteria, but not intestinal, modulate the formation of skin immunity. Raf kinases are well known in melanoma and play an important role in physiological conditions: they are not essential to the initial development of the melanocyte lineage but to maintain it. In culture, melanocytes can be dedifferentiated in melanoblasts. Sunburns are consecutive to the activation of TLR3 by UVB. ANRIL gene is involved in the polymorphism of neurofibromatosis 1 and gene RAD51B is linked to the risk of male breast cancer. MCV infection is linked to sites with sialic acid. Aging objectified by telomere shortening is accelerated by stress.
Nielson, Colton; West, Cameron; Shimizu, Ikue
The inherently visual nature of dermatology naturally lends itself to photography. As technology has evolved, smartphone cameras have become ubiquitous and have the potential to improve education and patient care in dermatology. Although patients and physicians may agree that photography can improve patient care, there are certain risks involved with smartphone photography in the medical field. Perhaps most concerning is the number of dermatologists using smartphones to take unsecured images in their daily practice. A recent study revealed that 22% of surveyed dermatologists used smartphone cameras multiple times per day in their practice. Dermatologists may also overestimate patient comfort with smartphone use in clinical photography. We present a review of the use of smartphones in dermatology and address the potential lack of security and accompanying ethical dilemmas.
Coondoo, Arijit; Sengupta, Sujata
Serendipity is a pleasant surprise of finding a particularly useful information while not looking for it. Significant historic events occurring as a result of serendipity include the discovery of the law of buoyancy (Archimedes principle) by the Greek mathematician Archimedes, of the Americas by Christopher Columbus and of gravity by Sir Isaac Newton. The role of serendipity in science has been immensely beneficial to mankind. A host of important discoveries in medical science owe their origin to serendipity of which perhaps the most famous is the story of Sir Alexander Fleming and his discovery of Penicillin. In the field of dermatology, serendipity has been responsible for major developments in the therapy of psoriasis, hair disorders, aesthetic dermatology and dermatosurgery. Besides these many other therapeutic modalities in dermatology were born as a result of such happy accidents.
Coondoo, Arijit; Sengupta, Sujata
Serendipity is a pleasant surprise of finding a particularly useful information while not looking for it. Significant historic events occurring as a result of serendipity include the discovery of the law of buoyancy (Archimedes principle) by the Greek mathematician Archimedes, of the Americas by Christopher Columbus and of gravity by Sir Isaac Newton. The role of serendipity in science has been immensely beneficial to mankind. A host of important discoveries in medical science owe their origin to serendipity of which perhaps the most famous is the story of Sir Alexander Fleming and his discovery of Penicillin. In the field of dermatology, serendipity has been responsible for major developments in the therapy of psoriasis, hair disorders, aesthetic dermatology and dermatosurgery. Besides these many other therapeutic modalities in dermatology were born as a result of such happy accidents. PMID:25814699
Boyd, Katherine; Shea, Sofia M; Patterson, James W
Neurogenic pain and pruritus are the common chief complaints at dermatology office visits. Unfortunately, they are also notoriously difficult conditions to treat. Topical capsaicin used as a single therapy or as an adjuvant offers a low-risk option for patients who do not achieve control on other therapies. This chapter presents the evidence behind topical capsaicin use in dermatologic conditions characterized by neurogenic pain or pruritus, including postherpetic neuralgia, notalgia paresthetica, brachioradial pruritus, lichen simplex chronicus, prurigo nodularis, pruritus ani, pruritus of hemodialysis, aquagenic pruritus, apocrine chromhidrosis, lipodermatosclerosis, alopecia areata, and psoriasis. It presents the most common capsaicin formulations, dosages, and durations of treatment for each condition. Additionally, the chapter addresses various adverse effects and limitations in the use of topical capsaicin in dermatology.
... HUMAN SERVICES Food and Drug Administration Dermatologic and Ophthalmic Drugs Advisory Committee; Cancellation AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The meeting of the Dermatologic and Ophthalmic Drugs Advisory Committee scheduled for June 28, 2010, is cancelled. This...
Lecocq, C; Pirard, D; del Marmol, V; Berlingin, E
Albert Einstein is undoubtedly the father of lasers. But it is not until 1964 that the first dermatological lasers were introduced. The Nd-YAG laser, the CO2 laser were developed by Kumar Patel. In a 40 year period lasers not only were diversified but have also become safer and miniaturized. This article hopes to strengthen general practionners' and specialist's knowledge of the different categories of available lasers. The most frequently used ones are ablative lasers (CO2-Erbium), vascular lasers (Nd-YAG, KTP, pulsed dye laser) and the pigment lasers (Q-Switched Nd-YAG, Alexandrite). A description of these lasers and their indications in dermatology will be discussed.
Prindaville, Brea; Antaya, Richard J; Siegfried, Elaine C
Up to 30% percent of pediatric primary care visits include a skin-related problem, and referrals are hampered by appointment wait times among the longest of any pediatric subspecialty. Despite the clear demand for pediatric dermatologists, there has been a long-standing shortage of providers, leaving dermatology as one of the most underserved pediatric subspecialties. Another consequence of the workforce shortage is the limited opportunity for pediatric dermatology training for residents and postgraduate general pediatricians and dermatologists. This review includes the evolution of the subspecialty from conception through the present, along with obstacles to workforce expansion and potential solutions to improve access to care for children with skin diseases.
Deckert, S; Apfelbacher, C; Schmitt, J
In order to determine the appropriate therapy for dermatological diseases, numerous measurement instruments are available to measure disease severity. Due to the lack of laboratory parameters for some dermatological diseases to objectify the disease severity (e.g., atopic dermatitis, psoriasis), questionnaires are used. Laboratory as well as questionnaire-based measurements should be reliable, valid, and sensitive to change. In addition, measurement instruments should be feasible. Classifications of disease severity which are based on inadequate measurement properties result in incorrect clinical decisions and limit evidence-based healthcare. Therefore, systematically developed and evidence-based recommendations for the use of individual measurement instruments should be taken into consideration.
Jindal, Nidhi; Jindal, Pooja; Kumar, Jeevan; Gupta, Sanjeev; Jain, VK
Dermatology world is brimming with myriad of interesting clinical conditions, signs and syndromes. It is infinite, which has systemic clinical connotations too. Complicated pronunciations of diagnosis have always placed residents in an intricate state. Each one is trying his best to make this cumbersome subject comparatively more acceptable and convenient. The present paper is an attempt to further simplify the subject by correlating difficult conditions with commonly used and seen things such as fruit and food. A total of 45 dermatological conditions were found to be based on fruit and food eponyms. For example, strawberries can remind us of strawberry gums of Wegener's granulomatosis and strawberry nevus. PMID:25814737
Branch, William T., Jr.; And Others
The problems encountered, diagnostic procedures performed, and treatments prescribed in dermatology were studied in a primary care practice and in a dermatology clinic. It is proposed that the findings of this study be the basis for designing a curriculum in dermatology for residents in primary care medicine. (Author/MLW)
which play a crucial role in the adaptive immunological response. It was shown that activation of the proliferation of the lymphocytes T after the migration of dendritic cells on the level of the lymphatic ganglion depended not on Langerhans cell, but of the dendritic cell. A new way appears to control the autoimmunity in the psoriasis and involves the plasmacytoid dendritic cells which are sensitized with the DNA itself when it is coupled with an antibacterial peptide. Mast cells express cathelicidin, which acts like an antibiotic with broad spectrum and influences the defence system of the epitheliums. We have perhaps found a new therapeutic target for rosacea by disclosing high rates of cathelicidin and a series of associated proteases in skin lesions. The sebocytes express antibacterial functional peptides deriving from cathelicidin which can have a bactericidal effect against P. Acnes. A vast genomic study in the androgenetic alopecia highlighted the existence of new loci localized on the 20p11 chromosome, associated with the risk of androgenetic alopecia. New alleles to determine the color of hair and the cutaneous pigmentation were identified. Two loci (IRF 4 and SLC24A4) are highly associated with the color of hair, like three other areas. The blue color of the eyes could be due to a change of an element located in gene HERC2 preventing of the expression of OCA2. Thus, many fields of dermatology were the object of research which opens new prospects for diagnosis and treatment.
Larson, P O
Topical hemostatic agents are very helpful in attaining capillary and small vessel hemostasis in dermatologic surgery. The commonly used topical hemostatic agents, including oxidized cellulose, absorbable gelatin, and thrombin are reviewed, along with newer agents such as microfibrillar collagen, fibrin sealants, and acrylates. Agents best suited for certain situations are recommended.
Weber, Rebecca J; Taylor, Brent R; Engelman, Dendy E
Knowledge of laser tissue reactions and tissue properties allows the practitioner to tailor a treatment to an individual patient's need and goals. A laser's power, spot size and pulse duration may be manipulated to yield different tissue reactions. Five tissue reactions, each the result of varying laser pulse durations and energy densities, may be achieved. They are photochemical, photothermal, photoablation, plasma-induced ablation and photomechanical. Of these, photothermal reactions are most utilized in dermatology. When higher powered pulses are applied, tissue often undergoes multiple reactions simultaneously. An understanding of these reactions allows their effects to be predicted. In this chapter, the various reactions are reviewed, and the reactions caused by many of the most commonly used lasers in dermatology are discussed.
Griffin, L L; Chiang, N Y Z; Tomlin, H; Young, H S; Griffiths, C E M
First described by John Debes(1) in 1968, visual literacy (VL) refers to the ability of an observer to derive meaning from images.(2) In addition to understanding the image itself, the wider meaning is considered and deeper critical thinking encouraged.(1,3) In contrast with other medical specialties, the interpretation of visual signs and gross pathology remains key to dermatological practice.(4) Diagnostic accuracy may be increased by careful observation without preconceptions.(4) Thus, description of lesions in dermatological practice may be considered as "the expression of pathological art".(5) On this basis we believe dermatologists should have fluent VL skills, which could be developed throughout their training. This article is protected by copyright. All rights reserved.
Hu, Jenny; McKoy, Karen; Papier, Art; Klaus, Sidney; Ryan, Terence; Grossman, Henning; Masenga, Elisante J; Sethi, Aisha; Craft, Noah
Human immunodeficiency virus and the acquired immunodeficiency syndrome (HIV/AIDS) have greatly complicated dermatologic disease and the required care in most regions of Africa. Opportunistic infections, ectoparasites, Kaposi sarcoma, and skin manifestations of systemic infections are exceedingly common in patients with HIV/AIDS. Dermatologists have contributed significantly to our knowledge base about HIV/AIDS and have played an important educational role regarding the clinical manifestations historically. Because of the increased burden of skin disease in Africa due to the HIV/AIDS epidemic we must redouble our efforts to provide dermatology education to care providers in Africa. We review the burden of skin disease in Africa, how it relates to HIV/AIDS and global infectious disease, current educational strategies in Africa to address this need, and suggest potential solutions to move these efforts forward. PMID:21887061
Taub, Amy Forman
Photodynamic therapy (PDT) uses a photosensitizer, light, and molecular oxygen to selectively kill cells. When localized in the target tissue, the photosensitizer is activated by light to produce oxygen intermediates that destroy target tissue cells. The easy access of skin to light-based therapy has led dermatologists to apply PDT to cutaneous disorders. In dermatology, PDT has been most successful in treating actinic keratoses, basal cell carcinoma, and Bowen's disease. The introduction of aminolevulinic acid, which does not make patients susceptible to phototoxicity for extended periods, has reduced morbidity associated with PDT. This has led to new interest in PDT not only for nonmelanoma skin cancer and premalignant lesions but also in the treatment of acne and as an adjuvant to photorejuvenation procedures. This review examines the historical roots of PDT and the research evaluating different light and laser sources as well as reports on new horizons for PDT in dermatology.
Łabuzek, Krzysztof; Sikorska, Patrycja; Szkudłapski, Dawid; Oleszczyk, Paulina; Juśko, Maciej; Kozłowski, Michał; Madej, Paweł; Okopień, Bogusław
Hirsutism is a symptom of excessive androgen secretion in women, which in recent years is becoming more common. It is a problem of physical, mental and social background and patients always require application of an appropriate therapy. In addition to medical therapy, there are also other forms of treatment of hirsutism. These include the dermatological treatment using mechanical methods of removing unwanted hair. The aim of this work is to systematize the existing knowledge about treatment of hirsutism and suggest different patterns of treatment. Dermatological treatment is a very important complement to drug therapy. Its use allows for more rapid achievement of an external effect, and thus to improve the patients compliance. Due to the variety of symptoms in patients population therapy should be adapted to the needs of every patient.
Taberner, R; Contestí, T
In recent years, digital photography has consolidated its role in clinical dermatology. In view of the quality and low cost of current equipment and the simplicity of digital storage, almost all dermatologists now use digital photography, which is also extremely versatile and readily applicable to teaching. However, to maximize its full potential, image retrieval must be available at any time and with the patient present. This requires a suitable storage system that may vary according to the characteristics of each center. Dermatologists must also find time to maintain and organize the digital archives. The present article describes current options in digital image storage and retrieval, ranging from multidepartmental picture archiving and communication systems at one end to image management freeware at the other, and also including dedicated dermatology software.
Mahajan, Vikram K.; Mehta, Karaninder S.; Chauhan, Pushpinder S.
Zinc, both in elemental or in its salt forms, has been used as a therapeutic modality for centuries. Topical preparations like zinc oxide, calamine, or zinc pyrithione have been in use as photoprotecting, soothing agents or as active ingredient of antidandruff shampoos. Its use has expanded manifold over the years for a number of dermatological conditions including infections (leishmaniasis, warts), inflammatory dermatoses (acne vulgaris, rosacea), pigmentary disorders (melasma), and neoplasias (basal cell carcinoma). Although the role of oral zinc is well-established in human zinc deficiency syndromes including acrodermatitis enteropathica, it is only in recent years that importance of zinc as a micronutrient essential for infant growth and development has been recognized. The paper reviews various dermatological uses of zinc. PMID:25120566
Bhandari, Prasan R.; Pai, Varadraj V.
Rituximab is a monoclonal therapeutic anti-CD20 antibody that has been approved for use in lymphoma and rheumatoid arthritis. Over the past decade several reports based on case series and observational studies have recorded the benefits of rituximab in particular groups of dermatological patients. Off-label use of rituximab in many dermatological indications is not uncommon in many countries in the world. This article reviews the available data that may be of use to the practicing dermatologist. Because of its potential complications, paucity of clinical data, and cost considerations, rituximab is favoured only when standard systemic therapies fail or corticosteroids are absolutely contraindicated. Further research is required in this field. PMID:25165639
Guarneri, F; Vaccaro, M; Guarneri, C
Digital image compression (reduction of the amount of numeric data needed to represent a picture) is widely used in electronic storage and transmission devices. Few studies have compared the suitability of the different compression algorithms for dermatologic images. We aimed at comparing the performance of four popular compression formats, Tagged Image File (TIF), Portable Network Graphics (PNG), Joint Photographic Expert Group (JPEG), and JPEG2000 on clinical and videomicroscopic dermatologic images. Nineteen (19) clinical and 15 videomicroscopic digital images were compressed using JPEG and JPEG2000 at various compression factors and TIF and PNG. TIF and PNG are "lossless" formats (i.e., without alteration of the image), JPEG is "lossy" (the compressed image has a lower quality than the original), JPEG2000 has a lossless and a lossy mode. The quality of the compressed images was assessed subjectively (by three expert reviewers) and quantitatively (by measuring, point by point, the color differences from the original). Lossless JPEG2000 (49% compression) outperformed the other lossless algorithms, PNG and TIF (42% and 31% compression, respectively). Lossy JPEG2000 compression was slightly less efficient than JPEG, but preserved image quality much better, particularly at higher compression factors. For its good quality and compression ratio, JPEG2000 appears to be a good choice for clinical/videomicroscopic dermatologic image compression. Additionally, its diffusion and other features, such as the possibility of embedding metadata in the image file and to encode various parts of an image at different compression levels, make it perfectly suitable for the current needs of dermatology and teledermatology.
Del Rosso, James Q.
This article reviews background on proteases and their functions, their physiological significance in skin, and the potential implications of incorporating specific proteases and protease blends into dermatological products, including skin care formulations. The history of protease blend formulations used in wound model studies and for other disorders is reviewed. In vitro data with use of a specific 3-protease blend with evaluation of the impact on various skin proteins and peptides is also discussed in this article. PMID:23882305
Bowler, Patrick J
The treatment options for facial rejuvenation using dermatological, nonsurgical techniques have dramatically increased in the past 10 years. This follows the introduction of botulinum toxin and a variety of dermal fillers. The public interest in noninvasive treatments has changed the market beyond recognition with more physicians involved in providing services to satiate the demand. The impact on the public and medical profession is discussed. PMID:19503770
Lee, Amy T; Zane, Lee T
Polycystic ovary syndrome (PCOS) affects 5-10% of reproductive-aged women and is one of the most common endocrine disorders in women. The disorder is commonly characterized by elevated levels of androgen and insulin. Women with PCOS may present with a range of signs and symptoms, and face increased risks of reproductive, metabolic, cardiovascular, psychologic, and neoplastic sequelae, particularly if the condition is left unrecognized or untreated. The clinical definition of PCOS has changed in recent years and includes as one of its cardinal criteria the dermatologic manifestations of hyperandrogenism, chiefly hirsutism, acne vulgaris, and androgenetic alopecia. Acanthosis nigricans, a cutaneous sign of hyperinsulinemia, may also be present. These dermatologic features may provide early clinical clues to recognition of PCOS, and treatment of these cutaneous conditions may improve the patient's quality of life and psychologic well-being. The effects of androgen on pilosebaceous units in the skin can vary by anatomic location, producing pathophysiologic effects on hair growth and differentiation, sebaceous gland size and activity, and follicular keratinization. Treatment modalities may include hormonal therapy intended to modulate androgen production and action as well as non-hormonal therapies directed toward specific dermatologic conditions.
Sureshbabu, Rengasamy; Kumari, Rashmi; Ranugha, Subramaniam; Sathyamoorthy, Ramanathan; Udayashankar, Carounanidy; Oudeacoumar, Paquirissamy
Down syndrome (DS) is associated with various uncommon dermatological disorders and increased frequency of some common dermatoses. This study was conducted over a 2-year period to evaluate the frequency of phenotypic and dermatologic manifestations in patients with Down syndrome in south India. The most common phenotypic manifestations that characterize DS include the epicanthic fold (93.7%), brachicephaly (90.6%), flat nasal bridge (84.2%), upward angle of eyes (83.2%), wide gap between first and second toe (81.1%), clinodactyly (77.9%), small nose (74.7%), short broad neck (72.6%), single palmar crease (61.1%), increased nuchal skin fold (61.1%), and fissured tongue (52.6%). The most common dermatological manifestation seen in patients with DS were lichenification, xerosis, dental anomaly, fine, sparse hair, and delayed dentition. Alopecia areata was seen in 9.4 percent of patients and tended to be severe. Infections were relatively less common in our study. Our study has highlighted many phenotypic features and dermatoses, which may help provide better care for patients and counseling to the families.
Afifi, Ladan; Shinkai, Kanade
A consultative dermatology service plays an important role in patient care and education in the hospital setting. Optimizing education in balance with high-quality dermatology consultative services is both a challenge and an opportunity for dermatology consultation teams. There is an emergence of new information about how dermatology can best be taught in the hospital, much of which relies on principles of workplace learning as well as the science of how learning and teaching best happen in work settings. These best practices are summarized in this narrative review with integrated discussion of concepts from outpatient dermatology education and lessons learned from other inpatient teaching models. In addition, consultative dermatology curricula should utilize a blended curriculum model comprised of patient care and active learning and self-study modalities. Specific educational methods will discuss 2 strategies: (1) direct patient-care activities (ie, bedside teaching rounds) and (2) nonpatient care activities (ie, case presentations, didactic sessions, online modules, and reading lists).
Gottlieb, Alice B; Levin, Adriane A; Armstrong, April W; Abernethy, April; Duffin, Kristina Callis; Bhushan, Reva; Garg, Amit; Merola, Joseph F; Maccarone, Mara; Christensen, Robin
As quality standards are increasingly in demand throughout medicine, dermatology needs to establish outcome measures to quantify the effectiveness of treatments and providers. The International Dermatology Outcome Measures Group was established to address this need. Beginning with psoriasis, the group aims to create a tool considerate of patients and providers using the input of all relevant stakeholders in assessment of disease severity and response to treatment. Herein, we delineate the procedures through which consensus is being reached and the future directions of the project.
Al Aboud, Ahmad; Al Aboud, Khalid
This is a concise overview in a table format for the current membership-based dermatology societies in the USA. The primary objective of these societies is to provide continuous medical education. These societies serve all health care providers in dermatology care, including physician assistants and nurses. There is a clear need for establishing more societies which focus on different aspect of dermatology. There is always a potential for improving the educational activities of these societies.
Shah, Hemal; Pozo-Garcia, Lucia; Koulouroudias, Marinos
Dermatological conditions form a significant number of consultations seen by general practitioners on a daily basis. There is a lack of training and formal assessment of dermatology during medical school and we propose that there should be a mandatory component in OSCEs for dermatology during medical school to enhance one's diagnostic and clinical reasoning skills which will ultimately lead to better care for the patient and efficacious use of NHS resources.
Slade, Karren; Grant-Kels, Jane M
Employment of aestheticians in dermatology offices is becoming an everyday occurrence, as the dermatology patients' demand for cosmetic services taxes the availability of limited resources. Proponents of the practice state that aestheticians can help meet patients' expectations, while allowing dermatologists to focus their practice on the medical needs of patients. Opponents believe employment of fee-for-service aesthetic technicians compromises our ethical duties to our patients and diminishes the stature of dermatology as a profession.
Kheterpal, Meenal K; Ellis, Charles N
In the past 15 years, research in dermatology has significantly increased. Dermatology-related contributions in premier medical journals such as The New England Journal of Medicine (NEJM) and The Journal of the American Medical Association (JAMA) are the representation of our field in the medical world. To analyze this representation, incidence of dermatology-related contributions in NEJM and JAMA during 3 separate years (during a 15-year period) was calculated.
Costa, Izelda Maria Carvalho; Vallarelli, Andrelou Fralete Ayres; Bonamigo, Renan Rangel; Reis, Vitor Manoel da Silva
In this special edition in celebration of the centennial of the Brazilian Society of Dermatology, the authors take a retrospective look at printed Brazilian dermatology from the very beginning onward, showing evidence of descriptive dermatology with rich discussions, illustrations and advertisements of medications much used at the time, such as bismuth for the treatment of syphilis, before the discovery of penicillin. This retrospective covers up to the current days, when publications in the Brazilian Annals of Dermatology have reached the modern era in electronics, science and layout as well.
Tsintsadze, N; Beridze, L; Tsintsadze, N; Krichun, Y; Tsivadze, N; Tsintsadze, M
The aim of our study was to find out the magnitude of anxiety and depression in our common dermatological patients and its correlation with age, sex. For this purpose, we used Hospital Anxiety and Depression Scale HADS. The psychometric validity of HADS has been established by validating the questionnaire against the structured psychiatric interviews. A study of anxiety and depression in patients with dermatologic diseases was conducted on the basis of outpatients department in 211 patients with dermatologic diseases; among them were 107 male and 104 female, aged 16 to 75 years. Among them were patients with Acne, Alopecia Areata, Psoriasis, Vitiligo, Neurodermatitis, Scabies, Eczema and Other diseases (Atopic Dermatitis, Chronic Urticaria, Lichen Planus, Herpes Zoster, Melasma, Warts and Etc.). Based on studies of patients reveals that 65.4% of them are anxiety, depression - 56.2%, both anxiety and depression in 24.7%, there figures higher than the dates of other authorizes. As a result of a direct link research risk disorder depressive spectrum with sex, age; in woman anxiety and depression occurs more frequently than men, and anxiety occurs more frequently in young age. Especially there are hight frequencies of manifestation of abuse in patients with Psoriasis (anxiety - 83.3%, depression - 69.4%, both - 38.8%), Eczema (anxiety - 73.3%, depression - 56.6%, both - 26.7%), Acne (anxiety - 78.4%, depression - 54%, both - 21.6%), Vitiligo (anxiety - 66.7%, depression - 60%, both - 33.3%). Our study noticed higher dates of anxiety and depression than the dates of other outhorizes.
Errichetti, Enzo; Stinco, Giuseppe
Over the last few years, dermoscopy has been shown to be a useful tool in assisting the noninvasive diagnosis of various general dermatological disorders. In this article, we sought to provide an up-to-date practical overview on the use of dermoscopy in general dermatology by analysing the dermoscopic differential diagnosis of relatively common dermatological disorders grouped according to their clinical presentation, i.e. dermatoses presenting with erythematous-desquamative patches/plaques (plaque psoriasis, eczematous dermatitis, pityriasis rosea, mycosis fungoides and subacute cutaneous lupus erythematosus), papulosquamous/papulokeratotic dermatoses (lichen planus, pityriasis rosea, papulosquamous sarcoidosis, guttate psoriasis, pityriasis lichenoides chronica, classical pityriasis rubra pilaris, porokeratosis, lymphomatoid papulosis, papulosquamous chronic GVHD, parakeratosis variegata, Grover disease, Darier disease and BRAF-inhibitor-induced acantholytic dyskeratosis), facial inflammatory skin diseases (rosacea, seborrheic dermatitis, discoid lupus erythematosus, sarcoidosis, cutaneous leishmaniasis, lupus vulgaris, granuloma faciale and demodicidosis), acquired keratodermas (chronic hand eczema, palmar psoriasis, keratoderma due to mycosis fungoides, keratoderma resulting from pityriasis rubra pilaris, tinea manuum, palmar lichen planus and aquagenic palmar keratoderma), sclero-atrophic dermatoses (necrobiosis lipoidica, morphea and cutaneous lichen sclerosus), hypopigmented macular diseases (extragenital guttate lichen sclerosus, achromic pityriasis versicolor, guttate vitiligo, idiopathic guttate hypomelanosis, progressive macular hypomelanosis and postinflammatory hypopigmentations), hyperpigmented maculopapular diseases (pityriasis versicolor, lichen planus pigmentosus, Gougerot-Carteaud syndrome, Dowling-Degos disease, erythema ab igne, macular amyloidosis, lichen amyloidosus, friction melanosis, terra firma-forme dermatosis, urticaria pigmentosa and
Guerra-Tapia, Aurora; Sancho Pérez, Blanca
Acne vulgaris, hirsutism, seborrhea and female pattern hair loss (FPHL) are common disorders of the pilosebaceous unit (PSU). In some women with hyperandrogenemia, an excess of androgens at the PSU can lead to the development of these dermatological manifestations. These manifestations can cause many psychiatric and psychological implications, such as social fears and anxiety, and can adversely affect quality of life. High androgen levels at the PSU as a possible underlying cause of acne vulgaris, hirsutism, seborrhea and FPHL supports the rationale for using combined oral contraceptives for the management of these conditions in women. The purpose of this review is to describe these dermatological manifestations of the PSU and the management of these conditions through the use of the oral contraceptive ethinylestradiol/chlormadinone acetate (EE/CMA). EE/CMA 0.03/2 mg is a combined monophasic contraceptive pill with anti-androgenic properties. It is approved in Europe for contraception and has been investigated in phase III trials for the treatment of acne. EE/CMA was better than placebo and similar to another low-dose oral contraceptive (ethinylestradiol/levonorgestrel) in improving symptoms of acne in two phase III randomized controlled trials in patients with mild to moderate papulopustular acne. In addition, in trials investigating the contraceptive efficacy of EE/CMA, limited data suggest that there were also improvements in hirsutism, FPHL and seborrhea in small subgroups of patients. EE/CMA has a good safety profile. The most commonly reported adverse events are breast tenderness/pain, headache/migraine and nausea. Evidence in the literature indicates that the use of EE/CMA for the treatment of dermatological disorders under the control of androgens may be a valid treatment option. Further investigation is warranted.
Paniagua, Ricardo T.; Fiorentino, David; Chung, Lorinda; Robinson, William H.
Tyrosine kinases are enzymes that catalyze the phosphorylation of tyrosine residues on protein substrates. They are key components of signaling pathways that drive an array of cellular responses including proliferation, differentiation, migration, and survival. Specific tyrosine kinases have recently been identified as critical to the pathogenesis of several autoimmune and inflammatory diseases. Small-molecule inhibitors of tyrosine kinases are emerging as a novel class of therapy that may provide benefit in certain patient subsets. In this review, we highlight tyrosine kinase signaling implicated in inflammatory dermatologic diseases, evaluate strategies aimed at inhibiting these aberrant signaling pathways, and discuss prospects for future drug development. PMID:20584561
Keller, Emily C
The world of aesthetic medicine is increasingly a consumer-driven market with a wide variety of home-use devices from which the consumer can choose for treating hair removal, hair loss, acne, facial rejuvenation, and other dermatologic conditions. Where these devices fit in the physician practice and consumer routine can be confusing, as scientific studies may be weak or lacking. The specifications, price, ease-of-use, maintenance, and technology can differ greatly between devices. Thus, the physician and consumer need to define exp.
This paper provides an overview of the recent developments of photonics in dermatology and aesthetic applications. The range of products covers lasers, continuous Xenon lamps, Intense Pulsed Light systems, and LEDs. We will mention several applications and how different photonics systems are used. We will also discuss methods combining photonics with other technologies. For example, in Photo Dynamic Therapy (PDT) this includes a drugs, or equally the combination of intense light pulses with Radio Frequency (RF) for applications like hair removal. We will also describe some new developments in photonics technology that affect the development of new products, showing the direction of market development. Additionally, some examples of new technology are shown.
Witmer, William K; Lebovitz, Peter J
Photography has been accepted for decades as a standard means for documenting dermatologic conditions and as an adjunct to their treatment, in both medical practice and research. The emergence of low-cost easy-to-use digital imaging systems has made good-quality photography more accessible to practitioners, while providing improved functionality in the clinical environment. Primary concerns are controlling lighting and positioning to provide a clear record of the patients skin condition and maintaining consistency over time to assure meaningful comparison of clinical end points.
Mavrogiorgou, P; Juckel, G
The relationship between skin and psychiatric disorders is not an uncommon occurrence in the clinical practice; however, there are only a few systematic studies and in addition knowledge about the neurobiological and immunological mechanisms is lacking. Impairments and disorders of the skin are often an (early) sign of a psychiatric disorder. In the sense of true psychosomatics, psychiatrists should also be aware of this relationship as far as possible. This review article focuses on the most important dermatological diagnoses in relation to the respective psychiatric comorbidities and presents the most important aspects of epidemiology, symptomatology, pathophysiology and treatment options.
Zalla, James A
In the past 6 years, significant changes have been made in Current Procedural Terminology codes, descriptors, and guidelines affecting dermatologists. These changes involved excision, repair, measuring excised diameter, measuring flap defects, skin biopsy and Mohs surgery guidelines, KOH examination, and fungus cultures. New codes were introduced for photodynamic therapy, laser treatment, and whole-body photography. Reimbursement issues affecting dermatologists are also discussed, including inappropriate bundling of separate services, failure to recognize modifiers, and unfair multiple procedure reduction. The successes of the American Academy of Dermatology Association advocacy efforts with insurance carriers are summarized, with an update on the current status of these issues. Physician responsibilities, documentation requirements, and expectations are also outlined.
Bissonnette, R; Lui, H
The accessibility of skin to light treatment, as well as the expertise developed by dermatologists in laser surgery and phototherapy, creates an exciting opportunity for dermatologic PDT to become part of our standard therapeutic armamentarium. PDT appears to be viable alternative to conventional therapy for superficial BCC and Bowen's disease, although definitive controlled studies are lacking. The introduction of ongoing research developments, new photosensitizers, and better light sources into clinical PDT trials in the coming years will undoubtedly expand the range of indications for this novel form of therapy, particularly for nononcologic conditions.
Kural, Esra; Roccia, Maria Grazia; França, Katlein; Lotti, Torello; Tirant, Michael; Fioranelli, Massimo
In the past and present, the status of men is often superior to women in most developing countries and it has a negative effect on the social development of these countries. If women are educated as men in a society, then this society can advance rapidly since the effect of educated women influence the quality of life and health in a positive way and not only for those women, but younger generations who follow them as well. This article reviews the history of some remarkable women in dermatology.
Lang, P G
Although dapsone and sulfapyridine have been used for years in dermatology, there has not always been a clear understanding of how these agents work. Recent investigation, however, has shed new light on thes agents which now allows a more rational approach to their use. This review is an attempt to familiarize the clinician with how these agents work, in what disease states they are effective, how to administer them, what adverse effects may occur, and how to monitor the patient to detect these adverse effects.
Robson, David C; Burton, Gregory G
Cyclosporin has been increasingly used for the treatment of skin diseases in small animals. Reported uses include the treatment of atopy, cutaneous lupus erythematosus, feline acquired alopecia resembling pseudopelade of humans, pemphigus erythematosus, pemphigus foliaceus, perianal fistulae and sebaceous adenitis. In addition, cyclosporin has been used anecdotally for several other skin diseases. Few side effects have been noted at doses therapeutic for dermatologic diseases. Current suggestions for monitoring, and the value of trough cyclosporin serum concentrations for prediction of toxicity and efficacy are discussed.
Károlyi, Z; Harhai, I; Erós, N
SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis) as a new disease entity was first described in 1987. The syndrome is characterized by the presence of pustular dermatoses together with aseptic osteoarticular lesions. The bone involvement includes hyperostosis, aseptic osteomyelitis or arthritis of the anterior chest wall, sacroiliac joints or long bones. Skin diseases include acne conglobata or acne fulminans, palmoplantar pustulosis and hidradenitis suppurativa. Authors describe the dermatological relationship of SAPHO syndrome reporting their 7 cases (3 acne fulminans, 4 palmoplantar pustulosis). Authors draw attention to the isotretinoin therapy as a possible provoking factor of the articular symptoms, and they emphasize the diagnostic role of bone scintigraphy.
Biologics are protein molecules which are used in various diseases to target the specific points in the immunopathogenesis of the diseases. The molecules are produced by recombinant DNA technology. The molecules bind to the specific targets without interfering wtih rest of the pathogenetic pathways. Therefore the so called ‘immunosuppressives’ have, although, a broader broader spectrum of action on immune system, their side-effects are also equally more. The biologics, because of their spefic action on the immune system, have very little side effects. The biologics which have revolutionized the treatment of various dermatologic diseases have been discussed here. PMID:20161849
Alfageme, F.; Cerezo, E.; Fernandez, I. S.; Aguilo, R.; Vilas-Sueiro, A.; Roustan, G.
Purpose: Teaching ultrasound procedures to undergraduates has recently been proposed to improve the quality of medical education. We address the impact of applying standardized dermatologic ultrasound teaching to our undergraduates. Materials and Methods: Medical students were offered an additional theoretical and practical seminar involving hands-on ultrasound dermatologic ultrasound during their mandatory dermatology practical training. The students’ theoretical knowledge and dermatologic ultrasoud skills were tested with a multiple choice questionnaire extracted from Level 1 Spanish Society of Ultrasound Dermatologic Ultrasound accreditation exam before and after the course. After the course, the students were asked to answer a course evaluation questionnaire Results: The multiple-choice question scores after the course showed statistically significant improvement (5.82 vs. 8.71%; P<0.001). The questionnaire revealed that students were satisfied with the course, felt that it increased both their dermatologic and ultrasound knowledge, and indicated that they wanted more sonographic hands-on training in both dermatologic ultrasound and other medical fields. Conclusion: Using both objective and subjective methods, we showed that the introduction of standardized ultrasound training programs in undergraduate medical education can improve both students’ understanding of the technique and the quality of medical education in dermatology. PMID:27933321
Klein, J A
Liposuction is now a well-established procedure in dermatologic surgery. The relative advantages and risks of the various forms of primary anesthesia and supplemental analgesia used for liposuction surgery in the office by dermatologic surgeons is described. Effective anesthetic techniques include infiltration of local anesthesia (LA) with or without intramuscular (IM), intravenous (IV), or nitrous oxide sedation, cryoanesthesia, and IV or inhalation general anesthesia (GA). Local anesthesia, using large volumes of dilute anesthetic solution containing lidocaine (0.05%), epinephrine (1:1,000,000), and sodium bicarbonate (12.5 meq/L), is a safe and effective modality for liposuction by dermatologists. In a study of 12 liposuction patients treated with this technique, the average lidocaine dose was 1181 mg (9.4 mg/kg/hr). The highest peak lidocaine blood level among all patients was 0.484 microgram/ml. Dermatologists should not assume the dual responsibility of surgeon and of monitoring patients given IV sedation. Any form of anesthesia has the potential for serious complications. The surgeon and office staff must be well trained and equipped to perform emergency resuscitation.
Shenefelt, Philip D
Patient stress and anxiety are common preoperatively and during dermatologic procedures and surgeries. Stress and anxiety can occasionally interfere with performance of procedures or surgery and can induce hemodynamic instability, such as elevated blood pressure or syncope, as well as producing considerable discomfort for some patients. Detection of excess stress and anxiety in patients can allow the opportunity for corrective or palliative measures. Slower breathing, biofeedback, progressive muscular relaxation, guided imagery, hypnosis, meditation and music can help calm and rebalance the patient's autonomic nervous system and immune functioning. Handheld miniaturized heart rate variability biofeedback devices are now available. The relaxation response can easily be taught. Guided imagery can be recorded or live. Live rapid induction hypnosis followed by deepening and then self-guided imagery requires no experience on the part of the patient but does require training and experience on the part of a provider. Recorded hypnosis inductions may also be used. Meditation generally requires more prior experience and training, but is useful when the patient already is skilled in it. Live, guided meditation or meditation recordings may be used. Relaxing recorded music from speakers or headphones or live performance music may also be employed to ease discomfort and improve the patient's attitude for dermatologic procedures and surgeries.
Niamba, Pascal; Sieba, Ibrahim; Faye, Ousmane; Traoré-Barro, Fatou; Traoré, Adama
In Burkina Faso as in other underdeveloped countries, access to health care in general and dermatology care in particular remains difficult. This situation puts pharmacies on the front line for providing counselling. We undertook a cross-sectional descriptive study of the pharmacies of Ouagadougou from October 1, 2002, through April 1, 2003. Our objective was to evaluate the prevalence of dermatological and cosmetic counselling. The study included 75.5% of all pharmacies and 150 service providers. Prevalence of dermatology counseling was considered moderate, as was the availability and use of dermatology products. Service providers did not know most of the common dermatology disorders and offered inappropriate advice and products. This study shows the gap between the need for counselling from pharmacies and its satisfaction. It also underlines the necessity of reorganization in this domain.
Hay, R; Marks, R
The International Foundation of Dermatology (IFD) was established by the International League of Dermatology Societies to promote the care of skin disease in the developing world. Starting from an initial base of the Regional Dermatology Training Centre in Tanzania it has successfully trained a cadre of clinical officers and dermatology residents from different African countries. It has now broadened this approach to an assessment of the effectiveness of focused training in Mali. The IFD is also completing a global assessment of dermatological needs in developing countries with a view to establishing guidelines and programmes for the control of common skin diseases. An ongoing strategy has been to work with other agencies to help ease the burden of other endemic tropical diseases that affect the skin; preventing the development of elephantiasis in filarial lymphoedema has been one such project implemented through a programme of skin hygiene.
Mukhopadhyay, Amiya Kumar
Since the early days of cutaneous medicine, naming of the entities had remained a confusing subject. Earlier texts of all ancient civilisations are almost similar in this topic The Biblical controversy regarding the actual translational meaning of the original Hebrew term Zara ‘at has become a centre of controversy amongst many research scholars of the medical history. Similar debate exists about the Ayurvedic term Kustha---- whether it meant leprosy or stood for a number of skin affliction is a matter of controversy. A scientific and rational classification system was, therefore needed. The process started with Galen and traversed a long path and ultimately with the eight orders classification system proposed by Robert Willan in the early part of the nineteenth century resolved the issue. This whole journey was eventful….almost all the great doyens of dermatology directly or indirectly contributed to this process. This overview will focus on the main such events of the medical history in nutshell. PMID:27904174
This article is a selection of the most significant developments in the field of pediatric dermatology through an analysis of the articles published between October 2012 and October 2013. In the field of vascular anomalies, propranolol remains a topic of interest for infantile hemangiomas. New clinical concepts appear in the field of vascular malformations in parallel to genetic progress in this area. New epidemiological data or new pathophysiological concepts apply to atopic dermatitis. Congenital or atypical nevi of the child benefit from genetic progress or improvement of clinical knowledge. Although rare, melanoma of the child concerns by its increasing incidence and its misleadingclinical characteristics. Other data reported here relate to infectious skin of the child, morpheas, neurofibromatosis type 1, psoriasis and other commonly seen dermatoses in children.
Casanova, J M; Sanmartín, V; Martí, R M; Morales, J L; Soler, J; Purroy, F; Pujol, R
The acquisition of competences (the set of knowledge, skills and attitudes required to perform a job to a professional level) is considered a fundamental part of medical training. Dermatology competences should include, in addition to effective clinical interviewing and detailed descriptions of skin lesions, appropriate management (diagnosis, differentiation, and treatment) of common skin disorders and tumors. Such competences can only be acquired during hospital clerkships. As a way of certifying these competences, we propose evaluating the different components as follows: knowledge, via clinical examinations or critical incident discussions; communication and certain instrumental skills, via structured workplace observation and scoring using a set of indicators; and attitudes, via joint evaluation by staff familiar with the student.
Jagadeesan, Soumya; Shenoy, Padmanabha
Dermatology and rheumatology are two specialties that deal with significant overlap. In this context, it is important that the dermatologists acquaint themselves with conditions presenting with arthropathy. As the first step, it is essential to know whether the origin of musculoskeletal symptom is articular or extra-articular; inflammatory or noninflammatory; acute or chronic; oligo- or poly-articular. This will help in narrowing down the differential diagnoses as well as in better correlation with the cutaneous symptoms. In this review, we discuss the skin and articular manifestations of common inflammatory and noninflammatory arthropathies including rheumatoid arthritis, spondyloarthropathies, connective tissue disorders, vasculitis, crystal arthropathies, infective arthritis, arthritis associated with degenerative, endocrine and metabolic conditions, etc. We have also added a section on the common cutaneous features associated with the treatment of rheumatologic diseases. A basic understanding of the joint pathologies and associated skin changes will help a long way in the better management of these conditions.
Conde Montero, E; Fernández Santos, M E; Suárez Fernández, R
In recent years, the use of platelet-rich plasma has increased notably in a range of diseases and settings. Uses of these products now go beyond skin rejuvenation therapy in patients with facial ageing. Good outcomes for other dermatological indications such as skin ulcers and, more recently, alopecia have been reported in case series and controlled studies. However, these indications are not currently included in the labeling given that stronger scientific evidence is required to support their real benefits. With the increased use of these products, dermatologists need to become familiar with the underlying biological principles and able to critically assess the quality and outcomes of the studies of these products in different skin diseases.
Lamberg, Anna Lei; Sølvsten, Henrik; Lei, Ulrikke; Vinding, Gabrielle Randskov; Stender, Ida Marie; Jemec, Gregor Borut Ernst; Vestergaard, Tine; Thormann, Henrik; Hædersdal, Merete; Dam, Tomas Norman; Olesen, Anne Braae
Aim of database The Danish Nonmelanoma Skin Cancer Dermatology Database was established in 2008. The aim of this database was to collect data on nonmelanoma skin cancer (NMSC) treatment and improve its treatment in Denmark. NMSC is the most common malignancy in the western countries and represents a significant challenge in terms of public health management and health care costs. However, high-quality epidemiological and treatment data on NMSC are sparse. Study population The NMSC database includes patients with the following skin tumors: basal cell carcinoma (BCC), squamous cell carcinoma, Bowen’s disease, and keratoacanthoma diagnosed by the participating office-based dermatologists in Denmark. Main variables Clinical and histological diagnoses, BCC subtype, localization, size, skin cancer history, skin phototype, and evidence of metastases and treatment modality are the main variables in the NMSC database. Information on recurrence, cosmetic results, and complications are registered at two follow-up visits at 3 months (between 0 and 6 months) and 12 months (between 6 and 15 months) after treatment. Descriptive data In 2014, 11,522 patients with 17,575 tumors were registered in the database. Of tumors with a histological diagnosis, 13,571 were BCCs, 840 squamous cell carcinomas, 504 Bowen’s disease, and 173 keratoakanthomas. Conclusion The NMSC database encompasses detailed information on the type of tumor, a variety of prognostic factors, treatment modalities, and outcomes after treatment. The database has revealed that overall, the quality of care of NMSC in Danish dermatological clinics is high, and the database provides the necessary data for continuous quality assurance. PMID:27822110
Vexiau, P; Chivot, M
Acne is a problem of the pilo-sebaceous follicle caused by the conjunction of three factors: seborrhea, follicle obstruction, and follicle inflammation. The key element, seborrhea, is under androgenic control. Acne in women is also influenced by developments and modifications in genital life, as well as by hormonal contraceptive and replacement therapies. Acne is rare prior to puberty, when it may indicate endocrine disease. At puberty, acne is quasi-physiological, because of the relative hyperandrogenism induced by the andrenarche preceding pubarche, as well as by the relative shortage of estrogens and progesterone during the first menstrual cycles. Other signs of hyperandrogenism, such as menstrual cycle difficulties and excess weight, which favor a hormonal origin, must be sought in cases of persistent or late-onset acne in adults. There is a mirror image of puberty during the peri-menopausal period, but with decreased seborrhea, so acne is rare. Finally, a tumoral origin must be sought in the rare cases of acne occurring after menopause. Hormonal investigation of acne should not be systematic, but is justified during prepuberty when other symptoms are associated with acne that resists well-conducted dermatological treatment. The therapeutic approach should be primarily dermatological, but hormone-oriented treatment should be considered when such therapy fails, or in the presence of other signs of hyperandrogenism. Sometimes the association of isotretinoin and an anti-androgen treatment are necessary to effectively treat such acne. Finally, particular attention must be paid to contraceptive therapies and hormone treatments, which can induce or aggravate acne, especially during the peri-menopausal period.
Weiland, Tracey J.; Chong, Alvin H.; Jelinek, George A.
Background/Objectives. There is minimal data available on the types of dermatological conditions which present to tertiary emergency departments (ED). We analysed demographic and clinical features of dermatological presentations to an Australian adult ED. Methods. The St. Vincent's Hospital Melbourne (SVHM) ED database was searched for dermatological presentations between 1 January 2009 and 31 December 2011 by keywords and ICD-10 diagnosis codes. The lists were merged, and the ICD-10 codes were grouped into 55 categories for analysis. Demographic and clinical data for these presentations were then analysed. Results. 123 345 people presented to SVHM ED during the 3-year period. 4817 (3.9%) presented for a primarily dermatological complaint. The most common conditions by ICD-10 diagnosis code were cellulitis (n = 1741, 36.1%), allergy with skin involvement (n = 939, 19.5%), boils/furuncles/pilonidal sinuses (n = 526, 11.1%), eczema/dermatitis (n = 274, 5.7%), and varicella zoster infection (n = 161, 3.3%). Conclusion. The burden of dermatological disease presenting to ED is small but not insignificant. This information may assist in designing dermatological curricula for hospital clinicians and specialty training organisations as well as informing the allocation of dermatological resources to ED. PMID:24800080
Messenger, Elizabeth; Kovarik, Carrie L; Lipoff, Jules B
Access to care is a known issue in dermatology, and many patients may experience long waiting periods to see a physician. In this study, an anonymous online survey was sent to all 274 Pennsylvania hospitals licensed by the US Department of Health in order to evaluate current levels of access to inpatient dermatology services. Although the response rate to this survey was limited, the data suggest that access to inpatient dermatology services is limited and may be problematic in hospitals across the United States. Innovation efforts and further studies are needed to address this gap in access to care.
Lewinson, Ryan T; Haber, Richard M
Biomechanics is increasingly being recognized as an important research area in dermatology. To highlight only a few examples, biomechanics has contributed to the development of novel topical therapies for aesthetic and medical purposes, enhanced our understanding of the pathogenesis of plantar melanoma, and provided insight into the epidemiology of psoriatic disease. This article summarizes the findings from recent studies to demonstrate the important role that biomechanics may have in dermatologic disease and therapy and places these biomechanical findings in a clinical context for the practicing physician. In addition, areas for future biomechanics research and development in dermatology are discussed.
Kryatova, Maria S; Okoye, Ginette A
Dermatology is greatly understudied in the American Indian/Alaska Native (AIAN) population. This topic deserves attention in light of the changing demographics of the United States and the healthcare disparities faced by AIAN, including access to dermatologic care. In this review, we discuss disorders that are more prevalent or otherwise important in the AIAN population, such as cutaneous malignancies, photodermatoses, acanthosis nigricans, connective tissue disorders, cutaneous infections, hypertrophic scar formation, and Heck's disease. We aim to provide an updated review and increase awareness of the dermatologic needs of the AIAN population.
Kudur, Mohan H; Hulmani, Manjunath
There are 'n' number of names and terminologies in dermatology. The real and unreal names lead to lot of confusion to the residents and practitioners of dermatology. The word 'pseudo' means 'unreal', 'false' or 'fake', and it has deep roots in dermatology providing herculean task to differentiate and understand the real conditions/diseases/signs in dermatology. We have made an attempt to list and describe the pseudo and associated real conditions in dermatology.
Binford, Robert T.; And Others
At Cornell University Medical College one 3-hour session in dermatology is required during the second year. A teaching exercise has been developed that combines a lecture, laboratory exercises, and presentations of patients. (Author)
Hoetzenecker, Wolfram; Guenova, Emmanuella; Krug, Markus; Goetz, Angelika; Amarov, Boyko; Haefner, Hans-Martin; Breuninger, Helmut
Parents experience anxiety and concern about their children's anesthesia and surgeries, which can adversely affect the children's outcomes. Therefore, it is important to identify the factors that influence parental fear. Because dermatological surgery is often performed in young children, we examined how a child's age and the size of the dermatological surgical area affected the levels of parental anxiety and concern. The parents' levels of anxiety and concern were accessed by parental self-reports in a prospective observational study of 106 children undergoing dermatological surgery. Correlation analysis showed that the level of parental anxiety decreased with the child's age. In contrast, the level of parental anxiety increased with the size of the surgical area. Our findings thus indicate that parents whose children undergo large-sized surgeries at a young age are at high risk. This result should be considered when performing dermatological surgery in children.
Barcaui, Elisa de Oliveira; Carvalho, Antonio Carlos Pires; Lopes, Flavia Paiva Proença Lobo; Piñeiro-Maceira, Juan; Barcaui, Carlos Baptista
Ultrasonography is a method of imaging that classically is used in dermatology to study changes in the hypoderma, as nodules and infectious and inflammatory processes. The introduction of high frequency and resolution equipments enabled the observation of superficial structures, allowing differentiation between skin layers and providing details for the analysis of the skin and its appendages. This paper aims to review the basic principles of high frequency ultrasound and its applications in different areas of dermatology. PMID:27438191
Tsai, S; Scott, J F; Keller, J J; Gerstenblith, M R
The role of inpatient Dermatology consultation and biopsy in evaluating suspicious cutaneous lesions is unknown.(1-3) Previous studies analyzed the diagnostic accuracy and utility of consultations for common rashes and infectious diseases, without considering suspicious lesions.(4-6) We sought to describe the frequency, clinicopathologic characteristics, and outcomes of suspicious lesions biopsied on an inpatient Dermatology consult service This article is protected by copyright. All rights reserved.
Zaun, H; Ludwig, E
In spite of remarkable therapeutic results obtained by gestagens with antiandrogenic activity, usually combined with estrogen, in oily seborrhea, acne, Fox-Fordyce disease, androgenetic alopecia and hirsutism many dermatologist still hesitate to treat the named disorders by hormones. The reason for their hesitation appears to be the erroneous belief, that the named disturbances represent hormonal disorders the treatment of which does not belong to dermatology. After a survey on the mechanism of action of antiandrogens the basic difference between androgen dependent skin disorders and endocrinopathies with manifestation on the skin and its appendages is explained. Androgen dependent skin disorders, like oily seborrhea and most cases of acne are not the result of endocrine disturbances in the sense of an pathologically increased or decreased production of sexual hormons. Administering sexual hormons the physician takes advantage of the sebosuppressive effect of female sexual hormons as he does of the antiallergic activity of the hormon cortisol (and related compounds) in the treatment of eczemas. The antiandrogenic treatment of androgenetic alopecia, hirsutism and androgenetic acne--with their underlying hormonal disturbance, consisting in an increased production of androgens, represents an quasi etiological therapy. As in these cases the hormonal disturbances finds its expression mainly or exclusively in disorders of the skin or hair growth, the dermatologist, preferentially in cooperation with endocrinogists and/or gynacologists remains entitled to take over the treatment. The available drugs are discussed and suggestions are made for their appropriate use.
Tan, Eunice K; Millington, George W M; Levell, Nick J
Classical acupuncture focuses primarily on treating the person, and secondarily treating the illness. The "symptoms" are regarded as "branch" expressions of a "root" (constitutional) imbalance. Different root imbalances can produce the same symptoms. Five patients with eczema, for example, may reveal five distinct root imbalances and would all be treated very differently. Because acupuncture treats the whole person, it has something to offer almost every condition. In many cases, acupuncture aims to bring about a complete cure; in others, it aims to manage the problem. Acupuncture remains a substantial part of the traditional Chinese medicine, which is used to treat many conditions including acne, alopecia, dermatitis, pruritus, psoriasis, rosacea, systemic lupus erythematosus, urticaria, herpes zoster, chicken pox, impetigo, leprosy, vitiligo, and tinea. This review introduces the historical context of acupuncture within Chinese medicine and how it relates to skin disease. Specifically, a key question is, what can we learn from the ancients with regard to their use of acupuncture as part of a holistic system of medicine, and how does this relate to the practice of modern dermatology?
Laboratory tests, including blood tests and urine analysis, are frequently performed in the dermatology outpatient clinic, but doctors often do not consider the cognitive or psychological effect of the examinations. Based on terror management theory, we hypothesized that performing laboratory tests increases the patient’s fear of mortality, and therefore has a positive effect on the patient’s attitude toward the doctor’s recommendations and willingness to accept them. The study employed a single factor between-subjects design, using a questionnaire completed by the patients. One group consisted of patients who had undergone laboratory tests 1 week before the survey, and the other group consisted of patients who had not undergone a laboratory test. Although the differences between two groups were not statistically significant, the patients who had laboratory tests had tendency to show even lower positive attitude toward the doctor’s recommendations and less intention to follow the recommendations. In contrast to our hypothesis, performing laboratory tests does not subliminally increase patients’ fears or anxieties about their disease or their compliance with doctors’ recommendations. PMID:24555101
Sehgal, Virendra N; Pandhi, Deepika; Khurana, Ananta
The advent of biologics in dermatologic treatment armentarium has added refreshing dimensions, for it is a major breakthrough. Several agents are now available for use. It is therefore imperative to succinctly comprehend their pharmacokinetics for their apt use. A concerted endeavor has been made to delve on this subject. The major groups of biologics have been covered and include: Drugs acting against TNF-α, Alefacept, Ustekinumab, Rituximab, IVIG and Omalizumab. The relevant pharmacokinetic characteristics have been detailed. Their respective label (approved) and off-label (unapproved) indications have been defined, highlighting their dosage protocol, availability and mode of administration. The evidence level of each indication has also been discussed to apprise the clinician of their current and prospective uses. Individual anti-TNF drugs are not identical in their actions and often one is superior to the other in a particular disease. Hence, the section on anti-TNF agents mentions the literature on each drug separately, and not as a group. The limitations for their use have also been clearly brought out. PMID:25284845
Wagner, Richard F; Raimer, Sharon S; Kelly, Brent C
Programmatic changes for the dermatology residency program at The University of Texas Medical Branch were first introduced in 2005, with the faculty goal incorporating formal dermatology research projects into the 3-year postgraduate training period. This curriculum initially developed as a recommendation for voluntary scholarly project activity by residents, but it evolved into a program requirement for all residents in 2009. Departmental support for this activity includes assignment of a faculty mentor with similar interest about the research topic, financial support from the department for needed supplies, materials, and statistical consultation with the Office of Biostatistics for study design and data analysis, a 2-week elective that provides protected time from clinical activities for the purpose of preparing research for publication and submission to a peer-reviewed medical journal, and a departmental award in recognition for the best resident scholarly project each year. Since the inception of this program, five classes have graduated a total of 16 residents. Ten residents submitted their research studies for peer review and published their scholarly projects in seven dermatology journals through the current academic year. These articles included three prospective investigations, three surveys, one article related to dermatology education, one retrospective chart review, one case series, and one article about dermatopathology. An additional article from a 2012 graduate about dermatology education has also been submitted to a journal. This new program for residents was adapted from our historically successful Dermatology Honors Research Program for medical students at The University of Texas Medical Branch. Our experience with this academic initiative to promote dermatology research by residents is outlined. It is recommended that additional residency programs should consider adopting similar research programs to enrich resident education. PMID:23901305
Silva, Cristiana Silveira; Souza, Murilo Barreto; Filho, Roberto Silveira Silva; de Medeiros, Luciana Molina; Criado, Paulo Ricardo
INTRODUCTION: Dermatological disorders are common in medical practice. In medical school, however, the time devoted to teaching dermatology is usually very limited. Therefore, online educational systems have increasingly been used in medical education settings to enhance exposure to dermatology. OBJECTIVE: The present study was designed to develop an e-learning program for medical students in dermatology and evaluate the impact of this program on learning. METHODS: This prospective study included second year medical students at the University of Technology and Science, Salvador, Brazil. All students attended discussion seminars and practical activities, and half of the students had adjunct online seminars (blended learning). Tests were given to all students before and after the courses, and test scores were evaluated. RESULTS: Students who participated in online discussions associated with face-to-face activities (blended learning) had significantly higher posttest scores (9.0±0.8) than those who only participated in classes (7.75±1.8, p <0.01). CONCLUSIONS: The results indicate that an associated online course might improve the learning of medical students in dermatology. PMID:21655756
Melosky, B.; Leighl, N.B.; Rothenstein, J.; Sangha, R.; Stewart, D.; Papp, K.
Targeting the epidermal growth factor receptor (egfr) pathway has become standard practice for the treatment of advanced non-small-cell lung cancer. Compared with chemotherapy, egfr tyrosine kinase inhibitors (tkis) have been associated with improved efficacy in patients with an EGFR mutation. Together with the increase in efficacy comes an adverse event (ae) profile different from that of chemotherapy. That profile includes three of the most commonly occurring dermatologic aes: acneiform rash, stomatitis, and paronychia. Currently, no randomized clinical trials have evaluated the treatments for the dermatologic aes that patients experience when taking egfr tkis. Based on the expert opinion of the authors, some basic strategies have been developed to manage those key dermatologic aes. Those strategies have the potential to improve patient quality of life and compliance and to prevent inappropriate dose reductions. PMID:25908911
Glick, Jaimie B; Kaur, Ravneet R; Siegel, Daniel
Bleeding is a common occurrence during any dermatologic surgery that disrupts blood vessels. The complications of excess bleeding can include delayed wound healing, hematoma formation, infection, dehiscence, and necrosis. In part one of this review, we discussed the pre-operative, intra-operative, and post-operative management of patients undergoing dermatologic surgery. In Part two, we discuss traditional and new topical hemostatic agents used to achieve hemostasis in dermatological procedures and surgery. We will evaluate the caustic and non-caustic hemostatic agents as well as hemostatic dressings. The mechanisms of action, side effect profile, and advantages and disadvantages of the topical hemostatic agents are provided. Sources for this article were found searching the English literature in PubMed for the time period 1940 to March 2012. A thorough bibliography search was also performed and key references examined.
Akyol, Melih; Ozçelik, Sedat
Systemic isotretinoin has been used to treat severe acne vulgaris for 20 years. However, isotretinoin also represents a potentially useful choice of drugs in many dermatologic diseases other than acne vulgaris. Diseases such as psoriasis, pityriasis rubra pilaris, condylomata acuminata, skin cancers, rosacea, hidradenitis suppurativa, granuloma annulare, lupus erythematosus and lichen planus have been shown to respond to the immunomodulatory, anti-inflammatory and antitumor activities of the drug. Isotretinoin also helps prevent skin cancers such as basal cell carcinoma or squamous cell carcinoma. A combination of systemic isotretinoin and interferon-alpha-2a may provide a more potent effect than isotretinoin alone in the prevention and treatment of skin cancers.Systemic isotretinoin may be considered as an alternative drug in some dermatologic diseases unresponsive to conventional treatment modalities. However, randomized clinical trials aimed at determining the role of systemic isotretinoin therapy in dermatologic diseases other than acne vulgaris are required.
Farkas, A.; Kemeny, L.
Excimer lasers contain a mixture of a noble inert gas and a halogen, which form excited dimers only in the activated state. High-energy current is used to produce these dimers, which have a very short lifetime, and after their fast dissociation they release the excitation energy through ultraviolet photons. The application of these lasers proved to be successful in medicine, including the field of ophthalmology, cardiology, angiology, dentistry, orthopaedics, and, in recent years, dermatology. For medical purposes, the 193-nm argon fluoride, the 248-nm krypton fluoride, the 351-nm xenon fluoride, and the 308-nm xenon chloride lasers are used. Recently, the 308-nm xenon chloride laser has gained much attention as a very effective treatment modality in dermatological disorders. It was successfully utilized in psoriasis; later, it proved to be useful in handling other lightsensitive skin disorders and even in the treatment of allergic rhinitis. This review summarizes the possible applications of this promising tool in dermatology.
Sawhney, Mossum K.; Hamblin, Michael R.
Over the last few years, low-level laser (light) therapy (LLLT) has been demonstrated to be beneficial to the field of aesthetic medicine, specifically aesthetic dermatology. LLLT encompasses a broad spectrum of procedures, primarily cosmetic, which provide treatment options for a myriad of dermatological conditions. Dermatological disorders involving inflammation, acne, scars, aging and pigmentation have been investigated with the assistance of animal models and clinical trials. The most commercially successful use of LLLT is for managing alopecia (hair loss) in both men and women. LLLT also seems to play an influential role in procedures such as lipoplasty and liposuction, allowing for noninvasive and nonthermal methods of subcutaneous fat reduction. LLLT offers a means to address such conditions with improved efficacy versatility and no known side-effects; however comprehensive literature reports covering the utility of LLLT are scarce and thus the need for coverage arises.
. Muscarinic acetylcholine receptors have been localized to keratinocytes, melanocytes and dermal fibroblasts, whereas nicotinic acetylcholine receptors have been found in keratinocytes. The role of acetylcholine and the role of DMAE as a modulator of acetylcholine-mediated functions in the skin remain to be elucidated.Thus, the benefits of DMAE in dermatology include a potential anti-inflammatory effect and a documented increase in skin firmness with possible improvement in underlying facial muscle tone. Studies are needed to evaluate the relative efficacy of DMAE compared with other skin-care regimens (e.g., topical antioxidant creams, alpha-hydroxy acids).
Aquino, Lisa L; Wen, Ge; Wu, Jashin J
There is a shortage of academic dermatologists in the United States. This study aimed to examine characteristics of US dermatology residency programs that affect the odds of producing academic dermatologists. Data regarding program size, faculty, grants, alumni residency program attended, lectures, and publications for all accredited US dermatology residency programs were collected; these data were correlated with the ratio of graduating full-time faculty members to estimated total number of graduates for each respective program. Results emphasize that the ratio of faculty to residents and the number of full-time faculty publications may represent key factors by which residency programs can increase their graduation of academic dermatologists.
Capriotti, Kara; Capriotti, Joseph A
Dimethyl sulfoxide is a colorless liquid derived as a by-product from wood pulp in the production of paper. This colorless liquid found immediate application as a polar, aprotic solvent miscible with water and able to dissolve an enormous catalog of polar and nonpolar small molecules. It is presently scarcely used in dermatology, but given its useful properties as a penetration-enhancing solvent excipient and active anti-inflammatory pharmaceutical agent, dimethyl sulfoxide has the potential to be used in a much broader capacity. The authors review the history, chemistry, and clinical utility of dimethyl sulfoxide as it pertains to dermatology.
Ludlow, Steven P; Pasikhova, Yanina
Dermatologic toxicity is a known reaction of ipilimumab and vemurafenib. Because of the lack of effective treatments and aggressive nature of melanoma, treatments are often discontinued and new treatments are initiated in rapid succession. We report what we believe to be the first case of cumulative dermatologic toxicity secondary to rapid-sequential treatment with ipilimumab and vemurafenib for metastatic melanoma that responded to high-dose steroids. This case highlights the combined toxicity of these two drugs that can occur as a result of overlapping toxicity. It also illustrates the need for a substantial wash out period between rapid cycling of these two drugs secondary to ipilimumab's long half-life.
Information about medications appropriate for dermatologists and patients with skin diseases is readily available on the Internet. Authoritative educational material is supplied by academic dermatologic associations and institutions and distributed by independent websites, large health portals, and search directories. Although it is easy to find excellent dermatological drug information, the World Wide Web is dynamic and unmoderated, and patients can be misled or exploited by inaccurate or fraudulent websites. Health on the Net and other organizations have developed ethical principles to aid consumers and evaluate the quality of health-related information.
Dermatological moulages rapidly lost their importance during the 1950s. The disadvantages of the classical moulage materials, plaster of Paris and wax, are pointed out. In the 1960s and 1970s modern plastics were introduced to moulage technology at the Linden Dermatological Clinic in Hannover. Silicon-caoutchouc and Vestolit-PVC were the substances used. This paper describes how the Hannover collection of plastic models was assembled and presents its current status. Wax and plastic models are set against each other in the illustrations.
França, Katlein; Ledon, Jennifer; Savas, Jessica; Nouri, Keyvan
The history of women in medicine has been marked by many challenges and achievements. Although the role of women in the "art of healing" can be traced back many centuries, only males are traditionally highlighted in history. Across antiquity, access to medical education was denied to females. Dermatology is a medical specialty in which women displayed particular skill and proficiency. Gradually, determination and competence allowed women to lay claim in an essentially male-dominated world. This article presents a brief review of the performance, progress and achievements of women in the history of medicine and dermatology. PMID:24626675
The art of cleansing has progressed immensely over several thousand years from simply scraping the skin to an exercise in relaxation and improvement in the skin's health and appearance in the present day. Soaps – the basic cleansing agent has also undergone a sea change in its evolution with many variants and newer constituents being incorporated into it. In dermatological disorders like acne, rosacea, atopic dermatitis, photoaging, ‘sensitive skin’, occupational dermatosis cleansers may have a beneficial role along with other therapeutic measures. With the advent of aesthetic dermatology, the act of cleansing and the use of various cleansing agents prior to aesthetic procedures has also assumed significance. PMID:21572782
Waldman, Abigail; Sobanko, Joseph F; Alam, Murad
This article identifies gaps in the practice of cosmetic dermatology and cosmetics education, and how to overcome these limitations. There is a rapid development of new devices and procedures, with limited data, patient-reported outcomes, and comparative effectiveness research from which to develop best cosmetic practice. There is a need for increased research and funding dedicated to these goals, improved and convenient training for staff to adopt new devices/procedures, and continuous evolution of databases to pool outcome data and develop outcome sets. Resident education can be improved by dedicated resident cosmetic clinics, didactic teaching from visiting professors, attendance of cosmetic dermatology courses and meetings, and encouraging postresidency training.
Lademann, Juergen; Richter, H.; Otberg, N.; Lawrenz, F.; Blume-Peytavi, U.; Sterry, W.
The state of the art of in-vivo and in-vitro penetration measurements of topically applied substances is described. Only optical techniques represent online measuring methods based on the absorption or scattering properties of the topically applied substances. Laser scanning microscopy (LSM) has become a promising method for investigations in dermatology and skin physiology, after it was possible to analyze the skin surface on any body side in-vivo. In the present paper the application of a dermatological laser scanning microscope for penetration and distribution measurements of topically applied substances is described. The intercellular and follicular penetration pathways were studied.
As a consultant for dermatology with special interested in tropical diseases, I accepted my employers offer (German Armed Forces) to start my training in tropical medicine and tropical dermatology in Africa. The dermatological part of the training was completed at the Regional Dermatology Training Centre (RDTC) in Moshi, Tanzania. This was followed by tropical medicine training at the Presbyterian Hospital in Agogo, Ghana. In this article, I report on my experiences in Africa and present selected case reports.
Disability insurance is an important purchase that dermatology residents will make prior to the completion of residency. This article elucidates commonly used disability insurance terms, common policy pitfalls to avoid, and tips on what type of policy is most advantageous to purchase.
Duliu, Alexandru; Gardiazabal, José; Lasser, Tobias; Navab, Nassir
Multispectral image acquisitions are increasingly popular in dermatology, due to their improved spectral resolution which enables better tissue discrimination. Most applications however focus on restricted regions of interest, imaging only small lesions. In this work we present and discuss an imaging framework for high-resolution multispectral imaging on large regions of interest.
Redbord, Kelley P; Hanke, C William
The Stegman Papers is a biography of Dr. Samuel J. Stegman. The papers were collected by Dr. Stegman during his lifetime as a dermatologic surgeon and leader. The manuscript includes a time line of Dr. Stegman's life and listing of his accomplishments, including significant publications.
Eaby-Sandy, Beth; Grande, Carolyn; Viale, Pamela Hallquist
Targeted therapies have produced significant treatment advances for patients diagnosed with a variety of tumor types. These therapies are associated with unique dermatologic toxicities that may hamper treatment efforts and cause significant discomfort for patients. Prevention and management of these toxicities can allow patients to remain on therapy and hence receive maximum clinical benefit from the drug. PMID:25031940
Franco, W; Gutierrez-Herrera, E; Kollias, N; Doukas, A
Endogenous molecules that exhibit fluorescence hold the potential to serve as reporters of tissue structure, activity and physiology. Fluorescence excitation spectroscopy is one means to measure and express tissue's innate fluorescence. This review focuses on the application of endogenous fluorescence ultraviolet excitation spectroscopy to dermatology.
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Ultraviolet lamp for dermatologic disorders. 878.4630 Section 878.4630 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices §...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ultraviolet lamp for dermatologic disorders. 878.4630 Section 878.4630 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices §...
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Ultraviolet lamp for dermatologic disorders. 878.4630 Section 878.4630 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices §...
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Ultraviolet lamp for dermatologic disorders. 878.4630 Section 878.4630 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices §...
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Ultraviolet lamp for dermatologic disorders. 878.4630 Section 878.4630 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices §...
Objectives Hairdressers in Korea perform various tasks and are exposed to health risk factors such as chemical substances or prolonged duration of wet work. The objective of this study is to provide descriptive statistics on the demographics and work characteristics of hairdressers in Korea and to identify work-related risk factors for dermatologic symptoms in hairdressers. Methods 1,054 hairdressers were selected and analyzed for this study. Independent variables were exposure to chemical substances, the training status of the hairdressers, and the main tasks required of them, and the dependent variable was the incidence of dermatologic symptoms. The relationships between work characteristics and dermatologic symptoms were evaluated by estimating odds ratios using multiple logistic regression analysis. Results Among the 1,054 study subjects, 212 hairdressers (20.1%) complained of dermatologic symptoms, and the symptoms were more prevalent in younger, unmarried or highly educated hairdressers. The main tasks that comprise the majority of the wet work were strictly determined by training status, since 96.5% of staff hairdressers identified washing as their main task, while only 1.5% and 2.0% of master and designer hairdressers, respectively, identified this as their main task. Multiple logistic regressions was performed to estimate odds ratios. While exposure to hairdressing chemicals showed no significant effect on the odds ratio for the incidence of dermatologic symptoms, higher odds ratios of dermatologic symptoms were shown in staff hairdressers (2.70, 95% CI: 1.32 - 5.51) and in hairdressers who perform washing as their main task (2.03, 95% CI: 1.22 - 3.37), after adjusting for general and work characteristics. Conclusions This study showed that the training status and main tasks of hairdressers are closely related to each other and that the training status and main tasks of hairdressers are related to the incidence of dermatologic symptoms. This suggests that
Uksal, Umit; Ozturk, Pinar; Colgecen, Emine; Taslidere, Nazan; Patiroglu, Turkan; Ozdemir, Mehmet Akif; Torun, Yasemin Altuner; Borlu, Murat
Objective: Diagnoses of skin, mucosae, hair and nail manifestations in malignant diseases are often challenging because of life-threatening drug reactions, opportunistic infections or skin involvement of primary processes. Description of morphology, configuration and distribution of lesions is important in order to differentiate the self-healing eruptions from serious side effects of chemotherapy. There are case reports from Turkey including dermatological manifestations of malignancies and case series in adult patients but there are no published large group studies assessing all manifestations in children. The aim of this study was to evaluate the morphological features of dermatological findings in children with haemato-oncological diseases. Materials and Methods: The study was performed at the Erciyes University, Faculty of Medicine Pediatric Hematology-Oncology Clinic, Turkey. Three dermatologists daily consulted all patients admitted to the clinic during a one-year period. Results: The study group comprised of 157 children (79 female/78 male) aged 1–16 years (mean 7.19±4.63). Detailed dermatological examinations were performed, including oral-genital mucosae, hair and nails. Thorough skin examination revealed that 70% of the patients exhibited at least one dermatological finding. Generalized xerosis and hyperpigmentation were the most common findings among patients undergoing chemotherapy (24.19%). Multiple nevi on at least 10 covered areas were very frequent among patients undergoing long-term chemotherapy (18.47%). Three were identified as dysplastic nevus, but malignant transformation was not observed during the one-year study period. Conclusion: Regular dermatological consultation may help resolve the diagnostic and therapeutic problems in paediatric haemato-oncology clinics. PMID:27551173
Kamimura-Nishimura, Kelly; Rudikoff, Donald; Purswani, Murli; Hagmann, Stefan
With an increasing number of children traveling internationally, there has been growing interest in studying the burden of travel-associated illnesses in children. We reviewed recently published (2007-2012) studies on travel-associated illness in children, and extracted the reported spectrum of dermatological conditions in children. Dermatologic problems are among the leading health concerns affecting children during and after return from international travel. Most are mild and self-limited, but an extended spectrum of conditions has been reported from a large retrospective multicenter study. Children may be especially at risk for infections related to environmental exposures, arthropod-related problems, and animal bites. Of note are also tropical and cosmopolitan systemic infections with potential for transmission in the receiving communities. Implications for pre- and post-travel care of children are emphasized.
García-Campayo, J; Pérez-Yus, M C; García-Bustinduy, M; Daudén, E
Many skin diseases are associated with mental disorders. When the psychological symptoms are mild, as is often the case in dermatology, it can be difficult to distinguish between normality and the manifestations of a mental disorder. To facilitate the distinction we review the concept of mental disorder in the present article. It is also important to have instruments that can facilitate early detection of psychological disease, i.e. when the symptoms are still mild. Short, simple, self-administered questionnaires have been developed to help dermatologists and other health professionals identify the presence of a mental disorder with a high degree of certainty. In this article, we focus on the questionnaires most often used to detect the 2 most common mental disorders: anxiety and depression. Finally, we describe the circumstances in which it is advisable to refer a dermatological patient to a psychiatrist, who can diagnose and treat the mental disorder in accordance with standard protocols.
Training in tropical dermatology at the Fundação de Medicina tropical (FMT-AM) in Manaus, Brazil, offers an ideal opportunity to become familiar with the broad spectrum of tropical skin-diseases which are endemic in the tropical rainforest of the Amazon region. Besides frequently observed cases of cutaneous leishmaniasis of the new world, mucocutaneous forms of leishmaniasis and all entities of the different deep mycoses of South America are also regularly diagnosed. Of special importance in the dermatological care of the population is the early diagnosis of all clinical forms of leprosy and the long-term care of HIV patients. Modern diagnostics, including histopathology and molecular biology analytical methods, enable patients at the FMT-AM to be diagnosed without having to solely rely on clinical presentation and epidemiological data.
Campbell, Shannon M; Winkelmann, Richard R; Walkowski, Stevan
Dermatological diseases, such as dysesthesia syndromes, stasis dermatoses, and hyperhidrosis are difficult to treat due to their complex etiologies. Current theories suggest these diseases are caused by physiological imbalances, such as nerve impingement, localized tissue congestion, and impaired autonomic regulation. Osteopathic manipulative therapy targets these physiological dysfunctions and may serve as a beneficial therapeutic option. Osteopathic manipulative therapy techniques include high velocity low amplitude, muscle energy, counterstrain, myofascial release, craniosacral, and lymphatic drainage. An osteopathic manipulative therapy technique is chosen based on its physiological target for a particular disease. Osteopathic manipulative therapy may be useful alone or in combination with standard therapeutic options. However, due to the lack of standardized trials supporting the efficacy of osteopathic manipulative therapy treatment for dermatological disease, randomized, well-controlled studies are necessary to confirm its therapeutic value.
Richarz, N A; Boada, A; Carrascosa, J M
Angiogenesis is the growth of new blood vessels from pre-existing vessels. It is a biological process essential in physiological wound healing or pathological inflammation and tumor growth, which underlies a complex interplay of stimulating and inhibiting signals. Extracellular matrix, cells of innate and adaptive immunity and endothelial cells itself are a major source of angiogenic factors that activate or inhibit specific receptors and consequently influence intracellular signaling pathways. Most inflammatory and neoplastic diseases in dermatology are characterized by excessive angiogenesis, such as psoriasis, atopic dermatitis, as well as melanoma, non-melanoma skin cancer, but also benign vascular neoplasia. In this article we describe current knowledge of angiogenesis and its most relevant mechanisms in different dermatological disorders with particular emphasis on the angiogenic factors (vascular endothelial growth factor) and angiopoietins as a target of current and future directions of anti-angiogenic therapy.
Wan, Marilyn T; Lin, Jennifer Y
In photodynamic therapy (PDT) a photosensitizer – a molecule that is activated by light – is administered and exposed to a light source. This leads both to destruction of cells targeted by the particular type of photosensitizer, and immunomodulation. Given the ease with which photosensitizers and light can be delivered to the skin, it should come as no surprise that PDT is an increasingly utilized therapeutic in dermatology. PDT is used commonly to treat precancerous cells, sun-damaged skin, and acne. It has reportedly also been used to treat other conditions including inflammatory disorders and cutaneous infections. This review discusses the principles behind how PDT is used in dermatology, as well as evidence for current applications of PDT. PMID:24899818
Butler, Lara; Mowad, Christen
With the growing number of dermatologic surgeries performed each year comes an increased potential for patient exposure and sensitization to allergens. Patients are exposed to many well-documented allergens in the preoperative, intraoperative, and postoperative settings during surgery. Postoperative skin complications of allergic contact dermatitis increase health care costs and cause patient suffering. Early recognition, diagnosis, and treatment by dermatologic surgeons are essential to decrease morbidity related to medically necessary and elective cutaneous surgeries. While a specific standard screening panel for cutaneous surgery-related allergens is not well established, we propose several categories of allergens be strongly considered and tested if a patient is suspected of having allergic contact dermatitis in an attempt to reveal pertinent allergens and prevent future exposures.
Baker, K E
A physician assistant (PA) is a licensed health care professional and dependent practitioner. The profession began in the 1960s and accredited programs now number 110 nationwide. PAs practice in every specialty, including dermatology, and their clinical duties vary tremendously. Research has shown enhanced productivity and increased patient satisfaction in practices using PAs. Most third-party payers cover services provided by PAs, making them ideally suited in this era of increasing managed care.
John, Ann M.; John, Elizabeth S.; Hansberry, David R.
Objective: Patients increasingly use the internet to find medical information regarding their conditions and treatments. Physicians often supplement visits with written education materials. Online patient education materials from major dermatologic associations should be written at appropriate reading levels to optimize utility for patients. The purpose of this study is to assess online patient education materials from major dermatologic associations and determine if they are written at the fourth to sixth grade level recommended by the American Medical Association and National Institutes of Health. Design: This is a descriptive and correlational design. Setting: Academic institution. Participants/measurements: Patient education materials from eight major dermatology websites were downloaded and assessed using 10 readability scales. A one-way analysis of variance and Tukey’s Honestly Statistically Different post hoc analysis were performed to determine the difference in readability levels between websites. Results: Two hundred and sixty patient education materials were assessed. Collectively, patient education materials were written at a mean grade level of 11.13, with 65.8 percent of articles written above a tenth grade level and no articles written at the American Medical Association/National Institutes of Health recommended grade levels. Analysis of variance demonstrated a significant difference between websites for each reading scale (p<0.001), which was confirmed with Tukey’s Honestly Statistically Different post hoc analysis. Conclusion: Online patient education materials from major dermatologic association websites are written well above recommended reading levels. Associations should consider revising patient education materials to allow more effective patient comprehension. (J ClinAesthet Dermatol. 2016;9(9):23–28.) PMID:27878059
Morelli, Vincent; Calmet, Erick; Jhingade, Varalakshmi
The exact pathophysiology and curative treatment of many common dermatologic conditions remain unclear. Often conventional treatments are only partially effective, leading patients to look for alternative treatments. Rosacea may be helped by azelaic acid. Seborrheic dermatitis may be helped by tea tree oil. Chronic urticaria may be helped by a focused dietary history and elimination of food additives and salicylates. Although various alternative treatments have been touted as useful in herpes simplex, few have proved efficacious.
Scott, Danny W; Miller, William H; Erb, Hollis N
Medical records of 1407 cats with dermatologic diagnoses made at Cornell University teaching hospital from 1988 to 2003 were tabulated. We expressed the diagnoses as counts, percentages of the cats with dermatologic disease (1407) and percentages of all cats seen at the university hospital (22,135) during the same period. A total of 1887 diagnoses were made in the 1407 cats. We compared the age, sex and breed group of our cases with all those 22,135 cats in ('1-by-c') χ(2) tests in which the hospital population was considered a standard (rather than a 'sample'). The 10 most common dermatoses, their counts, and the proportions of dermatologic diagnoses and of the total cat population that the cats with these dermatoses represented were: allergy (298; 15.8%; 1.35%), atopic dermatitis (194; 10.3%; 0.88%), bacterial folliculitis/furunculosis (189; 10.0%; 0.85%), otodectic mange (115; 6.1%; 0.52%), flea infestation (99; 5.2%; 0.45%), feline acne (74; 3.9%; 0.33%), flea-bite allergy (70; 3.7%; 0.32%), cutaneous adverse drug reaction (56; 3.0%; 0.25%), idiopathic eosinophilic-granuloma complex (55; 2.9%; 0.25%) and abscess (51; 2.7%; 0.23%). Allergies of all types, combined, accounted for 32.7% of all the feline dermatoses. Relative to the standard of the total hospital population, cats <2 years old and females (both intact and spayed) were significantly under-represented (all P≤0.001) in the dermatologic case series. In contrast, Himalayans (compared with domestic short- or longhair, Persian, Siamese and other breeds) and males (both intact and neutered) were significantly over-represented (all P ≤0.001).
John, Ann M; John, Elizabeth S; Hansberry, David R; Lambert, William Clark
Objective: Patients increasingly use the internet to find medical information regarding their conditions and treatments. Physicians often supplement visits with written education materials. Online patient education materials from major dermatologic associations should be written at appropriate reading levels to optimize utility for patients. The purpose of this study is to assess online patient education materials from major dermatologic associations and determine if they are written at the fourth to sixth grade level recommended by the American Medical Association and National Institutes of Health. Design: This is a descriptive and correlational design. Setting: Academic institution. Participants/measurements: Patient education materials from eight major dermatology websites were downloaded and assessed using 10 readability scales. A one-way analysis of variance and Tukey's Honestly Statistically Different post hoc analysis were performed to determine the difference in readability levels between websites. Results: Two hundred and sixty patient education materials were assessed. Collectively, patient education materials were written at a mean grade level of 11.13, with 65.8 percent of articles written above a tenth grade level and no articles written at the American Medical Association/National Institutes of Health recommended grade levels. Analysis of variance demonstrated a significant difference between websites for each reading scale (p<0.001), which was confirmed with Tukey's Honestly Statistically Different post hoc analysis. Conclusion: Online patient education materials from major dermatologic association websites are written well above recommended reading levels. Associations should consider revising patient education materials to allow more effective patient comprehension. (J ClinAesthet Dermatol. 2016;9(9):23-28.).
Serravallo, Melissa; Jagdeo, Jared; Glick, Sharon A; Siegel, Daniel M; Brody, Neil I
Sirtuins are a family of seven proteins in humans (SIRT1-SIRT7) that are involved in multiple cellular processes relevant to dermatology. The role of sirtuins in other organ systems is established. However, the importance of these proteins in dermatology is less defined. Recently, sirtuins gained international attention because of their role as "longevity proteins" that may extend and enhance human life. Sirtuins function in the cell via histone deacetylase and/or adenosine diphosphate ribosyltransferase enzymatic activity that target histone and non-histone substrates, including transcription regulators, tumor suppressors, structural proteins, DNA repair proteins, cell signaling proteins, transport proteins, and enzymes. Sirtuins are involved in cellular pathways related to skin structure and function, including aging, ultraviolet-induced photoaging, inflammation, epigenetics, cancer, and a variety of cellular functions including cell cycle, DNA repair and proliferation. This review highlights sirtuin-related cellular pathways, therapeutics and pharmacological targets in atopic dermatitis, bullous dermatoses, collagen vascular disorders, psoriasis, systemic lupus erythematosus, hypertrophic and keloid scars, cutaneous infections, and non-melanoma and melanoma skin cancer. Also discussed is the role of sirtuins in the following genodermatoses: ataxia telangiectasia, Cowden's syndrome, dyskeratosis congenita, Rubenstein-Taybi, Werner syndrome, and xeroderma pigmentosum. The pathophysiology of these inherited diseases is not well understood, and sirtuin-related processes represent potential therapeutic targets for diseases lacking suitable alternative treatments. The goal of this review is to bring attention to the dermatology community, physicians, and scientists, the importance of sirtuins in dermatology and provide a foundation and impetus for future discussion, research and pharmacologic discovery.
Oh, Sohee; Kim, Nack In; Ro, Young Suck; Kim, Joung Soo; Park, Young Min; Park, Chun Wook; Lee, Weon Ju; Kim, Dong Kun; Lee, Dong Won; Lee, Sang Jun
Background Cosmetics can affect the skin condition profoundly, and yet no survey has been performed in Koreans visiting dermatology clinics. Objective To assess knowledge and consumer behavior regarding cosmetics in Koreans visiting dermatology clinics. Methods A questionnaire consisting of 43 questions concerning demographics and use/knowledge/selection/purchase of cosmetics was given to patients and accompanying persons who visited dermatologic clinics in university and private clinic settings. Results In total 1,015 subjects (73.2% females, mean age 32.5 years) completed the survey. Education level was college or higher in 72.8%. Thirty-one percent had been diagnosed with a skin disorder, atopic dermatitis and seborrheic dermatitis being the most frequent diagnoses (33.7% and 16.8%, respectively). The frequency of makeup/sunscreen/functional cosmetics use, amount of sunscreen use, recognition of functional cosmetics, and knowledge of shelf life were significantly correlated with level of education. Among “functional cosmetics,” whitening products were used most frequently (29.2%). Regardless of education level, 79.2% purchased cosmetics without checking ingredients, and 85.7% were unaware of the all-ingredient-labelling regulations, and yet subjects considered ingredient the most important factor when purchasing a product. Conclusion Outpatient subjects in their twenties and thirties are the most knowledgeable about cosmetics in Korea. PMID:28392645
Wróbel, M. S.; Sekowska, A.; Marchwiński, M.; Galla, S.; Cenian, A.
A wide range of dermatological diseases can be efficiently treated using laser heating. Nevertheless, before the new laser is introduced into clinical practice, its parameters and ability to interact with human skin have to be carefully examined. In order to do that optical skin phantoms can be used. Such phantoms closely imitate the scattering and absorption properties of real human skin tissue along with its thermal properties, such as capacitance and conductivity specific heat. We have fabricated a range of optical tissue phantoms based on polyvinylchloride-plastisol PVC-P with varying optical properties, including the absorption, scattering and density of the matrix material. We have utilized a pre-clinical dermatological laser system with a 975 nm diode laser module. A range of laser settings were tested, such as laser pulse duration, laser power and number of pulses. We have studied laser irradiation efficiency on fabricated optical tissue phantoms. Measurements of the temporal and spatial temperature distribution on the phantoms' surface were performed using thermographic imaging. The comparison of results between tissues' and phantoms' optical and thermal response prove that they can be used for approximate evaluation of laser heating efficiency. This study presents a viable approach for calibration of dermatological lasers which can be utilized in practice.
Nelson, J S; Majaron, B; Kelly, K M
The clinical objective in the laser treatment of patients with specific dermatoses is to maximize thermal damage to the target chromophore while minimizing injury to the normal skin. Unfortunately, for some lesions, the threshold incident light dosage for epidermal injury can be very close to the threshold for permanent removal of the target chromophore, thus precluding the use of higher light dosages. An important method of overcoming the aforementioned problem is to selectively cool the most superficial layers of the skin. Although melanin absorption will result in heat production during laser exposure, cooling the epidermis can prevent its temperature elevation from exceeding the threshold for thermal injury. Spatially selective cooling can be achieved by active cooling using a cryogen spray or cold sapphire contact handpieces. These devices promote rapid and spatially selective epidermal cooling to low temperatures without affecting the target chromophore temperature before the laser pulse is delivered. Cooling has become an Integral part in the emerging discipline of laser dermatologic surgery. Attend almost any academic dermatology conference and you are likely to find many lectures that relate to cooling during dermatologic laser surgery. Although cooling in conjunction with laser therapy has become the clinical standard for many laser procedures, considerable controversy surrounds this methodology. We present herewith an overview of currently used techniques for active cooling of human skin and explore their advantages and disadvantages in relationship to specific dermatoses amenable to laser therapy.
Lee, C T; Tham, S N; Tan, T
CO2 laser was first used in the treatment of melanomas in animals. Since then, it has been successfully used in treating many dermatological conditions. A total of 47 patients were treated once as outpatients in Middle Road Hospital by using Model 720 Sharplan CO2 Laser System and Yoshida Opelaser-01 CO2 Laser System to determine the usefulness of CO2 laser in the treatment of various dermatological conditions. The laser was used mainly in the defocused mode at 10 watts. Local anaesthetic with 1% lignocaine HCL was employed in all cases. 3 patients defaulted follow-up. Of the 30 patients with warts, most of which were recalcitrant, 14 were cured and the remaining 16 showed marked improvement. 4 of the 5 patients with lichen simplex chronicus were cured. 1 patient each of the following conditions were also treated; prurigo nodularis, psoriasis, solar keratosis, ingrowing toe nail, Bowen's disease, infected callosity and lichen amyloidosis; cure was achieved in the former 4 conditions. The laser failed to cure 2 patients with pyogenic granuloma. Side effects included hypopigmentation (62%), mild post-operative pain (11%), scarring (11%), excess granulation tissue (11%), and infection (2%). CO2 laser is a potentially useful, effective and safe treatment modality for many dermatological conditions.
Ulrich, Martina; Lange-Asschenfeldt, Susanne
Confocal laser scanning microscopy (CLSM) represents an emerging technique for the noninvasive histomorphological analysis of skin in vivo and has shown its applicability for dermatological research as well as its value as an adjunct tool in the clinical management of skin cancer patients. Herein, we aim to give an overview on the current clinical indications for CLSM in dermatology and also highlight the diverse applications of CLSM in dermatological research.
The 11th World Congress of Pediatric Dermatology took place at the Queen Sirikit National Convention Center, Bangkok, Thailand on 17 to 19 November 2009. The theme was "Health and Beauty in Pediatric Dermatology." This report highlights several presentations discussing hemangiomas, infections, and novel and future diagnostic methods and treatment of pediatric dermatologic conditions. This report is not intended as a substitute for reading the conference educational handouts, online updates and related references quoted in this article.
Beroukhim, Kourosh; Nguyen, Catherine; Danesh, Melissa; Lee, Kristina; Liao, Wilson
Over the previous decade, several innovative teaching methods have been introduced to overcome the decreasing allotment of time dedicated to dermatology in U.S. medical school curricula. We report our experience of increasing medical student exposure to clinical dermatology thorough involvement in an extracurricular, volunteer-driven dermatology clinic. The clinic was well received by students and faculty. Our experience demonstrates that volunteer-driven dermatology clinics may be an effective method of teaching and engendering a culture of community outreach among medical students and faculty.
Husain, Zain; Alster, Tina S
The role of light-based technologies in dermatology has expanded dramatically in recent years. Lasers and intense pulsed light have been used to safely and effectively treat a diverse array of cutaneous conditions, including vascular and pigmented lesions, tattoos, scars, and undesired hair, while also providing extensive therapeutic options for cosmetic rejuvenation and other dermatologic conditions. Dermatologic laser procedures are becoming increasingly popular worldwide, and demand for them has fueled new innovations and clinical applications. These systems continue to evolve and provide enhanced therapeutic outcomes with improved safety profiles. This review highlights the important roles and varied clinical applications that lasers and intense pulsed light play in the dermatologic practice. PMID:26893574
Aquino, Lisa L; Wu, Jashin J
Shifts in interest toward cosmetic and surgical dermatology and away from medical and academic dermatology have been observed in recent years. We hypothesized that this trend would be evident in the types of books available for purchase from a major medical textbook supplier. Books published from 1998-2008 were categorized by type and statistical testing was performed to determine if this trend has been reflected in books published. The percentage of medical dermatology books decreased over time, whereas the percentage of cosmetic and surgical dermatology books increased over time.
Holmo, Nicole França; Orasmo, Cinthia Rosane; Marques, Silvio Alencar
In the last decade the presence of Brazilian physicians in International Meetings of Dermatology has been expressive. In parallel it has also been expressive the submission of poster abstracts in those Meetings. Considering the meetings from 2005 to 2013, 379 posters were presented in meetings of the American Academy of Dermatology. Brazilian universities were the origin of 59.9%. The Brazilian Society of Dermatology's recognized residency programs were the origin of 69.9% of the presented posters. Considering the period from 2005 to 2010 (n = 165 posters) the papers effectively published were 19 (11.5%). PMID:28099621
Kock, M.; Lüllau, F.
The market of medical devices is growing continuously worldwide. With the DLP™ technology from Texas Instruments Lüllau Engineering GmbH in Germany has realized different applications in the medical discipline of dermatology. Especially a new digital phototherapy device named skintrek™ PT5 is revolutionizing the treatment of skin diseases like psoriasis , Vitiligo and other Eczema. The functions of the new phototherapy device can only be realized through DLP™ technology which is not only be used for the selective irradiation process. In combination with other optical systems DLP™ technology undertakes also other functionalities like 3D-topology calculation und patient movement compensation.
Atakpo, Paul; Vassar, Matt
Systematic reviews and meta-analyses in dermatology provide high-level evidence for clinicians and policy makers that influence clinical decision making and treatment guidelines. One methodological problem with systematic reviews is the under representation of unpublished studies. This problem is due in part to publication bias. Omission of statistically non-significant data from meta-analyses may result in overestimation of treatment effect sizes which may lead to clinical consequences. Our goal was to assess whether systematic reviewers in dermatology evaluate and report publication bias. Further, we wanted to conduct our own evaluation of publication bias on meta-analyses that failed to do so. Our study considered systematic reviews and meta-analyses from ten dermatology journals from 2006 to 2016. A PubMed search was conducted, and all full-text articles that met our inclusion criteria were retrieved and coded by the primary author. 293 articles were included in our analysis. Additionally, we formally evaluated publication bias in meta-analyses that failed to do so using trim and fill and cumulative meta-analysis by precision methods. Publication bias was mentioned in 107 articles (36.5%) and was formally evaluated in 64 articles (21.8%). Visual inspection of a funnel plot was the most common method of evaluating publication bias. Publication bias was present in 45 articles (15.3%), not present in 57 articles (19.5%) and not determined in 191 articles (65.2%). Using the trim and fill method, 7 meta-analyses (33.33%) showed evidence of publication bias. Although the trim and fill method only found evidence of publication bias in 7 meta-analyses, the cumulative meta-analysis by precision method found evidence of publication bias in 15 meta-analyses (71.4%). Many of the reviews in our study did not mention or evaluate publication bias. Further, of the 42 articles that stated following PRISMA reporting guidelines, 19 (45.2%) evaluated for publication bias. In
Walia, Harneet K.; Mehra, Reena
Sleep disorders are very common, often under-recognized and therefore undertreated, are associated with a myriad of medical conditions and could lead to significant impairment of quality of life. This review provides an up-to-date synopsis of common sleep disorders encompassing insufficient sleep syndrome, insomnia, circadian rhythm disorders and obstructive sleep apnea with a brief overview of epidemiology, screening, diagnostic testing and treatment. We also emphasize the emerging area of the intersection of sleep disorders and dermatologic conditions and present compelling data regarding underlying mechanisms including sleep dysfunction in relation to disorders of skin inflammation, aging and skin cancer. PMID:27144559
Fanjul-Vélez, F.; Blanco-Gutiérrez, A.; Salas-García, I.; Ortega-Quijano, N.; Arce-Diego, J. L.
Optical techniques for treatment and characterization of biological tissues are revolutionizing several branches of medical praxis, for example in ophthalmology or dermatology. The non-invasive, non-contact and non-ionizing character of optical radiation makes it specially suitable for these applications. Optical radiation can be employed in medical ablation applications, either for tissue resection or surgery. Optical ablation may provide a controlled and clean cut on a biological tissue. This is particularly relevant in tumoral tissue resection, where a small amount of cancerous cells could make the tumor appear again. A very important aspect of tissue optical ablation is then the estimation of the affected volume. In this work we propose a complete predictive model of tissue ablation that provides an estimation of the resected volume. The model is based on a Monte Carlo approach for the optical propagation of radiation inside the tissue, and a blow-off model for tissue ablation. This model is applied to several types of dermatological tumoral tissues, specifically squamous cells, basocellular and infiltrative carcinomas. The parameters of the optical source are varied and the estimated resected volume is calculated. The results for the different tumor types are presented and compared. This model can be used for surgical planning, in order to assure the complete resection of the tumoral tissue.
del Río, E
Crisóstomo Martínez from Valencia was a pioneering microscopist in 17th-century Europe. The first microscopic representations of skin in Spain appeared in an 18th-century work by Martín Martínez. Microbiology and histopathology progressed considerably in the late 19th century thanks to anatomists like Maestre de San Juan and surgeons like Federico Rubio Galí. The first Spanish pathologist to specialize in dermatology was Antonio Mendoza, a colleague of José Eugenio de Olavide at the Hospital San Juan de Dios in Madrid. Claudio Sala and Juan de Azúa also made significant contributions, including the description of pseudoepithelioma. Several disciples of Santiago Ramón y Cajal and Jorge FranciscoTello, such as Lorenzo Ruiz de Arcaute and Guillermo de la Rosa King, consolidated the dermatology laboratory, but the Civil War sent many into exile or deprived them of their professional status. Juan Rubió in Barcelona and Julio Rodríguez Puchol in Madrid were the immediate predecessors of today's dermatopathologists.
Vassar, Matt; Atakpo, Paul; Kash, Melissa J
Objective Manual searches are supplemental approaches to database searches to identify additional primary studies for systematic reviews. The authors argue that these manual approaches, in particular hand-searching and perusing reference lists, are often considered the same yet lead to different outcomes. Methods We conducted a PubMed search for systematic reviews in the top 10 dermatology journals (January 2006–January 2016). After screening, the final sample comprised 292 reviews. Statements related to manual searches were extracted from each review and categorized by the primary and secondary authors. Each statement was categorized as either “Search of Reference List,” “Hand Search,” “Both,” or “Unclear.” Results Of the 292 systematic reviews included in our sample, 143 reviews (48.97%) did not report a hand-search or scan of reference lists. One-hundred thirty-six reviews (46.58%) reported searches of reference lists, while 4 reviews (1.37%) reported systematic hand-searches. Three reviews (1.03%) reported use of both hand-searches and scanning reference lists. Six reviews (2.05%) were classified as unclear due to vague wording. Conclusions Authors of systematic reviews published in dermatology journals in our study sample scanned reference lists more frequently than they conducted hand-searches, possibly contributing to biased search outcomes. We encourage systematic reviewers to routinely practice hand-searching in order to minimize bias. PMID:27822152
Castelo-Soccio, Leslie; Van Voorhees, Abby S.
Chronic dermatologic diseases affect millions of people. The long-term nature of these diseases creates psychological and financial burden as well as substantially impacts patients' quality of life. Biologics, including adalimumab, etanercept, alefacept, efalizumab, and infliximab, are the newest therapeutic agents in the treatment of moderate-to-severe psoriasis and psoriatic arthritis and have been used in a variety of other dermatologic diseases. These agents act relatively quickly and effectively in 12-week clinical trials. Because these agents are used to treat patients for longer than 12 weeks, there is a need to review the safety and efficacy of these agents over longer periods of time. Many levels of evidence are available for biologics including high level of evidence from large, randomized, double-blind, placebo-controlled clinical studies. This review focuses on the available data for efficacy and safety for greater than 24 weeks of therapy. The studies supporting the use of rituximab and intravenous immunoglobulin in autoimmune blistering diseases are also presented in this review. PMID:19222514
Leis-Dosil, V M; Garrido-Gutiérrez, C; Díaz-Díaz, R M
In 1936, Covisa and Bejarano published a treatise entitled Elementos de Dermatología (The Elements of Dermatology). In this surprisingly modern book they abandoned the nosological debates characteristic of the 19th century and instead classified diseases according to their etiology and pathogenesis based on the scientific and technical advances of the time. Moreover, unlike other books available at the time, which were essentially adaptations of foreign texts, this was the first medical work to reflect the reality of Spanish medicine. However, the future of both the book and its authors was to be determined by the start of the Spanish Civil War in the same year. Covisa and Bejarano, who were both extremely active in the public health system and medical education during the Second Republic, were obliged to seek exile in America. Due to the difficulties of the time, very few copies of the book reached the public and no new editions were ever printed. We will never know what would have happened if the war had not started, but we believe that this important work should be remembered.
Ghosh, Sangita; Jain, Vijay Kumar
In the bewildering array of scientific nomenclature in the medical field, it is important to use correct terminology, know their aberrations and the reason behind a specific terminology. This paper is an attempt towards compiling all the pseudo-nomenclatures coined in dermatology, in order to make it easier to retain and recollect these pseudo names, signs, morphology, diseases, and conditions. It is also imperative to know the true entities that these pseudo names masquerade as, so as to understand the explanation for assigning the term ‘pseudo’ to these conditions. A total of 52 pseudo-terms have been compiled here in reference to dermatology. Most of these pseudo-nomenclatures were coined due to some clinical or histopathological resemblance to the true conditions, while some were premature conclusions drawn from a flawed understanding of the basic nature of the condition. Clear understanding of each of these terms and the explanation behind them being pseudo will enable a dermatologist to avoid misdiagnosis and needless confusion. PMID:24082182
Basavaraj, K H; Johnsy, George; Navya, M A; Rashmi, R; Siddaramaiah
The skin is considered a complex organ for drug delivery because of its structure. Drug delivery systems are designed for the controlled release of drugs through the skin into the systemic circulation, maintaining consistent efficacy and reducing the dose of the drugs and their related side effects. Transdermal drug delivery represents one of the most rapidly advancing areas of novel drug delivery. The excellent impervious nature of the skin is the greatest challenge that must be overcome for successful drug delivery. Today, polymers have been proven to be successful for long-term drug delivery applications as no single polymer can satisfy all of the requirements. Biopolymers in the field of dermal application are rare and the mechanisms that affect skin absorption are almost unknown. Biopolymers are widely used as drug delivery systems, but as such the use of biopolymers as drug delivery systems in dermatologic therapy is still in progress. Commonly used biopolymers include hydrocolloids, alginates, hydrogels, polyurethane, collagen, poly(lactic-co-glycolic acid), chitosan, proteins and peptides, pectin, siRNAs, and hyaluronic acid. These new and exciting methods for drug delivery are already increasing the number and quality of dermal and transdermal therapies. This article reviews current research on biopolymers and focuses on their potential as drug carriers, particularly in relation to the dermatologic aspects of their use.
Hetzel, Fred W.; Chen, Qun; Hoskins, Greg
High powered lasers have been used in dermatological procedures such as tattoo removal. This use is associated with a potential, biological hazard of high speed tissue particles from the laser field. It has been proposed that by applying a clear dermatological would dressing directly over the laser treatment site, it may be possible to completely trap the potentially airborne tissue particles from the procedure. Some important questions must be addressed prior to the implementation of such a technique. While the use of a wound dressing may significantly reduce the airborne materials during the laser procedures, new problems may arise: 1 . The wound dressing or some of its components may absorb excessive amount of light energy. This would result in a very localized temperature rise which may be harmful to the patient; 2. The smooth surface of the wound dressing material could induce specular reflection of the incident laser beam, thus introducing a laser hazard to the staff and patient. To address these possible problems, we studied a series of ClearSite Wound Dressings which have been reportedly tested for such laser procedures. The objective of the studies were, to determine if the use of ClearSite in conjunction with laser procedures poses a possible hazard to either the patient or to the Operating Room personnel, and to determine the effect of the ClearSite dressing on the optical characteristics of the light beam. The latter includes light absorption and transmittance for various wavelengths.
Dreno, B; Araviiskaia, E; Berardesca, E; Bieber, T; Hawk, J; Sanchez-Viera, M; Wolkenstein, P
Our increased knowledge of normal skin physiology has ushered in a subtle revolution in cosmetic science. Originally designed as preparations to enhance personal appearance by direct application on to the skin, cosmetics have now taken on a new role in dermatology, through the support of the management of many skin disorders. This evolving role of cosmetics in skin care is primarily due to scientific and technological advancements that have changed our understanding of normal skin physiology and how cosmetics modify its appearance both physically and biologically. The vast array of techniques currently available to investigate skin responsivity to multiple stimuli has brought about a new era in cosmetic and dermocosmetic development based on a robust understanding of skin physiology and its varied responses to commonly encountered environmental insults. Most cosmetic research is undertaken on reconstructed skin models crucial in dermatological research, given the strict ban imposed by the European Union on animal testing. In addition, the design and conduct of trials evaluating cosmetics now follow rules comparable to those used in the development and evaluation of pharmaceutical products. Cosmetic research should now aim to ensure all trials adhere to strictly reproducible and scientifically sound methodologies. The objective of this review is to provide an overview of the multidisciplinary scientific approach used in formulating dermocosmetics, and to examine the major advances in dermocosmetic development and assessment, the safety and regulatory guidelines governing their production and the exciting future outlook for these dermocosmetic processes following good practice rules.
After almost 25 years of dictatorship and civil war, in the mid 1990s, Cambodia was in dire need of improvement of its medical infrastructure on all levels. Attention had already been focused on establishing primary care services such as emergency surgery, paediatrics and gynaecology/obstetrics; however dermatovenereology services had so far not been addressed. Using a comprehensive approach aiming at sustainable development, German, French and Cambodian institutions worked together to identify four core areas in need of improvement: postgraduate training, development of skin clinics, quality management, and integration of dermatology services into the health insurance scheme. Since 2005, this "Masterplan Dermatology" was financially supported by the Centre for International Migration and Development (CIM) based in Frankfurt am Main and Else Kröner Fresenius-Stiftung (EKFS) based in Bad Homburg auf der Höhe. Significant improvements have been made due to the efforts of the above institutions with the support of the donors; however challenges of this complex endeavor still remain.
Pehr, K; Forsey, R R
OBJECTIVE: To review the possible uses of topical and systemic tocopherols as therapy for skin conditions in light of the widespread use of vitamin E by patients. DATA SOURCES: Index Medicus was searched for articles published from 1922 (when vitamin E was discovered) to 1966 (the beginning of MEDLINE). MEDLINE was searched for articles in English and French on vitamin E or tocopherol in relation to dermatology. Additional original articles were identified from the reference lists of the review articles. STUDY SELECTION: Only well-designed controlled studies were accepted; anecdotes and open studies are cited for completeness and as direction for future research. DATA SYNTHESIS: There was some weak or conflicting evidence that vitamin E is of value in yellow nail syndrome, vibration disease, epidermolysis bullosa, cancer prevention, claudication, cutaneous ulcers, and collagen synthesis and wound healing. It was of no use in atopic dermatitis, dermatitis herpetiformis, psoriasis, subcorneal pustular dermatosis, porphyrias and skin damage induced by ultraviolet light. CONCLUSIONS: After 44 years of research there is still scant proof of vitamin E's effectiveness in treating certain dermatologic conditions. Further research in well-designed controlled trials is needed to clarify vitamin E's role. PMID:8221479
In the civilian dermatological setting, the top 5 skin diseases usually seen are eczema/dermatitis, acne, benign skin tumors, viral infections and pigmentary disorders. In comparison, the top 5 skin conditions encountered in the military sector are usually fungal infections, eczema/dermatitis, insect bite reactions, bacterial infections and acne. This is not surprising as military personnel, due to the special environment and vocations they are in, are prone to getting eczema as heat, sweating and wearing of the military uniform aggravate the condition. Fungal infections are common in those who wear the army boots. Insect bite reactions are not an uncommon sight among those who have to go to the jungle regularly for outfield training. Grass allergy or intolerance, contact dermatitis or acneiform eruption due to the application of military camouflage cream on the face, contact dermatitis to insect repellents, and military uniform allergy and intolerance are amongst the commonest dermatological problems encountered in the military field, and physicians should recognize them, investigate and manage these problems accordingly. Lastly, a diagnosis not to be missed in the military field is cutaneous melioidosis, especially when a military personnel presents with a non-healing ulcer.
In the civilian dermatological setting, the top 5 skin diseases usually seen are eczema/dermatitis, acne, benign skin tumors, viral infections and pigmentary disorders. In comparison, the top 5 skin conditions encountered in the military sector are usually fungal infections, eczema/dermatitis, insect bite reactions, bacterial infections and acne. This is not surprising as military personnel, due to the special environment and vocations they are in, are prone to getting eczema as heat, sweating and wearing of the military uniform aggravate the condition. Fungal infections are common in those who wear the army boots. Insect bite reactions are not an uncommon sight among those who have to go to the jungle regularly for outfield training. Grass allergy or intolerance, contact dermatitis or acneiform eruption due to the application of military camouflage cream on the face, contact dermatitis to insect repellents, and military uniform allergy and intolerance are amongst the commonest dermatological problems encountered in the military field, and physicians should recognize them, investigate and manage these problems accordingly. Lastly, a diagnosis not to be missed in the military field is cutaneous melioidosis, especially when a military personnel presents with a non-healing ulcer. PMID:24340268
Prohic, Asja; Jovovic Sadikovic, Tamara; Krupalija-Fazlic, Mersiha; Kuskunovic-Vlahovljak, Suada
The genus Malassezia comprises lipophilic species, the natural habitat of which is the skin of humans and other warm-blooded animals. However, these species have been associated with a diversity of dermatological disorders and even systemic infections. Pityriasis versicolor is the only cutaneous disease etiologically connected to Malassezia yeasts. In the other dermatoses, such as Malassezia folliculitis, seborrheic dermatitis, atopic dermatitis, and psoriasis, these yeasts have been suggested to play pathogenic roles either as direct agents of infection or as trigger factors because there is no evidence that the organisms invade the skin. Malassezia yeasts have been classified into at least 14 species, of which eight have been isolated from human skin, including Malassezia furfur, Malassezia pachydermatis, Malassezia sympodialis, Malassezia slooffiae, Malassezia globosa, Malassezia obtusa, Malassezia restricta, Malassezia dermatis, Malassezia japonica, and Malassezia yamatoensis. Distributions of Malassezia species in the healthy body and in skin diseases have been investigated using culture-based and molecular techniques, and variable results have been reported from different geographical regions. This article reviews and discusses the latest available data on the pathogenicity of Malassezia spp., their distributions in dermatological conditions and in healthy skin, discrepancies in the two methods of identification, and the susceptibility of Malassezia spp. to antifungals.
Landis, Erin T.; Davis, Scott A.; Taylor, Sarah
Abstract Background: Complementary and alternative medicine (CAM) has an increasing presence in dermatology. Complementary therapies have been studied in many skin diseases, including atopic dermatitis and psoriasis. Objectives: This study sought to assess oral CAM use in dermatology relative to medicine as a whole in the United States, using the National Ambulatory Medical Care Survey. Design: Variables studied include patient demographic characteristics, diagnoses, and CAM documented at the visits. A brief literature review of the top 5 CAM treatments unique to dermatology visits was performed. Results: Most CAM users in both dermatology and medicine as a whole were female and white and were insured with private insurance or Medicare. Fish oil, glucosamine, glucosamine chondroitin, and omega-3 were the most common complementary supplements used in both samples. Conclusions: CAM use in dermatology appears to be part of a larger trend in medicine. Knowledge of common complementary therapies can help dermatologists navigate this expanding field. PMID:24517329
Bhatia, Anuradha; Kanish, Bimal; Chaudhary, Paulina Rose; Samuel, Clarence James
Introduction The importance of dermatology inpatient consultation is of significant importance yet is not well documented. Aim To retrospectively analyse the spectrum of dermatology inpatient consultations from the various departments and to document the most commonly occurring dermatological disorders from each speciality. Materials and Methods This study was done in an 800 bedded premier teaching hospital in Ludhiana, Punjab, North Western India. It was an audit of inpatient referrals to the dermatology department from January 2014 to August 2014. We analysed the spectrum of dermatological disorders in relation to the various specialities, demographic profile and age groups. Statistical Analysis The data was entered in Microsoft Excel and analysed using SPSS Version 21. Descriptive statistics, frequency and proportions were used. Results Of the 559 in-patients, 60% were males. The majority of the patients belonged to age group 51-60 years (25.9%). The departments most commonly requesting for dermatology consultations were Medicine (27.7%), Neurology (9.7%), Cardiology (8.8%), Urology (7%), Haematology (6.4%), Nephrology (6.1%), Intensive Care Unit (ICU) (5.4%), General Surgery (5.2%), Orthopaedics (5%), Gynaecology and Neurosurgery (2.9%) and Paediatrics (2.7%). The commonest dermatological diagnoses for which consultations were sought were eczematous dermatitis (12.9%), superficial dermatophytosis (12.3%), drug reactions (8.9%) and viral skin infections (8.5%). Conclusion Dermatology consultations offer a significant role in diagnosis and management of the in-patients from various clinical speciality departments. There is a significant need of inter-departmental dermatology consultations which help to decrease morbidity and improve the quality of the patient’s hospital stay. Knowledge about the pattern of dermatoses in the inpatients can help the primary clinician to recognize when to seek dermatology consultation on a priority basis. PMID:28208985
Moreno-Ramírez, David; Ferrándiz, Lara; Ramírez-Soto, Gabriel; Muñoyerro, M Dolores
Introducción: La existencia de variabilidad en el gasto farmacéutico ajustado entre unidades asistenciales plantea la posibilidad de dificultades en el acceso a determinadas opciones terapéuticas, así como un posible gasto farmacéutico evitable. Sin embargo, los análisis de variabilidad de la práctica clínica no incorporan en general el gasto farmacéutico como medida de resultado. Objetivo: Identificar y cuantificar la variabilidad en cuanto al gasto farmacéutico de unidades de Dermatología comparables del Servicio Andaluz de Salud. Métodos: Análisis comparativo del gasto farmacéutico de 18 unidades de Dermatología del Servicio Andaluz de Salud, ajustado a población y producción asistencial. Los datos sobre resultados de contabilidad y producción asistencial (unidades de producción homogénea -UPH-) fueron proporcionadas por Inforcoan, sistema de información de contabilidad analítica del Servicio Andaluz de Salud. Resultados: La ratio de gasto farmacéutico observada fue de 0,97 ?/hab-8,90 ?/hab y de 208,45 ?/UPH-1.471,95 ?/UPH. El coeficiente de correlación de Pearson entre el gasto farmacéutico y la población fue de 0,25 y de 0,35 para el gasto farmacéutico y la producción homogénea (p=0,32 y p=0,15) respectivamente, ambos indicando la ausencia de correlación y existencia de variabilidad. Conclusión: El análisis cuantitativo de variabilidad realizado mediante correlación de Pearson ha permitido confirmar y cuantificar la variabilidad existente en cuanto al gasto farmacéutico en unidades de Dermatología comparables.
Sánchez-Martínez, M A; Garcia-Planella, E; Laiz, A; Puig, L
Inflammatory bowel disease (IBD) is a complex entity that includes Crohn disease and ulcerative colitis. It is characterized by a chronic proinflammatory state of varying intensity that often leads to considerable morbidity. In the last decade, several therapeutic targets have been identified that are susceptible to the use of biological agents, including anti-tumor necrosis factor alpha antibodies, which are associated with paradoxical psoriasiform reactions in 5% of patients. Decision-making in the management of these cases requires close collaboration between the dermatologist and gastroenterologist. Inflammatory bowel disease is also associated with various other dermatologic and rheumatologic manifestations, and presents a genetic and pathogenic association with psoriasis that justifies both the interdisciplinary approach to these patients and the present review.
Vidal Magalhães, Wagner; Gouveia Nogueira, Marcelo Fábio; Kaneko, Telma Mary
In recent years, several studies have demonstrated the protective effect of Heat Shock Proteins (HSP) on different organs and tissues under stressful conditions. However, most research explores the performance of those molecular chaperones during immune responses or pathological conditions like cancer, whereas the number of studies related to the performance of HSPs in the skin during diverse natural or physiopathological conditions is very low. Therefore, the aim of this article was to summarize the main concepts concerning the expression and performance of HSPs, from analysis of current medicine and cosmetics publications, as well as exploring the importance of these proteins in the dermatological area in physiological events such as cutaneous aging, skin cancer and wound healing and to present final considerations related to biotechnology performance in this area.
Hoffmann, Jochen H O; Enk, Alexander H
Neutrophil, or polymorphonuclear granulocytes (PMN) constitute the most abundant type of leucocytes in peripheral human blood. One of the major advances in the last decade was the discovery of neutrophil extracellular trap (NET) formation: a process by which neutrophils externalize web-like chromatin strands decorated with antimicrobial peptides. These structures were soon implicated in immune defense and auto-immunity alike and now link neutrophils to the pathogenesis of a variety of diseases of dermatological relevance. Currently, NET formation is mainly subdivided into suicidal and vital NETosis. Controversy exists regarding the capacity of NETs to kill pathogens, and little is known about the way NETs are formed in vivo. Here, we discuss the current terminology, methods for NET quantification, pathways leading to NET formation, and the role of NETs in systemic and cutaneous immune defense and auto-immunity, with a focus on psoriasis and systemic lupus erythematosus.
Kovalik, Marcel; Thoday, Keith L; van den Broek, Adri H M
Ciclosporin A (CsA) has potent immunosuppressive and immunomodulatory activity that has been exploited in human medicine to prevent the rejection of transplanted organs and to manage atopic dermatitis and psoriasis. Over the past decade, CsA has been employed more frequently in veterinary dermatology and its value in the management of several canine and feline dermatoses is now well established. CsA inhibits calcineurin phosphatase, suppressing T cell activation and the synthesis of T cell cytokines consequently impairing the activity of B cells, antigen-presenting cells, mast cells, basophils and eosinophils. The pharmacokinetics of CsA are similar in humans, dogs and cats and the drug has a wide safety margin in dogs, cats and rabbits. Adverse effects, principally transient vomiting and soft faeces/diarrhoea, may be seen shortly after instituting treatment but often resolve despite continuing treatment. Gingival hyperplasia and cutaneous effects such as hirsutism may occur after prolonged treatment.
Burstein Alva, Zuño
This article pays tribute to three Peruvian medical personalities: José Neyra Ramirez (1929-2012), Abelardo Tejada (1931-2013) and Oscar Romero Rivas (1929-2011), highlighting their valuable contributions to the field of Tropical Dermatology and Health Medicine that benefited public health and Peruvian medical education. The article mentions the formation of a group of young researchers called The Anacoretas, including professors Hugo Pesce, Enrique Encinas, Juan Francisco Valegas in Lima; and Enerst Nausk and Victor Manchego in Germany, who, with the support of the Peruvian and German governments promoted and created the first university research center of Tropical Medicine on the Pacific Coast of Latin America called Daniel A. Carrion Tropical Medicine Institute at Universidad Nacional Mayor de San Marcos in Lima (TMI/UNMSM).
Baran, Utku; Choi, Woo June; Wang, Ruikang K.
Optical coherence tomography (OCT) is a popular imaging technique used in ophthalmology, and on the way to become clinically viable alternative in dermatology due to its capability of acquiring histopathology level images of in vivo tissue, noninvasively. In this study, we demonstrate the capabilities of OCT-based angiography (OMAG) in detecting high-resolution, volumetric structural and microvascular features of in vivo human skin with various conditions using a swept source OCT system that operates on a central wavelength of 1310 nm with an A-line rate of 100 kHz. OMAG images provide detailed in vivo visualization of microvasculature of abnormal human skin conditions from face, chest and belly. Moreover, the progress of wound healing on human skin from arm is monitored during longitudinal wound healing process. The presented results promise the clinical use of OCT angiography in treatment of prevalent cutaneous diseases within human skin, in vivo.
Bove, Domenico; Lupoli, Amalia; Caccavale, Stefano; Piccolo, Vincenzo; Ruocco, Eleonora
Summary Some syndromes are of interest to both neurologists and dermatologists, because cutaneous involvement may harbinger symptoms of a neurological disease. The aim of this review is to clarify this aspect. The skin, because of its relationships with the peripheral sensory nervous system, autonomic nervous system and central nervous system, constitutes a neuroimmunoendocrine organ. The skin contains numerous neuropeptides released from sensory nerves. Neuropeptides play a precise role in cutaneous physiology and pathophysiology, and in certain skin diseases. A complex dysregulation of neuropeptides is a feature of some diseases of both dermatological and neurological interest (e.g. cutaneous and nerve lesions following herpes zoster infection, cutaneous manifestations of carpal tunnel syndrome, trigeminal trophic syndrome). Dermatologists need to know when a patient should be referred to a neurologist and should consider this option in those presenting with syndromes of unclear etiology. PMID:24125557
Gurjarpadhye, Abhijit Achyut; Parekh, Mansi Bharat; Dubnika, Arita; Rajadas, Jayakumar; Inayathullah, Mohammed
Infrared (IR) imaging is a collection of non-invasive imaging techniques that utilize the IR domain of the electromagnetic spectrum for tissue assessment. A subset of these techniques construct images using back-reflected light, while other techniques rely on detection of IR radiation emitted by the tissue as a result of its temperature. Modern IR detectors sense thermal emissions and produce a heat map of surface temperature distribution in tissues. Thus, the IR spectrum offers a variety of imaging applications particularly useful in clinical diagnostic area, ranging from high-resolution, depth-resolved visualization of tissue to temperature variation assessment. These techniques have been helpful in the diagnosis of many medical conditions including skin/breast cancer, arthritis, allergy, burns, and others. In this review, we discuss current roles of IR-imaging techniques for diagnostic applications in dermatology with an emphasis on skin cancer, allergies, blisters, burns and wounds.
Ducharme, Erin E; Silverberg, Nanette B
The pediatric dermatologist is equipped with several diagnostic and therapeutic tools that can be used in the office. The Wood's lamp, introduced nearly a century ago, continues to be a safe, noninvasive diagnostic tool used today for diagnosing cutaneous infections, pigmentary disorders, and porphyrias. The pulsed dye laser is the treatment of choice for vascular lesions and has an expanding list of other applications, such as warts, which are extremely common in the pediatric population. Dermoscopy has emerged as an effective adjunctive tool in the in vivo examination of pigmented skin lesions and early diagnosis of cutaneous malignant melanoma. Other uses are also being explored including diagnosis of scabies. Future directions of technology in the pediatric dermatology office include implementation of electronic medical record systems and treatment of conditions such as molluscum, warts, and acne vulgaris with photodynamic therapy.
Azar, Zion; Bank, Alexander; Donskoy, Dmitri M.; Nechitailo, Vladimir S.
The Q-switched Nd:YAG laser is the most recent in a series of pulsed laser systems for plastic surgery. The 532 nm wavelength has been shown to be absorbed by a variety of chromophores. These include tattoo pigments, oxygenated hemoglobin and melanin-containing epidermal cells. A simple multi-line solid state laser module pumped by double-frequency Q- switched YAG laser is presented. This solid state multi-line module enables tuning of the wavelength in the yellow spectral range to 560 nm or to 580 nm for dermatology applications. Conversion efficiency in excess of 70% was achieved at 10 Hz pulse repetition frequency and output energy per pulse of approximately 200 mJ.
Ruocco, E; Brunetti, G; Del Vecchio, M; Ruocco, V
Exfoliative cytology for diagnostic purposes is rarely used in Dermatology despite the rapid and reliable results which this procedure can offer in many clinical conditions. This simple procedure may prove advantageous in a wide range of skin diseases, including genodermatoses (Hailey-Hailey disease), infections (mainly herpetic infections, molluscum contagiosum, leishmaniasis), immune disorders (early oral pemphigus) and tumours (basal and squamous cell carcinomas, Paget disease, erythroplasia of Queyrat, and others). The specific circumstances where cytological examination provides a very helpful and practical aid to confirmation or exclusion of a clinically suspected diagnosis are briefly reviewed. Cytological patterns, along with some technical hints on how to take and stain Tzanck smears correctly, are described in connection with the diseases considered.
Hari, Aswin; Flach, Tracy L.; Shi, Yan; Mydlarski, P. Régine
Toll-like receptors (TLRs) are a class of conserved receptors that recognize pathogen-associated molecular patterns (PAMPs) present in microbes. In humans, at least ten TLRs have been identified, and their recognition targets range from bacterial endotoxins to lipopeptides, DNA, dsRNA, ssRNA, fungal products, and several host factors. Of dermatological interest, these receptors are expressed on several skin cells including keratinocytes, melanocytes, and Langerhans cells. TLRs are essential in identifying microbial products and are known to link the innate and adaptive immune systems. Over the years, there have been significant advances in our understanding of TLRs in skin inflammation, cutaneous malignancies, and defence mechanisms. In this paper, we will describe the association between TLRs and various skin pathologies and discuss proposed TLR therapeutics. PMID:20847936
Clark, Charlotte M; Rudolph, Jennifer; Gerber, Donald A; Glick, Sharon; Shalita, Alan R; Lowenstein, Eve J
Several studies have described a wide spectrum of hyperandrogenism diseases, many of which are difficult to distinguish from each other. In order to better understand diseases of hyperandrogenism, the authors performed a retrospective study of the cutaneous features and metabolic findings in women with hyperandrogenism. A retrospective chart analysis compiled by three dermatologists in both academic and private settings was performed, including patients presenting with > or = 2 manifestations of hyperandrogenism. Relevant dermatologic and associated manifestations and laboratory and imaging study findings were reviewed. Moderate to severe acne was the most common manifestation. Other common manifestations that patients first presented with include hirsutism, acanthosis nigricans, androgenic alopecia, and skin tags. Oligomenorrhea was the most common systemic presenting sign. Statistical analysis of various clinical markers revealed correlations with hyperandrogenemia. Acanthosis nigricans and hirsutism were found to be useful clinical markers for hyperandrogenism, whereas androgenic alopecia was not. This study provides some insights into the presentation and diverse manifestations seen in hyperandrogenism.
Darlenski, Razvigor; Fluhr, Joachim W.
Photodynamic therapy (PDT) is a noninvasive therapeutic method first introduced in the field of dermatology. It is mainly used for the treatment of precancerous and superficial malignant skin tumors. Today PDT finds new applications not only for nononcologic dermatoses but also in the field of other medical specialties such as otorhinolaryngology, ophthalmology, neurology, gastroenterology, and urology. We are witnessing a broadening of the spectrum of skin diseases that are treated by PDT. Since its introduction, PDT protocol has evolved significantly in terms of increasing method efficacy and patient safety. In this era of evidence-based medicine, it is expected that much effort will be put into creating a worldwide accepted consensus on PDT. A review on the current knowledge of PDT is given, and the historical basis of the method's evolution since its introduction in the 1900s is presented. At the end, future challenges of PDT are focused on discussing gaps that exist for research in the field.
Borroni, Riccardo G
Different individuals may respond diversely to the same drug, in terms of efficacy and toxicity. Adverse drug reactions cause about 6% of all hospital admissions and account for up to 9% of hospitalization costs. Drug-induced skin injury (DISI) is the most common presentation of adverse drug reactions, ranging from maculopapular eruptions to severe adverse cutaneous drug reactions (SCARs) with mortality of up to 40%. Specific genetic polymorphisms confer susceptibility to different types of DISI. Identifying patients genetically at risk for SCARs is one of the goals of pharmacogenomics. In this article, the aspects of clinical dermatology relevant to the pharmacogenetics of DISI are reviewed. Many SCARs are now preventable, with consequent reduction of morbidity, mortality and healthcare costs.
Gurjarpadhye, Abhijit Achyut; Parekh, Mansi Bharat; Dubnika, Arita; Rajadas, Jayakumar; Inayathullah, Mohammed
Infrared (IR) imaging is a collection of non-invasive imaging techniques that utilize the IR domain of the electromagnetic spectrum for tissue assessment. A subset of these techniques construct images using back-reflected light, while other techniques rely on detection of IR radiation emitted by the tissue as a result of its temperature. Modern IR detectors sense thermal emissions and produce a heat map of surface temperature distribution in tissues. Thus, the IR spectrum offers a variety of imaging applications particularly useful in clinical diagnostic area, ranging from high-resolution, depth-resolved visualization of tissue to temperature variation assessment. These techniques have been helpful in the diagnosis of many medical conditions including skin/breast cancer, arthritis, allergy, burns, and others. In this review, we discuss current roles of IR-imaging techniques for diagnostic applications in dermatology with an emphasis on skin cancer, allergies, blisters, burns and wounds. PMID:26691203
Clark, A R; Monroe, J R; Feldman, S R; Fleischer, A B; Hauser, D A; Hinds, M A
The NAMCS provides a wealth of information on use of PAs in all practices, including dermatology. Two important points regarding the NAMCS and SDPA data are addressed here: the number of visits to PAs for dermatologic symptoms and the expected growth of PA use in dermatologists' offices. Dermatologic symptoms were evaluated frequently by PAs, accounting for 14% of PA visits. These statistics do not address the number of referrals those PAs made to dermatologists. Perhaps PAs as a group should be targeted for increased dermatologic education, particularly stressing the need for appropriate referral to a dermatologist. PAs could increase the number of dermatology referrals from primary care offices with improved understanding of the importance of the dermatologist in the management of patients' overall skin health. At projected growth rates, the number of PAs employed by dermatologists should exceed 500 by the end of 2000. Most of this growth has been in private practices and rarely in HMOs or in large multispecialty clinics. There are a number of reasons for this growth, as follows: A PA may help reduce the patient load on the dermatologist, especially with sameday appointments and drop-ins. Some dermatologists are moving away from clinical dermatology into cosmetics, which not only leaves a vacuum in clinical dermatology, but also creates job opportunities for PAs in cosmetic dermatology. Regarding managed care growth, PAs can have a positive impact on the problem of having to see more patients for less money. PAs are cost-effective. In the 1998 SDPA survey, the ratio of billings generated (production) to gross income for the average dermatology PA ranged from 3:1 to 6:1. Even with inexperienced PAs new to dermatology, this ratio was usually at least 2:1 at the end of the first year. PAs can cover satellite offices, allowing for practice expansion. Effective with the new Medicare laws of January 1, 1998, PAs can now see new Medicare patients or Medicare patients
Mohd Nizam, Tzar; Binting, Rabiatul Adawiyah AG.; Mohd Saari, Shafika; Kumar, Thivyananthini Vijaya; Muhammad, Marianayati; Satim, Hartini; Yusoff, Hamidah; Santhanam, Jacinta
Background This study aimed to determine the minimum inhibitory concentrations (MICs) of various antifungal agents against moulds isolated from dermatological specimens. Methods We identified 29 moulds from dermatological specimens between October 2012 and March 2013 by conventional methods. We performed antifungal susceptibility testing on six antifungal agents, amphotericin B, clotrimazole, itraconazole, ketoconazole, miconazole and terbinafine, according to the Clinical and Laboratory Standards Institute guidelines contained in the M38-A2 document. Results Most antifungal agents were active against the dermatophytes, except for terbinafine against Trichophyton rubrum (geometric mean MIC, MICGM 3.17 μg/mL). The dematiaceous moulds were relatively susceptible to amphotericin B and azoles (MICGM 0.17–0.34 μg/mL), but not to terbinafine (MICGM 3.62 μg/mL). Septate hyaline moulds showed variable results between the relatively more susceptible Aspergillus spp. (MICGM 0.25–4 μg/mL) and the more resistant Fusarium spp. (MICGM 5.66–32 μg/mL). The zygomycetes were susceptible to amphotericin B (MICGM 0.5 μg/mL) and clotrimazole (MICGM 0.08 μg/mL), but not to other azoles (MICGM 2.52–4 μg/mL). Conclusion Amphotericin B and clotrimazole were the most effective antifungal agents against all moulds excepting Fusarium spp., while terbinafine was useful against dermatophytes (except T. rubrum) and Aspergillus spp. However, a larger study is required to draw more solid conclusions. PMID:27418867
Thapa, D P; Jha, A K; Kharel, C; Shrestha, S
Geriatric health care has become a major issue worldwide. There are no data regarding geriatric dermatologic diseases are available from Nepal. Patients of 60 years and above were enrolled in the Nepali fiscal year 2067(April 2010-April 2011). The data included age, sex, place, and diagnosis. The aim of the study is to determine the characteristic pattern and frequency of dermatoses in dermatologic patients aged 60 years and above. There were total of 6442 patients who visited out patients department. Out of which frequency of geriatric patients were 330, which constitute about 5.1%. The male to female ratio was 50% each. The most common cutaneous dermatoses was eczema 35.8%, fungal infection 13.6%, viral infection 7%, followed by pruritus 7.3%, scabies and photodermatitis 4.5% each, Inflammatory papulosquamous disorder 3.3%, Bacterial infection and Icthyosis 2.1% each, vesiculobullous 1.8%, tumors and pigmentary disorder 0.6% and Miscellaneous group (keratoderma, callus, urticaria, diabetic ulcer, burgers disease, burning feet syndrome, Rosacea, Drug rash-amoxicillin, senile acne, prurigo nodularis, hansens disease, pellagra, Actinic cheilitis) 15.8%. Few patients had more than one dermatoses which constitute < 1% .Photodermatitis was found to be statistically significant. The most common dermatoses were Eczema in females followed by Photodermatitis and comparatively in males viral and fungal infections were common. This study depicts various characteristic patterns of dermatoses seen in elderly. Eczema and infections was found to be most common diseases seen in elderly. Further epidemiologic studies including treatment, follow-up of elderly patients has to be carried out to know the burden of the disease and decrease morbidity and psychological concern associated with diseases.
Reuter, Juliane; Merfort, Irmgard; Schempp, Christoph M
Botanical extracts and single compounds are increasingly used in cosmetics but also in over-the-counter drugs and food supplements. The focus of the present review is on controlled clinical trials with botanicals in the treatment of acne, inflammatory skin diseases, skin infections, UV-induced skin damage, skin cancer, alopecia, vitiligo, and wounds. Studies with botanical cosmetics and drugs are discussed, as well as studies with botanical food supplements. Experimental research on botanicals was considered to a limited extent when it seemed promising for clinical use in the near future. In acne therapy, Mahonia, tea tree oil, and Saccharomyces may have the potential to become standard treatments. Mahonia, Hypericum, Glycyrrhiza and some traditional Chinese medicines appear promising for atopic dermatitis. Some plant-derived substances like dithranol and methoxsalen (8-methoxypsoralen) [in combination with UVA] are already accepted as standard treatments in psoriasis; Mahonia and Capsicum (capsaicin) are the next candidates suggested by present evidence. Oral administration and topical application of antioxidant plant extracts (green and black tea, carotenoids, coffee, and many flavonoids from fruits and vegetables) can protect skin from UV-induced erythema, early aging, and irradiation-induced cancer. Hair loss and vitiligo are also traditional fields of application for botanicals. According to the number and quality of clinical trials with botanicals, the best evidence exists for the treatment of inflammatory skin diseases, i.e. atopic dermatitis and psoriasis. However, many more controlled clinical studies are needed to determine the efficacy and risks of plant-derived products in dermatology. Safety aspects, especially related to sensitization and photodermatitis, have to be taken into account. Therefore, clinicians should not only be informed of the beneficial effects but also the specific adverse effects of botanicals used for dermatologic disorders and
Storan, Eoin R; McEvoy, Marian T; Wetter, David A; el-Azhary, Rokea A; Hand, Jennifer L; Davis, Dawn M R; Bridges, Alina G; Camilleri, Michael J; Davis, Mark D P
Data describing the management of pediatric patients admitted to a hospital under the care of a dermatologist and dermatology hospital consults for pediatric inpatients are limited. We aim to describe the role of an inpatient hospital service jointly run by dermatology and pediatrics and the activities of a pediatric dermatology hospital consult service. We retrospectively identified pediatric (age < 18 yrs) dermatology inpatients and hospital consult patients from January 1, 2009, through December 31, 2010. We examined patient demographics, indications for admission, length of stay, treatment provided, consult-requesting service, and consult diagnosis. One hundred eight admissions were by a dermatologist. The mean age was 5.8 years; the median length of stay was 3 days. Indications for admission included atopic dermatitis (86.1%), psoriasis (3.7%), and eczema herpeticum (2.8%). The main treatment provided was wet dressings (97.2%). Eighty-three dermatology hospital consults were requested. The mean age was 7.4 years. The main indications for dermatology consultation included drug rash (12.1%), cutaneous infections (12.1%), contact dermatitis (9.6%), psoriasis (8.4%), atopic dermatitis (6.0%), and hemangiomas (6.0%). This study describes the utility of the hospital pediatric dermatology inpatient and consult services in treating patients with severe skin disease.
Boixeda, P; Feltes, F; Santiago, J L; Paoli, J
We review novel technologies with diagnostic and therapeutic applications in dermatology. Among the diagnostic techniques that promise to become part of dermatologic practice in the future are optical coherence tomography, multiphoton laser scanning microscopy, Raman spectroscopy, thermography, and 7-T magnetic resonance imaging. Advances in therapy include novel light-based treatments, such as those applying lasers to new targets and in new wavelengths. Devices for home therapy are also appearing. We comment on the therapeutic uses of plasma, ultrasound, radiofrequency energy, total reflection amplification of spontaneous emission of radiation, light stimulation, and transepidermal drug delivery. Finally, we mention some basic developments in nanotechnology with prospects for future application in dermatology.
Skin diseases represent the greatest public health care problem in all developing countries. Tropical diseases tend to cluster in poor populations and often are defined as "neglected" because the investments made to combat them seem negligible compared with the massive amounts expended globally on the health problems of developed countries. After reviewing the worldwide situation, this article explains the principles of community dermatology and discusses the work of the San Gallicano Institute in Rome, which has developed a model for reducing the number of people suffering from dermatologic and other diseases and has established the first dermatologic hospital in Ethiopia.
Kaliyadan, Feroze; Khan, Abdul Sattar; Kuruvilla, Joel; Feroze, Kaberi
Many teaching centers have now adopted objective structured clinical examination (OSCE) as an assessment method for undergraduate dermatology courses. A modification of the standard OSCE in dermatology is computer based or electronic OSCE (eOSCE). We attempted to validate the use of a computer-based OSCE in dermatology in a group of fifth year medical students. The scores of the students in the computer-based OSCE showed a strong positive correlation with the scores on the clinical presentation (Pearson's co-efficient - 0.923, P value <0.000, significant at the 0.01 level) and a good correlation with overall scores of the student (Pearson's co-efficient - 0.728, P value <0.000, significant at the 0.01 level), indicating that this is a reliable method for assessment in dermatology. Generally, the students' feedback regarding the methods was positive.
Begic Fazlic, Lejla; Avdagic, Korana; Omanovic, Samir
This paper presents novel GA-ANFIS expert system prototype for dermatological disease detection by using dermatological features and diagnoses collected in real conditions. Nine dermatological features are used as inputs to classifiers that are based on Adaptive Neuro-Fuzzy Inference Systems (ANFIS) for the first level of fuzzy model optimization. After that, they are used as inputs in Genetic Algorithm (GA) for the second level of fuzzy model optimization within GA-ANFIS system. GA-ANFIS system performs optimization in two steps. Modelling and validation of the novel GA-ANFIS system approach is performed in MATLAB environment by using validation set of data. Some conclusions concerning the impacts of features on the detection of dermatological diseases were obtained through analysis of the GA-ANFIS. We compared GA-ANFIS and ANFIS results. The results confirmed that the proposed GA-ANFIS model achieved accuracy rates which are higher than the ones we got by ANFIS model.
Szabó, Csanád; Altmayer, Anita; Lien, Lars; Poot, Françoise; Gieler, Uwe; Tomas-Aragones, Lucía; Kupfer, Jörg; Jemec, Gregor B E; Misery, Laurent; Linder, M Dennis; Sampogna, Francesca; Middendorp, Henriët van; Halvorsen, Jon Anders; Balieva, Flora; Szepietowski, Jacek C; Romanov, Dmitry; Marron, Servando E; Altunay, Ilknur K; Finlay, Andrew Y; Salek, Sam S; Dalgard, Florence
Attachment styles of dermatological outpatients and satisfaction with their dermatologists were investigated within the framework of a multicentre study conducted in 13 European countries, organized by the European Society for Dermatology and Psychiatry. Attachment style was assessed with the Adult Attachment Scale. Patient satisfaction with the dermatologist was assessed with an 11-degree scale. A total of 3,635 adult outpatients and 1,359 controls participated in the study. Dermatological outpatients were less able to depend on others, were less comfortable with closeness and intimacy, and experienced similar rates of anxiety in relationships as did the controls. Participants who had secure attachment styles reported stressful life events during the last 6 months significantly less often than those who had insecure attachment styles. Patients with secure attachment styles tended to be more satisfied with their dermatologist than did insecure patients. These results suggest that secure attachment of dermatological outpatients may be a protective factor in the management of stress.
Rapid advances in use of technology and discovery of innovative therapeutic tips or clinically relevant epidemiological clues are discussed. Much of the literature-based review was drawn from somewhat non-traditional sources of dermatological information. PMID:28360972
Habre, Maya; Habre, Samer Bassilios; Kourie, Hampig R
Immune checkpoint inhibitors (ICI) represent a new revolutionary weapon in the armamentarium of anti-cancer therapies. The side effects of these new agents represent a new challenge for oncologists; they are usually unpredictable and sometimes life threatening, if not managed rapidly and adequately. The most frequent side effects are the dermatologic, but they are usually low grade side effects and consequently easily manageable. Rash, pruritus and vitiligo are the most frequent dermatologic side effects. We aimed in this review to describe first all the dermatologic side effects of ICI according to the subtype of ICI and combination therapies in the clinical trials, then to report all the rare case reports dermatologic side effects, and finally to present the management algorithm of these side effects.
Roberts, Wendy E
The proposed terminology Generational Dermatology encompasses prevention and involves medical, cosmetic, surgical and oncologic strategies over the decades to optimize skin performance throughout the course of a lifetime. Organ failure is the inability of the organ to perform its determined function as a part of normal physiology and it may be possible to take a Generational preventive approach toward reducing morbidities associated with the failure of our largest organ, the skin. Outside of skin cancer prevention efforts we have as a specialty primarily worked on the tertiary prevention realm. I advocate that we can increase our focus on the primary and secondary tiers where we as Dermatologists have the training and education to identify risk factors and detect early symptoms of skin disease. I appeal to the house of Dermatology to embrace this concept of Generational Dermatology as preventive medicine for the evolving aging patient. The practice of Generational Dermatology will decrease patient morbidity and bring down the cost of healthcare. Our global increased longevity increases the number of elderly worldwide. Longer lifespan means dermatologic needs will increase as the skin must perform its basic function longer. There are also new unknowns and skin issues which arise from large numbers of people in the 9th and 10th decades. Generational Dermatology is well suited to be a model for prevention as our patient's age and we can intervene at any decade. I believe the specialty will increasingly focus on how the skin can optimally perform for a longer period. Lastly, the practice of Generational Dermatology unifies the house of Dermatology as we need the innovations and input of every subspecialty to contribute to the health of the people we serve.
Choi, Jae Eun; Kim, Dai Hyun; Seo, Soo Hong; Kye, Young Chul
Background The rapid development of information and communication technology has replaced traditional books by electronic versions. Most print dermatology journals have been replaced with electronic journals (e-journals), which are readily used by clinicians and medical students. Objective The objectives of this study were to determine whether e-readers are appropriate for reading dermatology journals, to conduct an attitude study of both medical personnel and students, and to find a way of improving e-book use in the field of dermatology. Methods All articles in the Korean Journal of Dermatology published from January 2010 to December 2010 were utilized in this study. Dermatology house officers, student trainees in their fourth year of medical school, and interns at Korea University Medical Center participated in the study. After reading the articles with Kindle 2, their impressions and evaluations were recorded using a questionnaire with a 5-point Likert scale. Results The results demonstrated that gray-scale e-readers might not be suitable for reading dermatology journals, especially for case reports compared to the original articles. Only three of the thirty-one respondents preferred e-readers to printed papers. The most common suggestions from respondents to encourage usage of e-books in the field of dermatology were the introduction of a color display, followed by the use of a touch screen system, a cheaper price, and ready-to-print capabilities. Conclusion In conclusion, our study demonstrated that current e-readers might not be suitable for reading dermatology journals. However, they may be utilized in selected situations according to the type and topic of the papers. PMID:25473221
Williams, Hywel C
The need for understanding and reflecting on evidence-based dermatology (EBD) has never been greater given the exponential growth of new external evidence to inform clinical practice. Like any other branch of medicine, dermatologists need to acquire new skills in constructing answerable questions, efficiently searching electronic bibliographic databases, and critically appraising different types of studies. Secondary summaries of evidence in the form of systematic reviews (SR), that is, reviews that are conducted in a systematic, unbiased and explicit manner, reside at the top of the evidence hierarchy, because they are less prone to bias than traditional expert reviews. In addition to providing summaries of the best external evidence, systematic reviews and randomized controlled trials (RCTs) are also powerful ways of identifying research gaps and ultimately setting the agenda of future clinical research in dermatology. But like any paradigm, EBD can have its limitations. Wrong application, misuse and overuse of EBD can have serious consequences. For example, mindless pooling together of data from dissimilar studies in a meta-analysis may render it a form of reductionism that does not make any sense. Similarly, even highly protocolised study designs such as SRs and RCTs are still susceptible to some degree of dishonesty and bias. Over-reliance on randomized controlled trials (RCT) may be inappropriate, as RCTs are not a good source for picking up rare but important adverse effects such as lupus syndrome with minocycline. A common criticism leveled against SRs is that these frequently conclude that there is lack of sufficient evidence to inform current clinical practice, but arguably, such a perception is grounded more on the interpretation of the SRs than anything else. The apparent absence of evidence should not paralyze the dermatologist to adopt a state of therapeutic nihilism. Poor primary data and an SR based on evidence that is not up-to-date are also
Marmelzat, W L
We stop short, with Celsus, our glimpse of ancient dermatologic surgery in the West. As was stated at the beginning of the chapter, only a few examples and speculations are mentioned in this brief account. Much has gone unmentioned, including the contributions of great Eastern civilizations, such as ancient India, China, and Persia; the Bible; and the "ancient" inhabitants of the "new" world. We note especially the omission of the amazing ancient Hindu cosmetic operations that successfully employed rotating pedicle flaps in reconstructing amputated ears and noses. Important names before Celsus are missing from this account, especially the two Alexandrian physician-surgeons who flourished three centuries earlier--Herophilus (the Father of Anatomy) and Erasistratus (the Father of Physiology). Except for a few extant anatomic fragments, the works of Herophilus and Erasistratus are completely lost. We may with confidence, however, infer from the writings of Celsus and Galen that the brillant anatomy and physiology of the Alexandrian period made for good surgical diagnosis and practice. We must remember, too, that after Celsus' time, the slow disintergration of the Roman Empire took more than 500 years. This period of 500 years saw a number of important Roman physician-surgeons who contributed significantly with daring new operations and original surgical concepts and techniques: Heliodorus, Soranus, Rufus, Archigenes, Galen, Antyllus, Leonides, Oribasius, Aetius, Paulus, and others. The positive surgical contributions of these giants would be lost and rediscovered, many times.
Nino, Massimiliano; Calabrò, Gabriella; Santoianni, Pietro
To be effective an active drug or principle must cross the stratum corneum barrier; this process can be influenced to obtain better functional and therapeutical effects. In spite of the wide variety of the methods studied in order to improve the transdermal transfer to obtain systemic effects, the applicability is limited in this field. Attention to the epidermal barrier and penetration of active principles has been reported mostly in studies concerning dermocosmetics. Studies regarding methods of penetration are gaining experimental and clinical interest. Cutaneous bioavailability of most commercially available dermatological formulations is low. Increase of intradermal delivery can relate to chemical, biochemical, or physical manipulations. Chemical enhancers have been adopted to: (a) increase the diffusibility of the substance across the barrier; (b) increase product solubility in the vehicle; (c) improve the partition coefficient. Moreover methods of interference with the biosynthesis of some lipids allow the modification of the structure of the barrier to increase the penetration. The main physical techniques that increase cutaneous penetration of substances are: iontophoresis (that increases the penetration of ionized substances), electroporation (that electrically induces penetration through the barrier), and sonophoresis, based on 20 to 25 KHz ultrasound that induces alterations of the horny barrier, allowing penetration of active principles. Recent development of these methods are here reported and underline the importance and role of vehicles and other factors that determine effects of partition and diffusion, crucial to absorption.
Basavaraj, K H
Nanotechnology and nanomedicine are complementary disciplines aimed at the betterment of human life. Nanotechnology is an emerging branch of science for designing tools and devices of size 1–100 nm, with unique functions at the cellular, atomic and molecular levels. The concept of using nanotechnology in medical research and clinical practice is known as nanomedicine. Today, nanotechnology and nanoscience approaches to particle design and formulations are beginning to expand the market for many drugs and forming the basis for a highly profitable niche within the industry, but some predicted benefits are hyped. Under many conditions, dermal penetration of nanoparticles may be limited for consumer products such as sunscreens, although additional studies are needed on potential photooxidation products, experimental methods and the effect of skin condition on penetration. Today, zinc oxide and titanium dioxide nanoparticles (20–30 nm) are widely used in several topical skin care products such as sunscreens. Thus, in the present scenario, nanotechnology is spreading its wings to address the key problems in the field of medicine. The benefits of nanoparticles have been shown in several scientific fields, but very little is known about their potential to penetrate the skin. Hence, this review discusses in detail the applications of nanotechnology in medicine with more emphasis on the dermatologic aspects. PMID:22707765
Chadwick, R G; Traynor, N; Moseley, H; Gibbs, N
The setting reactions of a large number of dental materials are activated upon exposure to visible blue light emitted from a curing unit. Although the wavelength (lambda) from such devices is principally in the visible spectrum (lambda > 400 nm) a small amount of ultraviolet radiation (UV) is also present. Little attention has been paid to the consequences of such exposure upon the skin of dental surgeons' fingers. This investigation studied the level of UVA I (lambda = 340-400 nm) emitted by three commonly used polymerisation sources and assessed the level of protection afforded by six brands of surgical glove. The integrated irradiances of the Translux, Topaz T100 and Heliomat units in the UVA I range were 15861, 3611 and 305 mW/m2 respectively. For all gloves the mean % transmission, at lambda = 400 nm, was less than 4% with the exception of one brand where, in the stretched state, the level of transmission was 7%. It is concluded that the risk of initiating adverse dermatological consequences as a result of exposure to UVA I, emitted by light polymerisation units, is minimal in normal usage. The combined effects of exposure to radiation of this type and contamination of the fingers with quantities of irritant chemicals, such as found in many dental materials, are unknown. Due to the ability of the gloves to shield the skin from both chemicals and UVA I it is recommended that gloves are routinely worn for all light curing procedures.
Newman, Ben A.; Feldman, Fred F.
Part I of this report deals with the topical use of cortisone in a variety of skin diseases. Fifteen patients with chronic discoid lupus erythematosus, four patients with necrobiosis lipoidica diabeticorum, four with psoriasis, one with lichen planus and one with granuloma annulare were treated with cortisone ointment. All the patients with chronic discoid lupus erythematosus had some degree of improvement. In two patients with chronic lupus erythematosus, complete clearing of the eruption occurred. In four patients with necrobiosis lipoidica diabeticorum remarkable involution resulted. Patients with psoriasis, lichen planus and granuloma annulare were not benefited. Part II deals with the systemic use of cortisone. Eight patients with severe serum sickness-like penicillin reaction responded dramatically to parenterally administered cortisone. In two cases of pemphigus vulgaris and one case of Sulzberger-Garbe disease, the disease was kept in remission with cortisone administered intramuscularly as well as orally. Partial improvement resulted in a case of localized myxedema associated with malignant exophthalmus. Two patients with exfoliative dermatitis due to therapy with heavy metals responded dramatically to cortisone. No beneficial effects were noted in patients with chronic urticaria and atopic dermatitis. The systemic use of ACTH and cortisone in dermatology at present should be confined to patients with known fatal or hopelessly incapacitating diseases and to patients with extreme hypersensitivity reactions which may be protracted or life-endangering, and which can be controlled or cured with a relatively small total dosage of the agents in a short time. PMID:14886729
Zippi, Maddalena; Pica, Roberta; De Nitto, Daniela; Paoluzi, Paolo
Ulcerative colitis and Crohn's disease are the two forms of inflammatory bowel disease (IBD). The advent of biological drugs has significantly changed the management of these conditions. Skin manifestations are not uncommon in IBD. Among the reactive lesions (immune-mediated extraintestinal manifestations), erythema nodosum (EN) and pyoderma gangrenosum (PG) are the two major cutaneous ills associated with IBD, while psoriasis is the dermatological comorbidity disease observed more often. In particular, in the last few years, anti-tumor necrosis factor (TNF)-α agents have been successfully used to treat psoriasis, especially these kinds of lesions that may occur during the treatment with biological therapies. The entity of the paradoxical manifestations has been relatively under reported as most lesions are limited and a causal relationship with the treatment is often poorly understood. The reason for this apparent side-effect of the therapy still remains unclear. Although side effects may occur, their clinical benefits are undoubted. This article reviews the therapeutic effects of the two most widely used anti-TNF-α molecules, infliximab (a fusion protein dimer of the human TNF-α receptor) and adalimumab (a fully human monoclonal antibody to TNF-α), for the treatment of the major cutaneous manifestations associated with IBD (EN, PG and psoriasis).
Forslind, B.; Grundin, T.G.; Lindberg, M.; Roomans, G.M.; Werner, Y.
Electron microprobe and proton microprobe X-ray analysis can be used in several areas of dermatological research. With a proton probe, the distribution of trace elements in human hair can be determined. Electron microprobe analysis on freeze-dried cryosections of guinea-pig and human epidermis shows a marked gradient of Na, P and K over the stratum granulosum. In sections of freeze-substituted human skin this gradient is less steep. This difference is likely to be due to a decrease in water content of the epidermis towards the stratum corneum. Electron microprobe analysis of the epidermis can, for analysis of trace elements, be complemented by the proton microprobe. Quantitative agreement between the two techniques can be obtained by the use of a standard. Proton microprobe analysis was used to determine the distribution of Ni or Cr in human epidermis exposed to nickel or chromate ions. Possible differences in water content between the stratum corneum of patients with atopic eczema and normal stratum corneum was investigated in skin freeze-substituted with Br-doped resin. No significant differences were observed.
Zink, Alexander; Traidl-Hoffmann, Claudia
Green tea consumption has a long tradition in Asian countries--especially China. The epidemiologically and experimentally observed anticarcinogenic and antiinflammatory effects of green tea have led to the implementation of green tea extracts in multiple therapeutic applications - both in dermatological and cosmeceutical preparations. The most abundant evidence exists for the anticarcinogenic and chemopreventive effect of green tea or its major constituent epigallocatechin-3-gallate. Almost equally evident is the effect in infectious diseases such as cutaneous viral infections. For external genital warts, a topical ointment with green tea extracts was licensed in the USA in 2010, and recently also in Europe. Experimental evidence pinpointing the block of central signal transduction factors in inflammatory mechanisms has led to the evaluation of catechins in inflammatory disorders such as atopic dermatitis. The belief of green tea as a "wonder weapon" against diseases dates back thousands of years. According to a Chinese legend, ancient Emperor Shen Nung noted a delightful aroma after some leaves of a nearby tree had fallen into boiling water. He immediately proclaimed the new "drink" as "heaven-sent", starting the belief - persisting until today - of green tea as a medication from nature against many different diseases. This review summarizes biological effects and clinical implications of green tea.
The q-switched ruby laser has shown promising results in the treatment of blue and black tattoos. The red light of the ruby laser, 694 nm wavelength, selectively absorbed by dark pigments, is converted into heat and pigments are immediately vaporized. Energy levels range between 4, 5 and 12 J/cm2. Short exposure time does not exceed the thermal relaxation time of the target structures. Thus, thermal damage of the surrounding tissue is minimal. Not only exogenous pigment as tattoo ink but also physiological pigmented structures as melanocytes, melanosome loaden keratinocytes, and melanophages are affected by this type of laser application. Therefore the ruby laser represents a new option in the treatment of a variety of benign pigmented lesions in cosmetic dermatology. The benefit of this source can be seen in efficient clearing of the lesions without scarring. As a side effect transient hypopigmentation may occur. Ruby laser treatment of melanocytic lesions cannot be recommended because unpigmented nevus cells do not absorb red light and persist unaltered. They still bear the potency of further transformation, as into malignancy.
Rogues, A M; Lasheras, A; Amici, J M; Guillot, P; Beylot, C; Taïeb, A; Gachie, J P
The aim of this study was to assess infection control practices and their impact upon infectious complications in skin surgery conducted by private dermatologists. A prospective study was carried out by 73 volunteers belonging to the Surgical Group of the Société Française de Dermatologie over a period of three months. Data were collected for surgical procedures performed during this period, including the excision of all benign or malignant tumours, but excluding sebaceous cysts and pyodermas. A total of 3491 dermatological surgical procedures were included in the survey. Post-operative infections occurred in 67 patients (1.9%), with superficial suppuration accounting for 92.5% of surgical site infections. The incidence was higher in the excision group with a reconstructive procedure (4.3%) than in excisions alone (1.6%). Infection control precautions varied according to the site of procedure; multivariate analysis showed that haemorrhagic complications were an independent factor for infection in both types of surgical procedure. The male gender, immunosuppressive therapy and not wearing sterile gloves were independent factors for infections occurring following excisions with reconstruction. Not all of the procedures needed the use of a hospital theatre. It is clear that for excisions with a reconstructive procedure or for certain anatomical sites, such as the nose, there should be more emphasis upon infection control precautions. Further studies are needed to establish optimal guidelines for this kind of surgery.
Ochsendorf, F R; Boehncke, W-H; Sommerlad, M; Kaufmann, R
This is a prospective study to find out whether an interactive large-group case-based teaching approach combined with small-group bedside teaching improves student satisfaction and learning outcome in a practical dermatology course. During two consecutive terms a rotating system of large-group interactive case-study-method teaching with two tutors (one content expert, one process facilitator) and bedside teaching with randomly appointed tutors was evaluated with a nine-item questionnaire and multiple-choice test performed at the beginning and the end of the course (n = 204/231 students evaluable). The results of three different didactic approaches utilized over the prior year served as a control. The interactive course was rated significantly better (p < 0.0001) than the standard course with regard to all items. The aggregate mark given by the students for the whole course was 1.58-0.61 (mean +/- SD, range 1 (good)-5 (poor)). This was significantly better than the standard course (p < 0.0001) and not different from small-group teaching approaches. The mean test results in the final examination improved significantly (p < 0.01). The combination of large-group interactive teaching and small-group bedside teaching was well accepted, improved the learning outcome, was rated as good as a small-group didactic approach and needed fewer resources in terms of personnel.
Osteopathic medicine and the practice of dermatology: history and current status. An overview of the American Osteopathic College of Dermatology, an affiliate specialty college of the American Osteopathic Association.
Austin, Erik; Way, Bill V; Lustig, Chava; Green, Jason; Manlio, Christopher; Broomer, Amy; Persichetti, Greg; Akhtar, Asfa; Elias, Merrick; Favreau, Tracy; Skopit, Stanley
As the unified training body for osteopathic physicians specializing in dermatology, the American Osteopathic College of Dermatology (AOCD) sponsors 18 dermatology residency programs that integrate academic training (focusing on the core of basic medical sciences) with clinical instruction (emphasizing specialized diagnostic and laboratory techniques and the high-level performance of all dermatologic and surgical procedures) to engender the ability to provide superior, specialized dermatologic care. The board of directors of the American Academy of Dermatology (AAD) recommended passage of a bylaws amendment establishing a category of osteopathic fellow for those osteopathic physicians who are certified by the American Osteopathic Board of Dermatology; however, the AAD membership failed to adopt the amendment by the required two-thirds majority. Constitutional bylaws of both societies stress the importance of the goal of unification and representation of the specialty of dermatology. Continued rapprochement appears to be in the best interest of the AAD and AOCD and may well enhance our efforts to deal with the challenges that face dermatology and medical practice in the 21st century.
Gupta, Madhulika A; Gupta, Aditya K; Fink, Naomi H
There are no large-scale studies ofpolypharmacy (PP) in dermatology. The authors examined trends in PP (simultaneous use of > or = 4 medications in our study) and associated clinical factors among a nationally representative sample of 46,273 (weighted count +/- standard error [SE]: 617,970,596 +/- 25,187,959) dermatology-related (International Classification of Diseases, Ninth Revision, Clinical Modification codes 680-709) patient visits from 1995 to 2009. Data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Care Survey were examined. The overall frequency (+/- SE) of PP was 8.9% +/- 0.4%. There was almost a doubling in the frequency of PP in dermatology from 1995 to 2009 (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.67-2.44, after controlling for comorbidities and sex). This increase was noted among patients with > 1 diagnoses, and all age groups including the younger than 25 age category (PP frequency +/- SE, 7.4% +/- 0.4%; OR, 1.45; 95% CI, 1.12-1.88), and not just among patients in the geriatric age range with multiple complex dermatologic problems. Some of the most frequent conditions in the PP group included acne, psoriasis, atopic dermatitis, and infections of the skin and subcutaneous tissue, conditions that are known to be affected by psychodermatologic factors. PP among these patients may in part be an indication of their complex presentation caused by psychosocial vs dermatopathologic factors.
Elsner, P; Nenoff, P; Schliemann, S; Tittelbach, J; Reinel, D
Under the conditions of economic pressure in the medical system and the DRG system for hospitals in Germany, so-called "uneconomic" services and fields of specialized dermatologic competence such as pediatric dermatology, trichology, occupational dermatology and tropical dermatology are increasingly being neglected. While hospitals tend to train fewer residents in these subspecialties, there is a demand for additional high-quality training opportunities that are certified by the German Dermatologic Academy (DDA). Tropical and travel-related skin diseases are more frequently observed in Germany which can be explained by the increased world-wide travel activities, but also by the international migration from developing countries into Europe. Furthermore, dermatologists trained in Germany are working more and more also internationally. Thus, they require knowledge and experience in tropical and travel-related dermatology. The certificate "Tropical and Travel Dermatology (DDA)" was developed and published in 2013 in a cooperation between the International Society for Dermatology in the Tropics in cooperation with the German Academy of Dermatology (DDA). It consists of 3 full day teaching modules (basic, additional and special seminar). The first seminar cycle in 2013/2014 showed a high demand from dermatologists in hospitals and private practices. While the basic and the special seminars were held in Germany, the additional seminar took place in cooperation with the Regional Dermatology Training Center (RDTC) in Moshi, Tanzania. Many attending dermatologists fulfilling the requirements for the new certificate have practiced in developing countries or plan to do so. In order to gain practical experience on the basis of the knowledge acquired in the qualifying seminars, the International Society for Dermatology in the Tropics supports dermatologists to find internships and work placements in dermatological units in developing countries.
Salas-García, I.; Fanjul-Vélez, F.; Ortega-Quijano, N.; Arce-Diego, J. L.
Photodynamic Therapy (PDT) is an optical treatment modality that allows malignant tissue destruction. It is based on the administration of a photosensitizer and the posterior irradiation by an optical source. Photosensitizer molecules absorb the excitation light photons triggering a series of photochemical reactions in the presence of oxygen in the target tissue. During such interactions it is produced the de-excitation of the photosensitizer molecules in the singlet excited state which return to their minimum energy state by emitting fluorescence photons. These days, there are fixed clinical PDT protocols that make use of a particular optical dose and photosensitizer amount. However treatment response varies among patients and the type of pathology. In order to adjust an optimal dosimetry, the development of accurate predictive models plays an important role. The photosensitizer fluorescence can be used to estimate the degradation of the photoactive agent and as an implicit dosimetric measurement during treatment. However it is complex to know the fluorescence dependence with the depth in the tumor from observed fluorescence in the pathology surface. We present a first approach to predict the photosensitizer fluorescence dependence with depth during the PDT treatment applied to a skin disease commonly treated in the dermatological clinical practice. The obtained results permit us to know the photosensitizer temporal fluorescence evolution in different points of the tumor sample during the photochemical reactions involved in PDT with a predictive purpose related to the treatment evolution. The model presented also takes into account the distribution of a topical photosensitizer, the propagation of light in a biological media and the subsequent photochemical interactions between light and tissue. This implies that different parameters related with the photosensitizer distribution or the optical source characteristics could be adjusted to provide a specific treatment
Salas-García, I.; Fanjul-Vélez, F.; Ortega-Quijano, N.; Arce-Diego, J. L.
Photodynamic Therapy (PDT) is an optical treatment modality that allows malignant tissue destruction. It is based on the administration of a photosensitizer and the posterior irradiation by an optical source. Photosensitizer molecules absorb the excitation light photons triggering a series of photochemical reactions in the presence of oxygen in the target tissue. During such interactions it is produced the de-excitation of the photosensitizer molecules in the singlet excited state which return to their minimum energy state by emitting fluorescence photons. These days, there are fixed clinical PDT protocols that make use of a particular optical dose and photosensitizer amount. However treatment response varies among patients and the type of pathology. In order to adjust an optimal dosimetry, the development of accurate predictive models plays an important role. The photosensitizer fluorescence can be used to estimate the degradation of the photoactive agent and as an implicit dosimetric measurement during treatment. However it is complex to know the fluorescence dependence with the depth in the tumor from observed fluorescence in the pathology surface. We present a first approach to predict the photosensitizer fluorescence dependence with depth during the PDT treatment applied to a skin disease commonly treated in the dermatological clinical practice. The obtained results permit us to know the photosensitizer temporal fluorescence evolution in different points of the tumor sample during the photochemical reactions involved in PDT with a predictive purpose related to the treatment evolution. The model presented also takes into account the distribution of a topical photosensitizer, the propagation of light in a biological media and the subsequent photochemical interactions between light and tissue. This implies that different parameters related with the photosensitizer distribution or the optical source characteristics could be adjusted to provide a specific treatment
Rancan, Fiorenza; Blume-Peytavi, Ulrike; Vogt, Annika
Biodegradable polymeric materials are ideal carrier systems for biomedical applications. Features like controlled and sustained delivery, improved drug pharmacokinetics, reduced side effects and safe degradation make the use of these materials very attractive in a lot of medical fields, with dermatology included. A number of studies have shown that particle-based formulations can improve the skin penetration of topically applied drugs. However, for a successful translation of these promising results into a clinical application, a more rational approach is needed to take into account the different properties of diseased skin and the fate of these polymeric materials after topical application. In fact, each pathological skin condition poses different challenges and the way diseased skin interacts with polymeric carriers might be markedly different to that of healthy skin. In most inflammatory skin conditions, the skin’s barrier is impaired and the local immune system is activated. A better understanding of such mechanisms has the potential to improve the efficacy of carrier-based dermatotherapy. Such knowledge would allow the informed choice of the type of polymeric carrier depending on the skin condition to be treated, the type of drug to be loaded, and the desired release kinetics. Furthermore, a better control of polymer degradation and release properties in accordance with the skin environment would improve the safety and the selectivity of drug release. This review aims at summarizing the current knowledge on how polymeric delivery systems interact with healthy and diseased skin, giving an overview of the challenges that different pathological skin conditions pose to the development of safer and more specific dermatotherapies. PMID:24470766
Burlando, Bruno; Cornara, Laura
Honey is a bee-derived, supersaturated solution composed mainly of fructose and glucose, and containing proteins and amino acids, vitamins, enzymes, minerals, and other minor components. Historical records of honey skin uses date back to the earliest civilizations, showing that honey has been frequently used as a binder or vehicle, but also for its therapeutic virtues. Antimicrobial properties are pivotal in dermatological applications, owing to enzymatic H2 O2 release or the presence of active components, like methylglyoxal in manuka, while medical-grade honey is also available. Honey is particularly suitable as a dressing for wounds and burns and has also been included in treatments against pityriasis, tinea, seborrhea, dandruff, diaper dermatitis, psoriasis, hemorrhoids, and anal fissure. In cosmetic formulations, it exerts emollient, humectant, soothing, and hair conditioning effects, keeps the skin juvenile and retards wrinkle formation, regulates pH and prevents pathogen infections. Honey-based cosmetic products include lip ointments, cleansing milks, hydrating creams, after sun, tonic lotions, shampoos, and conditioners. The used amounts range between 1 and 10%, but concentrations up to 70% can be reached by mixing with oils, gel, and emulsifiers, or polymer entrapment. Intermediate-moisture, dried, and chemically modified honeys are also used. Mechanisms of action on skin cells are deeply conditioned by the botanical sources and include antioxidant activity, the induction of cytokines and matrix metalloproteinase expression, as well as epithelial-mesenchymal transition in wounded epidermis. Future achievements, throwing light on honey chemistry and pharmacological traits, will open the way to new therapeutic approaches and add considerable market value to the product.
Bree, Alanna F; Grange, Dorothy K; Hicks, M John; Goltz, Robert W
Goltz syndrome, caused by mutations in PORCN, is an X-linked dominant ectodermal dysplasia which is also known as focal dermal hypoplasia. This name is derived from the predominant pathologic skin findings of the syndrome. Nineteen Goltz-affected participants attended a multidisciplinary scientific and clinical conference convened by the National Foundation for Ectodermal Dysplasia which allowed further characterization of the features of this very rare condition. At birth, the affected areas of skin are typically erythematous and fragile. The hallmark cutaneous features, which vary widely due to mosacism and X-inactivation, include the previously described skin changes of asymmetric Blaschko-linear and reticulated atrophy, pigmentary changes, and telangectasias. Lipomatous changes and papillomas as characteristically defined were reported in the majority of patients. A newly recognized skin finding was progressive hyperpigmented freckling that occurred within the hypopigmented areas which were noted to be photosensitive. Many patients also had a pebbly texture to the central face, dorsal hands and feet. Punctate erosions within the atrophic areas and hypohidrosis were also common. Most had patchy alopecia and many had diffusely thin hair. Scanning electron microscopy of the hair shafts revealed abnormalities in the majority of participants with several different features identified, including atrophic hairs with reduced diameters, markedly flattened hairs as noted in cross-sectional views, trichorrhexis nodosa, pili torti, and pili trianguli et canaliculi. Nail changes included V-nicking and longitudinal ridging of the nail plate, in addition to micronychia. Early recognition of the dermatologic features, in addition to the variable but universal limb anomalies, of Goltz syndrome will allow early and accurate diagnosis without the need for extensive diagnostic studies, while also allowing for accurate prognosis and appropriate genetic counseling.
Harun, N A; Salek, S; Piguet, V; Finlay, A Y
Discharge from dermatology outpatients is a critical endpoint of patient care. Despite this, there has been very little research concerning the discharge process and factors influencing the discharge decision. To identify the factors influencing discharge decisions, articles from 1970 to April 2013 were searched in MEDLINE via Ovid, CINAHL, PROQUEST and Google Scholar using the keywords 'patient discharge', 'discharge decision', 'factors influencing discharge', 'clinical decision making', 'discharge decision making', 'process of discharge decision', 'outpatient', 'follow up', 'skin disease' and 'dermatology'. Only articles describing outpatient discharge decisions were included. Seventeen outpatient discharge articles were identified, 12 from the U.K. (seven dermatology) and five from the U.S.A., Canada, Australia and Taiwan (all nondermatology). The main influences on outpatient discharge identified were diagnosis and disease severity, clinician's level of experience and perception, patient's preferences, patient's behaviour and quality of life. These influences affected the clinician's judgement on discharge decisions both in appropriate and in inappropriate ways. Little is known concerning discharge decision making in dermatology. Given the central importance of such decisions in the appropriate care of patients and the efficient running of any dermatology service, greater understanding of the influences on discharge decision making is needed. It is therefore critical for dermatologists to be aware of these influences and to ensure that decisions are taken only in the best interests of patients. Further research is required to inform the training of dermatologists on how to take the most appropriate discharge decisions.
Boyers, Lindsay N; Schultz, Amanda; Baceviciene, Rasa; Blaney, Susan; Marvi, Natasha; Dellavalle, Robert P; Dunnick, Cory A
Although teledermatology (TD) is regarded as a tool to improve patient access to specialty healthcare, little has been done to evaluate its role in medical education. We describe the TD program at the Denver (CO) Department of Veterans Affairs Medical Center and evaluate its use as an educational tool for teaching dermatology to dermatology residents and medical students. Dermatology residents manage TD consultations and review all cases with a faculty preceptor; medical students participate as observers when possible. This study assessed dermatology resident (n=14) and medical student (n=16) perceptions of TD and its usefulness in teaching six core clinical competencies. Both residents (79%) and medical students (88%) "strongly agree" or "agree" that TD is an important educational tool. In general, medical students were slightly more satisfied than residents across all of the core competencies assessed except for patient care. Medical students and residents were most satisfied with the competencies of practice-based learning and improvement and medical knowledge, whereas they were least satisfied with those of interpersonal and communication skills and professionalism. Overall, TD is valued as a teaching tool for dermatology in the areas of patient care, medical knowledge, practice-based learning and improvement, and systems-based practice.
Kumar, Gurumoorthy Rajesh; Madhavi, Sankar; Karthikeyan, Kaliaperumal; Thirunavakarasu, MR
Introduction: Clinical Dermatology is a visually oriented specialty, where visually oriented teaching is more important than it is in any other specialty. It is essential that students must have repeated exposure to common dermatological disorders in the limited hours of Dermatology clinical teaching. Aim: This study was conducted to assess the effect of clinical images based teaching as a supplement to the patient based clinical teaching in Dermatology, among final year MBBS students. Methods: A clinical batch comprising of 19 students was chosen for the study. Apart from the routine clinical teaching sessions, clinical images based teaching was conducted. This teaching method was evaluated using a retrospective pre-post questionnaire. Students’ performance was assessed using Photo Quiz and an Objective Structured Clinical Examination (OSCE). Feedback about the addition of images based class was collected from students. Results: A significant improvement was observed in the self-assessment scores following images based teaching. Mean OSCE score was 6.26/10, and that of Photo Quiz was 13.6/20. Conclusion: This Images based Dermatology teaching has proven to be an excellent supplement to routine clinical cases based teaching. PMID:26677267
Holubar, K; Schmidt, C; Kokert, B
The Vienna surgeon Joseph Plenck first listed individual skin lesions, some of which we consider primary efflorescences today. He wrote many more treatises, relating to different areas of medicine, most of which reached Japan. One century later Keizo Dohi wrote, that Plenck's oeuvre will remain unforgotten in the history of dermatology, for his importance, in general and for the close relation to the development of medicine and dermatology in Japan. A search for Japanese translations of Plenck's books could prove that. Dohi himself wanted to become a surgeon but changed his plans and enrolled in Moriz Kaposi's (1837-1902) department in Vienna as a postgraduate student in 1893. Sifting through Dohi's textbook and papers, the importance of the Hebra-Kaposi School for Japan is again explicitly stated by the Japanese master, who founded the Japanese Dermatological Society in December of 1900 and the disciplines's journal in 1901. The language of publication was German. Dohi's first paper appeared in the Archiv für Dermatologie und Syphilis in 1896, in German. In recent years Austrian dermatology has become influential again in dermatological research after a mid century low. A series of investigators have spent sabbatical years or postgraduate training at the former Hebra-Kaposi Department in Vienna. Their scientific achievements were mainly in the field of immunobiology of the skin. A list of publications and their authors is presented.
Balai, Manisha; Gupta, Lalit K.; Khare, Ashok K.; Mittal, Asit; Mehta, Sharad; Bharti, Garima
Background: Dermatologists besides providing service to patients in the outdoors, also play a vital role in the care of inpatients admitted to dermatology unit and other departments. Aims: The aim of this study was to evaluate the pattern of referrals sent to the dermatology department by other departments. Materials and Methods: The study included all inpatients referred to dermatology department of a tertiary care centre of South Rajasthan during a 5-year period from October 2008 to September 2013. Results: A total of 1560 consultations with 1603 diagnoses were recorded. Most (770; 49.3%) consultations were received from internal medicine, followed by surgery (177; 11.3%), pediatrics (104; 6.7%), psychiatry (86; 5.5%) and gynecology (69; 4.4%) wards. Infectious skin diseases were most common (29.7%) followed by eczema (12.0%) and drug reactions (9.0%). Conclusion: Dermatology referrals can enhance the dermatological knowledge of non-dermatologists to diagnose and manage common dermatoses thus improving overall patient care. PMID:28217467
Kaur, Ravneet Ruby; Glick, Jaimie B.; Siegel, Daniel
As dermatological procedures continue to become increasingly complex, improved methods and tools to achieve appropriate hemostasis become necessary. The methods for achieving adequate hemostasis are variable and depend greatly on the type of procedure performed and the unique characteristics of the individual patient. In Part 1 of this review, we discuss the preoperative, intraoperative, and postoperative management of patients undergoing dermatologic surgery. We address oral medications and supplements that affect hemostasis, hemostatic anesthesia, and intraoperative interventions such as suture ligation and heat-generating cautery devices. In Part 2 of this review, we will discuss topical hemostats. The authors conducted an extensive literature review using the following keywords: “hemostasis,” “dermatology,” “dermatological surgery,” “dermatologic sutures,” “electrosurgery,” “hemostatic anesthesia,” and “laser surgery.” Sources for this article were identified by searching the English literature in the Pubmed database for the time period from 1940 to March 2012. A thorough bibliography search was also conducted and key references were examined. PMID:23741660
Damsky, William; King, Brett A
New molecularly targeted therapeutics are changing dermatologic therapy. Janus kinase-signal transducer and activator of transcription (JAK-STAT) is an intracellular signaling pathway upon which many different proinflammatory signaling pathways converge. Numerous inflammatory dermatoses are driven by soluble inflammatory mediators, which rely on JAK-STAT signaling, and inhibition of this pathway using JAK inhibitors might be a useful therapeutic strategy for these diseases. Growing evidence suggests that JAK inhibitors are efficacious in atopic dermatitis, alopecia areata, psoriasis, and vitiligo. Additional evidence suggests that JAK inhibition might be broadly useful in dermatology, with early reports of efficacy in several other conditions. JAK inhibitors can be administered orally or used topically and represent a promising new class of medications. The use of JAK inhibitors in dermatology is reviewed here.
Lynch, M D; Bashir, S
Platelet-rich plasma (PRP) is an autologous blood-derived product enriched in platelets, growth factors, chemokines and cytokines. Initial applications were predominantly in musculoskeletal and maxillofacial fields, however in recent years, it has been used for a range of dermatological indications including wound healing, fat grafting, alopecia, scar revision and dermal volume augmentation. Here, we critically appraise the literature relating to the usage of PRP within Dermatology. We have evaluated in vitro data, preclinical animal studies and human trials. We conclude that, whilst the literature may be consistent with a modest benefit for specific indications, there is not sufficient evidence supporting the efficacy of PRP to justify a role in routine dermatological practice at the present time. However, since PRP is generally well tolerated with few reported complications, further study may be justified in the context of organized trials.
de Argila Fernández-Durán, Nuria; Blasco Maldonado, Celeste; Martín Gómez, Mónica
Phototherapy with narrow band ultraviolet B is a treatment used in some dermatology units, and is the first choice in some dermatological diseases due to being comfortable and cheap. The aim of this paper is to describe the management and nursing care by grouping more specific diagnoses, following NANDA-NIC/NOC taxonomy, such as the methodology from application, technique, material, and personnel to space-related aspects, with the aim of avoiding the clinical variability and the possible associated risks for the patients, and for the nurses who administer the treatment. The continuity of the same nurse in the follow-up sessions stimulates the relationship between medical personnel and patients, key points for loyalty and therapeutic adherence. This paper examines a consensus procedure with the Dermatology Unit Team and accredited by the Hospital Quality Unit.
Background Although dermatology, as a medical subject, has been a facet of the training and education of podiatrists for many years, it is, arguably, only in recent years that the speciality of podiatric dermatology has emerged within the profession. Some indication of this gradual development may be identified through a content analysis of the podiatric literature in the UK, spanning a 21 year timeframe. Method 6 key professional journals were selected for content analysis in order to provide a picture of the emergence and development of podiatric dermatology over a period extending from 1989 to 2010. Both syntactical and thematic unitization were deployed in the analysis, revealing both manifest and latent content. Categories were devised using a prior coding, a codebook produced to define relevant concepts and category characteristics, and the coding scheme subject to an assessment of reliability. Results 1611 units appeared in the 6 journals across a 21 year timeframe. 88% (n = 1417) occurred in one journal (Podiatry Now and its predecessors). Modal categories within all journals included course adverts (n = 673), commercial adverts (n = 562) and articles by podiatrists (n = 133). There was an overall rise from 40 per annum in 1989, to over 100 in 2010. A wider range of dermatological topics were addressed, ranging from fungal nail infections to melanoma. Conclusions It is evident from this analysis that there has been an increasing focus on dermatology as a topic within the main podiatric journals in the UK over the last 21 years, primarily reflecting a rise in commercial advertising and an increase in academic dermatology related publications. Whilst earlier publications tended to focus on warts and fungal infections, more recent publications address a broader spectrum of topics. Changes in prescribing rights may be relevant to these findings, as may the enhanced professional and regulatory body requirements on continuing professional
Lotti, Torello; Handog, Evangeline B; Hercogová, Jana; Ramos-E-Silva, Marcia
The technical advances of the last century changed the understanding of the science of cutaneous physiology and pathology and the role of the dermatologist. The major challenges the international dermatologic community faces today are the lack of a common, logical, and accepted language within the specialty; long-accepted but questionable policies to advance academic careers; and the marginalization of dermatology. Methods for communicating and circulating data and ideas also have changed radically. The distribution of knowledge and essential/practical tools in different regions of the world is inequitable, and developing countries must cope with the challenges of high-impact skin diseases.
Gaur, Meenakshi; Dobke, Marek; Lunyak, Victoria V.
Operating at multiple levels of control, mesenchymal stem cells from adipose tissue (ADSCs) communicate with organ systems to adjust immune response, provide signals for differentiation, migration, enzymatic reactions, and to equilibrate the regenerative demands of balanced tissue homeostasis. The identification of the mechanisms by which ADSCs accomplish these functions for dermatological rejuvenation and wound healing has great potential to identify novel targets for the treatment of disorders and combat aging. Herein, we review new insights into the role of adipose-derived stem cells in the maintenance of dermal and epidermal homeostasis, and recent advances in clinical applications of ADSCs related to dermatology. PMID:28117680
Mebazaa, Amel; Zeglaoui, Faten; Ezzine, Nedia; Kharfi, Monia; Zghal, Mohamed; Fazaa, Bécima; Kamoun, Mohamed Ridha
We report a retrospective study of all scabies cases collected in the department of Dermatology of Charles Nicolle Hospital during a 8 year-period (1993-2000). 148 cases of scabies were collected with a mean incidence of 144 new cases/year (65-204). Diagnosis was made clinically in all cases. Parasitological exam was done in case of doubtful diagnosis. Our purpose is to try to define an epidemio-clinical profile of scabies in Tunisia and to estimate the incidence of this parasitosis through our dermatological consultation with reviewing the literature data.
Traenckner, I; Hölscher, K; Abeck, D; Berger, M; Ring, J
Atopic eczema is one of the most frequent dermatological diseases, with a still increasing incidence. Although its etiopathogenesis is still not completely understood, a variety of triggering factors are known. The following case report describes the clinical course of atopic dermatitis in a 2-year-old boy in whom both IgE-mediated allergic reactions and psychological factors were involved in triggering and maintenance of skin lesions. This demonstrates how important both dermatological therapy and close cooperation with the field of psychosomatic medicine can be.
Gupta, Saurabh Kumar; Saxena, Payal
General dentists should be aware that extraoral dental cutaneous lesions can be confused with dermatologic lesions. We report two cases of cutaneous lesions of dental origin that were initially misdiagnosed as being dermatologic in origin. Multiple treatments were performed, including plastic surgery, but the lesions did not resolve. Then, the lesions' dental etiology was identified. Endodontic intervention resulted in resolution of the problem, confirming the initial misdiagnosis. A dental etiology, as part of a differential diagnosis, should be kept in mind with orofacial skin lesions.
Huang, Vivian Wai-Mei; Dhami, Neil; Fedorak, Darryl; Prosser, Connie; Shalapay, Carol; Kroeker, Karen Ivy; Halloran, Brendan Phillip; Dieleman, Levinus Albert; Fedorak, Richard Neil
BACKGROUND: Although infliximab is an effective therapy for inflammatory bowel disease (IBD), it is associated with dermatological events and infusion reactions. It is not known whether a relationship between these adverse events (AEs) and infliximab trough levels (ITLs) exists. OBJECTIVES: To report the prevalence of infliximab-associated AEs in IBD patients receiving stable maintenance infliximab therapy, and to correlate ITLs with dermatological and infusion reactions to infliximab. METHODS: Adult IBD patients receiving stable maintenance infliximab therapy were recruited from the University of Alberta Infusion Clinic (Edmonton, Alberta). ITLs were measured in blood samples collected before infusion, and the patients’ records were reviewed for dermatological and infusion reactions to infliximab. RESULTS: One-quarter (18 of 71 [25.4%]) of patients experienced dermatological or infusion reactions to infliximab: nine (12.7%) dermatological events and nine (12.7%) infusion reactions. The median ITL was similar among patients with and without these AEs (7.2 μg/mL [interquartile range (IQR) 2.0 μg/mL to 13.3 μg/mL] versus 6.6 μg/mL [IQR 3.2 μg/mL to 12.7 μg/mL]; P=0.648). The median ITL of patients who experienced infusion reactions (2.0 μg/mL [IQR 0.1 μg/mL to 5.7 μg/mL]) was lower than that of patients who experienced no such AEs (6.6 μg/mL [IQR 3.2 μg/mL to 12.7 μg/mL]; P=0.008]) and lower than that of patients who experienced dermatological AEs (13.3 μg/mL [IQR 8.8 μg/mL to 17.4 μg/mL]; P<0.001). CONCLUSION: One-quarter of IBD outpatients receiving stable maintenance infliximab therapy experienced dermatological and infusion reactions. Low ITLs were correlated with infusion reactions, and normal or high ITLs with dermatological events. PMID:25706572
Gaur, Meenakshi; Dobke, Marek; Lunyak, Victoria V
Operating at multiple levels of control, mesenchymal stem cells from adipose tissue (ADSCs) communicate with organ systems to adjust immune response, provide signals for differentiation, migration, enzymatic reactions, and to equilibrate the regenerative demands of balanced tissue homeostasis. The identification of the mechanisms by which ADSCs accomplish these functions for dermatological rejuvenation and wound healing has great potential to identify novel targets for the treatment of disorders and combat aging. Herein, we review new insights into the role of adipose-derived stem cells in the maintenance of dermal and epidermal homeostasis, and recent advances in clinical applications of ADSCs related to dermatology.
Soares, Kelen Carine Costa; Santos, Gustavo Mendes Lima; Gelfuso, Guilherme M; Gratieri, Tais
This note aims to clarify the Brazilian regulatory bioequivalence recommendations for approval of generic topical dermatological drug products, since the legal framework of the "Brazilian Health Surveillance Agency" (ANVISA) is only available in Portuguese. According to Resolutions RE n. 1170 (December 19th 2006) and RDC n. 37 (August 3rd 2011) in Brazil, only in vitro studies are required for registration of generic topical dermatological drug products. Current Regulatory Agenda of ANVISA, which contains possible future resolutions to be revised over 2015-2016, includes a discussion on biowaiver requirements and on possible in vitro and in vivo comparability tests for these products.
Hazen, Paul G; Daoud, Shaza; Hazen, Brent P; Engstrom, Conley W; Turgeon, Karen L; Reep, Michael D; Tanphaichitr, Arthapol; Styron, Brandie T
Medical emergencies may occur in any setting, including dermatology offices. We examined the incidence of medical emergencies in a survey of 34 dermatologists northeast Ohio. Fifty-five events occurred over 565 combined years of clinical practice, an incidence of 1 episode every 10.3 years. We also review options for better preparedness for medical emergencies in dermatology practices, ranging from an emergency action plan for emergency personnel, basic life support (BLS) certification, advanced cardiac life support (ACLS) certification, and on-site automatic electronic defibrillators (AEDs).
Thavarajah, M; Szamocki, S; Komath, D; Cascarini, L; Heliotis, M
300 cases of non-melanoma cutaneous lesion procedures carried out by the Oral and Maxillofacial Surgery and Dermatology departments in a North West London hospital over a 6 month period between September 2011 and February 2012 were included in a retrospective case control study. The results from each speciality were compared. The mean age of the OMFS group was 75.8 years compared to 69.9 years in the dermatology group. There was no statistically significant difference in gender between the 2 groups. The OMFS group treated a higher proportion of atypical (17%) and malignant (64.9%) cases compared to the dermatology group (11.3% and 50.5% respectively). This could also account for the fact that the OMFS group carried out a higher number of full excisions compared to dermatology. Both groups had a similar number of false positives (a benign lesion initially diagnosed as malignant) and a similar proportion of false negatives (a malignant lesion initially diagnosed as benign). Overall, the results show that both specialities had similar outcomes when managing non-melanoma cutaneous lesions. Both groups adhere to the guidelines set out by the British Association of Dermatologists and the National Institute of Clinical Excellence when managing such lesions.
Fifty-eight fusaria isolated from 52 Italian patients between 2004 and 2007 were subject to multilocus DNA sequence typing to characterize the spectrum of species and circulating sequence types (STs) associated with dermatological infections, especially onychomycoses and paronychia, and other fusari...
Lyzak, W A; Flaitz, C M; McGuckin, R S; Eichmiller, F; Brown, R S
We report a confirmed case of intraoral contact mucositis secondary to nickel dental alloy hypersensitivity. The lesion resolved after removal of the offending prosthesis. The patient responded negatively to dermatologic patch tests, but a positive intraoral rechallenge confirmed the mucositis diagnosis. A nonreactive, gold alloy prosthesis was inserted for a successful result.
Kim, G R; Aronson, A R; Mork, J G; Cohen, B A; Lehmann, C U
Clinical dermatology cases are presented as images and semi-structured text describing skin lesions and their relationships to disease. Metadata assignment to such cases is hampered by lack of a standardized dermatology vocabulary and facilitated methods for indexing legacy collections. In this pilot study descriptive clinical text from Dermatlas, a Web-based repository of dermatology cases, was indexed to Medical Subject Heading (MeSH) terms using the National Library of Medicine's Medical Text Indexer (MTI). The MTI is an automated text processing system that derives ranked lists of MeSH terms to describe the content of medical journal citations using knowledge from the Unified Medical Language System (UMLS) and from MEDLINE. For a representative, random sample of 50 Dermatlas cases, the MTI frequently derived MeSH indexing terms that matched expert-assigned terms for Diagnoses (88%), Lesion Types (72%), and Patient Characteristics (Gender and Age Groups, 62% and 84% respectively). This pilot demonstrates the potential for extending the MTI to automate indexing of clinical case presentations and for using MeSH to describe aspects of clinical dermatology.
Halem, Monica; Karimkhani, Chanté
Skin lesions are extremely common, and early detection of dangerous lesions makes skin cancer one of the most highly curable malignancies. By simply becoming aware of common lesions and their phenotypic presentation, dental professionals are empowered to detect suspicious dermatologic lesions in unaware patients. This article serves as an introduction to skin cancer and benign skin lesions for dental professionals.
... HUMAN SERVICES Food and Drug Administration Dermatologic and Ophthalmic Drugs Advisory Committee; Amendment of Notice AGENCY: Food and Drug Administration, HHS. ACTION: Notice. The Food and Drug... portion of the meeting (Topic 2), relating to the appropriateness of marketing a single bottle of...
Houk, Laura D; Humphreys, Tatyana
Laser therapy is one of the fastest expanding and most exciting fields in dermatology. From its theoretical beginnings in Einstein's imagination, lasers have come to be used in treatments for conditions ranging from skin malignancy and acne to hirsutism and photoaging. We will briefly review the evolution of laser treatment, with a focus on the recent developments surrounding the new millennium.
Raney, Sam G; Franz, Thomas J; Lehman, Paul A; Lionberger, Robert; Chen, Mei-Ling
The pharmacokinetic approach has accelerated the development of high-quality generic medicines with extraordinary cost savings, transforming the pharmaceutical industry and healthcare system in the USA. While this is true for systemically absorbed drug products, the availability of generic versions of topical dermatological products remains constrained due to the limited methods accepted for bioequivalence evaluation of these products. The current review explores the possibility of developing appropriate bioequivalence approaches based on pharmacokinetic principles for topical dermatological products. This review focuses on the strengths and limitations of the three most promising pharmacokinetics-based methods to evaluate the performance and bioequivalence of topical dermatological products, which include in vivo skin stripping, in vivo microdialysis, and in vitro permeation testing (IVPT) with excised human skin. It is hoped that recent advances in pharmaceutical and regulatory science will facilitate the development of robust bioequivalence approaches for these dosage forms, enable more efficient methodologies to compare the performance of new drug products in certain pre-approval or post-approval change situations, and promote the availability of high-quality generic versions of topical dermatological products.
Tetzlaff, Michael T; Nagarajan, Priyadharsini; Chon, Susan; Huen, Auris; Diab, Adi; Omar, Pacha; Aung, Phyu P; Torres-Cabala, Carlos A; Mays, Steven R; Prieto, Victor G; Curry, Jonathan L
Immunotherapy targeting the programmed cell death 1 (PD-1) receptor has demonstrated tremendous promise in the treatment of advanced solid tumors. Dermatologic toxicities, however, are an emerging consequence of this therapy and have been clearly associated with immune checkpoint blockade antibodies. Distinctive clinical and histologic subtypes of dermatologic toxicity secondary to immunotherapy are emerging and include rare autoimmune bullous reactions (eg, bullous pemphigoid) and lichenoid eruptions. We report three patients who developed lichenoid dermatitis while receiving anti-PD-1 antibody therapy. The mean time to onset of lichenoid dermatologic toxicity was 42 days (range: 1-75 days) from initiation of anti-PD-1 antibody therapy. Lesions most frequently presented on the extremities and trunk as pustules, papules, and plaques. The face was not commonly involved. Of the five skin biopsies examined, all demonstrated dense band-like lymphocytic infiltrate, hyperkeratosis, hypergranulosis, saw-tooth rete ridge pattern, and dyskeratosis. Acanthosis was a feature in all of the skin biopsies, and in one, epidermal hyperplasia was prominent. In several skin biopsies, histologic features supporting a lichenoid drug eruption were present, including parakeratosis, spongiosis, periadnexal/perivascular inflammation, and eosinophils. Furthermore, the histologic features varied in skin biopsy specimens taken from the same patient at different sites, supporting a drug reaction. All patients' skin lesions improved with use of steroids: two were treated with topical steroids and one with systemic steroids. Recognition of the histopathologic patterns of dermatologic toxicities resulting from immune checkpoint blockade therapy will become increasingly important for ensuring appropriate management of dermatologic toxicities and optimal patient care.
Choi, Young M.; Marczynski, Wojciech
Background: Citation analysis is an effective way to gauge the impact of an article on the scientific community. Objective: The purpose of this study was to perform a citation analysis of 24 clinical dermatologic journals from 1970 to 2012, limited to the topic of psoriasis. Methods: The authors conducted a search of “psoriasis” in the Science Citation Index from 1970 to 2012, including articles that have received 100 or more citations. The top 100 most cited articles were further analyzed for country, institution, and study type. Results: Fifty of the top 100 most cited articles were from the United States and 81 of them were original articles. The majority of the top 100 classics were from dermatology programs in the United States, but institutions in the United Kingdom and Germany also made notable contributions. Citation classics in psoriasis were highly published from 1985 to 1989 and 2000 to 2004. Limitations: Limitations included potential neglect of a clinical dermatologic journal and the limited search term of “psoriasis.” Conclusion: The great majority of citation classics were published in the premier dermatologic journals. The top-ranking dermatology programs in the United States produced the majority of the top 100 classics in psoriasis. The high number of citation classics from 1985 to 1989 correlates to the discovery of the immune-mediated pathogenesis of psoriasis at that time. The 21st century brought forth the monumental development of biologic agents in psoriasis therapy, reflected by the high number of citation classics from 2000 to 2004. PMID:25371766
Lugão, Ariel Falbel; de Caldas, Tânia Alencar; de Castro, Eneida Lazzarini; Pereira, Elisabete Monteiro de Aguiar; Velho, Paulo Eduardo Neves Ferreira
BACKGROUND Some research indicates that physicians do not dominate the expected dermatological content for the proper exercise of the profession. This fact compromises their diagnostic and therapeutic performance, generating unnecessary costs. OBJECTIVE The aim of this study was to evaluate the relevance of Dermatology and the knowledge acquired in the specialty during the undergraduate course in clinical practice of graduates at the State University of Campinas Medical School (FCM/UNICAMP). METHOD A questionnaire with 22 closed questions and two open ones was electronically sent to physicians who had graduated more than 10 years ago and others for less than 10 years. In the first group, physicians were trained by the same curriculum and in the second group there were subjects trained by the old and the new curriculum. RESULTS Of the 126 respondents, 83% had completed a specialization course. Among all, 82% did not study dermatology after graduation. The majority considered that Dermatology has high relevance in clinical practice, regardless of the group. There was a statistically significant difference between non-dermatologist doctors graduated for more than 10 years and those graduated for less than 10 years regarding confidence about lesion diagnosis, diagnostic investigation and treatment of skin diseases. Physicians who have graduated for a longer time feel more insecure in relation to patients with dermatoses. Concerning contributions offered by graduation program completion they prioritized outpatient care, ability to diagnose, knowledge of pathology, research and knowledge of lesions. CONCLUSION This study has shown that Dermatology is relevant in medical practice and more recent graduates from the FCM/UNICAMP feel less insecure when treating a patient with dermatoses. PMID:26560207
Dermatologists from Germany are increasingly involved in international missions under tropical conditions. While civilian operations take place primarily in the context of international development cooperation, non-governmental organizations and private initiatives, dermatologists of the German Armed Forces have been engaged in numerous military missions and international disaster relief missions abroad. The specific requirements of these missions require a specialist qualification; however, the specialist training in "Skin and Venereal Diseases" under the conditions for medical care in Germany is frequently not sufficient. For an optimal preparation for dermatological missions in tropical regions, an additional qualification in tropical medicine is to be recommended. Since this additional training is time-consuming and can often not be put into practice, especially in the civilian sector, the acquisition of the certificate "Tropical and Travel Dermatology (DDA)" of the International Society for Dermatology in the Tropics in cooperation with the German Dermatological Academy (DDA) can be recommended. In the future, training in tropical dermatology should be incorporated into the main curriculum of dermatology for those specialists planning to work on dermatological missions in the tropics.
Gottlieb, Alice B; Armstrong, April W; Christensen, Robin; Garg, Amit; Duffin, Kristina Callis; Boehncke, Wolf-Henning; Merola, Joseph F; Gladman, Dafna D; Mease, Philip J; Swerlick, Robert A; Rosen, Cheryl F; Abernethy, April
In the United States, access to care is the number one issue facing our patients with dermatological conditions. In part, this is because we do not have outcome measures that are useful in clinical practice and available in databases where payers and governmental agencies can compare the performance of physicians and treatments. There is a growing recognition that insufficient attention has been paid to the outcomes measured in clinical trials and subsequently in clinical practice. The International Dermatology Outcome Measures group includes all willing stakeholders: patients, physicians, payers, and pharmaceutical scientists. As reported herein, the group's goal is to develop outcome measures in dermatology that address the needs of all involved.
Gallo, Richard L.; Thiboutot, Diane; Webster, Guy F.; Rosen, Ted; Leyden, James J.; Walker, Clay; Zhanel, George; Eichenfield, Lawrence
In this second part of a three-part series addressing several issues related to antibiotic use in dermatology, potential effects of antibiotic use on the human microbiota and microbiome are reviewed. Data from available literature on the microbiologic effects of specific therapeutic agents commonly used in dermatology, including oral isotretinoin, tetracycline agents, and sub-antimicrobial (sub-antibiotic) dose doxycycline, are also discussed.
The article presents an outline of the development of world and Polish dermatology. The author points out to the first descriptions of skin diseases by ancient and medieval medical luminaries. The outline of the Polish dermatology is based on examples of doctors living in the 16th and 17th centuries. The first clinics of skin and venereal diseases in Poland appeared, like in other European countries, in the second half of the 19th century. Antoni Rosner, the first associate professor of clinical studies, greatly contributed to the development of this medical field. The description of his life and work is the background for the presentation of opening and developing the clinic of skin and venereal diseases in Krakow as well as the presentation of university curriculum at the Faculty of Medicine of the Jagiellonian University. PMID:25097475
Garipova, A.; Denissov, I. A.; Solodovnikov, Vladimir; Digilova, I.
At present nobody doubts the advantages of minor laser surgery over the conventional one.Bloodless manipulations, ablation, minor injury to the tissues while using laser equipment ensures its wide application in such fields as dermatology and cosmetology, especially since the semiconductor lasers because available at the technological market. No doubt CO2 and solid laser are still playing an important role, however, their imperfect fiber optic qualities limit their use in these field,s where advantages of diode lasers with flexible and fine quartz-polymeric optical fiber are obvious. The elaboration of new diode surgical lasers made it possible to invent new surgical equipment for solving many medical problems in the optimal way. Application of contact and noncontact laser methods in dermatology, gynecological plastic surgery and otolaryngology is discussed. A combined use of these methods demonstrates a positive effect on therapy results and healing time.
Barbosa, Naiara S; Kalaaji, Amer N
Complementary and alternative medicine (CAM) is a group of non-traditional medical practices that includes natural products, manipulations, and mind and body medicine. CAM use has grown and become popular among patients. In dermatology, honey, green tea, and vitamin C have been used as topical treatments for a variety of diseases. We performed a systematic review to explore the cutaneous effects of each of these three products. Honey's unique antibacterial, anti-inflammatory, and antioxidant properties were shown to contribute to wound healing, especially in ulcers and burns. Green tea, among many health benefits, demonstrated protection from ultraviolet-induced events, such as photoimmunosuppression and skin cancer growth. Vitamin C, known for its antioxidant properties and key role in collagen production, has been shown to produce positive effects on skin hyperpigmentation and aging. Future large well-designed clinical trials are needed in order to further investigate the potential of these agents as dermatological therapies.
Enamandram, Monica; Rathmell, James P; Kimball, Alexandra B
A number of chronic dermatologic conditions may necessitate long-term adjunctive pain management in addition to treatment of the primary skin disease, such as hidradenitis suppurativa, lichen planus, and other systemic diseases associated with significant pain. Adequate management of chronic pain can represent a unique challenge, but remains an integral component of clinical treatment in relevant contexts. For nociceptive pain of moderate to severe intensity, opioid analgesics can be beneficial when other pain management strategies have failed to produce adequate relief. The decision to initiate long-term opioid therapy must be carefully weighed, and individualized treatment plans are often necessary to effectively treat pain while minimizing adverse effects. Part II of this 2-part continuing medical education article will describe the appropriate settings for initiation of opioid analgesia for dermatology patients and detail therapeutic strategies and patient monitoring guidelines.
Kumar, Sumir; Mahajan, Bharat Bhushan; Kamra, Nidhi
Probiotics are live microbial food supplements that are beneficial to the host health when administered in adequate amounts. Probiotics do have an exciting concept in digestive functions, but these live microbes have wider applicability as evidenced by gut-brain-skin axis theory given 80years back. However, the details regarding use of probiotics for dermatological indications ranging from atopic dermatitis to acne and sexually transmitted infections is dispersed in the literature, herein we have tried to focus all under one heading. Overall, probiotics seem to be promising and safe therapeutic modality, but the evidence as of now, from the available published data is low. This review will stimulate readers to carry out well designed, larger population based trials, so as to validate its use in dermatology practice.
Grzybowski, Andrzej; Pietrzak, Krzysztof
Maria Goeppert-Mayer (1906–1972) created the theoretic basis for investigations using the double-photon effect. She was also involved in work on the Manhattan Project for the development of the atomic bomb. In 1963, she received the Nobel Prize in physics for her discoveries concerning nuclear shell structure. Her theoretic results on double-photon absorption are directly used today in dermatology in nonlinear microscopy, multiphoton tomography, and photodynamic therapy.
Sen, Arpita; Chowdhury, Satyendranath; Poddar, Indrasish; Bandyopadhyay, Debabrata
Introduction: Dermatology is primarily a non-acute, outpatient-centered clinical specialty, but substantial number of patients need indoor admission for adequate management. Over the years, the need for inpatient facilities in Dermatology has grown manifold; however, these facilities are available only in some tertiary centers. Aims and Objectives: To analyze the characteristics of the diseases and outcomes of patients admitted in the dermatology inpatient Department of a tertiary care facility in eastern India. Materials and Methods: We undertook a retrospective analysis of the admission and discharge records of all patients, collected from the medical records department, admitted to our indoor facility from 2011 to 2014. The data thus obtained was statistically analyzed with special emphasis on the patient's demographic profile, clinical diagnosis, final outcome, and duration of stay. Results and Analysis: A total of 375 patients were admitted to our indoor facility during the period. Males outnumbered females, with the median age in the 5th decade. Immunobullous disorders (91 patients, 24.27%) were the most frequent reason for admissions, followed by various causes of erythroderma (80 patients, 21.33%) and infective disorders (73 patients, 19.47%). Other notable causes included cutaneous adverse drug reactions, psoriasis, vasculitis, and connective tissue diseases. The mean duration of hospital stay was 22.2±15.7 days; ranging from 1 to 164 days. Majority of patients (312, 83.2%) improved after hospitalization; while 29 (7.73%) patients died from their illness. About 133 patients (35.64%) required referral services during their stay, while 8 patients (2.13%) were transferred to other departments for suitable management. Conclusion: Many dermatoses require inpatient care for their optimum management. Dermatology inpatient services should be expanded in India to cater for the large number of cases with potentially highly severe dermatoses. PMID:27688450
Omi, Tokuya; Numano, Kayoko
Background: Tremendous advances have been made in the medical application of the laser in the past few decades. Many diseases in the dermatological field are now indications for laser treatment that qualify for reimbursement by many national health insurance systems. Among laser types, the carbon dioxide (CO2) laser remains an important system for the dermatologist. Rationale: The lasers used in photosurgery have wavelengths that differ according to their intended use and are of various types, but the CO2 laser is one of the most widely used lasers in the dermatology field. With its wavelength in the mid-infrared at 10,600 nm, CO2 laser energy is wellabsorbed in water. As skin contains a very high water percentage, this makes the CO2 laser ideal for precise, safe ablation with good hemostasis. In addition to its efficacy in ablating benign raised lesions, the CO2 laser has been reported to be effective in the field of esthetic dermatology in the revision of acne scars as well as in photorejuvenation. With the addition of fractionation of the beam of energy into myriad microbeams, the fractional CO2 laser has offered a bridge between the frankly full ablative indications and the nonablative skin rejuvenation systems of the 2000s in the rejuvenation of photoaged skin on and off the face. Conclusions: The CO2 laser remains an efficient, precise and safe system for the dermatologist. Technological advances in CO2 laser construction have meant smaller spot sizes and greater precision for laser surgery, and more flexibility in tip sizes and protocols for fractional CO2 laser treatment. The range of dermatological applications of the CO2 laser is expected to continue to increase in the future. PMID:24771971
Wang, Ruikang K.; Baran, Utku; Choi, Woo J.
Optical coherence tomography (OCT) based microangiography (OMAG) is a new imaging technique enabling the visualization of blood flow within microcirculatory tissue beds in vivo with high resolution. In this talk, the concept and advantages of OMAG will be discussed and its potential clinical applications in the dermatology will be shown, demonstrating its usefulness in the clinical monitoring and therapeutic treatment of various skin pathologies, e.g. acne, port wine stain and wound healing.
Pradhan, Swetalina; Madke, Bhushan; Kabra, Poonam; Singh, Adarsh Lata
Antibiotics (antibacterial, antiviral, and antiparasitic) are class of drugs which result in either killing or inhibiting growth and multiplication of infectious organisms. Antibiotics are commonly prescribed by all specialties for treatment of infections. However, antibiotics have hitherto immunomodulatory and anti-inflammatory properties and can be exploited for various noninfectious dermatoses. Dermatologists routinely prescribe antibiotics in treatment of various noninfectious disorders. This study will review anti-inflammatory and immunomodulatory effects of antibiotics and their use in dermatology. PMID:27688434
Schmitt, Jochen; Wozel, Gottfried; Garzarolli, Marlene; Viehweg, Antje; Bauer, Michael; Leopold, Karolina
Psychiatric morbidity is frequent in patients with psoriasis. We compared the effectiveness of dermatological vs. interdisciplinary dermatological and psychiatric care for psoriasis. Adults with moderate-to-severe psoriasis were randomly allocated to dermatological (n = 24) or interdisciplinary care (n = 23) and treated accordingly. Primary endpoint was the mean change in Dermatology Life Quality Index (DLQI) at 6 months. Data was analysed by intention-to-treat. Mean ± SD change in DLQI was 7.5 ± 7.3 and 10.5 ± 9.9 after 6 months of dermatological and interdisciplinary care, respectively (p = 0.27). At baseline, 10 patients in the interdisciplinary treatment group (43%) had at least one psychiatric disorder. These patients showed significantly better DLQI response (DLQI change 14.8 ± 9.7) than patients receiving dermatological care only (p = 0.03). Ninety percent of psoriasis patients with DLQI scores exceeding psoriasis area and severity index (PASI) scores had comorbid psychiatric disease. Although psychiatric co-treatment is not generally required for patients with moderate-to-severe psoriasis, those patients with higher DLQI scores than PASI scores might benefit from interdisciplinary care.
Khoshnegah, Javad; Movassaghi, Ahmad Reza; Rad, Mehrnaz
university small animal clinic, 1299 Iranian domestic dogs presented from September 2007 through March 2011 to the Ferdowsi University of Mashhad Veterinary Teaching Hospital, were examined. Dermatological disorders were noted in 17.00% (221/1299) of all the dogs examined. Pruritus was the most common presenting sign, accounting for 25.35% of the dermatological consultations. It was followed by erythema, maculo-papular-pustular eruptions (16.97%), erosive or ulcerative lesions (16.74%), scaling or crusting (13.02%), alopecia (8.84%) and visible ectoparasites (7.44%). The most common primary final diagnoses were superficial pyoderma, cutaneous manifestations of canine leishmaniasis, flea infestation and allergy, tick infestation, atopic dermatitis, scabies, unspecified dermatoses, otitis, furunculosis and food allergy. There were no apparent age or sex predilections for dermatological disease as a whole. Spitz (odds ratio = 3.38; p = 0.001), Terriers (odds ratio = 2.52; p < 0.001) and German Shepherds (odds ratio = 1.90; p = 0.001) appeared to be at increased risk for dermatological disease. In addition, Khorasani large cross breed dogs (odds ratio = 0.36; p = 0.003) and mixed breed dogs (odds ratio = 0.33; p < 0.001) showed decreased risk for dermatological conditions. To the best of our knowledge, this is the first survey study on canine dermatological conditions carried out in Iran. PMID:25653779
Tabolli, Stefano; Pagliarello, Calogero; Di Pietro, Cristina; Abeni, Damiano
Health status, health services utilization and mortality differ by marital status for both sexes in most conditions, but little is known about dermatological diseases. We evaluated whether marital status is associated with the impact that dermatological diseases have on quality of life (QoL). Data from two surveys on dermatological outpatients were pooled. Marital status, sex, age, and educational level were analysed in relation to QoL (using the scales of the Skindex-29 questionnaire: emotions, symptoms, and functioning) and psychological well-being (using the GHQ-12 questionnaire). Data on 5,471 patients (59% females, 46% married) were obtained. Married patients in univariate analysis had lower mean values on the emotions scale and higher mean values in the symptoms scale of the Skindex-29 compared to singles. Statistically significant differences were identified only in men, for the emotions scale and for the GHQ-12. Females had significantly higher mean scores than males on each of the Skindex-29 scales and on the GHQ-12. Married patients had a lower disease impact on the emotions scale even if they suffered a higher impact on the symptoms scale. However, after multiple adjustment, gender seems to be more relevant than marital status in the evaluation of health status.
Basarab, T; Munn, S E; Jones, R R
A study was undertaken of new referrals by GPs to a dermatology clinic in a district general hospital over a 6-month period. Six hundred and eighty-six consecutive referrals to one consultant were analysed for diagnostic accuracy and requirement for referral. Only 47% of referral letters contained the correct diagnosis. Viral warts and psoriasis were best diagnosed (82 and 78%, respectively), but seborrhoeic warts and dermatofibromas caused difficulty (22 and 19%, respectively). Cutaneous malignancy was correctly diagnosed in 45% of referrals, and eczema, the commonest condition referred, in 54% of cases. Sixty-eight percent of referrals required hospital-based facilities for diagnosis (31%) or treatment/management (37%). Twenty-one per cent of patients referred attended for once-only visits, requiring no specialized diagnostic or therapeutic procedures. Such referrals should decrease with improved GP education. Eleven percent of referrals were for minor surgical procedures such as curettage, shave biopsy, or cryotherapy and would become unnecessary if such facilities were available in the community. Our data demonstrate the potential for management of up to one-third of current dermatological referrals within the community by improving education of GPs and providing appropriate facilities within the community. However, over two-thirds of patients required hospital facilities, a finding of considerable relevance to the future location of dermatological services.
Barzilai, David A; Mikkilineni, Radha; Davis, Bryan R; Stevens, Seth R; Mostow, Eliot N
Dermato-epidemiology curriculum has been identified by the American Academy of Dermatology (AAD) as an important foundation for dermatology residency training. However, no one has yet reported implementation of dermato-epidemiology curriculum. To evaluate and relate our experience carrying out a dermato-epidemiology resident education initiative, based on recommendations by the AAD Epidemiology Committee. Monthly lectures based on topics suggested by the AAD Epidemiology Curriculum. Pre- and post-test multiple choice and free-form question measures were employed to examine performance, assess resident enthusiasm, and solicit feedback from the initiative. Quantitative achievement on multiple-choice items improved slightly, but insignificantly, from 53 percent to 58 percent. Resident level of enthusiasm and perceived efficacy for the intervention varied from 3.3 to 4.0 on a 5-point Likert scale where "1" indicates strongly disagree and "5" indicates strongly agree with measures of effectiveness. Dermato-epidemiology curriculum is desirable and achievable even in dermatology programs without full-time epidemiologists. A successful epidemiology curriculum should be clinically and board-examination relevant, incorporating aspects of problem-based, interactive learning.
Letulé, Valerie; Herzinger, Thomas; Schirner, Astrid; Hertrich, Frank; Lange, Dirk; Ruzicka, Thomas; Molin, Sonja
Misunderstanding and stigmatisation are common problems encountered by patients with hand eczema. Various misconceptions about the disease circulate in the general population. Although hand eczema has gained more attention in dermatology during the past years, information on public perception of the disease is still lacking. The aim of our study was to investigate perception of and level of knowledge on the subject hand eczema. There were 624 patients included from 2 general medicine practices and 2 dermatological practices. A self-administered questionnaire was filled out by the participants, covering issues on history of hand eczema, level of knowledge and attitude towards a clinical photograph of hand eczema. We found that a larger proportion of individuals from dermatological practice were more familiar with hand eczema as a disease than those from general medical practice. Women knew significantly more about and had a more positive perception of the disease than men. Our results imply that the level of knowledge on hand eczema in the general public is rather low and influenced by prejudice.
Banerjee, Mayuri; Kamath, Ramachandra; Tiwari, Rajnarayan R.; Nair, Narayana Pillai Sreekumaran
Background: India being a developing country has tremendous demand of physical infrastructure and construction work as a result there is a raising demand of construction workers. Workers in construction industry are mainly migratory and employed on contract or subcontract basis. These workers face temporary relationship between employer and employee, uncertainty in working hours, contracting and subcontracting system, lack of basic continuous employment, lack basic amenities, and inadequacy in welfare schemes. Objective: To estimate the prevalence of respiratory and dermatological symptoms among migratory construction workers. Materials and Methods: This cross-sectional study was conducted in Manipal, Karnataka, among 340 male migratory construction workers. A standard modified questionnaire was used as a tool by the interviewer and the physical examination of the workers was done by a physician. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 15.0. Result: Eighty percent of the workers belong to the age group of 18–30 years. The mean age of the workers was 26 ± 8.2 years. Most (43.8%) of the workers are from West Bengal followed by those from Bihar and Jharkhand. The rates of prevalence of respiratory and dermatological symptoms were 33.2% and 36.2%, respectively. Conclusion: The migrant construction workers suffer from a high proportion of respiratory and dermatological problems. PMID:26957808
Willoughby, Mark; Willoughby, Cole; Mafong, Erick; Han, Amy
Objective: The introduction of an electronic brachytherapy delivery system into an existing general dermatology practice is described. Radiobiologic rational for the dose fractionation schedule is detailed. Design: A miniaturized 50keV x-ray tube and delivery system are United States Food and Drug Administration cleared for nonmelanoma skin cancer. The device is introduced into an existing multi-physician dermatology practice in a standard unshielded treatment room. Setting: A multi-site, multi-physician dermatology practice Results: Fifteen months following introduction of the system, a total of 524 nonmelanoma skin cancer patients have been treated. At 12.5 months follow-up, there have been four recurrences and cosmesis has been excellent. Conclusions: Advances in radiobiology and radiotechnology permit the treatment course to be given in eight fractions over four weeks. Radiation therapy for nonmelanoma skin cancer can now be given in an office setting as an alternative to Mohs surgery for appropriately selected patients. Results are comparable or better than those of surgery. Advances in radiobiology and radiotechnology permit the treatment course to be given in as few as eight fractions over four weeks. Patients are pleased with the convenience of the short course of therapy given in the office. PMID:26705437
Del Duca, Ester; Bruscino, Nicola; Conti, Rossana; Cannarozzo, Giovanni
Flash-lamp pulsed-dye laser (FPDL) is a nonablative technology, typically used in vascular malformation therapy due to its specificity for hemoglobin. FPDL treatments were performed in a large group of patients with persistent and/or recalcitrant different dermatological lesions with cutaneous microvessel involvement. In particular, 149 patients (73 males and 76 females) were treated. They were affected by the following dermatological disorders: angiokeratoma circumscriptum, genital and extragenital viral warts, striae rubrae, basal cell carcinoma, Kaposi's sarcoma, angiolymphoid hyperplasia, and Jessner-Kanof disease. They all underwent various laser sessions. 89 patients (59.7%) achieved excellent clearance, 32 patients (21.4%) achieved good-moderate clearance, 19 patients (12.7%) obtained slight clearance, and 9 subjects (6.1%) had low or no removal of their lesion. In all cases, FPDL was found to be a safe and effective treatment for the abovementioned dermatological lesions in which skin microvessels play a role in pathogenesis or development. Further and single-indication studies, however, are required to assess a standardized and reproducible method for applying this technology to “off-label” indications. PMID:27631010
Buggiani, G; Troiano, M; Rossi, R; Lotti, T
Photodynamic therapy (PDT) is a treatment technique that permits the clearance of different skin lesions with high success rates in many dermatological diseases. Worldwide recognized uses for PDT in dermatology include non-melanoma skin cancer, actinic keratoses, acne vulgaris, photorejuvenation, and hidradenitis suppurativa. In the European Union, and in the USA, its indication is for the treatment of nonhyperkeratotic actinic keratoses (AKs) of the face and scalp, for basal cell carcinoma and for Bowen's disease. However, due to its intriguing mechanism of action, many dermatologists have begun to look at the use of PDT in photorejuvenation, acne vulgaris and hidradenitis suppurativa. Moreover, clinicians have to learn how to maximize this kind of therapy to treat other dermatologic entities, and many anecdotic reports can already be found in the literature. This paper aims to briefly but critically review these reports to give the dermatologist a useful guide to what could be the future experiences in PDT and how to target their efforts in clinics and research.
Yew, Elijah; Rowlands, Christopher
This review summarizes the historical and more recent developments of multiphoton microscopy, as applied to dermatology. Multiphoton microscopy offers several advantages over competing microscopy techniques: there is an inherent axial sectioning, penetration depths that compete well with confocal microscopy on account of the use of near-infrared light, and many two-photon contrast mechanisms, such as second-harmonic generation, have no analogue in one-photon microscopy. While the penetration depths of photons into tissue are typically limited on the order of hundreds of microns, this is of less concern in dermatology, as the skin is thin and readily accessible. As a result, multiphoton microscopy in dermatology has generated a great deal of interest, much of which is summarized here. The review covers the interaction of light and tissue, as well as the various considerations that must be made when designing an instrument. The state of multiphoton microscopy in imaging skin cancer and various other diseases is also discussed, along with the investigation of aging and regeneration phenomena, and finally, the use of multiphoton microscopy to analyze the transdermal transport of drugs, cosmetics and other agents is summarized. The review concludes with a look at potential future research directions, especially those that are necessary to push these techniques into widespread clinical acceptance. PMID:25075226
Leo, Michael S; Kumar, Alur S; Kirit, Raj; Konathan, Rajyalaxmi; Sivamani, Raja K
Platelet-rich plasma (PRP) is a highly concentrated autologous solution of plasma prepared from a patient's own blood. PRP contains platelets that are purported to release numerous growth factors that may be valuable in numerous dermatologic applications. Here, we review systematically the clinical cosmetic applications of PRP including: androgenetic alopecia, scar revision, acne scars, skin rejuvenation, dermal augmentation, and striae distensae to understand the potential and best practices for PRP use. A systematic search was conducted on three databases: Pubmed, Embase, and Web of Science. Publications were included if they were in English, investigated the clinical applications of PRP in aesthetic dermatology and reported clinical results either as case reports or clinical studies. There were a total of 22 manuscripts that fulfilled these criteria. Four evaluated hair-related applications, eight evaluated the treatment of scars and postprocedure recovery, eight evaluated skin rejuvenation and dermal augmentation, and two evaluated treatment of striae distensae. PRP is a relatively new treatment modality with studies suggesting its utility in aesthetic dermatology. The combination of PRP with other therapies is particularly interesting. Future studies should include controls, including incorporation of split-face comparisons, to reduce intersubject variability.
Afifi, Ladan; Shinkai, Kanade
Inpatient dermatology consultative services care for hospitalized patients with skin disease in collaboration with the primary inpatient team. Effective, efficient communication is important. A consultation service must develop strong relationships with primary inpatient teams requesting consults in order to provide optimal patient care. Prior studies have identified effective communication practices for inpatient consultative services. This narrative review provides a summary of effective communication practices for an inpatient dermatology consultation service organized into 5 domains: (1) features of the initial consult request; (2) best practices in responding to the initial consult; (3) effective communication of recommendations; (4) interventions to improve consultations; and (5) handling curbside consultations. Recommendations include identifying the specific reason for consult; establishing urgency; secure sharing of sensitive clinical information such as photographs; ensuring timely responses; providing clear yet brief documentation of the differential diagnosis, problem list, final diagnosis and recommendations; and limiting curbside consultations. Future studies are needed to validate effective strategies to enhance communication practices within an inpatient dermatology consultative service.
Tomas-Aragones, Lucía; Consoli, Silla M; Consoli, Sylvie G; Poot, Francoise; Taube, Klaus-Michael; Linder, M Dennis; Jemec, Gregor B E; Szepietowski, Jacek C; de Korte, John; Lvov, Andrey N; Gieler, Uwe
The classification of self-inflicted skin lesions proposed by the European Society for Dermatology and Psychiatry (ESDaP) group generated questions with regard to specific treatments that could be recommended for such cases. The therapeutic guidelines in the current paper integrate new psychotherapies and psychotropic drugs without forgetting the most important relational characteristics required for dealing with people with these disorders. The management of self-inflicted skin lesions necessitates empathy and a doctor-patient relationship based on trust and confidence. Cognitive behavioural therapy and/or psychodynamic and psychoanalytic psychotherapy (alone, or combined with the careful use of psychotropic drugs) seem to achieve the best results in the most difficult cases. Relatively new therapeutic techniques, such as habit reversal and mentalization-based psychotherapy, may be beneficial in the treatment of skin picking syndromes.
Kuhn, A; Aberer, E; Bata-Csörgő, Z; Caproni, M; Dreher, A; Frances, C; Gläser, R; Klötgen, H-W; Landmann, A; Marinovic, B; Nyberg, F; Olteanu, R; Ranki, A; Szepietowski, J C; Volc-Platzer, B
Cutaneous lupus erythematosus (CLE) is a rare inflammatory autoimmune disease with heterogeneous clinical manifestations. To date, no therapeutic agents have been licensed specifically for patients with this disease entity, and topical and systemic drugs are mostly used 'off-label'. The aim of the present guideline was to achieve a broad consensus on treatment strategies for patients with CLE by a European subcommittee, guided by the European Dermatology Forum (EDF) and supported by the European Academy of Dermatology and Venereology (EADV). In total, 16 European participants were included in this project and agreed on all recommendations. Topical corticosteroids remain the mainstay of treatment for localized CLE, and further topical agents, such as calcineurin inhibitors, are listed as alternative first-line or second-line topical therapeutic option. Antimalarials are recommended as first-line and long-term systemic treatment in all CLE patients with severe and/or widespread skin lesions, particularly in patients with a high risk of scarring and/or the development of systemic disease. In addition to antimalarials, systemic corticosteroids are recommended as first-line treatment in highly active and/or severe CLE. Second- and third-line systemic treatments include methotrexate, retinoids, dapsone and mycophenolate mofetil or mycophenolate acid, respectively. Thalidomide should only be used in selected therapy-refractory CLE patients, preferably in addition to antimalarials. Several new therapeutic options, such as B-cell- or interferon α-targeted agents, need to be further evaluated in clinical trials to assess their efficacy and safety in the treatment of patients with CLE.
Quave, Cassandra L; Pieroni, Andrea; Bennett, Bradley C
Background Dermatological remedies make up at least one-third of the traditional pharmacopoeia in southern Italy. The identification of folk remedies for the skin is important both for the preservation of traditional medical knowledge and in the search for novel antimicrobial agents in the treatment of skin and soft tissue infection (SSTI). Our goal is to document traditional remedies from botanical, animal, mineral and industrial sources for the topical treatment of skin ailments. In addition to SSTI remedies for humans, we also discuss certain ethnoveterinary applications. Methods Field research was conducted in ten communities in the Vulture-Alto Bradano area of the Basilicata province, southern Italy. We randomly sampled 112 interviewees, stratified by age and gender. After obtaining prior informed consent, we collected data through semi-structured interviews, participant-observation, and small focus groups techniques. Voucher specimens of all cited botanic species were deposited at FTG and HLUC herbaria located in the US and Italy. Results We report the preparation and topical application of 116 remedies derived from 38 plant species. Remedies are used to treat laceration, burn wound, wart, inflammation, rash, dental abscess, furuncle, dermatitis, and other conditions. The pharmacopoeia also includes 49 animal remedies derived from sources such as pigs, slugs, and humans. Ethnoveterinary medicine, which incorporates both animal and plant derived remedies, is addressed. We also examine the recent decline in knowledge regarding the dermatological pharmacopoeia. Conclusion The traditional dermatological pharmacopoeia of Vulture-Alto Bradano is based on a dynamic folk medical construct of natural and spiritual illness and healing. Remedies are used to treat more than 45 skin and soft tissue conditions of both humans and animals. Of the total 165 remedies reported, 110 have never before been published in the mainland southern Italian ethnomedical literature. PMID
The postural orthostatic tachycardia syndrome is a disease characterized by excessively increased heart rate during orthostatic challenge associated with symptoms of orthostatic intolerance including dizziness, exercise intolerance, headache, fatigue, memory problems, nausea, blurred vision, pallor, and sweating, which improve with recumbence. Postural orthostatic tachycardia syndrome patients may present with a multitude of additional symptoms that are attributable to vascular vasoconstriction. Observed signs and symptoms in a patient with postural orthostatic tachycardia syndrome include tachycardia at rest, exaggerated heart rate increase with upright position and exercise, crushing chest pain, tremor, syncope, loss of vision, confusion, migraines, fatigue, heat intolerance, parasthesia, dysesthesia, allodynia, altered traditional senses, and thermoregulatory abnormalities. There are a number of possible dermatological manifestations of postural orthostatic tachycardia syndrome easily explained by its recently discovered pathophysiology. The author reports the case of a 22-year-old woman with moderate-to-severe postural orthostatic tachycardia syndrome with numerous dermatological manifestations attributable to the disease process. The cutaneous manifestations observed in this patient are diverse and most noticeable during postural orthostatic tachycardia syndrome flares. The most distinct are evanescent, hyperemic, sharply demarcated, irregular patches on the chest and neck area that resolve upon diascopy. This distinct "evanescent hyperemia" disappears spontaneously after seconds to minutes and reappears unexpectedly. Other observed dermatological manifestations of this systemic disease include Raynaud's phenomenon, koilonychia, onychodystrophy, madarosis, dysesthesia, allodynia, telogen effluvium, increased capillary refill time, and livedo reticularis. The treatment of this disease poses a great challenge. The author reports the unprecedented use of an oral
Haddad Junior, Vidal
Contact between humans and coastal areas has increased in recent decades, which has led to an increase in injuries from aquatic animals. The majority of these present dermatological manifestations, and some of them show typical lesions. The highest percentages of injuries that occur in marine environments are associated with invertebrates such as sea urchins, jellyfish and Portuguese men-of-war (echinoderms and cnidarians). In this review, we discuss the clinical, therapeutic and preventive aspects of injuries caused by marine and freshwater invertebrates, focusing on first aid measures and diagnosis for dermatologists and professionals in coastal areas. PMID:24068119
Godoy-Gijón, Elena; Meseguer-Yebra, Carmen; Palacio-Aller, Lucía; Godoy-Rocati, Diego Vicente; Lahoz-Rallo, Carlos
The increased cardiovascular risk in some dermatological diseases has been demonstrated in recent decades. Diseases such as psoriasis and systemic lupus erythematosus are currently included in the guidelines for prevention of cardiovascular disease. Other diseases such as androgenic alopecia, polycystic ovary syndrome, hidradenitis suppurativa or lichen planus have numerous studies that point to an increased risk, however, they have not been included in these guidelines. In this article we review the evidence supporting this association, in order to alert the clinician to the need for greater control in cardiovascular risk factors in these patients.
Padilla-España, Laura; Ramírez-López, Belén; Fernández-Sánchez, Encarnación
There are certain skin disorders such as vitiligo, acne, vascular malformations and postoperative scars that can affect the quality of life of children and especially adolescents. It can become an obstacle to their psychosocial development. A review was conducted on 4 patients with vitiligo located on face, who took part in a camouflage treatment course from January to December 2012. The impact of the skin disorder on quality of life was assessed before and after the therapeutic make-up sessions. Corrective makeup can be a complementary, reproducible, cost-effective, non-invasive, and useful technique in the management of dermatological diseases that have a physical and emotional impact in childhood.
Deo, Maneka S; Vandal, Alain C; Jarrett, Paul
Objectives To estimate the prevalence of dermatological disease in aged care facilities, and the relationship between cognitive or physical disability and significant disease. Setting 2 large aged care facilities in Auckland, New Zealand, each providing low and high level care. Participants All 161 residents of the facilities were invited to participate. The only exclusion criterion was inability to obtain consent from the individual or designated guardian. 88 participants were recruited—66 females (75%), 22 males (25%) with average age 87.1 years (SD 5.5 years). Primary and secondary outcome measures Primary—presence of significant skin disease (defined as that which in the opinion of the investigators needed treatment or was identified as a patient concern) diagnosed clinically on full dermatological examination by a dermatologist or dermatology trainee. Secondary—functional and cognitive status (Rehabilitation Complexity Scale and Abbreviated Mental Test Score). Results 81.8% were found to have at least one significant condition. The most common disorders were onychomycosis 42 (47.7%), basal cell carcinoma 13 (14.8%), asteototic eczema 11 (12.5%) and squamous cell carcinoma in situ 9 (10.2%). Other findings were invasive squamous cell carcinoma 7 (8%), bullous pemphigoid 2 (2.3%), melanoma 2 (2.3%), lichen sclerosus 2 (2.3%) and carcinoma of the breast 1 (1.1%). Inflammatory disease was more common in those with little physical disability compared with those with serious physical disability (OR 3.69; 95% CI 1.1 to 12.6, p=0.04). No significant association was found between skin disease and cognitive impairment. Conclusions A high rate of dermatological disease was found. Findings ranged from frequent but not life-threatening conditions (eg, onychomycosis), to those associated with a significant morbidity (eg, eczema, lichen sclerosus and bullous pemphigoid), to potentially life-threatening (eg, squamous cell carcinoma, melanoma and breast cancer
Fathi, Ramin; Pfeiffer, Margaret L; Tsoukas, Maria
There is a high demand for facial aesthetic enhancement, and the periorbital region is one of the first areas to show signs of aging. Many nonsurgical therapies exist to tackle these problems. These therapies are becoming more efficacious while reducing postprocedural recovery time. The goal is to restore the natural youthful appearance rather than to create an effect that differs from the patient's appearance earlier in life. Eyelid care, and cosmetic dermatology in general, intends to restore balance and symmetry. We discuss the initial consultation, relevant anatomy for the dermatologist, and medical, laser and cosmetic therapies.
Guerra-Rosas, Esperanza; Álvarez-Borrego, Josué
In this paper a new methodology for the diagnosing of skin cancer on images of dermatologic spots using image processing is presented. Currently skin cancer is one of the most frequent diseases in humans. This methodology is based on Fourier spectral analysis by using filters such as the classic, inverse and k-law nonlinear. The sample images were obtained by a medical specialist and a new spectral technique is developed to obtain a quantitative measurement of the complex pattern found in cancerous skin spots. Finally a spectral index is calculated to obtain a range of spectral indices defined for skin cancer. Our results show a confidence level of 95.4%.
In the late 1950s and early1960s, there was a concerted effort to modernize teaching, training, and patient care in the Vargas Hospital of Caracas, Venezuela. The above included the development of research in the frame of postgraduate training. This effort was to be helped by USA funds and institutions but could only be achieved by the work of Venezuelans, sharing a vision of progress. Dermatology spearheaded this initiative, and the fruit of this was the exponential development of Venezuelan Dermatology and the creation of the National Institute of Dermatology on the grounds of the Vargas Hospital. The purpose of this contribution is to review these events that happened more than half a century ago from my own perspective. I sincerely hope that these lines could serve as an inspiration to the younger generations that toil today under less-than-favorable conditions.
Torii, Hideshi; Sueki, Hirohiko; Kumada, Hiromitsu; Sakurai, Yuko; Aoki, Keiji; Yamada, Ichimaro; Ohtsuki, Mamitaro
Telaprevir-based triple therapy is highly effective for chronic hepatitis C. However, concern has been expressed over the high frequency and severity of its dermatological side-effects compared with those associated with peginterferon (PEG-IFN) and ribavirin (RBV) therapy. Thus, here, we evaluated the dermatological adverse reactions of telaprevir-based triple therapy in Japanese multicenter phase III clinical trials in an attempt to characterize the dermatological side-effects and establish appropriate management plans. In these trials, 126 treatment-naïve patients and 141 treatment-failure patients were administrated telaprevir, PEG-IFN-α-2b and RBV for 12 weeks followed by PEG-IFN-α-2b and RBV for another 12 weeks (T12/PR24 group), and 63 treatment-naïve patients were administrated PEG-IFN-α-2b and RBV for 48 weeks (PR48 group). Dermatological adverse reactions developed in over 80% patients in both groups, and most of them were grade 1 or 2. In the T12/PR24 group, there were more grade 2 or grade 3 events, and the time to onset was earlier than that in the PR48 group. Most reactions could be managed with topical corticosteroids and oral antihistamines, and the rates of discontinuation due to dermatological reactions were not high even in the T12/PR24 group. In the T12/PR24 group, however, two cases of Stevens-Johnson syndrome and one case of drug rash with eosinophilia and systemic symptoms, which corresponds to drug-induced hypersensitivity syndrome in Japan, were reported. For appropriate treatments of individual dermatological adverse reactions, the judgment of discontinuation of antiviral drugs and treatment based on the severity are extremely important in this triple therapy.
Lenzi, Maria E R; Cuzzi-Maya, Tullia; Oliveira, André L A; Andrada-Serpa, Maria J; Araújo, Abelardo Q-C
Dermatological findings for patients with human T lymphotropic virus type 1(HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) were investigated and were compared with dermatological findings for a control group. Only xerosis, cutaneous candidiasis, and palmar erythema were significantly associated with HAM/TSP. Histopathological patterns of cutaneous lymphoma were seen in 25% of 32 patients who underwent biopsy, and, thus, the cutaneous alterations in HAM/TSP can be classified into nonspecific lesions, infectious lesions, immune-inflammatory-mediated lesions, and premalignant or malignant lesions.
Dantas, Lia Dias Pinheiro; Bakos, Lucio; Balbinot, Gabriela; Drechsler, Carine Elisabete Rost; Eidt, Letícia Maria
Skin diseases are common in hospitalized patients. However, there is a lack of data concerning their frequency. The objective of this study is to evaluate the prevalence of dermatological diagnoses in hospitalized patients after consultation requested by nondermatologist physicians to the Department of Dermatology, Hospital de Clinicas de Porto Alegre period of 10 years. A total of 5685 patients were evaluated, representing an average of 48.2 patients per month. The five most frequent groups were infectious dermatoses(33.25%), eczematous dermatoses (11.49%), drug reactions (11.43%), vascular dermatoses (6.81%) and group of pruritus, prurigo nodularis and urticaria (hives) (4.71%). PMID:26560228
Abdullah, Shaad E.; Haigentz, Missak; Piperdi, Bilal
Epidermal growth factor receptor (EGFR) inhibition has now been well established as an effective treatment for various cancers. The EGFR belongs to the ErbB family of tyrosine kinase receptors which regulate tumor cell differentiation, survival and proliferation. Activation of EGFR drives tumorigenesis in lung, head and neck, colorectal and pancreatic cancers. Irrespective of the type of cancer being treated and the mechanism by which tumor EGFR drives tumorigenesis, the major side effect of EGFR inhibition is a papulopustular (also described as maculopapular or acneiform) rash which occurs in about two thirds of treated patients. Interestingly, this rash has been commonly correlated with better clinical outcomes (objective tumor response and patient survival). The pathophysiology of dermatological toxicity from EGFR inhibitors is an important area of clinical research, and the proper management of the rash is essential to increase the therapeutic index from this class of drugs. In this paper, we review the dermatologic toxicities associated with EGFR inhibitors with an emphasis on its pathophysiology and clinical management. PMID:22997576
Yamamoto, Yoshihisa; Kumetani, Moemi; Onuki, Yoshinori; Koide, Tatsuo; Suzuki, Toyofumi; Fukami, Toshiro
The present study examined the stability of mixtures of various combinations of moisturizers, water in oil (w/o)-type or oil in water (o/w)-type cream preparations containing heparinoids, and steroidal ointments or creams (o/w-type) frequently used in children. Centrifugation at room temperature led to separation of mixtures of w/o-type moisturizers and steroidal ointments into three layers. Polarized microscopic observations, near-infrared (NIR) spectroscopy, and dye-based analyses revealed the presence of oily components in the upper and middle layers and water-soluble components in the lower layer. Separation into three layers upon centrifugation was also observed for mixtures of o/w-type moisturizers and steroidal ointments. In contrast, neither the o/w-type moisturizer and steroidal cream nor the w/o-type moisturizer and steroidal cream mixtures separated into layers upon centrifugation. Consideration of the characteristics of each preparation is necessary when mixing external-application dermatologic preparations. Centrifugation at 4°C did not result in layer separation of the w/o-type moisturizer and steroidal ointment mixture, suggesting that cold storage of such mixtures provides superior stability compared with room temperature storage. However, despite no obvious layer separation, the NIR spectra indicated that water movement was induced within the mixture. These results clearly indicate that methods such as NIR spectroscopy are useful for early determinations of the stability of mixed external-application dermatologic preparations.
Gupta, M A; Gupta, A K
We examined the prevalence of depression (measured by the Carroll Rating Scale for Depression, CRSD), wishes to be dead and acute suicidal ideation among 480 patients with dermatological disorders that may be cosmetically disfiguring, i.e. non-cystic facial acne (n = 72; 5.6% suicidal ideation), alopecia areata (n = 45; 0% suicidal ideation), atopic dermatitis (n = 146; 2.1% suicidal ideation) and psoriasis (79 outpatients, 2.5% suicidal ideation and 138 inpatients, 7.2% suicidal ideation). Analysis of variance revealed that the severely affected psoriasis inpatients (mean +/- SD total body surface area affected: 52 +/- 23.4%) had the highest (P < 0.05) CRSD score, followed by the patients with mild to moderate acne; both scores were in the range for clinical depression (CRSD score > 10). The 5.6-7.2% prevalence of active suicidal ideation among the psoriasis and acne patients was higher than the 2.4-3.3% prevalence reported among general medical patients. Our findings highlight the importance of recognizing psychiatric comorbidity, especially depression, among dermatology patients and indicate that in some instances even clinically mild to moderate disease such as non-cystic facial acne can be associated with significant depression and suicidal ideation.
Salgado, Ana; Gonçalves, Lídia; Pinto, Pedro C.; Urbano, Manuela; Ribeiro, Helena M.
It is of crucial importance to evaluate the safety profile of the ingredients used in dermatological emulsions. A suitable equilibrium between safety and efficacy is a pivotal concern before the marketing of a dermatological product. The aim was to assess the safety and biological effects of a new cold processed silicone-based emulsion (SilEmulsion). The hazard, exposure, and dose-response assessment were used to characterize the risk for each ingredient. EpiSkin assay and human repeat insult patch tests were performed to compare the theoretical safety assessment to in vitro and in vivo data. The efficacy of the SilEmulsion was studied using biophysical measurements in human volunteers during 21 days. According to the safety assessment of the ingredients, 1,5-pentanediol was an ingredient of special concern since its margin of safety was below the threshold of 100 (36.53). EpiSkin assay showed that the tissue viability after the application of the SilEmulsion was 92 ± 6% and, thus considered nonirritant to the skin. The human studies confirmed that the SilEmulsion was not a skin irritant and did not induce any sensitization on the volunteers, being safe for human use. Moreover, biological effects demonstrated that the SilEmulsion increased both the skin hydration and skin surface lipids. PMID:24294598
Raposo, Sara; Salgado, Ana; Gonçalves, Lídia; Pinto, Pedro C; Urbano, Manuela; Ribeiro, Helena M
It is of crucial importance to evaluate the safety profile of the ingredients used in dermatological emulsions. A suitable equilibrium between safety and efficacy is a pivotal concern before the marketing of a dermatological product. The aim was to assess the safety and biological effects of a new cold processed silicone-based emulsion (SilEmulsion). The hazard, exposure, and dose-response assessment were used to characterize the risk for each ingredient. EpiSkin assay and human repeat insult patch tests were performed to compare the theoretical safety assessment to in vitro and in vivo data. The efficacy of the SilEmulsion was studied using biophysical measurements in human volunteers during 21 days. According to the safety assessment of the ingredients, 1,5-pentanediol was an ingredient of special concern since its margin of safety was below the threshold of 100 (36.53). EpiSkin assay showed that the tissue viability after the application of the SilEmulsion was 92 ± 6% and, thus considered nonirritant to the skin. The human studies confirmed that the SilEmulsion was not a skin irritant and did not induce any sensitization on the volunteers, being safe for human use. Moreover, biological effects demonstrated that the SilEmulsion increased both the skin hydration and skin surface lipids.
Vijayamohan, N.; Nair, S. Pradeep
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a cause of increased morbidity and mortality in debilitated and immunocompromised patients. Aims and Objectives: To study the prevalence of MRSA among dermatology inpatients and elucidate its predisposing factors and antibiotic sensitivity pattern. Materials and Methods: This prospective study involved all the inpatients in the dermatology ward with suspected bacterial infections, both primary and secondary. Gram's stain, pus culture, and antibiotic sensitivity were the main tests done. Results: There were 61 patients in this study, with 36 males (59%) and 25 females (41%). The age group maximally affected was 41-50 years (21.6%). Vesiculobullous disorders (22, 36.1%) and eczemas (16, 26.2%) were the commonest dermatoses with secondary infection. Extremities (72.1%) and the trunk (26.2%) were the commonest sites involved. Diabetes mellitus (DM) was the commonest systemic illness (11.5%). Staphylococcus aureus was the commonest isolate, grown in 52 patients (85.2%) of whom 16 (30.80%) were MRSA positive. MRSA constituted 22.2% of the total bacterial isolates. All the MRSA isolates (100%) were resistant to cloxacillin and oxacillin, while all the isolates (100%) were sensitive to vancomycin and linezolid. Conclusions: The prevalence of MRSA in this study was high. It was most commonly seen in patients with vesiculobullous disorders. A high sensitivity of MRSA was found to amikacin. There was no relation between prolonged antibiotic therapy and MRSA in this study. PMID:25396125
Momesso, Roberta G. R. A. P.; Moreno, Carolina S.; Rogero, Sizue O.; Rogero, José R.; Spencer, Patrick J.; Lugão, Ademar B.
The polyphenol trans-resveratrol is a natural phytoalexin, which is found in red wine and in a wide variety of plant species. Resveratrol displays a wide array of biological activities, such as modulation of lipid metabolism, anti-inflammatory and antioxidant activities. This active compound immobilized in polyvinylpyrrolidone (PVP) hydrogel could be very interesting for topical administration, as a dressing form for dermatological use. However, PVP hydrogel obtained by radiation-induced crosslinking can cause undesirable hydrolysis reactions in the active compound. The aim of this work was to verify the resveratrol stability after irradiation at 0.5 and 1 kGy in the presence of ethanol, methanol or tert-butyl alcohol. The integrity of these samples was compared to unirradiated resveratrol by HPLC. The PVP hydrogel matrix was characterized by gel fraction, swelling and in vitro biocompatibility test. The results of gel fraction and swelling degree were approximately 90% and 1600%, respectively. The cytotoxicity assay showed absence of toxicity for this formulation after crosslinking and sterilization, indicating that the PVP hydrogel formulation was appropriate for resveratrol immobilization to produce a dressing for dermatological use.
Xiang, W. Z.; Xu, A. E.; Xu, J.; Bi, Z. G.; Shang, Y. B.; Ren, Q. S.
Confocal laser scanning microscopy (CLSM) allows noninvasive visualization of human skin in vivo, without needing to fix or section the tissue. Melanocytes and pigmented keratinocytes at the level of the basal layer form bright dermal papillary rings which are readily amenable to identify in confocal images. Our purpose was to explore the role of dermal papillary rings in assessment of lesion location, the diagnosis, differential diagnosis of lesions and assessment of therapeutic efficacy by in vivo CLSM. Seventy-one patients were imaged with the VivaScope 1500 reflectance confocal microscope provided by Lucid, Inc. The results indicate that dermal papillary rings can assess the location of lesion; the application of dermal papillary rings can provide diagnostic support and differential diagnosis for vitiligo, nevus depigmentosus, tinea versicolor, halo nevus, common nevi, and assess the therapeutic efficacy of NBUVB phototherapy plus topical 0.1 percent tacrolimus ointment for vitiligo. In conclusion, our findings indicate that the dermal papillary rings play an important role in the assessment the location of lesion, diagnosis, differential diagnosis of lesions and assessment of therapeutic efficacy by in vivo CLSM. CLSM may be a promising tool for noninvasive examination in dermatology. However, larger studies are needed to expand the application of dermal papillary rings in dermatology.
The author examines different aspects of patient-doctor relationship in dermatological consultations. At first, a definition of patients satisfaction is given, based on available literature. It has been shown that satisfaction depends on diagnosis, but also on the doctor's ability to provide explanations on the probable cause of the illness, information on how long the symptom will probably last, and if she/he demonstrates empathy. Satisfaction also increases if the illness is serious, but decreases if quality of life linked to the symptom is underestimated by the doctor. After providing a philosophical definition of ethics, which emphasizes the importance of mutual satisfaction of patient and doctor, the concepts of empathy and compassion in patient-doctor relations are defined. Their importance in consultations is underlined, reporting, for example, that doctors with good communication skills experience fewer difficult consultations (8% vs. 23%). Afterwards, the dermatological consultation is analysed in its practical aspects, trying to define a good-quality consultation. First of all, the pitfalls that can affect good time management are analysed, suggesting to structure the consultation using the Soap method. Particular situations are analysed, such as announcing bad news and dealing with borderline patients. Finally, the concept of transference is defined, remembering that doctor-patient relationships can replay some difficult relationship coming from the past, and thus doctors need to be aware of this possibility and learn how to manage it.
Casanova, J M; Soria, X; Borrego, L; De Argila, D; Ribera, M; Pujol, R M
A portfolio is a collection of material documenting reflection about practice. It contains documents (eg, case histories and questionnaires the resident has used), images, and video recordings that reveal that an individual has acquired the competencies needed for professional practice. This assessment tool simultaneously supports learning and provides evidence for certifying competence. The adoption of portfolio use by a dermatology department requires the support of both the training supervisor and the chief of department. The learning objectives defined by the National Board for Medical-Surgical Dermatology and Venereology must be taken into consideration so that ways to assess each objective can be included; this approach supports holistic ongoing education as well as the certification of competencies the resident finally achieves. Use of portfolios in medical residency training can improve on current assessment methods, which we believe lack precision. We propose that portfolios gradually begin to replace the resident's training log. We are currently developing an online software application that will facilitate the use of portfolios.
de Cabalier, M E; Chalub, D M
We present a learning experience conducted in the Chair of Dermatology Clinic of the Faculty of Medical Sciences, National University of Cordoba in the context of curriculum change. For comprehension,present a theoretical framework and practical from the conceptualization of the "portfolio" teaching and its role teaching and learning paradigms sustained constructivist medical education. The portfolio Teach-ing is not a collection of papers, but a coherent set of experiences led thoughtful learning between teachers and students. This resource allows to account for the "qualitative achievements" of students from their work produced, sorted and evaluated in a carefully planned sequence of experiences and case Dermatology Clinic. To introduce the teaching portfolio, the planned new student grouping shapes and a sequence of learning experiences for the construction of this resource, namely: "The development of theoretical material iconographic resources and working guidelines for students. "The clinical reasoning on a case or laboratory experience-Clinical case Discussion and bibliography. -The development of records to from observation of patients. "The study of clinical cases: diagnosis and evolution of clinical cases. Interconsultations-Registration and referrals. "The magazine room and sharing experiences. In each of these, production, tutorial feedback Team teaching and assessment tasks allowed assessment approach to learning and improving he achievements of the students to the approval of the subject.
... Annual Meeting 2013 OMED Schedule Needs Assessments Speaker Bios Meeting Feedback 2014 Midyear Meeting Attestation 2014 Midyear ... the skin which can contain fluid or solid material. DYSPLASIA - An ATYPICAL proliferation of cells. This may ...
Skin changes are common in children. Common concerns are birthmarks (e.g., hemangiomas and port wine stains), atopic and contact dermatitis, acne, and alopecia areata. The authors review advances in common and not so common skin changes in pediatric patients. PMID:28360970
... curette" does a similar task with a special scraping tool. These are often done to remove a ... about PUVA Phototherapy . ELECTRODESICCATION AND CURETTAGE (ED&C) Scraping or burning-off skin growths (also known as ...
Shmidt, Eugenia; Levitt, Jacob
Head lice are transmitted by head to head contact. Optimal therapy includes malathion lotion 0.5% repeated in one week left on for 30 minutes to 8 hours. Spinosad topical suspension 0.9% repeated in one week left on for 10 minutes is another option. Scabies is transmitted mainly by direct contact but also via heavily infested fomites due to crusted scabies. Permethrin 5% cream to the body repeated in four days is often sufficient; however, scalp treatment with malathion lotion 0.5% is helpful in crusted scabies and in infested children. Oral ivermectin 200 mcg/kg is another option, repeated in four days. For scabies more than lice, fomites should be placed in a drier at 60 °C for 10 minutes to kill the arthropods. Treatment of close contacts in both cases will control outbreaks and repeated infestations. Both have been associated with methicillin-resistant Staphylococcus aureus infection. Bed bugs are a common cause for papular urticaria. Identification of the insect in the mattress or bedding confirms the diagnosis. Prevention involves encasing the mattress in a sealed plastic cover and extermination. Delusions of parasitosis is a diagnosis of exclusion that is best treated with an antipsychotic.
Downes, Elizabeth A; Connor, Ann; Howett, Maeve
The purpose of this article is to describe a novel service–learning opportunity for graduate nursing students that promotes competency in dermatology. A hybrid service–learning course with online didactic content is described, along with tools for evaluation of dermatology competencies. Student evaluation of the course is discussed, and selected research articles are reviewed. Advanced practice nursing and medical education frequently does not adequately prepare primary care providers to be competent in the assessment and management of dermatologic conditions. Embedding dermatology content in a service–learning program can optimize the provision of care, strengthen competencies in dermatology and inter-professional care, and allow students to gain a deeper understanding of the population with which they work. The innovative service–learning program presented is a model for advanced practice nursing education. Tools for evaluating clinical competency and courses often need validation.
Surber, C; Elsner, P; Singh, J
The purpose of the present article is to briefly highlight some contributions of Prof. Howard I. Maibach to the field of dermatology. After a few introducing remarks regarding Howard's personal career, the article specifically reviews contributions to the understanding of percutaneous absorption and to occupational dermatology. He and his companions/coworkers established and introduced experimental prerequisites to better study and understand percutaneous absorption - both in vitro and in vivo. Not less influential was his contribution to occupational dermatology acting as a founding member of the International Contact Dermatitis Research Group and coinaugurating the North American Contact Dermatitis Group. These groups have been very active ever since. As an academic teacher, he inspired young colleagues to perform original research work and to establish their own working groups. He has done this most successfully with many fellows who worked with him over the years, and who are now leading departments or companies dedicated to dermatological research all over the world. Probably this is his most important and lasting achievement.
Monroe, Holly; Orengo, Ida; Rosen, Theodore
Background: Needlestickand sharps injuries are the leading causes of morbidity in the dermatologicfield. Among medical specialties, surgeons and dermatologists have the highest rates of needlestickand sharps injuries.The high rates of needlestickand sharps injuries in dermatology not only apply to physicians, but also to nurses, physician assistants, and technicians in the demnatologic field. Needlestickand sharps injuries are of great concern due to the monetary, opportunity, social, and emotional costs associated with their occurrence. Objective: A review of preventative techniques and post-exposure protocols for the majortypes of sharps injuries encountered in dermatologic practice. Design: The terms “needle-stick injuryT’sharps injuryTdermatologic surgery? “post-exposure prophylaxis,”and “health-care associated injury” were used in combinations to search the PubMed database. Relevant studies were reviewed for validity and included. Results The authors discuss the major types of sharps injuries that occur in the dermatologic surgery setting and summarize preventative techniques with respect to each type of sharps injury.The authors also summarize and discuss relevant post-exposure protocols in the event of a sharps injury. Conclusion: The adoption of the discussed methods, techniques, practices, and attire can result in the elimination of the vast majority of dermatologic sharps injuries. PMID:27847548
Sivek, Rachel; Marciniak, Brian
Competitive athletes endure extreme bodily stress when participating in sports-related activities. An athlete’s skin is particularly susceptible to a wide array of repetitive physical and environmental stressors that challenge the skin’s protective function. Many unique dermatoses are well-known to the serious athlete due to countless hours of intense physical training, but are frequently unrecognized by many healthcare professionals. Sports dermatology is a distinctive, budding field of dermatology that focuses on dermatoses frequently encountered in athletes. Athletic skin problems are notoriously infectious in nature due to the inherent environment of close-contact physical activity. Nonetheless, other skin conditions can manifest or worsen with recurring mechanical or traumatic injury or exposure to environmental hazards. Additionally, sports-related activities may exacerbate other pre-existing dermatological conditions that may possibly be unknown to the athlete or clinician. The objective of this two-part review is to arm the astute physician with the fundamental knowledge of the range of dermatological conditions distinct to the competitive athlete. Knowledge of these cutaneous conditions in the context of specific sporting events will permit the clinician to manage these unique patients most effectively. Part one will focus on traumatic or mechanical injuries, inflammatory conditions, and exacerbations of pre-existing conditions frequently seen in athletes. PMID:26060516
... plastic surgery and in dermatology. 878.4810 Section 878.4810 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4810 Laser surgical instrument for use in general and plastic surgery and...
... plastic surgery and in dermatology. 878.4810 Section 878.4810 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4810 Laser surgical instrument for use in general and plastic surgery and...
... plastic surgery and in dermatology. 878.4810 Section 878.4810 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4810 Laser surgical instrument for use in general and plastic surgery and...
Jamil, Adawiyah; Muthupalaniappen, Leelavathi; Md Nor, Norazirah; Siraj, Harlina Halizah; Salam, Abdus
Background Dermatology is a minor module in internal medicine undergraduate curriculum. Limited time is allocated for its teaching. Most graduates are inadequately prepared to diagnose and manage skin diseases. We aimed to identify the core content of a more effective dermatology module. Methods A modified Delphi method was used to reach a consensus. A questionnaire was developed by a selected panel and sent to 20 dermatologists, family physicians and general practitioners (GPs), respectively. They were asked to rate diseases according to importance. The participants then answered the questionnaire again with results of the first round made available to them. The final module content was identified based on the panel’s collective opinions. Results Eleven topics had mode and median values of 1 with an agreement level of more than 70%. They were as follows: (1) skin structure and function; (2) infections and infestations; (3) the skin in systemic diseases; (4) dermatology emergencies; (5) drug eruptions; (6) psoriasis; (7) eczema; (8) sexually transmitted infections; (9) leprosy; (10) acne; and (11) clinical skills and diagnostic procedures. A total of 56 diseases were identified as important. Conclusion Results of this study reflect the importance of understanding the influence of regional factors on common and important skin diseases. These topics may be used to develop a more effective dermatology module for the Malaysian undergraduate medical curriculum. PMID:27418873
Vides, Juliana Peloi; Schwardt, Tatianna Frate; Sobrinho, Ludmila Silva Vicente; Marinho, Márcia; Laurenti, Márcia Dalastra; Biondo, Alexander Welker; Leutenegger, Christian; Marcondes, Mary
Although dogs are considered the main domestic reservoirs for Visceral Leishmaniosis (VL), which is caused in the Americas by Leishmania chagasi, infected cats have also been recently found in endemic areas of several countries and became a public health concern. Accordingly, the purpose of this study was to evaluate cats with dermatologic lesions from an endemic area of VL and the natural infection of L. chagasi. A total of 55 cats were selected between April 2008 and November 2009 from two major animal shelters of Araçatuba, Southeastern Brazil. All cats underwent general and dermatologic examinations, followed by direct parasitological examination of lymphoid organs, immunosorbent assay (ELISA) and indirect immunofluorescence (IFAT). In addition, detection of amastigotes was performed by immunohistochemistry (IHC) in skin lesions of all cats. VL was diagnosed in 27/55 (49.1%) cats with dermatological problems. Amastigotes were found in lymphoid organs of 10/27 (37.0%) cats; serology of 14/27 (51.9%), 6/27 (22.2%) and 5/27 (18.5%) cats was positive for ELISA, IFAT and both, respectively. The IHC identified 9/27 (33.3%) cats; 5/27 (18.5%) were positive only for IHC and therefore increased the overall sensitivity. Specific FIV antibodies were found in 6/55 (10.9%) cats, of which 5/6 (83.3%) had leishmaniosis. Real time PCR followed by amplicon sequencing successfully confirmed L. chagasi infection. In conclusion, dermatological lesions in cats from endemic areas was highly associated to visceral leishmaniosis, and therefore skin IHC and differential diagnosis of LV should be always conducted in dermatological patients in such areas.
González, S; Gilaberte-Calzada, Y
In vivo reflectance confocal microscopy (RCM) is a non-invasive imaging tool that allows real-time visualization of cells and structures in living skin with near histological resolution. RCM has been used for the assessment of benign and malignant lesions, showing great potential for applications in basic skin research and clinical dermatology. RCM also reveals dynamic changes in the skin over time and in response to specific stimuli, like ultraviolet exposure, which makes it a promising tool in cosmetology, as it allows repetitive sampling without biopsy collection, causing no further damage to the areas under investigation. This review summarizes the latest advances in RCM, and its applications in the characterization of both normal and pathological skin.
Zeng, Haishan; MacAulay, Calum E.; McLean, David I.; Lui, Harvey; Palcic, Branko
A miniature spectrometer system has been constructed for both reflectance and autofluorescence spectral measurements of skin. The system is based on PC plug-in spectrometer, therefore, it is miniature and easy to operate. The spectrometer has been used clinically to collect spectral data from various skin lesions including skin cancer. To date, 48 patients with a total of 71 diseased skin sites have been measured. Analysis of these preliminary data suggests that unique spectral characteristics exist for certain types of skin lesions, i.e. seborrheic keratosis, psoriasis, etc.. These spectral characteristics will help the differential diagnosis in Dermatology practice. In conjunction with the spectral point measurements, we are building and testing a multispectral imaging system to measure the spatial distribution of skin reflectance and autofluorescence. Preliminary results indicate that a cutaneous squamous cell carcinoma has a weak autofluorescence signal at the edge of the lesion, but a higher autofluorescence signal in the central area.
Miracles which can be observed in different religions are often closely connected to medicine. These miraculous cures, considered to be inexplicable by medical science, have been documented in Christian religion and in occidental culture for more than 2000 years. These miraculous healings are also reported in the field of dermatology. The miraculous bulletins documented by the Catholic Church take their beginning in the Old Testament and extend to the miraculous cures of Lourdes in present time. We provide an overview of miraculous healings of skin diseases, whereby accounts documented in the Bible, reports during the Middle Ages, and cases documented throughout the last century are discussed. In view of modern medicine, most of the miraculous healings do not meet modern demands of science, but remain important as milestones in medical and religious history.
Vlassova, N; Han, A; Zenilman, J M; James, G; Lazarus, G S
Human skin is colonized by bacteria. The development of new genomic microbiological techniques has revealed that the bacterial ecology of human skin is far more complex than previously imagined and includes many fastidious or noncultivable bacterial species which are found on both normal and diseased skin. In nature, the predominant bacterial phenotype on epithelial surfaces is that of organisms organized within a biofilm. This contrasts with the widely held belief that bacteria are planktonic, i.e. free-floating single cells. Biofilms are sessile bacterial communities encased in an extracellular matrix that have a well-developed communication system and can regulate bacterial growth and metabolism, confer resistance to antimicrobials and to host inflammatory cells, and alter host metabolism. Biofilms have been observed on healthy skin and in a number of dermatological conditions, including some that were previously thought not to have an infectious aetiology. Here we review the concept of biofilms and their role in cutaneous health and disease.
Sandhofer, Matthias; Schauer, Patrick
Silicone gel has for many years had a primary role in the treatment and prevention of abnormal scars, in the form of hypertrophic scars and keloids after epithelialization. The authors report preliminary findings on the use of a new, medical-grade, film-forming silicone gel dressing approved for use on open wounds and injured skin as monotherapy and in combination with other treatments prior to re-epithelialization. An observational study involving 105 patients examined the silicone gel's effectiveness in promoting accelerated epithelialization, reducing the inflammatory response and in the prevention of scarring. The study was conducted on a range of dermatological surgical interventions. The authors' observations confirmed silicone's role in promoting accelerated wound healing, scar prevention, and the utility of this new film-forming silicone dressing when used in combination with various other treatment modalities.
Wang, Peiru; Zhang, Guolong; Wang, Xiuli
The prodrug 5-aminolevulinic acid (ALA) and its ester derivatives have been used in photodynamic therapy (PDT) in dermatology worldwide. In China, ALA-PDT was first used to treat urethral condylomata acuminata and non-melanoma skin cancers in 1997. A powder formulation of ALA hydrochloride was approved by the Chinese Food and Drug Administration for the treatment of condylomata acuminata in 2007. Large successful experience of treating condylomatas was accumulated compared with Western countries. Meanwhile, numerous clinical studies as well as off-label use of ALAPDT have been carried out in China. To reflect the progress of ALA-PDT in China, several major Chinese and English databases were searched and published data were reviewed in this article.
Bagatin, Ediléia; Miot, Helio A.
Cosmetic Dermatology is a growing subspecialty. High-quality basic science studies have been published; however, few double-blind, randomized controlled clinical trials, which are the major instrument for evidence-based medicine, have been conducted in this area. Clinical research is essential for the discovery of new knowledge, improvement of scientific basis, resolution of challenges, and good clinical practice. Some basic principles for a successful researcher include interest, availability, persistence, and honesty. It is essential to learn how to write a protocol research and to know the international and national regulatory rules. A complete clinical trial protocol should include question, background, objectives, methodology (design, variable description, sample size, randomization, inclusion and exclusion criteria, intervention, efficacy and safety measures, and statistical analysis), consent form, clinical research form, and references. Institutional ethical review board approval and financial support disclosure are necessary. Publication of positive or negative results should be an authors' commitment. PMID:23539006
Cornely, M; Schöldgen, W; Kautz, G; Kautz, I; Jünger, M; Claeson, M
Many operative-interventional methods are available for aesthetic dermatology. The established high-speed dermabrasion as developed by Schreus has been replaced in many indications by newer approaches. Laser ablation can be effectively used for resurfacing of sun-damaged or scarred skin, but is associated with extensive side effects. Newer developments such as fractionated laser treatment are designed to fill the gap between ablative and non-ablative skin resurfacing. The side effects are much less severe, but the effectiveness must be confirmed in larger studies. Photorejuvenation with intense pulsed light (IPL) offers a wide variety of treatment parameters for a broad spectrum of skin changes. Both superficial and deep structures can be treatment in one session using IPL.
Fuentes-Suárez, Adán; Domínguez-Soto, Luciano
With the emergence of medical specialties in different areas of medicine, assessment of patients became narrow and specialized. There is also the perception that some specialties are more difficult than others. Dermatology has long been seen by most physicians non dermatologists as a relaxed area, without real emergencies or requirement of great intellectual effort. Some specialists, erroneously think that everything can be cured with topical steroids and/or antifungal creams. Although several skin diseases are common complains seen by the general practitioner, very few time and credits are granted to cover these diseases during the years of undergraduate training. Thus, the primary care physicians and others medical specialists believe that skin diseases are not life threatening and hence irrelevant. Nonetheless, they feel competent enough to prescribe a variety of treatments for skin diseases that may lead to iatrogenesis.
Brown, S M; Oliphant, T; Langtry, J
As the incidence of non melanoma skin cancer rises, dermatologists will increasingly be called upon to perform excisions in the head and neck region. Damage to the motor nerves of the head and neck represents an important adverse event for patients, and a source of litigation for surgeons. Understanding the anatomy of this region is key to counselling patients about the possibility of motor nerve injury associated with particular skin surgical procedures. We describe the anatomy of the motor nerves of the head and neck that are most vulnerable to injury during dermatological surgery. The consequences of injury are outlined, and the surface anatomy and anatomical landmarks that may be used to identify the relevant danger zones are described.
Pinto, Ana Cecília Versiani Duarte; Wachholz, Patrick Alexander; Masuda, Paula Yoshiko; Martelli, Antonio Carlos Ceribelli
This is a cross-sectional study, conducted from May to November/2014, in a dermatology reference unit, through review of medical records and interviews. In a sample of 49 patients with brachioradial pruritus, we observed higher prevalence of Caucasian (81.6%) and women (73.5 %), with a mean age of 56.1 years. Pruritus occurred in the topography of brachioradialis muscle in 87.8% of cases; 59.2% of the sample reported worsening of pruritus with sun exposure; the mean intensity of this symptom before treatment was 8.63. Therapy effectiveness was described as "very good/good" in 79.2% of cases, and for 55.3% relapses were categorized as "uncommon".
Pinto, Ana Cecília Versiani Duarte; Wachholz, Patrick Alexander; Masuda, Paula Yoshiko; Martelli, Antonio Carlos Ceribelli
This is a cross-sectional study, conducted from May to November/2014, in a dermatology reference unit, through review of medical records and interviews. In a sample of 49 patients with brachioradial pruritus, we observed higher prevalence of Caucasian (81.6%) and women (73.5 %), with a mean age of 56.1 years. Pruritus occurred in the topography of brachioradialis muscle in 87.8% of cases; 59.2% of the sample reported worsening of pruritus with sun exposure; the mean intensity of this symptom before treatment was 8.63. Therapy effectiveness was described as "very good/good" in 79.2% of cases, and for 55.3% relapses were categorized as "uncommon". PMID:27579762
He, Zhongjun; Wang, Li
The inheritance of the theory in external medicine in the Republican period was mainly derived from Wai ke zheng zong (Orthodox Manual of External Medicine) and Yi zong jin jian (Golden Mirror of Medicine) and the sorting out of medical plasters, pills, and powders from Wai ke shi san fang (Thirteen Recipes of External Medicine). Zhang Shanlei's Yang ke gang yao (Guidelines for Ulcerations), based on the five-year experience of Zhu's family, offers new experience and ideas for syndrome differentiation; Ding Ganren's diagnosis for external medicine is exquisite with many well known formulae prescribed by himself; Monographs on leprosy and syphilis were published by famous physicians. Departments of external medicine and anal diseases, and classes on external medicine and dermatology and venereal diseases were set up in TCM schools in Guangdong and Zhejiang provinces with teaching materials compiled. All these mark the development of external medicine in modern age.
Choon, S E; Sapiah, W; Ismail, Z; Balan, V
A study was conducted in the Dermatology cum Genitourinary Clinic, Hospital Sultanah Aminah Johor Bahru to determine a local population's knowledge of HIV and their sexual behaviour in relation to it. A total of 231 men and 217 women were interviewed. The sexual culture seen is one of relatively late age of first sexual intercourse, low level of partner change and low level of condom use. Men reported a higher involvement in risk behaviour. Nearly all the respondents (95.8%) have heard of HIV/AIDS but had incorrect perceptions of its mode of transmission and its associations with risk groups. This study enable us to gain background information about our patients sexual behaviour and HIV knowledge. There is a need to continue HIV education to improve our public's HIV knowledge and the results of this study provides a baseline against which future educational interventions can be gauged.
Thorstensen, Katrina Alef; Birenbaum, Debra L
Lichen sclerosus, lichen planus, and lichen simplex chronicus are dermatologic conditions that can affect the vulva. Symptoms include vulvar itching, irritation, burning, and pain, which may be chronic or recurrent and can lead to significant physical discomfort and emotional distress that can affect mood and sexual relationships. With symptoms similar to common vaginal infections, women often seek care from gynecological providers and may be treated for vaginal infections without relief. Recognition and treatment of these vulvar conditions is important for symptom relief, sexual function, prevention of progressive vulvar scarring, and to provide surveillance for associated vulvar cancer. This article reviews these conditions including signs and symptoms, the process of evaluation, treatment, and follow-up, with attention to education and guidelines for vulvar care and hygiene.
Guerra-Rosas, Esperanza; Álvarez-Borrego, Josué
In this paper a new methodology for the diagnosing of skin cancer on images of dermatologic spots using image processing is presented. Currently skin cancer is one of the most frequent diseases in humans. This methodology is based on Fourier spectral analysis by using filters such as the classic, inverse and k-law nonlinear. The sample images were obtained by a medical specialist and a new spectral technique is developed to obtain a quantitative measurement of the complex pattern found in cancerous skin spots. Finally a spectral index is calculated to obtain a range of spectral indices defined for skin cancer. Our results show a confidence level of 95.4%. PMID:26504638
Krajewska-Kulak, Elzbieta; Niczyporuk, Wiaczeslaw; Lukaszuk, Cecylia; Bartoszewicz, Marianna; Roszkowska, Irena; Edyta, Moss
In the years 1981-2000, the department of dermatology at the Medical University of Bialystok, Poland, carried out a retrospective study of common difficulties in the diagnosis and treatment of tinea. The aim of this study was to assess the incidence of incorrect diagnosis and therapy of tinea and tinea incognito (TI) in the patients hospitalized at the institution over a 19-year period. Tinea was identified in 814 patients (4.3% of all patients). TI was diagnosed in 318 patients (39.1% of all patients with tinea). The most diagnostic-therapeutic problems were observed in the patients with tinea pedis, tinea cutis glabrae superficialis, intertrigo candidamycetica, tinea profunda cutis glabrae and tinea profunda barbae. The most common clinical isolates were T. rubrum, T. mentagrophytes, and Candida albicans. A high percentage of TI was present in comparison with all other tinea conditions.
Jalel, Akrem; Soumaya, Gaigi Siala; Hamdaoui, Mohamed Hédi
Background: Vitiligo is an important skin disease that can alter individual self-image and thus have major impact on the quality of life. Aims: The objective of this study was to translate and to test the reliability and validity of the 10-item Dermatology Life Quality Index (DLQI) questionnaire in Tunisian vitiliginous patients. Methods: Using a standard “forward-backward” translation procedure, the English language version of the questionnaire was translated into Persian (the Iranian official language) by two bilinguals. Seventy patients with vitiligo attending the Department of Dermatology, Regional Hospital, Medenine, Tunisia, were enrolled in this study. The reliability and internal consistency of the questionnaire were assessed by Cronbach's α coefficient and Spearman's correlation, respectively. Validity was performed using convergent validity. Results: In all, 70 people entered into the study. The mean age of respondents was 28.3 (SD=11.09) years. Scores on the DLQI ranged from 0 to 24 (mean ± SD, 7.05 ± 5.13). Reliability analysis showed satisfactory result (Cronbach's α coefficient=0.77). There were no statistically significant differences between daily activity (DA) and personal relationship (PR) scale mean scores in generalized versus focal-segmental involvement in sufferers (P = 0.056, P = 0.053, respectively). There were also strong differences between the mean scores of the PR scale with the involvement of covered only and covered/uncovered areas (P = 0.016) that was statistically significant in the second group. Conclusions: The study findings showed that the Tunisian version of the DLQI questionnaire has a good structural characteristic and is a reliable and valid instrument that can be used for measuring the effects of vitiligo on quality of life. PMID:20101332
Velez, Nicole F; Wei-Passanese, Erin X; Husni, M Elaine; Mody, Elinor A; Qureshi, Abrar A
Psoriasis and psoriatic arthritis (PsA) are chronic systemic inflammatory disorders with wide spectrums of cutaneous and musculoskeletal presentations. Management of joint disease in this population can be challenging and often requires the expertise of rheumatology in conjunction with dermatology. A multidisciplinary clinic setting may benefit these patients, and in this study we sought to evaluate the experience of such a model. We performed a retrospective chart review of patients evaluated between October 2003 and October 2009 in the Center for Skin and Related Musculoskeletal Diseases (SARM) at Brigham and Women's Hospital, Boston, MA, USA, where patients are seen by both an attending rheumatologist and dermatologist. Main outcomes included the presence of comorbidities, accuracy of the initial diagnosis, and escalation of treatment modalities. Over the 6-year period, 510 patients were evaluated. Two hundred sixty-eight patients had psoriasis and/or PsA. The prevalence of comorbidities was high (45% hypertension, 46% hyperlipidemia, 19% diabetes, and 36% history of the past or current smoking). Visit in SARM resulted in a revised diagnosis that differed from the previous diagnosis at outside clinics in 46% of cases. Patients were more likely to receive a systemic medication after the evaluation in SARM as compared to before, 25 versus 15%, respectively, with an odds ratio of 5.1. Patients were also more likely to be treated with a biologic agent after the evaluation in SARM as compared to before, 37 versus 16%, respectively. Multidisciplinary care may facilitate the diagnosis of joint disease and offers a more comprehensive treatment approach for patients with both psoriasis and PsA. Our data can be used to support the efforts to provide integrated rheumatologic and dermatologic care for this population.
Viswanath, Vishalakshi; Phiske, Meghana M; Gopalani, Vinay V
Systemic sclerosis (SSc) is a chronic, multisystem connective tissue disease with protean clinical manifestations. Recent advances in understanding the pathogenic mechanisms have led to development of target-oriented and vasomodulatory drugs which play a pivotal role in treating various dermatological manifestations. An exhaustive literature search was done using Medline, Embase, and Cochrane library to review the recent concepts regarding pathogenesis and evidence-based treatment of salient dermatological manifestations. The concept of shared genetic risk factors for the development of autoimmune diseases is seen in SSc. It is divided into fibroproliferative and inflammatory groups based on genome-wide molecular profiling. Genetic, infectious, and environmental factors play a key role; vascular injury, fibrosis, and immune activation are the chief pathogenic factors. Vitamin D deficiency has been documented in SSc and correlates with the severity of skin involvement. Skin sclerosis, Raynaud's phenomenon (RP) with digital vasculopathies, pigmentation, calcinosis, and leg ulcers affect the patient's quality of life. Immunosuppressives, biologicals, and hematopoietic stem cell transplantation are efficacious in skin sclerosis. Endothelin A receptor antagonists, calcium-channel blockers, angiotensin receptor inhibitors, prostacyclin analogs, and phosphodiesterase type 5 (PDE-5) inhibitors are the mainstay in RP and digital vasculopathies. Pigmentation in SSc has been attributed to melanogenic potential of endothelin-1 (ET-1); the role of ET 1 antagonists and vitamin D analogs needs to be investigated. Sexual dysfunction in both male and female patients has been attributed to vasculopathy and fibrosis, wherein PDE-5 inhibitors are found to be useful. The future concepts of treating SSc may be based on the gene expression signature. PMID:23918994
Papadaki, Šárka; Popesko, Boris
Background: Present trends in hospital management are facilitating the utilization of more accurate costing methods, which potentially results in superior cost-related information and improved managerial decision-making. However, the Activity-Based Costing method (ABC), which was designed for cost allocation purposes in the 1980s, is not widely used by healthcare organizations. This study analyzes costs related to selected categories of patients, those suffering from psoriasis, varicose ulcers, eczema and other conditions, within a dermatology department at a Czech regional hospital. Methods: The study was conducted in a hospital department where both inpatient and outpatient care are offered. Firstly, the diseases treated at the department were identified. Further costs were determined for each activity using ABC. The study utilized data from managerial and financial accounting, as well as data obtained through interviews with departmental staff. Using a defined cost-allocation procedure makes it possible to determine the cost of an individual patient with a given disease more accurately than via traditional costing procedures. Results: The cost analysis focused on the differences between the costs related to individual patients within the selected diagnoses, variations between inpatient and outpatient treatments and the costs of activities performed by the dermatology department. Furthermore, comparing the costs identified through this approach and the revenue stemming from the health insurance system is an option. Conclusions: Activity-Based Costing is more accurate and relevant than the traditional costing method. The outputs of ABC provide an abundance of additional information for managers. The benefits of this research lie in its practically-tested outputs, resulting from calculating the costs of hospitalization, which could prove invaluable to persons involved in hospital management and decision-making. The study also defines the managerial implications of
Webster, Guy F.; Rosen, Ted; Thiboutot, Diane; Leyden, James J.; Gallo, Richard; Walker, Clay; Zhanel, George; Eichenfield, Lawrence
Oral and topical antibiotics are commonly prescribed in dermatologie practice, often for noninfectious disorders, such as acne vulgaris and rosacea. Concerns related to antibiotic exposure from both medical and nonmedical sources require that clinicians consider in each case why and how antibiotics are being used and to make appropriate adjustments to limit antibiotic exposure whenever possible. This first article of a three-part series discusses prescribing patterns in dermatology, provides an overview of sources of antibiotic exposure, reviews the relative correlations between the magnitude of antibiotic consumption and emergence of antibiotic resistance patterns, evaluates the impact of alterations in antibiotic prescribing, and discusses the potential relevance and clinical sequelae of antibiotic use, with emphasis on how antibiotics are used in dermatology. PMID:27462384
Orchard, Ané; Sandasi, Maxleene; Kamatou, Guy; Viljoen, Alvaro; van Vuuren, Sandy
This study reports on the inhibitory concentration of 59 commercial essential oils recommended for dermatological conditions, and identifies putative compounds responsible for antimicrobial activity. Essential oils were investigated for antimicrobial activity using minimum inhibitory concentration assays. Ten essential oils were identified as having superior antimicrobial activity. The essential oil compositions were determined using gas chromatography coupled to mass spectrometry and the data analysed with the antimicrobial activity using multivariate tools. Orthogonal projections to latent structures models were created for seven of the pathogens. Eugenol was identified as the main biomarker responsible for antimicrobial activity in the majority of the essential oils. The essential oils mostly displayed noteworthy antimicrobial activity, with five oils displaying broad-spectrum activity against the 13 tested micro-organisms. The antimicrobial efficacies of the essential oils highlight their potential in treating dermatological infections and through chemometric modelling, bioactive volatiles have been identified.
Kalia, Sunil; Huang, Rachel Yuanshen; Phillips, Arlie; Su, Mingwan; Yang, Sen; Zhang, Xuejun; Zhou, Pingyu; Zhou, Youwen
Background There is a wide variation in the reported prevalence of primary hyperhidrosis in the literature. Further, it is unknown if primary hyperhidrosis is a lifelong condition, or if demographical factors influence hyperhidrosis prevalence. Objectives This study aims to examine the prevalence of hyperhidrosis in multiple ethnic groups from two ethnically diverse cities and to determine if the prevalence of primary hyperhidrosis changes according to age, gender, ethnicity, body mass index, and geographical locations. Methods In total, 1010 consecutive subjects attending dermatology outpatient clinics in Shanghai Skin Disease Hospital and 1018 subjects in Skin Care Center of Vancouver General Hospital were invited to fill out a questionnaire on their presenting concerns, demographical information, and sweating symptoms. The subjects were then classified to have primary hyperhidrosis using the criteria of International Hyperhidrosis Society, late-onset hyperhidrosis, or no-hyperhidrosis. The prevalence of primary HH and late-onset HH was calculated for the entire study population and in subgroups stratified according to age of examination, sex, ethnicity, presenting diagnosis, body mass index, and specific study cities. Multivariate logistic regression analyses were performed to assess the impact of these factors on HH prevalence. Results The prevalence of primary hyperhidrosis is very similar in Shanghai and in Vancouver, at 14.5% and 12.3% respectively. In addition, 4.0% of subjects in Shanghai and 4.4% subjects in Vancouver suffer from late-onset HH. Primary HH has highest prevalence in those younger than 30 years of age, decreasing dramatically in later years. Caucasian subjects are at least 2.5 times more likely to develop axillary hyperhidrosis compared to Chinese subjects. Obesity does not have much influence on primary HH presentation, although it does increase significantly the development of late-onset HH. Finally, there is no major difference of
Prescribed by ANSI Std Z39-18 Dermatology Consolidation 2 ACKNOWLEDGEMENTS This project could not have been possible without the support of my family ...California and Hawaii (Assistant Secretary for Defense, Health Affairs (ASD (HA)), 1998). Beginning in 1988, CRI offered service families a choice of ways...TRICARE program. TRICARE is DoD’s regional managed health care program for service families . It is designed to meet the department’s medical mission
Gül, Ülker; Kılıç, Arzu
Introduction The size and number of acquired melanocytic nevi (AMN) and presence of dysplastic nevi are the leading risk factors that should be recognized in the development of malignant melanoma. Aim To evaluate AMN and risk factors in the development of AMN in all age groups admitted to a dermatology outpatient clinic. Material and methods Four hundred and twelve patients who were admitted to the dermatology outpatient clinic for any dermatological symptom and who accepted to participate in the study were randomly included in the study. For each case, background-family history and dermatological findings were recorded. All AMN observed in the patients were dermatoscopically examined. Results The presence of more than 50 nevi was significantly higher in males, in individuals who had a history of sunburn and smokers. The number of nevi that were 5 mm and below was found to be higher in individuals who regularly sunbathed their face/body, in individuals using sunscreen, in individuals who had a history of sunburn, smokers and alcohol users. The number of nevi that were above 5 mm was higher in smokers. The total dermatoscopy score between 4.75 and 5.45 was found to be higher in individuals who had more than 50 nevi, in individuals exposed to more than one chemical substance and in alcohol users. Conclusions When determining the patient’s risk factors, factors such as the patient’s sunbathing habits and chemical substance exposure features should be taken into consideration besides the number and size of nevi. PMID:27881943
Bertanha, Fernanda; Nelumba, Erica Judite Pimentel; Freiberg, Alyne Korukian; Samorano, Luciana Paula; Festa Neto, Cyro
Background Knowledge of epidemiological data on skin diseases is important in planning preventive strategies in healthcare services. Objective To assess data from patients admitted to a triage dermatology clinic. Methods A retrospective study was performed of patients admitted over a one-year period to the Triage Dermatology Clinic at the Hospital das Clínicas of the University of São Paulo Medical School. Data were obtained from record books. The variables analyzed were: patient age, gender, dermatologic disease (initial diagnosis), origin (from where the patient was referred) and destination (where the patient was referred to). Results A total of 16,399 patients and 17,454 diseases were identified for analysis. The most frequent skin disorders were eczema (18%), cutaneous infections (13.1%), erythematous squamous diseases (6.8%) and malignant cutaneous neoplasms (6.1%). Atopic dermatitis was the most common disease in children. Acne was more common among children and adults, as were viral warts. Basal cell carcinoma and squamous cell carcinoma were more common in the elderly. Contact dermatitis and acne predominated in women. The most frequent origins were: the primary/secondary health system (26.6%), other outpatient specialties (25.5%), emergency care (14.9%); while the destinations were: discharged (27.5%), follow-up in our Dermatology Division (24.1%), return (14.1%) and the primary/secondary health system (20.7%). Conclusion Understanding the incidence of skin diseases is fundamental in making decisions regarding resource allocation for clinical care and research. Thus, we believe our findings can contribute to improving public health policies. PMID:27438199
Saleh, Nadia; Abdel Hay, Rania; Hegazy, Rehab; Hussein, Marwa; Gomaa, Dalia
Introduction The paucity of studies evaluating teledermatology (TD) in developing countries was the impetus behind conducting this work. We aimed to evaluate the feasibility and reliability of TD in remote areas where medical facilities and consultant dermatologists are not available, through measurement of diagnostic concordance rates between face-to-face diagnosis and store-and-forward (SAF) TD diagnosis. Methods A total of 600 patients with dermatological ailments who attended Abshway Hospital were recruited into the study, examined by an on-site dermatology resident, and offered a diagnosis. The clinical images and patients' history were collected and transferred (through the Dropbox application) to two remote consultant dermatologists. The reliability of the three physicians' agreement rates was assessed. Results Diagnostic agreement rates between the face-to-face dermatologist and the two teledermatologists were 86.7% and 87% respectively. Of the cases, 97% had complete or partial agreement and 81.3% of cases showed complete agreement between the three physicians. The reliability of the three physicians' agreement rates was assessed statistically using Cohen's kappa coefficient (κ) and this showed a range of 0.46-0.52. Conclusion This study might aid in enhancing the utilization of this tool in our country, especially in remote areas with a lack of a proper dermatological service. The simplicity and low cost of the adopted technique might facilitate its use over large sectors. It opens the door for gaining the benefit of this technology in other aspects such as teaching and monitoring health care providers.
Tyrrell, Jessica; Campbell, Sandra; Curnow, Alison
This study employed a commercially available, non-invasive, fluorescence imaging system (Dyaderm, Biocam, Germany), to measure protoporphyrin IX (PpIX) concentration at several different stages during clinical dermatological methyl aminolevulinate photodynamic therapy (MAL-PDT). We validated the system prior to use to ensure that the PpIX changes witnessed were accurate and not due to environmental or user induced artifacts. The system was then employed to acquire color (morphological) and fluorescent (physiological) images simultaneously during dermatological PDT. Clinical data was collected from a range of licensed dermatological conditions (actinic keratosis, Bowen's disease and superficial basal cell carcinoma) during initial and subsequent PDT treatment cycles. The initial clinical data indicated that each type of licensed lesion considered responded in a similar manner following the application of Metvix (Galderma, U.K.) and the subsequent light irradiation (Aktilite, Galderma, U.K.). Images acquired three hours after Metvix application showed a significant increase in PpIX concentration within the lesion (P < 0.05), whilst PpIX levels in the surrounding normal tissue remained unaltered. After irradiation, the PpIX concentration was significantly decreased and returned to a level similar to the initial concentration originally observed. Lesions that received subsequent treatment cycles accumulated significantly less PpIX (P < 0.05) prior to irradiation.
Wahl, Astrid K; Mørk, Cato; Lillehol, Bodil Mørk; Myrdal, Anne M; Helland, Svein; Hanestad, Berit R; Moum, Torbjørn
The objective of this study was to assess the impact of chronic dermatological diseases on quality of life (QoL) of Norwegian patients following in-patient management. QoL was measured by the Norwegian version of the Dermatology Life Quality Index, a validated, self-administered questionnaire. Adult in-patients with psoriasis and eczema were selected for one year from the dermatological departments in Norway. A total of 212 patients were included, and 126 patients (50% men, 85 with psoriasis and 41 with eczema, mean age 46 years) completed the questionnaires at time of hospital admission and one week after discharge. The patients reported adverse impact on QoL, but no differences between the psoriasis and eczema groups could be demonstrated. Patients with psoriasis improved from 18.3 (7.6) (mean (SD)) to 12.1 (8.2) (p < 0.01), and those with eczema improved from 20.0 (6.0) to 14.4 (7.8) (p < 0.01). Seventy percent of the patients showed improvement, 20% remained unchanged and 10% worsened. The parameters for which the most improvement was seen were those that were of most concern to the patients, i.e. their symptoms and embarrassment. In conclusion, the results are consistent with previous international studies.
Navarro, F A
Every year, thousands of technical neologisms are coined in English and must be rapidly imported into the Spanish language with the utmost precision, clarity, rigor, and linguistic correctness for Spanish to remain useful as a language of culture and learning that allows us to express the medicine of today. In 1999, the author published an extensive Glossary of Doubts in English-Spanish Translation of Dermatology that contained more than 500 words and expressions in dermatology that present difficulties in translation. Nine years later, the original glossary has been extended to include new English words and expressions that were not covered at that time. The author compiles and discusses 150 dermatological neologisms and technical terms in English that present problems for translation into Spanish or generate doubts regarding their use in that language, and offers reasoned proposals for their translation. The proposed translations are well founded and reflect the necessity for accuracy and clarity that should characterize all scientific language. In most cases, they are accompanied by detailed comments on normal usage among physicians, orthographic rules in Spanish, and official guidelines based on standardized nomenclature and the recommendations of the main international organizations.
Gómez Valverde, Juan J.; Ortuño, Juan E.; Guerra, Pedro; Hermann, Boris; Zabihian, Behrooz; Rubio-Guivernau, José L.; Santos, Andrés.; Drexler, Wolfgang; Ledesma-Carbayo, Maria J.
Optical Coherence Tomography (OCT) has shown a great potential as a complementary imaging tool in the diagnosis of skin diseases. Speckle noise is the most prominent artifact present in OCT images and could limit the interpretation and detection capabilities. In this work we propose a new speckle reduction process and compare it with various denoising filters with high edge-preserving potential, using several sets of dermatological OCT B-scans. To validate the performance we used a custom-designed spectral domain OCT and two different data set groups. The first group consisted in five datasets of a single B-scan captured N times (with N<20), the second were five 3D volumes of 25 Bscans. As quality metrics we used signal to noise (SNR), contrast to noise (CNR) and equivalent number of looks (ENL) ratios. Our results show that a process based on a combination of a 2D enhanced sigma digital filter and a wavelet compounding method achieves the best results in terms of the improvement of the quality metrics. In the first group of individual B-scans we achieved improvements in SNR, CNR and ENL of 16.87 dB, 2.19 and 328 respectively; for the 3D volume datasets the improvements were 15.65 dB, 3.44 and 1148. Our results suggest that the proposed enhancement process may significantly reduce speckle, increasing SNR, CNR and ENL and reducing the number of extra acquisitions of the same frame.
Jolivot, Romuald; Benezeth, Yannick; Marzani, Franck
In vivo quantitative assessment of skin lesions is an important step in the evaluation of skin condition. An objective measurement device can help as a valuable tool for skin analysis. We propose an explorative new multispectral camera specifically developed for dermatology/cosmetology applications. The multispectral imaging system provides images of skin reflectance at different wavebands covering visible and near-infrared domain. It is coupled with a neural network-based algorithm for the reconstruction of reflectance cube of cutaneous data. This cube contains only skin optical reflectance spectrum in each pixel of the bidimensional spatial information. The reflectance cube is analyzed by an algorithm based on a Kubelka-Munk model combined with evolutionary algorithm. The technique allows quantitative measure of cutaneous tissue and retrieves five skin parameter maps: melanin concentration, epidermis/dermis thickness, haemoglobin concentration, and the oxygenated hemoglobin. The results retrieved on healthy participants by the algorithm are in good accordance with the data from the literature. The usefulness of the developed technique was proved during two experiments: a clinical study based on vitiligo and melasma skin lesions and a skin oxygenation experiment (induced ischemia) with healthy participant where normal tissues are recorded at normal state and when temporary ischemia is induced.
Soares, Kelen Carine Costa; Moraes, Marcelo Vogler; Gelfuso, Guilherme Martins; Gratieri, Taís
The comparative evaluation required for the registration of generic topical medicines in Brazil is conducted by means of a pharmaceutical equivalence study, which merely assesses the physical/chemical and microbiological parameters of the formulations. At the international level, clinical or pharmacodynamic studies are now being required to prove the efficacy and safety of semisolid topical generic formulations. This work presents a comparison of the different requirements for the registration of topical formulations, taking into consideration the various regulatory authorities, and presents a survey of topical medicines registered in Brazil prior to 2013. The survey revealed that in comparison with the USA there were many more copies of these formulations registered in Brazil. This fact, together with the large number of studies in the literature showing the lack of bioequivalence of topical medication, is clear proof of the major importance of the need to realign Brazilian legislation with respect to the technical requirements for the registration of generic and similar medication for dermatological topical application in Brazil.
Corcuff, P; Gonnord, G; Piérard, G E; Lévéque, J L
In-depth exploration of cellular structures in living human skin in situ is possible with the tandem scanning microscope (TSM). However, the rigid design of the microscope limited observations to the arms, hands, and fingers. A mobile version allowing the investigation of any parts of the body has been designed. The head containing the Nipkow disk and the optical path were the only part saved from the original TSM. This prototype can be used to observe, in real time, the different skin structures down to a depth of 200 microns and to measure the thickness of the different layers with micron precision level. The hydration of the stratum corneum (SC) could be assessed. For example, lengthy immersion of the hand in water led to an increase in SC thickness without affecting that of the living epidermis. Occlusive patch tests also showed that water and, even more so. propylene glycol, led to transient swelling of the SC. In dermatology, the example of psoriasis illustrated the value of the TSM for describing, measuring, and assessing pathologic skin changes. The availability of this noninvasive method for observing changes with time in a given skin site should prove useful for monitoring treatment efficacy. This tool opens up new insight for the investigation of cutaneous pathophysiology.
Gaspar, L R; Camargo, F B; Gianeti, M D; Maia Campos, P M B G
Saccharomyces cerevisiae extract (SCE) is used in cosmetics since it can act in oxidative stress and improve skin conditions. This study investigated dermatological effects of cosmetic formulations containing SCE and/or vitamins A, C and E. The formulation studied was supplemented or not (F1: vehicle) with vitamins A, C and E esters (F2) or with SCE (F3) or with the combination of vitamins and SCE (F4). Formulations were patch tested on back skin of volunteers. For efficacy studies, formulations were applied on volunteers and transepidermal water loss (TEWL), skin moisture (SM), skin microrelief (SMR) and free radicals protection were analysed after 3h, 15 and 30 days of application. Volunteers were also asked about efficacy perception. It was observed that F4 provoked a slight erythema in one volunteer. All formulations enhanced forearm SM. Only F3 and F4 presented long term effects on SMR and showed higher texture values; F3 had the highest brightness values. Our results suggest that vitamins and SCE showed effects in SM and SMR. Only formulations containing SC had long term effects in the improvement of SMR. Thus, these kinds of evaluations are very important in cosmetics development to evaluate the best risk and benefit correlation.
van Diepeningen, Anne D; Feng, Peiying; Ahmed, Sarah; Sudhadham, Montarop; Bunyaratavej, Sumanas; de Hoog, G Sybren
Fusarium species are emerging causative agents of superficial, cutaneous and systemic human infections. In a study of the prevalence and genetic diversity of 464 fungal isolates from a dermatological ward in Thailand, 44 strains (9.5%) proved to belong to the genus Fusarium. Species identification was based on sequencing a portion of translation elongation factor 1-alpha (tef1-α), rDNA internal transcribed spacer and RNA-dependent polymerase subunit II (rpb2). Our results revealed that 37 isolates (84%) belonged to the Fusarium solani species complex (FSSC), one strain matched with Fusarium oxysporum (FOSC) complex 33, while six others belonged to the Fusarium incarnatum-equiseti species complex. Within the FSSC two predominant clusters represented Fusarium falciforme and recently described F. keratoplasticum. No gender differences in susceptibility to Fusarium were noted, but infections on the right side of the body prevailed. Eighty-nine per cent of the Fusarium isolates were involved in onychomycosis, while the remaining ones caused paronychia or severe tinea pedis. Comparing literature data, superficial infections by FSSC appear to be prevalent in Asia and Latin America, whereas FOSC is more common in Europe. The available data suggest that Fusarium is a common opportunistic human pathogens in tropical areas and has significant genetic variation worldwide.
Rohna, R; Ganesapillai, T; Salbiah, D; Zaiton, I
A two years retrospective analysis of patients diagnosed as contact allergic dermatitis with positive patch test attending the Dermatology clinic was performed. Of the 346 patients with a positive patch test, 14% had occupational dermatitis. This condition affected mainly young and inexperienced workers. An inverse relationship was seen between age and prevalence of occupational allergic dermatitis. Allergic hand dermatitis was the commonest presentation in occupational allergic dermatitis. This was followed by dermatitis of the exposed skin (face, neck, hands and forearms). The common sensitising agents identified were rubber chemicals and nickel. The two main groups at risk were factory workers and medical personnel. The common allergens found in factory workers were epoxy resin, pewter, nickel and rubber chemicals. Exposure dermatitis occurred in patients working in the pewter industry. Two thirds of medical personnel with hand dermatitis were allergic to rubber gloves. One year follow up after patch testing showed that 19% of patients still suffered from chronic dermatitis. Dermatitis improved in 34% of patients. Forty-seven percent were cured and stopped attending the clinic after patch testing and adequate counselling.
Bruch, Reinhard F.; Afanasyeva, Natalia I.; Sukuta, Sydney; Brooks, Angelique L.; Makhine, Volodymyr; Kolyakov, Sergei F.
Fiberoptical evanescent wave Fourier transform infrared (FEW- FTIR) spectroscopy has been applied in the middle infrared (MIR) wavelength range (3 to 20 micrometer) to the in vivo diagnostics of normal skin tissue, acupuncture points as well as precancerous and cancerous conditions. The FTIR-FEW technique, using nontoxic unclad fibers, is suitable for noninvasive, sensitive investigations of skin tissue for various dermatological studies of skin caner, aging, laser treatment, cosmetics, skin allergies, etc. This method is direct, nondestructive, and fast (seconds). Our optical fibers are nonhygroscopic, flexible, and characterized by extremely low losses. In this study, we have noninvasively investigated more than 300 cases of normal skin, acupuncture points, precancerous and cancerous tissue in the range of 1400 to 1800 cm-1. The results of our analysis of skin and other tissue are discussed in terms of structural and mathematical similarities and differences on a molecular level. In addition, we have also performed cluster analysis, using principal component scores, to confirm pathological classifications and to discriminate between genders. We have found good agreement with prior pathological classifications for normal skin tissue and melanoma tumors and normal females were distinctly separate from males.
Lerche, Catharina M.; Wulf, Hans Christian
Topical therapies constitute the mainstay of dermatological treatments for skin disorders, such as atopic dermatitis, contact dermatitis, psoriasis, or acne. Since some of these diseases are often chronic, treatment duration may last for years and may even last the patient's entire lifetime. Obviously, such long-term therapy may raise safety concerns, which also include the potential photocarcinogenic effect. Most patients are exposed to ultraviolet radiation (UVR) during leisure, work, vacations, or in tanning beds. Additionally, the patients may receive UVR via UVB phototherapy or psoralens plus UVA radiation (PUVA). The use of immunosuppressant's, such as corticosteroids and calcineurin inhibitors, has markedly increased. Patients with skin diseases have benefited from both systemic and topical treatment of both new and established drugs. The issue of a black box warning by the US Food and Drug Administration has increased concerns about photocarcinogenesis, which raises the question: “Are these drugs safe?” This review focuses on the mechanism of action and photocarcinogenic potential of commonly used topical treatments, such as corticosteroids, calcineurin inhibitors, and vitamin D analogs. PMID:25386250
Sobjanek, Michał; Michajłowski, Jerzy; Włodarkiewicz, Adam; Matuszewski, Marcin
Introduction So far there have been no papers analyzing the incidence of ‘non-pathological’ lesions or normal variants on the male external genitalia. Subsequently, the number of patients consulted due to the presence of such lesions remains unknown. The aim of the study was to estimate the incidence of normal variants in patients who were consulted due to lesions on the skin or mucosa of the male external genitalia. Material and methods The study group consisted of 400 males, aged 3-91, who were consulted due to lesions on the genitalia in the Department of Dermatology, Venereology and Allergology of the Medical University of Gdańsk. Results The most common lesions were hyperpigmentation of the median raphe of the penis and scrotum (85.6%), pearly penile papules (24%), and prominent veins (24%). Sebaceous hyperplasia or ectopic sebaceous glands were revealed in 9% of patients, respectively. Melanocytic nevi were diagnosed with similar frequency (9.5%), whereas skin tags more rarely (7%). Other ‘non-pathological’ lesions were diagnosed in a considerably lower number of patients. In 32 patients (8% of all patients) the reason of admission to the Clinic was just the presence of some ‘non-pathological’ lesions. Pearly penile papules were found to be the most common condition, occurring in 78.1% patients. Conclusions Normal variants represent a substantial percentage of generally asymptomatic lesions and the only indication for their removal is cosmetic discomfort or venerophobia. PMID:24578916
Rakers, Sebastian; Gebert, Marina; Uppalapati, Sai; Meyer, Wilfried; Maderson, Paul; Sell, Anne F; Kruse, Charli; Paus, Ralf
Fish skin is a multi-purpose tissue that serves numerous vital functions including chemical and physical protection, sensory activity, behavioural purposes or hormone metabolism. Further, it is an important first-line defense system against pathogens, as fish are continuously exposed to multiple microbial challenges in their aquatic habitat. Fish skin excels in highly developed antimicrobial features, many of which have been preserved throughout evolution, and infection defense principles employed by piscine skin are still operative in human skin. This review argues that it is both rewarding and important for investigative dermatologists to revive their interest in fish skin biology, as it provides insights into numerous fundamental issues that are of major relevance to mammalian skin. The basic molecular insights provided by zebrafish in vivo-genomics for genetic, regeneration and melanoma research, the complex antimicrobial defense systems of fish skin and the molecular controls of melanocyte stem cells are just some of the fascinating examples that illustrate the multiple potential uses of fish skin models in investigative dermatology. We synthesize the essentials of fish skin biology and highlight selected aspects that are of particular comparative interest to basic and clinically applied human skin research.
Dirschka, Thomas; Gupta, Girish; Micali, Giuseppe; Stockfleth, Eggert; Basset-Séguin, Nicole; Del Marmol, Véronique; Dummer, Reinhard; Jemec, Gregor B E; Malvehy, Josep; Peris, Ketty; Puig, Susana; Stratigos, Alexander J; Zalaudek, Iris; Pellacani, Giovanni
Actinic keratosis (AK) is a chronic skin disease in which multiple clinical and subclinical lesions co-exist across large areas of sun-exposed skin, resulting in field cancerisation. Lesions require treatment because of their potential to transform into invasive squamous cell carcinoma. This article aims to provide office-based dermatologists and general practitioners with simple guidance on AK treatment in daily clinical practice to supplement existing evidence-based guidelines. Novel aspects of the proposed treatment algorithm include differentiating patients according to whether they have isolated scattered lesions, lesions clustered in small areas or large affected fields without reference to specific absolute numbers of lesions. Recognising that complete lesion clearance is rarely achieved in real-life practice and that AK is a chronic disease, the suggested treatment goals are to reduce the number of lesions, to achieve long-term disease control and to prevent disease progression to invasive squamous cell carcinoma. In the clinical setting, physicians should select AK treatments based on local availability, and the presentation and needs of their patients. The proposed AK treatment algorithm is easy-to-use and has high practical relevance for real-life, office-based dermatology.
Soriani, A.; D'Alessio, D.; Cattelan, V.; Cameli, N.; Mariano, M.; Ungania, S.; Guerrisi, M.; Strigari, L.
The aim of this preliminary study is to investigate the correlation between clinical set-up at present used in the treatment of specific skin conditions and laser beam absorbed power in the tissue. This study focused on the CO2 and Nd-Yag laser equipment used in the daily clinical practice in the Department of Dermatology of San Gallicano Institute in Rome. Different types of tissue-equivalent material with various water and haemoglobin concentrations were tested to evaluate laser beam attenuation power. In particular, thinly sliced pork loin, of uniform consistency and without fat, was selected for its high content of haemoglobin to mimic human tissues. An optical power meter was used to measure the power or energy of a laser beam. During measurements, the tissue equivalent phantoms were positioned on the detector head and the laser beam was orthogonally oriented. The results of two experimental set-ups are reported here. The dependence of residual power (W) as a function of ex vivo tissue thickness (mm) for different laser output powers was studied. Data were fitted by a parametric logistic equation. These preliminary data allow for more accurately determining the energy fraction released from lasers to the tissues in order to improve clinical outcomes. PMID:25295246
Bashaw, Edward Dennis; Tran, Doanh C.; Shukla, Chinmay G.; Liu, Xiaomei
Dermatologic diseases can present in varying forms and severity, ranging from the individual lesion and up to almost total skin involvement. Pharmacokinetic assessment of topical drug products has previously been plagued by bioanalytical assay limitations and the lack of a standardized study design. Since the mid-1990's the US Food and Drug Administration has developed and implemented a pharmacokinetic maximal usage trial (MUsT) design to help address these issues. The MUsT design takes into account the following elements: the enrollment of patients rather than normal volunteers, the frequency of dosing, duration of dosing, use of highest proposed strength, total involved surface area to be treated at one time, amount applied per square centimeter, application method and site preparation, product formulation, and use of a sensitive bioanalytical method that has been properly validated. This paper provides a perspective of pre-MUsT study designs and a discussion of the individual elements that make up a MUsT. PMID:26634191
Lowenstein, Elie B; Lowenstein, Eve J
Isotretinoin has revolutionized the field of dermatology, offering a cure for severe acne vulgaris and a therapeutic option for a variety of other chronic diseases and cancers. This drug has done more for many diseases in medicine than many drug classes have done for a single disorder, and yet, its use and availability have been threatened in the United States. Federal restrictions in the form of the IPLEDGE teratogenicity prevention plan have made the use of this drug more complex. Millions of dollars in litigation and claims of injury have fueled hysteria among laymen about the use of this drug. Overwhelmed with worries of its potential adverse effects, the public forgets that withholding isotretinoin therapy is not without its own risks. Isoteretinoin therapy can prevent lifelong and permanent physical and psychological scarring that comes as a matter of course with severe acne. Over 20 million people worldwide have taken the drug, with several studies demonstrating its safety and few long term adverse effects. This wonder drug's continued availability depends upon its responsible and informed use. This paper will review and put in perspective the issues important to consider in the proper use of isotretinoin.
Vlahovic, Tracey C; Joseph, Warren S; Scher, Richard K; Tosti, Antonella; Plasencia, Jesse; Pariser, David M; Markinson, Bryan C
Onychomycosis is a fungal infection, and, as such, one of the goals of treatment should be eradication of the infective agent. Despite this, in contrast to dermatologists, many podiatric physicians do not include antifungals in their onychomycosis treatment plans. Before initiating treatment, confirmation of mycologic status via laboratory testing (eg, microscopy with potassium hydroxide preparation, histopathology with periodic acid-Schiff staining, fungal culture, and polymerase chain reaction) is important; however, more podiatric physicians rely solely on clinical signs than do dermatologists. These dissimilarities may be due, in part, to differences between specialties in training, reimbursement patterns, or practice orientation, and to explore these differences further, a joint podiatric medicine-dermatology roundtable was convened. In addition, treatment options have been limited owing to safety concerns with available oral antifungals and relatively low efficacy with previously available topical treatments. Recently approved topical treatments-efinaconzole and tavaborole-offer additional options for patients with mild-to-moderate disease. Debridement alone has no effect on mycologic status, and it is recommended that it be used in combination with an oral or topical antifungal. There is little to no clinical evidence to support the use of lasers or over-the-counter treatments for onychomycosis. After a patient has achieved cure (absence of clinical signs or absence of fungus with minimal clinical signs), lifestyle and hygiene measures, prophylactic/maintenance treatment, and proactive treatment for tinea pedis, including in family members, may help maintain this status.
Mahé, Antoine; Faye, Ousmane; N'Diaye, Hawa Thiam; Konaré, Habibatou Diawara; Coulibaly, Ibrahima; Kéita, Somita; Traoré, Abdel Kader; Hay, Roderick J.
OBJECTIVE: To evaluate, in a developing country, the effect of a short training programme for general health care workers on the management of common skin diseases--a neglected component of primary health care in such regions. METHODS: We provided a one-day training programme on the management of the skin diseases to 400 health care workers who worked in primary health care centres in the Bamako area. We evaluated their knowledge and practice before and after training. FINDINGS: Before training, knowledge about skin diseases often was poor and practice inadequate. We found a marked improvement in both parameters after training. We analysed the registers of primary health care centres and found that the proportion of patients who presented with skin diseases who benefited from a clear diagnosis and appropriate treatment increased from 42% before the training to 81% after; this was associated with a 25% reduction in prescription costs. Improved levels of knowledge and practice persisted for up to 18 months after training. CONCLUSIONS: The training programme markedly improved the basic dermatological abilities of the health care workers targeted. Specific training may be a reasonable solution to a neglected component of primary health care in many developing countries. PMID:16462986
Ortega, Viviana Gómez; Gaona, Jennifer; Motta, Adriana; Medina Barragán, Oskar Javier
Background: Gouty panniculitis is a rare clinical manifestation of gout, characterized by deposits of monosodium urate crystals in the hypodermis. Our aim was to describe atypical and rare clinical presentations of gouty tophi. Methods: We searched relevant English and Spanish literature of unusual gout manifestations using the following keywords: giant, gout, panniculitis, gouty panniculitis, gouty tophi, rare manifestations of gout, gouty, tophi, tophus, monosodium urate, uric acid, and unusual. Well-described case reports, case series, and review articles were evaluated and included in the literature review. Results: International literature has reported fewer than 10 cases of gouty panniculitis worldwide. In this case report, the patient presents a rare manifestation of gouty panniculitis, with typical joint injuries, gouty tophi in both lower and upper extremities, chronic gouty tophi in the nose, for which only 3 cases have been reported in literature, and great hypertrophy of adipose tissue in the lower back. Conclusions: Tophi can be found in atypical locations, which increase morbidities and deformities caused by the disease. We report an interesting case of gouty panniculitis associated with great hypertrophy of the adipose tissue, a rare manifestation of gout, and unusual locations of tophi. These clinical manifestations in our patient have not been recorded before, which leads us to think that we are in the presence of a new dermatological manifestation of gout. PMID:26301134
Weeratna, Jayanie B
Bite marks can be considered as a patterned injury where identification of the causative tool will lead to the identification of the perpetrator. When patterned injuries resembling bite marks are seen on the victim or an assailant of a potential crime, all efforts must be made to carry out an immediate and proper investigation. The classical human bite mark pattern will appear as an oval or circular injury. However there are several dermatological lesions which can be misinterpreted or confused with bite marks. Similarly scars left as a result of contact with hot objects can sometimes bear a resemblance to bite marks. To the untrained eye, identification of bite mark injuries is not an easy task. Since bite marks are common in cases of child abuse and neglect, it is recommended that dental surgeons with forensic background become members of the child abuse and neglect management teams. During investigation of bite marks in alleged cases of child abuse and neglect, it is imperative to compare the injury with dentition of all the persons who have direct access to the child including siblings and playmates. Information revealed through the forensic analysis of bite marks not only helps in the criminal investigation but also in the clinical management of the persons concern.
Casanova, J M; Soria, X; Borrego, L; de Argila, D; Ribera, M; Pujol, R
The medical resident's portfolio is a collection of materials that show reflective learning in the context of clinical practice. A portfolio contains documents (such as case histories and questionnaires the resident has used), images, and video recordings that reveal that an individual has acquired the competencies needed for professional practice. A portfolio is an assessment tool that simultaneously supports learning and gives evidence for certifying competence. It encourages independent continuing professional development that is incremental and centered on answering questions about what one has learned, how it might be applied, what still needs to be learned, and what must be done to reach one's goal. Answering such questions provides evidence of competencies that have been acquired and what is still lacking, allowing the trainee to develop a plan for personal improvement and evaluate subsequent achievements. The first step in creating a portfolio is to list required skills and abilities, along with the actions that will allow the resident to acquire them during each year of residency training. The ultimate goal is to define the resident's professional competence. We describe a model on which to base a training and assessment portfolio for residents in dermatology.
Ciccolini, Kathryn; Kloos, Richard T.; Agulnik, Mark
Background: Treatment options for patients with advanced or metastatic medullary thyroid cancer (MTC) have, in recent years, expanded with the approval of two tyrosine kinase inhibitors (TKIs): vandetanib and cabozantinib. Other agents, including TKIs, are under clinical investigation for MTC. Although patients treated with TKIs are at risk of developing dermatologic adverse events (AE), these untoward events may be mitigated through AE-driven algorithms. Summary: AE-driven algorithms combine effective nonpharmaceutical and pharmaceutical treatment modalities implemented by a multidisciplinary effort that incorporates nursing interventions, patient education, and referrals to pain-management specialists, podiatrists, and dermatologists, as appropriate. Effective AE prevention and management reduce the need for dose interruptions and modifications, allowing patients the opportunity to derive the maximal benefit from TKI therapy, while maintaining quality of life. Conclusions: Optimal use of targeted therapies in the treatment of MTC depends on careful patient selection, interdisciplinary communication, and patient education and encouragement to enhance compliance and safety, optimize consistent dosing, and maximize the use of effective therapies. PMID:24902006
Costa, Rosane Orofino; Macedo, Priscila Marques de; Carvalhal, Aline; Bernardes-Engemann, Andréa Reis
Potassium iodide, as a saturated solution, is a valuable drug in the dermatologist's therapeutic arsenal and is useful for the treatment of different diseases due to its immunomodulatory features. However, its prescription has become increasingly less frequent in dermatology practice. Little knowledge about its exact mechanism of action, lack of interest from the pharmaceutical industry, the advent of new drugs, and the toxicity caused by the use of high doses of the drug are some possible explanations for that. Consequently, there are few scientific studies on the pharmacological aspects, dosage and efficacy of this drug. Also, there is no conventional standard on how to manipulate and prescribe the saturated solution of potassium iodide, which leads to unawareness of the exact amount of the salt being delivered in grams to patients. Considering that dosage is directly related to toxicity and the immunomodulatory features of this drug, it is essential to define the amount to be prescribed and to reduce it to a minimum effective dose in order to minimize the risks of intolerance and thus improve treatment adherence. This review is relevant due to the fact that the saturated solution of potassium iodide is often the only therapeutic choice available for the treatment of some infectious, inflammatory and immune-mediated dermatoses, no matter whether the reason is specific indication, failure of a previous therapy or cost-effectiveness.
Scher, Richard K; Tosti, Antonella; Joseph, Warren S; Vlahovic, Tracey C; Plasencia, Jesse; Markinson, Bryan C; Pariser, David M
Onychomycosis prevalence is expected to rise as the population ages and the prevalence of diabetes, peripheral vascular disease, and other significant risk factors rise. Until recently, treatment options were limited due to safety concerns with oral antifungals and low efficacy with available topical agents. Efinaconzole and tavaborole were approved by the FDA in 2014 for onychomycosis treatment and provide additional effective topical treatment options for patients with mild-to-moderate disease. Dermatologists and podiatrists both regularly treat onychomycosis, yet there are striking differences between specialties in approach to diagnosis and treatment. In order to explore these differences a joint dermatology-podiatry roundtable of onychomycosis experts was convened. Although it has little effect on mycologic cure, debridement may be a valuable adjunct to oral or topical antifungal therapy, especially in patients with greater symptom burden. However, few dermatologists incorporate debridement into their treatment plans and referral to podiatry may be appropriate for some of these patients. Furthermore, podiatrists may be better equipped to manage patients with concurrent diabetes or peripheral vascular disease and elderly patients who are unable to maintain proper foot hygiene. Once cure is achieved, lifestyle and hygiene practices, maintenance/prophylactic onychomycosis treatment, and proactive tinea pedis treatment in patients and family members may help to maintain patients' cured status.
An account is given of the development of early dermatologic iconography, mostly in watercolors and copper prints, as a consequence of late Enlightenment perspectives and the development of a visually-dependent concept in a text-dominated discipline of dermatology. The first great atlases in the field of dermatology by Robert Willan (1757-1812) and Jean-Louis Alibert (1768-1837), and by M. N. Devergie (1784-1842) in venereology, are addressed and Willan's work is elaborated in detail.
Nagesh, T S; Akhilesh, A
Background: Topical steroids are one of the most commonly abused drugs. There are only a few studies available which have highlighted the severity of this problem in India. However, these studies have concentrated mainly on the topical steroid abuse and its side effects over the face. Aims: The aim of this study was to know the awareness among the people about various commonly available topical steroids and their combinations irrespective of usage and to know the extent of misuse of these drugs. Along with this, we also tried to find the source of recommendation of these medicines which will help to sensitize people about this menace. Materials and Methods: This was a prospective, questionnaire-based study done at a tertiary care hospital. A total of 1000 adult patients attending the dermatology outpatient department were administered a questionnaire about awareness and usage of topical steroid and its combinations. Results: A total of 1000 adult patients were included in the study, out of which 809 (80.9%) patients had heard about at least one of the topical steroids or its combinations mentioned in the questionnaire. Six hundred and twelve (61.2%) patients had used these creams. Acne and pigmentation were the most common indications for which topical steroid was used. These medicines were recommended by general practitioners in 302 (49.5%) patients and pharmacists in 71 (11.6%) patients. Totally, 318 (51.9%) patients complained of some form of side effect after using these creams. Aggravation of the symptoms and increased pigmentation were the most common adverse effects. Conclusion: Misuse of topical steroids not just over the face but also as a cream for any skin problem is quite common. Most of the times, it is recommended by general practitioners or pharmacists. It is very important to sensitize these people about the possible complications of these drugs and the extent of problem the society is facing because of irrational and unregulated use of these drugs
Akpinar, Fatma; Dervis, Emine
Background: Few clinical studies are found in the literature about patients hospitalized with a diagnosis of cutaneous drug eruption. Aims: To determine the clinical types of drug eruptions and their causative agents in a hospital-based population. Materials and Methods: This retrospective study was performed in the Dermatology Department of Haseki General Hospital. Through 1751 patients hospitalized in this department between 2002 and 2009, inpatients diagnosed as drug eruption were evaluated according to WHO causality definitions. 106 patients composed of probable and possible cases of cutaneous drug eruptions were included in this study. Results: Seventy one females and 35 males were evolved. Mean age was 44.03±15.14. Duration between drug intake and onset of reaction varied from 5 minutes to 3 months. The most common clinical type was urticaria and/or angioedema in 48.1% of the patients, followed by maculopapular rash in 13.2%, and drug rash with eosinophilia and systemic symptoms in 8.5%. Drugs most frequently associated with cutaneous drug eruptions were antimicrobial agents in 40.5% of the patients, followed by antipyretic/anti-inflammatory analgesics in 31.1%, and antiepileptics in 11.3%. Conclusion: Urticaria and/or angioedema and maculopapular rash comprised majority of the drug eruptions. Rare reactions such as acute generalized exanthematous pustulosis, sweet syndrome, oral ulceration were also found. Antimicrobial agents and antipyretic/anti-inflammatory analgesics were the most commonly implicated drugs. Infrequently reported adverse reactions to myorelaxant agents, newer cephalosporins and fluoroquinolones were also detected. We suppose that studies on drug eruptions should continue, because the pattern of consumption of drugs is changing in every country at different periods and many new drugs are introduced on the market continuously. PMID:22707770
Jha, Abhijeet Kumar; Sinha, Rajesh; Prasad, Smita
Background: Topical corticosteroids (TC) are being misused widely on the face without a prescription from the dermatologist. Aim: To evaluate the misuse of TC-containing preparations on the face and the adverse effects due to its application. Materials and Methods: A questionnaire-based analysis was done among patients attending the dermatology outpatient department of a tertiary care hospital between March 2014 and March 2015. Patients with various facial dermatoses were asked about their current use of topical preparations and on further followup questioning, those who revealed the use of TCs (25g or more) continuously or intermittently for a minimum duration of four weeks were included in the study and observed for local adverse effects. Results: A total of 410 patients were observed, 306 were females (74.6%) and 104 were males (25.3%). One hundred and seventy-eight patients (43.4%) used topical steroids alone, 124 (30.2%) used creams containing TC, hydroquinone, and tretinoin, 108 (26.3%) used creams containing a combination of TC, antibiotic, and/or antifungal. One hundred and seventy-six patients (42.9%) bought TC or TC containing creams over the counter on their own, without the prescription of a dermatologist, 35 (8.5%) were recommended TC by a beautician (beauty parlors), 82 (20%) by their friends, family members, or neighbors, 75 (18.2%) by a non-dermatologist practitioner, and 42 (10.2%) by a dermatologist. Limitations: The sample size was small. Conclusion: Dispensing of TCs must be regulated in India; they should only be issued against a doctor's prescription. PMID:27559498
Seité, S; Deshayes, P; Dréno, B; Misery, L; Reygagne, P; Saiag, P; Stengel, F; Roguedas-Contios, AM; Rougier, A
Background Disfiguring dermatoses may have a significant impact on patients’ quality of life, namely on their relationship with others, self image, and self esteem. Some previous studies have suggested that corrective foundation can improve the quality of life (QOL) of patients with facial dermatoses; in particular, in patients with acne vulgaris or pigmentary disorders. Objective The aim of this prospective study was to evaluate the impact of the skin conditions of patients with various skin diseases affecting their face (scars, acne, rosacea, melasma, vitiligo, hypo or hyperpigmentation, lentigines, etc) on their QOL and the improvement afforded by the use of corrective makeup for 1 month after being instructed on how to use it by a medical cosmetician during an initial medical consultation. Methods One hundred and twenty-nine patients with various skin diseases affecting the patients’ face were investigated. The patients were instructed by a cosmetician on how to use corrective makeup (complexion, eyes, and lips) and applied it for 1 month. The safety of the makeup application was evaluated and the QOL was assessed via a questionnaire (DLQI) and using a 10-cm visual analog scale (VAS) completed before the first application and at the final visit. The amelioration of their appearance was documented by standardized photography. Results No side effects occurred during the course of the study. A comparison of the standardized photographs taken at each visit showed the patients’ significant improvement in appearance due to the application of corrective makeup. The mean DLQI score dropped significantly from 9.90 ± 0.73 to 3.49 ± 0.40 (P < 0.0001). Conclusion Our results suggest that dermatologists should encourage patients with disfiguring dermatoses to utilize appropriate and safe makeup to improve their appearance and their QOL. Corrective makeup can also complement the treatment of face dermatological diseases in order to improve patient’s adherence. PMID
Buono, Silvia; Langellotti, Antonio Luca; Martello, Anna; Bimonte, Marida; Tito, Annalisa; Carola, Antonietta; Apone, Fabio; Colucci, Gabriella; Fogliano, Vincenzo
The use of microalgae in the skin care market is already established although the scientific rationale for their benefit was not clearly defined. In this work, the biological activities of dermatologic interest of the water extract from the microalga Botryococcus braunii (BBWE) were evaluated by a battery of in vitro assays. At concentrations ranging from 0.1 to 0.001 % (w/v) BBWE promoted adipocytes differentiation by inhibiting hormone-sensitive lipase, thus promoting triglyceride accumulation in the cells. BBWE also induced gene expression of proteins involved in the maintenance of skin cells water balance such as aquaporin-3 (AQP3), filaggrin (FLG) and involucrin (INV). 0.1 % BBWE increased the gene expression of AQP3 of 2.6-folds, that of FLG and INV of 1.5- and 1.9-folds, respectively. Moreover, it induced the biosynthesis of collagen I and collagen III by 80 and 40 %, respectively, compared to the untreated control. BBWE antioxidant activity, evaluated by oxygen radical absorbance capacity (ORAC) assay, was of 43.5 μmol Trolox per gram of extract: a quite high value among those found for other microalgae extracts. BBWE inhibited the inducible nitric oxide synthase (iNOS) gene expression and the consequent nitrite oxide (NO) production under oxidative stress. At a concentration of 0.02 % BBWE reduced by 50 % the expression of iNOS and by about 75 % the NO production. Taken together, the results demonstrated that B. braunii water extract exerted an array of biological activities concurring with the skin health maintenance; therefore, it is a potential bioactive ingredient to be included in cosmetic products.
Rivers, J K; Gallagher, R P
The mandate of the Canadian Dermatology Association's Sun Awareness Program is to increase awareness of the dangers of the sun's ultraviolet (UV) rays and to provide information on prevention and early detection of skin cancer. Major projects include an annual national press campaign, which reaches an increasing number of Canadians each year, and the production and distribution of educational materials. Each year during Sun Awareness Week, screening stations have been established across the country, staffed by volunteer dermatologists and members of the Canadian Cancer Society. In Vancouver between 1991 and 1993, 1767 people were screened for skin cancer. Results indicate that these events can attract people at risk for skin cancer, even though people older than age 65 are probably underrepresented as a group. Although popular with the public, these screenings are difficult to organize and are limited by human resources. These events continue in limited numbers, because they provide an excellent venue for the dissemination of educational material. Cooperation with federal agencies has been a major focus of the program. For the past 2 years, educational material on protecting newborns and children from the sun has been made available free to every new mother in Canada, while Environment Canada's Ultraviolet index program provides daily information on UV intensity along with public health messages. With the realization that health promotion requires a sustained change in behavior of an individual, we are now embarking on a national program to evaluate the knowledge, attitudes, and behavior of Canadians concerning UV radiation. With this information, we hope to adapt our educational materials so that people will adopt and maintain healthy behavior choices while out in the sun.
Eikje, N. Skrebova
Benefits of employing laser and optical technologies in clinical dermatology are enormous, including solving the complex of questions in diagnosis and treatments of many skin diseases; introducing new methods of diagnosis, treatment and its evaluation; advancing fundamental understanding not only of physiology of skin itself, but also of pathophysiology of different dermatological diseases and conditions. Through numerous innovations in laser and optical technologies a variety of specific and important information has become available in clinical dermatology on real-time normal and lesional skin characterization and visualization, on different type and pattern recognition, on monitoring of several dermatological conditions, on assessment of various parameters for measuring dynamics of skin lesions with further possibilities to assess severity of skin symptoms, and on evaluation of different treatment regimes and their comparisons. After a decade of experiences in inter- and multi-disciplinary research I would like to share the wisdom and pitfalls of my work how to get laser and optical technologies into clinical practice of dermatological interest, that are discussed in the paper.
Morris, Daniel O; Boston, Raymond C; O'Shea, Kathleen; Rankin, Shelley C
It has been shown that people and pets can harbour identical strains of meticillin-resistant (MR) staphylococci when they share an environment. Veterinary dermatology practitioners are a professional group with a high incidence of exposure to animals infected by Staphylococcus spp. The objective of this study was to assess the prevalence of carriage of MR Staphylococcus aureus (MRSA), MR S. pseudintermedius (MRSP) and MR S. schleiferi (MRSS) by veterinary dermatology practice staff and their personal pets. A swab technique and selective media were used to screen 171 veterinary dermatology practice staff and their respective pets (258 dogs and 160 cats). Samples were shipped by over-night carrier. Human subjects completed a 22-question survey of demographic and epidemiologic data relevant to staphylococcal transmission. The 171 human-source samples yielded six MRSA (3.5%), nine MRSP (5.3%) and four MRSS (2.3%) isolates, while 418 animal-source samples yielded eight MRSA (1.9%) 21 MRSP (5%), and two MRSS (0.5%) isolates. Concordant strains (genetically identical by pulsed-field gel electrophoresis) were isolated from human subjects and their respective pets in four of 171 (2.9%) households: MRSA from one person/two pets and MRSP from three people/three pets. In seven additional households (4.1%), concordant strains were isolated from only the pets: MRSA in two households and MRSP in five households. There were no demographic or epidemiologic factors statistically associated with either human or animal carriage of MR staphylococci, or with concordant carriage by person-pet or pet-pet pairs. Lack of statistical associations may reflect an underpowered study.
Szymańczyk, J.; Cenian, W.; Piechowski, L.; Sawczak, M.; Jedrzejewska-Szczerska, M.; Cenian, A.
The newly developed pulsed/cw dermatological laser (with wavelengths 975 nm) is applied for therapies requiring deep penetration of tissue e.g. cutaneous (dermal) neurofibroma (Recklinghausen disease) or hemangiomas. As the selected eight patients had been treated previously using pulsed a Nd:YAG laser a comparison of these therapies was possible. The results of cutaneous neurofibroma therapy using diode laser show an improvement compared with the case of Ho:YAG and Nd:YAG laser therapies - however this should be checked for a larger number of patients.
Nguyen, Tien V; Hong, Judith; Prose, Neil S
The motivation for developing patient-centered communication stems from a desire to enhance the quality of patient care, fulfill professional competency requirements, reduce medical errors, and improve health outcomes and patient satisfaction. Patient-centered communication skills can optimize the physician-patient relationship without significantly prolonging office visits. We propose a series of practical and generally effective techniques for verbal and nonverbal communication. We also suggest a targeted approach for specific difficult conversations that may occur frequently in the practice of dermatology.
Graudenz, K; Raulin, C
Laser technology has considerably expanded therapeutic modalities in dermatology and aesthetic medicine. In addition, lasers have broadened the spectrum of diagnostic and therapeutic options in many other medical fields. Dermatologists, especially Dr. Leon Goldman, played an important role in the evolution and use of medical lasers. There was a long way from the concept of stimulated emission as the fundamental idea of laser technology by Albert Einstein in 1917 to the practical use of the laser today. We review the development of laser technology from the early days through the latest advances.
Erthal, Aline; Lourenço, Silvia Vanessa; Nico, Marcello Menta Simonsen
There are no studies about pediatric oral mucosal diseases performed by dermatologists in Brazil. This study presents the casuistics of oral mucosal diseases in children examined at the Oral Diseases Clinic at the Department of Dermatology - University of São Paulo - Brazil. Cases were retrospectively studied from the hospital records from 2003 to 2015. A hundredsix children have been examined. Commoner lesions examined included mucoceles and aphthae. Rare and difficult cases were also seen and have been published; this clinic is based in a tertiary hospital center that deals mostly with complex cases. PMID:28099620
Sivasubramanian, K N; Henkin, R I
Two premature infants were observed to develop behavioral and dermatologic changes and low serum zinc and copper concentrations following cessation of prolonged parenteral alimentation, while being fed exclusively with human milk. Following treatment with exogenous oral zinc supplementation, prompt relief of symptoms and increases of serum zinc and copper concentrations were observed in both infants. These patients comprise about 5% of our premature infants who are treated with parenteral alimentation for more than two weeks. We recommend that premature infants on prolonged parenteral alimentation should be monitored for changes in serum zinc and copper concentrations and, if a marked fall is observed, supplementation should be considered.
[Reactions to infliximab infusions in dermatologic patients: consensus statement and treatment protocol. Working Group of the Grupo Español de Psoriasis de la Academia Española de Dermatología y Venereología ].
Puig Sanz, Lluís; Sáez, E; Lozano, M J; Bordas, X; Carrascosa, J M; Gallardo, F; Luelmo, J; Sánchez-Regaña, M; Alsina, M; García-Patos, V
Infliximab is a chimeric monoclonal antibody that binds to and blocks tumor necrosis factor alpha and is the most effective biologic agent approved for the treatment of moderate-to-severe psoriasis. It is administered by intravenous infusion, usually in day hospitals on an outpatient basis. The main problem with the administration of infliximab is the possibility of infusion reactions, which may be immediate or delayed; these reactions are related to the immunogenicity of this monoclonal antibody, leading to the production of anti-infliximab antibodies. Infusion reactions to infliximab are not usually anaphylactic (ie, they are not mediated by immunoglobulin E), and re-exposure of the patient using specific protocols to prevent and treat these reactions is therefore possible. The extensive experience in the use of infliximab for the treatment of rheumatic conditions and chronic inflammatory bowel disease has made it possible to develop infusion reaction management protocols; these can be applied to dermatologic patients, who constitute a growing proportion of patients treated with intravenous biological agents. The aim of this review is to draw up a consensus protocol for the treatment of infusion reactions in dermatologic patients treated with infliximab.
Blank, I H
Private-sector funding of biomedical research within academia may come from industry, foundations, the dermatologists themselves, and the public at large. Industry-funding is of benefit to both academia and industry. Industry may fund clinical and basic research and product testing. Industry is more willing to fund product testing and clinical research than basic research. Funds for dermatologic research may be obtained from manufacturers of drugs, medical devices, cosmetics, soaps, and detergents. Questions of academic freedom arise when research is funded by industry. The results of academic research are in the public domain; the results of intramural industry research are often proprietary, i.e., "trade secrets." When there is industry funding within academia, any restraints on publication should be held to a minimum and be temporary. Publication should occur in a timely fashion, although recognizing the need for delayed publication if the results concern patentable material. When there is a consultantship, pre-arranged terms of agreement may restrict communication. Patents usually are held by the investigator's institution. The funding company may be granted world-wide, royalty-bearing licenses. Conflicts of interest may arise during any research endeavor; this warrants close attention when the research is industry funded. Stock ownership, speaker fees, blind contracts, etc., should be avoided. In any communication, funding agreements should be stated. Indirect costs are a "necessary evil." There are non-research expenditures associated with all research projects for which the institution is justified in requesting compensation. Indirect costs must have definite connections to a project. As industrial funding of research within academia increases, various facets of the academia-industry relationship are receiving increasing attention. Several aspects of conflicts of interest and indirect costs must yet be resolved. When faced openly and directly, all of these
Fontana, M C; Rezer, J F P; Coradini, K; Leal, D B R; Beck, R C R
We developed a dermatological nanomedicine containing clobetasol propionate-loaded nanocapsules and evaluated its efficacy in a model of contact dermatitis after topical administration in rats. Hydrogels containing clobetasol propionate-loaded lipid-core nanocapsules or nanoemulsion (HG-CP-NC and HG-CP-NE, respectively) were prepared to evaluate the influence of the polymeric wall. They presented adequate pH values (5.50-6.50) and drug content (0.5 mg g(-1)) and their rheograms exhibited a non-Newtonian pseudoplastic behavior. The best in vitro drug release control was obtained for HG-CP-NC (1.03±0.11 μg cm(-2) h) compared to the HG-CP-NE (1.65±0.19 μg cm(-2) h) and the hydrogels containing nonencapsulated drug (HG-CP) (2.79±0.22 μg cm(-2) h). A significant increase in NTPDase activity was observed in lymphocytes for the group treated with 0.05% HG-CP-NC every other day compared to the group treated with 0.05% HG-CP every day using the in vivo model of contact dermatitis. The nanoencapsulation of clobetasol in nanocapsules led to a better control of the drug release from the semisolid nanomedicine and provided better in vivo dermatological efficacy.
Burgdorf, Walter H C; Bickers, David R
The rise to power of the National Socialist (Nazi) party led by Adolf Hitler and the subsequent tumultuous 12 years of their rule in Germany resulted in catastrophes including World War II, the most destructive war ever, and the premeditated and systematic murder of 5 to 6 million European Jews. Despite their notable contributions to the academic excellence that existed in German-speaking countries at that time, Jewish physicians were particularly vulnerable to persecution and death. Between 1933 and 1938, a series of repressive measures eliminated them from the practice of medicine in Germany and other countries. Although some died in concentration camps and others committed suicide, many were able to emigrate from Europe. Dermatology in the United States particularly benefited from the influx of several stellar Jewish dermatologists who were major contributors to the subsequent flowering of academic dermatology in the United States. A number of representative biographies of these immigrants are briefly recounted to illustrate their lasting influence on our specialty.
Morales-Cardona, Camilo A; Valbuena-Mesa, Martha C; Alvarado, Zulma; Solorzano-Amador, Andrea
Worldwide prevalence of non-dermatophyte mould onychomycosis has increased in recent years; however, available information on the topic is confusing and oftentimes contradictory, probably due to the small number of reported cases. The aim of this study was to determine and describe the aetiological agents, as well as the epidemiological and clinical characteristics of non-dermatophyte mould onychomycosis in a dermatology referral centre in Bogota, Colombia. A cross-sectional descriptive study was conducted between January 2001 and December 2011 among patients who attend the National Institute of Dermatology with a confirmed diagnosis of onychomycosis by non-dermatophytes moulds. There were 317 confirmed cases of non-dermatophyte mould onychomycosis in 196 women and 121 men whose average age was 43 years. Twenty-seven per cent of them had a history of systemic disease. The habit of walking and showering barefoot was the major infection-related factor. Distal and lateral subungual presentation was the most common pattern of clinical presentation. The most frequent non-dermatophyte mould was Neoscytalidium dimidiatum followed by Fusarium spp. No relationship was observed with predisposing factors previously reported in the literature. Clinical features found in this population are indistinguishable from onychomycosis caused by dermatophytes. High prevalence of N. dimidiatum found here was in contrast to a large number of studies where other types of moulds predominate.
Bandino, Justin P; Hang, Anna; Norton, Scott A
Meteorological data show that disastrous floods are increasingly frequent and more severe in recent years, perhaps due to climatic changes such as global warming. During and after a flood disaster, traumatic injuries, communicable diseases, chemical exposures, malnutrition, decreased access to care, and even mental health disorders dramatically increase, and many of these have dermatological manifestations. Numerous case reports document typical and atypical cutaneous infections, percutaneous trauma, immersion injuries, noninfectious contact exposures, exposure to wildlife, and exacerbation of underlying skin diseases after such disasters as the 2004 Asian tsunami, Hurricane Katrina in 2005, and the 2010 Pakistan floods. This review attempts to provide a basic field manual of sorts to providers who are engaged in care after a flooding event, with particular focus on the infectious consequences. Bacterial pathogens such as Staphylococcus and Streptococcus are still common causes of skin infections after floods, with atypical bacteria also greatly increased. Vibrio vulnificus is classically associated with exposure to saltwater or brackish water. It may present as necrotizing fasciitis with hemorrhagic bullae, and treatment consists of doxycycline or a quinolone, plus a third-generation cephalosporin and surgical debridement. Atypical mycobacterial infections typically produce indolent cutaneous infections, possibly showing sporotrichoid spread. A unique nontuberculous infection called spam has recently been identified in Satowan Pacific Islanders; combination antibiotic therapy is recommended. Aeromonas infection is typically associated with freshwater exposure and, like Vibrio infections, immunocompromised or cirrhotic patients are at highest risk for severe disease, such as necrotizing fasciitis and sepsis. Various antibiotics can be used to treat Aeromonas infections. Melioidosis is seen mainly in Southeast Asia and Australia, particularly in rice farmers, and
Background So far there have been no studies focusing on the prevalence of a wide spectrum of oral mucosal lesions (OML) in patients with dermatologic diseases. This is noteworthy as skin lesions are strongly associated with oral lesions and could easily be neglected by dentists. This study aimed to estimate the frequency and socio-behavioural correlates of OML in skin diseased patients attending outpatient's facility of Khartoum Teaching Hospital - Dermatology Clinic, Sudan. Methods A cross-sectional hospital-based study was conducted in Khartoum from October 2008 to January 2009. A total of 588 patients (mean age 37.2 ± 16 years, 50.3% females) completed an oral examination and a personal interview of which 544 patients (mean age 37.1 ± 15.9 years, 50% females) with confirmed skin disease diagnosis were included for further analyses. OML were recorded using the World Health Organization criteria (WHO). Biopsy and smear were used as adjuvant techniques for confirmation. Data were analysed using the Statistical Package for Social Science (Version 15.0.1). Cross tabulation and Chi-square with Fisher's exact test were used. Results A total of 438 OML were registered in 315 (57.9%, males: 54.6% versus females: 45.6%, p < 0.05) skin diseased patients. Thus, a certain number of patients had more than one type of OML. Tongue lesions were the most frequently diagnosed OML (23.3%), followed in descending order by white lesions (19.1%), red and blue lesions (11%) and vesiculobullous diseases (6%). OML in various skin diseases were; vesiculobullous reaction pattern (72.2%), lichenoid reaction pattern (60.5%), infectious lesions (56.5%), psoriasiform reaction pattern (56.7%), and spongiotic reaction pattern (46.8%). Presence of OML in skin diseased patients was most frequent in older age groups (62.4% older versus 52.7% younger, p < 0.05), in males (63.2% males versus 52.6% females, p < 0.05), patients with a systemic disease (65.2% with systemic versus 51.9% without
The white-tailed deer (Odocoileus virginianus) is a common and widespread North American game species. To evaluate the incidence, clinical manifestations, demography, and pathology of bacterial and parasitic dermatologic diseases in white-tailed deer in the southeastern United States, we retrospecti...
Background Skin diseases are underestimated and overlooked by most clinicians despite being common in clinical practice. Many patients are hospitalized with co-existing dermatological conditions which may not be detected and managed by the attending physicians. The objective of this study was to determine the burden of co-existing and overlooked dermatological disorders among patients admitted to medical wards of Muhimbili National hospital in Dar es Salaam. Study design and settings A hospital-based descriptive cross-sectional study conducted at Muhimbili National hospital in Dar es Salaam, Tanzania. Methods Patients were consecutively recruited from the medical wards. Detailed interview to obtain clinico-demographic characteristics was followed by a complete physical examination. Dermatological diagnoses were made mainly clinically. Appropriate confirmatory laboratory investigations were performed where necessary. Data was analyzed using the 'Statistical Package for Social Sciences' (SPSS) program version 10.0. A p-value of < 0.5 was statistically significant. Results Three hundred and ninety patients admitted to medical wards were enrolled into the study of whom, 221(56.7%) were females. The mean age was 36.7 ± 17.9 (range 7-84 years). Overall, 232/390 patients (59.5%) had co-existing dermatological disorders with 49% (191/390) having one, 9% (36/390) two and 5 patients (1%) three. A wide range of co-existing skin diseases was encountered, the most diverse being non-infectious conditions which together accounted for 36.4% (142/390) while infectious dermatoses accounted for 31.5% (123/390). The leading infectious skin diseases were superficial fungal infections accounting for 18%. Pruritic papular eruption of HIV/AIDS (PPE) and seborrheic eczema were the most common non-infectious conditions, each accounting for 4.3%. Of the 232/390 patients with dermatological disorders, 191/232 (82.3%) and 154/232 (66.3%) had been overlooked by their referring and admitting
Grzybowski, Andrzej; Pietrzak, Krzysztof
Niels Ryberg Finsen (1860–1904) developed a lamp based on electric carbon arcs (later known as the Finsen light) that was used for skin therapy a century ago. He became director of the Medical Light Institute in Copenhagen, later the Finsen Institute, where he developed this method of treatment. Within a few years, 40 Finsen Institutes were established in Europe and in the United States of America. In 1903, Finsen received the Nobel Prize in Medicine in recognition of his work on the treatment of diseases and, in particular, the treatment of lupus vulgaris by means of concentrated light rays. Finsen's scientific interests were greatly influenced by his health condition. Beginning in 1883, he began to experience symptoms of an illness that would be later diagnosed as Niemann-Pick disease. He spent the last years of his life confined to a wheelchair. Dermatology reaps the benefits of light treatment to this day.
Hamadeh, R R; Al-Roomi, K A
Environmental health data in Bahrain are scarce. This study in 4 governorates of Bahrain aimed to establish baseline data on the seasonal prevalence of certain disease groups that are sensitive to climate (respiratory, allergic, dermatological and non-specific gastrointestinal diseases) over a 1-year period and to record local climate and air pollutant data for the same year. A 5% sample of medical records for those who attended primary health-care centres during 2007 was taken. Visit rates for all 4 diseases had peaks, in spring and in autumn, with the lowest rates in the summer season when the average temperatures were highest and average humidity was lower. Respiratory-related visits were highest when the air concentrations of SO2 were highest. An ongoing surveillance system for climate-sensitive diseases should be initiated to monitor and relate health and environmental trends.
Fumimori, Takeaki; Tsuruta, Daisuke; Kawakami, Tamihiro; Ohata, Chika; Furumura, Minao; Hashimoto, Takashi
Palmoplantar pustulosis (PPP) is currently treated with various modalities, including excimer light, a form of ultraviolet lamp. This study reports effect of excimer light treatment in 34 Japanese PPP patients treated at a private clinic by one doctor, who was certified as a dermatological specialist by the Japanese Dermatological Association. The statistical analyses were performed upon a collaborative basis with faculties in universities. Disease response scores were determined by response to excimer light treatment. Scores of 1, 2, 3 or 4 were assigned to patients whose palmoplantar pustular psoriasis area and severity index (PPPASI) decreased to 25% or less, 25.1-50%, 50.1-75% or more than 75.1% of pretreatment PPPASI, respectively. In this study, 44.1% PPP cases had scores of 1 or 2, and considered good responders to excimer light treatment. There were no statistical differences between males and females, and between older (≥40 years) and younger groups (≤39 years) in terms of disease response score. Disease duration did not show any significant difference among these scores. Treatment times, total amount of ultraviolet and total treatment duration showed significant differences between score 1 and score 4 groups (P = 0.0164, =0.0137 and =0.0267, respectively). Particular interest was paid to smoking habits. Smoking in male patients was significantly higher than that in female patients (P = 0.0169). There was no statistical difference between smokers and non-smokers in terms of response to excimer light. In conclusion, this study suggested that excimer light is useful for both initial regimen and suppression of exacerbation in treatments of PPP.
Cobo-Ibáñez, Tatiana; Villaverde, Virginia; Seoane-Mato, Daniel; Muñoz-Fernández, Santiago; Guerra, Mercedes; Del Campo, Petra Díaz; Cañete, Juan D
The aim of the study was to analyze the efficacy and satisfaction of multidisciplinary dermatology-rheumatology management for patients with moderate-to-severe psoriasis and psoriatic arthritis (PsA). We conducted a systematic literature search in MEDLINE, EMBASE, and Cochrane Library up to September 2015. Selection criteria include (1) adult patients with moderate-to-severe psoriasis and PsA, (2) assessed in a multidisciplinary consultation, (3) comparison with routine separate consultations, and (4) outcome measures to evaluate efficacy and/or satisfaction. Meta-analyses, systematic reviews, clinical trials, cohort studies, and case series were included. The quality of the studies included was graded according to the Oxford Level of Evidence scale. Of 195 articles, three studies complied with the inclusion criteria: two case series and one descriptive study in which 506 patients were evaluated. Patients were referred to the multidisciplinary consultation from dermatology and rheumatology consultations in all but one study, in which primary care was also involved. The reason for the referral was to confirm the diagnosis and/or treatment. Patients were evaluated on a weekly and monthly basis in two and one study, respectively. The evidence obtained is scarce but suggests the efficacy of multidisciplinary consultations in terms of improved skin and joint symptoms after changing treatment (82-56 %), showing higher scores for this type of consultation compared to the usual [4.91 vs. 2.85 (0-5)] and a high level of satisfaction among patients (94 % "very satisfied"). However, waiting times were higher. With the limited evidence found, multidisciplinary management seems to be more effective and more satisfactory for patients with moderate-to-severe psoriasis and PsA than conventional consultations, though this could not be conclusively demonstrated. The results of this review support the benefit of implementing this type of consultation.
Singh, Harminder; Singh, Prabhakar; Tiwari, Pavan; Dey, Vivek; Dulhani, Navin; Singh, Amita
Background: Cutaneous disorders during HIV infection are numerous and skin is often the first and only organ affected during most of the course of HIV disease. Some Cutaneous disorders reflect the progression of HIV disease; though the relation is still controversial. Aims: The objective of this study, conducted at a tertiary care centre in Bastar, Jagdalpur, is to estimate the status of cutaneous manifestation in HIV-infected patients and its relationship with CD4 cell counts. Methods: We enrolled 137 HIV positive subjects. Demographic information such as age, gender, weight, height, socioeconomic status, and educational status were recorded. Laboratory parameter (CD4 counts) and treatment regimen were noted. Patients were examined for skin disorders by a dermatologist. Data were analyzed using chi-square test for categorical variables. Results: Majority of the patients were from rural area (65.69%) and belonged to a low socioeconomic and educational status. 30.65% of the patients were housewives, 23.35% drivers, and 16.78% labourers. Predominant mode of transmission was heterosexual contact (94.16%). Most common HIV-related dermatological manifestations were seborrheic dermatitis (74.16%), xerosis (52.5%), generalized skin hyperpigmentation 56 (46.67%), onychomycosis 53 (44.16%), pruritic papular eruption 27 (22.5%), oral candidiasis 21 (17.5%), photo dermatitis 21 (17.5%), and scabies 4 (3.33%). Significant correlation with low CD4+ cell counts was found for oral candidiasis (P < 0.0001) and Kaposi's sarcoma (P = 0.03), while other disorders such as seborrheic dermatitis (P = 0.22), xerosis (P = 0.25), and onychomycosis (P = 0.08) were not statistically significant. Conclusion: This study showed high prevalence of dermatological manifestations in HIV-infected subjects, and they occur more frequently with progression of HIV and decline in immune functions. Therefore, early diagnosis and management of skin disorders can improve the quality of life of HIV
Croxtall, Jamie D; Plosker, Greg L
glabrous skin and tinea pedis receiving topical 2% sertaconazole cream once or twice daily achieved a successful mycological cure compared with recipients of a placebo cream. Moreover, the clinical cure rate and the mycological cure rate of 2% sertaconazole cream twice daily was significantly higher than that of 2% miconazole cream twice daily in patients with a range of cutaneous mycoses (n = 631) in a randomized, double-blind, multicentre, phase III, comparator trial of 35 days' duration. Furthermore, a greater proportion of patients receiving sertaconazole achieved the category of clinically cured at a significantly earlier timepoint than recipients of miconazole. An open-label, noninferiority trial of 28 days' duration in 313 patients with tinea corporis, tinea pedis or a corresponding candidiasis showed that sertaconazole as a 2% solution was as effective as treatment with a 2% cream preparation. Sertaconazole as a single-dose 300 mg vaginal ovule or 500 mg tablet was successful in the eradication of Candida spp. in 65-100% of patients with vaginal candidiasis in trials that evaluated clinical and mycological cure rates up to 1 year after the last treatment application (n = 37-327). Furthermore, the clinical cure rate and the mycological cure rate of single-dose sertaconazole 500 mg tablet was significantly greater than that of triple-dose econazole 150 mg in the eradication of Candida albicans and also achieved a more rapid response rate in patients with vaginal candidiasis (n = 37). Sertaconazole was generally well tolerated in patients with dermatological and gynaecological mycoses. Adverse events associated with topical application of sertaconazole cream were mostly cutaneous-related and included contact dermatitis, dry or burning skin, application-site reaction, eczema, itch and skin tenderness. However, the frequency of adverse events did not differ from that of the placebo vehicle treatment arm. Furthermore, sertaconazole showed no evidence of a sensitizing
With five late-breaking research in dermatology forums, a very intensive program of other forum sessions and a popular electronic poster session with a wealth of new clinical and preclinical research, many of which reflecting advances in the management of skin and skin structure diseases that either endanger the lives of patients or severely limit their quality of life and psychological wellbeing, the American Academy of Dermatology meeting gathered attendees from all around the world to its annual meeting in San Francisco. The following report highlights some of the most relevant new findings directly related with therapy for conditions such as psoriasis, nonmelanoma skin cancer, and other inflammatory, immunological and infectious diseases of the skin.
March, at 5,000 feet above sea level, is not the best season for having much skin exposed, particularly when snow flurries are coming down on one's face. However, that was the time and place for sharing or getting new knowledge of skin science during this year's annual meeting of the American Academy of Dermatology. At high altitude, a high level of science was constant throughout the meeting sessions, including, notably, the Latest in Dermatology Research symposium held on Saturday March 22, and the electronic poster presentations available to attendees throughout the conference. This report summarizes the most significant new scientific findings reported during the meeting, which have a direct impact on how diseases of the skin are or will possibly be treated in the foreseen future.
Future considerations for clinical dermatology in the setting of 21st century American policy reform: The Medicare Access and Children's Health Insurance Program Reauthorization Act and Alternative Payment Models in dermatology.
Barbieri, John S; Miller, Jeffrey J; Nguyen, Harrison P; Forman, Howard P; Bolognia, Jean L; VanBeek, Marta J
With the introduction of the Medicare Access and Children's Health Insurance Program Reauthorization Act, clinicians who are not eligible for an exemption must choose to participate in 1 of 2 new reimbursement models: the Merit-based Incentive Payment System or Alternative Payment Models (APMs). Although most dermatologists are expected to default into the Merit-based Incentive Payment System, some may have an interest in exploring APMs, which have associated financial incentives. However, for dermatologists interested in the APM pathway, there are currently no options other than joining a qualifying Accountable Care Organization, which make up only a small subset of Accountable Care Organizations overall. As a result, additional APMs relevant to dermatologists are needed to allow those interested in the APMs to explore this pathway. Fortunately, the Medicare Access and Children's Health Insurance Program Reauthorization Act establishes a process for new APMs to be approved and the creation of bundled payments for skin diseases may represent an opportunity to increase the number of APMs available to dermatologists. In this article, we will provide a detailed review of APMs under the Medicare Access and Children's Health Insurance Program Reauthorization Act and discuss the development and introduction of APMs as they pertain to dermatology.
Ofenloch, Robert F; Diepgen, Thomas L; Weisshaar, Elke; Elsner, Peter; Apfelbacher, Christian J
Health-related quality of life (HRQOL) has become an important patient reported outcome in health service research. The dermatology life quality index (DLQI) is the most commonly used instrument in dermatology. In recent years, the psychometric properties of the DLQI have been a subject of debate as requirements of modern test theory seem not to be fulfilled. The aim of this study was to test whether those violations also occur in patients with hand eczema. We collected data of 602 hand eczema patients who participated in an inpatient dermatology rehabilitation program in Germany. In order to report meaningful scores of the DLQI, data were analysed according to the principles of modern test theory. We calibrated the DLQI using the Rasch model, resulting in a 6 item version with a range between 0-15 points. This version showed no significant misfit to the Rasch model (p>0.14). By using a Rasch analysis the results were evaluated in a second sample of hand eczema patients (n=511). Even if all demographic characteristic of this sample were different, we were able to replicate the results found in this study (p>0.21). In conclusion, we recommend to use an alternative scoring procedure as presented in this article if the DLQI is used in hand eczema patients.
Jolivot, Romuald; Nugroho, Hermawan; Vabres, Pierre; Ahmad Fadzil, M. H.; Marzani, Franck
This paper presents the validation of a new multispectral camera specifically developed for dermatological application based on healthy participants from five different Skin PhotoTypes (SPT). The multispectral system provides images of the skin reflectance at different spectral bands, coupled with a neural network-based algorithm that reconstructs a hyperspectral cube of cutaneous data from a multispectral image. The flexibility of neural network based algorithm allows reconstruction at different wave ranges. The hyperspectral cube provides both high spectral and spatial information. The study population involves 150 healthy participants. The participants are classified based on their skin phototype according to the Fitzpatrick Scale and population covers five of the six types. The acquisition of a participant is performed at three body locations: two skin areas exposed to the sun (hand, face) and one area non exposed to the sun (lower back) and each is reconstructed at 3 different wave ranges. The validation is performed by comparing data acquired from a commercial spectrophotometer with the reconstructed spectrum obtained from averaging the hyperspectral cube. The comparison is calculated between 430 to 740 nm due to the limit of the spectrophotometer used. The results reveal that the multispectral camera is able to reconstruct hyperspectral cube with a goodness of fit coefficient superior to 0,997 for the average of all SPT for each location. The study reveals that the multispectral camera provides accurate reconstruction of hyperspectral cube which can be used for analysis of skin reflectance spectrum.
Casetti, F; Bartelke, S; Biehler, K; Augustin, M; Schempp, C M; Frank, U
The aim of this work was to determine the antibacterial activity of essential coriander oil (ECO) on bacteria with dermatological relevance and to assess the skin tolerance of antimicrobial effective ECO concentrations. Essential coriander oil was tested on clinical isolates of different bacteria species, all of which may cause superficial skin infections. Antimicrobial susceptibility testing was performed using a standardized macrodilution test. Essential coriander oil showed good antibacterial activity towards the majority of the bacterial strains tested, including Streptococcus pyogenes (Lancefield group A) and methicillin resistant Staphylococcus aureus (MRSA), with mean minimal inhibitory concentrations of 0.04% v/v and 0.25% v/v, respectively. The skin tolerance of a cream and a lotion containing 0.5% and 1.0% ECO was assessed in 40 healthy volunteers using the occlusive patch test. No skin irritation could be observed by sensitive photometric assessment in any of the volunteers. Because of its activity against Streptococcus pyogenes, Staphylococcus aureus and MRSA combined with excellent skin tolerance, ECO might be useful as an antiseptic for the prevention and treatment of skin infections with Gram-positive bacteria.
Schmitt, Jochen; Apfelbacher, Christian; Spuls, Phyllis I; Thomas, Kim S; Simpson, Eric L; Furue, Masutaka; Chalmers, Joanne; Williams, Hywel C
Core outcome sets (COSs) are consensus-derived minimum sets of outcomes to be assessed in a specific situation. COSs are being increasingly developed to limit outcome-reporting bias, allow comparisons across trials, and strengthen clinical decision making. Despite the increasing interest in outcomes research, methods to develop COSs have not yet been standardized. The aim of this paper is to present the Harmonizing Outcomes Measures for Eczema (HOME) roadmap for the development and implementation of COSs, which was developed on the basis of our experience in the standardization of outcome measurements for atopic eczema. Following the establishment of a panel representing all relevant stakeholders and a research team experienced in outcomes research, the scope and setting of the core set should be defined. The next steps are the definition of a core set of outcome domains such as symptoms or quality of life, followed by the identification or development and validation of appropriate outcome measurement instruments to measure these core domains. Finally, the consented COS needs to be disseminated, implemented, and reviewed. We believe that the HOME roadmap is a useful methodological framework to develop COSs in dermatology, with the ultimate goal of better decision making and promoting patient-centered health care.
The early diagnosis of cancer is essential since it can be treated more effectively when detected earlier. Visual inspection followed by histological examination is, still today, the gold standard for clinicians. However, a large number of unnecessary surgical procedures are still performed. New diagnostics aids are emerging including the recent techniques of optical coherence tomography (OCT) which permits non-invasive 3D optical biopsies of biological tissues, improving patient's quality of life. Nevertheless, the existing bulk or fiber optics systems are expensive, only affordable at the hospital and thus, not sufficiently used by physicians or cancer's specialists as an early diagnosis tool. We developed two different microsystems based on Mirau interferometry and applied for swept source OCT imaging: one for dermatology and second for gastroenterology. In both cases the architecture is based tem based on spectrally tuned Mirau interferometry. The first configuration, developed in the frame of the European project VIAMOS, includes an active array of 4x4 Mirau interferometers. The matrix of Mirau reference mirrors is integrated on top of an electrostatic vertical comb-drive actuator. In second configuration, developed in the frame of Labex ACTION, we adapted VIAMOS technology to develop an OCT endomicroscope with a single-channel passive Mirau interferometer.
Highsmith, James T.; Weinstein, David A.; Highsmith, M. Jason; Etzkorn, Jeremy R.
The smartphone has become a ubiquitous tool in modern culture. Given the current high quality of smartphone cameras, they should be considered a valuable tool for the dermatologic surgeon in the pre-operative consultation. The purpose of this technical note is to describe a methodology using smartphone camera technology to improve the process for capturing biopsy site photographs and including those photos in decision making to maximize cutaneous surgical outcomes. This technical note describes a three-step procedure (BIOPSY 1-2-3) to simplify and standardize the protocol for capturing a biopsy site photograph using the patient's own smartphone. The steps are also intended to improve the resolution and value of the image. A case example is provided. Using the steps of BIOPSY 1-2-3, the case example biopsy site image is clearly identified compared to a less structured image. Using BIOPSY 1-2-3, biopsy site images taken by patient-owned smartphone cameras can empower and involve patients in their care, improve image quality, and reduce medical errors. PMID:28066529
Kaffenberger, Jessica A; Mosser, Joy; Lee, Grace; Pootrakul, Llana; Harfmann, Katya; Fabbro, Stephanie; Faith, Esteban Fernandez; Carr, David; Plotner, Alisha; Zirwas, Matthew; Kaffenberger, Benjamin H
Background: In an effort to avoid numerous problems associated with narrative letters of recommendation, a dermatology standardized letter of recommendation was utilized in the 2014-2015 resident application cycle. Objective: A comparison of the standardized letter of recommendation and narrative letters of recommendation from a single institution and application cycle to determine if the standardized letter of recommendation met its original goals of efficiency, applicant stratification, and validity. Methods: Eight dermatologists assessed all standardized letters of recommendation/narrative letters of recommendation pairs received during the 2014-2015 application cycle. Five readers repeated the analysis two months later. Each letter of recommendation was evaluated based on a seven question survey. Letter analysis and survey completion for each letter was timed. Results: Compared to the narrative letters of recommendation, the standardized letter of recommendation is easier to interpret (p<0.0001), has less exaggeration of applicants' positive traits (p<0.001), and has higher inter-rater and intrarater reliability for determining applicant traits including personality, reliability, work-ethic, and global score. Standardized letters of recommendation are also faster to interpret (p<0.0001) and provide more information about the writer's background or writer-applicant relationship than narrative letters of recommendation (p<0.001). Limitations: This study was completed at a single institution. Conclusions: The standardized letter of recommendation appears to be meeting its initial goals of 1) efficiency, 2) applicant stratification, and 3) validity. (J Clin Aesthet Dermatol. 2016;9(9):36-2.).
Guitart, Joan Ramon; Johnson, Jodi L.; Chien, Wade W.
Designer nucleases have gained widespread attention for their ability to precisely modify genomic DNA in a programmable manner. These genome-editing nucleases make double-stranded breaks at specified loci, and desired changes can be made to modify, ablate, or excise target genes. This technology has been used widely to develop human disease models in laboratory animals and to study gene functions by silencing, activating, or modifying them. Furthermore, the recent discovery of a bacterially derived programmable nuclease termed clustered regularly interspaced palindromic repeats (CRISPR)-associated protein 9 (Cas9) has revolutionized the field because of its versatility and wide applicability. In this article, we discuss various modalities used to achieve genome editing with an emphasis on CRISPR-Cas9. We discuss genome-editing strategies to either repair or ablate target genes, with emphasis on their applications for investigating dermatological diseases. Additionally, we highlight preclinical studies showing the potential of genome editing as a therapy for congenital blistering diseases and as an antimicrobial agent, and we discuss limitations and future directions of this technology. PMID:27542298
The diagnosis of human phtiriasis (often referred to as the "crab" or the "pubic louse") can be more difficult than other types of pediculosis (Pediculus corporis and Pediculus capitis) because this insect has a smaller body of 1.2 x 0.8 mm, may be lighter in color, not as mobile and therefore harder to see to the naked eye. Can dermoscopy aid to perform a better analysis of the skin? The clinical experience developed in two patients gives an affirmative answer, moreover adding useful information of insect and its eggs already known to entomologists but never used in dermatological diagnosis. The identification in vivo can distinguish Phthirus pubis from other skin signs while the conical shape of the operculum and the wide fixing sleeve of egg to hair, tells what species of louse is infesting, even if the insect is unavailable or nits are elsewhere from the pubic area. Entodermoscopy, provided that dermatologists have some knowledge of entomology, therefore promises advantages over standard microscopic examination.
Migheli, Quirico; Balmas, Virgilio; Harak, Henry; Sanna, Silvana; Scherm, Barbara; Aoki, Takayuki; O'Donnell, Kerry
Fifty-eight fusaria isolated from 50 Italian patients between 2004 and 2007 were subject to multilocus DNA sequence typing to characterize the spectrum of species and circulating sequence types (STs) associated with dermatological infections, especially onychomycoses and paronychia, and other fusarioses in northern and central Italy. Sequence typing revealed that the isolates were nearly evenly divided among the Fusarium solani species complex (FSSC; n = 18), the F. oxysporum species complex (FOSC; n = 20), and the Gibberella (Fusarium) fujikuroi species complex (GFSC; n = 20). The three-locus typing scheme used for members of the FSSC identified 18 novel STs distributed among six phylogenetically distinct species, yielding an index of discrimination of 1.0. Phylogenetic analysis of the FOSC two-locus data set identified nine STs, including four which were novel, and nine isolates of ST 33, the previously described widespread clonal lineage. With the inclusion of eight epidemiologically unrelated ST 33 isolates, the FOSC typing scheme scored a discrimination index of 0.787. The two-locus GFSC typing scheme, which was primarily designed to identify species, received the lowest discrimination index, with a score of 0.492. The GFSC scheme, however, was used to successfully identify 17 isolates as F. verticillioides, 2 as F. sacchari, and 1 as F. guttiforme. This is the first report that F. guttiforme causes a human mycotic infection, which was supported by detailed morphological analysis. In addition, the results of a pathogenicity experiment revealed that the human isolate of F. guttiforme was able to induce fusariosis of pineapple, heretofore its only known host. PMID:20107100
Garg, N; Truong, B; Ku, J H; Devere, T S; Ehst, B D; Blauvelt, A; Deodhar, A A
Delaying diagnosis of psoriatic arthritis (PsA) can lead to poor quality of life and disability. The purpose of this study is to identify simple questions for dermatologists to screen psoriasis patients for psoriatic arthritis. Data regarding psoriasis and arthritis were prospectively collected by a questionnaire from all psoriasis patients. Patients with joint-related symptoms were assessed by a rheumatologist for the presence of PsA. Retrospectively, the sensitivity and specificity, positive and negative predictive values, likelihood ratios, and posttest probabilities of various screening questions were calculated to identify the best combination of parameters. Of 517 patients seen in dermatology clinic, 117 (22.63 %) were found to have PsA. Four screening questions ("Do you have a history of joint pain or swelling?" "Do you have stiffness in the morning?" "Have you had X-rays taken of your joints?" "Do you have PsA?") with psoriatic nail changes demonstrated high sensitivity and specificity for predicting PsA. A cutoff of three out of these five parameters correctly classified patients with and without PsA with 86.9 % sensitivity, 71.3 % specificity, 53 % positive predictive value (PPV), 93.6 % negative predictive value (NPV), and area under the curve (AUC) of 0.87. Likelihood ratios for individual parameters varied between1.6 and 3.7, and with a combination of certain parameters, the posttest probability of PsA was 76 %. This is a preliminary data on a potential screening questionnaire which can help dermatologists quickly screen for PsA. All patients not having evaluated by a rheumatologist could have led to underdiagnosis of PsA and potential misclassification. Psoriasis patients seen at a specialty clinic may introduce a referral bias.
Nemeth, N M; Ruder, M G; Gerhold, R W; Brown, J D; Munk, B A; Oesterle, P T; Kubiski, S V; Keel, M K
The white-tailed deer (Odocoileus virginianus) is a common and widespread North American game species. To evaluate the incidence, clinical manifestations, demography, and pathology of bacterial and parasitic dermatologic diseases in white-tailed deer in the southeastern United States, we retrospectively evaluated white-tailed deer cases submitted to the Southeastern Cooperative Wildlife Disease Study from 1975 to 2012. Among 2569 deer examined, bacterial or parasitic dermatologic disease was diagnosed in 88 (3.4%) individuals, with Demodex spp (n = 37; 42.0%) and Dermatophilus congolensis (n = 19; 21.6%) as the most common causes. Demodicosis was significantly more common in deer older than 2 years and was most often detected in the fall; no statistically significant sex predilection was identified. Affected animals had patchy to generalized alopecia, often distributed over the head, neck, limbs, and trunk; microscopic lesions included epidermal crusts and cutaneous nodules with mild perifollicular, lymphoplasmacytic inflammation. Dermatophilosis was most common in males younger than 1 year that were often found dead. Crusting, erythema, and alopecia occurred on the face, ears, and distal extremities. Less commonly, infectious dermatologic diseases were associated with other bacteria (n = 13; 14.8%), fungi (n = 5; 5.7%), ectoparasites (chiggers, lice, mites, and ticks; n = 11; 12.5%), and larval nematodes (n = 7; 8.0%). Population-level effects of these diseases in white-tailed deer are likely minimal; however, due to their dramatic presentation, demodicosis, dermatophilosis, and other infectious skin diseases can be of concern to hunters and, in some cases, may have zoonotic potential.
Mattheus, A; Hofmann, R; Straube, W
Radial immunodiffusion, according to Mancini, was applied to 15 hospitalised patients, both during and after hospitalisation. They were of both sexes and all afflicted with dermatological diseases (psoriasis, eczema, mycosis). Determination of serum concentration of pregnancy-associated alpha 2-glycoprotein (alpha 2-PAG, PZ) was the purpose of the tests. While in the acute phase of the disease the PZ serum levels of the three groups of patients were higher than those recorded from a control group, conventional therapy failed to have any impact upon PZ serum concentration. Continuous decline in PZ serum concentration was recordable from psoriasis patients in response to photochemotherapy (PUVA).
Ruiz-Villaverde, R; Moreno-Ramírez, D; Galán-Gutierrez, M; de Troya, M; Reyes-Alcázar, V; Alcalde, M; García, E I; Linares, M; Martínez, L; Pulpillo, Á; Suárez, C; Vélez, A; García-Lora, E; Torres, A
Attention has been focused on new ways to understand and manage urticaria ever since the recent addition of novel drugs to the therapeutic arsenal, the updating of clinical practice guidelines, and the publication of pathophysiologic insights. The Andalusian Section of the Spanish Academy of Dermatology and Venereology (AEDV) has developed a clinical pathway that defines quality-of-care characteristics and makes recommendations on decision-making affecting patients with urticaria. We present a patient-centered approach to care, in which the patient's clinical pathway through the health care system includes links between primary and hospital care to ensure continuity-a key feature of quality.
Moreno-Ramírez, D; Ruiz-Villaverde, R; de Troya, M; Reyes-Alcázar, V; Alcalde, M; Galán, M; García-Lora, E; García, E I; Linares, M; Martínez, L; Pulpillo, Á; Suárez, C; Vélez, A; Torres, A
Benign skin lesions are a common reason for visits to primary care physicians and dermatologists. However, access to diagnosis and treatment for these lesions varies considerably between users, primarily because no explicit or standardized criteria for dealing with these patients have been defined. Principally with a view to reducing this variability in the care of patients with benign cysts or tumors, the Andalusian Regional Section of the Spanish Academy of Dermatology and Venereology (AEDV) has created a Process of Care document that describes a clinical pathway and quality-of-care characteristics for each action. This report also makes recommendations for decision-making with respect to lesions of this type.
Curnow, Alison; Owen, Sara J.
As lifetime exposure to ultraviolet (UV) radiation has risen, the deleterious effects have also become more apparent. Numerous sunscreen and skincare products have therefore been developed to help reduce the occurrence of sunburn, photoageing, and skin carcinogenesis. This has stimulated research into identifying new natural sources of effective skin protecting compounds. Alkaline single-cell gel electrophoresis (comet assay) was employed to assess aqueous extracts derived from soil or hydroponically glasshouse-grown roots of Althea officinalis (Marshmallow) and Astragalus membranaceus, compared with commercial, field-grown roots. Hydroponically grown root extracts from both plant species were found to significantly reduce UVA-induced DNA damage in cultured human lung and skin fibroblasts, although initial Astragalus experimentation detected some genotoxic effects, indicating that Althea root extracts may be better suited as potential constituents of dermatological formulations. Glasshouse-grown soil and hydroponic Althea root extracts afforded lung fibroblasts with statistically significant protection against UVA irradiation for a greater period of time than the commercial field-grown roots. No significant reduction in DNA damage was observed when total ultraviolet irradiation (including UVB) was employed (data not shown), indicating that the extracted phytochemicals predominantly protected against indirect UVA-induced oxidative stress. Althea phytochemical root extracts may therefore be useful components in dermatological formulations. PMID:26953144
Jalalat, Sheila Z; Wagner, Richard F
The open access University of Texas Dermatology Interest Group blog was established in 2004 for the purposes of increasing communication and collaboration between medical students and dermatology faculty, residents, and alumni, as well as to promote educational opportunities and the missions for which the interest group was created. This blog is unique because of its longevity and continuous postings directed toward the educational and professional needs of medical students and residents. A blog user survey was performed to assess viewers' thoughts, purpose of viewing, demographic profile, subscriber status, usage of the blog and other Web 2.0 tools (forums, Facebook, blogs, Twitter, podcasts), and perceived usefulness. Sixty-one anonymous online surveys were completed during a 1-month period. Statistical analyses of the responses demonstrated that the utilization of web-based tools and the blog were valuable resources for students, especially for blog subscribers, those more involved in an interest group, and those reading the blog for a longer period of time. The usefulness and impact of this method of communication and dissemination of information in medical education may encourage other student groups, faculty advisors, and educators to implement similar educational tools at their institutions.
Development of shampoo, soap and ointment formulated by green synthesised silver nanoparticles functionalised with antimicrobial plants oils in veterinary dermatology: treatment and prevention strategies.
Bansod, Sunita Dashrath; Bawaskar, Manisha Subrashrao; Gade, Aniket Krishnarao; Rai, Mahendra Kumar
Many scientists have focused their research on the role of nanotechnology for the control of human pathogens, but there are also many topical pathogens present in animals, which infect animals and transfer to humans. Topical therapy is extremely important for the management of dermatological condition in animals. Therefore, the present study aims to evaluate the efficacy of biogenic silver nanoparticles (AgNPs) in combination with herbal oils against animal skin infections which may be responsible for causing infections in human beings. Here, the authors synthesised and characterised the AgNPs from Azadirachta indica. The oils were extracted from medicinal plants including Cymbopogon citratus, Cymbopogon martini, Eucalyptus globules, A. indica and Ocimum sanctum and the antifungal and antibacterial activity of plant oils along with AgNPs were evaluated. An excision wound model was used for the study of wound healing activity in rabbits. AgNPs functionalised oil has demonstrated remarkable antimicrobial activity against pathogens present on the skin of animals. The nano-functionalised antimicrobial oils were used in the formulation of shampoo, soap and ointment for veterinary dermatology. Antimicrobial products of plant origin with AgNPs are valuable, safe and have a specific role in controlling diseases. The authors believe that this approach will be a good alternative therapy to solve the continuous antibiotic resistance developed by many bacterial pathogens and will be utilised in various animal contacting areas in medicine.
Heller, Elizabeth H.; Shiffman, Norman J.
The potential of vitamin A, or retinol, in the treatment of a variety of skin diseases has long been recognized, but because of serious toxic effects this substance generally could not be used. The recent development and marketing of two relatively nontoxic synthetic analogues, which are known as retinoids, has made it possible to treat some of the diseases that are resistant to standard forms of therapy. Isotretinoin is very effective in cystic and conglobate acne, while etretinate is especially useful in the more severe forms of psoriasis. Good results have also been obtained in other disorders of keratinization. Vitamin A and its derivatives apparently have an antineoplastic effect as well and may come to be used in both the prevention and the treatment of epithelial cancer. In many of these diseases the retinoids act by enhancing the normal differentiation and proliferation of epidermal tissues, but the exact mechanisms are not well understood. Their influence on the intracellular polyamines that control the synthesis of nucleic acids and proteins may be an important factor. Although the retinoids have few serious systemic effects, they are teratogenic, and because they persist in the body their use in women of childbearing potential is limited. ImagesFig. 3 PMID:3158386
Jowkar, Farideh; Namazi, Mohammad Reza
Statins are competitive inhibitors of 3-hydroxy-3-methylyglutaryl-coenzyme A reductase and reduce low-density lipoprotein-C levels. Statins are well-tolerated drugs used for prevention of atherosclerosis and cardiovascular events. Statins possess anti-inflammatory, immunomodulatory, antioxidant, metabolic, and possible anticancer effects. Statins are reported to be effective against psoriasis, dermatitis, graft-versus-host disease, uremic pruritus, vitiligo, and hirsutism. Topical forms of statins are employed in the treatment of acne, seborrhea, rosacea, and rhinophyma. Animal studies show the beneficial effect of statins against contact dermatitis and wound healing. They have promising anti-HIV effects as well. This article succinctly reviews the various cellular and molecular effects of statins, their applications in cutaneous medicine and their side effects.
Many systemic diseases have cutaneous manifestations. In some diseases skin involvement is the predominant factor (Behçet's syndrome, urticaria pigmentosa, discoid lupus erythematosus and pseudoxanthoma elasticum); in others the skin manifestations, when present, are an important part of the condition (sarcoidosis, systemic lupus erythematosus, hypersensitivity angiitis, porphyria). This report includes descriptions of and comments on these cutaneous manifestations. Erythema nodosum and erythema multiforme are reaction patterns of the skin and mucous membrane which may have many causes. The relationship between discoid and systemic lupus erythematosus is discussed. There is little doubt that these are variations of the same basic disease process, even though the prognoses are very different. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6 PMID:14063940
Kang, Jun K; Bhate, Chinmoy; Schwartz, Robert A
Spider bites represent an unusual and potentially over-represented clinical diagnosis. Despite a common fear of spiders, known as arachnophobia, current knowledge suggests that only a small number of families within the order Araneae are medically relevant. Moreover, most cutaneous spider reactions, including both evenomations and physical trauma, produce mild, local symptoms which may be managed with supportive care alone. The differential diagnosis for spider bites may be broad, especially if the offending arachnid is not seen or found. We describe a series of spiders relevant to the dermatologist in the United States.
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de Sá, Daniel Coelho; Festa Neto, Cyro
Inflammasomes are intracellular multiprotein complexes that comprise part of the innate immune response. Since their definition, inflammasome disorders have been linked to an increasing number of diseases. Autoinflammatory diseases refer to disorders in which local factors lead to the activation of innate immune cells, causing tissue damage when in the absence of autoantigens and autoantibodies. Skin symptoms include the main features of monogenic inflammasomopathies, such as Cryopyrin-Associated Periodic Syndromes (CAPS), Familial Mediterranean Fever (FMF), Schnitzler Syndrome, Hyper-IgD Syndrome (HIDS), PAPA Syndrome, and Deficiency of IL-1 Receptor Antagonist (DIRA). Concepts from other pathologies have also been reviewed in recent years, such as psoriasis, after the recognition of a combined contribution of innate and adaptive immunity in its pathogenesis. Inflammasomes are also involved in the response to various infections, malignancies, such as melanoma, autoimmune diseases, including vitiligo and lupus erythematosus, atopic and contact dermatitis, acne, hidradenitis suppurativa, among others. Inhibition of the inflammasome pathway may be a target for future therapies, as already occurs in the handling of CAPS, through the introduction of IL-1 inhibitors. This study presents a literature review focusing on the participation of inflammasomes in skin diseases. PMID:27828627
Singh, Lt Col G K
Approximately, 140 million people worldwide live permanently at high altitudes (HAs) and approximately another 40 million people travel to HA area (HAA) every year for reasons of occupation, sports or recreation. In India, whole of Ladakh region, part of Northwest Kashmir, Northern part of Sikkim and Tenga valley of Arunachal are considered inhabited areas of HAA. The low quantity of oxygen, high exposure of ultraviolet (UV) light, very low humidity, extreme subzero temperature in winter, high wind velocity, make this region difficult for lowlanders as well as for tourists. Acute mountain sickness, HA pulmonary edema, HA cerebral edema, and thromboembolic conditions are known to occur in HA. However, enough knowledge has not been shared on dermatoses peculiar to this region. Xerosis, UV-related skin disorders (tanning, photomelanosis, acute and chronic sunburn, polymorphic light eruption, chronic actinic dermatitis, actinic cheilitis, etc.), cold injuries (frostbite, chilblains, acrocyanosis, erythrocyanosis, etc.) nail changes (koilonychias), airborne contact dermatitis, insect bite reaction, and skin carcinoma (basal cell carcinomas, squamous cell carcinomas, and also rarely malignant melanoma) are the dermatoses seen in HAAs. Early diagnosis and knowledge of HA dermatoses may prevent serious consequences of disease and improve the quality of life for the visitors as well as for native of the place.
Singh, Lt. Col. G K
Approximately, 140 million people worldwide live permanently at high altitudes (HAs) and approximately another 40 million people travel to HA area (HAA) every year for reasons of occupation, sports or recreation. In India, whole of Ladakh region, part of Northwest Kashmir, Northern part of Sikkim and Tenga valley of Arunachal are considered inhabited areas of HAA. The low quantity of oxygen, high exposure of ultraviolet (UV) light, very low humidity, extreme subzero temperature in winter, high wind velocity, make this region difficult for lowlanders as well as for tourists. Acute mountain sickness, HA pulmonary edema, HA cerebral edema, and thromboembolic conditions are known to occur in HA. However, enough knowledge has not been shared on dermatoses peculiar to this region. Xerosis, UV-related skin disorders (tanning, photomelanosis, acute and chronic sunburn, polymorphic light eruption, chronic actinic dermatitis, actinic cheilitis, etc.), cold injuries (frostbite, chilblains, acrocyanosis, erythrocyanosis, etc.) nail changes (koilonychias), airborne contact dermatitis, insect bite reaction, and skin carcinoma (basal cell carcinomas, squamous cell carcinomas, and also rarely malignant melanoma) are the dermatoses seen in HAAs. Early diagnosis and knowledge of HA dermatoses may prevent serious consequences of disease and improve the quality of life for the visitors as well as for native of the place. PMID:28216727
Skin conditions of puppies and kittens are often infectious, such as ectoparasites or dermatophytosis. Hereditary and congenital skin problems are often detected at an early age. Young animals may be more prone to toxicity from medications, and labels should be read carefully for age limits. Husbandry factors, including nutrition, ectoparasites,temperature and humidity, cleaning products, and bedding, should be considered. Fleas are still a common problem despite recent improvements in flea control and can be debilitating in young animals because of blood loss.
Steen, Christopher J; Carbonaro, Paul A; Schwartz, Robert A
Arthropods are important in medicine for a multitude of reasons. Their bites and stings may induce allergic reactions, ranging from annoying to life-threatening. Many arthropod products are also capable of inciting allergic responses in sensitized persons. In recent years, bites and stings have gained greater attention owing to increased concern about disease transmission. A common hypersensitivity response to arthropod bites, stings, and products is papular urticaria. This eruption occurs primarily in children, who eventually "outgrow" this disease, probably through desensitization after multiple arthropod exposures. Papular urticaria is most often caused by fleas or bedbugs, but virtually any arthropod is capable of inducing such a reaction. Two arthropod classes of medical importance are the Arachnida (spiders, scorpions, ticks, and mites) and the Insecta (lice, fleas, bedbugs, flies, bees, and ants). Animals in these two classes are probably responsible for more morbidity and mortality worldwide than are any other group of venomous creatures. In general, the diagnosis of arthropod bites and stings is dependent on maintenance of a high index of suspicion and familiarity with the arthropod fauna not only in one's region of practice, but also in the travel regions of one's patients. Learning objective At the completion of this learning activity, participants should be familiar with the clinical manifestations caused by a variety of arthropods as well as the treatment and possible sequelae of arthropod attacks.
Maddy, A J; Tosti, A
The "open-access" model increases the influence that a researcher has in his field, as his work is freely available to anyone with an Internet connection. In order for articles to be free to the reader, expenses of the publisher are covered by article processing charges (APCs) paid by the author or institution of the paper. The scientific community benefits as more readers have access to more papers, allowing ideas to grow and build one upon another. However, the disadvantages of open-access publishing have come to light in the past years as the number of publishers has increased exponentially and the open-access concept has been exploited. This article is protected by copyright. All rights reserved.
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