Dermatology Commons^™

Considerations For The Use Of Medical Devices In Dermatology., Jordan Wang, Dorota Z. Korta, Christopher B. Zachary

Department of Dermatology and Cutaneous Biology Faculty Papers

This manuscript addresses the significant considerations concerning the development and use of medical devices in dermatology. With the rapidly growing demand and booming market for medical devices, especially lasers, it is crucial that dermatologists become familiar with the nuances associated with supporting clinical studies, consumer-driven marketing strategies, and the complex relationships that exist between physicians, industry, and consumers. An examination of these relationships includes an overview of the potential biases pertaining to advisory panels and treating clinicians. The aim of this paper is to serve as an introduction to the background of medical devices and to offer dermatologists important information …

Fungus Amungus -- A Common Disease State That Is Commonly Missed: A Survey Based Study, Ramsin Yadgar, Adam Friedman, Neal Bhatia

GW Research Days 2016 - 2020

Background: Dermatophyte infections involving the skin, hair, or nails affect an estimated 25% of the world's population, and accounted for 51 million outpatient visits over a ten-year period (1995-2004) in the United States alone. Dermatomycosis is routinely managed by dermatologists, though given the diversity of clinical presentations, is sometimes misdiagnosed, which can result in inappropriate therapy, worsening of symptoms, and even result in additional skin and soft tissue infections.

Methods: An interactive survey of board-certified dermatologists was conducted at the 2016 Orlando Dermatology Aesthetic & Clinical Conference, during a seminar on superficial mycotic infections. The structure of the survey entailed …

Thin Melanoma With Nodal Involvement: Analysis Of Demographic, Pathologic, And Treatment Factors With Regard To Prognosis., Giorgos Karakousis, Phyllis A Gimotty, Edmund K Bartlett, Myung-Shin Sim, Madalyn G Neuwirth, Douglas Fraker, Brian J Czerniecki, Mark B Faries

Articles, Abstracts, and Reports

BACKGROUND: Although only a small proportion of thin melanomas result in lymph node metastasis, the abundance of these lesions results in a relatively large absolute number of patients with a diagnosis of nodal metastases, determined by either sentinel lymph node (SLN) biopsy or clinical nodal recurrence (CNR).

METHODS: Independent cohorts with thin melanoma and either SLN metastasis or CNR were identified at two melanoma referral centers. At both centers, SLN metastasis patients were included. At center 1, the CNR cohort included patients with initial negative clinical nodal evaluation followed by CNR. At center 2, the CNR cohort was restricted to …

Review Article: Pathogenesis And Clinical Manifestations Of Gastrointestinal Involvement In Systemic Sclerosis., Sumit Kumar, Jagmohan Singh, Satish Rattan, Anthony J. Dimarino, Sidney Cohen, Sergio A. Jimenez

Department of Dermatology and Cutaneous Biology Faculty Papers

BACKGROUND: Gastrointestinal tract (GIT) involvement is a common cause of debilitating symptoms in patients with systemic sclerosis (SSc). There are no disease modifying therapies for this condition and the treatment remains symptomatic, largely owing to the lack of a clear understanding of its pathogenesis.

AIMS: To investigate novel aspects of the pathogenesis of gastrointestinal involvement in SSc. To summarise existing knowledge regarding the cardinal clinical gastrointestinal manifestations of SSc and its pathogenesis, emphasising recent investigations that may be valuable in identifying potentially novel therapeutic targets.

METHODS: Electronic (PubMed/Medline) and manual Google search.

RESULTS: The GIT is the most common internal …

Adverse Reactions Of Biological Therapies In Patients With Psoriasis, Maria I. Sârbu, Mircea Tampa, Mădălina I. Mitran, Cristina I. Mitran, Alexandra M. Limbău, Simona R. Georgescu

Journal of Mind and Medical Sciences

Psoriasis is a chronic, immune-mediated disorder characterized by well demarcated, erythematous plaques covered by thick, silvery-white scales, most often located on the knees, elbows, sacral area and scalp. It has a significant impact on the patient's quality of life.

Biological therapies revolutionized the treatment of psoriasis vulgaris but there has been concern regarding the use of those agents due to severe adverse reactions reported in patients receiving TNF-α inhibitors for various inflammatory diseases.

The aim of this paper is to review the most important adverse reactions reported in patients receiving biological treatments. The most common and severe side effects associated …

Pleomorphic Fibroma., Huyenlan Dinh Do, Cynthia L. Bartus Md, Nektarios I. Lountzis Md, Stephen M. Purcell Do

Department of Medicine

No abstract provided.

Atr Mutations Promote The Growth Of Melanoma Tumors By Modulating The Immune Microenvironment., Chi-Fen Chen, Rolando Ruiz-Vega, Priya Vasudeva, Francisco Espitia, Tatiana B Krasieva, Sebastien De Feraudy, Bruce J Tromberg, Sharon Huang, Chad P Garner, Jie Wu, Dave S B Hoon, Anand K Ganesan

Articles, Abstracts, and Reports

Melanomas accumulate a high burden of mutations that could potentially generate neoantigens, yet somehow suppress the immune response to facilitate continued growth. In this study, we identify a subset of human melanomas that have loss-of-function mutations in ATR, a kinase that recognizes and repairs UV-induced DNA damage and is required for cellular proliferation. ATR mutant tumors exhibit both the accumulation of multiple mutations and the altered expression of inflammatory genes, resulting in decreased T cell recruitment and increased recruitment of macrophages known to spur tumor invasion. Taken together, these studies identify a mechanism by which melanoma cells modulate the immune …

The Efficacy And Safety Of Apremilast, Etanercept And Placebo In Patients With Moderate-To-Severe Plaque Psoriasis: 52-Week Results From A Phase Iiib, Randomized, Placebo-Controlled Trial (Liberate)., K Reich, M Gooderham, L Green, A Bewley, Z Zhang, I Khanskaya, R M Day, J Goncalves, K Shah, V Piguet, J Soung

Dermatology Faculty Publications

BACKGROUND: Apremilast, an oral, small-molecule phosphodiesterase 4 inhibitor, has demonstrated efficacy in patients with moderate-to-severe psoriasis.

OBJECTIVE: Evaluate efficacy and safety of apremilast vs. placebo in biologic-naive patients with moderate-to-severe plaque psoriasis and safety of switching from etanercept to apremilast in a phase IIIb, randomized, double-blind, placebo-controlled study (NCT01690299).

METHODS: Two hundred and fifty patients were randomized to placebo (n = 84), apremilast 30 mg BID (n = 83) or etanercept 50 mg QW (n = 83) through Week 16; thereafter, all patients continued or switched to apremilast through Week 104. The primary efficacy endpoint was achievement of PASI-75 at …

Is Apremilast (Otezla) Effective In Reducing Pruritus In Adults Over 18 Years Old With Plaque Psoriasis?, Stephanie N. Carnes

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not apremilast (Otezla) is effective in reducing pruritus in adults over 18 years old with plaque psoriasis

STUDY DESIGN: This review is based on three randomized controlled trials (RCTs) published in 2012, and 2015.

DATA SOURCES: Three randomized controlled trials comparing the effectiveness of apremilast to a placebo in reducing pruritus in adults over 18 years old with plaque psoriasis, found using PubMed.

OUTCOMES MEASURED: The outcome studied was improvement of the psoriatic plaques based on reduction in pruritus measured by the Pruritus …

Acitretin For The Treatment Of Recalcitrant Plantar Warts, Deep Joshipura, A Goldminz, A Greb, Alice Gottlieb

NYMC Faculty Publications

No abstract provided.

Effect Of Systemic Antioxidant Allopurinol Therapy On Skin Flap Survival, M Ardakani, Kaveh Alizadeh, A Moghadam

NYMC Faculty Publications

No abstract provided.

The Influence Of Tumor Regression, Solar Elastosis, And Patient Age On Pathologists' Interpretation Of Melanocytic Skin Lesions., Linda Titus, Raymond L Barnhill, Jason P Lott, Michael W Piepkorn, David E Elder, Paul D Frederick, Heidi D Nelson, Patricia A Carney, Stevan R Knezevich, Martin A Weinstock, Joann G Elmore

Articles, Abstracts, and Reports

It is not known whether patient age or tumor characteristics such as tumor regression or solar elastosis influence pathologists' interpretation of melanocytic skin lesions (MSLs). We undertook a study to determine the influence of these factors, and to explore pathologist's characteristics associated with the direction of diagnosis. To meet our objective, we designed a cross-sectional survey study of pathologists' clinical practices and perceptions. Pathologists were recruited from diverse practices in 10 states in the United States. We enrolled 207 pathologist participants whose practice included the interpretation of MSLs. Our findings indicated that the majority of pathologists (54.6%) were influenced toward …

Challenges To Smartphone Applications For Melanoma Detection, Jordan V. Wang, Lance W. Chapman, Matthew S. Keller

Department of Dermatology and Cutaneous Biology Faculty Papers

This commentary addresses the emerging market for health-related smartphone applications. Specific to dermatology, there has been a significant increase not only in applications that promote skin cancer awareness and education but also in those meant for detection. With evidence showing that 365 dermatology-related applications were available in 2014--up from 230 in 2012--and that 1 in 5 patients under the age of 50 have used a smartphone to help diagnose a skin problem, there is clearly a large subset of patients participating in this growing trend. Therefore, we are obligated to take a closer look into this phenomenon. Studies have shown …

Ladarixin, A Dual Cxcr1/2 Inhibitor, Attenuates Experimental Melanomas Harboring Different Molecular Defects By Affecting Malignant Cells And Tumor Microenvironment., Daria Marley Kemp, Alyson Pidich, Mary Larijani, Rebecca Jonas, Elizabeth Lash, Takami Sato, Mizue Terai, Maria De Pizzol, Marcello Allegretti, Olga Igoucheva, Vitali Alexeev

Department of Dermatology and Cutaneous Biology Faculty Papers

CXCR1 and CXCR2 chemokine receptors and their ligands (CXCL1/2/3/7/8) play an important role in tumor progression. Tested to date CXCR1/2 antagonists and chemokine-targeted antibodies were reported to affect malignant cells in vitro and in animal models. Yet, redundancy of chemotactic signals and toxicity hinder further clinical development of these approaches. In this pre-clinical study we investigated the capacity of a novel small molecule dual CXCR1/2 inhibitor, Ladarixin (LDX), to attenuate progression of experimental human melanomas. Our data showed that LDX-mediated inhibition of CXCR1/2 abrogated motility and induced apoptosis in cultured cutaneous and uveal melanoma cells and xenografts independently of the …

Hyaline Fibromatosis Syndrome: A Novel Mutation And Recurrent Founder Mutation In The Cmg2/Antxr2 Gene., Leila Youssefian, Hassan Vahidnezhad, Yahya Aghighi, Vahid Ziaee, Sirous Zeinali, Maryam Abiri, Jouni Uitto

Department of Dermatology and Cutaneous Biology Faculty Papers

No abstract provided.

Review Of Applications Of Microneedling In Dermatology., Christopher Iriarte, Olabola Awosika, Monica Rengifo-Pardo, Alison Ehrlich

Dermatology Faculty Publications

Microneedling (MN) is a novel therapeutic modality in dermatology. Through physical trauma from needle penetration, MN induces a wound healing cascade with minimal damage to the epidermis. This allows for enhancement in the absorption of mainstay topical therapies across the thick stratum corneum. MN has become increasingly utilized over the last several years as it is a relatively simple procedure that is cost-effective, well tolerated, and offers both cosmetic and therapeutic benefits. The ability to treat localized areas of disease has led to numerous studies gauging its potential in focal diseases of inflammation, dyschromia, and photodamage. This review discusses the …

Sustained Nitric Oxide-Releasing Nanoparticles Interfere With Methicillin-Resistant Staphylococcus Aureus Adhesion And Biofilm Formation In A Rat Central Venous Catheter Model., Mircea Radu Mihu, Vitor Cabral, Rodney Pattabhi, Moses T Tar, Kelvin P Davies, Adam J Friedman, Luis R Martinez, Joshua D Nosanchuk

Dermatology Faculty Publications

Staphylococcus aureus is frequently isolated in the setting of infections of indwelling medical devices, which are mediated by the microbe's ability to form biofilms on a variety of surfaces. Biofilm-embedded bacteria are more resistant to antimicrobial agents than their planktonic counterparts and often cause chronic infections and sepsis, particularly in patients with prolonged hospitalizations. In this study, we demonstrate that sustained nitric oxide-releasing nanoparticles (NO-np) interfere with S. aureus adhesion and prevent biofilm formation on a rat central venous catheter (CVC) model of infection. Confocal and scanning electron microscopy showed that NO-np-treated staphylococcal biofilms displayed considerably reduced thicknesses and bacterial …

Systemic Sclerosis: Clinical Manifestations, Anesthetic And Orthopedic Considerations In A Patient, Obada Hasan, Muneeba Jessar, Muhammad Ashar, Shahryar Noordin, Tashfeen Ahmad

Section of Orthopaedic Surgery

Introduction: Systemic sclerosis is a rare and progressive multisystem autoimmune disorder that is characterized pathologically by vascular abnormalities, connective tissue sclerosis and atrophy of skin and various internal organs (e.g., alimentary tract, lungs, heart, kidney, CNS), and autoantibodies. With an unknown etiology, Scleroderma is a complex polygenetic disease. A recent Genome Wide Association Study (GWAS) confirmed a strong association with the Major Histocompatibility Complex (MHC) and autoimmunity. We provide a case scenario along with a review of the systems involved and challenges physicians can face in dealing with this rare disease.
Case Presentation: Our patient, a known case of systemic …

Insights Into Local Tumor Microenvironment Immune Factors Associated With Regression Of Cutaneous Melanoma Metastases By, Junbao Yang, Maris S Jones, Romela Irene Ramos, Alfred A Chan, Agnes F Lee, Leland J Foshag, Peter A Sieling, Mark Faries, Delphine J Lee

Articles, Abstracts, and Reports

No abstract provided.

Are Ceramide Containing Creams A Safe And Effective Treatment For Patients With Atopic Dermatitis?, Jennifer M. Francis

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not ceramide containing creams are a safe and effective treatment for patients with atopic dermatitis.

STUDY DESIGN: Review of three randomized controlled studies published in English between 2009-2016.

DATA SOURCES: Three assessor blind randomized controlled trials found using PubMed and EbscoHOST databases.

OUTCOMES MEASURED: Each of the three trials assessed safety and efficacy of a ceramide containing cream compared with another method in the treatment of atopic dermatitis. Outcomes were measured by Eczema Severity Score (ESS), rating of skin dryness on a 0-4 …

Do Submental Deoxycholic Acid Injections Reduce Submental Fat In Adult Patients Enough To Create A Significant Increase In Patient Satisfaction?, Alec W. Curry

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not “Submental deoxycholic acid injections reduce submental fat in adult patients enough to create a significant increase in patient satisfaction”

Study Design: Review of 3 double blind, randomized control trials that were selected based on their relevance to the clinical question.

Data Sources: All three peer-reviewed articles were found using PubMed and Cochrane Database. The keywords “ATX-101”, “submental fat”, and “deoxycholic acid” were used.

Outcomes Measured: Satisfaction with appearance in association with face and chin evaluated by a patient reported subject self-rating scale …

Is The Use Of Triamcinolone (Tac) In Combination With 5-Fluorouracil (5-Fu) More Effective Than Tac Alone In The Treatment Of Keloid Scars?, Jenna A. Barreto

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of the selective EBM review is to determine whether or not “Is the use of triamcinolone (TAC) in combination with 5-fluorouracil (5-FU) is more effective than TAC alone in the treatment of keloid scars?”

Study Design: Review of two (2) published, randomized control trials (RCT) and one (1) published, observational case control study (OCCS) in 2009 and 2014. All are in English.

Data Sources: The two (2) RCTs and the OCCS. Both were found using PubMed.

Outcomes Measured: Reduction in scar height and evolution of symptoms, specifically pain and pruritus. Other outcomes measured …

Does Adalimumab Effectively Treat Moderate To Severe Chronic Plaque Psoriasis In Adults?, Anthony J. Audia

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this EBM review is to determine whether or not “Does adalimumab effectively treat moderate to severe chronic plaque psoriasis in adults?”

STUDY DESIGN: This review is based on two randomized controlled trials and one retrospective study. The studies compared the efficacy of adalimumab in reducing the body surface area affected by plaque psoriasis.

DATA SOURCES: All articles used in this review are peer reviewed journals, published in English, and found using PubMed and Ebscohost.

OUTCOMES MEASURED: For all studies, the effectiveness of adalimumab on moderate to severe plaque psoriasis was evaluated using …

Is Oral Isotretinoin More Effective Than Antibiotics In The Treatment Of Severe Acne In Adults?, Eric Thomas

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not the use of oral isotretinoin is more effective than oral antibiotics in the treatment of severe acne.

Study Design: Review of all English language primary studies published after year 2000.

Data Sources: Three randomized control trials all found using PubMed. Outcomes Measured: Total number and percentage change in total acne lesions from baseline at various intervals.

Results: A randomized control trial (RCT) by Gollnick et al. (2001) found that oral isotretinoin was more effective than combination therapy involving minocycline in treating severe …

Is Platelet Rich Plasma Injection An Effective Treatment For Hair Loss In Androgenic Alopecia And Alopecia Areata?, Maciej Stanczak

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not Platelet Rich Plasma is efficacious in regrowth of hair in both androgenic alopecia and alopecia areata.

Study Design: Review of two blinded randomized controlled trials and one prospective cohort study. Populations studied were Adults over 18 with hair loss. All articles published in peer-reviewed journals in English.

Data Source: 3 articles found via PubMed and NCBI

Outcomes Measured: One prospective cohort study, and two randomized control trials evaluating hair regrowth after PRP scalp injections. Outcomes were reported by patient satisfaction, mean hair …

In Vitro Three-Dimensional Skin Tissue Constructs, Tinashe Dereck Gombedza

Theses

Human skin provides fortification against peripheral threats which may compromise the integrity and health of the human body. Its presence as the largest human organ forms a protective barrier making it an effective first line of defence against pathogenic, chemical and physical damage. Tissue engineering technology has enabled the development of in vitro three-dimensional (3D) organotypic skin cultures in order to understand the skin's physiology and architecture. This advancement has enabled the use of 3D skin model platforms to study skin diseases and conditions as well as facilitate drug discovery, clinical research and cosmetic product development.

In this study, an …

Slc11a1 Polymorphisms And Host Susceptibility To Cutaneous Leishmaniasis In Pakistan., Mariam Sophie,, Abdul L Hameed Institute Of Biomedical And Genetic Engineering (Ibge), 24-Mauve Area, G- 9/1, Islamabad, Pakistan., Akhtar Muneer, Azam J. Samdani, Saima Saleem, Abid Azhar

Department of Medicine

Background:The vector-borne cutaneous leishmaniasis (CL) is endemic in several regions of Pakistan mainly affecting poor populations. Host genetic factors, particularly SLC11A1 (solute carrier transmembrane protein) within macrophages, play a crucial role in disease pathology and susceptibility. Association of SLC11A1 with cutaneous leishmaniasis, a neglected tropical disease, is not well established. Inconsistencies have been observed within different populations worldwide with respect to genetic susceptibility. This study was designed to investigate genetic variation(s) in SLC11A1 and to assess possible association with cutaneous leishmaniasis in Pakistan.

Results: Eight polymorphisms (rs2276631, rs3731864, rs2290708, rs2695342, rs201565523, rs17215556, rs17235409, rs17235416) were genotyped across SLC11A1 in …

Papuloerythroderma Of Ofuji: A First Case Report From Indonesia, Graciella Regina, Listya Paramita, Sunard Radiono, Yohanes Widodo Wirohadidjojo, William R. Faber

Journal of General - Procedural Dermatology and Venereology Indonesia

Papuloerythroderma (PE) is a rare skin disease which was first described by Ofuji et al. in 1984, with a typical sign that the lesions spare the large cutaneous folds, known as the deck chair sign. Due to its recent identification, this disease is still underrecognized and may lead to misdiagnosis. We reported the first case report of PE of Ofuji from Indonesia in which the diagnosis was delayed for two years. Besides the deck chair sign in the large cutaneous fold, we also found that the area between and above his eyebrows that was relatively spared in contrast to the …

Pulsed-Dye Laser Efficacy In The Treatment Of Psoriasis In Adult Patients: An Evidence-Based Case Report, Made Ananda Krisna, Hanny Nilasari

Journal of General - Procedural Dermatology and Venereology Indonesia

Psoriasis is a chronic inflammatory skin disease known to be highly responsive to phototherapy. Narrow-band UVB (NBUVB) phototherapy has been one of the standard treatments for its moderate to severe form. However, its lack of efficacy in treating stable psoriatic plaques on extremities has lead researchers to find alternative treatments, one of which is pulsed-dye laser (PDL). Laser has been known to be effective in treating vascular lesions; in psoriasis, elongation of rete ridge along with tortuous dermal capillaries are one of the first pathologies identified early in the disease progression. Several in vivo and preliminary studies have found the …

Occupational Skin Cancer And Precancerous Lesions, Fifinela Raissa, Githa Rahmayunita, Sri Linuwih Menaldi, Dewi Soemarko

Journal of General - Procedural Dermatology and Venereology Indonesia

Occupational skin cancer and precancerous lesions are skin disorders caused by exposure to chemical carcinogens such as polycyclic hydrocarbons and arsenic, or radiation, such as ultraviolet light and ionizing light in the workplace. Annual increase in skin cancer incidence is believed to be related to various factors such as frequent intense sunlight exposure (i.e. at work, recreational activities, and sun-tanning habit), ozone depletion, an increase in number of geriatric population, and an increase of public awareness in skin cancer. The most common occupational skin cancers are basal cell carcinoma, squamous cell carcinoma, and melanoma. Examples of occupational precancerous lesion of …