Biomedical subjects
W F Bergfeld
Publications and source records attributed to W F Bergfeld.
Prurigo pigmentosa. A persistent lichenoid reaction to bismuth?
Explore the source record for details and available documents.
alpha-Hydroxy acid-based cosmetic procedures. Guidelines for patient management.
alpha-Hydroxy acid (AHA) peels and home regimens have recently been recognized as important adjunctive therapy in a variety of conditions including photodamage, actinic damage, melasma, hyperpigmentation disorders, acne, and rosacea. Overall in our experience and in the literature, AHAs have a proven level of safety and efficacy in a variety of skin types. Although their exact mechanism of action is unknown, it has been demonstrated that AHAs improve these disorders by thinning the stratum corneum, promoting epidermolysis, dispersing basal layer melanin, and increasing collagen synthesis within the dermis. In patients with photodamage, AHA peels and topical products are often combined with retinoids and other antioxidants for maximum benefit. Similarly, synergistic effects of fluorouracil and glycolic acid are observed in the treatment of diffuse actinic keratoses. For patients with melasma, AHA peels and combination products containing bleaching agents such as hydroquinone, kojic acid, and glycolic acid seem to have increased efficacy. Acne and rosacea patients can see improved results when standard regimens like antibacterials and topical retinoids are supplemented with AHA peels and lotions. However, care should always be taken prior to commencing treatment with AHA peels and topical products. By obtaining a thorough history and physical examination, the physician will identify any specific factors like medications, prior procedures and medical conditions which can affect the outcome of the peel. During the interview, there should be open discussion of patient questions and concerns so that realistic expectations can be made. Pre- and post-peel regimens should also be reviewed in full as patient compliance is essential to ensure the success of a series of AHA peels.
Epidermolysis bullosa acquisita. Diagnosis by electron microscopy.
Explore the source record for details and available documents.
Cutaneous blastomycosis. Report of a case presumably acquired by direct inoculation and treated with carbon dioxide laser vaporization.
Explore the source record for details and available documents.
Differentiation between AIDS-related and non-AIDS-related Kaposi's sarcoma.
Explore the source record for details and available documents.
Adult linear IgA disease associated with an erythema multiforme-like drug reaction.
Explore the source record for details and available documents.
Cutaneous Wegener's granulomatosis. Report of a case and review of the literature.
Explore the source record for details and available documents.
Extensive alopecia areata. Results of treatment with 3% topical minoxidil.
A 3% topical minoxidil solution was used to treat 31 normotensive persons (13 male, 18 female) with extensive alopecia areata. After 15 months, three patients (14%) had 75%-100% regrowth, 13 (59%) had some form of regrowth, and nine (41%) had no regrowth. In the initial three-month double-blind portion of the study, minoxidil was not shown to be more effective than placebo. Biopsy specimens from eight patients who underwent biopsy prior to treatment, after three months, and posttreatment showed no significant change in peribulbar or perivascular inflammation. Prominent, new anagen follicles were observed. The 3% topical minoxidil was generally well tolerated and skin irritation was minimal. Blood pressure monitoring revealed no significant changes in diastolic or systolic pressures. Minoxidil is a relatively safe treatment for extensive alopecia areata and may be effective in the treatment of some cases of recalcitrant disease.
Disseminated cutaneous fungal infection and AIDS.
We report a case of recalcitrant generalized cutaneous polydermatophyte and Candida infection in an AIDS patient who responded very poorly to topical, oral, and intravenous therapy. The patient died of respiratory arrest secondary to pneumonia 14 months after a cutaneous fungal infection developed and 12 months after AIDS was diagnosed. Extensive cutaneous fungal infections refractory to treatment may be a presenting sign of HIV infection.
Diagnostic approach to androgen disorders in women: acne, hirsutism, and alopecia.
The most common signs of androgen excess in women are acne, alopecia, and hirsutism. Less common manifestations include android obesity, virilization, and acanthosis nigricans. These changes appear to be the result of excessive androgen production or increased target organ sensitivity. To evaluate excessive androgen production, an androgen screening protocol is recommended that includes measurement of dehydroepiandrosterone sulfate, testosterone, androstenedione, prolactin, follicular stimulating hormone, and luteinizing hormone. When androgen excess is confirmed, dexamethasone suppression is recommended to determine the source of the androgen(s). Once excessive androgen production is confirmed, more specific therapies can be administered.
Treatment of androgenic disorders in women: acne, hirsutism, and alopecia.
Androgen excess disorders--acne, alopecia, and hirsutism--can be treated effectively with endocrine therapy such as androgen receptor blockers or antagonists, or with androgen suppression. Spironolactone, estrogen, and dexamethasone are considered the most effective approaches to treatment. Whatever the modality, careful planning is key to success, with recognition that response rates vary from patient to patient. A treatment regimen generally continues for at least 2 years.
Virilization secondary to topical testosterone.
Topical testosterone is recognized as a standard treatment for vulvar lichen sclerosus et atrophicus. Systemic androgenic side effects of this medication are widely believed to be uncommon and mild. A case is reported of severe hirsutism with other signs of virilization and markedly elevated serum testosterone levels secondary to use of topical testosterone propionate for vulvar lichen sclerosus et atrophicus. Caution is necessary in the use of topical testosterone, with close monitoring for signs of virilization. Alternative treatments for this condition, such as intralesional corticosteroids or topical progesterone, are recommended to avoid the risk of androgenic side effects.
Tretinoin emollient cream 0.01% for the treatment of photoaged skin.
Tretinoin emollient cream 0.01% was used to treat 40 patients with photoaged skin of the face and forearms in a 48-week, randomized, double-blind, placebo-controlled study. On the face, a significant difference between treatment groups was found in the investigator's global evaluation (P < .001), and in fine wrinkling (P < .001) and coarse wrinkling (P = .02) at 24 weeks. Tretinoin-treated forearms showed significantly greater improvement in roughness, mottled hyperpigmentation, fine wrinkling, and lentigines at 24 and 48 weeks. More consistent improvement was seen on the forearms than on the face. Adverse experiences on the face in both treatment groups included dryness, peeling, and acne. No significant difference in reported adverse experiences was found between forearms in both treatment groups. On forearms, dermatitis was the most common adverse event. Tretinoin 0.01% was generally well tolerated, and skin irritation was minimal. Tretinoin emollient cream 0.01% is a potentially safe, effective treatment for photodamaged skin.
A lifetime of healthy skin: implications for women.
During her lifetime, a woman faces the possibility of seeking dermatological assistance for a myriad of conditions, including acne, rosacea, striae, photodamage, and skin cancers. It is important for clinicians and patients to be aware of the symptoms of these conditions as well as the most beneficial approaches for prevention, diagnosis, treatment, and management. The life expectancy of women has increased and predictions for the year 2050 estimate the average age at 81 years. This will place women at greater risk for dermatological problems, especially photodamage and skin cancer. In addition, various ethnic groups may manifest these conditions differently. Although acne is most prevalent among teenaged males, most can expect clearing by age 25. Females may continue to experience acne into the adult years, sometimes beyond the age of 40. Although it is not a life-threatening disease, acne may have psychosocial and quality-of-life consequences. Treatments for acne can be topical or systemic, and include retinoids, antibiotics, benzoyl peroxide, azelaic acid, and hormonal therapy. Rosacea is more common in women (especially during menopause) than in men. It is a chronic condition that can cause complications, including telangiectasia, conjunctivitis, and blepharitis. Although there is no cure, rosacea can be managed and controlled with medication. Topical antibiotics, such as metronidazole, and systemic antibiotics, such as tetracycline, clarithromycin, and doxycycline, are used to manage rosacea. Striae, or stretch marks, occur most frequently in pregnant women, adolescents experiencing growth spurts, weight lifters, and the obese. Although not a health threat, they can be psychologically distressing. There are not many treatment options for striae, but topical tretinoin and the pulsed dye laser offer promising results. Intrinsic, or normal, aging of the skin results from the process of chronological aging. Photodamage is skin damage caused by chronic exposure to ultraviolet (UV) light. It is the leading cause of extrinsic aging, or alterations of the skin due to environmental exposure. Estimates indicate that almost half of a person's UV exposure occurs by age 18. Photoaging causes numerous histologic, physiologic, and clinical changes; it also increases the risk for skin cancer. Photodamage can be prevented through the use of sun screens, protective clothing, and avoidance of the sun during peak intensity time. The only product approved by the FDA for the treatment of photodamage (fine wrinkles, mottled hyperpigmentation, and skin roughness), topical tretinoin emollient cream, may help prevent additional photoaging when it is used to treat existing photoaging. Other management options for photodamaged skin include alpha-hydroxy acids, antioxidants, antiandrogens, moisturizers, and exfoliants. In patients with excessive manifestations of photodamage, surgical management may be needed, including dermabrasion, chemical peels, soft tissue augmentation, laser resurfacing, botulism toxin, and Gortex threads. Clinicians must educate their patients about the most appropriate skin care regimen as well as approaches for preventing and treating common afflictions. In this way, women will have the best opportunity for having and maintaining healthy skin.
The aging skin.
In the past, sun exposure has been an integral part of the American life style. Along with increased leisure time, outdoor recreational sports, and sun bathing has come greater exposure to the sun. The cumulative effects of unprotected sun exposure coupled with the changes in the ozone layer have resulted in a large photodamaged population and an epidemic of the most dangerous skin cancer, malignant melanoma. Photodamage begins early, with a child's first unprotected sun exposure. Clinical studies show that 50% of an individual's ultraviolet light exposure occurs before the age of 18 years. This damage from acute and chronic ultraviolet light exposure has produced the explosion of skin cancers. Over the next 4 years, it is expected that skin cancer will become the most common type of cancer, and malignant melanoma will become the leading cause of death from skin cancer. This growing hazard to the public has profound medical and psychological ramifications. This paper will focus on prevention, identification, evaluation and treatment of photodamage to skin, as well as skin cancer. Special emphasis will be given to the National Skin Cancer Prevention Education Program.