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Wilma F Bergfeld

Publications and source records attributed to Wilma F Bergfeld.

At least 19 recordsLinked to original sources
PubMed2006

Differences in biopsy techniques of actinic keratoses by plastic surgeons and dermatologists: a histologically controlled pilot study.

OBJECTIVE: To compare differences in biopsy techniques of actinic keratoses between dermatologists and plastic surgeons. DESIGN: Blinded, comparative, retrospective study. SETTING: Dermatopathology laboratory at a major academic medical center with referral of outside cases. Intervention We reexamined the histopathologic slides of 405 actinic keratosis biopsy specimens obtained by plastic surgeons and dermatologists from January 1, 1992, through May 31, 2002. We were specifically interested in the type of biopsy technique (shave, punch, or excisional biopsy) used for the surgical management of actinic keratoses by both groups of physicians. We also recorded the clinical diagnoses rendered on the dermatopathology request form and compared them with the histopathologic diagnoses. RESULTS: Excisional biopsies were performed by plastic surgeons in 50.0% of the cases, compared with only 1.4% by dermatologists. In contrast, shave biopsies of actinic keratoses were performed by plastic surgeons in only 32.4% of the cases, compared with 89.4% by dermatologists. Only 1 (0.5%) of the 198 dermatopathology request forms submitted by the plastic surgeons mentioned actinic keratosis, compared with 82 (39.6%) of 207 histopathologic evaluation requests submitted by dermatologists. CONCLUSIONS: The predominance of excisional biopsies of actinic keratoses by plastic surgeons may be related to a different ability in the clinical recognition of actinic keratoses compared with that of dermatologists. The surgical approach of dermatologists to shave diagnostically uncertain cutaneous lesions is less invasive than that of plastic surgeons and is more likely to achieve a better cosmetic outcome.

Academic Medical Centers↗
PubMed2006

Histopathologic evaluation of alopecias.

The alopecias can be broadly classified into non-scarring and scarring forms. The latter are divided into primary and secondary scarring types. In primary scarring alopecias, the hair follicle is the prime target of destruction as opposed to secondary scarring alopecias in which it is involved in a neighboring non-follicular process that impinges upon the follicle and ultimately destroys it. After an initial overview and a critique on the concept of scarring versus non-scarring, we outline in detail the histopathologic presentation of the major forms of alopecias. Because the correct histopathologic diagnosis often requires close clinicopathologic correlation, a brief description of the clinical presentation is included. This review also discusses important pathogenetic concepts, such as stem cell failure.

Alopecia↗
PubMed2005

Safety of ingredients used in cosmetics.

The Cosmetic Ingredient Review (CIR) program was established in 1976 by the Cosmetics, Toiletry, and Fragrance Association, with the support of the Food and Drug Administration (FDA) and the Consumer Federation of America (CFA). CIR performs independent, expert reviews to determine if ingredients used in cosmetics are safe. CIR staff prepares summaries of available data and the CIR Expert Panel reviews the data in open, public meetings. If more data are needed, requests are made. Unpublished studies may be provided, but become public and available for review once summarized in CIR safety assessments. Tentative conclusions are supported with a rationale and public comment is sought. Taking any input into consideration, a final safety assessment monograph is issued. These monographs are submitted for publication in the peer-reviewed International Journal of Toxicology . To date, 1194 individual cosmetic ingredients have been addressed. Of these, 683 were found to be safe in cosmetics in the present practices of use and concentration. With qualifications, another 388 have been found safe for use in cosmetics; specific qualifications for each are given. Nine ingredients have been deemed unsafe for use in cosmetics and the safety issue has been described. The available data were found insufficient to support the safety of 114 ingredients; the needed data are listed. Hair dyes represent an important product category reviewed by CIR. In considering hair dyes, the CIR Expert Panel reviews experimental and clinical data specific to the particular chemical structure of each hair dye and reviews epidemiologic studies that address hair dye use that are less specific. Recently the CIR Expert Panel concluded that the available epidemiologic studies are insufficient to conclude there is a causal relationship between hair dye use and cancer and other end points. It is inevitable that new information will become available concerning ingredients for which safety assessments were completed in the early days of the program. To consider new data, the CIR Expert Panel has instituted a re-review program. Sodium lauryl sulfate (SLS), formaldehyde, and parabens are discussed as examples. Safety assessments currently underway are listed, along with high-priority ingredients from which new work will be chosen. Although supported by the cosmetics industry, the CIR program has remained independent in its decision making, based on its open, public process; the integrity of the expert panel members; the participation of the FDA and the CFA; and the cooperation of the cosmetics industry.

Beauty Culture↗
PubMed2005

A retrospective biopsy study of the clinical diagnostic accuracy of common skin diseases by different specialties compared with dermatology.

BACKGROUND: With the recent trend for nondermatologists to treat dermatologic disorders, this retrospective biopsy study reviews the accuracy of the clinical diagnosis of physicians of different specialties performing surgical dermatologic procedures. OBJECTIVE: We assessed the diagnostic abilities of nondermatologist physicians who performed various types of skin biopsies and compared them with those of dermatologists. METHODS: The clinical diagnoses of family physicians, plastic, general, and orthopedic surgeons, and internists and pediatricians versus dermatologists were correlated with the histopathologic diagnoses. In total, 4451 cases were analyzed. RESULTS: Dermatologists diagnosed twice the number of neoplastic and cystic skin lesions correctly (75%) than nondermatologists (40%). The clinical diagnosis rendered by family practitioners matched the histopathologic diagnosis in only 26% of neoplastic and cystic skin lesions. Plastic surgeons, who performed the largest number of cutaneous surgical procedures among the nondermatologists, did better in the recognition of skin tumors than family physicians, but still had a diagnostic accuracy rate of only 45%. Inflammatory skin diseases were correctly diagnosed in 71% of the cases by dermatologists but in only 34% of the cases by nondermatologists. LIMITATIONS: A limitation of this retrospective, unblinded study is the use of the clinical data from the pathology requisition form as a surrogate for clinical diagnostic accuracy. CONCLUSIONS: The overall accuracy of the clinical diagnosis depends heavily on the clinicopathologic correlation. Without sufficient clinical data, the histopathologic diagnosis will be limited or restricted. This review concludes that without basic dermatology knowledge, clinicopathologic correlation is compromised.

Biopsy↗
PubMed2005

Expression profile and molecular genetic regulation of cyclin D1 expression in epithelioid sarcoma.

Epithelioid sarcoma is a distinctive, aggressive soft tissue tumor typically presenting as a subcutaneous or deep dermal mass in the distal extremities of young adults. Molecular genetic data of well-characterized cases of epithelioid sarcoma are sparse. A recent cytogenetic study of epithelioid sarcoma by conventional metaphase comparative genomic hybridization reported recurrent gains at chromosome 11q13, a region containing many genes, including the cyclin D1 gene. Cyclin D1 is a positive cell cycle regulator that is overexpressed in a variety of neoplasms, including mantle cell lymphoma and breast carcinoma. The objective of this study was to examine cyclin D1 expression in epithelioid sarcoma. Of 24 cases evaluated, 23 (96%) displayed cyclin D1 nuclear expression using immunohistochemical evaluation. Eight cases, which expressed cyclin D1 by immunohistochemistry, were evaluated by fluorescence in situ hybridization (FISH) and RNA in situ hybridization (RISH) for amplification of the cyclin D1 gene and messenger RNA (mRNA) expression, respectively. Seven of eight cases showed a typical eusomic state. One case showed pseudoamplification due to aneusomy/polysomy. There was no evidence of cyclin D1 gene amplification or messenger RNA overexpression detected by FISH or RNA in situ hybridization analyses, respectively. Our data clearly demonstrate that cyclin D1 protein is upregulated in epithelioid sarcoma, suggesting a role for this cell cycle regulator in the pathogenesis of epithelioid sarcoma. The high level of cyclin D1 protein expression in epithelioid sarcoma appears to be regulated by translational and/or post-translational mechanisms.

Cyclin D1↗
PubMed2005

Evaluation of surgical margins in melanocytic lesions: a survey among 152 dermatopathologists.

BACKGROUND: Although guidelines are established for reporting tissue specimens of melanomas, such guidelines are not available for reporting surgical margins of benign melanocytic lesions. METHODS: We surveyed 582 members of the American Society of Dermatopathology via a web-based questionnaire to evaluate the practice of reporting surgical margins in melanocytic lesions. We were especially interested if the evaluation of margins differs depending on the surgical technique used (shave, punch, and excision) and on the type of melanocytic lesion encountered. RESULTS: One hundred and fifty-two surveys (26.1%) were returned. Only 32.2% of the dermatopathologists comment routinely on margins of shaved melanocytic nevi and only 33.6% report margins in punch biopsies. More dermatopathologists (57.2%) routinely evaluate excision specimens of melanocytic nevi for margins but still almost half of the survey participants do not report margins in such a common clinical scenario. In contrast, routine evaluation for margins in excised melanomas is high (93.4%). Participants who use the terminology of dysplastic nevi evaluate margins more often and the reporting correlates with the degree of dysplasia. Asked for the terminology used to comment on surgical margins in melanocytic lesions, we observed a great variability in language. CONCLUSIONS: Although clinicians commonly request margin evaluation in melanocytic lesions, dermatopathologists often seem to be reluctant to do so depending on the type of procedure used to remove the lesion. There is a great variability in practice and terminology of when and how to report surgical margins in melanocytic skin lesions.

Health Surveys↗
PubMed2005

Alopecia areata: what to expect from current treatments.

Alopecia areata is relatively benign and often resolves on its own, although its psychosocial impact on children and young adults can be severe. Some form of treatment is usually required. Because current treatments may not show results for 3 to 6 months, reassuring the patient and the parents and informing them about the results that can be expected are an essential part of management. The choice of treatment depends on the patient's age and the extent of alopecia activity.

Adolescent↗
PubMed2005

Metastatic gastric adenocarcinoma presenting as an enlarging plaque on the scalp.

We present a case report of metastatic gastric adenocarcinoma in which the cutaneous metastases were the first sign of disease recurrence. A 73-year-old man presented with painless red plaques on his scalp and forehead. He was diagnosed with gastric carcinoma with metastases to perigastric lymph nodes 3 1/2 years earlier. Histopathology results revealed signet-ring cells consistent with gastric adenocarcinoma. The patient failed to respond to treatment with intralesional interleukin 2, previously reported to be effective, and expired 7 months later.

Adenocarcinoma↗
PubMed2004

Finasteride in the treatment of alopecia.

Finasteride is a 5alpha-reductase inhibitor approved for the treatment of male pattern hair loss. Originally approved for the treatment of benign prostatic hypertrophy in 1992, its approval was expanded in 1997 to include the treatment of androgenetic alopecia (AGA) in men at a dose of 1 mg/day. Finasteride inhibits 5alpha-reductase, thereby prohibiting the conversion of testosterone to dihydrotestosterone (DHT), which is implicated in the development of hairless in some men. Reduction in DHT results in a significant improvement in subjective and objective assessments of hair growth and density. Finasteride is well-tolerated with a favourable adverse event history. The most common adverse events include reduced libido, decreased ejaculate volume and gynaecomastia.

Alopecia↗
PubMed2004

The pathophysiology of acne vulgaris in children and adolescents, Part 1.

Microcomedones, the earliest lesions of acne, appear at adrenarche, which typically occurs at about 8 years of age when androgens of adrenal origin begin to stimulate follicular hyperkeratosis and sebaceous hyperplasia in pilosebaceous units on the face. Comedones appear about 2 years later, when androgens of gonadal origin are produced and colonization of follicles by Propionibacterium acnes increases. Inflammatory lesions, such as pustules, papules, and nodules, are the result of the host's immune responses to P acnes; the proinflammatory cytokines are released by immunocompetent leukocytes that are recruited in response to this bacterium and its metabolic by-products. Androgens also affect the barrier function of the skin, and disturbances of barrier function may stimulate epidermal DNA synthesis. This leads to epidermal hyperplasia, which may also contribute to follicular hyperkeratosis in acne. Optimal treatment for this disorder will address these various pathophysiologic factors.

Acne Vulgaris↗
PubMed2004

The pathophysiology of acne vulgaris in children and adolescents, part 2: Tailoring treatment.

Various pathophysiologic factors are involved in the development of acne lesions, microcomedones, comedones, and inflammatory lesions. These factors include follicular hyperkeratosis, increased colonization of follicles by Propionibacterium acnes, increased sebum production, and inflammatory mediators. Optimal treatment of acne involves the use of agents that address these various underlying pathogenetic factors.

Acne Vulgaris↗
PubMed2003

Primary cutaneous coccidioidomycosis.

Primary cutaneous coccidioidomycosis is usually secondary to laboratory or autopsy inoculation, but can result from trauma in endemic areas. We describe an unusual case of primary inoculation cutaneous coccidioidomycosis occurring in an immunocompetent woman in a nonendemic area. The clinical features, diagnostic tests, and therapy of this extremely rare disease are reviewed.

Adult↗
PubMed2003

Beryllium dermatitis.

Chronic beryllium disease is a granulomatous disorder characterized by a cell-mediated immune response to beryllium. Most reports of chronic beryllium disease discuss pulmonary and noncutaneous immunologic findings. This report of occupational chronic beryllium disease emphasizes cutaneous findings and discusses the potential role of skin exposure in the disease.

Adult↗
PubMed2003

Epithelioid sarcoma: an immunohistochemical analysis evaluating the utility of cytokeratin 5/6 in distinguishing superficial epithelioid sarcoma from spindled squamous cell carcinoma.

BACKGROUND: Epithelioid sarcoma (ES) is a rare, aggressive soft tissue tumor characterized by nodular aggregates of epithelioid and/or spindled cells that are immunoreactive to cytokeratins (CKs) and epithelial membrane antigen. ES that arises in the dermis may cause epidermal ulceration and can resemble, clinically, morphologically and immunohistochemically, cutaneous squamous cell carcinoma. CK 5/6 has recently been found to be an excellent marker of squamous cell carcinoma, including spindled variants, but it is not known if this marker can be utilized to distinguish superficial ES from cutaneous spindled squamous cell carcinoma (SSCC). METHODS: Twenty-four cases of ES with typical histologic features and 10 cases of SSCC with ultrastructural evidence of epithelial differentiation were studied. Immunohistochemical analysis using an antibody to CK 5/6 was performed. The extent of immunoreactivity was evaluated in a semiquantitative manner using the following scale: 0, < 5% of cells staining; 1+, 6-25% of cells staining; 2+, 26-50% of cells staining; 3+, 51-75% of cells staining; 4+, > 75% of cells staining. RESULTS: CK 5/6 was expressed in all 10 cases of SSCC, including one case with 3+ staining and six cases with 4+ staining. In contrast, CK 5/6 staining was found only in rare tumor cells (1+ staining) in one of 24 (4%) cases of ES. CONCLUSIONS: CK 5/6 staining is useful in distinguishing superficial ES from cutaneous SSCC.

Biomarkers, Tumor↗