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PubMed1988

Pruritus in psoriasis. A prospective study of some psychiatric and dermatologic correlates.

Among 82 inpatients with psoriasis, 67% (55 patients) reported moderate or severe pruritus. The degree of depressive psychopathology discriminated between the mild, moderate, and severe pruritus groups at admission. Prospectively, the change in depression scores correlated with the change in pruritus pretreatment to posttreatment. Pruritus severity did not correlate significantly with stress due to life events, age at onset, ethyl duration of psoriasis, age, sex, marital status, and average reported daily alcohol (ethanol) consumption. Among the objective dermatologic measures, including extent and severity of lesions, only the degree of perilesional irritation discriminated between the mild, moderate, and severe pruritus groups at admission, and prospectively, change in this measure correlated with the change in pruritus pretreatment to posttreatment. This finding was most likely related to the self-excoriation associated with pruritus. Intrapsychic factors (eg, the severity of depression) rather than external psychosocial or well-defined dermatologic factors, were the most significant correlates of pruritus in psoriasis.

Adult↗

PubMed1998

Phytotherapeutic approaches to common dermatologic conditions.

In this review, we discuss some common herbal preparations historically used for dermatologic conditions and recent studies that support their use. The traditional practice of topically treating dermatologic conditions with plant-derived medicines predates the cultures of ancient Egypt and remains vital today in the industrialized cultures of both the United States and Europe. Recent scientific studies lend support to some of the claims of herbal practitioners for the safety and efficacy of many herbs. The studies also elucidate, in some cases, the mechanisms by which these herbs act. With the growing interest in alternative and complementary therapies, practitioners need more information. Clinical studies and collected observations will help define specific indications for choice of herbal treatment based on both the skin disorder and the unique characteristics of the patient involved.

Humans↗

PubMed1999

Dermatologic manifestations of Hermansky-Pudlak syndrome in patients with and without a 16-base pair duplication in the HPS1 gene.

BACKGROUND: Hermansky-Pudlak syndrome (HPS) consists of oculocutaneous albinism, a platelet storage pool deficiency, and lysosomal accumulation of ceroid lipofuscin. Patients with HPS from northwest Puerto Rico are homozygous for a 16-base pair (bp) duplication in exon 15 of HPS1, a gene on chromosome 10q23 known to cause the disorder. OBJECTIVE: To determine the dermatologic findings of patients with HPS. DESIGN: Survey of inpatients with HPS by physical examination. SETTING: National Institutes of Health Clinical Center, Bethesda, Md (a tertiary referral hospital). PATIENTS: Sixty-five patients aged 3 to 54 years were diagnosed on the basis of the absence of platelet dense bodies in individuals with albinism and a bleeding diathesis. The presence of a 16-bp duplication in HPS1 was determined by polymerase chain reaction amplification; 40 patients were homozygous for the duplication and 25 lacked the duplication. All patients with the duplication were from northwest Puerto Rico; all patients without the duplication were non-Puerto Rican except 4 from central Puerto Rico. RESULTS: Both patients homozygous for the 16-bp duplication and patients without the duplication displayed skin color ranging from white to light brown. Patients with the duplication, as well as those lacking the duplication, had hair color ranging from white to brown and eye color ranging from blue to brown. New findings in both groups of patients with HPS were melanocytic nevi with dysplastic features, acanthosis nigricans-like lesions in the axilla and neck, and trichomegaly. Eighty percent of patients with the duplication exhibited features of solar damage, including multiple freckles, stellate lentigines, actinic keratoses, and, occasionally, basal cell or squamous cell carcinomas. Only 8% of patients lacking the 16-bp duplication displayed these findings. As a group, the patients with the duplication lived closer to the equator than those without the duplication. CONCLUSION: Patients with HPS exhibit wide variation in pigmentation and dermatologic findings.

Adolescent↗

PubMed2002

Exploration of "alternative" and "natural" drugs in dermatology.

OBJECTIVE: To review some of the promising natural remedies within dermatology to explore their potential clinical benefit in supplementing conventional drugs. DATA SOURCES: MEDLINE searches from January 1966 through October 2000 and Science Citation Index searches from January 1974 through October 2000 were conducted. STUDY SELECTION: Primary importance was given to in vivo and in vitro controlled studies, the results of which encourage further exploration. DATA EXTRACTION: The controls used, the statistical approach to analysis, and the validity of the experimental method analyzed were considered particularly important. Data were independently extracted by multiple observers. DATA SYNTHESIS: Natural remedies seem promising in treating a wide variety of dermatologic disorders, including inflammation, phototoxicity, psoriasis, atopic dermatitis, alopecia areata, and poison oak. CONCLUSIONS: The alternative medications presented seem promising, although their true effects are unknown. Many of the presented studies do not allow deduction of clinical effects. Further experimentation must be performed to assess clinical benefit.

Ascorbic Acid↗

PubMed2004

Fabry disease: a study of 6 hemizygous men and 5 heterozygous women with emphasis on dermatologic manifestations.

OBJECTIVE: To determine the significance of the dermatologic and systemic abnormalities found in 11 patients with Fabry disease (FD) which is an X-linked lysosomal storage disorder caused by the partial or complete deficiency of the alpha-galactosidase A enzyme. This defect leads to the accumulation of uncleaved glycosphingolipids throughout vascular endothelium and visceral tissues. DESIGN: Case series. SETTING: Pediatric Dermatology Division, Ramos Mejia Hospital (primary care center) and Laboratory of Neurochemistry (referral center for metabolic diseases). PATIENTS: Eleven patients with FD were studied: 6 hemizygous men (mean age, 23.0 years) and 5 heterozygous women (mean age, 49.4 years). RESULTS: Mucocutaneous angiokeratomas (AKs) were found in 5 (83%) of 6 hemizygotes and 4 (80%) of 5 heterozygotes. The AKs appeared at an average age of 13 years, affecting predominantly genitalia, back, elbows, and other frequently traumatized areas. All the hemizygotes and none of the heterozygotes suffered from hypohidrosis. Angiokeratomas on the trunk and oral mucosa without sweat abnormalities were detected in 80% of heterozygous women. All hemizygotic men presented with acral pain in childhood. CONCLUSION: We emphasize the value of early recognition of AKs and hypohidrosis as diagnostic clues to FD, a severe and progressive disorder.

Adult↗

PubMed2006

Cross-sectional study of bisphosphonate use in dermatology patients receiving long-term oral corticosteroid therapy.

OBJECTIVE: To examine whether patients had received bisphosphonates at the beginning of planned long-term glucocorticoid therapy, which is recommended by the guidelines from the American College of Rheumatology to prevent glucocorticoid-induced osteoporosis, prior to referral to a tertiary dermatology clinic. DESIGN: Cross-sectional study. SETTING: Tertiary referral center. PATIENTS: We reviewed 35 patients from an established cohort of patients referred with chronic skin diseases that require prolonged glucocorticoid use. MAIN OUTCOME MEASURE: The use of osteoporosis prophylaxis was determined by medical chart review and communication with patients. RESULTS: Of 35 patients, 28 (80%) were not receiving any bisphosphonates at referral. These patients began glucocorticoid therapy 17 months (median, 6 months; range, 1-102 months) prior to referral. The proportion of patients treated with bisphosphonates in our cohort did not change after the guidelines of the American College of Rheumatology were published. CONCLUSIONS: For patients of non-child-bearing potential with dermatological diseases in which prolonged oral corticosteroid treatment is anticipated, bisphosphonates should be prescribed concomitantly with the initiation of glucocorticoid therapy.

Absorptiometry, Photon↗

PubMed2006

Dermatologic adverse effects of lenalidomide therapy for amyloidosis and multiple myeloma.

OBJECTIVES: To examine dermatologic adverse effects of lenalidomide in patients with amyloidosis and multiple myeloma and to determine whether the adverse effects are different when lenalidomide is used alone compared with when it is used in combination with dexamethasone. DESIGN: Retrospective review of medical records. SETTING: Tertiary referral center. PATIENTS: Seventy-five patients with multiple myeloma and 23 patients with amyloidosis participating in clinical trials. INTERVENTION: In the 75 patients with multiple myeloma, lenalidomide was the treatment in 24 and lenalidomide and dexamethasone in 51. In the 23 patients with amyloidosis, lenalidomide was used alone. MAIN OUTCOME MEASURES: The frequency, type, severity, and time of onset of all skin eruptions that were temporally related to lenalidomide treatment were recorded. RESULTS: In the patients with amyloidosis treated with lenalidomide, 10 (43%) had rashes. In the patients with multiple myeloma, rashes occurred in 7 (29%) of those receiving lenalidomide alone and in 15 (29%) of those receiving lenalidomide and dexamethasone. The rashes were characterized as morbilliform, urticarial, dermatitic, acneiform, and undefined. Severe rashes required permanent discontinuation of lenalidomide therapy in 2 patients. In 23 patients (72%), rashes occurred in the first month after therapy was initiated; however, delayed-onset rashes occurred in 9 (28%). CONCLUSIONS: The prevalence of dermatologic adverse effects in patients receiving lenalidomide was higher in those with amyloidosis than in those with multiple myeloma. The prevalence of skin eruptions was not diminished by the concurrent use of systemic corticosteroids. Most skin eruptions were mild and did not necessitate withdrawal of lenalidomide therapy.

Amyloidosis↗

PubMed1991

Yield from total skin examination and effectiveness of skin cancer awareness program. Findings in 874 new dermatology patients.

The authors reviewed 874 dermatology charts to assess the acceptance rate of total skin examination (TSE), incidental skin findings, and patient compliance regarding treatment recommendations. Of the 874 new dermatology patients studied, 707 (80.9%) agreed to TSE. Important incidental findings were found in 151 (21.4%). These included: (1) biopsy specimen-confirmed malignant tumors (malignant melanoma, lentigo maligna, and basal cell and squamous cell carcinoma) in 24 of the 707 patients (3.4%), (2) biopsy specimen-confirmed premalignant tumors (actinic keratosis with dysplasia, Bowenoid actinic keratosis, Bowenoid papulosis, and lentigo with dysplasia, in five (0.7%), (3) clinically diagnosed premalignant actinic keratosis in 64 (9.1%), (4) biopsy specimen-confirmed dysplastic nevi in 17 (2.4%), and (5) congenital nevi in 41 (5.8%). Only 4.2% of the patients returned for a yearly TSE, and only 6.0% were found to follow all recommendations for monthly self examination, yearly professional examination, and sun protection. It is concluded that TSE for all new patients, and on a yearly basis for all return patients, is valuable in the detection of many skin conditions and allows skin cancer screening to be done, since patients for the most part do not follow recommendations for at-home screening.

Adult↗

PubMed1985

Prevalence of dermatologic disease in the United States: a review of the National Health and Nutrition Examination Survey, 1971-1974.

The National Health and Nutrition Examination Survey, 1971-1974, provides the only data on the prevalence of dermatologic disease in the United States. Details are given about specific diagnoses, disability, disfigurement, discomfort, and the relationship of skin change to environmental and occupational exposure. One-third of the individuals, which extrapolates to 60 million Americans, had dermatological problems that should have been seen at least once by a physician. Of those, at least a third considered their skin problems to be a handicap, 10% a handicap to employment or housework. These data provide a basis for evaluating the effect of environment and occupation and should be of interest to those concerned with chronic effects of mechanical injury to the skin.

Adolescent↗

PubMed2001

Progressive erosive arthropathy with contractures, multicentric osteolysis-like changes, characteristic craniofacial appearance, and dermatological abnormalities: a new syndrome?

We report a 27-year-old man with an apparently new syndromic form of progressive erosive arthropathy and contractures of small and large joints associated with mild epiphyseal changes, normal vertebrae, and generalized osteopenia. The patient had a characteristic craniofacial appearance, dermatological abnormalities, and normal intelligence. The head was large with frontal bossing. The face was elongated with malar hypoplasia, thin upper lip, prominent lower jaw, high arched palate, dental malocclusion, and prominent ears with absent ear lobules. Dermatological abnormalities included malar erythema and facial telangiectasia together with multiple nevi and lentigenes all over the body. Pseudorheumatoid arthropathy, spondyloarthropathy, and Borrone dermatocardioskeletal syndrome were considered in the differential diagnosis and were excluded. Also, no similar cases have been found in POSSUM or the London Dysmorphology databases.

Abnormalities, Multiple↗

PubMed2005

Sustained benefits of infliximab therapy for dermatologic and articular manifestations of psoriatic arthritis: results from the infliximab multinational psoriatic arthritis controlled trial (IMPACT).

OBJECTIVE: To investigate the efficacy and tolerability of infliximab therapy for the articular and dermatologic manifestations of active psoriatic arthritis (PsA). METHODS: One hundred four patients with PsA in whom prior therapy with at least 1 disease-modifying antirheumatic drug (DMARD) had failed were recruited into this investigator-initiated, multicenter, randomized, double-blind, placebo-controlled clinical trial. During the initial blinded portion of the study, patients received infusions of infliximab (5 mg/kg) or placebo at weeks 0, 2, 6, and 14. After week 16, patients initially assigned to receive placebo crossed over to receive infliximab 5 mg/kg every 8 weeks through week 50, while patients initially randomized to infliximab continued to receive active treatment at the same dose through week 50. The primary efficacy outcome was achievement of the American College of Rheumatology 20% criteria for improvement in rheumatoid arthritis (ACR20) at week 16. Additional predefined clinical efficacy assessments included the Psoriasis Area and Severity Index (PASI) score, the ACR50 and ACR70 criteria, the Disease Activity Score in 28 joints, the Health Assessment Questionnaire, ratings of enthesitis and dactylitis, and the Psoriatic Arthritis Response Criteria score. RESULTS: The proportion of infliximab-treated patients who achieved an ACR20 response at week 16 (65%) was significantly higher than the proportion of placebo-treated patients who achieved this response (10%). In addition, 46% of infliximab-treated patients achieved an ACR50 response, and 29% achieved an ACR70 response; no placebo-treated patient achieved these end points. Among patients who had PASI scores of >/=2.5 at baseline, 68% of infliximab-treated patients achieved improvement of >/=75% in the PASI score at week 16 compared with none of the placebo-treated patients. Continued therapy with infliximab resulted in sustained improvement in articular and dermatologic manifestations of PsA through week 50. The incidence of adverse events was similar between the treatment groups. CONCLUSION: Therapy with infliximab at a dose of 5 mg/kg significantly improved the signs and symptoms of arthritis, psoriasis, dactylitis, and enthesitis in patients with active PsA that had been resistant to DMARD therapy. With continued infliximab treatment, benefits were sustained through 50 weeks. The benefit-to-risk ratio appeared favorable in this study population.

Adult↗

PubMed2005

Our approach to pediatric dermatologic laser surgery.

BACKGROUND AND OBJECTIVES: Many pediatric dermatological conditions may be successfully treated with laser surgery. STUDY DESIGN/MATERIALS AND METHODS: The clinical approach to various pediatric dermatological conditions utilizing laser treatment options is discussed. RESULTS: Clinical uses of various modalities such as pulsed dye laser, KTP laser, Nd-YAG laser, Q-switched ruby laser, erbium-YAG laser, diode laser, non-coherent blue light sources, and fractional resurfacing are presented with successful parameters, developed over 22 years, utilized on a daily basis in a laser surgery clinic. CONCLUSION: Laser surgery can make a significant improvement in many pediatric skin lesions, thanks to the unique properties of pediatric skin and a vast array of laser technologies.

Acne Vulgaris↗

PubMed1988

Occupational skin disease in Finland. An analysis of 10 years of statistics from an occupational dermatology clinic.

An analysis of 10 years (1974-1983) of statistics was carried out at the Institute of Occupational Health, Helsinki, Section of Dermatology, which is devoted to occupational dermatology. A total of 1,082 cases of occupational skin diseases were diagnosed during this period. Allergic (50.1%) and toxic eczema (47.1%) comprised the majority of occupational cases of dermatosis. The most frequent causes of allergic occupational eczemas were rubber chemicals (19.9%), chromates (18.8%), and epoxy resins (13.1%). If the metals (chromium, nickel and cobalt) were considered as a group, they formed the largest category (28.4%), followed by the plastic materials (27.7%). Detergents (37.8%), followed by organic solvents (16.1%), were responsible for most of the irritant (toxic) eczemas. Occupational skin diseases currently make up about 20% of all occupational diseases in Finland, but the percentage is decreasing.

Allergens↗

PubMed1981

[Angiotensin-converting enzyme (ACE). Increased serum activities in patients with dermatological diseases (author's transl)].

Serum activities of ACE were investigated in 40 patients with dermatological disease and in nine patients with sarcoidosis. The method of Cushman and Cheung, modified according to Lieberman, was used. Both sarcoidosis patients and patients with dermatological diseases showed marked elevations of ACE-activity. The increase in ACE-activity might result from inflammation and immunological events.

Humans↗

PubMed1975

D-penicillamine in dermatology: influence on enzymatic activities of human skin in vitro.

By in vitro assay, 6 important enzymatic activities of human skin homogenates were determined following an incubation with D-penicillamine in concentrations between 10(-4) and 10 mg/ml, i.e. 67 X 10(-5) and 67 mM/l. The following enzymatic activities were recorded: lactate dehydrogenase (LDH), glucose-6-phosphate dehydrogenase (G-6-PDH), glyceraldehyde-3-phosphate dehydrogenase (GAPDH), alkaline phosphatase (AP), acid phosphatase (AcP), and "leucine aminopeptidase" (LAP). A dose-dependent activation by D-penicillamine occurred in the case of G-6-PDH- and AcP-activities, a dose-dependent inhibition by D-penicillamine was found with AP- and GAPDH-activities. LDH- and LAP-activities remained unchanged in the presence of D-penicillamine in concentrations up to 10 mg/ml (67 mM/l). From the data of pharmacokinetic studies in rats it may be concluded that concentrations of D-penicillamine which influence enzymatic activities may easily be reached in vivo, under the conditions of treating rheumatoid arthritis and Morbus Wilson. The biochemical actions of D-penicillamine are briefly discussed with secial regard to dermatological therapy and dermatological unwanted side-effects.

Acid Phosphatase↗

PubMed1993

Dysphagia in dermatologic disease.

Disorders of the oral cavity, pharynx, and esophagus may be found in some dermatologic diseases. The connective tissue diseases especially may be accompanied by dysphagia. Furthermore, some rare inflammatory and bullous dermatologic diseases can lead to esophageal disorders. Finally, some infectious and malignant diseases occurring in human immunodeficiency virus (HIV)-infected patients cause dysphagia (Table 1). The following discussion presents a comprehensive review of these diseases and their typical esophageal dysfunction.

Deglutition Disorders↗

PubMed2004

New hybrid stochastic-deterministic technique for fast registration of dermatological images.

Digital image processing in the medical field has become very popular in recent years owing to the significant advantages it offers over conventional techniques of visual or analogue image analysis. One of the most significant aspects in medical image processing has been that of image registration, which deals with the task of registering two images taken under different conditions. Image registration is considered an important issue in the field of dermatology, as pictures of a lesion taken in different periods need to be compared and quantitatively analysed. A hybrid image registration scheme was developed and evaluated for dermatological applications. The method splits the parameter estimation problem into two, with a combination of deterministic and iterative estimation techniques. The scaling and rotation parameters are estimated using a cross-correlation of image invariant image descriptors algorithm, whereas the two translation parameters are estimated with a non-parametric similarity criterion and a hill-climbing optimisation scheme. The efficacy of the method has been validated for the registration and comparison of malignant melanoma images. Determination of rotation and scaling parameters was performed using the log-polar transformation technique, which proved to be very accurate, even when high rotation and scaling values were imposed. Deviations for the rotation parameter estimations were less than 0.5%, whereas, for the scaling factor, differences were on average less than 2.5%, with a maximum difference estimated to be 4.5%. Translation parameter estimation was performed using integer similarity measures namely the stochastic sign change, the deterministic sign change (DSC) and the window value range, the performance of which has been assessed and, in all cases, was found to be highly effective. A novel hill-climbing optimisation algorithm has been proposed and, in combination with the DSC similarity criterion, was evaluated and proved to successfully estimate translation parameters. Thus the proposed hybrid registration technique can successfully estimate problem parameters in a time-efficient manner.

Algorithms↗

PubMed2002

[Malignant skin tumours in a private dermatology practice. A quality control study].

BACKGROUND AND OBJECTIVE: The campaign for early detection of malignant melanoma and the increase in people with photodamaged skin have a remarkable influence on the daily dermatological routine. Could these factors lead to the introduction of quality control in a private dermatology practice? PATIENTS AND METHODS: Over a period of one year the diagnoses of all patients were registered. The clinical diagnosis of any skin tumour undergoing surgical removal was compared with the final histopathological diagnosis. RESULTS: 56% of 3004 diagnoses involved females; 44%, males. In 40.5%, the possibility of a pigmented or non-pigmented skin tumour was raised. 49% of the 291 tumours removed were malignant (107 basal cell carcinoma, 20 squamous cell carcinoma, 16 melanoma) while 11.7% were malignant precursor lesions. 48% of 44 melanocytic naevi with clinical atypia showed histopathological dysplasia but none were a malignant melanoma. No cancers were detected among 59 clinically benign tumors. In 71.8% of cases, the clinical diagnosis agreed with the result of the histopathological examination. CONCLUSIONS: This study shows, in concordance with literature, that a dermatologist can provide high quality treatment and prophylaxis of malignant skin tumours. With an optimal cost-performance ratio, he or she is the most competent partner for patients and health insurance companies.

Basal Cell Carcinoma↗