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PubMed1990

Digital imaging techniques in dermatology.

Digital imaging is a versatile technique that has been infrequently used in dermatology to record visual images. We have used this technology for 10 patients to follow cutaneous lesions, including alopecia mucinosa, psoriasis, and dysplastic nevi. The setup included a personal computer, digitizer board, monitor, video camera, and lights. An introduction to electronic (digital) imaging is given and some of the many possible applications in dermatology are discussed.

Humans↗
PubMed1991

Spironolactone in dermatologic therapy.

In the treatment of androgen-mediated skin disorders spironolactone provides a valuable therapeutic option. This article reviews the use of spironolactone as an antiandrogen in dermatologic therapy. The endocrinologic effects, pharmacology, dermatologic uses, and side effects are discussed, and guidelines for its use are provided.

Acne Vulgaris↗
PubMed1995

Determining the true cause of death in a dermatological disaster.

Adverse drug reactions that result in patient death warrant special consideration to determine if the outcome was preventable. We report the results of an investigation into the cause of death of a 63 year old male who was thought to have phenytoin-induced toxic epidermal necrolysis (TEN). Most dermatological reactions from drugs are minor and resolve without sequelae once the drug is discontinued. In some cases, reactions are severe and can be life threatening. The patient arrived at the emergency department with extensive exfolative dermatitis. The differential diagnosis included phenytoin-induced TEN, scalded skin syndrome, and phenytoin hypersensitivity. After he was admitted his clinical status deteriorated and he died 13 days after admission. Autopsy findings were significant for necrotizing dermatitis, necrotizing pneumonia, multiple herpetic ulcerations, multisystem organ failure and blood cultures grew Staphylococcus aureus (TSS toxin positive). Findings that indicate a cause of death other than a drug-induced dermatological reaction are presented as well as an overview of the patients' medical history. The differential diagnosis of drug induced skin lesions are also discussed.

Journal Article↗
PubMed2006

Prevention of dermatologic side effects of bimatoprost 0.03% topical therapy.

PURPOSE: To investigate the efficacy of reducing the drop-skin contact to prevent dermatologic side effects of bimatoprost 0.03% topical therapy. DESIGN: Prospective, randomized, single-blinded, internally controlled study. METHODS: Enrolled subjects started bimatoprost 0.03% therapy once at night in both eyes and were instructed to wipe selectively only one eye (eye 1) with an adsorbent pad during and after drops administration for four months. The fellow eye acted as the internal control. Eyelash growth, regional skin hypertrichosis, and pigmentation on the periocular skin were assessed at baseline and during the four months of follow-up. RESULTS: A lower incidence of eyelash growth and skin pigmentation in the inferonasal pericanthal region were observed in eye 1. The incidence of pigmentation in the inferotemporal skin region and skin hypertrichosis were similar in the two eyes. CONCLUSION: The reduction of the drop-skin contact affects the regional incidence and the extent of dermatologic skin changes that are related to bimatoprost 0.03% topical therapy.

Adult↗
PubMedDate not supplied

Changing paradigms in parasitic infections: common dermatological helminthic infections and cutaneous myiasis.

Parasitic diseases caused by helminths, or worms, account for billions of human infections worldwide. Although most human pathogens caused by these organisms are infrequent in the United States, skin manifestations of parasitic diseases are being seen much more frequently in dermatologists' offices due to the increase in immigration and travel. Helminths are notable for their complicated lifecycles often including consecutive developmental phases, in separate hosts or in a free-living state. These parasitic organisms are usually macroscopic, multicellular organisms, and do not breed within their mammalian hosts. Notably, many helminthic diseases present with dermatologic signs and symptoms including skin nodules, cysts, migratory skin lesions, and pruritus. In this section, we discuss cutaneous myiasis as well as the four most common nematode dermatologic conditions seen in the United States.

Animals↗
PubMedDate not supplied

Dermatology of androgen-related disorders.

Hyperandrogenism in women can be caused by various conditions, the most prevalent of which is polycystic ovary syndrome. Common dermatologic manifestations of hyperandrogenism include hirsutism, acne, acanthosis nigricans, and androgenic alopecia. Hirsute women often have increased activity of 5 alpha-reductase, the enzyme that converts the androgen testosterone to its active metabolite, in hair follicles. Likewise, androgens affect the formation of acne by increasing sebum production from sebaceous glands in the skin. The diagnosis of polycystic ovary syndrome includes a complete history, physical examination with emphasis on evidence of androgen excess, and appropriate laboratory investigation to exclude other causes of hyperandrogenism. Treatments for the dermatologic conditions of hyperandrogenism include lifestyle modification, oral contraceptives, antiandrogens, and insulin-sensitizing medications.

5-alpha Reductase Inhibitors↗
PubMedDate not supplied

Dermatologic aspects of thyroid disease.

Thyroid disorders commonly have dermatologic manifestations. The purpose of the present chapter is to review and emphasize potential clinical dermatologic findings that can occur with Graves' disease, hypothyroidism and thyroid cancer. In autoimmune diseases such as Graves' disease and Hashimoto's thyroiditis the skin manifestations may be related to either thyroid hormone levels themselves or to the associated T and/or B cell abnormalities. Thyroid cancer may be associated with various syndromes that could have significant skin manifestations.

Autoimmune Diseases↗
PubMedDate not supplied

Dermatologic manifestations of hypopituitarism.

Hypopituitarism is characterized by diminished or absent secretion of one or more pituitary hormones. The clinical features of hypopituitarism vary depending on age, rapidity of onset, hormones involved, and degree of deficiency. Dermatologic signs of hypopituitarism may involve alterations in pigmentation, the epidermal and dermal skin structures, and the pilosebaceous unit. We describe the causes and presentation of hypopituitarism with an emphasis on its dermatologic manifestations.

Dermis↗
PubMedDate not supplied

Rheumatoid arthritis in dermatology.

Rheumatoid arthritis (RA) is a chronic progressive disorder characterized by symmetric inflammatory arthritis in association with systemic symptoms. Although considered a "joint disease," RA is associated with involvement in diverse organ systems, including the skin. Common manifestations include Raynaud phenomenon, rheumatoid nodules, and rheumatoid vasculitis. As with other extra-articular manifestations, dermatologic involvement tends to occur in patients with more severe RA. In addition to manifestations related to the disease, there are also sundry dermatologic reactions related to the medications used to treat RA. Understanding the etiology and therapy for cutaneous manifestations of RA will help optimize patient care.

Antirheumatic Agents↗
PubMed2007

Photodynamic therapy in dermatology: the next five years.

Photodynamic therapy (PDT) has had a rapid insurgence into the dermatologic armamentarium of clinicians from all over the world. Its use in actinic keratoses and in non-melanoma skin cancers is well described. Additional uses, including its use in the treatment of photorejuvenation and acne vulgaris and related disorders, are gaining more widespread use. More recent descriptions, including its potential use as a chemoprevention agent, warrant further investigations and discussions. PDT is a global treatment modality and physicians and investigators must view the therapy as such, and use the best photosensitizer for the best indication, and continue to evaluate new approaches to maximize the use of PDT in dermatology.

Forecasting↗
PubMed2004

Microbiologic evaluation of skin wounds: alarming trend toward antibiotic resistance in an inpatient dermatology service during a 10-year period.

BACKGROUND: Increasing resistance to commonly used antibiotics has been seen for patients with superficial skin wounds and leg ulcers. OBJECTIVES: We sought to evaluate bacterial isolates from leg ulcers and superficial wounds for resistance to commonly used antibiotics and to compare current data with previous data. METHODS: We performed a chart review for patients admitted to a tertiary care dermatology inpatient unit from January to December 2001. Comparison was made with 2 previous surveys of the same inpatient service from 1992 and 1996. RESULTS: Bacterial isolates were cultured from 148 patients, 84% (72 of 86) with leg ulcers and 38% (76 of 202) with superficial wounds. Staphylococcus aureus and Pseudomonas aeruginosa were the most common bacterial isolates in both groups. For patients with leg ulcers, S aureus grew in 67% of isolates (48/72) of which 75% (36/48) were methicillin-resistant (MRSA). Of leg ulcers, 35% (25/72) grew P aeruginosa, which was resistant to quinolones in 56% of cultures (14/25). For patients with superficial wounds, S aureus was isolated in 75% (57/76) and 44% were MRSA (25/57). P aeruginosa grew in 17% of isolates (13/76) and was resistant to quinolones in 18%. We found a marked increase in antibiotic resistance for both leg ulcers and superficial wounds. Over time, MRSA increased in leg ulcers from 26% in 1992 to 75% in 2001. For superficial wounds, MRSA increased from 7% in 1992 to 44% in 2001. P aeruginosa resistance to quinolones in leg ulcers increased from 19% in 1992 to 56% in 2001, whereas for superficial wounds there was no resistance in 1992 and 18% resistance in 2001. CONCLUSION: Rapid emergence of antibiotic-resistant bacteria continues and is a problem of increasing significance in dermatology. Common pathogenic bacteria, S aureus and P aeruginosa, showed increased resistance to commonly used antibiotics. Selection of antibiotics should be on the basis of local surveillance programs.

Drug Resistance, Bacterial↗
PubMed2006

Dermatologic side effects associated with the epidermal growth factor receptor inhibitors.

Epidermal growth factor receptor (EGFR) inhibitors are associated with unique and dramatic dermatologic side effects. Cetuximab, erlotinib, and gefitinib have been approved for patients with colorectal and non-small cell lung cancer refractory or intolerant to chemotherapy. Our aim was to describe key clinical features of common dermatologic adverse reactions among EGFR inhibitors, focusing mainly on skin toxicity, as well as to discuss the pathology, possible causes, and suggested treatments for these reactions. The most commonly encountered adverse effect was a mild skin toxicity characterized by a sterile follicular and pustular rash that may be treated empirically and usually does not require treatment modification. Although the precise mechanism for development of rash is not well defined, it is related to inhibition of EGFR-signaling pathways in the skin, and may serve as visible markers of anti-tumor activity and therapeutic efficacy. Secondary adverse reactions seen with anti-EGFR therapy include xerosis, pruritus, paronychia, hair abnormality, and mucositis.

Antibodies, Monoclonal↗
PubMed2006

Off-label uses of biologics in dermatology: interferon and intravenous immunoglobulin (part 1 of 2).

The introduction of a number of biologic therapies into the market has revolutionized the practice of dermatology. These therapies include interferons, intravenous immunoglobulin, infliximab, adalimumab, etanercept, efalizumab, alefacept, and rituximab. Most dermatologists are familiar with the Food and Drug Administration-approved indications of these medications. However, numerous off-label uses have evolved. As part 1 of a 2-part series, this article will review the literature regarding the off-label uses of the interferons and intravenous immunoglobulin in dermatology.

Adolescent↗
PubMed2006

Off-label uses of biologics in dermatology: rituximab, omalizumab, infliximab, etanercept, adalimumab, efalizumab, and alefacept (part 2 of 2).

Recently, dermatologists have witnessed a revolution in our therapeutic armamentarium with the development of several novel biologic immunomodulators. Although psoriasis remains the only condition in dermatology for which the use of biologic immunomodulators has been approved by the Food and Drug Administration, these drugs have the potential to significantly impact the treatment of several inflammatory conditions in dermatology. This article includes a review of the mechanism of action, dosing, and side-effect profile, as well as a review of the current literature on off-label uses of the CD20-positive B-cell antagonist rituximab, the IgE antagonist omalizumab, the tumor necrosis factor-alpha antagonists infliximab, etanercept, and adalimumab, and the T-cell response modifiers efalizumab and alefacept.

Adalimumab↗
PubMed2005

Formulation optimization of photocrosslinked polyacrylic acid modified with 2-hydroxyethyl methacrylate hydrogel as an adhesive for a dermatological patch.

A photopolymerization technique was applied in the preparation of a hydrogel composed of polyacrylic acid (PAA) in which 2-hydroxyethyl methacrylate (HEMA) was modified. The formulation of photocrosslinked PAA modified with HEMA hydrogel as an adhesive for a dermatological patch was optimized based on the simultaneous optimization technique. Photocrosslinked PAA modified with HEMA hydrogels that retained a large amount of water, above 85%, were successfully prepared. Based on the analysis of ANOVA, the gel strength and adhesiveness increased with an increase in the degree of modification with HEMA and the concentration of PAA modified with HEMA in the aqueous solution. For the optimization study, the modification with HEMA and the concentration of initiator were selected as causal factors. Gel yield, probe tack, degree of swelling and turbidity were selected as response variables. A set of causal factors and response variables was used as a tutorial date for the prediction of optimal formulation with a quadratic regression model, an artificial neural network (ANN) and a multivariate spline interpolation (MSI). Response surfaces generated with MSI well represented the nonlinear relationship between the factors and the responses, and all the observed values of the response variables coincided with the predictions. A high functional photocrosslinked PAA modified with HEMA hydrogel as an adhesive for a dermatological patch was successfully created using the simultaneous optimization technique incorporating MSI.

Acrylic Resins↗
PubMed2005

"Beauty is only skin deep": prevalence of dermatologic disease on a palliative care unit.

Skin disease affects the palliative care patient population because of their immunosuppressed state and decreased mobility; however, the prevalence of skin disease in this population has not been studied. We collected dermatologic histories and examinations of patients admitted to a hospital-based tertiary palliative care unit. Repeat examinations were performed to assess the incidence of cutaneous disease, as well as the progression of existing conditions. Sixteen of 65 patients admitted during 9 consecutive weeks participated in regular examinations. Six patients developed decubitus ulcers or had progression of existing ulcers. Dermatitis, xerosis, and pruritus were common diagnoses. Six patients sustained cutaneous trauma. Of the 49 non-participating patients, 4 developed decubitus ulcers, 1 had a drug reaction, and 3 had cutaneous infections. Palliative care patients are prone to developing decubitus ulcers and cutaneous infections. Aggressive control of systemic symptoms may exacerbate skin disease. Consideration of dermatologic conditions is an important factor in optimizing skin control in this population.

Aged↗
PubMed2005

Supporting adherence and healthy lifestyles in leg ulcer patients: systematic development of the Lively Legs program for dermatology outpatient clinics.

OBJECTIVES: The objective of our project was to develop a lifestyle program for leg ulcer patients at outpatient clinics for dermatology. METHODS: We used the intervention-mapping (IM) framework for systematically developing theory and evidence based health promotion programs. We started with a needs-assessment. A multidisciplinary project group of health care workers and patients was involved in all five IM steps; formulating proximal program objectives, selecting methods and strategies, producing program components, planning for adoption and implementation and planning for evaluation. Several systematic literature reviews and original studies were performed to support this process. RESULTS: Social Cognitive Theory was selected as the main theory behind the program 'Lively Legs' and was combined with elements of Goal-Setting Theory, the precaution adoption model and motivational interviewing. The program is conducted through health counseling by dermatology nurses and was successfully pre-tested. Also, an implementation and evaluation plan were made. CONCLUSION: Intervention mapping helped us to succeed in developing a lifestyle program with clear goals and methods, operational strategies and materials and clear procedures. PRACTICE IMPLICATIONS: Coaching leg ulcer patients towards adherence with compression therapy and healthy lifestyles should be taken on without delay. Systematic development of lifestyle programs for other patient groups should be encouraged.

Adolescent↗
PubMed2006

Dermatologic emergencies.

Primary care physicians are the gatekeepers of the medical community. They are the physicians to whom patients first present, and they are often the physicians with whom patients have the longest lasting relationships. Primary care physicians, as a result of these long-term relationships, have been endowed with a unique responsibility to the health of their patients. By the very nature of their practice, primary care physicians do not have the resources to treat emergent life-threatening conditions. They must, however, be able to diagnose these potentially life-threatening conditions and be able to stabilize and appropriately refer a patient for urgent evaluation by specialists or emergency physicians. There are many types of emergencies encountered in the outpatient setting, ranging from cardiac to toxicologic. As important as recognizing signs and symptoms of cardiac ischemia is the ability to recognize potentially life-threatening dermatologic disorders or dermatologic manifestations of life-threatening systemic diseases.

Emergencies↗