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PubMed2005

Psychopharmacologic therapies in dermatology: an update.

Many patients who have skin disorders have associated psychosocial issues. Psychotropic agents with improved side-effect profiles are available to allow physicians who are not psychiatrists to manage patients who have psychiatric conditions with agents that are effective, simple to administer, and generally well tolerated. Dermatologists who wish to help their patients who have psychodermatologic conditions can enhance their armamentarium by becoming familiar with the use of a few selected psychotropic agents. This article reviews the current status and future directions of psychopharmacology for the major types of psychopathologies encountered in dermatology practice.

Humans↗
PubMed2005

Acute gastrointestinal, genitourinary, and dermatological toxicity during dose-escalated 3D-conformal radiation therapy (3DCRT) using an intrarectal balloon for prostate gland localization and immobilization.

PURPOSE: We determined the acute gastrointestinal (GI), genitourinary (GU), and dermatologic (D) toxicity during dose-escalated three-dimensional conformal radiation therapy (3DCRT). A modified intrarectal balloon (Medrad) was used for prostate gland localization and immobilization. METHODS: Forty-six men with clinical category T1c to T3a, and at least one high-risk feature (PSA >10, Gleason > or =7, or MRI evidence of extracapsular extension or seminal vesical invasion) comprised the study cohort. Treatment consisted of hormonal therapy and 4-field 3DCRT using an intrarectal balloon for the initial 15 of 40 treatments. Planning treatment volume dose was 72 Gy (95% normalization). A Mantel-Haenzel Chi-square test compared the distribution of GU, GI, and D symptoms at baseline and at end of treatment (EOT). RESULTS: There was no significant difference between the 2 time points in the proportion of patients with bowel symptoms (p = 0.73), tenesmus (p = 0.27), nocturia (p = 1.00), or GU urgency (p = 0.40). However, there was a significant decrease in GU frequency (70% vs. 50%, p = 0.46) as a result of medical interventions and a significant increase in hemorrhoidal irritation (4% vs. 20%, p = 0.02) and anal cutaneous skin reaction (0% vs. 70%, p < 0.001). By 3 months after EOT compared to baseline, there was no significant difference in the proportion of patients experiencing hemorrhoidal bleeding (4% vs. 8%, p = 0.52), requiring intervention for hemorrhoidal symptoms (7% vs. 5%, p = 0.8), or experiencing persistent anal cutaneous skin reaction (0% vs. 3%, p = 0.31). CONCLUSION: Dose-escalated 3DCRT using an intrarectal balloon for prostate localization and immobilization was well tolerated. Acute GU, GI, and D symptoms resolved with standard dietary or medical interventions by the EOT or shortly thereafter.

Aged↗
PubMed2004

Halo nevus, rather than vitiligo, is a typical dermatologic finding of turner's syndrome: clinical, genetic, and immunogenetic study in 72 patients.

Turner's syndrome (TS) is a genetic disorder caused by numeric and/or structural abnormalities of the X chromosome; it is characterized by short stature, gonadal dysgenesis, and frequently by webbed neck, cubitus valgus, and lymphedema at birth. TS has been associated with several cutaneous abnormalities including an increased frequency of pigmented nevi, but few reports consider nevi in detail. Halo nevus (HN) is clinically defined as a melanocytic nevus surrounded by a halo of depigmentation. Vitiligo, a dermatologic disorder characterized by the presence of depigmented patches on the skin, has been described in the list of cutaneous findings associated with TS. The aim of this study was to determine the prevalence of HN and vitiligo in TS and to evaluate if a correlation between major histocompatibility complex genes, karyotype, autoimmunity, therapies, and the presence of HN exists. Of the 72 patients with TS examined, 13 had HN, a prevalence of 18.05%, which was significantly higher than in our control group (1%; P=.000001). On the contrary, only 2 patients with TS (2.77%, P=not significant) had vitiligo. By comparing the distribution of HLA class I alleles between patients with TS who did (13 of 72) and did not (59 of 72) have HN, we observed a significantly higher frequency of HLA-Cw6 in patients with TS and HN than in those without HN (26.92% vs 6.78%, respectively; P=.0067; odds ratio=5.06). The study of HLA class II genomic polymorphisms showed that the DRB1(*)0701 and DQB1*02 alleles for patients with TS and HN were overrepresented when compared with those without HN (34.61% vs 11.86%, respectively, P=.0078, odds ratio=3.93; and 34.61% vs 19.49%, respectively, P=.1386, odds ratio=2.19). In conclusion, this study is the first to demonstrate an increased prevalence of HN for patients with TS. Furthermore, the data suggest that a HN putative susceptibility gene in TS is located close to the HLA-C locus.

Adolescent↗
PubMed2004

Cutaneous adiaspiromycosis: a distinct dermatologic entity associated with Chrysosporium species.

Primary cutaneous infection with Chrysosporium, a saprophytic fungus commonly found in soil, is believed to be very rare, with only two previously reported cases. We present a case of localized cutaneous Chrysosporium in an immunocompromised heart transplant patient. Considering that the histology of the skin in this case is superimposable on that seen in pulmonary Chrysosporium known as adiaspiromycosis, we regard the cutaneous variant in the absence of pulmonary disease as a distinct dermatologic entity. The low frequency of reports of primary cutaneous Chrysosporium infection suggests either underreporting of this diagnosis in the literature, or misidentification of this fungus as another more common mycotic species sharing morphologic similarities. By amplifying our understanding of Chrysosporium infection in the skin, this disorder will be easier to identify and treat.

Adult↗
PubMed2005

Tropical dermatology: fungal tropical diseases.

UNLABELLED: Fungal infections are common in tropical countries and can have an important impact on public health. Lobomycosis is a common fungal infection in the tropical rain forest of South America, and paracoccidioidomycosis (South American blastomycosis) is a widespread and sometimes severe illness. Penicilliosis marneffei is an opportunistic infection of AIDS patients in southeast Asia. Chromoblastomycosis and mycetomas are causes of morbidity around the world. Sporotrichosis is a worldwide subcutaneous mycosis with a high incidence in tropical countries and is an important illness in immunocompromised patients. Rhinosporidiosis was classed as a fungal infection but is now considered a protistan parasite that belongs to the class Mesomycetozoea. It is included in this review because of its historical classification. In the past, most of these mycoses were restricted to specific geographic areas and natural reservoirs. There are, however, situations in which people from other regions come in contact with the pathogen. A common situation involves an accidental contamination of a traveler or worker who has contact with a tropical mycosis. Even minor trauma to the skin surface or inhalation of the fungal conidia can infect the patient. Thus recognition of the clinical symptoms and the dermatologic findings of the diseases, as well as the geographic distribution of the pathogens, can be critical in diagnosis of the tropical mycoses. This review discusses some of the more common tropical subcutaneous and systemic mycoses, as well as their signs, symptoms, methods of diagnosis, and therapies. LEARNING OBJECTIVE: At the completion of this learning activity, participants should be able to recognize the clinical and histologic presentations of tropical fungal diseases with cutaneous manifestations and be familiar with the appropriate therapies.

Animals↗
PubMed2006

Toll-like receptors: applications to dermatologic disease.

UNLABELLED: Toll-like receptors are a recently identified group of receptors that are an important component of the immune system. Thus far, ten different receptors have been identified and have unique tissue distribution, ligand binding properties, cellular signaling pathways, and cytokine production profiles. Importantly, ligand binding has been shown to regulate both the adaptive and host immune response; thus, defects in this pathway have the potential to lead to increased susceptibility to infection and inflammatory dysregulation. In this article, the burgeoning literature pertinent to the discovery and signaling mechanisms are reviewed in addition to the discussion of the important role Toll-like receptors may play in the pathogenesis of numerous skin diseases. LEARNING OBJECTIVE: At the completion of this learning activity, participants should be familiar with the role of Toll-like receptors in host defenses and their relevance to dermatologic diseases.

Animals↗
PubMed2006

Quality-of-life issues in psoriasis and psoriatic arthritis: outcome measures and therapies from a dermatological perspective.

Psoriasis and psoriatic arthritis are inflammatory immune-mediated skin and joint conditions with major impacts on patients' health-related quality of life (HRQOL). Physical manifestations include unsightly, scaly, pruritic plaques and inflamed joints for patients with psoriatic arthritis. These symptoms can severely impair physical functioning and occupational capability and negatively affect psychosocial domains. Consequently, patients often experience feelings of embarrassment, helplessness, and depression. Recent therapies, including the biologics, have been shown to improve not only the physical signs and symptoms of these conditions, but also patients' HRQOL. To accurately assess these improvements, standardized and validated instruments are needed. However, there are currently a limited number of feasible and validated tools available in dermatology for measuring HRQOL and function. Valuable insights can be acquired from the rheumatology field, and refinement of existing outcome measures through a cooperative and consensus building process between dermatologists and rheumatologists will lead to standardization of assessment tools in the years ahead.

Activities of Daily Living↗
PubMed2006

Useful plants of dermatology. VIII. The false hellebore (Veratrum californicum).

Plants have and continue to provide medicine with an abundance of pharmacologically interesting and useful chemicals. In recent years, cyclopamine, a steroidal alkaloid isolated from Veratrum californicum, has been instrumental in dissecting the sonic hedgehog pathway. This brief report outlines cyclopamine's discovery with discussion of its potential application to clinical dermatology.

Animals↗
PubMed2005

Applications of optical coherence tomography in dermatology.

Histology represents the gold standard for morphological investigation of the skin, though biopsy may alter the original morphology, is non-repeatable on the same site and always requires an iatrogenic trauma. In the past decade, advances in optics, fibre as well as laser technology have enabled the development of a novel non-invasive optical biomedical imaging technique, optical coherence tomography (OCT). The latter is based on a classic optical measurement method known as low-coherence interferometry that enables non-invasive, high resolution, two- or three-dimensional, cross-sectional imaging of microstructural morphology in biological tissue in situ. Using conventional OCT with a lateral resolution of 10-15 microm, the stratum corneum of glabrous skin (palmoplantar), the epidermis and the upper dermis can usually be identified, as well as skin appendages and blood vessels. For example, non-invasive monitoring of cutaneous inflammation, hyperkeratotic conditions and photoadaptive processes is possible by means of OCT. Furthermore, the development of high-output broadband light sources, e.g. femtosecond Ti:sapphire laser, might soon enable ultrahigh image resolutions of about 1 microm in order to investigate skin tissue on the cellular level, which could potentially allow the differentiation between benign and malignant tissues. Beyond a high resolution morphology in OCT images, tissue characterization by additional local physical parameters, such as the scattering coefficient and refractive index may be of great value, in particular in cosmetics and the pharmaceutical industry. Functional OCT imaging based on spectroscopy, tissue birefringence, elastography and Doppler flow reveals further information on tissue properties and represents an important progress of OCT technique in the field of dermatology. Therefore, the advanced versions of OCT technique might not only lead to significant new insights in skin physiology and pathology, but also in diagnosis and therapeutic control of cutaneous disorders with respect to non-invasive diagnosis of conditions and monitoring of disease activity in addition to treatment effects over time.

Humans↗
PubMed2003

Paroxetine in the treatment of severe non-dermatological pruritus: a randomized, controlled trial.

Severe pruritus may be an idiopathic phenomenon or associated with advanced systemic disease. It is one of the most distressing and difficult to treat symptoms. Uncontrolled studies have suggested that, in patients experiencing severe pruritus, paroxetine appeared to have a rapid anti-pruritic effect. This study was a prospective double-blind, randomized within patient comparison of paroxetine and placebo. The intensity of pruritus was measured subjectively with a numerical analogue scale. The primary endpoint of the trial was the mean pruritus score, measured for seven days after randomization and after cross-over. The secondary endpoint was individual global response to the treatment. Response was defined as at least 50% reduction of intensity of pruritus in the last three days of the treatment period vs. baseline. Adverse effects and patient satisfaction and preferences were also recorded. Twenty-six patients were included in the study; 17 of them had solid tumors, 4 had hematological malignancies and 5 had various nonmalignant or idiopathic conditions. Eight patients had drug-induced pruritus (none opioid-induced), 7 patients had paraneoplastic pruritus and 3 had cholestatic pruritus. After a run-in period, patients were randomly assigned to treatment with 20 mg paroxetine or placebo. The crossover took place after 7 days. Two patients discontinued treatment because of adverse effects of paroxetine. Twenty-four patients treated with paroxetine had lower pruritus intensity scores over the 7 treatment periods (mean+/-SE=5.2+/-0.32) as compared to placebo (mean+/-SE=6.0+/-0.32). Mean difference between placebo and paroxetine was 0.78 (95% CI=0.37-1.19). Nine of twenty-four patients (37.5%) fulfilled criteria of response. The onset of anti-pruritic action was observed usually after 2-3 days, irrespective of the order of treatment. The outcome of this study indicates that paroxetine is effective in the treatment of severe pruritus of non-dermatological origin.

Adult↗
PubMed2005

Overview of biologic agents in medicine and dermatology.

Three agents have recently been approved by the Food and Drug Administration for the treatment of chronic plaque psoriasis: alefacept, efalizumab, and etanercept. The field of dermatology has now entered a new era, joining other disciplines of medicine that have been using biologic agents for decades. These new therapies offer psoriatic patients the potential for safe and effective long-term management of this disease. This article reviews how an increased understanding of the pathophysiology of psoriasis led to the development of these products.

Alefacept↗
PubMed2006

Update on syndromes with cutaneous manifestations and new diagnoses in dermatology.

Systemic syndromes with cutaneous manifestations represent a continually evolving entity. New syndromes are described, while improved understanding of others, with new features of disease or enhanced genetic understanding of the disease are discovered. This review highlights the latest information on syndromes with cutaneous manifestations and presents several newly described dermatologic diagnoses.

Diagnosis, Differential↗
PubMed2006

Emerging infections in dermatology.

Cutaneous infections are common in dermatology. They occur in all populations and all ages. This review will focus on 3 emerging infections encountered by dermatologists; community-acquired methicillin-resistant Staphylococcus aureus, Epstein-Barr virus infections, and the atypical mycobacterial infections. The background, clinical presentation, diagnosis, and treatment of each of the 3 infections will be discussed.

Community-Acquired Infections↗
PubMed2005

Use of the Dermatology Life Quality Index in filarial lymphoedema patients.

The global programme to eliminate lymphatic filariasis has alleviation of suffering and disability as one of its components, and many efforts are being taken across the globe in this direction. However, there is no effective tool to assess the impact of these efforts on patients' quality of life and/or lessening of disability and suffering. The present paper reports the use of the Dermatology Life Quality Index (DLQI) in filarial lymphoedema patients. DLQI scores were collected from 203 patients recruited from a clinic and from the community. The DLQI score ranged from 0 to 17, and a mean score of 2.7 (SD 4.4) or 9.0% disability. This score is lower than many skin diseases reported so far. The scores for individual questions vary, but the degree of consistency of responses between questions is high. The differences between sexes, place of recruitment and grades of lymphoedema are not significant. Although the DLQI measures the quality of life due to lymphoedema, this study further warrants development of a good quality-of-life index for lymphoedema patients.

Adolescent↗
PubMed2006

Modified Dermatology Life Quality Index as a measure of quality of life in patients with filarial lymphoedema.

The quality of life (QoL) and correlates of the QoL of lymphoedema patients attending filariasis clinics and a hospital outpatient department were studied using a Life Quality Index (LQI) in a region endemic for Bancroftian filariasis in Sri Lanka. The index was derived by modifying a previously validated Dermatology Life Quality Index (DLQI) to focus on the oedematous limb rather than the skin. The index was scored from 0 (normal) to 30 (severely affects QoL). Lymphoedema was graded using criteria recommended by the WHO. Another semi-structured questionnaire was used to assess the patient's socioeconomic status, frequency of acute adenolymphangitis attacks (ADLA) and measures practiced for morbidity control. Ninety-one patients (62 females, 29 males; mean age 50.4 years) were studied. A single lower limb, both lower limbs or a single upper limb were affected in 78 (85.7%), 10 (11.0%) and 3 (3.3%) patients, respectively. The severity of lymphoedema ranged from stage 1 (mild) to stage 6 (severe). The mean LQI was 8.2 (SD 5.2, range 0-20). The modified DLQI scores showed a significant positive correlation with severity of lymphoedema and a negative correlation with age (R=0.59 and R=-0.1, respectively). The frequency of ADLAs correlated with an increased modified DLQI score. Local pain, embarrassment and limitations of physical activities were the most distressing aspects of lymphoedema. Disease severity and early onset lymphoedema were found to be significantly associated with poorer QoL in filarial lymphoedema.

Activities of Daily Living↗
PubMed2000

Sertaconazole in the treatment of mycoses: from dermatology to gynecology.

Sertaconazole is a pharmaceutical product in the form of a cream, gel, powder and solution for dermatological use and vaginal cream, tablets and ovules for gynecological use. It is marketed in 24 countries and registered in a further 22. The active ingredient is 2% sertaconazole nitrate. Sertaconazole nitrate is an azole antifungal agent, with notable antifungal activity. Its molecule has a highly lipophilic fragment. This is a review of the efficacy and safety of all pharmaceutical forms of sertaconazole in order to provide data on vaginal sertaconazole for marketing purposes.

Antifungal Agents↗
PubMed1978

Behavioral and dermatologic changes and low serum zinc and copper concentrations in two premature infants after parenteral alimentation.

Two premature infants were observed to develop behavioral and dermatologic changes and low serum zinc and copper concentrations following cessation of prolonged parenteral alimentation, while being fed exclusively with human milk. Following treatment with exogenous oral zinc supplementation, prompt relief of symptoms and increases of serum zinc and copper concentrations were observed in both infants. These patients comprise about 5% of our premature infants who are treated with parenteral alimentation for more than two weeks. We recommend that premature infants on prolonged parenteral alimentation should be monitored for changes in serum zinc and copper concentrations and, if a marked fall is observed, supplementation should be considered.

Child Behavior Disorders↗
PubMed1992

Dermatologic manifestations of human immunodeficiency virus infection.

Human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS) have become major health problems in the United States, and patients with manifestations of these diseases are seen by physicians in all areas of medicine. Cutaneous manifestations develop in as many as 92% of HIV-positive persons. Familiarity with these manifestations facilitates early diagnosis and enhances the care of HIV-infected patients. The spectrum of mucocutaneous disorders in these patients includes an acute exanthem, multiple infections, neoplastic processes, and miscellaneous disorders. Herein we review the most common and the most specific dermatologic manifestations associated with HIV infection, which often are atypical, more severe, or less responsive to treatment than the corresponding diseases encountered in non-HIV-infected persons.

AIDS-Related Opportunistic Infections↗