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Patel MH, Brumfiel CM, Breen I, Glembocki D, Luber A. Granulomatous Panniculitis as a Complication of Subcutaneous Testosterone Pellet Therapy. Skinmed 2023; 21:203-204. [PMID: 37634108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
A 51-year-old man with a 3-year history of exogenous testosterone pellet injections to the left buttock presented for routine skin examination. While the patient reported recurrent drainage from the site of testosterone replacement therapy (TRT) injections, he continued to receive repeated implantations every 6 months. On physical examination, a 12-mm irregular, brown macule was identified within a poorly demarcated, ecchymotic, and fluctuant subcutaneous plaque on the left buttock with a sinus tract draining serosanguinous fluid. The pigmented lesion was biopsied, revealing malignant melanoma in situ; hence, a wide local excision was scheduled. During the procedure, necrotic subcutaneous fat was observed surrounding the site of biopsy, and a region measuring 18 cm2 approximately was debrided and submitted for pathologic evaluation. Histopathologic examination revealed a diffused subcutaneous granulomatous infiltrate with septal and lobular panniculitis and fat necrosis as well as peripherally palisading histiocytes and hemosiderin deposition (Figures 1A and B). Similar findings were observed in another specimen from the same segment of debrided tissue, compatible with granulomatous panniculitis. Periodic acid-Schiff (PAS), Gram's, and acid-fast bacilli (AFB) stains revealed no microorganisms. During surgical exploration, six foreign bodies were discovered and identified as undissolved testosterone pellets. The patient was referred to a wound care center, but ultimately lost to follow-up.
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Affiliation(s)
- Meera H Patel
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ;
| | | | - Ilana Breen
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ
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2
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Puri P, Patel MH, Brumfiel CM, Pittelkow MR, Mangold AR. Consolidation of US dermatology practices. Int J Dermatol 2022; 61:e490-e491. [PMID: 34859886 DOI: 10.1111/ijd.16017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/27/2021] [Accepted: 11/11/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Pranav Puri
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Meera H Patel
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
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3
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Boudreaux BW, Pincelli TP, Bhullar PK, Patel MH, Brumfiel CM, Li X, Heckman MG, Pittelkow MR, Mangold AR, Sluzevich JC. Secukinumab for the treatment of adult-onset pityriasis rubra pilaris: a single-arm clinical trial with transcriptomic analysis. Br J Dermatol 2022; 187:650-658. [PMID: 35701384 DOI: 10.1111/bjd.21708] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/04/2022] [Accepted: 06/11/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND The pathogenesis of pityriasis rubra pilaris (PRP) is not completely understood, but interleukin (IL)-17 has been shown to play a critical role. There are no reliable immunomodulatory agents to treat PRP. We conducted an open-label, single-arm clinical trial of secukinumab, a monoclonal antibody that inhibits IL-17A, for the treatment of PRP. OBJECTIVES To evaluate the clinical efficacy of secukinumab and define the transcriptomic landscape of PRP and its response to IL-17A blockade. METHODS Twelve patients with PRP were recruited for an open-label trial of secukinumab. Patients received a 24-week course of secukinumab. The primary endpoint was a ≥ 75% reduction in Psoriasis Area and Severity Index (PASI 75) from baseline to week 28. Secondary endpoints included PASI 90, change in Physician's Global Assessment (PGA), and change in Dermatology Life Quality Index (DLQI). RNA sequencing was performed on lesional and nonlesional skin biopsies obtained at baseline and week 2. Sample groups were compared to identify differential gene expression and pathway enrichment. This trial was registered with ClinicalTrials.gov: 'Cosentyx (secukinumab) for the treatment of adult onset pityriasis rubra pilaris' - NCT03342573. RESULTS At week 28, six of 11 patients (55%) achieved PASI 75, and three patients (27%) achieved PASI 90. PGA (P = 0.008) and DLQI scores (P = 0.010) showed significant improvement with treatment. No serious treatment-related adverse events were encountered. Treatment with secukinumab normalized transcriptional differences between lesional and nonlesional skin. Transcriptomic data from nonresponsive patients suggest that overactivity of innate immune pathways may be driving resistance to secukinumab. CONCLUSIONS Secukinumab appears to be an effective treatment for PRP and warrants further investigation. PRP is a transcriptionally heterogeneous disease, reflecting its variable response to therapy. Agents targeting other IL-17 isoforms and innate immune mediators should be considered for future clinical trials. What is already known about this topic? The pathogenesis of pityriasis rubra pilaris is incompletely understood. Successful treatment has been reported with a variety of immunomodulatory agents, but disease is often refractory to therapy. Interleukin (IL)-17 is thought to drive keratinocyte proliferation and vascular dysfunction in this disease. A previous trial demonstrated efficacy of the anti-IL-17A drug ixekizumab for pityriasis rubra pilaris. What does this study add? Herein we describe the findings of a clinical trial of secukinumab, an anti-IL-17A monoclonal antibody, for the treatment of pityriasis rubra pilaris. Secukinumab was effective in treating pityriasis rubra pilaris. Our transcriptomic data give new insight into the expressional changes that occur in response to secukinumab and suggest mechanisms of treatment resistance.
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Affiliation(s)
| | | | - Puneet K Bhullar
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Meera H Patel
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | | | - Xing Li
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Mark R Pittelkow
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ, USA
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4
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Brumfiel CM, Jefferson IS, Rinderknecht FA, Worswick S, Rosman IS. Current perspectives of and potential reforms to the dermatology residency application process: A nationwide survey of program directors and applicants. Clin Dermatol 2022; 40:595-601. [PMID: 35287988 DOI: 10.1016/j.clindermatol.2022.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The COVID-19 pandemic has accelerated discussions about reforms needed in the dermatology residency application process. We sought to evaluate the perspectives of dermatology program directors (PDs) and applicants regarding changes implemented during the 2020-2021 application cycle and measure support for potential reforms. Two online surveys were distributed to PDs and applicants who participated in the 2020-2021 dermatology residency match. Responses were collected from a total of 79 PDs (73.8% response rate, 83.5% complete responses) and 232 applicants (83.6% complete responses). The top 3 reforms supported by PDs were application caps (89.4% in favor), interview caps (86.4% in favor), and token preference signaling (81.8% in favor). The top 3 reforms supported by applicants were coordinated interview invite release (89.7% in favor), national webinars with PDs and/or faculty to discuss the application process (86.6% in favor), and formalized mentorship programs with PDs and/or faculty (78.4% in favor). This study was limited by the inability to capture responses from more dermatology applicants, possibly affecting the generalizability of the results. We identified broad support for multiple proposed reforms to the dermatology residency application process, particularly to improve the efficiency of application review and strengthen communication between programs and applicants.
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Affiliation(s)
| | | | | | - Scott Worswick
- Department of Dermatology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA
| | - Ilana S Rosman
- Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri, USA.
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5
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Veerabagu SA, Strunck JL, Lin K, Wu AG, Jefferson IS, Brumfiel CM, Brodell RT, Etzkorn JR. Utility of an anonymous online interactive forum for dermatology residency program directors and applicants. Dermatol Online J 2022; 28. [DOI: 10.5070/d328357798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 11/08/2022] Open
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6
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Besch-Stokes J, Brumfiel CM, Patel MH, Harvey J, Montoya J, Severson KJ, Cumsky H, Buras M, Fagoaga JEG, Costello CM, Pittelkow MR, Mangold AR. Skin Cancer Knowledge, Attitudes and Sun Protection Practices in the Hispanic Population: A Cross-Sectional Survey. J Racial Ethn Health Disparities 2022; 10:1293-1303. [PMID: 35486349 DOI: 10.1007/s40615-022-01314-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022]
Abstract
Hispanics are more likely to be diagnosed with skin cancer at a later stage and experience worse overall survival than Whites. The objective of this cross-sectional study was to assess the skin cancer knowledge, attitudes, perceived risk, and sun protection practices among an underserved population in the Phoenix area. We recruited participants from the greater Phoenix area to undergo skin examination and complete a questionnaire. 208 participants were included. The majority were Hispanic (64.9%). Of this Hispanic group, most were from Mexico (87.9%). The Hispanic cohort had an overall mean skin cancer knowledge score of 3.68/6, the lowest of any other racial/ethnic group, but had the highest desire to learn more about skin cancer (64.6%, "strongly agree"). They were the most concerned about developing skin cancer (50.4%, "very concerned") but had relatively lower rates of sun protection practices (7.9% "always use" sunscreen, 22.0% "always use" sun-protective clothing). Limitations of this study include a small sample size, lack of validation for the skin cancer knowledge score, lack of season as a covariate in the multivariate analysis, lack of follow-up, and lack of robust skin cancer risk assessment. In conclusion, despite poorer skin cancer knowledge and sun protection practices, the Hispanic population had the highest concern for developing skin cancer and desire to learn more about skin cancer. Targeted and culturally relevant skin cancer and sun protection education for this group is needed.
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Affiliation(s)
| | | | - Meera H Patel
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Jamison Harvey
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Jordan Montoya
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | | | - Helen Cumsky
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Matthew Buras
- Division of Biostatistics, Department of Health Science Research, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | | | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA.
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7
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Johnson E, Patel MH, Brumfiel CM, Severson KJ, Bhullar P, Boudreaux B, Butterfield RJ, DiCaudo DJ, Nelson SA, Pittelkow MR, Mangold AR. Histopathologic Features of Necrobiosis Lipoidica. J Cutan Pathol 2022; 49:692-700. [DOI: 10.1111/cup.14238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 03/17/2022] [Accepted: 03/26/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Emma Johnson
- Department of Dermatology Mayo Clinic Rochester USA
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8
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Brumfiel CM, Patel MH, Severson KJ, Zhang N, Li X, Quillen JK, Zunich SM, Branch EL, Nelson SA, Pittelkow MR, Mangold AR. Ruxolitinib cream in the treatment of cutaneous lichen planus: A prospective, open-label study. J Invest Dermatol 2022; 142:2109-2116.e4. [DOI: 10.1016/j.jid.2022.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 02/08/2023]
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9
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Patel MH, Brumfiel CM, Glembocki D, Luber AJ. Cutaneous Desmoplastic Leiomyosarcoma Development at Smallpox Vaccination Site. Skinmed 2021; 19:462-463. [PMID: 35022120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
An 81-year-old man presented to the clinic with a 2.1 cm firm, skin-colored subcutaneous tumor on the left upper arm (Figure 1). The lesion arose at the site of a past smallpox vaccination and had been slowly enlarging for approximately 4 years. The differential diagnosis included sympastic leiomyoma, and a variety of desmoplastic spindle cell lesions such as desmoplastic melanoma, cutaneous spindle cell carcinoma, and desmoplastic leiomyosarcoma. Punch biopsy and immunohistochemical staining revealed positive spindle cells for desmin and caldesmon (Figures 2 and 3). Immunostain for p53 was also strongly and uniformly positive. Owing to poor circumscription on histopathology, symplastic leiomyosarcoma was ruled out. Demoplastic melanoma was also excluded due to positive immunoreaction to muscle markers (desmin and caldesmon) and negative S-100 staining. Additionally, cutaneous spinde cell carcinoma was also ruled out due to negative p63 and cytokeratin staining. Ultimately, clinicopathologic correlation favored a diagnosis of desmoplastic leiomyosarcoma. Staged excisions were performed to eradicate the lesion.
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Affiliation(s)
- Meera H Patel
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ;
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10
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Affiliation(s)
- Meera H Patel
- Creighton University School of Medicine Phoenix Regional Campus, Phoenix, Arizona
| | - Caitlin M Brumfiel
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Nicholas Bohrer
- Department of Dermatology, University of California, San Diego, California
| | - Amanda F Marsch
- Department of Dermatology, University of California, San Diego, California
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11
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Brumfiel CM, Patel MH, Puri P, Besch-Stokes J, Lester S, Rule WG, Khera N, Sluzevich JC, DiCaudo DJ, Comfere N, Bennani NN, Rosenthal AC, Pittelkow MR, Mangold AR. How to Sequence Therapies in Mycosis Fungoides. Curr Treat Options Oncol 2021; 22:101. [PMID: 34570278 DOI: 10.1007/s11864-021-00899-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 12/11/2022]
Abstract
OPINION STATEMENT Choice of therapy in mycosis fungoides is based on both patient- and lymphoma-specific factors, such as disease characteristics, comorbidities, symptoms and effect on quality of life, potential associated toxicities of therapy, response and tolerance to prior lines of therapy, and convenience and practicality. Generally, we sequence therapies from least toxic, targeted, nonimmunosuppressive to more toxic, immunosuppressive and from single agent to multiple agents, as necessary. If more toxic, immunosuppressive agents are required to alleviate disease burden or symptoms, we generally use them just long enough to control the disease, then transition to a maintenance regimen with less toxic, less immunosuppressive agents.
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Affiliation(s)
- Caitlin M Brumfiel
- Department of Dermatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Meera H Patel
- Department of Dermatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Pranav Puri
- Department of Dermatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Jake Besch-Stokes
- Department of Dermatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Scott Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - William G Rule
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Nandita Khera
- Division of Hematology Oncology, Mayo Clinic, Phoenix, AZ, USA
| | | | - David J DiCaudo
- Department of Dermatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Nneka Comfere
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - N Nora Bennani
- Division of Hematology Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Mark R Pittelkow
- Department of Dermatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA.
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12
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Besch-Stokes JG, Patel MH, Brumfiel CM, Costello CM, Rule W, Rosenthal A, Pittelkow MR, DiCaudo DJ, Mangold AR. Cutaneous B cell pseudolymphoma treated with rituximab and methotrexate. Dermatol Online J 2021; 27. [PMID: 34755980 DOI: 10.5070/d327955138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 11/08/2022] Open
Abstract
Cutaneous B cell pseudolymphoma (CBPL), or cutaneous lymphoid hyperplasia, is the most common pseudolymphoma. It typically responds well to local treatment and follows a benign course. Herein, we describe the unique case of a patient with CBPL that was refractory to a variety of treatments, with subsequent response to rituximab followed by methotrexate. This case explores the complex interplay of T and B lymphocytes, and the potential role of perifollicular T cells in treatment resistant CBPL. Further, it describes the additive therapeutic effect of rituximab and methotrexate to target both B cell and T cell populations in CBPL, a strategy already employed in a number of other conditions.
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13
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Mangold AR, Patel MH, Brumfiel CM, Severson KJ, Butterfield RJ, Zhang N, Nelson SA, DiCaudo DJ, Pittelkow MR, Sekulic A. 26941 The prognostic value of inositol polyphosphate 5-phosphatase in cutaneous squamous cell carcinoma in a random sampling representative of the general population. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Sluzevich JC, Patel MH, Pincelli TP, Brumfiel CM, Pittelkow MR, Mangold A. 25240 Cosentyx (secukinumab) for the treatment of adult onset pityriasis rubra pilaris: A single arm, open-label exploratory study. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Mangold AR, Brumfiel CM, Patel MH, Severson KJ, Zhang N, Pittelkow MR. 25713 Ruxolitinib cream in the treatment of cutaneous lichen planus. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Breen ID, Patel MH, Brumfiel CM, Nelson SA, Larsen JT, Mangold AR. 26121 A case of light chain amyloidosis presenting as hair loss. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Brumfiel CM, Patel MH, Bell KA, Cardis MA. Assessing the Safety and Efficacy of Trifarotene in the Treatment of Acne Vulgaris. Ther Clin Risk Manag 2021; 17:755-763. [PMID: 34345173 PMCID: PMC8324978 DOI: 10.2147/tcrm.s286953] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/20/2021] [Indexed: 11/23/2022] Open
Abstract
Acne vulgaris is a common skin condition of the face and trunk that negatively impacts quality of life. Trifarotene is a new first-in-class fourth-generation topical retinoid that has been uniquely studied in the treatment of both facial and truncal acne. Through selective agonism of retinoic acid receptor (RAR)-gamma, the most predominant RAR isotype in the epidermis, trifarotene exerts more targeted, skin-specific effects than earlier generation retinoids. This narrative review summarizes all currently available literature regarding the use of trifarotene in acne vulgaris. We focus on efficacy, safety, and tolerability data and highlight quality of life outcomes and patient-reported satisfaction. Future clinical trials and the clinical applicability of this novel medication in the treatment of acne are also discussed.
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Affiliation(s)
| | - Meera H Patel
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA
| | - Katheryn A Bell
- Georgetown University School of Medicine, Washington, DC, USA
| | - Michael A Cardis
- MedStar Washington Hospital Center/Georgetown University Hospital Department of Dermatology, Washington, DC, USA
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18
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Harvey JA, Severson KJ, Brumfiel CM, Patel MH, Butterfield RJ, Nelson SA, Sekulic A, Pittelkow MR, Mangold AR. Necrobiosis lipoidica-associated cutaneous malignancy. J Am Acad Dermatol 2021; 86:1428-1429. [PMID: 34153393 DOI: 10.1016/j.jaad.2021.06.848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/07/2021] [Accepted: 06/13/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Meera H Patel
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | | | | | | | | | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona.
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19
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Brumfiel CM, Patel MH, Aqel B, Lehrer M, Patel SH, Seetharam M. Immune checkpoint inhibitor therapy in a liver transplant recipient with autoimmune disease and metastatic cutaneous squamous cell carcinoma. JAAD Case Rep 2021; 14:78-81. [PMID: 34277916 PMCID: PMC8263514 DOI: 10.1016/j.jdcr.2021.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
| | - Meera H Patel
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, Arizona
| | - Bashar Aqel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona
| | - Michael Lehrer
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, Arizona.,Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona
| | - Mahesh Seetharam
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, Arizona
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Brumfiel CM, Patel MH, Zirwas MJ. Development of psoriasis during treatment with dupilumab: A systematic review. J Am Acad Dermatol 2021; 86:708-709. [PMID: 34022319 DOI: 10.1016/j.jaad.2021.05.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Affiliation(s)
| | - Meera H Patel
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, Arizona
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21
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Brumfiel CM, Patel MH, DiCaudo DJ, Rosenthal AC, Pittelkow MR, Mangold AR. Recurrence of primary cutaneous CD30-positive lymphoproliferative disorder following COVID-19 vaccination. Leuk Lymphoma 2021; 62:2554-2555. [PMID: 33974494 DOI: 10.1080/10428194.2021.1924371] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Meera H Patel
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, USA
| | - David J DiCaudo
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, USA
| | | | | | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, USA
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22
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Severson KJ, Costello CM, Brumfiel CM, Patel MH, Butterfield RJ, Nelson SA, Pittelkow MR, Mangold AR. Clinical and morphological features of necrobiosis lipoidica. J Am Acad Dermatol 2021; 86:1133-1135. [PMID: 33878403 DOI: 10.1016/j.jaad.2021.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/13/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Kevin J Severson
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | | | - Meera H Patel
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | - Steven A Nelson
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Mark R Pittelkow
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona.
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Patel MH, Brumfiel CM, Severson KJ, DiCaudo DJ, Nelson SA, Butterfield RJ, Zhang N, Baum C, Sekulic A, Mangold AR. The prognostic value of inositol polyphosphate 5-phosphatase in cutaneous squamous cell carcinoma in the general population. Int J Dermatol 2021; 60:e427-e429. [PMID: 33860939 DOI: 10.1111/ijd.15565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | | | | | | | - Nan Zhang
- Department of Health Sciences, Mayo Clinic Arizona, USA
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Breen ID, Brumfiel CM, Patel MH, Butterfield RJ, VanderPluym JH, Griffing L, Pittelkow MR, Mangold AR. Evaluation of the Safety of Calcitonin Gene-Related Peptide Antagonists for Migraine Treatment Among Adults With Raynaud Phenomenon. JAMA Netw Open 2021; 4:e217934. [PMID: 33871613 PMCID: PMC8056280 DOI: 10.1001/jamanetworkopen.2021.7934] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Calcitonin gene-related peptide (CGRP) antagonists have demonstrated tremendous promise in migraine management. However, these medications decrease reflex vasodilatory response, which may lead to exacerbation of microvascular disease in susceptible patients, such as patients with Raynaud phenomenon (RP). OBJECTIVE To investigate the microvascular complications of CGRP antagonists in patients with underlying RP. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was performed from May 18, 2018, to September 15, 2020, in Mayo Clinic Health System patients with Raynaud phenomenon while undergoing CGRP antagonist therapy to treat migraine. Inclusion criteria were age older than 18 years, history of migraine, past or current treatment with CGRP antagonists, and diagnosis of primary or secondary RP. EXPOSURE Treatment with CGRP antagonists. MAIN OUTCOMES AND MEASURES The main outcome measure was microvascular complications (eg, worsening RP, digital ulcerations, and gangrenous necrosis) after initiation of treatment with a CGRP antagonist. Patient demographic and clinical characteristics were compared between those who experienced complications and those who did not. RESULTS A total of 169 patients (163 [96.4%] female; 151 [89.3%] non-Hispanic White; mean [SD] age, 46 [13] years) were identified. Of the 169 patients, 9 (5.3%) exhibited microvascular complications, ranging from worsening RP to gangrene and autonecrosis that required distal digit amputation. Comparative analysis did not find statistically significant differences in demographic or clinical characteristics between the 2 cohorts. All 9 patients with complications were female (mean [SD] age, 40 [12] years). Five of the 9 patients (55.6%) had previously diagnosed RP; in 3 the RP was primary, and 2 it was secondary to scleroderma. The other 4 patients (44.4%) were newly diagnosed with RP. Eight of the 9 patients (88.9%) had chronic migraine; 4 had migraine with aura, and 5 had migraine without aura. The CGRP antagonist agents temporally associated with the microvascular complications included galcanezumab (in 3 patients), erenumab (in 5 patients), and fremanezumab (in 1 patient). CONCLUSIONS AND RELEVANCE The results of this study indicate that microvascular complications of CGRP antagonist use in patients with underlying RP are uncommon. The incidence of serious adverse events, although rare, warrant caution when considering the use of these agents in patients with RP.
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Affiliation(s)
- Ilana D. Breen
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale
| | | | - Meera H. Patel
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale
| | | | | | - Leroy Griffing
- Department of Rheumatology, Mayo Clinic Arizona, Phoenix
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Severson KJ, Patel MH, Brumfiel CM, Breen I, Butterfield RJ, Nelson SA, Sekulic A, Pittelkow MR, Mangold AR. Comorbidities and diabetic complications in patients with necrobiosis lipoidica. J Am Acad Dermatol 2021; 86:891-894. [PMID: 33722550 DOI: 10.1016/j.jaad.2021.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Kevin J Severson
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Meera H Patel
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | - Ilana Breen
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | | | - Steven A Nelson
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | - Mark R Pittelkow
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona.
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26
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Breen ID, Brumfiel CM, Patel MH, Rosenthal AC, Rule WG, DiCaudo DJ, Craig FE, Pittelkow MR, Mangold AR. Mogamulizumab-induced interface dermatitis drug rash treated successfully with methotrexate and extracorporeal photopheresis in a patient with Sézary syndrome. JAAD Case Rep 2021; 9:24-27. [PMID: 33604439 PMCID: PMC7873348 DOI: 10.1016/j.jdcr.2020.12.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ilana D. Breen
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | | | | | | | | | - David J. DiCaudo
- Mayo Clinic Arizona, Dermatology, Scottsdale, Arizona
- Mayo Clinic Arizona, Laboratory Medicine and Pathology, Phoenix, Arizona
| | - Fiona E. Craig
- Mayo Clinic Arizona, Laboratory Medicine and Pathology, Phoenix, Arizona
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Puri P, Severson KJ, Patel MH, Brumfiel CM, DiCaudo DJ, Rosenthal AC, Mangold AR. A case of B-cell lymphoblastic leukemia cutis flaring following CAR T-cell therapy in a patient with refractory acute lymphoblastic leukemia. JAAD Case Rep 2021; 8:64-66. [PMID: 33521213 PMCID: PMC7820298 DOI: 10.1016/j.jdcr.2020.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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28
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Severson KJ, Cumsky HJL, Brumfiel CM, Janeczek MC, Ginos BF, Kosiorek HE, Besch-Stokes J, Patel MH, Rule WG, DiCaudo DJ, Rosenthal AC, Pittelkow MR, Mangold AR. Blue light photodynamic therapy with 5-aminolevulinic acid in refractory mycosis fungoides: A prospective, open-label study. J Am Acad Dermatol 2021; 85:969-971. [PMID: 33493572 DOI: 10.1016/j.jaad.2021.01.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Kevin J Severson
- Department of Dermatology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Helen J L Cumsky
- Department of Dermatology, Mayo Clinic Arizona, Phoenix, Arizona
| | | | | | - Brenda F Ginos
- Department of Health Sciences Research, Mayo Clinic Arizona, Phoenix, Arizona
| | - Heidi E Kosiorek
- Department of Health Sciences Research, Mayo Clinic Arizona, Phoenix, Arizona
| | | | - Meera H Patel
- Department of Dermatology, Mayo Clinic Arizona, Phoenix, Arizona
| | - William G Rule
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - David J DiCaudo
- Department of Dermatology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Allison C Rosenthal
- Division Hematology-Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix, Arizona
| | - Mark R Pittelkow
- Department of Dermatology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic Arizona, Phoenix, Arizona.
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Abstract
Multisystem inflammatory syndrome in children (MIS-C) affects a small percentage of pediatric patients infected with COVID-19 and is characterized by fever, laboratory evidence of inflammation, multisystem involvement, and severe illness necessitating hospitalization. Skin findings are often present in these patients, and when initially compared with Kawasaki disease, they likely represent distinct phenomena and overall remain poorly characterized. In this retrospective review of 34 case reports and series, we identified cutaneous manifestations documented in 417 of 736 patients (57%) with MIS-C associated with COVID-19. “Rash” was the sole descriptor of skin findings in nearly half of patients. Case reports and smaller case series provided more detail, outlining a broad range of lesion morphologies (polymorphic, maculopapular, morbilliform, erythrodermic, urticarial, reticular, petechial, purpuric) in variable anatomic distribution. More thorough descriptions of dermatologic manifestations in patients with MIS-C are warranted to better characterize this syndrome, as they may lend important insight into pathogenic mechanisms of disease.
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Affiliation(s)
- Caitlin M Brumfiel
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Ashley M DiLorenzo
- Department of Dermatology, MedStar Washington Hospital Center/Georgetown University Hospital, Washington, District of Columbia, USA
| | - Vesna M Petronic-Rosic
- Georgetown University School of Medicine, Washington, District of Columbia, USA; Department of Dermatology, MedStar Washington Hospital Center/Georgetown University Hospital, Washington, District of Columbia, USA.
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Costello CM, Hill HE, Brumfiel CM, Yang YW, Swanson DL. Choosing between isotretinoin and acitretin for epidermal growth factor receptor inhibitor and small molecule tyrosine kinase inhibitor acneiform eruptions. J Am Acad Dermatol 2020; 84:840-841. [PMID: 33039483 DOI: 10.1016/j.jaad.2020.09.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022]
Affiliation(s)
| | - Hannah E Hill
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | | | - Yul W Yang
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - David L Swanson
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona.
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Abstract
OBJECTIVE This article reviews clinical trials to assess the efficacy, safety, and clinical application of trifarotene 0.005% cream (Aklief). DATA SOURCES A systematic review of the literature was performed using the terms trifarotene OR Aklief OR CD5789 in MEDLINE (PubMed) and EMBASE databases. Articles prior to May 2020 were considered for inclusion. Bibliographies and ClinicalTrials.gov were also searched to identify further studies. STUDY SELECTION AND DATA EXTRACTION Relevant English language and human studies related to pharmacology, clinical trials, and safety were considered. DATA SYNTHESIS In the 52-week phase III trial, treatment success rates for facial acne (Investigator Global Assessment [IGA] rating of no or almost no acne) and truncal acne (Physician's Global Assessment [PGA] rating of no or almost no acne) were 65.1% and 66.9%, respectively. Overall success rates (IGA and PGA success in the same patient) were 57.9%; 52.8% of patients had a Dermatology Quality of Life Index score of 0 or 1, compared with 22.6% at baseline. Trifarotene was well tolerated, with pruritus, irritation, and sunburn as the most common adverse effects. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Trifarotene is a newly Food and Drug Administration-labeled fourth-generation topical retinoid that shows particular promise in the treatment of facial and truncal acne vulgaris. It is an effective and safe addition to currently available retinoids. CONCLUSION Trifarotene is effective and safe for treatment of facial and truncal acne. Future trials should compare its efficacy and tolerability with that of the older, clinically established retinoids. Despite efficacy, cost may be a prohibitive factor.
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Affiliation(s)
- Katheryn A Bell
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - Wasim Haidari
- Georgetown University School of Medicine, Washington, DC, USA
| | - Laura Boger
- MedStar Washington Hospital Center and MedStar Georgetown University Hospital, Washington, DC, USA
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Bergman MJ, Prasad NR, Brumfiel CM, Harley EH. Neonatal neuroblastoma in otolaryngology: A case and literature review. INT J PEDIAT OTO CAS 2019. [DOI: 10.1016/j.pedeo.2019.100674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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