1
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Gutierrez RA, Berger TG, Shah V, Agnihothri R, Demir-Deviren S, Fassett MS. Evaluation of Gabapentin and Transforaminal Corticosteroid Injections for Brachioradial Pruritus. JAMA Dermatol 2022; 158:1070-1071. [PMID: 35830176 DOI: 10.1001/jamadermatol.2022.2376] [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] [Indexed: 11/14/2022]
Affiliation(s)
| | - Timothy G Berger
- Department of Dermatology, University of California, San Francisco
| | - Vinil Shah
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | | | - Sibel Demir-Deviren
- Spine Center, Department of Orthopedics, University of California, San Francisco
| | - Marlys S Fassett
- Department of Dermatology, University of California, San Francisco.,Department of Microbiology and Immunology, University of California, San Francisco
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2
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Chiu LW, Berger TG, Chang AY. Management of common scabies and postscabetic itch in adults: Lessons learned from a single-center retrospective cohort study. Int J Womens Dermatol 2022; 7:716-720. [PMID: 35028370 PMCID: PMC8714596 DOI: 10.1016/j.ijwd.2021.09.001] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/25/2021] [Accepted: 09/06/2021] [Indexed: 11/16/2022] Open
Abstract
Combined topical permethrin plus oral ivermectin treats common scabies Patients 55 years or older may be more likely to experience post-scabetic itch Post-scabetic itch may persist for a median of 52.5 days (interquartile range, 28-135)
Background Common scabies can be difficult to diagnose and treat. There are limited data on the clinical characteristics of patients who may benefit from combined topical permethrin plus oral ivermectin. Postscabetic itch is common, but there is scant data describing its prognosis and management. Objective This study describes the clinical characteristics and evaluates treatment outcomes of participants with common scabies treated with combined topical permethrin plus oral ivermectin and describes the prognosis and management of postscabetic itch. Methods We conducted a single-center retrospective cohort study of participants with common scabies treated with combined topical permethrin plus oral ivermectin therapy and topical permethrin only. Participants previously treated with permethrin and/or ivermectin were excluded. The primary outcome was clinical outcome at follow-up, categorized as cure, worsening, or no change. Secondary outcomes included time from treatment initiation to cure, duration of follow-up after cure, recurrence rate, frequency of postscabetic itch, and duration of postscabetic itch. Results Of 55 participants treated with combined topical permethrin plus oral ivermectin, 49 (89%) achieved cure, 5 (9%) had no change, and 1 (2%) had worsening disease. Of 48 participants treated with topical permethrin only, 46 (96%) achieved cure, 2 (4%) had no change, and 0 (0%) had worsening disease. Thirty-five participants (34%) experienced postscabetic itch for 52.5 days (interquartile range, 28–135). More participants in the older (mean: 55 years; standard deviation: 21 years; p = .002) combined treatment group experienced postscabetic itch than in the younger (mean: 42 years; standard deviation: 19 years) permethrin-only treatment group (42% vs. 25%; p = .072). Conclusion These findings support the use of combined topical permethrin plus oral ivermectin therapy in treating common scabies, highlight that postscabetic itch can persist for longer than previously reported, and reveal a potential relationship between older age and postscabetic itch.
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Affiliation(s)
- Le Wen Chiu
- School of Medicine, University of California San Francisco, San Francisco, California
| | - Timothy G Berger
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Aileen Y Chang
- Department of Dermatology, University of California San Francisco, San Francisco, California.,Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
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Cronin M, Berger TG, Cohen SH, Mahadevan U, North JP, Asch S. Cutaneous Chaetomium globosum Infection in a Vedolizumab-Treated Patient. Cutis 2021; 108:E13-E16. [PMID: 34735323 DOI: 10.12788/cutis.0329] [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] [Indexed: 11/20/2022]
Affiliation(s)
- Morgan Cronin
- Dr. Cronin is from the Department of Pediatrics; Dr. Berger is from the Department of Dermatology; Dr. Mahadevan is from the Department of Medicine, Division of Gastroenterology; and Dr. North is from Department Dermatology, all at the University of California, San Francisco. Dr. Cohen is from Division of Infectious Disease, University of California, Davis. Dr. Asch is from the Department of Dermatology, HealthPartners and Park Nicollet Medical Groups, St. Paul, Minnesota
| | - Timothy G Berger
- Dr. Cronin is from the Department of Pediatrics; Dr. Berger is from the Department of Dermatology; Dr. Mahadevan is from the Department of Medicine, Division of Gastroenterology; and Dr. North is from Department Dermatology, all at the University of California, San Francisco. Dr. Cohen is from Division of Infectious Disease, University of California, Davis. Dr. Asch is from the Department of Dermatology, HealthPartners and Park Nicollet Medical Groups, St. Paul, Minnesota
| | - Stuart H Cohen
- Dr. Cronin is from the Department of Pediatrics; Dr. Berger is from the Department of Dermatology; Dr. Mahadevan is from the Department of Medicine, Division of Gastroenterology; and Dr. North is from Department Dermatology, all at the University of California, San Francisco. Dr. Cohen is from Division of Infectious Disease, University of California, Davis. Dr. Asch is from the Department of Dermatology, HealthPartners and Park Nicollet Medical Groups, St. Paul, Minnesota
| | - Uma Mahadevan
- Dr. Cronin is from the Department of Pediatrics; Dr. Berger is from the Department of Dermatology; Dr. Mahadevan is from the Department of Medicine, Division of Gastroenterology; and Dr. North is from Department Dermatology, all at the University of California, San Francisco. Dr. Cohen is from Division of Infectious Disease, University of California, Davis. Dr. Asch is from the Department of Dermatology, HealthPartners and Park Nicollet Medical Groups, St. Paul, Minnesota
| | - Jeffery P North
- Dr. Cronin is from the Department of Pediatrics; Dr. Berger is from the Department of Dermatology; Dr. Mahadevan is from the Department of Medicine, Division of Gastroenterology; and Dr. North is from Department Dermatology, all at the University of California, San Francisco. Dr. Cohen is from Division of Infectious Disease, University of California, Davis. Dr. Asch is from the Department of Dermatology, HealthPartners and Park Nicollet Medical Groups, St. Paul, Minnesota
| | - Sarah Asch
- Dr. Cronin is from the Department of Pediatrics; Dr. Berger is from the Department of Dermatology; Dr. Mahadevan is from the Department of Medicine, Division of Gastroenterology; and Dr. North is from Department Dermatology, all at the University of California, San Francisco. Dr. Cohen is from Division of Infectious Disease, University of California, Davis. Dr. Asch is from the Department of Dermatology, HealthPartners and Park Nicollet Medical Groups, St. Paul, Minnesota
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4
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Crow LD, Perkins I, Twigg AR, Fassett MS, LeBoit PE, Berger TG, Khodosh R. Treatment of PD-1/PD-L1 Inhibitor-Induced Dermatitis Resolves Concomitant Eruptive Keratoacanthomas. JAMA Dermatol 2020; 156:598-600. [PMID: 32211828 DOI: 10.1001/jamadermatol.2020.0176] [Citation(s) in RCA: 4] [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] [Indexed: 11/14/2022]
Affiliation(s)
- Lauren D Crow
- Department of Dermatology, University of California, San Francisco
| | - Ifeoma Perkins
- Department of Pathology and Laboratory Medicine, University of Colorado School of Medicine, Aurora
| | - Amanda R Twigg
- Department of Dermatology, University of California, San Francisco
| | - Marlys S Fassett
- Department of Dermatology, University of California, San Francisco
| | - Philip E LeBoit
- Helen Diller Cancer Center, Department of Pathology and Dermatology, University of California, San Francisco
| | - Timothy G Berger
- Department of Dermatology, University of California, San Francisco
| | - Rita Khodosh
- Department of Dermatology, University of California, San Francisco
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Young AT, Yedidi RS, Raffi J, McCalmont TH, North J, Brinker A, Berger TG, Murase JE. Idiopathic pure sudomotor failure: A review and two cases. Int J Womens Dermatol 2020; 7:276-279. [PMID: 34222583 PMCID: PMC8243128 DOI: 10.1016/j.ijwd.2020.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/04/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 12/04/2022] Open
Abstract
Idiopathic pure sudomotor failure (IPSF) is a rare disease characterized by acquired impairment in total body sweating despite exposure to heat or exercise. Its etiology is unknown but thought to involve defective cholinergic receptors on eccrine sweat glands. This article reviews the epidemiology, pathophysiology, presentation, and management of IPSF. Additionally, we report two cases of IPSF treated with multimodal therapy, including stacked antihistamine regimens and omalizumab, resulting in symptom improvement. This is the first report of treatment of IPSF with omalizumab, although its benefit is uncertain and requires further study.
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Affiliation(s)
- Albert T Young
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Raagini S Yedidi
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Jodie Raffi
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States.,School of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Timothy H McCalmont
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States.,Department of Pathology, University of California, San Francisco, San Francisco, CA, United States
| | - Jeffrey North
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States.,Department of Pathology, University of California, San Francisco, San Francisco, CA, United States
| | - Alyson Brinker
- Naval Medical Center San Diego, San Diego, CA, United States
| | - Timothy G Berger
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Jenny E Murase
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States.,Department of Dermatology, Palo Alto Foundation Medical Group, Mountain View, CA, United States
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6
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Ständer S, Weisshaar E, Berger TG, Korman NJ, Yosipovitch G. 16257 Prevalence of prurigo nodularis in the United States. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.784] [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: 11/27/2022]
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7
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Kim BS, Berger TG, Yosipovitch G. Reply to "Comment on: Chronic pruritus of unknown origin (CPUO): Uniform nomenclature and diagnosis as a pathway to standardized understanding and treatment". J Am Acad Dermatol 2019; 85:e383. [PMID: 31374301 DOI: 10.1016/j.jaad.2019.07.080] [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: 07/17/2019] [Accepted: 07/19/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Brian S Kim
- Center for the Study of Itch, Washington University in St. Louis School of Medicine, St. Louis, Missouri; Division of Dermatology, Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri; Department of Anesthesiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri; Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Timothy G Berger
- Department of Dermatology, University of California, San Francisco
| | - Gil Yosipovitch
- Miami Itch Center, Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida.
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Kim BS, Berger TG, Yosipovitch G. Chronic pruritus of unknown origin (CPUO): Uniform nomenclature and diagnosis as a pathway to standardized understanding and treatment. J Am Acad Dermatol 2019; 81:1223-1224. [PMID: 31238084 DOI: 10.1016/j.jaad.2019.06.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 06/07/2019] [Accepted: 06/11/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Brian S Kim
- Center for the Study of Itch, Washington University School of Medicine in St Louis, St Louis, Missouri; Division of Dermatology, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri; Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri; Department of Pathology and Immunology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Timothy G Berger
- Department of Dermatology, University of California, San Francisco, California
| | - Gil Yosipovitch
- Miami Itch Center, Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida.
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9
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McKesey J, Berger TG, Lim HW, McMichael AJ, Torres A, Pandya AG. Cultural competence for the 21st century dermatologist practicing in the United States. J Am Acad Dermatol 2017; 77:1159-1169. [DOI: 10.1016/j.jaad.2017.07.057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/26/2017] [Accepted: 07/29/2017] [Indexed: 10/18/2022]
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10
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Mirmirani P, Maurer TA, Berger TG, Sands LP, Chren MM. Skin-Related Quality of Life in HIV-Infected Patients on Highly Active Antiretroviral Therapy. J Cutan Med Surg 2016. [DOI: 10.1177/120347540200600102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The overall health status and survival of HIV-infected patients has changed with the advent of highly active antiretroviral therapy (HAART). With this improved survival, there is a greater urgency to study quality-of-life issues. Objective: Our objectives were to measure skin-related quality of life in a cohort of HIV-infected patients and to determine whether the use of highly active antiretroviral therapy is associated with improved skin-related quality of life. Methods: We assembled a retrospective cohort of patients who were seen in our HIV-Dermatology Clinic at San Francisco General Hospital in June, July, or August of 1996. Eligible subjects were contacted by mail and asked (1) to complete a questionnaire (Skindex) and (2) to have a skin exam. Information on medication use and laboratory parameters was also collected. Results: Of 107 eligible patients, 76 (71%) responded to the questionnaire; 60 patients were examined. Many patients had multiple skin conditions. For most diagnoses (except warts and onychomycosis), there were no consistent differences in Skindex scores of HIV-infected patients compared with scores of patients not known to be infected with HIV. Patients on HAART for longer duration had significantly lower Skindex scores (improved skin-related quality of life) compared with those on HAART for a shorter duration. Conclusion: HAART is associated with improved quality of life with regard to HIV-associated skin diseases. Antécédents: L'état de santé général et le taux de survie des patients inféctés par le VIH ont changé grâce à l'avènement de traitements antirétroviraux hautement actifs (HAART). Cette amélioration du taux de survie implique un besoin urgent d'étudier les questions relatives à la qualité de vie. Objectifs: Mesurer la qualité de vie sur le plan dermatologique d'une cohorte de patients infectés par le VIH et déterminer si le recours à un traitement antirétroviral hautement actif est associé à une amélioration de la qualité de vie sur le plan dermatologique. Méthodes: Nous avons rassemblé une cohorte rétrospective de patients qui étaient suivis dans notre clinique de dérmatologie-VIH au San Francisco General Hospital, en juin, juillet ou aoôt de 1996. Nous avons contacté par courrier les sujets admissibles et leur avons demandé (1) de remplir un questionnaire (Skindex) et (2) de se soumettre à un examen dermatologique. Également, nous avons recueilli de l'information sur la consommation des médicaments et les paramètres de laboratoire. Résultats: Parmi les 107 patients admissibles, 76 (71%) ont retourné le questionnaire et 60 ont été examinés. Un grand nombre de patients présentaient multiples affections cutanées. Dans la plupart des diagnostics (sauf pour les verrues et les onychomycoses), les différences sont minimes entre les résultats du Skindex des patients infectés par le VIH et ceux des patients qui ne le seraient pas. Les patients qui ont suivi le traitement HAART pendant une plus longue durée accusent des résultats Skindex sensiblement inférieurs (meilleure qualité de vie sur le plan dermatologique) à ceux des patients ayant suivi un traitement HAART pendant une plus courte durée. Conclusion: Le traitement HAART est associé à une qualité de vie améliorée en ce qui concerne les maladies dermatologiques liées du VIH.
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Affiliation(s)
- Paradi Mirmirani
- Department of Dermatology, University of California, San Francisco, California, USA
| | - Toby A. Maurer
- Department of Dermatology, University of California, San Francisco, California, USA
| | - Timothy G. Berger
- Department of Dermatology, University of California, San Francisco, California, USA
| | - Laura P. Sands
- Department of Dermatology, University of California, San Francisco, California, USA
| | - Mary-Margaret Chren
- Department of Dermatology, University of California, San Francisco, California, USA
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Affiliation(s)
- Vikash S. Oza
- Department of Dermatology, New York University School of Medicine, New York
| | - Rabina Walsh
- Department of Dermatology, University of California, San Francisco
| | - Jeffrey North
- Department of Dermatology, University of California, San Francisco
| | | | - Jenny E. Murase
- Department of Dermatology, University of California, San Francisco3Department of Dermatology, Palo Alto Foundation Medical Group, Mountain View, California
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12
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Lim VM, Do A, Berger TG, Nguyen AH, DeWeese J, Malone JD, Jordan K, Hom F, Tuffanelli L, Fillari P, Siu S, Grossman R. A decade of burn unit experience with Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: Clinical pathological diagnosis and risk factor awareness. Burns 2016; 42:836-43. [PMID: 26847613 DOI: 10.1016/j.burns.2016.01.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 01/06/2016] [Accepted: 01/07/2016] [Indexed: 12/31/2022]
Abstract
Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN) is a rare and often fatal spectrum of mucocutaneous diseases usually attributable to severe adverse drug reactions. Burn units are referral centers for patients at the most extreme end of the disease continuum. Our burn center admits a much higher percentage of TEN (>30% BSA) cases than reported in most prior reviews. The purpose of this study was to analyze the diagnostic and prognostic value of variables collected on referred SJS/TEN patients. We retrospectively analyzed 94 patients admitted to our unit with a presumptive SJS/TEN diagnosis made in most cases by the referring center. Most of the diagnoses were clinical. Fifty of the 94 patients underwent biopsy when the clinical diagnosis was questionable. Of the 50 patients who underwent biopsy, 18 (36%) received an alternative diagnosis. Analysis was therefore limited to 76 patients, i.e. 44 patients felt to have firm clinical diagnoses plus 32 patients with diagnoses confirmed by biopsy. Mean age was 54.3 years (17-93) and overall gender ratio was 43 F vs. 33 M (56.6% vs. 43.4%). Mean LOS was 15.2 days (1-48) and overall mortality was 23.7% (18/76). Univariate analysis revealed percent body surface area (%BSA) did not show statistically significant association with mortality. Histopathological correlation for diagnosis is not standardized across institutions worldwide. Due to challenges in the diagnosis of SJS/TEN and the high incidence of error in clinical diagnosis, it is recommended that all patients with presumed SJS/TEN receive skin biopsies with H&E and direct immunofluorescence. We propose a diagnostic approach in order to address this need. Lack of association between %BSA and mortality suggests that all biopsy-proven SJS/TEN cases belong in specialty centers due to the unstable nature of the disease and risk for rapid progression.
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Affiliation(s)
- Victoria M Lim
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA.
| | - Annie Do
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA
| | - Timothy G Berger
- University of California San Francisco, 1701 Divisadero St, San Francisco, CA 94115, USA
| | - Austin H Nguyen
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA
| | - Jeffrey DeWeese
- Bothin Burn Center, Saint Francis Memorial Hospital, 900 Hyde St, San Francisco, CA 94109, USA
| | - J David Malone
- Bothin Burn Center, Saint Francis Memorial Hospital, 900 Hyde St, San Francisco, CA 94109, USA
| | - Kathleen Jordan
- Bothin Burn Center, Saint Francis Memorial Hospital, 900 Hyde St, San Francisco, CA 94109, USA
| | - Fred Hom
- Bothin Burn Center, Saint Francis Memorial Hospital, 900 Hyde St, San Francisco, CA 94109, USA
| | - Lucia Tuffanelli
- Bothin Burn Center, Saint Francis Memorial Hospital, 900 Hyde St, San Francisco, CA 94109, USA
| | - Paula Fillari
- Bothin Burn Center, Saint Francis Memorial Hospital, 900 Hyde St, San Francisco, CA 94109, USA
| | - Shirley Siu
- Bothin Burn Center, Saint Francis Memorial Hospital, 900 Hyde St, San Francisco, CA 94109, USA
| | - Richard Grossman
- Bothin Burn Center, Saint Francis Memorial Hospital, 900 Hyde St, San Francisco, CA 94109, USA
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13
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Maguiness SM, Farsani TT, Zedek DC, Berger TG. Imiquimod-induced subacute cutaneous lupus erythematosus-like changes. Cutis 2015; 95:349-351. [PMID: 26125212] [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: 06/04/2023]
Abstract
Imiquimod is a topical immunomodulator used to treat genital warts and cutaneous malignancies that exerts its effects via induction of proinflammatory cytokines through activation of toll-like receptor (TLR) 7. Although subacute cutaneous lupus erythematosus (SCLE) has been reported in association with multiple systemic medications, SCLE in patients treated with topical agents has not been widely reported. We report the case of a 50-year-old woman with local induction of lesions that clinically and histologically resembled SCLE following treatment with topical imiquimod.
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Affiliation(s)
| | - Terry T Farsani
- Palo Alto Medical Foundation, 701 E El Camino Real, Mountain View, CA 94306, USA.
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15
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Harp J, Coggshall K, Ruben BS, Ramírez-Valle F, He SY, Berger TG. Cutaneous granulomas in the setting of primary immunodeficiency: a report of four cases and review of the literature. Int J Dermatol 2015; 54:617-25. [PMID: 25773292 DOI: 10.1111/ijd.12765] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 04/10/2014] [Accepted: 05/20/2014] [Indexed: 11/30/2022]
Abstract
IMPORTANCE Cutaneous granulomas without an identifiable infectious etiology are a rare manifestation of primary immunodeficiency (ID). These cutaneous lesions can be misdiagnosed, often as sarcoidosis, when the skin findings precede the diagnosis of immunodeficiency. OBJECTIVE We present four cases from our institution and review the literature in order to emphasize the clinical relevance of this association, discuss the histologic and immunohistochemical features, and explore possible pathogenic mechanisms of granuloma formation. EVIDENCE REVIEW We retrospectively reviewed case reports of all patients presenting with cutaneous granulomas in the setting of primary immunodeficiency. Cases with insufficient information to confirm an immunodeficiency state were excluded. Four patients from our clinic were included, for 54 total cases. FINDINGS The majority of cutaneous granulomas are seen in three types of immunodeficiencies: ataxia-telangiectasia, severe combined immunodeficiency, and combined variable immunodeficiency. Twenty-six percent of patients developed cutaneous granulomas prior to their immunodeficiency diagnosis. Histologically, various granulomatous patterns have been described. Immunohistochemistry revealed a CD4+/CD8+ lymphocyte ratio of less than or equal to 1 in our four patients, which may help differentiate cutaneous granulomas in primary ID from sarcoidal granulomas that typically show a CD4+ predominance. CONCLUSIONS AND RELEVANCE Cutaneous granulomas are a rare manifestation of primary ID and occur predominantly in immunodeficiencies that affect T and B cell compartments.
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Affiliation(s)
- Joanna Harp
- Department of Dermatology, Weill Cornell Medical College, New York, NY, USA
| | - Kathleen Coggshall
- Department of Dermatology, School of Medicine, University of California, San Francisco, CA, USA
| | - Beth S Ruben
- Department of Dermatology, School of Medicine, University of California, San Francisco, CA, USA.,Department of Pathology, School of Medicine, University of California, San Francisco, CA, USA
| | - Francisco Ramírez-Valle
- Department of Dermatology, School of Medicine, University of California, San Francisco, CA, USA
| | - Steven Y He
- Department of Dermatology, School of Medicine, University of California, San Francisco, CA, USA
| | - Timothy G Berger
- Department of Dermatology, School of Medicine, University of California, San Francisco, CA, USA
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Berliner JG, Aldabagh B, Mully T, Yu SS, Schwartz BS, Berger TG. Non-tuberculous mycobacterial infections following cosmetic laser procedures: a case report and review of the literature. J Drugs Dermatol 2015; 14:80-83. [PMID: 25607912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Skin infections are not uncommon after cosmetic laser procedures. Infection rates following ablative laser resurfacing procedures are reported to be as high as 7.6%, compared to 1.9% for fractional ablation. An infrequent yet important infectious complication of ablative laser treatment is that caused by non-tuberculous mycobacteria (NTM).
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17
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Sorenson E, Levin E, Koo J, Berger TG. Successful use of a modified Goeckerman regimen in the treatment of generalized prurigo nodularis. J Am Acad Dermatol 2015; 72:e40-2. [DOI: 10.1016/j.jaad.2014.09.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 09/27/2014] [Accepted: 09/30/2014] [Indexed: 11/26/2022]
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Berliner JG, McCalmont TH, Price VH, Berger TG. Frontal fibrosing alopecia and lichen planus pigmentosus. J Am Acad Dermatol 2014; 71:e26-7. [DOI: 10.1016/j.jaad.2013.12.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 12/10/2013] [Accepted: 12/10/2013] [Indexed: 10/25/2022]
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19
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Sidbury R, Davis DM, Cohen DE, Cordoro KM, Berger TG, Bergman JN, Chamlin SL, Cooper KD, Feldman SR, Hanifin JM, Krol A, Margolis DJ, Paller AS, Schwarzenberger K, Silverman RA, Simpson EL, Tom WL, Williams HC, Elmets CA, Block J, Harrod CG, Begolka WS, Eichenfield LF. Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol 2014; 71:327-49. [PMID: 24813298 DOI: 10.1016/j.jaad.2014.03.030] [Citation(s) in RCA: 525] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/16/2014] [Accepted: 03/17/2014] [Indexed: 11/16/2022]
Abstract
Atopic dermatitis is a chronic, pruritic inflammatory dermatosis that affects up to 25% of children and 2% to 3% of adults. This guideline addresses important clinical questions that arise in atopic dermatitis management and care, providing recommendations based on the available evidence. In this third of 4 sections, treatment of atopic dermatitis with phototherapy and systemic immunomodulators, antimicrobials, and antihistamines is reviewed, including indications for use and the risk-benefit profile of each treatment option.
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Affiliation(s)
- Robert Sidbury
- Department of Dermatology, Seattle Children's Hospital, Seattle, Washington
| | - Dawn M Davis
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - David E Cohen
- Department of Dermatology, New York University School of Medicine, New York, New York
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco, California
| | - Timothy G Berger
- Department of Dermatology, University of California, San Francisco, California
| | - James N Bergman
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah L Chamlin
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kevin D Cooper
- Department of Dermatology, Case Western University, Cleveland, Ohio
| | - Steven R Feldman
- Department of Dermatology, Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Jon M Hanifin
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Alfons Krol
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - David J Margolis
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kathryn Schwarzenberger
- Kaplan-Amonette Department of Dermatology, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Wynnis L Tom
- University of San Diego, San Diego, California; Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California
| | - Hywel C Williams
- Center of Evidence-based Dermatology, Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom
| | - Craig A Elmets
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Julie Block
- National Eczema Association, San Rafael, California
| | | | | | - Lawrence F Eichenfield
- University of San Diego, San Diego, California; Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California
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20
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Sidorsky TI, Christine CW, Epstein JH, Berger TG. Development of corticobasal syndrome in a patient with congenital erythropoietic porphyria. Parkinsonism Relat Disord 2013; 20:349-50. [PMID: 24388147 DOI: 10.1016/j.parkreldis.2013.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 11/01/2013] [Accepted: 12/09/2013] [Indexed: 01/12/2023]
Affiliation(s)
- Tivon I Sidorsky
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Chadwick W Christine
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States.
| | - John H Epstein
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Timothy G Berger
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
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Abstract
IMPORTANCE Pruritus is a common problem among elderly people and, when severe, causes as much discomfort as chronic pain. Little evidence supports pruritus treatment, limiting therapeutic possibilities and resulting in challenging management problems. OBJECTIVES To present the evidence on the etiology, diagnosis, and treatment of pruritus in the elderly and, using the best available evidence, provide an approach for generalist physicians caring for older patients with pruritus. EVIDENCE REVIEW PubMed and EMBASE databases were searched (1946-August 2013).The Cochrane Database of Systematic Reviews and the Agency for Healthcare Research and Quality Systematic Review Data Repository were also searched from their inception to August 2013. References from retrieved articles were evaluated. FINDINGS More than 50% of elderly patients have xerosis (dry skin). Xerosis treatment should be included in the initial therapy for pruritus in all elderly patients. Calcium channel blockers and hydrochlorothiazide are important causes of pruritic skin eruptions in older patients. Neuropathic pruritus is infrequently considered but may cause localized itching (especially in the genital area) and generalized truncal pruritus (especially in patients with diabetes mellitus). Certain skin conditions are more common in elderly patients, including scabies, bullous pemphigoid, transient acantholytic dermatosis, and mycosis fungoides, and should be considered in elderly patients with pruritus. CONCLUSIONS AND RELEVANCE It is important to evaluate elderly patients for dermatological, systemic, and neurological etiologies of itch. A simple-to-apply diagnostic and therapeutic algorithm can be used. Xerosis, drug reactions, and neuropathy should be considered when evaluating pruritus.
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Affiliation(s)
- Timothy G Berger
- Department of Dermatology, University of California, San Francisco
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22
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Kanada KN, Schwartz BS, Pincus LB, Berger TG, Jacobs RA, Shinkai K. A therapeutic trial of antituberculous therapy for suspected lupus vulgaris: How long does it take to see clinical improvement? J Am Acad Dermatol 2013; 69:e252-e254. [PMID: 24124850 DOI: 10.1016/j.jaad.2013.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 06/13/2013] [Accepted: 06/16/2013] [Indexed: 11/19/2022]
Affiliation(s)
| | - Brian S Schwartz
- Division of Infectious Diseases, University of California, San Francisco
| | - Laura B Pincus
- Department of Dermatology, University of California, San Francisco; Department of Pathology, University of California, San Francisco
| | - Timothy G Berger
- Department of Dermatology, University of California, San Francisco
| | - Richard A Jacobs
- Division of Infectious Diseases, University of California, San Francisco
| | - Kanade Shinkai
- Department of Dermatology, University of California, San Francisco.
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Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, Berger TG, Bergman JN, Cohen DE, Cooper KD, Cordoro KM, Davis DM, Krol A, Margolis DJ, Paller AS, Schwarzenberger K, Silverman RA, Williams HC, Elmets CA, Block J, Harrod CG, Smith Begolka W, Sidbury R. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol 2013; 70:338-51. [PMID: 24290431 DOI: 10.1016/j.jaad.2013.10.010] [Citation(s) in RCA: 671] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 10/03/2013] [Accepted: 10/05/2013] [Indexed: 10/26/2022]
Abstract
Atopic dermatitis (AD) is a chronic, pruritic, inflammatory dermatosis that affects up to 25% of children and 2% to 3% of adults. This guideline addresses important clinical questions that arise in the management and care of AD, providing updated and expanded recommendations based on the available evidence. In this first of 4 sections, methods for the diagnosis and monitoring of disease, outcomes measures for assessment, and common clinical associations that affect patients with AD are discussed. Known risk factors for the development of disease are also reviewed.
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Affiliation(s)
- Lawrence F Eichenfield
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, San Diego, California
| | - Wynnis L Tom
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, San Diego, California
| | - Sarah L Chamlin
- Department of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Steven R Feldman
- Department of Dermatology, Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Jon M Hanifin
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Timothy G Berger
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - James N Bergman
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - David E Cohen
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Kevin D Cooper
- Department of Dermatology, Case Western University, Cleveland, Ohio
| | - Kelly M Cordoro
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Dawn M Davis
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Alfons Krol
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - David J Margolis
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Hywel C Williams
- Centre of Evidence-Based Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Craig A Elmets
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Julie Block
- National Eczema Association, San Rafael, California
| | | | | | - Robert Sidbury
- Department of Dermatology, Seattle Children's Hospital, Seattle, Washington
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24
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Kamangar F, Berger TG, Fazel N, Koo JYM. Methotrexate toxicity induced by ciprofloxacin leading to psoriatic plaque ulceration: a case report. Cutis 2013; 92:148-150. [PMID: 24153144] [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: 06/02/2023]
Abstract
We present the case of a 90-year-old woman with psoriasis vulgaris who had been treated with methotrexate for many years. The patient presented with psoriatic plaque ulcerations uniquely limited to the active border as well as acute oral ulcerations and severe gastrointestinal upset after undergoing a course of ciprofloxacin for treatment of a bacterial infection.
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Coggshall K, Farsani T, Ruben B, McCalmont TH, Berger TG, Fox LP, Shinkai K. Keratitis, ichthyosis, and deafness (KID) syndrome: A review of infectious and neoplastic complications. J Am Acad Dermatol 2013; 69:127-34. [DOI: 10.1016/j.jaad.2012.12.965] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 12/12/2012] [Accepted: 12/16/2012] [Indexed: 01/06/2023]
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26
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Heller MM, Wong JW, Lee ES, Ladizinski B, Grau M, Howard JL, Berger TG, Koo JYM, Murase JE. Delusional infestations: clinical presentation, diagnosis and treatment. Int J Dermatol 2013; 52:775-83. [DOI: 10.1111/ijd.12067] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Jillian W. Wong
- University of Utah School of Medicine; Salt Lake City; UT; USA
| | - Eric S. Lee
- Department of Dermatology; University of Miami; Miami; FL; USA
| | | | - Manuel Grau
- Department of Dermatology; Hospital 9 de Octubre; Valencia; Spain
| | | | - Timothy G. Berger
- Department of Dermatology; University of California San Francisco; San Francisco; CA; USA
| | - John Y. M. Koo
- Department of Dermatology; University of California San Francisco; San Francisco; CA; USA
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27
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Cipriano SD, Dybbro E, Boscardin CK, Shinkai K, Berger TG. Online learning in a dermatology clerkship: piloting the new American Academy of Dermatology Medical Student Core Curriculum. J Am Acad Dermatol 2013; 69:267-72. [PMID: 23683728 DOI: 10.1016/j.jaad.2013.04.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 04/03/2013] [Accepted: 04/07/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Multiple studies have shown that both current and future primary care providers have insufficient education and training in dermatology. To address the limitations and wide variability in medical student dermatology instruction, the American Academy of Dermatology (AAD) created a standardized, online curriculum for both dermatology learners and educators. OBJECTIVE We sought to determine the impact of the integration of the AAD online curriculum into a 2-week introductory dermatology clerkship for fourth-year medical students. METHODS In addition to their clinical duties, we assigned 18 online modules at a rate of 1 to 3 per day. We evaluated knowledge acquisition using a 50-item, multiple-choice pretest and posttest. Postmodule and end-of-course questionnaires contained both closed and open-ended items soliciting students' perceptions about usability and satisfaction. RESULTS All 51 participants significantly improved in their dermatology knowledge (P < .001). The majority of students found the modules easy to navigate (95%) and worth their time (93%). All respondents supported the continuation of the modules as part of the dermatology clerkship. LIMITATIONS Without a control group who did not experience the online curriculum, we are unable to isolate the specific impact of the online modules on students' learning. CONCLUSION This study demonstrates the successful integration of this educational resource into a 2-week, university-based dermatology clerkship. Students' perceptions regarding usability and satisfaction were overwhelmingly positive, suggesting that the online curriculum is highly acceptable to learners. Widespread use of this curriculum may be a significant advancement in standardized dermatology learning for medical students.
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Affiliation(s)
- Sarah D Cipriano
- Department of Dermatology, University of Utah, Salt Lake City, Utah, USA
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28
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Connolly SM, Baker DR, Coldiron BM, Fazio MJ, Storrs PA, Vidimos AT, Zalla MJ, Brewer JD, Smith Begolka W, Berger TG, Bigby M, Bolognia JL, Brodland DG, Collins S, Cronin TA, Dahl MV, Grant-Kels JM, Hanke CW, Hruza GJ, James WD, Lober CW, McBurney EI, Norton SA, Roenigk RK, Wheeland RG, Wisco OJ. AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: A report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery. J Am Acad Dermatol 2012; 67:531-50. [DOI: 10.1016/j.jaad.2012.06.009] [Citation(s) in RCA: 224] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 06/07/2012] [Accepted: 06/12/2012] [Indexed: 10/27/2022]
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29
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Connolly SM, Baker DR, Coldiron BM, Fazio MJ, Storrs PA, Vidimos AT, Zalla MJ, Brewer JD, Begolka WS, Berger TG, Bigby M, Bolognia JL, Brodland DG, Collins S, Cronin TA, Dahl MV, Grant-Kels JM, Hanke CW, Hruza GJ, James WD, Lober CW, McBurney EI, Norton SA, Roenigk RK, Wheeland RG, Wisco OJ. AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: a report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery. Dermatol Surg 2012; 38:1582-603. [PMID: 22958088 DOI: 10.1111/j.1524-4725.2012.02574.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The appropriate use criteria process synthesizes evidence-based medicine, clinical practice experience, and expert judgment. The American Academy of Dermatology in collaboration with the American College of Mohs Surgery, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery has developed appropriate use criteria for 270 scenarios for which Mohs micrographic surgery (MMS) is frequently considered based on tumor and patient characteristics. This document reflects the rating of appropriateness of MMS for each of these clinical scenarios by a ratings panel in a process based on the appropriateness method developed by the RAND Corp (Santa Monica, CA)/University of California-Los Angeles (RAND/UCLA). At the conclusion of the rating process, consensus was reached for all 270 (100%) scenarios by the Ratings Panel, with 200 (74.07%) deemed as appropriate, 24 (8.89%) as uncertain, and 46 (17.04%) as inappropriate. For the 69 basal cell carcinoma scenarios, 53 were deemed appropriate, 6 uncertain, and 10 inappropriate. For the 143 squamous cell carcinoma scenarios, 102 were deemed appropriate, 7 uncertain, and 34 inappropriate. For the 12 lentigo maligna and melanoma in situ scenarios, 10 were deemed appropriate, 2 uncertain, and 0 inappropriate. For the 46 rare cutaneous malignancies scenarios, 35 were deemed appropriate, 9 uncertain, and 2 inappropriate. These appropriate use criteria have the potential to impact health care delivery, reimbursement policy, and physician decision making on patient selection for MMS, and aim to optimize the use of MMS for scenarios in which the expected clinical benefit is anticipated to be the greatest. In addition, recognition of those scenarios rated as uncertain facilitates an understanding of areas that would benefit from further research. Each clinical scenario identified in this document is crafted for the average patient and not the exception. Thus, the ultimate decision regarding the appropriateness of MMS should be determined by the expertise and clinical experience of the physician.
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Affiliation(s)
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- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
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30
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Chong TA, Hansra NK, Ruben BS, Berger TG. Diverticulitis: an inciting factor in erythema nodosum. J Am Acad Dermatol 2012; 67:e60-2. [PMID: 22703921 DOI: 10.1016/j.jaad.2011.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 08/13/2011] [Accepted: 08/21/2011] [Indexed: 11/30/2022]
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31
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Broussard KC, Berger TG, Rosenblum M, Murase JE. Erosive pustular dermatosis of the scalp: A review with a focus on dapsone therapy. J Am Acad Dermatol 2012; 66:680-6. [DOI: 10.1016/j.jaad.2011.10.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 10/05/2011] [Accepted: 10/09/2011] [Indexed: 11/17/2022]
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Abstract
Patients with renal failure, usually end-stage renal disease (ESRD), commonly are afflicted by severe pruritus. The pathogenesis of ESRD pruritus is unknown, but improving the quality of dialysis can reduce the prevalence and severity of ESRD pruritus. Topical and systemic agents as well as broadband ultraviolet phototherapy can be extremely beneficial. Gabapentin has been recently discovered as an effective agent for the patient with ESRD pruritus. Kappa opiate agonists are promising new therapeutic options.
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Affiliation(s)
- Timothy G Berger
- Department of Dermatology, University of California San Francisco, San Francisco, CA 94143, USA.
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33
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Abstract
Atopic dermatitis is a common, pruritic, inflammatory skin disorder. Chronic, localized, or even generalized pruritus is the diagnostic hallmark of atopic dermatitis, and its management remains a challenge for physicians. The threshold for itch and alloknesis is markedly reduced in these patients, and infections can promote exacerbation and thereby increase the itch. Modern management consists of anti-inflammatory, occasionally antiseptic, as well as antipruritic therapies to address the epidermal barrier as well as immunomodulation or infection. Mild forms of atopic dermatitis may be controlled with topical therapies, but moderate-to-severe forms often require a combination of systemic treatments consisting of antipruritic and immunosuppressive drugs, phototherapy, and topical compounds. In addition, patient education and a therapeutic regimen to help the patient cope with the itch and eczema are important adjuvant strategies for optimized long-term management. This review highlights various topical, systemic, and complementary and alternative therapies, as well as provide a therapeutic ladder for optimized long-term control of itch in atopic dermatitis.
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Affiliation(s)
- Judith Hong
- Department of Dermatology, University of California San Francisco, San Francisco, CA 94143, USA
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34
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Abstract
Pruritus (itch) is a major symptom in many dermatologic as well as systemic diseases and has a dramatic impact on the quality of life in these patients. The symptom of itch has to be treated on the basis of its pathophysiology and its underlying disease. In daily practice, a "quick" diagnosis of the underlying disease is often difficult, although a rapid relief of the itch is desired. We often treat patients on the basis of the symptomatology. A rational therapeutic ladder for a symptomatic therapy is useful until the final diagnosis has been confirmed. There are probably many subtypes of pruritus, just as there are many diseases that cause itch. The pathophysiology in many subtypes of pruritus is still poorly understood, hindering a rapid and targeted treatment strategy. An extensive diagnostic workup is often required to determine the final cause(s) of the itch. Thus, in daily life, physicians often start with a more or less rational therapeutic strategy to combat the debilitating itch. We present possible therapeutic ladders that form the basis for effective therapeutic itch strategies in various diseases. On the basis of our current knowledge about the different pathophysiologies of itch, on clinical trials or case reports, and our own clinical experience, we aim to present therapeutic ladders for the rapid as well as long-term management of itch. Finally, we summarize current exciting developments of experimental strategies in itch research and in clinical development for itch therapy.
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Affiliation(s)
- Martin Steinhoff
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA.
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35
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Scharschmidt TC, Yost JM, Truong SV, Steinhoff M, Wang KC, Berger TG. Neurogenic rosacea: a distinct clinical subtype requiring a modified approach to treatment. ACTA ACUST UNITED AC 2011; 147:123-6. [PMID: 21242409 DOI: 10.1001/archdermatol.2010.413] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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36
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Ceric-Dehdari P, Houcinat Y, Berger TG. [Disseminated papules in a patient with acute myeloid leukemia]. Hautarzt 2010; 61:980-4. [PMID: 20927503 DOI: 10.1007/s00105-010-2048-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cryptococcosis most commonly occurs in immunosuppressed patients. The pathogen is the yeast Cryptococcus neoformans. This article reports on the case of a 20-year-old female patient with acute myeloid leukemia who suddenly developed disseminated livid red papules and papulovesicles. The clinical picture and in particular the histopathology findings led to the diagnosis of cutaneous cryptococcosis, which was successfully treated with amphotericin B. For the differential diagnosis generalized herpes zoster, erythema exudativum multiforme and disseminated molluscum contagiosum must be considered. To confirm the diagnosis attempts can also be made to culture the pathogen from skin biopsy preparations. Furthermore, fungal spores can be rapidly and simply detected with the Tzanck test.
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Affiliation(s)
- P Ceric-Dehdari
- Department of Dermatology, Tawam Hospital in affiliation with Johns Hopkins Medicine, Al Ain
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37
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Towersey L, Cunha MXD, Feldman CA, Castro CGCD, Berger TG. Dermoscopy of Norwegian scabies in a patient with acquired immunodeficiency syndrome. An Bras Dermatol 2010; 85:221-3. [PMID: 20520938 DOI: 10.1590/s0365-05962010000200013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Accepted: 10/30/2008] [Indexed: 11/22/2022] Open
Abstract
The authors report here on the case of a female patient with Norwegian (crusted) scabies and acquired immunodeficiency syndrome whose compliance with antiretroviral therapy was poor. Definitive diagnosis was confirmed by direct microscopic examination, which revealed numerous Sarcoptes scabei. Dermoscopy showed pathognomonic scabetic burrows and brownish structures in the shape of a hand-glider with a millipede-like appearance. The latter constitutes a diagnostic feature in the pathology of Norwegian scabies that has not yet been described. The patient responded well to oral ivermectin and topical vaseline with sulphur at a proportion of 10%. There was a simultaneous improvement in dermoscopic parameters.
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Affiliation(s)
- Loan Towersey
- Departamento de Dermatologia, Universidade da Califórnia, San Francisco, USA.
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38
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Abstract
Pruritus remains a significant problem facing dermatologists and can be associated with various dermatoses and systemic derangements. At times, one can treat the underlying cutaneous or systemic process to alleviate itch. However, it is frequently challenging to identify the cause of a patient's itch and, in this situation, even more difficult to manage the symptom effectively. In this article, the authors discuss the approach to a patient with generalized pruritus without clinically obvious dermatoses. They also addresses mechanisms and management modalities of itch in common systemic diseases, including cholestasis, uremia, and neuropathic dysfunction.
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Affiliation(s)
- Jamison D Feramisco
- Department of Dermatology, University of California at San Francisco, 1701 Divisadero Street, 3rd floor, San Francisco, CA 94115, USA
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Murase JE, Koo JY, Berger TG. Narrowband ultraviolet B phototherapy influences serum folate levels in patients with vitiligo. J Am Acad Dermatol 2010; 62:710-1. [DOI: 10.1016/j.jaad.2009.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 10/04/2009] [Accepted: 10/08/2009] [Indexed: 11/29/2022]
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Truong SV, Chang LC, Berger TG. Bisphosphonate-related osteonecrosis of the jaw presenting as a cutaneous dental sinus tract: A case report and review of the literature. J Am Acad Dermatol 2010; 62:672-6. [DOI: 10.1016/j.jaad.2008.09.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 09/03/2008] [Accepted: 09/21/2008] [Indexed: 10/19/2022]
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Pincus LB, Schwartz BS, Cunningham G, Saeed S, Berger TG. Cutaneous phaeohyphomycosis caused by Cladophialophora bantiana in a scar after treatment with intralesional corticosteroid injections. J Am Acad Dermatol 2009; 61:537-8. [PMID: 19700025 DOI: 10.1016/j.jaad.2008.11.908] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 11/05/2008] [Accepted: 11/07/2008] [Indexed: 11/30/2022]
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Hansra NK, O'Sullivan P, Chen CL, Berger TG. Medical school dermatology curriculum: are we adequately preparing primary care physicians? J Am Acad Dermatol 2009; 61:23-29.e1. [PMID: 19409656 DOI: 10.1016/j.jaad.2008.11.912] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 11/15/2008] [Accepted: 11/21/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is a lack of information regarding the dermatology learning needs of primary care physicians and residents. OBJECTIVE To determine dermatologic topics that primary care physicians consider important and to determine primary care residents' ratings of the teaching adequacy of these topics in the undergraduate medical curriculum. METHODS Primary care physicians and residents were surveyed regarding the importance and teaching adequacy of 17 dermatologic content areas. RESULTS Ninety-two primary care physicians identified 13 dermatologic content areas important for their practices. Two hundred fifty-two primary care residents identified 8 adequately taught topics and 9 inadequately taught topics. LIMITATIONS Internal medicine and family medicine physicians and residents from only 10 regions were surveyed. CONCLUSION Seventeen content areas can be divided into 3 categories: dermatologic topics that are important and adequately taught, topics that are unimportant, and a group of important, yet inadequately taught content areas. This latter group should be further integrated into dermatology curricula at U.S. medical schools.
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Affiliation(s)
- Nina K Hansra
- Department of Dermatology, University of California-San Francisco, 1701 Divisadero St. 340, San Francisco, CA 94143-0316, USA
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43
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Sander CS, Salman N, van Geel M, Broers JLV, Al-Rahmani A, Chedid F, Hausser I, Oji V, Al Nuaimi K, Berger TG, Verstraeten VLRM. A newly identified splice site mutation in ZMPSTE24 causes restrictive dermopathy in the Middle East. Br J Dermatol 2008; 159:961-7. [PMID: 18671782 DOI: 10.1111/j.1365-2133.2008.08772.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Restrictive dermopathy (RD) is a severe neonatal inherited skin syndrome of which children die shortly after birth. Clinical features include intrauterine growth retardation, taut translucent and easily eroded skin, multiple joint ankylosis and distinct facial features. RD is usually caused by homozygous or compound heterozygous mutations in ZMPSTE24, predicted to cause loss of function of the encoded zinc metalloproteinase STE24. ZMPSTE24 is essential for the processing of the nuclear intermediate filament protein prelamin A. We report two distantly related children from the United Arab Emirates with RD. Remarkably, they lived up to 2 months, suggesting some residual function of the mutant protein. We sought to confirm the diagnosis by thorough microscopic analysis of patient skin, to identify the causative mutation and to study its functional consequences. A skin biopsy was obtained and processed for light and electron microscopy. Peripheral blood leucocytes were used for DNA and RNA isolation, and detection of prelamin A by immunofluorescence. Analysis of the skin confirmed the earlier reported densely packed collagen bundles and lack of elastin fibres. In both patients a homozygous splice site mutation c.627+1G>C in ZMPSTE24 was identified. Analysis of the ZMPSTE24 mRNA revealed an in-frame exon 5 skipping. Accumulation of prelamin A could be detected at the nuclear envelope of patient blood lymphocytes. We thus report the first splice site mutation in ZMPSTE24, which is likely to be a founder mutation in the United Arab Emirates. The accumulation of prelamin A at the nuclear periphery is consistent with defective ZMPSTE24 function. Interestingly, a regular blood sample can be used to investigate prelamin A accumulation.
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Affiliation(s)
- C S Sander
- Department of Dermatology, Tawam Hospital in Affiliation with John Hopkins medicine, PO Box 15258, Al Ain, United Arab Emirates
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Affiliation(s)
- Nina K. Hansra
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Timothy G. Berger
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Patricia O'Sullivan
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Eva H. Chittenden
- Department of Medicine, University of California, San Francisco, San Francisco, California
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45
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Berger TG, Duvic M, Van Voorhees AS, VanBeek MJ, Frieden IJ. The use of topical calcineurin inhibitors in dermatology: safety concerns. Report of the American Academy of Dermatology Association Task Force. J Am Acad Dermatol 2006; 54:818-23. [PMID: 16635663 DOI: 10.1016/j.jaad.2006.01.054] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Revised: 01/25/2006] [Accepted: 01/25/2006] [Indexed: 11/16/2022]
Affiliation(s)
- Timothy G Berger
- Department of Dermatology, University of California, San Francisco, California, USA.
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46
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Berger TG, Kiesewetter F, Maczek C, Bauer N, Lueftl M, Schuler G, Simon M. Psoriasis confined strictly to vitiligo areas - a Koebner-like phenomenon? J Eur Acad Dermatol Venereol 2006; 20:178-83. [PMID: 16441627 DOI: 10.1111/j.1468-3083.2006.01354.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Vitiligo and psoriasis are both common skin disorders. However, psoriasis strictly confined to pre-existing vitiligo areas is rare and suggests a causal relationship. We report here on two patients with a strict anatomical colocalization of vitiligo and psoriasis. The histopathological examinations showed typical changes for both diseases together with a dense infiltrate of CD4+ and CD8+ T cells. By immunohistochemistry, intracytoplasmatic granzyme B and tumour necrosis factor alpha (TNF-alpha) were detected within the T-cell population, suggesting the functional activity of these cells and the creation of a local T helper 1 (Th1)-cytokine milieu. Additionally, in one patient we could identify anti-melanocytic T cells by tetramer staining and enzyme-linked immunospot (ELISPOT) analysis. These skin-infiltrating lymphocytes might trigger, by the local production of Th-1 cytokines such as TNF-alpha and interferon-gamma (IFN-gamma), the eruption of psoriatic plaques in patients with a genetic predisposition for psoriasis.
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Affiliation(s)
- T G Berger
- Department of Dermatology, University Hospital of Erlangen, Erlangen, Germany.
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47
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Wilkins K, Turner R, Dolev JC, LeBoit PE, Berger TG, Maurer TA. Cutaneous malignancy and human immunodeficiency virus disease. J Am Acad Dermatol 2006; 54:189-206; quiz 207-10. [PMID: 16443048 DOI: 10.1016/j.jaad.2004.11.060] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2004] [Revised: 11/22/2004] [Accepted: 11/22/2004] [Indexed: 12/21/2022]
Abstract
UNLABELLED Certain skin cancers occur with increased frequency or altered course in patients infected with HIV. Malignant melanoma and squamous cell carcinoma are examples of cutaneous malignancies that have a more aggressive course in patients with HIV. Others, such as basal cell carcinoma, appear more frequently in this population but do not appear to be more aggressive. The incidence of HIV-associated Kapsosi's sarcoma has markedly decreased since the advent of HIV antiretroviral therapy. Our understanding of the pathogenesis of this malignancy and its unique management issues are fully reviewed. Cutaneous T-cell lymphoma (CTCL) is rare in this population. Other types of cutaneous lymphoma and HIV-associated pseudo-CTCL are discussed. This article addresses prevention, treatment, and follow-up strategies for this at-risk population. LEARNING OBJECTIVE At the completion of this learning activity, participants should be familiar with the unique epidemiology, clinical course, and management of cutaneous malignancy in patients infected with HIV.
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MESH Headings
- Algorithms
- Animals
- Anti-Retroviral Agents/administration & dosage
- Anus Neoplasms/epidemiology
- Anus Neoplasms/pathology
- Carcinoma, Basal Cell/epidemiology
- Carcinoma, Squamous Cell/epidemiology
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/therapy
- HIV Infections/drug therapy
- HIV Infections/epidemiology
- Herpesviridae Infections/epidemiology
- Herpesvirus 8, Human/isolation & purification
- Humans
- Immunity, Cellular
- Immunohistochemistry
- Lymphoma, Large-Cell, Anaplastic/epidemiology
- Lymphoma, T-Cell, Cutaneous/epidemiology
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/pathology
- Melanoma/epidemiology
- Melanoma/therapy
- Papillomaviridae
- Papillomavirus Infections/epidemiology
- Risk Factors
- Sarcoma, Kaposi/drug therapy
- Sarcoma, Kaposi/epidemiology
- Seroepidemiologic Studies
- Skin Neoplasms/epidemiology
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Affiliation(s)
- Karl Wilkins
- Department of Dermatology, University of California-San Francisco, California, USA.
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48
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Yu SS, Connolly MK, Berger TG, McCalmont TH. Dermatitis herpetiformis associated with administration of a gonadotropin-releasing hormone analog. J Am Acad Dermatol 2006; 54:S58-9. [PMID: 16428002 DOI: 10.1016/j.jaad.2005.08.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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49
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Affiliation(s)
- B Alexander Yi
- Department of Dermatology, University of California, San Francisco, USA
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50
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Abstract
Patients infected with human immunodeficiency virus (HIV) have an increased risk of developing skin cancers. These at-risk patients may have atypical presentations and/or altered clinical courses. This article will review and discuss management issues for the following malignancies: lymphomas, malignant melanoma, basal cell carcinoma, squamous cell carcinoma, and Kaposi's sarcoma.
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