DMSO: an aid to combat pain and pruritus.

Dimethyl sulfoxide (DMSO) is a highly reactive by-product of paper production in the form of an odorless, colorless liquid that has been studied since the 1860s. Initially it was utilized as a solvent, but more recently it is being investigated for therapeutic applications. Owing to its versatility, the use of DMSO has been proposed in many different medical fields for a variety of applications, with possibly the widest use being in the field of dermatology. The clinical interest in the use of DMSO for dermatology conditions stems from this solution's efficacy as a vehicle to deliver pharmacological agents across the stratum corneum and its ability to penetrate biological membranes. Currently there is only one FDA approval for the use of DMSO, and it is not in the dermatologic field but rather for interstitial cystitis. Outside of the FDA scope of usage, DMSO is used frequently to treat osteoarthritis in humans and animals, as well as other chronic pain conditions. This suggests the possible utility of DMSO being applicable to other inflammatory conditions such as pruritus. Further research is necessary to explore the promising utilization opportunities of DMSO in dermatology.

Sunscreen regulations and use of anti-inflammatory agents in sunscreens.

The Food and Drug Administration (FDA) has been more proactive in regulating sunscreen products. In 2011, the FDA publicized a set of new requirements for marketing over-the-counter sunscreens in the United States. The primary goal of the new FDA requirements was to provide consumers with a clear understanding of the level of protection actually provided by a sunscreen. Furthermore, information about protection against ultraviolet A radiation, associated with early aging and skin cancer, was to be clarified. With the new regulations, sunscreen products that provide protection against ultraviolet A and ultraviolet B would be allowed to be marketed as broad-spectrum sunscreen [1].

The dangers of human papillomavirus (HPV) laser plume and best safety practices.

Human papillomavirus (HPV) remains to be one of the most common viruses that afflicts the skin and mucosa. Direct contact with cutaneous lesions facilitates a majority of viral transmission. However, the development of laser therapy as treatment for HPV brought to attention the concern of infectious laser plume and the risk it poses to those inhaling it. We conducted a literature review using English articles in PubMed to validate this risk and propose the best safety practices dermatologists can apply when using laser therapy as treatment for HPV. Our investigation identified smoke evacuators as primary modes of mitigation, and we suggest further studies will aid in the refinement of best practice recommendations.

The risk of metastases from squamous cell carcinoma of the skin.

Cutaneous squamous cell carcinoma (cSCC) is the second most common nonmelanoma skin cancer, accounting for 20% of all skin cancers. The risk of the disease continues to rise annually with an estimated 50-200% increase in incidence within the last three decades. Although cSCC is one of the most common skin cancers, reported having 1 million cases per year in the United States, there is inconsistency with its reported metastatic rate. Research exploring cSCC metastasis found an overall rate of 1.2-5% but this range varies, and some dermatologists are finding cSCC's ability to spread more worrisome. This allows for clinical variation in the appropriate treatments and follow-up guidelines when diagnosing a patient with cSCC. Poor prognosis in patients with a high metastatic potential makes cSCC clinically problematic. Clinician emphasis should be put on risk factors, anatomical site, tumor presentation, and histological features when evaluating cSCC's metastatic potential. In this review, specific skin conditions that predispose to cSCC and discrepancies in its reported metastatic potential will be discussed.

Cryosurgical treatment of warts: dimethyl ether and propane versus liquid nitrogen - case report and review of the literature.

For years, dermatologists have relied on cryotherapy with liquid nitrogen as a safe and effective treatment for warts. More recently, several over-the-counter (OTC) wart-freezing therapies have become available. Manufacturers have substituted liquid nitrogen with dimethyl ether and propane (DMEP), and marketed these new preparations to be safe and effective alternatives to in-office cryotherapy with liquid nitrogen. However, data from in vitro studies and comparative studies in humans refute manufacturers' claims that these products reproduce in-office cryotherapy.

Pain and Pruritus: a study of their similarities and differences.

Pruritus is one of the most common dermatologic complaints and, as the most common dermatologic symptom, is a major contributor to frequent dermatology visits. Chronic pruritus mirrors another major medical condition faced by millions of Americans each year - chronic pain. In older literature, pain and pruritus were thought to have been conveyed by the same C fiber, and the proportion contributing to pruritus was just a small subset of this general fiber. Overall, pain and pruritus share many integral similarities. Although these sensations both initiate the body's awareness to injury, pain and itch may have evolved for sensing different damages such as a burrowing parasite or a noxious stimulus, respectively. This seems to have been validated through analyses of their pathophysiology, acute and chronic conditions, and treatment modalities. However, their symptoms and intrinsic mechanisms vary considerably. It is important to view pruritus in more of an overall, whole body experience, rather than just the sensory aspect. Future studies should investigate the psychological treatment of chronic pruritus, considering the immense similarities with its chronic pain counterpart.

A case of sexually induced episodic urticaria.

A 33-year-old male experienced three episodes of urticaria precipitated by exposure to a hidden source of ampicillin. Each occurrence coincided temporally with his girlfriend taking ampicillin for a chest cold and/or allergies. We postulate that he was exposed to ampicillin in the body fluids of his sexual partner.

Use of a keratolytic agent with occlusion for topical treatment of hyperkeratotic seborrheic keratoses.

BACKGROUND: Seborrheic keratoses are the most common benign tumors in adults. Despite their negative cosmetic appearance, no topical treatment is commonly recommended for these lesions. OBJECTIVE: Our objective was to assess whether clinical benefit could be achieved by using a keratolytic topical agent and superficial scraping for this condition. METHODS: A topical 50% urea-containing product under occlusion was applied daily to large and/or thick hyperkeratotic seborrheic keratoses on the truck and extremities. The patients were instructed to digitally scrape the surface of the lesions in an attempt to reduce the thickness of the lesions. RESULTS: In a pilot nonrandomized open-label survey, patients expressed satisfaction with using this topical therapeutic technique. CONCLUSIONS: Hyperkeratotic seborrheic keratoses can be satisfactorily managed with topical agents and scraping with reasonable patient satisfaction. Further studies with various keratolytic agents using other delivery systems are warranted.

Another threat to the availability of isotretinoin: ocular side effects have aviation authorities considering restricting use from (even potential) pilots.

Current concerns about persistent visual abnormalities after the use of isotretinoin may lead the Federal Aviation Administration to further restrict its use in pilots or future pilots.

Expanding the microcomedone theory and acne therapeutics: Propionibacterium acnes biofilm produces biological glue that holds corneocytes together to form plug.

The Propionibacterium acnes biofilm has previously been shown to exist via genomic studies and to make a biological glue which allows for adherence to follicular walls. This gylcocalyx polymer secreted by P acnes also finds its way into sebum composition where it causes the adhesiveness of keratinocytes leading to comedones. An appreciation of P acnes biofilms and secretions has implications in immunogenicity of the organism, clinical course of acne, and therapy for comedonal and inflammatory acne.

Fomite transmission in head lice.

Control of various infestations requires an accurate understanding of transmission. After thousands of years of lice infestation, scientific documentation of indirect contact transmission has been substantiated. Lice can be transferred in the egg, instar, and adult stages. Lice have now been shown in the laboratory to be readily dislodged by air movements such as blow-drying one's hair, combing, and toweling. Moreover, passive transfer to adjoining fabric is also frequently observed. Louse transmission by fomites occurs more frequently than has been commonly believed. Close proximity suffices to increase the likeliness of a new infestation. Thus louse control measures should take account of fomite transmission and include screening of all individuals within an infested person's immediate circle of contact, laundering of everything within the infested individuals' bed or quarantining of such material for 10 days, thorough vacuuming of floors, carpets, upholstery, with a standard vacuum cleaner.

An in vitro study comparing temperatures of over-the-counter wart preparations with liquid nitrogen.

BACKGROUND: Over-the-counter (OTC) wart-freezing therapies have appeared on the market claiming that they reproduce in-office cryotherapy. OBJECTIVE: We sought to determine whether these OTC home wart removal products are as cold as liquid nitrogen. METHODS: The coldness obtained by 3 representative commercial wart products, and liquid nitrogen, was assessed using a thermometer calibrated from -100 degrees C to 50 degrees C. Temperatures of the commercial wart products used were measured and compared with those obtained with liquid nitrogen. RESULTS: None of the OTC coolants were as cold as liquid nitrogen, and they did not lower temperature as quickly as liquid nitrogen. LIMITATIONS: This study did not evaluate the clinical efficacy of any of the agents studied. CONCLUSIONS: Despite advertising messages, OTC refrigerants do not achieve freezing equivalent to liquid nitrogen.

Recent immunologic considerations regarding the itch and treatment of scabies.

Scabies continues to be a major public health problem. Recent findings reveal that these mites produce substances that modulate the host's immune response resulting in the latency period prior to symptoms. In terms of treatment, two cases of ivermectin resistance have come to fore in Australia in patients treated over fifty times with the agent. Additionally, work in the development of vaccination of hosts with antigenic midgut proteins of mites to control ectoparasitic infestations continues.

Head lice: scientific assessment of the nit sheath with clinical ramifications and therapeutic options.

Head lice, like many insects, produce a protective coating for their newly laid eggs that is essential to the survival of the species. Knowledge of the composition of the sheath, which is the glue by which the egg is attached to human hair, and the nit laying process could lead to production of agents that could be used to attack louse infestations by interfering with the normally protected environment of nymph development within the egg. The physical removal of nits has become an important part of treatment of head louse infestations given the "no-nit" policy in schools. Biochemical analysis has revealed that the nit sheath of the head louse is composed of 4 bands of protein, possibly cross-linked to aliphatic components with a tertiary structure of beta sheeting. Nature has protected the louse by making the nit sheath similar in composition to the hair; thereby, agents designed to unravel the nit sheath may also damage human hair. Possible targets to destroy the nit sheath include proteases, denaturants, beta sheet breaker proteins, and small protein inhibitors of sheath formation. Better understanding of insect glues may allow us to develop compounds so that the liquid secretions of the collateral glands of the female louse, which becomes the nit sheath, do not solidify by oxidation when placed with the louse egg onto human hair. Knowledge of insect behavior, such as oviposition, may also suggest methods for repelling female lice from laying eggs onto hair. Alternatively, agents that coat the nits and restrict the oxygen transfer to the developing larvae may prove beneficial.

Herpes acquisition and transmission.

Present dogma is based on herpesviruses (HSV-1 and HSV-2) residing only in the dorsal root ganglion and laying dormant unless reactivated. Polymerase chain reaction has improved specificity and sensitivity so that tenets based on previous methodologies can be questioned. On point, negative serology, such as with anti-glycoprotein G protein antibodies for HSV-1 and HSV-2, does not rule out the presence of herpes. Indeed, exposure to the virus is probably universal, with individuals displaying varied immunological responses to the herpesviruses. There is a bimodal temporal distribution of herpetic reactivation, explained by the existence of the virus in the epidermis as well as in the dorsal root ganglion. Additionally, herpes may share a symbiotic relationship with humans, in which the body actually retains the virus within numerous body organs for its possible anti-cancer properties.

Airborne contact dermatitis: common causes in the USA.

Airborne contact dermatitis (ABCD) is an inflammatory reaction involving the skin upon exposure to allergenic agents or irritants suspended in air. In allergic ABCD, the hypersensitivity is classified as a type IV reaction. Substances responsible for such reactions can be of plant or non-plant origin. Commonly reported plants include those of the Compositae family, which includes ragweed, goldenrod, and sunflowers. Establishing an accurate diagnosis is critical for preventing exposure and improving symptoms in patients. Obtaining a detailed history and performing a physical examination to determine the sites of involvement, as well as patch testing to establish the causative allergen, are the main methods of arriving at the correct diagnosis. Treatment often involves avoidance of the allergens or irritants when possible and may also include the application of topical barrier creams or systemic therapy in more severe cases. This article reviews the topic of ABCD and highlights its most common etiologies in the USA.