RESUMO
Atypical fibroxanthoma is a rare cutaneous malignancy that usually presents as a rapidly growing red papule on the head and neck in elderly white males. Several variants have been described. We report a patient who presented with a slowly enlarging pigmented lesion on his left ear that was clinically worrisome for malignant melanoma. Histopathologic evaluation with immunohistochemistry revealed an unusual case of hemosiderotic pigmented atypical fibroxanthoma. The tumor was successfully extirpated with Mohs micrographic surgery, with no recurrence at 6-month follow-up.
Assuntos
Hemocromatose , Melanoma , Neoplasias Cutâneas , Masculino , Humanos , Idoso , Neoplasias Cutâneas/patologia , Melanoma/patologia , Imuno-Histoquímica , Melanoma Maligno CutâneoRESUMO
As the incidence of non-melanoma skin cancer (NMSC) increases in the United States, one area of particular concern is NMSC arising on the genitalia. In the past, most genital skin tumors have been treated by conventional radical surgical approaches such as penectomy, vulvectomy, or wide local excision. In recent years, tissue sparing Mohs micrographic surgery (MMS) has been established as a safe and effective method of achieving cutaneous genital tumor clearance. The aim of this article is to provide an overview of NMSCs arising on genital skin treated with MMS, and describe some of their indications, results, and associated complications. A summary of case reports, case series, and retrospective reviews is made available to guide decision making and surgical planning for tumors of this nature. Pertinent anatomy, site-specific surgical techniques, and reconstruction options of genital skin will be discussed. J Drugs Dermatol. 2021;20(3):311-319. doi:10.36849/JDD.5656.
Assuntos
Neoplasias dos Genitais Femininos/cirurgia , Neoplasias dos Genitais Masculinos/cirurgia , Cirurgia de Mohs/métodos , Complicações Pós-Operatórias/epidemiologia , Neoplasias Cutâneas/cirurgia , Carcinoma Basocelular/patologia , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Feminino , Neoplasias dos Genitais Femininos/patologia , Neoplasias dos Genitais Masculinos/patologia , Genitália/patologia , Genitália/cirurgia , Humanos , Masculino , Cirurgia de Mohs/efeitos adversos , Complicações Pós-Operatórias/etiologia , Pele/patologia , Neoplasias Cutâneas/patologia , Resultado do TratamentoRESUMO
Verruca vulgaris is a common, benign infection of the skin and mucous membranes caused by human papillomavirus (HPV). Although many therapeutic options for warts exist, they have limited efficacy and there is no definitive cure for warts. We report the case of a 10-year-old girl with recalcitrant cutaneous warts persisting more than two years which resolved completely following vaccination with the nine-valent HPV vaccine.
Assuntos
Infecções por Papillomavirus , Vacinas contra Papillomavirus , Verrugas , Criança , Feminino , Humanos , Papillomaviridae , Pele , Vacinação , Verrugas/tratamento farmacológicoRESUMO
Recent studies have suggested that the intestinal microbiome plays an important role in modulating risk of several chronic diseases, including inflammatory bowel disease, obesity, type 2 diabetes, cardiovascular disease, and cancer. At the same time, it is now understood that diet plays a significant role in shaping the microbiome, with experiments showing that dietary alterations can induce large, temporary microbial shifts within 24 h. Given this association, there may be significant therapeutic utility in altering microbial composition through diet. This review systematically evaluates current data regarding the effects of several common dietary components on intestinal microbiota. We show that consumption of particular types of food produces predictable shifts in existing host bacterial genera. Furthermore, the identity of these bacteria affects host immune and metabolic parameters, with broad implications for human health. Familiarity with these associations will be of tremendous use to the practitioner as well as the patient.
Assuntos
Dieta , Microbioma Gastrointestinal , Saúde , Humanos , Polifenóis/farmacologia , Probióticos/farmacologiaRESUMO
INTRODUCTION: Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae, an intracellular acid-fast bacillus that tends to infect the skin and peripheral nerves. Because of the wide array of cutaneous manifestation, diagnosis is not always straightforward, especially in nonendemic regions of the world such as the United States. CASE REPORT: The authors report an unusual case of borderline tuberculoid leprosy in an 80-year-old white woman from California. Clinical examination revealed multiple nonscaly annular plaques, with central clearing and absence of lesional anesthesia, distributed over the trunk and extremities initially clinically diagnosed as granuloma annulare (GA). After 2 years of unsuccessful treatment with topical corticosteroid, biopsy revealed a palisaded and interstitial granulomatous infiltrate with necrobiosis, without discrete granulomas, compatible with GA. However, the presence of perineural lymphocytes in the reticular dermis prompted a Fite stain, which revealed acid-fast bacilli within the Schwann cells of a small peripheral nerve, pathognomonic for leprosy. CONCLUSION: This is the first reported case of leprosy masquerading both clinically and histologically as GA. Dermatopathologists should be aware of the possibility of leprosy given the presence of perineural lymphocytes amidst any pattern of granulomatous infiltrate and obtain a Fite stain.
Assuntos
Granuloma Anular/diagnóstico , Hanseníase Dimorfa/diagnóstico , Idoso de 80 Anos ou mais , Erros de Diagnóstico , Feminino , HumanosRESUMO
Atopic dermatitis (AD) is a common inflammatory dermatosis characterized by pruritus, erythema, induration, and lichenification. Current treatment options for generalized atopic dermatitis are limited and have potentially serious adverse effects, especially in patients with severe, chronic AD who frequently require systemic anti-inflammatory agents. Apremilast, an oral phosphodiesterase-4 inhibitor, was FDA approved in September 2014 for the treatment of moderate-to-severe plaque psoriasis. However, its upstream anti-inflammatory effects, ease of use as an oral agent, and mild side-effect profile make it an interesting treatment option for AD as well. Herein, we present a patient with a life-long history of AD recalcitrant to topical steroids and cyclosporine who attained subjective and objective improvement in pruritus and erythema after 10-week treatment with apremilast.
Assuntos
Dermatite Atópica/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Inibidores da Fosfodiesterase 4/uso terapêutico , Talidomida/análogos & derivados , Administração Oral , Doença Crônica , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Talidomida/uso terapêuticoRESUMO
BACKGROUND: Studies investigating the molecular basis of psoriasis have established the central roles of TNFa, interleukin (IL)-12, IL-22 and IL-23, and now there is increasing evidence that IL-17 plays a vital role in the complex pathophysiology of this disease. Preclinical and phase II studies of medications targeting IL-17 and its receptor have thus far proved to be promising. METHODS: We reviewed the results of the phase III clinical trials for the anti-IL-17 agents secukinumab, ixekizumab and brodalumab in order to assess the efficacy and safety profile of each agent. RESULTS: By week 12, the proportion of patients reaching a 75% improvement from baseline Psoriasis Area and Severity Index (PASI 75) was comparable between the different agents (secukinumab 83%, ixekizumab 89%, and brodalumab 85%). The safety profiles of the agents were similar with the most frequently reported adverse events of nasopharyngitis, upper respiratory infections, headache, and injection site reaction. CONCLUSION: The anti-IL-17 agents demonstrated a rapid and robust clinical improvement accompanied by a favorable short-term safety profile. The results of the phase III trials continue to reinforce the theory that the IL-17 pathway is an essential target in psoriasis treatment.
Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Interleucina-17/antagonistas & inibidores , Psoríase/tratamento farmacológico , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Humanizados/efeitos adversos , Ensaios Clínicos Fase III como Assunto , Humanos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Cryptococcus neoformans is a common fungus found throughout the environment that causes opportunistic disease in immunocompromised individuals. Infection of humans with C neoformans usually manifests as lung disease through inhalation of spores or meningoencephalitis by involvement of the central nervous system. Rarely, dissemination in the form of cutaneous lesions can occur in individuals with long term immunosuppression. We present a patient with C. neoformans manifesting as cellulitis with focal segmental glomerulosclerosis treated with corticosteroids. Because of the mortality associated with disseminated cryptococcosis, early identification, especially of atypical cutaneous presentations is critical from a dermatological perspective.
Assuntos
Celulite (Flegmão)/etiologia , Criptococose/etiologia , Fungemia/etiologia , Glomerulosclerose Segmentar e Focal/tratamento farmacológico , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Dermatoses da Perna/etiologia , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Celulite (Flegmão)/tratamento farmacológico , Celulite (Flegmão)/imunologia , Criptococose/tratamento farmacológico , Criptococose/imunologia , Cryptococcus neoformans , Ciclosporina/efeitos adversos , Fluconazol/uso terapêutico , Flucitosina/uso terapêutico , Fungemia/diagnóstico , Fungemia/tratamento farmacológico , Fungemia/imunologia , Humanos , Dermatoses da Perna/tratamento farmacológico , Dermatoses da Perna/imunologia , Dermatoses da Perna/patologia , Masculino , Pessoa de Meia-Idade , Prednisona/efeitos adversos , Pele/patologiaAssuntos
Etnicidade , Psoríase/diagnóstico , Psoríase/etnologia , Índice de Gravidade de Doença , População Branca , Adulto , Negro ou Afro-Americano , Idoso , Árabes , Asiático , Estudos Transversais , Feminino , Hispânico ou Latino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosAssuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Dermatite Atópica/tratamento farmacológico , Eczema/tratamento farmacológico , Talidomida/análogos & derivados , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Talidomida/uso terapêuticoRESUMO
In the title compound, C(13)H(10)N(2)O(4), the nitro N atom deviates by 0.031â (2)â Å from the plane of the benzene ring to which it is attached. The aromatic rings are oriented at a dihedral angle of 50.6â (1)°. An intra-molecular N-Hâ¯O hydrogen bond occurs. In the crystal, inversion dimers are formed by pairs of O-Hâ¯O inter-actions.
RESUMO
Undermining in difficult-to-reach positions often requires a shift in body position or stretching over the surgical field to obtain adequate reach. We propose a technique of reversing the grip on undermining scissors that improves efficiency without sacrificing technique.
Assuntos
Procedimentos Cirúrgicos Dermatológicos , HumanosAssuntos
Corticosteroides/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Alcatrão/uso terapêutico , Dermatite Atópica/radioterapia , Ceratolíticos/uso terapêutico , Terapia Ultravioleta/métodos , Administração Cutânea , Corticosteroides/administração & dosagem , Adulto , Anti-Inflamatórios/administração & dosagem , Antipruriginosos/administração & dosagem , Antipruriginosos/uso terapêutico , Alcatrão/administração & dosagem , Terapia Combinada , Dermatite Atópica/tratamento farmacológico , Feminino , Humanos , Ceratolíticos/administração & dosagem , Masculino , Projetos Piloto , Estudos Prospectivos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
The anti-inflammatory cytokine interleukin-10 (IL10) is essential for attenuating inflammatory responses, which includes reducing the expression of pro-inflammatory microRNA-155 (miR155) in lipopolysaccharide (LPS) activated macrophages. miR155 enhances the expression of pro-inflammatory cytokines such as TNFα and suppresses expression of anti-inflammatory molecules such as SHIP1 and SOCS1. We previously found that IL10 interfered with the maturation of pre-miR155 to miR155. To understand the mechanism by which IL10 interferes with pre-miR155 maturation we isolated proteins that associate with pre-miR155 in response to IL10 in macrophages. We identified CELF2, a member of the CUGBP, ELAV-Like Family (CELF) family of RNA binding proteins, as protein whose association with pre-miR155 increased in IL10 treated cells. CRISPR-Cas9 mediated knockdown of CELF2 impaired IL10's ability to inhibit both miR155 expression and TNFα expression.
Assuntos
Proteínas CELF/metabolismo , Interleucina-10/metabolismo , MicroRNAs/metabolismo , Precursores de RNA/metabolismo , Animais , Células HEK293 , Humanos , Lipopolissacarídeos/farmacologia , Camundongos , MicroRNAs/genética , Oligonucleotídeos/metabolismo , Ligação Proteica , Células RAW 264.7 , Precursores de RNA/genética , Reprodutibilidade dos Testes , Fator de Necrose Tumoral alfa/metabolismoRESUMO
OBJECTIVE: Patients diagnosed with delusions of infestation (DOI) at a psychodermatology clinic appeared to have a higher incidence of being prescribed narcotic or stimulant medications compared with the general dermatologic clinic population with chronic pruritic conditions. A retrospective study was conducted examining the correlation between patients with DOI and prescribed psychoactive medications. METHODS: Ninety-two patients with a diagnosis of DOI, seen at our University Psychodermatology Clinic, served as the study population. The comparison group (N=354) included dermatology patients seen at a dermatology clinic by the same dermatologist for itching, including adults seen for chronic pruritic conditions and contact dermatitis. For both groups, the reported use of any psychoactive prescription medications was noted. RESULTS: Patients with DOI were significantly more likely than other dermatology patients to receive prescriptions for narcotics [adjusted odds ratio (OR)=2.19; confidence interval (CI)=1.21-3.99) and stimulants (OR=5.44; CI=2.37-12.52). Patients with DOI were also more likely to be female (OR=2.49; CI=1.47-4.22) than patients who did not have such delusions. DISCUSSION: Few data are available concerning the etiology and management of DOI. Findings from this study indicated an association between the diagnosis of DOI and the prescribing of narcotics and stimulants, even when sex and age were taken into account. This information may be used to assist with the diagnosis of patients presenting with DOI and possible treatment options. It will be important to determine if these medications are a cause of the condition, or are merely correlated with other medical conditions.
Assuntos
Estimulantes do Sistema Nervoso Central/efeitos adversos , Delírio de Parasitose/induzido quimicamente , Entorpecentes/efeitos adversos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Dermatopatias/tratamento farmacológicoRESUMO
Allergic contact dermatitis is associated with significant disease and economic burden in the United States. To properly manage allergic contact dermatitis, it is important to accurately identify the substance(s) implicated in the dermatitis to prevent disease recurrence. The commercially available T.R.U.E Test (36 allergens) screening panel has been reported to have a conservative hypothetical allergen detection rate of 66.0%, at most. Importantly, these calculations are based on the 78% of patients who had clinically relevant reactions to allergens present on the North American Contact Dermatitis Group screening series (70 allergens), without the use of supplemental allergens. Testing with supplemental allergens beyond a screening series can more fully evaluate an individual's environmental and occupational exposure, which may significantly increase diagnostic accuracy. Comprehensive patch testing with additional allergens in sunscreens, cosmetics, and fragrances, for example, may increase the diagnostic yield as well as the likelihood of achieving a cure if the dermatitis is chronic and recalcitrant.
Assuntos
Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/etiologia , Testes do Emplastro/métodos , HumanosRESUMO
BACKGROUND: Allergic contact dermatitis (ACD) remains a significant burden of disease in the United States. Patch testing is the criterion standard for diagnosing ACD, but its use may be limited by reimbursement challenges. OBJECTIVE: This study aimed to assess the current rate of patch test utilization among dermatologists in academic, group, or private practice settings to understand different patch testing business models that address these reimbursement challenges. METHODS: All members of the American Contact Dermatitis Society received an online survey regarding their experiences with patch testing and reimbursement. RESULTS: A "yes" response was received from 28% of survey participants to the question, "Are you or have you been less inclined to administer patch tests or see patients needing patch tests due to challenges with receiving compensation for patch testing?" The most commonly reported barriers include inadequate insurance reimbursement and lack of departmental support. CONCLUSIONS: Compensation challenges to patch testing limit patient access to appropriate diagnosis and management of ACD. This can be addressed through a variety of innovative business models, including raising patch testing caps, negotiating relative value unit compensation, using a fixed salary model with directorship support from the hospital, and raising the percentages of collection reimbursement for physicians.
Assuntos
Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/etiologia , Dermatologia/economia , Reembolso de Seguro de Saúde , Testes do Emplastro/economia , Testes do Emplastro/estatística & dados numéricos , Centros Médicos Acadêmicos/economia , Dermatologia/organização & administração , Dermatologia/estatística & dados numéricos , Prática de Grupo/economia , Prática de Grupo/estatística & dados numéricos , Humanos , Modelos Econômicos , Ambulatório Hospitalar/economia , Ambulatório Hospitalar/estatística & dados numéricos , Prática Privada/economia , Prática Privada/estatística & dados numéricos , Escalas de Valor Relativo , Sociedades Médicas , Inquéritos e Questionários , Fatores de Tempo , Estados UnidosRESUMO
Individuals with obsessive-compulsive features frequently visit dermatologists for complaints of the skin, hair or nails, and often progress towards a chronic relapsing course due to the challenge associated with accurate diagnosis and management of their psychiatric symptoms. The current DSM-5 formally recognizes body dysmorphic disorder, trichotillomania, neurotic excoriation and body focused repetitive behavior disorder as psychodermatological disorders belonging to the category of Obsessive-Compulsive and Related Disorders. However there is evidence that other relevant skin diseases such as delusions of parasitosis, dermatitis artefacta, contamination dermatitis, AIDS phobia, trichotemnomania and even lichen simplex chronicus possess prominent obsessive-compulsive characteristics that do not necessarily fit the full diagnostic criteria of the DSM-5. Therefore, to increase dermatologists' awareness of this unique group of skin disorders with OCD features, we propose a novel classification system called Obsessive-Compulsive Insight Continuum. Under this new classification system, obsessive-compulsive skin manifestations are categorized along a continuum based on degree of insight, from minimal insight with delusional obsessions to good insight with minimal obsessions. Understanding the level of insight is thus an important first step for clinicians who routinely interact with these patients.