Anogenital Erosive Lichen Sclerosus in a Male With Multiple Autoimmune Conditions.

Lichen sclerosus (LS) is a chronic inflammatory disorder primarily affecting the anogenital region, with a higher prevalence in females and often linked to autoimmunity. This association is not clearly elucidated in males, with LS commonly presenting in uncircumcised males. The most affected areas include the glans penis, prepuce, and coronal sulcus. In this report, we present an 11-year case of treatment-resistant LS in a male patient with an extensive history of autoimmune disorders, manifesting in the intergluteal cleft as a hypertrophic plaque, a rare location. The patient had a complex autoimmune history, including porphyria cutanea tarda, discoid lupus, and Sjogren's syndrome. Histopathological analysis confirmed a diagnosis of erosive LS. Despite numerous treatments, including intralesional corticosteroids and various topicals, the lesion persisted. This case highlights the challenges in managing LS, particularly in uncommon sites and in patients with extensive autoimmune backgrounds. Treatment goals for LS focus on symptom relief, cosmetic improvement, and disease prevention. Although topical corticosteroids are commonly used, systemic options like hydroxychloroquine may be beneficial in resistant cases, although clear guidelines are lacking. Our case underscores the importance of a multidisciplinary approach in addressing LS and its associated autoimmune conditions.

Tumid Lupus Erythematosus: A Rare and Distinctive Variant of Cutaneous Lupus Erythematosus Masquerading as Urticarial Vasculitis.

Tumid lupus erythematosus (TLE) is a rare form of chronic cutaneous lupus that has triggered much debate regarding its clinical and histopathological features. It has been classically defined as annular erythematous, succulent, plaques involving the face and trunk that typically are devoid of any papulosquamous features such as scale and follicular plugging. These lesions are a clinical mimicker of other urticarial lesions such as urticarial vasculitis and lymphocytic infiltrate of Jessner. We report a case of TLE presenting in a 49-year-old Caucasian female whose initial clinical presentation was concerning for urticarial vasculitis due to presence of urticarial-like lesions present for approximately three months. Laboratory studies and histopathological correlations confirmed the diagnosis of TLE and the patient was successfully treated with topical corticosteroids.

Review and assessment of global and domestic ultraviolet light protection programs.

Skin cancer is the most commonly diagnosed cancer in the United States. A number of UV protection programs have been developed and initiated both globally and domestically, and this article will review and assess the effectiveness of each of these programs. The programs reviewed in this article target grade school aged children, as this is a time when adult health behaviors are being formed. Among these programs, multiunit programs were more effective at changing behavior as they were given over a longer period of time with more frequent interventions and included various learning techniques.

A regional survey of purse-string sutures for partial and complete closure of Mohs surgical defects.

BACKGROUND: The purse-string suture is a method for partial and complete closure of circular surgical defects. OBJECTIVE: Short-term and long-term efficacy and cosmesis were assessed to evaluate the utility of purse-string closure as the sole method of closure of Mohs defects in different locations. MATERIALS AND METHODS: Sixty-six circular wounds from Mohs surgery were closed with a running intradermal suture traversing the circumference of the wound. Preoperative and immediate postoperative wound areas were measured. Long-term cosmetic appearance was also assessed. RESULTS: An immediate decrease in average wound area was observed, most notably in the neck and arm. Long-term cosmetic results were best in the head and neck and were remarkably similar for a given anatomic area. CONCLUSION: The purse-string suture is rapid, simple, and associated with little morbidity. In properly selected cases, it is an excellent alternative for partial and complete closure of circular defects resulting from Mohs surgery.

Topical formulation engendered alteration in p53 and cyclobutane pyrimidine dimer expression in chronic photodamaged patients.

While the clinical attributes of photoaging are well characterized in the literature, the pathogenic mechanisms that underlie these changes are incompletely elucidated. At the molecular level, p53 tumor-suppressor gene product mediated excision repair of ultraviolet (UV)-induced DNA damage is a critical effector in xeroderma pigmentosum (XP) and potentially in conventional photoaging. We examined p53 activity and measured UV-induced DNA damage via cyclobutane pyrimidine dimers (CPDs) quantitatively in 20 volunteers before and after an 8-week, open-label prospective topical application of a proprietary DNA recovery serum (Celfix). There was a statistically significant decrease in immunohistochemically determined p53 and CPD levels. While these data are preliminary, the findings lend support to the theoretical possibility of a topical agent reversing the effects of photodamage at the molecular level and, potentially, an ameliorative outcome clinically.

Clearance of invasive melanoma with topical imiquimod.

A 93-year-old woman presented with biopsy-proven invasive melanoma of 2.75 mm depth, arising from a melanoma in situ. Standard treatment of this depth would be an extensive and mutilating excision, which presented a therapeutic dilemma. Imiquimod has the ability to clear melanoma in situ, but its effect on invasive melanoma is unknown. After a thorough discussion with the patient, we decided to attempt to treat the melanoma in situ with topical imiquimod and then excise the smaller invasive component. Following 5 weeks of topical imiquimod therapy, the area where the nodular melanoma had previously been was excised. Histological examination of the excisional specimen revealed no residual melanoma detected. In this case, it appears that 5 weeks of topical imiquimod therapy completely cleared an invasive melanoma of 2.75 mm depth, as well as clearing the component of melanoma in situ. The patient was followed for 14 months with no evidence of recurrence.

Comprehensive review of ultraviolet radiation and the current status on sunscreens.

In the past, manufacturers' labeling of sunscreen varied greatly, confusing the consumers regarding efficacy and the appropriate photoprotection provided by their products. Therefore, in June 2011, the United States Food and Drug Administration issued new guidelines for sunscreen labeling. Sunscreen products are over-the-counter drugs; therefore, they are regulated by the United States Food and Drug Administration to determine safety, efficacy, and labeling. This article discusses ultraviolet radiation and the positive and negative effects of ultraviolet radiation, provides a review of sunscreens, and discusses the new United States Food and Drug Administration regulations for sunscreens.

Clindamycin phosphate 1.2% and tretinoin 0.025% gel for rosacea: summary of a placebo-controlled, double-blind trial.

Rosacea is a common, chronic, and poorly understood dermatological condition characterized by an inflammatory component composed of papules and pustules and a vascular component composed of flushing and erythema. Current treatment options include topical, systemic, and light-based methods, each of which focuses on either the inflammatory or the vascular component. Retinoids are not routinely indicated as treatment because of the common conception that they would be too inflammatory for the sensitive rosacea patient. However, photodamage may play a role in rosacea and tretinoin is well-known to repair photodamage. Thirty rosacea subjects were enrolled to assess their response to the use of clindamycin phosphate 1.2% and tretinoin 0.025% gel (ZIANA; Medicis Pharmaceutical Corporation, Scottsdale, AZ) for a period of 12 weeks. The results showed a dramatic decrease in pustules and papules without any significant inflammation or overall intolerance. No improvement in facial redness was achieved. Based on our results, more investigation of topical retinoids for rosacea treatment is prudent.