Atypical Fibroxanthoma in a 13-Year-Old Guatemalan Girl with Xeroderma Pigmentosum.

Xeroderma pigmentosum (XP) is a rare, autosomal recessive disease involving a defect in DNA repair leading to the premature development of numerous aggressive cutaneous malignancies. Although atypical fibroxanthoma (AFX) is a neoplasm typically found in the setting of extensive sun exposure or therapeutic radiation, AFXs are rarely associated with children with XP. We report the case of a 13-year-old Guatemalan girl with the XP type C variant who developed one of the largest AFXs reported on a child's finger.

Effect of nutrient supplementation on atopic dermatitis in children: a systematic review of probiotics, prebiotics, formula, and fatty acids.

OBJECTIVE: To identify whether nutrient supplementation with probiotics, prebiotics, formula, or fatty acids prevents the development of atopic dermatitis (AD) or reduces the severity of AD in newborns to children younger than 3 years. DATA SOURCES: We searched MEDLINE, Cochrane Central Register of Controlled Trials, and LILACS (Latin American and Caribbean Health Science Literature) from January 1, 1946, to August 27, 2012, and performed an additional manual search. STUDY SELECTION: Randomized controlled trials and cohort studies examining nutritional supplementation in prevention and amelioration of AD among children younger than 3 years. DATA EXTRACTION: Of 92 articles, 21 met inclusion criteria. DATA SYNTHESIS: In the 21 studies, a total of 6859 participants received supplements, which included infants or mothers who were either pregnant or breastfeeding;4134 infants or mothers served as controls. Nutritional supplementation was shown to be an effective method in preventing AD (11 of 17 studies) or decreasing its severity(5 of 6 studies). The best evidence lies with probiotics supplementation in mothers and infants in preventing development and reducing severity of AD. Specifically, Lactobacillus rhamnosus GG was effective in long-term prevention of AD development. γ-Linolenic acid reduced severity of AD. Supplementation with prebiotics and black currant seed oil (γ-linolenic acid and ω-3 combination) was effective in reducing the development of AD. Conflicting findings were reported from different research groups that performed supplementation with an amino acid­based formula. CONCLUSIONS: Certain types of nutrient supplementation are beneficial in preventing AD development and reducing its severity. Future research elucidating the mechanisms underlying the actions of nutritional supplementation on AD is necessary.

Teledermatology operational considerations, challenges, and benefits: the referring providers' perspective.

BACKGROUND: Teledermatology has been used to provide increased specialty access for medically underserved communities. In California, policies enable the California Medicaid (Medi-Cal) program to provide reimbursement for both store-and-forward (S&F) and live-interactive teledermatology consultations. To assess the effectiveness of teledermatology operations for this population, understanding the referring providers' perspective is crucial. The primary objective of this study was to explore the perspective of referring primary care providers (PCPs) on teledermatology by focusing on the operational considerations, challenges, and benefits to participating in teledermatology referral in the context of the Medi-Cal population. SUBJECTS AND METHODS: We conducted hour-long one-on-one interviews with 10 PCPs who refer patients to teledermatology regularly and who together serve an average aggregate referral base of 2,760 teledermatology cases yearly. RESULTS: Of the 2,760 aggregate annual teledermatology referrals, PCPs reported that they serve predominantly uninsured or underinsured populations and participate in S&F consultations. The majority of surveyed PCPs treat common skin conditions themselves. However, these PCPs refer more patients to teledermatology consultations than in-person dermatology encounters. Several factors influence PCPs' decision to refer to teledermatology, which include complexity of the skin problem, distance to accessible dermatologist, patient's insurance, and patient's preferences. PCPs identified improved workflow, enhanced communication with dermatologists, and faster turnaround for recommendations as three areas that referring physicians would like improved in their experience with teledermatology. CONCLUSIONS: Understanding the referring provider's perspective and subsequently adopting policy and practice solutions to address their challenges are vital to prompting further teledermatology participation for underserved communities.

Advances in management of atopic dermatitis: new therapies and novel uses of existing treatments.

Atopic dermatitis (AD) is a chronic inflammatory skin condition marked by intensely pruritic, eczematous changes. First-line therapy includes topical corticosteroids during an exacerbation and long-term emollient use, followed by topical calcineurin inhibitors, phototherapy, and systemic therapy in more difficult cases. The need for more effective AD therapies with safer side effect profiles has pushed researchers to devise new therapies and to recycle traditional treatments for use in a novel manner. Innovative therapies include barrier therapy, novel antistaphylococcal treatments, new immunomodulatory agents, unconventional antipruritic agents, exclusionary diets, and probiotics. Advancements in these options have paved the way for a targeted approach to AD therapy. We will review the latest clinical research exploring these cutting-edge AD treatment modalities and discuss forward-thinking therapy strategies that use conventional AD medications in a novel manner.