Tretinoin Review With Newer Formulations: Providing Effective and Tolerable Solutions in Clinical Practice.

Topical tretinoin has historically been limited by poor tolerability and molecular instability. Research advances have enhanced its efficacy and tolerability, along with reducing oxidation and photodegradation. By overcoming historical limitations, tretinoin use can be extended to patient populations and clinical situations previously not suitable. This review discusses historical limitations of tretinoin, methods employed to overcome those limitations, use within clinical practice, and new formulations of tretinoin for the treatment of acne. J Drugs Dermatol. 2023;22(1):35-40. doi:10.36849/JDD.7146.

A recurrent melanocytic nevus phenomenon in the setting of Hailey-Hailey disease.

Atypical acquired melanocytic nevi in patients with epidermolysis bullosa (EB) have been referred to as EB nevi and are considered to be a type of recurrent nevus with atypical but distinctive histopathologic findings. Herein, we describe an atypical nevus in a patient with Hailey-Hailey disease with different histopathologic findings from EB nevi because of presumably different pathogenesis. It is important to be aware that the recurrent nevi phenomenon can be seen in acantholytic conditions as well as blistering disorders, given these lesions may clinically resemble melanoma.

Otophyma: a rare benign clinical entity mimicking leprosy.

Otophyma is a rare condition characterized by edematous deformation of the ear that is considered to be the end-stage of an inflammatory process such as rosacea and eczema. This report illustrates a case in an elderly male, originally thought to have leprosy. Biopsy revealed a nodular infiltration of inflammatory cells around adnexal structures and an intraepidermal cyst. No acid-fast organisms were identified. We present a patient who is of a different ethnic group than usually seen with this disease and provide a review of the clinical presentation, histopathological features, and management of this rare condition.

A Review of the Diagnostic and Therapeutic Gaps in Rosacea Management: Consensus Opinion.

Rosacea is a common, chronic inflammatory disease characterized by both fluctuating and fixed heterogeneous signs such as facial erythema, papules/pustules, telangiectasia, acute vasodilation (flushing), and phymatous changes, and symptoms such as cutaneous stinging and burning. The shift to a phenotype-based approach to rosacea management has improved the consistency of recommendations across recent published guidelines. Consistent and thorough guidance for the classification, diagnosis, and management of the disease is difficult, as the mechanisms underlying the development of rosacea are still not completely understood nor universally accepted. Here, we provide a critical review of current published guidance, and gaps in the knowledge and management of rosacea. We present the recently approved microencapsulated benzoyl peroxide as an effective topical treatment option for papulopustular rosacea. Benzoyl peroxide (BPO) has been used in acne management for many years; however, many clinicians perceive treatment of rosacea with any BPO formulation to be counterintuitive because of concerns of potential skin irritation, while the lack of an accepted mechanism of action on rosacea pathophysiology means that others may be hesitant to use BPO as a treatment. Minocycline foam 1.5% is also an option for the treatment of inflammatory lesions in rosacea, with a decreased risk of systemic adverse events compared with oral minocycline.

An unusual case of coccidioidomycosis presenting with skin lesions.

A 42-year-old white male without prior skin disease presented 8 months ago with chest pain, fever, and coughing to his primary physician. At that point, he had no skin lesions. The diagnosis was made by standard blood tests. The patient completed treatment and was symptom free for 8 months until he presented to his physician again with skin lesions on his right cheek and extremities. The patient was referred to our dermatology clinic for further evaluation. A complete skin examination revealed lesions on his face, extremities, and back. The lesions on his right face were 8 x 10-mm erythematous papules and nodules coalescing into a plaque. A biopsy was taken from his right cheek lesions.

Identical twins with primary cutaneous melanoma presenting at the same time and location.

Thus far there have been very few cases that document such a rarity as the same cancer occurring in monozygotic twins, at the same time, in the same location. We report this extraordinary phenomenon in our patients, 71-year-old identical female twins, presenting with melanoma at the same time (within 10 days of each other) and location (the right calf).

Reflectance confocal microscopy as a first-line diagnostic technique for mycosis fungoides.

Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma and is a diagnostic challenge in its early stages. It often can be misdiagnosed as chronic contact dermatitis, atopic dermatitis, psoriasis, or other common dermatoses. Histologic diagnosis remains the gold standard for MF; however, in many cases repeat biopsies may be needed over time, especially in early patch stages of MF. Reflectance confocal microscopy (RCM) is a quick and noninvasive diagnostic tool that may be useful to determine an appropriate area to biopsy. We present the case of a 60-year-old man with plaque and tumor lesions clinically suspicious for MF that had originally been misdiagnosed as psoriasis. Reflectance confocal microscopy was used to evaluate for findings specific to MF and to select an appropriate biopsy site. The features noted on RCM were consistent with MF, and subsequent biopsy revealed tumor-stage disease. This article describes a unique case in which RCM was used for initial primary diagnosis of tumor-stage MF in a clinical setting. As in prior studies, our evaluation failed to identify unique RCM features specific to tumor-stage MF when compared to plaque- or patch-stage disease. Nonetheless, RCM may be useful in providing a quick noninvasive diagnosis when the clinical presentation of MF is ambiguous, especially in early lesions.

High Levels of Inflammatory Adipokines and C-reactive protein, and Minimal Changes in Immune Cells in Overweight and Obese Saudi Female University Students

Increased body weight affects the whole body including the immune response, and leads to a state of non-specificinflammation, which leads to increased incidence of inflammatory diseases. The aim of this study was to determine therelationship between adiposity and the hematological profile, and serum concentrations of glucose, C-reactive protein(CRP), some pro-inflammatory [leptin, resistin, interlukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α)] and antiinflammatory (adiponectin) adipokines in 112 healthy Saudi female university students. Adiposity was determined using thebody mass index (BMI), waist-to-hip ratio (WHR), and waist circumference (WC). The results showed that the mean totalwhite blood cell counts were significantly higher for the high risk WHR group, and the mean platelet and red blood cellcounts were higher for the obese/morbidly obese BMI group compared to the respective controls. The white blood cell typesand hemoglobin did not show any significant differences. Mean serum CRP, leptin, resistin, and IL-6 concentrations weresignificantly higher for the obese/morbidly obese BMI and high risk WC subjects compared to the healthy weight subjects.The only significant difference for the WHR groups was a significantly higher mean resistin level for the moderate riskgroup compared to the control. Mean glucose, TNF-α and adiponectin concentrations were not significantly different amongthe groups. Thus, it may be concluded that the immune system cells and the hematological profile in subjects with highadiposity were minimally affected compared to the healthy weight subjects. They also had higher platelet counts, and CRP,leptin, resistin, and IL-6 concentrations, which are inflammatory effectors/markers, thus confirming that obese subjects hadheightened inflammation and a higher risk for inflammatory diseases.

A dermoscopy survey to assess who is using it and why it is or is not being used.

BACKGROUND: Dermoscopy is a noninvasive method of evaluation of the colors and microstructures of the epidermis, dermo-epidermal junction, and papillary dermis not visible to the naked eye. These structures are correlated with histologic features and used to assess whether a lesion is benign or malignant, further indicating whether or not the lesion should be biopsied. OBJECTIVE: To obtain a better understanding of how many dermatologists are utilizing dermoscopy and their reasons for doing or not doing so. METHOD: A survey was conducted focusing on the prevalence of the use of dermoscopy by US dermatologists, the method by which they learned dermoscopy, how often they use or do not use it, and whether or not they feel it is effective. The survey was distributed to dermatologists attending a dermoscopy seminar at the American Academy of Dermatology's (AAD's) Summer Academy Meeting in 2007, as well as to dermatologists who expressed an interest in dermoscopy. E-mail addresses were also obtained from dermatologists who attended the AAD's Summer Academy Meeting, and subsequent surveys were e-mailed to them as a secondary means of obtaining the data. The survey was conducted online through a website: http://www.surveymonkey.com. One hundred and five dermatologists started the survey and ninety-seven finished it, a completion percentage of 92.4%. RESULTS: Of the 105 dermatologists who began the survey, the majority (63; 60%) had training or experience in dermoscopy, and 42 (40%) did not. Of the 63 individuals who responded positively to having training or experience in dermoscopy, the majority (41; 69.5%) learned dermoscopy through attendance of a seminar; reading a book and spending time with an experienced dermatologist were the second most popular methods of learning dermoscopy. The frequency of dermoscopy was evaluated, and it was found that 44 (42.7%) dermatologists used dermoscopy more than once daily, but 44 (42.7%) dermatologists reported never having used dermoscopy. Further information was obtained with regard to whether or not published algorithms were used by dermatologists to diagnose pigmented lesions. Pattern analysis was the most common algorithm used by 51 (89.5%) dermatologists questioned. The dermatologists were also questioned as to why they thought dermoscopy was effective or ineffective. The majority of dermatologists (32; 61.5%) believed that it was effective because it reduced patient anxiety. Helping to detect melanoma early was the second most popular reason for believing dermoscopy to be effective. Twenty-three (62.2%) dermatologists thought dermoscopy was ineffective as it was not more useful for detecting melanoma earlier than traditional methods. Eleven (29.7%) dermatologists said that they thought that dermoscopy took too long, which made it ineffective. To build on this, an additional question was asked: how long does dermoscopy take? The overwhelming response of dermatologists (52; 82.5%) was that dermoscopy took less than 1 min to evaluate one lesion. CONCLUSION: Dermoscopy is a widely used tool for the diagnosis of pigmented skin lesions. The use of dermoscopy is increasing in popularity amongst dermatologists, making it necessary to better understand dermoscopy and to analyse why physicians use it or do not use it. The survey indicated that the majority of physicians used dermoscopy in order to reduce patient anxiety and to detect melanoma early. The main reason why dermatologists found dermoscopy to be ineffective was that they felt that it was not useful in detecting melanoma earlier than traditional methods; 35% of dermatologists surveyed believed that dermoscopy required excessive training. These results imply that current training methods need to be modified. Training is limited to large dermatology centers and is not being transferred to general centers, which would allow it to be more accessible to a larger group of dermatologists in training. There is also a need to make the learning of dermoscopy easier and to establish a universal method of teaching. Overall, there is a need for improvement in the education of dermoscopy, ranging from training to information on the basics of dermoscopy. This would include aspects such as how long the average examination takes and dermoscopy's effectiveness compared with alternate methods.