ISRN Dermatology最新文献

Background. Being predictive of the entire nodal bed, sentinel lymph node biopsy (SLNB) is invaluable in the surgical management of melanoma. Although the concept is simple, sentinel lymph node (SLN) identification and removal can be technically challenging. Methods. A total of 102 consecutive patients have undergone SLNB in the Division of Plastic and Reconstructive Surgery of Soroka University Medical Center from 2009 to 2012. Patients have undergone SLNB using a radioactive tracer and blue stain in order to identify the SLN. Although SLNB usually precedes the wide excision of melanoma, primary lesions in close proximity (<10 cm) to the lymph basin require wide excision before beginning the SLN quest. Results. All pathology reports confirmed the excision of lymph nodes. Conclusions. When treating MM in close proximity to the lymph basin, changing the sequence of the SLNB procedure seems to increase the efficacy of the method.

Background. Vitiligo is a pigmentary disorder characterized by depigmented macules due to absence of melanocytes. Increased levels of tumor necrosis factor alpha and interleukin-1 in the epidermis of lesions may play a role in keratinocyte apoptosis and less production of melanogenic cytokines. Tetracyclines reduce production of tumor necrosis factor alpha and interleukin-1. Objective. To evaluate the effect of topical tetracycline on vitiligo patients on phototherapy. Methods. Thirty cases of generalized stable vitiligo were chosen randomly and pigmentation of two assigned lesions on right and left sides (same size and location) was determined by vitiligo area severity index, and medication and placebo were randomly assigned to be applied twice daily on either right or left side, respectively. Images were taken of the lesions at the end of the 4th, 8th, and 12th weeks and pigmentations were compared to baseline using aforementioned index. The patients also took narrow band ultraviolet B two to three times a week. Results. Mean pigmentation, based on vitiligo area severity index, changed significantly from 90.1667 to 86.6667 (P = 0.026) and on placebo side from 89.6667 to 86.8333 (P = 0.026). There was no significant difference between medication and placebo sides in terms of pigmentation (P = 0.566). Conclusions. No significant difference in improving repigmentation between medication and placebo sides was seen.

The aim of this study is to assess the effectiveness of treatment with BTX-A in quality of life of patients suffering from primary focal hyperhidrosis. Materials and Methods. A total of 119 patients (62 females and 57 males) between 18 and 65 years suffering from moderate to severe focal hyperhidrosis were treated with BTX-A. Thirty-nine patients suffered from axillary hyperhidrosis, 47 patients from palmar hyperhidrosis, 12 patients from plantar hyperhidrosis, and 21 patients from palmar and plantar hyperhidrosis. A baseline and posttreated examination of patients 6 months after BTX-A is included. The Hyperhidrosis Disease Severity Scale (HDSS) was chosen to assess the disease severity and the modified Dermatology Life Quality Index was used (DLQI) to assess the quality of life. Results. Quality of life showed a significant improvement after treatment with BTX-A. The total DLQI score resulted significantly lower than the basal value (P < 0.0001). The seriousness of hyperhidrosis significantly decreased after the treatment (P < 0.0001). In addition, there was notable difference between the posttreatment DLQI scores and pretreatment severity of hyperhidrosis by sex. Conclusions. Treatment with BTX-A led to the reduction of disease severity and improvement of quality of life, while it is a safe, easy to use method with minimal side effects.

Background. We wanted to verify retrospectively the proportion of patients with psoriatic arthritis who were in remission after 1 year of continuous therapy with either etanercept or adalimumab. Remission was defined as the absence of both clinical and contrast-enhanced ultrasound (CEUS) findings suggestive of joint inflammation. Patients and Methods. The data of twenty-five patients with psoriatic arthritis were available for the clinical and CEUS evaluations before and after 1 year of continuous therapy with etanercept or adalimumab. The count of swollen (ACR66), tender (ACR68), and active inflamed joints (AJC) was used to measure the severity of joint involvement. PASI was used to score the severity of psoriasis. HAQ, DLQI, VAS pain, and VAS itching were administered to each patient before starting therapy and every 3 months, up to 1 year. Results. Eight (32%) out of twenty-five patients were in remission after 1 year of therapy with etanercept or adalimumab. A significant reduction of all clinical variables analysed was seen during the course of therapy. Conclusion. Although a significant proportion of patients achieved remission of arthritis after 1 year of effective anti-TNF therapy, the majority of them continued to have either clinical or CEUS findings suggestive of persistence of joint inflammation.

With the aim of clarifying the role of several polymorphisms around the HLA-C locus in the clinical expression of PsA, the distribution of several polymorphic markers and genes located around the HLA-C locus was analyzed in a well-established cohort of 110 patients with PsA, 50 patients with psoriasis alone, and 110 healthy controls. The frequency of these genes was also analyzed by PsA articular models, based on three main subgroups: oligoarthritis, polyarthritis, and spondylitis. Distal interphalangeal joint (DIP) involvement was associated with the presence of MICB-CA20 (OR 6.0, 95% CI: 1.58-22.69, P = 0.005). HLA-DRB∗07 was associated with oligoarticular forms of PsA (OR 4.1, 95% CI: 1.8-9.3, P = 0.0007). The spondylitic forms overexpressed the antigen HLA-B∗27 (OR 5.7, 95% CI: 2.4-13.6, P = 0.0001). MICA-A5.1 showed association with polyarthritis (OR 3.7, 95% CI: 1.5-8.8, P = 0.006). Genes telomeric to HLA-C were overexpressed in psoriasis but not in PsA subphenotypes. This study shows that the region centromeric to HLA-C is a key region that expresses not only disease risk genes but also genes that help explain the phenotypic variability of PsA.

Introduction. Topical application of local anesthetics is currently considered to be the easiest, most effective, and convenient way for treatment of patients who may be undergoing superficial dermatosurgical procedures. Materials and Methods. This study compares the anesthetic potential of 2.5% lidocaine and 2.5% prilocaine topical cream with 7% lignocaine and 7% tetracaine combination cream for radio ablative dermatosurgery when applied, under occlusion, for 30 minutes. 40 subjects of achrocordons were enrolled in this split-side randomized trial. Result. The pain severity experienced by subjects in terms of visual analogue scale score was significantly lesser for lignocaine/tetracaine combination cream as compared to lidocaine/prilocaine combination. Conclusion. This small study proves the efficacy of lidocaine/tetracaine combination as a topical anesthetic cream when applied for a short time interval of 30 minutes. This will help a dermatosurgeon to perform various dermatological procedures in a better and efficient manner with a shorter waiting period for analgesia to set in.

Psoriasis is a lifelong disorder characterized by approximately 8-fold reduction of the duration of normal skin keratinocyte cell cycle and 2-fold increase of the number of dividing cells. Multiple genes, several environmental factors, and immune system alterations are involved in the pathogenesis of psoriasis. Hyperleptinemia is associated with psoriasis and leptin acts as an angiogenic factor. Angiogenetic processes precede the epidermal hyperplasia in psoriasis, indicating possible involvement of leptin in the pathogenesis of psoriasis. Leptin gene polymorphisms and their association with psoriasis have been given very little attention. We present a study of the rs2060713C/T genetic polymorphism in the pathogenesis of psoriasis vulgaris in 263 vulgaris patients and 252 unrelated matched healthy controls. No statistically significant differences were observed between patients and controls. A statistically nonsignificant trend was observed in males with the early onset type of psoriasis (11.1% C/T in patients versus 5.6% in controls) and in females with the late onset type of the disease (12.8% C/T in patients versus 3.3% in controls). Still, there is no hard evidence on correlation of psoriasis vulgaris with this polymorphism. Possible association with specific forms of the disease and either gender needs further investigation in larger studies.

Background. Acne vulgaris is a disorder of sebaceous glands mainly affecting the adolescent population. There are some misconceptions about acne not only in the general population but also among the medical students. Methods. Second year medical undergraduate students attending dermatology postings for the first time were included in the study. A questionnaire (in yes or no answer format) with 20 questions on acne, each carrying one mark, was to be answered by the students. The students were categorized into 4 grades based on the marks obtained: Grade I 90% marks and above, Grade II 75%-90%, Grade III 50%-74%, and Grade IV <50% marks obtained. Results. Of the 144 students of the batch, 95 (69.5%) completed both pretest and posttest questionnaires. The average pretest score was 14.1 and that of the posttest was 16.9. The percentage of improvement in mean score from pretest to posttest was 16.5. Fischer's exact test was applied to analyze the improvement in scores between pretest and posttests which is significant at P = 0.015 (P < 0.05). In the paired t-test the improvement in mean scores between pretest and posttest was significant at P < 0.001.

Health communication scholars have a responsibility to be certain that both healthcare practitioners and government agencies accurately communicate health information to the public. In order to carry out this duty, health communication scholars must assess how messages are being received and if they are being received at all by the public. This paper details a two part study which assesses this phenomenon within the context of skin cancer. Study 1 utilized 29 in depth qualitative interviews to identify subcultures among college students whose communication puts them at risk for skin cancer by encouraging poor sun exposure behaviors. The results indicate that farmers, African Americans, and individuals who regularly participate in outdoor athletics are at risk groups. Study 2 reports a content analysis of the known population of skin cancer Public Service Announcements (PSAs) available via the internet in 2013. The aforementioned groups were not present in any of the PSAs. Detailed results and implications are discussed.

Background. Significant decreases in p16 expression have been shown to occur in melanoma compared to Spitz tumors, and loss of p16 staining has been found to correlate with melanoma tumor progression. However, comparison of p16 between atypical cellular blue nevi (CBN) and melanoma has not been reported previously. Methods. p16 immunohistochemical staining was evaluated in 14 atypical CBN, 8 conventional and atypical melanocytic nevi, and 16 melanomas, including 4 malignant CBN. p16 staining intensity was graded on a scale of 0-3 and the percentage of melanocytes stained with p16 was determined. Results. p16 staining was significantly higher in all CBN as a group when compared to melanomas (P = 0.001) and malignant CBN (P = 0.00008). Higher p16 expression was also seen in mildly (P = 0.0002) and moderately atypical (P = 0.02), but not severely atypical, CBN compared to melanomas. Conclusions. p16 immunohistochemical expression is higher in mildly and moderately atypical CBN compared to severely atypical CBN and melanomas. In conjunction with additional markers and histology, p16 staining may be useful in confirming the benign nature of these tumors, but is not useful in distinguishing severely atypical CBN from malignant cases, consistent with the overlapping histologic features between these tumors.