Seminars in Cutaneous Medicine and Surgery (SEMIN CUTAN MED SURG)

Publications in this journal

• Article: The immune system and atopic dermatitis.

  Elif Dokmeci, Christina A Herrick
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  ABSTRACT: Atopic dermatitis (AD) is a chronic inflammatory skin disease with a complex pathogenesis. It is clinically well-defined and represents one manifestation of the atopic state, along with asthma, food allergy and/or allergic rhinitis. Within the last several decades, there has been much evidence to support the contribution of immune mechanisms in the pathogenesis of AD. It has also been documented that the prevalence of all atopic disease, including AD, has been increasing, although the environmental factors that may be contributing to this increase are not clearly defined. A better understanding of the underlying immunopathogenesis of AD should aid in better clinical management and development of new treatment options.
  Seminars in Cutaneous Medicine and Surgery 07/2008; 27(2):138-43.
• Article: Atopic eczema and the filaggrin story.

  Sara J Brown, Alan D Irvine
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  ABSTRACT: The discovery that null mutations in the filaggrin gene (FLG) are associated with atopic eczema represents the single most significant breakthrough in understanding the genetic basis of this complex disorder. The association has been replicated in multiple independent studies during the past 2 years with the use of various methodologies, from populations in Europe, the United States, and Japan. Filaggrin plays a key role in epidermal barrier function, and its association with atopic eczema emphasizes the importance of barrier dysfunction in eczema pathogenesis. This review aims to summarize the current state of knowledge regarding the role of FLG mutations in ichthyosis vulgaris, atopic eczema, and other skin disorders, with an emphasis on potential clinical applications. Further research is needed to clarify the precise role of filaggrin in skin and systemic atopic disease, to pave the way for novel therapeutic interventions.
  Seminars in Cutaneous Medicine and Surgery 07/2008; 27(2):128-37.
• Article: Pediatric atopic dermatitis: the importance of food allergens.

  Jennifer S Kim
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  ABSTRACT: Food allergy and atopic dermatitis often occur in the same patients. Food-induced eczema may be perceived as a controversial topic because the immunologic mechanisms have yet to be fully elucidated. Nevertheless, published clinical studies have clearly demonstrated that foods can induce symptoms in a subset of patients with atopic dermatitis. Those at greatest risk are young children in whom eczematous lesions are severe or recalcitrant to therapy. Allergy testing can be helpful but must be applied judiciously. A medical history obtained by a skilled and knowledgeable health care provider is of paramount importance to interpret test results appropriately. Finally, the implementation of proper dietary avoidance can improve symptoms and provide safety from potentially fatal anaphylaxis. However, if inappropriate prescribed, elimination diets can have significant negative nutritional and social consequences.
  Seminars in Cutaneous Medicine and Surgery 07/2008; 27(2):156-60.
• Article: Atopic dermatitis: systemic immunosuppressive therapy.

  Arash Akhavan, Donald Rudikoff
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  ABSTRACT: Atopic dermatitis (AD) is a pruritic, relapsing skin disorder that negatively impacts the quality of life of those affected and that of their families. Treatment options for AD encompass a variety of emollients, topical corticosteroids, topical immunomodulators, phototherapy, and systemic agents. Such agents as systemic corticosteroids, cyclosporine, azathioprine, interferon-gamma, methotrexate, and mycophenolate mofetil have been shown to be efficacious in the treatment of moderate-to-severe AD but are not officially approved for this purpose. In this article, we review some of the data supporting efficacy of these medications and discuss some of the adverse events associated with their use.
  Seminars in Cutaneous Medicine and Surgery 07/2008; 27(2):151-5.
• Article: The epidermal barrier in atopic dermatitis.

  Jeffrey L Sugarman
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  ABSTRACT: Epidermal barrier function is abnormal in individuals with atopic dermatitis (AD). It is controversial whether primary epidermal barrier abnormalities alone account for the physiological and clinical abnormalities found in those persons with AD or whether the observed barrier dysfunction is a consequence of primary immunologic abnormalities. Recent evidence is strengthening the argument for the former hypothesis. Attention to epidermal barrier care (ie, gentle skin care) has long been an important part of the therapy of AD. Advances in our understanding of the biology of the epidermal barrier and how this relates to the clinical manifestations of this disease has important consequences for new therapeutic approaches in the management of AD.
  Seminars in Cutaneous Medicine and Surgery 07/2008; 27(2):108-14.
• Article: Topical therapy in pediatric atopic dermatitis.

  Andrew C Krakowski, Magdalene A Dohil
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  ABSTRACT: With a prevalence of 10% to 20% in the first decade of life, atopic dermatitis (AD) is one of the most common skin disorders in young children. It is a chronic illness with limited therapeutic options. Topical anti-inflammatory agents remain at the core of medical management; however, their efficacy must be balanced with safety concerns, especially as they relate to the pediatric population. This article discusses the principles of topical AD therapy with a detailed review of the differences between topical corticosteroids and topical calcineurin inhibitors. It also includes specialized topical treatment strategies for AD, such as wet wraps and diluted bleach baths, and highlights the most common challenges to patient compliance in atopic dermatitis.
  Seminars in Cutaneous Medicine and Surgery 07/2008; 27(2):161-7.
• Article: Atopic dermatitis.

  Sarah L Chamlin
  Seminars in Cutaneous Medicine and Surgery 07/2008; 27(2):107.
• Source

  Available from: newenglandsocietyofallergy.org

  Article: A multidisciplinary approach to evaluation and treatment of atopic dermatitis.

  Mark Boguniewicz, Noreen Nicol, Kim Kelsay, Donald Y M Leung
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  ABSTRACT: Atopic dermatitis is a common, complex disease that frequently follows a chronic, relapsing course. The disease can impact the quality of life (QOL) of patients and families to a significant degree. Patients and caregivers may focus on unproven triggers at the expense of proper skin care. A multidisciplinary approach is needed to comprehensively evaluate triggers and response to treatment, address confounding factors including sleep disruption, and educate patients and caregivers.
  Seminars in Cutaneous Medicine and Surgery 07/2008; 27(2):115-27.
• Article: Antimicrobial peptides, skin infections, and atopic dermatitis.

  Tissa R Hata, Richard L Gallo
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  ABSTRACT: The innate immune system evolved more than 2 billion years ago to first recognize pathogens then eradicate them. Several distinct defects in this ancient but rapidly responsive element of human immune defense account for the increased incidence of skin infections in atopics. These defects include abnormalities in the physical barrier of the epidermis, alterations in microbial pattern recognition receptors such as toll receptors and nucleotide binding oligomerization domains, and a diminished capacity to increase the expression of antimicrobial peptides during inflammation. Several antimicrobial peptides are affected including; cathelicidin, HBD-2, and HBD-3, which are lower in lesional skin of atopics compared with other inflammatory skin diseases, and dermcidin, which is decreased in sweat. Other defects in the immune defense barrier of atopics include a relative deficiency in plasmacytoid dendritic cells. In the future, understanding the cause of these defects may allow therapeutic intervention to reduce the incidence of infection in atopic individuals and potentially decrease the severity of this disorder.
  Seminars in Cutaneous Medicine and Surgery 07/2008; 27(2):144-50.
• Article: New advances in liposuction technology.

  Margaret W Mann, Melanie D Palm, Roberta D Sengelmann
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  ABSTRACT: Although suction-assisted liposuction under tumescent anesthesia remains the traditional method for body sculpting, newer technologies promise to increase efficiency, decrease surgeon fatigue, and minimize complication. Power-, ultrasound-, and laser-assisted devices are ideal in large volume cases and in areas of fibrous tissues as an adjunct to traditional liposuction. Although skepticism remains chemical lipolysis, more commonly termed mesotherapy or lipodissolve may be an alternative to surgical treatment of localized fat. This article reviews the recent advancements in the field of liposuction and the current literature which support their use.
  Seminars in Cutaneous Medicine and Surgery 04/2008; 27(1):72-82.
• Article: The use of high definition video modules for delivery of informed consent and wound care education in the Mohs Surgery Unit.

  Michael Migden, Arianne Chavez-Frazier, Tri Nguyen
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  ABSTRACT: The use of video in the informed consent process has been well documented in the literature to improve patient satisfaction, understanding, comprehension, and to decrease anxiety. At the MD Anderson Mohs Surgery Unit, we use high-definition (HD) audiovisual (AV) modules to assist with the delivery of informed consent and to educate patients on the subject of postoperative wound care. The purpose of this work was to develop HD-AV media to inform patients of the risks, benefits, and alternatives of Mohs surgery before they are asked to sign the consent form and to educate patients on basic wound care after Mohs Surgery. The use of a HD virtual surgeon and nurse in the videos educates the patient, allowing the surgeon and nursing staff to attend to other patients within the Mohs Surgery Unit. Using HD digital recording equipment, we captured real-time HD-AV media to explain the risks, alternatives, and benefits of Mohs surgery (surgeon explanation) and to give detailed instructions for postoperative wound care (nurse explanation). Once captured, HD modules were created and stored on a central University of Texas-MD Anderson Cancer Center server in the Texas Medical Center approximately 1 mile from the Mohs Surgery Unit. The full-screen HD modules are accessed on demand at the point of need with the use of standard institutional computers within any of the Mohs's center's examination/surgical suites. An early evaluation of this quality improvement initiative was performed to measure patient satisfaction, efficiency, and efficacy of the videos followed by physician/nurse discussion compared with physician/nurse discussion alone. Early evaluation of HD-AV modules used for the delivery of informed consent and postoperative wound care in the MD Anderson Mohs surgery Unit revealed that patient satisfaction was maintained and that this medium was preferred by patients in the video group over physician/nurse discussion alone. The HD modules allowed increased efficiency and patient comprehension, which improved patient education in the Mohs Surgery Unit.
  Seminars in Cutaneous Medicine and Surgery 04/2008; 27(1):89-93.
• Source

  Available from: doctor-smile.it

  Article: Fractional photothermolysis: a review and update.

  Ming H Jih, Arash Kimyai-Asadi
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  ABSTRACT: Fractional resurfacing is a new laser treatment modality that creates numerous microscopic thermal injury zones of controlled width, depth, and density that are surrounded by a reservoir of spared epidermal and dermal tissue, allowing for rapid repair of laser-induced thermal injury. This unique modality, if implemented with proper laser-delivery systems, enables high-energy treatments while minimizing risks. In this article, we review the various fractional laser devices, including the new fractional ablative devices, as well as the results of studies on the clinical efficacy of fractional photothermolysis. This technology offers patients significant clinical improvement in photodamage, melasma, and scarring with modest treatment-related downtime and minimal risk of complications.
  Seminars in Cutaneous Medicine and Surgery 04/2008; 27(1):63-71.
• Article: Technology in Dermatology and Dermatologic Surgery. Introduction.

  Ashish C Bhatia, Allan C Halpern, Girish Munavalli
  Seminars in Cutaneous Medicine and Surgery 04/2008; 27(1):1.
• Article: Paperless or less paper: realistic goals in dermatology practice.

  Stanford I Lamberg
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  ABSTRACT: Who benefits and who pays for the electronic health records? Patients may obtain better health care, while payers benefit from lower costs. Providers pay greater costs to implement health information technology, however, and may experience lower revenues after implementation. Although large multispecialty practices or medical centers may benefit from electronic health record systems, dermatologists-particularly those in dermatology specialty groups or in solo practice-may be adequately served by document-management systems that are less complex and less expensive. This article offers a perspective on medical record documentation alternatives.
  Seminars in Cutaneous Medicine and Surgery 04/2008; 27(1):86-8.
• Article: Selected applications of technology in the pediatric dermatology office.

  Erin E Ducharme, Nanette B Silverberg
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  ABSTRACT: The pediatric dermatologist is equipped with several diagnostic and therapeutic tools that can be used in the office. The Wood's lamp, introduced nearly a century ago, continues to be a safe, noninvasive diagnostic tool used today for diagnosing cutaneous infections, pigmentary disorders, and porphyrias. The pulsed dye laser is the treatment of choice for vascular lesions and has an expanding list of other applications, such as warts, which are extremely common in the pediatric population. Dermoscopy has emerged as an effective adjunctive tool in the in vivo examination of pigmented skin lesions and early diagnosis of cutaneous malignant melanoma. Other uses are also being explored including diagnosis of scabies. Future directions of technology in the pediatric dermatology office include implementation of electronic medical record systems and treatment of conditions such as molluscum, warts, and acne vulgaris with photodynamic therapy.
  Seminars in Cutaneous Medicine and Surgery 04/2008; 27(1):94-100.
• Article: Technological bases for teledermatopathology: state of the art.

  Domingo DeAgustín, Jose Sanmartín, Pablo Varela-Centelles, Santiago Vidal, Juan Seoane
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  ABSTRACT: Teledermatopathology can be defined as a telemedicine application related to histological diagnosis of cutaneous specimens. Its development and implementation around the world is very heterogeneous due to the wide range of existing geographical, social and healthcare conditions. This paper reviews the technological bases for static (use of images generated at one side, stored on a computer, and then transmitted to another site for a second diagnosis) and dynamic teledermatopathology (interaction between an user located on a remote area and a histological video image captured from a microscopy which allows navigation across the slide) as well as for virtual microscopy. The use of teledematopathology could increase the healthcare standard and the accessibility to the health care system in developing countries. However, some limitations related to economic, medico-legal and technical issues still remain, particularly when dealing with inflammatory skin diseases.
  Seminars in Cutaneous Medicine and Surgery 04/2008; 27(1):25-31.
• Article: DNA microarray technology in dermatology.

  Manfred Kunz
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  ABSTRACT: In recent years, DNA microarray technology has been used for the analysis of gene expression patterns in a variety of skin diseases, including malignant melanoma, psoriasis, lupus erythematosus, and systemic sclerosis. Many of the studies described herein confirmed earlier results on individual genes or functional groups of genes. However, a plethora of new candidate genes, gene patterns, and regulatory pathways have been identified. Major progresses were reached by the identification of a prognostic gene pattern in malignant melanoma, an immune signaling cluster in psoriasis, and a so-called interferon signature in systemic lupus erythematosus. In future, interference with genes or regulatory pathways with the use of different RNA interference technologies or targeted therapy may not only underscore the functional significance of microarray data but also may open interesting therapeutic perspectives. Large-scale gene expression analyses may also help to design more individualized treatment approaches of cutaneous diseases.
  Seminars in Cutaneous Medicine and Surgery 04/2008; 27(1):16-24.
• Article: Ultrasound technology in dermatology.

  Monika-Hildegard Schmid-Wendtner, Dorothee Dill-Müller
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  ABSTRACT: As a noninvasive diagnostic method, real-time B-mode sonography belongs to the diagnostic standard procedures in various fields of clinical medicine, for example, internal medicine, gynecology, and otorhinolaryngology. During the past 3 decades, ultrasound technology has been extended to clinical dermatology. High-frequency ultrasound systems with 20- to 50-MHz probes are used for the assessment of tumoral and inflammatory processes of the skin, providing information about their axial and lateral extension. They are of special interest in preoperative situations and for the monitoring of skin conditions under therapy. In contrast to high-frequency ultrasound systems, the value of ultrasound technology with the use of 7.5- to 15-MHz probes generally is not accepted worldwide, although it can be used easily and without significant side effects. Promising results have been reported from specialized diagnostic centers, especially for the assessment of peripheral lymph nodes and soft-tissue tumors. Although it is unable to provide malignancy specific information, ultrasound is nonetheless helpful in the follow-up of patients undergoing, for example, chemotherapy or radiotherapy. The 3-dimensional size and outline of a tumor as well as its relation to surrounding structures like vessels can be described. Moreover, information about the tumor quality (solid, cyst, complex) and the inner structure of a tumor (hypoechoic, hyperechoic, homogenous, inhomogenous, calcification foci, necroses) can be provided. In addition to conventional B-mode-sonography, newer ultrasound techniques like native and signal-enhanced color Doppler sonography as well as ultrasound-guided fine needle aspiration cytology are reviewed.
  Seminars in Cutaneous Medicine and Surgery 04/2008; 27(1):44-51.
• Article: Practical digital photography in the dermatology office.

  Suneel Chilukuri, Ashish Bhatia
  Seminars in Cutaneous Medicine and Surgery 04/2008; 27(1):83-5.
• Article: Photodynamic therapy in dermatology: an update on applications and outcomes.

  Mollie A MacCormack
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  ABSTRACT: Photodynamic therapy is a relatively new and rapidly evolving therapeutic option in dermatology. Initially used for the treatment of actinic damage and nonmelanotic skin cancer, more recent work indicates efficacy in the treatment of a wide range of conditions, such as acne, infectious processes, cutaneous T-cell lymphoma, and photorejuvenation, among others. This article provides a comprehensive review of applications and outcomes that use topical photodynamic therapy in the treatment of dermatologic disease.
  Seminars in Cutaneous Medicine and Surgery 04/2008; 27(1):52-62.