Sylvia Hsu

Publications (134)229.91 Total impact

• Article: JAAD Grand Rounds quiz: Keloidal nodules in an African American man.

  Milton R Moore, Kiran Motaparthi, Holly McIntire, Sylvia Hsu
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  ABSTRACT: Instructions: In answering each question, refer to the specific directions provided. Because it is often necessary to provide information occurring later in a series that give away answers to earlier questions, please answer the questions in each series in sequence.
  Journal of the American Academy of Dermatology 02/2013; 68(2):346-8. · 3.99 Impact Factor
• Article: Blue papules in a patient with neurologic symptoms-quiz case.

  Connie M Wang, Kiran Motaparthi, Sarah J Grekin, Sylvia Hsu
  JAMA dermatology (Chicago, Ill.). 01/2013; 149(1):97.
• Article: Treatment of pustular psoriasis: from the Medical Board of the National Psoriasis Foundation.

  Amanda Robinson, Abby S Van Voorhees, Sylvia Hsu, Neil J Korman, Mark G Lebwohl, Bruce F Bebo, Robert E Kalb
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  ABSTRACT: A task force of the National Psoriasis Foundation Medical Board was convened to evaluate treatment options for pustular psoriasis. Meetings were held by teleconference. Consensus on treatment of pustular psoriasis was achieved. Pustular psoriasis has been classified into localized and generalized forms. There are a number of treatment modalities, but there is little evidence-based information to guide the management of this type of psoriasis. The purpose of this article was to present treatment recommendations to aid in the treatment of patients with pustular psoriasis. A literature review was conducted to examine treatment options for pustular psoriasis and assess the strength of the literature for each option. Overall the quality of the literature about the treatment of pustular psoriasis is weak. Treatment should be governed by the extent of involvement and severity of disease. Acitretin, cyclosporine, methotrexate, and infliximab are considered to be first-line therapies for those with generalized pustular psoriasis. Adalimumab, etanercept, and psoralen plus ultraviolet A are second-line modalities in this setting. Pustular psoriasis in children, in pregnant women, and in localized forms alter which agents are first-line modalities as concerns such as teratogenicity need to be factored into the decisionmaking for the individual patient. There are few high-quality studies examining treatment options for pustular psoriasis. Treatment of patients with pustular psoriasis depends on the severity of presentation and patient's underlying risk factors. The data are extremely limited for this type of psoriasis and we encourage further exploration.
  Journal of the American Academy of Dermatology 05/2012; 67(2):279-88. · 3.99 Impact Factor
• Article: Pyogenic granuloma-like Kaposi sarcoma: a diagnostic pitfall.

  Pauline L Scott, Kiran Motaparthi, Bhuvaneswari Krishnan, Sylvia Hsu
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  ABSTRACT: Pyogenic granuloma-like Kaposi sarcoma (PG-like KS) is a clinicopathologic variant of Kaposi sarcoma (KS), a vascular tumor caused by human herpesvirus-8 (HHV-8). PG-like KS is a challenging entity to diagnose because its clinical and histological features encompass both pyogenic granuloma (PG) and KS characteristics. Immunhistochemical staining with HHV-8 latent nuclear antigen-1 (LNA-1) has been shown to exhibit high sensitivity and specificity for diagnosing KS. Therefore, the integration of clinical features and context, histopathogical findings, and immunohistochemical analysis is important in obtaining the correct diagnosis of PG-like KS. We report a case of PG-like KS in an HIV-positive man.
  Dermatology online journal 01/2012; 18(3):4.
• Article: HIV photodermatitis presenting with widespread vitiligo-like depigmentation.

  Rebecca C Philips, Kiran Motaparthi, Bhuvaneswari Krishnan, Sylvia Hsu
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  ABSTRACT: HIV photodermatitis encompasses a variety of clinical manifestations. We report a rare clinical presentation of HIV photodermatitis with widespread vitiligo-like depigmentation.
  Dermatology online journal 01/2012; 18(1):6.
• Source

  Available from: Andrew Blauvelt

  Article: Consensus guidelines for the management of plaque psoriasis.

  Sylvia Hsu, Kim Alexander Papp, Mark G Lebwohl, Jerry Bagel, Andrew Blauvelt, Kristina Callis Duffin, Jeffrey Crowley, Lawrence F Eichenfield, Steven R Feldman, David F Fiorentino, [......], Melissa A Michelon, Warwick Morison, Christopher T Ritchlin, Linda Stein Gold, Stephen P Stone, Bruce E Strober, Abby S Van Voorhees, Stefan C Weiss, Karolyn Wanat, Bruce F Bebo
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  ABSTRACT: The Canadian Guidelines for the Management of Plaque Psoriasis were reviewed by the entire National Psoriasis Foundation Medical Board and updated to include newly approved agents such as ustekinumab and to reflect practice patterns in the United States, where the excimer laser is approved for psoriasis treatment. Management of psoriasis in special populations is discussed. In the updated guidelines, we include sections on children, pregnant patients or pregnant partners of patients, nursing mothers, the elderly, patients with hepatitis B or C virus infections, human immunodeficiency virus-infected patients, and patients with malignant neoplasms, as well as sections on tumor necrosis factor blockers, elective surgery, and vaccinations.
  Archives of dermatology 01/2012; 148(1):95-102. · 4.76 Impact Factor
• Article: Review of treatment options for psoriasis in pregnant or lactating women: From the Medical Board of the National Psoriasis Foundation.

  Yoon-Soo Cindy Bae, Abby S Van Voorhees, Sylvia Hsu, Neil J Korman, Mark G Lebwohl, Melody Young, Bruce Bebo, Alexa Boer Kimball
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  ABSTRACT: Treating psoriasis in pregnant and lactating women presents a special challenge. For ethical reasons, prospective randomized control trials have not been conducted in this patient population although these patients do encounter new-onset psoriasis in addition to flares and may require treatment throughout their pregnancies. Our aim was to arrive at consensus recommendations on treatment options for psoriasis in pregnant and lactating women. The literature was reviewed regarding all psoriasis therapies in pregnant and lactating women. Topical therapies including emollients and low- to moderate-potency topical steroids are first-line therapy for patients with limited psoriasis who are pregnant or breast-feeding. The consensus was that second-line treatment for pregnant women is narrowband ultraviolet B phototherapy or broadband ultraviolet B, if narrowband ultraviolet B is not available. Lastly, tumor necrosis factor-α inhibitors including adalimumab, etanercept, and infliximab may be used with caution as may cyclosporine and systemic steroids (in second and third trimesters). Some specific strategies may be used to minimize risk and exposure. There are few evidence-based studies on treating psoriasis in pregnant and lactating women. Because there will always be a question of ethical concerns placing pregnant and lactating women in prospective clinical trials, investigation of both conventional and biologic agents are unlikely to ever be performed. Some of these medications used to treat psoriasis are known abortifacients, mutagens, or teratogens and must be clearly avoided but others can be used with relative confidence in select patients with appropriate counseling of risks and benefits.
  Journal of the American Academy of Dermatology 10/2011; 67(3):459-77. · 3.99 Impact Factor
• Article: JAAD Grand Rounds quiz. Adult with red-brown nodules and plaques.

  Farhan Khan, C Stanley Chan, Todd M LeLeux, A Hafeez Diwan, Sylvia Hsu
  Journal of the American Academy of Dermatology 08/2011; 65(2):469-71. · 3.99 Impact Factor
• Article: Psoriasis in the elderly: from the Medical Board of the National Psoriasis Foundation.

  Ivan S Grozdev, Abby S Van Voorhees, Alice B Gottlieb, Sylvia Hsu, Mark G Lebwohl, Bruce F Bebo, Neil J Korman
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  ABSTRACT: The continuous increase in the US population older than 65 years and the chronic course of psoriasis make management of psoriasis in the elderly an important health care problem. We sought to develop a treatment algorithm for patients with psoriasis who are older than 65 years. A systematic literature search for studies on elderly patients with psoriasis was performed using MEDLINE. We summarize the available published data on therapeutic modalities used in the elderly. We suggest a treatment algorithm including topical medications as first-line treatment for limited disease, with phototherapy, systemic retinoids, methotrexate, and biologics as the first-line systemic treatments for patients with more extensive disease. Cyclosporine should only rarely be used as a second-line systemic treatment for extensive disease in elderly patients with psoriasis. Limited data are available regarding treatment modalities specifically for elderly patients with psoriasis. Appropriate treatment for elderly patients with limited psoriasis includes topical corticosteroids, topical vitamin D analogues, and topical tazarotene. For appropriately monitored elderly patients who have psoriasis with extensive disease, phototherapy, acitretin, methotrexate, alefacept, etanercept, adalimumab, infliximab, and ustekinumab are first-line therapies that can generally be safely used. There remains a need for further research on the management of psoriasis in elderly patients with psoriasis.
  Journal of the American Academy of Dermatology 04/2011; 65(3):537-45. · 3.99 Impact Factor
• Article: In response to "Treatment of psoriasis with cyclosporine in patients with hepatitis C infection: risk or opportunity?".

  Amylynne Frankel, Abby S Van Voorhees, Sylvia Hsu, Neil J Korman, Mark Lebwohl, Bruce F Bebo, Alice Gottlieb
  Journal of the American Academy of Dermatology 04/2011; 64(4):788-90. · 3.99 Impact Factor
• Article: Frequency of thrombocytopenia in psoriasis patients treated with tumor necrosis factor-a inhibitors.

  Meng Chen, Michael J Holland, Mohsin R Mir, Michael G Wong, Brian P Kelley, Kelli D Grim, Sunaina S Bhuchar, Sylvia Hsu
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  ABSTRACT: Tumor necrosis factor-? (TNF-?) inhibitors are biologic agents that are currently in wide use for the treatment of psoriasis as well as other inflammatory diseases. Following reports of thrombocytopenia as a potential adverse effect of anti-TNF-? therapy, we performed a retrospective study to determine the frequency of thrombocytopenia, defined as a platelet count <50x109 cells/L, in a cohort of 187 psoriatic patients treated with anti-TNF-? agents over a nine-year period. Although none of our patients met serologic criteria for thrombocytopenia or displayed clinical manifestations of thrombocytopenia, two patients developed platelet counts below 100×109 cells/L. Thrombocytopenia induced by anti-TNF-? agents is a potential adverse effect, it is a rare occurrence that will require further investigation in large, placebo-controlled, double-blind, prospective studies.
  Journal of drugs in dermatology: JDD 03/2011; 10(3):280-4. · 1.57 Impact Factor
• Article: Epidermolytic acanthoma of the scrotum: A rare mimicker of condyloma acuminatum.

  Saivivek R Bogale, C Stanley Chan, Holly McIntire, Sylvia Hsu
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  ABSTRACT: Epidermolytic acanthoma is a rare benign tumor that is characterized by epidermolytic hyperkeratosis on histopathology. Epidermolytic acanthoma usually presents in adulthood as an asymptomatic tumor less than 1 cm in diameter with a verrucous surface. Whereas the lesions can present in either an isolated solitary, localized, or disseminated form, there tends to be a predilection for the genitoscrotal area.
  Dermatology online journal 01/2011; 17(1):6.
• Article: Granuloma annulare of the palms.

  Larissa R Stewart, Saira George, K Lyn Hamacher, Sylvia Hsu
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  ABSTRACT: Granuloma annulare (GA) is a common, benign skin condition, which was first described over a century ago, but still remains an enigma with respect to etiology, associated systemic diseases, and treatment. A number of clinical variants have been classified. We report an atypical presentation of GA localized to the palms.
  Dermatology online journal 01/2011; 17(5):7.
• Article: DRESS syndrome associated with raltegravir.

  Kevin S Zhang, Gunjan M Modi, Sylvia Hsu
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  ABSTRACT: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome or drug-induced hypersensitivity is a potentially life-threatening drug hypersensitivity syndrome most commonly associated with anticonvulsants, allopurinol, long-acting sulfonamides, dapsone, and minocycline. In the setting of HIV infection, the antiretroviral medicines abacavir, nevirapine, and efavirenz have all shown well-documented associations with DRESS syndrome. There has only been one case (in a poster presentation) of this syndrome in a patient who was taking raltegravir.
  Dermatology online journal 01/2011; 17(8):14.
• Article: Disseminated histoplasmosis mimicking secondary syphilis.

  Tony A Pastor, Maura J Holcomb, Kiran Motaparthi, Sarah J Grekin, Sylvia Hsu
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  ABSTRACT: A 34-year-old, HIV-positive man living in Texas presented with a 2-week history of fever, malaise, myalgias, oral ulcers, and papules on his chest, back, face, and extremities, including the palms. Initially secondary syphilis was suspected. However, RPR was negative. Histopathologic examination revealed a lymphocytic infiltrate with numerous intra-histiocytic fungal organisms. GMS and PAS stains were positive, consistent with the diagnosis of histoplasmosis. We report a case of disseminated histoplasmosis clinically mimicking secondary syphilis.
  Dermatology online journal 01/2011; 17(11):10.
• Source

  Available from: Andrew Blauvelt

  Article: Treatment of Psoriasis in the Setting of Excessive Alcohol Intake: From the Medical Board of the National Psoriasis Foundation

  Douglas J Pugliese, Alice B Gottlieb, Sylvia Hsu, Neil J Korman, Mark G Lebwohl, Melodie Young, Bruce F Bebo, Andrew Blauvelt, Abby S Van Voorhees
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  ABSTRACT: A task force of the National Psoriasis Foundation Medical Board was convened to evaluate treatment options for psoriasis in the setting of excessive alcohol intake. Consensus on treatment algorithms was achieved. Background: Psoriasis is a chronic, inflammatory, multisystem disease in which alcohol abuse is higher than in the general population. Alcohol may exacerbate psoriasis and can complicate the choices for therapy given the potential for the combined toxicity of ethanol and treatment. Evidence-based data to guide clinicians in managing these challenging patients are quite limited. Objective: Our aim was to create treatment recommendations to help dermatologists manage patients with psoriasis in the setting of excessive alcohol intake. Methods: A literature review was conducted to examine treatment options for psoriasis in the setting of excessive alcohol consumption. Results: Treatment should be dictated by the severity of disease and any patient comorbidities. First-line choices for extensive disease include phototherapy with narrowband ultraviolet B and photochemotherapy with psoralen plus ultraviolet A, as well as the tumor necrosis factor-alpha inhibitors adalimumab and infliximab. Second-line choices are acitretin, alefacept, cyclosporine, etanercept, and ustekinumab. A third-line choice would be methotrexate. Physicians should be vigilant to check liver function tests regularly. Limitations: There are few studies examining treatment options for psoriasis in the setting of excessive alcohol consumption. Thus, these recommendations are based on experience and expert opinions. Conclusion: Management of psoriasis in the setting of excessive alcohol consumption requires a thorough understanding of the treatment options that are available. Therapy should be based on the extent of the disease balanced with patients’ underlying comorbidities.
  Psoriasis Forum. 01/2011; 17(2):119-130.
• Source

  Available from: Andrew Blauvelt

  Article: Obesity and psoriasis: from the Medical Board of the National Psoriasis Foundation.

  Samuel Bremmer, Abby S Van Voorhees, Sylvia Hsu, Neil J Korman, Mark G Lebwohl, Melodie Young, Bruce F Bebo, Andrew Blauvelt
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  ABSTRACT: An association between obesity and psoriasis has been reported. For a variety of reasons, obese persons with psoriasis are often more difficult to treat. We sought to review the literature on obesity and psoriasis and to discuss efficacy and safety data that could be utilized by clinicians who are making treatment decisions for obese persons with psoriasis. We performed a literature review using the terms "obesity and psoriasis" and "metabolic syndrome and psoriasis." Evidence from relevant literature was evaluated and categorized according to the criteria of Shekelle et al (published 1999). Numerous reports cite an association between obesity and psoriasis. When compared with non-obese patients with psoriasis, obese patients with psoriasis are more likely to experience certain adverse effects to medications and are less likely to respond favorably to systemic therapies. The amount of category I evidence for objectively determining the best treatment choices for obese patients with psoriasis was scarce and thus did not allow for the development of a treatment algorithm that could be generally applied for all psoriasis patients who are obese. Efficacy and safety concerns affected by obesity are important considerations for clinicians who are making decisions on proper treatment of psoriasis.
  Journal of the American Academy of Dermatology 12/2010; 63(6):1058-69. · 3.99 Impact Factor
• Article: Innovative uses of thalidomide.

  Meng Chen, Sean D Doherty, Sylvia Hsu
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  ABSTRACT: Thalidomide is approved for treating erythema nodosum leprosum and multiple myeloma, but it has also emerged as a useful treatment option for many refractory dermatologic disorders. Some of the innovative but off-label uses of thalidomide include aphthous stomatitis, Behçet's disease, lupus erythematosus, prurigo nodularis, sarcoidosis, actinic prurigo, graft-versus-host disease, Langerhans cell histiocytosis, erythema multiforme, lichen planus, Kaposi sarcoma, Jessner lymphocytic infiltrate, uremic pruritus, pyoderma gangrenosum, scleroderma, scleromyxedema, and necrobiosis lipoidica. This article reviews the background, pharmacology, and innovative uses of thalidomide in dermatology.
  Dermatologic clinics 07/2010; 28(3):577-86. · 1.29 Impact Factor
• Article: Chronic, recurrent neutrophilic dermatosis: a case report.

  Alok Vij, Gunjan M Modi, Pitiporn Suwattee, Clay J Cockerell, Sylvia Hsu
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  ABSTRACT: Sweet syndrome is a reactive neutrophilic dermatosis that develops in response to various systemic illnesses. The cutaneous manifestations include an acute eruption of painful, edematous papules, plaques, pustules, or vesicles associated with fever and other constitutional symptoms. Although the etiology cannot always be determined, Sweet syndrome most commonly arises in reaction to systemic illnesses, such as infections, inflammatory bowel disease, medications, and malignancies. We report a case of chronic, recurrent Sweet syndrome lasting over 15 years in a patient with no identifiable underlying illness.
  Dermatology online journal 01/2010; 16(10):1.
• Article: Disseminated porokeratosis of Mibelli: A case report.

  Alok Vij, Sean D Doherty, Todd M LeLeux, Sylvia Hsu
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  ABSTRACT: Porokeratosis is a disorder of clonal hyperproliferation of keratinocytes with several different clinical manifestations. Cutaneous lesions vary in their appearance and distribution. All variants share the distinguishing cornoid lamella on histopathological examination. We present an unusual case of disseminated porokeratosis of Mibelli in an immunocompetent patient.
  Dermatology online journal 01/2010; 16(12):12.