Sewon Kang

Johns Hopkins Medicine, Baltimore, Maryland, United States

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Publications (97)549.37 Total impact

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    ABSTRACT: Aging and sun exposure are the leading causes of skin cancer. It has been shown that epigenetic changes, such as DNA methylation, are well established mechanisms for cancer, and also have emerging roles in aging and common disease. Here, we directly ask whether DNA methylation is altered following skin aging and/or chronic sun exposure in humans. We compare epidermis and dermis of both sun-protected and sun-exposed skin derived from younger subjects (under 35 years old) and older subjects (over 60 years old), using the Infinium HumanMethylation450 array and whole genome bisulfite sequencing. We observe large blocks of the genome that are hypomethylated in older, sun-exposed epidermal samples, with the degree of hypomethylation associated with clinical measures of photo-aging. We replicate these findings using whole genome bisulfite sequencing, comparing epidermis from an additional set of younger and older subjects. These blocks largely overlap known hypomethylated blocks in colon cancer and we observe that these same regions are similarly hypomethylated in squamous cell carcinoma samples. These data implicate large scale epigenomic change in mediating the effects of environmental damage with photo-aging.
    Genome biology 04/2015; 16(1):80. DOI:10.1186/s13059-015-0644-y · 10.47 Impact Factor
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    ABSTRACT: Post-inflammatory hyperpigmentation (PIH) is a problematic and distressing acne sequela. The difficulty of clinically assessing and managing post-inflammatory hyperpigmentation is especially prevalent in Asian populations. The Asian Acne Board conducted a study to evaluate concordance in diagnosis of post-inflammatory hyperpigmentation in patients with active acne, acne scarring, and pigmentation problems. Seven dermatologists reviewed 64 anonymous clinical photographs projected onto a screen during a single session. Results showed that there were two groups of raters, those who found a high frequency of PIH and those who found a low frequency. There was significant variability in these two groups in rating the presence of PIH, with an average of 30 diagnoses (24%) difference between high- and low-frequency raters. Results of severity ratings showed that while most cases of PIH were assessed as mild, there was marked variability between raters in their assessments of severity. Overall, variability in PIH diagnosis was greatest when active acne was present; in these cases, low PIH raters were more likely to report skin coloration as erythema instead of PIH. These findings uphold the importance of utilizing specific clinical criteria to improve accurate evaluation of skin color and we advocate future research into this area.
    The Journal of Dermatology 10/2014; 41(12). DOI:10.1111/1346-8138.12667 · 2.35 Impact Factor
  • Flora Poon, Sewon Kang, Anna L. Chien
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    ABSTRACT: PurposePhotoaging is frequently encountered in a dermatologic practice. This systematic literature review aims to explore the etiology of photoaging and address the evidence behind its current management.MethodsA comprehensive search of MEDLINE, EMBASE, UpToDate and the Cochrane Library was conducted. Articles were limited to those relating to photoaging.ResultsThere are two major approaches in the current management of photoageing. This includes strategies to prevent against UV damage (e.g sunscreen) and medications that attempt to reverse existing skin damage (topical retinoids and 5-fluorouracil).Conclusion There has been a large growth in the variety of treatment options in recent years. While it is important for such growth to continue, prevention via sensible photoprotection methods still remains the best current management option.
    Photodermatology Photoimmunology and Photomedicine 10/2014; 31(2). DOI:10.1111/phpp.12145 · 1.30 Impact Factor
  • Article: Photoaging.
    Anne Han, Anna L Chien, Sewon Kang
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    ABSTRACT: This article discusses photoaging or premature skin aging from chronic ultraviolet exposure. This is an important cosmetic concern for many dermatologic patients. Clinical signs include rhytids, lentigines, mottled hyperpigmentation, loss of translucency, and decreased elasticity. These changes are more severe in individuals with fair skin and are further influenced by individual ethnicity and genetics. Photoaging may be prevented and treated with a variety of modalities, including topical retinoids, cosmeceuticals, chemical peels, injectable neuromodulators, soft tissue fillers, and light sources.
    Dermatologic Clinics 07/2014; 32(3):291-299. DOI:10.1016/j.det.2014.03.015 · 1.43 Impact Factor
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    ABSTRACT: Background/Objectives: Widespread use of antibiotics in all areas of medicine has led to significant problems with antimicrobial resistance, which have begun to compromise the usefulness of antibiotics. Antibiotics have long been a keystone of acne therapy. There is a large population of patients with acne and antibiotic therapy is often used for long durations; thus, acne therapy results in extensive antibiotic exposure. This article discusses the role of antibiotic therapy in acne from the perspective of how clinicians can best preserve the utility of these important drugs while providing efficacious and safe therapy for acne patients. Methods: Review of literature augmented by expert opinion when literature was sparse. Results: Antibiotic monotherapy (topical or oral) is not recommended due to the availability of clinically superior regimens. Systemic antibiotics are important for managing moderate to severe acne and should be used for a limited duration of time (3-4 months). Topical antibiotics should be paired with benzoyl peroxide to limit potential for resistance. Information gained in recent years about the pathophysiology of acne has shed light on the role of Propionibacterium acnes as well as other key pathogenic pathways such as inflammation. Conclusions: The improved understanding of acne pathogenic mechanisms can and should be applied to develop modern therapeutic approaches that are efficacious and mesh with current public health concerns.
    04/2014; 24(3). DOI:10.1684/ejd.2014.2309
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    ABSTRACT: IMPORTANCE Solar UV irradiation causes photoaging, characterized by fragmentation and reduced production of type I collagen fibrils that provide strength to skin. Exposure to UV-B irradiation (280-320 nm) causes these changes by inducing matrix metalloproteinase 1 and suppressing type I collagen synthesis. The role of UV-A irradiation (320-400 nm) in promoting similar molecular alterations is less clear yet important to consider because it is 10 to 100 times more abundant in natural sunlight than UV-B irradiation and penetrates deeper into the dermis than UV-B irradiation. Most (approximately 75%) of solar UV-A irradiation is composed of UV-A1 irradiation (340-400 nm), which is also the primary component of tanning beds. OBJECTIVE To evaluate the effects of low levels of UV-A1 irradiation, as might be encountered in daily life, on expression of matrix metalloproteinase 1 and type I procollagen (the precursor of type I collagen). DESIGN, SETTING, AND PARTICIPANTS In vivo biochemical analyses were conducted after UV-A1 irradiation of normal human skin at an academic referral center. Participants included 22 healthy individuals without skin disease. MAIN OUTCOMES AND MEASURES Skin pigmentation was measured by a color meter (chromometer) under the L* variable (luminescence), which ranges from 0 (black) to 100 (white). Gene expression in skin samples was assessed by real-time polymerase chain reaction. RESULTS Lightly pigmented human skin (L* >65) was exposed up to 4 times (1 exposure/d) to UV-A1 irradiation at a low dose (20 J/cm2), mimicking UV-A levels from strong sun exposure lasting approximately 2 hours. A single exposure to low-dose UV-A1 irradiation darkened skin slightly and did not alter matrix metalloproteinase 1 or type I procollagen gene expression. With repeated low-dose UV-A1 irradiation, skin darkened incrementally with each exposure. Despite this darkening, 2 or more exposures to low-dose UV-A1 irradiation significantly induced matrix metalloproteinase 1 gene expression, which increased progressively with successive exposures. Repeated UV-A1 exposures did not suppress type I procollagen expression. CONCLUSIONS AND RELEVANCE A limited number of low-dose UV-A1 exposures, as commonly experienced in daily life, potentially promotes photoaging by affecting breakdown, rather than synthesis, of collagen. Progressive skin darkening in response to repeated low-dose UV-A1 exposures in lightly pigmented individuals does not prevent UV-A1-induced collagenolytic changes. Therefore, for optimal protection against skin damage, sunscreen formulations should filter all UV wavelengths, including UV-A1 irradiation.
    12/2013; 150(4). DOI:10.1001/jamadermatol.2013.8417
  • Journal of drugs in dermatology: JDD 12/2013; 12(12):1331-1332. · 1.32 Impact Factor
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    ABSTRACT: The temporal analysis of changes in biological skin parameters, including melanosome concentration, collagen concentration and blood oxygenation, may serve as a valuable tool in diagnosing the progression of malignant skin cancers and in understanding the pathophysiology of cancerous tumors. Quantitative knowledge of these parameters can also be useful in applications such as wound assessment, and point-of-care diagnostics, amongst others. We propose an approach to estimate in vivo skin parameters using a forward computational model based on Kubelka-Munk theory and the Fresnel Equations. We use this model to map the skin parameters to their corresponding hyperspectral signature. We then use machine learning based regression to develop an inverse map from hyperspectral signatures to skin parameters. In particular, we employ support vector machine based regression to estimate the in vivo skin parameters given their corresponding hyperspectral signature. We build on our work from SPIE 2012, and validate our methodology on an in vivo dataset. This dataset consists of 241 signatures collected from in vivo hyperspectral imaging of patients of both genders and Caucasian, Asian and African American ethnicities. In addition, we also extend our methodology past the visible region and through the short-wave infrared region of the electromagnetic spectrum. We find promising results when comparing the estimated skin parameters to the ground truth, demonstrating good agreement with well-established physiological precepts. This methodology can have potential use in non-invasive skin anomaly detection and for developing minimally invasive pre-screening tools.
    Proceedings of SPIE - The International Society for Optical Engineering 02/2013; DOI:10.1117/12.2001428 · 0.20 Impact Factor
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    ABSTRACT: OBJECTIVE To highlight the prevalence and impact of skin disease at the stump site in patients who have undergone amputation. DESIGN A cross-sectional health questionnaire of Vietnam War veterans with stump dermatoses at least 38 years after major limb amputation. SETTING A research registry of veterans with combat-related amputations who agreed to participate. PARTICIPANTS Recruitment began January 1, 2006, and ended December 31, 2009, with a registry of 416 veterans. MAIN OUTCOME MEASURES Results of a self-reported 35-item questionnaire. Participants were later contacted by telephone or asked to complete a Web survey. RESULTS Of the 247 veterans, 119 (48.2%) reported at least 1 skin problem within the preceding year. The most common were skin breakdown (25.2%), rash (21.8%), and abrasion (21.0%). In addition, 25.2% experienced skin problems more than 50% of the time, and 37.1% had to alter or replace their prosthesis. Stump dermatoses limited or prevented prosthesis use in the preceding year for 55.6% and caused pain or discomfort at the stump site in 61.5%. CONCLUSIONS More than 38 years after major limb amputation, skin complications at the stump site continue to cause significant morbidities and contribute to prosthesis abandonment. The high prevalence of stump dermatoses stresses the importance of disease prevention, early management, and advanced treatment of skin disease.
    Archives of dermatology 11/2012; 148(11):1283-6. DOI:10.1001/archdermatol.2012.3004 · 4.31 Impact Factor
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    ABSTRACT: Acne vulgaris is common throughout the world and often perceived by both patients and clinicians as an inconsequential disease of adolescence. In reality, however, acne is a chronic medical disease that lasts for years and causes a considerable impact on quality of life. Many patients with acne experience emotional problems due to their disease, which can lead to reduced social interactions and even a lower likelihood of employment. Little has been written specifically about acne in Asian patients in the English-language medical published work, perhaps due to an assumption that the management of acne is the same in all populations. A group of acne experts from nine Asian countries and the USA met to review and discuss acne care within the Asia-Pacific region, focusing on evidence-based medicine. This group developed a care algorithm using results of clinical trials as well as knowledge of practice patterns.
    The Journal of Dermatology 09/2011; 38(11):1041-8. DOI:10.1111/j.1346-8138.2011.01266.x · 2.35 Impact Factor
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    ABSTRACT: Intralymphatic histiocytosis (IH) is a rare condition first reported in 1994 by O'Grady et al. Less than 40 cases have been reported, with the majority occurring in patients with rheumatoid arthritis. We present a case of a 72-year-old man who developed an asymptomatic rash on his left upper arm 3 years after placement of a metal implant to stabilize a fractured humerus. Examinations revealed a poorly demarcated erythematous to brown indurated plaque with a pebbly surface overlying the inferior portion of the surgical scar. Biopsy revealed a mixed dermal infiltrate with a complex glomeruloid intravascular accumulation of histiocytes and neutrophils. Histiocytes were identified with immunostaining for CD68. Immunostains for CD31 and D2-40 confirmed the intravascular location of the histiocytes. This reactive process is closely related to reactive angioendotheliomatosis, but is best classified as IH. This is the only case of IH reported in association with a metal implant of the upper arm and the fourth case reported in association with a metal implant. Although the pathogenesis of IH is unknown, a role for lymphatic stasis secondary to chronic inflammation or surgery has been suggested. This is a benign process with a chronic course, and there are no known efficacious treatments.
    Journal of Cutaneous Pathology 04/2011; 38(4):351-3. DOI:10.1111/j.1600-0560.2010.01556.x · 1.56 Impact Factor
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    ABSTRACT: We have found a B2 repeat insertion in the gene encoding protein tyrosine phosphatase nonreceptor type 6 (PTPN6) in a mouse that developed a skin disorder with clinical and histopathological features resembling those seen in human neutrophilic dermatoses. Neutrophilic dermatoses are a group of complex heterogeneous autoinflammatory diseases that all demonstrate excessive neutrophil infiltration of the skin. Therefore, we tested the cDNA and genomic DNA sequences of PTPN6 from patients with Sweet's syndrome (SW) and pyoderma gangrenosum and found numerous novel splice variants in different combinations. Isoforms resulting from deletions of exons 2, 5, 11, and 15 and retention of intron 1 or 5 were the most common in a patients with a familial case of SW, who had a neonatal onset of an inflammatory disorder with skin lesions and a biopsy specimen consistent with SW. These isoforms were associated with a heterozygous E441G mutation and a heterozygous 1.7-kbp deletion in the promoter region of the PTPN6 gene. Although full-length PTPN6 was detected in all other patients with either pyoderma gangrenosum or SW, it was always associated with splice variants: a partial deletion of exon 4 with the complete deletion of exon 5, alterations that were not detected in healthy controls. The defect in transcriptional regulation of the hematopoietic PTPN6 appears to be involved in the pathogenesis of certain subsets of the heterogeneous group of neutrophilic dermatoses.
    American Journal Of Pathology 03/2011; 178(4):1434-41. DOI:10.1016/j.ajpath.2010.12.035 · 4.60 Impact Factor
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    ABSTRACT: IL-1F6, IL-1F8, and IL-1F9 and the IL-1R6(RP2) receptor antagonist IL-1F5 constitute a novel IL-1 signaling system that is poorly characterized in skin. To further characterize these cytokines in healthy and inflamed skin, we studied their expression in healthy control, uninvolved psoriasis, and psoriasis plaque skin using quantitative RT-PCR and immunohistochemistry. Expression of IL-1F5, -1F6, -1F8, and -1F9 were increased 2 to 3 orders of magnitude in psoriasis plaque versus uninvolved psoriasis skin, which was supported immunohistologically. Moreover, treatment of psoriasis with etanercept led to significantly decreased IL-1F5, -1F6, -1F8, and -1F9 mRNAs, concomitant with clinical improvement. Similarly increased expression of IL-1F5, -1F6, -1F8, and -1F9 was seen in the involved skin of two mouse models of psoriasis. Suggestive of their importance in inflamed epithelia, IL-1α and TNF-α induced IL-1F5, -1F6, -1F8, and -1F9 transcript expression by normal human keratinocytes. Microarray analysis revealed that these cytokines induce the expression of antimicrobial peptides and matrix metalloproteinases by reconstituted human epidermis. In particular, IL-1F8 increased mRNA expression of human β-defensin (HBD)-2, HBD-3, and CAMP and protein secretion of HBD-2 and HBD-3. Collectively, our data suggest important roles for these novel cytokines in inflammatory skin diseases and identify these peptides as potential targets for antipsoriatic therapies.
    The Journal of Immunology 02/2011; 186(4):2613-22. DOI:10.4049/jimmunol.1003162 · 5.36 Impact Factor
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    ABSTRACT: There remains the need for more effective therapeutic options to treat acne vulgaris. Interest in light-based acne treatments has increased, but few randomized, controlled clinical trials assessing the value of photodynamic therapy (PDT) for acne have been reported. We sought to examine the efficacy of PDT using 5-aminolevulinic acid (ALA) and pulsed dye laser therapy in the treatment of acne. We conducted a randomized, controlled, split-face, single-blind clinical trial of 44 patients with facial acne. Patients were randomized to receive three pulsed dye laser treatments to one side of the face after a 60-90 min ALA application time, while the contralateral side remained untreated and served as a control. Serial blinded lesion counts and global acne severity ratings were performed. Global acne severity ratings improved bilaterally with the improvement noted to be statistically significantly greater in treated skin than in untreated skin. Erythematous macules (remnants of previously active inflammatory lesions) decreased in number in treated skin when compared with control skin and there was a transient but significant decrease in inflammatory papules in treated skin when compared with untreated skin. There were no other statistically significant differences between treated and untreated sides of the face in terms of counts of any subtype of acne lesion. Thirty percent of patients were deemed responders to this treatment with respect to improvement in their inflammatory lesion counts, while only 7% of patients responded in terms of noninflammatory lesion counts. PDT with the treatment regimen employed here may be beneficial for a subgroup of patients with inflammatory acne.
    Journal of Cosmetic Dermatology 03/2010; 9(1):28-34. DOI:10.1111/j.1473-2165.2010.00483.x · 1.00 Impact Factor
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    ABSTRACT: UV irradiation from the sun elevates the production of collagen-degrading matrix metalloproteinases (MMPs) and reduces the production of new collagen. This imbalance of collagen homeostasis impairs the structure and function of the dermal collagenous extracellular matrix (ECM), thereby promoting premature skin aging (photoaging). We report here that aberrant dermal collagen homeostasis in UV-irradiated human skin is mediated in part by a CCN-family member, cysteine-rich protein-61 (CYR61/CCN1). CYR61 is significantly elevated in acutely UV-irradiated human skin in vivo, and UV-irradiated human skin fibroblasts. Knockdown of CYR61 significantly attenuates UV irradiation-induced inhibition of type-I procollagen and upregulation of MMP-1. Determination of CYR61 mRNA and protein indicates that the primary mechanism of CYR61 induction by UV irradiation is transcriptional. Analysis of CYR61 proximal promoter showed that a sequence conforming to the consensus binding site for transcription factor activator protein-1 (AP-1) is required for promoter activity. UV irradiation increased the binding of AP-1-family members c-Jun and c-Fos to this AP-1 site. Furthermore, functional blockade of c-Jun or knockdown of c-Jun significantly reduced the UV irradiation-induced activation of CYR61 promoter and CYR61 gene expression. These data show that CYR61 is transcriptionally regulated by UV irradiation through transcription factor AP-1, and mediates altered collagen homeostasis that occurs in response to UV irradiation in human skin fibroblasts.
    Journal of Investigative Dermatology 02/2010; 130(6):1697-706. DOI:10.1038/jid.2010.29 · 6.37 Impact Factor
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    ABSTRACT: Skin hair follicles (HF) contain bulge stem cells (SC) that regenerate HFs during hair cycles, and repair skin epithelia following injury. As natural aging is associated with decreased skin repair capacity in humans, we have investigated the impact of age on human scalp HF bulge cell number and function. Here, we isolated human bulge cells, characterized as CD200+/KRT15+/KRT19+ cells of the HF, by dissection-combined CD200 selection in young and aged human skin. Targeted transcriptional profiling indicates that KRT15, KRT19, Dkk3, Dkk4, Tcf3, S100A4, Gas1, EGFR and CTGF/CCN2 are also preferentially expressed by human bulge cells, compared to differentiated HF keratinocytes (KC). Our results demonstrate that aging does not alter expression or localization of these HF SC markers. In addition, we could not detect significant differences in HF density or bulge cell number between young and aged human scalp skin. Interestingly, hedgehog (Hh) signaling is activated in human bulge cells in vivo, and down-regulated in differentiated HF KCs, both in young and aged skin. In addition, activation of Hh signaling by lentivirus-mediated overexpression of transcription factor Gli1 induces transcription of HF SC markers KRT15, KRT19, and Gas1, in cultured KCs. Together with previously reported knock-out mouse results, these data suggest a role for Hh signaling in maintaining bulge cell phenotype in young and aged human skin.
    Aging cell 12/2009; 8(6):738-51. DOI:10.1111/j.1474-9726.2009.00526.x · 5.94 Impact Factor
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    ABSTRACT: The cytochrome P450 (CYP) enzyme CYP26 (retinoic acid [RA] 4-hydroxylase) initiates the catabolism of all-trans RA (tRA) and limits the effects of tRA. The CYP26 enzyme acts specifically on tRA, but not 13-cis RA (isotretinoin), a retinoid used to treat severe acne. However, 13-cis RA can isomerize to tRA, which can then be metabolized by CYP26. In healthy individuals, we assessed the variability of CYP26 enzymatic activity. We then investigated whether response to oral 13-cis RA among patients with acne correlates with variability in CYP26 expression. In healthy individuals, we isolated microsomal fractions from the epidermis of keratome biopsy specimens and measured CYP26 enzymatic activity in untreated skin and skin treated with tRA. Enzymatic activity was determined based on rate of formation of 4-hydroxy RA (pg/min/mg microsomal protein). Using real-time polymerase chain reaction we quantified CYP26 messenger RNA induction after tRA application in patients with acne who responded or did not respond to one course of 13-cis RA. In normal-appearing skin (N = 118), CYP26 enzymatic activity was widely variable (1-180 pg/min/mg microsomal fraction; mean 42.7 +/- 3.5). Furthermore, CYP26 enzymatic activity was inducible in a dose-dependent manner in normal-appearing skin after tRA application, but not correlated with age or sex (N = 29). In patients with acne, CYP26 messenger RNA induction after 0.1% tRA application did not differ (P > .05) between patients who responded (N = 8, 587 +/- 325-fold) or did not respond (N = 8, 657 +/- 227-fold) to one course of 13-cis RA. The small number of patients with acne treated with 13-cis RA was a major limitation. Factors other than CYP26 activity may determine response to isotretinoin in acne.
    Journal of the American Academy of Dermatology 07/2009; 61(2):252-8. DOI:10.1016/j.jaad.2009.03.013 · 5.00 Impact Factor
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    ABSTRACT: To examine clinical and molecular changes after topical fluorouracil treatment of photodamaged human facial skin for actinic keratoses. Nonrandomized, open-label 2-week treatment with fluorouracil cream, 5%, followed by clinical and molecular evaluation. Academic referral center. Twenty-one healthy volunteers, 56 to 85 years old, with actinic keratoses and photodamage. Interventions Twice-daily application of fluorouracil cream for 2 weeks and biopsies and clinical evaluation at baseline and periodically after treatment. Gene and protein expression of molecular effectors of epidermal injury, inflammation, and extracellular matrix remodeling 24 hours after fluorouracil treatment; clinical improvement measured by evaluators, photography, and patient questionnaires. One day after the final fluorouracil treatment, gene expression of the effectors of epidermal injury (keratin 16), inflammation (interleukin 1beta), and extracellular matrix degradation (matrix metalloproteinases 1 and 3) was significantly increased. Types I and III procollagen messenger RNA were induced at week 4 (7-fold and 3-fold, respectively). Type I procollagen protein levels were increased 2-fold at week 24. Actinic keratoses and photoaging were statistically significantly improved. Most patients rated photoaging as improved and were willing to undergo the therapy again. Topical fluorouracil causes epidermal injury, which stimulates wound healing and dermal remodeling resulting in improved appearance. The mechanism of topical fluorouracil in photoaged skin follows a predictable wound healing pattern of events reminiscent of that seen with laser treatment of photoaging.
    Archives of dermatology 07/2009; 145(6):659-66. DOI:10.1001/archdermatol.2009.97 · 4.31 Impact Factor
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    ABSTRACT: The Global Alliance to Improve Outcomes in Acne published recommendations for the management of acne as a supplement to the Journal of the American Academy of Dermatology in 2003. The recommendations incorporated evidence-based strategies when possible and the collective clinical experience of the group when evidence was lacking. This update reviews new information about acne pathophysiology and treatment-such as lasers and light therapy-and relevant topics where published data were sparse in 2003 but are now available including combination therapy, revision of acne scarring, and maintenance therapy. The update also includes a new way of looking at acne as a chronic disease, a discussion of the changing role of antibiotics in acne management as a result of concerns about microbial resistance, and factors that affect adherence to acne treatments. Summary statements and recommendations are provided throughout the update along with an indication of the level of evidence that currently supports each finding. As in the original supplement, the authors have based recommendations on published evidence as much as possible.
    Journal of the American Academy of Dermatology 06/2009; 60(5 Suppl):S1-50. DOI:10.1016/j.jaad.2009.01.019 · 5.00 Impact Factor
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    ABSTRACT: Many innovations in acne therapy have evolved since the discovery in 1949 that vitamin A derivatives affected epidermal proliferation. Approval of topical tretinoin solution in 1971 was followed by modifications in the formulation to improve tolerability and provide flexibility in dosing. Identification of retinoid receptors led to research that resulted in 2 receptor-selective synthetic retinoids: adapalene and tazarotene. Today, topical retinoids are one of the cornerstones of acne therapy and are recommended as first-line therapy for all but the most severe forms of acne. They are used as monotherapy in mild comedonal acne; for inflammatory acne, topical retinoids are used in combination with benzoyl peroxide (BPO) and antibiotics (topical or oral) and/or hormonal therapy for females. Because of the high prevalence of antibiotic-resistant strains of Propionibacterium acnes, topical antibiotics should no longer be used as monotherapy. Topical retinoid monotherapy is recommended for maintenance because it prevents formation of microcomedones, the precursor lesions in acne. Combination topical retinoid/antimicrobial therapy has become the current recommended standard of care for the management of patients with acne. Combination therapy can target multiple pathogenic factors: abnormal follicular keratinization, P acnes proliferation, inflammation, and increased sebum production. A number of fixed-combination products are available. These products are effective, generally well-tolerated, and more convenient for patients than multiple individual agents. By reducing the number of medications and applications, fixed-combination products have the potential to improve patient adherence, thereby improving treatment outcomes.
    Cutis; cutaneous medicine for the practitioner 03/2009; 83(2 Suppl):4-15. · 0.59 Impact Factor

Publication Stats

7k Citations
549.37 Total Impact Points


  • 2011–2014
    • Johns Hopkins Medicine
      • Department of Dermatology
      Baltimore, Maryland, United States
  • 2011–2013
    • Johns Hopkins University
      • Department of Dermatology
      Baltimore, Maryland, United States
  • 1997–2013
    • University of Michigan
      • • Department of Dermatology
      • • Medical School
      Ann Arbor, Michigan, United States
  • 1996–2010
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
  • 2006
    • Pennsylvania State University
      University Park, Maryland, United States
  • 2005
    • University of California, Davis
      Davis, California, United States
  • 2004
    • Baylor University
      Waco, Texas, United States
  • 2002
    • Seoul National University
      • Department of Dermatology
      Sŏul, Seoul, South Korea
  • 2001
    • The University of Manchester
      Manchester, England, United Kingdom
  • 1999
    • Bristol-Myers Squibb
      New York City, New York, United States