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ABSTRACT: Hidradenitis suppurativa (HS) and pyoderma gangrenosum (PG) are both rare inflammatory skin conditions that are associated with systemic inflammatory diseases. We performed a retrospective medical chart review of patients with an overlap of HS and PG.
We identified 11 cases of PG lesions presenting in patients with HS. Ten of the patients were women, and 9 were obese. All the patients developed HS lesions first, a median of 2.5 years (range, 0-15 years) preceding the appearance of PG lesions. All patients required multiple therapeutic agents because their diseases were often poorly responsive to standard therapies. Two patients received tumor necrosis factor inhibitors; 1 responded to treatment. One patient was treated with anakinra (interleukin-1 receptor antagonist) and had a 75% improvement of her lesions.
We have identified a group of patients who have an overlap of PG and HS. Pyoderma gangrenosum can appear at any point after the development of HS and often has a severe, refractory course. We propose that PG and HS may represent variant manifestations of cytokine dysregulation by the innate immune system with common etiology. New therapeutic agents are eagerly sought, and further investigation with regard to interleukin 1 blockade is warranted.
Archives of dermatology 11/2010; 146(11):1265-70. · 4.76 Impact Factor
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ABSTRACT: With the incidence of skin cancers continuing to increase, traditional clerkships may not be sufficient to teach medical students important detection and management skills.
We performed a randomized study to determine the efficacy of the online curriculum, eDerm.
Students were randomized to complete eDerm before or after clerkship (arm 1 vs 2) and were tested at 3 time points, including at baseline. The crossover design examined eDerm and clerkship, and the sequential effect of both.
In all, 252 participants completed all interventions and testing. Diagnosis and management scores significantly improved in both arms (P < .001; P < .001), reflecting increased scores after taking both eDerm and clerkship. eDerm after clerkship resulted in the highest improvement in diagnosis (P = .005), and eDerm improved the detection of melanoma significantly better than clerkship (malignant, P < .001; pigmented, P < .001).
We did not perform delayed testing of medical students for learning retention.
eDerm significantly improves the diagnosis and management of nonpigmented and pigmented skin lesions by medical students. It can be used as an alternative to a traditional 2-week clerkship if one is not available. Importantly, melanoma detection improved significantly more after eDerm than clerkship. When used as a supplement, eDerm administered after a clerkship will result in the highest level of overall learning.
Journal of the American Academy of Dermatology 11/2010; 65(6):e165-71. · 3.99 Impact Factor
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Journal of Cutaneous Pathology 02/2010; · 1.56 Impact Factor
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ABSTRACT: Dermal mucinoses are a heterogeneous group of disorders characterized by abnormal deposition of dermal mucin, an amorphous substance composed of hyaluronic acid and sulfated glycosaminoglycans. We describe two cases of dermal mucinosis in the setting of chronic venous insufficiency. Both patients presented with painful, edematous lower extremity plaques. Biopsies of all lesions showed striking dermal mucin deposition, a slight increase in small blood vessel density, slightly thickened vessel walls and no inflammation. Neither patient showed laboratory or clinical findings consistent with a secondary mucinosis such as thyroid dysfunction, lupus erythematosus, dermatomyositis, scleroderma, granuloma annulare, graft-vs.-host disease or mucin deposition post-ultraviolet or photochemotherapy treatment. Both patients were diagnosed with localized cutaneous mucinosis secondary to venous insufficiency. The clinicopathological features of this entity are described, and a pathogenic mechanism is proposed.
Journal of Cutaneous Pathology 08/2009; 37(2):292-6. · 1.56 Impact Factor
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ABSTRACT: Relapsing polychondritis is a rare autoimmune disease characterized by inflammation and degeneration of cartilaginous tissue. We describe the first reported cases of relapsing polychondritis in patients with human immunodeficiency virus (HIV) and no associated connective tissue diseases. The relationship between autoimmune and HIV diseases is complex and unclear. Treatment of HIV disease with antiretroviral therapy and subsequent immune restoration may lead to the development of autoimmune diseases in genetically susceptible individuals.
Journal of the American Academy of Dermatology 01/2005; 51(6):1023-5. · 3.99 Impact Factor
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ABSTRACT: To evaluate safety and efficacy of thalidomide in the treatment of prurigo nodularis in a group of human immunodeficiency virus (HIV)-infected patients whose condition was recalcitrant to standard treatment.
Prospective study.
Outpatient dermatology and neurology clinic, both referral settings.
Eight HIV-infected patients with refractory prurigo nodularis; a total of 10 met inclusion criteria, but 2 could not be followed up.
Treatment with thalidomide, 100 mg/d. Subjects were randomized after 1 month to receive 100 or 200 mg/d. If side effects were noted, the drug was reduced to a tolerable dose or discontinued. Subjects were monitored at baseline and monthly for degree of pruritus and total area of body involvement of prurigo nodularis. Sequential neurologic assessments were performed.
Efficacy and toxic effects.
The dosage of thalidomide ranged from 33 to 200 mg/d. Eight subjects had a greater than 50% response in reduction of itch over 3.4 months (average). Seven subjects had a greater than 50% reduction of skin involvement over 5 months (average). Three subjects developed thalidomide peripheral neuropathy (TPN). There was no correlation between duration of treatment, daily or cumulative dose, and TPN. A change in the Neuropathy Impairment Score of 10 points was a good marker of TPN, as was a greater than 50% decrease in the sural sensory nerve action potential amplitude.
Thalidomide reduced the signs and symptoms of prurigo nodularis in HIV-infected subjects. One third of subjects developed TPN, underscoring the importance of careful neurologic assessment.
Archives of Dermatology 08/2004; 140(7):845-9. · 3.89 Impact Factor
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ABSTRACT: To illustrate the potential for aggressive growth of cutaneous squamous cell carcinomas (SCCs) in patients infected with the human immunodeficiency virus (HIV) and to determine the factors associated with increased morbidity and mortality from aggressive SCCs in HIV-infected patients.
Retrospective nonrandomized case series.
University-based dermatologic referral center.
A consecutive sample of 10 patients infected with HIV who had "aggressive" SCC based on the following criteria: diameter larger than 1.5 cm, rapid growth rate, local recurrence, and/or evidence of metastasis.
Morbidity and mortality.
Five patients died of metastatic SCC within 7 years of their initial diagnosis despite treatment. Human immunodeficiency virus stage and the degree of immunosuppression were not associated with increased morbidity and mortality. Patients initially undergoing combination surgery and radiation therapy or radical neck dissection had the best outcomes.
Patients infected with HIV can develop rapidly growing cutaneous SCCs at a young age, with a high risk of local recurrence and metastasis. High-risk SCCs should be managed aggressively and not palliatively in patients infected with HIV.
Archives of Dermatology 07/2002; 138(6):758-63. · 3.89 Impact Factor
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ABSTRACT: To determine the efficacy of an Internet-based skin cancer triage intervention for physicians.
Physicians were randomly assigned to an intervention group or a control group. The 14 outcome measures included diagnosis and evaluation planning for malignant melanoma, basal cell carcinoma, and squamous cell carcinoma.
Forty-six physicians (27 of 39 in the intervention group) completed the program. The intervention group scored significantly higher than did the control group in nine of 14 outcome measures; this improvement was maintained for five of the nine outcomes.
The Internet intervention improved physicians' skin cancer diagnosis and evaluation planning test performances.
Journal of Cancer Education 02/2002; 17(1):7-11. · 0.76 Impact Factor
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Journal of drugs in dermatology: JDD 3(4):452-5. · 1.57 Impact Factor
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ABSTRACT: Background
Hidradenitis suppurativa (HS) and pyoderma gangrenosum (PG) are both rare inflammatory skin conditions that are associated with systemic inflammatory diseases. We performed a retrospective medical chart review of patients with an overlap of HS and PG.
Archives of Dermatology 146(11):1265-1270. · 3.89 Impact Factor
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ABSTRACT: Background and Design:
This study determines (1) the readiness of primary care physicians (PCPs) to triage optimally lesions suspicious for skin cancer, (2) the difference in their abilities from those of dermatologists, and (3) whether accurate diagnosis after viewing slide images transfers to accurate diagnosis after viewing lesions on patients. Seventy-one primary care residents and 15 dermatologists and resident dermatologists diagnosed and selected a treatment/diagnostic plan for skin lesions suspicious for cancer. The lesions were shown on slides, computer images, and patients. Participants' performance was compared with biopsy results of all lesions.
Archives of Dermatology 132(9):1030-1038. · 3.89 Impact Factor
