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Archives of dermatology 09/2011; 147(9):1112-5. · 4.76 Impact Factor
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ABSTRACT: Morphea (localized scleroderma) is a skin disorder with significant morbidity. No consistent recommendations exist for therapy, impeding patient care.
We sought to create an evidence-based therapeutic algorithm.
We reviewed English-language literature using search engines and hand searches for therapeutic interventions in morphea. Results were summarized.
Narrowband ultraviolet B is appropriate for progressive or widespread superficial dermal lesions; broadband ultraviolet A/ultraviolet A-1 is appropriate for widespread or progressive deeper dermal lesions. Systemic treatment with methotrexate, corticosteroids, or both is indicated for deep or function-impairing lesions and rapidly progressive or widespread (severe) disease. Topical treatment with calcipotriene or tacrolimus is supported for limited, superficial, inflammatory lesions. Use of oral calcipotriol, D-penicillamine, interferon gamma, and antimalarials is not supported.
Limitations are publication bias; lack of adequately powered, controlled trials; and no validated outcome measures.
Phototherapy, methotrexate/systemic corticosteroids, calcipotriene, and topical tacrolimus have the most evidence for efficacy in morphea. Treatment works best in inflammatory disease. Disease activity, severity, progression, and depth should play a role in therapeutic decision making.
Journal of the American Academy of Dermatology 06/2011; 65(5):925-41. · 3.99 Impact Factor
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ABSTRACT: Frequent and excessive tanning persists despite a growing understanding of its associated morbidity and mortality, suggesting that ultraviolet radiation may impart rewarding effects beyond the assumed cosmetic benefits. To empirically measure putative centrally rewarding properties of ultraviolet radiation (UVR), we assessed the effects of a commercially available tanning bed upon regional cerebral blood flow (rCBF), a measure of brain activity, using single-photon emission computed tomography (SPECT). Seven frequent salon bed tanners were placed under a UVA/UVB tanning light during two sessions; one session with UVR and the other with filtered UVR (sham UVR). Session order was randomized and subjects were blinded to study order. During the UVR session, relative to sham UVR session, subjects demonstrated a relative increase in rCBF of the dorsal striatum, anterior insula and medial orbitofrontal cortex, brain regions associated with the experience of reward. These changes were accompanied by a decrease in the subjective desire to tan. These findings suggest that UVR may have centrally rewarding properties that encourage excessive tanning.
Addiction Biology 04/2011; 17(3):680-6. · 4.83 Impact Factor
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Archives of dermatology 09/2010; 146(9):1044-5. · 4.76 Impact Factor
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ABSTRACT: Ultraviolet radiation (UVR) phototherapy has been associated with both deleterious and beneficial effects to patients with both localized and systemic skin disorders. Phototherapy is advantageous in diseases of the epidermis and dermis, as it provides the most direct approach minimizing systemic side effects. Most recently, ultraviolet A1 (UVA1) phototherapy has emerged as a specific UVR phototherapeutic mechanism. It has shown to be therapeutic in a number of sclerosing skin conditions and other dermatitides, in many cases proving to be more effective than other phototherapy modalities. Treatment advantages of UVA1 phototherapy include the ability to penetrate into the deep layers of the skin to affect changes on disease-causing T cells, as well as activation of endothelial cells to promote neovascularization. UVA1 therapy also has been shown to be relatively free of side effects associated with other phototherapy regimens, including erythema and cellular transformation. These properties make UVA1 phototherapy an important treatment option for many debilitating skin conditions.
International journal of dermatology 06/2010; 49(6):623-30. · 1.18 Impact Factor
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ABSTRACT: To determine the prevalence of extracutaneous manifestations and autoimmunity in adult and pediatric patients with morphea.
A retrospective review of 245 patients with morphea.
University of Texas Southwestern Medical Center-affiliated institutions. Patients Patients with clinical findings consistent with morphea.
Prevalence of concomitant autoimmune diseases, prevalence of familial autoimmune disease, prevalence of extracutaneous manifestations, and laboratory evidence of autoimmunity (antinuclear antibody positivity). Secondary outcome measures included demographic features.
In this group, adults and children were affected nearly equally, and African Americans were affected less frequently than expected. The prevalence of concomitant autoimmunity in the generalized subtype of morphea was statistically significantly greater than that found in all other subtypes combined (P = .01). Frequency of a family history of autoimmune disease showed a trend in favor of generalized and mixed subgroups. The linear subtype showed a significant association with neurologic manifestations, while general systemic manifestations were most common in the generalized subtype. Antinuclear antibody positivity was most frequent in mixed and generalized subtypes.
High prevalences of concomitant and familial autoimmune disease, systemic manifestations, and antinuclear antibody positivity in the generalized and possibly mixed subtypes suggest that these are systemic autoimmune syndromes and not skin-only phenomena. This has implications for the management and treatment of patients with morphea.
Archives of dermatology 06/2009; 145(5):545-50. · 4.76 Impact Factor
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ABSTRACT: We review the field of photoimmunology with emphasis on immunosuppression induced by ultraviolet B radiation. Recent studies have focused on UVB-induced alterations in epidermal Langerhans cell function, resulting in a shift from Th1 to Th2 phenotype and the activation of regulatory T cells as the source of IL-10 that is central to this form of immunosuppression.
Seminars in Immunopathology 05/2007; 29(1):65-70. · 6.27 Impact Factor
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ABSTRACT: Argyria is a rare skin disease caused by cutaneous deposition of silver granules in the skin as a result of exposure to silver substrate or ingestion of silver salt. This report describes a patient with generalized argyria caused by ingestion of homemade colloidal silver solution. The patient learned about the uses of the silver solution and its preparation at a convention for "natural medicine."
Journal of the American Academy of Dermatology 09/2005; 53(2 Suppl 1):S105-7. · 3.99 Impact Factor
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ABSTRACT: Good outcome measures are required to determine whether a therapy is effective, both in routine clinical practice and in experimental clinical trials. In disorders of skin thickening such as morphea and scleroderma, more commonly used outcome measures that use a subjective score based on palpated skin thickening are fraught with error. By contrast, measurements made by ultrasound have great promise as outcome measures that are quantitative, valid, reproducible, and responsive. Further studies should establish its role in the field. In this paper, the present authors used ultrasound to illustrate the criteria that are required to establish a technology-based outcome measure.
Dermatologic Therapy 20(2):86-92. · 1.69 Impact Factor
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Dermatologic Therapy 20(2):75-6. · 1.69 Impact Factor
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ABSTRACT: Outcomes (a variable intended for comparison between groups) are integral to the design, conduct, and data analysis of a clinical trial. They are broadly divided into four categories: physician based, patient reported, economic based, and technology based. Each is used in dermatology to some degree, but no consensus exists as to what type of outcome or degree of validation should be employed. This is problematical because poor quality outcomes or their incorrect use may invalidate the results of a clinical trial. Despite their importance, outcome measures in dermatology receive little attention. The present authors aim to provide an overview of important considerations for outcome measures and a practical approach to their analysis.
Dermatologic Therapy 20(2):77-85. · 1.69 Impact Factor
