Tania Phillips

Boston University | BU · Department of Dermatology

Xanthoma disseminatum (XD) is a rare disease that presents with pruritic papules, classically involving the extensor surfaces and mucosal areas. We present a case of XD that was misdiagnosed as eruptive xanthomas and eventually self-resolved. Self-resolving XD may be within a spectrum of adult-onset juvenile xanthogranuloma. However, as there may b...

Ulcers are skin injuries that result in complete absence of the epidermis. They result from a diverse range of underlying diseases. Because they frequently reflect the presence of underlying disease states, accurate diagnosis is imperative. This chapter reviews cutaneous ulcers with an emphasis on diabetic ulcers, pressure ulcers, vasculitic ulcers...

Wound healing is a complex and energy-demanding process. The relationship between nutrition and wound healing has been recognized for many centuries. Several studies have indicated that nutritional deficiencies are more prevalent among patients with chronic wounds. Malnutrition may alter the inflammatory response, collagen synthesis, and wound tens...

Chronic wounds impose a major burden on the individual and healthcare system, accounting for significant morbidity, decreased quality of life, and high costs. Despite the development of various advanced therapeutic modalities, chronic wounds remain extremely difficult to treat. Lasers, well-known for their use in a variety of dermatologic procedure...

Though preventable in most cases, pressure ulcers continue to pose a major burden to the individual and society, affecting ≤3 million adults annually in the United States alone. Despite increased national attention over the past 20 years, the prevalence of pressure ulcers has largely remained unchanged, while the associated costs of care continue t...

Prevention has been a primary goal of pressure ulcer research. Despite such efforts, pressure ulcers remain common in hospitals and in the community. Moreover, pressure ulcers often become chronic wounds that are difficult to treat and that tend to recur after healing. Especially given these challenges, dermatologists should have the knowledge and...

Ayman Grada,1 Zaidal Obagi,2 Tania Phillips11Department of Dermatology, Boston University School of Medicine, Boston, MA, USA; 2University of Toledo College of Medicine and Life Sciences, Toledo, OH, USACorrespondence: Ayman GradaDepartment of Dermatology, Boston University School of Medicine, Boston, MA 02118, USATel +1 317 525 5247Email Grada@bu....

Lymphedema is a localized form of tissue swelling resulting from excessive retention of lymphatic fluid in the interstitial compartment. It is caused by impaired lymphatic drainage. Lymphedema is a chronic progressive disease with serious physical and psychosocial implications. It can be challenging to diagnose, especially in obese patients and in...

Lymphedema is a localized form of tissue swelling resulting from excessive retention of lymphatic fluid in the interstitial compartment and caused by impaired lymphatic drainage. Lymphedema is classified as primary or secondary. Primary lymphedema is caused by developmental lymphatic vascular anomalies. Secondary lymphedema is acquired and arises a...

Diffuse dermal angiomatosis of the breast (DDAB) is an uncommon ulcerative angiomatosis, which occurs in middle aged women with large pendulous breasts, a history of cigarette smoking, and risk factors for atherosclerosis. Based on its rarity, no well-defined therapeutic regimen has been elucidated. We report a case of DDAB in a woman with no histo...

Both inherited and acquired hypercoagulable states can present with nonspecific clinical manifestations, such as petechiae, purpura, livedo reticularis, and ulcerations. A good history and physical examination are crucial to diagnoses of these conditions. Inherited conditions tend to present either in neonatal period or later in life, while acquire...

Hypercoagulable states are inherited or acquired predispositions to venous or arterial thromboses that are best understood in the context of the coagulation cascade. Dermatologists can play a critical role in diagnosing and treating patients with hypercoagulable states because cutaneous symptoms may be a presenting manifestation, thereby reducing m...

In the United States, chronic ulcers - including decubitus, vascular, inflammatory, and rheumatologic subtypes - affect >6 million people, with increasing numbers anticipated in our growing elderly and diabetic populations. These wounds cause significant morbidity and mortality and lead to significant medical costs. Preventative and treatment measu...

Wounds are an excellent example of how the field of dermatology represents a cross-section of many medical disciplines. For instance, wounds may be caused by trauma, vascular insufficiency, and underlying medical conditions, such as diabetes, hypertension, and rheumatologic and inflammatory disease. This continuing medical education article provide...

Venous leg ulcers account for approximately 70% of all leg ulcers and affect 2.2 million Americans annually. After a comprehensive patient and wound assessment, compression therapy remains the cornerstone of standard care. Adjuvant care with topical or systemic agents is used for wounds that do not heal within 4 weeks. Once healed, long-term compre...

Leg ulcerations are a common problem, with an estimated prevalence of 1% to 2% in the adult population. Venous leg ulcers are primarily treated in outpatient settings and often are managed by dermatologists. Recent advances in the diagnosis and treatment of leg ulcers combined with available evidence-based data will provide an update on this topic....

Treating posttraumatic lower extremity wounds can be challenging, especially in elderly patients. Recently, the use of fractional carbon dioxide laser has been shown to improve wound healing in scar-related wounds. We used this treatment modality in posttraumatic wounds that were slow to heal in 3 elderly patients. Each wound underwent one fraction...

A 34-year-old Haitian man presented with a 1-year history of a gradually en- larging, ulcerating nodule on the right posterior ankle that bled after trauma. The patient denied any history of prior trauma at the site of the lesion and foreign travel.There were no HIV risk factors or personal or family history of skin cancer.The patient was otherwise...

Chronic, nonhealing ulcers are a frustrating therapeutic challenge and investigation of innovative therapies continues to be an important research pursuit. One unique and newly applied intervention is the use of ablative fractional lasers. This technology has recently been employed for the treatment of hypertrophic, disfiguring and function-limitin...

PURPOSE:: The purpose of this learning activity is to provide information about the etiology and treatment of atrophie blanche. TARGET AUDIENCE:: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES:: After participating in this educational activity, the participant should be b...

Significance: Chronic wounds are a major healthcare burden.The practitioner should have an appropriate understanding of both the etiology of the wound as well as the optimal type of dressings to use. Fundamental wound characteristics may be used to guide the practitioner's choice of dressings. The identification of optimal dressings to use for a pa...

The goals of this study were to analyze the 2010 update of the Association for the Advancement of Wound Care (AAWC) Venous Ulcer Guideline (VUG) and examine recommendations with less than A-level evidence to identify important research questions. The AAWC VUG may be found at http://aawconline.org/professional-resources/resources and at the National...

Livedoid vasculopathy (LV) is a noninflammatory thrombotic condition presenting in a primary idiopathic or secondary subtype associated with abnormal coagulation factors. Different from atrophie blanche (AB), which is a clinical manifestation of certain scars, LV may have AB in combination with recurrent livedo reticularis with chronic and painful...

Cutaneous changes are a common feature of chronic venous insufficiency and include venous eczema and lipodermatosclerosis. This review will address the presumed pathophysiology of these conditions, their clinical findings, and important management strategies.

Covering wounds, acute and chronic, is one of the most fundamental activities of any medical practitioner. Although wound dressings primarily serve to contain the "good" and keep out the "bad," research has characterized more specifically the sophisticated interaction between the human wound bed and its dressing counterpart. Wound dressings for tod...

Watch any marathon or triathlon, and you will see knee-high stockings you thought were reserved for vasculopaths and pregnant women (Figure). “Compression sportswear” appears to be the latest twist on the beloved compression stocking. TheNew York Times first reported the trend in 2008, when they wrote that 415 of the 1677 competitors in the Ford Ir...

The management of acute and chronic wounds has drastically changed within the past 20 years. This update focuses on the most recent recommendations for acute wound care as well as new technologies that are available for chronic wounds.

Nutrition is an important component of wound healing. Several studies have indicated that nutrient deficiencies are more prevalent and cause delayed healing in patients with wounds. The exact role for nutrition and nutritional supplementation in the management of wounds remains uncertain, however. This contribution reviews available data regarding...

To evaluate the possible association of Parkinson disease (PD) and melanoma in North America. Thirty-one centers enrolled patients with idiopathic PD. At visit 1, a neurologist obtained a medical history. At visit 2, a dermatologist recorded melanoma risk factors, performed a whole-body examination, and performed a biopsy of lesions suggestive of m...

Treatment of venous leg ulcers (VLU) represents a considerable challenge to the health care professional and to the patient alike. Much of the current literature regarding VLU focuses on either wound pathophysiology and treatment of chronic venous insufficiency or the patients' experience of the condition. We present two studies that examine more c...

This investigation was conducted to determine if a correlation exists between wound healing outcomes and serial debridement in chronic venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs). We retrospectively analyzed the results from two controlled, prospective, randomized pivotal trials of topical wound treatments on 366 VLUs and 310 DFUs over...

The purpose of this manuscript was to determine whether the change in wound surface area over time could be described through nonlinear mathematics. We studied 3,588 serial wound tracings of 338 venous leg ulcers (VLUs) that had been followed during a controlled, prospective, randomized trial of two topical wound treatments. A majority (72%) of VLU...

In postmenopausal women, declining estrogen levels are associated with a variety of skin changes, many of which are reportedly improved by estrogen supplementation. A study was conducted to assess the effects of continuous combined norethindrone acetate (NA) and ethinyl estradiol (EE) in the control of mild to moderate age-related skin changes in p...

This study was undertaken to determine if healing rates are reliable early predictors of ultimate complete wound closure in venous leg ulcers and diabetic foot wounds. We conducted a retrospective analysis of 306 venous leg ulcers and 241 diabetic foot ulcers enrolled in two large controlled, prospective, randomized pivotal trials to compare topica...

Chronic venous ulceration is a common and important medical problem, which causes significant morbidity. Venous ulcers are expensive to treat, have substantial economic effects in terms of days of work lost, and adversely impact patient's quality of life. History and clinical findings are helpful in making the diagnosis of venous ulceration, but ad...

Evidence-based practice for venous ulcers may improve healing and reduce costs of care. The Association for the Advancement of Wound Care Government and Regulatory Task Force developed a content-validated venous ulcer guideline based on best available evidence supporting each aspect of venous ulcer care. After compiling all-inclusive lists of eleme...

Apligraf is a bilayered tissue-engineered product consisting of a bovine collagen matrix with neonatal fibroblasts, overlaid by a stratified epithelium containing living keratinocytes. The United States Food and Drug Administration has approved its use for venous leg ulcers and neuropathic diabetic foot ulcers. Apligraf provides a dermal matrix and...

The first gel formulation of ketoconazole has been tested in 2-week treatment courses. To evaluate the efficacy and safety of a new, once-daily, 2-week ketoconazole 2% gel treatment in moderate to severe seborrheic dermatitis. Four hundred fifty-nine subjects with moderate to severe seborrheic dermatitis were randomized to receive ketoconazole 2% g...

Delayed wound healing often occurs in the elderly, imposing significant medical, financial, and social burdens upon the patient and society. Post-menopausal decline in estrogens may negatively impact wound healing in the geriatric population. This article presents an overview of animal and human data on androgens and estrogens and their potential r...

A proportion of chronic wounds fail to heal in response to standard therapy. For venous leg ulcers, a correlation exists between longer duration before treatment initiation and poor healing response to compression therapy. Differences identified between the healing wound microenvironment and that of the non healing chronic wound suggests that many...

A 73-year-old white woman presented to the wound clinic with a chronic wound on the dorsum of her left second toe. The patient reported that the wound developed 3 years after cryotherapy to the toe. She had tried many different dressings and ointments on the wound without improvement. She noted that the wound had grown in size over several months p...

Unlabelled: Aging is associated with declining levels of several hormones, including estrogen. Although the effects of estrogen on the skin are still not fully understood, it is known that, in women, declining estrogen levels are associated with a variety of cutaneous changes, many of which can be reversed or improved by estrogen supplementation....

A 63-year-old white woman presented with a rash on all extremities and the face, conjunctivitis, and painful perioral and oral mucosal erosions. Her past medical history was significant for lung cancer, diagnosed 1 year prior to presentation, which was currently in remission. The patient also had a past medical history of dry eye syndrome and hyper...

The results from four phase III, randomized, vehicle-controlled studies showed that imiquimod 5% cream (imiquimod) was safe and effective in the treatment of actinic keratosis (AK). Patients applied imiquimod or vehicle cream to AK lesions on the face or balding scalp, dosing three times per week or two times per week for 16 weeks. To obtain long-t...

Wound-healing in the skin is a complex orchestration of cellular processes, which has been perfected throughout the eons of phylogeny. It has so many coordinated biologic processes invoked both simultaneously and in a regulated orderly fashion that it has been likened to a recapitulation of gestation. Part of the problem with studying wound healing...

A 49-year-old White female was referred for evaluation of a warty lesion, which had been present on her abdomen for 3 months. It had not responded to liquid nitrogen treatment or over-the-counter wart treatments. The lesion had gradually become more irritated and had increased in size. The patient had a 10-year history of rheumatoid arthritis and a...

Adapalene, tazarotene, and tretinoin are topical retinoids that are approved by the US Food and Drug Administration (FDA) and have overall favorable safety profiles. These agents are effective in a variety of skin disorders. Local adverse events, seen especially during the early course of treatment, include peeling, erythema, dryness, burning, and...

Wound fluid collected from chronic venous leg ulcers (chronic wound fluid (CWF)) has been shown to inhibit the growth of dermal fibroblasts by interfering with cell-cycle progression from G1 into S phase. Specifically, CWF was shown to downregulate the levels of hyperphosphorylated retinoblastoma tumor-suppressor gene (Rb) and cyclin D1, known to b...

Long-term (>1 year) placebo-controlled studies of tretinoin in the treatment of photodamaged skin have not been conducted. Recently, we conducted a 2-year placebo-controlled study of tretinoin emollient cream 0.05%, including histopathologic assessment of safety and analysis of markers of collagen deposition. The objective of the study was to deter...

A 25-year-old African American woman with a four-year history of dermatomyositis (DM) presented with an ulcer in the right popliteal fossa of five weeks duration. Initially, the patient was diagnosed with DM based on typical heliotrope rash, photosensitivity, high creatinine kinase (CK), and interstitial lung disease. Her serology for other connect...

A 51-year-old Hispanic female with poorly controlled insulin-dependent diabetes mellitus (IDDM) presented with an ulcer on the left leg. The lesion developed one month prior to presentation as a mildly pruritic erythematous papule resembling an insect bite, which gradually increased in size and ruptured to form a crusted ulcer. The clinical history...

An 85-year-old Black woman was referred for consultation regarding a necrotic ulcer over her left chest. Her past medical history was significant for breast cancer treated by radical mastectomy and radiation therapy 28 years previously. Physical examination revealed a pleasant, underweight Black woman who was alert and oriented. The authors discuss...

The authors present a case of ulcerated Kaposi's sarcoma and discuss the pathology and treatment options. The local treatments include cryotherapy, surgical excision, laser, and intralesional therapy. In addition to alitretinoin gel, the authors discuss other topicals that are emerging, e.g., antivirals and immune response modifiers. The authors de...

Estrogens improve skin thickness, decrease dryness, may improve fine wrinkling and elasticity, and contribute to improved wound healing. Although we do not advocate estrogen therapy for these cutaneous indications, women taking HRT for post-menopausal symptoms may experience beneficial effects on the skin. Data from the HERS32 and WHI2 studies have...

Excessive sebum production is a central aspect of the pathophysiology of acne vulgaris. Sebaceous gland function is under androgen control and it is hypothesized that dihydrotestosterone is formed by the action of 5 alpha-reductase. Type I is the controlling isoenzyme. This study describes a 3-month, multicenter, randomized, placebo-controlled clin...

A 57-year-old African-American woman presented with a three-year-history of arthritis and changes in the quality of her skin. Over the past year, the skin on the medial aspect of the foot had ulcerated, and she was concerned about the large amount of drainage from the wound. She also complained of joint stiffness and pain, muscle cramps, and Raynau...

In this review, unusual causes of leg ulcers are examined with an emphasis on pathophysiology, clinical presentation, and epidemiology. Cutaneous ulcers due to malignancy of unusual leg ulcers with hematologic disorders, vasculitis, sarcoidosis, calciphylaxis, Buerger's disease, and pyoderma gangrenosum are discussed.

To determine the safety and efficacy of photodynamic therapy (PDT) using 20% wt/vol aminolevulinic acid hydrochloride (hereinafter "ALA") and visible blue light for the treatment of multiple actinic keratoses of the face and scalp. Randomized, placebo-controlled, uneven parallel-group study. Patients (N = 243) were randomized to receive vehicle or...

A 78-year-old gentleman was referred for a non-healing ulcer in the left axilla. The history and physical examination combined with the biopsy results revealed a diagnosis of BCC. In this article, the presentation, significant physical findings, etiology, and treatment plans for the patient are discussed.

A previously healthy 71-year-old Caucasian woman presented with an ulcer on her left leg. She had a 5-month history of bilateral, indurated erythematous, and had purplish nodules and plaques on both lower extremities. One of the plaques on the right leg had ulcerated and healed spontaneously. The present ulceration began as a small opening at an in...

Ultraviolet (UV) irradiation to the skin causes apoptosis of keratinocytes. Melanocytes are more resistant to UV-induced apoptosis, due, in part, to high levels of antiapoptotic proteins such as Bcl-2. In vitro studies have shown that nerve growth factor (NGF), a neurotrophic polypeptide, is produced by keratinocytes and exerts a protective role fo...

A bilayered skin substitute has been heavily promoted for the treatment of venous ulcers and other wounds on the basis that it is composed of viable cells. How long do these living cells survive? The study by Phillips and colleagues1 entitled "The Longevity of a Bilayered Skin Substitute After Application to Venous Ulcers" appears to address this i...

1 +Bello YMHoss DKhachemoune APhillips TJ Diagnostic dilemmas. Wounds. 2000;1248- 502 +Wagner LKMcNeese MDMarx MVSiegel EL Severe skin reactions from interventional fluoroscopy: case report and review of the literature. Radiology. 1999;213773- 776Link to Article[[XSLOpenURL/10.1148/radiology.213.3.r99dc16773]]3 +Shope TB Radiation-induced skin inju...

Recent studies indicate that exogenous estrogens may promote wound healing. Many laser skin resurfacing (LSR) patients use hormone replacement therapy (HRT) or oral contraceptive pills (OCPs). To evaluate the effect of exogenous estrogen on LSR postoperative healing. This is a retrospective case control study of 44 female patients who underwent com...

BACKGROUND: Recent studies indicate that exogenous estrogens may promote wound healing. Many laser skin resurfacing (LSR) patients use hormone replacement therapy (HRT) or oral contraceptive pills (OCPs). OBJECTIVE: To evaluate the effect of exogenous estrogen on LSR postoperative healing. METHODS: This is a retrospective case control study of 44 f...

Exposure to UV radiation is a major risk factor for skin cancer, including malignant melanoma. Photocarcinogenesis is caused largely by mutations at sites of incorrectly repaired DNA photoproducts, of which the most common is the thymine dimer. Over the past decade, controversy has arisen over the use of sunscreens to prevent UV-induced skin cancer...

To determine the efficacy and safety of 0.1% tazarotene cream for the treatment of photodamage. A 24-week multicenter, double-blind, randomized, vehicle-controlled intervention study followed by a 28-week open-label extension. Ambulatory patients in private and institutional practice. Of 563 patients with facial photodamage, 91% and 86% completed t...

A 55-year old Caucasian woman presented to the clinic complaining of skin lesions on both shins. There were erythematous, yellow plaques on both anterior shins of the lower extremities. There were also superficial ulcers on both shins. The patient was diagnosed with pretibial myxedema. In this article, the presentation, significant physical finding...

Diabetes mellitus is a chronic disease of metabolic dysregulation involving the abnormal metabolism of glucose. Diabetes has a significant impact on the healthcare costs of the Western world. Nearly all patients with diabetes eventually develop cutaneous manifestations of the disease. Cutaneous signs of the disease can heighten the suspicions of a...

A bilayered skin substitute composed of allogeneic keratinocytes and fibroblasts in a collagen gel has been approved by the US Food and Drug Administration for the treatment of venous and diabetic ulcers. Its mechanism of action has not been fully determined. To determine the longevity of allogeneic fibroblasts and keratinocytes in a bilayered skin...

A 40-year-old Caucasian woman with systemic lupus erythematosus presented with a 10-day history ot blisters on her right shin. In this article, the presentation, significant physical findings, etiology, and treatment plans for the patient are discussed.

Cryopreserved epidermal cultures (CEC) offer an "off the shelf" treatment for chronic wounds. These cultures are derived from neonatal foreskin and grow rapidly in vitro to form epidermal sheets. They do not require a biopsy from the patient, an advantage compared to autografts. They seem to act as a biological dressing, stimulating epithelializati...

background.Cryopreserved epidermal cultures (CEC) offer an “off the shelf” treatment for chronic wounds. These cultures are derived from neonatal foreskin and grow rapidly in vitro to form epidermal sheets. They do not require a biopsy from the patient, an advantage compared to autografts. They seem to act as a biological dressing, stimulating epit...

To assess the safety and efficacy of 4 concentrations of tazarotene cream in the treatment of facial photodamage. Prospective weekly multicenter, investigator-masked, randomized, parallel-group study. University hospitals and clinical research centers. Three hundred forty-nine subjects with facial photodamage. Daily topical application of tazaroten...

Although no formal recommendations appear in the literature, the majority of data suggest that, in addition to ameliorating many menopausal symptoms, HRT with estrogen can have beneficial effects on the skin. In particular, estrogens may improve fine wrinkling, dryness, elasticity, and collagen content of postmenopausal skin. Estrogen also may impr...

Objective To assess the safety and efficacy of 4 concentrations of tazarotene cream in the treatment of facial photodamage.Design Prospective weekly multicenter, investigator-masked, randomized, parallel-group study.Setting University hospitals and clinical research centers.Patients Three hundred forty-nine subjects with facial photodamage.Inte...

Background: To meet the challenge of an aging population, providers and payors must optimize chronic wound care outcomes and contain costs. Objective: To explore the costs, outcomes, and effects of outcomes on costs of pressure and venous ulcer woundcare protocols. Design: Modeling study using outcomes from a literature review. Methods: The cost of...

Wound fluid collected from chronic venous leg ulcers (CWF) was previously reported to inhibit the growth of newborn dermal fibroblasts (NbFb) in part by modulating cell cycle-regulatory proteins. 1 The growth inhibitory activity in CWF was shown to be heat sensitive, 2 suggesting that a medical device that warms leg ulcers may assist in healing. In...

A 94-year-old Caucasian man with classic type Kaposi's sarcoma presented with an ulcer on the medial side of his left foot. In the following article, we describe the presentation, significant physical exam findings, and discuss the etiology and treatment plans for this patient.

About 600,000 people in the United States are estimated to be affected by venous ulcers. The cornerstone of care of chronic venous ulcers involves the application of compression bandages. Other therapies include treatment of associated infection, treatment for edema and inflammation, and debridement when necessary. Repifermin, a recombinant human K...

A 57-year-old Caucasian woman with spina bifida presented with an ulcer on the lateral side of her left foot. In the following article, we describe the presentation and significant physical exam findings and discuss the etiology and treatment plans for our patient.

Venous ulcers affect as many as 2.5 million people in the United States and can cause substantial pain and loss of function. To review current approaches to venous ulcers and compression. Treatment options that have been proposed in the literature are discussed utilizing the Cochrane library database, Medline, and the author's clinical experience....

J Am Acad Dermatol 2001;45:118-9.