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Analysis of a New York Times Article on the Public’s Perception of Dermatologists

from ArchDerm - 01 Jul 14

The American Academy of Dermatology (AAD) formally responded on January 21, 2014, to the New York Times article “Patients’ Costs Skyrocket; Specialists’ Incomes Soar,” by Elisabeth Rosenthal published on January 19, 2014 (part 6 of the “Paying Till it Hurts” series). The AAD’s statement was certainly sensible, and defending one’s specialty from potentially misleading and biased information is a worthy pursuit.



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Low-Dose Interleukin 2 to Reverse Alopecia Areata

from ArchDerm - 01 Jul 14

Cytokines have long been postulated to play a role in alopecia areata (AA), and antigen-specific scalp T cells from patients with extensive AA have been found to have an intrinsic defect in the production of TH1 cytokines such as interferon gamma and interleukin 2 (IL-2). In the interesting study presented by Castela et al, 5 patients with extensive AA were treated with low-dose IL-2, and 4 of the 5 patients attained considerable hair regrowth. This was accompanied by an increase in regulatory



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Durable Remission of Pemphigus With a Fixed-Dose Rituximab Protocol

from ArchDerm - 01 Jul 14

ImportanceRituximab induces B-lymphocyte apoptosis by targeting CD20 antigen and has shown efficacy in antibody-mediated autoimmune disease. Rituximab is increasingly being acknowledged as an effective and safe treatment option for pemphigus.ObjectiveTo assess the clinical response of patients with pemphigus to rituximab using a modified fixed-dose rheumatoid arthritis protocol (1 g intravenously on days 1 and 15, followed by 500 mg intravenously if clinically warranted at 6-month intervals or r



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Outcomes After Diagnosis of Mycosis Fungoides and Sézary Syndrome Before 30 Years of Age A Population-Based Study

from ArchDerm - 01 Jul 14

ImportanceMycosis fungoides and Sézary syndrome (MF/SS) are rare in children and young adults, and thus the incidence and outcomes in this patient population are not well studied.ObjectiveTo assess the incidence and outcomes of MF/SS in patients diagnosed before 30 years of age.Design, Setting, and ParticipantsRetrospective study of 2 population-based cancer registries—the California Cancer Registry (n = 204) and 9 US cancer registries of the Surveillance, Epidemiology, and End Results program (



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Effect of Host, Tumor, Diagnostic, and Treatment Variables on Outcomes in a Large Cohort With Merkel Cell Carcinoma

from ArchDerm - 01 Jul 14

ImportanceMerkel cell carcinoma (MCC) is a rare, aggressive, neuroendocrine-derived skin cancer with high rates of recurrence and associated mortality. Few published studies have used comprehensive patient data and long-term follow-up to examine factors that predict MCC outcomes.ObjectiveTo characterize MCC in a large defined-population cohort and analyze predictors of disease recurrence and survival.Setting, Design, and ParticipantsRetrospective cohort study of 218 patients with MCC from the ca



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Identification of Clinical Features and Autoantibodies Associated With Calcinosis in Dermatomyositis

from ArchDerm - 01 Jul 14

ImportancePrior studies have estimated that up to 20% of adults with dermatomyositis (DM) have calcinosis, which can lead to significant morbidity. Identification of risk factors may provide a better understanding of the pathogenesis and ultimately therapy for this difficult clinical problem. Risk factors for calcinosis in adults with DM have not been extensively studied.ObjectivesTo determine the prevalence of calcinosis and to identify associated clinical features in a cohort of extensively ph



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Delivery of Compression Therapy for Venous Leg Ulcers

from ArchDerm - 01 Jul 14

ImportanceDespite the documented effect of compression therapy in clinical studies and its widespread prescription, treatment of venous leg ulcers is often prolonged and recurrence rates high. Data on provided compression therapy are limited.ObjectiveTo assess whether home care nurses achieve adequate subbandage pressure when treating patients with venous leg ulcers and the factors that predict the ability to achieve optimal pressure.Design, Setting, and ParticipantsWe performed a cross-sectiona



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Practice Gaps in Patient Safety Among Dermatology Residents and Their Teachers A Survey Study of Dermatology Residents

from ArchDerm - 01 Jul 14

ImportanceCurriculum and role modeling adjustments are necessary to address patient safety gaps occurring during dermatology residency.ObjectiveTo identify the source of clinical practices among dermatology residents that affect patient safety and determine the best approach for overcoming gaps in knowledge and practice patterns that contribute to these practices.Design, Setting, and ParticipantsA survey-based study, performed at a national medical dermatology meeting in Itasca, Illinois, in 201



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Emergency Department Diagnosis and Management of Skin Diseases With Real-Time Teledermatologic Expertise

from ArchDerm - 01 Jul 14

ImportanceSkin conditions are a common reason for patients to consult emergency department (ED) physicians.ObjectiveTo evaluate real-time teledermatologic expertise with the use of mobile telephones for the diagnosis and management of skin conditions in patients seen in the ED.Design, Setting, and ParticipantsThis observational study of adults who consecutively consulted in the ED for a dermatologic condition was conducted under routine conditions in the ED from May 1, 2008, through June 30, 201



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Effects of Low-Dose Recombinant Interleukin 2 to Promote T-Regulatory Cells in Alopecia Areata

from ArchDerm - 01 Jul 14

ImportanceAn impaired inhibitory function of circulating CD4+CD25+ regulatory T (Treg) cells was reported to play a key role in alopecia areata (AA). We report the first use to our knowledge of low-dose interleukin 2 for treating severe AA by promoting the recruitment of Treg cells.ObservationsWe conducted a prospective open pilot study in 5 patients with severe AA resistant to previous systemic treatments. Subcutaneous interleukin 2 (1.5 million IU/d) was administered during 5 days, followed by



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Corticosteroid-Induced Meningococcal Meningitis in a Patient With Chronic Meningococcemia

from ArchDerm - 01 Jul 14

ImportanceAlthough chronic meningococcemia is an uncommon disorder, it is of great importance to clinicians across multiple disciplines because it presents similarly to reactive, neoplastic, or rheumatic disorders. Ruling out chronic meningococcemia, however, represents a diagnostic challenge because routine microbiological investigations frequently fail to identify Neisseria meningitidis. Although treatment with corticosteroids might be helpful in various conditions, corticosteroid treatment ma



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Widespread Morbilliform Eruption Associated With Telaprevir Use of Dermatologic Consultation to Increase Tolerability

from ArchDerm - 01 Jul 14

ImportanceTelaprevir, combined with pegylated interferon alfa and ribavirin, is an efficacious approach to treat hepatitis C virus infection. A morbilliform eruption associated with telaprevir is a common adverse effect experienced by patients. Current guidelines mandate telaprevir discontinuation in any patient with a severe, progressive, or unresponsive cutaneous eruption.ObservationsEight patients with a grade 3 (severe) widespread morbilliform eruption associated with telaprevir were referre



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Oral Pigmentation in McCune-Albright Syndrome

from ArchDerm - 01 Jul 14

ImportanceThe differential diagnosis for oral lentigines includes several syndromes with important associated systemic findings. McCune-Albright syndrome (MAS), a mosaic condition associated with café au lait pigmentation, is not typically considered a mucosal lentiginosis syndrome. The clinical phenotype of MAS is variable because of mosaicism, but oral pigmentation developing in mid-childhood to early adulthood should be recognized as a clinical feature of MAS.ObservationsWe present 4 patients








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Further Investigation Into the Risk of Skin Cancer Associated With the Use of UV Nail Lamps

from ArchDerm - 01 Jul 14

Use of UV radiation in nail salons for drying and curing polishes has come under scrutiny owing to concerns for carcinogenesis. A few recent studies evaluated potential irradiation scenarios and concluded that UV nail polish drying lamps pose only a small risk to clients. However, these studies lacked randomized light sampling from commercial salons.



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Alemtuzumab Therapy for Leukemic Cutaneous T-Cell Lymphoma Diffuse Erythema as a Positive Predictor of Complete Remission

from ArchDerm - 01 Jul 14

Low-dose alemtuzumab (LDA) therapy is highly effective and generally well tolerated for refractory cutaneous T-cell lymphoma (CTCL) with peripheral blood disease. Treatment with LDA is effective in patients with blood involvement (leukemic disease) but ineffective in mycosis fungoides (MF), reflecting the fact that these lymphomas derive from distinct T-cell subsets. Malignant T cells in patients with blood disease have the phenotype of CCR7+/L-selectin+ central memory cells (TCM) (migratory cel



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Compression of Venous Ulcers Standardizing Standard Care

from ArchDerm - 01 Jul 14

Venous leg ulcers (VLUs) are common, affecting upward of 1% of adults and with increasing incidence and prevalence with advancing age. Venous leg ulcers are associated with reduced quality of life and significant health care costs in addition to sustained ambulatory venous pressure (venous hypertension), which most often results from thrombosis and/or valve disease, affecting the superficial, perforator, or deep veins. As a result, calf muscle pump dysfunction ensues, leading to ulcer formation.



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True Leukonychia in Crohn Disease Induced by Selenium Deficiency

from ArchDerm - 01 Jul 14

Leukonychia is divided into 2 major types: true leukonychia, which involves the nail plate, and apparent leukonychia, which involves the nail bed. Herein, we present the first case to our knowledge of true leukonychia successfully treated with selenium substitution.



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Hydroxyurea-Induced Leg Ulceration in a Patient With a Homozygous MTHFR Polymorphism Misdiagnosed as Pyoderma Gangrenosum

from ArchDerm - 01 Jul 14

Both hydroxyurea, an antimetabolite used to treat chronic myeloproliferative diseases, and methylene tetrahydrofolate reductase (MTHFR) polymorphisms have been associated with cutaneous ulceration. We present a case of a severe leg ulcer that likely occurred from hydroxyurea use in a patient with a MTHFR polymorphism.



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Agminated Pyogenic Granuloma–Like Growth Arising in a Congenital Hemangioma

from ArchDerm - 01 Jul 14

Pyogenic granulomas (PGs), usually solitary and isolated, have rarely been reported to arise as lesions within preexisting vascular malformations. Multiple, distinct, PG-like lesions within capillary or arteriovenous malformations (AVMs) have been described. To our knowledge, no cases of solitary or agminated PG-type growths have been reported in congenital hemangiomas (CHs).


 

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