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A Privately Organized Dermatology Mission to the Dominican Republic Show and Tell

from ArchDerm - 01 Apr 14

Approximately 3.4 billion people live in areas with no access to basic skin treatment. Lack of dermatologic care in developing countries is problematic for patients in whom chronic cutaneous conditions are prevalent and seriously affect quality of life. This shortage provides an opportunity for dermatologists to make a significant impact on international public health. Organizations, such as the International Foundation for Dermatology, and the “community dermatology” concept were created to imp



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Isotretinoin and Pregnancy Prevention Do We Need to Take a Long, Hard Look at Ourselves?

from ArchDerm - 01 Apr 14

It’s no news that isotretinoin, the most effective treatment for severe or recalcitrant acne, is a potent teratogen. From its release as Accutane by Hoffman-LaRoche in 1982, isotretinoin had been classified as a pregnancy category X drug, defined as a drug with positive evidence of human fetal risk, where the risks involved in use of the drug in pregnant women clearly outweigh potential benefits. Risk management at the time of initial approval was limited to labeling, which described the risk of



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Enhancing Skin Cancer Screening Through Behavioral Intervention

from ArchDerm - 01 Apr 14

In this issue of JAMA Dermatology, Janda and colleagues report on the results of a randomized clinical trial (RCT) of a video-based behavioral intervention aimed at increasing clinical skin examination (CSE) among men 50 years or older in Queensland, Australia. At the 7-month follow-up, men who received informational brochures were as likely as the video intervention group to have obtained a CSE (53% vs 56%, respectively). However, the video intervention group was more likely than controls to se



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Women’s Experiences With Isotretinoin Risk Reduction Counseling

from ArchDerm - 01 Apr 14

ImportanceIsotretinoin, an effective anti-acne therapy, is a known teratogen that is strictly regulated through the iPLEDGE program. However, since this program has not significantly reduced rates of pregnancies exposed to isotretinoin, new strategies for reducing rates of isotretinoin-exposed pregnancies are needed.ObjectiveTo explore women’s experiences with counseling about isotretinoin risk reduction.Design, Setting, and ParticipantsStructured interviews were conducted between January and Se



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Clinical Skin Examination Outcomes After a Video-Based Behavioral Intervention Analysis From a Randomized Clinical Trial

from ArchDerm - 01 Apr 14

ImportanceOlder men are at risk of dying of melanoma.ObjectiveTo assess attendance at and clinical outcomes of clinical skin examinations (CSEs) in older men exposed to a video-based behavioral intervention.Design, Setting, and ParticipantsThis was a behavioral randomized clinical trial of a video-based intervention in men aged at least 50 years. Between June 1 and August 31, 2008, men were recruited, completed baseline telephone interviews, and were than randomized to receive either a video-bas



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Primary Cutaneous Mucinous Carcinoma A Systematic Review and Meta-analysis of Outcomes After Surgery

from ArchDerm - 01 Apr 14

ImportanceEvidence-based treatment guidelines are not available for primary cutaneous mucinous carcinoma (PCMC).ObjectiveTo assess outcomes associated with surgical treatment of PCMC.Data SourcesMEDLINE, Cumulative Index to Nursing and Allied Health, and Embase from 1952 to 2010. Search terms were “primary cutaneous mucinous carcinoma,” “primary mucinous adenocarcinoma of the skin,” “primary mucinous sweat-gland carcinoma,” and “endocrine mucin-producing sweat gland carcinoma.”Study SelectionArt



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Neuropathy and Ankle Mobility Abnormalities in Patients With Chronic Venous Disease

from ArchDerm - 01 Apr 14

ImportanceHow complications associated with chronic venous insufficiency (CVI) develop is not clear. The central source of the complications is likely a dysfunction of the calf muscle pump, which includes veins and their valves, the gastrocnemius and other lower leg and foot muscles as well as the nerves supplying the muscles, and ankle mobility limitations. The least well-studied source of complications is the relationship between range of ankle movement (ROAM), neuropathy, and the clinical sev



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International Prevalence of Indoor Tanning A Systematic Review and Meta-analysis

from ArchDerm - 01 Apr 14

ImportanceIndoor tanning is a known carcinogen, but the scope of exposure to this hazard is not known.ObjectiveTo summarize the international prevalence of exposure to indoor tanning.Data SourcesStudies were identified through systematic searches of PubMed (1966 to present), Scopus (1823 to present), and Web of Science (1898 to present) databases, last performed on March 16, 2013. We also hand searched reference lists to identify records missed by database searches and publicly available data no



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Dermal Damage Promoted by Repeated Low-Level UV-A1 Exposure Despite Tanning Response in Human Skin

from ArchDerm - 01 Apr 14

ImportanceSolar 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



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Increased Risk of Litigation Associated With Laser Surgery by Nonphysician Operators

from ArchDerm - 01 Apr 14

ImportanceControversy exists regarding the role of nonphysicians performing laser surgery and the increased risk of injury associated with this practice.ObjectiveTo identify the incidence of medical professional liability claims stemming from cutaneous laser surgery performed by nonphysician operators (NPOs).Design, Setting, and ParticipantsSearch of an online national database of public legal documents involving laser surgery by NPOs.ExposureLaser surgery by nonphysicians.Main Outcomes and Meas



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High Incidence of Gastrointestinal Tract Disorders and Autoimmunity in Primary Cutaneous Marginal Zone B-Cell Lymphomas

from ArchDerm - 01 Apr 14

ImportanceTo our knowledge, this is the first comprehensive study addressing comorbidities associated with primary cutaneous marginal zone B-cell lymphomas (PCMZLs).ObjectiveTo determine if patients with PCMZL were at risk for other medical conditions.Design, Setting, and ParticipantsCase-control study at a cutaneous lymphoma clinic and a dermatopathologic consultation service at a single academic institution using an extensive questionnaire of illnesses, symptoms, and environmental exposures fo



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The Reliability of Teledermatology to Triage Inpatient Dermatology Consultations

from ArchDerm - 01 Apr 14

ImportanceMany hospitals do not have inpatient dermatologic consultative services, and most have reduced availability of services during off-hours. Dermatologists based in outpatient settings can find it challenging to determine the urgency with which they need to evaluate inpatients when consultations are requested. Teledermatology may provide a valuable mechanism for dermatologists to triage inpatient consultations and increase efficiency, thereby expanding access to specialized care for hospi



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Long-term Plasmapheresis in Conjunction With Thalidomide and Dexamethasone for the Treatment of Cutaneous Ulcers and Neovascular Glaucoma in Recalcitrant Type I Cryoglobulinemia

from ArchDerm - 01 Apr 14

ImportanceCryoglobulins are cold-precipitating immunoglobulins that occur secondary to lymphoproliferative disorders, chronic viral infections, and autoimmune disorders. The treatment of cryoglobulinemia should target the underlying disorder; however, such an approach may be difficult, and therapeutic options remain limited for type I cryoglobulinemia.ObservationsWe report a case of recalcitrant type I cryoglobulinemia treated successfully with long-term plasmapheresis in conjunction with thalid



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Dermoscopic Findings in Cutaneous Metastases

from ArchDerm - 01 Apr 14

ImportanceCutaneous metastases rarely develop in patients with cancer but have important implications for prognosis and treatment. While dermoscopy is useful for many skin lesions, few data exist regarding dermoscopic findings in cutaneous metastases.ObservationsWe reviewed high-quality dermoscopic images of 20 outpatients with biopsy-proven cutaneous metastases and known diagnosis of underlying visceral malignancy and correlated these findings with clinical and histologic data. Most lesions wer



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Risk Prediction Models for Incident Primary Cutaneous Melanoma A Systematic Review

from ArchDerm - 01 Apr 14

ImportanceCurrently, there is no comprehensive assessment of melanoma risk prediction models.ObjectiveTo systematically review published studies reporting multivariable risk prediction models for incident primary cutaneous melanoma for adults.Evidence ReviewEMBASE, MEDLINE, PREMEDLINE, and Cochrane databases were searched to April 30, 2013. Eligible studies were hand searched and citation tracked. Two independent reviewers extracted information.FindingsNineteen studies reporting 28 melanoma pred







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Development of a Tongue-Piercing Method for Use With Assistive Technology

from ArchDerm - 01 Apr 14

Piercing the tongue for wearing jewelry is not infrequent among young adults. The procedure is not usually performed by medical personnel. A new assistive technology for people with tetraplegia, the Tongue Drive System (TDS), utilizes voluntary tongue movements for control. The operator uses a magnet attached to the tongue together with an externally mounted sensor array that detects changes in the magnetic field to drive powered wheelchairs and access computers. We hypothesized that a magnet-co



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Expression of Phosphodiesterase-5 in Lymphatic Malformation Tissue

from ArchDerm - 01 Apr 14

Lymphatic malformations (LMs) are uncommon and sometimes debilitating congenital vascular anomalies that presumably arise because of developmental dysplasia of the lymphatic network in utero. They comprise primitive lymphatic sacs surrounded by a thickened layer of connective tissue and interspersed muscle fibers. Current treatments for LM are palliative and only partially successful and include compression, surgical resection, laser ablation, and sclerotherapy. A recent report by Swetman and co



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Improving Accessibility to Inpatient Dermatology Through Teledermatology

from ArchDerm - 01 Apr 14

Inpatient dermatology as a subspecialty has matured during the past decade. However, even when admitted for a dermatologic-specific diagnosis, only 51% of patients receive a dermatologic consultation. Several factors contribute to the lack of accessible dermatologists, including the dermatologic workforce shortage, the location of most dermatologists in outpatient settings away from hospitals, low remuneration for time spent in the hospital, unease in caring for the diseases seen in hospitalized



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Multibranched Acquired Periungual Fibrokeratoma

from ArchDerm - 01 Apr 14

We have encountered a case of multibranched acquired periungual fibrokeratoma (APF).



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Treatment of Giant Cellulitis-like Sweet Syndrome With Dapsone

from ArchDerm - 01 Apr 14

Sweet syndrome is an inflammatory condition characterized by the abrupt development of erythematous plaques accompanied by fever and neutrophilia. Different clinical presentations of this disorder have been described in the literature. We read with interest a recent report in JAMA Dermatology describing a new clinical variant of Sweet syndrome, namely, giant cellulitis-like Sweet syndrome. Clinically these patients develop large, red erythematous plaques that recur and often are misdiagnosed as


 

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