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Menopausal Hormone Replacement Therapy in Dermatology

from ArchDerm - 01 Dec 14

Dermatologists provide care for perimenopausal and menopausal women with hormone-related complaints: hair loss, acne climacterica, acne rosacea, acne inversa (hidradenitis suppurativa), dry skin, wrinkling, hirsutism, pruritus vulvae, and other vulvar dermatoses. The question, “Should I take hormone replacement therapy (HRT)?” is usually unspoken. The answer was complicated in 2002 by the estrogen-progestin arm of the Women’s Health Initiative (WHI) study with the reported increased risk of inva



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Hidradenitis Suppurativa Current Progress and Future Questions

from ArchDerm - 01 Dec 14

Hidradenitis suppurativa (HS) is a chronic, destructive, debilitating inflammatory skin disease characterized by recurrent, painful, deep-seated nodules and/or abscesses in intertriginous areas. It is also relatively common, with a reported prevalence as high as 1% to 4%. Nevertheless, HS has historically been an orphan disease, unclaimed by any specialty, owing, perhaps largely, to the treatment challenges it poses for physicians and the resulting nonadherence on the part of patients.



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Association of Metabolic Syndrome and Hidradenitis Suppurativa

from ArchDerm - 01 Dec 14

ImportanceAn association between the metabolic syndrome (MetS) and chronic inflammatory diseases, such as psoriasis or rheumatoid arthritis, has been suggested. Hidradenitis suppurativa (HS), a more localized chronic inflammation of the skin, has been speculated to have a similar association. Hidradenitis suppurativa is a substantial burden for the individual and a socioeconomic burden globally. Information about the burden of possible comorbidities is scarce.ObjectiveTo investigate the possibil



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Efficacy of Photodynamic Therapy vs Other Interventions in Randomized Clinical Trials for the Treatment of Actinic Keratoses A Systematic Review and Meta-analysis

from ArchDerm - 01 Dec 14

ImportancePhotodynamic therapy (PDT) is used extensively to treat actinic keratoses (AKs). An analysis of the effectiveness of PDT compared with other treatments may help physicians decide what role it should play in their own clinical practices.ObjectiveTo determine the effectiveness of PDT for the treatment of AKs relative to other methods.Data SourcesMEDLINE, EMBASE, Web of Knowledge, and Cochrane Central Register. No restrictions on years were placed, and all searches extended to the year of



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The Accuracy of Dermatology Network Physician Directories Posted by Medicare Advantage Health Plans in an Era of Narrow Networks

from ArchDerm - 01 Dec 14

ImportanceInsurers are increasingly deploying “narrow networks” with fewer contracted physicians both in health plans offered in new state exchanges under the Affordable Care Act and in Medicare Advantage (MA) plans, which are commercial alternatives offered to Medicare beneficiaries. Patients choosing health plans rely on the accuracy of network directories posted by insurers. The MA plans must meet network adequacy requirements, and inaccurate directories of participating physicians might prej



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Regional Variation of and Association of US Birthplace With Vitiligo Extent

from ArchDerm - 01 Dec 14

ImportanceLittle is known about population-based risk factors and regional differences for vitiligo.ObjectiveTo determine the impact of place of birth and residence on vitiligo extent.Design, Setting, and ParticipantsA prospective questionnaire-based study using an online questionnaire with 2786 adults (72.2% of whom resided in the United States) with a history of physician-diagnosed vitiligo.ExposuresRegions of birth and residence.Main Outcomes and MeasuresBody surface area (BSA) of vitiligo le



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Comparison of Clinicopathologic Features and Survival of Histopathologically Amelanotic and Pigmented Melanomas A Population-Based Study

from ArchDerm - 01 Dec 14

ImportancePrevious studies have reported that histopathologically amelanotic melanoma is associated with poorer survival than pigmented melanoma; however, small numbers of amelanotic melanomas, selected populations, lack of centralized pathologic review, or no adjustment for stage limit the interpretation or generalization of results from prior studies.ObjectiveTo compare melanoma-specific survival between patients with histopathologically amelanotic and those with pigmented melanoma in a large



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Screening for Germline Mismatch Repair Mutations Following Diagnosis of Sebaceous Neoplasm

from ArchDerm - 01 Dec 14

ImportanceSebaceous neoplasms (SNs) define the Muir-Torre syndrome variant of Lynch syndrome (LS), which is associated with increased risk for colon and other cancers necessitating earlier and more frequent screening to reduce morbidity and mortality. Immunohistochemical (IHC) staining for mismatch repair (MMR) proteins in SNs can be used to screen for LS, but data on subsequent germline genetic testing to confirm LS diagnosis are limited.ObjectiveTo characterize the utility of IHC screening of



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Isotretinoin Exposure and Risk of Inflammatory Bowel Disease

from ArchDerm - 01 Dec 14

ImportanceIsotretinoin is the standard treatment for refractory severe nodulocystic acne. A true association between prior isotretinoin use and development of inflammatory bowel disease (IBD) is uncertain. Addressing the reality of this association is important in decision making for both the clinician and the patient when isotretinoin treatment is indicated.ObjectiveTo assess the risk of IBD mainly in patients with acne with and without isotretinoin exposure.Design, Setting, and ParticipantsIn



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High Anti–Desmoglein 3 Antibody ELISA Index and Negative Indirect Immunofluorescence Result in a Patient With Pemphigus Vulgaris in Remission Evaluation of the Antibody Profile by Newly Developed Meth

from ArchDerm - 01 Dec 14

ImportancePemphigus vulgaris (PV) is a disease that features blistering of the skin and mucous membranes caused by autoantibodies directed against desmoglein 3 (Dsg3) and/or desmoglein 1 (Dsg1). Indirect immunofluorescence (IIF) and enzyme-linked immunosorbent assay (ELISA) are 2 methods that are widely used to measure Dsg3 or Dsg1 antibody titers in PV. Although the titers of these autoantibodies are generally correlated with disease activity, some patients with a high ELISA index do not have s



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Subcutaneous Veltuzumab, a Humanized Anti-CD20 Antibody, in the Treatment of Refractory Pemphigus Vulgaris

from ArchDerm - 01 Dec 14

ImportanceB-cell depletion with the anti-CD20 antibody rituximab is highly effective for pemphigus vulgaris (PV) treatment. However, most patients experience relapse, and intravenous rituximab infusions are expensive. Therefore, cost-effective anti-CD20 therapies are desirable.ObservationsA compassionate-use investigational new drug protocol was approved to administer veltuzumab, a second-generation humanized anti-CD20 antibody, to a patient with refractory PV. Veltuzumab was administered as two



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Novel Genetic Mutations in a Sporadic Port-Wine Stain

from ArchDerm - 01 Dec 14

ImportancePort-wine stains (PWSs) are common congenital cutaneous capillary malformations. A somatic GNAQ mutation was recently identified in patients with sporadic PWSs and Sturge-Weber syndrome. However, subsequent studies to confirm or extend this observation are lacking.ObservationsWe report a long-standing, unilateral facial PWS of a man in his early 70s confirmed by histopathological analysis. Staged surgical excision of the vascular malformation was performed, and genomic DNA was extracte



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Alopecia Universalis Successfully Treated With Adalimumab

from ArchDerm - 01 Dec 14

ImportanceAlopecia universalis is an uncommon form of alopecia areata (AA) involving hair loss over the entire scalp and body and is often difficult to treat. Tumor necrosis factor (TNF) inhibitors have been largely unsuccessful in treating AA and have been reported to induce or worsen AA in patients. We report herein a case of alopecia universalis successfully treated with adalimumab and discuss the possible mechanism.ObservationsA woman in her 30s with alopecia universalis, refractory to multi



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Characterization of S628N A Novel KIT Mutation Found in a Metastatic Melanoma

from ArchDerm - 01 Dec 14

ImportanceThe KIT receptor is mutated in approximately 15% of acral, mucosal, and chronic, sun-damaged melanomas. The status of KIT mutations is of interest because they usually are mutually exclusive with N-RAS and B-RAF mutations and because of the availability of KIT kinase inhibitors in the clinic. Some recurrent KIT mutations are well characterized; others are poorly described.ObservationsWe describe a novel KIT mutation in a patient with metastatic melanoma. The mutation, located in exon 1








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A Conservative Method to Gutter Splint Ingrown Toenails

from ArchDerm - 01 Dec 14

Ingrown toenails can be due to trauma, improper nail cutting, and/or anatomic abnormalities of the nail apparatus. In the setting of normal anatomy, they are usually treated conservatively, but the presence of a sharp edge of the nail in the ulcer may prevent wound healing. Isolation of the nail plate from the ulcer bed using a gutter-shaped splint may improve healing. In the classic gutter splint method, the ingrown edge of the nail plate is freed up to the extreme proximal part and then splint



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Minimal Incision Extraction of Lipomas

from ArchDerm - 01 Dec 14

Lipomas are benign proliferations of mature fat that are occasionally tender. Common treatment approaches include elliptical excision, liposuction, and injection lipolysis. For most lipomas, we favor the minimal incision or “squeeze” technique, whereby lipomas are expressed through a small scalpel or punch incision. To our knowledge, the utilization rate of this simple, effective technique has not been previously studied.



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Androgen Levels and Semen Parameters Among Former Users of Finasteride With Persistent Sexual Adverse Effects

from ArchDerm - 01 Dec 14

Recent postmarketing studies and the US Food and Drug Administration have found that finasteride, 1 mg, for androgenic alopecia has been associated with persistent sexual and nonsexual adverse effects. The mechanisms of these symptoms in humans are unknown. Finasteride, 1 mg, has been associated with male infertility, and 5% of men taking a 5a-reductase inhibitor had a dramatic decline in total sperm count to below 10% of baseline. The present study was designed to assess whether otherwise healt



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Comparative Prevalence of Complementary and Alternative Medicine Use Among Outpatients in Dermatology and Primary Care Clinics

from ArchDerm - 01 Dec 14

Previous studies suggest that people with skin diseases use complementary and alternative medicine (CAM); however, it is not known whether CAM was used specifically to treat their skin disease. We conducted a survey to determine differences in CAM use for skin diseases between patients attending dermatology clinics and those attending primary care clinics.



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Photodynamic Therapy for Actinic Keratoses Aren’t We There Yet?

from ArchDerm - 01 Dec 14

Fifteen years ago the US Food and Drug Administration approved the use of photodynamic therapy (PDT) in dermatology for the treatment of actinic keratosis (AK). Photodynamic therapy using topical agents in combination with visible light has been investigated extensively with a general consensus that in cutaneous oncology, PDT is probably best suited for treating patients with multiple or larger superficial lesions. In a meta-analysis, Patel et al concluded that PDT resulted in a 14% better proba


 

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