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Assessing Medication Adherence Using Indirect Self-report

from ArchDerm - 01 Aug 14

Poor adherence to medication is common, particularly in patients with chronic diseases who are prescribed multiple medications. A major public health problem, nonadherence is associated with poor clinical outcomes, increased health care costs, prolonged hospitalization, and higher mortality and morbidity. Assessing patients’ medication adherence may be helpful for assessing responses to treatment and for modifying treatment regimens.



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Melanoma Surveillance in “High-Risk” Individuals

from ArchDerm - 01 Aug 14

Among cancers, melanoma is uniquely amenable to early visual detection and simple curative therapy. Screening may therefore reduce mortality, and this logic has led to population-based surveillance efforts in Germany, with initial results in the state of Schleswig-Holstein suggesting a nearly 50% decrease in melanoma mortality. The US Preventive Services Task Force (USPSTF) guidelines do not currently recommend population-based melanoma screening. Although the USPSTF identifies certain patient g



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Detection of Primary Melanoma in Individuals at Extreme High Risk A Prospective 5-Year Follow-up Study

from ArchDerm - 01 Aug 14

ImportanceThe clinical phenotype and certain predisposing genetic mutations that confer increased melanoma risk are established; however, no consensus exists regarding optimal screening for such individuals. Early identification remains the most important intervention in reducing melanoma mortality.ObjectiveTo evaluate the impact of full-body examinations every 6 months supported by dermoscopy and total-body photography (TBP) on all patients and sequential digital dermoscopy imaging (SDDI), when



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Correlation of Histologic Regression in Primary Melanoma With Sentinel Node Status

from ArchDerm - 01 Aug 14

ImportanceThe influence of regression on the status of the sentinel node (SN) is controversial. In many centers, the presence of regression in thin melanomas supports the performance of an SN biopsy.ObjectiveTo identify whether regression in primary melanoma has any influence on SN involvement.Design, Setting, and ParticipantsRetrospective study of melanomas with a Breslow thickness greater than 0.75 mm and undergoing SN biopsy from January 1, 2003, through December 31, 2010, at Instituto Valenc



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Intrinsic and Extrinsic Risk Factors for Sagging Eyelids

from ArchDerm - 01 Aug 14

ImportanceSagging eyelids, or dermatochalasis, are a frequent concern in older adults. It is considered a feature of skin aging, but risk factors other than aging are largely unknown.ObjectiveTo study nongenetic and genetic risk factors for sagging eyelids.DesignUpper eyelid sagging was graded in 4 categories of severity using digital photographs. Dermatochalasis was defined as the eyelid hanging over the eyelashes. Age, sex, skin color, tanning ability, hormonal status in women, current smoking



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The Use of Transient Elastography and FibroTest for Monitoring Hepatotoxicity in Patients Receiving Methotrexate for Psoriasis

from ArchDerm - 01 Aug 14

ImportanceThere is a need for noninvasive tools to monitor hepatotoxicity in patients with psoriasis who are receiving methotrexate sodium.ObjectiveTo evaluate the use of transient elastography (TE) and FibroTest (FibroSURE in the United States), an indirect serum marker of fibrosis, in this population.Design, Setting, and ParticipantsPatients receiving methotrexate therapy for psoriasis between January 2008 and September 2009 were recruited from a dermatology outpatient department. Transient el



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Efficacy of a Needling Device for the Treatment of Acne Scars A Randomized Clinical Trial

from ArchDerm - 01 Aug 14

ImportanceNeocollagenesis can be achieved using a dermal rolling needle device, thereby reducing the appearance of acne scars.ObjectiveTo determine the efficacy of a needling device for treatment of acne scars.Design, Setting, and ParticipantsWe performed a single-center, rater-blinded, balanced (1:1), split-face, placebo-controlled, parallel-group randomized clinical trial at an urban academic institution. The study took place from November 30, 2009, through July 27, 2010. Twenty healthy adults



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Curricular Factors Associated With Medical Students’ Practice of the Skin Cancer Examination An Educational Enhancement Initiative by the Integrated Skin Exam Consortium

from ArchDerm - 01 Aug 14

ImportanceAs medical school curricula become progressively integrated, a need exists to optimize education related to the skin cancer examination (SCE) for melanoma, a relevant competency gap that influences secondary prevention efforts.ObjectivesTo identify curricular factors associated with medical students’ confidence, intent, and performance regarding the SCE.Design, Setting, and ParticipantsSurvey-based cross-sectional study from the Integrated Skin Exam Consortium at accredited US medical



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Incidence and Survival for Merkel Cell Carcinoma in Queensland, Australia, 1993-2010

from ArchDerm - 01 Aug 14

ImportanceMerkel cell carcinoma (MCC) is an uncommon but highly invasive form of skin cancer. The mechanisms that cause MCC are yet to be fully determined.ObjectivesTo compare the incidence and survival rates of MCC in Queensland, Australia, known to be a high-risk area, with MCC incidence and survival elsewhere in the world. We also analyzed incidence trends and differences in survival by key demographic and clinical characteristics.Design, Setting, and ParticipantsRetrospective cohort study of



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Acquired Blue Nevi in Older Individuals Retrospective Case Series From a Veterans Affairs Population, 1991 to 2013

from ArchDerm - 01 Aug 14

ImportanceApart from the atypical mole phenotype, development of new melanocytic nevi in older individuals is uncommon and considered worrisome for melanoma. We performed a retrospective case series in a Veterans Affairs population from 1991 to 2013 to characterize blue nevi (BN) by patient age at biopsy, location, self-reported duration, and relation to prior or subsequent development of cutaneous melanoma.ObservationsA total of 204 BN were identified in 194 predominantly male patients (90.7%)



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Patient With Gorlin Syndrome and Metastatic Basal Cell Carcinoma Refractory to Smoothened Inhibitors

from ArchDerm - 01 Aug 14

ImportanceBasal cell carcinomas (BCCs) in patients with Gorlin syndrome have been reported to be extremely sensitive to Smoothened (SMO) inhibitors, a novel targeted therapy against the Hedgehog pathway, because of characteristic mutations in these patients. A few cases of disease refractory to oral therapy with SMO inhibitors have been reported in patients with Gorlin syndrome and nonmetastatic BCCs, but refractory disease in distantly metastatic tumors has not been documented in this high-risk



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D-Dimer Levels as a Marker of Cutaneous Disease Activity Case Reports of Cutaneous Polyarteritis Nodosa and Atypical Recurrent Urticaria

from ArchDerm - 01 Aug 14

ImportanceBiochemical markers of disease allow clinicians to monitor disease severity, progression, and response to treatment. C-reactive protein and erythrocyte sedimentation rate are commonly used biochemical markers of inflammatory disease. We present 2 cases that indicate that D-dimer levels may be useful as a potential biochemical marker of disease activity in certain cutaneous inflammatory conditions.ObservationsWe report 2 cases in which clinical disease activity correlates with D-dimer l



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Atrophic Skin Patches With Abnormal Elastic Fibers as a Presenting Sign of the MASS Phenotype Associated With Mutation in the Fibrillin 1 Gene

from ArchDerm - 01 Aug 14

ImportanceMarfan syndrome (MFS) is a dominantly inherited disorder of connective tissue caused by mutations in the fibrillin 1 gene (FBN1). The most common skin finding in MFS is striae distensae. Particular individuals referred for suspected MFS who do not completely fulfill the MFS diagnostic criteria are classified as having a MASS phenotype. The acronym represents the following manifestations: a prolapsed mitral valve, myopia, aortic root enlargement, and skeletal and skin manifestations. Mu







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Sun Protection Behaviors Among Puerto Rican Adults

from ArchDerm - 01 Aug 14

The incidence of skin cancer has been increasing among US Hispanics for several decades. Hispanic individuals residing in the continental United States do not sufficiently engage in routine sun protection behaviors. Hispanics are an important population to target for skin cancer prevention research and public health initiatives. However, there is a dearth of such efforts focusing on Hispanic populations outside the continental United States. From 1974 to 2005, the skin cancer incidence in Puerto



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Risk for Nevus Transformation and Melanoma Proliferation and Invasion During Natalizumab Treatment Four Years of Dermoscopic Follow-up With Immunohistological Studies and Proliferation and Invasion As

from ArchDerm - 01 Aug 14

Natalizumab is a monoclonal antibody targeting a4 integrin used to treat multiple sclerosis (MS). Seven cases of melanoma during natalizumab treatment have been reported since 2006. The objective of this study was to assess the effect of natalizumab on nevi transformation and tumor cell proliferation, invasion, and migration in preclinical models of melanoma.



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Methotrexate-Induced Liver Toxicity Replacing the Liver Biopsy

from ArchDerm - 01 Aug 14

Methotrexate-induced hepatotoxicity in patients with psoriasis occurs rarely and unpredictably. Although liver monitoring must occur, dermatologists currently lack a reliable test. Unfortunately, many of the current recommendations for the monitoring of patients with psoriasis are poorly substantiated by rigorous data. For example, cumulative methotrexate dosage appears to be irrelevant. In addition, the liver biopsy, considered the criterion standard, suffers from sampling error, intraobserver



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Cholesterol Embolization Syndrome With an Atypical Proximal Presentation Simulating Calciphylaxis

from ArchDerm - 01 Aug 14

Cholesterol embolization syndrome (CES) is associated with endovascular procedures or anticoagulation, which disrupt atheromatous plaques within large arteries releasing cholesterol crystals. These crystals lodge in the vasculature of various organs, most commonly the skin. Cutaneous involvement classically presents in the distal lower extremities as livedo reticularis (49%), gangrene (35%), cyanosis (28%), ulceration (17%), nodules (10%), purpura (9%), and splinter hemorrhages. We report a case



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Acinetobacter baumannii Emerging as a Multidrug-Resistant Skin and Soft-Tissue Pathogen Parallels to Methicillin-Resistant Staphylococcus aureus

from ArchDerm - 01 Aug 14

Over the last 30 years, the gram-negative coccobacillus Acinetobacter baumannii has risen to microbiologic notoriety for its ability to successfully evade nearly all available antibiotics. It is now a well-established source of nosocomial bacteremia and pneumonia, known to cause hospital outbreaks, particularly in the intensive care unit. Less often it represents a source of nosocomial skin and soft-tissue infection (SSTI) in the setting of war wounds, surgical sites, and burns.



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Primary Cutaneous Follicle Center Lymphoma With Follicular Mucinosis

from ArchDerm - 01 Aug 14

Follicular mucinosis (FM) is defined as the accumulation of a mucinous material within the hair follicle. Since its first description by Pinkus in 1957 in the setting of alopecia mucinosa, 2 main forms have been classically recognized: a benign idiopathic form, primary follicular mucinosis (PFM), which usually appears in young adults and regresses spontaneously; and a secondary form, lymphoma-associated follicular mucinosis (LAFM), which mostly occurs in elderly patients. Most cases of LAFM are



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Periorbital Subcutaneous Emphysema Mistaken for Unilateral Angioedema During Dental Crown Preparation

from ArchDerm - 01 Aug 14

Subcutaneous emphysema, defined as the abnormal introduction of air into subcutaneous tissues, is a rare complication of dental treatment. More common causes of this entity include trauma, head and neck surgery, and general anesthesia. We present a case of periorbital subcutaneous emphysema that clinically appeared as unilateral angioedema during a dental treatment.


 

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