Acquired perforating dermatosis: A clinical and dermatoscopic correlation

Acquired Perforating Dermatosis (APD) is a perforating disease characterized by transepidermal elimination of dermal material [1,2]. This disease usually develops in adulthood. APD has been reported to occur in association with various diseases, but is most commonly associated with dialysis-dependent chronic renal failure (CRF) or diabetes mellitus (DM) [1,2,3,4]. Morton et al found that APD occurs in up to 10% of patients undergoing hemodialysis [5]. Additionally, Saray et al found that sixteen of twenty-two cases with APD were associated with CRF [3]

Recycling of Previously Transplanted Hair: A Novel Indication for Follicular Unit Extraction

BACKGROUND: Hair transplantation has enhanced the realm of procedural dermatology. Before the advent of follicular transplantation, androgenetic alopecia was a difficult disease to manage, as there is a limited armamentarium of topical and systemic pharmaceuticals. However, as with other novel surgical procedures, there is a steep learning curve, that may result in poor transplantation or cosmesis.CASE REPORT: We present a case of androgenetic alopecia, where previously, poorly implanted hairs were recycled by follicular unit extraction to increase hair density at the vertex of the scalp, which resulted in improved cosmesis and patient satisfaction.CONCLUSION: We have demonstrated that re-transplantation is not only feasible but is effective; therefore redesigning of previous transplantations should be considered as a possible indication follicle unit extraction, particularly in the setting of scarce follicular reserves. The utility of our recycling method may also inspire hope in patients that have undergone failed or unsatisfactory hair transplantations

Lichenoid keratosis: non-invasive imaging in the setting of diagnostic uncertainty

Lichenoid keratosis: non-invasive imaging in the setting of diagnostic uncertainty

Adjuvant narrow band UVB improves the efficacy of oral azithromycin for the treatment of moderate to severe inflammatory facial acne vulgaris

Background: Acne vulgaris (AV) is a common inflammatory disease of the pilosebaceous unit. A variety of treatment modalities are available for the treatment of AV. Among the available options, oral azithromycin is popularly prescribed for its proven anti-inflammatory effects. Narrow band UVB (NBUVB) also has a potent anti-inflammatory action. Concomitant use of both modalities may result in a synergistic therapeutic response; however, the combined efficacy has not yet been evaluated for the treatment of inflammatory AV. Objective: The aim of this study was to compare the efficacy of oral azithromycin plus NBUVB (peak 311 nm) to oral azithromycin alone for the treatment of moderate to severe inflammatory AV. Materials and Methods: A randomized, open-label, clinical trial was conducted over 4 weeks. Subjects were randomized into two groups. Group 1 received 500 mg of oral azithromycin three times per week. Group 2 received 500 mg of oral azithromycin plus NBUVB three and two times per week, respectively. Concomitant topical or oral AV treatments were not permitted during the treatment period. Response to treatment was measured by photographic records at the primary endpoint (2 weeks) and at the end of treatment. Results: One hundred and four subjects were enrolled in the trial; 94 subjects completed the treatment period of the study. Group 2 demonstrated significant clinical improvement of the inflammatory papular lesions (88.55%) compared with group 1 (70.34%) at the end of treatment (P = 0.002). The clinical response of pustular (P = 0.562), nodular (P = 0.711) and cystic (P = 0.682) lesions did not significantly differ between the two treatment groups. Interestingly, response to treatment in group 2 had a significant anatomical predilection for the forehead (P = 0.023). There was no side-effect except erythema, which subsided within 1-2 days. Conclusion: NBUVB plus oral azithromycin is more effective than oral azithromycin alone for treating papular lesions of inflammatory AV. NBUVB is certainly a viable adjunct in acne therapy

Computational simulations establish a novel transducer array placement arrangement that extends delivery of therapeutic TTFields to the infratentorium of patients with brainstem gliomas

Background and Purpose: Tumor treating fields (TTFields) are a non-invasive, efficacious treatment modality currently approved for supratentorial glioblastomas. Despite their ability to improve overall survival in supratentorial tumors, the current placement of arrays is limited to the supratentorial head, precluding its use in infratentorial tumors. Infratentorial malignancies are in need of new therapy modalities given their poor prognoses in both children and adults. The aim of this research is to determine whether rearrangement of TTFields may allow for management of infratentorial tumors. Materials and methods: Delivery of TTFields using Novocure’s prototype Optune™ device human male head model was simulated based  on brain MRIs from patients with brainstem gliomas to develop a novel array layout designed to extend adequate infratentorial coverage. Results: Array placement on the vertex, bilateral posterolateral occiput, and superior-posterior neck achieved intensities above 1.1 V/cm (average 1.7 V/cm; maximum 2.3 V/cm) in the vertical field direction and above 1 V/cm (average 2 V/cm; maximum 2.8 V/cm) in the horizontal field direction of the infratentorium. The calculated field intensity within the simulated tumors were in the therapeutic range and demonstrated the effective delivery of TTFields to the infratentorial brain. Conclusions: Our findings suggest that rearrangement of the TTFields standard array with placement of electrodes on the vertex, bilateral posterolateral occiput, and superior-posterior neck allows for adequate electric field distribution in the infratentorium that is within the therapeutic range

Rash to the mTOR Inhibitor Everolimus Systematic Review and Meta-Analysis

Background: Everolimus is a mammalian target of rapamycin (mTOR) inhibitor approved for treatment of renal cell carcinoma, subependymal giant cell astrocytoma, breast cancer, and progressive neuroendocrine tumors of pancreatic origin. Its use may be hindered because of adverse events, including rash. The reported incidence and risk of a rash to everolimus varies widely and has not been closely investigated. Therefore, we conducted a systematic review and meta-analysis of the literature to determine the incidence and risk of developing a rash. Methods: We searched PubMed and Web of Science databases and abstracts presented at the American Society of Clinical Oncology from 1998 to December 2011 using the keyword "everolimus" to identify relevant clinical trials. Eligible studies included prospective phase II and III clinical trials of cancer patients on 10 mg of everolimus daily with available data on incidence of rash. The summary incidence and relative risk (RR) of rash were calculated using either the random-effects or fixed-effects model, depending on the heterogeneity of the constituent studies. Results: A total of 2242 patients with various malignancies from 13 clinical trials were included in the analysis. The summary incidences of all-grade and high-grade rash in patients on everolimus were 28.6% [95% confidence interval (CI), 20.8-38.0] and 1.0% (95% CI, 0.6-1.8), respectively. Everolimus was associated with a statistically significant increased risk of all-grade rash (RR = 3.853, 95% CI, 2.470-6.013, P = 0.000), but the RR for high-grade rash (RR = 2.997, 95% CI, 0.633-14.185) was not statistically significant, with a P value of 0.166. Conclusions: Everolimus is associated with a significant risk of developing a rash. Management of rash to everolimus is critical to prevent dose modifications and decreased quality of life, both of which can negatively affect overall clinical outcomes

Phosphodiesterase-4 Inhibition Reduces Cutaneous Inflammation and IL-1β Expression in a Psoriasiform Mouse Model but Does Not Inhibit Inflammasome Activation

Apremilast (Otezla®) is an oral small molecule phosphodiesterase 4 (PDE4) inhibitor approved for the treatment of psoriasis, psoriatic arthritis, and oral ulcers associated with Behçet’s disease. While PDE4 inhibition overall is mechanistically understood, the effect of apremilast on the innate immune response, particularly inflammasome activation, remains unknown. Here, we assessed the effect of apremilast in a psoriasis mouse model and primary human cells. Psoriatic lesion development in vivo was studied in K5.Stat3C transgenic mice treated with apremilast for 2 weeks, resulting in a moderate (2 mg/kg/day) to significant (6 mg/kg/day) resolution of inflamed plaques after 2-week treatment. Concomitantly, epidermal thickness dramatically decreased, the cutaneous immune cell infiltrate was reduced, and proinflammatory cytokines were significantly downregulated. Additionally, apremilast significantly inhibited lipopolysaccharide- or anti-CD3-induced expression of proinflammatory cytokines in peripheral mononuclear cells (PBMCs). Notably, inflammasome activation and secretion of IL-1β were not inhibited by apremilast in PBMCs and in human primary keratinocytes. Collectively, apremilast effectively alleviated the psoriatic phenotype of K5.Stat3 transgenic mice, further substantiating PDE4 inhibitor-efficiency in targeting key clinical, histopathological and inflammatory features of psoriasis. Despite lacking direct effect on inflammasome activation, reduced priming of inflammasome components upon apremilast treatment reflected the indirect benefit of PDE4 inhibition in reducing inflammation