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2.
Pediatr Dermatol ; 37(4): 592-596, 2020 Jul.
Article in English | MEDLINE | ID: mdl-32462667

ABSTRACT

BACKGROUND/OBJECTIVES: Little research has compared clinician acne severity assessment with either adolescent- or parent-rated scales of acne severity or impact on quality of life (QOL). We sought to assess how adolescents and their parents perceive the severity and impact of acne on the adolescent's QOL and correlate this with clinical severity. METHODS: Each adolescent and a parent completed a validated QOL survey regarding the adolescent's acne and rated the adolescent's acne severity and QOL impact using a Likert scale. Clinicians assessed the adolescent's acne using a standardized acne severity scale. Statistical analysis compared adolescent scores with respective parent scores or with clinician assessment using a paired t test or Spearman rank-order correlation test. RESULTS: The Likert impact score more accurately reflected acne impact on QOL for adolescents than for parents when considering the validated QOL survey as the gold standard (r2  = .56 vs r2  = .36). Likert scores for adolescents and parents were weakly correlated for acne severity but not for acne QOL impact (r2  = .36 vs r2  = .18). Correlations of acne severity scores between clinician and either adolescent or parent were weak. CONCLUSIONS: Parents and adolescents are in relative agreement regarding acne severity and QOL impact. However, parent and adolescent perceptions are disparate from clinician acne assessment. It is important that physicians identify and consider adolescent and parent perceptions in addition to clinical assessment to better inform the approach to acne management.


Subject(s)
Acne Vulgaris , Quality of Life , Adolescent , Humans , Parents , Perception , Severity of Illness Index , Surveys and Questionnaires
5.
Am J Dermatopathol ; 40(2): e28-e29, 2018 Feb.
Article in English | MEDLINE | ID: mdl-28953011

ABSTRACT

Neutrophilic panniculitis is a relatively rare condition, characterized by predominantly neutrophilic inflammation in the subcutaneous fat. Rarely, neutrophilic panniculitis may be induced by chemotherapeutics or targeted molecular therapies, including the Bruton tyrosine kinase inhibitor ibrutinib. Previously reported cases of ibrutinib-induced panniculitis were suppressed with sustained low-dose steroid therapy while continuing ibrutinib therapy. To our knowledge, self-limiting panniculitis during ibrutinib therapy has not yet been described. We describe a case of self-limiting, neutrophilic panniculitis which developed during ibrutinib therapy. A 78-year-old woman presented to the dermatology clinic with a 3-week history of painful erythematous nodules on her lower extremities which occurred 1 month after initiating ibrutinib therapy for chronic lymphocytic leukemia. Physical examination revealed tender erythematous poorly demarcated subcutaneous nodules on the anterior and posterior aspects of both lower legs. A panniculitis was suspected clinically, and a punch biopsy was performed. Histological evaluation revealed a lobular panniculitis with fat necrosis and infiltrates consisting predominantly of neutrophils. A diagnosis of neutrophilic panniculitis was rendered, which the patient opted not to treat. The eruption waned before resolving spontaneously over the course of 6 months despite continued ibrutinib therapy. This case illustrates panniculitis as an emerging adverse drug reaction after treatment with ibrutinib and that not all cases will require ibrutinib dose adjustment or steroid therapy but rather may be subject to spontaneous resolution.


Subject(s)
Antineoplastic Agents/adverse effects , Panniculitis/chemically induced , Protein Kinase Inhibitors/adverse effects , Pyrazoles/adverse effects , Pyrimidines/adverse effects , Adenine/analogs & derivatives , Aged , Female , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy , Neutrophils/pathology , Piperidines
6.
Am J Clin Dermatol ; 18(3): 391-403, 2017 Jun.
Article in English | MEDLINE | ID: mdl-28101718

ABSTRACT

Poisoning through pediatric skin leading to acute systemic symptoms is a relatively uncommonly reported phenomenon. Systemic toxicity through the skin typically occurs by direct contact between therapeutic or non-therapeutic topical agents and the skin. Though uncommon, poisoning through pediatric skin can have significant consequences and must be recognized so the offending agent may be discontinued and appropriate treatment initiated. We performed a literature search for all article types between 1950 and April 2016 to provide a single source of detectable cases of acute toxicity in pediatric patients due to percutaneous exposure. This literature review discusses relevant pediatric skin physiology along with reports of poisoning events that resulted in systemic signs and symptoms and even death to provide a comprehensive report on causes of pediatric poisoning through the skin.


Subject(s)
Poisoning/epidemiology , Skin Absorption , Skin/metabolism , Administration, Cutaneous , Child , Humans
7.
Cancer Prev Res (Phila) ; 9(6): 445-55, 2016 06.
Article in English | MEDLINE | ID: mdl-27020654

ABSTRACT

Oral cavity and oropharyngeal cancer (oral cancer) is a deadly disease that is increasing in incidence. Worldwide 5-year survival is only 50% due to delayed intervention with more than half of the diagnoses at stage III and IV, whereas earlier detection (stage I and II) yields survival rates up to 80% to 90%. Salivary soluble CD44 (CD44), a tumor-initiating marker, and total protein levels may facilitate oral cancer risk assessment and early intervention. This study used a hospital-based design with 150 cases and 150 frequency-matched controls to determine whether CD44 and total protein levels in oral rinses were associated with oral cancer independent of age, gender, race, ethnicity, tobacco and alcohol use, and socioeconomic status (SES). High-risk subjects receiving oral cancer prevention interventions as part of a community-based program (n = 150) were followed over 1 year to determine marker specificity and variation. CD44 ≥5.33 ng/mL was highly associated with case status [adjusted OR 14.489; 95% confidence interval (CI), 5.973-35.145; P < .0001, vs. reference group CD44 <2.22 ng/mL and protein <1.23 mg/mL]. Total protein aided prediction above CD44 alone. Sensitivity and specificity in the frequency-matched study was 80% and 48.7%, respectively. However, controls were not representative of the target screening population due, in part, to a high rate of prior cancer. In contrast, specificity in the high-risk community was 74% and reached 95% after annual retesting. Simple and inexpensive salivary CD44 and total protein measurements may help identify individuals at heightened risk for oral cancer from the millions who partake in risky behaviors. Cancer Prev Res; 9(6); 445-55. ©2016 AACR.


Subject(s)
Biomarkers, Tumor/analysis , Carcinoma, Squamous Cell/diagnosis , Early Detection of Cancer/methods , Head and Neck Neoplasms/diagnosis , Hyaluronan Receptors/analysis , Mouth Neoplasms/diagnosis , Adult , Aged , Area Under Curve , Case-Control Studies , Enzyme-Linked Immunosorbent Assay , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Proportional Hazards Models , ROC Curve , Risk , Saliva/chemistry , Sensitivity and Specificity , Squamous Cell Carcinoma of Head and Neck
8.
J Drugs Dermatol ; 13(1 Suppl): s17-20, 2014 Jan.
Article in English | MEDLINE | ID: mdl-24385127

ABSTRACT

The periorbital complex is a critical cosmetic unit. Treatments for this region range from topical prescriptions to enhance the brow hair to topical cosmeceuticals that improve the tone and texture of the skin. Lasers, radiofrequency, botulinum toxins, fillers, and a host of other treatments are used to treat the periorbital region. Judicious use of these treatments, alone or in combination, can greatly alter the appearance of the region. However, adverse events may also be associated with these treatments, and the clinician and patients need to consider both the risks and the benefits of treatment prior to embarking upon a regimen.


Subject(s)
Cosmetic Techniques , Esthetics , Eyebrows/anatomy & histology , Orbit/anatomy & histology , Botulinum Toxins/adverse effects , Cosmetic Techniques/adverse effects , Dermatologic Agents/adverse effects , Humans , Lasers/adverse effects , Rejuvenation , Skin Aging
9.
J Drugs Dermatol ; 12(10 Suppl): s147-50, 2013 Oct.
Article in English | MEDLINE | ID: mdl-24085060

ABSTRACT

Historically, basal cell carcinomas (BCCs) that are neither surgically resectable nor candidates for radiation therapy have had few treatment options. The hedgehog pathway inhibitor, vismodegib, represents a new opportunity for the treatment of such patients. Vismodegib has approval from the United States Food and Drug Administration for treatment of metastatic BCC, locally advanced BCC recurring after surgery, and BCC that is not treatable via surgery or radiation. We present the case of a patient with a BCC infiltrating the spinal column that was neither possible to fully remove surgically nor a candidate for primary treatment with radiation. Treatment with vismodegib followed by adjuvant radiation therapy resulted in complete disease clearance. Vismodegib represents a promising treatment option for patients with surgically non-resectable BCCs that are not candidates for radiation therapy. Mechanism of action, benefits, and adverse events of vismodegib are reviewed, along with a brief discussion on newer options in the hedgehog inhibitor class.


Subject(s)
Anilides/therapeutic use , Carcinoma, Basal Cell/drug therapy , Carcinoma, Basal Cell/surgery , Pyridines/therapeutic use , Skin Neoplasms/drug therapy , Skin Neoplasms/surgery , Aged , Anilides/adverse effects , Biopsy , Carcinoma, Basal Cell/pathology , Drug Approval , Hedgehog Proteins/antagonists & inhibitors , Humans , Male , Neoplasm Invasiveness , Postoperative Care , Pyridines/adverse effects , Skin Neoplasms/pathology , Spinal Neoplasms/pathology , Spinal Neoplasms/secondary , Spinal Neoplasms/surgery , Tomography, X-Ray Computed , United States , United States Food and Drug Administration
10.
J Am Acad Dermatol ; 69(4): 501.e1-11; quiz 511-2, 2013 Oct.
Article in English | MEDLINE | ID: mdl-24034379

ABSTRACT

Kawasaki disease, or mucocutaneous lymph node syndrome, most commonly affects children between 6 months and 5 years of age. Approximately 90% of patients have mucocutaneous manifestations. This article will focus on the epidemiology of Kawasaki disease in the United States as it relates to other countries, the diagnosis of Kawasaki disease, its clinical course, and the currently accepted theories of pathogenesis. A particular focus is given to the various dermatologic manifestations that may occur.


Subject(s)
Cardiovascular Diseases/prevention & control , Immunoglobulins, Intravenous/therapeutic use , Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/epidemiology , Age Distribution , Child, Preschool , Education, Medical, Continuing , Female , Humans , Infant , Infant, Newborn , Male , Mucocutaneous Lymph Node Syndrome/drug therapy , Mucocutaneous Lymph Node Syndrome/pathology , Prevalence , Prognosis , Risk Assessment , Severity of Illness Index , Sex Distribution , United States/epidemiology
11.
J Am Acad Dermatol ; 69(4): 513.e1-8; quiz 521-2, 2013 Oct.
Article in English | MEDLINE | ID: mdl-24034380

ABSTRACT

Kawasaki disease, or mucocutaneous lymph node syndrome, is the leading cause of acquired heart disease in children in the United States and other developed countries. Coronary artery lesions are the most significant cause of morbidity and mortality. Treatment should ideally be provided within 10 days of symptom onset to reduce the risk of coronary artery complications. The standard of care for treatment is intravenous immunoglobulin plus aspirin, but adding corticosteroids may provide additional benefit for high-risk patients. Some patients do not respond to intravenous immunoglobulin and require additional therapy. Part II of this continuing medical education article will focus on the complications of Kawasaki disease and potential treatment options.


Subject(s)
Coronary Artery Disease/drug therapy , Coronary Artery Disease/etiology , Mucocutaneous Lymph Node Syndrome/complications , Mucocutaneous Lymph Node Syndrome/drug therapy , Adrenal Cortex Hormones/therapeutic use , Aspirin/therapeutic use , Child , Child, Preschool , Coronary Aneurysm/etiology , Coronary Aneurysm/physiopathology , Coronary Aneurysm/therapy , Coronary Artery Disease/physiopathology , Drug Therapy, Combination , Education, Medical, Continuing , Female , Follow-Up Studies , Humans , Immunoglobulins, Intravenous/therapeutic use , Infant , Male , Mucocutaneous Lymph Node Syndrome/diagnosis , Risk Assessment , Treatment Outcome , United States
13.
J Clin Aesthet Dermatol ; 6(4): 22-9, 2013 Apr.
Article in English | MEDLINE | ID: mdl-23630638

ABSTRACT

Silicone injections may result in complications that bring patients to a dermatologist or plastic surgeon. These complications may be due to the use of nonmedical grade products, large volume injections, incorrect placement of the product, or a combination of the above. Frequently, complications result when injections are performed by unlicensed practitioners. Individuals who undergo large volume procedures may develop a variety of life-threatening problems ranging from infections to pulmonary emboli. Once they develop problems, these patients often present to licensed and board-certified physicians for treatment. Based on a review of the literature, this article provides a management algorithm for various complications. In addition, a medicolegal perspective is presented. Finally, the transgender experience as it relates to silicone injections is also reviewed.

14.
Transplantation ; 95(2): 309-18, 2013 Jan 27.
Article in English | MEDLINE | ID: mdl-23325005

ABSTRACT

BACKGROUND: Although a longer time on dialysis before kidney transplant waitlisting has been shown for Blacks versus non-Blacks, relatively few studies have compared this outcome between Hispanics and Whites. METHODS: A multivariable analysis of 1910 (684 Black, 452 Hispanic, and 774 White) consecutive patients waitlisted at our center for a primary kidney transplant between 2005 and mid-2010 was performed for time from starting dialysis to waitlisting (months), the percentage who were preemptively waitlisted (waitlisted before starting dialysis), and time from starting dialysis to waitlisting after excluding the preemptively waitlisted patients. RESULTS: The variables associated with significantly longer median times from starting dialysis to waitlisting and less preemptive waitlisting included Medicare insurance for patients ages <65 years (by far, the most significant variable in each analysis), Black race, higher percentage of households in the patient's zip code living in poverty, being a non-U.S. citizen (for preemptive waitlisting), Medicaid insurance, waitlisted for kidney-alone (vs. kidney-pancreas) transplant, and higher body mass index (longer median times for the latter three variables). Although the effect of Black race was mostly explained by significant associations with lower socioeconomic status (Medicare insurance for patients ages <65 years and greater poverty in the patient's zip code), an unexplained component still remained. The univariable differences showing poorer outcomes for Hispanics versus Whites were smaller and completely explained in multivariable analysis by significant associations with lower socioeconomic status and non-U.S. citizenship. CONCLUSION: Black and Hispanic patients had significantly longer times from starting dialysis to waitlisting, in large part related to their lower socioeconomic status and less preemptive waitlisting. A greater focus on earlier nephrology care may help to erase much of these disparities.


Subject(s)
Black or African American , Health Services Accessibility , Healthcare Disparities/ethnology , Hispanic or Latino , Kidney Failure, Chronic/therapy , Kidney Transplantation/ethnology , Renal Dialysis , Socioeconomic Factors , Waiting Lists , Adult , Black or African American/statistics & numerical data , Age Factors , Aged , Body Mass Index , Chi-Square Distribution , Emigrants and Immigrants , Female , Health Services Accessibility/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Hispanic or Latino/statistics & numerical data , Humans , Kidney Failure, Chronic/ethnology , Kidney Failure, Chronic/surgery , Kidney Transplantation/statistics & numerical data , Linear Models , Logistic Models , Male , Medicaid , Medicare , Middle Aged , Multivariate Analysis , Poverty/ethnology , Renal Dialysis/statistics & numerical data , Residence Characteristics , Time Factors , United States/epidemiology , White People/statistics & numerical data , Young Adult
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