Absence of Koebnerization Following Ablative and Nonablative Laser Therapy in Patients With Plaque Psoriasis.

BACKGROUND: The adverse effects of laser procedures performed in patients with psoriasis have not been reported to date. OBJECTIVE: The authors report the incidence of koebnerization in patients with psoriasis who underwent laser treatment with different devices over the past 12 years. MATERIALS AND METHODS: The medical records of 38 patients with psoriasis treated with laser therapy were reviewed. Patient characteristics, including duration and severity of psoriasis, baseline psoriasis treatment, laser modality and settings, facial areas treated, and number of sessions, were collected. The primary outcome of interest was incidence of koebnerization. RESULTS: None of the 38 patients with psoriasis treated with laser therapy experienced subsequent koebnerization. Seven patients were on oral systemic medications, 14 were on biologic agents, and 3 were on combination therapy. None of the patients experienced skin infections, delayed healing, or scarring, irrespective of their psoriasis therapy. CONCLUSION: Koebnerization did not occur on the face, neck, or scalp of patients with psoriasis who underwent laser therapy, irrespective of psoriasis severity or types of psoriasis medications they were receiving. Although these results are encouraging, the risk of koebnerization should be discussed with patients with psoriasis who wish to undergo laser procedures.

Profile of secukinumab in the treatment of psoriasis: current perspectives.

Secukinumab (Cosentyx™) is a human monoclonal IgG1k antibody that has been developed to target and block the actions of IL-17A. It is known that this cytokine is elevated in lesions of psoriasis. Interleukins in the Th17 pathway play a pivotal role in the pathogenesis of psoriasis and have thus become targets for recent biologic drug development. As a monoclonal antibody immune modulator, secukinumab exhibits the expected pharmacokinetic properties of slow subcutaneous absorption, low clearance, and long half-life, although formal studies examining the impact of impaired hepatic or renal function on the overall pharmacokinetic profile have not been conducted. Both Phase II and III clinical trials have demonstrated the effectiveness of secukinumab in the treatment of moderate-to-severe plaque psoriasis, psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis, and noninfectious uveitis. In June 2015, secukinumab was approved by the US Food and Drug Administration for the treatment of adults with moderate-to-severe plaque psoriasis, with a wealth of clinical trials showcasing its efficacy in improving psoriasis area and severity index scores, and it is superior to other comparable biologics on the market, including the TNF inhibitor etanercept. As such, this review focuses on the marquee clinical trials involving secukinumab treatment of plaque psoriasis, while also exploring this drug's efficacy in treating patients with psoriatic arthritis, a disease that has a well-documented comorbidity in patients diagnosed with moderate-to-severe plaque psoriasis. Finally, the safety and tolerability of this drug in a variety of clinical trials to date have also been reviewed, and will undoubtedly have a large impact on this drug's postmarketing surveillance and future studies regarding its long-term safety.

Persistent erythematous plaque after minor trauma in an immunocompromised woman.

Scedosporium apiospermum is a ubiquitous soil fungus with a worldwide distribution. It can cause a wide range of clinical disease, from cutaneous and subcutaneous infections, to pneumonia, brain abscess, and life threatening systemic illness. The diagnosis of cutaneous disease is with biopsy and culture. We discuss the case of an elderly immunocompromised woman who presented with a persistent erythematous plaque on the elbow after minor trauma. A biopsy revealed Scedosporium apiospermum. Treatment usually requires surgical resection in conjunction with antifungal therapy.

Family history as a risk factor for herpes zoster: a case-control study.

OBJECTIVE: To assess risk factors for herpes zoster beyond age and immunosuppression, especially the association with a family history of herpes zoster, since a preventative herpes zoster and postherpetic neuralgia vaccine is now available. DESIGN: We undertook a case-control study of herpes zoster, which represents reactivation of latent varicella zoster virus residing in dorsal root ganglia following primary infection, involving 504 patients and 523 controls. Interviews were conducted by trained medical investigators using a structured questionnaire. SETTING: The Center for Clinical Studies, an outpatient clinic and research center in Houston, Texas. PARTICIPANTS: Nonimmunocompromised patients with confirmed cases of herpes zoster were included in the study. Controls were nonimmunocompromised clinic patients with new diagnoses of skin diseases other than herpes zoster. RESULTS: Cases were more likely to report blood relatives with a history of zoster (39%) compared with controls (11%; P < .001). Risk was increased with multiple blood relatives (odds ratio, 13.77; 95% confidence interval, 5.85-32.39) compared with single blood relatives (odds ratio, 4.50; 95% confidence interval, 3.15-6.41). CONCLUSIONS: The results suggest an association between herpes zoster and family history of zoster. Future studies will be needed to investigate this association.

Epidermodysplasia verruciformis in the setting of graft-versus-host disease.

We report a case of epidermodysplasia verruciformis (EV)-like lesions in a patient with graft-versus-host disease after peripheral blood stem cell transplantation from his HLA-matched brother. The patient presented with a diffuse papular eruption that was clinically consistent with graft-versus-host disease; however, histopathology demonstrated viral cytopathic changes and polymerase chain reaction confirmed EV human papillomavirus types 8 and 20. Repeated biopsy specimen showed both human papillomavirus cytopathic effect and graft-versus-host disease, and further workup revealed ocular and hepatic involvement. This progressed to a lupuslike syndrome with lichenoid, violaceous, flat-topped papules in a malar distribution and positive antinuclear autoantibodies. Although EV-like lesions have been reported in patients who are immunocompromised, the incidence is low, and may be linked to EV-related haplotypes.

Managing herpes zoster in immunocompromised patients.

Herpes zoster infections are more common and often more complicated in immunocompromised patients. The key clinical objective in these patients is to reduce the incidence of cutaneous and visceral dissemination that can lead to life-threatening complications. This is best achieved with prompt antiviral therapy, which should be instituted in all immunosuppressed zoster patients if presentation occurs within 1 week of rash onset or any time before full crusting of lesions. For localized disease, most patients can be treated with oral valaciclovir, famciclovir or aciclovir, with close outpatient follow-up. Intravenous aciclovir therapy is reserved for those with disseminated varicella zoster virus infection, ophthalmic involvement, very severe immunosuppression or the inability to take oral medications. Foscarnet is the drug of choice to treat aciclovir-resistant herpes zoster. Appropriate analgesic therapy should be combined with early antiviral treatment to reduce the incidence and severity of acute zoster pain and post-herpetic neuralgia.

Cactus spine granuloma.

We describe the case of a 45-year-old woman with a 2-week history of painful erythematous papules on the palmar aspect of the fingertips of her right hand, resulting from contact with a cholla cactus 3 weeks prior in Arizona. The patient initially was given clobetasol propionate ointment, resulting in some improvement; however, the lesions resolved only after punch biopsies were performed to confirm the diagnosis of cactus spine granuloma.

Open-label study of valacyclovir 1.5 g twice daily for the treatment of uncomplicated herpes zoster in immunocompetent patients 18 years of age or older.

BACKGROUND: Herpes zoster (shingles) is a common disease caused by a reactivation of the latent varicella-zoster virus (chickenpox), which resides in the dorsal root ganglia. Valacyclovir HCl, the L-valyl ester of acyclovir, is an antiviral drug that is used to accelerate the resolution of the herpes zoster rash and associated pain and reduce the duration of postherpetic neuralgia. OBJECTIVE: To demonstrate the safety and efficacy of oral valacyclovir 1.5 g twice daily (bid) for the treatment of uncomplicated herpes zoster in immunocompetent patients over 18 years of age. The dosing schedule of bid versus three times daily is desirable for enhancing patient compliance and to subsequently reduce the incidence of viral resistance. METHODS: One treatment group of 125 patients was administered oral valacyclovir 1.5 g bid for 7 days. Administration of the first dose occurred within 72 hours after onset of rash. Patients were seen and assessed for cutaneous healing, zoster-associated pain (ZAP), and/or zoster-associated abnormal sensations (ZAAS). Patients under 50 years of age were followed for 4 weeks and patients 50 years of age and older were followed for a total of 24 weeks. Patients >or= 50 years were also asked to record a daily diary on pain and abnormal sensations throughout the 24-week study period. Responses to resource use and quality of life questions were also collected. Safety was monitored by means of routine hematologic and biochemical assessments and reporting of adverse experiences. RESULTS: Data from this study were compared with historical control groups both for three times daily antiviral therapy and for placebo. The results showed that twice-daily dosing was as safe and effective as three times daily dosing for the reduction of ZAP and ZAAS. Adverse-effect profiles were similar between the two different regimens, and both treatment groups showed better outcomes than the historical placebo group. Because it is standard of care to administer antivirals for the treatment of acute herpes zoster, a placebo-controlled trial is not possible, necessitating the use of historical controls. CONCLUSION: Oral valacyclovir 1.5 g bid is safe and effective for the treatment of uncomplicated herpes zoster in immunocompetent patients over 18 years of age. Twice-daily dosing may help increase patient compliance and therefore increase the effectiveness of treatment of the acute herpes zoster rash and the prevention of ZAP.

Human papillomaviruses and genital disease.

Human papillomavirus (HPV) infection is causally related to several benign and malignant diseases of the anogenital tract. In this article the authors detail the epidemiology, methods of transmission and risk factors, pathogenesis, and oncogenesis of HPV, and describe clinical manifestations and current treatments. Special attention is given to condyloma acuminatum and non-cervical anogenital intraepithelial neoplasia. The authors conclude with the latest information on prophylactic vaccine development and prospects for future control of HPV-related disease.

Tropical dermatology: bacterial tropical diseases.

UNLABELLED: Bacterial infections are common in tropical parts of the world and can include those species also seen regularly in temperate climates. Many tropical bacterial infections, however, are rarely diagnosed in temperate parts of the world and include bartonellosis, tropical ulcer, tropical pyomyositis, granuloma inguinale, lymphogranuloma venereum, yaws, pinta, melioidosis, and glanders. Some tropical bacterial diseases, eg, plague and anthrax, are associated with high mortality rates and are of potential use in bioterrorism. Some tropical bacterial diseases are closely associated with specific activities such as hunting (ie, tularemia) or eating raw seafood (Vibrio vulnificus infection). The bacterial diseases having the most severe medical impact in the tropics are those caused by members of the Mycobacterium genus. Millions of persons throughout the world suffer from tuberculosis and leprosy; Buruli ulcers are common causes of morbidity in many tropical countries. Because of the increasing frequency of travel to tropical parts of the world for tourism and work as well as the increasing number of immigrants and adoptees from these areas, it is imperative that physicians practicing in temperate climates be able to recognize the signs and symptoms of tropical bacterial diseases, carry out the proper diagnostic tests, and initiate appropriate therapy and prevention. LEARNING OBJECTIVE: At the completion of this learning activity, participants should be familiar with the clinical presentations, epidemiologies, diagnoses, therapies, and preventions of bacterial tropical diseases.

Sex differences in the transmission, prevention, and disease manifestations of sexually transmitted diseases.

BACKGROUND: Dermatological manifestations of sexually transmitted diseases (STDs) range from full body papulosquamous eruptions to genital ulcers and warts. The transmission, prevalence, and disease burden of STDs are not shared equally between the sexes. OBSERVATIONS: Women are more susceptible than men for the acquisition of the human immunodeficiency virus and other dangerous STDs because of economic, biological, and social factors, and often sustain more damage to their health from the disease. Conclusion This review article elucidates the differential effect of STDs on women vs men to better understand what is required to protect women from the morbidity and mortality of STDs.

Current and potential uses of imiquimod.

Imiquimod, an imidazoquinoline amine, is an immune response modifier first FDA-approved for the treatment of external genital and perianal warts in 1997. Since its appearance on the market, its antiviral and antitumor properties have been used in the treatment of a variety of dermatologic conditions. In this review article, the basic mechanism of action of imiquimod, current FDA-approved and non-FDA-approved uses of imiquimod, and key points of medication application frequency, possible adverse effects, and use in combination therapy are discussed. Common skin conditions that may be eradicated with imiquimod are emphasized.

Atrophic dermatofibrosarcoma protuberans: a case report and reappraisal of the literature.

Dermatofibrosarcoma protuberans (DFSP) is an uncommon cutaneous malignancy. Unusual presentations described as atrophic have been documented. A case of DFSP with both clinical and histologic atrophy is presented, and all cases purporting atrophy with this tumor are reviewed. Meaningful trends are extracted from this data. In addition, the imprecise use of the term atrophic in regard to DFSP is clarified. We maintain that the variant of atrophic DFSP that mimics atrophoderma or anetoderma, as in this case, is the rarest variant of atrophic DFSP. Atrophic DFSP should be in the differential for depressed lesions on the trunks of women or on the lower extremities of children.