A case of sclerodermatous graft-versus-host disease responsive to imatinib therapy.

Sclerodermatous graft-versus-host disease (sGVHD) is a rare, late complication of hematopoietic cell transplantation. Classified as a variant of chronic graft-versus-host disease, sGVHD is thought to be predominantly an immune-mediated response characterized by aberrant T-cell function and dysregulation of tyrosine kinase cascades. Recently, the profibrotic cytokine transforming growth factor B and stimulatory autoantibodies against the platelet-derived growth factor receptor have been implicated in the pathogenesis of sGVHD. Treatment of sGVHD remains disappointing and largely limited by systemic side effects. Imatinib mesylate is a small molecule tyrosine kinase inhibitor that has been shown to selectively inhibit both the platelet-derived growth factor receptor and transforming growth factor-ß signaling pathways. We report a case of sGVHD in a pediatric patient that was resistant to traditional therapy but showed improvement in cutaneous symptoms following daily treatment with 400 mg of imatinib mesylate. Due to its favorable side-effect profile, specificity for molecular pathways deranged in sGVHD and proven efficacy in other sclerodermoid diseases, imatinib mesylate is a promising new tool in the management of this challenging disease.

Nanoparticles: a closer look at their dermal effects.

Nano-sized particles represent a unique class of materials with novel physiochemical properties due to increased surface area. Many sunscreens and cosmetics are now using nano-sized titanium dioxide and zinc oxide, which avoids the white, chalky appearance of the older preparations. Although the U.S. Food and Drug Administration (FDA) has determined that nano-sized titanium dioxide is not a new ingredient, but a specific grade of the original product, recent studies suggest that nanomaterials products may not be equivalent to their respective bulk-form products, and the adverse effects of nanoparticles cannot be reliably predicted from the properties of the material in bulk form. Nanoparticles are incorporated into a variety of skin care products, and in the future may be useful as transdermal drug delivery devices. Thus, understanding potential epidermal and dermal penetration, as well as possible toxicity, is important to the field of dermatology. The authors present a review of the therapeutic applications and potential toxicity of nanoparticles relevant to the field of dermatology thus far.

Dermal scatter reduction in human skin: a method using controlled application of glycerol.

BACKGROUND AND OBJECTIVE: Previous studies in a hairless Guinea pig model showed that transdermal application of glycerol effected a temporary reduction in dermal scatter of light. This study focuses on the application of this protocol on human patients. STUDY DESIGN/MATERIALS AND METHODS: After stratum corneal removal, glycerol was applied to human subjects using a low pressure transdermal application device. Optical coherence tomography imaging showed increased intensity of radiation reaching deeper regions in the skin and photographs showed enhanced visualization of dermal structures. RESULTS/CONCLUSION: Topically applied glycerol increased light penetration of in vivo corneal-stripped skin. This minimally invasive approach to temporary dermal scatter reduction has the potential to improve the efficacy of light-based diagnostic or therapeutic devices.

Clouston syndrome and eccrine syringofibroadenomas.

Clouston syndrome and eccrine syringofibroadenoma are uncommon disorders that have been reported together rarely and only before the discovery of the GJB6 gene for Clouston syndrome. This case reports eccrine syringofibroadenoma in a patient with genetically confirmed Clouston syndrome.

Urticaria : a review.

Urticaria is often classified as acute, chronic, or physical based on duration of symptoms and the presence or absence of inducing stimuli. Urticarial vasculitis, contact urticaria, and special syndromes are also included under the broad heading of urticaria. Recent advances in our understanding of the pathogenesis of chronic urticaria include the finding of autoantibodies to mast cell receptors in nearly half of patients with chronic idiopathic urticaria. These patients may have more severe disease and require more aggressive therapies. Extensive laboratory evaluation for patients with chronic urticaria is typically unrevealing and there are no compelling data that associate urticaria with chronic infections or malignancy. Pharmacologic therapy consists primarily of the appropriate use of first- and second-generation histamine H(1) receptor antihistamines. Additional therapy may include leukotriene receptor antagonists, corticosteroids, and immunomodulatory agents for severe, unremitting disease. Despite our greater understanding of the pathogenesis of urticaria, the condition remains a frustrating entity for many patients, particularly those with chronic urticaria.

Mycosis fungoides with coccidioidomycosis.

Mycosis fungoides is an indolent, epidermotropic, cutaneous T-cell lymphoma of helper/memory T cells that presents as heterogeneous, papulosquamous patches, plaques, and tumors. We present a patient with mycosis fungoides and infection with Coccidioides immitis of the skin, which has not been previously reported.

Assessment of a blog as a medium for dermatology education.

Our first year experience with the use of a web log as a communication tool for our dermatology interest group at the University of Texas Medical Branch in Galveston (UTMB) is described. We find the UTMB Dermatology Interest Group Blog facilitates educational opportunities and serves as a dermatology resource for medical students, and improves communication. It is an educational innovation that could be adopted by other dermatology departments.

Mycosis fungoides with tinea pseudoimbricata owing to Trichophyton rubrum infection.

BACKGROUND: Dermatophytes can mimic or possibly trigger mycosis fungoides (MF). OBJECTIVES: To present the case of a 55-year-old male referred for MF refractory to therapy who instead had extensive tinea pseduoimbricata (concentric, annular lesions secondary to Trichophyton rubrum). METHODS: Case report with biopsy and cultures. RESULTS: Oral antifungal therapy dramatically improved his lesions, and only a few MF lesions persisted after treatment. CONCLUSIONS: Concurrent tinea may confound the treatment and diagnosis of MF.

Survey of antibiotic prescription use for inflamed epidermal inclusion cysts.

BACKGROUND: Symptomatic epidermal inclusion cysts (EICs) are variously called "inflamed" or "infected," and the mechanism of inflammation or suppuration is controversial. Whether physicians routinely prescribe antibiotics for inflamed EICs is of concern owing to cost and bacterial resistance. OBJECTIVES: To determine whether there is any difference in the diagnosis and treatment of EICs between primary care physicians and dermatologists and to estimate the rate and cost of antibiotic prescriptions for EICs. METHODS: One hundred twenty-five primary care physicians and 52 dermatologists were surveyed using a standard case study and a photograph. RESULTS: Sixty-seven percent of the primary care physicians used the term "infected," whereas 69% of the dermatologists used the term "inflamed" or "ruptured." Eighty-four percent of the general practitioners and 94% of the dermatologists chose antibiotics for treatment. CONCLUSION: This study shows that despite the differences between general practitioners and dermatologists in diagnosis, the majority of physicians use antibiotics for the treatment of inflamed EICs.

Acral necrotizing mycosis fungoides.

A 65-year-old male with long-standing acral "eczema" and patches of mycosis fungoides suddenly developed a transformed, necrotizing ulcerative cutaneous T-cell lymphoma manifesting as necrotic lesions of the toe and lip. The tumor had brown and/or black eschars on the surface and grew multiple opportunistic organisms. Markers CD3, Epstein-Barr virus-encoded small RNA, and T-cell receptor g gene rearrangement were positive, with CD4, 8, 30, 56, and TIA-1 negative. In spite of initial response to radiation, the patient succumbed to infection within 3 months.