US dermatology residency program rankings based on academic achievement.

This study provides rankings of individual US dermatology residency programs based on a number of factors, including annual amount of National Institutes of Health (NIH) funding received in 2014, number of publications by full-time faculty members in 2014, and number of faculty lectures given at 5 annual society meetings. The overall ranking of the top 20 US dermatology residency programs is given as well as the top 5 programs for the factors most reflective of academic achievement.

Lichenoid Dermatitis in an Adult with Immune Dysregulation, Polyendocrinopathy, Enteropathy, X-Linked (IPEX) Syndrome.

A 23-year-old man presented to our practice with erythroderma and an unusual retiform eruption, along with alopecia universalis and nail dystrophy. He had had no skin findings at birth, but since early infancy had had localized eczematous eruptions of his skin. At 10 years of age, he had developed a generalized eczematous flare requiring hospitalization, and another generalized episode occurred in October 2010. He was prescribed prednisone 60 mg daily, which initially provided an improvement, but tapering of the corticosteroid resulted in another generalized flare.

Incidence of Pulmonary Arterial Hypertension in Patients with Psoriasis: A Retrospective Cohort Study.

CONTEXT: Inflammatory signaling may play an important role in the pathogenesis of pulmonary arterial hypertension (PAH). OBJECTIVE: To assess the incidence of PAH in patients with mild and severe psoriasis compared with their respective controls. DESIGN: From January 2004 to November 2012, we performed a retrospective cohort study of patients with psoriasis in the Kaiser Permanente Southern California Health Plan. Patients with an International Classification of Diseases, Ninth Revision Clinical Modification diagnostic code for psoriasis (696.1) or psoriatic arthritis (696.0) without a prior diagnosis of primary PAH (416.0) or secondary PAH (416.8) were eligible for inclusion. Patients who had never received a diagnosis of psoriasis were frequency-matched by age, sex, and race to form the control cohorts. MAIN OUTCOME MEASURES: Incidence of PAH in patients with psoriasis compared with matched controls. RESULTS: There were 10,115 patients with mild psoriasis, 3821 with severe psoriasis, and 69,360 matched controls. On multivariable analysis, there was a significantly increased risk of PAH developing in the severe psoriasis cohort vs their controls (hazard ratio = 1.46, 95% confidence interval = 1.09-1.94). CONCLUSION: The systemic inflammatory process underlying psoriasis may be a cause for an increased risk of PAH, but there are numerous secondary causes of PAH, some of which were not accounted for in our study. Further prospective, randomized controlled trials are necessary to establish psoriasis as a risk factor for PAH.

From the Medical Board of the National Psoriasis Foundation: Perioperative management of systemic immunomodulatory agents in patients with psoriasis and psoriatic arthritis.

Treatment with systemic immunomodulatory agents is indicated for patients with moderate to severe plaque psoriasis and psoriatic arthritis. In these patients, surgery may confer an increased risk of infectious or surgical complications. We conducted a literature review to examine studies addressing the use of methotrexate, cyclosporine, and targeted immunomodulatory agents (tumor necrosis factor-alfa inhibitors, interleukin [IL]-12/23 inhibitors, IL-17 inhibitors) in patients undergoing surgery. We examined 46 total studies; the majority were retrospective studies in patients with rheumatoid arthritis and inflammatory bowel disease. One study in patients with psoriasis and psoriatic arthritis reviewed 77 procedures and did not find an elevated risk of postoperative complications with tumor necrosis factor-alfa and IL-12/23 inhibitors even with major surgeries. Based on level III evidence, infliximab, adalimumab, etanercept, methotrexate, and cyclosporine can be safely continued through low-risk operations in patients with psoriasis and psoriatic arthritis. For moderate- and high-risk surgeries, a case-by-case approach should be taken based on the patient's individual risk factors and comorbidities.

Association Between Mohs Surgery Wait Times and Surgical Defect Size in Patients With Squamous Cell or Basal Cell Carcinoma of the Skin.

BACKGROUND: Consequences of delays in treatment of nonmelanoma skin cancers (NMSCA) are largely unstudied. OBJECTIVE: To determine the relationship between Mohs micrographic surgery (MMS) delay time and final MMS defect size. METHODS: A retrospective chart review was performed to identify patients who underwent MMS for biopsy-proven basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) between 2004 and 2006. Time delay between date of biopsy and date of surgery and lesion diameter increase between biopsy and surgical defect were calculated. RESULTS: Two hundred eighty-three lesions qualified for inclusion in the study. No significant difference in mean change of major diameter between primary and recurrent tumors (1.0 vs 1.1 cm, p = .67), between BCCs and SCCs (both were 1.0 cm, p = .99), and between tumor size at presentation <1.0 versus ≥1.0 cm (1.1 vs 0.8 cm, p = .11) were found. However, the mean number of MMS layers taken was significantly different between BCCs and SCCs (1.9 vs 1.5, respectively; p = .0022). Linear regression analysis of major diameter change versus time delay to MMS showed no significant increasing trend over time. CONCLUSION: No evidence was found that time delays of up to 1 year from biopsy to MMS impact the growth of NMSCA.

European trends in the frequency of original research in acne vulgaris, rosacea, dermatitis, psoriasis, skin cancer, and skin infections, 1970-2010.

We analyzed trends in the frequency of original publications into common dermatologic topics in two premier European journals, the British Journal of Dermatology and the Journal of the European Academy of Dermatology and Venereology. Most notably, we found that psoriasis publications peaked around the mid-to-late 1980's as well as demonstrated an upward trend since the 21st century. Skin cancer research witnessed a gradual increase in the frequency of publications since 1970. These findings were consistent with a prior study analyzing trends in two American dermatology journals. We attempted to analyze these results from a historical perspective as well as provide an outlook on the future of research into these common dermatologic topics.

Trends in the frequency of original research in acne vulgaris, rosacea, dermatitis, psoriasis, skin cancer, and skin infections, 1970-2010.

CONTEXT: Medical journals have allowed researchers to share their latest discoveries, especially in the most common diseases affecting patients worldwide. OBJECTIVE: To analyze trends in the frequency of original research into common dermatologic diseases from 1970 to 2010. DESIGN: A retrospective review of the Journal of the American Academy of Dermatology and the Archives of Dermatology was performed using the MEDLINE database. All original research articles published between 1970 and 2010, by quinquennium, dealing with acne vulgaris, rosacea, skin cancer, dermatitis, psoriasis, or skin infections were included. MAIN OUTCOME MEASURE: Total number of publications dealing with each dermatologic topic considered. RESULTS: The frequency of research into acne vulgaris and rosacea decreased from 24% in 1970 to 5.1% in 2010. Psoriasis research increased in frequency from 17.6% to 26.5% from 2000 to 2010, and skin cancer research increased from 4% in 1970 to 48% in 2010. CONCLUSIONS: Topics that experienced early advancements in research, such as acne vulgaris and rosacea, demonstrated a decreasing trend in the frequency of publication. Published psoriasis research has increased in frequency since 2000, most likely because of the discovery of biologics. Finally, skin cancer research has continued to increase in frequency of publication, paralleling the increasing incidence of skin cancer.

Promising alternative clinical uses of prostaglandin F2α analogs: beyond the eyelashes.

Prostaglandin F2α analogs, commonly prescribed for glaucoma treatment, have been shown to induce side effects such as cutaneous hypertrichosis and hyperpigmentation. Therefore, these medications have theoretic applications in the treatment of alopecia and disorders of hypopigmentation. We reviewed the literature to find original studies assessing the use of prostaglandin F2α analogs in these settings. Studies and reports were analyzed in regards to androgenic alopecia, alopecia areata, chemotherapy-induced alopecia, vitiligo, and hypopigmented scarring. Based on the results of these studies, and consideration of pathophysiologic mechanism, the most promising applications for prostaglandin F2α analogs include androgenic alopecia, chemotherapy-induced alopecia, and alopecia areata concurrently treated with corticosteroids.

Risk of myocardial infarction in psoriasis patients: a retrospective cohort study.

BACKGROUND: Psoriasis may or may not be associated with a higher risk for myocardial infarction (MI). We sought to assess differences in MI incidence between control, mild psoriasis and severe psoriasis patients. METHODS: We performed a retrospective cohort study of Kaiser Permanente Southern California members with psoriasis between 1 January 2004 and 30 June 2012, assessing the risk and incidence rates of MI. RESULTS: There were 50,865 control patients matched to 10,173 patients with mild psoriasis and 19,205 control patients matched to 3841 patients with severe psoriasis. The MI incidence per 1000 person-years for mild psoriasis controls, mild psoriasis, severe psoriasis controls and severe psoriasis were 4.9, 6.7, 3.7 and 5.1, respectively. Upon multivariable analysis, mild psoriasis patients had a significantly higher risk of MI compared to matched control patients {hazard ratio (HR) = 1.31 [95% confidence interval (CI): 1.14, 1.51]} and severe psoriasis patients had a significantly higher risk of MI compared to matched control patients [HR = 1.28 (95% CI: 1.02, 1.60)]. CONCLUSION: Patients with psoriasis are at higher risk for MI compared to control patients.

Photodynamic therapy for psoriasis.

INTRODUCTION: Photodynamic therapy for psoriasis showed promise in the early 1990s with reports of plaque clearance following topical aminolevulinic acid - photodynamic therapy (ALA-PDT). METHODS: In December 2013, we conducted a systematic search of the PubMed Medline database using the keywords "psoriasis" and "photodynamic therapy". RESULTS: Numerous clinical studies have failed to demonstrate a consistent, efficacious response to topical ALA-PDT. Furthermore, severe pain and burning sensations were repeatedly reported, many cases being intolerable for patients. DISCUSSION: The variability in clinical response and the painful side effects have made topical ALA-PDT an unsuitable treatment option for chronic plaque psoriasis. Nonetheless, early clinical studies of other modalities such as topical hypericin and methylene blue, as well as systemic ALA and verteporfin, have shown that these photosensitizers are efficacious and much better tolerated than topical ALA. CONCLUSION: With the current landscape of phototherapy dominated by psoralen combined with ultraviolet A (PUVA) and narrow-band ultraviolet B (NB-UVB), an alternative light therapy utilizing the visible spectrum is certainly promising and a worthwhile endeavor to pursue.

The 100 most cited psoriasis articles in clinical dermatologic journals, 1970 to 2012.

BACKGROUND: Citation analysis is an effective way to gauge the impact of an article on the scientific community. OBJECTIVE: The purpose of this study was to perform a citation analysis of 24 clinical dermatologic journals from 1970 to 2012, limited to the topic of psoriasis. METHODS: The authors conducted a search of "psoriasis" in the Science Citation Index from 1970 to 2012, including articles that have received 100 or more citations. The top 100 most cited articles were further analyzed for country, institution, and study type. RESULTS: Fifty of the top 100 most cited articles were from the United States and 81 of them were original articles. The majority of the top 100 classics were from dermatology programs in the United States, but institutions in the United Kingdom and Germany also made notable contributions. Citation classics in psoriasis were highly published from 1985 to 1989 and 2000 to 2004. LIMITATIONS: LIMITATIONS included potential neglect of a clinical dermatologic journal and the limited search term of "psoriasis." CONCLUSION: The great majority of citation classics were published in the premier dermatologic journals. The top-ranking dermatology programs in the United States produced the majority of the top 100 classics in psoriasis. The high number of citation classics from 1985 to 1989 correlates to the discovery of the immune-mediated pathogenesis of psoriasis at that time. The 21st century brought forth the monumental development of biologic agents in psoriasis therapy, reflected by the high number of citation classics from 2000 to 2004.

Citation classics and top-cited authors of psoriasis in five high-impact general medical journals, 1970-2012.

Psoriasis is a relevant topic for publication in general medical journals. We conducted a search of the Thomson Reuters' Science Citation using the search term of "psoriasis" in five high-impact general medical journals. All citation classics from 1970 to 2012 were included and each author's total number of citations was summated. A total of 51 citation classics were collected. The most common topic of publication was psoriasis treatment (37), especially biologic agents (16). A total of 1037 authors of psoriasis articles were identified in our study and the top 25 most-cited authors were compiled. We hope our citation analysis provides a historical perspective and highlights the work of our colleagues and predecessors.

Most common dermatologic topics published in five high-impact general medical journals, 1970-2012: melanoma, psoriasis, herpes simplex, herpes zoster, and acne.

CONTEXT: General practitioners frequently encounter skin diseases and are accustomed to diagnosing the most common dermatologic conditions. OBJECTIVE: We sought to determine the most common dermatologic topics published in five high-impact general medical journals (New England Journal of Medicine, The Lancet, the Journal of the American Medical Association, British Medical Journal (now The BMJ), and Annals of Internal Medicine). DESIGN: We conducted an independent search of the Thomson Reuters' Science Citation Index for common dermatologic topics, limited to the period 1970 to 2012. MAIN OUTCOME MEASURE: Total number of publications dealing with each dermatologic topic considered. RESULTS: The five most common dermatologic topics published were melanoma, psoriasis, herpes simplex, herpes zoster, and acne. Melanoma and psoriasis were the top two dermatologic topics published in each journal except for Annals of Internal Medicine. CONCLUSIONS: Internists frequently diagnose herpes simplex, herpes zoster, and acne, which are also common dermatologic topics published. Although internists infrequently diagnose melanoma and psoriasis, they are major topics for general medical journals because of their increased community awareness, major advancements in therapeutic research, and their nondermatologic manifestations.

Flow cytometric analysis of the cell cycle phase specificity of DNA damage induced by radiation, hydrogen peroxide and doxorubicin.

We have optimized a flow cytometric DNA alkaline unwinding assay to increase the sensitivity in detecting low levels of DNA damage (strand breaks and alkali-labile sites) and to permit the measurement of the extent of DNA damage within each cell cycle compartment. The lowest gamma radiation dose that induced detectable DNA damage in each cell cycle phase of HeLa and CEM cells was 10 cGy. The lowest H(2)O(2) concentration that induced detectable DNA damage in each cell cycle phase was 0.5 microM in HeLa cells, and 1-2.5 TmicroM in CEM cells. For both HeLa cells and CEM cells, DNA damage in each cell cycle compartment increased approximately linearly with increasing doses of gamma radiation and H(2)O(2). Although untreated HeLa and CEM cells in S phase consistently exhibited greater DNA unwinding than did G(1) or G(2) cells (presumably due to DNA strand breaks associated with replication forks), there was no difference between the susceptibility of G(0)/G(1), S and G(2)/M phase cells to DNA damage induced by gamma radiation or H(2)O(2), or in the rate of repair of this damage. In each cell cycle phase, the susceptibility to gamma radiation-induced DNA damage was greater in CEM cells than in HeLa cells. In contrast to the lack of cell cycle phase-specific DNA damage induced by exposure to gamma radiation or H(2)O(2), the cancer chemotherapeutic drug doxorubicin (adriamycin) predominantly induced DNA damage in G(2) phase cells.