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Archives Volume 1 | Issue 3

Original Articles

TNf-Alpha and Apoptosis: Implications for the Pathogenesis and Treatment of Psoriasis

Frank C. Victor, Alice B. Gottlieb
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TNF-alpha is a key cytokine in innate immune responses and is increased in psoriatic lesions. TNF-alpha has many effects, ranging from inflammation to apoptosis. These effects are reviewed to better understand the role of TNF-alpha as it relates to the pathogenesis and treatment of psoriasis. TNF-alpha increases production of pro-inflammatory molecules (e.g. IL-1, IL-6, IL-8, NF-kappaB, vasoactive intestinal peptide) and adhesion molecules (e.g. intercellular adhesion molecule-1, P-selectin, E-selectin). TNF-alpha promotes apoptosis through binding to the TNF-receptor 1; however, psoriatic lesions are hyperproliferative despite an increase in TNFalpha. This paradox is partially explained as NF-kappaB activation seems to inhibit TNF-alpha-induced apoptosis. The importance of TNF-alpha and apoptosis in psoriasis is shown through the review of clinical trials using anti-TNF-alpha immunobiologics (e.g. etanercept, infliximab) and apoptosis-inducing treatments that result in clinical improvement of the disease.

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The Use of Tumescent Anesthetic Solution for Fat Transfer Donor and Recipient Sites

Rhoda S. Narins, MD
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Surgical Complications

Keyvan Nouri, MD and Halland Chen, MD
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The History of Flaps

Elizabeth K. Hale, MD
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The History of Skin Grafts

Alysa R. Herman, MD
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Biologic Therapy for Psorasis- The First Wave: Infliximab, Etanercept, Efalizumab, and Alefacept

Jeffrey M. Weinberg, MD; Ritu Saini, BA and William D. Tutrone, BS
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Over the last several years, a new generation of therapies for psoriasis has been in development. These biologic therapies target the activity of T lymphocytes and cytokines responsible for the inflammatory nature of this disease. In this review, we present an update on the progress of the four biologic agents in the forefront: infliximab, etanercept, efalizumab, and alefacept. The mechanism of each drug will be reviewed, as well as the most recent efficacy and safety data.

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The New Antihistamines-Desloratadine and Levocetirizine; A Review

Noah Scheinfeld, MD
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The Skin Cancer Foundation

Mitzi Moulds
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Case Reports

A Young Boy with Symmetric Hyperkeratotic Plaques: Progressive Symmetric Erythrokeratoderma (PSEK)

Martha P. Arroyo, MD
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In this report, a case is presented of a child, descendent from parents originating in the Virgin Islands, with symmetric and progressive hyperpigmented, hyperkeratotic plaques consistent with progressive symmetric erythrokeratoderma (PSEK). Additional family members were also affected in an autosomal dominant pattern of inheritance. Erythrokeratodermas are rare genodermatoses that have characteristic clinical presentations of well-demarcated, hyperkeratotic, and erythematous plaques. Three types exist, differentiated by their clinical presentation. In this report, a case of progressive symmetric erythrokeratoderma (PSEK) is presented. The clinical features, pathogenesis, and treatment options for erythrokeratodermas are discussed.

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Irbesartan- Associated Persistant Edema of the Eyelids, Face, and Neck

Philip R. Cohen, MD
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In this report, a case is presented of a child, descendent from parents originating in the Virgin Islands, with symmetric and progressive hyperpigmented, hyperkeratotic plaques consistent with progressive symmetric erythrokeratoderma (PSEK). Additional family members were also affected in an autosomal dominant pattern of inheritance. Erythrokeratodermas are rare genodermatoses that have characteristic clinical presentations of well-demarcated, hyperkeratotic, and erythematous plaques. Three types exist, differentiated by their clinical presentation. In this report, a case of progressive symmetric erythrokeratoderma (PSEK) is presented. The clinical features, pathogenesis, and treatment options for erythrokeratodermas are discussed.

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Management of Obstructive Airway Hemangiomans in the Neonate

Alysa R. Herman, MD and John A. Carucci, MD, PhD
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Pemphigus Foliaceus Presenting As Eruptive Seborrheic Keratosis and Responding to Oral Gold Treatment

Mohammed M. Bagheri, MD; Mehran Alagheband, MD; Omeed M. Memar, MD PhD and David B. Eiler, MD
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Pemphigus Foliaceus (PF) is an antibody-mediated autoimmune disease. IgG directed against desmoglein-1 induces acantholysis in the superficial epidermis, leading to the classic presentation of crusted erosions in a seborrheic distribution. We report a case of a 51-year-old African-American man with an 8-year history of PF, who developed multiple hyperpigmented, ‘stuck-on’ appearing verrucous papules and plaques on the back, chest, and neck. Skin biopsy and direct immunofluorescence from the seborrheic keratosis-like lesions was consistent with pemphigus foliaceus. The patient was treated by adding oral gold (auranofin) to his regimen of prednisone and discontinuing hydroxychloroquine. After six months of follow-up his erosions healed. This is the first report of treating pemphigus foliaceus with oral gold.

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Features

Pipeline Previews

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Washington Whispers

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Clinical Trial Review

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Archives Volume 1 | Issue 3

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