No abstract details for the moment.
Jennifer Soung MD, Wangui Muigai, Nilam Amin DO, Dana K. Stern MD, Mark G. Lebwohl MD
PUVA has become a common form of treatment for early stage mycosis fungoides (MF). The purpose of this retrospective
study was to review the clinical data of 51 MF patients (96% stage IA or IB) treated with PUVA at the Mt.
Sinai MF clinic over the past 20 years. We analyzed the efficacy, safety, and remission duration in patients who were
treated with a modified PUVA regimen. Forty-four of 51 patients (86%) achieved complete clinical clearing for all
stages after initial PUVA therapy. The mean duration of remission with maintenance treatment was more than 27
months (range: 3 weeks to 130 months). The mean duration of disease from start of first PUVA therapy for all patients
was 4.8 years (range: 0.7 to 130 months). PUVA for patients with early-stage MF is a safe and effective therapeutic
modality with prolonged disease-free remissions, however, PUVA alone was not adequate for more advanced disease.
James M. Spencer MD MS, Carole Hazan MD, Sherry Hsiung MD, Perry Robins MD
Actinic keratoses (AKs) represent the second most common reason to visit a dermatologist in the United States and
their therapy has become a major portion of most dermatologists’ practice. An ever-increasing array of therapeutic
options exist for the therapy of actinic keratoses, offering physicians and patients a greater number of choices than ever
before. Patient expectations and needs seem to be changing at the same time, thus effecting therapeutic decisionmaking.
While destructive therapies with resultant wounds, time for wound healing, and possible hypopigmentation or
scarring were acceptable in the past, many patients from the baby-boom generation are now developing AKs and have
little tolerance for any time for wound healing or any cosmetic changes. This paper will raise some fundamental questions
regarding AKs and their management.
Aditya K. Gupta MD PhD FRCP(C), Jennifer E. Ryder HBSc, Lindsay E. Lynch HBSc, Amir Tavakkol PhD Dip Bact
Terbinafine is an allylamine with fungicidal activity, first approved for the treatment of onychomycosis in the
United Kingdom in the early 1990s, and in the US in 1996. Terbinafine is the most frequently prescribed oral
antifungal agent in the US and Canada for onychomycosis. Its efficacy and safety in dermatophyte toenail
onychomycosis in adults has been established in many studies. In fact, 18 randomized controlled trials have shown
terbinafine to be highly effective, with a meta-average for mycological cure of 76% ± 3% (mean ± standard error).
In large surveillance studies, terbinafine exhibited excellent safety profiles consistent with results obtained in
pivotal studies. Additionally, terbinafine has been reported to be superior to both itraconazole and fluconazole in
comparative studies in the treatment of dermatophyte toenail onychomycosis. Recent studies have reported
terbinafine to be more cost effective than griseofulvin, fluconazole, or itraconazole. Terbinafine has also been used
to treat onychomycosis effectively and safely in special patient populations, such as children, the elderly,
immunocompromised patients, diabetics, and those with Down syndrome. Terbinafine should therefore be
considered for the management of onychomycosis in adults based on its effectiveness, broad spectrum, fungicidal
nature, established safety profile, and very low occurrence of drug interactions. Furthermore, the data support the
use of terbinafine to treat dermatophyte onychomycosis in children and the elderly.
Oren Shoshani MD, Joseph Berger MD, Lucian Fodor MD, Yitzchak Ramon MD, Avi Shupak MD, Izhak Kehat MD, Amos Gilhar MD, Yehuda Ullmann MD
Adipose tissue injection as a free graft for the correction of soft tissue defects is a widespread procedure in plastic surgery.
The main problem in achieving long-term soft tissue augmentation is partial absorption of the injected fat, and
hence the need for over-correction and re-injections. Lidocaine, used for local anesthesia, has been suspected as an
inhibitor of growth of adipocytes in culture and slowing down glucose transport and lipolysis in adipocytes. In addition,
reduced blood supply by local application of epinephrine was accused of having a negative effect on the graft. The purpose
of this study was to examine the effect of local anesthesia, administered to the fat donor site, on the take of the
Human adipose tissue, obtained by suction-assisted lipectomy, was injected subcutaneously into the scalp of nude mice.
Local anesthesia of the fat donor site consisted of a solution with 600 mg of lidocaine (0.06%) and epinephrine
1:1000000. In a control group, normal saline with no local anesthesia or epinephrine was administered to the donor
site. One cc of fat was injected after centrifugation into each animal scalp. There were 10 animals in each group.
The animals were sacrificed 15 weeks after the procedure. Graft weight and volume were measured, and histologic evaluation
was performed. No significant differences were demonstrated between the groups in regard with the grafts’
weight and volume and the histologic parameters investigated.
In conclusion, local anesthesia solution, consisting of lidocaine and epinephrine, does not alter the take of fat grafts,
and has no influence on the adipocytes viability.
David Rosmarin MA, Bruce E. Strober MD PhD
Interleukin 12 (IL-12) is an important cytokine produced by a variety of immune effector cells that leads to a type 1
helper T cell (Th1) response. IL-12 also directs T cells to the skin via induction of cutaneous lymphocyte antigen
(CLA) expression. In this article we report the current understanding of the immunobiology of IL-12, reviewing its
structure, receptor, and function. We also discuss the role of IL-12 in the pathogenesis of psoriasis. Some effective conventional
psoriasis treatments alter IL-12 levels. Importantly, specific antibodies directed against IL-12 may prove useful
against psoriasis but may also act by targeting IL-23 in addition to IL-12.
Melvin Lee, John Koo MD
The long-established notion that rosacea is worsened by light is of particular concern in the phototherapy of diseases
such as psoriasis, eczema, or vitiligo, which often can be coexistent with rosacea. A literature search was conducted
and much evidence was found to challenge this belief that light adversely affects rosacea. In fact, more patients actually
improved with sunlight in a more recent published survey. Several other studies have also shown that rosacea
patients were similar to control subjects in sun exposure, solar skin damage, and sun sensitivity. Additionally, all clinical
trials to date have failed to find a difference between rosacea patients and control subjects when challenged with
ultraviolet light. Thus, phototherapy with rosacea may be safer than is commonly believed.
Debra Breneman MD, Alan B Fleischer Jr. MD, David Kaplan MD, Mark G. Lebwohl MD, Bruce Miller, MD, David Pariser, MD, Toivo Rist MD, L. Swinyer MDh, Yin Liu PhD, Valerie Foley PharmD
Atopic dermatitis (AD) is a chronic inflammatory and pruritic skin disorder marked by alternating periods of
relapse and remission. This multicenter, randomized, active- and vehicle-controlled, investigator-blinded study
compared the efficacy and safety of clobetasol propionate lotion to clobetasol propionate cream formulation and
lotion vehicle in the treatment of moderate to severe AD. A total of 229 subjects applied treatment twice-daily
for 2 weeks. Clobetasol propionate lotion was significantly more effective than its lotion vehicle at 2 weeks and
comparable to the cream formulation. Clinical success after a 2-week, treatment-free follow-up period was greater
in the clobetasol propionate lotion group than in the cream group. Clobetasol propionate lotion is effective, safe,
well tolerated and offers a better remission profile in the treatment of moderate to severe AD as compared to clobetasol
propionate emollient cream.
Stefan C. Weiss MD MHSc, Josephine Nguyen MD, Susan Chon MD, Alexa B. Kimball MD MPH
Background: There are no published studies examining either the effectiveness of topical steroids in the treatment of
stasis dermatitis or indicating what steroid strength or duration of treatment is optimal to treat this common condition.
Objective: To investigate the efficacy of twice-daily application of the topical steroid betamethasone valerate 0.12%
foam for the treatment of stasis dermatitis.
Design: 42-day randomized, double-blinded, vehicle-controlled, pilot study.
Settings: Outpatient dermatology clinic at a university-affiliated clinic.
Subjects: 19 subjects, mean age of 73, with mild to moderate bilateral stasis dermatitis.
Intervention: Twice-daily application of betamethasone valerate 0.12% foam versus vehicle foam to bilateral randomly
assigned lower legs for 28 days with follow-up to day 42.
Main Outcome Measures: The primary clinical endpoints were the mean change in erythema, scale, swelling, petechiae,
post-inflammatory hyperpigmentation, and self-reported pruritus, assessed on a 5-point Likert scale (0 = clear, 1 =
almost clear, 2 = mild, 3 = moderate, 4 = severe). Secondary endpoints were changes in health related quality of life
(HRQL) using the EuroQol-5D (EQ-5D) utility score and visual analog scale (VAS) and the Dermatology Life Quality
Results: Although there was no overall difference between the foam and vehicle-treated leg at days 14 and 28, the
steroid-treated leg, but not the vehicle-treated leg, showed statistical improvement over baseline. Improvement in the
steroid-treated leg was statistically better than vehicle at days 14 and 28 in terms of erythema (P < .05) and petechiae
(P < .05). Improvement in VAS was notable at days 14 (7.1%), 28 (9.7%), and 42 (9.6%) (P < .001). Similarly, there
was a statistically significant improvement in the DLQI compared to baseline on visit days 14 (188.9%) and 28
(126.1%) (P < .001).
Conclusions: This study suggests that betamethasone valerate 0.12% foam is an effective and well-tolerated short-term
treatment of stasis dermatitis, but that higher potency steroids may be needed to achieve better efficacy. Furthermore,
these results are the first to suggest that the application of effective topical anti-inflammatory therapy can lead to
improvement in HRQL.
Pilar Luis-Montoya MD, Patricia Pichardo-Velázquez MD, María Teresa Hojyo-Tomoka MD, Judith Domínguez-Cherit MD
Background: Treatment options for cutaneous striae are very limited.
Objective: To determine if subcision is an effective treatment for cutaneous striae and compare a combination with
0.1% tretinoin cream against a single treatment.
Methods: 14 patients were evaluated, each with 3 white striae. One stria received treatment with subcision, one with
tretinoin cream in a 0.1% concentration, and one with subcision plus tretinoin. The length of follow-up was 3 months.
Two blind investigators evaluated improvement by comparison of the initial and final digital photographs.
Results: Only 7 patients completed 3 months follow-up. A decrease of width and clinical improvement was observed
with the 3 treatments. However, some striae showed no change at all and there was no statistically significant difference
between treatments. Three patients presented necrosis in striae treated with subcision.
Conclusions: There are no studies in the medical literature about subcision for the treatment of cutaneous striae. This
is a preliminary study and considering the undesirable effects of necrosis in a high percentage of striae treated with subcision,
the subjective way of evaluation, and the small study group, we can not recommend subcision as a treatment for
cutaneous striae. Large studies are necessary to corroborate or to discard our findings.