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Archives Volume 6 | Issue 12

Original Articles

Issues Affecting Specialty Career Paths in Dermatology

Aimee L. Leonard MD, C. William Hanke MD, Mark A. Bechtel MD, Isaac Brownell MD PhD, Larry J. Buckel MD, Robert M. Hurwitz MD, Sherry H. Hsiung MD, Amy S. Paller MD, Kirsten Turchan MD
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As the field of medicine changes, physicians deal with ever-increasing challenges and pressures. An overview of broad career paths within the specialty of dermatology is presented and important issues affecting these subspecialty tracks are discussed. These issues include increasing regulatory controls, the medical liability crisis, competitive forces, corporate and global outsourcing threats, managed care, and reimbursement.

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Pulsed Dye Laser for the Treatment of Hypergranulation Tissue with Chronic Ulcer in Postsurgical Defects

Steven Q. Wang MD, Leonard H. Goldberg MD FRCP
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Background and Objective: Hypergranulation tissue may complicate postoperative wounds, causing them to become chronic nonhealing ulcers. There is no reliably effective treatment. We report the use of the 595-nm pulsed-dye laser (PDL) for the treatment of wounds healing by second intention and complicated by hypergranulation tissue after Mohs micrographic surgery. Methods: In a retrospective case review, 9 patients with slow-healing or nonhealing postoperative wounds with hypergranulation tissue were treated with the 595-nm PDL. The majority of the wounds were located on the scalp, forehead, and temple. Results: All of the patients demonstrated dramatic improvement after one treatment. Most patients achieved complete or near complete re-epithelialization of the ulcers after 1 to 2 treatments. The PDL treatment required no local anesthesia, and there were no postlaser treatment complications reported. Conclusions: The 595-nm PDL is an effective, safe, and reliable treatment to promote second intention healing in postsurgical wounds complicated by the formation of hypergranulation tissue.

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Topical Photodynamic Therapy for Dermatologic Disorders: Results and Complications

Kelley Pagliai Redbord MD, C. William Hanke MD
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Background: Topical photodynamic therapy (PDT) involves the use of a photosensitizing topical medication that is activated by a light source in the presence of oxygen leading to cellular destruction and subsequent photorejuvenation. In 1999, the US FDA approved PDT for the treatment of nonhyperkeratotic actinic keratoses (AKs) on the face and scalp. Observations: The study population comprised 85 patients treated with short-contact, topical aminolevulinic acid (ALA)- PDT for a total of 247 treatments. Ninety percent of patients with a variety of dermatologic disorders had significant improvement or total clearance. Ninety-eight percent of patients had no complications. Only 2 patients in our series had a significant complication. Conclusions: Short-contact, topical ALA-PDT is a safe and effective treatment for a variety of dermatologic disorders including photoaging and AKs.

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Duration of Remission of Biologic Agents for Chronic Plaque Psoriasis

Richard G. Langley MD, Kenneth B. Gordon MD
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Background: The efficacy of biologic agents to treat psoriasis has been established in well-designed clinical trials. The primary endpoint is usually a 75% reduction from the baseline Psoriasis Area and Severity Index, stressing acute control of symptoms. Another important endpoint is remission, or duration of response off therapy, which reduces exposure to immunosuppressive agents and potentially lowers costs. Methods:We searched the literature for randomized controlled clinical trials of remission with biologic agents. Results and Conclusions: Among approved biologic agents, alefacept produced the longest posttreatment clinical benefits in responders (7 to 8.6 months after a 12-week course), followed by infliximab (4.7 months after a 6-week, 3-dose induction period), etanercept (2.8 to 3.5 months after 12 weeks of therapy), and efalizumab (2.8 months after 24 weeks of therapy). Long-term response to infliximab in some patients may be limited by neutralizing antibodies. Additional data on adalimumab are needed.

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Pyoderma Gangrenosum: Dermatologic Application of Hyperbaric Oxygen Therapy

William D. Tutrone MD, Kim Green MS, Jeffrey M. Weinberg MD, Selin Caglar MD, Dick Clarke
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Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis of skin and subcutaneous tissue. The current accepted theory is that PG is an immunologic-based phenomenon. Several therapies have been used to control this disease, including corticosteroids, antibiotics, immunotherapy, dapsone, and hyperbaric oxygen therapy. This article will review the application of hyperbaric oxygen (HBO) therapy in patients with PG. Information for this manuscript was derived from multiple searches of MEDLINE and the National Baromedical Service literature collection. HBO therapy has been shown to effectively treat PG ulcers and reduce pain associated with PG in several case studies. Evidence from the studies cited herein help to establish a foundation for further research to investigate the role of HBO therapy as an adjuvant therapy in the treatment of PG.

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Case Reports

New Onset Flushing due to Unauthorized Substitution of Niacin for Nicotinamide

Monique Kademian MD, Mark Bechte MD, Matt Zirwas MD
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Nicotinamide is the amide form of niacin and has anti-inflammatory properties that have led to its use in the treatment of several inflammatory dermatologic conditions, such as rosacea. Niacin has established its role in the prevention of coronary artery disease. Cutaneous flushing is a well-known and often dose-limiting side effect of niacin therapy, which does not occur with nicotinamide. We report a patient with rosacea who developed new onset flushing due to unauthorized substitution of niacin for nicotinamide. The anti-inflammatory mechanisms of nicotinamide and flushing mechanisms of niacin are discussed.

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Type I Hypersensitivity to Lidocaine

Reshma Nair Haugen MD, Clarence W. Brown MD
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Lidocaine hydrochloride is the most commonly used anesthetic agent in dermatology. Despite its widespread and frequent use, adverse reactions to lidocaine are uncommon. The majority of side effects include vasovagal reactions and local side effects consisting of bruising and edema at the injection site. Immunologically mediated allergic reactions are thought to account for only 1% of these adverse reactions. We report an extremely rare case of a true type I hypersensitivity allergy to lidocaine hydrochloride.

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Practical Experience with Efalizumab in Hand and Foot Psoriasis

David J. Cohen MD, Lubomira Scherschun MD
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Psoriasis of the hands and feet is highly debilitating and difficult to treat. It may be of a plaque-or pustular-type, or a combination of the two. Efalizumab (Raptiva®, Genentech Inc), a humanized monoclonal antibody that inhibits critical T cellmediated processes, is approved by the FDA for the treatment of adult patients with chronic moderate to severe plaque psoriasis. We present the cases of 7 patients who suffered from extensive hand and foot psoriasis recalcitrant to treatment. Each patient was treated with 1 mg/kg/wk of efalizumab and responded rapidly to treatment with favorable results appearing within 1 to 4 months. Patients were able to resume previous work responsibilities and no longer suffered from difficulties with ambulation. Efalizumab was effective for the rapid treatment of these 7 patients with psoriasis of the hands and feet.

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Minocycline-Induced Hyperpigmentation Resolves during Oral Isotretinoin Therapy

Jennifer Soung MD, Justine Cohen BA, Robert Phelps MD, Steven R. Cohen MD MPH
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Although disfiguring hyperpigmentation is a well-defined complication of minocycline therapy, modalities to reverse the phenomenon are unpredictable. We report a case of minocycline-induced, blue-black pigmentation in a 23-year-old Hispanic man, which resolved after treatment with oral isotretinoin for acne vulgaris.

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Features

AESTHETIC TRENDS

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NEWS, VIEWS, AND REVIEWS

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PIPELINE PREVIEWS

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SCHOOLS OF PHARMACOLOGY

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CLINICAL TRIAL REVIEW

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Archives Volume 6 | Issue 12

Original Articles

Case Reports

Features

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