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Background: Since July 2004, the United States (U.S.) Army has operated a forward-deployed dermatology clinic in Baghdad, Iraq. This paper outlines the prevalence of skin disease among deployed service men and women in Operation Iraqi Freedom.

Methods: A cross-sectional study was performed for all dermatology visits presenting to the Combat Dermatology Clinic, Ibn Sina, Iraq, between January 15, 2008 and July 15, 2008.

Results: In the six-month period reviewed, 2,696 total patients were evaluated. The most prevalent diagnoses included eczematous dermatitis [17%, n=462] and benign neoplasms [14%, n=375]. Eight percent (n=205) of the total visits were for skin cancer. This included: basal cell carcinoma, squamous cell carcinoma both in-situ and invasive, mycosis fungoides and melanoma. Actinic keratosis comprised 5% of the total visits (n=129). Bacterial infections comprised 6% (n=158) of the total visits and 31 of these cases were community acquired methicillin resistant Staphylococcus aureus (MRSA).

Limitations: Cross-sectional study with referral bias.

Conclusion: This is the largest publication of the prevalence of skin disease in an exclusively dermatologic clinic in a combat setting. For the first time the presence of skin cancer is noted in a combat setting. The prevalence of MRSA is noted and was exclusively seen in U.S. soldiers. There was a statistically significant rise in the prevalence of eczematous dermatitides when compared with previous conflicts. Dermatologists can have a significant and strategic impact on deployed military medicine.

Background: Topical agents containing mixtures of hydroquinone and glycolic acid often cause irritation in patients with melasma.

Objective: The authors assessed the safety and efficacy of a new cream containing hydroquinone (HQ), glycolic acid, and hyaluronic acid for epidermal melasma.

Methods: Fifteen Latin American women with bilateral epidermal melasma underwent twice-daily full face application with the study cream for 12 weeks. A moisturizer was added if irritation developed.

Results: Mexameter data revealed that 14 of 15 patients (93%) improved, and there was a significant decrease in MASI (melasma area and severity index) scores of 64% over the course of the study. Fifty-three percent of the patients required a moisturizer after eight weeks of treatment. The majority of adverse events were mild. Patient and physician global evaluation showed moderate, obvious or very marked improvement in all patients.

Limitations: Open, uncontrolled trial in a small number of patients.

Conclusion: A cream containing hydroquinone, glycolic acid and hyaluronic acid demonstrates improvement in patients with melasma.

There has been a proliferation of treatments for facial rejuvenation but, curiously, the use of such treatments on other areas of the body has not been widely investigated. The clinical effects of treating photodamaged skin of the neck and anterior chest area (décolletage) with a proprietary copper zinc malonate lotion and a proprietary 4% hydroquinone cream (twice daily), plus tretinoin cream (once daily), were evaluated in 42 females in a 24-week investigator-blind randomized study.

Treatment was associated with early and significant (P≤0.05) improvements in mean scores on an overall integrated assessment of photodamage (from week 4 onward) and for multiple signs of photodamage—tactile roughness (from week 2 onward); mottled hyperpigmentation, lentigines and fine wrinkling (from week 4 onward); laxity (from week 8 onward); and crepiness and coarse wrinkling (from week 12 onward). Treatment was generally well tolerated and 94% of subjects were satisfied or very satisfied with the overall improvement in their décolletage at week 24.

Recent advances in light therapy coupled with photosensitizers offer alternatives to topical creams and gels and systemic oral agents for acne treatment. To examine the safety and efficacy of the photosensitizer 5-aminolevulinic acid (ALA) in patients with moderateto- severe acne, a randomized, split-face study, using ALA on one side of the face, was followed by exposure of the entire face to 532 nm potassium titanyl phosphate (KTP) laser. Eight patients completed three treatments for up to 12 weeks. The average acne grading at baseline was 3.20, and improved to 2.12 at 12 weeks (34% improvement). Use of ALA improved acne by 52% compared with 32% on the side that did not receive the photosensitizer. Further studies are warranted to establish optimal parameters for photosensitizer use combined with light therapy for treatment of moderate-to-severe acne; however, the combined use of ALA and a 532 nm laser suggests promising results for acne treatment.

Prior to 1962, some of the most versatile drugs in dermatology were approved by the U.S. Food and Drug Administration (FDA) solely on the basis of safety. One of these is the combination 10% sodium sulfacetamide and 5% sulfur. Sodium sulfacetamide possesses anti-inflammatory and antibacterial properties while sulfur is a nonspecific antibacterial and antifungal. A new emollient foam formulation of 10% sodium sulfacetamide and 5% sulfur allows a thinner application film and leaves behind no residue on hair bearing or nonhair bearing skin. The sulfur smell is also more quickly dissipated with reduced irritation. This uncontrolled, observational, prospective, open-label, single site, eight-week study enrolled 24 subjects (eight with rosacea, eight with seborrheic dermatitis, eight with acne vulgaris) to evaluate the safety and efficacy of this novel foam formulation. At eight weeks, statistically significant improvement was seen in inflammatory rosacea lesion counts and the signs of seborrheic dermatitis. A 50% reduction was noted in the total acne lesion counts. These findings confirm the versatility of an emollient 10% sodium sulfacetamide and 5% sulfur foam.

Idiopathic guttate hypomelanosis (IGH) is a very common skin disorder, although the precise prevalence of which is unknown. There are no universally safe and efficacious treatments for this condition. The authors report the success of 1% pimecrolimus cream in inducing repigmentation is this hypomelanotic disorder.

The association between guttate psoriasis and pityriasis rosea with Streptococcus pyogenes (S. pyogenes) is well established in the literature; however treatment guidelines and necessity have not been clarified with respect to the infectious etiology. Also, the exact role of Streptococcus in the immunopathogenesis of these entities, and the associated risk of development of scarlet fever and poststreptococcal sequelae, are not centrally reported. No single report or case series definitively establishes the coexistence between guttate psoriasis and post-streptococcal sequelae in the same patient, supporting the theories of autoimmune protection conferred between these entities. Laboratory investigations and treatment of Streptococcus in the setting of guttate psoriasis are not necessary, as anti-streptococcal treatment does not significantly modify the course of cutaneous disease, and there is no theoretical or documented risk of post-streptococcal sequelae. However, due to minimal data, antibiotics may still have a role in pityriasis rosea.

Background: Over the ages, the use of leeches in medicine has evolved from haphazard bloodletting to a well-understood physiologic process with defined, rational applications.

Objective: The authors describe the current role of leech therapy in cutaneous surgery and medicine.

Methods: Case series and review of the literature.

Results: Leech saliva contains anticoagulative, anti-aggregative and vasodilatory components. Combined with the annelid’s mechanical ability to extract blood, leeches can contribute to patients’ health with minimal risks.

Conclusion: Leeches should be considered as novel therapies for disorders of coagulation and venous congestion. Implementation of leech treatment should be tempered with the potential adverse effects, including Aeromonas infection and a drop in hematocrit that might require a blood transfusion.

Porokeratosis is hypothesized to be an inherited autosomal dominant disorder with variable penetrance. It has been linked to ultraviolet (UV) radiation in genetically predisposed individuals, to antibody-related autoimmune disease treated with systemic steroids, and to other immunosuppressive states including chronic liver disease. The authors describe an unusual case of a patient with newonset hepatitis of unclear etiology who developed concomitant erythematous annular plaques with atrophic centers and elevated scaling borders on the lower extremities. The histological features of these lesions were consistent with disseminated superficial porokeratosis (DSP). The authors present this patient and a review of the literature to support the direct pathological link between hepatitis and DSP, irrespective of the state of the immune system. Further research would be helpful in clarifying the pathogenesis of porokeratoses in patients with hepatic dysfunction.

Scleromyxedema is a chronic, idiopathic disorder characterized by cutaneous dermal mucin deposition in association with increased dermal collagen and absence of thyroid disease. The clinical features involve sclerosis of skin with numerous, 2–3 mm, firm, waxy, papules in a symmetrical distribution pattern. The skin lesions may progress to widespread and indurated plaques resulting in patient disability via decreased mobility, sclerodactyly and microstomia. Abnormalities in the muscular, neurologic, rheumatologic, pulmonary, renal and cardiovascular systems may accompany the cutaneous lesions. Multiple attempts at therapeutic interventions have failed due to inconsistent, unsatisfactory results and/or severe adverse effects.1–6 Herein, the authors describe a case of scleromyxedema successfully treated with high-dose intravenous immunoglobulin (hdIVIG).

Hand-foot syndrome is a common adverse effect of therapy with capecitabine (Xeloda®) for the treatment of various carcinomas. Symptoms suggesting hand-foot syndrome include pain, pruritus, erythema, tingling and desquamation limited to the palms and soles of feet. Documented pathological findings are few, but include apoptosis of keratinocytes, bizarre mitotic figures, loss of polarity of keratinocytes and vacuolar degeneration of the basal layer of the epidermis. A 63-year-old white female presented with painful, pruritic palmar and plantar erythema and desquamation. A punch biopsy taken from her palm exhibited vacuolization of basal keratinocytes, but none of the other previously documented findings though there were increased mast cells (18–20 per high power field). The patient was treated with clobetasol lotion and her symptoms drastically improved in two weeks. The pathologic findings in this patient suggest new insights in the pathogenesis of hand-foot syndrome from capecitabine leads to a possible explanation for the edematous or urticarial clinical changes seen in these patients.

Necrobiotic xanthogranuloma (NXG) presents a therapeutic challenge to clinicians. Generalized NXG has limited treatment options. A patient presented to the authors with generalized NXG associated with monoclonal gammopathy of unknown significance (MGUS), a plasma cell dyscrasia considered to be a precursor to multiple myeloma.

The patient was treated with lenalidomide, a derivative of thalidomide with efficacy in treatment of multiple myeloma. Resolution of paraproteinemia was associated with resolution of NXG.

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No abstract details for the moment.

No abstract details for the moment.