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Original Articles
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Doxycycline Plus Levamisole: Combination
Treatment for Severe Nodulocystic Acne
Habib Ansarin MD, Sayied Savabynasab MD,
Ashkan Heshmatzade Behzadi MD, Nader Sadigh MD,
Jaleh Hasanloo MD
Abstract
Background: Levamisole is an agent without much potential use alone, but through immunomodulation, may synergistically improve
the efficacy of other drugs like doxycycline in the treatment of acne vulgaris.
Objective: The goal of this study was to determine the efficacy of levamisole in addition to doxycycline in the treatment of patients
suffering from severe nodulocystic acne.
Methods: A double-blind, randomized, placebo-controlled trial was conducted in the dermatology clinic of Rasoul-e-Akram Hospital in
Tehran, Iran in 2006. Sixty patients were randomly assigned to 1 of 2 study groups. The case group was administered oral levamisole
2.5 mg/kg/wk (up to 150 mg/wk) plus doxycycline 100 mg daily and the control group was given 100 mg of oral doxycycline daily and
a placebo. Patients were evaluated at baseline, and at 2-month, 4-month, and 6-month checkpoints.
Results: The responses to treatment were significantly higher in the case group according to the reduction in total lesions count,
acne severity index; and papule/pustule and nodule/cyst count at the 2nd, 3rd, and 4th visits.
Conclusion: Results indicated that adding oral levamisole to doxycycline is an effective treatment for severe nonresponsiveness
to conventional treatments of acne vulgaris. In the patient group, levamisole was well tolerated with an acceptable safety profile.
At the time of publication, this study is the first clinical trial that suggests levamisole as an effective new treatment for severe acne
vulgaris.
[more...]
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Long-term Safety of Mycophenolate Mofetil and
Cyclosporine: A Review
Catherine Buell MD, John Koo MD
Abstract
The prevailing notion in dermatology is that mycophenolate mofetil (MMF) is safer than cyclosporine (CsA), but that CsA has greater
effi cacy. This literature review evaluates the available long-term safety data of MMF and CsA. Literature in the fi elds of dermatology,
autoimmune disease, and transplantation were retrieved from PubMed. Data regarding immunosuppressive and non-immunosuppressive
side effects of MMF and CsA are presented along with available pregnancy safety data. Surprisingly, there is a paucity of
data on long-term MMF monotherapy. Transplant data is presented separately due to the concomitant use of other immunosuppressants
along with MMF. Trends that can be identifi ed include a less discernable cancer or end-organ damage risk in MMF compared
to CsA. However, MMF appears to have a greater risk in pregnancy and increased reports of herpes simplex and zoster infection
compared to CsA.
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Prevalence of Community-acquired
Methicillin-resistant Staphylococcus Aureus in a
Private Dermatology Office
Aaron M. Bruce DO, James M. Spencer MD MS
Abstract
Background: The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue
infection (SSTI) in private practice dermatology offi ce is largely unknown and the prescribing of antibiotic treatment could be infl uenced
by such data.
Objective: Investigators sought to examine the period prevalence of CA-MRSA infections involving skin and soft tissue in a suburban
private practice dermatology setting.
Methods: Chart reviews of 170 patients who had bacterial cultures taken from January 2007 to November 2007 were performed,
with an analysis of sex, age, immune status, species of growth, type of lesion, and culture site.
Results: The mean age of the study population was 54.0 years (SD 21.8) and 51.1% were male. Of the 170 cultures taken, 135 (79%)
grew 1 or more bacteria and MRSA positive cultures were found in 28 (21%) of 135 cultures.
Limitations: Only 1 geographic location was represented.
Conclusion: The rising rates of CA-MRSA skin and soft tissue infections should be evaluated with consideration of the unique
populations that the majority of reports represent. There is little doubt that the prevalence of skin infections caused by CA-MRSA
have increased dramatically and will likely continue to do so in the future. However, the authors caution the empiric prescribing of
antibiotics presently known to be effective against CA-MRSA and advocate the culturing of all infectious lesions upon presentation
and reserve these antibiotics (tetracyclines, trimethoprim-sulfamethoxazole [TMP-SMX], clindamycin, rifampin) for the treatment of
high-risk patients and patients with culture proven CA-MRSA infections.
[more...]
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Evaluating the Tolerability and Efficacy of
Etanercept Compared to Triamcinolone
Acetonide for the Intralesional Treatment of
Keloids
Bruce Berman MD PhD, Jitendrakumar K. Patel MD,
Oliver A. Perez MD, Martha H. Viera MD, Sadegh Amini MD,
Samantha Block, Deborah Zell MD, Sujatha Tadicherla MD,
Adriana Villa MD, Claudia Ramirez MD, Tami De Araujo MD
Abstract
Background: Tumor necrosis factor-alpha (TNF-α) is a proinfl ammatory and profi brotic cytokine that inhibits degradation of collagen
and glycosaminoglycans. Etanercept, a recombinant TNF-α receptor fusion protein, may decrease excessive fi brous tissue in keloids.
Objective: To evaluate the tolerability and effi cacy of etanercept as compared to triamcinolone acetonide (TAC) for the treatment
of keloids.
Methods: Twenty subjects were randomly assigned to receive monthly intralesional injections of either 25 mg of etanercept or 20
mg of TAC for 2 months. Keloids were evaluated at baseline, week 4, and week 8 by subjects and investigators in a blinded fashion
using physical, clinical, and cosmetic parameters. Photographs were taken and adverse events were noted during each evaluation.
Results: Etanercept improved 5/12 parameters including signifi cant pruritus reduction, while TAC improved 11/12 parameters at
week 8, although no statistical difference was observed as compared to baseline. There was no signifi cant difference between the
2 treatment groups. Both treatments were safe and well tolerated.
Conclusion: Etanercept was safe, well tolerated, improved several keloid parameters, and reduced pruritus to a greater degree than
TAC therapy. However, further studies are required before it can be recommended for the treatment of keloids.
[more...]
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The Effectiveness of Liquid Bandage as an
Adhesive and Antimicrobial Agent
Perry Robins MD, Leonard Goldberg MD,
Ronald Moy MD, Keyvan Nouri MD, Maritza Perez MD,
Ritu Saini MD, Deborah Sarnoff MD, James Spencer MD
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A Case-series of 48 Patients Treated With
Thalidomide
Sean D. Doherty MD, Sylvia Hsu MD
Abstract
Introduction: Thalidomide is approved by the Food and Drug Administration (FDA) for erythema nodosum leprosum, but has been
used in many other dermatological conditions that are refractory to standard therapy.
Methods: The medical records of 48 patients treated with thalidomide at Baylor College of Medicine (Houston, TX) were retrospectively
reviewed to determine the conditions treated with thalidomide, dosing, effi cacy, treatment duration, side effects, adverse
events, and reason for discontinuing therapy.
Results: Forty-eight patients (men=18, women=30) with a mean age of 49.6 years (range: 20-79) were included in this study.
Patients were treated for prurigo nodularis, discoid lupus erythematosus, tumid lupus erythematosus, subacute cutaneous lupus
erythematosus, systemic lupus erythematosus, lichen planus, lichen planopilaris, cutaneous sarcoidosis, and prurigo nodularis. All
conditions were refractory to standard therapy. Patients were treated for a mean of 7.5 months (range: 3 days to 70 months). In most
of the disorders, a majority of patients experienced clinical improvement. The most common reason for discontinuation of therapy
was side effects, the most frequent being peripheral neuropathy.
Limitations: This study was limited by being retrospective in nature.
Conclusion: Thalidomide effectively treats some dermatologic conditions that are refractory to standard medications. There are
inconveniences associated with obtaining the medication and it is expensive. Physicians must be vigilant for possible side effects,
especially peripheral neuropathy.
[more...]
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Low Risk of Postinflammatory
Hyperpigmentation in Skin Types 4 and 5 After
Treatment With Fractional CO2 Laser Device
Kee Lee Tan MD, Caroline Kurniawati RN,
Michael H. Gold MD
Abstract
Background/Objective: Hyperpigmentation occurs in more than 37% of dark-skinned subjects treated with a fully ablative CO2 laser
device. This study assessed the risk of postinfl ammatory hyperpigmentation (PIH) in subjects with skin types 4 and 5 treated once
with a specifi c protocol of treatment using a fractional CO2 laser.
Methods: Seven subjects with photodamaged skin received a single facial treatment using a fractional CO2 laser. Anesthesia was
limited to a lidocaine and prilocaine cream for 1 hour before the single-pass treatment. Subjects were evaluated for improvement and
PIH on alternate days for 14 days, and at 1 month, 3 months, and 6 months posttreatment.
Results: All subjects achieved improvement in their specifi c skin conditions and in skin texture. Postinfl ammatory hyperpigmentation
was not observed in any subject. Four subjects experienced no pain during treatment, while 3 reported mild pain. Recovery was associated
with minimal pain and itching.
Conclusion: In dark-skinned subjects, fractional CO2 laser treatment and topical anesthesia subjectively improves common skin
conditions without PIH.
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The Use of Acellular, Fetal Bovine Dermal Matrix
for Acute, Full-thickness Wounds
Rungsima Wanitphakdeedecha MD MA MSc,
T. Minsue Chen MD, Tri N. Hguyen MD
Abstract
Background: Skin substitutes may be used as part of the management of acute surgical wounds. The ideal skin substitute should
be biocompatible, inexpensive, free of potential pathogens, easy to store, prepare, and utilize.
Objective: To discuss the authors’ direct clinical experience with an acellular, fetal bovine dermal matrix for the treatment of Mohs
micrographic surgery (MMS) wound management.
Methods: After the cutaneous malignancies were cleared by MMS, a sheet of the product was prepared according to the manufacturer’s
instructions, trimmed to fit the defect, and then secured to the wound to enhance contact with the wound bed.
Results: Between June 2006 and July 2007, the product was used on a total of 10 wounds in 7 patients. Comorbidities included
organ transplantation, Sezary syndrome with hepatitis C, and graft-versus-host disease. Seventy percent of the lesions were located
on the lower extremities. The average defect area was 13.4 cm2 (range: 4.0-32.0 cm2). The dermal substitute was fully incorporated
in 80% of defects and those that did not fully incorporate had exposed bone and tendon without the periosteum and peritendon,
respectively.
Conclusion: Skin substitutes may provide temporary coverage of acute, full-thickness surgical wounds allowed to heal by second
intent. They may facilitate wound management with acceptable aesthetic outcomes. Alternate reconstructive options, however,
such as cutaneous flaps, should be considered when there is exposed bone and/or tendon without their periosteum and/or peritendon.
[more...]
Case Reports
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Nevus Lipomatosus Cutaneous Superfi cialis of the
Groin Arising in the Fifth Decade of Life
Mohammad Reza Namazi MD
Abstract
Nevus lipomatosus cutaneous superfi cialis (NLCS) is a rare malformation characterized by ectopic adipose tissue in the dermis.
The lesion is usually present from birth or noticed in the fi rst 2 decades of life. It occurs as sessile or pedunculated, domed nodular
growths with a smooth, wrinkled, or cerebriform surface. Multiple lesions have a marked predilection for the gluteal region, lower
back, and upper thigh, though solitary lesions may occur at unusual sites like the scalp, clitoris, and calf. An unusal case of NLCS is
presented here where the solitary lesion occurred as a large exophytic growth arising at the groin in the fi fth decade of life.
[more...]
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Successful Treatment of Metastatic Crohn’s Disease
With Cyclosporine
Dafnis C. Carranza MD, Lorraine Young MD
Abstract
Metastatic Crohn’s disease refers to cutaneous granulomatous lesions that are noncontiguous to the gastrointestinal tract. The treatment
of cutaneous Crohn’s disease is challenging. A patient with metastatic Crohn’s disease whose lesions cleared after a 3-month
course of cyclosporine is reported.
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Reticulated Phototoxic Eruption in a Patient on
Long-term Diltiazem Therapy
Miriam Hanson MD, Vesna Petronic-Rosic MD
Abstract
Diltiazem hydrochloride is a commonly prescribed medication in the treatment of cardiovascular disease. A case of diltiazem-induced
hyperpigmentation in a patient after signifi cant sun exposure is reported. The morphological appearance was reticulated and slategray
to blue in color. The pathogenesis of the hyperpigmentation is discussed and possible treatment options are reviewed.
[more...]
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Moxifl oxacin as the Likely Cause of Drug-induced
Linear Immunoglobulin A Bullous Dermatosis
Dianne Kovacic MD, Matthew Fox MD, Jason Reichenberg MD
Abstract
Linear immunoglobulin A bullous dermatosis (LABD) is an immune-mediated subepidermal blistering disease that can be triggered by
drug exposures, most notably, vancomycin. The authors report of a case of a 72-year-old man who developed LABD after a course of
moxifl oxacin. To the authors’ knowledge, there is no other case of LABD caused by moxifl oxacin in the medical literature.
[more...]
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Development of Systemic Lupus Erythematosus in a
Patient With Rheumatoid Arthritis Following Treatment
Conversion of Infl iximab to Adalimumab
Jamaiya Havel BA, Sina Aboutalebi MD, Lauren Doughty MD, Marla Wirges MD
Abstract
Systemic lupus erythematosus (SLE)-like syndromes and the development of lupus-related autoantibodies are known to occur during
treatment with certain medications. Here a case of complete SLE conversion in a patient with rheumatoid arthritis following sequential
treatment with infl iximab and adalimumab is reported. Potential mechanisms for development of SLE with this treatment regimen
are discussed, as well as the need for further exploration into autoimmune phenomenon with the use of immunobiologic agents.
[more...]
Features
