Anthony M. Rossi

Innovative Uses of Tumor Necrosis Factor α Inhibitors

Tumor necrosis factor alpha (TNF-alpha) is an inflammatory cytokine that is released by a variety of cell types, including immune effector cells and tissue-specific cells. TNF-alpha has been shown to promote inflammation via the activation and induction of cytokines interleukin 1 (IL-1), IL-6, and IL-8 and by the upregulation of adhesion molecules on endothelial cells leading to increased leukocyte extravasation. Theoretically, the blockade of TNF should have widespread potential in the treatment of numerous inflammatory diseases. Currently, 3 TNF-alpha inhibitors available in the United States are approved for psoriasis and psoriatic arthritis: infliximab, etanercept, and adalimumab. Numerous case reports and case series have been published in recent years reporting the off-label uses of these drugs in various inflammatory skin diseases. This review summarizes the most recent reports on 20 such conditions.

Prophylactic and empiric use of antibiotics in dermatologic surgery: a review of the literature and practical considerations.

BACKGROUND Although the risk of postoperative infection and bacteremia from dermatologic procedures remains low, many dermatologic surgeons continue to prescribe antibiotics, pre‐ and postoperatively. This practice can lead to unwanted morbidity and mortality and significantly increases associated healthcare costs and, even more ominously, increases bacterial resistance in the community. OBJECTIVE To provide a comprehensive overview of antibiotic usage in dermatologic surgery and use evidence‐based medicine to provide recommendations for antibiotic usage tailored to microbial pathogens. MATERIALS AND METHODS A literature review was conducted to provide the most current overview of the guidelines for antibiotic use against surgical site infections, infective endocarditis, and hematogenous joint infection. In addition, recommendations for antibiotic use with implantable materials, such as fillers, and for special populations, such as organ transplant recipients, are provided. RESULTS AND CONCLUSION We focused on the most common bacterial pathogens related to surgical sites and effective antibiotics for each. In doing so, we seek to limit the unwarranted use of antibiotics in dermatologic surgery.

Treatment of Hyperpigmentation

Disorders of hyperpigmentation encompass a plethora of pigmentary problems that can range from inherited to acquired. This article focuses on two prevalent disorders of hyperpigmentation and their treatment: melasma and postinflammatory hyperpigmentation. Each represents an acquired disorder of dyspigmentation with multifactorial etiology, which preferentially affects darker phototypes. Treatment can require a combination of medical, surgical, and laser modalities, as well as patience by both physician and patient. Treatment is limited mainly by the skin phototype of the patient, as darker skin types are more susceptible to adverse effects of treatment.

Laser Therapy in Latino Skin

Because the Latino/Hispanic ethnic group is made up of various skin phototypes there is no one particular laser parameter applied to all Latinos. This review examines specific laser therapies and tailors them for usage in the Latino population. Particular emphasis is placed on the selection of laser parameters, wavelengths, and pulse durations that are suitable and safe to use in Latino subtypes. Limitations are noted in the availability of certain lasers and the cost of such treatments as well as how the phototype of the patient limits what parameters can be used.

Combined bullous pemphigoid and pemphigus vulgaris in an 18-year-old female

We present a case of an 18‐year‐old female with clinical, histological and immunopathological features of overlapping pemphigus vulgaris and bullous pemphigoid. This case is unique both in the context of the distinctive hybrid nature of the bullous disorder and the young age of onset. An initial biopsy showed a combined pemphigus pattern histologically and a dominant pemphigoid pattern by immunofluorescence, hence posing a diagnostic conundrum. A subsequent biopsy however confirmed a combined pemphigus and pemphigoid pattern both in the context of the light microscopic findings and by immunofluorescence. The pathophysiologic basis of this distinctive hybrid dermatosis along with the other reported cases of overlapping pemphigus and pemphigoid are reviewed.