Brandon E. Cohen

Psoriasis and the Risk of Depression in the US Population: National Health and Nutrition Examination Survey 2009-2012

IMPORTANCE Psoriasis is a risk factor for depression. Depression may also trigger or exacerbate psoriasis. The relationship between psoriasis and depression, however, remains to be fully explored. OBJECTIVE To investigate the association between psoriasis and major depression in the US population. DESIGN, SETTING, AND PARTICIPANTS Population-based study using participants in the National Health and Nutrition Examination Survey from 2009 through 2012. MAIN OUTCOMES AND MEASURES Diagnosis of major depression based on the Patient Health Questionnaire-9. RESULTS We identified 351 (2.8%) cases of psoriasis and 968 (7.8%) cases of major depression among 12,382 US citizens included in our study. Fifty-eight (16.5%) patients with psoriasis met criteria for a diagnosis of major depression. The mean (SD) Patient Health Questionnaire-9 score was significantly higher among patients with a history of psoriasis than those without psoriasis (4.54 [5.7] vs 3.22 [4.3], P < .001). Psoriasis was significantly associated with major depression, even after adjustment for sex, age, race, body mass index, physical activity, smoking history, alcohol use, history of myocardial infarction (MI), history of stroke, and history of diabetes mellitus (OR, 2.09 [95% CI, 1.41-3.11], P < .001). Interaction term analyses involving patients with a history of both psoriasis and a cardiovascular event, specifically MI or stroke, did not reveal a synergistically increased risk of major depression (psoriasis and MI: OR, 1.09 [95% CI, 0.28-3.60], P = .91; psoriasis and stroke: OR, 0.67 [95% CI, 0.12-3.66], P = .63). In adjusted multivariable models, the risk of major depression was not significantly different between patients with limited vs extensive psoriasis (OR, 0.66 [95% CI, 0.18-2.44], P = .53). CONCLUSIONS AND RELEVANCE Self-reported history of psoriasis was independently associated with major depression as assessed by a validated screening tool, even when controlling for comorbidities. History of cardiovascular event did not modify the risk of major depression for patients with psoriasis. The severity of psoriasis was unrelated to the risk of major depression. Therefore, all patients with psoriasis, regardless of severity, may be at risk for major depression.

Viral Causes of Hearing Loss: A Review for Hearing Health Professionals

A number of viral infections can cause hearing loss. Hearing loss induced by these viruses can be congenital or acquired, unilateral or bilateral. Certain viral infections can directly damage inner ear structures, others can induce inflammatory responses which then cause this damage, and still others can increase susceptibility or bacterial or fungal infection, leading to hearing loss. Typically, virus-induced hearing loss is sensorineural, although conductive and mixed hearing losses can be seen following infection with certain viruses. Occasionally, recovery of hearing after these infections can occur spontaneously. Most importantly, some of these viral infections can be prevented or treated. For many of these viruses, guidelines for their treatment or prevention have recently been revised. In this review, we outline many of the viruses that cause hearing loss, their epidemiology, course, prevention, and treatment.

Acne scarring: A review of available therapeutic lasers

The utilization of lasers in dermatology has greatly expanded in recent decades. Acne scarring is a common indication in which lasers play an important therapeutic role.

Alternative Systemic Treatments for Vitiligo: A Review

Vitiligo is a common, acquired disorder of skin pigmentation that can significantly impact quality of life. It often represents a therapeutic challenge, which has resulted in interest in alternative treatments such as herbal and vitamin supplements. In this review, we provide an overview of the most commonly studied complementary agents, describe proposed mechanisms of action, identify potential adverse effects, and discuss the primary evidence supporting their use. Our discussion focuses on l-phenylalanine, Polypodium leucotomos, khellin, Ginkgo biloba, and vitamins and minerals, including vitamins B12, C, and E, folic acid, and zinc used as monotherapy or in combination with other treatments for the management of vitiligo.

Microneedling: A Comprehensive Review.

BACKGROUND Microneedling is a minimally invasive procedure that uses fine needles to puncture the epidermis. The microwounds created stimulate the release of growth factors and induce collagen production. The epidermis remains relatively intact, therefore helping to limit adverse events. The indications for microneedling therapy have grown significantly, and it is becoming a more widely used treatment in dermatology. OBJECTIVE A comprehensive review of microneedling in human subjects and its applications in dermatology. METHODS AND MATERIALS A search was performed using PubMed/MEDLINE and Science Direct databases. Search terms included “microneedling,” “needling,” and “percutaneous collagen induction.” All available studies involving human subjects were included in the discussion, with priority given to prospective, randomized trials. RESULTS Studies demonstrate microneedling efficacy and safety for the treatment of scars, acne, melasma, photodamage, skin rejuvenation, hyperhidrosis and alopecia and for facilitation of transdermal drug delivery. While permanent adverse events are uncommon, transient erythema and postinflammatory hyperpigmentation are more commonly reported. CONCLUSION Microneedling appears to be an overall effective and safe therapeutic option for numerous dermatologic conditions. Larger and more randomized controlled trials are needed to provide greater data on the use of microneedling for different dermatologic conditions in different skin types.

The Role of Elastic Fibers in Scar Formation and Treatment.

BACKGROUND Laser therapy is a continuously evolving treatment option for scars, and the underlying therapeutic mechanisms continue to be elucidated. OBJECTIVE To comprehensively review the literature to summarize the role of elastin in the formation scars, as well as treatment via therapeutic lasers. METHODS Review of the PubMED/MEDLINE database for available studies pertaining to the role of elastic fibers in scar formation and after laser-based therapy. RESULTS The loss and disorganization of elastic fiber components plays a role in the development of atrophic, hypertrophic, and keloid scars. While the majority of histologic studies focus on the underlying changes in collagen, neoelastogenesis and reorganization of elastic fibers have also been demonstrated in studies using ablative, nonablative, and fractional laser devices for the treatment of scars. CONCLUSION Production of novel elastin and normalization of elastic fiber organization occur after a variety of resurfacing procedures to treat scarring. As the treatment modalities to manage scars continue to evolve, further characterization of the role of elastin in the skin and in scar formation is merited.

CD30+ lymphoproliferative disorder with spindle-cell morphology.

Lymphomatoid papulosis (LyP) is classified as a CD30+ primary cutaneous lymphoproliferative disease. The phenotypic variability along the spectrum of CD30+ lymphoproliferative diseases is highlighted by the distinct histologic subtypes of LyP types A, B, C, and the more recently described types D, E, and F. We report the case of an elderly woman with a clinical presentation and histopathologic findings consistent with LyP, whose atypical CD30+ infiltrate uniquely demonstrated a spindle‐cell morphology. To our knowledge, this is the first reported case of LyP characterized by CD30+ spindle‐shaped cells, and may represent a new and distinct histologic variant of LyP.

Idiopathic pachymeningitis presenting with progressive sensorineural hearing loss, tinnitus and confusion.

The patient was a 74-year-old female who presented with progressive left hearing loss, nonpulsatile tinnitus, and confusion. She denied headache, visual symptoms, and vertigo. She had a normal neurotologic examination. Pure tone audiometry showed left low frequency sensorineural hearing loss (SNHL) and a bilateral symmetric high frequency SNHL, with word recognition of 100% right, 46% left (Fig. 1). Serologic studies revealed a nonspecific monoclonal gammopathy. Other serologic tests were negative, including CBC, ANA, Lyme titer, syphilis, angiotensin converting enzyme, anti-double stranded DNA and ANCA antibodies. Cerebrospinal fluid testing revealed normal cytology with a mild increase in protein. Computed tomography of the abdomen and chest was normal, as was bone marrow biopsy. Magnetic resonance imaging (MRI) demonstrated diffuse smooth dural thickening and enhancement consistent with idiopathic hypertrophic pachymeningitis (IHP) (Fig. 2). Figure 1 Pure tone audiograms from 2009 through 2012, demonstrating progressive hearing loss in the left (A) and right (B) ears. At baseline (solid black line), the patient had a left 30 dB SRT and 100% WR, and a right SRT of 20 dB and WR 100%. After onset of ... Figure 2 Axial T1-weighted contrast-enhanced MRI of brain from prior to treatment (A) demonstrating initial enhancement of dura of the internal auditory canals left > right (arrowheads) prior to treatment. Following pulse steroid treatment (B), a significant ... The patient was initially treated with oral prednisone with minimal improvement. She then received IV methylprednisolone infusions every two weeks for two months with improvement in left hearing, tinnitus, mental status, and dural enhancement on MRI. Six months following initial presentation, she showed no further progression of her symptoms while off steroid therapy.

Ethnic Hair Considerations for People of African, South Asian, Muslim, and Sikh origins

By the year 2060, there are expected to be almost 80 million foreign-born Americans, representing nearly 20 % of the US population. Dermatologists will increasingly come into contact with immigrant populations, and cultural considerations should be taken into account. Many will continue to adhere to time-tested cultural practices in hopes of achieving or maintaining healthy hair, though some may lead to hair and scalp disorders. Awareness of some of the more common hair practices in different racial and ethnic groups can help dermatologists make informed decisions regarding treatment guidelines and recommendations.

Comparison of Childhood Vitiligo Presenting with or without Associated Halo Nevi

Previous studies have characterized differences in vitiligo associated with halo nevi, but the features of vitiligo presenting with halo nevus in children have yet to be fully described.