Elizabeth E. Uhlenhake

Acne vulgaris and depression: a retrospective examination.

Backgroundu2002 Acne vulgaris is a common skin disease that affects patients both physically and mentally.

Conversations on psoriasis – what patients want and what physicians can provide: A qualitative look at patient and physician expectations

Background: The role of the patient–physician relationship is a key issue in the management of lifelong, chronic conditions such as psoriasis, with each side bringing different perspectives. Objective: To explore areas of congruence and disconnection in the relationship between psoriasis patients and dermatologists, with a focus on communication issues. Methods: Three discussion group sessions were held in four centers across the United States with dermatologists, patients, and a follow-up of the dermatologists after watching the patient discussion. Results: Patients want more information on psoriasis, fast treatments, clear expectations from the onset of therapy, and recognition of the emotional burden. Dermatologists found that patients do not receive or internalize adequate information and need further explanation of treatment regimens to increase compliance and patient satisfaction. Limitations: This was a qualitative study assessing the range of responses and was not a quantitative study designed to test specific hypotheses. The study may not be informative about the experiences of people with psoriasis not actively seeing a physician. Conclusions: Encounters between physicians and psoriasis patients can be enhanced by providing information on what psoriasis is, choosing fast-acting treatments that patients are willing to use, and providing written materials about the disease and treatment plan.

Spreading pigmented actinic keratosis: a review.

INTRODUCTIONnSpreading pigmented actinic keratosis (SPAK) is a common, but uncommonly reported or appreciated, variant of classic actinic keratosis (AK). It can mimic different pigmented lesions, which may be benign (eg, solar lentigo) or malignant (eg, lentigo maligna).nnnOBJECTIVEnWe sought to review current data and identify areas needing further research to establish diagnostic guidelines for SPAK and to increase awareness of this common entity.nnnMETHODSnA literature search was performed in both PubMed and MEDLINE databases using the search terms spreading pigmented actinic keratosis, pigmented solar keratosis, pigmented actinic, and pigmented solar. Each article was retrieved, reviewed, and summarized.nnnRESULTSnSPAK is a rarely reported lesion that can be difficult to distinguish from other benign and malignant pigmented lesions, including seborrheic keratosis, melanoma in situ (lentigo maligna type), and lentigo maligna melanoma. Located mainly on sun-exposed areas and with a size greater than 1.5 cm, the lesion typically spreads laterally. Pathologically, the lesion resembles classic AK with increased basal melanization. The malignancy potential has not yet been elucidated but destructive therapies such as cryotherapy are recommended.nnnLIMITATIONSnReports not yet published or not included in the comprehensive databases we used may exist that were not analyzed.nnnCONCLUSIONSnSPAK can be associated with adjacent melanoma in situ; therefore, its diagnosis merits increased suspicion for coexisting melanoma.

Optimal treatment of actinic keratoses

The most compelling reason and primary goal of treating actinic keratoses is to prevent malignant transformation into invasive squamous cell carcinoma, and although there are well established guidelines outlining treatment modalities and regimens for squamous cell carcinoma, the more commonly encountered precancerous actinic lesions have no such standard. Many options are available with variable success and patient compliance rates. Prevention of these lesions is key, with sun protection being a must in treating aging patients with sun damage as it is never too late to begin protecting the skin.

Efficacy and safety of ustekinumab and etanercept for the treatment of psoriasis

Importance of the field: TNF-α inhibitors such as etanercept have been used for psoriasis for years. A fairly well defined efficacy and safety profile has developed. A new biologic agent, ustekinumab, an IL-12 and IL-23 inhibitor, has recently been released in the US for the treatment of moderate-to-severe psoriasis. The purpose of this article is to compare the efficacy and safety profiles of ustekinumab and etanercept. Areas covered in this review: We examined safety and efficacy data regarding ustekinumab and etanercept from clinical reports, a head-to-head trial, review articles, and databases and registries from the last 20 years. What the reader will gain: Evidence is reviewed about the efficacy for the treatment of psoriasis as well as the safety profiles for both agents, ustekinumab and etanercept. Take home message: Both drugs have data to confirm efficacy and safety in patients with moderate-to-severe psoriasis in the short-term. The limited long-term data on the safety profile of ustekinumab requires careful judgment on the clinicians part, weighing well-defined benefits and potential unknown risks.

Annular hypopigmented mycosis fungoides: a novel ringed variant.

Hypopigmented mycosis fungoides (MF) is a relatively uncommon variant of cutaneous lymphoma that is mostly seen in darker skin types. We present a novel and unique clinical presentation in an African‐American female patient, consisting of regular hypopigmented annular rings in areas of normal skin and in more typical hypopigmented patches of MF. The lesions appeared diffusely on all extremities, anterior chest and back. Histopathologic examination showed an atypical lymphocytic infiltrate at the dermal–epidermal junction with epidermotropism and few Pautriers collections. The patient was otherwise healthy and improved with narrowband ultraviolet (UV)‐B. This case represents a presentation of a most unusual variant of hypopigmented MF, for which we propose the name ‘annular hypopigmented MF’.

Ustekinumab: differential use in psoriasis

Chronic plaque psoriasis is a systemic disease affecting over 3% of the population, and many patients are unsatisfied with their current treatment regimen. With advances in understanding of the pathophysiology of psoriasis, new therapeutic options are being developed. The newest of these agents, ustekinumab, offers patients rapid results and the convenience of four annual subcutaneous doses, with efficacy and safety profiles comparable with those of other biologics. However, ustekinumab has been on the market in the US for less than 2 years and will require years of extensive use before the full adverse event profile is fully understood. The purpose of this paper is to summarize the treatment options currently available for psoriasis, with an emphasis on ustekinumab in order to give prescribers an overview of the available data and allow them to make educated and informed prescribing decisions.

Prospective histologic examinations in patients who practice traumatic hairstyling.

Objectivesu2002 Alopecia is the fifth most common dermatologic diagnosis in African‐American patients. Central centrifugal cicatricial alopecia (CCCA) is the most common form of scarring alopecia in this group. This study sought to evaluate clinical and histologic findings in patients without clinical alopecia who use chemical and/or thermal straighteners to determine whether follicular damage is evidenced histologically.

Psoriasis Patient–Physician Interactions

Background Psoriasis patients are too frequently dissatisfied with the doctor–patient relationship. Purpose To explore how psoriasis patients and dermatologists view the doctor–patient relationship. Methods Separate discussion groups were held in which physicians and patients discussing their thoughts on interactions between psoriasis patients and their physicians. Four groups of six to eight dermatologists discussed patient expectations, observed psoriasis patients as they discussed their views on office visits, and finally discussed the patient encounter after observing the patient dialogues. Results Patients desired more information, quick treatments, clear therapeutic expectations, and recognition of emotional burden. After viewing patient discussions, dermatologists noted that patients often do not receive or internalize adequate information and therefore need further explanation of treatment regimens to increase compliance and patient satisfaction. Conclusions Dermatologists and patients had different impressions of key issues in the psoriasis patient–physician encounter. Patients needs may be better met by providing more information on psoriasis treatments, even when the information may not change the treatment plan, and by providing information in writing.

Dermatological patient safety: Problems and solutions

Background: Patient safety issues are the forefront of delivering effective quality healthcare. The fast pace and high volume of dermatology practice presents an opportunity for new research on error prevention and patient safety. Objective: To identify areas of concern in patient safety to introduce starting points for new improvement projects in dermatology. Methods: A literature search was performed using the PubMed database with the search terms ‘patient safety’ and ‘quality of care’. The articles were categorized into three topics concerning patient safety research: safety in treatment and procedures received; safety issues related to facility infrastructure; and human resource management. Results: Many issues identified as healthcare shortcomings such as wrong site surgery, patient misidentification, specimen errors, medication errors, communication failure, poor teamwork, healthcare worker management defects, and facility safety design problems were discussed in the literature. Each of these requires exploration with new safety initiatives for resolution. A limitation included omitting pieces on occupational health and safety that could contribute to overall patient safety. Our search also included only data from one database. Conclusions: Patient safety is an ever-evolving process requiring continuous attention by practicing physicians including dermatologists, healthcare staff, patients, and research scholars to discover and implement new safety initiatives for overall healthcare improvement.