Faranak Kamangar

Acne in the adult female patient: a practical approach.

Acne vulgaris is a common reason why adult women present to dermatologists and can be a clinical challenge to treat. It may also be an important sign of an underlying endocrine disease such as Polycystic Ovary Syndrome (PCOS). Although standard acne therapies can be successfully used to treat acne in adult female patients, hormonal treatment is a safe and effective therapeutic option that may provide an opportunity to better target acne in this population, even when other systemic therapies have failed. In this article, a practical approach to the adult female patient with acne will be reviewed to enhance the dermatologist’s ability to use hormonal acne therapies and to better identify and evaluate patients with acne in the setting of a possible endocrine disorder.

How psoriasis patients perceive, obtain, and use biologic agents: Survey from an academic medical center

Abstract The availability of new biologic agents for the treatment of psoriasis provides hope for improved quality of life outcomes. However, the way patients come to use biologics, the potential barriers they encounter, and their attitudes towards using these medications are still not well studied. Here, we conducted a survey of 106 psoriasis patients at an academic medical center to discern patient attitudes towards biologics. We found that most patients learn of biologics through their physician and perform follow-up research using the Internet. Most patients did not find it difficult to make the decision to start a biologic. Difficulty in obtaining biologics was associated with age less than 55 (p = 0.01), lower income level (p = 0.007), and lack of insurance (p = 0.04). Patients were found to have high satisfaction and compliance rates on biologics. Of patients who missed a dose of their biologic, this was mainly due to logistical reasons such as not having the medication or forgetting to take it, rather than being depressed or overwhelmed. Patients with lower income levels had increased cut backs in personal expenses due to co-payments (p = 0.001). Among respondents, the mean annual out-of-pocket expense for a biologic was

An evidence-based review of skin cancer rates on biologic therapies

557.12 per year, with a range of

Oral vitamin D, still a viable treatment option for psoriasis

0–7000.

Management of Pediatric Psoriasis

Abstract Objective: To critically review the body of clinical trials that report the rates of skin cancer in patients on a biologic therapy, in order to discern whether this therapy is associated with any increase risk of skin cancer. Data Sources: Review of MEDLINE database and the Cochrane library database was conducted, to identify randomized controlled trials and meta-analyses that evaluated the safety of biologic therapies, and specifically reported rates of skin cancer in patients on biologic therapies. Study Selection and Data Extraction: Two reviewers independently evaluated eligibility and collected the data. Studies selected were large randomized controlled trials and meta-analyses with large number of patient populations from clinical trials and post-marketing surveillance data that reported specifically the rate of skin cancer while on a biologic therapy. Data Synthesis: Nine studies met the eligibility criteria. All studies were of high quality with Strength of Recommendation Taxonomy (SORT) (J Am Board Fam Pract 2004) evidence level of 1. Eight of these trials demonstrated an increased risk of non-melanoma skin cancer (NMSC) while on a biologic therapy. In addition, studies suggested a possible increased risk in patients with history of prior treatments known to also increase risk of skin cancer. Case studies with SORT evidence level 3 are also included in this review for completion; however, these data were not used in the formation of final recommendations. Conclusion: Biologic medications are highly efficacious and have a relatively good safety profile; however, high-quality evidence suggests that use of biologic therapies may be associated with an increased risk of detection of NMSC. Psoriatic patients may be at an increased risk due to history of treatment with other therapies also known to increase the risk of skin cancer. As such, it may be important to consider biologic therapies as an additional risk factor for development of NMSC and implement regular skin examinations for patients on these therapies.

Ustekinumab for the treatment of psoriatic arthritis: an update

Abstract Vitamin D as a topical treatment has become one of the mainstays for treatment of psoriasis vulgaris. Oral vitamin D on the other hand has for the most part become a forgotten option. But a review of the literature on oral vitamin D as a treatment for psoriasis reveals that this treatment is efficacious. The main side effect of this therapy is hypercalcemia, which appears to be easily monitored and avoidable with proper dosing and monitoring. The literature also suggests a correlation between low levels of serum vitamin D in this patient population associated with increased severity of disease involvement. In addition, oral vitamin D improves psoriatic arthropathy. Moreover, vitamin D has been proven to have many health benefits such as prevention of cancer, improved cardiovascular health among many others. Psoriatic patients as a population are at increased risk of developing adverse health complications such as cardiovascular disease, and oral vitamin D may prove to be of benefit in this population. Oral vitamin D is inexpensive and easily available. It is still a viable option and should not be forgotten as a possible treatment for psoriasis.

Occlusive Therapy in Atopic Dermatitis

Tina Bhutani, MD, is Clinical Research Fellow, UCSF Psoriasis and Skin Treatment Center, UCSF Department of Dermatology. Faranak Kamangar, BSc, is Clinical Research Associate, UCSF Psoriasis and Skin Treatment Center UCSF Department of Dermatology. Kelly M. Cordoro, MD, is Assistant Professor of Clinical Dermatology and Pediatrics, University of California, San Francisco. Address correspondence to: Kelly M. Cordoro, MD, University of California, San Francisco; fax: 415-353-7478; email: cordorok@ derm.ucsf.edu. Dr. Bhutani and Ms. Kamangar have disclosed no relevant financial relationships. Dr. Cordoro has disclosed the following relevant financial relationships: consulting fees, Topaz Pharmaceuticals. doi: 10.3928/00904481-20111209-08 EDUCATIONAL OBJECTIVES C M E Management of Pediatric Psoriasis

Comparison of Effectiveness of Silicone Gel Sheeting With Microporous Paper Tape in the Prevention of Hypertrophic Scarring in a Rabbit Model

Psoriatic arthritis occurs in 30% of psoriasis patients, and the treatment can be challenging in some patients. Recently, the US Food and Drug Administration approved ustekinumab, a fully human monoclonal antibody, for the management of psoriatic arthritis. In this article, we review large-scale randomized clinical trials addressing the efficacy and safety profile of ustekinumab for the treatment of psoriatic arthritis.

Instant barrier repair: a pilot study investigating occlusion with a new hydrogel patch for the treatment of atopic dermatitis

Misha M. Heller1, Eric S. Lee2, Faranak Kamangar3, Wilson Liao4 and John Y. M. Koo4 1University of Southern California, Keck School of Medicine, Los Angeles, California 2University of Nebraska Medical Center, College of Medicine, Omaha, Nebraska 3University of California Davis, School of Medicine, Sacramento, California 4University of California San Francisco, Department of Dermatology San Francisco, California USA

Borderline Tuberculoid Leprosy Masquerading as Granuloma Annulare: A Clinical and Histological Pitfall.

OBJECTIVE To determine the effectiveness of treating scars with microporous paper tape or silicone gel sheeting (SGS) in preventing hypertrophic scarring. METHODS Forty hypertrophic scars were induced in a validated rabbit ear model. Wounds were randomized and bandaged for 30 days with either SGS (20 wounds), paper tape (20 wounds), or untreated controls (40 wounds). Two outcome measures of hypertrophic scarring included (1) histologic measurement of scar elevation index (SEI) and (2) blinded photograph analysis using a visual analog scale. RESULTS In histologic comparison, no difference in mean (SE) SEI between treatment groups was seen (paper tape group, 1.32 [0.2]; SGS group, 1.41 [0.18]; control, 1.35 [0.23]; P = .51). In photographic analysis, both treatment groups were superior to the control group (P < .01), whereas no difference was seen between the SGS and paper tape groups (P = .88). CONCLUSIONS Paper tape and SGS demonstrated equal effectiveness in the prevention of hypertrophic scarring on visual analysis, whereas histologic analysis demonstrated no difference in treatment groups from controls. The effectiveness of paper tape in preventing hypertrophic scarring in humans will require further laboratory and clinical investigation.