Lehavit Akerman

Trends in Dermatology Publications over the Past 15 Years

AbstractBackground: There is a continually increasing amount of medical literature, which makes the challenge of keeping up to date in the field of dermatology increasingly difficult. Objective: To test the hypothesis that the total number and the number in various categories of publications in pediatric and adult dermatology have increased over time in a linear fashion. Methods: We evaluated all MEDLINE articles from 1 January 1993 to 31 December 2007. We limited the search to ‘skin’ AND ‘diseases’ OR ‘dermatology’ for adults and children. We used regression analysis to determine the effect of the year of publication on the number of publications of each type. Results: MEDLINE reported 17 925 publications in adult dermatology and 9011 publications in pediatric dermatology during the evaluation period. There was a significant linear increase in the number of publications over the study period in both categories. There was a steady and similar increase over time in both pediatric and adult dermatology in total publications, randomized controlled trials, clinical trials, case reports, and letters to the editor, while there were too few meta-analyses, editorials, and clinical guidelines to make meaningful analyses of trends. Conclusions: The fields of pediatric and adult dermatology have had a significant yearly increase in studies providing a high level of scientific evidence with a much slower rise in the number of articles providing a lower level of evidence.

Intravenous immunoglobulin for treatment of pemphigus.

Pemphigus is a group of organ-specific, autoimmune, mucocutaneous blistering disorders with an established immunological basis. The goal of therapy in pemphigus is to eliminate or neutralize the pathogenic autoantibodies. As in other autoimmune diseases, early systemic therapy is important for control of the disease and for achieving sustained remissions. Because of the sparse number of controlled studies, the treatment of autoimmune bullous diseases remains controversial. In this article, we discuss the current therapeutical options in pemphigus with an emphasis on IVIg treatment and suggest guidelines for the use of IVIg in the treatment of pemphigus.

Cytokine gene polymorphisms in patch-stage mycosis fungoides.

Cytokine production is under genetic control and certain allelic variants of cytokine genes are associated with lower or higher cytokine production in vitro and in vivo. The general concept is that a shift from a Th1 to a Th2 cytokine profile accompanies disease progression from patch-stage mycosis fungoides to tumour stage, although the results of the studies carried out have not been entirely conclusive. We aimed to investigate whether certain cytokine polymorphisms might represent a risk factor for developing patch-stage mycosis fungoides. Genotyping for IFN-gamma (Th1 cytokine), IL-6, IL-10 (Th2 cytokines), TNF-alpha and TGF-beta 1 was undertaken for 33 patients with patch-stage mycosis fungoides and the results were compared with those in a control group. Genotype distribution showed no significant differences between the patients and the controls for any of the five cytokines studied. Our study suggests that patch-stage mycosis fungoides is not determined by a specific genotype polymorphism. However, further studies on larger numbers of cases are needed before definite conclusions can be drawn.

Luminex LiquiChip System for the Evaluation of Cytokine Levels in Patients with Contact Dermatitis to Potassium Dichromate

Background: Allergic contact dermatitis (ACD) is associated with increased production of cytokines. The patch test is the “gold-standard” diagnostic method, but it poses a risk of false results. Objective: To evaluate a novel laboratory technique, the Luminex LiquiChip, which simultaneously measures blood levels of multiple cytokines, as a diagnostic tool in patients with chrome-induced ACD. Methods: The study group included 20 patients with ACD and relevant patch test results for potassium dichromate and 19 patients with ACD for nickel or fragrance as control. Peripheral blood mononuclear cells (PBMCs) were cultured in the presence and absence of potassium dichromate. The Luminex LiquiChip was used to measure levels of the following cytokines: granulocyte-macrophage colony-stimulating factor, interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, interferon-γ, and tumor necrosis factor (TNF)-α. Results: Potassium dichromate-stimulated PBMCs secreted significantly higher amounts of all cytokines except TNF-α than nonstimulated PBMCs. PBMCs from patients with ACD to chromium secreted significantly higher amounts of all cytokines tested, except IL-4, compared to PBMCs from patients with ACD to nickel or fragrance. Conclusions: Potassium dichromate stimulates the production of both Th1- and Th2-type cytokines in patients with chrome allergy. The Luminex LiquiChip is a promising in vitro method and may serve as a diagnostic tool for ACD.

Capillary malformation associated with angiolipoma: analysis of 127 consecutive clinic patients.

AbstractBackground: Capillary malformations (also known as port-wine stains) are low-flow vascular malformations of the skin that occur in 0.3% of neonates. Angiolipomas are subcutaneous, benign, usually multiple, lesions, composed of adipose tissue and blood vessels, which occur in young adults. Objective: The aims of this study were to determine whether there is an association between capillary malformations and angiolipoma, and to describe the characteristics of patients with this association. Methods: Prompted by our finding of an accompanying subcutaneous mass in a patient with capillary malformation, we reviewed the entire pool of 127 patients (71 women, 56 men; average age 22.2 years) attending the Rabin Medical Center (Petach Tikva, Israel) for treatment of nonfacial capillary malformations. All patients underwent a detailed history and comprehensive physical examination. Biopsy samples were taken from suspect lesions. Results: In addition to the index patient, four patients were found to have a subcutaneous mass beneath the capillary formation. Imaging and histologic studies identified the mass as an angiolipoma. All of the lesions were relatively refractory to pulsed dye laser or intense pulsed light treatment. Conclusion: This unique report of an association between capillary malformation and angiolipoma is intended to raise the index of suspicion for underlying angiolipoma in clinicians treating patients with refractory nonfacial capillary malformations.

Lack of detectable effect of narrow-band ultraviolet B on peripheral blood mononuclear cell cytokine expression in early-stage mycosis fungoides

Immune imbalance and skewed cytokine in the blood even in patients with early-stage mycosis fungoides (MF) has been reported. Results were inconsistent and showed mostly an increase in levels of T-helper 2 (Th2) cytokines and a decrease in levels of T-helper 1 (Th1) cytokines. We found no data concerning specifically the effect of narrow-band ultraviolet B (NB UVB) treatment on the systemic cytokine expression in early-stage MF. This article is protected by copyright. All rights reserved.