Marlene T. Dytoc

First case series on the use of imiquimod for morphoea.

Background  Morphoea is characterized by fibrosis, which is mediated by cytokines including transforming growth factor (TGF)‐β.

First case series on the use of calcipotriol–betamethasone dipropionate for morphoea

1 Kawaoka JC, Gray J, Schappell D, Robinson-Bostom L. Eccrine nevus. J Am Acad Dermatol 2004; 51:301–4. 2 Mahdavy M, Smoller BR. Eccrine nevus presenting as a perianal skin tag. Am J Dermatopathol 2002; 24:361–3. 3 Vazquez MR, Gomez de la Fuente E, Fernandez JG et al. Eccrine naevus: case report and literature review. Acta Derm Venereol (Stockh) 2002; 82:154–6. 4 Park HS, Lee UH, Choi JC, Chun DK. Mucinous eccrine nevus. J Dermatol 2004; 31:687–9.

Therapy of external anogenital warts and molluscum contagiosum: a literature review

ABSTRACT:  Anogenital warts and mollusca contagiosum are virally induced, benign skin tumors for which there is no single preferable therapy. Treatments include physical and chemical destruction, surgical removal, and biological response modifiers to enhance the natural immune response. The choice of therapy is an art, and depends upon patient preference, finances, number of lesions, and lesional morphology. However, the therapy of these lesions can sometimes be very painful and expensive, and therapy should not be worse than the disease.

Analysis of interleukin-10 levels in lesions of vitiligo following treatment with topical tacrolimus.

Background  Vitiligo is an acquired dermatological condition that is characterized by depigmentation of patches of skin. It is relatively common, occuring in about 0·38–0·50% of the general population, and can engender significant cosmetic disfigurement and psychological sequelae in the affected individual. Recent studies demonstrate that topical tacrolimus (Protopic®; Astellas, Markham, ON, Canada) is efficacious in the treatment of vitiligo. We propose that the successful treatment of vitiligo with topical tacrolimus involves the unique immunosuppressive actions of the T lymphocyte T‐helper (Th) 2 cytokine, interleukin (IL)‐10.

The Pathogenesis of Vitiligo

Background: Vitiligo is a commonly encountered pigmentary disorder. Numerous studies and investigations from all over the world have attempted to determine the mechanisms behind this disease; however, the pathogenesis of vitiligo remains elusive. Objective: In this comprehensive review article, we present the findings behind the five overarching theories of what causes this disfiguring and psychologically debilitating disease. Method: We begin our discussion with the role of genetic predisposition and move onward to the neural theory first proposed in the 1950s. Next we discuss the autoimmune hypothesis, followed by the reactive oxygen species model, and conclude by describing the findings of the more recent melanocytorrhagy hypothesis. Conclusion: Although the exact pathogenesis of vitiligo is uncertain, each of these theories likely plays a role. Understanding each theory would pave the way for therapeutic advances for this disease.

Evaluation of the Efficacy and Safety of Topical Imiquimod 5% for Plaque-Type Morphea A Multicenter, Prospective, Vehicle-Controlled Trial

Background There is currently a lack of evidence-based therapies that are safe and effective for plaque-type morphea. We aimed to evaluate the therapeutic potential and safety profile of imiquimod 5% cream in plaque-type morphea. Methods We enrolled 25 adult patients from two Canadian centers with histologically confirmed plaque-type morphea. Imiquimod 5% was applied to a representative plaque, and vehicle was applied to a control plaque for 9 months. Treatment efficacy was assessed with the Dyspigmentation, Induration, Erythema, and Telangiectasias (DIET) score, histology, and ultrasound evaluation. Results and Conclusions Twenty-two patients completed the entire length of the study. Imiquimod 5% was superior to vehicle in reducing DIET scores at 3, 6, 9, and 12 months (p < .05). Induration demonstrated the greatest response. Histologic evaluation showed significant improvement or resolution of disease. However, no ultrasonographic differences were found in dermal and hypodermal thicknesses between the treatment and vehicle groups (p > .05). Adverse effects were minimal and well tolerated.

Gianotti-Crosti syndrome in two adult patients.

Background: Gianotti-Crosti syndrome was first described in Italy by Gianotti in 1955. It is considered a benign, self-limited exanthem that occurs in younger children. Adult cases are rare. Objective: We report two cases of Gianotti-Crosti syndrome in a previously healthy 37-year old Asian and 21-year old Caucasian female. Methods/Results: Histopathological analysis of 4-mm punch biopsies from the upper extremity of both patients revealed an interstitial dermatitis with mild to moderate perivascular lymphocytic infiltrate and occasional scattered eosinophils in the superficial and mid-dermis. Clinicopathological correlation was consistent with Gianotti-Crosti syndrome. Conclusion: Since both patients experienced significant pruritus, patient 1 was initially treated with a high potency topical corticosteroid followed by a two-week course of oral prednisone and patient 2 was treated with a potent topical corticosteroid. Both patients were asymptomatic at follow-up 3 to 4 weeks after their initial presentation.

Off-Label Uses of Topical Vitamin D in Dermatology: A Systematic Review

Background: Topical vitamin D is approved by the US Food and Drug Administration for the treatment of psoriasis but is also used off-label in the treatment of a variety of cutaneous diseases despite a lack of evidence-based guidelines. Objective: The objective of this study was to provide evidence-based clinical guidelines for the off-label use of topical vitamin D in the treatment of dermatologic disease. Methods: A systematic literature review was conducted via the MEDLINE, Embase, and CENTRAL databases for off-label uses of topical vitamin D analogues in the treatment of dermatologic disease other than psoriasis. The data were synthesized, and evidence-based recommendations were rendered according to the highest level of evidence available. Results: A total of 165 articles met the inclusion criteria. A moderate to strong recommendation was given for the use of topical vitamin D in combination with corticosteroids and phototherapy in vitiligo and as monotherapy for various ichthyoses, morphea, pityriasis alba, prurigo nodularis, and polymorphous light eruption. There is evidence showing that topical vitamin D is ineffective in the treatment of actinic keratosis, seborrheic keratosis, lichen planus, seborrheic dermatitis, alopecia areata, chemotherapy-induced alopecia, and hypertrophic scars. Conclusion: Topical vitamin D analogues have an important role in the off-label treatment of dermatologic disease, but higher quality studies are still required.

An Approach to Urinary Incontinence for Dermatologists.

Incontinence-associated dermatitis (IAD) is a condition often encountered by dermatologists. IAD is an inflammatory skin condition secondary to prolonged urine exposure—it is a dermatologic sequela of urinary incontinence. Incontinence should not be dismissed simply as an age-related disorder; rather, it is due to a number of pathologic conditions that can be either reversible or manageable. It is thus critical to identify and treat the underlying causes of urinary incontinence. Clinical management of this common medical issue restores normality to patients’ lives while also preventing future dermatologic complications. In this article, we aim to provide dermatologists with an overview of IAD and an approach to the diagnosis and initial management of urinary incontinence.

An Approach to Minimising Risk of Adrenal Insufficiency When Discontinuing Oral Glucocorticoids

Oral glucocorticoids are commonly used across every field of medicine; however, discontinuing them in patients can be challenging. The risk of acute adrenal crises secondary to glucocorticoid withdrawal can be fatal and arises from chronic suppression of the adrenal glands. Identifying risk factors for adrenal suppression in dermatological patients, such as doses greater than 5 to 7.5 mg of prednisone equivalent, duration of glucocorticoid use greater than 3 weeks, certain medications, and comorbidities, can help risk-stratify patients. The use of adrenal gland testing such as basal cortisol levels and adrenocorticotropic hormone stimulation tests can confirm adrenal suppression in patients. This review article provides an approach that dermatologists can use to minimise the risk of adrenal insufficiency in patients discontinuing glucocorticoids and when it may be appropriate to use adrenal gland testing.