Martha H. Viera

Prevention and management of hypertrophic scars and keloids after burns in children.

Hypertrophic scars and keloids are challenging to manage, particularly as sequelae of burns in children in whom the psychologic burden and skin characteristics differ substantially from adults. Prevention of hypertrophic scars and keloids after burns is currently the best strategy in their management to avoid permanent functional and aesthetical alterations. Several actions can be taken to prevent their occurrence, including parental and children education regarding handling sources of fire and flammable materials, among others. Combination of therapies is the mainstay of current burn scar management, including surgical reconstruction, pressure therapy, silicon gels and sheets, and temporary garments. Other adjuvant therapies such as topical imiquimod, tacrolimus, and retinoids, as well as intralesional corticosteroids, 5-fluorouracil, interferons, and bleomycin, have been used with relative success. Cryosurgery and lasers have also been reported as alternatives. Newer treatments aimed at molecular targets such as cytokines, growth factors, and gene therapy, currently in developing stages, are considered the future of the treatment of postburn hypertrophic scars and keloids in children.

Exacerbation of facial acne vulgaris after consuming pure chocolate

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Herpes simplex virus and human papillomavirus genital infections: new and investigational therapeutic options

Human papillomavirus and Herpes simplex virus are the most common genital viral infections encountered in clinical practice worldwide. We reviewed the literature focusing on new and experimental treatment modalities for both conditions, based on to the evidence‐based data available. The modalities evaluated include topical agents such as immune response modifiers (imiquimod, resiquimod, and interferon), antivirals (penciclovir, cidofovir, and foscarnet), sinecatechins, microbiocidals (SPL7013 gel, and PRO 2000 gel), along with experimental (oligodeoxynucleotides), immunoprophylactic, and immunotherapeutic vaccines.

Laser therapy in black skin.

This article provides a systematic overview of laser, light, and other energy devices for patients of African descent. It also reviews complications in skin of color and some treatment options for these adverse events.

Letter: A Comparison Study of the Tensile Strength of Sutures Used in Dermatologic Surgery Following Exposure to Petrolatum

A variety of sutures are currently used in dermatologic surgery, each with unique characteristics that include suture material, number of filaments, diameter, fluid absorption ability, elasticity, memory and plasticity, ability of the suture to cut through tissue, and tensile strength (TS). These characteristics, along with nature of the wound, such as its location, shape, and size, and the preference and previous experience of the surgeon, help to determine the type of suture to be used in each individual case.

Systemic lupus erythematosus with dystrophic calcifications

calcifications Editor, Calcinosis cutis, the deposition of calcium in skin and subcutaneous tissue, is seen in a variety of rheumatological disorders, including dermatomyositis, limited cutaneous form of systemic sclerosis, scleroderma, and overlap syndromes, but is a rare manifestation of systemic lupus erythematosus (SLE). We would like to report a case of SLE with dystrophic calcifications. The patient is a 52-year-old African-American woman with a 24-year history of discoid lupus who presented with enlarging, painful ulcers on her back, chest, and extremities, as well as large, atrophic, scarring, hypopigmented plaques diffusely. She had received treatment with prednisone until she was lost to follow-up in 2002. She presented again in 2009 and was diagnosed with SLE by meeting five of the 11 criteria, including discoid rash, arthritis, hemolytic anemia, positive antinuclear antibody (ANA), and positive anti-dsDNA. Her current treatment included prednisone 10 mg, hydroxychloroquine 400 mg, and azathioprine 50 mg daily. On physical examination, the patient had multiple small, firm, subcutaneous nodules on the arms; diffuse, hypopigmented, sclerotic patches and plaques on upper body and scalp; multiple large ulcerations of atrophic patches on the right upper back; and bilateral breasts (Fig. 1). Laboratory evaluation included a positive ANA, anti-Sm, RNP antibody, anti-dsDNA, and anticardiolipin antibody. Imaging revealed multiple soft tissue calcifications of the proximal left upper arm, right elbow, and dystrophic calcifications on posterolateral soft tissues of the back (Fig. 2). Histopathological examination of an ulcer on the left breast revealed a deep dense periadnexal lymphocytic infiltrate in the reticular dermis with no evidence of calcium deposits (Fig. 3), confirming active disease, which prompted us to increase azathioprine dose and consider thalidomide as adjuvant therapy. Calcinosis cutis is a rare complication of SLE, previously reported in only 36 patients. It is classified into four categories: dystrophic; metastatic; idiopathic; and calciphylaxis/iatrogenic. Dystrophic is the most commonly reported subset in patients with SLE; this involves abnormal deposition of calcium salts in skin, subcutaneous tissues, muscle, or tendons but usually lacks involvement of viscera. Some patients form plaques, which may ulcerate spontaneously. Calcium and phosphate levels are typically normal. The pathogenesis of this condition is unknown, but it has been proposed that calcification is a result of tissue ischemia secondary to a pressure effect caused by steroid-induced hypertrophied adipose cells. This is consistent with our patient, who had taken oral prednisone for many years prior to developing calcifications. Treatment options for calcinosis in patients with SLE are limited and, as of yet, are not supported by randomized controlled trials. Diltiazem, a calcium channel blocker, has been beneficial in treating calcinosis in patients with scleroderma but was unsuccessful in treating calcinosis in a patient with SLE. Aluminum hydroxide is an oral phosphate-binding agent that acts to decrease intestinal phosphate absorption and calcium deposition. It has been shown to be effective in patients with SLE. Other treatment strategies include etidronate disodium, sodium warfarin, and corticosteroid injections, but the results have been controversial. Surgical excision has shown benefits and is indicated for painful masses, infection, ulceration, loss of function, and cosmetic appearance. Promising new therapies include hematopoietic stem cell transplantation for calcinosis in patients

Pharmacotherapy of Basal Cell Carcinoma, Anogenital Warts, and Actinic Keratoses: Focus on Topical Imiquimod

Imiquimod, an imidazoquinoline compound, has been widely-recognized for its ability to induce both innate and adaptive immune responses. Topical imiquimod has been approved for the treatment of actinic keratoses (AK), external genital warts (EGW), and superficial basal cell carcinoma (BCC). There are reports of many successful off-label uses as well. The pharmacology and mechanisms of action, safety, efficacy, and adverse effects with regards to differing concentrations and dosing regimens are discussed in depth in this chapter. Field-directed therapies for AK along with non-surgical treatments for BCC are rapidly-evolving, with increasing numbers of studies providing evidence-based rationale for their use in management.