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Dive into the research topics where Melissa Piliang is active.

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Featured researches published by Melissa Piliang.


Archives of Dermatology | 2011

Medical and Environmental Risk Factors for the Development of Central Centrifugal Cicatricial Alopecia: A Population Study

Angela Kyei; Wilma F. Bergfeld; Melissa Piliang; Pamela Summers

OBJECTIVE To investigate medical and environmental risk factors for central centrifugal cicatricial alopecia (CCCA), the most common type of scarring alopecia in African American women. DESIGN A population study involving a quantitative cross-sectional survey of risk factors for CCCA. Survey results are then correlated with a clinical evaluation for CCCA using a standardized, previously published central scalp alopecia photographic scale. SETTING Two African American churches and a health fair for African American women in Cleveland, Ohio. PARTICIPANTS A total of 326 African American women who participated in the hair study. MAIN OUTCOME MEASURES Prevalence of CCCA in the general African American population and risk factors associated with CCCA. RESULTS Of the 326 responders, 28% received a grade of 2 or higher using a standardized, previously published central scalp alopecia photographic scale, a score consistent with clinically evident central hair loss. Advanced central hair loss with clinical signs of scarring (grade ≥ 3) was seen in 59% of these respondents and was interpreted as clinically consistent with CCCA. Diabetes mellitus type 2 was significantly higher in those with CCCA (P = . 01), as were bacterial scalp infections (P = .045) and hair styles associated with traction (eg, from braids and weaves) (P = .02). CONCLUSIONS Our survey results suggest that there is a high prevalence of central hair loss among African American women. Hair styles causing traction as well as inflammation in the form of bacterial infection may be contributing to the development of CCCA. The increase in diabetes mellitus type 2 among those with CCCA is in line with the recent theory that cicatricial alopecia may be a manifestation of metabolic dysregulation.


Arthritis Research & Therapy | 2011

A new category of autoinflammatory disease associated with NOD2 gene mutations

Qingping Yao; Lan Zhou; Philip Cusumano; Nilanjana Bose; Melissa Piliang; Bijal Jayakar; Le Chu Su; Bo Shen

IntroductionAutoinflammatory diseases are characterized by seemingly unprovoked episodes of inflammation, without high titers of autoantibodies or antigen-specific T cells, and derive from genetic variants of the innate immune system. This study characterized a cohort of patients with similar phenotypes and nucleotide oligomerization domain 2 (NOD2) gene mutations.MethodsDiagnostically challenging patients with the following clinical and genetic characteristics were prospectively studied between January 2009 and April 2011: periodic fever, dermatitis, polyarthritis, serositis, negative serum autoantibodies and additional positive NOD2 IVS8+158 gene mutation. Genetic testing for gene mutations of NOD2, tumor necrosis factor receptor-associated periodic fever syndrome (TRAPS) and familial Mediterranean fever (FMF) was performed.ResultsAll seven patients with the disease were Caucasians, with four being male. The mean age at disease onset was 40.7 years and disease duration was 3.2 years. These patients characteristically presented with periodic fever, dermatitis and inflammatory polyarthritis. There were gastrointestinal symptoms in three patients, granulomas of the skin and gut in two, and recurrent chest pain in two, with one having pleuritis and pericarditis. Three patients had sicca-like symptoms. Five patients had increased acute phase reactants. All seven patients had negative tests for autoantibodies but carried the NOD2 gene mutation IVS8+158 with four having concurrent R702W mutation.ConclusionsOur cohort may represent a new disease category of autoinflammatory disease with characteristic clinical phenotypes and genotypes. It may somewhat resemble pediatric Blaus syndrome.


Clinics in Laboratory Medicine | 2011

Acral Lentiginous Melanoma

Melissa Piliang

Acral lentiginous melanoma is an uncommon skin malignancy that occurs with equal frequency in all races and has a worse prognosis than other types of melanoma; it presents as dark, irregular macules, papules, or nodules on the feet and, less commonly, the hands. The histologic findings of acral lentiginous melanoma are characterized by an asymmetric, poorly circumscribed proliferation of continuous single melanocytes at the dermoepidermal junction. Single melanocytes predominate over nests. The tumor must be distinguished from benign acral lentiginous nevi, which can display site-related atypia.


Journal of The American Academy of Dermatology | 2015

The use of oral pioglitazone in the treatment of lichen planopilaris

Natasha Atanaskova Mesinkovska; Alejandra Tellez; Danyelle Dawes; Melissa Piliang; Wilma F. Bergfeld

The use of oral pioglitazone in the treatment of lichen planopilaris To the Editor: Current therapies for primary cicatricial alopecia remain empirical and often ineffective. Recent experimental evidence has suggested a potential role of aberrant peroxisome-proliferator-activated receptor (PPAR)functioning in the pathogenesis of cicatricial alopecias. On the basis of this finding, Mirmirani and Karnik successfully treated a patient with therapy-resistant lichen planopilaris (LPP) with a PPARagonist. The aim of this studywas to evaluate the efficacy of pioglitazone, a synthetic PPARligand, in the treatment of LPP. We performed a retrospective case analysis of the 22 patients who were prescribed pioglitazone hydrochloride for LPP in a tertiary hair research center from 2010 through 2012. Inclusion required therapy with pioglitazone for at least 1 month, and clinical follow-up longer than 3 months. Clinical grading, including subjective measures (pain, tenderness, pruritus), objective measures (perifollicular erythema, scale), and hair loss extent, were recorded at baseline and on subsequent visits. At each visit, a hair specialist physician assigned a score to each objective and subjective end-point grade, ranging from resolution (0), improvement (1), stable (2), to worsening (3) condition. Global response to treatment was graded by the investigators, based on clinical impression, supplemented with standardizedphotographic data. Clinical impression categories included: ‘‘complete remission,’’


Journal of Cutaneous Pathology | 2007

Soft-tissue perineurioma in a 20-year-old patient with neurofibromatosis type 1 (NF1): report of a case and review of the literature.

Gregory G. Ausmus; Melissa Piliang; Wilma F. Bergfeld; John R. Goldblum

Background:  Perineurioma is a rare benign soft‐tissue tumor composed of cells showing differentiation toward the perineurial cells of the nerve sheath. Although mutations in the neurofibromatosis 2 (NF2) gene have been documented in this tumor, there is no known association between perineuriomas and type 1 or 2 NF.


Journal of The American Academy of Dermatology | 2017

Prevalence of hormonal and endocrine dysfunction in patients with lichen planopilaris (LPP): A retrospective data analysis of 168 patients

Geraldine Cheyana Ranasinghe; Melissa Piliang; Wilma F. Bergfeld

Background: Studies on the pathophysiology and comorbidities associated with lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are limited. Objective: The purpose of this study was to determine the prevalence of androgen excess in the postmenopausal LPP population, in relation to demographics and comorbidities. Methods: A retrospective data analysis of 413 patients with LPP, FFA, and LPP/FFA seen in the Department of Dermatology at the Cleveland Clinic Foundation in Ohio between 2005 and 2015 was conducted. Of this cohort, 168 patients met the inclusion criteria. Results: Androgen excess was identified in 31.5% (n = 53) of the 168 patients with LPP and all subtypes (P < .001). Androgen deficiency was identified in 32.1% (n = 17) of the 53 patients with FFA (P < .001). The androgen excess group was significantly more likely to present with hirsutism, seborrheic dermatitis, polycystic ovary syndrome, ovarian cysts, or a combination of these (P < .001). Limitations: This study was limited by being retrospective. Conclusion: Our study demonstrated that LPP is associated with androgen excess, and FFA is associated with androgen deficiency.


JAMA Dermatology | 2017

Treatment of Alopecia Areata With Tofacitinib

Omer Ibrahim; Cheryl B. Bayart; Sara Hogan; Melissa Piliang; Wilma F. Bergfeld

This medical record review describes the characteristics and outcomes of patients with alopecia areata before and after treatment with tofacitinib.


Journal of Cutaneous Pathology | 2013

Morphologic mimickers of Cryptococcus occurring within inflammatory infiltrates in the setting of neutrophilic dermatitis: a series of three cases highlighting clinical dilemmas associated with a novel histopathologic pitfall

Jennifer S. Ko; Anthony P. Fernandez; Kyle A. Anderson; Laura M. Burdick; Steven D. Billings; Gary W. Procop; James T. McMahon; Wilma F. Bergfeld; Melissa Piliang

A neutrophil‐predominant inflammatory infiltrate in a cutaneous biopsy can be associated with a broad spectrum of diseases. Here we describe three cases showing a neutrophil‐predominant dermal infiltrate admixed with abundant acellular bodies surrounded by capsule‐like vacuolated spaces, which strikingly mimicked Cryptococcus. Two cases occurred within the settings of underlying hematologic malignancies; the third case was associated with immune dysregulation. Two patients were acutely ill in the medical intensive care unit. Fungal work‐up, including cultures and multiple stains were negative. Because of clinical deterioration in these patients, transmission electron microscopy was pursued to definitively rule out fungal infection. In both cases, characteristics most compatible with autolysing human cells, not Cryptococcus, were identified. Chemotherapy and high‐dose steroids were given, but both patients eventually succumbed to their diseases. To the best of our knowledge, these represent the first reported cases of autolysing human cells mimicking Cryptococcus organisms within neutrophilic infiltrates. They highlight the therapeutic dilemmas arising with histopathologic mimics, as well as the importance of thorough investigation to distinguish mimickers from true infectious organisms. We believe recognition of this microscopic pitfall will be useful to dermatopathologists faced with similar findings in the future, and may prevent unnecessary delay of appropriate therapy in acutely ill patients.


Modern Pathology | 2016

Histological pattern of Merkel cell carcinoma sentinel lymph node metastasis improves stratification of Stage III patients

Jennifer S. Ko; Victor G. Prieto; Paul Elson; Ricardo E. Vilain; Melissa Pulitzer; Richard A. Scolyer; Jordan Reynolds; Melissa Piliang; Marc S. Ernstoff; Brian R. Gastman; Steven D. Billings

Sentinel lymph node biopsy is used to stage Merkel cell carcinoma, but its prognostic value has been questioned. Furthermore, predictors of outcome in sentinel lymph node positive Merkel cell carcinoma patients are poorly defined. In breast carcinoma, isolated immunohistochemically positive tumor cells have no impact, but in melanoma they are considered significant. The significance of sentinel lymph node metastasis tumor burden (including isolated tumor cells) and pattern of involvement in Merkel cell carcinoma are unknown. In this study, 64 Merkel cell carcinomas involving sentinel lymph nodes and corresponding immunohistochemical stains were reviewed and clinicopathological predictors of outcome were sought. Five metastatic patterns were identified: (1) sheet-like (n=38, 59%); (2) non-solid parafollicular (n=4, 6%); (3) sinusoidal, (n=11, 17%); (4) perivascular hilar (n=1, 2%); and (5) rare scattered parenchymal cells (n=10, 16%). At the time of follow-up, 30/63 (48%) patients had died with 21 (33%) attributable to Merkel cell carcinoma. Patients with pattern 1 metastases had poorer overall survival compared with patients with patterns 2–5 metastases (P=0.03), with 22/30 (73%) deaths occurring in pattern 1 patients. Three (10%) deaths occurred in patients showing pattern 5, all of whom were immunosuppressed. Four (13%) deaths occurred in pattern 3 patients and 1 (3%) death occurred in a pattern 2 patient. In multivariable analysis, the number of positive sentinel lymph nodes (1 or 2 versus >2, P<0.0001), age (<70 versus ≥70, P=0.01), sentinel lymph node metastasis pattern (patterns 2–5 versus 1, P=0.02), and immune status (immunocompetent versus suppressed, P=0.03) were independent predictors of outcome, and could be used to stratify Stage III patients into three groups with markedly different outcomes. In Merkel cell carcinoma, the pattern of sentinel lymph node involvement provides important prognostic information and utilizing this data with other clinicopathological features facilitates risk stratification of Merkel cell carcinoma patients who may have management implications.


Journal of Investigative Dermatology Symposium Proceedings | 2015

Clinical Efficacy of Diphenylcyclopropenone in Alopecia Areata: Retrospective Data Analysis of 50 Patients.

Katherine Chiang; Natasha Atanaskova Mesinkovska; Melissa Piliang; Wilma F. Bergfeld

Diphenylcyclopropenone (DPCP) is widely considered the most effective topical immunotherapy for refractory or extensive alopecia areata (AA), but questions regarding how long to try DPCP therapy before terminating and what factors are prognostic of therapeutic success still remain unanswered. In this retrospective study of 50 AA patients, we evaluated DPCP efficacy and identified patient factors predictive of therapeutic success/failure. The median duration of DPCP treatment was 3 years, with 47% patients experiencing their first regrowth in the first 6 months of DPCP therapy, 20% between 6 months-1 year, and 8% between 1-2 years. In our study, treatment success, defined as ⩾50% terminal hair regrowth, was reached in 71% of alopecia totalis patients and in 56% of alopecia universalis patients. Three factors were statistically significant predictors of poor treatment outcome-extent of hair loss before DPCP treatment, history of thyroid disease, and extent of body hair involvement. Relapse was observed in 44% of patients and significantly associated with history of thyroid disease. Common side effects were itching, rash, and local lymphadenopathy. The results of this study support our belief that DPCP therapy is a viable treatment option, can be successfully accomplished at home, and should not be terminated before 2 years.

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