Mohammad Ali Yazdani Abyaneh

Photodynamic Therapy for Actinic Cheilitis: A Systematic Review

BACKGROUND Actinic cheilitis (AC) is a premalignant lesion of the lips that can progress to squamous cell carcinoma and metastasize. Actinic cheilitis is difficult to treat because surgical treatments have significant adverse effects whereas less invasive procedures have uncertain efficacy. Photodynamic therapy (PDT) may offer a noninvasive yet effective treatment option for AC. OBJECTIVE To systematically review the safety and efficacy of PDT for AC. METHODS The terms “photodynamic,” “actinic,” “solar,” “cheilitis,” and “cheilosis” were used in combinations to search the PubMed database. Studies were considered for inclusion based on eligibility criteria, and specific data were extracted from all studies. RESULTS The authors identified 15 eligible case series encompassing a total of 242 treated subjects. Among studies that evaluated subjects for complete clinical response, 139 of 223 subjects (62%) showed complete response at final follow-ups ranging from 3 to 30 months. Among studies that evaluated subjects for histological outcome, 57 of 121 subjects (47%) demonstrated histological cure at final follow-ups ranging from 1.5 to 18 months. Cosmetic outcomes were good to excellent in the majority of subjects, and adverse events were well tolerated. CONCLUSION Photodynamic therapy is safe and has the potential to clinically and histologically treat AC, with a need for future randomized controlled trials.

Famous lines in history: Blaschko lines.

The lines of Blaschko describe a linear pattern of distribution of various congenital, nevoid, andacquiredskindisorderswith their suspectedembryological origins not yet well understood. These lines were painstakingly and thoroughly documented first by German dermatologist AlfredBlaschko.Blaschkowas the sonof aphysician andwasborn in 1858 in Freienwalde and died in 1922 in Berlin. He was a private practitioner in Berlin, where his dermatologic interests ranged from dermatitis herpetiformis, leprosy, and, later in his career, occupational skin diseases to social hygiene and venereal diseases. Blaschko studied the distribution of various nevoid disorders, such as epidermal and sebaceous nevi, aswell as acquired disorders, such as linear psoriasis, eczema, lichen planus, lichen simplex chronicus, and scleroderma. He transposed the pattern of these lesions in more than 140 patients onto dolls and statues and eventually produced complete illustrations of his famous lines all over thebody.His findingswere published in 1901 as a supplement to the Proceedings of the German Dermatological Society’smeeting held inBreslau that year. Thepublication included 26 pages of hand drawings, the first 9 of which were illustrations of herpes zoster. Although we now know that zoster follows the distributionof cutaneousdermatomesandnotBlaschko lines, the2distributions were commonly confused at the time. In 1902, Blaschko helped in the founding of the German Society for the Fight against Venereal Diseases alongwith Albert Neisser, a leading expert in venereology and the discoverer of theNeisseria gonorrhoeae bacterium. He served as general secretary for the organization and led efforts to educate the public regarding venereal diseases by distributing pamphlets and leaflets, organizing lectures all over the country, offering seminars for teachers, and lobbying for sex education in classes. After reviewingBlaschko’swritingsduringthis time,RobertJackson,who in 1976 published a detailed review of Blaschko’s seminal findings, suggests hewas perhaps among the first advocates of thewomen’s liberationmovement. For instance, inanaddress in 1903Blaschkoargued that the best form of prophylaxis against venereal disease was improvement of the economic condition of women, which would only be possible in agenuinely freeanddemocratic state. In 1913, he counteredprevious legislative efforts to ban advertising for contraceptives by calling these efforts extremely dangerous, and championed the “recommendationofprophylacticsuntil thewholepopulation is fully informed from the onset of puberty.” Clearly,Blaschko’s legacy isas impressive forhisdiligentworkasadermatologistandeminenteyeforpatternrecognitionasit isforhiscourageous championing of social health reforms at the turn of the 20th century.

Cells to Surgery Quiz: August 2015.

QUESTIONS 1. A 50-year-old man underwent Mohs micrographic surgery for removal of a basal cell carcinoma on the nasal dorsum/sidewall. The resulting full-thickness wound pictured above elicits which of the following? a. Innate immune response. b. Adaptive immune response. c. Antigen presentation by dendritic cells. d. All of the above. e. None of the above. Cells to Surgery Quiz: August 2015 Mohammad-Ali Yazdani Abyaneh1, Brian J. Simmons1, Fleta N. Bray1, Mohammed Alsaidan1 and Keyvan Nouri1 Journal of Investigative Dermatology (2015) 135, e16. doi:10.1038/jid.2015.215

Famous Lines in History: Langer Lines

The orientation of surgical incisions over the skin iswidely considered to affect scarring and the final cosmetic outcome for patients. Whenmost surgeons visualize lines on the skin surface to guide such incisions, it is Langer lines (alsoknownasskincleavageor tension lines) thatmost readilycometomind.KarlLanger(1819-1887),themanbehindthefamouslines, was born in Vienna, Austria, where he spentmost of his life and later becameprofessor of anatomy at Joseph’s Academy. In 1861, Langer began publishing a series of 5 articles detailing his seminalwork on the physical andmechanicalpropertiesof theskin. In thefirstof thesearticles,Langer creditedDupuytrenandMalgaigne for their earlierobservations. In 1834, Dupuytren reported seeing a youngmanwhohad attempted to commit suicidebystabbinghimselfover theheart3 times.Thepatient claimedto haveusedaroundawlasthe instrument,buthedidnotfashionroundstab wounds onhis chest. This ledDupuytren to study thematter in cadavers anddiscover thata round instrument indeedproduced linearcleftswhen thrust throughtheskin.Healsonoticedthat thesecleftshaddifferentorientations in different parts of thebody.Malgaigne confirmed these findingsandobserved fromhisexperienceasa surgeon that the retractionof wounds differedwith the direction of incisions. Langer went on to use sharp conical spikes to produce wounds all over the body of a large series of cadavers—of different ages and body constitutions—toanalyze the relationshipof each small cleft to thenext. He further attempted to shed light on wound retraction and the tension in human skin bymaking small circular incisions all over the bodies of cadavers and documenting in the directions in which the resulting woundsnarrowedandbroadened, if at all. Bywayof these incredibly meticulous efforts, Langer was able to draw his famous lines. Unfortunately, Langer’sworkwas largely unappreciated and ignored during his lifetime. In fact, because his original publications were written in the classical scientific German of his era, with hints of his local Austrian dialect, it was not until 1978 that a translation of his work wasmade available to the English-speaking world. Today, elective surgical incisions may not follow Langer lines in all body areas, andother guides, such as relaxed skin tension lines running perpendicular to the direction of muscle contraction, may serve patients better. However, the concept of skin tension lines has helped improve the practice of surgery and forensicmedicine, and Langer’swork hasbeen instrumental inourunderstandingof themanyfascinatingproperties of the skin.

Dermatologic Etymology: Configuration and Form

11. Silverberg JI, Simpson EL. Association between severe eczema in children and multiple comorbid conditions and increased healthcare utilization. Pediatr Allergy Immunol. 2013;24(5):476-486. 12. Berth-Jones J, Damstra RJ, Golsch S, et al; Multinational Study Group. Twice weekly fluticasone propionate added to emollient maintenance treatment to reduce risk of relapse in atopic dermatitis: randomised, double blind, parallel group study. BMJ. 2003;326(7403):1367.

Evaluation of sunscreens distributed by 2 major US retailers for meeting recommendations by the American Academy of Dermatology

REFERENCES 1. Liberati A. Need to realign patient-oriented and commercial and academic research. Lancet 2011;378:1777-8. 2. Davila-Seijo P, Hernandez-Martin A, Morcillo-Makow E, Lucas R, Dominguez E, Romero N, et al. Prioritization of therapy uncertainties in dystrophic epidermolysis bullosa: where should research direct to? An example of priority setting partnership in very rare disorders. Orphanet J Rare Dis 2013;8:61. 3. World Heath Organization. International clinical trials registry platform. Available from: URL:http://apps.who.int/trialsearch/. Accessed November 21, 2013. 4. US National Institutes of Health. Clinical trials. Available from: URL:http://www.clinicaltrials.gov. Accessed November 21, 2013. 5. Hernandez-Martin A, Aranegui B, Escamez MJ, de Lucas R, Vicente A, Rodriguez-Diaz E, et al. Prevalence of dystrophic epidermolysis bullosa in Spain: a population-based study using the 3-source capture-recapture method. Evidence of a need for improvement in care. Actas Dermosifiliogr 2013;104:890-6.

Cryosurgery for psoriasis

Psoriasis is a chronic inflammatory disease affecting the skin with various treatment options. Cryosurgery has been studied in only a limited number of case series for the treatment of small plaque psoriasis with variable results. Findings from these studies suggest cryosurgery can improve the induration, erythema, and scaling of small psoriatic plaques with one or just a few treatments. Furthermore, these studies suggest that cryosurgery is a safe treatment modality with hypopigmentation as the only major adverse effect. However, further studies are necessary to clarify the role of cryosurgery in the armamentarium of psoriasis therapy.

Cells to Surgery Quiz: January 2015

1Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA Image appears with permission from VisualDx.

Cells to Surgery Quiz: February 2015

1Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA Image appears with permission from VisualDx.

Cells to Surgery Quiz: March 2015

1Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA Image appears with permission from VisualDx.