Renata Prado

In vitro and in vivo evaluation of topical formulations of spantide II.

The purpose of this study was to develop and evaluate topical formulations of Spantide II, a neurokinin-1 receptor (NK-1R) antagonist, for the treatment of inflammatory skin disorders. Spantide II lotion and gel was formulated with and without n-methyl-2-pyrrolidone (NMP) as a penetration enhancer. The release of Spantide II from gels was evaluated using microporous polyethylene and polypropylene membranes in a Franz Diffusion cell setup. In vitro percutaneous absorption of Spantide II from lotion and gel formulations was evaluated using the above setup by replacing the membranes with hairless rat skin. The in vivo anti-inflammatory activity of Spantide II formulations was evaluated in an allergic contact dermatitis (ACD) mouse model. Among different gels studied, PF127 gel showed highest (70-fold) release of Spantide II compared with hydroxypropyl methylcellulose (HPMC) and hydroxypropyl cellulose (HPC) gels. Lotion and gel formulations with or without NMP showed no detectable levels of Spantide II in the receiver compartment of the Franz diffusion cell until 24 hours. However, Spantide II showed significant retention in epidermis and dermis from lotion and gel formulations at 24 hours. The dermal levels increased ≈3.5- and 2-fold when the lotion and gel formulations contained NMP as compared with the formulation with no NMP (P<.05). The in vivo studies indicated that Spantide II formulations with NMP were effective in significantly reducing ACD response, similar to dexamethasone (0.5 mM). In conclusion, Spantide II was stable as a topical formulation and delivered to target skin tissue (epidermis and dermis) for the treatment of ACD. In addition this study supports the role of cutaneous neurosensory system in modulating inflammatory responses in the skin.

Collodion baby: An update with a focus on practical management

Collodion baby is an uncommon clinical presentation of several genetic conditions, primarily disorders of cornification. The severely compromised epidermal barrier presents the greatest challenge during the newborn period and advances in neonatal care have significantly improved the prognosis. This review summarizes the clinical characteristics, complications, outcomes, and differential diagnosis of the collodion baby. A practical approach to management based on the literature and clinical experience is presented.

Nonmelanoma Skin Cancer Chemoprevention

&NA; The authors have indicated no significant interest with commercial supporters.

Paraneoplastic Pemphigus Herpetiformis With IgG Antibodies to Desmoglein 3 and Without Mucosal Lesions

BACKGROUND Pemphigus herpetiformis (PH) is a rare clinical entity that combines the clinical features of dermatitis herpetiformis and the immunopathologic features of pemphigus. The target antigen is usually desmoglein 1, with exceptional cases manifesting autoantibodies against desmoglein 3. More recently, it has been found that many patients with PH also demonstrate autoantibodies against desmocollin. The association of PH with a malignant neoplasm is rare. OBSERVATIONS We describe a patient with PH and a lung neoplasm. Immunologic studies demonstrated IgG antibodies to desmoglein 3 and to an unknown 178-kDa protein but no antibodies to desmocollin. CONCLUSIONS The association of PH with a thoracic malignant neoplasm has been reported in only 4 previous cases, and the neoplasm could be responsible for the unusual immunologic profile in the patient described herein. To our knowledge, this is the first report of PH with an associated neoplasm in which only anti-desmoglein 3 antibody was detected.

Dermatology information on the Internet: An appraisal by dermatologists and dermatology residents

To the Editor: Patients increasingly seek health information on the World Wide Web both for personal knowledge and to facilitate patientephysician discussion at the timeofmedical consultation. In January 2008, approximately 44% of all health-related Web site traffic was on pages found via search engines, an increase of 3% in health-related traffic share from the previous year. Google.com received the greatest portion of this Internet traffic. The Internet provides an easily accessible forum through which health information, with varying accuracy, can be spread. This holds especially true with the development of Web 2.0, which is comprised of Web sites that are geared toward the facilitation of communication between Internet users (Wikipedia, blogs, etc). We sought to assess the content, accuracy, and quality of dermatologic health information on the Internet. The top three Web sites found through a query of the top eight dermatologic diagnoses using Google were analyzed by six board-certified dermatologists and three dermatology residents for accuracy, content, and completeness. Each Web site was given a positive, neutral, or negative rating according to the evaluators’ overall impression of the Web site, the accuracy of its disease description, treatment description, and photographic depiction, and its user-friendliness. Web sites were also categorized according to target audience, sponsorship or affiliation, number of languages, presence of reliability certification (ie, Health on the Net Foundation), and types and extent of consumer advertising. FlescheKincaid grade levels for readability were calculated for all Web sites using Microsoft Office Word software (Microsoft; Redmond, WA). Twenty-four Web sites were found by searching for the top eight dermatologic diagnoses on the search engine Google. There were no duplicate Web sites or broken links among the returned search results. Common Internet domains included: Wikipedia.org (8 Web sites), MayoClinic.com (2), and MedicineNet.com (2). Six additional Web sites were represented by dermatology-specific organizations (one each from AOCD.org, SkinCarePhysicians.com, SkinCancer.org, Psoriasis.org, Acne.org, and Acne.com), and five additional Web sites were represented by organizations with a general medical focus (one each from WebMD.com, eMedicine.com, Medline [NIH.gov], FamilyDoctor.org, andMerck.com). One Web site (About.com) was not specifically healthrelated. No Web sites were excluded. Dermatologists and dermatology residents rated dermatology Web sites found through Google as generally accurate (Table I). Importantly, Web 2.0 Web sites that were evaluated were found to be generally equal in accuracy and completeness to their noneWeb 2.0 counterparts. Furthermore, each Web site was categorized according to the various criteria mentioned above (Table II). Web sites found through Google are generally targeted for a lay patient audience, represent a wide variety of types of sponsorships and affiliations (Web 2.0 developments being the most common), have a number of language translations, possess some version of health reliability certification, and contain a fair amount of advertising. In general, however, Web sites had a FlescheKincaid grade level well above the recommended sixth grade level. While Internet resources regarding health information are subject to misinformation, dermatologic Web sites are relatively accurate and complete according to dermatologists and dermatology residents. However, our findings also suggest that Internet-based information may be too difficult for comprehension by a substantial portion of the patient population. Patients who want to know more about specific dermatologic conditions may benefit seeking information from reliable Web sites found through Google.com.

The closure of a large chronic abdominal wound in a neonate utilizing a biologic dressing.

The authors present the case of a 7-month-old female infant with a large, nonhealing abdominal surgical wound. She was born at 24 weeks from a twin pregnancy via cesarean delivery after prolonged labor. After birth, she had extremely low birth weight, respiratory distress, and necrotizing enterocolitis with intestinal perforation. The patient had an initial exploratory laparotomy with extensive bowel resection. She required multiple surgeries because of adhesions, small-bowel obstructions, and multiple wound dehiscences. At 5 months of age, an 8 x 3 x 0.2-cm wound occurred as a result of the last surgery. This wound was allowed to heal by secondary intention using an AlloDerm mesh (LifeCell Corporation, Branchburg, New Jersey). A combination of Mepitel (Molnlycke Health Care, Goteborg, Sweden), Sorbsan (UDL Laboratories, Rockford, Illinois), and Mepilex Border (Molnlycke Health Care) and regular dressing changes was used to protect the AlloDerm and promote moist wound healing. The wound base initially showed granulation tissue across the graft with wound edge contraction and reepithelialization progressing at the expected rate. The wound healing, however, was interrupted because of sepsis, abdominal distension, and parenteral nutrition–induced cholestasis. The wound care team was consulted to assist in the case due to a nonhealing wound. At that time, the lesion measured 8.7 x 3 x 0.5 cm and had no granulation tissue (Figure 1). The wound bed was initially prepared for 5 days, using a silver-based dressing. On day zero of graft placement, 2 Dermagraft (Advanced BioHealing, Westport, Connecticut) sheets were placed side by side on the open wound, covering the entire wound and also covering at least 1 cm of the surrounding normal skin. Dermagraft was covered using Mepitel, with a layer of moistened Acticoat (Smith and Nephew, St Petersburg, Florida) placed over it. This was covered with Mepilex Border. On day 3, the Mepilex Border and the Acticoat were removed and replaced by new products. On day 7, all dressings were removed, and the patient received a bath. Clinicians continued to treat the wound with dressing changes 3 times per week, including petrolatum to increase moisture and petrolatum gauze covered with a Mepilex Border. The wound proceeded to close by secondary intention with complete healing within 2 months of placement of Dermagraft (Figure 2).

Metastatic melanoma manifesting with purulent nodules composed of neutrophils and melanoma cells

ejd.2011.1415 Auteur(s) : Renata Prado1, James Daniel Jensen1, Miyako Okamoto1, Yuchun Luo1, Karl D. Lewis2, Mayumi Fujita1 mayumi.fujita@ucdenver.edu 1 Department of Dermatology, University of Colorado Denver, 12801 E 17th Ave, Aurora CO 80045, USA 2 Division of Medical Oncology, University of Colorado Denver, 12801 E 17th Ave, Aurora CO 80045, USA We describe a melanoma patient whose clinical and histological findings were different from previously-described inflammation-associated cancer. A 63-year-old [...]

Reconstruction of a Multi-Subunit Nasal Defect

&NA; The authors have indicated no significant interest with commercial supporters.