Sadegh Amini

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.

Newer technologies/techniques and tools in the diagnosis of melanoma

A number of non-invasive approaches have been developed over the years to provide an objective means of evaluating and diagnosing skin melanoma. However, the current gold-standard in melanoma diagnosis is the examination of a skin lesion by the trained eye of a physician followed by histological examination of an invasive excisional biopsy of the skin specimen. Diagnosis of melanoma by simple visual examination is incorrect in almost 1 out of every 3 melanoma diagnoses. Therefore, the diagnosis of early stage in-depth melanoma by non-invasive methods remains an active area of research. Recent advancements in computer and digital technology have provided several sensitive tools to evaluate the different characteristics of a melanoma lesion including its contour, edge, color, size, depth, and/or elevation. These tools include (1) digital imaging systems and computer analysis instruments such as MoleMax, SIAscope, SolarScan, MelaFind; (2) tape stripping mRNA; (3) laser-based technology such as Confocal scanning laser microscopy (CSLM), optical coherence tomography (OCT), laser Doppler perfusion imaging (LDPI), (4) Ultrasonography, and (5) other imaging tools such as electrical bio-impedance, MRI and PET scan. The ultimate goal of all investigational instrumentation is the prevention of unnecessary biopsies and a decrease in the prevalence and morbidity associated with malignant melanoma.

Pharmacotherapy of actinic keratosis

Actinic keratosis (AK) represents the initial intraepidermal manifestation of abnormal keratinocyte proliferation with the potential of progression to squamous cell carcinoma (SCC). When in limited numbers, clinically visible AKs are treated individually with ablative and/or surgical procedures (lesion-directed treatment), while multiple and sublinical AKs are treated with field-directed therapies that use ablative, nonablating and other topically applied treatment modalities. Owing to difficulties in predicting which AK will progress to SCC, the general rule is to treat all AKs. The goals of treatment are to eliminate the AKs, minimizing their risk of progression to invasive SCC, while pursuing good cosmetic outcomes. Prevention is the most important treatment modality for AKs. Avoidance of sun and artificial sources of ultraviolet light, applying sunscreen and self-examination are among the most effective preventive measures. Chemopreventive modalities such as retinoids, 2-(Difluoromethyl)-dl-ornithine (DFMO), perillyl alcohol, T4 endonuclease V, and dl-α-tocopherol are described. Lesion-directed treatment modalities include cryotherapy, surgery and electrodessication with or without curettage. Field-directed treatment modalities include nonablative and ablative laser resurfacing, dermabrasion, chemical peels, topical immunomodulators (imiquimod, 5-fluorouracil and diclofenac) and photodynamic therapy. And, finally, newer and investigational treatment modalities such as ingenol mebutate, resiquimod and betulinic acid are also being discussed.

Exacerbation of facial acne vulgaris after consuming pure chocolate

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Pharmacotherapy of actinic keratosis: an update

Introduction: Actinic keratosis (AK) represents the initial intraepidermal manifestation of abnormal keratinocyte proliferation, with the potential of progression to squamous cell carcinoma (SCC). Few visible AKs lead to the use of lesion-directed treatments, including ablative and/or surgical procedures. Multiple and/or the suspicion of subclinical (non-visible) AKs lead to the use of field-directed therapies, including topical and ablative treatments. Predicting which AK will progress to SCC is difficult, and so all are treated. The goals of treatment are to eliminate visible AKs and to treat subclinical (non-visible) AKs, minimizing their risk of progression to invasive SCC, while pursuing good cosmesis. Areas covered: This review discusses the prevention of AKs (such as ultraviolet light avoidance, sunscreen use, protective clothing, and frequent self-examinations, in addition to chemoprevention with retinoids, eflornithine, silymarin, and others). It also covers lesion-directed treatments (e.g., cryotherapy, electrodessication and curettage, and surgery). Field-directed treatments are also mentioned (including laser resurfacing, dermabrasion, chemical peels, topical immunomodulators (imiquimod and diclofenac), topical chemotherapeutic agents (5-fluorouracil and retinoids), and photodynamic therapy). Finally, newer and investigational treatments are discussed (including ingenol mebutate). Expert opinion: There is no panacea in the treatment of AKs. The current best approach is the sequential treatment with a lesion-directed and a field-directed therapy. Several combinations seem to work well; they just need to be selected based on the evidence and adjusted to patient needs, preferences and dermatologist expertise.

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.

Dermoscopic-Histopathologic Correlation of Cutaneous Lymphangioma Circumscriptum

C LINICALLY, CUTANEOUS LYMPHANGIOMA circumscriptum (CLC) (Figure 1A and Figure2A) should be differentiated from other vascular and lymphatic lesions, such as hemangiomas, angiokeratomas, lymphangioendotheliomas, and angiosarcomas, as well as from warts, molluscum contagiosum, condyloma acuminata, and hidrocystoma. The dermoscopic features of CLC demonstrate 2 distinct patterns: (1) yellow lacunae surrounded by pale septa without inclusion of blood (Figure 1B) and (2) yellow to pink lacunae alternating with dark-red or bluish lacunae due to the inclusion of blood (Figure 2B). In pattern 2, the blood cells precipitate, giving rise to 2-tone lacunae.

Alteration in Hair Texture Following Regrowth in Alopecia Areata: A Case Report

BACKGROUND Alopecia areata is a common cause of hair loss seen in 3.8% of patients in dermatology clinics and in 0.2% to 2.0% of the general US population. The pathology of the disease remains poorly understood. Hair loss in alopecia areata can range from a single patch to 100% loss of body hair. When hair regrowth occurs in alopecia areata, the new hair may demonstrate pigment alterations, but a change in hair texture (ie, curly or straight) has rarely been reported as a consequence of alopecia areata. OBSERVATIONS We report a case of a 13-year-old African American boy who experienced an alteration of hair shape following regrowth after alopecia areata. The new hair recapitulated his hair shape from early childhood. CONCLUSIONS The precipitating factor for a change in hair texture in alopecia areata may be a result of treatment, pathophysiologic changes, or a combination of both. Whether the change is triggered at the level of stem cell differentiation, by cytokine or hormonal influences, gene expression during hair follicle development, a combination of all of these, or an unknown cause is a question that remains to be answered.

A novel treatment for rheumatoid nodules (RN) with intralesional fluorouracil

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Dorsal Dimelia of the Fourth Toe in a Patient With Incontinentia Pigmenti

Development of a second nail plate on either the plantar or palmar surface of a digit, known as a double nail, is an extremely rare malformation. When dorsalization of the plantar skin is also present, the condition is referred to as dorsal dimelia. Additional findings associated with dorsal dimelia may include loss of flexion creases with absent flexion at the interphalangeal joints and tapering of the distal phalanx seen on radiography. We report herein a case of an affected toe in a patient with incontinentia pigmenti (IP).