Tracey N. Liebman

Cochlear implantation following treatment for medulloblastoma

Medulloblastoma is the most common pediatric malignant tumor of the central nervous system in children. Treatment includes surgical excision, external beam radiation, and multiagent chemotherapy. Otologic sequelae are common and may result from radiation and/or chemotherapy. Profound sensorineural hearing loss (SNHL) is a known complication of neuro‐oncologic treatment and may render these patients eligible for cochlear implantation (CI). Issues of CI in this population, including diagnosis, treatment of preoperative middle ear disease, operative and postoperative course, performance data, and long‐term tumor surveillance are highlighted and reviewed.

Cyclo-oxygenase-2 inhibitors for chemoprevention of nonmelanoma skin cancer: Is there a role for these agents?

AK: actinic keratosis BCC: basal cell carcinoma BCNS: basal cell nevus syndrome COX: cyclo-oxygenase FAP: familial adenomatous polyposis NMSC: nonmelanoma skin cancer XP: xeroderma pigmentosum S elective cyclo-oxygenase (COX)-2 inhibitors have been proposed as potentially useful agents in the chemoprevention of nonmelanoma skin cancer (NMSC). Although COX-2 inhibitors are not without considerable risks, they may hold benefit for certain patient subgroups at risk for NMSC. In this article, we review studies examining the use of these agents in cancer prevention, and offer suggestions for future investigations with oral and topical COX-2 inhibitors in the prevention of NMSC.

Dihydroxyacetone and sunless tanning: Knowledge, myths, and current understanding

DHA: dihydroxyacetone FDA: US Food and Drug Administration S unless tanning products, which contain dihydroxyacetone (DHA), produce a relatively long-lasting simulated tan without the risks of photodamage. DHA is a sugar that interacts with proteins in the skin to form brown-colored products called melanoidins. This reaction is limited to the stratum corneum, and in vitro skin absorption studies have found no significant systemic absorption of DHA when applied topically to the skin. In this Commentary, we review current misconceptions among the lay media and general public about the established risks of DHA-containing sunless tanning products, as well as US Food and Drug Administration (FDA)-approved guidelines for their proper use. DHA is FDA-approved for topical application to the skin (eg, cream or lotion formulations), but it ‘‘should not be inhaled, ingested, or exposed to areas covered by mucous membranes’’ such as the area around the eye or on the lips. DHA is not approved for use in all-over spray tans, including at-home spray tans and misting from tanning booths, due to limited safety data on these applications. The Skin Cancer Foundation and the American Academy of Dermatology maintain that self-tanning, with concomitant sunscreen use, is safer than tanning by ultraviolet radiation. Irritant and allergic contact dermatitis are the most common side effects. On a cellular level, DHA has been shown to cause severe morphologic changes and damage to cell proliferation and growth in cultured keratinocytes. Another in vitro study found that DHAwasmutagenic in Salmonella typhimurium and DNA-damaging in Bacillus subtilis. However,

What Is the Evidence that Riboflavin Can Be Used for Migraine Prophylaxis

Individuals with migraine often have recurrent, painful symptoms, and symptomatic treatments have detrimental side effects and do not prevent further attacks. Studies indicate that riboflavin can be used to decrease headache frequency and lessen the need for symptomatic treatment. Mitochondrial dysfunction may play a role in migraine pathogenesis by interfering with oxygen metabolism. Daily doses of riboflavin, vitamin B2, may improve mitochondrial function by increasing the reserve of brain mitochondrial energy, and there are minimal side effects with daily treatment. However, there is a need for further randomized, double-blind controlled studies to determine the effective dose. Although riboflavin may not fully eliminate migraine nor take effect for several months, riboflavin is a promising prophylactic agent with minimal adverse effects that may significantly reduce the frequency of migraine.

Melanoma risk after in vitro fertilization: A review of the literature

Background: The role of female sex hormones in the pathogenesis of malignant melanoma (MM) remains controversial. Although melanocytes appear to be hormonally responsive, the effect of estrogen on MM cells is less clear. Available clinical data does not consistently demonstrate that increased endogenous hormones from pregnancy or increased exogenous hormones from oral contraceptive pills and hormone replacement affect MM prevalence and outcome. Objective: We sought to examine potential associations between in vitro fertilization (IVF) and melanoma. Methods: A literature review was conducted. Primary outcomes were reported as associations between IVF and melanoma risk compared with the general population. Secondary outcomes included associations stratified by type of IVF regimen and subgroup, such as parous versus nulliparous patients. Results: Eleven studies met our inclusion criteria. Five studies found no increased risk for MM among IVF users compared with the general population. Two studies found an increase in MM in clomiphene users, and 4 studies found an increase in MM among patients who were gravid or parous either before or after IVF. Conclusion: The reviewed studies do not reveal consistent patterns of association between IVF and MM among all infertile women. However, the data indicates a potential increased risk for MM in ever‐parous patients treated with IVF. High‐quality studies including a large number of MM cases that control for well‐established MM risk factors are needed to adequately assess the relationship between IVF and MM, particularly among ever‐parous women.

Systemic lupus erythematosus and antineutrophil cytoplasmic antibody–associated vasculitis: An emerging overlap syndrome with cutaneous manifestations

AAV: antineutrophil cytoplasmic antibodyeassociated vasculitis ACR: American College of Rheumatology ANA: antinuclear antibody ANCA: antineutrophil cytoplasmic antibody anti-MPO: antimyeloperoxidase MCTD: mixed connective tissue disease p-ANCA: perinuclear antineutrophil cytoplasmic antibody RNP: ribonucleoprotein SLE/AAV: systemic lupus erythematosus antineutrophil cytoplasmic antibodyeassociated vasculitis overlap syndrome INTRODUCTION Systemic lupus erythematosus and antineutrophil cytoplasmic antibody (ANCA)eassociated vasculitis (SLE/AAV) overlap syndrome is a rare disease originally described in 2008. With only a few reports in the literature, this condition is characterized by aggressive crescentic glomerulonephritis, arthritis, cutaneous involvement, and both antinuclear antibody (ANA) and ANCA. Dermatologic manifestations are common and may occur at initial presentation. Although skin lesions may vary in morphology, the most commonly reported include cutaneous nodules and ecchymoses. Few reports have characterized the cutaneous findings seen in this disorder. We report a young woman with SLE/ AAV overlap syndrome who presented with a macular eruption and histopathology findings demonstrating interface dermatitis.

An immunosuppressed man with an isolated necrotic plaque on the chest

A 54-year-old man on systemic immunosuppressive therapy for 1 month after a liver transplant for hepatitis C virus presented with a 5-day history of a solitary plaque on the chest. Physical examination found an indurated, violaceous 53 3-cm tender plaque studded with pustules. Over the following days, the plaque became more purulent and developed a central erosion with necrosis (Fig 1). Punch biopsy found a nodular and diffuse dermal mixed cell infiltrate with multinucleated histiocytes and neutrophils (Fig 2, A). Fungal organisms with nonseptated hyphae and right angle branching were identified by Gomori methenamine silver stain (Fig 2, B).

Eczematous reaction to IVIG for the treatment of dermatomyositis

The use of high-dose intravenous immunoglobulin (IVIG) is an accepted therapy for patients with refractory dermatomyositis. Cases of eczematous reactions to IVIG have been reported in the literature, but to our knowledge, none in patients being treated for dermatomyositis. We report on the cases of two female patients with refractory dermatomyositis who developed pruritic, scaly pink plaques after receiving high-dose IVIG. This diffuse eczematous skin reaction to high-dose IVIG is a rare adverse event that most often occurs days after administration of therapy. Practitioners should be aware of this entity because the eczematous eruption may be extensive and can commonly worsen with subsequent re-exposure to IVIG.

Pregnancy and Melanoma: Recommendations for Clinical Scenarios

Managing pregnant patients with a history of melanoma or with a melanoma diagnosis can be daunting and confusing for dermatologists. We present three clinical scenarios that raise questions about the safety of pregnancy in patients with a history of melanoma, skin biopsies during pregnancy, and excisions and sentinel lymph node biopsies during pregnancy. Our recommendations incorporate the most up-to-date clinical data to help guide clinicians when faced with pigmented lesions and melanoma in a pregnant patient.

Bullous id eruption in the setting of orf

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