Wendy Cantrell

Chemoprevention of Nonmelanoma Skin Cancer With Celecoxib: A Randomized, Double-Blind, Placebo-Controlled Trial

Background Preclinical studies indicate that the enzyme cyclooxygenase 2 plays an important role in ultraviolet-induced skin cancers. We evaluated the efficacy and safety of celecoxib, a cyclooxygenase 2 inhibitor, as a chemopreventive agent for actinic keratoses, the premalignant precursor of nonmelanoma skin cancers, and for nonmelanoma skin cancers, including cutaneous squamous cell carcinomas (SCCs) and basal cell carcinomas (BCCs). Methods A double-blind placebo-controlled randomized trial involving 240 subjects aged 37–87 years with 10–40 actinic keratoses was conducted at eight US academic medical centers. Patients were randomly assigned to receive 200 mg of celecoxib or placebo administered orally twice daily for 9 months. Subjects were evaluated at 3, 6, 9 (ie, completion of treatment), and 11 months after randomization. The primary endpoint was the number of new actinic keratoses at the 9-month visit as a percentage of the number at the time of randomization. In an intent-to-treat analysis, the incidence of actinic keratoses was compared between the two groups using t tests. In exploratory analyses, we evaluated the number of nonmelanoma skin cancers combined and SCCs and BCCs separately per patient at 11 months after randomization using Poisson regression, after adjustment for patient characteristics and time on study. The numbers of adverse events in the two treatment arms were compared using χ2 or Fisher exact tests. All statistical tests were two-sided. Results There was no difference in the incidence of actinic keratoses between the two groups at 9 months after randomization. However, at 11 months after randomization, there were fewer nonmelanoma skin cancers in the celecoxib arm than in the placebo arm (mean cumulative tumor number per patient 0.14 vs 0.35; rate ratio [RR] = .43, 95% confidence interval [CI] = 0.24 to 0.75; P = .003). After adjusting for age, sex, Fitzpatrick skin type, history of actinic keratosis at randomization, nonmelanoma skin cancer history, and patient time on study, the number of nonmelanoma skin cancers was lower in the celecoxib arm than in the placebo arm (RR = 0.41, 95% CI = 0.23 to 0.72, P = .002) as were the numbers of BCCs (RR = 0.40, 95% CI = 0.18 to 0.93, P = .032) and SCCs (RR = 0.42, 95% CI = 0.19 to 0.93, P = .032). Serious and cardiovascular adverse events were similar in the two groups. Conclusions Celecoxib may be effective for prevention of SCCs and BCCs in individuals who have extensive actinic damage and are at high risk for development of nonmelanoma skin cancers.

Onychomycosis and diabetes.

Objective  This study aims to discuss factors specific to diabetics in the diagnosis and treatment of onychomycosis.

Diclofenac sodium 3% gel as a potential treatment for disseminated superficial actinic porokeratosis

Background  Disseminated superficial actinic porokeratosis (DSAP) is a chronic cutaneous disorder of keratinization for which there is no known cure. Current therapies are often ineffective, painful, or unappealing.

Safety and Efficacy of Subcutaneously Administered Efalizumab in Adults with Moderate-to-Severe Hand and Foot Psoriasis : An Open-Label Study

AbstractIntroduction: Hand and foot psoriasis may be more disabling than psoriasis at other body locations because of its interference with daily functional activities. Most treatment options have limited efficacy, short duration of response, toxicity, intolerability, or inconvenience. Objective: To investigate whether efalizumab (Raptiva®) is efficacious and safe for the treatment of patients with hand and foot psoriasis. Method: Adult patients with moderate-to-severe hand and/or foot psoriasis received a conditioning dose of efalizumab 0.7 mg/kg at week 0 with subsequent doses of efalizumab 1 mg/kg given weekly for 11 additional weeks (total of 12 doses). Patients were followed until week 24 (12 weeks after the last treatment) to monitor safety and efficacy. Static Physician’s Global Assessment (PGA) scores were used to measure efficacy. The primary efficacy endpoint was the number of patients achieving a 50% reduction in the global evaluation by static PGA from baseline at week 12. Results: Ten patients enrolled, six of whom completed the study. Of these six patients, four patients showed overall improvement at 12 weeks, including two patients that achieved 50% improvement overall. At 12 weeks, the hands of two patients and the feet of two patients showed at least 50% improvement from baseline. Efalizumab was well tolerated and there were no serious adverse events. Conclusion: Continuous treatment with efalizumab for 12 weeks was safe and efficacious in this open-label study of patients with hand and foot psoriasis.

Tinea capitis in Birmingham: survey of elementary school students.

Abstract:  Trichophyton tonsurans is currently the leading cause of tinea capitis, but was only introduced into the United States less than six decades ago. In this study, we found a prevalence of 11% in Birmingham, Alabama, which is similar to earlier reports from other geographic regions. Despite previous reports concerning escalation, the prevalence appears to be stable over the past decade.

Interest in cosmetic improvement as a marker for tanning behavior: a survey of 1602 respondents

Dermatologists see many patients interested in improving their physical appearance through cosmetic procedures or medical means. Dermatologists frequently counsel patients on sun protection as well, particularly those with a personal or family history of skin cancer, sun‐sensitive dermatoses or those with obvious sun damage. Our objective in this study was to identify novel markers of skin cancer risk, which may aid dermatologists in targeting extra sun protection counseling for certain groups. A 16‐question survey was distributed to subjects 19 years of age and older in public areas of downtown Birmingham, Alabama in August and September of 2008. Overall, about 40% of both genders reported that they were highly concerned that current sun exposure could cause skin cancer. Participants interested in at least one appearance‐related questionnaire item were significantly more likely than those not interested to rate tanned skin as highly important (31.6%vs. 17.5%, P < 0.001), and to report regret for previous sun exposure (12.5%vs. 3.6%, P < 0.001). Subjects who thought tanned skin was important were significantly more likely to report interest in improving their appearance through cosmetic procedures and medical means. We conclude that individuals with an interest in improving their physical appearance through cosmetic procedures or medical means may be especially in need of sun protection counseling.

An Idiopathic Leukonychia Totalis and Leukonychia Partialis Case Report and Review of the Literature.

Leukonychia totalis and leukonychia partialis are rare nail findings characterized by complete or partial whitening of the nail plate. Leukonychia totalis and leukonychia partialis are usually inherited or associated with systemic disease. Here, we report the case of a 25-year-old man with idiopathic acquired leukonychia totalis and leukonychia partialis and review the literature on this topic.

Putting onychomycosis under the microscope.

tion by the causative organism via keratinolytic proteases, which also provide a source of nutrition for fungal organisms. Dermatophytes (tinea unguium) are the most common cause of onychomycosis. The most common dermatophytes are Trichophyton rubrum (T. rubrum), T. mentagrophytes, T. tonsurans, Microsporum canis, and Epidermophyton fl occosum. Nondermatophytes and yeast also cause onychomycosis. The most commonly isolated nondermatophytes are Acremonium, Fusarium, and Scopulariopsis species.

Psoriasis & psoriatic therapies

Psoriasis is a chronic inflammatory disease primarily affecting the skin. This article discusses the presentation, epidemiology, and pathogenesis of psoriasis as well as a brief consideration of psoriatic arthritis. Psoriasis treatment options include topical agents, phototherapy, conventional systemic therapies, and biologics.

Single-Center, Prospective, Blinded Study Comparing the Efficacy and Compatibility of Efinaconazole 10% Solution in Treating Onychomycosis with and without Concurrent Nail Polish Use

Background: Topical efinaconazole 10% solution is a promising new treatment for distal lateral subungual onychomycosis (DLSO). However, it is unknown whether this treatment is both compatible and efficacious in individuals wearing toenail polish. Materials and Methods: We evaluated the efficacy and compatibility of efinaconazole 10% solution with concurrent nail polish use in treating DLSO over 52 weeks. Efficacy was assessed using the onychomycosis severity index (OSI) and by measuring nail growth and thickness, while compatibility with nail polish was evaluated with questionnaires. Results: Eleven patients completed the study; 6 wore nail polish regularly and 5 abstained from polish. The efficacy of efinaconazole was not diminished by concurrent nail polish use as measured by OSI, nail growth, and thickness. However, this treatment produced undesirable cosmetic changes to the quality of nail polish over time. Conclusions: While efinaconazole 10% solution is an effective treatment of DLSO in patients wearing nail polish, this treatment may diminish the quality of the polish. Further research and development is needed to enhance the compatibility of topical onychomycosis treatments with nail polish use.