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J Dermatolog Treat [journal]
- Do you make the correct management strategy on CO2 laser in treating Divided Nevus of the Eyelid? [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Jul 21.:1-3.
- Autologus Bone Marrow Stem Cells in Atrophic Acne Scars; A Pilot Study. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Jul 21.:1-26.
Abstract Acne scar is a very distressing and difficult problem for physicians and patients. Management of cutaneous scarring from acne can be challenging and confusing. The available modalities may be effective, having considerable morbidity and long down time. Besides, they may not have the same efficacy in different skin types or acne scar types. Objective: To evaluate the short-term safety and efficacy of autologous bone marrow stem cells in treating atrophic acne scars. Methods: 14 patients with moderate to severe atrophic acne scars were included. All patients were subjected to single session of autologous bone marrow stem cells therapy. Each patient received 5 microgram/kg/day granulocyte-colony stimulating factor (G-CSF) as a single subcutaneous dose for two successive days before bone marrow aspiration. The stem cells containing solution was injected under each scar intradermally. The scars of the patients were clinically assessed both qualitatively and quantitatively before and after 6 months. The Patients were given a preformed questionnaire CADI (Cardiff acne disability index) before and after treatment. Results: After six months of the injection, there was significant improvement in the qualitative grading, quantitative grading and CADI scores. All types of scars showed significant improvement. No significant adverse effects were reported in any patient. Conclusion: Autologous bone marrow stem cells seem to be safe and effective treatment option for the management of all types of atrophic facial acne scars.
- A randomised, controlled trial of a 4% cutaneous emulsion of sodium cromoglicate in treatment of atopic dermatitis in children. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Jul 18.:1-0.
Abstract Introduction. Atopic dermatitis (AD) is a chronic inflammatory skin disease. Sodium cromoglicate (SCG) is a chromone with anti-inflammatory, anti-itch and anti-allergic activity. This trial is a 12-week comparison (RCT) of a 4% SCG cutaneous emulsion with its vehicle in AD. Materials and methods: 208 children aged 2 - 12 years participated: 104 in each group. The primary endpoint, change in SCORAD score. Secondary endpoints included SASSAD score, topical steroid usage, global assessments. Results: SCORAD reduced by 28% (4%SCG group) and by 19% (vehicle): difference statistically significant (p=0.03) after 8 weeks and nearly significant (p=0.09) after 12. A similar result occurred in SASSAD (p=0.001 at 8 weeks). In subjects without major protocol deviations (4% SCG-64, Vehicle-63), difference in SCORAD remained significant at 12 weeks (p=0.04). Weight of topical steroids reduced in both groups: -0.60 ± 1.3g/day (35%), 4% SCG and - 0.05 ± 1.1 g/day (4%) vehicle (p=0.04). Treatment success, defined as % of investigator global opinions was significantly in favour of 4% SCG emulsion (p=0.025). Main adverse event was application site discomfort in 15.5% of subjects treated with SCG emulsion. Conclusions: SCG 4% cutaneous emulsion is an effective, well tolerated, steroid sparing treatment for atopic dermatitis in children.
- Racial Differences in the use of Extracorporeal Photopheresis for Mycosis Fungoides. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Jul 18.:1-0.
Abstract Background: Extracorporeal Photopheresis (ECP) is an effective treatment option for mycosis fungoides (MF) and associated with few systemic side effects. Objective: We sought to investigate whether there were differences in rates of ECP use between African-American and Caucasian patients with Stage III/IV MF. Methods: We conducted a retrospective review of all patients treated for MF at the Johns Hopkins Hospital main campus outpatient clinic between 1999 and 2011. Results: We identified 65 patients with Stage III or IV disease, 20 African-American and 45 Caucasian. Only 7 of 20 African-American patients (35%) compared to 30 of 45 (66%) of Caucasian patients were treated with ECP (p= .029). Additionally, ECP was discussed as an option for 45% of African-Americans compared to 82% of Caucasians (p=.007). When discussed as an option, African-Americans and Caucasians had identical rates of ECP use (78% vs 81%, p=.841). Conclusions: Differences in rates of ECP use exist among African-American patients when compared to their Caucasian counterparts and may be related to how often ECP is offered as a treatment option. Improving physician awareness of the factors which influence treatment decision making may help diminish discrepancies in treatment regimens among patients with MF.
- Treatment of Eyelid Nevus with CO2 Laser: a Double-Edged Sword. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Jul 18.:1-6.
- Nonablative fractionated laser skin resurfacing for the treatment of aged neck skin. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Jun 23.:1-18.
Abstract Background: Aging of the neck skin includes poikiloderma of Civatte, skin laxity and wrinkles. While the vascular alterations of poikiloderma of Civatte can be effectively treated with lasers or intense pulsed light, a successful treatment of dyschromia, skin laxity and wrinkles is still difficult to achieve. Objective: To evaluate the safety and efficacy of nonablative fractional 1540 erbium glass laser for the treatment of aged neck skin, also by means of in vivo reflectance confocal microscopy (RCM). Methods: A prospective study for neck resurfacing in 18 women with aged neck skin. Six laser treatments were performed in 4-weeks intervals with a 1540-nm erbium-glass fiber laser. Results: By using a 6-point grading scale, the mean score (±SD; range) at baseline was 3.6 (±1.5; 1-6) for skin dyschromia, 2.9 (±1.4; 1-6) for laxity, and 3.3 (±1.3; 1-5) for wrinkles. Three months after the last laser session, we found a significant clinical improvement of dyschromia (p = 0.0002; Wilcoxon test), and wrinkles (p = 0.0004; Wilcoxon test), with a mean (±SD) reduction of 2.5 (±1.0) and 1.9 (±1.1) points in the 6-point grading scale, respectively. No change was observed in laxity. These results were also supported by structural changes documented by RCM. Conclusion: Nonablative fractional 1540 erbium glass laser was both safe and effective for the treatment of dyschromia and wrinkles, but not effective for the laxity of the neck skin.
- Efficacy and safety of adalimumab in psoriatic patients previously treated with etanercept in a real-world setting. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Jul 1.:1-6.
Abstract Introduction: Knowledge on the efficacy and safety of adalimumab in psoriasis patients switching from etanercept is scarce, especially on the influence that causes of etanercept discontinuation may have on adalimumab response. Objectives: To evaluate the response, adverse effects and factors that may influence the efficacy and safety of adalimumab in psoriasis patients who failed on etanercept therapy in a real-world setting. Methods: Data from all moderate to severe plaque psoriasis patients who switched from etanercept to adalimumab were extracted from a registry of biological therapies of our department. Primary endpoint was the percentage of patients achieving PASI 50 at weeks 12, 24, and 52. Secondary endpoints were the percentages of patients achieving PASI 75 and PASI 90, patients who maintained PASI values <5 and <3, and the safety of adalimumab. Results: Of 35 patients who fulfilled the study criteria, 82.9% achieved PASI 50 at week 12, 74.3% at week 24, and 74.3% at week 52 on adalimumab treatment. Eleven of 16 primary and 11 of 17 secondary nonresponders to etanercept responded to adalimumab. There were no treatment discontinuations due to side effects. Conclusions: Previous etanercept failure seems not influence the success and safety of adalimumab treatment in moderate to severe plaque psoriasis.
- The effect of 4% sodium cromoglicate cutaneous emulsion compared to vehicle in atopic dermatitis in children - A meta-analysis of total SCORAD scores. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Jul 18.:1-7.
Abstract An emulsion containing 4% sodium cromoglicate (4% SCG emulsion) has been developed for the treatment of atopic dermatitis in children. We have conducted a meta-analysis of the primary outcome measure (the change in SCORAD score) used in randomized clinical trials (RCTs) with this product. We conducted a search of standard using the keywords, sodium cromoglicate, cromolyn sodium, topical, atopic dermatitis, clinical trial. We identified 19 clinical studies of which 3 used this 4% SCG emulsion formulation, one was a RCT using the change in SCORAD score. We were given access to two further unpublished RCTs, with this measure. The RCTs included 490 subjects (mean age 5.3 years). Each RCT was multicentre of 12 weeks duration, comparing 4% SCG emulsion with the vehicle in which the SCG was dissolved. Using study as the unit and the fixed effect model, the mean difference (95% CI) in the change in SCORAD score was -2.82 (-5.36; -0.29), p = 0.03. Using centre as the unit, and the fixed effect model, the mean difference (95% CI) in the change in SCORAD score was -2.82 (-5.82; -0.46), p = 0.02. These results support the efficacy of this new topical treatment in children with atopic dermatitis.
- Cutaneous lichen planus: A Systematic Review of Treatments. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Jun 11.:1-16.
Abstract Various treatment modalities are available for cutaneous lichen planus. Pubmed, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, and Health Technology Assessment Database were searched for all the systematic reviews and randomized controlled trials related to cutaneous lichen planus. Two systematic reviews and nine relevant randomized controlled trials were identified. Acitretin, griseofulvin, hydroxychloroquine and narrow band ultraviolet B are demonstrated to be effective in the treatment of cutaneous lichen planus. Sulfasalazine is effective, but has an unfavorable safety profile. KH1060, a vitamin D analogue, is not beneficial in the management of cutaneous lichen planus. Evidence from large scale randomized trials demonstrating the safety and efficacy for many other treatment modalities used to treat cutaneous lichen planus is simply not available.
- A case of multiple bone fractures due to the use of topical corticosteroid therapy for psoriasis. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Jun 10.:1-11.
Abstract A 45-year-old man who had psoriasis and had applied topical clobetasole 17 propionate ointment to his whole body 2-3 times a week after the bath for 20 years. Physical examination showed abdominal distension, atrophy all over the skin, psoriatic plaques on the trunk and extremities and multiple striae on the shoulders and legs. Morning plasma cortisol level and ACTH stimulation test confirmed the diagnosis of hypothalamic insufficiency. Bone mineral densitometry showed severe osteoporosis. Multiple bone fractures in the vertebrae and costa were detected on lumbar magnetic resonance imaging, the (99) Tc MDP whole-body bone scan and thoracoabdominal computarized tomography imaging. Topical corticosteroid therapies have possible local and/or systemic side effects such as atrophy, telangiectasia, hypertricosis and suppression of pituitary-adrenal axis. We present an interesting case with multiple bone fractures caused by long time topical corticosteroid use.