50 results on '"Jean-Phillip Okhovat"'
Search Results
2. Association between alopecia areata, anxiety, and depression: A systematic review and meta-analysis
- Author
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Maryanne M. Senna, Joseph J. Locascio, Jean-Phillip Okhovat, Dustin H. Marks, Athena Manatis-Lornell, and Dina Hagigeorges
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Referral ,business.industry ,MEDLINE ,Dermatology ,Publication bias ,Alopecia areata ,medicine.disease ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Systematic review ,030220 oncology & carcinogenesis ,Meta-analysis ,Medicine ,Anxiety ,medicine.symptom ,business ,Depression (differential diagnoses) ,Clinical psychology - Abstract
Background To date, there is no comprehensive meta-analysis analyzing the association between alopecia areata, anxiety, and depression. Objective We sought to analyze the existing literature to examine the association between alopecia areata, anxiety, and depression. Methods We extracted literature from four databases including Medline, Embase, PsychINFO, and Web of Science. We utilized the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines in order to finalize a list of relevant articles to be included in our systematic review and meta-analysis. There were no restrictions placed on publication year or age of participants. Results A total of 8 studies that included 6,010 patients with AA and 20,961 control patients were included in the quantitative analysis. These included 4 cross-sectional studies and 4 case-control studies. Analysis of these studies demonstrated a positive association with anxiety (pooled OR, 2.50; 95% CI, 1.54-4.06) and depression (pooled OR, 2.71; 95% CI, 1.52-4.82). Limitations Publication bias may be a limitation of the study. Conclusion This study suggests that patients with AA are at higher risk of both anxiety and depression. Healthcare professionals must be cognizant of this higher risk and consider routine assessment of these conditions and referral to appropriate providers when indicated.
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- 2023
3. Complementary and alternative medicine for alopecia areata: A systematic review
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Priya Manjaly, Arash Mostaghimi, Jean-Phillip Okhovat, Maryanne M. Senna, Kathie P. Huang, and Elizabeth Tkachenko
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medicine.medical_specialty ,business.industry ,MEDLINE ,Retrospective cohort study ,Dermatology ,Evidence-based medicine ,Alopecia areata ,medicine.disease ,law.invention ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Quality of life ,law ,030220 oncology & carcinogenesis ,medicine ,Adverse effect ,Intensive care medicine ,business ,Aromatherapy - Abstract
Background Despite high utilization of complementary and alternative medicine (CAM) for alopecia areata (AA), efficacy and safety remain unclear. Objective To identify all CAM therapies studied for treatment of AA. Outcomes of interest included disease course and psychological well-being. Methods PubMed and Embase were searched to identify English articles containing original data investigating CAM in human subjects with AA from 1950-2018. Quality was assessed with Oxford Centre for Evidence Based Medicine criteria. Results Of 1,015 initial citations, 16 articles met inclusion criteria: 5 randomized controlled trials, 5 prospective controlled cohorts, 4 prospective non-controlled cohorts, 1 retrospective cohort, and 1 case series. CAM therapies with best evidence and efficacy for hair growth in AA include essential oil aromatherapy, topical garlic, and oral glucosides of peony with compound glycyrrhizin. Hypnosis and mindfulness psychotherapy represent low quality evidence for improvement of psychological and quality of life outcomes. Adverse events were rare and mild for all therapies evaluated. Limitations Inconsistent or poorly reported study methodology and non-standardized outcomes limit the conclusions that can be made from these studies. Conclusions This work serves to inform physician management of patients with AA seeking CAM, while encouraging further investigation into these therapies to address some of the therapeutic challenges of AA.
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- 2023
4. Innovation interest within dermatology: a needs assessment for novel thought processes
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Lilit Garibyan, Jean-Phillip Okhovat, Kachiu C. Lee, Justin Cheeley, Ivy Lee, Darrel L. Ellis, Jennifer G. Powers, and Justin M. Ko
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medicine.medical_specialty ,Identifying problems ,Dermatology ,General Medicine ,Burnout ,Demographic data ,Patient care ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Work (electrical) ,030220 oncology & carcinogenesis ,Needs assessment ,Or education ,medicine ,Lack of knowledge ,Psychology - Abstract
Medical innovation is crucial to advancing our field, and physicians have the potential to play a leading role due to their daily patient care experiences. The objective of this study was to evaluate the interest in, and barriers to participating in innovation. Two surveys were conducted; the first cross-sectional survey was conducted among attendees of the Advancing Innovation in Dermatology Forum in Feburary 2019. The second survey was conducted among trainees (resident/fellows) and faculty dermatologists at Brown, Emory, Iowa, Stanford, and Vanderbilt Universities between June and November 2019. Demographic data were collected, as well as factors involved with identifying problems, developing solutions, training in innovation, and perceived barriers to innovation. In the first survey, the greatest perceived benefits include bringing joy to one's work and increasing professional fulfillment with work. Innovation was also perceived to decrease burnout. In the second survey of academic centers, faculty more commonly expressed interest in identifying problems (p = 0.04), and was also more confident in their ability to generate solutions to these problems as compared to trainees (p
- Published
- 2020
5. The ALT-70 cellulitis model maintains predictive value at 24 and 48 hours after presentation
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Adam B. Raff, Cara Joyce, Priyanka Vedak, Jeffrey M. Cohen, Daniela Kroshinsky, David G. Li, Arash Mostaghimi, Jean-Phillip Okhovat, Sean Singer, Christina Q Weng, and Nicole Gunasekera
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Male ,medicine.medical_specialty ,Time Factors ,Dermatology ,Severity of Illness Index ,Decision Support Techniques ,Cohort Studies ,Diagnosis, Differential ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Hospitals, Urban ,0302 clinical medicine ,Cost Savings ,Predictive Value of Tests ,Health care ,medicine ,Humans ,Generalizability theory ,Diagnostic Errors ,Hospital Costs ,Skin Diseases, Infectious ,Retrospective Studies ,business.industry ,Cellulitis ,Emergency department ,Length of Stay ,medicine.disease ,Predictive value ,Confidence interval ,030220 oncology & carcinogenesis ,Cohort ,Emergency medicine ,Female ,Presentation (obstetrics) ,Emergency Service, Hospital ,business - Abstract
Background Cellulitis has many potential mimickers, and its misdiagnosis often leads to unnecessary hospitalizations and higher health care costs. The ALT-70 predictive model offers an objective tool to help differentiate between cellulitis and other clinically similar conditions at the time of initial emergency department (ED) presentation. Objective To evaluate the performance of the ALT-70 predictive model at 24 and 48 hours following ED presentation. Methods We performed a retrospective review of our prior cohort and expanded our data collection to include data at 24 and 48 hours after initial ED presentation. We compared classification measures for the ALT-70 at the time of initial ED presentation, 24 hours after presentation, and 48 hours after presentation. Results There was a statistically significant difference in median ALT-70 score between patients with true cellulitis and those with mimickers of cellulitis at all time points. Sensitivity, specificity, positive predictive value, and negative predictive value of the ALT-70 score was similar across all 3 time points. Limitations Single-center design may reduce generalizability. Conclusion At 24 and 48 hours, the ALT-70 performed similarly to the way it performed at the time of initial ED presentation, allowing for its use in a wider array of clinical settings.
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- 2019
6. Low utility of radiologic imaging in evaluating cutaneous small-vessel vasculitis: A multi-institutional retrospective study
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Ryan S. Din, Peter B. Chansky, Jean-Phillip Okhovat, Andrew C. Walls, Arash Mostaghimi, and Robert G. Micheletti
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Adult ,Diagnostic Imaging ,Male ,Vasculitis ,medicine.medical_specialty ,business.industry ,Microcirculation ,Retrospective cohort study ,Dermatology ,Middle Aged ,Skin Diseases, Vascular ,medicine.disease ,Radiography ,Small vessel vasculitis ,Humans ,Medicine ,Female ,Radiology ,business ,Cutaneous small-vessel vasculitis ,Aged ,Retrospective Studies - Published
- 2021
7. Preclinical Studies Support Combined Inhibition of BET Family Proteins and Histone Deacetylases as Epigenetic Therapy for Cutaneous T-Cell Lymphoma
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Gary S. Wood, Lei Zhao, Youn H. Kim, E. Hong, and Jean-Phillip Okhovat
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0301 basic medicine ,Cancer Research ,business.industry ,Cutaneous T-cell lymphoma ,medicine.disease ,Malignancy ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,lcsh:RC254-282 ,3. Good health ,Bromodomain ,Romidepsin ,Lymphoma ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,hemic and lymphatic diseases ,030220 oncology & carcinogenesis ,medicine ,Cancer research ,business ,Vorinostat ,Epigenetic therapy ,Ex vivo ,medicine.drug - Abstract
Advanced-stage cutaneous T-cell lymphoma (CTCL) is usually a fatal malignancy despite optimal use of currently available treatments. In this preclinical study of novel CTCL therapy, we performed in vitro and ex vivo experiments to determine the efficacy of combination treatment with a panel of BET bromodomain inhibitors (BETi) (JQ1, OTX015, CPI-0610, I-BET762) and HDAC inhibitors (HDACi) (SAHA/Vorinostat, Romidepsin). BETi/HDACi combinations were synergistic (combination index
- Published
- 2019
8. Photodynamic therapy for Bowen’s Disease (squamous cell carcinoma in situ) current review and update
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Katie A O'Connell, Jean-Phillip Okhovat, and Nathalie C. Zeitouni
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0301 basic medicine ,030103 biophysics ,medicine.medical_specialty ,Skin Neoplasms ,medicine.medical_treatment ,Biophysics ,Antineoplastic Agents ,Bowen's Disease ,Cryotherapy ,Photodynamic therapy ,Dermatology ,Disease ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Pharmacology (medical) ,Basal cell ,In patient ,Adverse effect ,Bowen's disease ,Photosensitizing Agents ,business.industry ,medicine.disease ,Photochemotherapy ,Oncology ,Patient Satisfaction ,Neoplasm Recurrence, Local ,business - Abstract
The aim of this review is to provide clinicians with an overview of outcomes in the current literature concerning the use of Photodynamic Therapy to treat Bowen's Disease, also known as Squamous Cell Carcinoma in situ. The review discusses clinical response, recurrence rates, cosmetic outcomes, and adverse effects. Strong evidence shows that PDT is an effective therapy for SCCis with acceptable clinical response rates and lower recurrence rates in comparison to conventional therapies such as cryotherapy and 5-fluorouracil. Furthermore, PDT is associated with superior cosmetic outcomes and is generally well tolerated by patients, with minimal side effects. PDT is especially useful in patients with multiple lesions and those whom are considered to be non-surgical candidates.
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- 2018
9. Comparison of the safety and efficacy of daylight photodynamic therapy and conventional photodynamic therapy for actinic keratoses: A systematic review demonstrating noninferiority
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Peter R. Shumaker, Jean-Phillip Okhovat, and Kachiu C. Lee
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medicine.medical_specialty ,Photosensitizing Agents ,business.industry ,medicine.medical_treatment ,Actinic keratosis ,Photodynamic therapy ,Dermatology ,Actinic keratoses ,Aminolevulinic Acid ,medicine.disease ,Keratosis, Actinic ,Non inferiority ,Treatment Outcome ,Photochemotherapy ,Medicine ,Humans ,Daylight ,business - Published
- 2021
10. Diagnosing disseminated Mycobacterium haemophilum: the importance of 16S rRNA PCR
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Marcia S. Driscoll, Madison S. Hill, and Jean-Phillip Okhovat
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Mycobacterium Infections ,biology ,business.industry ,RNA ,Dermatology ,Ribosomal RNA ,16S ribosomal RNA ,biology.organism_classification ,Polymerase Chain Reaction ,Mycobacterium haemophilum ,Microbiology ,law.invention ,law ,RNA, Ribosomal, 16S ,Medicine ,Humans ,business ,Polymerase chain reaction - Published
- 2021
11. Educational brochure impact on postscreening practices of American Academy of Dermatology skin cancer screening participants
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Alan C. Geller, Jean-Phillip Okhovat, Elena B. Hawryluk, and Jessica A. Davine
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medicine.medical_specialty ,Skin Neoplasms ,business.industry ,MEDLINE ,Dermatology ,United States ,Family medicine ,Cancer screening ,medicine ,Humans ,Pamphlets ,DERMATOLOGY/SKIN ,Brochure ,business ,Melanoma ,Early Detection of Cancer - Published
- 2020
12. Innovation interest within dermatology: a needs assessment for novel thought processes
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Kachiu C, Lee, Ivy, Lee, Jean-Phillip, Okhovat, Justin, Ko, Jennifer Gloeckner, Powers, Darrel L, Ellis, Justin, Cheeley, and Lilit, Garibyan
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Cross-Sectional Studies ,Faculty, Medical ,Students, Medical ,Inventions ,Surveys and Questionnaires ,Biomedical Technology ,Humans ,Internship and Residency ,Dermatology ,Needs Assessment ,Research Personnel ,Dermatologists - Abstract
Medical innovation is crucial to advancing our field, and physicians have the potential to play a leading role due to their daily patient care experiences. The objective of this study was to evaluate the interest in, and barriers to participating in innovation. Two surveys were conducted; the first cross-sectional survey was conducted among attendees of the Advancing Innovation in Dermatology Forum in Feburary 2019. The second survey was conducted among trainees (resident/fellows) and faculty dermatologists at Brown, Emory, Iowa, Stanford, and Vanderbilt Universities between June and November 2019. Demographic data were collected, as well as factors involved with identifying problems, developing solutions, training in innovation, and perceived barriers to innovation. In the first survey, the greatest perceived benefits include bringing joy to one's work and increasing professional fulfillment with work. Innovation was also perceived to decrease burnout. In the second survey of academic centers, faculty more commonly expressed interest in identifying problems (p = 0.04), and was also more confident in their ability to generate solutions to these problems as compared to trainees (p 0.01). Major barriers to participating in innovation processes included lack of time and lack of training or education in innovation. Both trainees and faculty groups noted a lack of knowledge in creating prototypes, understanding regulatory approval for medical products, and inexperience with pitching to investors or obtaining funding. These cross-sectional needs assessment surveys found a strong interest in innovation coupled with a lack of education in innovation processes. These findings suggest an urgent need and opportunity for providing formal training to empower dermatologists with the tools to lead innovation within our field.
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- 2020
13. A geographically based cross-sectional analysis of SPOT me skin cancer screening data
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Allan C. Halpern, Alan C. Geller, Jean-Phillip Okhovat, Missy Lundberg, Dominique S. Michaud, Hensin Tsao, and Derek Beaulieu
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Adult ,Male ,medicine.medical_specialty ,Skin Neoplasms ,Adolescent ,Cross-sectional study ,MEDLINE ,Dermatology ,Article ,Young Adult ,Risk Factors ,Medicine ,Humans ,Mass Screening ,Early Detection of Cancer ,Societies, Medical ,Aged ,Health Services Needs and Demand ,Medically Uninsured ,Skin cancer screening ,Geography ,business.industry ,Middle Aged ,United States ,Cross-Sectional Studies ,Socioeconomic Factors ,Female ,business - Published
- 2020
14. Medical Treatments for Androgenetic Alopecia
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Dustin H. Marks, Maryanne M. Senna, and Jean-Phillip Okhovat
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medicine.medical_specialty ,business.industry ,medicine.disease ,Dutasteride ,Dermatology ,Flutamide ,chemistry.chemical_compound ,Hair loss ,chemistry ,Minoxidil ,medicine ,Finasteride ,Ketoconazole ,Dosing ,Adverse effect ,business ,medicine.drug - Abstract
Androgenetic alopecia (AGA) remains the most common etiology of hair loss as it affects up to 50% of men and women over the age of 40 years. Despite its prevalence, the FDA has currently approved only three medical treatments for AGA, including topical minoxidil, oral finasteride, and most recently, low-level laser therapy (LLLT). Although supported by less robust studies, other evidenced-based, off-label treatments available in the United States include oral dutasteride, oral flutamide, oral spironolactone, oral minoxidil, topical ketoconazole, and topical latanoprost. This chapter subsequently discusses the mechanism of action, indication, efficacy, adverse events profile, dosing, administration, and other considerations for both FDA and non-FDA-approved medical treatments for AGA.
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- 2020
15. Skin cancer interventions across the cancer control continuum: Review of technology, environment, and theory
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Alan C. Geller, Jean-Phillip Okhovat, Laura A. Dwyer, Jennifer M. Taber, Anne M. Hartman, Frank M. Perna, and Barbra A. Dickerman
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Gerontology ,Technology ,Skin Neoplasms ,Ultraviolet Rays ,Epidemiology ,Health Behavior ,Psychological intervention ,Social Theory ,Article ,03 medical and health sciences ,0302 clinical medicine ,Intervention (counseling) ,Survivorship curve ,Humans ,Medicine ,Health belief model ,030212 general & internal medicine ,Built Environment ,030505 public health ,business.industry ,Public Health, Environmental and Occupational Health ,Theory of planned behavior ,Cancer ,medicine.disease ,Skin cancer ,0305 other medical science ,business ,Social cognitive theory - Abstract
The National Cancer Institute's Skin Cancer Intervention across the Cancer Control Continuum model was developed to summarize research and identify gaps concerning skin cancer interventions. We conducted a mapping review to characterize whether behavioral interventions addressing skin cancer prevention and control from 2000 to 2015 included (1) technology, (2) environmental manipulations (policy and/or built environment), and (3) a theoretical basis. We included 86 studies with a randomized controlled or quasi-experimental design that targeted behavioral intervention in skin cancer for children and/or adults; seven of these were dissemination or implementation studies. Of the interventions described in the remaining 79 articles, 57 promoted only prevention behaviors (e.g., ultraviolet radiation protection), five promoted only detection (e.g., skin examinations), 10 promoted both prevention and detection, and seven focused on survivorship. Of the 79 non-dissemination studies, two-thirds used some type of technology (n=52; 65.8%). Technology specific to skin cancer was infrequently used: UVR photography was used in 15.2% of studies (n=12), reflectance spectroscopy was used in 12.7% (n=10), and dermatoscopes (n=1) and dosimeters (n=2) were each used in less than 3%. Ten studies (12.7%) targeted the built environment. Fifty-two (65.8%) of the studies included theory-based interventions. The most common theories were Social Cognitive Theory (n=20; 25.3%), Health Belief Model (n=17; 21.5%), and the Theory of Planned Behavior/Reasoned Action (n=12; 15.2%). Results suggest that skin cancer specific technology and environmental manipulations are underutilized in skin cancer behavioral interventions. We discuss implications of these results for researchers developing skin cancer behavioral interventions.
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- 2018
16. Ivermectin versus permethrin in the treatment of scabies: A systematic review and meta-analysis of randomized controlled trials
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Jean-Phillip Okhovat, Ashar Dhana, Nonhlanhla P. Khumalo, NaNa Keum, Hsi Yen, and Eunyoung Cho
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medicine.medical_specialty ,business.industry ,MEDLINE ,Dermatology ,medicine.disease ,law.invention ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Ivermectin ,Randomized controlled trial ,law ,Internal medicine ,Meta-analysis ,medicine ,Scabies ,030212 general & internal medicine ,business ,medicine.drug ,Permethrin - Published
- 2018
17. Willingness to Pay and QOL in Alopecia Areata
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Lewei Duan, Tristan Grogan, Jean-Phillip Okhovat, and Carolyn Goh
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medicine.medical_specialty ,business.industry ,Extramural ,MEDLINE ,Cell Biology ,Dermatology ,General Medicine ,Alopecia areata ,medicine.disease ,Willingness to pay ,Family medicine ,Medicine ,business ,Molecular Biology ,Biotechnology - Published
- 2020
18. Number needed to screen (NNS) for presumptive screening diagnoses among first-time SPOTme screening participants (1992–2010)
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Derek Beaulieu, Dominique S. Michaud, Jean-Phillip Okhovat, Alan C. Geller, Hensin Tsao, and Allan C. Halpern
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Male ,medicine.medical_specialty ,Skin Neoplasms ,business.industry ,Dermatology ,Middle Aged ,Number needed to screen ,Article ,Neoplasms, Multiple Primary ,Text mining ,Sex Factors ,Carcinoma, Basal Cell ,Family medicine ,Carcinoma, Squamous Cell ,Medicine ,Humans ,Female ,Medical diagnosis ,business ,Melanoma ,Early Detection of Cancer - Published
- 2019
19. Association of cicatricial alopecia with chemical hair straightening
- Author
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Maryanne M. Senna, Dustin H. Marks, Athena Manatis-Lornell, Amy J. McMichael, Dina Hagigeorges, and Jean-Phillip Okhovat
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Adult ,Aged, 80 and over ,Male ,medicine.medical_specialty ,business.industry ,Association (object-oriented programming) ,Hair Preparations ,Alopecia ,Dermatology ,Middle Aged ,Cicatrix ,Young Adult ,Case-Control Studies ,medicine ,Humans ,Female ,Hair straightening ,business ,Aged ,Retrospective Studies - Published
- 2019
20. Impact of skin biopsy on the management of acute graft‐versus‐host disease in a pediatric population
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Jennifer T. Huang, Jean-Phillip Okhovat, Hannah Song, Keith W. Morley, Birgitta Schmidt, and Hilary Haimes
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Male ,medicine.medical_specialty ,Adolescent ,Databases, Factual ,medicine.medical_treatment ,Graft vs Host Disease ,Dermatology ,Disease ,Hematopoietic stem cell transplantation ,Pediatrics ,Risk Assessment ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,immune system diseases ,Biopsy ,Humans ,Medicine ,Medical diagnosis ,Child ,Retrospective Studies ,Skin ,medicine.diagnostic_test ,business.industry ,Biopsy, Needle ,Age Factors ,Hematopoietic Stem Cell Transplantation ,Disease Management ,Prognosis ,Immunohistochemistry ,surgical procedures, operative ,Child, Preschool ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,Skin biopsy ,Female ,Histopathology ,Dermatopathology ,business ,Complication ,Follow-Up Studies - Abstract
BACKGROUND/OBJECTIVES Acute graft-versus-host disease (GVHD) of the skin is a common complication of hematopoietic stem cell transplantation (HSCT) but often represents a diagnostic challenge. The adult literature suggests that histopathology rarely dictates management decisions, but the clinical utility of skin biopsies in pediatric patients with suspected acute GVHD is unknown. The objective of this study was to determine the frequency with which skin biopsy leads to a definitive diagnosis of acute GVHD and changes the management of acute GVHD in the pediatric population. METHODS We conducted a retrospective analysis of histopathology results and the associated impact on clinical management based on chart review of pediatric patients who underwent skin biopsy for cutaneous eruptions suspicious for acute GVHD from 1995 to 2016. RESULTS Among 27 pediatric HSCT patients, skin biopsy yielded definitive diagnoses (GVHD or otherwise) in only 15% (4/27) of cases. Overall, dermatology consultation was associated with clinical management changes in 78% (21/27) of cases. A change in management was definitively based on skin biopsy results in only 7.4% (2/27) of cases. The mean duration of time between dermatology consultation and return of biopsy results was 4.8 days (range 1-17). CONCLUSIONS Our results suggest that skin biopsy of pediatric HSCT patients with findings concerning for acute skin GVHD rarely yields a definitive diagnosis or change in management.
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- 2019
21. Gender-related cost discrepancies in a cohort of 110 facial moisturizers
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Dustin H. Marks, Maryanne M. Senna, Dina Hagigeorges, Jean-Phillip Okhovat, and Athena Manatis-Lornell
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Marketing ,medicine.medical_specialty ,business.industry ,media_common.quotation_subject ,Significant difference ,Sexism ,Skin Cream ,Hypoallergenic ,Dermatology ,Fluid ounce (US) ,Gender related ,medicine.disease ,Cosmetics ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Hair loss ,030220 oncology & carcinogenesis ,Face ,Cohort ,Medicine ,business ,media_common ,Topical minoxidil - Abstract
Background Gender-related price inequalities for over-the-counter dermatologic products such as shampoos and conditioners, razors, deodorants, and lotions remain prevalent in the marketplace. This trend has also been found to apply to topical minoxidil, a common treatment for male and female pattern hair loss. Objective We sought to identify the gender-related price discrepancies of facial moisturizers, which are routinely recommended by dermatologists. Methods Three online retailers (Amazon, Target, and Walmart) were surveyed for available facial moisturizers in October 2018. Facial moisturizers were classified as men's, women's, or gender-neutral based on three specific marketing variables: language, container color/graphics, and container curvature/shape. Results In total, 110 facial moisturizers were included in this analysis. Of the 54 facial moisturizers evaluated for men, 47 (87%) contained the word "men" within the marketing language, while only three of 56 (5.4%) facial moisturizers targeted at women were explicitly labeled "for women." No statistically significant difference was found between the number of facial moisturizers listed as fragrance-free, SPF-containing, anti-aging, or those labeled as sensitive, hypoallergenic, or dermatologist recommended between the two groups. However, facial moisturizers marketed to women were on average $3.09 more per ounce than those marketed to men. A two-tailed t test revealed a statistically significant difference between the price per ounce of facial moisturizers for men ($6.20) and those for women ($9.29) (P = 0.013). Conclusion Facial moisturizers marketed to women were found to be significantly more expensive than comparable facial moisturizers marketed to men.
- Published
- 2019
22. The effect of scalp cooling on CIA-related quality of life in breast cancer patients: a systematic review
- Author
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Dina Hagigeorges, Maryanne M. Senna, Jean-Phillip Okhovat, Athena Manatis-Lornell, Dustin H. Marks, Steven J. Isakoff, and Mario E. Lacouture
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0301 basic medicine ,Bridged-Ring Compounds ,Cancer Research ,medicine.medical_specialty ,Breast Neoplasms ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Quality of life ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,Adverse effect ,Scalp ,integumentary system ,business.industry ,Alopecia ,Induction Chemotherapy ,medicine.disease ,Chemotherapy regimen ,humanities ,030104 developmental biology ,Hair loss ,Oncology ,Hair disease ,Cryotherapy ,030220 oncology & carcinogenesis ,Quality of Life ,Female ,Taxoids ,business ,Cohort study - Abstract
Chemotherapy-induced alopecia (CIA) remains a distressing adverse event of cancer treatment but may be prevented by scalp cooling. The effectiveness of scalp cooling, however, is dependent on the chemotherapy regimen with successful hair preservation (i.e.
- Published
- 2019
23. A pink enlarging plaque on the plantar foot: amelanotic acral lentiginous melanoma
- Author
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Jean-Phillip, Okhovat, Steven R, Tahan, and Caroline C, Kim
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Foot Diseases ,Male ,Antineoplastic Agents, Immunological ,Nivolumab ,Skin Neoplasms ,Dermatologic Surgical Procedures ,Humans ,Immunologic Factors ,Interferon-alpha ,Melanoma, Amelanotic ,Middle Aged ,Neoplasm Recurrence, Local - Abstract
Acral lentiginous melanomas account for less than 5% of all melanomas, whereas amelanotic melanomas account for around 2-8% of all melanomas. Amelanotic acral lentiginous melanomas are even less common and can often be mistaken for other clinical entities, including pyogenic granulomas, non-melanoma skin cancers, and warts. We describe a man in his 50s with a twenty-year history of a skin-colored plaque on the right plantar foot; after enlargement and failure of wart treatment, a shave biopsy revealed an amelanotic melanoma. A subsequent wide local excision and sentinel lymph node biopsy revealed melanoma in 4 lymph nodes and the patient underwent an abbreviated course of interferon-alpha therapy. The patient remained stable until 2 ? years after diagnosis, at which time he presented with in-transit metastases on the foot and right thigh; he has since been stable on nivolumab. This case represents the challenge of diagnosing amelanotic melanomas on acral surfaces and highlights the importance of considering a skin biopsy for diagnosis of any changing, atypical amelanotic lesions on the feet or hands.
- Published
- 2019
24. Evaluation of preoperative quality of life in patients with nonmelanoma skin cancer
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Robert J. Besaw, Chrysalyne D. Schmults, Frederick C. Morgan, Pritesh S. Karia, Jean-Phillip Okhovat, and Ariana N. Mora
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Adult ,Aged, 80 and over ,Male ,medicine.medical_specialty ,Skin Neoplasms ,business.industry ,MEDLINE ,Dermatology ,Middle Aged ,medicine.disease ,Article ,Young Adult ,Quality of life (healthcare) ,Internal medicine ,Preoperative Period ,Quality of Life ,Medicine ,Humans ,In patient ,Female ,Skin cancer ,Young adult ,business ,Aged - Published
- 2019
25. Comorbidities in patients with lichen planopilaris: A retrospective case-control study
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Dustin H. Marks, Athena Manatis-Lornell, Maryanne M. Senna, Jean-Phillip Okhovat, and Dina Hagigeorges
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Male ,medicine.medical_specialty ,business.industry ,Case-control study ,MEDLINE ,Lichen Planus ,Retrospective cohort study ,Dermatology ,Middle Aged ,Lichen planopilaris ,Case-Control Studies ,medicine ,Humans ,In patient ,Female ,business ,Aged ,Retrospective Studies - Published
- 2019
26. A pink enlarging plaque on the plantar foot: amelanotic acral lentiginous melanoma
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Steven R. Tahan, Jean-Phillip Okhovat, and Caroline C. Kim
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medicine.medical_specialty ,medicine.diagnostic_test ,integumentary system ,business.industry ,Melanoma ,Wide local excision ,medicine.medical_treatment ,Sentinel lymph node ,Dermatology ,General Medicine ,medicine.disease ,Acral lentiginous melanoma ,Skin biopsy ,Biopsy ,medicine ,amelanotic, melanoma, acral lentiginous melanoma ,Amelanotic melanoma ,business ,Shave biopsy ,neoplasms - Abstract
Acral lentiginous melanomas account for less than 5% of all melanomas, whereas amelanotic melanomas account for around 2-8% of all melanomas. Amelanotic acral lentiginous melanomas are even less common and can often be mistaken for other clinical entities, including pyogenic granulomas, non-melanoma skin cancers, and warts. We describe a man in his 50s with a twenty-year history of a skin-colored plaque on the right plantar foot; after enlargement and failure of wart treatment, a shave biopsy revealed an amelanotic melanoma. A subsequent wide local excision and sentinel lymph node biopsy revealed melanoma in 4 lymph nodes and the patient underwent an abbreviated course of interferon-alpha therapy. The patient remained stable until 2 ? years after diagnosis, at which time he presented with in-transit metastases on the foot and right thigh; he has since been stable on nivolumab. This case represents the challenge of diagnosing amelanotic melanomas on acral surfaces and highlights the importance of considering a skin biopsy for diagnosis of any changing, atypical amelanotic lesions on the feet or hands.
- Published
- 2019
27. Factors associated with suspected nonmelanoma skin cancers, dysplastic nevus, and cutaneous melanoma among first-time SPOTme screening program participants (2009-2010)
- Author
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Allan C. Halpern, Derek Beaulieu, Alan C. Geller, Hensin Tsao, Jean-Phillip Okhovat, and Dominique S. Michaud
- Subjects
medicine.medical_specialty ,business.industry ,Melanoma ,Dermatology ,medicine.disease ,Logistic regression ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Cutaneous melanoma ,medicine ,Dysplastic nevus ,Basal cell carcinoma ,Risk factor ,Skin cancer ,Medical diagnosis ,skin and connective tissue diseases ,business - Abstract
Background There have been no studies of the American Academy of Dermatology's SPOTme skin cancer screening program that have collectively analyzed the factors associated with suspected diagnoses of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), dysplastic nevus (DN), and cutaneous melanoma (CM). Objective Describe the demographics, risk factors, and access to care profile associated with suspected diagnoses of BCC, SCC, DN, and CM among first-time SPOTme screenees from 2009 to 2010. Methods We conducted a cross-sectional analysis of data from SPOTme skin cancer screenings conducted in 2009 and 2010. We performed multivariable logistic regression analysis for each diagnosis, incorporating traditional demographic, access to care, and risk factor variables in the models. Results Men, those without a regular dermatologist, persons reporting recently changing moles, and those with a personal history of melanoma were at increased risk for each of the suspected diagnoses analyzed. The uninsured were at increased risk for the suspected malignancies (BCC, SCC, and CM). Limitations Lack of histological confirmation for diagnoses; cross-sectional design. Conclusion Among first-time SPOTme participants, suspected diagnoses of BCC, SCC, DN, and CM shared several associated factors which may be considered when planning outreach and screening for populations at risk for skin cancer.
- Published
- 2018
28. A review of itch
- Author
-
Samuel J. Balin and Jean-Phillip Okhovat
- Subjects
medicine.medical_specialty ,business.industry ,Interpretation (philosophy) ,parasitic diseases ,otorhinolaryngologic diseases ,Medicine ,Treatment options ,Dermatology ,skin and connective tissue diseases ,business ,Intensive care medicine ,eye diseases - Abstract
Itch can be one of the most difficult complaints for physicians to treat. The cause of itch, especially if chronic, is often elusive. A body of research has emerged that has shed light on many of the mechanisms governing this common complaint. These mechanisms include the detection of pruritogens (p
- Published
- 2015
29. Clinicopathologic, misdiagnosis, and survival differences between clinically amelanotic melanomas and pigmented melanomas
- Author
-
Sandra J. Lee, Kathleen Zhu, Jean-Phillip Okhovat, Caroline C. Kim, Lauren C. Strazzulla, and Xiaoxue Li
- Subjects
Adult ,Male ,medicine.medical_specialty ,Skin Neoplasms ,Adolescent ,Dermatology ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Biopsy ,Skin Ulcer ,Mitotic Index ,Medicine ,Nevus ,Humans ,Family history ,Diagnostic Errors ,Hair Color ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Melanoma ,Age Factors ,Retrospective cohort study ,Melanoma, Amelanotic ,Neoplasms, Second Primary ,Odds ratio ,Middle Aged ,medicine.disease ,Tumor Burden ,Survival Rate ,Cross-Sectional Studies ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Dysplastic nevus ,Female ,Skin cancer ,business - Abstract
Background Amelanotic malignant melanoma (AMM) is challenging to diagnose. Clinical risk factors for AMM are not well defined. Objective To investigate clinicopathologic, misdiagnosis, and survival differences between patients with AMM and those with pigmented malignant melanoma (PMM). Methods A cross-sectional retrospective medical record review at a tertiary academic medical center. Results A total of 933 patients with melanoma with known presenting tumor color were identified (342 with AMM vs 591 with PMM). AMM was associated with older age, history of nonmelanoma skin cancer, and red hair, whereas AMM was inversely associated with a family history of melanoma, more than 50 nevi, and a history of dysplastic nevi. Compared with PMM, AMM was more likely to be located on the head and/or neck, had more aggressive pathologic features (greater Breslow depth and/or mitoses, ulceration, nodular subtype), and was less likely to be associated with a precursor nevus or regression. Finally, patients with AMM were more likely to be misdiagnosed than were patients with PMM (25% vs 12% clinically and 12% vs 7% pathologically), and they had poorer melanoma-specific survival (5-year overall survival rate, 0.77 [95% confidence interval, 0.72-0.82] vs 0.84 [95% confidence interval, 0.80-0.87]). Limitations Retrospective study design, single-institutional study. Conclusion Greater clinician awareness, lower biopsy thresholds, and increased patient education may be useful to enhance AMM detection in patients with certain characteristics.
- Published
- 2017
30. The first 30 years of the American Academy of Dermatology skin cancer screening program: 1985-2014
- Author
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Jean-Phillip Okhovat, Derek Beaulieu, Hensin Tsao, Allan C. Halpern, Dominique S. Michaud, Shimon Shaykevich, and Alan C. Geller
- Subjects
Adult ,Male ,medicine.medical_specialty ,Skin Neoplasms ,Time Factors ,Adolescent ,Dermatology ,Article ,Health Services Accessibility ,Cohort Studies ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Cancer screening ,Medicine ,Humans ,Mass Screening ,030212 general & internal medicine ,DERMATOLOGY/SKIN ,Registries ,Program Development ,Melanoma ,Early Detection of Cancer ,Societies, Medical ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Middle Aged ,United States ,Carcinoma, Basal Cell ,030220 oncology & carcinogenesis ,Carcinoma, Squamous Cell ,Female ,business ,Program Evaluation - Abstract
BACKGROUND: The incidence of melanoma is rising faster than that of any other preventable cancer in the United States. The American Academy of Dermatology has sponsored free skin cancer education and screenings conducted by volunteer dermatologists in the United States since 1985. OBJECTIVE: We aimed to assess the American Academy of Dermatology’s national skin cancer screening program from 1986 to 2014 by analyzing the risk factor profile, access to dermatologic services, and examination results. METHODS: We conducted several detailed statistical analyses of the screening population. RESULTS: From 1986 to 2014, records were available for 2,046,531 screenings, 1,963,141 (96%) of which were subjected to detailed analysis. Men comprised 38% of all participants. The number of annual screenings reached approximately 100,000 in 1990 and remained relatively stable thereafter. From 1991 to 2014 (data for 1995, 1996 and 2000 were unavailable), clinical diagnoses were rendered for 20,628 melanomas, 156,087 dysplastic nevi, 32,893 squamous cell carcinomas, and 129,848 basal cell carcinomas. Only 21% of screenees had a regular dermatologist. Those with a clinical diagnosis of skin cancer were more likely than the general screening population to be uninsured. LIMITATIONS: Inability to verify clinical diagnoses histopathologically. CONCLUSION: Our findings suggest that the SPOTme program has detected thousands of skin cancers that may have gone undetected or experienced a delay in detection.
- Published
- 2017
31. Alcohol intake and risk of nonmelanoma skin cancer: a systematic review and dose-response meta-analysis
- Author
-
Ashar Dhana, Abrar A. Qureshi, Jean-Phillip Okhovat, Hsi Yen, Eunyoung Cho, and NaNa Keum
- Subjects
Oncology ,Male ,medicine.medical_specialty ,Skin Neoplasms ,Alcohol Drinking ,Dermatology ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Basal cell carcinoma ,Dose-Response Relationship, Drug ,business.industry ,Public health ,Confounding ,medicine.disease ,Confidence interval ,Surgery ,Carcinoma, Basal Cell ,030220 oncology & carcinogenesis ,Meta-analysis ,Relative risk ,Carcinoma, Squamous Cell ,Female ,Skin cancer ,business ,Cohort study - Abstract
Nonmelanoma skin cancer (NMSC) comprises mainly basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). The association between alcohol intake and NMSC has been inconclusive; therefore the objective of this study is to quantify the relationship between alcohol intake and NMSC using meta-analyses. A systematic literature search of PubMed and Embase was performed on 30 October 2016. Eligible articles were case-control or cohort studies that examined alcohol intake and risk of BCC or cSCC and reported relative risks (RRs) with 95% confidence intervals (CIs). Of the 307 articles identified, 13 case-control and cohort studies were included in the systematic review, including 95 241 NMSC cases (91 942 BCC and 3299 cSCC cases). A random-effects model was used to obtain summary RRs and 95% CIs for dose-response meta-analyses. For every 10-gram increase in ethanol intake per day, a positive association was found for both BCC (summary RR of 1·07; 95% CI 1·04-1·09) and cSCC (summary RR of 1·11; 95% CI 1·06-1·16). While there was evidence suggesting a nonlinear association for BCC, it may be due to the sparse data at higher alcohol intake levels. This meta-analysis found evidence that alcohol drinking is positively associated with both BCC and cSCC risk in a dose-dependent manner. These results should be interpreted with caution due to potential residual confounding. Nonetheless, because alcohol drinking is a prevalent and modifiable behaviour, it could serve as an important public health target to reduce the global health burden of NMSC.
- Published
- 2017
32. Antimicrobial Peptides
- Author
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Andrew J. Park, Jean-Phillip Okhovat, and Jenny Kim
- Subjects
0301 basic medicine ,030207 dermatology & venereal diseases ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine - Published
- 2017
33. Lipedema
- Author
-
Afsaneh Alavi and Jean-Phillip Okhovat
- Subjects
medicine.medical_specialty ,business.industry ,Lipedema ,MEDLINE ,General Medicine ,Fat distribution ,Controlled studies ,Global Health ,Prognosis ,medicine.disease ,Diagnosis, Differential ,Lymphedema ,Lipectomy ,Epidemiology ,Physical therapy ,Humans ,Medicine ,Proper treatment ,Female ,Surgery ,Morbidity ,Differential diagnosis ,business ,Intensive care medicine - Abstract
Lipedema is a disorder of adipose tissue that primarily affects females and is often misdiagnosed as obesity or lymphedema. Relatively few studies have defined the precise pathogenesis, epidemiology, and management strategies for this disorder, yet the need to successfully identify this disorder as a unique entity has important implications for proper treatment. In this review, we sought to review and identify information in the existing literature with respect to the epidemiology, pathogenesis, clinical presentation, differential diagnosis, and management strategies for lipedema. The current literature suggests that lipedema appears to be a clinical entity thought to be related to both genetic factors and fat distribution. While distinct from lymphedema and obesity, there are some existing treatments such as complex decongestive physiotherapy, liposuction, and laser-assisted lipolysis. Management of lipedema is complex and distinct from lymphedema. The role of newer randomized controlled studies to further explore the management of this clinical entity remains promising.
- Published
- 2014
34. Updates in Rosacea: Epidemiology, Risk Factors, and Management Strategies
- Author
-
April W. Armstrong and Jean-Phillip Okhovat
- Subjects
medicine.medical_specialty ,business.industry ,Inflammatory skin disease ,Rhinophyma ,Dermatology ,medicine.disease ,Systemic therapy ,Papulopustular ,Rosacea ,Novel agents ,Epidemiology ,medicine ,medicine.symptom ,business ,Intensive care medicine ,Psychosocial - Abstract
Rosacea is a chronic, inflammatory skin disease that affects more than 15 million people in the United States. It is associated with significant psychosocial, physical, and economic burden. The pathogenesis of rosacea is poorly understood. Initial events include dysregulation in cutaneous neurovascular control and neuroimmune communication. Exacerbating factors may include UV light and infectious agents. Recent therapeutic advances have increased treatment options. Such therapies include avoidance of potential triggers, topical therapies, and systemic therapies. Treatment is targeted at reducing facial erythema and eliminating inciting agents that may contribute to the disease process. The tetracycline class of antibiotics has been most extensively studied for systemic therapy. Novel agents such as α-2 agonists have increased therapeutic options in rosacea.
- Published
- 2014
35. Rotterdam criteria-based diagnostic subtype is not a strong predictor of cutaneous phenotype in patients with polycystic ovary syndrome: A cross-sectional study
- Author
-
Lauri A. Pasch, Keshav Khanijow, Jean-Phillip Okhovat, Julie Lee, Timothy H. Schmidt, Heather G. Huddleston, Marcelle I. Cedars, Kanade Shinkai, and Erica T. Wang
- Subjects
Adult ,medicine.medical_specialty ,Pathology ,Hirsutism ,Cross-sectional study ,MEDLINE ,Dermatology ,Skin Diseases ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Acne Vulgaris ,Medicine ,Humans ,In patient ,Acanthosis Nigricans ,Obesity ,030219 obstetrics & reproductive medicine ,business.industry ,Alopecia ,Phenotype ,Polycystic ovary ,Cross-Sectional Studies ,Female ,business ,Hyperandrogenism ,Polycystic Ovary Syndrome - Published
- 2016
36. The Utility of Text Message Reminders for Acne Patients: A Pilot Study
- Author
-
Jean-Phillip Okhovat, Jenny Kim, Francesca Tenconi, and Christina N. Kim
- Subjects
medicine.medical_specialty ,Time Factors ,Reminder Systems ,MEDLINE ,Alternative medicine ,Pilot Projects ,Dermatology ,Text message ,Medication Adherence ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,Pharmacotherapy ,Phone ,Acne Vulgaris ,medicine ,Humans ,030212 general & internal medicine ,Acne ,Text Messaging ,business.industry ,Small sample ,General Medicine ,medicine.disease ,Patient Satisfaction ,Physical therapy ,Dermatologic Agents ,business ,Cell Phone ,Follow-Up Studies - Abstract
Acne vulgaris is one of the three most common cutaneous disorders, affecting approximately 50 million people in the US and many more throughout the world. We designed a pilot program to explore how patients may interact with cell phone technology to supplement medical care beyond patient reminders that would encompass education, interaction, and data capturing. Twenty-four patients completed a 3-month study in which participants received daily text message reminders for the first 2 weeks of the study, then once weekly thereafter, to take their oral medication or apply topical therapy either once or twice daily. Over a 3-month time period, patients become less responsive to text message reminders over time. Our survey data demonstrated a very high satisfaction with the program, helping patients follow their acne treatment recommendations (mean score 4.31 out of 5) and results demonstrated the mobile application device was easy to use (mean score 4.56 out of 5). Small sample size of the patient population. Patients find this approach acceptable and helpful, and it is a viable method for counseling patients. Based on our results, for future randomized controlled studies, we suggest maximizing messaging during the first month of therapy.
- Published
- 2016
37. Costs and Consequences Associated With Misdiagnosed Lower Extremity Cellulitis
- Author
-
Nicole Gunasekera, Cara Joyce, Jeffrey M. Cohen, Adam B. Raff, Priyanka Vedak, Jean-Phillip Okhovat, Arash Mostaghimi, Daniela Kroshinsky, and Qing Yu Weng
- Subjects
medicine.medical_specialty ,business.industry ,Patient characteristics ,Dermatology ,Emergency department ,medicine.disease ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Cellulitis ,Emergency medicine ,Health care ,medicine ,In patient ,030212 general & internal medicine ,Intensive care medicine ,Complication ,Medical Expenditure Panel Survey ,business ,Urban hospital - Abstract
Importance Inflammatory dermatoses of the lower extremity are often misdiagnosed as cellulitis (aka “pseudocellulitis”) and treated with antibiotics and/or hospitalization. There is limited data on the cost and complications from misdiagnosed cellulitis. Objective To characterize the national health care burden of misdiagnosed cellulitis in patients admitted for treatment of lower extremity cellulitis. Design, Setting, and Participants Cross-sectional study using patients admitted from the emergency department (ED) of a large urban hospital with a diagnosis of lower extremity cellulitis between June 2010 and December 2012. Patients who were discharged with a diagnosis of cellulitis were categorized as having cellulitis, while those who were given an alternative diagnosis during the hospital course, on discharge, or within 30 days of discharge were considered to have pseudocellulitis. A literature review was conducted for calculation of large-scale costs and complication rates. We obtained national cost figures from the Medical Expenditure Panel Survey (MEPS), provided by the Agency for Healthcare Research and Quality (AHRQ) for 2010 to calculate the hospitalization costs per year attributed to misdiagnosed lower extremity pseudocellulitis. Exposures The exposed group was composed of patients who presented to and were admitted from the ED with a diagnosis of lower extremity cellulitis. Main Outcomes and Measures Patient characteristics, hospital course, and complications during and after hospitalization were reviewed for each patient, and estimates of annual costs of misdiagnosed cellulitis in the United States. Results Of 259 patients, 79 (30.5%) were misdiagnosed with cellulitis, and 52 of these misdiagnosed patients were admitted primarily for the treatment of cellulitis. Forty-four of the 52 (84.6%) did not require hospitalization based on ultimate diagnosis, and 48 (92.3%) received unnecessary antibiotics. We estimate cellulitis misdiagnosis leads to 50 000 to 130 000 unnecessary hospitalizations and $195 million to $515 million in avoidable health care spending. Unnecessary antibiotics and hospitalization for misdiagnosed cellulitis are projected to cause more than 9000 nosocomial infections, 1000 to 5000 Clostridium difficile infections, and 2 to 6 cases of anaphylaxis annually. Conclusions and Relevance Misdiagnosis of lower extremity cellulitis is common and may lead to unnecessary patient morbidity and considerable health care spending.
- Published
- 2016
38. 916 Gynecologic and hormonal comorbidities of scarring alopecia: A retrospective review
- Author
-
Maryanne M. Senna, Athena Manatis-Lornell, Dustin H. Marks, Dina Hagigeorges, and Jean-Phillip Okhovat
- Subjects
Retrospective review ,medicine.medical_specialty ,business.industry ,medicine ,Cell Biology ,Dermatology ,Scarring alopecia ,medicine.disease ,business ,Molecular Biology ,Biochemistry ,Hormone - Published
- 2019
39. 894 Comprehensive patch testing in 22 patients with lichen planopilaris
- Author
-
JiaDe Yu, Maryanne M. Senna, Athena Manatis-Lornell, Dustin H. Marks, Dina Hagigeorges, and Jean-Phillip Okhovat
- Subjects
medicine.medical_specialty ,business.industry ,Medicine ,Cell Biology ,Dermatology ,business ,Lichen planopilaris ,Molecular Biology ,Biochemistry ,Patch testing - Published
- 2019
40. Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network Consortium (PPACMAN) Survey: Benefits and Challenges of Combined Rheumatology-dermatology Clinics
- Author
-
Jose U. Scher, Joseph F. Merola, Alexis Ogdie, Cheryl F. Rosen, Jean-Phillip Okhovat, and Soumya M. Reddy
- Subjects
medicine.medical_specialty ,Immunology ,Alternative medicine ,Dermatology ,urologic and male genital diseases ,Ambulatory Care Facilities ,Severity of Illness Index ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Psoriatic arthritis ,0302 clinical medicine ,Rheumatology ,Internal medicine ,Psoriasis ,medicine ,Humans ,Immunology and Allergy ,skin and connective tissue diseases ,030203 arthritis & rheumatology ,business.industry ,Arthritis, Psoriatic ,medicine.disease ,Optimal management ,business - Abstract
Optimal management of patients with both psoriasis and psoriatic arthritis (PsA) necessitates collaboration among dermatologists and rheumatologists. In this manuscript, we discuss challenges and opportunities for dual care models for patients with psoriasis and PsA and the results of a survey of combined clinics based in North America.
- Published
- 2017
41. 880 Divergent trends in acne vulgaris interest and research a decade of lost face value in the United States
- Author
-
Andrew J. Park and Jean-Phillip Okhovat
- Subjects
History ,Face value ,medicine ,Cell Biology ,Dermatology ,medicine.disease ,Molecular Biology ,Biochemistry ,Acne ,Demography - Published
- 2018
42. 400 Preclinical studies support combined inhibition of BET family proteins and histone deacetylases as epigenetic therapy for cutaneous T-cell lymphoma
- Author
-
Gary S. Wood, E. Hong, Youn H. Kim, Jean-Phillip Okhovat, and Lei Zhao
- Subjects
biology ,business.industry ,Cutaneous T-cell lymphoma ,Cell Biology ,Dermatology ,medicine.disease ,Biochemistry ,Histone ,medicine ,biology.protein ,Cancer research ,business ,Molecular Biology ,Epigenetic therapy - Published
- 2018
43. Polycystic Ovary Syndrome: Special Diagnostic and Therapeutic Considerations for Children
- Author
-
Kanade Shinkai, Lauri A. Pasch, Marcelle I. Cedars, Timothy H. Schmidt, B S Abram Beshay, Heather Huddleston, B S Jean-Phillip Okhovat, and Faranak Kamangar
- Subjects
Infertility ,medicine.medical_specialty ,Pediatrics ,endocrine system diseases ,Adolescent ,Psychological intervention ,Dermatology ,Endocrine Syndrome ,Comorbidity ,Risk Assessment ,Severity of Illness Index ,Insulin resistance ,Intervention (counseling) ,medicine ,Humans ,Obesity ,Child ,Gynecology ,business.industry ,Endometrial cancer ,Age Factors ,Disease Management ,medicine.disease ,Prognosis ,Polycystic ovary ,Pediatrics, Perinatology and Child Health ,Female ,Insulin Resistance ,business ,Infertility, Female ,Polycystic Ovary Syndrome - Abstract
Polycystic ovary syndrome (PCOS) is an endocrine syndrome with variable phenotypic expression and important systemic associations and sequelae, including obesity, insulin resistance, infertility, risk of endometrial cancer, and possible risk of cardiovascular events. PCOS is recognized as a condition influenced by genetic and environmental factors and distinct manifestations in all stages of life, including the prenatal period, childhood, adolescence, and adulthood. Identification of this disorder in childhood and adolescence has received growing attention, in part because of emerging evidence of the benefit of early intervention, but the diagnosis and management of PCOS in children and adolescents can be challenging. Diagnostic and therapeutic considerations of PCOS in children are reviewed to enhance identification and evaluation of patients suspected of having this disorder. When a diagnosis of PCOS is suspected in a child but cannot be confirmed, a provisional diagnosis is strongly recommended so as to prompt ongoing monitoring with an emphasis on important early interventions such as obesity reduction.
- Published
- 2015
44. 228 The prevalence of eczema beyond childhood: A systematic review and meta-analysis of longitudinal studies
- Author
-
Ashley M. Yu, Sinead Langan, Jean-Phillip Okhovat, Katrina Abuabara, and Isabel E. Allen
- Subjects
030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,business.industry ,030220 oncology & carcinogenesis ,Meta-analysis ,Medicine ,Cell Biology ,Dermatology ,business ,Molecular Biology ,Biochemistry ,Clinical psychology - Published
- 2017
45. A predictive model for diagnosis of lower extremity cellulitis: A cross-sectional study
- Author
-
Nicole Gunasekera, Daniela Kroshinsky, Jean-Phillip Okhovat, Arash Mostaghimi, Jeffrey M. Cohen, Qing Yu Weng, Adam B. Raff, Priyanka Vedak, and Cara Joyce
- Subjects
Male ,Tachycardia ,medicine.medical_specialty ,Leukocytosis ,Cross-sectional study ,Bacteremia ,Dermatology ,Predictor variables ,Sensitivity and Specificity ,Severity of Illness Index ,Patient care ,Diagnosis, Differential ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,Heart rate ,medicine ,Humans ,030212 general & internal medicine ,Diagnostic Errors ,Aged ,Leg ,business.industry ,Age Factors ,Cellulitis ,Emergency department ,Middle Aged ,Models, Theoretical ,medicine.disease ,Surgery ,Cross-Sectional Studies ,Female ,Emergencies ,medicine.symptom ,business - Abstract
Background Cellulitis has many clinical mimickers (pseudocellulitis), which leads to frequent misdiagnosis. Objective To create a model for predicting the likelihood of lower extremity cellulitis. Methods A cross-sectional review was performed of all patients admitted with a diagnosis of lower extremity cellulitis through the emergency department at a large hospital between 2010 and 2012. Patients discharged with diagnosis of cellulitis were categorized as having cellulitis, while those given an alternative diagnosis were considered to have pseudocellulitis. Bivariate associations between predictor variables and final diagnosis were assessed to develop a 4-variable model. Results In total, 79 (30.5%) of 259 patients were misdiagnosed with lower extremity cellulitis. Of the variables associated with true cellulitis, the 4 in the final model were asymmetry (unilateral involvement), leukocytosis (white blood cell count ≥10,000/uL), tachycardia (heart rate ≥90 bpm), and age ≥70 years. We converted these variables into a points system to create the ALT-70 cellulitis score as follows: Asymmetry (3 points), Leukocytosis (1 point), Tachycardia (1 point), and age ≥70 (2 points). With this score, 0-2 points indicate ≥83.3% likelihood of pseudocellulitis, and ≥5 points indicate ≥82.2% likelihood of true cellulitis. Limitations Prospective validation of this model is needed before widespread clinical use. Conclusion Asymmetry, leukocytosis, tachycardia, and age ≥70 are predictive of lower extremity cellulitis. This model might facilitate more accurate diagnosis and improve patient care.
- Published
- 2017
46. Tissue voltage discordance during tachycardia versus sinus rhythm: implications for catheter ablation
- Author
-
Roderick Tung, Eric Buch, Kalyanam Shivkumar, Osamu Fujimura, Noel G. Boyle, Jason S. Bradfield, Jeffrey Gornbein, William A. Huang, Jean-Phillip Okhovat, and Kenneth A. Ellenbogen
- Subjects
Tachycardia ,Male ,medicine.medical_specialty ,Radiofrequency ablation ,medicine.medical_treatment ,Catheter ablation ,law.invention ,law ,Heart Conduction System ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Sinus rhythm ,Atrium (heart) ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Cardiology ,Catheter Ablation ,Female ,medicine.symptom ,Electrical conduction system of the heart ,Cardiology and Cardiovascular Medicine ,business ,Electrophysiologic Techniques, Cardiac ,Atrial flutter ,Voltage - Abstract
Electroanatomic mapping systems are an important tool to identify cardiac chamber voltage and assess channels of slow conduction.To assess the correlation between electroanatomic mapping voltage maps obtained during macroreentrant tachycardia compared to sinus rhythm (SR) with a contact mapping system.We retrospectively evaluated patients with atrial flutter (AFL) referred for radiofrequency ablation with electroanatomic voltage maps obtained during AFL and SR. The atrium was divided into predetermined segments. Overall atrial and segmental peak-to-peak bipolar voltages in AFL and SR were assessed. To directly compare a region within the same patient, tissue voltage differences during AFL and SR were assessed on the basis of mean voltage difference.Sixteen patients (87% men) had available voltage maps. Eighty-one percent had typical cavotricuspid isthmus-dependent right AFL. A mean of 441.7±153.9 vs 398.1±125.4 total points (P = .22) were sampled during AFL and SR, with a mean of 99.5±58.9 vs 91.2±60.4 points (P = .45) sampled per region. Overall right atrial mean voltage was significantly higher during AFL than SR (0.554±0.092mV vs 0.473±0.079mV; P≤.001), with the lateral wall (0.707±0.120mV vs 0.573±0.097mV; P = .0004) and the cavotricuspid isthmus (0.559±0.100mV vs 0.356±0.066mV; P.0001) also showing higher mean voltage during AFL. When compared within an individual patient, 19% (14 of 75) of the patient regions had a0.5mV mean voltage difference and 40% (30 of 75) had a0.25mV mean voltage difference.These data suggest that voltage maps performed during macroreentrant atrial arrhythmias often vary significantly from maps obtained during SR.
- Published
- 2012
47. 201 A predictive model for suspected lower limb cellulitis in the emergency department
- Author
-
Jeffrey M. Cohen, Cara Joyce, Adam B. Raff, Arash Mostaghimi, Qing Yu Weng, Nicole Gunasekera, Priyanka Vedak, Jean-Phillip Okhovat, and Daniela Kroshinsky
- Subjects
medicine.medical_specialty ,business.industry ,Cell Biology ,Dermatology ,Emergency department ,medicine.disease ,Biochemistry ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Lower limb cellulitis ,Emergency medicine ,Medicine ,Medical emergency ,business ,Molecular Biology - Published
- 2016
48. Influence of ω-3 Fatty Acids on Triglyceride Levels in Patients Using Isotretinoin
- Author
-
Christina N. Kim, Sheila Krishna, Jean-Phillip Okhovat, and Jenny Kim
- Subjects
medicine.medical_specialty ,Reference range ,Dermatology ,Gastroenterology ,Article ,chemistry.chemical_compound ,Internal medicine ,Acne Vulgaris ,Fatty Acids, Omega-3 ,medicine ,Humans ,Longitudinal Studies ,Isotretinoin ,skin and connective tissue diseases ,Adverse effect ,Triglycerides ,Acne ,Retrospective Studies ,chemistry.chemical_classification ,Triglyceride ,business.industry ,Hypertriglyceridemia ,Fatty acid ,medicine.disease ,Discontinuation ,Treatment Outcome ,Endocrinology ,chemistry ,Dermatologic Agents ,business ,medicine.drug - Abstract
The effect of ω-3 fatty acid (ω-3FA) supplementation on triglyceride levels was assessed in a retrospective study of patients taking isotretinoin for acne. Oral isotretinoin (13-cis-retinoic acid) is commonly used in the treatment of severe and recalcitrant acne.1–3 This treatment commonly results in complete clearance of acne with long-term remission; however, treatment is associated with a number of adverse effects, including hypertriglyceridemia.4 At high levels of isotretinoin, hypertriglyceridemia may lead to acute pancreatitis.2,3 As many as 44% of patients with baseline triglyceride levels within the reference range who are treated with isotretinoin develop hypertriglyceridemia.4 Elevations in triglyceride levels during isotretinoin treatment can force dosage reductions or discontinuation of treatment. For less marked elevations, dietary modification or therapy to lower lipid levels may be used.
- Published
- 2015
49. Pyoderma Gangrenosum
- Author
-
Jean-Phillip, Okhovat and Kanade, Shinkai
- Subjects
Humans ,Dermatology ,Pyoderma Gangrenosum - Published
- 2014
50. Evaluation of serum B-cell maturation antigen in multiple myeloma
- Author
-
Jennifer S. Li, Dylan T. Kirk, Mingjie Li, Gabriel N. Waterman, Haiming Chen, Regina A. Swift, Austin A. Robinson, Erik K. Madden, Eric Sanchez, James R. Berenson, Cathy Wang, Jean-Phillip Okhovat, Benjamin Bonavida, and Alex Kitto
- Subjects
Cancer Research ,Oncology ,business.industry ,B-Cell Maturation Antigen ,Immunology ,medicine ,Malignant cells ,medicine.disease ,business ,Receptor ,Multiple myeloma - Abstract
e18549 Background: B cell maturation antigen (BCMA) is a receptor whose expression increases during B-cell development and is found on malignant cells from multiple myeloma (MM) patients; however, it has not been identified in human serum. Methods: Bone marrow (BM) aspirates and peripheral blood were obtained from patients with MM, monoclonal gammopathy of undetermined significance (MGUS) and healthy control subjects following informed consent (Western IRB BIO 001). Serum was isolated and analyzed with a BCMA enzyme‑linked immunosorbent assay. Values represent the mean of triplicate experiments. BM mononuclear cells (MCs) were isolated using density‑gradient centrifugation and cultured for 72 h in RPMI1640 supplemented with 10% fetal bovine serum. Our human MM xenograft (LAGκ-2)was grown in SCID mice and treated with bortezomib (BORT) with cyclophosphamide (CY); tumor volume and BCMA levels were determined. Statistical significance of differences observed was determined using a Student’s t test and analysis was determined using GraphPad prism software. Results: We showed that the supernatants of cultured BMMCs from MM patients had high concentrations of BCMA (median = 2,250 pg/ml) whereas normal subjects showed minimal amounts (56 ng/ml; P < 0.0001). The serum BCMA levels from newly diagnosed MM patients (n = 51) had much higher levels (13.74 ng/ml) than among controls (n = 40; median 2.58 ng/ml; P < 0.0001) and MGUS subjects (n = 26; median 5.40 ng/ml; P = 0.005). Notably, protein levels were much higher among patients with relapsed or refractory (R/R) disease (n = 79; median 20.02 ng/ml) compared to those with responsive (> partial response) disease (n = 80; median 4.14 ng/ml; P = 0.0038). Following treatment, patients with responsive disease showed decreases in BCMA levels whereas those with R/R disease showed increases. Following treatment with BORT and CY, we also showed a marked decrease in tumor volume and serum human BCMA levels in mice bearing the LAGκ-2 xenograft whereas untreated animals showed marked increases in tumor size and serum BCMA. Conclusions: This is the first report identifying serum BCMA in any human disease and suggests that these levels may be a novel biomarker for monitoring disease status and therapeutic response of MM patients.
- Published
- 2012
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