Search

Competing Interests: Conflicts of interest Dr Barbieri has received consulting fees from Dexcel Pharma and Honeydew Care for work unrelated to the current submission. Drs Lai, Golovko, and Wilkerson and authors Thang and Garate have no conflicts of interest to declare.

Competing Interests: Conflicts of interest Dr Barbieri has received consulting fees from Dexcel Pharma for work unrelated to the current submission. Authors Garate and Thang and Drs Lai, Golovko, and Wilkerson have no conflicts of interest to declare.

Healing of deep cutaneous wounds often results in detrimental sequelae, including painful and debilitating scars. Current therapies for full-thickness injuries that target specific phases of wound healing have moderate success; however, full resolution remains incomplete and negative consequences persist if skin homeostasis is not achieved. Photoactivated molecules can modulate cellular responses by generating reactive oxygen species and may provide a novel therapeutic option to improve wound healing. In the current study, we investigated the effects of Rose bengal (RB) dye in a preclinical model of full-thickness cutaneous injury. Monochromatic green light activates RB to generate ROS in the presence of oxygen, subsequently crosslinking collagen fibrils. In in vitro studies, we show that photoactivated RB is well tolerated by epidermal keratinocytes and dermal fibroblasts and can mitigate fibrotic signalling by downregulating collagen production. In a murine model of full-thickness injury, topically-applied and photoactivated RB closed wounds faster than control and vehicle treatments and showed significantly improved wound healing outcomes, including enhanced early granulation, better collagen organisation and increased vascularity in the presence of protracted tissue ROS. These data support an overall improved cutaneous wound healing profile after RB phototherapy and warrant further investigations into this versatile molecule., (© 2024 The Wound Healing Society.)

Competing Interests: Conflicts of interest None disclosed.

Competing Interests: Conflicts of interest Dr Barbieri has received consulting fees from Dexcel Pharma for work unrelated to the current submission. Authors Garate and Thang and Drs Damsky, Rosenabach, Golovko, and Wilkerson have no other conflicts to declare.

Proton pump inhibitors (PPIs) are the mainstay of treatment for many gastric acid-related diseases with a relatively safe drug profile. One of the rare side effects is PPI-induced bullous pemphigoid. We describe a case of new-onset bullous pemphigoid on initiation of lansoprazole for esophagitis after a nationwide Zantac recall. This condition can improve with the cessation of PPI and the use of corticosteroids. However, it poses a significant challenge to the management of gastroesophageal reflux disease by limiting available pharmacologic options. In addition, this case highlights the negative effects of a drug recall., (© 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)

Keloid scars are a common yet poorly understood complication of wound healing that can cause a diminished quality of life. Currently, there is little agreement amongst the medical community regarding the best treatment modality for keloids. For this reason, we have created an updated review of the most successful combination therapies for keloid scars and compared their efficacy based on rates of recurrence following treatment. Additionally, these combination therapies have been compared with intralesional triamcinolone acetonide corticosteroid (TAC), which is considered the mainstay monotherapy for keloids. All combination therapies included in our review were shown to produce superior outcomes than TAC monotherapy. We have also found that certain combination therapies are known to produce superior results when used in specific anatomic locations. Intralesional TAC plus intralesional cryotherapy appeared to have the most promising results for non-auricular keloids, and the authors suggest considering this as a first-line treatment. Additionally, the use of surgical excision plus compression therapy achieved superior results for auricular keloids and should be considered first-line for keloids in these locations., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Thornton et al.)

Background: The incidence of cutaneous nontuberculous mycobacteria (NTM) infections is increasing. These infections are a diagnostic and therapeutic challenge., Objective: We investigated the clinical features, diagnosis, and management of cutaneous NTM infections., Methods: A retrospective case series studied 78 patients from a Gulf Coast tertiary referral center diagnosed with cutaneous NTM infection by culture or stain of a skin biopsy specimen., Results: A history of trauma, procedure, or environmental exposure was common. The mean time between the initial evaluation and diagnosis was 12 weeks. Only 15% of acid-fast bacillus-positive cultures had a positive acid-fast bacillus smear, and only 43% of those accompanied by skin biopsy specimen had a positive Fite stain. Immunosuppressed patients were more likely to have a positive Fite stain. Treatment included surgery and multiple antibiotics. Immunosuppressed patients and Mycobacterium abscessus group infections were more likely to have persistent disease., Limitations: M chelonae and M abscessus isolates were indistinguishable and therefore were reported together. Five cases were not confirmed by culture., Conclusions: Even with clinical suspicion, the diagnosis of NTM infection can be difficult. Results of acid-fast bacillus smears and special stains are frequently negative. Antibiotic resistance is common. Multidrug treatment is often required, and surgical therapy may be needed., (Copyright © 2019 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

We present two cases of tinea corporis caused by  Trichophyton verrucosum and  Trichophyton interdigitale in a teenage girl who works with farm animals. We describe the differences in presentation between zoophilic dermatophytes and anthropophilic dermatophytes. Also, we report some of the typical features of the two rare species,  T. verrucosum  and T. interdigitale . This case is significant to dermatology as it raises awareness about these uncommon zoophilic dermatophytoses and demonstrates the importance of educating patients about their mode of infection., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2019, Crain et al.)

An anonymous 9-question survey was composed and distributed to members of the Texas Dermatological Society to evaluate dermatologists' prescription of commercial tanning beds for treatment of certain dermatologic and other medical conditions and to seek opinions on whether commercial tanning beds are a legitimate medical therapy. Results show that although dermatologists agree recreational tanning should always be discouraged, some Texas dermatologists do occasionally recommend commercial tanning bed use for some conditions in patients who cannot afford traditional in-office phototherapy because they lack insurance or have high copays or for those patients who live in regions with limited access to in-office phototherapy or have significant barriers to coming into the clinic. Conditions for which patients are referred to commercial tanning beds include psoriasis, renal prurigo, atopic dermatitis, and mycosis fungoides.

A 68-year-old male with type II diabetes mellitus presented with a nodule over the metacarpophalangeal joint of his right second finger after being spurred on the hand by a domestic turkey 2 weeks prior to onset of clinical symptoms. He was diagnosed with cryptococcal tenosynovitis caused by Cryptococcus luteolus identified by DNA sequencing. Complete clinical resolution was achieved with synovectomy and debridement followed by 1 year of fluconazole 800 mg daily.

We describe two pediatric cases of febrile ulceronecrotic Mucha-Habermann disease (FUMHD) with response to pentoxifylline and cyclosporine therapies. Based on our review of the literature, we are presenting the first case of FUMHD treated with pentoxifylline and the third case of FUMHD successfully treated with cyclosporine. These agents may be of therapeutic benefit in the treatment of FUMHD, in part by suppressing tumor necrosis factor-alpha, which we believe may mediate the disease process., (© 2012 Wiley Periodicals, Inc.)

We report an uncommon case of a cutaneous infection with Mycobacterium fortuitum arising in a new tattoo. A 29-year-old man presented with a several month history of a non-pruritic papular eruption within a tattoo; the papules developed 1-to-2 weeks after the tattoo procedure. He denied similar symptoms with previous tattoos. He had been treated unsuccessfully with cephalexin. Histopathologic examination revealed perifollicular chronic and granulomatous inflammation, consistent with chronic folliculitis. Acid-fast bacilli culture identified Mycobacterium fortuitum complex. The patient was treated with a 2-month course of oral trimethoprim-sulfamethoxazole (160mg/800mg twice daily) and ciprofloxacin (250 mg twice daily), with clinical improvement at follow up after three weeks of the antibiotic regimen. Rapidly growing mycobacteria have emerged as a cause of tattoo-associated cutaneous infection in recent years. Diagnosis and treatment can be difficult without clinical suspicion. M. fortuitum and other rapidly growing mycobacteria should be considered in the differential diagnosis of tattoo-associated dermatologic complications.

Titanium dioxide nanoparticles (nano-TiO(2) ) are widely used in cosmetics, skin care products, paints, and water treatment processes. Disagreement remains regarding the safety of nano-TiO(2) , and little epidemiological data is available to provide needed resolution. Most studies have examined effects using acute exposure experiments with relatively few studies using a chronic exposure design. We examined cyto- and genotoxicity in CHO-K1 cells following 60 days of continuous exposure to defined levels of nano-TiO(2) (0, 10, 20, or 40 μg/ml). Oxidative stress increased in a concentration-dependent manner in short- (2 days) and long-term cultures, but long-term cultures had lower levels of oxidative stress. The primary reactive oxygen species appeared to be superoxide, and ROS indicators were lowered with the addition of superoxide dismutase (SOD). No cyto- or genotoxic effects were apparent using the XTT, trypan-blue exclusion, and colony-forming assays for viability and the Comet and Hprt gene mutation assays for genotoxicity. Nano-TiO(2) increased the percentage of cells in the G2/M phase of the cell cycle, but this effect did not appear to influence cell viability or cell division. Cellular Ti content was dose-dependent, but chronically exposed cells had lower amounts than acutely exposed cells. CHO cells appear to adapt to chronic exposure to nano-TiO(2) and detoxify excess ROS possibly through upregulation of SOD in addition to reducing particle uptake., (Copyright © 2011 Wiley-Liss, Inc.)

Rituximab is a chimeric monoclonal antibody against CD20 that mediates B-cell depletion. It has been shown to be effective in a variety of autoimmune-related diseases, including pemphigus vulgaris. Most reports of pemphigus treatment utilize the weekly dosing regimen designed for the treatment of B-cell malignancy. The authors report a case of successful treatment of refractory pemphigus vulgaris in an adolescent male using three infusions of rituximab spread over a four-month period of time. The authors also discuss recent updates in rituximab's mechanism of action in autoimmune disease. Rituximab acts to destroy auto-reactive B-cells prior to their development into auto-antibody producing plasma cells. More recent reports have shown that rituximab also indirectly leads to a decrease of autoreactive CD4+ T cells via depletion of B-cells that are necessary for antigen presentation. Monthly to bi-monthly rituximab infusion dosing may be a more appropriate dosing strategy for autoimmune disease that minimizes potential side effects while generating remission of disease. Dermatology continues to see an increase in use of medications designed for treatment of rheumatologic disease and malignancy. Additional studies should focus on the appropriate dosing of these medications for dermatologic conditions that limit the risk of adverse effects while preserving therapeutic benefit.

Nontuberculous mycobacterial (NTM) infections are on the rise and often cause skin diseases that are misdiagnosed. The authors present three cases of atypical mycobacterial infections in insulin-dependent diabetics occurring in sites of subcutaneous insulin injections. One of the patients was vitamin D deficient at the time of infection with NTM. The history and clinical presentation of the cases are presented; pathogenesis and treatment are discussed in conjunction with the correlation of mycobacterial disease susceptibility with vitamin D deficiency.

Background: Tumors of the lacrimal sac are rare but noteworthy because of their significant potential to become malignant or life-threatening if treatment is delayed. Dermatologists may be the first to encounter such neoplasms., Observations: We report a case of a 53-year-old Caucasian woman who presented with a seven-year history of an asymptomatic, subcutaneous nodule near her right medial canthus. Histology of the lesion revealed transitional epithelium in a papillary growth pattern with numerous goblet cells, scattered mitoses and focal full-thickness atypia. The patient was diagnosed with transitional cell neoplasm (inverted papilloma-type) of the nasolacrimal duct. PCR evaluation identified HPV type 11 in the lesion., Conclusion: Our report is one of a growing number of case reports and series detecting HPV DNA in these tumors which further supports HPV as an etiologic agent in epithelial lacrimal sac tumors. We believe that dermatopathologists need to be aware of this entity, as dermatologists may be the first to encounter these neoplasms., Limitations: The association of HPV with this tumor does not prove causality.

Nano-sized particles represent a unique class of materials with novel physiochemical properties due to increased surface area. Many sunscreens and cosmetics are now using nano-sized titanium dioxide and zinc oxide, which avoids the white, chalky appearance of the older preparations. Although the U.S. Food and Drug Administration (FDA) has determined that nano-sized titanium dioxide is not a new ingredient, but a specific grade of the original product, recent studies suggest that nanomaterials products may not be equivalent to their respective bulk-form products, and the adverse effects of nanoparticles cannot be reliably predicted from the properties of the material in bulk form. Nanoparticles are incorporated into a variety of skin care products, and in the future may be useful as transdermal drug delivery devices. Thus, understanding potential epidermal and dermal penetration, as well as possible toxicity, is important to the field of dermatology. The authors present a review of the therapeutic applications and potential toxicity of nanoparticles relevant to the field of dermatology thus far.

Glomus tumors are benign localized tumors of the skin accounting for 1% to 2% of all soft tissue tumors. They may present as a solitary tumor or multiple tumors, termed glomangioma. We describe a 69-year-old man with a medical history of psoriasis and hypertension who presented with an incidental finding of multiple asymptomatic, noncompressible, blue lesions over his arms, chest, and back. The lesions, present since childhood, had never been subject to a workup. The patient had no history of gastrointestinal bleeding and no known family history of similar lesions. Physical examination revealed multiple nontender, blue, subcutaneous nodules that were 1 to 2 cm in diameter and located on the bilateral arms, chest, and back. The diagnosis of glomangioma was made and no further treatment was indicated.

Fluconazole is a rare cause of severe cutaneous adverse drug reactions. A case of a diffuse, exfoliative eruption due to fluconazole is presented. Convincing arguments for a diagnosis of both widespread bullous fixed drug eruption and toxic epidermal necrolysis are made. The clinical presentation, diagnosis, and differentiation of these 2 severe cutaneous acute drug reactions are discussed.

Acute generalized exanthematous pustulosis (AGEP) is a rare cutaneous eruption mainly provoked by drugs. A case of AGEP in a 74-year-old male that was attributed to the ingestion of terazosin hydrochloride is presented. This is the first reported case of this association in medical literature. The history, clinical presentation, and pathogenesis of AGEP are discussed.

Among 30 patients who received a clinical diagnosis of exfoliative dermatitis and were biopsied between 1982 and 1990, nine showed microscopic features of lichenoid dermatitis. Clinical information was available in eight of these cases. Possible etiologic factors included lymphoma, herpes simplex infection, connective tissue disease, and (in five cases) reactions to drugs. In each instance, microscopic features included a superficial perivascular lymphocytic infiltrate involving the dermal-epidermal interface, vacuolar alteration of the basilar layer, and individually necrotic keratinocytes at all levels of the epidermis. Such microscopic changes are not usually described in connection with exfoliative dermatitis, with the possible exception of those cases related to lichen planus or lupus erythematosus. Disseminated lichenoid drug eruption is one possible interpretation of the drug-induced cases. Erythema multiforme is another condition that has similar microscopic features and has been associated with drugs (many of which also cause exfoliative dermatitis), infectious agents, neoplasms, and connective tissue diseases. Lichenoid dermatitis can become generalized and clinically mimic and exfoliative dermatitis. Many, but not all, of these eruptions may be triggered by drugs.

In this eleventh report of dermatitis conforming to the outline of an underlying pacemaker, the authors suggest that most of these reactions are isomorphic responses to expansion of the subcutaneous tissues by the hard device. Allergic contact dermatitis has been documented in a few cases.

5-Fluoro-5'-(2-oxo-1,3,2-oxazaphosphorinan-2-yl)-2'-deoxyuridine (1a) and 5-fluoro-5'-(2-oxo-1,3,2-dioxaphosphorinan-2-yl)-2'-deoxyuridine (1b) were prepared by reaction of 5-fluoro-2'-deoxyuridine (7a) and phosphoryl chloride with 3-amino-1-propanol and 1,3-propanediol, respectively. The thymidine analogues, 1c and 1d, were prepared similarly from thymidine. Compound 1b was synthesized in better yield from 13a and trimethylene phosphate with triphenylphosphine/diethyl azodicarboxylate as a condensing agent. Compounds 1a-d were resistant to degradation by 5'-nucleotidase, alkaline phosphatase, venom phosphodiesterase, and crude snake venom. None of these compounds were significantly biotransformed when incubated with mouse hepatic microsomal preparations in the presence of an NADPH-generating system. When administered intraperitoneally (ip) for 5 consecutive days, 1a was nearly as effective as 5-fluorouracil at prolonging the life spans of BDF1 mice implanted intraperitoneally with leukemia P-388. However, much larger dosages of 1a were required for optimal activity. Compound 1b administered similarly was only marginally effective. Neither 1a nor 1b was active against a P-388 mutant resistant to 5-fluorouracil.

Diphenylcyclopropenone (DPCP) has recently been reported to be a potent contact sensitizer for the treatment of alopecia areata. DPCP is nonmutagenic in the Ames assay. Studies on chemical purity, stability, and mechanisms of action are lacking. DPCP is synthesized by cyclization of alpha, alpha'-dibromodibenzylketone. The latter elicits a reaction in guinea pigs sensitized to DPCP. We examined a commercial sample of DPCP by gas chromatography--mass spectrometry for the presence of contaminants. The stability of dilute solutions of DPCP in ethanol and cyclohexane to fluorescent light, sunlight, and heat was followed by ultraviolet (UV) spectrometry. The isosbestic point and half-life for this reaction were determined. We found no original or intermediate reagents in our sample. DPCP was found to decompose, forming diphenylacetylene on exposure to both sunlight and fluorescent light in less than 2 weeks. Samples shielded from the light at -70 degrees C and at room temperature were stable over a 4-week period. The extent of decomposition was the same in both ethanol and cyclohexane. It is possible that DPCP may act as a prosensitizer with the actual sensitizer liberated by a photoactivated intermediate (stable, metastable, or unstable) or a combination of these.

Actinic keratoses are premalignant lesions of the epidermis arising on sun-damaged skin. Sun exposure, skin color, tanning ability and heredity are important factors in their development. Actinic keratoses must be distinguished from seborrheic keratoses, squamous cell and basal cell carcinomas and keratoacanthomas. Treatment depends on the location and the extent of disease.

Red lunulae are associated with rheumatoid arthritis, systemic lupus erythematosus, alopecia areata, cardiac failure, hepatic cirrhosis, lymphogranuloma venereum, psoriasis, carbon monoxide poisoning, twenty-nail dystrophy, and reticulosarcoma. We examined four patients with red lunulae. Three had chronic obstructive pulmonary disease. Two of these three were alcohol abusers and were without any of the conditions previously associated with red lunulae. Two of the four also had palmar erythema. Histopathologic examination of the red lunula in one of the four cases did not show signs of neovascularization. We report our findings in these patients, which suggest that red lunulae result from increased arteriolar blood flow, a vasodilatory capacitance phenomenon, or changes in the optical properties of the overlying nail so that normal blood vessels become more apparent.

DNCB (2,4-dinitrochlorobenzene) is used in the treatment of alopecia areata, recalcitrant verrucae, and for evaluating immunocompromised patients. Currently, there is no pharmaceutical grade of DNCB available for clinical use. Recently, no nitrochlorobenzene contamination was found with the use of positive ion detection gas chromatography--mass spectrometry. We examined six commercial sources of DNCB, with the use of negative ion detection gas chromatography--mass spectrometry, for volatile impurities such as nitrochlorobenzene which might remain from the manufacturing process. The use of negative ion detection increases the sensitivity of this technic to benzene rings substituted with electron withdrawing groups like the nitrochlorobenzenes. We found that all sources of DNCB contain various combinations of nitrochlorobenzene, dinitrobenzene, nitrodichlorobenzene, and other isomers of DNCB. Nitrochlorobenzene has been shown to be mutagenic in the Ames test and carcinogenic in animal studies. The presence of nitrochlorobenzene and other contaminants in commercial grades of DNCB raises questions about the continued clinical application of this agent.

Two squaric acid diesters, squaric acid diethyl ester (SADEE) and squaric acid dibutyl ester (SADBE), have been suggested as replacements for 2,4-dinitrochlorobenzene in the treatment of alopecia areata and alopecia totalis. We synthesized these squaric acid diesters and examined them for the presence of carcinogenic contaminants, hexachlorobutadiene and tetrachloro-2-cyclobutene-1-one, by gas chromatography-mass spectrometry (GC-MS). The stability of SADBE to hydrolysis by water in acetone, butanol, isopropanol, and absorbent ointment with and without molecular sieves was examined. The stability of SADEE in ethanol and acetone, with and without molecular sieves, was also studied. Hydrolysis products were detected by their formation of a colored complex with ferric chloride. This complex absorbs in the visual range at 480 nm, thus affording a convenient method for determination of the concentration of free squaric acid in a solution. No contaminants were found by positive or negative ion detection in our GC-MS system. At the end of 3 weeks the extent of hydrolysis was greater in alcohols than in acetone when 10 and 100 molar excess of water were added to the solutions. In the presence of molecular sieves, hydrolysis was reduced even at 100 molar excess of added water in alcohol ar acetone. However, under storage conditions without sieves, acetone solutions and alcohol solutions were equally stable over a period of 2 months. Molecular sieves reduce hydrolysis of squarate esters in the presence of a large molar excess of water, regardless of solvent.

Herpes zoster has recently been reported in young patients with risk factors for AIDS. In high-risk patients under age 55, herpes may be the first manifestation of AIDS or AIDS-related complex. Dissemination of zoster does not appear to be greatly increased in this group, but corticosteroid therapy should be withheld.

The photochemical conversion of diphenylcyclopropenone to diphenylacetylene has recently been reported. Diphenylcyclopropenone is used in the treatment of alopecia areata and is nonmutagenic in a limited Ames assay. We examined diphenylcyclopropenone and diphenylacetylene, as well as synthetic precursors of diphenylcyclopropenone--dibenzylketone and alpha,alpha'-dibromodibenzylketone--for mutagenicity against TA100, TA98, TA102, UTH8413, and UTH8414. All compounds were nonmutagenic except alpha,alpha'-dibromodibenzylketone, which was a potent mutagen in TA100 with and without S-9 activation. The effect of photochemical activation of diphenylcyclopropenone in the presence of bacteria demonstrated mutagenicity in UTH8413 (two times background) at 10 micrograms/plate with S-9 microsomal activation. 8-Methoxypsoralen produces a mutagenic response in TA102 at 0.1 microgram/plate with 60 seconds of exposure to 350 nm light. In vitro photochemically activated Ames assay with S-9 microsomal fraction may enhance the trapping of short-lived photochemically produced high-energy mutagenic intermediates. This technique offers exciting opportunities to trap high-energy intermediates that may play an important role in mutagenesis. This method can be applied to a variety of topically applied dermatologic agents, potentially subjected to photochemical changes in normal use.

2,4-Dinitrochlorobenzene (DNCB) is used for immunotherapy of alopecia areata and verruca vulgaris. We initially postulated that the presence of mutagenic contaminants in commercially available DNCB might account for part of its mutagenicity. We have now characterized changes in the dose-mutagenic response curve of 99% DNCB modified by adding 1% concentrations of known contaminants: 1-chloro-2-nitrobenzene; 1,3-dinitrobenzene; and 2,4-dichloronitrobenzene. Dose-response curves were generated using Salmonella typhimurium tester strains TA-98 and TA-100 at concentrations of 0, 1, 5, 10, 25, 50, and 100 micrograms per plate in a modified Ames assay. We observed a linear dose-response relationship with a slight, but nonsignificant, shift to the right when contaminants were added. We conclude that DNCB is itself mutagenic, and that contaminants play a minor role in its observed mutagenicity.