Archives Of Dermatology Research Articles

A Highly Effective and Practical Corticosteroid Regimen to Overcome Skin Rash Associated with Immunomodulatory Drugs Allowing Reinstitution of Therapy

Introduction Immunomodulatory drugs (IMiDs) are backbone of myeloma therapy in induction and maintenance therapy after transplant for patients (pts) with Multiple Myeloma (MM). The incidence of IMiD-associated rash is up to 27% (Nardone, et al, Clinical Lymphoma Myeloma and Leukemia. 2013) and importantly heralds a favorable prognosis (Kojima, et al. Blood. 2016) suggesting more robust immune stimulation by this class of drugs; however, lack of optimal management strategy of this toxicity can deprive large subset of pts from maintenance therapy after transplant and lead to potential detrimental impact on survivals. The concurrent weekly dexamethasone (Dex) does not diminish the incidence of skin eruptions with IMiDs (Sviggum, et al. Archives of dermatology. 2006), therefore we designed a low dose daily and tapering corticosteroid regimen to tame this immune response upon restarting IMiDs and allow desensitization and reinstitution of the same IMiD which may not be achieved by standard weekly Dex. Here, we present our experience with this regimen. Methods In this retrospective study, pts with MM treated with lenalidomide and pomalidomide were reviewed for any IMiD-associated dermatologic toxicity. We followed the same corticosteroid regimen for all IMiD-related rash in our clinic without changing Dex dosing. Result A total of 160 pts were evaluated. The incidence of rash was found to be 13% (n=21). IMiDs were instituted as part of induction regimen in 71% (n=15) and as maintenance therapy after transplant in 29% (n=6) of pts. Median time to development of rash after IMiD initiation was 28 days (range, 2-232). The rashes were characterized as morbilliform in 86% (n=18), urticaria in 9.5% (n=2) and blisters in 5% (n=1) of pts. Pruritis or pain was associated with 86% of rashes (n=15). According to NCI-CTCAE, rashes were graded as low (I-II) in 89% (n=17) and high (III-IV) in 19% of pts. All pts were managed by temporary treatment interruption and upon clearance of rash, re-institution of the same IMiD concomitantly with a standardized 3-week steroid rash prophylaxis protocol (prednisone at 10 mg daily for 10 days, followed by 5 mg daily for 10 days, followed by 5 mg on alternate days for 10 days). As a result, all pts were able to restart the same IMiD either at same (n=5, 24%) or reduced (n=16, 76%) dose with none re-experiencing any dermatologic adverse effect afterward. There was no association between rash development and changes in creatinine clearance (p=0.42). Median eosinophil count at rash development was observed to be significantly higher as compared to eosinophil count at IMiD initiation (380 × 106 vs 130 × 106 respectively, p=0.01). Conclusion The proposed 3-week corticosteroid regimen showed 100% success rate in terms of reinstituting IMiDs, therefore it may provide a highly effective and practical short term immunosuppression required to enable pts to restart IMiDs.

Bibliometric analysis of literature on toxic epidermal necrolysis and Stevens-Johnson syndrome: 1940 \u2013 2015

BackgroundStevens Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but fatal adverse skin reactions that affect all age groups. In order to better understand literature on this topic, we conducted a bibliometric study using Scopus database to shed light on number and growth of publications, most active countries, institutions, journals and authors involved in publishing articles in this field, citation analysis, top cited articles, international collaboration, role of medications and genetic association. Bibliometric analysis will enrich the literature on these rare conditions and will provide baseline data for future comparison.ResultsThree thousand eight hundred fifty-six journal articles were retrieved. The h-index of retrieved documents was 95. Growth rates of publications were highest from 1966 to 1975 and from 2006 to 2015. The United States of America (n = 640; 16.57%) was the leading country in number of publications. However, French and Japanese researchers and institutions were most active in publishing articles on SJS and TEN. International collaboration among active countries was relatively low and ranges from 32.5% for Swiss researchers and 1.47% for Spanish researchers. The most frequently mentioned medication in retrieved articles was carbamazepine (n = 146) followed by phenytoin (n = 114) and allopurinol (n = 112). Mycoplasma infection was mentioned in 111 articles. Most documents on SJS and TEN were published in dermatology journals, specifically Archives of Dermatology. However, in the last decade, top cited articles appeared in dermatology and pharmacogenetic journals. Carbamazepine was frequently encountered with Han Chinese and HLA-B 1502 terms while allopurinol was frequently encountered with HLA-B 5801 and Japanese terms.ConclusionBibliometric analysis reveals that research publications on SJS and TEN have been increasing since the l940s, with relatively low international collaboration. Documents are being published, not only in dermatology journals, but also in genetic, public health and general medicine journals. Research on SJS and TEN can be helpful to clinicians and researchers not only to document complications and fatal outcomes, but also to identify potential causative agents and potential ethnic variations to note gaps in research.

Trends in the frequency of original research in acne vulgaris, rosacea, dermatitis, psoriasis, skin cancer, and skin infections, 1970-2010.

Medical journals have allowed researchers to share their latest discoveries, especially in the most common diseases affecting patients worldwide. To analyze trends in the frequency of original research into common dermatologic diseases from 1970 to 2010. A retrospective review of the Journal of the American Academy of Dermatology and the Archives of Dermatology was performed using the MEDLINE database. All original research articles published between 1970 and 2010, by quinquennium, dealing with acne vulgaris, rosacea, skin cancer, dermatitis, psoriasis, or skin infections were included. Total number of publications dealing with each dermatologic topic considered. The frequency of research into acne vulgaris and rosacea decreased from 24% in 1970 to 5.1% in 2010. Psoriasis research increased in frequency from 17.6% to 26.5% from 2000 to 2010, and skin cancer research increased from 4% in 1970 to 48% in 2010. Topics that experienced early advancements in research, such as acne vulgaris and rosacea, demonstrated a decreasing trend in the frequency of publication. Published psoriasis research has increased in frequency since 2000, most likely because of the discovery of biologics. Finally, skin cancer research has continued to increase in frequency of publication, paralleling the increasing incidence of skin cancer.

Factors Associatedwith with the Development of Striae Gravidarum

Abstract Background and aim: Striae Gravidarum is one of the common skin changes during pregnancy. There are several risk factors for striae development. The aim of this study was to survey of associated factors with the development of striae gravidarum. Materials and methods: A convenience sample of 325 primiparous women were assessed during the immediate postpartum period for evidence of SG. Data were collected by a questionnaire and physical examination. The presence and and severity of striae was evaluated by Davey’s score. To determine the possible risk factors for the development of SG, characteristics of women with and without striae were compared using chi square test, independent t test and logistic Regression. Findings: In 182 (81.3%) of participants striae gravidarum was developed. Development of SG in 174 of 182 women (95.6%) was on the abdomen, 110 of 182 (60.4%) was on the thighs and in 74 of 182 (40.6%) SG was developed on the breasts during their pregnancy. Mean and SD of Davey score in breast, abdomen and thighs were (1.08 ± 1.55), (4.31 ± 2.21) and (1.76 ± 2.02) respectively. Family history of SG in mother, weight gain and body mass index during pregnancy and newborn weight, were signi fi cantly associated with the development of SG. Conclusions: This study showed that genetic factors (family history of striae gravidarum) and physical factors (weight gain and body mass index during pregnancy) may have a significant role in development of striae gravidarum. Therefore, conducting studies in the future to identify how these factors can cause striae gravidarum seem to be helpful. Keywords: Striae Gravidarum, Striae, Prevalenceو Risk Factors. REFERENCES Atwal GS ML, Griffiths CE, Polson DW (2006) Striae Gravidarum in Primipae. British Journal of Dermatology . 155(5) 965-9. Chang AL Agredano YZ Kimball AB (2004) Risk Factors Associated with Striae Gravidarum. Journal of the American Academy of Dermatology , 51(6) 881-5. Cunningham FG, Bloom SL, Leveno KJ (2010) Williams Obstetrics 23rd Ed. New York: McGraw-Hill. Davey CM(1972) Factors Associated with the Occurrence of Striae Gravidarum. An International of Journal Obstetrics and Gynecology . 79(12) 1113-4. Durmazlar SPK, Eskioglu F(2009) Striae Gravidarum: Associated Factors in Turkish Primiparae. Journal of the Turkish Academy Dermatology , 3(4) 93401a. Fitzpatrick TB(1988) The Validity and Practicality of Sun-Reactive Skin Types I Through VI. Archives of Dermatology . 124(6) 869. Gabbe S.G. NJR, Simpson J.L (2002) Obstetrics: Normal and Problem Pregnancies . 4th Ed. New York (NY): Churchill Livingstone. Ghasemi A, Gorouhi F, Rashighi Firoozabadi M, Jafarian S, Firooz A (2007) Striae Gravidarum: Associated Factors. Journal of the European Academy of Dermatology and Venereology . 21(6) 743-6. Lerdpienpitayakul R, Manusirivithaya S, Wiriyasirivaj B, Lorwatthanasirikul J(2009) Prevalence and Risk Factors of Striae Gravidarum in Primiparae. Thai Journal of Obstetrics and Gynaecology . 17(2) 70-9 Liu D(1974) Letter:Striae gravidarum. Lancet. 1(7858) 625. McDaniel DH, Ash K, Zukowski M(1996) Treatment of Stretch Marks with the 585-nm Flashlamp-Pumped Pulsed Dye Laser. Dermatologic Surgery . 22(4) 332-8. Osman H, Rubeiz N, Tamim H, Nassar AH (2007) Risk Factors for the Development of Striae Gravidarum. American Journal of Obstetrics and Gynecology . 196(1) 62 e1-5. Ratree JO, Titapant V, Chuenwattana P, Tontisirin P (2008) Prevalence and Associate Factors for Striae Gravidarum. Journal of the Medical Association of Thailand = Chotmaihet Thangphaet . 91(4) 445-51. Salter SA, Batra RS, Rohrer TE, Kohli N, Kimball AB (2006) Striae and Pelvic Relaxation: Two Disorders of Connective Tissue with a Strong Association. Journal of Investigative Dermatology . 126(8) 1745-8. Shuster S. 1979. The Cause of Striae Distensae. Acta Dermato-Venereologica Supplementum , 59(85) 161. Thomas R, Liston W(2004) Clinical Associations of Striae Gravidarum. Journal of Obstetrics & Gynecology . 24(3) 270-1. Wade TR, Wade SL, Jones HE (1978) Skin Changes and Diseases Associated with Pregnancy. Obstetrics & Gynecology .52(2) 233-42. Watson R, Parry E, Humphries J, Jones C, Polson D, Kielty C, et al (1998) Fibrillin Microfibrils Are Reduced in Skin Exhibiting Striae Distensae. British Journal of Dermatology . 138(6) 931-7. Wong RC, Ellis CN. 1984. Physiologic Skin Changes in Pregnancy. Journal of the American Academy of Dermatology , 10(6) 929-40.

A Plea for Biobanking of All Equivocal Melanocytic Proliferations

In 2005, in an editorial in the Archives of Dermatology (now JAMADermatology), wemade a plea for a combined diagnostic approach tohistopathologic anddermoscopic evaluation.1 Weconcludedoureditorialwith the followingstatement1 (p211): Histopathology, as every other purelymorphologicmethod, is limited by methodologic drawbacks and sometimes by practitioners’ personal limitations.Todayweareon the edgeofanew biology in histopathology, and one can foresee that our beloved classic morphology will soon be replaced by new technologies. In themeantime, a combinedmorphologic approach linkingdermoscopy and histopathology might be helpful for pathologists to come tomore reliable diagnostic conclusions for patients and their physicians.

Declines in melanoma deaths occur in most‐educated individuals

Declines in melanoma mortality rates in non-Hispanic, US whites primarily have occurred among the most highly educated population, according to an American Cancer Society study published in the Archives of Dermatology.1 The findings point to the need for early detection strategies that target high-risk, low-educated, non-Hispanic white individuals and the physicians who care for them, researchers say. Although the overall melanoma mortality rate has been declining in non-Hispanic whites between the ages of 25 and 64 years since the early 1990s, it was not known whether the rates differed according to socioeconomic status. Vilma Cokkinides, PhD, and colleagues reviewed death certificates from 26 states, representing approximately 45% of the US population. They learned that melanoma mortality rates declined by approximately 10% percent in men and women over the latest 10-year span (from 1993-1997 and 2003-2007.) However, the declines occurred only among those individuals with at least 13 years of education, regardless of sex. The least-educated group actually experienced a nonsignificant increase in mortality. The findings showed the educational gap in mortality rates widening by 51.7% in men and 35.7% in women between the 2 time periods. Dr. Cokkinides says the reasons for the gap are not yet known, although the key to melanoma control is recognizing the signs and symptoms early. Lower education/socioeconomic levels are associated with less knowledge of the disease, inadequate health insurance, and reduced rates of skin self-examinations and physician screenings, she says. Reference

Decline of dermatological publications in the UK: truth or myth?

For some time, there has been a suspicion that the number of articles published by UK-based authors in dermatology has declined. This probably reflects a reduction in the publication output of dermatology departments generally. We identified articles with British authorship in the British Journal of Dermatology between 1970 and the present date, and compared the journal with the three most commonly cited dermatological journals: Archives of Dermatology, Journal of Investigative Dermatology and Journal of the American Academy of Dermatology. Later, we expanded this search to include a further 33 dermatological journals. Despite an increase in the total number of published papers by the British Journal of Dermatology, there was a decline in the number of British-authored papers, from 97 (57%) in 1970 to 80 (22%) in 2005. The trend was also seen in the Journal of the American Academy of Dermatology, with 16 papers (5%) in 1989 and 7 (2%) in 2005. In Journal of Investigative Dermatology, British papers increased from 10 papers in 1975 to 17 in 2005, with a percentage decrease from 7% to 4%. Overall, despite an increase in the total number of publications in dermatological journals from 2745 in 1985-5034 in 2005, British publications increased from 271 in 1989 to only 289 in 2005, which represents a percentage decrease from 10% to 6%. Despite a three-fold increase in dermatology consultants and registrars in UK, a three-fold increase in dermatological journals and a four-fold increase in dermatological papers published, the overall number of British papers has remained static over the years.

How prominent are patient-reported outcomes in clinical trials of dermatological treatments?

Assessment of symptoms or disease improvement by study participants is an important aspect of assessing new dermatological therapies in clinical trials, especially for chronic skin diseases that lack objective severity markers. We sought to determine the frequency and prominence of reporting of participants' subjective efficacy outcomes in dermatological clinical trials. Our secondary objective was to determine whether participant and physician outcomes agree in terms of direction and magnitude. Systematic review of 125 randomized controlled trials identified from the Archives of Dermatology, British Journal of Dermatology, Clinical & Experimental Dermatology, Journal of Dermatological Treatment and Journal of the American Academy of Dermatology published between 1994 and 2001 (25 from each). Studies were retrieved in hard copy from the Cochrane Skin Group specialized register of trials and data were abstracted and summarized. Participant efficacy outcomes were mentioned in some form in only 32 of 125 trials (25.6%, 95% exact confidence interval 18.2-34.2%). Of these 32 studies, participant outcomes were mentioned only in the methods section in two studies, in the methods and results section without further data in nine studies and with further data in 21. Data were presented in figure format only in 12 of these studies and in tables and figures in nine. Participant efficacy outcomes were mentioned in the abstract section in just over half (53%) of the 32 trials that included participant efficacy outcomes. There was not enough information to assess agreement in direction and magnitude of participant vs. assessor outcomes. Overall, only 17 papers (13.6%) clearly declared their main outcome measures beforehand in the introduction or methods section. Asking study participants for their views of treatment efficacy seems like a good idea in dermatological clinical trials, yet only about a quarter of the trials examined in this review did so. Even when such information was recorded, it was often poorly and incompletely reported and given low prominence within the trial report. Our study findings call for a more comprehensive uptake for including participant efficacy outcomes alongside other assessor outcomes in clinical trials and, when included, to report those outcomes in full.

Fitzpatrick’s Dermatology in General Medicine

..".surpasses the standards set in all [previous editions]"-Archives of Dermatology, review of prior editionWidely acclaimed dermatological treatise is completely revised and updated with over forty new chapters and an entirely new section on dermatologic surgery. Important new chapters include growth factors, thermoregulation, cell biology, vitiligo, albinism and more. Firmly places dermatology within the continuum of internal medicine and deploys over 1,600 exquisite color photos to depict clinical states.

Modern dressings: must do better

Another month, another review that casts doubt on current wound-care practice. An article published in the October 2007 issue of Archives of Dermatology presents the outcomes of a systematic review by a group of French medics of efficacy studies on modern wound dressings. The review is worthy of particular note for the English-speaking wound world because it includes studies published in French and English, and so covers a wider range of journals than we might otherwise consider.

This Month in Archives of Dermatology

This Month in Archives of Dermatology

Refining dermatology journal impact factors using PageRank

Thomson Institute for Scientific Information's journal impact factor, the most common measure of journal status, is based on crude citation counts that do not account for the quality of the journals where the citations originate. This study examines how accounting for citation origin affects the impact factor ranking of dermatology journals. The 2003 impact factors of dermatology journals were adjusted by a weighted PageRank algorithm that assigned greater weight to citations originating in more frequently cited journals. Adjusting for citation origin moved the rank of the Journal of the American Academy of Dermatology higher than that of the Archives of Dermatology (third to second) but did not affect the ranking of the highest impact dermatology journal, the Journal of Investigative Dermatology. The dermatology journals most positively affected by adjusting for citation origin were Contact Dermatitis (moving from 22nd to 7th in rankings) and Burns (21st to 10th). Dermatology journals most negatively affected were Seminars in Cutaneous Medicine and Surgery (5th to 14th), the Journal of Cutaneous Medicine and Surgery (19th to 27th), and the Journal of Investigative Dermatology Symposium Proceedings (26th to 34th). Current measures of dermatology journal status do not incorporate survey data from dermatologists regarding which journals dermatologists esteem most. Adjusting for citation origin provides a more refined measure of journal status and changes relative dermatology journal rankings.

Uniform Resource Locator Decay in Dermatology Journals

To describe dermatology journal uniform resource locator (URL) use and persistence and to better understand the level of control and awareness of authors regarding the availability of the URLs they cite. Software was written to automatically access URLs in articles published between January 1, 1999, and September 30, 2004, in the 3 dermatology journals with the highest scientific impact. Authors of publications with unavailable URLs were surveyed regarding URL content, availability, and preservation. Uniform resource locator use and persistence and author opinions and practices. The percentage of articles containing at least 1 URL increased from 2.3% in 1999 to 13.5% in 2004. Of the 1113 URLs, 81.7% were available (decreasing with time since publication from 89.1% of 2004 URLs to 65.4% of 1999 URLs) (P<.001). Uniform resource locator unavailability was highest in The Journal of Investigative Dermatology (22.1%) and lowest in the Archives of Dermatology (14.8%) (P=.03). Some content was partially recoverable via the Internet Archive for 120 of the 204 unavailable URLs. Most authors (55.2%) agreed that the unavailable URL content was important to the publication, but few controlled URL availability personally (5%) or with the help of others (employees, colleagues, and friends) (6.7%). Uniform resource locators are increasingly used and lost in dermatology journals. Loss will continue until better preservation policies are adopted.

Errors in the Archives of Dermatology and the Journal of the American Academy of Dermatology From January Through December 2003

To assess the frequency of statistical errors in the dermatology literature. Original studies published in the Archives of Dermatology and the Journal of the American Academy of Dermatology from January through December 2003 were analyzed for correctness of statistical methods and reporting of the results. Of 364 studies published, 155 included statistical analysis. Of these, 59 (38.1%) contained errors in the methods or omissions in reporting of the statistical results. Fourteen percent of the articles with statistical analysis contained errors in the methods used (considered to be more significant errors), 26.5% contained errors in the presentation of the results, and 2.6% contained errors in both. The misuse of statistical methods is prevalent in the dermatology literature, and the appropriate use of these methods is an integral component of all studies. Readers should critically analyze the methods and results of studies published in the dermatology literature.

In Appreciation of Our Reviewers

In 2005, the ARCHIVES converted from paper-based submission and review of manuscripts to electronic methods. The international dermatology community of authors appreciates the shorter turn-around time that is possible with reviews performed electronically. We wish to recognize the superb efforts of our reviewers, who made it possible to review manuscripts by e-mail. Like the letter carriers, who get the mail through in blizzards, these peer reviewers get the reviews through the spam blockers, viruses, and worms that beset our e-mail systems in 2005. We offer our profound thanks to these reviewers for their critical analyses and dedication to advancing the field of dermatology. We look forward to processing manuscripts for the Archives of Dermatology with a Web-based system in 2006.

Pediatric Dermatology Articles in May Archives of Dermatology

Pediatric Dermatology Articles in May Archives of Dermatology

Analysis of original contributions in three dermatology journals

In a cross-sectional analysis, the three top ranking dermatology journals ( Archives of Dermatology , British Journal of Dermatology , and the Journal of the American Academy of Dermatology ) were evaluated for their scientific content, the characteristics of their authors, and funding aspects in 2002. A flood of scientific papers are published each year covering a broad variety of dermatologic topics. Aside from the actual content, a scientific article provides information about the number of authors, their nationality and affiliations, and, with some limitation, about previous presentations and funding. The present study analyzes this situation in dermatology by evaluating the content in the three top dermatologic journals.

Old Scratch.

Old Scratch.

This Month in Archives of Dermatology

This Month in Archives of Dermatology

Pattern analysis: a two-step procedure for the dermoscopic diagnosis of melanoma

Pattern recognition has historically been used by clinicians and histopathologists to differentiate benign lesions from malignant neoplasms. A similar process has been found useful with dermoscopy and has been termed “pattern analysis.” In 1987 the Austrian group of Pehamberger, Steiner, and Wolff published their classic article on pattern analysis in the Journal of the American Academy of Dermatology.1 On the basis of 3,000 pigmented lesions, the Viennese group demonstrated that pattern analysis of specific dermoscopic features permitted a distinction between the various types of pigmented skin lesions, specifically between benign and malignant melanocytic lesions. Since then, the concept of classic pattern analysis has been confirmed and redefined continuously by experts from all over the world. Special references include the Consensus Meeting in 1990,2 an article by Kenet et al3 in the Archives of Dermatology in 1993, an educational CD in 2000 by Argenziano et al,4 and the Consensus Net Meeting in 2000. This article primarily utilizes the terminology and descriptions from the Consensus Net Meeting of 2000 (http://www.dermoscopy. org), the Atlas of Dermoscopy, and the educational compact disc by Argenziano et al.4 There are two steps in the process of pattern analysis (Fig 1). The first step is to decide whether the lesion is melanocytic or nonmelanocytic (Fig 2). A modification of the Stolz algorithm4–8 is used for this first step, and a determination is made for the presence of aggregated globules, a pigment network (excluding fingerprint-like network), or branched streaks. If this is the case, the lesion should be considered a melanocytic lesion. If not, one should evaluate the lesion for the presence of homogeneous steel-blue areas. If so, the lesion should be considered as a blue nevus (unusual exceptions are a pigmented basal cell carcinoma or a metastatic melanoma). The lesion should then be evaluated for the presence of moth-eaten borders, fingerprinting, comedolike openings, milialike cysts, and fissures. If so, the lesion is suggestive of either a solar lentigo or a seborrheic keratosis. One then looks for red or red-blue to black lagoons, and if these structures are present, the lesion should be considered a hemangioma or an angiokeratoma. Finally, the lesion is evaluated for leaflike structures, arborizing telangiectasias, spoke-wheel-like areas, and gray-blue ovoid nests. If present, the lesion is likely a basal cell carcinoma. If all the preceding questions were answered with “no,” the lesion should be considered a melanocytic lesion. Step 2 in the pattern analysis process is the differentiation of benign melanocytic lesions from melanomas. The overall general appearance of Color, Architectural order, Symmetry of pattern, and Homogeneity (CASH) are important components in distinguishing these two From the Pigmented Skin Lesion Unit, Department of Dermatology, University Hospital Geneva, and the Departement Hospitalo-Universitaire Romand de Dermatologie et Venerologie, Geneva/Lausanne, Switzerland; Skin and Cancer Associates, Plantation Florida and Department of Dermatology, University of Miami School of Medicine, Miami, Florida; and the Oncology Section, Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York. Address correspondence to R. P. Braun, Department of Dermatology, University Hospital Geneva, 24, rue Micheli-du-Crest, CH–1211 Geneva 14, Switzerland. E-mail address: braun@melanoma.ch Figure 1. Two-step procedure for dermoscopic diagnosis of pigmented skin lesions.