Faculty Bibliography

Natural ingredients have been used traditionally for millennia and their application in topical creams, lotions and preparations within the traditional medicines and healing traditions of many cultures has been observed. Over the last 20 years, clinical and laboratory studies have identified the benefits of an array of natural ingredients for skin care. Consequently, a number of these ingredients and compounds are today being developed, used or considered not only for anti-aging effects, but also for use in dermatologic disorders. Certain ingredients, such as colloidal oatmeal and aloe vera, have been identified as beneficial in the treatment of psoriasis and atopic dermatitis, respectively, due to their anti-inflammatory properties. For combating acne and rosacea, green tea, niacinamide and feverfew are considered efficacious. As to hyperpigmentation and antioxidative capabilities, licorice, green tea, arbutin, soy, acai berry, turmeric and pomegranate are among those plants and compounds found to be most beneficial. Additional research is needed to determine to confirm and elucidate the benefits of these ingredients in the prevention and management of skin disease

The incidence of malignant melanoma has reached more than 62,000 people this past year alone. Much is unknown about the genetic predisposition of this cancer. The authors present a 62-year-old woman with a history of Charcot-Marie-Tooth disease (CMTD), diagnosed at age five, who has also developed multiple primary cutaneous malignant melanomas since 2003. The patient presented to the authors' clinic with a pigmented lesion on the left thigh, which was increasing in size and changing color. The patient was diagnosed with malignant melanoma in situ on biopsy. As both CMTD and malignant melanoma are neural crest derived disorders, this may suggest a shared underlying genetic defect. A gene locus of particular interest is 1p36, both previously recognized in the proposed pathogenesis of CMTD and malignant melanoma (MM)

The authors discuss various filling agents currently available that can be used to augment the lips, correct perioral rhytides, and enhance overall lip appearance. Fillers are compared and information provided about choosing the appropriate agent based on the needs of each patient to achieve the much coveted 'pouty' look while avoiding hypercorrection. The authors posit that the goal for the upper lip is to create a form that harmonizes with the patient's unique features, taking into account age and ethnicity; the goal for the lower lip is to create bulk, greater prominence, and projection of the vermillion

Epidermolytic hyperkeratosis is a rare genetic disorder of keratinization. In childhood, patients are erythrodermic and have a compromised stratum corneum, replaced with generalized hyperkeratosis as the patients age. Treatment consists of topical emollients as well as, topical and oral retinoids. Ultraviolet (UV) light, often in combination with psoralen ultraviolet A (PUVA) is widely used as a therapeutic modality for a multitude of hyperproliferative disorders. Although not strictly indicated for epidermolytic hyperkeratosis, it has been utilized as experimental treatment, particularly in the days prior to retinoids. Psoralen ultraviolet A has also been implicated in the development of nonmelanoma skin cancers, especially, squamous cell carcinoma (SCC). Retinoids are well-known to protect against nonmelanoma skin. A patient with epidermolytic hyperkeratosis with multiple nonmelanoma skin cancers, previously treated with PUVA and long-standing oral retinoids is reported

Basal cell carcinoma (BCC) is the most common human malignancy, which often occurs as a result of ultraviolet light on sun-exposed areas. A more rare location for the presentation of BCC is the non-sun-exposed genital area, where squamous cell cancer occurs frequently in the setting of human papilloma virus and chronic inflammatory lesions (i.e., lichen sclerosus et atrophicus). Consequently, such tumors may escape detection by the dermatologist and be mistaken by the gynecologist for an inflammatory condition. A delay in diagnosis can result in wider surgical margins and potential recurrences. We present a case of BCC of the vulva with involvement of the clitoris presenting with unilateral pruritus and treated as an allergic contact dermatitis with topical corticosteroids. The patient was treated with Mohs micrographic surgery in conjunction with topical imiquimod to spare surrounding tissue

A 12-month-old male presented with edematous purpuric plaques on the extremities (including the palms and soles), and violaceous targetoid macules on the hard palate and earlobes. The patient had an upper respiratory infection and conjunctivitis 10 days prior to the development of the skin lesions, and was vaccinated 3 weeks before this presentation. He was found to have increased IgA levels and increased ESR. Skin biopsies demonstrated leukocytoclastic vasculitis and IgA granular deposition on superficial dermal vessels. These findings are characteristic of acute hemorrhagic edema of infancy, an entity that must be distinguished from other leukocytoclastic vasculitis, especially Henoch-Schonlein purpura