Faculty Bibliography

BACKGROUND: Fentichlor elicits high rates of positive photopatch test reactions despite its currently unknown clinical relevance. OBJECTIVES: The aims of this study were to provide a comprehensive review of fentichlor, to investigate the characteristics of patients with photosensitivity to fentichlor, and to explore the current uses of fentichlor. METHODS: A review of photopatch test studies involving fentichlor was performed. A retrospective chart review was conducted in patients with positive photopatch test reactions to fentichlor at our institution. Product inquiries were placed to manufacturers of fentichlor to elicit the current uses of fentichlor. RESULTS: In selected photopatch test studies, positive reactions to fentichlor occurred in 0.0% to 11.8% of subjects. We found that 25 companies distribute or manufacture fentichlor worldwide, which includes 2 companies that sell 25-kg drums of fentichlor. The most common current uses of fentichlor are in research, in high throughput screening, and in antibacterial and antifungal creams. CONCLUSIONS: Our review of selected photopatch test studies demonstrates that fentichlor remains a potent photosensitizing allergen worldwide. The bulk quantities of fentichlor available for sale and the current uses of fentichlor suggest that fentichlor may be currently incorporated into consumer products. We recommend that fentichlor remain in the standard series of photopatch test allergens.

We present a 67-year-old man with an ulcerated, indurated plaque on the right mid back with a presumed diagnosis of morphea that was complicated by an allergic contact dermatitis. Further clinical and histopathologic data elucidated the diagnosis of fluoroscopy-induced radiation dermatitis. We present a brief review of the common locations, clinical characteristics, pathophysiology, and management options for fluoroscopy-induced radiation dermatitis.

Background Fentichlor elicits high rates of positive photopatch test reactions despite its currently unknown clinical relevance. Objective: To provide a comprehensive review of fentichlor, investigate the characteristics of patients with photosensitivity to fentichlor, and explore the current uses of fentichlor. Methods: A review of photopatch test studies involving fentichlor was performed. A retrospective chart review was conducted in patients with positive photopatch test reactions to fentichlor at our institution. Product inquiries were placed to manufacturers of fentichlor to elicit the current uses of fentichlor. Results: In selected photopatch test studies, positive reactions to fentichlor occurred in 0.0 to 11.8% of subjects. We found that 25 companies distribute or manufacture fentichlor worldwide, which includes two companies that sell 25 kg drums of fentichlor. The most common current uses of fentichlor are in research, in high throughput screening, and in antibacterial and antifungal creams. Conclusions: Our review of selected photopatch test studies demonstrates that fentichlor remains a potent photosensitizing allergen worldwide. The bulk quantities of fentichlor available for sale and the current uses of fentichlor suggest that fentichlor may be currently incorporated into consumer products. We recommend that fentichlor remains in the standard series of photopatch test allergens

Background: Chronic actinic dermatitis is a photosensitivity disorder with scant epidemiologic data. Case series in Europe have previously shown that improvement or resolution of chronic actinic dermatitis occurs over time in the majority of patients. However, the natural history of chronic actinic dermatitis in patients in the United States has not been studied. Objective: To study the natural history of chronic actinic dermatitis in patients in the United States. Methods: We performed a retrospective chart review and telephone questionnaire after a 3 to 19 year follow-up period. Results: Of 20 patients, 7 patients (35%) experienced resolution and an additional 11 patients (55%) experienced improvement of their chronic actinic dermatitis. The proportion of patients experiencing improvement or resolution of their chronic actinic dermatitis increased at 5, 10, and 15 years after diagnosis. Similar proportions of patients with skin types I to II and skin types III to VI experienced improvement or resolution. Conclusions: Our study demonstrates that abnormal photosensitivity to sunlight in chronic actinic dermatitis improves or resolves over time in themajority ofNew York patients. The rates of improvement or resolution in our New York patients are similar to the rates in case series in Europe, despite likely patient demographic differences

BACKGROUND: There is no known association between the development of keratoacanthomas and prurigo nodules. OBJECTIVE: We report a case series of 7 patients with a long-standing history of actinic damage, pruritus, and prurigo nodularis who developed widespread keratoacanthomas within the same affected area. METHODS: This was a retrospective case series assessing the clinical characteristics of patients with multiple keratoacanthomas arising in association with prurigo nodules. RESULTS: All 7 patients were elderly Caucasian women (mean age 79 +/- 3.7 years) with actinically damaged skin and a long-standing history of widespread pruritus and prurigo nodules. All patients had histologically confirmed keratoacanthomas, or squamous cell carcinomas with the clinical appearance of a keratoacanthoma, that developed within the field of prurigo nodules. All 7 patients had a clinical response to acitretin with a decrease in the number of lesions. Four patients had an associated eczematous dermatitis and were also treated with cyclosporine with improvement in pruritus and prurigo nodules and no increase in keratoacanthomas. LIMITATIONS: The retrospective design and small number of patients are limitations to this study. CONCLUSION: Our case series represents a distinct subset of elderly individuals with extensive actinic damage who we believe are predisposed to developing both prurigo nodules and keratoacanthomas.

Actinic keratosis (AK) constitutes the initial epidermal lesion in a disease continuum that may progress to invasive squamous cell carcinoma (SCC). A number of treatment options are available to clear lesions, and thus reduce the risk for progression. Field-directed approaches are primarily used to clear multiple AKs and subclinical lesions. Current field-directed approaches still have a number of unmet needs, and a number of investigational agents are being evaluated. Topical therapy can be improved by shortening treatment periods; enhancing tolerability, compliance, and patient satisfaction; reducing recurrence rates; and lowering cost. This 2-part review will explain the role of field-directed therapy in the treatment of AK. Part 1 focuses mainly on investigational agents that are being studied for topical patient-administered, field-directed therapy.

Actinic keratosis (AK) constitutes the initial epidermal lesion in a disease continuum that may potentially progress to invasive squamous cell carcinoma (SCC). A number of treatment options are available to clear lesions and thus reduce the risk for progression to SCC. Field-directed therapies are primarily used to clear multiple AKs and subclinical lesions. Part 1 of this review explaining the role of field-directed therapy for the treatment of AK discussed the unmet needs with current therapies and the investigational agents that are being developed to fill treatment gaps. Part 2 will mainly focus on field-directed therapies that currently are available for AK, such as resurfacing procedures, patient-administered topical therapy, and photodynamic therapy (PDT), as well as lesion-directed therapy, which is used to clear discrete lesions in relatively small numbers.

INTRODUCTION: Traditional clinical trials in psoriasis exclude a significant proportion of patients with complex disease and comorbidities. A consensus panel of 14 experts in the field of psoriasis was formed to conduct a Delphi method exercise to identify difficult-to-treat psoriasis clinical scenarios and to rank treatment approaches. METHODS: The exercise consisted of both survey questionnaires and a live meeting to review and discuss current data (as of 2009, when the exercise was conducted) and arrive at a consensus for optimal treatment options. Seventy difficult treatment scenarios were identified, and the top 24 were selected for discussion at the live meeting. RESULTS: Six of the 24 discussed case scenarios are presented in this article (another five are presented in Part 2): (1) psoriasis with human papilloma virus-induced cervical or anogenital dysplasia; (2) concomitant psoriasis and systemic lupus erythematosus; (3) severe psoriatic nail disease causing functional or emotional impairment; (4) psoriasis therapies that potentially reduce cardiovascular morbidity and mortality; (5) older patients (>/=65 years of age) with psoriasis; and (6) severe scalp psoriasis that is unresponsive to topical therapy. CONCLUSION: The Delphi exercise resulted in guidelines for practicing physicians to utilize when confronted with challenging patients with psoriasis.

INTRODUCTION: Clinicians may be confronted with difficult-to-treat psoriasis cases for which there are scant data to rely upon for guidance. To assist in managing such patients, who are typically excluded from clinical trials, a consensus panel of 14 experts in the field of psoriasis was formed to conduct a Delphi method exercise. METHODS: The exercise consisted of both survey questionnaires and a live meeting to review and discuss current data (as of 2009, when the exercise was conducted) and arrive at a consensus for optimal treatment options. Seventy difficult treatment scenarios were identified, and the top 24 were selected for discussion at the live meeting. RESULTS: Five of the 24 discussed case scenarios are presented in this article: (1) moderate-to-severe psoriasis that has failed to respond to all currently approved therapies for psoriasis; (2) palmoplantar psoriasis that is unresponsive to topical therapy and phototherapy; (3) erythrodermic psoriasis; (4) pustular psoriasis; and (5) the preferred therapeutic choice to combine with low-dose methotrexate. A previous article (part 1) presented six other scenarios. CONCLUSION: The Delphi exercise resulted in guidelines for practicing physicians to utilize when confronted with patients with challenging cases of psoriasis.

Purpura annularis telangiectoides of Majocchi (PATM) is a clinical variant of pigmented purpuric dermatoses. It is characterized by asymptomatic or mildly pruritic, erythematous, annular patches that vary in size. The patches exhibit central clearing and peripheral cayenne pepper petechiae. It classically occurs on the lower legs but may be more generalized. Histopathologic features include a lymphocytic capillaritis with subsequent capillary leakage and extravasated erythrocytes, which is typical of all pigmented purpuric dermatoses. The pathogenesis of PATM is unknown, but it may uncommonly be associated with underlying diseases such as hematologic disorders and rarely cutaneous T-cell lymphoma. There is no standard effective treatment.