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Pulsed Dye Laser at Subpurpuric Settings for the Treatment of Pulsed Dye Laser-Induced Ecchymoses in Patients With Port-Wine Stains

Brauer, Jeremy A; Farhadian, Joshua A; Bernstein, Leonard J; Bae, Yoon-Soo; Geronemus, Roy G
BACKGROUND: Post-procedure purpura is a major complaint of patients with port-wine stains (PWSs) treated with pulsed dye laser (PDL). OBJECTIVE: To assess the safety and efficacy of using PDL at nonpurpuric settings to treat ecchymoses that develop within PWSs after treatment with PDL. MATERIALS AND METHODS: Prospective, randomized, controlled study using 595-nm PDL for treatment of PWSs and laser-induced ecchymoses. Port-wine stains were treated in entirety at baseline. Two days later, ecchymoses on randomly selected half of the lesion were re-treated with PDL at subpurpuric settings. Treatment series was repeated 4 to 8 weeks later, and follow-up was at 1 month. Reduction in bruising and PWS clearance were assessed. Three masked evaluators graded clinical improvement using a 4-point scale (1 = 1%-25% improvement, 2 = 26%-50% improvement, 3 = 51%-75% improvement, and 4 = 76%-100% improvement). RESULTS: Twenty adults with 21 PWSs on the head, trunk, and extremities were treated. After first treatment, reduction of bruising was graded a mean value of 2.43 for the treatment side, compared with 1.93 for the control side (p = .012); after the second treatment, 2.83 compared with 2.40 (p = .021). No significant adverse events occurred. CONCLUSION: Pulsed dye laser can be used safely and effectively to reduce treatment-induced purpura in patients with PWSs.
PMID: 28858925
ISSN: 1524-4725
CID: 2679652

Skin-limited relapse of systemic anaplastic large-cell lymphoma

Farhadian, Joshua A; Terushkin, Vitaly; Meehan, Shane A; Kornreich, Craig
Anaplastic large-cell lymphomas (ALCLs) are agroup of CD30-positive non-Hodgkin lymphomasthat are linked by common morphologic andimmunophenotypic features but have varyingclinical and genetic characteristics. The World HealthOrganization classification currently recognizes threesubtypes of ALCL: systemic anaplastic lymphomakinase-positive ALCL, systemic anaplastic lymphomakinase-negative (ALK-) ALCL, and primary cutaneousALCL. Here we present a 42-year-old man with ahistory of systemic ALK- ALCL, who was in remissionfor six months before relapsing with skin-limitedanaplastic large-cell lymphoma.
PMID: 28329531
ISSN: 1087-2108
CID: 2494572

Primary cutaneous marginal-zone lymphoma

Farhadian, Joshua; Terushkin, Vtaly; Meehan, Shane A; Latkowski, Jo-Ann
Primary cutaneous B cell lymphomas (PCBCL) are thesecond most common type of primary cutaneouslymphoma. The three main types of PCBCL areprimary cutaneous marginal-zone lymphoma(PCMZL), primary cutaneous follicle-centerlymphoma, and primary cutaneous diffuse largeB-cell lymphoma, leg type. PCMZL has an indolentcourse with a five-year survival rate approaching99%. Lesions most often present on the trunk or armas erythematous-to-violaceous papules, plaques, ornodules. Approximately one-half of patients havesolitary skin lesions. Treatment options includesurgery, radiation, and topical, intralesional orsystemic therapy. We present the case of a 33-yearoldHispanic woman with firm, pruritic, pink papuleson the forehead and cheeks, who was diagnosedwith PCMZL.
PMID: 28329553
ISSN: 1087-2108
CID: 3150162

IgA vasculitis (Henoch-Schonlein purpura)

Farhadian, Joshua A; Castilla, Carmen; Shvartsbeyn, Marianna; Meehan, Shane A; Neimann, Andrea; Pomeranz, Miriam Keltz
We report the first case of direct immunoflourescence-proven immunoglobulin A (IgA) vasculitis associated with influenza infection in an adult patient. IgA vasculitis, which was previously known as Henoch-Schonlein purpura, is the most common systemic vasculitis in children but rarely occurs in adults. Disease onset often occurs after upper respiratory tract infections that are caused by adenovirus or enterovirus. The American College of Rheumatology defines IgA vasculitis by the presence of any two of the following four criteria: age
PMID: 26990342
ISSN: 1087-2108
CID: 2051352

Angiolymphoid hyperplasia with eosinophilia

Farhadian, Joshua A; Shvartsbeyn, Marianna; Meehan, Shane A; Urbanek, Richard W
Angiolymphoid hyperplasia with eosinophilia is a rare, benign, vascular proliferation that presents as dome-shaped, light-pink-to-red-brown papules or subcutaneous masses that lack distinguishing surface changes. The condition typically presents as a single lesion or multiple lesions that involve contiguous areas. The pathogenesis is poorly understood. Angiolymhpoid hyperplasia with eosinophilia has been associated with antecedent trauma, T-cell proliferation, infection, and hormone imbalance. This report details a case of widespread angiolymphoid hyperplasia with eosinophilia that flared while the patient was pregnant.
PMID: 26990330
ISSN: 1087-2108
CID: 2051232

RSK1 activation promotes invasion in nodular melanoma [Meeting Abstract]

Salhi, A; Farhadian, J A; Giles, K M; De, Miera E V -S; Silva, I P; Bourque, C; Yeh, K; Chhangawala, S; Wang, J; Ye, F; Zhang, D Y; Hernando, E; Houvras, Y; Osman, I
Background: The two major melanoma histologic subtypes, superficial spreading and nodular melanomas, are believed to differ in their speed of dermal invasion but to converge biologically once they invade and metastasize. Here, we tested the hypothesis that distinct molecular alterations arising in primary melanoma cells might persist as these tumors progress to invasion and metastasis. Materials and methods: Expression of 141 signaling proteins was evaluated by protein pathway array in 3 Radial Growth Phase (RGP)/SSM and 3 Vertical Growth Phase (VGP)/NM cell lines. The impact of p90- ribosomal-S6-kinase (RSK1) and its inhibition on proliferation, migration and invasion was assessed in SSM and NM cell lines, and confirmed using NM cells treated with a RSK inhibitor (BI-D1870) in microarray profiling studies. The effect of constitutive RSK1 activation in vivo was further studied using a zebrafish model. Results: We show that p90-ribosomal-S6-kinase (RSK1) was significantly hyper-activated in human melanoma lines and metastatic tissues derived from nodular compared with superficial spreading melanoma. RSK1 was constitutively phosphorylated at Ser-380 in nodular but not superficial spreading melanoma and was not directly correlated with BRAF or MEK activation. Nodular melanoma cells were more sensitive to RSK1 inhibition using both siRNA and pharmacological inhibitor BI-D1870 compared with superficial spreading cells. In addition, gene expression microarray analyses revealed that RSK1 orchestrates a program of gene expression that promotes cell motility and invasion. Our data also demonstrate a differential over expression of the pro- metastatic MMP-8 and TIMP-1 in metastatic nodular compared to metastatic superficial spreading melanoma. Finally, using an in vivo zebrafish model, constitutive RSK1 activation increased melanoma invasion. Conclusions: Together, our data reveal a novel role for activated RSK1 in the progression of nodular melanoma, and suggest that melanoma originating from different histological subtypes may be biologically distinct and that these differences are maintained as the tumors invade and metastasize
EMBASE:72289925
ISSN: 1479-5876
CID: 2150442

Male Aesthetics: A Review of Facial Anatomy and Pertinent Clinical Implications

Farhadian, Joshua A; Bloom, Bradley S; Brauer, Jeremy A
Aesthetics continues to be a rapidly growing field within dermatology. In 2014, Americans spent 5 billion dollars on an estimated 9 million minimally invasive cosmetic procedures. Between 1997 and 2014, the number of aesthetic procedures performed on men increased by 273%. The approach to male aesthetics differs from that of females. Men have a squarer face, a more angled and larger jaw, and equally balanced upper and lower facial proportions. Facial muscle mass, subcutaneous tissue, and blood vessel density are also increased in men relative to women. While many of the same cosmetic procedures are performed in males and females, the approach, assessment, and treatment parameters are often different. Improper technique in a male patient can result in feminizing facial features and patient dissatisfaction. With an increasing number of men seeking aesthetic procedures, it behooves dermatologists to familiarize themselves with male facial anatomy and the practice of cosmetic dermatology in this population.
PMID: 26355624
ISSN: 1545-9616
CID: 2019682

RSK1 Activation Promotes Invasion in Nodular Melanoma

Salhi, Amel; Farhadian, Joshua A; Giles, Keith M; Vega-Saenz de Miera, Eleazar; Silva, Ines P; Bourque, Caitlin; Yeh, Karen; Chhangawala, Sagar; Wang, Jinhua; Ye, Fei; Zhang, David Y; Hernando-Monge, Eva; Houvras, Yariv; Osman, Iman
The two major melanoma histologic subtypes, superficial spreading and nodular melanomas, differ in their speed of dermal invasion but converge biologically once they invade and metastasize. Herein, we tested the hypothesis that distinct molecular alterations arising in primary melanoma cells might persist as these tumors progress to invasion and metastasis. Ribosomal protein S6 kinase, 90 kDa, polypeptide 1 (RSK1; official name RPS6KA1) was significantly hyperactivated in human melanoma lines and metastatic tissues derived from nodular compared with superficial spreading melanoma. RSK1 was constitutively phosphorylated at Ser-380 in nodular but not superficial spreading melanoma and did not directly correlate with BRAF or MEK activation. Nodular melanoma cells were more sensitive to RSK1 inhibition using siRNA and the pharmacological inhibitor BI-D1870 compared with superficial spreading cells. Gene expression microarray analyses revealed that RSK1 orchestrated a program of gene expression that promoted cell motility and invasion. Differential overexpression of the prometastatic matrix metalloproteinase 8 and tissue inhibitor of metalloproteinases 1 in metastatic nodular compared with metastatic superficial spreading melanoma was observed. Finally, using an in vivo zebrafish model, constitutive RSK1 activation increased melanoma invasion. Together, these data reveal a novel role for activated RSK1 in the progression of nodular melanoma and suggest that melanoma originating from different histologic subtypes may be biologically distinct and that these differences are maintained as the tumors invade and metastasize.
PMCID:4348467
PMID: 25579842
ISSN: 0002-9440
CID: 1474572

Hyperactivation of RSK1 is a hallmark of metastatic nodular melanoma [Meeting Abstract]

Salhi, Amel; Farhadian, Joshua A; Giles, Keith M; de Miera, Eleazar CVega-Saenz; Da Silva, Ines Pires; Bourque, Caitlin; Yeh, Karen; Chhangawala, Sagar; Wang, Jinhua; Ye, Fei; Zhang, David Y; Hernando-Monge, Eva; Houvras, Yariv; Osman, Iman
ISI:000370972700009
ISSN: 1538-7445
CID: 2029692

Crystal deodorant-induced axillary granulomatous dermatitis [Letter]

Leventhal, Jonathan S; Farhadian, Joshua A; Miller, Kristen E; Tlougan, Brook E; Patel, Rishi R; Sanchez, Miguel R
PMID: 23621443
ISSN: 0011-9059
CID: 549442