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Aggarwal I, Rossi M, Puyana C, Tsoukas M. Review of Fractional Nonablative Lasers for the Treatment of Dermatologic Conditions in Darker Skin Phototypes. Dermatol Surg 2024; 50:459-466. [PMID: 38335306 DOI: 10.1097/dss.0000000000004111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
BACKGROUND Fractional nonablative lasers (NAFLs) have demonstrated efficacy and safety for treating dermatologic conditions in patients with darker skin phototypes. Nonablative lasers are preferred in darker skin tones due to lower risk of postinflammatory hyperpigmentation. OBJECTIVE This review aims to identify the ideal laser options and parameters for treating common dermatologic conditions in patients with skin types IV-VI. MATERIALS AND METHODS A comprehensive literature search was conducted on PubMed in May 2023. Of 1,065 articles were identified, and 40 articles met the inclusion criteria. The studies were classified based on design, dermatologic condition, and skin phototype of patients, and assigned levels of evidence according to the Modified Criteria of the Oxford Center of Evidence Based Medicine. RESULTS Strong level 1 evidence supports the treatment of melasma and atrophic scars using NAFL. Moderate level 2 evidence was found for using NAFL in acne vulgaris, striae, and skin rejuvenation; 45% of the studies examined skin types III-IV, 20% III-V, 7.5% II-IV, 5% II-V, 5% IV alone, and 2.5% I-IV. CONCLUSION Further research is needed to determine the optimal treatment modalities and parameters for skin types V and VI. Appropriate device selection and conservative treatment settings are crucial for optimizing outcomes and minimizing adverse events.
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Affiliation(s)
- Ishita Aggarwal
- All authors are affiliated with the Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois
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2
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Akella SS, Lee J, May JR, Puyana C, Kravets S, Dimitropolous V, Tsoukas M, Manwar R, Avanaki K. Using optical coherence tomography to optimize Mohs micrographic surgery. Sci Rep 2024; 14:8900. [PMID: 38632358 PMCID: PMC11024158 DOI: 10.1038/s41598-024-53457-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 01/31/2024] [Indexed: 04/19/2024] Open
Abstract
Mohs micrographic surgery (MMS) is considered the gold standard for treating high-risk cutaneous basal cell carcinoma (BCC), but is expensive, time-consuming, and can be unpredictable as to how many stages will be required or how large the final lesion and corresponding surgical defect will be. This study is meant to investigate whether optical coherence tomography (OCT), a highly researched modality in dermatology, can be used preoperatively to map out the borders of BCC, resulting in fewer stages of MMS or a smaller final defect. In this prospective study, 22 patients with BCC undergoing surgical excision were enrolled at a single institution. All patients had previously received a diagnostic biopsy providing confirmation of BCC and had been referred to our center for excision with MMS. Immediately prior to performing MMS, OCT was used to map the borders of the lesion. MMS then proceeded according to standard protocol. OCT images were compared to histopathology for agreement. Histopathologic analysis of 7 of 22 MMS specimens (32%) revealed a total absence of BCC, indicating resolution of BCC after previous diagnostic biopsy. This outcome was correctly predicted by OCT imaging in 6 of 7 cases (86%). Nine tumors (9/22, 41%) had true BCC and required a single MMS stage, which was successfully predicted by pre-operative OCT analysis in 7 of 9 cases (78%). The final six tumors (27%) had true BCC and required two MMS stages for complete excision; preoperative OCT successfully predicted the need for a second stage in five cases (5/6, 83.3%). Overall, OCT diagnosed BCC with 95.5% accuracy (Cohen's kappa, κ = 0.89 (p-value = < 0.01) in the center of the lesion. Following a diagnostic biopsy, OCT can be used to verify the existence or absence of residual basal cell carcinoma. When residual tumor is present that requires excision with MMS, OCT can be used to predict tumor borders, optimize surgery and minimize the need for additional surgical stages.
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Affiliation(s)
- Sruti S Akella
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA
- Department of Ophthalmology and Visual Sciences, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jenna Lee
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA
| | - Julia Roma May
- School of Medicine, University of Illinois-Chicago, Chicago, IL, USA
| | - Carolina Puyana
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA
| | - Sasha Kravets
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois-Chicago, Chicago, IL, USA
| | | | - Maria Tsoukas
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA
| | - Rayyan Manwar
- Department of Biomedical Engineering, University of Illinois-Chicago, Chicago, IL, USA
| | - Kamran Avanaki
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA.
- Department of Biomedical Engineering, University of Illinois-Chicago, Chicago, IL, USA.
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Lin CH, Lukas BE, Rajabi-Estarabadi A, May JR, Pang Y, Puyana C, Tsoukas M, Avanaki K. Rapid measurement of epidermal thickness in OCT images of skin. Sci Rep 2024; 14:2230. [PMID: 38278852 PMCID: PMC10817904 DOI: 10.1038/s41598-023-47051-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/08/2023] [Indexed: 01/28/2024] Open
Abstract
Epidermal thickness (ET) changes are associated with several skin diseases. To measure ET, segmentation of optical coherence tomography (OCT) images is essential; manual segmentation is very time-consuming and requires training and some understanding of how to interpret OCT images. Fast results are important in order to analyze ET over different regions of skin in rapid succession to complete a clinical examination and enable the physician to discuss results with the patient in real time. The well-known CNN-graph search (CNN-GS) methodology delivers highly accurate results, but at a high computational cost. Our objective was to build a computational core, based on CNN-GS, able to accurately segment OCT skin images in real time. We accomplished this by fine-tuning the hyperparameters, testing a range of speed-up algorithms including pruning and quantization, designing a novel pixel-skipping process, and implementing the final product with efficient use of core and threads on a multicore central processing unit (CPU). We name this product CNN-GS-skin. The method identifies two defined boundaries on OCT skin images in order to measure ET. We applied CNN-GS-skin to OCT skin images, taken from various body sites of 63 healthy individuals. Compared with CNN-GS, our described method reduced computation time by 130 [Formula: see text] with minimal reduction in ET determination accuracy (from 96.38 to 94.67%).
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Affiliation(s)
- Chieh-Hsi Lin
- Department of Computer Science, University of Illinois at Chicago, Chicago, IL, 60607, USA
| | - Brandon E Lukas
- Richard and Loan Hill Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, 60607, USA
| | - Ali Rajabi-Estarabadi
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
- Department of Dermatology, Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - Julia Rome May
- University of Illinois College of Medicine, Chicago, IL, 60607, USA
| | - Yanzhen Pang
- University of Illinois College of Medicine, Chicago, IL, 60607, USA
| | - Carolina Puyana
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, 60607, USA
| | - Maria Tsoukas
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, 60607, USA
| | - Kamran Avanaki
- Richard and Loan Hill Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, 60607, USA.
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, 60607, USA.
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Krajewski PK, Tsoukas M, Szepietowski JC. Pathological and Therapeutical Implications of Pyroptosis in Psoriasis and Hidradenitis Suppurativa: A Narrative Review. Curr Issues Mol Biol 2024; 46:663-676. [PMID: 38248345 PMCID: PMC10814322 DOI: 10.3390/cimb46010043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
This manuscript explores the role of pyroptosis, an inflammatory programmed cell death, in the pathogenesis of two chronic dermatoses, psoriasis and hidradenitis suppurativa (HS). The diseases, though clinically diverse, share common pathogenetic pathways involving the unbalanced interaction between the adaptive and innate immune systems. This review focuses on the molecular changes in psoriatic and HS skin, emphasizing the activation of dendritic cells, secretion of interleukins (IL-17, IL-22, and TNF-α), and the involvement of inflammasomes, particularly NLRP3. This manuscript discusses the role of caspases, especially caspase-1, in driving pyroptosis and highlights the family of gasdermins (GSDMs) as key players in the formation of pores leading to cell rupture and the release of proinflammatory signals. This study delves into the potential therapeutic implications of targeting pyroptosis in psoriasis and HS, examining existing medications like biologics and Janus kinase inhibitors. It also reviews the current limitations and challenges in developing therapies that selectively target pyroptosis. Additionally, the manuscript explores the role of pyroptosis in various inflammatory disorders associated with psoriasis and HS, such as inflammatory bowel disease, diabetes mellitus, and cardiovascular disorders. The review concludes by emphasizing the need for further research to fully elucidate the pathomechanisms of these dermatoses and develop effective, targeted therapies.
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Affiliation(s)
- Piotr K. Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chalubinskiego 1, 50-368 Wroclaw, Poland;
| | - Maria Tsoukas
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL 60607, USA;
| | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chalubinskiego 1, 50-368 Wroclaw, Poland;
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Chang C, Kuritza V, Liu W, Tsoukas M. Nevus trichilemmocysticus: a case report and review of the rare type of epidermal nevi. Int J Dermatol 2024; 63:e2-e4. [PMID: 37706433 DOI: 10.1111/ijd.16828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/21/2023] [Accepted: 08/23/2023] [Indexed: 09/15/2023]
Affiliation(s)
- Christy Chang
- College of Medicine, University of Illinois College of Medicine, Chicago, IL, USA
| | - Victoria Kuritza
- Department of Dermatology, University of Illinois College of Medicine, Chicago, IL, USA
| | - Wenhua Liu
- Consolidated Pathology Consultants, Libertyville, IL, USA
| | - Maria Tsoukas
- Department of Dermatology, University of Illinois College of Medicine, Chicago, IL, USA
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Lee J, Beirami MJ, Ebrahimpour R, Puyana C, Tsoukas M, Avanaki K. Optical coherence tomography confirms non-malignant pigmented lesions in phacomatosis pigmentokeratotica using a support vector machine learning algorithm. Skin Res Technol 2023; 29:e13377. [PMID: 37357662 PMCID: PMC10228288 DOI: 10.1111/srt.13377] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/19/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Phacomatosis pigmentokeratotica (PPK), an epidermal nevus syndrome, is characterized by the coexistence of nevus spilus and nevus sebaceus. Within the nevus spilus, an extensive range of atypical nevi of different morphologies may manifest. Pigmented lesions may fulfill the ABCDE criteria for melanoma, which may prompt a physician to perform a full-thickness biopsy. MOTIVATION Excisions result in pain, mental distress, and physical disfigurement. For patients with a significant number of nevi with morphologic atypia, it may not be physically feasible to biopsy a large number of lesions. Optical coherence tomography (OCT) is a non-invasive imaging modality that may be used to visualize non-melanoma and melanoma skin cancers. MATERIALS AND METHOD In this study, we used OCT to image pigmented lesions with morphologic atypia in a patient with PPK and assessed their quantitative optical properties compared to OCT cases of melanoma. We implement a support vector machine learning algorithm with Gabor wavelet transformation algorithm during post-image processing to extract optical properties and calculate attenuation coefficients. RESULTS The algorithm was trained and tested to extract and classify textural data. CONCLUSION We conclude that implementing this post-imaging machine learning algorithm to OCT images of pigmented lesions in PPK has been able to successfully confirm benign optical properties. Additionally, we identified remarkable differences in attenuation coefficient values and tissue optical characteristics, further defining separating benign features of pigmented lesions in PPK from malignant features.
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Affiliation(s)
- Jenna Lee
- Department of DermatologyUniversity of Illinois‐ChicagoChicagoIllinoisUSA
| | - Mohammad Javad Beirami
- Center for Cognitive ScienceInstitute for Convergence Science and Technology (ICST)Sharif University of TechnologyTehranIslamic Republic of Iran
| | - Reza Ebrahimpour
- Center for Cognitive ScienceInstitute for Convergence Science and Technology (ICST)Sharif University of TechnologyTehranIslamic Republic of Iran
- Department of Computer EngineeringShahid Rajaee Teacher Training UniversityTehranIslamic Republic of Iran
- School of Cognitive SciencesInstitute for Research in Fundamental Sciences (IPM)TehranIslamic Republic of Iran
| | - Carolina Puyana
- Department of DermatologyUniversity of Illinois‐ChicagoChicagoIllinoisUSA
| | - Maria Tsoukas
- Department of DermatologyUniversity of Illinois‐ChicagoChicagoIllinoisUSA
| | - Kamran Avanaki
- Department of DermatologyUniversity of Illinois‐ChicagoChicagoIllinoisUSA
- Department of Biomedical EngineeringUniversity of Illinois‐ChicagoChicagoIllinoisUSA
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Lee J, Benavides J, Manwar R, Puyana C, May J, Tsoukas M, Avanaki K. Noninvasive imaging exploration of phacomatosis pigmentokeratotica using high-frequency ultrasound and optical coherence tomography: Can biopsy of PPK patients be avoided? Skin Res Technol 2023; 29:e13279. [PMID: 37113090 PMCID: PMC10234170 DOI: 10.1111/srt.13279] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 01/03/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Phacomatosis pigmentokeratotica (PPK) is a distinct and rare type of epidermal nevus syndrome characterized by coexisting nonepidermolytic organoid sebaceous nevus (SN) with one or more speckled lentiginous nevi (SLN). Atypical nevi including compound Spitz and compound dysplastic may manifest within regions of SLN. Patients with PPK, or similar atypical nevus syndromes, may be subject to a significant lifetime number of biopsies, leading to pain, scarring, anxiety, financial burden, and decreased quality of life. The current literature includes case reports, genetics, and associated extracutaneous symptoms of PPK, but use of noninvasive imaging techniques have not been explored. We aim to investigate the value of high-frequency ultrasound (HFUS) and optical coherence tomography (OCT) in discriminating morphological features of pigmented lesions and nevus sebaceous within one patient with PPK. MATERIALS AND METHODS Two modalities, (1) HFUS imaging, based on acoustic properties and (2) OCT imaging, based on optical properties, were used to image a patient with PPK. Benign pigmented lesions, which may raise clinical suspicion for significant atypia, and nevus sebaceous, were selected on different areas of the body to be studied. RESULTS Five pigmented lesions and one area of nevus sebaceous were imaged and analyzed for noninvasive features. Distinct patterns of hypoechoic features were seen on HFUS and OCT. CONCLUSION HFUS provides a deep view of the tissue, with ability to differentiate gross structures beneath the skin. OCT provides a smaller penetration depth and a higher resolution. We have described noninvasive features of atypical nevi and nevus sebaceous on HFUS and OCT, which indicate benign etiology.
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Affiliation(s)
- Jenna Lee
- Dermatology DepartmentCollege of MedicineUniversity of Illinois—ChicagoChicagoIllinois
| | - Juliana Benavides
- Richard and Loan Hill Biomedical Engineering DepartmentCollege of Engineering and MedicineUniversity of Illinois—ChicagoChicagoIllinois
| | - Rayyan Manwar
- Richard and Loan Hill Biomedical Engineering DepartmentCollege of Engineering and MedicineUniversity of Illinois—ChicagoChicagoIllinois
| | - Carolina Puyana
- Dermatology DepartmentCollege of MedicineUniversity of Illinois—ChicagoChicagoIllinois
| | - Julia May
- Dermatology DepartmentCollege of MedicineUniversity of Illinois—ChicagoChicagoIllinois
| | - Maria Tsoukas
- Dermatology DepartmentCollege of MedicineUniversity of Illinois—ChicagoChicagoIllinois
| | - Kamran Avanaki
- Dermatology DepartmentCollege of MedicineUniversity of Illinois—ChicagoChicagoIllinois
- Richard and Loan Hill Biomedical Engineering DepartmentCollege of Engineering and MedicineUniversity of Illinois—ChicagoChicagoIllinois
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Puyana C, Chandan N, Tsoukas M. Applications of bakuchiol in dermatology: Systematic review of the literature. J Cosmet Dermatol 2022; 21:6636-6643. [PMID: 36176207 DOI: 10.1111/jocd.15420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/26/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Bakuchiol (BAK), a meroterpene phenol abundant in the plant Psoralea corylifolia, is an emerging cosmeceutical agent with promising anti-aging, anti-inflammatory, and antibacterial properties. The trend for "clean" skincare products and search for anti-aging retinoid alternatives have poised BAK as a "must-have" ingredient in skincare. AIMS Our aim was to review the data for the applications of BAK in dermatology. METHODS This is a systematic review of PubMed. RESULTS Thirty articles matched our search terms ["Bakuchiol" and "Dermatology"] or ["Bakuchiol" and "Skin"] of which one did not meet inclusion criteria, 16 were pre-clinical studies, seven clinical studies, three commentaries, two narrative reviews, and one report on adverse events. BAK has been mostly studied for its effects on photoaging, acne, and post-inflammatory hyperpigmentation (PIH), showing beneficial results comparable to those achieved by topical retinoids. While having no structural resemblance to retinoids, BAK can function as a retinol analog, through retinol-like regulation of gene expression. In in vivo studies, BAK was used alone or in combination with other products resulting in a significant reduction in photodamage, hyperpigmentation, wrinkle scores, and acne severity. Additionally, in vitro studies hinted at its anti-cancer properties by inhibiting epidermal growth factor induced neoplastic cell transformation. Also, demonstrated potential applications in psoriasis by normalizing keratinocyte activity and in pigmentary disorders through inhibition of melanogenesis. There was one adverse event case reported of contact dermatitis in the literature. CONCLUSIONS Bakuchiol is a retinol alternative with anti-aging, antibacterial, and anti-inflammatory properties. Additional studies are warranted to better understand its applications in dermatology.
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Affiliation(s)
- Carolina Puyana
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Neha Chandan
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Maria Tsoukas
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois, USA
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Nickles M, Tsoukas M, Sweiss N, Ennis W, Altman I. Atypical Ulcers: A Stepwise Approach for Clinicians. Wounds 2022. [DOI: 10.25270/wnds/21060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Chronic ulcers are associated with significant morbidity and mortality. Typical ulcers are due to venous insufficiency, diabetes, ischemia, pressure, and lymphedema. A chronic ulcer that does not respond to standard therapies should be reevaluated for potential atypical etiologies. Atypical ulcers are less common and more difficult to diagnose due to a wide range of possible etiologies, including inflammatory (autoimmune), neoplastic, vasculopathy, hematologic, infectious, drug-induced, or external. No standardized approach to the management of complex atypical ulcers exists. In this review, a stepwise approach to atypical ulcers is proposed with the aim of assisting physicians in their identification and diagnosis. If perfusion is adequate and there are no signs of infection, then the authors recommend obtaining an ulcer biopsy for microbiologic, DIF, and histopathologic evaluation as the criterion standard for diagnosis. Laboratory testing, including an autoimmune panel, a hypercoagulable panel, and an infectious diseases panel, can further aid in diagnosis. Atypical ulcers often require multidisciplinary care, with input from specialists in rheumatology, dermatology, infectious diseases, wound care, vascular surgery, hematology, and oncology. Effective communication within the health care team is essential for accurate diagnosis and management of atypical ulcers. Active dialogue between providers can improve consult efficiency and ultimately lower the cost of care.
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Hunt S, Ashack KA, Tsoukas M, Braniecki M. A co-existing dermoid and bronchogenic cyst on the back of a child. J Cutan Pathol 2021; 49:507-509. [PMID: 33590500 DOI: 10.1111/cup.13940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/03/2020] [Accepted: 12/13/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Samantha Hunt
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Kurt A Ashack
- Dermatology Associates of West Michigan, Grand Rapids, MI.,Michigan State University College of Human Medicine, Grand Rapids, MI
| | - Maria Tsoukas
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Marylee Braniecki
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois.,Department of Pathology, University of Illinois at Chicago College of Medicine, Chicago, Illinois
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Hessler M, Jalilian E, Xu Q, Reddy S, Horton L, Elkin K, Manwar R, Tsoukas M, Mehregan D, Avanaki K. Melanoma Biomarkers and Their Potential Application for In Vivo Diagnostic Imaging Modalities. Int J Mol Sci 2020; 21:E9583. [PMID: 33339193 PMCID: PMC7765677 DOI: 10.3390/ijms21249583] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/09/2020] [Accepted: 12/12/2020] [Indexed: 12/16/2022] Open
Abstract
Melanoma is the deadliest form of skin cancer and remains a diagnostic challenge in the dermatology clinic. Several non-invasive imaging techniques have been developed to identify melanoma. The signal source in each of these modalities is based on the alteration of physical characteristics of the tissue from healthy/benign to melanoma. However, as these characteristics are not always sufficiently specific, the current imaging techniques are not adequate for use in the clinical setting. A more robust way of melanoma diagnosis is to "stain" or selectively target the suspect tissue with a melanoma biomarker attached to a contrast enhancer of one imaging modality. Here, we categorize and review known melanoma diagnostic biomarkers with the goal of guiding skin imaging experts to design an appropriate diagnostic tool for differentiating between melanoma and benign lesions with a high specificity and sensitivity.
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Affiliation(s)
- Monica Hessler
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48201, USA; (M.H.); (Q.X.); (S.R.); (L.H.); (K.E.); (R.M.)
- Department of Dermatology, School of Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA;
| | - Elmira Jalilian
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60607, USA;
| | - Qiuyun Xu
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48201, USA; (M.H.); (Q.X.); (S.R.); (L.H.); (K.E.); (R.M.)
| | - Shriya Reddy
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48201, USA; (M.H.); (Q.X.); (S.R.); (L.H.); (K.E.); (R.M.)
| | - Luke Horton
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48201, USA; (M.H.); (Q.X.); (S.R.); (L.H.); (K.E.); (R.M.)
- Department of Dermatology, School of Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA;
| | - Kenneth Elkin
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48201, USA; (M.H.); (Q.X.); (S.R.); (L.H.); (K.E.); (R.M.)
- Department of Dermatology, School of Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA;
| | - Rayyan Manwar
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48201, USA; (M.H.); (Q.X.); (S.R.); (L.H.); (K.E.); (R.M.)
- Richard and Loan Hill Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Maria Tsoukas
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL 60607, USA;
| | - Darius Mehregan
- Department of Dermatology, School of Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA;
| | - Kamran Avanaki
- Richard and Loan Hill Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL 60607, USA;
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12
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Rajkumar J, Tsoukas M. 13399 Primary Tumor location predicts survival in melanoma: A retrospective cohort study of 239,257 cases. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Agnihotri G, Loucks E, Ashack K, Tsoukas M. Mycoplasma pneumoniae-associated mucositis complicated by herpes simplex virus dissemination and Staphylococcus Epidermidis bacteremia. Pediatr Dermatol 2020; 37:769-770. [PMID: 32500927 DOI: 10.1111/pde.14209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Prominent mucositis with minimal or no cutaneous involvement in the setting of Mycoplasma pneumoniae infection describes a clinical entity recently termed Mycoplasma-induced rash and mucositis (MIRM). About 81% of patients with MIRM experience complete resolution; however, the disease course in approximately 11% of patients is complicated by mucosal sequelae. We describe a patient with MIRM complicated by HSV dissemination and Staphylococcus epidermidis bacteremia and outline the management of mucocutaneous eruptions without systemic immunosuppressant agents.
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Affiliation(s)
- Gaurav Agnihotri
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Emily Loucks
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Kurt Ashack
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Maria Tsoukas
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
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Abstract
Neoplastic cells originating from a primary cancer can uncommonly spread to the skin, where they suggest a poor prognosis for the patient. In women, melanoma, breast, ovarian, oral cavity, and lung are the most common primary sources; in men, melanoma, lung, colon, and squamous cell carcinoma of the head and neck predominate. The classic presentation of cutaneous metastases is a firm, painless, flesh-colored to an erythematous dermal nodule (or nodules); however, several other presentations, including inflammatory, cicatricial, and bullous lesions, have been reported. Cutaneous metastases may also mimic benign conditions such as lipomas, hemangiomas, or cellulitis. A high degree of clinical suspicion is necessary, and the diagnosis is confirmed by biopsy, which may also be used to establish the primary malignancy if unknown, as the histopathologic appearance of the metastatic tissue may mimic the primary tumor. Treatments include excision of the metastases, chemotherapy, immunotherapy, radiation, and/or palliative care.
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Affiliation(s)
- Joanna Jaros
- Department of Internal Medicine, AMITA St. Joseph Hospital, Joliet, Illinois, USA
| | - Samantha Hunt
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Eucabeth Mose
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Olivia Lai
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Maria Tsoukas
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois, USA.
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Abstract
Many studies have investigated cutaneous reactions to antitumor drugs and found them to be quite numerous. We describe drug eruptions that may be associated with different therapies by class: antimetabolite chemotherapeutics, genotoxic agents, spindle inhibitors, signal transduction inhibitors, and immunotherapies. Methotrexate is most often associated with mucocutaneous reactions, alkylating antimetabolite agents with hyperpigmentation, and platinum antimetabolite agents with type I IgE-mediated hypersensitivity reactions. Anthracycline derivatives can induce the hand-foot syndrome in patients, and bleomycin is associated with a bleomycin-induced flagellate erythema. Taxane spindle inhibitors can result in acneiform eruptions, which may also be seen with use of epidermal growth factor receptor inhibitors. Imatinib and its derivatives can cause a truncal maculopapular eruption, whereas multikinase inhibitors can produce a hand-foot-skin reaction. Vemurafenib can result in squamous cell carcinomas and photosensitivity. First-generation mammalian target of rapamycin inhibitors may cause a maculopapular eruption initially involving the face and neck. Programmed death (PD)-1-ligand and receptor inhibitors are associated with bullous pemphigoid. Ipilimumab, targeting Cytotoxic -T- Lymphocyte- associated (CTLA-4) receptors, can cause a morbilliform reaction, whereas Interleukin -2 (IL-2) analogs can create the capillary leak syndrome. Chemotherapeutic drug eruptions classically can manifest in the aforementioned ways; however, it is important to understand that they are associated with myriad cutaneous adverse effects, which may be mistaken for organic skin disease. Oncologists prescribing these medications should be familiar with the cutaneous side effects of these medications, and so they may counsel patients to be on the lookout for them.
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Affiliation(s)
- Catherine Ludwig
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Vivien Goh
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Jeffrey Rajkumar
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Jeremiah Au
- Department of Dermatology, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Maria Tsoukas
- Department of Dermatology, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA.
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16
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Abstract
Advances in laser therapy have led to novel therapeutic approaches to common pediatric skin conditions. As a non-invasive alternative to surgical options, laser therapy is efficacious in treating a broad range of conditions, from vascular and pigmented lesions to tattoo and hair removal. This paper reviews the basic mechanics of laser therapy, its role in common pigmented pediatric dermatoses, and special considerations for this unique age group.
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17
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Abstract
Actinic keratoses (AKs) are atypical, precancerous proliferations of keratinocytes that develop because of chronic exposure to ultraviolet (UV) radiation. Treatment of AK can be lesion-directed or field-directed. Field cancerization theory postulates that the skin surrounding AK is also at increased risk for possible malignant transformation since it has been exposed to the same chronic UV light. Field-directed therapies thus have the potential to address subclinical damage, reduce AK recurrence rates, and potentially reduce the risk of squamous cell carcinoma (SCC) development. Published clinical studies have found lesion clearance rates ranging from 81 to 91% for photodynamic therapy (PDT) with either aminolevulinic acid (ALA) or methylaminolevulinate (MAL). Clinical studies have also been published on various topical treatments. Complete clinical clearance (CCC) was significantly higher in patients treated with a combination of 5-fluorouracil and salicylic acid (5-FU-SA) than in the vehicle group across multiple studies, and CCC ranged between 46 and 48% following treatment with imiquimod. Additionally, treatment with diclofenac sodium (DFS) found reduction in lesion sizes to range from 67 to 75%. Reported results have been similar for another non-steroidal anti-inflammatory drug (NSAID), piroxicam, which has more cyclooxygenase (COX)-1 activity than DFS. Active treatments with ingenol mebutate were also significantly more effective than vehicle at clearing AK lesions. All treatments resulted in mild, localized skin reactions. PDT using conventional light sources was associated with increased severity of pain and/or discomfort, while PDT using daylight as the light source was associated with less pain and occasionally no pain at all. Though no widely accepted algorithm for the treatment of AKs exists, field-directed therapy can be particularly useful for treating photo-exposed areas containing multiple AKs. Additional research with more direct comparisons between these field-directed therapies will help clinicians determine the best therapeutic approach. Here, we provide a balanced and comprehensive narrative review of the literature, considering both light-based and topical therapies with a focus on their field-therapy aspects, and propose a therapeutic algorithm for selecting an appropriate treatment in the clinical setting.
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Affiliation(s)
- Nathan Jetter
- University of Illinois College of Medicine, 808 S. Wood St. R380 MC624, Chicago, IL, 60612, USA
| | - Neha Chandan
- University of Illinois College of Medicine, 808 S. Wood St. R380 MC624, Chicago, IL, 60612, USA
| | - Stephanie Wang
- Department of Dermatology, University of Illinois College of Medicine, 808 S. Wood St., Suite 380, Chicago, IL, 60612, USA
| | - Maria Tsoukas
- Department of Dermatology, University of Illinois College of Medicine, 808 S. Wood St., Suite 380, Chicago, IL, 60612, USA.
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18
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Lake E, Tsoukas M. The town hall model in dermatology. Med Educ 2017; 51:545-546. [PMID: 28394047 DOI: 10.1111/medu.13319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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19
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Lake EP, Hughart R, Jones ST, Kreppel A, Tsoukas M, Harrington AT. Cutaneous Nocardiosis: A Conspicuous Eyelid Eschar. J Pediatr 2016; 177:327. [PMID: 27496269 DOI: 10.1016/j.jpeds.2016.06.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
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20
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Hughart R, Merrick M, Adelaja OT, Bleasdale SC, Harrington A, Tsoukas M. Cutaneous phaeohyphomycosis caused by Biatriospora mackinnonii in a renal transplant recipient. JAAD Case Rep 2016; 2:230-2. [PMID: 27299152 PMCID: PMC4890109 DOI: 10.1016/j.jdcr.2016.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Rosemara Hughart
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois
| | - Maria Merrick
- Department of Infectious Diseases, University of Illinois at Chicago, Chicago, Illinois
| | - Oluwatobi T Adelaja
- Department of Pathology, University of Illinois at Chicago, Chicago, Illinois
| | - Susan C Bleasdale
- Department of Infectious Diseases, University of Illinois at Chicago, Chicago, Illinois
| | - Amanda Harrington
- Department of Pathology, University of Illinois at Chicago, Chicago, Illinois
| | - Maria Tsoukas
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois
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21
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Farr OM, Ko BJ, Joung KE, Zaichenko L, Usher N, Tsoukas M, Thakkar B, Davis CR, Crowell JA, Mantzoros CS. Posttraumatic stress disorder, alone or additively with early life adversity, is associated with obesity and cardiometabolic risk. Nutr Metab Cardiovasc Dis 2015; 25:479-488. [PMID: 25770759 PMCID: PMC4404181 DOI: 10.1016/j.numecd.2015.01.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/02/2015] [Accepted: 01/23/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS There is some evidence that posttraumatic stress disorder (PTSD) and early life adversity may influence metabolic outcomes such as obesity, diabetes, and cardiovascular disease. However, whether and how these interact is not clear. METHODS We analyzed data from a cross-sectional and longitudinal study to determine how PTSD severity influences obesity, insulin sensitivity, and key measures and biomarkers of cardiovascular risk. We then looked at how PTSD and early life adversity may interact to impact these same outcomes. RESULTS PTSD severity is associated with increasing risk of obesity, diabetes, and cardiovascular disease, with higher symptoms correlating with higher values of BMI, leptin, fibrinogen, and blood pressure, and lower values of insulin sensitivity. PTSD and early life adversity have an additive effect on these metabolic outcomes. The longitudinal study confirmed findings from the cross sectional study and showed that fat mass, leptin, CRP, sICAM-1, and sTNFRII were significantly increased with higher PTSD severity during a 2.5 year follow-up period. CONCLUSIONS Individuals with early life adversity and PTSD are at high risk and should be monitored carefully for obesity, insulin resistance, and cardiometabolic risk.
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Affiliation(s)
- O M Farr
- Section of Endocrinology, VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA; Division of Endocrinology, Diabetes & Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - B-J Ko
- Division of Endocrinology, Diabetes & Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - K E Joung
- Division of Endocrinology, Diabetes & Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA
| | - L Zaichenko
- Section of Endocrinology, VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA; Division of Endocrinology, Diabetes & Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - N Usher
- Judge Baker Children's Center, Boston, MA 02120, USA
| | - M Tsoukas
- Section of Endocrinology, VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA; Division of Endocrinology, Diabetes & Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - B Thakkar
- Section of Endocrinology, VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA; Division of Endocrinology, Diabetes & Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Section of Endocrinology, Diabetes, and Nutrition, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - C R Davis
- Judge Baker Children's Center, Boston, MA 02120, USA
| | - J A Crowell
- Judge Baker Children's Center, Boston, MA 02120, USA; Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - C S Mantzoros
- Section of Endocrinology, VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA; Division of Endocrinology, Diabetes & Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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22
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23
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Kaminska ECN, Nwaneshiudu AI, Ruiz de Luzuriaga A, Tsoukas M, Bolotin D. Giant cellulitis-like Sweet syndrome in the setting of autoimmune disease. J Am Acad Dermatol 2014; 71:e94-5. [DOI: 10.1016/j.jaad.2014.03.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 03/06/2014] [Accepted: 03/10/2014] [Indexed: 01/03/2023]
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24
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Kaminska EC, Iyengar V, Tsoukas M, Shea CR. Borderline sebaceous neoplasm in a renal transplant patient without Muir-Torre syndrome. J Cutan Pathol 2012; 40:336-40. [PMID: 23174034 DOI: 10.1111/cup.12046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 05/26/2012] [Accepted: 09/06/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Edidiong C.N. Kaminska
- Section of Dermatology, Department of Medicine; University of Chicago Medical Center; Chicago IL USA
| | - Vivek Iyengar
- Section of Dermatology, Department of Medicine; University of Chicago Medical Center; Chicago IL USA
| | - Maria Tsoukas
- Section of Dermatology, Department of Medicine; University of Chicago Medical Center; Chicago IL USA
| | - Christopher R. Shea
- Section of Dermatology, Department of Medicine; University of Chicago Medical Center; Chicago IL USA
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25
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de Imus G, Golomb C, Wilkel C, Tsoukas M, Nowak M, Falanga V. Accelerated healing of pyoderma gangrenosum treated with bioengineered skin and concomitant immunosuppression. J Am Acad Dermatol 2001; 44:61-6. [PMID: 11148478 DOI: 10.1067/mjd.2001.107962] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pyoderma gangrenosum is a rare, destructive, neutrophilic dermatosis, the origin of which remains largely obscure. The ulcerative variant of this inflammatory disorder causes painful, necrotic, rapidly enlarging ulcers. Because of pathergy, many clinicians avoid managing these nonhealing ulcers with aggressive surgical debridement and autologous grafts. This article proposes that the application of an allogeneic cultured human skin equivalent (Graftskin) not only circumvents this problem, but also hastens re-epithelialization of the ulcer bed. An added benefit of the possible improvement of the cosmetic appearance of the final scar by preventing severe wound contracture is also postulated. We report a newly diagnosed case of ulcerative pyoderma gangrenosum; the use of bioengineered skin as an adjunct to concurrent immunosuppressive therapy with cyclosporine hastened the healing and diminished pain in a rapidly enlarging leg ulcer. Within 2 weeks, the ulcer was 30% to 40% healed, achieving 100% re-epithelialization within 6 weeks.
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Affiliation(s)
- G de Imus
- Department of Dermatology and Skin Surgery, Roger Williams Medical Center, Boston University School of Medicine, Providence, RI 02908, USA
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