Perforating lichen nitidus is a rare subtype of lichen nitidus, with approximately 11 cases reported worldwide. Lesions typically present in young male patients at sites prone to mechanical irritation, including the hands, feet, forearms, elbows, and knees. Classic histopathologic features of perforating lichen nitidus show a lymphohistiocytic infiltrate within the papillary dermis between hyperplastic rete ridges with transepidermal elimination of dermal contents. Very few cases are reported in the literature of lichen nitidus and its association with atopic dermatitis. This is the first case describing perforating lichen nitidus in a patient with a history of atopic dermatitis being treated with dupilumab injections. Lesions of perforating lichen nitidus worsened with successful treatment of atopic dermatitis. These findings suggest a unique pathophysiology of perforating lichen nitidus lesions.

As primary care providers and experts on diseases affecting the skin, such as herpes zoster (shingles) and human papillomavirus-related cancers, dermatologists are often asked to make important recommendations on vaccines and vaccinations; however, a rise in antivaccine attitudes-sometimes referred to as "vaccine hesitancy"-among patient populations, especially in North America and Europe, has created new challenges for the practicing dermatologist. Here we provide a brief overview of some of the major evidence that refutes commonly held misperceptions about vaccines.

Background The rates of short-term clearance of actinic keratoses appear to be comparable in clinical trials of topical treatments used in field therapy, but direct comparisons of efficacy results can be problematic. Trials use different efficacy end points, have different study designs, involve different anatomic sites, and enroll different patient populations. In addition, because adherence in real-world clinical practice differs from that observed in clinical trials, conclusions drawn from efficacy outcomes can be misleading. The objective of this review was to examine the efficacy end points used in studies of topical therapy for actinic keratosis, address other factors influencing efficacy outcomes in these studies, and discuss the possible influence of nonadherence on effectiveness.Methods Review of the available literature on topical therapy for actinic keratosis.Results The end points used to determine efficacy of therapies for actinic keratosis include a disparate group of outcomes, which can often make comparison between studies impossible.Conclusions Efficacy end points of clinical studies designed to assess the treatment of actinic keratosis should be standardized to facilitate between-trial comparisons, and studies should focus on the end points that are most clinically relevant.

The rates of short‐term clearance of actinic keratoses appear to be comparable in clinical trials of topical treatments used in field therapy, but direct comparisons of efficacy results can be problematic. Trials use different efficacy end points, have different study designs, involve different anatomic sites, and enroll different patient populations. In addition, because adherence in real‐world clinical practice differs from that observed in clinical trials, conclusions drawn from efficacy outcomes can be misleading. The objective of this review was to examine the efficacy end points used in studies of topical therapy for actinic keratosis, address other factors influencing efficacy outcomes in these studies, and discuss the possible influence of nonadherence on effectiveness.

According to survey data, 35-69% of patients with skin disease have used complementary and alternative medicine (CAM) in their lifetime. A literature search on this subject reveals a number of studies on the efficacy of CAM treatment for dermatologic conditions, as well as a number of articles showing the growing prevalence of CAM use amongst patients suffering from these conditions. Given the consensus amongst these articles that dermatologists require increased education on CAM, this paper presents an overview of some of the most widely used systems of alternative medicine to serve as a tool for practicing dermatologists. Specifically, the history and theory behind psychocutaneous therapies, traditional Chinese medicine (including acupuncture), homeopathy, and Ayurvedic medicine will be described, along with current evidence for their efficacy and reports of their adverse effects. The authors conclude that more evidence and better studies are needed for each of the major CAM modalities before they may be considered as independent therapeutic options. Moreover, given the shortage of evidence supporting the efficacy and safety of CAM, dermatologists should obtain a thorough history of CAM use from their patients. In general, ingestible substances including most homeopathic, Ayurvedic, and traditional Chinese medicine herbal formulations that are not US FDA regulated should be viewed with caution as they may cause severe adverse effects such as arsenicosis and hepatotoxicity. On the other hand, less invasive techniques such as acupuncture and psychocutaneous therapies may be more acceptable given their low-risk profile. Ultimately, until the availability of more sound data, these treatments should primarily be used in combination with conventional treatment and rarely independently.

According to survey data, 35–69% of patients with skin disease have used complementary and alternative medicine (CAM) in their lifetime. A literature search on this subject reveals a number of studies on the efficacy of CAM treatment for dermatologic conditions, as well as a number of articles showing the growing prevalence of CAM use amongst patients suffering from these conditions. Given the consensus amongst these articles that dermatologists require increased education on CAM, this paper presents an overview of some of the most widely used systems of alternative medicine to serve as a tool for practicing dermatologists. Specifically, the history and theory behind psychocutaneous therapies, traditional Chinese medicine (including acupuncture), homeopathy, and Ayurvedic medicine will be described, along with current evidence for their efficacy and reports of their adverse effects. The authors conclude that more evidence and better studies are needed for each of the major CAM modalities before they may be considered as independent therapeutic options. Moreover, given the shortage of evidence supporting the efficacy and safety of CAM, dermatologists should obtain a thorough history of CAM use from their patients. In general, ingestible substances including most homeopathic, Ayurvedic, and traditional Chinese medicine herbal formulations that are not US FDA regulated should be viewed with caution as they may cause severe adverse effects such as arsenicosis and hepatotoxicity. On the other hand, less invasive techniques such as acupuncture and psychocutaneous therapies may be more acceptable given their low-risk profile. Ultimately, until the availability of more sound data, these treatments should primarily be used in combination with conventional treatment and rarely independently.

The treatment of patients with advanced or recurrent endometrial cancer remains problematic, because chemotherapy and hormonal therapy have yielded low response rates and limited progression‐free survival. Because the combination of gemcitabine and cisplatin demonstrated synergism in preclinical studies, the authors attempted to determine the efficacy and toxicity of this combination in women with advanced or recurrent endometrial cancer.

OBJECTIVE:To evaluate the possible association of Parkinson disease (PD) and melanoma in North America.DESIGN, SETTING, AND PATIENTS:Thirty-one centers enrolled patients with idiopathic PD. At visit 1, a neurologist obtained a medical history. At visit 2, a dermatologist recorded melanoma risk factors, performed a whole-body examination, and performed a biopsy of lesions suggestive of melanoma for evaluation by a central dermatopathology laboratory. We compared overall prevalence of melanoma with prevalence calculated from the US Surveillance Epidemiology and End Results (SEER) cancer database and the American Academy of Dermatology skin cancer screening programs.RESULTS:A total of 2106 patients (mean [SD] age, 68.6 [10.6] years; duration of PD, 7.1 [5.7] years) completed the study. Most (84.8%) had received levodopa. Dermatology examinations revealed 346 pigmented lesions; dermatopathological findings confirmed 20 in situ melanomas (0.9%) and 4 invasive melanomas (0.2%). In addition, histories revealed 68 prior melanomas (3.2%). Prevalence (5-year limited duration) of invasive malignant melanoma in the US cohort of patients with PD (n = 1692) was 2.24-fold higher (95% confidence interval, 1.21-4.17) than expected in age- and sex-matched populations in the US SEER database. Age- or sex-adjusted relative risk of any melanoma for US patients was more than 7 times that expected from confirmed cases in American Academy of Dermatology skin cancer screening programs.CONCLUSIONS:Melanoma prevalence appears to be higher in patients with PD than in the general population. Despite difficulties in comparing other databases with this study population, the study supports increased melanoma screening in patients with PD.

The Global Alliance to Improve Outcomes in Acne published recommendations for the management of acne as a supplement to the Journal of the American Academy of Dermatology in 2003. The recommendations incorporated evidence-based strategies when possible and the collective clinical experience of the group when evidence was lacking. This update reviews new information about acne pathophysiology and treatment-such as lasers and light therapy-and relevant topics where published data were sparse in 2003 but are now available including combination therapy, revision of acne scarring, and maintenance therapy. The update also includes a new way of looking at acne as a chronic disease, a discussion of the changing role of antibiotics in acne management as a result of concerns about microbial resistance, and factors that affect adherence to acne treatments. Summary statements and recommendations are provided throughout the update along with an indication of the level of evidence that currently supports each finding. As in the original supplement, the authors have based recommendations on published evidence as much as possible.

Background  The armadillo was the first animal model of leprosy. Its role in the transmission of leprosy remains controversial. The sooty mangabey model of leprosy led to the discovery that rhesus monkeys were more susceptible to leprosy when coinfected with simian immunodeficiency virus (SIV), but that leprosy may play a protective role against acquired immunodeficiency syndrome (AIDS) mortality. Recently, molecular methods have been developed for leprosy and may help resolve the role of zoonoses in leprosy.

A phase 4, open-label, multicenter, community-based study was conducted in subjects with mild to moderately severe papulopustular rosacea of various etiologies and locations to identify subgroups particularly responsive to twice-daily application of metronidazole topical gel 0.75% to the affected areas of the face. A total of 582 subjects were randomized. Evaluations were conducted at baseline and at weeks 4, 8, and 12. At each evaluation, investigator global assessment (IGA) scores, mean papule and pustule counts, erythema scores, and telangiectasia scores improved significantly (P < .0001), with consistent results across sex and age subgroups. The mean erythema severity score decreased significantly (P < .0001) from baseline by week 4 and continued to decline at all study visits, with a nearly 50% reduction by week 12. At study end, subjects indicated a 25% improvement in itching, pain, soreness, or stinging; a 53% improvement in embarrassment or self-consciousness; and a 31% improvement in rosacea's effect on social or leisure activities. Metronidazole topical gel 0.75% was associated with a very low incidence of side effects in this trial, similar to previous clinical trials. The most common treatment-related adverse event (AE) reported in this study was mild application-site discomfort. The gel formulation was well-tolerated and effective in all subject subgroups and in a variety of climates. The findings of this study expand the collected data on the efficacy and safety of metronidazole topical gel 0.75% beyond that demonstrated in controlled clinical trials and confirm the utility of this therapy in the community setting.

respectively, p <0.001). In Study B, 33% of patients treated with diclofenac 3% gel for 60 days achieved complete clearance (TLNS = 0), compared with 10% of placebo patients (p <0.05) (8). Complete lesion clearance, however, is an extremely rigorous study end-point that can underestimate the clinical benefits of a treatment as a patient who ex - periences a resolution of 9 out of 10 lesions would be classed as a failure, and frequently patients experience an increase in lesion count during treatment due to the appearance of subclinical lesions. Partial clearance (≥75%), therefore, has been proposed as a more clini- cally meaningful end-point and has been used in other clinical trials investigating treatments for AK (11-13). A recent open-label study, evaluating the efficacy of diclo - fenac 3% gel, showed that 78% of patients had at least a 75% clearance after 90 days of treatment, rising to 85% at the post-treatment follow up on day 120 (9). Based on this rationale, we re-analyzed the TLNS and CLNS data from the two randomized, double-blind, placebo-controlled, multicenter studies (Study A (7) and Study B (8) in order to establish the proportion of patients achieving a lesion clearance rate of ≥75%.

International Journal of DermatologyVolume 46, Issue 1 p. 94-98 Randomized, double-blind clinical evaluation of the efficacy and safety of topical eflornithine HCl 13.9% cream in the treatment of women with facial hair John E. Wolf Jr MD, John E. Wolf Jr MD From the Baylor College of Medicine, Houston, TX, Gillette Advanced Technology Center/US, Needham, MA, Bristol-Myers Squibb, Princeton, NJSearch for more papers by this authorDouglas Shander PhD, Douglas Shander PhD From the Baylor College of Medicine, Houston, TX, Gillette Advanced Technology Center/US, Needham, MA, Bristol-Myers Squibb, Princeton, NJSearch for more papers by this authorFerdinand Huber BS, Ferdinand Huber BS From the Baylor College of Medicine, Houston, TX, Gillette Advanced Technology Center/US, Needham, MA, Bristol-Myers Squibb, Princeton, NJSearch for more papers by this authorJoseph Jackson PhD, Joseph Jackson PhD From the Baylor College of Medicine, Houston, TX, Gillette Advanced Technology Center/US, Needham, MA, Bristol-Myers Squibb, Princeton, NJSearch for more papers by this authorChen-Sheng Lin PhD, Chen-Sheng Lin PhD From the Baylor College of Medicine, Houston, TX, Gillette Advanced Technology Center/US, Needham, MA, Bristol-Myers Squibb, Princeton, NJSearch for more papers by this authorBarbara M. Mathes MD, Barbara M. Mathes MD From the Baylor College of Medicine, Houston, TX, Gillette Advanced Technology Center/US, Needham, MA, Bristol-Myers Squibb, Princeton, NJSearch for more papers by this authorKathy Schrode PhD, Kathy Schrode PhD From the Baylor College of Medicine, Houston, TX, Gillette Advanced Technology Center/US, Needham, MA, Bristol-Myers Squibb, Princeton, NJSearch for more papers by this authorthe Eflornithine HCl Study Group, the Eflornithine HCl Study Group Eflornithine study group: Wilma F. Bergfeld, MD, Francisco Camacho, MD, Adrian S. Dobs, MD, Frank Dunlap, MD, Maria Hordinsky, MD, Irving H. Katz, MD, Mark Lebwohl, MD, Amy McMichael, MD, Elise A. Olsen, MD, David M. Pariser, MD, Daniel Piacquadio, MD, Vera Price, MD, Geoffrey P. Redmond, MD, David Rodriguez, MD, Marty E. Sawaya, MD PhD, Jonathan S. Weiss, MD, David A. Whiting, MD, David C. Wilson, MD, John E. Wolf, Jr. MDSearch for more papers by this author John E. Wolf Jr MD, John E. Wolf Jr MD From the Baylor College of Medicine, Houston, TX, Gillette Advanced Technology Center/US, Needham, MA, Bristol-Myers Squibb, Princeton, NJSearch for more papers by this authorDouglas Shander PhD, Douglas Shander PhD From the Baylor College of Medicine, Houston, TX, Gillette Advanced Technology Center/US, Needham, MA, Bristol-Myers Squibb, Princeton, NJSearch for more papers by this authorFerdinand Huber BS, Ferdinand Huber BS From the Baylor College of Medicine, Houston, TX, Gillette Advanced Technology Center/US, Needham, MA, Bristol-Myers Squibb, Princeton, NJSearch for more papers by this authorJoseph Jackson PhD, Joseph Jackson PhD From the Baylor College of Medicine, Houston, TX, Gillette Advanced Technology Center/US, Needham, MA, Bristol-Myers Squibb, Princeton, NJSearch for more papers by this authorChen-Sheng Lin PhD, Chen-Sheng Lin PhD From the Baylor College of Medicine, Houston, TX, Gillette Advanced Technology Center/US, Needham, MA, Bristol-Myers Squibb, Princeton, NJSearch for more papers by this authorBarbara M. Mathes MD, Barbara M. Mathes MD From the Baylor College of Medicine, Houston, TX, Gillette Advanced Technology Center/US, Needham, MA, Bristol-Myers Squibb, Princeton, NJSearch for more papers by this authorKathy Schrode PhD, Kathy Schrode PhD From the Baylor College of Medicine, Houston, TX, Gillette Advanced Technology Center/US, Needham, MA, Bristol-Myers Squibb, Princeton, NJSearch for more papers by this authorthe Eflornithine HCl Study Group, the Eflornithine HCl Study Group Eflornithine study group: Wilma F. Bergfeld, MD, Francisco Camacho, MD, Adrian S. Dobs, MD, Frank Dunlap, MD, Maria Hordinsky, MD, Irving H. Katz, MD, Mark Lebwohl, MD, Amy McMichael, MD, Elise A. Olsen, MD, David M. Pariser, MD, Daniel Piacquadio, MD, Vera Price, MD, Geoffrey P. Redmond, MD, David Rodriguez, MD, Marty E. Sawaya, MD PhD, Jonathan S. Weiss, MD, David A. Whiting, MD, David C. Wilson, MD, John E. Wolf, Jr. MDSearch for more papers by this author First published: 03 January 2007 https://doi.org/10.1111/j.1365-4632.2006.03079.xCitations: 87 Dr John E. Wolf, Jr, MD Baylor College of Medicine Suite 1050 1709 Dryden Houston TX 77030-3411 USA E-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume46, Issue1January 2007Pages 94-98 RelatedInformation

Rosacea is an inflammatory dermatologic disorder characterized by the presence of facial erythema, visible blood vessels, papules, and pustules. The National Rosacea Society has established a classification system that identifies 4 distinct rosacea subtypes based on clinical presentation: erythematotelangiectatic, papulopustular, phymatous, and ocular. The goal of topical therapy for rosacea is to reduce inflammatory lesion counts; decrease intensity of erythema; and reduce symptoms such as stinging, burning, and pruritus. Metronidazole and azelaic acid are thought to reduce the inflammation associated with rosacea by inhibiting the production of reactive oxygen species produced by neutrophils. Both metronidazole 1% gel and azelaic acid 15% gel recently have been approved for the treatment of rosacea. The current study was conducted to compare the once-daily application of metronidazole 1% gel with twice-daily applications of azelaic acid 15% gel for the treatment of patients with moderate rosacea (N=160). Both treatments showed similar reductions in inflammatory lesion counts (77% for metronidazole 1% gel and 80% for azelaic acid 15% gel) and high success rates in both global severity (53.7% vs 56.4% for metronidazole 1% gel and azelaic acid 15% gel, respectively) and erythema (42.7% vs 42.3% for metronidazole 1% gel and azelaic acid 15% gel, respectively). On average, the efficacy (including reduction in erythema) of the once-daily application of metronidazole 1% gel and twice-daily applications of azelaic acid 15% gel were similar.

Adverse events and a high potential for cutaneous irritation may have a negative effect on patient adherence to acne treatments, the primary factor contributing to optimal outcomes. In addition to effectiveness and subject satisfaction, the Measuring Acne Outcomes in a Real-World Experience (MORE) trial evaluated adverse events and cutaneous tolerability of adapalene gel 0.1% in 1396 subjects who received initial combination therapy with adapalene gel 0.1% and 468 subjects who added adapalene gel 0.1% to their existing regimen (safety population). Adverse events were uncommon (reported by 5.8% of subjects) and generally mild, the most frequent being skin and subcutaneous tissue disorders (2.7%). Overall, investigators rated cutaneous tolerability as high. Adherence to therapy also was high with both the initial combination and add-on therapies. The MORE trial confirms that adapalene gel 0.1% is safe and well tolerated and therefore likely to enhance adherence to treatment and the likelihood of optimal treatment outcomes for patients with moderate to moderately severe acne.

Despite its prevalence, rosacea has not received the same attention of researchers as other dermatologic disorders. Nevertheless, new pharmacologic and nonpharmacologic therapies for the condition continue to be developed. The future of rosacea treatment will probably involve a combination of drugs and devices. Certain core therapies (i.e., topical metronidazole, topical azelaic acid, oral tetracyclines, and topical sulfur/sodium sulfacetamide) are validated by the greatest amount of high-order clinical evidence and will undoubtedly remain first-line therapeutic choices. However, more research is necessary to validate the efficacy and safety of newer pharmacologic agents and light-based therapy. Because rosacea is a chronic condition, pharmacologic maintenance therapy is necessary to maintain remission.

The above faculty engaged in a lively discussion about the rosacea disease state, its pharmacologic and nonpharmacologic interventions, and the evidence supporting use of these interventions.