Publications by authors named "Amor Khachemoune"

225 Publications

Therapeutic Use of Trace Elements in Dermatology.

Altern Ther Health Med 2021 Jul 16. Epub 2021 Jul 16.

Trace elements (microminerals) play a role in many physiological functions, including hormone production and cellular growth. However, their importance in diagnosing and treating dermatologic disease has not been well examined. In this review, we discuss the functions, sources, and recommended requirements of each micromineral. In addition, we analyze the systemic and dermatological manifestations associated with micromineral imbalances. The pathogenesis of genodermatoses, such as Wilson disease, Menkes disease, acrodermatitis enteropathica, and allergic dermatitis, are also discussed. Included are studies examining the potential therapeutic role of zinc, selenium, and copper in inflammatory diseases, skin cancer, and photoaging.
View Article and Find Full Text PDF

Download full-text PDF

Source
July 2021

Review of Perineural Invasion in Keratinocyte Carcinomas.

Am J Clin Dermatol 2021 Jun 8. Epub 2021 Jun 8.

Brooklyn Campus of the VA NY Harbor Healthcare System, 800 Poly Place, Brooklyn, NY, 11209, USA.

Perineural invasion is an infiltrative process of peripheral nerves by the primary neoplasm within the immediate vicinity. Aggressive forms of keratinocyte carcinomas, such as basal cell and squamous cell carcinomas, may feature perineural invasion, which is often associated with tumor recurrence and poorer prognosis. Diagnosis requires a high clinical suspicion. Imaging and histopathology are used to assess for extent of disease while surgical excision with complete circumferential peripheral and margin assessment is the treatment goal. However, there is still significant uncertainty about adjuvant chemotherapy and definitive management guidelines. Here, we summarize the current understanding of this complex pathogenic process, the clinical presentation, and the significance of perineural inflammation. We also discuss the recommendations about staging, prognosis, adjuvant radiotherapy, and general guidelines for managing keratinocyte carcinomas with perineural invasion. A better understanding of perineural invasion is essential to improve diagnosis, tailor interventions, and mitigate patient morbidity and mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40257-021-00615-6DOI Listing
June 2021

A review of Nigella sativa plant-based therapy in dermatology.

Int J Dermatol 2021 Apr 26. Epub 2021 Apr 26.

Veterans Affairs Medical Center, Brooklyn, NY, USA.

Nigella sativa (N. sativa) is a widely used medicinal herb with a rich cultural and religious history in Unani, Ayurveda, Chinese, and Arabic medicine. N. sativa contains many natural bioactive agents including alkaloids, saponins, alpha-hederin, and thymoquinone that contribute to its broad range of benefits as a diuretic, bronchodilator, antihypertensive, antidiabetic, and analgesic. In addition, N. sativa possesses antimicrobial, anti-inflammatory, and antineoplastic effects, making it an interesting potential therapy for the treatment of dermatological conditions. This article reviews the current literature surrounding the pharmacological effects of N. sativa for the treatment of acne vulgaris, melanoma, vitiligo, atopic dermatitis, plaque psoriasis, and wound healing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ijd.15615DOI Listing
April 2021

Vibrio vulnificus: Review of Mild to Life-threatening Skin Infections.

Cutis 2021 Feb;107(2):E12-E17

Ms. Coerdt is from the Georgetown University School of Medicine, Washington, District of Columbia. Dr. Khachemoune is from the Department of Dermatology, SUNY Downstate, Brooklyn, and the Department of Dermatology, Brooklyn Campus of the VA NY Harbor Healthcare System.

Vibrio vulnificus is a motile, gram-negative, halophilic, aquatic bacterium that is part of the normal estuarine microbiome and typically is found in warm coastal waters. Infection with the pathogen typically is due to consumption of contaminated seafood or exposure to contaminated seawater. Vibrio vulnificus has a mortality rate of almost 33% in the United States and is responsible for more than 95% of seafood-related deaths in the United States. Vibrio vulnificus can cause a vast spectrum of diseases, such as gastroenteritis, cellulitis, necrotizing fasciitis, and sepsis. Gastroenteritis is self-limited, whereas septicemia often is fatal. Gastroenteritis and septicemia are caused by ingestion of contaminated shellfish, whereas wound infections and necrotizing fasciitis are caused by exposure to contaminated seawater or handling of contaminated seafood. Septicemia is the most common presentation of V vulnificus and accounts for the most fatalities from the bacteria. Prompt diagnosis and treatment are vital to prevent mortality. It is important to keep V vulnificus on the differential when a patient presents with bullae or cellulitis or has a history of raw seafood consumption or exposure to brackish water, as missing the diagnosis could lead to necrotizing fasciitis, sepsis, and death.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12788/cutis.0183DOI Listing
February 2021

Surgical instrument disinfection during the era of COVID-19.

Dermatol Online J 2021 Feb 15;27(2). Epub 2021 Feb 15.

Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY.

View Article and Find Full Text PDF

Download full-text PDF

Source
February 2021

Surgical Site Infection After Dermatologic Procedures: Critical Reassessment of Risk Factors and Reappraisal of Rates and Causes.

Am J Clin Dermatol 2021 Jul;22(4):503-510

Department of Dermatology, State University of New York Downstate, Veterans Affairs Medical Center, 800 Poly Place, Brooklyn, NY, 11209, USA.

While rates are low, surgical site infections are the most common complication of dermatologic surgery. Surgical site infections have important consequences including impairment of wound healing, suboptimal cosmetic outcome, hospitalization, increased healthcare costs, and rarely, systemic infection. It is imperative to understand the risk factors and existing preventative measures to minimize the development of infection. This article reviews the available literature regarding surgical site infections following dermatologic procedures, to evaluate the standard of diagnosis and role of wound culture, risk factors, mimicking conditions, and significance of antibiotic prophylaxis. We offer a critical reassessment of the current literature on risk factors and reappraisal of infection rates to promote evidence-based patient care. We conclude that the strongest evidence suggests that diabetes mellitus is likely associated with increased surgical site infections. Immunosuppression is often clinically considered a risk factor; however, the evidence is mixed. In general the addition of antibiotics does not confer benefit except in high-risk sites. Conclusively, Mohs micrographic surgery has been proven safe in office and inpatient settings. We agree that sterile glove use for simple procedures is likely not a significant factor in the development of surgical site infections; however, we hypothesize that the overall sterile technique and setting may play a role in longer and/or more complex procedures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40257-021-00599-3DOI Listing
July 2021

Reappraising Elements of the Aseptic Technique in Dermatology: A Review.

Dermatol Pract Concept 2021 Jan 29;11(1):e2021126. Epub 2021 Jan 29.

Veterans Affairs Medical Center, Brooklyn, NY, USA.

Dermatologic procedures are performed under varying degrees of antisepsis, and no clear guidelines exist regarding the role of the aseptic technique in dermatology. This review aims to clarify the terminology surrounding surgical asepsis and examines the importance of various components of the aseptic technique in cutaneous surgery. Included are studies examining optimal glove type, surgical instruments, skin antisepsis, and cost-reducing protocols. Our review highlights that most dermatology procedures are not performed under completely sterile conditions due to the lack of environmental and foot traffic controls in dermatology offices. In addition, for some outpatient procedures, such as for minor excisions and Mohs surgery before reconstruction, elements of the clean technique can be used without increasing infection rates. However, data on the feasibility of a clean protocol for Mohs reconstruction is conflicting. Future prospective, randomized trials analyzing various components of the aseptic technique in dermatology are greatly needed so that guidelines can be established for practicing dermatologists.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5826/dpc.1101a126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7875669PMC
January 2021

Review and reappraisal of assessment parameters of second intention healing after Mohs micrographic surgery.

Arch Dermatol Res 2021 Feb 20. Epub 2021 Feb 20.

Department of Dermatology, State University of New York Downstate, Veterans Affairs Medical Center, 800 Poly Place, Brooklyn, NY, 11209, USA.

Mohs micrographic surgery (MMS) is used to remove cutaneous tumors in cosmetically sensitive anatomic areas. Surgeons can provide several reconstructive options to patients following tumor removal, including primary closure, skin grafts, local, regional or free flaps, and secondary intention healing (SIH). Notably, with the advancement of surgical and reconstructive techniques, the use of second intention healing has declined and may be underutilized. This review aims to critically evaluate the literature regarding indications, anatomical considerations, advantages, and complications of second intention wound healing following Mohs surgery. We also offer reappraisal of SIH following MMS to promote evidence-based postoperative care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00403-021-02209-yDOI Listing
February 2021

Tender nodules on the foot and buttock.

JAAPA 2021 Mar;34(3):55-56

Samiya Khan is a student in the Long School of Medicine at the University of Texas Health Science Center at San Antonio. Amor Khachemoune is on the faculty at SUNY Downstate Medical Center and practices at the Veterans Affairs Medical Center, both in Brooklyn, N.Y. The authors have disclosed no potential conflicts of interest, financial or otherwise.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/01.JAA.0000733280.28389.c1DOI Listing
March 2021

An updated review of the sebaceous gland and its role in health and diseases Part 2: Pathophysiological clinical disorders of sebaceous glands.

Dermatol Ther 2021 03 19;34(2):e14862. Epub 2021 Feb 19.

Veterans Affairs Hospital and SUNY Downstate Dermatology Service, Brooklyn, New York, USA.

Sebaceous glands are sebum-secreting components of pilosebaceous units. In the second of this two-part series, we review the pathologies in which sebaceous glands are primarily and secondarily implicated. They are primarily involved in steatocystoma simplex and multiplex, sebaceous gland hyperplasia, sebaceoma, sebaceous adenoma, sebaceous carcinoma, nevus sebaceus, and folliculosebaceous cystic hamartoma. Sebaceous glands are secondarily involved in acne vulgaris, seborrheic dermatitis, and androgenic alopecia. Steatocystoma multiplex is a benign congenital anomaly presenting as yellow cysts primarily on the upper body. Sebaceous gland hyperplasia is characterized by yellow, telangiectatic papules with a central dell, and it can be treated with topical retinoids or surgical excision. Sebaceoma clinically presents on the head and neck region as a skin-colored nodule and can be distinguished by immunohistochemistry. Stains used in the diagnosis of sebaceous adenoma and carcinoma include epithelial membrane antigen and adipophilin immunoperoxidase. Surgical excision is the preferred treatment for sebaceoma, sebaceous adenoma, and sebaceous carcinoma. Excision is not always indicated for nevus sebaceus. Folliculosebaceous cystic hamartoma is a relatively rare condition exhibiting both epithelial and mesenchymal components. Patients with acne vulgaris commonly present with papules of closed and open comedones displaying hypercornification. Seborrheic dermatitis presents as sharply demarcated yellow or red patches or plaques; antifungal agents, corticosteroids, and combination antifungal/anti-inflammatory therapies are common treatment modalities. As a result of hair follicle miniaturization, females with androgenic alopecia present with diffuse hair thinning, while men tend to present with balding and hairline recession.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/dth.14862DOI Listing
March 2021

Is the first-line systemic chemoprevention of nonmelanoma skin cancer nicotinamide or acitretin?

Int J Dermatol 2021 Jun 9;60(6):749-750. Epub 2021 Feb 9.

Brooklyn Campus of the VA NY Harbor Healthcare System, Brooklyn, NY, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ijd.15442DOI Listing
June 2021

An updated review of the sebaceous gland and its role in health and diseases Part 1: Embryology, evolution, structure, and function of sebaceous glands.

Dermatol Ther 2021 01 1;34(1):e14695. Epub 2021 Jan 1.

Veterans Affairs Hospital and SUNY Downstate Dermatology Service, Brooklyn, New York, USA.

Sebaceous glands are sebum-secreting components of pilosebaceous units. The embryological development of the sebaceous gland follows that of the hair follicle and epidermal tissue, beginning between weeks 13 and 16 of fetal development. New sebaceous glands do not normally develop following birth, but their size increases with age. Sebocytes express a multitude of hormone receptors and are heavily regulated to secrete sebum by androgens. There is a large increase of sebum excretion at birth and again at puberty, until approximately age 17. In adulthood, sebum production remains stable and declines to zero in postmenopausal women and in men aged 60-70. Besides the production and release of sebum, sebaceous glands function to lubricate the skin and hair, provide thermoregulation, and exhibit antimicrobial activity. Research has shown sebaceous glands to possess the cellular capability to transcribe genes necessary for androgen metabolism. Dysfunction of the sebaceous gland can be seen primarily in steatocystoma simplex and multiplex, sebaceous gland hyperplasia, sebaceoma, sebaceous adenoma, sebaceous carcinoma, nevus sebaceus, and folliculosebaceous cystic hamartoma. Sebaceous glands are secondarily involved in acne vulgaris, seborrheic dermatitis, and androgenic alopecia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/dth.14695DOI Listing
January 2021

Neuropathic ulcers: a focused review.

Int J Dermatol 2020 Dec 17. Epub 2020 Dec 17.

Department of Dermatology, State University of New York Downstate, Brooklyn, NY, USA.

Neuropathic ulcers or diabetic foot ulcers are preventable ulcers associated with diabetes mellitus. These ulcers occur in the setting of unrecognized trauma, peripheral neuropathy, and foot deformities; however, they are often complicated by peripheral arterial disease and infection. Approximately 15% of individuals with a neuropathic ulcer require limb amputation as a result of infection. Not only are neuropathic ulcers a burden to the patient but also to the economy. The cost of diabetic foot ulcer care is approximately $1.38 billion per year. This makes neuropathic ulcers an important therapeutic target. This review presents the pathophysiology, clinical presentation, evaluation, management, and prevention of neuropathic ulcers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ijd.15362DOI Listing
December 2020

Pediatric teledermatology: A review of the literature.

Pediatr Dermatol 2021 Jan 9;38(1):39-44. Epub 2020 Dec 9.

Veterans Affairs Medical Center, Brooklyn, NY, USA.

Skin complaints are common among pediatric patients, yet as of 2020, fewer than 400 board-certified pediatric dermatologists currently practice in the United States. Pediatric teledermatology may address barriers to dermatologic care in children, assisting with distant geographic locations and long wait times. A review of the literature was conducted to synthesize important features of teledermatology for pediatric dermatologists. We summarize types of telemedicine platforms, common dermatologic conditions seen by pediatric teledermatologists, diagnostic accuracy and concordance, and guidelines from the American Academy of Dermatology and the American Telemedicine Association regarding teledermatology. This report highlights the utility of pediatric telemedicine in both the outpatient and inpatient dermatology setting to increase access to high-quality dermatologic care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/pde.14479DOI Listing
January 2021

Vitamins A, B, C, and D: A Short Review for the Dermatologist.

Altern Ther Health Med 2020 Nov 27. Epub 2020 Nov 27.

Background: Vitamins and their derivatives are used extensively in the field of dermatology to treat a range of conditions, both benign and malignant. Additionally, over the past decade, vitamin supplements have been heavily advertised for improving overall health. Due to the widespread use of vitamins and their derivatives for dermatologic conditions, a comprehensive review of the evidence is needed.

Objective: Here we review several of the well-established uses of vitamins A, B, C, and D in the management of dermatologic conditions ranging from acne vulgaris to malignant melanoma. Additionally, we examine the dermatologic consequences of both deficiency and excess of vitamins A, B, C, and D. Finally, we delve into newer applications for these vitamins and evaluate the evidence behind them.

Conclusion: Vitamins, in both topical and oral forms, play a key role in treating many dermatologic conditions. Some of the newer applications of vitamins, such as the use of vitamin B3 for non-melanoma skin cancer prevention, vitamin B6 for prevention of chemotherapy-induced alopecia, and vitamin C as an adjuvant treatment for malignant melanoma, appear promising. Further data is needed to validate these findings. Additionally, many people use vitamin B7 for hair, skin, and nail health. There is evidence that supports vitamin B7 supplementation in patients with uncombable hair syndrome, brittle nail syndrome, and seborrheic dermatitis. Some studies Some studies have also demonstrated a benefit in healthy individuals, although other studies have shown a neutral effect. Further randomized controlled trials are needed. Likewise, the use of vitamin D for the treatment of atopic dermatitis has conflicting results and requires further investigation. New research continues to emerge regarding vitamin supplementation, and it is an important topic for dermatologists.
View Article and Find Full Text PDF

Download full-text PDF

Source
November 2020

Hydroxyurea: a reappraisal of its cutaneous side effects and their management.

Int J Dermatol 2021 Jul 12;60(7):810-817. Epub 2020 Nov 12.

Brooklyn Campus of the VA NY Harbor Healthcare System, Brooklyn, NY, USA.

Hydroxyurea (HU) is known to cause a broad spectrum of cutaneous side effects, ranging from relatively benign to severe. Although dermatologists are often consulted for the treatment of these side effects, a comprehensive resource discussing the different types and their management is lacking. In this study, we conducted a literature search in order to critically evaluate the reported types and management of hydroxyurea's cutaneous side effects, as well as review its mechanism of action, dermatologic uses, and common systemic side effects. Relatively common and benign side effects include hyperpigmentation, xerosis, and skin atrophy. While serious cutaneous side effects such as leg ulcers or nonmelanoma skin cancers occur in a substantial proportion of patients, these may resolve with HU discontinuation and proper dermatologic management. Therefore, it is crucial for dermatologists to be aware of these various cutaneous side effects and their management as prompt diagnosis and proper treatment will improve patient outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ijd.15302DOI Listing
July 2021

Cosmetic skin lightening use and side effects.

J Dermatolog Treat 2020 Nov 10:1-6. Epub 2020 Nov 10.

Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY, USA.

Cosmetic skin lightening is a growing dermatologic public health problem that affects communities of color worldwide. Despite well-documented adverse health effects, cosmetic skin lightening continues to be a popular practice among patients of color. Given the US's changing demographics, it is critical for dermatologists to be knowledgeable about the medical impact as well as social and cultural implications of this practice. This review article aims to serve as a primer for the dermatologist on the medical and sociocultural aspects of cosmetic skin lightening, as well as an approach to discuss the issue of cosmetic skin lightening with patients. We conducted a comprehensive PubMed search using the terms 'skin lightening agents,' 'skin bleaching,' and 'depigmenting agents,' and reviewed the literature on cosmetic skin lightening products, active ingredients, and adverse side effects. Herein, we review the prevalence, ingredients, and health implications of cosmetic skin lightening products. We also provide recommendations for counseling patients who practice cosmetic skin lightening in a culturally sensitive manner.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09546634.2020.1845597DOI Listing
November 2020

Dermatologic uses of bloodroot: a review and reappraisal.

Int J Dermatol 2020 Oct 31. Epub 2020 Oct 31.

Veterans Affairs Medical Center, State University of New York Downstate, Brooklyn, NY, USA.

Bloodroot (Sanguinaria canadensis) is a plant, native to North America, containing bioactive compounds that interrupt biological processes. It has been around for centuries and is known for its medicinal properties. Today, naturopathic remedies are becoming more and more popular, especially for skin ailments. There are an alarming number of online vendors marketing their bloodroot-containing products as cures for skin cancer without any scientific evidence supporting such claims. Clinical data concerning the efficacy of bloodroot primarily come from case studies with unfavorable outcomes involving patients who self-treated with bloodroot-containing black salves. However, recent preclinical studies have concluded that sanguinarine, the active component of bloodroot, shows positive evidence of being an efficacious treatment for skin cancers at micromolar doses. This article reviews the mechanism of action of bloodroot as a skin cancer treatment, its misuse in clinical dermatology, and the FDA's stance on products containing bloodroot that are marketed and sold to laypersons. Members of the public should be made aware of the dangers of self-treating with bloodroot-containing products through effective communication and education by clinicians.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ijd.15273DOI Listing
October 2020

Beyond Mohs surgery and excisions: A focused review of treatment options for subtypes of basal cell carcinoma.

Dermatol Ther 2021 01 9;34(1):e14476. Epub 2020 Nov 9.

Department of Dermatology, State University of New York Downstate, Brooklyn, New York, USA.

Basal cell carcinoma (BCC) is the most common nonmelanoma skin cancer. It originates from undifferentiated cells in the basal cell layer of the epidermis or from the outer root sheath of the hair follicle. The most important factor in development of BCC is ultraviolet radiation. Surgery is considered the gold standard of treatment for BCC. However, nonsurgical options are available for individuals who are unsuitable for surgery. The purpose of this review is to summarize the efficacy and indications of alternative, nonsurgical treatments that can be used in the management of BCC. An extensive literature review was performed for the nonsurgical options for the treatment of BCC. Resources searched included PubMed and Google Scholars, limited to the years 1995 to 2020. Key words searched included BCC, destructive methods, photodynamic therapy (PDT), radiotherapy, topical medication, laser, hedgehog pathway inhibitors (HPIs). The most relevant results such as systematic reviews, randomized controlled trials, or comparative studies were selected to provide a summary for the most common nonsurgical methods used for treating BCC. Effective nonsurgical treatments for BCC include destructive methods (eg, curettage alone, cryosurgery, or electrodessication), PDT, topical medications, radiotherapy, laser, and HPIs. Nonsurgical therapeutic alternatives are safe and effective for the treatment of BCC. Factors such as tumor location, size, and histopathological subtype should be taken into consideration when selecting optimal treatment. In addition to clinical factors, cosmetic results and patient preference should be considered.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/dth.14476DOI Listing
January 2021

Upstaging of basal cell and squamous cell carcinomas during definitive surgery: a review of predictive preoperative clinical and histologic features.

Arch Dermatol Res 2021 Jul 27;313(5):319-325. Epub 2020 Oct 27.

Veterans Affairs Medical Center, Brooklyn, NY, USA.

The incidence of nonmelanoma skin cancer (NMSC) in the United States is increasing with approximately 3.6 million cases diagnosed per year. The staging and treatment of NMSC is guided by histologic subtype based on skin biopsy, along with other tumor-specific factors. However, a biopsy only represents a portion of the tumor, so there is a risk of upstaging at the time of definitive surgery. We conducted a review of the literature and found that a significant proportion of NMSC were upstaged during surgery. The rate of upstaging of basal cell carcinoma (BCC) was 7-31% and that of squamous cell carcinoma in situ (SCCIS) to squamous cell carcinoma (SCC) was 3-39%. Biopsy sampling error and variability in interpreting and reporting by dermatopathologists contribute to these discrepancies. It is pertinent to consider more comprehensive treatment modalities for tumors at high risk for upstaging. Diligence to identify tumors at higher risk for upstaging will allow clinicians to optimize management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00403-020-02151-5DOI Listing
July 2021

Systematic review of Mohs micrographic surgery in children: Identifying challenges and practical considerations for successful application.

J Am Acad Dermatol 2021 Jul 1;85(1):152-161. Epub 2020 Oct 1.

Division of Dermatology, McGill University Health Center, Montreal, Quebec, Canada; Department of Dermatology, University of New York Downstate and Veterans Affairs Medical Center, Brooklyn, New York. Electronic address:

Background: Few data exist to guide the application of Mohs micrographic surgery (MMS) in the pediatric population.

Objective: We sought to summarize the clinical characteristics of children undergoing MMS, identify challenges that limit the use of MMS in this population, and examine how these challenges can be overcome.

Methods: A systematic review of PubMed and EMBASE, from inception of databases to November 2, 2019, identified all cases of pediatric skin lesions treated with MMS.

Results: A total of 111 patients were included. The median patient age was 11 years (range 6 weeks to 17 years). The most commonly treated tumor was dermatofibrosarcoma protuberans (n = 62), followed by basal cell carcinoma (n = 30). The most common location was the head and neck (n = 34), followed by the trunk (n = 28) and the extremities (n = 23). The most commonly cited challenges in the application of MMS in children included patient cooperation, concerns for the safety of prolonged general anesthesia, availability of a MMS service in the pediatric setting, and access to a histopathology laboratory experienced in MMS sectioning.

Limitations: Many articles did not report specific patient characteristics.

Conclusion: Multiple obstacles limit the application of MMS in pediatric patients. This review describes practical methods to circumvent these obstacles to facilitate the appropriate use of MMS in children.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaad.2020.09.052DOI Listing
July 2021

Current and emerging treatment options for metastatic melanoma: a focused review.

Dermatol Online J 2020 Jul 15;26(7). Epub 2020 Jul 15.

Veterans Affairs Medical Center, Brooklyn, New York, USA Department of Dermatology, SUNY Downstate, Brooklyn, New York, USA.

Melanoma is responsible for nearly 9,000 deaths each year in the United States. Until the early 2000s, chemotherapeutic agents were the mainstay of treatment for metastatic disease. Currently approved treatments include therapies that block signal transduction pathways (BRAF inhibition), increase anti-tumor immune responses (CTLA-4 blockade), or stimulate tumor-infiltrating T cells (IL2). In recent years, various new strategies have emerged. Radiation therapy has been widely underutilized, but it can prime tumor cells that are distant from the field of radiation, a phenomenon termed the abscopal effect. Other therapies such as pembrolizumab disrupt the tumor cells' typical mechanisms of T-cell avoidance. Various other treatments involving imiquimod, adoptive T-cell therapy, and vaccines are currently being studied and can play a role in metastatic melanoma treatment in the future. Herein, we review the past treatment modalities, currently approved treatments, and potentially effective options for the future. We also provide strengths of recommendation and level of evidence for each treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
July 2020

Collision tumors: A review of their types, pathogenesis, and diagnostic challenges.

Dermatol Ther 2020 11 15;33(6):e14236. Epub 2020 Sep 15.

Brooklyn Campus of the VA NY Harbor Healthcare System, Brooklyn, New York, USA.

A collision tumor is a neoplastic lesion comprised of two or more distinct cell populations that maintain distinct borders. Collision tumors, which are rare but well documented, can be composed of two benign tumors, a benign and malignant tumor, and two malignant tumors. Although case reports and reviews on specific types of collision tumors exist, a cohesive source discussing these tumors is lacking. We critically reviewed the literature by analyzing case reports and retrospective studies in order to evaluate the following regarding collision tumors: definitions, types, pathogenesis, diagnosis, and management. Reports of these tumors are infrequent but not insignificant, and accurate classification and diagnosis will lead to better patient outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/dth.14236DOI Listing
November 2020

The Therapeutic Use of Antioxidants for Melasma.

J Drugs Dermatol 2020 Aug;19(8):788-792

Melasma is a chronic dermatologic condition with an incompletely understood pathogenesis and well-demonstrated impact on patient quality of life. Melasma is a common cause for seeking dermatologic care, and with no universally efficacious therapy or cure, com-bination treatment is the best approach for many cases. Numerous studies have demonstrated the role of oxidative stress in patients with melasma, prompting investigation into several antioxidants for melasma therapy. In this review, we discuss the well-defined role of oxidative stress in melasma and the therapeutic efficacy of various antioxidants for patients suffering from melasma. We focus our discussion on studies investigating the role of vitamin C, azelaic acid, cysteamine, glutathione, carotenoids, and numerous other antioxidants in disorders of hyperpigmentation. There is promising evidence for the use of these antioxidants, as topical, oral, and intra-venous preparations, both in isolation and in conjunction with other melasma therapies. J Drugs Dermatol. 2020;19(8):788-792. doi:10.36849/JDD.2020.5079.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.36849/JDD.2020.5079DOI Listing
August 2020

Treatment of melasma: a review of less commonly used antioxidants.

Int J Dermatol 2021 Feb 20;60(2):166-173. Epub 2020 Aug 20.

Department of Dermatology, State University of New York Downstate, Brooklyn, NY, USA.

Melasma, a common cause for seeking dermatologic care, is a chronic condition of skin hyperpigmentation. With a poorly understood pathogenesis, and no universal cure, melasma is a challenge for many dermatologists. For decades, there has been investigation into the role of oxidative stress in melasma. In this literature review, we introduce the role of oxidative stress in melasma and discuss the function of various topical and oral antioxidant therapies for patients suffering from melasma. Numerous studies have shown efficacy of various antioxidant therapies for treatment of hyperpigmentation, and in this review, we focus primarily on those with less widespread use. Vitamin E, niacinamide, polypodium leucotomos, pycnogenol, grape seed extract, amino fruit acids, phytic acid, zinc, silymarin, Korean red ginseng powder, plant extracts, and parsley all have well-demonstrated evidence of antioxidant properties, and these substances have been studied in the context of skin hyperpigmentation. Although there is conflicting evidence of their therapeutic efficacy, the use of these naturally occurring substances is promising for patients and medical providers seeking alternative therapeutic options.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ijd.15133DOI Listing
February 2021

Patient education in Mohs surgery: a review and critical evaluation of techniques.

Arch Dermatol Res 2021 May 12;313(4):217-224. Epub 2020 Aug 12.

Department of Dermatology, SUNY Downstate, Brooklyn, New York, USA.

Background: Traditional in-person discussion alone is often used for preoperative education in Mohs micrographic surgery (MMS). The appropriate use of more modern education techniques is not well defined in the MMS literature.

Objective: The authors aim to evaluate patient education techniques for MMS, address education in special populations, and highlight opportunities for improvement.

Methods And Materials: We performed a PubMed literature search with keywords "Mohs" and "education", "teaching", "understanding", "explanation", "preoperative", or "consent" with no restriction on publication time frame due to literature scarcity.

Results: Teledermatology consultation, MMS videos, 3D models, pamphlets/online materials, and shared medical appointments appear to be effective techniques (GRADE B). Analogies are also anecdotally helpful when integrated into traditional verbal education (GRADE C). The role of preoperative educational phone calls is more controversial (GRADE C).

Conclusion: Regardless of the education technique utilized, no singular technique entirely replaces the traditional in-person discussion. Having access to multiple modalities can be beneficial for patients, allowing them options to choose their preferred method(s) of education. MMS is a difficult topic to conceptualize, and further research into educational techniques is needed to provide clear guidelines for Mohs surgeons.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00403-020-02119-5DOI Listing
May 2021

Fish Pedicure: Review of Its Current Dermatology Applications.

Cureus 2020 Jun 30;12(6):e8936. Epub 2020 Jun 30.

Dermatology, State University of New York Downstate Medical Center, Brooklyn, USA.

Ichthyotherapy or fish pedicure is a unique form of biotherapy in which the species or doctor fish is used to exfoliate the skin and potentially aid in healing diseases, such as psoriasis. The practice has gained popularity since its origins in Kangal Fish Spring in Turkey; however, safety concerns, especially among immunocompromised patients, remain. This article reviews the studied dermatological benefits of ichthyotherapy and theorized mechanisms of action. Included are cases examining both infectious and noninfectious complications of this procedure. This review highlights the need to educate susceptible patients about possible adverse effects and the need for more studies assessing this procedure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.8936DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398691PMC
June 2020

What is the ulcerated pink nodule on this patient's scalp?

JAAPA 2020 Aug;33(8):55-56

Kathleen M. Coerdt is a student at Georgetown University School of Medicine in Washington, D.C. Amor Khachemoune is on the faculty at SUNY Downstate Medical Center and practices at the Veterans Affairs Medical Center, both in Brooklyn, N.Y. The authors have disclosed no potential conflicts of interest, financial or otherwise.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/01.JAA.0000684144.71148.80DOI Listing
August 2020

Reappraising Diabetic Foot Ulcers: A Focus on Mechanisms of Ulceration and Clinical Evaluation.

Int J Low Extrem Wounds 2020 Jul 31:1534734620944514. Epub 2020 Jul 31.

Veterans Affairs Medical Center, Brooklyn, NY, USA.

Diabetic foot ulcers (DFU) are one of the most devastating complications of diabetes as they have significant effects on patient morbidity and mortality. Since their first description in the 19th century, our understanding of DFU has evolved as we uncover the mechanisms that mediate ulceration. In this review, we aim to summarize the various pathways that lead to the development of DFU in order to reappraise physicians' understanding of these complex wounds. Relevant pathways include the following: (1) neuropathy (motor neuropathy, loss of protective sensation, and autonomic sympathetic dysfunction), (2) vascular disease (arterial ischemia, venous insufficiency, and microvascular changes), and (3) metabolism (signaling and immunological effects of hyperglycemia). We also discuss the clinical presentation of DFU and an evidence-based evaluation to assist clinicians in early identification and classification of these wounds to inform management of DFU. Finally, we summarize complications of DFU caused by the various pathways mediating ulceration and briefly overview DFU management in order to educate physicians about the potential risks if left untreated. A better understanding of the synergistic pathways leading to DFU is essential for clinicians to improve DFU diagnosis, tailor intervention, and mitigate significant patient morbidity and mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1534734620944514DOI Listing
July 2020

Making the world's skin crawl: dermatologic implications of COVID-19.

Cutis 2020 06;105(6):306-308

Department of Dermatology, SUNY Downstate, Brooklyn, and the Department of Dermatology, Brooklyn Campus of the VA NY Harbor Healthcare System, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
June 2020
-->