Publications by authors named "Euphemia Mu"

34 Publications

Impact of COVID-19 on melanoma diagnosis.

Melanoma Res 2021 Feb 18. Epub 2021 Feb 18.

The Ronald O. Perelman Department of Dermatology, Dermatopathology Section, NYU Grossman School of Medicine, New York Piedmont Plastic Surgery & Dermatology, Cornelius, North Carolina Laura and Isaac Perlmutter Cancer Center, NYU Grossman School of Medicine, NYU Langone Health, New York, USA.

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http://dx.doi.org/10.1097/CMR.0000000000000717DOI Listing
February 2021

Histopathologic reaction patterns to differentially cross-linked hyaluronic acid fillers: A retrospective case series.

J Cutan Pathol 2020 Dec 22. Epub 2020 Dec 22.

The Ronald O. Perelman Department of Dermatology, New York School of Medicine, New York, New York, USA.

Background: Hyaluronic acid (HA) filler reactions have been increasingly observed in recent years. Our study investigates whether the increased number of filler reactions observed since 2014 is associated with a specific histopathologic inflammatory pattern and type of filler.

Methods: The institution's dermatopathology electronic database was retrospectively searched for histopathologic reactions to HA from January 2014 to December 2019. The age, sex, type of filler, procedure, location, and histopathologic patterns were recorded.

Results: From 2014 to 2019, there were 15 cases of granulomatous reactions to HA filler. In 10 of these cases, there was a characteristic inflammatory pattern characterized by tightly cuffed palisades of histiocytes with varying numbers of eosinophils. Of the 11 cases in which the type of filler was known, all used Vycross technology, a novel manufacturing process in the production of HA filler.

Conclusion: A characteristic histopathologic pattern of discrete foci of tightly cuffed palisaded granulomas with eosinophils is associated with fillers manufactured using Vycross technology.
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http://dx.doi.org/10.1111/cup.13947DOI Listing
December 2020

Learning Analytics to Enhance Dermatopathology Education Among Dermatology Residents

J Drugs Dermatol 2019 Dec;18(12):1231-1236

BACKGROUND: With the advent of digital microscopy, learning analytics can be leveraged to advance teaching of dermatopathology in dermatology residency. OBJECTIVE: To analyze the acquisition and decay of dermatopathology visual recognition skills and areas of diagnostic confusion amongst residents using learning metrics generated by a web-based learning tool. METHODS: This was a prospective, longitudinal study of dermatology residents who studied digital photomicrographs of 18 routine diagnostic entities using an online software platform. Residents at different years of training were given 60 minutes to complete assessments on three occasions (initial test with follow-ups at one and three months). RESULTS: 4,938 responses were analyzed. Accuracy and time to diagnosis improved within each assessment and between the first and second assessments. First year residents showed knowledge decay when tested at three months (67% vs 64%; P=0.002) while third year residents retained knowledge and continued to improve upon their accuracy after three months (83% to 91%, <0.001). Learning analytics highlighted diagnostically challenging cases for residents that contradicted experts’ predictions (R=0.48). CONCLUSIONS: The use of learning analytics and interactive digital platforms enhances dermatopathology curriculum development by identifying challenging diagnostic entities, assessing mastery of subject material, and optimizing review schedules. J Drugs Dermatol. 2019;18(12):1231-1236.
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December 2019

Response to: "Comment on 'Infertility and teratogenicity after paternal exposure to systemic dermatologic medications: A systematic review'".

J Am Acad Dermatol 2019 06 14;80(6):e175-e176. Epub 2019 Jan 14.

Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2019.01.006DOI Listing
June 2019

Infertility and teratogenicity after paternal exposure to systemic dermatologic medications: A systematic review.

J Am Acad Dermatol 2019 Apr 2;80(4):957-969. Epub 2018 Oct 2.

Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York. Electronic address:

Background: This systematic review assesses effects of paternal exposure to dermatologic medications by using the former US Food and Drug Administration (FDA) pregnancy categories as a benchmark.

Objective: To assess whether systemic dermatologic medications can cause infertility and teratogenicity when taken by men.

Methods: Categories D and X dermatologic medications were identified; a systematic review of the literature and reviews of the FDA Adverse Events Reporting System and prescribing information were performed to identify the effects of these medications on male fertility and teratogenicity. A secondary search was performed to assess for other systemic dermatologic medications causing teratogenicity or infertility following paternal exposure.

Results: A total of 13 medications met the inclusion criteria. Of 1,032 studies identified, 19 were included after a systematic review of the literature. Studies evaluating medication effects with paternal exposure were identified for 10 of the 13 evaluated medications, and evidence of a negative effect was identified for 6 medications.

Limitations: We did not encounter any studies for 3 medications that met the inclusion criteria. Information submitted to the FDA Adverse Events Reporting System may not reflect the incidence of side effects.

Conclusions: Many former pregnancy category D and X systemic dermatologic medications also have effects on male fertility. More research and better-quality studies are required in this area, particularly studies assessing potential teratogenicity.
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http://dx.doi.org/10.1016/j.jaad.2018.09.031DOI Listing
April 2019

55-year-old man with ulcers in inguinal fold and intergluteal cleft found to have systemic Langerhans cell histiocytosis.

JAAD Case Rep 2018 Sep 18;4(8):837-840. Epub 2018 Sep 18.

Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jdcr.2018.05.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6143693PMC
September 2018

Margin Assessment for Punch and Shave Biopsies of Dysplastic Nevi.

J Drugs Dermatol 2018 Jul;17(7):810-812

Introduction: Biopsies of atypical melanocytic nevi are among the most commonly performed procedures by dermatologists. Margin assessment is often used to guide re-excision, but can be a point of confusion as negative margins reported in the planes of sections examined do not always reflect complete removal of a lesion. This study investigates the rates of false negative margins after both punch and shave biopsies.

Methods: We performed a retrospective analysis of 50 consecutive punch and shave biopsy specimens (1) diagnosed as DN, and (2) reported as having clear margins in the planes of section examined. Identified specimen blocks were then sectioned through to examine true margin involvement.

Results: Of the 50 specimens identified, 20% (n = 10) were found to have positive margins upon additional sectioning. We found no difference between the groups with respect to biopsy technique, type of nevus, degree of atypia, or gender.

Conclusion: This study observed false negative peripheral margin status in a sizeable proportion of biopsy specimens, which did not vary significantly based on biopsy technique or pathologic characteristics. This finding reflects a limitation of standard tissue processing, in which a limited proportion of the true margin is evaluated, and may be of note to many dermatologists who base their decision to re-excise on the reporting of margin involvement. J Drugs Dermatol. 2018;17(7):810-812.
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July 2018

Dermatologist Practices During Total Body Skin Examinations: A Survey Study.

J Drugs Dermatol 2018 May;17(5):516-520

Though screening for skin cancer is an essential practice in dermatology, limited data are published on dermatologists' total body skin examination (TBSE) behaviors. We surveyed 6500 dermatologists on their TBSE practices, including questions about less commonly examined body sites. We found varied TBSE practices among all dermatologists and discrepancies in examinations between dermatologists of opposite genders. J Drugs Dermatol. 2018;17(5):516-520.
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May 2018

Demographic and Tumor Characteristics of Patients Younger Than 50 Years With Nonmelanoma Skin Cancer Referred for Mohs Micrographic Surgery.

J Drugs Dermatol 2018 May;17(5):499-505

Background: An increase in nonmelanoma skin cancer (NMSC) in younger patients has been reported. Many are treated with Mohs micrographic surgery (MMS).

Objective: Investigate patient and tumor characteristics in patients less than 50 years undergoing MMS for NMSC at a large, referral-based practice.

Methods & Materials: Retrospective chart review of 1,332 tumors occurring in 1,018 consecutive patients over a five-year period.

Results: 81.7% of tumors were BCC and 55.3% occurred in women. Patients less than 30 years were more likely to be female (P equals 0.016) and women were more likely to have BCC (P equals 0.010). SCCs were more likely with increasing age (P less than 0.001). Of all tumors, 3.6% were recurrent, 2.7% had diameters ≥ 2 centimeters, and 5.5% of all BCCs had a high-risk histologic subtype. Women were more than twice as likely as men to be referred to plastic surgery for repair (P equals 0.020).

Conclusion: Patients < 50 years with NMSC may represent a growing population referred for MMS, especially young women with BCC. High-risk tumor features were rare among young patients, and female gender was associated with an increased rate of referral for repair by a plastics subspecialty. Study was performed at the Laser & Skin Surgery Center of New York.

Irb Status: Approved by Essex Institutional Review Board, Protocol #MOHS40-65

J Drugs Dermatol. 2018;17(5):499-505.

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May 2018

Epidermolysis bullosa acquisita.

Dermatol Online J 2017 Dec 15;23(12). Epub 2017 Dec 15.

New York University, New York.

Epidermolysis bullosa acquisita (EBA) is a rare, acquired subepidermal blistering disease. EBA is characterized by autoantibodies to collagen VII,which serves to link the epidermis to the dermis. The two most common presentations of EBA are classical noninflammatory EBA and bullous pemphigoid-like EBA. Diagnosis of EBA can be challenging as it sharesclinical and histopathologic features with other blistering diseases. Treatment is often recalcitrant and will often necessitate multiple therapies. We presenta case of a thirty-six-year-old Chinese man with EBA and review the literature.
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December 2017

Evaluation of MITF, SOX10, MART-1, and R21 Immunostaining for the Diagnosis of Residual Melanoma In Situ on Chronically Sun-Damaged Skin.

Dermatol Surg 2018 07;44(7):933-938

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

Background: Melanocytic immunostains can assist in margin evaluation of melanoma in situ (MIS) excisions; however, their accuracy and reliability relative to hematoxylin & eosin (H&E) is yet to be determined.

Objective: The objective of this study was to evaluate the sensitivity, specificity, and concordance of 4 melanocyte-specific immunostains for diagnosing MIS occurring on chronically sun-damaged skin.

Materials And Methods: Serial permanent sections from representative areas of negative margin and residual tumor were stained using H&E, MITF, MART-1, SOX10, and R21 and examined in a blinded fashion. The study set included 100 digital microscopy images from 10 cases of MIS excisions from the face. Two board-certified dermatopathologists, 4 fellowship-trained Mohs surgeons, 2 Mohs fellows, and 2 dermatology residents independently reviewed the 100 images.

Results: The average melanocyte density was 11 versus 28 melanocytes per 0.5 mm for chronically sun-damaged skin versus residual MIS on H&E, respectively. Statistically significantly higher melanocyte densities were observed using MITF, MART-1, and SOX10 on negative margins. The sensitivity and interobserver concordance was highest using MITF and SOX10. The intraobserver agreement on 4 duplicate images was 85%.

Conclusion: In conclusion, the nuclear immunostains (MITF and SOX10) show the most promise for improving the diagnosis of MIS in chronically sun-damaged skin.
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http://dx.doi.org/10.1097/DSS.0000000000001493DOI Listing
July 2018

An immunosuppressed man with an isolated necrotic plaque on the chest.

JAAD Case Rep 2018 Mar 12;4(2):114-116. Epub 2018 Jan 12.

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jdcr.2017.02.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5767909PMC
March 2018

Line scanning, stage scanning confocal microscope (LSSSCM).

Biomed Opt Express 2017 Aug 24;8(8):3807-3815. Epub 2017 Jul 24.

Ronald O. Pearleman Department of Dermatology, New York University, 240 E. 38th St., New York, NY 10016, USA.

For rapid pathological assessment of large surgical tissue excisions with cellular resolution, we present a line scanning, stage scanning confocal microscope (LSSSCM). LSSSCM uses no scanning mirrors. Laser light is focused with a single cylindrical lens to a line of diffraction-limited width directly into the (Z) sample focal plane, which is parallel to and near the flattened specimen surface. Semi-confocal optical sections are derived from the linear array distribution (Y) and a single mechanical drive that moves the sample parallel to the focal plane and perpendicular to the focused line (X). LSSSCM demonstrates cellular resolution in the conditions of high nuclear density within micronodular basal cell carcinoma.
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http://dx.doi.org/10.1364/BOE.8.003807DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5560842PMC
August 2017

Characterization of Herpes Simplex Virus Infections Seen in the Pediatric Dermatology Office.

Pediatr Dermatol 2017 Jul 21;34(4):446-449. Epub 2017 Jun 21.

Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

Background/objectives: Atypical and severe clinical manifestations of primary and recurrent herpes simplex virus (HSV) infections may present to a pediatric dermatologist for evaluation. The purpose of this study was to characterize the clinical features of the population diagnosed with HSV referred to a pediatric dermatology office.

Methods: This retrospective case series examined patients diagnosed with HSV in a pediatric dermatology practice at an academic medical center from 2005 to 2015. Characteristics of the population were collected and analyzed.

Results: In this study of 48 children diagnosed with HSV, 33% presented at age 2 years or younger, with approximately half having exhibited initial symptoms before 2 years of age; 39.6% of the population had six or more outbreaks per year. The outbreaks were equally divided between unifocal and multifocal presentations, with 60% of children without any labial or mucosal involvement. Suppressive treatment was initiated in 33% of patients; the average age at initiation was 6 years.

Conclusion: Our data characterize a subset of immunocompetent young children who present to pediatric dermatologists with frequent HSV outbreaks that are often multifocal and involve cutaneous sites, with or without mucosal involvement.
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http://dx.doi.org/10.1111/pde.13190DOI Listing
July 2017

The Transposition Flap for the Reconstruction of Lower Cutaneous Lip Defects.

J Drugs Dermatol 2017 Apr;16(4):385-387

The lower cutaneous lip is a highly visible and functionally sensitive unit, and numerous factors must be considered when deciding on the optimal repair for defects in this area. The transposition flap represents an excellent option in the reconstruction of larger lower cutaneous lip defects. We describe the use of random pattern transposition flaps for the repair of lower lateral cutaneous lip defects.

J Drugs Dermatol. 2017;16(4):385-387.

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April 2017

Dermoscopic features of a solitary fibrofolliculoma on the left cheek.

J Am Acad Dermatol 2017 Feb;76(2S1):S8-S9

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jaad.2016.03.041DOI Listing
February 2017

Use of Digitally Stained Multimodal Confocal Mosaic Images to Screen for Nonmelanoma Skin Cancer.

JAMA Dermatol 2016 12;152(12):1335-1341

Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York.

Importance: Confocal microscopy has the potential to provide rapid bedside pathologic analysis, but clinical adoption has been limited in part by the need for physician retraining to interpret grayscale images. Digitally stained confocal mosaics (DSCMs) mimic the colors of routine histologic specimens and may increase adaptability of this technology.

Objective: To evaluate the accuracy and precision of 3 physicians using DSCMs before and after training to detect basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in Mohs micrographic surgery fresh-tissue specimens.

Design: This retrospective study used 133 DSCMs from 64 Mohs tissue excisions, which included clear margins, residual BCC, or residual SCC. Discarded tissue from Mohs surgical excisions from the dermatologic surgery units at Memorial Sloan Kettering Cancer Center and Oregon Health & Science University were collected for confocal imaging from 2006 to 2011. Final data analysis and interpretation took place between 2014 and 2016. Two Mohs surgeons and a Mohs fellow, who were blinded to the correlating gold standard frozen section diagnoses, independently reviewed the DSCMs for residual nonmelanoma skin cancer (NMSC) before and after a brief training session (about 5 minutes). The 2 assessments were separated by a 6-month washout period.

Main Outcomes And Measures: Diagnostic accuracy was characterized by sensitivity and specificity of detecting NMSC using DSCMs vs standard frozen histopathologic specimens. The diagnostic precision was calculated based on interobserver agreement and κ scores. Paired 2-sample t tests were used for comparative means analyses before and after training.

Results: The average respective sensitivities and specificities of detecting NMSC were 90% (95% CI, 89%-91%) and 79% (95% CI, 52%-100%) before training and 99% (95% CI, 99%-99%) (P = .001) and 93% (95% CI, 90%-96%) (P = .18) after training; for BCC, they were 83% (95% CI, 59%-100%) and 92% (95% CI, 81%-100%) before training and 98% (95% CI, 98%-98%) (P = .18) and 97% (95% CI, 95%-100%) (P = .15) after training; for SCC, they were 73% (95% CI, 65%-81%) and 89% (95% CI, 72%-100%) before training and 100% (P = .004) and 98% (95% CI, 95%-100%) (P = .21) after training. The pretraining interobserver agreement was 72% (κ = 0.58), and the posttraining interobserver agreement was 98% (κ = 0.97) (P = .04).

Conclusions And Relevance: Diagnostic use of DSCMs shows promising correlation to frozen histologic analysis, but image quality was affected by variations in image contrast and mosaic-stitching artifact. With training, physicians were able to read DSCMs with significantly improved accuracy and precision to detect NMSC.
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http://dx.doi.org/10.1001/jamadermatol.2016.2997DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5757842PMC
December 2016

A Clinical Review of Laser and Light Therapy for Nail Psoriasis and Onychomycosis.

Dermatol Surg 2017 Feb;43(2):161-172

*All the authors are affiliated with The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

Background: There are considerable emerging data in the use of lasers and lights to treat onychomycosis and psoriasis of the nail subunit.

Objective: We aimed to review all of the medical literature on laser therapy of nail psoriasis and onychomycosis published since 1992.

Methods And Materials: We performed a PubMed literature search using the search terms "nail," "laser therapy," "laser surgery," "light," with search terms "psoriasis" and "onychomycosis." In addition, we performed extensive MeSH and bibliographic searches as delineated in the manuscript. Because of the poor quality of evidence, we were not able to complete a quantitative review and thus present our findings qualitatively.

Results: Although the trials are small, PDL (595 nm) and IPL with a 550-nm filter demonstrate compelling data in treating nail psoriasis. Laser studies of onychomycosis fall short on many levels. Q-switched Nd:YAG lasers with very short pulse durations and fractionated CO2 demonstrate the most promise for the treatment of onychomycosis.

Conclusion: The data for treating nail psoriasis and onychomycosis with laser and light therapy are rapidly emerging. With increased subject data, improved study methodology, and more precise output parameters, lasers may become an important modality in the treatment of nail psoriasis and onychomycosis.
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http://dx.doi.org/10.1097/DSS.0000000000000841DOI Listing
February 2017

A case of perniosis.

Dermatol Online J 2016 Dec 15;22(12). Epub 2016 Dec 15.

Ronald O. Perelman Department of Dermatology, NYU School of Medicine, NYU Langone Medical Center.

Perniosis is a localized, inflammatory reaction that ischaracterized by erythematous papules and nodulesthat often are located on the acral surfaces in youngwomen. The lesions of perniosis are thought to bedue to cold-induced vasoconstriction that leadsto hypoxemia and inflammation of the vessel wall.Histopathologic and laboratory studies are indicatedfor patients with suspected perniosis to distinguishbetween idiopathic perniosis and secondaryperniosis. Treatment includes adequate heating andclothing, proper food intake, nifedipine, ultravioletA1 phototherapy, topical glucocorticoids, andvasodilators.
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December 2016

Herpes simplex virus in erythrokeratoderma variabilis.

Dermatol Online J 2016 Dec 15;22(12). Epub 2016 Dec 15.

Ronald O. Perelman Department of Dermatology, NYU School of Medicine, NYU Langone Medical Center.

We report a 48 -year-old woman witherythrokeratoderma variabilis, which is a rarehereditary disorder of keratinization, who developednew, painful, blisters within her skin lesions. Thediagnosis of herpes simplex virus infection was madebased on the clinical history and histopathologicfeatures. She was successfully treated withprophylactic valacyclovir, and her herpetic outbreakshave halted. This case serves as a reminder thateven among the most rare skin disorders, commonsecondary complications may be easily overlooked.
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December 2016

Comparison of Childhood Vitiligo Presenting with or without Associated Halo Nevi.

Pediatr Dermatol 2016 Jan-Feb;33(1):44-8. Epub 2015 Nov 17.

Ronald O. Perelman Department of Dermatology, School of Medicine, New York University, New York, New York.

Background: Previous studies have characterized differences in vitiligo associated with halo nevi, but the features of vitiligo presenting with halo nevus in children have yet to be fully described.

Aims: We sought to provide an epidemiologic and clinical comparison of cases of childhood vitiligo presenting with or without associated halo nevi.

Materials And Methods: This was a retrospective chart review of children diagnosed with vitiligo in an academic pediatric dermatology practice from January 1990 to November 2014. The characteristics of children with vitiligo with or without associated halo nevi were compared.

Results: Halo nevi were identified in 55 (26%) of 208 children with vitiligo. Patients with halo nevi were significantly more likely to be male and develop vitiligo at a later age. Children with vitiligo associated with halo nevi were more likely to present with generalized vitiligo, defined according to the presence of bilateral macules.

Discussion: There was no significant association between groups in the percentage of body surface area with vitiligo or family history of vitiligo or autoimmune diseases. Patients with halo nevi were no more likely to develop new areas of vitiligo during the follow-up period, but there was a nonsignificant trend toward a higher rate of repigmentation in vitiligo associated with halo nevus.

Conclusion: Halo nevi are a common finding in children with vitiligo. The presence of a halo nevus in a child with vitiligo is associated with generalized vitiligo. The presence of a halo nevus does not significantly alter the risk of disease progression and rate of treatment.
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http://dx.doi.org/10.1111/pde.12717DOI Listing
October 2016

Men and Cosmetics: Social and Psychological Trends of an Emerging Demographic.

J Drugs Dermatol 2015 Sep;14(9):1023-6

Though still accounting for a small fraction of all cosmetic procedures in the United States, men are an emerging and rapidly expanding demographic in the field of aesthetic medicine. In this article we highlight the trends contributing to the rise of male aesthetic procedures in dermatology, touching on social influences, psychological motivations, and treatment outcomes.
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September 2015

Alternative Systemic Treatments for Vitiligo: A Review.

Am J Clin Dermatol 2015 Dec;16(6):463-74

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th Street, New York, NY, 10016, USA.

Vitiligo is a common, acquired disorder of skin pigmentation that can significantly impact quality of life. It often represents a therapeutic challenge, which has resulted in interest in alternative treatments such as herbal and vitamin supplements. In this review, we provide an overview of the most commonly studied complementary agents, describe proposed mechanisms of action, identify potential adverse effects, and discuss the primary evidence supporting their use. Our discussion focuses on L-phenylalanine, Polypodium leucotomos, khellin, Ginkgo biloba, and vitamins and minerals, including vitamins B12, C, and E, folic acid, and zinc used as monotherapy or in combination with other treatments for the management of vitiligo.
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http://dx.doi.org/10.1007/s40257-015-0153-5DOI Listing
December 2015

Early-onset childhood vitiligo is associated with a more extensive and progressive course.

J Am Acad Dermatol 2015 Sep 26;73(3):467-70. Epub 2015 Jun 26.

Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

Objectives: Vitiligo commonly presents in children, with half of all cases developing before 20 years of age. Although studies have characterized differences between pediatric and adult vitiligo, little is known about vitiligo presenting in early childhood. The purpose of this study was to compare clinical features of early-onset (<3 years old) and later-onset (3-18 years old) childhood vitiligo.

Methods: This retrospective case series examined patients given a diagnosis of vitiligo in a pediatric dermatology practice at an academic medical center from 1990 to 2014. Characteristics of the early- and later-onset groups were compared by χ(2) and t test for categorical and continuous variables, respectively.

Results: Of the 208 children in the study, 31 had early-onset and 177 had later-onset disease. Early-onset vitiligo was associated with higher percentages of body surface area involvement and increased rates of disease progression during an average 1.9 years of follow-up. There were no significant differences between the 2 groups in repigmentation, vitiligo type, halo nevi, gender ratio, or personal and family history of autoimmune diseases.

Limitations: This was a retrospective, single-institution study.

Conclusion: Patients given a diagnosis of vitiligo at younger ages tend to have more extensive and progressive disease.
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http://dx.doi.org/10.1016/j.jaad.2015.05.038DOI Listing
September 2015

Older Age is Associated with a Higher Incidence of Melanoma Death but a Lower Incidence of Sentinel Lymph Node Metastasis in the SEER Databases (2003-2011).

Ann Surg Oncol 2015 Jul 5;22(7):2120-6. Epub 2015 May 5.

Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA,

Purpose: Elderly melanoma patients are known to have lower survival rates than younger patients with melanoma. Paradoxically, a few recent studies have shown a lower frequency of sentinel lymph node (SLN) positivity in older individuals. This is the first analysis of a large national sample to examine the relationship between SLN metastasis and melanoma death across all age groups.

Methods: The U.S. Surveillance Epidemiology and End Results (SEER) Databases were queried to examine SLN biopsy and mortality outcomes in 158,813 melanoma cases reported from 2003 to 2011, the most current data available in SEER.

Results: In bivariate analyses of the 47,577 cases with coded tumor depths and nodal surgery, increasing age varied directly with melanoma death and inversely with SLN positivity, for tumor depths >1 mm (P < 0.001). In multivariate regression analyses, 60-79 year-olds were more likely to die of melanoma compared with 20-39 year-olds [odds ratio (OR) 1.83, 95 % confidence interval (CI) 1.64-2.05], but they were less likely to be SLN-positive (OR 0.62, 95 % CI 0.57-0.68). The inverse association between melanoma mortality and SLN positivity was most pronounced at the extremes of age.

Discussion: The finding that increasing age is associated with a higher incidence of melanoma death but a lower incidence of SLN metastasis highlights the need for further study into age-related differences in melanoma biology, immunological surveillance, and host response. It also questions whether the 5- and 10-year survival rates associated with the current melanoma staging system should be stratified by age to predict outcomes more accurately for melanoma patients.
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http://dx.doi.org/10.1245/s10434-015-4538-8DOI Listing
July 2015

Culinary Metaphors in Dermatology: Eating Our Words.

JAMA Dermatol 2015 Aug;151(8):912

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York.

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http://dx.doi.org/10.1001/jamadermatol.2014.5416DOI Listing
August 2015

Paraneoplastic erythema annulare centrifugum eruption (PEACE).

Dermatol Online J 2015 Dec 16;21(12). Epub 2015 Dec 16.

New York University School of Medicine.

Erythema annulare centrifugum (EAC) is a reactive erythema with distinct, annular, erythematous plaques with trailing scale. This condition has been associated with various etiologies, which include an associated malignant condition. EAC with cancers or paraneoplastic erythema annulare centrifugum eruptions (PEACE), is more likely to be associated with lymphoproliferative malignancies such as lymphomas and leukemias. Histopathologic features include a superficial and deep, lymphohistiocytic perivascular infiltrate. We present a patient with a history of diffuse large B cell lymphoma in remission for two years, who presented with a one-year history of EAC.
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December 2015

Acrokeratoelastoidosis.

Dermatol Online J 2015 Dec 16;21(12). Epub 2015 Dec 16.

New York University School of Medicine.

Acrokeratoelastoidosis is a rare palmoplantar keratoderma. We report the case of a 32-year old man with multiple keratotic papules and plaques on the peripheral margins of his hands and feet. Histopathologic evaluation showed compact orthokeratosis; Verhoeff van Gieson stain showed thin and fragmented elastic fibers. The differential diagnosis includes focal acral hyperkeratosis, which has a similar presentation but with normal elastic fibers. Treatment of acrokeratoelastoidosis is often disappointing, with minimal response to topical glucocorticoids, keratolytics, retinoids, cryotherapy, and lasers.
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December 2015

Womb to grow.

Authors:
Euphemia W Mu

JAMA Intern Med 2013 May;173(9):729

Johns Hopkins University School of Medicine, 733 N Broadway, Ste 137, Baltimore, MD 21205-2196, USA.

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http://dx.doi.org/10.1001/jamainternmed.2013.313DOI Listing
May 2013

Facial lichen striatus in children: retracing the lines of Blaschko.

Pediatr Dermatol 2013 May-Jun;30(3):364-6. Epub 2012 Sep 7.

Department of Dermatology, School of Medicine, Johns Hopkins University, Baltimore, MD21287, USA.

We report seven patients with facial lichen striatus along the lines of Blaschko who presented to our pediatric dermatology unit between 2003 and 2009. The mean age of diagnosis was 4.6 years (range 2.5-9 years). Three of the cases were associated with atopic dermatitis, and one case presented with vitiligo. In the six patients for whom we have follow-up, all lesions resolved without pigmentary changes in an average of 11 months. This case series describes the distribution, presentation, and natural history of lichen striatus along facial lines of Blaschko. From our experience, clinical diagnosis and monitoring without biopsy is a reasonable approach to the management of uncomplicated lichen striatus, particularly when the face is involved.
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http://dx.doi.org/10.1111/j.1525-1470.2012.01844.xDOI Listing
January 2014