Publications by authors named "Robert A Schwartz"

350 Publications

The invincible Professor Rajendra Kapila (1939-2021): A life to emulate.

Dermatol Ther 2021 Jun 29:e15039. Epub 2021 Jun 29.

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http://dx.doi.org/10.1111/dth.15039DOI Listing
June 2021

Treatment Delay in Melanoma: A Risk Factor Analysis of an Impending Crisis.

Cutis 2021 Apr;107(4):E19-E26

Drs. Elias, Schwartz, and Lambert are from the Division of Dermatology, Rutgers New Jersey Medical School, Newark. Dr. Lambert also is from the Department of Pathology, Immunology, and Laboratory Medicine. Dr. John is from the Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey.

Risk factors associated with melanoma treatment delay (MTD) have been inadequately studied. To elucidate MTD associations based on patient and tumor characteristics, a retrospective cohort study was performed for cutaneous melanoma cases reported to the National Cancer Database (NCDB) between 2004 and 2015. We evaluated the number of days from diagnosis to treatment initiation, analyzing postponements more than 45 days as moderate MTD (mMTD) and postponements more than 90 days as severe MTD (sMTD). Greater MTD rates were independently associated with patients who are older than 50 years, female, nonwhite, not privately insured, and treated at an academic facility and who have more advanced tumor stage and head/neck primaries.
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http://dx.doi.org/10.12788/cutis.0235DOI Listing
April 2021

Botanical Briefs: Phytophotodermatitis Is an Occupational and Recreational Dermatosis in the Limelight.

Cutis 2021 Apr;107(4):187-189

Rutgers New Jersey Medical School, Newark. Dr. Schwartz from the Departments of Dermatology, Pathology, Pediatrics, and Medicine. Mr. Janusz also is from Saint Joseph University, Philadelphia, Pennsylvania.

Phytophotodermatitis (PPD) is a toxic reaction resulting from contact with a photosensitizing botanical chemical followed by exposure to solar or artificial UV light. It may present with bizarre patterns and linear streaks due to a phototoxic agent splashing onto various cutaneous sites; thus, it affects the skin at points of contact and exposure to UV light. Individuals typically experience symptoms within 24 hours of exposure. Children and adolescents seem particularly prone to developing PPD, as they tend to spend time in the sun and also may come into contact with common irritants such as wild parsley in lawn grass or beverages flavored with lime. However, PPD may be more than a recreational dermatitis; it also may represent a serious occupational dermatosis. In any case, the resultant acute dermatitis may be mild or severe with painful bullae and occasionally is more prominently evident as postinflammatory hyperpigmentation.
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http://dx.doi.org/10.12788/cutis.0225DOI Listing
April 2021

A new Editor: A fresh beginning on our 25th anniversary.

Dermatol Ther 2021 05;34(3):e14983

Editor-in-Chief, DTH.

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http://dx.doi.org/10.1111/dth.14983DOI Listing
May 2021

Recognition and treatment of devastating vasculopathic systemic disorders: Coronavirus disease 2019 and rickettsioses.

Dermatol Ther 2021 May 18:e14984. Epub 2021 May 18.

Rutgers New Jersey Medical School, Newark, New Jersey, USA.

Cutaneous involvement can be an important sign of both COVID-19 and rickettsioses. Rickettsial infections may be first evident as an exanthem with eschars as a key finding. In contrast, eschars and necrotic lesions can be seen in critically ill COVID-19 patients. Both illnesses share a similar mechanism of infecting endothelial cells resulting in vasculopathy. Rickettsia parkeri and Rickettsia 364D are both characterized by eschars unlike Rickettsia rickettsii. Other eschar causing rickettsioses such as Rickettsia conorii, Rickettsia africae, and Orientia tsutsugamushi are commonly diagnosed in people from or having traveled through endemic areas. While there is no consensus on treatment for COVID-19, rickettsioses are treatable. Due to possibly serious consequences of delayed treatment, doxycycline should be administered given an eschar-presenting patient's travel history and sufficient suspicion of vector exposure. The proliferation of COVID-19 cases has rendered it critical to differentiate between the two, both of which may have overlapping vasculopathic cutaneous findings. We review these diseases, emphasizing the importance of cutaneous involvement, while also discussing possible therapeutic interventions.
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http://dx.doi.org/10.1111/dth.14984DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8209862PMC
May 2021

Pandemics throughout the centuries.

Clin Dermatol 2021 Jan-Feb;39(1):5-8. Epub 2020 Dec 17.

Departments of Dermatology, Pathology, and Pediatrics, Rutgers New Jersey Medical School, Infectious Diseases, Newark, New Jersey, USA. Electronic address:

Pandemics have ravished the globe periodically, often associated with war, at times commencing as fever and rash, beginning in recorded history in the crowded walled city of Athens during the Peloponnesian War as described in great detail by the Athenian historian and military general Thucydides in 430 BCE. As the world now faces the first major pandemic of the 21st century, we focus on the "plague" commencing in Athens in 430 BCE and the 2 pandemics of the more recent century, which killed more than one million, the Spanish flu of 1918 and the Asian flu of 1957. The latter linked with successful vaccine development thanks to the heroic efforts of microbiologist Maurice Hilleman. We now look back and then forward to the viral infection coronavirus disease 2019 now devastating the world.
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http://dx.doi.org/10.1016/j.clindermatol.2020.12.006DOI Listing
May 2021

What we have learned from the COVID-19 pandemic: Time to think outside the box, maybe far outside.

Clin Dermatol 2021 Jan-Feb;39(1):107-117. Epub 2020 Dec 16.

Department of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA.

The coronavirus disease 2019 pandemic has had a profound effect on our lives and careers; this presentation explores some of the lessons we have learned from it and others that it may yet teach us. Socioeconomic effects have been profound, not all of them favorable. Travel and meeting activities, as well as many other activities, have been severely restricted. Social unrest has become intense, and it may have questionable political consequences, as the United States is undergoing a contested election result.
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http://dx.doi.org/10.1016/j.clindermatol.2020.12.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834261PMC
May 2021

The new pandemic COVID-19: I.

Clin Dermatol 2021 Jan-Feb;39(1):1-4. Epub 2020 Dec 15.

Department of Dermatology, Rutgers-New Jersey Medical School, Newark, New Jersey, USA; Department of Pathology, Immunology and Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.

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http://dx.doi.org/10.1016/j.clindermatol.2020.12.005DOI Listing
May 2021

Keratin Scaffolds Containing Casomorphin Stimulate Macrophage Infiltration and Accelerate Full-Thickness Cutaneous Wound Healing in Diabetic Mice.

Molecules 2021 Apr 27;26(9). Epub 2021 Apr 27.

Department of Dermatology, Medical University of Warsaw, 02-091 Warsaw, Poland.

Impaired wound healing is a major medical challenge, especially in diabetics. Over the centuries, the main goal of tissue engineering and regenerative medicine has been to invent biomaterials that accelerate the wound healing process. In this context, keratin-derived biomaterial is a promising candidate due to its biocompatibility and biodegradability. In this study, we evaluated an insoluble fraction of keratin containing casomorphin as a wound dressing in a full-thickness surgical skin wound model in mice ( = 20) with iatrogenically induced diabetes. Casomorphin, an opioid peptide with analgesic properties, was incorporated into keratin and shown to be slowly released from the dressing. An in vitro study showed that keratin-casomorphin dressing is biocompatible, non-toxic, and supports cell growth. In vivo experiments demonstrated that keratin-casomorphin dressing significantly ( < 0.05) accelerates the whole process of skin wound healing to the its final stage. Wounds covered with keratin-casomorphin dressing underwent reepithelization faster, ending up with a thicker epidermis than control wounds, as confirmed by histopathological and immunohistochemical examinations. This investigated dressing stimulated macrophages infiltration, which favors tissue remodeling and regeneration, unlike in the control wounds in which neutrophils predominated. Additionally, in dressed wounds, the number of microhemorrhages was significantly decreased ( < 0.05) as compared with control wounds. The dressing was naturally incorporated into regenerating tissue during the wound healing process. Applied keratin dressing favored reconstruction of more regular skin structure and assured better cosmetic outcome in terms of scar formation and appearance. Our results have shown that insoluble keratin wound dressing containing casomorphin supports skin wound healing in diabetic mice.
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http://dx.doi.org/10.3390/molecules26092554DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8125279PMC
April 2021

Favre-Racouchot disease: protective effect of solar elastosis.

Arch Dermatol Res 2021 Mar 2. Epub 2021 Mar 2.

Dermatology, Rutgers New Jersey Medical School, 185 South Orange Ave, Newark, NJ, 07103, USA.

Favre-Racouchot disease (FRD) is an occupational disorder characterized by solar elastosis with open and cystically dilated comedones that tend to appear on the periorbital and temporal face of elderly light-complexioned men. It is a benign condition caused by chronic excessive ultraviolet exposure, as well as ionizing radiation and/or smoking. However, malignant skin neoplasms are uncommonly observed arising in FRD, which suggests a protective role of some element of FRD against carcinogenesis. We explore elastosis as a possibly beneficial tissue response. The clinical manifestations, pathogenesis, and recommended treatment options of this disorder are reviewed.
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http://dx.doi.org/10.1007/s00403-021-02202-5DOI Listing
March 2021

Simvastatin in vitiligo: an update with recent review of the literature.

Int J Dermatol 2021 Feb 7. Epub 2021 Feb 7.

Department of Dermatology, University Medical Center Mainz, Mainz, Germany.

Patients with vitiligo often seek medical attention, as it diminishes their quality of life resulting in significant morbidity. Several topical and systemic therapies are in vogue targeting the immunological aspect of this disease, but results are often unsatisfactory, and complete cure remains elusive. Recently, simvastatin, a 3-hydroxy-3-methylyglutaryl-coenzyme A (HMG-CoA) reductase inhibitor, is being evaluated for vitiligo management because of its multimodal action, easy availability, and low cost. The proposed multimodal actions range from anti-inflammatory, antioxidant, to immunomodulatory properties which may be of therapeutic benefit in vitiligo patients. The authors intend to evaluate the role of simvastatin as a novel therapeutic agent for vitiligo along with relevant review of literature.
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http://dx.doi.org/10.1111/ijd.15330DOI Listing
February 2021

Neurosyphilis and the Jarisch-Herxheimer reaction: A therapy concern with HIV disease.

Dermatol Ther 2021 Mar 15;34(2):e14839. Epub 2021 Feb 15.

Medicine, Dermatology, Pathology, and Pediatric, Rutgers New Jersey Medical School, Newark, New Jersey, USA.

Jarisch-Herxheimer reaction (JHR) should be anticipated in treating neurosyphilis with coexistent human immunodeficiency virus (HIV) encephalitis. In that context we have devised a staging classification for JHR. In addition, an illustrative case is provided to emphasize the need to consider the diagnosis of neurosyphilis in HIV patients, and if delineated, to be prepared for a severe JHR.
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http://dx.doi.org/10.1111/dth.14839DOI Listing
March 2021

Contact dermatitis: etiologies of the allergic and irritant type.

Acta Dermatovenerol Alp Pannonica Adriat 2020 Dec;29(4):181-184

Department of Dermatovenerology, Faculty of Medicine, University of Latvia, Riga, Latvia.

The term contact dermatitis describes an inflammatory process of the skin that occurs in response to contact with exogenous substances and involves pruritic and erythematous patches. Approximately 80% of all contact dermatitis is primary irritant contact dermatitis (ICD), whereas allergic contact dermatitis (ACD) makes up only 20% of contact dermatitis cases, the estimated prevalence of contact dermatitis in the United States being 1.4%. Among patch-tested patients, nickel has been identified as the most common allergen. Cobalt is the second most common metal allergen and is found in various dental alloys, paints, and coloring components of porcelain and glass. The average prevalence of dermatitis due to p-phenylenediamine (PPD) was found to be 4.3% in Asia, 4.0% in Europe, and 6.2% in North America. Rubber gloves are a major cause of occupational ACD in healthcare workers. Occupations involving frequent handwashing, between 20 and 40 times per day, have shown an increased incidence in cumulative ICD. The prevalence of occupational hand dermatitis was 69.7% in workers that reported a handwashing frequency exceeding 35 times per shift. The use of alcohol-based sanitizers is much more prevalent among today's healthcare workers than frequent handwashing. Both allergic and ICD are worldwide problems.
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December 2020

The Goldman-Fox syndrome: Treating and preventing green pseudomonas nails in the era of COVID-19.

Dermatol Ther 2021 Jan 10;34(1):e14624. Epub 2020 Dec 10.

Dermatology, Infectious Diseases, and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA.

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http://dx.doi.org/10.1111/dth.14624DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744894PMC
January 2021

Nevus depigmentosus: the analysis of 37 cases.

Ital J Dermatol Venerol 2021 Feb 23;156(1):62-67. Epub 2020 Nov 23.

Department of Dermatology, Baghdad Medical City Complex, Baghdad, Iraq.

Background: Nevus depigmentosus (ND) is an uncommon congenital nonprogressive hypopigmented skin disorder that can be seen anywhere on the body. We considered other depigmenting disorders and focused on distinguishing ND from vitiligo and tuberous sclerosis complex in infancy.

Methods: The diagnosis of patients with nevus depigmentosus was made differentiating it from nevus anemicus, pityriasis alba, tuberous sclerosis complex, vitiligo and other depigmenting disorders.

Results: Of the 37 individuals with nevus depigmentosus evaluated, 36 were children, twenty-two (59.4%) were males and 15 (40.5%) were females, with male to female ratio 1.4:1.

Conclusions: Distinguishing ND from other disorders with depigmentation can be challenging, in particular in case of tuberous sclerosis complex and vitiligo in infancy.
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http://dx.doi.org/10.23736/S0392-0488.20.06681-XDOI Listing
February 2021

Microcystic adnexal carcinoma of the head and neck: Characteristics, treatment, and survival statistics.

Dermatol Ther 2021 01 3;34(1):e14559. Epub 2020 Dec 3.

Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA.

Studies on microcystic adnexal carcinoma (MAC) survival rates have been limited. This effort examines the association of patient demographics, treatment modalities, and tumor stage with overall survival (OS) in patients with MAC of the head and neck. All cases of MAC with primary sites of the skin of the head and neck, confirmed histologically, and diagnosed from 2004 to 2016 in the National Cancer Database, were analyzed. We utilized Kaplan-Meier and Cox proportional-hazard models to analyze the characteristics and survival outcomes of the 415 cases that met the criteria. The mean age of diagnosis was 63.8 years (SD ±15.8). Mean OS was 10.8 years with 5- and 10-year OS being 81.0% and 68.0%, respectively. Women were more frequently affected (59.0%; P < .001). Stand-alone primary site surgery was the most common treatment (81.4%): 15.9% of patients were treated with postexcision radiation therapy (RT). 18.3% were treated with RT with or without surgery and/or chemotherapy. RT was independently associated with a decreased hazard of death (HR = 0.23; P = .044). MAC of the head and neck disproportionately affects whites, is more common in women, and has the potential to metastasize. Surgical excision is the commonest treatment; our study shows benefit from judicious RT.
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http://dx.doi.org/10.1111/dth.14559DOI Listing
January 2021

Leiner's disease (erythroderma desquamativum): A review and approach to therapy.

Dermatol Ther 2021 01 17;34(1):e14510. Epub 2020 Nov 17.

Dermatology, Pediatrics and Pathology, Rutgers University New Jersey Medical School, New Jersey Medical School, Newark, New Jersey, USA.

Leiner's disease (LD) is a rare and serious syndrome of infantile erythroderma of severe and progressive generalized seborrheic-like dermatitis, recalcitrant diarrhea, malabsorption and wasting, and recurrent local and systemic infections. The purpose of this study is to provide an updated review on management with a summarized review of available peer-reviewed articles on LD. The mechanisms underlying this disease process remain unclear. The diagnosis includes demonstration of deficient opsonic activity along with the clinical tetrad of erythroderma, persistent gastrointestinal disturbance, superimposed bacterial or candidal infection, and marked wasting. An important correlation between LD and defective yeast and Staphylococcus aureus opsonization has been established. For the familial form of LD, an association of either complement three deficiency or complement five dysfunction has been made. LD should be distinguished from other types of infantile erythroderma, including Omenn syndrome. Treatment includes fluid and nutrition replacement, antibiotics to control infection, and fresh-frozen plasma therapy. The prognosis is unclear; it depends on treatment. LD is a life-threatening condition that requires prompt identification and hospitalization. Affected infants who receive vigorous treatment not only have the prospect of surviving, but also generally lead a normal life after infancy.
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http://dx.doi.org/10.1111/dth.14510DOI Listing
January 2021

COVID-19: Topical agents and therapeutic prevention of nasal viral acquisition.

Dermatol Ther 2021 Jan 10;34(1):e14454. Epub 2020 Nov 10.

Department of Dermatology and Pathology, Rutgers University New Jersey Medical School, Newark, New Jersey, USA.

Since the spread of SARS-CoV-2 became a pandemic, the number of cases has been continuously growing worldwide. Numerous recommendations and suggestions have been published to prevent the acquisition and spread of the SARS-CoV-2, especially to protect health workers and front-line caregivers. SARS-CoV-2 is transmitted by aerosol, rendering air defense with suitable ventilation and adequate mask use pivotal. Recently, locally applied antiseptic, antiviral, or structure competitive receptor blockers were suggested to attack the virus at its main point of invasion, the nasal mucosa and nasopharynx. We discuss the most plausible and safe ideas to reduce viral load at the point of entry, and subsequently the spread of SARS-CoV-2 to the lower respiratory tract, lungs, and other organs. In addition, we analyze the value and recommend clinical trials employing topical trichloroacetic acid (TCA), a substance well known from dermatologic and cosmetic procedures. It has been proven to successfully block the nasal entry for airborne allergens, preventing the development of allergic rhinitis and asthma, and to be curative for early stages of viral infections entering through the oral mucosa. For SARS-CoV-2, TCA in a single, short-time application is expected to remodel the nasal and nasopharyngeal epithelia, eliminating both the receptors and cells responsible for viral entry and subsequent viral spread to the lower respiratory tract. Moreover, this may have therapeutic benefits for those recently infected by reducing local viral replication. Such procedures are cheap, safe, and can be conducted in almost every setting, especially in regions with inadequate financial and logistic resources.
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http://dx.doi.org/10.1111/dth.14454DOI Listing
January 2021

Systemic Medications of Dermatological Importance in COVID-19.

J Drugs Dermatol 2020 Sep;19(9):889-892

Early December 2019 witnessed an international outbreak of a novel coronavirus (COVID 19) designated severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2). Since then, a number of therapeutic molecules have been explored to have potential efficacy against the SARS-Cov-2 per se or its sequelae. There are no Food and Drug Administration specific therapies approved so far; however, numerous drugs based on varying levels of evidence, in vitro studies and compassionate drug trials are being established as therapeutic agents, especially drugs approved for previous emergence of the severe acute respiratory syndrome (SARS-CoV-1) and Middle east respiratory syndrome coronavirus (MERS-Cov). Numerous active clinical trials for COVID-19 with more than 150 drugs and products are under study. Needless to say, many dermatological drugs are being employed to mitigate this pandemic threat. We aim to review drugs with potential against SARS-Cov-2 widely used in dermatology practice. Additionally, rampant and overzealous use of these drugs as well as introduction of new molecules might lead to emergence of adverse effects associated with these agents. Dermatologists must be on lookout for any cutaneous adverse effects of these drugs. J Drugs Dermatol. 2020;19(9):889-892. doi:10.36849/JDD.2020.5323.
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http://dx.doi.org/10.36849/JDD.2020.10.36849/JDD.2020.5323DOI Listing
September 2020

Neurofibromatosis type 1 and subungual glomus tumors: A noteworthy association.

J Am Acad Dermatol 2021 Jun 17;84(6):e271. Epub 2020 Sep 17.

Dermatology, Pediatrics, Medicine, and Pathology, Rutgers-New Jersey Medical School, Newark, New Jersey.

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http://dx.doi.org/10.1016/j.jaad.2020.09.041DOI Listing
June 2021

The Botfly, A Tropical Menace: A Distinctive Myiasis Caused by Dermatobia hominis.

Am J Clin Dermatol 2021 Jan;22(1):81-88

Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA.

Dermatobia hominis, also known as the human botfly, is native to tropical and subtropical Central and South America and seen in travelers from endemic to temperate regions including the United States and Europe. Cutaneous infestation botfly myiasis involves the development of D. hominis larvae in the skin and is common in tropical locations. The distinct appearance of a cutaneous D. hominis infestation facilitates early diagnosis and intervention where cases are common. However, the identification of D. hominis in temperate regions may prove challenging due to its rarity. D. hominis may be misdiagnosed as folliculitis, an epidermal cyst, or an embedded foreign object with secondary impetigo. One should have a heightened suspicion in someone returning from a vacation in an endemic area, such as Belize. Here we describe the presentation, differential diagnosis, and treatment and encourage enhanced preventative measures among tourists when visiting tropical and subtropical regions. Additionally, we propose a novel classification system for assessing the various stages of infestation and suggest that patients reporting travel to Latin America and experiencing pain disproportionate to an insect bite should lead physicians to consider myiasis caused by D. hominis.
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http://dx.doi.org/10.1007/s40257-020-00522-2DOI Listing
January 2021

Neurofibromatosis type 1: New developments in genetics and treatment.

J Am Acad Dermatol 2021 Jun 6;84(6):1667-1676. Epub 2020 Aug 6.

Department of Dermatology, Rutgers-New Jersey Medical School, Newark, New Jersey. Electronic address:

Neurofibromatosis type 1 is the most common neurocutaneous syndrome, with a frequency of 1 in 2500 persons. Diagnosis is paramount in the pretumor stage to provide proper anticipatory guidance for a number of neoplasms, both benign and malignant. Loss-of-function mutations in the NF1 gene result in truncated and nonfunctional production of neurofibromin, a tumor suppressor protein involved in downregulating the RAS signaling pathway. New therapeutic and preventive options include tyrosine kinase inhibitors, mTOR inhibitors, interferons, and radiofrequency therapy. This review summarizes recent updates in genetics, mutation analysis assays, and treatment options targeting aberrant genetic pathways. We also propose modified diagnostic criteria and provide an algorithm for surveillance of patients with neurofibromatosis type 1.
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http://dx.doi.org/10.1016/j.jaad.2020.07.105DOI Listing
June 2021

COVID-19 and immunosuppressive therapy in dermatology.

Dermatol Ther 2020 11 3;33(6):e14140. Epub 2020 Sep 3.

University of Studies Guglielmo Marconi, Rome, Italy.

Coronavirus 2019 (COVID 19) was first detected in December 2019 in China. It has become a pandemic. With concern about therapies that may decrease immunity and enhance the severity of an individual's COVID-19 infection, leading to a possibly fatal outcome, use of immunosuppressants has become an important concern. This work focuses on management of various skin diseases individuals lacking immunity to COVID-19 but requiring a systemic immunosuppressant, keeping in view the challenge of the COVID 19 pandemic and that our knowledge of this virus and its effects on the immune system are incomplete including knowledge as to an individual's immunity after COVID-19 infection.
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http://dx.doi.org/10.1111/dth.14140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7435553PMC
November 2020

Gender differences in cutaneous melanoma: Demographics, prognostic factors, and survival outcomes.

Dermatol Ther 2020 11 6;33(6):e14131. Epub 2020 Sep 6.

Department of Pathology and Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA.

Several recent studies have reported a considerably higher overall survival (OS) rate in females in various geographic regions This study further investigates the characteristics of melanoma that contribute to OS of women residing in the United States. Chi-square, Kaplan-Meier, and Cox regression models were used to analyze differences in demographics, treatment, and survival of invasive cutaneous melanoma in men and women diagnosed from 2004 to 2016 in the National cancer database. In 316 966 patients met inclusion criteria. Men had a significantly higher median age of diagnosis at 61 years (interquartile range or IQR: 51-72) in comparison to women where the median age of diagnosis was 55 years (IQR: 43-68) (P < .0001). The most common primary site for men was the trunk (35.5%), whereas the lower extremities were the most common primary site for women (30.3%). Women had a higher 5 year (82.6%) and 10 year (73.1%) OS compared to 5 year and 10 year OS of 72.2% and 58.7%, respectively, in men (P < .0001). When adjusting for confounders, female gender was independently associated with improved OS (ref: male HR = 0.791; 95% confidence interval 0.773-0.809; P < .0001). Overall, we conclude that female gender is an independent favorable prognostic factor for melanoma survival.
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http://dx.doi.org/10.1111/dth.14131DOI Listing
November 2020

Disseminated intravascular coagulation: A devastating systemic disorder of special concern with COVID-19.

Dermatol Ther 2020 Nov 4;33(6):e14053. Epub 2020 Sep 4.

Dermatology, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.

Disseminated intravascular coagulation (DIC) is linked with severe COVID-19, prompting considerable concern. DIC can be a devastating systemic disorder. It is often markedly manifest on the skin as acrocyanosis or as petechiae and purpura with progression to hemorrhagic bullae. Subcutaneous hematomas may occur, as may thrombotic findings including necrosis and gangrene. The most common cause is infection, with special emphasis now on COVID-19. We have reviewed the medical literature under the search terms "Disseminated intravascular coagulation" and "consumption coagulopathy" for the past two decades in the English language using Medline and Google Scholar to update special concerns and considerations, focusing on those with COVID-19. Skin findings with DIC may be prominent. The severity of cutaneous lesions often correlates with the gravity of systemic disease. DIC is most effectively treated by addressing the underlying cause and resuscitating the patient using supportive measures. It is pivotal to recognize and treat DIC early, before deadly complications, such as multiple organ failure, arise.
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http://dx.doi.org/10.1111/dth.14053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404500PMC
November 2020

Female pattern hair loss: A comprehensive review.

Dermatol Ther 2020 11 31;33(6):e14055. Epub 2020 Aug 31.

Rutgers New Jersey Medical School, Newark, New Jersey, USA.

Female pattern hair loss is a common form of hair loss in women that increases in incidence with age. The etiology is unknown with numerous factors identified that influence its onset. Female pattern hair loss may be viewed as a marker for an increased risk of cardiovascular and metabolic disease. New treatments include microneedling, low-level laser therapy, and autologous fat transfer. This article focuses on the pathophysiology, diagnosis, systemic associations, and current treatments for female pattern hair loss, which is the most common cause of alopecia in women.
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http://dx.doi.org/10.1111/dth.14055DOI Listing
November 2020

Pioneering research on American onchocerciasis: a tribute to Leon Goldman, MD.

Int J Dermatol 2021 Mar 19;60(3):e80-e81. Epub 2020 Jul 19.

Rutgers New Jersey Medical School, Newark, NJ, USA.

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http://dx.doi.org/10.1111/ijd.15067DOI Listing
March 2021

Localized sebaceous carcinoma treatment: Wide local excision verses Mohs micrographic surgery.

Dermatol Ther 2020 11 6;33(6):e13991. Epub 2020 Aug 6.

Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA.

The optimal surgical management of sebaceous carcinoma (SC) has yet to be determined between Mohs micrographic surgery (MMS) and wide local excision (WLE). To investigate overall survival (OS) differences for SC undergoing WLE or MMS, The National Cancer Database (NCDB) was queried for all SC from 2004 to 2015 (n = 2863). Cases missing staging data, undergoing palliative care, showing lymph node extension, or of AJCC Stage III/IV were omitted. Chi-squared tests were used to analyze patient demographics, cancer characteristics, and treatment modalities. Kaplan-Meier and Cox proportional hazards regression modeling analyzed OS outcomes. A total of 554 cases met inclusion criteria (WLE [n = 243], MMS [n = 311]). Multivariate analysis revealed that cases treated in academic facilities (ref: non-acad; OR = 2.273; CI95% [1.448-3.568]; P < .001] were independently associated with greater MMS rates, whereas those with primaries on the trunk (ref: head/neck OR = 0.359; CI95%[0.203-0.634]; P < .001) and extremities (ref: head/neck OR = 0.399; CI95% [0.182-0.877]; P = .022) held lower MMS rates. Between surgical modalities, Kaplan-Meier survival showed no significant difference in outcomes (P = .611), with WLE and MMS demonstrating 5-year OS rates of 65.8% and 61.4%, respectively. On Cox proportional hazard regression, the survival outcomes of MMS and WLE did not show any significant differences in OS (HR = 0.832; CI95% [0.996-3.662]; P = .334). MMS and WLE of localized SC demonstrate similar overall survival outcomes. MMS may be preferred for margin control, tissue conservation, and cosmesis.
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November 2020

The pathophysiology of pityriasis alba: Time-dependent histologic changes.

Clin Dermatol 2020 May - Jun;38(3):354-356. Epub 2019 Jul 11.

Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA. Electronic address:

Although pityriasis alba is a common dermatologic condition, its pathogenesis is poorly understood, and there are many discrepancies in the literature. To assess the effect of the duration of disease on the histologic findings, a search of cases labeled "pityriasis alba" was performed on any cases submitted to our dermatopathology laboratory. Of 179 cases of pityriasis alba, five cases identified the duration of the disease, when the biopsy was taken. A biopsy for a lesion of only 1-month duration demonstrated groups of large, prominent melanocytes heaped up upon one another. Compared with biopsies from patients who had the lesions for increasingly longer periods of time, it was apparent that the melanocytes became progressively less abundant and smaller with less prominent dendritic processes. The time that the biopsy is taken may affect the histologic findings of pityriasis alba. Additionally, an abundance of melanosomes was observed between the melanocytes in all sections examined which may reflect a problem with the transfer of melanosomes into keratinocytes in this condition.
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http://dx.doi.org/10.1016/j.clindermatol.2019.07.002DOI Listing
September 2020