Publications by authors named "William W Huang"

55 Publications

Resolution of microneedling-associated granulomatous dermatitis with oral methotrexate.

JAAD Case Rep 2021 Apr 23;10:96-98. Epub 2021 Feb 23.

Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina.

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http://dx.doi.org/10.1016/j.jdcr.2021.02.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008152PMC
April 2021

Oral dapsone for the treatment of generalized granuloma annulare: A retrospective case series.

J Am Acad Dermatol 2021 Mar 20. Epub 2021 Mar 20.

Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina.

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http://dx.doi.org/10.1016/j.jaad.2021.03.045DOI Listing
March 2021

Mycophenolate mofetil as adjunctive therapy to corticosteroids for the treatment of pyoderma gangrenosum: a case series and literature review.

Int J Dermatol 2021 Mar 19. Epub 2021 Mar 19.

Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA.

Pyoderma gangrenosum is a rare neutrophilic dermatosis that is commonly treated with systemic corticosteroids; however, their potent side effects may warrant tapering, and non-steroidal systemic immunosuppressants may help maintain or bolster disease clearance during weaning. Although cyclosporine is regarded as a favorable corticosteroid-sparing agent, it is associated with several side effects, such as renal toxicity and hypertension, that may limit its feasibility. Mycophenolate mofetil is a well-tolerated alternative with limited data. Institutional review board approval was obtained to review patients from a single institution who received mycophenolate mofetil for pyoderma gangrenosum between January 1, 2010, and December 31, 2019. A systematic MEDLINE (PubMed) review was performed of articles containing linked keywords: "mycophenolate mofetil" and "pyoderma gangrenosum". Patient demographics, presentation details, and treatment regimen characteristics were recorded. Fourteen of our pyoderma gangrenosum patients were treated with mycophenolate mofetil concomitantly with prednisone. Ninety-three percent of our patients achieved improvement within 12 months (mean 4.5 months), including five patients who experienced complete healing. Outcomes in literature patients were comparable; 77% either improved or maintained clearance with mycophenolate mofetil. Greater than 80% of total patients experienced healing or adequate disease control at a median dose of 2000 mg daily. The most common side effects of mycophenolate mofetil were myelosuppression and gastrointestinal upset, which were both seen in 18% of patients. Although this study is subject to publication bias, mycophenolate mofetil appears to be an efficacious and well-tolerated adjunctive therapy option for pyoderma gangrenosum.
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http://dx.doi.org/10.1111/ijd.15539DOI Listing
March 2021

Dapsone as corticosteroid-sparing therapy for Sweet syndrome.

J Am Acad Dermatol 2021 Mar 2. Epub 2021 Mar 2.

Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina.

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http://dx.doi.org/10.1016/j.jaad.2021.02.067DOI Listing
March 2021

The next quantum leap forward? Bimekizumab for psoriasis.

Lancet 2021 02;397(10273):446-448

Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27157-1071, USA. Electronic address:

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http://dx.doi.org/10.1016/S0140-6736(21)00269-5DOI Listing
February 2021

The dermatology residency application process.

Dermatol Online J 2021 Jan 8;26(12). Epub 2021 Jan 8.

Department of Medicine, Henry Ford Hospital, Detroit MI.

The dermatology application process is grueling, that is tough to navigate without the proper guidance. This commentary is meant to shed light on the factors that can help applicants stand out in order to be successful in the match. It includes observations from successful applicants from the most recent match process.
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January 2021

The ethical foundation for honesty and the focused use of deception in dermatology.

Dermatol Online J 2020 Nov 15;26(11). Epub 2020 Nov 15.

Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC Department of Internal Medicine, Vidant Medical Center/East Carolina University, Greenville, NC.

Physicians have a fiduciary duty to be honest and to act in the patients' best interest. There are times when these two duties conflict. Honesty is paramount in supporting the physician-patient relationship and loss of patient trust is devastating. Furthermore, even minor deception can suggest a return to the physician authoritarianism of the past century that has been decried by modern ethicists. Nonetheless, circumstances can arise in which good judgement may require less than complete honesty to avoid harm to the patient. If the benefit for the patient is large and the risk from deception is small, thoughtful application of minor deception could be designed to benefit patients. Of course, research is required to fully assess this strategy.
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November 2020

Reply to Letter to the Editor.

J Am Acad Dermatol 2021 Feb 8;84(2):e111-e112. Epub 2020 Oct 8.

Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina.

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http://dx.doi.org/10.1016/j.jaad.2020.10.004DOI Listing
February 2021

The importance of publications, research, volunteer, and work experience in dermatology residency applicants.

J Am Acad Dermatol 2021 Feb 30;84(2):e99-e100. Epub 2020 Sep 30.

Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina.

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http://dx.doi.org/10.1016/j.jaad.2020.09.066DOI Listing
February 2021

Mycophenolate mofetil for the treatment of cutaneous lichen planus: A retrospective case series.

J Am Acad Dermatol 2021 Apr 26;84(4):1091-1094. Epub 2020 Aug 26.

Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Dermatology, University of Southern Denmark, Odense, Denmark.

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http://dx.doi.org/10.1016/j.jaad.2020.08.090DOI Listing
April 2021

Publication rates on the topic of racial and ethnic diversity in dermatology versus other specialties.

Dermatol Online J 2020 Mar 15;26(3). Epub 2020 Mar 15.

Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC.

Background: The population of the U.S. is becoming more diverse every year. The field of dermatology is not following the same trend.

Objective: To assess the promotion of diversity in the field of dermatology by analyzing publications focused on diversity, compared to other specialties.

Methods: The PubMed database was systematically searched to identify publications focused on diversity from January 2008 to July 2019. The search criteria were as follows: dermatology/radiology/ophthalmology/ anesthesiology/orthopedic surgery/family medicine/ internal medicine/general surgery AND diversity/ diverse/racial/race/ethnic/ethnicity/cultural/culture/competency/competence. Comparisons were made using single-factor ANOVA and two-group t-tests. A qualitative analysis was performed for publications in the field of dermatology.

Results: From January 2016 to July 2019, there were 25 publications focused on diversity in dermatology (Mean=6.25, SD=2.06), compared to 6 in radiology (Mean=1.50, SD=1.29, P=0.01), two in ophthalmology (Mean=0.50, SD=0.58, P=0.01), two in anesthesiology (Mean=0.50, SD=1.00, P=0.01), 12 in orthopedic surgery (Mean=3.00, SD=1.41, P=0.04), 23 in family medicine (Mean=5.75, SD=2.22, P=0.75), 9 in internal medicine (Mean=2.25, SD=1.71, P=0.02), and 7 in general surgery (Mean=1.75, SD=0.50, P=0.02).

Conclusions: Although the field of dermatology has suffered from a lack of racial/ethnic diversity, efforts to promote diversity via increased publications in the last four years have been stronger in dermatology compared to many other fields.
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March 2020

Clinical case-viewing sessions in dermatology: the patient perspective.

Cutis 2020 Apr;105(4):200-201

Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.

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April 2020

SECURE-Psoriasis: a de-identified registry of psoriasis patients diagnosed with COVID-19.

J Dermatolog Treat 2020 06 16;31(4):327. Epub 2020 Apr 16.

Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina.

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http://dx.doi.org/10.1080/09546634.2020.1753996DOI Listing
June 2020

Steroid phobia isn't reduced by improving patients' knowledge of topical corticosteroids.

J Am Acad Dermatol 2020 12 26;83(6):e403-e404. Epub 2020 Jul 26.

Wake Forest School of Medicine, Department of Dermatology, Winston-Salem, North Carolina.

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http://dx.doi.org/10.1016/j.jaad.2020.03.011DOI Listing
December 2020

Clinical recommendations made in dermatology publications are frequently not supported by adequate evidence.

J Dermatolog Treat 2020 Jan 6:1-2. Epub 2020 Jan 6.

Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, NC, USA.

Absolute risk and cost-benefit analyses are necessary to guide clinical decision making. The purpose of this study was to evaluate whether clinical recommendations in dermatology publications were supported by adequate evidence. We also assessed whether dermatology residents report sufficient evidence when they author publications. We analyzed the clinical cohort, case-control, and case series studies published in JAMA Dermatology and the Journal of American Academy of Dermatology from January 2018 to December 2018 for statistical significance, absolute associations, diagnostic and therapeutic clinical recommendations, and risk-benefit analysis. We also identified articles with a U.S. dermatology resident as first or second author. We found that the majority of articles reported statistical significance, but only 3% included absolute risk analyses and none had risk-benefit analysis. Furthermore, 42% of studies with a dermatology resident as a primary author reported statistical significance, but none provided absolute risk or risk-benefit analyses. Reviewers need to be more aware of the evidentiary needs required for clinical recommendations, and dermatology residents may benefit from additional statistics training.
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http://dx.doi.org/10.1080/09546634.2019.1708247DOI Listing
January 2020

Publication productivity of authors of psoriasis clinical practice guidelines with and without ties to industry.

J Am Acad Dermatol 2019 12 11;81(6):1432-1433. Epub 2019 Jun 11.

Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.

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http://dx.doi.org/10.1016/j.jaad.2019.06.001DOI Listing
December 2019

An increasing trend in the number of publications and research projects among dermatology residency applicants.

J Am Acad Dermatol 2020 Jul 19;83(1):214-216. Epub 2019 Sep 19.

Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina.

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http://dx.doi.org/10.1016/j.jaad.2019.09.021DOI Listing
July 2020

Asboe-Hansen sign in toxic epidermal necrolysis.

Cutis 2019 Apr;103(4):E6-E8

Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.

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April 2019

Rosacea: Relative risk versus absolute risk of malignant comorbidities.

J Am Acad Dermatol 2019 08 14;81(2):623-624. Epub 2019 Jan 14.

Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2019.01.013DOI Listing
August 2019

Adverse cutaneous effects of neratinib.

J Dermatolog Treat 2019 Aug 28;30(5):487-488. Epub 2018 Nov 28.

a Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA.

Neratinib is a tyrosine kinase inhibitor that was FDA-approved for extended adjuvant treatment in adults with human epidermal growth factor receptors-2 (HER-2) positive breast cancer in 2017. Due to the novelty of the drug, there are no current reports in the literature of adverse cutaneous effects associated with neratinib therapy. We present a case of a woman on neratinib for HER-2 positive infiltrating ductal carcinoma of the right breast who presented to the dermatology clinic with changes to the fingernails, acne, and a rash on the face. Physical examination revealed erythema, induration, and some serum crust along the lateral nail folds of the right fourth and left third digits as well as monomorphic acneiform papules and pustules on the face. The timeline of the patient's paronychia and acneiform rash were consistent with a diagnosis of neratinib-associated skin changes. The patient was prescribed doxycycline to control the acneiform eruption. For the nails, she used mupirocin ointment as well as Listerine soaks. She experienced great improvement on this regimen at her 3-month follow-up visit. This case highlights similar cutaneous side effects to epidermal growth factor receptor (EGFR) inhibitors with a newer agent, neratinib, that have not been documented in the literature.
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http://dx.doi.org/10.1080/09546634.2018.1536253DOI Listing
August 2019

Eosinophilic fasciitis: a case series with an emphasis on therapy and induction of remission.

Drugs Context 2018 2;7:212529. Epub 2018 Oct 2.

Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.

Eosinophilic fasciitis is an uncommon connective tissue disorder that affects patients of all ages, resulting in significant morbidity. Systemic corticosteroids can induce remission of disease. However, there is no universally accepted treatment ladder for eosinophilic fasciitis. This case series evaluates treatment efficacy in patients with eosinophilic fasciitis seen at Wake Forest University Department of Dermatology outpatient clinics. Patient charts were screened using ICD-9 diagnosis code 710.9 (unspecified diffuse connective tissue disease) to identify patients with eosinophilic fasciitis (n=10) seen at our institution. Patients were treated for an average 24 months with a combination of methotrexate and prednisone therapy, unless one or both were contraindicated, with each medication tapered conservatively to prevent disease flares. Alternate treatments included mycophenolate mofetil with prednisone, azathioprine with prednisone, prednisone monotherapy, and methotrexate monotherapy. Disease remission off therapy and on low-dose therapy was 66 and 70%, respectively. Our first-line therapy of concomitant methotrexate and prednisone is well-tolerated and effective for managing patients with eosinophilic fasciitis. Our study was limited to cases seen at a single academic institution.
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http://dx.doi.org/10.7573/dic.212529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6172017PMC
October 2018

Current treatment options for acanthosis nigricans.

Clin Cosmet Investig Dermatol 2018 7;11:407-413. Epub 2018 Aug 7.

Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC,

Acanthosis nigricans (AN) is a common dermatologic manifestation of systemic disease that is associated with insulin resistance, diabetes mellitus, obesity, internal malignancy, endocrine disorders, and drug reactions. Treatment of AN primarily focuses on resolution of the underlying disease processes causing the velvety, hyperpigmented, hyperkeratotic plaques found on the skin. While the goal of therapy is to treat the primary cause, cosmetic resolution of AN lesions can be important for patients and their quality of life. Treatment options for AN have not been extensively studied; however, smaller powered clinical trials and case reports exist in the literature. Our review aims to explore and evaluate the current treatment options that exist for AN.
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http://dx.doi.org/10.2147/CCID.S137527DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086114PMC
August 2018

A case of gemcitabine-related acute lipodermatosclerosis.

J Oncol Pharm Pract 2019 Jul 24;25(5):1271-1274. Epub 2018 Jul 24.

2 Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, USA.

Introduction: Gemcitabine is a chemotherapeutic agent used to treat several solid organ malignancies. The most common cutaneous toxicities are a mild erythematous rash and pruritus, which are often attributed to infectious etiologies. However, certain clinical characteristics may favor a drug-related reaction. Clinicians should recognize these phenomena to avoid potentially unnecessary antibiotic treatment or withdrawal of chemotherapeutic agents.

Objective: We aim to report a case of gemcitabine-related acute lipodermatosclerosis-like eruption, add to the evolving classification of this condition, and highlight developing literature on gemcitabine that may explain this toxicity.

Case: Dermatology was consulted for presumed cellulitis in a 62-year-old female with pancreatic carcinoma. The patient presented to the emergency department five days after her first dose of gemcitabine with erythema in both lower extremities. A diagnosis of gemcitabine-related acute lipodermatosclerosis was made and the patient was started on topical triamcinolone.

Conclusion: It is important to recognize gemcitabine-related acute lipodermatosclerosis in order to avoid unnecessary antibiotic use and disruptions in chemotherapy.
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http://dx.doi.org/10.1177/1078155218788709DOI Listing
July 2019

Public Perception of Ethical Issues in Dermatology: Evidenced by New York Times Commenters.

Dermatol Surg 2018 12;44(12):1571-1577

Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina.

Background: A 2017 New York Times (NYT) article questioning the appropriateness of skin cancer treatment modality by dermatology providers stimulated discussion among the public pertaining to ethics in the current state of dermatologic practice.

Objective: The purpose of this study is to characterize issues raised by the comments on the NYT article, discuss strategies to address these concerns, and encourage reflection on ethics in dermatologic care.

Materials And Methods: A qualitative analysis was performed on the 309 comments on the NYT article. General themes were identified, resulting in the inclusion of 222 comments. These comments were reviewed and characterized by the type of commenter, his or her stance on health care, and what issues they raised.

Results: Providers interested in "profit over patient" was the most common theme, followed by mistrust of APPs, health care system interested in "profit over patient," inadequate supervision by advanced practice providers (APPs), finding the "right" provider, support for coordinated APP and physician care, support for APP credentials, and finally inappropriate elderly care.

Conclusion: The NYT article raises the concern of identifying quality care and choosing the "right provider"-one who successfully balances the various incentives affecting skin cancer management including appropriate usage of APPs.
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http://dx.doi.org/10.1097/DSS.0000000000001585DOI Listing
December 2018

Molluscum contagiosum in immunocompromised patients: AIDS presenting as molluscum contagiosum in a patient with psoriasis on biologic therapy.

Cutis 2018 Feb;101(2):136-140

Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.

Molluscum contagiosum (MC) is a common, self-limited cutaneous infection in immunocompetent individuals. However, in immunocompromised individuals the infection often has an atypical presentation and can be difficult to eradicate, making both the diagnosis and treatment challenging. Due to advancements in the management of patients with human immunodeficiency virus (HIV) and cancer, there is a growing population of immunosuppressed individuals, signaling the need for dermatologists to recognize and manage related skin diseases. We present a case of an atypical MC eruption in a patient on biologic therapy for psoriasis and an unrecognized underlying HIV infection, followed by a current review of the presentation and treatment of MC in various immunosuppressed states. With a growing population of immunosuppressed patients, it is important to recognize MC as a potential indicator of underlying immunosuppression. Testing for HIV should be offered to any patient starting immunosuppressive therapy such as biologic agents.
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February 2018

Rosacea Pathogenesis.

Dermatol Clin 2018 Apr 15;36(2):81-86. Epub 2017 Dec 15.

Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA.

Rosacea is a chronic inflammatory skin disorder that is not fully understood but involves the complex interplay of genetic factors, immune dysregulation, neurovascular dysregulation, presence of microorganisms, and environmental factors. Increased activation of the immune system occurs through multiple stimuli, including increased levels of cathelicidin and kallikrein 5, Toll-like receptor 2, matrix metalloproteinases, and mast cells within the skin. Their effects are enhanced by the presence of microorganisms and external triggers, such as UV radiation.
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http://dx.doi.org/10.1016/j.det.2017.11.001DOI Listing
April 2018

The safety of treatments used in pyoderma gangrenosum.

Expert Opin Drug Saf 2018 01 27;17(1):55-61. Epub 2017 Oct 27.

a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine  , Winston-Salem , NC , USA.

Introduction: Pyoderma gangrenosum (PG) is a severe ulcerating orphan dermatosis characterized by painful and rapidly progressive skin ulcers often associated with underlying inflammatory disease.

Areas Covered: In this article, we review and analyze the literature regarding treatment options for patients with PG, with particular attention to the efficacy and safety of therapies. Despite the significance of this problem, there are few studies devoted to the efficacy or safety of therapeutics in PG. We aim to present and evaluate existing studies and reports, and to make treatment recommendations based on the efficacy and safety data reviewed.

Expert Opinion: All patients with PG should be counseled on avoiding trauma, optimizing glycemic control, and smoking cessation. Proper local wound care and surveillance of superimposed infection is essential to healing. Control of underlying inflammatory conditions should be co-managed with appropriate specialists. Patients with limited disease should consider high potency topical steroid or topical calcineurin inhibitors. For systemic therapy, the best evidence supports the use of systemic steroids or cyclosporine. Biologic therapy should be reserved in patients as a third line therapy or in patients with underlying systemic inflammatory disease. There is an existing need for well-designed studies to evaluate the efficacy and safety of therapeutics in PG.
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http://dx.doi.org/10.1080/14740338.2018.1396316DOI Listing
January 2018

Herpes zoster following varicella vaccination in children.

Cutis 2017 Mar;99(3):207-211

Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.

Herpes zoster (HZ), or shingles, is commonly seen in older adults but does occur in children. Routine administration of the varicella vaccine started in 1995 in the United States; since then, the incidence of varicella and HZ has declined. We report a case of HZ in an otherwise healthy 19-month-old boy who had been vaccinated at 13 months of age and recovered fully after acyclovir treatment. We review previously reported cases of HZ in healthy vaccinated children.
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March 2017

Dermatology Residents are Prescribing Tanning Bed Treatment.

Dermatol Online J 2016 Jul 15;22(7). Epub 2016 Jul 15.

Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina.

Although 90% of dermatologists discourage the use of tanning beds, about half of psoriasis patients report using tanning beds and most of these note improvement. The purpose of this investigation was to determine if dermatology residents are advocating the tanning bed use to their patients.
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July 2016

The proliferation of online for-profit medical journals.

J Am Acad Dermatol 2016 Sep;75(3):656-657

Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2016.02.1156DOI Listing
September 2016