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Melbourne, Australia

Caresana G.,Dermatology Unit | Giardini R.,Pathology Unit
Journal of the European Academy of Dermatology and Venereology | Year: 2010

Background: In basal cell carcinoma (BCC), excision margins between 3 and 10 mm, according to site, size, borders, previous treatment and histology, can allow for radical excision in at least 95% of cases. Objective: The objective was to ascertain whether dermoscopy can detect more accurately the lateral borders in BCCs than clinical examination alone, and allow us to obtain radical excision in more than 95% of cases with only 2-mm excision margins. Methods: A prospective study was performed of 200 consecutive BCCs of the head and neck removed with 2-mm dermoscopically detected excision margins. Morpheaform BCC, deeply recurrent BCC, BCC in Gorlin-Goltz syndrome, BCC located in sites not accessible through dermoscopy and superficial multifocal BCC were excluded. All cases of excised BCC were submitted to a uniform method of histological examination of the whole specimen with serial parallel sections at 2-mm intervals. Results: In only three cases did surgical excision with 2-mm margins prove to be inadequate; in the remaining 197 cases, the excision margins were tumour-free. The comparison of clinical and dermoscopic extension measurement showed concordance in 131 cases (65.5%). In 69 cases (34.5%), dermoscopic evaluation showed a larger peripheral extension. Conclusions: These results indicate that 2-mm dermoscopically detected excision margins can achieve histologically confirmed complete excisions in 98.5% of cases. © 2010 European Academy of Dermatology and Venereology.

Landau M.,Dermatology Unit | Fagien S.,Private Practice
Plastic and Reconstructive Surgery | Year: 2015

Loss of viscoelasticity is one of the primarily signs of skin aging, followed by appearance of visible wrinkles. Hyaluronic acid (HA)-based fillers are widely used to fill wrinkles and compensate for volume loss. Recent clinical observations demonstrate persistence of the filling effect longer than the biological availability of the filler. Stimulation of new collagen by cross-linked HA and up-regulation of elastin have been suggested as possible explanation to this observation and have been supported experimentally. Cross-linked HA substitutes for fragmented collagen in restoring extracellular matrix required for normal activity of fibroblasts, such as collagen and elastin production. To restore extracellular matrix efficiently, serial monthly treatments are required. Boosting of facial and nonfacial skin through fibroblast activation is a new indication for HA-based products. Injectable HA has also been recently registered in Europe as agents specific for the improvement of skin quality (Restylane Skinboosters). Further explanation of the possible mechanisms supported by long-term clinical examples is presented herein. Copyright © 2015 by the American Society of Plastic Surgeons.

Lipozencic J.,University of Zagreb | Wolf R.,Dermatology Unit
Clinics in Dermatology | Year: 2010

We conducted a systematic Medline search of the literature (1998-2008) on the criteria for performing the skin prick test and atopy patch testing (APT) to determine their utility in atopic dermatitis (AD). The skin prick, scratch, and skin patch tests are performed to identify which allergen is causing eczematous skin symptoms in patients with AD, or sneezing, nasal congestion, itchy eyes, wheezing, skin rash, and swelling. Many allergens in foods, drugs, and environmental substances (eg, ragweed and fungus), as well as contact allergens, can elicit eczematous skin reactions after epicutaneous application. Because no gold standard exists for aeroallergen provocation in AD, the APT is currently used to evaluate allergen without comparison with another accurate and reliable method. The APT is presumed to reflect delayed-phase clinical reactions. Even with delayed onset of symptoms (more than 2 hours after food ingestion), APT findings were not consistent among AD children. The APT could be used in children with gastrointestinal reactions to foods as well as AD. After standardization, the APT may provide further diagnostic information in addition to the skin prick test and serum immunoglobulin E values and may be able to evaluate the actual clinical relevance of immunoglobulin E-mediated sensitizations for eczematous lesions. The European APT model used with standardization of allergen concentration and vehicle may provide an important diagnostic tool to select patients for avoidance and for procedures of allergen-specific immunotherapy, but the clinical relevance of positive APT reactions awaits standardized provocation and avoidance testing. © 2010 Elsevier Inc. All rights reserved.

Koh H.Y.,Dermatology Unit
Clinical, Cosmetic and Investigational Dermatology | Year: 2013

Background: Skin problems are common in patients with hematological disorders. Dermatologists play an important role in providing consultative service to other medical specialties. While most requests for dermatologic consultations are for common skin conditions, challenging scenarios and diagnostic dilemmas are frequently encountered, especially in acutely ill, immunocompromised patients. Aim: To characterize the profile of dermatological problems encountered in a hematology unit in a tertiary hospital, and to delineate clinical features that may help to distinguish cutaneous adverse drug reactions from toxic erythema of chemotherapy. Materials and methods: A retrospective study was conducted reviewing all inpatient referrals for dermatology consultations from the hematology unit during a 6-month period from January 2010 to June 2010, at the largest multidisciplinary tertiary hospital in Singapore. Results: Of the 692 referrals for dermatology consultation, 58 (8.3%) came from the hematology department. A total of 60 dermatological diagnoses were made. Most patients were referred for primary dermatological disorders (43.33%, n = 26). The most common diagnoses within this category were cutaneous infections (15%, n = 9) and dermatitis (13.33%, n = 8). Cutaneous adverse drug reactions (16.67%, n = 10) and toxic erythema of chemotherapy (10%, n = 6) were also frequently encountered. We could not identify any distinctive clinical feature that may help to differentiate the two conditions. Conclusion: Our study reinforces the importance of inpatient medical dermatology in terms of both service and education to nondermatologists, who continue to face difficulties diagnosing common skin disorders. Cutaneous adverse drug reactions and toxic erythema of chemotherapy are clinically similar and difficult to differentiate. Larger prospective studies are needed to examine this problem. © 2013 Koh, publisher and licensee Dove Medical Press Ltd.

Di Lernia V.,Dermatology Unit
Expert Opinion on Therapeutic Targets | Year: 2015

Introduction: Recent data about atopic dermatitis (AD) pathogenesis postulate that T cells and their related cytokines and chemokines are primarily responsible for the inflammatory responses.Areas covered: AD, the primary complex disease associated with filaggrin deficiency, is characterized by cutaneous inflammation driven by type 2 helper T (TH2) cells. TH2-related molecules, such as IL-4, IL-13, dominate the immune infiltrate. Experimental evidences suggest that these cytokines may be considered attractive therapeutic targets in AD, particularly in extrinsic AD with IgE overproduction. Recently, a fully human monoclonal antibody directed against the IL-4 receptor α subunit blocking IL-4 and IL-13 signaling has been evaluated in Phase I and Phase II clinical trials in patients with moderate-to-severe AD with significant improvement in disease severity. Phase III trials are ongoing.Expert opinion: Treatment of AD represents a therapeutic challenge. TH2 cytokine-targeted therapies represent promising treatment options that could improve the therapeutic armamentarium for AD. These therapies are likely to become future therapeutic options in AD, particularly in the extrinsic AD. © 2015 Informa UK, Ltd.

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