Open journal of clinical & medical case reports, Oct 27, 2023
The high prevalence of psoriasis creates a significant barrier for the global healthcare system, ... more The high prevalence of psoriasis creates a significant barrier for the global healthcare system, affecting nearly 7.4 million US adults with direct treatment costs accumulating to over $12 billion annually . Biologic drugs have become a major component of psoriasis management, with anti-TNF inhibitors, IL-17 inhibitors, IL-12, TYK 2 inhibitors, and other medications becoming integral to a patient's psoriasis treatment regimen . However, given the ubiquitous use of biologics in psoriasis management, the response to these medications is not homogenous, with differences in patient genomics contributing to nearly 70% of the inter-individual drug response differences . Pharmacogenetics provides dermatologists with more targeted treatment modalities to illicit the best response in psoriasis patients with minimal adverse effects. Given the costly nature of biologic medications, identifying the optimal drug for each patient may reduce annual healthcare expenditures. Biologic treatment for psoriasis is largely a "trial-and-error" process with most dermatologists changing the biologic agents for 10-30% of their patients in the first year and an intra-class switch of at least 50% of treatment-nonresponsive patients . A retrospective claims analysis indicated that 46% of psoriasis patients discontinued their biologic within 12 months and only 38% of patients were adherent to treatment . Adherence to clinical guidelines such as the Clinical Pharmacogenetics Implementation Consortium (CPIC) regarding drug-gene interactions which may guide individual drug-dose therapy including making dose adjustments, identifying efficacious medications, and monitoring drug events. Genomic datasets are being developed that allow dermatologists to search for cell lines of interest and evaluate genotype data to predict dose-response data for various biologics (Table ). These datasets along with pharmacogenetic testing can be utilized by physicians to aid in optimal biologic agent selection to minimize the "trial and error" process and associated costs. Additionally, other machine learning based
Purpose: A rise in market demand for anti-aging skin care products has resulted in a proliferatio... more Purpose: A rise in market demand for anti-aging skin care products has resulted in a proliferation of cosmeceuticals, including products that contain vitamin C. Many topicals containing vitamin C claim to reduce the appearance of wrinkles. However, these claims have not been systematically evaluated. Methods: A systematic review of literature published between January 2015 and September 2022 was performed per PRISMA guidelines. Scopus, Web of Science, and PubMed were queried for records relevant using the following Medical Subject Heading (MeSH) terms: “Topical Vitamin C OR Ascorbic acid”, “Vitamin C efficacy”, “dermatology”, “cosmetology”, and “skin anti-aging”. Variables of interest included: study type, study location, study duration, sample size, patient description, type and ingredients of the topical formulation, outcome measurement, results, and adverse events. Results: After deduplication, consideration of inclusion and exclusion criteria, and title/abstract screening, 5,428 initial records were reduced to 7 articles, including 4 meeting Level IB criteria, one meeting Level IIA criteria, and 2 meeting Level IIB criteria. Methods for assessing clinical improvements included global photodamage score, skin topography assessment, reflectance confocal microscopy (RCM) skin analysis, Dynamical Atlas, and participant self-assessment. Conclusions: While 4 of the 7 studies met Level IB evidence, further high-quality, prospective, and comparative studies are indicated to better elucidate the role of topical vitamin C in wrinkle reduction. All the studies used vitamin C in combination with other ingredients or therapeutic mechanisms, thereby complicating any specific conclusions regarding the efficacy of vitamin C. Citation: Sanabria B, Berger LE, Mohd H, et al. Clinical efficacy of topical vitamin C on the appearance of wrinkles: a systematic literature review. J Drugs Dermatol. 2023;22(9):898-904. doi:10.36849/JDD.7332.
Background: Melasma often presents as a therapeutic challenge to dermatologists. Due to its relap... more Background: Melasma often presents as a therapeutic challenge to dermatologists. Due to its relapsing nature, long-term topical maintenance therapies are often required which may be time consuming and costly for patients. As a result, light and laser therapies have become increasingly popular in the treatment of melasma. Yet, clinical studies on melasma tend to focus more on the efficacy of these treatments rather than their ability to achieve long-term results. Objective: To assess the ability of light and laser treatments to achieve long lasting results in melasma. Methods: A literature review was conducted to assess the long-term efficacy of laser and light treatments in epidermal, mixed and dermal melasma. Results: Out of 128 articles reviewed, 17 studies of laser and light therapies included patient follow-up without maintenance therapies in their study designs. According to these studies, IPL and Nd:YAG achieved long lasting results for up to 6-months. Studies also suggest that combining these therapies together as well as combining them with other topical or procedural therapies, may result in enhanced long-term efficacy. Despite this, these treatments are less commonly used than topical therapies in clinical practice due to their cost and potential side effects, such as scarring, post inflammatory hyperpigmentation and prolonged erythema. Studies also indicate that these therapies vary in efficacy depending on the melasma subtype. Limitations: There was a lack of standardized outcome assessments. In conclusion, light and laser treatments have a role in treating melasma. To study their efficacy in treating melasma long-term, more studies with extended duration of follow-ups and standardized outcome measures are needed.
Journal of Cutaneous Medicine and Surgery, Oct 1, 1996
Background: Data show that intermittent painful sunburns are an important causative factor for cu... more Background: Data show that intermittent painful sunburns are an important causative factor for cutaneous malignant melanoma. Objective: This study was undertaken to determine whether the differences in the anatomic distribution of melanomas in men,compared to women, could be accounted for by the distribution of sunburns and whether the high incidence of melanomas on the lower extremities of women is associated with the distribution of sunburns. Methods: One hundred and fifty nonmelanoma patients, men and women aged 20 to 60 years, recalled having painful sunburns within the previous 6 months. The locations of the sunburns were indicated on body surface diagrams. The locations of 1168 melanomas as recorded in the NYU-Melanoma Cooperative Group data base were plotted on anatomic diagrams. The anatomic distribution of melanomas and of sunburns for men and women were compared. Results: There was no statistically significant difference in the distribution of sunburns on any anatomic location in men as compared to women. However, there was a disproportionately high number of melanomas on the backs of men and on the legs of women. In both men and women, there was a significant difference between the anatomic distribution of painful sunburns and melanomas. Conclusion: Since the anatomic distribution of painful sunburns is similar in men and women, whereas the anatomic distribution of melanomas differ, it would appear that factors in addition to sunburns in adults account for the differences in the anatomic distribution of melanomas in men and women. I ntermittent intense sun exposure, resulting in painful sunburns, has been reported to be a risk factor for the development of malignant melanomas (MMS).l-4 The anatomic distribution of cutaneous MMs is different in men and women, favouring the backs of men and the legsof women."? The precise reason for this gender-related difference in the
BACKGROUND Dysplastic nevi (DN) have been a matter of controversy since their initial description... more BACKGROUND Dysplastic nevi (DN) have been a matter of controversy since their initial description in 1978 because of differences in the clinical and histological terminology, and large studies on histological outcomes of excising moderate to severely DN have not previously been described. OBJECTIVE To determine the clinical characteristics of DN and histologic outcomes of excised moderate and severe DN. METHODS Retrospective chart review of patients with DN or Clark's nevi at the Dermatology Department at Rutgers-Robert Wood Johnson Medical School in Somerset, New Jersey, from January 2009 to June 2012. Three hundred ninety-three lesions from 380 patients were included in this study. MAIN OUTCOME MEASURE Histologic results of excised moderate and severe DN. RESULTS Thirty-four percent of DN were excised because of the presence of moderate or severe atypia, personal history of melanoma, or both. None of the excised lesions showed evidence of melanoma; 81.6% of excisions showed scar or granulation tissue. Only 14% of excised lesions were found to have residual lesions, and 4.4% showed recurrent nevi. CONCLUSION In 134 excisions of moderate to severe DN, no melanoma was identified. Most of the excisions showed scar or granulation tissue. The rate of residual lesions after shave biopsy of moderate or severe DN was lower than after punch biopsy.
Journal of The American Academy of Dermatology, Aug 1, 2014
inadequate response to narrowband UVB, PUVA, topical corticosteroids, and topical tacrolimus. B, ... more inadequate response to narrowband UVB, PUVA, topical corticosteroids, and topical tacrolimus. B, Left upper back. Significant perifollicular repigmentation seen 1 week following 2 sessions of intralesional triamcinolone acetonide injection spaced 2.5 months apart. C, Left upper back. Complete repigmentation seen 1 year later. This patient only had a total of 2 injection sessions of intralesional triamcinolone acetonide as stated in B. J AM ACAD DERMATOL VOLUME 71, NUMBER 2 Letters 393
Journal of The American Academy of Dermatology, Dec 1, 2014
The roles of dietary factors in aggravating, preventing, or treating skin diseases are common que... more The roles of dietary factors in aggravating, preventing, or treating skin diseases are common questions encountered in dermatology practice. Part II of this two-part series reviews dietary modifications that can potentially be utilized in the management of melanoma, chronic urticaria, and psoriasis patients. Specifically, we examine the effect of alcohol consumption and supplementation with vitamins D and E, polyunsaturated fatty acids, selenium, green tea, resveratrol, and lycopene on melanoma risk. The relationships between chronic urticaria symptoms and dietary pseudoallergens, gluten, and vitamin D are analyzed. We explore weight loss, reduced alcohol consumption, and gluten avoidance as means of reducing psoriasis-associated morbidity, as well as the possible utility of supplementation with polyunsaturated fatty acids, folic acid, vitamin D, and antioxidants. With proper knowledge of the role of diet in these cutaneous disease processes, dermatologists can better answer patient inquiries and consider implementation of dietary modifications as adjuncts to other treatments and preventative measures.
Journal of The American Academy of Dermatology, Sep 1, 1998
Congenital melanocytic nevi (CMN) are commonly classified as small (<1.5 cm in greatest diameter)... more Congenital melanocytic nevi (CMN) are commonly classified as small (<1.5 cm in greatest diameter), medium-sized (1.5 to 19.9 cm), and large (20 cm or greater). Although an increased risk for malignant melanoma (MM) arising in large CMN seems well established, 3-10 the risks associated with medium-sized and small CMNs are matters of controversy. Therefore uniformly accepted recommendations regarding their management have not been made. 17-23 Some suggest life-long observation of small and medium-sized CMNs that do not undergo significant unexpected changes. Additional reasons for removal are cosmesis and the inability to observe the lesions clinically. This report concerns a follow-up study of medium-sized melanocytic nevi, clinically judged to be congenital. The goal of this study was to assess the risk for melanoma arising in such lesions. Cases of medium-sized CMNs were identified by reviewing charts of patients first seen from November 1955 to September 1996 in the private dermatology practice of one of the authors (A. W. K.). A nevus was judged to be congenital on the basis of its clinical characteristics. Data extracted from each CMN chart included the patient's ages at the time of initial visit and last follow-up, and anatomic location, shape, size, elevation, surface characteristics (including presence or
Journal of The American Academy of Dermatology, Oct 1, 1996
Background: Patients with a large congenital melanocytic nevus (LCMN) may have associated leptome... more Background: Patients with a large congenital melanocytic nevus (LCMN) may have associated leptomeningeal melanocytosis with or without central nervous system (CNS) melanomas. These patients are considered to have neurocutaneous melanosis, a disorder that, when symptomatic or otherwise manifest neurologically, carries a poor prognosis even in the absence of malignancy. Objective: Our purpose was to identify typical clinical features in patients who have manifest CNS melanosis in association with LCMN. Methods: The records of 117 patients with LCMN in the New York University Registry of LCMN and the reports of 172 cases of LCMN in the world literature were included for features that might signal a high risk for the development of manifest CNS involvement. Results: Of the 289 patients with LCMN, 33 had manifest CNS melanosis. In all 33 in whom symptomatic neurocutaneous melanosis was diagnosed, the LCMNs were present in a posterior axial location on the head, neck; back, and/or buttocks. "Satellite" nevi were known to be present in 31 of the 33 patients. Patients with LCMN in a posterior axial location, especially when associated with "satellite" melanocyfic nevi, are at greater risk for the development of manifest neurocutaneous melanosis than patients with LCMN limited to the extremities or those who are lacking satellite nevi. 0 Am Acad Dermatol 1996;35:529-38.) The management of a patient with a large congenital melanocytic nevus (LCMN) must take into From the Ronald O. Perelman Department of Dermatology a and the
International Journal of Environmental Research and Public Health, Mar 17, 2022
1) Background: As smartphones have become more widely used, they have become an appealing tool fo... more 1) Background: As smartphones have become more widely used, they have become an appealing tool for health-related functions. For dermatology alone, hundreds of applications (apps) are available to download for both patients and providers. (2) Methods: The Google Play Store and Apple App Store were searched from the United States using dermatology-related terms. Apps were categorized based on description, and the number of reviews, download cost, target audience, and use of AI were recorded. The top apps from each category by number of reviews were reported. Additionally, literature on the benefits and limitations of using smartphones for dermatology were reviewed. (3) Results: A total of 632 apps were included in the study: 395 (62.5%) were marketed towards patients, 203 (32.1%) towards providers, and 34 (5.4%) towards both; 265 (41.9%) were available only on the Google Play Store, 146 (23.1%) only on the Apple App Store, and 221 (35.0%) were available on both; and 595 (94.1%) were free to download and 37 (5.9%) had a cost to download, ranging from USD 0.99 to USD 349.99 (median USD 37.49). A total of 99 apps (15.7%) reported the use of artificial intelligence. (4) Conclusions: Although there are many benefits of using smartphones for dermatology, lack of regulation and high-quality evidence supporting the efficacy and accuracy of apps hinders their potential.
Few research studies evaluating the impact of dermatologic diseases in the United States (US) hav... more Few research studies evaluating the impact of dermatologic diseases in the United States (US) have adequately included underrepresented groups. All of Us (AoU) is an ongoing precision medicine-based research initiative by the National Institutes of Health (NIH) that facilitates research in populations traditionally underrepresented in biomedical research by prioritizing them for data collection. Our objective was to evaluate the burden of onychomycosis in underrepresented groups de ned by the framework provided by AoU. The AoU Registered Tier dataset version 5 was used which includes data collected between May 30, 2017 and April 1, 2021. We conducted a cross-sectional analysis linking survey and electronic health record (EHR) data to estimate the prevalence of onychomycosis in underrepresented groups de ned by race, ethnicity, age (≥75 years), disability, sexual orientation/gender identity (LGBTQIA+), income (annual household income ≤$35 000) and education (less than a high school degree). The latest All of Us data release includes 329,038 participants. Of these, 251,597 (76%) had EHR data and 13,874 had onychomycosis (overall prevalence, 5.5%; 95% CI, 5.4-5.6). Multivariate analyses adjusted by tinea pedis, diabetes mellitus, immune compromise, nail psoriasis, and insurance status, in addition to the aforementioned variables, revealed that, compared with White participants, Black and Hispanic participants had a higher adjusted odds of onychomycosis (OR, 1.29; 95% CI, 1.23-1.36 and OR, 1.24; 95% CI, 1.17-1.31, respectively). Higher adjusted odds of onychomycosis were also observed in underrepresented groups. Our ndings suggest a disproportionately high burden of onychomycosis in underrepresented groups, although further studies are needed to replicate our ndings and address this disparity.
UNSTRUCTURED Steven-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap... more UNSTRUCTURED Steven-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap syndrome are a spectrum of life-threatening conditions characterized by sloughing of the skin and epidermal necrosis. SJS/TEN generally occurs after initiation of a new medication and lead to infection, electrolyte imbalances, multi-organ failure and death. Despite the mortality risk, there is a lack of consensus in the acute management of SJS/TEN, with systemic interventions and supportive measures being the general course of treatment. This manuscript aims to summarize the key findings from the original Cochrane systematic review of interventions for treatment of SJS, TEN and SJS/TEN overlap syndrome. To evaluate the systemic therapies for SJS/TEN, a systematic review of clinical trials and prospective observational comparative studies of SJS/TEN was conducted. The primary endpoint was disease specific mortality (DSM) and adverse events (AE's) leading to discontinuation of the sys...
Open journal of clinical & medical case reports, Oct 27, 2023
The high prevalence of psoriasis creates a significant barrier for the global healthcare system, ... more The high prevalence of psoriasis creates a significant barrier for the global healthcare system, affecting nearly 7.4 million US adults with direct treatment costs accumulating to over $12 billion annually . Biologic drugs have become a major component of psoriasis management, with anti-TNF inhibitors, IL-17 inhibitors, IL-12, TYK 2 inhibitors, and other medications becoming integral to a patient's psoriasis treatment regimen . However, given the ubiquitous use of biologics in psoriasis management, the response to these medications is not homogenous, with differences in patient genomics contributing to nearly 70% of the inter-individual drug response differences . Pharmacogenetics provides dermatologists with more targeted treatment modalities to illicit the best response in psoriasis patients with minimal adverse effects. Given the costly nature of biologic medications, identifying the optimal drug for each patient may reduce annual healthcare expenditures. Biologic treatment for psoriasis is largely a "trial-and-error" process with most dermatologists changing the biologic agents for 10-30% of their patients in the first year and an intra-class switch of at least 50% of treatment-nonresponsive patients . A retrospective claims analysis indicated that 46% of psoriasis patients discontinued their biologic within 12 months and only 38% of patients were adherent to treatment . Adherence to clinical guidelines such as the Clinical Pharmacogenetics Implementation Consortium (CPIC) regarding drug-gene interactions which may guide individual drug-dose therapy including making dose adjustments, identifying efficacious medications, and monitoring drug events. Genomic datasets are being developed that allow dermatologists to search for cell lines of interest and evaluate genotype data to predict dose-response data for various biologics (Table ). These datasets along with pharmacogenetic testing can be utilized by physicians to aid in optimal biologic agent selection to minimize the "trial and error" process and associated costs. Additionally, other machine learning based
Purpose: A rise in market demand for anti-aging skin care products has resulted in a proliferatio... more Purpose: A rise in market demand for anti-aging skin care products has resulted in a proliferation of cosmeceuticals, including products that contain vitamin C. Many topicals containing vitamin C claim to reduce the appearance of wrinkles. However, these claims have not been systematically evaluated. Methods: A systematic review of literature published between January 2015 and September 2022 was performed per PRISMA guidelines. Scopus, Web of Science, and PubMed were queried for records relevant using the following Medical Subject Heading (MeSH) terms: “Topical Vitamin C OR Ascorbic acid”, “Vitamin C efficacy”, “dermatology”, “cosmetology”, and “skin anti-aging”. Variables of interest included: study type, study location, study duration, sample size, patient description, type and ingredients of the topical formulation, outcome measurement, results, and adverse events. Results: After deduplication, consideration of inclusion and exclusion criteria, and title/abstract screening, 5,428 initial records were reduced to 7 articles, including 4 meeting Level IB criteria, one meeting Level IIA criteria, and 2 meeting Level IIB criteria. Methods for assessing clinical improvements included global photodamage score, skin topography assessment, reflectance confocal microscopy (RCM) skin analysis, Dynamical Atlas, and participant self-assessment. Conclusions: While 4 of the 7 studies met Level IB evidence, further high-quality, prospective, and comparative studies are indicated to better elucidate the role of topical vitamin C in wrinkle reduction. All the studies used vitamin C in combination with other ingredients or therapeutic mechanisms, thereby complicating any specific conclusions regarding the efficacy of vitamin C. Citation: Sanabria B, Berger LE, Mohd H, et al. Clinical efficacy of topical vitamin C on the appearance of wrinkles: a systematic literature review. J Drugs Dermatol. 2023;22(9):898-904. doi:10.36849/JDD.7332.
Background: Melasma often presents as a therapeutic challenge to dermatologists. Due to its relap... more Background: Melasma often presents as a therapeutic challenge to dermatologists. Due to its relapsing nature, long-term topical maintenance therapies are often required which may be time consuming and costly for patients. As a result, light and laser therapies have become increasingly popular in the treatment of melasma. Yet, clinical studies on melasma tend to focus more on the efficacy of these treatments rather than their ability to achieve long-term results. Objective: To assess the ability of light and laser treatments to achieve long lasting results in melasma. Methods: A literature review was conducted to assess the long-term efficacy of laser and light treatments in epidermal, mixed and dermal melasma. Results: Out of 128 articles reviewed, 17 studies of laser and light therapies included patient follow-up without maintenance therapies in their study designs. According to these studies, IPL and Nd:YAG achieved long lasting results for up to 6-months. Studies also suggest that combining these therapies together as well as combining them with other topical or procedural therapies, may result in enhanced long-term efficacy. Despite this, these treatments are less commonly used than topical therapies in clinical practice due to their cost and potential side effects, such as scarring, post inflammatory hyperpigmentation and prolonged erythema. Studies also indicate that these therapies vary in efficacy depending on the melasma subtype. Limitations: There was a lack of standardized outcome assessments. In conclusion, light and laser treatments have a role in treating melasma. To study their efficacy in treating melasma long-term, more studies with extended duration of follow-ups and standardized outcome measures are needed.
Journal of Cutaneous Medicine and Surgery, Oct 1, 1996
Background: Data show that intermittent painful sunburns are an important causative factor for cu... more Background: Data show that intermittent painful sunburns are an important causative factor for cutaneous malignant melanoma. Objective: This study was undertaken to determine whether the differences in the anatomic distribution of melanomas in men,compared to women, could be accounted for by the distribution of sunburns and whether the high incidence of melanomas on the lower extremities of women is associated with the distribution of sunburns. Methods: One hundred and fifty nonmelanoma patients, men and women aged 20 to 60 years, recalled having painful sunburns within the previous 6 months. The locations of the sunburns were indicated on body surface diagrams. The locations of 1168 melanomas as recorded in the NYU-Melanoma Cooperative Group data base were plotted on anatomic diagrams. The anatomic distribution of melanomas and of sunburns for men and women were compared. Results: There was no statistically significant difference in the distribution of sunburns on any anatomic location in men as compared to women. However, there was a disproportionately high number of melanomas on the backs of men and on the legs of women. In both men and women, there was a significant difference between the anatomic distribution of painful sunburns and melanomas. Conclusion: Since the anatomic distribution of painful sunburns is similar in men and women, whereas the anatomic distribution of melanomas differ, it would appear that factors in addition to sunburns in adults account for the differences in the anatomic distribution of melanomas in men and women. I ntermittent intense sun exposure, resulting in painful sunburns, has been reported to be a risk factor for the development of malignant melanomas (MMS).l-4 The anatomic distribution of cutaneous MMs is different in men and women, favouring the backs of men and the legsof women."? The precise reason for this gender-related difference in the
BACKGROUND Dysplastic nevi (DN) have been a matter of controversy since their initial description... more BACKGROUND Dysplastic nevi (DN) have been a matter of controversy since their initial description in 1978 because of differences in the clinical and histological terminology, and large studies on histological outcomes of excising moderate to severely DN have not previously been described. OBJECTIVE To determine the clinical characteristics of DN and histologic outcomes of excised moderate and severe DN. METHODS Retrospective chart review of patients with DN or Clark's nevi at the Dermatology Department at Rutgers-Robert Wood Johnson Medical School in Somerset, New Jersey, from January 2009 to June 2012. Three hundred ninety-three lesions from 380 patients were included in this study. MAIN OUTCOME MEASURE Histologic results of excised moderate and severe DN. RESULTS Thirty-four percent of DN were excised because of the presence of moderate or severe atypia, personal history of melanoma, or both. None of the excised lesions showed evidence of melanoma; 81.6% of excisions showed scar or granulation tissue. Only 14% of excised lesions were found to have residual lesions, and 4.4% showed recurrent nevi. CONCLUSION In 134 excisions of moderate to severe DN, no melanoma was identified. Most of the excisions showed scar or granulation tissue. The rate of residual lesions after shave biopsy of moderate or severe DN was lower than after punch biopsy.
Journal of The American Academy of Dermatology, Aug 1, 2014
inadequate response to narrowband UVB, PUVA, topical corticosteroids, and topical tacrolimus. B, ... more inadequate response to narrowband UVB, PUVA, topical corticosteroids, and topical tacrolimus. B, Left upper back. Significant perifollicular repigmentation seen 1 week following 2 sessions of intralesional triamcinolone acetonide injection spaced 2.5 months apart. C, Left upper back. Complete repigmentation seen 1 year later. This patient only had a total of 2 injection sessions of intralesional triamcinolone acetonide as stated in B. J AM ACAD DERMATOL VOLUME 71, NUMBER 2 Letters 393
Journal of The American Academy of Dermatology, Dec 1, 2014
The roles of dietary factors in aggravating, preventing, or treating skin diseases are common que... more The roles of dietary factors in aggravating, preventing, or treating skin diseases are common questions encountered in dermatology practice. Part II of this two-part series reviews dietary modifications that can potentially be utilized in the management of melanoma, chronic urticaria, and psoriasis patients. Specifically, we examine the effect of alcohol consumption and supplementation with vitamins D and E, polyunsaturated fatty acids, selenium, green tea, resveratrol, and lycopene on melanoma risk. The relationships between chronic urticaria symptoms and dietary pseudoallergens, gluten, and vitamin D are analyzed. We explore weight loss, reduced alcohol consumption, and gluten avoidance as means of reducing psoriasis-associated morbidity, as well as the possible utility of supplementation with polyunsaturated fatty acids, folic acid, vitamin D, and antioxidants. With proper knowledge of the role of diet in these cutaneous disease processes, dermatologists can better answer patient inquiries and consider implementation of dietary modifications as adjuncts to other treatments and preventative measures.
Journal of The American Academy of Dermatology, Sep 1, 1998
Congenital melanocytic nevi (CMN) are commonly classified as small (<1.5 cm in greatest diameter)... more Congenital melanocytic nevi (CMN) are commonly classified as small (<1.5 cm in greatest diameter), medium-sized (1.5 to 19.9 cm), and large (20 cm or greater). Although an increased risk for malignant melanoma (MM) arising in large CMN seems well established, 3-10 the risks associated with medium-sized and small CMNs are matters of controversy. Therefore uniformly accepted recommendations regarding their management have not been made. 17-23 Some suggest life-long observation of small and medium-sized CMNs that do not undergo significant unexpected changes. Additional reasons for removal are cosmesis and the inability to observe the lesions clinically. This report concerns a follow-up study of medium-sized melanocytic nevi, clinically judged to be congenital. The goal of this study was to assess the risk for melanoma arising in such lesions. Cases of medium-sized CMNs were identified by reviewing charts of patients first seen from November 1955 to September 1996 in the private dermatology practice of one of the authors (A. W. K.). A nevus was judged to be congenital on the basis of its clinical characteristics. Data extracted from each CMN chart included the patient's ages at the time of initial visit and last follow-up, and anatomic location, shape, size, elevation, surface characteristics (including presence or
Journal of The American Academy of Dermatology, Oct 1, 1996
Background: Patients with a large congenital melanocytic nevus (LCMN) may have associated leptome... more Background: Patients with a large congenital melanocytic nevus (LCMN) may have associated leptomeningeal melanocytosis with or without central nervous system (CNS) melanomas. These patients are considered to have neurocutaneous melanosis, a disorder that, when symptomatic or otherwise manifest neurologically, carries a poor prognosis even in the absence of malignancy. Objective: Our purpose was to identify typical clinical features in patients who have manifest CNS melanosis in association with LCMN. Methods: The records of 117 patients with LCMN in the New York University Registry of LCMN and the reports of 172 cases of LCMN in the world literature were included for features that might signal a high risk for the development of manifest CNS involvement. Results: Of the 289 patients with LCMN, 33 had manifest CNS melanosis. In all 33 in whom symptomatic neurocutaneous melanosis was diagnosed, the LCMNs were present in a posterior axial location on the head, neck; back, and/or buttocks. "Satellite" nevi were known to be present in 31 of the 33 patients. Patients with LCMN in a posterior axial location, especially when associated with "satellite" melanocyfic nevi, are at greater risk for the development of manifest neurocutaneous melanosis than patients with LCMN limited to the extremities or those who are lacking satellite nevi. 0 Am Acad Dermatol 1996;35:529-38.) The management of a patient with a large congenital melanocytic nevus (LCMN) must take into From the Ronald O. Perelman Department of Dermatology a and the
International Journal of Environmental Research and Public Health, Mar 17, 2022
1) Background: As smartphones have become more widely used, they have become an appealing tool fo... more 1) Background: As smartphones have become more widely used, they have become an appealing tool for health-related functions. For dermatology alone, hundreds of applications (apps) are available to download for both patients and providers. (2) Methods: The Google Play Store and Apple App Store were searched from the United States using dermatology-related terms. Apps were categorized based on description, and the number of reviews, download cost, target audience, and use of AI were recorded. The top apps from each category by number of reviews were reported. Additionally, literature on the benefits and limitations of using smartphones for dermatology were reviewed. (3) Results: A total of 632 apps were included in the study: 395 (62.5%) were marketed towards patients, 203 (32.1%) towards providers, and 34 (5.4%) towards both; 265 (41.9%) were available only on the Google Play Store, 146 (23.1%) only on the Apple App Store, and 221 (35.0%) were available on both; and 595 (94.1%) were free to download and 37 (5.9%) had a cost to download, ranging from USD 0.99 to USD 349.99 (median USD 37.49). A total of 99 apps (15.7%) reported the use of artificial intelligence. (4) Conclusions: Although there are many benefits of using smartphones for dermatology, lack of regulation and high-quality evidence supporting the efficacy and accuracy of apps hinders their potential.
Few research studies evaluating the impact of dermatologic diseases in the United States (US) hav... more Few research studies evaluating the impact of dermatologic diseases in the United States (US) have adequately included underrepresented groups. All of Us (AoU) is an ongoing precision medicine-based research initiative by the National Institutes of Health (NIH) that facilitates research in populations traditionally underrepresented in biomedical research by prioritizing them for data collection. Our objective was to evaluate the burden of onychomycosis in underrepresented groups de ned by the framework provided by AoU. The AoU Registered Tier dataset version 5 was used which includes data collected between May 30, 2017 and April 1, 2021. We conducted a cross-sectional analysis linking survey and electronic health record (EHR) data to estimate the prevalence of onychomycosis in underrepresented groups de ned by race, ethnicity, age (≥75 years), disability, sexual orientation/gender identity (LGBTQIA+), income (annual household income ≤$35 000) and education (less than a high school degree). The latest All of Us data release includes 329,038 participants. Of these, 251,597 (76%) had EHR data and 13,874 had onychomycosis (overall prevalence, 5.5%; 95% CI, 5.4-5.6). Multivariate analyses adjusted by tinea pedis, diabetes mellitus, immune compromise, nail psoriasis, and insurance status, in addition to the aforementioned variables, revealed that, compared with White participants, Black and Hispanic participants had a higher adjusted odds of onychomycosis (OR, 1.29; 95% CI, 1.23-1.36 and OR, 1.24; 95% CI, 1.17-1.31, respectively). Higher adjusted odds of onychomycosis were also observed in underrepresented groups. Our ndings suggest a disproportionately high burden of onychomycosis in underrepresented groups, although further studies are needed to replicate our ndings and address this disparity.
UNSTRUCTURED Steven-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap... more UNSTRUCTURED Steven-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap syndrome are a spectrum of life-threatening conditions characterized by sloughing of the skin and epidermal necrosis. SJS/TEN generally occurs after initiation of a new medication and lead to infection, electrolyte imbalances, multi-organ failure and death. Despite the mortality risk, there is a lack of consensus in the acute management of SJS/TEN, with systemic interventions and supportive measures being the general course of treatment. This manuscript aims to summarize the key findings from the original Cochrane systematic review of interventions for treatment of SJS, TEN and SJS/TEN overlap syndrome. To evaluate the systemic therapies for SJS/TEN, a systematic review of clinical trials and prospective observational comparative studies of SJS/TEN was conducted. The primary endpoint was disease specific mortality (DSM) and adverse events (AE's) leading to discontinuation of the sys...
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Papers by Babar Rao