P6439
P6267
An investigator-initiated study to assess the safety and efficacy of imiquimod 3.75% cream when used after cryotherapy in the treatment of hypertrophic actinic keratoses on dorsal hands and forearms Amylynne Frankel, MD, Mount Sinai School of Medicine, New York, NY, United States; Gary Goldenberg, MD, Mount Sinai School of Medicine, New York, NY, United States; Rita Patel, MD, Mount Sinai School of Medicine, New York, NY, United States Background: Current therapies for the treatment of actinic keratoses (AK) include excisional surgery, cryotherapy, electrodessication and curettage, topical chemotherapy and light therapies. Treatment of AKs with cryotherapy followed by imiquimod appears to be logical, because cryotherapy has cytodestructive effects with immediate short-term efficacy on treated AKs, while imiquimod is able to treat the entire field via an immunologic mechanism and may treat subclinical lesions with long-term efficacy. Therefore, combination treatment of actinic keratoses (AKs) using imiquimod postcryotherapy should combine the immediate effects of cryotherapy and the long term benefits of the imiquimod. Objective: To evaluate the efficacy of combination cryotherapy and imiquimod 3.75% cream versus cryotherapy alone in the treatment of hypertrophic actinic keratosis (HAK) on the dorsal hand and forearm. Methods: An investigator-blinded bilateral comparison study included subjects (n ¼ 20) with at least 3 hypertrophic AKs on each dorsal hand or forearm underwent cryotherapy treatment to 3 lesions. After cryotherapy, subjects were randomized to have either their right or left dorsal hand or forearm treated with imiquimod 3.75% cream to begin on the same day as cryotherapy treatment. Subjects then used the 2 weeks on, 2 weeks off, 2 weeks on regimen of imiquimod 3.75% cream. Local skin reactions (LSRs) were also assessed. Results: For the cryotherapy/imiquimod 3.75% arm (N ¼ 20) and cryotherapy alone arm (N ¼ 20), median total HAK reductions were -5.12 versus -2.24 (P \.0094), respectively.
An unusual foreign body in the penis: Transurethral extrusion of penile prosthesis Miguel Angel Arrabal-Polo, PhD, San Cecilio University Hospital, Granada, Spain; Fernando L opez-Carmona Pintado, MD, San Cecilio University Hospital, Granada, Spain; Miguel Arrabal-Martin, PhD, San Cecilio University Hospital, Granada, Spain; Salvador Arias-Santiago, PhD, San Cecilio University Hospital, Granada, Spain Background: Erectile dysfunction is an increased condition with high prevalence in men because of the increasing prevalence of cardiovascular disease and diabetes mellitus. This, together with increasing male longevity, has produced an expansion of the indication of the penile prosthesis placement, part of the third step of erectile dysfunction therapy. In general, there are different types of penile prostheses, but the most used today are the 2 or 3 hydraulic components that allow a more natural erection similar to physiologic erection.
Limitations: LSRs unblind the investigator. Conclusion: Cryotherapy plus imiquimod 3.75% cream resulted in a statistically significant improvement in the reduction of hypertrophic AKs than cryotherapy alone at 14 weeks.
Case report: A 39-year-old man with a medical history of hypertension and dyslipidemia that had a penile prosthesis of 3 components because of erectile dysfunction for 10 years without any disturbance during this period presented to our clinic because after intense sexual intercourse. He presented with a foreign body through the penis, which produced urinary retention. Physical examination revealed an extrusion of one of the cylinders through the urethral meatus and a suprapubic bladder catheter was placed. After 3 days, the patient underwent an operation and the excision of the left cylinder was performed. At least 6 months with left carvernosum body resting to facilitate the closure of the orifice of the extrusion is necessary and after a reposition of a new cylinder will be performed. Discussion: The extrusion of penile prosthesis is a rare process that when is presented shortly after placement it is usually caused by a lesion of the corpus cavernosum that goes unnoticed during placement. If it is produced many years later, it can be related to the syndrome of ‘‘cowboy sex,’’ or intense sexual relation, erosion occurs in the corpus cavernosum and the extrusion of the prosthesis is produced. This is the most likely mechanism that occurred in this patient, because it happened more than 10 years postprocedure. In general, initial treatment should be to remove the cylinder extruded and rest to maintain the corpus cavernosum to close it, and then to put a new cylinder after 4 to 6 months. Commercial support: None identified.
This research study was funded by Graceway Pharmaceuticals and Medicis Pharmaceutical Corp.
P6830 Anetoderma and aging skin face Lana Kris Montagnani, MD, Fundacao Pele Saudavel, S~ao Paulo, Brazil; Ana Flavia Paiva, MD, Fundacao Pele Saudavel, S~ao Paulo, Brazil; Cristina Beretta, MD, Fundacao Pele Saudavel, S~ao Paulo, Brazil; Elen Kris Montagnani, Fundacao Pele Saudavel, S~ao Paulo, Brazil; Fabiana Gambarato, MD, Fundacao Pele Saudavel, S~ao Paulo, Brazil; Larissa Giacchero, MD, Fundacao Pele Saudavel, S~ao Paulo, Brazil; Ricardo Tadeu Villa, MD, Fundacao Pele Saudavel, S~ao Paulo, Brazil
Conclusion: A number of cutaneous reactions have been described in patients with hematologic malignancy, from specific, related to the infiltration of tumor cells, to nonspecific. This last group includes eosinophilic dermatosis of hematologic malignancy, a reactive entity, which usually occurs within years of the diagnosis of neoplasia, or even to precede it. It is presented as pruritic papules, nodules, and/or vesiculobullous eruption refractory to standard treatment, associated with an infiltrate in the superficial and deep dermis made up of lymphocytes and abundant eosinophils. In recent years, it has been observed that the presence of this reaction is associated with progression of the underlying disease; therefore, special monitoring of these patients is necessary.
Background: Anetoderma (anetos, Greek for slack) is a benign condition with focal loss of dermal elastic tissue, resulting in localized areas of flaccid or herniated sacelike skin. It can be classified as primary or secondary (after infectious and inflammatory processes or after the use of medication). It corresponds to the entity more common in women, present between the second and fourth decade of life and the involvement of the face is unusual. It presents a case of anetoderma associated with skin aging from the face after the use of captopril. Case report: Male patient, 48 years old, white, born in Parana. He complained of rapidly and progressive aging of his face for the last 4 years. He refers the use of captopril for a short period of time, in order to control his blood pressure. Upon dermatologic examination, there were circumscribed areas of flaccid skin, forming depressions, wrinkling, and saccular protuberances. The patient underwent a serologic tests for the investigation of systemic diseases, all being negative. The pathologic examination showed vasodilation in the papillary dermis with a mild perifollicular lymphocytic infiltrate and absence of elastic fibers in the reticular dermis. After an anatomicoclinical correlation, it was confirmed the diagnosis of anetoderma. Based on the history of the use of captopril and the possibility of a drug related (penicillamine) which can cause a similar condition, it was considered that the case represents a secondary anetoderma of the use of captopril. It was chosen the use of dapsone as the first treatment, in order to abolish the inflammation present in the pathologic examination. Later, it will be scheduled a facial lifting. Discussion: The main characteristic of anetoderma is the damage of the dermal elastic fibers, the mechanism of these changes is unknown. The treatment is directed to control the inflammatory condition and preventing new lesions. It is essential the removal of inflammatory diseases, infectious and autoimmune diseases and possible triggering drugs when the diagnosis, since the therapeutic options are limited and their results are disappointing. It is a rare entity and the suspicion is important for the diagnosis.
Commercial support: None identified.
Commercial support: None identified.
P6309 An itchy eruption in 3 patients with hematologic malignancy Perez Garcia M.Pilar, Hospital Doctor Peset, Valencia, Spain; Bernat Garcia Josefa, Hospital Doctor Peset, Valencia, Spain; De Asis Cuestas Sofia, Hospital Doctor Peset, Valencia, Spain; Marquina Amparo, Hospital Doctor Peset, Valencia, Spain; Mateu Puchades Almudena, Hospital Doctor Peset, Valencia, Spain Background: In patients with chronic lymphocytic leukemia, it has been described a dermatosis that is characterized by tissue eosinophilia, which has been called insect biteelike reaction, or more recently, eosinophilic dermatosis of hematologic malignancy. We report 3 cases of this entity attended in our service. Cases: Three men with ages ranging between 65 and 77 years presented with erythematous pruritic papules and nodules, some of them excoriated, on the trunk, face, and limbs, they remained apyretic and without systemic symptoms. The 3 patients had been previously diagnosed of hematologic malignancies. The histologic study of the biopsies showed a dense perivascular and periadnexal infiltrate of lymphocytes and numerous eosinophils.
APRIL 2013
J AM ACAD DERMATOL
AB43