- Email: [email protected]
Clinical exuberance of purpura annularis telangiectodes of Majocchi
Changes in office based microscopy: 2001 to 2009
(Poster reference number 5043)
Charles Phillips, MD, Brody School of Medicine at East Carolina University, Greenville, NC, United States; Paul Vos, PhD, Department of Biostatistics, East Carolina University, Greenville, NC, United States; Tracy McLean, MD, Brody School of Medicine at East Carolina University, Greenville, NC, United States Background: Office-based microscopic procedures have been a valuable tool for the practicing dermatologist. Little data exist to the current use or changes in the use of these diagnostic procedures in clinical dermatology practice. Objective: The objective was to identify any change in the use of commonly performed office based microscopic procedures over time including potassium hydroxide preparations (with chlorazol black), Gram stains, Tzanck preparations, fungal cultures, and wet preps or scabies preparations.
Clinical evaluation of the effectiveness and tolerance of a facial lotion on subjects with rosacea
(Poster reference number 5554)
Susana Raab, L’Oreal Research and Innovation, Clark, NJ, United States; Christian Oresajo, L’Oreal Research and Innovation, Clark, NJ, United States; Margarita Yatskayer, L’Oreal Research and Innovation, Clark, NJ, United States; Zoe Draelos, MD, Duke University School of Medicine, Durham, NC, United States Background: Rosacea is a chronic skin condition involving inflammation of the cheeks, nose, chin, and forehead. It causes redness, flushing, and inflammatory papules. Subjects with rosacea have sensitive skin that is easily irritated by skin care products. There is a need for a topical product that reduces the signs and symptoms of rosacea without exacerbating the disease.
Results: The only statistically significant changes were in the Gram stain P ¼ .008 (odds ratio, 0.862; 95% CI, 0.77-0.96) and the fungal culture P ¼ .0001 (odds ratio, 0.40; 95% CI, 0.332-0.480). Both showed a relative increase in the latter 4 years when compared to the first 5 years. The results for KOH P ¼.808 (odds ratio, 0.992; 95% CI, 0.92-1.06), Tzanck prep P ¼ .348 (odds ratio, 0.876; 95% CI, 0.667-1.151), and scabies preparation P ¼ .39 (odds ratio, 0.883; 95% CI, 0.662-1.178). Conclusion: In our clinic, the Gram stain and dermatophyte test media (DTM) have been used more over the past 4 years (2006-09) than the initial 5 years (2001-05). There was no significant change in the use of potassium hydroxide, Tzanck, or scabies preparations.
Methods: This study evaluates a facial lotion formulated with palmitoyl tripeptide-8, epurea extract, bisabolol, caffeine and zinc gluconate, in female volunteers with mild to moderate facial rosacea and the presence of a minimum of three inflammatory papules. This clinical study included 50 female subjects between the ages of 25 and 60 with evaluations at baseline, postapplication, 2 weeks, 4 weeks, 8 weeks, and 12 weeks after product application. For the duration of the study, volunteers used the facial lotion twice daily, and continued using any rosacea medications provided the type and dosage was stable for 3 months prior to study participation. Evaluations were performed by a board-certified dermatologist and included objective and subjective tolerance grading, clinical efficacy grading of facial skin attributes for redness, flushing, smoothness, radiance, skin tone evenness, overall appearance, and rosacea severity using a 5-point ordinal scale. Lesion counts, noninvasive bioinstrumentation to assess transepidermal water loss (TEWL), hydration and skin redness, subject self-assessment questionnaires, and digital photography were also included in the study. Results: The results of this study showed significant improvements in redness, flushing, smoothness, radiance, overall appearance and rosacea severity. The results showed a significant reduction in lesion count at all time points when compared to baseline. There was a statistically significant drop in facial redness at week 4 and the TEWL measurements remained steady throughout the study demonstrating that the lotion is a gentle to the skin. Tolerance evaluations indicated the facial lotion was well tolerated by the study panel.
Commercial support: None identified.
Commercial support: 100% is sponsored by L’Oreal Research and Innovation.
Methods: We extracted data from the electronic medical record (Logician/Centricity) used by our academic dermatology clinic between the years 2001 to 2009. The data looked at included the number of patients seen in the general dermatology clinics, and the number of each individual office based microscopic procedures performed (KOH, Gram stain, Tzanck preparation, fungal culture, and wet/scabies prep). The number of recorded laboratory evaluations was looked at and grouped into either the first 5 years of the EMR (2001-05) or the second 4 years (2006-9). Fisher exact test and the associated 95 % confidence interval for the odds ratio were used to compare the 01-05 group to the 06-09 group.
Chronic idiopathic urticaria treated successfully with mycophenolate mofetil
(Poster reference number 5441)
Renuga Ramesh Raghavendran, Heart of England NHS Trust, Birmingam, United Kingdom; Manjit Kaur, Heart of England NHS Trust, Birmingham, United Kingdom Background: Mycophenolate mofetil (MMF) is a prodrug of mycophenolic acid which acts by inhibiting lymphocyte proliferation and antibody production. It is a well-tolerated immunosuppressive used in organ transplant recipients, and has been reported to be effective in treating several dermatologic conditions, including psoriasis, pemphigus, pyoderma gangrenosum, bullous lichen planus, and connective tissue diseases, such as lupus and dermatomyositis. We would like to discuss the role of MMF in the treatment of chronic idiopathic urticaria. Case report: A 34-year-old woman presented with intermittent urticaria and angiodema for 3 months. Conventional antihistamines failed to control her symptoms. She was diagnosed with chronic idiopathic urticaria (CIU) after screening blood tests and history failed to identify any underlying cause/trigger. She had a family history of hypothyroidism and positive thyroid peroxidase antibodies. She was therefore commenced on cyclosporin 3 mg/kg with an excellent response and this was stopped after 6 months without any relapse for 3 years. On subsequent flare of her CIU, ciclosporin was again effective but was discontinued within 3 months because of renal toxicity, hypertension and hypertrichosis. She responded to prednisolone 25 mg/day and MMF 500 mg/day was commenced as a steroid-sparing agent. MMF dose was gradually increased over 3 months to 1.5 g/day and she remained well on this dose for a further 6 months. We are now planning to reduce this down gradually to stop over the next few months.
Clinical exuberance of purpura annularis telangiectodes of Majocchi
(Poster reference number 5051)
Maria Vict oria Santos, Policlınica Geral do Rio de Janeiro, Rio de Janeiro, Brazil; Bernard Kac, Santa Casa de Miseric oria do Rio de Janeiro, Rio de Janeiro, Brazil; Carlos Gustavo Castro, Policlınica Geral do Rio de Janeiro, Rio de Janeiro, Brazil; Felipe Carvalho, Policlınica Geral do Rio de Janeiro, Rio de Janeiro, Brazil; Fernanda Pires, Policlınica Geral do Rio de Janeiro, Rio de Janeiro, Brazil; Fred Bernardes, Policlınica Geral do Rio de Janeiro, Rio de Janeiro, Brazil
Discussion: Chronic urticaria is recognized as an autoreactive disorder with over half the patients demonstrate serologic mediators for whealing and autoantibodies against the high affinity IgE receptors. This has prompted the therapeutic approach with immunomodulatory drugs. Urticarial patients who do not respond to oral antihistamines need short or prolonged courses of oral corticosteroids or cyclosporin to control their symptoms. However, potential adverse effects limit this regimen. MMF’s lack of renal/hepatic toxicity is a significant advantage over other immunosuppressive medications currently used in dermatology. It is a valuable and relatively safe alternative for patients who require aggressive treatment to control their disease symptoms.
The authors describe a case of purpura annularis telangiectodes Majocchi and review the literature on the subject. Purpura annularis telangiectodes Majocchi is ranked within the group of chronic pigmented purpura, as a rare capillaritis of unknown cause. It was first described in 1896 by Majocchi, is characterized by purpuric lesions of arcuate or annular aspect with symmetric telangiectases, and are most commonly found in young adults, especially women. Exercise can be a trigger factor. The lesions appear in the absence of venous stasis, are resistant to treatment, heal spontaneously, or persist for years. A 34-year-old woman who was born in Rio de Janeiro presented in October 2010, referred for asymptomatic purplish spots on the legs for the last 2 months. The dermatologic examination revealed the presence of petechiae and purpuric annular lesions localized on anterior, posterior, medial, and lateral legs. Laboratory tests, such as complete blood count and coagulation, were normal. A punch biopsy of the lesion was performed on the posterior left leg. Histopathologic findings were acanthosis, vacuolization of the basal layer, superficial perivascular mononuclear infiltrate with extravasation of red blood cells and edema. Daily moisturizer and expectant management were prescribed, with spontaneous resolution in 2 months. Despite having histopathologic features in common, chronic pigmented purpura have clinical differences. When combined with the exuberance of the dermatologic and histopathologic characteristics, we conclude that the patient presents purpura annularis telangiectodes of Majocchi.
Commercial support: None identified.
Commercial support: None identified.
APRIL 2012
J AM ACAD DERMATOL
AB45
(Poster reference number 5043)
Charles Phillips, MD, Brody School of Medicine at East Carolina University, Greenville, NC, United States; Paul Vos, PhD, Department of Biostatistics, East Carolina University, Greenville, NC, United States; Tracy McLean, MD, Brody School of Medicine at East Carolina University, Greenville, NC, United States Background: Office-based microscopic procedures have been a valuable tool for the practicing dermatologist. Little data exist to the current use or changes in the use of these diagnostic procedures in clinical dermatology practice. Objective: The objective was to identify any change in the use of commonly performed office based microscopic procedures over time including potassium hydroxide preparations (with chlorazol black), Gram stains, Tzanck preparations, fungal cultures, and wet preps or scabies preparations.
Clinical evaluation of the effectiveness and tolerance of a facial lotion on subjects with rosacea
(Poster reference number 5554)
Susana Raab, L’Oreal Research and Innovation, Clark, NJ, United States; Christian Oresajo, L’Oreal Research and Innovation, Clark, NJ, United States; Margarita Yatskayer, L’Oreal Research and Innovation, Clark, NJ, United States; Zoe Draelos, MD, Duke University School of Medicine, Durham, NC, United States Background: Rosacea is a chronic skin condition involving inflammation of the cheeks, nose, chin, and forehead. It causes redness, flushing, and inflammatory papules. Subjects with rosacea have sensitive skin that is easily irritated by skin care products. There is a need for a topical product that reduces the signs and symptoms of rosacea without exacerbating the disease.
Results: The only statistically significant changes were in the Gram stain P ¼ .008 (odds ratio, 0.862; 95% CI, 0.77-0.96) and the fungal culture P ¼ .0001 (odds ratio, 0.40; 95% CI, 0.332-0.480). Both showed a relative increase in the latter 4 years when compared to the first 5 years. The results for KOH P ¼.808 (odds ratio, 0.992; 95% CI, 0.92-1.06), Tzanck prep P ¼ .348 (odds ratio, 0.876; 95% CI, 0.667-1.151), and scabies preparation P ¼ .39 (odds ratio, 0.883; 95% CI, 0.662-1.178). Conclusion: In our clinic, the Gram stain and dermatophyte test media (DTM) have been used more over the past 4 years (2006-09) than the initial 5 years (2001-05). There was no significant change in the use of potassium hydroxide, Tzanck, or scabies preparations.
Methods: This study evaluates a facial lotion formulated with palmitoyl tripeptide-8, epurea extract, bisabolol, caffeine and zinc gluconate, in female volunteers with mild to moderate facial rosacea and the presence of a minimum of three inflammatory papules. This clinical study included 50 female subjects between the ages of 25 and 60 with evaluations at baseline, postapplication, 2 weeks, 4 weeks, 8 weeks, and 12 weeks after product application. For the duration of the study, volunteers used the facial lotion twice daily, and continued using any rosacea medications provided the type and dosage was stable for 3 months prior to study participation. Evaluations were performed by a board-certified dermatologist and included objective and subjective tolerance grading, clinical efficacy grading of facial skin attributes for redness, flushing, smoothness, radiance, skin tone evenness, overall appearance, and rosacea severity using a 5-point ordinal scale. Lesion counts, noninvasive bioinstrumentation to assess transepidermal water loss (TEWL), hydration and skin redness, subject self-assessment questionnaires, and digital photography were also included in the study. Results: The results of this study showed significant improvements in redness, flushing, smoothness, radiance, overall appearance and rosacea severity. The results showed a significant reduction in lesion count at all time points when compared to baseline. There was a statistically significant drop in facial redness at week 4 and the TEWL measurements remained steady throughout the study demonstrating that the lotion is a gentle to the skin. Tolerance evaluations indicated the facial lotion was well tolerated by the study panel.
Commercial support: None identified.
Commercial support: 100% is sponsored by L’Oreal Research and Innovation.
Methods: We extracted data from the electronic medical record (Logician/Centricity) used by our academic dermatology clinic between the years 2001 to 2009. The data looked at included the number of patients seen in the general dermatology clinics, and the number of each individual office based microscopic procedures performed (KOH, Gram stain, Tzanck preparation, fungal culture, and wet/scabies prep). The number of recorded laboratory evaluations was looked at and grouped into either the first 5 years of the EMR (2001-05) or the second 4 years (2006-9). Fisher exact test and the associated 95 % confidence interval for the odds ratio were used to compare the 01-05 group to the 06-09 group.
Chronic idiopathic urticaria treated successfully with mycophenolate mofetil
(Poster reference number 5441)
Renuga Ramesh Raghavendran, Heart of England NHS Trust, Birmingam, United Kingdom; Manjit Kaur, Heart of England NHS Trust, Birmingham, United Kingdom Background: Mycophenolate mofetil (MMF) is a prodrug of mycophenolic acid which acts by inhibiting lymphocyte proliferation and antibody production. It is a well-tolerated immunosuppressive used in organ transplant recipients, and has been reported to be effective in treating several dermatologic conditions, including psoriasis, pemphigus, pyoderma gangrenosum, bullous lichen planus, and connective tissue diseases, such as lupus and dermatomyositis. We would like to discuss the role of MMF in the treatment of chronic idiopathic urticaria. Case report: A 34-year-old woman presented with intermittent urticaria and angiodema for 3 months. Conventional antihistamines failed to control her symptoms. She was diagnosed with chronic idiopathic urticaria (CIU) after screening blood tests and history failed to identify any underlying cause/trigger. She had a family history of hypothyroidism and positive thyroid peroxidase antibodies. She was therefore commenced on cyclosporin 3 mg/kg with an excellent response and this was stopped after 6 months without any relapse for 3 years. On subsequent flare of her CIU, ciclosporin was again effective but was discontinued within 3 months because of renal toxicity, hypertension and hypertrichosis. She responded to prednisolone 25 mg/day and MMF 500 mg/day was commenced as a steroid-sparing agent. MMF dose was gradually increased over 3 months to 1.5 g/day and she remained well on this dose for a further 6 months. We are now planning to reduce this down gradually to stop over the next few months.
Clinical exuberance of purpura annularis telangiectodes of Majocchi
(Poster reference number 5051)
Maria Vict oria Santos, Policlınica Geral do Rio de Janeiro, Rio de Janeiro, Brazil; Bernard Kac, Santa Casa de Miseric oria do Rio de Janeiro, Rio de Janeiro, Brazil; Carlos Gustavo Castro, Policlınica Geral do Rio de Janeiro, Rio de Janeiro, Brazil; Felipe Carvalho, Policlınica Geral do Rio de Janeiro, Rio de Janeiro, Brazil; Fernanda Pires, Policlınica Geral do Rio de Janeiro, Rio de Janeiro, Brazil; Fred Bernardes, Policlınica Geral do Rio de Janeiro, Rio de Janeiro, Brazil
Discussion: Chronic urticaria is recognized as an autoreactive disorder with over half the patients demonstrate serologic mediators for whealing and autoantibodies against the high affinity IgE receptors. This has prompted the therapeutic approach with immunomodulatory drugs. Urticarial patients who do not respond to oral antihistamines need short or prolonged courses of oral corticosteroids or cyclosporin to control their symptoms. However, potential adverse effects limit this regimen. MMF’s lack of renal/hepatic toxicity is a significant advantage over other immunosuppressive medications currently used in dermatology. It is a valuable and relatively safe alternative for patients who require aggressive treatment to control their disease symptoms.
The authors describe a case of purpura annularis telangiectodes Majocchi and review the literature on the subject. Purpura annularis telangiectodes Majocchi is ranked within the group of chronic pigmented purpura, as a rare capillaritis of unknown cause. It was first described in 1896 by Majocchi, is characterized by purpuric lesions of arcuate or annular aspect with symmetric telangiectases, and are most commonly found in young adults, especially women. Exercise can be a trigger factor. The lesions appear in the absence of venous stasis, are resistant to treatment, heal spontaneously, or persist for years. A 34-year-old woman who was born in Rio de Janeiro presented in October 2010, referred for asymptomatic purplish spots on the legs for the last 2 months. The dermatologic examination revealed the presence of petechiae and purpuric annular lesions localized on anterior, posterior, medial, and lateral legs. Laboratory tests, such as complete blood count and coagulation, were normal. A punch biopsy of the lesion was performed on the posterior left leg. Histopathologic findings were acanthosis, vacuolization of the basal layer, superficial perivascular mononuclear infiltrate with extravasation of red blood cells and edema. Daily moisturizer and expectant management were prescribed, with spontaneous resolution in 2 months. Despite having histopathologic features in common, chronic pigmented purpura have clinical differences. When combined with the exuberance of the dermatologic and histopathologic characteristics, we conclude that the patient presents purpura annularis telangiectodes of Majocchi.
Commercial support: None identified.
Commercial support: None identified.
APRIL 2012
J AM ACAD DERMATOL
AB45