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The use of rapid plasma reagin testing in patients with pityriasis rosea: Is it worth it?
5305
4637
The use of Alexandrite based diode for hair removal on Brazilian skin type Valeria Campos, MD, Faculdade de Medicina de Jundiai; Juliana Favaro, MD, private practioner; Ana Flavia Salai, MD, Faculdade de Medicina de Jundiai; Karina Infanti, PA, private practioner; Bruna Lunardi Dal Bello, MD, Faculdade de Medicina de Jundiai
The use of rapid plasma reagin testing in patients with pityriasis rosea: Is it worth it? Pierre Halteh, Pierre Halteh; Shari Lipner, MD, Weill Cornell Medicine
Background: The Soprano ICE platform offers a unique hair removal technique with different wavelengths of choice. The aim of this study is to evaluate safety and efficacy of its alexandrite based 755nm diode laser module in hair removal of small areas in Brazilian skin type’s patients. Methods: 8 female subjects, all of Brazilian skin type III-V were treated for hair removal in small areas of the body in a 4 to 6 weeks intervals in a total of 4 sessions. Hair density was evaluated before and 6 months following 4th sessions and treatment area were photographed before and after. Results: 6 months following 4 sessions of SHR In-Motion technique, hair count had presented a hair density decrease of 63% in total (42.25 vs 16.11), with an average fluence of 9.28J (range 7-12J) used and an average accumulation of 6.28kJ per area (range 5-10 kJ). No adverse effects were reported by the patients within and between sessions. Conclusion: The ALEX 755nm module of the Soprano ICE platform was proven safe and effective using the SHR In-Motion technique treating small body areas on Brazilian skin type II-V. Commercial support: None identified.
Pityriasis rosea (PR) is an acute self-limited exanthem characterized by oval erythematous patches with scale, typically beginning with a ‘‘herald patch.’’ Since histopathologic features are not specific, the diagnosis of PR is based on characteristic features from the history and physical examination. Clinically PR may be difficult for differentiate from secondary syphilis, but a rapid plasma reagin test (RPR) can be used to rule in the latter with 100% sensitivity and 85-99% specificity. A retrospective study was performed on 142 patients at Weill Cornell Medicine, diagnosed with PR from 2000-2016, who also received RPR testing, to assess the frequency of secondary syphilis when the initial clinical impression was PR. The mean age was 31.3 years (range, 3-71), 65.5% were women, and 69.7% were single. In the majority of cases, the sexual history was unknown; such as history of STD (57.7%), sexual orientation (62.7%), number of sexual partners (73.9%), and use of safe-sex practices (89.4%). For social history, 20.4% smoked tobacco, 49.3% drank alcohol, and 1.4% used intravenous (IV) drugs. Only 2 patients (1.4%) had a reactive RPR test. Both were men, were diagnosed by dermatologists, had RPR titers of 1:32, and positive follow-up treponemal-specific testing. In both cases, the rashes were described as erythematous patches with collarettes of scale in a ‘‘Christmas tree’’ distribution. A ‘‘herald patch’’ was present in one patient. Neither patient had lymphadenopathy, nor involvement of the mucous membranes or palms/soles. One patient was a 27-year-old Latino HIV positive, who smoked and drank alcohol, but unknown sexual history, and sexual orientation. The other patient was a 36-year-old homosexual white man, with an unknown number of sexual partners but practiced safe sex, but unknown history of STD; who drank alcohol but did not smoke. Both patients denied using IV drugs. A previous prospective study was conducted to evaluate the frequency of secondary syphilis in patients with a clinical diagnosis of PR. While 3/50 patients (6%), had positive RPR tests, none of the rashes were attributed to syphilis. All 3 patients had a documented history of treated syphilis before diagnosis of PR. Primary and secondary syphilis cases have been increasing since 2000, with 19999 cases reported in 2014. In 15% of people infected with syphilis, progression to the late stage disease may occur resulting in cardiovascular and central nervous center dysfunction. While our study demonstrated that only 1.4% of patients with clinical diagnosis of PR had syphilis, we advocate that careful social and sexual histories be taken in all patients diagnosed with PR and syphilis screening performed if risk factors are present. Our recommendation stems from the US Preventive Services Task Force (USPSTF) recommendation for screening of asymptomatic non-pregnant individuals with increased risk factors for syphilis. Commercial support: None identified.
4740 The viral etiology of trichodysplasia spinulosa: Novel perspectives on a pathogenic mechanism driven by middle T and small T antigens Julie Wu, Baylor College of Medicine; Deepika Narayanan, University of Texas Health Science Center at Houston; Rebecca Simonette, MS, University of Texas Health Science Center at Houston; Hung Doan, MD, University of Texas Health Science Center at Houston; Harrison Nguyen, Yale University; Peter Rady, MD, University of Texas Health Science Center at Houston
Methods: We report a series of surgical defects following MMS which were allowed to heal by secondary intention. Results: The granulation of surgical wounds was significantly hastened by postoperative course of oral minocycline 100 mg daily. These defects included areas of exposed bone where periosteum was stripped as part of the tumor removal. Lacking periosteum normally impedes the granulation process. Conclusions: Given its reported beneficial effects on the healing milieu, minocycline represents a therapeutic consideration as adjuvant therapy for wounds allowed to heal by secondary intention or in those wounds responding poorly to basic wound care. Our postoperative implementation of minocycline as an aid to secondary intention healing demonstrates successful and fast granulation of surgical defects over exposed bone.
Patients receiving immunosuppressive therapy are susceptible to a number of rare skin diseases with infectious etiology, such as trichodysplasia spinulosa (TS). TS is characterized by uncontrolled inner root sheath cell proliferation and folliculocentric papular eruption that can progress to disfiguring leonine facies when left untreated. Recent evidence has identified the trichodysplasia spinulosa-associated polyomavirus (TSPyV) as the causative factor for TS, and genomic sequence data demonstrates that TSPyV encodes the small tumor (sT) and middle tumor (mT) antigens. Although sT and mT antigens of other polyomaviruses have been implicated in carcinogenic processes, whether and how these two tumor antigens influence the pathogenic progression of TS remain unknown. Thus we aim to investigate the mechanistic properties of TSPyV sT and mT antigens, which may serve as potential diagnostic markers for TS. In the current study, co-immunoprecipitation experiments and pull-down assays were performed to evaluate proteinprotein interactions of both sT and mT antigens. Our results demonstrated that both T antigens are capable of sequestering protein phosphatase 2A (PP2A). As PP2A is a critical tumor suppressor that controls the phosphorylation and activation of oncogenic regulators, sT and mT antigen-mediated inhibition of PP2A may implicate TSPyV in mechanisms that disrupt cell growth homeostasis and protein phosphorylation status. In order to further understand the significance of these findings, we performed Western blot analysis using phospho-site specific antibodies to evaluate key pathways downstream of PP2A. Our data show that sT and mT expression enhanced the activation of the MEK and ERK oncogenic kinases, which are direct effectors of PP2A activity. Moreover, mutational analysis demonstrated that these effects are dependent upon intact zinc binding motifs that facilitate sT and mT association with PP2A. In contrast, the activation status of other protein targets of PP2A, including 4E-BP1, AKT, PI3K, Shc, and Src were not affected by sT or mT expression. Given that PP2A interaction and MEK-ERK phosphorylation are associated with high levels of cell proliferation, our findings provide further evidence that TSPyV tumor antigens may contribute to the uninhibited cell proliferation that leads to TS development. In this context, the possibility that sT and mT antigens may serve as diagnostic or prognostic markers for TS should be further explored.
Commercial support: None identified.
Commercial support: None identified.
4815 The use of minocycline in promoting secondary intention healing of defects following Mohs micrographic surgery Danny Guo, MD, Department of Dermatology and Skin Science, University of British Columbia; Iren Kossintseva, MD, Department of Dermatology and Skin Science, University of British Columbia Background: Tetracyclines are reported to increase collagen content and reduce connective tissue degeneration through their inhibitory effects on collagenolytic matrix metalloproteinases (MMPs), while also having anabolic potential in periosteal fibroblasts. While there is a paucity of literature on the use of tetracyclines in Mohs micrographic surgery (MMS) surgical defects allowed to heal by secondary intention, the tetracycline antibiotic minocycline has been reported in the dental literature for its matrix stimulatory effects on connective tissue and bone. Furthermore, through its inhibition of MMPs, immunomodulatory and anti-inflammatory effects, it has also proven beneficial in the healing of chronic venous ulcers. Our aim is to bridge and bring this knowledge into the post-operative practice of Mohs surgeons.
AB258
J AM ACAD DERMATOL
JUNE 2017
4637
The use of Alexandrite based diode for hair removal on Brazilian skin type Valeria Campos, MD, Faculdade de Medicina de Jundiai; Juliana Favaro, MD, private practioner; Ana Flavia Salai, MD, Faculdade de Medicina de Jundiai; Karina Infanti, PA, private practioner; Bruna Lunardi Dal Bello, MD, Faculdade de Medicina de Jundiai
The use of rapid plasma reagin testing in patients with pityriasis rosea: Is it worth it? Pierre Halteh, Pierre Halteh; Shari Lipner, MD, Weill Cornell Medicine
Background: The Soprano ICE platform offers a unique hair removal technique with different wavelengths of choice. The aim of this study is to evaluate safety and efficacy of its alexandrite based 755nm diode laser module in hair removal of small areas in Brazilian skin type’s patients. Methods: 8 female subjects, all of Brazilian skin type III-V were treated for hair removal in small areas of the body in a 4 to 6 weeks intervals in a total of 4 sessions. Hair density was evaluated before and 6 months following 4th sessions and treatment area were photographed before and after. Results: 6 months following 4 sessions of SHR In-Motion technique, hair count had presented a hair density decrease of 63% in total (42.25 vs 16.11), with an average fluence of 9.28J (range 7-12J) used and an average accumulation of 6.28kJ per area (range 5-10 kJ). No adverse effects were reported by the patients within and between sessions. Conclusion: The ALEX 755nm module of the Soprano ICE platform was proven safe and effective using the SHR In-Motion technique treating small body areas on Brazilian skin type II-V. Commercial support: None identified.
Pityriasis rosea (PR) is an acute self-limited exanthem characterized by oval erythematous patches with scale, typically beginning with a ‘‘herald patch.’’ Since histopathologic features are not specific, the diagnosis of PR is based on characteristic features from the history and physical examination. Clinically PR may be difficult for differentiate from secondary syphilis, but a rapid plasma reagin test (RPR) can be used to rule in the latter with 100% sensitivity and 85-99% specificity. A retrospective study was performed on 142 patients at Weill Cornell Medicine, diagnosed with PR from 2000-2016, who also received RPR testing, to assess the frequency of secondary syphilis when the initial clinical impression was PR. The mean age was 31.3 years (range, 3-71), 65.5% were women, and 69.7% were single. In the majority of cases, the sexual history was unknown; such as history of STD (57.7%), sexual orientation (62.7%), number of sexual partners (73.9%), and use of safe-sex practices (89.4%). For social history, 20.4% smoked tobacco, 49.3% drank alcohol, and 1.4% used intravenous (IV) drugs. Only 2 patients (1.4%) had a reactive RPR test. Both were men, were diagnosed by dermatologists, had RPR titers of 1:32, and positive follow-up treponemal-specific testing. In both cases, the rashes were described as erythematous patches with collarettes of scale in a ‘‘Christmas tree’’ distribution. A ‘‘herald patch’’ was present in one patient. Neither patient had lymphadenopathy, nor involvement of the mucous membranes or palms/soles. One patient was a 27-year-old Latino HIV positive, who smoked and drank alcohol, but unknown sexual history, and sexual orientation. The other patient was a 36-year-old homosexual white man, with an unknown number of sexual partners but practiced safe sex, but unknown history of STD; who drank alcohol but did not smoke. Both patients denied using IV drugs. A previous prospective study was conducted to evaluate the frequency of secondary syphilis in patients with a clinical diagnosis of PR. While 3/50 patients (6%), had positive RPR tests, none of the rashes were attributed to syphilis. All 3 patients had a documented history of treated syphilis before diagnosis of PR. Primary and secondary syphilis cases have been increasing since 2000, with 19999 cases reported in 2014. In 15% of people infected with syphilis, progression to the late stage disease may occur resulting in cardiovascular and central nervous center dysfunction. While our study demonstrated that only 1.4% of patients with clinical diagnosis of PR had syphilis, we advocate that careful social and sexual histories be taken in all patients diagnosed with PR and syphilis screening performed if risk factors are present. Our recommendation stems from the US Preventive Services Task Force (USPSTF) recommendation for screening of asymptomatic non-pregnant individuals with increased risk factors for syphilis. Commercial support: None identified.
4740 The viral etiology of trichodysplasia spinulosa: Novel perspectives on a pathogenic mechanism driven by middle T and small T antigens Julie Wu, Baylor College of Medicine; Deepika Narayanan, University of Texas Health Science Center at Houston; Rebecca Simonette, MS, University of Texas Health Science Center at Houston; Hung Doan, MD, University of Texas Health Science Center at Houston; Harrison Nguyen, Yale University; Peter Rady, MD, University of Texas Health Science Center at Houston
Methods: We report a series of surgical defects following MMS which were allowed to heal by secondary intention. Results: The granulation of surgical wounds was significantly hastened by postoperative course of oral minocycline 100 mg daily. These defects included areas of exposed bone where periosteum was stripped as part of the tumor removal. Lacking periosteum normally impedes the granulation process. Conclusions: Given its reported beneficial effects on the healing milieu, minocycline represents a therapeutic consideration as adjuvant therapy for wounds allowed to heal by secondary intention or in those wounds responding poorly to basic wound care. Our postoperative implementation of minocycline as an aid to secondary intention healing demonstrates successful and fast granulation of surgical defects over exposed bone.
Patients receiving immunosuppressive therapy are susceptible to a number of rare skin diseases with infectious etiology, such as trichodysplasia spinulosa (TS). TS is characterized by uncontrolled inner root sheath cell proliferation and folliculocentric papular eruption that can progress to disfiguring leonine facies when left untreated. Recent evidence has identified the trichodysplasia spinulosa-associated polyomavirus (TSPyV) as the causative factor for TS, and genomic sequence data demonstrates that TSPyV encodes the small tumor (sT) and middle tumor (mT) antigens. Although sT and mT antigens of other polyomaviruses have been implicated in carcinogenic processes, whether and how these two tumor antigens influence the pathogenic progression of TS remain unknown. Thus we aim to investigate the mechanistic properties of TSPyV sT and mT antigens, which may serve as potential diagnostic markers for TS. In the current study, co-immunoprecipitation experiments and pull-down assays were performed to evaluate proteinprotein interactions of both sT and mT antigens. Our results demonstrated that both T antigens are capable of sequestering protein phosphatase 2A (PP2A). As PP2A is a critical tumor suppressor that controls the phosphorylation and activation of oncogenic regulators, sT and mT antigen-mediated inhibition of PP2A may implicate TSPyV in mechanisms that disrupt cell growth homeostasis and protein phosphorylation status. In order to further understand the significance of these findings, we performed Western blot analysis using phospho-site specific antibodies to evaluate key pathways downstream of PP2A. Our data show that sT and mT expression enhanced the activation of the MEK and ERK oncogenic kinases, which are direct effectors of PP2A activity. Moreover, mutational analysis demonstrated that these effects are dependent upon intact zinc binding motifs that facilitate sT and mT association with PP2A. In contrast, the activation status of other protein targets of PP2A, including 4E-BP1, AKT, PI3K, Shc, and Src were not affected by sT or mT expression. Given that PP2A interaction and MEK-ERK phosphorylation are associated with high levels of cell proliferation, our findings provide further evidence that TSPyV tumor antigens may contribute to the uninhibited cell proliferation that leads to TS development. In this context, the possibility that sT and mT antigens may serve as diagnostic or prognostic markers for TS should be further explored.
Commercial support: None identified.
Commercial support: None identified.
4815 The use of minocycline in promoting secondary intention healing of defects following Mohs micrographic surgery Danny Guo, MD, Department of Dermatology and Skin Science, University of British Columbia; Iren Kossintseva, MD, Department of Dermatology and Skin Science, University of British Columbia Background: Tetracyclines are reported to increase collagen content and reduce connective tissue degeneration through their inhibitory effects on collagenolytic matrix metalloproteinases (MMPs), while also having anabolic potential in periosteal fibroblasts. While there is a paucity of literature on the use of tetracyclines in Mohs micrographic surgery (MMS) surgical defects allowed to heal by secondary intention, the tetracycline antibiotic minocycline has been reported in the dental literature for its matrix stimulatory effects on connective tissue and bone. Furthermore, through its inhibition of MMPs, immunomodulatory and anti-inflammatory effects, it has also proven beneficial in the healing of chronic venous ulcers. Our aim is to bridge and bring this knowledge into the post-operative practice of Mohs surgeons.
AB258
J AM ACAD DERMATOL
JUNE 2017