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BACKGROUND: In the USA, the geriatric population, almost 12% of which will be comprised of African-Americans, is expected to exceed 88 million by 2050. Data on dermatologic conditions in elderly African-Americans are deficient. OBJECTIVES: This study aimed to identify prevalences of self-reported skin disease and skin-related concerns in elderly African-Americans, and to assess participants' perceptions of skin disease and awareness of skin cancer. METHODS: Elderly African-Americans were recruited into a cross-sectional study and asked to complete a 17-item questionnaire. RESULTS: A total of 101 participants aged 60-91 years (median age: 71 years) completed the questionnaire. The majority (75.2%) of the subjects were female. The most common self-reported skin diseases were eczema/dermatitis (28.7%), fungal skin infections (16.8%), alopecia (6.9%), viral skin infections (4.9%), and urticaria (4.9%). The most common skin concerns were dry skin/pruritus (40.6%), moles (27.7%), hair loss (25.7%), skin discoloration (20.8%), and wrinkles (15.8%). Overall, 40.6% of participants reported concern about skin cancer, and 75.2% reported examining their skin regularly. However, 34.7% did not believe that people with darker skin types should be concerned about skin cancer. CONCLUSIONS: This study provides an important overview of the most common self-reported skin conditions in elderly African-Americans. Substantial age-related differences in the frequencies of skin disorders were apparent. It is important to include the elderly population within campaigns to educate minority group members on skin cancer.

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Milia-like idiopathic calcinosis cutis (MICC) is a rare dermopathy, usually occurring in children with Down syndrome. We report a case of an 8-year-old girl with Down syndrome who presented with histologically verified MICC, briefly review the literature on MICC, discuss the differential diagnosis, and describe the use of dermoscopy in the evaluation of lesions, which we believe has never been published previously with this entity.

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Whether the symptoms are mild, moderate, or severe, the optimal treatment plan is the one the patient is most likely to follow.

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BACKGROUND: In the United States, liposuction is the most commonly performed cosmetic surgical procedure. Laser lipolysis is the latest adjunct to liposuction. This technique employs laser energy to induce lipolysis and hemostasis and stimulate neocollagenesis. Multiple laser systems have been studied. METHODS: PubMed literature search with the key words laser lipolysis and laser assisted liposuction. Original articles that studied the internal application of laser energy to adipose tissue were reviewed and included. RESULTS: Nineteen manuscripts were reviewed. One double-blind randomized controlled trial compared laser liposuction with tumescent liposuction. Several authors claimed that laser lipolysis offers fewer side effects than "traditional" liposuction performed under general anesthesia. A true objective comparison with tumescent liposuction is missing in the literature. LIMITATIONS: Comparison studies between laser-assisted lipolysis and conventional liposuction are limited, as are comparisons between the different laser systems and wavelengths. Standardization of laser energy settings is lacking. CONCLUSION: Laser-assisted lipolysis is a safe and efficacious procedure that may possess advantages over conventional liposuction. Lipolysis occurs in a dose-response relationship. No advantage over tumescent liposuction has been demonstrated. A specific laser wavelength may prove superior for each clinical application, but more studies are needed.

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Chronic plaque psoriasis is a systemic disease affecting over 3% of the population, and many patients are unsatisfied with their current treatment regimen. With advances in understanding of the pathophysiology of psoriasis, new therapeutic options are being developed. The newest of these agents, ustekinumab, offers patients rapid results and the convenience of four annual subcutaneous doses, with efficacy and safety profiles comparable with those of other biologics. However, ustekinumab has been on the market in the US for less than 2 years and will require years of extensive use before the full adverse event profile is fully understood. The purpose of this paper is to summarize the treatment options currently available for psoriasis, with an emphasis on ustekinumab in order to give prescribers an overview of the available data and allow them to make educated and informed prescribing decisions.

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Tinea capitis is a common fungal infection in children but rare among neonates. We present a case of a 3-week-old infant with multiple scalp lesions for 1 week. A diagnosis of tinea capitis due to Microsporum canis was made based on clinical morphology, Wood's lamp, and biopsy with a positive PAS stain. She was effectively treated with oral griseofulvin and ketoconazole shampoo.

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OBJECTIVE: To assess clinical and histopathologic changes occurring after long-pulsed 1064-nm Nd:YAG laser treatment of hidradenitis suppurativa (HS). DESIGN: Prospective, controlled clinical and histologic study of patients with Hurley stage II HS disease. SETTING: Outpatient dermatology department at Henry Ford Hospital, Detroit, Michigan. PARTICIPANTS: Nineteen patients with Fitzpatrick skin types II to VI with Hurley stage II HS lesions of the axilla and groin. Interventions Two monthly laser sessions were performed using the long-pulsed 1064-nm Nd:YAG laser. Main Outcome Measure Clinical response was scored using the modified Sartorius scale for HS reflecting Lesion Area and Severity Index (LASI). Histologic changes were examined before treatment and 1 week, 1 month, and 2 months after treatment. RESULTS: The percentage change in HS severity after 2 sessions of laser treatment was -31.6 over all anatomic sites (P < .005), -24.4 for the axillary site (P = .008), and -36.8 for the inguinal site (P = .001). Histologic changes corresponded to clinical response. Findings from serial biopsy specimens showed increased inflammation at 1 week after treatment and decreased inflammation with resulting fibrosis and scarring at 1 month and 2 months after treatment. CONCLUSIONS: The long-pulsed 1064-nm Nd:YAG laser is a novel effective treatment option for HS. Our histopathologic data suggest that HS is primarily a follicular disorder. The Nd:YAG laser penetrates for selective photothermolysis of the follicular unit and destruction of organized inflammatory lesions in the superficial to mid dermis. Our study offers insight into the pathogenesis of HS and the mechanism of the Nd:YAG laser in treatment of patients with this chronic, debilitating disease.

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BACKGROUND: With the advent of incorporating the immunoperoxidase staining technique into the processing of frozen tissue, the use of Mohs micrographic surgery (MMS) has been expanded to include several high-risk tumors such as lentigo maligna, malignant melanoma, and dermatofibrosarcoma protuberans. OBJECTIVES: To thoroughly review the English medical literature pertaining to the use of immunohistochemical staining techniques on frozen sections during MMS and to summarize the basic relevant outcomes from the different relevant studies. MATERIALS AND METHODS: Medline search was conducted, with the following words used in the search criteria: "Mohs surgery,""staining,""immunostaining," and "immunoperoxidase." RESULTS Generally, all immunostains showed advantage over the traditional hematoxylin and eosin approach. Studies of MART-1 in melanoma chemosurgery indicated that it is typically crisp and has less background staining than MEL-5 and better staining consistency than HMB-45. In cases of desmoplastic melanomas, S100 is the stain of choice. CONCLUSION: Immunostaining offers an advantage in MMS. Large, randomized, prospective studies comparing the different immunostains are still lacking in the literature. The authors have indicated no significant interest with commercial supporters.

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BACKGROUND: The heterogeneous histological features of melanoma may often overlap with melanocytic nevi. For this reason, pathologists have sought after immunohistochemistry to assist with difficult cases. Recently, Wilms' tumor 1 protein (WT1) has been suggested to differentiate between melanoma and melanocytic nevi. OBJECTIVE: Our objective was to determine whether immunohistochemistry analysis of WT1 expression is a reliable tool in differentiating cutaneous melanoma from melanocytic nevi. METHODS: Forty-five melanoma and 43 melanocytic nevi were immunostained with anti-WT1 monoclonal antibody (clone 6F-H2). RESULTS: Forty of the 45 cutaneous melanoma (89%) and 22 of the 43 melanocytic nevi (51%) stained (> 10% cells) for WT1. The highest sensitivity for WT1 was expressed by nodular melanoma (19/20), superficial spreading melanoma (8/10) and Spitz nevi (9/11). At the threshold of above 75% WT1-stained cells, the specificity for melanoma was 95% but the sensitivity was only 31%. At the threshold of 10%, the sensitivity increased to 89% but the specificity decreased to only 49%. Finally, at the threshold of 25% and 50%, the sensitivity and specificity were 71%, 61% and 64%, 77%, respectively. CONCLUSIONS: Our data suggest that melanoma is associated with increased WT1 expression. However, as a single immunostaining marker, WT1 is not sufficient for distinguishing melanoma from melanocytic nevi.

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A 31-year-old Caucasian male presented with a history of erythematous, saccular outpouchings of the skin on his back, shoulders, and upper extremities (Fig. 1). The patient reported that his mother and aunt had a similar skin disorder, which initially began with inflammation, but healed leaving lax skin in its wake. He did not recall the name of the skin condition. Physical examination revealed large confluent zones of sac-like protrusions of erythematous skin on the back and shoulders. Histopathologic examination of the excisional biopsy revealed a relatively unremarkable epidermis. Perivascular lymphocytes were present in small numbers in the papillary dermis. Adnexal structures and deep dermis remained intact. The acid-orcein-Giemsa stain highlighted the absence of elastic fibers within the mid and lower reticular dermis (Fig. 2a,b), consistent with anetoderma.

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Clear cell papulosis is a rarely described disease characterized by multiple white maculopapules. Histopathologically, diagnostic clear cells are seen mainly among the basal cells of the epidermis. The origin of the clear cells has been thought to be eccrine or apocrine secretory cells in the epidermis because of the positive immunostaining with anticytokeratin antibody AE1, carcinoembryonic antigen (CEA), epithelial membrane antigen, and gross cystic disease fluid protein-15. IKH-4 and CEA have been reported to stain the eccrine secretory cells, but not the apocrine secretory cells. On the contrary, lysozyme has been reported to stain apocrine glands, but not eccrine glands. CAM5.2 has been reported to show a positive reaction to staining in secretory cells of eccrine glands, but only occasional weak staining in the inner surface of eccrine ducts. In our study, the clear cells in the epidermis stained with IKH-4, CEA and CAM5.2, but not with lysozyme. These results suggest that the clear cells may be eccrine secretory cells.

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