Case studies.
Explore the source record for details and available documents.
Administration, Cutaneous↗
Biomedical subjects
Joseph B Bikowski
Publications and source records attributed to Joseph B Bikowski.
Lymphangioma circumscriptum: treatment with hypertonic saline sclerotherapy.
A 38-year-old woman came for treatment of multiple clear vesicles and hemorrhagic papules on the posterior aspect of the right shoulder and the right axillary vault of 5 years' duration. These lesions would spontaneously manifest as clear or blood-filled vesicles (or both) and appear to be exacerbated by physical contact from certain articles of clothing. A biopsy was done and the results revealed lymphangioma circumscriptum. The purpose of this case study was to evaluate a new form of treatment of lymphangioma circumscriptum with the use of 23.4% hypertonic saline sclerotherapy. The patient's lymphangioma circumscriptum significantly resolved with minimal side effects, such as mild hyperpigmentation. Decreased sensitivity was noted and no further treatment was indicated. This case showed that hypertonic saline 23.4% solution can be effective in treating the appearance of vesicles containing clear fluid or lymph and those containing red blood cells in superficial lymphangiomas and that this treatment can be considered for long-term management of lymphangioma circumscriptum.
Adjuvants, Immunologic↗
The pharmacologic therapy of rosacea: a paradigm shift in progress.
A number of topical and systemic pharmacologic therapies, some of which remain investigational, have been used to treat rosacea. The pathophysiology of rosacea appears to be inflammatory, and most of the interventions modulate the inflammatory process in some way. Topical agents include various formulations of sodium sulfacetamide and sulfur, metronidazole, azelaic acid, and benzoyl peroxide/clindamycin. Oral agents include antibiotics in conventional and subantimicrobial doses. A paradigm shift in progress in the management of rosacea encompasses the use of these and other agents either alone or, increasingly, in different combinations, based on the subtype of rosacea.
Adrenal Cortex Hormones↗
Molluscum contagiosum: the need for physician intervention and new treatment options.
Molluscum contagiosum is an infection caused by a poxvirus that gives rise to small, benign, white, pink, or flesh-colored, umbilicated, raised papules or nodules located in the epidermal layer of the skin. The disease can be transmitted by direct bodily contact including sexual activity, fomites, or self-inoculation. There has been continued debate about whether physicians should actively treat molluscum contagiosum. Many dermatologists recommend treatment to reduce the incidence of contagious transfer and reduce self-inoculation. Furthermore, individuals with weakened immune systems (eg, patients with human immunodeficiency virus infection) not only are at greater risk for secondary inflammation and bacterial infection but also are prone to lesions that typically persist for prolonged periods. In addition to the commonly administered treatments (ie, physical and chemical destruction), novel treatment opportunities exist, including immunomodulated therapy with imiquimod.
Administration, Cutaneous↗
Subantimicrobial dose doxycycline for acne and rosacea.
Acne vulgaris and rosacea present therapeutic challenges due to their chronicity, potential for disfigurement, and psychosocial impact. Although pathophysiologically distinct, both conditions have major inflammatory components. Consequently, topical and systemic antimicrobial agents are routinely prescribed for extended periods. Emergence of resistant strains of Propionibacterium acnes, adverse events, and compliance issues associated with chronic systemic tetracycline use have led to new treatment approaches. At subantimicrobial doses, tetracyclines reduce inflammation via anticollagenolytic, antimatrix-degrading metalloproteinase, and cytokine down-regulating properties. Subantimicrobial dose (SD) doxycycline (Periostat 20 mg) has clinical utility in periodontitis and has been investigated in a double-blind, placebo-controlled trial in the treatment of moderate facial acne as well as in an open label study in the treatment of rosacea. The results of subantimicrobial dose doxycycline treatment in early trials support its benefits and further investigation in acne and rosacea.
Acne Vulgaris↗
Rosacea: where are we now?
Advances continue to be made in the classification and treatment of rosacea, a chronic dermatologic syndrome. A new empiric classification system identifies 4 rosacea subtypes (erythematotelangiectatic, papulopustular, phymatous, and ocular) that may aid in more precise diagnosis. Several new therapies have recently been approved for treatment of rosacea. Azelaic acid 15% gel is a new first-tier topical agent proven effective in reducing inflammatory lesions and erythema. New formulations of metronidazole and sulfacetamide 10%/sulfur 5% that offer cosmetic or tolerability advantages are now available. Intense pulsed light therapy has demonstrated effectiveness in reducing flushing, erythema, and telangiectases, with greater tolerability than existing laser systems. Other treatments under investigation include low-dose doxycycline hyclate (which may provide greater safety than existing oral antibiotics), benzoyl peroxide/clindamycin gel, and tacrolimus ointment (for steroid-induced rosacea). With this expanded armamentarium of medical and light-based therapies, clinicians can now implement a multifaceted approach to treatment, crafting new treatment combinations to address the unique and evolving features of rosacea in each individual patient.
Administration, Cutaneous↗
Mechanisms of the comedolytic and anti-inflammatory properties of topical retinoids.
Retinoids comprise a family of compounds with structures and mechanisms of action that resemble those of vitamin A (retinol), an essential nutrient which plays a role in cell growth and differentiation. The retinoids, which interact with nuclear receptors and affect gene transcription, have enormous therapeutic potential, particularly if they are receptor- and function-selective. Tretinoin was the first topical retinoid employed for the treatment of acne. In recent years, other topical retinoids for the treatment of acne have been designed from a disease-specific approach, with enhanced receptor and function selectivity, which translates to improved therapeutic effects and more favorable tolerability. The properties that differentiate the topical retinoids tretinoin, adapalene, and tazarotene have permitted clinicians to tailor acne treatment regimens for maximum therapeutic outcomes. Tretinoin (all-trans-retinoic acid), considered a first-generation retinoid, acts by altering the milieu of the microcomedo and influences desquamation of abnormal epithelium. Two receptor-selective synthetic retinoids, adapalene and tazarotene, may be classified as third-generation retinoids. Adapalene, a derivative of naphthoic acid, has comedolytic, antiproliferative, and anti-inflammatory properties. Tazarotene is a prodrug metabolized to tazarotenic acid that modulates cellular differentiation, desquamation, and inflammation.
Adapalene↗
Clinical experience results with clindamycin 1% benzoyl peroxide 5% gel (Duac) as monotherapy and in combination.
This article will examine various clinical experiences with acne patients successfully treated with topical clindamycin 1% benzoyl peroxide 5% gel (Duac) alone and in combination with other acne treatments. Clindamycin 1% benzoyl peroxide 5%, the only once-daily prescription topical aqueous gel combining a benzoyl peroxide and an antibiotic, has demonstrated excellent tolerability and efficacy and is stable when used concomitantly with other therapies. A regimen of topical clindamycin 1% benzoyl peroxide 5% gel, oral doxycycline hyclate (Doryx), and adapalene gel (Differin) seems especially advantageous from a theoretical and practical perspective. Improvement is noted by means of photographic, physician, and/or patient assessments at baseline and follow-up visits.
Acne Vulgaris↗