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Biomedical subjects

Mark D P Davis

Publications and source records attributed to Mark D P Davis.

At least 19 recordsLinked to original sources
PubMed2007

Early cutaneous gene transcription changes in adult atopic dermatitis and potential clinical implications.

Atopic dermatitis (AD) is a common pruritic dermatitis with macroscopically non-lesional skin that is often abnormal. Therefore, we used high-density oligonucleotide arrays to identify cutaneous gene transcription changes associated with early AD inflammation as potential disease control targets. Skin biopsy specimens analysed included normal skin from five healthy non-atopic adults and both minimally lesional skin and nearby or contralateral non-lesional skin from six adult AD patients. Data were analysed on an individual gene basis and to identify biologically relevant gene networks. Transcription levels of selected genes were also analysed by quantitative PCR. Differential transcription occurring early in AD skin was indicated for (i) individual genes such as C-C chemokine ligand (CCL)18, CCL13, and interferon-alpha2 (IFNalpha2), (ii) genes associated with peroxisome proliferator-activated receptor (PPAR)alpha- and PPARgamma-regulated transcription, and possibly for (iii) immunoglobulin J-chain and heavy chain isotype transcripts. These data suggest that local changes in immunoglobulin-associated transcription may favour IgE over secretory immunoglobulin (multimeric IgM and IgA) expression in AD skin. Decreased PPAR activity appears common to both AD and psoriasis, and reduced cutaneous IFNalpha2 transcription also appears characteristic of AD. Identification of these genes and pathways will direct future research towards controlling AD.

Adult↗
PubMed2006

Calciphylaxis: natural history, risk factor analysis, and outcome.

BACKGROUND: Calciphylaxis is characterized by ischemic cutaneous ulceration, high mortality, and ineffective treatment. METHODS: We conducted a retrospective study of 64 patients with calciphylaxis (including 49 dialysis patients age- and sex-matched to 98 dialysis controls). RESULTS: The estimated 1-year survival rate of calciphylaxis was 45.8%. Risk factors for calciphylaxis included obesity, liver disease, systemic corticosteroid use, calcium-phosphate product more than 70 mg(2)/dL(2), and serum aluminum greater than 25 ng/mL. Survival rates were similar for 16 patients who received parathyroidectomy and 47 who did not. An estimated 1-year survival rate of 61.6% was observed for 17 patients receiving surgical debridement compared with 27.4% for the 46 who did not (P = .008). LIMITATIONS: The study was limited by its retrospective design and there was no control group for the 15 nondialysis cases. CONCLUSIONS: Calciphylaxis is multifactorial and usually fatal. Prevention of calciphylaxis may include correction of risk factors identified in this study. Surgical debridement was associated with improved survival, but parathyroidectomy was not.

Adult↗
PubMed2006

Dermatologic adverse effects of lenalidomide therapy for amyloidosis and multiple myeloma.

OBJECTIVES: To examine dermatologic adverse effects of lenalidomide in patients with amyloidosis and multiple myeloma and to determine whether the adverse effects are different when lenalidomide is used alone compared with when it is used in combination with dexamethasone. DESIGN: Retrospective review of medical records. SETTING: Tertiary referral center. PATIENTS: Seventy-five patients with multiple myeloma and 23 patients with amyloidosis participating in clinical trials. INTERVENTION: In the 75 patients with multiple myeloma, lenalidomide was the treatment in 24 and lenalidomide and dexamethasone in 51. In the 23 patients with amyloidosis, lenalidomide was used alone. MAIN OUTCOME MEASURES: The frequency, type, severity, and time of onset of all skin eruptions that were temporally related to lenalidomide treatment were recorded. RESULTS: In the patients with amyloidosis treated with lenalidomide, 10 (43%) had rashes. In the patients with multiple myeloma, rashes occurred in 7 (29%) of those receiving lenalidomide alone and in 15 (29%) of those receiving lenalidomide and dexamethasone. The rashes were characterized as morbilliform, urticarial, dermatitic, acneiform, and undefined. Severe rashes required permanent discontinuation of lenalidomide therapy in 2 patients. In 23 patients (72%), rashes occurred in the first month after therapy was initiated; however, delayed-onset rashes occurred in 9 (28%). CONCLUSIONS: The prevalence of dermatologic adverse effects in patients receiving lenalidomide was higher in those with amyloidosis than in those with multiple myeloma. The prevalence of skin eruptions was not diminished by the concurrent use of systemic corticosteroids. Most skin eruptions were mild and did not necessitate withdrawal of lenalidomide therapy.

Amyloidosis↗
PubMed2006

Livedoid vasculopathy: further evidence for procoagulant pathogenesis.

OBJECTIVE: To further characterize the clinical and pathologic features, disease associations, and laboratory abnormalities of livedoid vasculopathy. DESIGN: Retrospective study of patients identified from our institutional database from January 1, 1990, to December 31, 2000. SETTING: Tertiary care institution. Patients Forty-five patients with biopsy-proved livedoid vasculopathy. MAIN OUTCOME MEASURES: Clinical presentation, histopathologic diagnosis, results of testing for coagulation abnormalities, and assessment of vascular status. RESULTS: Thirty-two patients (71.1%) were female (mean age, 45 years; age range, 10-85 years). Bilateral lower extremity disease occurred in 36 patients (80.0%), ulceration in 31 (68.9%), and atrophie blanche in 32 (71.1%). In patients tested, transcutaneous oximetry measurements were decreased in 20 (74.1%) of 27, and factor V Leiden mutation (heterozygous) was noted in 2 (22.2%) of 9, decreased activity for protein C or protein S in 2 (13.3%) of 15, prothrombin G20210A gene mutation in 1 (8.3%) of 12, and lupus anticoagulant in 5 (17.9%) of 28. Anticardiolipin antibodies were present in 8 (28.6%) of 28 patients, and elevated homocysteine levels in 3 (14.3%) of 21. Intraluminal thrombosis was observed in 44 (97.8%) of 45 skin biopsy specimens. Direct immunofluorescence disclosed multiple vascular conjugates in 31 (86.1%) of 36 biopsy specimens. CONCLUSIONS: Livedoid vasculopathy was predominantly bilateral, affected the lower extremities, and was associated with ulceration and atrophie blanche. Histologic evidence of intraluminal thrombosis was observed in almost all biopsy specimens reviewed. Laboratory testing revealed numerous heterogeneous coagulation abnormalities, providing further evidence of procoagulant mechanisms.

Adolescent↗
PubMed2006

Thermoregulatory sweat testing in patients with erythromelalgia.

OBJECTIVES: To examine the results of thermoregulatory sweat testing in patients with erythromelalgia and to compare them with the results of other neurophysiologic tests of small-fiber nerve function. DESIGN: Retrospective study. SETTING: Tertiary referral center. PATIENTS: Thirty-two consecutive patients with erythromelalgia who had thermoregulatory sweat testing in addition to vascular and nerve testing. INTERVENTION: The following information was abstracted for each patient: demographics, clinical presentation, and results of thermoregulatory sweat testing, vascular (noninvasive) testing, and nerve testing (electromyography and autonomic reflex screen, including quantitative sudomotor axon reflex test). MAIN OUTCOME MEASURES: Results of thermoregulatory sweat testing to evaluate small-fiber neuropathy, compared with other tools used to estimate small-fiber neuropathy. RESULTS: Thermoregulatory sweat testing results were abnormal in 28 (88%) of 32 patients, and quantitative sudomotor axon reflex test results were abnormal in 22 patients (69%). Abnormalities noted on thermoregulatory sweat testing varied from local hypohidrosis or anhidrosis to global anhidrosis. Global or almost-global anhidrosis was present in 8 patients (25%); in 19 patients (59%) the anhidrosis was distal, and 1 other patient (3%) had a less specific pattern of anhidrosis (multifocal or regional). The area of anhidrosis generally corresponded to the area that was symptomatic of the erythromelalgia. CONCLUSIONS: Small-fiber neuropathy is prevalent in most patients with erythromelalgia. Thermoregulatory sweat testing is a sensitive and useful marker of small-fiber neuropathy in these patients.

Adolescent↗
PubMed2006

Erythromelalgia.

No treatment is consistently effective in the management of patients with erythromelalgia. There is a dearth of adequate studies examining the response of erythromelalgia to treatment. Most recommendations are suggested based on case reports, small case series, and anecdotal reports. The management of erythromelalgia is difficult and frequently involves a multidisciplinary approach. An approach to management of individuals with erythromelalgia includes patient education, learning to avoid episodes, relieving discomfort of the episodes, controlling secondary and underlying factors, and use of drugs used to control erythromelalgia.

Journal Article↗
PubMed2006

Cutaneous complications of intravesical treatments for bladder cancer: granulomatous inflammation of the penis following BCG therapy and penile gangrene following mitomycin therapy.

Transitional cell carcinoma of the bladder is frequently treated with intravesical injection of immunotherapeutic (eg, BCG) or chemotherapeutic (eg, mitomycin C) agents. The aim of this study was to report cutaneous complications of intravesical therapy in 2 patients with transitional cell carcinoma of the bladder. A 69-year-old man had an ulceration at the base of the penis and papules involving the glans penis 1 month after injection of intravesical BCG. Biopsy findings showed granulomatous inflammation with foci of dermal necrosis suggestive of a BCG-related granulomatous reaction. The second patient was a 73-year-old man with penile gangrene. Erythema involving his penis and perineum had developed within 24 hours after intravesical administration of mitomycin C, which spilled onto his perineum during catheter removal. The resulting penile gangrene required penectomy 3 months after the injection. Mitomycin C patch testing showed a clear allergic contact reaction. Dermatologists should be aware of these potential cutaneous complications.

Administration, Intravesical↗
PubMed2006

Pyoderma gangrenosum of the breasts precipitated by breast surgery.

Pyoderma gangrenosum may occur in unusual sites and not be readily recognized. Delays in diagnosis and appropriate treatment may result in extensive ulcerations and scarring. We present two patients with pyoderma gangrenosum involving the breasts after breast operation. Delays in diagnosis resulted in extensive ulcerations and scarring of the breasts.

Adrenal Cortex Hormones↗
PubMed2006

Histopathologic findings in primary erythromelalgia are nonspecific: special studies show a decrease in small nerve fiber density.

The histopathology of primary erythromelalgia has been poorly characterized. A total of 33 skin biopsy specimens from 29 patients with a diagnosis of primary erythromelalgia were re-examined. Histopathologic findings were nonspecific. Vascular thrombi were not identified. A relative decrease in small nerve fiber density was noted in specimens from 13 of 16 patients.

Adult↗
PubMed2006

Should macular erythema reactions be counted as positive allergic patch-test reactions?

BACKGROUND: Positive allergic patch-test results are generally described as erythematous papules, vesicles, or a spreading reaction with crust and ulceration. This description excludes milder reactions, including macular erythema. OBJECTIVE: Our aim was to investigate the prevalence and relevance of reactions graded as macular erythema at Mayo Clinic. METHODS: Between January 2001 and June 2004, patients suspected of having allergic contact dermatitis were patch-tested with our institution's standard patch test, a screening series of 68 to 72 allergens. In total, 2,823 patients were patch-tested with 193,530 allergen applications. Reactions were interpreted with the North American Contact Dermatitis Group scale, including and excluding reactions graded as macular erythema. Irritant reactions were excluded from calculations. For this study, scores for current, questionable, and past relevance were combined. RESULTS: On day 5, with the exclusion of reactions graded as irritant, 7,274 allergen applications were associated with reactions, including 3,082 (42.4%) that were graded as macular erythema. Of the macular erythema reactions, 2,430 (78.8%) were graded as relevant. The rate of reaction in our patients was 2.2% if macular erythema was excluded, 3.8% if all macular erythema reactions were included, and 3.4% if only those macular reactions deemed relevant were included. CONCLUSION: Patch-test reactions rated as macular erythema are common and may be of clinical relevance. For the purposes of patient education, they should not be disregarded. Consideration should be given to including these reactions when reporting patchtest results.

Allergens↗