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Biomedical subjects

N B Silverberg

Publications and source records attributed to N B Silverberg.

At least 19 recordsLinked to original sources
PubMed2001

Do hair care practices affect the acquisition of tinea capitis? A case-control study.

OBJECTIVE: To determine the influences of hair-grooming practices and environmental factors as risk factors for the acquisition of tinea capitis (TC) in children. DESIGN: Case-control study comparing children with culture-proved TC with age-, sex-, and race-matched control subjects without scalp disease. SETTING: A multicenter study involving 3 urban referral centers in the United States. PARTICIPANTS: A convenience sample of 66 patients aged 12 years and younger presenting to pediatric dermatology clinics with clinical evidence of TC were enrolled as cases. Matched control subjects (n = 68), without known scalp disease, were enrolled from the outpatient pediatric clinics at the same institutions. RESULTS: Significant associations with TC in the conditional logistic regression model were a prior history of TC (odds ratio, 3.11; 95% confidence interval, 1.02-9.43; P =.04) and exposure to TC (odds ratio, 16.32; 95% confidence interval, 3.55-75.16; P =.001). The use of a hair conditioner was statistically significant in the univariable model but not in the multivariable model (odds ratio, 0.46; 95% confidence interval, 0.20-1.08; P =.07). Hairstyling, frequency of washing, use of oils or grease, and other hair care practices were not shown to be associated with the presence of TC. CONCLUSIONS: Hair-grooming practices do not appear to play a major role in the acquisition of TC. Hair conditioners may be protective in children at risk for TC, but further studies are needed to confirm this finding.

Case-Control Studies↗
PubMed2001

Update on malignant melanoma in children.

Malignant melanoma is a rare event in children. Yet, the overall incidence has consistently risen in the past 20 years. Thus, the likelihood that our pediatric patients will develop malignant melanoma is increasing. Previously, the bulk of lesions were estimated to occur in children with large congenital melanocytic nevi. Recent reports, however, have highlighted new risk factors for malignant melanoma in children, while demystifying other entities previously believed to have a grave prognosis. Knowledge of risk factors and participation in public health efforts toward prevention and early intervention can help the practitioner protect pediatric patients from this malignancy.

Adolescent↗
PubMed2001

Cutaneous malignancy in albinism.

Albinism is a disorder of hypopigmentation affecting the skin, appendages, and eyes. Ultraviolet light-induced cutaneous tumors are common in patients with albinism due to reduced or absent protection from melanin. Squamous cell carcinoma (SCC) is the number one skin tumor seen in patients who are albinos. Although nonmelanomatous skin cancers are more common in patients with albinism, dysplastic nevus and melanoma present a greater diagnostic challenge in this group because of their hypopigmented appearance. We report 2 cases of cutaneous malignancies in patients who had oculocutaneous albinism (OCA). The first case involves a 45-year-old man with OCA type 2 (OCA2) who developed a large SCC of the neck. The second case involves a 24-year-old man with Hermansky-Pudiak syndrome (HPS) who developed amelanotic melanoma. In both cases, hypopigmentation of the lesions contributed to a delay in diagnosis. We review the clinical, diagnostic, and therapeutic concerns for patients with albinism who have cutaneous malignancies.

Adult↗
PubMed2001

Psoriasis in infancy: therapy with calcipotriene ointment.

Psoriasis in infancy is often more therapeutically challenging than atopic and seborrheic dermatitis. The generalized nature of psoriasis and the intensity of inflammation often reduce the efficacy of topical corticosteroids. Furthermore, involvement of intertriginous skin and the presence of scalp disease limit the potency of the topical steroids that can be prescribed. We report on an infant treated with topical calcipotriene for infantile psoriasis who experienced greater benefit than he had with standard corticosteroid medications. Laboratory testing for calcium metabolism was normal during the course of therapy. We conclude that calcipotriene can be a safe and effective therapy for psoriasis in early infancy.

Calcitriol↗
PubMed2000

Squaric acid immunotherapy for warts in children.

BACKGROUND: Warts are a common pediatric skin infection caused by human papillomavirus (HPV). Spontaneous clearance of warts involves anti-HPV immunity, which may be enhanced by contact sensitizers. Squaric acid dibutylester (SADBE) is a nonmutagenic sensitizing agent useful for immunotherapy of alopecia areata. OBJECTIVE: We hypothesized that SADBE home application might be effective therapy for warts. METHODS: An open-label, retrospective study of 61 children with warts was performed. Sensitization with 2% SADBE on the forearm was followed with home application of 0.2% SADBE to warts 3 to 7 nights per week for at least 3 months. RESULTS: Complete clearing occurred in 34 patients (58%), with a mean duration of therapy of 7 weeks. Partial clearing occurred in 11 (18%), and no response in 14 (24%). Clearance correlated with plantar distribution, wart duration under 2 years (P <.05), and first-line therapy with SADBE. Mild side effects occurred in one third of patients, were limited most commonly to mild erythema at the site of sensitization, and necessitated discontinuation of therapy in only 2 patients. CONCLUSION: SADBE topical immunotherapy is a safe, effective option for home therapy of warts in children.

Adjuvants, Immunologic↗
PubMed2000

Childhood molluscum contagiosum: experience with cantharidin therapy in 300 patients.

BACKGROUND: Molluscum contagiosum (MC) is a common cutaneous infection in children. Cantharidin, a chemovesicant that is highly effective in treating MC, has lost favor with some physicians because of concerns over its safety. OBJECTIVE: We attempted to determine the safety, efficacy, and parental satisfaction of cantharidin therapy for MC in children who were treated in a pediatric dermatology clinic at a large referral hospital. METHODS: A total of 537 charts of children who presented with MC were reviewed. We found 300 children who were treated with cantharidin and who had parents available for telephone interview, which was performed in addition to chart review. RESULTS: With cantharidin therapy, 90% of patients experienced clearing and 8% improved. The average number of treatment visits was 2.1. Blisters occurred at sites of application in 92% of patients. Temporary burning, pain, erythema, or pruritus was reported in 6% to 37% of patients. No major side effects were reported, and no patients experienced secondary bacterial infection. A total of 95% of parents reported they would proceed with cantharidin therapy again. CONCLUSION: To our knowledge ours is the largest retrospective series of childhood MC treated with cantharidin. In these patients the therapy was extremely effective and well tolerated, and parental satisfaction was high. Cantharidin is a safe and effective therapy for MC in children.

Blister↗
PubMed2000

Medical hazards of the tear gas CS. A case of persistent, multisystem, hypersensitivity reaction and review of the literature.

A 30-year-old incarcerated man was sprayed with the "tear gas" ortho-chlorobenzylidene malononitrile (CS). He was hospitalized 8 days later with erythroderma, wheezing, pneumonitis with hypoxemia, hepatitis with jaundice, and hypereosinophilia. During the subsequent months he continued to suffer from generalized dermatitis, recurrent cough and wheezing consistent with reactive airways dysfunction syndrome, and eosinophilia. These abnormalities responded to brief courses of systemic corticosteroid but recurred off therapy. The dermatitis resolved gradually over 6-7 months, but the patient still had asthma-like symptoms a year following exposure. Patch testing confirmed sensitization to CS. The mechanism of the patient's prolonged reaction is unknown but may involve cell-mediated hypersensitivity, perhaps to adducts of CS (or a metabolite) and tissue proteins. This is the first documented case in which CS apparently caused a severe, multisystem illness by hypersensitivity rather than direct tissue toxicity. Both the ethics and safety of CS use remain controversial, in part because of the difficulty documenting sporadic injuries received in the field, and also because the charged circumstances surrounding CS use may lead to both underreporting and exaggerated claims of medical harm. The medical literature on CS focuses mainly on its immediate irritant effects and on transient dermal and ocular injuries, with only 2 prior case reports of acute lung injury related to CS exposure. Given the paucity of documented lasting effects despite its widespread use for more than 3 decades, CS appears to be safe when deployed (outdoors) in a controlled manner, but it can cause important injuries if misused or if applied to a sensitized individual.

Adult↗
PubMed1996

Quality of care: issue or oversight in health care reform?

BACKGROUND: Health care reform is not dead but merely on hiatus. The vehicle for the reform is managed care, in particular health maintenance organizations (HMOs). HMOs employ primary care physicians as gatekeepers to act as regulators and points of entry into the health care system. It is through these gatekeepers that most dermatologic care is rendered. OBJECTIVE: Our purpose was to assess (1) the level of dermatology training of family practice physicians compared with dermatologists and (2) the impact on the delivery of quality dermatology services. METHODS: a national study of university residency programs was undertaken. Twenty color Kodachromes of typical cutaneous diseases were analyzed by the two physician groups. A questionnaire was used to evaluate the average formal dermatology training received, the number of primary dermatology patients examined by family practitioners, the correct response rates to the questions, and the dermatologic procedures performed by family practitioners. A total of 723 family practice physicians and 443 dermatologists responded. RESULTS: Our results indicate that, in comparison to dermatologists, primary care physicians significantly are deficient in their ability to recognize common and serious dermatoses. CONCLUSION: this study provides data emphasizing the need for reevaluation of the dermatology curriculum in medical schools and family practice residencies. Most important, it suggests that direct access to dermatologists provides better quality of care to members of HMOs and hence indirectly is most cost effective for the provision of dermatology services.

Cost-Benefit Analysis↗