Biomedical subjects
Robert B Skinner
Publications and source records attributed to Robert B Skinner.
Medical pearl: circle of desquamation--a clue to the diagnosis of folliculitis and furunculosis caused by Staphylococcus aureus.
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Experience with keloids after excision and application of 5% imiquimod cream.
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The role of topical immune response modifiers in skin cancer.
Topical immune response modifiers include imiquimod and resiquimod. The mechanism of action of immune response modifiers is complex and not completely understood. It involves the stimulation of innate and cell-mediated immune responses through Toll-like receptor-mediated induction of cytokines. Imiquimod is approved for the treatment of actinic keratoses, superficial basal cell carcinomas and warts; it has also been documented to successfully treat other forms of skin cancer such as squamous cell carcinoma in situ, melanoma and extramammary Paget's disease.
Disseminated blastomycosis presenting as oligoarticular septic arthritis in a 12-year-old girl.
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Topical imiquimod treatment for nodular basal cell carcinomas: an open-label series.
BACKGROUND: Imiquimod has been used for basal cell carcinomas (BCCs). This is the first open-label series using imiquimod for nodular BCC with Mohs surgery resection for confirmation of treatment. OBJECTIVE: To evaluate the efficacy of topical imiquimod in patients with biopsy-proven nodular BCC. RESULTS: After 12 weeks for three times a week application, treatment sites at week 15 were surgically excised using Mohs micrographic surgery. All 15 treatment subjects were clear of BCC. At the 18-month follow-up, no patients had recurrent tumor. CONCLUSION: Imiquimod 5% cream may be another treatment modality for nodular BCC.
Imiquimod.
Imiquimod is the first of the immune response modifiers to stimulate a localized immune response to treat infectious skin conditions. The reported TLR-7 activation to provoke an immune response suggests that imiquimod might mimic a microbial antigen. The immune response initiated by induced production of IFN-alpha and TFN-alpha is specifically aimed at an infectious antigen and appears mediated (in part) by enhanced migration of Langerhans' cells to regional lymph nodes. The approved indication for imiquimod is for treatment of genital warts. The drug has demonstrated a 50% to 60% clearance rate and a 12% to 20% recurrence rate for this indication (Table 1). This recurrence rate is the lowest reported among the currently recommended treatment modalities. The self-applied treatment avoids costly and painful office-based procedures. Case reports and open-label studies have demonstrated the efficacy of imiquimod in treating some cases of common, plantar, and flat warts, as well as molluscum contagiosum and leishmaniasis. Common and plantar warts respond better to imiquimod in combination with cryosurgery, occlusion, and keratolytics. Reports of successful imiquimod treatment of granuloma annulare, alopecia areata, and vitiligo might suggest an infectious etiology to those conditions, although this hypothesis is highly speculative.
Topical imiquimod 5% cream as an effective treatment for external genital and perianal warts in different patient populations.
BACKGROUND: Genital infection with human papillomavirus, the cause of genital warts, is one of the most common sexually transmitted diseases. GOAL: The aim of this analysis was to determine whether patients' demographic variables affect the efficacy of imiquimod 5% cream versus vehicle cream for the treatment of external genital and perianal warts. STUDY DESIGN: Male and female immunocompetent patients applied imiquimod 5% cream topically to external genital warts 3 times a week until wart clearance or for up to 16 weeks. RESULTS: As previously published, the intent-to-treat (ITT) clearance rate was 50% (54/109) in the imiquimod-treated group and 11% (11/100) in the vehicle-treated group ( P< 0.0001). The ITT clearance rate in the imiquimod-treated group was higher in females (72%) than in males (33%). We have examined the clearance rates for subgroups based on variables of gender, baseline wart area, duration of current outbreak of warts, previous wart treatment, and tobacco use. For each of these subgroups, imiquimod was statistically more effective than vehicle in eradicating external genital and perianal warts. CONCLUSION: Imiquimod 5% cream is an effective treatment for external genital and perianal warts and provides a significant benefit in comparison with vehicle cream, independent of gender, initial wart size, duration of current outbreak of warts, previous wart treatment, or tobacco use.
Photo quiz. Sunken cheeks.
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Direct medical cost for surgical and medical treatment of condylomata acuminata.
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Treatment of molluscum contagiosum with imiquimod 5% cream.
Molluscum contagiosum is a benign cutaneous viral disease. This article describes 5 immunocompetent patients with molluscum contagiosum who were successfully treated with imiquimod 5% cream.
Maffucci syndrome: a case report.
The multiple enchondromas and hemangiomas of Maffucci syndrome affect the skin and skeletal systems. The disease develops slowly, with enlargement of enchondromas and hemangiomas occurring during the first 2 decades of life. Effects of the disease range from those requiring minor adjustments in activities of daily living to almost total incapacitation.
Granuloma annulare resolved with topical application of imiquimod.
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Treatment of granuloma annulare with topical 5% imiquimod cream.
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Immunotherapy of alopecia areata with intralesional Candida antigen.
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Early diffuse alopecia in a neonate with congenital syphilis.
Neonatal alopecia has been described in many circumstances but never as a part of the constellation of signs in congenital syphilis. Common clinical features of early congenital syphilis include hepatosplenomegaly, skeletal deformities, hematologic disturbances, and mucocutaneous features such as rhinitis and maculopapular rash. Syphilitic alopecia has previously been described only in conjunction with secondary syphilis. In this article, we describe the first occurrence of alopecia in a neonate with congenital syphilis.
Skin basement membrane zone: a depository for circulating microbial antigen evoking psoriasis and autoimmunity.
BACKGROUND: Elevated levels of antibody to streptococcal exoenzymes have been found in patients with psoriasis or psoriatic arthritis. Research on the role of streptococcal antigen in psoriasis has been hampered by a potential molecular mimicry between streptococcal epitopes and human epidermal keratin. OBJECTIVE AND METHODS: Evidence of microbial product was sought in skin biopsies of psoriasis patients thought clinically to have either streptococcal carrier state or gastrointestinal candidal colonization. A polyclonal antibody to streptococcal-derived exoenzymes unlikely to share antigenic structures with normal human skin, and an anticandidal antibody, were used with linked streptavidin biotin amplification stain. RESULTS: The predicted microbial product appeared heavily in lesional epidermis, but unexpectedly also as a thin deposit along the skin basement membrane zone (SBMZ) of apparently unaffected skin. Staining was negative for nonpsoriatic subjects. CONCLUSIONS: The findings support a direct effect of microbial antigen in psoriasis. They also suggest an important role for SBMZ as a very large adhesive surface in the first step of a process of percutaneous epidermal elimination of foreign antigens and microbial toxins. The many autoimmune phenomena seen so often at the SBMZ are probably a physiologic part of this important immune function. Efforts to enhance the adhesive properties of SBMZ should be exploitable for both diagnostic and therapeutic benefit.