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Biomedical subjects

Thomas D Horn

Publications and source records attributed to Thomas D Horn.

14 recordsLinked to original sources
PubMed2006

Cheilitis glandularis: a clinical marker for both malignancy and/or severe inflammatory disease of the oral cavity.

We report the case of an 84-year-old white male who underwent vermilionectomy for removal of a tumor, which proved to be squamous cell carcinoma. Chelitis glandularis related to marked actinic damage was noted at a subsequent visit. The presence of chelitis glandularis should be investigated for the presence of neoplasia, immunosuppression, or inflammatory diseases related to extremely poor oral hygiene.

Aged, 80 and over↗
PubMed2005

Necrolytic acral erythema: a patient from the United States successfully treated with oral zinc.

BACKGROUND: Recently, necrolytic acral erythema (NAE) has been described as a cutaneous marker for hepatitis C virus (HCV) infection. Only 2 cases have been reported in the United States. Successful remission has been induced only with interferon therapy with or without ribavirin. OBSERVATIONS: We describe a 46-year-old, HCV-positive African American woman with well-defined, dusky, erythematous plaques on the dorsa of the feet, Achilles tendons, legs, knees, and elbows. Histologic examination revealed confluent upper epidermal necrosis, acanthosis, papillomatosis, and superficial and deep perivascular inflammation. She was diagnosed as having NAE. We induced successful disease remission with oral zinc administration. This is the third NAE case reported in the United States and the first report of disease remission with oral zinc therapy alone. CONCLUSIONS: Since its initial description in Egypt, more cases of NAE are being reported in the United States. Increased awareness of this entity is crucial. Oral zinc might represent a less toxic alternative therapeutic option for patients with NAE.

Acrodermatitis↗
PubMed2005

Intralesional immunotherapy of warts with mumps, Candida, and Trichophyton skin test antigens: a single-blinded, randomized, and controlled trial.

BACKGROUND: Warts occur commonly in humans. Destructive modalities are generally the first physician-administered therapy. Other treatment options include immunotherapy. Intralesional immunotherapy using mumps, Candida, or Trichophyton skin test antigens has proved efficacy in the treatment of warts. OBJECTIVES: To determine rates of wart resolution in response to injection of antigen alone, antigen plus interferon alfa-2b, interferon alfa-2b alone, and normal saline; and to compare response according to viral type, major histocompatibility complex antigens, and peripheral blood mononuclear cell proliferation to autologous human papillomavirus antigen before and after injection. DESIGN: Randomized, single-blinded, placebo-controlled, clinical trial. SETTING: Medical school-based dermatology department. PATIENTS: Two hundred thirty-three patients clinically diagnosed as having 1 or more warts. Main Outcome Measure Clinical resolution of warts in response to intralesional immunotherapy. RESULTS: Responders were observed in all treatment arms, but were significantly more likely to have received antigen (P<.001). Resolution of distant untreated warts was observed, and was significantly more likely in subjects receiving antigen (P<.001). Interferon did not significantly enhance the response rate (P = .20) and did not differ from normal saline (P = .65). No viral type or major histocompatibility complex antigen correlated with response or lack of response (P>.99 and P = .86, respectively). A positive peripheral blood mononuclear cell proliferation assay result (2 times pretreatment levels) was significantly more likely among responders (P = .002). While there was no significant difference in response based on sex (P = .56), older subjects (>40 years) were less likely to respond (P = .01). CONCLUSIONS: Intralesional immunotherapy using injection of Candida, mumps, or Trichophyton skin test antigens is an effective treatment for warts, as indicated by significantly higher response rates and distant response rates in subjects receiving antigen. Viral type and major histocompatibility complex antigens did not seem to influence treatment response. Response is accompanied by proliferation of peripheral blood mononuclear cells to human papillomavirus antigens, suggesting that a human papillomavirus-directed cell-mediated immune response plays a role in wart resolution.

Adult↗
PubMed2005

Pseudoporphyria induced by voriconazole.

Pseudoporphyria is an uncommon blistering disorder with clinical and histologic similarities to porphyria cutanea tarda but which lacks urine and serum porphyrin elevations. Pseudoporphyria has been linked with numerous causes including chronic renal failure, ultraviolet radiation, and numerous medications. We report a case of pseudoporphyria attributed to the relatively new triazole antifungal agent voriconazole. This medication has not been previously identified as a cause of pseudoporphyria.

Antifungal Agents↗
PubMed2005

Necrolytic acral erythema: a cutaneous sign of hepatitis C virus infection.

BACKGROUND: Hepatitis C virus (HCV) infection is globally epidemic. Several mucocutaneous diseases are well established in association with HCV infection. Few case reports describe the recently recognized HCV-related skin disorder termed necrolytic acral erythema (NAE). METHODS: Thirty patients with NAE were identified in a university-based dermatology clinic in Cairo, Egypt. These patients were observed over time to document the clinical and histologic findings of this disorder. RESULTS: All patients were infected with HCV. Erythematous papules arose most commonly on the dorsal aspect of the feet, particularly the dorsal surface of the great toe. Progression resulted in confluence into erythematous dusky plaques with adherent scale and central erosion. The eruption extended to involve the lower leg and other regions in some patients but never affected palms or soles, the nail bed, nail plate, or mucous membranes. Skin biopsy specimens from fully evolved lesions displayed psoriasiform changes in association with more characteristic findings of keratinocyte necrosis and papillomatosis. LIMITATIONS: We did not perform a prospective review of patients known to be infected with HCV. Patients were identified from a general clinic population and then assayed for HCV serology. CONCLUSIONS: NAE is a distinctive skin disorder associated with HCV infection in all cases reported to date. Recognition of this disease should alert practitioners to the need for viral testing and appropriate counseling of patients.

Adolescent↗
PubMed2005

Tacrolimus ointment is safe and effective in the treatment of atopic dermatitis: results in 8000 patients.

OBJECTIVE: We sought to evaluate the safety and efficacy of tacrolimus ointment in a large cohort of adult and pediatric patients with atopic dermatitis (AD). METHODS: A cohort of 3964 adult and 3959 pediatric patients with AD were enrolled in this open-label noncomparative study. Patients applied tacrolimus 0.03% or 0.1% ointment twice daily to the affected areas. Efficacy and safety assessments included percentage of body surface area affected and incidence of adverse events, respectively. RESULTS: A total of 7923 patients were evaluated; 95.5% had severe or moderate AD at baseline. There was a 52% decrease from baseline in the mean percentage of body surface area affected at month 1 and a 91% decrease at month 18. Two of the most common adverse events, skin burning and pruritus, were generally mild, transient in nature, and decreased in prevalence as AD improved. Severity and frequency of other common adverse events were consistent with expected rates in the general population. CONCLUSION: Tacrolimus ointment monotherapy in almost 8000 pediatric and adult patients led to continuous improvement in AD and revealed no change in the safety profile reported in previous clinical trials.

Adult↗
PubMed2005

The diagnostic concordance of actinic keratosis and squamous cell carcinoma.

Diagnostic concordance of intraepithelial malignancy is generally only fair. Because the diagnosis of actinic keratosis (AK) and squamous cell carcinoma (SCC) is not uniform and because such terms are not consonant with the nomenclature of other human epithelial malignancies, nomenclature revisions have been attempted. One hundred dermatopathologists were solicited to review 15 tissue sections representing a spectrum of varying thickness epidermal malignancy and to choose either AK or SCC as the diagnosis. Among the 77 participating dermatopathologists, intraclass correlation was high for what was perceived as AK, SCC, and their differentiation. Development of a two-tiered diagnostic system that retains our present diagnostic capabilities, but better fits the pathobiology of superficial epidermal malignancy is suggested. Davis DA, Donahue JP, Bost JE, Horn TD. The diagnostic concordance of actinic keratosis and squamous cell carcinoma.

Carcinoma in Situ↗
PubMed2004

Evaluation of anti-thrombomodulin antibody as a tumor marker for vascular neoplasms.

BACKGROUND: Various endothelial markers are available for the evaluation of vascular tumors and malformations, including anti CD34, anti-CD31, von Willebrand factor (vWF), and anti-thrombomodulin (anti-TM) antibodies. All have their limitations, and we sought to compare the utility of anti-TM antibody as a marker for several types of vascular neoplasms vs. previously established endothelial markers. METHODS: We examined immunostaining profiles of 30 capillary hemangiomas, 10 pyogenic granulomas, five tufted angiomas, 17 Kaposi's sarcomas, and nine angiosarcomas. Immunostains for TM, CD34, and vWF were carried out using a labeled streptavidin-biotin peroxidase detection system. RESULTS: Anti-TM antibody showed moderately intense immunostaining in 89% of benign and malignant vascular neoplasms. Anti-CD34 antibody showed moderate to diffuse immunostaining in 98% of vascular neoplasms, and vWF showed weak focal staining in 84% of all vascular neoplasms examined. CONCLUSION: Anti-TM antibody proved to be a sensitive marker for both benign and malignant vascular neoplasms. While not as sensitive as anti-CD34, it may have some advantages in specificity that would make it a more reliable vascular tumor marker in certain situations.

Antigens, CD34↗
PubMed2003

Necrolytic migratory erythema as the only presenting sign of a glucagonoma.

We describe a 39-year-old man with a 3-year history of a recalcitrant psoriasiform eruption that was accentuated in the intertriginous areas. Hsitopathology was consistent with psoriasis. A glucagon level was 744 pg/mL with the upper limit of normal being 130 pg/mL. Computed tomographic scan of the abdomen revealed a 5-cm mass in the tail of the pancreas. The tumor was removed and found to be a glucagonoma (pancreatic islet tumor). The clinical eruption resolved promptly with surgical excision. Neither the clinical eruption nor the tumor has recurred for 6 months. The course of disease confirms the diagnosis of necrolytic migratory erythema associated with a glucagonoma.

Adult↗
PubMed2003

Comparing therapy costs for physician treatment of warts.

To compare the cost of several common modalities used to treat non-genital warts in immunocompetent patients, we identified studies published in English using standard search strategies and evaluated the literature for the following common non-genital wart therapies: cryotherapy with liquid nitrogen, carbon dioxide and pulsed-dye laser therapy, topical squaric acid, intralesional bleomycin, intralesional interferon alpha injections, and intralesional immunotherapy with Candida antigens. Standard treatment algorithms, compiled by dermatologists experienced in the treatment of patients with moderate wart burdens, were utilized for cost-comparison analyses. Based on the cost analysis model, the least expensive treatment option for non-genital warts were carbon dioxide laser therapy (157 dollars) and Candida antigen injections (190 dollars). The other treatment modalities examined ranged from 495 dollars (bleomycin) to 1227 dollars (interferon alpha). Although treatment with the carbon dioxide laser therapy is the least expensive, pain and post-procedure complications limit the use of this modality.

Arkansas↗
PubMedDate not supplied

Immunotherapy for recalcitrant warts in children using intralesional mumps or Candida antigens.

Intralesional injection of mumps and Candida skin test antigens has been shown to be effective in the treatment of warts. Warts are generally difficult to treat in children. To determine the efficacy of intralesional skin test antigen injection for the treatment of resistant warts in children, we treated 47 pediatric patients with one or more warts with intralesional injection of mumps or Candida skin test antigen into one wart. Twenty-two patients (47%) with resistant warts experienced complete resolution of treated warts. An average of 3.78 treatments were necessary. An additional 34% of children had a greater than 25% improvement in their warts. Sixty-eight percent of subjects with more than one wart also noted at least partial resolution (greater than 25% resolution) of untreated warts at distant sites, with 34% experiencing complete resolution. We concluded that intralesional injection of skin test antigens is an effective therapy for children who have recalcitrant, nongenital, cutaneous warts.

Adolescent↗
PubMedDate not supplied

Intralesional immunotherapy for warts using a combination of skin test antigens: a safe and effective therapy.

Warts are a common dermatologic problem. There are many treatments available. Intralesional injection of a skin test antigen has been shown to be efficacious at eradicating all warts when only a part of one wart is injected. The aim of this study was to determine whether injection of the combination of Candida albicans, mumps, and Trichophyton skin test antigens was more efficacious than and as safe as single antigen injection. Seventy-one percent of subjects had resolution of their warts with the injection of the combination of skin test antigens in this open label single arm study.

Adult↗