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Seminars in Cutaneous Medicine and Surgery

Cameron C Trenor
We have entered an exciting era in the care of patients with vascular anomalies. These disorders require multidisciplinary care and coordination and dedicated centers have emerged to address this need. Vascular tumors have been treated with medical therapies for many years, while malformations have been historically treated with endovascular and operative procedures. The recent serendipitous discoveries of propranolol and sirolimus for vascular anomalies have revolutionized this field. In particular, sirolimus responses are challenging the dogma that vascular malformations are not biologically active...
September 2016: Seminars in Cutaneous Medicine and Surgery
Maria C Garzon, Nicole Weitz, Julie Powell
Vascular anomalies are very common in children and encompass a wide spectrum of diseases. Many vascular anomalies can be mistaken for infantile hemangioma (IH). In addition, there is a variety of rare disorders including benign and malignant tumors that may mimic IH and other types of vascular anomalies. Understanding the clinical features, natural history, and typical clinical course of different types of vascular anomalies is essential in order to make the correct diagnosis and guide management. Radiologic imaging plays an important role in establishing the diagnosis; and when the diagnosis remains in doubt, a biopsy performed by a surgical specialist with expertise may prove to be lifesaving...
September 2016: Seminars in Cutaneous Medicine and Surgery
Solveig L Hagen, Kristen P Hook
This review provides a clinically-oriented summary of the most commonly encountered overgrowth syndromes associated with vascular malformations. This manuscript will outline morphologic features, clinical evaluation and management of this complex group of patients. Recent genetic advances have aided in classification and help to explain overlapping clinical features in many cases.
September 2016: Seminars in Cutaneous Medicine and Surgery
Laura E Levin, Christine T Lauren
Multifocal vascular lesions are important to recognize and appropriately diagnose. Generally first noticed on the skin, multifocal vascular lesions may have systemic involvement. Distinguishing among the different types of multifocal vascular lesions is often based on clinical features; however, radiological imaging and/or biopsy are frequently needed to identify distinct features and guide treatment. Knowledge of the systemic associations that can occur with different vascular anomalies may reduce life-threatening complications, such as coagulopathy, bleeding, cardiac compromise, and neurologic sequelae...
September 2016: Seminars in Cutaneous Medicine and Surgery
Stacy E Croteau, Deepti Gupta
Kasposiform hemoangioendothelioma (KHE) and tufted angioma (TA) are classifed as vascular tumors with locally aggressive and benign growth potential, respectively, within the classification schema proposed by the International Society for the Study of Vascular Anomalies. A unique feature of these vascular tumors is the risk of Kasabach-Merritt phenomenon (KMP), a severe thrombocytopenia with mild to moderate coagulopathy resulting from intralesional platelet trapping. As with many vascular anomalies, accurate description of clinical course, responses to therapy, and long-term outcomes have been hindered by lesion misidentification, imprecise nomenclature, and lack of prospective, randomized clinical trials to assess therapeutic efficacy...
September 2016: Seminars in Cutaneous Medicine and Surgery
Daniel D Miller, Anita Gupta
Precise diagnosis of childhood vascular anomalies is challenging, and requires careful correlation of clinical findings, diagnostic imaging, histopathology and genetic analysis. Skin and soft tissue biopsies remain an important element in the complete evaluation of many vascular anomalies included in the revised 2014 International Society for the Study of Vascular Anomalies (ISSVA) classification. Here we present an overview of the light microscopic and immunohistochemical features of the entities in this updated classification scheme, with emphasis on newly-included diagnoses such as PTEN hamartoma of soft tissue...
September 2016: Seminars in Cutaneous Medicine and Surgery
A Yasmine Kirkorian, Anna L Grossberg, Katherine B Püttgen
The fundamental genetics of many isolated vascular anomalies and syndromes associated with vascular anomalies have been elucidated. The rate of discovery continues to increase, expanding our understanding of the underlying interconnected molecular pathways. This review summarizes genetic and clinical information on the following diagnoses: capillary malformation, venous malformation, lymphatic malformation, arteriovenous malformation, PIK3CA-related overgrowth spectrum (PROS), Proteus syndrome, SOLAMEN syndrome, Sturge-Weber syndrome, phakomatosis pigmentovascularis, congenital hemangioma, verrucous venous malformation, cutaneomucosal venous malformation, blue rubber bleb nevus syndrome, capillary malformation-arteriovenous malformation syndrome, Parkes-Weber syndrome, and Maffucci syndrome...
September 2016: Seminars in Cutaneous Medicine and Surgery
Christina Boull, Sheilagh M Maguiness
Congenital hemangiomas are rare solitary vascular tumors that do not proliferate after birth. They are characterized as either rapidly involuting congenital hemangiomas (RICHs) or noninvoluting congenital hemangiomas (NICHs) based on their clinical progression. NICHs have no associated complications, but are persistent. RICH, while usually asymptomatic, may ulcerate or bleed early in their presentation, but involute quickly during the first few months of life. Hepatic RICHs are not associated with cutaneous RICHs, but may result in high-output cardiac failure due to arteriovenous or portovenous shunting...
September 2016: Seminars in Cutaneous Medicine and Surgery
Minnelly Luu, Ilona J Frieden
In a subset of patients, infantile hemangiomas may be associated with structural anomalies. Structural anomalies may affect the upper body (PHACE Syndrome) or the lower body (LUMBAR Syndrome). Since their initial descriptions, improved understanding of these two syndromes has lead to recognition of a broader phenotypic spectrum than initially recognized. This paper aims to provide an updated review of the presentation, associated anomalies, and management of PHACE and LUMBAR syndromes, two well-characterized syndromes associated with IH...
September 2016: Seminars in Cutaneous Medicine and Surgery
Carol Erin Cheng, Sheila Fallon Friedlander
Infantile hemangiomas (IHs) are the most common vascular tumors of infancy. While the majority regress without the need for intervention, approximately 10%, often site dependent, can cause serious complications and require treatment. IH complications can be categorized as life threatening, obstructive, ulcerative or disfiguring. Life threatening complications include airway and hepatic IHs. Functional complications obstructing vital structures or impairing function include periocular, nasal, labial, parotid, auricular, and breast IHs...
September 2016: Seminars in Cutaneous Medicine and Surgery
Craig L Leonardi
The anti-tumor necrosis factor (TNF)-α agents represent the second generation of psoriasis therapy. Research has produced a third generation of biologic treatments, some of which offer greater efficacy than the TNF-α inhibitors. This article reviews the data documenting the efficacy and safety of three types of biologics.
June 2016: Seminars in Cutaneous Medicine and Surgery
Francisco A Kerdel
No abstract text is available yet for this article.
June 2016: Seminars in Cutaneous Medicine and Surgery
Linda F Stein Gold
Acne vulgaris is one of the most prevalent skin conditions. Antibiotics, when considered, are most effective in combination with other therapies, and limited evidence suggests that submicrobial doses of antibiotics may improve acne without increasing the risk for antibiotic resistance. A small but significant risk for inflammatory bowel disease has also been identified in children treated with multiple courses of antibiotics. New topical agents are expanding therapeutic options for acne. Semin Cutan Med Surg 35(supp6):S114-S116...
June 2016: Seminars in Cutaneous Medicine and Surgery
Joseph F Fowler, Christopher B Zachary
No abstract text is available yet for this article.
June 2016: Seminars in Cutaneous Medicine and Surgery
Theodore Rosen
Onychomycosis and tinea pedis are common fungal infections affecting the nails and feet, respectively. Two newly approved topical agents for onychomycosis are efinaconazole and tavaborole, both of which have demonstrated respectable cure rates in clinical studies. For tinea pedis, naftifine 2% and luliconazole 1% are new agents, both administered for relatively short courses, that may foster greater adherence Semin Cutan Med Surg 35(supp6):S110-S113.
June 2016: Seminars in Cutaneous Medicine and Surgery
Christopher B Zachary
For decades, devices and peels have been used for facial rejuvenation and the treatment of skin damage. In recent years, new laser systems have been developed, including fractionated ablative and non-ablative lasers which, while not as effective as the traditional laser resurfacing, can provide nice results with reduced side effects. While fractionated hybrid systems, picosecond lasers, and daylight photodynamic therapy have all been rolled out for clinicians to assess their efficacy, future technology, including TRASER (total reflection amplification of spontaneous emission of radiation) technology, should be just around the corner...
June 2016: Seminars in Cutaneous Medicine and Surgery
Nowell Solish
The goal of treating the aging face is to restore facial balance and modify shadows. A facial evaluation should focus on areas of volume loss and opportunities to use neuromodulators (eg, botulinum toxin A) and the use of fillers. A thorough understanding of facial anatomy, including muscles, nerves, bone, and fat pads, is essential for effective and safe treatment. Semin Cutan Med Surg 35(supp6):S120-S121.
June 2016: Seminars in Cutaneous Medicine and Surgery
Joseph F Fowler
Rosacea is a chronic skin disorder associated with flushing, erythema, dryness, burning and stinging, and inflammatory papules and pustules. New treatments available or in development target the inflammatory and erythematous components of the disease. These agents include the selective α2 receptor agonist brimonidine, the topical agents ivermectin cream 1% and azelaic acid foam 15%, and use of tetracyclinetype antibiotics, which affect the cathelicidin pathway. Semin Cutan Med Surg 35(supp6):S107-S109.
June 2016: Seminars in Cutaneous Medicine and Surgery
Nowell Solish
Soft tissue augmentation products (or fillers) are used for the correction of age-related changes in areas of the face. The most common filler material is hyaluronic acid, which is synthetically cross-linked. These materials are generally safe, but some side effects do occur. New fillers are expected to be approved in the United States in the near future. Semin Cutan Med Surg 35(supp6):S117-119.
June 2016: Seminars in Cutaneous Medicine and Surgery
Jeffrey M Sobell
Emerging data describe new potential indications for tumor necrosis factor (TNF) inhibitors in dermatology, including pediatric psoriasis and hidradenitis suppurativa. New biosimilar TNF agents are in late stages of development and may be available in the United States in the near future. Biosimilar agents are similar but not identical to available TNF inhibitors, and approval requires extensive analytic, toxicity, pharmacokinetic, pharmacodynamic, and clinical testing. Semin Cutan Med Surg 35(supp6):S104-S106...
June 2016: Seminars in Cutaneous Medicine and Surgery
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