Dermatology RSS : Gourt

Pacific Northwest City of 150k, 'The Emerald City', 99% Outpatient, #3349 :: Oregon :: Timeline Recruiting

Upgrade your quality of life and downgrade your stress by relocating to this fabulous city. Ramp up quickly and be part of a stable, cohesive team anxiously awaiting your services. You will love working

State-of-the-art Facility in SE Indiana :: Indiana :: Enterprise Medical Service

New state-of-art facility located in SE Indiana in need of full time Dermatologist due to patient demand. This full time general Dermatology position will be hospital employed and work out of hospital

Central New Jersey Needs Dermatologists :: New Jersey :: Enterprise Medical Service

Several general dermatologists sought for locations in Central New Jersey. Locations include Princeton, Edison and Lawrenceville. The needs with this large dermatology group are due to growth and expansion.

Dermatologist Sought for Gulf Coast! :: Mississippi :: Enterprise Medical Service

Come experience quality of life on the Mississippi coast! This employed opportunity is to set up a brand new practice with complete assistance from the hospital. Huge needs for a new Dermatologist as

Northern Jersey close to Shore :: New Jersey :: Booth-Yellin Physician Recruitment

A Multi-specialty group practice located less than a hour to NYC and only 25 miles from the NJ beach has a opening for a BE/BC Dermatologist to join them. Practice offers several employment options including

NW Georgia Seeks Dermatologist :: Georgia :: Enterprise Medical Service

Become a partner in Georgias largest physician-owned multi-specialty group located in NW Georgia. Second Dermatologist now needed to join dynamic female Dermatologist, working clinical hours of M-F,

Albuquerque, NM Seeks MOHS :: New Jersey :: Enterprise Medical Service

Dermatologist/MOHS Surgeon sought to join growing, well-established MSG in Albuquerque! This position will be a mix of Dermatology and MOHS, though you can decide how much of each you would like to do.

Hilton Head Island, SC :: South Carolina :: Enterprise Medical Service

Hilton Head Island, SC, practice in need of Dermatologist with MOHS due to patient demand. Highly desirable location on the island. Mostly clinical based practice with in-house hospitalists to care

Central Pennsylvania :: Pennsylvania :: Enterprise Medical Service

Well respected multi-specialty group in central Pennsylvania in need of adding 2nd full time Dermatologist due to patient demand. Minimal call. General clinical practice, no MOHS. Financial package to

Southwest Michigan :: Michigan :: Enterprise Medical Service

Southwest Michigan facility in need of first full time Dermatologist due to patient demand. The hospital is the largest employer in this community with satellite offices in Clarksville, Delton, Hastings,

Pittsburgh Area :: Pennsylvania :: Health Search, Inc.

Need 1 to 2 dermatologists supporting a 300 bed hospital. Great location, close to city w/o living smack in it.

South Western :: Wisconsin :: Medical Search International

We have a client in South Western Wisconsin that is recruiting for a Dermatologist to join them. Until that time they would like to look at using some locums coverage. This need would be starting in August

South Western :: Washington :: Medical Search International

I have a great Dermatology opportunity in Southwestern WA. This is a long term locums assignment working Monday through Friday 8 am 5pm. No call and no OT. Please let me know if you might be interested

Garden City :: New York :: Winston Staffing

Expanding Long Island Practice, New Grads encouraged to apply!!! Come join one of the most progressive mid-sized Dermatology practices in the area. This is a great opportunity to join a collegial,

Washington :: Washington :: Medical Search International

I have a client in Washington that needs locums coverage in Sept-November possibly longer. If you are interested or know someone that would be please contact me at clay@medsearchint.com or 877-706-4949.

Nationwide :: Texas :: Physician Referral Network

Physician Referral Network is your best source to learn about the latest practice opportunities. We are not a recruiting firm, so we promise you'll never be pressured to look at or take a position that

New York :: New York :: Winston Staffing

Highly Progressive and very collegial practice on Long Island seeks a full time Board Certified Dermatologist to work in fully equipped office. Salaries based upon experience and full benefits offered.

New York :: New York :: Winston Staffing

New York City, Major Prestigious private practices seek fulltime or parttime Board Certified or Board Eligible Dermatologists to work in fully equipped practices that are long established in NYC, offices

Central :: South Carolina :: Medical Search International

DERMATOLOGY - SOLO WITH HOSPITAL ASSISTANCE - LAKE FRONT COMMUNITY - GREAT PLACE TO LIVE & PRACTICE - We are seeking a Dermatologist to start a new private practice. Currently there are two Dermatologists

Dallas :: Texas :: Phyllis Vajda & Associates, LLC

Opportunity Well-established private practice seeks to replace third Pulmonary/Critical Care physician for primarily hospital-based practice with some clinic work in office attached to the hospital.

About This Journal [About This Journal]

This Month in Archives of Dermatology [This Month in Archives of Dermatology]

The Increase of Certain Contagions Following the Great Fire in San Francisco [Archives a Century Ago]

Fractional Photothermolysis: A New Therapeutic Modality for Xanthelasma [The Cutting Edge]

Large Sample of Nephrogenic Systemic Fibrosis Cases From a Single Institution [Study]

Objectives To estimate and stratify the risk of development of nephrogenic systemic fibrosis (NSF) in well-defined at-risk subpopulations from a large single institution, and to perform a single-institution case series study of patients with biopsy-proven NSF. Design Retrospective cohort of patients exposed to gadolinium-based contrast agents (GBCAs) at a single institution during an 8-year period (January 1, 1999, to December 31, 2006), and a case series study of patients with biopsy-proven NSF. Setting A primary, secondary, and tertiary health care center that treated more than 2.2 million outpatients and had 135 000 hospital admissions in 2007. Patients A total of 94 917 patients exposed to GBCAs; patients at risk for NSF (3779 patients on hemodialysis, 1694 patients with renal transplants, and 717 patients with liver transplants, a well-defined subgroup that includes patients at risk for reduced renal function); and 61 patients with a clinical diagnosis of NSF. Main Outcome Measure Risk estimate for NSF. Results The risk of development of NSF is 1.0% for patients who undergo hemodialysis (8 of 827), 0.8% for patients with renal transplantation (4 of 527), and 0% for patients with liver transplantation at our institution (0 of 327). Conclusions Despite the limitations, this study, which reviewed a large number of patients who underwent intravascular GBCA injections, demonstrates a 77-fold higher risk of NSF among patients who undergo hemodialysis and a 69-fold higher risk in patients with renal transplantation. This increased risk is thought to be associated with poor clearance of most GBCAs.

Highly Sensitive Multivariable Assay Detection of Melanocytic Differentiation Antigens and Angiogenesis Biomarkers in Sentinel Lymph Nodes With Melanoma Micrometastases [Study]

Objectives To evaluate the prognostic value of melanocytic differentiation antigens and angiogenesis biomarkers in sentinel lymph nodes (SLNs) with melanoma micrometastases. Design Prognostic study of an inception cohort. Setting Academic research. Patients Between July 1, 1999, and July 31, 2002, all patients who had primary cutaneous or mucosal melanomas that have a Breslow depth of 1.5 mm or greater, ulceration, or Clark level IV or V, or had SLN biopsies. Main Outcome Measures By the use of quantitative reverse transcription–polymerase chain reaction, the expression of the following was analyzed in SLNs: 2 melanocytic differentiation antigens (tyrosinase [P17646] and melanoma antigen recognized by T cells [MART-1; Q16655]) and genes involved in angiogenesis (VEGF [NM_001025366] and VEGFR2 [AF035121]), lymphangiogenesis (VEGFC [NM_005429], VEGFR3 [X68203], LYVE1 [NM_016164], and PROX1 [002763]), and invasion (uPA [NM_002658], PAI1 [NM_00602], and EMMPRIN [L10240]). Outcome measures were the association of these melanocytic differentiation antigens and angiogenesis biomarkers with clinicopathologic characteristics of patients, and an evaluation of the prognostic value for relapse-free survival and overall survival. Results Ninety-one patients were included, with a median follow-up period of 41 months. Micrometastases were present in 15% (14 of 91) of patients. Tyrosinase (P < .001), MART-1 (P < .001), vascular endothelial growth factor 121 (VEGF121) (P = .007), and PAI1 (P = .02) expression was significantly associated with micrometastasis. In univariate analysis, histologic findings and tyrosinase and MART-1 expression were significantly associated with relapse-free survival. Tyrosinase and MART-1 expression was associated with overall survival. A multiple Cox proportional hazards regression model identified negative histologic findings and tyrosinase expression that exceeded 27 copies/copy of TATA box-binding protein (third quartile) as significantly associated with an increased risk of relapse or death. Conclusions Quantitative assessment of melanocytic differentiation antigens in SLNs, which has prognostic value, is more specific than qualitative assessment. Prognosis may be more effectively predicted by the combination of quantitative assessment of melanocytic differentiation antigens in SLNs with histologic assessment. A significant association was found between the presence of micrometastases and the expression of angiogenesis biomarkers.

The Incredible Being of Lightness [Notable Notes]

Molecular Analysis of Aggressive Microdermabrasion in Photoaged Skin [Study]

Objective To investigate dermal remodeling effects of crystal-free microdermabrasion on photodamaged skin. Design Biochemical analyses of human skin biopsy specimens following microdermabrasion treatment in vivo. Setting Academic referral center. Participants Volunteer sample of 40 adults, aged 50 to 83 years, with clinically photodamaged forearms. Intervention Focal microdermabrasion treatment with diamond-studded handpieces of varying abrasiveness on photodamaged forearms and serial biopsies at baseline and various times after treatment. Main Outcome Measures Quantitative polymerase chain reaction, immunohistochemistry, and enzyme-linked immunosorbent assay were used to quantify changes in inflammatory, proliferative, and remodeling effectors of normal wound healing. Type I and type III procollagen served as the main outcome marker of dermal remodeling. Results Coarse-grit microdermabrasion induces a wound healing response characterized by rapid increase in induction of cytokeratin 16 and activation of the AP-1 transcription factor in the epidermis. Early inflammation was demonstrated by induction of inflammatory cytokines, antimicrobial peptides, and neutrophil infiltration in the dermis. AP-1 activation was followed by matrix metalloproteinase–mediated degradation of extracellular matrix. Consistent with this wound-healing response, we observed significant remodeling of the dermal component of the skin, highlighted by induction of type I and type III procollagen and by induction of collagen production enhancers heat shock protein 47 and prolyl 4-hydroxylase. Dermal remodeling was not achieved when microdermabrasion was performed using a medium-grit handpiece. Conclusions Microdermabrasion using a coarse diamond-studded handpiece induces a dermal remodeling cascade similar to that seen in incisional wound healing. Optimization of these molecular effects is likely the result of more aggressive treatment with a more abrasive handpiece. Trial Registration clinicaltrials.gov Identifier: NCT00111254

Practical Guidelines for Evaluation of Loose Anagen Hair Syndrome [Study]

Objectives To better categorize the epidemiologic profile, clinical features, and disease associations of loose anagen hair syndrome (LAHS) compared with other forms of childhood alopecia. Design Retrospective survey. Setting Academic pediatric dermatology practice. Patients Three hundred seventy-four patients with alopecia referred from July 1, 1997, to June 31, 2007. Main Outcome Measures Epidemiologic data for all forms of alopecia were ascertained, such as sex, age at onset, age at the time of evaluation, and clinical diagnosis. Patients with LAHS were further studied by the recording of family history, disease associations, hair-pull test or biopsy results, hair color, laboratory test result abnormalities, initial treatment, and involvement of eyelashes, eyebrows, and nails. Results Approximately 10% of all children with alopecia had LAHS. The mean age (95% confidence interval) at onset differed between patients with LAHS (2.8 [1.2-4.3] years) vs patients without LAHS (7.1 [6.6-7.7] years) (P < .001), with 3 years being the most common age at onset for patients with LAHS. All but 1 of 37 patients with LAHS were female. The most common symptom reported was thin, sparse hair. Family histories were significant for LAHS (n = 1) and for alopecia areata (n = 3). In 32 of 33 patients, trichograms showed typical loose anagen hairs. Two children had underlying genetic syndromes. No associated laboratory test result abnormalities were noted among patients who underwent testing. Conclusions Loose anagen hair syndrome is a common nonscarring alopecia in young girls with a history of sparse or fine hair. Before ordering extensive blood testing in young girls with diffusely thin hair, it is important to perform a hair-pull test, as a trichogram can be instrumental in the confirmation of a diagnosis of LAHS.

Rates of Skin Cancer Screening and Prevention Counseling by US Medical Residents [Study]

Objective To determine factors related to residents’ self-reported skill level for the skin cancer examination (SCE). Design Survey of residents in November 2003. Setting Four US residency programs. Participants Medical residents in family medicine, pediatrics, obstetrics and gynecology, and internal medicine and specialists. Main Outcome Measure Proportion of residents reporting their current skill level for the performance of the SCE. Results Of 454 surveys distributed, 342 residents completed the survey (75.3% response rate). Clinical training for the SCE during residency was infrequent. During residency, 75.8% were never trained in the SCE, 55.3% never observed an SCE, and 57.4% never practiced the examination. Only 15.9% of residents reported being skilled in the SCE. However, the conduct of 4 SCEs (or slightly more than 1 per each year of residency) was associated with manifold increases in self-reported skill levels. Conclusions Information now collected from 7 medical schools and 4 residency programs underscores the need for more supervised opportunities to enable physicians in training to perform an SCE during routine patient examinations.

Reflectance Confocal Microscopy and Features of Melanocytic Lesions: An Internet-Based Study of the Reproducibility of Terminology [Study]

Objective To test the interobserver and intraobserver reproducibility of the standard terminology for description and diagnosis of melanocytic lesions in in vivo confocal microscopy. Design A dedicated Web platform was developed to train the participants and to allow independent distant evaluations of confocal images via the Internet. Setting Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. Participants The study population was composed of 15 melanomas, 30 nevi, and 5 Spitz/Reed nevi. Six expert centers were invited to participate at the study. Intervention Evaluation of 36 features in 345 confocal microscopic images from melanocytic lesions. Main Outcome Measure Interobserved and intraobserved agreement, by calculating the Cohen statistics measure for each descriptor. Results High overall levels of reproducibility were shown for most of the evaluated features. In both the training and test sets there was a parallel trend of decreasing values as deeper anatomic skin levels were evaluated. All of the features, except 1, used for melanoma diagnosis, including roundish pagetoid cells, nonedged papillae, atypical cells in basal layer, cerebriform clusters, and nucleated cells infiltrating dermal papillae, showed high overall levels of reproducibility. However, less-than-ideal reproducibility was obtained for some descriptors, such as grainy appearance of the epidermis, junctional thickening, mild atypia in basal layer, plump bright cells, small bright cells, and reticulated fibers in the dermis. Conclusion The standard consensus confocal terminology useful for the evaluation of melanocytic lesions was reproducibly recognized by independent observers.

Efficacy and Safety of Microfoam Sclerotherapy in a Patient With Klippel-Trenaunay Syndrome and a Patent Foramen Ovale [Observation]

Background Sclerotherapy with polidocanol microfoam injection under duplex guidance is a new treatment for venous malformations associated with Klippel-Trenaunay syndrome. Multidetector-row computed tomography (MDCT) venography is extremely helpful in the assessment of disease extension and the planning of therapy. Observation In this particular case, MDCT venography demonstrated the origin, course, and relationship to adjacent anatomical structures of aberrant vessels that configure the superficial venous system with an anatomically normal and patent deep venous system. At the end of the treatment, which consisted of 8 sessions of microfoam sclerotherapy within 12 months, a considerable reduction in the number and size of the percutaneously treated aberrant veins was observed. The obvious clinical improvement was objectively demonstrated with MDCT venography, which showed clear reduction in the number and size of treated veins. Further clinical investigation performed because of isolated migraine episodes related to the sclerotherapy session revealed that the patient had a patent foramen ovale. A transcranial Doppler examination during the procedure showed middle cerebral artery bubbles, which indicated right-to-left shunt. No cerebral damage was observed in a subsequent diffusion-weighted magnetic resonance examination. Conclusions Microfoam sclerotherapy is an effective treatment option in patients with Klippel-Trenaunay syndrome. MDCT venography allows diagnosis of the disease, planning of therapy, and assessment of response to treatment. Although foam-induced microembolism is a common phenomenon during sclerotherapy, in this report we demonstrate that polidocanol microfoam prepared with a low-nitrogen gas mixture is safe in a patient with a patent foramen ovale.

Adenosquamous Carcinoma of the Skin: A Case Series [Observation]

Background Adenosquamous carcinoma is an uncommon cutaneous malignant neoplasm with mixed glandular and squamous differentiation and a propensity for aggressive clinical behavior. Observations Of 27 patients diagnosed as having adenosquamous carcinoma, 19 were men and 5 were immunosuppressed. The mean age was 74 years. The majority of tumors were located on the face and scalp (19 of 27 [70%]) or upper extremity (4 of 27 [15%]). Squamous and glandular differentiation was characteristic. Thickness of the primary lesion ranged from 1.2 to 9.2 mm, with all tumors extensively invading the reticular dermis. Perineural invasion was seen in 4 of 27 primary cases (15%). Although 3 of 6 patients treated with Mohs micrographic surgery had subsequent locoregional recurrences, there was no evidence of distant metastasis after a mean of 2.3 years of patient follow-up. Conclusions Adenosquamous carcinoma is best considered as a locally aggressive high-risk subtype of cutaneous squamous cell carcinoma. Tumor thickness and perineural invasion are high-risk histopathological attributes, and immunosuppression is an important clinical risk factor. Although Mohs micrographic surgery may be the best initial treatment, locoregional recurrence is common.

Subcorneal Pustular Dermatosis-Type IgA Pemphigus With Autoantibodies to Desmocollins 1, 2, and 3 [Observation]

Background IgA pemphigus is a rare neutrophilic acantholytic autoimmune disease that is characterized by IgA deposits on keratinocyte cell surfaces. Clinically and histologically, IgA pemphigus is divided into 2 major subtypes: subcorneal pustular dermatosis and intraepidermal neutrophilic IgA dermatosis. We report the first case of subcorneal pustular dermatosis–type IgA pemphigus that showed reactivity to all 3 isoforms of the desmocollin family by indirect immunofluorescence microscopy of COS7 cells transfected with desmocollin 1, 2, or 3. Observations We describe a 94-year-old woman with IgA pemphigus with a unique immunopathologic pattern. Direct immunofluorescence microscopy revealed IgA deposits throughout the entire epidermis, with stronger staining in the upper epidermis. The autoantibodies from this patient did not show IgA or IgG reactivity with desmogleins via immunoblotting or enzyme-linked immunosorbent assay. By indirect immunofluorescence by the use of COS7 cells transfected with desmocollin 1, 2, or 3, IgA autoantibodies in a serum sample from our patient clearly reacted with all of them. Conclusions The pathophysiology and autoantigen profile of bullous autoimmune diseases, especially pemphigus and its subforms, are more complex than previously believed. Because pemphigus seems to be a heterogeneous disorder, further studies are needed to evaluate the complexity of the disease.

Detection of Clonal T Cells in the Circulation of Patients With Nephrogenic Systemic Fibrosis [Observation]

Background Nephrogenic systemic fibrosis is a sclerodermalike disease in patients with acute or chronic renal insuffiency related to administration of gadolinium-containing contrast agents. Previous studies have demonstrated clonal T-cell populations in the blood of patients with systemic sclerosis, suggesting that these cells may be involved in the pathogenesis of the disease. Facing the clinical similarities of both diseases, we hypothesized that clonal expansion of T cells could be present in nephrogenic systemic fibrosis as well. Observations Findings from polymerase chain reaction and high-resolution capillary electrophoresis for T-cell receptor gene rearrangement analysis showed that all 6 prospectively evaluated patients (100%) with nephrogenic systemic fibrosis had detectable clonal T cells in their peripheral blood. In contrast, only 4 of the 15 control patients (27%) with chronic renal failure and none of the 12 healthy individuals analyzed in this study had evidence for T-cell clonality using the same type of examination. Clonal T-cell–positive patients with systemic sclerosis have previously been reported to better respond to extracorporeal photopheresis. However, this was not the case in 2 of our patients with nephrogenic systemic fibrosis. Conclusion As in systemic sclerosis, clonally expanded T-cell populations could play a critical role in the pathogenesis of nephrogenic systemic fibrosis, probably as an in vivo–activated inflammatory response to gadolinium exposure.

UV-A1 Therapy for Nephrogenic Systemic Fibrosis [Observation]

Background Nephrogenic systemic fibrosis (NSF) is a rare sclerosing skin condition associated with end-stage renal disease and gadolinium exposure. Therapy for NSF is challenging, with few options other than preventing exposure to gadolinium and improving renal function through transplant. However, in some cases neither of these options is tenable. We report the successful use of UV-A1 phototherapy in 4 patients with NSF. Observations Four patients with NSF were treated with UV-A1 phototherapy at a tertiary medical center from 2005 through 2007. To our knowledge, it is unique to this series that all patients were receiving hemodialysis before, during, and after therapy with UV-A1. All experienced improvement in the degree of induration, and 2 experienced improvement in mobility of the hands and legs. Total treatments ranged from 22 treatments (with a cumulative dose of 1855 J/cm2) to 50 treatments (total UV-A1 exposure, 3850 J/cm2). No adverse events were observed. Conclusions Although no patient had complete resolution of indurated plaques, the improvement was substantial. For 2 patients, it resulted in a resumption of hand and leg mobility. As a result, UV-A1 therapy may represent a treatment for NSF when kidney transplantation is not an option or is delayed. Limitations of this study include the lack of a controlled trial, lack of quantification of gadolinium levels within tissue, and the lack of a defined grading scale for NSF severity.

A Glimpse of Future Management of Melanoma [Editorial]

Estimates of Risk, Empirical Treatment Observations, and Unexpected Laboratory Findings Reveal the Complexity of Nephrogenic Systemic Fibrosis [Editorial]

Orange-Yellow Diffuse Cutaneous Eruption in an 82-Year-Old Woman--Quiz Case [Off-Center Fold]

Orange-Yellow Diffuse Cutaneous Eruption in an 82-Year-Old Woman--Diagnosis [Off-Center Fold]

Asymptomatic Red Plaque on the Leg of a 7-Year-Old Girl--Quiz Case [Off-Center Fold]

Asymptomatic Red Plaque on the Leg of a 7-Year-Old Girl--Diagnosis [Off-Center Fold]

Multiple Blue Macules and Papules on the Scalp--Quiz Case [Off-Center Fold]

Multiple Blue Macules and Papules on the Scalp--Diagnosis [Off-Center Fold]

Slowly Enlarging Nodule on a Finger--Quiz Case [Off-Center Fold]

Slowly Enlarging Nodule on a Finger--Diagnosis [Off-Center Fold]

Defining Wound Microbial Flora: Molecular Microbiology Opening New Horizons [Research Letters]

Physician Workforce for Acne Care in the United States, 2003 Through 2005 [Research Letters]

Squamous Cell Carcinoma in Solid Organ Transplant Recipients: Influences on Perception of Risk and Optimal Time to Provide Education [Research Letters]

A New Dermoscopic Finding in Healthy Children: Dirt! [Correspondence]

A New Dermoscopic Finding in Healthy Children: Dirt!--Reply [Correspondence]

Large Amelanotic Melanoma and Vitiligo [Correspondence]

Axillary Web Syndrome or Cording, a Variant of Mondor Disease, Following Axillary Surgery [Correspondence]

Classic Kaposi Sarcoma Treated With Intralesional 5-Aminolevulinic Acid Injection Photodynamic Therapy [Correspondence]

Acute Edema/Cutaneous Distention Syndrome Associated With Refeeding in a Patient With Anorexia Nervosa [Correspondence]

Dermoscopic Features of Birt-Hogg-Dube Syndrome [skINsight]