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Misdiagnosis of Fungal Skin Infections

Fungal skin infections may be commonly misdiagnosed, according to a survey in the Journal of the American Academy of Dermatology. George Washington University (GW) dermatologist Adam Friedman, MD and colleagues along with Therapeutics Clinical Research in San Diego, CA asked dermatologists to anonymously review 13 clinical images and determine whether or not the image was consistent with a fungal skin infection.

The majority of cases were only appropriately classified by 50 percent of participants, with only one of the cases correctly identified by 90 percent of the audience, the survey showed.

“It is crucial to push for proper and continued medical education on dermatophyte and other fungal skin infections to minimize misdiagnoses and ultimately curb disease impact,” says Dr. Friedman, associate professor, director of the residency program, and director of translational research in the Department of Dermatology at the GW School of Medicine and Health Sciences, in a news release.

The survey highlights the challenge of distinguishing between certain fungal skin infections and primary inflammatory conditions, and the ease with which one may miss the correct diagnosis.

“Secondary syphilis, annular psoriasis, and pityriasis rosea are among a few inflammatory skin diseases that mimic dermatophyte infections,” says Dr. Friedman. “However, knowledge and training of bedside diagnostic techniques like potassium hydroxide preps during residency and beyond can combat misdiagnosis.”

Two New Studies Suggest BPX-01 Topical Minocycline May Hold Advantages

Taken together, two new studies suggest that BioPharmX Corp.’s BPX-01 topical minocycline may have a favorable pharmacokinetic advantage compared with oral minocycline for the treatment of acne vulgaris.

In one study, daily use of BPX-01 1% topical minocycline gel for four weeks resulted in a statistically significant reduction in P. acnes. Treatment was well tolerated and there was no detectable minocycline in the plasma. Prior observations indicate that BPX-01 was effectively delivered into the pilosebaceous units, which was confirmed clinically by a reduction in P. acnes counts without evidence of systemic exposure.

The second study indicated that daily administration of oral minocycline for the same period of time resulted in high circulating levels of minocycline. A confirmatory phase 2b clinical study to support this observation is in progress.

The research was presented at the Skin Disease Education Foundation’s 17th Annual Las Vegas Dermatology Seminar.

Dermatology Scientist Sarah Millar Receives 2016 Focus Award For The Advancement Of Women In Medicine

Penn dermatology scientist Sarah E. Millar, PhD received the 2016 FOCUS Award for the Advancement of Women in Medicine.

Dr. Millar, the Albert M. Kligman Endowed Professor and vice chair for basic science research in the department of Dermatology at the Perelman School of Medicine at the University of Pennsylvania, is studying the development and renewal of skin, hair follicles, teeth, and mammary glands. She has collaborative interests in the areas of lung and heart development.

The award, recently presented at the annual FOCUS fall conference, recognizes “a faculty member at Penn Medicine, male or female, whose outstanding efforts and achievements have promoted the career success, leadership, and overall quality of life for Penn women in academic medicine.” FOCUS on Health & Leadership for Women is a Penn Medicine-based program that supports the advancement and leadership of women in academic medicine and promotes education and research in women’s health and women’s careers.

“Dr. Millar is a highly respected researcher and scholar, outstanding supervisor, and exemplary mentor with an ardent commitment to the development and advancement of younger scientists, students, and post-doctoral fellows,” says Stephanie Abbuhl MD, executive director of FOCUS, in a news release. “Promoting women’s academic and professional excellence has been a priority throughout her distinguished career. Her mentoring has had a profound effect on numerous Penn-based young researchers, as well as nationally and internationally. And she regularly plays an active role in many initiatives here at Penn, bringing clear vision and exceptional levels of energy and dedication to every project.”

Dr. Millar was also cited for serving as chair of the School of Medicine’s Child Care Task Force during 2013-14, when she led the planning of a child care center at Penn Medicine, which is slated to open in 2018.

Millar has worked extensively with fellow Penn Medicine senior women faculty members and the school’s Office of Inclusion and Diversity to identify and rectify space and salary constraints hindering women’s progress in the basic sciences. In April 2016 she co-organized a symposium on gender bias in scientific publishing, which featured presentations and discussions with editors of the journals Cell, Science, and JAMA, examining ways to enhance gender equity in publishing in top-tier journals.

ADAM Accepting Nominations for Practice Manager of the Year

The Association of Dermatology Administrators and Managers is accepting nominations for its annual Practice Manager of the Year Award. Now in its fourth year, the Practice Manager of the Year Award recognizes the office professional who best demonstrates innovative thinking, insight and leadership within their practice and community.

The 2017 Practice Manager of the Year will receive free registration to ADAM’s 26th Annual Meeting in 2018, and a cash prize of $1,000, which is underwritten by CareCredit, the founding supporter.

Details about the Practice Manager of the Year Award and the nomination process are available at The call for nominations is open until Jan. 9, 2017. Selection criteria, review of nominations and award recipient are determined by ADAM.

New Combo Therapy Beats Out Gold Standard Treatment For AKs

Combining a cream formulation of 5-fluorouracil with a synthetic form of vitamin D called calcipotriol may trigger a robust immune response against actinic keratosis, according to research out of rom Washington University School of Medicine in St. Louis and Harvard Medical School in Boston.

Topical 5-fluorouracil alone is prescribed to treat actinic keratosis. Calcipotriol is FDA-approved for treatment of psoriasis.

The new research, published Nov. 21 in The Journal of Clinical Investigation, shows that the combination therapy activates the immune system’s T cells.

On average, the investigational therapy reduced the number of precancerous skin lesions on the face by almost 88 percent compared with a 26 percent reduction using the standard chemotherapy, the study showed. “Our study shows this combination therapy is more effective and better tolerated than current treatment practices,” says Washington University dermatologist and study co-author Lynn A. Cornelius, MD, director of the Division of Dermatology.

While some side effects such as skin scaling and itching were similar with both treatments, patients receiving the investigational therapy reported more redness and increased burning sensations, which are consistent with the immune response it triggers. Patients who had been treated previously with conventional therapies reported decreased pain and discomfort with the combination treatment, according to Dr. Cornelius, who is also the Winfred A. and Emma R. Showman Professor of Dermatology.

Earlier work at Washington University showed that a protein called TSLP in the skin activates the immune system’s T cells, which then attack tumor cells. Calcipotriol also was known to cause the skin to produce TSLP.

The current study involved 132 patients with actinic keratosis who were treated at Washington University School of Medicine in St. Louis. Sixty-five of these patients were randomly assigned to receive the investigational drug combination of 5-fluorouracil plus calcipotriol. The remaining 67 served as a control group and received the standard 5-fluorouracil plus Vaseline petroleum jelly. Patients applied the assigned cream twice daily for four days.

Patients in the investigational and control groups began the trial with similar numbers of precancerous lesions on each part of the body examined. At each body site evaluated, there were on average about 15 lesions on the face, 22 lesions on the scalp, 14 lesions on the right arm and 12 on the left arm. Following treatment, facial lesions were reduced by 88 percent in the investigational group versus 26 percent in the control group. On the scalp, lesions were reduced by 76 percent in the investigational group compared with about 6 percent for the control group. On the right arm, the reduction was 69 percent for the investigational treatment versus about 10 percent for the control. On the left arm, the precancerous lesions were reduced by 79 percent for the investigational treatment compared with 16 percent for the control.

“Because calcipotriol has been shown to induce an immune response, we are now interested in seeing if the anti-tumor immunity of the activated T cells can be recalled later to help prevent both precancerous and cancerous skin lesions,” Cornelius says in a news release. “We are now planning to re-contact our patients to determine whether there are differences in precancerous and skin cancer rates between the two treatment groups.”n

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