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Human papillomavirus (HPV) remains to be one of the most common viruses that afflicts the skin and mucosa. Direct contact with cutaneous lesions facilitates a majority of viral transmission. However, the development of laser therapy as treatment for HPV brought to attention the concern of infectious laser plume and the risk it poses to those inhaling it. We conducted a literature review using English articles in PubMed to validate this risk and propose the best safety practices dermatologists can apply when using laser therapy as treatment for HPV. Our investigation identified smoke evacuators as primary modes of mitigation, and we suggest further studies will aid in the refinement of best practice recommendations.

Dimethyl sulfoxide (DMSO) is a highly reactive by-product of paper production in the form of an odorless, colorless liquid that has been studied since the 1860s. Initially it was utilized as a solvent, but more recently it is being investigated for therapeutic applications. Owing to its versatility, the use of DMSO has been proposed in many different medical fields for a variety of applications, with possibly the widest use being in the field of dermatology. The clinical interest in the use of DMSO for dermatology conditions stems from this solution's efficacy as a vehicle to deliver pharmacological agents across the stratum corneum and its ability to penetrate biological membranes. Currently there is only one FDA approval for the use of DMSO, and it is not in the dermatologic field but rather for interstitial cystitis. Outside of the FDA scope of usage, DMSO is used frequently to treat osteoarthritis in humans and animals, as well as other chronic pain conditions. This suggests the possible utility of DMSO being applicable to other inflammatory conditions such as pruritus. Further research is necessary to explore the promising utilization opportunities of DMSO in dermatology.

Pruritus is one of the most common dermatologic complaints and, as the most common dermatologic symptom, is a major contributor to frequent dermatology visits. Chronic pruritus mirrors another major medical condition faced by millions of Americans each year - chronic pain. In older literature, pain and pruritus were thought to have been conveyed by the same C fiber, and the proportion contributing to pruritus was just a small subset of this general fiber. Overall, pain and pruritus share many integral similarities. Although these sensations both initiate the body's awareness to injury, pain and itch may have evolved for sensing different damages such as a burrowing parasite or a noxious stimulus, respectively. This seems to have been validated through analyses of their pathophysiology, acute and chronic conditions, and treatment modalities. However, their symptoms and intrinsic mechanisms vary considerably. It is important to view pruritus in more of an overall, whole body experience, rather than just the sensory aspect. Future studies should investigate the psychological treatment of chronic pruritus, considering the immense similarities with its chronic pain counterpart.

Control of various infestations requires an accurate understanding of transmission. After thousands of years of lice infestation, scientific documentation of indirect contact transmission has been substantiated. Lice can be transferred in the egg, instar, and adult stages. Lice have now been shown in the laboratory to be readily dislodged by air movements such as blow-drying one's hair, combing, and toweling. Moreover, passive transfer to adjoining fabric is also frequently observed. Louse transmission by fomites occurs more frequently than has been commonly believed. Close proximity suffices to increase the likeliness of a new infestation. Thus louse control measures should take account of fomite transmission and include screening of all individuals within an infested person's immediate circle of contact, laundering of everything within the infested individuals' bed or quarantining of such material for 10 days, thorough vacuuming of floors, carpets, upholstery, with a standard vacuum cleaner.

Background Concerns have arisen over the development of antibiotic-resistant organisms due to the prolonged use of oral and topical antibiotics in acne vulgaris. We have previously demonstrated that benzoyl peroxide used in consort with a chemical with an accessible tertiary amine, such as an allylamine, increases radical activity and biological effect. Objectives The purpose of this pilot study was to assess the efficacy of two nonantibiotic topical remedies for mild to moderate acne, with one of the agents being a combination of benzoyl peroxide with butenifine, an allylamine. Methods In an open-label, patient-satisfaction, 8-week comparative study, 23 patients demonstrating mild to moderate facial acne were given randomly either benzoyl peroxide in Proactiv Solution or the combination of benzoyl peroxide with an allylamine. Results The allylamine–benzoyl peroxide combination therapy outperformed Proactiv Solution during each 2-week stage of evaluation in terms of reduction of comedones, inflammatory lesions, and degree of oiliness. There was a marked preference for the allylamine–benzoyl peroxide combination in terms of patient satisfaction. Conclusions Benzoyl peroxide used in consort with antimicrobial agents that contain an accessible tertiary amine, such as erythromycin, has previously been shown to increase radical activity and biological effect. Trials of short duration with small numbers of patients do not adequately inform practitioners about whether the combination of allylamines with benzoyl peroxide is a viable alternative to topical antibiotic therapy for acne. Nevertheless, the higher satisfaction with the allylamine–benzoyl peroxide combination certainly warrants further investigation.

Background: Pediculus humanus capitis (head lice) belongs to the order Anoplura, which are blood-feeding ectoparasites that live on human hair. Within these insects reside symbiotic bacteria that enable the insect to flourish on dietary sources of limited nutritional value. These symbiotic bacteria are essential to the survival of the insect. Objective: To assess the feasibility of treating head lice by altering their symbiotic bacteria. Methods: In addition to a literature review of the expanded role of symbiotic bacteria in other organisms, the anatomic localization of their presence in human head lice and molecular characterization of the head louse symbiont were analyzed. Results: Anatomically, the bacterial symbiotes are localized to the midgut mycetome in males and the ovaries in females. The 16S ribosomal ribonucleic acid phylogenetic analysis was presented. Features of this bacterial symbiote may make this symbiont accessible as a target for pediculocidal and ovicidal therapy by altering its habitat and existence. Conclusions: An understanding of the nature of bacterial symbiotes of head lice might lead to alternative strategies for eradication or inhibition of these necessary bacteria, thereby controlling head lice with less toxic agents than conventional insecticides, to which the organism continues to increase its resistance.

Head lice, like many insects, produce a protective coating for their newly laid eggs that is essential to the survival of the species. Knowledge of the composition of the sheath, which is the glue by which the egg is attached to human hair, and the nit laying process could lead to production of agents that could be used to attack louse infestations by interfering with the normally protected environment of nymph development within the egg. The physical removal of nits has become an important part of treatment of head louse infestations given the "no-nit" policy in schools. Biochemical analysis has revealed that the nit sheath of the head louse is composed of 4 bands of protein, possibly cross-linked to aliphatic components with a tertiary structure of beta sheeting. Nature has protected the louse by making the nit sheath similar in composition to the hair; thereby, agents designed to unravel the nit sheath may also damage human hair. Possible targets to destroy the nit sheath include proteases, denaturants, beta sheet breaker proteins, and small protein inhibitors of sheath formation. Better understanding of insect glues may allow us to develop compounds so that the liquid secretions of the collateral glands of the female louse, which becomes the nit sheath, do not solidify by oxidation when placed with the louse egg onto human hair. Knowledge of insect behavior, such as oviposition, may also suggest methods for repelling female lice from laying eggs onto hair. Alternatively, agents that coat the nits and restrict the oxygen transfer to the developing larvae may prove beneficial.

Parasitic diseases caused by helminths, or worms, account for billions of human infections worldwide. Although most human pathogens caused by these organisms are infrequent in the United States, skin manifestations of parasitic diseases are being seen much more frequently in dermatologists' offices due to the increase in immigration and travel. Helminths are notable for their complicated lifecycles often including consecutive developmental phases, in separate hosts or in a free-living state. These parasitic organisms are usually macroscopic, multicellular organisms, and do not breed within their mammalian hosts. Notably, many helminthic diseases present with dermatologic signs and symptoms including skin nodules, cysts, migratory skin lesions, and pruritus. In this section, we discuss cutaneous myiasis as well as the four most common nematode dermatologic conditions seen in the United States.

Airborne contact dermatitis (ABCD) is an inflammatory reaction involving the skin upon exposure to allergenic agents or irritants suspended in air. In allergic ABCD, the hypersensitivity is classified as a type IV reaction. Substances responsible for such reactions can be of plant or non-plant origin. Commonly reported plants include those of the Compositae family, which includes ragweed, goldenrod, and sunflowers. Establishing an accurate diagnosis is critical for preventing exposure and improving symptoms in patients. Obtaining a detailed history and performing a physical examination to determine the sites of involvement, as well as patch testing to establish the causative allergen, are the main methods of arriving at the correct diagnosis. Treatment often involves avoidance of the allergens or irritants when possible and may also include the application of topical barrier creams or systemic therapy in more severe cases. This article reviews the topic of ABCD and highlights its most common etiologies in the USA.

Objective: To assess the chemical composition of cerumen by flash pyrolysis-gas chromatography/mass spectrometry. Study Design: Collected earwax specimens were fractionated into residue and supernatant by means of deoxycholate. This natural bile acid produces significantly better disintegration of earwax in vitro than do presently available ceruminolytic preparations, and also has demonstrated excellent clinical results in vivo to date. Patients: The sample for analysis was obtained from a patient with clinical earwax impaction. Results: The supernatant is composed of simple aromatic hydrocarbons, C5-C17 straight-chain hydrocarbons, a complex mixture of compounds tentatively identified as diterpenoids, and steroids, in particular cholesterol. The residue, on the other hand, produced simple aromatic compounds (including benzenes, phenols, and benzonitriles), C5-C25 straight-chain hydrocarbons, greater relative quantities of nitrogen compounds and phenol, and lesser importance of the (tentatively identified) diterpenoids. Conclusions: Through the use of the detergent deoxycholate, squalene and a tentatively identified diterpenoid were revealed to be present in a free, unbound state, whereas some steroids and hydrocarbons appeared to be bound to a macromolecular structure by nitrogen linkages or other bonds. Additionally, this study reintroduces detergents as a viable method of earwax removal, specifically the bile acids.

Background: The incidence of head lice infestations in North America is escalating with an estimated 12 million cases of head lice per year despite the existence of insecticidal therapies. Objective: To evaluate certain characteristics of the human head louse, including their chitinous structure, nymphal developmental stages, legs with claw adaptations, antennae with sensory perceptions, and spiracles by which oxygen exchange occurs, for assessment of possible means to control the spread and growth of this insect. Methods: Scanning electron-microscopic examination of head lice was performed. Results: Newer treatments of head lice must acknowledge defense mechanisms that are based on anatomic structure and physiologic characteristics, details of louse transmission, and the insects' ability to ‘resurrect’ after sham death. Conclusions: An understanding of lice entomology is essential in the pursuit of novel means to control the lice epidemic.

Objective: To assess the protein and simple sugar content of earwax in pursuit of better ceruminolytic agents. Study Design: Collected earwax specimens were tested in several media for dissolution before being analyzed for amino acid and carbohydrate content. Patients: The samples were obtained from eight random patients requiring ear plug removal. Results: The amino acid composition differs considerably from hair and stratum corneum of glabrous skin. Sugar analysis revealed high levels of galactosamine and galactose. Conclusions: This analysis of proteins and carbohydrates further characterizes earwax. Future ceruminolytic agents must dissolve lipid, keratin, and a monolayer of lipid covalently bound to the epidermal cells, which encourages cellular aggregation.

The Propionibacterium acnes biofilm has previously been shown to exist via genomic studies and to make a biological glue which allows for adherence to follicular walls. This gylcocalyx polymer secreted by P acnes also finds its way into sebum composition where it causes the adhesiveness of keratinocytes leading to comedones. An appreciation of P acnes biofilms and secretions has implications in immunogenicity of the organism, clinical course of acne, and therapy for comedonal and inflammatory acne.

Physician: “No one has the foggiest notion why God gave us moles on our skin ... and that’s the honest truth.” Melanocytes are derived from melanoblasts that arise from the neural crest. Melanocyte numbers vary little between human populations, although they differ in size, number, and the structure of melanosomes. 1 In the human epidermis, they have a close association with keratinocytes via dendrites. Although well known for their role in skin pigmentation, this is probably not the only function of these cells. Indeed, melanocytes have numerous enzymes with capabilities in antimicrobial defense, as well as genetic, biochemical, and functional links to the immune system. 2 Melanin, endogenously produced by melanocytes, is able to interact with enzymes and modulate their behavior, is a powerful cation chelator, and can bind and neutralize oxidants, microbicidal peptides, and antimicrobial drugs. 3–6 A better appreciation of the biological effects of melanocytes may assist in all aspects of the evaluation, understanding, and treatment of diseases associated with this cell line, such as vitiligo and melanoma. There are definite flaws in the media dogma that melanin’s main role is in protection against ultraviolet light. To begin with, it fails to explain the increase in the prevalence of melanin and melanocytes in skin not normally exposed to the sun, such as the genitalia, 1 and other body tissues, such as the epithelium of the inner ear, uveal tract of the eye, brain tissue, and the peritoneum. 7 Moreover, many nocturnal animals, such as bats, are highly melanized on their exterior surface. In addition, African albinos, despite the absence of melanin’s sun protection, do not have an increased incidence of melanoma. 2

In recent years, it has become increasingly clear that genital ulcers from herpes simplex virus (HSV) are associated with HIV acquisition. In light of this evolving synergy in transmission and the availability of effective antiviral therapy, proper diagnosis and management of HSV becomes increasingly important. Unfortunately, conventional HSV management is founded on several popular misconceptions. Herein, we hope to dispel these common misconceptions and expand the current model of herpetic reactivation. By doing so, we aimed to unveil potential pitfalls in current herpetic management.

Current concerns about persistent visual abnormalities after the use of isotretinoin may lead the Federal Aviation Administration to further restrict its use in pilots or future pilots.

A 33-year-old male experienced three episodes of urticaria precipitated by exposure to a hidden source of ampicillin. Each occurrence coincided temporally with his girlfriend taking ampicillin for a chest cold and/or allergies. We postulate that he was exposed to ampicillin in the body fluids of his sexual partner.

Seborrheic keratoses are the most common benign tumors in adults. Despite their negative cosmetic appearance, no topical treatment is commonly recommended for these lesions.Our objective was to assess whether clinical benefit could be achieved by using a keratolytic topical agent and superficial scraping for this condition.A topical 50% urea-containing product under occlusion was applied daily to large and/or thick hyperkeratotic seborrheic keratoses on the truck and extremities. The patients were instructed to digitally scrape the surface of the lesions in an attempt to reduce the thickness of the lesions.In a pilot nonrandomized open-label survey, patients expressed satisfaction with using this topical therapeutic technique.Hyperkeratotic seborrheic keratoses can be satisfactorily managed with topical agents and scraping with reasonable patient satisfaction. Further studies with various keratolytic agents using other delivery systems are warranted.

Scabies continues to be a major public health problem. Recent findings reveal that these mites produce substances that modulate the host's immune response resulting in the latency period prior to symptoms. In terms of treatment, two cases of ivermectin resistance have come to fore in Australia in patients treated over fifty times with the agent. Additionally, work in the development of vaccination of hosts with antigenic midgut proteins of mites to control ectoparasitic infestations continues.

Head lice infestation is a common and growing problem, primarily affecting school-aged children. There are growing numbers of treatment failures due to the emergence of treatment-resistant lice to the popular over-the-counter products that have been used for the past several decades. Resistance has also decreased the efficacy of lindane, a prescription pediculicide that has been commonly used for several generations. Malathion, recently reintroduced in the US as a prescription pediculicide, has been associated with some treatment resistance depending upon its formulation. Other insecticidal treatments, such as ivermectin, will have to be developed further, given the limited options presently available for the treatment of head lice. Given the number of anecdotal and market-driven reported studies on head lice, assessment of topical lice therapies requires standardised in vitro testing. Based on concerns about safety and decreasing efficacy due to resistance, a reassessment of the general topic of pediculicides for head lice is warranted.

Background Pinworms are the most common helminth infection in the USA and Western Europe, with prevalence rates in some communities of as high as 30–50%. Pinworms generally live in the gastrointestinal tract, and helminth infestations have been noted in over one-quarter of acute appendectomies on histologic examination. Results & Conclusions Although transmission is often attributed to the ingestion of infective eggs by nail biting and inadequate hand washing, inhalation and ingestion of airborne eggs also occur. The female Enterobius vermicularis migrates nightly to the perianal area to deposit her eggs, but some worms find their way into adjacent orifices, most commonly the female genitourinary tract, producing an array of symptoms. More consideration of this entity is justified in patients presenting with genitourinary complaints not responding to normal therapies. In the treatment of pinworms affecting genitourinary organs, treatment with possibly two oral agents, namely mebendazole and ivermectin, and a topical therapy for the eggs may be warranted.

Head lice infestation is a common and growing problem that primarily affects school-aged children. Most cases of head lice are diagnosed and treated by nonphysicians. Misdiagnosis may lead to treatment when no lice are present. Treatment failure may lead to repeated use of and improperly applied pediculicides, potentially resulting in overexposure to pesticides. These treatment failures are primarily due to the emergence of treatment-resistant lice. In regions where resistant lice are common, patients may self-treat numerous times with over-the-counter pediculicides before seeking treatment from a physician. Resistance has decreased the efficacy of lindane, a prescription pediculicide that has been used for decades. In addition, the Food and Drug Administration recently warned of potentially serious adverse effects associated with lindane and recommended strict controls for its use. Malathion, recently reintroduced in the United States as a prescription pediculicide, has not been associated with treatment resistance or notable adverse effects, although it is flammable due to its alcohol base. Because of concerns about decreasing efficacy due to resistance and safety concerns about over-the-counter products and some prescription pediculicides, a reassessment of pediculicide safety is warranted. The safety and efficacy of commonly used over-the-counter and prescription pediculicide products are discussed, along with the safety and efficacy of other treatments, such as ivermectin, that are not indicated for the treatment of head lice but are being used increasingly.

Background There is clinical uncertainty concerning the effectiveness of the new topical immunomodulators vs. the conventional use of topical steroids for the treatment of atopic dermatitis. Objectives To assess patient satisfaction with these two prescription topical remedies for atopic eczema. Methods In an open-label, 2-week, comparative study, 10 patients demonstrating atopiform dermatitis were given tacrolimus and 0.1% hydrocortisone butyrate in a 70% oil-in-water base to apply to the eczema on opposite sides of the body. After 2 weeks of applying the agents twice daily to their respective sides of the body surface, the study subjects completed a 12-question survey to assess their opinions of the two products. Results There was a preference for the nonfluorinated topical steroid over tacrolimus in this cursory head-to-head study. There were no withdrawals from the study or side-effects reported with either product. Conclusions Trials of short duration with small numbers of patients do not adequately inform practitioners regarding the use of these topical remedies. However, the higher satisfaction of patients with 0.1% hydrocortisone buyrate in a 70% oil-in-water base over tacrolimus certainly warrants further investigation.

Contact irritant dermatitis can be defined by four interrelated elements: skin barrier disruption, epidermal skin changes, cytokine release, and nerve ending changes. The predominant symptom of eczema relates to the fourth constituent, which produces pruritic symptoms that are often neglected when using pre-formulated topical steroids and immunomodulators. Although the induction of pruritus with proteinases and cytokines demonstrates the close connections between immune and neurotrophic factors in the pathophysiology of pruritus, agents that specifically affect the cutaneous nerve endings are often beneficial for use in patients affected by dermatitis. Besides avoiding triggering factors, agents such as pramoxine, phenol, camphor, and menthol are extremely valuable in allaying patients' symptoms of pruritus. Indeed, therapeutic remedies, which incorporate anti-pruritic agents in their formulation, may be advantageous for the bulk of patients with contact irritant dermatitis.