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Background: Hyperpigmentation and solar damage remains a difficult problem to treat with topical agents., Aims: To evaluate a novel skin-lightening complex (SLC) comprising four actives targeting melanin formation at multiple levels, namely disodium glycerophosphate, L-leucine, phenylethyl resorcinol, and undecylenoyl phenylalanine, in an oil-in-water emulsion cream., Patients/methods: Skin-lightening complex was evaluated in 80 female subjects of skin types I-III with at least moderate mottled hyperpigmentation. After a wash-out period of 1 month with a sunscreen, the subjects added a cream containing the SLC for 12 weeks twice daily to entire face and continued the sunscreen use., Results: Whereas there was no significant change during the wash-out period, the primary endpoint mottled hyperpigmentation decreased by 32% after the 12-week treatment period with the SLC cream. Secondary endpoints such as severity and number of lentigines, skin tone, and skin brightness also improved. In all, 57% of the subjects showed at least a moderate response, 17% did not improve, and 3% got worse after the treatment., Conclusions: The SLC cream was well tolerated, in particular when comparing with exfoliating or peeling agent containing skin-lightening products. When used with a daily sunscreen, this study confirms that the SLC represents an alternative to hydroquinone, retinoids, and many other skin-lightening actives., (© 2013 Wiley Periodicals, Inc.)

In addition to dysregulated JAK/STAT signaling, activation of the AKT/mTOR pathway occurs in myelofibrosis, a myeloproliferative neoplasm with no approved therapies. We conducted a phase 1/2 study with everolimus, an mTOR inhibitor, in 39 high- or intermediate-risk primary or postpolycythemia vera/postessential thrombocythemia myelofibrosis subjects. Responses were evaluated in 30 patients of phase 2. No dose-limiting toxicity was observed in phase 1 up to 10 mg/d. When this dose was used in phase 2, grade ≥ 3 toxicities were infrequent; the commonest toxicity was grade 1-2 stomatitis. Rapid and sustained splenomegaly reduction of > 50% and > 30% occurred in 20% and 44% of subjects, respectively. A total of 69% and 80% experienced complete resolution of systemic symptoms and pruritus. Response in leukocytosis, anemia, and thrombocytosis occurred in 15%-25%. Clinical responses were not associated with reduced JAK2V617F burden, circulating CD34(+) cells, or cytokine levels, whereas CCDN1 mRNA and phospho-p70S6K level, known targets of mTOR, and WT1 mRNA were identified as possible biomarkers associated with response. Response rate was 60% when European Network for Myelofibrosis criteria were used (8 major, 7 moderate, 3 minor responses) or 23% when IWG-MRT criteria (1 partial response, 6 clinical improvements) were used. These results provide proof-of-concept that targeting mTOR pathway in myelofibrosis may be clinically relevant.

We evaluated the prognostic role of 18FDG-PET performed before ASCT in patients affected by lymphoma who underwent high-dose chemotherapy followed by ASCT as first-line treatment for high-risk disease or as second-line or more for relapsed or refractory disease. We retrospectively analyzed 53 consecutive patients, 14 with Hodgkin Lymphoma (HL) and 39 with non-Hodgkin Lymphoma (NHL), treated between February 1999 and October 2006 at our institution, who had a pre-ASCT FDG-PET (pPET) evaluation. Median age was 45 years (range: 18-69). After a median follow-up of 31 months (range: 8-91), 7 out of 16 pPET+ patients and 10 out of 37 pPET- patients experienced lymphoma relapse. The 5-year OS is 90% and 55% (p = 0.01) in patients with negative and positive pPET, respectively. In conclusion, a positive pPET indicates a poorer outcome after ASCT with respect to a negative pPET; this subset of patients should be considered candidate to more intensive or investigational approaches.

Evidence of the signs associated with skin aging often first appears in the periorbital area and includes wrinkles, eyelid bags, circles around the eye, or a "tired" look. This multicenter study aimed to investigate a novel eye cream containing a proprietary mixture of human growth factors and cytokines in combination with caffeine, bisabolol, glycyrrhetinic acid, and sodium hyaluronate for periorbital rejuvenation. The study, which was completed by 37 female subjects between 36 to 65 years of age, revealed that clinical signs for wrinkles, lower eyelid bags or sagging, dark circles, and skin texture show significant improvement (average 14%-28%) after 6 weeks of twice-daily application. These clinical improvements were confirmed by a subject questionnaire. The subjects further reported that their tired look significantly improved by 32% in average. All subjects tolerated the eye cream well and liked the way it felt. The cream's efficacy, excellent tolerability in the delicate periorbital skin area, and pleasant sensory properties explain why a large majority (78%) would continue regular use.

Epithelioid sarcoma is familiar to orthopedic surgeons but not to dermatologists. Because this malignant neoplasm presents as a subcutaneous mass, often with overlying epidermal changes, the patient may be seen by a dermatologist for evaluation. The differential diagnosis often includes nodular fasciitis and tenosynovitis. The histopathologic interpretation of the biopsy specimen may be difficult, so it is helpful for the physician to suspect and consider epithelioid sarcoma in the differential diagnosis given to the pathologist. Early, accurate diagnosis can be achieved and can thus spare the patient significant morbidity or even death.

Sclerotherapy is enjoying great popularity as a technique to eliminate unsightly spider and varicose veins. This study of 200 charts reveals a high success rate and a low incidence of long-term adverse sequelae. To minimize complications, several suggestions are made based on clinical observations. As with any procedure, experience, meticulous technique, and good patient rapport are at the heart of its success.