Matthew J. Zirwas, MD
- Prednisone is drug of choice for expected short term therapy – weeks.
- Cyclosporine is drug of choice for expected “medium term therapy” – months.
- Methotrexate is drug of choice for chronic therapy in patients without liver, kidney, or hematologic co-morbidities.
- Mycophenolate is drug of choice for chronic therapy in patients with liver, kidney, or hematologic co-morbidities.
- Cyclosporine has many drug interactions – must use a computerized drug interaction checker.
- Methotrexate has a few drug interactions but they are extremely serious and can be fatal.
- Mycophenolate has few drug interactions.
- Patients on methotrexate should take folic acid on days they do not take the methotrexate.
- Older patients on mycophenolate, in particular, are at high risk of zoster.
- If patients on cyclosporine have elevations in creatinine, they need to stop the medication.
Ashfaq Marghoob, MD
Dr Marghoob provides us with his clinical pearls on pigmented lesions….
- The larger the congenital nevus the greater is the risk for developing melanoma.
- The risk of a melanoma developing in a small congenital nevi is small enough that prophylactic excision is not required.
- Presence of many nevi and dysplastic nevi are strong risk factors for melanoma.
- Analytical, Differential and comparative recognition are all helpful in differentiating nevi from melanoma.
- Total body photography assists clinicians in finding concerning lesions.
- Dermoscopy assists clinicians in deciding which lesions require a biopsy.
- Unna’s theory of nevogenesis is not supported by recent cross sectional and longitudinal studies.
- Nevi with a peripheral globular pattern or a starburst pattern are growing nevi (not yet in senescence).
- Most halo nevi have a globular pattern.
- Patient driven healthcare with the use of Apps is likely to help in finding early melanomas.
Andrew Blauvelt, MD
Dr Blauvelt provides us with the 10 most important take-home messages from his immunology presentation at MauiDerm NP+PA Summer 2014….
- Key features of the innate immune system include: rapid response, non-specificity, phagocytosis, no memory.
- Key features of the acquired immune system include: slow response, very specific, lymphocyte-mediated, memory.
- Keratinocytes are active participants in generating immune responses by secreting numerous cytokines upon activation.
- 4.Toll-like receptors are pattern recognition receptors on keratinocytes that recognize foreign antigenic material.
- Antimicrobial peptides are natural antibiotic molecules found in skin that are abundant in psoriasis skin and sparse in atopic dermatitis skin.
- 6.Epidermal Langerhans cells are antigen presenting cells that recognize/process skin antigens and migrate to lymph nodes, where they present antigen to T cells.
- 7.T cells require 3 signals to become fully activated: 1) recognition of antigen by the T cell receptor via MHC on the surface of antigen presenting cells; 2) binding of co-stimulatory molecules on T cells and antigen presenting cells to one another; and 3) secretion of soluble cytokines by the T cells.
- CD4+ T cells are T helper cells that recognize antigen via MHC class II and secrete cytokines to enhance CD8+ T cell and B cell immune responses, whereas CD8+ T cells are cytotoxic T cells that recognize antigen via MHC class I and kill cells upon contact.
- B cells secrete antibodies that specifically bind to antigen.
- Primary immune responses are slow, occur after first exposure to antigen, and involve creation of memory cells, whereas secondary immune responsesare fast, occur after subsequent exposures to antigens, and involve reactivation of memory cells.