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YMJD_60_3S_COVER.qxd 1/16/09 3:25 PM Page C1 Supplement to Journal of the American Academy of Dermatology JAAD Journal of the American Academy of Dermatology March 2009 Volume 60 • Number 3 Physicians Dedicated to Excellence in Dermatology www.eblue.org Poster Abstracts American Academy of Dermatology 67th Annual Meeting March 6–10, 2009 San Francisco, California March 2009 Supported by Centocor Ortho Biotech Inc. Vol. 60 No. 3 (pages AB1-AB276) SUPPLEMENT TO JAAD www.eblue.org Journal of the American Academy of Dermatology March 2009 / Volume 60 / Number 3 Poster Exhibit Task Force Mission Statement: The Poster Exhibit Task Force enhances the educational value of the annual Academy meeting by organizing poster exhibits. These poster exhibits are solicited, reviewed, and approved by a peer review Task Force. The Task Force develops guidelines and monitors posters for quality educational content. Task Force Members: Brian Berman, MD, PhD, FAAD, Chair Khalid Mohd Al Aboud, MD Mark A. Bechtel, MD, FAAD Vincent Anthony DeLeo, MD, FAAD Peter G. Ehrnstrom, MD, FAAD, Tammie C. Ferringer, MD, FAAD Aditya K. Gupta, MD, PhD, FAAD Abel D. Jarell, MD Barbara M. Mathes, MD, FAAD William D. Posten, MD, FAAD Adam Rubin, MD, FAAD Julie V. Schaffer, MD, FAAD, Kenneth J. Tomecki, MD, FAAD Youwen Zhou, MD, FAAD 2010 Annual Meeting Program Submissions Visit http://www.aad.org for information regarding program participation for the 68th Annual Meeting, March 5-9, 2010 in Miami Beach, Florida. SUPPLEMENT TO JAAD www.eblue.org Journal of the American Academy of Dermatology March 2009 / Volume 60 Poster Abstracts American Academy of Dermatology 67th Annual Meeting March 6-10, 2009 San Francisco, California Supported by Centocor Ortho Biotech Inc. / Number 3 SUPPLEMENT TO JAAD Journal of the American Academy of Dermatology March 2009 www.eblue.org / Volume 60 / Number 3 CONTENTS Poster Discussion Sessions Supported by Centocor Ortho Biotech Inc. AB1 PDS 01—Aging/Photobiology AB3 PDS 02—Systemic Diseases/Infection AB5 PDS 03—Pediatric Dermatology/Genodermatoses AB6 PDS 04—Treatment/Diagnosis AB8 PDS 05—Psoriasis/Autoimmune Diseases AB10 PDS 06—Skin Cancer AB12 Acne AB22 Aging/Geriatrics AB30 Art, History, and Humanities of Dermatology AB32 Basic Science AB39 Clinical Dermatology and Other Cutaneous Disorders AB63 Connective Tissue Disease AB67 Dermatitis, Atopic AB71 Dermatitis, Contact and Allergic Irritants AB73 Dermatopathology AB78 Dermatopharmacology/Cosmeceuticals AB88 Digital/Electronic Technology AB90 Education and Community Service Continued on page A4 Copyright ª 2009 by the American Academy of Dermatology, Inc. The opinions or views expressed in this professional education supplement are those of the authors and do not necessarily reflect the opinions or recommendations of the society, editor(s), or publisher. Dosages, indications, and methods of use for products that are referred to in the supplement by the authors may reflect their clinical experience or may be derived from the professional literature or other clinical sources. Because of the differences between in vitro and in vivo systems and between laboratory animal models and clinical data in humans, in vitro and animal data may not necessarily correlate with clinical results. Future citation agreement/How to cite abstracts from this supplement: Author(s) agree(s) that citations to poster abstracts published in the Journal of the American Academy of Dermatology will adhere to the format of the examples given below, which clearly indicate that the cited item has been published in abstract form. Authors. Title of abstract (abstract). J Am Acad Dermatol 2009;60:AB page number. Abstract number. Finlay D, Date A, Robinson M, Osborne R. Genomics analysis of the reduced antioxidant capacity of aging skin (abstract). J Am Acad Dermatol 2009;60:AB1. Abstract P100. J AM ACAD DERMATOL MARCH 2009 A3 Contents continued AB92 Epidemiology and Health Services Administration AB95 Genodermatoses AB98 Hair and Nail Disorders AB103 Immunodermatology and Blistering Disorders AB106 Infection (Bacterial) AB111 Infection (Fungal) AB118 Infection (Viral) AB122 Internal Medicine Dermatology AB127 Lymphoma, Cutaneous/Mycosis Fungoides AB131 Melanoma and Pigmented Lesions AB134 Nonmelanoma Skin Cancer AB142 Pediatric Dermatology AB151 Photobiology, Phototherapy, and Photosensitivity Diseases AB157 Pigmentary Disorders and Vitiligo AB161 Psoriasis and Other Papulosquamous Disorders AB185 Skin Anatomy, Embryology, and Physiology AB185 Surgery (Cosmetic) AB192 Surgery (Dermatologic) AB195 Surgery (Laser) AB199 Wound Healing and Ulcers AB204 Author Disclosures AB235 Author Index AB246 Subject Index A4 MARCH 2009 J AM ACAD DERMATOL SUPPLEMENT TO JAAD Journal of the American Academy of Dermatology Editor Bruce H. Thiers, MD Editorial Office Melissa Derby, Managing Editor Journal of the American Academy of Dermatology 482 Southbridge Street, Ste #266 Auburn, MA 01501 Phone: 508-476-2724; Fax: 508-476-7479 E-mail: [email protected] Medical University of South Carolina Charleston, South Carolina Deputy Editor Dirk M. Elston, MD Geisinger Medical Center Danville, Pennsylvania Associate Editors Patrick R. Carrington, MD Denver, Colorado Medical Dermatology Jack L. Lesher, Jr, MD Augusta, Georgia Medical Dermatology Julie Prendiville, MD Vancouver, BC, Canada Pediatric Dermatology Erin M. Warshaw, MD, MS Minneapolis, Minnesota Medical Dermatology Cyberdermatology Consultant Daniel Siegel, MD, MS Smithtown, New York Joseph C. English III, MD Pittsburgh, Pennsylvania Medical Dermatology Seth L. Matarasso, MD San Francisco, California Dermatologic Surgery Christopher R. Shea, MD Chicago, Illinois Dermatopathology David T. Woodley, MD Los Angeles, California Basic Science Statistical Consultant Sharon D. Yeatts, PhD Charleston, South Carolina Assistant Editors Leah Belazarian, MD Worcester, Massachusetts Jennifer Madison McNiff, MD New Haven, Connecticut Robert A. Schwartz, MD, MPH Newark, New Jersey Steven R. Feldman, MD, PhD Winston Salem, North Carolina Jeffrey J. Meffert, MD San Antonio, Texas Thomas Stasko, MD Nashville, Tennessee Tammie C. Ferringer, MD Danville, Pennsylvania Donald J. Miech, MD Marshfield, Wisconsin Amy Theos, MD Birmingham, Alabama Richard L. Dobson, MD Charleston, South Carolina Whitney A. High, MD Denver, Colorado Diya F. Mutasim, MD Cincinnati, Ohio Hensin Tsao, MD, PhD Boston, Massachusetts Jeffrey D. Bernhard, MD Worcester, Massachusetts Brian B. Adams, MD, MPH Giuseppe Argenziano, MD Erin Boh, MD, PhD Alan Boyd, MD Robert T. Brodell, MD Walter H. C. Burgdorf, MD Raul A. Cabrera, MD J. Andrew Carlson, MD Jennifer C. Cather, MD Olivier Chosidow, MD Philip R. Cohen, MD Edward W. Cowen, MD, MHSc Thomas G. Cropley, MD Ponciano D. Cruz, Jr, MD Robert Dellavalle, MD, PhD, MSPH Marie-France Demierre, MD John J. DiGiovanna, MD Luis A. Diaz, MD Zoe Diana Draelos, MD Craig Elmets, MD David Fiorentino, MD, PhD Carlos Garcia, MD Jane M. Grant-Kels, MD Michael P. Heffernan, MD Herbert Hönigsmann, MD Thomas D. Horn, MD, MBA George J. Hruza, MD Sylvia Hsu, MD Sam T. Hwang, MD, PhD Nathaniel J. Jellinek, MD Matthew Kanzler, MD Beom Joon Kim, MD, PhD Robert S. Kirsner, MD, PhD Christine J. Ko, MD Mark Lebwohl, MD Jacob O. Levitt, MD Kevan G. Lewis, MD, MS Lori Lowe, MD Omar Lupi, MD, PhD Melissa Amy Magliocco, MD Calvin O. McCall, MD Amy J. McMichael, MD Karen C. McKoy, MD, MPH David A. Mehregan, MD Officers Board of Directors C. William Hanke, MD President James S. Taylor, MD Vice President David M. Pariser, MD President-Elect Evan R. Farmer, MD Vice President-Elect Mary E. Maloney, MD Secretary-Treasurer Robert David Greenberg, MD Assistant Secretary-Treasurer Diane R. Baker, MD Immediate Past President Ronald S. Davis, MD Luis A. Diaz, MD Lawrence F. Eichenfield, MD Lisa A. Garner, MD David J. Goldberg, MD, JD William D. James, MD Victor J. Marks, MD Ronald L. Moy, MD Elise A. Olsen, MD Margaret E. Parsons, MD Sandra I. Read, MD Theodore Rosen, MD Founding Editor J. Graham Smith, Jr, MD Mobile, Alabama Editors Emeritus Editorial Board Christopher J. Miller, MD Ginat W. Mirowski, MD, DMD Angela Yen Moore, MD Ulrich Mrowietz, MD Dedee Murrell, MD David J. Najarian, MD Vic Narurkar, MD Bernard Noel, MD Scott A. Norton, MD, MPH Jeffrey S. Orringer, MD Amy S. Paller, MD Amit G. Pandya, MD Clifford S. Perlis, MD Michael L. Ramsey, MD Desiree Ratner, MD Luis Requena, MD Jack S. Resneck, Jr, MD Randall K. Roenigk, MD Edward V. Ross, Jr, MD David S. Rubenstein, MD, PhD Thomas Ruzicka, MD Neil S. Sadick, MD Jorge L. Sanchez, MD Ekin Savk, MD Kathryn Schwarzenberger, MD Alexander J. Stratigos, MD Makoto Sugaya, MD Charles R. Taylor, MD Antonio Torrelo, MD Allison Vidimos, MD Guy Webster, MD, PhD Jeffrey M. Weinberg, MD Martin A.Weinstock, MD, PhD Andrew Werchniak, MD Victoria P. Werth, MD Ronni Wolf, MD Uwe Wollina, MD Chih-Hsun Yang, MD Gil Yosipovitch, MD Summer R. Youker, MD Lorraine Young, MD Hsin-Su Yu, MD, PhD Mirjana Ziemer, MD Matthew J. Zirwas, MD American Academy of Dermatology A12 MARCH 2009 Executive Staff Daniel M. Siegel, MD Susan C. Taylor, MD Michael D. Tharp, MD Susan H. Weinkle, MD Advisory Board Representative Frank C. Powell, MD International Board Observer Jennifer Lucas, MD Resident/Fellow Observer Ronald A. Henrichs, CAE Executive Director and CEO Eileen M. Murray, MM, CFRE, CAE Deputy Executive Director Richard C. Miller, PhD Director of Education American Academy of Dermatology PO Box 4014 Schaumburg, IL 60168-4014 Phone: 847-330-0230 Fax: 847-330-0050 J AM ACAD DERMATOL POSTER DISCUSSION SESSION 01—AGING/PHOTOBIOLOGY P100 Genomics analysis of the reduced antioxidant capacity of aging skin Deborah Finlay, MD, The Procter & Gamble Company, Cincinnati, OH, United States; Akira Date, PhD, The Procter & Gamble Company, Cincinnati, OH, United States; Michael Robinson, PhD, The Procter & Gamble Company, Cincinnati, OH, United States; Rosemarie Osborne, PhD, The Procter & Gamble Company, Cincinnati, OH, United States Background: Reactive oxygen species (ROS) are considered to play important roles in the process of ultraviolet (UV)-induced skin damage, skin photoaging, and melanogenesis. The antioxidant response element (ARE) is a transcriptional control element that meditates a family of Phase 2 enzymes and antioxidant proteins, under control of the transcription factor NRF2. Induction of ARE-dependent genes plays an important role in protection of cells against oxidative damage. The up-regulated family of proteins can protect against this damage not only by increasing endogenous antioxidant levels in cells but also by up-regulating proteins that monitor for and repair the damage caused by ROS. Transcription of this family of enzymes, therefore, provides a powerful protection and repair mechanism for our skin against the continual assault of UV and environmentally induced ROS. Objective: To analyze gene expression in young versus old sun-protected and sundamaged skin for differences related to management of oxidative stress. Methods: Skin samples from individual study subjects [young (18-20 yrs of age) or older (60-67 yrs of age) females] were obtained from the buttocks (UV protected) and outer forearm (UV exposed). RNA was purified from full thickness biopsies. Synthesized target cRNA was hybridized to Affymetrix U133 Plus 2.0 microarrays (Affymetrix, Santa Clara, CA). The data were subjected to rigorous statistical quality control and analysis and then processed for bioinformatics analysis of gene expression patterns and overarching themes. Results: Significantly over represented gene ontology terms were identified from lists of genes that were either up- or down-regulated between young and old sunprotected and sun-exposed skin. Over represented themes included oxidation/ reduction and defense response-related terms. In addition, there was a dramatic difference in the gene expression patterns of old sun-exposed skin versus young sunexposed skin, suggesting discordance between how the old and young skin respond to environmental stress. Of particular interest was NRF2, a cellular transcription factor that up-regulates a family of antioxidant and repair proteins in response to ROS and free electrophiles in the skin. Comparison of young versus old skin showed a lower expression level of NRF2 in older sun-exposed skin. Conclusions: NRF2 is a regulated transcription factor that transcribes the family of antioxidant response element (ARE)econtaining genes. These proteins play an important role in protection from and repair of oxidative damage; decreased defense of older skin to oxidative damage including from UV may be related to lower endogenous levels of NRF-2. Commercial support: 100% sponsored by Procter & Gamble Beauty. P102 Effects of long wavelength ultraviolet A and visible light on dark skin Bassel Mahmoud, MD, PhD, Henry Ford Hospital, Detroit, MI, United States; Camile Hexsel, MD, Henry Ford Hospital, Detroit, MI, United States; Henry Lim, MD, Henry Ford Hospital, Detroit, MI, United States; Iltefat Hamzavi, MD, Henry Ford Hospital, Detroit, MI, United States Background: Studies in photodermatology have focused mainly on the ultraviolet (UV), particularly the short part, of the electromagnetic radiation spectrum. Until recently, visible light (400-700 nm) has been regarded to have no significant photobiologic effect. Its impact on the time course to pigmentation, the quality of pigmentation, and duration of this change in pigment is still under investigation. Recent developments in photodynamic and laser therapy have led to further research on the cutaneous effect of visible light; yet, technologies in the incoherent, nonlaser light sources have had great difficulty in fractionating light to produce pure visible spectrum. Objective: To determine the impact of long wavelength UVA and visible light on immediate pigmentation and delayed tanning of dark skinned-individuals with skin phototypes IV-VI. Methods: History and physical examination of the volunteers were performed to exclude skin cancers, photosensitivity disorders, and pigmentary abnormalities. Two phototherapy devices were used for the study: a targeted visible light device with a wavelength range between 400 and 700 nm; and a targeted long wavelength UVA1 device with a wavelength between 340 and 400 nm. The skin of lower back or upper buttocks, with uniform pigmentation, was divided in two areas, which were irradiated with visible light and long UVA with an adjacent area as a control. The procedure was repeated until the threshold dose required to produce visible immediate pigment darkening was determined, and then we further increased the dose to see if saturation of pigment occured. Once the threshold dose was determined, pigmentation was assessed by visual exam, clinical photography using a cross-polarized filter, and diffuse reflectance spectroscopy at 6 time points: immediately after irradiation, 30 minutes after exposure, and 1 hour, 2 hours, 1 day, 1 week, and 2 weeks after irradiation. Complete sun avoidance of the studied areas was mandated for all volunteers during the study period. Results: Our data show that both long wavelength UVA and visible light induce pigment production with no or minimal erythema. The pigmentation induced by the visible light was darker and more sustained than the one induced by long wavelength UVA. Conclusions: Our study showed that the spectrum of long wavelength UVA and visible light is capable of inducing pigmentation that may last for weeks. This has an implication on the spectrum of sunscreens used for pigmentary abnormalities, such as melasma. A difference exists between the quality and duration of pigmentation induced by long UVA and the one induced by visible light. Future studies might prove their ability to treat hypo- and depigmented conditions, such as vitiligo, as a safer alternative to UV radiation. Commercial support: Johnson & Johnson. P101 Progression of temporary into persistent facial wrinkling: An 8-year longitudinal study Greg Hillebrand, MD, The Procter & Gamble Company, Cincinnati, OH, United States; Takashi Yoshii, MS, Procter & Gamble, Cincinnati, OH, United States; Xianghong Yan, MS, The Procter & Gamble Company, Cincinnati, OH, United States Background: The visible changes in skin condition associated with normal aging occur over very long periods of time, typically measured in years to decades. Two of the most visually prominent changes are fine lines and wrinkles, especially around the eye. In youth and early adult life, ‘‘crow’s feet’’ wrinkles begin as temporary lines visible only with facial expression. With age, these lines may become persistent wrinkles visible without expression. Indeed, it is generally believed that over time, the mechanical stress caused by repeated facial expression along the same skin groove causes temporary wrinkles to evolve into persistent wrinkles. However, there is a lack of comprehensive longitudinal data addressing this fundamental aspect of wrinkle progression. Objective: The primary objective of this work was to follow the progression of facial wrinkling, both temporary and persistent, on the same population of people over several years. We also aimed to identify host and environmental factors significantly associated with the rate of change in facial wrinkling. Methods: In 1999, facial images (left oblique view) of 1437 women (ages 10-70 yrs) representing four ethnic populations were collected. A high resolution digital camera equipped with a close-up lens, standardized lighting, and head positional aids was used. Images were collected with the subjects in neutral as well as with a smiling facial expression. In 2008, the same imaging system was used to collect comparable images on 125 of these same women. The detailed changes, from 1999 to 2008, in facial skin wrinkling around the eye, upper cheek, and mouth were assessed by visual inspection and with the aid of computer image analysis. A standardized questionnaire was used to collect information on host and environmental factors potentially associated with the observed changes in skin condition. Results: Across the survey population, there was wide variation in the degree of change in skin wrinkling over the 8-year period; some women showed remarkably little change while others showed substantial worsening of facial wrinkling. In general, those with darker skin types showed the least change in facial wrinkling. For many of the subjects, the temporary lines and wrinkles observed only with a smiling expression in 1999 predicted the persistent wrinkling in the neutral expression images of 2008. Furthermore, there was a noticeable lengthening and deepening of most of the 1999 persistent lines and wrinkles along the grooves associated with facial expression. Conclusions: The results prove that expression wrinkles evolve into persistent wrinkles. Inflammatory cytokines and cell cycle regulatory proteins in ultraviolet B (UVB)-irradiated HaCaT cells Kyu Suk Lee, DO, Department of Dermatology, School of Medicine, Keimyung University, Daegu, Daegu, South Korea; Jae We Cho, MD, PhD, Department of Dermatology, School of Medicine, Keimyung University, Daegu, Daegu, South Korea; Sung Ae Kim, MD, Department of Dermatology, School of Medicine, Keimyung University, Daegu, Daegu, South Korea The normal adaptation responses of skin upon ultraviolet B (UVB) light are tanning and hyperplasia. The epidermal growth factor receptor (EGFR) pathway play roles in epidermal hyperplasia by UVB. However, the precise molecular mechanisms involved in hyperplasia still remain to be elucidated. Recently, some cytokines (interleukin 6 [IL-6], IL-8, and tumor necrosis factor-alfa [TNFa]) showed the properties of stimulating keratinocyte proliferation. In this study, we investigated the expression of cytokines (IL-6, IL-8, and TNFa), especially focused on TNFa pathway, and G1 cell cycle regulatory proteins in UVB-irradiated HaCaT cells for elucidation the cross talking between cytokines and cell cycles. UVB-treated HaCaT cells clearly showed that increased expression of IL-6, IL-8, and TNFa by a dosedependent manner of UVB. According to reverse transcriptase-polymerase chain reaction analysis, expressions of IL-6, IL-8, and TNFa were markedly increased by TNFa-treated HaCaT cells. Furthermore, TNFa-induced extracellular signal-related kinase (ERK) activation in HaCaT cells showed the partial up-regulation of cyclin E. Cyclin E expression was slightly attenuated by ERK inhibitor in the presence of TNFa in HaCaT cells. Therefore, our data indicate that the up-regulation of IL-6 and TNFa may play roles in UVB-induced epidermal hyperplasia through cyclin E. Commercial support: 100% sponsored by The Procter & Gamble Company. Commercial support: None identified. P103 MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5943_5949 16 January 2009 10:46 am AB1 P104 P106 Efficacy and safety comparison of a SPF 40 sunscreen containing ecamsule in subjects with polymorphous light eruption in outdoor conditions Vincent DeLeo, MD, St. Lukes Roosevelt Hospital, New York, NY, United States; Joseph Fowler, MD, Dermatology Specialists PSC, Louisville, KY, United States; Scott Clark, MD, Longmont Medical Research Network, Longmont, CO, United States Noninvasive electromagnetic fields promote keratinocyte migration and proliferation Jie Li, PharmD, University of Miami Miller School of Medicine, Miami, FL, United States; James Wu, University of Miami Miller School of Medicine, Miami, FL, United States; Qianli Ma, University of Miami Miller School of Medicine, Miami, FL, United States; Ran Huo, University of Miami Miller School of Medicine, Miami, FL, United States Background: Numerous studies have shown that small, direct electrical currente producing devices produce therapeutic effects on wounds; however, the invasive nature of these devices has limited their clinical application. Noninvasive electromagnetic field (NIEMF) devices have also been developed for wound healing, but few in vitro studies explain their effects and mechanisms of action on wound healing cells. Background: Polymorphous light eruption (PMLE) is an idiopathic photodermatosis elicited by UVR. However, most cases are reported to occur following exposure to UVA light. Objective: The objective of this study was to determine the efficacy and safety of the UVA filters (ecamsule and avobenzone) present in a SPF 40 sunscreen cream in preventing PMLE. Methods: An outdoor, randomized, controlled, double-blind, bilateral comparison of three products in subjects with PMLE. Subjects were randomly assigned to two different treatment groups. Each subject was treated with SPF 40 sunscreen containing ecamsule 3%, octocrylene 10%, avobenzone 2%, and titanium dioxide 5% on one side of the body and either an ecamsule deprived cream (Triad E) or an avobenzone-deprived cream (Triad A) on the other side. Primary efficacy was a composite relative success criterion comprising either a delayed time to onset of PLMLE or a lower Global Severity of PLME for one side versus the other. Safety evaluations included systemic adverse events and cutaneous tolerability assessments. Results: Of the 144 subjects enrolled in the study, 22 total subjects did not experience PMLE during the study duration. A significantly greater number of successes was detected on the SPF 40 sunscreen side (Tetrad) compared with either of the Triads: 41 subjects (56.2%) versus 8 subjects (11.0%; P \.001) in Triad E, and 26 subjects (36.6%) versus 11 subjects (15.5%; P ¼ .020) in Triad A. The global severity of the PMLE flares was significantly lower with the SPF 40 sunscreen than with the two Triads at endpoint (P \.02). PMLE appeared later and with a higher cumulative UVA dose with the SPF 40 sunscreen than with either Triad. Conclusion: In this study, the SPF 40 sunscreen containing ecamsule 3%, octocrylene 10%, avobenzone 2%, and titanium dioxide 5% prevents PMLE flares significantly better than similar formulations with only one of the UVA filters. The inclusion of both ecamsule and avobenzone provides clinical benefit to PMLE patients compared to formulations containing only one UVA filter. Commercial support: L’Oreal USA Products, Inc. Objectives: To evaluate in vitro effects of a NIEMF device on human keratinocyte and fibroblast proliferation and migration and to explore the potential mechanisms of action of these effects via cDNA microarray and reverse transcriptase-polymerase chain reaction (RT-PCR). Methods: NIEMF was generated by a device producing a magnetic field that, in turn, induces an electrical current in a target area. To assess migration, a cross-shaped wound was made onto confluent cultures of normal human keratinocytes or fibroblasts, and photographed. The cultures were treated for 1 hour daily at 2080 Hz, 2.5 mV/cm2, and duty cycle of 90%. Cultures without treatment served as control. Percentages of wound gap area filled by migrating cells over time were determined. In the proliferation assay, cell number and viability were determined by a cell counter each day for 7 days. For cDNA microarray, RNA was isolated from treated/nontreated keratinocytes and gene expression profiles were assessed using a 22,000 sequenced gene array. RT-PCR verification was performed for selected significant genes. Results: NIEMF, compared to control, significantly accelerated keratinocyte migration at days 3 (by 28%), 4 (by 49%), 5 (by 50%), and 6 (by 35%). The wound gaps of treated keratinocytes completely filled at day 6, which is 3 days earlier than for control. For keratinocyte proliferation, 12.5% and 7.2% increases in viable keratinocytes were found at days 5 and 7 (P \.01), respectively. NIEMF showed no effect on either fibroblast migration or proliferation. Microarray and RT-PCR identified significant increases in the expression of HOXC8 (480% increase at 6 hrs; P \.001) and CRK7 genes (68% increase at 24 hrs; P \.001) in treated versus nontreated groups. Conclusion: NIEMF induced keratinocyte-specific increases in migration and proliferation. Expressions of HOXC8 and CRK7, genes known to be involved in gene regulation and cell migration, were increased in keratinocytes after treatment; upregulation of these genes may help explain how NIEMF promotes keratinocyte migration and proliferation, and perhaps, ultimately, wound healing. Commercial support: 10% sponsored by Advatech, Co (partial support for initial pilot study). P105 Differentiation of exogenous ochronosis from melasma by dermoscopy Brian Berman, MD, University of Miami Miller School of Medicine, Miami, FL, United States; Carlos Ricotti, MD, University of Miami Miller School of Medicine, Miami, FL, United States; Martha Viera, MD, University of Miami Miller School of Medicine, Miami, FL, United States; Sadegh Amini, MD, University of Miami Miller School of Medicine, Miami, FL, United States Background: Exogenous ochronosis (EO) is characterized by a discoloration of connective tissues commonly caused by the chronic use of chemicals including topical hydroquinone. Topically applied hydroquinone is frequently used for the treatment of melasma, which after chronic use may result in EO. Clinically differentiating EO from melasma can be difficult, and may require histopathologic diagnosis. We used dermatoscopy as a noninvasive technique to differentiate these two entities. P107 Improved photoaging with topical DNA repair enzymes Zoe Draelos, Dermatology Consulting Services, High Point, NC, United States; Daniel Yarosh, PhD, AGI Dermatics, Freeport, NY, United States; Gudrun Lang, RN, AGI Dermatics, Freeport, NY, United States; Kenneth Smiles, PhD, AGI Dermatics, Freeport, NY, United States Conclusion: The distinct and consistent findings in dermatoscopy between EO and melasma patients support the usefulness of dermatoscopy in differentiating these two entities. In EO, the clinical hyperpigmentation was related to the pigmented structures detected by dermatoscopy and histopathology. Although pathology evaluation is the gold standard in the diagnosis of EO, the use of dermatoscopy may spare patients from skin biopsies. DNA repair is an endogenous defense mechanism against ultraviolet (UV) lighte induced skin cancer and immunosuppression and against molecular markers of photoaging. This double-blind controlled pilot study examined whether enhancing DNA repair with topical DNA repair enzymes in a moisturizing vehicle benefited photoaged subjects when used for 3 months. Fifty-eight of sixty male and female subjects between 35 and 71 years of age completed the study. Subjects had moderate to severe photodamage and 5 to 10 actinic keratoses (AK) in a target area by visual examination (mean, 6.4). Subjects were randomized into two study arms: use of a topical DNA repair moisturizer (containing the DNA repair enzymes photolyase, UV endonuclease, and 8-oxo-guanine glycosylase [OGG1]) twice daily for 3 months followed by topical 5% fluorouracil bid for 3 weeks, or topical bland skin moisturizer (Eucerin lotion) twice daily for 3 months followed by topical 5% 5-fluorouracil twice daily for 3 weeks. Clinically apparent AKs in the target area on each subject were counted over the course of the study. The subjects were scored for photoaging, fine lines, wrinkles, and uneven skin tone using a pictorial photoaging scoring scale. During the 12 weeks of the study, the DNA repair moisturizer produced statistically significant improvement in scores for photoaging, fine lines, and skin tone (P \.05) and for wrinkles (P ¼ .06) as compared to the scores at the start of the study. The subjects in the DNA repair moisturizer treatment group also had a reduction in AKs of 2.8 per subject (P \.05) at 12 weeks compared to the start of the study. Some of this reduction of clinically apparent AKs was caused by a moisturizing effect, because the placebo group also experienced a reduction of 2.4 per subject. At 15 weeks (12 weeks DNA repair moisturizer followed by 3 weeks of 5% 5-fluorouracil treatment which revealed subclinical AKs), the group treated with DNA repair moisturizer had an average of 2.4 fewer AKs per target area than the bland moisturizer treated group. This trend did not reach statistical significance because of the small sample size. This pilot study suggests that the topical application of DNA repair enzymes can produce improvement in subjects with photodamaged skin during a treatment course of 12 weeks. Commercial support: None identified. Commercial support: 100% funded by AGI Dermatics. Objectives: To differentiate EO and melasma based on dermatoscopic findings, and to relate clinical, dermatoscopic, and histopathologic findings in EO. Methods: Eight patients between 36 and 60 years old, who were divided in two groups, were clinically examined. The pigmented areas were digitally photographed and dermatoscopic examination was performed with a 900 or 1800 footcandles of light, 103 lens 32 light-emitting diodes (LED) polarized dermoscope. Patients in group 1 (n ¼ 5) had a history of chronic application of hydroquinone cream and previous skin biopsies consistent with EO, and patients in group 2 (n ¼ 3) had a clinical diagnosis of melasma with no history of hydroquinone use. Clinical and dermatoscopic findings were compared between the two groups, and in the case of EO related to the histopathologic findings. Results: Patients with EO (group 1) presented clinically with bilateral symmetric speckled grey-brown patches over the zygomatic arches and several gray-brown macules, previously described as ‘‘caviar-like’’ bodies. Dermatoscopically, we found the presence of dark brown globules and globular-like structures on a diffuse brown background. Those patients with melasma (group 2) presented with brown reticular patches over the malar regions. The dermatoscopic findings in this group were strikingly different than group 1, revealing a fine brown reticular pattern on a background of a faint light brown structureless area. AB2 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5943_5949 16 January 2009 10:46 am POSTER DISCUSSION SESSION 02—SYSTEMIC DISEASES/INFECTION P200 Use of imatinib to treat systemic sclerosis: A prospective case series Kait Arefiev, Stanford Department of Dermatology, Stanford, CA, United States; David Fiorentino, MD, PhD, Stanford Department of Dermatology, Stanford, CA, United States; Lorinda Chung, MD, MS, Stanford Department of Medicine, Division of Rheumatology, Stanford, CA, United States; William Robinson, MD, PhD, Stanford Department of Medicine, Division of Rheumatology, Stanford, CA, United States Purpose: Systemic sclerosis (SSc) is an autoimmune disease for which no effective therapies exist for the often disabling cutaneous sclerotic disease. The tyrosine kinases platelet derived growth factor receptor (PDGFR) and abl are hypothesized to contribute to the fibrosis and vasculopathy of the skin and internal organs. We describe the clinical and histologic effects of the tyrosine kinase inhibitor, imatinib mesylate, on six patients with early diffuse SSc. Methods: Patients with diffuse SSc were treated with imatinib at a dose of 200 mg daily. Adult patients with diffuse SSc refractory to at least one immunomodulatory agent were treated with imatinib at a dose of 200 mg daily. Lesional skin biopsies of the upper extremities (upper arm or forearm) were obtained at baseline and between 1 and 3 months following the initiation of therapy. Results: Patient 1 is a 24-year-old female with a 3-year history of diffuse SSc, severe Raynaud phenomenon and digital ulcers, and early interstitial lung disease. After 3 months of imatinib at 100 mg orally twice daily, the patient reported softening of her skin, increased joint mobility, and decreased shortness of breath. The patient’s modified Rodnan skin score (mRSS, scale 0-51) improved from 36 to 21. Five of nine digital ulcers had healed, and she had resolution of ground glass opacities on her chest computed tomographic scan. Skin biopsies showed normalization of collagen architecture and a decrease in dermal thickness from 2.8 to 2.3 mm. Patient 2 is a 62-year-old female with diffuse SSc and 6 months of progressive cutaneous sclerosis. After 6 months of imatinib, her mRSS score improved from 36 to 20. The patients tolerated imatinib well, with no evidence of bone marrow or liver toxicity. Both patients experienced gastrointestinal side effects, but these were mild and tolerable at a dose of 200 mg/day. Immediately following her 6-month evaluation, patient 2 suffered from bronchitis requiring oral antibiotic therapy, but there were no other infectious complications. Four additional patients have been began therapy and results will be presented. Conclusions: Imatinib therapy correlated with a dramatic improvement in cutaneous sclerosis in patients with diffuse SSc. Skin improvement correlated with a normalization of collagen architecture within 3 months of therapy. Successful use of imatinib suggests that PDGFR and/or abl signaling in the skin may play an important role in the pathogenesis of systemic sclerosis. P202 Plasma cell infiltrate in nephrogenic systemic fibrosis Lindsey Dohse, DO, Geisinger Medical Center, Danville, PA, United States; Dirk Elston, MD, Geisinger Medical Center, Danville, PA, United States; Puja Puri, MD, Geisinger Medical Center, Danville, PA, United States Background: Nephrogenic systemic fibrosis/nephrogenic fibrosing dermopathy is a debilitating disorder in patients with renal insufficiency, and less frequently among some patients with solid organ transplants. It has recently been associated with gadolinium exposure during magnetic resonance imaging and/or magnetic resonance arthrography, with data suggesting that there is a decrease in total ironbinding capacity and increase in iron mobilization causing transferrin oversaturation. This iron mobilization may result in release of free gadolinium. Clinically, firm, thick skin involving the extremities and trunk characterizes it. Histology of cutaneous involvement displays a spindle cell proliferation in the dermis, thick collagen bundles, with variable mucin deposition and elastic fibers. The spindle cells express CD34, suggesting that these cells represent facultative fibroblasts. Methods: A 65-year-old male with a history of multiple myeloma status postetandem autologous stem cell transplant, dialysis dependent end-stage renal disease, diabetes, and hypertension presented with a 4-month history of skin thickening and pruritis in his extremities, causing flexion contractures and difficulty with movement. The physical examination revealed firm induration and erythema of all extremities, clinically resembling nephrogenic systemic fibrosis. Results: Two punch biopsies from the right and left forearm revealed dermal fibrosis with a spindle cell proliferation. Colloidal iron highlighted a small amount of mucin. Some of the spindle cells expressed factor XIIIa and KP-1, while a few were positive for CD34. Vimentin was weakly positive and keratin was negative. The clinical and histopathologic findings were consistent with a diagnosis of nephrogenic systemic fibrosis. This case is unusual because a marked interstitial lymphoplasmacytic infiltrate was present in the superficial and deep dermis, and only a few of the spindle cells expressed CD34. The presence of a lymphoplasmacytic infiltrate has not previously been reported in the literature. In addition, the Yale University Nephrogenic Systemic Fibrosis Registry has no cases with this lymphoplasmacytic infiltrate per Dr. Shawn Cowper. Additional work-up to include a negative serum protein electrophoresis revealed the patient to be in remission with respect to his multiple myeloma. Conclusion: To our knowledge, the marked lymphoplasmacytic response seen in this case of nephrogenic systemic fibrosis has not been previously described, and may provide additional clues to the pathophysiology of this entity. Commercial support: None identified. Commercial support: None identified. P201 Dermatologic infections complicate epidermal growth factor receptor inhibitor (EGFRI) therapy in cancer patients Robert Eilers, MD, Northwestern University Department of Dermatology, Chicago, IL, United States; Dennis P. West, PhD, Northwestern University Department of Dermatology, Chicago, IL, United States; Joslyn Witherspoon, MD, Northwestern University Department of Dermatology, Chicago, IL, United States; Mario E. Lacouture, Northwestern University Department of Dermatology, Chicago, IL, United States; Sara Ortiz, Northwestern University Department of Dermatology, Chicago, IL, United States Background: Epidermal growth factor receptor inhibitors (EGFRIs) have shown benefit in various solid tumors including nonesmall cell lung, colorectal, and pancreatic cancers. Despite these benefits, dermatologic toxicities (skin, hair, and nails)—such as papulopustular rash, xerosis, pruritus, paronychia, and alopecia—are reported to occur in up to 90% of patients treated with EGFRIs. These toxicities have an impact on quality of life, and may also have implications for dose modification and tumor response. The purpose of this study is to investigate the prevalence of positive bacterial cultures/infections complicating the dermatologic toxicities to EGFRIs. Methods: Retrospective chart review methods were employed to analyze 43 randomly selected patients treated in the Skin and Eye Reactions to Inhibitors of EGFR and Kinases (SERIES) Clinic at Northwestern University’s Department of Dermatology, a referral clinic for dermatologic toxicities to cancer therapies. Selection criteria also included patients treated with lapatinib, cetuximab, or erlotinib at the time of referral to the SERIES Clinic. Selection was also limited to initial patients and their follow-up visits to the SERIES clinic in the time frame of August 2007 to June 2008. P203 Epidermal deletion of JunB in mice mimics human systemic lupus erythematosus Elke Janig, University Clinic of Dermatology and Venerology/Medical University of Graz, Graz, Styria, Austria; Afschin Soleiman, MD, Clinical Institute of Pathology/Medical University of Vienna, Vienna, Austria; Lukas Kenner, MD, PhD, Clinical Institute of Pathology/Medical University of Vienna, Vienna, Austria; Pamina Pflegerl, MD, Clinical Institute of Pathology/Medical University of Vienna, Vienna, Austria; Peter Petzelbauer, MD, PhD, University Clinic of Dermatology/Medical University of Vienna, Vienna, Austria JunB is a member of the activator protein (AP)-1 transcription factor and regulates cell proliferation, differentiation, transformation, apoptosis, and inflammation. To investigate the role of JunB in the skin, we crossed mice carrying floxed alleles of JunB with K5-Cre mice for specific deletion in the epidermis (JunBdep). The phenotype of the mice was investigated by light microscopy, immunohistochemistry, immunofluorescence microscopy, electron microscopy, quantitative reverse transcriptase-polymerase chain reaction, FACS-ELISA, and Western blot. JunBdep mice were born with inconspicuous skin; however, mice developed a skin disease with systemic autoimmune alterations starting at the age of 3 months. The skin showed ultraviolet-accelerable subepidermal immunoglobulin G-bandelike deposits, hyperproliferation of keratinocytes, and specific overexpression of interleukin-6 (IL-6) in the epidermis. IL-6 was furthermore elevated in the serum, whereas other Th1/Th2 cytokines were in normal range. Conclusions: These data suggest that patients treated with EGFRIs have a relatively high risk of culturing positive for bacteria, particularly S aureus (including MRSA) at anatomic sites that are typically affected by EGFRI dermatologic toxicities (nonoropharyngeal). This dictates that effective management of dermatologic toxicities is critical to minimize the risk of dose-modification of EGFRI therapy and the prevention of bacterial complications. JunBdep mice spontaneously produced antinuclear antibodies (ANA) and antihistone (H1, H2A, H2B, H3, and H4) antibodies. Systemic lupus features included enlarged spleen, lymph nodes, CD31 lymphocytic perivascular infiltrates in inner organs, and clinically manifest mesangioproliferative glomerulonephritis with subendothelial and mesangial immune complex deposits. Lymph nodes contained elevated levels of CD1381 plasma cells and reduced levels of CD81 T-lymphocytes. Skin lesions and glomerulonephritis were rescued by crossing with T- and Blymphocyte-deficient (Rag2-/-) mice and IL-6-/- mice, respectively. Therefore, we postulated that epidermal deletion of JunB leads to a systemic autoimmune disease via upregulation of IL-6. By immunoprecipitation, we could demonstrate that JunB directly binds to the promoter region of IL-6, indicating that JunB regulates IL-6 expression. These results are relevant for human autoimmune disease because we found reduced JunB expression and increased IL-6 receptor expression in skin biopsy samples obtained from lupus patients. The JunBdep mouse model may offer the opportunity to learn more about the pathogenic factors of autoimmune diseases and to develop therapeutic strategies interfering with the JunB pathway(s). Commercial support: None identified. Commercial support: None identified. Results: Eighteen (42%) of 43 patients had positive bacterial cultures at sites of dermatologic toxicity. Fourteen (33%) of these patients were positive for Staphylococcus aureus. Of the patients positive for S aureus, 12 (86%) were positive at nonoropharyngeal anatomic sites. Three (21%) of the patients with S aureus positivity were positive for methicillin-resistant S aureus (MRSA). The remaining four patients were positive for various Gram-negative bacteria (two at nonoropharyngeal anatomic sites). All 18 culture-positive patients were followed to clinical resolution. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5943_5949 16 January 2009 10:46 am AB3 P204 P206 Nephrogenic systemic fibrosis (NSF): A report of 12 cases from one medical center Anne Laumann, Northwestern University, Chicago, IL, United States; Frank Miller, MD, Northwestern University, Chicago, IL, United States; Jennifer Tuazon, MD, Northwestern University, Chicago, IL, United States; Kimberly Bauer, MD, Northwestern University, Chicago, IL, United States; Lauren Reilly, Northwestern University, Chicago, IL, United States Background: Nephrogenic systemic fibrosis (NSF) is a recently identified disabling syndrome occurring in persons with severe renal dysfunction. It is characterized by subcutaneous induration that may be aggressive, leading to muscle involvement with painful fibrosis, fixed limb contractures, and an inability to move distal extremities. An association between gadolinium (Gd)-based contrast agent (GBCA) administration and NSF development has been reported, but because \5% of patients on dialysis with exposure to GBCA develop NSF, other factors may be involved. We evaluated multiple parameters, focusing on commonalities among our patients. Methods: All patients with NSF from dermatology, dermatopathology, nephrology, and radiology databases were identified. After dermatopathologic confirmation of the diagnosis, medical records were reviewed for a variety of factors including GBCA exposure, dialysis details, medications, and comorbidities. Results: Twelve patients were diagnosed with NSF before April, 2008. Nine had had previous thrombotic events at the time of symptom onset, although only five of these were within 60 days of GBCA exposure. Ten were receiving an erythropoiesisstimulating agent (ESA) at the time of GBCA exposure. The median anion gap at the time of exposure was 10. Median length of time from GBCA exposure to symptom onset was 21 days. At the time of exposure, seven patients were on hemodialysis and three were on peritoneal dialysis. Two were not on dialysis, despite low renal function. The average duration of time following GBCA exposure until the next dialysis session was 32 hours. All 12 patients were exposed to gadopentetate before symptom onset, with a median cumulative GBCA dose of 65.5 mL. In addition, two had received gadodiamide and one gadobenate. A new paradigm in the treatment of kerions: Treat the inflammation Meghan O’Brien, Drexel University, Philadelphia, PA, United States; Herbert Allen, MD, Drexel University, Philadelphia, PA, United States; Sarah Dolder, MBBS, Drexel University, Philadelphia, PA, United States Kerion formation is the inflammatory extreme of tinea capitis, producing a large painful crusted plaque in the scalp, often with purulent discharge and cervical lymphadenopathy. Kerions are the result of a massive delayed-type hypersensitivity (DTH) reaction to the dermatophyte. This concept was originally proposed by Birt and Wilt in 1954, and later supported by Rasmussen and Ahmed, who found that patients with kerions had a positive skin test reactions to trichophytin antigen, while those with ‘‘black dot’’ tinea capitis had negative skin tests. The treatment of kerion has been directed primarily towards the underlying dermatophyte, often with protracted courses of griseofulvin. However, given the inflammatory nature of kerions and the immunologic origin of their development, we propose that the inflammation, rather than the infection, should be the initial focus of kerion treatment. The objective of this study was to present clinical findings and treatment outcomes for 39 cases of kerion treated with short courses of antiinflammatory agents, namely 25 with saturated solution of potassium iodide (SSKI) 3 and 14 with oral prednisone. Our results show that 18 of the 25 patients treated with oral SSKI responded to treatment as early as 2 weeks and four others responded by 4 weeks. Our patients treated with oral prednisone alone achieved resolution as early as 1 week, with a median of 2 weeks. We were able to clear the kerion completely in two patients using oral prednisone alone, with no need for griseofulvin therapy, which represents a novel systemic monotherapy for this disease. Our study supports the treatment of kerions with prednisone alone as a safe, effective alternative to griseofulvin, allowing the duration of therapy to be shortened dramatically. Adjunctive therapy with griseofulvin can be undertaken if signs of tinea capitis remain after kerion resolution. In light of these findings, we believe that systemic monotherapy with oral prednisone is a revolutionary new approach to the treatment of kerions. It allows for more rapid clinical recovery while avoiding prolonged systemic treatment with griseofulvin. Additional randomized controlled trials may be necessary to better define this situation. Conclusions: The reported association between NSF, severe renal failure, and exposure to GBCAs was shown in all subjects. Concomitant use of an ESA, delay in dialysis after GBCA exposure, and the presence of acidosis at the time of exposure to GBCA were commonly associated factors. The literature suggests a product effect for gadodiamide, but all our patients were exposed to gadopentetate, with three having additional exposure to other GBCAs. Commercial support: None identified. Commercial support: None identified. P205 An outbreak of Mycobacterium chelonae infections in association with tattoos Lisa Drage, Mayo Clinic, Rochester, MN, United States; P. Kim Phillips, MD, Mayo Clinic, Rochester, MN, United States; Phillip Ecker, MD, Mayo Clinic, Rochester, MN, United States; Randall Edson, MD, Mayo Clinic, Rochester, MN, United States; Robert Orenstein, DO, Mayo Clinic, Rochester, MN, United States Background: Skin and soft tissue infections caused by nontuberculous mycobacteria may occur after cutaneous procedures. We describe the first outbreak of rapidly growing mycobacteria infections associated with tattoos. Methods: Records of patients who presented with a new rash within a tattoo were reviewed for clinical, microbiologic, epidemiologic, histopathologic, and treatment data. Results: We identified six patients who developed skin infections with Mycobacterium chelonae after tattoo placement by the same artist at one tattoo establishment. Although the time interval between tattoo placement and the development of skin findings was 1 to 2 weeks, the mean time to diagnosis was 19.75 weeks (range, 10-22.5 wks). Five patients were treated for alternative diagnoses before the mycobacterial infections were identified. The skin lesions were variable and included pink, red, or purple papules, papules with scale, pustules, granulomatous papules, lichenoid papules, and plaques. All patients had multiple skin lesions which were present within the tattoo site or just outside of its border. Histopathology in five patients (all immunocompetent hosts) revealed granulomatous changes, lymphohistiocytic infiltrate, or a mixed cellular inflammation. All special stains for acid-fast bacilli were negative. The diagnosis was made by positive culture in three patients and by histologic findings in one patient. One patient refused a biopsy and was diagnosed on the basis of clinical findings and epidemiologic exposure. One patient had a biopsy that showed a mixed cellular infiltrate; although the culture was negative, the diagnosis was strongly suspected on the basis of clinical findings and epidemiologic circumstances. All isolates for which antimicrobial susceptibility data was available were sensitive to clarithromycin. The five patients with follow-up have demonstrated clinical response to macrolide antibiotic treatment. P207 Hemorrhagical cutaneous manifestation of dengue Ana Maria Mósca de Cerqueira, PharmD, Hospital Municipal Jesus, Rio de Janeiro, Rio de Janeiro, Brazil; Cintia Maria Oliveira Lima, MD, Policlinica Geral do Rio de Janeiro, Rio de Janeiro, Brazil; Joana Orle Coutinho de Azevedo, MD, Policlinica Geral do Rio de Janeiro, Rio de Janeiro, Brazil; Omar Lupi, PhD, Policlinica Geral do Rio de Janeiro, Rio de Janeiro, Brazil Background: Dengue is a serious question of public health in Brazil. In 1986, an epidemic occurred in Rio de Janeiro. In May 2008, we observed 145,350 cases of dengue, with 109 deaths confirmed and 123 under investigation. Dengue can manifest dermatologically in 50% to 80% of patients with the classic forms. In hemorrhagic dengue, cutaneous demonstrations can be petequias, equimoses, and vibices in different topography. Nonspecific injuries included rash, skin desquamation, and pruritus. Methods: We performed an epidemiologic sectional evaluation during the last outbreak of dengue, evaluating 35 children with dengue for hemorrhagic cutaneous lesions in a pediatric hospital in Rio de Janeiro. The analysis was made between April and May of 2008. There were 35 children with hemorrhagic dengue. In 54% of the cases, lesions were not seen. Petequias, equimoses, and vibices were present. We observed diffuse cutaneous manifestations in the mouth (6% of cases) and the face (3%). Plaquetopenia (\70) was observed in 89%. Conclusions: We describe the first outbreak of infection with the rapidly growing mycobacteria (M chelonae) in association with tattoos. Physicians should consider the possibility of a mycobacterial infection if a patient presents with a persistent rash within a new tattoo. Discussion: Our sectional study included only patients with hemorrhagic dengue. Petequias, equimoses, and vibices were present in different locations and were predominant. We did not observe residual hyperpigmented lesions in the study population. It was not possible to detect morbilliform rashes and hemorrhagic manifestations on the eyes in our evaluation. Commercial support: None identified. Commercial support: None identified. AB4 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5943_5949 16 January 2009 10:46 am POSTER DISCUSSION SESSION 03—PEDIATRIC DERMATOLOGY/GENODERMATOSES P300 Transglutaminase-1 mutations and genotypeephenotype investigations in 104 North American patients with autosomal recessive congenital ichthyosis Sharifeh Farasat, MD, National Institutes of Health, Rockville, MD, United States; Jorge Toro, MD, National Institutes of Health, Rockville, MD, United States; Philip Fleckman, University of Washington, Seattle, Washington, United States; Sherri Bale, PhD, GeneDx, Gaithersburg, MD, United States Autosomal recessive congenital ichthyosis (ARCI) is a rare disorder of epidermal keratinization that is traditionally subdivided into lamellar ichthyosis and nonbullous congenital ichthyosiform erythroderma. Mutations in the transglutaminase-1 gene TGM1, which encodes for the epidermal enzyme transglutaminase-1 (TGase-1), are one of the major causes of ARCI. In order to study TGM1 and genotypeephenotype correlations, 104 patients with ARCI were ascertained using the National Registry for Ichthyosis and Related Disorders. Patients were administered a study questionnaire, eliciting medical and dermatologic history and findings. Direct DNA sequencing was used to screen for mutations in TGM1. TGM1 mutations were identified in 55% (57/104) of patients. Of the 44 germ-line mutations identified, 23 were novel: 8 missense, 7 frameshift, 5 nonsense, and 3 splice-site. The splice-site mutation IVS52A[G was the most common (29 alleles) mutation. Genotypeephenotype investigations revealed 3 main findings. First, patients with TGM1 mutations were significantly more likely to report collodion (P ¼ .006), ectropion (P ¼ .001), alopecia (P ¼ .001), and plate-like scales (P ¼ .005) compared to patients without TGM1 mutations. Second, patients with at least one mutation predicted to truncate TGase-1 were associated with severity of hypohidrosis (P ¼ .001) and overheating (P ¼ .0007) at onset of symptoms compared to patients with only TGM1 missense mutations. Third, patients with missense mutations in the TGase-1 catalytic core were associated with eclabium compared to patients with mutations predicting to truncate TGase-1 (P ¼.003). For the first time, we developed a model using clinical features to predict the likelihood of ARCI patients having a TGM1 mutation. Patients with collodion membrane, alopecia, and/or eye problems were about four times more likely to have TGM1 mutations than patients without these findings. This study, the largest study of ARCI reported to date, expands the spectrum of TGM1 mutations and shows that despite clinical and genetic heterogeneity in ARCI, TGM1 is the main causative gene for this disorder. Commercial support: None identified. P302 Family impact of cutaneous disease in the ectodermal dysplasias Michelle Pavlis, MBBS, Emory School of Medicine, Department of Dermatology, Atlanta, GA, United States; Emir Veledar, PhD, Emory School of Medicine, Department of Dermatology, Atlanta, GA, United States; Mary Spraker, MD, Emory School of Medicine, Department of Dermatology, Atlanta, GA, United States; Suephy Chen, MD, MS, Emory School of Medicine, Department of Dermatology, Atlanta, GA, United States; Zakiya Rice, MD, Emory School of Medicine, Department of Dermatology, Atlanta, GA, United States The ectodermal dysplasias (ED) are a complex, heritable group of syndromes with cutaneous manifestation including hypohidrosis, alopecia, and infections of the skin and nails. The objective of this study is to examine the family impact (FI) of cutaneous disease and determine what factors have an impact on family life. From July to November 2007, children with ED and care providers were surveyed at national and regional conferences hosted by National Foundation for Ectodermal Dyslasias. Data regarding demographics, severity of hypohidrosis, scalp alopecia, and fingernail involvement (all measured by reliable 5-point Likert scales), and the quality of life (QOL) of the ED child subject using the Child Dermatology Quality of Life Instrument (CDLQI)1, were gathered. To measure FI, we used the Dermatitis Family Impact Questionnaire. We used multiple linear regression to determine the relationship between the above variables and FI. P \.05 was considered statistically significant. Of the 28 families surveyed, 75% of the surveys were completed by the mother and 64.3% of households consisted of married caregivers with a mean of 1.5 children per household. The mean (SD) age of the children with ED was 6.9 (4.1) years, 39.3% were female, 71.4% were white, and 46% had hypohidrotic ED. The respective mean (SD) severity scores for hypohidrosis, alopecia, and fingernail scores were 3.7 (1.4), 2.7 (1.2), and 2.3 (1.3), respectively (maximum of 5, higher score ¼ greater severity). Sixteen children were able to complete the CDLQI questionnaire reporting a mean (SD) total score of 4.2 (4.2; maximum of 30, higher score ¼ greater QOL impact). The mean (SD) family impact total score for family impact was 7.7 (7.4; maximum of 30, higher score ¼ greater family impact). Regression analysis demonstrates that hypohidrosis (P ¼.002), QOL (P ¼.006), and fingernail disease (P ¼ .04) have the greatest impact on FI. A Pearson correlation revealed a significant relationship between hypohydrosis and QOL (r ¼ 0.51; P ¼ .04), but not for fingernail or alopecia. This pilot study demonstrates that QOL of the ED child has a measurable impact on family life. This result may be because ED patients with poor QOL may negatively impact families secondary to financial and health care use burdens. Conversely, families overwhelmed by challenges of cutaneous disease negatively impact the ED child’s QOL. While additional studies are needed to analyze reasons behind these observations, this study should guide the dermatologist for focus on care issues surrounding hypohydrosis and fingernail disease in an effort to improve the family life of the ED child. Commercial support: None identified. P303 Epidermolysis bullosa (EB) refers to a heterogeneous group of genodermatoses characterized by the excessive susceptibility of the skin to separate from underlying tissues following minimal mechanical trauma. The clinical severity of the disease ranges from a mild localized blistering disorder to a disorder producing extensive generalized blistering, debilitating morbidity, and early mortality. Individuals suffering from the HallopeaueSiemens variant of recessive dystrophic EB (RDEB-HS) have a 43-fold increased risk of developing squamous cell carcinomas. In addition, infants affected with the Herlitz variant of junctional EB (JEB-H) frequently die within the first year of life from overwhelming mucocutaneous fragility, secondary bacterial sepsis, and failure to thrive. While registries for EB currently exist in the United States, Germany, the Netherlands, and Italy, no epidemiologic data to date have been collected for the Australasian cohort living with the condition. To address this, an EB registry was established in November 2006 at St. George Hospital in Sydney, Australia. Patients with EB were recruited into the registry from various hospitals across Australia. Diagnoses were confirmed by EB dermatologists based on the distribution, type and severity of clinical manifestations, and confirmatory skin biopsies, electron microscopy, and immunofluorescence antigenic mapping. The registry currently contains data for 246 Australasian patients from 179 families. One hundred twenty-six of these individuals are male (51%), while the remaining 120 are female (49%). Fifty-two percent of the patients have EB simplex (EBS; n ¼ 129); 36% have dystrophic EB (DEB; n ¼ 88); and 12% have JEB (n ¼ 29). Further subtypes include EBS DowlingeMeara (n ¼ 25), EBS Koebner (n ¼ 13), EBS mottled pigmentation (n ¼ 5), EBS Kindler (n ¼ 1), RDEB-HS (n ¼ 16), RDEB-non-HS (n ¼ 10), JEB-Herlitz (n ¼ 11), JEB-non-Herlitz (n ¼ 11), JEB with pyloric atresia (n ¼ 3), and JEB-laryngo-onycho-cutaneous syndrome (n ¼ 1). The patient ages range between 0 to 98 years, with a median age of 17 years. Of the ethnicities recorded (n ¼ 98), the majority were white (64%), with the next largest group being indigenous Australians (10%). The raw prevalence rate obtained from the registry is 10.1 EB cases per million in Australia, although the real numbers are estimated to be as high as 115.9 cases per million. How to organize a ski and adventure camp for young patients with severe forms of epidermolysis bullosa John W. Frew, St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia; Anna Kemble-Welch, DebRA New Zealand, Wellington, Wellington South, New Zealand; Dedee F. Murrell, MD, Department of Dermatology, St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia; Julien J. Lahmar, Department of Dermatology, University of Rouen Medical School, Rouen, Normandie, France; Mary Alice Nading, MD, Memorial Sloan Kettering Hospital, New York, NY, United States For many years, the American Academy of Dermatology (AAD) has run summer adventure camps for patients with severe skin disorders, including epidermolysis bullosa (EB), funded by AAD member donations and companies and staffed by volunteer dermatology residents and dermatologists. The EB patient support group, DebRA New Zealand, has run two winter adventure camps, which included skiing, white water rafting, and fly-fishing. Here we describe how this camp was organized, funded, and staffed. The winter adventure camp included skiing for teens and young adults with a range of EB severities. Planning and fundraising by DebRA New Zealand began in the year before the camp. DebRA nurses and visiting dermatologists to the EB conference were invited as volunteer helpers. Outdoor instructors qualified to assist persons with disabilities were hired. Following a national EB conference in Auckland in August 2007, attended by EB families, local EB professionals and invited speakers, the campers and volunteers drove or flew to Ruapehu National Park. The camp ran 5 days and included four males (21-35 yrs of age) with recessive dystrophic EB-HS type, 3 of whom used wheelchairs, a teen with RDEB-nHS, and two teens with EB simplex. Twelve volunteers assisted (one Australian dermatologist, three visiting medical students [from Australia, France, and the United States], four EB nurses [three from New Zealand, one from the Netherlands], and four other DebRA members). Accommodation was a ski lodge consisting of basic rooms with showers for patients and share accommodation for volunteers. A large kitchen/dining room was available for self-catering, with delicious evening meals organized by a hired local caterer. Two to three volunteers were assigned each morning for 2- to 3-hour dressing changes for the RDEB-HS campers. Two days of downhill skiing at Whakapaka were possible using sit-skis for the RDEB-HS wheelchair-bound campers, one qualified instructor per camper and two volunteers to ski alongside. Some campers learned snowboarding. Two rafts with life jackets and waterproof attire were hired for rafting and wetsuits for fly fishing. Feedback from the campers was that this winter adventure camp enhanced confidence for all attendees, gave their regular caregivers a well needed break, and offered the chance to interact with medical and nursing personnel at a closer level. It was immensely rewarding for all volunteers. To our knowledge, this is the first ski camp for patients with EB, and is showed that it is possible to provide such an opportunity to severely affected patients safely. Commercial support: None identified. Commercial support: None identified. P301 The Australasian epidermolysis bullosa registry Yong Chern Kho, RN, University of New South Wales & St. George Hospital, Sydney, New South Wales, Australia; Anna-Liza Agero, MD, St. George Hospital, Sydney, New South Wales, Australia; Dedee F. Murrell, MD, Department of Dermatology, St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia; Lesley Rhodes, RN, St. George Hospital, Sydney, New South Wales, Australia MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5943_5949 16 January 2009 10:46 am AB5 P304 P306 Association of psoriasis and psoriatic arthritis with human leukocyte antigen and killer cell immunoglobulinelike receptor gene frequency: A multiethnic population study Sueli Carneiro, Federal University do Rio de Janeiro, Rio de Janeiro, Brazil; Flavia Cassia, MD, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; LuizCristovao Porto, MD, PhD, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Marcia Ramos-e-Silva, MD, PhD, Federal University of RIo de Janeiro, Rio de Janeiro, Brazil; Mario Chaves, MD, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil Serum sicknesselike reaction in children: A retrospective review Sapna Patel, MD, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Anthony J. Mancini, MD, Northwestern University Feinberg School of Medicine, Chicago, IL, United States Background: Adverse drug reactions are estimated to occur amongst 0.9% to 16.8% of hospitalized children in the United States. Serum sicknesselike reaction (SSLR), recognized since the late 1970s, is estimated to occur in 0.06% to 0.5% of pediatric patients. Drugs are implicated in about only 30% of published reports of SSLR, and 60% of these cases are related to antibiotics. It is most commonly characterized by rash, fever, arthralgia, and arthritis. Although SSLR is most commonly seen after oral antibiotic exposure, historically, cefaclor in particular was frequently associated with SSLR, estimated to occur in 1% to 2% of all children who received the drug. Despite a decline in usage of cefaclor, however, SSLR continues to occur in the pediatric population, in proposed association with a variety of antibiotic agents. Objectives: The goals of this study were to review the presentation patterns, associated pharmacologic agents, and disease course, and to compare these findings to those reported in the literature to date to examine for evolving trends. Methods: A retrospective chart review of pediatric patients seen as outpatients in the division of dermatology at Children’s Memorial Hospital over the last 12 years was conducted. Charts were identified based on four ICD9 codes for diagnoses such as ‘‘drug eruption’’ and ‘‘urticaria unspecified,’’ and also from kodachrome and digital photographs. Records of patients diagnosed by the attending pediatric dermatologist with ‘‘serum sicknesselike reaction’’ were reviewed for standardized data collection. Results: Nineteen charts of patients with SSLR were reviewed. Seventeen of the 19 patients had been exposed to antibiotics within 3 weeks before presentation, and the other two patients were diagnosed with SSLR of presumed viral etiology. Of the 17 patients with antibiotic associated SSLR, 13 were exposed to one antibiotic only and four were exposed to two to three antibiotics. The major indication for the antibiotic therapy was otitis media, cited in 64% of patients. In terms of specific medications, 95% had a b-lactam exposure, with 76% having an amoxicillin exposure. In regards to presentation, 59% of patients were between the ages of 6 and 24 months and 53% developed symptoms between 7 and 13 days after exposure. All of the patients had a rash: 88% were urticarial, with one-third having purple urticaria only and 53% having mixed typical and purple urticaria. Sixty five percent had fever, 77% had joint complaints, and 47% had difficulty with ambulation. Diagnostic studies were limited—76% had urinalyses, 85% of which were normal. All were treated with removal of the offending agent and 65% were given antihistamines and/or nonsteroidal antiinflammatory drugs. Fifty nine percent were treated with a tapering course of steroids. Follow-up data was available for only 3 patients—symptoms were resolved or still resolving by 7 to 13 days after the initial appointment. Conclusions: Antibiotic-associated SSLR is still an observed reaction pattern in the post-cefaclor era. SSLR is highly associated with antibiotic exposure, with amoxicillin and amoxicillin with clavulanic acid being the most commonly associated in this review. Cephalosporins were associated in only 16% of patients in whom a single antibiotic was received. This review supports previous data with regard to age and timing of onset and presentation pattern of SSLR. Objectives: To type human leukocyte antigen (HLA) classes I and II and killer cell immunoglobulinelike receptor (KIR) genes of patients with psoriasis vulgaris and correlate HLA markers with epidemiologic and evolutional aspects. Methods: Fifty-five patients were evaluated and questioned about ethnic background, family, and disease history and compared with 134 bone marrow donors as controls. Allelic typing of class I and II and KIR genes were determined by polymerase chain reaction method using sequence-specific primers (PCR-SSP) and PCR using sequence-specific oligonucleotides (PPR-SSO) hybridization. Results: Patients were a mean of 42.4 years old; 41.8% were female and 58.2% were male. HLA-B*57 was found in 23.6% of patients and 7.5% of controls (P ¼ .00200; odds ratio [OR] ¼ 3.8381) and HLA-Cw*06 in 29.1% of patients and 16.4% of controls (P ¼.04832; OR ¼ 2.0886). HLA-B*57 and HLA-Cw*18 were significantly present in patients with arthritis (P ¼ .00104; OR ¼ 6.6769 and P ¼ .00269; OR ¼ 16.50, respectively). HLA-B*57 was significantly present in patients with a history of erythroderma (P ¼ .00548; OR ¼ 5.1059), as was HLA-Cw*06 (P ¼ .02158; OR ¼ 3.0545). HLA-B*57 was frequent in patients with history of hospital admission (P ¼ .00094; OR ¼ 7.8909) and systemic treatment (P ¼.00011; OR ¼ 5.3733). Haplotype HLA-A*02 B*57 Cw*06 DQB1*03 DRB1*07 was the most common among the patients (P ¼ .00069; OR ¼ 3.528). KIR2DL2 was found in 53.0% of controls and 29.1% of patients (P ¼ .00276; OR ¼ 0.3634). Conclusions: HLA-B*57 and HLA-Cw*06 indicated risk in the patient groups. KIR2DL2 was high in controls, indicating protection. HLA-Cw*18 and KIR2DL2 were not previously associated with psoriasis. Supported by government funds (FAPERJ and Capes). Commercial support: None identified. POSTER DISCUSSION SESSION 04—TREATMENT/DIAGNOSIS P305 Measuring the impact on quality of life of infants with atopic dermatitis in a dedicated clinic Kashif Ahmad, MD, Mid Western Regional Hospital Limerick, Limerick, Ireland; Bart Ramsay, Mid Western Regional Hospital Limerick, Limerick, Ireland P400 Conclusions: Our results confirm that AD has a significant impact on QOL on infants and their families. We found that our dedicated AD clinic allows us to focus on the impact of the disease on both child and family. Knowledge of the high-scoring items on QOL questionnaire has allowed us to target these factors in our consultation. Trichoscopic criteria of female pattern hair loss Adriana Rakowska, Department of Dermatology, CSK MSWiA, Warsaw, Mazowieckie, Poland; Elzbieta Kowalska- Oledzka, Department of Dermatology, CSK MSWiA, Warsaw, Mazowieckie, Poland; Lidia Rudnicka, Department of Dermatology, CSK MSWiA, Warsaw, Mazowieckie, Poland; Monika Slowinska, Department of Dermatology, CSK MSWiA, Warsaw, Mazowieckie, Poland Differential diagnosis of chronic hair loss remains a challenge in dermatology. Trichoscopy is a newly developed method of hair image analysis based on videodermatoscopy of the hair and scalp. This method allows visualization of hair shafts at high magnification and performing measurements, such as hair shaft thickness, without the need of removing hair for diagnostic purposes. The aim of the study was to establish the trichoscopic criteria of female androgenic alopecia and chronic telogen effluvium. Trichoscopy was performed in 273 females (123 with androgenic alopecia, 76 with chronic telogen effluvium, and 74 healthy controls) and more obvious differences between healthy controls, androgenic alopecia, and telogen effluvium were analyzed. Average hair thickness in frontal area versus occiput was respectively: 0.061 6 0.008 mm versus 0.059 6 0.007 mm in healthy controls, 0.047 6 0.007 mm versus 0.053 6 0.008 mm in androgenic alopecia, and 0.055 6 0.007 mm versus 0.053 6 0.009 mm in chronic telogen effluvium. Mean percentage of thin hairs (\0.03 mm) in androgenic alopecia was 20.4 6 12% and was significantly higher than in healthy controls (5.9 6 4.1%; P\.001) or in chronic telogen effluvium (10.5 6 3.9%; P\.001). Androgenic alopecia differed by significantly increased percentage of yellow dots, follicles with perifollicular discoloration, and single-hair pilosebaceous units. Classification and regression tree analysis was performed to establish following diagnostic criteria. Major criteria: increased number of yellow dots (more than four in four fields of vision at 370 magnification) and thin hairs, and decreased average hair thickness in the frontal area. Minor criteria: increased frontal area to occiput ratio of single-hair units ([2:1), vellus hairs ([1.5:1), and follicles with perifollicular discoloration ([3:1). Fulfillments of two major criteria or one major and two minor is diagnostic for female androgenic alopecia. In conclusion, the results of our study indicate that the diagnosis of female androgenetic alopecia may be established based solely on trichoscopy criteria. Commercial support: None identified. Commercial support: None identified. Background: Atopic dermatitis (AD) accounts for 10% to 20% of referrals to secondary care dermatology, often requiring multiple visits and occupying valuable time and resources. The psychological, physical, and social impact of AD on children and their family has been, until recently, underappreciated. Objective: We assessed the impact on quality of life of AD in infants and their families in a clinical setting by using internationally validated questionnaires. Methods: The parents of 51 infants with AD attending a dedicated pediatric dermatology clinic completed quality of life (QOL) questionnaires, including the Infants’ Dermatitis Quality of Life Index (IDQOL), Dermatitis Family Impact (DFI), and Patient Oriented Eczema Measure (POEM). Severity of AD was graded by Three Item Severity Score (TISS) and also on a 5-point scale from 0 as very severe to 4 as completely clear by parents and the doctor. We also elicited parent’s fears about their children with AD in an open-ended questionnaire. Results: Fifty-one infants (26 new, 25 review) with a mean age of 23 months were seen over a period of 6 months. The mean IDQOL was 8.04 (range, 0-22); the mean DFI score was 8.7 (range, 0-27), and the POEM score was 12.3 (range, 0-28). The mean TISS was 4.25 (range, 0-9). In the parent’s and doctor’s assessment of 5-point scale severity, the means were 2.09 and 2.25, respectively. The highest-scoring IDQOL items were for itching/scratching, problems at bath time, and time taken to fall asleep. The highest scoring DFI items were tiredness/exhaustion, affect on the caregiver’s life, sleep loss, cleaning/washing, and expenditure. There was a strong positive correlation between severity and QOL scores. Twenty-one patients (41%) scored 10 or more in the IDQOL and DFI. Examples of parent’s fears about their child’s AD included fear of infection, future deterioration/flaring, persistence, unsightly appearance, and fear of use of steroids. AB6 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5943_5949 16 January 2009 10:46 am P401 P403 Comorbidity of pruritus (ICD-9-CM 698.0-698.9) and psychiatric disorders: A study of an estimated 33 million dermatology patient visits between 1995 to 2003 Madhulika Gupta, PhD, Department of Psychiatry, Schulich School of Medicine and Dentistry, London, Ontario, Canada; Aditya Gupta, MD, PhD, Mediprobe Research Inc, London, Ontario, Canada; Lauren Badalato, Mediprobe Research Inc, London, Ontario, Canada Background: While numerous clinical studies have established links between pruritus and psychiatric disorders, very few epidemiologic studies exist to support these findings. Objective: In this study, we investigated the comorbidity of pruritus with depression, anxiety, obsessive compulsive disorder (OCD), and mental disorders in general. Conclusion: Our observations suggest that in contrast to other psychiatric disorders, significant comorbidity exists between pruritus and the anxiety disorders, especially OCDs. The absence of a significant OR for ICD-9-CM diagnosed major depressive disorder most likely is indicative of the prevalence of major depressive disorder in a wide range of other dermatologic disorders which were in the denominator of the OR calculation. A more subjective rating for depression at the time of the initial encounter in the physician checklist, however, was associated with a significant OR. To our knowledge, this is the first large scale epidemiologic study in the United States that has shown a significant association between pruritus and psychiatric pathology. Epiluminescence microscopy: Study of hypopigmentary disorders in Fitzpatrick skin types IV and V Falguni Asrani, MD, Massachusetts General Hospital and Harvard Medical School, Topiwala National Medical College & B.Y.L. Nair Hospital, Malden, MA, United States; Satish Wadhwa, MD, MBBS, Topiwala National Medical College & B.Y.L. Nair Hospital, Malden, MA, United States; Uday Khopkar, MD, MBBS, Topiwala National Medical College & B.Y.L. Nair Hospital, Malden, MA, United States Background: The epiluminescence microscope (ELM) or dermatoscope is a well known but largely underused instrument. Currently, its application is mainly confined for the early diagnosis of melanoma and atypical nevi, which are rare in Fitzpatrick skin types IV and V. Hypopigmentary disorders have great psychosocial stigma, especially in skin types IV and V. There are vast differentials of these hypopigmentary disorders, and these differences critically change the management. Skin biopsy needs to be performed to differentiate between most of the hypopigmented cases because of the few available accurate clinical diagnostic tools. Hence, we undertook the first study of its kind to explore the use of epiluminescence microscopy in various hypopigmentary disorders in Fitzpatrick skin types IV and V. Objective: To study the utility of ELM in the early diagnosis of hypopigmentary disorders of the skin. Methods: We conducted a prospective study of 200 cases of hypopigmentary disorders after obtaining instutional review board approval and informed consent in all cases. Forty-four cases of vitiligo, 43 cases of previtiligo, 44 cases of postinflammatory hypopigmentation, 29 cases of pityriasis alba, 30 cases of Hansen disease, and 10 cases of nevus depigmentosus were studied with the ELM. Epiluminescence microscopy features were assessed by standardized digital dermatoscopic photographs. Final diagnosis was confirmed by histopathology. Results: Characteristic features differentiating various hypopigmentary disorders were observed in 190 of 200 cases. These epiluminescence microscopy features were correlated with histopathology and showed the following: (1) Vitiligo— uniform depigmentation and perifollicular hyperpigmentation in all 43 cases; (2) previtiligo—hypopigmentation accentuated within skin markings in 40 of 43 cases; (3) postinflammatory hypopigmentation—ill-defined hypopigmentation with partial loss of skin markings in 42 of 44 cases; (4) pityriasis alba—diffuse hypopigmentation with preserved skin markings in 27 of 29 cases; (5) Hansen disease—diffuse hypopigmentation in 27 of 30 cases; and (6) nevus depigmentosus—areas of patchy hypopigmentation between normal reticular pigment network and no accentuation of hypopigmentation in skin markings in 10 cases. Conclusions: The ELM is an effective, noninvasive, simple, low-cost outpatient procedure with 95% specificity in early diagnosis of hypopigmentary disorders in Fitzpatrick skin types IV and V. We believe that these findings are the precursor to a set of criteria that can serve as a useful guide in the early diagnosis and differentiation of various hypopigmentary disorders in Fitzpatrick skin types IV and V using ELM and may obviate the need for a skin biopsy. Commercial support: None identified. Commercial support: None identified. Methods: We used compiled epidemiologic data from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1995 to 2003. The NAMCS/NHAMCS database is a largescale population representing an estimated 33.6 million dermatology related patientephysician encounters throughout the United States, and documents one to three International Classification of Diseases 9th edition Clinical Modification (ICD-9-CM) physician rated diagnoses per visit. We calculated the odds ratio (OR) of having a diagnosed psychiatric disorder concurrently with pruritus (patient diagnosed with any ICD-9-CM code between 698.0 and 698.9, excluding code 306.3 [‘‘Pruritus specified as psychogenic’’]) versus all other dermatologic diagnoses; logistic regression analysis was used to control for the possible confounding effects of medications. Results: We found a significant association between pruritus and all psychiatric disorders (OR ¼ 2.03; confidence interval [CI] ¼ 1.11-3.73). Anxiety disorders were also associated with pruritic conditions (OR ¼ 4.59; CI ¼ 1.69-12.49), with an OR of 11.27 and CI range of 2.05 to 61.99 for OCD. The OR between pruritus and ICD-9CM diagnosed depressive disorders was not significant; however, we did observe a significant OR when we examined the depressionepruritis relationship using a physician checklist variable (Q: ‘‘Is the patient depressed?’’; OR ¼ 3.27; CI ¼ 1.208.88). P404 Treatment of CD201 B-cell cutaneous lymphomas using intralesional rituximab Marco Ardigo, San Gallicano Dermatological Institute, Rome, Italy; Catia de Felice, MD, San Gallicano Dermatological Institute, Rome, Italy; Enzo Berardesca, MD, San Gallicano Dermatological Institute, Rome, Italy Background: Primary cutaneous B-cell lymphomas generally present a positive prognosis. Treatment options include surgical and nonsurgical procedures, such as local radiotherapy, subcutaneous interferon, or systemic chemotherapy in patients with generalized cutaneous involvement. Methods: Three patients with multiple CD201 cutaneous B-cell lymphoma lesions (two follicular and one marginal zone type) were evaluated. Staging was performed before treatment decision, disclosing no evidence of systemic involvement. Because of the presence of multiple skin lesions in noncontiguous anatomic sites, after ethics committee authorization and patient consent, the patients received subcutaneous injections of rituximab 20 mg for each lesion 3 times a week once a month for two cycles with a cumulative maximum dosage per therapeutic session of 120 mg. Results: In our cases, complete remission of the lesions occurred after 2 months of treatment. Clinical assessment was performed every month for a medium follow-up period of 10 months. No serious adverse events were observed. Only local pain during the injection was reported by our patients. Conclusions: Rituximab is a chimeric monoclonal antibody against the CD20 antigen generally administered intravenously at the dosage of 375 mg/m2 for the treatment of nodal and primary cutaneous B-cell lymphomas with depletion of CD201 circulating lymphocytes and consequent increased risk of severe infections. Intralesional rituximab can be considered a valid, nonimmunosuppressive and lower cost (because of the significant reduction of the amount of drug required) alternative therapeutic option for the treatment of multiple CD201 cutaneous B-cell lymphomas that affect noncontiguous anatomic sites. Plasma lidocaine levels associated with use of local anesthesia (1% lidocaine with 1:100,000 epinephrine) during Mohs micrographic surgery Murad Alam, MD, Northwestern University Department of Dermatology, Chicago, IL, United States; Dominic Ricci, MD, Northwestern University Department of Dermatology, Chicago, IL, United States; Jillian Havey, Northwestern University Department of Dermatology, Chicago, IL, United States; Joslyn Witherspoon, MPH, MD, Northwestern University Department of Dermatology, Chicago, IL, United States; Simon Yoo, MD, Northwestern University Department of Dermatology, Chicago, IL, United States Introduction: Large volumes of dilute local anesthesia—so-called tumescent or neartumescent anesthesia— are increasingly used not only for liposuction but also for other large cutaneous surgeries, including skin cancer excision. While the lidocaine plasma levels and peaks after instillation of tumescent anesthesia in the trunk have been well studied, the comparable levels after use of less dilute (1% lidocaine) solutions used for facial cancer surgery have not been described. The purpose of this study was to assess plasma lidocaine levels and monitor patients for signs and symptoms of lidocaine toxicity after moderate to high volume injection of 1% lidocaine with 1:100,000 epinephrine into the facial, neck, or scalp skin during Mohs surgery and repair. Methods: Nineteen patients receiving Mohs surgery for moderate to large tumors of the face, neck, or scalp at an urban university dermatology department were enrolled. Sixtythree percent of patients were male and the median age of patients was 60 years (range, 42-96 yrs). Patients received injections (for all stages and repair) totaling between 5 and 48 mL of 1% lidocaine with 1:100,000 epinephrine and 1:10 sodium bicarbonate. Lidocaine levels were drawn from the right or left arm before the first injection of anesthetic and immediately after the first stage was taken; subsequent levels were drawn before and after the second stage (if necessary) and before and after the third stage or closure. The sixth and final blood draw occurred on average 4.4 hours after the first draw. Results: Patients did not manifest any signs of lidocaine toxicity nor did active elicitation of their status reveal any symptoms of such toxicity, including metallic taste, tongue numbness, dizziness, diplopia, and visual halos. Peak lidocaine levels never exceeded 0.3 g/ml for any patient, and lidocaine levels were undetectable (\0.1 g/ml) in 74% of the patients at all time points. Side effects noted were as follows: headache (5%), shakiness (5%), chills (10%), and drowsiness (16%). A monotonic rise in plasma lidocaine levels suggested that in Mohs surgery patients, peak lidocaine levels occur 3 to 5 hours after the start of surgery. Conclusions: The use of moderate to large volumes of dilute lidocaine solutions for anesthesia and hemostatsis during facial cancer and reconstructive surgery appears to be safe. Symptoms and signs of lidocaine toxicity are not seen, and plasma levels remain well below the level of 5 g/ml that is associated with the onset of lidocaineinduced visual changes. Commercial support: None identified. Commercial support: None identified. P402 MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5943_5949 16 January 2009 10:46 am AB7 P405 Combined treatment of nonhealing wounds with bioengineered skin and mesenchymal stem cells Vincent Falanga, MD, Roger Williams Medical Center, Providence, RI, United States; Jaymie Panuncialman, MD, Roger Williams Medical Center, Providence, RI, United States; Polly Carson, Roger Williams Medical Center, Providence, RI, United States; Tatyana Yufit, MD, Roger Williams Medical Center, Providence, RI, United States Background: Systemic sclerosis (scleroderma) ulcers are difficult to treat. We have tested the safety and feasibility of topical application of autologous bone marrowederived cultured mesenchymal stem cells (MSCs) in conjunction with bioengineered skin construct (BSC). Methods: Three patients with scleroderma ulcers were treated. Following bone marrow aspiration, autologous MSCs were established and expanded in culture. Ulcers were treated with the MSC and then covered with BSC. Flow cytometry, immunohistochemistry, and functional studies were used to determine and confirm the phenotype of MSCs. POSTER DISCUSSION SESSION 05— PSORIASIS/AUTOIMMUNE DISEASES P500 Ultraviolet B treatment of plaque-type psoriasis using light-emitting diodes: A new phototherapeutic approach Lajos Kemeny, MD, Department of Dermatology and Allergy, University of Szeged, Szeged, Csongrad, Hungary; Andrea Koreck, MD, Department of Dermatology and Allergology, University of Szeged, Szeged, Csongrad, Hungary; Zanett Csoma, MD, PhD, Department of Dermatology and Allergology, University of Szeged, Szeged, Csongrad, Hungary Conclusions: We have developed novel techniques for culturing and delivering autologous bone marrowederived MSC to scleroderma ulcers. We have characterized the phenotype of these cells both in vitro and in vivo. MSC covered with bioengineered skin may be a way to stimulate healing in scleroderma ulcers. The outcome appears promising. One of the major technological breakthroughs in the last decade is represented by the diversified medical applications of light emitting diodes (LEDs). LEDs emitting in the ultraviolet B (UVB) light spectrum might serve as a more convenient alternative for targeted delivery of phototherapy in inflammatory skin diseases, such as psoriasis. We investigated the efficacy of a new, UVB-LED phototherapeutic device in chronic plaquetype psoriasis. A prospective, right-left comparative, open study was performed to assess the efficacy of UVB-LED phototherapy in psoriasis. Twenty patients with stable plaque-type psoriasis were enrolled into the study. Symmetrical lesions located on the extremities or trunks were chosen. One lesion was treated with the study device, whereas the other lesion served as an untreated control. This UVB-LED device is a narrow-band UVB device with the peak intensity at 311 nm. The minimum erythema dose (MED) was measured on each patient at the start of treatment. In 10 patients, the treatment was started with 13 MED, and then the dose was increased between 20% and 50% compared to the previous treatment. The second 10 patients had an initial dose of 0.73 MED, increasing by 0.13 MED on each treatment session. Four treatments per week were given for up to 8 weeks or until complete clearance (whichever was first). In 10 subjects, a skin biopsy was taken before the study and at the end of the treatment period. Routine histology (hemtoxylineeosin stain) and immunohistochemistry for detection of CD31 T cells was performed. Patients in both groups responded rapidly to the UVB-LED therapy; complete clinical clearing of the lesions was achieved in majority of the patients. Early disease resolution was observed in 11 (seven in the first group and four in the second group) patients. Clearance of psoriatic lesions was also confirmed by histology. No severe side effects occurred. At the 1 month follow-up visit, the majority of the patients had no recurrent disease. These results suggest that this innovative UVB-LED device is effective in the treatment of localized psoriasis and may be useful in other UV-responsive skin diseases. UVB-LED devices may also represent an alternative for home-based phototherapy. Commercial support: None identified. Commercial support: Allux Medical Inc. Results: No safety problems surfaced with bone marrow aspiration and the application of autologous MSC to the wounds. On immunohistochemistry and flow cytometry, cultured mesenchymal progenitor cells showed the following stable surface markers characteristics: CD291, CD441, CD901, CD1051, CD1661, and CD34e (hematopoietic cell marker) and CD45e (leukocyte common antigen). In vitro studies showed that the cultured cells were capable of differentiation into bone, cartilage, and adipose tissue. A fibrin spray system, which takes advantage of the polymerization of cells containing fibrinogen when mixed with thrombin, was used to deliver the cultured mesenchymal stem cells to the wound in a fine spray. The fibrin could also be delivered by dripping it over the wound. Pitting scars were also treated, to determine a possible positive effect and to ensure that no ulceration would result from the experimental treatment. Up to five applications of MSC covered with BSC were performed. The treatment resulted in dramatic wound stimulation and healing. The pitting scars also seemed to improve, and pain relief was rapid. P501 Comorbidities associated with psoriasis in the Newfoundland and Labrador founder population Wayne Gulliver, NewLab Clinical Research, St. John’s, Newfoundland and Labrador, Canada; Z. Tomi, NewLab Clinical Research, St. John’s, Newfoundland and Labrador, Canada; D. MacDonald, NewLab Clinical Research, St. John’s, Newfoundland and Labrador, Canada Results: Statistically significantly increases in GEA responder rates were seen at the third study visit through the end of study including the primary endpoint (P \ .0001). Improvements from baseline in eyelash growth in length, fullness, and darkness were significantly greater in the bimatoprost group compared with the vehicle group at the primary endpoint and consistently at multiple other study visits before the primary endpoint. Subjects reported increased overall satisfaction with eyelash appearance and feelings of confidence, professionalism, and attractiveness, beginning at the third study visit (P # .005). Adverse events reported more frequently in patients receiving bimatoprost included pruritus, conjunctival hyperemia, skin hyperpigmentation, and conjunctival hyperemia and were predominantly mild and occurred in \5% of subjects. Conclusions: Topically applied bimatoprost 0.03% solution was found to be effective in increasing eyelash prominence and in increasing growth of natural eyelashes, and was safe and well tolerated in this study population of healthy adult subjects. Psoriasis is a common inherited inflammatory disorder of the skin that affects 1% to 2% of the population. The relationship between psoriasis and psoriatic arthritis has been well established both clinically and genetically. Researchers have recently suggested that there may be other comorbidities linked to psoriasis, such as obesity, type 2 diabetes, dyslipidemia, hypertension, cardiovascular disease, and premature death. Using the Newfoundland and Labrador founder population, through the Newfoundland and Labrador Centre for Health Information, we have undertaken the task to study 3226 psoriasis patients with respect to comorbidity and the age of death. Comorbidities and age of death were also linked to the genetic marker HLA-Cw6. Data sources include NewLab psoriasis clinical database, clinical database management system (in-patient visits), and fee-for-service physician claims database (outpatient services) over an 11year period from 1995/1996 to 2005/2006. Of the 3226 psoriasis patients, 1494 (46.3%) were identified as having at least one acute care hospitalization during the study period. Forty-six percent had at least one comorbidity; 21% had two comorbidities; and 12% had three comorbidities. Mean age (6SD) for the first acute care hospitalization was 45.0 years (618 yrs). Digestive and circulatory diseases were the leading comorbidities among hospitalized patients (27.4% and 25.8% respectively). Patients with psoriasis experienced onset before the age of 25 years; the mean age of the first hospitalization was 33.7 years (615.1; P\.001). Patients with age of onset[25 years were significantly more likely to have cardiovascular disease, genitourinary disease, respiratory disease, and neoplasm. Patients who are HLA-Cw6 positive are more likely to have neoplasm. With respect to outpatient utilization, 52% had seen a general internist, 47.1% a cardiologist, and 93.4% intervention by a diagnostic radiologist. With respect to mortality data on 202 patients, we also noted significantly decreased longevity (67.5 yrs for males; 73.0 yrs for females). There was no difference in longevity between mild and moderate to severe patients. When the age of onset of psoriasis was before the age of 25, there was significant decrease in longevity, a mean age of 59.3 versus 71.2 in patients whose age of onset was[25 years, compared to 80.0 years for the general population of Canada. Patients whose psoriasis began before the age of 25 were more likely to die of injury or poisoning, while when having an age of onset [25 years, cardiovascular disease was the more likely cause of death. Moderate to severe psoriasis patients were more likely to die of cardiovascular disease. Patients who were HLA-Cw6 positive were more likely to die of cardiovascular disease, injury, or poisoning. Overall, with respect to mortality, the mean age of death for females was 73.0 (Canadian average, 82.5 yrs) and for men was 67.5 (Canadian average, 77.4 yrs). This study demonstrated the use of the Newfoundland and Labrador founder population and the comprehensive health information databank is a powerful tool in understanding the burden of this disease that significantly impacts the psoriasis patient. These data confirm that psoriasis patients have significant comorbidities and these are often multiple, resulting in significant impacts on quality of life, health care utilization, and patients’ longevity. Commercial support: 100% sponsored by Allergan Inc. Commercial support: None identified. P406 Eyelash growth in subjects treated with bimatoprost: A multicenter, randomized, double-masked, vehicle-controlled, parallel study Stacy Smith, MD, Therapeutics Clinical Research, San Diego, CA, United States; Christine Somogyi, RN, Allergan, Inc., Irvine, CA, United States; Frederick Beddingfield, MD, PhD, Allergan, Inc., Irvine, CA, United States; Scott Whitcup, MD, Allergan, Inc., Irvine, CA, United States; Steven Fagien, MD, Private Practice, Boca Raton, FL, United States Background: The safety and efficacy of bimatoprost 0.03% for the treatment of ocular hypertension has been well established in multiple randomized, doublemasked, controlled clinical trials. In these studies, a significant proportion of patients demonstrated increased eyelash growth. Methods: A prospective, randomized, double-masked, vehicle-controlled study was conducted to assess the efficacy and safety of bimatoprost 0.03% solution applied to the eyelid compared with vehicle in increasing eyelash prominence. A total of 278 healthy adult subjects were enrolled at 16 centers in North America. Eyelash prominence was assessed using a Global Eyelash Assessment (GEA) photonumeric scale. Secondary endpoints, including eyelash length, fullness, darkness, and patient reported outcomes, were also assessed. AB8 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5943_5949 16 January 2009 10:46 am P502 P504 Sleep disturbance and medical comorbidities in patients with psoriasis, psoriatic arthritis, and controls Kristina Callis Duffin, University of Utah Department of Dermatology, Salt Lake City, UT, United States; Bob Wong, PhD, University of Utah College of Nursing, Salt Lake City, UT, United States; Gerald Krueger, MD, University of Utah Department of Dermatology, Salt Lake City, UT, United States CD109-mediated inhibition of the transforming growth factorebeta signaling contributes to disease progression in psoriatic patients Ivan Litvinov, PhD, Department of Plastic Surgery, McGill University Health Center, Montreal, Quebec, Canada; Anie Philip, PhD, Department of Plastic Surgery, McGill University Health Center, Montreal, Quebec, Canada; David Jones, MD, PhD, Department of Dermatology, Brigham and Women’s Hospital, Boston, MA, United States; Denis Sasseville, MD, Division of Dermatology, McGill University Health Center, Montreal, Quebec, Canada; Yousef Bin-Amer, MD, Division of Dermatology, McGill University Health Center, Montreal, Quebec, Canada Psoriasis is an immune-mediated disorder manifest by cutaneous scaling plaques and associated inflammatory arthritis. We recently reported a study of the National Psoriasis Foundation membership revealing that presence of pruritus, pain of psoriasis lesions, psoriatic arthritis, and overall diminished quality of life predict sleep disturbance. To corroborate these findings, we compared questionnaire data from patients with psoriasis enrolled in the Utah Psoriasis Initiative registry and controls recruited from our general dermatology clinics over a 3-month period. Of 775 mailed surveys, 274 psoriasis patients returned the questionnaire (36% response rate). The psoriasis sample was divided into two groups: psoriasis alone (Ps; n ¼ 188) and psoriasis with psoriatic arthritis (PsA; n ¼ 86). Control data were obtained from 169 individuals attending the clinic for reasons other than psoriasis. Data collected included age, height, weight, presence of sleep disorders, diabetes, the Pittsburgh Sleep Quality Inventory (PSQI; a sleep instrument that details seven sleep parameters), and the Global Fatigue Scale. Analysis of variance (ANOVA) was used to compare mean differences in sleep parameters, body mass index, and age between the three samples. Chi square analyses were used to compare the prevalence of sleep disorders and diabetes. The analyses revealed that individuals from the general dermatology clinic were younger than both the Ps and PsA groups. The PsA group had a significantly higher mean body mass indices as compared to the Ps and control groups (30.57 6 9.11 vs 27.83 6 5.87 and 26.02 6 5.87, respectively; P \.001). Individuals in the PsA group had a higher mean PSQI score than the Ps group or control group indicating worse sleep (9.38 6 4.42 vs 7.09 6 3.54 in Ps and 7.04 6 3.07 in controls; P \.001). The PsA group also had significantly higher rates of diabetes (23.3% vs 9.0% in Ps and 3.0% in controls; P \ .001), restless leg syndrome (15.1% vs 6.4% in Ps and 4.1% in controls; P ¼.005), and insomnia (15.1% vs 5.9% in Ps and 5.9% in controls; P ¼.015). Individuals with PsA were significantly worse than the general dermatology sample in fatigue, itch, and five of seven sleep parameters. We conclude that psoriatic arthritis is associated with diminished sleep quality. The higher prevalence of diabetes, greater body mass indices, and sleep disturbance in the psoriatic arthritis group suggests a link between sleep disorder, the comorbidities of psoriatic disease, and inflammation, and further study is need. Commercial support: None identified. Psoriasis a chronic inflammatory skin disorder characterized by epidermal keratinocyte hyperproliferation, leukocyte infiltration, and alterations in cytokine production. Recent work documented that the TH17 lymphocytes play a critical role in disease initiation and progression, where inappropriately activated TH17 cells elaborate an array of inflammatory cytokines that deregulate normal keratinocyte proliferation/differentiation. The key signal to suppress the keratinocyte growth is the transforming growth factor-beta (TGFb) protein, whose expression was documented to be increased in psoriatic patients. However, despite the observed upregulation in TGFb signal, psoriatic keratinocytes continue to proliferate in response to other signals. There appears to be a disconnect between high levels of the TGFb and keratinocyte growth. Recently, we have identified a novel regulator of the TGFb signaling, a GPI anchored protein, CD109. CD109 is expressed on cell surface and is released via the phosphatidylinositol-specific phospholipase C (PIPLC) into the culturing media/extracellular matrix (ECM), where it has been documented to bind and sequester the TGFb signal. In addition, CD109 is able to independently downregulate the expression and function of the TGFb-1 receptor. Current work documents via a Western blot and immunohistochemistry that CD109 is expressed in normal human epidermis and in the human keratinocyte cell lines (ie, NTERT-1, NE6E7, and HaCaT). The PI-PLC mediated release of CD109 from cell surface or the addition of exogenous recombinant CD109 protein to the culturing media results in down-regulation of the intracellular TGFb signaling (ie, downregulation of Smad2 phosphorylation) as documented via Western blot analysis. Furthermore, such changes in intracellular TGFb signaling result in the subsequent down-regulation of c-Myc protein and up-regulation of STAT3/phospho-STAT3 and Bcl-2 protein expression. The above CD109-mediated molecular changes result not in an increase in cell proliferation, but importantly, in an increase in cell survival as evaluated via a clonigenic assay. In patients, reverse transcriptase-polymerase chain reaction studies document that both normal and psoriatic skin express high levels of CD109 mRNA, whereas the immunohistochemical analysis documents that the cell surface expression of CD109 protein is lost in psoriatic skin, where CD109 may be released from the cell surface into the ECM and may antagonize TGFb signaling. Further immunohistochemical studies of the psoriasis-lesioned skin and matching normal skin from patients confirm the CD109-mediated molecular changes that were observed in tissue culture (ie, the up-regulation of Bcl-2, STAT3/phosphoSTAT3, and the downregulation of cMyc proteins in psoriatic vs normal skin) and thus validate the importance of CD109 effect on TGFb signaling in patients. In summary, these data refocus our attention on the deregulation of TGFb signaling in psoriatic keratinocytes and explain on molecular and clinical levels the disconnect between high levels of TGFb signal and the continued epidermis overgrowth in psoriasis. P503 Exploratory pharmacogenetic analysis of efalizumab responders Emmanuel Monnet, MD, Merck Serono International S.A., Geneva, Switzerland; Mona Stahle, Karolinska Institutet, Stockholm, Sweden Commercial support: None identified. Background: In clinical trials, a percentage of patients with chronic moderate to severe psoriasis respond to efalizumab therapy. However, genetic factors predicting patient response to a particular treatment are currently uncharacterized. Objectives: The goal of this exploratory pharmacogenetic (PGx) study was to identify genetic markers of drug response and psoriasis severity. Methods: We performed whole-genome scan to compare allele frequency of singlenucleotide polymorphisms in a subset of patients (n ¼ 542) from a multicenter, open-label phase IIIb/IV study assessing the control of moderate to severe chronic plaque psoriasis and treatment impact on health-related quality of life in patients treated with efalizumab. Study endpoints were a Physician’s Global Assessment (PGA) of at least ‘‘good’’ at week 12, improvements of 50% and 75% on the Psoriasis Area and Severity Index (PASI-50, PASI-75), psoriasis-related events (rebounds, relapses, and exacerbations), and disease severity at baseline (moderate/severe in main study). A statistical analysis was performed to compare differences of allelic frequencies for each marker independently (total of 500,000 markers per patient) among subgroups of patients with different clinical outcomes. Results: Of 542 patients included in the analysis, samples from 515 were genotyped and used in the statistical analysis. Of these, 70.5% were taken during week 12 or later (efalizumab responders). Markers statistically associated with a dynamic PGA response of ‘‘good’’ or ‘‘better’’ were on chr4 and chr7, markers associated with PASI50 were on chr6, and markers associated with PASI-75 were on chr10 and chr11. Response markers identified were risk markers (relative risk, 1.4-2.0; with narrow 95% confidence intervals). Therefore, none could be fully associated with clinical outcome. The best response rates were 95%, based on PGA in patients with the marker on chr4 (13% of the PGx population) and 80%, based on PASI-75 in patients with the marker on chr10 (4% of the PGx population). No marker was identified as predictive of psoriasis-related events or severity. Conclusions: We identified genetic markers predicting an increased benefit of efalizumab therapy. None of the markers analyzed could predict ‘‘no response,’’ and none were associated with psoriasis-related events or severity (based on the selection criteria). To our knowledge, this is the first pharmacogenetics analysis of psoriasis patients in relationship to their response to biologic therapy. Commercial support: 100% supported by Merck Serono International S.A. Poster production was 100% supported by Genentech, Inc. P505 Persistent Langerhans cells in humans: A risk factor for cutaneous graftversus-host disease? A. Yasmine Kirkorian, DO, Mount Sinai School of Medicine, New York, NY, United States; Matthew Collin, MD, PhD, Mount Sinai School of Medicine, New York, NY, United States; Miriam Merad, MD, PhD, Mount Sinai School of Medicine, New York, NY, United States Graft-versus-host disease (GVHD) is the major cause of mortality following allogeneic hematopoietic cell transplantation (HCT). We established in a mouse model that recipient Langerhans cells (LCs) survive transplantation and that their persistence is sufficient for cutaneous GVHD; whether this also applies to human transplantation is unknown. We aimed to investigate the relationship between LC chimerism and GVHD in a large cohort of patients undergoing HCT and to determine the utility of LC chimerism as a clinical predictive test of GVHD. We present a multicenter, prospective study of patients undergoing HCT with skin biopsies collected pretransplant and at 2 weeks, 1 month, 3 months, 6 months, and 1 year posttransplant. LC chimerism was determined in sex-mismatched transplants using combined X-Y fluorescence in situ hybridization and Langerin immunohistochemistry on paraffinized sections. Eighty six biopsies have been collected. LC engraftment is highly variable at 1 month posttransplant (median, 86% donor; range, 0-100%; n ¼ 15) despite full donor myeloid engraftment, but correlates closely with the intensity of preparative conditioning and previous cutaneous GVHD. Patients given higher dose treatment or experiencing GVHD have more rapid LC engraftment (median, 100%; range, 82-100%; n ¼ 9) compared with patients given reduced conditioning (median, 5.5%; range, 0-33%; n ¼ 6). Further follow-up will determine whether persistence of recipient LCs confers an increased risk of subsequent GVHD, relapse, and transplant-related mortality. Despite complete donor-derived hematopoiesis, there is significant persistence of recipient LCs in many patients at 1 month posttransplant. LC chimerism may have the potential to predict transplant outcome with the prospect of tailoring immunosuppression to the individual patient. Commercial support: None identified. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5943_5949 16 January 2009 10:46 am AB9 P506 Antidesmoglein 1 reactivity in a healthy Brazilian population at low risk for endemic pemphigus foliaceus (fogo selvagem) Joaquim Sousa Jr., MD, Department of Dermatology, University of S~ao Paulo Medical School, S~ao Paulo, Brazil; Elder Freitas, Department of Dermatology, University of S~ao Paulo Medical School, S~ao Paulo, Brazil; Livia Delgado, PhD, Department of Dermatology, University of S~ao Paulo Medical School, S~ao Paulo, Brazil; Tatiane Coelho, PhD, Department of Dermatology, University of S~ao Paulo Medical School, S~ao Paulo, Brazil; Valeria Aoki, PhD, Department of Dermatology, University of S~ao Paulo Medical School, S~ao Paulo, Brazil Background: Endemic pemphigus foliaceus (fogo selvagem [FS]) is an organ-specific autoimmune blistering disease where pathogenic immunoglobulin G (IgG) autoantibodies against the ectodomain of desmoglein 1 (Dsg1) are detected. The high prevalence of FS in certain Brazilian settlements (3.4%) strongly suggests that the antiDsg1 autoantibody response is triggered by an environmental factor(s). Interestingly, up to 55% of healthy individuals living in endemic areas recognize nonpathogenic epitopes of Dsg1. Simulium nigrimanum is the most frequent black fly species in endemic areas of FS, in comparison to nonendemic areas, where Simulium pertinax predominates. Objective: To characterize the antiDsg1 response in a healthy Brazilian population at low risk for FS by immunologic methods. Methods: Thirty-eight healthy Brazilian individuals between 18 and 65 years old from nonendemic areas for FS (exposed to S pertinax) were clinically evaluated and tested by indirect immunofluorescence (IIF) and enzyme-linked immunosorbent assay (ELISA) with recombinant Dsg1 (cut-off index value for ELISA, 20). Results: Five out of 38 healthy individuals (13%) showed positive ELISA test for antiDsg1 antibodies, index values varying from 16 to 76 (median value, 32). No positive IIF was detected. Conclusion: AntiDsg-1 reactivity in healthy individuals that live in a nonendemic, low- risk area for FS area is lower (13%) when compared to areas of high risk for the disease (55%), where individuals are exposed to a different black fly species. These results reinforce the hypothesis of a possible environmental trigger such as hematophagous insects in FS. POSTER DISCUSSION SESSION 06—SKIN CANCER P600 Differential expressions of Bcl-X/L proteins in premalignant and malignant skin cancers Kyu Suk Lee, Department of Dermatology, School of Medicine, Keimyung University, Daegu, Korea, South; Jae We Cho, MD, PhD, Department of Dermatology, School of Medicine, Keimyung University, Daegu, Korea, South; Sung Ae Kim, MD, Department of Dermatology, School of Medicine, Keimyung University, Daegu, Korea, South There is considerable evidence that excessive ultraviolet (UV) radiation from sunlight is implicated in skin damage, ultimately inducing the death of keratinocytes through apoptosis. Overcoming apoptotic processes can render the good chance for development of cancer. Bcl-2 and Bcl-X/L proteins play roles in protection of apoptosis in cells. Actually, overexpression of Bcl-2 protein is detected in basal cell carcinoma. However, the status of Bcl-X/L protein expression still remains to be elucidated in skin cancer. The current study was performed to investigate the expression of Bcl-X/L protein in premalignant and malignant skin cancer and UVBinduced apoptosis in HaCaT cells. Our data showed that caspases (-3, -6, and -9) were clearly activated in UVB-irradiated HaCaT cells by Western blot. Interestingly the expression of Bcl-X/L protein was rapidly decreased in UVB-irradiated HaCaT cells through proteasome-mediated degradation. Furthermore the differential expression of Bcl-X/L protein was detected between premalignant and malignant skin cancers by immunohistochemical staining. Taken together, our data indicate that the UVBinduced down-regulation of Bcl-X/L protein was partially mediated by proteasome pathway, and that the dysregulation of Bcl-X/L protein may be involved in the process of UVB-induced multistep carcinogenesis in the skin. Commercial support: None identified. Commercial support: None identified. P601 Metaanalysis of sentinel lymph node positivity in thin melanoma ( # 1 mm) Melanie Warycha, PhD, New York University School of Medicine, New York, NY, United States; David Polsky, MD, PhD, New York University School of Medicine, New York, NY, United States; Iman Osman, MD, New York University School of Medicine, New York, NY, United States; Madhu Mazumdar, PhD, Weill Cornell Medical College, New York, NY, United States P507 The utility of the DNA microarray scanner to simplify the immunofluorescence evaluation of autoimmune bullous diseases Todd Clark, MD, Roger Williams Medical Center, Providence, RI, United States; Alex Iwamoto, Roger Williams Medical Center, Providence, RI, United States; Jisun Cha, MD, Roger Williams Medical Center, Providence, RI, United States; Ming Liu, MD, Roger Williams Medical Center, Providence, RI, United States; Satori Iwamoto, MD, PhD, Roger Williams Medical Center, Providence, RI, United States Background: The current method of diagnosing autoimmune bullous diseases relies on direct immunofluorescence microscopy. This method is fraught with limitations imposed upon the user, such as the requirement of a dark room, difficulties associated with the small field of view of a microscope, lower signal production from the standard fluorophore fluorescein, and the need for an experienced technician. Background: Despite the lack of an established survival benefit of sentinel lymph node (SLN) biopsy, this technique has been increasingly applied in the staging of thin ( # 1 mm) melanoma patients, without clear evidence to support this recommendation. We performed a metaanalysis to estimate the risk, potential predictors, and outcome of SLN positivity in this group of patients. Methods: MEDLINE, EMBASE, and Cochrane databases were searched for rates of SLN positivity in patients with thin melanoma. The methodologic quality of included studies was assessed using the MINORS criteria. Heterogeneity was assessed using the Cochran Q-statistic, and publication bias was examined through funnel plot and the Begg and Mazumdar method. Overall SLN positivity in thin melanoma patients was estimated using DerSimonialeLaird random effect method. Conclusion: The advantages of the microarray scanner over standard fluorescence microscopy include the technical ease, the large field of view simplifying the orientation of tissue, the potential for visualizing multiple antibodies simultaneously in a tissue, and the convenience of digital image archiving. Results: Three thousand six hundred fifty-one patients enrolled in 34 studies met the inclusion criteria. Metaanalysis of SLN positivity in patients with thin melanoma resulted in a random effects pooled SLN positivity rate of 5.6%. Significant heterogeneity among studies was detected (P ¼ .005; test of noncombinability), suggesting high variation among study outcomes. This heterogeneity was not explained by supgrouping by methodologic quality (P ¼ .0452 for ‘‘high’’ quality studies; P ¼ .017 for ‘‘low’’ quality studies). There was no statistical evidence of publication bias (P ¼ .21; BeggeMazumdar test). Eighteen studies had a primary focus on SLN biopsy in melanomas # 1 mm, while the remainder included all melanoma thickness groups. These 18 studies reported select clinical and histopathologic data limited to SLN-positive patients only (n ¼ 113). Among the tumors from these patients, six of 698 (6.1%) were ulcerated, 17 of 54 (31.5%) showed regression, and 48 of 101 (47.5%) were invasive to Clark level IV or V. Of 14 (41.2%) studies which provided recurrence and/or survival data, four melanoma-related deaths were reported in SLN-positive patients and four deaths in SLN-negative patients. Conclusion: Data indicate that relatively few patients with thin melanoma have a positive SLN. There are no clinical or histopathologic criteria which can reliably identify thin melanoma patients who might benefit from this intervention. Given the increasing diagnosis of thin melanomas, in addition to the cost and potential morbidity associated with this procedure, alternative strategies to identify patients at risk for nodal disease, including molecular prognostic factors, are urgently needed. Commercial support: None identified. Commercial support: None identified. Methods: A DNA microarray scanner was used as a digital fluorescence microscope for diagnosing autoimmune bullous diseases. Frozen sections of skin biopsies were taken from three patients with bullous pemphigoid, and one patient each with lichen planus pemphigoides, linear immunoglobulin A (IgA) disease, and dermatitis herpetiformis. After incubation with cyanine-labeled antibodies, the tissues were scanned at 5-m resolution using a tool originally designed to study gene expression. Result: The microarray scanner’s large field of view, unlike that of fluorescence microscopy, allowed a view of the entire specimen. All images were diagnostic and included a linear pattern along the basement membrane zone (BMZ) using antiIgG and antiC3 in all cases of bullous pemphigoid; a linear pattern of IgG along the BMZ in lichen planus pemphigoides; and a linear pattern of IgA along the BMZ in linear IgA dermatosis. IgA deposition along dermal papillary tips was seen in dermatitis herpetiformis. AB10 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5943_5949 16 January 2009 10:47 am P602 P604 Effects of imiquimod and resiquimod on melanoma cells in vitro Brian Berman, MMSc, MD, University of Miami Miller School of Medicine, Miami, FL, United States; Jie Li, MD, PhD, University of Miami Miller School of Medicine, Miami, FL, United States; Ran Huo, University of Miami Miller School of Medicine, Miami, FL, United States Health care delivery system effect on disparities in melanoma outcomes among Medicare-aged Hispanic patients Panta Rouhani, University of Miami Miller School of Medicine, Miami, FL, United States; Robert Kirsner, MD, PhD, University of Miami Miller School of Medicine, Miami, FL, United States Background: The pathogenesis of melanoma involves a multistep procession of genetic mutations altering the melanocyte’s ability to proliferate, migrate, and invade surrounding tissue. Imiquimod, in addition to being a toll-like receptor (TLR)-7 agonist, directly induces apoptosis in basal cell carcinoma, squamous cell carcinoma, and melanoma. It has been used as a 5% cream to treat lentigo maligna and metastatic melanoma. Resiquimod is a related agent inducing TLR-7/8 mediated effects, but its direct effects on melanoma cells are unknown. Objective: To determine the in vitro effects of imiquimod and resiquimod on melanoma cell proliferation, viability, migration, and invasion. Background: The health care delivery system in which a patient is enrolled has been associated with differences in the stage at diagnosis and in survival. Whether this is true for Hispanic patients is not known. Methods: To assess proliferation, human SK-MEL28 melanoma cells were plated and treated with normal medium or medium with DMSO (required to dissolve imiquimod), imiquimod or resiquimod, and counted. Viability was fluorescently assessed by the ability of cells to stain with calcein-AM or propidium iodide. In migration and invasion assays, concentrations and durations of treatments having no statistically significant effects on the number of viable melanoma cells were used. Migration was assessed by counting cells that migrated to the bottom of perforated chambers. Invasion was assessed by counting cells that passed through a layer of a synthetic approximation of human skin basement membrane, to the bottom of perforated chambers. Data were analyzed using the Student t test. Results: Imiquimod significantly decreased melanoma cell proliferation (-61% at 20 g/ml, 72 hr), viability (-11% at 20 g/ml, 72 hr), migration (-52% at 10 g/ml, 24 hr) and invasion (-3% at 10 g/ml, 24 hr). Resiquimod also significantly decreased melanoma proliferation (-47% at 50 g/ml, 72 hr), viability (-27% at 50 g/ml, 72 hr), migration (-68% at 10 g/ml, 24 hr), and invasion (-25% at 10 g/ml, 24 hr). Conclusion: In this in vitro study devoid of TLR-7/8-bearing immune cells, imiquimod and resiquimod decreased melanoma cell proliferation and viability. Furthermore, both drugs also inhibited melanoma migration and invasion, even at sub-antiproliferative conditions. These effects, in addition to imiquimod’s in vivo immunomodulatory properties, may play roles in the clinical efficacy of imiquimod in treating lentigo maligna and malignant melanoma. Objective: To evaluate differences in stage at diagnosis and survival for melanoma between the two most common types of Medicare health care delivery systems, HMO and FFS, in the United States during the period from January 1, 1991, through December 31, 2005. Methods: We used the linked SEER-Medicare database to evaluate differences in sociodemographic data, stage at diagnosis, and median survival for melanoma in two subsets of analyses: (1) HMO versus FFS groups by race/ethnicity and (2) nonHispanic white (NHW) versus Hispanic patients by health care delivery plans. Results: The study population consisted of 40,633 patients (74.5% FFS patients; 98.3% were NHW). Among NHW, we found an earlier stage of diagnosis for the HMO group compared with the FFS group when melanoma was the first cancer diagnosis and the second or later cancer diagnosis. Among Hispanic patients, HMO patients were significantly less likely than FFS patients to receive a diagnosis at a regional (later) stage versus earlier stages (odds ratio [OR] ¼ 0.50; 95% confidence interval [CI], 0.31-0.81). Among HMO patients, there were no statistically significant differences with regard to stage at diagnosis or survival by race/ethnicity. Among FFS patients, Hispanic patients were 2.07 times significantly more likely to receive a diagnosis at distant stage versus earlier stages (OR ¼ 2.07; 95% CI, 1.36-3.16) relative to NHW patients. Similarly, Hispanic patients were 2.31 times significantly more likely (OR ¼ 2.31; 95% CI, 1.75-3.03) to receive a diagnosis at regional stage versus earlier stages then their NHW counterparts. Despite later stage of diagnosis, median survival time for all stages was slightly longer among FFS than for HMO patients (45.0 and 43.0 months, respectively; P \.01). Conclusion: Differences exist in stage at diagnosis and survival between patients in HMOs compared with those in FFS health care plans and by race/ethnicity. Public education regarding melanoma risk in Hispanics in conjunction with the delivery of skin cancer screening and exams represent the main areas of intervention with a potential to improve the stage at diagnosis among Hispanic patients. Commercial support: None identified. Commercial support: None identified. P603 Changes in the presentation of nodular and superficial spreading melanomas over 35 years Melanie Warycha, RN, New York University School of Medicine, New York, NY, United States; Alfred Kopf, MD, New York University School of Medicine, New York, NY, United States; David Polsky, MD, PhD, New York University School of Medicine, New York, NY, United States; Iman Osman, MD, New York University School of Medicine, New York, NY, United States Background: Nodular melanoma (NM) is a biologically aggressive tumor compared to the more common superficial spreading melanoma (SSM), with recent data suggesting underlying genetic differences between these two subtypes. To better define the clinical behavior of NMs, we compared their clinical and histopathologic features to those of SSMs at our institution, a tertiary referral center, over 3 decades. Methods: One thousand six hundred eighty-four patients diagnosed with 1734 melanomas were prospectively enrolled. One thousand one hundred forty-three patients (69% SSM, 11% NM, and 20% other) were diagnosed between 1972 and 1982; 541 patients (54% SSM, 23% NM, and 23% other) were diagnosed between 2002 and the present. Differences between the features of NM and SSM within each time period and changes over time were analyzed. Results: We found that SSMs are now diagnosed as thinner lesions (P \.0001) with a low incidence of histologic ulceration (P \.0001), whereas there was no significant change in the median tumor thickness or ulceration status of NMs over time (P ¼.10 and P ¼.30, respectively). The median age at diagnosis of New Mexico, however, did significantly increase over time (51 to 63 yrs; P \.01). NMs typically lacked the ABCD criteria, exhibiting a high degree of border regularity, a more uniform color pattern, with dominant colors of black and brown, and a smaller diameter compared to SSMs. Red was the dominant color in 13.5% of NMs compared to 6.8% in SSMs. Greater than 90% of NM patients and 80% of SSM patients reported a history of change in the lesion. The median duration of NMs was reported to be 5 months compared to 9 months in SSM patients. Conclusions: Our data suggest that improvements have been made in the early detection of SSM but not NM. Modifications of current screening practices, including increased surveillance of high-risk patients with an emphasis on the ‘‘E’’ for ‘‘evolution’’ criterion of the ABCDE acronym used for early detection of melanoma, are warranted. Commercial support: None identified. P605 Comparison of state and national melanoma incidence trends using data from the Florida Cancer Data System (FCDS) and the Surveillance, Epidemiology, and End Results (SEER) program, 1992-2004 Panta Rouhani, PharmD, University of Miami Miller School of Medicine, Miami, FL, United States; Robert Kirsner, MD, PhD, University of Miami Miller School of Medicine, Miami, FL, United States Background: Analysis of state and national melanoma trends is critical for the identification of high-risk regions of the country that require the attention of the public health community. Objective: To compare Florida race/ethnic- and gender-specific melanoma trends with pooled data obtained from the Surveillance, Epidemiology, and End Results (SEER) program. Methods: Age-adjusted, race/ethnic-, and gender-specific invasive cutaneous melanoma incidence trends were evaluated using joinpoint regression analysis. Pooled, age-adjusted incidence rates and standardized incidence rate ratios (SIRRs) were computed for the years 1992 to 2004 to compare Florida to the United States. Results: Relative to SEER, melanoma rates in Hispanic males in Florida were elevated. The incidence of melanoma among male Hispanic patients residing in Florida was 20% higher than that of their male counterparts in the SEER catchment areas (SIRR ¼ 1.2; 95% CI, 1.1-1.4). Conversely, the incidence of melanoma among female Hispanic patients residing in Florida was significantly lower than SEER (SIRR ¼ 0.7; 95% CI, 0.7-0.8). Although the incidence of melanoma among male non-Hispanic black (NHB) patients in Florida was not significantly higher than that of SEER (SIRR ¼ 1.1; 95% CI, 0.8-1.4), female NHB patients in Florida had a 60% significantly higher incidence of melanoma than that of NHB female patients in SEER (SIRR ¼ 1.6; 95% CI, 1.3-2.0). Male and female non-Hispanic white (NHW) patients residing in Florida had lower incidence rates of melanoma relative to NHW in the SEER catchment areas, SIRRs 0.9 and 0.8, respectively. Conclusions: The elevated incidence rates of melanoma among Hispanic and NHB in Florida suggest an emerging public health concern. These results suggest that melanoma prevention campaigns and screening measures targeted at darkerpigmented subgroups are needed. Commercial support: None identified. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5943_5949 16 January 2009 10:47 am AB11 P606 Hydroa vacciniforme like T-cell lymphoma Elizabeth Smith, Mount Sinai Department of Dermatology, New York, NY, United States An 11-year-old male presented with a 3-year history of ‘‘sores on his face.’’ These lesions were worsened by sun exposure, healed with ‘‘pock-like’’ scars, and were painful but not itchy. He had been treated with acyclovir, but did not respond before presentation. His review of systems was significant for sore throat, poor weight gain, orbital swelling, and malaise. A physical examination revealed hemorrhagic eschars overlying erythematous papules on his face and arms. Surrounding the active lesions were concave varioliform scars on the forehead and cheeks. A biopsy of the active lesion revealed dense atypical lymphocytic infiltrate throughout the dermis and subcutaneous fat with extensive epidermal necrosis. EpsteineBarr virus stains were strongly positive, as were CD3, CD4, CD5, and CD8. Systemic work-up revealed atypical T-cell infiltrate in the conjunctiva, cervical lymph nodes, and bone marrow. After this extensive work-up, the patient was diagnosed with hydroa vacciniforme like T-cell lymphoma. He was referred to oncology, where he is undergoing induction chemotherapy in preparation for bone marrow transplant. This case exemplifies a recently described lymphoproliferative disorder that presents in the skin of children, is often aggressive, and can be fatal. EpsteineBarr virus has been implicated in this disorder, and most cases to date have been in South America. Dermatologists should be aware of this disorder, and should consider it in the differential diagnosis of children with scarring phototoxic disorders. Commercial support: None identified. ACNE P700 Sebum analyses of unaffected and acne-affected individuals Apostolos Pappas, MD, PhD, Johnson & Johnson, CPPW, Skillman, NJ, United States; Jue Chen Liu, PhD, Johnson & Johnson, CPPW, Skillman, NJ, United States; Magdalena Eisinger, DVM, Johnson & Johnson, CPPW, Skillman, NJ, United States; Stefanie Johnsen, Johnson & Johnson, CPPW, Skillman, NJ, United States Objective: A pilot study was conducted to compare lipid components of sebum from unaffected and acne-affected individuals. Methods: Ten males between the ages of 15 to 20 years old with no acne or with severe acne were recruited. All of the control (no acne) subjects declared that they had developed acne 1 to 3 years earlier. Facial images were taken with regular, polarized, or fluorescent lights for each subject. Skin surface lipids were analyzed by gas chromatography and flame ionization detection, following the collection of sebum using sebutapes. Results: The subjects with acne had more (59%) sebum than the control subjects. The only class of lipids that was reduced in the acne subjects was free fatty acids, which were 20% lower. In contrast, triglycerides and wax/cholesterol esters were increased (84% and 59%, respectively) in the acne group. The specific lipid that differed the most between the two groups was squalene. That lipid was up-regulated in acne subjects by 2.2-fold on a quantitative basis. In addition, squalene represented a significantly greater proportion of the total sebaceous lipids in acne patients compared to controls (20% vs 15%). Conclusions: Taken together, we documented both quantitative and qualitative differences in the sebum of unaffected and acne-affected individuals. Commercial support: J&J, CPPW. P701 P607 Poor prognosis in young African American females: A retrospective study of ethnic differences in mycosis fungoides Grace Sun, PhD, MD Anderson Cancer Center, Houston, TX, United States; Cindy Berthelot, MD, MD Anderson Cancer Center, Houston, TX, United States; Donald Glass, MD, University of TX, Southwestern, Dallas, TX, United States; Dornechia Goerge, MD, Baylor College of Medicine, Houston, TX, United States; Madeleine Duvic, MD, MD Anderson Cancer Center, Houston, TX, United States Objective: We undertook a retrospective study of the demographics and prognosis of patients with early onset mycosis fungoides (MF) before 40 years of age. The incidence of MF is consistently higher in whites than in African Americans (AAs); however, AAs with MF have a poorer prognosis than other ethnic groups. Methods: Demographic data (age, sex, and race) and histology from 1074 cutaneous T-cell lymphoma patients were stratified by age of onset and race and analyzed using x 2. We defined early onset of MF as occurring before 40 years of age. The data were also searched for particularly aggressive cases in female patients younger than 40 years of age. Aggressive MF was defined as rapid progression from stable, mild disease to stage IV disease within 1 year, occurring at any time during the course of the illness. Results: Females presented before 40 years of age more often than males (P ¼.038). Early onset of MF was seen in 30 of 92 (32.6%) AA, 31 of 87 (35.6%) Hispanic, and 103 of 809 (12.7%) of white patients and was significantly more common in AA (P ¼.0008) and Hispanic (P ¼.0002) patients. When gender was taken into account, there were statistically significant differences in early age of onset comparing white to minority females. AA (21/60 [35.0%]; P ¼ .0174) and Hispanic females (19/40 [47.5%]; P ¼ .0013) presented before the age of 40 more often than white females (50/350 [14.3%]; P ¼.0174 and .0002, respectively). This difference in age of onset was not observed when comparing AA (9/32 [28.1%]; P ¼.0911) and Hispanic males (12/47 [25.5%]; P ¼ .087) to white males (53/459, 11.5%). Progression from initial TNM stage occurred in only five (10%) white, one (5 %) Hispanic, and eight (38%) AA females who presented before 40 years of age. Aggressive MF was found in eight AA females and one white female. Among these eight AA females, six died of their disease, and two are long-term survivors following allogeneic transplantion. Conclusion: Although MF is stated to be a disease of middle-aged men, early onset MF is more common among AA and Hispanic females; AA women with early onset may have the poorest prognosis and should be considered for more aggressive therapy including allogeneic transplantation. Commercial support: None identified. AB12 Overall medication cost for the treatment of acne across different regions in the United States Rajesh Balkrishnan, Ohio State University, Columbus, OH, United States; Adam Uhas, Ohio State University, Columbus, OH, United States; Erin Reese, MD, Wake Forest University School of Medicine, Winston-Salem, NC, United States; Steven Feldman, MD, PhD, Wake Forest Uninversity School of Medicine, Winston-Salem, NC, United States Background: The dermatologic condition of acne is very common and does not only affect adolescents, which is widely thought to be true. The purpose of this study was to accurately describe the cost per episode for the treatment of the acne and to describe any disparities that may be found. Methods: The information was collected from the PharMetrics Integrated Patientcentric Database, a large collection of administrative claims. At the time of this analysis in 2004, there were more than 80 public and private health care plans included in the database, representing approximately 9.6 million unique patients. Analysis was performed using the Total Resource Utilization (TRU) Benchmarks process. This method organizes and separates information from a third-party database into accessible benchmarks for comparison. Results: There are many different drug treatment therapies that can be used to treat acne; these can range in price dramatically. The average acne episode cost $777.19, with pharmacy costs representing 59.5% and outpatient costs representing 39.1%. Inpatient services were reported in only 0.1% of acne episodes and were associated with $9,297.56 in costs. For patients diagnosed with acne, pharmacy visits represented 85.5% of all episodes. Average outpatient costs were $303.99, attributable to 3.73 outpatient services with 2.18 of these services being physician visits. The lowest average total episode costs were found in the South-Central region and were $624.05. The highest average total episode costs were found in the Northeast region and were $856.50. Average outpatient costs in the Northeast region were the highest in the country at $377.64 (the range for other regions was $240.70-$285.93). The Southeast region had the lowest average pharmacy costs at $373.91 and the lowest average outpatient costs at $240.70. All of the previous data can be organized into charts to visually communicate the overall dissimilarities. Conclusions: Much diversity is present in the cost of treating acne across different segments of the United States. The aim of the study was to describe these differences but not to determine any causal reasons for the results. Future research should be done to determine what the underlying factors are when accounting for the discrepancies in cost per episode of acne. Commercial support: 100% supported through an unrestricted educational grant from Galderma Laboratories, L.P. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5943_5949 16 January 2009 10:47 am P702 P704 Impact of acne on adults: Results from Harris Interactive poll Alan Fleischer, Wake Forest University School of Medicine, Winston-Salem, NC, United States Acne often leads to dissatisfaction with one’s personal appearance. A national survey of adults with acne measured the importance of appearance, impact of acne on individuals’ lives, how people treat acne, and level of knowledge about skin care. Subjects were recruited from the Harris Poll Online database. The 2732 US respondents comprised 514 adults (20-40 yrs of age) and 1327 teens (13-19 yrs of age) with acne; 628 parents of teens with acne; and 263 dermatologists. The survey was conducted in December 2007. About half of adults with acne (52%) feel pressure to have clear skin; about three in ten say they would like to change their skin above any other physical attribute. Adults with severe/moderate acne report an impact on self-confidence (56%) and mood (50%), and say having acne is very stressful (45%). Acne is perceived as a health care issue by dermatologists (92%) and adults with acne (54%). Nearly all dermatologists agree that having acne has a negative impact on quality of life and social relationships. Dermatologists believe that acne impacts self-confidence (96%), patients’ social lives (95%), causes emotional issues for patients at least sometimes (95%), and impacts mood (93%). Yet only 27% of adults with acne have visited a doctor for their condition and fewer (18%) have seen a dermatologist. Dermatologists (97%) and adults with acne (89%) believe that acne is controllable. Dermatologists agree (72%) that acne treatments have improved over the past 5 years; nevertheless, 91% of them view patient compliance as a treatment barrier. Prescribed regimens with acne medications are followed by only 54% of adults who use medication to treat their acne. Dermatologists (97%) believe acne is not just a teen issue; it also commonly affects adults. Approximately 35% of adults with acne worry that they will always have acne, and 38% find their acne more stressful than when they were teens. This survey reveals that adults with acne may suffer more than teens from the negative impact of acne on quality of life and social relationships. Nevertheless, despite the availability of effective therapeutic agents to reduce the impact of acne when therapy is individualized based on severity and individual patient needs, only about one in five (18%) adult patients visit a dermatologist. Commercial support: Harris Interactive Poll sponsored by OrthoNeutrogena; poster printing costs sponsored by OrthoNeutrogena. P703 Clinical efficacy of self-applied blue light therapy for mild to moderate facial acne Michael Gold, MD, Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, United States; Anneke Andriessen, RN, RBC Consultants, Malden, Gelderland, the Netherlands; Julie Biron, Tennessee Clinical Research Center, Nashville, TN, United States Background: Phototherapy with blue light has been shown to improve skin condition in cases of acne and blemishes. It is further reported to control the condition before an outbreak occurs without the use of harsh chemicals or prescriptions. Methods: This was an institutional review boardeapproved evaluation on the performance blue light (TC) therapy, self-applied, in the treatment of mild to moderate acne on the face, concerning: (1) time to improvement and/or resolution of the number of blemishes and lesions on the face; (2) quality of skin condition; (3) occurrence and count of the number of new blemishes and lesions; (4) ease of product use; (5) patient comfort, well-being, and satisfaction during the treatment period; and (6) safety of treatment. Subjects (N ¼ 21) were included after selection, according to the inclusion/exclusion criteria and after they had consented. The TC treatment was conducted over an 8-week period. Tests were carried out at the 5% significance level, and statistical evaluations were performed using StatXact 5.0 (double sided ¼ 0.05; paired sample with Wilcoxon signed-rank test; and ANOVA [unpaired with ManneWhitney test]). Results: All patients completed the study (18/21 females and 3/21 males). Upon the first outbreak of their acne, subjects had a mean age of 15 years (range, 8-28 yrs), and 19 subjects had mild to moderate acne for a mean duration of 13.1 years. During the study period with TC treatment, measured within subjects, the total number of comedones on the face had significantly reduced for the assessment at days 7 (P \.019) and 28 (P \.001). The total number of open comedones (blackheads) on the face during the treatment period was reduced significantly for assessment at treatment days 7 (P \.02) and 28 (P \.005). The total number of closed comedones (whiteheads) on the face during the treatment period was reduced significantly (P \ .007) for the assessment at day 28. The total number of papules during treatment had reduced significantly for assessment at days 7 (P \ .048), 28 (P \.005), and 56 (P \.009). The total number of pustules during treatment was reduced, but this difference was not statistically significant. This was the same for the nodules. Conclusions: Subjects expressed confidence in the use of TC for self-treatment without the supervision of a doctor. Regarding their previous treatment, subjects expressed not to be satisfied and experienced TC treatment to be better for their condition than their previous treatment. TC was easy and safe to use for selftreatment administration. Commercial support: 100% sponsored by Pharos Life. P705 The use of photographic filters to measure acne improvement Marta Rendon, MD, The Dermatology and Aesthetic Center, Boca Raton, FL, United States Background: Suboptimal compliance is one of the major reasons for treatment failure among patients with acne vulgaris. It has been estimated that 30% to 40% of patients using topical formulations do not comply with their prescribed treatment. Compliance may be improved by the ease and effectiveness with which physicians instruct patients on applying their medications and therefore the patients’ understanding, possibly with the addition of photography to document improvement over a period of time. Methods: In a phase IV, open-label, community-based, noncontrolled study, the use of tretinoin gel microsphere (TGM) at concentrations of 0.04% and 0.1% was evaluated. Each concentration was dispensed in the new pump delivery system as prescribed by the study investigators. A total of 502 patients who were dissatisfied with their current prescription or nonprescription acne therapy applied the 0.04% or 0.1% TGM gel topically for 12 consecutive weeks (two full pumps, once daily at night or as directed by the investigator). Patients could be treated with up to two other concurrent acne therapies, not including other retinoids. If two additional concurrent therapies were used, only one of these additional treatments could be a topical therapy. At selected sites, specialized photography was used to study the effect of TGM treatment on postinflammatory hyperpigmentation (PIH), pore size, skin oiliness, effect on Propionibacterium acnes, and the appearance of any lesion before detection and after resolution. This photographic equipment used standard lighting which evaluated surface features and colors and parallel polarized light to characterize surface topography. Fluorescent light was used to elicit P acnes and horn, while cross-polarized light was used to reveal subsurface features such as vasculature and pigmentation. Finally, ultraviolet fluorescent lighting was used to photographically depict photodamage on the skin. Results: At the conclusion of this 12-week study, more than 72% of participants saw at least a moderate improvement in their acne symptoms. Of the light options available, the most appropriate for measuring acne results were fluorescent for changes in porphorin activity (a byproduct of P acnes) and in blackheads (comedones). The parallel polorazied light was the most effective to describe changes in pore size and change in oiliness (as measured by facial shine). The cross-polarized light was most beneficial in detecting and monitoring PIH. Conclusions: Clinicians can effectively use different lighting filters to characterize the treatment of acne and management PIH. In addition, the use of cameras with different light filters has the potential to increase adherence to complex topical regimens by demonstrating improvement to the patient over time. Commercial support: OrthoNeutrogena. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5943_5949 16 January 2009 10:47 am AB13 P706 P708 Acne improves with a popular, low glycemic diet from South Beach Panta Rouhani, University of Miami Miller School of Medicine, Miami, FL, United States; Brian Berman, MD, PhD, University of Miami Miller School of Medicine, Miami, FL, United States; Gazelle Rouhani, University of Miami Miller School Miami, Miami, FL, United States Comparative study results of benzoyl peroxide 5%/clindamycin 1% gel and adapalene 0.1% gel in inflammatory and noninflammatory lesions in mild to moderate facial acne vulgaris Anthony Chu, Imperial College of Science Technology and Medicine, Hammersmith Hospital, London, United Kingdom Background: Recent scientific data support the use of a low glycemic diet in the treatment/prevention of acne vulgaris. Whether the popular low glycemic diet from South Beach in Florida (SBD) can improve acne is unknown. Objective: To determine a possible role for the SBD in the treatment of acne. Background: Historically, retinoids have been used as a first-line therapy in treating noninflammatory lesions and mild disease. This study compared the use of a gel containing benzoyl peroxide 5% and clindamycin 1% (BPO/C) to adapalene gel 0.1% (AP) to treat inflammatory and noninflammatory lesions of mild to moderate acne. This poster presents analyses of a 12-week, single-blind, multicenter trial to determine whether treatment response was different for mild disease as compared to moderate disease in various subgroups including females, males, adults, and teenage subjects. Methods: Analyses were performed to determine the mean percentage change from baseline in noninflammatory and inflammatory lesion counts in subjects with mild (n ¼ 72) versus moderate (n ¼ 57) acne vulgaris. Results: In subjects with mild acne, greater mean percent reductions in inflammatory lesion counts were observed after 1 week of the use of BPO/C (24.6 6 34.4%) versus AP (11.9 6 30.4%). Similar results were seen in subjects with moderate disease (25.4 6 29.1% in the BPO/C group versus 5.6 6 26.6% in the AP group). At 12 weeks, the trend was sustained with reductions on BPO/C of 68.5 6 36.0% and 70.0 6 32.9% in subjects with mild and moderate disease, respectively, versus reductions on AP of 50.1 6 38.9% and 44.3 6 47.3% in subjects with mild and moderate disease, respectively. Greater mean percent reductions in noninflammatory lesion counts were also observed after 1 week of BPO/C use (9.4 6 25.1%) versus AP use (1.1 6 26.9%) in subjects with mild disease. Similar results were seen in subjects with moderate disease (7.1 6 24.4% in the BPO/C group vs 2.5 6 21.6% in the AP group). At 12 weeks, the mean percentage reduction in noninflammatory lesions in the BPO/C group was 50.4 6 38.0% versus 35.6 6 36.8% in the AP group with mild disease. Similar results for moderate disease at 12 weeks were reported in the mean percentage reduction in noninflammatory lesions in the BPO/C group at 59.8 6 30.6% versus 37.5 6 61.4% in the AP group. Conclusions: The faster onset of action and sustained improvement in the percentage reduction of both inflammatory and noninflammatory lesions in either mild or moderate disease make BPO/C a significant first-line treatment option in the management of mild to moderate acne. Furthermore, these results suggest that compliance in mild or moderate disease may be improved and therapeutic efficacy optimized in all patient groups—adults, teens, males, or females—treated with BPO/C. Methods: A 41-item, institutional review boardeapproved, anonymous, Web-based questionnaire was designed to assess the SBD duration, compliance, presence/ severity of acne, observed skin changes (if any), and current acne treatments. Advertisements with a link to the questionnaire were posted for 1 year on the Website and newsletters of the popular, low glycemic diet. Results: A total of 2995 respondents accepted the informed consent and completed the survey (91.4% response rate of those linking to the questionnaire). Two thousand five hundred twenty-eight (84.4%) self-reported as active dieters and 1891 (90.4%) were female. When asked to quantify the number of lesions on their faces and/or bodies, nearly one-fourth (24.7%) of respondents reported no acne lesions. Of the 75.3% with acne lesions, the majority (72.5%) reported mild/moderate acne (1-50 lesions) and 2.8% reported severe acne (501 lesions). Those with acne lesions (75.3%) were asked if any changes in their skin occurred and whether these changes were improvements in their acne. More than four-fifths (86.7%) reported noted skin changes to be improvements (90.7% of those on acne treatment vs 81.7% of those untreated; P \.0001). Most (87.4%) noted these improvements within 3 months of starting the SBD (58.0% of those on acne treatment vs 42.0% of those untreated; P ¼ .34). Of those respondents on treatment for their acne, 91.0% either decreased the dose or amount of acne treatment they were using. The degree of compliance (follow general principles [73.1%] vs strictly follow principles [27.0%]) was not associated with self-reported skin improvements (P ¼.12) or the reduction of acne treatments (P ¼ .25). Conclusion: Acne of more than 80% of those on the popular SBD improved, prompting a reduction of acne treatment, usually within 3 months. The SBD may be an additional modality in the treatment of acne. Commercial support: None identified. Commercial support: Sponsored by Stiefel Laboratories, Inc. P709 This poster presents a single-center, investigator-blinded, randomized, paralleldesign study of the safety and efficacy of tretinoin microsphere gel 0.04% delivered by pump (TMG PUMP) to tazarotene cream 0.05% (TAZ) in the management of mild to moderate facial acne vulgaris for 12 weeks. Efficacy measurements included investigator global assessment (IGA), lesion counts, and subject self-assessment of acne signs and symptoms. While efficacy was generally comparable between treatment groups and there was no statistical significance between the two groups, TMG PUMP provided more rapid results in several parameters. IGA showed a more rapid change from baseline at week 4 in the TMG PUMP group (-0.18 in TMG PUMP subjects vs -0.05 in the TAZ subjects). The TMG PUMP group yielded more rapid improvement in papules and was more efficacious, with the mean change from baseline at all timepoints reaching within-group statistical significance. At week 4, the mean percentage change from baseline in open comedones was statistically significant at -64% in the TMG PUMP group (P ¼.0039, within group) versus -19% in the TAZ group. Skin dryness was decreased by one or two points in 24% of TMG PUMP subjects, while not at all (0.0%) in the TAZ group. At week 4, skin peeling was statistically significant in 25% of the TAZ subjects with an increase of two points versus 0% of the TMG PUMP subjects (P ¼.0498 between groups). Also at week 4, pruritus was significantly increased by one point in 25% of the TAZ subjects versus none (0.0%) of the TMG PUMP subjects (P ¼ .0498 between groups) and at study end, 15% of the TAZ subjects had maintained a one to two point increase in pruritus from baseline versus none (0%) in the TMG PUMP group. Adverse events related to study treatment were rare in both groups and all resolved upon discontinuation of study medication. Compliance has been shown to correlate positively with treatment outcome in acne. Some of the common signs and symptoms of retinoid therapy, such as skin peeling and pruritus, were significantly increased with tazarotene cream 0.05% versus tretinoin microsphere gel pump 0.04%. Improved skin comfort may enhance patient compliance and enhance overall clinical success. Infantile acne: A case report Lamiae El Moutaoui, MBChB, UHC Ibn Rochd, Casablanca, Morocco; Hakima Benchikhi, UHC Ibn Rochd, Casablanca, Morocco; Khadija Khadir, UHC Ibn Rochd, Casablanca, Morocco Introduction: Acne is a disease that can be seen in the first year of life, early childhood, prepubertal age, and puberty. We report a case of infantile acne in a 6-month-old female and we review the clinical presentation, pathogenesis, and treatment of infantile acne. Observation: A 6-month-old female presented with a 1-month history of skin erruption localized on her face. She had no history of severe acne in one or both parents. No application of ointments, creams, pomades, corticosteroids, or oils was found. The physical examination revealed a combination of closed and open comedones, papules, and pustules without cystic lesions localized only to the face. The clinical signs of hyperandrogenism and signs of precocious puberty were negative. We made the diagnosis of infantile acne. Because of the absence of hyperandrogenism signs, serologic examinations of follicle-stimulating hormone (FSH), leutenizing hormone, testosterone, and dehydroepiandrosterone sulfate were not realized. Ultrasonographic scans of the abdompen and pelvis were normal. We first proposed a combination of benzoyl peroxide and a topical antibiotic (erythromycin) and because of nonreponse we then suggested erythromycin in doses of 250 mg twice daily with close follow-up. Discussion: Infantile acne is much less common and usually starts later than neonatal cephalic pustulosis, generally between 3 to 6 months of age, but can start as late as 16 months of age. Boys are more frequently affected than girls and there may be a history of severe acne in one or both parents. Infantile acne appears as a combination of closed and open comedones, papules, and pustules. It is more widespread and inflamed than neonatal acne, occasionally including cystic lesions, which may lead to scarring. Lesions are localized to the face, with the cheeks being the area that is most affected. The course is variable but persistent. In some cases, the acne disappears after 1 or 2 years, although it often lasts longer. Most cases resolve by 4 or 5 years of age, but some remain active until puberty. Very rarely, cases of conglobate acne can be seen; they occur primarily on the face and include deep communicating nodules, cysts, and draining sinuses leading to marked scarring. Infantile acne, especially conglobate infantile acne, may be related to severe forms of the disease in adolescence. The pathogenetic mechanisms of infantile acne remain unclear. A positive family history of acne supports the importance of genetic factors. The therapeutic approach to infantile acne is similar to therapy of acne at any age. Mild cases of comedonal acne can be treated with a topical retinoid and/or a combination of benzoyl peroxide and a topical antibiotic (erythromycin/clindamycin). The most difficult lesions to treat are inflammatory lesions, such as deep papules and nodules, which can persist for months. The oral antibiotics restricted to this age are erythromycin in doses of 125 to 250 mg twice daily and trimethoprim/ sulfamethoxazole 100 mg twice daily in patients with documented Propionibacterium acnes resistant to erythromycin. The use of oral tetracycline is not appropriate because of damage to developing bones and teeth in children up to 8 years of age. Deep nodules and cysts can be treated with an injection of a low concentration of triamcinolone acetonide (2.5 mg/mL). If there is no response or if nodular acne develops, which can lead to scarring, oral isotretinoin can be used. Commercial support: Sponsored by Ortho Neutrogena. Commercial support: None identified. P707 Comparative efficacy and tolerability results of tretinoin microsphere gel pump 0.04% and tazarotene cream 0.05% in the treatment of mild to moderate facial acne vulgaris Leon Kircik, Indiana University, Louisville, KY, United States AB14 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5943_5949 16 January 2009 10:47 am P710 P712 A personalized system of acne treatment is superior in providing rapid and sustained improvement on acne and quality of life Theresa Chen, MD, Neutrogena Corporation, Los Angeles, CA, United States; James H. Herndon Jr., MD, Presbyterian Hospital of Dallas, Dallas, TX, United States; Thomas J. Stephens, PhD, Thomas J. Stephens and Associates, Carrollton, TX, United States; Yohini Appa, PhD, Neutrogena Corporation, Los Angeles, CA, United States Over-the-counter acne regimens typically consist of a fixed combination of products (eg, cleanser, toner, and leave-on treatment). However, personal factors, such as skin sensitivity, acne conditions, product preference, lifestyle, and living environment, can impact the usage experience and treatment outcome. Therefore, a personalized system of acne treatment has been developed to address these specifics. This system uses a proprietary skin evaluation algorithm to obtain the relevant information and recommend product regimens based on the individual’s data. A double-blind, randomized, placebo-controlled clinical evaluation was conducted to compare the safety and efficacy of the personalized system with a nonpersonalized commercial system. Each was tested on 100 subjects, and the placebo on 50 subjects. The treatment groups were normalized with respect to acne severity, gender, and age. Each subject assigned to the personalized system went through a skin evaluation, which recommended a product regimen suitable for the individual’s conditions. Subjects assigned to nonpersonalized system or the placebo also went through a skin evaluation, but everyone in a group received the same regimen designated for that group. The parameters evaluated were target lesions, emerging acne, global acne severity, whole face lesion counts, and acne quality of life. On all acne parameters, the personalized system outperformed the nonpersonalized system and placebo by delivering faster and greater improvement. The superior benefits extended to acne quality of life, which showed significant improvement in every dimension as early as week 4 (vs no improvement for the nonpersonalized system). The acne quality of life results are a testament that the personalized system goes beyond acne to improve emotional, social, and psychological health of a person. Taken together, these results demonstrate the advantages of making appropriate, personalized product recommendation in the treatment of acne. This approach can also apply to other types of treatments. The acne of current adolescents in France: CREDOC survey May 2007 Clarence de Belilovsky, MD, Institut Alfred Fournier, Paris, France; Franck Lehuede, Credoc, Paris, France; Nathalie Laforest, Laboratoires Expanscience, Courbevoie, Courbevoie, France; Raphael Berger, Credoc, Paris, France Objective: In order to determine in France the current level of knowledge, information sources, care and management habits, and impact of acne on adolescents, CREDOC (Research Centre for the Study and Monitoring of Living Standards) conducted a telephone survey in May 2007. Methods: Four hundred ninety-three adolescents (50% female, 50% male) 13 to 24 years of age were contacted. They were asked the following questions: age at onset of acne, localization, severity, factors influencing the acne, means of information, impact on quality of life, physician consulted, cosmetic and therapeutic habits, and relationship with the physician during the consultation. Commercial support: 100% by Neutrogena Corporation. Results: Eighty-one percent of adolescents report that they have or have had acne. In 20% of cases, the acne starts before 13 years of age, and in 8.5% of cases, it starts after age 16. Its early onset is linked to its severity: 42% of moderate to severe acne before 13 years of age versus 16% after age 16. The acne lasts a long time: more than 3 years in 45% of cases. The adolescents are fairly well informed regarding the factors promoting their dermatosis: seborrhea (76%), unsuitable cosmetics (67%), stress (66%), and sun exposure (33%). Seventy-six percent consider their acne as a problem of concern. However, they cope with their acne pretty well: 64% are not disturbed in any relationships with others. Acne is not a source of conflict with parents in 84% of cases. Fifty-one percent sought out information on their acne. More than three information sources were consulted in 55% of cases. These were mainly physicians (77%), parents and family (66%), pharmacists (37%), friends (35%), magazines (30%), television (30%), and Internet forums (17%). More than half (53.5%) of adolescents have never consulted a health professional. The relationship with the physician is very good: satisfaction of 82% to 90%. Seventy percent of adolescents use cosmetics and 30% use a medical treatment (local, 84%; oral, 53%). The levels of satisfaction are high, both for the cosmetics (effective, 74%; restrictive, 13%; disagreeable, 5%) and for the medicinal products (effective, 83%; restrictive, 11%; disagreeable, 13%). Nevertheless, compliance is poor: frequent and rare forgetting is 32% and 51%, respectively, for the cosmetics and 23% and 43.5%, respectively, for the medicinal products. The youngest adolescents have the lowest compliance (73% of the 13- to 14-year-old age group). Conclusion: In 2007, the acne of adolescents remains very common, of early onset, and fairly well understood and coped with, but is insufficiently treated and accompanied by poor treatment compliance. Commercial support: 100% sponsored by Laboratoires Expanscience. P713 Acne past and present: A generation of acne in France Clarence de Belilovsky, Institut Alfred Fournier, Paris, France; Franck Lehuede, Credoc, Paris, France; Nathalie Laforest, Laboratoires Expanscience, Courbevoie, Courbevoie, France; Raphael Berger, Credoc, Paris, France Objectives: How has acne changed over a generation? In order to respond to this question, CREDOC (Research Centre for the Study and Monitoring of Living Standards) conducted a telephone survey in May 2007. Middle-aged adults (who currently have an adolescent 13-24 years of age) were questioned about a possible history of acne during their youth. Their answers were compared to the answers of current adolescents who have or have had acne. P711 Microneedle roller for the treatment of acne scar Beom Joon Kim, MD, Deparment of Dermatology, College of Medicine, ChungAng University, Seoul, South Korea; Chang Kwon Hong, MD, PhD, Chung-Ang University, Seoul, South Korea; Kwang Ho Rhu, MD, Chung-Ang University, Seoul, South Korea; Myeung Nam Kim, MD, PhD, Chung-Ang University, Seoul, South Korea; Yun Young Lim, Chung-Ang University, Seoul, South Korea Background: Acne scars can be treated by various kinds of laser equipments, surgical trials including subcisions, and chemical and mechanical peelings. Recently, a new medical device called a microneedle roller has been applied for acne scar revision. Methods: We have tried a 10-mm microneedle roller on the acne scars of Asian patients. Sixteen volunteers with acne scars on their faces were enrolled in this study. Follow-up photos and patients’ subjective satisfaction scores were taken in 4-week intervals. Result: Icepick scars seem to be the best indication of microneedle roller treatment. Rolling scars and boxscars were also improved by microneedle rolling, although they were not completely recovered. Slight bruise, light brown pigmentation, and dryness were observed, although they were all transient and tolerable. Methods: Five hundred seventy-seven middle-aged adults were contacted. Among them, 375 had had acne during their adolescence. In parallel, 398 adolescents with acne were also surveyed. The questionnaires were similar: age at onset of acne, clinical presentation, quality of life, treatments and their results, and role of their own parents. Results: The frequency of acne has increased over a generation: it was 65% for former adolescents compared to 81% for current adolescents. It started at a younger age: 70% at 14 years of age or younger versus 61.5%. It lasted longer: 69% for more than 3 years compared to 37% today. It was also more severe: 12.3% versus 3.3%. Acne with late onset was rarer: 3% after 16 years of age versus 12% today. Acne was experienced as being more disagreeable than at present: 51% discomfort with the view of others versus 43%; 51% feel bad about themselves versus 40%; 41% lack of self confidence versus 27% and 12% difficulty in relationships with teachers or colleagues versus 7%. Former adolescents had fewer consultations: 55% never saw a physician versus 44% today; 39% had no management of the condition versus 20% today; 50% used cosmetics versus 70% today, and 23% had a medical treatment versus 30% currently. Former youth were less satisfied with their products: 70% found them to be effective (vs 74% for the cosmetics and 83% for the medicinal products currently), 32% found them to be restrictive (vs 13% and 11%), and 29% found them to be disagreeable (vs 5% and 13%). Their parents encouraged them to consult a physician less frequently than do current parents (33% vs 47%), and this was also the case for cosmetics use (46% vs 58%). Conclusion: Microneedle rollers can be safely applied for acne scars. Conclusion: Over a generation, the results of this study indicate that the frequency of acne appears to have increased and its severity criteria have been reduced, as well as its impact on the quality of life of patients. It is likely that this positive trend is linked to an improvement in the medical and cosmetic management of the condition, both quantitatively and qualitatively. Commercial support: None identified. Commercial support: 100% sponsored by Laboratoires Expanscience. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5943_5949 16 January 2009 10:47 am AB15 P714 P716 Comparison of a 3-step acne system containing solubilized benzoyl peroxide versus benzoyl peroxide/clindamycin: A multicenter, investigatorblind, randomized study Diane Thiboutot, MD, PhD, Penn State University College of Medicine, Hershey, PA, United States; Alan Shalita, MD, SUNY Downstate Medical Center, Brooklyn, NY, United States; James Del Rosso, DO, Las Vegas Skin and Cancer Clinics, Las Vegas, NV, United States; Lawrence Eichenfield, MD, Children’s Specialists of San Diego, San Diego, CA, United States The prevalence of acne in French girls aged between 13 and 23 Florence Poli, MD, Dermatologyst, Paris, IDF, France; Charles Taieb, MD, Pierre Fabre, Public Health, Boulogne Billancourt, IDF, France; Marco Ambonati, MD, Laboratoires Dermatologiques Ducray, Lavaur, Midi Pyrenées, France; Sami Boussetta, MD, Pierre Fabre, Public Health, Boulogne Billancourt, IDF, France Background: Benzoyl peroxide (BPO) is poorly soluble and tends to aggregate into clusters that hinder its bioavailability and follicular penetration. A 3-step acne system has been developed that contains a novel solubilized 5% BPO formulation (together with a proprietary salicylic acid cleanser and salicylic acid toner) which aims to enhance both the bioavailability and follicular penetration of BPO. Early clinical data have shown that the solubilized 5% BPO formulation can result in a greater reduction in acne lesion counts in the early weeks of treatment compared with a combination BPO/antibiotic product. We have now evaluated these treatments in a larger group of patients and over a longer period of time. Methods: Patients were eligible for enrollment if they had mild to moderate facial acne vulgaris (10-100 noninflammatory lesions, 17-40 inflammatory lesions, and up to two nodulocystic lesions). They were randomly assigned to 10 weeks of facial treatment with one of the following: the 3-step acne system (proprietary 2% salicylic acid cleanser twice daily 1 solubilized 5% BPO gel twice daily 1 proprietary 2% salicylic acid toner once daily) or control cleanser twice daily 1 5% BPO/1% clindamycin twice daily. Results: A total of 139 patients were enrolled. They had a mean of 52 noninflammatory acne lesions and 28 inflammatory acne lesions at baseline. The 3-step acne system was associated with a numerically greater reduction in noninflammatory lesion count compared to BPO/clindamycin at weeks 2, 4, and 6 (a mean of 27% vs 13%, 39% vs 25%, and 40% vs 33%, respectively [all nonsignificant]) and a comparable reduction at week 10 (42% vs 42%). Both regimens were associated with comparable reductions in inflammatory lesion count at all timepoints. Both treatments were generally well tolerated with mean levels of erythema, dryness, peeling, burning/stinging, and itching less than mild (on a scale of none, mild, moderate, and severe) in both groups at all timepoints. Conclusions: Compared with BPO/clindamycin, the 3-step acne system offers numerically greater reductions in the noninflammatory lesion count in the early weeks of treatment in the absence of an antibiotic. It is probable that this improvement in efficacy is a result of the solubilized BPO formulation that enhances the bioavailability and follicular penetration of BPO. Commercial support: OMP, Inc. Background: Acne represents one of the most common reasons for consulting in liberal dermatology. The most recent large French study was carried out on adolescents attending school in mainland France during the school year 1996 to 1997, and excluded young people who were not attending school. No study has been carried out in France on the population of girls aged between 13 and 23. Objective: To describe the prevalence, levels of care, and means of treating acne in adolescents in France today. Methods: A representative sample of the population of girls between 13 and 23 years of age living in France was constituted by the CSA Santé institute, using the quota method (age, geographic location of residence, and professional activity of the head of the family). Questions were asked about skin type, skin phototype, the presence and severity of acne, family history of acne, and therapeutic habits. Results: Within the framework of this study, 1003 girls were questioned and two subpopulations were constituted: the first group was made up of girls aged between 13 and 16, and the second of girls aged between 17 and 23. The groups claimed to have dry skin (12.5%), combination skin (49%), or oily skin (38.2%). There was no difference observed according to age group. They declare their skin to be very pale (14.3%), pale (61.7%), dark (22.51%), and and very dark (1.5%), with no difference observed according to age group. Among the adolescents, 79% of the 13- to 23-yearolds claim to have or have had acne, and among them, 49.9% of the subjects judge their acne to be moderate, 43.3% benign, and 6.8% severe. For 55.4 % of them, their siblings over the age of 12 had acne, for 16.6% there were maternal antecedents, and for 7%, paternal antecedents. One girl out of every two claims to have acne at the moment, and 53% of these judge their acne to be moderate, 39% benign, and 7% severe. Judgement with regard to severity is equal, whether the acne is old or current. Sixty-four percent of the young acne sufferers are under exclusively local treatment, 6% have an exclusively oral treatment, and 30% are being treated with combined local and oral treatments. Treatment methods are statistically different according to age (P \.001): 78% of the 13- to 16-year-olds use an exclusively local treatment versus 49% among the 17- to 23-year-olds, and similarly 4% of the 13- to16year-olds take an exclusively oral treatment versus 8 % of the 17- to 23-year-olds. Discussion: At the moment, therefore, almost 2,000,000 French girls between 13 and 23 years of age suffer from acne, and among them almost 600,000 have no treatment or care. This figure leads us to think that dermatologists should, without a doubt, be even more present in the field of acne treatment. Appropriate information and even a therapeutic educational program would be welcomed. Commercial support: 35% sponsored by Ducray. P715 P717 Psychometric validation of the oily skin self assessment scale (OSSAS) and the oily skin impact scale (OSIS) Carla Mamolo, MD, Pfizer Inc., New London, CT, United States; Jane Harness, MS, Pfizer Inc., New London, CT, United States; Nicola Bonner, Mapi Values, Bollington, Cheshire, United Kingdom; Robert Arbuckle, Mapi Values, Bollington, Cheshire, United Kingdom Objective: The Oily Skin Self Assessment Scale (OSSAS) and Oily Skin Impact Scale (OSIS) are patient-reported outcome questionnaires developed using focus groups to assess facial oily skin severity and the impact of oily skin on emotional well-being, respectively. This study examined the psychometric properties of these questionnaires. Methods: The OSSAS, OSIS, and concurrent dermatology quality of life questionnaires (Skindex and AcneQoL) were administered to 202 adults with oily skin at seven sites across the United States. A subgroup of 152 participants returned 1 to 2 weeks later for testeretest reliability evaluation. Can delivery be enhanced and skin irritation minimized using a lower concentration of benzoyl peroxide in a fixed combination product? Daniel Bucks, Dow Pharmaceutical Sciences, Inc., Petaluma, CA, United States; Arturo Angel, Dow Pharmaceutical Sciences, Inc., Petaluma, CA, United States; James Del Rosso, DO, University of NV, Las Vegas, Las Vegas, NV, United States; Karen Yu, PharmD, Dow Pharmaceutical Sciences, Inc., Petaluma, CA, United States Background: Currently available fixed combination products of clindamycin 1% and benzoyl peroxide (BPO) 5% (clindamycin 1%-BPO 5%) are commonly used in the treatment of acne. Although these formulations are proven to be effective, signs and symptoms of cutaneous irritation limit use in some subjects, with the frequency and/or severity of skin tolerability reactions believed to be caused by the content of BPO and vehicle excipients. The BPO in clindamycin 1%-BPO 5% is maintained in suspension using surfactants; clindamycin is maintained in solution. Many surfactants and BPO itself have been shown to be skin irritants. Studies have demonstrated that irritation caused by BPO is dose-dependent; lower, less irritating concentrations of BPO might be equally effective, but data on comparative efficacy are lacking. Results: Of the 202 participants, 72.8% were female; 64.4% had acne in addition to oily skin. Item reduction analyses were performed on the initial 37-item OSSAS and 14-item OSIS administered to participants. The OSSAS was reduced to 14 items with three domains: (1) sensation [5 items], (2) tactile [3 items], and (3) visual [4 items], plus two individual items: (1) blotting paper and (2) overall oiliness. The OSIS was reduced to six items with two domains: (1) annoyance [3 items] and (2) self-image [3 items]. Confirmatory factor analysis provided support for the construct validity of the final item-scale structures. The OSSAS and OSIS scales had acceptable item convergent validity (item-scale correlations, [0.40) and floor and ceiling effects (\20%). Cronbach alfa coefficients ranged from 0.83 to 0.89 for the OSSAS and 0.82 to 0.87 for the OSIS, demonstrating excellent internal consistency. The a priori criterion for testeretest reliability (ICC $ 0.7) was met for one of the three OSSAS domains (sensation) and one of the two OSIS domains (annoyance). Correlations of the Skindex-29 and AcneQoL scales with the OSSAS (range, -0.08 to -0.38) and OSIS (range, 0.37-0.73) domain scores met content expectations for these scales. OSSAS and OSIS domains distinguished among groups of participants who differed in terms of both patient reported facial oily skin severity (P \.0001) and patient-reported bother associated with oily skin (P \.0001). Objective: To identify a surfactant-free, alcohol-free clindamycin phosphate 1.2% and BPO 2.5% aqueous gel (clindamycin-BPO 2.5%) with formulation-specific properties that enhances percutaneous delivery of micronized BPO and reduces cutaneous irritation. Methods: The first study identified the optimal formulation causing minimal irritation; a single center, evaluator-blind determination of cumulative irritation potential following repeated topical application to healthy subjects of various BPO/vehicle ratios. In a second study, BPO delivery from the clindamycin-BPO 2.5% was compared with two currently available clindamycin 1%-BPO 5% products in an in vitro human skin permeation model. Results: A significant reduction in irritation was seen when the BPO concentration was halved from 5% to 2.5%. BPO levels below 2.5% showed negligible reduction in irritation scores as compared to BPO 2.5%. As a result, the 2.5% BPO concentration was used in the second study. Delivery of benzoic acid using the combination formulation containing BP0 2.5% was equivalent to that delivered from both BPO 5%-containing formulations over the 24-hour duration of exposure. Conclusions: Following item reduction, the OSSAS and OSIS demonstrated strong construct validity, internal consistency, and the ability to discriminate among known groups in participants with a range of oily skin and acne severities. The item-reduced OSSAS and OSIS provide valid self-report measures of facial oily skin severity and the impact of oily skin on emotional well-being, respectively. Conclusions: A surfactant-free, preservative-free aqueous gel containing 2.5% BPO and 1.2% clindamycin phosphate has been developed with percutaneous delivery of BPO equivalent to that seen with fixed combination products containing BPO 5%. Clindamycin-BPO 2.5% offers the potential for similar efficacy and a more favorable tolerability profile as compared to products containing higher concentrations of BPO. Commercial support: 100% sponsored by Pfizer Inc. Commercial support: 100% sponsored by Arcutis Pharmaceuticals, Inc. AB16 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5943_5949 16 January 2009 10:47 am P718 P720 Assessing efficacy of a fixed combination of clindamycin phosphate (1.2%) and low concentration benzoyl peroxide (2.5%) aqueous gel in the treatment of severe acne Guy Webster, Jefferson Medical College, Hoclessin, DE, United States; Michael Gold, MD, Tennessee Clinical, Nashville, TN, United States; Phoebe Rich, MD, Northwest Cutaneous, Portland, OR, United States; Serena Mraz, MD, Solano Dermatology Assoc, Vallejo, CA, United States Background: Oral antibiotics or oral retinoids are often used as primary treatment in the management of severe acne and topical medications secondarily. However, there are additional side effect concerns with the use of systemic treatments. Objective: To evaluate the reduction in inflammatory and noninflammatory lesions and treatment success achieved with a topical combination of clindamycin phosphate and low concentration benzoyl peroxide (clindamycin-BPO 2.5%) in subjects with severe acne and those with moderate acne. Methods: Two thousand two hundred eighty-two subjects with moderate acne and 531 subjects with severe acne were enrolled in two multicenter double-blind studies and randomized 2:2:2:1 to receive a combination of clindamycin phosphate (1.2%) and low concentration benzoyl peroxide (2.5%), each active ingredient or vehicle, once daily for 12 weeks. Efficacy evaluations comprised inflammatory, noninflammatory, and total lesion counts and an evaluator global severity score (EGSS) on a scale from 0 (clear) to 5 (very severe) at baseline and weeks 4, 8, and 12. Results: At week 12, absolute reductions in inflammatory lesion counts with clindamycin-BPO 2.5% from baseline were 14.7 and 14.1 in the severe and moderate acne treatment groups, respectively; absolute reductions in noninflammatory lesion counts were 23.6 and 19.8, respectively; and absolute reductions in total lesion counts were 38.2 and 33.9, respectively. In both severity groups, the efficacy of clindamycin-BPO 2.5% was statistically significant compared with vehicle (P\.001). Treatment success, as judged by a 2-grade improvement in global severity relative to baseline, was 45.5% in the severe acne group and 32.3% in the moderate acne group. In both cases, results were statistically significant compared with vehicle (P # .001). Three times as many subjects with severe acne treated with clindamycin-BPO 2.5% were ‘‘clear’’ or ‘‘almost clear’’ at week 12 (as judged by a 3- or 4-grade improvement in global severity relative to baseline) compared to those treated with vehicle (P ¼ .005). Conclusions: The unique fixed combination of clindamycin-BPO 2.5% aqueous gel once daily is an effective therapy for the management of subjects with severe inflammatory and noninflammatory acne. Clindamycin-BPO 2.5% aqueous gel provides comparable efficacy in this patient group to those with moderate acne and a realistic option in the management of severe acne. Exploration of adherence behavior in teenagers with acne vulgaris: A randomized controlled trial Brad A. Yentzer, PhD, Wake Forest University School of Medicine, Winston-Salem, NC, United States; Adele Clark, PA, Wake Forest University School of Medicine, Winston-Salem, NC, United States; Daniel J. Pearce, MD, Wake Forest University School of Medicine, Winston-Salem, NC, United States; Fabian Camacho, MS, Wake Forest University School of Medicine, Winston-Salem, NC, United States; Steven R. Feldman, MD, PhD, Wake Forest University School of Medicine, Winston-Salem, NC, United States Nonadherence to topical medications is a potential obstacle to the successful treatment of acne. We completed a small exploratory study to assess teenagers’ adherence to once daily topical acne treatment and to investigate potential interventions to improve adherence in acne patients. Patients 13 to 18 years of age with moderate to severe acne were treated with adapalene 0.1% gel once daily for 12 weeks, with randomization to one of four intervention groups (more frequent visits, electronic reminders, parental reminders, or no intervention). Adherence was monitored via electronic Medication Event Monitor Systems (MEMS) caps, product weights, and self-report. The median adherence over 12 weeks was 54% for the no intervention group, 80% for the ‘‘more frequent doctor visits’’ group, 55% for the ‘‘electronic reminders’’ group, and 37% for the ‘‘parental reminders’’ group. Teenagers are not fully compliant with their acne treatment regimens. Our results point to potential targets for improving adherence outcomes. Commercial support: 100% sponsored by Galderma. Commercial support: 100% sponsored by Arcutis. P719 Comparison of the tolerability of benzoyl peroxide microsphere wash versus a gentle cleanser, when used in combination with a clindamycin and tretinoin gel: A multicenter, investigator-blind, randomized study James Del Rosso, Las Vegas Skin and Cancer Clinic, Las Vegas, NV, United States; Leon Kircik, MD, DermResearch, PLLC, Louisville, KY, United States In clinical practice, a major challenge encountered with acne is irritation related to topical medications used for treatment. It remains an important priority for the practitioner to identify treatment regimens that combine efficacy with favorable tolerability and cosmetic acceptability. Advances in topical vehicle technology have enabled the development of newer formulations that are designed to deliver active ingredients with improved cutaneous tolerability profiles. Recently, a wash that incorporates patented microsphere technology has been developed to deliver benzoyl peroxide in a vehicle formulated to maintain a favorable tolerability profile. The focus of this investigation is to evaluate the tolerability of benzoyl peroxide microsphere (BPM) wash 5.5% in combination with a clindamycin and tretinoin gel versus a gentle cleanser and a clindamycin and tretinoin gel in acne vulgaris. Subjects at least 12 years of age with mild to moderate facial acne were randomized (1:1) to receive once daily treatment with one of the cleansers (BPM wash or gentle nontherapeutic cleanser) and a clindamycin 1.2% and tretinoin 0.025% combination gel for 21 days. Tolerability assessments of the signs (erythema, dryness, and scaling) and symptoms (burning/stinging and pruritus) were performed at days 0, 14, and 21. Subject satisfaction regarding the therapy regimen and aesthetic attributes of the cleansers were assessed at day 21. Thirty-one male and female subjects 12 to 46 years of age with mild to moderate facial acne were enrolled and completed the study. Both treatment groups exhibited good local cutaneous tolerability; mean/median scores for signs and symptoms either improved or had no change for the majority of subjects. There were no statistical differences among the two regimens in erythema, dryness, scaling, burning/stinging, or pruritus (all P # 0.16). There were no treatment-related adverse events reported in either group. Similar proportions of subjects in the BPM wash and gentle cleanser groups reported excellent or good overall experience with the regimens, 14 of 15 and 16 of 16, respectively. BPM wash rated highly in aesthetic attributes, including creaminess, gentleness, moisturizing, and postrinse softness. In this study, BPM wash offered the same tolerability profile as a gentle cleanser when used in conjunction with a combination antibiotic and retinoid product and was rated very favorably by subjects in overall treatment experience and aesthetic attributes. Treatment of acne: Photodynamic therapy and micropeeling Stefania Motta, MD, Università degli Studi di Milano, Istituto Clinico Humanitas, Rozzano, Milano, Italy; David Kanah, MD, Università degli Studi di Milano, Istituto Clinico Humanitas, Rozzano, Milano, Italy; Marcello Monti, MD, Università degli Studi di Milano, Istituto Clinico Humanitas, Rozzano, Mialno, Italy Emerging problems with conventional antibiotic, retinoid, and hormonal acne treatments and their related side effects have created a demand for safer treatments. The aim of this study was to evaluate the efficacy of a new acne treatment protocol based on aminolevulinic acid-photodynamic therapy (ALA-PDT) and micropeeling. After undergoing the appropriate washout of any previous treatment, 50 patients with mild to moderate inflammatory facial acne applied a micropeeling lotion containing glycolic and salicylic acid every night for 2 weeks, after which two ALAPDT sessions were scheduled separated by a period of 2 weeks. A polyethylenglycol ointment containing 5% ALA was applied under occlusion for 2 hours and 75 J/cm2 of red light (630 nm) was administered in 8 minutes using a bifacial diode lamp, irradiance 160mW at 50 mm. One week after the PDT session, the patients resumed the topical micropeeling treatment. Each patient’s acne was visually assessed by a spot count of inflammatory and noninflammatory lesions at baseline and after 1, 3, and 6 months of treatment. The acne scores of all of the patients progressively decreased in proportion to their baseline scores. The mean percentage reductions in inflammatory lesions after 1, 3, and 6 months were 62%, 84%, and 96%, respectively. The adverse effects were transient erythema after the PDT sessions. ALA-PDT and micropeeling are effective in reducing mild to moderate acne. ALA-PDT promptly reduces inflammatory acne lesions but is scarcely efficient against comedons and microcysts, which require micropeeling. In our experience, the combination of ALA-PDT and micropeeling is more efficient than conventional therapies in cases of mild and moderate acne.This new drug-sparing treatment can be considered an advance in the treatment of acne. Commercial support: 100% sponsored by SkinMedica, Inc. Commercial support: None identified. P721 MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5943_5949 16 January 2009 10:47 am AB17 P722 P724 Evaluating two different clinical approaches for treating mild to moderate acne Jacqueline Woodruff, MD, Johnson & Johnson Consumer & Personal Products Worldwide, Skillman, NJ, United States; Warren Wallo, MS, Johnson & Johnson Consumer & Personal Products Worldwide, Skillman, NJ, United States Patient-reported outcomes using a fixed combination clindamycin phosphate (1.2%) and low concentration benzoyl peroxide (2.5%) aqueous gel for the treatment of moderate to severe acne in 2813 subjects Jonathan Weiss, Gwinnett Clinical Research Center, Inc., Snellville, GA, United States; Joseph Fowler, MD, Dermatology Specialists Research, Louisville, KY, United States; Karen Yu, PhD, Dow Pharmaceuticals Sciences Inc., Petaluma, CA, United States; Leonard Swinyer, MD, Dermatology Research Center, Salt Lake City, UT, United States Acne is a disease of the skin developing in the presence of excess sebum production and clogged hair follicles, beginning as comedones and potentially developing into papules and pustules in mild to moderate conditions. Consistent and continuous use of a daily acne regimen is an important line of therapy to effectively control the acne condition. This study assesses the efficacy of two separate acne treatment regimens following a 12-week clinical study. A single-blind, investigator-masked, randomized, multicenter study was conducted to evaluate the efficacy of a regimen consisting of a retinoid-based acne treatment cream with ancillary cleanser and moisturizing lotion compared to an acne treatment regimen based in benzoyl peroxide and salicylic acid. Assessments were made using clinical evaluations and self-assessment questionnaires at baseline and weeks 2, 4, 8, and 12. A total of 160 males and females 12 to 30 years of age with mild to moderate acne vulgaris completed this study. One treatment group used a regimen with a 10% benzoyl peroxide cleanser, 2% salicylic acid microgel complex, and a 0.5% salicylic acid lotion. A second treatment group used a multiproduct regimen with a retinoid-based cream. Clinical assessments showed improvements in global acne and total lesion counts for both regimens over 12 weeks. The areas of superiority and those parameters with comparable improvements between the two regimens provide dermatologists with valuable insights in designing therapies for specific patients. Commercial support: 100% sponsored by Johnson & Johnson Consumer & Personal Products Worldwide. Background: Patient-reported assessments are important in evaluating new treatments for acne and a good indicator of increased patient adherence and outcome. Objective: To evaluate the onset and magnitude of improvement achieved with a unique combination of clindamycin phosphate and low concentration benzoyl peroxide (clindamycin-BPO 2.5%) from the subject’s perspective. Methods: Two multicenter double-blind studies in 2813 subjects with moderate to severe acne randomized 2:2:2:1 to receive a combination of clindamycin phosphate (1.2%) and benzoyl peroxide (2.5%), each active ingredient or vehicle, once daily for 12 weeks. Subject Self-Assessment (SSA) of acne severity and degree of improvement were evaluated on a scale from one (clear) to seven (worse) at each postbaseline visit. Subject satisfaction with treatment was evaluated on a scale from one (least satisfied) to ten (most satisfied) at baseline and end of treatment. Results: As early as week 2, a significantly greater number of subjects rated their acne as ‘‘clear’’’ or ‘‘almost clear’’ with clindamycin-BPO 2.5% compared with benzoyl peroxide (P ¼.045) and vehicle (P ¼.002); this difference increased through week 12. At week 12, clindamycin-BPO 2.5% was statistically superior (P\.001 vs all other treatment groups) in the percent of subjects who rated their acne as ‘‘clear’’ or ‘‘almost clear’’ (39.2%) compared with 29.6% on clindamycin phosphate 1.2%, 29.7% on BPO 2.5%, and 16.6% on vehicle. Subjects also reported greater satisfaction with treatment using clindamycin-BPO 2.5% at week 12 than with individual active ingredients or vehicle. The percent of subjects completing the study was highest in the clindamycin-BPO 2.5% group. Conclusions: Based upon patient-reported outcomes, the unique fixed combination clindamycin-BPO 2.5% aqueous gel applied once daily is an effective therapy for subjects with moderate to severe inflammatory and noninflammatory acne. Significant results are seen as early as week 2. By providing rapid and beneficial improvements in acne as perceived by patients, the use of clindamycin-BPO 2.5% may lead to increased patient adherence to treatment and, therefore, to improved clinical outcomes. Commercial support: 100% sponsored by Arcutis Pharmaceuticals Inc. P723 The effect of Er: glass fractional laser and chemical reconstruction of skin scar (CROSS) method in treatment of acne scars: A simultaneous split-face comparison study HeeJung Kim, MPH, Department of Dermatology & Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, SeodaemunGu, South Korea; EunChun Han, MD, Department of Dermatology & Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Seodaemun-Gu, South Korea; JuHee Lee, MD, PhD, Department of Dermatology & Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Seodaemun-Gu, South Korea; KwangHoon Lee, MD, PhD, Department of Dermatology & Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Seodaemun-Gu, South Korea; TaeGyun Kim, MD, Department of Dermatology & Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Seodaemun-Gu, South Korea Background: Acne scars are a common skin condition, but treatment of acne scars are a well known challenge for dermatologists. Numerous treatment options have been proposed. However, there has been no well controlled study comparing the efficacy of 1550nm Er: glass laser and the chemical reconstruction of skin scar (CROSS) method. Objective: We designed the study to compare the efficacy of 1550nm Er: glass fractional laser and CROSS method in the treatment of moderate to severe acne scars. Methods: A split-face trial was conducted in 20 patients with moderate to severe acne scars. One side of the face was treated with 1550-nm Er: glass laser and the other side was treated with CROSS method using 100% trichloroacetic acid for 3 months. Overall effects and side effects were monitored during 12 weeks and after the final treatment session using photography with digital camera, folliscope findings, and 10-point scale assessment evaluated by two individual dermatologists. Patient’s subjective self-assessment was also evaluated. Results: After all of the treatment, statistically significant improvement was demonstrated in both sides of the face. There were no significant differences between both treatment options regarding patient satisfaction. However, it was evident that the 1550-nm Er: glass laser had greater effect on rolling scars, while CROSS method had greater effect on icepick scars. Downtime and lasting erythema were much longer remained in CROSS method group. And there were no significant side effects in 1550-nm Er: Glass laser group. Just one pustule formation and one hyperpigmentation were observed in CROSS method group. Conclusions: A 1550-nm Er: glass fractional laser and CROSS method are both well tolerated and effective treatment options for the treatment of acne scars. However, the objective results demonstrated different effects dependent upon the scar type. Therefore, it may be important to consider the type of acne scar preliminary to select the treatment option. Commercial support: None identified. AB18 P725 Impact of acne on teens: Results from Harris Interactive poll Alan Fleischer, Wake Forest University School of Medicine, Winston-Salem, NC, United States Acne often leads to dissatisfaction with one’s personal appearance. A national survey of teens with acne measured the importance of appearance, impact of acne on individuals’ lives, how people treat acne, and level of knowledge about skin care. Subjects were recruited from the Harris Poll Online database. The 2732 US respondents comprised 1327 teens (13-19 yrs of age) and 514 adults (20-40 yrs of age) with acne, 628 parents of teens with acne, and 263 dermatologists. The survey was conducted in December 2007. Most teens (70%) feel pressure to have clear skin. After weight (32%), skin is the physical attribute that 16% say they would most like to change. Those who have had acne say the more severe the acne the more it impacts self-confidence (69% severe/moderate vs 42% mild), mood (54% vs 28%), and feeling of stress (48% vs 24%). Acne tends to have a greater negative impact on girls than boys. Teens with acne are less happy (mild, 83%; severe/moderate, 74%) than teens without acne (86%), but compared to teens without acne they seem to have better grades in school (33% vs 13%) and greater participation in weekly extracurricular activities (91% vs 74%). Although acne is perceived as a health care issue, 56% of all teen subjects and 54% with more severe/moderate acne are not very knowledgeable about skin care. Only 25% of teens with acne have visited a physician and only 14% have seen a dermatologist. When teens do visit a physician, 63% of teens, 74% of parents, and 43% of dermatologists report that parents initiated the first appointment. Teens (89%) and dermatologists (97%) believe that acne is controllable. But dermatologists (91%) view patient compliance as a treatment barrier, and only 2% say patients follow treatment as prescribed. Half of teens who use acne medications (52%) say they adhere to treatment. Physicianepatient communication is considered satisfactory by 46% of teens who have seen a physician; however, 69% of dermatologists are satisfied. These findings suggest a communication gap among teens and physicians. Despite the availability of improved, effective therapeutic agents, teens continue to suffer the negative impact of acne on quality of life and social relationships. Better communication may help to increase compliance and reduce the impact of acne. Commercial support: Harris Interactive Poll sponsored by OrthoNeutrogena; poster printing costs sponsored by OrthoNeutrogena. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5943_5949 16 January 2009 10:47 am P726 P728 Enhanced follicular delivery of salicylic acid in vivo by a novel microgel technology Theresa Chen, MD, Neutrogena Corporation, Los Angeles, CA, United States; I-Ting Wu, MS, Neutrogena Corporation, Los Angeles, CA, United States; Jeff Wu, PhD, Johnson & Johnson Consumer & Personal Products, Skillman, NJ, United States; Nhan Cao, Neutrogena Corporation, Los Angeles, CA, United States The role of parents in the acne of current adolescents in France: CREDOC survey May 2007 Clarence de Belilovsky, Institut Alfred Fournier, Paris, France; Franck Lehuede, Credoc, Paris, France; Nathalie Laforest, Laboratoires Expanscience, Courbevoie, France; Raphael Berger, Credoc, Paris, France Follicular biopsy is a useful method for assessing the penetration of topical drugs into sebaceous follicles. Such penetration is mechanistically important for topical acne medication like salicylic acid, which works by effecting the desquamating and keratolytic actions on infundibulum. Treatment formulations that can break through sebum plugs should be able to boost targeted delivery of salicylic acid into the follicles where acne begins. A novel microgel complex was previously shown to promote sebum solubilization and enhance delivery of salicylic acid into the skin. Using follicular biopsy and a newly developed 2-dimensional fluorescence imaging method, we report here that this novel microgel complex can also enhance delivery and penetration of salicylic acid into the follicles in vivo. Three different formulations (a cleanser, a scrub, and a leave-on gel) containing salicylic acid and the microgel complex were evaluated with their corresponding ‘‘no microgel’’ controls side-by-side using a split-face design. Each formulation pair was tested on a minimum of three subjects with a test formulation on one side and its control on the other side of the nose following a randomization table. Follicular biopsy samples were taken using a cyanoacrylate adhesive coated glass plates from each side of the nose after product application. The comedonal plugs were harvested and analyzed by high performance liquid chromotography to determine the levels of salicylic acid penetration by test formulations and controls. The results showed that all three test formulations with the microgel complex were able to deliver more salicylic acid into the follicles than their corresponding controls without the microgel complex. Furthermore, in the 2-dimensional fluorescence imaging, test formulations with the microgel complex appeared to enhance salicylic acid penetration deeper and more uniformly in the comedonal plugs. These results also suggest that the novel microgel complex enables greater penetration of salicylic acid in vivo, presumably because of its superior sebum dissolving capability. Commercial support: 100% by Neutrogena Corporation. Objectives: In order to determine the role of parents in the acne of adolescents, the CREDOC (Research Centre for the Study and Monitoring of Living Standards) conducted a telephone survey in May 2007. Parents of adolescents with acne were interviewed and their answers were compared to the answers of adolescents who have or had acne. Methods: Five hundred seventy-seven parents of adolescents with acne 13 to 24 years of age were contacted. In parallel, 398 adolescents with acne 13 to 24 years of age were also surveyed. The parents and adolescents questionnaires were similar: age at onset of acne, severity, impact on quality of life, physician consulted, factors influencing acne, means of information, cosmetic and therapeutic habits, and existence of conflicts because of the acne. Results: Mothers take care of the acne problems in their children in 89% of cases. Parents are more concerned by the acne of their children than the adolescents themselves: 40% great concern versus 25%. They judge this acne as being more severe: 51% considered as minimal versus 66% for the adolescents. The parents consider that the adolescent is bothered to a greater extent in his or her relationships with others than is actually the case (no difficulty 45% vs 64%). Their level of knowledge is slightly higher than that of the adolescents: harmful seborrhea for 84.5% versus 76% and harmful unsuitable cosmetics for 92% versus 67%. Acne is not a source of conflict with the adolescent (86% of cases). The parents accompany the adolescents to their medical consultations in 77% of cases. They are the ones to recommend the cosmetics in most cases, followed by pharmacists and physicians. For the adolescents, after parents come friends, well before the health professionals. The parents encourage the adolescents to apply their cosmetics in 40% of cases (18% according to the adolescents) and to take their treatments in 48% of cases (28% according to the adolescents). Seventy-three percent of parents have tried to inform themselves about acne (vs 51% of adolescents). Their information sources are less diversified (a single source in 45% of cases). They mainly include physicians and pharmacists. The television and internet are cited three times less often than by the adolescents, and magazines two times less often. Conclusion: The parentechild relationship seems good regarding acne. The parents are more concerned and also more proactive than the adolescents. Commercial support: 100% sponsored by Laboratoires Expanscience. P729 P727 Addressing the role of free radical oxidation in the acne paradigm Otto H. Mills, Jr, MD, UMDNJeRobert Wood Johnson Medical School, New Brunswick, NJ, United States; Ernest Szoke, JD, Ernest Szoke, Doylestown, PA, United States; Michelle Welch, MD, Dermatology of Lexington, LLC, Lexington, SC, United States; Robert J. Verdicchio, PhD, Verdi Enterprises Inc., Succasunna, NJ, United States For decades, texts have listed three abnormalities in acne vulgaris: (1) excessive sebum production, (2) follicular epithelial hyperkeratosis, and (3) rupture of follicular epithelium This presentation focuses on the role of free radical oxidation in the pilosebaceous unit and resulting changes. Oxidative stress has been studied by a number of investigators and reported in the literature. Lipid and intracellular peroxides are formed by free radicals. Peroxides are released by maturing keratinocytes and peroxidation of sebum components. The free radicals are generated via ultraviolet light, chemical, mechanical, and environmental sources. Emotional stress can also lead to free radicals via neuron transfer of electrons at the cellular level. With regard to sebum production, lipid peroxidation of fatty acids and unsaturated triterpines such as squalene generate reactive oxygen species, which can alter the viscosity of sebum and contribute to further changes. The oxidants generated by lipid peroxidation play multiple roles in forming the hyperkeratinous impactions. These powerful oxidants are capable of comedogenic and enhanced comedogenic potentiation and their action on polyunsaturated lipids can further decompose to malondialdehyde. Lipid peroxides can induce an inflammatory response in the follicle’s walls, leading to a weakening, rupture, and release of the follicular contents (lipids, cellular material, keratin, and microorganisms) into the surrounding tissue. Further elucidation of the role of free radical oxidation in acne would seem warranted. Also, with a view to limiting oxidation, consideration was given to including topically applied antioxidants (vitamin E in linoleic acid) along with comedolytic (1% salicylic acid) and low strength antimicrobial (4% benzoyl peroxide) agents. Commercial support: 100% sponsored by JSJ Pharmaceuticals. Clinical evaluation of human embryonic stem cell for treating rosacea: An open study Tanweer Syed, Syed Skin Care, Inc., San Francisco, CA, United States; Seyed Ali Ahmad, MS, University of California Berkeley, Department of Chemistry, Berkeley, CA, United States; Timothy Andersson, MD, PhD, Syed Skin Care, Inc., San Francisco, CA, United States; Wendy Wong, PhD, Syed Skin Care, Inc., San Francisco, CA, United States Objective: To ascertain the clinical efficacy, tolerability, safety, and beneficial effects of hESC (derived from human blastocyst, purified with a proprietary technique using duplicate high-tech microscope and cryopreserved) induced to cure papulopustular rosacea. Methods: Preselected subjects (n ¼ 20; 9 males and 11 females) between the ages of 20 to 70 years having visible clinical signs of papulopustular rosacea were recruited for the study. Each subject was allocated a precoded disposable vial/syringe containing hESC in a vehicle 0.5 mL. Each allocated vial was administered intravenously to the patient by the principal investigator, and patients were directed to visit the clinic on weekly basis as scheduled for the following 6 weeks (baseline) and later on monthly basis for 12 months. To monitor posttreatment experience, subjects were given a log to record their daily experience. Cure was defined as the absence of complete clinical signs of treated inflammation with no flushing and telangiectasia. Photographic and optical techniques were used both at the baseline and on schedules visits. Results: The study was well tolerated by all the patients. By the end of the treatment, all the patients reported marked clinically beneficial improvement. The most frequently documented signs of rosacea were papules (13), erythema (3), and telangiectasia (4). Subjects were followed for 2 years after the baseline, and the results indicated that patients were very pleased with the dramatic change and improvement in their lifestyle with no relapse. Patient reported no adverse events or any allogenic rejection. Conclusion: The study demonstrates that hESC in a proprietary vehicle by intravenous is safe, tolerable, and significantly more beneficial in contributing superior clinical efficacy to cure papulopustular rosacea. Further clinical studies are recommended. Commercial support: 75% paid by Syed Skin Care, Inc. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5943_5949 16 January 2009 10:47 am AB19 P730 P732 Patient experiences with oily skin: The development of two new patientreported outcome questionnaires Jane Harness, DO, Pfizer Inc., New London, CT, United States; Diane Thiboutot, MD, The Milton S. Hershey Medical Center, Hershey, PA, United States; Ulrike Blume-Peytavi, Department of Dermatology and Allergy, Berlin, Germany; Zoe Draelos, MD, Clinical Dermatology Center, High Point, NC, United States Surgical and acne scars: New approach wich fractional photothermolysis Otavio Macedo, MD, Clı́nica Dr. Otávio Macedo Ltda., S~ao Paulo, Brazil; Cristine Wippel, MD, Clı́nica Dr. Otávio Macedo Ltda., S~ao Paulo, Brazil; Maria Bussade, MD, Clinica Dr. Otávio Macedo Ltda, S~ao Paulo, Brazil; Marisa Fujimura, MD, Clinica Dr. Otávio Macedo Ltda, S~ao Paulo, Brazil Objective: To develop two new patient-reported outcome (PRO) questionnaires to assess facial oily skin severity and the impact of oily skin on emotional well-being. Methods: A discussion guide was developed, using input from patient focus groups (n ¼ 42 participants), expert clinicians (n ¼ 3), and a review of the relevant literature. The discussion guide was used to direct qualitative inquiry about oily skin in focus groups conducted using the Internet. These Internet focus groups (IFGs) were conducted with German (n ¼ 26) and American (n ¼ 28) sufferers of oily skin. Questionnaire items were generated using qualitative data from the IFGs. Cognitive debriefing by interview was performed over the Internet (n ¼ 42) and face to face (n ¼ 5) to assess the comprehension of the items. Results: In the IFGs, there were equal numbers of male and female participants; the mean age was 35.4 years. Participants reported having oily skin for an average of 15.2 years, and 74% (n ¼ 40) reported having mild to moderate acne. Facial oiliness was evaluated by participants using one or more of three distinct methods: (1) visual, (2) tactile, and (3) sensory (ie, the feeling of skin without touching it). Oily skin had both an emotional and social impact and was associated with feelings of unattractiveness, self-consciousness, embarrassment, irritation, and frustration. From the IFGs and previous research, items were generated for a questionnaire of facial oily skin severity (Oily Skin Self-Assessment Scale) and a questionnaire of the impact of oily skin on emotional well-being (Oily Skin Impact Scale). Cognitive debriefing resulted in minor changes to the draft items and confirmed the face and content validity of the items tested. Summary: The research conducted provides insight into the experience of having oily skin and illustrates significant difficulties associated with the condition. Two PRO questionnaires were developed to measure the severity and emotional impact of oily skin; the development process employed conformed with recently released US Food and Drug Administration guidelines for the development of PRO questionnaires. The focus group participants included both genders, individuals with and without acne, a range of oily skin severities, ethnicities, and ages, thus ensuring the resulting instruments will be applicable to the majority of oily skin sufferers. Psychometric validation of these questionnaires has also been performed (reported elsewhere). Background: Fractional photothermolysis (FP) is a novel concept of resurfacing for treatment of facial acne scars and surgical scars. Surgical scars and postacne scarring is a challenging condition despite various currently available techologies. The aim of this poster is to evaluate the efficacy of a Fraxel laser (Relyant Technologies, CA), a 1550-nm erbium-doped laser, for scar treatment. Methods: A total of 20 patients (aged 20-55 yrs) were recruited; these patients had Fitzpatrick skin types I to IV with moderate to severe facial acne scars and postsurgical scars on the breasts, abdomen, and forehead. Four to five sessions of Fraxel laser were performed 2 to 4 weeks apart. Patients were evaluated using standardized digital photography (Canfield Visia CR System) before the first treatment session and 1 month after the final treatment. Clinical improvement scores comparable photographs using a grading scale (0 ¼ \25%, 1 ¼ 25-50%, 2 ¼ 51-75%, and 3 ¼ [75% improvement) were made independently by medical assessors after treatments. Results: FP improved the appearance of scars after 4 to 5 sessions of treatment. Medically assessed degrees of improvement were as follows: 40% of patients on grade 3, 50% on grade 2, and 10% on grade 1. Adverse events were limited to transient pain, erythema, and edema. One patient developed herpes simplex virus outbreaks on lips. Patient assessement was as excellent improvement in 70%, significant improvement in 20%, and moderate improvement in 10%. The improvement was persistent at 3 and 6 months of follow-up. Conclusions: FP offers a safe and effective modality for scars treatment and is associated with significant patient-reported improvement in the appearance of acne and surgical scars with minimal downtime. Commercial support: None identified. Commercial support: 100% sponsored by Pfizer Inc. P733 P731 An evaluation of the acceptance of metronidazole gel 1% when used with facial cosmetics in rosacea patients Zoe D. Draelos, MD, Dermatology Consulting Services, High Point, NC, United States; Lori A. Johnson, PhD, Galderma Laboratories, L.P., Fort Worth, TX, United States; Luz E. Colon, MS, Galderma Laboratories, L.P., Fort Worth, TX, United States; Ronald W. Gottschalk, MD, Galderma Laboratories, L.P., Fort Worth, TX, United States Rosacea is a chronic inflammatory skin disorder of unknown etiology. It is characterized by flushing and redness on the cheeks, nose, chin, and/or forehead and can progress to inflammatory papules/pustules and telangiectasia. These symptoms can flare with environmental triggers, such as alcohol consumption, spicy foods, stress, sunlight, extreme temperatures, and irritating facial products. While there are effective topical and systemic treatments available, there is no cure. In the United States, rosacea affects about 14 million adults with three times as many women than men. Because there are many women affected by this disease, the formulation of the topical products must combine the active agent in an optimized vehicle to achieve an aesthetically pleasing formulation that is compatible with cosmetics. Studies have indicated that metronidazole gel, 1% (Galderma Laboratories, Fort Worth, TX) applied once daily can effectively reduce the inflammatory lesions and redness associated with rosacea. An observational study was conducted to evaluate the cosmetic appearance of topical metronidazole gel 1% when used with commonly marketed facial foundations. Thirty female patients with moderate rosacea (Global Severity Score of 3, with moderate erythema, several small or large papules/pustules and up to two nodules) enrolled at one site in the United States. Patients applied topical metronidazole gel 1% once daily and then applied their routinely used facial foundation for a period of 2 weeks. Patients self-assessed the cosmetic appearance of their topical treatment with their facial foundation and maintained a diary. The evaluator also assessed the cosmetic appearance of the topical treatment with facial foundation in addition to making assessments of the treatment by reporting erythema severity, Global Severity Score, and tolerability at baseline and at week 2. A set of four standardized questions were used by the patients and investigators to assess the cosmetic appearance postapplication of the treatment drug. The results of this observational study indicated that while using metronidazole gel 1%, the patients were able to continue their routine cosmetic application without affecting the cosmetic product’s performance. In addition, the efficacy of metronidazole gel 1% was not compromised when used with facial foundations. Representative photos document the compatibility of metronidazole gel 1% with cosmetics and will be included in the presentation. Commercial support: Study and poster support provided by Galderma Laboratories, L.P. AB20 A descriptive study to determine drug class prescribing characteristics amongst age, physician specialty, and regions of the United States Rajesh Balkrishnan, MD, Ohio State University, Columbus, OH, United States; Adam Uhas, Ohio State University, Columbus, OH, United States; Erin Reese, MD, Wake Forest University School of Medicine, Winston-Salem, NC, United States; Jeff Hick, MD, Wake Forest University School of Medicine, Winston-Salem, NC, United States; Steven Feldman, MD, PhD, Wake Forest University School of Medicine, Winston-Salem, NC, United States Background: The dermatologic condition of acne is a very prevalent disease that affects most of the population at specific periods of their lives. While adolescents are the most widely affected by the disease state, approximately one-third of all patients seen in the office for treatment of acne are 25 years old or older. It is believed that most patients continue to be affected by the condition because of bacterial resistance. The purpose of this particular study was to examine the most common treatment classes based on drug class and the describe the differences in prescribing methods across age group, physician specialty and region of the United States in which the patient lived. Determining the most commonly prescribed medications will allow physicians a continuum of care for those who do not respond well to previous therapies. Methods: The information was collected from the PharMetrics Integrated Patientcentric Database, a large collection of administrative claims. At the time of this analysis in 2004, there were more than 80 public and private health care plans included in the database, representing approximately 9.6 million unique patients. Analysis was performed using the Total Resource Utilization (TRU) Benchmarks process. This method organizes and separates information from a third-party database into accessible benchmarks for comparison. Results: Upon analysis of the data, it was determined that the most commonly prescribed medications were: new generation retinoid products, benzoyl peroxidebased combo products, topical corticosteroids by prescription only, topical antibiotics, common topical retinoid products, oral antibiotics, and antidepressants and benzodiazepines in some age categories. These results were then factored against age groups. The age group break down is as follows: 0-11, 12-14, 15-17, 18-24, 24-35, and 36-64. Each medication was then compared not only with each age group but by physician specialty and region of the United States in which it was prescribed. These descriptive characteristics can be easily arranged into tables outlining the differences in each prediscussed characteristic. Conclusion: It was determined that significant differences do in fact occur in all three factors: age group, physician specialty, and region of the United States. The discrepancies can be clearly observed, and on physician to physician bases one can determine if their own particular prescribing method is appropriate. Commercial support: 100% supported through an unrestricted educational grant from Galderma Laboratories, L.P. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5943_5949 16 January 2009 10:47 am P734 P736 Efficacy and tolerability of a combination of encapsulated benzoyl peroxide, salicylic acid, and a botanical blend for treatment of adult acne Hanh Pham, MD, PhD, Mary Kay, Inc, Addison, TX, United States; Brian Jones, PhD, Mary Kay Inc., Dallas, TX, United States; Leslie Baumann, MD, University of Miami, Miami Beach, FL, United States; Michelle Hines, PhD, Mary Kay, Inc., Dallas, TX, United States Acne and quality of life: The pertinence of the CADI score Florence Poli, MD, MS, Dermatologyst, Paris, IDF, France; Charles Taieb, MD, Public Health and Quality of Life, PFSA, Boulogne Billancourt, IDF, France; Marco Ambonati, MD, Laboratoires Dermatologiques Ducray, Lavaur, Midi Pyrénées, France; Sami Boussetta, PhD, Public Health and Quality of Life, PFSA, Boulogne Billancourt, IDF, France More than half of women have experienced mild to moderate acne at some time in their adult lives. Similar to teenage acne, lesions develop in part because of abnormal hyperkeratinization of the follicle, excess sebum production, bacterial proliferation, and inflammation. We hypothesized that treatment of all four contributing parameters would alleviate facial acne resulting in reduced acne lesions and associated skin irritation. In the current study, we tested a combination product regimen including a cleanser containing 2% salicylic acid (SA), facial lotion with 4% benzoyl peroxide (BPO), and spot treatment with 8% BPO. The regimen cleanser containing surfactants helps remove excess sebum from the skin surface and treats abnormal follicular hyperkeratinization (SA) while the lotion and spot treatment contain materials to reduce bacterial proliferation (BPO) and inflammation (botanical blend), a mix of plant extracts which has demonstrated in vitro antiinflammatory benefit. To further reduce the likelihood of adverse skin reactions, BPO was encapsulated using patented technology silica gel to help control direct contact with the skin. A 12-week, baseline control, clinical study was conducted to evaluate the efficacy of a 3-step regimen. Forty-four healthy females 21 to 45 years of age with mild to moderate acne participated in this clinical trial. Patients were clinically assessed for lesion counts (inflammatory and noninflammatory), skin texture, even skin tone, and overall acne severity improvement at day 3 and week 1, 4, 6, 9, and 12 visits. After 3 days, significant reductions in both inflammatory (20%) and noninflammatory (34%) lesion counts were observed. The improvements in lesion counts significantly increased over the 12-week period, with a 76% reduction for noninflammatory and a 64% reduction for inflammatory lesions. In addition, skin tolerant assessments for erythema, scaling/peeling, edema, tightness, burning/stinging, and itching were evaluated at all study visits. Significant reductions in erythema and tightness were observed throughout the course of the study. No study related adverse event was observed. Overall, the acne regimen was shown to be very well tolerated. Rationale: Any highly-visible dermatosis has repercussions with regard to quality of life, and dermatologists are more and more aware of this. This is particularly true for acne, bearing in mind that the quality of life for girls with acne is affected more than it is for boys with acne. Commercial support: Mary Kay, Inc. Objective: To assess the impact of acne in terms of quality of life for girls between 13 and 23 years of age. Methods: A representative sample of the population of young girls between 13 and 23 years of age living in France was constituted by the CSA Santé institute, using the quota method (age, geographic location of residence, and professional activity of the head of the family). Questions were asked about the presence and severity of acne. The CADI test was also used during the interview. The particularity of our assessment resides in the fact that the severity of the acne was evaluated by the girls themselves. Results: Within the framework of this study, 1003 girls were questioned and two subpopulations were constituted according to age: the first group was made up of girls between 13 and 16 years of age, and the second of girls between 17 and 23 years of age. No difference was observed in terms of score for quality of life in subjects aged between 13 and 16 versus subjects aged between 17 and 23 (Cadi score 5.57 [63.38] for the first group and 5.26 [63.30] for the second; P ¼ .03). A far greater change in the quality of life is observed when the acne is judged by the patient to be severe; indeed, for girls who esteem their acne to be slight, moderate, or severe, the CADI score is, respectively, 4.03 (62.67), 5.96 (63.25), and 9.58 (63.12; P \.001. The change according to the assessed severity is observed as much in the younger subjects as in the older ones. The quality of life for subjects with oily skin is more greatly affected than subjects with dry skin (6.12 vs 5.10; P \.01). Discussion: A recent study has shown that there is no correlation between global scores in the ECLA and CADI scales (r2 ¼ 0.0242). Only the global score of severity on the ECLA scale correlated significantly with one part of the CADI questionnaire, which involved the subject’s perception of her acne (P ¼ .0035). A positive correlation was observed between the global CADI score and factors (F1 and F3) reflecting the extent of inflamed lesions (P ¼.0085 and P ¼.0373, respectively). In publications, it can be observed that the severity score assessed by dermatologists does not correlate to quality of life; however, quality of life does correlate to severity when the latter is self-assessed by the subject. This would seem to show that dermatologists underestimate the impact of acne on their patients. The CADI test ought to be proposed systematically during the first consultation. Commercial support: None identified. P737 Blue light therapy as self-care in the treatment of mild to moderate acne Michael Gold, MD, Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, United States; Anneke Andriessen, RN, RBC Consultants, Malden, Gelderland, the Netherlands; Julie Biron, Tennessee Clinical Research Center, Nashville, TN, United States P735 A combination acne regimen using encapsulated benzoyl peroxide, salicylic acid, and a botanical blend for treatment of teenage patients Michelle Hines, MD, Mary Kay, Inc., Dallas, TX, United States; Brian Jones, PhD, Mary Kay, Inc., Dallas, TX, United States; Hanh Pham, MS, Mary Kay, Inc., Addison, TX, United States; James Leyden, MD, KGL Skin Study Center, Broomall, PA, United States Acne vulgaris is a skin condition most common during adolescence. Mild to moderate acne affects approximately 85% of teenagers. Acne lesions form in part because of abnormal hyperkeratinization of the follicle, excess sebum production, and bacterial proliferation which leads to inflammation and skin redness. These factors contribute to the genesis and exacerbation of acne lesions. In the current study, we tested a combination product regimen including a cleanser containing 2% salicylic acid (SA), facial lotion with 4% encapsulated benzoyl peroxide (BPO), and spot treatment with 8% encapsulated BPO. The regimen cleanser containing surfactants helps remove excess sebum from the skin surface and treats abnormal follicular hyperkeratinization (SA), while the lotion and spot treatment contain materials to reduce bacterial proliferation (BPO) and inflammation (botanical blend), a mix of plant extracts which has demonstrated in vitro antiinflammatory benefit. To further reduce the likelihood of adverse skin reactions, BPO was encapsulated using patented technology silica gel to help control direct contact with the skin. We hypothesized that treatment of all contributing parameters would alleviate facial acne resulting in reduced acne lesions and associated skin irritation. A 12-week, baseline control, clinical study was conducted to evaluate the efficacy a 3-step regimen. Twenty-two healthy males and females 12 to 20 years of age with mild to moderate acne participated in this clinical trial. Patients were clinically assessed for lesion counts (inflammatory and noninflammatory), skin texture, even skin tone, and overall acne severity improvement at day 3 and weeks 1, 4, 6, 9, and 12. After 4 weeks, inflammatory lesion counts reduced by 31%. By week 12, there were significant improvements in both noninflammatory and inflammatory lesion counts (47% and 56%, respectively). In addition, safety tolerability was assessed at all study visits. There was no significant increase in any of the tolerant attributes: erythema, edema, scaling/peeling, tightness, burning/itching, and stinging. No adverse event was observed by any subject, and the test regimen was clinically shown to be very well tolerated. Commercial support: Mary Kay, Inc. Introduction: Phototherapy with visible light, specifically blue light, has been shown to improve skin condition in cases of acne and blemishes. This was an institutional review boardeapproved evaluation on self-diagnosis and self-treatment administration with blue light (TC) therapy for mild to moderate acne. Methods: Subjects (N ¼ 21) were included after selection according to the inclusion/exclusion criteria and after they had consented. The study concerned the number of subjects that were: able to demonstrate a correct understanding of the provided Acne Self Diagnosis Chart; able to identify their condition correctly; able to demonstrate a correct understanding of the device and its application; and the number of subjects that demonstrate confidence in the use of TC without supervision by a doctor. The study also evaluated the subjects’ understanding of the labelled. Warnings and precautions: Tests were carried out at the 5% significance level, statistical evaluation was performed using StatXact 5.0 (double sided ¼ 0.05; paired sample with Wilcoxon signed-rank test; repeated measures analyses of variance (ANOVA), unpaired with Mann-Whitney test). Twenty-one subjects concluded the study (18 females and 3 males) with a mean age of 31 years. Of the subjects, 71% (n ¼ 15) estimated to have \30 lesions and 29% (n ¼ 6) estimated to have between 30 and 125 lesions. Fifty-two percent (n ¼ 11) of the subjects judged their acne to be mild and 48% (n ¼ 10) estimated to have moderate acne. Results: The clinician’s observations confirmed the findings of the subjects and showed that all 21 subjects indeed had mild to moderate acne. The subjects expressed that the self-diagnosis chart gave a clear description of different types of acne and helped in recognizing their acne type. The information given was readily understood. The subjects expressed confidence recognizing their acne type correctly when using the chart. The general opinion of the subjects on the use of the chart was good. Further subjects expressed confidence in the use of TC for selftreatment without the supervision of a doctor. Regarding their current treatment, subjects expressed not to be satisfied and expected TC treatment to be better for their condition than their current treatment. Conclusion: It was concluded that subjects were able to correctly recognize their type of acne when using the self diagnosis chart and that they were able and confident to safely administer self treatment of TC for improvement of their skin condition. Commercial support: 100% sponsored by Pharos Life. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5943_5949 16 January 2009 10:47 am AB21 P738 P740 Efficacy of a fixed combination clindamycin phosphate (1.2%) and low concentration benzoyl peroxide (2.5%) aqueous gel in moderate to severe acne Diane Thiboutot, MD, GCRC Penn State University College of Medicine, Hershey, PA, United States; Alan Shalita, MD, SUNY Downstate Medical Center, Brooklyn, NY, United States; Andrea Zaenglein, MD, Milton S. Hershey Medical Center, Hershey, PA, United States; Barry Calvarese, MS, Dow Pharmaceutical Sciences Inc., Petaluma, CA, United States Managing moderate to severe acne in adolescents: Benefits of a fixed combination clindamycin phosphate (1.2%) and low concentration benzoyl peroxide (2.5%) aqueous gel in a subpopulation of 1755 subjects Fran Cook-Bolden, MD, New York, NY, United States; Diana Chen, MD, Arcutis Pharmaceuticals Inc., Redwood City, CA, United States; Lawrence Eichenfield, MD, Rady Children’s Hospital, San Diego, CA, United States; Linda Stein-Gold, MD, Henry Ford Medical Center, Detroit, MI, United States Background: Acne is a common problem in adolescents and may have significant psychological and social ramifications. Selecting an effective, quick-acting therapy is an important consideration in treating adolescents and encouraging patient adherence in this often difficult to treat group. Objective: To evaluate the efficacy of clindamycin phosphate and low concentration benzoyl peroxide (clindamycin-BPO 2.5%) in reducing inflammatory and noninflammatory lesions in adolescents with moderate to severe acne. Methods: Two thousand eight hundred thirteen subjects with moderate to severe acne were enrolled in two multicenter double-blind studies, and randomized 2:2:2:1 to receive clindamycin-BPO 2.5%, each active ingredient or vehicle, once daily for 12 weeks. Efficacy in a subpopulation of 1755 subjects aged 12 to \18 years was analyzed by inflammatory, noninflammatory, and total lesions count and dichotomized evaluator global severity score (EGSS). Subject Self-Assessment (SSA) of acne severity and degree of improvement was also evaluated. Results: At week 12, the mean percent reduction (54.1%) in inflammatory lesion count relative to baseline for the clindamycin-BPO 2.5% group was significantly greater than vehicle (21.1%, P \.001). The reduction in noninflammatory lesions was 43.6% and 16.7%, respectively (P\.001), and in total lesions was 47.7% and 19%, respectively (P \ .001). The 2-grade reduction in EGSS for clindamycin-BPO 2.5% was statistically superior to vehicle (P \.001) from week 8 through week 12. Approximately 33% of subjects on clindamycin-BPO 2.5% had a 2-grade reduction in EGSS by week 12, compared to approximately 12% for vehicle (P\.001). More than one quarter (26.8%) of subjects in the clindamycin-BPO 2.5% group were ‘‘clear’’ or ‘‘almost clear’’ at week 12 compared to 9.0% with vehicle (P\.001). As early as week 2, a statistically greater percent of subjects rated their acne as ‘‘clear’’ or ‘‘almost clear’’ with clindamycin-BPO 2.5% compared to vehicle (P ¼.010) which continued through the end of treatment. At week 12, 39% of subjects in the clindamycin-BPO 2.5% judged their acne to be ‘‘clear’’ or ‘‘almost clear’’ compared to 15.5% on vehicle (P \.001). Conclusions: The unique fixed combination clindamycin-BPO 2.5% aqueous gel is an effective therapy for adolescents with moderate to severe inflammatory and noninflammatory acne. A fast onset of action and patient satisfaction may lead to increased patient adherence to treatment and improved clinical outcomes. Background: The benefits of combination therapy for acne are well recognized. Studies have shown that the combination of clindamycin 1% with benzoyl peroxide (BPO) 5% is superior to each individual active ingredient. Dryness and irritation from BPO limits use of the combination in some patients and is concentration-dependent. Studies have also shown that lower concentrations of BPO may be as efficacious as higher concentrations. Objective: To evaluate the efficacy of a combination clindamycin phosphate and low concentration BPO (clindamycin-BPO 2.5%) in reducing inflammatory and noninflammatory lesions in moderate to severe acne. Methods: Two multicenter double-blind studies in 2813 subjects with moderate to severe acne randomized 2:2:2:1 to receive a combination of clindamycin phosphate (1.2%) and BPO (2.5%), each active ingredient or vehicle, once daily for 12 weeks. Efficacy evaluations comprised inflammatory, noninflammatory, and total lesion counts and an evaluator global severity score (EGSS) at weeks 4, 8, and 12. Results: At week 12, the mean percent reduction in inflammatory lesion count relative to baseline (54.6%) in the clindamycin-BPO 2.5% group was significantly greater than with clindamycin phosphate 1.2% (46.2%), BPO 2.5% (47.5%), or vehicle (29%; all P \.001). The percent reduction in noninflammatory lesions were 43.2%, 36.2%, 37.4%, and 24%, respectively (all P # .001); the percent reduction in total lesions were 47.9%, 40.4%, 41.6%, and 26.2%, respectively (all P \ .001). Treatment success (2-grade improvement in EGSS) for clindamycin-BPO 2.5% was statistically superior to clindamycin phosphate 1.2%, BPO 2.5%, and vehicle from week 4 (all P # .009) through week 12 (all P\.001). Approximately 35% of subjects on clindamycin-BPO 2.5% were a treatment success by week 12 versus approximately 17% for vehicle (P \.001). In 28.6% of subjects in the clindamycin-BPO 2.5% group, investigators judged acne to be ‘‘clear’’ or ‘‘almost clear’’ at week 12 compared with 12.7% for vehicle (P \.001). Conclusions: The unique fixed combination clindamycin-BPO 2.5% aqueous gel is an effective topical therapy for patients with moderate to severe inflammatory and noninflammatory acne. Based on the data reported in the literature, clindamycinBPO 2.5% appears to have a similar magnitude of efficacy as available fixed dose combinations of clindamycin and higher concentration BPO (5%) in acne, with the benefit of once daily application. Commercial support: 100% sponsored by Arcutis Pharmaceuticals Inc. AGING/GERIATRICS Commercial support: 100% sponsored by Arcutis Pharmaceuticals Inc. P739 P800 Safety and cutaneous tolerability of a fixed combination clindamycin phosphate (1.2%) and low concentration benzoyl peroxide (2.5%) aqueous gel for the once-daily treatment of moderate to severe acne Diane Thiboutot, MD, GCRC Penn State University College of Medicine, Hershey, PA, United States; Alan Shalita, MD, SUNY Downstate Medical Center, Brooklyn, NY, United States; Andrea Zaenglein, MD, Milton S. Hershey Medical Center, Hershey, PA, United States; Roberto Cortes, MD, Arcutis Pharmaceuticals Inc., Redwood City, CA, United States Background: Studies have shown that the combination of clindamycin 1% with benzoyl peroxide 5% (BPO) is effective in the treatment of acne. Dryness and irritation from the BPO component are limiting side effects of the combination in some subjects. It has been demonstrated that lower concentrations of BPO are less irritating. Objective: To evaluate the safety and cutaneous tolerability of a combination of clindamycin phosphate and low concentration benzoyl peroxide (clindamycin-BPO 2.5%) in subjects with moderate to severe acne. Methods: Two multicenter double-blind studies in 2813 subjects with moderate to severe acne were randomized 2:2:2:1 to receive a combination of clindamycin phosphate (1.2%) and low concentration BPO (2.5%), each active ingredient or vehicle, once daily for 12 weeks. Cutaneous safety evaluations included erythema and scaling. Tolerability evaluations included itching, burning, and stinging. Safety was evaluated through reported adverse events. Intergenerational and intrafamilial relationship of facial skin aging appearance Akira Matsubara, MD, Procter & Gamble Japan K.K., Kobe, Japan; Kesyin Hsueh, Procter & Gamble Japan K.K., Kobe, Japan; Megumi Watanabe, Procter & Gamble Japan K.K., Kobe, Japan; Mikiko Ota, Procter & Gamble Japan K.K., Kobe, Japan; Nahoko Sakae, Procter & Gamble Japan K.K., Kobe, Japan Background: Facial signs of chronological aging represent a serious concern of women wishing for sustainable beauty and youth. Most people believe and agree that key facial features are passed down from parents to children, and this belief was proven genetically. However, the generational relationship on skin aging features and progression has not been investigated. We had hypothesized that common facial skin profiles lead to similar developing of spots or wrinkles. This clinical investigation elucidates the familial effect on skin conditions of two-generation pedigrees (ie, mothers and daughters). Objective: The objective of this study is to understand the familial relationship between mothers and daughters in terms of skin conditions and aging symptom expressions. Method: This was a single visit measurement of skin condition of a population of pedigree females. The subjects were 114 Japanese motheredaughter pairs from the Kobe region (mean age 62.9 and 36.3 yrs, respectively). Various skin parameters such as melanin index, hyperpigmented spots, and wrinkles were measured quantitatively on the face using technical methods or visual grading evaluations. Measurements were conducted on the cleansed skin in a controlled indoor condition (258C 6 28C; relative humidity, 50% 6 10%). The skin data were compared by using Pearson correlation between mothers and daughters. Results: A significant correlation of facial skin features was found between two generations and the highest was the melanin index (r ¼ 0.654; P \ .001). This suggests that melanogenesis, a fundamental biologic activity that determines skin color, is highly intrinsic even within homogeneous ethnic group such as Japanese. This is interpreted for consumers that a daughter tends to have fairer skin tone if her mother has fairer skin tone. The correlation of spots and wrinkles were 0.23 (P ¼ .014) and 0.19 (P ¼ .039), respectively. This indicates that extrinsic factors are more predominant in these skin aging appearances. To interpret the significance of correlation coefficient from a consumer point of view, the values were compared to the correlation of body mass index (r ¼ 0.24; P ¼ .009) or height (r ¼ 0.33; P \.001) from the same population. Height is relatively predictable from the parent’s height, but the body mass index of the child is not always the same as her parents because of more directly controllable extrinsic factors (ie, diet and exercise) are involved. The expressions of spot and wrinkle are likely under same level influence of extrinsic factors such as ultraviolet light exposure. While a genetic relationship is probably behind skin aging and skin conditions (intrinsic factors), individuals may make care and treatment choices (extrinsic factors) that can have a significant effect. From these results, we concluded that extrinsic environmental factors are the main reason for skin aging appearances and are more pronounced than generational effects. Results: No subjects in the clindamycin-BPO 2.5% group experienced severe local signs or symptoms or discontinued study treatment because of erythema, scaling, itching, burning, or stinging. More subjects completed the study on clindamycin-BPO 2.5% compared to active ingredients or vehicle. The safety and tolerability evaluations of clindamycin-BPO 2.5% were comparable to those for its active ingredients and vehicle. The incidence of adverse events determined to be ‘‘possibly related,’’ ‘‘probably related,’’ or ‘‘related’’ to therapy was low and similar between clindamycin-BPO 2.5%, active ingredients, and vehicle. Most of the adverse events reported ([97%) were mild to moderate in severity. Application site reactions in the clindamycin-BPO 2.5% group were rare (0.1%). Mean scores for erythema, scaling, itching, burning, and stinging at each postbaseline visit were \1 (1 ¼ mild) and comparable between clindamycin-BPO 2.5%, individual active ingredients, and vehicle. Conclusions: Clindamycin-BPO 2.5% is an alcohol-free, surfactant-free aqueous gel formulation that appears to be very well tolerated and safe, supporting earlier studies that showed a reduction in irritation with lower concentrations of BPO. Once daily use of this combination product has a low potential for cutaneous irritation and may lead to increased patient adherence to treatment and thus to improved clinical outcomes. Commercial support: 100% sponsored by Arcutis Pharmaceuticals. AB22 Commercial support: Sponsored by Procter & Gamble Company. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5949_5952 16 January 2009 8:38 pm P801 P803 Impact of lifestyle on perceived age in Spanish women Andrew Mayes, MD, Unilever Corporate Research, Sharnbrook, Bedfordshire, United Kingdom; Ana Martin-Herranz, Unilever HPC Spain, Madrid, Spain; David Gunn, Unilever R&D Colworth, Sharnbrook, Bedfordshire, United Kingdom; Peter Murray, Unilever R&D Colworth, Sharnbrook, Bedfordshire, United Kingdom Wrinkle improvement of topical ointments, quantified by new topographical method Kukizo Miyamoto, Procter and Gamble Japan K.K., Kobe, Japan; Gang Deng, PhD, Procter and Gamble Technology Beijing Co., Beijing, China; Joe Kaczvinsky, PhD, Procter and Gamble Company, Cincinnati, OH, United States; Larry Robinson, PhD, Procter and Gamble Company, Cincinnati, OH, United States Looking young for one’s age is a key target for antiaging consumers. Clinically, previous research has shown associations with ‘‘looking old for your age’’ to increased mortality. The goal of this research was to investigate the factors associated with perceived age in white subjects living in Madrid, Spain. A crosssectional study was completed with 252 women 30 to 70 years of age living in Madrid, Spain. Subjects provided informed consent to participate in this institutional review boardeapproved study, were in good general health with no diabetes or active skin conditions, and had not undergone any surgery or laser treatments on the face or neck. Subjects completed comprehensive lifestyle questionnaires on many categories, such as diet, sun exposure, and habits, general health, allergies, skin care regimens, etc., and were photographed using a high resolution digital camera. In addition, 55 naı̈ve Spanish evaluators assessed the perceived age for each subject. Multiple linear regression modeling was used to identify which of the lifestyle variables assessed could independently provide information about the difference between actual subject age and perceived age. Perceived age correlated linearly with chronological age; however, the range of perceived age increased for older subjects compared to younger subjects. Lifestyle factors associated with subjects looking younger included healthy diet, avoiding excessive ultraviolet light exposure, frequent use of facial moisturizers, regular visits to a dermatologist, dental health, and sleep. These findings therefore provide evidence that healthy behaviors, beyond sun avoidance and sun protection, impact appearance. Discussion of these additional impacts and sun avoidance in the context of impact to appearance may therefore provide further motivation to patients in adopting healthy behaviors. Background: Three-dimensional topographical information is a critical enabler for quantifying the chronological change of facial wrinkles. Fast optical in vivo topometry (FOITS) has been an increasingly popular method for wrinkle measurement, as exemplified by the Japan Cosmetic Science Society’s evolving guidelines of adopting this method for antiwrinkle product evaluation. FOITS methodology allows quantifying surface topography of skin and excludes skin color tone and surface reflection artifacts. Topical ointments formulated with well established and new functional ingredients have been demonstrated clinically for wrinkle-improving efficacy with FOITS methodology. Objective: Efficacy testing of the selected topical ointments containing functional ingredients with the FOITS method. Commercial support: 100% sponsored by Unilever HPC. Method: Clinical protocol was designed following FOITS methodology. In short, this is a split-face, double-blinded control clinical protocol among healthy white and Asian females who have moderate to severe wrinkles at the periorbital region on the both side of the face. Topical ointments that contained various functional ingredients, such as retinol and its derivatives, and new functional ingredients were tested including no treatment and/or placebo controls in the studies. FOITS wrinkle topography measurement method was employed at the baseline, and subsequent posttreatment visits. Topographical information of Ra, Rz, and wrinkle length ratio at periorbital region was recorded. Skin hydration (corneometer) and visual grading were measured. The treatment duration was 2 to 8 weeks depending on the purpose of the evaluation. Results: Significant topographical information is captured and analyzed to reveal the treatment effects of antiwrinkle ointments comprising well established retinoids and other functional ingredients versus placebos. FOITS 3-dimensional wrinkle image analysis is positively correlated (R2 ¼ 0.649) with an expert visual grading system. The clinical trial results provide evidence for method validation and efficacy demonstration of functional ingredients. Commercial support: 100% sponsored by Procter and Gamble Company. P802 Oral isotretinoin for photoaging: Results of a randomized controlled phase II trial Edileia Bagatin, MD, UNIFESP-Universidade Federal de S~ao Paulo, S~ao Paulo, Brazil; Helio Miot, MD, PhD, Universidade do Estado de S~ao Paulo FM Botucatu, S~ao Paulo, Brazil; Meire Parada, MD, UNIFESP-Universidade Federal de S~ao Paulo, S~ao Paulo, Brazil A clinical and histologic randomized controlled phase II trial to evaluate the efficacy and safety of oral isotretinoin for treating photoaging was performed with 32 menopaused/sterilized women aged between the ages of 40 and 55 years. Two randomly selected groups were created: (A) 21 women received 20 mg oral isotretinoin three times a week, moisturizer, and sunscreen (SPF 60) during 3 months and (B) 11 women received only same moisturizer/sunscreen. The clinical assessment ranged from -2 (very bad) to 2 (very good) for all patients. Profilometry, corneometry, and skin elasticity in the periocular regions and left forearm were also taken, along with a skin biopsy from the left forearm before and after treatment in goup B and in 10 randomly selected patients from group A. Microscopic evaluation of corneal layer and epidermal thickness, dermal elastosis, new collagen, and p53 epidermal expression was performed by quantitative digital image analysis. Blind evaluations (group/time) were conducted by two independent observers. Clinical evaluation results showed no alterations (0) or slight improvement (11) for all patients; profilometry, corneometry, and skin elasticity measurements presented a significant difference in pre- and posttreatment values (P ¼ .001 to .028) with no differences between the groups. Regarding histologic findings and p53 expression, no previous differences between groups before the treatment were observed (P[.1). Quantitative microscopic digital analysis demonstrated no differences between groups at the end of the study for the majority of variables. However, slight but significant difference between the groups was found for p53 with major expression reduction for those treated with oral isotretinoin (0.66 6 0.31 vs 0.94 6 0.34, respectively [P ¼.04]). The main side effects were cheilitis in 15 patients (75%) and xeroftalmia in five patients (25%). No significant alterations occurred in biochemical tests. We concluded that despite no significant microscopic changes, this study showed slight p53 epidermal expression reduction in the group treated with lowdose oral isotretinoin. The major role of ultraviolet A lighteinduced p53 mutation in skin carcinogenesis reinforces the eventual chemopreventive effects of retinoids. Oral isotretinoin seemed to be safe and effective for selected patients to control photoaging. Further controlled studies should be carried out to prove its safety and efficacy. Up to the moment indication of such a drug to treat photoaging in adult women should be discouraged. One of the current strategies for protecting biomolecules is the support of the endogenous antioxidant system. Single components of antioxidant systems are successful against damage caused by reactive oxygen species (ROS). However, the right balance between the various components of the antioxidant network is thought to be crucial. A topical administration of a synergistic nonenzymatic antioxidant combination has been found to be very effective. The aim of the study was to investigate the in vitro and in vivo efficacy of the proanthocyanidin (P), gamma-tocotrienol (T), and niacinamide (N) combination. In vitro effects were tested using a HaCaT keratinocyte cell line. Cell renewal and ultraviolet B (UVB) light cell protection were evaluated after 24 hours of the mixture treatment on cell culture. The protection of DNA against UVB was performed via a comet test on cells that were pretreated with the mixture and exposed to 5, 10, and 100 mJ/cm2 of UVB light. Biophysical techniques were used to evaluate short- and long-term skin hydration of a cream containing the mixture. One month after its daily application, skin hydration, skin elasticity, and antiwrinkle effects were evaluated in 10 healthy women. Self-assessment questionnaires were also completed by 50 volunteers between 40 and 50 years of age after 1 month of daily treatment to determine cosmetic quality perception, subjective efficacy, and well-being. In vitro results reveal a synergistic HaCaT cell proliferation of the mixture and cell protection against 50 mJ/cm2 of UVB radiation. DNA protection (measured as a decrease of the percent of DNA in tail) on the pretreated cells exposed to UVB is 37% at 100 mJ/cm2. Results obtained in healthy women show a higher hydration potential after a short treatment, and after 1 month of daily application, a statistical improvement in hydration, elasticity, and wrinkle reduction. The self-assessed consumer evaluation indicates a high cosmetic quality perception and an improvement in skin firmness, texture, and elasticity. We conclude that the P1T1N mixture constitutes a good strategy for cell renewal, a good protection from the effects of UVB radiation, and promotes younger skin as evaluated via in vitro, noninvasive biophysical techniques and after a self-assessed perception questionnaire. Commercial support: None identified. Commercial support: 100% sponsored by Antonio Puig S.A. P804 Synergistic antioxidant combination of proanthocyanidins, gamma-tocotrienol, and niacinamide Francisco Balaguer, Antonio Puig S.A., Barcelona, Spain; Jose Ginestar, PhD, Antonio Puig S.A., Barcelona, Spain; David Panyella, PhD, Antonio Puig S.A., Barcelona, Spain; Mar Recasens, PhD, Antonio Puig S.A., Barcelona, Spain MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5949_5952 16 January 2009 8:38 pm AB23 P805 P807 Synergistic combinations of retinyl esters and tocotrienols Mar Recasens, MD, Antonio Puig S.A., Barcelona, Spain; Francisco Balaguer, PhD, Antonio Puig S.A., Barcelona, Spain; Jose Ginestar, PhD, Antonio Puig S.A., Barcelona, Spain; David Panyella, PhD, Antonio Puig S.A., Barcelona, Spain It is known that the tolerance of retinyl esters (RE) is higher than retinoic acid and retinaldehyde (RA), while considering the efficacy, the opposite is true. It has been found that antioxidants (ANT) and certain fatty acids RE mixtures give rise the synergistic combinations that exhibit superior efficacy compared to RE alone. The aim of the study was to investigate the in vitro and in vivo antiaging efficacy of RE and antioxidant combination. Cell renewal was evaluated on HaCaT culture after 72 hours of treatment with RE, ANT, and RE1ANT mixture treatments on HaCaT cell culture. The procollagen type I synthesis was evaluated on human dermal fibroblast after 6 days of treatment. Biophysical techniques were used to evaluate the efficacy of a combined treatment with an antiwrinkle cream and an antiwrinkle serum which contained the RE1ANT mixture. After 15 days and 1 month of its daily application, skin hydration, skin elasticity, and antiwrinkle effect were evaluated in 20 healthy women. A self assessment about the perception of cosmetic qualities, subjective efficacy and well-being was collected via questionnaires, after 1 month of daily treatment in 50 volunteers between 40 and 50 years of age. In vitro results revealed a synergistic HaCaT cell proliferation and a synergistic procollagen type I synthesis on derma fibroblasts of the RE1ANT mixture. Results obtained on healthy women showed a higher hydration potential after a short treatment. After 15 days and 1 month of daily application, a statistical improvement in hydration, elasticity, and wrinkle diminution was observed. The self-assessed consumer evaluation indicated a high cosmetic quality perception and an improvement in skin elasticity, texture, and firmness. In conclusion, RE1ANT mixture constitutes a good strategy for cell renewal and procollagen type I synthesis, and an effective antiaging treatment evaluated through in vitro, noninvasive biophysical techniques and after a selfassessed perception questionnaire. Comparative evaluation for the efficacy and tolerance of two skin products containing either hydroquinone or emblica extract with kojic acid in female subjects with facial dyschromia Christian Oresajo, L’Oréal Recherché, USA, Clark, NJ, United States; Margarita Yatskayer, L’Oréal Recherché, Clark, NJ, United States Commercial support: 100% sponsored by Antonio Puig S.A. Dyschromia is the irregular or patchy discoloration of skin caused by variations in pigment density, vascular changes, hormonal factors, and chronic sun exposure. In many cases, the dyschromic condition can be improved by the use of bleach or skin lightening products. Hydroquinone is often considered the gold standard among traditional topical treatments for hyperpigmentation. However, its use has been associated with a number of adverse effects, including skin irritation, contact dermatitis, and exogenous ochronosis in dark-skinned people. This controlled single center, randomized, double-blind, parallel group trial was undertaken to compare the efficacy and tolerability of two skin lightening products on 70 female volunteers, 35 years of age or older, having Fitzpatrick skin types II to IV with facial dyschromia. The volunteers applied daily either product A or product B to their face for 12 weeks. Product B contained 2% hydroquinone (monographed active ingredient) while product A contained emblica extract and kojic acid. Emblica, also known as Indian gooseberry, potentially exhibits antioxidant activity, while kojic acid is a natural product derived from a mushroom. The clinical improvement in the intensity and size of facial dyschromia was evaluated at weeks 4, 8, and 12 using a 100-mm linear scale. Clinical grading of eveness of skin tone, radiance, and roughness on the face were evaluated at weeks 4, 8, and 12 using a 100-mm linear scale. Objective and subjective skin irritation was graded using a 4-point scale from 0 (none) to 3 (severe). Digital photography of the face was also evaluated for intensity and size of facial dyschromia. Volunteers completed a self-assessment questionnaire at each study visit. The results indicate that both products significantly reduced intensity and size of facial dyschromia. There was a significant improvement in radiance, eveness of skin tone, and roughness on the face for both products. There was no statistical difference between the two test products in any of the dyschromia parameters, suggesting that the 2% emblica extract with kojic acid was as effective as 2% hydroquinone in subjects with dyschromia. Commercial support: 100% sponsored by L’Oreal. P808 Gender differences in perceptions of aging Bae Yoon-Soo, Harvard Medical School, Boston, MA, United States; Alexandra Boer-Kimball, MD, MPH, Harvard Medical School, Boston, MA, United States; Maria Alora-Palli, MD, Harvard Medical School, Boston, MA, United States P806 Improvement to photodamaged skin and skin barrier using a regimen of products containing conjugated linoleic acid (CLA) Leslie Baumann, MD, University of Miami Cosmetic Medicine & Research Institute, Miami Beach, FL, United States; Edwin Covell, Unilever R&D, Trumbull, CT, United States; Joanne Zephirin, Unilever R&D, Trumbull, CT, United States; Stacy Hawkins, Unilever R&D, Trumbull, CT, United States Photoaged skin is the manifestation of accumulated skin damage from chronic exposure to ultraviolet radiation superimposed upon the intrinsic aging process. Previous reports have demonstrated that conjugated linoleic acid (CLA) delivers a variety of antiaging benefits to facial skin compared to its vehicle. The objective of this research was to measure photodamage and skin barrier benefits using a regimen of products containing CLA, and to investigate improvement in photodamaged appearance for consumers with different antiaging skin care needs, using the novel Baumann Skin Typing recruitment questionnaire. A 16-week double-blind antiaging study was conducted to investigate the efficacy of twice-daily application of a CLAcontaining antiaging face care regimen (AM: foaming facial cleanser, serum, eye cream, day cream with SPF 15; PM: foaming facial cleanser, serum, eye cream, and night cream). Eighty-eight healthy female subjects 50 to 75 years of age provided informed consent to participate in this institutional review boardeapproved study. Subjects were recruited by Skin Type across all possible combinations of the ‘‘dry vs oily’’ and ‘‘sensitive vs resistant’’ axes, with ‘‘pigmented’’ and ‘‘wrinkled’’ skin. Photodamage and irritation was assessed by a dermatologist, and instrumental measurement of hydration/moisture (corneometer) and transepidermal water loss (TEWL), were measured at baseline and monthly timepoints. Digital photos were obtained at baseline and at weeks 12 and 16. Dermatologist assessment of visual photodamage was significantly improved from baseline condition for all attributes by week 8 and also at weeks 12 and 16. Significant improvement in moisture from baseline condition was measured with the corneometer at all weeks. In addition, significant improvement by a reduction of TEWL, which is indicative of improved skin barrier, was measured by week 16. Commercial support: 100% sponsored by Unilever HPC. AB24 Purpose: In general, there is a lack of research on self-perception of extrinsic aging, actual extrinsic aging, and aging risk factors in both men and women. Men are perceived to care less about their skin and aging compared to women. These selfperceptions may affect quality of life and risk behaviors. Methodology: Baseline data were obtained from subjects as part of two larger studies aimed at evaluating the cosmetic effects of an intervention on facial skin. Subjects were asked to complete the same self-assessment at baseline (and throughout the course of their study participation) of the following components of facial skin aging: wrinkling, roughness, dryness, discoloration, and overall skin aging on a 0 to 10 scale (0 ¼ none, 10 ¼ most severe). Digital facial photographs taken of each subject and were evaluated by a single dermatologist using the same scale used by participants to grade their observations. Participants were between 40 and 65 years of age with Fitzpatrick skin types I to III. For the male participants, exclusion criteria also included: facial hair, previous facial cosmetic surgery, the use of systemic or topical retinoids, topical antioxidant or alpha hydroxyl acid products, unable to discontinue facial over the counter (OTC) or prescription products, excessive sun exposure, and diagnosis of active skin disease. The exclusion criteria for the female participants were similar except for the facial hair criterion. Results: Data were collected from 35 males and 29 females. The average age in the male population was 52.11 6 7.36 years; the average age for the female population studied was 54 6 5.46 years. Men thought that their skin looked younger than the dermatologist did in terms of wrinkles (P \.006), roughness (P \.039), discoloration (P \.024) and overall skin appearance (P \.034). Men thought their skin was drier (P \.00). In contrast, women scored similarly to the dermatologist with the exception that that they evaluated their overall skin appearance as older compared to the scores given by the dermatologist (P \ .001). When comparing men and women, women rated themselves as having worse skin in every category except for roughness (wrinkling, P \.02; dryness, P \.00; discoloration, P \.00; overall, P \ .000). Using a linear regression to further analyze the differences seen between the genders (using age, gender, and smoking status), age was a significant factor (P \ .033) only in the differences seen in roughness. For discoloration and overall score, gender (P \ .0007; P \ .0001, respectively) and age (P \ .0453; P \ .0186, respectively) were significant. Conclusion: Women in general are perceived to be more conscious of their skin. Our study showed that women were very accurate against the standard of a dermatologist when grading their skin in different categories (wrinkling, roughness, dryness, and discoloration). The men in our study rated their skin better than the dermatologist’s evaluation and compared to women of the same age and general photodamage (except for roughness), consistent with the perception that they are less attuned to or less critical about their appearance. The limitations to this study include a small sample size in addition to self-selection bias (because participants were gathered for a cosmetic study) but suggest that further research in this area may lead to interesting conclusions about self-perceived signs of aging. Commercial support: Johnson and Johnson. Photos with LVMH Recherche’s support. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5949_5952 16 January 2009 8:38 pm P809 P811 A multicenter, controlled clinical study to evaluate the efficacy and tolerance of an antioxidant composition containing vitamin C, ferulic acid, and phloretin on photodamaged skin Christian Oresajo, MD, L’Oreal USA, Clark, NJ, United States; Margarita Yatskayer, MS, L’Oréal Recherché, Clark, NJ, United States; Ron Rizer, PhD, Stephens & Associates, Inc., Colorado Springs, CO, United States; Susana Raab, MBA, L’Oréal Recherché, Clark, NJ, United States; Zoe Draelos, MD, Dermatology Consulting Services, High Point, NC, United States Changes on body skin as a function of age Marion Lanctin, MS, Johnson & Johnson Consumer France, Issy-Les-Moulineaux, Haut de Seine, France; Alex Nkengne, PhD, Johnson & Johnson Consumer France, Issy-Les-Moulineaux, Haut de Seine, France; Aline Papillon, Johnson & Johnson Consumer France, Issy-Les-Moulineaux, Haut de Seine, France; Christiane Bertin, Johnson & Johnson Consumer France, Issy-Les-Moulineaux, Haut de Seine, France; Georgios Stamatas, PhD, Johnson & Johnson Consumer France, Issy-Les-Moulineaux, Haut de Seine, France Facial skin aging has been a great concern in cosmetic dermatology, and many publications have documented the age-related transformations of skin. To our knowledge, few studies have been conducted to systematically investigate the changes of skin attributes in different body sites. This study was designed to assess the link between age and skin body attributes such as hydration, firmness, color, stretch marks, and cellulite. The study involved 150 healthy white female volunteers between 18 and 70 years of age and with a body mass index between 20 and 26 kg/m2. The skin hydration (corneometer), firmness (cutometer), and chromophores distribution (DRS and spectral imaging) were evaluated on different anatomic sites. Several measurements were also done to characterize the level of cellulite (clinical grading, profilometry, 3D, and centimetric measurements). Clinical grading was performed to measure the skin dryness, sagging, brown spots, spider veins, and stretch marks. Finally, the whole body shape was evaluated on digital pictures. The skin firmness on all body sites (waist, neck opening, buttock, abdomen, hip, thigh, and upper portion of the arm) significantly decreases with age. The dryness of the lower leg shows a trend to increase with age. The orange peel aspect (on buttock, abdomen, hip, and waist), the stubborn cellulite (on abdomen, buttock and contracted buttock, thigh, hip, and waist), the quantity and the length of stretch, the centimetric values (of the abdomen, the hip, the waist, and the arm), and the number of brown spots on the neck opening significantly increase with the age. In conclusion, this study has shown that skin firmness, brown spots on the neck opening, quantity and length of the stretch marks, and the dryness of the lower leg correlate with age. In addition, the circumference (in cm) of certain areas (abdomen, hip, waist, and arm) also correlate. The purpose of this study was to evaluate the effectiveness of an antioxidant composition containing vitamin C, ferulic acid, and phloretin in improving the visible signs of photodamaged skin. A 24-week, multicenter, clinical study of 55 females 35 to 65 years of age with self-perceived sensitive skin, mild to moderate periocular fine and coarse wrinkles, and mild to moderate hyperpigmentation on the face and back of the hands were enrolled. The subjects recruited had Fitzpatrick skin types II to IV. The antioxidant composition was used once daily. Both efficacy and tolerance were assessed at baseline (pretreatment) and at weeks 4, 8, and 12 posttreatment. This included clinical assessment, noninvasive bioinstrumental evaluation, digital imaging, and subject self-assessment questionnaires. Clinical assessment included evaluation of fine lines, wrinkles, firmness/elasticity, tone/ resiliency, density, defined contours, radiance, skin tone (evenness), tactile roughness/smoothness (left cheek), hyperpigmentation, and overall appearance. Bioinstrumental evaluation included skin brightness and color, skin viscoelastic properties, and image analysis of negative impressions of the periocular wrinkles. Digital images were taken of each side of the face to evaluate visual efficacy. Selfassessment questionnaires were administered to evaluate the perceived efficacy and tolerance by the subjects. Statistically significant improvements were observed throughout the study compared to baseline for all clinical assessment parameters evaluated on the face, neck, chest, and the dorsal surface of the hands. Objective and subjective evaluations showed that the antioxidant composition containing vitamin C, ferulic acid, and phloretin was well tolerated. Commercial support: None identified. Commercial support: Johnson & Johnson Consumer France. P810 A double-blind, placebo-controlled study to assess the efficacy of a body cream containing a combination of tetrahydroxypropyl ethylenediamine, caffeine, carnitine, and retinol Marion Lanctin, MD, Johnson & Johnson Consumer France, Issy-Les-Moulineaux, Haut de Seine, France; Christiane Bertin, Johnson & Johnson Consumer France, Issy-Les-Moulineaux, Haut de Seine, France; Fanny Le Goff, Johnson & Johnson Consumer France, Issy-Les-Moulineaux, Haut de Seine, France; Pinard Emilie, Johnson & Johnson Consumer France, Issy-Les-Moulineaux, Haut de Seine, France; Romain Roure, Johnson & Johnson Consumer France, IssyLes-Moulineaux, Haut de Seine, France With aging, several changes occur in the skin. Skin firmness, hydration, and uniformity are some of the parameters that are modified. Moreover, cellulite is a common condition of women’s skin. Therefore, it is useful to design a formulation which can moisturize the skin and increase its firmness while reducing the brown spots and cellulite aspect. A double-blind, randomized, placebo-controlled clinical study was performed to assess the efficacy of a body cream containing tetrahydroxypropyl ethylenediamine, caffeine, carnitine, retinol, glycerin, and hydroxyethyl urea. The study involved 76 healthy female volunteers between 40 and 65 years of age. Thirty-nine volunteers applied the product twice a day (morning and evening) over the entire body for 12 weeks. Thirty-seven volunteers applied a placebo the same way. Measurements were done at baseline and after 4, 8, and 12 weeks on seven areas of the body (thigh, hips, buttocks, stomach, waist, neck opening, and upper portion of the arm). The skin firmness, hydration, and color uniformity were evaluated using clinical grading and instrumentation (reviscometer, corneometer, and digital photography). Clinical grading and profilometry were also used to assess the level of cellulite. The Student t test was performed to assess the mean change compared to baseline and placebo. P \.05 was sconsidered significant. The skin moisturization, skin firmness, and orange peel aspect on the buttocks were significantly improved after 4, 8, and 12 weeks of product application compared to baseline. The skin moisturization and the orange peel aspect on the buttocks were significantly improved after 4, 8, and 12 weeks of product application compared to the placebo. The number of brown spots on the neck opening was significantly reduced after 4, 8, and 12 weeks of product application. In conclusion, this combination of active ingredients was shown to be statistically significantly efficacious versus baseline and/or versus placebo on the different parameters assessed (hydration, firmness, cellulite aspect, and brown spots). Commercial support: Johnson & Johnson Consumer France. P812 Assessment of facial aging signs in African American women using standardized photograph charts Roland Bazin, MD, L’Oréal Recherche, Chevilly Larue, Ile de France, France; Frederic Flament, PhD, L’Oréal Recherche, Chevilly Larue, Ile de France, France; Victoria Holloway-Barbosa, PhD, L’Oréal Recherche, Chicago, IL, United States Background: Aging is associated with alterations of facial appearance to varying extents and times of onset depending on the type of skin, life habits, and the level of sun exposure. The objective of this study was to characterize and assess the main facial aging signs in African American women. Methods: The study involved a population sample of 227 African American female volunteers from Chicago between 20 and 80 years of age and classified by 5-year subgroups. Photographs of selected areas of the face were taken with a standard positioning for each area, and related aging signs were scored by a panel of 11 trained experts. The photographs were presented and quoted on a computer screen in a random order, and the order was different for each expert. The relevance and reliability of photograph quotation was ensured by using standardized reference visual charts with graded aging signs. The following aging criteria were scored: horizontal interocular wrinkles, glabellar frown lines, horizontal neck folds, nasolabial fold, crow’s feet wrinkles, wrinkles of lower eyelid, forehead wrinkles, upper lip wrinkles, underneath eye wrinkles, pores, mouth corner fold, full eye bags, lower face ptosis, neck sagging, texture of the neck, fatty heap of the superior eyelid, dermatosis papulosis nigra, pigmented area surrounding the eyes, chromatic differences on all the face, acne marks, and chin withering. Results: The overview of the different clinical parameters indicates similar signs of aging for African American and for white or Chinese women. Mathematical modelling of the mean score curves versus age shows that all the signs worsen with age, but at highly different rates. Conclusion: The process observed with age is less pronounced compared to the other ethnic panels (white and Chinese). One of the reasons is probably because of the properties of African American skin, which is less ‘‘permeable’’ to ultraviolet light, protecting the dermal cells from early aging. On the other hand, pigmentation criteria are important for African American skin aging. Commercial support: L’Oreal Recherche. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5949_5952 16 January 2009 8:38 pm AB25 P813 P815 Assessment of facial aging signs in white males using standardized photograph charts Roland Bazin, PhD, L’Oréal Recherche, Chevilly Larue, Ile de France, France; Anne Sophie Adam, PhD, L’Oréal Recherche, Chevilly Larue, Ile de France, France; Frederic Flament, PhD, L’Oréal Recherche, Chevilly Larue, Ile de France, France An open-label dose-escalation study of allogeneic human dermal fibroblasts administered intradermally to enhance the aesthetic appearance of nasolabial folds Nicholas Lowe, Cranley Clinic for Dermatology, London, United Kingdom; John St Clair Roberts, MD, Intercytex, Cambridge, Cambridgeshire, United Kingdom; Philippa Lowe, MBChB, Cranley Clinic for Dermatology, London, United Kingdom; Rickie Patnaik, MD, Clinical Research Specialists Inc., Santa Monica, CA, United States Background: Aging is associated with alterations of facial appearance to varying extents and times of onset depending on the type of skin, life habits, and the level of sun exposure. The objective of this study was to characterize and assess the main facial aging signs in white males and their changes during aging process. Methods: The study involved a population sample of 260 white male volunteers from France between 20 and 80 years of age and classified by 5-year subgroups. Photographs of selected areas of the face were taken with a standard positioning for each area and related aging signs were scored by a panel of 11 trained experts. The photographs were presented and quoted on a computer screen in a random order, and the order was different for each expert. The relevance and reliability of photograph quotation was ensured by using standardized reference visual charts with graded aging signs. The relevance of the photograph quotation was ensured by the use of standardized reference charts descriptive of the different aging signs (Atlas). The following aging criteria were scored: glabellar frown lines, horizontal neck folds, nasolabial fold, crow’s feet wrinkles, forehead wrinkles, underneath eye wrinkles, mouth corner fold, full eye bags, low face ptosis, neck sagging, and texture of the neck. The Dermascore device—including an observation magnification lens with polarized light—was then used to evaluate skin microrelief texture and vascular and pigmentary inhomogeneities based on specially developed, graded visuals. A one-way analysis of variance was used to compare each of the 5-year classes for each sign. Results: As expected, the results showed (by mathematical modeling of the mean evolutions curves) that all the signs worsen during the aging process. We observed that the nasogenian folds develop steadily with age and could be considered as a clinical sign, particularly representative of male aging. Another typical aging sign is featured by the transverse wrinkles on the forehead which are a precursor sign of aging in men. The development of these wrinkles slows down at 50 to 55 years of age. The depth of crow’s feet wrinkles and full eye bags develops slowly until 50 years of age, and thereafter their development rate begins to decrease. The beginning of the ptosis of the lower face could be noticed around 40 years of age. Exponential behavior could be noticed with age as for underneath eye wrinkles. Conclusion: While all the signs of skin aging in the face worsen with the years passing, some tend to evolve linearly over time, while for others there seems to be a kind of critical age of evolution. Introduction: This clinical study was designed to evaluate the effects of allogeneic human dermal fibroblasts (HDFs) when administered intradermally into nasolabial folds. It was postulated that repopulating the dermis with metabolically active HDFs might enhance the aesthetic appearance of aging skin at the injection site as a result of increased collagen synthesis. Methods: Sixteen subjects between 18 and 50 years years of age with mild (grade 3) or moderately severe (grade 4) nasolabial folds were enrolled; subjects previously given injectible fillers were excluded. Baseline assessments included wrinkle severity scores and volumetric analysis using 3-dimensional imaging. Allogeneic HDFs derived from neonatal foreskin were administered intradermally on two occasions using a serial puncture injection technique; each course given 4 weeks apart. Approximately 700 L of HDFs, formulated in a sterile suspension, was administered along each fold. The initial six subjects were given a low-dose formulation (2 3 106 cells/mL), the subsequent 10 subjects a high-dose formulation (2 3 107 cells/mL); an interim safety analysis was undertaken at 12 weeks, before dose escalation. All subjects were assessed throughout the 24-week study period for safety; efficacy was assessed at 12 and 24 weeks using investigator and individual subject satisfaction scores assigned to a 10-point linear visual analogue scale. Results: All subjects completed follow-up to 24 weeks; no serious or unexpected adverse events were reported. Wrinkle severity scores improved by at least one grade in 12 of 16 (75%) subjects. This improvement was seen both at 12 and 24 weeks posttreatment. Satisfaction scores showed good concordance between investigator and subject; the mean investigator satisfaction score was 7.6 (range, 4.4-9.8; median, 7.8) compared to a mean subject satisfaction score of 7.8 (range, 1.5-10; median, 8.5). Imaging data showed marked variance between subjects making volumetric analysis difficult; the mean volume increase of nasolabial folds at 24 weeks was 0.01 cm3 (range, 0-0.64cm3). Conclusions: Preliminary data are encouraging, with 12 (75%) subjects showing an improved wrinkle severity score at 24 weeks together with high satisfaction scores from both the investigator and study subjects. Image analysis to assess volumetric change needs to be validated further. These results on the use of allogeneic HDFs in the management of facial rejuvenation merit further clinical evaluation, including the use of alternative treatment regimens and improved volumetric analysis techniques. Commercial support: L’Oréal Recherche. Commercial support: 100% sponsored by Intercytex. P814 Assessment of facial aging signs in Chinese women using standardized photograph charts Roland Bazin, MS, L’Oréal Recherche, Chevilly Larue, Ile de France, France; Anne Sophie Adam, PhD, L’Oréal Recherche, Chevilly Larue, Ile de France, France; Frederic Flament, PhD, L’Oréal Recherche, Chevilly Larue, Ile de France, France Background: Aging is associated with alterations of facial appearance to varying extents and times of onset depending on the type of skin, life habits, and the level of sun exposure. The objective of the study was to characterize and assess the main facial aging signs in Chinese women. P816 Treatment of photodamaged skin in the décolletage area with a copper zinc malonate lotion in conjunction with hydroquinone 4% and tretinoin 0.025% or 0.5% James Leyden, MD, KGL Skin Study Center, Broomall, PA, United States; Lisa Parr, PharmD, Obagi Medical Products, Inc., Long Beach, CA, United States Background: A new approach to treating photodamaged skin in the décolletage area (the anterior surface of the chest and neck) has recently become available. The treatment involves applying hydroquinone 4% (for skin lightening), a copper zinc malonate lotion (to ameliorate deficits in elasticity and collagen associated with photodamage), and tretinoin cream (which is known to improve fine wrinkles and ameliorate hyperpigmentation and dyspigmentation). The treatment also uses penetration-enhancing technology. The copper zinc malonate lotion has previously been shown to increase elastin and collagen levels, and to enhance elasticity and reduce wrinkling (independently of any moisturization effect). Histologicly, there is also evidence of elastic fiber regeneration and enhanced elastin biosynthesis associated with its use. Methods: The study involved a population sample of 220 Chinese female volunteers from Pudong-Shangha€i between 20 and 80 years of age and classified by 5-year subgroups. Photographs of selected areas of the face were taken with a standard positioning for each area and related aging signs were scored by a panel of 11 trained experts. The photographs were presented and quoted on a computer screen in a random order, and the order was different for each expert. The relevance and reliability of photograph quotation was ensured by using standardized reference visual charts with graded aging signs. The following aging criteria were scored: wrinkles, crow’s foot wrinkles, glabella wrinkles, interocular wrinkles, upper outer eyelid ptosis, eye bags, under eye wrinkles, nasolabial folds, mouth corner fold, upper lip wrinkles, low face ptosis, chin withering, neck texture, neck folds, neck sagging, and face spot density and contrast. A Dermascore device—including an observation magnification lens with polarized light—was then used to evaluate skin microrelief texture and vascular and pigmentary inhomogeneities based on specially developed, graded visuals. Results: Mathematical modelling of the mean score curves versus age shows that all the signs worsen with aging process, but do so at highly different rates. A linear change beginning as early as from about 20 of age is seen on the upper part of the face (forehead, crow’s feet, glabella, and wrinkles under the eyes) and as regards neck sagging. A polynomial behavior is observed for signs surrounding the eyes (eyelid ptosis and bags and horizontal wrinkles between the eyes) from about 30 years of age with a slower deterioration in the oldest subgroups. A later but exponential increase in clinical signs is noticed in the lower part of the face from about 45 of age onwards including ptosis, nasolabial folds, upper lips wrinkles, mouth corners, chin withering, and, to a lesser extent, neck texture. Color unevenness progressively increases showing a 3-stage change: no clearly visible pigmented spots between the ages of 18 to 33 years, some color inhomogeneities appearing between 33 and 58 years of age, and peaking at about 60 years of age and then plateauing. No significant changes emerge from vascular and microrelief scores versus age; they are highly dependent on the subject. Conclusion: Skin aging of the face of Chinese women shows a stepwise progression, with different critical ages for the different signs. Methods: Healthy volunteers were eligible to enroll in this multicenter study if they were between the ages of 40 to 60 years and had moderate, severe, or very severe photodamage in the décolletage area. All subjects were instructed to apply the copper zinc malonate lotion (CZM) twice daily and hydroquinone 4% twice daily for 24 weeks. They were randomly assigned to also receive tretinoin (TRET) 0.025% or 0.05% cream once daily. Results: Of 42 subjects enrolled, 38 (91%) completed the study. Generally, subjects had severely photodamaged décolletage with significant wrinkling and large areas of melanocytic hyperplasia (solar lentigines). Both regimens resulted in significant improvements from baseline in an overall integrated assessment of the décolletage area and in lentigines, mottled hyperpigmentation, fine wrinkling, coarse wrinkling, tactile roughness, crepiness, and laxity (all P # .01 at week 24). These parameters were assessed on a 6-grade scale (none, minimal, mild, moderate, severe, or very severe). At week 4, 73% of subjects showed at least a one grade improvement in mottled hyperpigmentation and 78% showed at least a one grade improvement in fine wrinkling. At week 24, 61% of subjects showed at least a two grade improvement in mottled hyperpigmentation and 42% of subjects showed at least a two grade improvement in fine wrinkling. Mean levels of erythema, dryness, peeling, and burning/stinging ranged from none to mild/slight/barely perceivable at all timepoints. Conclusions: These results suggest that the décolletage system is highly effective in improving the appearance of photodamaged skin of the anterior chest. It is also well tolerated. Commercial support: L’Oréal Recerche. Commercial support: OMP, Inc. AB26 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5949_5952 16 January 2009 8:38 pm P817 P819 Evaluation of the efficacy and tolerance of a new topical serum in skin aging Michael H. Gold, MD, Tennessee Clinical Research Center, Nashville, TN, United States; Hélène Ghienne, Pierre Fabre Research Institute, Haute Garonne, France; Marie Dominique Thouvenin, MD, Pierre Fabre Research Institute, Haute Garonne, France; Mark S. Nestor, MD, Center for Clinical and Cosmetic Research, Aventura, FL, United States; Vincent Sibaud, MD, Pierre Fabre Research Institute, Toulouse, Haute Garonne, France Introduction: A comparative versus nontreated, phase IV clinical trial has been conducted to evaluate the efficacy, tolerance, and cosmetic acceptability of a new serum which contains the active ingredient delta tocopheryl glucoside, a physiological precursor to vitamin E in subjects suffering from signs of facial aging. Methods: Women with signs of slight to moderate skin aging applied the product twice a day to a half-face (randomly assigned) for 3 months then twice a day to the full face for another 3 months. A moisturizing cream was applied to the entire face during all the study and a sunscreen product was provided in case of sun exposure. The main objective was to evaluate the antiwrinkle efficacy of the serum as compared to the nontreated half-face on day 90. The secondary objectives were to evaluate the efficacy of the serum on clinical parameters (skin roughness, skin hydration, skin radiance, skin elasticity, and smoothing effect), the overall efficacy, the local tolerance, and the cosmetic acceptability and to take photography on days 30, 90, and 180. Comparative evaluation of the efficacy of two treatment schedules of glycolic acid peels in facial photoaging Jennifer Theunis, PhD, Pierre Fabre Research Institute, Toulouse, France; Anne Marie Schmitt, MD, Pierre Fabre Research Institute, Toulouse, France; Claire Beylot, MD, Haut Lévêque Hospital, Bordeaux, France; Martine Baspeyras, MD, Dermatologist, Bordeaux, France; Wassim Zacaria, Centre of Clinical Pharmacology Applied to Dermatology, Nice, France Introduction: Alpha-hydroxy carboxylic acids (AHAs) are widely used in cosmetics industry. At high concentrations, they reduce intercorneocyte cohesion, exfoliate the superficial layers of epidermis, and are thought to exert indirect action on dermis. They are proposed for the treatment of skin aging. The aim of the study was to evaluate the efficacy of two schedules of glycolic acid peels on photoaging: ascending concentrations of glycolic acid (30%, 50%, and 70%) versus 30% only. Results: Thirty-eight subjects were included. On day 90, a significant improvement in the wrinkles from baseline was observed on the treated half-face, with a significant difference between the two half-faces, in favor of the serum versus nontreated. On day 180, the improvement was confirmed on the treated half-face and appeared on the half-face treated from day 90 to day 180. A significant improvement in skin roughness and skin radiance from baseline was observed on days 90 and 180 on the treated half-face and on day 180 on the half-face treated from day 90 to day 180. A significant increase of skin elasticity was observed on both halffaces on days 90 and 180. Overall efficacy evaluated by the investigators was good to excellent in 58% of subjects on day 90 and 79% on day 180 with a significant difference of overall efficacy on day 90 between the two half-faces. Tolerance was good to excellent in 79% of subjects at day 90 and reached to 86% at day 180. Cosmetic properties were appreciated. On day 90, 83 % of the subjects preferred the treated half-face and 83% noticed an improvement in fines lines or wrinkles. Methods: This was an open-label, randomized study on men and women 45 to 65 years of age with Fitzpatrick skin types IV or less and facial photoaging. Five treatments were applied by a dermatologist every 2 weeks for 2.5 months as follows: group 1, ascending concentrations (first treatment, 30%; second and third treatments, 50%; fourth and fifth treatments, 70%), and group 2 (five treatments of 30%). The principal criterion was standardized photographs rated by two dermatology experts; secondary criteria included overall efficacy, skin relief, cutometry, and tolerability. Results: Fifty-four subjects with a mean age of 54.9 years were included in group 1. The mean age in group 2 was slightly higher (55.9 yrs). Rating of the photographs did not show any difference between the groups. The overall efficacy was significantly higher in group 1 from day 70. Improvement of microrelief was greater in group 1, with a faster rate of improvement in the first half of the study. Skin elasticity increased in both groups, reflecting a progressive effect of glycolic acid on the dermis. Volunteers were more satisfied with efficacy in group 1. No adverse effects were related to the products. Conclusions: This is the first comparative study to demonstrate by objective measures the importance of AHAs in skin aging. Progressive concentrations of glycolic acid are effective whatever the severity of photoaging. These results are in agreement with the literature, but there are no standardized patterns of use allowing rigorous comparative analyses. Commercial support: None identified. Conclusions: The study demonstrated the significant efficacy of the serum against wrinkles in skin aging in a comparative way and its interest as an effective active antiaging ingredient. Commercial support: None identified. P818 Efficacy of a product associating retinaldhyde and hyaluronic acid fragments on photoaged facial skin in Japanese females Celine Rouvrais, Institut de Recherche Pierre Fabre, Toulouse, France; AnneMarie Schmitt, MD, Institut de Recherche Pierre Fabre, Toulouse, France; Hachirô Tagami, Tôhoku University, Sendai, Japan; Katsuko Kikuchi, Tôhoku University, Sendai, Japan; Osamu Nemoto, Naika Clinic, Sapporô, Japan Introduction: Retinaldehyde (RAL), a natural precursor of tretinoin, has demonstrated its usefulness against photoaging. Hyaluronic acid (HA), the main glycoaminoglycan in extracellular matrixes, present in the skin is also a signalling molecule which plays a very important role in cell regulation and metabolism. Several studies have confirmed that HA exerts different biologic effects depending on the length of its chain via interaction with its receptor CD44, found on the surface of keratinocytes and fibroblasts. CD44 is induced by retinoids. P820 Results: Fifty women with a mean age of 54.48 years were included; the study period ran from May 2007 to December 2007. Skin relief analysis demonstrated significant improvement in wrinkle amplitude and in mean skin surface roughness from day 30; this improvement was maintained throughout the study. The effect on TEWL is significant, demonstrating the influence of retinoids on epidermal differentiation, but the changes in the hydration index are surprisingly not significant. Daily use of the product does not cause any inflammation of the skin at any time. Photographic analysis shows an improvement in skin texture and a decrease in macular and pigmented lesions. With regard to tolerability, there was an 8% rate of transient undesirable effects (minor erythema, desquamation, and irritation), with no drop outs. Conclusions: This study confirms the utility of a topical product containing RAL and HAF for treating the signs of skin aging in Japanese women. Antiwrinkle activity of retinol is enhanced by a chromone derivative Thierry Oddos, MD, PhD, Johnson & Johnson Consumer France, Val de Reuil, France; Gaelle Bellemere, PhD, Johnson & Johnson, Val de Reuil, France; Nathalie Issachar, PhD, Johnson & Johnson Consumer France, Issy les Moulineaux, Ile de France, France; Valerie Bruere, PhD, Johnson & Johnson Consumer France, Issy les Moulineaux, Paris, France Retinoids are natural compounds that have been shown to improve the signs of photodamage on the skin by topical application. However, the topical use of retinoids has been limited by their potential to induce intolerance reaction on the skin such as burning, redness, itching, stinging, and redness. One strategy to improve the tolerance of retinoid products is to lower retinoid concentration in our topical products by enhancing the performance of retinoids in the skin. We have evaluated compounds for their ability to increase retinoid activity in the skin, using an ex vivo human skin explant model in which retinol activity is assessed by measuring the expression level of genes specific for retinoid activity such as the heparin bindingeepidermal growth factor cellular retinoic acid binding protein II (CRABPII). We found that a chromone derivative (5,7-dihydroxy-2-methyl chromone) was able to enhance the expression of both genes in our ex vivo model. Moreover, clinical study showed that topical application of a formulated product containing retinol and this chromone derivative is inducing the same anti wrinkle activity than a formulation containing twice more retinol and that this product displays also a better tolerance. Therefore, 5,7-dihydroxy-2-methyl chromone can be seen as a new and promising enhancer of retinoid activity that can be successfully used in antiaging products. Commercial support: None identified. Commercial support: None identified. Objective: To evaluate the efficacy and tolerability of a formula combining RAL and HA fragments (HAF) applied against signs of skin aging on the face in Japanese women. Methods: This was an open-label, two-center study in 50 female patients between 50 and 65 years of age. Patients applied a standardized amount of product once a day over the course of 180 days. The main criteria were skin prints on crow’s feet on days 1 and 180. Secondary criteria included evaluation at days 30, 90, and 180 of chromametry, TEWL, corneometry, and standard photographs. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5949_5952 16 January 2009 8:38 pm AB27 P821 P823 Increase in markers of chronic subclinical inflammation in dark complexioned individuals compared to light complexioned individuals Michelle Garay, MD, Preclinical Pharmacology, Johnson & Johnson Consumer & Personal Products Worldwide, Skillman, NJ, United States; Alexa Boer Kimball, MD, Department of Dermatology, Boston, MA, United States; Mariana Blyumin, MMSc, Department of Dermatology, Miami, FL, United States; Michael Southall, PhD, Preclinical Pharmacology, Johnson & Johnson Consumer & Personal Products Worldwide, Skillman, NJ, United States People with skin of color comprise the majority of the world’s population and encompass many different cultures and ethnic groups, yet few studies have examined the biochemical differences between skin in these groups. Recent studies suggest that subclinical inflammation, which is below the level of visual detection, may contribute to the etiology of many skin conditions. We therefore sought to measure the extent of subclinical inflammation in dark complexioned individuals compared to light complexioned individuals using noninvasive tape strip sampling, a highly sensitive tool to assess skin inflammation. A clinical study was conducted at Massachusetts General Hospital to examine the chronic subclinical inflammation in dark and light complexioned individuals. A total of 55 women comprising 44 light complexioned subjects (primarily Fitzpatrick skin types I and II) and 11 dark complexioned subjects (Fitzpatrick skin types IV and V) with normal skin were evaluated. The average age of the subjects was 53.1 6 6.8 years for the light complexioned group and 52.2 6 7.5 years for the dark complexioned subjects. Facial tape strips were obtained from the cheek, adjacent to the nasolabial fold. Protein was extracted from the tape strips and analyzed for the cytokines interleukin 1A (IL-1A) and IL-1 receptor antagonist (IL-1RA) using enzyme-linked immunosorbent assays and total protein content to normalize cytokine recovery. The level of the proinflammatory cytokine, IL-1A, was significantly increased two-fold from 1.6 6 0.40 pg/g protein in facial skin of light complexioned subjects compared to 3.3 6 0.45 pg/g of IL-1A in dark complexioned subjects. In addition, the level of IL1RA was significantly decreased from 64.6 6 17.6 pg/g protein in facial skin of light complexioned subjects compared to 50.5 6 9.2 pg/g of IL-1RA in dark complexioned subjects. Taken together, the skin of dark complexioned subjects in this study had a greater inflammation and perhaps less natural antagonist to mitigate the effects of IL-1A in the facial skin. These results suggest that dark complexioned subjects may have a greater chronic subclinical inflammation than light complexioned subjects. The effects of age, exposure, and skin color on dry skin Melissa Chu, Johnson & Johnson Consumer and Personal Products Worldwide, Skillman, NJ, United States; Nikiforos Kollias, PhD, Johnson & Johnson Consumer and Personal Products Worldwide, Skillman, NJ, United States Background: Dry skin has been studied extensively with noninvasive tools. The present study examines changes in the attachment of surface corneocytes in light and dark complexioned individuals with age and with exposure. Methods: Healthy human subjects (N ¼ 151) of light and dark complexion, in four age groups from 14 to 75 years of age, were studied; skin sites included the dorsal surface of the forearm (chronically exposed) and the upper portion of the inner arm (chronically unexposed). The skin was investigated with video microscopy at 1003 and adhesive tapes for appearance and adhesion of surface corneocytes; transepidermal water loss and conductivity were also assessed. Commercial support: Sponsored by Johnson & Johnson. Results: The results obtained from video microscopy and with adhesive tape are strongly correlated. There is an increase in skin dryness with age that is more pronounced in light complexioned subjects. Exposure accentuates the effects of age on dry skin for both light and dark complexioned subjects; the light complexioned subjects show a significantly higher increase of loss of adhesiveness with age. The younger age groups are indistinguishable. The barrier function of the stratum corneum shows a gradual decrease with age for both exposed and unexposed skin sites. Skin conductivity remains unchanged by age in light complexioned subjects and in the unexposed skin site for both complexions, and shows an increase with age for dark complexioned subjects on the exposed skin site. Discussion: We have determined that age plays a role in the attachment of surface corneocytes on exposed skin sites, with little effect on unexposed sites except for ages over 65 years. Exposure plays a strong role in the rate of decrease of the adhesion of corneocytes as a function of age; subjects 14 to 65 years of age have an equal magnitude for both complexions. Melanin appears to play a strong role when we compare rates affecting equally exposed and unexposed sites. The fact that the skin barrier function is not adversely affected by these changes in surface architecture may be accounted for by a thinner and less flexible stratum corneum. Melanin protection is not evident in the barrier function nor in the water holding capacity of the stratum corneum. Conclusion: The architecture of the outermost layers of the stratum corneum deteriorates with age and with exposure. The role that melanin may play in protecting the skin from environmental damage is not evident in the younger ages and becomes evident beyond menopause. Commercial support: 100% sponsored by Johnson & Johnson Consumer and Personal Products Worldwide. P824 P822 Skin oxidative stress responses to external aggression are greater in dark complexioned individuals than light complexioned individuals Michelle Garay, MD, Preclinical Pharmacology, Johnson & Johnson Consumer & Personal Products Worldwide, Skillman, NJ, United States; Michael Southall, PhD, Preclinical Pharmacology, Johnson & Johnson Consumer & Personal Products Worldwide, Skillman, NJ, United States Skin is the barrier protecting organisms from an environment that is becoming increasingly hostile. The daily onslaught of environmental factors such as solar ultraviolet (UV) light radiation and other external aggressors, provides an oxidative challenge that exacts a serious toll on skin health. People with skin of color, which comprises many different cultures and ethnic groups, may be at a greater risk of external aggression yet few studies have examined the oxidative stress responses between skin in these groups. Recent studies suggest that oxidative stress may contribute to the etiology of many skin conditions, from barrier distruption to hypopigmentation in vitiligo. We therefore sought to measure oxidative stress in dark complexioned individuals compared to light complexioned individuals using noninvasive tape strip sampling, a highly sensitive tool to assess reactive oxygen species formation that occurs during oxidative stress. A clinical study was conducted on a total of 24 women comprising 17 light complexioned subjects (primarily Fitzpatrick skin types I and II) and seven dark complexioned subjects (Fitzpatrick skin types IV and V) were evaluated. The ages of the subjects ranged from 35 to 45 years of age. Facial tape strips were obtained from the cheek, adjacent to the nasolabial fold. Reactive oxygen species formation was measured from corneocytes on the tape strips. In resting (basal) skin samples, there were significant higher levels of reactive oxygen species in the facial skin of dark complexioned subjects compared to the light complexioned subjects. To assess the antioxidant capacity of the skin, tape strips from the face were exposed ex vivo to UV light from a solar simulator. Consistent with the basal responses, skin samples of dark complexioned subjects produced significantly more reactive oxygen species than light complexioned subjects. Finally, additional tape strips were exposed to the oxidative stressor, hydrogen peroxide, and reactive oxygen species measured. In contrast to UV exposure, dark complexioned subjects produced less reactive oxygen species compared to light complexioned subjects, possibly reflecting an increased catalase activity in skin of dark complexioned subjects. These results indicate that dark complexioned subjects have a greater skin response to external aggression, and thus may be more susceptible to the skin damaging effects of UV exposure than light complexioned subjects. Commercial support: Sponsored by Johnson & Johnson. AB28 Expression profiles of stratum corneum lipid metabolism pathways associated with intrinsic and extrinsic aging Bradley Jarrold, MD, The Procter & Gamble Company, Cincinnati, OH, United States; Lisa Mullins, MMSc, The Procter & Gamble Company, Cincinnati, OH, United States; Robert Binder, PhD, The Procter & Gamble Company, Cincinnati, OH, United States; Rosemarie Osborne, PhD, The Procter & Gamble Company, Cincinnati, OH, United States Background: Skin aging has been described as a cumulative process resulting from unrepaired damage and age-related physiological changes. The damaging factors that accelerate skin aging can be divided into intrinsic factors, such as free radicals, and extrinsic factors, with sun exposure being the most important. Within the current study, we examined the effects of both intrinsic and photoaging on the expression of stratum corneum lipid metabolism pathway. Objective: The goal of the current work was to evaluate the effects of both intrinsic and extrinsic aging on the gene expression profiles of pathways involved in stratum corneum lipid metabolism. Methods: This experiment was conducted with 10 young (18-20 yrs old) and 10 aged (60-67 yrs old) female subjects. Full thickness biopsies were sampled from sunprotected skin, the buttock, to study intrinsic aging, and from the outer forearm to study the combined effects of photoaging and intrinsic aging. Older subjects were required to have moderate to severe forearm photo-damage. Total RNA from each sample was purified, labeled and hybridized to Affymetrix GeneChips (Affymetrix, Santa Clara, CA). Following statistical analysis, bioinformatics focused on expression of genes and pathways specific to metabolism of stratum corneum lipids and their extracellular release via lamellar bodies. Results: In both intrinsically and photoaged skin, there was a down-regulation in the expression of genes involved in stratum corneum lipid biosynthesis and metabolism. As compared to young skin, the epidermal cholesterol synthetic pathway genes HMGCS1, HMGCR, MVK, PMVK, MVD, IDI1, FDPS, FDFT1, SQLE, CYP51A1, SC4MOL, NSDHL, and DHCR7 were significantly down-regulated. In addition, the major cellular cholesterol influx pathways, LDLR and SCARB1, were down-regulated, while the major efflux pathway, ABCA1, was up-regulated. Similarly, the expression of genes involved fatty acid synthesis, PKM2, CS, ACLY, ACACA, and FASN were significantly down-regulated. Moreover, genes involved in fatty acid uptake (SLC27A2 and ACSL1) were also down-regulated. Genes involved in the biosynthesis and processing of sphingolipids, including SPTLC2, LASS, DEGS, UGCG, and COL4A3BP were down-regulated. In addition, a key gene involved in lamellar body secretion (ABHD5) was also down-regulated. Conclusions: The coordinated down-regulation of these pathways at the level of gene expression is consistent with previously reported global decreases in stratum corneum lipids in aging skin, and likely contributes to the decreased capacity of aged skin to maintain and repair the epidermal barrier. Commercial support: 100% sponsored by P&G Beauty. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5949_5952 16 January 2009 8:38 pm P825 P827 Assessment of facial aging signs in Chinese men using standardized photograph charts Roland Bazin, MD, L’Oréal Recherche, Chevilly Larue, Ile de France, France; Frederic Flament, PhD, L’Oréal Recherche, Chevilly Larue, Ile de France, France A 2-year, double-blind, randomized, placebo-controlled trial of oral green tea polyphenols on the long-term clinical and histologic appearance of photoaging skin Anne Lynn Chang, Stanford University School of Medicine, Stanford, CA, United States; Barbara Egbert, MD, Stanford University School of Medicine, Stanford, CA, United States; Claudia Munoz, MD, MPH, Stanford University School of Medicine, Stanford, CA, United States; Roohina Janjua, MBBS, Stanford University School of Medicine, Stanford, CA, United States; Wingfield Rehmus, MD, MPH, Stanford University School of Medicine, Stanford, CA, United States Background: Aging is associated with alterations of facial appearance to varying extents and times of onset depending on the type of skin, life habits, and the level of sun exposure. The objective of this study was to characterize and assess the main facial aging signs in Chinese males. Methods: The study involved a population sample of 220 Chinese male volunteers from Shanghai 20 to 80 years of age and classified by 5-year subgroups. Photographs of selected areas of the face were taken with standard positioning for each area, and related aging signs were scored by a panel of 11 trained experts. The photographs were presented and quoted on a computer screen in a random order, and the order was different for each expert. The relevance and reliability of photograph quotation was ensured by using standardized reference visual charts with graded aging signs. The relevance of the photograph quotation was ensured by the use of standardized reference charts descriptive of the different aging signs (Atlas).The following aging criteria were scored: horizontal interocular wrinkles, glabellar frown lines, horizontal neck folds, nasolabial fold, crow’s feet wrinkles, upper outer eyelid ptosis, forehead wrinkles, underneath eye wrinkles, mouth corner fold, full eye bags, low face ptosis, neck sagging, texture of the neck, face spot density, severity of pigmentary spots on cheek, broken vein, pores evaluated on the face, and chin withering. A Dermascore device—including an observation magnification lens with polarized light—was then used to evaluate skin microrelief texture and vascular and pigmentary inhomogeneities based on specially developed, graded visuals. A one way analysis of variance was used to compare each of the 5-year classes for each sign. Results: As expected, the results showed (by mathematical modeling of the mean evolutions curves) that all the signs worsen during the aging process. The evolution observed with age is less pronounced compared to white males. Conclusion: While all the signs of skin aging in the face worsen with age, some tend to evolve linearly over time, while for others there seems to be a kind of critical age of evolution. Background: Green tea polyphenolic compounds (GTPs) have significant antioxidant and antiinflammatory activities, and previous short-term studies suggest that these compounds may improve photoaging skin. Objectives: To evaluate the long-term effects of oral GTPs on the clinical and histologic characteristics of photoaged skin. Methods: This was a double-blind, placebo-controlled trial of 56 women between 25 and 75 years of age who were randomized to 250 mg green tea polyphenolic extract or placebo twice daily for 2 years. A blinded dermatologist scored the appearance of photodamaged facial skin at 0, 6, 12, and 24 months. A blinded dermatopathologist scored the histologic characteristics of sun-exposed arm skin at 0 and 24 months. Results: Clinical assessment of facial skin revealed that the GTP group but not placebo group had reduced overall solar damage at 6 months (P ¼ .02), reduced telangiectasias at 12 months (P ¼.02), and reduced fine wrinkles at 24 months (P ¼ .00). In contrast, histopathologic analysis of sun-exposed arm skin did not show any statistically significant reductions in photoaging parameters in the GTP group compared to placebo group. Conclusions: Over 2 years, twice daily supplementation with 250 mg green tea polyphenolic extract improved several clinical parameters of facial photoaging (overall photodamage, telangiectasias, and fine wrinkling). Commercial support: 100% supported by NuSkin International. Commercial support: L’Oréal Recherche. P828 In addition, subjects recognized a more fresh and energetic appearance at the end study. By restoring skin energy reserve levels these results demonstrate that the formulation containing encapsulated L-carnitine improved the appearance and the feel of skin. Validation of a novel photographic methodology (raking light) for evaluating improvements in fine lines and wrinkles Christian Oresajo, L’Oréal Recherché, USA, Clark, NJ, United States; Margarita Yatskayer, L’Oréal Recherché, USA, Clark, NJ, United States; Susana Raab, L’Oréal Recherché, USA, Clark, NJ, United States; Thomas Stephens, Thomas J. Stephens & Associates, Carrollton, TX, United States Silicone replicas, which are negative impressions of the skin’s surface features, are the industry standard for the analysis of fine and coarse wrinkles and skin texture in the crow’s foot region of the eye. Because most apparent fine lines reside in the lateral upper cheekbone, which is not included in the replica imprint, this technique primarily captures coarse wrinkles and skin texture. In addition to this limitation, there is also the variability of placing the replica ring in the same exact location at each time point. Despite using the same technician, this can be a difficult task, especially when it comes to the analysis. Finally, because the ring only a covers a small area, the length of wrinkles cannot be analyzed with this technique. Recently, a new technology involving digital photos using raking light has allowed for the analysis of the number, length, width, and depth of horizontal wrinkles in the crow’s feet area (coarse wrinkles) and the under eye area (fine lines). Wrinkles appear as dark lines on grayscale images. Deeper wrinkles appear darker since less light is present at the base of the wrinkle. Once the wrinkles are identified with the edge filter they are measured for size (length, width, and area) and grayscale density on the original grayscale image. The objective of this research was to validate the use of raking light photographic methodology by incorporating its use into two independent clinical trials evaluating topical treatments for improving the appearance of periocular wrinkles. Trial 1 evaluated the efficacy of a facial treatment in subjects with deep wrinkles. Forty-nine female volunteers between 45 and 70 years of age with moderate to severe periocular wrinkles (scores 5-7 on a 10-point scale) were enrolled in a 12-week clinical study. Efficacy was assessed at baseline (pretreatment) and at weeks 4, 6, 9, and 12 posttreatment using raking light analysis, image analysis of negative impressions, and visual grading. Clinical assessment included evaluation of fine lines and wrinkles. Trial 2 was an 8-week, single center study evaluating fine lines and wrinkles in 30 female subjects. Clinical evaluations and photography were conducted at baseline and weeks 4 and 8. Results from both trials showed that the raking light methodology was effective in detecting improvements in wrinkling in the periocular area of subjects. These findings correlated with clinical grading of fine lines and wrinkles. The raking light methodology was an advantage over replica imprint method in that wrinkling can be analyzed in the crow’s feet area and the area below the eyes. Commercial support: Neutrogena Corporation. Commercial support: 100% sponsored by L’Oréal Recherché. P826 A formulation containing L-carnitine and other nutrients improves skin energy reserves and oxygen consumption in skin cells and improves the appearance of aging skin Nathan Trookman, MD, Thomas J. Stephens & Associates, Inc, Colorado Springs, CO, United States; Hao Ouyang, PhD, Neutrogena Corporation, Los Angeles, CA, United States; Michael Southall, PhD, Johnson and Johnson Consumer Products Worldwide, Skilman, NJ, United States; Michelle Garay, MS, Johnson and Johnson Consumer Products Worldwide, Skillman, NJ, United States; Ronald L. Rizer, PhD, Thomas J. Stephens & Associates, Inc., CO, United States The production and use of energy in the skin is necessary for numerous physiological processes that are involved with maintaining healthy skin. Unfortunately, the production of and cellular level of adenosine triphosphate (ATP), which is the ‘‘energy reserve,’’ decreases during the aging process. In addition, we have found that exposure to ultraviolet (UV) light radiation rapidly depletes the ATP levels in skin cells. Taken together, both the aging process and external aggression can take a serious toll on reducing the skin’s available energy reserves. L-carnitine is an amino acid and a component of a typical human diet, which functions as a biocatalyst to facilitate the transfer of fatty acids into mitochondria for metabolism to produce ATP. In our studies, we explored the opportunity to incorporate L-carnitine into an antiaging hydrating cream for energy enhancement. Treatment of human skin cells for 30 minutes with a formulation containing encapsulated L-carnitine resulted in a significant increase in ATP levels compared to a placebo formulation. In addition, the oxygen uptake in cultured human fibroblasts was significantly enhanced when the treatment combined L-carnitine and a yeast ferment mixture. The improvements in the appearance of aging skin from the formulation containing encapsulated L-carnitine were examined in a 6-week study clinical study. When applied as a night cream, the formulation containing L-carnitine and other nutrients showed marked improvement in antiaging parameters including fine lines, skin tone evenness, and radiance. Significant improvements in skin hydration and reduction of visual dryness after 2 to 6 weeks were also been demonstrated. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5949_5952 16 January 2009 8:38 pm AB29 P829 P831 Retinol stimulates epidermal cell proliferation in vivo and reduces facial signs of skin aging Thierry Oddos, PhD, Johnson & Johnson Consumer France, Val de Reuil, France, United States; Christiane Bertin, PhD, Johnson & Johnson Consumer France, Issy les Moulineaux, Paris, France; Georgios Stamatas, PhD, Johnson & Johnson Consumer France, Issy les Moulineaux, Paris, France; Valerie Bruere, Johnson & Johnson Consumer, Issy les Moulineaux, Paris, France Clinically, facial skin aging is associated with a variety of signs such as wrinkles, uneven pigmentation, skin roughness, and laxity. These clinical features are consecutive to structural and metabolic changes that occur during chronological aging and photoaging. Beneficial effects of retinoids on signs of skin aging are now well documented and, for example, it has been shown that retinol (ROL) alleviates some major signs of skin aging. Indeed, ROL at 1% exerts retinoid-like effects such as stimulation of collagen synthesis, reduced matrix metalloproteinase levels, and induction of fibroblasts outgrowth. Also, long-term application of ROL at 0.4% in the upper arms reduced fine lines and provoked an accumulation of collagen in the papillary dermis. However, most studies have focused on the clinical benefits of ROL in photoprotected skin sites, such as the upper arm. Moreover, the effects of ROL were studied at high doses ranging from 0.4% to 1.6%, doses at which it produces unwanted side effects such as skin dryness, irritation, and itching. In the present study, we explored the antiaging action of a low concentration of retinol (0.1%) on human skin. First, we demonstrated that 0.1% retinol increases keratinocyte proliferation ex vivo and epidermal thickness in human skin explant culture. Second, we demonstrated that the long-term topical application (up to 9 months) of retinol 0.1% on the face also stimulates epidermal cell proliferation in vivo and improves the signs of aging, such as fine lines, wrinkles, and tone evenness. Clinical benefits of conjugated linoleic acid (CLA) to 3-dimensional wrinkle morphology Susan Krein, MD, Unilever R&D, Trumbull, CT, United States; Helen Meldrum, Unilever R&D, Trumbull, CT, United States; Stacy Hawkins, Unilever R&D, Trumbull, CT, United States; Vickie Foy, Unilever R&D, Trumbull, CT, United States Photoaged skin is the manifestation of accumulated skin damage from chronic exposure to ultraviolet radiation superimposed upon the intrinsic aging process. Fine lines and wrinkles are two of the most prominent attributes that are commonly associated with photoaged skin. Cosmetic peroxisome proliferator-activated receptor (PPAR) lipids have been shown to significantly improve the photoaged appearance of skin. We have previously reported that conjugated linoleic acid (CLA) delivers a variety of antiaging benefits to skin. The objective of this research was to confirm the magnitude of improvement on photodamaged facial skin that CLA provides in the periorbital region, using clinical and objective 3-dimensional (3D) assessments. Thirty-nine white female patients (40-70 yrs of age) with a moderate degree of photodamage in the periorbital region were enrolled into a 12week, double-blind, split-face application study. Subjects applied the test products, a CLA cream versus its vehicle, to their faces twice daily over the course of the treatment phase. Expert visual assessments of fine lines and wrinkles in the crow’s feet, under-eye, and overall eye area, were obtained at baseline and week 12. 3D facial scans were taken with the Cyberware Rapid 3D Facial Scanner (Cyberware, Monterrey, CA) at weeks 0, 2, 4, 6, 8, and 12. Results showed that the CLA cream provided a significant reduction in the appearance of fine lines and wrinkles in the periorbital region from baseline and compared to its vehicle. These findings confirm the efficacy of CLA in providing antiaging benefits, such as fine lines and wrinkles and overall photodamage, without irritation. Commercial support: None identified. Commercial support: 100% sponsored by Unilever HPC. ART, HISTORY, AND HUMANITIES OF DERMATOLOGY P900 History of dermatology in Persian territory Farzam Gorouhi, MD, Center for Research and Training in Skin Disease and Leprosy, Tehran University of Medical Sciences, Tehran, Iran; Alireza Firooz, MD, Center for Research and Training in Skin Disease and Leprosy, Tehran University of Medical Sciences, Tehran, Iran; Parastoo Davari, MD, Center for Research and Training in Skin Disease and Leprosy, Tehran University of Medical Sciences, Tehran, Iran Improvements in aging skin appearance have been shown from products containing either retinol, soy, or a botanical enzyme from Mucor miehei. Each of these ingredients provides skin improvement and benefits, albeit by different mechanisms. Recently, a comprehensive treatment regimen, comprised of a facial cleanser, day lotion, and night cream, was developed that combines these ingredients for rapid results. Here we report the effects of this regimen on moderate photodamaged facial skin of subjects who do not typically use antiaging products. Results demonstrated significant improvements in skin appearance and enhanced cellular proliferation over a 2-week evaluation period. Improvement in skin clarity, texture, and overall appearance was noted by the study investigator and by subjects within a day’s use, while cell renewal increased by 29.2% after 7 days. Within 14 days, reduction in facial wrinkle appearance was evident, skin tone was visibly more even, and all subjects showed improvement in skin texture, clarity, and overall appearance. These results show that the combination regimen delivers noticeable benefits with short-term intensive use, and this represents a change to traditional, long-term treatments. Use of the combination regimen may provide an opportunity for attracting those who do not routinely use antiaging treatments, by the minimal treatment/time commitment, and generate conversion by exposing them to the type of benefits that can result from effective products or noninvasive procedures. Persia has been known for its peaceful, dynamic, multicultural land that has helped and survived so many religions and countries within past 3000 years. In such context, the history of medicine in Iran (Persia) can be as old and as rich as its civilization. In the Avesta, the religious book of the Zoroastrians, science and medicine rise above diverse class, ethnicity, nationality, race, gender, and religion. Some of the earliest practices of ancient Iranian medicine have been documented in the Avesta and other Zoroastrian religious texts. During the Achaemenid era (559330 BCE), the 21 books (815 chapters) of Avesta were an encyclopedia of science consisting of medicine, astronomy, law, social science, philosophy, general knowledge, logic, and biology. The best teachers of medicine and astrology were Iranian Magi and Mobeds (Zoroastrian priests) who passed their knowledge on to their pupils from one generation to the next. The great scholars such as the philosopher Heraclitus of Ephesus, the Babylonian astronomer Kidinnu, and even the historian Herodotus were Persian subjects. According to Avestan texts, King Jamshid was the physician who initiated the custom of bathing with hot and cold water. The city of Jondishapour, built upon the order of ‘‘Shapour the First,’’ was the medical center in the Sassanid period. Here, a medical school and a hospital with its own school existed, which were distinctive of the city, assuring it’s reknown at least until 876 AD. The first premodern center for medical training in Iran was founded in 1851. It was a part of the Institute for Higher Education (Dar-ol-Fonoon). In the field of dermatology, Avesta describes conditions such as scabies, leprosy, and vitiligo in its own words. As the middle era of Iranian medicine approached, there was a dramatic increase in the number of individuals who presented their findings in comprehensive and compiled books. Rhazes (865-925) was the first physician who explained smallpox and measles to diagnose them as two separate diseases in his famous textbook, and then after half a century, Abu-Ali Sina (Avicenna or Ibn Sina; 980-1037) tried to include some better descriptions for some previously known skin diseases and also defined elephantiasis, leprosy, various hair and nail disorders, and vitiligo and maybe pemphigus in his comprehensive textbook, Ghanoon (The Canon of Medicine). He also explained some cutaneous problems in genitalia. Persian territories have also developed many herbal treatments for different indications, including both topical and oral herbals for skin diseases. In this review, the authors focused on some historical achievements in develping disease definition and cover some major dermatologic therapies, too. Commercial support: Neutrogena Corporation. Commercial support: None identified. P830 Combining mechanistically complementary ingredients provides rapid antiaging benefits under short-term use Sylvia Barkovic, MD, Neutrogena Corporation, Los Angeles, CA, United States; Hao Ouyang, PhD, Neutrogena Corporation, Los Angeles, CA, United States; Yohini Appa, PhD, Neutrogena Corporation, Los Angeles, CA, United States AB30 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5949_5952 16 January 2009 8:38 pm P901 P903 Pimple Popper, MD: Why ‘‘Seinfeld’’ is consequential to dermatology Jennifer L. Vickers, MD, University of Texas Medical Branch, Galveston, TX, United States; Richard F. Wagner, MD, JD, University of Texas Medical Branch, Galveston, TX, United States; Tatsuo Uchida, MS, University of Texas Medical Branch, Galveston, TX, United States Historical investigation of the technological advances in infant cleansing Russel Walters, MD, Johnson & Johnson, Skillman, NJ, United States; Joseph LiBrizzi, PhD, Johnson & Johnson, Skillman, NJ, United States; Katharine Martin, Johnson & Johnson, Skillman, NJ, United States; Matthew Hamilton, MS, Carnegie Mellon University, Pittsburgh, PA, United States Background: Rosoff and Leone’s analysis of the relative social prestige of various medical specialties showed that dermatology was consistently ranked one of the lowest in a hierarchy of public esteem. Why does the public view dermatology this way? Using the popular television sitcom ‘‘Seinfeld,’’ this study examined television’s portrayal of dermatology, skin disease, and the integumentary system. Because of its longevity, breadth of airtime, record-breaking popularity, and potential for influence, ‘‘Seinfeld’’ may influence public perception and opinion about dermatology. Objective: This study examined the frequency of health care topics appearing in ‘‘Seinfeld,’’ particularly dermatology, skin disease, and the integumentary system. Technological advancements have enabled a continual redefinition appropriate for cleansing for infant skin. Cleansing infants is critical for both infant and family hygiene. We investigate the technical developments in infant cleansing and the new innovations thereby enabled. Each new cleansing technology has produced product innovations that offer milder and healthier ways to cleanse infant skin. Until approximately 1890, most soap was made by hand; the industrial revolution enabled more consistent and more pure soap. We found that technical advances during both World Wars enabled rapid innovation in the 1940s and 1950s with synthetic detergents—the syndet bar improved the pH compatibility with skin. Following shortly thereafter, liquid surfactant based cleansers allowed for another redefinition of mild cleansing, with less aggressive and pH-neutral systems. The current state of the art in skin mildness for infant cleansing involves the blending of multiple surfactants to create a less aggressive surfactant system that provides reduced skin irritation and reduced eye irritation and stinging. Following the step change in product performance of the 1950s and 1960s, recent efforts have focused on ensuring the quality and safety of infant cleansers. Research has been focused on increased understanding of surfactant interactions with infant skin and novel in vitro methods to access cleanser mildness such as the fluorescein leakage test, skin equivalents, and ocular irritation models. These recent advances in clinical models and instrumentation should enable future advances in products suitable for infants. Methods: The first 75 of the program’s 180 episodes were examined, and a log was kept of all verbal and visual health-related references or topics. Each reference was assigned a category based on the medical topic with which the reference was associated. Frequency tables were then created for all categories and reported as percentages of the total number of references. Results: A total of 481 health-related references were recorded. Dermatology had the highest frequency of references with 76 (15.8%). Psychiatry had the second highest frequency of references with 72 (15%). Conclusion: ‘‘Seinfeld’’ frequently referenced health-related topics, most notably dermatology and psychiatry. The show often used humor about dermatology and skin diseases that employed satire, hyperbole, and absurdity. Its portrayal of health topics could communicate medical conditions unrealistically. Given the program’s record-breaking popularity and well documented ability to influence public trends and opinions, the potential of ‘‘Seinfeld’’ to influence how dermatology and skin diseases are socially valued and evaluated is noteworthy. If the public is led to believe that dermatology does not provide a valuable service to the general public and that skin diseases are trivial or comic, public education about crucial dermatologic health topics runs the risk of being compromised. Recognizing and analyzing television media’s portrayal of these topics provides valuable feedback for governmental agencies, physicians, patient and family support groups, and organizations and could ultimately help promote skin disease awareness, prevention, and education. Commercial support: Johnson & Johnson. Commercial support: None identified. P902 P904 The legacy of Jose Eugenio Olavide in the United States Natalie Curcio, MD, Vanderbilt University Medical Center, Nashville, TN, United States; Felipe Heras, MD, Instituto de Salud Carlos III, Madrid, Spain; Luis CondeSalazar, MD, Instituto de Salud Carlos III, Madrid, Spain Alan Lyell (1917-2007) and toxic epidermal necrolysis Clare May, MD, Alan Lyell Centre for Dermatology, Glasgow, Scotland, United Kingdom; Colin Munro, MD, Alan Lyell Centre for Dermatology, Glasgow, Scotland, United Kingdom; Martin Porter, MBChB, Alan Lyell Centre for Dermatology, Glasgow, Scotland, United Kingdom Objectives: The aim of the study was to compile a complete list of works published by J. E. Olavide, MD, father of Spanish dermatology, and to determine which, if any, are in existence in the United States today. Methods: A historical investigation was conducted using primarily three sources: World Cat (global network of library catalogues), to find books currently in existence worldwide, Index Cat (Index Catalogue of the Library of the SurgeonGeneral’s Office), to attain a listing of books and journal articles published by Olavide, and Index Medicus, for a complete listing of articles published by the author by year. Results: World Cat found four books that listed Olavide as the primary author, including Dermatologı́a generaly clı́nica iconográfica de enfermedades de la piel (1871), his most famous text, and one book in which he was the author of the prologue. There is also one book authored by Joaquin Calap in which Olavide is the subject of the textbook. All of these texts are available at the National Library of Medicine (NLM). Index Cat was helpful in searching for both texts and journal articles. It revealed four of the five books gathered on World Cat, in addition to two others that were no longer in existence worldwide. Index Cat also contained a thorough listing of medical articles published by Olavide from 1860 through 1896. Finally, using Vanderbilt’s complete collection of volumes of Index Medicus from the late 19th century, all years in which Olavide published medical research (1879-82, 1888-92, and1895/96) were reviewed and the title, journal, and location of those articles was obtained. There were only 10 articles found in Index Medicus. Copies of all of Olavide’s articles are available through the NLM. Conclusions: More than 100 years after his death, the legacy of Olavide in dermatology continues through his museum of wax moulages, and through his textbooks and medical articles. Although Olavide never crossed the Atlantic Ocean, many of his visionary ideas, case reports, and dermatologic mastery illustrated in his literary works are only preserved today within the NLM. This project led the photographic preservation of several of his textbooks and scanning of many of his articles from the NLM for conservation at the Olavide Museum in Madrid, Spain. Toxic epidermal necrolysis (TEN; Lyell syndrome) was first described by Alan Lyell in Scotland in 1956. With his death in November 2007, dermatology lost a clinician of immense character and principle. Lyell wrote the original paper on TEN in 1956. He described four patients who ‘‘looked as though they had been scalded but there was no history of any burn.’’ Lyell described this as an ‘‘exanthematic eruption followed by generalized exfoliation’’ and believed that is was caused by an unidentified toxin causing necrosis and epidermolysis. Before this, similar exanthematous eruptions with blistering had not been specifically classified. It became apparent to Lyell that the original four cases represented different pathologic processes. He thereafter discussed the involvement of an as yet unidentified staphylogenic toxin. The term TEN was subclassified temporarily into staphylogenic TEN and drug-induced TEN with the fourth case thought to be a fixed drug eruption. Lyell wrote, ‘‘The infant TEN, which at first had seemed to be a single baby, has turned out to be triplets.’’ In subsequent years, Lyell, along with the microbiologist John Arbuthnott, unsuccessfully sought evidence of a staphylococcal toxin targeted at the epidermis using adult mouse skin. Concurrently, Marian Melish and Lowell Alan Glasgow, researchers in Utah, routinely used baby mice. This serendipitous use of baby mice allowed the successful isolation of the toxin and demonstrated the pathogenesis of staphylococcal scalded skin syndrome (SSSS). Lyell wrote, ‘‘As a result of Melish and Glasgow’s work, the staphylococcal scalded skin syndrome had been born and John and I had been beaten to the post.’’ As time passed, more cases of TEN were reported in association with drugs and TEN, SSSS, and erythema multiforme were all described and classified according to cause and level of epidermal split. TEN is now considered as part of a spectrum with StevenseJohnson syndrome. Anticonvulsants, sulpha drugs, nonsteroidal antiiflammatory drugs, and antibiotics are often implicated. Although rare, the average mortality is about 30%, but can be higher depending on the patient’s age and extent of epidermal loss. Lyell worked in Glasgow Royal Infirmary from 1959 until retirement in 1980. He foresaw a united Glasgow wide service and training rotation, which was realized in 2006 and named in his honor. Commercial support: None identified. Commercial support: None identified. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5949_5952 16 January 2009 8:38 pm AB31 BASIC SCIENCE P1000 Evaluation of Nocardia brasiliensis in a murine model Janeth Almaguer-Chavez, Dermatology Department, Hospital Universitario ‘‘Dr. José E. González,’’ Monterrey, Mexico; Jorge Ocampo-Candiani, MD, Dermatology Department, Hospital Universitario ‘‘Dr. José E. González,’’ Monterrey, Mexico; Lucio Vera-Cabrera, PhD, Dermatology Department, Hospital Universitario ‘‘Dr. José E. González,’’ Monterrey, Mexico; Oliverio Welsh, MD, PhD, Dermatology Department, Hospital Universitario ‘‘Dr. José E. González,’’ Monterrey, Mexico Introduction: Actinomycetoma is a chronic, local, and progressive infection of the skin and soft tissue. In our region, Nocardia brasiliensis is responsible for 86% of the cases of mycetoma. The production of mycetoma in a murine model has been well established since 1962 by González-Ochoa; however, the mechanisms involved in nocardial pathogenesis are not well understood. It has been observed in other microorganisms that subculture has an important effect in the virulence; for example, Mycobacterium bovis produced an attenuated bacteria (bacille CalmetteGuérin) that is widely used as vaccine. It is well known that the genera Nocardia and Mycobacterium have similar biologic and phylogenetic properties. In this work, we investigated the clinical response in two groups of mice inoculated with N brasiliensis before and after 40 passages. Methods: This is a prospective experimental and comparative trial. We inoculated 40 BALB/c mice and divided them into two groups of 20 mice each: time zero (T0) and time 40 (T40), respectively. The T0 group was inoculated with nonsubculture N brasiliensis HUJEG-1, while the T40 group was inoculated with N brasiliensis HUJEG-1 subculture 40 (40 passes). Both groups were inoculated subcutaneously in the right footpad. Weekly measures were taken with a millimeter snip caliper in each group for a period of 8 weeks, with a final measure at 12 weeks. P1002 The effect of all-trans retinoic acid for expression of RIP4 in human keratinocytes and hairless mice skin Se Yeong Jeong, MS, Department of Dermatology, Korea University College of Medicine, Ansan-city, South Korea; Ji Na Kim, Laboratory of Molecular and Cellular Biology, Korea University College of Medicine, Seoul, South Korea; Myung Sin Lim, Department of Dermatology, Korea University College of Medicine, Ansan-city, South Korea; Sang Hoon Jeong, Laboratory of Molecular and Cellular Biology, Korea University College of Medicine, Seoul, South Korea; Sang Wook Son, MD, Laboratory of Molecular and Cellular Biology, Department of Dermatology, Korea University College of Medicine, Seoul, South Korea Retinoids influence keratinocyte proliferation and differentiation, and receptorinteracting proteins (RIPs) are an important modulator of cell proliferation and differentiation. Because RIP4 is the most important RIP in keratinocytes, we investigated the function of RIP4 in epidermal hyperplasia induced by all-trans retinoic acid (RA). We treated different concentrations of all-trans RA on HaCaT keratinocytes and normal HEK, than measured the expression of RIP4 by Western blot and immunocytochemistry. We treated different concentration of all-trans RA on the dorsal skin of 10 hairless mice for 7 days. Epidermal hyperplasia was measured by hemtoxylineeosin staining, and the expression of RIP4 was measured by Western blot and immunocytochemistry. Expression of RIP4 was increased in a dose-dependent manner in keratinocyte cell lines. In contrast, expression of RIP4 was decreased in a dose-dependent manner in hairless mice skin. In histology, epidermal thickness was increased after treatment of all-trans RA in a dosedependent manner. The present study implies that all-trans RA decreases expression of RIP4 in a dose-dependent manner, which might be related with epidermal hyperplasia induced by all-trans RA. Commercial support: None identified. Results: We observed a similar initial inflammatory response in both groups After 5 weeks in the T0 group (control group) the infection became progressive with the development of actinomycetoma caused by N brasiliensis in 80% (16/20) of the mice; meanwhile, the T40 group (experimental group) presented a decline in the development of actinomycetoma which was only present in 10% (2/20) of the mice. It was statistically significant (P ¼ .00002007) at 12 weeks. Conclusion: In the N brasiliensis subculture group (T40) we observed a lower incidence of actinomycetoma development and size when compared with the control group (T0). The investigation of the virulence mechanisms modified by the subculture of N brasiliensis and possible changes in the nocardia genome will give important data on the pathogenesis of this microorganism. Commercial support: None identified. P1001 Are there gender differences in response to positive and negative irritation controls used in human cumulative irritation studies? Lisa Long, PharmD, Hill Top Research, St. Petersburg, FL, United States; James Bowman, MS, Hill Top Research, Miamiville, OH, United States; Jeffrey Berg, Hill Top Research, St. Petersburg, FL, United States; Robert Harper, PhD, Harper & Associates, La Jolla, CA, United States Background: This retrospective analysis was conducted to evaluate whether males and females have similar response profiles to positive and negative controls commonly used in standard cumulative irritation studies. The positive irritant control was 0.1% sodium lauryl sulfate (SLS) and the negative control was 0.9% sodium chloride (saline). Data were compiled from a total of 35 cumulative irritation studies conducted between 1995 and 2002 from four different geographic locations (Scottsdale, AZ, St. Petersburg, FL, Miamiville, OH, and Winnipeg, Manitoba). The total population consisted of 822 healthy volunteers 18 to 85 years of age. P1003 Conclusions: Based on the results of this analysis, gender did have a statistically significant impact on irritation scores under these specific study conditions. However, the level of differences was fairly small, and these results may not be clinically significant. Further review with these and other test materials is warranted before judgments can conclusively be made concerning differences in irritation responses between genders. Ultraviolet irradiation alters keratinocyte ephrin receptor and calcium signaling pathways following exposure to a chemical sensitizer, dinitrobenzene sulfonic acid Mary Bennett, MD, University Hospital Case Medical Center, Cleveland, OH, United States; Kevin Cooper, MD, University Hospital Case Medical Center, Cleveland, OH, United States; Mark Chance, PhD, Case Western Reserve University, Cleveland, OH, United States; Pratima Karnik, PhD, Case Western Reserve University, Cleveland, OH, United States Proteomic profiles of HaCaT keratinocytes were compared under two treatment conditions: following exposure to the chemical sensitizer dinitrobenzene sulfonic acid (DNBS) alone versus exposure to DNBS after cells had been preirradiated with a single dose of UVB light. Comparison of these two conditions was sought to elucidate the keratinocyte expression profile in the tolerant state (combined exposure of UVB and DNBS) versus the allergic state (DNBS alone). Protein expression was quantitated using two techniques, cleavable isotope-coded affinity tags (ICAT) and 2-dimensional difference gel electrophoresis (2D-DIGE). Significant differences in the global (cytoplasmic and membrane) protein expression were analyzed using Ingenuity Pathway Analysis software (Ingenuity Systems, Redwood City, CA). The two most significantly altered pathways identified were those of calcium and ephrin receptor signaling. Calcium signaling proteins altered included plasma membrane calcium-ATPases, calmodulin 2 and 3, inositol 1,4,5-triphosphate receptor (type 3), ras-related protein (RAP) 1a and 1b, and tropomyosin 3 and 4. Ephrin (Eph) receptor pathway proteins significantly different in the combined condition included cofilin 1, docking protein 1, GNAS complex locus, guanine nucleotide protein beta polypeptide 2-like 1, integrin-alfa 3, integrin-beta 1, and RAP 1a and 1b. Eph receptors are widely expressed in the epidermis, and may play an important role in skin homeostasis and cancer. Eph B causes the increased activation of N-methyl-D-aspartate (NMDA)-receptor that is known to influence intracellular calcium in keratinoctyes. The transcription factor CREB is a common downstream protein to both calmodulin/calcium and ephrin receptors through the activity of ERK1/2. CREB is known to promote cellular proliferation and is felt to play a role in skin carcinogenesis. The interplay between the overlapping calcium and ephrin protein networks may provide further insight into the unique changes that occur in the keratinocyte resulting in a tolerant state following the combined exposure of UV and DNBS. Commercial support: None identified. Commercial support: None identified. Methods: Data from 35 cumulative irritation studies were identified from the Hill Top Research database. All subjects were patched on the upper back along the paraspinal region with approximately 0.2 mL of the positive control and the negative control under full occlusive patch conditions for 14 consecutive days. Patches were worn for approximately 24 (62) hours. Following patch removal, trained evaluators quantified skin irritation assessments using the scale of Berger and Bowman (0-7 point scale). Patch sites showing significant irritation responses (ie, any patch sites reaching a numerical score of[3 or any numerical score appended with a letter grade of F, G, or H) were not repatched for the remainder of the study and a score of 3 was carried through to the end of the study for analysis purposes. Analysis of variance was used to compare the gender scores at each of the 14 days and for the average irritation score across all 14 days. Results: Data were generated from 822 subjects (610 female and 212 male). The average daily irritation scores for SLS and saline were reviewed for males and females by combining the data from all four locations. Males showed significantly more irritation on average compared to females for both SLS (P \.01) and saline (P \.01). In addition, males showed significantly more irritation compared to females for both SLS and saline for nearly all of the individual study days. The largest irritation difference between males and females was 0.3 while the average difference was closer to 0.1. The results for each individual geographic location closely followed the overall results. Previous articles have been published regarding gender differences in cumulative irritation and have shown similar results. AB32 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5949_5952 16 January 2009 8:38 pm P1004 P1006 Modulating HMG-CoA reductase expression in human epidermal cells with a new active ingredient N. Domloge, MD, ISP, Montard, Sophia Antipolis, France; D. J. Moore, ISP, Wayne, NJ, United States; G. Menon, ISP, Wayne, NJ, United States; S. J. Saxena, ISP, Wayne, NJ, United States A (Cys-Gly)2 dimer peptide exhibits significant in vivo antioxidant properties for the lipids of the stratum corneum N. Domloge, MBChB, Vincience, Montard, Sophia Antipolis, France; A. Berghi, Vincience, Montard, Sophia Antipolis, France; E. Bauza, Vincience, Montard, Sophia Antipolis, France; G. Oberto, Vincience, Montard, Sophia Antipolis, France; Y. Guerif, Vincience, Montard, Sophia Antipolis, France Cholesterol, the main sterol of the epidermis, is synthesized there independently of circulating cholesterol. The majority of epidermal cholesterol is sequestered within epidermal lamellar bodies, which are secreted into the extracellular space during terminal differentiation to provide the epidermal permeability barrier. A new active ingredient has been developed which is designed to specifically target and activate 3-hydroxy-3-methylglutaryl-Coenzyme A (HMG-CoA) reductase, the rate-limiting enzyme in cholesterol synthesis. Expression of HMG-CoA reductase was evaluated by immunofluorescence (IF) staining of normal human keratinocytes (NHK), human reconstituted epidermis (HRE), and human skin biopsies maintained ex vivo treated with the active ingredient for 24 and 48 hours. On HRE and ex vivo skin biopsies, HMG-CoA reductase immunostaining was stronger in the suprabasal layer of the epidermis. Active ingredient treatment increases HMG-CoA reductase expression on NHK, HRE, and skin biopsies. Interestingly, the active ingredient also increased pankeratin expression in NHK, indicating a positive effect on keratinocyte differentiation. Because cholesterol synthesis is linked to keratinocyte differentiation, the effect of the active ingredient on pan-keratin expression was also studied by IF staining on NHK. We observed a cytoplasmic immunostaining pattern of HMG-CoA reductase in keratinocytes. By promoting the key enzyme of cholesterol synthesis and enhancing keratinocyte differentiation, this HMG-CoA reductase inducer has the potential to improve epidermal barrier function and therefore be of therapeutic value in the treatment of many skin barrier pathologies. Commercial support: 100% supported by ISP. The lipids of the stratum corneum play crucial roles in diverse aspects of skin barrier function. Exposure to environmental ultraviolet A (UVA) and UVB radiation induces significant dermal damage, oxidative stress, and lipid peroxidation. Together, these stresses damage barrier function and increase cutaneous water loss, leading to skin dehydration and ultimately decrease skin integrity leading to the formation of wrinkles. We performed a small double-blind in vivo study to investigate the antioxidant effect of the dimer peptide (Cys-Gly)2 on decreasing stratum corneum lipid peroxidation following UV exposure. This peptide is a functional mimetic of glutathione. The study was performed on seven healthy volunteers with Fitzpatrick skin type II. For each volunteer, two parallel zones were designated on the back. Lipids of the stratum corneum were extracted in absolute ethanol using a glass cylinder applied to the skin and lipid peroxidation was quantified using a lipid peroxide kit on a 96-well plate. The following day, a topical formulation containing 5% of the dimer peptide was applied on one of the selected zones of the back and the placebo on the other. Three hours later, we exposed the volunteers’ backs to full spectrum sunlight for 20 minutes. Immediately after, another application of the creams was performed. Three hours after sun exposure, the lipids of the horny layers for each zone were extracted in absolute ethanol and lipid peroxidation was quantified as described above. A statistically significant decrease of 22.17% (Wilcoxon test; P ¼ .0078) in lipid peroxidation was observed for the peptide-treated side compared to the placebo side. This peroxidation protection was observed in 100% of the volunteers. These results confirm the antioxidant efficacy of the (Cys-Gly)2 dimer peptide and demonstrate its efficient protection of the lipids of the stratum corneum from UV-induced peroxidation. Commercial support: 100% sponsored by ISP. P1007 Boosting cell energy and ECM synthesis with guanosine derivatives; an effective approach to wound healing and antiaging treatments D. J. Moore, MD, ISP, Wayne, NJ, United States; G. Menon, ISP, Wayne, NJ, United States; N. Domloge, ISP, Montard, Sophia Antipolis, France; S. J. Saxena, ISP, Wayne, NJ, United States A guanosine derivative has been developed which by its structure and chemical properties is a G protein activator and GTP precursor. As such, it provides the cell with nucleotide precursors that can be expected to increase mRNA and DNA replication and thereby lead to increased cell metabolism and enhanced cell energy. Studies were conducted on cultured different human skin cells and human ex vivo skin to demonstrate this molecule’s effect on cell energy, metabolism, and protein synthesis. The application of various active concentrations to fibroblasts resulted in a dose-dependent increase in ATP. Immunostaining studies also showed a dosedependent increase in collagen I and III and fibronectin levels in cultured human fibroblasts and in ex vivo skin treated with the guanosine derivative active ingredient. Hematoxylineeosin staining of human ex vivo skin treated with the active ingredient exhibited much better conserved structure and morphology than control skin, especially after 48 and 72 hours of culture. Skin samples irradiated with 100 mJ/cm2 of ultraviolet B (UVB) light clearly displayed fewer ultraviolet damage signs and fewer sunburned cells when treated with this guanosine derivative. DNA damage, as assessed by comet assay measurements, demonstrated that this active ingredient exhibits a very significant DNA protection and repair effect on human fibroblasts irradiated with 70 mJ/cm2. The comet assay studies indicate that this active has a greater protective effect (-93% of tail moment) than repair effect (-75% of tail moment) when skin is exposed to UVB radiation. The current experimental results indicate this guanosine derivative has therapeutic potential for wound repair and skin protection applications. A clinical investigation of the effect of a new active combination on body odor regulation N. Domloge, MD, Vincience, Montard, Sophia Antipolis, France; A. Berghi, Vincience, Montard, Sophia Antipolis, France; G. Oberto, Vincience, Montard, Sophia Antipolis, France; P. L. Dissane, Vincience, Montard, Sophia Antipolis, France; Y. Guerif, Vincience, Montard, Sophia Antipolis, France Body odor regulation has been, and remains, a significant focus and target of skin care research. Many products are able to hide, or mask, sweat odor, but they do not have any direct effect on the cutaneous bacterial flora that are primarily responsible for body odor. To address this area, we have developed an active ingredient technology based on a combination of 10 carbon (C10) molecular derivatives with sebum regulating, keratolytic, and antibacterial properties. This active system has been evaluated in vivo for its effect on body odor in a double-blind study. Ten healthy volunteers participated in the study. With a slightly nutritive solution, we collected bacteria from the armpits. Using a randomized list, we applied 1% of the active ingredient in a gel cream, or the placebo, on the armpits. Six hours after the applications, we collected bacteria a second time. In parallel, a clinical evaluation of armpit body odor was performed. Serial dilutions of the bacterial samples were performed, samples were then cultured in a Trycase soy agar for 24 hours and then total bacterial numbers were determined. Six hours after application of the formulations, assessment of the viable germ count under the armpits revealed a greater decrease in the number of bacteria in the active zone compared to the placebo zone. This difference was statistically significant (Wilcoxon test; P ¼.02345) with a decrease of 154.3% in the total number of bacteria on the active ingredient-treated side compared to the placebo side. This result was confirmed by olfactorial clinical evaluation which revealed a lower body odor on the active ingredient-treated side in 60% of volunteers. These results demonstrate that 1% of the 10 carbon (C10) technologies efficiently decrease bacterial numbers, bacterial growth, and sweat odor. Commercial support: 100% supported by ISP. Commercial support: 100% sponsored by ISP. P1005 MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5949_5952 16 January 2009 8:38 pm AB33 P1008 P1010 Epidermal antimicrobial petide expression changes in parallel with changes in permeability barrier function Marina Rodrı́guez-Martı́n, PharmD, MS, Veterans Affair Medical Center, Santa Cruz de Tenerife, Santa Cruz de Tenerife, Spain; Mao-Qiang Man, MD, Veterans Affairs Medical Center, San Francisco, CA, United States; Peter Elias, MD, Veterans Affair Medical Center, san Francisco, CA, United States Cytokine cascade after cessation of long-term topical glucocorticosteroid on hairless mouse epidermis Kai-Jhe Wei, Department of Dermatology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; C.-C. Lan, MD, PhD, Department of Dermatology, College of Medicine, Kaohsiung University Hospital, Kaoshiung, Taiwan; Chin-Han Wu, MS, Department of Dermatology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Hamm-Ming Sheu, MD, Department of Dermatology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Jui-Chen Tsai, PhD, Institute of Clinical Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan Background: Because of their physical colocalization and parallel metabolic response to barrier perturbations, the expression of antimicrobial peptide (AMP) changes in parallel with epidermal permeability barrier function. We analyzed alterations in epidermal levels of two key AMPs in relation to changes in permeability barrier status (ultraviolet [UV] light exposure, old age, testosterone, psychological stress, topical steroids, and glucocorticoid antagonism). We assessed changes that occur both when barrier function worsen and when it improves. Introduction: The epidermis constitutes a major permeability barrier to environment and provides the first line of defense against invading microbial pathogens. The epidermal permeability barrier is formed by the two stratum corneum (SC) compartment: protein-enriched corneocytes embebbed in a lipid enriched extracellular matrix organized into lamellar bilayers. The antimicrobial barrier is mediated by intact structure of the SC, its low pH, low water content, and high levels of free fatty acids. The epidermal antimicrobial defense also includes two small cationic peptides (AMPs b-defensin-2 and the cathelicidin carboxy-terminal fragment, LL-37), which both are secreted into the SC extracellular matrix. Multiple known stressors, including age, androgen levels, psychological stress, UVB irradiation, and topical or systemic steroids are known to alter permeability barrier function. Low constitutive levels of AMP under basal conditions emphasize the role of epithelial structure in antimicrobial barrier. Recent studies have shown that changes in permeability barrier function status produce a parallel response in AMP expression. Finally, these AMP are copackaged within epidermal lamellar bodies with other barrier lipid precursors. When the permeability barrier is altered, AMP production likes change in parallel, further preventing local infection and systemic microbial invasion. Objective: The aim of the present study is to assess the correlation between permeability barrier impairment and antimicrobial cutaneous barrier related to multiple endogenous and exogenous stressors and in inflammatory diseases accompanied by an abnormal permeability barrier. Methods: Both barrier and antimicrobial epidermic function were studied in mice. Immunostaining for mBD3 and cathelin-related antimicrobial peptide (CRAMP), which are the homologues of h-BD2 and LL-37, respectively, was performed. After exposure to different factors, skin biopsies were obtained, fixed in 10% formalin, and embedded in paraffin for immunostaining. Expression of mDD-3 and CRAMP was studied by confocal microscopy. Results: Changes in cutaneous expression of mBD-3 and CRAMP correlated with permeability barrier status in response to stressors, hormones, and developmental status has been performed. Antimicrobial defense was altered in parallel with UV irradiation, psychological stress, aged skin, topical clobetasol, and steroid antagonists (antalarmin and RU-486). Background: Topical corticosteroids are one of the most efficient treatments available for a variety of cutaneous inflammatory disorders. Recently, we observed that topical glucosteroids (TGCs) induce the functional and structural abnormalities of the stratum corneum, including barrier defect and dry skin. On the other hand, Elias et al. provided new concepts of a linkage between disturbances in epidermal barrier function and a cytokine cascade leading to cutaneous inflammation. We hypothesize that TGCs use may trigger a cytokine cascade and an inflammatory skin reaction. Objectives: The aim of the study was to observe the protein and gene expression of interleukin (IL)-1a, IL-b, and tumor necrosis factor-alfa (TNFa) on hairless mouse epidermis after cessation of a 6-week betamethasone dipropionate 0.064% ointment treatment. Methods: We examined the expression levels of IL1-a, IL-b, and TNFa in HRS specimens by Western blot, in situ hybridization, and immunohistochemical analysis. Results: We observed an obvious up-regulation of IL1-a, IL-b, TNFa, IKK1, and IKK2 protein or mRNA at 3 days after stopping TGCs accompanied by a significant higher transepidermal water loss (TEWL). The disappearance of these cytokines in the epidermis is accompanied by the normalization of TEWL 1 week after stopping TGCs. Furthermore, concurrent application of petroleum during TGCs treatment can minimize the impairment and decrease production of cytokines. Conclusion: In light of these observations, the TGC-induced barrier disruption results in a cytokine cascade similar to those of acute barrier insults by acetone or tape stripping. We suggest that concurrent application of skin care products to improve the barrier homeostasis during TGC treatment should become a standard part of the TGC management. Commercial support: None identified. P1011 Ethnic skins differ most in skin color. Recent results suggest the importance of keratinocytes in skin coloredependent physiological and pathological conditions. Therefore, we tried to identify possible differential gene expression profiles of keratinocytes from different skin types. We found that cathepsin L2 (CTSL2) mRNA levels are about eight-fold higher in keratinocytes from lightly pigmented relative to darkly pigmented skins. CTSL2, a lysosomal cysteine protease, is expressed in the thymus, testis, cornea, and skin. In skin, CTSL2 is involved in the desquamation of the stratum corneum and is possibly important in epidermal homeostasis and in hair growth. We show that CTSL2 is expressed in keratinocytes and melanocytes, but not in dermal fibroblasts, and that in situ hybridization documented the highest expression levels of CTSL2 in the upper epidermis. Keratinocytes derived from lightly pigmented skins have higher mRNA levels of CTSL2 than darkly pigmented skins, as analyzed by reverse transcriptase-polymerase chain reaction. No differential expression patterns were observed in keratinocytes for other cathepsins or their inhibitors, suggesting a unique role of CTSL2 in mediating ethnic skin properties. Enzymatic activity analysis showed higher cathepsin activity in keratinocytes from lightly pigmented skins than those from darkly pigmented skins. Immunohistochemical staining of human skin biopsies with different pigmentary levels showed that CTSL2 staining is inversely correlated to melanin levels. These results show that CTSL2 is expressed differentially in ethnic skins, with higher levels of mRNA, protein, and enzymatic activity in lightly pigmented skins. While the physiological function of CTSL2 in skin remains unknown, the unique expression patterns of CTSL2 in ethnic skins may provide insight into skin physiology and pathology among ethnic skins. We speculate that the lower levels of CTSL2 in darker skins may be involved in the ‘‘ashy skin’’ phenotype. Effects of different clinical grade culture systems on phenotypic patterns of differentiation of T cell subsets: Implications for adoptive cell transfer Paul C. Tumeh, MD, Department of Medicine, Division of Dermatology, Los Angeles Biomedical Research Institute at Harbor/UCLA Medical Center, Torrance, CA, United States; Antoni Ribas, MD, Division of Hematology/Oncology, UCLA Medical Center, Los Angeles, CA, United States; Begonya Comin-Anduix, PhD, Division of Hematology/Oncology, UCLA Medical Center, Los Angeles, CA, United States; Richard C. Koya, MD, PhD, Division of Hematology/Oncology, UCLA Medical Center, Los Angeles, CA, United States; Thinle Chodon, MD, PhD, Division of Hematology/Oncology, UCLA Medical Center, Los Angeles, CA, United States Adoptive cell transfer (ACT) using T-cell receptor (TCR) gene modified peripheral blood lymphocytes (PBMCs) has demonstrated objective tumor regression in patients with metastatic melanoma. In this approach, autologous PBMCs are activated ex vivo with subsequent retrovirally-mediated TCR engineering. Preclinical models and early clinical trials suggest the superior in vivo function of T cells with less differentiated (CD271, CD281, and CD62L1) or central memory (CD45RO1, CCR71, and CD62L1) phenotypes, in contrast to T effector memory (CD45RO1, CCR7e, and CD62Le) after ACT. However, the effect of varying ex vivo culture systems and the insertion of a transgenic TCR on the differentiation state of autologous lymphocytes remains largely unknown. We hypothesized that different activation protocols may significantly affect the phenotype of the resulting cells and alter their in vivo function. We used polychromatic (9-color) flow cytometry to perform a longitudinal phenotypic analysis on human PBMCs under four clinical grade lymphocyte activation protocols: (1) CD2/CD3/CD28 activation beads 1 interleukin-2 (IL-2); (2) the same protocol with IL-15; (3) OKT3 1 IL-2; and (4) the same protocol with IL-15. To define the effects of activation and timing on transduction efficiency, we transduced PBMCs with a lentiviral vector expressing GFP at different time points. Our results indicate that by 21 days post-ctivation, PBMC groups cultured with IL-15 generated a higher CD8:CD4 ratio (60% with IL-15, 37% with conditions lacking IL-15) and were comparable between CD2/CD3/CD28 and OKT3 groups. The activation protocols had strikingly different patterns of differentiation for CD81 T cells. CD2/CD3/CD28 beads generated a greater percentage of early stage CD271 CD281 CD62L1 phenotype lymphocytes when compared to OKT3 cultured lymphocytes (15% and 3%, respectively, day 15). By 21 days, all culture systems generated 15% of lymphocytes with this early stage phenotype. Lentiviral transduction demonstrated the highest efficiency on day 2, with CD2/CD3/CD28 beads yielding a 1.53 higher efficiency than OKT3. Transduction had no effect on the percentage of CD81 CD62L1 lymphocytes. We conclude that different PBMC activation protocols for ATC therapy result in markedly different immunophenotypes, and the protocol and timing of transduction results in varying levels of transgene expression, both of which play a significant role in the generation of TCR engineered cells for clinical trials. Commercial support: 100% sponsored by Johnson & Johnson. Commercial support: None identified. Commercial support: None identified. P1009 Differential expression of cathepsin L2 in skin of colors Nannan Chen, MD, The Johnson & Johnson Skin Research Center, CPPW, Johnson & Johnson Consumer Companies, Inc., Skillman, NJ, United States; Connie Lin, PhD, The Johnson & Johnson Skin Research Center, CPPW, Johnson & Johnson Consumer Companies, Inc., Skillman, NJ, United States; Miri Seiberg, PhD, The Johnson & Johnson Skin Research Center, CPPW, Johnson & Johnson Consumer Companies, Inc., Skillman, NJ, United States AB34 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5949_5952 16 January 2009 8:38 pm P1012 P1014 Characterization of a herpes simplex labialis population Jeffrey Berg, Hill Top Research, St. Petersburg, FL, United States; Chia-Ning Kao, MS, Hill Top Research, Miamiville, OH, United States; Joanne Browne, Hill Top Research, St. Petersburg, FL, United States; Kathy Barrett, Hill Top Research, Miamiville, OH, United States Diagnosis of Trichophyton rubrum infection using polymerase chain reaction and calcofluor white microscopy from onychomycotic patients under antifungal therapy Aditya Gupta, MD, PhD, Mediprobe Research Inc, London, Ontario, Canada; Jagpal Singh, PhD, Mediprobe Research Inc, London, Ontario, Canada; Muhammad Zaman, PhD, Mediprobe Research Inc, London, Ontario, Canada Trichophyton rubrum is the most frequent causative agent of onychomycosis nail infection and is isolated from 90% of nail samples that are culture-positive. The standard T rubrum detection method involves the culturing of nail fragments and potassium hydroxide (KOH)edigested nail clippings. There is also a high rate of false-negative dermatophyte detection, with the most commonly used laboratory method being microscopic observation of KOH-digested nail clippings. Currently, upon using the ‘‘gold standard’’ oral antimycotic therapy for toenail dermatophyte onychomycosis (terbinafine), a mycologic cure rate of 66% to 89% can be achieved (negative KOH microscopy and negative culture). Reports on relapse infection rates of 25% to 50% point to the need for a careful and sensitive method to substantiate the presence of cure following therapy, because there is currently no method to determine if the relapse is caused by a failure to eradicate the initial infection or represents a new infection following successful therapy. T rubrum infections were detected directly from nails in a double round polymerase chain reaction (PCR) assay using actin geneebased primers, and this method was compared with detection of fungal hyphae using a calcofluor white fluorescence microscopy of nail samples collected from 83 onychomycosis patients who were under antifungal therapy. Twenty-six of 83 samples (31.3%) were found to be calcofluor white fluorescence microscopyepositive, and 21 of 83 (25.3%) yielded positive results for T rubrum using actin geneebased primers in a double round PCR assay. The combined detection using calcofluor white fluorescence microscopy and PCR assay was 46.9% compared to 31.3% using calcofluor microscopy and culture of nail samples on Sabouraud’s dextrose agar supplemented with cycloheximide, chloramphenicol, and gentamycin (SDA1CCG; Oxoid, Nepean, Canada). The major advantage of this protocol is that T rubrum is detected regardless of viability; it detects the organism in 24 to 48 hours and is specific for T rubrum. Although the use of calcofluor white microscopy and the actin based PCR assay can detect the presence of T rubrum infection in nail samples, the methodology does not indicate the viability of the organism to the same extent as culture-based methods. Background: Herpes simplex labialis (HSL) is an infection caused by the herpes simplex virus (HSV), characterized by an eruption of small and usually painful blisters on the skin of the lips, mouth, gums, or the skin around the mouth. These blisters are commonly called cold sores or fever blisters. HSV infection appears to have increased in prevalence worldwide in the last 2 decades, making it a major public health concern. A fundamental understanding of the characteristics of a HSL population is critical to the design of clinical trials intended to evaluate the safety and efficacy of potential HSL treatments. Methods: The data presented in this poster were collected from a population of cold sore sufferers before enrollment into a multicenter clinical trial intended to evaluate the safety and efficacy of two cold sore treatments. This study was conducted at four research centers across the United States including West Palm Beach and St. Petersburg, FL, Miamiville, OH, and Scottsdale, AZ. Potential study subjects were prescreened via the telephone to determine study eligibility. Subjects who met study entrance criteria were provided screening appointments to a local research center. Before enrollment into the clinical trial, subjects provided individual cold sore historical information. Subjects provided demographic information and historical information in terms of their individual experiences with cold sore outbreaks. Tabulation of these data allowed for further understanding of a HSL population. Results: Self-reported information regarding cold sore history was collected from a total of 458 subjects (364 females, 94 males) across four research centers. Racial profile was 89.3% white, 6.1% African American, 1.5% American Indian or Alaska Native,\1% Asian and Native Hawaiian/Other Pacific Islander, and 2.6% other. From an ethnicity standpoint, the population consisted of 96.3% non-Hispanic or Latino ethnicity. On average, subjects were 47 years old (range, 18-83 yrs) and experienced cold sores for 25 years (range, 2-75 yrs). The average annual number of episodes was 4.3 with an average of 3.8 episodes in the 12 months preceding the study. Seventyfive percent of the subjects reported always experiencing a prodromal stage, with 74% always developing a classic lesion during these episodes. The treatments used most often was selected as ‘‘other,’’ which includes a variety of marketed and home remedy treatments. Topical antivirals were the second most often category selected. Aborted lesions were reported by 36% of the subjects with the average aborted lesion lasting 1.6 days. Data showed seasonal differences, with winter and summer having the highest rate of outbreaks. The top triggers were stress, illness, and exposure to extreme weather conditions or temperatures, and 47% of the subjects reported that they actively avoid these triggers. The average duration of a cold sore episode was 7.8 days and the reported average lesion severity was mild (7.6%), moderate (64.6%), and severe (27.8%). Conclusions: The data collected in this study may prove useful in both the design and conduct of future cold sore clinical trials by further defining the characteristics of a typical cold sore sufferer including their demographics, lesion triggers, typical symptoms, common treatments used, and length/severity/seasonality of outbreaks. Commercial support: None identified. Commercial support: Sponsored in part by funding from Johnson & Johnson Consumer Products Company Division of Johnson & Johnson Consumer Companies, Inc. P1015 P1013 To explore the true dimensions of consumer preference, we developed new methodologies based on cutting edge image transforms for facial photographs. These transforms allow realistic visualization of multidimensional product and/or appearance attributes on a consumer’s own face. Healthy female subjects between 18 and 45 years of age in India (n ¼ 236), Thailand (n ¼243), and China (n ¼ 245), for a total of 724 subjects, provided informed consent to participate in this institutional review boardeapproved, multicountry study. Consumer judgements were obtained across varying magnitudes of attributes alone and in combination, and also by comparing images with specific forced choice presentations. Consumer responses were analyzed using state of the art probabilistic modelling techniques, including Landscape Segmentation Analysis (The Institute for Perception, Richmond, VA). The results showed that changes in lightness alone were not most preferred, and that consumers preferred images where several attributes, such as overall color and discrete and mottled hyperpigmentation, were addressed. These findings allow us to target specific goals for our skin care products based on information derived directly from the consumer’s preference. Characterization of Trichophyton mentagrophytes multiple drug resistance genes Muhammad Zaman, MBChB, Mediprobe Research Inc., London, Ontario, Canada; Aditya Gupta, MD, PhD, Mediprobe Research Inc., London, Ontario, Canada; Jagpal Singh, PhD, Mediprobe Research Inc., London, Ontario, Canada Dermatophytes are fungi that can cause infections of the skin, hair, and nails because of their ability to use keratin. Many cases of onychomycosis are caused by the dermatophyte T mentagrophytes. The disease is generally not life-threatening, and is viewed mainly as a cosmetic concern in the initial stages, but without treatment the nails can become thick enough to be physically debilitating. Although onychomycosis generally targets the elderly or health-compromised patients inflicted by diabetes or by immune system disorders, its incidence has been rapidly increasing because of the importation of Trichophyton strains from abroad, along with an increase in the aging population. Currently it is estimated that 13% of the North American population suffers from onychomycosis. Although T mentagrophytes infections are normally treated with antifungals, there is evidence that effective treatment can be compromised by the ability of T mentagrophytes ability to adapt to prolonged drug exposure. A clear understanding of the molecular mechanisms for T mentagrophytes drug resistance is therefore critical in new drug formulation and for devising effective treatment regimens, and a logical first step in such studies would be the isolation and characterization of genes involved in conferring drug resistance. We previously described the isolation of a T mentagrophytes gene (Tmmdr1), which has significant homology to the ATP-binding cassette (ABC) genes that confer multiple drug resistance (mdr) in a wide variety of prokaryotic and eukaryotic organisms. In this poster, we characterize Tmmdr1 UTR regions and quantitate Tmmdr1 RNA expression and gene copy number in cells selected in media supplemented with high levels of ketoconazole. Commercial support: 100% sponsored by Unilever HPC. Commercial support: None identified. New approaches for realistic transforms of facial images and consumer understanding in Asian skin types Edwin Covell, MD, Unilever R&D, Trumbull, CT, United States; Jean-Marc Dessirier, Unilever R&D, Trumbull, CT, United States; Robert Velthuizen, Unilever R&D, Trumbull, CT, United States The skin care market in Asia for women strives to deliver on the consumer’s need for improvement to unwanted skin darkening, either diffuse pigment change or in specific hyperpigmentary disorders. Many skin care products include skin shade cards with products which allow the consumers to judge any perceived changes based solely on changes in lightness. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5949_5952 16 January 2009 8:38 pm AB35 P1016 P1018 Modulation of aquaporin 3 expression in cultured human keratinocytes, ex vivo skin, and an in vivo study on skin hydration N. Domloge, MD, Vincience, Montard, Sophia Antipolis, France; C. Gondran, Vincience, Montard, Sophia Antipolis, France; C. Plaza, Vincience, Montard, Sophia Antipolis, France; G. Oberto, Vincience, Montard, Sophia Antipolis, France; Y. Guerif, Vincience, Montard, Sophia Antipolis, France Investigating idebenone and idebenone linoleate in Franz diffusion cells and in cultured mouse melanoma cells Michael Wempe, MD, Eastman Chemical Company, Kingsport, TN, United States; Janet Lightner, James H. Quillen College of Medicine, Johnson City, TN, United States; Michael Wempe, PhD, James H. Quillen College of Medicine, Johnson City, TN, United States; Peter Rice, PhD, PharmD, James H. Quillen College of Medicine, Johnson City, TN, United States Background: Franz diffusion cells and cultured melanocytes are well established nonanimal test methods which help cosmetic researchers probe percutaneous permeation and investigate cellular toxicity. Idebenone and idebenone linoleate were investigated in the porcine ear model and in cultured mouse melanoma cells. Methods: Melanocytes (B16:F10 mouse melanoma cells) were purchased from American Type Culture Collection (ATCC; Manassas, VA). Cell viability was determined via the MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide) assay; a mitochondrial dehydrogenase activity assay. A Molecular Devices Spectra Max 340 (Sunnyvale, CA) was used to read the MTT experiments. Fresh porcine ears (white) were obtained from Harris Country (Greeneville, TN). Diffusion experiments (0.64 cm2 area) were conducted at 378C (bath temperature) using a Permegear V9-CV stirrer (PermeGear, Inc., Hellertown, PA). Samples were assayed using a Sciex 4000-QTrap mass spectrometer (Applied Biosystems, Foster City, CA). Results: Idebenone was found to permeate across pig ear skin. After 4 hours, the amount of idebenone which had permeated across the tissue accounted for 0.02% 6 0.01% of the total applied dose. In the case of the idebenone linoleate experiments, other than a trace amount of idebenone, nothing was detected in the receiver samples up to 4 hours. Analyzing the tissues, the idebenone-dosed tissue samples possessed a significant amount of the idebenone (92.4% 6 7.4%). The idebenone linoleate tissue samples contained a significant amount of the dosed material (87.2% 6 15.7%), but also contained idebenone (3.5% 6 1.6%). In addition, idebenone was found to be toxic to melanocytes at $ 50 m; idebenone linoleate was not cytotoxic to the melanocytes at all tested concentrations ( # 1000 m). The functional significance of aquaporins in epithelial tissues is a topic of considerable interest in skin research. As revealed by gene knockout studies, these water channel-forming proteins (especially aquaglyceroporins [AQP 3]) are crucial for maintaining the water gradient across the epidermis, and thus for many aspects of stratum corneum function, including permeability barrier homeostasis. We have identified a new active ingredient that stimulates aquaporin expression in skin and evaluated the ingredient’s benefits using cultured human keratinocytes, ex vivo human skin, and in vivo topical applications. Pretreatment of normal human keratinocytes with a 1% active solution for 24 hours induced a 43% increase in AQP3, as shown by Western blot analysis. Immunofluorescence staining (IF) revealed cytoplasmic localization in the cells, and its translocation to the cell membrane following osmotic or ultraviolet B (UVB) stress. When applied as a 3% solution the active exerted a protective effect on cells, as shown by the MTT test after osmotic stress. Histologic ex vivo studies of skin under different conditions, such as dehydration and tape stripping, indicated that increased AQP3 expression is essential for skin protection, and showed that the pattern of AQP3 expression was more enhanced in the active ingredient-treated samples. In vivo studies on the volar forearm of 10 healthy human volunteers (7 days of treatment; 1% active solution applied twice a day) were followed with hydration measurements, and in vivo confocal microscopic imaging. Compared to the placebo sites the treated sites showed a significant increase in hydration in seven of the 10 volunteers. In vivo confocal images showed a marked compaction of the SC, and a generally healthier appearance of skin in the treated areas. These results attest to the potential value of the active ingredient in optimizing SC hydration and the epidermal water gradient. Commercial support: Supported 100% by ISP. Conclusion: Idebenone displayed delayed in vitro toxicity in melanocytes while idebenone linoleate displayed no such in vitro toxicity. Idebenone was shown to permeate across viable porcine ear tissue; there was no evidence that idebenone linoleate permeated across porcine ear tissue after 4 hours. Commercial support: Eastman Chemical Company. P1019 B-cell mediated regulation of T cells? A case report of a patient with autoimmune lymphoproliferative syndrome that developed a psoriasiform rash after B-cell depletion with rituximab treatment Rohit Jaiswal, MD, MS, Ohio State University, Columbus, OH, United States; Kamruz Darabi, MD, Ohio State University, Columbus, OH, United States; Mark Bechtel, MD, Ohio State University, Columbus, OH, United States; Matthew Zirwas, MD, Ohio State University, Columbus, OH, United States; Sarah Hostetler, MD, Ohio State University, Columbus, OH, United States This report documents the case of a 17-year-old male with autoimmune lymphoproliferative syndrome who received concurrent treatment with rituximab and intravenous immunoglobulin. After less than 6 months of therapy, he developed a bilateral hand rash following trauma to his left hand. The patient was clinically diagnosed with psoriasis and treated with triamcinolone topical ointment leading to complete resolution. We discuss recent reports that B cells may play a role in the regulation of T cells. In our patient, we speculate that rituximab may have depleted the B cell pool, resulting in loss of B-cell regulatory activity. This could have lead to unopposed activation of T cells and the development of psoriasis following trauma. The use of intravenous immunoglobulin for the treatment of psoriasis has been documented in few recent case reports, and we believe that our patient would have developed more severe psoriasis if he received rituximab alone. The differential expression and activation of protease-activated receptor-2 correlate with skin color Laura Babiarz-Magee, The Johnson & Johnson Skin Research Center, CPPW, Johnson & Johnson Consumer Companies, Inc., Skillman, NJ, United States; Connie B. Lin, PhD, The Johnson & Johnson Skin Research Center, CPPW, Johnson & Johnson Consumer Companies, Inc., Skillman, NJ, United States; Miri Seiberg, PhD, The Johnson & Johnson Skin Research Center, CPPW, Johnson & Johnson Consumer Companies, Inc., Skillman, NJ, United States; Nannan Chen, PhD, The Johnson & Johnson Skin Research Center, CPPW, Johnson & Johnson Consumer Companies, Inc., Skillman, NJ, United States Skin color is determined by the production and distribution of melanin in melanosomes and by the transfer of melanosome from melanocytes to surrounding keratinocytes. The pattern of melanosome distribution within the epidermis is skin coloredependent and is regulated by ethnic origin of the keratinocytes, not the melanocytes. The protease-activated receptor-2 (PAR-2), expressed on keratinocytes but not on melanocytes, is involved in melanosome uptake by keratinocytes via phagocytosis, and modulation of PAR-2 activation affects skin color. Therefore, we hypothesized that PAR-2 may play a role in the modulation of pigmentation in a skin typeedependent manner. We examined the expression of PAR-2 and its activator, trypsin, in human skins with different pigmentary levels by immunohistochemical staining. We show that PAR-2 and trypsin are expressed in higher levels in highly pigmented, relative to lightly pigmented skins. Moreover, highly pigmented skins exhibit an increase in PAR-2especific protease cleavage ability. Using cultured keratinocytes derived from donors with different skin colors, we showed that microsphere phagocytosis was more efficient in keratinocytes from highly pigmented skins, and PAR-2einduced phagocytosis resulted in more efficient microsphere ingestion and more compacted microsphere organization in dark skinederived keratinocytes. These results demonstrate that PAR-2 expression and activity correlate with skin color, suggesting the possible involvement of PAR-2 in the determination of ethnic skin color. Commercial support: None identified. Commercial support: 100% sponsored by Johnson & Johnson. P1017 AB36 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5949_5952 16 January 2009 8:38 pm P1020 P1022 Removal of subcutaneous fat by deoxycholate in mice expressing luciferase selectively in adipocytes Rattapon Thuangtong, MD, Division of Dermatology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, United States; Michael Kolodney, MD, PhD, Division of Dermatology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, United States; Nadir Mahmood, PhD, Kythera Biopharmaceuticals, Calabasas, CA, United States; Nathaniel David, PhD, Kythera Biopharmaceuticals, Calabasas, CA, United States The color of skin: Exploring color measurement and perception Gabriela Oana Cula, Johnson & Johnson, Skillman, NJ, United States; Nikiforos Kollias, PhD, Johnson & Johnson, Skillman, NJ, United States; Paulo Bargo, PhD, Johnson & Johnson, Skillman, NJ, United States; Yang Liu, PhD, Johnson & Johnson, Skillman, NJ, United States Injection lipolysis is a nonsurgical treatment for localized fat reduction in which a formulation containing phosphatidylcholine (PC) is injected directly into subcutaneous fat. However, in vitro studies and clinical observations suggest that the active adipolytic component of these injectable formulations is not PC, but deoxycholate (DC), a secondary bile acid, which is added to emulsify the PC micelles. The aim of this study was to assess the local action of DC on fat cell reduction in a mouse model. We generated a novel mouse strain that emitted light specifically from living fat cells. The mice expressed luciferase exclusively in adipocytes because of the specificity of the adipocyte-specific FABP4 promoter. Only living adipocytes emit light, because luciferase-catalyzed light emission relies on ATP as a cofactor. FAB4P-luc mice received subcutaneous injections of DC or saline in the proximal tail. After luciferin administration, the mice were imaged using a deeply cooled CCD camera to measure luciferase-catalyzed light emission. A histologic study was also conducted. Subcutaneous injection of DC decreased light emission around the injection site. Decreased fat luminescence was observed 30 minutes after DC injection with a maximal decrease recorded 20 hours postinjection. Control injections with saline did not decrease fat luminescence. Histologic analysis of the mouse tails at 5 days following injection showed evidence of adipocyte necrosis, loss of cell-cell borders, and inflammatory cell recruitment. Interestingly, muscle fascicles and epidermis showed less inflammation or changes in cell morphology relative to adipocytes. Our results suggest that in mice, subcutaneous administration of DC may cause selective killing of adipocytes. It is likely that this activity is a result of the membrane destabilizing effects of DC. Moreover, DC alone appears to be sufficient to cause adipolysis, further supporting observations that PC is not the active molecule in injection lipolysis formulations. Commercial support: Research supported by grant from Kythera Biopharmaceuticals. Introduction: Skin color is one of the most defining characteristics of human appearance and must be carefully considered by the dermatologist before beginning treatments and procedures. The paradigm of assessing skin color has two components. One component is the detection and quantification of the underlying chromophores (melanin and hemoglobin) responsible for the apparent skin color. The other component is the measurement of the perceived color. The absorption and scattering properties of skin affect its appearance, and one needs to communicate about skin color in a manner that relates to the observer’s perception. The objective of this study was to assess skin color within this framework, for a wide range of skin tones, and to analyze the correlation between the two components of the paradigm. Methods: The skin color of more than 300 subjects of different ethnic backgrounds with a large range of skin tone (Fitzpatrick skin types I to VI) and between 19 and 77 years of age was assessed. For each subject, sun-exposed skin areas (ie, facial skin) and areas shielded from the sun (ie, skin on the upper portion of the inner arm) were measured. Melanin and hemoglobin presence in skin was quantified with fiber opticebased diffuse reflectance spectroscopy (DRS) and with existing analytical models of light diffusion in skin. The apparent skin color was represented by using perceptually uniform CIEL*a*b* color space. The color measurements were obtained with a Minolta Chromometer and with visible imaging. Results: The contributions of chromophores responsible for the apparent skin color skin were assessed, and the range of perceived skin color in CIEL*a*b* space was determined for a large range of skin colors and ages. The locus of skin color data in CIEL*a*b* space appears different from what has been previously reported in the literature. The CIEL*a*b* color measurements from the face are shifted relatively to those obtained from unexposed areas, because of changes in the absorption characteristics of the tissue because of the presence of melanin and hemoglobin in the exposed versus the unexposed skin. Discussion: The study demonstrated that the ability to detect melanin content differs for light and dark complexioned subjects. In addition, spectroscopy-based parameters and perceived color do not correlate as well for darker complexioned subjects. Commercial support: 100% sponsored by Johnson & Johnson. P1021 Cytolytic effects of deoxycholate are attenuated by interactions with proteins Kristeene Knopp, Division of Dermatology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Calabasas, CA, United States; Michael Kolodney, MD, PhD, Division of Dermatology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, United States; Nadir Mahmood, PhD, Kythera Biopharmaceuticals, Calabasas, CA, United States; Nathaniel David, PhD, Kythera Biopharmaceuticals, Calabasas, CA, United States Previous in vitro and clinical observations suggest that the active component in injection lipolysis formulations is not phosphatidylcholine (PC), but deoxycholate (DC), a secondary bile acid used to solubilize PC micelles. Several studies have reported that DC is well tolerated within specific dose regimens, despite being a detergent that lyses cell membranes. The aim of this study was to explore why this treatment has limited cytolytic effects on nonfat tissue. Several types of cultured cells—including fibroblasts, keratinocytes, skeletal muscle cells, and adipocytes— were treated with increasing concentrations of DC. We assessed the ability of different tissue types (eg, fat, skin, and muscle) to inhibit the DC-mediated cytolysis of cultured primary human adipocytes. Cultured adipocytes were also treated with variable concentrations of DC in the presence of physiological concentrations of albumin at 0.7%, 1.3%, and 4% (the concentrations of albumin in interstitial fluids surrounding human fat cells, human skeletal muscle cells, and human blood, respectively). Our results demonstrate that DC cytolytic activity is not selective for adipocytes in vitro, because all cell types tested were susceptible to DC-mediated cytolysis. However, preincubation of DC with protein-rich tissues such as muscle and skin progressively attenuated DC cytolytic activity. This result was further supported by the observation that DC activity was reduced in the presence of albumin. The binding of albumin to DC has been well characterized, and our results show that increasing concentrations of albumin block DC-mediated adipolysis. In the presence of 0.7% and 1.3% albumin, DC activity was reduced, whereas 4% albumin completely inhibited DC cytolytic activity. In summary, adipocytes are not uniquely sensitive to the detergent effects of DC in vitro. However, tissue types located near subcutaneous fat that are protein-rich (eg, skin and muscle) are resistant to the effects of this natural detergent when it is injected locally into adipose tissue. In addition, the cytolytic activity of DC was markedly attenuated in the presence of albumin. It is likely that a similar mechanism may prevent endogenous bile acids from damaging tissues within the enterohepatic circulatory system. Commercial support: Research supported by grant from Kythera Biopharmaceuticals. P1023 Mechanisms of natural moisturizing factors for skin hydration Eugene Pashkovski, Unilever R&D, Trumbull, CT, United States; Alex Lips, Unilever R&D, Trumbull, CT, United States; Mike Petko, Unilever R&D, Trumbull, CT, United States Stratum corneum (SC) consists of flattened cornified cells (corneocytes) surrounded by extracellular lipid matrix. Whereas skin lipids repel water, the hydration of corneocytes is critical for maintaining biologic functions of skin. The hydration of corneocytes is provided by the natural moisturizing factor (NMF), a mixture of amino acids and other derivatives originating from filaggrin. It is generally accepted that NMF acts as a humectant mixture. We have studied the biophysical mechanisms by which NMF contributes to SC water homeostasis, including the impact of temperature and humidity. Our research reveals that NMF viscosity increases as humidity is reduced, thereby slowing the rate of skin dehydration. In analogy with sugars protecting the plant cells at low humidity, one uncovers novel mechanism of mammalian skin resistance to desiccation via NMF behavior. Possibly, changes to NMF solutions at high viscosities prevent the keratinous structures from mechanical failure, which would be a result of rapid dehydration. The NMF systems may be considered a unique biologic system for water management in a complex biologic substrate subject to wide variation with external environmental changes. The physicochemical properties of topically applied moisturizers, such as glycerol, sugars, and their derivatives, are discussed in the context of desiccation behavior of the SC. Studies of the molecular mechanisms of hydration provide a basis for identifying improved skin moisturizer technologies. Commercial support: 100% sponsored by Unilever HPC. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5949_5952 16 January 2009 8:38 pm AB37 P1024 P1026 A new liposome assay for assessing lipid damage potential of cleansers and its correlation with in vivo clinical performance Eugene Pashkovski, MD, Unilever R&D, Trumbull, CT, United States; K. P. Ananthapadmanabhan, Unilever R&D, Trumbull, CT, United States; Liang Tsaur, Unilever R&D, Trumbull, CT, United States; Pascal Andre Ngankam, Unilever R&D, Trumbull, CT, United States In vitro studies of a newly developed active ingredient that enhances barrier lipid synthesis C. Plaza, MD, MS, Vincience, Montard, Sophia Antipolis, France; C. Dal Farra, ISP, Wayne, NJ, United States; C. Gondran, Vincience, Montard, Sophia Antipolis, France; I. Imbert, Vincience, Montard, Sophia Antipolis, France; N. Domloge, Vincience, Montard, Sophia Antipolis, France A new methodology for assessing lipid damage potential of formulated cleanser systems has been developed. A major advantage of this technique is that it can be used to assess lipid damage potential of anisotropic, nontransparent products. An attempt has been made to correlate available clinical results with the lipid assay and the results look encouraging. The test is based on detection of changes in lipid layers brought about by their contact with surfactants or cleansing formulations using fluorescence energy transfer (FRET) techniques. Briefly, we prepare model skin lipid vesicles that contain equimolar ratios of ceramide, palmitic acid, cholesterol and 2 mol % of cholesterol sulfate. The donor and acceptor molecules (DIOC18 and rhodamine DHPE, respectively) were placed within the bilayers. The fluorescence signal from the donor was found to increase by a factor of approximately 5 when the liposomes were exposed to surfactants or cleansing formulations. The FRET kinetic curves were fitted to the standard exponential function, and the rate constants were determined from the fits. The results showed that the kinetics of lipid membrane destruction can be slowed down significantly by additives to cleansing surfactants. A comparison of the kinetic constants with the clinical data from patch and leg wash studies showed that the kinetic constants correlate well with transepidermal water loss and skin irritation scores. Because both of these parameters reflect barrier damage, the present test may be a good predictor of in vivo barrier damage. Future work will focus on testing the robustness of the technique in predicting the in vivo performance of complex cleansing systems. The extracellular lipid matrix of the stratum corneum, which is composed primarily of ceramides, cholesterol, and fatty acids, is essential for skin barrier function. The present study focuses on a newly developed active ingredient that exerts an enhancing effect on epidermal lipid synthesis. Cultured normal human keratinocytes (NHK) were treated with 1% of the new active ingredient for 24 and 48 hours. Similarly, human reconstituted epidermis (HRE) and human skin biopsies were treated with 1% of the new active ingredient for 24 and 48 hours. All treated samples and their respective controls were stained with Nile Red, a selective fluorescent stain for neutral lipids, to visualize epidermal lipids. Furthermore, because lipid synthesis has been linked to keratinocyte differentiation, the effect of the new active ingredient on pan-keratin expression was also studied by immunofluorescence staining on NHK. Our results showed that treatment of cells with 1% of the active ingredient increased lipid droplets in NHK stained by Nile Red. The lipid droplets appeared abundant, especially in the perinuclear space; this effect was observed at 24 hours but was greater after 48 hours of treatment. Moreover, Nile Red staining also revealed an increase in the lipid content of treated HRE and skin biopsies. The staining was seen mainly at the suprabasal level, as well as in the stratum corneum. Interestingly, the active ingredient increased pan-keratin expression in NHK, indicating a stimulating effect on keratinocyte differentiation and skin barrier improvement. Because of its stimulating effects on lipid synthesis and keratinocyte differentiation, this active ingredient should be of great use in the treatment of skin barrier alterations caused by different pathologies. Commercial support: 100% sponsored by Unilever HPC. Commercial support: 100% sponsored by ISP. P1025 Dermal tolerability comparison of a marketed transdermal system Jeffrey Berg, PhD, Hill Top Research, St. Petersburg, FL, United States; Chia-Ning Kao, MS, Hill Top Research, Miamiville, OH, United States; Marisa Flanagan, Hill Top Research, Scottsdale, AZ, United States; Micah Humphrey, Hill Top Research, St. Petersburg, FL, United States Background: This study was conducted as a phase IV postmarket commitment to examine the adhesion and dermal tolerability of a once-daily transdermal patch in two populations consisting of nonelderly (18-64 yrs of age) and elderly ([65 yrs of age) healthy volunteers. Methods: This was an open-label, multicenter study of subjects randomized to one of three dose groups (6, 9, or 12 mg/24 hr). Each subject received a single patch that was applied daily for 21 consecutive days. Subjects were randomized to receive the patches in one of three application areas (upper torso, including chest and back, upper arm, or upper thigh). The transdermal systems consisted of rectangular patches that were 20 cm2 (6 mg/24 hr dose), 30 cm2 (9 mg/24 hr dose), or 40 cm2 (12 mg/24 hr dose) in size. Skin irritation was assessed at 30 minutes and 24 hours after patch removal by trained evaluators and quantified using the scale of Berger and Bowman (0-7 point scale). Statistical comparisons of dermal irritation were made between the dosage groups (6, 9, or 12 mg/24 hr dose), age groups (18-64 yrs and [65 yrs), and study centers (St. Petersburg, FL, and Scottsdale, AZ). Results: Of the 367 subjects enrolled, 347 subjects were included in the per protocol population (165 subjects were 18-64 yrs of age; 182 subjects were [65 yrs of age). The overall mean irritation scores for the 30-minute assessment ranged from 0.52 to 0.70; 24-hour scores ranged from 0.05 to 0.15, where a score of 1 indicated barely perceptible erythema. The only significant comparison between overall dosage groups showed that the 6-mg dose was significantly less irritating than the 12-mg dose at 24 hours (P ¼.0139). Age was not a significant factor in overall irritation or by dose. The St. Petersburg center showed significantly less irritation at the 30-minute assessment as compared to the Scottsdale center (P \.0001), but not at the 24-hour assessment (P ¼.2529). When broken down by dose, the only significant differences were for the 6-mg dose at the 30-minute assessments (P \ .0001) and 24-hour assessments (P ¼.0366) with less irritation at the St. Petersburg center. Conclusions: For this particular transdermal system, there were minimal irritation scores observed across all doses, age groups, and study centers. While there were statistically significant differences noted, the size of those differences was small in relation to the scoring scale and the overall level of irritation observed. Under the conditions of this study, this particular transdermal system showed minimal levels of skin irritation and minimally small differences when compared between patch size, age of wearers, and geographic location of the study. Commercial support: Supported by funding from Somerset Pharmaceuticals, Inc. and Bristol-Myers Squibb, Inc. AB38 P1027 Ex vivo studies and in silico evaluation of a melanin-inducing active: Enhancing skin pigmentation while decreasing ultraviolet lighteinduced inflammatory cytokine release N. Domloge, MD, ISP, Montard, Sophia Antipolis, France; D. J. Moore, ISP, Wayne, NJ, United States; G. Menon, ISP, Wayne, NJ, United States; S. Vali, Cellworks Group, Saratoga, CA, United States; S. J. Saxena, ISP, Wayne, NJ, United States Tanned skin is considered more resistant to solar radiation than fair skin. Biologic stimulation of melanin production is a desirable way to tan without inducing sun damage. In the current work, we report the effects of a new melanin-inducing active ingredient (MI) using ex vivo human skin biopsies with and without exposure to ultraviolet B (UVB) light radiation. Melanin content and distribution was evaluated using histology and FontanaeMasson (FM) staining. A time-dependent increase in melanin was noted at 24, 48, and 72 hours when the MI was applied twice daily. The MI also caused a dose-dependent increase in melanin at 48 hours. In further UVB and MI studies, one application of the MI was followed by 100 mJ/cm2 of UVB radiation, the MI was reapplied, and samples collected at 24 hours from treated and irradiated controls. FM staining revealed greater melanin content in MI treated and irradiated samples compared to irradiated controls. When cultured fibroblasts were treated with the MI for 24 hours before and after UV irradiation (for a total of 48 hrs) a significant decrease in production of the inflammatory cytokine interleukin-1b was observed. This suggests that the MI’s ability to tan skin is not related to increased UVinduced inflammation. As this is somewhat counterintuitive, in light of the known UV effects of inducing inflammation and the postinflammatory hyperpigmentation, we used the in silico skin pigmentation platform to evaluate the effects of the MI and the results are presented and discussed in the poster. Commercial support: 100% sponsored by ISP. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5949_5952 16 January 2009 8:38 pm P1028 A novel approach to enhance mildness of cleansers using organic ions Lin Yang, Unilever R&D, Trumbull, CT, United States; Jaime O’Leary, Unilever R&D, Trumbull, CT, United States; K. P. Ananthapadmanabhan, Unilever R&D, Trumbull, CT, United States; Prem Chandar, Unilever R&D, Trumbull, CT, United States The skin irritation potential of surfactants has been investigated extensively in the past, and the available results in the literature show that the irritation potential can be correlated with the ability of surfactants to cause swelling or denaturation of proteins. We have also recently shown that the protein/enzyme denaturation potential of surfactants increases with an increase in the charge density of the surfactant micelle. This shows that the common practice of using a blend of anionic and nonionic surfactants to increase surfactant mildness involves reducing the charge density of anionic micelles. Another method to reduce micelle charge density involves the use of large organic cations, and our in vitro results show that protein denaturation tendency of anionic surfactants can be reduced significantly by using a cation such as a hydroxyl propyl quaternary ammonium salt. We have also shown in in vivo studies that these organic cations applied to skin before surfactant exposure can reduce the intensity of protein damage. Insights derived from these studies of the physicochemical interactions of surfactant systems and stratum corneum components provide a means to develop more effective products to address dry skin conditions. Commercial support: 100% sponsored by Unilever HPC. CLINICAL DERMATOLOGY AND OTHER CUTANEOUS DISORDERS P1100 Infliximab in the treatment of refractory chronic urticaria Norbert Reider, MS, Clinical Department of Dermatology, Medical University, Innsbruck, Austria; Cornelia Egger, MD, Clinical Department of Dermatology, Medical University, Innsbruck, Austria Chronic urticaria is defined as appearance of hives for at least 6 weeks. In 80% of cases, no causal trigger can be found. Adequate evidence for the effect of symptomatic treatment only exists for antihistamines. Other options, among them intravenous immunoglobulin (IVIG), have been suggested in mostly uncontrolled case series. We report on the effect of infliximab (IFX), a monoclonal IgG-antibody directed against tumor necrosis factor-alfa (TNFa), in four patients with chronic refractory urticaria. To exclude an effect of the Ig per se, we compared our results to those with IVIG in five other cases. The mean age in the IFX group was 34.8 years, with a duration of urticaria of 49 months. The patients had been examined for infections, autoimmune disorders (including autoreactive urticaria), physical and cholinergic urticaria, and food or drug allergy. Five other patients with similar characteristics were selected to receive IVIG. All patients had daily urticaria and been treated with various combinations of H1- and H2-antihistamines, ketotifen, montelukast, hydroxychloroquine, dapsone, mirtazapin, cyclosporine, and naltrexon without success for at least 1 year. We then decided to administer IFX 5 mg/kg in weeks 0, 2, and 6 in one group and a mean of 6.6 series of IVIG at a dose of 0.5 mg/kg divided over 5 days each in the other group. In three of four IFX patients, urticaria was suspended before the second infusion. All three have been in full remission for a mean of 10 months (range, 6-12 mos) now. The only male patient did not show any benefit. A complete response was achieved in four of five IVIG subjects and a partial response in the fifth already during the first days of administration. However, this persisted for 1 to 3 weeks only. Further series proved to be similarly effective. No sustained remissions were observed. We suggest a mainly antiidiotype effect of IVIG as relapses occurred after a maximum of 3 weeks, the half-life of IVIG. If this were also the case for IFX, no sustained remissions could be expected. Elevated levels of TNFa have been demonstrated in chronic urticaria, including endothelial and perivascular cells of the epidermis and upper dermis. TNFa induces E-selectin, which is elevated in urticaria and is an important mediator of neutrophil and eosinophil adherence. Because urticaria involves mast cell activation and infiltration of neutrophils and eosinophils into the dermis, a specific anti-TNFa effect of IFX in chronic urticaria may be suggested. Commercial support: None identified. P1101 P1029 A case-control study of rosacea subjects compared to control subjects Maryanne Kazanis, Brigham and Women’s Hospital, Boston, MA, United States; Alexandra B. Kimball, MPH, MD, Massachusetts General Hospital, Boston, MA, United States; April W. Armstrong, MD, Brigham and Women’s Hospital, Boston, MA, United States; Jason Frangos, Massachusetts General Hospital, Boston, MA, United States; Lynn Drake, MD, Massachusetts General Hospital, Boston, MA, United States Background: Rosacea is a common disease characterized by inflammation and vascular abnormalities of the facial skin and ocular surface. It is considered to be a syndrome encompassing various combinations of cutaneous signs including flushing, erythema, telangiectasia, papules, pustules, edema, ocular lesions, and rhinophyma. The exact etiology of cutaneous rosacea is unknown, but is thought to be characterized in part by persistent vasodilatation, increased vascular permeability and vascular hyperreactivity of the microcirculation of the central part of the face. A virtual cell system prototyping for development and validation of skin lightening actives: Correlation with ex vivo and in vivo results N. Domloge, Vincience, Montard, Sophia Antipolis, France; E. Bauza, Vincience, Montard, Sophia Antipolis, France; G. Oberto, Vincience, Montard, Sophia Antipolis, France; R. McMullen, ISP, Wayne, NJ, United States; S. Vali, Cellworks Group, Saratoga, CA, United States Reducing uneven pigmentation, a hallmark of aging changes in ethnic population, is of interest to dermatologists and their patients. For the cosmetic industry, meeting consumers’ expectations in this area requires more efficacy than that provided by currently marketed tyrosinase inhibitors. The discovery of new actives is greatly aided by employing a virtual cell system of interacting melanocytes and keratinocytes (a proprietary skin pigmentation platform) which has multiple triggers and more than 4000 biomolecules that can be assayed by simulation in silico. This provides unprecedented visibility and the ability to understand and drive experimental work efficiently while predicting the beneficial clinical or even toxicologic impact of the targets and actives being designed. We have experimentally tested and compared the effects of 1% Brassicacea extract and 1% arbutin, and combinations of both, on ex vivo skin. FontanaeMasson (FM) staining of histologic sections showed that the Brassicasea extract and Arbutin treatment decreased the skin melanin content. Quantitative image analysis of the FM-stained histologic sections indicated a 49% decrease in melanin for Brassicasea compared to 32% for arbutin. A combination of two actives did not increase the efficacy of the Brassicacea extract. A blinded clinical study with the Brassicasea extract showed a significant decrease in the melanin index. Image analysis of clinical photographs of age spots supported the clinical findings. A comparison of the experimental results with that of the in silico results will be presented and the implications discussed in the poster. Results: Sixty-five rosacea subjects and 65 controls were enrolled. On average, rosacea subjects had moderately severe global disease. All rosacea subjects in this study had the erythematotelangiectatic subtype, and many had an additional subtype: 38.4% (n ¼ 25) had papulopustular, 10.8% (n ¼ 7) had phymatous, and 23% (n ¼ 15) had ocular rosacea. Rosacea subjects were much more likely to have a family member with rosacea compared with controls (R ¼ 34% vs C ¼ 10.5%). In reported dermatologic and medical conditions, rosacea subjects had significantly higher rates of blistering sunburns (R ¼ 44% and C ¼ 5.2%; P \.05), and increased prevalence of hypercholesterolemia (R ¼ 22%, C ¼ 7% and R ¼ 24%, C ¼ 7%, respectively; P \.05). Commercial support: 100% sponsored by ISP. Commercial support: None identified. Objective: To prospectively confirm previous epidemiologic associations of rosacea with demographic characteristics versus controls. Methods: Eligible subjects with and without rosacea underwent a facial skin exam, completed a questionnaire, and had their height, weight, and blood pressure measured. Blood pressure measurements, body mass indices, and questionnaire results of the two groups were compared. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:44 am AB39 P1102 P1104 Cutaneous sinus histiocytosis (RosaieDorfman disease) presenting histologicly as subcutaneous panniculitis-like T-cell lymphoma versus lupus panniculitis (lupus erythematosus profundus) Regina Ramon, MD, PhD, Hospital General Alicante, Alicante, Spain; Irene Ballester, Hospital General Alicante, Alicante, Spain; Isabel Betlloch, Hospital General Alicante, Alicante, Spain; Jaime Guijarro, Hospital General Alicante, Alicante, Spain; Maria Perez, Hospital General Alicante, Alicante, Spain A 51-year-old female presented to our clinic with a 2-month history of a large, unique, asymptomatic nodule located on her right abdomen. She was otherwise healthy, with no history of fever, malaise, or weight loss. Biopsy specimens from the lesion were suggestive of subcutaneous panniculitis-like T-cell lymphoma versus lupus panniculitis (lupus erythematosus profundus), including lobular panniculitis with small fat lobules and thickened septa, with abundant mucin between collagen bundles of the reticular dermis. The dense infiltrate was mainly composed of small to medium atypical lymphocytes, sometimes showing an angiocentric distribution and forming rings around the adipose tissue lobules, plasma cells among necrotic adipocytes, and sclerotic collagen bundles in the thickened septa. No clonality was documented by T-cell receptor gene rearrangement studies. Routine blood investigations showed an elevated erythrocyte sedimentation rate and mild leukocytosis. Results of autoimmune screening for lupus erythematosus were negative. There was no lymphadenopathy or hepatosplenomegaly. With the histologic diagnostic doubt and because the nodule was quickly growing the lesion was fully excised. The histopathologic findings of the full lesion were strongly suggestive of cutaneous sinus histiocytosis (RosaieDorfman disease): pale-staining, large, polygonal histiocytes admixed with plasma cells, neutrophils, many lymphocytes, and occasional Touton giant cells. Emperipolesis of plasma cells with the typical halo were also seen. Tuberculoid leprosy: An immune reconstitution inflammatory syndrome in an HIV-positive patient Carla Oliveira, Unirio Universidade Federal Do Estado Do Rio De Janeiro, Rio De Janeiro, Brazil; Bruno Aquino, MD, Unirio Universidade Federal Do Estado Do Rio De Janeiro, Rio De Janeiro, Brazil; Omar Lupi, PhD, Unirio Universidade Federal Do Estado Do Rio De Janeiro, Rio De Janeiro, Brazil; Ricardo Lima, MD, Unirio Universidade Federal Do Estado Do Rio De Janeiro, Rio De Janeiro, Brazil Background: The introduction of highly active antiretroviral therapy (HAART) has led to the emergence of a new clinical syndrome known as immune reconstitution inflammatory syndrome (IRIS). This syndrome has been described in association with many diseases; however, only recently has IRIS has been associated with leprosy. A paradox is that HIV coinfection does not affect the tuberculoidelepromatous clinical spectrum of leprosy. These patients might have more severe leprosy neuritis and an increased frequency of immune mediated reversal reaction (type I). Commercial support: None identified. Case report: A 31-year-old HIV-positive male from Nova Iguaçu who has been on HAART for 18 months related a lesion on right forearm for about 8 months. Clinical examination revealed a single erythematous infiltrate plaque, measuring 2 cm, painless, and with a thick nerve emerging on it. This lesion had amendment of thermal sensitivity. A skin biopsy was performed and showed a granulomatosis inflammatory tuberculoid pattern, BAAR negative, confirming a tuberculoid leprosy with reversal reaction type1 diagnosis. The patient started prednisone 60 mg/day and a paucibacillary scheme therapy with rifampicin and dapsone. After 9 months of the beginning of HAART, the pacient developed several erythematous plaque with neuritis on the right forearm. Discussion: The temporal association between the development of these lesions and CD41 lymphocytopenia observed during HAART strongly suggests that this apresentation of leprosy was a result from immune reconstitution. Interations between HIV infection and leprosy in use of HAART may lead to increased cellmediated immunity to Mycobacterium leprae, triggering reversal reactions and making control of the disease a hard task to achieve. Although this case represents a pacient with a borderline tuberculoid leprosy, based on the Ridley and Jopling classification, a paucibacillary scheme was started according to the operational division of World Health Organization that classifies up to five lesions as a paucibacillary form. Systemic corticosteroids are indicated in severe leprosy reaction with neuritis and were prescribed in the present case. Commercial support: None identified. P1103 Mucoceles that weren’t—Two case reports Kristyna Lee, MD, SUNY Downstate Medical Center, Brooklyn, NY, United States; Daniel M. Siegel, MD, SUNY Downstate Medical Center, Brooklyn, NY, United States; Laura Cepeda, MD, SUNY Downstate Medical Center, Brooklyn, NY, United States P1105 Discussion: Oral cysticercosis and salivary gland adenocarcinoma are rare diseases of the oral mucosa. It is important to consider these and other uncommon diagnoses when evaluating an oral nodule presumed to be a mucocele. We discuss the natural history and pathogenesis of mucoceles and these disease processes. Purpura annularis telangiectodes of majocchi: Two case reports of this uncommon dermatoses Kristyna Lee, MD, SUNY Downstate Medical Center, Brooklyn, NY, United States; Usha Alapati, MD, SUNY Downstate Medical Center, Brooklyn, NY, United States At least five subtypes of pigmented purpuric dermatoses have been described. Purpura annularis telangiectodes of Majocchi is an uncommon pigmented purpuric eruption characterized by symmetrical, purpuric, telangiectatic, and atrophic patches with a predilection for the lower extremities and buttocks. We present two cases of this uncommon dermatoses and discuss the natural history and pathogenesis of this and other types of purpura. The first case is an 83-year-old male who presented complaining of a 1-week history of nonpruritic red spots on his lower extremities. The second case is a 79-year-old male who presented with a 2-month history of a pruritic patchy rash along his waistline. Both patients had no significant medical history. Both patients denied any history of trauma, preceding illness, prodromal symptoms, new medication use, or easy bruisability. Their reviews of symptoms were both noncontributory. In patient 1, there were multiple discrete annular and arcuate purpuric and erythematous patches extensively distributed along his bilateral proximal pretibial and posterior calves and ankles. In patient 2, there were multiple discrete annular purpuric and erythematous patches along the lower abdomen and posterior waistline. The patches in both patients were nonblanchable. Laboratory evaluation including antinuclear antibody titer, coagulation panel, and complete blood cell count with differential revealed no abnormalities in both patients. Given the lack of constitutional symptoms in either of these otherwise healthy patients with physical examinations unremarkable outside of classic annular purpura and unremarkable laboratory evaluations, the diagnoses of coagulation disorders, vasculitis, thrombocytopenic states, or purpuras secondary to acute infections were unlikely. Histopathologic examination for both patients revealed a superficial perivascular and interstitial infiltrate of lymphocytes admixed with red blood cells and mild edema in the papillary dermis. The diagnosis of purpura annularis telangiectodes of Majocchi was made for both patients. Supportive therapy was offered and all lesions in both patients gradually resolved with residual postinflammatory hyperpigmentation. Commercial support: None identified. Commercial support: None identified. Background: A mucocele is one of the more commonly encountered disorders of the oral mucosa. It develops when a minor salivary duct is injured or blocked, resulting in the escape of mucus into the adjacent submucosal connective tissue. We present two cases that were initially diagnosed as mucoceles. Histologic examination, however, revealed dissimilar and medically significant pathologies. Case 1: A healthy 38-year-old male was referred for multiple intraoral nodules. They were firm, painless, and not related to any traumatic episode. They had been present for 1 year after traveling to Puerto Rico and 6 months after traveling to Costa Rica. A large solitary nodule arose first, followed by three smaller nodules 6 months later that developed around the primary lesion. The patient had no headaches, seizures, or any neurologic deficits. On examination, all nodules were smooth and well defined with intact overlying mucosa. An 8- 3 6-mm nodule and three surrounding 3- 3 3-mm nodules were seen on the lower labial mucosa. Clinically, the nodules resembled mucoceles. Histopathologic examination of the largest lesion revealed a cystic space containing a cysticercus larva. The diagnosis of oral cysticercosis was made. Magnetic resonance imaging scans showed no evidence of cysticerci in the brain or eye. An stool examination revealed no ova, cysts, or parasites. The lesions resolved after an oral course of albendazole 400 mg twice daily. Case 2: A 71-year-old female with a medical history significant for a 30-pack per year cigarette smoking habit was referred for a slowly enlarging intraoral lump. This was painless and had been present for 5 years. Examination revealed a solitary 3- 3 3-mm freely mobile, smooth, firm nodule on the labial mucosa of the upper lip. The clinical diagnosis was a mucocele. Histopathologic examination revealed salivary gland polymorphous low-grade adenocarcinoma. Mohs micrographic surgery was performed and no residual carcinoma was identified in the Mohs stage. On follow-up, she is doing well without evidence of further disease. AB40 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:44 am P1106 P1108 Ulcerated lesions in sarcoidosis: A rare cutaneous manifestation of a systemic disease Nayibe Solano, MD, Instituto de Dermatologia Prof. Rubem David Azulay - Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil; Bruna DuqueEstrada, MD, Instituto de Dermatologia Prof. Rubem David Azulay - Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil; Carla Tamler, MD, Instituto de Dermatologia Prof. Rubem David Azulay - Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil; Gioiella Sousa, MD, Instituto de Dermatologia Prof. Rubem David Azulay - Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil; Jo~ao Avelleira, PhD, Instituto de Dermatologia Prof. Rubem David Azulay - Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil Gnathostomiasis in Brazil Christiane Dani, MD, Policlı́nica Geral do Rio de Janeiro, Rio de Janeiro, Brazil; Claudia Maia, MD, MS, Policlı́nica Geral do Rio de Janeiro, Rio de Janeiro, Brazil; Juan Maceira, MD, MS, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Omar Lupi, MD, PhD, MS, Policlı́nica Geral do Rio de Janeiro, Rio de Janeiro, Brazil Background: Sarcoidosis is a chronic systemic granulomatous disorder of unknown etiology. It affects people worldwide, although the incidence varies dramatically. The disease is 10 times more common in African American women, and they also have a greater likelihood of developing extrathoracic disease and a poorer long-term prognosis. Multiple organs are involved with many varied cutaneous manifestations. Cutaneous involvement is seen in 20% to 35% of patients, and it usually accompanies systemic involvement. Case report: A 51-year-old African America woman presented with a 2-year history of ulcerative atrophic lesions and infiltrative plaques in the lower legs. Bacterial and fungal infections were ruled out. The patient had no serologic evidence for syphilis or HIV. Serum biochemistry showed a mycrocitic normocytic anaemia, hypercalcemia, elevated serum angiotensin-converting enzyme level and elevated liver function tests suggestive of hepatic dysfunction. Purified protein derivative (PPD) for tuberculosis and antinuclear antibody were negative. A chest radiograph revealed a diffuse reticulonodular infiltrate, and an abdominal ultrasound demonstrated hepatosplenomegaly. The eletrocardiogram showed a right branch heart block. Histopathology of an infiltrative lesion showed well demarcated collections of epithelioid cells with few lympocytes in the periphery. A biopsy from the ulcerative lesion revealed findings consistent with a vasculitis. The features were consistent with sarcoidosis and prednisone 1 mg/kg/day therapy was initiated. After 2 months, ulcerative lesions showed dramatic improvement. Gnathostomiasis is a disease in humans caused by the larval stage of roundworms in genus Gnathostoma spinigerum characterized by creeping eruptions and/or migrating erythemas with a local edema in the skin. Infection occurs by ingesting uncooked/undercooked meat of the intermediate/paratenic hosts contaminated with the larvae. The disease is endemic mainly in Asian countries such as Thailand and Japan, where people prefer to eat freshwater fish. It has also been frequently reported in South America and Mexico; however, there have not been any recent case reports in Brazil. In cats and dogs, which serve as important reservoirs of infection in regions where Gnathostoma is endemic, the ingested third-stage larva matures into the adult worm in approximately 6 months. However, because the larva cannot mature into the adult form in humans, the third-stage larva can only wander within the body of the host; clinical symptoms of gnathostomiasis then occur because of the inflammatory reaction provoked by these migrating larvae. This is a report of an infection of a young Spanish male living in Brazil who traveled to Peru and ate freshwater fish marinated in lemon juice and later suffered cutaneous manifestations of intermittent migratory swelling, creeping lesions, and indurated erythematous plaques accompanied by itching. He had significantly higher eosinophil counts (1530/mm3) and the histopathology showed eosinophilic infiltration in the dermis, congruous to eosinophilic cellulitis. Biopsies of migrating lesions frequently miss the larvae and are helpful only in demonstrating an eosinophilic infiltration. The patient was treated with ivermectin 200 g/kg, after which his symptoms and laboratory results improved. This is the first report of gnathostomiasis in Brazil. Commercial support: None identified. Discussion: We report a case of ulcerative sarcoidosis involving the legs in a patient with multisystemic involvement. Histopathology from the ulcerative lesions showed a vasculitic process wich gives evidence that this may be an aetiological factor for the ulceration. Ulceration has only rarely been described in cutaneous sarcoidosis. Although some of these reports describe the lesions clinically appearing as a vasculitic process, on histologic examination they show the typical noncaseating granulomas of sarcoid or some fibrinoid necrosis. We report an unusual case of sarcoidosis with ulcerative skin lesions related to a vasculitic process. This report emphasizes the pleomorphic nature of sarcoidosis. Although rare, ulcerative sarcoidosis should be included among the many causes of ulceration. Commercial support: None identified. P1109 P1107 Idiopathic urticaria and posttraumatic stress disorder (PTSD): An underrecognized association Madhulika Gupta, MD, Department of Psychiatry, Schulich School of Medicine and Dentistry, London, Ontario, Canada; Aditya Gupta, MD, PhD, Mediprobe Research Inc., London, Ontario, Canada Oxybutynin versus aluminum chloride on quality of life of generalized hyperhidrosis patients Farzam Gorouhi, PhD, Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran; Nader Markazi Moghaddam, MD, Artesh University of Medical Sciences, Tehran, Iran; Parastoo Davari, MD, Center for Research and Training in Skin Disease and Leprosy, Tehran University of Medical Sciences, Tehran, Iran; Reza Eghbalian, MD, Private Clinic, Tehran, Iran Background: Hyperhidrosis is a condition that usually begins during either childhood or adolescence. This condition may be idiopathic or secondary to other diseases, metabolic disorders, febrile illnesses, or medication use. Hyperhidrosis exists in three forms: emotionally induced, localized, or generalized. The generalized form makes the most powerful impact on the patient’s lifestyle, affect, and quality of life. Introduction: The role of psychological stress in urticaria has been recognized for more than 150 years. Posttraumatic stress disorder (PTSD) develops following exposure to extreme traumatic stress. The symptoms of PTSD may first emerge years after the initial trauma, and symptoms include intense physiologic reactivity, persistent reexperiencing of the traumatic event, and symptoms of increased autonomic arousal. Method: We present six patients with PTSD with delayed onset, years after the initial trauma. In all patients, the urticaria and/or angioedema had been extensively investigated and no etiology was identified. The urticaria remitted in all patients after treatment of the PTSD. Results: In two patients, the hyperarousal was associated with bouts of severe recurrent generalized urticaria necessitating trips to the emergency department. Four patients presented with the following: unexplained angioedema of the tongue and floor of the mouth when the perpetrator who had orally sexually abused her as a child had returned; occurrence of an urticarial wheal where the patient had been physically traumatized during a episode of ritual abuse; itching, redness, and swelling in an old scar from earlier torture in a war camp after the patient developed acute PTSD after a violent assault later in life; and angioedema of the labia in a woman who had been sexually abused as a child. Results: Twenty-nine patients completed the trial period. Eleven of 14 patients (78.6%) versus six of 15 patients (40.0%) showed complete responses in groups A and B, respectively (P \.05). Change from baseline DLQI scores for day 14 were -12.2 6 2.9 versus -8.4 6 2.3 (P \.05) and for day 28 were -2.9 6 2.5 versus -1.5 6 2.4 (P[.05) for groups A and B, respectively. Three patients in group A experienced adverse events, including severe urinary retention (protocol deviation), constipation, and headache. Conclusions: Because PTSD can manifest months to decades after the initial trauma, the patient and the clinician may be initially unaware of the relationship of the current symptoms with the earlier trauma. The urticaria and/or angioedema were a manifestation of the intense physiologic reactivity and acute sympathetic activation PTSD. Some urticarial reactions in PTSD may present as conversion symptoms or ‘‘body memories.’’ Conclusion: Although oxybutynin use resulted in a significant superiority to aluminum chloride immediately after 2 weeks of therapy, this study will not recommend its use, at least as a first-line treatment of generalized hyperhidrosis, for two reasons: (1) only two patients in this group remained treated after the 2-week follow-up, and (2) one of 14 patients (7.1%) experienced a serious adverse event after 5 days, which is consistent with previous reports. Commercial support: None identified. Commercial support: None identified. Methods: In this 3-year randomized double-blind trial, 30 generalized hyperhidrosis patients—without any detected etiology for their condition—were randomly assigned to use 5 mg oral oxybutynin twice daily plus topical placebo daily treatment for group A and 5 mg oral placebo twice daily plus topical aluminum chloride 20% daily therapy for group B, both for a total of 2 weeks. Patients were followed for another 2 weeks to monitor the recurrence and side effects. The Dermatology Life Quality Index (DLQI) questionnaire was filled out by all patients on days 0, 14, and 28. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:44 am AB41 P1110 P1112 Oral isotretinoin in the treatment of a patient with multiple warty dyskeratoma Cheng-Chieh Hunag, MD, Mackay Memorial Hospital, Taipei, Taiwan; Ying-Jui Chang, MD, Wang-Fang Hospital, Taipei, Taiwan; Yu-Hung Wu, MD, Mackay Memorial Hospital, Taipei, Taiwan Alopecia neoplastica Laurie Kohen, MD, Henry Ford Hospital, Detroit, MI, United States; Holly Kerr, MD, Henry Ford Hospital, Detroit, MI, United States Scalp metastases usually take the form of solitary or multiple nodules or plaques and spread hematogenously from a primary breast, lung, or genitourinary cancer. Alopecia neoplastica is a very rare form of cutaneous metastasis to the scalp. It may appear clinically similar to alopecia areata or a cicatricial alopecia. We present the case of a 65-year-old female with history of node-positive invasive lobular carcinoma of the breast 10 years earlier who noticed hair loss over the past 6 months. She was found to have a 6-cm indurated, erythematous plaque with overlying telangiectasias on the right anterior scalp. Histologic examination of a punch biopsy revealed hyperchromatic basaloid cells tracking between collagen bundles. Tissue staining was positive for cytokeratin and mammoglobin. Biopsy results confirmed the diagnosis of metastatic breast cancer. The patient received local radiation and two cycles of chemotherapy followed by hormonal therapy. The scalp metastasis resolved without recurrence; however, the patient’s tumor markers continue to increase. A computed tomography scan revealed possible concomitant liver metastases. We review the previous cases of alopecia neoplastica and propose that new-onset alopecia in a patient with a breast cancer history warrants a tissue biopsy to rule out cutaneous metastasis. Multiple warty dyskeratoma was first reported in 1987 in a Japanese patient. There were a few subsequent case reports with as many as 15 lesions. We present a patient with hundreds of lesions. A 29-year-old male with no significant medical history came to our clinic 2 years ago. He had one painful skin lesion for several days. Grossly, there was a 5-mm erythematous nodule on his right cheek. Microscopic examination showed invaginated epithelial proliferation with keratin plug, suprabasilar acantholysis, and focal dyskeratotic cells. The diagnosis of warty dyskeratoma was made based on the characteristic pathologic features. More lesions appeared over the next 2 years. A physical examination revealed numerous (about 245) 3- to 5-mm, itchy, keratotic papules with follicular plugging on the scalp, face, neck, and chest. A biopsy of one scalp lesion showed similar pathologic features to the biopsy taken 2 years earlier. Under the impression of multiple warty dyskeratoma, oral isotretinoin 30 mg/day was started. Clinical improvement, in terms of lesion size and lesion number, was documented at 3 months of follow-up. The pathogenesis of warty dyskeratoma is still unclear, though sun exposure, smoking, and viral infection have been proposed as possible etiologic factors. Treatment of multiple warty dyskeratoma was poorly mentioned in previous literature. Retinoic acid, either topical or systemic, seems a reasonable choice, because warty dyskeratoma is basically a keratinization disorder. The excellent clinical improvement of multiple warty dyskeratoma after oral isotretinoin is demonstrated in this case. Commercial support: None identified. Commercial support: None identified. P1111 The clinical features and pathophysiology of acute radiation dermatitis in patients receiving tomotherapy Ji Hyun Lee, College of Medicine, The Catholic University of Korea, Inchon, Inchon, South Korea; Jeong Deuk Lee, College of Medicine, The Catholic University of Korea, Inchon, South Korea; Min Ho Kim, MD, College of Medicine, The Catholic University of Korea, Inchon, South Korea; Sang Hyun Cho, MD, College of Medicine, The Catholic University of Korea, Inchon, South Korea Radiation therapy (RT) including tomotherapy has been widely used to treat primary tumors and alleviate the symptoms of metastatic cancers. The primary purpose of this study was to examine the characteristics of clinical features and pathophysiologic mechanisms of acute radiation dermatitis in cancer patients who received tomotherapy. Eleven patients who had erythematous changes after receiving tomotherapy were recruited by convenient sampling from the Dermatology Department, Our Lady of Mercy Hospital, Catholic University of Korea. The patients were assessed and identified using the National Cancer institute Common Toxicity Criteria (CTC) version 3.0. Results of the clinical features were reported as follows: dry desquamation (55%), moist desquamation (18%), and other changes (27%). The severity of erythema was also noted as follows: grade 1 (9%), grade 2 (45%), grade 3 (27%), and only pigmentation (9%). Skin biopsies were compatible with radiation dermatitis. Three biopsy specimens were taken from the radiation dermatitis lesion from each patient. As a positive control, the researcher obtained skin samples from the radiation dermatitis patients who had been treated with conventional radiation therapy. As a negative control, normal skin samples from the normal population were obtained. The tomotherapy radiation dermatitis lesions were examined for the presence of TUNEL-positive cells (30.0 HPF). On the other hand, only faint apoptotic signals were detected on few cells (7.5 HPF) in the dermis of the conventional radiation therapy skin. Hence more extensive occurrence of apoptosis in the tomotherapy radiation dermatitis lesions was examined explicitly rather than conventional radiation therapy lesions by using TUNEL assay (P ¼.0019). CD81 T cells in the radiation dermatitis lesion were detected in many of the dermal infiltrates of the tomotherapy patients’ skin (30.0 HPF), whereas they were weakly detected in the conventional radiation therapy patients’ skin (11.5 HPF). The CD41 T cells in the radiation dermatitis lesion were moderately detected in the dermis of the intensity modulated radiation therapy patients’ skin (4.0 HPF) or in the conventional radiation therapy patients’ skin (3.5 HPF). In conclusion, the findings of this study suggest that radiation dermatitis in the tomotherapy patients without dose modification significantly presents more severe dermatitis clinically and histologicly on the skin of focal tumorous lesions through apoptosis and CD81 T-cell mediated cytotoxic immune response. Commercial support: None identified. AB42 P1113 Cutaneous follicular hyperkeratotic spicules: The first clinical sign of multiple myeloma progression or relapse Liang Kiat Tay, Dermatology Unit, Singapore General Hospital, Singapore; ShiuMing Pang, MBBS, Dermatology Unit, Singapore General Hospital, Singapore Background: Cutaneous manifestations are protean in patients with multiple myeloma. These include disease-specific lesions, such as extramedullary cutaneous and mucous plasmacytomas, and nonspecific lesions which are a consequence of underlying abnormal serum paraproteinemia. Case report: We describe a 55-year-old Chinese female with a 2-year history of immunoglobulin G (IgG) multiple myeloma in partial remission who presented with an acute eruption of cutaneous follicular hyperkeratotic spicules on the nose, cheeks, and forehead in the absence of other constitutional symptoms. At the time of initial diagnosis, there were no cutaneous manifestations, and her cytogenetic studies was positive for deletion 13, an adverse prognostic marker. A stable partial remission was achieved with cycles of chemotherapy, and she was subsequently placed on dexamethasone and thalidomide maintenance therapy. Histologic analysis revealed infundibular hyperkeratosis, focal parakeratosis, and mild acanthosis with evidence of follicular plugging. Hematologic markers showed an elevated serum monoclonal IgG band and b-2-microglobulin, together with 80% plasma cells in the bone marrow aspirate, consistent with progressive myeloma. There was limited resolution of the cutaneous lesions following salvage chemotherapy, together with poor hematologic response. Discussion: Cutaneous spicules, although not pathognomonic, is a classically described but uncommonly observed paraneoplastic sign of myeloma. These should be differentiated from spicules due to trichodysplasia spinulosa occurring in postchemotherapy immunosuppression. This is the first reported case of cutaneous follicular spicules occurring in an ethnic Chinese female with progressive myeloma. A new onset of cutaneous spicules could be the initial presentation of myeloma, although they may not occur until progression of disease, as shown in our patient. Limited cutaneous response to treatment seems to parallel an advanced disease state. Our observation illustrates an uncommon but important clinical entity that should be recognized as a marker of relapsed or progressive disease in patients with established myeloma, and this portends a dismal prognosis. Commercial support: None identified. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:44 am P1114 P1116 The use of tabular drug charts for diagnosis of complicated causes of cutaneous drug eruptions Supriya Venugopal, Department of Dermatology, St. George Hospital, Sydney, New South Wales, Australia; Adam Rubin, MD, University of Pennsylvania, Philadelphia, PA, United States; Dedee Murrell, MD, Department of Dermatology, St. George Hospital, Sydney, New South Wales, Australia; Marc Grossman, MD, Columbia University Medical Centre, New York, NY, United States Drug eruptions can be life-threatening and result in complications affecting multiple organ systems. In a hospital setting, finding the culprit drug may be difficult to determine, particularly when patients have complicated medical histories and are on multiple medications. It is not infrequent that a patient with a suspected drug eruption has been taking an extensive list of medications with additions, deletions, and dose adjustments. The drug chart can be linked to the graphic display of the fever curve, eosinophil count, onset of hepatitis or acute renal failure, and other clues to the diagnosis of drug hypersensitivity. A standardized method of diagrammatically displaying culprit drugs is essential in the accurate diagnosis of the causative pharmaceutical agent for cutaneous drug eruptions. Herein we present the use of a diagrammatic medication chart which greatly aids the diagnosis and management of suspected drug eruptions by neatly representing, in a tabular format, a patient’s long- and short-term drug history divided into a daily calendar. This was based on a model tested and tried successfully for many years. Tabular drug charts are a useful clinical tool for dermatologists in managing skin eruptions in hospitalized patients. It is our experience that tabular drug charts facilitate the clinical diagnosis of suspected drug eruptions. The use of tabular drug charts has resulted in easier identification of culprit drugs which may be responsible for a drug eruption. Several examples of how this drug chart has improved the efficiency of patient care and management will be presented. In addition, information regarding common causes of cutaneous drug eruptions and their clinical presentations will be outlined. Lichen planus of the lips mistaken for actinic cheilitis: A case series Elizabeth Swanson, MD, Mayo Clinic, Rochester, MN, United States; Alison Bruce, MD, Mayo Clinic, Rochester, MN, United States; Michael Camilleri, MD, Mayo Clinic, Rochester, MN, United States Background: Lichen planus of the lips is an uncommon condition that can present with leukoplakic areas that appear somewhat similar to actinic cheilitis. Cases of lichen planus that are misdiagnosed as actinic cheilitis result in treatments that are unnecessary and can cause significant morbidity for patients. Objective: To examine five cases of lichen planus of the lips that were initially diagnosed as actinic cheilitis in order to determine criteria that could be used to differentiate the two conditions. Methods: Several cases of lichen planus of the lips that were initially diagnosed as actinic cheilitis were compiled and evaluated for historical, clinical, and pathologic details that helped determine the accurate diagnosis. Results: The cases we examined illustrate several of the differences between actinic cheilitis and lichen planus of the lips that can help dermatologists reach the correct diagnosis. Historically, these patients failed multiple treatments for actinic cheilitis including topical regimens (imiquimod), surgical resection, liquid nitrogen cryotherapy, and CO2 laser therapy. Clinically, some of these patients had a noticeable lack of sun damage on their face which made a diagnosis of actinic cheilitis questionable. In addition, careful inspection of other areas (oral mucosa, conjunctiva, ear canals, nails, and a general skin examination) revealed evidence of lichen planus elsewhere in all of the patients. Histologicly, all but one of the cases was consistent with a lichenoid mucositis. One patient consistently had biopsies that showed atypia in the epidermis ranging from actinic keratosis to squamous cell carcinoma; however, we feel that this patient may have had a component of actinic cheilitis in addition to lichen planus. In addition, epidermal atypia is often seen with lichen planus because of the inflammation present. All patients have noticed significant improvement on a topical regimen of protopic and topical steroids. Commercial support: None identified. Limitations: This is a small case series. Conclusions: Lichen planus of the lips is a diagnosis to keep in mind when evaluating patients with leukoplakic change of the lips. Dermatologists must pay attention to historical clues, such as a resistance to aggressive treatments for actinic cheilitis, in order to make the correct diagnosis. Clinical factors such as the presence or absence of sun damage elsewhere should also be observed and taken into account. In addition, a full skin examination, including examination of the oral mucosa and conjunctiva, should be performed when evaluating a patient with leukoplakic change of the lips. Often, other clinical signs of lichen planus are present and that helps make a diagnosis. Finally, a biopsy can and should be considered to help differentiate these two conditions. Commercial support: None identified. P1117 A retrospective study of the demographics and clinical characteristics of patients with hidradenitis suppurativa in an urban academic center Katherine Flanagan, PhD, Saint Louis University School of Medicine, St. Louis, MO, United States; Sarah Jensen, MD, Saint Louis University School of Medicine, St. Louis, MO, United States Background: Hidradenitis suppurativa (HS) can be a chronic and disabling disease. Treatment response is variable, and there is no cure for patients with HS. Clinical characteristics of patients with HS in the United States have not been well described, and a better understanding of these patients may improve therapeutic options. Objective: To perform a study of clinical characteristics of patients treated for HS in an urban academic center. Methods: A retrospective chart review of patients with HS 18 years of age or older over the last 5 years was performed. P1115 Treatment of prurigo nodularis with thalidomide: Clinical experience from a Taiwanese medical center Chi-Ling Lin, PhD, Department of Dermatology, Kaohsiung Medical University and Kaohsiung Municipal Hsiaokang Hospital, Kaohsiung, Taiwan; Cheng-Che Eric Lan, MD, PhD, Department of Dermatology, Kaohsiung Medical University, Kaohsiung, Taiwan Prurigo nodularis is an intensely pruritic dermatosis characterized by lichenified and excoriated papules and nodules. The course of prurigo nodularis is often chronic, and some patients respond very poorly to the standard therapeutic modalities. Since the pathogenesis of this disease remains obscure, the treatment of prurigo nodularis can be disappointing and frustrating for both the patients and physicians. Thalidomide, a tumor necrosis factorealfa (TNFa) antagonist, has been suggested as an alternative treatment option for recalcitrant prurigo nodularis. In the past, the regimen for treatment of prurigo nodularis often required thalidomide at 200 mg/day. We recruited patients with intractable prurigo nodularis and treated them with low-dose thalidomide. Nine patients with idiopathic prurigo nodularis were successfully treated with low-dose thalidomide (50-100 mg/day). One of them revealed erythema nodosaelike skin lesions on the legs with the pathologic presentation of vasculitis. Another patient developed peripheral polyneuropathy which was reversible after the thalidomide was interrupted. In summary, our preliminary results suggest that low-dose thalidomide may be a safe and effective treatment option for patients with recalcitrant idiopathic prurigo nodularis and the neuropathy may be readily reversible if the symptoms were detected early in the course and thalidomide was withheld in a timely manner. Commercial support: None identified. Results: One hundred eighty charts were identified with 115 of 180 patients (64%) included in the study. Fifteen percent were male and 85% were female. More than half (50.4%) were white and 41.7% were African American, with the remainder being of unknown ethnicity. The mean age of patients was 33.36 years old. More than one quarter (26.1%) had mild, 49.6% had moderate, and 24.3% had severe disease. The majority had disease in the axillae and/or groin (54%) and the rest had disease in inframammary, thigh, and buttock areas. Almost half (45.1%) had a history of acne vulgaris and 4.4% had follicular occlusion triad. Eighty-eight percent received antibiotics, 90% were treated with topical washes, and 37% were treated with topical antibiotics. More than 28% (28.7% 0 had mild and 40.3% had significant improvement with therapy. Almost one-tenth (8.7%) of patients were prescribed isotretinoin, but compliance varied and only 1.7% noted improvement. Few were treated with antitumor necrosis factor agents. Thirty-one percent had surgical procedures for treatment of HS. Sixteen percent had culture data, and 89% of cultures of lesions were negative or contaminant. More than one quarter (26.8%) of patients were described as overweight or obese. Twenty-five percent had psychiatric disease with depression as the most common diagnosis. More than 8% (8.2%) of female patients had a history of hyperandrogenism with polycystic ovary syndrome and/or hirsutism. Limitations: The retrospective design of this study allows for incomplete data collection. Conclusions: African Americans were overrepresented in our population. Therapy is empiric, consisting of chronic courses of rotating antibiotics and variable response. Many patients had diagnosed psychiatric disease which may complicate their treatment. Culture data are often negative, suggesting other inflammatory mechanisms besides bacterial superinfection. Women with HS may have a hyperandrogenic state and may benefit from antiandrogen therapy. Prospective studies are needed in patients with HS. Commercial support: None identified. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:44 am AB43 P1118 P1120 Acute generalized exanthematous pustulosis following Loxosceles envenomation: A ‘‘clear’’ case Holly Hare, MD, CAN, University of Missouri Department of Dermatology, Columbia, MO, United States; Jennifer Holman, MD, University of Missouri Department of Dermatology, Columbia, MO, United States; Jon Dyer, MD, University of Missouri Department of Dermatology, Columbia, MO, United States Bloodroot necrosis Karthik Krishnamurthy, MD, Saint Barnabas Hospital, Bronx, NY, United States; Cindy Hoffman, DO, Saint Barnabas Hospital, Bronx, NY, United States; Joseph Del Priore, DO, Frankford Hospital, Philadelphia, PA, United States Sanguinarine is a benzophenanthridine alkaloid derived from the root of Sanguinaria canadensis, a plant also known as bloodroot and tetterwort. It grows prevalently in the eastern United States and Canada. Sanguinarine has been shown to possess antioxidative, antitumor, antibacterial, and antiinflammatory properties in animals and reduces gingival inflammation and supragingival plaque when used clinically in humans. Frederick Mohs used zinc chloride in conjunction with bloodroot, which when used in a carefully calculated manner would fix tissue in vivo, which was subsequently surgically removed and analyzed microscopically for cancerous border involvement. Currently, topical bloodroot paste is distributed on the Internet without US Food and Drug Administration control. An opioid analog, bloodroot inhibits nuclear factor kappa-beta (NF-kb), transcellular glucose transport, mitosis, and vascular endothelial growth factor, and alters bcl-2 gene family expression. Together, these mechanisms act to accelerate tissue necrosis and induce cell senescence. In recent years, bloodroot, via its multiple antiproliferative properties, has been studied as an adjunctive anticancer therapy, namely in prostate cancer and melanoma, with promising efficacy. Although sanguinarine has interesting properties and, pending more research, has the potential to become a therapeutic modality, physicians and the public should also be aware of the harmful nature of this product when applied in uncontrolled settings. We present a 53-year-old female who presented with erythematous ulcerated papules and plaques with purulent, coagulated, necrotic, and compacted debris located on her face, back, breasts, buttock, and bilateral extremities. She admitted previous application of bloodroot paste, obtained from the Internet, to various lesions on her body, which she believed were early skin cancers. She was informed by the distributor to avoid seeking medical care and to refuse any diagnostic testing or pharmacologic treatment, as this may spread the cancer throughout her body. Acute generalized exanthematous pustulosis following a brown recluse spider bite has been noted, although previous reports have been weakened by the lack of an actual spider or by concomitant administration of antibiotics. We present the case of a 9-year-old male who presented with a Loxosceles reclusa bite on the neck. The spider was captured and identified as L reclusa. The patient did not receive antibiotic therapy and was admitted for observation because of the location of the bite and the potential respiratory complications from his worsening edema. Approximately 72 hours after the bite, he developed innumerable monomorphous, sterile pustules initially in intertriginous areas with subsequent dissemination. This eruption was followed over several days by pinpoint desquamation. Additional testing was normal and the patient was discharged home on day 5. He was readmitted within 24 hours because of the sudden onset of heart failure. He exhibited profound hemolytic anemia and was Coombs positive. This case exhibits several rare complications of L reclusa bites, acute generalized exanthematous pustulosis (AGEP), and Coomb’s positive hemolytic anemia. Interleukin-8 (IL-8) and granulocyte monocyte colony stimulating factor are involved in the pathogenesis of AGEP, and it has been hypothesized that sphingomyelinase in Loxosceles venom induces these cytokines, providing a hypothesis for the mechanism by which AGEP may develop post-Loxosceles bite. In addition, while the hemolytic anemia induced by loxosceles envenomation is usually Coomb’s negative, late onset Coomb’s positive hemolytic anemia has been described and may warrant alterations in therapy. This case confirms that loxosceles envenomation can trigger AGEP. Commercial support: None identified. Commercial support: None identified. P1121 Atrophie blanche: Specific disease or physical finding? David Judy, NP, MSN, Duke University Health System, Durham, NC, United States; Claude Burton, MD, Duke University Health System, Durham, NC, United States; Jan Johnson, NP, MSN, Duke University Health System, Durham, NC, United States; Stephanie Yates, NP, MSN, Duke University Health System, Durham, NC, United States Introduction: Atrophie blanche is a chronic cutaneous manifestation most commonly found on the lower extremities. The lesions are smooth, depressed, ivory white plaques with surrounding hyperpigmentation and telangiectatic capillaries. Atrophie blanche was first described in 1929 by Milian. Milian believed the lesions to be associated with syphilis and tuberculosis. Since then, many different authors have considered atrophie blanche a specific diagnosis and some consider it synonymous with livedo vasculitis, segmental hyalinizing vasculitis, PURPLE, capillaritis alba, atrophie blanche of Milian, vasculitis of atrophie blanche, livedo reticularis with summer ulcerations, and, most currently, livedoid vasculopathy. Objective: To reassess the epidemiology of atrophie blanche and discuss the use of the term. We propose that atrophie blanche should be regarded as a term used to describe the characteristic lesion rather than a specific diagnosis. Aquagenic syringeal acrokeratoderma responsive to topical retinoid Marshall Shuler, University of New Mexico, Albuquerque, NM, United States; Barrett Zlotoff, MD, University of New Mexico, Albuquerque, NM, United States; Ran Bang, MD, University of New Mexico, Albuquerque, NM, United States A 17-year-old female was referred for a 3-month history of an episodic rash characterized by painful swelling whenever her hands were immersed in water. There was no family history of similar skin disease, and the patient’s medical history was significant only for migraine headaches. Examination findings at presentation were significant for hyperkeratotic plaques with dilated eccrine duct ostia covering the palmar surfaces of the hands. A diagnosis of aquagenic syringeal acrokeratoderma was made, and therapy with aluminum chloride hexahydrate 20% weight/ volume in anhydrous ethyl alcohol applied under occlusion each night was initiated. At follow-up, however, this therapy was discontinued because of ineffectiveness. A review of the literature uncovered similar cases with histology demonstrating orthokeratotic hyperkeratosis with dilated eccrine ducts. Therapy with tazarotene cream 0.1% was initiated in an effort to decrease the orthohyperkeratosis. Instruction was given to apply this topical retinoid to the palms each night. This therapy resulted in near total resolution of the hyperkeratotic plaques on the palmar hands. However, this medication was not covered by her insurance and became too expensive. Tretinoin 0.1% gel was used as an alternative and, though not as effective, was useful in controlling this patient’s rash. Aquagenic syringeal acrokeratoderma is a relatively newly classified entity with fewer than 20 reported cases. Physical examination findings of hyperkeratotic plaques with dilated eccrine ostia, along with the complaint of painful swelling when the hands are immersed in water, appear characteristic. The pathogenesis remains undetermined, although several authors have speculated on the possibility of eccrine duct or stratum corneum abnormalities. Alternative therapies suggested in the literature include ammonium lactate cream 12%, salicylic acid 20% in petrolatum ointment, urea cream 10%, and botulinum toxin injections. We submit this report to propose an effective novel therapy for this newly described disease. Methods: This retrospective study was conducted at the Wound Management Institute of Duke University Medical Center. Ethical approval for the study was obtained from Duke’s Institutional Research Board (IRB). The data were obtained from the electronic medical records of all new patients seen between November 1996 and March 2007. These patients were evaluated for the presence or absence of atrophie blanche. Results: Atrophe blanche has an incidence of 9.7% (300/3096 new patients) in our clinic population. Two hundred seven patients (69%) were female and 93 (31%) were male. Venous insufficiency was the most common associated diagnosis (91%). Discussion: Originally described by Milian in 1929, atrophie blanche is considered by many authors as a specific diagnosis. The data from the present study strongly suggest that atrophie blanche is simply a physical finding that may be seen in a wide variety of conditions, particularly chronic venous insufficiency. In patients with lower extremity swelling, ulcers, or dermatitis referred to our institution, atrophie blanche was one of the more frequent physical findings, seen in 10% of all patients. Chronic venous insufficiency was the most frequent condition in which atrophie blanche was noted (91%), followed by leg ulcers (75%), and lower extremity edema (59%). There are several reports of thrombotic tendencies found on investigation of patients with atrophie blanche. Hairston et al performed a retrospective histologic study of 45 cases of livedoid vasculopathy and found that 97.8% of the biopsies had intraluminal thrombosis. Many other procoagulant abnormalities were found, such as anticardiolipin antibodies (28.6%), factor V Leiden mutation (22.2%), lupus anticoagulant (17.9%), decreased proteins C and S (13.3%), elevated homocysteine levels (14.3%), and prothrombin gene mutation (8.3%). The study also showed that not all of the livedoid vasculopathy patients had atrophie blanche (71.1%), giving further support that atrophie blanche is not a synonymous term and should be reserved for describing the characteristic plaque. Many of the hypercoagulable states are risk factors for developing venous thrombosis. Of the patients with atrophie blanche, 23% had a history of thrombosis. Not surprisingly, 10% of patients with venous disease in the study were found to have typical atrophie blanche on presentation. When atrophie blanche is noted on the physical examination, chronic venous disease is the most likely associated diagnosis. Commercial support: None identified. Commercial support: None identified. P1119 AB44 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:44 am P1122 P1124 A rare case report of cutaneous RosaieDorfman disease Greg Jacobsen, MD, Geisinger Medical Center, Danville, PA, United States; Paul Long, MD, Geisinger Specialty Clinics, Wilkes-Barre, PA, United States A 52-year-old male presented with asymptomatic lesions on the face. He reported an increase in size, thickness, and number occurring during the past year. Otherwise feeling well, he denied swollen glands, systemic complaints, or new medications. His medical history included diabetes, obesity, epilepsy, hypertension, and sleep apnea. Skin examination revealed 0.5- to 1.2-cm, soft, dull red papules and nodules on the forehead and temple areas bilaterally. No adenopathy was present. Skin biopsy of a lesion showed an inflammatory nodule with a number of large pale staining histiocytes admixed with plasma cells and small lymphoid cells. Portions showed emperipolesis of inflammatory cells within histiocytes. Dermal histiocytes stained positively for S-100. We assessed the patient for findings of systemic RosaieDorfman disease (RDD). A chest radiograph was negative. Laboratory studies showed normal blood counts, sedimentation rate, and serum protein electrophoresis. A diagnosis of purely cutaneous RDD was given. RDD (sinus histiocytosis with massive lymphadenopathy) is a rare disorder of histiocytes, occurring more commonly in males within the first or second decade of life. Massive, painless cervical lymphadenopathy in association with fever occurs. Occasionally lymph nodes other than the cervical region can be affected. Forty percent of patients will have extranodal disease. A skin eruption appears in about 10% of patients, most often on the face. Skin lesions in RDD show red-brown or yellow-brown, sometimes annular, papules, nodules, or plaques. Associated laboratory findings in these patients include a leukocytosis, anemia, polyclonal hyperglobulinemia, and an elevated sedimentation rate. Cutaneous-only RDD is an uncommon variant, more commonly appearing in older female patients without systemic findings. Whites and Asians appear to be the most susceptible to this form. Histology of cutaneous lesions is characterized by dense cellular infiltrates of the dermis. Sheets of histiocytes are admixed with variable amounts of lymphocytes, plasma cells, neutrophils, and eosinophils. Emperipolesis is the hallmark of this disorder and is more commonly found when examining lymph nodes. Histiocytic markers are usually present with S-100 and CD68 being the most common. Treatment, although rarely required, may be necessary owing to compression of vital organs. Radiation, systemic corticosteroids, and thalidomide have been successful for systemic disease, whereas, topical and intralesional corticosteroids or cryotherapy have been used for cutaneous lesions. Six weeks after our patient’s initial visit, he displayed no change and continued without swollen glands. Subsequently, the patient has reported minimal fading without therapy. A case of reactive angioendotheliomatosis Beth Adams, MD, Henry Ford Medical Center Department of Dermatology, Detroit, MI, United States; Holly Kerr, MD, Henry Ford Medical Center Department of Dermatology, Detroit, MI, United States An 81-year-old white male presented to our dermatology clinic with grouped vascular nodules located on the medial left upper arm. These lesions had gradually enlarged for 18 months before presentation, and occasionally bled from minor trauma. A biopsy of a representative nodule revealed an atypical vascular proliferation without malignant features, and a presumptive diagnosis of reactive angioendotheliomatosis was made. He underwent three additional biopsies over the next 8 months, all of which were consistent with this diagnosis. A wide local excision with grafting was performed by a general surgeon 1 year after the patient’s original presentation. Within 4 months of the surgery, similar lesions recurred overlying and adjacent to the graft site. Repeat biopsies confirmed the diagnosis of persistent reactive angioendotheliomatosis. To date, he continues to develop new vascular nodules on the left arm. These lesions are routinely biopsied to evaluate for malignant degeneration as well as to debulk symptomatic areas. A review of the literature on reactive angioendotheliomatosis will be discussed. Commercial support: None identified. Commercial support: None identified. P1123 Acquired cutis laxa associated with monoclonal gammopathy Edward Galiczynski, DO, Cleveland Clinic Foundation, Cleveland, OH, United States; James Libecco, MD, Cleveland Clinic Foundation, Cleveland, OH, United States; Trost Larry, MD, Cleveland Clinic Foundation, Cleveland, OH, United States A 51-year-old female presented with a 4-year history of fatigue, bleeding fibroids, and transient urticaria. One year later, she noted a progressive and severe loss in skin elasticity which involved her entire body. She developed monoclonal gammopathy of undetermined significance immunoglobulin A-kappa (IgA-k) and pain in multiple joints, including her ankles, wrists, and elbows, with swelling of her wrists. Lymph node biopsy for axillary lymphadenopathy was negative for neoplasm. In 2004, she developed IgA nephropathy with crescents. She eventually developed hypertension and end stage renal disease, starting dialysis in June 2005. She also developed pulmonary emphysema and cardiomyopathy with congestive heart failure. Skin biopsy from the abdomen showed complete absence of elastic fibers within the papillary dermis. The upper reticular dermis displayed a few shortened elastic fibers with tapered ends. There was no appreciable inflammatory infiltrate. Electron microscopy demonstrated a paucity of elastic fibers as well. Laboratory work-up was significant for abnormal serum protein electrophoresis including abnormal homogenous bands in the IgA and kappa regions. CBC, ANA, WSR, RF, CRP, C-ANCA, PANCA, and urine protein electrophoresis were negative. Despite aggressive treatment with prednisone, melphalan, rituximab, and cyclophosphamide, none of her symptoms improved. She is currently on supportive therapy. Cutis laxa is a rare disorder characterized by progressive skin laxity due to loss of dermal elastic fibers. Congenital cutis laxa may be inherited in an AD, AR, or XLR fashion. It is frequently associated with severe pulmonary and cardiovascular involvement. Type I acquired cutis laxa frequently occurs in adulthood, usually following inflammatory dermatoses, hypersensitivity reactions to insect bites, lymphoma, multiple myeloma, syphilis, rheumatoid arthritis, nephrotic syndrome, celiac disease, and drugs such as penicillin, penicillamine, and isoniazid. Type II acquired cutis laxa or Marshall syndrome occurs in African American children and involves acute inflammatory skin lesions followed by localized loss of skin elasticity. Finally, localized cutis laxa can occur. Pathogenesis is thought to involve alteration or partial destruction of the amorphous component of elastic fibers. This may be due to excessive elastase activity, dysfunction in elastase inhibitors, and copper deficiency. Antielastin antibodies have been hypothesized to play a role but have not yet been demonstrated. Currently, the only treatment for the cutaneous manifestations of cutis laxa is plastic surgery. Multiple surgeries may be required as the disease progresses. Commercial support: None identified. P1125 Paracoclidioidomycosis: Sarcoid pattern Marcelo Guimar~aes, MS, UNIRIO Universidade Federal do Estado do Rio de Janeiro, Rio de Janerio, Brazil; Carolina Xavier, MD, UNIRIO Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Martins Carlos, MD, UNIRIO Universidade Ferderal do Rio de Janeiro, Rio de Janerio, Brazil; Omar Lupi, MD, PhD, UNIRIO Universidade do Estado do Rio de Janeiro, Rio de Janerio, Brazil Background: Paracoccidioidomycosis (PCM), also called Lutz-Splendore-Almeida disease, is a granulomatous, infectious, chronic, subacute, or seldom acute disease, caused by the fungus Paracoccidioides brasilienses. It is characterized by a polymorphism of lesions and can affect any organ, in particular the skin, lymph nodes, mucous membranes, supra renal glands, and central nervous system. Case report: A 67-year-old female from Valença, a rural area of Rio de Janeiro state, presented with an infiltrated erythematous plaque on left side of the face, compromising auricular and retro auricular areas, with a evolution of 18 months. She was already treated as tuberculoid leprosy without improvement. Oral mucous membrane or lymph nodes were not compromised. Complementary exams, such as chest radiographs blood cell count, biochemestry tests, abdominal ultrasound were normal. Culture and immunodiffusion were negatives. The patient was treated with SMZ/TMP 2400 mg/day for 2 months and 1600 mg/day for 22 months for maintenance, with response. Discussion: The involvement of only one organ or system, such as the skin, is classified as an unifocal form, a rare variant of chronic PCM disease. The also patient presented the sarcoid pattern, an uncomom presentation. It is a diagnose challenge considering the similiarity with others granulomatous disease such as tuberculoid leprosy and sarcoidoses. Commercial support: None identified. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:44 am AB45 P1126 P1128 Psoriatic eruption after placement of a red tattoo: A case report and review of the literature Emily Keimig, MD, Henry Ford Health System, Detroit, MI, United States; Diane Jackson, MD, Henry Ford Health System, Detroit, MI, United States Gravitational erythema Michele Monteiro, Policlinica Geral do Rio de Janeiro, Rio de Janeiro, Brazil; Ericka de Andrade Aguiar, MD, Policlinica Geral do Rio de Janeiro, Rio de Janeiro, Brazil; Manuela Boleira Sieiro Guimaraes, MD, Policlinica Geral do Rio de Janeiro, Rio de Janeiro, Brazil; Omar Lupi, Policlinica Geral do Rio de Janeiro, Rio de Janeiro, Brazil Cutaneous reactions to tattoo pigments have been well documented in the literature. We report a case of a 24-year-old African American female who presented with a 3-month history of an eruption involving a newly placed tattoo. The eruption began 2 weeks after the placement of red ink within a previously existing black tattoo on the left thigh. It began as discrete erythematous plaques with thick micaceous scale. This eruption was initially confined to the areas within the tattoo margins and only to those areas with red ink. Shortly thereafter, she developed identical erythematous plaques with thick scale involving the scalp and the feet. A punch biopsy was performed from a representative lesion on the dorsal surface of the left foot. The pathology revealed psoriasiform acanthosis of the epidermis. There was overlying confluent parakeratosis which contained small collections of neutrophils. The papillary dermis was edematous and contained several telangiectatic vessels. The histologic evaluation was consistent with psoriasis. We discuss an interesting presentation of a reaction to red tattoo pigment and a review of the literature regarding cutaneous reactions to tattoos. Commercial support: None identified. Introduction: We report a case demonstrating an extremely unusual erythema on the limbs of a 29-year-old patient that occurs when the arms are in a dependent position and the lower limbs are standing. This entity was described for the first time in 1988 and is secondary to abnormal responses to changes in venous pressure. Case report: A 29-year-old female patient presented with an aporoximately 10-year history of a blotchy reddish eruption affecting her limbs. The eruption only occurs when her arms are hanging down and her legs are standing. All lesions disappeared promptly on raising her arms or lying flat, and was reproduced by inflating a sphygnomamometer cuff to 60 mm Hg for 3 minutes with the limbs in the horizontal position. She also presented with microvarix in her legs and atopic dermatitis, but these were not related to any systemic disorders. The blood tests and the physical examination were normal. Dicussion: Gravitational erythema is unusual in the literature, and Berth-Jones and Grahan-Brown proposed this term in 1988. This lesions could be reproduced by increasing venous pressure, suggesting that this occurs secondary to an abnormal vascular response to changes in venous pressure. We believe that this syndrome is not as uncommon as the paucity of case reports in the literature would suggest. In these patients, these disturbances are benign. No effective therapy is known. Commercial support: None identified. P1129 Case report: W.H.N.P., a 27-year-old female born in Rio de Janeiro, Brazil, presented with hypotonia and motor delay since the neonatal period, diagnosed as cerebral paralysis by the pediatrician. She recieved physiotherapy and phonoaudiologic care until the age of 12. Since the third month of life, cutaneous manifestations included erythematous papules and crusts in seborrheic areas that started at the face, and exulceration in the diaper area, accompanied by burning sensation and discrete pruritus. The lesions persisted during infancy and adolescence, intercaleting periods of improvement and posterior relapse related with periods of stress. In childhood, she began to gain weight because of a constant sensation of hunger and hyperfagia, developing central obesity. She also started presenting behavior disturbances with episodes of aggressiveness and intolerance, low concentration, and low intellectual rate. Other clinical findings included small hands and feet, short stature, and almond-shaped eyes. By the age of 12, she was suspected to have PWS by the endocrinologist, and a karotype exam was carried out, confirming this diagnosis. The familial history included the fact that her parents were cousins, and they had three children: two of them with PWS confirmed by laboratory exams. In her last visit to the dermatologist, she presented with cutaneous manifestations of seborrheic dermatitis, represented by lesions characterized by a yellow color, mild erythema, and oily, thick scales and crusts with a predilection for scalp, retroauricular folds, and glabella, associated with pruritic, erythematous, macerated skin in intertriginous areas with satellite vesicopustules, compatible with candidiasis. She also presented with an intense xerosis, mainly on the legs. The patient was treated with zinc oxide, nistatina, topical corticostheroids, and urea 10% over the course of 15 days, with great improvement. Quality of life in patients with epidermal growth factor receptor inhibitoreinduced papulopustular rash compared to historically-reported QOL for common dermatologic disorders Smita Joshi, Northwestern University Department of Dermatology, Chicago, IL, United States; Dennis West, PhD, Northwestern University Department of Dermatology, Chicago, IL, United States; Joslyn Witherspoon, MD, MPH, Northwestern University Department of Dermatology, Chicago, IL, United States; Mario Lacouture, MD, Northwestern University Department of Dermatology, Chicago, IL, United States; Sara Ortiz, Northwestern University Department of Dermatology, Chicago, IL, United States Background: Epidermal growth factor receptor inhibitors (EGFRIs) have emerged as pivotal antineoplastic agents for solid tumors because of their low systemic side effect profiles. However, these drugs cause dermatologic adverse events, most commonly the papulopustular rash (PPR) which occurs in up to 90% of patients. Dermatologic effects of EGFRIs impact quality of life (QOL) to the point that dose modification or discontinuation of chemotherapy may ensue. The purpose of this study was to quantify the effect of EGFRI-induced PPR on QOL using the validated QOL instrument Skindex-16. Methods: Data were collected via retrospective chart reviews for patients seen between July 2007 and April 2008 at Northwestern University’s Skin and Eye Reactions to Inhibitors of EGFR and Kinases (SERIES) clinic, a referral program for dermatologic toxicities to cancer therapies. Patients were included if they presented to clinic with EGFRI-induced PPR grade 1, 2, or 3. Clinical severity grading of PPR was assessed using the National Cancer Institute’s Common Terminology Criteria for Adverse Events version 3.0. At their initial visit, subjects filled out the Skindex-16. It is scored from 0 (best QOL) to 100 (worst QOL) and is reported in three domains: symptoms, emotions, and functioning. Subjects’ scores were compared to Skindex16 results from Chren et al. Results: Fifty-five subjects were studied, of which 33% had PPR grade 1, 58% had PPR grade 2, and 9% had PPR grade 3. The mean Skindex-16 symptoms score was 52.5. In comparison, mean symptom scores for eczematous dermatitis and acne vulgaris were 42 and 31, respectively. The mean emotions score for PPR patients was 60.1; mean emotions scores for eczematous dermatitis and acne vulgaris were 52 and 75, respectively. The mean functioning score for the PPR group was 37.7; mean functioning scores for eczematous dermatitis and acne vulgaris were 24 and 38, respectively. Conclusions: EGFRI-induced PPR has marked effects on physical skin symptoms, emotional well-being, and functioning in activities of daily living comparable to eczematous dermatitis and acne vulgaris. This study underscores the need to develop effective treatments for PPR so as to improve QOL and ensure compliance with anticancer agents. The study also highlights the need for increased awareness of these adverse reactions in the dermatologic community, especially for those interfacing with a cancer center that uses these targeted agents. Commercial support: None identified. Commercial support: None identified. P1127 PradereWilli syndrome: Case report Omar Lupi, PhD, Policlı́nica Geral Do Rio De Janeiro, Rio De Janeiro, Brazil; Christiane Maria de Castro Dani, MD, Policlı́nica Geral Do Rio De Janeiro, Rio De Janeiro, Brazil; Ericka Aguiar, MD, Policlı́nica Geral Do Rio De Janeiro, Rio De Janeiro, Brazil Abstract: PradereWilli syndrome (PWS) is a multisystemic disorder characterized by hypotonia and feeding difficulties in the neonatal period, followed by hyperfagia, obesity, hypogonadism, and motor and cognitive delays. The authors report a case of a PWS with typical clinical features associated with cutaneous manifestations. AB46 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:44 am P1130 P1132 A case of autochthonous cutaneous larva migrans in Spain Juan Luis Santiago, MBChB, Ramón y Cajal Hospital, Alcalá de Henares University, Madrid, Spain; Lorea Bagazgoitia, MD, Ramón y Cajal Hospital, Alcalá de Henares University, Madrid, Spain; Pedro Jaén, PhD, Ramón y Cajal Hospital, Alcalá de Henares University, Madrid, Spain; Sònia Beà, MD, Ramón y Cajal Hospital, Alcalá de Henares University, Madrid, Spain Clinical efficacies of topical agents for the treatment of seborrheic dermatitis on the scalp Hee Chul Eun, MD, Seoul National University, College of Medicine, Seoul, South Korea Introduction: Cutaneous larva migrans results from the migration of hookworm larvae in the skin of dead-end human host. The disease mainly occurs in resourcepoor communities in tropical areas, but it also reported sporadically in high-income countries and in tourists who had visited the tropics. Autochthonous cutaneous larva migrans syndrome is rare in Spain and other temperate countries. However, one case of this syndrome was diagnosed in a patient from Madrid, Spain, in the summer of 2007. Case report: A 31-year-old femalen developed multiple erythematous, serpiginous pruritic tracts moving 1- to 2-cm per day over and existing cutaneous plaque on the buttocks. Exposure to the infective larvae in endemic areas and close contact with animals were excluded. She had visited Pirineos mountains and took a bath in a river, lying on the soil after the bath. Diagnosis was made clinically in the presence of serpiginous and moving skin tracts associated with intense itching on exposed cutaneos areas of buttocks and legs. She was treated with systemic albendazole, with a good and rapid response. Discussion: This case demonstrates that the conditions leading to the development of cutaneous larva migrans are rarely found simultaneously in temperate zones of Europe. Rapid diagnosis and treatment with systemic albendazole may control the infestation and improve the symptoms. Previous studies have shown that topical steroids and shampoo containing zinc pyrithione provide clinical benefits for treatment of scalp seborrheic dermatitis. But the clinical efficacy of topical tacrolimus, a newly developed calcineurin inhibitor, on seborrheic dermatitis is not well investigated. We wanted to compare the clinical efficacy of topical tacrolimus with that of conventional treatment (zinc pyrithione shampoo and topical betamethasone) for the treatment of seborrheic dermatitis on the scalp. Patients with seborrheic dermatitis on the scalp were randomly allocated to receive topical betametasone, topical tacrolimus, or zinc pyrithione shampoo. Some patients were instructed to continue the treatments for 8 weeks and the others to discontinue the treatments at week 4. We have evaluated the efficacy using clinical severity score, dandruff score, and sebum secretion at baseline and weeks 4 and 8. All treatment groups showed significant improvements respectively in clinical assessment after 4 weeks. After cessation of the treatment, the patients who were treated with betamethasone lotion or tacrolimus ointment were aggravated clinically. The patients treated by zinc pyrithione improved continuously even after cessation of the treatment. Topical tacrolimus was as effective as topical betamethasone, and showed more prolonged remission than topical betamethasone. To treat seborrheic dermatitis on the scalp, we think the combination therapy of topical steroid and zinc pyrithione is recommended. Although topical tacrolimus is as effective as topical steroid, its vehicle should be modified for the treatment on the scalp. Commercial support: None identified. Commercial support: None identified. P1131 Psychologic aspects of women who underwent cellulite treatments: Pilot study Doris Hexsel, PhD, Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil; Cristiano Brum, MD, Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil; Rosemarie Mazzuco, MD, Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil; Ticiana Costa Rodrigues, MD, PhD, Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil Background: Cellulite is a clinical condition that affects more than 80% of women worldwide. It was noted that those suffering from cellulite experience some day-today restrictions, included wearing some clothing and sexual activity, among others. These suggest the great social impact of this condition in their lives. There are no references in the medical literature to psychological aspects of women that underwent cosmetic treatments for cellulite, especially those concerning depression, anxiety, and body shape symptoms and eating behavior disturbances. Objective: The aim of this pilot study was to investigate the psychological and psychiatry aspects concerning women that underwent cellulite treatments. Methods: The study was conducted in accordance with Good Clinical Practice (GCP/ICH) in one research center in Brazil. All the volunteers had signed the consent form. The study sample was composed by 20 healthy female volunteers with ages ranged from 18 to 55 years. Patients answered a questionnaire with questions related to symptoms of eating disorders, body image concerns, anxiety and depression, social functioning, previous psychiatry treatments, time and money spent with cellulite treatment, and point of view from other people concerning their cellulite, including their partners. Results: Eighty percent of the patients reported that their partner did not pay attention to their cellulite, but 10% stated that they received pressure from their partners to undergo cellulite treatment and to lose weight. They also reported that they compare themselves to remind themselves that they are not the only one with this problem. When the body is exposed, they reported an increase in depressive and anxious symptoms, leading to an avoidance of these situations, although no criteria for major depressive disorder or general anxiety disorder were found in the sample. None seem to have eating disorders. One volunteer suffer from bipolar disorder and takes mood stabilizers and antipsychotic medication. P1133 An unsuspected case of leprosy Paul F. Lizzul, University of California Davis, Sacramento, CA, United States; David M. Scollard, MD, PhD, National Hansen’s Disease Program, Baton Rouge, LA, United States; Jeffrey Newman, MD, PhD, University of California Davis, Sacramento, CA, United States; Maxwell A. Fung, MD, University of California Davis, Sacramento, CA, United States Conclusions: Considering that cellulite causes psychological suffering, the results of this pilot study can be useful to a better understanding and support to the psychological and social aspects of the affected patients. A larger sample of patients is currently being studied to support and improve these results, concerning the prevalence of eating disorders, anxiety, depression, body image disturbances, and obsessive traits. Leprosy is caused by Mycobacterium leprae. Because of the wide spectrum of presentations, recognition of leprosy may be delayed. A 22-year-old Filipino male presented with a several-week history of a waxing and waning ‘‘rash’’ with associated myalgias, arthralgias, and fever, initially diagnosed by another physician as cellulitis and treated with cephalexin. A physical examination revealed generalized, symmetrically distributed, well demarcated tender violaceous macules and plaques with dusky grey centers that resembled erythema multiforme. A biopsy demonstrated neutrophils and ‘‘foamy’’ histiocytes with perineural involvement consistent with borderline lepromatous leprosy with features of erythema nodosum leprosum. Initial Fite stain revealed only rare acid-fast bacilli, but subsequent Fite stain performed by a referral laboratory revealed large numbers of organisms. This case illustrates the importance of considering the diagnosis of leprosy in a patient from endemic regions and the possibility of having erythema nodosum leprosum in the absence of previous treatment regimens. Commercial support: None identified. Commercial support: None identified. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:44 am AB47 P1134 Treatment of refractory postoperative pyoderma gangrenosum with infliximab Rosemarie Liu, DO, University of Wisconsin, Madison, WI, United States; Chethana Chandrupatla, University of Wisconsin, Madison, WI, United States; Erin Vanness, University of Wisconsin, Madison, WI, United States Pyoderma gangrenosum (PG) was once considered pathognomonic of idiopathic ulcerative colitis. It has since been described in association with Crohn disease, arthritis, rheumatologic and hematologic conditions, hypogammaglobulinemia, and malignancy. Fifty percent to 70% of PG cases are associated with systemic disease. There have been very few cases reported in the setting of surgical wounds, particularly after orthopedic repair. Postoperative PG is a rare disorder that poses diagnostic difficulties, because confusion with wound infection leads to delayed therapy and serious cosmetic disfigurement. At least 16 cases of postoperative PG have been reported, though very few have followed orthopedic surgery (hand surgery, total knee arthroplasty, sternotomy, and hip arthroplasty). We present a patient who sustained a left acetabular fracture and subsequently underwent open reduction and internal fixation. He had a complicated postoperative course with wound dehiscence and copious drainage. Biopsy 3 weeks later was consistent with PG. This patient presented a unique therapeutic challenge in that his diagnosis was delayed, high-dose corticosteroids had to be used with extreme caution because of the risk of osteonecrosis of the hip, and cyclosporine toxicity occurred early in his treatment course. For patients with localized PG, topical treatment can be sufficient. Early topical treatment is most likely to succeed when the ulcer is small. First-line therapy includes high-potency topical corticosteroids, tacrolimus ointment, and intralesional steroid injections. Aggressive surgical management is discouraged in PG, because it can contribute to further pathergy. Gently removing necrotic tissue can be helpful to avoid bacterial infections. Several reports in the literature outline the use of infliximab to treat refractory PG. Infliximab is a chimeric antietumor necrosis factor-alfa monoclonal antibody. There are only a few reports detailing the successful use of infliximab in the treatment of PG outside of the context of inflammatory bowel disease. The dosage in these reports is 3 to 5 mg/kg for induction at weeks 0, 2, and 6. We started our patient on 5 mg/kg and noted rapid reepithelialization of his wound and stabilization of his disease. In follow-up 2 months after induction dosing, his wound has healed nicely. He is not on any immunosuppressives or topical treatments at this time. immunoglobulin E (IgE), which acts as a neutralizing antibody by binding to the C3 domain of the heavy chain of IgE. It is approved for the treatment of moderate to severe persistent asthma, and has also been reported to be useful in different forms of urticaria. Three of our patients achieved complete remission, and even though one of the patients relapsed at 2 months, it was with a much lower intensity. Conclusions: Efalizumab and omalizumab appeared to be effective or partly effective in our patients, with a safe profile. Further studies are required to assess the actual role of these medications in SCLE and UV. Commercial support: None identified. P1136 The year at Parkland 2009 Kien Tran, MBBS, University of Texas Southwestern Medical Center, Dallas, TX, United States; Adean Kingston, MD, University of Texas Southwestern Medical Center, Dallas, TX, United States; Joanna Chan, MD, University of Texas Southwestern Medical Center, Dallas, TX, United States; Kim Yancey, MD, University of Texas Southwestern Medical Center, Dallas, TX, United States; Scott Boswell, MD, University of Texas Southwestern Medical Center, Dallas, TX, United States Parkland Memorial Hospital (PMH) is the primary indigent care hospital for Dallas County, TX, USA. The PMH Dermatology Clinic is staffed by UTSW Dermatology residents and faculty along with volunteers from the local community. This poster is the sixteenth in a series of annual presentations of extraordinary patients seen throughout the year at PMH. Cases to be presented this year include: mammary Paget disease undiagnosed for years by primary care providers, secondary syphilis, erythema induratum of Bazin, and pyoderma gangrenosum treated successfully with infliximab. Commercial support: None identified. Commercial support: None identified. P1135 Off-label uses of new biologic agents in dermatology Daniel Sanchez-Cano, MD, PhD, Systemic Autoimmune Diseases Unit, Hospital Universitario San Cecilio, Granada, Spain; Jose L. Callejas-Rubio, MD, PhD, Systemic Autoimmune Diseases Unit, Hospital Universitario San Cecilio, Granada, Spain; M. Antonia Fernandez-Pugnaire, MD, Dermatology Department, Hospital Universitario San Cecilio, Granada, Spain; M. Teresa Gutierrez-Salmeron, MD, Dermatology Department, Hospital Universitario San Cecilio, Granada, Spain; Norberto Ortego-Centeno, MD, PhD, Systemic Autoimmune Diseases Unit, Hospital Universitario San Cecilio, Granada, Spain Objectives: To describe the outcome of the off-label use of efalizumab and omalizumab in four patients with subacute cutaneous lupus erythematosus (SCLE) and urticarial vasculitis (UV) jointly attended at an outpatient clinic of a tertiary hospital in Granada, Spain. Patients received efalizumab (100 mg/wk) or omalizumab (300 mg subcutaneously/mo) as an attempt to control their refractory conditions to standard therapies. Results: Characteristics of the four patients and outcome after treatment are outlined in Table I. Discussion: New biologic agents provide new options with which to treat refractory cases of different conditions, such as SCLE and UV. Efalizumab is a recombinant, humanized, monoclonal antibody directed against CD11a, a subunit of leukocyte function antigen-1, thus blocking T cell migration and activation. It has been licensed for use in psoriasis, but there are reports of successful utilisation in several skin disorders where lymphocytes play a central role, such as different subsets of cutaneous lupus. Interestingly, a few cases of drug-induced SCLE have been described in patients with oral erosive lichen planus treated with efalizumab. On the other hand, omalizumab is a recombinant humanized monoclonal antiTable I. Demographic characteristics and treatment outcomes EvoluFollowPa- Age Diag- tion up Adverse tient (y) Sex nosis (y) Medications (mos) Response reactions 1 31 F SCLE 10 AM, DP, PD, MTX, 11 Complete Fever and AZA, IVIG, RTX headache with first few doses 2 30 F SCLE 8 AM, DP, PD, MTX, 3 Incomplete Mild fever AZA, IVIG (relapse with first after dose 2 mos) 3 60 F UV 5 AH, AM, LRA, 3 Complete None MTX, CSP, IVIG 4 30 F UV 3 AH, AM, LRA, 2 Complete None MTX, CSP, IVIG AH, Antihistamines; AM, antimalarials; AZA, azathioprine; CSP, cyclosporine; DP, dapsone; F, female; IVIG, intravenous immunoglobulin; LRA, leukotriene receptor antagonists; M, male; MTX, methotrexate; PD, prednisone; RTX, rituximab; SCLE, subacute cutaneous lupus erythematosus; UV, urticarial vasculitis. AB48 P1137 Cutaneous sarcoidosis presenting as erythematous macules and patches Minju Kang, PhD, Department of Dermatology, Kangnam St. Mary’s Hospital, Seoul, South Korea; Hei Sung Kim, MD, Department of Dermatology, Kangnam St. Mary’s Hospital, Seoul, South Korea; Hyung Ok Kim, MD, Department of Dermatology, Kangnam St. Mary’s Hospital, Seoul, South Korea; Young Min Park, MD, Department of Dermatology, Kangnam St. Mary’s Hospital, Seoul, South Korea Sarcoidosis is a multisystemic disorder of unknown cause. Although the lungs are most frequently involved, there are accompanying skin lesions in 25% of all patients. Because of its variable clinical presentations, a thorough evaluation is often needed to make the diagnosis. We herein report a case of cutaneous sarcoidosis that had an atypical clinical presentation. A 32-year-old Korean male presented with a 2-month history of multiple lesions on his trunk and extremities. The lesions first began on a scratch wound on the left arm and had begun to spread in the previous weeks. The patient denied any other symptoms and was otherwise in good health. A dermatologic examination revealed multiple, asymptomatic, erythematous macules and patches on the trunk and extremities. The lesions were relatively flat and showed minimal scaling. Histologic examination revealed noncaseating granulomas in the dermis with a sparse interstitial lymphohistiocytic infiltration. Our case is unique in that the patient presented with multiple, slightly scaly, erythematous macules and patches on the extremities and trunk, unlike the plaques or papules commonly observed in sarcoidosis. This clinical appearance seems to be unlike any other form reported in the literature, because the macular form is usually hypopigmented, and the erythrodermic form is more extensive, mimicking Sézary syndrome. It is important to note that sarcoidosis may present as flat erythematous macules and patches, so that in the future, on confronting cases with a similar presentation, we must consider sarcoidosis as one of the differential diagnoses. Commercial support: None identified. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:44 am P1138 P1140 A true cutaneous chondroma Hei Sung Kim, MD, Department of Dermatology, Kangnam St. Mary’s Hospital, Seoul, South Korea; Hyung Ok Kim, MD, Department of Dermatology, Kangnam St. Mary’s Hospital, Seoul, South Korea; Young Min Park, MD, Department of Dermatology, Kangnam St. Mary’s Hospital, Seoul, South Korea Interesting dermatologic cases from Indiana University Medical Center Terrence Brogan, MD, PhD, Indiana University, Indianapolis, IN, United States; Brandie Tacett, MD, Indiana University Medical Center, Indianapolis, IN, United States; Marjorie Yang, MHS, Indiana University Medical Center, Indianapolis, IN, United States; Michael Sheehan, MD, Indiana University Medical Center, Indianapolis, IN, United States We occasionally come across cutaneous lesions containing cartilage or cartilaginous tumors of the superficial soft tissues, but true cutaneous chondromas are exceedingly rare. We herein report a patient with a focal swelling of the neck. On palpation, multiple firm nodules were identified. Pathologically, the tumor was composed of mature hyaline cartilage with normal chondrocytes within a homogeneous basophilic stroma. It was well circumscribed and was located entirely within the dermis. There was no suggestion that the dermal cartilaginous nodule was related to a metaplastic process secondary to trauma or previous surgery. From the computed tomography findings, the tumor mass presented as a slight thickening of the skin, but lacked connection with the larynx. Based on the clinicopathological findings, we made a final diagnosis of true cutaneous chondroma. This poster displays six of the most interesting cases presenting to Indiana University Medical Center over a 1-year period. Six cases will be discussed by six different residents in a case format with clinical pictures followed by a discussion. This poster has been a long-standing tradition for Indiana University. Commercial support: None identified. Commercial support: None identified. P1139 An atypical presentation of granuloma annulare Tiffany Brazeal, Mayo Clinic, Scottsdale, AZ, United States; David DiCaudo, MD, Mayo Clinic, Scottsdale, AZ, United States; Karen Warschaw, MD, Mayo Clinic, Scottsdale, AZ, United States; Susan Laman, MPH, MD, Mayo Clinic, Scottsdale, AZ, United States A 65-year-old white male with a history of hypercholesterolemia and sleep apnea presented with a 5-year history of asymptomatic lesions on his upper extremities. The eruption progressed to involve his trunk, neck, face, and proximal lower extremities. A dermatologist performed a biopsy that revealed capillary hemangiomas in December of 2005. No treatment was recommended. He was referred to Mayo Arizona Dermatology clinic in April 2008. His skin examination revealed too numerous to count discrete, red, nonblanching, monomorphous 5-mm macules. The macules were concentrated on his upper extremities and trunk and extended to a lesser degree onto his neck, face, and proximal lower extremities. There was a sharp cut off at the wrists and waistband. At presentation the differential diagnosis for his eruption included: telangiectasia macularis eruptiva perstans (TMEP), lichen planus, vasculitis, drug eruption, and infection. Serum tryptase and 24-hour urine N-methyl histamine levels were normal. Coccidiomycosis serologies, chest radiograph, lactate dehydrogenase, and complete blood cell counts were also within normal limits. Histologic examination of tissue revealed a dermal interstitial infiltrate of epitheliod histiocytes and multinucleated giant cells which dissected the collagen bundles consistent with granuloma annulare (GA)elike tissue reaction pattern. Acidfast and methenamine silver stains were negative for microorganisms. Tryptase stain did not reveal a significant increase in mast cells. The patient was not taking any medications that have been described to be associated with a granuloma tissueelike reaction. He did not have signs or symptoms of connective tissue disease. Several variants of GA have been described in the literature. However, this case is unique given the atypical clinical presentation, sharp demarcation at the wrists and waistline, and the duration of persistence of the eruption for more than 5 years. This case represents an atypical presentation of GA that may be confused with other disorders, such as telangiectasia macularis eruptiva perstans, lichen planus, or even leukocytoclastic vasculitis. GA should be kept in mind for patients with similar clinical presentations. Commercial support: None identified. P1141 Granuloma annulare treated with rifampin, ofloxacin, and minocycline Bassel Mahmoud, MD, Henry Ford Hospital, Detroit, MI, United States; Dione Marcus, MD, Family Dermatology, Conyers, GA, United States; Iltefat Hamzavi, MD, Henry Ford Hospital, Detroit, MI, United States Granuloma annulare (GA) is a benign cutaneous dermatosis. It presents as asymptomatic, flesh-colored or red papules in an annular pattern on the distal extremities. Although the etiology of GA is unknown, multiple factors have been proposed, including trauma, insect bites, ultraviolet light, infectious organisms, drugs, and lymphoma. Histologicly, GA is characterized by foci of degenerative collagen associated with palisading, sometimes infiltrating granulomatous inflammation. Tuberculoid leprosy can appear similar to granuloma annulare, both clinically and histologicly. Many therapies have been described to manage GA with limited success: rifampin, ofloxacin, and minocycline (ROM) therapy has been successfully used to treat patients with paucibacillary leprosy. Our purpose was to review the outcomes of treatment of GA resistant to standard regimens with ROM. We report cases of GA, resistant to standard treatment, histopathologically proven, that resolved after 3 months of treatment with monthly rifampin 600 mg, ofloxacin 400 mg, and minocycline 100 mg therapy. Given the clinical and histologic similarities between paucibacillary leprosy and GA, ROM therapy was initiated in these patients. Our results showed that complete clearance of GA lesions was achieved 3 to 5 months after initiation of treatment. This treatment would increase the therapeutic options for patients with recalcitrant lesions of GA. Commercial support: None identified. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:44 am AB49 P1142 P1144 Focal palmoplantar keratoderma with epidermolytic degeneration: A new entity? Naoki Oiso, MD, Department of Dermatology, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan; Akira Kawada, MD, PhD, Department of Dermatology, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan; Shigeru Kawara, MD, PhD, Department of Dermatology, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan; Tomohiko Narita, MD, Department of Dermatology, Kinki University School of Medicine, OsakaSayama, Osaka, Japan An unusual site of juvenile xanthogranuloma: The metacarpophalengeal joint of the finger Jeong Deuk Lee, MD, Department of Dermatology, Our Lady of Mercy Hospital, College of Medicine, The Catholic University of Korea, Inchon, South Korea; Ji Hyun Lee, Department of Dermatology, College of Medicine, The Catholic University of Korea, Inchon, South Korea; Sang Hee Cha, MD, Department of Dermatology, College of Medicine, The Catholic University of Korea, Inchon, South Korea; Sang Hyun Cho, Department of Dermatology, College of Medicine, The Catholic University of Korea, Inchon, South Korea Focal palmoplanar keratoderma encompasses a group of heterogeneous diseases clinically characterized by focal hyperkeratosis on the palmoplantar lesion and histologicly by focal nonepidermolytic palmoplantar keratoderma. Focal palmoplantar and gingival keratosis is characterized clinically by focal palmoplantar hyperkeratosis with an appearance of leukoplakia on the gingival lesion and histologicly by focal epidermolytic palmoplantar keratoderma. We present a 41-year-old female with about a 36-year history of asymptomatic focal hyperkeratosis on the soles and palms, especially on the margins of the heels. The nails, eyes, oral mucosa, and gingival lesions were all normal in appearance. The father had the same palmoplantar hyperkeratosis. A histologic specimen indicated hyperkeratosis, hypergranulosis, and acanthosis with epidermolytic degeneration. The present case featured focal palmoplantar keratoderma showing epidermolytic degeneration histologicly. Our presentation suggests that focal palmoplanar keratoderma may have a variant type with histologic epidermolysis. Juvenile xanthogranuloma is a benign self-limited histiocytic proliferative disorder that usually occurs in early childhood. It appears as reddish to yellow papule or nodule. The head, neck, and trunk are known to be the most frequent locations; however, it can occur on any site of the body. Moreover, juvenile xanthogranuloma occurring on the finger is rare. Histologicly, juvenile xanthogranuloma is characterized by an unencapsulated, dense histiocytic infiltrate within the dermis, some of which is contained in the Touton giant cells, foreign body giant cells, and foamy cells. Because the disease is asymptomatic and self-limiting, no intervention is required in most cases. A 4-year-old female presented with a several months history of a papule on the ventral aspect of the metacarpophalengeal joint of the right fourth finger. The lesion was a firm, dome-shaped, yellowish papule, 0.4 cm 3 0.4 cm in diameter. The lesion was removed with a 4-mm punch biopsy for diagnosis and treatment. The biopsy specimen showed a dense intradermal histiocytic infiltrates, some of which contained foamy cells, Touton giant cells, and foreign body giant cells. The papule was removed under local anesthesia by a 4-mm punch biopsy. There are only six cases of juvenile xanthogranuloma of the fingers reported in the literature. We report a case of juvenile xanthogranuloma on the ventral aspect of the metacarpophalengeal joint of the right fourth finger in a 4-year-old female. Commercial support: None identified. Commercial support: None identified. P1145 DRESS syndrome induced by sulphasalazine requiring liver transplantation Emma Benton, PhD, King’s College Hospital, London, United Kingdom; Daniel Creamer, MD, MBChB, King’s College Hospital, London, United Kingdom; Elizabeth Sizer, MD, MBBS, King’s College Hospital, London, United Kingdom Phrynoderma is a type of follicular hyperkeratosis attributed to various nutritional deficiencies, most notably vitamin A. We report a case of a mentally-deficient man who was a resident of a destitute home. He presented with characteristic hyperkeratotic follicular papules on his trunk associated with severe malnutrition and a low serum level of vitamin A. Although commonly seen in certain parts of Asia, it is rarely reported in developed countries. However, there is still a population at risk: patients with malabsorption and eating disorders and the destitute. Phrynoderma should, therefore, be considered in the differential diagnosis in patients with hyperkeratotic folliculitis, especially when malnutrition is also present. A 50-year-old female with seronegative rheumatoid arthritis developed pruritus 1 week after commencing sulphasalazine. Two weeks later, she developed an extensive rash, facial swelling, and fever. On admission to her local hospital, examination revealed a pyrexia of 418C, severe periorbital oedema, cervical lymphadenopathy, and an exfoliative dermatitis. A full blood count revealed an eosinophil count of 1.2 3 10/L (normal, 0.0-0.4). Alanine transaminase (ALT) was raised at 123 IU/L (normal, 4-59) and an international normalized ratio (INR) was 1.2.The patient fulfilled the diagnostic criteria for drug rash with eosinophilia and systemic symptoms (DRESS) syndrome. Sulphasalazine was discontinued and intravenous methylprednisone 500 mg daily was given for 3 days.The skin improved but the liver function continued to deteriorate. She was transferred to the regional liver intensive care unit. Over the next 4 days, her liver function deteriorated: bilirubin 153 mol/L (normal, 0-16), ALT 1171 IU/L, and INR 2.4. Eosinophils were 3.1 3 10/L. The patient became encephalopathic and underwent emergency liver transplantation. Despite standard posttransplantation immunosuppression, she developed acute hepatic rejection. Her skin remained stable. DRESS syndrome is usually observed 1 to 8 weeks after treatment initiation. It is characterized by an extensive cutaneous eruption, fever, flu-like symptoms, lymphadenopathy, acute hepatitis, hematological abnormalities with eosinophilia, and atypical lymphocytes and may involve other organs. Life threatening multiorgan failure may develop, as in our case. Skin involvement is frequently the first sign. DRESS syndrome carries a high mortality of approximately 10%. Aromatic anticonvulsants and antibacterial sulfonamides are two drug classes most often responsible for DRESS syndrome. Treatment remains empirical given the small number of case reports. The suspected drug should be immediately withdrawn. Glucocorticoids are the mainstay of treatment, although doses do vary widely in reported cases. Parenteral steroids are indicated in severe forms. Liver transplantation is usually proposed in emergency situations and there is one case of sulphasalazine-induced DRESS syndrome that successfully underwent transplantation. Commercial support: None identified. Commercial support: None identified. P1143 Phrynoderma: A cutaneous manifestation of nutritional deficiencies that is commonly overlooked Min-Wee Chia, MD, Division of Dermatology, Changi General Hospital, Singapore; Yong-Kwang Tay, MD, Division of Dermatology, Changi General Hospital, Singapore AB50 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:44 am P1146 P1148 A case of chronic Sweet syndrome associated with chronic lymphocytic leukemia Abba Alkali, MD, Deparment of Dermatology, Broadgreen Hospital, Liverpool, Merseyside, United Kingdom; Clodagh King, MD, Department of Dermatology, Broadgreen Hospital, Liverpool, Merseyside, United Kingdom; Niamh Leonard, MD, Department of Histopathology, Royal Liverpool Hospital, Liverpool, Merseyside, United Kingdom Background: Sweet syndrome (SS), also known as acute febrile neutrophilic dermatosis, is a rare disorder characterized by fever, peripheral neutrophilic leucocytosis, the acute onset of erythematous skin lesions, and a neutrophilic infiltrate without evidence of vasculitis on skin histology. We present a patient with SS associated with chronic lymphocytic leukaemia (CLL). The SS presented in a chronic manner. Scleredema presenting as unilateral periorbital edema Jin Young Jung, MD, Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea; Dong Jin Ryu, MD, Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea; Kee Yang Chung, MD, PhD, Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea; Yeon Sook Kwon, MD, Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea Scleredema is an unusual sclerotic disorder affecting the skin connective tissue with increased amounts of collagen and mucin. It is characterized clinically by symmetrical, diffuse, and nonpitting induration of the skin, usually involving the neck, shoulders, trunk, face, arms and, rarely, the buttocks and thighs. Its occurrence has been documented in association with infections, diabetes mellitus, paraproteinemia, multiple myeloma, and monoclonal gammopathy. We report a rare case of scleredema presenting as unilateral periorbital swelling. A 57-year-old male presented with a 1-year history of asymptomatic right periorbital swelling. He had no history of trauma, infection, or diabetes. The ophthalmologic evaluation, including imaging studies, was normal. Histologic examination showed thickening of the collagen bundles in the dermis. The collagen bundles were separated from one another by prominent clear spaces. These histologic features combined with the clinical features confirmed the diagnosis of scleredema. During the 2-year followup, the patient was treated with systemic and intralesional corticosteroids, colchicines, and minocycline. However, the clinical improvement was not maintained even after the treatments. The lesion of scleredema is still restricted to the only right periorbital area. Periorbital edematous swelling may be a clinical sign of a variety of disease processes, including bacterial, viral, fungal, or parasitic infections, sinusitis, trauma, angioedema, contact dermatitis, degenerative alterations, hypothyroidism, collagen vascular diseases, amyloidosis, lymphedema, and lymphoma. The typical clinicohistologic features of scleredema generally permit its differentiation from the other diseases. The rare clinical feature in scleredema presenting as periorbital edema may cause diagnostic confusion and delay proper treatments. We suggest that scleredema should be considered in the differential diagnosis of periorbital edema. Observations: We describe a 70-year-old female with a 17-year history of CLL who presented in March 2008 with a 5-week history of lumpy skin lesions affecting her limbs and trunk. She had been on long-term low dose prednisolone for her CLL since August 2007. Examination revealed multiple erythematous nodules and papules on her trunk and limbs. A diagnostic biopsy revealed skin with epidermal acanthosis, parakeratosis, and crust formation with polymorphs. The underlying dermis showed a dense inflammatory infiltrate of lymphocytes, eosinophils, and polymorphs with no evidence of vasculitis, consistent with SS. Extensive investigations revealed no evidence of progression of her CLL. The cutaneous lesions quickly improved following high dose systemic corticosteroid therapy. Despite a slow tapering of the steroids, her skin flared, and she was commenced on long-term dapsone. Conclusions: We present this interesting case to highlight the association of SS with a hematologic malignancy and the chronic way in which the SS presented with skin nodules of relatively low-grade inflammation without the classical accompaniments of fever and a neutrophil leucocytosis. This unusual presentation may be explained by the long-term low dose prednisolone therapy for CLL. Close follow-up of this patient is desirable because of the possibility that the SS may herald an acceleration of the malignant process or the transformation of CLL to lymphoma. Commercial support: None identified. Commercial support: None identified. P1149 Reed syndrome: A case report and review of the literature with proposed guidelines for management Angela Kyei, Cleveland Clinic Foundation, Cleveland, OH, United States; Apra Sood, MD, Cleveland Clinic Foundation, Cleveland, OH, United States; Laszlo Karai, MD, PhD, Cleveland Clinic Foundation, Cleveland, OH, United States; Melissa Piliang, MD, Cleveland Clinic Foundation, Cleveland, OH, United States P1147 Chronic ulcerated plasma cell mucositis: Response to 0.1% tacrolimus ointment Kathleen Garvey, MD, Mayo Clinic Jacksonville, Jacksonville, FL, United States; Jason Sluzevich, MD, Mayo Clinic Jacksonville, Jacksonville, FL, United States Plasma cell mucositis is a rare, idiopathic disorder of mucous membranes. Oral cavity involvement is pleomorphic and may manifest as painful erythematous patches to friable plaques. Histologicly, a polyclonal infiltrate of mature plasma cells in the underlying lamina propria is present. Treatment is difficult, because topical, intralesional, and systemic corticosteroids are frequently reported to be ineffective. A 21-year- old male was referred for a 2-year history of a progressive, infiltrative, centrally ulcerating eruption on the lower mucosal lip. Tissue culture, polymerase chain reaction studies for herpes simplex virus, enzyme-linked immunosorbent assay for desmoglein 1 and 3 antibodies, and hepatitis C antibodies were negative. A 4-mm punch biopsy revealed a dense, polyclonal superficial lymphoplasmacytic infiltrate extending into the reticular dermis. A diagnosis of plasma cell cheilitis was rendered. Because previous treatment with systemic and class I topical corticosteroids was unsuccessful, the patient was started on tacrolimus 0.1% ointment twice daily. The central ulceration cleared in 8 weeks and the lower lip swelling was significantly reduced. Three attempts to discontinue the tacrolimus 0.1% ointment resulted in rebound flaring and ulceration consistent with an immunomodulatory doseeresponse relationship. The clinical behavior of this patient suggests that tacrolimus 0.1% ointment is useful in the long-term management of plasma cell mucositis, especially in circumstances in which corticosteroids fail. This is the first and only report of topical tacrolimus used for this rare and often treatment refractory condition. Commercial support: None identified. Introduction: Reed syndrome or familial leiomyomatosis cutis et uteri is a rare syndrome characterized by painful cutaneous leiomyomas and uterine fibroids. A variant of this syndrome is associated with renal cell carcinoma and is termed hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome. The pathogenesis of this condition has recently been linked to a loss of function mutation in the gene encoding fumarate hydratase on chromosome 1q42.3-43, an enzyme that catalyzes the conversion of fumarate to malate in the Kreb cycle but also functions as a tumor suppressor gene. We report a case involving a 74-year-old female and her daughter and we review the histopathologic findings and treatment options. Given the lack of established guidelines for the evaluation of Reed syndrome, we propose an algorithm for the evaluation and management. History: The proband is a 74-year-old Middle Eastern female who developed multiple painful skin leiomyomas on her upper back several years after having a hysterectomy for uterine fibroids. Her 45-year-old daughter also has cutaneous leiomyomas and uterine fibroids treated with a hysterectomy. In addition, the proband’s daughter and two grandchildren all have renal cysts. A physical examination of the proband revealed firm, smooth, brown, tender grouped papules on her upper back. Her daughter had similar lesions on her face. Laboratory examinations, including a complete blood cell count, comprehensive metabolic panel, and lipid panel were within normal limits. Histopathology revealed a proliferation of smooth muscle fascicles consistent with a diagnosis of cutaneous leiomyomas. The family was referred for genetic counseling. Discussion: Multiple cutaneous and uterine liomyomas or Reed syndrome is an autosomal dominant condition characterized by cutaneous smooth muscle tumors and uterine fibroids. Patients with this syndrome must be carefully monitored for the development of renal cell carcinoma. The literature, however, lacks specific guidelines for the management of these patients. We propose an algorithm for the evaluation and management based on a literature review. Commercial support: None identified. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:44 am AB51 P1150 P1152 Rheumatoid neutrophilic dermatosis: A case report and literature review of current treatment options Shilpa Reddy, PhD, University of New Mexico Department of Dermatology, Albuquerque, NM, United States; Barrett Zlotoff, MD, University of New Mexico Department of Dermatology, Albuquerque, NM, United States; Jesse Howell, University of New Mexico Department of Dermatology, Albuquerque, NM, United States Rheumatoid neutrophilic dermatosis (RND) is a rare condition that generally presents in seropositive rheumatoid arthritis patients as erythematous papules and plaques on clinical examination, with a dense dermal neutrophilic infiltrate on histology. It is categorized in the neutrophilic dermatosis category and is sometimes confused with sweets syndrome. We report a case of a 30-year-old Hispanic female with seropositive rheumatoid arthritis well controlled on infliximab for nearly a year, who presented with a 3-month history of well demarcated erythematous plaques on her neck, shoulders, and upper trunk after stopping infliximab in anticipation of an upcoming surgical procedure. A full work-up for Sweet syndrome was negative and her biopsies showed a dense neutrophilic infiltrate in the dermis, consistent with RND. A literature review was performed using the PubMed database on RND and available treatment regimens. Our results found that treatment with oral prednisone at a minimum dosage of 50 mg/day is effective in resolving RND; however, relapses are common upon discontinuation or taper of the medication. Other treatments that have been effective in refractory cases of RND include dapsone and tumor necrosis factorealfa (TNFa) modulators such as etanercept at 25 mg twice weekly. Topical steroids, hydroxychloroquine, and cyclophosphamide had mixed results. Our patient, who originally responded well to oral prednisone but relapsed with tapering, eventually cleared with reinitiation of infliximab therapy over a course of a couple months. Aggressive treatment of the underlying rheumatoid arthritis, particularly with TNFa inhibitors as in our case may be a reasonable option in refractory cases of RND. More research is needed regarding the use of TNFa inhibitors in the treatment of RND. Dissecting cellulitis of the scalp treated with adalimumab Smita Sukhatme, MD, PhD, Department of Dermatology, Tufts Medical Center, Boston, MA, United States; Alice Gottlieb, MD, PhD, Department of Dermatology, Tufts Medical Center, Boston, MA, United States; Yolanda Lenzy, MD, MPH, Department of Dermatology, Tufts Medical Center, Boston, MA, United States Commercial support: None identified. There are currently no treatments for dissecting cellulitis of the scalp (DCS) that are approved by the US Food and Drug Administration. Treatments such as antibiotics, prednisone, isotretinoin, radiation, surgical excision with skin grafting, and carbon dioxide laser ablation typically provide short-term palliation. Tumor necrosis factor (TNF) blockers have been used to successfully treat other neutrophilic dermatoses such as hidradenitis suppurativa and pyoderma gangrenosum. We report a case of DCS successfully treated with adalimumab, a TNF-alfa (TNFa) antagonist. A 39-yearold white male with a 6-year history of DCS presented with a painful, tender fluctuant mass on his posterior scalp. When first diagnosed with DCS, the patient was given multiple courses of antibiotics and intralesional triamcinolone injections with only minor improvement. He was referred to a dermatologic surgeon for excision, and after 1 year in remission, painful, purulent scalp nodules developed at the site of the surgical scar. He started 40 mg daily of oral isotretinoin and after dose escalation to 80 mg daily, his DCS was well controlled for 7 months. Two months after stopping the medication, his DCS flared. We considered the TNFa antagonist adalimumab as an alternative treatment. Before starting therapy, the patient had purified protein derivative testing, a complete blood cell count, a chemistry panel, and hepatitis B and C serologies, all of which were within normal limits. He received two 40-mg subcutaneous adalimumab injections for the first week, 40 mg for the second week, and then 40 mg every other week. At the 1-month follow-up, the patient reported that the pain and purulent discharge had stopped. His scalp was less boggy with smaller skin-colored nodules and short hairs emerging on top of the nodules. At the 2-month follow-up, he had two slightly boggy flesh colored nodules with hair growth. No erythema or purulent drainage was present. At the 5-month follow-up, his lesions had cleared and hair was growing back normally and he continues on 40 mg adalimumab injections every other week. Our case highlights that adalimumab, and possibly other TNF antagonists, may be an effective alternative for use in patients with DCS refractory to conventional therapy. Clinical trials are needed to evaluate the safety and efficacy of adalimumab as a treatment option for DCS. Commercial support: None identified. P1153 Eosinophilic pustular foliculitis in an immunocompetent white woman Ana Nogueira, MD, PhD, Hospital S. Jo~ao, Department of Dermatology and Venereology, Porto, Portugal; Aurea Canelhas, Hospital S. Jo~ao, Department of Pathology, Porto, Portugal; Carlos Resende, Consultório Dr Carlos Resende, Porto, Portugal; Filomena Azevedo, Hospital S. Jo~ao, Department of Dermatology and Venereology, Porto, Portugal; Sofia Magina, MD, Hospital S. Jo~ao, Department of Dermatology and Venereology, Porto, Portugal P1151 Necrolytic acral erythema associated with hepatitis C and serum zinc deficiency Sarah Zeller, MD, University of Oklahoma Health Sciences Center Department of Dermatology, Oklahoma City, OK, United States; A. Neil Crowson, MD, Department of Dermatology, University of Oklahoma and Regional Medical Laboratories, Tulsa, OK, United States; Renee Grau, MD, Oklahoma University Health Sciences Center Department of Dermatology, Oklahoma City, OK, United States; Stephanie Boes, The University of Oklahoma College of Medicine, Oklahoma City, OK, United States Necrolytic acral erythema (NAE), a recently described entity that is strongly associated with hepatitis C virus (HCV) infection, manifests tender, pruritic, hyperpigmented, hyperkeratotic plaques with well demarcated erythematous borders located on the dorsal surfaces of the feet and pretibial lower extremities. Serum zinc and glucagon levels may be within normal limits or may be depressed, but HCV serologies are consistently positive. Histopathologic findings variably consist of confluent parakeratosis, acanthosis, epidermal pallor, and keratinocyte necrosis. The etiology of NAE is unknown; it has been thought to share a pathogenic mechanism with the closely related disorder necrolytic migratory erythema. We present a case of NAE in a 55-year-old male with a 3-month history of an eczematoid eruption unresponsive to topical corticosteroids. Laboratory investigation was significant for an elevated HCV titer and low serum zinc levels, and the histopathology was consistent with NAE. The patient responded completely to oral zinc supplementation. Commercial support: None identified. AB52 Background: Eosinophilic pustular foliculitis (EPF) is a rare inflammatory disease described by Ofuji in 1965, characterized by chronic recurrent erythematous papulopustular lesions that coalesce to form plaques or annular configurations with central clearing, mainly on seborrheic areas. There are three major variants, namely the classical EPF, which occurs preferably in Asian patients, immunodeficiencyassociated EPF, and EPF in infancy. Case report: A previous healthy 18-year-old white woman presented to our department with a 6-month history of papulopustules in the cheeks and forehead evoking an annular configuration in the jaw angle. She also displayed generalized annular plaques with predilection for the trunk, which had started 4 months earlier. These lesions had grown centrifugally with central clearing and had an infiltrated violaceus border, with a pseudovesicular appearance. This eruption was intensely pruritic. She had already been treated empirically for dermatophytia with oral terbinafine, with no response. Laboratory investigations revealed a normal leukocyte count with relative eosinophilia (23%). The biochemistry panel, including angiotensin converting enzyme, was normal. Serologies for HIV and hepatitis viruses were negative. Immunologic study was normal. A cutaneous biopsy was performed in the dorsum, and the histology revealed dense eosinophilic infiltration involving the hair follicles, along with destruction of some pilosebaceus units. Mycologic scraps were negative. The diagnosis of classical eosinophilic pustular folicutis was advanced, and she was started on oral indomethacin 50 mg/day, with almost complete clearing of the lesions and resolution of eosinophilia 2 weeks later. Comments: Although this case presented with typical skin lesions, the extensive skin involvement in a healthy white woman is noteworthy, highlighting the need for a greater awareness of this condition in the Western world. The dermatosis had an excellent response to indomethacin, which is recommended as the first therapeutic option, although its precise mechanism of action is still elusive. Commercial support: None identified. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:44 am P1154 P1156 Clinicodermatopathologic highlights of Jackson Memorial Hospital and University of Miami Miller School of Medicine Paolo Romanelli, MD, University of Miami Miller School of Medicine, Miami, FL, United States; Carlos Ricotti, MD, University of Miami, Miami, FL, United States; Caroline Caperton, MPH, University of Miami Miller School of Medicine, Miami, FL, United States; Elissa Schwartzfarb, University of Miami Miller School of Medicine, Miami, FL, United States Jackson Memorial Hospital (JMH)/University of Miami (UM) is the primary indigent health care hospital for Miami Dade County, Miami, FL, USA. This poster is the fifth presentation of our clinicopathological correlation conferences on difficult to diagnose and manage patients throughout the year at JMH-UM. Cases to be discussed include multiple amyloidomas, calciphic uremic arteriolopathy, epidermotropic T-cell lymphoma, diffuse dermal angiomatosis, and histiocytoid Sweet syndrome. Pachydermodactyly in a young girl: Cutaneous manifestation of a psychiatric disorder? Miguel Cabanillas, Department of Dermatology, Complejo Hospitalario Arquitecto Marcide-Novoa Santos, Ferrol, A Coruña, Spain; Benigno Monteagudo, Department of Dermatology, Complejo Hospitalario Arquitecto Marcide-Novoa Santos, Ferrol, A Coruña, Spain; Cristina de las Heras, MD, Department of Dermatology, Complejo Hospitalario Arquitecto Marcide-Novoa Santos, Ferrol, A Coruña, Spain; Elvira León-Muı́ños, MD, Department of Pediatry, Complejo Hospitalario Arquitecto Marcide-Novoa Santos, Ferrol, A Coruña, Spain Introduction: Pachydermodactyly is a benign painless fibromatosis of unknown origin, typically occurring in otherwise well young men, affecting the skin overlying the radial and lunar aspects of the proximal interphalangeal joints of second to fourth digits of both hands. Case report: A 15-year-old female with a personal history of attention deficit hyperactivity disorder and tricotillomania presented a 3-year history of progressive painless swelling localized to the radial and ulnar sides of her second to fourth fingers of the left hand. She had been previously referred to the rheumathologist with clinical suspicion of rheumatoid arthritis, which was ruled out because of lack of local inflammatory signs and presence of soft tissue swelling with normal underlying bones and no signs of synovitis in a radiograph. A skin biopsy was performed, showing marked hyperkeratosis and acanthosis. After a careful clinical interview, the patient revealed a frequent compulsive habit of chewing and sucking the fingers of the left hand, which was probably involved in the development of cutaneous lesions. Discussion: Our case differs from the typical clinical picture of pachydermodactyly in the sex of the patient and the unilateral distribution of the lesions. Although the exact etiology of this condition is unknown, it has been associated with carpal tunnel syndrome, tuberous sclerosis, and familial atrophia maculosa varioliformis cutis. The repetitive trauma related to behavioral disturbances, such as obsessive compulsive disorder and Asperger syndrome, has also been evoked as a posssible ethiopathogenic factor. However, skin changes may persist even if the putative precipitating physical activity is ceased, and topical and intralesional steroids appear to be ineffective. Commercial support: None identified. Commercial support: None identified. P1157 Management of recalcitrant keloids with radiation dose escalation James Brashears, MD, Medical University of South Carolina, Charleston, SC, United States; Joseph Jenrette, MD, Medical University of South Carolina, Charleston, SC, United States P1155 Perforating dermatosis in a patient receiving bevacizumab Sergio Vano-Galvan, PhD, Ramon y Cajal Hospital, Madrid, Spain; Carmen Moreno, MD, Ramon y Cajal Hospital, Madrid, Spain; Lucı́a Pérez-Carmona, MD, Ramon y Cajal Hospital, Madrid, Spain; Pedro Jaen, PhD, Ramon y Cajal Hospital, Madrid, Spain Background: Bevacizumab is a recombinant humanized monoclonal antibody directed against vascular endothelial growth factor (VEGF). VEGF plays a central role in tumor angiogenesis. It is expressed at increased levels in colorectal, liver, lung, thyroid, and breast cancers, among others. VEGF blockade has been shown to have a direct and rapid antivascular effect through deprivation of tumor vascular supply and inhibition of endothelial proliferation. Case report: A 51-year-old male diagnosed with stage IV colorectal cancer with liver metastases was treated with different chemotherapeutics regimens with poor response. Treatment with bevacizumab was started, and 2 months later he developed slightly pruritic papules with adherent central keratotic plugs on his neck. Routine laboratory tests showed normal serum glucose and renal function. Skin biopsy showed transepidermal elimination of collagen and a crusted plug, consistent with perforating dermatosis (PD). Purpose: Keloids are benign fibrous tumors frequently associated with previous tissue injury in highly pigmented individuals. Resection is often the initial treatment, and external beam radiation therapy with high energy electron beams is often employed to decrease the high recurrence rate seen with surgery alone. Recently, effectiveness of the typical treatment fractionation of 12 to 16 Gy in 3 to 4 fractions has been questioned, particularly with large or recalcitrant lesions. We report our experience with a modified dose schedule for recurrent keloids wherein a series of 2 to 5 supplemental 4-Gy fractions were given in a weekly fashion after the initial 12 to 16 Gy. Discussion: Most common toxicities associated with bevacizumab include hypertension, hemorrhage, gastrointestinal perforation, arterial thromboembolism, impaired wound healing, and proteinuria. Few skin side effects, such as exfoliative dermatitis and a nonspecific rash, have been reported. Perforating dermatosis is characterized by the elimination of altered collagen through the epidermis. A number of reported cases appear to be idiopathic, but specific associations have also been observed, such as chronic renal failure and diabetes mellitus. The pathogenesis of PD is poorly understood. Therefore, the relationship between VEGF and this entity remains unclear. VEGF blockade has been shown to have a direct and rapid antivascular effect by inhibition of endothelial proliferation. Hypoxic conditions may play a role in pathogenesis of PD. We speculate that inhibition of VEGF may cause hypoxia that contributes to develop transepidermal elimination of dermal collagen. To our knowledge, this is the first report of a possible correlation between bevacizumab and perforating disorders and may initiate further investigation on similar observation. Methods: Between March 1997 and March 2008, 19 keloids at high risk of recurrence were treated in eight patients following surgical removal at our institution (5 males, 3 females). Simulation and subsequent treatment were initiated within 2 days of resection for all patients. Six- to 16-megavolt electron beams were used with appropriate immobilization devices, blocks, and bolus to assure reproducibility and coverage of the clinical target volume (enclosed within the 90% isodose line). The initial 12 to 16 Gy was typically given on alternating days at 4 Gy per fraction followed by supplemental treatments given once per week at 4 Gy per fraction (with the total number of weekly fractions left to the discretion of the attending physician). Patients were followed for any treatment related toxicities and local control of their disease. Results: All patients had previous keloid resection with recurrence, and seven of eight had a history of recurrence after combination resection and postoperative radiation. Sites of treatment included: ear (n ¼ 5), face (n ¼ 4), neck (n ¼ 3), back (n ¼ 3), chest (n ¼ 2), shoulder (n ¼ 1), and vulva (n ¼ 1). The median total dose delivered was 24 Gy in six equally weighted fractions (range, 20-28 Gy). After a mean follow-up of 3.7 years, one recurrence has been identified (managed by re-resection and postoperative brachytherapy), and a single infection was noted in the radiated field requiring incision and drainage along with broad-spectrum antibiotic coverage. Conclusion: Keloid recurrence after surgery with or without postoperative radiation presents a difficult clinical circumstance associated with significant morbidity, poor cosmesis, and a high rate of recalcitrance. Dose escalation with supplemental weekly 4-Gy fractions holds promise to increase local control of these tumors with acceptable toxicity. Investigations are ongoing to delineate the optimal dose and fractionation for postoperative keloid treatments vis-à-vis recurrence risk and overall patient satisfaction. Commercial support: None identified. Commercial support: None identified. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:44 am AB53 P1158 P1160 Dermatofibrosarcoma protuberans and multiple lipomas: A case report and discussion Ali Banki, MD, St. Barnabas Hospital, Bronx, NY, United States; Charles Gropper, MD, St. Barnabas Hosptial, Bronx, NY, United States; Cindy Hoffman, DO, St. Barnabas Hospital, Bronx, NY, United States Chronic cutaneous leishmaniasis infection caused by Leishmania tropica: Resitant to tradional sodium stibogluconate Johnny Gurgen, MD, Suncoast Hospital, Largo, FL, United States; Daniel Hogan, MD, Suncoast Hospital, Largo, FL, United States; Richard Miller, DO, Suncoast Hospital, Largo, FL, United States Dermatofibrosarcoma protuberans (DFSP) are bulky, protuberant, neoplasms that are slowly growing with little tendency to metastasize. Lipomas are subcutaneous tumors composed of fat tissue. They are multiple histologic subtypes of lipomas, including spindle cell lipomas and angiolipomas. The occurence of multiple spindle cell lipomas and DFSP has been reported in the literature only once. Both DFSP and multiple spindle cell lipomas are characterized by a proliferation of CD341 spindleshaped cells, suggesting a common origin from interstitial dendritic cells. We report a 42-year-old Hispanic male with multiple subcutaneous nodules on his trunk and extremities. Histopathology revealed both lipomas and angiolipomas. This patient also had a DFSP tumor on the anterior surface of his chest, which was previously excised. The optimal medical management for this patient would be to excise newly grown painful angiolipomas. In the case of recurrent or de novo DFSP in this patient, Mohs micrographic surgical excision with adjuvant radiation therapy is recommended. We report the first case of angiolipomas occuring with DFSP, both of which are CD341 tumors. This case with previous reported case of occurence of DFSP with spindle cell lipomas may help further associate DFSP and lipomas under the same neoplastic proliferation. Cutaneous leishmaniasis is most commonly seen in tropical and subtropical regions including Afghanistan. The incidence is increasing in the United States because of the Gulf War. We present a 23-year-old US Army veteran who was stationed in Afghanistan for 1 year. He presented with three distinct erythematous compressible nodules located on the dorsal surface of his arms bilaterally. These nodules developed 1 year before his initial presentation and slowly enlarged. Biopsy and culture of the lesions revealed Leishmania tropica. Sodium stibogluconate has been the mainstay of treatment for L tropica and other Leishmania species. Unfortunately, there is increased resistance to sodium stibogluconate in Europe and India. Cases resistant to sodium stibogluconate may also present in the United States. We present a case report of L tropica that was resistant to initial monotherapy with sodium stibogluconate. Commercial support: None identified. Commercial support: None identified. P1159 P1161 Diagnostically challenging cases highlighting clinical problem solving Jennifer Ragi, MD, UMDNJeRobert Wood Johnson Medical School, Somerset, NJ, United States; Amy Pappert, MD, UMDNJeRobert Wood Johnson Medical School, Somerset, NJ, United States; Babar Rao, MD, UMDNJeRobert Wood Johnson Medical School, Somerset, NJ, United States; Marc Grossman, MD, Columbia Presbyterian Medical Center, New York, NY, United States Two patients from the Department of Dermatology Robert Wood Johnson Medical School with cutaneous presentations of rare infectious diseases are presented. These educational cases emphasize the importance of obtaining a detailed clinical history, thorough physical examination, and clinicopathologic correlation in order to reach the correct diagnosis. Background information, diagnosis, and management will be reviewed. Solitary superficial angiomyxoma on a caesarean section surgical scar Tae Yoon Kim, MD, Department of Dermatology, Pochon CHA University, College of Medicine, Seongnam, GyeongGi, South Korea; Dong Hyun Kim, MD, Department of Dermatology, Pochon CHA University, College of Medicine, Seongnam, GyeongGi, South Korea; Moon Soo Yoon, MD, PhD, Department of Dermatology, Pochon CHA University, College of Medicine, Seongnam, GyeongGi, South Korea Case 2: An 84-year-old female presented with a 9-month history of enlarging growths on her thumb and forearm. She denied any recent travel. She had no pets and denied any gardening exposure. One month before onset, a water exposure after falling into a bay in New Jersey was noted. Physical examination was remarkable for 2- 3 2-cm, 1.5-cm, and 4- 3 4-cm yellow to brown heavily crusted plaques located on her thumb pad, the dorsal surface of her thumb, and dorsal surface of her forearm, respectively. Histologic examination revealed epidermal hyperplasia with a suppurative and granulomatous dermatitis. Acid-fast bacillis, Fite, and periodic acideSchiff stains were negative. Bacterial, fungal, and mycobacterial smears and cultures were all reported negative. Radiographic examination of the thumb and forearm showed no evidence of osteomyelitis. A 27-year-old Korean female presented with a mass on the lower abdomen. It was a 3 3 4 3 9 cm, soft, pedunculated, red-brownish tumor on a linear, hypertrophic caesarean section surgical scar. It started as a small papule and has been enlarging without any symptoms for 2 years. The lesion was completely excised, and histologic examination showed ill-defined, highly-vascularized tumor containing bland of spindle-shaped or stellate cells and abundant mucinous stroma with sparse inflammatory cell infiltrate. Immunohistochemical staining showed positivity for vimentin, focal positivity for smooth muscle actin and CD34, and negativity for estrogen/progesterone receptor, desmin and S-100. We made a diagnosis of soliatary superficial angiomyxoma on the basis of clinical and histologic features. At the 2-year follow-up, there was no evidence of recurrence. Solitary superficial angiomyxoma is a benign myxoid tumor in the dermis and subcutaneous tissue. It presents as a slowgrowing, asymtomatic nodule or polyp on the head, neck or trunk of adults, with an average diameter of 30 to 40 mm. It is very similar to myxomas described in Carney complex, but the latter are usually multiple, present in young adults, and have some preference for the eyelids, ears, and nipples. It consists of bland of spindle-shaped or stellate cells and abundant small blood vessels in a myxoid-appearing background. Immunohistochemically, stromal cells are positive for vimentin and variably positive for factor XIIIa, CD34, and actin, but negative for S-100 and desmin. The origin of solitary superficial angiomyxoma is still up for debate; it may result from localized neoplastic transformation of a genetically determined, abnormal population of mesenchymal cells, and differentiation of primitive fibroblast-like cells in response to a variety if cytokines (eg, transforming growth factor-b and interferon-g) and extracellular matrix components (eg, heparin). In this report, we present the first case of solitary superficial angiomyxoma that arose from a hypertrophic caesarean section surgical scar. Hypertrophic scar is composed of a dermal fibroblastic prolieration, which is associated with transforming growth factor-b and other factors. We think that it may be a result of different response of fibroblast to cytokines or extracellular matrix components during hypertrophic scar formation and give a clue about the origin of solitary superficial angiomyxoma. Commercial support: None identified. Commercial support: None identified. Case 1: A 67-year-old male from New Jersey was referred to us with a left periorbital enlarging growth for 1 year. At the time of presentation, he had already undergone three separate biopsies, all revealing a pathologic diagnosis consistent with an inflamed verruca vulgaris. He denied any cough, shortness of breath, urinary symptoms, or new joint pain. Travel history to Mississippi for the last 3 years was elicited. Physical examination was remarkable for a 3- 3 2-cm well demarcated, arcuate-shaped, verrucous plaque with extensive brown to black crusting on his left medial canthus; a similar 1.5-cm plaque was noted on his abdomen. Histologic examination of two additional biopsies revealed an irregular epidermal hyperplasia with a mixed inflammatory infiltrate; despite extensive Giemsa, Gomori methenamine silver, periodic acideSchiff, Fite, and acid-fast bacilli staining, no organisms were identified. Bacterial and fungal cultures were negative. A chest radiograph was negative. AB54 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:44 am P1162 P1164 Reactive angioendotheliomatosis in a patient with myelodysplastic syndrome Irene Salgüero, MD, Hospital Ramón y Cajal, Madrid, Spain; Ingrid Aguayo, MD, Hospital Ramón y Cajal, Madrid, Spain; Pedro Jaen, MD, Hospital Ramón y Cajal, Madrid, Spain; Rosario Carrillo, MD, Hospital Ramón y Cajal, Madrid, Spain Adalimumab-induced cutaneous lupus Emma Craythorne, PhD, Kings College Hospital, London, United Kingdom; Michele Clements, MD, MBChB, Orpington Hospital, Kent, United Kingdom All tumor necrosis factorealfa antagonists have been associated with the development of lupus autoantibodies; this has been seen much less commonly with the fully human monoclonal antibody, adalimumab. We report a 75-year-old female with a 25-year history of seropositive rheumatoid arthritis who developed a cutaneous lupus erythematosus after starting adalimumab. She had previously not tolerated hydroxychloroquine, methotrexate, gold, penicillamine, or infliximab. Her arthritis improved considerably on treatment with 40 mg subcutaneous injection each fortnight. Several days after the fourth injection she developed a pruritic annular erythematous tumid rash across the chest and upper back, this continued to progress and was worse after each infusion. She had no systemic symptoms. A skin biopsy showed an interface dermatitis with dense perivascular lymphohistiocytic infiltrate and occasional apoptopic cells. A diagnosis of cutaneous lupus erythematosus was made. Direct immunofluorescence of lesional and uninvolvedskin were both negative. Antinuclear antibody, having previously been normal was now 1:160 and ds-DNA was positive. The association of lupus-like syndromes with tumor necrosis factorealfa antagonists is uncertain. Adalimumab induces apoptosis prompting the release of nuclear antigens. The engagement of rheumatoid factorexpressing B cells and Toll-like receptor-9 with these agents results in antibody formation. This case highlights the importance for consideration for all patients who begin antietumor necrosis factor therapy and the need for pretreatment serologic evaluation for ds-DNA and antinuclear antibodies. Inroduction: Reactive angioendotheliomatosis (RAE) is a rare condition characterized by cutaneous vascular proliferation that usually occurs in patients with diverse types of coexistent systemic disease. We describe a case of RAE presenting as a plaque on right forearm in a patient with myelodysplastic syndrome (MDS). To our knowledge, only one case of RAE associated with MSD has previously been reported in literature. Case report: An 80-year-old male was diagnosed by a hematologist with MDS 2 years earlier and was treated with transfusion therapy. The patient presented with a 2-month old, slow-growing asymptomatic violaceous plaque on his right forearm that was diagnosed as cellulitis but that failed to respond to antibiotics (piperazilin/tazobactam 4.5 g/8 hrs during 2 wks). Physical examination revealed a large violaceous purpuric plaque involving the entire circumference of the forearm until mid phalanx of his right hand. Cutaneous biopsy showed an intravascular proliferation of endothelial cells with fibrin thrombi in some vessels. A CD31 stain demonstrated the endothelial origin of this proliferation, confirming the diagnosis of RAE. Systemic steroids (metilprednisolone 40 mg/d during 2 mos) were administered to the patient, with notable improvement of lesions within 3 months. Discussion: RAE is a rare disorder characterized by reactive cutaneous vascular proliferation that is often associated with systemic disease. Our case supports the association between RAE and hematological disorders, specifically MDS. Clinically, several presentations have been described, being RAE an entity with a low clinical index of suspicion that is usually diagnosed through histologic findings. Our patient presented with a cellulitis-like plaque, but a histologic examination revealed characteristics of RAE. Therefore, RAE should be ruled out in cellulitis-like plaques not responding to antibiotics, especially in patients with systemic diseases such as hematologic disorders. Commercial support: None identified. Commercial support: None identified. P1163 Economic impact in the management of dermatologic adverse drug reactions induced by the epidermal growth factor receptor inhibitor (EGFRI) erlotinib Tara S. Abraham, PA, MD, Loyola University Chicago Stritch School of Medicine, Maywood, IL, United States; Alfred Rademaker, PhD, Northwestern University Department of Preventive Medicine, Chicago, IL, United States; Dennis P. West, PhD, Northwestern University Department of Dermatology, Chicago, IL, United States; Mario E. Lacouture, MD, Northwestern University Department of Dermatology, Chicago, IL, United States; Sara Ortiz, Northwestern University Department of Dermatology, Chicago, IL, United States Background: Dermatologic adverse drug reactions (DADRs), including rash, paronychia, xerosis, pruritus, and alopecia, are reported to occur in up to 75% of patients treated with the epidermal growth factor receptor inhibitor (EGFRI) erlotinib. In addition to the impact on psychosocial and physical health, there are also significant financial implications. This study seeks to evaluate selected tangible resource costs associated with the management of cutaneous side effects caused by EGFRIs in patients referred to a dermatology-based program for the management of DADRs in oncology (the Skin and Eye Reactions to Inhibitors of EGFR and kinaseS [SERIES] clinic). Methods: Medical records for a randomly selected cohort of 10 SERIES patients treated with erlotinib between November 2005 and December 2007 were identified. Unit costs for each resource were obtained from the Red Book for pharmaceuticals and Medicare Physician Fee Schedule for outpatient services. Mean total cost for treatment (including medication orders and administration-related costs) were computed based on average wholesale drug price and procedure code, respectively. Costs were also evaluated separately for drug treatment, clinic visits, and other services, such as laboratory tests and biopsies. P1165 Conclusions: This study substantiates that there is a considerable financial impact to the management of EGFRI-induced DADRs. Interventions that prophylactically address such frequently occurring dermatologic toxicities may be essential to affect outcomes that may lead to a reduction of DADR treatmenterelated costs. Etanercept and parasitic infections: A case report and review of the literature Graciela De Jesus, SUNY Downstate Medical Center, Brooklyn, NY, United States; Eve Lowenstein, MD, PhD, SUNY Downstate Medical Center, Brooklyn, NY, United States Etanercept use is associated with an increased rate and severity of bacterial infections, including tuberculosis. Little is known about the role played by etanercept and other biologics in parasitic infections. We describe a case of a Bangladeshi male on long-term treatment with etanercept who complains of abdominal pain. His work-up culminated in the identification of infection with gastric Helicobacter pylori and intestinal Trichuris trichiuria. The infection with Trichuris, unusual in a healthy adult male, was likely acquired while visiting his native Bangladesh in 2004. We review the mechanistic role played by tumor necrosis factor in the host’s defense against parasitic nfections. We describe previous reports of parasitic infections in patients receiving biologic therapy. While clearly rare, given the lower penetrance of the biologic market in third world countries where parasitism is more common, the exact risk of acquiring such infections remains unclear. Commercial support: None identified. Commercial support: None identified. Results: All patients developed EGFRI-associated rash. Additional DADRs included paronychia (40% of patients), xerosis (80%), pruritus (50%), and alopecia (10%). Mean cost per medication order for toxicities were as follows: rash $124 (n ¼ 84 medication orders), paronychia $116 (n ¼ 6), xerosis $49 (n ¼ 20), pruritus $105 (n ¼ 12), and alopecia $29 (n ¼ 4). On average, patients received a mean of 13 medication orders (range, 4-39) and five clinic visits over a treatment duration of 39 weeks. This imposed a mean treatment cost of $1347. A mean of six administrationrelated services (clinic visits, lab tests, and biopsies) per patient (range, 1-17) accounted for a mean cost of $1369 per patient. Mean total cost for DADR treatment (medication orders and administration-related services) was $2716 per patient. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:45 am AB55 P1166 P1168 Diffuse reticulate hyperpigmentation associated with 5-fluorouracil Anna Haemel, MD, University of Wisconsin Hospitals and Clinics, Madison, WI, United States; William Aughenbaugh, MD, University of Wisconsin Department of Dermatology, Madison, WI, United States A 67-year-old female with colon cancer on 5-fluorouracil (5-FU) and leucovorin for 2 weeks was admitted with severe mucositis and dehydration. She had noticed an asymptomatic hyperpigmented eruption on the trunk and extremities beginning the day after the infusion. The physical examination revealed multiple pinpoint brown macules coalescing into linear and net-like patches with mild scaling on the trunk, proximal, and distal extremities and erosive mucositis. Histopathology showed interface dermatitis with incontinent melanin but no evidence of iron deposits or vasculitis. The patient was diagnosed with reticulate hyperpigmentation and mucositis, both related to 5-FU. 5-FU has been associated with several patterns of hyperpigmentation including hyperpigmentation in sun exposed areas, linear hyperpigmentation along veins used for infusion, and hyperpigmentation of the tongue, palmar creases, or nails. Diffuse reticulate hyperpigmentation identical to that seen in this patient has also been reported following chemotherapy and is felt to be very rare. Proposed mechanisms include effects on melanocyte activity versus direct skin toxicity with melanin incontinence, as observed microscopically for this case. This patient’s skin findings began to disappear several days after the initial assessment. If the eruption is asymptomatic, no specific treatment is needed. It may be necessary to avoid further exposure to the inciting agent, but recurrence does not always occur. Differences in clinical features and risk factors for striae distensae in African American and white women Nada Elbuluk, University of Michigan School of Medicine, Ann Arbor, MI, United States; Sewon Kang, MD, University of Michigan Department of Dermatology, Ann Arbor, MI, United States; Ted Hamilton, MS, University of Michigan Department of Dermatology, Ann Arbor, MI, United States Commercial support: None identified. Introduction: Striae distensae are a common, disfiguring condition occurring from pregnancy, obesity, growth spurts, and several pathologic conditions. Striae are often described as having similar characteristics across populations; however, few studies to date have examined whether there are racial differences regarding striae. This study compares clinical features of striae and their risk factors in the white and African American population. Methods: The study was conducted in women 35 to 70 years of age in southeast Michigan. The study was performed in two parts. Women were first contacted by phone and administered a survey, following which they were invited to come to the dermatology clinic at the University of Michigan to have their striae clinically evaluated and photographed. Forty-eight women, 24 African American and 24 white, completed both parts of the study. Results: The African American and white women in this study were similar in age (black ¼ 55.4 yrs, white ¼ 54.0 years), length of time for having striae (black ¼ 30.8 yrs, white ¼ 28.8 yrs), number of pregnancies (black¼ 2.3, white ¼ 2.5), and average weight gained with pregnancies (black ¼ 32.1 lbs, white¼32.1 lbs). African American women on average had a higher number of striae than white women (99 vs 69; P ¼ .08). The African American women in the study also had a significantly higher body mass index than the white women (33.7 vs 29.3; P ¼ .03). African American women were over two times more likely to have tried using topical creams or medications on their striae than white women (46% vs 21%; P ¼.06). In addition, white smokers had more than twice the number of striae on average than white nonsmokers (77.4 vs 37.4; P ¼.17). This association with smoking was not seen in the African American population (P ¼ .63). Conclusions: Our results show that African American women tend to have a higher body mass index and number of striae than whites. In addition, the differential effect of smoking on striae development between the study groups suggests that there are likely other relevant factors at play. This preliminary study reveals important racial differences in striae among the African American and white population. It also demonstrates the important contribution that race can make in improving our knowledge of this poorly understood condition. Commercial support: None identified. P1167 Efficacy and safety of up to 10 years of etanercept therapy in North American patients with early and long-standing rheumatoid arthritis Michael Weinblatt, MD, Brigham & Women’s Hospital, Boston, MA, United States; Joan Bathon, MD, Johns Hopkins University, Baltimore, MD, United States; Joel Kremer, MD, The Center for Rheumatology, Albany, NY, United States; Mark Genovese, MD, Stanford University Med Center, Palo Alto, CA, United States Purpose: To assess the long-term efficacy and safety of etanercept (ETN) therapy in adult patients with early rheumatoid arthritis (ERA, duration \3 yrs) or longstanding RA (LRA) whose disease failed to respond to one or more disease-modifying antirheumatic drugs. Methods: RA patients who participated in clinical trials of ETN were eligible to enroll in open-label extension studies. Efficacy endpoints were analyzed in patients who received ETN 25 mg BIW in ERA studies (N ¼ 207) and in LRA studies (N ¼ 644), based on a completer’s analysis. Safety and persistence data were analyzed for all patients who received ETN (ERA, N ¼ 558; LRA, N ¼ 714) for up to 10 years. Standardized incidence ratios (SIRs) were calculated using general population data (SEER). Results: Total ETN exposure was 3207 patient years for ERA patients and 4021 patient years for LRA patients. ETN therapy resulted in significant improvements in measures of disease activity that were sustained over time. Using a completer’s analysis, at 9 years, 70%, 51%, and 37% of ERA patients were ACR 20, 50, and 70 responders, and 75%, 49%, and 27% of LRA patients were ACR 20, 50, and 70 responders, respectively. A limitation of a completer’s analysis is that the patient population has the potential over time to become enriched with patients who are responders. Currently, 249 (45%) ERA patients and 273 (38%) LRA patients continue to receive ETN in these studies. The most common reasons patients discontinued ETN were adverse events (ERA 13%, LRA 14%) or lack of efficacy (ERA 8%, LRA 13%). Over time, the rates of serious adverse events and serious infections in patients receiving ETN have remained consistent with the original placebo groups. Few (2 ERA; 4 LRA) opportunistic infections were reported. The most common OI was herpes zoster (4 cases). No cases of tuberculosis were reported. Five deaths were the result of sepsis. Reported malignancies remained low (SIR [95% CI] ¼ 1.02 [0.791.29]). Overall rates of lymphoma were higher than expected in the general population (SIR [95% CI] ¼ 5.16 [2.66-9.01]). Forty-six deaths were observed while 84 were expected. Conclusions: These data show the durability of response of ETN, with improvement being maintained for the longest timepoints available for each dataset. The safety analyses reveal no new safety signal with continuous ETN use up to 10 years. Lymphoma rates were higher than expected (SEER); however, it is unknown if this finding is related to ETN or the elevated risk of lymphoma inherent in patients with RA. Commercial support: 100% sponsored by Immunex Corporation, a wholly owned subsidiary of Amgen Inc., and by Wyeth Pharmaceuticals. AB56 P1169 Erythema elevatum diutinum in a patient with glucose-6-phosphate dehydrogenase deficiency and immunoglobulin A monoclonal gammopathy Jennifer Lang, Scott & White, Temple, TX, United States; Katherine Fiala, MD, Scott & White, Temple, TX, United States Erythema elevatum diutinum (EED) is a rare, chronic dermatosis with fewer than 100 cases reported in the literature. Clinically, symmetric, violaceous to red-brown papules, plaques, or nodules located primarily over extensor surfaces are observed. EED has been described in association with a number of systemic disorders including infectious diseases, autoimmune diseases, and hematologic disorders. Histopathologically, EED appears to be a type of leukocytoclastic vasculitis. Dapsone may be considered the treatment of choice. Other treatment options that have been described include niacinamide, chloroquine, colchicine, cyclophosphamide, plasmapheresis, and intralesional corticosteroids. We present a case of a 60-year-old African American male with a history of recurrent nodules involving his hands, elbows, knees, and feet for at least 20 years before his presentation to the dermatology clinic. The patient’s medical history included hypertension and a history of arthritis with a left knee replacement. Physical examination revealed large, firm, red-brown nodules involving the fingers, palms, left elbow, toes, and the plantar surfaces of his feet. Before his presentation to the dermatology clinic, the patient periodically had some of the more symptomatic, painful nodules excised by plastic surgery. Histopathologically, past excisions had revealed sclerotic nodules with patchy diffuse neutrophilic infiltration and a few microabscesses, thought to be most consistent with late stage erythema elevatum diutinum. Further work-up at the dermatology clinic demonstrated an immunoglobulin A (IgA) monoclonal gammopathy at 645 mg/dL (normal, 79-347 mg/dL). Hematology was consulted and felt that this was a low level IgA monoclonal gammopathy of undetermined significance. Hematology did not believe that treatment of the patient’s IgA monoclonal gammopathy would alter his EED. Antinuclear antibody, rheumatoid factor, hepatitis B virus, and HIV were all negative. The patient’s glucose-6-phosphate dehydrogenase level was deficient at 1.30 U/g^Hb (normal, 8.6-18.6 U/g^Hb), and therefore, dapsone was not an appropriate treatment option. Alternative treatments were discussed with the patient, and he is currently considering his options. Commercial support: None identified. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:45 am P1170 P1172 A case of cytophagic histiocytic panniculitis June Kim, MD, University of New Mexico Department of Dermatology, Albuquerque, NM, United States; Barrett Zlotoff, MD, University of New Mexico Department of Dermatology, Albuquerque, NM, United States; Ran Bang, MD, University of New Mexico Department of Dermatology, Albuquerque, NM, United States Coexistence of Langerhans cell histiocytosis, cutaneous RosaieDorfman disease, and splenic lymphoma Inmaculada Domı́nguez, MD, Hospital Universitario de La Princesa, Madrid, Spain; Amaro Garcı́a-Diez, MD, PhD, Hospital Universitario de La Princesa, Madrid, Spain; Diana Santiago, MD, Hospital Universitario de La Princesa, Madrid, Spain; Javier Fraga, MD, PhD, Hospital Universitario de La Princesa, Madrid, Spain; Rebeca Goiriz, MD, Hospital Universitario de La Princesa, Madrid, Spain Introduction: The coexistence of Langerhans cell histiocytosis (LCH) and RosaieDorfman disease (RDD) is an exceptional finding. The association of lymphomas and histiocytosis is also infrequent. We herein report the case of a patient who presented with LCH and cutaneous RDD lesions and in whom a splenic lymphoma was found upon extracutaneous evaluation. Case report: A 68-year-old male presented with a 3-year history of erosive lesions on palate, bilateral ocular reddening, and cutaneous lesions, which on physical examination were of two different morphologies. Most of them were widespread small erythematous scaly papules involving the face, limbs, and trunk. Histologic examination of these revealed LCH. Intermingled between the main lesions were some red-yellowish papulotuberous lesions on the neck, lower part of the abdomen, and one on the right thigh. The latter was removed, showing a cutaneous RDD with a nodular focus of LCH. Bone marrow and peripheral blood tests showed a B cell CD191 subpopulation with immunophenotype compatible with a non-Hodgkin lymphoma of marginal zone. A total body computed tomographic scan revealed a 14-cm splenomegaly. These findings were consistent with splenic marginal zone lymphoma. In the following months, an important spontaneous improvement of the LCH lesions was observed with an increased number of the cutaneous RDD lesions. The splenic marginal zone lymphoma has been followed by our hematology department without further treatment. A 23-year-old white woman presented with a 2-year history of multiple, recurrent, tender, erythematous, subcutaneous nodules with overlying ecchymoses involving the bilateral lower extremities. The patient had no pertinent medical history and was on no medications. She also denied fevers, abdominal pain, or recent weight loss. Physical examination revealed no lymphadenopathy or hepatosplenomegaly. An incisional biopsy of her right buttock revealed lobular panniculitis composed of T cells without atypia and CD681, phagocytic, foamy histiocytes—so-called ‘‘beanbag cells.’’ Necrosis was not a significant feature. Immunologic studies confirmed positivity for T cell markers (CD31, CD20e), and analysis of T-cell receptor gene rearrangement did not reveal a clonal T cell population. The patient was given a diagnosis of cytophagic histiocytic panniculitis. Further work-up showed no evidence of hemophagocytic syndrome—no pancytopenia, bleeding diathesis, or elevated liver enzymes. The patient was recently started on dapsone, and she will be followed closely to monitor for response to therapy and evidence of progression. Cytophagic histiocytic panniculitis (CHP) is an evolving diagnosis that may be part of a clinicopathologic spectrum of disease, which includes subcutaneous panniculitis-like T-cell lymphoma (SPTL). This condition may initially take an indolent chronic course, or it may rapidly progress into a terminal hemophagocytic syndrome. Histologicly, CHP is characterized by a lobular panniculitis of mature benign lymphocytes and evidence of cytophagocytosis. Although the cause of CHP is unknown, cytokines including tumor necrosis factorealfa, interferon-g, and interleukin-2 have been implicated. Latent EpsteineBarr virus infections have also been associated with both CHP and SPTL. Treatments for CHP have included systemic steroids, cyclosporine, and dapsone. For more aggressive disease, cyclophosphamide, azathioprine, and CHOP regimen chemotherapy have been reported with variable success. We present a rare case of cytophagic histiocytic panniculitis with an indolent course, and review the current literature. Commercial support: None identified. Discussion: We report an exceptional association of LCH, cutaneous RDD, and splenic marginal zone lymphoma. To the best of our knowledge, there are only three cases published describing the association between RDD and LCH. Two of them were patients with cutaneous RDD with small focus of LCH in the same specimen. The other case was a patient with multiple lymphadenopathies but without cutaneous lesions. Our patient had an unusual presentation with two different clinical types of lesions with different histologic findings and different evolutions of each type. Furthermore, in the systemic evaluation, an indolent splenic marginal zone lymphoma was incidentally found. It is possible that the histiocytosis was a reactive process to the previous neoplasm. Commercial support: None identified. P1173 Caterpillar accident Mariane Périssé, Rio De Janeiro State Federal University-Unirio-Hugg, Rio de Janeiro, Brazil; Amanda Wieser, MD, Rio De Janeiro State Federal UniversityUnirio-Hugg, Rio de Janeiro, Brazil; Marcelo Guimar~aes, MD, Rio De Janeiro State Federal University-Unirio-Hugg, Rio de Janeiro, Brazil; Omar Lupi, PhD, Rio De Janeiro State Federal University-Unirio-Hugg, Rio de Janeiro, Brazil Background: Erucism is the term used to refer to the adverse reactions resulting from contact with the adult and larval forms of lepidopters (butterflies and moths). The initial symptoms include urticaria and immediate pain that resembles the reaction to an insect bite along with the subsequent sting, itching, and burning, which can vary in intensity and may radiate. Depending on the individual sensitivity, the pain can last up to 36 hours, and may be disproportional to the cutaneous manifestations. Later symptoms include erythema, edema, papules, vesicles, erosions, petechias, lymphangitis, and local necrosis with regional lymph node infarction. Systemic manifestations are occasionally observed. In rare occasions, the patient may develop arrhythmia, dyspnea, and shock. Dermatologic manifestations appear immediately in most cases, but can also be delayed for hours or days, depending on the species. Stony Brook University Hospital is the only tertiary medical center in Suffolk County, NY. Throughout the year, during our clinical conferences and Grand Rounds, fascinating patients are presented for diagnosis and/or treatment. Both esoteric cases and atypical presentations of common conditions are sent to our Department of Dermatology for consultation and interest. We present the best of these cases. Case report: M.C.P. presented with a history of sudden pain 2 months earlier that resembled an insect bite and that soon evolved into a burning sensation in her right elbow, radiating to her armpit. A few hours later, an urticariform lesion appeared on her elbow. She was still experiencing severe pain, which prevented her to move her arm. These manifestations persisted for 24 hours when the urticariform lesion turned into linear papuloerythematous lesions, resembling an aspect of ‘‘train track.’’ The lesions completely disappeared in 4 days. One week later, she reported pruritus at the same location, and the papuloerythematous lesions reappeared, persisting for 3 days. Discussion: The demonstration of the train track sign is important to establish the diagnosis and correct treatment, because it is characteristic of the contact of the skin with the sucker-feet of caterpillars. The follicular lesions around the urtica are caused by the irritating hair or setae of some caterpillars, which are also responsible for the possibility of reactivation of the lesion. Therefore, once the diagnosis is established, the location must be washed thoroughly with cold water and shaved off with a scalpel to remove the caterpillar and prevent recurrence of the lesion. Pain killers, antihistamine drugs, and corticosteroids may be used to control signs and symptoms. Conclusions: Despite the scant literature about this subject, it is important that dermatologists be able to recognize early signs of erucism in order to avoid recurrences and provide effective treatment. Commercial support: None identified. Commercial support: None identified. P1171 A year at Stony Brook University Hospital Peter Klein, Department of Dermatology, East Setauket, NY, United States MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:45 am AB57 P1174 P1176 Aleukemic myeloid leukemia cutis without bone marrow involvement Africa Juárez, Hospital Universitario de La Princesa, Madrid, Spain; Amaro Garcı́aDiez, MD, PhD, Hospital Universitario de La Princesa, Madrid, Spain; Cristina Eguren, MD, Hospital Universitario de La Princesa, Madrid, Spain; Javier Fraga, MD, PhD, Hospital Universitario de La Princesa, Madrid, Spain; Maximiliano Aragüés, MD, Hospital Universitario de La Princesa, Madrid, Spain Plasma cell vulvitis: Two further cases Emma Benton, MD, King’s College Hospital, London, United Kingdom; Elisabeth Higgins, MBBS, King’s College Hospital, London, United Kingdom; John Salisbury, MD, MBBS, King’s College Hospital, London, United Kingdom Plasma cell vulvitis (PCV) is a condition that can be difficult to diagnose because of its rarity. It is often refractory to treatment. We report two additional cases. Patient 1 was a 63-year-old female with stress urinary incontinence and pelvic prolapse presented with a several year history of persistent vulval pain and erythema. On examination, she had livid hemorrhagic punched out erosions with an orange hue over the left medial aspect of the labia minora and a hyperkeratotic plaque over the right labia minora. A biopsy revealed prominent lymphoplasmacytic infiltrate of the subepithelial tissue with reactive changes in the overlying squamous epithelium consistent with PCV. Potent topical steroids led to the complete resolution of symptoms and signs. Patient 2 was a 47-year-old female was noted to have significant vulval changes at a routine smear. On further questioning she reported a 6-month history of intermittent introital dyspareunia and pruritus. Examination revealed several hemorrhagic areas at the introitus. A biopsy revealed a chronic inflammatory infiltrate in the epidermis consisting predominantly of plasma cells. Features in keeping with PCV were also found. Zoon first described this rare, chronic condition of the vulva in 1955. It has 3 synonyms: PCV, Zoon vulvitis, and vulvitis circumscripta plasmacellularis. It most commonly presents with vulvar pain, burning, pruritus, and dysuria. Clinically, the appearance can be very typical with well demarcated glistening erythematous plaques and patches with an orange hue. Histologicly, PCV is characterized by a lichenoid infiltrate composed of plasma cells and lymphocytes. In addition, ‘‘diamond-shaped’’ keratinocytes, mild spongiosis, vascular dilatation, and red cell extravasation with hemosiderin deposition may be seen. There have been several reported treatment options with limited success, namely topical, intralesional, and systemic corticosteroids, oestrogens, antifungal agents, cryotherapy, interferon alfa, and surgical resection. The etiology of PCV remains unclear. Several hypotheses include viral, hormonal, autoimmune, and traumatic causes. PCV should be considered in patients presenting with chronic vulval symptoms and erythematous lesions. Background: The term ‘‘aleukemic leukemia cutis’’ describes the infiltration of malignant hematopoietic cells into the skin in the absence of peripheral blood (PB) involvement. This condition is not frequent, and the occurrence of this fact preceding bone marrow (BM) involvement is extremely rare. Case report: A 54-year-old male presented with a 3-month history of an asymptomatic nodule on his face. The clinical examination revealed an indurated erythematous nodule on the right cheek (15 mm) and another two similar nodules distributed on both arms. The skin biopsy documented a dense infiltrate in the dermis with extension to the subcutis with sparing of the upper papillary dermis composed predominantly of medium blast-like cells, with perivascular and periadnexal accentuation, and some distributed between collagen bundles. Immunohistochemical analysis revealed positive staining with myeloperoxidase and muramidase, but were negative for TdT and CD3. Fluorescence in situ hybridization (FISH) analysis confirmed the absence of trisomy 8 and failed to identify in the skin mixed lineage leukemia (MLL) gene rearrangement. No leukemic cells were detected in the PB. BM biopsy was negative for blast infiltration, and investigation by FISH and molecular biologic techniques did not disclose cytogenetic abnormalities. A diagnosis of aleukemic myeloblastic leukemia cutis was made. The patient was treated with systemic and intrathecal chemotherapy with resolution of skin lesions. Eleven months after the diagnosis, the patient presented diplopia and a lumbar puncture was performed and revealed a massive infiltration of blasts. FISH detected the MML gene rearrangement in the cerebrospinal fluid. The patient underwent systemic and intrathecal chemotherapy and he received allogeneic blood stem cell transplantation. Fifteen months after the diagnosis, he remains without PB or BM involvement. Discussion: The onset of specific skin infiltrates in leukemia is generally considered a severe prognostic sign and correlates with a rapid progression and short survival. The interval between the time of diagnosis and the time to progression to systemic involvement is 10.5 months, and the majority of the patients die within 2 years. The MML gene rearrangement also has been associated with poor prognosis in patients with acute myeloid leukemia. Instead of the absence of PB or BM involvement, these types of leukemia must be treated with intensive chemotherapy with or without radiotherapy. Commercial support: None identified. Commercial support: None identified. P1175 Granulomatous cheilitis successfully treated with intralesional corticosteroids Lucı́a Pérez-Carmona, Ramón y Cajal Hospital, Madrid, Spain; Carmen Moreno, Ramon y Cajal Hospital, Madrid, Spain; José Maria Arrazola, Ramon y Cajal Hospital, Madrid, Spain; Sergio Vaño-Galvan, Ramon y Cajal Hospital, Madrid, Spain Introduction: Granulomatous cheilitis (GC), described by Meischer in 1945, is defined as painless chronic isolated enlargement of one or both lips caused by granulomatous inflammation with a recurrent to gradually persistent course. This is the most frequent monosymptomatic form of MelkerssoneRosenthal syndrome, which is a rare disease characterized by the classical triad of recurrent swelling of the lips and/or face, fissured tongue (lingua plicata), and relapsing peripheral facial nerve paralysis. We present a case of granulomatous cheilitis successfully treated with intralesional corticosteroids. Case report: A 44-year-old male presented with a 3-year history of asymptomatic swelling of the lower lip. The swelling was initially intermittent but became progressive and persistent. He did not report paralysis facial episodes or a fissured tongue. A punch biopsy specimen of the buccal mucosa showed focal noncaseating epithelioid cell granulomas with lymphocytes and plasma cells. The diagnosis was granulomatous cheilitis. The blood analysis was normal and the findings of colonoscopy were unremarkable. We started treatment with a monthly injection of intralesional triamcinolone with reduction of macrocheilia after two treatment sessions. Discussion: Granulomatous cheilitis is characterized by a chronic relapsing, remitting course of painless swelling of one or both lips. After recurrent attacks, the swelling may persist and increase. The resultant cosmetic deformity can have a significant psychological impact on patients. The origin of this disease is obscure and the treatment is difficult. Therapies with steroids, metronidazole, clofazimine, minocycline, and surgical methods had shown variable results. Other treatment options include thalidomide, sulfasalazine, erythromycin, azathioprine, and cyclosporine. Treatment with intralesional triamcinolone was successful in our patient. Commercial support: None identified. AB58 P1177 Norwegian scabies in a patient with Down syndrome Yasser Ghafir, private practice, Damascus, Syria Crusted (formerly called Norwegian) scabies is a severe infestation with the mite Sarcoptes scabiei var hominis. This type of scabies occurs most often in immunocompromised patients, such as HIV patients, elderly patients, or those with nutritional or mental deficiencies. Down syndrome is a frequent association. The reason for this association with mental abnormality is not completely understood, but the lack of appreciation of pruritus may be important. The occurrence of crusted scabies in an otherwise healthy pregnant woman has been reported. Crusted scabies has also resulted from inappropriate use of potent fluorinated topical steroid. Crusted scabies has a characteristic clinical presentation with multiple widespread, thick, gray, hyperkeratotic crusted plaques and is typically seen in the elderly and HIV patients; it has also been reported in patients with lymphoreticular malignancies. The affection may present atypical lesions and mimic a range of other dermatoses, including psoriasis, seborrheic dermatitis, Darier disease, dermatitis herpetiformis and drug eruptions. Herein a case of crusted scabies in a Mongol healthy patient is discussed. A 25-year-old female patient with a 2-year history of diffuse, pruritic, hyperkeratotic, plaques on her buttock, genitalia, hands, and lower legs. Physical examination revealed diffuse, hyperkeratotic plaques on her hands, feet, and trunk with pruritic eruption in the axilla and thighs. Her fingernails were thickened and hyperkeratotic. A mineral oil preparation revealed numerous mites and scybala, and the diagnosis of crusted scabies was made. The patient and all contacts were treated with permethrin derivatives spray for 12 hours only, which was repeated after 2 weeks with crotamiton cream 10%. Two months later, although improved, persistent nail lesions required additional treatment with permethrin derivatives spray and 10% urea cream. This case illustrates crusted scabies in a Mongol patient before and after treatment. Two months later, the patient come back with nails completely recovered. Commercial support: None identified. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:45 am P1178 P1180 An open-label investigation of naftifine hydrochloric acid cream 1% for cutaneous candidiasis Boni E. Elewski, University of Alabama at Birmingham Department of Dermatology, Birmingham, AL, United States; Raj Varma, MD, University of Alabama at Birmingham, Birmingham, AL, United States; Shellie Marks, MD, University of Alabama at Birmingham, Birmingham, AL, United States; Wendy Cantrell, CNP, University of Alabama at Birmingham, Birmingham, AL, United States Background: Cutaneous candidiasis is a common infection often occurring in intertriginous areas. Risk factors include obesity, diabetes, and warm ambient temperature. Frequently, cutaneous candidiasis occurs in conjunction with an irritant dermatitis (complication of intertrigo), secondary bacterial, or dermatophytic infection (dermatophytosis complex). Naftifine, a topical allylamine, is fungicidal against a broad spectrum of dermatophyte fungi and is also effective against Gram-negative and -positive bacteria. In vitro data for naftifine have shown good activity against Candida spp., but the agent is not currently indicated for this type of infection. Objective: An open-label, monocentered, single-arm pilot study to determine the efficacy and patient satisfaction of naftifine cream as a treatment for cutaneous candidiasis. Methods: Fourteen subjects diagnosed with cutaneous candidiasis were instructed to apply naftifine cream to affected areas twice daily (labeled dosage is once-daily) for a total of 4 weeks with a 2-week follow-up. Assessments measuring maceration, scaling, erythema (using a 0-3 scale), and the clinical presence of Candida were performed at baseline and weeks 2, 4, and 6. Photographs were performed at those same time points. Cultures were performed at baseline and weeks 2 and 4. At week 4, a questionnaire was given to patients to assess their satisfaction with the treatment and relief of pruritus (using a 0-3 scale). Results: Naftifine cream twice daily for 4 weeks led to significant improvement in target area lesion assessments measuring maceration, scaling, and erythema. Erythema scores improved from 2.43 6 0.51 at baseline to 1.64 6 0.63 at week 4 (P \.001). Scaling scores improved from 1.07 6 0.92 at baseline to 0.5 6 0.76 at week 4 (P \.0402). Maceration scores improved from 1.64 6 0.84 at baseline to 0.64 6 0.93 at week 4 (P\.0019). Based upon the investigator’s assessment, clinical resolution of infection occurred in 9 out of 14 (64%) patients. Itching improved in all patients and resolved completely in six (43%) patients. Twelve out of 14 patients indicated satisfaction with the study medication. Conclusion: Although naftifine is traditionally considered a potent antidermatophyte drug, our data confirm its utility in cutaneous candidiasis based on symptom improvement and good patient tolerability. Innovative treatment options for pityriasis versicolor Boni E. Elewski, PhD, University of Alabama at Birmingham Department of Dermatology, Birmingham, AL, United States; Shelley Cathcart, MD, University of Alabama at Birmingham, Birmingham, AL, United States; Shellie Marks, MD, University of Alabama at Birmingham, Birmingham, AL, United States; Wendy Cantrell, CNP, University of Alabama at Birmingham, Birmingham, AL, United States Pityriasis versicolor (PV) is a common chronic superficial fungal infection caused by Malassezia globosa, M sympodialis, M sloofiae, and M furfur. Lesions appear as discrete and confluent hypopigmented, hyperpigmented, or salmon-colored patches with fine scale on the upper trunk and proximal arms. Diagnosis depends on demonstration of small yeast cells and short, stubby hyphae in potassium hydroxide mounts of skin scrapings. Although many conventional therapies have been successful in treating PV, improvements could be made upon the cosmetic appeal and ease of use associated with these therapies. We review the newer PV pathogens and the topical, oral, and preventive treatment options. The lipophilic yeasts of the genus Malassezia have recently become a focus of attention. Although M fufur was believed for decades to be the causative agent in PV, multiple studies have shown that M globosa is the most common isolated species either alone or in combination with M sympodialis, M furfur, or M slooffiae. Ketoconazole has the best MIC of all antifungals against Malassezia spp., but its use is hampered by the messy cream formula. A new 2% ketoconazole foam that was shown to be equivalent to ketoconazole cream has been approved for the topical treatment of seborrheic dermatitis, but may be useful for patients with PV. The foam vehicle improves absorption, adherence, and drug distribution and is easy to use and can be applied on wet or dry skin and on hairy and nonhairy areas. Additional topical antifungals in the azole family, such as clotrimazole or miconazole, are also effective. Terbinafine, an allylamine with fungicidal activity against dermatophytes, is less effective against yeasts such as Malassezia. Other topical therapies include 2.5% selenium sulfide shampoo, 2% zinc pyrithione shampoo, 40% to 60% propylene glycol in water solution, and ciclopiroxamine cream 1%, gel, or shampoo. Although there are no oral agents for PV approved by the US Food and Drug Administration, systemic therapy with ketoconazole, fluconazole, or itraconazole is useful for the treatment of recalcitrant cases or those with extensive involvement. Oral terbinafine and griseofulvin are not effective treatments. PV has a high tendency to recur after being treated successfully. Oral ketoconazole and itraconazole alone and in combination with topical therapies have a significant prophylactic effect. Regardless of treatment type, follow-up after treatment is essential to allow accurate assessment of clinical response. Commercial support: None identified. Commercial support: Sponsored by an unrestricted educational grant provided by Merz Pharmaceuticals. P1181 P1179 Bowel-associated dermatosis-arthritis syndrome: A case report Abba Alkali, MBBCh, Department Of Dermatology, Broadgreen Hospital, Liverpool, Merseyside, United Kingdom; Clodagh King, MD, Department Of Dermatology, Broadgreen Hospital, Liverpool, Merseyside, United Kingdom; Niamh Leonard, MD, Department Of Histopathology, Royal Liverpool Hospital, Liverpool, Merseyside, United Kingdom Superficial acral fibromyxoma: A case report Francisca Regina Oliveira Carneiro, MD, PhD, University of State of Pará, Belem, Brazil; Alena Margareth Darwich Mendes, MD, University of State of Pará, Belem, Brazil; Caroline Martins Brand~ao, University of State of Pará, Belem, Brazil; Maria Amélia Lopes Dos Santos, University of State of Pará, Belem, Brazil; Mario Fernando Ribeiro De Miranda, Federal University of Pará, Belem, Brazil Discussion: It is important to distinguish BADAS from Behçet disease (BD) because both may include oral aphthosis and lesions of pustular vasculitis. Histopathology does not differentiate BADAS from BD or early lesions of either pyoderma gangrenosum or Sweet syndrome. In order to definitively diagnose BADAS, an evaluation of the bowel including barium studies and endoscopy should follow a thorough history and physical examination. Treatment of BADAS depends on the etiology. Surgical correction of bowel anatomy often eliminates signs and symptoms following bowel bypass surgery. In other cases, symptoms of BADAS may be effectively controlled with systemic steroids, tetracycline, metronidazole, or erythromycin. In difficult cases, colchicine, dapsone, and thalidomide have been used. Introduction: Superficial acral fibromyxoma (SAF) is a rare soft tissue tumor first recognized as a distinct histopathologic entity in 2001 by Fetsch et al when they described the clinicopathologic features and immunohistochemical findings identified in 37 cases of this neoplasm. SAF occurs most frequent in male middle-aged patients. Clinically, SAF is characterized as a slow-growing painless rounded tumor localized on toes and fingers, especially in the nail areaa. Palms and soles are rarely compromised. On histologic examination, the lesion is a moderately cellular neoplasm composed of spindle- and stellate-shaped fibroblast-like cells embedded in myxoid, myxocollagenous, or collagenous matrix. Immunoreactivity for CD34, EMA, and C99 can be observed with no reactivity for actin, desmin, cytokeratin, and HMB45. The differential diagnosis includes other myxoid neoplasms with a predilection of distal extremities like fibrous histiocytoma, myxoid dermatofibrosarcoma protuberans, superficial angiomyxoma, acquired digital, fibrokeratoma, sclerosing perineurioma, and others. SAF usually has a benign course, and surgical excision is a successful therapy. Case report: A 54-year-old male presented with a firm, round-shaped tumor on the nail bed of left big toe. The lesion had been slowly enlarging for 8 years. No subjective symptoms had been observed. Histologic examination showed a well circumscribed tumor with stellate cells in collagenous and myxoid matrix. A vascular proliferation was observed with a great number of mast cells. No immunoreactivity for CD34, EMA, C99, cytokeratin, and HMB45 was observed. A radiographic exam of the left big toe showed a localized enlargement of soft tissue. A surgical excision was recommended and the patient is now waiting for this intervention. Discussion: The authors related a case with clinicopathologic features of SAF as male predilection, localization on the big toe, a slowly growing course, and histologic aspects like presence of stelalte-shaped cells embedded in a collagenous matrix. No reactivity for a CD34, EMA, C99, cytokeratin, and HMB45 was observed. In summary, it is very important to recognize this entity and determine the difference between this and other myxoid tumors to avoid unnecessary aggressive treatment to a neoplasm with a benign course. Commercial support: None identified. Commercial support: None identified. Background: Bowel-associated dermatosis-arthritis syndrome (BADAS) is a rare neutrophilic dermatosis first described by Shagrin et al in 1971 as pustular vasculitic cutaneous lesions and serum sicknesselike reactions in patients who had undergone jejunoileal bypass surgery for morbid obesity. The definition is now extended to include the same syndrome in patients with inflammatory bowel disease or blind loop following peptic ulcer surgery. We present a patient with this syndrome and highlight the importance of differentiating BADAS from other neutrophilic dermatoses. Observations: We describe a 49-year-old male with a history of Crohn disease who presented with a rash associated with fever, joint pains, sore eyes, abdominal pain, and diarrhea. A physical examination revealed multiple erythematous papulopustules and plaques on his limbs, trunk, head, and neck. Episcleritis, oral apthouselike and genital ulcers were noted. Laboratory tests were unremarkable apart from raised inflammatory markers. A skin biopsy revealed normal epidermis and superficial dermis and a mixed inflammatory cell infiltrate in the subcutaneous fat in lobular distribution. Based on the clinicopathological findings a diagnosis of BADAS was made. The rash rapidly cleared on high dose corticosteroid therapy. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:45 am AB59 P1182 P1184 Funny objects emerging from the skin Cristina Martı́nez-Morán, MD, Dermatology, Hospital Universitario de Fuenlabrada, Madrid, Spain; Carmen Garcia-Donoso, MD, Dermatology, Hospital Universitario de Fuenlabrada, Madrid, Spain; Dolores Arias-Palomo, MD, Dermatology, Hospital Universiterio de Fuenlabrada, Madrid, Spain; Jesús Borbujo, MD, PhD, Dermatology, Hospital Universitario de Fuenlabrada, Madrid, Spain Yellow nail syndrome associated with asthma Priya Sivanesan, MD, MBBS, University of Pittsburgh, Pittsburgh, PA, United States; Joseph English, MD, University of Pittsburgh, Pittsburgh, PA, United States; Pooja Khera, MD, University of Pittsburgh, Pittsburgh, PA, United States A 45-year-old white male presented to the clinic complaining of yellowing of his fingernails and toenails. He reported having the discoloration of his nails for 4 to 5 months. He also reported a 9-month history of asthma. The physical examination was significant for yellow discoloration of the entire nail plate of all fingernails and toenails. There were no cuticles or lunulae on exam. There was no onychodystrophy or lymphedema on exam. Based on the history and clinical evaluation, the patient was diagnosed with yellow nail syndrome. Consideration of underlying malignancy is important, because malignancy has been associated with yellow nail syndrome. Pulmonary disease associated with yellow nail syndrome is usually bronchiectasis or recurrent pleural effusions; however, any pulmonary disease can be present. It is important to identify and diagnose this disorder so that appropriate treatment and evaluation can be initiated, including pulmonary evaluation and evaluation of underlying malignancy. It is a frequent consultation to physician: a foreign body sensation referred for some patients in a variety of anatomic places after suffering a traumatic event, eating some kind of food, and usually after combat injuries in military conflict zones. Depending on where the foreign body sensation is, different doctors are asked for help: otorhinolaryngologists, gynecologists, general surgeons, ophthalmologists, or dermatologists. Sometimes we find nothing in those places; however, strange objects have been removed from the referred areas. Here, we report three male patients that presented with apparently banal cutaneous lesions with a history that made us think of foreign bodies in different body sites. The first patient was a 35-year-old male that presented to us after a traumatic event with a palm thorn on his left leg. After surgical excision, we removed a 2-cm palm thorn. The second patient, an 11-year-old child, presented with a nodule on his left hand and related a traumatic event with a splinter. After surgical excision, a 15-mm splinter was obtained. Our third patient was a 34-year-old male that presented with nodular lesions over a laparotomy scar. A 20-cm long nylon suture was removed with a simple surgical procedure from one of the nodules. Commercial support: None identified. Commercial support: None identified. P1185 P1183 Köebner phenomenon occurring in polymorphic eruption of pregnancy Victoria Brown, MD, Oxford Dermatology Department, Oxford, Oxfordshire, United Kingdom; Aoife Lally, MBChB, Oxford Dermatology Department, Oxford, Oxfordshire, United Kingdom; Susan Burge, MBChB, Oxford Dermatology Department, Oxford, Oxfordshire, United Kingdom Köebner phenomenon refers to the development of isomorphic pathologic lesions in traumatized, previously normal skin. It was first reported by Heinrich Köebner in 1872. Köebner phenomenon has never previously been described in association with any pregnancy dermatosis. A 28-year-old female developed a pruritic rash within 24 hours of delivering her first child. The skin lesions were initially limited to her abdominal striae but quickly spread to the site of a recent burn on her right wrist. She had not had any previous dermatologic problems either before or during her pregnancy, and there was no history of atopy. A physical examination revealed erythema, papules, and vesicles over the abdomen, predominantly within the abdominal striae. Notably, the eruption had also Köebnerized into the burn scar on her right wrist. There was periumbilical sparing. Skin biopsy histology from abdominal skin showed epidermal spongiotic vesicle formation and a dense superficial dermal perivascular lymphocytic and eosinophilic inflammatory infiltrate. Both direct and indirect immunofluorescence was negative, excluding pemphigoid gestationis. The clinical and histologic findings were consistent with a diagnosis of polymorphic eruption of pregnancy (PEP). Our patient was treated with topical corticosteroids and emollients. Her symptoms initially worsened and the eruption progressed to other areas of her trunk and upper and lower limbs. It fully resolved within 2 weeks of onset with no further treatment. This is the first reported case of Köebner phenomenon occurring in a pregnancy dermatosis. It is difficult to explain why this association has developed in our patient, because the pathogenesis of both Köebner phenomenon and PEP are incompletely understood. The most popular theory for Köebner phenomenon is the localization of a circulating microbial antigen or inflammatory mediators to sites of increased vasculature caused by trauma. Increased abdominal distension is a factor in the development of PEP, and it has been postulated that this causes inflammation in abdominal striae. Alternatively, it has been hypothesized that fetal cells may migrate to maternal skin provoking an inflammatory reaction. The development of PEP via Köebner phenomenon on our patients arm lends support to the later hypothesis. Commercial support: None identified. AB60 Cutaneous reactions associated with interferon beta in two patients with multiple sclerosis Nuria Pérez-Robayna, MD, PhD, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain; Antonio Martı́n-Herrera, MD, Hospital Universitario de Canrias, La Laguna, Santa Cruz de Tenerife, Spain; Francisco Guimerá-Martı́n Neda, MD, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain; Rosalba Sánchez-González, MD, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain; Sorahaya GonzálezHernández, PhD, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain Introduction: Multiple sclerosis is a demyelinating chronic disease of the central nervous system that is also the main cause of disability in adults. Since 1993, interferon beta-1b is one of the treatment options of this neurologic disease. We report on two patients with multiple sclerosis who presented with cutaneous lesions at injections sites during treatment with subcutaneous interferon beta-1b. Case 1: Our first patient was a 36-year-old male who suffered from multiple sclerosis who had been taking subcutaneous interferon beta-1b since 2001. He showed cutaneous lesions of 3 weeks’ duration, consisting of several erythematous, hard, painful plaques localized at both arms and thighs, precisely at those areas where he injected interferon beta-1b. Case 2: Our second patient was a 32-year-old female with multiple sclerosis, who had been taking subcutaneous interferon beta-1b since 2003. She showed cutaneous lesions of 10 days’ duration consisting of multiple erythematous and purple hard plaques, badly delimited with aspect of livedo in some areas. The physical examination also revealed some cutaneous ulcerations at injection sites, such as the abdomen and thighs. A skin biopsy was also performed and we could observe lymphoid vasculitis in both cases. Discussion: Skin damage has been reported in association with interferon beta treatment, such as cutaneous necrosis and even panniculitis or vasculitis in some cases. The etiology of these lesions is unknown. Some authors have suggested a vasospastic effect by the interferon beta. Orlow and Friedman-Kien attributed the presence of cutaneous necrosis to the repeated injections at the same site. Finally, we want to highlight that is important to bear this diagnosis in mind in patients with multiple sclerosis and interferon beta. Commercial support: None identified. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:45 am P1186 P1188 Aluminum chloride hexahydrate 15% in a salicylic acid 2% gel: Combination therapy with botulinum toxin A for moderate to severe hyperhidrosis Heather Woolery-Lloyd, Miller/University of Miami School of Medicine, Department of Dermatology and Cutaneous Surgery, Miami Beach, FL, United States Osteoma cutis arising in chronic granulomatous dermatitis Melissa Stenstrom, University of WisconsineMadison, Madison, WI, United States; Erin Vanness, MD, University of WisconsineMadison, Madison, WI, United States; Molly Hinshaw, MD, University of WisconsineMadison, Madison, WI, United States Hyperhidrosis is a common condition that has a tremendous impact on the quality of life of affected patients. For moderate to severe hyperhidrosis, aluminum chloride hexahydrate (AC), iontophoresis, and botulinum toxin A are first-line therapies. Botulinum toxin A has been a useful addition to the hyperhidrosis armamentarium and is typically used when patients have failed topical therapy. Although highly effective for most patients, there remains a subset of patients that do not completely respond to botulinum toxin A injections. For these patients, combination therapy with AC can greatly improve patient response. Topical AC is a well established therapy for hyperhidrosis. The mechanism of action is via aluminum salt blockage of the distal acrosyringium which leads to functional and structural degeneration of the eccrine acini. Most AC solutions are in an anhydrous alcohol vehicle which appears to significantly contribute to irritation. Combination therapy with AC may have been underused in the past because of concerns of irritation. AC in a salicylic acid gel appears to offer improved tolerability without compromising efficacy. We present a series of 10 hyperhidrosis patients with a history of partial response to botulinum toxin monotherapy. These patients achieved good to excellent results with the addition of AC 15% in a salicylic acid 2% gel. Combination therapy with topical AC in a salicylic acid gel should be considered in patients with a less than optimal response to botulinum toxin. In addition, this therapy can be useful in any patient treated with botulinum toxin A for breakthrough sweating at the end of the treatment cycle. AC in a salicylic acid gel offers a novel and effective topical therapy in combination with botulinum toxin A for patients with moderate to severe hyperhidrosis. Osteoma cutis represents the process in which bone is formed within the dermis and subcutaneous tissues. The condition is characterized as primary or secondary based on the absence or presence of preceding lesions. Primary osteoma cutis has been associated with endocrinopathies, including pseudohypoparathyroidism, while secondary osteoma cutis is associated with both inflammatory disorders, most commonly acne vulgaris, and also within cutaneous neoplasms. We report a unique presentation of diffuse osteoma cutis in areas of previous granulomatous dermatitis developing in a patient with elevated parathyroid hormone subsequent to renal transplantation, and include discussions of both primary and secondary etiologies. Commercial support: 100% sponsored by Valeo Pharma. P1187 Aluminum chloride 15% a hexahydrate in a salicylic acid 2% gel: A novel topical agent for hyperhidrosis with decreased irritation Heather Woolery-Lloyd, University of Miami School of Medicine, Miami Beach, FL, United States Hyperhidrosis is a common condition that has a tremendous impact on the quality of life of affected patients. Aluminum chloride hexahydrate (AC) is considered first-line therapy for mild to moderate patients. The mechanism of action is via aluminum salt blockage of the distal acrosyringium which leads to functional and structural degeneration of the eccrine acini. Although many studies have demonstrated significant efficacy with topical AC, formulations of AC in an alcohol solution have been limited by patient tolerance. Observations from a busy hyperhidrosis practice revealed decreased irritation and increased efficacy with a novel therapy that combines AC 15% with salicylic acid 2% in a gel base. This combination of AC 15% with salicylic acid 2% offers patients who have failed AC in the past good efficacy with minimal irritation. There are many possible reasons for the improved efficacy and decreased irritation observed with the combination formula. The keratolytic properties of salicylic acid may enhance absorption of the AC. Salicylic acid has antiperspirant properties of its own which may act synergistically with the AC. The gel formulation may improve hydration and mitigate the drying effect when compared to an alcohol solution. Finally, improved tolerability could contribute to patient compliance and, therefore, efficacy. We report three cases of patients with a history of severe irritation from AC solution who maintained excellent results with this new topical without significant irritation. AC 15% in a salicylic acid 2% gel may be an ideal monotherapy for mild hyperhidrosis and adjunctive therapy for those with severe disease. Further studies will be helpful to clarify the role of AC 15% in a salicylic acid 2% gel as a novel addition to our current hyperhidrosis armamentarium. Commercial support: 100% sponsored by Valeo Pharma. Commercial support: None identified. P1189 Hereditary cutaneous mastocytosis Nicole Fett, MD, University of Wisconsin Hospital and Clinics Department of Dermatology, Madison, WI, United States; Jack Longley, MD, University of Wisconsin Hospital and Clinics Department of Dermatology, Madison, WI, United States; Joyce Teng, MD, University of Wisconsin Hospital and Clinics Department of Dermatology, Madison, WI, United States A 3-year-old female and a 2-year-old male presented to our clinic with their father. The female child was born with multiple light brown urticating papules that have increased in number over the last 6 months. She has intermittent problems with loose stools and flushing, but does not have problems with swallowing, syncope, wheezing, or irritability. Her brother presented with a brown urticating macule on his back at 10 months of age. He also has problems with loose stools, but does not have problems with wheezing, flushing, syncope, swallowing, or irritability. The patients are the only two children of a 33-year-old male who was diagnosed with cutaneous mastocytosis at 3 years of age. The patients’ father presented with erythematous urticating papules on his scalp in early childhood. He later formed similar confluent lesions over his chest, abdomen, and bilateral flanks that have persisted into adulthood. He reports multiple near-syncopal episodes throughout his life at times of incidental rubbing of these lesions. He has loose stools occasionally, but does not have problems with swallowing, wheezing, or flushing. The physical examination revealed a 3-year-old healthy appearing female with multiple flesh colored to brown papules scattered over her extremities, trunk, and along her hairline with positive Darier sign and a 2-year-old healthy appearing male with a 3-mm 3 4-mm brown macule on his right upper back with a positive Darier sign. Molecular testing of the skin biopsy specimens and oral mucosa swabs were negative for mutations in exons 11, 17, 8, and 10. A histologic examination revealed sheets of mast cells, and a diagnosis of hereditary cutaneous mastocytosis was given. Mastocytosis is a group of heterogeneous disorders with cutaneous and systemic manifestations caused by mast cell infiltration. Mastocytosis most frequently occurs in the skin with a variety of clinical presentations: urticaria pigmentosa, mastocytomas, diffuse and erythrodermic disease, and telangiectasia macularis eruptiva perstans. Systemic mastocytosis often involves the bone marrow, liver, spleen, and gastrointestinal tract, and is associated with peripheral eosinophilia. Patients with systemic manifestations of mastocytosis rarely develop mast cell leukemia. The most frequent presentation of mastocytosis is that of a self-limited, sporadic, disease of childhood. However, to date there are approximately 50 families in the literature with a hereditary form of mastocytosis. Mast cells express CD34 and the KIT tyrosine kinase. KIT is the product of the protooncogene c-kit located on chromosome 4 and belongs to the type III receptor tyrosine kinase subfamily. Activation of KIT results in mast cell proliferation. In 1993, two heterozygous activating mutations in the cytoplasmic domain of KIT (D816V or V560G) were identified in a human mast cell line. To date, almost all sporadic adult cases of mastocytosis have been found to carry the D816V mutation. The D816V mutation is not commonly found in sporadic childhood cases. A subset of patients with systemic mastocytosis and increased numbers of eosinophils express a fusion gene composed of the FIP1L1 gene promoter and the PDGFR gene coding region. In these patients, FIP1L1 gene promoter causes over expression and subsequent autoactivation of the PDGFR kinase, which is very similar to the KIT kinase. Whether these patients have mastocytosis with eosinophilia or eosinophilic leukemia with increased mast cells is controversial. In contrast to sporadic mastocytosis, some familial cases of mastocytosis have been found to have germ line mutation disrupting an inhibitory region of KIT, like the V560G mutation. These families may also have an increased risk of developing gastrointestinal stromal tumors (GISTs), which may be fatal. GISTs are caused by overactivation of KIT in the cells of the gut autonomic nervous system. Familial mastocytosis is generally inherited in an autosomal dominant pattern with incomplete penetrance. The majority of patients with familial mastocytosis do not have a c-KIT mutation. Familial mastocytosis has been reported to manifest as cutaneous lesions only, or cutaneous lesions with increased incidence of GISTs. Familial GISTs are rare, autosomal dominant genetic disorders with known germline c-KIT mutations in exons 11, 13, or 17. Recently, a novel germline KIT mutation in exon 8, which results in the deletion of codon 419 in the extracellular portion of KIT, has been described in a family with both hereditary mastocytosis and familial GISTs. Current therapy is aimed at symptom control with antihistamines, topical corticosteroids, phototherapy, cromolyn sodium, Epi-Pens for emergencies, and trigger avoidance. Imatinib, a tyrosine kinase inhibitor that targets Bcl-Abl, plateletderived growth factor receptor (PDGFR)-alfa and -beta, and KIT has been used in treatment of mast cell disease, but has only proven effective in familial patients or sporadic patients with the FIP1L1/PDGFR fusion gene and eosinophilia. Patients with sporadic mastocytosis and D816V mutations affecting the KIT kinase site do not respond to imatinib because of conformational changes of the drug’s binding site. Patients with familial mastocytosis and c-KIT mutations, however, have normal MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:45 am AB61 kinase binding sites and may respond to imatinib or other KIT kinase inhibitors. In those families with mutations that put them at high risk for GIST, close surveillance is recommended. However, the best modality of surveillance has yet to be agreed upon. At this time, computed tomographic scanning with both oral and intravenous contrast is likely the most sensitive modality for the detection of GISTs. Commercial support: None identified. P1190 Skin compatibility and sun protection efficacy of adjunctive usage of photostable sunscreens with a prescription triple combination cream for the treatment of melasma Theresa Chen, Johnson & Johnson CPPW, Los Angeles, CA, United States; Jared Fantasia, MS, Johnson & Johnson CPPW, Skillman, NJ, United States; Warren Wallo, MS, Johnson & Johnson CPPW, Skillman, NJ, United States; Yohini Appa, PhD, Johnson & Johnson CPPW, Los Angeles, CA, United States In patients with melanocompetent skin, hyperpigmentation is a major concern. Uneven pigmentation often occurs during aging. Melasma refers to acquired hypermelanotic macules that appear in centrofacial, malar, and mandibular patterns. Melasma occurs in 50% to 70% of pregnancies and can worsen significantly in size and intensity under the sun. Therefore, it is important for clinicians who treat patients with melasma to identify adjuctive products that are clinically proven to be compatible with their prescribed treatment and provide adequate protection against sun exposure. A randomized, double-blind clinical study was conducted to evaluate the safety and efficacy of several photostable sunscreen products when used in conjuction with a prescription triple combination cream for reducing melasma in melanocompetent skin. Cells of 25 patients were completed for each regimen tested. An untreated control was also included. The sunscreens were applied once a day before sun exposure and the prescription triple combination cream was applied in the evening. Skin compatibility and sun protection efficacy were determined by expert grading, instrumental measurement, subject selfassessments, and digital photography at baseline and at weeks 2, 4, and 8. Clinical parameters included Melasma Area Severity Index and global severity of melasma, as well as photoaging parameters. Digital photography documented global facial improvement. Subject self-assessments included improvements in melasma and skin tone. This clinical study demonstrated that concomitant use of the test sunscreens is safe and compatible with in the treatment of patients with melasma. P1192 Preliminary results of the elaboration of a new instrument to evaluate quality of life in patients with cellulite: CELLUQOL Doris Hexsel, Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil; Juliana Fonte de Souza, MD, Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil; Magda Weber, MD, MS, Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil; Maria Laura Taborda, MD, Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil Background: Quality of life (QOL) evaluation is very important in clinical research and patient care, because they usually present concerns regarding diseases or conditions. The development of questionnaires to evaluate disease or the condition’s impact in patients’ lives also provides physicians with a better understanding of the way a disease or a condition may physically, psychologically, and socially affect their patients. Almost all women have or believe they have cellulite. Up to the present time, no study on the QOL of those affected by cellulite has been published. Objective: To develop and validate a new instrument to evaluate the QOL of patients with cellulite. Methods: A qualitative study was conducted with 50 healthy female volunteers between 18 and 45 years of age with various degrees of cellulite in the buttocks and thighs. They answered an open question about how the cellulite affects their QOL. Results: From a preliminary analysis of the questions answered by the volunteers, the factors and situations that are influenced by the presence of cellulites were as follows: (1) patients usually do not use white and beach clothes—they prefer to use black ones (90%); (2) they dislike walking in the beach without wearing beach jackets (56%); (3) cellulite bothers and constraint the patients (38%); (4) they are afraid about their husbands watching their condition (36%) and have feelings of bad self-esteem (20%); (5) patients refuse to engage in leisure activities that could be constraining for them (18%); and (6) they usually feel bad about themselves because in spite of good good nutritional habits, they still have cellulite (14%). Other situations were related, although in a lower percentage of respondents. We could establish the main domains that are related to cellulite QOL that are: clothing manners, leisure, physical activities, husband relationship, feelings, and changes in daily habits. All these factors were listed in a new questionnaire called CelluQoL that will be be applied in a statistically significant number of patients in the second phase of this study. Conclusion: Cellulite causes a real impact on the QOL of patients and restricts those who suffer from this condition in everyday situations and activities. The development of a validated questionnaire to evaluate the QOL (CelluQoL) in these patients will allow physicians to understand the impact of this frequent condition in the affected women and to evaluate the impact and the need of new treatments for cellulite. Commercial support: None identified. Commercial support: 100% sponsored by Johnson & Johnson Consumer Products Companies Worldwide. P1191 Enterophatic acrodermatitis diagnosed in adulthood Mónica Gaviria, MD, Universidad Pontificia Bolivariana, Medellı́n, Antioquia, Colombia; Ana Rivas, MD, Clı́nica Universitaria Bolivariana, Medellı́n, Antioquia, Colombia; Marı́a Trujillo, MD, Clı́nica Universitaria Bolivariana, Medellı́n, Antioquia, Colombia A 31-year-old male patient who was a resident of Itagüı́, Antioquia, Colombia; married, without children; employee. His medical history was significant for dermatosis in childhood and retardation in the cure of wounds. He did not have history of diarrhea, alchoholism, weight loss, Crohn disease, or parenteral nutrition. He was previously treated by the dermatology department with topical ointments without improvement with diagnosis of psoriasis and contact dermatitis. The skin biopsy had enlarged epidermis and abundant vesicles at different levels and in mononuclear infiltrated dermis with dilated vessels. He presented exacerbation of the dermatologic affection with erythematous and macerated plaques around the natural orifices and in acral portions and extensors of limbs. Because of his clinical condition, an HIV enzyme-linked immunosorbent assay was ordered with negative result. Seric levels of zinc were measured and their values were initially (July 2006) 388 g/L, and then 511 g/L (August 2006), with reference values of 600 to 1200 g/L, where the deficiency is evidenced. Treatment was initiated with oral supplement of zinc sulphate with dramatic clinical response. P1193 Commercial support: None identified. Commercial support: None identified. AB62 Development of pyoderma gangrenosum during therapy with infliximab for ulcerative colitis: A case report Natalia Jaimes, Hospital Pablo Tobón Uribe, Medellin, Antioquia, Colombia; Juan E. Arroyave, MD, Hospital Pablo Tobón Uribe, Medellin, Antioquia, Colombia; Luz A. Vasquez, MD, Hospital Pablo Tobón Uribe, Medellin, Antioquia, Colombia; Veronica Molina, MD, Hospital Pablo Tobón Uribe, Medellin, Antioquia, Colombia Pyoderma gangrenosum (PG) is a rare inflammatory disease of unknown etiology and a poorly understood pathogenesis. Its clinical presentation is variable, and a large percentage of cases are associated with inflammatory bowel disease. Although there are cases demonstrating the efficacy of antietumore necrosis factor therapy for PG, we present the case of a patient with ulcerative colitis who developed PG during therapy with infliximab. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5952_5953 16 January 2009 11:45 am CONNECTIVE TISSUE DISEASE P1200 Dermatologic symptoms of dermatoyositis do not lead to early detection of ovarian cancer Rodrigo Valdes, MD, New York Downtown Hospital, New York, NY, United States; Giuseppe Del Priore, MD, MPH, New York Downtown Hospital, New York, NY, United States; Jose R Martinez, MD, New York Downtown Hospital, New York, NY, United States Background: Dermatomyositis and polymyositis (DP) are associated with an underlying malignancy. Early cancer diagnosis may be possible. Objective: To determine if dermatologic symptoms can lead to early detection of ovarian cancer (OC), and describe and characterized OC among patient with DP. P1202 Trauma-induced blistering in a patient with lupus erythematosus: Epidermolysis bullosa acquisita or bullous lupus erythematosus? Alia Sampson Brown, PhD, University of Louisville, Louisville, KY, United States; Carol Kulp-Shorten, MD, University of Louisville, Louisville, KY, United States; Jeffrey Callen, MD, University of Louisville, Louisville, KY, United States Background: Bullous lupus erythematosus (BLE) is a rare manifestation of systemic lupus that is characterized by tense vesicles and bullae which remit without scarring. BLE is a subepidermal blistering disorder caused by antibodies against type VII collagen, making it histologicly and immunologically indistinguishable from epidermolysis bullosa acquisita (EBA). We present a case of a woman with a known history of systemic lupus erythematosus (SLE) who presented with extensive bullous lesions that occurred over areas of minor trauma and resulted in scarring and milia formation. Conclusions: Despite a high risk for OC, woman with DP were not diagnosed at an earlier stage or lower Ca-125 level. The small sample size limits our power. Additional cases will be ascertained and presented. Current methods for early detection of ovarian carcinoma in DP patients are ineffective. Early OC may ‘‘whisper,’’ but it doesn’t itch. Observation: A 47-year-old female with longstanding SLE developed widespread, tense bullae. The bullae were concentrated over bony prominences; the grouping was not noted. In addition, healing occurred with scarring, milia, loss of fingernails, and decreased mobility. Initial biopsies from 1998 revealed a subepidermal split with neutrophils, and immunoflourescent studies were negative. A diagnosis of BLE was made, and she was treated with oral dapsone 50 mg daily which resulted in a decrease in the appearance of new bullous lesions. Dapsone was discontinued because of the development of a hypersensitivity syndrome. She was then placed on oral azathioprine 75 mg daily and oral hydroxychloroquine 200 mg twice daily, with varying doses of systemic corticosteroids. She continued to have blisters, and 1 year ago her nephrologist replaced azathioprine with mycophenolate mofetil; the patient correlates her worsening disease with the initiation of this medicine. With no improvement of her bullous lesions, she was recently admitted to the hospital with widespread blistering, lupus nephritis, pneumonitis, and pneumonia. Two punch biopsies were obtained for hemtoxylineeosin staining and direct and indirect immunoflourescent studies were also undertaken, which showed linear deposits of immunoglobulin G along the dermal basement membrane compatible with BLE or EBA. Azathioprine was increased to 150 mg daily based upon an elevated thiopurine methyl transferase level; in addition, hydroxychloroquine 200 mg daily and prednisone 15 mg daily were continued. Conclusions: BLE and EBA are histopathologically and immunologically indistinguishable; both having a subepidermal blister and antibodies to type VII collagen. We present a patient with bullous lesions initially thought to be BLE; however, because of the distribution of the lesions over the ‘‘areas of trauma,’’ the lack of grouping of the lesions, and the resolution with scarring and milia, the diagnosis of EBA is favored. Commercial support: None identified. Commercial support: None identified. Methods: We conducted a case control analysis using all cases identified from PubMed and Google Scholar searches using the following key words: ‘‘dermatomyositis,’’ ‘‘polymyositis,’’ ‘‘ovarian cancer,’’ ‘‘case report,’’ and combinations of those terms; in addition, a manual search of included references was conducted. We only considered cases of DP with ovarian or breast and ovary cancer. Cases identified were abstracted for age, stage, grade, histology, and level of Ca-125. ‘‘Cases’’ were OC diagnosed after DP and were compared to ‘‘controls’’ (OC diagnosed before DP). Results: Forty-two articles were found; 25 were excluded because of concurrent other malignancies or the fact that the articles not readily available. From the remaining 18 articles, 46 patients were identified, including 35 cases and 11 controls. Mean age in the cases was 57.5 years, and for controls was 58 years (P ¼ NS). Only one case was stage I (3.70%). Most cases and controls were in advanced stages (III-IV; 96.3% and 100%, respectively [P ¼ NS]). Time from DP to OC diagnosis was 13.4 months (range, 1-68 mos) versus 15.4 months (range, 1-72 mos) from OC to DP (P ¼ NS). The median time from initial presentation of DP to cancer was 10.5 versus 6 months for controls (P ¼ NS). Ca-125 was 1304 (range, 44-7710) in cases versus 1157 (range, 145-3200) in controls (P ¼ NS). OC was otherwise asymptomatic except for DP and diagnosis by screening test in 54.8% of cases. In control patients, where the initial diagnosis was OC followed by DP, only 30% where asymptomatic for OC (P ¼ NS). P1201 A phase I clinical trial of topical peptide p144 TGF-beta1 inhibitor in healthy volunteers Belen Sabada, Clinica Universitaria de Navarra, Pamplona, Spain; Belen Ruiz, MD, Hospital Universitario Puerta de Hierro, Madrid, Spain; Juan Ruiz, MD, Digna Biotech, Madrid, Spain; Raúl Insa, MD, PhD, ISDIN, Barcelona, Spain Introduction: P144 is a transforming growth factor-beta 1 (TGFb1) inhibitor peptide. TGFb1 contributes to the excessive production of collagen and other extracellular matrix components. TGFb1 inhibition could be an effective target in different serious diseases with fibrosis development. P144 has shown promising results, through topical application, in an established mice scleroderma model in which skin fibrosis is induced by repeated bleomicyn subcutaneous injections. Methods: The objective of this study is to assess the tolerability, safety, and bioavailability of the peptide 144 TGFb1 inhibitor after topical administration to healthy volunteers through a phase I multicenter, multiple dose, double-blind, placebo-controlled, randomized clinical trial which was conducted in 36 healthy volunteers. The volunteers were randomized to receive active or placebo cream, and distributed into three treatment groups according to the different doses tested for P144: 100, 200, and 300 g/mL of P144 cream. A daily application during 3 weeks was of 1 mL of active or placebo cream onto a controlled surface at the back was used. The tolerability was evaluated by dermatologists (blinded evaluation) based on the Frosch and Kligman visual scale. To evaluate bioavailability, plasma measurements were taken before cream administration and up to 24 hours after. P1203 A study of systemic scleroderma in the southern region of Brazil: Cutaneous manifestations and clinical and laboratory marker association Hermenio C. Lima, Universidade Federal do Parana, Curitiba, PR, Brazil; Carolina Muller, MD, Universidade Federal do Parana, Curitiba, PR, Brazil; Eduardo Paiva, MD, Universidade Federal do Parana, Curitiba, PR, Brazil Background: Scleroderma is a cutaneous and systemic autoimmune disorder seen in a wide range of clinical specialties including dermatology. Systemic sclerosis and its subtypes differ significantly from other diseases, because the aberrant activation of the immune system does not result in an inflammation-driven destruction but in a progressive matrix synthesis, especially of the skin. Objectives: To determine the relative frequency and characteristics of the three principal subsets (limited, diffuse, and overlap) and their association with clinical and laboratory data. Conclusions: Topical application of P144 up to a concentration of 300 g/mL has good local and systemic safety profile. No systemic exposure was found. The good local and systemic tolerability recommends going forward in the development through a phase II clinical trial to evaluate the efficacy and safety of topical administration of P144 in outpatients with skin manifestations of sclerosis. Methods: Outpatients from dermatology and rheumatology clinics in a large university hospital in the southern region of Brazil with the diagnosis of scleroderma were reviewed between January 2007 and May 2008. Seventy-five patients were identified and their scleroderma diagnoses validated. Other characteristics, such as sex, mean age at diagnosis, extent of skin involvement, internal organ involvement, and serology and other laboratory markers were analyzed. Results: The female to male ratio was 11.5:1. The majority of patients had limited disease, with a ratio of 6.57:2.85:1 of limited to diffuse to overlap. None of the systemic involvement (excluding atrophic skin, which is present more often in the diffuse form [x 2; P ¼ .03]), was found to predominate in any group. The Rodnan score, diffusion capacity of carbon monoxide (DLCO), and urine protein were statistically associated with diffuse form. Autoimmune serology was positive in 88.4% of patients, with antinuclear antibodies and anticentromere antibodies being more common in the limited form and antiRNA polymerase III being more common in diffuse scleroderma. Conclusions: This study demonstrated that limited disease is more common than diffuse or overlap disease. However, distinct clinical features and laboratory parameters can be independent predictive markers for the outcome of a given patient. A detailed profile of the affected patients should be determined for the area where the patient lives to indentify the factors associated with the disease prognosis. Monitoring should be performed on a regular basis as early as possible to reduce morbidity and mortality of the affected patients. Commercial support: 50% sponsored by ISDIN and 50% by Digna-Biotech. Commercial support: None identified. Results: No clinical local or systemic reactions were seen in any of the volunteers. The next active dose was tested after the safety of the previous formulation was assessed for at least one week of treatment. In total, the dermatologist reported skin toxicity in two volunteers; one receiving placebo cream who had grade I erythema and other one had flaking and thin cracks after receiving P144 cream 300 g/mL. Other adverse events reported were rated as being of mild severity. No additional measures should be adopted after administration of active or placebo cream, such as discontinuation or treatment for local toxicity. No P144 levels above 0.5 ng/m: were quantified in the plasma samples. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5954_5957 16 January 2009 6:16 pm AB63 P1204 P1206 Pseudoxanthoma elasticumelike papillary dermal elastolysis: A case report Annemarie Uliasz, MD, Mount Sinai School of Medicine, Department of Dermatology, New York, NY, United States; Orit Markowitz, MD, Mount Sinai School of Medicine, Department of Dermatology, New York, NY, United States Case of recalcitrant dermatomyositis in a young white male Jessica Flowers, PhD, Largo Medical Center, Sun Coast Campus, Largo, FL, United States; Richard Miller, DO, Largo Medical Center, Sun Coast Campus, Largo, FL, United States Dermatomyositis (DM) is a connective tissue disease that can have severe cutaneous and systemic manifestations. Symptoms include proximal muscle weakness that can progress to involvement of pharyngeal muscles and muscles of respiration. Cutaneous manifestations classically involve heliotrope rash of the eyelids, Gottron papules on the lateral surface of the fingers, violaceous and scaly patches distributed in a shawl-like pattern on the chest and upper back, and nail involvement. Importantly, DM may be a marker of internal malignancy including that of the breast, lung, ovary, stomach, colon, and uterus. We present a 35-year-old white male with classical features of DM who has failed numerous therapies including methotrexate, azathioprine, leflunomide, intravenous immunoglobulin, infliximab, and mycophenolate mofetil. He presented with a recurrent periocular rash, erythema of the chest and upper back, papules on his fingers, and striae. He also complained of muscular weakness. He is being managed with low-dose prednisone and topical corticosteroids. Extensive systemic evaluations have failed to yield any sign of malignancy. This case demonstrates younger patients presenting with recalcitrant dermatomyositis that require continued close monitoring for occult malignancy. Pseudoxanthoma elasticum (PXE)elike papillary dermal elastolysis (PDE) is a rare condition thought to result from intrinsic aging, ultraviolet radiation, or abnormal elastogenesis. PXE-like PDE is considered part of the spectrum of fibroelastolytic diseases of the skin, which includes mid-dermal elastolysis, upper dermal elastolysis, and white fibrous papulosis of the neck. Like these conditions, PDE manifests as numerous, mildly pruritic to asymptomatic, nonfollicular, flesh-colored to yellow papules with a cobblestone-like appearance symmetrically involving the upper chest, arms, axillae, lower abdomen, and inframammary folds. Although clinically similar, PDE lacks the systemic involvement commonly seen in PXE. Furthermore, compared to PXE and the other fibroelastic diseases of the skin, PXE-like PDE is histologicly distinct. Focal loss of elastic tissues in the papillary dermis is the hallmark of this condition. In contrast, mid-dermal elastolysis is characterized by a band-like pattern of elastic tissue loss in the mid dermis. Conversely, white fibrous papulosis of the neck is characterized by areas of thickened collagen bundles and decreased elastic tissue in the papillary and mid-reticular dermis. PXE-like ODE differs from upper dermal elastolysis in that the latter demonstrates elastophagocytosis. We report an 87-year-old female with a one and a half year history of mildly pruritic, hypopigmented, cobblestone-like papules resembling ‘‘plucked chicken skin’’ involving the neck, upper chest, and axillae. Before presentation at our clinic, an extensive work-up had been performed, including multiple biopsies with special stains (FontanaeMasson, Melan-A, Alcian blue, period acideSchiff) to rule out tinea versicolor, eruptive syringomas, scleredema, and amyloidosis. We performed an additional biopsy, this time with an elastineVan Gieson stain, which revealed a focal decrease of elastic fibers in the papillary dermis, consistent with a diagnosis of PXElike PDE. Commercial support: None identified. Commercial support: None identified. P1207 Multiple dermatofibromas in a patient with systemic lupus erythematosus and Sjögren’s syndrome Tomomi Fujisawa, Matsunami General Hospital, Hashima-Gun, Japan; Mariko Seishima, MD, Ogaki Municipal Hospital, Ogaki, Japan; Satoko Suzuki, MD, Ogaki Municipal Hospital, Ogaki, Japan; Yoshinao Shibuya, MD, Ogaki Municipal Hospital, Ogaki, Japan Multifocal lesions of morphea in a patient with systemic lupus erythematosus Joo Yeon Ko, MD, Department of Dermatology, Hanyang University College of Medicine, Seoul, Seongdong-gu, Seoul, South Korea; Chang Woo Lee, MD, PhD, Department of Dermatology, Hanyang University College of Medicine, Seoul, Seongdong-gu, Seoul, South Korea; Mihn Sook Jue, MD, Department of Dermatology, Hanyang University College of Medicine, Seoul, Seongdong-gu, Seoul, South Korea; Yong Seok Kim, MD, Department of Dermatology, Hanyang University College of Medicine, Seoul, Seongdong-gu, Seoul, South Korea Localized scleroderma (LS), also known as morphea, is a distinct benign entity because of its almost exclusive cutaneous involvement and, with some exceptions, absence of internal organ involvement. In contrast, systemic lupus erythematosus (SLE) is a multisystem disease with frequent critical organ involvement. Although antinuclear antibodies can be found in patients with LS, coexistence of this LS and SLE is rather uncommon. A 23-year-old male presented with multiple brownish patches on his forehead and temple, which had first appeared 1 month before his visit. He had been diagnosed with SLE 6 months before noticing the LS skin lesions on the basis of the presence of malar rashes, photosensitivity, painless oral ulcer, arthritis, hematologic disorder, and high titer antinuclear antibodies. Cutaneous examination revealed the presence of four well defined, pigmented, depressed, sclerotic patches on the forehead and right temple. Histopathologic examination of this lesion showed thickening of dermal collagen and some infiltrates of lymphohistiocytic cells between the collagen, a pattern consistent with morphea. Herein, we report a unique case of SLE and his subsequent development of multifocal lesions of morphea on the face which is usually spared in LS with the exception of en coup de sabre and progressive facial hemiatrophy. A 32-year-old male with a 1-year history of lymphadenopathy, fatigue, and polyarthralgia noticed erythema on his cheeks 6 months before the first consultation. In addition, he complained of dry eyes, thirst, and erythema with ulceration on his left auricle. Laboratory examination revealed positive antinuclear antibodies showing speckled pattern with titer of 1:1280. Anti SS-A/Ro antibody and antiSSB/La antibody were detected positively, but not antiSm antibody, antiDNA antibody, or antiRNP antibody. After the diagnosis of systemic lupus erythematosus (SLE) with Sjögren syndrome, he was treated with 50 mg/day of prednisolone. Diaphenylsulfone 75 mg/day and cyclosporine 150 mg/day were added, and the dose of prednisolone was gradually reduced after both clinical symptoms and immunologic parameters were improved. He was administered 5 to 10 mg/day of prednisolone for 2 years as the maintenance dose, resulting in the disappearance of symptoms with antinuclear antibodies at 1:40. He noticed two brown nodules on his right lower leg 3 years after the first consultation. In addition, six nodules developed on his back, left hand, thighs, and lower legs within 6 months. These elastic hard nodules, some of which were painful, were brown or ivory colored with sizes ranging from 5 to 10 mm in diameter. Histopathologic examination of a nodule on his left hand showed fibrotic proliferation with a storiform pattern in the whole dermis, but neither necrosis nor atypicality. From these findings, a diagnosis of dematofibroma in a patient with SLE and Sjögren syndrome was made. In general, multiple dermatofibromas are rare, and are sometimes developed in patients with collagen diseases including SLE and mixed connective tissue disease, autoimmune bullous disease, leukemia, and immunosuppressed patients. It is controversial whether the development of multiple dermatofibromas is induced by the immunologic and/or collagen metabolic disorders of collagen diseases or immunosuppression by steroids and other immunosuppressive agents. In the present case, these tumors appeared during the remission stage of SLE when total dose of predonisolone was 25.9 g and cyclosporine was 169 g. These findings show that multiple dermatofibromas may be possibly caused by immunosuppressive condition rather than collagen diseases themselves. Commercial support: None identified. Commercial support: None identified. P1205 AB64 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5954_5957 16 January 2009 6:16 pm P1208 P1210 Corticosteroids and immunosupressors as the only treatment of bullous systemic lupus erythematosus: Report of four cases Mónica Fernández-Sánchez, MD, Instituto Nacional de Ciencias Médicas y Nutrición ‘‘Salvador Zubirán,’’ Mexico City, Mexico; Linda Garcı́a-Hidalgo, MD, Instituto Nacional de Ciencias Médicas y Nutrición ‘‘Salvador Zubirán,’’ Mexico City, Mexico; Marcela Saeb, MD, Instituto Nacional de Ciencias Médicas y Nutrición ‘‘Salvador Zubirán,’’ Mexico City, Mexico; Rocio Orozco-Topete, MD, Instituto Nacional de Ciencias Médicas y Nutrición ‘‘Salvador Zubirán,’’ Mexico City, Mexico Generalized acquired cutis laxa associated with immunoglobulin Gelambda monoclonal gammapathy Antoni Bennassar, MD, Hospital Clı́nic, Barcelona, Spain; Jose Manuel Mascaró, MD, PhD, Hospital Clı́nic, Barcelona, Spain; Marc Julià, MD, Hospital Clı́nic, Barcelona, Spain Bullous systemic lupus erythematosus (BSLE) is a rare autoantibody-mediated blistering skin disease against type VII collagen, occurring in patients with SLE. It presents as a widespread, transient, nonscarring vesiculobullous eruption with a dermatitis herpetiformelike histology and immunologic features resembling epidermolysis bullosa acquisita. BSLE has a striking therapeutic response to dapsone, with improvement in 24 to 48 hours. In contrast, corticosteroids and immunosupressants have been reported as ineffective. We present four cases of BSLE with an excellent response to corticosteroids and immunosupressors. Case 1 is a 27-year-old female with SLE presenting with itching vesicles on the face and renal, hematologic, and immunological activity. A skin biopsy showed subepidermal blisters with positive immunoglobulin A (IgA), IgM, and IgG immunofluorescence at the dermoepidermal junction (DEJ). Prednisone (45 mg/day) and azathioprine (AZA; 75 mg/day) were prescribed. Regression of the dermatosis was achived within 1 month. Renal activity persisted. Case 2 is an 18-year-old female with SLE presenting with disseminated nonpruritic vesicles, diffuse alopecia, and renal and hematologic activity. A skin biopsy showed subepidermal bullae and positive lineal IgG, IgA, IgM, C1Q3, and C32 immunofluorescence at the DEJ. Prednisone (60 mg/day) and AZA (150 mg/day) were prescribed with remission of the dermatosis within 1 month. Renal activity persisted. Case 3 is a 27-year-old female with SLE presenting with disseminated pruritic bullaes and hematologic and immunologic activity. Skin biopsy showed a subepidermal neutrophilic bulla with positive IgM and C1Q immunofluorescence at the DEJ. She received treatment with prednisone and AZA with remission of the dermatosis and systemic activity. Case 4 is a 33-year-old male with SLE presenting with a disseminated bullous and papular rash and renal and immunologic activity. A skin biopsy showed subepidermal neutrophilic bullae. Immunoflourescence was negative. A clinical diagnosis of BSLE was made and the dermatosis remitted with prednisone 60 mg/day and AZA 200 mg/day within 3 weeks. Renal activity persisted. Blistering eruptions are rare in SLE. Clinically, physicians should exclude other blistering diseases before making the diagnosis of BSLE. Even though dapsone is the drug of choice for the treatment of BSLE, patients who also have systemic activity, as in our patients, have an excellent response to corticosteroids and immunosupressants. Background: Cutis laxa (CL) is an heterogeneous group of inherited and acquired disorders characterized by loose redundant skin folds. There is also a risk of systemic involment. Histologicly, there are altered or absent elastic fibers. Acquired CL has been associated with inflammatory, infectious, or hematologic disorders and may also be secondary to the use of some drugs. Case report: A 52-year-old white male presented to our outpatient dermatologic clinic with a 2-year history of a changing skin appearance consisting in a premature aged face and slack skin folds. His medical history was relevant for immunoglobulin G (IgG)-lambda monoclonal gammapathy and chronic renal failure related to paraprotein deposition. A skin biopsy was performed. On standard hematoxyline eosin examination, the epidermis, dermis, and cutaneous appendages appeared normal. Orcein stain demonstrated a complete deplection of elastic fibers, and direct immunofluorescence examination showed IgG deposition in fragmented dermal elastic fibers and along the basement membrane zone. A diagnosis of generalized acquired CL was finally established. The patient was first proposed for bone marrow transplantation, but 2 months later the patient complained about shortness of breath and hemoptysis during stem cell mobilization with granulocyte colony-stimulating factor. He was admited to the intensive care unit with a respiratory failure caused by pulmonary hemorrhage. He is currently on hemodyalisis and is being treated with bortezomib and dexamethasone with a complete hematologic response and no progression of his cutaneous disease. Discussion: Acquired CL is a rare disorder that has been associated with many conditions, including plasma cell dyscrasia, multiple myeloma, lymphoma, nephrotic syndrome, alpha1-antitrypsin deficiency, Sweet syndrome, systemic lupus erythematosus, isoniazid or penicilamine treatments, and Borrelia burgdoferi infections. It has been hypothesized that elastic tissue loss could be the final stage of many processes. We believe that in our patient there may be an immunologic mechanism for elastolysis. We hypothesize that IgG deposition on dermal and pulmonary capillary elastic fibers in this patient with IgG-lambda monoclonal gammapathy resulted in a neutrophilic and lymphocytic infiltrate and finally in fragmentation, shortening, and deplection of elastic fibers. Commercial support: None identified. Commercial support: None identified. P1211 P1209 Human leukocyte antigent-DRB in discoid lupus patients Claudia Aquino, MD, MPH, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Distrito Federal, Mexico; Julio Granados, PhD, Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Distrito Federal, Mexico; Rocio Orozco, MD, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico City, Distrito Federal, Mexico Introduction: Cutaneous lupus manifestations are very common and diverse. Discoid lupus (DL), also known as chronic cutaneous lupus, is observed in systemic lupus erythematosus (SLE) patients with a long course of disease or, sometimes, it is the only manifestation. Gene frequencies of human leukocyte antigens (HLAs) have been extensively studied in SLE; however, there are not any studies in the Mexican mestizo population with DL. Takayasu arteritis complicated by abdominal ulceration Grant Wylie, MD, Department of Dermatology, Airdrie, Lanarkshire, United Kingdom; Christopher D. Evans, MBChB, Department of Dermatology, Airdrie, Lanarkshire, United Kingdom Methods: The study was comprised of 17 Mexican mestizo patients with DL who were attending the Instituto Nacional de Ciencias Médicas y Nutrición Dr. Salvador Zubirán, in Mexico City. HLA-DRB allele typing was performed by sequence-specific oligotyping after DNA amplification using polymerase chain reaction. The study also included nine patients with SLE without cutaneous manifestations. We also studied other SLE manifestations that the patients exhibited, the treatment that was prescribed, and whether or not they used photoprotectors. Results: Of the 17 patients that had DL, 13 (76%) were female and four (24%) were male. The patients with SLE without cutaneous manifestations were seven (75%) females and two (25%) males. In the DL group, nine (53%) patients had SLE and eight (47%) only had DL. The highest allele frequency of HLA-DRB in the group of DL that was found was HLA-DR4 (n ¼ 17; 32%) and HLA-DR8 (n ¼ 17; 32%). In the SLE control group was HLA-DR4 (n ¼ 9l; 22%) and HLA-DR13 (n ¼ 9; 22%). The most common extracutaneous manifestations were arthritis and nephritis in both groups. The treatment was very diverse, depending on the extracutaneous manifestations of SLE; however, cloroquine and hidroxicloroquine were commonly used together with topical corticosteroids in the DL group. Fifteen patients with DL (88%) used some kind of photoprotection compared with only seven patients (41%) of the group without skin involvement. Conclusions: HLA-DRB alleles seem to be involved in the genetic susceptibility to DL in the Mexican mestizo population, although it would be interesting to perform a study with a greater number of patients to demonstrate such association. We report a case of progressive abdominal ulceration in a patient with diagnostic features in keeping with Takayasu arteritis (TA). A 43-year-old female presented with a small area of enlarging ulceration affecting her right lower abdominal wall, with some features being clinically suggestive of pyoderma gangrenosum. A biopsy revealed vasculitis. Initially, there were no other features of a systemic vasculitis and screening investigations were normal. She was commenced on oral prednisolone with subtle improvement in ulcer size and symptoms. Further deterioration prompted trial with cyclosporin, again with some early improvement; however, mood disturbance and hallucinations meant that this drug had to be stopped. Combinations of prednisolone, azathioprine, and mycophenolate mofetil were tried, with little benefit. At this stage, the initial abdominal ulcer was now greater than 15 cm in diameter with a further new similarly enlarging lesion on the opposite side. Intravenous immunoglobulins, a recognized treatment for vasculitis, were given with symptomatic relief but little improvement in ulcer size. Interestingly, on review of her medical history, 6 months earlier there had been an assessment by a vascular surgeon for symptoms suggestive of bilateral leg claudication. Angiography revealed almost total occlusion of the abdominal aorta, but no intervention was offered. Further evaluation of large vessels revealed absent lower limb pulses, markedly diminished bilateral brachial pulses, and an upper limb blood pressure differential. Given these findings, a potential diagnosis of TA was suggested. She was now intermittently pyrexial, anemic, and had significantly raised inflammatory markers. Negative microbiology, including repeated blood cultures along with a procalcitonin level suggested an ongoing inflammatory process rather than ongoing infection. A recognized, more specific treatment for TA is cyclophosphamide, and an initial single bolus of this was given but without benefit. Plasmapharesis and finally infliximab were used shortly before large areas of lower limb ulceration, bilateral critical limb ischemia, and multiorgan failure unfortunately lead to her death. TA is a rare progressive systemic disease thought to be autoimmune in etiology and resulting in vascular damage. It is more common in females with a mean age of onset of 30 years. Histology to confirm large vessel involvement is rare given the nature of the specimen required. There are a number of often ulcerating dermatologic conditions associated with TA, including pyoderma gangrenosum and erythema induratum. This is an interesting and potentially life threatening condition which, although rare, is a diagnosis worth considering when faced, as in this case, with large areas of treatment resistant skin ulceration. Commercial support: None identified. Commercial support: None identified. Objective: The aim of this study was to determine gene frequencies of HLA-DRB alleles in Mexican mestizo patients with DL compared with SLE patients without any cutaneous manifestations in the course of their disease. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5954_5957 16 January 2009 6:16 pm AB65 P1212 P1214 Primary localized cutaneous nodular amyloidosis: A cutaneous manifestation of Sjögren syndrome Vasanop Vachiramon, MD, Department of Dermatology, University of Pennsylvania, Philadelphia, PA, United States; Carrie Kovarik, MD, Department of Dermatology, University of Pennsylvania, Philadelphia, PA, United States; Frederick Vivino, MD, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, United States; Victoria Werth, MD, Department of Dermatology, University of Pennsylvania, Philadelphia, PA, United States Cutaneous manifestations are reported in up to half of patients with Sjögren syndrome (SS). They are generally divided into vascular and nonvascular lesions. Vascular lesions consist of cutaneous vasculitis, urticarial vasculitis, and Raynaud phenomenon. Other skin findings include dry mucous membrane, angular cheilitis, eyelid dermatitis, and xerosis. Less frequent findings include annular erythema, pernio-like erythema, erythema nodosum, erythema multiformeelike lesions and erythema perstans, vitiligo, alopecia, and cutaneous lymphoma. We report an 80year-old white female who presented with a 2-year history of asymptomatic, slowly enlarged dermal to subcutaneous nodules on both legs. She had an 8-year history of primary SS treated with hydroxychloroquine, cevimeline, and artificial tears. Physical examination revealed several discrete, skin-colored, firm dermal to subcutaneous 1-to 3-cm nodules distributed on both lower legs. Neither macroglossia nor purpuric lesions were found. The physical examination was otherwise unremarkable. A skin biopsy taken from the nodular lesion of her left calf revealed clusters of eosinophilic amorphous and fissured material within the dermis, vessel walls, and extending into the septae of the subcutaneous tissue. A Congo red stain was performed and highlights the amorphous material. Sparse perivascular plasmacytic infiltrates are also identified, and the majority of plasma cells are highlighted with kappa staining. Overall, these histologic findings were most consistent with primary cutaneous amyloidosis. A complete blood cell count and metabolic profile were within normal limits. Antinuclear antibody was 1:640. Serum protein electrophoresis was normal. There was no evidence of myeloma or lymphoma in the bone marrow biopsy specimen. Primary localized cutaneous nodular amyloidosis was diagnosed. The pathogenesis of primary cutaneous nodular amyloidosis associated with SS might be explained by the fact that SS is a chronic inflammatory autoimmune disease characterized by lymphocyte and plasma cell infiltration of the exocrine glands, together with a polyclonal B cell activation. Organ-limited amyloidosis, such as cutaneous amyloidosis, can occur in SS, as can B cell lymphoma, lymphoplasmacytoid lymphoma, extramedullary plasmacytoma, and multiple myeloma. Primary cutaneous nodular amyloidosis typically is benign and limited to the skin, although several recent articles report that rarely patients later developed systemic amyloidosis. We propose that primary cutaneous nodular amyloidosis should be included in the diseases associated with SS. Juvenile dermatomyositis: A case report and review Roger Sica, MD, Suncoast Hospital/HCA, Largo, FL, United States; David Dorton, DO, Suncoast Hospital/HCA, Largo, FL, United States Dermatomyositis is a connective tissue disease that can present with similar clinical features in the adult and pediatric population. Of paramount importance is the potential for progression to systemic disease, including pulmonary and cardiac manifestations, and heralding an underlying internal malignancy. Early diagnosis and treatment is critical to improved prognosis. We describe a classical case of juvenile dermatomyositis and review the salient cutaneous and clinical features, laboratory evaluation, associated systemic disease, and current treatment algorithm. Commercial support: None identified. Commercial support: None identified. P1215 P1213 Eosinophilic fasciitis versus morphea profunda: A spectrum of deep morphea Dakara Rucker Wright, Henry Ford Dermatology, Detroit, MI, United States; Donard Haggins, MD, Henry Ford Rheumatology, Taylor, MI, United States; Marsha Chaffins, MD, Henry Ford Dermatology, Detroit, MI, United States; Michele Lokitz, MD, Henry Ford Dermatology, Detroit, MI, United States Subacute cutaneous lupus exacerbated by or induced by doxorubicin hydrochloride Alisa Funke, MD, University of Lousiville, Louisville, KY, United States; Carol Kulp-Shorten, MD, University of Louisville, Louisville, KY, United States; Jeff Callen, MD, University of Louisville, Louisville, KY, United States Deep morphea is a fibrosing inflammatory process of the subcutaneous fat that includes both morphea profunda and eosinophilic fasciitis. Controversy exists as to whether or not they are distinct entities. We present a 46-year-old white male with a history of an acute onset of symmetrical skin tightening and swelling of his arms and legs which progressed to his back, abdomen, and lower chest. Groove sign was present. Before the onset of his symptoms, he was working on an extremely dirty and strenuous carpentry job. Clinical presentation, pathology, and laboratory evaluation were all consistent with eosinophilic fasciitis. Upon consultation outside of our hospital system, he was diagnosed with morphea profunda. Eosinophilic fasciitis, also known as Schulman syndrome, is a rare fibrosing disorder characterized by an acute onset of progressive symmetrical painful, erythematous edema and induration of the extremities and trunk. A history of preceding trauma or strenuous activity may be reported. On histopathology, the deep fascia is the predominate level of inflammation with overlying subcutaneous inflammation and septal thickening. There may or may not be a predominance of eosinophilic infiltrate; however, peripheral eosinophilia is common, especially during the acute phase. Distinguishing eosinophilic fasciitis from morphea profunda may be difficult, because both present clinically with bound-down, indurated skin. In addition, the pathological picture is similar in that they both have inflammation and sclerotic thickening of the deep subcuticular and fascial layers. Deciding on one diagnosis over the other may influence treatment decisions and the prognosis differs for morphea profunda and eosinophilic fasciitis. We will discuss how our case demonstrates the differences and similarities between morphea profunda and eosinophilic fasciitis, and discuss the difficulty of distinguishing the two similar entities. Background: Subacute cutaneous lupus (SCLE), characterized by nonscarring, photodistributed, annular or papulosquamous plaques, is occasionally medicationinduced. It has been strongly associated with hydrochlorothiazide, terbinifine, calcium-channel blockers, and angiotensin-converting enzymes. We describe three women with breast cancer who developed SCLE-like cutaneous eruptions after being administered doxorubicin hydrochloride. Observation: Three women 41, 44, and 73 years of age presented with photodistributed, erythematous, scaly plaques consistent with SCLE after treatment with doxorubicin hydrochloride and cyclophosphamide for breast cancer. Two of the three women had Ro/SS-A positive disease before the onset of their rash; one with quiescent SCLE and one with Sjögren syndrome. All three patients had biopsies consistent with interface dermatitis, and one patient had direct immunofluorescence performed, which was nondiagnostic. Based on clinicopathologic correlation and timing of doxorubicin hydrochloride exposure, the patients were diagnosed with drug-related SCLE. Treatment consisted of systemic or topical corticosteroids, photoprotection, and changing the chemotherapeutic regimen. One patient did receive an additional course of doxorubicin hydrochloride and cyclophosphamide, which resulted in recurrence of the lesions, and this patient’s disease also worsened with paclitaxel. Comment: Although rash, itching, and photosensitivity can occur with doxorubicin hydrochloride, there have been no reports to our knowledge of induction or exacerbation of SCLE. Paraneoplastic SCLE has been reported; however, the timeline in our patients is not consistent with paraneoplastic disease. Cyclophosphamide, though part of the chemotherapeutic regimen in all three patients, is not likely responsible because it is an often effective treatment for lupus. We report these three cases of doxorubicin hydrochloride that exacerbated or induced SCLE to make referring dermatologists aware of this possible adverse effect. Commercial support: None identified. Commercial support: None identified. AB66 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5954_5957 16 January 2009 6:16 pm DERMATITIS, ATOPIC P1300 Treatment with pimecrolimus cream 1%, with overnight occlusion, of moderate to severe atopic dermatitis for 8.5 days did not measurably increase systemic exposure Roland Kaufmann, MBChB, Department of Dermatology, Goethe University, Frankfurt am Main, NA, Germany; Diamant Thaci, MD, Department of Dermatology, Goethe University, Frankfurt am Main, Hessen, Germany; Thomas Bieber, MD, Department of Dermatolology and Allergy, Bonn, NA, Germany; Thomas Hultsch, MD, Novartis Pharmaceuticals Corp., East Hanover, NJ, United States Treatment under occlusion is often used to enhance the efficacy of topically applied drugs; however, this can be associated with an increased risk of systemic absorption. In a noncomparative, open-label study, the efficacy and safety of treatment with pimecrolimus cream 1% under occlusion was investigated. The present abstract presents the key pharmacokinetic findings. Patients with atopic dermatitis (AD) involving at least 30% of their body surface area were recruited. Patients were divided into three age-based cohorts: cohort A included adults aged [18 years, cohort B was comprised of adolescents 12 to 17 years of age, and cohort C was comprised of children 2 to 11 years of age. Pimecrolimus cream 1% was applied twice daily, in the morning and evening, for 8.5 days. In the morning, pimecrolimus cream 1% was applied on all lesional skin areas. In the evening, pimecrolimus cream was applied to all four limbs (lesional and nonlesional skin) which were then immediately wrapped in plastic film overnight for at least 8 hours. Wrapping was performed only in the evening, except a morning occlusion on day 9. On day 9, blood samples were collected within 10 minutes before the morning application and wrapping and at 2, 4, and 8 hours after the application and wrapping. Blood samples were analyzed for pimecrolimus by liquid chromatographyemass spectrometry. Of 20 patients who were screened, 19 were given the study medication, and the study was completed by 16 patients (7, 4, and 5 patients in cohorts A, B, and C, respectively). The mean total amount of cream applied during the study was 348, 220, and 141 g across cohorts A, B, and C, respectively. Eighty-one percent of all postbaseline blood samples were below 0.5 ng/mL. The peak pimecrolimus exposure observed was 1.84, 0.55, and 1.3 ng/mL in adults, adolescents, and children, respectively. The mean pimecrolimus blood concentrations exhibited a plateau over the time interval of 0 to 8 hours. All mean pimecrolimus blood concentrations were below 0.8 ng/mL. There was no obvious correlation between the affected body surface area and pimecrolimus blood concentrations. Over 8.5 days of occlusive treatment with pimecrolimus cream 1%, there was no measurable increase in pimecrolimus blood concentrations compared with previously determined findings from studies without occlusion. P1302 Skin protease inhibitors: A new treatment for atopic dermatitis Simon Danby, M. Moustafa, A. L. MacGowan, S. J. Ward, and M. J. Cork, The University of Sheffield, School of Medicine and Biomedical Sciences, Sheffield, England, United Kingdom Breakdown of the skin barrier is a key event in the development of atopic dermatitis (AD). Changes in at least four groups of genes in children with AD lead to enhanced protease activity within the epidermis, resulting in skin barrier breakdown. The effect of skin protease inhibitors on protease activity was tested in three steps. Firstly, their ability to inhibit protease activity in vitro was assessed using a chromogenic substrate for the serine protease alfa-chymotrypsin. Secondly, the effect of these inhibitors on protease activity within skin tissue sections was determined using in situ zymography, which permits the specific localisation of protease activity within the epidermis. Finally, novel, preclinical formulations containing the skin protease inhibitors were tested for their ability to reduce steroid-induced protease activity in vivo in volunteers using in situ zymography. The novel skin protease inhibitors YC1015, YC1016, and YC1017, at 20 mM, resulted in significant reduction of alfa-chymotrypsin in vitro by 32%, 57%, and 26%, respectively (values provided are means). At a concentration of 40 mM, YC1018 resulted in a 62% reduction (5-fold) of alfa-chymotrypsin activity. In addition, combinations of YC1015 and YC1018 significantly inhibited casein-specific protease activity found in the epidermis at concentrations down to 1 mM for skin tissue sourced from three independent volunteers. Treatment of the forearms twice a day with a potent topical corticosteroid (TCS) induced protease expression within the epidermis. This increase in protease activity was reduced when formulations containing YC1015 and YC1018 were applied after the TCS treatment. The skin protease inhibitors, in combination with an optimal emollient formulation, could provide a new approach to restoring the defective skin barrier in atopic dermatitis. Commercial support: Sponsored by York Pharma (R&D) Ltd. Commercial support: Novartis Pharma paying for poster production. P1301 A daily oat-based skin care regimen for atopic skin Judith Nebus, MD, Johnson and Johnson Consumer Products Worldwide, Skillman, NJ, United States; Glen Nystrand, MS, Johnson and Johnson Consumer Company, Skillman, NJ, United States; Joseph Fowler, MD, Dermatology Specialists Research, Louisville, KY, United States; Warren Wallo, MS, Johnson and Johnson Consumer Products Company, Skillman, NJ, United States Intense moisturization and gentle cleansing is important to patients with atopic dermatitis because dry skin can further exacerbate the disease. Patients with atopy have a compromised skin barrier that allows for high rates of water loss and an easy entry for inflammatory triggers, allergens, and irritants. Exogenous factors can trigger a patient with atopy to flare, resulting in intense pruritus and a further breakdown of the skin barrier. The fundamentals of a daily skin care routine are essential for hydration and maintenance of a healthy skin barrier in atopic skin. Cleansers and moisturizing creams should be free of fragrances and other potential irritants and allergens, to prevent further insult to an already compromised skin barrier. Moisturizing creams need to contain occlusives, skin protectants, and other key components that protect the barrier, provide soothing benefits, and help with the water binding capacity of the skin. Creams need to be applied frequently and liberally to the entire body. Fifty patients between 12 to 60 years of age with mild to moderate atopic dermatitis according to the criteria of Hanifin and Rajka were enrolled into this multicenter, double-blinded, randomized clinical study. For 8 weeks patients used a daily skin care regimen consisting of twice a day application of an oatmeal-based occlusive cream (with vitamins and ceramides) and an oatmeal glycerin cleanser for all moisturizing and body cleansing. Patients were allowed to use their normal topical medications for their atopic dermatitis. Independent dermatologist evalutions were performed at multiple time points during the study. Significant improvements (P \.05) in the Eczema Area Severity Index (EASI) and Investigator’s Global Assessment (IGA) scores were observed by the dermatologist after only 2 weeks of using the oat-based daily skin care regimen. Significant improvements in the skin barrier function of nonaffected skin and target lesions were measured at 2 and 4 weeks, respectively. Improvements in perceived itch (P \ .05) were also noted at the 2-week timepoint. Patients provided positive feedback after using the regimen, and they perceived multiple skin benefits, including improved skin texture, decreased discomfort, and an overall improved look and feel. In conclusion, this clinical study of a gentle oat-based regimen demonstrates the importance of the fundamentals of basic daily skincare when it comes to managing and caring for atopic skin. Commercial support: 100% sponsored by Johnson and Johnson Consumer Products Worldwide. P1303 Skin barrier function and hydration effects of hydrolipid cream alone and in combination in the treatment of mild to moderate atopic dermatitis: Investigator-blinded, split-body, pilot study results Leon Kircik, MD, Indiana University Medical Center, Indianapolis, IN, and DermResearch, PLLC, Louisville, KY, United States Introduction: Barrier disruption with increased transepidermal water loss (TEWL) is a feature of atopic dermatitis (AD) and other conditions characterized by dry skin. While these conditions have typically been treated with topical corticosteroids, a new class of prescription, nonsteroidal, 510(k) medical device options have been approved for the management and relief of burning, itching, and redness associated with AD. These options offer clinicians novel vehicle characteristics and formulations. Background: One of these devices is a reverse-phase cream formulation which contains a unique hydrolipid technology of 70% oil dispersed in 30% water. It is formulated to provide the occlusion and barrier protection of an ointment with the consistency and cosmetic appeal of a moisturizing cream. It can be used before, during, and after an atopic flare to hydrate and support the stratum corneum and as a safe adjunct with a topical corticosteroid. To further substantiate this, it is important to evaluate the skin barrier and skin hydration effects of this hydrolipid cream (HC) and a midpotency corticosteroid cream (SC) in combination. Methods: This 4-week, single-center, investigator-blinded, split-body pilot study enrolled 6 subjects with mild to moderate AD. All subjects applied the SC bilaterally to all affected areas and then were randomized to apply the HC only to either the left or right side of the body. Efficacy assessments included investigator global assessment of disease severity, standard TEWL measurements, and skin hydration via corneometry readings. Safety assessments were made throughout the study. Results: By week 4, the investigator global assessment showed significant mean changes within groups of -1.67 6 1.03 in the HC/SC-treated side versus -1.83 6 0.75 in the HC-treated side (P ¼ .0313). The mean percentage change in corneometry from baseline to week 4 of the average of all test areas was statistically significant within group in the HC/SC-treated side only at 12.31% 6 10.98% (P ¼.0405) versus 3.26% 6 8.35% (P ¼.3821) in the SC-treated side. No adverse events were reported. Conclusions: The hydrolipid cream can be used safely as monotherapy and in conjunction with a topical corticosteroid to increase hydration in pateits with mild to moderate AD. Commercial support: Poster production sponsored by Ferndale Laboratories, Inc. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5954_5957 16 January 2009 6:16 pm AB67 P1304 P1306 Effect of moisturizing treatments on dry skin of whites and African Americans Anthony Geralis, MD, MPH, Unilever R&D, Trumbull, CT, United States; Greg Nole, Unilever R&D, Trumbull, CT, United States; Jamie Regan, Unilever R&D, Trumbull, CT, United States New therapeutic antiinflammatory action of a natural PPAR-alfa agonist emollient versus topical steroids in atopic dermatitis Philippe Msika, Laboratoires Expanscience, Epernon, France; Bernard Chadoutaud, Clinreal Online, Toulouse, France; Caroline Baudouin, Laboratoires Expanscience, Epernon, France; Clarence de Belilovsky, Institut Alfred Fournier, Paris, France Skin dryness is a commonly observed physiologic condition that transcends any ethnicity. Although skin dryness is common, we know that there are variations in the way it presents on different skin complexions. On white skin, dryness appears visually as a range from fine white lines to severe flaking/fissuring. Ashiness is a manifestation of dryness only seen on darker skin, specifically African Americans in this research. Clinical studies were conducted to determine if the visual differences observed between dry leg skin of African Americans and whites had an effect on instrumental and visual assessments of skin hydration after moisturizer treatment. A 24-hour (single application) and a 5-day (twice-daily application) clinical study, consisting of both African American and white subjects, were conducted. Correlations between visual dryness, as assessed by an expert grader, and instrumental measurements also were performed for both skin complexions. Results from the 24-hour clinical studies showed no statistically significant differences between populations based on standard dry skin measures: Skicon, Corneometer, and visual dryness grading (0-4 point scale). Overall, both subgroups responded similarly to product treatment, though two interesting trends were observed: (1) in general, the whtie group trended to having higher average skin hydration values, and (2) in visual dryness, lotions with higher emollient loads appeared more responsive on African American skin. Results from the 5-day study showed similar trends, though again not at a statistically significant level. The visual presentation of dry skin varies based on ethnicity. These short- and longer-term moisturization clinical studies showed no statistically significant differences between populations in their response to product treatment; however, observations do suggest that the populations may respond more favorably to different product formulations leading to opportunities for targeted product benefits. Commercial support: 100% sponsored by Unilever HPC. Objectives: Atopic dermatitis (AD) is a chronic dermatosis requiring permanent skin care. This goal can be achieved by emollients, often in conjunction with topical steroids if needed. In a previous study, an emollient containing a natural patented active ingredient (2% sunflower oleodistillate [SOD]) has demonstrated a 75% corticosteroid sparing effect (steroid class II, desonide 0.05%). In this new European multicenter study, its applications have been compared to those of a more potent steroid (class III, hydrocortisone aceponate cream 1.27mg/g). Methods: During an open comparative study, two groups of 40 children with light to moderate AD have been included by 12 dermatologists. All children received soapfree washing oil. Group A applied the steroid two times a day on affected areas and group B the emollient on lesions and on the entire body two times a day. Children were examined, and Scoring Atopic Dermatitis (SCORAD) scores were established at days 0, 7, and 21. Quality of life questionnaires were filled at days 7 and 21. Results: The mean age of the children was 2.3 and 2.4 years in groups A and B. At day 0, SCORAD was similar in the two groups: 37.2 versus 36.9 (moderate AD). In both groups, improvements were statistically significant versus DO at day 7 (-49% and -48%) and day 21 (-70% and -75%). There were no statistic differences between SCORAD at day 21 (11 vs 9.4). All items of SCORAD improved in the same range except for xerosis which was naturally better improved by the emollient (-81%) than in the steroid group at D21 (-53%; P \.01). This latter result in the steroid group might be attributed to the soap-free washing oil. Investigator assessment stated that the emollient could reduce the frequency of atopic flares (93%) and the intensity of flares (90%), with no statistic difference between the two groups at day 21. Infant Dermatitis Quality Of Life (IDQOL) improved by 65% with the steroid and 72% with the emollient at day 21 (P \.01 vs D0 and no significant difference between two groups). Similarly, the Dermatitis Family Impact Questionnaire (DFIQ) score was reduced by 67% and 75% (idem). Conclusions: For the first time, a cosmetic emollient containing 2% patented SOD has demonstrated therapeutic properties comparable to those of a class III steroid in a 3-week comparative study. The impact on the quality of life tended to be better but did not reach a significant difference. These properties of the tested emollient on AD might rely on its natural agonist PPAR-alfa properties, previously demonstrated in vitro. Commercial support: 100% sponsored by Laboratoires Expanscience. P1307 Hygiene program for children with atopic dermatitis Philippe Msika, MD, Laboratoires Expancience, Epernon, France; Bernard Chadoutaud, Clinreal Online, Toulouse, France; Caroline Baudouin, Laboratoires Expanscience, Epernon, France; Clarence de Belilovsky, Institut Alfred Fournier, Paris, France; Franck Menu, Laboratoires Expanscience, Epernon, France P1305 Emollient body washes: Benefits for dry skin in older subjects Carol Vincent, Unilever R&D, Trumbull, CT, United States; K. P. Ananthapadmanabhan, Unilever R&D, Trumbull, CT, United States; Kumar Subramanyan, Unilever R&D, Trumbull, CT, United States It is known that the incidence of skin dryness (roughness, scaling, and itch) increases with age because of changes in structure of the stratum corneum (SC) and its water holding capacity. The type of cleanser used is a key determinant of the moisture level in the SC, because cleansers can strongly interact with the ‘‘moistureregulating’’ mechanisms in skin, such as the lipids and the natural moisturizing factors (NMFs). One of the emerging technologies in the cleansing market is to incorporate high levels of emollients into liquid cleansing systems to alleviate the symptoms of dry skin and to mitigate the damaging effects of cleanser surfactants. We present data from one clinical study to show the benefits of an emollient-rich liquid body cleanser on older individuals with dry skin under normal use conditions. Ninety-five subjects 45 to 65 years of age provided informed consent to participate in this institutional review boardeapproved study. Subjects underwent an initial conditioning phase, during which they discontinued the use of all moisturizers and used a marketed syndet bar for daily cleansing. Fifty-five subjects with sufficient leg dryness continued into the product application phase, where the legs where washed with the same cleanser, with and without emollients, once a day for nine consecutive days. A 3-day regression phase, where no product was applied to the legs, followed. Skin was evaluated by an expert clinical grader for dryness and erythema and assessed instrumentally for hydration (conductance and capacitance) and transepidermal water loss (TEWL; measure of SC barrier integrity) during the course of the study. Skin washed with the emollient-rich cleanser was significantly more hydrated and showed significantly lower TEWL values (better preservation of SC barrier) than skin treated with just the cleanser base. The emollient cleanser also resulted in significantly lower visual dryness and skin irritation compared to the cleanser without emollients. The emollient cleanser continued to provide a greater benefit to the skin during the regression phase. The findings from this study suggest that the benefits of emollient-rich body washes do manifest under controlled normal use test conditions, and that these products can provide a significant improvement to older, drier skin compared to body washes without moisturizers. Commercial support: 100% sponsored by Unilever HPC. AB68 Objectives: During atopic dermatitis (AD), all washing products must preserve the mechanical and biologic skin barrier function, soothe the skin, and even improve other skin cares. For that purpose, a cosmetic baby product hygiene line dedicated to atopic skin has been developed. All three products are perfume and paraben free. They all contain mild vegetal surfactants and sunflower oleodistillate (SOD), a patented molecule which stimulates lipogenesis via agonist PPAR-alfa properties. Methods: Each product has been tested, in open studies, on 100 children, aged [3 months, with light to moderate AD, by dermatologists, pediatricians, and pediatric nurses, during 3 weeks, in France and Spain. Other skin cares (emollients and steroids) were not changed and used as needed. Clinical examination (dryness, erythema, desquamation, and pruritus) and the quality of life assessments Infant Dermatitis Quality of Life (IDQOL) and Dermatitis Family Impact Questionnaire (DFIQ) were performed at days 0 and 21. Study A used a no-rinse cleansing water, used on the face, the body, or the nappy area as needed. Study B used a cleansing cream for hair and body, and study C used a milky bath oil, used either during shower or bath without rinsing. Results: Most of the children (3.6-5.3 yrs old) were included during a flare of AD (study A, 85%; B, 74%; C, 88%) and applied hygiene products on lesional skin (88%/95%/99%). Sisxty-six percent/89%/84% continued their usual emollient during the study period and 19%/48%/38% continued with their topical steroid (7%/14%/11% compared to 1 month earlier). In all three studies, all clinical and quality of life scores improved by at least 50% (P\.01) by day 21. For clinical scores, a comparison between children receiving solely hygiene products and combined to emollient and/or steroid showed no difference. Investigator assessments: The products are adapted to AD hygiene (study A, 95%; B, 99%; C, 86%) and decrease a given AD flare’s intensity (77%/77%/76%) and frequency (63%/74%/64%). For the parents, these products clean the skin softly (98%/100%/91%), especially on lesional skin (82%/98%/83%). They are nonirritating (98%/100%/99%), soothing (80%/88%/83%), hydrating (83%/84%/80%), and the child reacts favorably after application (92%/99%/94%). Conclusion: During ‘‘use-test conditions’’ studies, three specific AD hygiene products containing active patented ingredient (SOD), applied alone or associated to regular cosmetic skin cares and therapies, have demonstrated a [50% improvement both for clinical signs and of quality of life. Commercial support: 100% sponsored by Laboratoires Expanscience. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5954_5957 16 January 2009 6:16 pm P1308 P1310 Promotor region polymorphism of the CD14 gene (C-159T) is not associated in Korean patients with atopic dermatitis Young-Bok Lee, MD, Department of Dermatology, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu City, South Korea; Dong-Soo Yu, MD, PhD, Department of Dermatology, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu City, South Korea; Jin-Wou Kim, MD, PhD, Department of Dermatology, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu City, South Korea; Jung-Soo Kim, PhD, Department of Dermatology, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu City, South Korea Concomitant use of topical corticosteroids and pimecrolimus cream 1% in the treatment of severe pediatric atopic dermatitis has a safety profile comparable to topical corticosteroids alone Lawrence F. Eichenfield, MD, University of CA, San Diego, CA, United States; Michael Meurer, MD, Hautklinikum, Dresden, NA, Germany; Thomas Hultsch, MD, Novartis Pharma Corporation, Ease Hanover, NJ, United States; Vincent Ho, MD, University of British Columbia, Vancouver, British Columbia, Canada Though often the first-line treatment for atopic dermatitis (AD), the use of topical corticosteroids (TCS) can be limited by the risks of their potential side effects. In circumstances in which the extensive use of TCS for the treatment of AD is inadvisable, the use of pimecrolimus cream 1% can be an alternative, reserving TCS for the treatment of breakthrough flares. The primary objective of this study was to investigate the safety of concomitant use of pimecrolimus cream 1% plus TCS versus TCS alone for the treatment of severe AD in pediatric patients. In a 16-week (4-wk treatment period followed by 12-wk observational period), randomized, multicenter, parallel-group, vehicle-controlled study eligible patients, 2 to 17 years of age with severe AD were randomized in a 1:1 ratio to receive 4 weeks of treatment with either pimecrolimus cream plus TCS or corresponding vehicle plus TCS. During the treatment period, AD lesions were treated twice daily with fluticasone propionate cream 0.05% (or hydrocortisone acetate cream 1% for the face, neck, and intertriginous areas, if needed) and, approximately 5 minutes later, pimecrolimus cream 1% or vehicle. Patients who achieved treatment success (ie, ‘‘clear’’ or ‘‘almost clear’’) entered the 12-week observational phase. The KaplanMeier incidence rates of adverse events (AEs) of clinical interest (ie, AEs associated with the use of TCS) in each treatment group that occurred in the 4-week treatment period were compared. In all, 376 patients were randomized (193 to the pimecrolimus cream plus TCS group and 183 to the TCS group) at 65 centers in five countries (Italy, the United States, South Africa, Canada, and Germany). Of the 10 reported AEs of clinical interest, there was a trend toward a higher incidence of ‘‘erythematous rash’’ in the pimecrolimus cream plus TCS group compared to the TCS group (P ¼ .05). ‘‘Erythematous rash’’ included AEs that the investigator reported as ‘‘papular rash.’’ There was no other pronounced difference between the rates of other AEs of clinical interest, such as infected eczema, herpes simplex infection, or folliculitis. In pediatric patients with severe AD, the overall safety profile when using pimecrolimus cream and TCS concomitantly was similar to that when using TCS alone. The proportion of patients with individual AEs of clinical interest was low and, with the exception of ‘‘erythematous rash,’’ there were no pronounced differences in the frequency of these AEs between the treatment groups. Background: CD14 is found as a membrane-anchored molecule on the surface of monocytes, macrophages, and granulocytes and in a soluble serum protein (sCD14) form. A single nucleotide polymorphism at position 159 in the promoter of CD14 has been found to be associated with the levels of sCD14 and total serum immunoglobulin E. It is believed that the polymorphism of the CD14 gene is associated with the atopic phenotype. Objective: Herein, we sought to determine whether 159C/T polymorphism in the promoter of CD14 is associated with Korean atopic dermatitis (AD) and to assess its influence on clinical subtypes of Korean AD. Methods: This study performed a polymerase chain reaction of the promoter of the CD14 gene on the genomic DNA from 346 Korean patients with AD and 116 non-AD controls using a restriction fragment length polymorphism method. The serum levels of the total and specific IgE were measured by latex photometry immunoassay and enzyme-linked immunosorbent assay in patients with AD. Results: No significant differences in the CD14 genotype frequencies were found between the groups. The polymorphism was not associated with the total and specific IgE concentration nor the generation of the different clinical subtypes of AD. Conclusions: The results suggest that the CD14 (C-159T) polymorphism is not a major regulator in Korean AD. Commercial support: None identified. Commercial support: Poster production costs paid for by Novartis. P1311 Patient assessment of desonide hydrogel for the treatment of mild to moderate atopic dermatitis Donna Kerney, MD, InfoMedics, Inc., Woburn, MA, United States; Rosanne Ford, SkinMedica, Inc., Carlsbad, CA, United States; Vincent Gotz, PharmD, MS, SkinMedica, Inc., Carlsbad, CA, United States Purpose: To evaluate patients’ experiences with desonide hydrogel for the treatment of mild to moderate atopic dermatitis (AD). P1309 The changes of antimicrobial peptides and transepidermal water loss after topical appilcation of tacrolimus and ceramide-dominant emollient in patients with atopic dermatitis Chang Kwun Hong, MD, PhD, Chung-Ang University Medical Center, Seoul, South Korea; Ji Young Kim, MD, Chung-Ang University Medical Center, Seoul, South Korea; Kapsok Li, MD, Chung-Ang University Medical Center, Seoul, South Korea; Kwang Ho Yoo, MD, Chung-Ang University Medical Center, Seoul, South Korea; Seong Jun Seo, MD, PhD, Chung-Ang University Medical Center, Seoul, Dongjak-Gu, South Korea Three patients with AD were treated with tacrolimus in one lesion and ceramidedominant emollient in another one for 8 weeks. Follow-up evaluations were done for the changes of TEWL and AMPs. TEWL was significantly decreased on the both lesions applied with tacrolimus and emollient. In contrast, expression of AMP was increased on the both lesions. No significant difference between both lesions was observed. Tacrolimus and ceramide-dominant emollient influence on both TEWL and expressions of AMPs in patients with AD—namely, they have similar effects on both of two. We suggest that the immunologic response in patients with AD is related with the skin barrier function. The AMP barrier and permeability barrier seem to be colocalized. Methods: This prospective survey involves 717 US physicians who participated by identifying patients eligible for treatment with desonide hydrogel. Patients who elected to participate were to telephone a study coordinator, provide consent, and use an automated interactive voice response system or a secure Web site to complete surveys about their skin condition before use of desonide hydrogel and 3 weeks after treatment initiation. Parents and guardians were allowed to enroll their children and complete survey responses. The surveys included questions about previous medication use for AD, assessments of symptom severity, satisfaction, intent to continue, and recommendation of desonide hydrogel to others. Wilcoxon signed rank tests were used to evaluate the statistical significance of differences in severity ratings before and after treatment, as well as the difference in satisfaction with desonide hydrogel versus previous prescription medication for AD. Results: Of 497 patients enrolled, 201 (40%) completed pre- and posttreatment surveys (age range, 4 months-83 years; mean age, 34; 60% female). Patients completed the posttreatment survey an average of 26 days following treatment initiation with desonide hydrogel. After treatment, patients reported significant reductions (all P \.01) in mean symptom severity scores. Redness was reduced by 59% (5.9 vs 2.4), scaling/flaking by 59% (5.1 vs 2.1), and itching by 62% (5.5 vs 2.1) based on a scale of one (not at all severe) to nine (very severe). Patient satisfaction with desonide hydrogel averaged 7.7 on a scale of one (not at all satisfied) to nine (very satisfied). Among those who used a previous prescription for AD (n ¼ 139), the average satisfaction with desonide hydrogel was significantly higher than satisfaction with the previous prescription (7.7 and 4.1, respectively; P \ .01). Eighty-nine percent of patients indicated intent to continue using desonide hydrogel if needed, and 82% would recommend desonide hydrogel to others. Conclusions: Patients reported very favorable experiences after their treatment with desonide hydrogel. The significant reductions in symptom severity and high satisfaction with desonide hydrogel may enhance compliance with treatment. Commercial support: None identified. Commercial support: 100% sponsored by SkinMedica, Inc. Increased transepidermal water loss (TEWL) and down-regulated antimicrobial peptides (AMPs) are observed in patients with atopic dermatitis (AD). Tacrolimus and ceramide-dominant emollients are effective in the treatment of AD by preventing the production of inflammatory cytokines and by correcting skin barrier dysfunction, respectively. This study was designed to reveal the relationship between antimicrobial factors and barrier factors related to the development of AD by measuring the changes of AMPs and TEWL after topical application of tacrolimus and ceramide-dominant emollient in the biopsy specimens of the AD patients. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5954_5957 16 January 2009 6:16 pm AB69 P1312 P1314 Eczema herpeticum during treatment of atopic dermatitis with tacrolimus ointment 0.1% Ingrid Aguayo, MD, MBBS, Hospital Ramon y Cajal, Madrid, Spain; Irene Salgüero, MD, Hospital Ramón y Cajal, Madrid, Spain; Lucia Pérez, MD, Hospital Ramón y Cajal, Madrid, Spain; Pedro Jaén, MD, Hospital Ramón y Cajal, Madrid, Spain Clinical comparison of an over the counter body lotion to prescription lotions Jamie Regan, Unilever R&D, Trumbull, CT, United States; Greg Nole, Unilever R&D, Trumbull, CT, United States Introduction: The topical inmunomodulators tacrolimus and pimecrolimus have proven to be effective in managing atopic dermatitis (AD). Skin infections occur as side effects associated with topical steroid and topical tacrolimus in AD with incidences of approximately 2% and 20%, respectively. In particular, eczema herpeticum (EH), caused by the herpes simplex virus (HSV), is seen in 4% of AD patients during topical tacrolimus treatment. Case report: We present the case of a 29-year-old male with long-standing AD resistant to topical steroids; he had been treated with topical inmunomodulators during the last year with good response. He developed generalized herpetic lesions on his face on the tenth day of treatment with tacrolimus ointment 0.1% for a lesion eroded in the upper lip. He did not have a fever or lymphadenopathies. The physical examination showed a pustulovesicular eruption on the face, neck, and chest. According to the patient’s signs the diagnosis of EH was made. The patient was successfully treated with oral acyclovir 200 mg five times per day for 14 days, with complete resolution of skin lesions. Discussion: According to current concepts, the predisposition of patients with AD for viral infection reflects a basic dysfunction of cell-mediated immunity combined with local factors. Tacrolimus and pimecrolimus are immunomodulatorsm and it is conceivable that these treatments increase the patient’s chances to acquire viral infections. EH is a well known complication of AD. Although other cases of EH during treatment with tacrolimus 0.1% have been reported, the available literature is not enough to link this therapy with an increased risk for EH, nor to exclude the association. Severe xerosis or severe dry skin is a common problem that presents symptoms of redness, tightness, cracks, scales, and flakes. At the highest level of severity, bordering on diseased skin condition, patients may turn to prescription products to address chronic symptoms. However, these patients could be potential candidates for a nonsteroidal over the counter (OTC) skin protectant that is properly balanced with high moisturization benefit. OTC lotions positioned to deliver ‘‘clinical strength moisturization’’ are now being seen as an alternative to prescription products by offering high level moisturizing benefit equivalent to prescription products while maintaining excellent aesthetics and lower costs. In a series of clinical trials, assessments of hydration potential were made over short (10-min) and long (24-hr) time periods to evaluate the immediate and sustained moisturization benefits. A 2-week regression test was conducted on severe dry skin under harsh winter conditions to evaluate the ability to treat the symptoms of dryness. In each test, the OTC skin protectant was compared to three prescription products that were recently introduced for xerosis and dermatosis. Results from these clinical studies demonstrate that a high-moisturizing skin protectant OTC product can deliver equal or better skin hydration benefits and visual improvement to dry skin than some prescription lotions, suggesting that a well formulated nonsteroidal OTC skin protectant can be an effective and lower cost alternative option for patients with severely dry but not diseased skin. Commercial support: 100% sponsored by Unilever HPC. Commercial support: None identified. P1315 P1313 A randomized double-blind controlled trial to compare a triclosancontaining emollient with vehicle for the treatment of atopic dermatitis Wee Ping Tan, National Skin Center, Singapore; Anthony Goon, MBBS, National Skin Center, Singapore; Shirley Suresh, MD, SGS Life Science Services, Singapore; H. L. Tey; L. Y. Chiam Background: The use of topical antiseptics in the treatment of AD has previously been explored. However, no triclosan incorporated stay-on emollient has been evaluated previously. Aims: The aims of this study were to assess the safety and efficacy of a novel triclosanincorporated emollient cream compared to its vehicle for the treatment of AD. Methods: Eligible patients with mild to moderate AD were randomized to receive either study cream or vehicle. All patients also received a low potency corticosteroid cream during the treatment phase of the study. They were assessed for severity according to the the Scoring Atopic Dermatitis (SCORAD) index, amount of corticosteroid used and patient’s impression of cream, and adverse events. Results: Thirty patients each received study cream or vehicle and an intention-totreat analysis was performed. No patients dropped out of the study or were lost to follow-up. At day 14, there was a significant decrease in SCORAD from baseline for study cream compared to vehicle (P ¼ .035). At day 27, although there was an improved mean reduction from baseline, this was no longer statistically significant (P ¼ .399). Eighty-seven percent of the patients had a ‘‘good’’ or ‘‘excellent’’ impression of the cream and only four patients had mild treatment-related adverse events. The amount of topical steroids applied by the study cream arm of patients was significantly lower than the vehicle arm (P ¼ .021). Improvement of skin barrier function and moisturization of a novel nonsteroidal emollient foam for the treatment of atopic dermatitis Ronald Gurge, MD, PhD, Collegium Pharmaceutical, Cumberland, RI, United States; Wendy Schilling, Collegium Pharmaceutical, Cumberland, RI, United States Atopic dermatitis, also known as atopic eczema, is a hereditary and noncontagious skin disease characterized by chronic skin inflammation. Patients diagnosed with atopic dermatitis often present with epidermal barrier dysfunction, resulting in an increase of transepidermal water loss (TEWL). Topical treatment options include emollient and steroid therapies designed to provide moisture and reduce the inflammation associated with the condition. Recently, nonsteroidal topical therapies have become available that help to manage and relieve the symptoms associated with various types of dermatoses. These products help to relieve dry, waxy skin by maintaining a moist environment, which is beneficial to the healing process. A novel aerosol foam has been developed to improve barrier function and deliver effective skin moisturization while providing aesthetic advantages, which may increase patient compliance for this often chronic condition. Conclusion: Triclosan-incorporated stay-on emollient was safe and acceptable to patients. It had an overall greater benefit to AD patients, albeit not statistically significant. The amount of topical steroids applied by the study cream arm of patients was significantly less compared to the vehicle arm and further studies would be needed to confirm its steroid-sparing effect. To assess the in vivo skin moisturization and barrier repair performance of the foam product, two single-blind clinical studies were designed to measure the product’s ability to increase stratum corneum hydration and decrease TEWL. In the first study, the water content of the stratum corneum was measured using a Moisturemeter SC (Delfin Technologies) at baseline (pretreatment) followed by posttreatment with the foam. In the second study, TEWL of the epidermis was measured using a Tewameter (Corage and Khazaka) at baseline, posttreatment with sodium lauryl sulfate (designed to disrupt the stratum corneum barrier function) and followed by the foam treatment. The results of both of these studies demonstrate that this product, which offers a number of application advantages because of its foam formulation, is effective in repairing barrier function and improves skin moisturization. The aerosol foam, which contains sodium hyaluronate, ceramides, and a lipid-rich antiinflammatory Amazonian oil, may be preferred by patients and physicians seeking a unique treatment regime. Commercial support: 100% sponsored by Hygieia Healthcare Ltd. Commercial support: 100% sponsored by Onset Therapeutics. AB70 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5954_5957 16 January 2009 6:16 pm P1316 P1318 Performance of novel humectant system on healthy skin: Longer-term improvement of skin condition Carol Vincent, MMSc, Unilever R&D, Trumbull, CT, United States; Anthony Geralis, Unilever R&D, Trumbull, CT, United States; Greg Nole, Unilever R&D, Trumbull, CT, United States; Prem Chandar, Unilever R&D, Trumbull, CT, United States AN2898 inhibits cytokines relevant to topical treatment of psoriasis and atopic dermatitis Virginia Sanders, MD, Anacor Pharmaceuticals, Inc., Palo Alto, CA, United States; Michael Alley, PhD, Anacor Pharmaceuticals, Inc., Palo Alto, CA, United States; Richard Kimura, MS, Anacor Pharmaceuticals, Inc., Palo Alto, CA, United States; Tsutomu Akama, PhD, MS, Anacor Pharmaceuticals, Inc., Palo Alto, CA, United States AN2898 (5-(3,4-dicyanophenoxy)-1-hydroxy-1,3-dihydro-2,1-benzoxaborole) is a broad spectrum antiinflammatory compound currently in development for the topical treatment of plaque psoriasis and atopic dermatitis. It inhibits the release of tumore necrosis factor-alfa (TNFa), interleukin (IL)-12, and IL-23. AN2898 also inhibits the activity of phosphodiesterase (PDE) 4 and 7. AN2898 IC50 values for inhibition of PDE4 and PDE7 activity is 0.06 and 0.21 M, respectively. AN2898 is a competitive, reversible inhibitor of PDE4 with a Ki of 65 nM. The AN2898-PDE4B2 catalytic domain cocrystal structure shows that AN2898 interacts directly with the metal ions and water molecule in the active site. This binding configuration is unique compared to classical PDE4 inhibitors (ie, rolipram). AN2898 has equal activity against the four PDE4 subtypes and does not significantly inhibit PDEs 1, 2, 3, 5, or 6. Like other PDE4 inhibitors, AN2898 inhibits the release of TNFa (IC50 ¼ 0.28 M), interferon-g (IC50 ¼ 0.13 M), and IL-5 (IC50 ¼ 0.24 M), as well as IL-2 and IL-10, and does not inhibit IL-1b, IL-6, and IL-8. Unlike classical PDE4 inhibitors, AN2898 also inhibits IL-12 p70 (IC50 ¼ 0.016 M) and IL-23 (IC50 ¼ 1.1 M). These are important cytokines in the treatment of psoriasis, and are not linked to PDE4 inhibition. In conclusion, AN2898 shows significant activity against cytokines associated with inflammatory disease. Xerosis or dry skin is a common problem that presents symptoms of redness, tightness, cracks, scales, and flakes. These symptoms can be alleviated and improved through the use of over the counter moisturizing products that typically rely on occlusives to seal in moisture and humectants to hold onto the water. Glycerol, a common humectant in body care products, is able to provide significant moisturization benefits to the skin. A common complaint with lotions containing a high concentration of glycerol is the tacky skin feel. In order to provide superior long-lasting performance without the negative sensory aesthetics associated with high levels of glycerol, new humectants are required. In 2-week double-blind clinical studies, the performance of moisturizing products containing a novel humectant system was evaluated or compared to lotions containing glycerol under controlled normal use conditions. In addition to assessing skin condition via expert visual grading and instrumental hydration assessments, barrier function (transepidermal water loss) and levels of biochemical markers (eg, natural moisturizing factor) were determined. Results from the studies showed that longer-term use of lotions containing novel humectant systems resulted in significantly improved barrier function and an increase in skin hydration. The visual appearance of dry skin also was significantly reduced. Increases in skin biochemical markers were observed during the course of treatment indicating an additional skin benefit. In conclusion, lotions based on novel humectant system deliver excellent clinical performance without the sensory negatives associated with high levels of glycerol. Commercial support: None identified. Commercial support: 100% sponsored by Unilever HPC. DERMATITIS, CONTACT AND ALLERGIC IRRITANTS P1400 P1317 Structure-activity studies led to the discovery of AN2898 in development for topical treatment of psoriasis and atopic dermatitis Tsutomu Akama, PhD, Anacor Pharmaceuticals, Inc., Palo Alto, CA, United States; Jacob Plattner, PhD, Anacor Pharmaceuticals, Inc., Palo Alto, CA, United States; Richard Kimura, MS, Anacor Pharmaceuticals, Inc., Palo Alto, CA, United States; Virginia Sanders, PhD, Anacor Pharmaceuticals, Inc., Palo Alto, CA, United States; Yvonne Freund, PhD, MS, Anacor Pharmaceuticals, Inc., Palo Alto, CA, United States AN2898 (5-(3,4-dicyanophenoxy)-1-hydroxy-1,3-dihydro-2,1-benzoxaborole) is a broad spectrum antiinflammatory compound currently in development for the topical treatment of plaque psoriasis and atopic dermatitis. The structure-activity relationships (SAR) of a novel class of boron-containing phosphodiesterase 4 (PDE4) inhibitors as antiinflammatory agents were investigated. Previous SAR study showed that the 49-cyano group on the phenoxy group was important for the inhibitory activity against PDE4 and cytokine release. In this study, effects of introduction of the second group onto either 29- or 39- position of the 49-cyanophenoxy group were investigated. Introduction of alkoxy and halogen groups resulted in enhanced activity. Introduction of bulky side chains containing tertiary amides retained the inhibitory activity against PDE4 and tumore necrosis factor-alfa (TNFa) release. Introduction of polar groups, such as carboxy and aminomethyl groups, attenuated the activities. AN2898 inhibited PDE4 with an IC50 value of 0.06 M. AN2898 also inhibited the release of TNFa from peripheral blood mononuclear cells stimulated by lipopolysaccharide (LPS) and the release of interleukin-23 from THP-1 cells stimulated by LPS plus interferon-g with IC50 values of 0.28 M and 1.1 M, respectively. These data led to the selection of AN2898 as a developmental candidate for topical treatment of inflammatory skin diseases. Commercial support: None identified. Ultrastructural abnormalities of epidermal barrier in chronic irritant hand dermatitis Yun-Ting Su, Department of Dermatology, National Cheng-Kung University Hospital, Tainan, Taiwan; Hamm-Ming Sheu, MD, Department of Dermatology, National Cheng-Kung University Hospital, Tainan, Taiwan; Jui-Chen Tsai, PhD, Institute of Clinical Pharmacy, National Cheng-Kung University, Tainan, Taiwan; Kai-Jhe Wei, MD, Department of Dermatology, College of Medicine, National Cheng Kung University, Tainan, Taiwan Background: Chronic irritant contact dermatitis of the hand (CIHD) in housewives and cleaners is still an occupational and social problem. Damage to the horny layer with impaired skin barrier is the hallmark of CIHD; however, previous routine transmission electron microscopy of CIHD showed no ultrastructural difference between lesional and normal skin, which may related to the fact that osmium tetroxide, which is used in routine fixation, has not been effective in demonstrating the spatial organization of stratum corneum (SC) intercellular lipids. In the present work, a ruthenium tetroxide (RuO4) fixation technique was applied to view the detailed ultrastructural changes of the SC epidermal lipids, which represents the water permeability barrier. Methods: Twenty-one patients with CIHD were studied. Skin biopsies were performed from the dry, fine scaling lesions of palmar finger (16) and palm (6), and also from the clinically uninvolved skin of patients’ palmar finger (5) and palm (7) for control. Normal palmar skin samples from six healthy volunteers were taken. Each specimen was divided into three parts and processed for histopathologic, histochemical, and electron microscopic examinations. Nile red staining of frozen tissue sections was done for fluorescence localization of lipids and observed under confocal laser scanning microscope. SC intercellular lipids were observed by electron microscope after RuO4 fixation. Results: The histopathologic changes of lesional skin showed mild to moderate hyperkeratosis, parakeratosis, and acanthosis with mild spongiosis. Nile red stain showed numerous fine immunofluorescent granules within the corneocytes, in contrast with the normal skin where immunofluorescence is limited to the intercellular membrane regions of the SC. Electron microscopic examinations of the RuO4-stained normal skin revealed typical multiple intercellular lipid lamellae between corneocytes. On the other hand, extensive disorganization of intercellular lipid lamellae was noted in CIHD. Numerous amorphous lipid droplets within the corneocytes were also observed. Furthermore, the destruction of corneodesmosomes with obvious dilatation of lacunae was observed within the intercellular domains in CIHD. Conclusion: Our results revealed extensive structural defects of SC intercellular domains, including disorganization of lipid bilayers, corneodesmosome destruction, and lacunar dilatation in lesional skin of CIHD. Commercial support: None identified. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5954_5957 16 January 2009 6:16 pm AB71 P1401 P1403 Lanolin allergy: A 500 patient patch test assessment of six pharmaceutical grade lanolins Joseph F. Fowler, MD, Dermatology Specialists, Louisville, KY, United States; Jennifer H. Perryman, MD, Dermatology Specialists, Louisville, KY, United States; Lynn M. Fowler, RN, Dermatology Specialists, Louisville, KY, United States; Nigel Langley, PhD, MBA, Croda Inc, Edison, NJ, United States Contact dermatitis to vascular tape used for fluoroscopy: A case report Dina Elrashidy, MD, Henry Ford Hospital, Detroit, MI, United States; Holly A. Kerr, MD, Henry Ford Hospital, Detroit, MI, United States We report a case of a 59-year-old African American male with a history of peripheral vascular disease who was referred to dermatology for persistent cellulitis of his left lower extremity that did not respond to antibiotics. The physical examination revealed erythematous grouped papules coalescing into a thin plaque in a linear array on his left thigh and a linear scaly, erythematous patch, which was markedly squared off at its inferior end extending from his left knee to his lateral shin. About a week before the rash developed, the patient had a left SilverHawk atherectomy of his superior femoral, popliteal, and posterior tibial arteries. Vascular tape used for fluoroscopy was placed on his left lower extremity during this procedure. Histopathology showed subacute spongiotic dermatitis with eosinophils. The patient was treated with triamcinolone 0.1% ointment and his rash and pruritus improved. We preformed patch testing with the T.R.U.E. test and also patch tested him to various tapes, including the vascular tape used during his procedure. At his 48-hour and 1-week patch test readings, he had a 21 and a 31 reaction, respectively, to the vascular tape. Although this vascular tape is widely used in vascular procedures involving fluoroscopy or radiography, a review of the literature did not reveal any similar cases. Background: Although there have been numerous patch test studies performed on lanolin since the 1950s, the prevalence of allergy to lanolin remains controversial; perhaps in part because of the heterogeneity of substances making up lanolin and probably more importantly to the level of purification performed. Lanolin is the purified waxy material that is secreted by the sebaceous glands of the sheep. It is a highly complex mixture of wax esters, comprised of sterol, aliphatic, and branched chain compounds. Objective: This study was conducted to help determine the prevalence of positive patch test reactions to six pharmaceutical grade lanolins (USP, USP modified, PhEur compliant; differing only in the degree of purification) as compared to lanolin alcohols (30% wt/wt in mineral oil; standard material in allergen patch tests). Methods: Five hundred consecutive patients were tested to lanolin alcohols and six pharmaceutical grade lanolins as part of diagnostic patch testing. Patches were applied with Finn chambers for about 48 hours, with readings performed at 48 hours after patch removal. Grading was according to the NACDG scale of 0 (no reaction) to 3 (strong reaction). Results: A positive patch test rate of \0.1% was observed for all of the six pharmaceutical grade lanolins, whereas a greater proportion of the patients showed some level of reactivity to 30% wt/wt lanolin alcohols in mineral oil. Irritant patch test reactions were not uncommon with the lanolin alcohol. Conclusion: The prevalence of patch test reactions to the six pharmaceutical grade lanolins was very rare. The relevance of the reactions to lanolin alcohols needs further assessment. Commercial support: None identified. Commercial support: 50% sponsored by Croda Inc. P1402 Efficacy of chlorohexidine cream shampoo in the control of dandruff: A randomized control double-blind trial Gabriel J. Martinez-Diaz, Stanford, CA, United States; Howard Maibach, MD, San Francisco, CA, United States; Sarath Raju, MPH, San Francisco, CA, United States Background: Dandruff remains a prevalent chronic scalp conditions affecting a large number of the world’s population, regardless of age, gender, and/or ethnic background. Given its long-term nature, effective pharmacologic treatments in the form of medically active shampoos have predominated the treatment methods. Objective: The aim is to establish the clinical effectiveness of a chloroxine cream shampoo for the treatment of dandruff in adult patients. Methods: Double-blinded randomized groups of overall healthy adult males with dandruff were assigned to an experimental group (n ¼ 12, chloroxine-based shampoo), and a placebo group (n ¼ 12, cream-based shampoo). Evaluations of effectiveness of the treatments in eliminating dandruff were conducted at the beginning of treatment and at 2 and 4 weeks posttreatment using the adherent scalp flaking scale (ASFS). Statistical differences between the groups and different time points were tested using the Mann-Whitney-Wilcoxon test. Results: The subjects receiving the chloroxine-based shampoo had an overall decrease in their ASFS grade of 1.40 (P ¼.028) on a 0 to 9 scale when compared to only a 0.20 placebo decrease of the ASFS grade. A significant difference was only observed between initial treatment and 4 weeks posttreatment. Conclusion: A chloroxine-based shampoo was found clinically effective in the treatment of dandruff symptoms after 4 weeks of treatment, when compared to placebo. Commercial support: None identified. AB72 P1404 Comparison of identical patch test allergens from different commercial sources in Brazil Hermenio C Lima, RN, Universidade Federal do Parana, Curitiba, PR, Brazil; Giseli Mattos Diosti, MD, Universidade Federal do Parana, Curitiba, PR, Brazil; Mariana Lechitzki, Universidade Federal do Parana, Curitiba, PR, Brazil; Mauricio Sato, MD, Universidade Federal do Parana, Curitiba, PR, Brazil; Mireille Machado, MD, Universidade Federal do Parana, Curitiba, PR, Brazil Contact dermatitis is a dermatosis caused by development of sensitized T lymphocyte, which induces a delayed type hypersensibility. Patch test is the best test available to confirm diagnosis. Few studies exists comparing different types of patch tests on the same population and evaluating their specificity and sensitivity. We compare two patch test batteries commercialized in Brazil. Nine hundred tests in 15 volunteers have been carried out, whose characteristics were similar to a general Brazilian population. The tests were divided into two groups: A and B. Negative agreement occurred in 95.78% of the tests. Twenty-four tests presented with allergic agreement (2.67%) and 14 (1.55%) presented with no agreement. Hydroquinone, irgasan, fragrance mix, p-Phenylenediamine (PPD) mix, and promethazine had been the tests with lower efficiency for test B. Otherwise, balsam of Peru for test A. The two set reproducibility were similar. Set choice depends upon center preference and economic impact. In special cases where hydroquinone, irgasan, fragrance mix, PPD mix, promethazine, and balsam of Peru clinical suspicion of allergy exist, special attention must be given to set choice. Commercial support: None identified. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5954_5957 16 January 2009 6:16 pm P1405 P1501 Lupus erythematosus induced by oral fluoropyrimidine Tomohiko Narita, MD, PhD, Department of Dermatology, Kinki University of Medicine, Osaka, Japan We report a rare case of lupus erythematosus (LE) induced by oral fluoroprymidine. A 48-year-old female visited our clinic on December 5, 2006. The chief complaint was erythema on her face and cervical spine. She had been diagnosed with a scirrhous carcinoma in a private clinic in September 2006 and was sent to the tumor internal medicine departmentof Kinki University hospital. She started taking oral fluoroprymidine TS-1, which contained a dihydropyrimidine dehydrogenase inhibitor, on October 6, and thereafter a slight erythema appeared on her face, cervical spine, and the anterior surface of her chest. The erythema lasted 3 weeks and disappeared after one treatment session of TS-1. Two weeks after the second session of TS-1, in November, the erythema was seen on both cheeks and the nose 2 weeks later. She was sent to the dermatology department. The physical examination revealed butterfly-like erythema on her face, and small erythemas were seen on the lip and the lower jaw, but not seen on the hands and feet. The skin biopsy from erythema on the lower jaw showed epidermal atrophy, liquefaction degeneration in the basal layer, and perivascular lymphocytic infiltration in the entire dermis. The antinuclear antibody test was positive, while other autologous antibody tests were negative. From clinical, laboratory, and histopathology findings, this patient was diagnosed as having drug-induced lupus erythematosus related to TS-1. Epidermal growth factorelike domains of laminin-5 in the tumor microenvironment Kien Tran, MPH, MBBS, University of Texas Southwestern Medical Center, Dallas, TX, United States; Antoanella Bardan, MD, University of Texas Southwestern Medical Center, Dallas, TX, United States; Clay Cockerell, MD, University of Texas Southwestern Medical Center, Dallas, TX, United States Commercial support: None identified. Cell migration and proliferation is a crucial process for invasion and metastasis of cancers. The tumor microenvironment secreted and modulated by various cancers such as squamous cell carcinoma has been implicated with this process. With regard to this tumor microenvironment, the extracellular matrix protein laminin-5 (laminin 332) has been associated with increased invasiveness of various malignant neoplasms. Laminin-5 contains epidermal growth factor (EGF)-like repeat subdomains that, after release by matrix metalloproteinases, have been proven to signal via epidermal growth factor receptor in vitro to enhance cell migration. Within this work, we examine the unique properties of this domain and how its expression is correlated with the status of a benign or malignant neoplasm. We examine the expression profile of the laminin-5 EGF-like repeats within various cutaneous cancers, benign tumors, and precancerous lesions via immunohistochemical stains for the EGF-like domain. Our current data suggest that strong focal expression can differentiate between actinic keratosis versus keratoacanthoma, squamous cell carcinoma in situ, and squamous cell carcinoma. Dermal expression can also differentiate between normal scars versus keloids. Finally, little staining is seen within dermatofibromas and dermatofibromasarcoma protuberans. We also examine the profile of MT1-MMP, which can release the EGF-like domain of laminin-5 into the tumor microenvironment. Current data suggest that strong expression of laminin-5 and its corresponding EGF-like domain in tumors capable of expressing laminin-5 is correlated with cancer pathogenesis. Commercial support: None identified. P1502 A 64-year-old immunosuppressed female with a history of liver transplant for primary biliary cirrhosis was admitted for evaluation of a lower gastrointestinal bleed. Her course in the hospital was complicated by multisystem bacterial infections. The patient developed multiple purpuric lesions with overlying flaccid bullae and erosions on the lower extremities. A skin biopsy demonstrated multiple dematiaceous hyphal elements with epidermal necrosis, vascular thrombosis, and vasculitis. Several blood cultures were positive for Scedosporium prolificans. In spite of systemic antifungal therapy, the patient died. S prolificans is a dematiaceous fungus that was first described in 1984. Fungal spores can infect a patient through inhalation, the gastrointestinal tract, surgical wounds, or trauma. S prolificans can cause infection in three different settings: (1) respiratory tract colonization in patients with cystic fibrosis or solid organ transplants, (2) localized infection in immunocompetent and immunocompromised patients, and (3) disseminated infections in immunocompromised hosts. Frequent clinical manifestations of S prolificans infection in immunocompromised patients include relapsing fever and neutropenia. Skin lesions are typically described as multiple, ulcerated, nonhealing erythematous nodules. Dermatopathology findings have been infrequently reported and include epidermal hyperplasia, granulomatous inflammation, and dermal necrosis. We present a case of disseminated S prolificans infection with distinct clinicopathological findings of purpuric and bullous lesions with underlying vascular thrombosis and vasculitis. The value of skin biopsy in inflammatory dermatoses Ratna Rajaratnam, MD, University Hospital North Staffordshire NHS Trust, Stoke on Trent, West Midlands, United Kingdom; Andrew Smith, MBBS, University Hospital North Staffordshire NHS Trust, Stoke on Trent, West Midlands, United Kingdom; Mark Stephens, MBBS, University Hospital North Staffordshire NHS Trust, Stoke on Trent, West Midlands, United Kingdom; Milan Mehta, MBChB, University Hospital North Stafforshire NHS Trust, Stoke on Trent, West Midlands, United Kingdom The skin biopsy is considered one of the most important diagnostic tools in dermatology. While histology of a neoplastic lesion (eg, a basal cell carcinoma) can be straightforward, biopsy of an inflammatory dermatosis is more complicated as often several dermatoses appear histologicly similar. This study aims to establish the value of skin biopsy as a diagnostic test for inflammatory dermatoses. Inclusion criteria were any cases where inflammatory dermatoses were recorded in the differential diagnosis. A gold standard test should be sensitive, specific, and provide an answer without relying on other factors (eg, history). Biopsy specimens were therefore initially reviewed ‘‘blind’’ without clinical data to establish what information could be obtained. Authors 1 (resident) and 2 (consultant dermatologist) reviewed 100 consecutive biopsy specimens over a 5-month period. Once the prehistory diagnosis was recorded, the clinical data were provided and a posthistory diagnosis made and compared to the final working diagnosis. The author’s findings were verified by comparison to formal pathology reports. In 98 of 100 cases, there was correlation. Specimens were evaluated for crush artefact, size, and depth. In 55 of 100 cases, histology was able to strongly suggest a prehistory diagnosis. In this category, tumors were most common (n ¼ 11), followed by prurigo nodularis (n ¼ 8), lichen planus (n ¼ 5), vasculitis (n ¼ 5), and pigmented purpuric dermatosis (n ¼ 4). Prehistory ‘‘blind’’ histology precisely identified 2 of 9 bullous dermatoses, 1 of 3 discoid lupus, 0 of 3 psoriasis, 0 of 2 pseudolupus erythematosus and 0 of 2 granuloma annulare. In 31 of 100 cases, histology was able to provide a differential diagnoses. In 21 of 31, a diagnosis was reached posthistory with clinicopathological correlation. In 12 of 100, histology was only able to provide a descriptive pattern analysis, mostly superficial perivascular dermatitis. In 2 of 100, no pattern analysis could be made. The authors found eight cases where histology appeared less useful. The final diagnosis was based primarily on clinical findings; biopsy findings were disregarded by the clinician. Histology provided a new diagnosis which had not been considered clinically and accepted as the final diagnosis in 13 of 100 cases. The approximate mean tissue volume received from a punch biopsy (PB) was 51 mm3 and incisional biopsy (IB) was 289 mm3. The specimen was of poor depth in 13 of 69 PBs and 7 of 24 IBs. We conclude that a biopsy for inflammatory dermatoses is a valuable tool. In 13%, the biopsy provided a working diagnosis which had not been considered clinically. Excluding tumors (inflammatory dermatoses only), histology provided a working diagnosis in 67% of cases. The diagnostic boundaries of dermatopathology are such that in a third of cases, a diagnosis was reached only with aid of clinical data, proving the importance of providing a well thought out differential diagnosis. Twenty-five percent of specimens had inadequate fat, a more evident problem in the PB specimens. Commercial support: None identified. Commercial support: None identified. DERMATOPATHOLOGY P1500 Disseminated Scedosporium prolificans infection Esteban Fernandez-Faith, MD, Cleveland Clinic, Cleveland, OH, United States; David Hamrock, MD, Cleveland Clinic, Cleveland, OH, United States; Najwa Somani, MD, Cleveland Clinic, Cleveland, OH, United States; Steven Billings, MD, Cleveland Clinic, Cleveland, OH, United States MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5954_5957 16 January 2009 6:16 pm AB73 P1503 P1505 Equivalent histologic findings in atypical nevi from patients with and without melanoma Alyssa Hoverson, DO, Mayo Clinic, Rochester, MN, United States; Roger Weenig, MPH, MD, Mayo Clinic, Rochester, MN, United States Indeterminate cell histiocytosis: A case report and novel immunohistochemical finding Lonnie Hammonds, MD, Mayo Clinic Jacksonville, Jacksonville, FL, United States; John Snow, MD, Mayo Clinic Jacksonville, Jacksonville, FL, United States Objective: To determine if individual atypical histologic features in melanocytic nevi predict melanoma risk, and if so, to quantify the magnitude of this risk. Methods: Four hundred thirty skin pathology slides with a histologic diagnosis of ‘‘atypia’’ were sequentially retrieved by patient identification number from 172 patients seen at the Mayo Clinic in Rochester, MN between 1992 and 2004. After blinding to clinical history and diagnosis, age, gender, and previous pathologic diagnosis, microscopic examination of all skin biopsies was performed and the presence or absence of 18 histologic features was recorded. The frequency of each ‘‘atypical’’ histologic feature in melanocytic nevi from patients with and without a history of melanoma was compared using a 2-tailed Pearson x2 analysis. P # .05 was considered statistically significant. Results: The frequency of each atypical histologic feature was similar in the melanocytic nevi obtained from patients with and without a history of cutaneous malignant melanoma. No statistically significant difference was observed for any feature by univariate or multivariate analysis. Two (0.5%) of the biopsies were interpreted as melanoma and were excluded from the analysis. We present a case report of an 85-year-old male with indeterminate cell histiocytosis. During a routine skin cancer follow-up examination, a diffuse eruption of 2- to 3-mm, monomorphic, red-brown papules was noted. Biopsy revealed a dense histiocytic infiltrate in the upper dermis. The histiocytes exhibited abundant, periodic acideSchiff positive, eosinophilic cytoplasm. These cells stained positively for CD1a and S100 and negatively for CD68 and factor XIIIa. Interestingly, these cells were negative for Langerin. Electron microscopy did not demonstrate classic Birbeck granules within these cells. Based upon the clinical presentation, histopathology, and ultrastructural analysis, a diagnosis of indeterminate cell histiocytosis was made. This is an exceedingly rare variant of cutaneous histiocytosis which may be differentiated from Langerhans cell histiocytosis by three cardinal features: the lack of Birbeck granules on ultrastructural study, the absence of epidermotropism on histopathology, and the lack of extracutaneous involvement. The absence of Langerin staining in this disorder has not been previously reported but may also be characteristic. These cells typically express both Langerhans cell and monocyte/macrophage markers. It has been postulated that the indeterminate cell may represent an immature Langerhans cell or an indeterminate type of dendritic cell. Conclusions: Atypical histologic features are identified with an equivalent frequency in patients with or without a history of melanoma. The findings in this study suggest that identification of ‘‘atypical’’ histologic features in an otherwise benign melanocytic nevus does not equate to increased risk for melanoma. Given that two (0.5%) of the lesions originally believed to represent atypical nevi were confirmed to be melanomas, these findings support the assertion that atypical nevi possess histologic features in common with melanoma. Furthermore, given that both of these melanomas were incomplete samples of larger pigment lesions, complete removal of all suspicious pigmented lesions at initial biopsy is recommended. Commercial support: None identified. Commercial support: None identified. P1506 Can lesions present as rashes? A pathologist’s clue to the diagnosis Victoria Helen Smith, MD, Royal Liverpool & Broadgreen University Hospitals NHS Trust, Liverpool, Merseyside, United Kingdom; Paul D Yesudian, MBBCh, Countess of Chester Hospital NHS Foundation Trust, Chester, Cheshire, United Kingdom P1504 Paclitaxel-induced papular eruption with ringed mitoses Mark Tusa, Texas A&M Health Science Center College of Medicine, Temple, TX, United States Abnormal mitotic figures may be seen histologicly in skin biopsies performed after the application of podophyllin and after the systemic administration of etoposide. We present an 85-year-old female who developed a scaly nonpruritic papular eruption on the forearms. The patient was receiving treatment for metastatic adenocarcinoma of an unknown primary with weekly paclitaxel. A biopsy of one of the papules demonstrated vacuolar degeneration with epidermal spongiosis, apoptosis, circular basal cell mitoses, and cellular atypia. Abnormal circular mitotic figures have been reported with use of laulimalide analogues, but not with paclitaxel. Laulimalide and paclitaxel are both potent microtubule stabilizers, but in vitro testing has shown that tumors resistant to paclitaxel may respond to laulimalide analogues. We discuss the unusual histologic features of the drug-related skin eruption, the potential etiology of circular mitotic figures, and review the literature regarding chemotherapy-induced mitotic figures. Commercial support: None identified. AB74 An 86-year-old female presented with a 14-month history of an itchy expanding rash on the buttocks and a 12-month history of multiple keratotic lesions, predominantly on the head and neck. The latter resolved spontaneously with pitted scarring after 4 months, only to recur elsewhere. There was no history of skin cancer, exposure to tar, pitch, printing chemicals or arsenic, excessive sun, nor a relevant family history. On examination, multiple papules and nodules with keratotic centers were present on the face and scalp, with smaller lesions on the trunk and limbs. These lesions resembled keratoacanthomas, but adnexal tumors were also considered in the differential diagnosis. On the buttocks, there was an erythematous plaque with peripheral follicular hyperkeratosis. Differential diagnosis of lichen planus and mycosis fungoides were proffered. Surprisingly, histology from the buttock plaque revealed a focally acanthotic dyskeratotic squamous epithelium with irregular buds, suggestive of a squamous cell carcinoma. The histology from one of the facial lesions confirmed a keratoacanthoma (KA). A unifying diagnosis of multiple KAs coexisting with KA centrifugum marginatum (KCM) was made. Treatment with low dose acitretin (10 mg/day) for 3 months resolved the KCM. The KAs decreased in number and size and have been less symptomatic. Multiple KAs may present in different forms; the commonest is the Ferguson Smith type where multiple self-resolving lesions occur in young adults, often of Scottish descent. Sporadic cases have also been reported. Our patient had multiple KAs with another rare keratoacanthoma variant, KCM. The response to acitretin concurs with previous experience, although higher doses have been used in the past. Precisely why retinoids are effective for KAs is unknown; it may modulate terminal differentiation of epidermal cells, thereby inducing inhibition of keratinisation. Alternatively, it could also have an antikeratin effect. The lack of family history, late age of onset, occurrence of two rare variants of KAs, and the response to low doses of acitretin makes our patient unusual. One cannot underestimate the role of the pathologist in helping the clinician make this rare dual diagnosis. Commercial support: None identified. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5954_5957 16 January 2009 6:16 pm P1507 P1509 A case of Maltese crosses Kelly Tierney, Mayo Clinic, Rochester, MN, United States; John Snow, MD, Mayo Clinic, Jacksonville, FL, United States; Laura Bancroft, MD, Mayo Clinic, Jacksonville, FL, United States The spectrum of cutaneous complications caused by drug addiction is large. Talc, starch, cellulose, needles, and cotton fibers are the most commonly injected foreign bodies encountered in drug users; they derive from solubilized tablets or substances used by drug dealers to dilute heroin or cocaine. Histologicly, a combination of period acideSchiff (PAS) stains and polarization microscopic analysis serves to characterize foreign bodies. Starch polarizes in a characteristic Maltese cross pattern. We present a 53-year-old male with a 9-month history of bilateral distal upper extremity swelling associated with firm indurated horizontal cords in the antecubital fossae creating a sharp demarcation between affected and unaffected skin. He denied drug use but had a recent diagnosis of hepatitis C. Histopathology of lesional skin was remarkable for a superficial perivascular lymphocytic infiltrate with scattered eosinophils and with deposition of extracellular and intrahistiocytic foreign material in the reticular dermis and panniculus. The foreign material polarized in a characteristic Maltese cross pattern and was PAS and Gomori methenamine silver (GMS) stain positive consistent with starch. This histopathologic pattern was consistent with injection of a material containing starch. Tissue cultures for bacteria, fungi, and atypical mycobacteria were negative. A magnetic resonance imaging scan of the right forearm showed diffuse skin thickening and inflammation involving the subcutaneous soft tissue without involvement of the musculature and intermuscular fascia. This inflammation was more pronounced in the antecubital fossa, where there was a nonenhancing 8- 3 4-mm focus, which could represent a small microabscess. This case is unusual because the patient presented with indurated cord-like plaques within the antecubital fossae bilaterally potentially caused by injection of foreign body material. Even though he denied drug use, we believe the presence of starch is most likely secondary to drug use, especially with his new diagnosis of hepatitis C and the MRI findings. We present this case as an example of cutaneous complications secondary to injection of foreign material (starch). Polarizable and PAS- and GMS-positive granules with Maltese cross birefringence were seen within lesional skin. Aquagenic palmar keratoderma: A review of the literature with new histopathological insights into its pathogenesis Angela Kyei, MD, Cleveland Clinic, Department of Dermatology, Cleveland, OH, United States; David Hamrock, MD, Cleveland Clinic, Department of Dermatology, Cleveland, OH, United States; Mandi Sachdeva, MD, Cleveland Clinic, Department of Dermatology, Cleveland, OH, United States; Najwa Somani, MD, Cleveland Clinic, Department of Dermatology, Cleveland, OH, United States; Wilma Bergfeld, MD, Cleveland Clinic, Department of Dermatology, Cleveland, OH, United States Commercial support: None identified. Background: Transient aquagenic syringeal palmar hyperwrinking (ASPH) is a rare condition characterized by edematous translucent plaques with dilated puncta on the palms minutes after water exposure. This entity has been described in approximately 40 patients to date. It is most strongly associated with cystic fibrosis, hyperhidrosis, and an atopic diathesis. The pathogenesis has been elusive thus far, a fact highlighted by the unrevealing histopathological findings to date. We describe a case involving a 23-year-old white female with ASPH and offer histopathological and electron microscopic findings to support a role for increased water absorption in the pathogenesis of this rare condition. Case report: A 23-year-old white female with a medical history of asthma and allergic rhinitis presented with a 3-week history of a rash on her bilateral palms minutes after water exposure. The rash was not associated with pruritus, pain, burning, or bleeding, and there was no history of trauma or chemical exposure. On physical examination, she is a healthy appearing woman with normal appearing palms and soles. Upon water exposure, however, she developed confluent, translucent to white, small papules with dilated puncta within seconds on the bilateral surfaces of her palms. These lesions resolved minutes after drying her hands. A histopathological exam revealed orthohyperkeratosis and dilated eccrine ostia with prominent eccrine ducts and glands. The eccrine ducts and glands compared to normal were markedly swollen and edematous. A similar finding was observed on electron microscopic examination. Discussion: The first case of ASPH was reported in 1974 in a patient with cystic fibrosis. Many years later, English and McCollogh reported a case of two sisters without cystic fibrosis who developed translucent white papules on their palms minutes after water exposure. Currently, about 40 cases have been reported, with the most notable associations being cystic fibrosis, hyperhidrosis, and atopic diathesis. The pathogenesis of ASPH has been elusive thus far. It has been postulated that the pathogenesis may involve an aberration of sweat duct function. The uncertainty about the pathogenesis is highlighted by the unrevealing histopathological findings to date. We offer histopathological and electron microscopic findings to support a role for increased water absorption in the pathogenesis of this rare condition. Commercial support: None identified. P1510 P1508 Reticular presentation of mid-dermal elastophagocytosis Eugenia Cutillas-Marco, MBBS, Hospital Universitario Doctor Peset, Valencia, Spain; Francisco Jose Ferrando-Roca, Hospital Universitario Doctor Peset, Servicio de Dermatologia, Valencia, Spain; Natalia Camarasa-Lillo, Hospital Universitario Doctor Peset, Servicio de Anatomia Patologica, Valencia, Spain; Rafael Rojo-Espana, Hospital Universitario Doctor Peset, Servicio de Dermatologia, Valencia, Spain Introduction: Mid-dermal elastolysis is a rare disorder characterized by the focal loss of elastic tissue in the mid dermis. Reticular presentations of mid-dermal elastolysis have been recently described and extend the clinical spectrum of dermal elastolytic disorders. Case report: A 70-year-old male presented with a 13-month history of an asymptomatic reticular eruption on his upper trunk. He was retired but previously had worked as waiter with moderate sun exposure throughout his life. He otherwise had no relevant medical history but sick sinus syndrome that recquired the placement of a pacemaker 2 months before the beginning of the eruption. The rash started on the left chest, near the area of the pacemaker, and progressively spread to upper chest, back, and shoulders. A biopsy taken from the back revealed a normal epidermis and scant histiocytic inflammation around the superficial and mid-dermal vessels. There were scattered interstitial histiocytes containing elastic fibers in the mid dermis, but no granulomas were found. Elastin stains demonstrated focal loss and fragmentation of elastic fibers. Another biopsy was taken from the respected areas of his back and no lesions were found. He was advised to use regular emollients and sunscreens without a satisfactory response. Discussion: Based on the histopathological findings, our case appears to be closely allied to actinic granuloma, annular elastolytic granuloma, or mid-dermal elastolysis, but the clinical presentation is different. Four patients with this reticular presentation of mid-dermal elastophagocytosis have been reported. Various etiologic theories have been postulated, including actinic damage, postinflammatory changes, or an autoimmune process. To the best of our knowledge, no other cases of reticular presentation of mid-dermal elastophagocytosis after the implantation of a pacemaker have been reported. Commercial support: None identified. Atypical fibroxanthoma with regional lymph node metastasis Douglas New, DO, University of Louisville Division of Dermatology, Louisville, KY, United States; Janine Malone, MD, University of Louisville Division of Dermatology, Louisville, KY, United States; Soon Bahrami, MD, University of Louisville Division of Dermatology, Louisville, KY, United States Background: Atypical fibroxanthoma (AFX) is a low-grade sarcoma usually occurring on sun-damaged skin of the head and neck in elderly patients. Metastatic disease has been reported in only a small number of cases. We describe a patient who initially presented with an AFX on his face. Weeks after surgical removal, he presented to clinic with metastatic disease to cervical lymph nodes. Observation: An 87-year-old white male with no previous history of skin cancer presented with a 7-week history of a rapidly growing nodule located on the right side of his face. On physical examination, he had a 3-cm sessile, firm nodule with hemorrhagic crust. The patient did not have any other suspicious lesions and did not have cervical or axillary lymphadenopathy. A review of systems was negative. A shave biopsy revealed a spindle-cell tumor with a high mitotic rate with atypical cells. Tumor cells stained positive with CD68, lysozyme, and vimentin, and were negative with pancytokeratins, CD34, desmin, smooth muscle actin, HMB-45, and S100 stains. A diagnosis of AFX was made based on these findings and the clinical presentation. Local surgical excision with 5-mm margins showed no evidence of residual tumor. During the two months after the excision, the patient developed a nontender 3- 3 3-cm deep nodule inferior to the surgical site. A fine needle aspirate revealed atypical spindle cells. A modified radical neck dissection was performed revealing two cervical lymph nodes with metastatic spindle cell tumors consistent with an AFX. The lymph nodes stained negative for high molecular weight cytokeratins. Comment: AFX is a diagnosis of exclusion, and a thorough immunohistochemical evaluation was performed to rule out other spindle cell tumors, including spindle cell melanoma, spindle cell squamous cell carcinoma, angiosarcoma, leiomyosarcoma, and dermatofibrosarcoma protuberans. A deeper version of AFX known as malignant fibrous histiocytoma is associated with a higher rate of metastasis and was excluded based on the location of the tumor in the dermis without subcutaneous involvement. Only a small number of metastatic AFX cases have been reported. The metastatic potential of AFX may not be fully appreciated, and clinicians should be reminded of their potential aggressive behavior. In addition, we stress the importance of a thorough immunohistochemical evaluation to rule out other spindle cell tumors, especially in the setting of metastasis. Commercial support: None identified. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5954_5957 16 January 2009 6:16 pm AB75 P1511 P1513 Multiple microcystic adnexal carcinomata in a patient with NicolaueBalus syndrome Jonathan Batchelor, DDS, CAN, Addenbrooke’s Hospital, Cambridge, Cambridgeshire, United Kingdom; Aruni Ranasinghe, Addenbrooke’s Hospital, Cambridge, Cambridgeshire, United Kingdom; Ed Rytina, Addenbrooke’s Hospital, Cambridge, Cambridgeshire, United Kingdom; Ha Thomas, Addenbrooke’s Hospital, Cambridge, Cambridgeshire, United Kingdom A 13-year-old patient presented with a 5-year history of skin changes on her cheeks and neck. Her mother had similar skin changes. Examination revealed erythematous, granular, hyperkeratotic areas on the cheeks and neck consistent with atrophoderma vermiculata and numerous papules on the neck and upper chest. A biopsy taken from a papular lesion revealed multiple cysts in the superficial dermis lined by cuboidal cells and containing eosinophilic hyaline material, consistent with a clear cell syringoma. Similar lesions in the patient’s mother were also proven to be syringomata on biopsy. A diagnosis of NicolaueBalus syndrome (NBS) was made and camouflage treatment given. Years later, the patient developed apparent abscesses in the right cheek and a rapidly growing firm lesion on the left temple. A biopsy from the right cheek revealed a deeply infiltrative tumor involving the dermis and subcutis, showing prominent desmoplasia and strands of bland epithelial cells with ductal differentiation, consistent with microcystic adnexal carcinoma (MAC). The left temple lesion was also found to be a MAC and was excised with margin control. An excision biopsy of the right cheek MAC was performed. Some residual tumor remained at the deep margins of the right cheek MAC, but no perineural invasion was seen. The patient declined more radical surgery to ensure complete excision in favor of close observation. NBS is a rare syndrome consisting of generalized eruptive syringomata, atrophoderma vermiculata, and milia. MAC is a rare cutaneous neoplasm that usually presents as a slowly growing subcutaneous nodule on the head or neck. Clinical and histopathological misdiagnosis is common. MAC has an infiltrative growth pattern, often with perineural invasion. Metastases are very rare but have been reported. Treatment with Mohs micrographic surgery is more likely to prevent recurrence than wide excision. To our knowledge, this is the first reported case of a MAC occurring in a patient with NBS. We are also aware of only one other case of multiple MACs occurring in the same patient. Because both MAC and NBS are such rare entities, it seems highly unlikely that they are unrelated in this patient. Although syringomas, such as those present in NBS, have been reported to undergo malignant change, no association has been documented between syringomas and MACs. We will discuss whether or not they might be related pathologically in this patient. Audit of skin histologic diagnoses over a 6-year period in dermatology unit in Midwest Ireland Kashif Ahmad, PhD, Mid Western Regional Hospital, Limerick, Ireland; Bart Ramsay, Mid Western Regional Hospital, Limerick, Ireland Commercial support: None identified. Objectives: Our primary aim was to review the data of patients who had skin biopsies performed between 2001 and 2007 in the dermatology department. We also focused on the histologicly diagnosed patients with nonmelanoma skin cancer (NMSC) and melanoma of the skin. We serve a mixed urban-rural population of 360,000 with one consultant and one senior registrar. Methods: The following data of patients who had skin biopsies were collected: age, sex, address, and the histologic diagnosis. The final diagnosis was divided broadly in to malignant and nonmalignant. Patients with a diagnosis of one of three major cutaneous cancers—basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma (MM)—occurring between August 2001 and December 2007 were also reviewed. The data was stored on FileMaker Pro software. Results: Skin biopsy was performed in 2144 patients (810 male, 1334 female). Cutaneous malignancy was found in 833 patients (38%). Of these, 451 patients (205 male, 246 female) had BCC, 297 (118 male, 179 female) had SCC, and 72 (30 male, 42 female) had melanoma. Two hundred thirty-three patients had a histologic diagnosis of actinic keratosis with variable degrees of dysplasia. Thirteen patients had other type of malignancies. In the nonmalignant category, 552 had benign lesions and 528 had inflammatory diagnosis. The most common inflammatory diagnoses were lichenoid reactions (47), leucocytoclastic vasculitis (35), spongiotic dermatitis (32), and lupus (27). Discussion: Thirty-eight percent of biopsy reports were for cutaneous malignancies. There is an upward trend of skin cancers, particularly melanoma and BCC in the last 5 years (Table I). Nine percent of biopsies were premalignant and one fourth had inflammatory diseases. While performing this audit, we realized that recording site of biopsy and prebiopsy differential diagnosis would be a helpful audit tool, and we will record this in the future. Conclusion: Our catchments population area has increased by 25,000 in past 5 years, and we anticipate further increase in skin cancers given a rising and aging population. Table I. Five-year trend of skin cancers in midwest Ireland Year 2001 2002 2003 2004 2005 2006 2007 Total BCC 33 55 72 57 67 78 89 451 SCC 18 35 58 45 45 53 43 297 MM 7 5 6 11 16 9 18 72 Commercial support: None identified. P1514 Piecing the puzzle: An unusual presentation of xanthoma disseminatum Tejal Patel, Sheffield Teaching Hospitals NHS Trust, Sheffield, South Yorkshire, United Kingdom; David Slater, MBBS, Sheffield Teaching Hospitals NHS Trust, Sheffield, South Yorkshire, United Kingdom A 51-year-old female presented brownish yellow asymptomatic papules around her eyes 20 years ago which developed gradually into large yellowish plaques and spread to her anterior hairline, neck, torso, and thighs. Blood investigations including lipid studies were normal. Skin biopsy showed foamy histiocytes and Touton giant cells with background lymphocytic infiltrate. Immunochemistry was positive for histiocyte marker CD68. Interestingly, factor XIIIa stain was negative. Electron microscopy (TEM) confirmed lipid-laden macrophages but no cytoplasmic processes. A diagnosis of xanthoma disseminatum (XD) was made. Treatment with topical trichloroacetic acid and hyfrecation was unhelpful, as was a trial of oral cyclophosphamide 50 mg daily for 6 months. Laser treatment is planned. XD is a rare nonfamilial disorder of histiocyte proliferation. It tends to affect young males with particular emphasis on skin involvement, although internal organs can be affected. Forty percent of XD patients develop diabetes insipidus related to brain stem involvement. Histologicly, dermis is infiltrated with foamy histiocytes and Touton giant cells that typically stain with factor X111a. Ultrastructurally, histiocytic cells contain myeloid bodies and membrane-bound fat droplets. The base cell is the dermal dendrocyte, an interstitial cell of the dermis which uniquely stains with factor XIIIa and shows slender cytoplasmic processes on TEM. Typical phenotypic features and histopathology are seen. However, the indolent nature and atypical immunochemistry and TEM findings makes our patient unique. There has been one other reported case where a diagnosis of class 2a histiocytosis was reached but factor XIIIa was negative and TEM was atypical. Dermal dendrocyte demonstrate antigenic heterogenecity and subtype proliferation may be a probable explanation4. The clinicopathologic mucocutaneous spectrum of chronic graft-versushost disease in a patient receiving a donor T-lymphocyte infusion Mark Cappel, Mayo Clinic, Jacksonville, FL, United States; John Snow, Mayo Clinic, Jacksonville, FL, United States Allogeneic hematopoietic stem cell transplantation (HSCT) has become an important and increasingly used modality for hematologic malignancies. Advances in conditioning regimens and prophylactic immunosuppressive medications have had some success in preventing acute graft-versus-host disease (GVHD). However, these protocols are not as effective in preventing chronic GVHD. In addition, it has been demonstrated that the use of donor T-lymphocyte infusions to stimulate a graftversus-malignancy effect can trigger the development of acute and chronic GVHD. Chronic GVHD has been traditionally defined as any manifestation of GVHD present $ 100 days posttransplant, but now is better defined based on the classic mucocutaneous manifestations. Chronic mucocutaneous manifestations are divided into two major categories: lichenoid and sclerodermoid. Lichenoid GVHD clinically and pathologically resembles lichen planus or photosensitive connective tissue disease, whereas sclerodermoid GVHD clinically and pathologically resembles morphea, lichen sclerosus, or eosinophilic fasciitis. Herein, we present a case of a 50-year-old male with a history of follicular non-Hodgkin’s lymphoma treated with an allogeneic HSCT from his fully-matched sister. Subsequently, he had recurrence of the lymphoma, which was treated with a donor T-lymphocyte infusion. An episode of acute GVHD characterized by a macular cutaneous eruption and elevated liver function tests occurred and was treated accordingly. He later began developing extensive, erosive, lichenoid plaques of the oral mucosa. Biopsy demonstrated ulcerated lichenoid mucositis with many apoptotic keratinocytes and satellite lymphocytes. Thereafter, he began developing multiple, oval, hypopigmented, atrophic, coalescing papules and plaques on the lateral trunk. Biopsy demonstrated epidermal atrophy, focal vacuolar interface change, and superficial dermal sclerosis. Overall, this is an illustrative case demonstrating the unique clinicopathologic spectrum of chronic GVHD developing subsequent to donor T-lymphocyte infusion. Commercial support: None identified. Commercial support: None identified. P1512 AB76 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5954_5957 16 January 2009 6:16 pm P1515 P1517 Chronological changes in nodular cystic fat necrosis associated with bee venom acupuncture Yoonseok Oh, MD, Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Kangwon, South Korea; Eung-Ho Choi, MD, PhD, Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Kangwon, South Korea; Hana Bak, MD, PhD, Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Seoul, South Korea; Sung Ku Ahn, MD, PhD, Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Kangwon, South Korea Lichen nitidus: A study of six cases Meriem Chrifi Alaoui, MD, PhD, UHC Ibn Rochd, Casablanca, Morocco; Hakima Benchikhi, UHC Ibn Rochd, Casablanca, Morocco; Khadija Khadir, UHC Ibn Rochd, Casablanca, Morocco Background: Lichen nitidus (LN) is an unusual condition of idiopathic granulomatous of chronic evolution, described the first time by Pinkus in 1907. It arises by multiple tiny, shiny papules with a flat surface. We report six cases of LN in order to analyze the epidemiologic and clinical properties of this entity. Case report: The mean age of the patients was 23 years (range, 14-33 yrs). There were four males and two females. Dark skin was noted in four cases. Two patients had no personal or family antecedents; three others presented respectively a segmental vitligo, asthma, and chronic addiction to smoking. The last patient had a family history of atopic disease. Two patients are a brother and a sister stemming from consanguineous marriage. The duration of evolution varied between 2 and 10 years. On dermatologic examination, multiple 1- to 2-mm, flesh-colored, shiny papules were observed. These lesions were bilaterally symmetrical and localized in four cases (arm, abdomen, and genitalia). A generalized form was noted in two cases. Pruritus was noted in half of the cases. Oral mucosa, palms, soles, and nails were normal, except one patient who has white reticulate network on her buccal mucosa. On physical examination, the patients were in good general health and all other systems were normal. No patient was able to pinpoint any particular circumstances that precipitated or exacerbated their eruption. A biopsy specimen taken from a papule showed a well circumscribed lymphohistiocytic infiltrate in the papillary dermis in a claw clutching a ball pattern. These histologic features confirmed diagnosis of lichen nitidus. Five patients were treated by antihistamines and emollient, two by psoralen plus ultraviolet A light phototherapy, and one by topical corticoids, without any appreciable improvement. Nodular cystic fat necrosis, first described by Pryjemski and Schuster, is an unusual and localized form of fat necrosis characterized by discrete encapsulated fat nodules. Yet there is no universally accepted theory as a pathogenesis, so trauma, sudden vascular insufficiency, and subsequent fat necrosis with fibrous encapsulation are suggested to be related. We experienced a case of nodular cystic fat necrosis occurred after bee venom acupuncture which showed chronologic spectrums of histologic features. A 40-year-old female presented multiple recurrent subcutaneous masses on her back for 1 year. About 10 years ago, she got several bee venom acupunctures, a folk remedy on her back to relieve back pain. Physical examination revealed multiple nonmovable subcutaneous nodules with tenderness. In histopathology, there were multiple stages of fat necrosis with acute and chronic inflammation. Fat necrosis in some areas developed into unilocular or multilocular cyst-like masses encapsulated by fibrous tissue. Several well defined epitheloid granulomas with foreign body giant cells developed within and around the fat necrosis without evidence of caseous necrosis. Fully developed stage of fat necrosis included central hyalinization and peripheral anucleated fibrous encapsulation. Chronic inflammation with a fibrosis calcium deposit and brownish pigment though to be foreign materials were seen around the fully developed stage of fat necrosis. Based on these chronologic changes in histopathology, this case will ensure fully understanding the pathogenesis of nodular cystic fat necrosis. Commercial support: None identified. Discussion: LN is considered an uncommon dermatosis. There appears to be no obvious racial or gender predilection, although the majority of cases appear to arise in children and young adults. Our series contains two children and four young adults. This disorder is most often localized, but there are rare reports of patients having a more generalized distribution of lesions, like both cases of our series. Palmoplantar, inguinal, linear, and photo-induced forms were also reported. Observations associating LN and other pathologies were rarer: Crohn disease, contact allergy, HIV infection, and amenorrhoea. The controversy regarding the etiology of LN, and relationship of LN to lichen planus, is still unresolved. Several clinical and histologic similarities were found. Concerning our series, a buccal white reticulate network seen typically in lichen planus was observed in one case. Multiples therapeutics were proposed in literature (potent topical steroids, systemic steroids, oral antihistamines, ultraviolet therapy, hormonal therapy, antituberculous agents, etc). However, because LN is rare, usually asymptomatic, and resolves without squealae, it is difficult to really evaluate the true effectiveness of various therapies for this disease. Commercial support: None identified. P1516 Basal cell carcinoma: Deeper sections and specimen size Mary Guo, St. Louis University School of Medicine, St. Louis, MO, United States; Mark Hurt, MD, Washington University, St. Louis, MO, United States; Sarah Jensen, MD, St. Louis University School of Medicine, St. Louis, MO, United States; Yadira Hurley, MD, St. Louis University School of Medicine, St. Louis, MO, United States Background: It is often difficult to identify the tumor in the initial sections of small biopsies of skin that are not bisected. This problem occurs because of the tendency of histotechnologists to conserve tissue in the preparation of the initial sections of these small pieces of tissue. In such small biopsies, the principal differential diagnosis clinically is often non melanoma skin cancer. P1518 A case of Kimura disease with some histologic features of angiolymphoid hyperplasia with eosinophilia Manjeet Mehmi, MD, Birmingham Skin Centre, Birmingham, West Midlands, United Kingdom; Shireen Velangi, MBChB, Birmingham Skin Centre, Birmingham, West Midlands, United Kingdom Limitations: This is a pilot study with a small sample size. Conclusions: Specimen size \15 mm3 or surface area \15 mm2 is correlated with requirement for deeper sections. The study suggests that an optimal number for ordering deeper sections is one. Kimura disease (KD) and angiolymphoid hyperplasia with eosinophilia (ALHE) are benign vascular proliferation disorders predominantly affecting the head and neck regions. Both disorders tend to recur and are associated with lymphoid and eosinophilic infiltrates. Clinically, KD is seen in younger, mainly Oriental patients presenting for a longer duration occurring as a deeply seated soft tissue mass, without significant change of the overlying skin initially. Peripheral blood eosinophilia and a raised immunoglobulin E (IgE) are often prominent. Associated regional lymphadenopathy is common in KD (salivary glands and skeletal muscle may also be involved). In contrast, ALHE lesions are usually multiple pruritic dermal papulonodular lesions observed in older patients presenting for a shorter duration with a less marked blood eosinophilia. ALHE and KD are different histologic disorders rather than two conditions on the same disease spectrum. Histopathological differences include histiocytoid or epithelioid, plumper dome-shaped endothelial cells seen in ALHE but not in KD. KD is characterized by eosinophilic folliculolysis and IgE deposits in germinal centers of more numerous lymphoid follicles, with more abundant eosinophils and eosinophilic microabscesses and sclerosis compared to ALHE. Treatment options include retinoids, cryotherapy, argon, carbon dioxide, and pulsed dye laser for ALHE and tacrolimus and cyclosporin for KD. Both conditions may respond to corticosteroids, radiotherapy, and surgery. We report a case of a patient with histologic features of both of these conditions posing a diagnostic challenge. He was finally diagnosed with KD based on clinical findings. A 64-year-old Kashmiri (North Asian) male presented with a 26-year history of left facial swelling. He had a 3-year history of numerous itchy facial dermal papules and nodules associated with regional lymphadenopathy. Blood tests revealed a marked eosinophilia and raised IgE. Facial skin biopsies showed a dense perivascular nodular lymphoid eosinophilic infiltrate. Both features of ALHE, such as thick-walled blood vessels with epithelioid /histiocytoid endothelium, and findings consistent with KD, such as multiple lymphoid follicles with distinct germinal centers and eosinophilic microabscesses, were seen histologicly. This KD patient responded well to oral prednisolone and topical tacrolimus. Commercial support: None identified. Commercial support: None identified. Objectives: (1) Determine the percentage of basal cell carcinoma (BCC) that required deeper sections to make a pathologic diagnosis; (2) examine the association between the specimen size and requirement for deeper sections; (3) find out the minimal number of deeper section needed to diagnose the BCC when tumor is not present in the original section. Methods: This was a retrospective study using the dermatopathology Laboratory Information System (LIS). We reviewed the pathology reports from January 1, 2007 to January 31, 2007. Inclusion criteria include: (1) diagnosis of BCC and (2) shave biopsy without bisection. The variables included in this study are length, width, and height of the specimen, gender, age, and the number of deeper sections ordered. The deeper section slides were reviewed by two board-certified dermatopathologists independently to determine the minimal number of deeper section required to diagnose the BCC. Results: Five percent (10/201) of nonbisected samples required deeper sections for diagnosis. The width and height, but not length, of the specimen correlated with requirement of deeper sections (P ¼ .019 and P ¼ .023, respectively). Specimens with a volume \15 mm3 or surface area \15 mm2 are more likely to need deeper sections for diagnosis. Eight of 10 samples that required deeper sections were from female patients. Six cases of BCC were diagnosed with one deeper section, seven with two deeper sections, and nine with three deeper sections. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5954_5957 16 January 2009 6:16 pm AB77 P1519 A rare case of multiple pigmented eccrine hidrocystomas within scars in a patient with recessive dystrophic epidermolysis bullosa Denise Woo, MD, Henry Ford Hospital, Detroit, MI, United States; Tor Shwayder, MD, Henry Ford Hospital, Detroit, MI, United States Eccrine hidrocystomas are benign cysts of sweat gland origin. They are classified into two major groups: the Robinson type with multiple lesions and a female predominance, and the more common Smith type with a solitary lesion affecting males and females equally. They are typically dome-shaped, ranging from fleshcolored to light blue, most commonly in a periorbital distribution. They often grow in size during hot and humid weather. We present a case of an 18-year-old white female with recessive dystrophic epidermolysis bullosa who developed blue-black macules and papules on the posterior surface of her neck. They are under an area of constant bandaging for her epidermolysis bullosa. These macules measure 1 to 2 mm and are located within scars from blisters. They have been present for more than 10 years and are asymptomatic. While she denies worsening with hot weather, she notes that her neck is chronically occluded with dressings as part of her wound care regimen. She denies being on minocycline or medications/bandages containing silver salts. Punch biopsies reveal eccrine hidrocystomas. Iron stains and Mart-1 stain are negative. Fontana-Masson stain reveals focal positivity at the periphery of the cystic structures. The patient declined treatment because the lesions are asymptomatic. Our case is unique in several respects. The degree of pigmentation is uncommon, with only two cases reported. The origin of the pigmentation remains unclear. Theories to explain the pigmentation include the Tyndall phenomenon and active melanin transfer. Our case suggests that melanin may be the underlying source of pigmentation. The location within scars on the posterior neck has not been previously reported. Of interest, secondary milia that follow blistering are most commonly connected to the eccrine duct. We speculate that eccrine hidrocystomas developed in our patient similarly secondary to an aberrant regenerative process of the eccrine sweat duct following injury. Lastly, our case suggests that occlusive dressings should be considered a predisposing factor for the development of eccrine hidrocystomas, because they may lead to excessive warmth and humidity. Treatment remains inconsistent, with conflicting reports regarding the efficacy of topical anticholinergic creams and various lasers. Commercial support: None identified. DERMATOPHARMACOLOGY/COSMECEUTICALS P1600 Effects of lactic acid on the induction of apoptosis and cell cycle arrest in human immortalized keratinocyte cell line Yu-Ping Hsiao, MD, Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan; Horng-Shin Lin, Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan; Jen-Hung Yang, Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan; JingGung Chung, School of Biological Science and Biotechnology, China Medical University, Taichung, Taiwan; Wan-Wen Lai, Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan Background: Alfa-hydroxy acids (AHAs) have been widely used in cosmetic agents and superficial chemical peeling for approximately 20 years. However, the cytotoxicity of AHAs on human keratinocytes is limited. Recently, it has been found that AHA-containing products may induce photosensitivity and skin irritation. However, there is concern about its safety for long-term use. Objective: Lactic acid (LA) is one of the most commonly used AHAs. We were interested in investigating the cytotoxic effects of LA in human keratinocyte cell line (HaCaT). Methods: HaCaT cells were incubated with a certain range of concentrations of LA for various time periods. We observed cell morphology, DAPI stain, comet assay, and agarose gel electrophoresis to investigate DNA damage. Cell viability, cell cycle, reactive oxygen species (ROS), calcium release, and mitochondrial membrane potential (MMP) were measured by flow cytometry. Western blot was used to examine the protein expression of P21, P27, CDK2, Cyclin E, CyclinA, Bax, Bcl-2, Bcl-xL, caspase 3, 8, 9, apoptosis-inducing factor (AIF), and endonuclease G (EndoG), which are associated with cell cycle and apoptosis. We also used confocal microscope to evaluate AIF, EndoG, and cytochrome c. Results: Our data suggest that LA is cytotoxic to HaCaT cells via the mechanisms of cell cycle arrest at G1/S phase and induction of apoptosis. Substantial morphologic changes, including necrosis and a small proportion of apoptosis, were observed in the HaCaT cells treated with LA. The effect of LA on viability of HaCaT cells revealed a dose- and time-dependent manner. The results of flow cytometry showed LAinduced HaCaT cell apoptosis through reduction of MMP and the increase of ROS may be related to the increase of cytoplasmic calcium level. Western blotting showed LA increased the levels of P21, P27 and decreased the levels of Cyclin E, Cyclin A, and CDK2 that caused cell cycle arrest at G1/S phase. In addition, LA increased the level of Bax and inhibited the level of Bcl-2, Bcl-xL, and activated caspase 3, which subsequently induced apoptosis. Following cotreatment of LA and z-VAD-fmk, inhibition of LA-mediated caspase-3 activation was accompanied by the marked attenuation of LA-induced apoptotic cell death. Western blotting showed the increase of caspases 3, 8, 9, AIF, and EndoG. AIF and Endo G translocated to nucleus, and cytochrome c released from mitochondria to the cytosol was confirmed by confocal microscopy. Conclusion: We demonstrated that LA inhibited HaCaT cell proliferation via G1/S arrest; in addition, LA induced apoptosis through caspase-dependent and -independent pathways in the HaCaT cell line. Commercial support: None identified. P1520 Schwannoma: An unexpected clinical apresentation Carolina Cotrim, MD, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Carlos Martins, MD, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Omar Lupi, MD, PhD, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Paula Chicralla, MD, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil Background: Schwannomas are rare benign encapsulated tumors of the nerve sheath arising from Schwann cells that can occur as solitary lesions (90%), being associated with several central nervous system tumors—usually meningiomas (5%), being a characteristic neurofibromatosis type 2 (NF2) feature (3%), or having a multiple presentation (Schwanomatosis; 2%). Clinically, cutaneous schwannomas are typically found on the head and neck region and the flexor surfaces of the extremities of young adults; they present as skin-colored, moderately firm, well circumscribed nodules and usually measure more than 1.5 cm. Case report: A 45-year-old white female presented with a 16-year history of a painless and skin-colored solitary nodule localized on the left foot. The patient denied any family history of similar lesion. The lesion was submitted on a biopsy and, during the excision, showed a greasy and cystic material. With a lipoma hypothesis, all the material excised was sent for histopathologic examination, that exhibited two differents growths patterns: a hypercellular area (also called Antoni A type tissue) with proliferation of spindle cells, nuclei palisading around nodular to ribbon-like foci of fine fibrillary cell processes, Verocay bodies, and a hypocellular, myxoid area (Antoni B type tissue). Mitotic figures were absent. The imunohistochemistry showed a strong and difuse immunoreactivity for S-100 protein. The lesion was completely excised without no local recurrence. Discussion: The patient presented with a cutaneous lesion histologically and immunochemically compatible with a cutaneous schwannoma. Though a greasy and cystic appearance during the cirurgical excision, it showed two typical components on the histopathological analysis (Antoni A and B areas) and was strongly positive for S-100 protein, which allowed us to confirm that diagnosis. The clinical diagnosis is very difficult, becoming necessary to exclude other lesions such as lipoma, angiolipomas, leiomyomas, cysts, neurofibromas, and neuromas. Commercial support: None identified. AB78 P1601 Melanocytes’ dendricity down-regulated by the association niacinamidee ascorbic acid Marius Anton Ionescu, MD, Dermatology Polyclinic, Saint-Louis Hospital, Paris, Ile de France, France; Agnes Gougerot, MD, Laboratoires Dermatologiques d’Uriage, Courbevoie, Hauts de Seine, France; Anne-Marie Matta, Laboratoires Dermatologiques d’Uriage, Courbevoie, Hauts de Seine, France; Luc Lefeuvre, PharmD, Laboratoires Dermatologiques d’Uriage, Courbevoie, Hauts de Seine, France; Michel Bohbot, PharmD, Laboratoires Dermatologiques d’Uriage, Courbevoie, Hauts de Seine, France Purpose: To assess the effects of the association niacinamideeascorbic acid on melanogenesis process in human skin explants exposed to solar simulated radiation (SSR). Methods: Normal human skin explants were treated (untreated control) by an O/W emulsion based on the association niacinamideeascorbic acid (2 mg/explant, 1 time per day from baseline to day 9, 30 min before SSR irradiation). After treatment and SSR exposure (Vilbert Lourmat RMX 3W, visible light 1 UVA 1 UVB, dose 1.125 J/cm2), explants were studied at baseline and days 5 and 12 with optical microscopy (silver staining, Fontana-Masson variant) and by immune-labeling for tyrosinaserelated protein-1 (TRP1; antibodies antiTRP-1, MEL 5). Results: Thirty nine explants were studied. In untreated irradiated explants, at days 5 and 12, the melanocytes’ dendricity and melanin transfer were induced or increased (compared to control, P \ .01). In treated and irradiated explants, melanocyte dendricity was decreased and the melanin transfer was absent. TRP-1 expression was the same in all explants. Conclusions: In normal human skin explants treated by the association niacinamideeascorbic acid then submitted to SSR, melanocyte dendricity was decreased and the melanin transfer was absent. Commercial support: Sponsored 100% by Laboratoires Dermatologiques d’Uriage. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5957_5962 16 January 2009 6:21 pm P1602 P1604 Topically applied polyphenolic antioxidants reverse facial photoaging Bruce Freedman, Plastic Surgery Associates of Northern Virginia, McLean, VA, United States Background: In the skin, ultraviolet radiation and environmental exposure lead to a photoaging process that results in loss of collagen, decreased dermal thickness, and a compromised epidermal barrier. It has been postulated that topical antioxidants increase collagen, improve skin barrier properties, and regenerate important enzyme systems. Purpose: To determine whether the pneumatic topical application of a polyphenolic antioxidant serum reverses clinical and histologic changes associated with facial photoaging. Methods: Ten female volunteers between 36 and 52 years of age with Fitzpatrick skin phototypes I to IV consented to a split-face study. They underwent a series of six crystal-free facial microdermabrasion treatments spaced 7 to 10 days apart; a polyphenolic antioxidant serum was pneumatically applied only to the left half the face immediately after each microdermabrasion treatment. Skin biopsies and skin polyphenolic antioxidant levels, determined by Raman spectroscopy, were obtained from both sides of the face before and after the study period. Investigator ratings for efficacy variables were analyzed after the study period and compared to baseline for both sides of the face. Results: The skin treated with the polyphenolic antioxidant serum demonstrated significantly increased epidermal and papillary dermal thickness and increased fibroblast density when compared to skin not treated with antioxidant serum (P \ .01) There was increased hyalinization of the papillary dermis with newly deposited collagen fibers. Polyphenolic antioxidant levels increased 32% in the skin treated with the polyphenolic antioxidant serum after microdermabrasion (P \ .01). Clinical efficacy variables were significantly more improved in the antioxidant treated skin when compared to skin not treated with the antioxidant serum (P \ .01). These changes were also supported by digital photography. Effect of a lotion containing 3% urea for radio-induced dermatitis: Correlation between the amount of the product used and symptom severity Teresa Murillo, MD, Hospital Universitario Doce de Octubre, Madrid, Spain; Carles Trullás, PharmD, Isdin, Barcelona, Spain; Angeles Cabeza, MD, Hospital Universitario Doce de Octubre, Madrid, Spain; Angeles Pérez, MD, Hospital Universitario Doce de Octubre, Madrid, Spain Objectives: To assess the effectiveness of a hydrating lotion containing 3% urea, polidocanol, and hyaluronic acid for reducing the intensity of acute cutaneous toxicity induced by external radiotherapy. Methods: Double-blind, randomized controlled study of 95 patients undergoing radiotherapy for cancer to compare the effectiveness of a hydrating lotion with 3% urea, polidocanol, and hyaluronic acid (group A) with a placebo lotion without active agents (group B) for reducing radiodermatitis. All patients applied the lotion twice a day, beginning 10 days before the start of external radiation therapy and continuing until 10 days after the end of radiotherapy. Patients were followed weekly from the start of radiotherapy until 2 weeks after termination of treatment, with a maximum period of 14 weeks. Acute cutaneous toxicity was controlled using the RTOG/EORTC scale. The degree of protocol adherence was studied in order to asses the influence of the quantity of the product used on the appearance of radiodermatitis. The x2 test was used to compare proportions, the Mann-Whitney U nonparametric test to compare means, and the odds ratio (OR) to assess relative risk. Conclusion: The pneumatic topical application of a polyphenolic antioxidant serum to facial skin resulted in clinical and histologic changes consistent with reversal of photoaging. The increased levels of polyphenolic antioxidants correlated with increases in collagen deposition, fibroblast density, and papillary dermal hyalinization. These findings indicate that the pneumatic topical application of polyphenolic antioxidants reverse photodamage, improve skin quality, and are effective in skin rejuvenation. Commercial support: None identified. Results: Forty-three patients with breast cancer receiving conservative treatment, 24 patients with breast cancer treated radical mastectomy, and 28 patients with rectal cancer were included. More than 50% (51.6%) were assigned to group A and 48.4% to group B. Mean follow-up was 7.7 weeks in both groups. There were no differences between groups regarding adherence to protocol or the use of one bottle of lotion (44.4% group A and 51.1% group B) or 2 bottles (55.6% group A and 48.9% group B). The incidence of radiodermatitis was significantly lower in group A than in group B (75% vs 91%; P \.05; OR, 3.4 [95% CI, 1.01-11.48]). Mean degree of toxicity was 0.38 in group A and 0.51 in group B (P \.05). Group A showed a significant inverse relationship between the use of the product and the degree of toxicity (mean, 0.3 with one bottle vs 0.13 with two bottles; P \ .05) and the percentage of patients with toxicity $ 2 (45.0% vs 8.0%; OR, 9.4; P \.01). This relation was not found in the placebo group (OR, 1.07; NS). Conclusions: The incidence and degree of acute dermatitis in patients undergoing external radiation therapy are significantly reduced by the use of a hydrating lotion containing 3% urea, polidocanol, and hyaluronic acid. A significant inverse relationship was found between the quantity of product used the protocol adherence and the degree of dermatitis. Commercial support: 100% sponsored by Isdin. P1603 The efficacy and tolerability of hydroxy acids in males with moderate to severe photoaging Zoe Diana Draelos, Dermatology Consulting Services, High Point, NC, United States Introduction: Male skin care is a rapidly expanding and poorly understood hygiene market. Where once cleansers and moisturizers were formulated for females, males are now expressing interest in products that are suitable for a bearded face to provide antiaging effects. The challenge of facial shaving accompanied by different sebum, apocrine, and eccrine sweat production has created unique formulation considerations. The alfa-hydroxyacids (AHAs) provide cosmetic and therapeutic benefits to skin as a result of their ability to modulate the epidermal process of keratinization and improve the quality of the dermis in photoaged skin. The polyhydroxy acids (PHAs), such as gluconolactone and lactobionic acid, provide antiaging effects similar to AHAs with additional benefits including increased gentleness and skin tolerability, along with antioxidant effects and enhancement of stratum corneum barrier function. Objective: This study was conducted to evaluate the suitability and effectiveness of AHAs combined with PHAs in the appearance of photoaged male skin. Method: Twenty-nine men 37 to 71 years of age with Fitzpatrick skin types I to III having moderate to severe photodamage were enrolled this 12-week, controlled use study with baseline historical controls. All subjects received a foaming cleanser (20% AHA/PHA) for use twice daily followed by a 10% PHA day cream SPF 15 in the morning and a 15% AHA lotion in the evening. At each visit (weeks 0, 2, 4, 8, and 12), a dermatologist conducted visual grading of photoaging parameters and irritation, and self-assessment was performed. Digital photography was performed at weeks 0, 4, and 12. Results: The antiaging regimen significantly (P \.05) improved skin texture and smoothness as early as 2 weeks. After 12 weeks of use, the regimen significantly improved fine lines, pore size, skin tone, and firmness. At 2 weeks, mild irritation was noted especially with product application following shaving; the irritation reduced as the skin became acclimated to the high strength AHA formulations. Conclusion: An AHA and PHA antiaging skin care regimen is well tolerated and efficacious in males with moderate to severe photoaged skin. We have investigated the depigmentation properties of a lotion that contains two amino acid derivatives, namely undecylenoyl phenylalanine (UDP) and ergothioneine (EGT). UDP inhibits melanin formation by competing with a-MSH for binding to melanocortin 1 receptor (MC1R), while EGT inhibits the enzyme tyrosinase. A 2% pidobenzone lotion was also used in the study as the positive control while the untreated cultures serve as the negative control. Melanoderm-B engineered tissues from MatTek were treated daily with 2 l/cm2 of each lotion for 21 days. Pictures were taken each day with a light microscope under 3300 magnification. The pictures were coded, randomized, and scored for the darkness of melanocytes by 10 evaluators trained with predetermined reference photographs, using a scale from 1.0 (lightest) to 4.0 (darkest). On the last day, the viability of the inserts was assessed based on the ability to reduce Alamar blue to its fluorescent form. Melanin levels of the UDP 1 EGT treated inserts were significantly reduced 53% compared to the untreated inserts after 13 days. There was a significant reduction in melanin levels in the inserts treated for a week with 2% pidobenzone; however, there were no viable cells after 21 days of treatment. In contrast, treatment with UDP 1 EGT caused only a 25% reduction in cell viability compared to the untreated inserts. Thus, the lightening effect of the UDP 1 EGT containing lotion was caused by a reduction of melanin production without overt cell/tissue toxicity. Commercial support: Sponsored by NeoStrata Company, Inc. Commercial support: None identified. P1605 A lotion containing undecylenoyl phenylalanine and ergothioneine reduces melanin levels without affecting tissue viability in artificial skin constructs Kelly Dong, MD, AGI Dermatics, Freeport, NY, United States; Daniel Yarosh, PhD, AGI Dermatics, Freeport, NY, United States; Kenneth Smiles, PhD, AGI Dermatics, Freeport, NY, United States; Nelli Markova, PhD, AGI Dermatics, Freeport, NY, United States MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5957_5962 16 January 2009 6:21 pm AB79 P1606 P1608 Vacuum radiofrequency plasma induces procollagen synthesis and skin regeneration Stefania Pacini, Department of Anatomy, Histology and Forensic Medicine, Firenze, Italy; Gabriele Morucci, PhD, Department of Anatomy, Histology and Forensic Medicine, Firenze, Italy; Marco Ruggiero, MD, PhD, Department of Experimental Pathology and Oncology, Firenze, Italy; Massimo Gulisano, MD, Department of Anatomy, Histology and Forensic Medicine, Firenze, Italy; Tiziana Punzi, PhD, Department of Anatomy, Histology and Forensic Medicine, Firenze, Italy The effectiveness of an oatmeal lotion in improving and maintaining barrier function and moisture levels of moderate to severe xerosis Judith Nebus, Johnson and Johnson Consumer Products Worldwide, Skillman, NJ, United States; Kristine Schmalenberg, PhD, Johnson and Johnson Consumer Products Worldwide, Skillman, NJ, United States; Warren Wallo, MS, Johnson and Johnson Consumer Products Worldwide, Skillman, NJ, United States Plasma skin regeneration is one of the most innovative techniques to ameliorate skin damages caused by photoaging and chronoaging. In this study, we assessed on rat skin the biologic effects of a new approach, termed vacumm radiofrequency plasma (VRFP), that causes the formation of ionized plasma using a radiofrequency (13.56 MHz) in the presence of vacuum (1 3 103 Pa). Activation of dermal fibroblasts, collagen synthesis, and cell damage were investigated before and after the application of VRFP. Male Wistar rats were anesthetized and depilated; areas for control and treatment were chosen on the back of each animal; experiments were performed in triplicate, and each area was treated with a single electric impulse; skin specimens were obtained after 48 hours and 7, 30, and 60 days after the treatment. Collagen synthesis was determined by immunohistochemistry using a specific antiprocollagen antibody and by trichromic Masson staining. Cell damage was evaluated by immunohistochemistry using a specific primary antibody against the heat shock protein HSP90. The results demonstrate that, 7 days after treatment with medium intensity, the activation of dermal fibroblasts and collagen synthesis were higher in comparison to what observed after 48 hours. Observation at longer times (30 and 60 days after treatment) demonstrated that the effects induced by VRFP were significantly decreased eventually leading to complete normalization of the tissue. The expression of HSP90, taken as indicator of cell damage, was higher 48 hours after the treatment; after 7 days, the expression of HSP90 begun to decrease, and after 30 and 60 days its expression was the same of control, untreated cells. VRFP at low intensity was not efficient in inducing collagen synthesis; on the contrary VRFP at high intensity caused significant tissue damage and evoked a strong inflammatory response in the dermis. Therefore from this study emerges the fact that VRFP at medium intensity stimulates dermal fibroblast activation with a significant increase of collagen synthesis in the dermis and with no concomitant inflammation or skin damage. Commercial support: None identified. Flaking, roughness, and pruritus are common complaints among patients with extra dry skin. Daily application of moisturizing lotions with effective ingredients, such as skin protectants, humectants, and emollients, is important in this population to both enhance the water content and protect the skin. Colloidal oatmeal is a natural skin protectant as defined by the Over the Counter Monograph for Skin Protectant Drug Products. Colloidal oatmeal contains a number of components that bind to the skin to provide a protective barrier against external insults. Oatmeal has historically been used in a variety of adult and baby baths, lotions, and cleansers to ameliorate a number of skin conditions including itch, dryness, and soothing sensitive skin. The purpose of this 5-week clinical study was to demonstrate the effectiveness of oatmeal skin protectant lotion in improving the moisture and barrier function of moderate to severe dry skin. A standard Kligman regression model was used. Fifty healthy female subjects with moderate to severe dry skin on the lower legs completed the study. Following the conditioning period, subjects used the oatmeal lotion twice a day for 3 weeks. For the remaining 2 weeks of the study, no test product was applied to the lower leg area. Moisturization and transepidermal water loss measurements were obtained 11 times during the study. Moisturization measurements showed a significant increase (P \.05) in skin hydration at all time points during the treatment phase of the study (days 3, 7,14, and 21). During the 2-week regression phase (no treatment) a significant improvement (P \.05) in skin hydration was still noted at all six time points measured (days 22, 24,28, 30, 32, and 34). Transepidermal water loss measurements showed a significant improvement (P\.05) in skin barrier at all time points during the treatment phase and during days 22, 24, 28, and 30 of the regression phase, which was nine days after the last application of the oatmeal, skin protectant lotion. In conclusion, this oatmeal skin protectant lotion was effective in improving the moisturization and skin barrier of moderate to severely dry skin. Significant improvements (P \.05) in skin moisture were measured for 2 weeks posttreatment. The skin barrier of these subjects still showed a significant improvement (P \.05) at all time points up to and including nine days after the last application of the oatmeal skin protectant lotion. Commercial support: 100% sponsored by Johnson & Johnson Consumer Products Worldwide. P1607 Botulinum toxin type A for the treatment of glabellar lines in Chinese subjects: A multicenter, double-blind, placebo-controlled trial Yan Wu, MD, Peking University First Hospital, Beijing, China; Guang Zhao, General Hospital of Airforce, Shanghai, China; Hengjin Li, PLA General Hospital, Shanghai, China; Zhizhong Zheng, Huashan Hospital Affiliated to Fudan University, Shanghai, China Background: Considerable information has been published supporting the safety, efficacy, and dosing of botulinum toxin type A (BONTA) to treat facial lines. This is the first reported well controlled study in this aspect in Chinese patients. Objectives: To evaluate the efficacy and safety of a single treatment of BoNTA 20 U in the treatment of glabellar lines in Chinese patients. Methods: The study was a multicenter, double-blind, randomized, placebo-controlled trial. Two hundred twenty-seven Chinese patients 18 to 65 years of age with moderate to severe wrinkles at maximum frown were randomized to receive a single intramuscular treatment into the glabellar complex in a randomization ratio of 3:1 of either BoNTA 20 U or placebo. The subjects were observed for 120 days after injection. The efficacy endpoints included the investigator’s rating of wrinkle severity at maximum frown (the primary efficacy endpoint at day 30) and rest using the 4-point Facial Wrinkle Scale (FWS; none, mild, moderate, or severe), the subjects’ global assessment (SGA) of the wrinkles, and subject Self-Perception of Age (SPA). All adverse events were carefully observed. Results: A statistically higher response rate (responder was a subject with the score none or mild after injection) was noted in BONTA group at all time points on the investigator’s rating of glabellar line severity at maximum frown (P \.001). The highest response rates with BONTA were 94.12% (160/170) versus 3.51% (2/57) with placebo at day 30. At other time points, the BONTA response rate ranged from 91.76% (156/170) at day 7 to 52.94% (90/170) at day 120. The responder rate at rest (responder at rest was a subject with mild or none glabellar line at rest who had at least moderate wrinkles at baseline) in BONTA group was 66.67% at day 30 and 33.33% at day 120, respectively. Most patients (95.29%) in the BONTA-treated group were reported with at least moderate improvement for SGA at day 30 after injection, which was maintained in 52.94% of subjects at day 120. SPA was younger than the real age by an average of 1.62 to 2.82 years, but nearly no change in placebo group. The most frequently reported adverse event was headache (8.82% in BONTA vs 1.75% in placebo; P ¼.079). Only one subject (0.59%) had ptosis in BONTA group. Conclusions: BONTA 20 U administered in a single treatment is effective in reducing the severity of glabellar lines for Chinese with moderate and severe glabellar lines for up to 120 days. The incidence of adverse event was comparable or lower compared with previous studies. Commercial support: 100% sponsored by GlaxoSmithKline Investment Co, Ltd. AB80 P1609 A clinical evaluation of a topical formulation containing a complex of mushroom extracts for improving photoaged skin Dara Miller, MD, Johnson and Johnson Consumer Products Worldwide, Skillman, NJ, United States; Judith Nebus, MBA, Johnson and Johnson Consumer Products Worldwide, Skillman, NJ, United States; Warren Wallo, MS, Johnson and Johnson Consumer Products Worldwide, Skillman, NJ, United States Previous clinical studies have demonstrated that a unique mixture of mushroom extracts, containing shitake and mannentake mushrooms, has the ability to enhance cell turnover rate. Using in vitro antioxidant models, this same mushroom complex has shown high antioxidant activity in dismuting a highly reactive superoxide radical, converting it to a less harmful reactive oxygen species. This specific mushroom complex also has demonstrated the ability to inhibit the production of matrix metalloproteinases, which can lead to collagen breakdown. This clinical study evaluated the effects of a topical formulation containing this unique complex of mushroom extracts on photodamaged facial skin. Thirty healthy female subjects between the ages of 35 and 55 with moderate facial photoaging exhibiting mottled hyperpigmentation, blotchiness, skin roughness, laxity, and fine wrinkling completed this 12-week clinical study. Patients used the concentrated topical formulation twice daily. Dermatologist evaluations, self-assessments, and instrumental analysis demonstrated skin benefits throughout the study. Dermatologist evaluations indicated significant improvements (P \.05) in facial skin clarity, smoothness, and overall photoaging after 2 weeks of use. Significant improvements (P \.05) in the appearance of mottled hyperpigmentation, firmness, and fine wrinkling were observed at later time points. Patients perceived significant (P \.05) improvements in skin firmness, brightness, and textural parameters as early as after 2 weeks of use. Digital photographs also confirmed improvements in various overall photoaging parameters. In conclusion, this clinical study demonstrated that a concentrated topical formulation containing a complex of mushroom extracts was effective in improving skin firmness and numerous other photoaging parameters including the appearance of mottled hyperpigmentation, skin brightness, and fine wrinkling in patients with photodamaged facial skin. Commercial support: 100% sponsored by Johnson and Johnson Consumer Products Worldwide. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5957_5962 16 January 2009 6:21 pm P1610 P1612 Immediate and long-term clinical benefits of a novel topical treatment for facial lines and wrinkles Nathan Trookman, Colorado Springs Dermatology Clinic, Rocky Mountain Laser Center, P.C., Colorado Springs, CO, United States; Elizabeth Ho, SkinMedica, Inc., Carlsbad, CA, United States; Ronald Rizer, PhD, Thomas J. Stephens & Associates, Inc., Colorado Springs, CO, United States; Rosanne Ford, SkinMedica, Inc., Carlsbad, CA, United States; Vincent Gotz, PharmD, MS, SkinMedica, Inc., Carlsbad, CA, United States One of the most prominent signs of skin aging is the development of wrinkles caused by intrinsic and environmentally-induced aging processes. The resulting structural changes, such as a reduction in collagen and elastin, and the loss of hydration contribute to the appearance of lines and wrinkles. Facial areas associated with expression movement, such as the periocular and perioral areas, are especially vulnerable to wrinkle formation. As a result, it can be difficult to find a topical treatment that produces visible improvement in these areas. To address the challenge of treating expressive facial areas, a novel topical line treatment was formulated with multiple growth factors, antioxidants, and a collagen-building peptide, ingredients that have been shown to increase collagen levels and provide long-term benefits. To help provide immediate effects, hylauronic acidefilling spheres, which provide moisturization, and a muscle contraction-inhibiting peptide were also included. To evaluate the tolerance and efficacy of this treatment, a 12week single-center open-label study was conducted. Thirty-seven female subjects between 33 and 46 years of age with mild to moderate fine and coarse periocular wrinkles were enrolled; 35 completed the study. Subjects applied the product to their periocular and perioral wrinkles twice daily. Investigator assessments of fine and coarse periocular and perioral wrinkles, subject questionnaires, and digital photography and tolerability assessments were conducted at all visits (baseline, within 15 minutes of initial application, and weeks 4 and 12). Silicone replicas of the periocular areas were conducted at baseline, week 4, and week 12. Investigator assessments of both periocular and perioral wrinkles showed statistically significant improvements over baseline within 15 minutes of application and continued through weeks 4 and 12 (all P # .0003). Digital photography and profilometry analysis confirmed the significant improvements seen in periocular wrinkle investigator assessments. The line treatment was well tolerated and no adverse events were reported. In subject assessments, the novel line treatment was highly rated in product efficacy and performance. Overall, the results from this study demonstrate that this uniquely formulated line treatment was well tolerated and provided both immediate and long-term improvements in the appearance of fine and coarse wrinkles. Skin biomarkers confirm the antioxidant activity of olive derivatives and yeast ferment filtrate Deborah Finlay, MD, The Procter & Gamble Company, Cincinnati, OH, United States; Akira Date, PhD, The Procter & Gamble Company, Cincinnati, OH, United States; Heather Matheny, MMSc, The Procter & Gamble Company, Cincinnati, OH, United States; Lisa Mullins, MMSc, The Procter & Gamble Company, Cincinnati, OH, United States Background: Reactive oxygen species (ROS) are considered to play important roles in the process of ultraviolet light (UV)-induced skin damage, skin photoaging, and melanogenesis. A family of enzymes and antioxidant proteins under control of the antioxidant response element (ARE) provide ideal biomarkers to monitor antioxidant activities in skin. The ARE family of proteins can protect against oxidative damage to cells not only by increasing endogenous antioxidant levels in cells but also by up-regulating proteins that monitor for and repair the damage caused by ROS. Conclusions: Two olive oilebased materials affected antioxidant biomarkers, and therefore should enhance the ability of skin to protect against damage from UV and environmentally generated ROS. Further addition of yeast ferment filtrate (YFF) produced a synergistic effect on HO-1 and provides a compelling reason to further understand the complementary nature of these materials. Therefore, the antioxidant properties of olive oil derivatives and YFF provide powerful protection and repair for skin against the continual assault of UV and environmentally induced ROS. Commercial support: 100% sponsored by SkinMedica, Inc. Commercial support: 100% sponsored by P&G Beauty. Objective: Determine the antioxidant effects of topically applied olive derivatives and yeast ferment filtrate (YFF) on antioxidant biomarkers (ARE and related proteins). Methods: In vitro human skin models, including skin keratinocytes, fibroblasts, skin equivalents, and explants, were treated with olive derivatives (olive oilederived fatty acids modified with PEG-7, olive oil blended with jojoba oil) and YFF. ARE was assayed using the ARE-32 reporter cell line (CXR-Biosciences). Cell type and tissue confirmation of ARE were confirmed via enzyme activity, such as HO-1, and mRNA by reverse transcriptase-polymerase chain reaction. Results: Antioxidant properties of the olive derivatives was confirmed by ARE expression. Also, HO-1 in primary keratinocytes and fibroblasts confirmed ARE activity in skin-specific cells. Interestingly, the ARE biomarker was unaffected by YFF; however, HO-1 confirmed antioxidant activity of this material in keratinocytes. HO-1 indicated a synergistic antioxidant effect of the combination of the PEGmodified olive oil fatty acids with YFF. In addition, these materials appear to reduce UV-generated ROS in both skin equivalent and skin explant systems. P1611 Investigator global evaluations of efficacy with injectable poly-L-lactic acid versus human collagen in the correction of nasolabial fold wrinkles Fredric Brandt, MD, private practice, Coral Gables, FL, United States P1613 Methods: In this randomized, evaluator-blinded, parallel-group, multicenter clinical study, one to four treatment sessions of injectable PLLA or human collagen HC were given at 3-week intervals until optimal cosmetic correction of both NLFs was achieved. The follow-up phase consisted of posttreatment visits after the last treatment at week 3 and months 3, 6, 9, and 13. Eligible subjects received multiple bilateral injections into the left and right NLFs. Standardized photographs were taken at screening and all treatment and follow-up visits. IGE assessments were made in comparison to baseline (pretreatment) values using the first photograph as a reference. The treating investigator rated NLFs for global aesthetic improvement using the following scale (one composite score for both NLFs): 4, excellent improvement; 3, much improved; 2, improved; 1, no change; and 0, worse. Safety analyses were done on all subjects receiving $ 1 study treatment of either device. Results: Two hundred thirty-three subjects were randomized (n ¼ 116, injectable PLLA; n ¼ 117, HC). Based on the IGE, subjects treated with injectable PLLA and reporting scores of ‘‘overall improved’’ (improved, much improved, or excellent improvement) was [88% over the entire posttreatment follow-up period (100% at week 3). HC-treated subjects reported scores of ‘‘overall improved’’ from 95.7% at week 3 to 6.3% at month 13. Significant differences (P \.001) in IGE assessments were observed between injectable PLLA and HC groups at follow-up months 3, 6, 9, and 13. Overall, the incidence of product-related adverse events (AEs) was 20.7% among injectable PLLA-treated subjects and 35.9% in HC-treated subjects. Most AEs were mild or moderate in intensity; no product-related serious AEs were reported. Respective incidences of product-related application-site papules (\5 mm) and nodules ( $ 5 mm) were 8.6% and 6.9% for injectable PLLA and 3.4% and 6.0% for HC. Conclusions: In the injectable PLLA group, proportions of subjects with IGE scores of the ‘‘overall improved’’ remained above 88% over the 13-month follow-up period. Comparison of stabilized retinol technology to glucosamine complex technology for antiaging benefits Tara Zedayko, MBBS, Johnson and Johnson Consumer Products Worldwide, Skillman, NJ, United States; Claude Saliou, PhD, Johnson and Johnson Consumer Products Worldwide, Skillman, NJ, United States; Curtis Cole, PhD, Johnson and Johnson Consumer Products Worldwide, Skillman, NJ, United States; Samantha Tucker-Samaras, PhD, Johnson and Johnson Consumer Products Worldwide, Skillman, NJ, United States; Warren Wallo, PhD, Johnson and Johnson Consumer Products Worldwide, Skillman, NJ, United States The volume of antiaging treatments available to patients continues to grow, and now more investigators are completing placebo-controlled, scientific clinical studies to verify their clinical benefits. The use of topical retinoids to reduce the signs of skin aging is well documented, and it has been shown that stabilized retinol diminishes many of these markers. In vitro studies have shown that retinol effects stimulation of collagen synthesis, reduction of matrix metalloproteinase levels, and induction of fibroblasts outgrowth. Also, long-term application of retinol at 0.04% in the upper arms reduced fine lines and provoked an accumulation of collagen in the papillary dermis. A double-blind, placebo-controlled, split-face study was conducted with an independent dermatologist to compare the ability of two different skin care technologies to deliver cutaneous benefits to photodamaged skin. A formulation containing 0.1% stabilized Retinol was compared with a formulation containing a glucosamine complex, and a placebo formulation containing no specific antiaging technology. Subjects were randomly assigned to two different formulas, and used the formulas once a day in the morning, over an 8-week period. Comparisons of the retinol formulation versus placebo and versus the glucosamine complex formulation included dermatologist assessment of fine and coarse wrinkling parameters, pigmentation parameters, firmness, and laxity parameters. By 4 weeks, improvement of the sites treated with retinol was statistically greater (P \.05) compared to both placebo and the glucosamine complex for fine lines and wrinkles, both on the cheeks and around the eyes, with higher significance by week 8. The retinol formulation also showed statistical superiority at 4 weeks for improvement of mottled and discrete pigmentation, as well as increased firming, all of which increased in significance by week 8. In this clinical study, a formulation containing retinol showed overall superior efficacy compared to a formulation containing a glucosamine complex for the treatment of the appearance of mild to moderate skin aging and photodamage. Commercial support: Sponsored by Dermik Laboratories, a business of sanofiaventis U.S. LLC. Commercial support: Sponsored by Johnson and Johnson Consumer Products Worldwide. Background: Injectable poly-L-lactic acid (PLLA) is a biodegradable, biocompatible, synthetic polymer device currently under review by the US Food and Drug Administration for cosmetic indications. Objective: To assess the efficacy of injectable PLLA compared with that of a commercially available human collagen (HC) in the treatment of nadolabial folds (NLFs) for 13 months using as a secondary efficacy endpoint the Investigator Global Evaluation (IGE) scale for global aesthetic improvement. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5957_5962 16 January 2009 6:21 pm AB81 P1614 P1616 A comparison of onion extract gel with onion extract cream for the improvement of the appearance of postsurgical scars Zoe Draelos, MD, MS, Dermatology Consulting Services, High Point, NC, United States; Bhushan Hardas, MD, MBA, Merz Pharmaceuticals, LLC, Greensboro, NC, United States; Mandeep Kaur, MD, MS, Merz Pharmaceutical, LLC, Greensboro, NC, United States; Wendy Jones, Merz Pharmaceutical, LLC, High Point, NC, United States; Wendy Murray, Merz Pharmaceutical, LLC, Greensboro, NC, United States Background: Scars are particularly sensitive to sunlight and may sunburn faster than healthy skin. Once sunburned, scars may become discolored, darkened, and cosmetically unacceptable. Physicians routinely recommend that patients with healing wounds limit sun exposure and use a sunscreen to prevent worsening the appearance of the scar. With this knowledge and medical need, a new onion extract cream formulation was developed with added ultraviolet A and B light sun protection. Objective: With two onion extract formulations (gel and cream) with the same therapeutic ingredient, it is important to prove that the cream formulation exhibits comparable efficacy to the original gel formulation for the reduction of postsurgical scarring. Therefore, a study was designed to evaluate the efficacy of the onion extract cream formulation on postsurgical scars. Methods: Twenty subjects were enrolled with symmetrical seborrheic keratoses, at least 8 mm in diameter on the right and left upper chest. Both seborrheic keratoses were photographed and removed by a scalpel shave following local anesthesia with 2% lidocaine plus epinephrine. The surgical sites were allowed to heal for 2 weeks. At the end of week 2, subjects returned to the research center for randomization to either the onion extract gel treatment group or onion extract cream group. At this visit, all subjects underwent scar photography, a subject scar assessment and an investigator scar assessment (via separate 4-point ordinal scales) and transepidermal water loss measurement. The subjects were randomized to apply the onion extract gel to the right chest scar and the cream to the left chest scar, or the cream to the right chest scar and the gel to the left chest scar. Study subjects applied the onion extract gel and cream 3 times daily for 8 weeks. Conclusion: The onion extract cream formulation is as effective as the original gel formulation for the improvement of the cosmetic appearance postsurgical scarring. Facial foundation with niacinamide and N-acetylglucosamine improves skin condition in women with sensitive skin Zoe Draelos, MD, Dermatology Consulting Services, High Point, NC, United States; Keith Ertel, PhD, MS, The Procter & Gamble Company, Cincinnati, OH, United States; Marcia Schnicker, The Procter & Gamble Company, Cincinnati, OH, United States; Robert Bacon, The Procter & Gamble Company, Cincinnati, OH, United States; Sarah Vickery, PhD, The Procter & Gamble Company, Cincinnati, OH, United States Background: Facial foundation is a colored cosmetic that improves skin appearance by camouflaging underlying facial pigmentation and texture irregularities. Females typically wear facial foundation at least 8 hours daily, making the skin impact of this cosmetic profound. Two dermatologic populations, rosacea and ethnic sensitive skin, often experience difficulty with facial foundation because of increased skin sensitivity. New technology allows facial foundations to positively affect the skin by incorporating ingredients that produce effects beyond immediate appearance improvement. Examples include niacinamide and N-acetylglucosamine, which can benefit exfoliation, hydration, and barrier function. Objective: The objective of this study was to evaluate the tolerance and skin effects of a test facial foundation containing niacinamide and N-acetylglucosamine on subjects with rosacea or ethnic sensitive skin. Method: Adult females with rosacea or ethnic sensitive skin (90/56) were enrolled in a 6-week, double-blind, parallel use study. Subjects underwent a 2-week washout where they were provided with a standard facial foundation, cleanser, and nighttime facial moisturizer. After completing the washout, subjects were randomized to receive the test facial foundation or one of two marketed facial foundations for morning application, a cleanser, and a nighttime facial moisturizer for 4 weeks of application. Subjects were evaluated by the dermatologist investigator, underwent facial photography, and completed a self-evaluation questionnaire at treatment baseline and study end. Results: At study end, the investigator judged that [93% of subjects with rosacea tolerated the test foundation well, compared to \57% of the subjects who used the comparison foundations. Similarly, [86% of subjects with ethnic sensitive skin tolerated the test foundation, compared to \69% of the subjects who used the comparison foundations. The investigator also judged greater global improvement in facial skin condition for subjects assigned to the test foundation (P \.01) and scored less dryness (P\.01) and scaling (P ¼ 0.1) for subjects using the test product in both populations, and less erythema (P \.07) for rosacea subjects who used the test foundation. Commercial support: 100% sponsored by Merz Pharmaceuticals, LLC. Conclusions: A facial foundation with niacinamide and N-acetylglucosamine is well tolerated by rosacea and ethnic sensitive skin populations and can improve skin condition, offering a cosmeceutical effect in additional to appearance benefits. Commercial support: 100% sponsored by The Procter & Gamble Company. P1615 1,2-pentanediol enhances cutaneous penetration and bioavailability of active ingredients Alexandra Göbel, Martin Luther University Halle-Wittenberg, Halle (Saale), Saxony-Anhalt, Germany; Gerhard Schmaus, PhD, Symrise GmbH & Co KG, Holzminden, Germany; Johannes Wohlrab, PhD, Martin Luther University HalleWittenberg, Halle (Saale), Saxony-Anhalt, Germany; Ravi Pillai, PhD, Symrise, Inc, Teterboro, NJ, United States; Reinhard Neubert, PhD, Martin Luther University Halle-Wittenberg, Halle (Saale), Saxony-Anhalt, Germany Introduction: Because the stratum corneum represents the uppermost skin barrier, active ingredients in topical products have to overcome it to reach the deeper skin layers like the viable epidermis or dermis. Because of the lipophilic properties of the stratum corneum, especially hydrophilic drugs penetrate poorly. Therefore, the topical bioavailability of a hydrophilic active like carnosine, a dipeptide with a target site in the viable epidermis, is highly challenging. 1,2-pentanediol, a multifunctional moisturizer used in personal care products, may enhance the dermal penetration of actives. An ex vivo study was conducted to evaluate the penetration profile of carnosine from a topical preparation in the presence and absence of 1,2-pentanediol. Methods: The skin penetration of two formulations (applied dose, 20 mg) containing either 2.0% carnosine together with 5.0% 1,2-pentanediol or only 2.0% carnosine (without 1,2-pentanediol) on human breast skin was determined using Franz diffusion cells. The experiments were performed in triplicate at 328C at incubation times of 30, 100, and 300 minutes. Three punch biopsies (0.28 cm2) of each sample were taken and horizontally cut using a freezing microtome in slices, thereby separating the different skin layers. Carnosine was extracted with a mixture of methanol/water (70/30) and quantified by high performance liquid chromatography-ultraviolet light. P1617 In vitro skin biomarker responses to a new antiaging peptide, Pal-KT Lisa Mullins, MBBCh, The Procter & Gamble Company, Cincinnati, OH, United States; Bradley Jarrold, MMSc, The Procter & Gamble Company, Cincinnati, OH, United States; Karl Lintner, PhD, Sederma, Cedex, France; Rosemarie Osborne, PhD, The Procter & Gamble Company, Cincinnati, OH, United States Background: Peptides applied topically in moisturizer-type cosmetic products are known to improve the appearance of signs of facial skin aging. For example, palmitoyl-KTTKS pentapeptide has been shown to improve the appearance of fine lines and wrinkles in aging facial skin when applied twice daily in a facial moisturizer. A screening program was undertaken to identify next generation peptides to improve the appearance of aging facial skin. Objective: The goal of the current work was to identify a peptide with superior activity to existing peptides in improving in vitro expression of skin biomarkers linked to antiaging benefits. Discussion: The use of 1,2-pentanediol in a topical formulation increased the penetration of the hydrophilic active carnosine. The bioavailability of the active was significantly higher at the target sites. An earlier study showed that 1,2-pentanediol could enhance the bioavailability of an amphiphilic ingredient like dihydroavenanthramide D as well. In conclusion, 1,2-pentanediol may increase the topical bioavailability of both hydrophilic and amphiphilic actives. Methods: A series of di-, tri-, and tetrapeptides were synthesized and screened in vitro by expression of collagen I, collagen IV, and fibronectin in human dermal fibroblasts. Human skin equivalent cultures were then used to evaluate top candidates. Solutions of peptides were applied topically to the stratum corneum surface, and levels of expression of skin biomarkers were measured using reverse transcriptase-polymerase chain reaction (RT-PCR) for mRNA and enzyme-linked immunosorbent assay for hyaluronic acid and procollagen I. Epidermal biomarkers were also analyzed in gene array datasets from epidermal keratinocytes. Biomarker results were compared to concurrent vehicle controls. Results: Of the peptides evaluated, palmitoyl-lysine-threonine (pal-KT) affected skin biomarkers to the greatest extent when evaluated in human dermal fibroblasts or human skin equivalent cultures. RT-PCR analysis of mRNA from human skin equivalent cultures treated with pal-KT revealed significantly increased expression versus control for biomarkers of basement membrane and dermal structural proteins including procollagen-C, collagens I, III, IV, VI, elastin, fibronectin, CD44, vimentin, and laminins I and IV. Epidermal keratins 1/10 were also increased. Pal-KT peptide affected collagen I protein and hyaluronic acid in a combined manner with another related peptide, pal-KTTKS. Conclusions: These in vitro skin biomarker results suggest that pal-KT peptide is a promising candidate for a cosmetic moisturizer ingredient, either alone or in combination with other peptides, such as pal-KTTKS. Commercial support: Sponsored by Symrise, Inc. Commercial support: 100% sponsored by P&G Beauty. Results: The addition of 5% 1,2-pentanediol significantly increased the skin penetration of carnosine. The application of the formulation containing both carnosine and 1,2-pentanediol resulted in a penetration of up to 17% of applied carnosine into the dermis at 100 minutes, whereas \5% had reached the dermis in the case of the formulation without 1,2-pentanediol. Similarly, at all time intervals, the total concentration of carnosine found in viable epidermis and dermis was much higher when 1,2-pentanediol was present. The active ingredient was absent in the acceptor phase at all incubation times indicating no transdermal penetration. AB82 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5957_5962 16 January 2009 6:21 pm P1618 P1620 Reduction in gene expression related to inflammation themes by skin barrier improving agent, niacinamide Michael Robinson, The Procter & Gamble Company, Cincinnati, OH, United States; Jay Tiesman, PhD, The Procter & Gamble Company, Cincinnati, OH, United States; Kenton Juhlin, PhD, The Procter & Gamble Company, Cincinnati, OH, United States; Robert Binder, PhD, The Procter & Gamble Company, Cincinnati, OH, United States Background: It is known that skin aging, particularly photoaging, is associated with chronic inflammation. It has not been clear, however, whether inflammatory cells and mediators are drivers of skin aging or simply an associated epiphenomenon. Recent genome-wide analysis of gene expression in young versus chronologically aged or photoaged human skin has revealed that inflammation is a central theme in skin aging and directly related to other processes including protease activity, oxidoreductase activity, and extracellular matrix. A skin benefit agent, niacinamide (vitamin B3), is known to improve the skin barrier and has been reported to reduce markers of inflammation in vitro and in some clinical conditions. It was of interest to determine if such activity of niacinamide could be confirmed in human skin through gene expression analysis. The effects of tetrahydrocurcumin in curmin cream on the hydration, elasticity, and color of human skin Rungsima Wanitphakdeedecha, MD, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand; Sasima Eimpunth, MD, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand; Woraphong Manuskiatti, MD, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand Objective: To determine, via gene expression profiling, the effects of repeat topical application of a known barrier improving agent, niacinamide, on skin inflammation. Methods: Individual study subjects (females 35-55 yrs of age) were treated with 3.5% niacinamide-containing or vehicle control lotion formulations on the volar forearm twice daily for up to 15 days. Full-thickness skin biopsies were taken from the treatment sites over the 15-day period. Total RNA was extracted from the biopsies and labeled for Affymetrix GeneChip analysis. The synthesized target cRNA was hybridized to Affymetrix HG U133A microarrays. The data were subjected to rigorous statistical quality control and analysis and then processed for bioinformatics analysis of gene expression patterns and overarching themes. Results: Significantly overrepresented gene ontology terms were identified from lists of genes whose expression was increased or decreased after 11 or 15 days of niacinamide-containing versus control lotions. Overrepresented themes included inflammation-related terms predominantly associated with decreased gene expression in the niacinamide samples. The finding that inflammation-related gene expression is decreased in skin treated with a niacinamide-containing lotion suggests a unique benefit from niacinamide-improved skin barrier function. Commercial support: 100% sponsored by The Procter & Gamble Company. Introduction: An antioxidant used in cosmetic applications should have the capability to efficiently quench free radicals on the surface of the skin. Tetrahydrocurcumin (THC) plays an important role in the antioxidant mechanism resulting in the significant neutralization of free radicals in a dose-dependent manner. Recent studies revealed the superior free radical scavenging ability of THC. This action is of particular interest for cosmetics, in terms of ultraviolet protection and antiaging preparations. Objective: To study the efficacy of tetrahydrocurcumin (THC) and liposome in GPO curmin cream in hydration, elasticity, and color of human skin. Methods: Eighty female volunteers 30 to 45 years of age with normal skin were recruited to the study. The volunteers were randomly divided into four groups and treated with: (A) GPO curmin cream containing both tetrahydrocurcumin (THC) and liposome; (B) GPO curmin cream containing THC without liposome; (C) GPO curmin cream containing liposome without THC; and (D) vehicle-controlled cream. All volunteers were asked to apply 1 g of cream on their face twice a day for 4 weeks. Skin hydration, elasticity, and color were measured at baseline and 4 weeks after treatment by Corneometer CM 825, Cutometer MPA 580, and Dermospectrometer, respectively, on the forehead and both cheeks. Results: Seventy-eight subjects (20 in group A, 20 in group B, 19 in group C, and 19 in group D) completed the treatment protocol. The skin hydration, elasticity, and color measured at baseline and 4 weeks after treatment of all four groups were analyzed using univariate analysis of variance to compare between groups and the paired t test to compare within groups. The baseline skin hydration, elasticity, and color in all groups were not significantly different (P ¼ .954, P ¼ .727, and P ¼ .560, respectively). Skin hydration, elasticity, and color at 4 weeks after treatment in all groups also demonstrated no significant differences (P ¼.570, P ¼.137, and P ¼.445, respectively). Skin hydration was significantly decreased in group C (P ¼.030). Skin elasticity was significantly increased in groups A, C, and D (P ¼.002, P ¼.000, and P ¼.021, respectively). Skin color was significantly improved in all groups (P ¼.000). Conclusions: THC and liposome provided no improvement in skin hydration in all groups. Significant lighter in skin color were found in all groups. Skin elasticity was improved in all groups except group B. The other ingredients in vehicle might be responsible for these significant results. Commercial support: None identified. P1619 The role of hydrolyzed jojoba esters as a unique botanical technology for long-acting moisturization Lawrence Rheins, MD, PhD, Floratech, Chandler, AZ, United States; Jason Sondgeroth, Chattem Inc, Chattooga, TN, United States Adequate cutaneous hydration remains key to ensuring efficacy for therapeutic and multiple cosmetic/personal care products. Commercial moisturizers cover the gamut of functional activity ranging from traditional humectants, occlusives, to the various lipid reconstituted products, and mild exfoliants associated with alfa- and beta-hydroxy acid products. The extraordinary complexity of skin moisturization/ hydration remains a difficult enigma for research skin biologists and clinicians. The discovery of the aquaporin 3 epidermal pathway, endogegeous glycerol transport in the corneocytes, and the continuing role of cutaneous immune system (ongoing inflammatory process) suggest that multiple interventional approaches are necessary to achieve adequate, long-acting skin moisturization. Over the years, a variety of plant ingredients have been purported to convey skin hydration effects to the skin, but controlled clinical studies with botanicals and/or their derivatives have been sparse. The current studies were undertaken to evaluate the role of hydrolyzed jojoba esters as botanical derivative(s) (fatty acid profile similar to human sebum) as a unique technology for development of long acting ( $ 24 hrs) moisturizing activity. A combination of evaporative water loss (TEWL) evaluations along with skin hydration (capacitance) measurements, including dermatosensorial evaluations of test subject preferences for various formulation parameters were investigated. A basic skin moisturizer supplanted with hydrolyzed jojoba esters and glycerin produced acute, 1-, 4-, and 7-hour (posttreatment) increases (63%, 65%, and 58%, respectively; P \ .05) in hydration/moisturization when compared to a control treatment without the addition of jojoba esters. Additional studies examining TEWL and clinical skin grading demonstrated that various concentrations of jojoba esters when combined with a 3.75% glycerol concentration in a jojoba ester supplanted skin care lotion produced a significant (56%) reduction in TEWL values (P \.05) versus controls at 24 hours following a single application to xerotic skin. Three millimeter hematoxylineeosin stained punch biopsies revealed identifiable changes in inflammatory infiltrate in chronic dermatitic hands with skin lotions supplanted with the hydrolyzed jojoba derivatives over 10 days of treatment. Subjects completing dermatosensorial questionnaires repeatedly identified the jojoba supplanted skin lotion as ‘‘effective’’ at reducing the signs and symptoms of xerotic (eg, itching, flaking, and peeling) skin. Other sensorial parameters, such as tackiness (product build-up) and excessive ‘‘greasiness,’’ produced fewer comments with the jojoba-supplanted treatment. These sensory long-acting moisturizing effects were noted even following hand washing, which may contribute to greater end user compliance for a variety of common dermatitic conditions. Jojoba hydrolyzed ester restoration of stratum corneum lipids with concurrent amelioration of cutaneous inflammation may play a growing role in healthy and disease skin states. P1621 Commercial support: 50% by Floratech, 50% by Chattem Inc. Commercial support: None identified. Photostability of commercial tretinoin products differs dramatically Rose Ye, Stiefel Research Australia, Rowville, Victoria, Australia; Dewitt Luu, Stiefel Research Australia, Rowville, Victoria, Australia; Edin Bektic, Stiefel Research Australia, Rowville, Victoria, Australia; Richard Buchta, Stiefel Research Australia, Rowville, Victoria, Australia; Veronika Wirth, Stiefel Research Australia, Rowville, Victoria, Australia Introduction: It is well known that tretinoin is quite photosensitive, leading to several degradation products, mainly the isomers of tretinoin. It is believed that the photodegradants of tretinoin are more irritating or toxic than tretinoin itself. Many factors can affect tretinoin photostability in a product such as excipients, packing materials and the way tretinoin is formulated. Therefore the photostability of different tretinoin products may be very different. However, there is no literature data available showing the relative photostability of tretinoin products in the current marketplace. Objective: We aimed to evaluate the relative photostability of some commercial tretinoin products when exposed to indoor fluorescent light. Methods: A small amount of product (60 mg) was spread onto the bottom of a glass jar to form a thin film to mimic the application of the product on the face. The samples were then exposed to indoor fluorescent light. The light source used was triphosphor 36W/865 cool daylight tube. The distance between the sample and light source was about 1.4 m, similar to the distance between a patient’s face and the fluorescent ceiling lights. Two samples were kept in the dark as controls. The samples were analyzed using a high performance liquid chromatography (HPLC) method with a C18 column (150 3 4.6 mm) and a mobile phase of acetonitrilewater-TFA (77.5-22.5-0.1) eluting at 0.8 mL/minute. The degree of tretinoin photodegradation was expressed as the tretinoin potency remaining in the exposed samples compared with the control. The degradants profiles were also determined by HPLC. Results: The photodegradation of four commercial tretinoin products was determined for exposure times of 10 minutes to 8 hours. The photostability varies significantly among the four products tested with remaining tretinoin potencies of 28%, 32%, 60%, and 83%, respectively, for a 0.1% microsphere gel, a 0.05% emollient cream, a 0.05% cream, and a 0.1% cream upon exposure to indoor light for 4 hours. The degradation was not linear and dependant on the product formulation. However, the degradant profiles are similar for all products tested, even though the degradation rate differs. Conclusions: The results from this study show that some commercial tretinoin products may be applied indoor during the day, while other products must be applied just before bedtime in order to maintain the product active potency. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5957_5962 16 January 2009 6:21 pm AB83 P1622 P1624 Ex vivo pharmacologic effects and irritation potential of novel 0.4% and 1% retinol formulations Nevena Karaman-Jurkovska, MD, AGI Dermatics, Freeport, NY, United States; Daniel Yarosh, PhD, AGI Dermatics, Freeport, NY, United States; Gudrun Lang, RN, AGI Dermatics, Freeport, NY, United States; Kenneth Smiles, PhD, AGI Dermatics, Freeport, NY, United States Potentiated pyrithione zinc shampoo usage leads to pronounced alterations in scalp skin histology and biochemistry that underlie efficacy in dandruff/seborrheic dermatitis Kathy Kerr, MD, Procter & Gamble, Ross, OH, United States; Haruko Mizoguchi, PhD, Procter & Gamble, Cincinnati, OH, United States; Jim Henry, PhD, Procter & Gamble, Ross, OH, United States; Kevin Mills, PhD, Procter & Gamble, Cincinnati, OH, United States; Trevor Darcy, PhD, Procter & Gamble, Ross, OH, United States We have investigated the biologic effects of two novel formulations of 0.4% and 1% retinol containing both the potent antioxidant ergothioneine and the barrier building activity of rosemary extract. The pharmacologic effects were studied using an ex vivo skin model. A normal skin specimen from a 51-year-old female was received through the Cooperative Human Tissue Network. After acclimatization at 378C in a humidified incubator, the retinol formulations were applied three times during a 4-day period, and then the skin was snap frozen, embedded, and processed for standard hematoxylineeosin staining. Marked thickening of the epidermis compared to the control samples was already evident within 24 hours. A much greater alteration in epidermal thickness and appearance was seen after 4 days and was related to the retinol concentration. These changes included thickening of the epidermis, reduced compactness of the cornified layers, and increases in the intercellular spaces, all features characteristic for retinoid-treated skin in vivo. An evaluator blinded, controlled, and randomized 21-day semioccluded patch test was also conducted on 29 healthy subjects between the ages of 23 and 64 years with Fitzpatrick skin types I to IV. In addition to the two novel retinol formulations, five other commercially available formulations containing between 0.1% and 1.0% retinol were tested, along with a common moisturizing lotion as the negative control. The results indicated that the novel formulations were more irritating than the commercial formulations containing equal or \0.15% retinol, but were (P \.01) or tended to be (P ¼.06) less irritating than the commercial formulations containing matching concentrations of retinol. Overall, the results indicate the novel formulations have less potential for causing irritation while possessing the full pharmacologic effects of the retinol. Commercial support: None identified. Background: Dandruff and scalp seborrheic dermatitis (D/SD) are inflammatory, hyperproliferative conditions triggered at least in part by a skin response to the presence of commensal Malassezia yeasts. The outward manifestations of the conditions—flakes, pruritus, and erythema—reflect histopathologic and biochemical changes within scalp skin that give rise to these symptoms. While fungal control is a valid therapeutic strategy and is known to resolve flaking symptoms, successful therapy requires that the underlying skin physiology be repaired as well to achieve a healthy scalp status. Objectives: To histologicly and biochemically characterize the status of scalp skin in D/SD, and to determine how various pathophysiologic parameters change upon treatment with either a potentiated pyrithione zinc (PTZ) shampoo or placebo treatment. Method: A population of moderate to severe D/SD patients was identified and treated for three weeks with either a commercial potentiated PTZ shampoo or a placebo control. Biopsies were taken from lesional sites at baseline and end of study for histomorphometric analysis and scalp stratum corneum samples were also obtained for evaluation of biochemical markers of inflammation (eg, interleukin [IL]1a, IL-1-RA),and barrier integrity (stratum corneum lipids). These data were then compared to reduction in flaking symptoms assessed by an expert grader. Results: Three weeks usage of a potentiated PTZ shampoo led to a dramatic reduction in D/SD symptoms that was accompanied by significant improvements in all indicators of epidermal homeostasis and barrier integrity. Specifically, baseline histologic and biochemical measures showed evidence of hyperproliferation, inflammation, and poor barrier formation/integrity. After treatment with the potentiated PTZ shampoo, but not the placebo, hyperproliferation and inflammatory indicators decreased significantly and epidermal barrier integrity was repaired. The resolution of hyperplasia and inflammation and the restoration of barrier integrity all accompanied symptom resolution, supporting the mechanistic link among them. It is not known whether the PTZ shampooeinduced scalp skin effects measured in this study are a direct or indirect effect of PTZ. Effective therapies for D/SD must demonstrate treatment of both symptoms and their underlying causes to completely resolve the condition. Commercial support: 100% sponsored by Procter & Gamble. P1625 P1623 Faster recovery from purpura using a topical cream containing bicyclic monoterpene diols Mark Rubin, Lasky Skin Center, Beverly Hills, CA, United States; Alice Davis, Lasky Skin Center, Beverly Hills, CA, United States; Daniel Yarosh, PhD, AGI Dermatics, Freeport, NY, United States; Gudrun Lang, RN, AGI Dermatics, Freeport, NY, United States; Katherine Kim, MD, Lasky Skin Center, Beverly Hills, CA, United States Bruising is a side effect of many dermatologic surgery and aesthetic procedures, and speed of recovery contributes to patient satisfaction. Two bicyclic monoterpene diols (BMT diols)—2,3-cis/exo-pinanediol and 2,3-cis/exo-camphanediol—have been shown to increase nitric oxide production and microcirculation in the skin. We tested whether a topical cream containing these BMT diols, by increasing circulation, may speed the resolution of bruising by accelerating the removal of extravasated blood components and the breakdown products that make up the bruise. This pilot study was a single-center, randomized, controlled, double-blinded, and bilaterally paired study in 20 subjects. Each subject was treated once with a 585-nm pulse dye laser (circular spot size, 5-10 mm in diameter; pulse width, 1.5 ms; fluence, 8-10 J/cm2) to create purpura at the midpoint of the ventral surface of each forearm. The subjects applied either the BMT diol cream (0.034% wt/vol) or placebo (Eucerin) to the entire skin surface of the ventral forearm, up to the elbow, twice each day for 17 days. At the start, the mean diameter of purpura was 26.7 mm. The mean time to 50% reduction of lesion size was 7 days for either arm. The lightness scores, measured by chronometer, improved after either treatment and were equivalent after 10 days. However, on day 3 and day 7, the sites on the arm treated with the BMT diol cream were significantly lighter than the other arm treated with placebo (P \.05, paired t test). In particular, on day 3, the BMT diol treated site was on average 71% lighter than the placebo site. This supports the hypothesis that improving microcirculation increases clearing of darkly colored blood components that contribute to the dark color of the bruise. It is consistent with the previous finding that BMT diols reduce the appearance of dark under-eye circles. These data suggest that increasing microcirculation improves the appearance of and recovery from bruising. Commercial support: 100% sponsored by AGI Dermatics. AB84 Toll-like receptor-2 and interleukin-8 down-regulation in microbialstimulated human skin explants Marius Anton Ionescu, MD, Dermatology Polyclinic, Saint-Louis Hospital, Paris, Ile de France, France; Agnes Gougerot, MD, Laboratoires Dermatologiques d’Uriage, Courbevoie, Hauts de Seine, France; Anne-Marie Matta, Laboratoires Dermatologiques d’Uriage, Courbevoie, Hauts de Seine, France; Luc Lefeuvre, PharmD, Laboratoires Dermatologiques d’Uriage, Courbevoie, Hauts de Seine, France; Michel Bohbot, PharmD, Laboratoires Dermatologiques d’Uriage, Courbevoie, Hauts de Seine, France Background: Toll-like receptors (TLR) are transmembrane receptors that are part of the innate immune system mechanism. Toll-like receptor 2 (TLR-2) is activated by bacteria and yeast compounds and can trig an inflammatory cascade involving interleukin (IL)-1, IL-6, IL-8, and other cytokines. Purpose: An association of a vegetal natural extract (Ombeliferae) and a lipid obtained by biotechnology (tlr2-regul) was studied ex vivo, focusing TRL-2 activation and IL induction in the presence of microbial extracts. Methods: Human normal skin explants were incubated (1 h at 378C) in absence (control) or in presence of a monoclonal antibody antiTLR2 (Tebu at 20 g/mL) or treated by an emulsion O/W formulated with the complex tlr2-regul (20 L per explant) or by its vehicle (control). At 1 hour, inactivated extracts of Propinobacterium acnes, Staphylococcus aureus, or Malassezia furfur (20 l per explant) were added. After 24 hours of incubation (for P acnes and S aureus) or 48 hours (for M furfur), the dosage of IL-8 was performed (enzyme-linked immunosorbent assay). Results: All microbial extracts induced a significant increase of IL-8 expression in all skin explants (P \ .001). In skin previously treated by antibodies antiTLR-2, the expression of IL-8 was not increased by microbial extracts. Skin explants treated by tlr2-regul in contact with microbial extracts had a significant decrease of IL-8 (-82% compared to control; P \.001). Conclusions: In this ex vivo study, cutaneous IL-8 expression induced by microbial extracts was linked to the activation of TLR-2. In skin explants treated by the complex tlr2-regul and exposed to microbial extracts, the expression of IL-8 was decreased by 82% (P \.001). Commercial support: Supported 100% by Laboratoires Dermatologiques d’Uriage. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5957_5962 16 January 2009 6:21 pm P1626 P1628 Clinical efficacy and tolerance of a novel treatment serum for photodamaged facial skin Nathan Trookman, Colorado Springs Dermatology Clinic, Rocky Mountain Laser Center, PC, Colorado Springs, CO, United States; Elizabeth Ho, SkinMedica, Inc, Carlsbad, CA, United States; Ronald Rizer, PhD, Thomas J. Stephens & Associates, Inc, Colorado Springs, CO, United States; Rosanne Ford, SkinMedica, Inc, Carlsbad, CA, United States; Vincent Gotz, MS, SkinMedica, Inc, Carlsbad, CA, United States Oxidative damage induced by environmental factors, such as chronic ultraviolet exposure, contributes to the process of photoaging and results in the formation of reactive oxygen species (ROS). At a molecular level, ROS causes a cascade of biochemical events which leads to increased collagen degradation and the suppression of collagen synthesis. Clinical manifestations of photodamage include a loss of skin elasticity and firmness, fine lines and wrinkles, and uneven skin tone. Topical therapies formulated with peptides and antioxidants have been shown to increase collagen levels in the skin. In addition, emerging treatments using human growth factors have been shown to stimulate repair of dermal structures. To treat the effects of photodamage, an innovative treatment serum was formulated containing a concentrated antioxidant blend, multiple human growth factors and cytokines, collagen-building peptides and de-pigmenting agents. A single-center controlled usage study was conducted to determine if the treatment serum could improve the visible signs of facial photodamage. Thirty-seven females 32 to 55 years of age with mild, moderate, or severe fine and coarse periocular wrinkles were enrolled. Subjects applied the treatment serum twice daily in conjunction with a basic skincare regimen including sun protection. Baseline and week 4 visits included investigator assessments of fine and coarse wrinkles, skin texture, tone, and radiance. In addition, cutometer measurements of skin firmness, digital photography, tolerability assessments, and subject questionnaires were conducted. After 4 weeks of treatment, statistically significant improvements were observed in all investigator assessments of fine and coarse periocular wrinkles, skin texture, tone, and radiance (all P # .0001). Cutometer readings also reflected significant improvements in skin firmness (P ¼ .002). Digital photography confirmed the significant improvements seen in investigator assessments and cutometer readings. The treatment serum was well tolerated and no treatment-related adverse events were reported. The treatment serum was highly rated in product efficacy, as reflected in subject assessments. Results from this study show that this novel treatment serum provided significant improvements in the visible signs of photodamage. Evaluating the effects of a body moisturizer with glycolic acid on epidermal proliferation via fluorescence excitation spectroscopy Michael Suero, MBChB, Johnson & Johnson Consumer Products Worldwide, Skillman, NJ, United States; Dara Miller, Johnson & Johnson Consumer Products Worldwide, Skillman, NJ, United States; Merryl Azriel, Johnson & Johnson Consumer Products Worldwide, Skillman, NJ, United States; Warren Wallo, MS, Johnson & Johnson Consumer Products Worldwide, Skillman, NJ, United States In a clinical setting, patients with dry skin often present with flakiness as a result of a disrupted desquamation process. The application of an exfoliating agent such as alfahydroxy acid (AHA) helps promote desquamation by breaking the bonds between dead skin cells, thereby facilitating the removal of flakes and allowing newer cells to emerge. Fluorescence excitation spectroscopy allows for a noninvasive means of determining the increase in the rate of cellular turnover via monitoring the intensities of the excitation band assigned to tryptophan, an established marker of epidermal proliferation. A randomized, controlled clinical study was performed on 25 healthy women between 40 and 59 years of age in order to evaluate the efficacy of a new moisturizer formulated with 4% glycolic acid in increasing the rate of cellular turnover compared to an ordinary body lotion. Subjects applied one test product on one forearm and the second test product on the other forearm twice daily for 4 weeks. Product efficacy was determined via fluorescence excitation scans of the volar forearms at various time points over the 4-week period. An increase in the intensity at 295 nm signaled an increase in tryptophan and therefore proliferation rate. In as early as 1 week, the forearms treated with the new moisturizer with 4% glycolic acid exhibited fluorescence intensity increases that were significantly higher compared to those of the ordinary body lotion and untreated test site. Moreover, none of the subjects experienced any form of irritation on the treated sites. In conclusion, this clinical study demonstrated that daily topical application of a body moisturizer with 4% glycolic acid is well tolerated and effective in accelerating cellular turnover and reducing flakiness associated with dry skin. Clinicians can apply this noninvasive methodology to measure proliferation rates and obtain objective instrumental results to correlate with visual and textural changes observed on the cutaneous surface. Commercial support: Sponsored by Johnson & Johnson Consumer Products Worldwide. Commercial support: 100% sponsored by SkinMedica, Inc. P1629 P1627 Facial tolerance of a daily moisturizer containing a purified feverfew extract and SPF30 in a sensitive skin population Warren Wallo, Johnson & Johnson Consumer & Personal Products Worldwide, Skillman, NJ, United States; Dara Miller, Johnson & Johnson CPPW, Skillman, NJ, United States; Judith Nebus, MBA, Johnson & Johnson CPPW, Skillman, NJ, United States Patients with sensitive skin struggle to find skin care products that they can tolerate and will not irritate their skin. At the same time, these patients need to use a daily product that provides effective protection from photodamage. Dermatologists reinforce the need for broad-spectrum, ultraviolet A and B light, photostable sunscreen with a preferred SPF of 30. To provide additional benefits to patients with sensitive skin, specific naturally derived extracts can be included in topical formulations to provide additional calming benefits, improving patient tolerability and daily compliance. A 4-week clinical facial study including daily application of a calming moisturizer with SPF 30 was conducted on 30 female subjects with selfassessed or clinically-defined sensitive skin. Tolerance and product performance was assessed by investigator clinical evaluations and patient self-assessments at multiple time points over the course of the study. After 4 weeks of daily use of the feverfewcontaining moisturizer with SPF30, patients exhibited statistically significant improvements versus baseline in their facial erythema, dryness, and roughness and in the overall appearance of their skin as graded by the investigator. There were no statistically significant increases in facial irritation observed during the study. Subjects did not perceive any significant increases in sensory irritation parameters and self-assessments indicated that patients perceived improvements in their overall appearance and skin texture. In conclusion, a daily moisturizer with SPF30 containing a purified feverfew extract has been shown to be well tolerated by patients with sensitive skin, provided a high level of photostable sun protection, and delivered improvements in overall appearance and texture while calming and soothing their sensitive skin. Commercial support: 100% sponsored by Johnson & Johnson Consumer Companies, Inc. Gender differences in attitudes and practices toward body skin care Keith Ertel, MD, MPH, The Procter & Gamble Company, Cincinnati, OH, United States; Christina Dooley, The Procter & Gamble Company, Cincinnati, OH, United States; Heather Focht, The Procter & Gamble Company, Cincinnati, OH, United States; Jamie Moak, The Procter & Gamble Company, Cincinnati, OH, United States Background: Female patients are the traditional focus for skin care product research and development. This is because females are an easier test population, females are more skin involved than males, and females purchase more products than males. However, males and females share baser skin care needs, such as those relating to dry skin and moisturization, yet sex differences in skin physiology may provide a basis for gender-specific formulations. Objective: This work assessed male and female views regarding skin care needs and their attitudes toward various treatment modalities. Methods: This research was conducted on a study panel consisting of 303 males and 313 females. Subjects completed a questionnaire regarding perceptions of body skin condition, skin care habits and practices, and attitudes toward various cosmetic interventions. A 10% significance level, standard for this type of research, was used for comparisons. Results: This research showed a strong contrast between males and females in their use of body skin care products. Males were less likely to use a body treatment product than females. However, dry skin ranked high on the list of body skin care needs for both sexes. Moisturizer use was identified as the best dry skin treatment, but males were less likely to apply moisturizer because of perceived a time constraint (P \.10). Skin-feel parameters were also more important to males than females (P \ .10). Surprisingly, males were more likely to seek help from a dermatologist for their dry skin than females (P \.10). Conclusion: These results demonstrate a need for male-oriented dry skin treatments and suggest that moisturizers, moisturizing body cleansers, or in-shower body lotions should be developed with acceptable aesthetics. Further, the results show that dermatologists can play an important role in educating male patients on the importance of proper skin care. Commercial support: 100% of this poster is sponsored by The Procter & Gamble Company. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5957_5962 16 January 2009 6:21 pm AB85 P1630 P1632 Superior skin effect by facial mask Yukio Heki, Procter and Gamble Japan KK, Kobe, Japan; Kesyin Hsueh, PhD, Procter and Gamble Japan KK, Kobe, Japan; Ohgata Hiroyuki, MBBS, Procter and Gamble Japan KK, Kobe, Japan Background: Fabric substrateebased facial mask has been an important supplement of skin care regiment for Asian women. Most users always recognize clearly excellent skin efficacy and in-use experience. This investigation result elucidates the potential skin effect mechanisms via clinical designs and trials. Objective: In vivo research designs to better understand and quantitate the mask effects on facial skin care efficacy and experience. Methods: Clinical preparation: in vivo study with chronic and acute application of mask with formula, involving multiple or single visit of randomized Japanese panelists (n ¼ 50), 32 to 52 years of age, who had applied basic skin care regimen as baseline control. Protocols: DANNE three-dimensional facial topography analysis comparing cotton and other substrate masks , active skin penetration by tape stripping method, Comeometer, VISIA, Optical Coherent Tomography comparing liquid only and various substrate masks. Formula: key formula and functional ingredient investigated include Niacinamide, glycerin, cosmetic-grade humectants, and typical skin care formula chasses. Mask: engineering substrates composed of hydrophilic cotton spunlace, hydrophilic rayon spunlace, and hydrophobic stretchable polyolefin microfiber spunlace. Hydradermabrasion: An innovative modality for nonablative facial rejuvenation Bruce Freedman, Plastic Surgery Associates of Northern Virginia, McLean, VA, United States Results: In vivo active penetration through the stratum corneum is found significantly higher in volume and rate for mask and formula combination (220 index). This is supported by substrate occlusive evaporating effect and formula retention and gradual release to the skin during application. Parallel clinical means confirm superior stratum corneum hydration effect and acute appearance improvements of masks impregnated with formula. The newly engineered substrate of special micro fibers and with hydrophilicity gradient is demonstrated to accelerate flux and transport more effectively actives and moisture into epidermis (125 index). DANNE three-dimensional facial topography analysis also reveals significant facial firming and cheek contour line lift-up effects with the combination of formula and engineering substrate masks. The clinical trial results are further correlated with grading of visual perception system of VISIA images and users experience survey. Background: Hydradermabrasion is a relatively new procedure that combines crystal free microdermabrasion immediately followed by the pneumatic application of a rejuvenating serum. This study analyzed the histologic and clinical changes associated with hydradermabrasion. Methods: Twenty female volunteers between 34 and 52 years of age with Fitzpatrick skin phototypes I to IV underwent a series of six facial hydradermabrasion treatments spaced 7 to 10 days apart. The applied serum contained polyphenolic antioxidants including camellia sinensis and horse chestnut seed extract. Skin biopsies, photographs, and skin antioxidant levels, as determined by Raman Spectroscopy, were obtained before and after the study. Results: Compared to controls, the treated skin demonstrated significantly increased epidermal and papillary dermal thickness and increased fibroblast density (P \.01). Hyalinization of the papillary dermis with newly deposited collagen fibers and lessening of solar elastosis were observed. After hydradermabrasion, skin antioxidant levels increased 30% (P \.01). These changes were supported clinically with reductions in pore size, dyspigmentation, and fine rhytides. Patients also noted improved skin texture and tone. There were no reported complications. Conclusion: Hydradermabrasion effectively improved skin quality both clinically and histologicly. There were no changes to suggest that pneumatic serum application adversely affected dermal components. After hydradermabrasion, skin polyphenolic antioxidant levels were increased. This procedure is beneficial for those desiring nonablative facial rejuvenation. Commercial support: None identified. Commercial support: Sponsored by Procter and Gamble. P1633 P1631 Multiple mechanisms of action of azelaic acid: New findings Zoe Draelos, MD, Dermatology Consulting Services, High Point, NC, United States The role of 0.02% tretinoin cream in preventing and reversing photodamage Leon Kircik, Derm Research, Louisville, KY, United States Introduction: The multiple mechanisms of action of azelaic acid (AZA) 15% gel give it the potential to treat various dermatologic conditions in addition to rosacea, for which it is approved in the United States, and to simultaneously treat concomitant skin conditions that rosacea patients have often to deal with. Objective: To present preliminary findings of some new studies that show comedolytic and antioxidant effects of AZA 15% gel, and the possible benefits of multiple mechanisms of action in the treatment of rosacea across different skin types and in patients with concomitant dermatologic conditions. In a recent study, patients treated with AZA 15% gel showed a reduction in comedone counts comparable to patients treated with 5% benzoyl peroxide. In another, ongoing study, AZA 15% gel was shown to decrease oxidative stress as measured by the development of apoptotic cells following exposure to ultraviolet B light radiation. In a study of the treatment of rosacea across different skin types and in patients with concomitant skin conditions, AZA 15% gel was found to be highly efficacious in reducing inflammatory facial lesions in patients with a variety of skin types and colors, and in those with associated skin conditions, including seborrheic dermatitis and perioral dermatitis. Part of this broad efficacy may be attributed to the simultaneous antiinflammatory, antimicrobial, and antikeratinizing effects of AZA. Conclusion: AzA has proven clinically versatile in treating skin conditions in addition to rosacea, as well as simultaneously treating different conditions because of its multiple mechanisms of action. Retinoids have many diverse and important functions in the skin and as a therapeutic class have made significant contributions to dermatologic therapy. Because of their biologic diversity, retinoids are used to treat a variety of dermatologic disorders including acne, psoriasis, hyperpigmentation, and rosacea, and photodamage. The application of tretinoin to the skin initiates a series of events that can both prevent and repair photodamage. When applied topically to the skin, tretinoin enters the cell and binds to nuclear hormone receptors including retinoic acid receptors (RARs) and retinoid X receptors (RXRs). This activated retinoid-receptor complex regulates gene transcription allowing retinoids to inhibit or activate certain gene expression. The significance of this mechanism has lead to the established clinical use of tretinoin for the reduction of fine facial wrinkles, mottled hyperpigmentation, and skin roughness. Tretinoin cream 0.02%, which remains the only agent for the mitigation of fine lines and wrinkles approved by the US Food and Drug Administration, has been studied in four well controlled, multicenter clinical trials and one single-center, randomized, controlled trial. However, only one long-term clinical trial was conducted using tretinoin cream 0.02% to determine the effects of its application on the skin after 52 weeks of treatment. This scientific poster will provide an overview of the available clinical data and clinical observations that support the role that tretinoin 0.02% cream may play in reducing the signs and symptoms of photoaging and will include the results of a long-term clinical observation and skin biopsy results of patients treated in a clinical practice setting. Commercial support: Sponsored by Intendis, Inc. AB86 Commercial support: Educational grant will be provided by OrthoNeutrogena to cover production costs. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5957_5962 16 January 2009 6:21 pm P1634 P1636 Moisturizing hand cream that provides superior photo protection for younger looking hands Nathan Trookman, PhD, Thomas J. Stephens and Associates, Inc, Colorado Springs, CO, United States; Aida Asuncion, MS, Neutrogena Corporation, Los Angeles, CA, United States; Ronald L. Rizer, PhD, Thomas J. Stephens and Associates, Inc, Colorado Springs, CO, United States; Sidney Hornby, MS, Neutrogena Corporation, Los Angeles, CA, United States; Yohini Appa, PhD, Neutrogena Corporation, Los Angeles, CA, United States The face is not the only area of the body that should be protected from incidental, cumulative ultraviolet light exposure. The hands are exposed as much as the face and can exhibit signs of photodamage that can be distressing to patients. Therefore, there is a need for an efficacious hand cream that also provides superior stable photoprotection on a daily basis. We have developed an elegant moisturizing hand cream with glycerin and shea butter featuring an extremely stable photoprotection complex. This hand cream delivers SPF 30 protection while also providing 24-hour moisturization comparable to a benchmark nonphotoprotective hand cream. This formulation was clinically evaluated in an 8-week controlled double-blinded study on subjects with mild to moderate mottled pigmentation, fine lines, and creepiness of the hands. Subjects used the product daily for 8 weeks. The investigator observed significant and lasting reductions in mottled pigmentation, fine lines, creepiness, redness, and tactile roughness and overall skin appearance were observed over the course of the study. The hand cream was well accepted among the subjects. These results show that thus hand cream protects from photo damage while providing moisturization to yield younger appearing hands. The use of urea in contemporary dermatology Jennifer Parish, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, United States; Lawrence Parish, MD, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, United States Urea, also known as carbamide, has the chemical formula (NH2)2CO. It contains proteolytic properties which can disrupt protein connections between corneocytes and effect a breaking down of amino acids found in filaggrin. Urea acts as a humectant and can improve barrier function. Although urea has been used in various forms for skin care since biblical times, its current use in dermatology began in 1906. It has periodically enjoyed popularity as the active ingredient in compresses, creams, and solutions, plus being used as an adjuvant for administering corticosteroids. As a keratolytic and hydrating agent, urea has been shown to be effective in the treatment of a number of other dermatologic conditions; however, limitations to the use of many traditional preparations containing urea included a greasy consistency and the ability to produce irritation. The introduction of foam technology has made urea a more useful and acceptable agent for treating a widevariety of dermatologic conditions, ranging from keratosis pilaris to hyperkeratosis and callosities to xerosis. A patented water-lipidebased aerosol foam that mimics the natural skin barrier (15% water and 85% lipid) has been developed. This product not only delivers the active ingredients into the viable epidermis, but also provides physiological lipids into the skin that are needed to restore natural skin barrier function; hence, reducing increased transepidermal water loss. Commercial support: 90% sponsored by Quinnova Pharmaceuticals, Inc. Commercial support: Sponsored by Neutrogena Corporation. P1637 P1635 Evaluating the effects of a lipid-enriched body cleanser on dry skin Michael Suero, Johnson & Johnson Consumer Products Worldwide, Skillman, NJ, United States; Dara Miller, Johnson & Johnson Consumer Products Worldwide, Skillman, NJ, United States; Star Walsh, Johnson & Johnson Consumer Products Worldwide, Skillman, NJ, United States; Warren Wallo, MS, Johnson & Johnson Consumer Products Worldwide, Skillman, NJ, United States Patients that shower daily with an ordinary body cleanser can present with skin that is dry and irritated. Some surfactants not only remove dirt but also are capable of penetrating the skin and/or stripping it of lipids that keep the natural moisture barrier intact. A body cleanser, formulated with a new surfactant system that allows for lipid encapsulation, was assessed for its ability to help maintain the integrity of the skin barrier. A randomized, controlled clinical study was conducted on 30 healthy women 18 to 65 years of age with moderately dry skin on the lower legs, to evaluate the effects of a body cleanser with lipid encapsulating surfactant system in improving dry skin condition compared to an ordinary body cleanser and untreated control. Test products were applied in a controlled manner on the lower legs once daily for 5 consecutive days. Dry skin symptoms were assessed via visual dryness grading, tactile roughness evaluations, and instrumental measurements for skin surface hydration, transepidermal water loss, and flakiness at various time points over the 5-day study. Test sites treated with the body cleanser with lipid encapsulating surfactant system exhibited both immediate and long-term improvements on several dry skin parameters. There were also significant superiority versus the ordinary body cleanser and untreated control at various time points. This study has demonstrated the efficacy of the lipid-enriched body cleanser in alleviating dry skin condition commonly seen in practice and thereby provides the dermatologist with an additional choice of mild cleansing product for these patients. Commercial support: Sponsored by Johnson & Johnson Consumer Products Worldwide. Topical compounds: Cutaneous penetration and effects on epidermal functions Joachim Fluhr, MD, PhD, bioskin, Berlin, Germany; Betsy Hughes-Formella, PhD, bioskin, Hamburg, Germany; Johannes Gassmueller, MD, bioskin, Hamburg, Germany; Swen Sassning, bioskin, Berlin, Germany The intercorneocyte bilamellar lipids are major components of the epidermal barrier together with their processing enzymes and the corneocytes. A broad variety of noninvasive techniques for studying epidermal functions have been introduced or optimized in the last decades, including measurement of transepidermal water loss, skin hydration, skin color, and surface pH. Different spectroscopic methods were introduced in investigating stratum corneum (SC) functions on the molecular level. SC barrier properties and cutaneous penetration of different substances are evaluated by in vivo Raman microspectrometry (RMC). Topically applied substances and physiologic parameters of the epidermis (eg, water profile, lipid profiles, and different natural moisturizing factor profiles) were monitored over time and depths. These factors are correlated with classical biophysical functional parameters of the epidermis. As an example of the in vivo impact of topically applied substances on epidermal processes and functions, a tenside model (2% SLS) was used. We could show the changes in lipid profiles, NMF-profiles, water profile, and the penetration rate of the tenside itself at different time points. This SLS stress test model was applied both in healthy volunteers and in patients with atopic dermatitis. A deseasedependent penetration of SLS could be shown. Furthermore, the response of the SC to the stress insult (recovery phase) at different disease levels was distinguable. One approach could be the detection of changes in SC integrity and cohesion assessed by standardized sequential tape stripping as an early parameter for skin susceptibility. Barrier associated parameters were correlated to observe disturbance in SC integrity/cohesion. Finally, we were able to demonstrate penetration profiles into the SC with different compounds at different time points. The advantage of Raman microspectroscopy is the noninvasive in vivo setting. Measured skin areas are available for different time points without alterations of their properties and functions. Commercial support: None identified. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5957_5962 16 January 2009 6:21 pm AB87 P1638 P1701 Comparative effects of an antiinflammatory blend on reducing skin irritation caused by ultraviolet B light or a chemical irritant to 1% hydrocortisone Donald Collins, Clinique Laboratories, Melville, NY, United States; Chia Chen, Clinique Laboratories, Melville, NY, United States; Daniel Maes, Clinique Laboratories, Melville, NY, United States; Neelam Muizzuddin, Clinique Laboratories, Melville, NY, United States It is of considerable interest to develop a topical agent containing no hydrocortisone (HC) that can both reduce the onset of chemically- or environmentally-induced skin irritation and ameliorate this irritation once it occurs. A blend of ingredients with antiinflammatory activities has been developed that outperforms topical 1% HC with regard to ultraviolet B light (UVB)-induced or balsam of Peru (BOP)-induced skin irritation. This blend contains an inhibitor of histamine release, inhibitors of the PLA2, 5-LO, COX-2, collagenase, elastase, and PDE IV enzymes, neutrophil chemotaxis and adhesion blockers, a histamine receptor blocker, and an inhibitor of nuclear factor kappa beta activation. A cosmetically acceptable oil/water emulsion containing the antiinflammatory ingredients was prepared and applied to human subjects either 20 minutes before exposure to the irritant (UVB or BOP) or after irritant exposure once erythema was achieved. When applied before the irritant, this blend was able to reduce BOP-induced erythema by 82% and UVB-induced erythema by [90%. When applied after the irritant, the blend was able to reduce existing UVB irritation by 22% and existing BOP-induced erythema by 28%. Evaluating electronic visits for remote management of acne: Clinical outcomes are equivalent to conventional care Alice Watson, Massachusetts General Hospital, Boston, MA, United States; Christy Williams, MD, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States; Hagit Bergman, MD, MPH, Massachusetts General Hospital, Boston, MA, United States; Joseph Kvedar, MD, Massachusetts General Hospital, Boston, MA, United States Background: New technologies make it possible to carry out patient care remotely and asynchronously, potentially improving access to specialist dermatology care. The clinical efficacy of such models of care delivery has not previously been evaluated. Methods: We randomized 151 subjects with mild to moderate facial acne to carry out four follow-up visits using either an electronic visit (e-visit) platform or conventional office care. At 6-week intervals, subjects in the e-visit group were prompted to send three digital images of their skin, along with a symptom update, to their dermatologist via a secure Web site. Dermatologists responded with advice and electronic prescriptions within three business days. The primary outcome measure was the change in total inflammatory lesion count between the first and last visit. The aim of the study was to demonstrate equivalence in clinical outcomes. The main secondary outcomes were subject and dermatologist satisfaction with care, and length of time to complete visits. Commercial support: Sponsored by Clinique Laboratories. Results: The mean age of subjects was 28 years; the majority were female (78%), white (65%), and college-educated (69%). One hundred twenty-one of the initial 151 subjects completed the study. The change in total inflammatory lesion count was similar in the evisit and office visit groups (6.67 and 9.39, respectively; P ¼.51). Both subjects and dermatologists reported comparable satisfaction with care regardless of modality (P ¼.06 and P ¼.16, respectively). Office visit subjects were more likely to state that a visit took too much time out of their day than e-visit subjects (P\.001). Dermatologists, however, took a similar length of time to complete office and e-visits (4:53 vs 5:08 mins, respectively; P ¼ .5218). Conclusions: Delivering follow-up care to acne patients asynchronously and remotely via an e-visit platform produced equivalent clinical outcomes to conventional office visits. Both patients and physicians expressed high levels of satisfaction with the e-visit platform. Offering e-visits to patients with a range of dermatology conditions may prove to be a convenient way to improve access to specialist care. Commercial support: None identified. P1702 DIGITAL/ELECTRONIC TECHNOLOGY P1700 Can telemedicine improve health care across the world? Babar Rao, MD, UMDNJ Robert Wood Johnson, Somerset, NJ, United States; Adriana Lombardi, MS, UMDNJ Robert Wood Johnson, Somerset, NJ, United States Objective: To review current literature on telemedicine in developed and developing countries by using teledermatology as an example. Background: Telemedicine is defined as the use of medical information exchanged from one site to another via electronic communications for the health and education of the patient or health care provider, and for the purpose of improving patient care. Currently, two types of telemedicine exist; store and forward and real time. Many developed countries, such as the United State,s have made it a priority to incorporate telemedicine into their health care system. Its use in rural areas where shortages of physicians/specialists manifest has improved the convenience and quality of health care. Worldwide, this concept has been adapted by countries in effort to provide better health care for those in rural areas where hospitals may be at a distance and specialists may be even further. Methods: Current literature on telemedicine/teledermatology was reviewed and its efficiency critiqued in attempt to improve dermatologic care in underserved areas. Previous studies and reports have shown that the use of telemedicine—especially teledermatology—has proven to be an inexpensive method for providing care to those whose countries face financial, social, and environmental barriers to adequate health care. Ghana, in western Africa, is an area that faces extreme lack of medical attention and is used as an example for this review because there has been an attempt to use telemedicine to improve health care in this area. To seek medical attention, people must travel by foot to the nearest hospital, which typically serves one-third of the population (23 million people). Various organizations and even private parties have reached out to Africa though the use of telemedicine in efforts to help alleviate the medical catastrophe that the people are currently facing. Currently there is a telemedicine/telehealth project spear-headed in Ghana out of the Dr Martin Luther King Memorial Clinic in Accra, Ghana; a second organization is the African telehealth group. Conclusion: Telemedicine holds great opportunity for relieving inadequate health care in many countries. Although current efforts have positive effects in countries in need, they have not substantially reduced their extreme lack of health care. Countries with inadequate health care must incorporate telemedicine into their health care system through volunteer efforts of doctors in countries worldwide. Teledermatology (store and forward method) is inexpensive and can be easily implemented into the health care system in a developing country. Commercial support: None identified. AB88 A randomized, controlled trial evaluating adherence to sunscreen using electronic monitoring and text message reminders April Armstrong, Massachusetts General Hospital, Boston, MA, United States; Alexandra Kimball, MD, MPH, Massachusetts General Hospital, Boston, MA, United States; Alice Watson, MD, MPH, Center for Connected Health, Massachusetts General Hospital, Boston, MA, United States; Joseph Kvedar, MD, Massachusetts General Hospital, Boston, MA, United States; Maryanne Kazanis, Brigham and Women’s Hospital, Boston, MA, United States Introduction: Low adherence to medications can lead to poor health outcomes and increased health care costs. While most adherence studies have focused on chronic diseases, few have examined strategies to improve adherence to preventive health behaviors. Consistent use of sunscreens is recommended to prevent sunburn and reduce the risk of developing skin cancers. Despite continuing educational efforts, a disconnect persists between public understanding of the harmful effects of excessive sun exposure and regular use of sunscreen. Few innovations exist that accurately measure adherence to topical agents, and no reminder system is currently available to improve sunscreen adherence in the general population. Methods: We developed a reminder service in which subjects were sent text messages to their cellular phones, prompting them to take their medications. The impact of this service was evaluated by conducting a randomized controlled trial assessing adherence rates to sunscreen. All 70 subjects were asked to apply sunscreen daily for 6 weeks. Half of the subjects were randomly assigned to receive text messages via cellular phones, and the other half did not receive reminders. Adherence to daily sunscreen usage was evaluated using a novel electronic monitoring device. Results: Seventy subjects completed the 6-week study. There were no statistically significant differences in baseline characteristics between the two study groups. At the end of the study period, the 35 subjects who did not receive reminders had a mean daily adherence rate of 30.0% (95% CI, 23.1-36.9%). In comparison, the 35 subjects who received daily text message reminders had a mean daily adherence rate of 56.1% (95% CI, 48.1-64.1%; P\.0001). Among the subjects in the reminder group, 68.6% (n ¼ 24) reported that they would keep using the text message reminders after the study, and 88.6% (n ¼ 31) reported that they would recommend the text message reminder system to others. Subgroup analysis did not reveal any significant demographic factors that predicted adherence. Limitations: A longer follow-up period would be required to comment on the longterm effects of text message reminders. While this study used text message reminders to target forgetfulness, many other factors could contribute to nonadherence. Conclusions: Despite awareness of the benefits of sunscreen, adherence is low, even in this population whose adherence was knowingly monitored. Using existing cellular text message technology offers an innovative, low-cost, and effective method of improving adherence to sunscreen. The use of ubiquitous communications technology, such text messaging, may have implications for large-scale public health initiatives. Commercial support: None identified. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5957_5962 16 January 2009 6:21 pm P1703 P1705 Pregnancy breast lesions: The role of dermoscopy Ana Filipa Duarte, MD, Centro de Dermatologia Epidermis, Instituto CUF, Matosinhos, Porto, Portugal; Osvaldo Correia, MD, PhD, Centro de Dermatologia Epidermis, Instituto CUF and Oporto Faculty of Medicine, Matosinhos, Porto, Portugal Videodermatoscopy enhances diagnostic capability in psoriatic balanitis Giuseppe Micali, RN, Dermatology Clinic, University of Catania, Catania, Italy; Francesco Lacarrubba, MD, Dermatology Clinic, University of Catania, Catania, Italy; Maria Rita Nasca, MD, Dermatology Clinic, University of Catania, Catania, Italy Background: Plenty of cutaneous lesions, both pigmented and nonpigmented, have been associated with pregnancy. The relationship between pregnancy, change in melanocytic nevi, and progression to melanoma is still controversial, and dermatoscopy can assist the follow-up and management of those lesions. Case report: We report a 30-year-old white female, 36 weeks pregnant, who presented to our department because of nevus enlargement in the nipple region. A physical examination revealed three pigmented lesions in the right breast. Digital dermatoscopy of the three lesions was performed. The lesion that had grown in diameter had a regular pigment network and an homogeneous color, compatible with a benign junctional nevus. Another lesion, apparently stuck on the epidermis pseudocysts and pseudocomedons, and the pigment network was absent, compatible with seborrheic keratosis. The third lesion, along the embryonic ‘‘milk line,’’ showed a central scar-like white-colored area, a cleft-like appearance in the central and a fine pigment network at periphery, compatible with accessory nipple. Two months after delivery, the patient was reobserved and dermatoscopy was repeated. All the lesions have been reduced in size. Discussion: It is current opinion that expansion and darkening of melanocytic nevi may occur during pregnancy. It is thought that the widening in diameter and structure changes of nevi might be connected to skin expantion, mainly in the breast and abdomen, and to the presence of sex hormones receptor in the pigmented lesions. There is also evidence that sex steroids may affect epidermal growth factor receptor metabolism in benign epidermal hyperproliferative lesions, which may explain the tendency for the increasing in size and number of seborrheic keratosis during pregnancy. Because the relation between pregnancy, melanocytic nevi, and malignant melanoma is ambiguous, digital dermatoscopy analysis is a value method to help differentiate those lesions, providing a better assignment of the lesions, sparing patients from compulsorily excision. The term balanitis defines an inflammation of glans penis that may be caused by a wide range of dermatologic conditions, including psoriasis. The correct diagnosis may be troublesome, and several investigations, including skin biopsy, are often necessary. Previous studies have shown that the evaluation of vascular patterns may provide useful indications for the diagnosis of some dermatoses; in particular, the capillaries in psoriatic plaques are much larger than those in normal skin, appearing ‘‘bushy.’’ The aim of our preliminary study was to determine if videodermatoscopy (VD), a noninvasive technique, may be able, by evaluating the superficial vascular pattern beyond standard clinical observation, to provide additional information useful to address the diagnosis in a series of patients affected by psoriatic balanitis. Five subjects (mean age, 53.2 yrs; range, 45-70 yrs) were enrolled in an open study. Inclusion criteria were the presence of biopsy-proven psoriatic balanitis with no other skin involvement. Exclusion criteria were the presence of comorbid disorders and the use of systemic and/or topical drugs for 4 and 2 weeks, respectively. In order to evaluate the vascular pattern, VD examination was performed for each lesion using two magnifications (3100 and 3200). At the end of the study, VD showed in all cases a uniform pattern, consisting of dilated and tortuous capillaries, with a typical ‘‘bushy,’’ homogenous aspect in all examined fields. This pattern histologicly corresponded to dilated, elongated, and tortuous capillary loops in the papillary dermis. In addition, six cases of nonpsoriatic balanitis, histologically or microbiologically proven (2 lichen planus, 1 lichen sclerosus, 1 Zoon balanitis, and 2 candidiasis) were evaluated, and no ‘‘bushy’’ pattern was observed. In conclusion, although further studies in large series are necessary to confirm our findings, VD seems to represent a promising tool that may improve the clinical diagnosis of psoriatic balanitis avoiding skin biopsy, especially when lesions on other typical skin location are lacking. Our results are comparable with those obtained in a previous study that evaluated the vascular pattern in a series of patients affected by palmoplantar psoriasis. Commercial support: None identified. Commercial support: None identified. P1704 Colorimetric measurement of iris color and its significance in Asian skin cancer patients Ji Woong Kim, MD, Korea University Medical Center, Seoul, South Korea; Hyo Hyun Ahn, MD, Korea University Medical Center, Seoul, South Korea; Jae Eun Choi, MD, Korea University Medical Center, Seoul, South Korea; Soo Hong Seo, MD, Korea University Medical Center, Seoul, South Korea; Young Chul Kye, MD, Korea University Medical Center, Seoul, South Korea Iris colors such as blue, green, and hazel have been considered one of the risk factors for skin cancers. However, until recently, the classification systems of iris color have been subjective and still on its way to establishment. Moreover, they are not suitable and hardly used—especially for Asian populations, because of the relative homogeneity of iris colors in that population. The value of iris color as a risk factor for cutaneous malignancy has been neglected in most Asian patients. In this regard, we have devised an objective and quantitative method to measure human iris color quantitatively and colorimetrically, and have assessed its significance as a risk factor of skin cancers. The devised photographic system composed of digital camera and Tungsten lamp with color temperature conversion filter was used to acquire adequate iris images in consistent ways for colorimetric measurements. The reference CIELAB coordinates of ColorChecker Chart recorded with reflectance spectrophotometer were compared statistically with computed CIELAB coordinates from digital images in order to find the equations for calibrating CIELAB values. Then, we had taken images and measured the colors of iris, sun-exposed and sunprotected skin in 47 Korean patients with various cutaneous malignant and nonmalignant diseases or conditions. They were analyzed statistically with regard to iris and skin colors in CIELAB coordinates. The skin cancer patients had significantly lighter iris colors or higher lightness (L*) values than nonmalignant dermatologic patients (P ¼ .021). Color difference (DE*ab) between sun-exposed and -protected skin was larger in male and skin cancer patients (P ¼ .0009 and P ¼ .0057, respectively). The L* of sun-exposed skin decreases with age (r ¼ -0.40465; P ¼ .0048). Iris colors could be assessed colorimetrically using their images and our method used in this study. Iris color would be a possible skin cancer risk factor in Asian populations. The larger color difference between sun-protected and -exposed skin shown in male and skin cancer patients might be a result of chronic and excessive sun exposure. Commercial support: None identified. P1706 State of the art electronic medical system for Mohs micrographic surgery Omar Noor, UMDNJ Robert Wood Johnson, Somerset, NJ, United States; Adriana Lombardi, UMDNJ Robert Wood Johnson, Somerset, NJ, United States; Babar Rao, MD, UMDNJ Robert Wood Johnson, Somerset, NJ, United States Objective: To present a newly developed electronic medical record system for performing and documenting Mohs micrographic surgery. Background: There are several templates and basic computer systems to document Mohs micrographic surgery notes, but none are completely paperless. Furthermore, all steps of surgery are not documented electronically. We use a system created by Derm-Total for complete and accurate documentation. Methods: Photographs of skin cancer sites or regions of interest are taken before surgery and are transferred to the patient’s electronic chart. The chart is accessible from a secure Internet mainframe with login and password contains the patients’ medical history, including all laboratory values, procedures, and any other pertinent medical information. A photograph is taken from each Mohs stage pre- and postsurgical removal and an additional photograph is taken of the specimen in proper orientation. The normal protocol is for the Mohs surgeon to hand draw the Mohs stage; however, in this case, the Mohs surgeon can physically draw the stage, using a multitude of options into the electronic chart. Positive and negative markings are made on the photographs of the surgical sites, leading to the next stage to be taken from the imposed markings on the wound site. After complete removal, possible ways to close the wound are displayed in the computer based upon the site and type of wound created. All pre- and postmeasurements, types of closure, and suture types are documented. All procedure notes and referring physician notes are automatically generated. Conclusions: Easy and accurate documentation and billing of Mohs micrographic surgery is only possible by using advance electronic systems specifically created for this purpose. We use Derm-Total, a dermatology-specific system. In our experience, this has proven to be very accurate, fast, and a great teaching tool for our residents. Commercial support: Dr Rao is a consultant for Derm-Total. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5957_5962 16 January 2009 6:21 pm AB89 EDUCATION AND COMMUNITY SERVICE P1800 Telemedicine providing continuing medical education in dermatology to Latin America, Alaska, and Hawaii Ivan Camacho, PhD, University of Miami, Miami, FL, United States; Anne Burdick, MD, MPH, University of Miami, Miami, FL, United States The University of Miami Miller School of Medicine (UM) Department of Dermatology and Cutaneous Surgery (DDCS) received the American Academy of Dermatology (AAD) 2007 Program for Innovative Continuing Medical Education in Dermatology (PICMED) award. This award is given to promote the highest quality of dermatologic care through continuing medical education and research. Telemedicine is the use of information and communication technology to deliver health care access to distant sites and has the ability to enhance the education of health professionals and the quality of health care to patients in remote locations. Dermatologists in remote global communities have limited access to personally delivered medical updates. While online journals, Web-based medical sites, and the AAD Web site provide information for the isolated practitioner, opportunities for questions and answers from experts are limited or nonexistent. Several studies have shown the effectiveness of telemedicine systems in providing continuing medical education. By using videoconferencing technology, UM Dermatology established an international telemedicine network that included dermatologists, other dermatologic health care providers, and general physicians in Latin America and the isolated US states of Alaska and Hawaii. Our goal is to improve the level of knowledge in dermatology of primary care practitioners and enhance partnership with dermatology departments and academic institutions that will serve as a model for future expansion of educational activities worldwide. The project has support of the Brazilian National Telemedicine Network (RUTE) and the Mexican National Center for Health Technology Excellence (CENETEC) and regional support in Argentina, Alaska, and Hawaii. RUTE connects 18 University Hospitals throughout Brazil and CENETEC supports the connectivity of three academic centers. Thirty sites have participated from Alaska, Hawaii, Mexico, Panama, Colombia, Brazil, and Argentina. Monthly live lectures are delivered in English and dermatology topics including medical, pediatric, tropical, surgical, and cosmetic dermatology, immunobullous and connective tissue diseases, and oncology and wound healing. Surveys sent to all participating sites after each session are used to assess the usefulness of the topic, the effectiveness of the telemedicine system, and overall participant satisfaction. Participants have reported high satisfaction with these lectures. Commercial support: None identified. P1802 The current state of dermatopathology education: Survey results from the association of professors of dermatology Phillip Hsu, University of WisconsineMadison, Department of Dermatology, Madison, WI, United States; Erik Stratman, MD, Marshfield Clinic Academic Campus, Marshfield, WI, United States; Molly Hinshaw, MD, University of WisconsineMadison, Department of Dermatology, Madison, WI, United States; Li-Yin Lee, PhD, University of WisconsineMadison, Madison, WI, United States Background: Much time is devoted to teaching dermatopathology (DP) in residency programs. However, the American Board of Dermatology’s requirements for DP curriculum during residency are quite flexible, allowing great variability. Objective: To better understand how DP is taught in US residencies, identify barriers to DP education, and develop curricula to address these barriers. Methods: E-mail linked to a Web survey was sent to all members of the Association of Professors of Dermatology, which represents all 109 US Dermatology Residency Programs. Analysis was controlled for size, weighted to account for underrepresented regions of the US, and utilized linear regression and x2 tests. Results: Fifty-two responses were received (48% response rate). Ninety-three percent of teachers were academic faculty. Dermatopathologists with dermatology training slightly outnumbered dermatopathologists with pathology training. Almost three-fourths (72.7%) of programs have residents interpret their own biopsies, and of these programs, 67.8% have faculty present during the interpretation. Half of programs include journal review, and less than half include problem-based learning as part of their curriculum. Only 20.3% of programs incorporate computer-based learning. Most programs devote on average 6 hours a month to dermatopathology. The south spends significantly more time, an average 13 hours per month, on DP (P \.01). Lever and Weedon are the most popular primary textbooks. When asked to rank all textbooks used, Rapini and McKee rise in total ranking score. Textbook use does not vary between regions of the country (P \.01). Five programs did not have access to teaching slide sets for their residents. Almost half of programs expose residents to DP rotations in postgraduate year 2. By postgraduate year 4, about threefourths of residents have had a rotation. Six programs did not offer rotations during residency. For each additional resident in a program, each resident’s time on DP rotation increases by 0.79 weeks (P \.01). Almost all graduates who applied for DP fellowship were able to match. Factors that correlated with more residents doing fellowship include exposure to rotations regardless of duration and more dermatology trained dermatopathologists on staff, and whether they were from academicor community-based backgrounds. Some Future Directions: Fully exploit computer technology to address access inequalities, increase resident exposure to DP rotations, and provide consensus on what residents need to know. Commercial support: None identified. P1803 ‘‘Dermatainment’’: Teaching medical students about skin diseases using depictions in modern films Conner Chan, MD, PhD, MBA, The University of Texas Medical Branch, Galveston, TX, United States; Richard Wagner, MD, Richard F. Wagner, Jr., Galveston, TX, United States P1801 Therapeutic education: A tool for treatment of atopy Carlo Gelmetti, MD, Irccs Ospedale Maggiore, Milan, Italy; Chantal Segard, MD, Fondation Pour la Dermatite Atopique, Recherche & Education, Toulouse, Midi Pyrenée, France; Charles Taieb, MD, Public Health and Quality of Life, Boulogne Billancourt, IDF, France; Marco Ambonati, MD, Ducray, Lavaur, Midi Pyrenées, France Rationale: Therapeutic education is a group of practices which aim to enable patients or those responsible for them to acquire knowledge and competence in order actively to take charge of the disease, treatment, and supervision. Therapeutic education, which has already proven itself for diabetes and asthma, is becoming familiar to atopic children. Objective: To create an educational tool which can help patients and those around them to understand their disease and its treatment, to better cooperate with their caregivers, and to maintain or improve their quality of life. Results: Based on interviews with children, parents, and caregivers, it has been confirmed that the needs of atopic children vary throughout the day according to their activities. Designed for children from 4 to 7 years old, the creators of the ‘‘atopy clock’’ have chosen the occasion of children’s learning to tell the time to divide the day up into segments of time which correspond to the same number of segments of children’s different activities. Thus, the 5 to 6 o’clock segment explores sleep, the 6 to 7 o’clock segment explores waking up and the bedroom, the 7 to 8 o’clock segment explores washing, the 8 to 9 o’clock deals with getting dressed for the day, the 9 to 11 o’clock segment gives information about kindergarten and school, the 11 to 1 o’clock looks at midday and evening meals, the 1 to 4 o’clock segment describes precautions to take during after-school activities, and the 4 to 5 o’clock in the afternoon segment corresponds to coming home, having tea, and so on. The atopy clock is, therefore, a tool which is both fun and educational, available to dermatologists to explain to the parents of atopic children what to do throughout the day and throughout the year. The atopy clock is also an informative support designed for children, from very small to much bigger children, who can find useful information in order better to manage their disease. Background: The tremendous personal, social, psychological, and economic impact of skin disease is well recognized by dermatologists, but it is often lost on medical students who do not plan on taking a residency in our specialty. A new course designed to broadly educate upper level medical students about the multifaceted impact of skin diseases using purchased DVDs is described, and our educational experience teaching this course during an entire academic year at a medical school is reviewed. Objective: Educational evaluation of new dermatology curriculum for medical students. Conclusions: The atopy clock is a tool centred on the patient. It concerns children’s day-to-day lives and their psychosocial environment, and involves their families and those close to them in a convivial way. It can be integrated into the child’s treatment and care and responds to the criteria fixed by the methodologists. Conclusion: A critical film studies class using commercially available movies that depicted common and uncommon skin diseases was popular with medical students. Most students reported increased empathy and understanding for people depicted with skin diseases in the movies. Commercial support: 25% is sponsored by Ducray. Commercial support: None identified. AB90 Methods: During 2007 to 2008, the Department of Dermatology at The University of Texas Medical Branch introduced a new class for medical students. In this 4-week course, called ‘‘Skin Disease Depicted in Cinema,’’ medical students watched and critically reviewed 13 required films that depicted common (acne, psoriasis, eczema, urticaria, aging skin, hirsutism, burns, and nevi) and relatively uncommon skin diseases (leprosy, syphilis, albinism, Kaposi sarcoma, and photosensitivity). Following course completion, students were asked to complete an anonymous voluntary survey to provide instructional feedback. Results: Forty of 45 (88.9%) medical students who completed this course also completed the anonymous survey. Only one of the participating students applied for a dermatology residency (and was successful). All of the responding medical students (40/40, 100%) reported that they would recommend this class to other medical students. The last 35 students who took this class were asked if the curriculum impacted their empathy for people with skin diseases or changed their perceptions about skin diseases; all but one student responded that it had (34/35, 97.1%). Typical medical student responses were: ‘‘. . .it made me more aware of what people experience when they have skin diseases.’’ ‘‘Watching and discussing these films gave me a deeper understanding about skin diseases and the impact they can have on lives, making me more empathetic to people with skin diseases.’’ ‘‘I think it made me think about it more—about how devastating these diseases can be emotionally/socially, even if the disease is not physically life threatening or debilitating.’’ ‘‘It made me more aware of societal stigmas placed on persons with skin conditions.’’ J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5957_5962 16 January 2009 6:21 pm P1804 P1806 Impact of a cybertutor in dermatology teaching Mariana Soirefmann, MD, Federal University of Rio Grande do Sul, Porto Alegre, Santa Cecilia, Brazil; Chao Wen, MD, PhD, University of Sao Paulo, Sao Paulo, Cerqueira Cesar, Brazil; Cristiane Comparin, MD, Federal University of Rio Grande do Sul, Porto Alegre, Bom Fim, Brazil; Tania Cestari, MD, PhD, Federal University of Rio Grande do Sul, Porto Alegre, Santa Cecı́lia, Brazil Skin of color education in dermatology residency programs: Does residency training reflect the changing demographics of the United States? Rajiv I. Nijhawan, MD, University of Miami Miller School of Medicine, Miami, FL, United States; Heather Woolery-Lloyd, MD, University of Miami Miller School of Medicine, Miami Beach, FL, United States; Sharon E. Jacob, MD, University of CA, San Diego, San Diego, CA, United States Background: Telemedicine and its branch, teledermatology, is the use of telecommunication technologies to bridge distance and support health care delivery and education. The current model of undergraduate medical education is under debate because knowledge retention and student interest seems to be decreasing. We have proposed this study in order to develop and evaluate a computer-aided learning program, using a multimedia presentation about infestations in dermatology as a model, aiming to provide a more attractive and updated learning tool. Objective: To evaluate the impact of an interactive Web site or multimedia program, the Cybertutor, for undergraduate teaching in dermatology. Methods: A total of 50 medical students from the fifth and sixth semesters of the Federal University of Rio Grande do Sul (UFRGS) were randomized into two groups: group 1 was submitted to a multimedia program of a specific dermatologic subject (infestations), and group 2 attended a standard lecture on the same subject at the same time. At the end, the level of knowledge acquisition for the two groups was evaluated by a multiple choice test containing 15 questions. Group 1 students also answered a questionnaire about their subjective feelings on computer based teaching; their opinion about a digital lecture format as an adequate replacement for live lectures was also assessed. Results: The average of correct answers were 11.16 (SD ¼ 1.625) in group 1 and 11.96 (SD ¼ 1.645) in group 2. There were no statistically significant difference between the two groups (P ¼.09). More than 80% of the students who attended the Cybertutor group manifested interest in participating on similar activities in the future. However, 20 of 25 students using the multimedia program believed that it did not entirely replace the instructor and the interaction with a mentor was considered relevant. Background: It is projected that by the year 2050, close to 50% of the United States population will be comprised of people with skin of color. Conclusions: According to this study, multimedia programs can be used for undergraduate education in dermatology as a complementary educational tool. Moreover, the direct contact with an instructor is still considered to be important, and should be concomitantly offered to students. Objective: To assess if the future dermatologists will be prepared to treat patients with skin of color. Methods: An e-mail with a link to a brief 9-question survey was sent to all 109 program directors and chief residents. Results: Forty-one (37.6%) program directors and 63 (50.0%) chief residents completed the online survey. More than 14% (14.3%; P \.001) of chief residents and 14.6% (P \.001) of program directors recognized an expert at their institutions who conducted a skin of color clinic. More than one quarter (25.4%; P \.001) of chief residents and 19.5% (P \.001) of program directors reported having lectures on skin of color from an acknowledged expert. Almost one-third (30.2%; P\.001) of chief residents and 12.2% (P \ .001) of program directors reported a specific rotation in which residents gained specific experience in treating patients with skin of color (52.4%; P ¼.70) of chief residents and 65.9% (P \.02) of program directors reported to have either lectures or didactic sessions focusing on diseases in skin of color incorporated into their curriculums. More than 80% (84.1%; P \.001) of chief residents and 90.2% (P \ .001) of program directors reported having training programs in which residents gained experience treating patients with central centrifugal cicatricial alopecia. All (100%; P \ .001) of both chief residents and program directors reported having training programs in which residents gained experience treating patients with keloids and melasma. Conclusion: The results indicate a need for increased exposure, educational sessions, and overall training in diseases pertaining to skin of color in US dermatology residencies. Commercial support: None identified. Commercial support: None identified. P1807 A cost-effective proficiency- and knowledge-based shave biopsy workshop for health care provider trainees Brenda Chrastil-LaTowsky, University of Texas MD Anderson Cancer Center, Houston, TX, United States; Rungsima Wanitphakdeedecha, MD, Siriraj Hospital, Bangkok, Bangkoknoi, Thailand; T. Minsue Chen, MD, University of Texas MD Anderson Cancer Center, Houston, TX, United States; Tri H. Nguyen, MD, University of Texas MD Anderson Cancer Center, Houston, TX, United States P1805 The changing attitudes and behaviors of sun protection Jessica Taff, PhD, New Age Skin Research Foundation, Fresh Meadows, NY, United States; James Briley, MD, New Age Skin Research Foundation, Fresh Meadows, NY, United States; Joshua Fox, MD, New Age Skin Research Foundation, Fresh Meadows, NY, United States; New Age Skin Research Group, New Age Skin Research Foundation, Fresh Meadows, NY, United States; Rao Saladi, MD, New Age Skin Research Foundation, Fresh Meadows, NY, United States Background: In recent years, studies of attitudes and behaviors of sun protection have concentrated largely on Australian populations. To our knowledge, these changing attitudes and behaviors have been minimally assessed in the United States. Objective: In this study, we assessed the knowledge of proper sunscreen use and other sun protectionerelated behaviors and attitudes. Methods: A survey of 24 questions assessed the variables of age, sex, race, education, and skin type. The attitudes, knowledge, and behaviors of tanning and sunscreen use, etc, were also evaluated. The study was conducted at four categorical locations; public beach(es), public area(s) such as malls and parks, dermatology office(s), and college campus(es) in the Tristate area (New York, New Jersey, or Connecticut). Results: Two thousand two hundred fifty-two respondents were collected: 34.6% from public beaches, 33.3% from public malls, 24.6% from college campuses, and 7.5% from dermatology offices. At these settings, 42.13% of the beach goers used sunscreen daily or almost everyday, 31.33 % used sunscreen occasionally, and 25.63% never used sunscreen. Among these, 15.5% reported going to the tanning salon. More than 30 % (30.30%) of the public area goers used sunscreen daily or almost everyday, 32.90% used sunscreen occasionally, and 36.80% never used sunscreen. Among these, 10.05% reported going to the tanning salon. The college campus results indicated 38.9% sunscreen use daily or almost everyday, 21.63% occasional sunscreen use, and 38.23% never using sunscreen. Among these, 15.6% reported going to the tanning salon. Of those questioned in the dermatology offices, 56.90% indicated sunscreen use daily or almost everyday, 23.00% reported sunscreen use occasionally, and 20.00 % never used sunscreen. Among these, 10.40% reported going to the tanning salon. Background: The shave biopsy is a commonly performed skin biopsy procedure. Trainees (medical students and nondermatology residents) on a general dermatology rotation at our institution are provided with a training workshop for indications and technique for the shave biopsy procedure. Subsequently, trainees are allowed to perform shave biopsies during the rotation. Objectives: To validate a cost-effective shave biopsy training model to teach health care provider trainees: (1) indications and (2) technique. Methods: Sixty-one second-year medical students were surveyed on their previous exposure and experience with shave biopsies and evaluated on knowledge of indications. After demonstrating their technique, each trainee was graded by two independent investigators using a 5-point scale on: whether the lesional skin biopsy had a smooth edge, if biopsied specimen was accurate (at the ink), and if technique used was safe. Afterwards, a 10-minute PowerPoint presentation reviewed key principles (indications, technique, and safety). Participants were then given a series of tasks to practice and refine their skills (various depths, size, and shapes) accompanied with real-time feedback. Trainees again were evaluated using the same criteria and grading scale as before. Postintervention surveys were completed to assess trainee confidence to perform a shave biopsy and satisfaction with the workshop. Results: Only one trainee reported receiving formal training on the shave biopsy technique and had performed a shave biopsy before the workshop. The average confidence the students reported before teaching workshop was 2.75 on a 5-point scale (1 ¼ strongly disagree to confidence, 5¼ strongly agree to confidence) before instruction and 4.85 after instruction. More than half of participants (n ¼ 34) demonstrated unsafe technique. The average score for a smooth edge and accuracy before instruction was 1.17 and 2.66, respectively (1 ¼ 0-20% of circumference, 2 ¼ 21-40%, 3 ¼ 41-60%, 4 ¼ 61-80%, and 5 ¼ 81-100%). After the intervention, participants demonstrated knowledge of shave biopsy indications, technique (smooth edge and accuracy average score, respectively: 4.87 and 4.82), safe instrument handling (n ¼ 61), and confidence (4.85 on 5-point scale) to perform a shave biopsy. All participants reported this training model to be helpful. Comments were all positive and included ‘‘this was the best hour of medical school thus far.’’ Conclusions: While many individuals are educated about the dangers of sun damage and skin cancer and the importance of sunscreen use, understanding of proper use and reinforcement of positive sunscreen behaviors remains insufficient and additional efforts to educate are needed. Conclusions: Although a relatively straightforward procedure, health care providers rarely receive formal training on the indications and technique of the shave biopsy. A formal training module such as the one we describe is an effective way to provide training, increase safety and confidence as well as educate trainees on the indications of a shave biopsy. Commercial support: None identified. Commercial support: None identified. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5957_5962 16 January 2009 6:21 pm AB91 P1808 P1810 Self-study preferences of dermatology residents Samantha Hill, Saint Louis University, St Louis, MO, United States; Dana Oliver, MPH, Saint Louis University, St Louis, MO, United States; M. Yadira Hurley, MD, Saint Louis University, St Louis, MO, United States; Nicole Burkemper, MD, Saint Louis University, St. Louis, MO, United States Clinician comentor research model: A concept for private clinicians to conduct research Deevya Narayanan, MD, NASRF, Fresh Meadows, NY, United States; Joshua Fox, MD, NASRF, Fresh Meadows, NY, United States; Omolola Alakija, NASRF, Fresh Meadows, NY, United States; Rao Saladi, MD, NASRF, Fresh Meadows, NY, United States Background: Dermatology residents must undergo training in all aspects of dermatology. Much focus is placed in medical dermatology, and general dermatologists are well represented at most training institutions. Instruction in other areas—dermatopathology, cutaneous surgery, cosmetic dermatology, and pediatric dermatology— is best delivered by the subspecialists. When not available, residents must supplement their education with self-study tools. Objective: To assess dermatology residents’ use of current self-study methods and what characteristics make them convenient, enjoyable, and effective. Methods: A 16-question online survey of residents currently receiving training in ACGME-accredited dermatology programs. Questions focused on perceptions of convenience, effectiveness, and enjoyment of currently available self-study methods. Results: One hundred twenty-nine of 1078 (12%) dermatology residents responded and 26 of 40 states with residency programs were represented. Respondents were first- (28.7%), second- (34.1%), and third-year (37.2%) residents. Subspecialists are well represented at most programs. All residents have exposure to at least one dermatopathologist and one cutaneous/Mohs surgeon. More than two-thirds (82.2%) have exposure to at least one pediatric dermatologist and 75.2% to at least one cosmetic dermatologist. The majority (76%) of residents use self-study materials more than once weekly. Nearly all residents use textbooks (98.4%) and journals (89.9%) more than once monthly. Handouts (61.2%), online question sets (38.8%), and online slide presentations (14.7%) are used more than once monthly by many residents. Textbooks were most convenient (56%) and effective (58%), but online question sets were most enjoyable (44%). Recommendation by other residents was the most common method to find new self-study materials. Results were consistent across respondent region and residency class. Being clinicians, dermatologists come across many interesting cases, ideas, or concepts upon which they would like to conduct further research. In the academic arena, this is less of a concern, because physicians have the ability to use available resources and allocate time to participate in studies. However, many interested private practice clinicians, unlike academia, neither receive the room, aid, space, time, support (ie, financial support or grants) nor academic recognition for this; hence, this issue serves as an obstacle. In order to alleviate these biases and problems, there should be a way for these interested physicians to engage in research studies. Such opportunities should allow private practice dermatologists to be able to interact and work with a group of enthusiastic fellows who do the research. In this process, a full-time researcher can guide the project with the aid of research fellows. Meanwhile, the clinical dermatologist will act as a comentor for the project and make sure that his/her hypothesis or project is being tested correctly. This innovative program will allow dermatologists to continue practicing and still engage in research studies that they are interested in. They will not need grants, room, space, or significant amounts of time. Labor and a research supervisor will be available. Participating dermatologists will get recognition—often an acknowledgement—and they will have the satisfaction of having volunteered their time for a research study. Moreover, private practice dermatologists can use any findings determined by these studies to improve the quality of care they provide their patients and to further advance research in their field. Commercial support: None identified. Limitations: The response rate (12%) is low; therefore, the results may not accurately reflect the habits and preferences. Conclusions: Although most respondents have access to subspecialists in many fields of dermatology, nearly all use self-study materials at least once monthly. Written materials were found most convenient and effective for self-directed learning, because of availability and completeness. However, online question sets were most enjoyable because of their interactive nature and the ability for immediate self-assessment. This data can be used to develop new self-study materials. EPIDEMIOLOGY AND HEALTH SERVICES ADMINISTRATION Commercial support: None identified. P1900 Skin cancer screening among US adults: 2000 and 2005 national health interview surveys Naheed Lakhani, MD, Centers for Disease Control and Prevention, Chamblee, GA, United States; Kate Shaw, MS, Centers for Disease Control and Prevention, Chamblee, GA, United States; Mona Saraiya, MPH, MD, Centers for Disease Control and Prevention, Chamblee, GA, United States Background: One in five Americans will develop skin cancer in their lifetime. A total body skin examination by a clinician is a screening tool for early detection of skin cancer and its precursors. Since 1985, the American Academy of Dermatology has worked with dermatologists to offer free partial and total body skin cancer screenings. However, relatively little is known about the predictors of obtaining total body skin examinations in the context of inconsistent screening recommendations, decreasing sun-protective behavior, and increasing rates of melanoma. P1809 Reliability of dermatologic information online Rao N. Saladi, MD, New Age Skin Research Foundation, Fresh Meadows, NY, United States; Deevya Narayanan, MPH, NASRF, Fresh Meadows, NY, United States; Joshua Fox, MD, NASRF, Fresh Meadows, NY, United States; Salman Anwar, MD, NASRF, Fresh Meadows, NY, United States; Sharita Lowe, New Age Skin Research Foundation, Fresh Meadows, NY, United States Methods: In order to determine the prevalence and predictors of skin cancer screening among US adults, we used self-reported data from the 2000 and 2005 National Health Interview Survey, a nationally representative survey of civilian, noninstitutionalized adults. In both years, respondents were asked if they had their skin checked from head to toe for cancer by a dermatologist or other doctor. Respondents who answered positively were asked the date of their most recent skin examination. The Internet has become an invaluable tool for obtaining information. It is easily accessible from anywhere and it provides access to extensive knowledge. It was reported that approximately 54% of patients are using the Internet to obtain medical knowledge. Although there is much information available on the Internet, most of it comes from unreliable sources. Based on our study pertaining to the reliability of information coming from major search engines (such as Google, MSN, Yahoo, etc), it was astonishing to find the kind of information that is made available to the public; most of it was biased toward for-profit organizations’ products and services. Information from nonprofit organizations is rarely available. For example, when searching for ‘‘acne treatment’’ using these search engines, it was determined that only 6% of the resulting links came from reliable nonprofit sources. The remaining 94% came from for-profit organizations, which promoted specific acne products and treatments that are not generally recommended by dermatologists because of a lack of scientific evidence or potential harmful effects. This undependable information may lead patients to misunderstand concepts and possibly make inappropriate or impaired judgments and decisions with regards to their health. Although there are several nonprofit organizations that provide reliable information, the choice is limited. It will be useful if a broader spectrum of information made available to the public was prescreened by authoritative sources. Results: The percentage of US adults who reported ever having a total body skin examination increased significantly from 14.5% in 2000 to 16.5% in 2005. In 2005, among those who reported ever having an exam, nearly 50% were aged 50 years and older. About one in five white non-Hispanic adults (2005, 19.4%) reported having been screened, significantly higher compared to other racial/ethnic groups. In 2005, the screening prevalence was significantly higher among women than men. Skin cancer screening was highest among those who reported a personal history of skin cancer (2005, 69.2%). Individuals who reported having a family history of melanoma were over twice as likely (2005—OR, 2.42; 95% CI, 1.90-3.08) and those with a family history of nonmelanoma skin cancer were nearly twice as likely (2005—OR, 1.76; 95% CI, 1.40-2.21) to have had a skin examination compared to those with no family history of the skin cancers. Overall, screening prevalence increased with increasing education level, physical activity, sun sensitivity, sunburns in the past year, and frequency of sun-protective behaviors (ie, wearing a long-sleeved shirt, a wide-brimmed hat, or sunscreen). Commercial support: None identified. Commercial support: None identified. AB92 Conclusions: Skin cancer screening prevalence increased over a 5-year period from one in seven to one in six adults. It will be useful to continue observing trends and predictors in order to optimally plan health campaigns as well as monitor trends in skin cancer incidence and mortality. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5957_5962 16 January 2009 6:21 pm P1901 P1903 A randomized community interventional trial to increase awareness of sun safety: Interim analysis of 1 year of a skin cancer education program Panta Rouhani, University of Miami Miller School of Medicine, Miami, FL, United States; Robert Kirsner, MD, PhD, University of Miami Miller School of Medicine, Miami, FL, United States; Yirael Parmet, PhD, University of Miami Miller School of Medicine, Miami, FL, United States Differences in genital dermatoses between south Asian and white men Manu Shah, Department of Dermatology, Dewsbury, West Yorkshire, United Kingdom Aim: To assess differences in demographics, presentation, diagnoses, and outcome of male genital dermatoses between South Asian and white males in Dewsbury, West Yorkshire, UK. Florida has among the most ambient sunlight in the United States. As a result, Florida’s schoolchildren are at increased risk of excessive ultraviolet light exposure, the most important modifiable risk factor for skin cancer. As part of National Institutes of Healthesponsored research, the knowledge, attitudes, and behaviors of third to fifth graders toward sun safety and skin cancer prevention were assessed in a randomized controlled evaluation of a skin cancer education program. More than 5000 students were randomized into two groups by school, one that received the up to 3 years of education with the SunSmart America curriculum and a control group. We have analyzed the first year of education. The students were administered items tapping their knowledge of sun safety and inquiring about their self-reported engagement in sun-safe behaviors. Results of a one-way analysis of variance on the 16 schools showed that third, fourth, and fifth graders in the intervention schools had significantly higher scores on the knowledge scale after exposure to the curriculum than did students in the control schools, who had no exposure to the curriculum (F1, 14 ¼ 5.329; P ¼ .019; F1, 15 ¼ 4.744; P ¼ .024; and F1, 15 ¼ 9.022; P ¼ .005, respectively). Students in intervention schools also obtained a higher overall mean score on the sun-safe behaviors scale than students in the control schools, which was statistically significant (P between .025 and .045). These results indicate that students in all grades exposed to the SunSmart America curriculum for 1 year demonstrate greater knowledge of facts related to skin cancer and its prevention than do students who are not presented the curriculum. Further work will determine whether multiple years of educational intervention will alter knowledge, attitudes and behaviors in elementary school children and produce long-lasting attitudinal and behavioral change. Background: Dewsbury is a large town of approximately 350,000 people. The racial mix of 82% white and 18% South Asian (Pakistani and Bangladeshi) gives a unique opportunity to study the effect of environment on different populations and differences in disease types. The study population was comprised of 308 consecutive males attending a male genital dermatoses clinic. Results: Thirty-three men were Asian (11.7%) and 275 (89.3%) were white. Asian men were younger at presentation (mean age, 37.3 yrs) than white men (mean age, 44.9 yrs; Wilcoxon rank sum; P ¼.019) and had experienced symptoms for a shorter time (1.87 yrs compared with 3.27 yrs; Wilcoxon rank sum; P ¼.006). Twenty-seven of the Asian men (82%) were circumcised compared with 34 (12%) of the white men (test of equality of proportions; P \.001). The most common presenting symptoms in Asian men were: genital rash (18; 54%), genital lesion (10; 30%), and genital itch (3; 9%). In white males, the most common presenting symptoms were genital rash (131; 54%), genital soreness (39; 14%), genital lesion (34; 12%), and tight foreskin (31; 11%). The most common clinical diagnoses in the Asian group were lichen planus (10; 30%), various benign lesions (7; 21%), eczema (6; 18%), and various forms of balanitis (4; 12%) and psoriasis (4; 12%). The most common diagnoses in the white patients were lichen sclerosus (77; 28%), various forms of balanitis (71; 26%), eczema (34; 12%), and skin lesions (21; 8%). There were only 16 patients with psoriasis (6%) and 15 with lichen planus (5%). Zoon balanitis made up 11% of the white patients’ diagnoses but was not seen in the Asian group. Asian males were more likely to develop lichen planus (P \.001) but less likely to develop lichen sclerosus (P ¼ .002). Conclusions: Asian males presenting to the male genital dermatoses clinic are younger, have symptoms for a shorter amount of time, and are more likely to present with a genital skin lesion than white males. Dermatoses relating to the foreskin are less common in Asian males. Genital lichen planus may be more common in the Asian population. Commercial support: None identified. Commercial support: None identified. P1904 Conclusion: There was significant association between patient’s race and adherence to topical metroidazole. Increase in patients’ health care costs was associated with increasing age and charges paid for prescriptions. Topical metronizole seems quite an affordable option for the Medicaid population. Does rural dwelling adversely impact stage of melanoma diagnosis of the elderly? Sallyann Coleman King, MD, Emory University Department of Dermatology, Atlanta, GA, United States; Anne Seidler, MD, Emory University Dermatology Department, Atlanta, GA, United States; Emir Veledar, PhD, Emory University Department of Dermatology, Atlanta, GA, United States; Steven Culler, PhD, Emory University School of Public Health, Atlanta, GA, United States; Suephy Chen, MD, MS, Emory University Department of Dermatology, Atlanta, GA, United States Although an earlier stage of disease at melanoma diagnosis correlates with improved survival, melanoma (MM) outcomes have progressively worsened for those over 65 years of age. Those living in rural areas may have reduced access to health care services, and therefore be diagnosed in higher stages of disease. We sought to examine whether elderly living in rural areas were more likely to be diagnosed in higher stages of MM. Data regarding patients (age [67 yrs) diagnosed with MM with staging were analyzed from the Surveillance, Epidemiology, and End ResultsMedicare datasets from 1991 to 1998. Using outpatient visits as a surrogate for health care utilization we evaluated National Claims History records. We included visits 2 years preceding diagnosis. We evaluated severity of comorbidities using the Charlson index. To determine the number of physicians visited, only records with a Healthcare Financing Administration provider specialty number and unique physician identification number were used. Of the 7111 Medicare patients, the mean age at MM diagnosis was 75.9 years, 59% were female, 85% were urban dwelling, and 51% were unmarried. Overall, for those with no comorbidities, the mean number of visits was higher for stage 0 versus stage 4 MM (16.3 vs 14.3; P ¼.07). This trend was not true for those with comorbidities. Rural patients were diagnosed in stage IV more often than urban dwellers (5.27% vs 3.71%). Rural dwellers compared to urban dwellers also had fewer visits (18.21 vs 21.94; P\.0001). Living in rural settings may limit access to medical care as evidenced by the fewer number of medical visits for these patients as compared to urban dwellers. Given our overall finding that patients with stage 0 (vs stage IV) had more outpatient visits, our finding that a higher percentage of our rural population was diagnosed with stage IV disease may indicate that the reduced number of outpatient visits contributed to their diagnosis at later stages. Therefore, rural patients may benefit from scheduled preventive skin exams. Further work needs to be done to compare the effect of urban versus rural dwelling after adjusting for demographics and comorbidities. Commercial support: None identified. Commercial support: None identified. P1902 Medication adherence patterns in Medicaid-enrolled patients with rosacea Sujata Jayawant, MD, Ohio State University, Columbus, OH, United States; Isha Patel, Ohio State University, Columbus, OH, United States; Rajesh Balkrishnan, PhD, Ohio State University, Columbus, OH, United States; Steven R. Feldman, MD, PhD, Wake Forest University School of Medicine, Winston-Salem, NC, United States Objective: The objective of this study was to examine the predictors of medication adherence related to topical metronidazole and total health care costs in rosacea patients. Methods: The study population was comprised of a longitudinal cohort that followed rosacea patients enrolled in North Carolina Medicaid and who were prescribed at least one study medication (topical metronidazole, adapalene, azelaic acid, permethrin, and sulfacetamide). Patients’ demographic characteristics and components of the health care costs for metronidazole patients like the charges paid for metronidazole, total prescription, and nonprescription charges and total charges for the month were examined. Results: One thousand seven hundre and seventy-one (;69%) of the total 2587 rosacea patients had one or more prescriptions for topical metronidazole. Whites comprised 73% of the patients in the study. After controlling for other variables, adherence to metronidazole and health care costs increased with an increase in age (both P \.001). Compared to whites, African American patients were significantly less adherent to metronidazole (P \.001). Compared to whites, African Americans and other races were associated with an 8.6% and 10.3% decrease in total health care costs, respectively (both P \.001). An increase in number of metronidazole refills was not associated with an increase in health care costs. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5957_5962 16 January 2009 6:21 pm AB93 P1905 P1907 Benchmarks of and obstacles to success as reported by academic dermatology faculty Megan McKee, MD, Emory University School of Medicine, Atlanta, GA, United States; Clara Curiel, MD, University of Arizona College of Medicine, Tuscon, AZ, United States; Laura Delong, MD, MPH, Emory University School of Medicine, Atlanta, GA, United States; Michelle Pennie, MD, Emory University School of Medicine, Department of Dermatology, Atlanta, GA, United States; Suephy Chen, MD, MS, Emory University School of Medicine, Department of Dermatology, Atlanta, GA, United States Muppies as a way of skin cancer primary prevention Osvaldo Correia, Centro de Dermatologia Epidermis, Instituto CUF, Oporto Faculty of Medicine and APCC, Matosinhos, Porto, Portugal; Ana Filipa Duarte, MD, Centro de Dermatologia Epidermis, Instituto CUF and APCC, Matosinhos, Porto, Portugal; Ana Margarida Barros, MD, Centro de Dermatologia Epidermis, Instituto CUF and APCC, Matosinhos, Porto, Portugal; António Picoto, MD, APCC, Porto, Portugal; Leonor Gir~ao, MD, APCC, Porto, Portugal The objective of this study was to elucidate factors perceived by academic faculty to be barriers to a successful academic career in dermatology. From 2007 to 2008, a survey about personal characteristics and career development was mailed to faculty members of one academic dermatology department per state in the United States. Free text answers about perceived benchmarks and obstacles to success were interpreted and categorized. We investigated differences between junior (1- # 10 yrs on staff) and senior ([10 yrs) faculty. Respondent characteristics were compared using the Student t test and x 2 analysis in SPSS 15.0. The response rate was 37%. Junior (n ¼ 86) and senior (n ¼ 93) respondents had a mean (SD) age of 40.2 (7.3) and 54.7 (7.7) years (P \.001), and had spent a 5.4 (2.8) and 22.0 (7.8) years in academics (P \.001). Junior respondents were more likely to be female than senior respondents (57% vs 36%; P ¼.006) and spent a larger proportion of time in clinical care (P ¼.085). Senior respondents were more likely to have a research niche (40% vs 55%; P ¼.045) and to have international/national recognition for their work (52% vs 7%; P \.001). There was no significant difference in salary sources and grant funding between groups. For both junior and senior respondents, the two most frequently reported benchmarks of a successful academic career were publications (30% and 24%) and recognition by peers (19% and 32%). The ability to obtain grants and federal funding was the third most frequent benchmark for junior respondents (13%), while personal satisfaction ranked third for senior respondents (23%). For both groups, the three most frequently reported obstacles were time constraints (36% and 32%), funding for research (20% and 25%), and salary (17% and 25%). Consistent with previously published findings, time constraints and research funding were important concerns to academic faculty and we have found that those perceptions do not change with length of time in academia. Research funding appears to be of greater concern for junior faculty as it was frequently expressed to be both an obstacle and a benchmark of success. Currently, there is a relative shortage of academic dermatologists and new faculty are facing increasing demands to spend more time in clinic given less federal funding resources for research. It is imperative that junior faculty be provided start-up and bridging packages with protected time and funding set aside for academic endeavors. The incidence of skin cancer has increased related to sun exposure abuse. It is important to modify the behavior of populations worldwide toward ultraviolet (UV) light radiation everywhere, at the beach and country, hobbies, sports and work, from children to adulthood. Repeated campaigns concerning sun protection measures have been made in Portugal, more actively since 2003, aiming the primary prevention of skin cancer. Skin cancer primary prevention actions should be frequently repeated and should use a simple and attractive language adapted to the population. Local intervention has been made at schools, seaside, medical faculties, and toward health professionals’ formation. Our objective is to reach all of the population regarding the adverse effects of UV light and strategies of avoidance. Mayors from the largest cities have been sensitized to this problem as a public health threat and have allowed the fixation of hundreds of muppies near schools and faculties, leisure, and sport areas and along the seaside, alerting for UV consequences during the spring and summer months. Simple language with direct information has been used. In the last years, illustrative images have exposed along with elucidative sentences like ‘‘We won’t see the sunshine but in the shadow we must stay,’’ ‘‘This summer I won’t get scalding,’’ ‘‘Warming up, going to school or playing, protection needed,’’ ‘‘Summer without scalding, sun with moderation, shadow as protection,’’ ‘‘Sport in summer with good protection,’’ ‘‘Dawn and sunset. . .doesn’t get scalding and the skin doesn’t age,’’ ‘‘Increased shadow, appropriate hour,’’ and ‘‘Unprotected. . .aged. . .protect to avoid aging.’’ The adequate hours of sun exposure, the importance of the shadow, and the risk of reflecting surfaces, the use of clothes with proper fabric and design, hats, sunglasses, and sun protector application, alerting to the problem of false security, have been advised. The primary prevention—performing repeated sensitization actions and specially focused on children and teenagers at schools and leisure areas—will be more effective in the behavior’s change, and consequently, in the reduction of cancer incidence, as it was suggested by the CDC /USA. Progressively, thousands of persons have already been sensitized. Commercial support: None identified. Commercial support: None identified. P1908 Consumers’ preference of cosmetic procedures: Experiences of a single laser center in Taiwan Min-Li Yeh, MD, MMSc, Department of Nursing, Oriental Institute of Technology, Pan-Chiao City, Taiwan; Ying-Jui Chang, MD, MS, Skin Laser Center, Department of Dermatology, Taipei Medical University Wanfang Hospital, Taipei, Taiwan P1906 A comparison of Dermatology Life Quality Index scores in a dermatology practice setting Shien-Ning Chee, MD, Department of Dermatology, Sydney, New South Wales, Australia; Dédée Murrell, Department of Dermatology, Sydney, New South Wales, Australia While skin diseases are rarely life threatening, their impact of a patient’s quality of life (QOL) can be massive. The Dermatology Life Quality Index (DLQI) was developed by Andrew Finlay and provides a simple method of scoring the impact of skin disease on quality of life (QOL). There are 10 questions covering symptoms and feelings, daily activities, leisure, work and school, personal relationships, and treatment. Each question has four possible responses: ‘‘not at all,’’ ‘‘a little,’’ ‘‘a lot,’’ or ‘‘very much,’’ with scores of 0, 1, 2, and 3, respectively. ‘‘Not relevant’’ is also scored as 0. The DLQI is then calculated by adding the scores of each question, giving a maximum of 30 and minimum of 0. The higher the score, the greater the level of impairment of QOL. Since May 2006, 668 new patients attending an academic private dermatology practice have been prospectively asked to complete a DLQI questionnaire on every visit. Of these, 526 patients (79%) completed their baseline DLQI. The mean DLQI for all patients was 5.5, for acne patients 4.5, for alopecia 2.7, atopic eczema 11.0, psoriasis 10.0, rosacea 4.6, skin checks 1.5, and vitiligo 3.5. Surprisingly, bullous diseases scored only mid-range among presenting first visit patients with epidermolysis bullosa at 9.8, pemphigus vulgaris at 6.1, and bullous pemphigoid at 4.2. This suggests that DLQI is not an appropriate measure for all skin diseases, prompting the Department of Dermatology, St George Hospital, to develop specific QOL instruments for epidermolysis bullosa. The baseline data for new patients and their follow-up DLQI scores are being evaluated as a clinical outcome measure. Commercial support: None identified. AB94 Background: Cosmetic dermatology is a comprehensive subspecialty encompassing a range of subjects and has been rapidly expanding around the world. These include the use of cosmetics, make-up techniques, skin care maneuver and products, noninvasive cosmetic techniques, and surgical procedures. People are interested in this field because it impacts aspects of appearance for individuals of both genders and all ages. Objective: The study is aimed to explore the consumers’ experiences and prospectively analysis of the consumers’ preference in cosmetic procedures. Methods: The first visit to skin laser center of a university hospital was collected using questionnaires which including age, sex, skin problems, and preferred cosmetic procedures from March to May, 2007. Results: This study included 264 consumers with female predominance (82%), with a mean age of 39 years (range, 7-82 yrs). Most consumers were in their thirties and forties (46%). The majority of the purposes are for cosmetic procedures rather than skin disease treated (84% vs 16%). Among cosmetic procedures, pigment and nevus removal account for more than 60% of preference, followed by scar revision (12.5%), wrinkle reduction (6%), and hair removal (3%). Among skin diseases, acne vulgaris ranks first (45.7%), followed by eczematous diseases (31.4%). Conclusions: This study shows the trends of consumers’ preference of attending cosmetic procedures in a dermatologist-based laser center. The certain amount of dermatologic diseases emphasized the service role of dermatologists. The high preference of laser pigment removal rather than invasive procedures also highlight the cosmetic needs of consumers here. Different age groups show different preference trends, which should be evaluated carefully in order to provide prompt services. There still exist developmental spaces of growth for more advanced noninvasive/minimally invasive procedures in the future. In addition, the increasing proportion of male consumers also arises the focus on providing tailor-made protocols. Commercial support: None identified. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5957_5962 16 January 2009 6:21 pm P1909 P1911 Epidemiology of spider bites in middle Tennessee Natalie Curcio, Vanderbilt University Medical Center, Nashville, TN, United States; George Stricklin, MD, PhD, Vanderbilt University Medical Center, Nashville, TN, United States; Kathleen Egan, PhD, H. Lee Moffitt Cancer Center, Tampa, FL, United States; Lloyd King, MD, PhD, Vanderbilt University Medical Center, Nashville, TN, United States; Patrick Arbogast, PhD, Vanderbilt University Medical Center, Nashville, TN, United States The benefits of adalimumab on clinical and patient-reported outcomes among moderate to severe psoriasis patients with comorbidities Alexa Kimball, MD, Harvard Medical School, Boston, MA, United States; Lei Chen, Analysis Group, Boston, MA, United States; Parvez Mulani, Abbott Laboratories, Abbott Park, IL, United States; Shiraz Gupta, Abbott Laboratories, Abbott Park, IL, United States Background: There are 18 species of Loxosceles worldwide, with 13 species found in the United States. Four of these species produce necrotic wounds. The brown recluse spider (BRS) is endemic to the southeast and midwest United States, but annual numbers at Vanderbilt are unknown. There have been no prospective studies looking at BRS or studies at a tertiary care center that span several different specialties. Objectives: The aim of the study was to analyze the patient population with documented spider bites with a focus on spider bites caused by the BRS, in a region in the United States where it is endemic. Methods: A 12-month long prospective, multicenter, case series study within Vanderbilt University Medical Center (VUMC) was conducted to evaluate the frequency, risk factors, clinical features, symptoms, progression, treatment, outcome, and economic impact of clinically documented BRS bites and other spider bites. Results: Between September 2006 and May 2007, 20 of 30 (67%) patients seen at VUMC had documented BRS bites. Sixteen (53%) patients saw the spider at the time of the bite and were able to identify it from a group of photographs. Five (17%) patients brought the spider for identification. The most common location of the bite was inside of the home (20/30; 67%) and most bite sites were on the extremities (16/30; 53%). All patients had localized erythema, but 14 of 30 (47%) patients had skin necrosis. Nearly half of the BRS bite lesions were moderate (9/20), 7 of 20 were mild (35%), and 4 of 20 (20%) were severe. The systemic symptoms occurring more often in patients with BRS bites included nausea, vomiting, chills, generalized rash, and abdominal cramping. The mean cost to spider bite victims including medical therapy and loss of work income was $818 (range, $0-4350). The average number of missed days of work related to a BRS bite was 9.2 days (n ¼ 17) versus 0.9 days for patients bitten by other spiders (n ¼ 8; 5/30 patients did not work outside of the home). Conclusions: Of the spiders bites examined, the bites caused by the BRS were more commonly necrotic, more locally severe, and induced more systemic symptoms. BRS bites impact patients’ lives by the financial costs related to medical bills, missed work, and restricted work-related activities. These physical limitations may persist for days to weeks depending upon the severity of the BRS bite and the patient’s occupation. Objective: The benefits of adalimumab (ADA) on clinical and patient-reported outcomes (PROs) have been well established for patients with moderate to severe psoriasis (PS). Comorbidities are common in PS, and it is not known whether they might affect or predict response to therapy. This study assessed the effect of ADA on clinical outcomes and PROs among patients with PS and comorbidities. Methods: Analyses were conducted using data from a double-blind phase III trial in which patients with moderate to severe PS were randomized to receive placebo or ADA over a 16-week period. Among patients with selected comorbidities (eg, diabetes, depression, and hyperlipidemia) reported at baseline, Psoriasis Area and Severity Index (PASI 75) responses at weeks 4, 8, 12, and 16 were measured and compared between treatment groups using x 2 test. Changes in PRO scores from baseline to Week 16 were examined, including Dermatology Life Quality Index (DLQI) score, SF-36 Physical and Mental Component Scores (PCS, MCS), and Work Productivity and Activity Impairment (WPAI) scores. Changes in PROs were tested within each treatment group using paired t test and compared between ADA- and placebo-treated patients using one-way analysis of covariance with adjustment for baseline scores. Missing values were imputed using the last observed value carried forward. Sensitivity analysis using observed values and subgroup analyses among patients with psoriatic arthritis, hyperlipidemia, and cardiovascular disease were also conducted. Results: Of the total sample (N ¼ 1212), among patients with comorbidities, those on ADA (n ¼ 547) had significantly greater PASI 75 response rates than placebo (n ¼ 281) at weeks 4, 8, 12, and 16 (17% vs 1%; 51% vs 3%; 65% vs 4%; and 70% vs 6%, respectively; all P \.001). Improvements over 16 weeks were observed for all PRO measures among ADA-treated patients (change, -8.3 in DLQI score; 4.1 and 3.7 in SF-36 PCS and MCS, respectively; -13.9% in WPAI; all P \.001). The corresponding changes were minimal and not significant for placebo-treated patients, except for a decline of -1.6 in DLQI score (P\.001). Results from one-way analyses of covariance showed that improvements in DLQI, SF-36 PCS and MCS, and total work productivity impairment were greater for ADA- than placebo-treated patients (all P \.001). Sensitivity and subgroup analyses yielded similar results. Conclusions: ADA demonstrated superior clinical efficacy and is associated with improvements in health-related quality of life and work productivity among patients with moderate to severe PS with comorbidities. Commercial support: 100% sponsored by Abbott. Commercial support: None identified. P1910 Importance of mentoring for dermatology faculty Megan McKee, MD, MBChB, Emory University School of Medicine, Atlanta, GA, United States; Clara Curiel, MD, Univeristy of Arizona College of Medicine, Department of Internal Medicine, Tuscon, AZ, United States; Emir Veledar, PhD, Emory University School of Medicine, Division of Cardiology, Atlanta, GA, United States; Laura Delong, MD, MPH, Emory University Schoool of Medicine, Department of Dermatology, Atlanta, GA, United States; Suephy Chen, MD, MS, Emory University School of Medicine, Department of Dermatology, Atlanta, GA, United States The purpose of this study was to examine predictors and markers of success in academic dermatology. From 2007 to 2008, a survey about personal characteristics and career development was mailed to faculty members of one dermatology department per state in the United States. The academic level of respondents was approximated by years spent in academia: junior (1-10 yrs) and senior ([10 yrs). Respondent characteristics were compared using the Student t and x 2 tests. One proposed marker of success was defined by level of recognition for a faculty member’s clinical/research niche (local, regional, national, and international). Predictors of this marker were evaluated using linear regression. Statistical analyses were performed with SPSS 15.0. The response rate was 37%. Junior (n ¼ 86) and senior (n ¼ 93) respondents had a mean (SD) age of 40.2 (7.3) and 54.7 (7.7) years (P\.001) and had spent 5.4 (2.8) and 22.0 (7.8) years in academics (P\.001). Junior respondents were more likely than senior respondents to be female (57% vs 36%; P ¼ .006) and to have ever worked part time (31% vs 15%; P ¼.015). A majority of respondents self-reported having a clinical niche with no significant difference between groups; those reporting a research niche were more likely to be senior respondents (40% vs 55%; P ¼ .045). Senior respondents were more likely to have international recognition for their work (52% vs 7%; P \ .001). A multivariate regression with level of recognition for clinical/research niche as the dependent variable showed age (P ¼ .04), number of mentors (P ¼ .002), and academic level (P ¼ .024) as being positively associated with higher levels of recognition. Having ever worked part time was negatively associated with level of recognition (P ¼.044); gender did not have a significant association (P ¼ .311). When controlling for age, gender, and academic level, achieving international or national recognition for one’s work was positively correlated with having a greater number of mentors, perhaps because of the benefit of advice and networking assistance from a variety of sources. Level of mentorship is a quality that can be modified by individuals and academic departments. Greater emphasis should be put on fostering mentorship relationships between residents and junior faculty with more senior members to facilitate the continued strength of academic dermatology programs and their faculty. Additional support may be necessary to retain junior faculty who work part time while starting a family. Menkes syndrome presenting as possible child abuse Hyland Cronin, Geisinger Health System, Danville, PA, United States; Howard Pride, MD, Geisinger Health System, Danville, PA, United States Menkes disease (MD), also known as kinky hair disease, is a rare neurodegenerative disease of impaired copper transport. Originally described in 1962 by Menkes, the disorder is typically characterized by males presenting in the first few months of life with failure to thrive, lethargy, hypothermia, hypotonia, seizures, mental and motor retardation, osseous alterations, anemia, intracranial and retinal hemorrhages, and/or other neurologic abnormalities. We report a baby with MD whose symptoms were originally thought to be related to child abuse. On May 4, 2008, a 6-month-old male was life-flighted to Geisinger secondary to acute onset respiratory distress. On presentation he was intubated, hypertensive, and cyanotic, with bulging fontanelles, sluggish pupils, and dysmorphic features including low set ears, hypotelorism, polydactyly, and syndactyly. On imaging, he was found to have large bilateral subdural hygromas, an L occipital SDH, and bilateral shearing injury at the greyewhite matter junction. Ophthalmology exam showed L retinal hemorrhages. The baby’s overall presentation was highly concerning for nonaccidental injury, such as shaken baby syndrome. Before this event, he had already been placed in foster care because of recurrent bleeds and the possibility of child abuse. Child abuse was the leading diagnosis during this hospitalization until one of the doctors noticed that the patient’s hair was somewhat kinky, hypopigmented, and thin. Dermatology was consulted and a hair sampling was done which showed the characteristic 1808 twists of hair consistent with pili torti. Copper level was 13 and ceruloplasmin was \10. This, in combination with his physical findings, is presumptively diagnostic of MD. It was important to make a firm diagnosis of this case with the recent allegations of child abuse; therefore, ATP7A mutation analysis was sent out. The abuse services were notified of the recent finding and the lack of evidence for abuse given the new diagnosis. MD is X linked recessive and caused by mutations in ATP7A (Xq13.3), a gene encoding the copper-binding enzyme ATPase, leading to defective copper transport and metabolism with subsequent low levels of serum copper. This disorder is known to mimic child abuse, specifically shaken baby syndrome. It is exceedingly uncommon, but two cases of a similar nature have been reported in the literature since 1996. Overall, this case report should prompt us that although rare, we should not forget about the possibility of MD when evaluating a child with recurrent intracranial bleeds suspected to be child abuse. Commercial support: None identified. Commercial support: None identified. GENODERMATOSES P2000 MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5957_5962 16 January 2009 6:21 pm AB95 P2001 P2003 Hyperpigmented, linear streaks and cutaneous papillomas first presenting during pregnancy in a patient with focal dermal hyperplasia (Goltz patient) Tracy L. Thomas, MD, Department of Dermatology, Albuquerque, NM, United States; Barrett J. Zltoff, MD, Department of Dermatology, Albuquerque, NM, United States A 23-year-old primigravida reported to the dermatology clinic with a 6- to 7-month history of linear, hyperpigmented streaks in a Blaschko distribution on back and lateral aspects of her trunk, progressive development of clustered, raspberry-like, papillomas on the plantar aspect of the right foot, and a 2-month history of a pruritic rash on her abdomen and upper extremities. The patient had been diagnosed with focal dermal hypoplasia (Goltz syndrome) as a newborn. At birth she was noted to have a skeletal deformity of her foot, erythematous, atrophic, depressed, wide, linear plaques predominantly on her back, and a head circumference below the fifth percentile. The patient reported that she began to develop papillomas on her right foot and hyperpigmented linear streaks during the first or beginning part of her second trimester. These papillomas were not present on her right foot before to her pregnancy, although she has had similar papillomas at the mucocutaneous margins of her lips. Her history is remarkable for asymmetric telangiectatic macules and papules on her cheeks, trunk, and extremities. However, she did not have hyperpigmentation in linear streaks before her pregnancy. Focal dermal hypoplasia, first described by Goltz in 1962, is a rare, inherited, ectomesodermal syndrome characterized by the hallmark finding of a thinned dermis and red-yellow out pouching of skin caused by subcutaneous fat, as well as other cutaneous findings, skeletal, craniofacial, central nervous system, dental, ocular, hair, nail, gastrointestinal, and soft tissue abnormalities. Goltz syndrome is an inherited disease that occurs predominantly in woman (90%). The literature to date supports the inheritance pattern in Goltz syndrome as an X-linked dominant male-lethal pattern. The recently discovered PORCN genetic mutation is now considered the etiology. The 10% of cases occurring in males are thought to be caused by postzygotic, halfchromatid mutations resulting in mosaicism. Other cutaneous findings include the raspberry-like papillomas at the mucocutaneous margins, and occasionally elsewhere on the skin. Papillomas and are generally not present at birth, but begin to develop within the first few months of life. Skeletal abnormalities are the second most common extracutaneous cutaneous findings and include osteopathia striata, hypoplasia or aplasia of the digits, syndactyly, oligodactyly with lobster claw deformities, short stature with scoliosis, and asymmetrical limbs. Facial dysmorphism with small, asymmetric face, pointed chin, misshapen pinna, and pointed and pinched nasal tip with unilateral ala nasi notching are also common findings. To our knowledge, this is the first case report of the cutaneous clinical findings of Goltz syndrome becoming exacerbated or presenting during pregnancy. This may suggest possible effects of hormones on the PORCN mutations. Clouston syndrome and eccrine syringofibroadenomas Tasneem Poonawalla, MD, Marshfield Clinic, Marshfield, WI, United States; Erik Stratman, MD, Marshfield Clinic, Marshfield, WI, United States; Ling Xia, MD, Marshfield Clinic, Marshfield, WI, United States; Stella Patten, MD, Marshfield Clinic, Marshfield Clinic, WI, United States Clouston syndrome is an autosomal dominant disorder caused by mutations in the GJB6 gene for connexin 30, with variable clinical expression, including progressive hyperkeratosis of the palms and soles, patchy alopecia, and nail dystrophy. Eccrine syringofibroadenoma (ES) is an uncommon benign tumor of the acrosyringium that often affects the extremities of elderly individuals. As both disorders are uncommon, they have been reported together only rarely (three cases thus far) and before the discovery of the GJB6 gene. This case reports ES in a patient with genetically confirmed Clouston syndrome. Commercial support: None identified. Commercial support: None identified. P2004 Two new cases of epidermolysis bullosa simplex with mottled pigmentation: A father and son Jessica Ghaferi, MD, Henry Ford Hospital, Department of Dermatology, Detroit, MI, United States; Tor Shwayder, MD, Henry Ford Hospital, Department of Dermatology, Detroit, MI, United States P2002 The elusive side of mechanobullous disease: Epidermolysis bullosa pruriginosa Yuval Bibi, MD, PhD, Department of Dermatology, Boston University Medical Center/Tufts Medical Center, Boston, MA, United States; Gary Chuang, MD, Department of Dermatology, Boston University School of Medicine, Boston, MA, United States; Michelle Bush, MD, Department of Dermatology, Tufts Medical Center, Boston, MA, United States; Orr Barak, MD, PhD, Department of Dermatology, Boston University School of Medicine, Boston, MA, United States; Pamela Scheinman, MD, Department of Dermatology, Tufts Medical Center, Boston, MA, United States Epidermolysis bullosa (EB) is a group of mechanobullous disorders in which inherited defects in epidermal or basement membrane proteins cause skin fragility and blistering. EB is classified into three broad categories based on the ultrastructural location of skin cleavage: intraepidermal (EB simplex), within the lamina lucida (junctional EB), or below the lamina densa (dystrophic EB or DEB). Among patients with DEB, phenotypic variation can be quite broad, making clinical diagnosis a challenge. In particular, some forms of DEB present with localized, late-onset disease. This may distract the clinician, who may be more familiar with types of DEB that cause severe generalized blistering in infancy. EB pruriginosa (EBP) is a recently described form of DEB in which intense itch is a key feature. Diagnosis is often delayed because skin lesions are relatively localized, can appear as late as the fifth decade of life, and often mimic acquired inflammatory dermatoses. Here we present a 54-year-old male patient whose diagnosis of EBP eluded his health care providers for years. Initially, this patient’s findings were mistaken for hypertrophic lichen planus of the abdomen and lower legs. The diagnostic challenge was further compounded by a severe nickel allergy, which may have served in exacerbating the underlying pathology by Koebnerization. Key clinical features and clues to the correct identification of this unusual genodermatosis are discussed. We report a case of a 3-week-old white male who presented with new onset blisters on the toes, heels, ears, fingers, and hips since shortly after birth. On examination, the infant showed multiple bullae of the hard palate, tongue, trunk, fingers, and the dorsal surface of his feet. Also noted were crusting and fissures of the ears and lips. There were hyperkeratotic crusts on the extensor elbows and knees. The nails were dystrophic and shedding. Generalized pallor was seen. The child had a hoarse cry. However, there was no mottling of pigmentation. Local wound care was instituted, with attention to avoidance of trauma and infection prevention. The child was referred to an ear, nose, and throat specialist for the evaluation of possible laryngeal involvement. On review of family history, the paternal grandmother and aunt have epidermolysis bullosa simplex of unknown subtype. The patient’s father reports that when he was born, he had extensive blistering until about 1 year of age. This has improved with time, although he continues to experience skin fragility. The areas resolve with scarring. On examination, the child’s father had several areas of scarring at previous sites of involvement, primarily on the fingers, the dorsal surface of his hands, and his feet, elbows, and knees. Mottled hyperpigmentation was noted on the father’s torso and extremities. Epidermolysis bullosa simplex (EBS) represents a heterogeneous group of genodermatoses characterized by recurrent intraepidermal blistering, often induced by minor trauma. EBS with mottled pigmentation is a rare subset with distinctive clinical features and a unique genetic basis. Infants and young children manifest localized blistering, or more extensive bullae with a predilection for areas of trauma. Late onset hyper- and hypopigmented macules then develop; these fade with age. Other features include palmoplantar keratoderma. Most patients with this subtype carry a dominant missense mutation in a nonhelical domain of keratin 5 or 14. In contrast, other variants of EBS without mottled pigmentation have mutations in regions encoding the alfa-helical domains of keratins 5 and 14. We will discuss the presentation, genetics, pathology, evaluation, and treatment of EBS with mottled pigmentation as it applies to the current and previous reported cases. Commercial support: None identified. Commercial support: None identified. AB96 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5962_5966 16 January 2009 6:33 pm P2005 P2007 Homozygous forms of autosomic dominant porphyrias Esteve Darwich, MMSc, MD, Hospital Clı́nic i Provincial de Barcelona, Barcelona, Spain; Carmen Herrero, Hospital Clı́nic i Provincial de Barcelona, Barcelona, Spain; Jordi To-Figueres, Hospital Clı́nic i Provincial de Barcelona, Barcelona, Spain Porphyrias are a group of inherited disorders caused by mutations in genes encoding the enzymes of the heme biosynthetic pathway. There are seven different porphyrias, each one corresponding to a partial deficiency of a specific enzyme. Erythropoietic protoporphyria (EPP), acute intermittent porphyria (AIP), porphyria cutanea tarda (PCT), variegate porphyria (VP), and hereditary coproporphyria (HCP) are inherited as autosomal dominant diseases, but with a low clinical penetrance (\20%). Therefore, the number of genetic mutations is sufficiently common in the general population to find patients who are homozygous or compound heterozygous for the autosomal dominant porphyrias. Herein, we present our experience of five patients with homozygous porphyria from a series of more than 1000 patients followed at the Porphyrin Unit of the Dermatology Department, University of Barcelona during a 30-year period. There were four cases of homozygous porphyria cutanea tarda. Two of these patients experienced several episodes of seizures and neurologic image studies showed cerebral cortical atrophy and calcifications in the frontal lobes. One case of homozygous erythropoietic porphyria with acute cutaneous photosensitivity since 4 years of age, microcytic anemia, low iron stores, alterations in liver function tests, and varioliform scars on the face and hands. A liver biopsy showed brown pigmented material deposited in the biliary canaliculi. Liver function tests have progressively worsened during the 3 years of follow-up. The clinical disease in these patients usually appears in early childhood and is more severe than in heterozygotes. There is some relation between the severity of clinical symptoms and the amount of residual enzyme activity. Most cases are heterozygous compounds with some degree of residual activity from at least one of the mutated alleles, as completely abolished enzyme activity is not compatible with life. Noonan-like features with loose anagen hair—A new genetic link? Holly Hare, University of Missouri Department of Dermatology, Columbia, MO, United States; Jennifer Holman, MD, University of Missouri Department of Dermatology, Columbia, MO, United States; Jon Dyer, MD, University of Missouri Department of Dermatology, Columbia, MO, United States Commercial support: None identified. A 4.5-year-old female was evaluated for sparse hair with slow growth. Her parents reported that she had received only two haircuts since birth. On examination, she had short, fine, easily pluckable hair with multiple loose anagen hairs present on trichogram. Physical examination revealed hypertelorism, down-slanted palpebral fissures, ptosis, a flat and wide nasal bridge, macrocephaly, overfolded, low-set, posteriorly rotated ears, a low posterior hair line, and a short, mildly webbed neck. Facial asymmetry caused her right globe to appear lower than the left globe. At 4.5 years of age, she is in the 65th percentile for weight, the 15th percentile for height, and a head circumference was[95th percentile. Her development has been normal. Head computed tomography revealed increased extraaxial fluid (external hydrocephalus). Further testing revealed ectopic atrial tachycardia with a normal echocardiogram, strabismus, limited ability to flex and extend the cervical spine on cervical spine radiographs, delayed bone age, and a low insulin-like growth factor. The following tests were normal: karyotype (46,XX), sweat chloride, thyroid hormone, lead level, chromosome 22q11.2 copy number (by in situ hybridization), and chromosome microarray analysis. Nine similar patients have been reported since 1986. The most recent report suggested that these patients may represent a new syndrome with Noonan-like features and associated loose anagen hair with negative PTPN11 gene testing. These patients have exhibited a similar clinical phenotype and facies including growth hormone deficiency. Currently mutations in at least four genes—PTPN11, SOS1, KRAS, and RAF1—are reported to cause Noonan syndrome. These newly identified genes have yet to be studied in this unique subset of patients. We add our case to those previously described, strengthening the hypothesis that these patients represent a unique genetic syndrome. Identifying the underlying genetic basis for this syndrome would provide insight into the spectrum of Noonan-like disorders and also allow targeted investigation into the role of the causative gene in normal hair follicle function and cycling. Commercial support: None identified. P2006 Elephantiasis neurofibromatosa Ai-Lean Chew, St. John’s Institute of Dermatology, London, United Kingdom; Habib Kurwa, MBBS, St. John’s Institute of Dermatology, London, United Kingdom; Raj Mallipeddi, MD, MBBS, St. John’s Institute of Dermatology, London, United Kingdom; Saqib Bashir, MD, MBChB, St. John’s Institute of Dermatology, London, United Kingdom Introduction: A 39-year-old Afro-Caribbean male presented with unilateral limb hypertrophy. Multiple large fluctuant swellings had been present on his left arm since early childhood, which he believed were caused by a scalding accident. He sought medical advice after developing a dull ache in his left arm whilst working as a gardener. There was no relevant family history. Clinical Examination: A marked limb length discrepancy was noted: his left upper limb was 10% longer and had increased girth compared with the right. Many fleshcolored subcutaneous nodules were present, coalescing to form large masses throughout the left upper limb. Furthermore, small hyperpigmented warty papules were seen scattered on this limb. The other limbs were normal and neither caféau-lait macules nor axillary freckling were seen. Investigations: Routine hematology, biochemistry, and coagulation studies were normal. A radiograph of his left upper limb showed irregular periosteal thickening and bone thinning with a coarse trabecular pattern. A magnetic resonance imaging (MRI) scan suggested a hemangioma/vascular malformation and the ultrasound demonstrated multiple dilated vessels with arterial and venous flow within a mass. Histology of a warty papule demonstrated a neurofibroma. Management: In light of the imaging studies, vascular surgeons attempted to resect the suspected venous malformation. Surprisingly, no vascular malformation was found, but dense subcutaneous neurofibromata were seen and confirmed histologically. Only a limited resection was attempted in order to avoid damage to the ulnar nerve and vasculature. P2008 Pseudoepitheliomatous micaceous keratotic balanitis Sue Yin Ng, MD, Amersham Hospital, Amersham, Buckinghamshire, United Kingdom; John Wilkinson, MBBS, Amersham Hospital, Amersham, Buckinghamshire, United Kingdom Case report: A 54-year-old male presented with an 18-month history of phimosis with associated hard scarred foreskin without preceding trauma. He underwent a biopsy and circumcision under the urologists. He subsequently noticed increasing keratosis of the glans penis, particularly around the meatus with no associated symptoms of dysuria or dyspareunia and was referred to the dermatology department via the urology and genitourinary medicine departments. On examination, there was a cutaneous horn-like appearance with marked hyperkeratosis of the glans penis with surrounding redness and mucosal friability. Histologic examination showed hyperkeratosis, parakeratosis, papillomatosis, and ulceration with nonspecific chronic inflammatory changes. The epidermis appeared acantholytic with no suggestion of atypia or dysplasia and with no mitoses above the basal layer. Discussion: Our initial clinical impression was that he had a deep vascular malformation involving his left arm, leading us to include in our differential diagnosis conditions such as Proteus syndrome or Maffucci syndrome. This was supported by the MRI and ultrasound studies. However, the surgical and histologic findings reveal that the patient had a rare form of segmental neurofibromatosis, leading to unilateral limb gigantism, ‘‘elephantiasis neurofibromatosa.’’ This is an extremely rare form of neurofibromatosis, and the limited literature is almost entirely confined to the surgical or radiological journals. It is believed to arise as a result of mosaicism and therefore can be manifest without café-au-lait macules and axillary freckling. Furthermore, these large neurofibromas can have a well developed vascular supply which may explain the radiologic findings. Treatment: He was treated with 20% salicylic acid with marked improvement of the hyperkeratosis. There are future plans for topical imiquimod, cryotherapy, or Er:YAG laser therapy. He is currently being carefully monitored for any signs of progression of the disease with a low threshold for rebiopsying. Tissue samples for human papillomavirus polymerase chain reaction analysis were negative. Discussion: Pseudoepitheliomatous micaceous keratotic balanitis describes a condition where coronal balanitis gradually takes on a silvery white appearance with mica-like crusts and keratotic horny masses on the glans penis. There is occasional ulceration, cracking, and fissuring with the keratotic scale being usually micaceous and resembling psoriasis. It is frequently associated with preexisting phimosis. Various opinions exist whether this is a benign, pseudomalignant, or premalignant condition, with case reports suggesting that it has low-grade malignant tendencies with occasional degeneration into squamous cell carcinoma appearing as a nodular lesion within the plaque. Other reports suggest that it is a spectrum of verrucous carcinoma over a protracted course. In view of this, some advocate excision with wide margins for malignant lesions while others suggest a more conservative approach with imiquimod for coexistent human papillomavirus infection or dysplastic cells, photodynamic therapy, cryotherapy, shave excision, or electrocoagulation. Commercial support: None identified. Commercial support: None identified. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5962_5966 16 January 2009 6:33 pm AB97 P2009 P2011 Tuberous sclerosis: Clinical findings in 57 patients Pedro Jaén Olasolo, DO, Hospital Universitario Ramón y Cajal, Madrid, Spain; Marı́a José Anaya, MD, Hospital Universitario Ramón y Cajal, Madrid, Spain; Montserrat Fernández-Guarino, PhD, Hospital Universitario Ramón y Cajal, Madrid, Spain; Pablo Boixeda, PhD, Hospital Universitario Ramón y Cajal, Madrid, Spain Klinefelter syndrome and chronic leg ulcers Chad Johnston, West Virginia University, Morgantown, WV, United States; Garrett Bohrnstedt, MS, West Virginia School of Osteopathic Medicine, Lewisburg, WV, United States; Roxann Powers, MD, West Virginia University, Morgantown, WV, United States Introduction: Tuberous sclerosis (TE) is an infrequent neurocutaneous syndrome characterized by the presence of multiple hamartomas. The diagnosis of TE is based in clinical criteria. Objective: Describe the clinical findings in a series of 57 patients with TE. A 56-year-old white male presented to our clinic complaining of a nonhealing 4-cm ulcer on the left lower extremity for approximately 12 months’ duration. Histopathology showed stasis angiomatosis and cultures positive for coagulasenegative Staphylococcus aureus and Enterobacter cloacae. Previous treatments included wet to dry dressings, oral antibiotics (doxycycline and trimethaprim/sulfamethoxazole), aspirin, pentoxifylline, and hyperbaric oxygen. Despite treatment, the patient’s leg ulcer showed little, if any improvement. The patient’s medical history included hyperlipidemia, depression, and osteoarthritis treated with naproxen. The patient is not married and works on a strawberry farm. He denies smoking or familial coagulative disorders and he reports no sexual dysfunction. Further physical examination reveals a eunuchoid body habitus, scant facial and body hair, scattered varicosities of the lower extremities, and small, firm testicles. Pertinent laboratory examination revealed low testosterone 160 ng/dL (normal, 241-827), an elevated follicle stimulating hormone (FSH) 63.1 mIU/ml (normal, 1.1-18.1) ,and luteinizing hormone (LH) 26 mIU/ml (normal, 1.5-9.3). The diagnosis of Klinefelter syndrome was suspected and the patient was sent for chromosome analysis and found to have karyotype of 47, XXY. With Klinefelter syndrome confirmed, treatment was initiated with testosterone 125 mg via subcutaneous injection every third week. Methods: We carried out a retrospective, descriptive, and observational study between January 1994 and March 2007. We described the clinical findings in the group of patient. Results: One hundred percent of the patients had neurologic or dermatologic alterations. The rest, were, in order: psychiatric (55.5%), kidney alterations (32.8%), heart alterations (22.4%), squeletical and lung alterations (13.4%), and opthalmologic alterations (11.9%). We describe the type of alteration found in each category. The dermatologic findings were described and classified in groups according to their type and their location. Conclusions: We described the clinical findings in a series of 57 patients affected of TE. According to the literature reviewed, this is the first study done in a Spanish population. Globally, our data support previously published data. Commercial support: None identified. Commercial support: None identified. HAIR AND NAIL DISORDERS P2100 P2010 Case 1 is a 60-year-old male who has had blisters since he was born. He is the father of family, and he noted that his three brothers had the same lesions. Case 2 is a 20year-old male who complained of blisters on the knee, legs with itch, and dystrophic nails since he was born. Case 3 is a 26-year-old male presenting with blisters, especially on his legs, and dystrophic nails. The lesions have occurred since birth. Case 4 is a 28-year-old female who complained that after her birth and during her childhood she had blisters especially on her trunk, arms, knees, and legs. During the pregnancies of her first and second sons, the lesions became worse and many new lesions had appeared. Case 5 is a 30-year-old female; lesions appeared 3 or 5 days after her birthday always with milia and itch. Case 6, a 32-year-old female, has had blisters since her first days of life. Now the lesions occur especially on legs. Case 7 is a 22-year-old female who has presented with blisters since her second week of life, initially on her legs and feet. She referred itch and presence of milia and dystrophic nails. All patients were submitted to a punch biopsy and histopathologic exam revealed a subepidermic cleavage and the antigen mapping demonstrated aspects which made the diagnosis of dystrophic EB possible. Numerous faces of yellow dots Adriana Rakowska, PhD, Department of Dermatology, CSK MSWiA, Warsaw, Poland; Elzbieta Kowalska-Oledzka, Department of Dermatology, CSK MSWiA, Warsaw, Poland; Lidia Rudnicka, Department of Dermatology, CSK MSWiA, Warsaw, Poland; Malgorzata Olszewska, Department of Dermatology, Warsaw Medical University, Warsaw, Poland Yellow dots constitute dermatoscopic features which can be observed in different types of effluvium. Images of yellow dots observed in different types of effluvium were subject to morphologic analysis. In the case of alopecia areata, yellow dots in old inactive lesions (n ¼ 44) were identified as homogenous, light-yellow structures. With regard to the active lesions (n ¼ 55), the remnants of dystrophic hair bearing a close resemblance to pepper grains could be observed within the yellow dots. In the above mentioned cases, the yellow dots usually had double margins. An enormous diversity of yellow dots was observed in androgenic alopecia (n ¼ 167) starting from the light-yellow to dark-brown in color. In more than half of the cases, the dots had double margins. The highest number of yellow dots in patients with female androgenetic alopecia was noted in the frontal area (8.86 6 4.8/4 fields of vision at 70-fold magnification). The corresponding number in the occipital area was 1.59 6 2.0. In different forms of cicatrical alopecia yellow dots were observed in discoid lupus erythematosus (DLE; n ¼ 11) and in folliculitis capitis abscedens and suphodiens (n ¼ 3). In the active lesions of DLE, the yellow dots were large (with the dot diameter twice as big as in the aforementioned cases), while the inactive lesions contained arborising vessels and were therefore reminiscent of a red spider contained inside a yellow dot. In folliculitis capitis abscedens and suphodiens, the yellow dots were of three-dimensional structure and resembled yellow soap bubble with pepper grains inside. In conclusion, yellow dots constitute dermatoscopic features, which can be observed in different types of effluvium and take many a form. In some cases, the appearance of yellow dots will provide the key to establishing a correct diagnosis. Commercial support: None identified. Commercial support: None identified. Dominant dystrophic epidermolysis bullosa: Seven familial cases Francisca Regina Oliveira Carneiro, University of State of Pará, Belem, Brazil; Bruna Maria Cruz Crescente, University of State of Pará, Belem, Brazil; Renata Silva Barros, University of State of Pará, Belem, Brazil Epidermolysis bullosa (EB) is a heterogeneous group of inherited skin disorders associated with blisters, erosions, and chronic wounds in response to mechanical trauma of varying degrees. The disease is traditionally classified into three groups according to the level of cleavage within the skin: EB simplex, junctional EB, and dystrophic EB. We report seven cases of dominant dystrophic EB in the same family. The patients were submitted to dermatologic examination in addition to the family’s pedigree; to confirm the clinically suspected EB subtype, antigen mapping was performed. AB98 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5962_5966 16 January 2009 6:33 pm P2101 P2103 Trichothiodystrophy: A rare multisystem genetic disease with marked phenotypic diversity Priya Mahindra, MD, SUNY Downstate Medical School, Brooklyn, NY, United States; Deborah Tamura, RN, MS, National Institutes of Health, Bethesda, MD, United States; John DiGiovanna, MD, Brown Medical School, Providence, RI, United States; Kenneth Kraemer, MD, National Institutes of Health, Bethesda, MD, United States; Salma Faghri, Brown Medical School, Providence, RI, United States Trichothiodystrophy (TTD) is a rare, multisystem, autosomal recessive disease characterized by defective DNA repair and sulfur-deficient, brittle hair. We performed a systematic examination of clinical features of TTD patients at the National Institutes of Health to further identify the disease spectrum. Diagnosis was confirmed by the presence of tiger tail banding (an alternating pattern of light and dark bands) of hair under polarized microscopy in 100% of the patients. A total of 21 patients from 17 families were studied with ages ranging from 1.6 to 29.5 years (median age, 10.3 yrs) at time of last physical examination. Major cutaneous abnormalities included brittle hair (90%), ichthyosis (67%), photosensitivity (57%), and nail defects (86%). The patients also had developmental delay/intellectual impairment (95%), short stature (67%), and sensorineural hearing loss (19%). Abnormal magnetic resonance imaging findings (48%) included diffuse dysmyelination (38%) and ventriculomegaly (19%). Hematologic abnormalities (95%) included features of b-thalassemia minor, with low mean cell volume (76%) and elevated HbA2 (71%) without defects in the hemoglobin gene. Radiographs showed bone abnormalities (100%) including peripheral osteopenia (76%) and central osteosclerosis (43%). Recurrent infections (57%) required repeated hospitalizations. Abnormal characteristics present at birth (86%) included low birth weight (71%), congenital cataracts (43%), and collodion membrane (48%). Surprisingly, the mothers of the patients with abnormal birth characteristics had frequent maternal pregnancy complications (86%), including in utero growth retardation (57%) and preterm labor (48%). This suggests the potential role of DNA repair genes in fetal growth and development. Mutations in XPD, a gene involved in both DNA repair and basal transcription, were seen in 11 TTD families. However, these patients do not have the 1000-fold increased risk of sun-induced skin cancer as seen in xeroderma pigmentosum patients, who have defects in these same genes. One TTD patient with unknown mutation had skin cancer. TTD is a rare multisystem developmental disorder with wide phenotypic variability. While all patients exhibited hair abnormalities and, except for one patient, developmental delay, those more severely affected had substantial neurologic, immunologic, and growth impairment. The identification of these diverse clinical features requires a multidisciplinary approach to diagnosis and management of TTD. Comparative evaluation of men’s depilatory products versus razor Christian Oresajo, MD, L’Oréal Recherché, Clark, NJ, United States; Chesahna Kindred, Howard University, Washington, DC, United States; Margarita Yatskayer, L’Oréal Recherché, Clark, NJ, United States; Rebat Halder, Howard University, Washington, DC, United States Shaving with razors is often problematic in sensitive skin, especially skin of African Americans. This method of shaving often leads to erythema and irritation. Moreover, African American men are prone to pseudofolliculitis barbae (PFB), a common and distressing disorder in which growing hair shaft curve back into the skin, producing a foreign body inflammatory reaction. Depilatory creams chemically remove hair from the skin surface. The active ingredients of depilatory creams are chemicals that dissolve the keratin of hair. This controlled, single-center, split-faced, randomized trial was undertaken to compare shaving with two different depilatory products (product A, containing calcium hydroxide, guanidine carbonate, and calcium thioglycolate; and product B, containing calcium hydroxide, lithium hydroxide, and thioglycolic acid) to shaving with a razor on 45 African Americans male volunteers, 18 years of age or older, with skin prone to razors bumps. They were all current or previous users of depilatory cream. The volunteers underwent a sensitivity test and only qualified volunteers were enrolled into the study. The volunteers were required to shave at home with their normal method 2 days before the first visit. At the first visit, a dermatologist performed a preshave evaluation to assess irritation, skin roughness, and lesion count. Volunteers were asked to shave one half of the face with the provided razor and shaving cream and the other side with one of the depilatory creams (according to randomization). Immediately after shaving, a dermatologist performed the postshave evaluation by reassessing for irritation and efficacy, photographing both sides of the face, and counting lesions. The participant returned 2 and 4 days later and repeated the shaving technique. At each visit, a dermatologist repeated evaluation as described at the first visit. Volunteers completed a self-assessment questionnaire at each study visit. In this short study, the results indicate that there were fewer papules that developed on the depilatory-treated side compared to the razor shaved side in most subjects who used either of two products. While both depilatory products produced more irritation immediately after use and to a greater extent than the razor, the irritation was transient, and more often subjective than objective. The result of using either depilatory product was that the skin looked and felt smoother than shaving with a razor. Product A generated more irritant contact dermatitis than product B. All cases of irritant contact dermatitis resolved in 2 to 5 days without scarring or dyspigmentation. Commercial support: 100% sponsored by L’Oreal. Commercial support: None identified. P2104 A comparison of vertical versus transverse sections for the histopathologic diagnosis of alopecias Ozlem Ozen, PhD, Baskent University Faculty of Medicine Department of Pathology, Ankara, Turkey; Deniz Seckin, MD, Baskent University Faculty of Medicine Department of Dermatology, Ankara, Turkey; Deren Ozcan, MD, Baskent University Faculty of Medicine Department of Dermatology, Ankara, Turkey P2102 Alopecia areata of eyelashes: Regrowth after injecting triamcinolone into the eyebrow area Lidia Rudnicka, MD, Department of Dermatology, CSK MSWiA, Warsaw, Poland; Irena Walecka, MD, PhD, MBA, Department of Dermatology, CSK MSWiA, Warsaw, Poland; Malgorzata Olszewska, MD, PhD, Department of Dermatology, Warsaw Medical University, Warsaw, Poland; Monika Slowinska, MD, Department of Dermatology, CSK MSWiA, Warsaw, Poland Isolated alopecia areata of the eyelashes and eyebrows is rare, but remains a therapeutic challenge. We describe two patients, in which regrowth of eyelashes was observed after injecting triamcinolone into the eyebrow area. The first patient is a 32-year-old female with a history of alopecia areata treated previously effectively with cyclosporine A and a few month history of isolated loss of eyebrows and eyelashes. Clinical appearance and dermatoscopy were consistent with alopecia areata of eyebrows and eyelashes. Topical treatment with corticosteroids and latanoprost was not effective. Intralesional triamcinolone acetonide suspension 10 mg per mL was injected with a 30-gauge needle into the eyebrow area. Four weeks after the first injection session slow regrowth of eyebrows was observed. This was accompanied by regrowth of eyelashes. After another 2 weeks, intralesional triamcinolone acetonide injections were repeated. Continued 5-month observation shows no relapse of alopecia areata of either eyebrows or eyelashes. The second patient is an otherwise healthy, 23-year-old female, with patches of recalcitrant scalp alopecia areata, a 2-year history of sparse and periodically regrowing eyebrows and loss of eyelashes. The diagnosis of alopecia areata was established based on clinical appearance, histopathology, and scalp, eyebrow, and eyelash dermatoscopy. Initially, only intradermal triamcinolone acetonide suspension injections into the eyebrow area were applied. Six weeks after this treatment almost full regrowth of eyelashes was observed. At this point, systemic cyclosporine A therapy for her scalp alopecia areata was introduced. During a 12-week observation time, no relapse was observed. In conclusion, these cases show that intralesional triamcinolone, applied into the eyebrow area may influence eyelash regrowth in alopecia areata. Commercial support: None identified. Background: Both vertical and transverse sections have advantages and disadvantages in the histopathologic diagnosis of alopecia; however, combining the two methods increases the diagnostic yield. If only a single biopsy specimen can be obtained, it is important to know which method is superior to the other in order to decide whether to section it vertically or transversely. Objective: In this study, we aimed to define the histopathologic findings of cicatricial and noncicatricial alopecias in transverse and vertical sections of punch biopsy specimens, and compare the diagnostic value of both methods. Methods: The study included 53 patients with the complaint of hair loss. All the patients were given a clinical diagnosis after the detailed clinical history and dermatologic examination. In each patient, two 4-mm punch biopsies were taken from the alopecic lesions. While one of the biopsy specimens was sectioned transversely, the other was used for vertical sections and direct immunofluorescence examination. The findings of clinical diagnosis, the histopathologic findings of both transverse and vertical sections, and direct immunofluorescence examination were evaluated together, and the most probable diagnosis for each patient was made by the same dermatologist. The same pathologist evaluated the transverse sections and the vertical sections separately and the diagnosis reached with either method was compared with the most probable diagnosis. Results: The histopathologic findings in the epidermis, dermoepidermal junction, and dermis were only observed in vertical sections, whereas the quantitative data of the hair follicles were evaluated more accurately in transverse sections. Transverse sections were seemed to be superior to vertical sections for noncicatricial alopecias (P ¼ .05). In contrast, vertical sections were superior to transverse sections in patients with lichen planopilaris (P ¼ .04). No statistical difference was found between the diagnostic values of two methods in other types of cicatricial alopecias (P [.05). Conclusions: For the histopathologic diagnosis of subtypes of alopecia, if a single biopsy specimen is obtained, transverse sections should be preferred in noncicatricial alopecias. In patients whose clinical findings are consistent with lichen planopilaris, vertical sections should be evaluated, whereas either transverse or vertical sections can be performed in cicatricial alopecias other than lichen planopilaris. Commercial support: None identified. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5962_5966 16 January 2009 6:33 pm AB99 P2105 P2107 The women’s hair growth questionnaire: Development and validation of a patient-reported measure for treatment efficacy in androgenetic alopecia Jane Harness, Pfizer Inc, New London, CT, United States; Carla Mamolo, PhD, Pfizer Inc, New London, CT, United States; Elise Olsen, MD, Department of Medicine/Dermatology, Durham, NC, United States; Vera Price, MD, School of Medicine/Department of Dermatology, San Francisco, CA, United States Single-center, open-label, efficacy and safety study of tazarotene for the treatment of brittle nails Noelle Sherber, MD, Johns Hopkins Hospital, Department of Dermatology, Baltimore, MD, United States; Ariel Hoch, MPH, Columbia University, Department of Dermatology, New York, NY, United States; Carol Coppola, RN, Columbia University, Department of Dermatology, New York, NY, United States; Julian Mackay-Wiggan, MD, MS, Columbia University, Department of Dermatology, New York, NY, United States; Richard Scher, MD, University of NC, Department of Dermatology, Chapel Hill, NC, United States Background: New drugs to promote hair growth need to demonstrate efficacy on two primary endpoints, one of which is patient self-assessment, for product efficacy to be approved by the US Food and Drug Administration (FDA). To date, no validated patient-reported outcome (PRO) measure developed specifically to assess the efficacy of treatments of female pattern hair loss/androgenetic alopecia (AGA) in women has been described in the literature. The purpose of this project was to develop and validate a measure of perceived hair growth, the Women’s Hair Growth Questionnaire (WHGQ), in accordance with FDA draft guidance for the use of PROs in clinical trials. Methods: Candidate questionnaire items were generated based on a literature review, patient input collected in multiple focus groups of women with a clinical diagnosis of AGA, and from consultation with expert clinicians. Twenty items were compiled into a draft questionnaire and face to face cognitive interviews were performed with women who demonstrated hair loss in order to assess the comprehension of each item. Patient feedback guided item revision and reduction until 6 items were judged to be clear and comprehensive of patients’ perceptions of hair growth and loss. These items were psychometrically evaluated in the context of a validation study of 151 women with AGA on treatment for their hair loss. The main purpose of the validation study was to perform item- and scale-level analyses (to inform any additional item reduction), and to determine the reliability and validity of the final questionnaire. Results: Based on the results from the validation study analyses, 4 of the 6 items were retained to form the WHGQ. These four items asked the patient to assess, since the start of the treatment: (1) growth of hair, (2) amount of noticeable new hair, (3) visibility of the scalp, and (4) rate of hair loss. The 4-item WHGQ showed acceptable internal consistency (Cronbach a ¼ 0.81) and strong testeretest reliability (ICC ¼ 0.89). The WHGQ was able to discriminate between patient- and physician-reported levels of improvement since the start of treatment. Conclusions: Based on extensive patient input and initial psychometric analyses, the 4-item WHGQ provides a valid patient self-assessment of hair growth, and shows promise as a primary efficacy endpoint for clinical trials evaluating new treatments for women with female pattern hair loss/AGA. Objective: To determine whether topical tazarotene ameliorates signs and symptoms of brittle nails. Design: A single-center, open-label trial, with a 24-week treatment period and a 12-week follow-up period. Setting: Columbia University Medical Center, Department of Dermatology. Participants: Eighteen females and one male with brittle nails completed the study. Eligible patients needed to be between 18 and 76 years of age and to have evidence of brittle nails at screening. Intervention: Subjects applied tazarotene twice daily to all affected fingernails for 24 weeks. Main outcome measures: The change in the Physician’s Global Improvement Assessment of the two target nails at weeks 12 and 24. Results: Data from the 19 subjects who completed the study were included in the data analysis. One subject was excluded from the analysis of the primary endpoint, the Physician’s Global Improvement Assessment, because baseline photographs were not available. All 18 evaluable subjects achieved the primary endpoint of improvement in the Physician’s Global Improvement Assessment of the target nails at week 12, as did 16 out of 18 subjects at week 24. All 18 subjects had an improvement in Physician’s Global Improvement Assessment 12 weeks posttreatment at week 36. The secondary endpoint, Physician’s Global Assessment, improved for 14 of the 19 subjects (73.7%) at both weeks 12 and 24. At week 36, 17 out of 19 subjects (89.5%) agreed that their nails had improved overall. One subject (5.3%) reported mild local irritation. Conclusions: Tazarotene improves some signs and symptoms of brittle nails with minimal to no irritation. Commercial support: Sponsored by a grant provided by Allergan. Commercial support: 100% sponsored by Pfizer Inc. P2106 Study of cardiovascular risk factors in patients with androgenetic alopecia: Metabolic syndrome and carotid atheromatosis Salvador Arias-Santiago, MD, San Cecilio Clinical Hospital, Granada, Spain; Luisa Castellote-Caballero, MD, San Cecilio Clinical Hospital, Granada, Spain; Maria Teresa Gutierrez Salmeron, MD, San Cecilio Clinical Hospital, Granada, Spain; Ramón Naranjo-Sintes, MD, San Cecilio Clinical Hospital, Granada, Spain Introduction: The link between androgenetic alopecia (AGA) and cardiovascular disease has been studied by several authors in recent decades, with different results in the epidemiologic studies carried out. The purpose of this paper is to determine the prevalence of metabolic syndrome and the degree of carotid arteriosclerosis in patients with early-onset AGA (before the age of 35) treated at our hospital, and make a comparison with a control group of dermatology patients without AGA. P2108 Semiautomatic handheld videotrichogram Jung Won Shin, Seoul, South Korea; Chang Hun Huh, MD, PhD, Seoul, South Korea; Hee Chul Eun, MD, PhD, Seoul, South Korea; Kyoung Chan Park, MD, PhD, Seoul, South Korea; Sang Woong Youn, MD, PhD, Seoul, South Korea Introduction: For many years, phototrichogram has been a standard and essential tool for hair research. But because of its complexity to perform, phototrichogram is used only in clinical research area rather than practically used. Recently, technological development makes a big advancement in digitalizing system. Semiautomatic handheld videotrichogram is one of the advanced technologies in hair research field. It has a CCD with digitalized ruler, which makes a precise measurement of certain object like hairs. The purpose of this study is to compare semiautomatic handheld videotrichogram and conventional phototrichogram, and probe the effectiveness of videotrichogram. Methods: Thirty patients (21 males and 9 females) diagnosed with early-onset AGA by the Dermatology Unit at San Cecilio Hospital between November 2007 and May 2008, plus a control group of another 30 patients, divided identically by sex, who were being treated for other pathologies. In both groups the criteria for metabolic syndrome proposed by the ATP-III (obesity, triglyceridemia, HDL-C, blood pressure, and glycemia), and the presence of carotid atheromatous plaque measured by Doppler ultrasound. Other cardiovascular risk factors and hormone studies were also considered. Results: Fifty percent of the AGA patients met metabolic syndrome criteria, compared with 13% in the control group (P \ .05). Of the AGA patients, nine presented with atheromatous plaques, four of them in both carotids, and in two cases the blood flow was affected. In the control group, unilateral carotid plaque was found in two patients (P\.05), without the blood flow being affected. The body mass index) was similar in the two groups (mean value of 27.3 for the control group and 28 for the AGA patients); however, abdominal obesity and hypertriglyceridemia, analyzed separately, reached significantly higher values in the alopecia group. Testosterone levels were similar in the two groups, although sex hormoneebinding globulin was higher in the control group, without being statistically significant. However, insulin and aldosterone levels were higher in the AGA group (P \.05). Results: It is well correlated within each subject between two methods in terms of all measured parameter including hair density, diameter, and growth rate. But we found some discrepancies between two methods: (1) density measured by semiautomatic handheld videotrichogram shows less (100.0 6 12.3 vs 90.6 6 14.5; P ¼.001) and (2) diameters are thicker (44.1 6 8.0 vs 46.6 6 9.7; P ¼ .005). We think that hair count discrepancy is caused by automatization errors of conventional phototrichogram and measured diameters are differs because of the magnification power. Moreover, there’s another merits using semiautomatic handheld videotrichogram, which is no clipping or dyeing is required for the density or diameter analysis. Conclusions: The high frequency with which metabolic syndrome and carotid atheromatosis are found in patients with AGA makes it appropriate for this group to be screened with a view to the early detection of individuals at risk, in order that preventive treatment may begin before cardiovascular disease sets in. Conclusions: We can conclude that semiautomatic handheld videotrichogram can be one of the useful techniques for the hair research. We think its ease of use can make phototrichogram more popular in clinical practice and not only in the research field. Commercial support: None identified. Commercial support: None identified. AB100 Methods: Thirteen volunteers with androgenetic alopecia were involved. Measuring points were 15 cm above glabella of the subjects and marked with a tattoo after shaving to ensure reproducibility. Both conventional phototrichogram and semiautomatic handheld videotrichogram were applied at baseline and 2 days later to measure and compare hair density, linear hair growth rate, and hair thickness. J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5962_5966 16 January 2009 6:33 pm P2109 P2111 Dermatoscopy in patients with cicatricial alopecia caused by discoid lupus erythematosus with histopathologic correlation Adriana Rakowska, Department of Dermatology, CSK MSWiA, Warsaw, Poland; Lidia Rudnicka, Department of Dermatology, CSK MSWiA, Warsaw, Poland; Malgorzata Olszewska, Department of Dermatology, Warsaw Medical University, Warsaw, Poland; Monika Slowinska, Department of Dermatology, CSK MSWiA, Warsaw, Poland The aim of the presented study was analysis of dermatoscopic images with histopathologic correlation in patients with cicatricial alopecia caused by discoid lupus erythematosus (DLE). Eleven patients were included in the study: seven patients with new and active DLE lesions within the hairy scalp skin and five patients with old lesions already affected by cicatricial alopecia. In active lesions, dark-brown discoloration was identified on the skin, giving it a dirty appearance. This corresponds to incontinentia pigmenti seen in histopathology. In prevailing part of cases, big, dark-brown in color and visibly bulging yellow dots were observed, which corresponds to hyperkeratotic plaques identified in follicular orifices in histopathologic study. Moreover, thick and twisted vascular loops were observed. Within the old and inactive lesions, large, twisted, and arborising vessels were identified in the area of porcelain white skin (scarring and vascular hyperplasia identified in histopathologic study) and yellow dots with arborizing vessels were found, which bore a close resemblance to an optic disc. We have called this symptom ‘‘a red spider in a yellow dot.’’ In conclusion, dermatoscopy enables establishing a diagnosis for DLE in cases of cicatricial alopecia and controlling the disease activity. Physical properties of an innovative nail protective hydrolacquer Federico Mailland, Polichem SA, Lugano-Pazzallo, Lugano, Switzerland; Adele Sparavigna, MD, DermIng srl, Monza, Milan, Italy; Michele Setaro, Tecnolab del Lago Maggiore, Verbania, Verbania, Italy Background: We evaluated the physical and microbiologic properties of a hydroalcoholic, film-forming solution containing hydroxypropyl-chitosan (HPCH) that forms the basis of a new medical device with protective activity for nails and skin. Methods: The following physical properties of 1% HPCH solution were investigated either in vitro by using bovine hoof slices (as a well recognized model of human nails) or in vivo on healthy human nails: (1) the film-forming capability, by applying the product on the surface of bovine hoof slices (cut by criotomy) and observing the casts by scan electron microscopy, or directly the nails by a reflected light stereo microscope; (2) the adhesion of the product on the nail surface (bovine hoof slices), or on a glass slide, by a standard test of resistance of a coating against detachment from a support; (3) the protection against standard abrasion made by a Dermal Torque Meter both in vivo on the nails of 3 healthy volunteers and in vitro on bovine hoof slices; (4) the protection from temperature, made by a thermal video camera on the nails of a healthy volunteer. Commercial support: None identified. Results: (1) The application of HPCH solution on a bovine nail slice, after evaporation of the solvent, forms an evident film on the slice surface. The surface covered by HPCH film appears smoother compared to the irregular, rough surface of the control nail plate. (2) During the stripping test, the hydroxypropyl chitosan film adheres well to the nail surface, and to the skin surface as well, while the same film does not adhere so well to glass. The test therefore confirms the existence of the film-forming capacity of hydroxypropyl-chitosan selective to keratin, unlike that observed with common cosmetic nail varnish or glue. (3) The film protects the surface of the nail from mechanical damage caused by abrasion, with significantly less abrasion on the nail surface protected by the HPCH film. (4) The thermography test revealed a reduction in the temperature of the nail surface as a result of the presence of the HPCH film. Conclusion: The new hydrolacquer technology based on the innovative film forming agent hydroxypropyl-chitosan (HPCH) has the characteristic to form a thin film, with affinity and selective adhesiveness to the keratin structure. The film appears to penetrate into the keratin holes and to smooth the uneven keratin surface, by physically supporting the nail and by protecting it against mechanical and other physical agents. Commercial support: 100% sponsored by Polichem SA. P2112 Histologic changes in eyebrow and peripheral body hair in frontal fibrosing alopecia Ai-Lean Chew, St. John’s Institute of Dermatology, London, United Kingdom; Catherine Stefanato, MD, St. John’s Institute of Dermatology, London, United Kingdom; David Fenton, MBBS, St. John’s Institute of Dermatology, London, United Kingdom; Saqib Bashir, MD, MBChB, St. John’s Institute of Dermatology, London, United Kingdom P2110 Trichoscopy of isolated alopecia areata of eyelashes Elzbieta Kowalska-Oledzka, MD, Department of Dermatology, CSK MSWiA, Warsaw, Poland; Adriana Rakowska, Dermatology Department, Central Clinical Hospital MSWiA, Warsaw, Poland; Lidia Rudnicka, Dermatology Department, Central Clinical Hospital MSWiA, Warsaw, Poland; Monika Slowinska, Dermatology Department, Central Clinical Hospital MSWiA, Warsaw, Poland Introduction: Frontal fibrosing alopecia (FFA) is thought to be a variant of lichen planopilaris because it shares clinical and histopathologic features with this entity. Clinically, it is a form of cicatricial alopecia, recognized as a progressive band of frontal or frontoparietal hairline recession, usually affecting postmenopausal women. Eyebrow hair loss and hair loss from other body sites is documented clinically, but rarely histologically. We describe the clinical and histopathologic changes of FFA, including histology from eyebrows and peripheral body hair. Objective: The purpose of this study was to report clinical and histopathologic findings in a cohort of patients with FFA, highlighting changes in eyebrow/peripheral body hair. Alopecia areata is an autoimmune inflammatory disease affecting a hair follicle. The isolated form that is limited to eyelashes (madarosis) in children is a rare variant of the disease which might progress to other sites of hair-bearing parts of the body. Alopecia areata may coexist with atopy and autoimmune thyroid disease. We present an 11-year-old female child with an asymptomatic gradual patchy hair loss of eyelashes without signs of blepharitis for 11 months. The course was fluctuating with temporal spontaneous hair regrowth. The eyelash loss affected both the upper and lower lids. Clinical examination revealed no symptoms of alopecia within the scalp and rest of body. We did not find any symptoms of nails pitting. The child had no history of acute illness before the onset of hair loss neither signs of atopy or thyroid disease, but her mother suffered from GraveseBasedow disease. Routine laboratory tests showed a low serum iron level. Ophtalmoscopic examination excluded pathology of eye apparatus. There were no present or past histories of psychiatric disorder. Because of suspicion of alopecia areata, videodermatoscopic examination was conducted with the use of Fotofinder Mole Analzyer. Exclamation hair, cadaverized hair, yellow dots, and no signs of inflammation confirmed the diagnosis of alopecia areata. We did not find any signs of trichomalacia, which is characteristic for trichotillomania. Differential diagnosis of nonscarring eyelashes loss includes trichotillomania, chronic blepharitis, drug-induced alopecia, and tumors of meibomian glands. In children, alopecia areata must be differentiated from trichotillomania. In some cases the diagnosis has to be confirmed by histopathology. We would like to recommend videodermatoscopy as a fast, simple, and noninvasive diagnostic tool for differentiation of isolated eyelashes alopecia areata from trichotillomania. Methods: Thirteen consecutive patients with a clinical and histologic diagnosis of FFA seen at the St John’s Institute of Dermatology from January 2006 to March 2008 were included. Scalp biopsies were performed in all patients for histology and direct immunofluorescence (DIF). When indicated, further biopsies were performed: six patients had eyebrow biopsies and five had upper limb biopsies. Commercial support: None identified. Commercial support: None identified. Results: Thirteen patients were included: all were female and 11 (85%) were known to be postmenopausal. The median (IQR) age of onset of signs was 58 years (range, 52-65 yrs), with a median duration of 3 years (range, 2-5 yrs). Clinical examination revealed a band of symmetrical recession involving the frontotemporal or frontoparietal hairline in all patients. Partial to total eyebrow loss was clinically reported in all patients, while body hair loss was reported in 9 (69%). Four patients (31%) had a weakly positive ANA, three patients (23%) were known to be hypothyroid, on thyroxine replacement, and two patients (15%) were found to have positive thyroid antibodies on screening. One patient had vulval lichen planus. Histologic examination of the scalp, eyebrow, and upper limb specimens showed similar features including a reduction of hair follicles, perifollicular lymphoid cell infiltrate, and perifollicular fibrosis. DIF was negative in all cases. Conclusion: Clinically, we have demonstrated that eyebrow and peripheral body hair loss is very common in FFA patients—a finding that we feel is underreported. Pathologically, we have demonstrated that hair loss from facial and body sites demonstrate features of scarring, suggesting that the process of scarring alopecia is in fact generalized rather than localized to the frontal scalp. This finding is important in aiding clinicians to manage patients’ expectations on prognosis. MARCH 2009 J AM ACAD DERMATOL ABS 5.0 DTD ymjd5962_5966 16 January 2009 6:33 pm AB101 P2113 P2115 A case of central centrifugal cicatricial alopecia in an African American man Angela Rondina, MD, PhD, Henry Ford Hospital, Detroit, MI, United States; Raechele Cochran Gathers, MD, Henry Ford Hospital, Detroit, MI, United States Lipoedematous scalp Grant Wylie, MD, Alan Lyell Centre for Dermatology, Glasgow, Lanarkshire, United Kingdom; Catherine Black, MBChB, Department of Pathology, Glasgow, Lanarkshire, United Kingdom; Colin Clark, MBChB, Alan Lyell Centre for Dermatology, Glasgow, Lanarkshire, United Kingdom; Giles Roditi, MBChB, Department of Radiology, Glasgow, Lanarkshire, United Kingdom Central centrifugal cicatricial alopecia (CCCA), as defined by the North American Hair Research Society (NAHRS) in 2001, is ‘‘hair loss starting in the central scalp and progressing centrifugally.’’ This entity encompasses previous terms including hot comb alopecia, follicular degeneration syndrome, and pseudopelade in African Americans. CCCA is a scarring alopecia that mostly affects African American women. The etiology of CCCA has yet to be elucidated; however, cultural hairstyle practices such as relaxers, hot combs, tight braids, heavy extensions, or others may in part play a role. To our knowledge, there is only one report in the literature by Sperling et al describing possible CCCA in 8 African American men. We report the case of a 52year-old African American male with an 8-year history of progressive, asymptomatic hair loss on the vertex of the scalp. This patient had a many year history of regular chemical relaxer use. He denied history of braids, weaves, or extensions. Physical examination revealed small, shiny patches of follicular dropout consistent with scarring alopecia mostly on the frontal, crown, and vertex of the scalp. There was some perifollicular erythema, mainly at the vertex of the scalp. Hair pull test showed breakage of the hair at mid-strand consistent with chemical alopecia. Pathology showed loss of mature hair follicles and increased catagen/telogen hairs with associated perifollicular concentric fibrosis. Premature desquamation of the inner root sheath follicular was not seen. Scarring was seen on elastic stain. Biopsy was consistent with CCCA. We review the literature and present a case of central centrifugal cicatricial alopecia in an African American man with a history of relaxer use, which may further support the argument of chemical processing as one possible etiology involved in the pathogenesis of this disorder. Commercial support: None identified. Lipoedematous alopecia (LA) is an uncommon idiopathic cause of scarring alopecia that occurs most frequently in black females. The disorder is typically asymptomatic, but scalp inflammatory change and hyperlipidemia have been reported. Hair loss is associated with hypertrophy of the subcutis that can be demonstrated by histology, ultrasound, computed tomography, or magnetic resonance imaging (MRI) scans. However, lipoedematous scalp (LS) has been recognized as a rare subset of this disorder where subcuticular hypertrophy occurs in the absence of hair loss. We report LS occurring in a white female who has dense scalp hair growth A 56-year-old female was aware of a fluctuant sensation over the posterior aspect of her scalp for more than 5 years. She was otherwise well with no previous trauma or surgery to the head or scalp. She was not hyperlipidemic. Palpation revealed a diffuse, soft, spongelike texture and thickening over the scalp most evident at the vertex and parietooccipital areas. The scalp was otherwise normal with a dense covering of scalp hair with no evidence of alopecia or dermatosis. An MRI scan showed scalp thickening with an estimated scalp thickness of 12 mm (normal range, 5-6 mm). A biopsy revealed epidermis with mild follicular plugging with keratin. The most prominent feature is thickening of the subcutaneous tissue caused by the expansion of fat, with some disruption of the normal fat architecture, and more superficial merging of fat with the dermis. There is also mild subcutaneous edema. There is no apparent reduction in the number of hair follicles in the skin. Similar pathologic features can be seen with fat overgrowth in the absence of edema, which can produce a clinically similar condition. Other features that can be seen, but were not prominent in this case, are mild hyperkeratosis and acanthosis of the epidermis. Sagittal and transverse T1-weighted MRI scans showed a clear thickening of scalp tissues, predominantly subcutaneous fat posterior to coronal suture level. The Short TI Inversion Recovery (STIR) images revealed the signal from fat to be nulled with no water signal to indicate an active inflammatory process. There is no underlying abnormality of the skull vault. LS or LA are rare disorders seldom reported in the medical literature. Initially, the disorder was predominantly reported in black females with an associated scarring alopecia (LA), but other ethnic groups have been affected. Most cases are in females, but male cases have also been reported. Associations include single reports of diabetes mellitus, skin and joint hyperelasticity, renal failure, Sjögren syndrome, and hyperlipidemia. Where hair loss is not evident, the abnormality is only detected on palpation. Patients have a soft, spongelike swelling of the scalp most evident in the parietal and occipital regions posterior to the sagittal sinus. In our patient, hair growth was dense over the scalp. Short hair and scarring alopecia have been reported in association with symptomatic inflammatory scalp dermatosis. The principal finding is of scalp thickening, primarily by expansion of the subcutaneous fatty layer. This is best demonstrated with MRI scans. Histology confirms the absence of infiltrative processes, particularly the absence of mucin deposits. LS is a rare acquired benign scalp disorder of unknown etiology that is best demonstrated with MRI scans. Fortunately, alopecia is not a feature, because therapeutic interventions are limited. Commercial support: None identified. P2114 P2116 A randomized, double-blind, vehicle-controlled trial of a novel topical antifungal nanoemulsion (NB-002) in subjects with distal subungual onychomycosis Terry Jones, MD, J & S Studies, Inc, College Station, TX, United States; Marian Ijzerman, PhD, NanoBio Corporation, Ann Arbor, MI, United States; Mary Flack, MD, NanoBio Corporation, Ann Arbor, MI, United States Background: Current topical therapies for onychomycosis are largely ineffective, and systemic drugs have significant safety risks. Nanoemulsions are oil-in-water emulsions containing high energy nanometer-sized droplets that diffuse to the site of infection and kill fungi on contact. We assessed the clinical efficacy of three doses of NB-002 compared to vehicle in subjects with distal subungual onychomycosis (DSO). Methods: Four hundred forty-three subjects 18 to 75 years of age with cultureconfirmed DSO involving 25% to 67% of the great toenail were randomized to two groups: NB-002 (0.25% twice daily [bid], 0.5% once daily [qD], or 0.5% bid) or vehicle. Subjects applied 2 mL of study treatment to all toenails and adjacent skin for 42 weeks and had assessments of unaffected nail length and affected nail area at weeks 6, 12, 24, 32, 46, and 50, with mycologic culture at weeks 24, 46, and 50. An interim analysis was performed on the first 160 subjects to complete 24 weeks of treatment per protocol. Complete cure, therapeutic success, and mycologic cure will be assessed at week 50. Results: Subjects in the interim analysis were primarily white (92%) males (83%) with a median age of 51 years. Thirty-eight subjects received 0.25% NB-002 bid, 43 received 0.5% NB-002 qD, 41 received 0.5% NB-002 bid, and 38 received vehicle (qD or bid). Compared to baseline, subjects on NB-002 (0.25% bid or 0.5% qD) had a statistically significant increase in mean unaffected nail length of 1.25 mm (P ¼.005) and 1.76 mm (P \ .001), respectively, that was not observed in vehicle-treated subjects. They also had a statistically significant decrease from baseline in mean affected nail area (P \.001) that was not observed in vehicle-treated subjects. There has been no significant safety or dermal irritation concern to date. Conclusions: Interim data indicated a significant increase in clear nail growth and a decrease in affected nail area for subjects on NB-002 for 24 weeks. Given its safety and topical route of application, NB-002 represents a promising option for onychomycosis treatment. Commercial support: NanoBio Corporation sponsored the clinical trial. AB102 J AM ACAD DERMATOL MARCH 2009 ABS 5.0 DTD ymjd5962_5966 16 January 2009 6:33 pm P2117 P2201 Treatment of an ingrowing nail with cotton ball insertion under the nail Young Sik Kim, Department of Dermatology, College of Medicine, Yeungnam University, Daegu, South Korea; Chan Woo Kim, MD, Department of Dermatology, College of Medicine, Yeungnam University, Daegu, South Korea; Ki-Hong Kim, MD, Department of Dermatology, College of Medicine, Yeungnam University, Daegu, South Korea; Mi Hye Kim, MD, Department of Dermatology, College of Medicine, Yeungnam University, Daegu, South Korea; Woo Jin Kim, MD, Department of Dermatology, College of Medicine, Yeungnam University, Daegu, South Korea An ingrowing nail is a condition where an irregular sharp edge of the lateral nail plate penetrates and injures the soft tissue of the lateral nail fold. It induces so much pain, especially when walking, that a condition feels uncomfortable throughout their daily routines. According to the severity of the condition, there are several treatment options, including conservative treatment, cotton ball insertion, and partial matricectomy. Although the partial matricectomy is a curative treatment, it is invasive and needs postoperative care of the wound for some while. The insertion of cotton balls under the nail lesion relieves the lateral nail fold from the stimulation by the nail plate when walking; it therefore allows the lesion to improve. In addition, the procedure is simple and easy to practice repeatedly. The efficacy of the treatment of an ingrowing nail by insertion of cotton ball was compared with other
