P8515

P7619An observational study on the management of rosacea in private practice

Sophie Seite, PhD, La Roche-Posay Dermatologic Laboratories, Asnieres SurSeine, France

Objective: This study investigates whether a skincare product containingAmbophenol, Neurosensine, and La Roche-Posay thermal spring water formulatedin a highly protective packaging can have an impact in the management of rosacea-prone skin subjects as either monotherapy and/or adjunctive therapy.

Methods: During this study, dermatologists practicing in Germany, Slovakia, andCanada were asked about their management of 614 patients suffering from rosacea(n¼ 210, 247 and 157 respectively). A questionnaire, containing information aboutpatient’s characteristics, severity of the pathology and the prescribed therapy wascompleted by dermatologists at baseline and 2 months later.

Results: In monotherapy, there was significant efficacy of the test formula associatedwith excellent tolerance. Significant improvement of all the clinical signs andsymptoms of rosacea and a reduction of the skin reactivity to ‘‘trigger factors’’ wereshown as either monotherapy or adjunctive therapy.

Conclusions: This study highlights the interest, value and impact of a skincareproduct containing Ambophenol, Neurosensine, and La Roche-Posay thermal springwater formulated in a highly protective packaging in monotherapy or in combina-tion with a therapeutic treatment in the management of patients suffering fromrosacea.

AB36

cial support: None identified.

Commer

J AM ACAD DERMATOL

P7848An unusual differential for nonmelanoma skin cancer on the dorsum of ahand: Superficial cutaneous actinomycosis

Rhydian Davies, MBBS, Dermatology Department, Swansea, United Kingdom;Dafydd Roberts, MBBS, Dermatology department, Swansea, United Kingdom

Introduction: Primary actinomycosis is a rare and difficult to recognize identity.Infection manifests slowly and systemic symptoms are uncommon. Usuallyassociated with an oral, abdominal or uterine focal nidus, isolated primary infectionsare usually as a result of penetrating trauma. The causative bacteria are facultativeintracellular anaerobic parasites that are difficult to culture. The detection ofsulphur granules histologically is pathognomic.

Case report: Our patient was a 78-year-old woman with type 2 diabetes. She wasknown to our department having previously had NMSCs treated on her legs. Shepresented with a 6-month history of a nonhealing erythematous plaque on thedorsum of her right hand. She did recall grazing the area on a rusty door lock some 6months earlier. Incisional biopsy and histology was obtained which showedinflammatory change. There were no acid-fast bacilli nor fungal elements andsulphur granules were detected. Subsequent tissue culture was unsuccessful indetecting a causative organism and negative for actinomycosis cultures. Resolutionof the lesion was achieved with 6 weeks empirical phenoxymethylpenicillin.

Discussion: Actinomycoses was first isolated in 1885 by Israel, hence the name ofthe most virulent species in humans, Actinomyces israeli. Before the emergence ofantibiotics, it was once a common clinical diagnosis. Today, outside of thedeveloping world, primary actinomyces infection are rare. Infection of sites notrelated to the oral cavity or abdominal cavity are rarer still. Our case is a rare examplewhere inoculation of subcutaneous tissue with a suspected actinomyces species hasresulted in a chronic cutaneous infection and localised inflammatory response.Despite attempts to culture a causative organism, only skin commensal organismswere grown. Clinical diagnosis of actinomycosis requires a high degree of clinicalsuspicion. Tissue cultures can be unhelpful but fortunately resistance to beta lactamantibiotics is rare.

cial support: None identified.

Commer

P8384Anatomy of a skin biopsy: A retrospective analysis of outpatient biopsyresults from 2000 to 2010

Charles Phillips, MD, Brody School of Medicine at East Carolina University,Greenville, NC, United States; Austin Newsome, MD, Hampton UniversitySkin ofColor Institute, Hampton, VA, United States; Defazio Jennifer, MD, MD, BrodySchool of Medicine at East Carolina University, Greenville, NC, United States; FixLindsey, MS, Brody School of Medicine at East Carolina University, Greenville,NC, United States; Harris Green, MD, Dermatology Assoc-Tallahassee,Tallahassee, FL, United States; Tracy McLean, MD, Brody School of Medicine atEast Carolina University, Greenville, NC, United States

Skin biopsies are frequently used in dermatology for diagnosis of and identificationof malignant conditions. Although biopsies have been around as a standard tool inskin lesion analysis, little is known about the frequency of biopsies or the resulting‘‘positive’’ yield. The purpose of this study was to evaluate clinical biopsy resultsfrom 2000 to 2010 to determine the characteristics of biopsy as a means fordiagnosis of suspicious skin lesions. A retrospective analysis was conducted on allpathology results from skin biopsies performed between 2000 and 2010 in theDermatology clinic at East Carolina University. Biopsy samples were taken from adiverse population of patients seen in an outpatient setting in Greenville, NC. Theassessment of results was further stratified based on the reason for biopsy(inflammatory versus tumor; concern for a pigmented lesion) and the diagnosesof either basal cell carcinoma, squamous cell carcinoma, melanoma, ‘‘othercutaneous malignancy’’ and dysplastic nevus. From a sample size of approximately67,000 office visits that occurred between 2000 and 2010, 20% of patientencounters resulted in skin biopsy. Of the biopsies, 87.9% were performed forsuspected malignancy and 12.1% were performed for inflammatory conditions.Among the skin tumor biopsies, 27.5% were diagnosed as basal cell carcinoma,19.2% were squamous cell carcinoma, 1.5% were melanoma, and 1% were othercutaneous malignancies. Of the biopsies to evaluate tumors, 29.5% were performedto further analyze a pigmented lesion; 5.1% were melanoma. Of the pigmentedlesions, 16% were identified as dysplastic nevi with 45.1% had mild atypia, 18.4%moderate atypia, 9.9% severe atypia, and 26.6% uncategorized. Analysis of the totalmalignancies identified per patient over the 10-year period showed a vast majority ofpatient (98.5%) diagnosed with 10 malignancies or less. The remaining 2.5% ofpatients that exceeded 10 malignancies varied greatly with 7 patients having morethan 35 skin cancers over the course of the decade. The primary reason forperforming a biopsy is typically to identify or verify suspected malignancy. Thisstudy showed a 50% positive diagnostic rate for biopsies of lesions that werebiopsied to identify skin cancer. A minority of skin biopsies are used to clarify thenature of a rash.

cial support: None identified.

Commer

MAY 2014