An early-stage study to evaluate the safety and efficacy of an experimental Zika vaccine in humans is being launched by the National Institute of Allergy and Infectious Diseases (NIAID). “Results in animal testing have been very encouraging,” said NIAID Director Anthony Fauci, MD. “Although it will take some time before a vaccine against Zika is commercially available, the launch of this study is an important step forward.”

The NIAID scientists developed the investigational vaccine earlier this year. The approach is similar to that taken for another NIAID investigational vaccine developed for West Nile virus, which was found to be safe and effective in a phase 1 clinical trial. The vaccine includes a plasmid (small piece of DNA) engineered to contain genes that code for proteins of the Zika virus. The body reads the genes and makes Zika virus proteins, which cause an immune response. The DNA vaccines do not contain infectious material and cannot cause a vaccinated person to become infected with Zika.

The phase 1 clinical trial (VRC 319) will involve 4 groups of 20 people. The participants will be vaccinated at the first visit, and then half will receive another vaccination 8 weeks or 12 weeks later. The remaining participants will receive 2 additional vaccines, 1 group at week 4 and week 8; the other group, at week 4 and week 20. Participants will be followed for 44 weeks.

The study will be conducted at the NIH Clinical Center in Bethesda, the Center for Vaccine Development at the University of Maryland, and Emory University, Atlanta. Initial safety and immunogenicity data from the trial are expected by January 2017. In early 2017, If the results are favorable, NIAID plans a phase 2 trial in Zika-endemic countries.

An early-stage study to evaluate the safety and efficacy of an experimental Zika vaccine in humans is being launched by the National Institute of Allergy and Infectious Diseases (NIAID). “Results in animal testing have been very encouraging,” said NIAID Director Anthony Fauci, MD. “Although it will take some time before a vaccine against Zika is commercially available, the launch of this study is an important step forward.”

The NIAID scientists developed the investigational vaccine earlier this year. The approach is similar to that taken for another NIAID investigational vaccine developed for West Nile virus, which was found to be safe and effective in a phase 1 clinical trial. The vaccine includes a plasmid (small piece of DNA) engineered to contain genes that code for proteins of the Zika virus. The body reads the genes and makes Zika virus proteins, which cause an immune response. The DNA vaccines do not contain infectious material and cannot cause a vaccinated person to become infected with Zika.

The phase 1 clinical trial (VRC 319) will involve 4 groups of 20 people. The participants will be vaccinated at the first visit, and then half will receive another vaccination 8 weeks or 12 weeks later. The remaining participants will receive 2 additional vaccines, 1 group at week 4 and week 8; the other group, at week 4 and week 20. Participants will be followed for 44 weeks.

The study will be conducted at the NIH Clinical Center in Bethesda, the Center for Vaccine Development at the University of Maryland, and Emory University, Atlanta. Initial safety and immunogenicity data from the trial are expected by January 2017. In early 2017, If the results are favorable, NIAID plans a phase 2 trial in Zika-endemic countries.

An early-stage study to evaluate the safety and efficacy of an experimental Zika vaccine in humans is being launched by the National Institute of Allergy and Infectious Diseases (NIAID). “Results in animal testing have been very encouraging,” said NIAID Director Anthony Fauci, MD. “Although it will take some time before a vaccine against Zika is commercially available, the launch of this study is an important step forward.”

The NIAID scientists developed the investigational vaccine earlier this year. The approach is similar to that taken for another NIAID investigational vaccine developed for West Nile virus, which was found to be safe and effective in a phase 1 clinical trial. The vaccine includes a plasmid (small piece of DNA) engineered to contain genes that code for proteins of the Zika virus. The body reads the genes and makes Zika virus proteins, which cause an immune response. The DNA vaccines do not contain infectious material and cannot cause a vaccinated person to become infected with Zika.

The phase 1 clinical trial (VRC 319) will involve 4 groups of 20 people. The participants will be vaccinated at the first visit, and then half will receive another vaccination 8 weeks or 12 weeks later. The remaining participants will receive 2 additional vaccines, 1 group at week 4 and week 8; the other group, at week 4 and week 20. Participants will be followed for 44 weeks.

The study will be conducted at the NIH Clinical Center in Bethesda, the Center for Vaccine Development at the University of Maryland, and Emory University, Atlanta. Initial safety and immunogenicity data from the trial are expected by January 2017. In early 2017, If the results are favorable, NIAID plans a phase 2 trial in Zika-endemic countries.

1. Role of Insulin Therapy in Diabetes
2. Basal Insulin in Primary Care
3. Innovations in Insulin: Insulin Degludec U-100 and U-200
4. Innovations in Insulin: Insulin Glargine U-300

Click here to read supplement

1. Role of Insulin Therapy in Diabetes
2. Basal Insulin in Primary Care
3. Innovations in Insulin: Insulin Degludec U-100 and U-200
4. Innovations in Insulin: Insulin Glargine U-300

Click here to read supplement

1. Role of Insulin Therapy in Diabetes
2. Basal Insulin in Primary Care
3. Innovations in Insulin: Insulin Degludec U-100 and U-200
4. Innovations in Insulin: Insulin Glargine U-300

Click here to read supplement

New findings show there are several major risk factors that influence late-life depression (LLD), with physical/functional limitations the most prevalent, according to Shun-Chiao Chang, ScD, of Brigham and Women’s Hospital, Boston, and her associates.

They examined 21,728 women aged older than 65 years who had no prior depression. During a 10-year follow-up, 3,945 incident LLD cases were identified. In those cases, social factors and lifestyle/behavioral factors did affect LLD, but the categories with the largest effect magnitudes for higher LLD risk were severe/very severe bodily pain (hazard ratio, 2.22; 95% confidence interval, 1.88-2.62), difficulty sleeping most/all the time (HR, 2.04; 95% CI, 1.77-2.36), and daily sleep of 10 hours or more (HR, 1.96; 95% CI, 1.56-2.46). The most prevalent risk factor, physical/functional limitations, was associated with a 42% increase in risk

©giocalde/Thinkstock

Sleep difficulty some to all of the time, no/very little exercise, and moderate to very severe bodily pain also were factors, with population attributable fraction (PAF) values of 10% or higher. The factor with the largest PAF was physical/functional limitation (26.4%).

Overall, the behavioral factors appeared to contribute relatively equally to LLD among women with and without physical/functional limitations; however, health factors had much bigger contributions to risk among women with limitations.

“Together, model predictors accounted for almost 60% of all new LLD cases in this population, and physical/functional limitation is the largest single contributor to total risk,” the researchers concluded. “A substantial proportion of LLD cases may be preventable by increasing exercise and intervening or preventing sleep difficulties and pain.”

Find the full study in Preventive Medicine (doi: 10.1016/j.ypmed.2016.08.014).

[email protected]

New findings show there are several major risk factors that influence late-life depression (LLD), with physical/functional limitations the most prevalent, according to Shun-Chiao Chang, ScD, of Brigham and Women’s Hospital, Boston, and her associates.

They examined 21,728 women aged older than 65 years who had no prior depression. During a 10-year follow-up, 3,945 incident LLD cases were identified. In those cases, social factors and lifestyle/behavioral factors did affect LLD, but the categories with the largest effect magnitudes for higher LLD risk were severe/very severe bodily pain (hazard ratio, 2.22; 95% confidence interval, 1.88-2.62), difficulty sleeping most/all the time (HR, 2.04; 95% CI, 1.77-2.36), and daily sleep of 10 hours or more (HR, 1.96; 95% CI, 1.56-2.46). The most prevalent risk factor, physical/functional limitations, was associated with a 42% increase in risk

©giocalde/Thinkstock

Sleep difficulty some to all of the time, no/very little exercise, and moderate to very severe bodily pain also were factors, with population attributable fraction (PAF) values of 10% or higher. The factor with the largest PAF was physical/functional limitation (26.4%).

Overall, the behavioral factors appeared to contribute relatively equally to LLD among women with and without physical/functional limitations; however, health factors had much bigger contributions to risk among women with limitations.

“Together, model predictors accounted for almost 60% of all new LLD cases in this population, and physical/functional limitation is the largest single contributor to total risk,” the researchers concluded. “A substantial proportion of LLD cases may be preventable by increasing exercise and intervening or preventing sleep difficulties and pain.”

Find the full study in Preventive Medicine (doi: 10.1016/j.ypmed.2016.08.014).

[email protected]

New findings show there are several major risk factors that influence late-life depression (LLD), with physical/functional limitations the most prevalent, according to Shun-Chiao Chang, ScD, of Brigham and Women’s Hospital, Boston, and her associates.

They examined 21,728 women aged older than 65 years who had no prior depression. During a 10-year follow-up, 3,945 incident LLD cases were identified. In those cases, social factors and lifestyle/behavioral factors did affect LLD, but the categories with the largest effect magnitudes for higher LLD risk were severe/very severe bodily pain (hazard ratio, 2.22; 95% confidence interval, 1.88-2.62), difficulty sleeping most/all the time (HR, 2.04; 95% CI, 1.77-2.36), and daily sleep of 10 hours or more (HR, 1.96; 95% CI, 1.56-2.46). The most prevalent risk factor, physical/functional limitations, was associated with a 42% increase in risk

©giocalde/Thinkstock

Sleep difficulty some to all of the time, no/very little exercise, and moderate to very severe bodily pain also were factors, with population attributable fraction (PAF) values of 10% or higher. The factor with the largest PAF was physical/functional limitation (26.4%).

Overall, the behavioral factors appeared to contribute relatively equally to LLD among women with and without physical/functional limitations; however, health factors had much bigger contributions to risk among women with limitations.

“Together, model predictors accounted for almost 60% of all new LLD cases in this population, and physical/functional limitation is the largest single contributor to total risk,” the researchers concluded. “A substantial proportion of LLD cases may be preventable by increasing exercise and intervening or preventing sleep difficulties and pain.”

Find the full study in Preventive Medicine (doi: 10.1016/j.ypmed.2016.08.014).

[email protected]

The patient was diagnosed with Behçet’s disease (BD) based on his clinical presentation. BD is a rare multisystem inflammatory disorder of unknown cause. The development of ulceration at the site of superficial skin injury (pathergy) is typical of BD. (The patient underwent multiple venipunctures while being investigated for a presumed infective illness prior to this presentation.)

There are no diagnostic laboratory tests for BD; laboratory findings usually reflect systemic inflammation. The International Study Group for BD, however, has derived classification criteria for use in clinical research studies. Their criteria include oral ulceration (that has recurred at least 3 times in a 12-month period), plus 2 of the following: recurrent genital ulceration, eye lesions, cutaneous lesions, or a positive pathergy test.

Recurrent mouth ulcers frequently involve the soft palate and oropharynx. Genital ulceration is the second most common manifestation of BD and is present in 57% to 93% of patients. The scrotum is most commonly involved, although the shaft and glans penis may also be affected. Ocular involvement is also seen in 30% to 70% of patients and is more frequent and severe in men.

There is no curative treatment for BD. The goals of treatment are to prevent organ damage and alleviate symptoms. Mucocutaneous disease is treated with potent topical corticosteroids. Severe attacks are treated with oral corticosteroids—1 mg/kg of prednisolone. The drug is tapered and discontinued once the disease is under control. Colchicine or dapsone is also an option. In refractory cases, consider thalidomide (50 mg once a day) or azathioprine (1-3 mg/kg). An anti-tumor necrosis factor agent may also be considered.

In this case, the patient was prescribed prednisolone 60 mg once a day, but relapsed once he was weaned off of it. He was then given thalidomide 50 mg once a day for 4 months and the disease resolved completely. The thalidomide was then reduced to 50 mg 3 times a week for 4 weeks, and then stopped completely. Nearly 2 years later, the patient has remained disease free.

Adapted from: Aslam A, Chalmers R. Mucocutaneous ulceration in a previously healthy man. J Fam Pract. 2014;63:97-100.

The patient was diagnosed with Behçet’s disease (BD) based on his clinical presentation. BD is a rare multisystem inflammatory disorder of unknown cause. The development of ulceration at the site of superficial skin injury (pathergy) is typical of BD. (The patient underwent multiple venipunctures while being investigated for a presumed infective illness prior to this presentation.)

There are no diagnostic laboratory tests for BD; laboratory findings usually reflect systemic inflammation. The International Study Group for BD, however, has derived classification criteria for use in clinical research studies. Their criteria include oral ulceration (that has recurred at least 3 times in a 12-month period), plus 2 of the following: recurrent genital ulceration, eye lesions, cutaneous lesions, or a positive pathergy test.

Recurrent mouth ulcers frequently involve the soft palate and oropharynx. Genital ulceration is the second most common manifestation of BD and is present in 57% to 93% of patients. The scrotum is most commonly involved, although the shaft and glans penis may also be affected. Ocular involvement is also seen in 30% to 70% of patients and is more frequent and severe in men.

There is no curative treatment for BD. The goals of treatment are to prevent organ damage and alleviate symptoms. Mucocutaneous disease is treated with potent topical corticosteroids. Severe attacks are treated with oral corticosteroids—1 mg/kg of prednisolone. The drug is tapered and discontinued once the disease is under control. Colchicine or dapsone is also an option. In refractory cases, consider thalidomide (50 mg once a day) or azathioprine (1-3 mg/kg). An anti-tumor necrosis factor agent may also be considered.

In this case, the patient was prescribed prednisolone 60 mg once a day, but relapsed once he was weaned off of it. He was then given thalidomide 50 mg once a day for 4 months and the disease resolved completely. The thalidomide was then reduced to 50 mg 3 times a week for 4 weeks, and then stopped completely. Nearly 2 years later, the patient has remained disease free.

Adapted from: Aslam A, Chalmers R. Mucocutaneous ulceration in a previously healthy man. J Fam Pract. 2014;63:97-100.

The patient was diagnosed with Behçet’s disease (BD) based on his clinical presentation. BD is a rare multisystem inflammatory disorder of unknown cause. The development of ulceration at the site of superficial skin injury (pathergy) is typical of BD. (The patient underwent multiple venipunctures while being investigated for a presumed infective illness prior to this presentation.)

There are no diagnostic laboratory tests for BD; laboratory findings usually reflect systemic inflammation. The International Study Group for BD, however, has derived classification criteria for use in clinical research studies. Their criteria include oral ulceration (that has recurred at least 3 times in a 12-month period), plus 2 of the following: recurrent genital ulceration, eye lesions, cutaneous lesions, or a positive pathergy test.

Recurrent mouth ulcers frequently involve the soft palate and oropharynx. Genital ulceration is the second most common manifestation of BD and is present in 57% to 93% of patients. The scrotum is most commonly involved, although the shaft and glans penis may also be affected. Ocular involvement is also seen in 30% to 70% of patients and is more frequent and severe in men.

There is no curative treatment for BD. The goals of treatment are to prevent organ damage and alleviate symptoms. Mucocutaneous disease is treated with potent topical corticosteroids. Severe attacks are treated with oral corticosteroids—1 mg/kg of prednisolone. The drug is tapered and discontinued once the disease is under control. Colchicine or dapsone is also an option. In refractory cases, consider thalidomide (50 mg once a day) or azathioprine (1-3 mg/kg). An anti-tumor necrosis factor agent may also be considered.

In this case, the patient was prescribed prednisolone 60 mg once a day, but relapsed once he was weaned off of it. He was then given thalidomide 50 mg once a day for 4 months and the disease resolved completely. The thalidomide was then reduced to 50 mg 3 times a week for 4 weeks, and then stopped completely. Nearly 2 years later, the patient has remained disease free.

Adapted from: Aslam A, Chalmers R. Mucocutaneous ulceration in a previously healthy man. J Fam Pract. 2014;63:97-100.

Incidence rates for localized- and regional-stage prostate cancer continued to decline 2 years following the recommendation by the U.S. Preventive Services Task Force against prostate-specific antigen (PSA) testing in all men.

“Convincing evidence demonstrates that the PSA test often produces false-positive results [and] false-positive PSA test results are associated with negative psychological effects, including persistent worry about prostate cancer,” the task force stated in a recommendation published in October 2011 and finalized in May 2012.

From 2011 to 2012, immediately following the recommendation, there was a significant decline in early-stage cancer incidence rates among men 50 years or older, according to an analysis of data from the Surveillance, Epidemiology, and End Results (SEER) program.

For the current study, Ahmedin Jemal, DVM, PhD, and his associates at the American Cancer Society analyzed incidence data for invasive prostate cancer from 18 SEER registries, which, combined, represented about 28% of the U.S. population.

Investigators reported a continued decline in localized- and regional-stage prostate cancer incidence from 2012 to 2013. Specifically, the incidence rates per 100,000 men decreased from 356.5 to 335.4 in men aged 50-74 years and from 379.2 to 353.6 in men 75 years and older (JAMA Oncol. 2016 Aug 16. doi: 10.1001/jamaoncol.2016.2667).

Incidence rates for distant-stage disease were unchanged during the same time period for men of all ages.

Similar results were reported for non-Hispanic whites and non-Hispanic blacks.

“Whether this pattern will lead to a future increase in the diagnosis of distant-stage disease and prostate cancer mortality requires long-term monitoring because of the slow growing nature of this malignant neoplasm,” the investigators noted.

The American Cancer Society funded the study. The authors had no relevant disclosures to report.

[email protected]

On Twitter @jessnicolecraig

Incidence rates for localized- and regional-stage prostate cancer continued to decline 2 years following the recommendation by the U.S. Preventive Services Task Force against prostate-specific antigen (PSA) testing in all men.

“Convincing evidence demonstrates that the PSA test often produces false-positive results [and] false-positive PSA test results are associated with negative psychological effects, including persistent worry about prostate cancer,” the task force stated in a recommendation published in October 2011 and finalized in May 2012.

From 2011 to 2012, immediately following the recommendation, there was a significant decline in early-stage cancer incidence rates among men 50 years or older, according to an analysis of data from the Surveillance, Epidemiology, and End Results (SEER) program.

For the current study, Ahmedin Jemal, DVM, PhD, and his associates at the American Cancer Society analyzed incidence data for invasive prostate cancer from 18 SEER registries, which, combined, represented about 28% of the U.S. population.

Investigators reported a continued decline in localized- and regional-stage prostate cancer incidence from 2012 to 2013. Specifically, the incidence rates per 100,000 men decreased from 356.5 to 335.4 in men aged 50-74 years and from 379.2 to 353.6 in men 75 years and older (JAMA Oncol. 2016 Aug 16. doi: 10.1001/jamaoncol.2016.2667).

Incidence rates for distant-stage disease were unchanged during the same time period for men of all ages.

Similar results were reported for non-Hispanic whites and non-Hispanic blacks.

“Whether this pattern will lead to a future increase in the diagnosis of distant-stage disease and prostate cancer mortality requires long-term monitoring because of the slow growing nature of this malignant neoplasm,” the investigators noted.

The American Cancer Society funded the study. The authors had no relevant disclosures to report.

[email protected]

On Twitter @jessnicolecraig

Incidence rates for localized- and regional-stage prostate cancer continued to decline 2 years following the recommendation by the U.S. Preventive Services Task Force against prostate-specific antigen (PSA) testing in all men.

“Convincing evidence demonstrates that the PSA test often produces false-positive results [and] false-positive PSA test results are associated with negative psychological effects, including persistent worry about prostate cancer,” the task force stated in a recommendation published in October 2011 and finalized in May 2012.

From 2011 to 2012, immediately following the recommendation, there was a significant decline in early-stage cancer incidence rates among men 50 years or older, according to an analysis of data from the Surveillance, Epidemiology, and End Results (SEER) program.

For the current study, Ahmedin Jemal, DVM, PhD, and his associates at the American Cancer Society analyzed incidence data for invasive prostate cancer from 18 SEER registries, which, combined, represented about 28% of the U.S. population.

Investigators reported a continued decline in localized- and regional-stage prostate cancer incidence from 2012 to 2013. Specifically, the incidence rates per 100,000 men decreased from 356.5 to 335.4 in men aged 50-74 years and from 379.2 to 353.6 in men 75 years and older (JAMA Oncol. 2016 Aug 16. doi: 10.1001/jamaoncol.2016.2667).

Incidence rates for distant-stage disease were unchanged during the same time period for men of all ages.

Similar results were reported for non-Hispanic whites and non-Hispanic blacks.

“Whether this pattern will lead to a future increase in the diagnosis of distant-stage disease and prostate cancer mortality requires long-term monitoring because of the slow growing nature of this malignant neoplasm,” the investigators noted.

The American Cancer Society funded the study. The authors had no relevant disclosures to report.

[email protected]

On Twitter @jessnicolecraig

1. A 25-year-old woman reports anogenital itching, burning, and redness, present for 3 months. She says she developed a yeast infection after antibiotic therapy for a dental infection. The yeast infection was treated with terconazole, which resulted in immediate severe burning, redness, and swelling. Clobetasol cream used twice daily also caused burning, so she discontinued it. Her symptoms improved when she tried cool soaks and applied topical benzocaine gel as a local anesthetic.

Diagnosis: Irritant contact dermatitis (as opposed to allergic contact dermatitis) associated with the use of terconazole and clobetasol. This was followed by allergic contact dermatitis in association with benzocaine. Treatment consists of withdrawal of benzocaine, reinitiation of cool soaks, and a switch to clobetasol ointment rather than cream. Nighttime sedation enables the patient to sleep through the itching and gradually allows her skin to heal.

For more information on this case, see “Chronic vulvar irritation, itching, and pain. What is the diagnosis?” OBG Manag. 2014;26(6):30-37.

2. This 13-year-old presents with sudden-onset vulvar pain and sores. The child developed a sore throat and low-grade fever 3 days earlier, with vulvar pain and vulvar dysuria the next day. Oral acyclovir was prescribed for herpes simplex virus infection, but the girl’s condition has not improved. She claims sexual abstinence, and her mother believes her.

Diagnosis: Vulvar aphthae, believed to be of hyperimmune origin, are often precipitated by a viral syndrome. They are most common in girls aged 9 to 18 years.

Aphthae are uncommon and under-recognized on the vulva. Genital aphthae are usually much larger than oral aphthae. Most patients are mistakenly evaluated and treated for sexually transmitted infection, but the large, well-demarcated, painful, nonindurated, deep nature of the ulcer is pathognomonic for an aphthous ulcer.

Recommended treatment is prednisone 40 mg/day plus hydrocodone in usual doses of 5/325, one or two tablets every 4 to 6 hours, as needed; topical petroleum jelly (especially before urination); and sitz baths. When the patient returns one week later, she is much improved.

For more information on this case, see “Chronic vulvar irritation, itching, and pain. What is the diagnosis?” OBG Manag. 2014;26(6):30-37.

3. A 36-year-old woman reports introital itching, vulvar dysuria, and superficial dyspareunia that have lasted 6 months. Apparent on physical examination are redness of the vestibule, medial labia minora, and vaginal walls, with edema of the surrounding skin and yellowish, copious vaginal secretions at the introitus. Lab tests for chlamydia, trichomonas, and gonorrhea are returned as normal.

Diagnosis: Desquamative inflammatory vaginitis (DIV) is described as noninfectious inflammatory vaginitis in a setting of normal estrogen and absence of skin disease of the mucous membranes of the vagina. The condition is characterized by an increase in white blood cells and parabasal cells and absent lactobacilli, with relatively high vaginal pH. DIV is thought to represent an inflammatory dermatosis of the vaginal epithelium. Although some clinicians believe that DIV is actually lichen planus, the latter exhibits erosions as well as redness, nearly always affects the mouth and the vulva, and produces remarkable scarring. DIV does not erode, affect any other skin surfaces, or scar.

Treatment for DIV consists of clindamycin vaginal cream, 1/2 to 1 full applicator nightly, with a weekly oral fluconazole tablet (200 mg is more easily covered by insurance) to prevent secondary candidiasis. Schedule a follow-up visit in one month.

For more information on this case, see “Chronic vulvar irritation, itching, and pain. What is the diagnosis?” OBG Manag. 2014;26(6):30-37.

4. A 43-year-old woman reports a “recalcitrant yeast infection” of the vulva, with itching and irritation. She is overweight and diabetic, with mild stress incontinence. Physical examination reveals a fairly well-demarcated red, rough plaque on the vulva and labiocrural folds, with satellite red papules and peripheral peeling. Similar plaques occur in the gluteal cleft, umbilicus, and axillae as well as under the breasts. A fungal preparation of the vagina and skin is negative.

Diagnosis: Of the several morphologic types of psoriasis, anogenital psoriasis is most often of the inverse pattern. Inverse psoriasis preferentially affects skin folds and is frequently mistaken for (and often initially superinfected with) candidiasis. Scale is thin and unapparent, and there often is a shiny, glazed appearance to the skin. Tiny satellite lesions are often visible as well. A skin biopsy of inverse psoriasis often is not diagnostic, showing only nonspecific psoriasiform dermatitis; this does not disprove psoriasis.

Psoriasis is a systemic condition and is associated with metabolic syndrome, carrying an increased risk for overweight, hypertension, diabetes, and cardiovascular disease. Management of these conditions is very important in the overall treatment of the patient.

The recommended treatment is clobetasol ointment applied to the skin folds, along with continuation of the topical miconazole cream. A week later, the patient’s condition is remarkably improved, and her biopsy shows psoriasiform dermatitis. The potency of her corticosteroid was reduced by switching to desonide cream, sparingly applied daily.

For more information on this case, see “Chronic vulvar irritation, itching, and pain. What is the diagnosis?” OBG Manag. 2014;26(6):30-37.

1. A 25-year-old woman reports anogenital itching, burning, and redness, present for 3 months. She says she developed a yeast infection after antibiotic therapy for a dental infection. The yeast infection was treated with terconazole, which resulted in immediate severe burning, redness, and swelling. Clobetasol cream used twice daily also caused burning, so she discontinued it. Her symptoms improved when she tried cool soaks and applied topical benzocaine gel as a local anesthetic.

Diagnosis: Irritant contact dermatitis (as opposed to allergic contact dermatitis) associated with the use of terconazole and clobetasol. This was followed by allergic contact dermatitis in association with benzocaine. Treatment consists of withdrawal of benzocaine, reinitiation of cool soaks, and a switch to clobetasol ointment rather than cream. Nighttime sedation enables the patient to sleep through the itching and gradually allows her skin to heal.

For more information on this case, see “Chronic vulvar irritation, itching, and pain. What is the diagnosis?” OBG Manag. 2014;26(6):30-37.

2. This 13-year-old presents with sudden-onset vulvar pain and sores. The child developed a sore throat and low-grade fever 3 days earlier, with vulvar pain and vulvar dysuria the next day. Oral acyclovir was prescribed for herpes simplex virus infection, but the girl’s condition has not improved. She claims sexual abstinence, and her mother believes her.

Diagnosis: Vulvar aphthae, believed to be of hyperimmune origin, are often precipitated by a viral syndrome. They are most common in girls aged 9 to 18 years.

Aphthae are uncommon and under-recognized on the vulva. Genital aphthae are usually much larger than oral aphthae. Most patients are mistakenly evaluated and treated for sexually transmitted infection, but the large, well-demarcated, painful, nonindurated, deep nature of the ulcer is pathognomonic for an aphthous ulcer.

Recommended treatment is prednisone 40 mg/day plus hydrocodone in usual doses of 5/325, one or two tablets every 4 to 6 hours, as needed; topical petroleum jelly (especially before urination); and sitz baths. When the patient returns one week later, she is much improved.

For more information on this case, see “Chronic vulvar irritation, itching, and pain. What is the diagnosis?” OBG Manag. 2014;26(6):30-37.

3. A 36-year-old woman reports introital itching, vulvar dysuria, and superficial dyspareunia that have lasted 6 months. Apparent on physical examination are redness of the vestibule, medial labia minora, and vaginal walls, with edema of the surrounding skin and yellowish, copious vaginal secretions at the introitus. Lab tests for chlamydia, trichomonas, and gonorrhea are returned as normal.

Diagnosis: Desquamative inflammatory vaginitis (DIV) is described as noninfectious inflammatory vaginitis in a setting of normal estrogen and absence of skin disease of the mucous membranes of the vagina. The condition is characterized by an increase in white blood cells and parabasal cells and absent lactobacilli, with relatively high vaginal pH. DIV is thought to represent an inflammatory dermatosis of the vaginal epithelium. Although some clinicians believe that DIV is actually lichen planus, the latter exhibits erosions as well as redness, nearly always affects the mouth and the vulva, and produces remarkable scarring. DIV does not erode, affect any other skin surfaces, or scar.

Treatment for DIV consists of clindamycin vaginal cream, 1/2 to 1 full applicator nightly, with a weekly oral fluconazole tablet (200 mg is more easily covered by insurance) to prevent secondary candidiasis. Schedule a follow-up visit in one month.

For more information on this case, see “Chronic vulvar irritation, itching, and pain. What is the diagnosis?” OBG Manag. 2014;26(6):30-37.

4. A 43-year-old woman reports a “recalcitrant yeast infection” of the vulva, with itching and irritation. She is overweight and diabetic, with mild stress incontinence. Physical examination reveals a fairly well-demarcated red, rough plaque on the vulva and labiocrural folds, with satellite red papules and peripheral peeling. Similar plaques occur in the gluteal cleft, umbilicus, and axillae as well as under the breasts. A fungal preparation of the vagina and skin is negative.

Diagnosis: Of the several morphologic types of psoriasis, anogenital psoriasis is most often of the inverse pattern. Inverse psoriasis preferentially affects skin folds and is frequently mistaken for (and often initially superinfected with) candidiasis. Scale is thin and unapparent, and there often is a shiny, glazed appearance to the skin. Tiny satellite lesions are often visible as well. A skin biopsy of inverse psoriasis often is not diagnostic, showing only nonspecific psoriasiform dermatitis; this does not disprove psoriasis.

Psoriasis is a systemic condition and is associated with metabolic syndrome, carrying an increased risk for overweight, hypertension, diabetes, and cardiovascular disease. Management of these conditions is very important in the overall treatment of the patient.

The recommended treatment is clobetasol ointment applied to the skin folds, along with continuation of the topical miconazole cream. A week later, the patient’s condition is remarkably improved, and her biopsy shows psoriasiform dermatitis. The potency of her corticosteroid was reduced by switching to desonide cream, sparingly applied daily.

For more information on this case, see “Chronic vulvar irritation, itching, and pain. What is the diagnosis?” OBG Manag. 2014;26(6):30-37.

1. A 25-year-old woman reports anogenital itching, burning, and redness, present for 3 months. She says she developed a yeast infection after antibiotic therapy for a dental infection. The yeast infection was treated with terconazole, which resulted in immediate severe burning, redness, and swelling. Clobetasol cream used twice daily also caused burning, so she discontinued it. Her symptoms improved when she tried cool soaks and applied topical benzocaine gel as a local anesthetic.

Diagnosis: Irritant contact dermatitis (as opposed to allergic contact dermatitis) associated with the use of terconazole and clobetasol. This was followed by allergic contact dermatitis in association with benzocaine. Treatment consists of withdrawal of benzocaine, reinitiation of cool soaks, and a switch to clobetasol ointment rather than cream. Nighttime sedation enables the patient to sleep through the itching and gradually allows her skin to heal.

For more information on this case, see “Chronic vulvar irritation, itching, and pain. What is the diagnosis?” OBG Manag. 2014;26(6):30-37.

2. This 13-year-old presents with sudden-onset vulvar pain and sores. The child developed a sore throat and low-grade fever 3 days earlier, with vulvar pain and vulvar dysuria the next day. Oral acyclovir was prescribed for herpes simplex virus infection, but the girl’s condition has not improved. She claims sexual abstinence, and her mother believes her.

Diagnosis: Vulvar aphthae, believed to be of hyperimmune origin, are often precipitated by a viral syndrome. They are most common in girls aged 9 to 18 years.

Aphthae are uncommon and under-recognized on the vulva. Genital aphthae are usually much larger than oral aphthae. Most patients are mistakenly evaluated and treated for sexually transmitted infection, but the large, well-demarcated, painful, nonindurated, deep nature of the ulcer is pathognomonic for an aphthous ulcer.

Recommended treatment is prednisone 40 mg/day plus hydrocodone in usual doses of 5/325, one or two tablets every 4 to 6 hours, as needed; topical petroleum jelly (especially before urination); and sitz baths. When the patient returns one week later, she is much improved.

For more information on this case, see “Chronic vulvar irritation, itching, and pain. What is the diagnosis?” OBG Manag. 2014;26(6):30-37.

3. A 36-year-old woman reports introital itching, vulvar dysuria, and superficial dyspareunia that have lasted 6 months. Apparent on physical examination are redness of the vestibule, medial labia minora, and vaginal walls, with edema of the surrounding skin and yellowish, copious vaginal secretions at the introitus. Lab tests for chlamydia, trichomonas, and gonorrhea are returned as normal.

Diagnosis: Desquamative inflammatory vaginitis (DIV) is described as noninfectious inflammatory vaginitis in a setting of normal estrogen and absence of skin disease of the mucous membranes of the vagina. The condition is characterized by an increase in white blood cells and parabasal cells and absent lactobacilli, with relatively high vaginal pH. DIV is thought to represent an inflammatory dermatosis of the vaginal epithelium. Although some clinicians believe that DIV is actually lichen planus, the latter exhibits erosions as well as redness, nearly always affects the mouth and the vulva, and produces remarkable scarring. DIV does not erode, affect any other skin surfaces, or scar.

Treatment for DIV consists of clindamycin vaginal cream, 1/2 to 1 full applicator nightly, with a weekly oral fluconazole tablet (200 mg is more easily covered by insurance) to prevent secondary candidiasis. Schedule a follow-up visit in one month.

For more information on this case, see “Chronic vulvar irritation, itching, and pain. What is the diagnosis?” OBG Manag. 2014;26(6):30-37.

4. A 43-year-old woman reports a “recalcitrant yeast infection” of the vulva, with itching and irritation. She is overweight and diabetic, with mild stress incontinence. Physical examination reveals a fairly well-demarcated red, rough plaque on the vulva and labiocrural folds, with satellite red papules and peripheral peeling. Similar plaques occur in the gluteal cleft, umbilicus, and axillae as well as under the breasts. A fungal preparation of the vagina and skin is negative.

Diagnosis: Of the several morphologic types of psoriasis, anogenital psoriasis is most often of the inverse pattern. Inverse psoriasis preferentially affects skin folds and is frequently mistaken for (and often initially superinfected with) candidiasis. Scale is thin and unapparent, and there often is a shiny, glazed appearance to the skin. Tiny satellite lesions are often visible as well. A skin biopsy of inverse psoriasis often is not diagnostic, showing only nonspecific psoriasiform dermatitis; this does not disprove psoriasis.

Psoriasis is a systemic condition and is associated with metabolic syndrome, carrying an increased risk for overweight, hypertension, diabetes, and cardiovascular disease. Management of these conditions is very important in the overall treatment of the patient.

The recommended treatment is clobetasol ointment applied to the skin folds, along with continuation of the topical miconazole cream. A week later, the patient’s condition is remarkably improved, and her biopsy shows psoriasiform dermatitis. The potency of her corticosteroid was reduced by switching to desonide cream, sparingly applied daily.

For more information on this case, see “Chronic vulvar irritation, itching, and pain. What is the diagnosis?” OBG Manag. 2014;26(6):30-37.

AATS welcomes you to submit your abstracts and videos to AATS Week 2017.

AATS Mitral Conclave
April 27-28, 2017
New York, NY

AATS Centennial
April 29-May 3, 2017
Boston, MA

Submission Deadlines:

AATS Centennial: Monday, October 17, 2016 @ 11.59 pm EDT

Mitral Conclave: Sunday, January 8, 2017 @ 11.59 pm EST

Submit online

AATS welcomes you to submit your abstracts and videos to AATS Week 2017.

AATS Mitral Conclave
April 27-28, 2017
New York, NY

AATS Centennial
April 29-May 3, 2017
Boston, MA

Submission Deadlines:

AATS Centennial: Monday, October 17, 2016 @ 11.59 pm EDT

Mitral Conclave: Sunday, January 8, 2017 @ 11.59 pm EST

Submit online

AATS welcomes you to submit your abstracts and videos to AATS Week 2017.

AATS Mitral Conclave
April 27-28, 2017
New York, NY

AATS Centennial
April 29-May 3, 2017
Boston, MA

Submission Deadlines:

AATS Centennial: Monday, October 17, 2016 @ 11.59 pm EDT

Mitral Conclave: Sunday, January 8, 2017 @ 11.59 pm EST

Submit online

The AATS Graham Foundation is calling for submission for its “Honoring Our Mentors” fellowships.

This series is named after prominent CT surgeons who have demonstrated longstanding leadership and dedication over the course of their careers in both their clinical practices and commitment to training the future generation.

Lawrence H. Cohn Clinical Scholar Program
Allows young cardiac surgeons who are in their final year of their residency or have recently completed their residency to obtain advanced experience with valvular surgery or care.

Deadline: December 1, 2016

More information

Denton A. Cooley Fellowship
New! Provides a deserving CT surgeon resident or young postgraduate surgeon the opportunity to enrich his/her education during four weeks of study at the Texas Heart Institute and Baylor St. Luke’s Medical.

Deadline: December 1, 2016

More information

Marc de Leval Fellowship
Offers four to six weeks of congenital heart surgery training at an international center for a North American surgeon.

Deadline: December 1, 2016

More information

F. Griffith Pearson Fellowship
Surgeons who have finished their residency/fellowship in general thoracic surgery advance their clinical techniques at a North American host institute.

Deadline: December 1, 2016

More information

The AATS Graham Foundation is calling for submission for its “Honoring Our Mentors” fellowships.

This series is named after prominent CT surgeons who have demonstrated longstanding leadership and dedication over the course of their careers in both their clinical practices and commitment to training the future generation.

Lawrence H. Cohn Clinical Scholar Program
Allows young cardiac surgeons who are in their final year of their residency or have recently completed their residency to obtain advanced experience with valvular surgery or care.

Deadline: December 1, 2016

More information

Denton A. Cooley Fellowship
New! Provides a deserving CT surgeon resident or young postgraduate surgeon the opportunity to enrich his/her education during four weeks of study at the Texas Heart Institute and Baylor St. Luke’s Medical.

Deadline: December 1, 2016

More information

Marc de Leval Fellowship
Offers four to six weeks of congenital heart surgery training at an international center for a North American surgeon.

Deadline: December 1, 2016

More information

F. Griffith Pearson Fellowship
Surgeons who have finished their residency/fellowship in general thoracic surgery advance their clinical techniques at a North American host institute.

Deadline: December 1, 2016

More information

The AATS Graham Foundation is calling for submission for its “Honoring Our Mentors” fellowships.

This series is named after prominent CT surgeons who have demonstrated longstanding leadership and dedication over the course of their careers in both their clinical practices and commitment to training the future generation.

Lawrence H. Cohn Clinical Scholar Program
Allows young cardiac surgeons who are in their final year of their residency or have recently completed their residency to obtain advanced experience with valvular surgery or care.

Deadline: December 1, 2016

More information

Denton A. Cooley Fellowship
New! Provides a deserving CT surgeon resident or young postgraduate surgeon the opportunity to enrich his/her education during four weeks of study at the Texas Heart Institute and Baylor St. Luke’s Medical.

Deadline: December 1, 2016

More information

Marc de Leval Fellowship
Offers four to six weeks of congenital heart surgery training at an international center for a North American surgeon.

Deadline: December 1, 2016

More information

F. Griffith Pearson Fellowship
Surgeons who have finished their residency/fellowship in general thoracic surgery advance their clinical techniques at a North American host institute.

Deadline: December 1, 2016

More information

October 20-22, 2016
Hyatt Regency O’Hare
Chicago, IL

Program Directors
David H. Harpole, Jr.
Marco A. Zenati

This course is an intensive, interactive training program for cardiothoracic surgeons across all subspecialties. It will permit them to acquire the critical skills necessary for effective clinical trial design and implementation. The course is particularly suited for professionals who are planning to apply for clinical trial funding, allowing them to better understand the complex nature of preparing and submitting clinical trial proposals.

Invited faculty includes currently funded clinical trial leading investigators and experts in the field of biostatistics and health sciences research. The program will offer a process in which the clinical trial protocol development can be streamlined. Interactive features will include hands-on focus groups and mock study sessions.

Register Today! Space available for only 40 participants.

Registration/Housing/Preliminary Program

October 20-22, 2016
Hyatt Regency O’Hare
Chicago, IL

Program Directors
David H. Harpole, Jr.
Marco A. Zenati

This course is an intensive, interactive training program for cardiothoracic surgeons across all subspecialties. It will permit them to acquire the critical skills necessary for effective clinical trial design and implementation. The course is particularly suited for professionals who are planning to apply for clinical trial funding, allowing them to better understand the complex nature of preparing and submitting clinical trial proposals.

Invited faculty includes currently funded clinical trial leading investigators and experts in the field of biostatistics and health sciences research. The program will offer a process in which the clinical trial protocol development can be streamlined. Interactive features will include hands-on focus groups and mock study sessions.

Register Today! Space available for only 40 participants.

Registration/Housing/Preliminary Program

October 20-22, 2016
Hyatt Regency O’Hare
Chicago, IL

Program Directors
David H. Harpole, Jr.
Marco A. Zenati

This course is an intensive, interactive training program for cardiothoracic surgeons across all subspecialties. It will permit them to acquire the critical skills necessary for effective clinical trial design and implementation. The course is particularly suited for professionals who are planning to apply for clinical trial funding, allowing them to better understand the complex nature of preparing and submitting clinical trial proposals.

Invited faculty includes currently funded clinical trial leading investigators and experts in the field of biostatistics and health sciences research. The program will offer a process in which the clinical trial protocol development can be streamlined. Interactive features will include hands-on focus groups and mock study sessions.

Register Today! Space available for only 40 participants.

Registration/Housing/Preliminary Program

Every day, CT surgeons transform the lives of their patients around the world. Your support is essential to ensure the future of our specialty and continue advancing global innovation in CT surgery. Please make a gift to the Graham Foundation or renew your commitment. Together, we can promote our specialty not only for the next generation of surgeons, but also the patients they serve.

View the Graham Annual Report

Learn more about individual and corporate/organizational giving opportunities.

Contact Development Office: 978-927-8330

Every day, CT surgeons transform the lives of their patients around the world. Your support is essential to ensure the future of our specialty and continue advancing global innovation in CT surgery. Please make a gift to the Graham Foundation or renew your commitment. Together, we can promote our specialty not only for the next generation of surgeons, but also the patients they serve.

View the Graham Annual Report

Learn more about individual and corporate/organizational giving opportunities.

Contact Development Office: 978-927-8330

Every day, CT surgeons transform the lives of their patients around the world. Your support is essential to ensure the future of our specialty and continue advancing global innovation in CT surgery. Please make a gift to the Graham Foundation or renew your commitment. Together, we can promote our specialty not only for the next generation of surgeons, but also the patients they serve.

View the Graham Annual Report

Learn more about individual and corporate/organizational giving opportunities.

Contact Development Office: 978-927-8330