Alfred Lane

All Publications

• Safety and Wound Outcomes Following Genetically Corrected Autologous Epidermal Grafts in Patients With Recessive Dystrophic Epidermolysis Bullosa. JAMA Siprashvili, Z., Nguyen, N. T., Gorell, E. S., Loutit, K., Khuu, P., Furukawa, L. K., Lorenz, H. P., Leung, T. H., Keene, D. R., Rieger, K. E., Khavari, P., Lane, A. T., Tang, J. Y., Marinkovich, M. P. 2016; 316 (17): 1808-1817

  Abstract

  Recessive dystrophic epidermolysis bullosa (RDEB) is a devastating, often fatal, inherited blistering disorder caused by mutations in the COL7A1 gene encoding type VII collagen. Support and palliation are the only current therapies.To evaluate the safety and wound outcomes following genetically corrected autologous epidermal grafts in patients with RDEB.Single-center phase 1 clinical trial conducted in the United States of 4 patients with severe RDEB with a measured area of wounds suitable for grafting of at least 100 cm2. Patients with undetectable type VII collagen keratinocyte expression were excluded.Autologous keratinocytes isolated from biopsy samples collected from 4 patients with RDEB were transduced with good manufacturing practice-grade retrovirus carrying full-length human COL7A1 and assembled into epidermal sheet grafts. Type VII collagen gene-corrected grafts (approximately 35 cm2) were transplanted onto 6 wounds in each of the patients (n = 24 grafts).The primary safety outcomes were recombination competent retrovirus, cancer, and autoimmune reaction. Molecular correction was assessed as type VII collagen expression measured by immunofluorescence and immunoelectron microscopy. Wound healing was assessed using serial photographs taken at 3, 6, and 12 months after grafting.The 4 patients (mean age, 23 years [range, 18-32 years]) were all male with an estimated body surface area affected with RDEB of 4% to 30%. All 24 grafts were well tolerated without serious adverse events. Type VII collagen expression at the dermal-epidermal junction was demonstrated on the graft sites by immunofluorescence microscopy in 9 of 10 biopsy samples (90%) at 3 months, in 8 of 12 samples (66%) at 6 months, and in 5 of 12 samples (42%) at 12 months, including correct type VII collagen localization to anchoring fibrils. Wounds with recombinant type VII collagen graft sites displayed 75% or greater healing at 3 months (21 intact graft sites of 24 wound sites; 87%), 6 months (16/24; 67%), and 12 months (12/24; 50%) compared with baseline wound sites.In this preliminary study of 4 patients with RDEB, there was wound healing in some type VII collagen gene-corrected grafts, but the response was variable among patients and among grafted sites and generally declined over 1 year. Long-term follow-up is necessary for these patients, and controlled trials are needed with a broader range of patients to better understand the potential long-term efficacy of genetically corrected autologous epidermal grafts.clinicaltrials.gov Identifier: NCT01263379.

  View details for DOI 10.1001/jama.2016.15588

  View details for PubMedID 27802546

• Phase I clinical trial for Recessive Dystrophic Epidermolysis Bullosa using genetically corrected autologous keratinocytes Siprashvili, Z., Nguyen, N. T., Gorell, E. S., Loutit, K., Khuu, P., Furukawa, L. K., Lorenz, H. P., Leung, T. H., Keene, D., Rieger, K., Khavari, P. A., Lane, A., Tang, J., Marinkovich, P. ELSEVIER SCIENCE INC. 2016: S65

  View details for DOI 10.1016/j.jid.2016.02.400

  View details for Web of Science ID 000380028800367

• Transdermal Delivery of Functional Collagen Via Polyvinylpyrrolidone Microneedles ANNALS OF BIOMEDICAL ENGINEERING Sun, W., Inayathullah, M., Manoukian, M. A., Malkovskiy, A. V., Manickam, S., Marinkovich, M. P., Lane, A. T., Tayebi, L., Seifalian, A. M., Rajadas, J. 2015; 43 (12): 2978-2990

  Abstract

  Collagen makes up a large proportion of the human body, particularly the skin. As the body ages, collagen content decreases, resulting in wrinkled skin and decreased wound healing capabilities. This paper presents a method of delivering type I collagen into porcine and human skin utilizing a polyvinylpyrrolidone microneedle delivery system. The microneedle patches were made with concentrations of 1, 2, 4, and 8% type I collagen (w/w). Microneedle structures and the distribution of collagen were characterized using scanning electron microscopy and confocal microscopy. Patches were then applied on the porcine and human skin, and their effectiveness was examined using fluorescence microscopy. The results illustrate that this microneedle delivery system is effective in delivering collagen I into the epidermis and dermis of porcine and human skin. Since the technique presented in this paper is quick, safe, effective and easy, it can be considered as a new collagen delivery method for cosmetic and therapeutic applications.

  View details for DOI 10.1007/s10439-015-1353-0

  View details for PubMedID 26066056

• Evaluation of Treatments for Pruritus in Epidermolysis Bullosa. Pediatric dermatology Danial, C., Adeduntan, R., Gorell, E. S., Lucky, A. W., Paller, A. S., Bruckner, A. L., Pope, E., Morel, K. D., Levy, M. L., Li, S., Gilmore, E. S., Lane, A. T. 2015; 32 (5): 628-634

  Abstract

  Pruritus is a common complication in patients with epidermolysis bullosa (EB). There is limited published data about the treatments that individuals with EB use for pruritus. The objective of the current study was to determine quantitatively which treatments individuals with EB have used for pruritus and to evaluate the perceived effectiveness of these treatments in pruritus relief. A questionnaire was developed to evaluate the treatments and therapies used for pruritus in patients of all ages and for all types of EB. Questions about bathing products, moisturizers, topical products, oral medications, dressings, and alternative therapies were included. A 5-point Likert scale (-2 = relieves itch a lot, -1 = relieves itch a little, 0 = no change, 1 = increases itch a little, 2 = increases itch a lot) was used to evaluate perceived effectiveness. Patients from seven North American EB centers were invited to participate. Greasy ointments (53.4%), lotions (45.2%), creams (40.4%), and oral hydroxyzine (39.0%) were the most frequently used treatments for pruritus. Treatments that were used frequently and perceived to be the most effective included creams (mean = -1.1), topical prescription corticosteroids (mean = -1.0), oils (mean = -0.9), oral hydroxyzine (mean = -0.9), topical diphenhydramine (mean = -0.9), and vaporizing rub (menthol, camphor, eucalyptus) (mean = -0.9). Systemic opioids (mean = 0.3), adherent bandages (mean = 0.3), and bleach baths (mean = 0.2) slightly increased pruritus. Randomized controlled trials of therapies will be necessary to develop evidence-based recommendations for control of pruritus in individuals with EB.

  View details for DOI 10.1111/pde.12486

  View details for PubMedID 25557557

• Purified Type I Collagen Wound Matrix Improves Chronic Wound Healing in Patients with Recessive Dystrophic Epidermolysis Bullosa PEDIATRIC DERMATOLOGY Gorell, E. S., Leung, T. H., Khuu, P., Lane, A. T. 2015; 32 (2): 220-225

  Abstract

  Recessive dystrophic epidermolysis bullosa is a severe genetic blistering skin condition resulting in chronic wounds. Nonhealing wounds were treated over 8 weeks using a reconstituted natural purified type I collagen skin substitute. Chronic wounds were defined as nonhealing wounds present for longer than 6 months. For each patient, two chronic wounds were identified and randomized into a control or treatment group. Both groups received standard-of-care wound dressings. The treatment group received an additional type I collagen skin substitute. Wound size was measured at baseline and weeks 1, 4, and 8. Pain, pruritus, and burning and stinging were assessed. Wound cultures were obtained at baseline and thereafter as was considered clinically relevant. Ten subjects were enrolled; seven completed the study. Six subjects showed a positive response to the type I collagen skin substitute. Three subjects demonstrated full wound reepithelialization. Wounds treated using the collagen skin substitute showed statistically significantly greater improvement. Average scores for pruritus and pain decreased significantly. Reconstituted natural purified type I collagen skin substitutes improved the healing of chronic wounds and may be a valuable addition to the epidermolysis bullosa wound care arsenal.

  View details for DOI 10.1111/pde.12492

  View details for Web of Science ID 000351747500017

  View details for PubMedID 25557742

• Prevalence and characterization of pruritus in epidermolysis bullosa. Pediatric dermatology Danial, C., Adeduntan, R., Gorell, E. S., Lucky, A. W., Paller, A. S., Bruckner, A., Pope, E., Morel, K. D., Levy, M. L., Li, S., Gilmore, E. S., Lane, A. T. 2015; 32 (1): 53-59

  Abstract

  Qualitative data suggest that pruritus is a burdensome symptom in patients with epidermolysis bullosa (EB), but the prevalence of pruritus in children and adults with EB and factors that contribute to pruritus are unknown. The objective of the current study was to quantitatively identify and to characterize pruritus that EB patients experience using a comprehensive online questionnaire. A questionnaire was developed to evaluate pruritus in all ages and all types of EB. Questions that characterize pruritus were included and factors that aggravate symptoms were investigated. Patients from seven North American EB centers were invited to participate. One hundred forty-six of 216 questionnaires were completed (response rate 68%; 73 male, 73 female; median age 20.0 years). Using a 5-point Likert scale (1 = never, 2 = rarely, 3 = sometimes, 4 = often, 5 = always), itchiness was the most bothersome EB complication (mean 3.3). The average daily frequency of pruritus increased with self-reported EB severity. Pruritus was most frequent at bedtime (mean 3.8) and interfered with sleep. Factors that aggravated pruritus included healing wounds, dry skin, infected wounds, stress, heat, dryness, and humidity. Pruritus is common in individuals with EB and can be bothersome. Future studies will need to investigate the most effective treatments given to individuals with EB for pruritus.

  View details for DOI 10.1111/pde.12391

  View details for PubMedID 25236506

  View details for PubMedCentralID PMC4315706

• Human COL7A1-corrected induced pluripotent stem cells for the treatment of recessive dystrophic epidermolysis bullosa SCIENCE TRANSLATIONAL MEDICINE Sebastiano, V., Zhen, H. H., Derafshi, B. H., Bashkirova, E., Melo, S. P., Wang, P., Leung, T. L., Siprashvili, Z., Tichy, A., Li, J., Ameen, M., Hawkins, J., Lee, S., Li, L., Schwertschkow, A., Bauer, G., Lisowski, L., Kay, M. A., Kim, S. K., Lane, A. T., Wernig, M., Oro, A. E. 2014; 6 (264)

  Abstract

  Patients with recessive dystrophic epidermolysis bullosa (RDEB) lack functional type VII collagen owing to mutations in the gene COL7A1 and suffer severe blistering and chronic wounds that ultimately lead to infection and development of lethal squamous cell carcinoma. The discovery of induced pluripotent stem cells (iPSCs) and the ability to edit the genome bring the possibility to provide definitive genetic therapy through corrected autologous tissues. We generated patient-derived COL7A1-corrected epithelial keratinocyte sheets for autologous grafting. We demonstrate the utility of sequential reprogramming and adenovirus-associated viral genome editing to generate corrected iPSC banks. iPSC-derived keratinocytes were produced with minimal heterogeneity, and these cells secreted wild-type type VII collagen, resulting in stratified epidermis in vitro in organotypic cultures and in vivo in mice. Sequencing of corrected cell lines before tissue formation revealed heterogeneity of cancer-predisposing mutations, allowing us to select COL7A1-corrected banks with minimal mutational burden for downstream epidermis production. Our results provide a clinical platform to use iPSCs in the treatment of debilitating genodermatoses, such as RDEB.

  View details for DOI 10.1126/scitranslmed.3009540

  View details for Web of Science ID 000345595200003

  View details for PubMedCentralID PMC4428910

• Human COL7A1-corrected induced pluripotent stem cells for the treatment of recessive dystrophic epidermolysis bullosa. Science translational medicine Sebastiano, V., Zhen, H. H., Haddad, B., Bashkirova, E., Melo, S. P., Wang, P., Leung, T. L., Siprashvili, Z., Tichy, A., Li, J., Ameen, M., Hawkins, J., Lee, S., Li, L., Schwertschkow, A., Bauer, G., Lisowski, L., Kay, M. A., Kim, S. K., Lane, A. T., Wernig, M., Oro, A. E. 2014; 6 (264): 264ra163-?

  Abstract

  Patients with recessive dystrophic epidermolysis bullosa (RDEB) lack functional type VII collagen owing to mutations in the gene COL7A1 and suffer severe blistering and chronic wounds that ultimately lead to infection and development of lethal squamous cell carcinoma. The discovery of induced pluripotent stem cells (iPSCs) and the ability to edit the genome bring the possibility to provide definitive genetic therapy through corrected autologous tissues. We generated patient-derived COL7A1-corrected epithelial keratinocyte sheets for autologous grafting. We demonstrate the utility of sequential reprogramming and adenovirus-associated viral genome editing to generate corrected iPSC banks. iPSC-derived keratinocytes were produced with minimal heterogeneity, and these cells secreted wild-type type VII collagen, resulting in stratified epidermis in vitro in organotypic cultures and in vivo in mice. Sequencing of corrected cell lines before tissue formation revealed heterogeneity of cancer-predisposing mutations, allowing us to select COL7A1-corrected banks with minimal mutational burden for downstream epidermis production. Our results provide a clinical platform to use iPSCs in the treatment of debilitating genodermatoses, such as RDEB.

  View details for DOI 10.1126/scitranslmed.3009540

  View details for PubMedID 25429056

• An open-label study to evaluate sildenafil for the treatment of lymphatic malformations. Journal of the American Academy of Dermatology Danial, C., Tichy, A. L., Tariq, U., Swetman, G. L., Khuu, P., Leung, T. H., Benjamin, L., Teng, J., Vasanawala, S. S., Lane, A. T. 2014; 70 (6): 1050-1057

  Abstract

  Lymphatic malformations can be challenging to treat. Mainstay interventions including surgery and sclerotherapy are invasive and can result in local recurrence and complications.We sought to assess the effect of 20 weeks of oral sildenafil on reducing lymphatic malformation volume and symptoms in children.Seven children (4 boys, 3 girls; ages 13-85 months) with lymphatic malformations were given oral sildenafil for 20 weeks in this open-label study. The volume of the lymphatic malformation was calculated blindly using magnetic resonance imaging performed before and after 20 weeks of sildenafil. Lymphatic malformations were assessed clinically on weeks 4, 12, 20, and 32. Both the physician and parents evaluated the lymphatic malformation in comparison with baseline.Four subjects had a lymphatic malformation volume decrease (1.0%-31.7%). In 2 subjects, despite a lymphatic malformation volume increase (1.1%-3.7%), clinical improvement was noted while on sildenafil. One subject had a 29.6% increase in lymphatic malformation volume and no therapeutic response. Lymphatic malformations of all 6 subjects who experienced a therapeutic response on sildenafil softened and became easily compressible. Adverse events were minimal.A randomized controlled trial will be necessary to verify the effects of sildenafil on lymphatic malformations.Sildenafil can reduce lymphatic malformation volume and symptoms in some children.

  View details for DOI 10.1016/j.jaad.2014.02.005

  View details for PubMedID 24656411

• Characterizing the relationship between free drug samples and prescription patterns for acne vulgaris and rosacea. JAMA dermatology Hurley, M. P., Stafford, R. S., Lane, A. T. 2014; 150 (5): 487-493

  Abstract

  IMPORTANCE Describing the relationship between the availability of free prescription drug samples and dermatologists' prescribing patterns on a national scale can help inform policy guidelines on the use of free samples in a physician's office. OBJECTIVES To investigate the relationships between free drug samples and dermatologists' local and national prescribing patterns and between the availability of free drug samples and prescription costs. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study investigating prescribing practices for acne, a common dermatologic condition for which free samples are often available. The settings were, first, the offices of nationally representative dermatologists from the National Disease and Therapeutic Index (an IMS Health Incorporated database) and, second, an academic medical center clinic without samples. Participants were ambulatory patients who received a prescription from a dermatologist for a primary initial diagnosis of acne vulgaris or rosacea in 2010. MAIN OUTCOMES AND MEASURES National trends in dermatologist prescribing patterns, the degree of correlation between the availability of free samples and the prescribing of brand-name medications, and the mean cost of acne medications prescribed per office visit nationally and at an academic medical center without samples. RESULTS On a national level, the provision of samples with a prescription by dermatologists has been increasing over time, and this increase is correlated (r = 0.92) with the use of the branded generic drugs promoted by these samples. Branded and branded generic drugs comprised most of the prescriptions written nationally (79%), while they represented only 17% at an academic medical center clinic without samples. Because of the increased use of branded and branded generic drugs, the national mean total retail cost of prescriptions at an office visit for acne was conservatively estimated to be 2 times higher (approximately $465 nationally vs $200 at an academic medical center without samples). CONCLUSIONS AND RELEVANCE Free drug samples can alter the prescribing habits of physicians away from the use of less expensive generic medications. The benefits of free samples in dermatology must be weighed against potential negative effects on prescribing behavior and prescription costs.

  View details for DOI 10.1001/jamadermatol.2013.9715

  View details for PubMedID 24740450

• Corrected patient-specific, iPSC-derived epithelial sheets for dystrophic epidermolysis bullosa Sebastiano, V., Zhen, H., Wang, P., Haddad, B., Bashkirova, E., Ameen, M., Siprashvili, Z., Melo, S., Li, J., Kim, S., Lane, A., Wernig, M., Oro, A. NATURE PUBLISHING GROUP. 2014: S79

  View details for Web of Science ID 000334560400452

• Characterizing the relationship between free drug samples and prescription patterns for acne vulgaris and rosacea. JAMA dermatology Hurley, M. P., Stafford, R. S., Lane, A. T. 2014; 150 (5): 487-493

  Abstract

  IMPORTANCE Describing the relationship between the availability of free prescription drug samples and dermatologists' prescribing patterns on a national scale can help inform policy guidelines on the use of free samples in a physician's office. OBJECTIVES To investigate the relationships between free drug samples and dermatologists' local and national prescribing patterns and between the availability of free drug samples and prescription costs. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study investigating prescribing practices for acne, a common dermatologic condition for which free samples are often available. The settings were, first, the offices of nationally representative dermatologists from the National Disease and Therapeutic Index (an IMS Health Incorporated database) and, second, an academic medical center clinic without samples. Participants were ambulatory patients who received a prescription from a dermatologist for a primary initial diagnosis of acne vulgaris or rosacea in 2010. MAIN OUTCOMES AND MEASURES National trends in dermatologist prescribing patterns, the degree of correlation between the availability of free samples and the prescribing of brand-name medications, and the mean cost of acne medications prescribed per office visit nationally and at an academic medical center without samples. RESULTS On a national level, the provision of samples with a prescription by dermatologists has been increasing over time, and this increase is correlated (r = 0.92) with the use of the branded generic drugs promoted by these samples. Branded and branded generic drugs comprised most of the prescriptions written nationally (79%), while they represented only 17% at an academic medical center clinic without samples. Because of the increased use of branded and branded generic drugs, the national mean total retail cost of prescriptions at an office visit for acne was conservatively estimated to be 2 times higher (approximately $465 nationally vs $200 at an academic medical center without samples). CONCLUSIONS AND RELEVANCE Free drug samples can alter the prescribing habits of physicians away from the use of less expensive generic medications. The benefits of free samples in dermatology must be weighed against potential negative effects on prescribing behavior and prescription costs.

  View details for DOI 10.1001/jamadermatol.2013.9715

  View details for PubMedID 24740450

• Gene Therapy for Skin Diseases COLD SPRING HARBOR PERSPECTIVES IN MEDICINE Gorell, E., Ngon Nguyen, N., Lane, A., Siprashvili, Z. 2014; 4 (4)

  Abstract

  The skin possesses qualities that make it desirable for gene therapy, and studies have focused on gene therapy for multiple cutaneous diseases. Gene therapy uses a vector to introduce genetic material into cells to alter gene expression, negating a pathological process. This can be accomplished with a variety of viral vectors or nonviral administrations. Although results are promising, there are several potential pitfalls that must be addressed to improve the safety profile to make gene therapy widely available clinically.

  View details for DOI 10.1101/cshperspect.a015149

  View details for Web of Science ID 000338019700003

• The availability of free samples of acne medications increases the prescription of more expensive, branded drugs in lieu of generic alternatives 75th Annual Meeting of the Society-for-Investigative-Dermatology Hurley, M., Stafford, R., Lane, A. NATURE PUBLISHING GROUP. 2012: S45–S45

  View details for Web of Science ID 000302866900264

• Successful Investigational New Drug Preparation without Reinventing the Wheel JOURNAL OF INVESTIGATIVE DERMATOLOGY Gorell, E. S., Tichy, A. L., Lane, A. T. 2011; 131 (5): 996-998

  View details for DOI 10.1038/jid.2011.38

  View details for Web of Science ID 000289789900002

  View details for PubMedID 21494234

• Long-Term Type VII Collagen Restoration to Human Epidermolysis Bullosa Skin Tissue HUMAN GENE THERAPY Siprashvili, Z., Nguyen, N. T., Bezchinsky, M. Y., Marinkovich, M. P., Lane, A. T., Khavari, P. A. 2010; 21 (10): 1299-1310

  Abstract

  In spite of advances in the molecular diagnosis of recessive dystrophic epidermolysis bullosa (RDEB), an inherited blistering disease due to a deficiency of type VII collagen at the basement membrane zone (BMZ) of stratified epithelium, current therapy is limited to supportive palliation. Gene delivery has shown promise in short-term experiments; however, its long-term sustainability through multiple turnover cycles in human tissue has awaited confirmation. To characterize approaches for long-term genetic correction, retroviral vectors were constructed containing long terminal repeat-driven full-length and epitope-tagged COL7A1 cDNA and evaluated for durability of type VII collagen expression and function in RDEB skin tissue regenerated on immune-deficient mice. Type VII collagen expression was maintained for 1 year in vivo, or over 12 epidermal turnover cycles, with no abnormalities in skin morphology or self-renewal. Type VII collagen restoration led to correction of RDEB disease features, including reestablishment of anchoring fibrils at the BMZ. This approach confirms durably corrective and noninjurious gene delivery to long-lived epidermal progenitors and provides the foundation for a human clinical trial of ex vivo gene delivery in RDEB.

  View details for DOI 10.1089/hum.2010.023

  View details for Web of Science ID 000282955500008

  View details for PubMedID 20497034

  View details for PubMedCentralID PMC2957245

• The integrity of the dermatology National Resident Matching Program: Results of a national study J Am Acad Dermatol Sbicca, Gorell, Kanzler, lane 2010; 63 (4): 594-601
• Vitamin D deficiency in the San Francisco bay area JOURNAL OF PEDIATRIC ENDOCRINOLOGY & METABOLISM McAllister, J. C., Lane, A. T., Buckingham, B. A. 2006; 19 (3): 205-208

  View details for Web of Science ID 000236479400003

  View details for PubMedID 16607919

• TOPICAL OINTMENT THERAPY HAS SYSTEMIC BENEFIT FOR PREMATURE-INFANTS NOPPER, A. J., HORII, K., SOOKDEODROST, S., MANCINI, A. J., LANE, A. T. WILLIAMS & WILKINS. 1994: A243

  View details for Web of Science ID A1994NG77901441

• Measurement of skin adhesion in recessive dystrophic epidermolysis bullosa patients JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Nazaroff, J., Manoukian, M., Barriga, M., Lane, A., Marinkovich, M., Tang, J. Y. 2021; 85 (2): 491-492

  View details for DOI 10.1016/j.jaad.2018.07.034

  View details for Web of Science ID 000687299800034

• Diaper dermatitis prevalence and severity: Global perspective on the impact of caregiver behavior. Pediatric dermatology Carr, A. N., DeWitt, T., Cork, M. J., Eichenfield, L. F., Folster-Holst, R., Hohl, D., Lane, A. T., Paller, A., Pickering, L., Taieb, A., Cui, T. Y., Xu, Z. G., Wang, X., Brink, S., Niu, Y., Ogle, J., Odio, M., Gibb, R. D. 2019

  Abstract

  OBJECTIVES: To compare prevalence and severity of diaper dermatitis (DD) in infants and toddlers (babies) across three countries (China, USA, and Germany), including diapered skin measures and caregiver practices.METHODS: A cross-sectional study of 1791 babies (~600 from each country) was recruited at each clinical site. Based on regional toilet-training habits, exclusively diaper-wearing infants were recruited between ages 2-8months in China and 2-18months in the USA and Germany. DD was measured, as well as skin pH, transepidermal water loss (TEWL), and relative humidity (RH) in the diapered region. Caregiver habits were collected via a questionnaire and included information on hygienic practices.RESULTS: Diaper dermatitis was highest in the perianal area, followed by the intertriginous, genital, and buttock regions. In general, DD was significantly lower in babies in China, highest in Germany, and intermediate in the USA. This rank ordering of DD by geography was also observed in baby age 2-8months. The lower DD observed in China was associated with lower skin pH and TEWL on diapered skin and decreased RH in the diaper. Chinese caregivers had the highest rate of prophylactic topical product usage, the most robust cleaning of the diapered area, lack of cleansing after urine-only diaper changes, and Chinese infants spent the least time in an overnight diaper.CONCLUSIONS: These data suggest caregiver behaviors including prophylactic use of topical products, thorough cleaning after stooling and reduced time in an overnight diaper are associated with less DD, lower superficial skin pH, and enhanced skin barrier.

  View details for DOI 10.1111/pde.14047

  View details for PubMedID 31793090

• Measurement of Skin Adhesion in Recessive Dystrophic Epidermolysis Bullosa Patients. Journal of the American Academy of Dermatology Nazaroff, J., Manoukian, M., Barriga, M., Lane, A., Marinkovich, M. P., Tang, J. Y. 2018

  View details for PubMedID 30081112

• Phase I/IIa clinical trial for recessive dystrophic epidermolysis bullosa using EB-101 (COL7A1 gene-corrected autologous keratinocytes) Siprashvili, Z., Nguyen, N. T., Gorell, E. S., Loutit, K., Dutt-Singkh, Y., Nazaroff, J., Khuu, P., Furukawa, L., Lorenz, H. P., Leung, T. H., Keene, D. R., Rieger, K. E., Khavari, P. A., Lane, A. T., Tang, J. Y., Marinkovich, M. P. MARY ANN LIEBERT, INC. 2017: A10

  View details for Web of Science ID 000418410700026

• Phase I/IIa clinical trial for recessive dystrophic epidermolysis bullosa using genetically corrected autologous keratinocytes Siprashvili, Z., Nguyen, N., Gorell, E., Loutit, K., Dutt-Singkh, Y., Nazaroff, J., Khuu, P., Furukawa, L., Lorenz, H., Leung, T., Keene, D., Rieger, K., Khavari, P. A., Lane, A., Tang, J. Y., Marinkovich, M. ELSEVIER SCIENCE INC. 2017: S89

  View details for DOI 10.1016/j.jid.2017.02.539

  View details for Web of Science ID 000406862400513

• Characterization of patients with dystrophic epidermolysis bullosa for collagen VII therapy BRITISH JOURNAL OF DERMATOLOGY Gorell, E. S., Nguyen, N., Siprashvili, Z., Marinkovich, M. P., Lane, A. T. 2015; 173 (3): 821–23

  View details for DOI 10.1111/bjd.13737

  View details for Web of Science ID 000362176800031

  View details for PubMedID 25703736

  View details for PubMedCentralID PMC4545744

• Phase I clinical trial for recessive dystrophic epidermolysis bullosa using genetically corrected autologous keratinocytes Siprashvili, Z., Nguyen, N. T., Gorell, E., Loutit, K., Khuu, P., Furukawa, L. K., Lorenz, H. P., Leung, T. H., Keene, D. R., Khavari, P., Lane, A., Tang, J. Y., Marinkovich, M. NATURE PUBLISHING GROUP. 2015: S72

  View details for Web of Science ID 000352783200418

• Instrument for Scoring Clinical Outcome of Research for Epidermolysis Bullosa: A Consensus-Generated Clinical Research Tool PEDIATRIC DERMATOLOGY Schwieger-Briel, A., Chakkittakandiyil, A., Lara-Corrales, I., Aujla, N., Lane, A. T., Lucky, A. W., Bruckner, A. L., Pope, E. 2015; 32 (1): 41–52

  Abstract

  Epidermolysis bullosa (EB) is a genetic condition characterized by skin fragility and blistering. There is no instrument available for clinical outcome research measurements. Our aim was to develop a comprehensive instrument that is easy to use in the context of interventional studies. Item collection was accomplished using a two-step Delphi Internet survey process for practitioners and qualitative content analysis of patient and family interviews. Items were reduced based on frequency and importance using a 4-point Likert scale and were subject to consensus (>80% agreement) using the nominal group technique. Pilot data testing was performed in 21 consecutive patients attending an EB clinic. The final score, Instrument for Scoring Clinical Outcome of Research for Epidermolysis Bullosa (iscorEB), is a combined score that contains clinician items grouped in five domains (skin, mucosa, organ involvement, laboratory abnormalities, and complications and procedures; maximum score 114) and patient-derived items (pain, itch, functional limitations, sleep, mood, and effect on daily and leisurely activities; maximum score 120). Pilot testing revealed that combined (see below) and subscores were able to differentiate between EB subtypes and degrees of clinical severity (EB simplex 21.7 ± 16.5, junctional EB 28.0 ± 20.7, dystrophic EB 57.3 ± 24.6, p = 0.007; mild 17.3 ± 9.6, moderate 41.0 ± 19.4, and severe 64.5 ± 22.6, p < 0.001). There was high correlation between clinician and patient subscores (correlation coefficient = 0.79, p < 0.001). iscorEB seems to be a sensitive tool in differentiating between EB types and across the clinical spectrum of severity. Further validation studies are needed.

  View details for DOI 10.1111/pde.12317

  View details for Web of Science ID 000348765600017

  View details for PubMedID 24650374

• Phase 1 clinical trial of genetically corrected autologous epidermal keratinocytes for recessive dystrophic epidermolysis bullosa Siprashvili, Z., Nguyen, N. T., Gorell, E., Khuu, P., Furukawa, L., Lorenz, H. P., Leung, T. H., Keene, D. R., Khavari, P., Marinkovich, M., Lane, A. T. NATURE PUBLISHING GROUP. 2014: S75

  View details for Web of Science ID 000334560400429

• Eczema and sensitization to common allergens in the United States: a multiethnic, population-based study. Pediatric dermatology Fu, T., Keiser, E., Linos, E., Rotatori, R. M., Sainani, K., Lingala, B., Lane, A. T., Schneider, L., Tang, J. Y. 2014; 31 (1): 21-26

  Abstract

  The relationship between food and environmental allergens in contributing to eczema risk is unclear on a multiethnic population level. Our purpose was to determine whether sensitization to specific dietary and environmental allergens as measured according to higher specific immunoglobulin E (IgE) levels is associated with eczema risk in children. National Health and Nutrition Examination Survey participants ages 1 to 17 years were asked whether they had ever received a diagnosis of eczema from a physician (n = 538). Total and specific serum IgE levels for four dietary allergens (egg, cow's milk, peanut, and shrimp) and five environmental allergens (dust mite, cat, dog, Aspergillus, and Alternaria) were measured. Logistic regression was used to examine the association between eczema and IgE levels. In the United States, 10.4 million children (15.6%) have a history of eczema. Eczema was more common in black children (p < 0.001) and in children from families with higher income and education (p = 0.01). The median total IgE levels were higher in children with a history of eczema than in those without (66.4 vs 50.6 kU/L, p = 0.004). In multivariate analysis adjusted for age, race, sex, family income, household education, and physician-diagnosed asthma, eczema was significantly associated with sensitization to cat dander (odds ratio [OR] = 1.2, 95% confidence interval [CI] 1.05, 1.4, p = 0.009) and dog dander (OR = 1.5, 95% CI, 1.2, 1.7, p < 0.001). After correction for multiple comparisons, only sensitization to dog dander remained significant. U.S. children with eczema are most likely to be sensitized to dog dander. Future prospective studies should further explore this relationship.

  View details for DOI 10.1111/pde.12237

  View details for PubMedID 24283549

• Polyvinylpyrrolidone microneedles enable delivery of intact proteins for diagnostic and therapeutic applications ACTA BIOMATERIALIA Sun, W., Araci, Z., Inayathullah, M., Manickam, S., Zhang, X., Bruce, M. A., Marinkovich, M. P., Lane, A. T., Milla, C., Rajadas, J., Butte, M. J. 2013; 9 (8): 7767-7774

  Abstract

  We present a method of fabricating microneedles from polyvinylpyrrolidone (PVP) that enables delivery of intact proteins (or peptides) to the dermal layers of the skin. PVP is known to self-assemble into branched hollow fibers in aqueous and alcoholic solutions; we utilized this property to develop dissolvable patches of microneedles. Proteins were dissolved in concentrated PVP solution in both alcohol and water, poured into polydimethylsiloxane templates shaped as microneedles and, upon evaporation of solvent, formed into concentric, fibrous, layered structures. This approach of making PVP microneedles overcomes problems in dosage, uniform delivery and stability of protein formulation as compared to protein-coated metallic microneedles or photopolymerized PVP microneedles. Here we characterize the PVP microneedles and measure the delivery of proteins into skin. We show that our method of fabrication preserves the protein conformation. These microneedles can serve as a broadly useful platform for delivering protein antigens and therapeutic proteins to the skin, for example for allergen skin testing or immunotherapy.

  View details for DOI 10.1016/j.actbio.2013.04.045

  View details for PubMedID 23648574

• An investigational study to evaluate sildenafil for the treatment of lymphatic malformations International Investigative Dermatology Meeting Danial, C., Tichy, A., Tariq, U., Swetman, G. L., Khuu, P., Leung, T., Teng, J., VASANAWALA, S., Lane, A. NATURE PUBLISHING GROUP. 2013: S175–S175

  View details for Web of Science ID 000317698901320

• A follow-up survey of the integrity of the dermatology National Resident Matching Program JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Sbicca, J. A., Gorell, E. S., Peng, D. H., Lane, A. T. 2012; 67 (3): 429-435

  Abstract

  Our group's 2009 study of the integrity of the dermatology match revealed that some dermatology program directors violated National Resident Matching Program (NRMP) policy during their communications with applicants. Our group's article concluded with recommendations to change this behavior.We repeated a survey of dermatology applicants to understand if dermatology program personnel behavior has changed since our group's 2009 study of the dermatology match.We surveyed 2011 applicants to Department of Dermatology, Stanford University, Palo Alto, CA. The survey was anonymous and available online.Of applicants, 14% were asked to reveal how they intended to rank a program before match day. Of applicants, 32% felt pressured to reveal how they intended to rank programs. Of applicants, 90% were asked about interviews at other programs. Of applicants, 44% were asked about their marital status and 19% were asked if they had children or intended to have children.The response rate for applicants was 53%.Although our previous study increased knowledge about the problems within the dermatology match, dermatology program personnel continue to violate NRMP policy. The most widespread violations are asking applicants where they will interview, asking applicants if they are married, and pressuring applicants to reveal how they intend to rank programs. We continue to recommend that programs avoid postinterview contact, and recommend that the NRMP create training videos for applicants and interviewers.

  View details for DOI 10.1016/j.jaad.2011.09.035

  View details for Web of Science ID 000307824000027

  View details for PubMedID 22088426

• Therapies for dystrophic epidermolysis bullosa require close evaluation for development of antibodies to type VII collagen 75th Annual Meeting of the Society-for-Investigative-Dermatology Gorell, E. S., Nguyen, N., Siprashvili, Z., Marinkovich, P., Lane, A. NATURE PUBLISHING GROUP. 2012: S68–S68

  View details for Web of Science ID 000302866900402

• Applying for dermatology residency is difficult and expensive JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Tichy, A. L., Peng, D. H., Lane, A. T. 2012; 66 (4): 696-697

  View details for DOI 10.1016/j.jaad.2011.10.005

  View details for Web of Science ID 000301444600034

  View details for PubMedID 22421121

• Sildenafil for Severe Lymphatic Malformations NEW ENGLAND JOURNAL OF MEDICINE Swetman, G. L., Berk, D. R., Vasanawala, S. S., Feinstein, J. A., Lane, A. T., Bruckner, A. L. 2012; 366 (4): 384-386

  View details for Web of Science ID 000299464100029

  View details for PubMedID 22276841

• The integrity of the dermatology National Resident Matching Program: Results of a national study JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Sbicca, J. A., Gorell, E. S., Kanzler, M. H., Lane, A. T. 2010; 63 (4): 594-601

  Abstract

  National Resident Matching Program (NRMP) policy outlines the conduct expected by both program directors and residency applicants. However, recent studies and personal experiences have introduced the possibility that NRMP policy is violated during the residency application process.To investigate the communications that occur between dermatology applicants and dermatology programs during the residency application process.From April to July 2009, we surveyed 2009 Stanford dermatology applicants, current US dermatology residents, and US dermatology program directors. The survey was anonymous and available online. The main outcome measures were the frequency and incidence of dermatology NRMP policy violations.Thirty-one percent of Stanford applicants and 19% of US dermatology residents felt pressured to reveal to programs how they ranked them before match day. Seventeen percent of Stanford applicants and 14% of US dermatology residents witnessed behavior that made them feel uncomfortable or that they thought was a possible ethical infraction of NRMP policy.Response rates were as follows: 43% of Stanford applicants, 46% of residents, and 61% of program directors.Our data suggest that some dermatology program directors violate NRMP policy during their communications with applicants. The most widespread violation is pressuring applicants into revealing how they intend to rank programs. Other violations include apparent sexual discrimination and reserving NRMP positions for preselected applicants. Additional studies should be done in order to determine the incidence of dermatology applicants violating NRMP policy.

  View details for DOI 10.1016/j.jaad.2009.11.009

  View details for Web of Science ID 000282069400006

  View details for PubMedID 20599295

• Diagnosis of Pilomatricoma Using an Otoscope PEDIATRIC DERMATOLOGY Barreto-Chang, O. L., Gorell, E. S., Yamaguma, M. A., Lane, A. T. 2010; 27 (5): 554-557

  Abstract

  Pilomatricoma is a benign tumor that presents as a 3-30-mm, firm, solitary, deep, dermal or subcutaneous tumor on the head, neck, or upper extremities. The clinical diagnosis is often made by the firm, sometimes rock-hard texture of the skin. The diagnosis can be confirmed by a skin biopsy or excision of the lesion. We have recently noted that pilomatricomas appear as a black mass in the skin when the lesion is transilluminated by placing the light of a fiberoptic otoscope adjacent to the skin lesion. To our knowledge, this is the first report demonstrating preoperative diagnosis of pilomatricoma by transilluminating the lesion with an otoscope.

  View details for DOI 10.1111/j.1525-1470.2010.01264.x

  View details for Web of Science ID 000282178800036

  View details for PubMedID 20807359

• Cause-specific mortality in patients with severe psoriasis BRITISH JOURNAL OF DERMATOLOGY Berk, D. R., Taube, J. M., Bruckner, A. L., Lane, A. T. 2010; 163 (3): 653–54

  View details for DOI 10.1111/j.1365-2133.2010.09876.x

  View details for Web of Science ID 000281135800040

  View details for PubMedID 20518781

• Acquired Bilateral Agminated Spitz Nevi in a Child with Langerhans Cell Histiocytosis PEDIATRIC DERMATOLOGY Berk, D. R., Lane, A. T. 2010; 27 (3): 282-284

  Abstract

  Multiple Spitz nevi are rare and may occur in agminated, widespread, or dermatomal distributions. Agminated Spitz nevi usually arise in children, presenting on grossly normal, hyperpigmented, or most rarely, hypopigmented skin. We present a child with Langerhans cell histiocytosis who developed bilateral agminated Spitz nevi in the inguinal area. Unusual features included the multifocal distribution, bilateral inguinal location, and co-occurrence with Langerhans cell histiocytosis.

  View details for DOI 10.1111/j.1525-1470.2010.01139.x

  View details for Web of Science ID 000278037100012

  View details for PubMedID 20609146

• Association of IgE levels and eczema in the US population: Results from NHANES 2005-2006 Fu, T., Keiser, E., Linos, E., Kanzler, M., Sainani, K., Lane, A., Tang, J. NATURE PUBLISHING GROUP. 2010: S66

  View details for Web of Science ID 000276455100395

• Support groups for children and their families in pediatric dermatology PEDIATRIC DERMATOLOGY Goh, C., Lane, A. T., Bruckner, A. L. 2007; 24 (3): 302-305

  Abstract

  Recent discussions regarding the burden of skin disease and patient-centered medicine highlight the profound effects skin disease can have on individuals, their families, and society as a whole. Local support groups, often connected to national patient advocacy groups, can be an invaluable resource for patients, and offer physicians the opportunity to learn more about patients' disease experiences while providing adjunctive therapy for conditions such as alopecia areata and vitiligo, for which medical options are often limited. We created a support group for children with alopecia areata and their parents as a model for other diseases such as vitiligo and epidermolysis bullosa. Herein we outline the steps involved in establishing a support group, including the many resources available for patient support, steps in the recruitment of patients, topics for discussion and goals for the group, and the logistics of running a meeting. Creating this family support group was a relatively straightforward and rewarding experience for us, and we hope that other pediatric dermatologists can utilize this model for their patients.

  View details for Web of Science ID 000247174400021

  View details for PubMedID 17542885

• Treatment decision-making for patients with the Herlitz subtype of junctional epidermolysis bullosa JOURNAL OF PERINATOLOGY Yan, E. G., Paris, J. J., Ahluwalia, J., Lane, A. T., Bruckner, A. L. 2007; 27 (5): 307–11

  Abstract

  The Herlitz subtype of junctional epidermolysis bullosa (JEB-H) is a lethal genetic disorder characterized by recurrent and persistent erosions of the epithelial surfaces that heal with exuberant granulation tissue. In addition, respiratory distress, refractory anemia and failure to thrive are often seen. Mortality in the first year of life approaches 90%. JEB-H is caused by mutations in the genes that encode the protein laminin 5, a structural molecule involved in the adhesion of epidermis to dermis. There is currently no cure for JEB-H. Medical interventions treat complications but do not ultimately limit mortality. Ethical principles contend that offering comfort and company to the patient and family, not aggressive therapies, should comprise the mainstay of care for affected infants.

  View details for DOI 10.1038/sj.jp.7211694

  View details for Web of Science ID 000246105400011

  View details for PubMedID 17363907

• Pharmaceutical support of dermatology residency electives: slippery slope or synergy? The virtual mentor : VM Lane, A. T. 2006; 8 (8): 509-511

  View details for DOI 10.1001/virtualmentor.2006.8.8.medu1-0608

  View details for PubMedID 23234687

• Diffuse morbilliform eruption after consumption of ginkgo biloba supplement JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Chiu, A. E., Lane, A. T., Kimball, A. B. 2002; 46 (1): 145–46

  View details for DOI 10.1067/mjd.2001.118545

  View details for Web of Science ID 000173294800027

  View details for PubMedID 11756966

• Skin benefits from continuous topical administration of a zinc oxide/petrolatum formulation by a novel disposable diaper Baldwin, S., Odio, M. R., Haines, S. L., O'Connor, R. J., Englehart, J. S., Lane, A. T. EUROPEAN ACAD DERMATOLOGY & VENEREOLOGY. 2001: 5–11

  Abstract

  Diaper dermatitis is a common childhood affliction. Aiming to help reduce the prevalence of this problem, we have advanced in our development of a novel diaper that delivers dermatological formulations to help protect the skin from over-hydration and irritation.To determine the clinical benefits of a novel disposable diaper designed to deliver a zinc oxide and petrolatum-based formulation continuously to the skin during use.All studies were independent, blinded, randomized clinical trials. Study A was conducted to confirm transfer of the zinc oxide/petrolatum (ZnO/Pet) formulation from the diaper to the child's skin during use. Children wore a single diaper for 3 h or multiple diapers for 24 h. After the use period, stratum corneum samples were taken from each child and analysed for ZnO/Pet. Study B evaluated the prevention of skin irritation and barrier damage from a standard skin irritant (SLS) in an adult arm model. Study C evaluated skin erythema and diaper rash in 268 infants over a 4-week usage period. One half of the infants used the ZnO/Pet diaper, while the other half used a control diaper that was identical except for the absence of the ZnO/Pet formulation.The ointment formulation and ZnO transferred effectively from the diaper to the child's skin during product use. Transfer of ZnO increased from 4.2 microg/cm2 at 3 h to > 8 microg/cm2 at 24 h. Exposure to the formulations directly on adult skin prior to an irritant challenge was associated with up to a 3.5 reduction in skin barrier damage and skin erythema. Greatest reductions were seen for the ZnO containing formulations. Wearing of the formulation treated diaper was also associated with a significant reduction in skin erythema and diaper rash compared to the control product.The results demonstrated the clinical benefits associated with continuous topical administration of a zinc oxide/petrolatum-based formulation by this novel diaper.

  View details for DOI 10.1046/j.0926-9959.2001.00002.x

  View details for Web of Science ID 000171762300002

  View details for PubMedID 11720074

• Diaper dermatitis PEDIATRIC CLINICS OF NORTH AMERICA Kazaks, E. L., Lane, A. T. 2000; 47 (4): 909-?

  Abstract

  The primary goals of preventing and treating diaper dermatitis include keeping the skin dry, protected, and infection free. Frequent diaper changes with the superabsorbent disposable diapers may be the best tactic for infants' skin, if not the environment. Also, the more time that infants spend without diapers, the less dermatitis they experience, but a practical balance must be struck. Gentle cleansing and barrier creams are beneficial, and candidal infection must be treated. Finally, any recalcitrant diaper dermatitis must be further investigated to uncover underlying disease (Fig. 6).

  View details for Web of Science ID 000088348800011

  View details for PubMedID 10943265

• Gene therapy for a lethal genetic blistering disease: a status report. Transactions of the American Clinical and Climatological Association BAUER, E. A., Herron, G. S., Marinkovich, M. P., Khavari, P. A., Lane, A. T. 1999; 110: 86-92

  View details for PubMedID 10344009

• Skin manifestations of mitochondrial DNA syndromes: Case report and review JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Flynn, M. K., Wee, S. A., Lane, A. T. 1998; 39 (5): 819-823

  Abstract

  Mitochondrial DNA syndromes are an emerging class of diseases that can present at any age. Clinical findings are legion and may include renal tubulopathy, growth retardation, myopathy, seizures, and ophthalmoplegia. Mitochondrial DNA syndromes have presented with symmetric cervical lipomas, poikiloderma, and anhidrosis. We describe a child with a novel mitochondrial DNA syndrome who had poikiloderma on sun-exposed areas. We also reviewed 274 patients with mitochondrial DNA disorders for skin findings. Symmetric cervical lipomas were consistently associated with myoclonic epilepsy as part of 1 syndrome. With the exception of lipomas, skin findings were reported in 16 patients.

  View details for Web of Science ID 000076813000001

  View details for PubMedID 9810906

• A young boy with a large hemifacial plaque with histopathologic features of trichoepithelioma JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Oh, D. H., Lane, A. T., Turk, A. E., Kohler, S. 1997; 37 (5): 881-883

  Abstract

  Trichoepitheliomas commonly appear as sporadic solitary lesions or, more rarely, as multiple lesions that are often dominantly inherited. We describe an 8-year-old boy with multiple facial papules that coalesced into a large plaque. This presentation of multiple trichoepitheliomas may represent an unusual type of nevus.

  View details for Web of Science ID A1997YF41300016

  View details for PubMedID 9366858

• Efficacy and safety of topical steroids in paediatric atopic dermatitis Lane, A. T. ELSEVIER SCIENCE BV. 1997: S24–S27

  View details for Web of Science ID A1997YD08100006

• Warts and molluscum contagiosum - Beware of treatments worse than the disease POSTGRADUATE MEDICINE ORDOUKHANIAN, E., Lane, A. T. 1997; 101 (2): 223-?

  Abstract

  To treat or not to treat, that is the question. Two cutaneous infections, warts and molluscum contagiosum, have evaded eradication for centuries, and the viruses continue to thrive and to expand in number despite all attempts at destruction. Meanwhile, many cases regress spontaneously. In this article, the authors review the characteristics of the viruses involved; discuss their transmission, epidemiology, and clinical manifestations; and assess the effectiveness of available therapies.

  View details for Web of Science ID A1997WJ34700022

  View details for PubMedID 9046937

• Topical ointment therapy benefits premature infants JOURNAL OF PEDIATRICS Nopper, A. J., Horii, K. A., SOOKDEODROST, S., Wang, T. H., Mancini, A. J., Lane, A. T. 1996; 128 (5): 660-669

  Abstract

  Premature infants have an ineffective epidermal barrier. The aim of this study was to investigate the cutaneous and systemic effects of preservative-free topical ointment therapy in premature infants.We conducted a prospective, randomized study of 60 infants less than 33 weeks' estimated gestational age. The treated infants received therapy for 2 weeks with twice-daily preservative-free topical ointment therapy while the control group received no topical treatment or as-needed therapy with a water-in-oil emollient. Data collection included transepidermal water loss (TEWL) measurement, skin condition evaluations, fungal and quantitative bacterial skin cultures, analysis of fluid requirements, patterns of weight low or gain, and the incidence of blood and cerebrospinal fluid cultures positive for microorganisms.We found that topical ointment therapy significantly decreased TEWL during the first 6 hours after the initial application. TEWL was decreased by 67% (p = 0.0001) when measured 30 minutes after application and 34% (p = 0.001) when measured 4 to 6 hours after application. We also observed significantly superior skin condition scores in the treated group on study days 7 and 14 (p = 0.001) and 0.0004, respectively). Quantitative bacterial cultures revealed significantly less colonization of the axilla on day 2, 3, or 4 and on day 14 (p = 0.008 and 0.04, respectively). The incidence of positive findings in blood and/or cerebrospinal fluid cultures was 3.3% in the treated group of infants versus 26.7% in the control group (p = 0.02). There was no statistical difference in the fluid requirements or patterns of weight gain or loss during the 2 weeks of the study.Preservative-free topical ointment therapy decreased TEWL for 6 hours after application, decreased the severity of dermatitis, and decreased bacterial colonization of axillary skin. Infants treated with ointment had fewer blood and cerebrospinal fluid cultures positive for microorganisms. These data support the use of topical ointment therapy in very premature infants during the first weeks after birth.

  View details for Web of Science ID A1996UJ94600015

  View details for PubMedID 8627439

• Cutaneous candidiasis PEDIATRIC DERMATOLOGY Lane, A. T. 1995; 12 (4): 369-369

  View details for Web of Science ID A1995TM65500018

  View details for PubMedID 8747589

• Increased migration of human fetal keratinocytes occurs without accompanying changes in attachment or integrin expression WOUNDS-A COMPENDIUM OF CLINICAL RESEARCH AND PRACTICE SookdeoDrost, S., Chen, J. D., Woodley, D. T., Lane, A. T. 1995; 7 (6): 203–10

  View details for Web of Science ID A1995TL71300002

• INCREASED MIGRATION OF FETAL KERATINOCYTES OCCURS WITHOUT ACCOMPANYING CHANGES IN ATTACHMENT OR INTEGRIN EXPRESSION SOOKDEODROST, S., CHEN, J. D., WOODLEY, D. T., LANE, A. T. BLACKWELL SCIENCE PUBL INC CAMBRIDGE. 1995: 610

  View details for Web of Science ID A1995QR53200353

• Increased migration of human fetal keratinocytes occurs without accompanying changes in attachment of integrin expression Wounds Lane AT, Drost SS, Chen JD, Woodley DT 1995
• Infant skin care: When, why and what? 7th International Congress of Pediatric Dermatology - The Worlds Reality in the Childrens Skin Lane, A. T. ELSEVIER SCIENCE PUBL B V. 1995: 247–250

  View details for Web of Science ID A1995BE47A00050

• IMPETIGO - AN OVERVIEW PEDIATRIC DERMATOLOGY Darmstadt, G. L., Lane, A. T. 1994; 11 (4): 293-303

  Abstract

  This article reviews in detail the pathogenesis, clinical characteristics and management of impetigo in children. Impetigo is the most common bacterial skin infection of children. Most cases of nonbullous impetigo and all cases of bullous impetigo are caused by Staphylococcus aureus. The remainder of cases of nonbullous impetigo are due to group A beta hemolytic streptococci (GABHS). GABHS colonize the skin directly by binding to sites on fibronectin that are exposed by trauma. In contrast, S. aureus colonizes the nasal epithelium first; from this reservoir, colonization of the skin occurs. Patients with recurrent impetigo should be evaluated for carriage of S. aureus. Superficial, localized impetigo may be treated successfully in more than 90% of cases with topical application of mupirocin ointment. Impetigo that is widespread or involves deeper tissues should be treated with a beta-lactamase-resistant oral antibiotic. The choice of antibiotics is affected by the local prevalence of resistance to erythromycin among strains of S. aureus, antibiotic cost and availability, and issues of compliance.

  View details for Web of Science ID A1994PY11400001

  View details for PubMedID 7899177

• PROTEUS SYNDROME PEDIATRIC DERMATOLOGY Darmstadt, G. L., Lane, A. T. 1994; 11 (3): 222-226

  Abstract

  A 10-month-old girl had macrodactyly, facial and extremity hemihypertrophy, plantar cerebriform hyperplasia, a subcutaneous mass on the back, macrocephaly, and lumbar kyphosis. These findings were diagnostic of Proteus syndrome. The clinical features, etiology, management, and points of differential diagnosis are discussed.

  View details for Web of Science ID A1994PE28000005

  View details for PubMedID 7971556

• SEMIPERMEABLE DRESSINGS IMPROVE EPIDERMAL BARRIER FUNCTION IN PREMATURE-INFANTS PEDIATRIC RESEARCH Mancini, A. J., SOOKDEODROST, S., Madison, K. C., SMOLLER, B. R., Lane, A. T. 1994; 36 (3): 306-314

  Abstract

  Infants of less than 32 wk gestation have a defective epidermal barrier, with increased skin permeability and transepidermal water loss (TEWL). We studied the effect of a nonadhesive semipermeable dressing on the epidermal barrier of premature infants and on fetal skin transplanted to nude mice. Fifteen infants with a mean estimated gestational age of 27.7 wk and 16 human fetal skin grafts (estimated gestational age, 23-26 wk) transplanted to eight nude mice were studied. One lower leg (or skin graft) was treated and the other left untreated as a control. In the infants, TEWL was measured on control skin and treated skin (both through the dressing and after temporary dressing removal) on d 0, 1, 2, 4, and 7. Bacterial and fungal cultures were also performed. In the mice, TEWL and skin blood flow were measured on d 0, 2, and 4. Biopsies were obtained on d 4 for a cell proliferation assay, histology, and electron microscopy. Treated infant skin showed a consistently lower bacterial number and a significantly decreased TEWL (measured through the dressing). There was also a significantly lower TEWL on the treated side, measured after temporary dressing removal, on d 1, 2, 4, and 7, documenting improved epidermal barrier function. The animal study revealed decreased TEWL and a nearly 2-fold greater d-4 keratinocyte proliferation (p = 0.01) in treated skin and decreased blood flow on d 4 in control skin (p = 0.01). There was no significant difference in the volume density of membrane coating granules or the morphology of intercorneocyte spaces.(ABSTRACT TRUNCATED AT 250 WORDS)

  View details for Web of Science ID A1994PC73300007

  View details for PubMedID 7808826

• TOPICAL OINTMENT THERAPY HAS SYSTEMIC BENEFIT FOR PREMATURE-INFANTS NOPPER, A. J., HORII, K., DROST, S. S., MANCINI, A. J., LANE, A. T. SLACK INC. 1994: A90

  View details for Web of Science ID A1994MR21400486

• PICTURE OF THE MONTH AMERICAN JOURNAL OF DISEASES OF CHILDREN Darmstadt, G. L., Lane, A. T., Tunnessen, W. W. 1993; 147 (12): 1339-1339

  View details for Web of Science ID A1993MX51100027

  View details for PubMedID 8249959

• EFFECTS OF REPEATED APPLICATION OF EMOLLIENT CREAM TO PREMATURE NEONATES SKIN PEDIATRICS Lane, A. T., DROST, S. S. 1993; 92 (3): 415-419

  Abstract

  Emollient cream moisturizers are often used on premature newborns in neonatal intensive care units without accurate knowledge of the risks or benefits to the neonate.We prospectively compared premature neonates treated with a water-in-oil emollient cream for up to 16 days to untreated premature neonates.The study was completed in a neonatal intensive care unit on neonates admitted for respiratory distress and/or possible sepsis.Thirty-four neonates, between 29 and 36 weeks estimated gestational age, entered the study.One-half of the neonates were treated twice a day with an water-in-oil emollient cream, and the other half served as controls.The skin condition of the neonates' hands, feet, and abdomen was evaluated on entering the study and twice a week. Fungal cultures and quantitative bacterial cultures were obtained from the axilla and abdomen on entering the study and twice a week.The mean gestational age of the treated neonates was 32.3 weeks, whereas the mean gestational age of the control neonates was 32.5 weeks. The neonates treated with emollient cream demonstrated statistically less dermatitis of their hands (day 2 through day 11), their feet (day 2 through day 16), and their abdomen (day 7 through day 11). Fungal cultures and quantitative bacterial cultures of the abdomen and axilla were equivalent in both groups.These studies document that emollient cream moisturizer therapy of premature neonates decreases dermatitis without changing the microbiological flora.

  View details for Web of Science ID A1993LV81500011

  View details for PubMedID 8361795

• SEMIPERMEABLE DRESSINGS ACCELERATE EPIDERMAL BARRIER MATURATION IN PREMATURE-INFANTS MANCINI, A. I., LANE, A. T. BLACKWELL SCIENCE INC. 1993: 537

  View details for Web of Science ID A1993KW39500594

• SEMIPERMEABLE DRESSINGS ACCELERATE EPIDERMAL BARRIER MATURATION IN PREMATURE-INFANTS MANCINI, A. J., LANE, A. T. SLACK INC. 1993: A421

  View details for Web of Science ID A1993KW76101734

• THERAPY OF THE PREMATURE-INFANTS SKIN WITH EUCERIN(R) CREME LANE, A. T., DROZD, S. BLACKWELL PUBLISHING INC. 1992: 601

  View details for Web of Science ID A1992HL84600568

• THERAPY OF THE PREMATURE-INFANTS SKIN WITH EUCERIN(R) CREME LANE, A. T., DROZD, S. SLACK INC. 1992: A458

  View details for Web of Science ID A1992HN74101836

• CANDIDA AND MALASSEZIA AS NURSERY PATHOGENS SEMINARS IN DERMATOLOGY Stuart, S. M., Lane, A. T. 1992; 11 (1): 19-23

  Abstract

  Candida and Malassezia can be both normal flora and pathogens in the nursery. Very low-birth-weight infants are at high risk for systemic infection from these organisms. We review the microbiology and clinical manifestations of disease within the neonatal nursery.

  View details for Web of Science ID A1992HF18500004

  View details for PubMedID 1550712

• COMPARISON OF MOMETASONE FUROATE 0.1-PERCENT CREAM AND HYDROCORTISONE 1.0-PERCENT CREAM IN THE TREATMENT OF CHILDHOOD ATOPIC-DERMATITIS JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Vernon, H. J., Lane, A. T., Weston, W. 1991; 24 (4): 603-607

  Abstract

  We conducted a 6-week randomized, blinded study that compared mometasone furoate 0.1% cream, applied once daily, and hydrocortisone 1.0% cream, applied twice daily, in 48 children with moderate to severe atopic dermatitis. Mometasone furoate, a moderate-potency steroid, produced significantly greater improvement than the low-potency hydrocortisone used twice daily. The difference in therapeutic response was particularly evident in patients with involvement of more than 25% of their body surface area. Morning plasma cortisol levels were assayed before treatment, after 1 week of therapy, and at the end of the clinical trial. Plasma cortisol levels were transiently suppressed in one child who was treated with hydrocortisone and in none of the children treated with mometasone.

  View details for Web of Science ID A1991FD90300016

  View details for PubMedID 2033138

• SEMIPERMEABLE DRESSINGS ON PREMATURE-INFANTS SKIN REDUCE BACTERIAL COLONIES AND DO NOT ALTER BACTERIAL TYPE STUART, S. M., LANE, A. T., MICKELSEN, P. A. BLACKWELL PUBLISHING INC. 1991: 573

  View details for Web of Science ID A1991FE59100274

• SEMIPERMEABLE DRESSINGS ON PREMATURE-INFANTS SKIN REDUCE BACTERIAL COLONIES AND DO NOT ALTER BACTERIAL TYPE STUART, S. M., LANE, A. T., MICKELSEN, P. A. SLACK INC. 1991: A509

  View details for Web of Science ID A1991FH32302099

• INTRAEPITHELIAL ANCHORING FIBRIL COMPONENTS ARCHIVES OF DERMATOLOGY GOLDSMITH, L. A., MCCOON, P., PARTRIDGE, A., LANE, A. T. 1991; 127 (1): 53–56

  View details for DOI 10.1001/archderm.127.1.53

  View details for Web of Science ID A1991ET99000006

• SEMIPERMEABLE DRESSING AND TRANSEPIDERMAL WATER-LOSS IN PREMATURE-INFANTS PEDIATRICS VERNON, H. J., LANE, A. T., WISCHERATH, L. J., DAVIS, J. M., MENEGUS, M. A. 1990; 86 (3): 357–62

  Abstract

  Within the first days of life, 10 infants, of 32 weeks' gestational age or less, began 2 weeks of treatment with a semipermeable wound dressing over a small area of skin. The effects of the dressing on transepidermal water loss and cutaneous microflora were evaluated. Transepidermal water loss from the semipermeable dressing-treated skin was significantly less than that from the untreated skin immediately after placement of the dressing (8.1 +/- 1.8 g/m2.h-1 vs 17.7 +/- 3.5 g/m2.h-1, P less than .0001). The normal accelerated skin maturation process that occurs in these infants continued beneath the semipermeable dressing. The number of gram-negative bacilli or other bacteria did not increase beneath the semipermeable dressing beyond that seen on the untreated site. Malassezia furfur was found only on the control site, never beneath the semipermeable dressing. According to results of this preliminary study, a semipermeable dressing can be safely used in premature infants and the use of a semipermeable dressing may decrease the excessive transepidermal water loss associated with prematurity.

  View details for Web of Science ID A1990DW64600005

  View details for PubMedID 2388784