Dermatology 2019 Projects

Project Title: Allergen-specific immunotherapy in subjects with atopic dermatitis and allergic asthma

Faculty Mentor’s Name: Dr. Anna De Benedetto

Student’s Name: Patrick Rizk

Project Description

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease. Importantly, AD is often the first manifestation for the so-called atopic march (i.e. asthma, food allergy, and allergic rhinitis). About 80% of subjects with AD have a high IgE level. Allergen-specific immunotherapy is routinely used for the management of allergic conditions, such as seasonal allergies and asthma as it can potentially be a disease modifying treatment option. Although recently benefits have also been found on those with atopic dermatitis, its use remains controversial.

Aims of this study include characterization of the population receiving this monoclonal antibody in the University of Florida for the treatment of AD or allergic asthma. A retrospective chart review will be performed to investigate the effect of immunomodulatory therapy in subjects with allergic asthma or atopic dermatitis over the past 3 years.

We will look at the effect of several variables (e.g. sex, body mass index, initial total IgE or skin test results, allergic comorbidities and AD or asthma severity) and their relations with clinical outcomes. We will also investigate the effect a biologic medication dupilumab (targeting key Th2 cytokine IL4 and IL13) on immunotherapy. While dupilumab was is FAD approved for moderate to severe AD and moderate to severe asthma with eosinophilic type or oral corticosteroid dependent asthma. It is our goal to investigate if dupilumab has an effect on in vivo or in vitro sensitization on atopic subjects receiving dupilumab for either atopic condition.

For this project the medical student will be involved in obtaining the necessary IRB approval for the study, perform chart review and data collection in the REDcap system, data analysis and draft of a manuscript. The student will also have the opportunity to closely work with the mentors to write a review article summarizing current knowledge and gaps in the impact of immunomodulatory therapy in fields of allergy and dermatology.

Zhu R, Yang L; 2017
Boyle RJ, et al.; 2016.

Co Mentor: Mario Rodenas, MD
Assistant Professor, Allergy & Clinical Immunology

Project Title: Tissue preservation and wound scar orientation using the circular defect with dog-ear deformities (CDDE) excision technique vs traditional fusiform excision

Faculty Mentor’s Name: Dr. Maria Longo

Student’s Name: Ali Malik

Project Description:

The standard of care for the majority of localized, non-superficial forms of cutaneous malignancies is surgical excision. Although the excision technique may vary (standard excision vs Mohs micrographic surgery), the most widely employed reconstruction technique for simple closure involves the design of a fusiform defect that has a length-to-width ratio of 3 to 1 and produces a 30-degree angulation at both edges of the wound. This pre-planned reconstruction is intended to decrease wound tension, allowing for easier advancement of the wound skin edges and eliminating the puckering of the skin at the corners, the “dog-ear deformity”.

The orientation of the fusiform excision is planned following the lines of tension, but many times the defect may acquire a different orientation due to the tension derived from the underlying muscular structures. This is difficult to predict from the apparent wrinkling of the skin that gives the orientation of the lines of tension.

There is evidence that the circular defect with dog ear deformities (CDDE) technique might be a better option for reconstructing defects as it spares a significant amount of normal skin (14 21%).1,2 The CDDE technique entails excising a skin tumor in a circular fashion with the use of the dog ear repair to correct the corner deformity. It has also been shown that the scar orientation differs between the projected fusiform excision to the final reconstruction after circular excision in 22-45% of the cases.1,2 Despite the evidence, the majority of dermatologic surgeons and other specialists performing simple cutaneous excisions still prefer the fusiform excision over the CDDE technique. Published studies have not included more than 51 patients and there has not been a systematic correlation between the main outcomes (shorter scar length and scar orientation) and variables pertinent to the patients demographic data or the tumor location.

We hypothesize that the circular defect with dog ear deformities (CDDE) technique can spare more normal tissue compared to the classic fusiform excision, especially in certain areas like the trunk, therefore, minimizing the risks associated with larger surgical wounds such as hemorrhage and infection and improving cosmesis with a shorter surgical scar. Additionally, the primary excision with a circular defect may allow better visibility of the real tension of the skin as the defect will acquire the shape following the maximum tension lines. Optimal alignment of the scar with the skin tension lines will minimize wound dehiscence, especially in areas around the joints or the back.