2024-03-29T13:49:04Zhttps://escholarship.org/oaioai:escholarship.org:ark:/13030/qt1q91h62d2024-03-20T16:23:49Zqt1q91h62dErythema gyratum repens-like presentation of folliculotropic mycosis fungoidesHida, YasutoshiNakano, RihoYuasa, RyougaMaehama, KannaYamashita, MichikoUrano, Yoshio2024-01-01erythema gyratum repensfolliculotropicgamma chainimmunohistochemistrymycosis fungoidespolymerase chain reactionT cell receptorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1q91h62darticleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt51w7973d2024-03-20T16:23:47Zqt51w7973dElectronic consultation in supportive oncodermatology: a single center retrospective cohortBetancourt, Nicolas JJohnson, Austin NClawson, Rebecca CKo, Justin MRana, Jasmine K2024-01-01cancerconsultationdermatologydermato-oncologyeconsultoncodermatologyteledermatologyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/51w7973darticleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt8x71108d2024-03-20T16:23:44Zqt8x71108dJellyfish envenomation with delayed hypersensitivity and concurrent SARS-CoV-2 infectionCheema, Karan SJohanis, MichaelYoung, Peter ABae, Gordon H2024-01-01Cnidariaconcurrent viral infectionCOVID-19delayed hypersensitivityenvenomationjellyfishnematocystsSARS-CoV-2WaikikiHawaiiapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8x71108darticleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt2fj887j52024-03-20T16:23:43Zqt2fj887j5Three cases of Anti-MDA5 positive dermatomyositis with interstitial lung disease and pneumomediastiumFigueiredo, CarolinaMatos, Ana LuisaCalvao, JoanaGoncalo, Margarida2024-01-01anti-MDA5anti-RO52antibodydermatomyositispneumodiastinumapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2fj887j5articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt3pr6235s2024-03-20T16:23:41Zqt3pr6235sArtificial intelligence in dermatology: GPT-3.5-Turbo demonstrates strengths and limitations in residency examsHaynes, DylanLewis, WilliamJariwala, Neha N2024-01-01artificial intelligencebasicChatGPTexamtestapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3pr6235sarticleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt1qk2138z2024-03-20T16:23:40Zqt1qk2138zAdvancing dermatology education with AI-generated images.Breslavets, MaksymBreslavets, DenysLapa, Tatiana2024-01-01AI generatedartificial intelligencegenerative adversarial networksimagesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1qk2138zarticleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt83r9c4qv2024-03-20T16:23:37Zqt83r9c4qvOsteonecrosis of the jaw after radiation followed by bevacizumabPark, LilyVasile, GabriellaHensley, HeatherBuckley, Christopher2024-01-01Osteonecrosis of the jaw is a recognized complication associated with bevacizumab. Here, we present a patient with squamous cell carcinoma of the tonsil who experienced minimal skin fibrosis following intensity-modulated radiation therapy. Subsequently, the patient developed rectal adenocarcinoma and encountered osteonecrosis of the jaw after receiving two cycles of bevacizumab. Close monitoring, accompanied by thorough examination to detect early signs of osteonecrosis of the jaw, should be considered for patients who have undergone radiation therapy in the head and neck region and are receiving bevacizumab or other medications known to be associated with osteonecrosis of the jaw.bevacizumabjawmedication-relatedosteonecrosisosteoradionecrosisradiationapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/83r9c4qvarticleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt846053fq2024-03-20T16:23:36Zqt846053fqMilia en plaque on the shoulder as an early manifestations of mycosis fungoidesRodrigues, Felipe TavaresCabral, Gabriela Coutinho Coutinho ChequerAlvim, Priscilla Filippo de Minas FilippoJunior, Dirceu David de Andrade DavidCiganha, Leonardo SeixasLeal, Juliana MartinsScotelaro, Maria de Fatima GuimarãesGripp, Alexandre Carlos2024-01-01Milia en plaque (MEP) is an uncommon skin condition identified as retroauricular confluent milium by Boulzer and Fouqet in 1903 [1]. It can be mistaken for other dermatoses like Favre-Racouchot nodular elastosis, steatocystoma multiplex, and nevus comedonicus. Milia en plaque can either be primary or secondary and is typically benign, often triggered by dermatological procedures like cryotherapy, as reported in this journal. In some cases, MEP can arise as a secondary manifestation of other diseases, including folliculotropic mycosis fungoides (FMF). Despite this association, there are few documented cases in the literature. Herein, we present a patient in whom MEP served as the initial clinical presentation of FMF; the treatment involved oral retinoids and phototherapy. Furthermore, we highlight distinctive features of both conditions. It is important to emphasize that early diagnosis and treatment of FMF are vital for the patient's quality of life. The presence of MEP can serve as a valuable indicator for identifying it.miliamycosis fungoideslymphomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/846053fqarticleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt0gt361tg2024-03-20T16:23:34Zqt0gt361tgCongenital liquified subcutaneous fat necrosis in a newborn: an unusual caseRegaieg, ChirazThabet, Afef BenKolsi, NadiaSellami, KhadijaTurki, HamidaCharfi, ManelHmida, Nedia2024-01-01Subcutaneous fat necrosis of the newborn is a self-limited disorder of the panniculus that arises in the first six weeks of life. Some differential diagnoses may be difficult such as bacterial cellulitis or erysipelas. The prognosis is usually favorable but there are serious complications for which the patient must be regularly monitored, especially hypercalcemia. We report a case of a full-term newborn with a liquidated area of subcutaneous fat necrosis. A surgical incision was performed because of the discomfort and the lack of regression. Hypercalcemia and nephrocalcinosis appeared afterward. A set of clinical, biological, and histological arguments allows the diagnosis of subcutaneous fat necrosis. Follow-up to early detection and to manage such complications is necessary.fat necrosishypercalcemianewbornsubcutaneous surgeryapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0gt361tgarticleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt57q552jp2024-03-20T16:23:32Zqt57q552jpStevens-Johnson syndrome/toxic epidermal necrolysis associated with natural thyroid medicationObagi, SabineObagi, ZaidalThiede, Rebecca2024-01-01Steven-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) is a rare immunologic hypersensitivity reaction to stimuli that presents as widespread eruption with mucocutaneous detachment and involvement of other organs. Multiple causes have been noted in literature, including numerous medications. In this report, we present a 52-year-old woman who arrived at the emergency department with a complaint of rash, malaise, and pruritus. She subsequently developed diffuse cutaneous and mucosal detachment. Work-up supported a diagnosis of SJS/TEN secondary to her thyroid replacement therapy, derived from desiccated pig thyroid glands. The patient's natural thyroid medication was discontinued and she responded well to appropriate treatment. This case is unique in that thyroid replacement therapy is not a commonly reported trigger of SJS/TEN. Providers should be aware of the potential for natural thyroid and other animal-derived natural medications to cause adverse reactions such as SJS/TEN.animaldrugmedicationnaturalpigrashreactionSJSTENthyroidapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/57q552jparticleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt43w6t0pz2024-03-20T16:23:30Zqt43w6t0pzVerrucous carcinoma presenting as recalcitrant verruca plantarisHornback, Cheyenne JWeinberger, Christine H2024-01-01Verrucous carcinoma (VC) is a rare, low-grade variant of well-differentiated squamous cell carcinoma. Plantar verrucous carcinoma presents as a slow-growing, exophytic, verrucous plaque on weight bearing areas of the foot. Verrucous carcinomas have low metastatic potential, but are high risk for local invasion. We describe a patient with a 20-year history of a slowly growing, ulcerated, verrucous plaque on the sole of the left foot that was erroneously treated for years as verruca plantaris and was eventually diagnosed as invasive verrucous carcinoma. Verrucous carcinomas are a diagnostic challenge due to clinical and histopathologic mimicry of benign lesions. Mohs micrographic surgery should be employed to allow the ability to intraoperatively assess tumor margins while excising the minimal amount of necessary tissue. It is important for clinicians to recognize the characteristics and accurately diagnose verrucous carcinomas. Delays in treatment may require more extensive dissection or amputation.cuniculatum plantareepitheliomaMohs surgeryverruca plantarisverrucous carcinomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/43w6t0pzarticleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt6nd6w2f52024-03-20T16:23:29Zqt6nd6w2f5Fast and safe clinical response to sonidegib in a 98-year old woman affected by locally advanced basal cell carcinomaMason, ElenaPascucci, EnricoSchena, DonatellaGirolomoni, Giampiero2024-01-01A 98-year-old woman presented with histologically confirmed locally advanced basal cell carcinoma of the face. A multidisciplinary approach excluded surgery because of the site near sensitive organs, extension, age, and comorbidities. Patient and caregivers declined radiotherapy considering the necessity of multiple hospital appointments. The patient was then placed on therapy with sonidegib, an oral inhibitor of the Hedgehog signaling pathway. There was a very rapid clinical response after only 28 days of treatment. The basal cell carcinoma improved progressively, with no adverse events reported. This case illustrates the efficacy and safety of this treatment in an advanced age patient. This treatment had a remarkably positive impact on quality of life, including that of the caregivers.advanced carcinomabasal cellfaceHedgehog inhibitorsonidegibapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6nd6w2f5articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt1wr1d18m2024-03-20T16:23:27Zqt1wr1d18mMultiple juvenile xanthogranulomataGarcia-Sirvent, LuciaEspineira-Sicre, JoaquinRuiz-Sanchez, JuanCuesta-Montero, Laura2024-01-01Juvenile xanthogranuloma is the most frequent form of non-Langerhans cell histiocytosis in children. Clinically, it presents as well defined, yellowish papules that are typically located on the head, neck, upper trunk, and proximal region of the extremities. Although solitary lesions are the most common presentation, few cases of multiple juvenile xanthogranuloma have been described, more frequently associated with extracutaneous involvement. We report a 2-month-old girl with 22 cutaneous papules, clinically and histologically compatible with juvenile xanthogranulomas. Screening of visceral involvement was performed with no evidence of systemic disease. Identifying high-risk factors of systemic disease in patients with multiple juvenile xanthogranuloma is essential to perform an appropriate management of this entity.histiocytosisjuvenile. myelomonocytic leukemiamultiple xanthogranulomaneurofibromatosissystemic diseaseapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1wr1d18marticleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt7sr3b07h2024-03-20T16:23:26Zqt7sr3b07hSpindle cell lipoma: a rare case report on the halluxLiu, Caroline CSchulman, Joshua MDahle, Sara EAlley, Shelby M2024-01-01Spindle cell lipomas are a rare type of lipoma usually presenting in middle-aged to older men, often located on the posterior neck or shoulder; presentation on the foot is exceptionally uncommon. We report a 24-year-old man with spindle cell lipomas on the hallux of his left foot. He experienced an uneventful recovery after excision of the mass. We discuss clinical, radiologic, and histopathologic features of spindle cell lipomas and we review the differential diagnosis at this anatomic site.atypical lipomafoothalluxrare diseasessoft tissue massspindle cellapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7sr3b07harticleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt9q97x41f2024-03-20T16:23:24Zqt9q97x41fPatients with a new-onset cutaneous sebaceous neoplasm following immunosuppression should be evaluated for Muir-Torre syndrome with germline mismatch repair gene mutation analysis: case reportsCohen, Philip RKurzrock, Razelle2024-01-01Patients with Muir-Torre syndrome may have a systemic malignancy and a sebaceous neoplasm such as an adenoma, epithelioma, and/or carcinoma. The syndrome usually results from a germline mutation in one or more mismatch repair genes. Iatrogenic or acquired immunosuppression can promote the appearance of sebaceous tumors, either as an isolated event or as a feature of Muir-Torre syndrome and may unmask individuals genetically predisposed to the syndrome. Two iatrogenically immunosuppressed men with Muir-Torre syndrome features are described. Similar to these immunocompromised men, Muir-Torre syndrome-associated sebaceous neoplasms have occurred in solid organ transplant recipients, human immunodeficiency virus-infected individuals, and patients with chronic diseases who are treated with immunosuppressive agents. Muir-Torre syndrome-associated sebaceous neoplasms occur more frequently and earlier in kidney recipients, who are receiving more post-transplant immunosuppressive agents, than in liver recipients. The development of sebaceous neoplasms is decreased by replacing cyclosporine or tacrolimus with sirolimus or everolimus. Specific anti-cancer vaccines or checkpoint blockade immunotherapy may merit exploration for immune-interception of Muir-Torre syndrome-associated sebaceous neoplasms and syndrome-related visceral cancers. We suggest germline testing for genomic aberrations of mismatch repair genes should routinely be performed in all patients-both immunocompetent and immunosuppressed-who develop a Muir-Torre syndrome-associated sebaceous neoplasm.adenomacarcinomaepitheliomagermlinemicrosatellite instabilitymismatch repairMuir-Torre syndromeneoplasmsebaceoussomaticapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9q97x41farticleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt3z30h45r2024-03-20T16:23:23Zqt3z30h45rInfliximab-induced amicrobial pustulosis of the folds in a patient with Crohn diseaseMeyer, Summer NMyers, BridgetCaro-Chang, Leah AntoinetteTartar, Danielle MWu, PeggyKiuru, MaijaToussi, Atrin2024-01-01Tumor necrosis factor (TNF) inhibitors may paradoxically induce pustular eruptions, most of which are classified as pustular psoriasis. Amicrobial pustulosis of the folds (APF) is a much rarer entity that was recently recognized to occur in the setting of chronic anti-TNF therapy and inflammatory bowel disease, with 12 existing cases in the literature. Amicrobial pustulosis of the folds is a neutrophilic dermatosis characterized by aseptic pustules involving the major and minor skin folds, genital regions, and scalp. Herein, we report an additional case of paradoxical APF induced by chronic infliximab therapy in a patient with Crohn disease.Crohn diseaseinfliximabinflammatory bowel diseasepustulosisTNF inhibitorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3z30h45rarticleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt5836f5db2024-03-20T16:23:21Zqt5836f5dbBasal cell carcinoma in situ of the skin revisited: case reports of the superficial type and fibroepithelioma type of this in situ cutaneous neoplasmCohen, Philip R2024-01-01Cutaneous basal cell carcinoma in situ is a recently proposed subtype of this skin cancer. It is characterized by either restriction of the tumor cells within the epidermis or the presence of tumor cells contiguous with the overlying epidermis that extend into the underlying dermis, or both. Importantly, cancer invasion-demonstrated by non-contiguous aggregates of basaloid tumor cells in the dermis-is not a feature of in situ basal cell carcinoma of the skin. A 63-year-old woman with cutaneous basal cell carcinoma in situ-superficial type that presented as an erythematous scaly plaque on her abdomen and a 61-year-old man with a cutaneous basal cell carcinoma in situ-fibroepithelioma type that presented as a flesh-colored smooth exophytic nodule on his back are reported. The characteristics of in situ basal cell carcinoma of the skin in these individuals are summarized. In conclusion, similar to other cutaneous malignant neoplasms-such as squamous cell carcinoma, malignant melanoma, and Merkel cell carcinoma-basal cell carcinoma of the skin can also present as an in situ cancer.basalcarcinomacellcancercutaneousfibroepitheliomain situneoplasmsuperficialapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5836f5dbarticleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt45n0r4h12024-03-20T16:23:20Zqt45n0r4h1Successful secukinumab treatment of generalized pustular psoriasisGuo, Heng-ShanZhou, Xiu-LianChen, Hong-HuiHu, TingLiu, Min-HongLiu, Fang-YanMa, Li-LiLi, Wei-Quan2024-01-01Generalized pustular psoriasis is a rare variant of psoriasis. Evidence recommending generalized pustular psoriasis treatment with secukinumab is limited. This report aims to evaluate the use of secukinumab in two patients with generalized pustular psoriasis. The standard treatment regimen for secukinumab was as follows: 300mg subcutaneously once weekly in weeks 0-4, followed by 300mg every four weeks. The efficacy was evaluated by analyzing the psoriasis area and severity index (PASI) and dermatology life quality index (DLQI). One patient had generalized pustular psoriasis, which had developed from palmoplantar pustulosis over 12 years. The second patient was an adolescent with recurrent generalized pustular psoriasis. The first patient achieved PASI-75 response by week 3 and both PASI-90 and a DLQI score of 0 were observed by week 8. The second patient achieved PASI-75 response by week 4 and complete clinical resolution, except for nail changes, and a DLQI of 0 by week 8, without any adverse events.generalizedpustular psoriasissecukinumabapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/45n0r4h1articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt0vj409562024-03-20T16:23:19Zqt0vj40956A confounding clinically aggressive case of necrotizing granulomatous and suppurative dermatitisBormann, Jordan LPetersen, Marta JSontheimer, Richard DZussman, Jamie2024-01-01Superficial granulomatous pyoderma gangrenosum is a rare, superficial, vegetating form of pyoderma gangrenosum that tends to occur as a single lesion, most commonly on the trunk. Herein, we report a clinically confounding case of disseminated superficial granulomatous pyoderma gangrenosum in a patient with a 5-year history of painful and chronic ulcerations of the bilateral upper extremities and face in a sun exposed distribution. This was a diagnostically challenging case due to the treatment-refractory nature of our patient's skin lesions and the atypical clinical and histologic presentations encountered. We review our clinical decision process and acknowledge other entities that were considered during the clinical course of this case. Additionally, we discuss the lack of responsiveness to various treatment options with eventual successful clearance of this patient's active skin disease with initiation of adalimumab.granulomatous dermatitispyoderma gangrenosumsuperficialsuppurativeapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0vj40956articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt40k8c3jk2024-03-20T16:23:17Zqt40k8c3jkRetronychia: the importance of proper footwearRiopelle, Alexandria MRajanala, SusruthiKhan, SaaraKosuru, Sindhu BBryant, BriaAdigun, Chris GKuchnir, Louis2024-01-01Retronychia is commonly underdiagnosed and exhibits classic features of proximal nail fold elevation and nail plate layering. Herein we summarize the literature and discuss cause, diagnosis, and treatment of this condition.avulsionparonychiapreventionretronychiatreatmentapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/40k8c3jkarticleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt26b4s0sh2024-03-20T16:23:15Zqt26b4s0shClinical features of atypical presentations of mucocutaneous herpes simplex virus infection observed in immunosuppressed individuals. Part II: the knife-cut signCohen, Philip R2024-01-01The knife-cut sign is a distinctive manifestation of herpes simplex virus (HSV) type 1 or HSV type 2 infection that has been described in at least 10 immunocompromised patients. It appears as an extremely painful linear erosion or fissure in an intertriginous area such as the body folds beneath the breast, or within the abdomen, or in the inguinal region. Also, concurrent HSV infection at other mucocutaneous sites, or viscera, or both have been observed. The patients had medical conditions (at least 9 patients) and/or immunosuppressive drug therapy (6 patients). The diagnosis of HSV infection was confirmed by viral culture (8 patients), biopsy (4 patients), direct fluorescence antibody testing (3 patients), immunohistochemistry staining (2 patients), polymerase chain reaction (2 patients), or Western blot serologic assay (1 patient). Knife-cut sign-associated HSV infection is potentially fatal; three patients died. However, clinical improvement or complete healing occurred in the patients who received oral valacyclovir (1 patient), or intravenous acyclovir (2 patients), or intravenous acyclovir followed by foscarnet (1 patient). In summary, HSV infection associated with a positive the knife-cut sign is a potentially fatal variant of HSV infection that occurs in the intertriginous areas of immunocompromised patients and usually requires intravenous antiviral therapy.brainCrohndiseaseencephalitisHermanskyherpesherpeticknife-cutimmunocompromisedneurosyphilisPudlaksignsimplexsyndromevirusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/26b4s0sharticleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt0k50k8732024-03-20T16:23:15Zqt0k50k873Clinical features of atypical presentations of mucocutaneous herpes simplex virus infection observed in immunosuppressed individuals. Part I: herpetic geometric glossitisCohen, Philip R2024-01-01Herpetic geometric glossitis is a unique morphologic variant of HSV (herpes simplex virus) type 1 infection on the dorsum of the tongue that presents as an extremely painful linear central lingual fissure with a branched pattern. in the center of the tongue; there is a branched pattern of fissures that extend bilaterally from the central linear fissure. Herpetic geometric glossitis has been reported in 11 patients; 8 of these individuals were immunocompromised. Medical conditions and immunosuppressive medication treatment (7 patients) or only medical disorders (3 patients) or neither (1 patient) were present. HSV type 1 infection was diagnosed by viral culture in (7 patients), Tzanck preparation (2 patients) or clinically (2 patients). Mucocutaneous HSV infection at non-lingual locations--including the lips, labial mucosa, face and chest--were observed in 5 patients. All patients' symptoms and lesions responded to treatment with oral antiviral therapy: acyclovir (9 patients), famciclovir (1 patient) or valacyclovir (1 patient). The lingual pain and dorsal tongue fissures completely resolved completely within two to 14 days. In summary, herpetic geometric glossitis is a unique HSV type 1 infection, usually in immunocompromised patients, that occurs on the dorsal tongue and responds completely after treatment with orally administered antiviral therapy.branchedfissureherpesherpeticgeometricglossitisimmunocompromisedinfectionlinearlinguallongitudinalpainfulsimplextonguevirusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0k50k873articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt0vh549nr2024-01-24T19:43:35Zqt0vh549nrSpontaneous, long-lasting re-pigmentation of grey hair: an association with psychoemotional stress reliefSevilla, AlecPicard, MartinHoresh, Elijah JRajabi-Estarabadi, AliPaus, Ralf2023-01-01greyinghairmelanocytepigmentationpsychodermatologystressapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0vh549nrarticleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt8hf3h0812024-01-24T19:43:33Zqt8hf3h081Provider language proficiency information on dermatology residency program web sitesOlsen, EricCastanedo-Tardan, Mari Paz2023-01-01dermatologistinternetlanguage barrierproficiencysurveyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8hf3h081articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt8d68f7tc2024-01-24T19:43:31Zqt8d68f7tcActinic comedonal plaque sine elastosis: a rare presentation or a hitherto unexplored variant of comedonal plaque in skin of color?Hilts, AlexisGhosh, KisalayBehera, BiswanathBrodell, RobertVerma, Shyam Bhanushankar2023-01-01actinic comedonaldamageFavre Racouchotplaquesolar elastosisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8d68f7tcarticleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt9px8n48q2024-01-24T19:43:29Zqt9px8n48qPainful subcutaneous nodules in an alcoholic: a case of pancreatic panniculitisCortes, MarianneSmirnov, Brittany P2023-01-01Pancreatic panniculitis is an uncommon manifestation of pancreatic disease, affecting approximately 2-3% of patients with acute or chronic pancreatitis [1]. Its accurate diagnosis is crucial for effective treatment as skin manifestations usually precede systemic symptoms of pancreatitis. The diagnosis of pancreatic panniculitis requires identifying and confirming pancreatic disease in addition to the typical histopathological findings of lobular panniculitis without vasculitis. Herein, we present a patient with pancreatic panniculitis, underlying acute pancreatic failure, and kidney injury.necrosispancreatitispanniculitissubcutaneous nodulesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9px8n48qarticleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt1kj3x7x72024-01-24T19:43:28Zqt1kj3x7x7A widespread blistering eruption: diffuse cutaneous mastocytosisEwulu, AdaoraCardis, Michael ACarter, Melody CHabeshian, Kaiane A2023-01-01Diffuse cutaneous mastocytosis with bullous formation is a rare childhood disease. We report a 5-month-old male who presented with a 3-week history of cutaneous bullae and pruritus. On examination, he had erythema of the cheeks bilaterally and diffuse slightly hyperpigmented, indurated skin on his trunk and abdomen. There were tense vesicles, bullae, and erosions linearly arranged on his trunk and extremities. Both the laboratory and imaging workup were normal. Subsequently, a punch biopsy of a vesicle on the abdomen was obtained and findings confirmed a diagnosis of diffuse cutaneous mastocytosis. An EpiPen(r) was prescribed due to the slightly increased anaphylaxis risk compared to other forms of mastocytosis. There are many purported triggers of diffuse cutaneous mastocytosis and there is currently no known cure which makes management of this disease challenging. This case highlights a rare condition for which official treatment guidelines do not exist. A prompt dermatologic diagnosis is necessary to ensure proper workup and regulation is in place.bullaecutaneousmast cellmastocytosispediatricapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1kj3x7x7articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt9dz0x4q52024-01-24T19:43:26Zqt9dz0x4q5Is orofacial granulomatosis a distinct clinical disorder?Jackson, Tiaranesha KSow, Yacine NWachuku, ChristopherBarrera, Tatiana MOmueti-Ayoade, KatherineChu, EmilyTaylor, Susan CMollanazar, Nicholas2023-01-01Orofacial granulomatosis is a rare disorder that is heterogeneously defined in the published literature. Herein, we describe a patient with orofacial granulomatosis with clinical and histologic evidence, discuss differential diagnoses, and offer clinical pearls for diagnosing and assessing this disorder. Our case provides support that orofacial granulomatosis is a distinct disorder as opposed to a sequela of other systemic granulomatous diseases. This information will aid dermatologists in decision making and diagnosing the disorder.granulomagranulomatous cheilitisMelkersson-Rosenthalorofacial granulomatosisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9dz0x4q5articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt35g1j48f2024-01-24T19:43:24Zqt35g1j48fSymptomatic perineural and intraneural invasion of the trigeminal nerve and subsequent abducens Nerve palsy by cutaneous squamous cell carcinomaWinsett, Frank TArmenta, Andrew MGleghorn, Kristyna LGoodwin, Brandon PKelly, Brent CWagner, Richard F2023-01-01A 74-year-old woman who presented initially with trigeminal neuralgia of the left forehead and scalp was later found to have a poorly differentiated squamous cell carcinoma (SCC) with large-nerve perineural and intraneural invasion of the left supraorbital nerve. Negative histopathologic margins were achieved in three stages of permanent fixed tissue en face processing and the final defect was repaired with a large rotation flap. Approximately one month after repair, the patient presented with new-onset diplopia and was found to have a complete left cranial nerve VI palsy suspicious for continued disease spread. MRI confirmed perineural spread along the ophthalmic branch of the trigeminal nerve through the superior orbital fissure into the cavernous sinus. She was subsequently treated with radiation therapy (66Gy in 33 fractions). The involvement of two distinct cranial nerves by perineural invasion is uncommon and has mostly been described involving branches of the trigeminal and facial nerves. This case highlights the rare presentation of perineural invasion involving both the trigeminal nerve and the abducens nerve. Anatomically, this clinical presentation can be explained by the retrograde perineural spread along the ophthalmic branch of the trigeminal nerve through the supraorbital fossa into the cavernous sinus where these two nerves are in close proximity.abducens nervecarcinomaperineural invasionspreadsquamous celltrigeminalapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/35g1j48farticleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt8jg938302024-01-24T19:43:23Zqt8jg93830Cutaneous erythematous lupus with acneiform presentationCaputo, Gabriela CBartos, Carolina SHPagliari, CarlaCriado, Paulo R2023-01-01We present a 57-year-old woman with cutaneous lupus erythematosus (CLE), initially treated as acne. She noted blemishes, including nodules and facial swelling for nine months associated with discrete itching of the ears. Examination showed multiple malar nodules, comedones, pustules, atrophic scars, and hyperpigmentation. A biopsy was performed and revealed atrophic epidermis, discrete hyperkeratosis, vacuolar degeneration of basal layer, basal membrane zone with upper dermal lymphohistiocytic inflammatory infiltrate and deep perivascular and peri-adenexal lymphocytes, vascular ectasia, and mucin deposits. The acneiform presentation of CLE is commonly underdiagnosed due to the similarity with inflammatory acne. Histopathologic diagnostic in acneiform lupus is of extreme importance. This case emphasizes the relevance of knowing the notable variety of presentations of CLE and considering this diagnosis.acnelupusskinapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8jg93830articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt77f7z8082024-01-24T19:43:21Zqt77f7z808Recurrence of non-sexually acquired acute genital ulceration following COVID-19 vaccinationWaterman, Christy LAronson, Iris K2023-01-01There is a rare subset of non-sexually acquired acute genital ulcers, previously called Lipschutz ulcers, that are often preceded by a constitutional prodrome and have been associated with multiple viral and bacterial infections. These ulcers are categorized by some as a variant of complex aphthosis, with one hypothesized etiology involving a non-specific systemic inflammatory response to acute infection or vaccination. Although painful, these lesions resolve over the course of several weeks and recurrence is rare but possible. Recently, there have been reports of genital ulcer development due to either acute infection with COVID-19 or following vaccination against the same. We report a case of non-sexually acquired acute genital ulceration that initially presented in 2008 as Lipschutz labial ulcers associated with acute Epstein-Barr virus infection, with recurrence twelve years later following administration of the second dose of the Pfizer-BioNTech COVID-19 vaccine. This case report and exhaustive literature review challenges widely accepted views regarding the typical age range of patients affected by non-sexually acquired acute genital ulceration, the sexual history of affected populations, the pathophysiology of lesion occurrence, and possibility of lesion recurrence.Lipschultzrecurrenceulcerationvaccinationapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/77f7z808articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt1h2913p12024-01-24T19:43:20Zqt1h2913p1A case of filgrastim-induced neutrophilic dermatosis of the dorsal hands in a patient with Felty SyndromeJoshi, Tejas PDokic, YelenaVerstovsek, GordanaRosen, Theodore2023-01-01Neutrophilic dermatosis of the dorsal hands (NDDH) is a variant of Sweet syndrome that presents with erythematous bullae, papules/plaques, or pustules on the dorsal hands. It is most commonly associated with hematologic and solid organ malignancies, though cases of NDDH associated with inflammatory bowel disease, rheumatologic disorders, and medication exposure have also been described in the literature. Felty syndrome is a rare complication of long-standing rheumatoid arthritis characterized by neuropathy, splenomegaly, and neutropenia. Granulocyte colony stimulating factors (e.g., filgrastim) can be utilized to rescue the neutropenia observed in Felty syndrome, but this treatment may subsequently cause Sweet syndrome. Herein, we present a 64-year-old man with Felty syndrome and a complex medical history who presented with sudden onset, painful blisters located on the dorsal and palmar aspects of his bilateral hands. Given the patient's past medical history, a broad differential diagnosis, including disseminated fungal and viral infection was initially considered. A punch biopsy of the skin lesion disclosed neutrophilic dermatosis, which together with laboratory data satisfied the von den Driesch criteria for Sweet syndrome. As the lesions were localized exclusively on the patient's hands, the qualification of NDDH was also endorsed.Felty syndromerheumatoid arthritisSweet syndromeapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1h2913p1articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt88z197dr2024-01-24T19:43:18Zqt88z197drLinear discoid lupus erythematous simulating en coup de sabre morphea in a female chronic granulomatous disease carrierDao, Diem-PhuongSahni, Dev RamSontheimer, Richard D2023-01-01Discoid lupus erythematosus (DLE), a subtype of chronic cutaneous lupus may be observed in a linear pattern. A 21-year-old woman with history of chronic granulomatous disease state presented to our clinic for a chronic six-year skin eruption on her left eyebrow, left cheek, and left forehead. A punch biopsy of involved left forehead skin was performed and revealed perivascular and periadnexal lymphohistiocytic infiltrate without features of morphea or panniculitis, confirming the histopathologic changes of cutaneous lupus erythematous. The patient was diagnosed with linear DLE, mimicking en coup de sabre, within Blaschko lines. The pathogenesis for DLE in association with chronic granulomatous disease is ambiguous; however, X-linked lyonization is crucial for both conditions and may explain cooccurrence of disease states.Blaschko linesdiscoid lupusgranulomatous diseaselinear morphealupus erythematosusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/88z197drarticleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt0tq7m2sz2024-01-24T19:43:17Zqt0tq7m2szLupus erythematosus-specific bullous lesionsSmith, Kristin NMaddy, Austin JMotaparthi, Kiran2023-01-01Lupus erythematosus (LE)-specific bullous lesions are often difficult to distinguish from other bullous diseases presenting in patients with systemic lupus erythematosus. Herein, we describe a 49-year-old woman with systemic lupus erythematosus with recurrent tense bullae on the forearms. Clinical, histopathologic, and serologic findings led to the diagnosis of LE-specific bullous lesions. We also summarize the diagnostic clues for distinguishing LE-specific bullous lesions, bullous systemic lupus erythematosus, and erythema multiforme-like lesions in LE (Rowell syndrome).bullous lupusblistering diseaselupus erythematosusRowell syndromeapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0tq7m2szarticleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt3f95d3hj2024-01-24T19:43:15Zqt3f95d3hjLetterer-Siwe disease presenting with gastrointestinal and cutaneous manifestationsStadnikova, Antonina SergeevnaAbbas, Walaa FadhilTamrazova, Olga BorisovnaPristanskova, Ekaterina AndreevnaZakharova, Irina NikolaevnaBerezhnaya, Irina VladimirovnaSkobeev, Dmitry AlexandrovichGoncharova, Lyudmila Viktorovna2023-01-01Histiocytosis is a set of distinct proliferative illnesses defined by the proliferation and infiltration of varied numbers of dendritic cells, macrophages, and monocytes in the afflicted tissues. The skin and other organs may be impacted by the inflammatory infiltration. It can occur at any age. The severity of the symptoms can range from mild to severe, depending on the degree and type of organ involvement. Although certain forms of histiocytosis can be fatal, others can be treated successfully without sequelae. Langerhans cell histiocytosis manifests itself clinically in both children and adults. A combination of clinical, histological, and radiological tests is required to achieve a diagnosis. A severe, multisystemic, acute form of Langerhans cell histiocytosis is called Letterer-Siewe illness, which usually affects infants in their first year of life. In this article, we provide a brief literature review and a case study of a 9-month-old girl who presented with recurring gastrointestinal problems as the first sign of Letterer-Siwe disease.gastrointestinalhistiocytosisLangerhans cellLetterer-Siwe diseaseseborrheic dermatitisskin rashapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3f95d3hjarticleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt2v9044942024-01-24T19:43:14Zqt2v904494Linear IgA bullous dermatosis associated with immunotherapyMomin, BaharNguyen, Tue FGlade, DanielMesser, Alison2023-01-01Linear IgA bullous dermatosis (LABD) is a rare mucocutaneus blistering autoimmune disease caused by IgA autoantibodies. Its clinical manifestation can be indistinguishable from bullous pemphigoid (BP), a similar autoimmune bullous disease caused by IgG and IgE autoantibodies. Although BP has been reported as an adverse cutaneous effect of immunotherapy, LABD has rarely been associated with immunotherapy in the literature. We present the case of a 67-year-old woman with metastatic ovarian cancer receiving anti-PD1 and anti-CTLA4 with new onset pruritic tense bullae to the trunk, hands, elbows (in annular distribution) that occurred after immunotherapy. Skin biopsy showed subepidermal blister with abundant neutrophils on H&E histology, and linear IgA staining at the basement membrane on direct immunofluorescence consistent with the diagnosis of LABD. The condition did not improve on initial prednisone taper, but blisters rapidly resolved a few days after initiation of dapsone therapy. We favor that our patient's LABD is secondary to her immunotherapy. Our case highlights the importance of both H&E histology and direct immunofluorescence in diagnosis of blistering disorders in patients on immunotherapy to help in choosing the most effective treatment option in an attempt to avoid discontinuation of immunotherapy.bullous pemphigoiddermatopathologyendometrial cancerimmunotherapylinear IgAovarian cancerapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2v904494articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt2fn9d2tr2024-01-24T19:43:12Zqt2fn9d2trPediatric cutaneous mucormicosisMatei, Mariana ClaudiaRamirez, Sandra CastejonSanz, Sara SanzCazana, Tamara GraciaGomez, Concepcion LopezArnau, Neus MartinezAlonso, Matilde BustilloAlonso, Isabel Bernad2023-01-01A 9-year-old boy diagnosed with acute myeloblastic leukemia and undergoing chemotherapy, was admitted with febrile neutropenia. During his admission, several violaceous plaques appeared on the upper extremities and anterior left hemithorax, which worsened and acquired a necrotic center. We performed a biopsy and histology showed a cutaneous infarction at the dermoepidermal and subcutaneous level. We observed abundant wide hyphae with right-angled branching and a culture isolated Rhizopus oryzae. A plastic surgery consultant performed a surgical debridement of the lesions and treatment was started with intravenous amphotericin B. The patient did well on treatment and after almost a month of hospitalization, he was discharged with oral posaconazole. Mucormycosis is an opportunistic fungal infection associated with immunosuppression, particularly involving prematurity and hematological diseases in the pediatric age group. Multiple lesions, as in our case, are infrequent. The clinical presentation is variable. Direct smear or histological observation is the quickest diagnostic technique whereas culture is the most definitive. The combination of surgical debridement and amphotericin B is the treatment with the highest survival rates.amphotericin Bmucormycosisnecrotic plaquesRhizopus oryzaeapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2fn9d2trarticleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt277908hf2024-01-24T19:43:10Zqt277908hfCutaneous type IV hypersensitivity reaction following tebentafusp treatment for uveal melanomaFahmy, Lauren MSchreidah, Celine MMcDonnell, Diana ECarvajal, Richard DMagro, Cynthia MGeskin, Larisa J2023-01-01Tebentafusp is a bispecific protein that recently underwent FDA approval for the treatment of metastatic uveal melanoma that functions by redirecting cytotoxic T cells to glycoprotein-100, a protein highly expressed in melanoma. Although clinical trials have demonstrated that rashes are common in the first few days of treatment, little is known about skin reactions that develop later in the treatment course. Herein, we describe a type IV hypersensitivity reaction and vitiligo-like depigmentation that developed six weeks into treatment and discuss the possible mechanisms underlying these reactions. The type IV hypersensitivity reaction resolved without intervention within seven weeks of onset, suggesting that tebentafusp can be safely continued in select patients who develop this cutaneous reaction.depigmentationdrug reactionhypersensitivitytype IVuveal melanomavitiligoapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/277908hfarticleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt2863x96n2024-01-24T19:43:09Zqt2863x96nDisseminated blastomycosis with cutaneous involvement in a 57-year-old woman: a case report and review of managementStrain, JeremyHamm, CamilleShamsuyarova, AnastasiaGamble, David2023-01-01Blastomycosis is an infectious disease produced by the fungal organisms, Blastomyces dermatiditis and Blastomyces gilchristi. We present a 57-year-old woman with pulmonary blastomycosis and secondary cutaneous involvement. Her diagnosis was facilitated by dermatology consultation after approximately one year of delay. In endemic areas including Canada and the USA, individuals are at risk for blastomycosis when non-motile fungal spores are inhaled, thus producing pulmonary disease. The organism may disseminate over time, affecting a variety of extrapulmonary organ systems including the skin. In endemic regions of blastomycosis, this important cutaneous manifestation of disease should be considered with a high index of suspicion as to avoid delayed resolution and adverse outcomes.B. dermatiditisB. gilchristiblastomycescutaneous blastomycosisfungal infectionapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2863x96narticleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt693825g72024-01-24T19:43:08Zqt693825g7When a travel bug gets you down[SS1]: severe, hypotensive African tick bite fever and response to therapySaxena, Sarthak SinghZeidan, SofiaMeyer, SummerFung, Maxwell ATartar, Danielle M2023-01-01African tick bite fever, resulting from Rickettsia africae inoculation, is endemic in sub-Saharan Africa. We present a United States traveler with African tick bite fever 5 days after she returned from a mission trip to Zimbabwe. The patient exhibited symptomatic hypotension in addition to more typical findings, including fever, fatigue, and a necrotic eschar. The diagnosis was supported by histopathological findings and the patient's symptoms rapidly resolved with oral doxycycline therapy. We believe this case represents the first African tick bite fever diagnosis associated with symptomatic hypotension. This case additionally serves as a reminder of the importance of evaluating patient travel history.African tick. bite feverdermatologyinternationalRickettsia africaeapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/693825g7articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt1f85k8q32024-01-24T19:43:06Zqt1f85k8q3ChatGPT offers an editorial on the opportunities for chatbots in dermatologic research and patient careKim, Yong-HunZhang, Michael ZVidal, Nahid Y2023-01-01ChatGPT is a chatbot developed by OpenAI, an artificial intelligence research laboratory, that is trained on massive-scale internet text data to understand a broad range of language styles and topics. As a mature, conversational chatbot, ChatGPT can respond to follow-up questions and produce coherent primary texts based on the user's request. We explore the opportunities and risks of integrating chatbots into dermatologic patient care and research while presenting ChatGPT's response to the same question.artificial intelligencechatbotdermatologyresearchapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1f85k8q3articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt7mh056g62024-01-24T19:43:05Zqt7mh056g6Implementation of a dermatology skin of color educational module for medical studentsHan, JosephDahabreh, DanteAgarwal, AneeshLuu, YenKamat, SamirGolant, AlexandraUngar, JonathanGulati, Nicholas2023-01-01Research in dermatology education highlights the lack of skin of color (SOC) instruction for medical students, leading to concerning healthcare outcomes. Because of the already limited opportunity for students to have dedicated teaching in pathophysiology, management, and treatment of dermatologic diseases in medical school, we developed an educational module that addresses these gaps. We created a one-hour virtual lecture for medical students focused on common skin diseases tested on the United States Medical Licensing Examination with visual images across all skin types. A questionnaire was administered before and after the educational module to assess outcomes comparing disease identification in lighter (Fitzpatrick scale I-III) versus darker (Fitzpatrick scale IV-VI) skin tones and to determine medical school student attitudes. An analysis of 43 examination scores before, and after attending the educational module determined rosacea, psoriasis, and basal cell carcinoma to be conditions in SOC patients that demonstrated the most significant improvement (47.3%, 54.9%, and 30.8%, respectively). Our results also highlighted worse performance outcomes for diseases in SOC in the pre-examination questionnaire. Thus, our study indicates that a concise education module focused on disease presentations inclusive of all skin types may efficiently increase students' ability to identify diseases commonly misdiagnosed in the clinical setting.dermatologyeducationFitzpatrickskin of colorsurveyUSMLEapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7mh056g6articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt10q117sn2023-11-03T16:46:29Zqt10q117snWe hardly knew ye... goodbye, #dermtwitter?Kennedy, JakeHutchinson, KatieZheng, David XGuckian, Jonathan2023-01-01academic medicinedermatologyMastodonmedical educationsocial mediaTwitterapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/10q117snarticleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt8wj331h22023-11-03T16:46:28Zqt8wj331h2COVID-19 vaccine-induced cutaneous lupus erythematosusFamularo, GiuseppePatti, Anna LindaMacciomei, Maria Cristina2023-01-01COVID-19cutaneouslupus erythematosusvaccineapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8wj331h2articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt952731x62023-11-03T16:46:26Zqt952731x6Associations between different mask wearing patterns and rosacea severityShah, Pooja MMD, Uros RakitaPorter, CarolineFeldman, Steven R2023-01-01coveringsCOVID-19face masksrhinophymarosaceaSARS-CoV-2application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/952731x6articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt8n41c4s52023-11-03T16:46:25Zqt8n41c4s5The effect of perceived health status on satisfaction with care among acne patients: A population-based studyKingston, PaigeKorouri, EdwinPeterson, HannahLee, KathrynAguero, RosarioHuang, Margaret YYee, DanielleArmstrong, April W2023-01-01acnesatisfactionapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8n41c4s5articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt1n60m7t42023-11-03T16:46:23Zqt1n60m7t4Prescription trends of antidepressant, anxiolytic, and anticonvulsant medications among dermatologists from 2013 to 2020Roster, KatieKann, RebeccaBrownstone, Nicholas2023-01-01antidepressantsdermatologyMedicarepsychodermatologyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1n60m7t4articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt0739t59r2023-11-03T16:46:22Zqt0739t59rUnderemphasis of histopathology training in the micrographic fellowship application processSarlin, SamanthaAsadi, Zane KGoldberg, Leonard HBeroukhim, KouroshKimyai-Asadi, Arash2023-01-01dermatopathologyfellowshipMohstrainingapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0739t59rarticleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt3k93d1ft2023-11-03T16:46:21Zqt3k93d1ftAssessment and quality improvement of the Community Care Network: Veterans Administration (VA) patient access to community Mohs micrographic surgeryChattopadhyay, AheliSaylor, DrewTwigg, Amanda2023-01-01accessMohsschedulingsurgeryVeterans Administrationapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3k93d1ftarticleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt0c0377tx2023-11-03T16:46:20Zqt0c0377txLivedoid vasculopathyLeeolou, Melissa CRieger, Kerri EYeh, Jennifer E2023-01-01Livedoid vasculopathy is a painful thrombo-occlusive vascular disorder characterized by spontaneous thrombosis in medium-size arterioles, which causes localized hypoxia and skin ulceration. As livedoid vasculopathy is rare, case reports are the primary means of expanding collective knowledge about its presentation and response to various therapies.livedolivedoidreticularisvasculopathyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0c0377txarticleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt6631v7vv2023-11-03T16:46:19Zqt6631v7vvFicus carica L photodermatitis: a report of five cases with histopathologic study and review of the literature.Veraldi, StefanoRossi, Luisa CarlottaNazzaro, Gianluca2023-01-01Phytophotodermatitis is a condition caused by contamination of the skin with phototoxic plant substances, followed by exposure to ultraviolet rays. Ficus carica L 1753, belonging to the Moraceae family, can be responsible for acute photodermatitis. We present five cases of photodermatitis caused by contact with Ficus carica L and subsequent exposure to sunlight. A histopathologic study and review of the literature are included.Ficus carica Lfig5-methoxypsoralenphytophotodermatitispsoralenapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6631v7vvarticleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt9r81m80n2023-11-03T16:46:17Zqt9r81m80nErythematous scaly plaques and nodules on scalpHo, Peiying AudreyGwee, Yee YenOh, Choon Chiat2023-01-01Cutaneous manifestations of syphilis are varied and may present with non-specific features. We describe a 45-year-old man who presented with erythematous scaly plaques and nodules on his scalp. In previously reported cases, there were only descriptions of nodules as well as tumors. However, in our case, the patient presented with plaques and nodules on his scalp that quickly resolved with treatment for syphilis. It is important to recognize and treat syphilis at an early stage.infectionscalpsyphilisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9r81m80narticleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt7cf9b9wd2023-11-03T16:46:16Zqt7cf9b9wdRed crusty plaques in a young manFarsi, MishmaJohnson, Cassandra MSegars, KellyRhim, Jonathan2023-01-01Pemphigus foliaceus is a superficial blistering disorder characterized by erosions and scaling in a seborrheic distribution. The condition typically occurs in healthy individuals but issues arise from delayed diagnosis. Many cases remain undiagnosed or misdiagnosed due to the lack of awareness of the condition. With use of common diagnostic tools, pemphigus foliaceus can be easily identified and monitored. Histological analysis exhibits "chicken wire" patterning along keratinocytes in the upper epidermis, whereas immunofluorescence study displays subcorneal acantholysis. Pemphigus foliaceus is confirmed via ELISA studies revealing the presence of autoantibodies against desmoglein 1. Once correctly diagnosed, typically the condition is responsive to corticosteroid therapy. However in recalcitrant cases such as in ours, adjunctive immunosuppressive therapy with dapsone or rituximab may be indicated.blisterdesmogleinpemphigusrituximabseborrheicsuperficialapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7cf9b9wdarticleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt81j436wv2023-11-03T16:46:15Zqt81j436wvAn unusual presentation of pigmented purpuric lichenoid dermatitisDe Antonis, ChristineHyde, Jordan TLee, Jason BHsu, Sylvia2023-01-01Pigmented purpuric lichenoid dermatitis (PPLD) is a rare subtype of pigmented purpuric dermatosis, which classically presents with a mixture of lichenoid papules and patches on the bilateral lower extremities. Herein, we describe an unusual case of a 47-year-old man with PPLD who presented with 1-3mm discrete papules without the presence of larger patches. The diagnosis of PPLD should be considered for patients presenting with bilateral symmetric discrete papules on the legs.BlumcapillaritisdermatosisGougerotlichenoidpigmentedpurpuricapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/81j436wvarticleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt3xx728nk2023-11-03T16:46:14Zqt3xx728nkCutaneous metastasis as a first sign of adenocarcinoma of the cervixGociman, ShadaiFlorell, Scott RClarke, Jennie T2023-01-01Cervical cancer remains one of the most common malignancies diagnosed in women as well as a leading cause of cancer related deaths in women worldwide. Cutaneous metastasis associated with cervical malignancy is a remarkably rare phenomenon. We present a patient whose cutaneous signs led to the diagnosis of metastatic adenocarcinoma of the cervix.adenocarcinomacervicalcervixmalignancymetastasisskinapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3xx728nkarticleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt2pk4t34w2023-11-03T16:46:13Zqt2pk4t34wErythema elevatum diutinum in a patient with rheumatoid arthritisBittencourt, Maraya SemblanoSerruya, TallyLoureiro, Luana de Oliveirade Souza, Aline Dias CoelhoNeri, Camilla CorreaMoutinho, Ana Thais MachadoLima, Caren dos Santos2023-01-01Erythema elevatum diutinum (EED) is a rare cutaneous neutrophilic vasculitis with many associated diseases reported in the literature. We report a 65-year-old woman with painful and itchy lesions on her elbows, hands, knees, and foot for a year. Histopathologic examination confirmed the diagnosis of erythema elevatum diutinum and treatment with dapsone produced significant clinical improvement within few weeks. Erythema elevatum diutinum is a rare disease that should be considered in patients with violaceous nodular plaques located over the extensor regions of the limbs. Knowledge of this unusual pathology and its association helps to avoid misdiagnosis and late treatment.arthritisrheumatoidvasculitisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2pk4t34warticleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt3v78n67p2023-11-03T16:46:12Zqt3v78n67pA case series of hydroxychloroquine exacerbating the dermatomyositis rashRypka, KatelynBuonomo, MicheleBuechler, ConnorBenolken, MollySwigost, AdamKonstantinov, NikiforGaddis, KevinGoldfarb, Noah2023-01-01Hydroxychloroquine (HCQ) is an antimalarial agent that is commonly used in the management of rheumatic skin disease. Few reports exist documenting exacerbation of dermatomyositis (DM) related to HCQ. Herein, we describe three adult patients with worsening DM cutaneous disease after starting HCQ and resolution or improvement with cessation. The time to exacerbation ranged from two weeks to nine months after the initiation of HCQ 400mg/day. Two of the three patients had antibodies to transcription intermediary factor 1γ (TIF1γ) and the other had antibodies to anti-nuclear matrix protein 2 (NXP2). After discontinuation of HCQ, the time to improvement or resolution of cutaneous symptoms ranged from six weeks to six months. Hydroxychloroquine may be associated with worsening cutaneous features in DM. In patients who are not improving despite escalation of immunosuppressive medications, or are worsening, we recommend a trial of discontinuing HCQ.adverse effectautoimmunedermatomyositishydroxychloroquinerheumatologyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3v78n67particleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt64j2q2102023-11-03T16:46:11Zqt64j2q210A case of monkeypox and cytomegalovirus coinfection manifesting with crusted lesions mimicking rupiod syphilisZevallos, JeanAurich, JhoannQuiroz, Jose2023-01-01Human monkeypox is a viral zoonosis that has recently emerged worldwide. Clinical cutaneous features include papules, vesicles, and pustules. However, atypical manifestations mimicking other infectious diseases are being reported more frequently. We present a 41-year-old man patient with untreated HIV with generalized rupioid crusted ulcerated plaques with perineal ulceration that were found to represent monkeypox and cytomegalovirus infections.cytomegalovirusHIVmonkeypoxapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/64j2q210articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt6c07c81q2023-11-03T16:46:10Zqt6c07c81qExacerbation of Darier disease with lithium therapyTamazian, ShantSimpson, Cory L2023-01-01Darier disease is an autosomal dominant blistering disorder linked to mutation of the endoplasmic reticulum calcium pump, SERCA2, which compromises keratinocyte adhesion and differentiation. Beyond the typical keratotic and eroded skin lesions, patients with Darier disease often present with psychiatric co-morbidities. Herein, we present a biopsy-confirmed case of Darier disease in a patient with bipolar disorder, whose cutaneous disease dramatically worsened upon initiation of lithium therapy. In consultation with the patient's psychiatrist, lithium was tapered, leading to rapid improvement in her skin. This case highlights the potential for lithium to complicate management of Darier disease and underscores the need for dermatologists to collaborate with psychiatrists to optimize both cutaneous and mental health in patients.ATP2A2Darier diseasegenodermatosislithiumSERCA2application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6c07c81qarticleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt1k43w2tc2023-11-03T16:46:09Zqt1k43w2tcGeneralized perforating granuloma annulare associated with latent tuberculosis successfully treated with isoniazid: case report and reviewKapetanovic, IgorBosic, MartinaLekic, BranislavZivanovic, Dubravka2023-01-01Generalized perforating granuloma annulare (GPGA) is a very rare form of granuloma annulare, with only 31 reported cases to the best of our knowledge. Furthermore, GPGA is a chronic disease that mimics many diseases, with no known exact etiology, resulting in a lack of specific clinical criteria leading to a lack of guidelines for diagnosis and therapy. In GPGA, papules are the predominant lesions followed by central crusting/scaling or umbilication; pustules, plaques, annular lesions or nodules are less frequent. We report a 66-year-old woman who presented with a 7-month history of mostly asymptomatic generalized infiltrated, flesh-colored to red-brown umbilicated or crusted papules. Histopathological findings were compatible with perforating granuloma annulare. Diagnostic workup revealed latent tuberculosis. To the best of our knowledge, this is the second published case of GPGA associated with latent tuberculosis and the first one that was successfully treated by isoniazid monotherapy. From our case we can speculate and support the theory that GPGA is a phenotypic granulomatous response to multiple etiologies and/or antigenic stimulation and that testing for tuberculosis should be seriously considered in the evaluation of patients with GPGA.granulomaannulareisoniazidlatent tuberculosistherapyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1k43w2tcarticleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt1335h4q12023-11-03T16:46:08Zqt1335h4q1Two congenital cases of pigmented epithelioid melanocytoma with unique clinical and genetic featuresZaaroura, HibaCyrenne, BenoitSomers, Gino RWong, Karen WYDavidge, Kristen MPropst, Evan JKulkarni, Abhaya VLo, WinnieVillani, AnitaLara-Corrales, IreneLevy, Rebecca2023-01-01Pigmented epithelioid melanocytomas (PEM) are intermediate-grade melanocytic lesions with frequent lymph node involvement and rare metastases that tend to follow an indolent course with a favorable outcome. We report two unique cases of congenital PEM with PRKCA fusion transcripts: a multifocal PEM with an aggressive incompletely resectable scalp tumor and a solitary palmar PEM with newly reported ITGB5-PRKCA fusion. Through these case reports and a summary of previously reported cases, we outline the spectrum of disease of PEM and highlight the key clinical and histopathologic features associated with PEM with PRKCA fusion transcripts. We also discuss the treatment options and suggest that surgical excision without further adjuvant systemic treatment is reasonable first-line therapy given the favorable prognosis.epithelioidmelanocytomapigmented. PRKCA[HZ1]application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1335h4q1articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt0hm4w7hz2023-11-03T16:46:07Zqt0hm4w7hzSecondary syphilis presenting as leukocytoclastic vasculitis in a 61-year-old manMohamed, NadaDacy, Nicole NLopez, Lisa MBicknell, Lindsay M2023-01-01Cutaneous lesions of secondary syphilis are highly infectious and can mimic many skin disorders, making the diagnosis more difficult. They typically present as generalized, nonpruritic erythematous-to-copper-colored macules and papules, characteristically involving palms and soles. In 80% of patients the rash develops insidiously. However, rare forms of secondary syphilis present as rapidly progressive papulopustular lesions. These forms of syphilis are usually associated with human immunodeficiency virus infection and immunosuppression. We report a case of secondary syphilis presenting with an acute, rapidly progressive purpuric eruption mimicking leukocytoclastic vasculitis. A 61-year-old man presented with a 6-day history of nonpruritic rash on his chest and lower extremities associated with fatigue, sore throat, and night sweats. Examination revealed purpuric papules, extending from the dorsal feet to the hips; mucosal surfaces were not involved. A diagnosis of cutaneous small-vessel vasculitis was favored with possible triggers of IgA vasculitis. Initial work-up showed acute kidney injury and microscopic hematuria. Renal biopsy showed IgA nephropathy with mesangioproliferative glomerulonephritis. The patient's rash progressed to cover almost his entire body sparing palms and soles. Skin biopsy showed heavy perivascular lymphoplasmacytic infiltrate, capillary endothelial cell swelling, and sparse perivascular neutrophilic nuclear dust. Spirochetal stain highlighted scattered epidermal and dermal organisms.leukocytoclasticpalpable purpurasecondary syphilistreponema pallidumvasculitisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0hm4w7hzarticleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt59n0n0d62023-11-03T16:46:06Zqt59n0n0d6Anti-laminin 332 antibodies in graft-versus-host disease-associated bullous pemphigoid after allogeneic peripheral blood stem cell transplantationHida, YasutoshiKageji, RihoBekku, HirofumiIshii, Norito2023-01-01We report a 48-year-old woman with bullous pemphigoid (BP) with antibodies against the B3 subunit of laminin 332 after the development of graft-versus-host disease (GVHD). She was diagnosed with recurrent acute lymphoblastic leukemia at 40 years of age and underwent two rounds of allogeneic peripheral blood stem cell transplantations (PBST). Two and a half years after the second PBST, multiple tense blisters appeared on her face, hands, and lower legs. The diagnosis of BP was based on hematoxylin eosin and immunofluorescence staining and immunoblotting analyses. A combination regimen of topical corticosteroids (clobetasol propionate) and tetracycline/niacinamide was administered. Complete clinical resolution was achieved after four weeks of therapy without the use of immunosuppressive drugs. To maintain the graft-versus-tumor effect, topical corticosteroids and immunomodulatory drugs are preferred for BP after hematopoietic stem cell transplantation considering the risk of recurrence of hematologic malignancies. To date, there have been no reports of successful treatment of GVHD-associated BP without immunosuppressive drugs. Chronic GVHD is characterized by the production of autoantibodies. Furthermore, this autoimmune subepidermal blistering disease, BP, may be a manifestation of chronic GVHD. However, the precise mechanism of autoantibody production in chronic GVHD is not yet fully elucidated.bloodbullous pemphigoidgraft-versus-hostlaminin 332niacinamideperipheralstem celltetracyclinetransplantationtumorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/59n0n0d6articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt0vk376bp2023-09-08T19:48:26Zqt0vk376bpTache and talon noir in patient with mycosis fungoides on acitretinObijiofor, ChinemelumYin, EmilyShvartsbeyn, MariannaLatkowski, Jo-AnnAhearn, IanGutierrez, Daniel2023-01-01acitretinacral hemorrhagemycosis fungoidestachetalon noirapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0vk376bparticleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt0j14g1mv2023-09-08T19:48:22Zqt0j14g1mvBullous pemphigoid after the second SARS-CoV-2 infectionCorreia, CatarinaAlpalhao, MiguelSoares-de-Almeida, LuisFilipe, Paulo2023-01-01autoimmune diseasesbullousCOVID-19pemphigoidapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0j14g1mvarticleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt6nc6x9xr2023-09-08T19:48:19Zqt6nc6x9xrMethotrexate-induced hypersensitivity pneumonitis in a patient with bullous pemphigoidAgarwal, AshimaFalcone, Lauryn MJames, Alaina J2023-01-01bullous pemphigoidhypersensitivitymethotrexatepneumonitisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6nc6x9xrarticleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt2577x0fx2023-09-08T19:48:18Zqt2577x0fxDermatology elective curriculum: introduction to a dermatology birdwatching listEley, Sarah JAldosari, ElhamPandya, ArjunYacoub, NourMostow, Eliot N2023-01-01curiositycurriculumdermatologyeducationinteractive learningmedical educationmedical studentmotivationphysiciansprimary careself-guidedskin diseasesvirtualapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2577x0fxarticleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt26d180dw2023-09-08T19:48:17Zqt26d180dwDocument by example: resident perception of SmartPhrases for inpatient dermatology consultationsGold, SarahMustin, Danielle ECheeley, Justin T2023-01-01dermatologyeducationelectronicinpatientresidencytechnologyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/26d180dwarticleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt9f28w3f52023-09-08T19:48:16Zqt9f28w3f5Update on patterns of use of a genetic expression profiling adhesive test to detect melanoma: a cross-sectional survey of academic pigmented lesion experts and private practice cliniciansTrepanowski, NicoleChang, Michael SZiad, AminaGrossman, DouglasKim, Caroline CHartman, Rebecca I2023-01-01cliniciandetectionDermTechdiagnosticdoctorgene expression profilingGEPlesion assayLINCmelanomaphysicianpigmentedPLAPRAMEprovidersurveytestapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9f28w3f5articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt5bh3v1pn2023-09-08T19:48:11Zqt5bh3v1pnIncreased prescriptions of oral minoxidil after a high-profile newspaper article about its benefits for hair lossMirmirani, ParadiYoung, Peter AVanderweil, Stefan GVanchinathan, VeenaClick, James WMcCleskey, Patrick E2023-01-01advertisingalopeciaeducationhair-lossmarketingmediaminoxidilapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5bh3v1pnarticleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt6234s1wb2023-09-08T19:48:09Zqt6234s1wbCutaneous manifestations and treatment of monkeypox cases in the U.S.Patel, Heli ARevankar, Rishab RRevankar, Nikita RFeldman, Steven R2023-01-01dermatological treatmentinfectious diseasesmonkeypox virusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6234s1wbarticleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt79c0z5m82023-09-08T19:48:06Zqt79c0z5m8Dynamic ultrasound examination: a useful tool for the diagnosis of multiple muscular herniasBarrabes-Torrella, CristinaSeto-Torrent, NuriaIglesias-Sancho, MaribelQuintana-Codina, MonicaMarin-Pinero, DidacSalleras-Redonnet, Montse2023-01-01Muscular hernias are an uncommon condition that typically present as subcutaneous nodules on the legs that appear or enlarge while standing or exercising. They are usually asymptomatic, although they may sometimes be tender or painful and may cause cramps, especially in athletes. Physical examination and ultrasound imaging are the key for determining the diagnosis. We present a 67-year-old woman with tender subcutaneous nodules on both lower legs in which dynamic ultrasound examination confirmed the diagnosis of muscular hernias.dynamicmuscular hernianoduleultrasoundapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/79c0z5m8articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt58b0n1dp2023-09-08T19:48:03Zqt58b0n1dpSubepidermal calcified nodule presenting as a cutaneous horn: two cases and a review of the literatureBrown, Richard BBeatty, Colleen JChoudhary, SonalKress, DouglasMarks, KatherineVaughan, Victoria CKazlouskaya, Viktoryia2023-01-01Subepidermal calcified nodules are an uncommon subtype of idiopathic calcinosis cutis. Morphologically, this entity typically present as a single, well-circumscribed, white-yellow nodule. Based on clinical appearance alone, subepidermal calcified nodules are frequently misdiagnosed and often requires histological confirmation. We describe two cases of subepidermal calcified nodules presenting atypically as cutaneous horns. Subepidermal calcified nodules presenting as a cutaneous horn has rarely been reported; on review, there are fewer than 10 such cases have been described within the past 30 years. The cases described here illustrate the clinical variety and should increase awareness of subepidermal calcified nodules presented.calcified nodule[RB1]calcinosis cutispediatric dermatologySCNapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/58b0n1dparticleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt3bc2f1s22023-09-08T19:48:02Zqt3bc2f1s2Erosive lesion of the nipple: What is your diagnosis?Mancha, DoraBrazao, ClaudiaLopes, LeonorSoares-de-Almeida-, Luis2023-01-01Erosive and oozing lesions of the nipple, especially when unilateral, should raise suspicion about malignant neoplasms. Herein we report a patient with typical clinical and histopathological features of erosive adenomatosis of the nipple (EAN). It is an uncommon, benign proliferative process of lactiferous ducts of the nipple. Clinically, EAN is characterized by erosion, serous discharge, edema, itching, and erythema of one of the nipples. Complete excision of the tumor yields excellent results. Although EAN is a rare disease, clinicians must be aware of this benign neoplasm in patients with erosive lesions of the nipple. The main concern is the need to rule out malignant proliferations in the differential diagnosis. Histology is the gold standard for diagnosis. The coexistence of nipple adenoma and breast cancer is well-reported in the literature. Thus, it is necessary to encourage patients with a history of EAN to maintain regular breast screening.adenomatosisbenignbreasterosionnippleapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3bc2f1s2articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt6d4477s22023-09-08T19:48:00Zqt6d4477s2Invisible palmar needles: thyroid disorder associated spiny keratoderma and the importance of proper light for visualizationRousseau, Morgan ANelson, Emelie ERashid, Rashid M2023-01-01Spiny keratoderma is a rare skin condition that presents on the palmar and plantar surfaces of the hands and/or feet. This condition is difficult to appreciate under ambient lighting but can be both physically and emotionally distressing to patients. Furthermore, because of the association with various neoplasms and systemic diseases, timely diagnosis and appropriate follow-up is of importance. We evaluate a case of spiny keratoderma in a patient with recently diagnosed hypothyroidism and emphasize the importance of proper lighting during a dermatology-focused physical examination. The patient's palmar lesions were only appreciable under LED light and with physical examination. A biopsy of the lesions confirmed the diagnosis of spiny keratoderma.hypothyroidismkeratodermaneoplasmapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6d4477s2articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt5z24g1qc2023-09-08T19:47:57Zqt5z24g1qcCutaneous larva migrans in the northeastern USJohanis, MichaelCheema, Karan SYoung, Peter ANarala, SaisindhuSaleem, AtifNovoa, Roberto ABae, Gordon H2023-01-01Cutaneous larva migrans (CLM) is a dermo-epidermal parasitic infection with a disproportionate incidence in developing countries, particularly in, and near tropical areas. It is characterized by erythematous, twisting, and linear plaques that can migrate to adjacent skin. Herein, we present an otherwise healthy 45-year-old woman who acquired a pruritic, erythematous, and serpiginous rash localized to her right medial ankle during a trip to New England. Oral ivermectin, the preferred first-line treatment for cutaneous larva migrans, was administered in combination with triamcinolone. This was followed by removal of the papular area via punch biopsy; treatment was successful with a one-week recovery. Although cutaneous larva migrans has traditionally been considered a tropical disease, clinicians should be cognizant of its expanding geographic spread.Ancylostoma braziliensecreeping eruptioncutaneousdog and cathookwormslarva migransNecator americanusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5z24g1qcarticleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt33b6c24c2023-09-08T19:47:54Zqt33b6c24cLenalidomide-induced symmetrical drug-related intertriginous and flexural exanthemaPatel, Riya TQuan, Eugenie YEikenberg, Joshua DGrider, Douglas JPhillips, Mariana A2023-01-01Symmetric drug-related intertriginous and flexural exanthema (SDRIFE) is a cutaneous drug reaction that presents with symmetrical erythema in the flexures. The reaction typically appears hours-to-days after drug exposure but has been reported to occur months after drug initiation. Diagnostic criteria include cutaneous reaction after exposure to a systemic drug, erythema of the gluteal region and/or V-shaped erythema of the inguinal areas, involvement of an additional intertriginous site, symmetry, and absence of systemic involvement. The rash typically presents as macular erythema. However, variations in morphology have been reported including papules, pustules, vesicles, and bullae. The histopathology of SDRIFE is non-specific and the diagnosis is made clinically. Cessation of the causative drug leads to gradual rash resolution. Beta-lactam antibiotics are the most implicated medications but case reports describe SDRIFE following monoclonal antibodies, chemotherapeutic agents, and various other medications. We present a patient with SDRIFE secondary to lenalidomide, an immunomodulatory agent. This case highlights the importance of considering SDRIFE in the differential diagnosis of patients presenting with intertriginous erythema.baboon syndromedrug eruptionlenalidomidemultiple myelomaSDRIFEapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/33b6c24carticleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt7cz368pz2023-09-08T19:47:52Zqt7cz368pzNeutrophilic urticarial dermatosis preceding adult-onset Still's diseaseTsang, Denise AnnHui, LauraCheo, Fan FoonPang, Shiu Ming2023-01-01Neutrophilic urticarial dermatosis is a distinct entity strongly associated with underlying autoinflammatory disease. The pathogenesis of this condition has been considered to center around interleukin-1. We report a young woman with neutrophilic urticarial dermatosis who presented with a recurrent urticarial rash for two years prior to the onset of other systemic features including persistent fevers, sore throat, leukocytosis, elevated ferritin, and splenomegaly. She was ultimately diagnosed with adult-onset Still disease and responded well to treatment with systemic corticosteroids. Although neutrophilic urticarial dermatosis is known to occur in the setting of systemic symptoms and disease, its occurrence preceding the onset of systemic inflammation is less well-described in current literature.adult-onsetneutrophilic urticariaStill diseaseurticarial dermatosisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7cz368pzarticleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt0382v0g92023-09-08T19:47:50Zqt0382v0g9Sickle cell crisis presenting as livedo racemosaNguyen, Tue FChapman, Sara EMorrissey, Matthew WHall, Kelly H2023-01-01Sickle cell disease is a monogenic hemoglobinopathy that results in the abnormal production of hemoglobin S, which yields the characteristic sickle-shaped red blood cells. Sickle cell vaso-occlusive crisis is a painful complication of sickle cell disease caused by red blood cell entrapment within the microcirculation. The resulting tissue ischemia triggers a secondary inflammatory process involved in the pathogenesis of varying inflammatory skin conditions. Chronic leg ulcers are the most common skin presentation in sickle cell disease. A 58-year-old woman with sickle cell disease presented with systemic edematous plaques with the most notable involvement of her bilateral legs, which exhibited reticulated purpuric patches with central pallor. We report a case highlighting an unusual presentation of livedo racemosa as the presenting sign in a patient with sickle cell disease in vaso-occlusive crisis.crisislivedo racemosalivedo reticularissickle cellvaso-occlusiveapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0382v0g9articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt9m98s49f2023-09-08T19:47:48Zqt9m98s49fA rare case of skin metastasis from a chordomaVaz Cunha, MariaCarvalho Mendonca, JoanaSilva Oliveira, MartaLima, BarbaraPereira, OlgaMonteiro, Pedro2023-01-01Chordoma is an uncommon, indolent malignant tumor arising from notochordal remnants. The incidence of distant metastasis varies between 30 and 40% in different series. Even though local involvement of the skin by direct invasion of chordoma is common, distant skin metastasis are rare, with less than 30 cases reported in the literature. The present clinical case illustrates the slow-growing natural history of a sacral chordoma, which evolved with lung metastasis, followed three years later by skin metastasis, thus giving us the opportunity to review the diagnostic approach, as well as the clinical and histopathological characteristics of this rare tumor.chordomametastasisskinapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9m98s49farticleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt5mq5z39h2023-09-08T19:47:47Zqt5mq5z39hLow dose oral minoxidil and the conundrum of cardiovascular complicationsIbraheim, Marina KristyElsensohn, AshleyHauschild, ChristopherHilliard, AnthonyDao, Harry2023-01-01In recent months, the general public has become more cognizant of the potential of oral minoxidil to promote hair growth; this was promulgated, in part, by an article published in the New York Times entitled, "An Old Medicine Grows New Hair for Pennies a Day, Doctors Say." Minoxidil was added to the pharmacologic armamentarium as an antihypertensive nearly 60 years ago and was found to trigger hypertrichosis in many patients, but its use dropped sharply as cardiologists observed a number of adverse cardiovascular events including ischemic heart disease, left ventricular hypertrophy, pleural effusions, and pericardial effusions. Studies in the realm of dermatology have explored the utility and safety of low dose oral minoxidil (LDOM) for management of alopecia. This article highlights potential clinical conundrums posed by these rare but severe cardiovascular complications and the importance of collaboration between cardiologists and dermatologists when employing this agent in patients with cardiorenal or cardiovascular risk factors.alopeciacardiaceffusionhypotensionminoxidilrenalapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5mq5z39harticleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt4qv771072023-09-08T19:47:46Zqt4qv77107A systematic review of the management of postoperative scars with silicone gel-based products in randomized controlled trialsNguyen, AnhHuynh, ChristyGoh, AmyCo, AngelicaHassan, OmronPhan, Sheshanna2023-01-01Although postoperative scarring may be considered a cosmetic concern, it can greatly impact a patient's quality of life. This extends beyond psychosocial burden influenced by hypertrophic scars and keloids, as patients also experience discomfort and pain. This systematic review evaluates the efficacy of silicone gel (SG)-based products in preventing postoperative abnormal scar formation. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a PubMed search was performed to find randomized, controlled trials investigating the effect of SG-based products on postoperative wound healing. The search yielded 359 publications, but only 30 studies published between 1991-2022 were found to fit the inclusion criteria. Outcomes were extracted from the literature and subsequent quality and risk of bias assessments were performed. Most studies indicated improvement of at least one quality of the scar with the use of SG-based products. The greatest potential variable increasing bias was an inadequate control group. Studies also suffered from small sample sizes, use of unvalidated scar assessment scales, lack of double-blinding, and short follow-up periods. Overall, SG-based products demonstrated potential in preventing abnormal scar formation during postoperative healing, but further studies are required to validate the results of current literature.hypertrophic scarkeloidsilicone gelwound healingapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4qv77107articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt24s0n3vw2023-07-17T18:45:47Zqt24s0n3vwPosition Title: Academic DermatologistDepartment of Dermatology, University of California, Davis School of Medicine2023-01-01The University of California, Davis, School of Medicine, Department of Dermatology, is recruiting for two academic dermatologists in the Clinical X series or Health Sciences Clinical Professor (HSCP) series at the Assistant/Associate/Full Professor level based on experience and qualifications. These positions are for general medical dermatologists. Expectations of the Clinical X series are to engage in teaching, research, service, and clinical work, while expectations of the faculty in the HSCP series are primarily clinical and include teaching, service, and scholarly and/or creative activityapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/24s0n3vwarticleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt71h6f05c2023-07-17T18:45:45Zqt71h6f05cAmicrobial pustulosis of the folds: long-term remission achieved with low dose dapsone and topical pimecrolimusBrinia, ChrysaTsiogka, AikateriniPlatsidaki, EftychiaMarkantoni, VasilikiGregoriou, StamatiosRigopoulos, DimitrisKontochristopoulos, Georgios2023-01-01amicrobialdapsonepimecrolimuspustulosistreatmentapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/71h6f05carticleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt2jt8n9xn2023-07-17T18:45:44Zqt2jt8n9xnTattoo-associated Sweet syndromeCohen, Philip R2023-01-01black tattoocontactcytokinedermatitisdermatosishennaneutrophilicparaphenyenediaminepigmentSweetsyndromewomanapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2jt8n9xnarticleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt0hs897p22023-07-17T18:45:43Zqt0hs897p2Periocular Demodex folliculorum folliculitisChiriac, AncaWollina, Uwe2023-01-01Demodexfolliculitisperiocullarapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0hs897p2articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt72m857v82023-07-17T18:45:42Zqt72m857v8Congenital dermatofibrosarcoma protuberans with PDGFB gene rearrangement detected using fluorescence in situ hybridizationMizuta, HarukiYoshida, AkihikoTakahashi, AkiraNamikawa, KenjiroOgata, DaiYamazaki, Naoya2023-01-01dermatofibrosarcoma protuberansfluorescencegene rearrangementgrowth factorin situ hybridizationPDGFplateletapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/72m857v8articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt9zz9v05q2023-07-17T18:45:40Zqt9zz9v05qOcular rosacea associated with transient monocular vision loss: resolution with oral metronidazoleKazemi, SoroushHawkes, Jason E2023-01-01amaurosis fugaxocular rosaceaoral metronidazoletransient monocularvision lossapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9zz9v05qarticleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt8xz080cs2023-07-17T18:45:39Zqt8xz080csEffects of virtual interviews on dermatology match trends: a retrospective cohort analysisDiamond, CarrieCardones, Adela RLiu, BeiyuGreen, Cynthia LLesesky, Erin2023-01-01COVID-19Dermatology Residency MatchHome institutionMatch outcomesVirtual Interviewsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8xz080csarticleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt3mw5v82z2023-07-17T18:45:38Zqt3mw5v82zBarriers to dermatologic care for American Indian/Alaskan Native individuals at urban Indian organizationsDo, Ngan N2023-01-01accessAlaskan NativeAmerican Indianbarrierapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3mw5v82zarticleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt2c11z02s2023-07-17T18:45:37Zqt2c11z02sPatient satisfaction with dermatologists, resident physicians, and physician assistants: a multi-year cross-sectional study in an academic medical centerGriffith, Cynthia FYoung, Peter AFroman, Richard LVasquez, RebeccaMauskar, Melissa M2023-01-01dermatologistdermatologyresidentPApatient satisfactionphysician assistantPress Ganeyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2c11z02sarticleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt5dx0t4rr2023-07-17T18:45:35Zqt5dx0t4rrMacrolides for the treatment of bullous pemphigoidZou, HenryDaveluy, Steven2023-01-01Keywords: bullous pemphigoidclarithromycincytokineerythromycininterleukinmacrolidesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5dx0t4rrarticleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt9jm0x1rq2023-07-17T18:45:34Zqt9jm0x1rqPaclitaxel-induced dorsal hand-foot syndromeQuan, Eugenie YEngel, CaseyRush, Patrick SEikenberg, Joshua D2023-01-01Hand-foot syndrome (HFS), also known as palmoplantar erythrodysesthesia or acral erythema, is a known adverse effect of chemotherapeutic agents that most commonly presents as palmoplantar dysesthesia and erythematous plaques localized to the palms and soles. Paclitaxel is an uncommon cause of HFS and is notable for its unique presentation on the dorsal hands and feet. We present an unusual case of paclitaxel-induced HFS localized to the dorsal hands of a 66-year-old man with metastatic angiosarcoma. Early identification and management of HFS is critical to allow for continuation of chemotherapy while improving patient quality of life.acral erythemachemotherapyhand-foot syndromepaclitaxelpalmoplantar erythrodysesthesiatoxic erythemaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9jm0x1rqarticleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt39j2n4b12023-07-17T18:45:33Zqt39j2n4b1Successful radical surgical resection of a giant neurofibromaBean, Eric LLewis, Daniel JAbbott, JamesJiang, Angela JFischer, John PPechet, Taine TVBronfenbrener, Roman2023-01-01Large neurofibromas often cause significant patient morbidity and present a unique challenge to dermatologists and surgeons. Radical resection offers the lowest rate of recurrence but is not often pursued due to the high risk of intraoperative hemorrhage and difficulty in repairing large defects. Subtotal resection and debulking are more frequently performed, leading to higher rates of recurrence. This case highlights a particularly large neurofibroma and demonstrates how surgical techniques like preoperative embolization and advancement flaps can improve outcomes in the radical resection of large neurofibromas.advancementembolizationflapneurofibromaneurofibromatosissurgeryapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/39j2n4b1articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt9hq354w12023-07-17T18:45:32Zqt9hq354w1Localized alopecic myxedema of the scalpDoost, Mohammad SaffariLove, Nick RFung, Maxwell ATartar, Danielle M2023-01-01Myxedema is a rare, cutaneous complication of autoimmune thyroid diseases that most often affects the anterior shins. Herein, we report a patient with a history of Graves disease and Hashimoto thyroiditis who presented with boggy, alopecic patches associated with scalp pruritus. Punch biopsies from these lesions showed increased interstitial mucin in the reticular dermis, consistent with localized myxedema. This report showcases a rare presentation of localized myxedema of the scalp, highlighting the diverse cutaneous manifestations of autoimmune thyroid diseases.alopeciaGraves diseaseHashimoto thyroiditismyxedemascalp pruritusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9hq354w1articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt6bc931cj2023-07-17T18:45:31Zqt6bc931cjMultiple keratotic projections on the palms and solesBarbosa, JoanaCoelho, MiguelJoao, Alexandre2023-01-01Spiny keratoderma (SKD) is a rare palmoplantar keratoderma that presents with few to numerous millimetric hyperkeratotic projections on the palms and soles. It has been described with both hereditary and acquired variants. The acquired form, which presents in older adults, has been associated with a variety of systemic diseases and malignant conditions. In patients suspected of having acquired spiny keratoderma, an evaluation for malignant conditions may be warranted. Treatment with topical keratolytics or topical and oral retinoids is usually insufficient. Herein, we present the case of a 58-year-old man diagnosed with idiopathic SKD.keratodermaspinypalmoplantarapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6bc931cjarticleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt40h7p1pn2023-07-17T18:45:30Zqt40h7p1pnSmokeless tobacco keratosisPetruzzelli, Curtis JVarano, AlisonDesrosiers, AndrewHossler, Eric WMowad, Christen M2023-01-01Smokeless tobacco keratosis is a benign lesion characterized by the formation of white, gray, or pale macules or papules with wrinkling or rugae. It forms in the oral mucosa in response to the use of smokeless tobacco products. We present a 50-year-old man with an extensive history of smokeless tobacco use and development of the characteristic lesion. Shave biopsy showed typical changes of this benign condition and tobacco cessation was recommended.chronic irritationkeratosisoral mucosasmokeless tobaccowhite plaquesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/40h7p1pnarticleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt47s2q8zk2023-07-17T18:45:28Zqt47s2q8zkCutaneous rhabdomyoma in an 82-year-old White manCasale, JarettUddin, SabihaUpchurch, BrittonArida, MuammarIngraffea, Adam2023-01-01This case highlights a primary cutaneous rhabdomyoma presenting as a slowly enlarging subcutaneous nodule on the mentum of an 82-year-old White man with a medical history of two intracranial rhabdomyomas. Although they are rarely syndromic, it is important to note that the most common demographic for presentation of rhabdomyomas includes older males presenting as a subcutaneous nodule on the head, neck, or oral cavity. They are most often seen in isolation but can be multifocal in up to 25% of all cases. Being a rare entity, there is no generally recognized treatment consensus; however, complete surgical excision is recommended to prevent recurrence and morbidity from local tissue destruction.cardiaccutaneousexcisionmesenchymalmuscleneoplasmrhabdomyomaskeletalstriatedapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/47s2q8zkarticleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt00g297qh2023-07-17T18:45:26Zqt00g297qhCytokeratin-20 negative nodal Merkel cell carcinoma with regressed primary: a potential pitfall in interpretation of nodal metastasisMohamed, NadaRampisela, DebbyGowan, Alan C2023-01-01Merkel cell carcinoma (MCC) is a rare, highly aggressive cutaneous neuroendocrine carcinoma that affects sun-damaged skin. Histologically, the tumor consists of round cells with fine chromatin positive for cytokeratin 20 in ~90% of cases. Rare cases of MCC can regress spontaneously and present as nodal metastasis. Nodal MCC of unknown primary can cause a potential pitfall as they can be misinterpreted as other neuroendocrine carcinomas such as small cell carcinoma. We report a case of nodal MCC with an atypical immunohistochemistry pattern presented as bilateral axillary lymphadenopathy in a 90-year-old man with a remote history of a skin lesion that healed spontaneously leaving a scar.CK-20cytokeratin 20Merkel cell carcinomaneuroendocrinenodal metastasisregressionTTF1application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/00g297qharticleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt1wq2s9j92023-07-17T18:45:25Zqt1wq2s9j9Usefulness of immunohistochemical staining in diagnosing a challenging case of oral primary syphilisSugaya, NorbertoTrierveiler, MariliaMigliari, Dante2023-01-01Clinicians involved in the diagnosis of mucocutaneous diseases should be aware that syphilis is still prevalent among humans and its accurate diagnosis may require substantial clinical evaluation. Herein, we report a case of primary syphilis presenting as an isolated ulcer on the upper left labial oral mucosa. The lesion exhibited no specific features and could have been easily mishandled. An important clinical observation was the presence of a satellite-enlarged lymph node in the left submandibular area, which was highly indicative of primary syphilis. Histopathological examination of the specimen obtained by punch biopsy revealed features suggestive of syphilis and immunohistochemical staining with antitreponemal antibody confirmed its diagnosis with the detection of numerous Treponema pallidum in the specimen.cervical lymphadenopathydifferential diagnosisprimary syphilisoral ulcerationapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1wq2s9j9articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt8625q85m2023-07-17T18:45:24Zqt8625q85mDiffuse skin findings secondary to lymph node tularemia in a patient with chronic rheumatoid arthritis on methotrexateKandemir, SDezoteux, FLoiez, CHubiche, TLaurent, SDarras, S2023-01-01Tularemia has many atypical presentations which can represent a diagnostic challenge. The history is essential in the investigation of this disease. Bite-induced primary skin lesions should be distinguished from the infrequent immune-mediated secondary skin lesions. Herein, we present an atypical pseudovesicular rash secondary to Francisella tularensis.adenopathycase reportimmunosuppressedskintularemiaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8625q85marticleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt8kq929qx2023-07-17T18:45:23Zqt8kq929qxA national survey comparing practice patterns and residency training satisfaction for categorical dermatology versus combined internal medicine and dermatology trained physiciansHan, JooheeRonkainen, Sanna DJacobsen, AudreyBohjanen, Kimberly AMerola, Joseph FColavincenzo, Maria LDeWitt, Christine AFett, Nicole MHaemel, AnnaRosenbach, MishaWerth, Victoria PLunos, ScottGoldfarb, Noah2023-01-01Combined internal medicine and dermatology (med-derm) training programs were created to advance complex medical dermatology and inpatient dermatology care. A prior study demonstrated that compared to categorical dermatology residents, med-derm residents had less program satisfaction, yet indicated a stronger desire to pursue careers in academia. No follow-up data on practice patterns after training has been reported. We aimed to characterize differences in residency program satisfaction and practice patterns between physicians trained in categorical dermatology compared to med-derm residency programs. We surveyed physicians who graduated from combined med-derm programs along with their counterparts, from six institutions, that either currently or historically had a combined med-derm training, from 2008-2017. Fifty-five percent of med-derm and forty-one percent of categorical-trained physicians responded. The practice patterns between the two groups were similar. A quarter of med-derm physicians continued to provide general internal medicine services. Categorical trained physicians were significantly more satisfied with their training (P=0.03) and performed more excisions on the head/neck (P=0.02). The combined graduates had significantly greater confidence in multidisciplinary care (P=0.003), prescribed more biologic (P<0.001) and non-biologic immunosuppressive agents (P=0.002), and volunteered more for the underserved patients in their communities (P=0.04). Although few differences in overall practice patterns between categorical and med-derm trained graduates were appreciated, med-derm graduates seem more comfortable with multidisciplinary care and may care for more medically complex patients requiring immunosuppression.dermatologyinternal medicineresidencymed-dermpractice patternstrainingapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8kq929qxarticleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt9gt192c82023-07-17T18:45:21Zqt9gt192c8Workforce requirements for keratinous cysts: clinicians expend 1200 full-time effort years annuallyRivin, Gabrielle MFleischer, Alan B2023-01-01Keratinous cysts are amongst the 10 most common dermatologic ambulatory diagnoses. Thus, we aimed to estimate the time and cost spent annually on management of keratinous cysts. We conducted a cross-sectional study using the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey between 2007 and 2018 (most recent years available). Conservatively, $2.1 billion per year was spent on healthcare for keratinous cysts. On average, the full-time work of 1200 (840-1800) physicians and non-physician providers are required to manage keratinous cysts yearly in the outpatient and emergency departments.We used Medicare reimbursement rates for the cost analysis which provides a conservative estimate of the total cost. Keratinous cysts impose a significant time and cost burden on the healthcare system. Treating inflamed, draining, or painful keratinous cysts or ones that occur in undesirable locations such as the face are likely of high-value due to the quality of life impact. Managing asymptomatic keratinous cysts may be of lower value. Given this burden, clinicians should continue to evaluate the value they are providing to the patient when managing keratinous cysts.cystepidermoidNAMCSNHAMCSpilarsebaceousapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9gt192c8articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt7r30085b2023-07-17T18:45:20Zqt7r30085bBiosimilars in dermatology: identifying myths and knowledge gapsPatel, Palak vPurvis, Caitlin GHamid, Ramiz NFeldman, Steven R2023-01-01Biosimilars are beginning to gain regulatory approval in the United States. Biosimilars are structurally near identical to the innovator and must demonstrate identical pharmacokinetics via the same binding affinity and biological function on assays. However, biologics are so complex that even the innovator company cannot produce exact duplicates; there is batch-to-batch variation. The International Psoriasis Council has outlined a biosimilarity index, which aims to standardize preclinical definitions of biosimilarity. Such an index, paired with post-approval monitoring, could provide a transparent, quantitative definition of biosimilarity. Such an index could increase trust in biosimilar medicines and the preclinical assessment process without increasing costs. As preclinical analyses are critical to biosimilar approval, manufacturers should devote proportionate resources to completing them. Dermatologists, who might reflexively look for indication-specific clinical data, might also shift their focus to preclinical variables. Finally, it should be noted that biosimilars provide more evidence of similarity than we have for different batches of the innovator product. Thus, any clinical testing standards, or lack thereof, for different batches of innovator products should also apply to biosimilars.biologicsbiosimilarscost-containmentdermatologyimmunogenicitypsoriasisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7r30085barticleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt9jn4p23h2023-07-17T18:45:19Zqt9jn4p23hNon-psoriatic uses of calcipotriol: a concise updated reviewPatel, Riya TGay, Jane JFagan, Kiley KEikenberg, Joshua D2023-01-01Calcipotriol (calcipotriene) is a synthetic vitamin D3 derivative that is a standard treatment option for psoriasis. It is generally well tolerated with minimal side effects. Due to its ability to reduce keratinocyte proliferation and induce keratinocyte differentiation as well as its immunomodulatory effects, calcipotriol has been used to treat a variety of skin disorders such as atopic dermatitis, actinic keratoses, lichen planus, seborrheic keratoses, and vitiligo [1]. We surveyed the literature examining the use of calcipotriol for non-psoriatic dermatologic disease.alopeciacalcipotriolcalcipotrienedermatitiseczemavitamin Dvitíligoapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9jn4p23harticleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt6n9400vw2023-05-03T18:59:49Zqt6n9400vwPosition Title: Basic ScientistDepartment of Dermatology, The University of California, Davis School of Medicine2023-01-01The University of California, Davis, School of Medicine, the Department of Dermatology is currently recruiting for a full-time basic research position in the series of Ladder rank or In-Residence at the Assistant, Associate or Full Professor rank. Appointees to this position will be predominantly engaged in research, but also participate in teaching and engage in University and public service. This position may be 100% tenure track or a 50/50 appointment, in which case the position will be 50% tenure track and 50% In Residence. Professor In-Residence titles are intended to be used for individuals supported by non-State funds.The successful candidate will be expected to excel at student teaching and inclusive mentoring, write and submit research proposals to government agencies to secure additional funding and will be expected to spend a minimum of 70% effort in research. Candidates shall have the ability to adhere to University policies and procedures and to work cooperatively and collegially within a diverse environment.application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6n9400vwarticleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt7gs957r72023-05-03T18:59:48Zqt7gs957r7Cutaneous metastases revealing a second hidden neoplasmde Matos, Pedro RoloSilva, MiguelNogueira, AnaPacheco, JoaoAzevedo, Filomena2023-01-01gliomalung adenocarcinomametastasispathologyskinapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7gs957r7articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt1ws7x0982023-05-03T18:59:46Zqt1ws7x098Skin picking: the overlooked cutaneous manifestation of Prader-Willi syndromePatrocinio, JoaoFrade, JoanaSousa, DiogoCorreia, CatarinaFilipe, Paulo2023-01-01dermatillomaniahyperphagiaN-acetylcysteineobesitypickingPrader-Williskinapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1ws7x098articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt93f5p3fv2023-05-03T18:59:45Zqt93f5p3fvSkin cancer in patients treated with photobiomodulation for alopecia: a retrospective chart reviewWipf, AngelaGoldfarb, NoahHordinsky, Maria KRubin, NathanGriffith, MacKenzieBenner, AshleyBellefeuille, GretchenFarah, Ronda S2023-01-01alopeciabasal cellcarcinomalow-level laserphotobiomodulationskin cancerapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/93f5p3fvarticleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt8pk3858h2023-05-03T18:59:43Zqt8pk3858hTumor treating fields applied to the skin as a novel adjuvant oncology treatment: allergic contact dermatitis in a patient with glioblastoma multiformeKazemi, SoroushHawkes, Jason E2023-01-01adhesiveallergydermatitisglioblastomaOptune?TTFieldsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8pk3858harticleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt374497cm2023-05-03T18:59:41Zqt374497cmImprovement of psoriasis after initiation of antiviral therapy for hepatitis BChung, MimiHakimi, MarwaYeroushalmi, SamuelBartholomew, ErinBhutani, Tina2023-01-01anti-retroviral therapyinflammatoryskin diseasetenofovirapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/374497cmarticleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt042406782023-05-03T18:59:40Zqt04240678Out of thin air? Investigating the association between pollution and psoriasis in the United StatesMehta, Manan DYee, DanielleKhan, SamiyaZagona-Prizio, CaterinaKhan, SabrinaMaynard, NicoleReddy, RasikaArmstrong, April W2023-01-01epidemiologypollutionpsoriasispublic healthapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/04240678articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt4bb5s2bm2023-05-03T18:59:38Zqt4bb5s2bmLichen planus associated with secukinumab treatment for plaque psoriasisLiu, VivianMoiin, AliDiaz, Cristian2023-01-01Secukinumab and ixekizumab are IL17A inhibitors most commonly used to treat psoriasis. Common side effects include upper respiratory tract infections, injection site reactions, and mucocutaneous candidiasis. Recently, these medications have been reported to trigger lichen planus and lichenoid reactions have also been reported as an emerging side effect of biologics, especially tumor necrosis factor inhibitors. Herein, we report a patient with lichen planus that appeared after initiation of secukinumab for the treatment of psoriasis.drug eruptionIL17Ainterleukin 17lichen planusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4bb5s2bmarticleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt7xc3n6xv2023-05-03T18:59:36Zqt7xc3n6xvA rare case of herpes zoster triggered by a non-live varicella vaccineWilliams, Josiah AHowell, Seth THuang, William W2023-01-01Herpes zoster is caused by reactivation of the latent varicella zoster virus and often occurs in immunocompromised individuals. We describe a rare case of an immunocompetent patient with herpes zoster triggered by Shingrix, a non-live vaccine designed to protect against herpes zoster. Although herpes zoster has been described as a reaction to vaccinations before, to our knowledge this is the first report of herpes zoster triggered by a varicella zoster vaccine.general dermatologyherpes zosterimmunologyvaccineapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7xc3n6xvarticleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt2h80d70f2023-05-03T18:59:35Zqt2h80d70fPost-zoster fibroelastolytic papulosis: an example of Wolf isotopic responseShawa, HarrisonOpene, CarolineSchulman, Joshua M.Sood, Apra2023-01-01Wolf isotopic response describes the onset of a new dermatosis at the site of a previous, healed dermatosis, which is usually a herpes zoster infection. Fibroelastolytic papulosis is a poorly understood elastolytic condition defined by a loss of elastic fibers specific to the papillary dermis. The present report describes a case of fibroelastolytic papulosis with onset following herpes zoster infection. This association provides new evidence for an immunopathogenic origin for fibroelastolytic papulosis and further supports current theories of the pathogenesis of Wolf isotopic response.dermal elastolysisfibroelastolytic papulosisherpes zosterisotopic responsepapillaryWolfapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2h80d70farticleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt1mt6j9tb2023-05-03T18:59:33Zqt1mt6j9tbA pruritic pedunculated pink nodule on the legKazmi, MahaOpene, CarolineKiuru, Maija2023-01-01Herein, we present a patient with a lipidized fibrous histiocytoma, an underrecognized variant of dermatofibroma (cutaneous fibrous histiocytoma). Our patient presented with a nodule on the ankle that showed foamy histiocytes and hyalinized collagen bundles on histology. This case highlights a classic presentation and features of lipidized fibrous histiocytoma, raising further awareness of this distinctive variant of dermatofibroma that should be distinguished from xanthoma and xanthogranuloma.dermatofibromafibroushistiocyteshistiocytomalipidizedxanthogranulomaxanthomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1mt6j9tbarticleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt3pr3g15x2023-05-03T18:59:31Zqt3pr3g15xCutaneous mucormycosis involving a colostomy siteAkram, Muhammad RMiller, StantonVandergriff, Travis2023-01-01Cutaneous mucormycosis is a rapidly advancing fungal infection that most commonly occurs due to airborne spread or direct inoculation and requires early detection and prompt treatment for optimal survival. Major risk factors include diabetes, transplantations, malignancies, surgical procedures, and HIV. Diagnostic criteria are based on microscopy and culture. We present an immunocompromised patient with cutaneous mucormycosis that developed in a peristomal ulcer following a hemicolectomy procedure. Histopathologic evaluation was indicative of mucormycosis. Intravenous posaconazole treatment was initiated, but unfortunately, the patient's condition deteriorated and he passed away.colostomycutaneous mucormycosisMucoraleszygomycosisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3pr3g15xarticleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt0sg646zv2023-05-03T18:59:29Zqt0sg646zvMycobacterium marinum infection of the wristChumsaengsri, ChumsaengKhommee, JirawanUrairerkkul, Papitchaya2023-01-01Mycobacterium marinum is a nontuberculous mycobacterium capable of causing skin and soft tissue infections. Most infections are associated with skin trauma and contact with contaminated water in fish tanks, pools, or infected fish. The incubation period is about 21 days but can be prolonged up to 9 months before the onset of symptoms. We report a patient with cutaneous Mycobacterium marinum infection with a non-pruritic erythematous plaque on his right wrist for three months. A history of exposure to contaminated freshwater two years prior was the only exposure that could be determined. Treatment with oral ciprofloxacin combined with clarithromycin produced a good outcome.cutaneousinfectionMycobacterium marinumapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0sg646zvarticleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt6fs5n7c32023-05-03T18:59:28Zqt6fs5n7c3Amyopathic dermatomyositis with TIF1? positivity treated with IVIGJiang, Simon WKwock, Jeffery TMarano, Anne L2023-01-01Dermatomyositis is an inflammatory myopathy involving the skin that typically affects patients between 40-60 years of age and is more likely to be diagnosed in women. Around 10-20% of dermatomyositis cases present with subclinical or absent muscle involvement, termed "clinically amyopathic." Presence of anti-transcription intermediary factor 1? (TIF1?) antibodies is an important indicator of underlying malignancy. We present a patient with anti-TIF1? positive amyopathic dermatomyositis associated with bilateral breast cancer. The patient was safely treated with trastuzumab for breast cancer and intravenous immunoglobulin for dermatomyositis.amyopathiccancerdermatomyositisimmunoglobulinintravenousIVIGTIF1?trastuzumabapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6fs5n7c3articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt925005wh2023-05-03T18:59:27Zqt925005whCutaneous lymphangitis carcinomatosa: a unique presentation of a rare diseasePeterson, HDesai, MTawfik, MKerstetter, JElsensohn, AFurukawa, B2023-01-01A 75-year-old man with a three-year history of metastatic lung adenocarcinoma was diagnosed with cutaneous lymphangitic carcinomatosa of unique morphology. He was admitted to our hospital for right neck swelling, erythema, and failure to thrive. Skin examination demonstrated an indurated, thickened, firm, hyperpigmented plaque extending from the right neck and chest to the right ear, cheek, and eyelids. Skin biopsy demonstrated poorly differentiated adenocarcinoma, morphologically consistent with metastasis from the patient's known pulmonary adenocarcinoma and showed dermal invasion, perineural invasion, and involvement of dermal lymphatics. The diagnosis was an atypical presentation of cutaneous lymphangitis carcinomatosa from metastatic lung adenocarcinoma. This case presentation affirms that cutaneous lymphangitis carcinomatosa has a variety of atypical presentations, so physicians must maintain a high index of suspicion when evaluating cutaneous lesions in patients with known or suspected internal malignancy.cancerdermatologylungsmetastasesoncologyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/925005wharticleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt5x52n3tg2023-05-03T18:59:25Zqt5x52n3tgNodular lymphangitis related to methicillin-resistant staphylococcus aureus infectionTrepanowski, NicoleAlomran, AbdulazizMahalingam, MeeraYasuda, Mariko RHartman, Rebecca I2023-01-01Nodular lymphangitis, also known as lymphocutaneous syndrome or sporotrichoid lymphangitis, presents with inflammatory nodules along the lymphatic vessels, typically involving the upper or lower extremities. Although the most common cause of nodular lymphangitis is infection due to Sporothrix schenckii, Nocardia brasiliensis, Mycobacterium marinum, or Leishmania braziliensis, it is important for clinicians to be aware of methicillin-resistant Staphylococcus aureus as a rare cause of nodular lymphangitis and perform gram stain, bacterial culture, and antibiotic sensitivity profiles when appropriate. History of recent travel or exposures, incubation time, presence of systemic symptoms, and presence of ulceration, suppuration, or drainage can serve as diagnostic clues, but microbiological tissue cultures and histopathologic studies confirm the diagnosis. Herein, we present a case of nodular lymphangitis caused by methicillin-resistant Staphylococcus aureus (MRSA); tissue culture and antibiotic sensitivities were used to guide treatment.abscesscellulitisinfectionlymphangitislymphocutaneousMRSAnodularsporotrichosissporotrichoidapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5x52n3tgarticleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt0h81f7mg2023-05-03T18:59:24Zqt0h81f7mgAn oral lesion masquerading as lichen planusMustin, Danielle EWetzel, Stephanie LFeldman, Ron J2023-01-01Proliferative verrucous leukoplakia (PVL) is a rare, aggressive form of oral leukoplakia with a substantial risk of malignant transformation. The slowly progressive course and the lack of a single defining histopathologic characteristic for PVL make this entity a diagnostic challenge. We report on a patient who presented with a 7-year history of worsening oral lesions.cancermalignant disorderoralproliferativeverrucous leukoplakiaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0h81f7mgarticleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt59n531fv2023-05-03T18:59:23Zqt59n531fvWidespread localized areas of annular patches, plaques, and erythemaPatel, Arsh NBowers, NathanNiehaus, Angela GYu, DongfangAkkurt, Zeynep Meltem2023-01-01Without prompt diagnosis and treatment, patients with Lyme disease may develop life threatening multi-organ system complications. As such, we discuss the key diagnostic features of the condition along with patient-specific suggested treatment protocols. Additionally, Lyme disease is reportedly expanding to regions that were previously not impacted, key epidemiological features are outlined. We discuss a patient with severe Lyme disease who presented with widespread cutaneous involvement and atypical pathologic findings within an uncharacteristic geographic region. Erythematous, annular patches and plaques with dusky-to-clear centers were initially observed on the right thigh and later extended to the trunk and bilateral lower extremities. The diagnosis of Lyme disease was made clinically and confirmed with western blot testing that was positive for IgM antibodies. The patient additionally had a history of rheumatoid arthritis, for which he discontinued treatment prior to the current presentation with Lyme disease. During follow up visits, the patient noted lower extremity joint pain. Due to the overlapping clinical features of post-Lyme arthritis and rheumatoid arthritis, key differences are outlined to prevent misdiagnosis. Data revealing trends in the geographic distribution of the disease and possible need for increased surveillance and prevention strategies within previously unaffected areas are discussed.Borrelia burgdorferichronicum migranserythemainfectiousLyme diseaseapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/59n531fvarticleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt02g0p03p2023-05-03T18:59:21Zqt02g0p03pParaneoplastic or treatment-associated dermatomyositis: a diagnostic challengeEsperanca-Martins, MiguelDamaso, SaraCarreira, NunoPena, BarbaraCorreia, CatarinaAguado-Lobo, MartaEspinosa-Lara, PabloSoares-de-Almeida, LuisAbreu Ribeiro, LeonorCosta, Luis2023-01-01Dermatomyositis (DM) is a systemic autoimmune disorder characterized by proximal myopathy and dermatological findings. Approximately 15-30% of DM cases emerge as a paraneoplastic syndrome caused by a concomitant malignancy. Although more rare, in cancer patients DM has also been reported as a possible result of toxicity of some antineoplastic agents, such as taxanes and monoclonal antibodies. Herein, we report a 35-year-old woman with metastatic breast cancer who presented with skin lesions after initiation of paclitaxel and anti-HER2 agents. Clinical, laboratory, and histological findings were consistent with the diagnosis of DM.breast cancercutaneous toxicitydermatomyositismetastaticparaneoplasticapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/02g0p03particleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt78w4s27r2023-05-03T18:59:20Zqt78w4s27rBilateral eccrine angiomatous hamartomas of the proximal interphalangeal jointsNunez, M MikeSelim, Maria AngelicaFlynn, M SethMurray, John Carroll2023-01-01Eccrine angiomatous hamartoma is an uncommon, benign clinical entity constituting a nodular proliferation of eccrine glands and vascular structures localized to the dermis that typically present as unilateral, flesh-colored, erythematous, or violaceous papules on the extremities. These hamartomas may be associated with pain, hyperhidrosis, joint deformity, or functional impairment depending on the severity of the disease process. We present a case of bilaterally symmetric, asymptomatic eccrine angiomatous hamartomas involving all proximal interphalangeal joints of both hands. To date, there are only four prior cases of bilaterally symmetric eccrine angiomatous hamartomas reported in the literature, suggesting that the distribution experienced by our patient may represent a previously undescribed syndrome.angiomatous hamartomadermatopathologyeccrine glandsinterphalangeal jointproximalapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/78w4s27rarticleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt06t5877g2023-05-03T18:59:19Zqt06t5877gArtificial intelligence in medicine - dermatology compared to other medical specialties in FDA-cleared software as medical deviceVidal, Nahid YSidey, KirkKim, Yong-HunVidal, David E2023-01-01Artificial intelligence (AI) and machine learning (ML) have occupied the center stage in healthcare as research groups and institutions investigate their capabilities and risks. Dermatology is often cited as one of the medical specialties most ripe for disruption with AI technology due to the heavy incorporation of visual information into clinical decisions and treatments. Although the literature on AI in dermatology is rapidly growing, there has been a noticeable absence of mature AI solutions utilized by dermatology departments or patients. This commentary provides insight into the regulatory challenges facing AI solutions for the specialty of dermatology and the unique considerations that should be factored into AI development and deployment.artificial intelligencedermatologyFDA regulationmachine learningmedical deviceapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/06t5877garticleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt4gw9m6vd2023-05-03T18:59:18Zqt4gw9m6vdThe psychosocial impacts of vitiligo, psoriasis, and alopecia areata on pediatric patientsCruz, SebastianLei, Donald KCarr, HannahRosenblatt, Adena2023-01-01Children and adolescents with chronic cutaneous conditions are at risk of experiencing adverse psychosocial effects such as anxiety, depression, and loneliness. The well-being of these children's families may also be impacted by their child's condition. It is important for the quality of life of patients and their families to better understand the psychosocial impact caused by pediatric dermatologic conditions and interventions that help mitigate these effects. This review summarizes the psychological impact of the common pediatric dermatological disorders, vitiligo, psoriasis, and alopecia areata, on children and their caregivers. Studies examining quality of life, psychiatric conditions, and other measures of psychosocial impact in children and caregivers, as well as those evaluating the effectiveness of interventions aimed at addressing psychosocial effects, were included. This review highlights the increased risk that children with these conditions have in experiencing adverse psychosocial effects including quality of life impairment, psychological pathology, and social stigmatization. In addition, the specific risk factors within this population that are associated with increased negative effect such as age and severity of disease are discussed. This review demonstrates a need for increased support of these patients and their families and additional research on the effectiveness of current interventions.adolescentage of onsetanxiety disordersautoimmune disorderscaregiverschilddepressive disorderdisease burdenquality of lifesocial environmentapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4gw9m6vdarticleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt62x4n5pz2023-02-28T17:01:35Zqt62x4n5pzInstagram utilization by dermatology journals in the COVID-19 eraMalik, Ali MMontanez-Wizcovich, Marjorie E2023-01-01dermatologyengagementInstagramlikesmediasocialSoMeviewsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/62x4n5pzarticleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt9t23911n2023-02-28T17:01:34Zqt9t23911nHerpetic infection in Hailey-Hailey diseaseLim, SubinO'Connell, Katie APariser, Robert J2023-01-01familialHailey-Haileyherpes simplexpemphigusvirusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9t23911narticleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt3qh1q6zz2023-02-28T17:01:34Zqt3qh1q6zzDoes acne equal #dirtylaundry? Social media versus evidence-based medicineHaller, Courtney NDiven, Dayna G2023-01-01acnehygieneInstagramapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3qh1q6zzarticleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt78g924ks2023-02-28T17:01:33Zqt78g924ksCapecitabine-induced palmo-plantar erythrodysesthesia (toxic erythema of chemotherapy)Pugalia, NidhiSingh, RiddhimaMadke, BhushanRusia, KaveriJaiswal, Sharwari2023-01-01adverse effectsbreast cancercapecitabinechemotherapyhand foot syndrometoxic erythemaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/78g924ksarticleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt7hd7j8wm2023-02-28T17:01:32Zqt7hd7j8wmJAK inhibitors for dermatitis herpetiformis: check the gut!Boutrid, NadaRahmoune, Hakim2023-01-01celiac diseasedermatitis herpetiformisJAK inhibitorlymphomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7hd7j8wmarticleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt77b745bb2023-02-28T17:01:31Zqt77b745bbDermatology e-consult at a county hospital: pilot reviewJoseph, Sarah MAspey, LauraChisolm, Sarah2023-01-01dermatologygeneralmedicalteledermatologytelemedicineapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/77b745bbarticleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt1016c4g52023-02-28T17:01:30Zqt1016c4g5Social support is associated with reduced impact of hidradenitis suppurativa on quality of life: an observational studySingh, RohanKelly, Katherine AParis, Paul HSenthilnathan, AditiFeldman, Steven RPichardo, Rita O2023-01-01dermatology life quality indexhidradenitis suppurativasocial supportapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1016c4g5articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt1820m79x2023-02-28T17:01:29Zqt1820m79xDelayed diagnosis of DRESS syndrome in a patient with skin of colorBean, Eric LLewis, Daniel JWeir, Michelle AMicheletti, Robert G2023-01-01We describe a particularly severe case of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome with hemodynamic instability, erythroderma, profound eosinophilia, and severe organ dysfunction. We attribute the severity in part to a delay in diagnosis due to patient's skin of color, as the erythroderma was not noticed until a dermatologist was consulted. This case highlights how even severe skin disease can present less conspicuously in patients with darker skin types. We outline several strategies that can help clinicians to recognize DRESS and other skin disease phenotypes in patients of color, thereby avoiding delays in diagnosis as seen in this case.ceftriaxoneDRESSdrug reactioneosinophiliaerythrodermaskin of colorsystemic symptomsvancomycinapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1820m79xarticleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt9081j00w2023-02-28T17:01:28Zqt9081j00wBullous impetigo on a young man's abdomenYoung, Peter ALeeolou, Melissa CNarala, SaisindhuSaleem, AtifBae, Gordon H2023-01-01Bullous impetigo is a variant of epidermal infection by Staphylococcus aureus, representing 30% of impetigo cases. Its clinical appearance may mimic certain autoimmune blistering dermatoses and other cutaneous infections, sometimes necessitating careful evaluation. Herein we present a patient with bullous impetigo in a striking and characteristic appearance and briefly overview the approach to diagnosis, treatment, and prevention.atopic dermatitisblistering dermatosesbullous impetigoStaphylococcus aureusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9081j00warticleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt3m8478pb2023-02-28T17:01:27Zqt3m8478pbReddish-brown, papulonodular skin lesions in the periungual regionNosewicz, JacobMoad, John CKaffenberger, Jessica2023-01-01Multicentric reticulohistiocytosis is a rare, non-Langerhans cell histiocytosis that most commonly presents in women in their fourth or fifth decades of life. Cutaneous involvement, characterized by reddish-brown papules in a "string of pearls" or "coral bead" linear formation, and joint involvement are the two most common manifestations at presentation. Histopathology demonstrates dermal proliferation of epithelioid histiocytic-appearing cells with ground glass cytoplasm. We report a 51-year-old woman who presented with ruddy, periungual papules and bilateral joint pain in the hands, consistent with multicentric reticulohistiocytosis. We describe the clinical and histopathologic presentation, therapeutic options, and differential diagnosis of this rare condition.coral beadhistiocytosismulticentric reticulohistiocytosisstring of pearlsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3m8478pbarticleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt2bj244212023-02-28T17:01:26Zqt2bj24421Sneddon-Wilkinson disease following COVID-19 vaccinationMcCoy, TatianaShamsian, DaliaPan, AdrianneSivamani, Raja K2023-01-01Sneddon-Wilkinson disease, also known as subcorneal pustular dermatosis (SPD), is a rare disease characterized by vesicles or pustules that may rapidly expand and coalesce. Idiopathic in nature, SPD's clinical presentation of "half-half" blisters, with half of each blister containing pus and half containing clear fluid, is characteristic of this disease. We describe a previously healthy 21-year-old man who developed acute pustular vesicular eruptions consistent with SPD eight days following the Moderna COVID-19 vaccination.COVID-19Moderna vaccinepustular dermatosisSneddon-Wilkinsonsubcornealapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2bj24421articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt4s94w5dr2023-02-28T17:01:25Zqt4s94w5drVarenicline-induced drug eruption: case and review of the literatureCorreia, CatarinaFernandes, SoniaCorreia, TeresaSoares-de-Almeida, LuisFilipe, Paulo2023-01-01Cutaneous side-effects of varenicline, a selective partial agonist of the a4B2 nicotinic acetylcholine receptor used to treat smoking addiction, are relatively rare and mainly consist of acute generalized exanthematous pustulosis. We describe an atypical clinical presentation of a varenicline-induced drug eruption, which occurred one day after drug initiation. We report this case since we believe no drug reaction to varenicline has had this clinical presentation or rapidity of onset. Clinicians should be aware of this potential adverse cutaneous reaction in patients taking varenicline for smoking cessation.drug eruptionssmoking cessationvareniclineapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4s94w5drarticleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt4cd5c9bf2023-02-28T17:01:24Zqt4cd5c9bfMyxoid perineurioma: an entity with many mimicsKim, Seo HyunFagan, KileyDorsey, Susan BGrider, Douglas J2023-01-01We present a case of a female patient who presented with a 0.6cm flesh-colored "rubbery" papule on the left thigh. Biopsy revealed a dermal myxoid tumor containing spindled cells, tapered nuclei, indistinct cell borders, and a large number of mast cells. The spindle cells stained negative for S100 protein and Sox10 on immunohistochemistry, excluding myxoid neurofibroma, but positive for epithelial membrane antigen (EMA), and CD34, supporting a diagnosis of myxoid perineurioma. Interestingly, the mast cells showed cytoplasmic and nuclear positivity for microphthalmia transcription factor (MiTF). The lesion was fully excised one year later with identical histopathology and ancillary immunohistochemical profile.mast cellsmyxoid perineuriomaneurofibromaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4cd5c9bfarticleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt89n6g1hh2023-02-28T17:01:23Zqt89n6g1hhAtezolizumab-induced psoriasiform drug eruption successfully treated with ixekizumab: a case report and literature reviewGleason, LHunter, ECohen, ASuriano, JNikbakht, N2023-01-01Immune-related cutaneous adverse events (ircAE) are commonly seen with immune checkpoint inhibitors such as atezolizumab. Atezolizumab-induced psoriasis has been previously reported as an ircAE, especially in patients with pre-existing psoriasis. The severity of the reaction influences treatment of the cutaneous eruption. Biologics should be considered as a treatment option for severe refractory psoriasiform eruptions even in patients with complex medical conditions like chronic infections and malignancy. This is the first reported case of successful treatment of atezolizumab-induced psoriasiform eruption with ixekizumab, a neutralizing IL17A monoclonal antibody, to the best of our knowledge. Herein, we present a 63-year-old man with a history of human immunodeficiency virus and psoriasis who presented with atezolizumab-induced psoriasiform eruption while being treated for metastatic hepatocellular carcinoma. After initiating ixekizumab, atezolizumab was restarted without cutaneous eruption.atezolizumabixekizumabpsoriasisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/89n6g1hharticleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt1jm0674r2023-02-28T17:01:22Zqt1jm0674rA case of self-improving collodion ichthyosis associated with a rare variant of the ALOX12B geneAmoedo, PCerejeira, APacheco, JCruz, MJMota, A2023-01-01Collodion baby is usually a manifestation of autosomal recessive congenital ichthyosis, a heterogeneous group of congenital hyperkeratotic genodermatoses with highly variable severity and genetic background. Herein, we report a case of self-improving collodion ichthyosis, a rare subtype of autosomal recessive congenital ichthyosis, characterized by an almost-complete spontaneous resolution of symptoms.collodion ichthyosisgenodermatosesichthyosisself-improvingapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1jm0674rarticleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt5c13t4s42023-02-28T17:01:21Zqt5c13t4s4A case report of granulomatous lymphomatoid papulosisVincek, VladimirVause, AvaHarrison, AlexKrutchik, MichaelMiller, RichardMotaparthi, Kiran2023-01-01Lymphomatoid papulosis is a chronic CD30-positive cutaneous lymphoproliferative disorder that is characterized by recurring red-brown necrotic papules. It exhibits a wide spectrum of histopathologic findings and is often associated with cutaneous T-cell lymphomas. Six different histological subtypes have been classified by the WHO, but there is limited understanding regarding rare histopathologic variants. We describe a 51-year-old man who presented with recurring, necrotic papules for 6 years that progressed to involve the face, scalp, trunk, axilla, and scrotum. Histopathology demonstrated sarcoidal granulomas, along with a CD30-positive T cell infiltrate which demonstrated clonality by T cell receptor gamma gene rearrangement. A diagnosis of lymphomatoid papulosis associated with granulomas was established based on the clinical and histopathologic presentation. The clinical understanding of granulomatous lymphomatoid papulosis is limited in the available literature and more awareness of this histopathologic variant is required for accurate classification of this disorder.CD30granulomaslymphomatoid papulosislymphoproliferative disordersmycosis fungoidesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5c13t4s4articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt0tz012ps2023-02-28T17:01:20Zqt0tz012psEpstein-Barr virus-positive CD30+ B-cell lymphoproliferative disease with histologic features resembling grade III lymphomatoid granulomatosis induced by methotrexateQuaye, Elizabeth HD'Angelis, ChristopherPowell, Jennifer2023-01-01Methotrexate (MTX) is a first-line systemic medication used to treat rheumatoid arthritis because of its immunomodulatory effects. However, MTX has also been linked to the development of lymphoproliferative disorders (LPD) in patients with rheumatoid arthritis. We describe a patient with long-standing rheumatoid arthritis treated with MTX who developed cutaneous Epstein-Barr virus (EBV)-positive B cell lymphoproliferative disease resembling grade III lymphomatoid granulomatosis localized to the right leg. The lymphomatoid process resolved with withdrawal of the MTX. The pathogenesis of iatrogenic lymphoproliferative disorder was most likely triggered by the rheumatoid inflammation and the immunosuppressing effects of MTX, which led to EBV reactivation. We recommend a trial of MTX discontinuation prior to considering chemotherapy in patients with rheumatoid arthritis treated with MTX who develop EBV-positive B cell lymphoproliferative disease resembling a high grade B-cell lymphoma.B cellEpstein-Barrgrade IIIlymphomalymphomatoid granulomatosislymphoproliferative diseasemethotrexaterheumatoid arthritisspontaneous regressionvirusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0tz012psarticleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt8133412b2023-02-28T17:01:18Zqt8133412bNovel teprotumumab treatment of severe thyroid dermopathy; ototoxicity as an adverse side effectPatel, Riya TGrider, Douglas JRamey, Nicholas2023-01-01Pretibial myxedema, more generally thyroid dermopathy, results from mucopolysaccharide accumulation in the dermis, typically between the knee and dorsal foot. Thyroid dermopathy presents in Graves disease, but can occur in Hashimoto thyroiditis, primary hypothyroidism, and euthyroid patients. Treatment of thyroid eye disease with teprotumumab is established in the literature, with few case reports also showing improvement in pretibial myxedema. Reported is a 76-year-old man with thyroid eye disease and pretibial myxedema treated with teprotumumab; improvement was demonstrated in both conditions. He developed "muffled" hearing as an adverse effect, a complication not widely published in the dermatology literature. At 18 months post-treatment, his symptoms are stable without recurrence, but hypoacusis persists. Given the long-term efficacy and side-effects, dermatologists should recognize the potential benefits and risks of using teprotumumab for thyroid dermopathy. A baseline audiogram may be considered prior to therapy. Additionally, longitudinal data is needed to document the benefits and risks of this novel therapy.Graves diseasehearingIGF-1Rophthalmopathypretibial myxedemateprotumumabapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8133412barticleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt82f9d5w62023-02-28T17:01:17Zqt82f9d5w6A pediatric case of disseminated American cutaneous leishmaniasis in Rio de Janeiro, BrazilBarbosa, Sandra Mariade Alencar, Alice GuiottiBraga, Renato MouraDestefani, Carolina AiraoVilar, Enoi Guedes2023-01-01American cutaneous leishmaniasis is an infectious disease caused by the protozoa of the genus Leishmania. Clinical manifestations vary according to the virulence of the parasite speciesand the host's immune response. We report a case of a 2-year-old girl vertically exposed to HIV who presented painful and itchy papules throughout her lower limbs with further dissemination of vegetative ulcers all over the body and scalp. The histopathological examination evidenced the amastigote form of Leishmania and the polymerase chain reaction was positive for Leishmania sp. in the tissue sample. The patient was treated with amphotericin B and demonstrated improvement of lesions. Despite successful treatment for American cutaneous leishmaniasis, she developed osteomyelitis related to a bacterial secondary infection over the site of a previous ulcer on the left ankle and required a 6-week course of intravenous antimicrobial treatment. Children with vertical exposure to HIV, even without seroconversion, are at greater risk of infections if compared to non-exposed children. This is perhaps the reason for such an exuberant and rare case of complicated eishmaniasis.LeishmanialeishmaniasisHIVapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/82f9d5w6articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt3217m2vn2023-02-28T17:01:15Zqt3217m2vnNirmatrelvir-ritonivir, COVID-19, and possible adverse cutaneous reactionsAlbrecht, J MarkCooper, Benjamin RWaller, Jacquelyn DPresley, Colby LPulsipher, Kayd JRundle, Chandler WDellavalle, Robert P2023-01-01Nirmatrelvir-ritonivir (Paxlovid) recently received emergency use authorization for the treatment of coronavirus disease 2019 (COVID-19). Literature has linked numerous cutaneous adverse effects to nirmatrelvir and ritonavir, the copackaged tablets within Paxlovid. A review and comparison of these adverse effects to the common cutaneous manifestations of COVID-19 is provided. Numerous drug-to-drug interactions exist between nirmatrelvir-ritonivir and commonly-used medications within dermatology.COVID-19cutaneousdrug reactionsnirmatrelvir-ritonivirpaxlovidprotease inhibitorsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3217m2vnarticleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt7p03c5xg2023-02-28T17:01:13Zqt7p03c5xgGeospatial analysis of access to dermatology care in Los Angeles County: a cross sectional studyMcKenzie, Shanice ASeivright, Justine RHakopian, SarmenVassar, Stefanie DHsiao, Jennifer LBrown, Arleen FChiu, Melvin W2023-01-01Geographic maldistribution of dermatologists contributes to disparities in access to dermatologic care. We aimed to investigate the geographic distribution of, and differences in wait times for medical dermatology services in Los Angeles County (LAC). We placed phone calls to 251 dermatology practices in LAC to ask for a new patient appointment for a changing mole. We found West LAC (Service Planning Area [SPA] 5) had the highest number of dermatologists and South LAC (SPA 6) had the lowest (26.1 versus 0 per 100,000 residents, P=0.01). Service Planning Area 6 has a higher non-White, uninsured, and impoverished population than SPA 5. Dermatology appointment wait times and Medicaid acceptance varied between SPAs but was not statistically significant (P=0.37 and P=0.20, respectively). Medicaid-accepting practices had a significantly longer mean wait time for an appointment than practices that did not accept Medicaid (26.1 versus 15.1 days, P=0.003). Regions with predominantly non-White, Spanish-speaking, and medically underinsured residents were found to be disproportionately lacking in dermatologists across LAC, which may contribute to impaired access to dermatology services in LAC.care accessdermatologist distributionhealthcare disparitiesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7p03c5xgarticleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt7sp2m4442023-02-28T17:01:12Zqt7sp2m444Differences in accessing dermatology offices, primary care offices, and emergency departments between Hispanics and Non-Hispanic White PatientsZagona-Prizio, CaterinaKhan, SabrinaYee, Danielle KKhan, SamiyaMaynard, NicoleReddy, RasikaMehta, Manan DWu, KevinArmstrong, April W2023-01-01How Hispanic patients access dermatologic care for skin diseases is unknown. This study aims to determine if differences exist in accessing the emergency department (ED), primary care, and outpatient dermatologic offices for skin diseases between Hispanic and non-Hispanic White patients. This cross-sectional study used nationally representative data from the Medical Panel Expenditure Survey (MEPS) from 2016-2019. A total of 109,337,668 (weighted) patients with any skin disease diagnosed at an ED, primary care, or dermatology visit were identified. Hispanics comprised 13.0% and non-Hispanic Whites comprised 68.8% of this subpopulation. Overall, 94.1% of Hispanic patients attended a primary care visit for their skin complaint, 5.8% saw a dermatologist, and 0.1% attended an ED visit. Compared to non-Hispanic Whites, Hispanics were more likely to attend a primary care visit (aOR 1.865; 95%CI, 1.640-2.122) and less likely to attend an outpatient dermatology visit (aOR 0.536; 95%CI, 0.471-0.610), after adjusting for insurance status, education, income, sex, age, and comorbidities. Our study suggests that, compared to non-Hispanic Whites, Hispanic patients access primary care more frequently and outpatient dermatologic offices less frequently for their skin conditions. Language barriers, less familiarity with the healthcare system, and lack of adequate health insurance may play roles in this observation.dermatologic caredermatology visithealthcare utilizationHispanic healthMEPSUnited Statesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7sp2m444articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt0fr2c39r2022-12-29T18:32:15Zqt0fr2c39rAnalysis of patient attitudes and behavior regarding dermatologic care during the COVID-19 pandemic: a survey-based study at a single academic institutionGao, D XKahn, J SCohen, S RDumont, NYang, F CRosmarin, D2022-01-01attitudesCOVID-19dermatologyhealth inequitiesmaskskin checkapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0fr2c39rarticleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt0d99b75p2022-12-29T18:32:14Zqt0d99b75pPerception of wig use in patients with hair lossCook, Madison KLarrondo, JorgeFeldman, Steven RMcMichael, Amy J2022-01-01alopeciahair lossquality of lifewig useapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0d99b75particleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt9jf534xz2022-12-29T18:32:13Zqt9jf534xzOptimizing effective communication between physicians and patients by minimizing language and cultural barriers in health careCohen, Philip R2022-01-01barrierscarecommunicationculturalcultureeffectivehealthinterpreterlanguagepatientsphysicianstranslatorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9jf534xzarticleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt8438j9np2022-12-29T18:32:11Zqt8438j9npSharps injuries during micrographic surgery and dermatologic oncology fellowship trainingRosales Santillan, MonicaSalian, PrernaWeiss, Jonathan2022-01-01Mohsneedlesticksafetysharpssurgerytrainingapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8438j9nparticleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt2vm3d29w2022-12-29T18:32:10Zqt2vm3d29wChatbot utilization in dermatology: a potential amelioration to burnout in dermatologyDiamond, CarrieRundle, Chandler WAlbrecht, J MarkNicholas, Matilda W2022-01-01artificial intelligenceburnoutdigital imagingmessagingpatient portalapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2vm3d29warticleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt0zp9w2hx2022-12-29T18:32:09Zqt0zp9w2hxA case series of tumor necrosis factor inhibitor-induced psoriasis in patients with hidradenitis suppurativaKelly, Katherine AEdminister, JohnPichardo, Rita OFeldman, Steven R2022-01-01hidradenitis suppurativapsoriasisTNF inhibitortumor necrosis factorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0zp9w2hxarticleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt34k2h53t2022-12-29T18:32:07Zqt34k2h53tRapid and sustained response to apremilast in a patient with long-standing acrodermatitis continua of HallopeauFusta-Novell, XavierEsquius, MireiaCreus-Vila, Lidia2022-01-01acrodermatitisapremilastHallopeaupsoriasisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/34k2h53tarticleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt2dk6v1252022-12-29T18:32:06Zqt2dk6v125Cerebriform eruption related to acute coral dermatitisDyson, Mary EKimyai-Asadi, Arash2022-01-01A 27-year-old woman presented with an acute, tender, geographic lesion on her left shin that developed after contact with a brain coral while scuba diving. Photographs obtained two hours after the incident reveal a well-demarcated, geographic, erythematous plaque with a serpiginous and cerebriform pattern at the site of contact, resembling the outermost surface contour of brain coral. The plaque resolved spontaneously over a three-week period. The biology of corals and potential biological features that lead to cutaneous eruptions are reviewed.aquaticcoraldermatitisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2dk6v125articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt5dp8418s2022-12-29T18:32:04Zqt5dp8418sLarge, linear pigmentation anomaly: an unusual dyspigmentation caseVander Does, AshleyMotosko, CatherineYosipovitch, Gil2022-01-01Segmental pigmentation anomalies can be further divided into segmental pigmentation disorder (SPD) complex and café-au-lait macules (CALMs). Both are congenital skin conditions characterized by hyper- or hypopigmentation. Segmental pigmentation disorder is a rare entity, whereas CALMs are common skin lesions that may be associated with various genetic conditions, especially when several are present and the patient has other indicators of a genetic abnormality. When the CALM is segmental, segmental neurofibromatosis (type V) may be considered in the differential diagnosis. Herein we present a 48-year-old woman with a history of malignant melanoma who presented with a large, linear, hyperpigmented patch on her shoulder and arm, present since around birth. The differential diagnosis consisted of CALM versus hypermelanosis (a subtype of SPD). Given a family history of a similar lesion, in addition to a personal and family history of melanoma and internal cancers, a hereditary cancer panel was completed demonstrating genetic variance of uncertain significance. This case brings attention to a rare dyspigmentation disorder and questions a possible association with melanoma.café-au-laitCHEK2hypermelanosisneurofibromatosispigmentation disordersegmentalapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5dp8418sarticleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt1645n2t22022-12-29T18:32:03Zqt1645n2t2Hemosiderotic (pigmented) atypical fibroxanthoma mimicking malignant melanomaZhu, Tian HaoPainter, CollinHendrix, John D2022-01-01Atypical fibroxanthoma is a rare cutaneous malignancy that usually presents as a rapidly growing red papule on the head and neck in elderly white males. Several variants have been described. We report a patient who presented with a slowly enlarging pigmented lesion on his left ear that was clinically worrisome for malignant melanoma. Histopathologic evaluation with immunohistochemistry revealed an unusual case of hemosiderotic pigmented atypical fibroxanthoma. The tumor was successfully extirpated with Mohs micrographic surgery, with no recurrence at 6-month follow-up.atypicalfibroxanthomaMohs micrographiconcologysurgerysurgical dermatologyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1645n2t2articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt9gd5m8p52022-12-29T18:32:01Zqt9gd5m8p5Bleeding complication following a shave biopsy in a patient taking ibrutinibEsfandiari, NegarBombardier, NathanPierson, Joseph C2022-01-01Ibrutinib is an oral Bruton tyrosine kinase inhibitor approved for use in patients with B-cell malignancies and has been shown to increase progression-free survival in patients with chronic lymphocytic leukemia (CLL). Ibrutinib is known to increase bleeding risk in patients with CLL. We report a patient with CLL on ibrutinib who experienced significant and prolonged bleeding after a routine superficial tangential shave biopsy for suspected squamous cell carcinoma. This prompted temporary cessation of this medication for the patient's subsequent Mohs surgery. This case demonstrates the possible severity of bleeding following routine dermatologic procedures. It is important to consider holding the medication prior to planned procedures such as dermatologic surgery.bleedingcarcinomachronic lymphocytic leukemiaibrutinibmohs surgeryshave biopsysquamous cellapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9gd5m8p5articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt0bk4f4tf2022-12-29T18:32:00Zqt0bk4f4tfPyoderma gangrenosum associated with pseudo-Pelger-Huet anomaly in a patient with idiopathic myelofibrosisFurci, AntonioBruni, ManfredoGeat, DavideColato, ChiaraGirolomoni, GiampieroSchena, Donatella2022-01-01Pseudo-Pelger-Huët anomaly is a condition in which almost all the granulocytes are hyposegmented and/or hypogranulated. It is typically recognized in peripheral blood smears and represents a marker of several disorders, such as myeloproliferative diseases and myelodysplasia. The occurrence of the pseudo-Pelger-Huët anomaly in the cutaneous infiltrate of pyoderma gangrenosum is very rare. We describe the case of a 70-year-old man with idiopathic myelofibrosis who developed pyoderma gangrenosum. Histological examination showed an infiltrate consisting of granulocytic elements with features of dysmaturity and segmentation anomalies (hypo- and hypersegmented forms), suggestive of pseudo-Pelger-Huët anomaly. Methylprednisolone treatment resulted in progressive improvement of pyoderma gangrenosum.pseudo-Pelger-Huëtpyoderma gangrenosumapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0bk4f4tfarticleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt4nm6593v2022-12-29T18:31:59Zqt4nm6593vA crack in the armor: Wolf isotopic response manifesting as cutaneous lupusDarsha, AdrijaOldenburg, ReidHinds, BrianParavar, Taraneh2022-01-01Wolf isotopic response represents the development of skin lesions of one particular morphology occurring at the same site as another morphologically distinct and unrelated skin lesion. Cutaneous lupus erythematosus (CLE) is an autoimmune connective tissue disorder encompassing a wide range of phenotypes that may be associated with systemic involvement. Although CLE is a well-described entity with a broad spectrum, the occurrence of lesions manifesting as an isotopic response is rare. We present a patient with systemic lupus erythematosus who developed CLE in a dermatomal distribution following herpes zoster. When CLE lesions present in a dermatomal distribution, these cases may be difficult to distinguish from recurrent herpes zoster infection in an immunosuppressed patient. Therefore, they pose a diagnostic challenge and require balancing antiviral therapy with immunosuppression to sufficiently maintain adequate control of the autoimmune disease while addressing possible infections. To avoid treatment delay, clinicians should have elevated suspicion for an isotopic response when disparate lesions erupt in areas previously affected by herpes zoster or in cases of persistent eruptions at sites of prior herpes zoster. We discuss this case within the context of Wolf isotopic response and review the literature for similar cases.cutaneouserythematosusherpesisomorphicisotopicKoebnerlupusresponsesystemicWolfzosterapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4nm6593varticleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt0ts6k2mk2022-12-29T18:31:58Zqt0ts6k2mkHitchhiking spider: a case of unilateral vasculitisPeterson, Malina YamashitaHan, JooheeXiong, MichelleWerling, RobertNeeley, AnneScherman, JosephKozlowski, Anna2022-01-01A 63-year-old man presented with two days of palpable purpura over the right anterior shin and calf with notable point tenderness on the distal mid-calf without any palpable deep abnormality. Localized right calf pain worsened with walking and was associated with headache, chills, fatigue, and low-grade fevers. A punch biopsy of the anterior right lower leg showed necrotizing neutrophilic vasculitis of superficial and deep vessels. Direct immunofluorescence showed non-specific focal granular deposition of C3 within vessel walls. Three days after presentation, a live spider was found and microscopically identified as a male hobo spider. The patient suspected the spider arrived via packages shipped from Seattle, Washington. The patient was treated with a prednisone taper with full resolution of his cutaneous symptoms. Given the unilaterality of his symptoms and otherwise unexplained etiology, the patient was diagnosed with acute unilateral vasculitis secondary to hobo spider bite. Microscopic examination is required for identification of hobo spiders. Although not deadly, there have been several reports of cutaneous and systemic reactions resulting from hobo spider bites. Our case illustrates the importance of considering hobo spider bites in areas outside of their native regions, as they are known to travel in packaged items.bitehobo spidervasculitisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0ts6k2mkarticleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt0hp3h4ft2022-12-29T18:31:57Zqt0hp3h4ftAn unexpected case of non-uremic calciphylaxis in a patient with multiple risk factorsNugent, ShannonKaraisz, FredElbadawi, MaisaTouati, AndrewNikbakht, NedaLee, Jason BArif, Hasan2022-01-01A 58-year-old woman with a history of morbid obesity, asthma, and prior warfarin use presented to the hospital with shortness of breath and a three-month history of painful, ulcerated ulcers with retiform purpura of her bilateral distal extremities. A punch biopsy specimen demonstrated focal necrosis and hyalinization of the adipose tissue with subtle arteriolar calcium deposition, findings consistent with calciphylaxis. We discuss the presentation of non-uremic calciphylaxis and review the risk factors, pathophysiology, and interdisciplinary management approach of this rare disease.calciphylaxisnon-uremicretiform purpuraapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0hp3h4ftarticleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt5cz2h04b2022-12-29T18:31:56Zqt5cz2h04bPrimary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoproliferative disorder in a young womanLeeolou, Melissa CYoung, Peter ASaleem, AtifNarala, SaisindhuBae, Gordon H2022-01-01Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder (CD4+PCSM-LPD) is a low-grade cutaneous T cell disorder. There is no standardized approach to treatment of CD4+ PCSM-LPD due to its rarity. Herein, we discuss a 33-year-old woman with CD4+PCSM-LPD which resolved after a partial biopsy. We highlight that conservative and local treatment modalities should be considered prior to utilizing more aggressive and invasive treatment options.CD4+PCSM-LPDCD4+cutaneous lymphomalymphoproliferative disordermediumsmallT cellapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5cz2h04barticleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt29b1f3np2022-12-29T18:31:55Zqt29b1f3npAcne agminata: dermoscopic features and a short reviewTan, Wen HaoGoh, Jia YiBusmanis, InnyOh, Choon Chiat2022-01-01Acne agminata is a rare idiopathic inflammatory dermatosis. Treatment is variable with no clear consensus. We herein report a case of a 31-year-old man with sudden onset papulonodular eruptions on his face over two months. Histopathological examination revealed superficial granuloma composed of epithelioid histiocytes and scattered multinucleated giant cells, confirming acne agminata. Dermoscopy showed focal orangish structureless areas with follicular openings with white keratotic plugs. He achieved complete clinical resolution with oral prednisolone in 6 weeks. We also reviewed the literature regarding the reported treatment regimens used.acne agminatacorticosteroidfacial nodulesgranulomapapulonodular eruptionapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/29b1f3nparticleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt3k3243zj2022-12-29T18:31:54Zqt3k3243zjTrichodysplasia spinulosa: a presentation of polyomavirus infection in immunosuppressed patientsJi-Xu, AntonioArtounian, KimberlyFung, Maxwell ABurrall, Barbara A2022-01-01Trichodysplasia spinulosa (TS) is a rare skin condition that occurs mainly in immunosuppressed patients. Although initially postulated to be an adverse effect of immunosuppressants, TS-associated polyomavirus (TSPyV) has since been isolated from TS lesions and is now considered to be the causative agent. Trichodysplasia spinulosa presents with folliculocentric papules with protruding keratin spines, most commonly on the central face. Trichodysplasia spinulosa can be diagnosed clinically, but the diagnosis can be confirmed with histopathological examination. Histological findings include the presence of hyperproliferating inner root sheath cells containing large eosinophilic trichohyaline granules. Polymerase chain reaction (PCR) can also be used to detect and quantify TSPyV viral load. Owing to the paucity of reports in the literature, TS is frequently misdiagnosed and there is no high-quality evidence to guide management. Herein, we present a renal transplant recipient with TS that did not respond to topical imiquimod but improved upon treatment with valganciclovir and reduction of the mycophenolate mofetil dose. Our case highlights the inverse relationship between immune status and disease progression in this condition.immunosuppressionmycophenolate mofetiltransplanttrichodysplasia spinulosavalganciclovirapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3k3243zjarticleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt8kb4f1352022-12-29T18:31:53Zqt8kb4f135Importance of and instruction for starting a vitiligo patient support groupGeisler, AmarisO'Connell, Katie APandya, RachitaMilburn, AmandaRobinson, CamilleParks-Miller, AngelaDockins, Patrick MHuggins, Richard H2022-01-01Starting and maintaining a vitiligo support group can appear to be a daunting task. However, with proper planning and organization, the process can become manageable and rewarding. Our guide details the reasons to start a vitiligo support group, how to start a group, how to run a group, and how to promote a group. Legal protections and details regarding retention and funding are also discussed. The authors have extensive experience leading and/or assisting support groups for vitiligo and other disease states and we also sought out other current vitiligo support leaders for their valuable insights. Previous research has found that support groups for various medical conditions may have a protective effect and membership can build resilience among participants as well as foster a sense of hope regarding their disease. Further, groups can provide a network for those living with vitiligo to connect with, uplift, and learn from one another. These groups provide the opportunity to initiate lifelong connections with those facing similar circumstances and provide members with new insight and coping strategies. Members can share perspectives with one another and empower one another. We encourage dermatologists to provide vitiligo patients with support group information and to consider being involved in, starting, or otherwise supporting them.guidelinespatient supportvitiligoapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8kb4f135articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt6xs8q91c2022-12-29T18:31:53Zqt6xs8q91cCharacteristics of patients with juvenile dermatomyositis from 2001-2021 at a tertiary care centerSimmons, ElaneeKazmi, MahaWilson, MachelleKiuru, MaijaTartar, Danielle M2022-01-01Background: Juvenile dermatomyositis (JDM) is the most common inflammatory myopathy in the pediatric population and can represent a medical emergency. However, many features of JDM remain poorly understood, disease presentation is highly variable, and predictors of disease course have yet to be identified.Methods: This retrospective chart review included 47 JDM patients seen at a tertiary care center over a 20-year period. Characteristics such as demographics, clinical signs and symptoms, antibody positivity, dermatopathology features, and treatments were recorded.Results: All patients had evidence of cutaneous involvement, whereas 88.4% experienced muscle weakness. Constitutional symptoms and dysphagia were commonly present. The most frequent cutaneous findings were Gottron papules, heliotrope rash, and nailfold changes. Anti-TIF1? was the most prevalent myositis-specific autoantibody. Management involved systemic corticosteroids in nearly all cases. Strikingly, the dermatology department was only involved in the care of four in every ten (19/47) patients.Conclusions: Prompt recognition of the strikingly reproducible skin findings present in JDM can improve disease outcomes in this population. This study highlights the need for increased education of such pathognomonic findings as well as more multidisciplinary care. In particular, a dermatologist should be involved in the care of patients presenting with muscle weakness and skin changes.autoantibodyautoimmuneJDMjuvenile dermatomyositismyopathyretrospective studyvasculopathyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6xs8q91carticleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt564612w52022-11-02T23:08:31Zqt564612w5Lichen planus related to COVID-19 vaccine: report of two cases.Ceballos, Omar Al-WattarRodriguez, Marcos CarmonaBolado, Fernando MoroMontalvo, Laura MartinezGarcia-Arpa, Monica2022-01-01COVID-19drug eruptionslichen planusvaccinesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/564612w5articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt2s07d47r2022-11-02T23:08:30Zqt2s07d47rA virtual dermatology elective for underrepresented in medicine medical studentsChopra, SharaSimmers, JocelynKirby, JoslynFlamm, Alexandra2022-01-01dermatology educationmedicalUIMunderrepresentedvirtualapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2s07d47rarticleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt6wj347f52022-11-02T23:08:29Zqt6wj347f5Pathological complete response to preoperative avelumab treatment in a patient with advanced Merkel cell carcinomaMizuta, HarukiOgata, DaiJinnai, ShunichiNamikawa, KenjiroTakahashi, AkiraYamazaki, Naoya2022-01-01avelumabcomplete responseMerkel cell carcinomaneoadjuvantapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6wj347f5articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt7g82d93h2022-11-02T23:08:28Zqt7g82d93hAcute localized pustular drug reaction to pembrolizumabPineiro, AlexandraEffle, Kaitlin EAbraham, AkhilCockerell, Clay JShanler, Stuart DOndo, Andrew L2022-01-01checkpoint inhibitordrug reactionpembrolizumabapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7g82d93harticleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt9jk6c3rc2022-11-02T23:08:27Zqt9jk6c3rcEpidemiology of warts in U.S. adults: a survey studyPerche, Patrick OFunk, Parker JCook, Madison KHagen, Erin MFeldman, Steven R2022-01-01application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9jk6c3rcarticleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt2p99p9zm2022-11-02T23:08:26Zqt2p99p9zmA rare case of lues maligna in an HIV-negative womanNguyen, Christopher NShaw, Fiona MLi, Monica MBlalock, Travis W2022-01-01We describe an HIV-negative 43-year-old woman presenting with a diffuse ulceronodular eruption and positive serological tests for syphilis consistent with lues maligna. Lues maligna is a severe and rare variant of secondary syphilis characterized by prodromal constitutional symptoms followed by the formation of multiple well-circumscribed nodules with ulceration and crust. This case depicts a particularly rare presentation as lues maligna usually involves HIV-positive men. The clinical presentation of lues maligna can pose a diagnostic challenge, with infections, sarcoidosis, and cutaneous lymphoma as just a few entities in its broad differential diagnosis. However, with a high index of suspicion, clinicians can diagnose and treat this entity earlier and reduce morbidity.HIVlues malignamalignant syphilisulceronodularapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2p99p9zmarticleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt14x0d1sv2022-11-02T23:08:25Zqt14x0d1svLinear IgA bullous dermatosis of childhoodNasri, JasminJungo, PierreBlickenstorfer, MarcelMühleisen, BedaNavarini, Alexander AJuratli, Hazem ALapides, RebeccaRoider, Elisabeth2022-01-01A 4-year-old boy presented with blistering on his face and distal upper and lower extremities. Subepidermal blisters containing neutrophils and eosinophils visualized on histology supported the diagnosis of linear IgA bullous dermatosis of childhood (LABDC). The dermatosis presents with vesicles and tense blisters in an annular distribution, erythematous papules, and/or excoriated plaques. Histopathology shows subepidermal blisters with a neutrophilic infiltrate in the dermis, mainly concentrated at the tips of dermal papillae in the early stage of the disease, which can be mistaken for the pattern of neutrophilic infiltration as seen in dermatitis herpetiformis. Dapsone is the treatment of choice, which is started at a dosage of 0.5mg/kg/day. Linear IgA bullous dermatosis of childhood is a rare autoimmune disease that can be mistaken for other conditions with similar presentations but should always be considered in the differential diagnosis of children with blistering.bullous dermatosislinear IgAvesiculobullousapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/14x0d1svarticleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt51m6r9md2022-11-02T23:08:23Zqt51m6r9mdSmall lymphocytic lymphoma presenting as chronic diffuse lip swellingYeh, Jennifer ELorenzo, Mayra ELarocca, CeciliaFisher, David CForeman, Ruth K2022-01-01Although rare, small lymphocytic lymphoma can present as chronic lip swelling and papules, thus mimicking the features of orofacial granulomatosis, a chronic inflammatory disorder characterized by subepithelial noncaseating granulomas, or papular mucinosis, characterized by localized dermal mucin deposition of mucin. When assessing lip swelling, one must carefully consider the clinical clues and have a low threshold to perform a diagnostic tissue biopsy, preventing delays in treatment or progression of the lymphoma.chroniclip swellinglymphocytic leukemiasmallapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/51m6r9mdarticleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt27v8j30n2022-11-02T23:08:22Zqt27v8j30nTelangiectasias of the breasts showing diffuse dermal angiomatosis in a patient with diffuse livedo reticularisLemery, RSaillard, CLe Gall, FBismut, MDupuy, A2022-01-01The breasts are a common location for diffuse dermal angiomatosis (DDA) in a context of obesity and macromastia. The typical clinical presentation includes erythematous or purplish plaques, reticulated telangiectasias, and sometimes livedo reticularis, often complicated by painful ulcerations of the breasts. Biopsy usually confirms a dermal proliferation of endothelial cells staining positively for CD31, CD34 and SMAa and negatively for HHV8. We report herein a woman with DDA of the breasts presenting as diffuse livedo reticularis and acrocyanosis, both long-standing and considered idiopathic following extensive investigations. Since a biopsy of the livedo did not document DDA features in our case, we suggest that our patient's livedo reticularis and telangiectasias could constitute a vascular predisposition for DDA, as its pathogenesis frequently involves an underlying disease involving ischemia, hypoxia, or hypercoagulability.livedoproliferative disordertelangiectasiavascularapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/27v8j30narticleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt18n0q7zx2022-11-02T23:08:21Zqt18n0q7zxTreating linear porokeratosis with topical lovastatin/cholesterol creamBuhle, Anna CFagan, Kiley KJohnson, Nathan MGrider, Douglas J2022-01-01Linear porokeratosis is a rare variant of porokeratosis that is characterized by unilateral lesions along the lines of Blaschko. Like all variants of porokeratosis, linear porokeratosis is characterized by the histopathologic finding of cornoid lamellae bracketing the lesion. The underlying pathophysiology involves a two-hit post-zygotic knockdown of genes involved in mevalonate biosynthesis in embryonic keratinocytes. Although there is currently no standard or effective treatment, therapies targeted to rescue this pathway and restore keratinocyte cholesterol availability are promising. Presented here is a patient with a rare, extensive case of linear porokeratosis treated with compounded 2% lovastatin/2% cholesterol cream leading to partial resolution of the plaques.cornoid lamellaelinear porokeratosisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/18n0q7zxarticleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt3251n6032022-11-02T23:08:19Zqt3251n603Leukocytoclastic vasculitis with features of flagellate purpura: a comparison with flagellate erythemaJi-Xu, AntonioMansatta, KushalBali, RadhikaMoezinia, Carine J2022-01-01Leukocytoclastic vasculitis is a histopathologic term describing a type of small-vessel vasculitis characterized by a predominantly neutrophilic inflammatory infiltrate and nuclear debris. Skin involvement is common and can have a heterogeneous clinical presentation. Herein, we describe a 76-year-old woman with no history of chemotherapy or recent mushroom ingestion that presented with focal areas of flagellate purpura secondary to bacteremia. Histopathology revealed leukocytoclastic vasculitis and her rash resolved after antibiotic treatment. It is important to distinguish flagellate purpura from a similar condition, flagellate erythema, as they have been reported in association with distinct etiological and histopathological features.bacteremiaflagellate purpuraleukocytoclastic vasculitisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3251n603articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt154310bh2022-11-02T23:08:18Zqt154310bhQuestions raised by a case of adult-onset linear nodular sclerodermaMarcelus, ChristinaJimenez, AmberZussman, JamieHansen, Christopher BSontheimer, Richard D2022-01-01Morphea presenting clinically with nodular or keloidal skin changes is extremely rare. Nodular scleroderma or keloidal morphea presenting in a linear distribution is even more uncommon. We present an otherwise healthy young woman with unilateral, linear, nodular scleroderma and review the somewhat confounding earlier literature in this area. To date, this young woman's skin changes have proven refractory to oral hydroxychloroquine and ultraviolet A1 phototherapy. Several aspects of this case including the patient's family history of Raynaud disease, her nodular sclerodermatous skin lesions, and the presence of U1RNP autoantibodies raised concern about her management with respect to future risk of developing systemic sclerosis.hydroxychloroquinekeloidallinearmorpheanodularphototherapysclerodermaUVA1application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/154310bharticleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt4wq003hp2022-11-02T23:08:17Zqt4wq003hpCutaneous leukocytoclastic vasculitis after second dose of mRNA COVID-19 vaccineSimon, Sonja CSOlsavszky, Victor2022-01-01Numerous cutaneous reactions following COVID-19 vaccination have already been described. Vasculitis, however, is a rare adverse event, occurring mainly after the first COVID-19 vaccination. Herein, we report a patient with IgA-positive cutaneous leukocytoclastic vasculitis, unresponsive to a moderate dose of systemic corticosteroid that erupted after the second dose of the Pfizer/BioNTech vaccine. Since booster vaccinations are being administered, we intend to raise awareness among clinicians and to highlight this potential reaction and its therapeutic approach.COVID-19mRNAvaccinationvasculitisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4wq003hparticleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt89m5c60z2022-11-02T23:08:16Zqt89m5c60zMultiple skin neoplasms at one site (MUSK IN A NEST): collision tumor consisting of epidermal (macular seborrheic keratosis) and dermal (lichen amyloidosis) componentsLaborada, JenniferErickson, Christof PCalame, AntoanellaCohen, Philip R2022-01-01A collision tumor is a neoplastic lesion comprised of two or more tumors consisting of distinct cell populations in the concurrent location. Multiple skin neoplasms at one site (MUSK IN A NEST) is a term recently coined to describe two or more cutaneous benign or malignant tumors occurring at the same anatomic site. In retrospective studies, seborrheic keratosis and cutaneous amyloidosis have both individually been documented as a component of a MUSK IN A NEST. This report describes a 42-year-old woman who presented with a pruritic skin condition on her arms and legs of 13 years' duration. Skin biopsy results showed epidermal hyperplasia with hyperkeratosis, hyperpigmentation of the basal layer with mild acanthosis, and evidence of amyloid deposition in the papillary dermis. Based on the clinical presentation and pathology findings, a concurrent diagnosis of macular seborrheic keratosis and lichen amyloidosis was established. A MUSK IN A NEST consisting of a macular seborrheic keratosis and lichen amyloidosis is likely a more common occurrence than implied by the paucity of published cases of this phenomenon.amyloidosisbenigncollisionkeratosislichenmalignantneoplasmseborrheicskintumorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/89m5c60zarticleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt8566q1s62022-11-02T23:08:15Zqt8566q1s6Epidermolytic ichthyosis complicated by staphylococcal scalded skin syndrome in the newbornPeck, Gabrielle MFlood, KelseyMarathe, Kalyani2022-01-01Epidermolytic ichthyosis is characterized by erythema and blistering at birth. We present a neonate with epidermolytic ichthyosis who had a subtle change in clinical findings while hospitalized, including increased fussiness, erythema, and a change in her skin odor, which represented superimposed staphylococcal scalded skin syndrome. This case highlights the unique challenge of recognizing cutaneous infections in neonates with blistering skin disorders and emphasizes the importance of having a high suspicion for superinfection in this population.blisterepidermolytic hyperkeratosisinfantkeratin 1newbornstaphylococcal scalded skin syndromeapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8566q1s6articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt53x207tm2022-11-02T23:08:14Zqt53x207tmHerpes manuum: a new name for non-digit herpetic whitlowMiller, Austinn CJr, Alfredo SillerAdjei, SusuanaTemiz, Laurie ATyring, Stephen K2022-01-01Herpes simplex virus (HSV) is one of the most prevalent infections worldwide. It consists of two types: HSV1 and HSV2 that primarily cause orofacial and genital disease. However, both types can infect any site. Rarely, HSV infection of the hand occurs and is often documented as herpetic whitlow. Herpetic whitlow is primarily recognized as an HSV infection of the digits and thus HSV infection of the hand is largely associated with infection of the fingers. This is problematic, as HSV is often left off the differential diagnosis of non-digit hand pathology. We present two cases of non-digit HSV infection of the hand that were misdiagnosed as bacterial infections. As our cases and others demonstrate, the lack of knowledge that HSV infections can occur on the hand leads to confusion and delayed diagnosis among a myriad of providers. Therefore, we seek to introduce the term "herpes manuum" to increase awareness that HSV can appear on the hand in locations aside from the digits and thus differentiate it from herpetic whitlow. By doing so, we hope to encourage more timely diagnosis of HSV hand infections to decrease associated morbidity.herpes manuumherpetic whitlowHSVlymphangitispalmarsimplex virusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/53x207tmarticleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt9zz2c3072022-11-02T23:08:13Zqt9zz2c307Limited impact of teledermoscopy on referrals to face-to-face dermatologyMontejano, Rubi DanielleOh, Dennis HTwigg, Amanda R2022-01-01Background: Teledermoscopy improves teledermatology clinical outcomes, but the practical impact of this and other teleconsultation variables on patient management are unclear. We assessed the impact of these variables, including dermoscopy, on face-to-face (F2F) referrals to optimize effort by imagers and dermatologists. Methods: Using retrospective chart review, we retrieved demographic, consultation, and outcome variables from 377 interfacility teleconsultations sent to San Francisco Veterans Affairs Health Care System (SFVAHCS) between September 2018 to March 2019 from another VA facility and its satellite clinics. Data were analyzed using descriptive statistics and logistic regression models. Results: Of 377 consults, 20 were excluded due to patient F2F self-referral without teledermatologist recommendation. Analysis of consults showed that age, clinical image, and problem number but not dermoscopy were associated with F2F referral. Analysis of problems contained in consults showed that lesion location and diagnostic category were also associated with F2F referral. Skin cancer history and problems on the head/neck were independently associated with skin growths in multivariate regression. Conclusions: Teledermoscopy was associated with variables related to neoplasms but did not affect F2F referral rates. Rather than utilize teledermoscopy for all cases, our data suggests that referring sites prioritize teledermoscopy for consultations with variables associated with a likelihood of malignancy.dermoscopyteledermatologyteledermoscopytelemedicineAbbreviations: Community-based outpatient clinics (CBOCs)Dermoscopic and clinical image teleconsultations (DTC)Electronic Health Record (EHR)Face-to-face (F2F)Head and neck (HN)Multiple sites (M)Primary care provider (PCP)San Francisco Veterans Affairs Health Care System (SFVAHCS)Store-and-forward (SAF)Trunk and limbs (TL)/Abbreviationsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9zz2c307articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt57x5s3zt2022-11-02T23:08:12Zqt57x5s3ztDermatology urgent care model reduces costs and healthcare utilization for psychodermatology patients - a retrospective chart reviewJohnson, JacobCutler, BrettLatour, EmileKeller, Jesse J2022-01-01Background: Patients with psychiatric dermatoses may be high users of healthcare, especially emergency services. A dermatology urgent care model may reduce healthcare utilization in this population. Objective: To determine whether a dermatology urgent care model can reduce healthcare utilization among patients with psychiatric dermatoses. Methods: We conducted a retrospective chart review of patients seen in dermatology urgent care at Oregon Health and Science University between 2018 and 2020 with diagnoses of Morgellons disease and neurotic excoriations. Rates of diagnosis-related healthcare visits and emergency department visits were annualized before and during engagement with the dermatology department. Rates were compared using paired t-tests. Results: We found an 88.0% reduction in annual rates of healthcare visits (P<0.001) and 77.0% reduction in emergency room visits (P<0.003). Results were unchanged when controlled for gender identity, diagnosis, and substance use. Limitations: We could not account for healthcare use not included in electronic health record. Conclusion: Urgent care models in dermatology may reduce overuse of healthcare and emergency services among patients with psychiatric dermatoses.healthcare utilizationpsychodermatologyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/57x5s3ztarticleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt5v56r9wh2022-11-02T23:08:11Zqt5v56r9whWhole exome sequencing in a sample of Peruvian patients diagnosed with epidermolysis bullosaZevallos-Morales, AlejandroIberico, Rosario TorresObispo, DaisyDanos, PierinaSanchez, Rodrigo MFujita, RicardoGuevara-Fujita, Maria L2022-01-01Background: Epidermolysis bullosa (EB) is a complex and heterogeneous dermatological disease. Four main types of EB have been described, each of them with distinct characteristics: EB simplex (EBS), dystrophic EB (DEB), junctional EB (JEB) and Kindler EB (KEB). Each main type varies in its manifestations, severity, and genetic abnormality. Methods: We sought mutations in 19 genes known to cause EB and 10 genes associated with other dermatologic diseases in 35 Peruvian pediatric patients of a rich Amerindian genetic background. Whole exome sequencing and bioinformatics analysis was performed. Results: Thirty-four of 35 families revealed an EB mutation. Dystrophic EB was the most frequently diagnosed type, with 19 (56%) patients, followed by EBS (35%), JEB (6%), and KEB (3%). We found 37 mutations in seven genes; 27 (73%) were missense mutations; 22 (59%) were novel mutations. Five cases changed their initial diagnosis of EBS. Four were reclassified as DEB and one as JEB. Inspection into other non-EB genes revealed a variant, c.7130C>A, in the gene FLGR2, which was present in 31 of the 34 patients (91%). Conclusion: We were able to confirm and identify pathological mutations in 34 of 35 patients.dystrophicepidermolysis bullosajunctionalKindlersequencingwhole exomeapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5v56r9wharticleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt85h7m5312022-11-02T23:08:10Zqt85h7m531The use of oral vitamin A in acne management: a reviewCook, Madison KPerche, Patrick OFeldman, Steven R2022-01-01Background: Changes to the iPLEDGE platform on December 13, 2021 made isotretinoin virtually inaccessible for many patients. Prior to the FDA approval of isotretinoin, a derivative of vitamin A, in 1982, vitamin A was used for severe acne. Objective: To review the efficacy, safety, affordability, and practicality of vitamin A as a substitute for isotretinoin when the latter is inaccessible. Methods: A literature review of PubMed was conducted using the key words: oral vitamin A, retinol, isotretinoin, Accutane, acne, iPLEDGE, hypervitaminosis A, and side effects. Results: We identified 9 studies (8 clinical trials and one case report); acne improved in 8 studies. Dosages ranged from 36,000IU daily to 500,000IU with 100,000IU as the most common. Mean duration until clinical improvement was 7 weeks to four months after initiation of therapy. Mucocutaneous side effects were most common, along with headaches, which resolved with either continued treatment or cessation. Conclusion: Oral vitamin A is efficacious for the treatment of acne vulgaris, although the available studies have limited controls and outcomes. Side effects are qualitatively similar to those of isotretinoin and avoiding pregnancy for at least three months after stopping treatment is critical; like isotretinoin, vitamin A is a teratogen.acneiPLEDGEisotretinoinretinolvitamin Aapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/85h7m531articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt6cs8c3m62022-11-02T23:08:09Zqt6cs8c3m6Efficacy of gabapentinoids for acute herpes zoster in preventing postherpetic neuralgia: a systematic review of randomized controlled trialsMenaldi, Sri LinuwihHalim, Paulus AnthonyKurniawan, Kristian2022-01-01Gabapentinoids (e.g., gabapentin and pregabalin) have been established as a treatment for postherpetic neuralgia (PHN), but their effects on the prevention of PHN are unclear. This systematic review aimed to evaluate the efficacy of gabapentinoids for acute herpes zoster (HZ) in preventing PHN. PubMed, EMBASE, CENTRAL, and Web of Science were queried December 2020 to collect data on relevant randomized controlled trials (RCTs). A total of four RCTs (including 265 subjects) were retrieved. Overall, the incidence of PHN was lower, but not statistically significant in the gabapentinoid-treated group compared to the control group. Subjects treated with gabapentinoids were more likely to experience adverse events such as dizziness, somnolence, and gastrointestinal symptoms. This systematic review of RCTs showed that the addition of gabapentinoids during acute HZ are not significantly effective in preventing PHN. Nevertheless, the evidence on this subject remains limited. Physicians should carefully weigh the risks and benefits of prescribing gabapentinoids during the acute phase of HZ owing to its side effects.gabapentinherpes zosterpostherpetic neuralgiapregabalinapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6cs8c3m6articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt9pq4b97k2022-09-05T04:13:13Zqt9pq4b97kThe impact of the COVID-19 pandemic on dermatologists' suture preferences for epidermal approximationKobic, AjdinKim, Yong-hunDemer, Addison MVidal, Nahid Y2022-01-01application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9pq4b97karticleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt1kv748f22022-09-05T04:13:12Zqt1kv748f2Surgical and non-surgical treatment modalities for lymphangioma circumscriptumShah, AatmanChennareddy, SumanthSharma, SayeshaSanghvi, JayTassavor, BryanLewin, Jesse M2022-01-01CO2 laserlymphangioma circumscriptumsclerotherapysurgeryapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1kv748f2articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt7gc3k55c2022-09-05T04:13:11Zqt7gc3k55cTreatment of longstanding alopecia areata universalis of the eyebrows/facial hair with oral and topical tofacitinibGonzalez Matheus, GAHerat, A2022-01-01alopecia universalisareatatofacitinibapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7gc3k55carticleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt7jm714k12022-09-05T04:13:10Zqt7jm714k1Herpes zoster after COVID-19 vaccination in an adolescentThonginnetra, SaraiornLimtanyakul, PiyakanTawinprai, Kriangkrai2022-01-01COVID-19herpes zostervaccinationvaricella zoster virusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7jm714k1articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt77m782vs2022-09-05T04:13:10Zqt77m782vsDrug eruption-like scabies surrepticius: an uncommonly described variant of scabies appearing in a non-classic clinical presentationCohen, Philip R2022-01-01adversecrusteddrugeffecteggeruptionfecesmedicationmitenivolumabscabiesscybalasubtypesurrepticiusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/77m782vsarticleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt98q9474t2022-09-05T04:13:09Zqt98q9474tModified keystone flap used to repair nose defect after Mohs micrographic surgeryLobos, CMachado, SBazzano, CMagliano, J2022-01-01Mohs micrographic surgery (MMS) is a surgical technique used to remove skin tumors with a complete evaluation of the margins. The keystone flap technique is generally used to repair large surgical defects on limbs. We present a case where a modified keystone flap technique was used to close a large defect after Mohs micrographic surgery in a patient with a basal cell carcinoma on the nose. An excellent functional and aesthetic result was obtained with no complications during or after the procedure. We offer a novel indication for this technique for surgical defects in this area.basal cellcarcinomakeystone flapkeystone flapmicrographic surgerymodifiedMohsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/98q9474tarticleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt91n125fg2022-09-05T04:13:07Zqt91n125fg"Knife-cut" intertriginous ulcers related to herpes simplex virus in three patientsMillan, SarahAli, RowanneSanfilippo, EricSiegel, MarcCardis, Michael ASaardi, Karl M2022-01-01Linear intertriginous erosions and ulcerations related to herpes simplex virus (HSV) infection have been reported in patients with underlying immunosuppression. This rare presentation of HSV seems to occur predominantly in patients undergoing treatment of hematologic malignancies and rheumatologic conditions. Herein, we report three cases of linear "knife-cut" ulcerations in patients who were not undergoing active pharmacologic immunosuppressive therapy and lacked coexisting malignancy or autoimmune disease. Close examination of the skin folds for HSV infection is warranted to rule out disseminated infection as early intervention can be lifesaving.general dermatologymedical dermatologyinpatient dermatologyherpes simplexinfectious diseaseviral diseaseapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/91n125fgarticleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt5f19f26k2022-09-05T04:13:06Zqt5f19f26kImiquimod-induced hypertrophic lupus erythematosus-like reaction.Safadi, Mohannad GHassan, ShahzebPatel, VikiViglione, MichaelZahner, Scott L2022-01-01Imiquimod is a topical immunomodulator that acts as an inducer of interferon (IFN)-a expression through Toll-like receptor (TLR)7 signaling with indications for the treatment of non-hyperkeratotic actinic keratosis of the face or scalp, superficial basal cell carcinoma (BCC), and external genital and perianal warts. Imiquimod is also used off-label for nodular BCC, cutaneous T-cell lymphoma, pyogenic granuloma, and melanoma. Imiquimod-induced lupus-like reactions have been reported. However, hypertrophic lupus erythematosus (HLE) is a rare variant of cutaneous lupus and imiquimod-induced hypertrophic lupus has not been reported to date. We report a case of local induction of a plaque that resembled HLE clinically and histologically in an 82-year old woman following topical treatment with imiquimod.drug reactionhypertrophicimiquimodlupus erythematosusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5f19f26karticleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt0zb2c2d42022-09-05T04:13:06Zqt0zb2c2d4Successful treatment of exanthematous lichen planus in a young adult with low dose oral corticosteroid and isotretinoin.Rahman, AtiyaHafeez, Danish2022-01-01Lichen planus is an inflammatory disease affecting the skin and mucosal membranes often with a chronic course lasting months to years with episodes of relapses. Classically it presents as flat topped, purple, polygonal, pruritic papules on the volar aspect of wrists and forearms, ankles, lower legs, and lumbo-sacral spine. We report a young woman with an exanthematous/eruptive variant of lichen planus who had a sudden outbreak of multiple papules and plaques all over the body with relative sparing of head and neck region. Eruptive lichen planus is rarely reported in adults and effective treatments are not well documented. We prescribed a short course of oral corticosteroid to which the patient did not respond. This was followed by oral isotretinoin and there was dramatic improvement in her symptoms and cutaneous lesions. A short course of oral corticosteroid followed with oral isotretinoin may be considered as a valuable management plan for exanthematous lichen planus. This combination may avoid serious adverse effects of both drugs when prescribed in high doses.disseminatederuptiveexanthematouslichen planusoral isotretinoinoral steroidtreatmentapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0zb2c2d4articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt7qg9190f2022-09-05T04:13:04Zqt7qg9190fA new eruption of bullous pemphigoid following mRNA COVID-19 vaccinationDaines, BryanMadigan, Lauren M.Vitale, Patricia AKhalighi, MazdakInnes, Matthew2022-01-01The rapid development and implementation of COVID-19 vaccines throughout the global population has given rise to unique, rare, adverse skin reactions. This case report describes an elderly man with new-onset bullous pemphigoid following the second dose of the Pfizer-BioNTech (mRNA) COVID-19 vaccine.bullous pemphigoidCOVID-19vaccine reactionapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7qg9190farticleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt29j7573d2022-09-05T04:13:04Zqt29j7573dAngioimmunoblastic T-cell lymphoma with elevated serum IgA and infiltration of IgA-positive plasma cells into a skin lesionTabata, NobukoKunikata, NagisaTanata, MuneoFukuhara, Osamu2022-01-01Angioimmunoblastic T-cell lymphoma (AITL) is one of the most common types of peripheral T-cell lymphoma. Laboratory examination exhibits immunological abnormalities, such as polyclonal hypergammaglobulinemia and hemolytic anemia. Skin lesions are also observed in approximately half of AITL cases. However, the relationship of skin involvement with the clinical course and prognosis is unknown. Herein, we report the case of a patient with AITL with elevated serum immunoglobulin A (IgA) level, which was a predictive element of poor prognosis, and infiltration of IgA-positive plasma cells into the skin lesions. Based on this case, we believe that skin manifestations could be used to identify the characteristics of immune disorders and prognosis of AITL.angioimmunoblasticIgAplasma cellT-cell lymphomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/29j7573darticleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt66w875t52022-09-05T04:13:03Zqt66w875t5Blastic plasmacytoid dendritic cell neoplasm presenting as violaceous forehead plaqueMorrison, Georgia MaeHopkins, AmyKnapp, CalvinKulkarni, RajScopetta, John P2022-01-01A 72-year-old man with a history of squamous cell carcinoma presented to the Portland VA with forehead discoloration. He was initially diagnosed with actinic damage and prescribed topical treatment. However, he returned to clinic months later with a large, violaceous forehead plaque. Upon biopsy, he was diagnosed with blastic plasmacytoid dendritic cell neoplasm (BPDCN), a rare hematological malignancy. This case report illustrates the importance of keeping BPDCN in the differential diagnosis for ecchymotic plaques that fail to respond to first line therapy.blasticcutaneous lymphomadendritic celldermatologyneoplasmplasmacytoidapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/66w875t5articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt3s82x7dh2022-09-05T04:13:02Zqt3s82x7dhAnnular elastolytic giant cell granuloma in a woman with metabolic syndromeAbbas, Walaa FadhilRadionova, Ekaterina EvgenievnaMolochkov, Anton VladimirovichBobrov, Maxim AlexandrovichMelnichenko, Olga O2022-01-01Annular elastolytic giant cell granuloma (AEGCG) is a rare granulomatous skin condition. It belongs to a group of skin and elastic fiber disorders. When it affects sun-exposed skin, it is also called actinic granuloma. The etiology and pathogenesis are still debated. However, sun-induced actinic damage to elastic fibers is acknowledged as the primary triggering factor, though the pathogenesis of instances in sun-covered areas is unknown. The most commonly linked systemic illness is diabetes mellitus. Different case reports show an association of this disease with hematological conditions, infections, sarcoidosis, and protoporphyria. Multisystemic involvement was also reported in a case. The disease is clinically recognized by erythematous non-scaly annular patches and plaques with raised borders and hypopigmented or skin-colored centers, sometimes atrophic. It is usually asymptomatic or mildly itchy. The presence of an inflammatory infiltration with non-palisading granulomas, multinucleate large cells, elastin degradation, and elastophagocytosis, as well as the absence of necrobiosis and mucin, are histopathological characteristics. We report a 5-year history of annular elastolytic giant cell granuloma in a 66-year-old woman with a history of type two diabetes mellitus, hypertension, and fatty liver disease (steatosis). She presented with asymptomatic polymorphic erythematous skin lesions mainly in sun-exposed areas.actinic granulomaannular elastolyticdiabetes mellituselastophagocytosisgiant cellapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3s82x7dharticleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt3277d6t22022-09-05T04:13:01Zqt3277d6t2Werner syndrome associated with acroosteolysisKhalid, TanzeelaInam, FatimaIqbal, Muhammad Areeb2022-01-01Werner syndrome (WS) is an autosomal recessive syndrome characterized by genomic instability that affects multiple body systems. The characteristic features of the disease include growth retardation, short stature, alopecia, scleroderma, atrophic skin with ulcerations, infertility, cataracts, premature arteriolosclerosis, diabetes, osteoporosis, and increased risk of malignancies. Werner syndrome protein (WRN) protein deficiency in this disease causes changes in gene expression, similar to those observed in normal aging. As the median age of death in WS is the fourth or fifth decade of life, early diagnosis leads to a better screening opportunity for malignancies. Herein, we present a 28-year-old woman who presented with growth arrest, dyspigmentation, and acroosteolysis and was later diagnosed with Werner syndrome.acroosteolysisdistal phalangesprogeriaWerner syndromeapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3277d6t2articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt2nk7k0pk2022-09-05T04:13:00Zqt2nk7k0pkPityriasis rubra pilaris heralding diagnosis of urothelial carcinoma: a case reportYoung, Peter ARangel, JavierKeller, Lia C2022-01-01Pityriasis rubra pilaris is a papulosquamous inflammatory dermatosis that can be associated with HIV, autoimmunity, infections, certain medications, and neoplasms. Paraneoplastic pityriasis rubra pilaris has previously been reported in association with solid organ malignancies and once with leukemia. Herein, we present an elderly man with paraneoplastic pityriasis rubra pilaris, heralding the diagnosis of low-grade papillary urothelial carcinoma. Our patient's pityriasis rubra pilaris resolved after surgical resection of the tumor.erythrodermapapillaryparaneoplastic dermatosespityriasis rubra pilarisPRPurothelial carcinomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2nk7k0pkarticleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt8qz544vz2022-09-05T04:12:59Zqt8qz544vzAnti-laminin 332 mucous membrane pemphigoid in a young woman treated with rituximabGitin, AlexanderPorta, Adriana DellaBisbee, ElizabethBraunlich, KatherineMotaparthi, Kiran2022-01-01Mucous membrane pemphigoid, formerly known as cicatricial pemphigoid, is a rare and difficult-to-treat bullous disorder that occurs most commonly in older adults. We describe a 32-year-old woman who was diagnosed with anti-laminin 332 mucous membrane pemphigoid through indirect immunofluorescence for laminin 332 following nonspecific histologic and direct immunofluorescence findings. At 16 weeks following completion of her first cycle of with rituximab 375mg/m2 weekly for four weeks, her mucosal erosions had resolved. Although not widely available, this case highlights the utility of anti-laminin 332 immunofluorescence for diagnostic confirmation of this entity and the efficacy of rituximab in obtaining disease control.indirect immunofluorescencelaminin 332mucous membrane pemphigoidRituximabapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8qz544vzarticleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt5cc5c8xw2022-09-05T04:12:58Zqt5cc5c8xwNoninflammatory presentation of cutaneous breast cancer: a retrospective case series at a single academic institution with review of the literaturePeach, AaronBlaise, BrittanyParker, JordanLarson, Rebecca2022-01-01Breast cancer with skin involvement is an uncommon clinical presentation of this malignancy. Breast cancer overall has a relatively high mortality rate and wide variety of presentations, making skin involvement by breast cancer a necessary consideration in the differential diagnosis for many types of breast lesions. A retrospective review of our own small academic dermatology outpatient clinic, between August 2006 and January 2020, found four cases of noninflammatory breast cancer with skin involvement diagnosed through biopsy by our dermatologists. This review was approved by the local Institutional Review Board. Of the four patients identified, three were female and one was male. One patient had prior history of invasive ductal carcinoma in remission before recurrence was diagnosed. Another patient had a history of melanoma in situ before diagnosis with breast cancer. Patients were treated with various combinations of surgery, radiation, and hormone therapy. These four cases are presented here in detail, which emphasize the role of the dermatologist in recognizing various cutaneous manifestations of noninflammatory breast cancer in order to make a timely diagnosis.breast cancercancercase reportnoninflammatoryseriesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5cc5c8xwarticleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt7qr987b02022-09-05T04:12:57Zqt7qr987b0A unique case of subcutaneous panniculitis-like T-cell lymphoma presenting as an abscess following an arthropod biteTay, Daniel ZunshengLim, Hua Liang JoelLiang, Michelle Weiting2022-01-01Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare form of low-grade cutaneous lymphoma that usually presents with multifocal non-tender subcutaneous nodules over the trunk and extremities. We present an exceptional case of SPTCL masquerading as a solitary abscess which developed following an antecedent arthropod bite. Unique histological features encountered include foci of neutrophilic aggregation and admixed eosinophils within the neoplastic lymphomatous subcuticular infiltrate. As SPTCL rarely presents as an abscess, the authors wish to highlight this diagnostic pitfall and suggest excluding SPTCL as a cause of pseudo-pyoderma in patients who are afebrile with a discordant inflammatory marker profile. In addition, this condition should be suspected in non-diabetic patients who experience a rapid clinical course with suppuration and demonstrate a poor response to appropriate antibiotics. As such, we recommend sending tissue for histopathological examination for patients with atypical presentations.abscessarthropod bitecellulitislymphomamalignancypanniculitisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7qr987b0articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt6zj648262022-09-05T04:12:56Zqt6zj64826Characteristics of non-melanoma skin cancers in Native American patients treated with Mohs micrographic surgeryTchanque-Fossuo, Catherine NRavichandran, NiharikaBarbosa, Naiara S2022-01-01Despite the lower incidence of non-melanoma skin cancers in skin of color populations, greater morbidity and mortality have been reported. Literature describing non-melanoma skin cancers in Native Americans is scarce. We designed a retrospective review study aimed to evaluate the characteristics of non-melanoma skin cancers (basal cell carcinoma and squamous cell carcinoma) in Native American patients treated with Mohs micrographic surgery between January 2015 and August 2020, at a single academic center. Twenty-six patients with 28 tumors were identified; 12 squamous cell carcinomas (92% well-differentiated) and 16 basal cell carcinomas (94% nodular). Most tumors were on the head and neck, with mean size of 563mm2 (squamous cell carcinomas) and 350mm2 (basal cell carcinomas). Tumor clearance was achieved in one stage for 75% of tumors. Recurrence was seen in two patients with squamous cell carcinoma. No mortality reported, although follow up was limited. Few Native Americans patients underwent Mohs micrographic surgery for non-melanoma skin cancers. Squamous cell cancers were larger, lower risk while basal cell carcinomas were predominantly nodular. Average time from biopsy to Mohs micrographic surgery was three months. Further studies are needed to better characterize non-melanoma skin cancers in Native Americans and to identify barriers to prompt care.American Indianbasal cellcancercarcinomaMohs surgeryNative Americannon-melanomaskin of colorsquamousapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6zj64826articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt1fm0m3652022-09-05T04:12:55Zqt1fm0m365Treatment modalities in brachioradial pruritis: a systematic reviewZakaria, AdamAmerson, Erin2022-01-01Introduction: Brachioradial pruritis is a rare dysesthesia syndrome that is known to negatively impact quality of life. No consensus exists regarding optimal treatment strategies. Methods: We searched MEDLINE, EMBASE, and the Cochrane Collaboration Clinical Trials Registry from 1966 to 2021 for studies using the title word "brachioradial pruritis" with no language restriction. One author (A.Z.) screened and performed full article reviews of all randomized clinical trials, cohort studies, case-control studies, case reports, and case series describing treatment outcomes among patients with brachioradial pruritis. Results: We identified 239 potential articles with a final set of 45 articles meeting inclusion criteria. Only a single randomized clinical trial was identified, finding no significant benefit of topical capsaicin cream. Treatment modalities with the greatest number of reported successful therapeutic trials include gabapentin and tricyclic antidepressants. In patients with confirmed cervical spine disease, spine-directed therapies such as epidural injections were found to be beneficial. Case reports and small case series describing less-common treatments were also identified. Discussion: The literature is overall limited with the greatest support for gabapentin, pregabalin, tricyclic antidepressants, and spine-directed therapies in appropriate patients with brachioradial pruritis. Future randomized clinical trials are needed to compare the relative effectiveness of available treatments.brachioradial pruritiscapsaicincervical spinegabapentinsystematic reviewtherapeuticstreatmentstricyclic antidepressantsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1fm0m365articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt6md761402022-06-23T23:07:54Zqt6md76140The legacy of Daisy Maude Orleman-Robinson: the first woman dermatologist in the United StatesMuthiah, NallammaiVenkatesh, AnishaKamath, Preetha2022-01-01historymedicinewomenapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6md76140articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt52k6561d2022-06-23T23:07:52Zqt52k6561dClassic ulcerative pyoderma gangrenosum in Fitzpatrick V skin typeGomez, JasonWang, Elizabeth ANord, Kristin M2022-01-01pyoderma gangrenosumsweet’s syndromeskin of colorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/52k6561darticleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt0gq7d56b2022-06-23T23:07:52Zqt0gq7d56bUtility of an anonymous online interactive forum for dermatology residency program directors and applicantsVeerabagu, Surya AStrunck, Jennifer LLin, KrystaWu, Albert GJefferson, Itisha SBrumfiel, Caitlin MBrodell, Robert TEtzkorn, Jeremy R2022-01-01applicationCOVID-19dermatologyinterest groupresidencywebinarapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0gq7d56barticleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt7mz2564g2022-06-23T23:07:51Zqt7mz2564gToward an understanding of the burnout phenomenon among dermatology residentsAltahan, NouranShadid, Asem2022-01-01burnoutdepersonalizationdermatologyemotional exhaustionpersonal accomplishmentapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7mz2564garticleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt8vv4m2gj2022-06-23T23:07:49Zqt8vv4m2gjUse of a thermoplastic splint to prevent auditory meatus strictureMehrzad, MehrnazDanesh, Melissa JEisen, Daniel B2022-01-01clinical researchdermatologymastoid flapMohs micrographic surgeryoncologysurgicalapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8vv4m2gjarticleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt1gd4v5zh2022-06-23T23:07:48Zqt1gd4v5zhEducational attainment is inversely correlated with hidradenitis suppurativa severitySingh, RohanMohney, LindseySenthilnathan, AditiFeldman-, Steven RPichardo, Rita O2022-01-01burningdemographicsdisease severityHurley scorenodulesscarringsocial theoriessocioeconomic implicationsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1gd4v5zharticleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt4h15t5cg2022-06-23T23:07:47Zqt4h15t5cgPost ambulatory swollen hands (POTASH) revisited: post ambulatory hand swelling in a half marathon participantCohen, Philip R2022-01-01acuteambulatorychronicedemafisthandpostPOTASHsignswellingapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4h15t5cgarticleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt4wr7d49s2022-06-23T23:07:46Zqt4wr7d49sAssociation of ocular cicatricial pemphigoid with a history of malignancy and severe vision loss.Echuri, HarikaJafari, Alexander JMurina, Andrea TBoh, Erin E2022-01-01autoimmuneblistering disordercicatricial pemphigoiddermatologic diseasemembrane pemphigoidmucousocularapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4wr7d49sarticleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt18k4p0dp2022-06-23T23:07:45Zqt18k4p0dpDiverse cutaneous adverse reactions associated with encorafenib therapyGodse, RamaClark, AshleyChu, Emily Y2022-01-01adverse reactionBRAF inhibitorscutaneoustargeted therapyverrucous keratosisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/18k4p0dparticleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt9vz206xw2022-06-23T23:07:43Zqt9vz206xwCalciphylaxis: utility of skin biopsy within a diagnostic algorithmKwapnoski, ZacharyBrassard, Alain2022-01-01algorithmbiopsycalciphylaxisclinicaldiagnosticapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9vz206xwarticleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt8792b7v32022-06-23T23:07:42Zqt8792b7v3Pruritic papules after induction chemotherapy with daunorubicin and cytarabineSimmons, ElaneeFoutouhi, SorayaTartar, Danielle MKiuru, Maija2022-01-01We present a 65-year-old woman who developed a diffuse pruritic papular eruption after receiving induction chemotherapy with daunorubicin and cytarabine for newly diagnosed acute myelomonocytic leukemia. The rash improved clinically with triamcinolone treatment and chemotherapy was allowed to continue. This case adds to the growing literature of transient acantholytic dermatosis development in the setting of anti-cancer therapy and emphasizes the importance of clinicopathologic correlation in cutaneous eruptions in cancer patients.acantholytic dermatosisGrover diseaseacute myeloid leukemiaacute myelomonocyticinduction chemotherapydaunorubicincytarabinepapularpruritictransientapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8792b7v3articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt3nk1v9jc2022-06-23T23:07:40Zqt3nk1v9jcSecondary cutaneous diffuse large B-cell lymphoma presenting with focal vesicular lesionsAlsukait, Sarah FTaher, Leena YAlJasser, Mohammed I2022-01-01Blister formation as a presentation of B-cell lymphoma is extremely rare; only one case has been previously reported in the literature to our knowledge. We report a patient known to have refractory systemic diffuse large B-cell lymphoma who presented with nodules with overlying vesicular lesions, which was consistent with secondary cutaneous spread of diffuse large B-cell lymphoma.B cellblisterbullouscutaneouslymphomavesicularapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3nk1v9jcarticleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt1sd2q9f22022-06-23T23:07:39Zqt1sd2q9f2Localized myxedema histologically mimicking spindle cell lipomaBolton, EBezecny, JHan, DCarlson, JMengden Koon, SBerry, EG2022-01-01In this report, a 55-year-old woman with Graves disease and exophthalmos had a recurrent nodule on the foot. Her initial biopsy and excision specimens were believed to be consistent with spindle cell lipoma, which aligned with her early tumor-like clinical morphology. Her tumor recurred after excision, which is not consistent with spindle cell lipoma. As her condition progressed, her clinical morphology became more consistent with localized myxedema and her biopsies were congruent, securing clinicopathologic correlation. With standard treatment for localized myxedema, she improved significantly. This case emphasizes how clinicians need to have high suspicion for localized myxedema in patients with history of Graves disease and exophthalmos. It also emphasizes how localized myxedema should be included in the histologic differential diagnosis for spindle cell lipoma with prominent myxoid stroma, particularly in those not responding to treatment as anticipated.Graves diseaselipomapretibial myxedemarecurrent nodulespindle cellthyroid diseaseapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1sd2q9f2articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt4p50g0xq2022-06-23T23:07:38Zqt4p50g0xqSquamous cell carcinoma or squamous proliferation associated with nivolumab treatment for metastatic melanomaVu, MarieChapman, SaraLenz, BrittanyWohltmann, Wendi2022-01-01Nivolumab is a programmed death-1 (PD1) immune checkpoint inhibitor that treats various types of cancers including non-small cell lung carcinoma and melanoma, among others. Although it serves as an effective immunotherapy, there are many associated immune-related adverse events. Even years after the introduction of nivolumab, the breadth of its side effect profile continues to expand. We present a case of squamous cell carcinoma associated with nivolumab treatment for metastatic melanoma.nivolumabmetastatic melanomaPDL1 inhibitorsquamous proliferationapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4p50g0xqarticleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt8g28912s2022-06-23T23:07:37Zqt8g28912sMilia en plaque manifesting as a post-herpetic isotopic responseDraper, ElizabethRollins, BenjaminMatlock, StephenWong, HenryShalin, Sara2022-01-01Isotopic response in dermatology refers to the development of a new primary dermatosis at the site of a previous reaction such as cutaneous herpes virus infection. We report a 63-year-old woman with a recent history of a bullous drug eruption treated with prednisone who presented with herpetic dermatitis and subsequent milia en plaque. This unique case represents a novel presentation of milia en plaque manifesting as a complication from post-herpetic isotopic response and highlights the wide array of isotopic responses that can occur following a cutaneous herpes simplex infection.herpes simplexisotopic responsemilia en plaquevirusWolf post-herpeticapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8g28912sarticleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt9cn102hk2022-06-23T23:07:36Zqt9cn102hkLucio phenomenon with concomitant necrotizing fasciitis and acute kidney injuryNorman, ThomasZikry, JosephWorswick, ScottKim, GeneOchoa, Maria T2022-01-01Lucio phenomenon is a rare vasculopathy that can occur in patients with Hansen disease, particularly diffuse lepromatous leprosy. It is characterized by retiform purpura and necrotic ulcerations, most commonly affecting the extremities. Diagnosing Lucio phenomenon can be challenging, especially when secondary bacterial infections occur. We report a patient with Lucio phenomenon who presented with acute necrotizing fasciitis of his left upper extremity and a 10-year history of chronic ulcerations. Shortly following admission, he also developed acute kidney injury. The necrotizing fasciitis was treated with prompt surgical debridement and intravenous antibiotics. Biopsy and PCR of a right upper extremity ulcer confirmed the presence of Mycobacterium lepromatosis. Multidrug therapy and prednisone were used to treat the Lucio phenomenon. After initiating treatment, no new lesions developed, kidney function improved, and the patient underwent successful skin graft of his left upper extremity. Although corticosteroid use is controversial, our patient's marked response to multidrug therapy with prednisone highlights the importance of this regimen in severe presentations of Lucio phenomenon. To the best of our knowledge, only two other cases of Lucio phenomenon confirmed to be caused by M. lepromatosis have been reported in living patients (rather than retrospectively identified post-mortem), underscoring the importance of the presented clinical course and treatment regimen.acuteclofazimineglomerulonephritisgroup A strepHansen diseaseleprosyLucio phenomenonminocyclineMycobacterium lepromatosisnecrotizing fasciitisprednisonerenal insufficiencyretiformrifampinulcersvasculopathyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9cn102hkarticleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt8pt9t1k72022-06-23T23:07:35Zqt8pt9t1k7Total body skin exams: the role of gynecology and dermatology-a cross-sectional studyKim, Joyce YMartin, AmyleeStuparich, MalloryDao, Harry2022-01-01The literature demonstrates practice gaps in performance of the genital skin examination. To further elucidate and understand these practice gaps, we surveyed dermatologist and obstetrician-gynecologist (OB/GYN) attending and resident physicians. Analysis of 73 dermatology survey responses revealed a lack of satisfaction with training received in examination of the female genitalia. Moreover, examination of 69 OB/GYN survey responses showed a lack of satisfaction with residency training received to identify high risk skin lesions. Interestingly, only 52.2% of OB/GYN respondents inspect perianal skin during pelvic region examinations. Our results highlight the need to improve residency training through standardization of breast/genitalia skin examinations during both dermatology and OB/GYN residency and for increased collaboration between specialties.breastcancereducationpelvic regionpreventionskin examinationapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8pt9t1k7articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt6pv8d2802022-06-23T23:07:35Zqt6pv8d280A unique case of concurrent cutaneous lichen amyloidosis and myxedemaGaghan, LindseyPaci, KarinaFoulke, GalenGooge, Paul BLugo-Somolinos, Aida2022-01-01Lichen amyloidosis is believed to be caused by damage to keratinocytes, often by chronic scratching. It has also been associated with autoimmune conditions, including thyroid disease. Dermatologic manifestations of poorly controlled thyroid disease are well described within the medical literature, within both hypothyroid and hyperthyroid states. Myxedema is a rare complication of Graves disease. We report a unique case of concurrent myxedema and lichen amyloidosis in a 63-year-old patient with uncontrolled hypothyroidism in the setting of post-ablative Graves disease.amyloidautoimmuneGraves diseaselichen amyloidosismyxedemamucinosismucinous myxedemapretibial myxedemathyroid dermopathyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6pv8d280articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt7qx2k0w42022-06-23T23:07:34Zqt7qx2k0w4Innovation in dermatology: where are the dermatologists? A retrospective review of the Pitchbook DatabaseKim, Yong-HunKim, LucasVidal, Nahid Y2022-01-01To investigate the extent to which dermatologists are involved in innovative dermatology start-up companies, we analyzed the Pitchbook database which covers private capital markets. From January 1, 2010 to June 23, 2021, there were 105 dermatology companies, of which six (5.7%) had a dermatologist chief executive officer (CEO), 16 (15.2%) had a dermatologist founder, and 19 (18.1%) had a dermatologist advisor or board member. There were 98 dermatologists with leadership positions, including six (6.1%) CEOs, 21 (21.4%) founders, 11 (11.2%) chief medical officers (CMOs), and 60 (61.2%) advisors. Our findings highlight the underrepresentation of dermatologists in start-up ventures relating to dermatology.commercializationdermatologistentrepreneurshipinnovationventure capitalapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7qx2k0w4articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt8jv7r1q52022-06-23T23:07:33Zqt8jv7r1q5Understanding eligibility creep in psoriasis assessments: a survey studyRakita, UrosGuraya, ArmaanPorter, Caroline LBray, Jeremy KFeldman-, Steven R2022-01-01Psoriasis severity assessments for clinical trial entry may be unintentionally overestimated, especially if trial eligibility is chiefly dependent on rating of disease severity. When this results in patients with less severe phenotypes joining clinical trials it is referred to as eligibility creep. We investigated the potential impact of psychosocial incentives on psoriasis lesion severity grading. A survey was constructed and disseminated through Amazon Mechanical Turk. Participants completed two vignette-style questions prompted with a randomly allocated psychosocial incentive. Questions required participants to grade and select psoriasis lesion pictures for a fictional trial. Participants also decided whether or not to schedule re-evaluation of patients deemed ineligible at initial visit. There were 646 participants. There was no significant difference in number of total lesions selected for study inclusion between incentive groups (Kruskal-Wallis, P=0.30). In general, participants completing empathy and professional uncertainty incentives selected the most and least number of lesion pictures for trial inclusion, respectively. Participants prompted with empathy incentives had significantly greater rates of choosing to schedule a follow-up visit for ineligible patients compared to participants prompted with other incentives (69.7% versus 59.1%, Chi square P=0.046). Situations evoking empathy may contribute to eligibility creep.clinical trialeligibility creepPASIpsoriasissurveyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8jv7r1q5articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt3kc392p92022-05-16T01:03:54Zqt3kc392p9Position Title: Basic ScientistDepartment of Dermatology, The University of California, Davis, School of Medicine,2022-01-01The University of California, Davis, School of Medicine, the Department of Dermatology is currently recruiting for a full-time basic research position in the series of Ladder rank or In-Residence at the Associate or Full Professor rank. Appointees to this position will be predominantly engaged in research, but also participate in teaching and engage in University and public service. This position may be 100% or 50/50 appointment. Professor In-Residence titles are intended to be used for individuals supported by non-State funds.recruitmentjobresearchscientistapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3kc392p9articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt60j6f1zn2022-05-16T01:03:53Zqt60j6f1znOn the validity of biopsy cost analysis pertaining to nonphysician cliniciansYoung, Peter AMarchetti, Michael A2022-01-01biopsy numberdiagnostic excellencenonphysician cliniciansnurse practitionersphysician assistantsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/60j6f1znarticleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt4gr0601w2022-05-16T01:03:52Zqt4gr0601wPsoriasis, sarcoidosis, and bullous pemphigoid: more than a coincidence in a single patient?Escalas, Juandel Pozo, LuisGracia-Darder, Ines2022-01-01anti TNF-inducedbullous pemphigoidphototherapypsoriasissarcoidosisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4gr0601warticleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt1zf1t8g72022-05-16T01:03:51Zqt1zf1t8g7Improving dermatology residency program website transparency in the era of preference signalingVeerabagu, Surya AJia, JustinYu, ZiziGao, DavidKahn, Jared STanner, JordanBurkemper, Nicole MFriedman, Adam JHuang, Jennifer TNord, Kristin MRosmarin, DavidMurina, Andrea T2022-01-01application equityCOVID-19dermatology residencymatchmedical educationpreference signalingtransparencyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1zf1t8g7articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt1nk5g5w92022-05-16T01:03:50Zqt1nk5g5w9Survey participants are more willing to receive dermatology care from dermatologists than from advanced care practitionersRanpariya, Varun KSalisbury, Katherine RFeldman, Steven R2022-01-01adalimumabassociatebotoxcorticosteroiddermatologistestheticianexcisionnurse practitionerphysician assistantprovidersurgerytrainingwillingnessapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1nk5g5w9articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt2qw5f63b2022-05-16T01:03:49Zqt2qw5f63bNon-dermatology visits account for a slight majority of dermatologic diagnoses: a representative sample of U.S. outpatient visitsRanpariya, Varun KPeck, Gabrielle MMuddasani, SurajFleischer, Alan BFeldman, Steven R2022-01-01common diagnosesdermatologyinternal medicineNAMCSoutpatientprimary carevisitsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2qw5f63barticleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt4t49f41z2022-05-16T01:03:48Zqt4t49f41zBeyond traditional meetings and webinars: identifying the educational preferences of practicing dermatologistsSingh, RohanFarr, Morgan AChan, Warren HAkkurt, Zeynep MHuang, William WStrowd, Lindsay CFeldman, Steven R2022-01-01case-based discussioncontinuing medicaldermatology educationexpert panelmedicalsmall groupapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4t49f41zarticleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt6553c5ps2022-05-16T01:03:47Zqt6553c5psAdvanced squamous cell carcinoma with massive cranial invasion: walking around without a foreheadOliveira, NikhilKandathil, Lorraine JTchernev, Georgi2022-01-01Squamous cell carcinomas with widespread invasion of the skull, meninges and brain parenchyma are extremely rare. Herein, we present an 86-year-old man with an 18-year history of sunburn who developed a large osteodestructive SCC that invaded through the frontal bone, frontal sinuses, and the dura mater. No neurological signs or symptoms or distant metastasis were noted. Such cases arise through patient neglect or lack of access to care and pose many challenges as lack of symptoms tend to deceive patients from seeking medical advice. Urgent aggressive treatment by a multidisciplinary team is paramount to achieving a successful outcome.bone invasioncancercarcinomainvasive tumormultidisciplinarysquamous cellapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6553c5psarticleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt0s56t9gm2022-05-16T01:03:46Zqt0s56t9gmDegenerative collagenous plaques of the hands in an elderly womanYoung, Peter ARangel, JavierPettey, Adam A2022-01-01Degenerative collagenous plaques of the hands is an underrecognized acquired dermatosis characterized by slowly progressive linear depressed bands appearing symmetrically at the margins of palmar and dorsal skin of the hands. It is more common in the elderly and is believed to result from chronic pressure and ultraviolet radiation. We present an elderly woman with degenerative collagenous plaques of the hands to highlight an underrecognized rare dermatosis.collagenousdegenerativehandskeratoelastoidosis marginalisplaquesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0s56t9gmarticleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt9kc732n12022-05-16T01:03:45Zqt9kc732n1Acroangiodermatitis presenting as unilateral hypertrophic verrucous plaquesLauck, KyleNguyen, Quoc-BaoKlimas, NatashaRogge, Megan2022-01-01Acroangiodermatitis (AAD)[KL1] is a rare vasoproliferative disorder often involving the extremities that has been classified into two variants. Mali-type AAD is more common and associated with chronic venous stasis. Stewart-Bluefarb syndrome[KL2], the other variant, is associated with underlying arteriovenous abnormalities. Mali-type AAD is a relatively benign diagnosis but it may mimic more harmful etiologies such as Kaposi sarcoma both clinically and histologically. A 67-year-old woman with a history of varicose veins, deep vein thrombosis, stroke, and obesity presented to our outpatient clinic with verrucous red-brown papules and plaques on her right lower extremity worsening for three years. Biopsy was consistent with a diagnosis of Mali-type AAD. Providers should be aware of AAD and its variants to accurately differentiate it from more harmful entities.acroangiodermatitispseudo-Kaposi sarcomastasis dermatitisvenous insufficiencyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9kc732n1articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt5sr475s02022-05-16T01:03:44Zqt5sr475s0Interstitial granulomatous dermatitis and concurrent immunotherapy associated encephalitis with nivolumab and ipilimumabStarling, Caroline TMesser, Alison AKleiman, AnneMcQuade, Jennifer LGlitza, Isabella CTorres-Cabala, Carlos AntonioHeberton, Meghan2022-01-01Immune-related adverse events (irAEs) are common in patients receiving immune checkpoint inhibitors for metastatic melanoma and other advanced malignancies. Cutaneous, gastrointestinal, and endocrine (thyroid) irAEs are most prevalent, whereas neurologic irAEs are rare. We present a 73-year-old man with dementia and metastatic melanoma who developed immunotherapy-associated encephalitis and subsequently, interstitial granulomatous dermatitis with nivolumab/ipilimumab. High-dose corticosteroids successfully treated both conditions, though he never regained his baseline mental status. We review the literature on interstitial granulomatous dermatitis and encephalitis with immunotherapy.granulomatous dermatitisimmunotherapyinterstitialmelanomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5sr475s0articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt6qr6c5jb2022-05-16T01:03:43Zqt6qr6c5jbCutaneous hydrophilic polymer emboli following endovascular repair of an abdominal aortic aneurysm: a case and review of literatureCasale, FioreSilva, FloydPosligua Alban, AlbaElwood, HillaryStepenaskie, ShellyAltman, Emily2022-01-01Hydrophilic polymer embolism (HPE) is a rare iatrogenic complication of the use of polymer-coated intravascular devices, which may affect several organ systems including the skin. Herein, we present a patient who developed a cutaneous eruption with associated neurologic manifestations secondary to localized HPE. This is a potentially underdiagnosed, life-threatening complication and physicians should consider HPE when evaluating skin eruptions in patients who have undergone endovascular procedures.cutaneousemboliendovascular grafthydrophilic polymeriatrogenic complicationintravascular surgerylivedo racemosaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6qr6c5jbarticleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt88f861dc2022-05-16T01:03:42Zqt88f861dcA rare case of cutaneous metastasis of distal phalanx chondrosarcoma.Correia, CatarinaFernandes, SoniaFilipe, PauloKutzner, HeinzSoares-de-Almeida-, Luis2022-01-01Chondrosarcoma is the second-most common primary malignant bone tumor but chondrosarcoma of small bones of the hand is extremely rare, representing less than 2% of all cases, with exceedingly rare skin metastases. Cutaneous metastases of chondrosarcoma represent less than 3% of all cutaneous metastases. According to PubMed, there are only four previous case reports of cutaneous metastases originating from chondrosarcoma of small bones of the hand. We present an additional case of cutaneous metastases of phalangeal chondrosarcoma with a unique immunophenotype.bonechondrosarcomametastasesneoplasmsskinapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/88f861dcarticleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt8gg6693r2022-05-16T01:03:41Zqt8gg6693rA case of nivolumab-induced bullous pemphigoid successfully treated with dupilumabBruni, ManfredoMoar, AgataSchena, DonatellaGirolomoni, Giampiero2022-01-01A 76-year-old man came to our attention for the presence of itchy skin lesions localized on the trunk. The patient had a nodular melanoma removed two years earlier. Because of metastatic pulmonary melanoma, he underwent a lung lobectomy and began adjuvant therapy with nivolumab. After six months of treatment, the patient reported the appearance of itchy lesions on the trunk that were diagnosed as eczema and successfully treated with systemic corticosteroids. Upon corticosteroid discontinuation, the eruption relapsed presenting with erythematous macules, tense blisters, and erosions on the trunk and limbs. The presence of linear deposits of IgG and C3 at the dermo-epidermal junction and high serum levels of anti-BP180 antibodies confirmed the suspicion of nivolumab-induced bullous pemphigoid. Treatment with 0.6mg/kg methylprednisolone and 200mg/day doxycycline as well as nivolumab discontinuation induced temporary remission. After tapering methylprednisolone to 16mg/day, the patient developed new blisters. Therefore, dupilumab 300mg every other week was added with progressive improvement while methylprednisolone was tapered down and withdrawn after four months. After six months the patient was still in full clinical remission. Many cases of conventional bullous pemphigoid have been treated successfully with dupilumab, which can also be used safely in cancer patients without inducing overt immunosuppression.bullous pemphigoiddupilumabnivolumabapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8gg6693rarticleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt5f65w32k2022-05-16T01:03:40Zqt5f65w32kMyopericytoma presenting as a painful dark subungual discolorationAntunes-Duarte, SofiaAguado Lobo, MartaEspinosa Lara, PabloFraga, AnaSoares-de-Almeida, Luis2022-01-01Myopericytoma is an uncommon benign neoplasm that arises from the perivascular myoid cells. It typically presents as a painless well-circumscribed cutaneous or soft-tissue nodule, most commonly on the extremities of adults. Histologically, it is characterized by spindle-shaped myoid-appearing cells with a concentric arrangement in vessel walls, that are immunoreactive to alpha-smooth muscle actin and often for h-caldesmon, but negative for other smooth muscle markers. Herein, we present an unusual case of a painful subungual myopericytoma presenting as a dark subungual discoloration.myopericyticmyopericytomatumorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5f65w32karticleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt3df5f83z2022-05-16T01:03:39Zqt3df5f83zCD4/CD8 double-negative mycosis fungoides with large cell transformation and involvement of the lungs and leptomeningesWilmas, Kelly MAria, Alexander BLandis, Laura NChaitanya, Sri KrishnaPrieto, Victor GDuvic, Madeleine2022-01-01Mycosis fungoides (MF), the most common cutaneous T-cell lymphoma, classically has an indolent clinical course, with lesions slowly progressing from patch to plaque to tumor stage. In some cases, the late stages of disease involve extra-cutaneous dissemination to lymph nodes or viscera. Although this "Alibert-Bazin" type is the prototypic MF, there are several variants and subtypes of MF that may have different clinical implications for treatment and prognosis. We describe a woman whose disease course involved a variety of histopathologic and immunophenotypic variants including folliculotropic MF, granulomatous MF with loss of CD8, and then finally CD4/CD8 double-negative MF with large cell transformation and extra-cutaneous dissemination. Clinically her disease behaved as classic indolent stage IA MF for nearly two decades before transitioning to tumor stage and then, finally, involving the lungs and leptomeninges. It is important for physicians to be aware of the clinically relevant variants of MF as well as the possibility of transformation of previously stable disease both clinically and histopathologically.CTCLcutaneousdisseminationdouble-negativeextra-cutaneousFMFfolliculotropicGMFgranulomatouslarge cellLCTMFmycosis fungoidesT-cell lymphomatransformationapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3df5f83zarticleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt8zk543482022-05-16T01:03:38Zqt8zk54348Sexual orientation and gender identity (SOGI) data in dermatologic studies and opportunities for inclusionPresley, Colby LPulsipher, Kayd JSzeto, Mindy DRundle, Chandler WMilitello, MichelleWard, Kristen HSwink, Shane MConcilla, AnthonyHusayn, Sameeha SLaughter, Melissa RDellavalle, Robert P2022-01-01Dermatologists serve a vast array of patients with unique backgrounds. The National Institutes of Health (NIH) designated members of sexual and gender minorities as underrepresented in scholarly literature. Our study examines the past 10 years of studies published in highly-cited dermatologic journals, surveying each study for common data collection of sexual orientation and gender identity (SOGI) in dermatological studies. We found representation of sexual and gender minorities to be increasing in dermatological studies but recommend that SOGI data be collected regularly just as any other common variable in dermatological patient studies.bisexualgaygender identitygender minoritieslesbianqueersexual orientationtransgenderapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8zk54348articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt9j53k98k2022-05-16T01:03:37Zqt9j53k98kImpact of an evolving regulatory landscape on skin cancer drug development in the U.S.Miller, David MShalhout, Sophia ZCasey, DeniseFashoyin-Aje, LolaLemery, StevenTheoret, Marc RPazdur, Richard2022-01-01Background: There has been a rapid proliferation of FDA-approved medications with labeled indications for skin cancer over the last decade, with particular growth over the last 5 years. Objective: We aimed to evaluate the impact of an evolving U.S. regulatory framework on drug development programs to better understand current trends and regulatory considerations when adjudicating drug approvals for patients with skin cancer. Methods: We reviewed publicly-available regulatory documents of all systemic medications with a labeled indication for skin cancer. Results: We identified 130 FDA approvals that resulted in a unique indication, usage, formulation, or dosage change in skin cancer since 1949. Limitations: Publicly available data from the mid-to-late 20th century is limited. Conclusions: The therapeutic landscape in skin cancer has changed greatly since the first approval in 1949. In concert, regulatory medicine has also evolved over the last 70 years with the aim of ensuring safe and effective medicines for a diverse array of patients.carcinomacutaneousmelanomaMerkel`regulatory medicinesquamousapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9j53k98karticleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt7dh0k1xr2022-05-16T01:03:37Zqt7dh0k1xrSubscription-based and open access dermatology journals: the publication model dilemmaDing, JeffreyVijayasarathi, ArvindAmornteerasawas, Orapin MHiebert, GabrielleKhosa, Faisal2022-01-01Medical journalism and the dissemination of peer-reviewed research serve to promote and protect the integrity of scholarship. We evaluated the publication models of dermatology journals to provide a snapshot of the current state of publishing. A total of 106 actively-publishing dermatology journals were identified using the SCImago Journal Rankings (SJR) citation database. Journals were classified by publication model (subscription-based and open-access), publishing company, publisher type (commercial, professional society, and university), MEDLINE-indexing status, and SJR indicator. Of these, 65 (61.32%) dermatology journals were subscription-based and 41 (38.68%) were open-access. In addition, 59 (55.66%) journals were indexed in MEDLINE and most were subscription-based (N=51) and published by commercial entities (N=54). MEDLINE-indexing status was significantly different across publisher types (P<0.001), access-types (P<0.001), and the top four publishers (P=0.016). Distribution of SJR indicator was significantly different across publisher types (P<0.001) and access-types (all journals, P=0.001; indexed journals only, P=0.046). More than 91% of MEDLINE-indexed titles were published by commercial entities, and among them, four companies controlled the vast majority. Discontinuation of access to any one of the top publishers in dermatology can significantly and disproportionately impact education and scholarship.dermatologyjournalsopen-accesspublication modelsubscription-basedapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7dh0k1xrarticleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt3p96v4mp2022-04-23T00:16:34Zqt3p96v4mpPPE dermatitis in Skin of Color during the COVID-19 pandemicAhuja, GeetaLi, Sandy2022-01-01dermatitisCOVID-19hyperpigmentationhypersensitivitymelaninapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3p96v4mparticleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt6c73g6zb2022-04-23T00:16:33Zqt6c73g6zbMelanoma presenting as a Marjolin ulcer on the lower extremityMorrison, Georgia MaeMorrison, Lynne HKoon, Stephanie MengdenAndeen, NicoleChung, Jina2022-01-01blisteringdermatosismalignancyMarjolinulcerapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6c73g6zbarticleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt6f18k6zq2022-04-23T00:16:32Zqt6f18k6zqCurettage of skin cancer-the bruised apple analogyShi, KevinDavis, DerekDavis, Daniel ASrivastava, DivyaNijhawan, Rajiv I2022-01-01cancercurettagedebulkfriableMohsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6f18k6zqarticleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt3sx049jm2022-04-23T00:16:31Zqt3sx049jmConjunctival malignant melanoma treated successfully with BRAF inhibitor: encorafenib plus binimetinibMiura, ShinpeiOnishi, MasazumiWatabe, DaisukeAmano, Hiroo2022-01-01binimetinibBRAFconjunctivalencorafenibinhibitormutationmelanomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3sx049jmarticleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt05z8g6c72022-04-23T00:16:29Zqt05z8g6c7Cutaneous T-cell lymphoma developing during nivolumab treatment for metastatic melanomaHida, YasutoshiKageji, RihoBekku, HirofumiWatanabe, ShunsukeSeike, TakuyaYamashita, Michiko2022-01-01cutaneousinhibitorlymphomamalignant melanomanivolmabPD1programmed cell death-1T cellapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/05z8g6c7articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt2m7847qv2022-04-23T00:16:28Zqt2m7847qvSocial and demographic factors associated with differences in skin self-examination practices for skin cancer detectionDesai, SheenaMoore, Kevin JTrepanowski, NicoleHartman, Rebecca I2022-01-01cancerexaminationpreventionselfskinapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2m7847qvarticleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt66x3q5bz2022-04-23T00:16:26Zqt66x3q5bzUndesirable repigmentation in vitiligo patient receiving methotrexate therapy for the treatment of psoriasis: treatment or side effect?Ugurer, EceAltunay, Ilknur KivancErdem, YaseminOzkur, EzgiTuncel, Deniz2022-01-01Vitiligo is an acquired skin depigmentation disorder related to the destruction of melanocytes. There are a limited number of case reports and studies in current literature that show methotrexate (MTX) is effective in the treatment. A 44-year-old man presented to our clinic with a one-year history of psoriasis. On dermatological examination, there were erythematous, scaly papules and plaques on knees, elbows, gluteal area, and scalp compatible with psoriasis. In addition there was total depigmentation over the body. He had a 30-year history of vitiligo, beginning localized but progressed gradually and covered the entire body surface. Subcutaneous methotrexate 10mg weekly was started for psoriasis. On the 6th week of methotrexate treatment, he presented to our clinic with newly developed brown macules on his face. The result of the punch biopsy taken from a macule was reported as normal skin findings. Because his body was fully depigmented, his brown melanocytic macules on his face were considered as repigmentation associated with MTX treatment. His MTX treatment was stopped by patient request. On his 6-month follow-up, hypopigmentation was observed at prior repigmented macules. Methotrexate can be considered an alternative treatment for vitiligo patients when topical therapy and phototherapy are ineffective or not applicable.methotrexaterepigmentationvitiligoapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/66x3q5bzarticleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt18d5v7hw2022-04-23T00:16:26Zqt18d5v7hwPublic understanding of the training requirements for dermatology providers: more education may be neededRanpariya, Varun KSalisbury, Katherine RFeldman, Steven R2022-01-01assistantassociatedermatologisteducationestheticiannursephysicianpractitionerprovidertrainingapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/18d5v7hwarticleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt68f641rr2022-04-23T00:16:25Zqt68f641rrBasal cell carcinoma invasion of an ear piercingDreher, KatieKern, MalanRush, LoganJennings, Thomas2022-01-01Basal cell carcinoma (BCC) development in the context of a piercing is a rare phenomenon, reported in the literature in only six instances. We present a 55-year-old woman with nodular BCC involving her auricular piercing and extending clinically onto the posteroinferior right ear lobule and right post-auricular crease. Histological analysis revealed spread of the BCC through the piercing onto the anterior lobule, with evidence that the cancer utilized the piercing as a low resistance pathway for this microscopic invasion. This case is, to our knowledge, the first report of microscopic BCC present within an auricular piercing itself. Chronic inflammation related to repeated trauma from the embedded jewelry may have played a role in its formation. A piercing may provide a path of least resistance for BCC tumor cells to invade, providing a nidus for recurrence. Careful histological examination with possible complete excision of the piercing is prudent to prevent cancer return.basal cellcancercarcinomaearpiercingsskinapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/68f641rrarticleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt3r6133hv2022-04-23T00:16:23Zqt3r6133hvAn exuberant case of protothecosis: an emergent disease in tropical dermatology.Melo, Raissa RodriguezRodrigues, Felipe TavaresBaka, Jessica Lana Lana Conceição e SilvaAlmeida, Maite DomingosAlves, Maria de Fatima Guimarães ScotelaroGripp, Alexandre Carlos2022-01-01Protothecosis is a rare condition caused by the aclorophylated algae of the genus Prototheca. We described an exuberant case treated as sporotrichosis with prolonged course which evolved to arm deformation. Itraconazole treatment for 8 months was inefective.algaldiseasesharmfulinfectiousmedicinephotothecosisproliferationskintropicalapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3r6133hvarticleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt8g76064d2022-04-23T00:16:22Zqt8g76064dFixed drug eruption from atezolizumabKearns, DonovanGardner, Jeffrey TKerstetter, JustinFurukawa, Betsy2022-01-01Fixed drug eruption (FDE) is a cutaneous drug reaction that tends to recur in the same area (fixed location) upon re-exposure to the offending agent. We present a 48-year-old woman with FDE being treated for metastatic breast cancer with atezolizumab. We believe this is the first reported case of FDE secondary to atezolizumab.atezolizumabbreastcancerfixed drug eruptionapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8g76064darticleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt5pg0k0p02022-04-23T00:16:21Zqt5pg0k0p0A case of pleomorphic dermal sarcoma with perineural invasion treated with Mohs micrographic surgery and adjuvant radiation therapyKurtti, AlanaFarhadian, JoshuaMeehan, ShaneMadu, PamelaBradu, Stefan2022-01-01Pleomorphic dermal sarcoma (PDS) was recognized in the 2013 World Health Organization Classification of Tumors of Soft Tissue and Bone as a clinical entity with adverse histopathologic features compared to the more superficial and less aggressive atypical fibroxanthoma (AFX). Although the gold standard treatment of AFX is Mohs micrographic surgery (MMS), the optimal treatment for PDS has yet to be determined. We report the case of a 71-year-old man with a PDS with perineural invasion on the scalp, with no recurrence one-year post-treatment with MMS and adjuvant radiation therapy. In contrast to wide local excision, MMS offers complete margin control and tissue preservation, which helps minimize scarring and morbidity. The comparative efficacy of MMS versus wide local excision in the treatment of PDS with and without radiation remains unknown and warrants further investigation.atypicalcutaneousdermalfibroxanthomaMohspleomorphicradiotherapysarcomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5pg0k0p0articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt37f1t16d2022-04-23T00:16:20Zqt37f1t16dEarly onset drug-induced hypersensitivity syndrome with lymphopenia, hepatitis, and normal eosinophils induced by BRAF/MEK inhibitor after immune checkpoint inhibitor therapyBuhle, AnnaJohnson, NathanGrider, DouglasPhillips, Mariana2022-01-01Targeted therapy (BRAF/MEK inhibitors) is frequently employed in the treatment of metastatic melanoma following immune checkpoint inhibitor therapy inefficacy or intolerance. Although BRAF inhibitors are commonly associated with cutaneous eruptions, they rarely cause severe cutaneous adverse drug reactions such as drug-induced hypersensitivity syndrome (DIHS). Drug-induced hypersensitivity syndrome is a severe drug reaction characterized by extensive eruption often seen in conjunction with fever, facial edema, lymphadenopathy, eosinophilia, atypical lymphocytosis, and variable visceral organ injury characteristically beginning 2-8 weeks after initiating the causative drug. We report a case of atypical DIHS with reduced latency, mucosal involvement, lymphopenia, normal eosinophils, and no lymphadenopathy that occurred secondary to vemurafenib and cobimetinib therapy following melanoma progression while on pembrolizumab. Previous immune checkpoint inhibitor therapy has been associated with atypical DIHS in patients on BRAF/MEK inhibitors. Early recognition of the atypical clinical features of this hypersensitivity reaction is important so that drug discontinuation and corticosteroids can be initiated early.DIHSDRESSdrugeosinophiliahypersensitivityimmunePD1pembrolizumabrashvemurafenibapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/37f1t16darticleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt3149s14c2022-04-23T00:16:19Zqt3149s14cLichenoid eruption in a child receiving growth hormone for dwarfismAlhameedy, Meshal M2022-01-01A wide variety of medications have been associated with lichenoid drug eruption. They present similarly or even identically to idiopathic lichen planus, both clinically and histologically. Lichenoid eruption has been associated with recombinant human growth hormone intake in two previous patients. Herein, we describe a young boy who developed a lichenoid eruption following growth hormone injection for dwarfism.childrendermoscopyeruptiongrowthhormonelichenlichenoidplanusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3149s14carticleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt3wv549wb2022-04-23T00:16:18Zqt3wv549wbToxic erythema of chemotherapy induced by liposomal doxorubicin, a clinical caseEsperanca-Martins, MiguelLobo-Martins, SoraiaSanches, MariaBrazao, ClaudiaPena, BarbaraCorreia, CatarinaAguado-Lobo, MartaEspinosa-Lara, PabloCosta, LuisSoares-de-Almeida, LuisFernandes, Isabel2022-01-01A 76-year-old woman presented to the medical oncology outpatient clinic with painful, burning, pruritic erythematous plaques involving both palms and axillae that had suddenly appeared five days before. Examination revealed no additional relevant findings and laboratory studies did not show any alteration. The patient had been recently diagnosed with a high-grade angiosarcoma of the breast (probably radiation induced) and after frequent local recurrences, was being treated with liposomal doxorubicin (three cycles were administered, the last of which was seven days before the appearance of the mentioned lesions). Oral corticosteroids were started, treatment with liposomal doxorubicin was stopped, and cutaneous biopsies performed that revealed features compatible with toxic erythema of chemotherapy induced by liposomal doxorubicin. Complete resolution of the cutaneous lesions was verified one month after. No signs of recurrence of angiosarcoma were documented at follow-up three months later.angiosarcomachemotherapyliposomal doxorubicintoxic erythemaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3wv549wbarticleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt75k7b00v2022-04-23T00:16:17Zqt75k7b00vComplete response of Merkel cell carcinoma with talimogene laherparepvec (TVEC) monotherapyCasale, FioreTchanque-Fossuo, CatherineStepenaskie, ShellyDurkin, John2022-01-01Merkel cell carcinoma (MCC) is a rare neuroendocrine neoplasm, warranting surgical excision with sentinel lymph node biopsy. In later stages, adjuvant chemotherapy and radiation are required owing to its aggressive malignant behavior. We describe a 62-year-old woman who presented with multifocal recurrence of MCC and was not a candidate for immunotherapy or surgery. The patient underwent four treatments of intratumoral talimogene laherparepvec (TVEC) and demonstrated a complete response with no histologic evidence of remaining MCC on four scouting biopsies. Although TVEC therapy is currently approved for the treatment of advanced stage melanoma, it is still being investigated in MCC. This case supports the use of TVEC as monotherapy in select patients with locally advanced MCC who are not candidates for surgery or systemic immunotherapy.carcinomaMerkeltalimogene laherparepvecTVECapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/75k7b00varticleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt73p005z52022-04-23T00:16:16Zqt73p005z5Cutaneous perivascular epithelioid cell tumor (PEComa): case report and world literature review of clinical and molecular characteristicsCohen, Philip RKato, Shumei MErickson, Christof PCalame, AntoanellaKurzrock, Razelle2022-01-01Perivascular epithelioid cell tumor (PEComa) expresses melanocytic and smooth muscle markers. A man with a primary malignant cutaneous (distal left forearm) PEComa is reported. Immunohistochemistry demonstrated MiTF, HMB-45, caldesmon, desmin, and smooth muscle actin, as well as BCL1, CD10, and CD68. Next generation sequencing showed four pathogenic genomic aberrations involving BIRC3, FANCC, TP53, and TSC1 genes. His work-up was negative for metastatic disease; a wide local excision was performed. Including the reported patient, cutaneous PEComa has been described in 65 individuals: primary benign (N=58), primary malignant (N=5), and metastatic malignant (N=2). Cutaneous PEComa typically presented as a painless, slowly growing nodule of <2 centimeters on the lower extremity of a woman in her fifth decade. The neoplasms consisted of epithelioid cells, spindle cells, or both. The most reliable markers were MiTF (100%), HMB45 (94%), and NKIC3 (94%) for melanocytes and smooth muscle actin (43%) and desmin (40%) for smooth muscle. There has been no reported recurrence of a primary cutaneous benign or malignant PEComa after complete excision. Genomic alterations in malignant PEComas frequently involve TSC1 and TSC2 genes (mTOR activators), as well as TFE3 fusions. In November 2021, the FDA approved nab-sirolimus (mTOR inhibitor) for PEComas.aberrationcellepithelioidgenerationgenomicnextPEComaperivascularsequencingtumorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/73p005z5articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt2q30p2jt2022-04-23T00:16:15Zqt2q30p2jtTeledermatology during COVID-19: a comparison of video and telephone visits with patient-uploaded images at an urban academic medical centerSchroedl, Liesl MDuan, Grace Yde Luzuriaga, Arlene Ruiz2022-01-01The COVID-19 pandemic stimulated adoption of teledermatology via video and telephone modalities by outpatient dermatology clinics. However, it was unknown how patient-related factors may have impacted, whether video or phone visits were used, and if visit modality impacted management. Consequently, we conducted a retrospective cross-sectional study of teledermatology visits occurring between March 30, 2020 and May 30, 2020 at an urban tertiary care center. A total of 788 teledermatology visits including 525 video visits and 263 telephone visits, mostly supplemented by patient-uploaded images, were analyzed. Patient age (P<0.001) and visit type (new versus return patient status), (P<0.001) were significant predictors of likelihood of video visit. No significant difference between video and telephone visits was found with regard to frequency of treatment modification (P=0.52), frequency of biopsy referral (P=0.73), biopsy noncompliance rate (P=0.44), or proportion of biopsies showing a new malignant lesion (P=0.92). With age as a significant predictor of visit modality, maintaining both video and phone modalities could prove useful to maximize patient participation. It appears either can be used without concern that choice of modality would impair the ability to change treatment, recognize a lesion requiring biopsy, recognize a new malignant lesion, or negatively affect compliance with biopsy.COVID-19teledermatologytelephonevideovirtualapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2q30p2jtarticleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt9kr0342z2022-04-23T00:16:14Zqt9kr0342zClinical presentation of verruca vulgaris in HIVLeavens, JYoung, PMMert, MSawcer, DAhronowitz, I2022-01-01Background: Immunocompromised patients, including those with human immunodeficiency virus (HIV), have been observed to have verrucae that are more extensive and treatment-resistant compared to those in immunocompetent patients. However, there is a critical lack of data in the current literature on the characteristics of verruca vulgaris in individuals with HIV.Methods: This retrospective chart review included a cohort of HIV-positive individuals and a control group of immunocompetent individuals presenting to an outpatient, county hospital-based dermatology clinic for evaluation of verruca vulgaris between the years of 2016 and 2018. Clinical characteristics, including gender, age, last CD4 count, viral load, antiretroviral therapy adherence, and total number and location of lesions were recorded.Results: A total of 66 patients (33 HIV-positive, 33 immunocompetent) were included in the study. HIV-positive status was significantly associated with a higher total number of lesions (42% of immunocompromised patients versus 21% of immunocompetent patients presented with four or more lesions, P=0.04) as well as location of lesions on the face, scalp, and neck (51.5% versus 9.1%, P<0.001).Conclusions: HIV-positive status may be associated not only with a higher burden of verruca vulgaris lesions but also a higher number of lesions in locations at or above the neck.HIVhuman papillomavirusverruca vulgarisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9kr0342zarticleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt3h12w6572022-04-23T00:16:14Zqt3h12w657Ethnic distribution of populations in the highest and lowest dermatologist-dense areas: is there more to the story?Rehman, RafeyMateen, ZaidOsto, MuhammadMehregan, Darius2022-01-01Several studies in the past decade have highlighted the lack of adequate dermatological care in skin of color (SOC) patients. This inquiry has led to further research to identify the sources of this disparity. Previous studies have highlighted the uneven geographic distribution of dermatologists, with a higher density of dermatologists in urban areas compared to other areas. However, the exact ethnic populations served by these dermatologists has remained largely uncharacterized. The purpose of this study was to compare the ethnic distributions in the ten highest and lowest dermatologist-dense areas across the United States to determine if there is equal access to dermatological care for minorities. Stratified by ethnicities, the highest dermatologist-dense areas consisted of 60% White alone (not Hispanic or Latino), 13% Hispanic or Latino, 13% Asian alone, and 12% Black or African American. Conversely, the least dermatologist-dense areas consisted of 45% White alone (not Hispanic or Latino), 28% Black or African American, 21% Hispanic or Latino, and 4% Asian alone. Our analysis highlights the presence of larger proportions of SOC patients in the lowest dermatologist-dense areas and this lack of access to dermatologists may contribute to inferior dermatological care and outcomes in Hispanic or Latino, and Black or African American minorities.densitydisparitydiversityepidemiologyracialapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3h12w657articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt710572t72022-03-20T23:43:19Zqt710572t7Lichen spinulosus: insights into treatmentSahni, Vikram NDao, Diem-PhuongSahni, Dev RSecrest, Aaron M2021-01-01application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/710572t7articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt1pm738wt2022-03-20T23:43:19Zqt1pm738wtDiagnostic differences for older adults with dermatologic disease: considering paradigm changesSreekantaswamy, Shreya AKassamali, BinaLaChance, AveryButler, Daniel C2021-01-01application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1pm738wtarticleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt4ft1b5f92022-03-20T23:43:18Zqt4ft1b5f9Distribution of Skin of Color Representation in Medical Education ResourcesMcNamara, Griffin PJTo, JenniferChaudhry, Sofia B2021-01-01application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4ft1b5f9articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt2pn9n8tz2022-03-20T23:43:17Zqt2pn9n8tzThe utilization of cryptocurrency as financial reimbursement in dermatology practicesZaza, TamaraBoudreau, Hunter SBoyd, Carter J2021-01-01application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2pn9n8tzarticleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt7b0782452022-03-20T23:43:16Zqt7b078245Alopecia areata in the United States: a ten-year analysis of patient characteristics, comorbidities, and treatment patternsGutierrez, YasminPourali, Sarah PJones, Madison ERajkumar, Jeffrey RKohn, Alison HCompoginis, Goli SArmstrong, April W2021-01-01application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7b078245articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt1vh950z92022-03-20T23:43:15Zqt1vh950z9Cat-associated zoonotic conditionsCohen, Philip R2021-01-01application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1vh950z9articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt1198z48x2022-03-20T23:43:13Zqt1198z48xClinical utility of cell-free DNA liquid biopsies in Merkel cell carcinomaShalhout, Sophia ZEmerick, KevinKaufman, Howard LMiller, David M2021-01-01application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1198z48xarticleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt7rx6d9jx2022-03-20T23:43:12Zqt7rx6d9jxSolitary asymptomatic lobular perianal nodule on an infantOmorodion, ItohanLee, JackGru, Alejandro AZlotoff, Barrett J2021-01-01Folliculosebaceous cystic hamartoma (FSCH) is a benign lesion that presents as a solitary papule or nodule that typically affects the face and scalp of adults. A few reports have observed a congenital presentation. We present an infant boy exhibiting a tumor with overlap features between an FSCH and fibrofolliculoma in the perianal region that was first noticed at 6 months of age. The histological examination showed a hamartomatous benign proliferation of hair follicles and disordered sebaceous glands, which is consistent with the infundibular structures and radiating sebaceous glands that are typically observed in previously reported cases of FSCH. Sebaceous differentiation is a hallmark feature of FSCH. Folliculosebaceous cystic hamartoma is believed to be a late-stage form of trichofolliculoma (TF). Another consideration is that FSCH and TF are two distinct entities set apart by their degree of sebaceous or follicular differentiation and development of the mesenchymal stroma.benign neoplasmdermatopathologyfolliculosebaceous cystichamartomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7rx6d9jxarticleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt8jb5h6b32022-03-20T23:43:11Zqt8jb5h6b3Concurrent diffuse dermal angiomatosis and granuloma inframammary adultorum of the breastWellman, ElekReserva, JeaveMauzo, Shakuntala2021-01-01Diffuse dermal angiomatosis (DDA) is a cutaneous reactive angiomatosis. Typically presenting as ulcerated, erythematous, violaceous, or purpuric plaques on the breast or lower extremities, DDA is believed to be a reaction to tissue ischemia. Granuloma inframammary adultorum (GIA) is a type of irritant dermatitis of multifactorial etiology, clinically presenting as papules and nodules. Herein, we report an interesting rash presenting as fungiform papulonodules overlying a large violaceous plaque on the left breast. Biopsy revealed an exuberant epidermal proliferation and a diffuse and deep dermal proliferation, consisting of small slit-like blood vessels in between collagen bundles. In light of these clinical and histopathologic findings in the setting of an indurated plaque on a pendulous breast of a woman with multiple risk factors for local tissue ischemia, a diagnosis of concurrent diffuse angiomatosis of the breast (DDAB) and GIA was rendered. This case highlights the critical importance of clinicopathologic correlation in the diagnosis of multiple diagnostic entities.adultorumangiomatosisbreastcarcinomacelldermaldiffusedermatosiserosivegranulomainframammarypapulonodularsquamousapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8jb5h6b3articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt3g67z4mj2022-03-20T23:43:10Zqt3g67z4mjPrimary cutaneous perivascular epithelioid cell tumors: two cases and a review of the literatureWong, JenniferMammino, JasonSeyffert, JenniferSchmits, KristenMarks, EtanRivlin, Daniel2021-01-01Report _Case Presentation _Photo Vignette _Letter Authors declare that the contents of this article are their own original unpublished findings. Title: Primary cutaneous perivascular epithelioid cell tumors: two cases and a review of the literature Authors: Jennifer Wong1 DO, Jason Mammino2 DO, Jennifer Seyffert3 DO, Kristen Schmits4 MD, Etan Marks4 MD, Daniel Rivlin3 MD Affiliations: 1Department of Dermatology, LECOM- Larkin Community Hospital, Miami, Florida, USA, 2Department of Dermatology, KCUMB - Advanced Dermatology and Cosmetic Surgery, Orlando, Florida, USA, 3Department of Dermatology, LECOM- Skin and Cancer Associates, Miami Beach, Florida, USA, 4Department of Dermatopathology Advanced Dermatology and Cosmetic Surgery Pathology Laboratory, Delray Beach, Florida, USA Corresponding Author: Jennifer Seyffert DO, 4308 Alton Road, Suite 510, Miami Beach, FL 33140, Tel: 305-674-8865, Fax: 305-674-1459, Email: jseyf12@gmail.com Abstract: Perivascular epithelioid cell tumors, also known as PEComas, are mesenchymal neoplasms which uncommonly originate within the skin, with only 23 cases documented within the literature. These rare neoplasms classically display epithelioid cells composed of granular or clear cytoplasm arranged in sheets, nests, or cords. Their immunoreactivity for melanocytic and smooth muscle markers makes these tumors distinct and unique.[1] We herein present two cases of primary cutaneous PEComas that clinically mimic other common cutaneous neoplasms and illustrate the necessity for clinical-pathologic correlation. A literature review is also presented to compare the different clinical and histological presentations of cutaneous PEComas.epithelioid cellmesenchymal neoplasmPEComaperivascular epithelioid cell tumorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3g67z4mjarticleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt2pp519wn2022-03-20T23:43:09Zqt2pp519wnCalciphylaxis: how specific are the pathological features: avoiding false-positives and false-negativesMahmood, Muhammad N2021-01-01Calciphylaxis is considered a critical inflammatory dermatosis with potentially devastating clinical consequences. Skin biopsies are expedited for evaluation and are often considered as a gold standard for diagnostic confirmation and exclusion of other conditions. The key histopathological features include a combination of vascular and extra-vascular calcifications, intravascular microthrombi, and changes related to resulting ischemia. The pathological diagnosis of calciphylaxis is not always a straightforward process as it can be influenced by a number of factors. The specificity of pathological diagnosis of calciphylaxis has been questioned and a systematic approach with multidisciplinary collaboration is required to avoid potential errors.calciphylaxiscritical dermatosisdermatopathologyhistopathologyspecificityapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2pp519wnarticleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt3571n0832022-03-20T23:43:08Zqt3571n083Pediatric teledermatology: a tool for combating dermatology care disparitiesAhuja, GeetaKhushbakht, MyraJoe, JenitaEskinder, HenokEkwunazu, ChiamakaBoos, Markus D.2021-01-01Social distancing requirements associated with the COVID-19 pandemic have allowed for the expansion of different healthcare delivery modalities. Namely, there has been an increase in the utilization of remote diagnostic services for both primary and specialist care. Dermatology care has traditionally been inaccessible to many pediatric patients; this is due in part to a limited number of practicing pediatric dermatologists, as well as a maldistribution of the pediatric dermatology workforce with the majority of providers located in large metropolitan areas. There is therefore a need for an accessible alternative for care to reach underserved patient populations. This commentary highlights evidence from recent studies on remote dermatology care (teledermatology) and how it has not only improved access to dermatologic care but also quality of care. Although teledermatology does not completely replace traditional in-person visits and is limited by poor broadband access in traditionally underserved areas, teledermatology can, in some instances, be a cost-effective and efficient alternative for pediatric patients otherwise lacking dermatologic care.COVID-19internet access disparitypediatric dermatologyrural medicineteledermatologyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3571n083articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt76x4h9x22022-03-20T23:43:07Zqt76x4h9x2How to improve the interface between dermatology and psychiatry: a review and expert suggestion regarding the management of delusional patientsStarzyk, ToryKoo, John2021-01-01Psychodermatological problems are prevalent in dermatology practices. Among those, delusional infestation (DI) is the subject of one of the most challenging patient encounters practicing dermatologists may experience. This difficulty arises, at least partly, from the unavailability of psychiatric knowledge and skillset necessary to properly manage these patients, reflecting that most dermatology residency programs are unable to provide training in psychodermatology. This relates to the lack of faculty available with such expertise. This article reviews various suggestions made in the medical literature to try to improve this current unfortunate situation. However, the more common suggestion regarding organizing a multidisciplinary psychodermatologic clinic may be difficult to achieve as reflected by the scarcity of such clinics in the U.S. The authors offer alternative suggestions beyond the idea of organizing a multidisciplinary clinic.delusional infestationdelusions of parasitosisMorgellons diseasepsychodermatologyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/76x4h9x2articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt57b984r42022-03-20T23:43:06Zqt57b984r4Telogen effluvium caused by COVID-19 in Elmhurst, New York: report of a cohort and reviewGruenstein, DianaO'Mara, MelissaPA, Samantha HussainLevitt, JacobPA, Stacy LiTom, JackLeger, Marie2021-01-01The prevalence of telogen effluvium (TE) has increased during COVID-19. In this study we describe the clinical characteristics of patients with COVID-19-related TE and review the current literature on COVID-19-associated TE. We conducted a retrospective chart review of 66 patients, all of which had COVID-19 infection (confirmed by PCR or antibodies) and had either non-scarring hair loss or TE in Elmhurst, Queens. Our data suggest that this form of TE is similar to other forms of TE, after which many patients experience regrowth within several months.COVID-19telogen effluvium (TE)hair lossalopeciahair sheddingapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/57b984r4articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt7pr1g45g2022-03-20T23:43:05Zqt7pr1g45gDeterminants of patient and physician treatment satisfaction in moderate-to-severe psoriasis: a multinational survey of psoriasis patientsTeeple, AmandaVillacorta, ReginaldPharmD, Seina LeeFakharzadeh, StevenLucas, JamesPhD., Nan Li2021-01-01There is a lack of validated information of both physician and patient-reported treatment satisfaction, and association with outcomes in psoriasis. Data from the 2015 Adelphi Psoriasis Disease Specific Programme were used to compare self-reported satisfaction with biologic and non-biologic therapy for psoriasis in physicians and their consulting patients in the United States (USA) and five European countries (EU5). Disease severity and health-related quality of life (HRQoL) were assessed using Body Surface Area (BSA) affected by psoriasis and the Dermatology Life Quality Index (DLQI), respectively. Patients satisfied with biologic therapy reported better HRQoL than unsatisfied patients, whereas a greater proportion of unsatisfied patients on biologic therapy had moderate-to-severe psoriasis (USA: 95.1% versus 52.4%, EU5; 86.4% versus 43.1%, P<0.0001). Multivariate logistic regression indicated that having a BSA affected by psoriasis of >10% was associated with lower likelihoods of physician and patient treatment satisfaction versus <3% (P<0.0001). A one-unit increase in the DLQI score lowered the likelihood of a patient being satisfied by approximately 20% (P<0.0001). Patients were ~60% more likely to be satisfied on biologic therapy than non-biologic therapy (P=0.0012). Physician and patient-reported treatment satisfaction was associated with greater HRQoL and lesser disease severity.biologic therapydisease severitynon-biologicpsoriasisquality of lifetreatment satisfactionapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7pr1g45garticleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt5tw6x51z2022-03-20T23:43:04Zqt5tw6x51zThe Impact of teledermatology during the COVID-19 pandemicShah, PoojaDorrell, Deborah NFeldman, Steven RHuang, William W2021-01-01Teledermatology has been widely adopted during the COVID-19 pandemic as virtual patient care promotes social distancing and decreases viral exposure risk. As teledermatology has become more prominent during this period, it is essential to assess whether virtual visits allow for adequate patient care. To assess perceptions of advantages and disadvantages of teledermatology, a survey was sent to academic dermatologists through the Association of Professors of Dermatology (APD) listserv. Of the physicians surveyed, 94% reported their departments had implemented teledermatology during the COVID-19 pandemic. The majority (64%) described teledermatology as an effective tool for patient care because of improved access to care, decreased risk of COVID-19 exposure, and convenience. Frequently cited limitations of teledermatology were image quality, technical difficulties, and inability to perform a comprehensive skin examination. Thirty-seven percent of respondents reported teledermatology as a contributor to their professional burnout. Although teledermatology has become more prevalent as a result of the pandemic, its role moving forward is uncertain given its limitations.academic dermatologistsburnoutCOVID-19dermatologyteledermatologyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5tw6x51zarticleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt2rm294722022-03-20T23:43:03Zqt2rm29472Evaluation of clinical characteristics and pre-biopsy impressions of primary Merkel cell carcinoma of the skinSaqlain, FareesShalhout, Sophia ZWright, KaylaMiller, David M2021-01-01Merkel cell carcinoma is an aggressive carcinoma of the skin notable for protean presentation on physical exam. A retrospective cohort of 232 patients with primary cutaneous Merkel cell carcinoma was reviewed for availability of data on pre-biopsy clinical differential diagnosis based on clinical exam. Data was available for 192 patients (83%). The three most common impressions were cyst (33.3%), basal cell carcinoma (31.8%), and squamous cell carcinoma (19.8%). Merkel cell carcinoma was correctly suspected in only 13 cases (6.8%). A greater proportion of lesions that were less than or equal to 2 cm in diameter (10.2%) or carried BCC as a co-diagnosis (11.5%) were correctly suspected as Merkel cell carcinoma prior to biopsy, versus lesions greater than 2 cm in diameter (1.6%) or carrying SCC as a co-diagnosis (2.6%), suggesting that clinicians may be anchoring on the well-publicized concept of Merkel cell carcinoma as a small, pearly papule in real-world practice.diagnosisMerkel cell carcinomastagingAbbreviations:BCC: Basal Cell CarcinomaMCC: Merkel Cell CarcinomaNMSC: Non-melanoma Skin CancerNOS: Not Otherwise SpecifiedNUB: Neoplasm of Uncertain Behavior/Neoplasm Not Otherwise SpecifiedSCC: Squamous Cell CarcinomaUV: Ultraviolet Radiationapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2rm29472articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt8x39p1xz2022-03-20T23:43:02Zqt8x39p1xzInnovations in translational research in dermatology: minimally invasive methods for biosample acquisitionHadeler, EdwardMosca, MeganHong, JulieBrownstone, NicholasLiao, WilsonBhutani, Tina2021-01-01Translational research has improved patient care over the last decade. In dermatology, this research often requires human tissue for laboratory analysis. The skin biopsy remains the gold standard for tissue acquisition, but the procedure comes with a small risk of bleeding and infection. It also causes scarring and anxiety in certain populations. These risks and concerns may affect participation rates in translational studies, which can require multiple biopsies. Minimally invasive procedures may mitigate these risks and concerns. We queried the PubMed database for all minimally invasive technologies studied as of May 2021. Of the 53 articles reviewed, we identified 13 unique, minimally invasive methods for tissue biosample acquisition. Herein, we describe each sampling method, biosample type analyzed, disease target, molecular application, procedure, quantity of obtained biosample, purpose, and required equipment. We organize this information into a comprehensive chart. We then synthesize this information into another table that compares the pros and cons of each intervention. We found that tape stripping, suction blistering, hair plucking, microbiopsy, and microneedle patching provide a variety of useful biosample types for laboratory analysis. In translational research, these technologies have the potential to replace more invasive methods like the punch biopsy, likely improving participation in studies.hair pluckingmicrobiopsymicroneedle patchminimallynon-invasivepunch biopsyskin researchsuction blistertape striptranslationalapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8x39p1xzarticleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt4vx6g4hf2022-03-20T23:43:02Zqt4vx6g4hfDermatologists are more likely than oncologists to prescribe skin-directed therapies for early-stage cutaneous T-cell lymphoma: a retrospective reviewLin, JaimieRumsey, KellinStepenaskie, ShellyDurkin, John R2021-01-01Early-stage cutaneous T-cell lymphoma (CTCL) is managed effectively with skin-directed therapies such as topical medications, phototherapy, and local ionizing radiation. Patients with CTCL often seek care from both dermatologists and oncologists. Our study aimed to compare the frequency that skin-directed treatments were prescribed to patients managed by each of these specialties. Overall, we found there was a statistically detectable relationship between the presence or absence of oncologist involvement and the likelihood that a patient would be prescribed skin-directed therapies (P=0.0003). Of the oncologists included in the study, 66% opted for management revolving around systemic rather than skin-directed therapies. However, when a dermatologist and oncologist worked together in a patient's care, the number of patients receiving skin-directed therapies increased to 100%. Our study suggests that patients with early stage CTCL may benefit from having a dermatologist involved in their care.CTCLoncologyT-cell lymphomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4vx6g4hfarticleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt5dj4j2jd2022-03-16T18:54:35Zqt5dj4j2jdPosition Title: Academic Pediatric DermatologistDepartment of Dermatology, University of California, Davis School of Medicine2021-01-01Position descriptionThe University of California, Davis, School of Medicine, Department of Dermatology, is recruiting for a pediatric dermatologist in the Clinical X series or Health Sciences Clinical Professor (HSCP) series at the Assistant/Associate Professor level based on experience and qualifications. Expectations of the Clinical X series are to engage in teaching, research, service, and clinical work, while expectations of the faculty in the HSCP series are primarily clinical and include teaching, service, and scholarly and/or creative activity. The appointments may be made up to 100%.application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5dj4j2jdarticleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt4wm8004g2022-03-16T18:54:34Zqt4wm8004gPalbociclib-induced IgA vasculitisPatel, Payal MKelm, Ryan CAmber, Kyle T2021-01-01application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4wm8004garticleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt2x39m6q82022-03-16T18:54:32Zqt2x39m6q8Reconstruction of cutaneous dorsal finger defectsRickstrew, JaceNeill, Brett CRoberts, ErinTolkachjov, Stanislav N2021-01-01Background: Reconstruction of surgical defects on the dorsal finger can be challenging because of a lack of adjacent tissue reservoirs, poor laxity, and often thin, atrophic skin surrounding the defect.Objective: To present reconstructive options for cutaneous dorsal finger defects.Methods: We describe our five preferred approaches to reconstructing cutaneous dorsal finger defects based on the amount of available underlying tissue and location of the defect on the finger.Results: In the authors’ opinion, for smaller defects between and including the metacarpophalangeal joint extending to the proximal interphalangeal joint, a transposition flap or unilateral advancement flap is preferable. For proximal finger defects that are wider, a unilateral rotation flap is appropriate. A Burow full-thickness skin graft can be used for any proximal defect with underlying soft tissue present. For defects with underlying bone or tendon present, a reverse cross-finger interpolation flap can be utilized.Conclusions: The unilateral advancement flap, unilateral rotation flap, transposition flap, full-thickness skin grafts, or the reverse cross-finger interpolation flap can be used to reconstruct the majority of cutaneous dorsal finger defects.cutaneousdermatologicdorsalfingerlocal flapsmohs micrographicreconstructionskin cancersurgeryapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2x39m6q8articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt26m5p0m52022-03-16T18:54:31Zqt26m5p0m5The Twizzler: a modified primary closure for distal lower extremity wound reconstruction utilizing a dynamic winch stitchPotter, Christian TCamargo, Anthony MCecere, Robert AWang, AnnieSchanbacher, Carl F2021-01-01Management of lower extremity wounds following successful tumor excision presents multiple challenges. Distal lower extremity integument is highly prone to edema often lacks adequate skin laxity for standard primary closures. The closure must be resilient enough to withstand mobility. As a result, optimal reconstruction may include skin grafting, rotational flaps, free tissue transfers, healing by second intention, or some combination. These methods may involve multiple steps in reconstruction, a prolonged recovery period, increased cost, and higher infection risk. We propose a modified primary closure that takes advantage of the visco-elastic properties of the skin without introducing additional components or steps. This technique is initiated with percutaneous suture in order to intermittently stretch the skin with constant tension. This load cycling allows for lower extremity skin to stretch over time and ultimately reduce wound edge tension, allowing for ease of absorbable suture placement. The Twizzler technique is cost-effective, uses readily available supplies, and effectively closes relatively large defects on the lower extremities.dermatotractionlower extremity primary closureskin cancer reconstructionapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/26m5p0m5articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt7qk8p1zz2022-03-16T18:54:29Zqt7qk8p1zzA pearly nodule on an indurated plaqueMiller, AustinnSiller Jr, AlfredoRodriguez, RamiroGill, PavandeepCurry, Jonathan LTyring, Stephen K2021-01-01We present an 81-year-old man who presented for evaluation of an indurated plaque with an exophytic, pearly, skin-red-brown colored nodule with central ulceration on his chest that evolved over the course of several months and was initially suspected to be basal cell carcinoma. Biopsy demonstrated histological features of dermal spindle cell proliferation in a storiform fashion with CD34 positivity confirming a diagnosis of dermatofibrosarcoma protuberans (DFSP). Dermatofibrosarcoma protuberans are rare, slowly progressive soft tissue sarcomas. The rate of DFSP is greatest among African Americans (8.3/1,000,000), occurring nearly twice as frequently when compared to Caucasians. Aside from race/ethnicity, age, and skin trauma, no specific risk factors are associated with DFSP. Complete excision is curative. Given its pearly skin colored appearance, papular/nodular/atrophic morphology variants, and tendency to form indurated plaques, DFSP may be mistaken for nodular and morpheaform basal cell carcinoma subtypes, as well as a variety of other conditions. This case highlights the importance of maintaining DFSP on the differential diagnosis of slowly progressive nodules and indurated plaques, especially in African Americans.African-Americanbasal cell carcinomadermatofibrosarcoma protuberanspearly noduleapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7qk8p1zzarticleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt3dr0g30c2022-03-16T18:54:29Zqt3dr0g30cUnilateral swelling and hyperpigmented papulesAjayi, AyodejiSokumbi, Olayemi2021-01-01Lymphangioendothelioma, also known as acquired progressive lymphangioma, is a rare vascular neoplasm of lymphatic origin. Although in light-skinned individuals lesions typically present as erythematous to violaceous papules or plaques, in dark-skinned patients lesions often appear hyperpigmented. Histopathologic distinction of lymphangioendothelioma from early Kaposi sarcoma and angiosarcoma is imperative considering the therapeutic and prognostic implications. Herein, we present a 71-year-old woman with slowly progressive hyperpigmented papules and histopathology demonstrating thin-walled vascular spaces interspersed between collagen bundles, consistent with lymphangioendothelioma. We describe the clinical and histologic findings of this rare entity and highlight histologic mimics that might result in diagnostic delay.lymphangioendotheliomaacquired progressive lymphangiomaskin of colorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3dr0g30carticleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt87m0h96c2022-03-16T18:54:27Zqt87m0h96cLaugier-Hunziker syndrome: a case and dermoscopic featuresIngordo, VitoFerrara, GerardoMarangi, GraziaMagnasco, SalvatoreArgenziano, Giuseppe2021-01-01Laugier-Hunziker syndrome (LHS) is a sporadic, acquired, and infrequent condition characterized by the onset of brown macules on the lips, the oral mucosa, and the acral glabrous skin (mainly fingers and toes) in middle-aged patients. In several cases melanonychia of fingernails and toenails coexists. No other systemic involvement is observed. A case of LHS in a 50-year-old woman is described, with particular attention to dermoscopic features. No dermoscopic specific findings of mucosal/cutaneous maculae have been to date described in the literature. Accumulation of dermoscopic observations of pigmented lesions in LHS is needed and if found to be distinct, it may contribute to a more accurate diagnosis in the futuredermoscopydiagnosisdifferentialhistopathologyLaugier-Hunziker syndromeapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/87m0h96carticleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt3p94v1xm2022-03-16T18:54:25Zqt3p94v1xmDelayed-onset cutaneous eruption associated with lenalidomide in setting of multiple myelomaBuonomo, MicheleKabbur, GowriEl Jurdi, NajlaGiubellino, AlessioSchultz, Brittney2021-01-01Lenalidomide (LEN) is increasingly being used for the treatment of multiple myeloma (MM). Adverse cutaneous reactions to LEN are common and present almost exclusively within one month of initiating therapy. We report a case of delayed-onset LEN-associated eruption presenting over three years after starting treatment. Histopathologic findings are also described, which are infrequently reported for LEN-associated eruptions. Our case serves as a reminder that proper recognition and management of LEN-associated eruption is important in the treatment of MM. Dermatologists should be aware of the potential for delayed presentations of adverse cutaneous reactions to LEN, even years after initiation.hematology/oncologydermatopathologydrughypersensitivitylenalidomidereactionapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3p94v1xmarticleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt41j8k3hd2022-03-16T18:54:24Zqt41j8k3hdErythema multiforme as a consequence of COVID-19 infectionArndt, MaryHeath, ChristopherHealey, BraydenAltman, David2021-01-01Cutaneous manifestations of the 2019 coronavirus disease (COVID-19) are diverse and may be the only clinical evidence of infection, particularly in children [1]. The authors report a 10-year-old girl with erythematous vesicular papules and targetoid lesions of the extremities two weeks after polymerase chain reaction (PCR) confirmed severe acute respiratory syndrome coronavirus two (SARS-COV-2) infection. Biopsy depicted classic erythema multiforme (EM) and serology confirmed positive COVID-19 antibodies. This report demonstrates one of the first reported pediatric cases of typical clinical and histopathologic EM in relation to confirmed COVID-19.COVID-19erythema multiformeinterface dermatitisnecrotic keratinocytesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/41j8k3hdarticleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt2rt5p3jj2022-03-16T18:54:23Zqt2rt5p3jjAtypical vascular lesions extending outside the radiation field: a diagnostic challengeBreneman, AlyssaHooey, LeahSpicknall, Kerith EBreneman, Debra L2021-01-01Atypical vascular lesion (AVL) is an uncommon, benign vascular proliferation seen in previously irradiated skin, most commonly after radiotherapy for breast cancer. Atypical vascular lesion and angiosarcoma may share overlapping clinical and histopathologic features. We report the first case of AVL occurring outside the field of radiation. This patient's clinical course and histopathology was overall consistent with AVL, including two biopsies with focal MYC positivity. However, due to variations in the interpretation of her histopathology, the management plans devised by two centers involved in her care were widely discordant and she was treated with chemotherapy and extensive surgery for angiosarcoma. Great care must be taken to distinguish between these entities, as treatment for angiosarcoma may be associated with significant morbidity.angiosarcomaatypicaldiagnosishistopathologyradiation-inducedmanagementvascularapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2rt5p3jjarticleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt5tw5t4t32022-03-16T18:54:22Zqt5tw5t4t3An acute, ulcerative, sarcoidal tattoo reaction following SARS-CoV-2 mRNA-1273 vaccinationManci, RJennings, TMclarney, RMHeymann, WRSommer, LL2021-01-01Two weeks after her first dose of the SARS-CoV-2 mRNA-1273 (Moderna) vaccine, a 38-year-old woman developed acute-onset pain and ulceration within a tattoo on the distal left leg. Progressive ulceration was noted approximately one week following her second dose of the vaccine. A biopsy revealed sarcoidal granulomas and a dense neutrophilic infiltrate. Ultimately, the final diagnosis of what we have termed a "sarcoidal reaction with a Sweet-like phenomenon" was made; the patient experienced a reduction in pain and re-epithelialization of the ulcers with two weeks of the use of topical clobetasol 0.05% cream twice daily.application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5tw5t4t3articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt43h117d42022-03-16T18:54:21Zqt43h117d4Prurigo pigmentosa in a patient with newly diagnosed type one diabetes with diabetic ketoacidosisBurli, AnukPaul, DeborahScott, GlynisSomers, Kathryn E2021-01-01Prurigo pigmentosa is a rare inflammatory cutaneous disorder associated with ketosis that resolves with reticulate hyperpigmentation. A 19-year-old man was admitted to the hospital with diabetic ketoacidosis. He also had developed reticulate papules coalescing into plaques over the posterior neck, back, and abdomen. Histopathological findings consistent with the clinical findings suggested the diagnosis of prurigo pigmentosa. After treatment with topical triamcinolone and oral doxycycline along with resolution of his ketosis after insulin administration, the patient's rash healed with reticulate hyperpigmentation.hyperpigmentationketosisprurigo pigmentosatype one diabetesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/43h117d4articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt7mz3x55z2022-03-16T18:54:20Zqt7mz3x55zPhotodermatitis following knee intra-articular hylan G-F 20 injection for osteoarthritis: two casesSullivan, Danielle YHawkes, Jason E2021-01-01Hyaluronic acid (HA) intra-articular injections are increasingly used for the treatment of knee osteoarthritis. Described adverse reactions of HA intra-articular injections include injection site pain or swelling. A 71-year-old man and a 65-year-old woman independently presented with photodistributed lesions shortly after receiving a repeat HA injection (hylan G-F 20) intra-articularly. A punch biopsy was performed which was consistent with a photodrug reaction or hypersensitivity reaction. Two cases are presented to describe a novel presentation of a photosensitivity reaction to HA.application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7mz3x55zarticleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt5cg2s0k92022-03-16T18:54:19Zqt5cg2s0k9Sclerosing perineurioma: a rare benign tumor in a pediatric patientJohnson, CassandraBrazen, BrettRoss, RisaVincek, Vladimir2021-01-01A 15-year-old boy presented to outpatient dermatology clinic for evaluation of a lesion on the hand. Originally small and asymptomatic, the lesion had rapidly enlarged in the six months prior to evaluation. A shave biopsy was performed and histopathologic evaluation demonstrated a well-circumscribed nodular proliferation of dense, bland, epithelioid to spindle cells on a fibrillary background. Tumor cells were diffusely epithelial membrane antigen (EMA) positive; S100 and Melan-A were negative. These findings are consistent with a diagnosis of sclerosing perineurioma. This case illustrates the presentation of sclerosing perineurioma in a pediatric patient and we review the pertinent pathologic and immunohistochemical findings necessary for diagnosis. It is imperative to distinguish this entity from other soft tissue tumors on the hand, both benign and malignant, to avoid overly aggressive surgical intervention.benigncutaneousneoplasmnerveperineuriomasheathsclerosingapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5cg2s0k9articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt3t55g37q2022-03-16T18:54:18Zqt3t55g37qAn uncommon case of metastatic myxofibrosarcoma presenting with elbow and hip massesWilliams, Josiah ACull, Deborah BBruinsma, Raquel LHowell, Seth T2021-01-01Myxofibrosarcoma frequently recurs locally but rarely metastasizes. Herein, we describe an elderly woman who had myxofibrosarcoma of the right elbow that went untreated during the COVID-19 pandemic. She subsequently presented with two large tumors ulcerating through the skin of her right elbow and left hip.cancerdermatologymedical dermatologymetastasismyxofibrosarcomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3t55g37qarticleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt6xz7j1bd2022-03-16T18:54:16Zqt6xz7j1bdPostauricular apocrine hidrocystoma: a case and dermoscopy reviewCavanagh, MaryPham, MeredithNguyen, JeannieTarbox, Michelle2021-01-01Apocrine hidrocystoma (AH) is a benign cystic proliferation of apocrine sweat glands that classically presents as a slow-growing nodule on the face, especially in the periorbital region. Histopathological evaluation is required to definitively diagnose an apocrine hidrocystoma. Previous studies have described apocrine hidrocystomas in unusual locations. However, the authors have identified only two reported cases of apocrine hidrocystoma in the postauricular region. We present a third case of a postauricular hidrocystoma in a 26-year-old woman, as well as a brief review of the dermoscopic findings of apocrine hidrocystomas in the existing literature.apocrine hidrocystomadermoscopypostauricularsweat glandsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6xz7j1bdarticleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt5mt9v5r82022-03-16T18:54:16Zqt5mt9v5r8Reactive granulomatous dermatitis associated with ovarian cancer and a review of its role as a harbinger for malignancySherban, AlexanderCha, JisunJones, Elizabeth2021-01-01Reactive granulomatous dermatitis (RGD) is a rare dermatosis with a variety of cutaneous manifestations unified by a dermal granulomatous infiltrate on histology. Rheumatoid arthritis and autoimmune disease are classic associations, but an increasing number of cases have been attributed to covert malignancy. Only 41 cases of paraneoplastic RGD have been documented to our knowledge and we present an additional case that manifested eight months prior to the diagnosis of ovarian cancer and clinically mimicked morphea. Histopathologic examination identifying palisaded CD68+ cells and collagen degeneration are helpful in diagnosing this entity which may mimic a host of other cutaneous processes, including metastatic disease. Cancer-directed therapies have been successful in clearing paraneoplastic RGD with or without the addition of corticosteroids, as RGD severity may be driven by the underlying malignancy. This case highlights the importance of utilizing histopathology to confirm the diagnosis given its nonspecific clinical findings, as well as the importance of considering malignancy and metastatic disease in patients diagnosed with RGD regardless of their cancer history.granulomatous dermatitisparaneoplasticapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5mt9v5r8articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt88v4z4jr2022-03-16T18:54:14Zqt88v4z4jrCutaneous dystrophic calcification following high-dose radiotherapy for a liposarcomaGreen, Austin RDurkin, John2021-01-01Cutaneous dystrophic calcification as a late change of radiation therapy is a rarely reported finding. Initially, it was almost exclusively described as occurring on the chest wall in breast cancer patients but has since been described in several other malignancies. We describe the first reported case of radiotherapy-induced calcinosis cutis occurring at the site of a previous liposarcoma. Review of the literature including risk factors, similar cases, pathophysiology, and management is also explored.calcinosis cutisliposarcomaradiotherapyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/88v4z4jrarticleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt73q2w7v92022-03-16T18:54:14Zqt73q2w7v9Extranodal NK/T-cell lymphoma primarily presenting as two adjacent slowly growing skin nodules with prominent epidermotropism and CD30 expression, a case report and review of literatureMohammed, AroojDave, UtpalMS, Sahand Rahnama-MoghadamAlomari, Ahmed K2021-01-01Extranodal NK/T-cell lymphoma (NKTCL) is a rarely occurring non-Hodgkin lymphoma with predilection for the nasal cavity. Cutaneous involvement, rarely occurring and often aggressive in behavior, may present as nodular mass-forming lesions with or without ulceration. Histologically, lesions are characterized by an atypical dermal lymphoid infiltrate with angioinvasion and associated necrosis. Fortuitously, Epstein-Barr virus (EBV) infection, implicated in the pathogenesis of this entity, serves as a useful diagnostic marker (i.e. EBER in situ hybridization). We present a 54-year-old-man who initially presented with two ulcerations on the right lower leg which progressed despite antibiotic therapy. Histologic examination demonstrated dense lymphoid infiltrates exhibiting epidermotropism, angiocentricity and angioinvasion extending into the deep dermis. Immunohistochemical staining demonstrated expression of CD2, CD3, CD8, TIA-1, perforin, and granzyme-B, consistent with a cytotoxic T-cell phenotype. Additionally, CD56 was positive, confirming the presence of a coexistent NK cell phenotype. Testing also demonstrated significant CD30 expression, and molecular analysis was positive for TCR gene rearrangement. These findings, in conjunction with EBER in situ hybridization positivity, confirmed a diagnosis of extranodal NKTCL. We aim to increase awareness of this rarely occurring lymphoma with cutaneous involvement. CD30 expression in NKTCL raises the possibility of targeted treatment with brentuximab.brentuximabCD30EBVepidermotropismNK/T-cell lymphomaTCRapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/73q2w7v9articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt2cv8s2hw2022-03-16T18:54:13Zqt2cv8s2hwPrimary cutaneous diffuse large B-Cell lymphoma, leg type mimicking subcutaneous panniculitis-like T-cell lymphoma in a COVID-19 setting: case report and review of literatureLara-Endara, JorgeMontalvo, NelsonRedroban, LigiaMushtaq, Ahmadwali2021-01-01Primary cutaneous diffuse large B-cell lymphoma, leg type is a rare entity accounting for 4% of all primary cutaneous lymphomas whose clinical presentation encompasses a range of possibilities. COVID-19 has caused a delay in diagnosis of malignant neoplasms and consequently, this has resulted in poorer prognoses. A 62-year-old woman presented with two smooth-surfaced, mobile, well-circumscribed, oval, skin-colored nodules approximately one-cm in diameter with nonerythematous borders on the lower third of the left leg. Two months later, eleven nodules measuring between one and 1.5cm with erythematous halo, slight scaling, central erosion, and crusting had appeared. Histological study showed moderate pericapillary lymphocytic infiltration in the papillary and reticular dermis and prominent diffuse proliferation of medium to large cells in the subcutis. These exhibited irregular vesicular nuclei, a conspicuous solitary nucleolus of two to three small nucleoli, and three mitoses per high power field. Adipocytes were consistently encircled by neoplastic lymphocytes. Primary cutaneous diffuse large B-cell lymphoma, leg type is a high-grade lymphoma that can manifest as a diagnostic challenge and requires adequate immunohistochemistry and in situ hybridization studies for proper diagnosis, treatment, and prognosis.BCL2cMYCCOVID-19p63primary cutaneous diffuse large B-cell lymphoma leg typesubcutaneous panniculitis-like T-cell lymphomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2cv8s2hwarticleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt9k26d06b2022-03-16T18:54:12Zqt9k26d06bDermatology residency preparation curriculum: a model for initiating new residents into dermatology clinical careNakamura, MioMcClean, KellyHarms, KellyHelfrich, YolandaWang, FrankMaier, LisaDo, ThyCha, Kelly B2021-01-01Entering dermatology residency is an immersive experience requiring new specialty-specific skills. There is no standard Accreditation Council for Graduate Medical Education (ACGME) protocol for orienting new dermatology residents. We aimed to design, develop, and evaluate a curriculum for incoming first-year dermatology residents focusing on practical introduction to dermatologic clinical care emphasizing ACGME dermatology milestones. A concentrated 8-hour residency preparation course for first-year dermatology residents was designed and developed by faculty. The course encompassed clinical competencies, procedural techniques, and professionalism and collegiality principles. Teaching methods included lectures, video demonstrations, simulated patient experiences, and one-on-one practical instruction. Surveys were distributed before, immediately after, and 6-months following the course from 2016-2018 to assess participants’ skill-based confidence level and perceived usefulness of the course. A total of 24 first-year dermatology residents participated in the residency preparation course over 3 years from 2016-2018. Residents’ confidence levels in performing dermatology-specific skills immediately increased following the course and continued to increase 6 months into training. The majority of first-year residents “agreed” or “strongly agreed” that the course was helpful for improving clinical competence. Our residency preparation course increased first-year residents’ confidence and perceived competence in performing clinical skills related to ACGME dermatology milestones.ACGMEeducationorientationresidency preparationsimulation trainingapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9k26d06barticleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt6pt405g12022-03-16T18:54:11Zqt6pt405g1The effect of the COVID-19 pandemic on perceptions of teledermatologyLy, SophiaPorter, CarolineKakatkar, SaraHaidari, WasimFeldman, Steven R2021-01-01There is limited information of the effect of the COVID-19 pandemic on the general population's perceptions towards teledermatology. This study aims to assess the pandemic's impact on people's willingness to use teledermatology as well as to investigate influencing factors. We recruited 544 participants through Amazon Mechanical Turk (MTurk) and surveyed them using REDCap. Participants' willingness to use teledermatology before, during, and after the COVID-19 pandemic was measured via a 5-point Likert scale. The survey also included questions regarding factors influencing participants' attitudes towards teledermatology and their sociodemographic characteristics. Of the 185 participants who reported unwillingness to use teledermatology prior to the COVID-19 pandemic, 79.2% and 66.5% became either neutral or willing to use teledermatology during and after the pandemic, respectively. Less than half of prior satisfactory telemedicine users reported willingness to use teledermatology before the pandemic; willingness to use teledermatology increased to 80.1% and 63.8% during and after the COVID-19 pandemic, respectively. The top reason for lack of interest in teledermatology was concern for security and privacy (24.4%). Although a useful tool, teledermatology has been met with reluctance by the public. However, the unique circumstances of the COVID-19 pandemic have improved the public's perceptions and readiness to use teledermatology.COVID-19 pandemicteledermatologytelemedicineapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6pt405g1articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt7t5478m52022-03-10T14:36:17Zqt7t5478m5Position Title: Academic DermatologistDepartment of Dermatology, The University of California, Davis, School of Medicine,2021-01-01The University of California, Davis, School of Medicine, Department of Dermatology, is recruiting for two academic dermatologists in the Clinical X series or Health Sciences Clinical Professor (HSCP) series at the Assistant/Associate/Full Professor level based on experience and qualifications. These positions are for general medical dermatologists.Expectations of the Clinical X series is to engage in teaching, research, service and clinical work, while expectations of the faculty in the HSCP series are primarily clinical and include teaching, service and scholarly and/or creative activity. The appointments may be made up to 100%.application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7t5478m5articleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt5xm4g4rp2022-03-10T14:36:16Zqt5xm4g4rpAsymptomatic large lingual thyroidNamazi, Mohammad RKetabi, Yasaman2021-01-01application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5xm4g4rparticleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt72c0v1pz2022-03-10T14:36:15Zqt72c0v1pzTik Tok tylomaBarry, Kelly KHawryluk, Elena B2021-01-01calluscalloustylomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/72c0v1pzarticleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt7pk5q1w32022-03-10T14:36:14Zqt7pk5q1w3Etodolac-induced erythrodermaSeara, VeraCosta-Fernandes, SoniaDuarte, MariaMaia, Lilian2021-01-01desquamationerythrodermaexfoliative dermatitisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7pk5q1w3articleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt3ht1640b2022-03-10T14:36:13Zqt3ht1640bVancomycin-induced drug reactions with eosinophilia and systemic symptoms syndrome in a patient with positive family historyDeMaio, AlexaCarlock, SarahWinterfield, Laura S2021-01-01anticonvulsant hypersensitivity syndromedrug hypersensitivity syndromedrug-induced hypersensitivity syndromedrug reaction with eosinophilia and systemic symptomshypersensitivityvancomycinapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3ht1640barticleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt4d21j0jt2022-03-10T14:36:12Zqt4d21j0jtCrusted scabies masquerading as a drug eruption related to nivolumabAdris, TusitaMcEwen, Matthew WJones, Emily2021-01-01checkpoint inhibitorsnivolumabscabiesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4d21j0jtarticleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt7zp4b9zs2022-03-10T14:36:11Zqt7zp4b9zsAn acneiform eruption associated with elexacaftor/tezacaftor/ivacaftor treatmentBreneman, AlyssaSoliman, Yssra SGallitano, Stephanie M2021-01-01cneacneiform eruptioncystic fibrosis medication adherencepsychological burdenapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7zp4b9zsarticleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt4h74480z2022-03-10T14:36:10Zqt4h74480zAtopic dermatitis patient perspectives on dupilumab therapy during the COVID-19 pandemic: an international survey studyRakita, UrosGuraya, ArmaanPorter, Caroline LFeldman, Steven R2021-01-01atopic dermatitisCOVID-19dupilumabSARS-CoV-2application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4h74480zarticleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt5tr5s0vm2022-03-10T14:36:08Zqt5tr5s0vmCharacteristics of patients with dermatomyositis from 2011-2021 at a tertiary care centerEngel, Tess NRoberts, Callie MTartar, Danielle M2021-01-01adult dermatomyositisautoantibodycharacteristics of dermatomyositismalignancymyopathyretrospective studyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5tr5s0vmarticleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt69n762jr2022-03-10T14:36:07Zqt69n762jrInfantile myofibromatosis: multiple firm nodules in a premature newbornSzeto, Mindy DMaymone, Mayra BCKim, Lori SBodmer, JennaTreece, Amy LDiaz-Miron, Jose L2021-01-01Infantile myofibromatosis is a rare myofibroblastic proliferative disorder characterized by firm, skin-colored to red-purple cutaneous and subcutaneous nodules; these are the most prevalent fibrous tumors observed in infancy. A premature male infant presented at birth with multiple subcutaneous firm skin-colored nodules measuring about 1-2cm each. Full body MRI and excisional biopsy of the right chest nodule confirmed the diagnosis. We review the case of infantile myofibromatosis and discuss its highly heterogeneous presentation and clinical course, as well as histopathology, genetic testing, and approaches to management.infantile myofibromatosisIMFmyofibromamyofibromatosisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/69n762jrarticleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt1w5508jk2022-03-10T14:36:07Zqt1w5508jkNew-onset cutaneous lupus erythematosus after the COVID-19 vaccineLiu, VivianMessenger, Nathaniel Brandon2021-01-01Vaccine development for COVID-19 has progressed expeditiously. To date, the Food and Drug Administration (FDA) has authorized the Moderna/mRNA-1273, Pfizer-BioNTech (BNT162b2), and Johnson & Johnson’s Janssen (JNJ-78436735) vaccines for use in the United States. Immediate side effects have included myalgia fatigue, chills, fever, and headache. We report an elderly patient with a history of lung cancer and no prior history of autoimmune disease who developed cutaneous lupus erythematosus two ½ months after the second dose of the Pfizer-BioNTech COVID-19 vaccine.COVID-19 vaccine reactionsvaccine-induced lupus erythematosuscutaneous lupus erythematosusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1w5508jkarticleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt9m4790gw2022-03-10T14:36:05Zqt9m4790gwSpontaneous resolution of exuberant localized sporotrichosis after childbirthAlvarenga, Julian VDuraes, Sandra MBVieira, Muller2021-01-01Sporotrichosis is caused by the thermodimorphic fungi of the genus Sporothrix. It is the most common cutaneous mycosis in Latin America, but it is considered uncommon in pregnancy. We report a pregnant woman with with an exuberant ulcerated plaque that proved to be localized sporotrichosis. Therapy choice is a difficult decision in this group of patients. In this case, there was complete resolution of the infection after delivery, without any therapeutic intervention.pregnancysporotrichosistherapeutic.application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9m4790gwarticleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt6394q7wg2022-03-10T14:36:04Zqt6394q7wgMetastatic renal clear cell carcinoma masquerading as a pyogenic granuloma on the lipWilliams, JosiahDepcik-Smith, NatalieWilliams, ToddFeldman, Steven R2021-01-01Metastases to the face are rare. We report on a patient with a history of renal cell carcinoma who presented with a 1.2cm violaceous papule on his lower lip. Although clinically thought to be a pyogenic granuloma, biopsy revealed metastatic renal cell carcinoma recurring after 7 years of latency.case reportgeneral dermatologymedical dermatologymetastasisoncologyrenal cell carcinomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6394q7wgarticleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt91b9n1nn2022-03-10T14:36:03Zqt91b9n1nnTP63-related disorders: two case reports and a brief review of the literatureNanda, ArtiAlLafi, AtlalWolf, SabrinaAlMasry, Iman MBetz, Regina2021-01-01TP63-related disorders comprise a group of six overlapping autosomal dominant (AD) syndromes caused by heterozygous pathogenic variants in the tumor protein p63 gene (TP63). The present report describes the identification of heterozygous de novo pathogenic variants in the DNA binding domain (DBD) of the TP63 gene in two patients diagnosed with Ectodermal dysplasia-Ectrodactyly-Cleft lip/palate syndrome three (EEC3) and Ankyloblepharon-Ectodermal defects-Cleft lip/palate syndrome (AEC), respectively. The report discusses the phenotypic and genotypic characteristics of these patients and provides a brief review of the TP63-related disorder literature.ankyloblepharon-ectodermal defects-cleft lip/palate syndromeectodermal dysplasia-ectrodactyly-cleft lip/palate syndrome 3TP63 pathogenic variantsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/91b9n1nnarticleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt6sn6f16w2022-03-10T14:36:03Zqt6sn6f16wAcquired giant plantar fibrokeratoma: case report and reviewMalik, SaraErickson, Christof PCalame, AntoanellaCohen, Philip R2021-01-01Acquired digital fibrokeratoma is a benign fibrous tumor usually located on the toes and fingers. A 63-year-old man with an acquired giant plantar fibrokeratoma is described. He presented with an asymptomatic exophytic nodule of ten years duration; there is no history of trauma to the site. It measured 15x10x5mm and was located on the plantar foot proximal to the third toe. Excisional biopsy established the diagnosis of fibrokeratoma. Giant acquired fibrokeratoma,has been described in 16 patients including ours: three women and 13 men. They are located on either the upper extremity (one man) or the lower extremity (15 individuals). Acquired plantar fibrokeratoma is rare. Including our patient, it has been reported in 11 patients: one woman and ten men. The woman was 13 years of age and the men ranged from 15 to 77-years-old. Plantar acquired fibrokeratomas are located on either the plantar aspect of the toes, the sole of the foot, or the heel. An excisional biopsy provided adequate treatment without subsequent recurrence of both giant and plantar fibrokeratomas.acquiredCD34digitfibrokeratomafingerfootgiantheelperiungualplantarsubungualtoeapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6sn6f16warticleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt8kp442792022-03-10T14:36:02Zqt8kp44279Improving care for delusional infestation patients: What can dermatologists learn from an entomologist?Cheng, ChristianRidge, GaleKoo, JohnBrownstone, Nicholas2021-01-01Delusional Infestation (DI), represents one of the most difficult patient encounters that dermatology practitioners may experience. It is common for DI patients to doctor shop. Thus, dermatologists are one of several disciplines that may encounter DI patients in their practices. Others include veterinarians, epidemiologists, emergency departments, mental health practitioners, and entomologists. In this article, entomologist, Dr. Gale E. Ridge, with extensive DI experience, was interviewed to find out what an entomologist's perspective has been and what we, the dermatology providers, can learn from that. This is followed by a discussion by the dermatology experts on how the experience of entomologists compares to our experience and what we can learn from them.delusional infestationdelusions of parasitosisentomologyMorgellons diseasepsychocutaneous medicinepsychodermatologyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8kp44279articleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt7pp046292022-03-10T14:36:01Zqt7pp04629DMSO: an aid to combat pain and pruritusAnzelc, MadisonBurkhart, Craig G.2021-01-01Dimethyl sulfoxide (DMSO) is a highly reactive by-product of paper production in the form of an odorless, colorless liquid that has been studied since the 1860s. Initially it was utilized as a solvent, but more recently it is being investigated for therapeutic applications. Owing to its versatility, the use of DMSO has been proposed in many different medical fields for a variety of applications, with possibly the widest use being in the field of dermatology. The clinical interest in the use of DMSO for dermatology conditions stems from this solution's efficacy as a vehicle to deliver pharmacological agents across the stratum corneum and its ability to penetrate biological membranes. Currently there is only one FDA approval for the use of DMSO, and it is not in the dermatologic field but rather for interstitial cystitis. Outside of the FDA scope of usage, DMSO is used frequently to treat osteoarthritis in humans and animals, as well as other chronic pain conditions. This suggests the possible utility of DMSO being applicable to other inflammatory conditions such as pruritus. Further research is necessary to explore the promising utilization opportunities of DMSO in dermatology.chronic paindimethyl sulfoxideDMSOpharmacologypruritusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7pp04629articleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt3jt915562022-03-10T14:36:00Zqt3jt91556Off-label uses of TNFa inhibitors and IL12/23 inhibitors in dermatologyHong, Julie JHadeler, Edward KMosca, Megan LBrownstone, Nicholas DBhutani, TinaLiao, Wilson J2021-01-01TNFa inhibitors, which include adalimumab, infliximab, etanercept, certolizumab, and golimumab, and IL12/23 inhibitor, ustekinumab, have been widely used as a U.S. Food and Drug Administration (FDA) approved for the treatment of psoriasis. Outside of psoriasis, high levels of TNFa had also been found in several skin diseases including hidradenitis suppurativa. IL12 and IL23 play important role in the pathogenesis of SLE, alopecia areata, and vitiligo. This paper reviews the off-label uses of TNFa inhibitors and IL12/23 inhibitors in skin disorders.adalimumabinfliximabetanerceptcertolizumabgolimumabustekinumabTNF-aTNFhidradenitis suppurativaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3jt91556articleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt3vj0k0q62021-10-25T19:28:25Zqt3vj0k0q6Dermatoscopy and locally advanced or multiple basal cell carcinomas: a non-invasive tool to evaluate sonidegib effectivenessConforti, ClaudioToffoli, LudovicaAgozzino, MarinaDi Meo, NicolaZelin, EnricoZalaudek, Iris2021-01-01dermoscopysonidegibtotal body mappingapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3vj0k0q6articleDermatology Online Journalvol 27, iss 9oai:escholarship.org:ark:/13030/qt77w127wv2021-10-25T19:28:23Zqt77w127wvLabial comedones induced by petroleum jelly: a florid exampleAlbusair, MoathShadid, AsemAltalhab, Saad2021-01-01drug-induced comedoneslabialpetrolatumpetroleum jellyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/77w127wvarticleDermatology Online Journalvol 27, iss 9oai:escholarship.org:ark:/13030/qt87b3h55r2021-10-25T19:28:22Zqt87b3h55rEffect of teledermatology triage on primary care and dermatology provider workloads: a retrospective cohort analysisZakaria, AdamAmerson, Erin H2021-01-01accessefficiencyprovider workloadstore-and-forwardteledermatologytelehealthtelemedicineunderserved populationsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/87b3h55rarticleDermatology Online Journalvol 27, iss 9oai:escholarship.org:ark:/13030/qt3vg3c4c72021-10-25T19:28:21Zqt3vg3c4c7Characterizing dermatology mobile applications that use artificial intelligenceRanpariya, VarunFeldman, Steven R2021-01-01app storeAIartificial intelligencecomputer visionmachine learningmobileapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3vg3c4c7articleDermatology Online Journalvol 27, iss 9oai:escholarship.org:ark:/13030/qt8m77413g2021-10-25T19:28:20Zqt8m77413gThe impact of COVID-19 on the dermatology match: an increase in the number of students matching at home programsEderle, AmandaShahriari, ShawhinWhisonant, CeesStewart, ScottRoberson, PaulaValdes-Rodriguez, Rodrigo2021-01-01dermatologyinternshipmatchresidencyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8m77413garticleDermatology Online Journalvol 27, iss 9oai:escholarship.org:ark:/13030/qt23b9136n2021-10-25T19:28:19Zqt23b9136nExtrusion of suture and granuloma formation from a neck thread liftChoi, EllieCheong, Ee CherkLeow, Yung Hian2021-01-01cosmetic surgeryface liftforeign body reactiongranulomatousneck rejuvenationsuture extrusionthreadapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/23b9136narticleDermatology Online Journalvol 27, iss 9oai:escholarship.org:ark:/13030/qt2sw968cw2021-10-25T19:28:17Zqt2sw968cwDermoscopy in cutaneous sarcoidosisLoo Lim, Agnes YeokTang, Po YinOh, Choon Chiat2021-01-01Cutaneous sarcoidosis has a wide variety of manifestations and can be challenging to diagnose clinically. Dermoscopy is a useful tool to support the clinical diagnosis. Herein, we report an elderly woman with pruritic facial plaques. Dermoscopy showed translucent orange globules with shiny white lines, and microscopic examination showed non-necrotizing granulomas with perigranulomatous fibrosis. Shiny white structures on dermoscopy are conventionally associated with basal cell carcinoma, melanoma, and dermatofibroma, and have not yet been reported in sarcoidosis. Current descriptions of dermoscopy findings of sarcoidosis in the literature are summarized. Further differential diagnostic entities for this presentation are described and treatment options for cutaneous sarcoidosis are discussed.dermoscopygranulomatous diseasesarcoidosisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2sw968cwarticleDermatology Online Journalvol 27, iss 9oai:escholarship.org:ark:/13030/qt0sq4r5282021-10-25T19:28:17Zqt0sq4r528Papulolinear collagenoma: a rare entity in childrenLópez, DiegoBeltramo, PilarAcosta, Agustina2021-01-01Papulolinear collagenoma is a rare kind of connective tissue nevus. It is a dermal hamartoma characterized by an increase in collagen. We report a young girl's collagen nevus with a papulolinear distribution.collagenomaconnective tissue nevusdermatopathologyhamartomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0sq4r528articleDermatology Online Journalvol 27, iss 9oai:escholarship.org:ark:/13030/qt0nq2s9rd2021-10-25T19:28:15Zqt0nq2s9rdAdenoid cystic carcinoma located on the lower lipSinger, RalfiGürpınar, BerkYalçın, Özben2021-01-01Adenoid cystic carcinoma is a relatively rare epithelial tumor of the major and minor salivary glands that makes up less than 1% of head and neck neoplasms. The typical clinical and pathological findings of this neoplasm include slow growth, perineural invasion, multiple local recurrences, and distant metastasis. Herein, we report a patient with adenoid cystic carcinoma located to the lower lip which is quite uncommon.adenoid cystic carcinomalipsalivary gland tumorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0nq2s9rdarticleDermatology Online Journalvol 27, iss 9oai:escholarship.org:ark:/13030/qt1vv1r4p82021-10-25T19:28:14Zqt1vv1r4p8Scalp metastasis as initial presentation of neuroendocrine carcinomaPeng, Cynthia CBurke, Katherine TCardis, Michael A2021-01-01Neuroendocrine carcinomas are a rare, heterogenous group of malignancies that arise from neuroendocrine cells throughout the body. Cutaneous metastasis of neuroendocrine carcinoma is uncommon and they can be easily misdiagnosed as benign epidermal cysts or Merkel cell carcinoma. Collectively, histopathology, immunochemical profile, biochemical markers, and nuclear imaging can guide the diagnosis of neuroendocrine metastasis and localization of primary tumors.cutaneous metastasisneuroendocrine carcinomasomatostatin receptor imagingapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1vv1r4p8articleDermatology Online Journalvol 27, iss 9oai:escholarship.org:ark:/13030/qt3r29b1m12021-10-25T19:28:13Zqt3r29b1m1Papulopustular rosacea during nivolumab therapy of metastatic squamous cell esophageal carcinomaGahoonia, Nimrit KCarrington, Alexis EChambers, Cindy JSivamani, Raja K2021-01-01We present a 76-year old man who developed papulopustular rosacea after receiving nivolumab treatment for his esophageal carcinoma, metastatic to the lungs. Nivolumab is an emerging cancer therapy whose immune-related adverse events are still not fully recognized and likely underreported. The treatment has been reported to cause a myriad of cutaneous immune-related adverse events. However, nivolumab-induced-papulopustular rosacea has been scarcely reported. Thus, this case presents a clinically important finding that physicians should be aware of when seeing patients on nivolumab therapy.nivolumab-induced rosaceapapulopustularapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3r29b1m1articleDermatology Online Journalvol 27, iss 9oai:escholarship.org:ark:/13030/qt3kq5k0xm2021-10-25T19:28:12Zqt3kq5k0xmKnuckle pads: an ancient disease frequently misdiagnosed because of minimal modern attentionVincek, VladimirVause, AvaVincek, ErikMarion, TylerBender, NicoleCarstens, StephanieMotaparthi, Kiran2021-01-01Knuckle pads are benign painless papules and nodules that most commonly appear on the extensor surfaces of the proximal interphalangeal joints. Knuckle pads are frequently misdiagnosed due to their location overlying joints, which can lead to costly interventions and patient discomfort for a relatively harmless condition. We describe a 44-year-old woman who presented with mildly painful nodules on multiple bilateral proximal interphalangeal joints. The patient did not have a family history of fibromatosis and the rheumatoid factor was negative. Histology showed mild epidermal hyperkeratosis, papillomatosis, and acanthosis with a deep dermal, poorly circumscribed, proliferative nodule made of spindled myofibroblasts without cytological atypia. The diagnosis of knuckle pads was established based on the clinical and morphological presentation of the nodules. Treatment with intralesional triamcinolone acetonide injection produced significant clinical improvement. Our findings highlight the challenging diagnosis of knuckle pads and the importance of increasing the familiarity of knuckle pads in modern medical practice.fibromatosishelodermaknuckle padsproximal interphalangeal jointsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3kq5k0xmarticleDermatology Online Journalvol 27, iss 9oai:escholarship.org:ark:/13030/qt4t0335f62021-10-25T19:28:11Zqt4t0335f6Cutaneous B cell pseudolymphoma treated with rituximab and methotrexateBesch-Stokes, Jake GPatel, Meera HBrumfiel, Caitlin MCostello, Collin MRule, WilliamRosenthal, AllisonPittelkow, Mark RDiCaudo, David JMangold, Aaron R2021-01-01Cutaneous B cell pseudolymphoma (CBPL), or cutaneous lymphoid hyperplasia, is the most common pseudolymphoma. It typically responds well to local treatment and follows a benign course. Herein, we describe the unique case of a patient with CBPL that was refractory to a variety of treatments, with subsequent response to rituximab followed by methotrexate. This case explores the complex interplay of T and B lymphocytes, and the potential role of perifollicular T cells in treatment resistant CBPL. Further, it describes the additive therapeutic effect of rituximab and methotrexate to target both B cell and T cell populations in CBPL, a strategy already employed in a number of other conditions.B cell disordersmethotrexatepseudolymphomarituximabapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4t0335f6articleDermatology Online Journalvol 27, iss 9oai:escholarship.org:ark:/13030/qt3rw338qb2021-10-25T19:28:10Zqt3rw338qbAssessing smoldering adult T cell leukemia/lymphoma: a case reportOlayinka, JTHeilman, EVatanchi, M2021-01-01Adult T cell leukemia/lymphoma (ATLL) is a rare, extremely aggressive malignancy with four different clinical variants, all of which are associated with human T cell lymphotropic virus type 1. Antiretrovirals have been recognized as an effective therapy after study in clinical trials around the world. However, oncologists traditionally wait for asymptomatic patients with ATLL to reach a more severe stage of disease before treatment is initiated. We describe a patient with Fitzpatrick Skin Type V who presented with asymptomatic dyschromia of her neck, breast, and jaw. Her clinical, laboratory, and histological findings were consistent with smoldering type-ATLL. We teamed up with her oncologist to successfully treat her cutaneous symptoms with interferon-alpha/zidovudine. This report demonstrates efficacy with the employment of antiretroviral therapy immediately following a diagnosis of smoldering type ATLL.adult T cell leukemia/lymphomaantiretroviralsATLLcutaneous manifestationsHTLV1human T cell lymphotropic virus type 1leukemialymphomasmolderingapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3rw338qbarticleDermatology Online Journalvol 27, iss 9oai:escholarship.org:ark:/13030/qt1wr6m73b2021-10-25T19:28:09Zqt1wr6m73bDupilumab for the treatment of nivolumab-induced bullous pemphigoid: a case report and review of the literatureKlepper, Edward MRobinson, Howard N2021-01-01Immune checkpoint inhibitors, a relatively new class of drugs, are used to treat a variety of malignancies. These drugs have a known association with cutaneous side effects, such as bullous pemphigoid. Bullous pemphigoid is a pruritic blistering disorder that is caused by autoantibodies forming against the basement membrane of the epidermis. New research has shown that interleukin-4, interleukin-13, and eosinophils play a significant role in the pathogenesis of bullous pemphigoid. Dupilumab, an IL4 alpha receptor antagonist has been shown to reduce IL4 and IL13 in atopic dermatitis. We present a case of nivolumab-induced bullous pemphigoid that was successfully treated with dupilumab.autoantibodybullaebullous pemphigoiddupilumabeosinophilsimmune checkpoint inhibitorsimmunotherapyIL4IL13nivolumabPD1PDL1pruritusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1wr6m73barticleDermatology Online Journalvol 27, iss 9oai:escholarship.org:ark:/13030/qt52s7b02x2021-10-25T19:28:08Zqt52s7b02xHealth insurance relationship to sun protection practices and beliefsEngel, Tess NNguyen, MimiPan, AdrianneSivamani, Raja K2021-01-01Purpose: Lower socioeconomic status is associated with decreased sun protection practices. This survey study investigated practices and beliefs surrounding sun protection based on health insurance. Methods: 401 surveys were administered May to June 2019 at two dermatology clinics in Sacramento, California. 384 surveys by private insurance, Medi-Cal (California's Medicaid), and Medicare coverage were analyzed. Results: Patients with Medi-Cal are twice as likely to rarely or never use sunscreen (OR=2.37; 95% CI 1.45-3.87; P<0.001) compared to those with private insurance. Patients with Medi-Cal or Medicare are less likely to use sunscreen (P<0.001), protective clothing (P=0.025), and sun avoidance (P=0.028). Medi-Cal patients more often used tanning beds (OR=4.90; 95% CI 1.30-18.50; P=0.019). Over half of patients with Medi-Cal agreed it is worth getting burned for a tan (54.6%, OR=2.54; 95% CI 1.41-4.62; P=0.0021). There were no significant differences in opinion that sunscreen is a hassle to apply or expensive. Groups did not differ significantly in ethnicities or skin type. Conclusion: Those with Medi-Cal are less likely to use all forms of sun protection and more likely to value tanning. Negative opinions of sunscreen and perceived knowledge and concern for skin cancer were similar, pointing to additional factors influencing these disparities.behaviorhealth insurancesocioeconomic statussun protectionapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/52s7b02xarticleDermatology Online Journalvol 27, iss 9oai:escholarship.org:ark:/13030/qt1gq3j2cb2021-10-25T19:28:07Zqt1gq3j2cbReal-world biologic and apremilast treatment patterns in patients with psoriasis and psoriatic arthritisFeldman, Steven RZhang, JingchuanMartinez, Diane JLopez-Gonzalez, LorenaHoit Marchlewicz, ElizabethShrady, GeorgeZhao, YangMendelsohn, Alan M2021-01-01Purpose: Real-world treatment patterns among psoriasis patients with and without psoriatic arthritis (PsA) newly initiating treatment with a biologic or apremilast were assessed. Patients and methods: MarketScan claims data from adults with psoriasis and ?1 new prescription for secukinumab, adalimumab, ustekinumab, etanercept, or apremilast from January 1, 2015, to August 31, 2018, were assessed for adherence, switching, and combination therapy by index medication and PsA diagnosis. Results: At treatment initiation, 22.0%-45.7% of patients had PsA. Over 24 months, discontinuation rates were high (34.4%-54.6%) overall and higher in patients with versus without PsA (all P<0.05 except secukinumab). Adherence was poor (16.8%-34.8%); switching and combination therapy were common. Conclusion: Treatment patterns varied, with better outcomes in PsA patients receiving anti-tumor necrosis factor versus anti-IL17/IL12/23 agents.claims datacombination therapypersistencepsoriasispsoriatic arthritisswitchingtreatment adherenceapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1gq3j2cbarticleDermatology Online Journalvol 27, iss 9oai:escholarship.org:ark:/13030/qt7263t7fk2021-10-25T19:28:06Zqt7263t7fkCultural and biological factors in body dysmorphic disorder in East AsiaHong, JulieHadeler, EdwardMosca, MeganBrownstone, NicholasBhutani, TinaKoo, John2021-01-01Body dysmorphic disorder (BDD) can cause severe distress and impairment in many important areas of functioning. Although BDD has been well studied in Western populations, there is limited information on BDD in other cultures. In this review, we discuss the prevalence and presentation of BDD in East Asian countries and the significance of conducting further research in this particular group.body dysmorphic disorderdissatisfactionimageEast Asiaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7263t7fkarticleDermatology Online Journalvol 27, iss 9oai:escholarship.org:ark:/13030/qt7dq2h5752021-10-25T19:28:05Zqt7dq2h575Management of surgical soft tissue defects of the lower extremitiesRich, Matthew DMazloom, Sean ESorenson, Thomas JPhillips, Mariana A2021-01-01Management of post-operative soft-tissue defects on the lower legs is challenging owing to arterial and venous insufficiency, poor skin quality including epidermal and dermal atrophy, insufficient tissue laxity, and increased risk of infection. This paper highlights the management of post-operative soft-tissue defects on the lower extremity that cannot be closed primarily or by reconstruction with a local flap. A systematic review of the literature was performed using the National Library of Medicine (NLM) PubMed online database. Articles were included if they reported the management of post-operative lower extremity soft-tissue defects with secondary intention healing, full-thickness skin graft, split-thickness skin grafts, or skin substitutes. Sixty-three articles were included for analysis. There are several options for managing surgical defects on the lower legs and the method chosen should depend on various factors, including the quality of the skin, vascularity and size of the defect, medical history of the patient, and the experience of the surgeon.cancerlower extremityreconstructionsoft-tissue defectapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7dq2h575articleDermatology Online Journalvol 27, iss 9oai:escholarship.org:ark:/13030/qt39x7b6fd2021-10-25T19:28:05Zqt39x7b6fdVaccine considerations for adult dermatology patients on immunosuppressive and immunomodulatory therapies: a clinical reviewTan, Alice JStreicher, Jenna LMerola, Joseph FNoe, Megan H2021-01-01Adults with chronic inflammatory skin disease are at increased risk of vaccine-preventable illnesses and infections, likely because of the underlying disease itself and also their treatment with immunosuppressive and immunomodulatory medications. Despite the association between these agents and increased susceptibility to infection, vaccination rates in dermatology patients remain low. Although preventative care such as vaccinations is typically managed by primary care providers, dermatologists serve a critical role in spreading awareness of the specific risks of immunosuppressive and immunomodulatory agents and promoting understanding of individualized vaccine recommendations. In this review, we provide evidence-based information on vaccine recommendations for adult dermatology patients, specific to age and medication use.general dermatologyimmunosuppressionmedicalpreventative carevaccinationvaccineapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/39x7b6fdarticleDermatology Online Journalvol 27, iss 9oai:escholarship.org:ark:/13030/qt2qr5t5g92021-10-07T22:26:17Zqt2qr5t5g9Corrigendum: Updates on treatment guidelines for psoriasis, atopic dermatitis (eczema), hidradenitis suppurativa, and acne/rosacea during the COVID-19 pandemicYim, Rebecca MSingh, IndiraArmstrong, April W2021-01-01application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2qr5t5g9articleDermatology Online Journalvol 27, iss 8oai:escholarship.org:ark:/13030/qt2xf6v0jw2021-10-07T22:26:15Zqt2xf6v0jwChronic spontaneous urticaria: a 16-year analysis of pediatric patient demographics, treatment patterns, and comorbiditiesPourali, Sarah PKohn, Alison HJones, Madison EArmstrong, April W2021-01-01chronic urticariaidiopathicNational Ambulatory Medical Care Surveypopulation studyurticariaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2xf6v0jwarticleDermatology Online Journalvol 27, iss 8oai:escholarship.org:ark:/13030/qt7md4b1t72021-10-07T22:26:14Zqt7md4b1t7Trichotillomania in the United States: An epidemiologic study of patient characteristics, comorbidities, and treatment patternsGutierrez, YasminJones, Madison ERajkumar, Jeffrey RKohn, Alison HPourali, Sarah PChen, AllenCompoginis, Goli SArmstrong, April W2021-01-01epidemiologyhair disordersNational Ambulatory Medical Care Surveypatient characteristicspopulation studytrichotillomaniaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7md4b1t7articleDermatology Online Journalvol 27, iss 8oai:escholarship.org:ark:/13030/qt5rr550hj2021-10-07T22:26:13Zqt5rr550hjBleomycin-induced skin toxicity: a case of flagellate dermatitis.Pretorius, MoniqueSteenkamp, IlanaSpies, Leanavan der Linde, Gerhard2021-01-01Bleomycin, an antineoplastic, glycopeptide antibiotic is commonly used to treat several malignancies, in particular, lymphomas, testicular carcinoma, and squamous cell carcinoma. As bleomycin degradation by enzyme hydrolase is less in the skin and lungs, a higher likelihood of cutaneous toxicity exists. We present a case of bleomycin-induced flagellate dermatitis, a characteristic cutaneous eruption that occurred as a result of bleomycin administration. A 58-year-old man with Stage 4 diffuse large B-cell lymphoma presented with sudden onset of skin lesions that appeared five weeks after initiation of third-line bleomycin-containing palliative chemotherapy. The whip-like, linear, hyperpigmented plaques were indicative of flagellate dermatitis. We aim to present the natural course of bleomycin flagellate dermatitis and its natural course.bleomycincutaneous eruptionflagellate dermatitislarge B-cell lymphomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5rr550hjarticleDermatology Online Journalvol 27, iss 8oai:escholarship.org:ark:/13030/qt2wn388bx2021-10-07T22:26:11Zqt2wn388bxConcomitant endogenous and exogenous etiology for gingival pigmentationPanucci, Beatriz Zamboni MartinsFerrisse, Tulio MorandinBufalino, AndreiaLeón, Jorge Esquiche2021-01-01Oral pigmented lesions can be physiological or pathological, exogenous or endogenous, as well as focal, multifocal, or diffuse. Among them, the oral melanotic macule (OMM) is a small, well-delimited brown-to-black macule, often affecting the lip and gingiva. Amalgam tattoo (AT) is a grey or black area of discoloration on the oral mucosa as a result of entry of dental amalgam into the soft tissues, commonly gingiva and alveolar ridge. Herein, we present a patient with gingival pigmentation with features of both OMM and AT in the same location.amalgam tattoohistopathologymelanotic maculeoral mucosapigmentation disordersapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2wn388bxarticleDermatology Online Journalvol 27, iss 8oai:escholarship.org:ark:/13030/qt18g699b22021-10-07T22:26:09Zqt18g699b2Recurrent fungating tumor and a chronic rash in an immunosuppressed transgender patient: a case of Buschke-Lowenstein condyloma and epidermodysplasia verruciformisShamloul, NorhanGuerra, RicardoKozak, MerrickNoland, Mary2021-01-01A transgender female in her 40s with history of HIV and testicular cancer status post-genital X-irradiation presented with a perianal mass and pruritic rash across her chest. Physical examination revealed a bulky, verrucous tumor protruding outward from the anus involving the medial buttocks. Examination of the chest and arms showed numerous guttate, pink, flat-topped papules coalescing into plaques. Clinically and histologically the lesions were consistent with Buschke-Löwenstein condyloma (BLC) and acquired epidermodysplasia verruciformis (AEDV). Buschke-Löwenstein condyloma incisional biopsy tested negative for common low- and high-risk human papillomavirus (HPV) subtypes, including 6, 11, 16, and 18, possibly implicating beta HPV subtype or a less common pathogenic subtype. The patient underwent abdominoperineal resection of the BLC, which tested positive for low-risk HPV subtypes, suggesting the possibility of multiple implicated HPV subtypes in the same tumor. This case demonstrates a possible role of beta HPV or rarer HPV subtypes in the pathogenesis of verrucous carcinoma, particularly in the setting of immunosuppression.acquired epidermodysplasia verruciformisBuschke-L�wenstein condylomahuman papillomavirusimmunodeficiency virusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/18g699b2articleDermatology Online Journalvol 27, iss 8oai:escholarship.org:ark:/13030/qt5dn986tr2021-10-07T22:26:08Zqt5dn986trPink nodule of the chin: an unusual presentation of metastatic carcinomaChelliah, PriyaShah, Kishan MVandergriff, TravisNijhawan, Rajiv I2021-01-01Renal cell carcinoma (RCC) is the most lethal urological tumor, often because it is widely metastasized at the time of diagnosis. There are reports of cutaneous metastases, most commonly to the head and neck, presenting late after RCC is diagnosed. This case presentation explores a 45-year old female patient with a growing skin lesion on her chin, previously treated as an epidermoid cyst before presenting to dermatology clinic. We present a case of cutaneous metastatic clear cell renal cell carcinoma presenting 7 years after initial diagnosis.metastasisoncologyrenal cell cancerapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5dn986trarticleDermatology Online Journalvol 27, iss 8oai:escholarship.org:ark:/13030/qt57j4b12p2021-10-07T22:26:07Zqt57j4b12pAdenodermatofibroma: a rare variantRussomanno, KristenDeng, MinCardis, Michael2021-01-01Adenodermatofibroma is a newly recognized variant of fibrous histiocytoma (dermatofibroma), a benign lesion frequently encountered in dermatologic practice. There are many established variants of fibrous histiocytoma but there are only eight reported cases of this specific variant in the literature. This report reviews a case of an adenodermatofibroma presenting as a large, firm, atrophic plaque on the thigh. Histopathologic findings showed dilated glandular structures with apocrine features within a fibrohistiocytic cellular infiltrate, consistent with the diagnosis. We review the characteristic findings of adenodermatofibroma, discuss the differential diagnosis, and examine current theories speculating the origin of apocrine glands present within these lesions.adenodermatofibromabenign fibrous histiocytomacutaneousdermatofibromaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/57j4b12particleDermatology Online Journalvol 27, iss 8oai:escholarship.org:ark:/13030/qt38k3v8hw2021-10-07T22:26:05Zqt38k3v8hwDupilumab in HIV-positive patients with atopic dermatitis: a long-term follow-up patient and a literature reviewAvallone, GianlucaTrunfio, MattiaGiura, Maria TeresaSiliquini, NiccolòViola, RiccardoOrofino, GiancarloMastorino, LucaOrtoncelli, MichelaQuaglino, PietroRibero, Simone2021-01-01Dupilumab is an IgG4 human monoclonal antibody licensed for the treatment of moderate-to-severe atopic dermatitis. Despite evidence suggesting that T helper type two cytokines can modulate HIV-1 replication and anti-HIV-specific immune responses, impacting on viral reservoirs, HIV-positive patients under immunomodulating therapy have been excluded from clinical trials. We report a 47-year-old HIV-positive man with late-onset severe atopic dermatitis, treated with dupilumab and followed up for 27 months. Improvements in skin lesions and quality of life were observed after four months. Blood tests showed normalization of IgE levels, with the clinical condition remaining stable at a 27- month follow-up. We gathered 16 other cases reported in the literature of HIV-positive patients treated with dupilumab, with no, or few adverse reactions, for which it is unclear if dupilumab should be held accountable. With our case and literature review, we aim to shed light on dupilumab efficacy, safety, and tolerability among HIV-positive patients suffering from atopic dermatitis. In this regard, future research should focus on the effective role, underlying mechanisms, and efficacy of dupilumab in HIV-positive patients and HIV-positivity could be questioned as a valid exclusion criterion for clinical trials.antiretroviral therapyatopic dermatitisCD4 countdupilumabHIVviral loadapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/38k3v8hwarticleDermatology Online Journalvol 27, iss 8oai:escholarship.org:ark:/13030/qt4wn0c4mp2021-10-07T22:26:04Zqt4wn0c4mpCutaneous Leishmania aethiopica diagnosed in the United StatesGilkey, TyUlman, Catherine AMcGwire, BradfordPlaza, Jose A.2021-01-01Cutaneous leishmaniasis is a parasitic infection caused by certain Leishmania spp and is endemic in the New world (Central and South America) and Old World (Africa and the Middle East) where it is transmitted via sandflies of the Phlebotomus and Lutzomyia species. We describe a case of a 61-year-old woman who presented with an asymptomatic red-brown papule on her lower back approximately one year after returning to the United States from a trip to Ethiopia and Cameroon. Polymerase chain reaction was performed on the biopsy material and identified Leishmania aethiopica. This case highlights an atypical location and demonstrates how to accurately diagnose and treat this parasitic infection.amastigotesCamerooncutaneous leishmaniasisEthiopiaLeishmania aethiopicasandflyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4wn0c4mparticleDermatology Online Journalvol 27, iss 8oai:escholarship.org:ark:/13030/qt8b15d4582021-10-07T22:26:02Zqt8b15d458Angiokeratoma-like purpuric palmar nodules following chemotherapyTorre, Eduardo AKersh, Anna EFischer, Andrew SXu, XiaoweiRosenbach, MishaShields, Bridget E2021-01-01We describe a patient with leukemia undergoing chemotherapy who developed painful purpuric nodules of the digits. These findings were concerning for endocarditis (clinically) and angiokeratomas on gross histology. After extensive evaluation, we report the development of painful purpuric nodules as a likely side effect of the patient's therapeutic regimen (hydroxyurea, danorubicin, cytarabine, and methotrexate).angiokeratomachemotherapycutaneous chemotherapy side effectcytarabinedanorubicinintraepithelial hemorrhagemicroemboliOsler nodespainful purpuric nodulesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8b15d458articleDermatology Online Journalvol 27, iss 8oai:escholarship.org:ark:/13030/qt80j1q6942021-10-07T22:26:01Zqt80j1q694Darier disease, radiation therapy, and herpesvirus -- an unfortunate triadWesterdahl, J SkylarGrant, JohnSontheimer, RichardZussman, Jamie2021-01-01Darier disease (DD) is a rare autosomal dominant keratinizing disorder often characterized by brown scaly pruritic papules over the face, neck, and trunk. Herein is reported a patient who developed secondary cutaneous herpes simplex virus (HSV) following exacerbation of his DD as a result of radiation therapy. In November 2020, a 78-year-old man presented to clinic for a pruritic rash on his back consistent with DD. He had developed the rash after the conclusion of chemoradiation therapy for recently diagnosed urothelial carcinoma of the bladder with squamous differentiation. However, he returned two weeks later complaining of a marked worsening of the rash associated with a pain and burning sensations. Histopathology was non-conclusive, but the lesions were found to be positive for HSV-1 by PCR. The patient recovered without complication over a period of two weeks following a course of valacyclovir. There is precedent in the literature for ionizing radiation inducing flares of DD lesions in overlying skin. In addition, DD has been shown to put a patient at increased risk for secondary infections such as HSV. This case report demonstrates that HSV could pose a significant risk to those with DD receiving radiation therapy and thus could warrant prophylactic treatment.Darier diseaseeczema herpeticumherpes simplexKaposi varicelliform eruptionradiation oncologyradiation therapyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/80j1q694articleDermatology Online Journalvol 27, iss 8oai:escholarship.org:ark:/13030/qt5s61z4v22021-10-07T22:25:59Zqt5s61z4v2Milia-like calcinosis cutis in Down syndrome: a new case with a review of the literatureMoar, AgataMaurelli, MartinaColato, ChiaraSchena, DonatellaGirolomoni, Giampiero2021-01-01We report an 11-year-old girl who presented with white papules on the dorsal and palmar region of the hands bilaterally. The parents reported that the lesions had appeared four months before and some had resolved spontaneously. The girl was suffering from celiac disease, Down syndrome, and alopecia areata treated with topical corticosteroids. At the first visit, the girl presented with alopecia areata, corticosteroid acne, and a dozen white papules located on the hands. On dermoscopy, a whitish structureless area was seen. Histological examination showed the presence of calcium deposits without tissue damage, thus confirming the diagnosis of milia-like idiopathic calcinosis cutis. At 6-month follow up, the lesions had completely disappeared. Milia-like idiopathic calcinosis cutis is a benign cutaneous disorder consisting of calcium deposits in an apparently undamaged dermis and is typically associated with Down syndrome. Up to a quarter of patients have coexisting syringomas. The milia-like papules tend to self-resolve as patients reach adulthood, so a wait-and-see approach is recommended.calcinosiscutismilia-likeDown syndromeapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5s61z4v2articleDermatology Online Journalvol 27, iss 8oai:escholarship.org:ark:/13030/qt5618f0db2021-10-07T22:25:58Zqt5618f0dbResponse of eosinophilic fasciitis associated with Waldenström macroglobulinemia to rituximabKromer, ChristianMatzke, Silke SBleckmann, AnnalenOverbeck, TobiasLippert, UndineSchön, Michael PMössner, Rotraut2021-01-01Eosinophilic fasciitis (EF) and generalized morphea (GM) are rare and difficult-to-treat sclerosing skin diseases which may occur in association with hematologic disorders. We present a 66-year-old man with EF and associated Waldenström macroglobulinemia who received combination therapy with rituximab (375mg/m2 every other week, gradually extended to every eight weeks), prednisolone (1.25-30mg/d), and methotrexate (7.5-15mg/w). Three months after rituximab initiation, his skin condition improved steadily accompanied by a significant improvement in joint mobility with only mild and transitory flares (observation period: 59 months under treatment with rituximab). To date, there are five case reports on rituximab treatment of EF/GM with an association to hypergammaglobulinemia in three of those cases. Therapy effected significant improvement in four patients. Our case adds to the hitherto limited evidence that rituximab may be a promising therapeutic strategy for EF/GM in association with hypergammaglobulinemia.biologiclocalized sclerodermarituximabShulman's syndromeapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5618f0dbarticleDermatology Online Journalvol 27, iss 8oai:escholarship.org:ark:/13030/qt7xj3c5m72021-10-07T22:25:57Zqt7xj3c5m7Characteristics and comorbidities of Medicare beneficiaries receiving care from Mohs micrographic surgeons based on fellowship training and practice settingGronbeck, ChristianFeng, Hao2021-01-01The characteristics and medical conditions of patients being managed by Mohs micrographic surgeons (MMS) have not been extensively established. In this cross-sectional review of 2017 Medicare Public Use data, we compared patient demographics and medical comorbidities among dermatologists billing for MMS based on surgeon fellowship training and practice settings. Overall patient complexity, as measured through Medicare's Hierarchical Condition Category (HCC) score, did not significantly differ by fellowship training status. However, among fellowship-trained surgeons, those in academic centers managed a higher proportion of dual Medicare-Medicaid beneficiaries (9.4% versus 5.4%, P<0.0001) with higher mean HCC scores (1.33 versus 1.13, P<0.0001). Depression and chronic kidney disease were notably more common among academic beneficiaries. These findings help to establish the patient complexity distribution among dermatologic surgeons, which may have important implications for perioperative management and monitoring given the growing prevalence of skin cancer and other medical comorbidities.hierarchical condition category scoreMedicaidmedical complexityMedicareMohs micrographic surgerypatient comorbiditiessocioeconomicsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7xj3c5m7articleDermatology Online Journalvol 27, iss 8oai:escholarship.org:ark:/13030/qt8tj3w49h2021-10-07T22:25:56Zqt8tj3w49hEvaluating the association of central centrifugal cicatricial alopecia (CCCA) and fibroproliferative disordersSamrao, ALyon, LMirmirani, P2021-01-01Background: In central centrifugal cicatricial alopecia (CCCA), a lymphocytic scarring alopecia that primarily affects black women, it has been postulated that there is a "pro-fibrotic" tendency and increased risk for systemic fibroproliferative disorders. Objective: To determine whether women with biopsy-proven CCCA have a greater likelihood of systemic fibroproliferative disorders (FPDs) of the lungs (interstitial lung disease), arteries (atherosclerosis of the aorta), liver (non-alcoholic steatohepatitis), kidney (end stage renal disease), or uterus (uterine leiomyoma). Methods: We conducted a retrospective matched cohort study evaluating 427 cases with biopsy-proven CCCA and 1281 age- and sex-matched controls. Results: Black women with biopsy-proven CCCA, were not more likely to have interstitial lung disease (ILD), atherosclerosis of the aorta, non-alcoholic steatohepatitis (NASH), end stage renal disease (ESRD), or uterine leiomyoma. Central centrifugal cicatricial alopecia was associated with a history of never smoking and higher body mass index. Conclusion: In this large cohort of biopsy-proven women with CCCA, there was no association with specific fibroproliferative disorders when compared with age and sex matched controls. Future longitudinal studies may help confirm these results.central centrifugal cicatricial alopeciafibrosisfibroproliferative disordersapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8tj3w49harticleDermatology Online Journalvol 27, iss 8oai:escholarship.org:ark:/13030/qt1p07939s2021-10-07T22:25:55Zqt1p07939sIncidence estimates for lichen planopilaris and frontal fibrosing alopecia in a New York City health care systemLavian, JonathanTrager, Megan HLee, Eunice YGary, DahsanJenkins, FabianChristiano, Angela MBordone, Lindsey A2021-01-01Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are scarring alopecias that cause significant distress and psychological morbidity. Limited studies have been performed examining the epidemiology of FFA and LPP. We performed a retrospective case cohort analysis by querying for patients with the ICD 10 code L66.1 (LPP, FFA) between 2015 and 2018 using the Clinical Data Warehouse (CDW) at NewYork-Presbyterian Hospital and Columbia Doctors. We calculated the one-year incidence of LPP/FFA between January 1, 2018 to December 31, 2018 by identifying all patients without a previously recorded ICD code for L66.1 who presented as a new hair loss patient based on chart review. A total of 170 patients were identified with a new diagnosis of LPP or FFA in 2018 among 1,187,583 patients. The standardized incidence per 100,000 was 12.75 for LPP and FFA combined, 7.35 for LPP alone, and 5.41 for FFA alone. The incidence peaked in the 51 to 60 age range (3.36). The incidence was highest in non-Hispanic White patients (17.27), White patients of unknown ethnicity (26.26), and non-Hispanic Asian patients (17.27). In New York City, LPP and FFA are uncommon diseases that are most common in middle-aged females and non-Hispanic White patients.epidemiologyfrontal fibrosing alopeciaincidencelichen planopilarisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1p07939sarticleDermatology Online Journalvol 27, iss 8oai:escholarship.org:ark:/13030/qt2991p68x2021-10-07T22:25:54Zqt2991p68xThe continued inappropriate use and overuse of combination topical clotrimazole-betamethasoneFlint, Nicholas DRhoads, Jamie L WCarlisle, RyanFerrel, MeganneHopkins, Zachary HSecrest, Aaron M2021-01-01Objective: Combination topical clotrimazole/ betamethasone dipropionate (C-BM) contains a high-potency topical corticosteroid and is not infrequently prescribed for inappropriate patient groups and body sites. Use of C-BM can lead to inadequate clearance or exacerbation of fungal infections as well as cutaneous atrophy, striae, and other skin maladies. Methods: We performed a retrospective chart review of 1,978 clinical visits where C-BM was prescribed within the University of Utah Health system between 2014 and 2018 to better understand current prescribing patterns. Results: 1,974 prescriptions were written for C-BM. 91.6% of patients were at least the recommended age of 17 years. C-BM was most commonly prescribed for rashes of an inflammatory (42.2%) or fungal nature (38.1%). Clotrimazole/betamethasone dipropionate was prescribed for sensitive areas (face, axillae, groin or diaper region) in 48.9% of patients. Family medicine clinicians prescribed 58.3% of C-BM prescriptions, whereas dermatology clinicians accounted for 3.4%. Conclusion: We strongly recommend clinicians use alternative treatments for rashes or refer to dermatologists.fungal infectionsinflammatory rashesside effectstopical antifungalstopical corticosteroidsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2991p68xarticleDermatology Online Journalvol 27, iss 8oai:escholarship.org:ark:/13030/qt6vv6f40w2021-10-07T22:25:53Zqt6vv6f40wCompeting risks analysis of Merkel cell carcinoma with concurrent chronic lymphocytic leukemia and non-Hodgkin lymphomaNguyen, Kevin AMaloney, Nolan JYang, Jason JBach, Daniel QZaba, Lisa C2021-01-01Background: Although hematogenous malignancy is a risk factor for poorer prognosis in Merkel cell carcinoma (MCC), current guidelines make no specific recommendations for surveillance. Objective: We aim to characterize MCC-specific mortality compared to other causes of death for patients with hematologic malignancy in MCC, which will guide workup and surveillance strategies. Methods: The Surveillance, Epidemiology, and End Results-18 registry was queried for MCC patients with chronic lymphocytic leukemia (CLL) or non-Hodgkin lymphoma (NHL). Results: Of 8519 patients with MCC, 146 (1.7%) had CLL and 234 (2.8%) had NHL. Chronic lymphocytic leukemia patients had 5-year cumulative incidence of MCC-specific mortality of 38.4% versus 28.4% in patients without CLL/NHL. For both cohorts, oncologic risk was highest within the first three years of diagnosis with competing risks favored thereafter. On competing risk regression, a history of CLL trended toward statistical significance with poorer MCC-specific mortality (subdistribution hazard ratio: 1.33, 95% CI: 0.963-1.834, P=0.084), while NHL was not prognostic. Conclusions: Merkel cell carcinoma patients with CLL may benefit from more aggressive initial management. Surveillance for similar length in CLL patients with MCC may be appropriate; this co-morbidity did not affect the timeframe by which the risk of competing causes of death exceeded oncologic risks.hematogennomaous malignancyMerkel cell carci surveillanceapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6vv6f40warticleDermatology Online Journalvol 27, iss 8oai:escholarship.org:ark:/13030/qt4v04q67g2021-10-07T22:25:52Zqt4v04q67gClinical recommendations to address dermatologic healthcare disparities in sexual and gender minority patients: a reviewScholl, MatthewJimenez, AntonioCulbertson, ClaireHoyer, PaigeRoss, Lindy2021-01-01Background: In the United States, an estimated 4.5% of the population identifies as a sexual or gender minority (SGM). Efforts are underway to address this population's healthcare disparities. [A1] Objective: This review aims to highlight dermatologist's role in treating SGM patients, raise awareness about SGM-related stigma, and identify clinical interventions to improve SGM care. Methods: Articles were selected by review of literature from PubMed's database from 2000-2020. Results: The first intervention outlines methods to educate the healthcare team on the terminology used by the SGM community and how HIV epidemiology is a distinct topic through separate trainings. The second intervention emphasizes better communication with SGM patients in routine discussions, including the proper elicitation of a sexual history by avoiding heteronormative questioning. The last intervention discusses enhancing this population's clinical experience by updating clinical intake forms to include a fill-in-the-blank for patients' pronouns, refraining from gender-specific bathrooms, and advertising commitment to SGM care online. Conclusion: Our review article highlights a dermatologist's integral role in SGM care. The review emphasizes three distinct intervention areas that aim to destigmatize sexual/gender identity in the workplace, promote cultural humility, and improve the therapeutic alliance between SGM patients with dermatologists.general dermatologyHIV healthLGBT healthmedical dermatologysexual gender minority healthapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4v04q67garticleDermatology Online Journalvol 27, iss 8oai:escholarship.org:ark:/13030/qt2md8r5ms2021-10-07T22:25:51Zqt2md8r5msMorgellons disease etiology and therapeutic approach: a systematic reviewBeuerlein, Katherine GBalogh, Esther AFeldman, Steven R2021-01-01Morgellons disease is characterized by patient reports of fibers embedded in and protruding from the skin. Etiologies from infection to delusion have been endorsed, and treatment guidelines are not well-defined. The objective of this manuscript is to evaluate the existing evidence regarding the etiology and treatment of Morgellons disease in an effort to better inform clinical management. A PubMed search including key words "Morgellons," "delusional parasitosis and fibers," "delusions of parasitosis and fibers," or "delusional infestation and fibers" was completed. Original publications directly assessing etiology or treatment methods of Morgellons disease published between January, 2010 and the time of manuscript preparation were reviewed and evaluated. Sixteen articles regarding etiology were reviewed. All studies were correlative in nature with various limitations. Support for a psychiatric etiology was more widespread than support for an infectious etiology. Eleven articles regarding treatment efficacy were reviewed. Antipsychotic regimens have the most evidence of efficacy. Existing data regarding Morgellons disease suggests a psychiatric etiology and supports treatment with a low-dose antipsychotic agent once non-psychiatric causes have been excluded.antipsychoticsBorrelia burgdorferidelusional infestationdelusions of parasitosisetiologyfibersfilamentsMorgellonstick-borneapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2md8r5msarticleDermatology Online Journalvol 27, iss 8oai:escholarship.org:ark:/13030/qt8ct8t2g02021-08-26T00:10:47Zqt8ct8t2g0Position Title: ScientistDepartment of Dermatology, University of California, Davis, School of Medicine,2020-01-01The University of California, Davis, School of Medicine, Department of Dermatology, is recruiting for a scientist position with skin immunology and microbiome research experience at the rank of Associate or Full Professor/In-Residence series based on experience and qualifications. Expectations of a Clinical X series is to engage in teaching, research, service, and clinical work, while expectations of faculty in the HSCP series are primarily clinical and include teaching, service, and scholarly and/or creative activities. The appointment may be made up to 100% and will report to the Chair of the Department of Dermatology. We especially welcome applicants whose research, teaching, and community outreach demonstrably attest to their commitment to inclusion of under-represented and/or nonmajority individuals into their respective area of specialization within their discipline.application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8ct8t2g0articleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt0pc4316n2021-08-26T00:10:45Zqt0pc4316nPosition Title: Academic DermatologistDepartment of Dermatology, The University of California, Davis, School of Medicine,2020-01-01The University of California, Davis, School of Medicine, Department of Dermatology, is recruiting for two academic dermatologists in the Clinical X series or Health Sciences Clinical Professor (HSCP) series at the Assistant/Associate/Full Professor level based on experience and qualifications. These positions are for general medical dermatologists.Expectations of the Clinical X series is to engage in teaching, research, service and clinical work, while expectations of the faculty in the HSCP series are primarily clinical and include teaching, service and scholarly and/or creative activity. The appointments may be made up to 100%.application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0pc4316narticleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt8s8156r72021-08-26T00:10:44Zqt8s8156r7A case of disseminated superficial porokeratosis in a patient with chronic graft-versus-host diseaseIrie, Kinuko2020-01-01graft-versus-host diseaseGvHDporokeratosisimmunosuppressionapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8s8156r7articleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt01j7n9qw2021-08-26T00:10:43Zqt01j7n9qwUse of topical 2.4% glycopyrronium tosylate in familial benign pemphigus (Hailey-Hailey disease)Bindernagel, RichardKimmis, Brooks DavidLiu, Deede2020-01-01genodermatosesgeneral medical dermatologypharmacologyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/01j7n9qwarticleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt1r37k2722021-08-26T00:10:41Zqt1r37k272Apixaban-induced cutaneous hypersensitivity: a case series with evidence of cross-reactivityIsaq, Nasro AVinson, Whitney MRahnama-Moghadam, Sahand2020-01-01novel oral anticoagulants (NOACs)apixabanrivaroxabandrug induced rashapixaban hypersensitivity reactionrivaroxaban cross reactivitynovel oral anticoagulant induced hypersensitivity reactionapixaban induced rashapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1r37k272articleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt5rc548m62021-08-26T00:10:40Zqt5rc548m6Hypertrichosis lanuginosa acquisita preceding the diagnosis of breast cancerJibbe, AHoang, NJibbe, NWang, T2020-01-01hypertrichosiscutaneous paraneoplastic syndromemalignant downbreast cancerapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5rc548m6articleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt763667dd2021-08-26T00:10:39Zqt763667ddPedunculated atypical fibroxanthomas of the faceXiao, HonglinBittar, Peter GWolverton, Jay E2020-01-01Atypical fibroxanthomas are rare, superficial dermal tumors. Most cases are benign and only locally destructive with a low rate of metastasis. Lesions are most commonly found on sun-exposed sites of elderly light-skinned patients and present as asymptomatic nodules with irregular borders; ulcerations and friability are other key characteristics. Pedunculated lesions, however, are rarely described in the literature. We present two cases of atypical fibroxanthoma manifesting as exophytic, pedunculated lesions on the face: one in a 74-year-old man and the other in an 82-year-old woman. These tumors are very effectively treated by excision with Mohs micrographic surgery.atypical fibroxanthomasurgical dermatologyMohs micrographic surgeryoncologyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/763667ddarticleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt91q8q1f12021-08-26T00:10:38Zqt91q8q1f1Hallopeau type of pemphigus vegetans, an unusual clinical presentation of an infrequent diseaseCuellar, IsabelMejia, MaddyCastellanos-Angarita, AlejandroCasas-Barrera, Maria Alejandra2020-01-01Pemphigus vegetans is a rare variant of pemphigus vulgaris, characterized by vegetative lesions that develop mainly in flexural areas. Herein, we present a middle-aged woman who presented to the emergency department with a rare cutaneous finding of bilateral axillary pustules that progressed over months to vegetant and malodorous plaques associated with subsequent painful erosions.pemphigus vulgarisvesicobullous diseaseautoimmune diseaseapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/91q8q1f1articleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt4w21m02k2021-08-26T00:10:37Zqt4w21m02kSevere erosive gingivostomatitis in a patient treated by vedolizumabSemeria, LDadban, ABrazier, FFumery, MIkoli, JFArnault, JPAdas, ADairi, MLok, CChaby, G2020-01-01Vedolizumab is a humanized monoclonal antibody that binds to the human a4β7 integrin and is approved for use in inflammatory bowel diseases. We describe a patient with severe, refractory erosive gingivostomatitis, which appeared a few days after the first dose of vedolizumab and resolved after discontinuation of the drug. We believe the gingivostomatitis to be a direct side effect of vedolizumab, rather than an extraintestinal manifestation of the underlying inflammatory bowel diseases. The clinicians need to be aware of this adverse event, which could be mistakenly considered as an extraintestinal manifestation of inflammatory bowel diseases.vedolizumabinflammatory bowel diseaseulcerative colitisaphthous stomatitisgingivostomatitis.application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4w21m02karticleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt3cm905c12021-08-26T00:10:37Zqt3cm905c1Circumscribed storiform collagenoma, an unusual tumorLira-Valero, Francisco JavierCarrillo-Cisneros, Eunice RebecaPulido-Díaz, NancyQuintal-Ramírez, Marissa de JesúsGodínez-Aldrete, Liliana2020-01-01Circumscribed storiform collagenoma is a rare benign tumor. It appears as an isolated skin lesion or as part of the clinical spectrum of Cowden syndrome. The pathogenesis is still controversial. Although its clinical expression is heterogeneous, it has a characteristic histological pattern. We describe a case of a solitary circumscribed storiform collagenoma not associated with Cowden syndrome.circumscribed storiform collagenomasolitary sclerotic fibromaCowden syndromeapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3cm905c1articleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt78f4g57m2021-08-26T00:10:35Zqt78f4g57mLivedo racemosa secondary to hyaluronic acid injectionToussi, AtrinMa, ChelseaTartar, Danielle M2020-01-01Iatrogenic vascular occlusion secondary to filler injection, such as with hyaluronic acid, is a known but rare, entity. It typically occurs in the setting of facial cosmetic procedures but has also been described in the setting of osteoarthritis. We present a patient with ankle osteoarthritis who developed an asymmetric, reticular, livedoid eruption after intraarticular injection with hyaluronic acid. She was diagnosed with livedo racemosa secondary to vascular occlusion and placed on low molecular weight heparin. Later, a transition to low-dose daily aspirin maintained the improvement.livedo racemoseosteoarthritisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/78f4g57marticleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt4c36775g2021-08-26T00:10:35Zqt4c36775gCrusted scabies in an elderly womanCartron, Alexander MBoettler, MichelleChung, CatherineTrinidad, John C2020-01-01Crusted scabies is a highly contagious variant of classic scabies. Affected individuals are often elderly or immunocompromised and disease is associated with significant morbidity and mortality. Herein, we report an elderly woman residing in an assisted living facility who presented with diffuse sand-on-skin scale on her trunk, proximal extremities, scalp, hands, and feet. She was diagnosed with crusted scabies, isolated from other patients, and subsequently treated with permethrin 5% lotion and ivermectin. She died two weeks after initial presentation owing to sepsis.crusted scabieselderlysepsisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4c36775garticleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt5d2676s22021-08-26T00:10:33Zqt5d2676s2Scented lotions may cause scaring and premature fading of tattoosPona, AdrianGonzalez, Cristian DWalkosz, Barbara JDellavalle, Robert P2020-01-01Although tattoo artists provide tattoo aftercare instructions to their clients, recommendations are often not cost-effective or supported by evidence. A 22-year-old man developed a pruritic red rash over his healing tattoo one week after receiving the tattoo. Although multiple queries were negative, the patient did note use of a scented lotion before the eruption. We determined that allergic contact dermatitis from the scented lotion caused scarring and premature fading of the new tattoo. Tattoo artists should recommend avoidance of scented lotions and instruct clients to care for their new tattoo like a wound in their aftercare instructions.allergic contact dermatitistattoosinkpigmentallergic reactionallergyhypersensitivitycase reportskin of colorcarbon black 7application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5d2676s2articleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt0s39g4tt2021-08-26T00:10:32Zqt0s39g4ttAsymptomatic disseminated telangiectasias: a rare case of cutaneous collagenous vasculopathyLobo, YolankaBlake, TristanHerat, Asoka2020-01-01Cutaneous collagenous vasculopathy (CCV) is a rare idiopathic microangiopathy affecting superficial dermal blood vessels. It is characterized by asymptomatic, disseminated, telangiectatic macules that typically involve the extremities. We report the case of a 58-year-old woman who presented with widespread telangiectasias of three years' duration on the upper extremities and abdomen. Cutaneous collagenous vasculopathy may be underdiagnosed as it is often mistaken for disorders that are morphologically very similar, including generalized essential telangiectasia, hereditary hemorrhagic telangiectasia, and pigmented purpuric dermatosis. The diagnosis of CCV is made histologically and findings feature dilated superficial dermal vessels with thickened walls containing periodic acid-Schiff-positive eosinophilic hyaline material. Effective treatment options for CCV have yet to be established and given its benign disease course, treatment may not be necessary. Pulsed dye laser can be offered to patients for cosmetic improvement but the extent of the disease makes complete lesion clearance challenging in most cases. Given the lesions were asymptomatic our patient declined all offered treatment modalities.Cutaneous collagenous vasculopathydisseminatedmicroangiopathytelangiectasiaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0s39g4ttarticleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt6vs4d5gz2021-08-26T00:10:31Zqt6vs4d5gzSuccessful treatment of recurrent advanced cutaneous squamous cell carcinoma with cemiplimabCervantes, Jose AFox, Matthew C2020-01-01A 90-year-old man presented for evaluation of an incompletely excised squamous cell carcinoma above the right brow, with pathology demonstrating tumor extending to resection margins with perineural invasion. A cord of tumor was noted to extend past the orbital rim and towards the posterior orbit. Mohs excision versus coordinated resection and reconstruction with colleagues in the head and neck surgery and craniofacial plastic surgery departments were considered. Multidisciplinary consensus was to proceed with radical resection in the operating room followed by adjuvant radiation therapy. One year later, the patient presented to our Mohs unit with a 3cm eroded multinodular plaque. Following an in-depth discussion regarding the options of further surgery versus systemic treatment, the patient and his family opted to pursue consultation with a medical oncology consultant to discuss restaging and potential systemic therapy. A PET scan with concurrent CT revealed a hypermetabolic right temporal scalp mass without evidence of bony invasion or extension into the nodal basin. Immunotherapy with cemiplimab was started at a dose of 350mg IV every three weeks. After 7 cycles, the patient demonstrated complete clinical resolution with a repeat PET scan showing interval near resolution of abnormal metabolic activity.cutaneous squamous cell carcinomacemiplimabimmunotherapyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6vs4d5gzarticleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt4dg0x6rk2021-08-26T00:10:30Zqt4dg0x6rkHypocomplementemic cutaneous small vessel vasculitis in a patient with IgG4-related diseaseSato, MayuHonda, AkiYamamoto, Toshiyuki2020-01-01A 62-year-old man was diagnosed with IgG4-related disease based on multiple sites of lymphadenopathy, lymph node biopsy, and elevated serum levels of IgG4. Hypocomplementemia was also observed. During admission, he was referred to our department complaining of multiple areas of purpura on the lower legs. Histological examination revealed leukocytoclastic vasculitis with fibrinoid necrosis, neutrophil infiltration, and nuclear dust in the upper dermis. To date, only a few cases of cutaneous vasculitis have been reported in IgG4-related disease, all of which showed hypocomplementemia. The role of IgG4 in the etiology of leukocytoclastic vasculitis in IgG4-related disease remains unknown and further studies are necessary.IgG4-related diseaseleukocytoclastic vasculitispurpuralower extremitiesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4dg0x6rkarticleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt8b53d6tx2021-08-26T00:10:28Zqt8b53d6txConradi–Hünermann–Happle syndrome: report of a novel heterozygous mutation on the emopamil-binding protein gene, c.333delCBatista, MarianaMorgado, FranciscaCardoso, José CarlosMoreno, AnaRamos, Leonor2020-01-01Conradi-Hünermann-Happle Syndrome, also called X-linked rhizomelic chondrodysplasia punctata, is a rare genodermatosis that presents with cutaneous, skeletal, and ophthalmological abnormalities. Herein, we report a full-term newborn that presented at birth with scattered blaschkolinear bands of adherent scales and scalp erosions in a spiral distribution. Genetic analysis of emopamil-binding protein gene revealed a previously undescribed heterozygous mutation of c.333delC.genodermatosisConradi-Hünermann-Happle SyndromemutationEBPapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8b53d6txarticleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt4xc955rq2021-08-26T00:10:27Zqt4xc955rqTumoral melanosis after immunotherapy with pembrolizumab - a response sign mimicking melanomaRelvas, MariaAlves, FranciscaMariano, AngelinaCardoso, JoséCoutinho, Inês2020-01-01Tumoral melanosis is a rare histopathological finding characterized by aggregates of melanophages, in the absence of melanocytes, usually observed in sites of regressed melanocytic lesions, including melanoma. A 72-year-old woman with a history of a completely excised melanoma on her right arm (T3bN0M0, Stage IIb) presented with clinically-evident regional lymph node metastasis. This was treated with right axillary lymphadenectomy. Subsequently, a 2-centimeter blue-colored patch over the excision scar was identified, along with a blue nodule within the posterior aspect of the same arm, consistent with in-transit metastases. Additional metastases on the right hilar region of the lungs were detected by PET/CT. Hence, the patient began immunotherapy with pembrolizumab. After three months, a second PET/CT revealed a complete response, but the patient maintained the blue-colored patch previously observed. Given the discrepancy between the clinical and metabolic response she underwent a skin biopsy; histological examination showed findings compatible with tumoral melanosis resulting from complete regression of a metastatic lesion. In cases of metastatic melanoma under immunotherapy with anti-PD1 agents, especially pembrolizumab, tumoral melanosis has been anecdotally associated with tumor regression and favorable treatment response. The patient has been maintained on pembrolizumab, accomplishing 15 cycles, and has had a complete response to date.pembrolizumabimmunotherapymelanomatumoralmelanosisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4xc955rqarticleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt7677c8r42021-08-26T00:10:26Zqt7677c8r4Efficacy and safety of ingenol disoxate gel in field treatment of actinic keratosis on full face, scalp or large area (250 cm2) on the chest: results of four phase 3 randomized controlled trialsBerman, BrianBukhalo, MichaelHanke, C WilliamJarner, Mikala FiigLarsson, ThomasSiegel, Daniel MSkov, TorstenSzeimies, Rolf-Markus2020-01-01Introduction: Actinic keratosis (AK) is a skin condition arising from chronic exposure to ultraviolet light and may lead to the development of malignancies. This trial aimed to evaluate efficacy and safety of ingenol disoxate gel (IngDsx, 0.018% for face/chest [FC]; 0.037% for scalp [S]), versus vehicle. Methods: Four identical phase 3 trials in patients with AK on the full face/up to 250cm2 of chest or full balding scalp, with an initial 8-week period and 12-month follow-up, were conducted. FC and S trials were pooled for analysis. The primary endpoint was complete clearance at Week 8. Results: Across trials, 616 patients were randomized to FC and 626 to S, with 410 and 420 assigned to receive IngDsx, respectively. In the FC and S trials, 25.9% and 24.5% of patients in the IngDsx group, respectively, achieved the primary endpoint. IngDsx was relatively well tolerated. During extended follow-up, there were more identified non-melanoma skin malignancies in the IngDsx group than vehicle group; HR: 2.38 (95% CI: 1.28, 4.41). Conclusion: Treatment with IngDsx was superior to vehicle on all clinical endpoints, patient-reported and cosmetic outcomes. During the 12-month follow-up, slightly increased skin malignancies in the treatment area were identified, potentially due to unintentional detection bias.ingenol disoxateactinic keratosisingenolcancerapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7677c8r4articleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt7nv6227b2021-08-26T00:10:25Zqt7nv6227bPhototherapy in sclerosing and pseudo-sclerosing skin diseases Fototerapia en enfermedades cutáneas esclerosantes y pseudoesclerosantesCastellanos-Angarita, AlejandroValbuena, Martha Cecilia2020-01-01Sclerosing and pseudo-sclerosing skin diseases are a therapeutic challenge. Ultraviolet radiation, depending on its wavelength, penetrates into different layers of the skin and acts on cells that promote tissue remodeling and differentiation, such as keratinocytes and fibroblasts. Furthermore, it modulates the inflammatory processes in dendritic cells, endothelial cells, and leukocytes by intervening in the production of cytokines and profibrotic molecules. For these reasons ultraviolet light is a useful option in the treatment of these conditions. Las enfermedades esclerosantes y pseudoesclerosantes de la piel son un grupo de dermatosis que suponen un reto terapéutico para el clínico. La radiación ultravioleta, de acuerdo con su longitud de onda, penetra en las diferentes capas de la piel y actúa sobre aquellas células que favorecen la diferenciación y remodelación tisular como queratinocitos y fibroblastos. Además, modula los procesos inflamatorios en células dendríticas, endoteliales y leucocitos al intervenir en la producción de citoquinas y moléculas profibróticas, volviéndose una alternativa útil en el tratamiento de estas condiciones.phototherapysclerodermasystemicsclerodermalocalizedskinapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7nv6227barticleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt5sc9j0qx2021-08-26T00:10:25Zqt5sc9j0qxValue of personal statements to dermatology programs: a survey-based critical reviewFlanigan, Kendall LMears, Caroline TMorrell, Dean S2020-01-01The personal statement is a required component of the residency application, offering applicants the opportunity to showcase their personality as well as unique thoughts and experiences not explicitly stated elsewhere in their application. Although the applicant-generated nature of personal statements can gauge an applicant's professionalism, creativity, sound judgement, and tact, specific criteria for evaluating personal statements and comparing them to one another is lacking. Research on the value of personal statements in the application process is also lacking. The purpose of this research project is to quantify the perceived value of the personal statement to program directors and faculty members of U.S. dermatology programs involved in residency application review. Analysis of our survey responses determined that although the majority of participants consider the personal statement to be a necessary element of an application, it was rated least important compared to other components of the application. An applicant's Medical Student Performance Evaluation, clerkship grades, research projects and publications, board scores, and letters of recommendation were consistently rated as more important than the personal statement. These findings suggest the personal statement lacks the standardization needed for decision makers to confidently choose the best new dermatology residents for their program.personal statementdermatologyresidencyapplicationElectronic Residency Application ServiceERASapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5sc9j0qxarticleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt9q40r8v82021-08-26T00:10:24Zqt9q40r8v8Pseudoatrophoderma colli: distinct entity or just a variant of confluent and reticular papilomatosis of Gougerot-CarteaudSudy, EmilioUrbina, FranciscoGubelin, WalterMisad, CarlosEspinoza, Arturo2020-01-01Pseudoatrophoderma colli is a rare entity described in the same time period as confluent and reticular papillomatosis of Gougerot-Carteaud and the two conditions have certain similarities. Pseudoatrophoderma colli is clinically characterized by lesions with an atrophic and wrinkled appearance, which are mainly located on the trunk and neck (hence the name colli). Few references exist in the literature and most of them are very old. Histopathological findings are nonspecific, showing mild hyperkeratosis, thinning of the stratum granulosum, and acanthosis and papillomatosis in some areas. In the papillary dermis there is vascular dilatation with a sparse inflammatory lymphohistiocytic perivascular infiltrate. Fragmentation of elastic tissue has been described only in one case. There is no specific treatment, with variable responses to diverse therapies including ultraviolet light, vitamin A, lactic acid and minocycline. We describe in detail two patients with pseudoatrophoderma colli and show histology. The first patient was treated with minocycline 100mg per day for two months and the second patient was treated with lymecycline 600mg per day for three months and 300mg per day for another two months. Both patients demonstrated a good response within the first month of treatment.pseudoatrophoderma colliconfluent and reticular papillomatosislymecyclineminocyclineapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9q40r8v8articleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt75p7q57j2021-08-26T00:10:23Zqt75p7q57jDigital future of dermatologyGlines, Katelyn RHaidari, WasimRamani, LeenaAkkurt, Zeynep MFeldman, Steven R2020-01-01Evolution of technology in the past several decades has undeniably transformed the practice of medicine. Dermatology, a field relying on visual cues, has been particularly impacted by advancement in imaging technologies. The purpose of this study was to review the current status as well as digital future of dermatology. The PubMed database was searched for articles pertaining to digital dermatology using search terms digital dermatology, teledermatology, and dermatopathology education. Digital dermatology has found a role in almost every aspect of dermatology: research, dermatology education and training, and clinical practice including disease prevention, diagnosis, treatment, and patient follow-up. Smartphone applications such VisualDx, MyDermPath, YouDermoscopy serve as diagnostic aid tools and can also help increase the user's knowledge of dermatology. Tools such as multispectral digital skin lesion analysis (MSDSLA) improve diagnostic accuracy and lead to fewer unnecessary biopsies. Teledermatology increases patient satisfaction, as they are able to experience shorter waits times and decreased costs. Underserved communities and those in rural settings are more likely to have a dermatologic evaluation by a specialist via teledermatology. Addressing important topics such as legal framework and updating reimbursement policies will allow for a smoother incorporation of digital dermatology into clinical practice and likely benefit patient care.teledermatologydigital dermatologydermatopathology educationdiagnosistreatmentadherencereimbursementpatient privacyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/75p7q57jarticleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt0j5150df2021-08-26T00:10:22Zqt0j5150dfUpdates on treatment guidelines for psoriasis, atopic dermatitis (eczema), hidradenitis suppurativa, and acne/rosacea during the COVID-19 pandemicYim, Rebecca MSingh, IndiraArmstrong, April W2020-01-01Owing to the evolving COVID-19 pandemic and emerging data regarding immunosuppressant therapies for inflammatory cutaneous diseases, dermatologists are being encouraged to reevaluate their patients' treatment regimens to minimize any potential risk of SARS-CoV-2 infection. This article includes an overview of the up-to-date international and U.S. treatment guidelines for psoriasis, atopic dermatitis, hidradenitis suppurativa, and acne/rosacea; it provides tables summarizing these resources to assist providers and patients in remaining updated regarding recommended treatment modifications during the pandemic (See Tables 1-4).COVID-19SARS-CoV-2psoriasisatopic dermatitishidradenitis suppurativaacnerosaceaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0j5150dfarticleDermatology Online Journalvol 26, iss 10oai:escholarship.org:ark:/13030/qt6rt939kz2021-08-11T22:26:50Zqt6rt939kzRuta graveolens phytophotodermatitisAvallone, GianlucaMastorino, LucaAgostini, AndreaMerli, MartinaSiliquini, NiccolòRubatto, MarcoFierro, Maria TeresaRibero, SimoneQuaglino, Pietro2021-01-01photodermatitisphototoxicityphytophotodermatitisRutaceaeRuta graveolensapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6rt939kzarticleDermatology Online Journalvol 27, iss 7oai:escholarship.org:ark:/13030/qt9w19t2fp2021-08-11T22:26:48Zqt9w19t2fpIntralesional 5-fluorouracil utilizing abbreviated tourniquet device in patients with overlying stasis dermatitis or lymphedemaFronek, LisaHarrison, AlexCooper, HassieDorton, David2021-01-015-fluorouracillymphedemanon-melanoma skin cancerstasis dermatitisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9w19t2fparticleDermatology Online Journalvol 27, iss 7oai:escholarship.org:ark:/13030/qt0n01j4692021-08-11T22:26:47Zqt0n01j469Surgical and non-surgical treatment modalities for glomuvenous malformationsShah, AatmanTassavor, MichaelSharma, SayeshaTassavor, BryanTorbeck, Richard2021-01-01glomangiomaglomuvenous malformationslaser therapysclerotherapysurgical excisionapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0n01j469articleDermatology Online Journalvol 27, iss 7oai:escholarship.org:ark:/13030/qt8ft7h8n42021-08-11T22:26:46Zqt8ft7h8n4Congenital homozygous protein S deficiency revealed by neonatal purpura fuminansAgharbi, Fatima-ZahraChiheb, Soumiya2021-01-01CIVDcongenitaldeficiencyfulminansneonatalprotein Spurpuraapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8ft7h8n4articleDermatology Online Journalvol 27, iss 7oai:escholarship.org:ark:/13030/qt4wc2g49h2021-08-11T22:26:45Zqt4wc2g49hState-level weather pattern and utilization of skin cancer related procedures among Medicare beneficiaries.Duan, YBenlagha, INguyen, BM2021-01-01ambient temperatureclimate patternsMedicareproceduresskin cancerultraviolet radiationapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4wc2g49harticleDermatology Online Journalvol 27, iss 7oai:escholarship.org:ark:/13030/qt7x57v28j2021-08-11T22:26:44Zqt7x57v28jImpact of the COVID-19 pandemic on dermatology departments' support of medical students: A survey studyBell, Katheryn APorter, CarolineWoods, Alexander DAkkurt, Zeynep MFeldman, Steven R2021-01-01COVID-19 pandemicdepartmentsdermatology applicantsmedical educationstudentsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7x57v28jarticleDermatology Online Journalvol 27, iss 7oai:escholarship.org:ark:/13030/qt0ct2p2t92021-08-11T22:26:44Zqt0ct2p2t9COVID-19 pandemic-related impact on two-week wait window for clinic visits in dermatology departments-results of pre-visit image referralsRamesh, SLiakapoulou, ACelebi, PZacharaki, L MWatts, SPalamaras, I2021-01-01covid 19 pandemicfinancial impactimage qualityskin cancertelephone consultationtwo week waitapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0ct2p2t9articleDermatology Online Journalvol 27, iss 7oai:escholarship.org:ark:/13030/qt35m1h49k2021-08-11T22:26:42Zqt35m1h49kHistopathological features of iatrogenic occlusive vasculopathy caused by intra-articular hyaluronic acid injection for osteoarthritisMahmood, Muhammad N2021-01-01Occlusive vasculopathy may rarely occur after intra-articular injection with hyaluronic acid. The associated histological changes are not well described. Herein, we would like to present representative histology of this phenomenon.dermatopathologyhyaluronic acidiatrogenicocclusive vasculopathyosteoarthritisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/35m1h49karticleDermatology Online Journalvol 27, iss 7oai:escholarship.org:ark:/13030/qt4rj5w7mm2021-08-11T22:26:41Zqt4rj5w7mmAnogenital giant condyloma in an infant with liver transplantationSatoh, MasatakaYamamoto, Toshiyuki2021-01-01Human papillomavirus (HPV) types 6 and 11 were detected in a 3-year-old girl with extensive anogenital condylomata. Although sexual abuse must be considered, non-sexual transmission is evident in at least 57% of children with anogenital warts. Perinatal transmission may occur in approximately 24.5% of infants born to HPV-positive mothers. We present an immunosuppressed child with giant condylomata and discuss transmission, work up, and treatment.condylomahuman papillomavirusimiquimodliver transplantationtacrolimusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4rj5w7mmarticleDermatology Online Journalvol 27, iss 7oai:escholarship.org:ark:/13030/qt705677d42021-08-11T22:26:40Zqt705677d4Reactive arthritis: imagesAitken-Saavedra, JuanMaturana-Ramirez, AndreaFernández Moraga, JavierDoro Dias, ValescaGaldino-Santos, LayllaPineda Flores, Dustan2021-01-01Reactive arthritis is an extremely rare spondyloarthritis that affects the peripheral joints and spine, resulting in common symptoms such as arthritis, urethritis, conjunctivitis, and mucocutaneous lesions. On rare occasions, oral lesions such as circinate erosions on the hard and soft palate, gums, tongue, and cheeks may occur. Reactive arthritis may develop during or after genitourinary or gastrointestinal bacterial infections such as Shigella, Salmonella, Yersinia, and Chlamydia. A 36-year-old man presented with circinate balanitis, urethral discharge, oligoarthralgia, conjunctivitis, lymphadenopathy, pharyngitis, and erythematous lesions on the palate. Culture examination showed presence of Neisseria gonorrhoeae and antibiotic treatment resulted in improvement of conjunctivitis and the lesions on the penis. However, severe oligoarthralgia, palatal erosions that increased in severity and size, and depilated areas on the tongue were observed. The definitive diagnosis was reactive arthritis. The prevalence of sexually transmitted infections is increasing, highlighting the need to increase awareness of associated risks such as reactive arthritis. Moreover, consideration of non-specific oral manifestations in a systemic context may aid in effective diagnosis and treatment, suggesting the need for multidisciplinary teams.reactive arthritisreiter syndromeNeisseria gonorrhoeaechlamydia infectionsoral ulcersspondyloarthritisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/705677d4articleDermatology Online Journalvol 27, iss 7oai:escholarship.org:ark:/13030/qt5nm8c0zq2021-08-11T22:26:39Zqt5nm8c0zqIntramuscular lipoma of the scapular regionKhalfe, YasminOrengo, IdaBuren, George VanRosen, Theodore2021-01-01Intramuscular lipomas are rare, benign soft tissue neoplasms characterized by infiltrative growth into muscle tissue or between muscle fibers. These benign tumors can present similarly to malignant soft tissue neoplasms, such as liposarcomas. Unlike subcutaneous lipomas, intramuscular lipomas require diagnostic imaging to better distinguish the tumor and rule out alternative, malignant etiologies. It is imperative that dermatologists are able to identify this rare lipoma variant and have a thorough understanding of the diagnosis, imaging, and treatment options for this uncommon soft tissue tumor. Our case serves as a reminder for dermatologists to be cognizant of this rare tumor and aware of the importance of diagnostic testing in ruling out similarly-presenting, soft tissue malignancies.atypical lipomatous tumordiagnostic imagingintramuscular lipomaliposarcomamagnetic resonancesoft tissue malignancysurgeryapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5nm8c0zqarticleDermatology Online Journalvol 27, iss 7oai:escholarship.org:ark:/13030/qt9fm8513b2021-08-11T22:26:37Zqt9fm8513bAcitretin-induced periungual pyogenic granulomas and reviewThomas, MathewShon, WonwooTruong, Allison K2021-01-01Periungual pyogenic granulomas are benign vascular tumors that present as painful, round, spontaneously bleeding lesions composed of rapidly proliferating capillaries and excess tissue. The vast majority of pyogenic granulomas are caused by physical trauma or infectious agents and they may resolve spontaneously. Herein, we highlight a very rare case of periungual pyogenic granulomas induced by the regularly prescribed oral retinoid acitretin during treatment for congenital palmoplantar keratoderma. This unique case showed that it is feasible to continue acitretin therapy in the presence of pyogenic granuloma development if proper dose reduction and topical therapies are utilized. The patient's lesions resolved within two weeks of this protocol's initiation and the pyogenic granulomas did not recur over the course of a six-month follow-up observation period. In addition, we performed a systematic review of the literature using PubMed databases for the clinical features and treatments in other reported acitretin-induced pyogenic granuloma cases; we compiled a comprehensive list of other prescription drugs known to cause pyogenic granulomas up-to-date.acitretinoral retinoidsperiungual pyogenic granulomaspalmoplantar keratodermaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9fm8513barticleDermatology Online Journalvol 27, iss 7oai:escholarship.org:ark:/13030/qt8zx2q52p2021-08-11T22:26:36Zqt8zx2q52pCervicofacial actinomycosis: a unique diagnostic challengeFronek, LisaBrazen, BrettRoss, RisaMiller, Richard2021-01-01Actinomycosis is a rare, chronic bacterial infection caused by Actinomcyes israelii. This anaerobic filamentous gram-positive bacterium frequently colonizes the human mouth, digestive, and genital tracts. Cervicofacial actinomycosis infections have a proclivity for affecting the upper and lower mandibles and occur in 50% of cases. Most cases present in immunocompetent individuals and almost always involve some degree of pre-existing mucosal trauma through either recent dental procedures or poor dental hygiene. Herein, we present a 54-year-old man diagnosed with cervicofacial actinomyces infection in the absence of periodontal disease or recent dental procedures. The purpose of this testimony is to discuss the pathogenesis and clinical and histologic findings of actinomycosis. In addition, we review diagnostic techniques and the current breadth of treatment options. It is our hope that this manuscript will serve as a guide for physicians of all specialties in accurately recognizing and promptly treating actinomycosis.Actinomyces israeliicervicofacial actinomycosisinfectious diseaseapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8zx2q52particleDermatology Online Journalvol 27, iss 7oai:escholarship.org:ark:/13030/qt7rt5r9tx2021-08-11T22:26:35Zqt7rt5r9txSevere EGFR inhibitor-induced acneiform eruption responding to dapsoneBeshay, AbramPetersen, MartaRhoads, Jamie L W2021-01-01Epidermal growth factor receptor (EFGR) inhibitors are targeted chemotherapeutic agents that are effective in treating various epithelial cancers. Cutaneous adverse effects, most commonly acneiform/papulopustular eruption, can occur with these medications and limit their tolerability. In severe cases, patients may refuse treatment with EGFR inhibitors because of the significant impact on the quality of life and aesthetic discomfort. We present a 72-year-old-man with a history of EGFR+ non-small-cell lung carcinoma who developed a severe acneiform eruption secondary to afatinib that failed to improve with various traditional treatment modalities. The patient was treated with dapsone and his acneiform eruption resolved within two months of initiating therapy. Patient tolerated dapsone with no reported adverse effects and continues on low dose dapsone, as he will remain on afatinib indefinitely. Dapsone can be an effective therapy for refractory or severe cases of EGFR-induced acneiform eruptions. As in this case, dapsone may improve patient adherence to EGFR inhibitors, thereby allowing for effective therapy of underlying malignancy.acneiform eruptionafatinibdapsoneEGFR tyrosine kinase inhibitorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7rt5r9txarticleDermatology Online Journalvol 27, iss 7oai:escholarship.org:ark:/13030/qt33x595n42021-08-11T22:26:35Zqt33x595n4Significant improvement of dermatitis herpetiformis with tofacitinibKahn, Jared SMoody, KatherineRosmarin, David2021-01-01Dermatitis herpetiformis (DH) is a rare autoimmune blistering disorder in which patients with celiac disease, a gluten-sensitive enteropathy, present with a severely pruritic papulovesicular eruption over extensor surfaces such as the knees, elbows, lower back, buttocks, and neck. Patients are instructed to adhere to a gluten-free diet for purposes of improving their skin disease and gluten-sensitive enteropathy; this is the only treatment that lowers risk of enteropathy-associated T cell lymphoma. Patients who adhere to a strict gluten-free diet often have remission of their skin disease over months to years. Dapsone is a rapid and extremely effective first-line treatment option and often used while transitioning to a gluten-free diet. Aside from gluten-free diet and dapsone, second-line treatment options include sulfapyridine, sulfasalazine, and colchicine. Some patients have difficulty adhering to a gluten-free diet or develop intolerable side effects to systemic therapies. Furthermore, there is limited data on the use of the second-line treatments. Recent studies have shed light on the role of JAK-STAT-dependent pathways in the pathogenesis of dermatitis herpetiformis. We present a patient treated with tofacitinib, 5mg twice daily, an oral JAK1/3 inhibitor, who demonstrated clinical improvement of DH and control of new lesion development.dermatitis herpetiformisJAK inhibitortofacitinibapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/33x595n4articleDermatology Online Journalvol 27, iss 7oai:escholarship.org:ark:/13030/qt76n2w09w2021-08-11T22:26:34Zqt76n2w09wDermatologic ultrasound in the management of childhood linear morpheaLaverde-Saad, AlexandraLopez-Negrete, ElenaRoustan, GastonAlfagemeb, Fernando2021-01-01Linear morphea is the most common subtype of localized scleroderma in the pediatric population. This condition can be quite disabling, with complications such as growth defects and painful flexion contractures. Assessment of disease progression and early intervention are key to minimize morbidity. We report linear morphea in a previously healthy 12-year-old girl. The patient presented with a one-year history of a linear plaque crossing her left antecubital fossa, measuring 7x3cm. The diagnosis was confirmed by biopsy, in which deep tissue involvement was noted. Subsequent management and evaluation of the disease activity was done by ultrasound, which allowed precise guidance of pharmacotherapy. The patient improved both clinically and sonographically with a methotrexate course. Sonographic changes accurately described the disease activity on follow up assessments. Features suggestive of an active phase include a thickened and hypoechoic dermis contrasting hyperechoic subcutaneous tissue. The atrophic stage is characterized by a thinned-out dermis and subcutaneous area. Typical vascular traits of each disease phase can also contribute to the assessment. Ultrasound is a grossly underused tool in the field of dermatology. It can provide accurate and sensitive information about disease activity in linear morphea, allowing for more timely intervention and optimal patient management.dermatologylinear morphealocalized sclerodermapediatricsultrasoundapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/76n2w09warticleDermatology Online Journalvol 27, iss 7oai:escholarship.org:ark:/13030/qt9dh4v79g2021-08-11T22:26:33Zqt9dh4v79gPediatric necrobiosis lipoidica: case report and review of the literatureBerman, Hannah SShabihkhani, MaryamHogeling, Marcia2021-01-01Necrobiosis lipoidica (NL) is a rare, granulomatous disease considered to be associated with diabetes. It is frequently seen in female and middle-aged patients and is rarely observed in children. We present a 14-year-old boy with poorly controlled type 1 diabetes who developed biopsy-proven NL. He had improvement, but not resolution of the plaque with improved glycemic control. Pediatric NL may be associated with diabetes and could be related to poor glycemic control. However, further investigation is warranted in this young population.diabetes mellitusnecrobiosis lipoidicaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9dh4v79garticleDermatology Online Journalvol 27, iss 7oai:escholarship.org:ark:/13030/qt5cj8h7gb2021-08-11T22:26:32Zqt5cj8h7gbAdult colloid milium is clinically distinguishable from its histopathologic mimic cutaneous amyloidosisShenoy, TanyaHarber, IraCruse, AllisonBrodell, Robert2021-01-01Colloid milium, also known as colloid degeneration of the skin or dermal hyalinosis, is a cutaneous deposition disease that presents as three subtypes: juvenile, nodular, and adult. Adult colloid milium is characterized by amyloid-like depositions in the dermis, mimicking cutaneous amyloidosis histologically. A 70-year-old man presented with lesions on the sun-exposed skin of the face, dorsal hands, and dorsal forearms resembling adult colloid milium. A punch biopsy was performed on the left zygoma and histopathological features were consistent with this diagnosis, though cutaneous amyloidosis was considered. A case of adult colloid milium is presented to emphasize the clinical and histopathologic differentiation from cutaneous amyloidosis.colloid miliumlichen amyloidosisnodular amyloidosisprimary localized cutaneous amyloidosisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5cj8h7gbarticleDermatology Online Journalvol 27, iss 7oai:escholarship.org:ark:/13030/qt6bw8896c2021-08-11T22:26:31Zqt6bw8896cSocial media (SoMe) enhances exposure of dermatology articlesLiakos, WilliamBurrall, Barbara AHsu, Daniel KCohen, Philip R2021-01-01Social media (SoMe) refers to a variety of virtual platforms used to enhance sharing of information. To evaluate the influence of SoMe with regards to views and downloads of published dermatology articles, we conducted a retrospective study from July 2020-March 2021 examining articles published on Instagram and Twitter under Dermatology Online Journal (DOJ) accounts and compared these with type-matched and issue-matched articles that were not posted on social media. During this time period, 163 total articles of the three types used for social media (Case Report, Case Presentation, and Photo Vignette) were published in DOJ and 15 were promoted via SoMe. Utilization of SoMe demonstrated a significant (P<0.0001) positive effect with regards to both views (175.5±16.4) and downloads (31.5±4.0) over matched articles not published on SoMe. Similar trends illustrating the positive effect of SoMe on readership have been previously observed in the field of dermatology as well as other medical specialties. Most direct accessions to articles arrived via Instagram rather than Twitter, diverging from previous studies on SoMe use in medical journals. Social media, in particular Instagram, can be a successful platform to enhance the exposure of peer-reviewed medical information.articledermatologydownloadsengagementInstagrammediasocialSoMeTwitterviewsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6bw8896carticleDermatology Online Journalvol 27, iss 7oai:escholarship.org:ark:/13030/qt480931812021-08-11T22:26:30Zqt48093181Treatment of rosacea during pregnancyGomolin, TamarCline, AbigailPereira, Frederick2021-01-01Background: Exacerbation of rosacea may occur during pregnancy and there are multiple associated cases of rosacea fulminans (RF). Treatment during pregnancy poses a significant challenge as many rosacea treatments are contraindicated or have limited evidence regarding potential adverse fetal effects. Objective: Review the pregnancy categories of various treatments and develop algorithms for treating pregnant patients with rosacea and RF. Methods: Rosacea treatments showing efficacy in randomized controlled trials were searched through DailyMed to review pregnancy labelling. Searching the PubMed/MEDLINE database for English articles using keywords "rosacea fulminans AND pregnancy" without publishing-time restrictions yielded 8 articles. We summarized treatments used in cases of RF during pregnancy. Results: Topical ivermectin was more effective than metronidazole, but has a more concerning pregnancy category. Three pregnant women with RF were treated successfully with topical metronidazole in combination with other therapies. Azithromycin is the only oral rosacea therapy that is considered safe for pregnant patients and it has been used to treat RF. Conclusions: This review highlights the challenging aspects of treating pregnant patients with rosacea, as there is limited pregnancy-related treatment efficacy and safety data. The pregnancy categories of therapeutic options are summarized. Further studies are needed to learn which therapies are effective and safe for use during pregnancy.pregnancyrosaceatherapeuticsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/48093181articleDermatology Online Journalvol 27, iss 7oai:escholarship.org:ark:/13030/qt2wn5v11r2021-08-10T01:11:36Zqt2wn5v11rAn abdominal skin lesion: to lump or split? a case presentationYoung, Albert TYedidi, Raagini SMarano, Paul JPincus, Laura BLai, Andrew R2021-01-01Syphilis has many atypical morphologies which can present a diagnostic challenge, especially in patients with HIV/AIDS who may have multiple concurrent conditions. We describe a 41-year-old man with recently diagnosed HIV who was admitted for acute right vision loss and a diffuse rash with involvement of the palms and soles. He received diagnoses of secondary syphilis and Kaposi sarcoma in the setting of AIDS. Examination revealed an unusual dark brown-to-purple umbilicated papule with a necrotic center on the abdomen, raising a diagnostic dilemma. Skin biopsy showed secondary syphilis, despite the concurrent diagnosis of Kaposi sarcoma. The patient was treated with antibiotic and antiretroviral therapy and symptoms resolved. This case aims to share the clinical reasoning behind diagnosing a patient with HIV/AIDS with multiple concurrent conditions and to raise awareness of the many atypical cutaneous manifestations of secondary syphilis.case reportclinical reasoningHIVKaposi sarcomasyphilisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2wn5v11rarticleDermatology Online Journalvol 27, iss 6oai:escholarship.org:ark:/13030/qt9v7926vr2021-07-15T18:32:15Zqt9v7926vrSuccessful outcome of psoriasis in a laryngeal cancer patient treated with ixekizumab, a possible beneficial treatment for both pathologiesPorcar Saura, SarayMartínez Casimiro, LucíaGarcía Vázquez, AlejandroPons Benavent, MartíGuillén-Climent, SantiagoMontesinos Villaescusa, Encarna2021-01-01laryngeal cancerpsoriasistreatmentapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9v7926vrarticleDermatology Online Journalvol 27, iss 6oai:escholarship.org:ark:/13030/qt2vx329tv2021-07-15T18:32:13Zqt2vx329tvThe various treatment modalities of dermatofibrosarcoma protuberansShah, AatmanTassavor, MichaelSharma, SayeshaTorbeck, Richard2021-01-01chemotherapydermatofibrosarcoma protuberansMohsradiationsurgeryapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2vx329tvarticleDermatology Online Journalvol 27, iss 6oai:escholarship.org:ark:/13030/qt269735qq2021-07-15T18:32:12Zqt269735qqEffect of pre-operative informational video on Mohs surgery patient experienceArzeno, JuliaLiu, ReginaGoldbach, HayleyMoon, DeborahSoriano, TeresaBeynet, DavidGreco, JosephMS, Myung-Shim SimKim, Jenny2021-01-01Mohs micrographic surgerypatient educationvideoapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/269735qqarticleDermatology Online Journalvol 27, iss 6oai:escholarship.org:ark:/13030/qt3mc0k6nn2021-07-15T18:32:11Zqt3mc0k6nnPrevention of surgical site infection using 2-octylcyanoacrylate following Mohs micrographic surgery: case series in a high-risk patient populationLeonard, NicholasGuldbakke, Kjetil KSWang, AnnieNelson, AndrewSchanbacher, Carl F2021-01-012-octylcyanoacrylatemethicillin-resistant Staphylococcus aureusMohs micrographic surgeryapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3mc0k6nnarticleDermatology Online Journalvol 27, iss 6oai:escholarship.org:ark:/13030/qt5ww9219p2021-07-15T18:32:09Zqt5ww9219pExfoliative cheilitis related to psychologic factors uncovered during primary immunodeficiency evaluationIncontri-Abraham, DCarrillo-Martin, IBosch, WBruce, AJGonzalez-Estrada, ASokumbi, O2021-01-01A 40-year-old previously healthy, non-atopic woman was referred for evaluation of a possible immunodeficiency disorder in the setting of an unusual erosive cheilitis and history of recurrent methicillin-resistant Staphylococcus aureus (MRSA) infection. Extensive work-up was non-diagnostic, including screening for immunologic disorders. She had failed multiple therapeutic modalities, including corticosteroid and immunosuppressive therapy. Tissue biopsy from the lip proved pivotal in demonstrating changes suggestive of factitial disease. This led to further detailed history-taking, yielding evidence of considerable psychologic distress. The patient was diagnosed with exfoliative cheilitis related to factitial disease in association with underlying untreated anxiety and psychologic trauma.anxiety disorderexfoliative cheilitisimmunodeficiencyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5ww9219particleDermatology Online Journalvol 27, iss 6oai:escholarship.org:ark:/13030/qt2g89j2cc2021-07-15T18:32:08Zqt2g89j2ccFamilial multiple basaloid follicular hamartomaCerejeira, AGomes, NPacheco, JPedrosa, ABaudrier, TAzevedo, F2021-01-01Basaloid follicular hamartoma (BFH) is a rare follicular hamartoma of benign nature, which should be part of the differential diagnoses of basal cell carcinoma. Familial multiple BFH (FMBFH) is a hereditary subtype which typically presents early in life with multiple small, skin-colored papules primarily on the central face. Although these lesions are usually asymptomatic, they can be cosmetically disfiguring. Treatment options include surgery, cryotherapy, CO2 laser and imiquimod; no standard of care has been determined. We present a case of FMBFH presenting in adulthood, which was treated with CO2 laser with satisfactory results.basal cell carcinomabasaloid follicular hamartomasonic hedgehog pathwayvismodegibapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2g89j2ccarticleDermatology Online Journalvol 27, iss 6oai:escholarship.org:ark:/13030/qt9qc1656r2021-07-15T18:32:07Zqt9qc1656rPilomatrix carcinoma: a rare cutaneous adnexal tumor.Dell'Antonia, MassimoFerreli, CaterinaPilloni, LucaAtzori, Laura2021-01-01Pilomatrix carcinoma is a rare tumor that is generally not diagnosed clinically. An 80-year-old man presented with a 5-month history of rapidly growing nodule of the submandibular area. Histological examination revealed a pilomatrix carcinoma, an aggressive malignancy with metastatic potentialadnexalcarcinomapilomatricomapilomatrixtumorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9qc1656rarticleDermatology Online Journalvol 27, iss 6oai:escholarship.org:ark:/13030/qt48x7s3ct2021-07-15T18:32:05Zqt48x7s3ctGlomangioma of the elbowStumpf, NatalieHuang, SimoPritchett, EllenLee, Jason2021-01-01We present a patient with a painful, mobile nodule on the elbow. The nodule was skin-colored and had no punctum or discharge. It was excised and histopathology showed that the lesion was a glomangioma, or glomuvenous malformation. This is a neoplasm that arises from the glomus body, a thermoregulatory neurovascular structure. The glomus body is composed of glomus cells, vascular cells, and smooth muscle cells. Three subtypes of neoplasms may arise from the glomus body, depending on the extent to which they involve the three types of cells. They include glomus tumors, glomangiomas/glomuvenous malformations, and glomangiomyomas. This case was unusual in that it did not present with surface color change to indicate a vascular component.angiolipomaelbowglomangiomaglomangiomyomaglomulinglomus apparatusglomus tumorglomuvenous malformationneoplasmapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/48x7s3ctarticleDermatology Online Journalvol 27, iss 6oai:escholarship.org:ark:/13030/qt5z7958dw2021-07-15T18:32:04Zqt5z7958dwEndocrine mucin-producing sweat gland carcinoma of the cheekKatsura, YuriSasaki, AzusaMinagawa, DaisukeKato, IkumaUeda, Takashi2021-01-01Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a low-grade adnexal malignant neoplasm. We report a 90-year-old man who had a hard, dome-shaped tumor approximately 9 mm in diameter on the left cheek. Dermoscopy showed an overall, non-uniformly light-pink tumor with crust. The diagnosis of EMPSGC is made histologically from excisional biopsy. No signs of recurrent disease were evident at 42 months postoperatively.carcinomadermoscopyendocrinemucin-producingnon-pigmented basal cellsweat glandtumorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5z7958dwarticleDermatology Online Journalvol 27, iss 6oai:escholarship.org:ark:/13030/qt4gb0c51q2021-07-15T18:32:03Zqt4gb0c51qAcquired unilateral facial melanocytosis: nevus of SunNazzaro, GianlucaBortoluzzi, PaoloGiacalone, SerenaVeraldi, Stefano2021-01-01Acquired dermal melanocytoses include pigmented lesions with a clear late onset, histologically characterized by the presence of melanocytes in the dermis. In this report, we describe a rare case of acquired unilateral facial melanocytosis, also called nevus of Sun, in a Caucasian woman.dermal melanocytosisacquired dermal melanocytosisnevus of Sunapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4gb0c51qarticleDermatology Online Journalvol 27, iss 6oai:escholarship.org:ark:/13030/qt1z2326sd2021-07-15T18:32:02Zqt1z2326sdPainful scrotal dermatitis secondary to topical 5-fluorouracilYi, Julie ZHimes, Richard SSmith, Robert JMcKee, Phillip HRoberts, Alice A2021-01-015-Fluorouracil (5-FU) is an antineoplastic agent that is used topically to treat actinic keratoses. Although topical 5-FU frequently causes irritant contact dermatitis at the site of application, distant skin reactions are rare and could relate to accidental transfer or systemic absorption of the drug. We present a patient who developed a painful scrotal dermatitis after applying the topical cream to actinic keratoses on his chest. Upon discontinuation of topical 5-FU, the reaction resolved over a four-week period with oral prednisone and topical betamethasone ointment. The patient was re-challenged with topical 5-FU one year later and again developed scrotal pain and erythema similar to the initial reaction. Scrotal dermatitis is a rare adverse effect of topical 5-FU therapy that can be associated with significant distress and disruption of daily activities.5-fluorouracilactinic keratosisadverse effectcontact dermatitishistologyinterface changescrotumsystemic toxicityapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1z2326sdarticleDermatology Online Journalvol 27, iss 6oai:escholarship.org:ark:/13030/qt2s74r0kn2021-07-15T18:32:01Zqt2s74r0knDisseminated atypical mycobacterial infection in an allogeneic stem cell transplant recipientKarri, Padmavathi VTorres, Carlos ADailey Garnes, Natalie JMRonen, ShiraKhawaja, FareedBhatti, Micah MHosing, ChitraPatel, Anisha B2021-01-01Nontuberculous mycobacteria are pathogens with diverse manifestations in immunocompromised hosts. The lesser-known Mycobacterium haemophilum usually causes cutaneous infection. Diagnosis is challenging but is aided by molecular testing and multidisciplinary communication. We present an immunocompromised patient with disseminated cutaneous mycobacterial infection with digital tenosynovitis.cutaneous diseaseMycobacterium haemophilumnontuberculous mycobacteriastem cell transplantapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2s74r0knarticleDermatology Online Journalvol 27, iss 6oai:escholarship.org:ark:/13030/qt8jf5g9ck2021-07-15T18:32:00Zqt8jf5g9ckAdalimumab for treatment of severe ulcerative sarcoidosisVetos, DevelynWu, Dominic JDowning, Malia BRajpara, Anand2021-01-01Ulcerative sarcoidosis is a rare variant of cutaneous sarcoidosis that may present as ulceration with necrotic yellow plaques on the lower extremities, face, arms, trunk, or genital area. Adalimumab, a human monoclonal anti-TNF antibody, is an emerging treatment for recalcitrant cutaneous sarcoidosis. We describe severe ulcerative sarcoidosis in a 60-year-old woman with chronic ulcerative necrobiosis lipoidica-like plaques on her left arm for over 20 years. Her condition had not responded to previous treatments with hydroxychloroquine, methotrexate, and sulfasalazine. After a four-month course of adalimumab therapy in addition to pentoxifylline and prednisone with taper, the patient had significant improvement in her skin disease.biologicscutaneoussarcoidosisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8jf5g9ckarticleDermatology Online Journalvol 27, iss 6oai:escholarship.org:ark:/13030/qt11w4h6jc2021-07-15T18:31:59Zqt11w4h6jcLeukemia cutis and eccrine squamous syringometaplasiaBouceiro-Mendes, RAntunes-Duarte, SAguado-Lobo, MEspinosa-Lara, PSoares-de-Almeida, LFilipe, P2021-01-01Eccrine squamous syringometaplasia (ESS) is a histological term describing a mature squamous metaplasia of the eccrine ducts. Eccrine squamous syringometaplasia is not an infrequent histological finding and may be associated with chemotherapy or with a variety of non-specific conditions including infections, neoplastic conditions, and inflammatory skin diseases. We report a 75-year-old man who developed ESS within lesions of leukemia cutis (LC). The patient had an inaugural diagnosis of acute myeloid leukemia (AML) and he was not on chemotherapy when the biopsy was performed.eccrineleukemia cutismetaplasiasquamous syringometaplasiaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/11w4h6jcarticleDermatology Online Journalvol 27, iss 6oai:escholarship.org:ark:/13030/qt06v2k8n32021-07-15T18:31:57Zqt06v2k8n3The spectrum of focal epithelial hyperplasia-a report of two casesCerejeira, AGomes, NMelo, DSobrinho-Simões, JAzevedo, FLisboa, C2021-01-01Focal epithelial hyperplasia is a rare, benign, and asymptomatic disorder, characterized by soft papules on the oral cavity. It is primarily associated with human papillomavirus genotypes 13 and 32. It most commonly affects children and young adults. When it affects young adults, it is important to differentiate it from oral condyloma acuminata. Its diagnosis may be made clinically, but histologic examination and PCR genotyping are often useful. Treatment is not always mandatory.focal epithelial hyperplasiahuman papillomavirusHeck diseaseapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/06v2k8n3articleDermatology Online Journalvol 27, iss 6oai:escholarship.org:ark:/13030/qt24n7b4n32021-07-15T18:31:56Zqt24n7b4n3An unusual case of keratinopathic icthyosis: a diagnostic conundrumShajil, ChandanaSathishkumar, DharshiniDanda, SumitaThomas, Meera2021-01-01Epidermolytic ichthyosis (EI) is a rare inherited ichthyosis related to heterozygous mutations in the Keratin 1 or Keratin 10 genes. Because of the broad phenotypic spectrum, it is sometimes difficult to differentiate it from other keratinopathic ichthyoses (KI) in clinical practice. We report an intriguing case of KI presenting as generalized ichthyosis in a reticulate pattern surrounding islands of normal skin, epidermolytic hyperkeratosis and binucleate cells on histopathology, and heterozygous mutation in KRT10. Through this case, we would like to demonstrate the importance of genetic studies and genotype-phenotype correlation in diagnosing such challenging cases.epidermolytic hyperkeratosiskeratin 10keratinopathic ichthyosisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/24n7b4n3articleDermatology Online Journalvol 27, iss 6oai:escholarship.org:ark:/13030/qt8wq9v1fj2021-07-15T18:31:55Zqt8wq9v1fjSocial media use in residency recruitment during the COVID-19 pandemicKim, Yong-hunAli, Nora SVidal, Nahid Y2021-01-01To investigate the extent to which dermatology programs use social media to connect with applicants, we conducted a search of all 140 residency programs on Instagram, Facebook, Twitter, and YouTube. Our search revealed 74 (53%) Instagram, 21 (15%) Facebook, 20 (14%) Twitter, and four (3%) YouTube accounts for dermatology programs, with the number of Instagram accounts increasing five-fold from the end of 2019 to present. Our results demonstrate that conditions created during the coronavirus disease 2019 (COVID-19) pandemic accelerated dermatology residency programs' acceptance of social media, particularly Instagram, as a means to communicate and share information with applicants.dermatologyeducationFacebookInstagramresidency programssocial mediaTwitterYouTubeapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8wq9v1fjarticleDermatology Online Journalvol 27, iss 6oai:escholarship.org:ark:/13030/qt5x36x0hk2021-07-15T18:31:54Zqt5x36x0hkHow should medical students prepare for a clinical dermatology rotation?Boswell, Nicole DPorter, Caroline LFeldman, Steven RAkkurt, Zeynep M2021-01-01Skin diseases are commonly encountered in medical practice, yet medical students often receive little dermatology training. There is little research on what self-study materials best prepare students. We aim to identify which resources dermatology residents have found to be most useful in preparing for clinical dermatology rotations and dermatology residency. Forty current dermatology residents and fellows responded to our REDCap-generated survey. Data was analyzed using descriptive statistics. Most respondents (N=36, 90%) reported using outside resources to prepare for clinical dermatology rotations and dermatology residency. American Academy of Dermatology (AAD) modules and other online resources were most used (N=31, 77.5%) and most recommended (N=32, 80%). However, 67.5% of all respondents also used printed textbooks in some capacity, but low-to-no cost, usefulness, and easy accessibility of online resources made them more favorable among study participants. Multiple clinical dermatology rotations were recommended for preparing for dermatology residency (N= 34, 85%), as were other rotations, including internal medicine (N=22, 55%) and rheumatology (N=17, 42.5%). Overall, the AAD modules and online resources are most useful when preparing for clinical dermatology rotations because of favorable cost and accessibility. Compared to clinical rotations in other specialties, multiple rotations in dermatology may be most helpful for dermatology residency.dermatologyresidencyresourcesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5x36x0hkarticleDermatology Online Journalvol 27, iss 6oai:escholarship.org:ark:/13030/qt8n24g1762021-07-15T18:31:53Zqt8n24g176Cost-effectiveness of skin biopsies performed by non-physician clinicians for Medicare beneficiariesGronbeck, ChristianFeng, Paula WCohen, Jeffrey MFeng, Hao2021-01-01An increasing number of non-physician clinicians (NPCs) are providing dermatologic care. We compared the cost-effectiveness of skin biopsies performed by dermatologists and dermatology NPCs using publicly-available Medicare claims data and numbers needed to biopsy (NNBs) published in the literature. We estimated that dermatology NPCs performed slightly greater mean numbers of skin biopsies per beneficiary (0.51 versus 0.47) at a lower payment per biopsy ($44.93 versus $55.10) as compared to dermatologists. However, we estimated a higher mean cost per malignancy diagnosed by dermatology NPCs relative to dermatologists (range based on literature NNB values, $39.08 to $190.23). This translated to a $16.7M-$43.3M aggregate cost of additional, benign biopsies performed by NPCs on Medicare beneficiaries. Although this preliminary analysis has several limitations, including the reliance on NNB values for calculations, it likely highlights the importance of training, education, and supervision to promote diagnostic accuracy. Further investigation is needed so that the potential cost of additional skin biopsies performed by NPCs can be appropriately weighed against the improvement in dermatologic access by including NPCs in the dermatology workforce.beneficiariesbiopsycost-effectivenessdermatologistsMedicarenon-physician cliniciansnumber needed to biopsynurse practitionersphysician assistantsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8n24g176articleDermatology Online Journalvol 27, iss 6oai:escholarship.org:ark:/13030/qt4dq8m0vk2021-07-15T18:31:53Zqt4dq8m0vkThe impact of the coronavirus disease 2019 pandemic on dermatologist burnout: a survey studyShah, PoojaDorrell, Deborah NFeldman, Steven RHuang, William W2021-01-01Burnout in dermatology is on the rise, with 36% of U.S. dermatologists experiencing burnout in 2020. The coronavirus disease 2019 (COVID-19) pandemic may exacerbate this problem with healthcare workers reporting increased anxiety, depression, and insomnia. To assess the rate, severity, and causes of burnout before and during the pandemic, a survey was sent to academic dermatologists through the Association of Professors of Dermatology (APD) listserv and compared to a similar survey administered to the same population prior to the pandemic. Burnout rates have increased from 2018, with 53% of participants experiencing burnout once a week or more and 17% experiencing burnout daily during the pandemic. The most common COVID-related burnout factors involve uncertainty about the future, teledermatology, fear of exposing loved ones to COVID-19, and compensation reduction. The challenges posed by the COVID-19 pandemic compound existing burnout within dermatology, warranting consideration by academic institutions.academic dermatologistsburnoutCOVID-19dermatologyteledermatologyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4dq8m0vkarticleDermatology Online Journalvol 27, iss 6oai:escholarship.org:ark:/13030/qt9bx595cz2021-06-18T19:21:14Zqt9bx595czAgminated melanocytic nevus status post dabrafenib therapy for metastatic melanomaAgulló, AlfredoHinds, BrianSantesteban, RaquelMitxelena, Josune MitxelenaYanguas, Ignacio2016-01-01Agminated melanocytic nevus is an uncommon type of mole, characterized by a local group of macular or papular pigmented lesions, well demarcated, without a common pigmented background. This pattern has also been associated with Spitz nevi, dysplastic melanocytic nevi, and non-melanocytic lesions.We describe the onset of an acquired agminated melanocytic nevus after dabrafenib treatment. Our case highlights paradoxical MAPK activation in the setting of single-agent BRAF blockade and underscores the importance of characterizing the diverse side effects of selective BRAF inhibitors. This is the first case, to our knowledge, of agminated melanocytic nevus in association with dabrafenib.Melanomaagminated melanocytic nevusDabrafenibapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9bx595czarticleDermatology Online Journalvol 22, iss 7oai:escholarship.org:ark:/13030/qt8ht9300r2021-06-18T19:21:13Zqt8ht9300rAllergic contact dermatitis from cetearyl alcohol in Thrombocid® ointmentArmengot-Carbo, Miquel Armengot-CarboRodríguez-Serna, MercedesTaberner-Bonastre, PilarMiquel-Miquel, Javier2016-01-01Thrombocid® ointment (Lacer, Barcelona, Spain) is widely used in Spain and other countries for varicose veins and 22 hematomas. To our knowledge, there are no reported cases of allergic contact dermatitis following its use. Herein we present 23 two cases of allergic contact dermatitis to Thrombocid® ointment, owing to cetearyl alcohol.application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8ht9300rarticleDermatology Online Journalvol 22, iss 7oai:escholarship.org:ark:/13030/qt4rx5g4zz2021-06-18T19:21:11Zqt4rx5g4zzA Quick Review of the Cutaneous Findings of the Zika VirusSingh, Rasnik KAtanelov, ZazaAabodi, NatalieKoo, John2016-01-01The current outbreak of Zika virus is a growing public health concern, especially for pregnant women. Zika virus infection may manifest as a maculopapular skin eruption that progresses rostrocaudally, with or without hemorrhagic manifestations such as petechiae and gingival bleeding. Recognizing the cutaneous findings associated with Zika virus may aid in early diagnosis, particularly in individuals at increased risk for the disease.Zika Viruscutaneous viral manifestationsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4rx5g4zzarticleDermatology Online Journalvol 22, iss 7oai:escholarship.org:ark:/13030/qt20b8h76b2021-06-18T19:21:10Zqt20b8h76bExposure to teledermatology and resident preparedness for future practice: results of a national surveyQureshi, SarahMostaghimi, Arash2016-01-01Teledermatology (TD) is an emerging modality for providing remote dermatologic care with high diagnostic and management 25 concordance compared to face-to-face clinic dermatology. TD training among dermatology residency programs in the United 26 States has not been characterized. We disseminated a survey to all dermatology residents at ACGME accredited programs in the 27 United States to explore the prevalence and distribution of TD training and trainee perceptions of TD. One hundred out of a 28 potential 1170 responses (RR 8.5%) were collected from residents in every geographic location from all years in training: 67/100 29 of residents reported that TD was practiced at their institutions, although at these sites only 21/100 residents participated in 30 clinical sessions. Residents with TD exposure were more likely to feel comfortable managing a TD consult after residency 31 (p<0.001), but were not more likely to incorporate teledermatology into their future plans. Results of this study provide insight 32 into the impact of TD exposure on resident perceptions of TD and demonstrate the need for expanding TD training across all 33 dermatology residency programs.teledermatologyresidencyeducationcurriculumapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/20b8h76barticleDermatology Online Journalvol 22, iss 7oai:escholarship.org:ark:/13030/qt92n4f40x2021-06-18T19:21:09Zqt92n4f40xGranuloma faciale treatment with tacrolimusSantos-Alarcon, SergioSanchis-Sánchez, CeliaFerrando-Roca, FranciscoMateu-Puchades, Almudena2016-01-01We present a 40-year-old woman with a one-year history of a solitary and asymptomatic facial lesion. On physical examination a slightly infiltrated, smooth red to brown nodule was seen at the left malar region. A biopsy established the diagnosis of granuloma faciale. After two-months therapy with topical tacrolimus 0,1%, nodule was resolvedapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/92n4f40xarticleDermatology Online Journalvol 22, iss 7oai:escholarship.org:ark:/13030/qt43b4k7j62021-06-18T19:21:07Zqt43b4k7j6Congenital cartilaginous rest of the neck in a boyBlattner, Collin MathewRoss, FawnBohlke, AngelaYoung, III, John2016-01-01Congenital cartilaginous rest of the neck is a rarely encountered entity that requires surgical excision. In this case report, we describe a 12-year-old boy with asymptomatic congenital cartilaginous rest of the neck. We also discuss the associated congenital malformations that dermatologists must be aware of when caring for patients with this disease.application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/43b4k7j6articleDermatology Online Journalvol 22, iss 7oai:escholarship.org:ark:/13030/qt8vw382nx2021-06-18T19:21:06Zqt8vw382nxUnilateral indurated plaque in the axilla: a case of metastatic breast carcinomaShagalov, DevorahXu, MichelleLiebman, TraceyTaylor, Gina2016-01-01Breast cancer is the most commonly diagnosed cancer among American women and is also the most common internal malignancy to metastasize to the skin. Rarely, cutaneous metastases represent the first indication of breast carcinoma, putting dermatologists in an instrumental position to make the diagnosis of breast carcinoma. We report the case of a 71-year-old woman with a 10-year history of a slowly-enlarging, indurated plaque in the right axilla. Review of symptoms was significant only for occasional numbness and tingling that extended from the right axilla to the right hand. Biopsy revealed cells infiltrating in a single–file between the collagen bundles in the dermis and subcutis and immunohistochemical staining consistent with a diagnosis of invasive lobular carcinoma. Subsequent work up revealed a primary breast lesion and extensive bony metastases.application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8vw382nxarticleDermatology Online Journalvol 22, iss 7oai:escholarship.org:ark:/13030/qt0n60013n2021-06-18T19:21:05Zqt0n60013nLangerhans cell histiocytosis with nail changes and multisystem disease: a case reportde Jesus Semblano Bittencourt, MarayaMoraes Dias, CarolinaLima Lage, ThaianeMagno Parijós, AmandaBrito Mesquita, LetíciaHaber Carvalho, Alessandra2016-01-01Nail involvement in Langerhans cell histiocytosis is uncommon and is said to indicate a poor prognosis. We describe a 2-year-old boy with onycholysis, subungual hyperkeratosis, and hemorrhages on his fingernails. He also had hepatosplenomegaly and pulmonary involvement. The diagnosis of Langerhans cell histiocytosis was made by histopathologic examination of skin and liver.The role of nail involvement as an unfavorable prognostic sign is still unclear and this paper concludes that nail involvement in Langerhans cell histiocytosis is a possible sign of multisystemic involvement.histiocytosisLangerhans cellnail diseasesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0n60013narticleDermatology Online Journalvol 22, iss 7oai:escholarship.org:ark:/13030/qt7nt074w42021-06-18T19:21:04Zqt7nt074w4Generalized Bullous Fixed Drug Eruption due to BromhexineVide, JMoreira, CCunha, A. P.Baldaia, HMagina, SAzevedo, F2016-01-01We describe a patient with a generalized bullous form of Fixed Drug Eruption (FDE) induced by bromhexine, a commonly used drug for respiratory symptoms. This is a rare association and generalized bullous FDE is also very rare. We emphasize the importance of patch tests in identifying the culprit drug.application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7nt074w4articleDermatology Online Journalvol 22, iss 7oai:escholarship.org:ark:/13030/qt2jw6t7cs2021-06-18T19:21:02Zqt2jw6t7csKaposi Sarcoma of the eyelid as an initial manifestation of AIDSTeixeira, Ana IsabelNeno, MiguelBadura, RobertBorges-Costa, JoãoFilipe, Paulo Leal2016-01-01Kaposi sarcoma (KS) is a multifocal systemic disease that originates in the vascular endothelium related to Human Herpes Virus 8 (HHV-8). In the early 1980s the first series of cases of disseminated Kaposi Sarcoma in HIV infected patients were reported. However, with the advent of highly active antiretroviral therapy (HAART) since 1997, these cases are less frequently observed by clinicians. We report the case of a 40-year-old woman, presenting with two asymptomatic purpuric nodules localized in the superior and inferior left eyelids, occluding the palpebral fissure, which were present for 4 months prior to presentation. The eyelid nodules were determined to represent KS, but there were no additional cutaneous lesions. Pulmonary and gastric KS involvement was documented. Antiretroviral therapy was initiated along with pegylated liposomal doxorubicin. The nodules gradually disappeared and her immune status eventually improved. Ocular and periorbital involvement of KS associated with HIV-1 infection as the initial clinical manifestations is a rare advent. This case is important as it illustrates that disseminated KS was not to be predicted by the number or the extension of cutaneous lesions.kaposi´s sarcomadisseminatedAIDSapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2jw6t7csarticleDermatology Online Journalvol 22, iss 7oai:escholarship.org:ark:/13030/qt9v67b10b2021-06-18T19:21:01Zqt9v67b10bSuccessful treatment of eosinophilic cellulitis with dapsoneCoelho de Sousa, VirgíniaLaureano Oliveira, AndréCardoso, Jorge2016-01-01A 55-year-old woman presented with a 3-year history of recurrent episodes of pruritic cellulitis-like erythematous plaques, mostly located on the limbs. Simultaneously, fever, malaise and peripheral eosinophilia were noted. The clinical diagnosis of eosinophilic cellulitis (also known as Well’s syndrome) was supported by the histopathological finding of typical “flame figures”. Treatment with dapsone was initiated at a dose of 50 mg per day. After one year of follow-up the patient was relapse-free. Eosinophilic cellulitis is an uncommon, recurrent inflammatory skin disease. The management is often a challenge, due to the frequent need for long-term therapy. Dapsone is an effective and safe treatment option.DapsoneEosinophilic cellulitisUrticariaWells’ syndromeapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9v67b10barticleDermatology Online Journalvol 22, iss 7oai:escholarship.org:ark:/13030/qt9mx8r32z2021-06-18T19:21:00Zqt9mx8r32zWidespread cutaneous metastasis from ovarian serous adenocarcinomaKara, AsudeBelli, Asli AkinAlatas, Emine TugbaTanriverdi, OzgurDere, Yelda2016-01-01Cutaneous metastasis can be rarely first manifestation of internal cancers; these usually develop with advanced stage malignancies. Cutaneous metastasis of ovarian cancer is rare and the majority of are seen around the pelvic region compatible with the localization of the primary ovarian tumor. Herein, we report a patient with ovarian cancer with widespread and distant cutaneous metastases showing multiple nodules and ulcers.Cutaneous metastasisovarian adenocarcinomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9mx8r32zarticleDermatology Online Journalvol 22, iss 7oai:escholarship.org:ark:/13030/qt3rc114rg2021-06-18T19:20:59Zqt3rc114rgCosmetic tattoo pigment reactionGreywal, TanyaCohen, Philip R2016-01-01BackgroundCutaneous reactions to tattoos are most commonly granulomatous or lichenoid.PurposeWe describe a woman who developed a lymphocytic reaction following a cosmetic tattoo procedure with black dye. The reaction occurred not only at the site of the tattoos (eyebrows and eyelash lines), but also in non-tattooed skin (bilateral malar cheeks).Methods and MaterialsWe reviewed PubMed for the following terms: cosmetic, dye, granuloma, granulomatous, lichenoid, lymphocytic, perivascular, pigment, pseudolymphoma, reaction, and tattoo. We also reviewed papers containing these terms and their references.ResultsHistopathologic examination of the left eyebrow and left cheek punch biopsies showed predominantly a perivascular lymphocytic reaction secondary to exogenous tattoo pigment.ConclusionsPerivascular lymphocytic reaction is an uncommonly described complication of tattooing. Our patient had an atypical presentation since she had no prior tattoos, became symptomatic only a few days after the procedure, reacted to black dye, and involved skin both within and outside the confines of the tattoos. Her symptoms and lesions resolved after treatment with systemic and topical corticosteroids and oral antihistamines.cosmeticdyegranulomagranulomatouslichenoidlymphocyticperivascularpigmentpseudolymphomareactionand tattooapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3rc114rgarticleDermatology Online Journalvol 22, iss 7oai:escholarship.org:ark:/13030/qt66k5j4wt2021-06-18T19:20:57Zqt66k5j4wtSegmental neurofibromatosis and cancer: report of triple malignancy in a woman with mosaic Neurofibromatosis 1 and review of neoplasms in segmental neurofibromatosisCohen, Philip R2016-01-01BackgroundSegmental neurofibromatosis, referred to as mosaic neurofibromatosis 1, patients present with neurofibromas or café au lait macules or both in a unilateral segment of the body.PurposeA woman with segmental neurofibromatosis and triple cancer (renal cell carcinoma, mixed thyroid carcinoma, and lentigo maligna) is described and cancers observed in patients with segmental neurofibromatosis are reviewed.MethodsPubMed was used to search the following terms, separately and in combination: cancer, malignancy, mosaic, neoplasm, neurofibroma, neurofibromatosis, segment, segmental, tumor.ResultsMalignancy (13 cancers) has been observed in 11 segmental neurofibromatosis patients; one patient had three different cancers. The most common neoplasms were of neural crest origin {malignant peripheral nerve sheath tumor (3 patients) and melanoma (3 patients)] and gastrointestinal tract origin [colon (1 patient) and gastric (1 patient)]. Breast cancer, Hodgkin lymphoma, lung cancer, kidney cancer, and thyroid cancer each occurred in one patient.ConclusionsSimilar to patients with von Recklinghausen neurofibromatosis 1, individuals with segmental neurofibromatosis also have a genodermatosis-associated increased risk of developing cancer.cancermalignancymosaicneoplasmneurofibromaneurofibromatosissegmentsegmentaltumorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/66k5j4wtarticleDermatology Online Journalvol 22, iss 7oai:escholarship.org:ark:/13030/qt9vx9d51m2021-06-18T19:20:56Zqt9vx9d51m360-degree Evaluations on Physician Performance as an Effective Tool for Interprofessional Teams: A critical analysis of physician self-assessment as compared to nursing staff and patient evaluations of providers.Kamangar, FaranakDavari, ParastooParsi, Kory KLi, Chin-ShangWang, QinluMathis, StephenFazel, Nasim2016-01-01ImportanceThe dynamics of the medical care team, including interactions between physicians and nursing staff, has a large role to play in patient care, patient satisfaction, and future possible reimbursement determination. In order to implement changes to improve this dynamic within the medical team, it is imperative that appropriate assessments are completed to determine baseline satisfaction of our patients and nursing staff in addition to provider self-assessment.ObjectiveWe aimed to investigate patient and nursing staff satisfaction with regards to provider quality of care in an outpatient academic dermatology clinic setting. We also sought out to determine provider insight in regards to satisfaction of patient and nursing staff.MethodsOur nursing staff, patients, and providers completed a questionnaire. We then compared nursing satisfaction data and patient satisfaction data with provider self-assessment to determine provider self-awareness.ResultsA total of 23 provider and nurse surveys and 562 patient satisfaction surveys were completed. Paired comparison and descriptive statistics were utilized to compare patient satisfaction, nursing satisfaction, and provider self-assessments.ConclusionsOverall, the results of the surveys demonstrated that the nursing staff and patients had high satisfaction in their interactions with the dermatology physicians. The physicians had appropriate insight into how they were perceived by the nursing staff and patients. Attending physicians as compared to resident physicians and male physicians as compared to female physicians tended to underrate themselves.Physician self evaluationevaluationinterprofessional teamnursing staffpatient evaluationapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9vx9d51marticleDermatology Online Journalvol 22, iss 7oai:escholarship.org:ark:/13030/qt1zm883qs2021-06-18T19:20:54Zqt1zm883qsDermatology Interest Groups in Medical SchoolsQuirk, Shannon KRiemer, ChristieBeers, Paula JBrowning, Richard JCorrea, MarkFawaz, BilalLehrer, MichaelMounessa, JessicaLofgreen, SethOetken, TaraSaley, Taylor PTinkey, KatherineTracey, Elisabeth HDellavalle, RobertDunnick, Cory2016-01-01Involvement in a Dermatology Interest Group (DIG) allows students to learn about dermatology, partake in service projects, get involved in research, and ask questions about the application process for residency programs. In this article, we review the activities and member involvement of DIGs from 11 medical schools. To our knowledge, this is the first descriptive analysis of DIGs across the United States. This comparison of DIGs is not only potentially helpful for medical schools interested in establishing a DIG, but it also offers insight into how previously established DIGs could improve and have a greater impact both in individual medical schools and in the community at-large.Dermatologymedical studentsinterest groupapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1zm883qsarticleDermatology Online Journalvol 22, iss 7oai:escholarship.org:ark:/13030/qt19h4k7sx2021-06-18T19:20:53Zqt19h4k7sxDermatology Residents are Prescribing Tanning Bed TreatmentAnderson, Kathryn LHuang, Karen EHuang, William WFeldman, Steven R2016-01-01Although 90% of dermatologists discourage the use of tanning beds, about half of psoriasis patients report using tanning beds and most of these note improvement. The purpose of this investigation was to determine if dermatology residents are advocating the tanning bed use to their patients.application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/19h4k7sxarticleDermatology Online Journalvol 22, iss 7oai:escholarship.org:ark:/13030/qt2fh826302021-06-18T19:20:52Zqt2fh82630Trends in mortality from skin diseases in the United States: skin infectious diseases are claiming more livesFleischer, Jr, Alan B2016-01-01BackgroundAlthough there has been some excellent work published on the mortality from non-neoplastic skin disease In the United States, further analysis of trends is limited.MethodsData from the Centers for Disease Control and Prevention (CDC) for mortality abstracted from Death Certificates was obtained from the WONDER (wide-ranging online data for epidemiologic research) system from 1999 to 2014. Categorical variables were analyzed with Excel 2013 data analysis software using Chi-squared tests whereas regression was performed for trends.ResultsCrude death rates were highest in the South, especially in Mississippi and Louisiana. This work also confirmed that Blacks or African Americans had higher risk of death from skin disease, whereas Hispanic or Latinos had lower risk. Overall mortality from non-neoplastic diseases is increasing over time and significant increases in mortality from infectious and papulosquamous diseases were observed, whereas there appears to be decreasing mortality from dermatitis and miscellaneous skin disorders (ICD-10-CM L80-90).ConclusionsMortality is increasing from non-neoplastic diseases, especially infectious and papulosquamous diseases. Demographic factors such age race and Hispanic or Latino ethnicity also confer differential risk.application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2fh82630articleDermatology Online Journalvol 22, iss 7oai:escholarship.org:ark:/13030/qt4nc3p4q22021-06-18T19:20:51Zqt4nc3p4q2Most people with psoriasis or rosacea are not being treated: a large population studyWehausen, BrookeHill, Dane EFeldman, Steven R2016-01-01When left untreated, psoriasis and rosacea can have long-term health and psychosocial implications. The purpose of this study was to estimate the percentage of Americans with psoriasis or rosacea who are not being treated. Patient data from a large claims-based database were analyzed to identify the number of patients who are treated for psoriasis or rosacea. The numbers of patients treated were compared to the estimated prevalences of these diseases in the general population, identified from previously published sources. Of the 18,632,362 patients in the database, 140,439 (0.75%) were seen for psoriasis and 165,130 (0.89%) were seen for rosacea. Based on published sources, 3.2% of Americans have psoriasis and about 5.0% have rosacea. We therefore estimated that 77% of people with psoriasis and 82% of people with rosacea are untreated. Greater awareness, resources, and community outreach projects are potential tools that could eliminate this disparity and increase the quality of life for patients with these diseases.psoriasisrosaceatreatmentuntreatedprevalencepopulationapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4nc3p4q2articleDermatology Online Journalvol 22, iss 7oai:escholarship.org:ark:/13030/qt4vb7q7rr2021-06-18T19:20:50Zqt4vb7q7rrImpact of psoriasis flare and remission on quality of life and work productivity: a real-world study in the USAKorman, NJZhao, YRoberts, JPike, JSullivan, ETsang, YKaragiannis, T2016-01-01Although psoriasis patients often report a negative impact on health-related quality of life (HRQoL) and work productivity, less is known about how disease burden varies between periods of flare and remission. The aim of this study was tocompare HRQoL and work productivity by disease activity level. Data were extracted from Adelphi 2011/2013 Disease Specific Programmes, two real world surveys of US dermatologists and psoriasis patients. HRQoL was measured using the EuroQOL 5-Dimension Health Questionnaire (EQ-5D) and Dermatology Life Quality Index (DLQI). Work productivity was measured using the Work Productivity Activity index (WPAI). Three levels of disease activity were constructed based on physician reports: remission, active not flaring, active, and flaring. Multivariable regression analyses explored the relationship between disease activity, HRQoL and work productivity, controlling for differences in demographics and comorbidities. Out of 681 psoriasis patients 24% were in remission, 62% had active disease without flaring, and 15% experienced active disease and were currently flaring. Greater disease activity was associated with worse HRQoL. EQ-5D scores decreased with more active disease (remission vs. active not flaring vs. active and flaring: 0.93 vs. 0.90 vs. 0.82; p<0.05), while DLQI scores increased (remission vs. active not flaring vs. active and flaring: 2.0 vs. 5.00 vs. 8.7; p<0.05). WPAI scores increased with disease activity indicating increased productivity loss (remission vs. active not flaring vs. active and flaring: 5.9 vs. 14.8 vs. 26.9; p<0.05). The same trends were confirmed by multivariable regression analyses.Remissionflarework productivityquality of lifeapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4vb7q7rrarticleDermatology Online Journalvol 22, iss 7oai:escholarship.org:ark:/13030/qt7405k1nn2021-06-18T19:20:48Zqt7405k1nnSatisfaction with current psoriasis treatment: misalignment between physician and patient perceptionsKorman, NJZhao, YPike, JRoberts, JSullivan, EKemhus, M2016-01-01Psoriasis patients often report dissatisfaction with treatment. However, the extent to which patients and their treating dermatologists are aligned regarding satisfaction with psoriasis therapy is largely unknown. This was explored using data derived from the Adelphi 2011/2013 Psoriasis Disease Specific Programmes, two real world surveys of US dermatologists and their patients. Physicians and patients independently reported their satisfaction with psoriasis control (satisfied, dissatisfied). Two levels of satisfaction alignment between physician and patient responses were constructed: aligned (same responses) and misaligned (different responses). In addition, dermatologists provided patient treatment history and disease/symptom severity whereas patients reported data on health-related quality of life (HRQoL), using the EuroQOL 5-Dimension Health Questionnaire (EQ-5D) and Dermatology Life Quality Index (DLQI), and work productivity using the Work Productivity Activity index (WPAI). Multivariate regressions were employed to examine the relationship between satisfaction alignment, overall disease and symptom severity, HRQoL, and work productivity controlling for differences in patient demographics and comorbidities.From 627 paired dermatologist and psoriasis patient records, 512 (81.7%) and 115 (18.3%) cases fell into the ‘aligned’ and ‘misaligned’ groups, respectively. Compared with patients in the aligned group, those in the misaligned group had more moderate to severe psoriasis (82.3% vs. 43.7%), moderate to severe itching (45.6% vs. 27.8%), pain (23.0% vs. 10.6%), and scaling (54.8% vs. 36.1%), and had lower current biologics use (27.0% vs. 42%) (all p<0.05). The misaligned group was associated with reduced HRQoL (lower EQ-5D score: 0.86 vs. 0.91; higher DLQI score: 7.06 vs. 4.23) and greater work productivity loss (higher WPAI scores: 18.27 vs. 11.43) (all p<0.05). Multivariate analyses confirmed these results (p<0.05). Almost 1 in 5 patients were misaligned with their dermatologist’s level of satisfaction with their psoriasis treatment; misalignment was associated with increased disease and symptom severity, reduced HRQoL, and reduced work productivity.application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7405k1nnarticleDermatology Online Journalvol 22, iss 7oai:escholarship.org:ark:/13030/qt2nv2d1n02021-06-18T19:19:29Zqt2nv2d1n0Phytophotodermatitis related to carrot extract-containing sunscreenBosanac, SSClark, AKSivamani, RK2018-01-01Phytophotodermatitis is a clinical diagnosis from phototoxicity of the skin induced by contact with plants or their extracts. Phytophotodermatitis maypresent with burning, erythema, patches, plaques, vesicles, bullae, or hyperpigmented patches in welldemarcated and unusual shapes. Inquiring about occupation, hobbies, and plant or plant extract contact is essential to establishing the diagnosis. Herein we present a case of phytophotodermatitisafter use of carrot extract-containing sunscreen presenting as a hyperpigmented patch in a geometric distribution with accentuation of pigment within the dynamic rhytides.phytophotodermatitisfurocoumarinshyperpigmentationcarrotsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2nv2d1n0articleDermatology Online Journalvol 24, iss 1oai:escholarship.org:ark:/13030/qt4rq2k5fr2021-06-18T19:19:27Zqt4rq2k5frCoexistence of keloids and pilomatricoma in a patient with Rubinstein-Taybi syndromeYagi, YosukeKuwatsuka, YutakaAsai, MisachiHonda, MaiUtani, Atsushi2018-01-01Rubinstein-Taybi syndrome (RTS) is an autosomaldominant hereditary disease, which contains many skeletal and organ anomalies as well as mental retardation. Although high incidence of keloids in RTS is known, it is difficult to find a detailed report on the clinical features of keloids. In the following letter, we report an RTS patient fulfilling diagnostic criteria whosuffered from both keloids and pilomatricoma. We also performed a literature search, which identified the possible involvement of the Wnt/β-catenin signaling pathway in the pathogenesis of these two skin lesions.Rubinstein-Taybi syndromekeloidspilomatricomaWnt/β-cateninapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4rq2k5frarticleDermatology Online Journalvol 24, iss 1oai:escholarship.org:ark:/13030/qt6394z6nc2021-06-18T19:19:26Zqt6394z6ncAdult blaschkolinear acquired inflammatory skin eruption (BLAISE) with simultaneous features of lichen striatus and blaschkitisRaposo, InêsMota, FernandoFernandes, Iolanda CondeCanelhas, ÁureaSelores, Manuela2018-01-01Blaschkitis and lichen striatus are generally distinguished in the literature by the age of onset, lesion distribution, and histopathology. However, there is currently no clear consensus among authors about whether to consider blaschkitis and lichen striatus different clinical entities or a spectrum ofthe same disease. We present a case of adult BLAISE with features of both lichen striatus and blaschkitis, which seems to support the theory that these clinical entities may in fact represent a spectrum of the same pathological process.blaschkitislichen striatusBLAISEblaschkolinear skin eruptionapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6394z6ncarticleDermatology Online Journalvol 24, iss 1oai:escholarship.org:ark:/13030/qt00q4s69z2021-06-18T19:19:24Zqt00q4s69zPrecalcaneal congenital fibrolipomatous hamartomaHafez, DhaferAlmasoudi, AshjanAl Assiri, WaleedAlassmi, MahaAl-Dawsari, Najla A2018-01-01Precalcaneal congenital fibrolipomatous hamartoma is a benign condition of infancy that is sometimes misdiagnosed due to lack of reports in the literature. Lesions usually present with painless, non-pruritic, skin colored bilateral, solitary, symmetric nodules located in the middle of the heels. The lesions gradually increase in size and then regress by the age of 2 to3 years old.precalcanealcongenitalfibrolipomatoushamartomadermatologypediatricapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/00q4s69zarticleDermatology Online Journalvol 24, iss 1oai:escholarship.org:ark:/13030/qt0rf8h71b2021-06-18T19:19:23Zqt0rf8h71bClear cell papulosis: report and reviewSeykora, Caitlin MDalton, Scott RBrown, Patrick J. Brown J2018-01-01A 12-month-old boy presented with three months of asymptomatic hypopigmented flat-topped papules on the suprapubic skin and lower abdomen. Emollients and topical steroids offered no improvementand the patient was referred to the dermatology department. Shave biopsy revealed a papillated epidermis with scattered solitary mononuclearclear cells at all levels of the epidermis and an overlying basket weave orthokeratosis. The cells were epithelioid with increased amphophilic cytoplasm. Immunohistochemical staining was positive for CK7,CEA, and CAM5.2 and negative for S100, CD1a, and Mart-1. These findings were consistent with clear cell papulosis. No treatment was recommended as these lesions were asymptomatic. However, yearlyfollow up was recommended given the resemblance of these cells to those of Paget disease. Review of the literature demonstrates a total of 31 biopsy confirmed cases with AE1, CEA, and EMA positivity and S100negativity as the most consistent staining properties. A recent retrospective review of 19 cases documents long term follow-up of at least six years and up to 21 years. The results suggested a tendency toward selfresolution and an absence of malignant progression, supporting the benign nature of these lesions.clear cell papulosisprimary intraepidermal Paget diseaseextramammary Paget diseaseapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0rf8h71barticleDermatology Online Journalvol 24, iss 1oai:escholarship.org:ark:/13030/qt3x33s9m72021-06-18T19:19:22Zqt3x33s9m7Interstitial granulomatous dermatitis in a patient with chronic hepatitis C and mixed cryoglobulinemiaRato, MGil, FMonteiro, AFAranha, JTavares, E2018-01-01A 55-year-old man presented with a history of asymptomatic, bilateral, figurate dermatosis consisting of erythematous, annular, linear, andarciform, indurated nodules and plaques on the lateral walls of thorax, flanks, and hypogastrium. His medical history was positive for chronic hepatitis C. Skin biopsy was compatible with the diagnosisof interstitial granulomatous dermatitis. Additionalinvestigation revealed positive rheumatoid factor, antinuclear antibodies, and cryoglobulins. Thepatient started treatment with high-potency topical corticosteroid. After 12 weeks of treatment there was a partial clinical improvement of thedermatosis. Interstitial granulomatous dermatitis exhibits a distinct histopathological pattern with a diverse clinical appearance, which can be associated with autoimmune systemic diseases, neoplasms, several drugs, and infections. Optimal therapy for this condition is yet to be established, but topical corticosteroids have been a mainstay of treatment.granulomatous dermatitisinterstitial granulomatous diseasehepatitis Cmixed cryoglobulinemiaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3x33s9m7articleDermatology Online Journalvol 24, iss 1oai:escholarship.org:ark:/13030/qt89q966n72021-06-18T19:19:20Zqt89q966n7El rojo es un problema: Reacciones cutáneas a pigmento rojo de tatuajesBenavente-Villegas, FelipeDíaz-Corpas, TaniaGarcía-Briz, MaríaMoneva-Léniz, LyaSánchez-Motilla, JoséPrats-Máñez, AmeliaFuertes-Prosper, AmparoSoriano-Sarrió, Pilar2018-01-01La práctica de tatuajes tienen más de 8000 años de antigüedad, existiendo un incremento continuo en la sociedad occidental en las últimos 3 décadas La introducción de una sustancia exógena en la pielpuede provocar una respuesta inmunológica en su contra, estando descritas reacciones cutáneas por hipersensibilidad a una variedad de pigmentos, las que se limitan al área de un determinado color,atribuyéndose a los materiales inyectados. El color más reportado en la literatura es el rojo, que tradicionalmente se confeccionaban a base dederivados del mercurio (cinabrio). Diversos patrones histológicos de reacción están descritos, siendo el más frecuente el liquenoide. Presentamos una serie de 10 pacientes con reacción de hipersensibilidad a tatuaje rojo, con patrón histológico predominante dereacción granulomatosa y con moderada respuesta a tratamiento. Es importante cuando se está ante un patrón granulomatoso de reacción descartar sarcoidosis sistémica e infecciones por micobacterias.tattoocutaneous hypersensitivity reactiontatuajesreacción de hipersensibilidadgranulomatosoapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/89q966n7articleDermatology Online Journalvol 24, iss 1oai:escholarship.org:ark:/13030/qt1ph217qf2021-06-18T19:19:19Zqt1ph217qfA novel association of pseudoainhum and epidermolytic ichthyosis, successfully treated with full thickness skin graft after failed z-plasty repairSimkin, DavidHo, Jonathan DSimkin, Daren JTomany, Kevin2018-01-01Pseudoainhum is a rare constriction band variant thatmay progress to spontaneous digital strangulationand auto-amputation. Although its association withpalmoplantar keratodermas is well established, ithas not been reported in conjunction with classicepidermolytic ichthyosis. We describe the first suchcase in a 25-year-old woman who presented witha painful constricting band of the fifth toe. We alsodescribe her treatment course, which consisted ofa failed z-plasty, the traditional therapeutic optionfor acute pseudoainhum, and report the success ofsubsequent full thickness skin graft, suggesting thebenefit of this procedure as a therapeutic alternativefor patients with pseudoainhum.epidermolytic ichthyosiscongenital icthyosiform erythrodermaepidermolytic hyperkeratosispseudoainhumapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1ph217qfarticleDermatology Online Journalvol 24, iss 1oai:escholarship.org:ark:/13030/qt9kq755812021-06-18T19:19:18Zqt9kq75581Eosinophilic infiltrate resembling eosinophilic cellulitis (Wells syndrome) in a patient with mycosis fungoidesEmge, Drew ALewis, Daniel JAung, Phyu PDuvic, Madeleine2018-01-01Mycosis fungoides (MF) is a T-cell, non-Hodgkin lymphoma that primarily involves the skin. Extracutaneous involvement, such as in the parotidgland, is characteristic of end-stage disease. Eosinophilic cellulitis, or Wells syndrome, is a rare inflammatory dermatitis that involves a dermal infiltrate of eosinophils. We report a case of an 80-year-old man with a long-standing diagnosis of stage IIB MF who acutely developed parotid gland involvement and marked hypereosinophilia that most likely represented eosinophilic cellulitis. Activated T cells from his MF were likely a trigger factor for the development of his eosinophilic cellulitis. To our knowledge, this is the first reported case of an MF patient with atypical parotid gland involvement andeosinophilic cellulitis.cutaneous T cell lymphomamycosis fungoidesparotid glandeosinophilic cellulitisWells syndromeapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9kq75581articleDermatology Online Journalvol 24, iss 1oai:escholarship.org:ark:/13030/qt3v77g2zg2021-06-18T19:19:16Zqt3v77g2zgHerpes zoster as a cause of atypical chronic ulcerations associated with tofacitinibNoell, ClaireArbeit, RobertKanhoush, Rima2018-01-01Tofacitinib is a targeted inhibitor of janus kinase (JAK), currently approved for the treatment of rheumatoid arthritis. We present a patient on treatment withtofacitinib who had an episode of classic dermatomal herpes zoster followed months later by atypical chronic cutaneous ulcers also caused by herpes zoster.herpes zostervaricella zoster virustofacitinibulcerationapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3v77g2zgarticleDermatology Online Journalvol 24, iss 1oai:escholarship.org:ark:/13030/qt4xf465w62021-06-18T19:19:15Zqt4xf465w6Nivolumab reactivation of hypertrophic lichen planus, a case report and review of published literature.Maarouf, MelodyAlexander, ChristinaShi, Vivian Y2018-01-01We report a case of nivolumab-induced lichen planus (LP) reactivation that was previously in remission following chemotherapy for non-smallcelllung cancer (NSCLC). Chemotherapy-induced immunosuppression allowed for complete resolution of the patient’s pre-existing LP, a T-cell mediatedautoimmune process. When the patient was switched to nivolumab immunotherapy owing to progression of NSCLC, PD-1 inhibition led to an overwhelming T-cell response that seemed to have provoked a severe LPreactivation. Although lichenoid reactions have been reported with nivolumab, to our knowledge, this is the first reported case of nivolumab monotherapycausing LP reactivation in a patient with a strong personal and family history of the disease that was previously in remission after chemotherapy.PD-1 inhibitornivolumablichen planusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4xf465w6articleDermatology Online Journalvol 24, iss 1oai:escholarship.org:ark:/13030/qt6n9456xv2021-06-18T19:19:13Zqt6n9456xvFocal linear elastosis in a patient with joint hypermobility syndromeClement, Barak CForster, ChristopherLogemann, Nicholas2018-01-01Focal linear elastosis (FLE) is a benign skin findingcharacterized by hypertrophic linear plaques withabnormal elastic fibers on histology. We present aunique case in which focal linear elastosis occurredin the setting of joint hypermobility syndrome(JHS). Our patient, a 20-year-old man with a medicalhistory significant for symptoms consistent with JHS,had been followed by the rheumatology clinic formany months. He was referred to the dermatologydepartment for further evaluation of asymptomaticlongitudinal bands on his back that had been presentfor many years. He denied trauma but endorsed ahistory of ‘stretch marks.’ On examination there werenumerous horizontally oriented, firm, linear, yellowto flesh colored bands, all non-tender to palpation.Punch biopsies were performed of involved anduninvolved skin. Histopathology of normal skinrevealed no significant abnormalities whereasinvolved skin demonstrated broadened collagenbundles in the deep dermis. The elastic fiber stain,Verhoeff-Van Gieson, revealed a gross increase in thenumber of elastic fibers, fragmented fibers, fiberswith “paintbrush” or widened-ends, fibers of varyingthickness, and clumped fibers. This combination ofhistopathologic and clinical features was consistent with FLE.focal linear elastosisjoint hypermobility syndromeEhlers-Danlosapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6n9456xvarticleDermatology Online Journalvol 24, iss 1oai:escholarship.org:ark:/13030/qt1vd4j2t22021-06-18T19:19:12Zqt1vd4j2t2Unusually extensive scalp ulcerations manifested in pemphigus erythematosusChandan, NehaLake, Eden PChan, Lawrence S2018-01-01Senear-Usher Syndrome, or pemphigus erythematosus, is an autoimmune skin blistering disorder with an overlapping clinical presentation of pemphigus foliaceus and lupus erythematosus. Lesions typically involve the scalp, face, and upper chest or back. This case study focuses on a patient who presentedwith progressive scalp ulcers, hyperpigmentation, and eroded plaques with overlying hemorrhagic crust. Pemphigus erythematosus was diagnosedwith direct immunofluorescence, demonstrating immunoglobulin G and complement deposition both intercellularly and at the dermoepidermal junction. The patient is continuing treatment with systemicsteroids and steroid-sparing immunosuppressants.pemphigus erythematosusSenear-Usher Syndromelupus erythematosuspemphigus foliaceusdermoepidermal junctionapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1vd4j2t2articleDermatology Online Journalvol 24, iss 1oai:escholarship.org:ark:/13030/qt7940069z2021-06-18T19:19:11Zqt7940069zAnaplastic large cell lymphoma localized to the left breast years after radiotherapy for breast cancerMin, Michelle SAl-Haseni, AliSuccaria, FarahGoldberg, LynneLerner, AdamSahni, Debjani2018-01-01Anaplastic large cell lymphoma (ALCL) is a rare type of non-Hodgkin lymphoma that can involve the skin primarily or secondarily. Our case describes an unusual presentation of eruptive tumors localized to the leftbreast region several years following breast cancer surgery and radiation for carcinoma of the breast. This report highlights the challenges in reachingthe diagnosis of an aggressive systemic lymphoma presenting on the skin.non-Hodgkin lymphomaanaplastic large cell lymphomaALKapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7940069zarticleDermatology Online Journalvol 24, iss 1oai:escholarship.org:ark:/13030/qt41x7q1z52021-06-18T19:19:10Zqt41x7q1z5Schnitzler syndrome in a patient with a family history of monoclonal gammopathyWilmas, KellyAria, AlexanderTorres-Cabala, Carlos ALu, HuifangDuvic, Madeleine2018-01-01Schnitzler syndrome is a rare disease characterized by chronic urticaria and a monoclonal gammopathy, most commonly IgM with light chains of the kappa type. There are currently no known risk factorsassociated with development of the disease. We report a case of Schnitzler syndrome in a 48-year-old man with a family history of monoclonal gammopathies. The patient’s disease has been well controlled with anakinra therapy. Our case may contribute to a better understanding of the etiology of Schnitzler syndrome as his history could suggest a hereditarypredisposition for the disease. Further studies are necessary to determine whether a genetic component of Schnitzler syndrome exists, as first-degree relatives of patients with monoclonal gammopathies may be at risk for the development of the disease.Schnitzler syndromemonoclonal gammopathyWaldenström macroglobulinemiamultiple myelomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/41x7q1z5articleDermatology Online Journalvol 24, iss 1oai:escholarship.org:ark:/13030/qt6d56n4j82021-06-18T19:19:09Zqt6d56n4j8The use of cyclosporine for Stevens-Johnson syndrome-toxic epidermal necrolysis spectrum at the University of Louisville: A case series and literature reviewConner, Clayton DMcKenzie, EmilyOwen, Cindy E2018-01-01Introduction: Cyclosporine therapy for Stevens-Johnson syndrome-toxic epidermal necrolysis (SJSTEN) was first reported in the literature by Renfro et al. in 1989. Herein we report an additional 4 cases of SJS-TEN treated with cyclosporine.Methods: Case information was collected retroactively at the University of Louisville Hospital in Louisville, KY. All cases had a diagnosis of SJS or TEN by a dermatologist. All patients were ≥18 years of age and treated with cyclosporine during their admission.Results: Three of four patients re-epithelialized within an average of 3.67 days of starting 3-4 mg/kg/day of cyclosporine. One patient passed away, likely due to advanced endometrial cancer.Discussion: We provide a review of the literature on cyclosporine use for SJS/TEN, including various outcome measures — stabilization (cessation of new lesions), time to re-epithelialization, mortality rate, and hospital length of stay and, where available, comparison to other systemic agents.Conclusion: The outcomes appear to be consistent with rapid re-epithelialization and low mortality as seen in many previous reports. Treating SJS-TEN with systemic agents including cyclosporine will remaincontroversial because the vast majority of data comes from case reports, case series, or small open prospective trials.Stevens-Johnson syndromeSJStoxic epidermal necrolysisTENcyclosporinereepithelializationSCORTENapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6d56n4j8articleDermatology Online Journalvol 24, iss 1oai:escholarship.org:ark:/13030/qt7qn5268s2021-06-18T19:19:08Zqt7qn5268sVaccine-induced toxic epidermal necrolysis: A case and systematic reviewChahal, DevAleshin, MariaTuregano, MaminaChiu, MelvinWorswick, Scott2018-01-01Background: Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are cutaneous hypersensitivityreactions that develop in response to specific triggers such as medications and certain infections. Vaccines, which undergo rigorous safety testing prior to use in humans, are a rare cause of SJS/TEN and little is known about the frequency of such events and corresponding pathogenesis.Objective: Herein, we discuss a case of suspected TEN in a 19-year-old woman who received the meningococcal B vaccine (the first report of such an association) and conduct a systematic review of the associated literature. We also discuss management of this patient with a single dose of etanercept.Methods: Relevant literature was searched using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method.Results: A total of 29 articles reporting EM, SJS, or TEN following vaccination were included from >5 countries. Of the 29, 22 articles reported EM, 6/29 reported SJS, and 4/29 reported TEN (3 articlesreported cases of both EM and SJS/TEN).Conclusions: We suggest consideration of vaccines as an etiology for cases of SJS or TEN that begin with an EM-like presentation, and provide further evidence for the use of etanercept as a viable treatment for TEN.Stevens-Johnson syndrometoxic epidermal necrolysiserythema multiformevaccinesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7qn5268sarticleDermatology Online Journalvol 24, iss 1oai:escholarship.org:ark:/13030/qt5tq947nk2021-06-18T19:19:07Zqt5tq947nkA pilot program for community dermatologists working with primary care residents to provide dermatology consults to a regional hospitalGiesey, RachelNarively, DoriaFuller, ValerieMostow, Eliot2018-01-01With the high demand and limited supply of dermatologists, the majority dedicate their time primarily to outpatient practice. A number ofobstacles to inpatient dermatology consults have been described, as well as the essential benefits for some of the sickest patients. Dermatology residency programs partially relieve this need, however with the transition to a single Graduate Medical Education accreditation system and many previously American Osteopathic Association-accredited dermatologyprograms ceasing to train residents after 2020, it is prudent to recruit additional possible consultants. One possible solution is to involve non-dermatology residents as part of the consult service team. We report on our experience of piloting such a program, for community dermatologists providing consults to a regional hospital utilizing family medicine andinternal medicine residents.consultinpatienttelemedicineHIPAAapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5tq947nkarticleDermatology Online Journalvol 24, iss 1oai:escholarship.org:ark:/13030/qt1fh739nx2021-06-18T19:19:06Zqt1fh739nxDelusions of parasitosis: a brief review of the literature and pathway for diagnosis and treatmentLaidler, Nicholas2018-01-01A large proportion of patients seen in dermatology practices have underlying psychological issues associated with their skin diseases. One of the most flagrant examples of this are patients with delusions of parasitosis. These patients have false fixed beliefs that they are infested by parasites and experience cutaneous sensations of crawling, biting, and stinging associated with their delusions. There is no organic skin disorder and all cutaneous manifestations are self-induced. Rather than a psychiatrist, the dermatologist is often designated by the patient to handle the chief complaint, even though the main disorder is psychogenic. In spite of their limited evidence, antipsychotic medications have become the mainstay of therapy for delusions of parasitosis. The dermatologist must therefore be familiar with the approach to diagnosis and the use of antipsychotic or neuroleptic medications, which usually reside in the domain. There are few clinical trials and no substantial randomized controlled trials examining the efficacy of the psychiatrist antipsychotic medication used to treat delusions of parasitosis. This review article synthesizes the current available research and distils it down to analyzes 17 case reports, comprising 37 cases, examining the use of risperidone and olanzapine in the treatment of delusions of parasitosis. These findings are synthesized into a clinical pathway designed to assist dermatologists in effectively managing patients with delusions of parasitosis.delusions of parasitosisEkbom syndromedelusory parasitosispsychogenic parasitosisdelusional infestationdelusional ectoparasitosisformicationchronic tactile hallucinosisparasitophobiaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1fh739nxarticleDermatology Online Journalvol 24, iss 1oai:escholarship.org:ark:/13030/qt6fc0t5pq2021-06-18T19:18:09Zqt6fc0t5pqAngioqueratomas de fordyce múltiplos de vulva associados à cirrose hepáticaSouza Teixeira, Marcelodos Santos Lima, Carende Abreu Neves Salles, SimoneLuz, Flávio BarbosaRoberta Duarte Bezerra Pinto, RobertaPantaleão, Luciana2016-01-01Fordyce angiokeratoma is a benign skin neoplasm, characterized by erythematous-violet keratotic papules with mamillated surface, which follows a chronic and minimally symptomatic course. However, symptoms can be related such as itching, burning, bleeding, dyspareunia; aesthetic and social concerns may prompt request for treatment. The condition mainly affects men and usually occurs in the scrotum, but rarely may occur in women. A 30-year-old woman with liver cirrhosis and portal hypertension is described. Over a period of two years she developed multiple angiokeratomas of the vulva, complicated by frequent bleeding. Histopathologic analysis of the lesion confirmed the diagnosis of angiokeratoma and all lesions were surgically removed. The results of the treatment were very satisfactory, with no relapses or complications.Angioqueratoma de Fordyce é uma dermatose incomum que compõe o grupo das neoplasias cutâneas benignas, caracterizando-se pelo aparecimento de lesões papuloceratósicas, eritemato-violáceas de superfície mamilonada, que apresentam curso crônico e oligossintomático. No entanto, outros sintomas podem estar associados, como prurido, ardência, sangramento e dispareunia, além de problemas estéticos e de ordem social. Afeta principalmente homens, acometendo a região escrotal, sendo raro seu surgimento em mulheres. Relata-se caso de uma paciente com 30 anos de idade, portadora de cirrose hepática e hipertensão portal evoluindo há 2 anos com múltiplos angioqueratomas na vulva de sangramento frequente. A análise histopatológica confirmou o diagnóstico de angioqueratoma e a paciente foi submetida à exérese cirúrgica das lesões. Os resultados terapêuticos foram satisfatórios, sem recidivas ou complicações.AngioqueratomaCirroseFordyceVulvarapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6fc0t5pqarticleDermatology Online Journalvol 22, iss 5oai:escholarship.org:ark:/13030/qt2z11f34c2021-06-18T19:18:08Zqt2z11f34cIncreasing adherence to topical therapy in psoriasis through use of solution medicationHill, DaneFarhangian, Michael EFeldman, Steven R2016-01-01Patient outcomes and clinical improvement are closely related to topical medication adherence, and is especially important in chronic dermatological diseases such as psoriasis. About one-fifth of patients undergoing topical treatment were dissatisfied with its convenience for various reasons. Providers can help increase adherence through selecting the correct medication vehicle, involving family members or friends in the patient’s mediation application, and explaining likely side effects to the patient prior to use of the medication. Increased inherence will lead to better psoriasis disease control.psoriasistopical treatmentcompliancesteroid solution spraypatient carescalpapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2z11f34carticleDermatology Online Journalvol 22, iss 5oai:escholarship.org:ark:/13030/qt0w28m8h42021-06-18T19:18:07Zqt0w28m8h4Hypotrichosis with juvenile macular dystrophy: Portuguese caseElfatoiki, Fatima zahraCordoliani, FlorancePascal Regane, PascalAfforitit-Demoge, Aude2016-01-01Hypotrichosis with juvenile macular dystrophy is a rare congenital disease mainly found in the Druze population of Northern Israel. This disorder is caused by the CDH3 mutation encoding P-cadherin, which is expressed in retinal pigment epithelium and hair follicles. An 11-year-old girl who was born to related Portuguese parents, had hypotrichosis since birth and macular dystrophy diagnosed at age 5. Fundus examination and fluorescein angiography revealed located macular pigmentary abnormalities. No molecular analysis was done. A fundus examination should be considered mandatory in the assessment of congenital hypotrichosis.hypotrichosismacular dystrophyP-cadherinCDH3 mutationapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0w28m8h4articleDermatology Online Journalvol 22, iss 5oai:escholarship.org:ark:/13030/qt5h25d0xs2021-06-18T19:18:06Zqt5h25d0xsMicosis fungoide e inhibidores del TNFα: ¿riesgo o beneficio?Maroñas-Jiménez, LidiaBurillo-Martínez, SaraTous-Romero, FátimaRodríguez-Peralto, Jose LuisOrtiz de Frutos, JavierOrtiz-Romero, Pablo Luis2016-01-01The growing use of anti-TNF drugs during the last years has reopened the discussion about the possible increased risk of developing non-Hodgkin lymphoma in patients with such type of treatments. We present our clinical experience and critical opinion about the current situation of such issue regarding cutaneous T-cell lymphomas.El creciente uso de fármacos anti-TNF durante los últimos años ha reabierto el debate sobre el posible aumento de riesgo de linfomas no Hodgkin en los pacientes con este tipo de tratamientos. Presentamos nuestra experiencia clínica y opinión critica sobre la situación actual de este tema en relación a los linfomas cutáneos de células T.Mycosis fungoidescutaneous T-cell lymphomasanti-TNF therapytumoral necrosis factorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5h25d0xsarticleDermatology Online Journalvol 22, iss 5oai:escholarship.org:ark:/13030/qt22m7j3fk2021-06-18T19:18:04Zqt22m7j3fkInfantile myofibroma: a firm, round plaque in an infantAmano, ShinyaHalsey, MarkYasuda, MarikoO’Donnell, PatrickCsikesz, Courtney2016-01-01Infantile myofibroma is a rare fibromatous tumor that is variable in presentation and is frequently mistaken for hemangioma or rhabdomyosarcoma. We describe a 14-month-old boy who presented with multiple, enlarging, firm lesions on the shoulder. Biopsy revealed a proliferation of small spindle cells with myxoid and hyalinized stroma infiltrating into the superficial adipose tissue. We provide a brief review of the clinical presentation, histopathologic features, management, and recent advances in our understanding of this rare condition.Infantile MyofibromaMyofibromatosisFibromatous Tumorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/22m7j3fkarticleDermatology Online Journalvol 22, iss 5oai:escholarship.org:ark:/13030/qt47p4d8zv2021-06-18T19:18:03Zqt47p4d8zvPenicillamine-associated cutis laxa and milia en plaque - case report and review of cutaneous changes associated with penicillamineVajdi, TinaLee, Wiggin WuParavar, Taraneh2016-01-01Penicillamine-induced skin changes are rare and include: hypersensitivity reactions, autoimmune reactions, and cutaneous elastoses. We report a case of a 73-year-old man with cystinuria taking penicillamine for over 50 years who presented with penicillamine-induced cutis laxa and milia en plaque. A brief review of penicillamine induced skin changes, specifically cutis laxa and milia en plaque, is presented.penicillamineelastic tissuecystinuriacutis laxamilia en plaqueapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/47p4d8zvarticleDermatology Online Journalvol 22, iss 5oai:escholarship.org:ark:/13030/qt69q6k8z82021-06-18T19:18:02Zqt69q6k8z8Criptococosis cutánea primaria en paciente inmunocompetenteVázquez-Osorio, IgorGarcía-Rodiño, SaraRodríguez-Rodríguez, MartaLabandeira, JavierSuárez-Peñaranda, José ManuelSánchez-Aguilar, MDoloresVázquez-Veiga, Hugo2016-01-01La criptococosis cutánea es una micosis propia de pacientes inmunodeprimidos, sobre todo aquellos con infección por el virusde la inmunodeficiencia humana (VIH). Sin embargo, existen casos infrecuentes de criptococosis cutánea en pacientes inmunocompetentes, que suelen simular otras dermatosis, lo que retrasa su diagnóstico y tratamiento. Presentamos el caso de un varón pluripatológico de 79 años, con úlceras dolorosas en dorso de mano derecha que no respondían a tratamientos tópicos. A través del estudio histopatológico y micológico se alcanzó el diagnóstico de criptococosis cutánea primaria, lográndose la remisión de las lesiones tras 6 meses de tratamiento con fluconazol.CriptotococosisCryptococcus neoformansFluconazolÚlcera cutáneaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/69q6k8z8articleDermatology Online Journalvol 22, iss 5oai:escholarship.org:ark:/13030/qt0r05j1cc2021-06-18T19:18:01Zqt0r05j1ccCutaneous Richter Syndrome mimicking a lower limb cellulitis infection - a case report and review of the literatureCésar, ArturCalistru, AnaPardal, JoanaMagina, SofiaMota, AlbertoAzevedo, Filomena2016-01-01Richter syndrome (RS) is characterized by the development of a high-grade lymphoma in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). Herein, we present the case of an 85-year-old woman with a 3-year history of stable asymptomatic CLL that developed a cutaneous RS. The patient presented with painless inflammation in the left leg and foot that was initially diagnosed as a cellulitis infection. She was treated accordingly with ceftriaxone and clindamycin. However, after completing the antibiotic regimen, not only did the inflammation persist, but also superimposed painless nodules gradually appeared on the left leg and foot over the course of four months. The histopathological examination of the nodules revealed a large B-cell cutaneous lymphoma. The patient underwent chemotherapy with CVP, followed by R-CHOP, resulting in a reduction of size of the nodules and remission of the inflammation. The patient died five months after the diagnosis owing to a bacterial pneumonia. We identified in previous reports a total of fifteen cases of cutaneous RS. Most cases presented with rapidly growing tumors or multiple erythematous nodules, similar to our case. This case of a cutaneous RS mimicking a cellulitis infection underlines the importance of a low threshold for performing biopsies of suspicious skin lesions in patients with CLL/SLL.LeukemiaLymphocyticChronicB-CellLymphomaB-CellSkin Neoplasmsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0r05j1ccarticleDermatology Online Journalvol 22, iss 5oai:escholarship.org:ark:/13030/qt7080c5gs2021-06-18T19:18:00Zqt7080c5gsMilia-like idiopathic calcinosis cutis in a child with Down syndromeKumar, PiyushSavant, Sushil SNimisha, EstherDas, AnupamDebbarman, Panchami2016-01-01Idiopathic calcinosis cutis refers to progressive deposition of crystals of calcium phosphate in the skin and other areas of the body, in the absence of any inciting factor. Idiopathic calcinosis cutis may sometimes take the form of small, milia-like lesions. Most commonly, such milia like lesions are seen in the setting of Down syndrome. Herein, we report a 5-year-old girl with multiple asymptomatic discrete milia-like firm papules distributed over the face and extremities. A diagnosis of milia-like idiopathic calcinosis cutis associated with Down Syndrome was provisionally made and was confirmed by histopathology and karyotyping.Down syndromecalcinosis cutismiliaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7080c5gsarticleDermatology Online Journalvol 22, iss 5oai:escholarship.org:ark:/13030/qt9c50d26x2021-06-18T19:17:59Zqt9c50d26xPigmented hidrocystoma of nasal epithelium (PHONE): report of a man with a pigmented hidrocystoma of his nose and literature reviewRappazzo, Katherine CCohen, Philip R2016-01-01Background: Hidrocystomas are benign tumors of apocrine or eccrine epithelium. They most commonly occur on the head and neck, especially periorbitally. Albeit rare, these adnexal tumors may present as pigmented lesions.Purpose: To describe a patient with a pigmented eccrine hidrocystoma of his nose and to review the features of other individuals with pigmented hidrocystoma of the nasal epithelium.Material and Methods: PubMed was used to search the follow terms: hidrocystoma and pigmented. All papers were reviewed and relevant manuscripts, along with their reference citations were evaluated.Results: A 52-year-old man who presented with a pigmented eccrine hidrocystoma on his nasal bridge was described. The features of three previously described patients with pigmented hidrocystoma of the nose were evaluated. The tumors presented as single or multiple, less than 2mm, blue papules. Our patient’s tumor would intermittently bleed, which prompted consideration of a possible basal cell carcinoma. Biopsy established the diagnosis showing a cystic lesion lined by eccrine epithelium with pigmented secretion within the cyst’s lumen. The cyst content stained positive with Fontana-Masson stain. Our patient’s excisional biopsy resulted in excellent cosmetic appearance and complete removal of the benign adnexal tumor.Conclusion: Pigmented hidrocystomas may be mistaken for other skin lesions, such as a pigmented basal cell carcinoma and melanoma. A biopsy readily establishes the diagnosis. We respectfully suggest that a hidrocystoma located on the nose that is pigmented be referred to as a PHONE: pigmented hidrocystoma of the nasal epithelium.apocrineeccrinehidrocystomamultiplenasalnosepigmentedsolitaryapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9c50d26xarticleDermatology Online Journalvol 22, iss 5oai:escholarship.org:ark:/13030/qt3sd5h1n22021-06-18T19:17:57Zqt3sd5h1n2Successful treatment of pityriasis lichenoides chronica with narrow-band ultraviolet B therapy in a patient with Keratitis-Ichthyosis-Deafness syndrome: a case reportSalman, AndacGencosmanoglu, Dilek SeckinYucelten, Ayse DenizElcioglu, NurselRichard, GabrieleDemirkesen, Cuyan2016-01-01Keratitis-ichthyosis-deafness (KID) syndrome is a rare genodermatosis causing ichthyosis-like skin lesions, keratitis, and deafness. Herein, we report a patient with this rare syndrome in association with pityriasis lichenoides chronica, which was succesfully treated with narrow-band ultraviolet B phototherapy despite our concerns regarding the increased risk of squamous cell carcinoma, hyperpyrexia, and keratitis.application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3sd5h1n2articleDermatology Online Journalvol 22, iss 5oai:escholarship.org:ark:/13030/qt2x2188282021-06-18T19:17:56Zqt2x218828Plasmablastic lymphoma: an atypical cutaneous presentation of a rare entityMota, FernandoMesquita, BrunoCarvalho, SCoelho, AndréVelho, GlóriaLima, MargaridaSelores, Manuela2016-01-01Plasmablastic lymphoma is a very rare B-cell lymphoma typically associated with immunosuppression: It occurs primarily in the oral cavity, although some cases were reported in other organs and tissues.To date, only 10 cases of primary cutaneous plasmablastic lymphoma have been described. Clinically, primary cutaneous plasmablastic lymphoma presents as non-specific cutaneous lesions (purple nodules, erythematous infiltrated plaques). In previously described cases, as in this case, histology and immunohistochemistry are required to make the diagnosis. Owing to the rarity of this entity, there is no established therapy, which makes its management an individualized, patient-based decision.plasmablastic lymphomaB-cell lymphomasHuman herpesvirus 8HIV infectionapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2x218828articleDermatology Online Journalvol 22, iss 5oai:escholarship.org:ark:/13030/qt0ss9x4vf2021-06-18T19:17:55Zqt0ss9x4vfIntravascular papillary endothelial hyperplasia of the vulva: report of a patient with Masson tumor of the vulva and literature reviewBeutler, Bryce DavidCohen, Philip R2016-01-01Background: Intravascular papillary endothelial hyperplasia -- also known as Masson tumor -- is a rare, benign vascular condition that manifests on the skin as a firm, blue-black colored nodule or papule. Lesions range in size from 0.25 to 5 centimeters in diameter and may be tender or painless. In some individuals, nodules appear red colored, mimicking hemangioma or pyogenic granuloma. Histologically, intravascular papillary endothelial hyperplasia is characterized by the presence of an organizing thrombus in the vascular lumen with accompanying hyperplastic endothelial cell proliferation. Common sites of presentation include the head, neck, and extremities. However, albeit rarely, lesions may also appear in the genital region.Purpose: We describe the clinical and pathologic findings of a woman who developed intravascular papillary endothelial hyperplasia of the vulva. We also review the characteristics of other patients with intravascular papillary endothelial hyperplasia of the vulva and summarize the differential diagnosis and treatment options for this condition.Materials and methods: The features of a woman with intravascular papillary endothelial hyperplasia of the vulva are presented. Using PubMed, the following terms were searched and relevant citations assessed: intravascular papillary endothelial hyperplasia, IPEH, labia majora, Masson hemangioma, Masson pseudoangiosarcoma, Masson tumor, and vulva. In addition, the literature on intravascular papillary endothelial hyperplasia is reviewed.Results: A 32-year-old woman presented with a 3 x 2 millimeter painless, black colored submucosal papule on her left labia majora. The lesion was removed by excisional biopsy. Microscopic examination revealed a re-canalizing thrombus and a proliferation of erythrocytes within a dilated vascular structure. Based on correlation of the clinical presentation and histopathologic findings, a diagnosis of intravascular papillary endothelial hyperplasia was established. The patient applied mupirocin 2% ointment to the biopsy site, which subsequently healed without complication or recurrence.Conclusion: Intravascular papillary endothelial hyperplasia -- also known as Masson tumor -- is a rare, benign vascular eruption. Cutaneous lesions typically present as red colored or blue-black colored nodules ranging in size from 0.25 to 5 centimeters in diameter. The most common sites of presentation include the head, neck, and extremities. However, albeit rarely, lesions may also appear in the genital region. The histologic hallmark of intravascular papillary endothelial hyperplasia is an organizing thrombus in the vascular lumen with associated hyperplastic endothelial cell proliferation. Lesions often appears similar to other neoplastic and non-neoplastic cutaneous tumors, including hemangiomas, pyogenic granulomas, and cutaneous angiosarcomas. Therefore, pathologic examination is required to confirm the suspected diagnosis and exclude malignancy. The condition can usually be treated with simple local excision.intravascular papillary endothelial hyperplasiaIPEHlabia majoraMasson hemangiomaMasson pseudoangiosarcomaMasson tumorvulvaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0ss9x4vfarticleDermatology Online Journalvol 22, iss 5oai:escholarship.org:ark:/13030/qt7qn7v4bf2021-06-18T19:17:54Zqt7qn7v4bfLhermitte-Duclos Disease in association with Cowden SyndromeNielson, ColtonFischer, ToriaFischer, RyanDonald, JosephRajpara, Anand2016-01-01Cowden syndrome (CS) is a rare genetic disorder with autosomal dominant inheritance, linked to germline mutations in the PTEN tumor suppressor gene on chromosome 10. Cowden syndrome often co-exists with Lhermitte–Duclos disease (LDD), with LDD included as a major criterion in CD diagnosis. This case involves a woman presenting with many of the classic diagnostic criterions and associations of CD, as well as with several comorbidities and unique objective findings.Cowden syndromeLhermitte-Duclos diseaseverrucous keratosesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7qn7v4bfarticleDermatology Online Journalvol 22, iss 5oai:escholarship.org:ark:/13030/qt91j9n0kt2021-06-18T19:17:53Zqt91j9n0ktGoodness, gracious, great balls of fire: A case of transient lingual papillitis following consumption of an Atomic FireballRaji, KehindeRanario, JenniferOgunmakin, Kehinde2016-01-01Transient lingual papillitis is a benign condition characterized by the inflammation of one or more fungiform papillae on the dorsolateral tongue. Although it is a common condition that affects more than half of the population, few cases have been reported in the dermatological literature. Therefore, it is a condition uncommonly recognized by dermatologists though it has a distinct clinical presentation that may be easily diagnosed by clinicians familiar with the entity. We report an interesting case of transient lingual papillitis in a 27 year-old healthy woman following the consumption of the hard candy, Atomic Fireball. We describe treatment and resolution of the condition, and its recurrence following re-exposure to the identified culprit. This report further reviews the literature to illustrate the clinical manifestations, etiology, differential diagnosis, course, and treatment of this condition.transient lingual papillitisoral pathologyoral conditionsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/91j9n0ktarticleDermatology Online Journalvol 22, iss 5oai:escholarship.org:ark:/13030/qt1q15b9032021-06-18T19:17:52Zqt1q15b903Tumor stage mycosis fungoides: a single-center study on clinicopathologic features, treatments, and patient outcomePatrawala, Samit ABroussard, Karen CWang, LiZic, John A2016-01-01Background: Tumor stage mycosis fungoides (MF) is a subtype of cutaneous T-cell lymphoma (CTCL). Tumor stage MF is rarely curable. Treatment is aimed towards controlling the disease and minimizing side effects from therapy.Objective: To characterize clinicopathologic features of tumor stage MF and the impact of clinical characteristics and treatment modalities on patient outcome.Methods: A retrospective chart review was conducted on 39 patients with tumor stage MF followed at Vanderbilt University between July 1995 and July 2010.Results: The median age of diagnosis was 61 years (IQR: 54-70). Sixty-nine percent of the patients were male (27/39). The median follow-up time was 13.6 months (IQR: 5.5-35.9). Among the patients younger than 60 years at the time of initial diagnosis (n = 19), median overall survival (OS) was 7.0 years (95% CI: 2.1-17.9), compared with 3.3 years (95% CI: 2.4-9.3) in patients who were 60 years or older at initial diagnosis. Ten patients with T1/T2 stage at diagnosis had median OS of 5.0 years (95% CI 3.2-7.0). Twenty-eight patients with T3 stage at diagnosis had median OS of 5.8 years (95% CI 2.4-14.2). Median OS for patients with large cell transformation (LCT) and without LCT was 3.3 and 7.7 years, respectively.Limitations: This is a retrospective study with the bias of a tertiary-care referral center.Conclusion: Although LCT and older age at diagnosis were not statistically significant negative prognostic indicators of OS, there was a trend towards statistical significance for LCT. Clinical stage at diagnosis may not affect OS in patients who develop tumor stage MFbexarotenelarge cell transformationoverall survivaltumor stagemycosis fungoidescutaneous T-cell lymphomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1q15b903articleDermatology Online Journalvol 22, iss 5oai:escholarship.org:ark:/13030/qt32r353c42021-06-18T19:17:51Zqt32r353c4Hormones and clocks: do they disrupt the locks? Fluctuating estrogen levels during menopausal transition may influence clock genes and trigger chronic telogen effluviumMirmirani, Paradi2016-01-01Chronic telogen effluvium describes the clinical condition noted mostly in middle-aged women of increased, diffuse scalp hair shedding that is prolonged and often presents with a fluctuating course that may continue for years but does not lead to visible hair thinning. Despite its description almost 20 years ago, the underlying pathologic cause of CTE is yet to be identified. However the culmination of research in the field of hair biology and the burgeoning field of chronobiology may lead to exciting breakthroughs in our understanding of CTE. In this paper the current literature on CTE is reviewed and a hypothesis is put forth that CTE may be triggered by hormonal fluctuations and alterations in circadian control genes.chronic telogen effluviumclock genesestrogenapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/32r353c4articleDermatology Online Journalvol 22, iss 5oai:escholarship.org:ark:/13030/qt4c81f6tn2021-06-18T19:06:58Zqt4c81f6tnUNIVERSITY OF CALIFORNIA HEALTH SYSTEM SCHOOL OF MEDICINE DEPARTMENT OF DERMATOLOGYFaculty Recruitment, UC Davis Department of Dermatology2016-01-01application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4c81f6tnarticleDermatology Online Journalvol 22, iss 8oai:escholarship.org:ark:/13030/qt4ws351w82021-06-18T19:06:56Zqt4ws351w8Zebrafish for modeling skin disordersCline, AbigailFeldman, Steven R2016-01-01The experimental advantages of zebrafish make this model system highly amenable to the field of dermatology. Zebrafish skin development is similar to humans and its genome is ~70% orthologous to the human genome. Its external developmental process allows for genetic manipulation and analysis of embryogenesis within a short time frame with all important internal organs and skin compartments formed within 6 days. Zebrafish models of cutaneous human diseases offer insight into pathogenesis and a unique platform for testing of potential therapies. This review details the specific advantages of zebrafish and highlights its use in dermatological research.ZebrafishDermatologyAnimal Modelsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4ws351w8articleDermatology Online Journalvol 22, iss 8oai:escholarship.org:ark:/13030/qt3cp819gj2021-06-18T19:06:55Zqt3cp819gjUremic pruritus treated successfully with the Goeckerman ProgramNakamura, MioKoo, JohnBhutani, Tina2016-01-01Uremic pruritus (UP) is a common condition among patients with chronic kidney disease (CKD) on hemodialysis (HD). We report 19 a case of severe UP recalcitrant to conventional therapy including topical corticosteroids, anti-histamines, and phototherapy, 20 which was treated successfully with the Goeckerman regimen consisting of topical coal tar, topical corticosteroids, and broadband 21 UVB (BB-UVB). Little is known about the pathophysiology of UP, and there is currently no consensus or evidence-based 22 treatments for UP. Although further studies are necessary, Goeckerman therapy may be a promising treatment option when 23 available for severe UP intractable to conventional therapies.uremic prurituschronic kidney diseaseGoeckermanphototherapyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3cp819gjarticleDermatology Online Journalvol 22, iss 8oai:escholarship.org:ark:/13030/qt45d4x70k2021-06-18T19:06:54Zqt45d4x70kActive tuberculosis in a psoriasis patient treated with tumor necrosis factor inhibitors despite an initial negative tuberculin skin test and no known risk factorsGilbert, Kathleen E Gilbert EManalo, Iviesan FWu, Jashin J2016-01-01Tumor necrosis factor (TNF) inhibitors are becoming more common in the treatment of moderate-to-severe chronic plaque psoriasis. These medications have a low incidence of serious adverse events and are generally considered safe; however, they do make patients more susceptible to tuberculosis (TB) infection both through latent reactivation and primary infection. We describe a case of a patient who had an initial negative tuberculin skin test (TST), began TNF inhibitor therapy, and then 11 years later was diagnosed with active TB. After the initial screening, the patient did not have any subsequent screenings for TB and no apparent change to his TB risk status. TB is still common in many areas of the United States and travel is not necessary to be exposed. Patients on TNF inhibitors that develop active TB have increased morbidity and mortality than those who are not. It is necessary that dermatologists limit the risk of TB to patients by screening them before initiation and annually when they are on the TNF inhibitor.Tuberculosispsoriasistumor necrosis factor inhibitortuberculin skin testrisk factorsinterferon-gamma release assayapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/45d4x70karticleDermatology Online Journalvol 22, iss 8oai:escholarship.org:ark:/13030/qt4xq796m42021-06-18T19:06:53Zqt4xq796m4Top-cited psoriasis authors in 4 high-impact dermatology journals: 2000-2012Reddy, ShivaniVu, ChristinaChoi, Young MikeWu, Jashin J2016-01-01Psoriasis is a largely researched topic with abundant potential for publication in dermatologic journals. We used the Thomson Reuters’ Web of Science citation database using the search term “psoriasis” in the titles of any literature published in 4 high-impact dermatology journals. We compiled a ranking of the top 25 cited first authors and top 25 cited authors overall on the subject of psoriasis between 2000-2012. We hope our analysis highlights the achievements of our colleagues and predecessorspsoriasistop-citedauthorsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4xq796m4articleDermatology Online Journalvol 22, iss 8oai:escholarship.org:ark:/13030/qt1z53b1x52021-06-18T19:06:52Zqt1z53b1x5External ear nodule revealing a disseminated Kaposi diseaseRachadi, HananeZemmez, YoussefZnati, KaoutarIsmaili, NadiaHassam, Badreddine2016-01-01Kaposi disease (KD) is an angiogenetic tumor process, characterized by its various clinical aspects. Its pathogenesis is multifactorial and it was attributed to HHV-8 infection. We report an original case of disseminated KD revealed by solitary lesion of external ear in a patient treated by corticosteroids for bullous pemphigoid.application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1z53b1x5articleDermatology Online Journalvol 22, iss 8oai:escholarship.org:ark:/13030/qt9zw0w33v2021-06-18T19:06:51Zqt9zw0w33vA case of pachydermodactyly in a seventeen year old associated with repetitive minor traumaAbdelrahman, WWalsh, MYSmyth, AAlderice, D2016-01-01A boy presented initially to a Rheumatology clinic with a three year history of asymptomatic swelling of the third to fourth proximal interphalangeal (PIP) joints bilaterally. A presumptive diagnosis of seronegative arthritis was made. Sulfasalazine was commenced without improvement and resulted in mood disturbance. Blood tests including ESR, lupus anticoagulant, rheumatoid factor and CCP antibodies were unremarkable. Hand radiographs were normal. MRI showed oedema within soft tissues around PIP joints. His care was transferred to the Rheumatology unit in our hospital and the rheumatological diagnosis was revised; sulfasalazine was stopped and skin biopsy organised. Onward referral to Dermatology was made. Examination revealed symmetrical swelling and thickening of soft tissues on PIP joints with no evidence of joint synovitis. He denied habitual behaviour but was noted to rub his fingers subconsciously. With this as a cause of repetitive minor trauma, a clinical diagnosis of pachydermodactyly was made. Skin biopsy was supportive showing a dermis with coarse collagen. Pachydermodactyly is rare. This case highlights the importance of prompt recognition to avoid invasive and excessive diagnostic procedures as well as unnecessary immunosuppression.Pachydermodactylyswelling proximal interphalangeal jointsdigital fibromatosisrepetitive traumaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9zw0w33varticleDermatology Online Journalvol 22, iss 8oai:escholarship.org:ark:/13030/qt4mm751qr2021-06-18T19:06:50Zqt4mm751qrErythematous papules over the neck: a diagnostic conundrumDas, AnupamKumar, Piyush2016-01-01Syringomas are common appendageal neoplasms, manifested as skin-colored papules, most commonly distributed over the periorbital region. We describe a patient with syringoma localized over the neck and upper chest.application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4mm751qrarticleDermatology Online Journalvol 22, iss 8oai:escholarship.org:ark:/13030/qt58b7h20z2021-06-18T19:06:49Zqt58b7h20zPrimary periungual leiyomyosarcomaRachadi, HananeDerrabi, NoraMarnissi, FaridaChiheb, Soumaya2016-01-01Primary superficial leiomyosarcoma is a very uncommon malignant tumor which occurs most commonly the lower limbs. We report one case of unusual topography of this tumor. An 81-year-old female patient presented with a 2 year history of a periungual tumor of the left index finger. The histopathological and immunohistochemical examination of a biopsy specimen was compatible with the diagnosis of leiomyosarcoma. There was no evidence of metastatic disease. An amputation of the index was performed.leiyomyosarcomanailsmooth muscle tumorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/58b7h20zarticleDermatology Online Journalvol 22, iss 8oclc_dc:doj:500:4290:eyJmaXJzdCI6NTAwLCJpbmNsdWRlIjpbIlBVQkxJU0hFRCIsIkVNQkFSR09FRCJdLCJvcmRlciI6IlVQREFURURfREVTQyIsImxhc3RJRCI6InF0NThiN2gyMHoiLCJsYXN0RGF0ZSI6IjIwMjEtMDYtMThUMTI6MDY6NDktMDc6MDAifQ