2026-05-12T14:58:22Zhttps://escholarship.org/oaioai:escholarship.org:ark:/13030/qt724667042025-06-17T18:39:44Zqt72466704Response to: "Psychodermatology fellowship: is it time?"Modanlo, NinaYan, Xiaofeng2025-01-01fellowshippsychodermatologyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/72466704https://escholarship.org/content/qt72466704/qt72466704.pdfinfo:doi/10.5070/D331365378articleDermatology Online Journalvol 31, iss 3oai:escholarship.org:ark:/13030/qt7mf5r5c92025-06-17T18:39:43Zqt7mf5r5c9In vivo parallel relaxing incisions for scalp defect repairsClark, Marie MQue, Syril Keena T2025-01-01clinical researchMohs surgeryrelaxing incisionsscalp woundssurgeryapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7mf5r5c9https://escholarship.org/content/qt7mf5r5c9/qt7mf5r5c9.pdfinfo:doi/10.5070/D331365376articleDermatology Online Journalvol 31, iss 3oai:escholarship.org:ark:/13030/qt37r8s9rs2025-06-17T18:39:43Zqt37r8s9rsEmergence of Microsporum audouinii in a tertiary hospital in BrazilAlvim de Minas Santos, Priscilla FilippoTavares Rodrigues, FelipeFichman, VivianAzulay-Abulafia, Luna2025-01-01hair diseasesmycosestinea capitisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/37r8s9rshttps://escholarship.org/content/qt37r8s9rs/qt37r8s9rs.pdfinfo:doi/10.5070/D331365377articleDermatology Online Journalvol 31, iss 3oai:escholarship.org:ark:/13030/qt1n6587962025-06-17T18:39:42Zqt1n658796Dermatologist prescriptions for biologics contribute to thousands of tons of plastic wasteNouafo, MichaRivin, GabrielleFleischer, Jr, Alan2025-01-01atopic dermatitisautoinflammatory diseasebiologicsplastic wastepsoriasisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1n658796https://escholarship.org/content/qt1n658796/qt1n658796.pdfinfo:doi/10.5070/D331365375articleDermatology Online Journalvol 31, iss 3oai:escholarship.org:ark:/13030/qt9r27p22m2025-06-17T18:39:41Zqt9r27p22mArticle processing charges in dermatology journals: a bibliometric analysisYang, KevinKantamneni, KavitaKole, Lauren CS2025-01-01open-accesspublicationsubscriptionapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9r27p22mhttps://escholarship.org/content/qt9r27p22m/qt9r27p22m.pdfinfo:doi/10.5070/D331365374articleDermatology Online Journalvol 31, iss 3oai:escholarship.org:ark:/13030/qt80n5j2wm2025-06-17T18:39:40Zqt80n5j2wmThe Effect of anchoring on patients' likeliness to take an injection treatment for hidradenitis suppurativaSmith, Aaron DLyons, Catherine ELovell, KatieDao, Diem-Phuong DFeldman, Steven R2025-01-01anchoringbiologicshidradenitisinjectionneedlepsychologicaltreatmentwillingnessapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/80n5j2wmhttps://escholarship.org/content/qt80n5j2wm/qt80n5j2wm.pdfinfo:doi/10.5070/D331365373articleDermatology Online Journalvol 31, iss 3oai:escholarship.org:ark:/13030/qt6j13z3pr2025-06-17T18:39:40Zqt6j13z3prAsymptomatic telangiectatic macules on the trunk and proximal extremitiesLi, ChristinePutterman, ElanaYim, KaitlynDeng, AprilLevin, Nikki A2025-01-01Cutaneous collagenous vasculopathy is a rare microangiopathy that presents with asymptomatic telangiectasias and distinct histopathological features, including hyaline material deposition in vessel walls. Diagnosis requires biopsy and differentiation from other telangiectatic disorders. Current treatment options are limited, but increased awareness may improve recognition and management of this rare condition. Herein, we describe an unusual presentation of cutaneous collagenous vasculopathy as asymptomatic, pink, mat-like telangiectatic macules on the trunk and proximal extremities of a 62-year-old woman. Histopathologic evaluation revealed dilated superficial dermal vessels with hyaline thickening of the vessel walls, consistent with a diagnosis of cutaneous collagenous vasculopathy.collagenmicroangiopathytelangiectasiasvasculopathyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6j13z3prhttps://escholarship.org/content/qt6j13z3pr/qt6j13z3pr.pdfinfo:doi/10.5070/D331365372articleDermatology Online Journalvol 31, iss 3oai:escholarship.org:ark:/13030/qt4vq5f2s62025-06-17T18:39:39Zqt4vq5f2s6Facial sinus tract mimicking cutaneous cyst or scar: unveiling a dental infectionCastellano, Ariel Orlando FAlves, Maria Eduarda TFAlves, Flavio RF2025-01-01A 39-year-old man with an unrecognized facial sinus tract under his chin initially presented with an innocuous lesion resembling an acne pimple. The patient's journey began with dermatologic intervention, involving systemic and topical antibiotics. Upon treatment failure, referral to a general dentist revealed a carious lesion on the lower right lateral incisor, prompting further investigation. A subsequent referral to an endodontic specialist led to the diagnosis of a chronic periapical abscess, and an endodontic intervention was initiated. Despite the persistence of intracanal purulent exudate, a strategic application of pure calcium hydroxide was implemented, followed by a temporary seal. A two-year follow-up demonstrated complete healing of the periapical lesion and resolution of the extraoral cutaneous sinus tract. The report showcases the intricate diagnostic journey, meticulous endodontic intervention, and successful management of an extraoral cutaneous sinus tract mimicking scar or cyst, emphasizing the importance of a correct diagnosis to avoid ineffective treatment.dermatitisendodonticsfistulaperiodontitisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4vq5f2s6https://escholarship.org/content/qt4vq5f2s6/qt4vq5f2s6.pdfinfo:doi/10.5070/D331365371articleDermatology Online Journalvol 31, iss 3oai:escholarship.org:ark:/13030/qt0d16q2nd2025-06-17T18:39:38Zqt0d16q2ndEnfortumab vedotin-induced bullous dermatitisWang, RobinFernandez, KristenZelman, BrandonSpeiser, JodiDahiya, MadhuEilers, David2025-01-01Enfortumab vedotin is a first-in-class antibody-drug conjugate used in the treatment of locally advanced or metastatic urothelial carcinoma. A range of cutaneous adverse events has been reported with enfortumab vedotin use. Nectin-4, a transmembrane protein overexpressed by urothelial carcinoma cells, is the intended target of enfortumab vedotin. However, as nectin-4 is also expressed by epidermal keratinocytes, sweat glands, and hair follicles, it is believed that cutaneous toxicity is mediated though off-target delivery of enfortumab vedotin. We present a patient with metastatic urothelial carcinoma who developed a grade 3 bullous dermatitis after his second treatment cycle of enfortumab vedotin and pembrolizumab therapy. Histopathologic findings showed intraepidermal blisters with prominent dyskeratotic and necrotic keratinocytes. Temporary withholding of enfortumab vedotin and pembrolizumab and treatment with potent topical corticosteroids led to significant improvement and enfortumab vedotin (with pembrolizumab) was resumed at a reduced dosage of enfortumab vedotin without recurrence. We present this case to highlight the clinical manifestations, histopathologic findings, and management of enfortumab vedotin-induced cutaneous toxicity.bullous dermatitiscutaneous toxicityenfortumab vedotinnectin-4application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0d16q2ndhttps://escholarship.org/content/qt0d16q2nd/qt0d16q2nd.pdfinfo:doi/10.5070/D331365370articleDermatology Online Journalvol 31, iss 3oai:escholarship.org:ark:/13030/qt3k13p13t2025-06-17T18:39:37Zqt3k13p13tPurpura fulminans secondary to toxic shock syndrome induced by Group A Streptococcal bacteremia in an adult patientHartmann, BredesenKemper, KortniBlaise, Brittany2025-01-01Purpura fulminans is a rare life-threatening presentation of disseminated intravascular congestion that presents with widespread purpura and skin necrosis secondary to considerable tissue thrombosis. It usually occurs in pediatric patients and can have various causes with acute infection being the most common. Common infectious triggers include Neisseria and Streptococcus pneumoniae as well as varicella. Our report describes a generally healthy adult patient who developed purpura fulminans in the setting of Group A Streptococcus bacteremia. Group A Streptococcus is a rare cause of purpura fulminans in adult patients with only a few documented cases reported in the literature.purpura fulminansStreptococcus pyogenes [KL1]application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3k13p13thttps://escholarship.org/content/qt3k13p13t/qt3k13p13t.pdfinfo:doi/10.5070/D331365368articleDermatology Online Journalvol 31, iss 3oai:escholarship.org:ark:/13030/qt3j09q8rh2025-06-17T18:39:37Zqt3j09q8rhMinimally invasive management of osteoma cutis miliarisPinzon-Luna, JulianaSanchez-Zapata, Maria JRodriquez-Lechtig, BladimirSarmiento-Ruiz, AnaRolon, MariamMotta-Beltran, Adriana2025-01-01Osteoma cutis miliaris is a rare condition of bone formation in the dermis, often misdiagnosed. We present a 52-year-old woman with asymptomatic, hard papules on the forehead, initially treated as acne. Biopsy confirmed osteoma cutis, and surgical removal via microincisions successfully extracted the lesions with no recurrence. This case emphasizes the importance of accurate diagnosis and highlights a minimally invasive approach as an effective, low-risk treatment option.facial dermatosesosteomaosteoma cutisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3j09q8rhhttps://escholarship.org/content/qt3j09q8rh/qt3j09q8rh.pdfinfo:doi/10.5070/D331365369articleDermatology Online Journalvol 31, iss 3oai:escholarship.org:ark:/13030/qt6m03q9pt2025-06-17T18:39:36Zqt6m03q9ptExtensive colloid milium in a patient with chronic actinic dermatitisAziz, HiraRahman, AtiyaShafqat, SaraAltaf, AnamBajwa, Akhtar2025-01-01Colloid milium is a rare and clinically underdiagnosed dermatosis, characterized by deposition of amorphous material in the dermis. Definitive diagnosis is established by histopathology which reveals the presence of colloid in dermal papillae. Photo-exposed areas are the most frequently involved sites and include dorsa of hands, neck, and ears. We present an adult man with an outdoor occupation who had longstanding chronic actinic dermatitis. For one and a half years he had been developing skin colored to slightly erythematous papules and nodules on his face, anterior neck, and dorsal aspect of the hands, symmetrically. These discrete lesions arose on the background of his eczematous sun exposed skin. Skin biopsy for histopathology of these papules showed deposition of amorphous colloid material in the dermal papillae with an uninvolved Grenz zone along with dermal solar elastoses. The coexistence of colloid milium with chronic actinic dermatitis in the same patient has not been previously reported in the medical literature even though both conditions are precipitated by chronic sun exposure. Similarly, such extensive lesions of colloid milium have rarely been reported and we ascribe this to his profession, compelling him to spend numerous hours in the sun every day.colloid miliumsun-inducedsolar elastosisphoto-dermatosesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6m03q9pthttps://escholarship.org/content/qt6m03q9pt/qt6m03q9pt.pdfinfo:doi/10.5070/D331365367articleDermatology Online Journalvol 31, iss 3oai:escholarship.org:ark:/13030/qt7vw3x18s2025-06-17T18:39:35Zqt7vw3x18sTemporary improvement of porokeratotic inflammatory linear verrucous epidermal nevus with fractionated CO2 laser resurfacingNugent, MatthewBravo, AlexanderShackelton, Jeffrey2025-01-01Inflammatory linear verrucous epidermal nevus is a rare benign epidermal nevus that classically presents in childhood with pruritic, linear, erythematous, scaly coalescing papules and plaques distributed along the lines of Blaschko. We report a 28-year-old woman with a long-standing history of photosensitive pruritic dermatosis, exhibiting minimal improvement with topical therapies, including clobetasol, cholesterol/lovastatin cream, and ruxolitinib. Histologic evaluation revealed psoriasiform epidermal hyperplasia with focal cornoid lamella. The combination of clinical and histologic features led to the diagnosis of porokeratotic inflammatory linear verrucous epidermal nevus, a proposed variant of inflammatory linear verrucous epidermal nevus with overlapping features of linear porokeratosis. The patient demonstrated substantial improvement following CO2 laser therapy, highlighting its potential as an effective treatment option for this variant of inflammatory linear verrucous epidermal nevus.CO2-laserILVENmosaicismneviporokeratosispruriticapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7vw3x18shttps://escholarship.org/content/qt7vw3x18s/qt7vw3x18s.pdfinfo:doi/10.5070/D331365366articleDermatology Online Journalvol 31, iss 3oai:escholarship.org:ark:/13030/qt0fz1214h2025-06-17T18:39:35Zqt0fz1214hArtri King induced Cushing syndrome in an 82-year-old manChoi, SuyoungYoun, ChristopherYang, VivianBax, ChristinaBae, Gordon2025-01-01An 82-year-old man with a history of hypertension, thyroid nodule, and parkinsonism on carbidopa/levodopa was referred for a sudden eruption of scattered purpuric macules. He noted fatigue, weakness, ankle swelling, abdominal fullness, headaches, lapses in memory, and dysphasia. On physical examination, he had thin and atrophied upper extremities and central obesity, as well as nonblanching red to purple macules on the lower abdomen and ecchymosis on bilateral arms. The patient denied the use of any corticosteroids. Lab workup showed an abnormally high post-dexamethasone cortisol level, which raised suspicion for Cushing syndrome. Further inquiry into the patient's medication and supplement history revealed that he was consuming Artri King, a supplement marketed for the treatment of joint pain and arthritis. Artri King can lead to numerous dermatological manifestations akin to endogenous Cushing syndrome such as thin skin, easy bruising, and purple striae. This case illustrates the potential risks of over-the-counter dietary supplements, which often circumvent the strict Food and Drug Administration regulations applied to prescription medications, posing significant health hazards to users. There is critical need for transparency and regulation of supplements.Artri KingCushing diseaseherbalssupplementsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0fz1214hhttps://escholarship.org/content/qt0fz1214h/qt0fz1214h.pdfinfo:doi/10.5070/D331365365articleDermatology Online Journalvol 31, iss 3oai:escholarship.org:ark:/13030/qt6m7229wp2025-06-17T18:39:34Zqt6m7229wpUnilateral discoid lupus erythematosus: two atypical cases with distinct presentationsHalim, P AnthonyRizky, Luddwi AchmadFitri, Eyleny MeisyahNovianto, EndiPutri Maharani, Maria AngelaSirait, Sondang PBudianti, Windy Keumala2025-01-01Discoid lupus erythematosus can present in various atypical forms, posing significant diagnostic challenges as it can mimic other infectious or neoplastic dermatoses. Herein, we detail two cases of strictly unilateral, multifocal discoid lupus erythematosus and compare them with previously reported cases. This report contributes to the limited literature on this unusual presentation, particularly in individuals with skin of color.atypicaldermoscopydiscoidlupus erythematosusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6m7229wphttps://escholarship.org/content/qt6m7229wp/qt6m7229wp.pdfinfo:doi/10.5070/D331365364articleDermatology Online Journalvol 31, iss 3oai:escholarship.org:ark:/13030/qt7wk892h12025-06-17T18:39:33Zqt7wk892h1Concurrent tinea pedis HPV-associated squamous cell carcinoma of the ventral toes treated with Mohs micrographic surgeryWang, AnnieSenthilnathan, AditiWang, HongbeiBridges, AlinaSharon, Victoria2025-01-01We present a case of human papillomavirus-associated squamous cell carcinoma arising between the ventral toes. A 60-year-old man presented with a 6-year history of a growth between the right fourth and fifth toes that had previously been thought to be secondary to hammertoe deformity. Initial biopsy favored verruca vulgaris with associated fungal hyphae and he was treated accordingly. Subsequent biopsy showed squamous cell carcinoma in situ with positive for high-risk human papillomavirus subtypes 16 and 18. He was successfully treated with Mohs surgery. This is the first published case of human papillomavirus 18-associated interdigital squamous cell carcinoma of the toes treated with Mohs surgery.HPVinterdigital webspaceMohs surgerySCCapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7wk892h1https://escholarship.org/content/qt7wk892h1/qt7wk892h1.pdfinfo:doi/10.5070/D331365363articleDermatology Online Journalvol 31, iss 3oai:escholarship.org:ark:/13030/qt1nc1g9cn2025-06-17T18:39:33Zqt1nc1g9cnImprovement of pruritus associated with erythrocytosis in transmasculine patients undergoing gender-affirming therapy with phlebotomy: a report of two patientsGalamgam, JaydenBaroni, ErinTsai, StevenCheng, Carol E2025-01-01Gender-affirming hormone therapy with testosterone may be a component in the treatment plan for transmasculine individuals. Secondary erythrocytosis induced by testosterone therapy and its subsequent complications, such as pruritus, have been reported in the literature in cisgender men. This report presents two transmasculine patients who developed generalized pruritus shortly after initiating testosterone therapy for gender-affirming care. Both patients exhibited elevated hemoglobin and hematocrit levels indicative of testosterone-induced erythrocytosis. Despite treatments, including topical corticosteroids, antihistamines, gabapentin, and benzodiazepines, their symptoms persisted. Symptomatic relief was achieved through therapeutic phlebotomy. The occurrence of polycythemia vera-like pruritus underscores a significant but less commonly recognized side effect of testosterone therapy. Balancing effective gender-affirming care and patient goals with the management of associated side effects is essential for optimizing patient outcomes.erythrocytosisgender-affirminggender-affirming caregender-affirming therapypruritustestosterone therapytransgendertransgender healthtransmasculineapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1nc1g9cnhttps://escholarship.org/content/qt1nc1g9cn/qt1nc1g9cn.pdfinfo:doi/10.5070/D331365362articleDermatology Online Journalvol 31, iss 3oai:escholarship.org:ark:/13030/qt9r09m0jf2025-06-17T18:39:32Zqt9r09m0jfAtypical presentation of axillary web syndrome following punch biopsy: case report and literature reviewRahmani, LioraLieberman, Miriam RGroysman, TatyanaRosen, Meryl2025-01-01Axillary web syndrome, or cording, presents as fibrotic bands that develop beneath the skin, causing pain and restricted shoulder movement. Axillary web syndrome typically arises as a complication following axillary surgery for breast cancer. We present a unique case of a 38-year-old woman with no history of malignancy, breast surgery, or trauma, who developed AWS following a punch biopsy after initially presenting with a subcutaneous nodule in the right axilla. This case highlights the need for increased exploration of the pathogenesis of axillary web syndrome, suggesting a potentially higher incidence of axillary web syndrome than currently reported owing to its self-limiting nature. In addition, the case demonstrates the importance of dermatological awareness of this condition, as its presentation is not limited to breast cancer patients who have undergone major axillary and breast procedures.biopsybreast cancerbreast surgerydermatologyprocedure complicationpunch biopsyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9r09m0jfhttps://escholarship.org/content/qt9r09m0jf/qt9r09m0jf.pdfinfo:doi/10.5070/D331365361articleDermatology Online Journalvol 31, iss 3oai:escholarship.org:ark:/13030/qt4818z4jr2025-06-17T18:39:31Zqt4818z4jrAn evolving supraclavicular plaque: diagnostic challenges in dermatofibrosarcoma protuberans with atrophic and myxoid featuresKazmi, MahaKusari, AyanHaemel, AnnaLeBoit, Philip EYu, Siegrid S2025-01-01Dermatofibrosarcoma protuberans is an uncommon locally aggressive mesenchymal neoplasm that classically presents with a proliferation of monomorphic spindled cells with thin nuclei and scant cytoplasm. We report a man in his twenties who presented for an unrelated skin concern and was incidentally noted to have a large, atrophic scar-like depression of the left supraclavicular neck and shoulder. The plaque was photographed and the patient was instructed to follow-up in one year, and careful photo comparison revealed the lesion had subtly enlarged and darkened in color. Accordingly, a punch biopsy revealed features of myxoid dermatofibrosarcoma protuberans, a dermal proliferation of spindled cells with mucinous degeneration and more cellular areas with extensive nuclear palisading resembling the Verocay bodies of a neurofibroma. Clinicians should be aware of the broad clinicopathologic spectrum of DFSP to ensure timely diagnosis and effective treatment. Myxoid dermatofibrosarcoma protuberans is a rare and clinically challenging diagnosis, as the mucinous areas can impart a bluish hue. Dermatofibrosarcoma protuberans can also be atrophic, with the loss of the normal dermal thickness corresponding to a clinical appearance easily mistaken for anetoderma or atrophic scar. Palisaded nuclei resembling the Verocay bodies of schwannoma are sometimes seen and can further obfuscate the diagnosis.dermatofibrosarcoma protuberansVerocaymyxoidapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4818z4jrhttps://escholarship.org/content/qt4818z4jr/qt4818z4jr.pdfinfo:doi/10.5070/D331365359articleDermatology Online Journalvol 31, iss 3oai:escholarship.org:ark:/13030/qt1sx0x4j32025-06-17T18:39:31Zqt1sx0x4j3Histiocytoid Sweet syndrome-like presentation of mature plasmacytoid dendritic cell proliferationRypka, KatelynMeisenheimer, JohnShaver, RobRavishankar, AdarshPeltola, JustinMesa, HectorJacobson-Dunlop, ErickCollier, SigridGaddis, KevinGoldfarb, Noah2025-01-01Mature plasmacytoid dendritic cell proliferation is a condition associated with myeloid neoplasms, most commonly chronic myelomonocytic leukemia. Plasmacytoid dendritic cells can resemble lymphocytes and histiocytes morphologically and immunophenotypically. Mature plasmacytoid dendritic cell proliferation may therefore go unrecognized if the diagnosis is not suspected and appropriate stains for plasmacytoid dendritic cells are not performed. Herein, we present a case of mature plasmacytoid dendritic cell proliferation masquerading clinically and histologically as histiocytoid Sweet syndrome. The patient, who had previously been diagnosed with mature plasmacytoid dendritic cell proliferation that presented as pink, edematous, pruritic papules and plaques, had initially resolved following induction chemotherapy for acute myelomonocytic leukemia. However, he presented later with indurated purpuric plaques on the trunk within weeks of receiving filgrastim for neutropenia. Biopsies demonstrated marked dermal edema, interstitial, superficial, and deep infiltrate with histiocytoid appearing cells concerning for histiocytoid Sweet syndrome. Further work-up demonstrated that the infiltrate was predominantly composed of CD3-, CD4+, CD34-, CD123+, CD56-, CD68-, myeloperoxidase negative mononuclear cells consistent with mature plasmacytoid dendritic cell proliferation. This case demonstrates that MPDCP should be considered in the differential diagnosis of eruptions that clinically and histologically look like histiocytoid Sweet syndrome but stain negatively for myeloperoxidase.dermatologyhistiocytoidmimicpathologyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1sx0x4j3https://escholarship.org/content/qt1sx0x4j3/qt1sx0x4j3.pdfinfo:doi/10.5070/D331365360articleDermatology Online Journalvol 31, iss 3oai:escholarship.org:ark:/13030/qt9p75464j2025-06-17T18:39:30Zqt9p75464jFrequency of statistical mistakes and associated article characteristics: a cross-sectional analysis of dermatology journalsWoodie, Brad RFreking, Justin AJones, Grace MPorter, JustinFleischer, Sarah EPauley, Annabella GFleischer, Alan B2025-01-01Statistical mistakes can undermine research credibility. Identifying common errors may help researchers avoid them in future studies. This study evaluated the frequency and types of statistical mistakes in dermatology journal articles and identified article characteristics that predict these errors. A cross-sectional analysis was conducted on articles published in the 2023 volumes of 8 dermatology journals. Articles were screened for statistical tests, with a target sample of 200 selected pseudorandomly. Multivariable logistic regressions assessed predictors of statistical mistakes, including journal impact factor, statistician involvement, funding source, first author highest degree, and statistical package. Of the 189 articles analyzed, 78% contained at least one statistical mistake. Reporting mistakes were found in 67% and test selection errors in 46%. The absence of statistician involvement (aOR 2.49, P=0.03) and low journal impact factor (aOR 3.82, P=0.02) predicted the presence of at least one mistake. This sample from 8 journals is not representative of all dermatology literature. Original data were not available for testing of test assumptions, so appropriate test selection was determined using statistical conventions. Statistical mistakes are prevalent in dermatology literature. Researchers should review statistical best practices and consider involving a statistician in their work.biostatisticserrorsregression analysisresearch designstatistics[KL3][BW4]application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9p75464jhttps://escholarship.org/content/qt9p75464j/qt9p75464j.pdfinfo:doi/10.5070/D331365357articleDermatology Online Journalvol 31, iss 3oai:escholarship.org:ark:/13030/qt51c0100s2025-06-17T18:39:30Zqt51c0100sMalignant melanoma arising within tattoos as a risk factor for delayed diagnosis: a case report and systematic reviewBenandi, KatherineSieving, DevonMartin, KatherineWolf, Kristin2025-01-01Malignant melanoma lesions arising in tattoo pigment pose diagnostic challenges, but current literature lacks quantitative data on delayed diagnosis. This study reports a new case involving multiple melanoma lesions in tattoo pigment, alongside a systematic review of past cases. Our objectives were to evaluate the potential for delayed diagnosis in patients with melanoma lesions in tattoo pigment and its impact on prognosis, comparing tumor characteristics with large-scale melanoma studies. A systematic review was conducted using PubMed and Ovid MEDLINE. Included studies were English-language reports of melanoma lesions in tattoo pigment, identifying new cases via case reports/series. Independent review and discussion resolved discrepancies. The review yielded 37 articles with 42 reports of melanoma lesions in tattoo pigment, totaling 43 cases. Of these, 35 were invasive, with mean and median Breslow thickness of 2.49mm and 0.9mm, respectively, which is higher than in large-scale studies. Patients also had a higher incidence of invasive lesions at diagnosis. The increased Breslow depth and risk of dermal invasion suggest a higher risk for delayed diagnosis and worse prognosis in melanoma arising in tattoo pigment. Further analysis of dermatoscopic differences is needed to improve diagnostic guidelines and avoid delayed diagnosis.Malignant melanomaskin cancertattoosapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/51c0100shttps://escholarship.org/content/qt51c0100s/qt51c0100s.pdfinfo:doi/10.5070/D331365358articleDermatology Online Journalvol 31, iss 3oai:escholarship.org:ark:/13030/qt3qk6r1sz2025-05-23T11:14:01Zqt3qk6r1szUnilateral acne: think about cell-phone acneRachadi, HananeElfatoiki, FZHali, FChiheb, Soumiya2025-01-01acnecell phone acneunilateral acneapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3qk6r1szhttps://escholarship.org/content/qt3qk6r1sz/qt3qk6r1sz.pdfinfo:doi/10.5070/D331265307articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt81z6p7ss2025-05-23T11:14:00Zqt81z6p7ssStyling practices, crown thinning, and scalp health in Black womenPyles, JosephineOlukoga, ChrisleneAvashia-Khemka, Nidhi2025-01-01alopeciablackbleachbraidscccacentrifugalcrownhairrelaxerscalpapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/81z6p7sshttps://escholarship.org/content/qt81z6p7ss/qt81z6p7ss.pdfinfo:doi/10.5070/D331265305articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt4r33j5mp2025-05-23T11:14:00Zqt4r33j5mpDeconstructing the prevalence of undifferentiated pleomorphic sarcoma across socio-demographic groups: a potential launchpad for future researchFu, ShangyiTaing, MatthewHuynh, DannyKeeling, BrettAhmed, Ammar2025-01-01epidemiologyskin cancersocial issuesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4r33j5mphttps://escholarship.org/content/qt4r33j5mp/qt4r33j5mp.pdfinfo:doi/10.5070/D331265306articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt1gc1m39j2025-05-23T11:13:59Zqt1gc1m39jOccupational dermatologic conditions in nail salon techniciansPham, Vy XBriones, Naomi FPark, Helen HJiang, Shang I Brian2025-01-01allergycosmetologydermatitisdermatologyirritantoccupationalapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1gc1m39jhttps://escholarship.org/content/qt1gc1m39j/qt1gc1m39j.pdfinfo:doi/10.5070/D331265304articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt8zz4431f2025-05-23T11:13:58Zqt8zz4431fLandscape of dermatology education in allopathic medical schools across the United StatesPoppens, McKaylaMcClain, WestonCollier, ErinCheng, KyleHogeling, Marcia2025-01-01curriculumdermatologymedical educationUSMLEapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8zz4431fhttps://escholarship.org/content/qt8zz4431f/qt8zz4431f.pdfinfo:doi/10.5070/D331265303articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt550605832025-05-23T11:13:57Zqt55060583Evaluating dermatology appointment lead times with Zocdoc: a cross-sectional studyAparicio, MarianaDyson, Mary EBlack, T AustinAnderson, Isabella RRashid, Rashid M2025-01-01accessibilitycross-sectionaldisparitiesinternetmedicaidonlineschedulestechnologyurban dermatologyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/55060583https://escholarship.org/content/qt55060583/qt55060583.pdfinfo:doi/10.5070/D331265302articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt5ck9m3f12025-05-23T11:13:56Zqt5ck9m3f1Changes in public interest for Mohs micrographic surgery: a Google Trends analysisBurshtein, JoshuaShah, MilaanZakria, DannyDeBusk, LaurenRosenberg, AngelaRigel, Darrell2025-01-01eclare that the contents of this article are their own original unpublished findings. Title: Changes in public interest for Mohs micrographic surgery: a Google Trends analysis Authors: Joshua Burshtein1 MD, Milaan Shah2 MD, Danny Zakria3 MD MBA, Lauren DeBusk4 MD, Angela Rosenberg4 DO, Darrell Rigel5 MD MS Affiliations: 1Department of Dermatology, University of Illinois Chicago, Chicago, Illinois, USA, 2Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina, USA, 3Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA, 4Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas, USA, 5Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA Corresponding Author: Joshua Burshtein MD, 808 South Wood Street, Chicago, IL 60612, Tel: 845-596-9482, Email: jburshtein13@gmail.comapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5ck9m3f1https://escholarship.org/content/qt5ck9m3f1/qt5ck9m3f1.pdfinfo:doi/10.5070/D331265301articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt1103r44c2025-05-23T11:13:55Zqt1103r44cUnited States public interest in melanoma and prevention and its association with incidence, mortality, and dermatologist densityBurshtein, JoshuaShah, MilaanZakria, DannyDeBusk, LaurenRosenberg, AngelaRigel, Darrell2025-01-01dermatologist densitygoogle trendsincidencemelanomamortalitypublic healthapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1103r44chttps://escholarship.org/content/qt1103r44c/qt1103r44c.pdfinfo:doi/10.5070/D331265300articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt77z0670n2025-05-23T11:13:54Zqt77z0670nSafe and efficacious use of the Q-switched alexandrite laser to treat traumatic tattooWhite, HarrisonAshchyan, HovikMinkis, Kira2025-01-01Traumatic tattoos result from the forceful implantation of foreign material into the skin and may present a significant cosmetic burden to patients. Long-lasting or permanent skin pigmentation in traumatic tattoo may arise from particles of numerous materials such as fireworks, metals, gunpowder, asphalt, and dust embedded within injured skin. Our aim was to demonstrate the appropriate and beneficial use of the Q-switched alexandrite laser to treat traumatic tattoos. The patient's pigmented scars were biopsied and processed using standard histological methods to demonstrate foreign material within the scars. Following patient consent and laser tolerance testing, pigmented scars on the face were treated on two occasions with the Q-switched alexandrite laser. Progress photos were obtained before and after each treatment. The pigmented lesions responded well to treatment with the Q-switched alexandrite laser and exhibited almost complete resolution of foreign body pigmentation after just two treatments. The Q-switched alexandrite laser was used safely and effectively to treat traumatic tattoos.alexandritecosmeticdermatologylaserpigmentQ-switchedtattootraumatic tattooapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/77z0670nhttps://escholarship.org/content/qt77z0670n/qt77z0670n.pdfinfo:doi/10.5070/D331265299articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt9jw9q7r12025-05-23T11:13:53Zqt9jw9q7r1Foreign body granuloma from retained temporary epicardial pacing wire disguised as a painful, nonhealing cutaneous noduleClass, MadelynPatel, Bansri MYamane, KentaroKen, Kimberly M2025-01-01A 76-year-old woman with a significant cardiac surgery and breast cancer history presented to the dermatology clinic with a three-year history of an enlarging, tender, nonhealing cutaneous nodule on her upper abdomen. A shave biopsy was attempted given concern for nonmelanoma skin cancer or cutaneous metastasis. The biopsy was halted after a white wire was visualized. Retrospective computed tomography (CT) imaging review revealed a hyperdense linear structure becoming superficial at the location of the nodule seen on examination. Discussion with a cardiothoracic surgeon revealed this wire was likely a retained temporary epicardial pacing wire that was placed at the time of the patient's cardiac surgery three years prior. The decision was made to excise the lesion to fully remove the wire. Given intraoperative resistance with traction, the wire was partially removed by cutting it flush to the skin's surface. The patient healed appropriately with complete resolution of her symptoms. This case is unique because the wire was fully visualized on the CT scan, and it was unable to be fully removed.Cutaneous noduleforeign bodygranulomanonhealing lesionpacing wireretained wireapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9jw9q7r1https://escholarship.org/content/qt9jw9q7r1/qt9jw9q7r1.pdfinfo:doi/10.5070/D331265298articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt1nr8d8vk2025-05-23T11:13:52Zqt1nr8d8vkEnchondroma of the toe presenting as clubbing and painless longitudinal erythronychiaLevian, BrandonRavi, VigneshMosallaei, DanielCruz, SebastianChiu, MelvinDeClerck, BrittneyHu, Jenny2025-01-01Enchondromas are frequently occurring cartilaginous tumors, accounting for 10-25% of all benign bone neoplasms. We present a distinctive case involving distal clubbing of the right third toenail with a painless, 5mm-wide red longitudinal streak. Clinical examination, nail matrix biopsy, and imaging confirmed the presence of an enchondroma in the distal phalanx. Although solitary enchondromas often present with pain or pathological fractures, asymptomatic cases like this one are quite rare. Given the low risk of malignant transformation, the patient chose regular magnetic resonance imaging (MRI) monitoring. This case highlights the need to consider enchondromas in the differential diagnosis of painless longitudinal erythronychia, an infrequent manifestation. Proper diagnosis is essential to differentiate these lesions from malignant chondrosarcomas, which have a different management approach.cartilageenchondromaerythronychianail neoplasmnail tumorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1nr8d8vkhttps://escholarship.org/content/qt1nr8d8vk/qt1nr8d8vk.pdfinfo:doi/10.5070/D331265297articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt1353g84q2025-05-23T11:13:51Zqt1353g84qMultiple bluish papules and nodules in a 12-year-old child with lower gastrointestinal bleeding: a diagnostic challengeBrazao, ClaudiaMancha, DoraSun, LanyuAntunes-Duarte, SofiaFernandes, SoniaRodrigues, LuisRodrigues, Marciade Vasconcelos, PedroSoares-de-Almeida, LuisFilipe, Paulo2025-01-01Blue rubber bleb nevus syndrome (BRBNS) and familial multiple glomuvenous malformations (GVM) are genetic disorders characterized by multiple cutaneous vascular malformations. Unlike multiple GVM, BRBNS comprises a risk of systemic involvement with vascular malformations in other organs, potentially causing life-threatening bleeding. The correct distinction between these two conditions is challenging due to their clinical similarity, but it is crucial in light of the pivotal differences in prognosis and follow-up. We report a case of multiple glomuvenous malformations in a child with lower gastrointestinal bleeding that posed a thought-provoking diagnosis.BRBNSgastrointestinal hemorrhageglomus tumorGVMvascular malformationsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1353g84qhttps://escholarship.org/content/qt1353g84q/qt1353g84q.pdfinfo:doi/10.5070/D331265296articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt7j7943rv2025-05-23T11:13:50Zqt7j7943rvSecondary anetoderma following lichen planusLiu, Alex YBorda, Luis JPariser, Robert J2025-01-01Anetoderma is commonly characterized by well-circumscribed areas of slack or baggy skin related to the loss of elastic fibers in the dermis. It has associations with some well-defined skin lesions, such as acne vulgaris and varicella. We report a 67-year-old woman with clinical and pathologically confirmed anetoderma at sites of previously documented lichen planus.anetodermalichen planussecondaryapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7j7943rvhttps://escholarship.org/content/qt7j7943rv/qt7j7943rv.pdfinfo:doi/10.5070/D331265295articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt59g2t27m2025-05-23T11:13:50Zqt59g2t27mA case of trastuzumab-deruxtecan-induced subacute cutaneous lupus erythematousTrepanowski, NicoleShah, PayalBai, HeidiYan, ShaofengFragoso, NatalieBarton, Dorothea2025-01-01Drug-induced subacute cutaneous lupus erythematosus (DI-SCLE) is an erythematous, photodistributed, scaly, and annular cutaneous eruption that is clinically similar to subacute cutaneous lupus erythematosus. However, DI-SCLE is associated with medication use and generally resolves or greatly improves following discontinuation. Chemotherapeutic agents are common triggers of DI-SCLE. We report a patient with breast cancer who experienced multiple episodes of DI-SCLE associated with the use of different chemotherapeutic agents for treatment-resistant cancer. Notably, to the best of our knowledge, this case highlights the first reported association of DI-SCLE with trastuzumab deruxtecan. Additionally, this case is unique owing to a component of radiation recall dermatitis, as the rash was prominent in areas that had prior ionizing radiation. A prior history of DI-SCLE in oncology patients who continue to undergo treatment should prompt clinicians to consider DI-SCLE when faced with a new photodistributed, erythematous, annular, and scaly eruption. Early initiation of immunomodulating agents like hydroxychloroquine in patients with a history of moderate to severe DI-SCLE to chemotherapy who continue to undergo anti-cancer treatment may provide benefit and warrants further investigation.adversebreastcancercutaneouscyclophosphamidedermatitisderuxtecandoxorubicindrug-inducedeffecteribulinerythematosusgemcitabinelupusmultipleoncologyradiationrecallrecurrentsubacutetrastuzumabapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/59g2t27mhttps://escholarship.org/content/qt59g2t27m/qt59g2t27m.pdfinfo:doi/10.5070/D331265294articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt7hp9d0nz2025-05-23T11:13:49Zqt7hp9d0nzCutaneous metastasis of serous ovarian carcinomaPadniewski, JessicaEsse, IlhanTruong, AndrewGaddis, Kevin2025-01-01Ovarian carcinoma ranks among the top causes of cancer-related fatalities among women in the United States [1]. In the spectrum of ovarian carcinomas, low-grade serous ovarian carcinoma (LGSOC) is a relatively rare form, constituting only 2-5% of all ovarian carcinomas [2]. Although metastasis to the peritoneum and other organs is frequently observed, cutaneous metastasis of ovarian carcinoma is uncommon, occurring in less than 4% of cases and occurring even less often in the serous subtype [3]. Owing to its rare and variable presentation, cutaneous involvement in ovarian carcinoma is particularly challenging to recognize. Patients presenting with skin lesions in the setting of a history of ovarian carcinoma should raise suspicion for cutaneous metastasis. We present a rare case of LGSOC with non-nodular cutaneous involvement presenting as asymptomatic erythematous papules and hyperpigmented patches on the upper chest, abdomen, and lower back.cutaneous metastasishgsocovarian carcinomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7hp9d0nzhttps://escholarship.org/content/qt7hp9d0nz/qt7hp9d0nz.pdfinfo:doi/10.5070/D331265293articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt2399t7xv2025-05-23T11:13:48Zqt2399t7xvErlotinib-induced trichomegaly of eyelashes in lung cancer treatment: Epidermal growth factor receptor inhibitor side effectEl Haddad, MeriemEl Jouari, OuiameSalim, Gallouj2025-01-01Erlotinib is one of the epithelial growth factor receptor tyrosine kinase inhibitors that have been developed and extensively employed in the treatment of non-small cell lung cancer, particularly in individuals with activating epithelial growth factor receptor mutations. This report presents a case of erlotinib induced eyelash trichomegaly and irritation, a rare side effect in a woman who received erlotinib for lung adenocarcinoma. Following the detection of an epithelial growth factor receptor mutation in tumor tissue from a non-small cell lung cancer in a nonsmoking woman, the patient was initiated on erlotinib therapy. After several months, she experienced significant overgrowth of both eyelashes, leading to vision problems. Dermoscopy findings revealed an increase in the length and thickness of the eyelashes associated with inflammation of the eyelid's edges. It has been hypothesized that the inhibition of epithelial growth factor receptor signaling by epithelial growth factor receptor tyrosine kinase inhibitors could alter the growth pattern of hair, potentially leading to the induction of abnormal hair growth, such as trichomegaly, which has been reported only in a small number of case reports.erlotinibepithelial growth factor receptor tyrosine kinase inhibitorslung adenocarcinomatrichomegalyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2399t7xvhttps://escholarship.org/content/qt2399t7xv/qt2399t7xv.pdfinfo:doi/10.5070/D331265292articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt5mh323cc2025-05-23T11:13:47Zqt5mh323ccAngiomatoid melanomaHulse, JackFraga, GarthFink, Matthew2025-01-01Angiomatoid melanoma is a rare variant of malignant melanoma not currently recognized by the World Health Organization classification system. In this study, we present a case of primary angiomatoid melanoma in a 57-year-old man who presented to clinic with a complaint of a growing lesion on the frontal scalp for four months. Microscopic examination of the lesion revealed cavernous spaces filled with extravasated red blood cells. Immunohistochemical markers were positive for melanoma and negative for vascular endothelium. We also review the literature on angiomatoid melanoma, finding distinct morphological differences in previously reported cases. Owing to these differences, we propose new diagnostic criteria and offer a mechanism for formation of blood-filled cavernous spaces while cautioning against misinterpretation of CD31 expression by macrophages in zones of immune regression. Angiomatoid melanoma is a diagnostic challenge because of its rarity, signaling a need for further histopathological evaluation and more complete awareness of its features.angiomatoidCD31melanomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5mh323cchttps://escholarship.org/content/qt5mh323cc/qt5mh323cc.pdfinfo:doi/10.5070/D331265290articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt4mm2z13p2025-05-23T11:13:47Zqt4mm2z13pFluoroscopic radiation induced skin reactions: Radiation dermatitis and radiation-induced morpheaYoung, Kelly ZKolli, Sree SKwa, Michael CMcHargue, Chauncey2025-01-01Given the rise of radiation based medical procedures, cutaneous radiation reactions are increasing in frequency. Diagnosis of fluoroscopic radiation-related cutaneous injuries are challenging, as patients are often unaware of or cannot recall radiation exposure. It is important to maintain clinical suspicion of radiation induced skin injuries in patients with persistent morpheaform areas and localized areas of dermatitis or ulceration. Several cutaneous radiation induced injuries have overlapping clinical presentations. Histopathology may be required to help differentiate between these distinct disorders. Treatment of cutaneous radiation reactions may vary, dictated by a variety of factors, including the disease process, the severity of the lesions, and the presence of comorbidities. Herein, we present two cases to highlight the spectrum of fluoroscopic radiation induced cutaneous injuries.radiation dermatitisradiation injuryradiation-induced morpheaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4mm2z13phttps://escholarship.org/content/qt4mm2z13p/qt4mm2z13p.pdfinfo:doi/10.5070/D331265291articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt8tq5q33q2025-05-23T11:13:46Zqt8tq5q33qAn atypical mycobacterial infection while on Janus kinase inhibitor therapyValek, Stephanie ABlack, T AustinAboul-Fettouh, NaderRogge, Megan N2025-01-01Janus kinase inhibitors are immunomodulatory drugs increasingly used to treat a broad range of inflammatory dermatologic conditions. Although effective, they carry a risk of serious adverse effects, including opportunistic infections. We present a patient who developed an atypical mycobacterial infection while on the Janus kinase 1 and Janus kinase 3 inhibitors, tofacitinib. A 76-year-old man was started on tofacitinib for a severe ulcerative colitis flare. Six weeks after starting therapy, he developed an erythematous papule on his right forearm that progressed into an ulcerating nodule. Initial biopsies suggested subcutaneous pyoderma gangrenosum. However, after failing multiple treatments, repeat biopsies and cultures were performed. An acid-fast bacilli stain was positive and specialized tissue cultures identified Mycobacterium chelonae. The lesions resolved after 6 weeks of clarithromycin therapy. This case highlights the immunosuppressive effects of Janus kinase inhibitors, which can lead to atypical infections including nontuberculous mycobacteria. Additionally, this case highlights the diagnostic challenges associated with these infections, which often require multiple biopsies and specialized microbiological techniques to diagnose. As the use of Janus kinase inhibitors expands, clinicians must maintain a high suspicion for atypical infections, particularly in patients with unusual dermatologic symptoms. Prompt diagnosis and intervention are essential to prevent complications.immunosuppressionJanus kinasemycobacterium chelonaetofacitinibapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8tq5q33qhttps://escholarship.org/content/qt8tq5q33q/qt8tq5q33q.pdfinfo:doi/10.5070/D331265289articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt47x6c53r2025-05-23T11:13:45Zqt47x6c53rClarifying the role of skin tension lines in dermatological surgeryPomerantz, Erin RGriffin, Nicole LBrownstone, Nicholas D2025-01-01Skin tension lines are fundamental guidelines in surgical procedures for determining optimal incision placement to enhance healing and minimize visible scarring. This paper delves into the historical development and practical implications of Langer lines and relaxed skin tension lines. Utilization of relaxed skin tension lines enhances the precision of incisions and closures by considering facial muscle tension, an aspect not addressed by Langer cleavage lines. Relaxed skin tension lines more accurately reflect skin dynamics, underscoring the importance of patient positioning. Additionally, Cornelius Kraissl played a significant role in highlighting the alignment of scars with wrinkle lines. The interchangeable use of relaxed skin tension lines and Langer lines often leads to confusion within the field. Clarifying their distinct origins and criteria is crucial for the optimization of surgical outcomes.elective surgeryincisionsLanger linestensionanatomyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/47x6c53rhttps://escholarship.org/content/qt47x6c53r/qt47x6c53r.pdfinfo:doi/10.5070/D331265288articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt8p73r5h42025-05-23T11:13:44Zqt8p73r5h4Pearls for dermatology resident education in cosmetic and laser proceduresRichmond, AlexandraRay, LuciaTruong-Balderas, KevinAlmukhtar, RawaaMinkis, KiraEshaq, MiladKuemmet, TravisJoo, Jayne SDesai, ShraddhaLucas, RobertaWambier, CarlosBoucher, AlisonKang, BiancaLevin, YakirWyles, SaranyaAlam, Murad2025-01-01Comprehensive education in cosmetic and laser procedures is fundamental during dermatology residency to meet the demand for cosmetic medical procedures and effectively treat a myriad of complex dermatological conditions. This article highlights the importance of structured learning to provide step-wise opportunities for proficiency throughout residency. Although reading assignments and didactic sessions create a solid foundation, focused workshops, resident cosmetic clinics, and offsite electives serve as important experiences for residents to practice hands-on skills. This article provides guidance for curriculum development and establishing hands-on procedural learning. Additionally, the importance of joining professional societies to receive unique training as well as mentorship is highlighted. Having a structured and comprehensive cosmetic curriculum will equip dermatology residents with the toolkit to successfully care for diverse patient needs effectively and safely.cosmeticcurriculumeducationproficiencyresidentapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8p73r5h4https://escholarship.org/content/qt8p73r5h4/qt8p73r5h4.pdfinfo:doi/10.5070/D331265287articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt1bv6h2392025-05-23T11:13:44Zqt1bv6h239Geospatial impacts on melanoma stage at initial diagnosis - a systematic reviewHitchcock, DakotaLoczi-Storm, AngelaPatel, AryaBolen, RebeccaTchernogorova, ElizabethBrinzo, PaigeSzmanski, TionnaDeehan, EmilyDellavalle, Robert2025-01-01Melanoma, an invasive and potentially fatal form of skin cancer, is projected to comprise 5% of new cancer cases and 1.4% of cancer-related deaths in 2024 alone [1]. Survival rates are closely linked to the stage at detection, with thicker tumors at initial diagnosis associated with reduced overall survival rate [2,3]. Increased distance to healthcare providers creates barriers to early detection; disparities in sun exposure and healthcare access between rural and urban populations underscore the need for targeted interventions. This review explores the relationship between rurality and distance to providers with melanoma staging at detection. A search was conducted of the PubMed and Embase databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines [4]. The included studies examined melanoma staging and Breslow thickness in rural versus urban areas and the impact of distance to healthcare provider. Greater distance to healthcare providers was associated with more advanced tumor stages at diagnosis, while rurality status had largely insignificant effects. This review investigates the impact of rurality status and distance to a healthcare provider on melanoma detection. Ensuring equitable access is crucial for better melanoma management across different regions.accessibilityBreslowdermatologydistancemelanomaruralstagingurbanapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1bv6h239https://escholarship.org/content/qt1bv6h239/qt1bv6h239.pdfinfo:doi/10.5070/D331265286articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt8948t37q2025-05-23T11:13:43Zqt8948t37qAllergenic characterization of best-selling personal lubricantsGessner, NicholasNeman, SophiaChiang, ChavyLin, JohnYounessi, DavidDommasch, EricaAkinshemoyin Vaughn, OlusholaLiszewski, WalterZampella, JohnTrinidad, John2025-01-01Personal lubricants vary appreciably in ingredient composition. Although some products are labeled hypoallergenic, these claims are seldom evidence-based. The objective was to determine the potential allergenicity of popular lubricants and elucidate the validity of hypoallergenic product claims. This cross-sectional study involved publicly available data on Amazon's 50 best-selling lubricants as of July 2023. Product ingredient lists were cross-referenced with the North American Contact Dermatitis Group and American Contact Dermatitis Society allergen series. Associations were explored between lubricant price per ounce, average customer rating, number of customer reviews, hypoallergenic claim, lubricant base, and allergen quantity using descriptive statistics, Kruskal-Wallis tests, Wilcoxon tests, ?2 tests, and Spearman correlation analyses. Of all studied, 30% (n=15) of products were allergen-free. Nine personal lubricants (18%) were advertised as hypoallergenic, 5 of which were among the 15 products without allergens. Hypoallergenic products were less likely to contain allergens than lubricants without this claim (P=0.03). Silicone-based lubricants contained fewer allergens than water-based lubricants (P<0.01) but were more expensive (P=0.01). Understanding potential allergenicity of personal lubricants should inform clinicians' product recommendations and differential diagnosis of anogenital contact dermatitis. Silicone-based lubricants labeled as hypoallergenic may be the safest option for sensitive skin but are not guaranteed to be allergen-free.allergenicitycontact dermatitispersonal lubricantsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8948t37qhttps://escholarship.org/content/qt8948t37q/qt8948t37q.pdfinfo:doi/10.5070/D331265285articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt8js5f9282025-05-23T11:13:42Zqt8js5f928Forensic onychology of heavy metal exposure: forensic dermatology of the manifestations of heavy metal toxicity in nailsCohen, Philip R.Sutton, Lerah2025-01-01Fingernails and toenails can be an important source of trace evidence at a crime scene investigation. Arsenic, gold, lead, mercury, selenium, silver, and thallium are heavy metals; exposure to these metals can result not only in dyschromia of the nail, but also dystrophy of the nail plate. Mees lines, either single or multiple transverse white bands on the nail, were originally described in association with arsenic exposure. Similar white horizontal bands of transverse leukonychia have also been observed in patients following exposure to selenium and thallium. A diagnostic clue for persons who investigate forensic crime scenes to the possibility of heavy metal toxicity in the victim can be changes in the fingernails and toenails. The nails can be photographed and subsequently analyzed for the presence of the causative metal when the possibility of heavy metal exposure is entertained by crime scene investigators and/or medical examiners or coroners.dermatologyexposureforensicheavylinesMeesmetalnailonychologytoxicityapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8js5f928https://escholarship.org/content/qt8js5f928/qt8js5f928.pdfinfo:doi/10.5070/D331265284articleDermatology Online Journalvol 31, iss 2oai:escholarship.org:ark:/13030/qt9nw2w1fx2025-03-11T11:21:40Zqt9nw2w1fxA case of mixed mycosis fungoides and superficial morphea: a clinicohistopathologic challengeAdeuyan, Oluwaseyi O.Schreidah, Celine MFahmy, Lauren MGordon, Emily RLapolla, Brigit AGeskin, Larisa J2025-01-01cutaneous lymphomaextracorporeal photopheresismycosis fungoidessuperficial morpheaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9nw2w1fxhttps://escholarship.org/content/qt9nw2w1fx/qt9nw2w1fx.pdfinfo:doi/10.5070/D331164985articleDermatology Online Journalvol 31, iss 1oai:escholarship.org:ark:/13030/qt8t1956902025-03-11T11:21:39Zqt8t195690Repair of adjacent defects on the nasal dorsum and nasal sidewallLevin, AdamZahir, AmirFakhoury, TamaraKouba, David2025-01-01aestheticBurrow's flapsMohsnasalreconstructionsurgeryapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8t195690https://escholarship.org/content/qt8t195690/qt8t195690.pdfinfo:doi/10.5070/D331164975articleDermatology Online Journalvol 31, iss 1oai:escholarship.org:ark:/13030/qt4mw0f7782025-03-11T11:21:38Zqt4mw0f778Recalcitrant Nicolau syndrome following repeated intramuscular diclofenac injectionsUnal, Ismail H.Akoglu, GulsenSimsek, Gulcin2025-01-01adverse reactionNicolau syndromeulcerapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4mw0f778https://escholarship.org/content/qt4mw0f778/qt4mw0f778.pdfinfo:doi/10.5070/D331164973articleDermatology Online Journalvol 31, iss 1oai:escholarship.org:ark:/13030/qt5wh9n9p42025-03-11T11:21:37Zqt5wh9n9p4Urgent care in dermatology: first year experience of an academic clinicSuresh, TaraPollard, BruinHajda, HanaChen, LilyRosman, Ilana2025-01-01epidemiologyhealth-systemsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5wh9n9p4https://escholarship.org/content/qt5wh9n9p4/qt5wh9n9p4.pdfinfo:doi/10.5070/D331164972articleDermatology Online Journalvol 31, iss 1oai:escholarship.org:ark:/13030/qt0dr6s72d2025-03-11T11:21:36Zqt0dr6s72dPatient perception of delays in the dermatology clinicHunter, Emily RBhatti, SafiyyahMcGrath, Lauren NJackson, Stephanie RJones, Elizabeth2025-01-01delaydermatologysatisfactionapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0dr6s72dhttps://escholarship.org/content/qt0dr6s72d/qt0dr6s72d.pdfinfo:doi/10.5070/D331164971articleDermatology Online Journalvol 31, iss 1oai:escholarship.org:ark:/13030/qt6pt4p4qq2025-03-11T11:21:35Zqt6pt4p4qqMetastatic lung cancer mimicking varicella-zoster virusSnow, KatherineMoody, RyleeKremer, MichaelChaudhry, Sofia2025-01-01_Case Presentation X Photo Vignette _Letter Authors declare that the contents of this article are their own original unpublished findings. Title: Metastatic lung cancer mimicking varicella-zoster virus Authors: Katherine Snow1 BA, Rylee Moody1 MD, Michael Kremer2 MD, Sofia Chaudhry2 MD Affiliations: 1Saint Louis University, School of Medicine, St. Louis, Missouri, USA, 2SSM Health Saint Louis University Hospital, Department of Dermatology, St. Louis, Missouri, USA Corresponding Author: Katherine Snow, 1008 South Spring Avenue, St. Louis, MO 63110, Tel: 314-617-2660, Email: katherine.snow@health.slu.edu Abstract: Cutaneous metastases from lung adenocarcinoma are rare and usually signify advanced disease with a poor prognosis. This case describes a 63-year-old woman with stage IV lung adenocarcinoma who presented with a painful, initially unilateral, rash on her breast. The clinical appearance of erythematous plaques with vesiculo-papules suggested disseminated herpes zoster, leading to the initiation of intravenous acyclovir. However, histopathology revealed atypical epithelial cells consistent with cutaneous metastasis from the primary lung carcinoma. Although cutaneous metastases from lung cancer typically present as nodules, zosteriform skin metastases are extremely rare. This case is a unique instance of bilateral zosteriform skin metastases from lung carcinoma, underscoring the importance of considering cutaneous metastasis in patients with atypical skin lesions and underlying malignancy. Early recognition and accurate diagnosis are crucial for patient management and prognosis.adenocarcinomaaosteriform eruptionscutaneous metastasesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6pt4p4qqhttps://escholarship.org/content/qt6pt4p4qq/qt6pt4p4qq.pdfinfo:doi/10.5070/D331164970articleDermatology Online Journalvol 31, iss 1oai:escholarship.org:ark:/13030/qt5c29n8sh2025-03-11T11:21:34Zqt5c29n8shA novel presentation of calcinosis cutis of the scalp in adult dermatomyositisTeames, CharlesFlorell, Scott RHansen, Christopher2025-01-01Dystrophic calcinosis cutis is the aberrant deposition of insoluble calcium in cutaneous tissue generally secondary to inflammatory connective tissue disease. Although calcinosis cutis is commonly seen in juvenile dermatomyositis, it is a relatively rare occurrence in adult disease. Herein, we discuss an 82-year-old woman with extensive history of dermatomyositis of the scalp who presented with new-onset calcinosis cutis of the scalp.calcinosis cutisdermatomyositisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5c29n8shhttps://escholarship.org/content/qt5c29n8sh/qt5c29n8sh.pdfinfo:doi/10.5070/D331164984articleDermatology Online Journalvol 31, iss 1oai:escholarship.org:ark:/13030/qt01z1q2bd2025-03-11T11:21:33Zqt01z1q2bdErythematous patches in a female teenager: a novel mutation of RASA1 in capillary malformation-arteriovenous malformation syndrome type 1Matos, Pedro RoloGranja, BarbaraOliveira, RenataCosta, CatarinaNogueira, Ana2025-01-01The heterogeneous syndromes caused by germline mutations in genes belonging to the RAS/mitogen-activated protein kinase pathway are often referred to as RASopathies. Abnormal activation of this pathway plays a key role in the development of these disorders. Pathogenic variants in RASA1 gene cause an autosomal dominant syndrome called capillary malformation-arteriovenous malformation syndrome type 1 characterized by a broad phenotypic variability, even within the same family. In this syndrome, multifocal capillary and arteriovenous malformations are mainly localized in the central nervous system and skin. Herein, we report a patient with capillary malformation-arteriovenous malformation syndrome type 1 with a novel deletion on RASA1 gene. As this syndrome has been described just over two decades ago, it is most likely underdiagnosed. These kinds of skin lesions, even if unremarkable, should be evaluated by an experienced dermatologist.genodermatosisvascular malformationRASopathyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/01z1q2bdhttps://escholarship.org/content/qt01z1q2bd/qt01z1q2bd.pdfinfo:doi/10.5070/D331164983articleDermatology Online Journalvol 31, iss 1oai:escholarship.org:ark:/13030/qt7jn105cb2025-03-11T11:21:32Zqt7jn105cbSquamous cell carcinoma originating in folliculitis decalvansLuu, YenKimmis, Brooks D.Pulumati, AnikaJaroonwanichkul, SandraFraga, GarthRajpara, Anand2025-01-01Folliculitis decalvans is a chronic and progressive scarring alopecia at the vertex and occipital scalp with a predilection for middle-aged men. Squamous cell carcinoma is an exceedingly rare complication of folliculitis decalvans, reported in 5 cases to date. Herein, we present a case of squamous cell carcinoma of the scalp in a patient diagnosed with recalcitrant folliculitis decalvans and review the clinicopathologic characteristics of all reported cases in the literature.folliculitis decalvansscarring alopeciasquamous cellPotential conflicts of interest: The authors declare no conflicts of interest.application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7jn105cbhttps://escholarship.org/content/qt7jn105cb/qt7jn105cb.pdfinfo:doi/10.5070/D331164986articleDermatology Online Journalvol 31, iss 1oai:escholarship.org:ark:/13030/qt29r7v39p2025-03-11T11:21:32Zqt29r7v39pRituximab treatment of refractory skin involvement in anti-TIF1 gamma dermatomyositisSaid, FatmaJridi, MaysamNaceur, InesBen Achour, TayssirSmiti, Monia2025-01-01Dermatomyositis is one type among a heterogeneous group of idiopathic inflammatory myopathies. Among these anti-TIF1 gamma dermatomyositis is characterized by specific skin lesions, often severe and refractory to conventional treatments. We report a 58-year-old woman who had fatigue associated with myalgia with proximal and bilateral muscle weakness along with a generalized lilac erythematous rash on the face with Gottron papules on the metacarpophalangeal joints and periungual erythema on both hands. She also exhibited a widespread dark-violaceous-red skin eruption on the whole trunk. She was diagnosed with anti-TIF1 gamma dermatomyositis and received a treatment regimen of topical corticosteroids, hydroxychloroquine, oral corticosteroids, and conventional immunosuppressive drugs (methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide, and immunoglobulins) with no improvement of the skin rash. Therefore, she received rituximab, and three months later, the skin lesions improved magnificently. Rituximab is an efficient and safe option for patients with dermatomyositis-related skin disease refractory to conventional treatments.dermatomyositisskintreatmentapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/29r7v39phttps://escholarship.org/content/qt29r7v39p/qt29r7v39p.pdfinfo:doi/10.5070/D331164969articleDermatology Online Journalvol 31, iss 1oai:escholarship.org:ark:/13030/qt2n6608jq2025-03-11T11:21:31Zqt2n6608jqImprovement of Fox-Fordyce disease with botulinum toxin type ASun, LanyuBrazao, ClaudiaSousa, Diogo dePatrocinio, JoaoVasconcelos, Pedro deSoares-de-Almeida, LuisFilipe, Paulo2025-01-01Fox-Fordyce disease is a rare, chronic, pruritic papular eruption affecting apocrine gland-rich areas, predominantly in premenopausal women. There is no standardized treatment for Fox-Fordyce disease and various therapies have yielded mixed results. Botulinum toxin type A injections have shown promise in at least three refractory cases reported in literature. We present an additional case of Fox-Fordyce disease that improved after a single treatment with Botulinum toxin type A.Fox-Fordyce diseasebotulinum toxinapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2n6608jqhttps://escholarship.org/content/qt2n6608jq/qt2n6608jq.pdfinfo:doi/10.5070/D331164982articleDermatology Online Journalvol 31, iss 1oai:escholarship.org:ark:/13030/qt8jv391mc2025-03-11T11:21:30Zqt8jv391mcEarly malignant syphilis in an immunocompetent young manDuenaz-Diaz, Jesus EnriquePaz-Luna, Dinorah ElizabethDuenaz-Diaz, Isaias GiovanniSalcedo-Gomez, AstridAguilar-Roman, Gema YasminParedes-Solis, VanesaChavez-Guzman, Sara ElenaZavala-Alvarez, Elsa Daniela2025-01-01Malignant syphilis, also known as lues maligna, is an atypical and aggressive form of secondary syphilis characterized by nodules and ulcers associated with a spectrum of nonspecific systemic manifestations. The underlying states of immunosuppression represent the primary risk factor. We present a 30-year-old immunocompetent man exhibiting dermatological lesions at various stages clinically and histologically consistent with the established criteria for malignant syphilis. He received antibiotic therapy with complete clearing. Furthermore, we emphasize the importance of proper interpretation of serological tests, both for diagnosis and systematic monitoring.malignant syphilisimmunocompetentsecondary syphilisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8jv391mchttps://escholarship.org/content/qt8jv391mc/qt8jv391mc.pdfinfo:doi/10.5070/D331164981articleDermatology Online Journalvol 31, iss 1oai:escholarship.org:ark:/13030/qt41t3v7fn2025-03-11T11:21:30Zqt41t3v7fnPrimary cutaneous plasmacytosis in a woman with previously undiagnosed celiac diseaseGordon, Emily RTrager, Megan HAdeuyan, OluwaseyiLapolla, Brigit AGru, Alejandro AMagro, Cynthia MGeskin, Larisa J2025-01-01Cutaneous plasmacytosis has <60 cases worldwide, typically characterized by multiple asymmetric facial and truncal cutaneous nodules and plaques. We describe the case of a 68-year-old woman with erythematous plaques on the feet who had a biopsy showing primary cutaneous plasmacytosis and subsequent workup revealing celiac disease. Our patient's clinical presentation of symmetric plaques on the dorsal feet is previously unreported. Additionally, plasmacytosis occurs predominantly in Japanese patients and men younger than 40. Cutaneous plasmacytosis is hypothesized to be reactive from overreaction to stimuli including trauma, infections, or malignancies. The origin of our patient's reactive process could be related to celiac disease or could be unknown. Plasmacytosis in bone marrow has been reported with celiac disease, but to our knowledge, this is the first report of cutaneous plasmacytosis in a patient with celiac disease.celiac diseasecutaneous plasmacytosisplasmacytic infiltrateapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/41t3v7fnhttps://escholarship.org/content/qt41t3v7fn/qt41t3v7fn.pdfinfo:doi/10.5070/D331164980articleDermatology Online Journalvol 31, iss 1oai:escholarship.org:ark:/13030/qt78b6k3p62025-03-11T11:21:29Zqt78b6k3p6A unique presentation of diffuse multiple eruptive miliaDiLeo, MckenzieMoore, ReeceNelson, Emelie E.Rashid, Rashid M.2025-01-01Milia are small, benign firm white papules that commonly manifest on the face and torso. Several subtypes exist, including multiple eruptive milia-a condition characterized by the eruption of numerous milia that arise over the course of weeks to months. Although limited literature exists on this rare presentation, there seems to be no uniform patient demographic, etiology, or consistent anatomical localization of the milia. We describe a case of multiple eruptive milia presenting diffusely across the cheeks, forehead, superior neck, and preauricular and postauricular skin of an adult female. Additionally, this case is particularly unique as biopsies of representative lesions demonstrate a distinct lymphohistiocytic infiltrate. This atypical presentation underscores a gap in literature regarding multiple eruptive milia and calls into question whether a subtype of milia may exist with an inflammatory component.inflammatory miliamultiple eruptiveapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/78b6k3p6https://escholarship.org/content/qt78b6k3p6/qt78b6k3p6.pdfinfo:doi/10.5070/D331164967articleDermatology Online Journalvol 31, iss 1oai:escholarship.org:ark:/13030/qt6m0736152025-03-11T11:21:28Zqt6m073615Lupus miliaris disseminatus faciei: A unique presentation with extrafacial involvementFields, Alicia BMargheim, Ashlee MCallen, Jeffrey PStrickley, John DMalone, Janine C2025-01-01Lupus miliaris disseminatus faciei is a rare papular eruption primarily affecting the face, but extrafacial involvement can occur, which poses diagnostic challenges. We present a young woman with both facial and axillary involvement of lupus miliaris disseminatus faciei and review the literature to highlight less common extrafacial locations. Despite its rarity, lupus miliaris disseminatus faciei should be considered in the differential diagnosis of persistent papular eruptions. Histopathologic confirmation is essential, particularly in cases lacking facial involvement. Early recognition and treatment can minimize scarring, but a uniformly successful treatment option is lacking. Our report emphasizes the importance of biopsy to establish a diagnosis, especially in the absence of facial involvement given the misleading nature of the current nomenclature.granulomatous dermatitishistopathologyLMDFapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6m073615https://escholarship.org/content/qt6m073615/qt6m073615.pdfinfo:doi/10.5070/D331164979articleDermatology Online Journalvol 31, iss 1oai:escholarship.org:ark:/13030/qt5vh4j2z12025-03-11T11:21:28Zqt5vh4j2z1Asymptomatic hepatotoxicity following exposure to oral terbinafine for onychomycosis treatmentHill, Rachel C.Lipner, Shari R.2025-01-01Hepatotoxicity is a known but very rare side effect of oral terbinafine therapy. To our knowledge, there are no reported cases of patients with cleared hepatitis B infection prescribed oral terbinafine. We report an 82-year-old woman with previous hepatitis B exposure who experienced asymptomatic elevation of aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase levels following 28 days of therapy with 250mg of oral terbinafine daily for onychomycosis treatment. After drug discontinuation, her liver function tests returned to baseline about three months later, without permanent liver damage. Oral terbinafine therapy, although typically efficacious and well-tolerated for onychomycosis treatment, rarely causes hepatoxicity. Physician knowledge of this rare but important side effect is necessary to prevent morbidity and mortality resulting from continued therapy. Oral terbinafine therapy might not reactivate hepatitis B in patients with past infection.liver functiononychomycosisterbinafineapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5vh4j2z1https://escholarship.org/content/qt5vh4j2z1/qt5vh4j2z1.pdfinfo:doi/10.5070/D331164965articleDermatology Online Journalvol 31, iss 1oai:escholarship.org:ark:/13030/qt4rs4s68r2025-03-11T11:21:27Zqt4rs4s68rAmyloid associated alopecia: A case report and review of the literaturePrincipe, PatriciaWong, LuluLuke, Janiene2025-01-01Primary systemic amyloidosis is a condition marked by the extracellular deposition of amyloid proteins within various organ systems in the body. Although cutaneous involvement is well-described, scalp involvement in the form of alopecia is rarely reported. We report a case of amyloid associated alopecia confirmed by histologic analysis to highlight this rare scalp manifestation associated with systemic amyloidosis.androgenetic alopeciacase reportscalpsystemic amyloidosisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4rs4s68rhttps://escholarship.org/content/qt4rs4s68r/qt4rs4s68r.pdfinfo:doi/10.5070/D331164964articleDermatology Online Journalvol 31, iss 1oai:escholarship.org:ark:/13030/qt9w42773z2025-03-11T11:21:26Zqt9w42773zBacillary angiomatosis in a HIV-negative patientVivancos Koopman, IreneMpunga, NdanziaMenezes, AndrewRivero-Moragrega, PalomaSiddiqui, HumaCadena-Zuluaga, JoseDanaher, Patrick J.Hivnor, Chad2025-01-01Bacillary angiomatosis is a rare cutaneous manifestation caused by infection with Bartonella henselae that is most often seen in immunocompromised individuals, particularly those with HIV. We present an HIV-negative elderly man with bacillary angiomatosis with unexplained pancytopenia. The patient presented with a solitary, pedunculated, vascular nodule on his right forearm, and a shave biopsy was performed to rule out metastatic cancer. Biopsy results were consistent with bacillary angiomatosis, which was confirmed with polymerase chain reaction. Further evaluation revealed severely low CD4 counts in our patient, despite two negative HIV tests and lack of immunosuppressive drugs or conditions besides cytopenia. He eventually met criteria for idiopathic CD4 lymphocytopenia and was treated with doxycycline for coverage of possible disseminated infection. This case demonstrates the importance of keeping bacillary angiomatosis in the differential diagnosis in patients presenting with pedunculated angioproliferative lesions, regardless of HIV status.bacillary angiomatosisdisseminated diseaseHIV-negativeidiopathic lymphocytopeniaimmunodeficiencyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9w42773zhttps://escholarship.org/content/qt9w42773z/qt9w42773z.pdfinfo:doi/10.5070/D331164963articleDermatology Online Journalvol 31, iss 1oai:escholarship.org:ark:/13030/qt37z2x4nv2025-03-11T11:21:25Zqt37z2x4nvBlastic plasmacytoid dendritic cell neoplasmFlynn, Elaine N.Dadras, Soheil S.Petty, AnnaOlugbade, Idowu D.Imahiyerobo-Ip, Joyce2025-01-01Blastic plasmacytoid dendritic cell neoplasm is an uncommon, aggressive hematologic neoplasm carrying a poor prognosis with a median survival of one year, making early detection vital. Patients present with a number of characteristic cutaneous manifestations and are treated with chemotherapy and hematopoietic stem cell transplantation, which may improve survival. In this case, a 65-year-old man with a history of basal cell carcinoma presented with a nodule on his forehead with a honey-crusted border. Although the patient was treated with intralesional triamcinolone and a 7-day course of cephalexin for concurrent staphylococcal infection, the patient reported rapid growth of the nodule, new ecchymosis and edema involving his right cheek, and erythematous patches of the right temple and neck. Biopsy of lesions and immunohistochemical analysis confirmed the diagnosis of blastic plasmacytoid dendritic cell neoplasm. The patient was referred for further management, leading to sustained complete remission at 18 months after hematopoietic stem cell transplantation. Because blastic plasmacytoid dendritic cell neoplasm has varied cutaneous presentations that often mimic benign disease, particularly when presenting as bruise-like lesions, providers must maintain a high index of clinical suspicion and willingness to biopsy in order to make the diagnosis.BPDCNHPSCTCD4CD56CD123immunohistochemistryTagraxofuspIMGN632application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/37z2x4nvhttps://escholarship.org/content/qt37z2x4nv/qt37z2x4nv.pdfinfo:doi/10.5070/D331164962articleDermatology Online Journalvol 31, iss 1oai:escholarship.org:ark:/13030/qt65m729532025-03-11T11:21:24Zqt65m72953Risks of topical corticosteroid therapy and role for advanced targeted topical treatments for inflammatory skin diseases: an expert consensus panelBurshtein, JoshuaChovatiya, RajGolant, AlexandraZakria, DannyShah, MilaanLio, PeterLebwohl, Mark2025-01-01Topical corticosteroids are a first-line therapy for inflammatory skin diseases and are commonly used for chronic management. Topical corticosteroids can lead to cutaneous and systemic adverse events. The purpose of this expert consensus panel was to review published literature on the safety and efficacy of topical corticosteroids and role for advanced targeted topical therapies for inflammatory skin diseases. A comprehensive literature search was completed using a combination of keywords: "topical," "corticosteroid," "non-steroid," "efficacy," "adverse effects," "malpractice," and "inflammatory skin diseases." Articles were screened for relevance to topic of safety and efficacy of topical corticosteroids and noncorticosteroid therapies for inflammatory skin diseases. A panel of four dermatologists with expertise treating inflammatory skin diseases reviewed the articles and created consensus statements. A modified Delphi process was used to approve each statement and a strength of recommendation was assigned. The literature search produced 350 articles. A screening of the studies resulted in 24 articles that met criteria. The panel unanimously voted to adopt 10 consensus statements and recommendations. Topical corticosteroids and systemic corticosteroids are associated with numerous adverse effects, and medical-legal risks for clinicians prescribing these medications exist. Advanced targeted topical therapies have demonstrated safety and effectiveness as an alternative to corticosteroids.inflammatory diseasestopicalsystemiccorticosteroidschronicnon-steroidtopical therapiespsoriasisatopic dermatitisseborrheic dermatitisadverse effectsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/65m72953https://escholarship.org/content/qt65m72953/qt65m72953.pdfinfo:doi/10.5070/D331164978articleDermatology Online Journalvol 31, iss 1oai:escholarship.org:ark:/13030/qt19q4s9tf2025-03-11T11:21:24Zqt19q4s9tfClinical pearls addressing hair growth and loss in transgender patients on hormone replacement therapyOnejeme, ChinenyeFitzgibbon, MaryJimenez, AntonioRoss, Lindy2025-01-01Hair is a defining feature of human appearance and plays an essential role in personality and identity development. Currently, about 1.6% of US adults identify as transgender. Within the transgender community, hair serves not only as a means of self-expression but also as a crucial element in affirming gender identity, helping individuals to align their outward appearance with their inner sense of self. However, there are significant disparities in the care provided to transgender patients, particularly those seeking a more masculine or feminine appearance through hormone replacement therapy. Studies on transgender patient satisfaction with current therapies are limited but indicate overall dissatisfaction with the standard of care. Dermatologists play a pivotal role in advocating and caring for transgender patients regarding their hair and skin needs. A deeper understanding of hormone replacement therapy and hair growth/loss therapy is crucial to prescribing medications aligned with patients' treatment goals. This commentary aims to provide clinical guidance to dermatologists, aiding them in educating transgender patients undergoing hormone replacement therapy about accessible options for hair growth and loss. Treatment algorithms have been proposed based on efficacy, pharmacodynamic interactions with hormone replacement therapy, cost-effectiveness, adverse reactions, and care accessibility tailored specifically for transfeminine and transmasculine patients.androgenestrogengenderhairhormonestransgenderapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/19q4s9tfhttps://escholarship.org/content/qt19q4s9tf/qt19q4s9tf.pdfinfo:doi/10.5070/D331164961articleDermatology Online Journalvol 31, iss 1oai:escholarship.org:ark:/13030/qt2jk4c4vq2025-01-09T15:25:04Zqt2jk4c4vqErythematous-purpuric lesions in a one-year-old child revealing a case of acute hemorrhagic edema of childhood.Klitzke, Aline SchultzGoral, Roberto AndreDestefani, Carolina AiraoBarbosa, Sandra Maria2024-01-01hemorrhagic edemainfancyleukocytoclastic vasculitispalpable purpuraapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2jk4c4vqhttps://escholarship.org/content/qt2jk4c4vq/qt2jk4c4vq.pdfinfo:doi/10.5070/D330664703articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt83g6t19z2025-01-09T15:25:02Zqt83g6t19zFrom squats to spots: vitiligo koebnerization triggered by powerliftingSnow, KatherinePoole, MackenzieMehrmal, SinoGuo, Aibing Mary2024-01-01dermatologyexercisekoebnerizationpowerliftingsportsvitiligoweightliftingapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/83g6t19zhttps://escholarship.org/content/qt83g6t19z/qt83g6t19z.pdfinfo:doi/10.5070/D330664702articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt9f3615ks2025-01-09T15:25:01Zqt9f3615ksPersonal protective equipment modification by health care workers owing to skin concerns during the COVID-19 pandemic: a multicenter cross-sectional studyTrepanowski, NicoleRaef, Haya SElmariah, Sarina BGoldminz, Ari MLarson, Allison RMeltzer, Rachel2024-01-01COVID-19dermatosesequipmentfacegogglegownhealthcaremaskmodificationmodifyN95occupationpandemicPPEpersonalprotectiveshieldworkerapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9f3615kshttps://escholarship.org/content/qt9f3615ks/qt9f3615ks.pdfinfo:doi/10.5070/D330664701articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt0bh1f71j2025-01-09T15:25:00Zqt0bh1f71jAtrichia with papular lesions mimicking alopecia areata universalisAntakanavar, Gajanand MRelhan, VineetChauhan, Neha2024-01-01alopecia universalisatrichiaappendageslesionpopularapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0bh1f71jhttps://escholarship.org/content/qt0bh1f71j/qt0bh1f71j.pdfinfo:doi/10.5070/D330664700articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt47j356b32025-01-09T15:24:59Zqt47j356b3Prescription trends of antipsychotic medications in dermatology among Medicare patients, 2013-2020Roster, KatieErickson, Katherine MZufall, AlinaPereira, Frederick A2024-01-01antipsychoticsdermatologymedicarepimozidepsychodermatologicapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/47j356b3https://escholarship.org/content/qt47j356b3/qt47j356b3.pdfinfo:doi/10.5070/D330664699articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt7mc5q99v2025-01-09T15:24:58Zqt7mc5q99vRecognizing localized perioral solar elastosis: a common finding often overlookedKeatts, Sydney AShin, RileyBlack, T AustinRashid, Rashid M2024-01-01Solar elastosis is a form of photoaging theorized to result from long-term exposure to ultraviolet radiation. Clinically, solar elastosis manifests as yellow, atrophic, rhytid skin with a leathery appearance, most commonly affecting sun-exposed areas such as the face, neck, chest, or arms. Owing to its well-documented association with an elevated risk of skin cancer, recognizing the presence of solar elastosis is essential for clinicians. In this case, we evaluate a presentation of solar elastosis confined strictly to the perioral region, sparing the remainder of sun-exposed facial areas.elastosisperioralphotoagingsolarultravioletapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7mc5q99vhttps://escholarship.org/content/qt7mc5q99v/qt7mc5q99v.pdfinfo:doi/10.5070/D330664705articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt5tp780kn2025-01-09T15:24:57Zqt5tp780knSubungual chondroma in a teenagerVoloshynovych, MBoichuk, TBerezkin, OGirnyk, GMatkovska, NBerezkina, I2024-01-01Soft tissue chondroma is a rare benign tumor that occurs more often in the distal limbs and is unattached to the underlying bone. An 11-year-old boy, presented with a nodule of the subungual area of the right big toe. Objectively, the nail plate was partially destroyed owing to protrusion. Digital dermoscopy revealed yellow keratinous masses in the subungual area, with fibers adhering to the surface. Post-traumatic hemorrhages were observed in the tumor. Owing to functional discomfort, the patient underwent removal of the mass under local anesthesia. The histological picture is consistent with subungual soft tissue chondroma. Subungual soft tissue chondroma is more common in adults, but can affect people of all ages.chondromadiagnostictreatmenttumorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5tp780knhttps://escholarship.org/content/qt5tp780kn/qt5tp780kn.pdfinfo:doi/10.5070/D330664698articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt0733g17s2025-01-09T15:24:56Zqt0733g17sWolf isotopic response: immunotherapy-related lichenoid eruption localizing to prior radiation siteJafari, Alexander JKuraitis, Drew2024-01-01Wolf isotopic response refers to a new skin disorder manifesting in the area of a previous skin lesion that has healed. A variety of disease processes and dermatoses have been described that evoke an isotopic response. We report a man with metastatic hepatocellular carcinoma who received palliative radiation and later experienced a pembrolizumab-induced lichenoid dermatitis at the same site of radiation, representing a cutaneous immune-related adverse event displaying an isotopic response.adverse eventcutaneousimmune-relatedimmunotherapyisomorphic responseisotopiclichen planuslichenoid dermatitisWolfapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0733g17shttps://escholarship.org/content/qt0733g17s/qt0733g17s.pdfinfo:doi/10.5070/D330664696articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt48t2z35h2025-01-09T15:24:55Zqt48t2z35hRippled-pattern basal cell carcinoma: a unique characteristic of an otherwise common diagnosisAtmatzidis, Douglas HZouzias, ChristosRogachefsky, ArleneLee, Kristyna2024-01-01Herein we present a 48-year-old man who was diagnosed with a nodular basal cell carcinoma (BCC) of the left chin that was revealed on Mohs frozen sections to be a rippled-pattern BCC with invasion into muscle and necessitated interdisciplinary care for concern for a concurrent salivary gland carcinoma. Rippled-pattern BCC has been documented in fewer than ten cases, though this may also be attributed to confusion regarding nomenclature. Microscopically, rippled-pattern BCC exhibits distinctive features that differentiates it from other patterns. The tumor cells form interconnected networks or cords with intervening mucinous spaces within a fibrotic stroma resulting in a rippled appearance. As they are generally considered nodular BCCs, management of rippled-pattern BCCs can involve surgical excision, Mohs micrographic surgery, or other appropriate treatment modalities based on the tumor's location, size, and degree of invasion.`basalMohsrippledapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/48t2z35hhttps://escholarship.org/content/qt48t2z35h/qt48t2z35h.pdfinfo:doi/10.5070/D330664695articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt64g973kq2025-01-09T15:24:54Zqt64g973kqDeoxycholic acid injections as a nonsurgical treatment for lipomas in adiposis dolorosa (Dercum disease)Schwartz, ZivBrockmeyer, KaylaNikbakht, Neda2024-01-01Adiposis dolorosa (Dercum disease) is a rare condition characterized by diffuse and recurring painful lipomas on the trunk and extremities. Patients are typically middle-aged females with an elevated BMI presenting with chronic pain. Physical examination reveals soft subcutaneous nodules and masses, tender to palpation. The associated pain significantly impacts quality of life and requires therapeutic intervention. The most common treatment option is surgical excision. Alternative options should be considered for patients with numerous lipomas where surgical management is not practical or is not desired. Deoxycholic acid injections are a viable alternative non-surgical technique. We present a case of a 55-year-old woman who presented with a history of Dercum disease and worsening pain associated with multiple lipomas. The patient desired a non-surgical intervention. She was subsequently treated with three rounds of deoxycholic acid injections with reduction in pain and improved mobility. Intralesional deoxycholic acid injections are a safe and effective nonsurgical alternative for patients with multiple lipomas.adiposis dolorosadeoxycholic acidDercum's diseaselipomaquality of lifeapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/64g973kqhttps://escholarship.org/content/qt64g973kq/qt64g973kq.pdfinfo:doi/10.5070/D330664693articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt0qj5d2h22025-01-09T15:24:53Zqt0qj5d2h2Liquefactive subcutaneous fat necrosis of the newbornEsfandiari, NegarPorter, Hannah JMorley, Keith2024-01-01Subcutaneous fat necrosis of the newborn is a disease affecting neonates in the first weeks to months of life. It is characterized by dermal edema and underlying fat necrosis, typically presenting with firm, erythematous subcutaneous plaques and nodules, often located on the shoulders, back, buttocks, thighs, and extremities. We report an unusual presentation of liquefactive subcutaneous fat necrosis of the newborn in a two-week old term infant. The neonatal period was complicated by respiratory failure requiring intubation and severe encephalopathy. After completion of therapeutic hypothermia, the patient developed fluctuant and liquefactive nodules on her back. The neonate also had initial hypocalcemia that required treatment and then developed hypercalcemia, that resolved without intervention. The nodules and plaques on her back persisted into the first year of life and then gradually started to improve when she was 13 months old.hypercalcemialiquefactivenewbornfat necrosissubcutaneoustherapeutic hypothermiaultrasoundapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0qj5d2h2https://escholarship.org/content/qt0qj5d2h2/qt0qj5d2h2.pdfinfo:doi/10.5070/D330664694articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt8142w7md2025-01-09T15:24:52Zqt8142w7mdSevere disseminated paracoccidioidomycosisMartins, Ezequias BAlves, Halber FMVilte, Remberto MCPantaleao, Lucianada Silva, Isadora OCPSilva, Natalia CZFerreira, Laura CRonchini, Karla ROMVieira, Thais OM, Maria VitoriaLeite, Veronica RBM, Patricia Yvonne2024-01-01Paracoccidioidomycosis is a systemic fungal disease with a highly variable distribution, endemic to Central and South America with the highest prevalence in Brazil, Argentina, and Colombia. The chronic presentation of the disease is commonly observed in adult men and they manifest with pulmonary and mucocutaneous lesions. We report a fatal case of disseminated paracoccidioidomycosis in a 68-year-old immunocompetent man, with pulmonary, skin, mucosal, and cerebral involvement. Mucocutaneous lesions were decisive for the etiological diagnosis.fungal diseaseparacoccidioidomycosissystemic mycosisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8142w7mdhttps://escholarship.org/content/qt8142w7md/qt8142w7md.pdfinfo:doi/10.5070/D330664692articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt6bs4c7qz2025-01-09T15:24:52Zqt6bs4c7qzDrug reaction with eosinophilia and systemic symptoms (DRESS)with anti-tuberculosis drugs, a rare and serious complicationBouhamdi, AbirBouhamdi, ChaimaeTassa, Jean JuniorDouhi, ZakiaTahiri, LaylaSerraj, MouniaEl Biaze, MohammedBenjelloun, Mohammed ChakibMernissi, Fatima ZahraeAmara, Bouchra2024-01-01Drug hypersensitivity syndrome or DRESS (drug reaction with eosinophilia and systemic symptoms) is a severe reaction with an estimated mortality of 10%. Antibacillary drugs are rarely incriminated. A 28-year-old patient with tubercular miliaria who developed antibacillary-induced DRESS is presented. The dermatological lesions appeared four weeks after the beginning of the antitubercular treatment. The diagnosis of DRESS was made when all the Registry of Severe Toxidermia (RegiSCAR) criteria were present. The treatment was stopped and the patient was put on symptomatic treatment under supervision in the intensive care unit, with progressive improvement. Substitution with second-line antituberculosis drugs was necessary and was done with caution. DRESS with antituberculosis drugs is rare and its management is not codified.antibacillaryDRESSdrug reactioneosinophiliareintroductiontoxidermiaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6bs4c7qzhttps://escholarship.org/content/qt6bs4c7qz/qt6bs4c7qz.pdfinfo:doi/10.5070/D330664691articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt8jv9d3bf2025-01-09T15:24:51Zqt8jv9d3bfLichen planus pigmentosus inversus presenting with clinical features mimicking acanthosis nigricansYouh, JoohyungIwata, HiroakiKitamura, ShinyaUjiie, Hideyuki2024-01-01Lichen planus pigmentosus (LPP) is recognized as a rare variant of lichen planus, characterized by dermal hyperpigmentation. Specifically, a particular intertriginous variant of LPP is known as lichen planus pigmentosus inversus (LPPI). In our case, the patient presented with symmetric, hyperpigmented dark brown patches mainly in axillary areas, closely resembling the features of acanthosis nigricans (AN). The differential diagnosis considered included LPPI, AN, post-inflammatory hyperpigmentation related to contact dermatitis, symmetrical drug-related intertriginous and flexural exanthema, fixed drug eruption, and erythema dyschromicum perstans (EDP). Histopathological examination revealed the absence of hyperkeratosis and papillomatosis, typically associated with AN. Dermoscopy revealed diffuse brownish hue along with dots and globules of inconsistent size, which suggests dermal pigmentary incontinence and the likelihood of LPPI. This case illustrates the challenge in differentiating LPPI from similar flexural hyperpigmentation disorders based on the comprehensive approach including thorough history taking, clinical manifestations, histopathological analysis, and dermoscopic examination.acanthosis nigricansdermoscopyhyperpigmentationintertriginous arealichen planuspigmentosus inversusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8jv9d3bfhttps://escholarship.org/content/qt8jv9d3bf/qt8jv9d3bf.pdfinfo:doi/10.5070/D330664690articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt47m5h7vj2025-01-09T15:24:50Zqt47m5h7vjDrug-induced subacute cutaneous lupus erythematous from cenobamate: case presentation and review of the literatureBhatti, Safiyyah AJoffe, DanielWebster, TimothyLee, Jason B2024-01-01A 68-year-old woman with a history of seizures on cenobamate presented with an itchy rash all over her body. The rash started about one month prior to her presentation to the dermatology clinic. The rash was initially treated with topical triamcinolone with improvement at one-month follow-up. However, four months later the rash flared and there was concern that cenobamate was the cause. Biopsy was performed showing vacuolar interface dermatitis with atrophy, suggestive of subacute lupus erythematosus. Blood work revealed positive antinuclear antibody, anti-ribonucleoprotein antibody, Sjogren Anti-SS-A and positive histone antibody. Given the worsening rash, positive labs, and cenobamate as the only changed drug several months before initial onset, she was diagnosed with drug-induced subacute cutaneous lupus erythematous and her cenobamate was discontinued. To the best of your knowledge, this is the first reported case of a medication in the carbamate family leading to drug induced subacute cutaneous lupus erythematosus.cenobamatedrug reactionlupusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/47m5h7vjhttps://escholarship.org/content/qt47m5h7vj/qt47m5h7vj.pdfinfo:doi/10.5070/D330664689articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt1xc4770m2025-01-09T15:24:49Zqt1xc4770mCutaneous nodules secondary to Mycobacterium avium complex in a patient with human immunodeficiency virusPatel, JaySayyadioskoie, ShannonSiatecka, HannaRosen, Theodore2024-01-01We present a patient with human immunodeficiency virus who developed multiple painful lesions that previously in the past had speciated as Cryptococcus neoformans cutaneously, and in the lung. Despite induction therapy for presumed re-infection, the patient did not improve so a biopsy was performed and this was speciated as Mycobacterium avium complex, with final diagnosis being disseminated Mycobacterium avium complex. This case highlights the importance of considering a broad differential diagnosis for any new lesions regardless of prior culture data.Cryptococcus neoformansHIVMycobacterium aviumapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1xc4770mhttps://escholarship.org/content/qt1xc4770m/qt1xc4770m.pdfinfo:doi/10.5070/D330664688articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt7zn1x7vc2025-01-09T15:24:48Zqt7zn1x7vcA case of blastomycosis presenting as a non-healing unifocal ulcerative nodule on the jawlineSnow, KatherinePoole, MackenzieMehrmal, SinoKhoshnoodi, PooriaBurkemper, NicoleChaudhry, Sofia B2024-01-01Blastomyces dermatitidis is a dimorphic fungus that can disseminate in the immunocompetent and immunodeficient. Many infected patients display heterogenous cutaneous findings, making it one of dermatology's great clinical mimics. Cases presenting as single lesions are often mistaken for neoplasms or other infections. We report a patient with diabetes mellitus who presented to the emergency department with a two-month history of an ulcerated jawline nodule. Treatment with incision/drainage and doxycycline for presumed bacterial abscess was unsuccessful. Upon re-presentation 10 days later, biopsy and fungal culture of the tumor confirmed infection with B. dermatitidis. Chest computed tomography revealed disease dissemination. Halfway through a 6-month course of itraconazole, cutaneous and pulmonary findings were notably improved. Diabetes is an emerging risk factor for dissemination that likely contributed to the severity in our case. Early biopsy can prevent potentially life-threatening treatment delays, highlighting the need for blastomycosis to be considered in the differential diagnosis of non-healing wounds.Blastomyces dermatitidisdermatologydimorphicfacefungalinfectious diseasejawlineskin of colorulcerwoundsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7zn1x7vchttps://escholarship.org/content/qt7zn1x7vc/qt7zn1x7vc.pdfinfo:doi/10.5070/D330664687articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt1vp142v52025-01-09T15:24:48Zqt1vp142v5Acquired reactive perforating collagenosis in skin of colorMcClure, Spencer PLiakos, WilliamSeger, Edward WAbdo, MaryamMurray, AbigailGillihan, Ryan2024-01-01Acquired reactive perforating collagenosis is an uncommon disorder that present as keratotic plugs on the skin owing to transepidermal perforation of dermal connective tissue. Etiology is unclear, although the condition has been associated with renal disease, diabetes, and HIV. It can frequently be misdiagnosed and lead to significant impact on quality of life, particularly in patients with skin of color. Herein, we present an skin of color patient with this condition who experienced severe pruritus over years before receiving a definitive diagnosis. Clobetasol improved her condition and quality of life over several months.acquiredperforatingcollagenosisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1vp142v5https://escholarship.org/content/qt1vp142v5/qt1vp142v5.pdfinfo:doi/10.5070/D330664686articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt4fs883qg2025-01-09T15:24:47Zqt4fs883qgBullous herpes zoster in a patient with bullous systemic lupus erythematosusJaroonwanichkul, SandraLuu, YenNguyen, KatherineDai, HongyanRajpara, Anand2024-01-01Bullous systemic lupus erythematosus (SLE) is a rare cutaneous manifestation of SLE characterized by sudden vesiculobullous eruptions. Herpes zoster infection may lead to rapid bullae development in patients with known bullous SLE. Herein, we describe a case of rapid development of bullous herpes zoster in a patient with bullous SLE. Patients with SLE and lupus nephritis exhibit an increased risk for herpes zoster infection. Bullous herpes zoster has been described in a previous patient with SLE and lupus nephritis. The current case illustrates that the presence of bullous SLE may have precipitated the development of bullous variant herpes zoster, as blisters leading to breakages in the skin increase risk for superinfection by viral pathogens. The current case highlights the importance of monitoring for skin changes in patients with SLE and maintaining a low threshold for infectious workup. Furthermore, it is important to recognize that the presence of bullae in SLE may confuse the diagnosis of bullous herpes zoster, leading to delays in diagnosis and management. Given high rates of morbidity and mortality in disseminated herpes zoster infection, the emergence of bullae in patients with SLE should raise a high index of suspicion for herpes zoster infection and prompt systemic workup.bullousherpes zosterlupuslupus nephritisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4fs883qghttps://escholarship.org/content/qt4fs883qg/qt4fs883qg.pdfinfo:doi/10.5070/D330664685articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt7zx9962p2025-01-09T15:24:46Zqt7zx9962pEnfortumab vedotin-induced widespread vesiculobullous eruption mimicking disseminated herpetic infection in a patient with metastatic urothelial carcinomaNihal, AmanBacon, PearlPei, Susan2024-01-01Enfortumab vedotin (EV) is a monoclonal antibody drug conjugate composed of antibody against nectin-4 and linked to the microtubule inhibitor monomethyl auristatin E that is used to treat metastatic urothelial carcinoma. Enfortumab vedotin-associated cutaneous adverse events are common and are clinically diverse, ranging from papulosquamous eruption to vesiculobullous eruptions such as Stevens-Johnson syndrome/toxic epidermal necrolysis and erythema multiforme-like eruption with vesiculobullae. Despite clinically diverse appearance, histopathology of EV-associated cutaneous adverse reactions often demonstrates interface dermatitis. We present the clinical and histopathologic features in a unique case of EV-associated widespread vesiculobullous eruption initially concerning for disseminated herpetic infection in a patient undergoing treatment of metastatic urothelial carcinoma with EV and pembrolizumab.bullousdermatitisdrug-eruptionenfortumabtoxicityvesicularapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7zx9962phttps://escholarship.org/content/qt7zx9962p/qt7zx9962p.pdfinfo:doi/10.5070/D330664684articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt5dk2h0wj2025-01-09T15:24:45Zqt5dk2h0wjActionable avenues for dermatologists to reduce their environmental impactSilva, Genevieve SGotschall, Jeromy WRosenbach, Misha2024-01-01Climate change poses an increasing threat to human health, with well-documented impacts on dermatologic conditions. However, the U.S. healthcare sector is paradoxically a significant contributor to climate change-worsening greenhouse gas emissions. To address this negative externality, calls to action to decarbonize healthcare delivery have spurred research and initiatives around improving the environmental sustainability of medicine. Published sustainability recommendations for dermatologic practices have addressed themes such as renewable energy, single-use disposable materials, regulated medical waste, and clinician advocacy. Our current commentary provides an analysis of the potential of existing recommendations and outlines additional, novel, and actionable interventions. We highlight recently released decarbonization resources and regulatory changes. We emphasize the importance of reassessing procedure kits, minimizing medication waste, and implementing green procurement policies. We also address nuances in promoting environmentally-conscious transit, maximizing the efficient use of technology, supporting alternatives to single-use items, leveraging resources for patient education, assessing appropriate use of carbon credits, and bolstering community climate resilience.climatedermatologymanagementmedicinesustainabilityapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5dk2h0wjhttps://escholarship.org/content/qt5dk2h0wj/qt5dk2h0wj.pdfinfo:doi/10.5070/D330664683articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt1qs895xr2025-01-09T15:24:45Zqt1qs895xrBasics of building a private dermatology practice--a startup guideBirda, AbhinavZaino, Mallory LGold, Michael HFeldman, Steven RYentzer, Brad A2024-01-01The growing demand for dermatologic services and shortage of dermatologic providers sets the stage for favorable market conditions to open a private dermatology practice. However, business-related education in medicine is lacking and the concept of starting a new practice may be daunting for dermatologists in any stage of training. We describe key components of starting a private dermatology practice. Topics include strategies to build a business plan, find a location, explore financial options, structure a legal framework, and incorporate branding and marketing.dermatologymedical entrepreneurshipprivate practicestart-upapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1qs895xrhttps://escholarship.org/content/qt1qs895xr/qt1qs895xr.pdfinfo:doi/10.5070/D330664704articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt3hm0x02t2025-01-09T15:24:44Zqt3hm0x02tThe most powerful topical anti-inflammatory: the cautionary and enlightening story of SKIN-CAPFaulk, Carlton TPittelkow, Mark RFeldman, Steven RSwanson, David L2024-01-01Topical treatment with glucocorticosteroids is a mainstay therapy for many dermatologic conditions. Though efficacious in many, topical therapies often fail to achieve desired positive results in clinical practice. SKIN-CAP spray (Cheminova Laboratories International SA, Madrid, Spain), a product containing activated zinc pyrithione, and subsequently found to have contained clobetasol, provided unprecedented clearing of psoriasis even when ultra-high potency topical glucocorticosteroids had failed. A PubMed for terms related to corticosteroids, topical therapy, patient adherence, and SKIN-CAP spray was performed. Articles from 1997 to 2023 were included in the review of SKIN-CAP spray. In this review, we report the background of SKIN-CAP as well as studies that were performed in an attempt to explain its perceived high efficacy. The remarkable efficacy that occurred with SKIN-CAP over other delivery systems for high potency topical corticosteroids was initially speculated to be a consequence of an interaction between the zinc pyrithione and the clobetasol. However, no synergistic efficacy was identified, and there was no greater drug delivery. Better adherence to the SKIN-CAP product may explain the efficacy. The SKIN-CAP story provides insights into the need for healthy skepticism, the importance of treatment adherence, and ways to encourage better adherence to topical medications.adherenceadulteratedclobetasolcorticosteroidpsoriasispyrithionezincapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3hm0x02thttps://escholarship.org/content/qt3hm0x02t/qt3hm0x02t.pdfinfo:doi/10.5070/D330664682articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt1m88116m2025-01-09T15:24:44Zqt1m88116mMohs micrographic surgery for superficial leiomyosarcoma: a systematic reviewOlsen, Eric CSvoboda, Steven A2024-01-01Superficial leiomyosarcoma is a rare malignancy of muscular origin arising in the skin and soft tissues. Although wide local excision is the standard of care for these tumors, Mohs micrographic surgery is a promising treatment option as it provides for optimal margin control. The object of this systematic review is to examine the efficacy of micrographic surgery in the management of superficial leiomyosarcoma. A literature search was conducted using the PubMed/Medline and Cochrane databases; 14 studies representing 66 patients were included. Analysis demonstrated a notably low rate of recurrence (1.5%) and metastasis (0.0%) in tumors treated with micrographic surgery, contrasting with increased rates of recurrence and metastasis in tumors treated with wide local excision. These data may be influenced by a shortage of subcutaneous leiomyosarcoma in the included patients, as subcutaneous tumors are more likely to recur and metastasize. Further research is warranted to determine the value of Mohs micrographic surgery in treating superficial leiomyosarcoma and specifically, the subcutaneous variant.cutaneous malignancydermatologic surgeryleiomyosarcomamicrographic surgeryMohsoutcomesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1m88116mhttps://escholarship.org/content/qt1m88116m/qt1m88116m.pdfinfo:doi/10.5070/D330664681articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt09x443x62025-01-09T15:24:43Zqt09x443x6Topical cantharidin use in dermatology: an updated reviewGhali, HelanaSmith, Logan RKrenitsky, AmandaJoseph, Alexia MAung-Din, DavidHennessy, KerryMoore, SarahGrichnik, James M2024-01-01Cantharidin, a natural toxin produced by the blister beetle, is a topical agent that induces acantholysis of the epidermis, breaking down desmosome plaques through the release of serine proteases. Cantharidin is available in three liquid forms: Ycanth (0.7%), Canthacur (0.7%), and Canthacur PS (1% cantharidin, 30% salicylic acid, 2% podophyllotoxin). Ycanth is used to treat molluscum contagiosum (MC). Canthacur is routinely used to treat a variety of dermatologic conditions including MC, plantar warts, and common warts, whereas Canthacur PS is a more potent formulation indicated for treatment of plantar warts only. The objective of this review is to highlight the efficacy, safety, and diverse use of topical cantharidin in the treatment of various skin conditions. Conditions in which treatment with topical cantharidin yielded a good-to-excellent response include MC, plantar warts, and common warts. Topical cantharidin treatment of anogenital warts yielded mixed results. None of the indications reviewed herein yielded a poor response to topical cantharidin. Overall, topical cantharidin resulted in a good-to-excellent clinical response in several conditions with mild and transient adverse events. The results of this review suggest the safe and efficacious use of topical cantharidin in the field of dermatology and highlight the potential for future use.cantharidindermatologyefficacywartsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/09x443x6https://escholarship.org/content/qt09x443x6/qt09x443x6.pdfinfo:doi/10.5070/D330664680articleDermatology Online Journalvol 30, iss 6oai:escholarship.org:ark:/13030/qt7zp7j0mt2024-11-07T08:54:25Zqt7zp7j0mtComments on a recent paper Jellyfish envenomation with delayed hypersensitivity and concurrent SARS-CoV-2 infectionCrow, Gerald LHolland, Brenden S2024-01-01CnidariaAlatina alatabox jellyfishsting treatmentsHawaiiapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7zp7j0mthttps://escholarship.org/content/qt7zp7j0mt/qt7zp7j0mt.pdfinfo:doi/10.5070/D330564443articleDermatology Online Journalvol 30, iss 5oai:escholarship.org:ark:/13030/qt82h1b1k82024-11-07T08:54:24Zqt82h1b1k8Phacomatosis spilorosea and phacomatosis melanorosea: further phenotype expansionTorchia, Daniele2024-01-01melanoroseaphacomatosispigmentovascularisspiloroseaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/82h1b1k8https://escholarship.org/content/qt82h1b1k8/qt82h1b1k8.pdfinfo:doi/10.5070/D330564442articleDermatology Online Journalvol 30, iss 5oai:escholarship.org:ark:/13030/qt8698d2182024-11-07T08:54:23Zqt8698d218What your patients need to know about skin supplementsKatta, RajaniShe, JennyPerez-Sanchez, Ariadna2024-01-01qualityregulatorysafetysupplementssupraphysiologicapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8698d218https://escholarship.org/content/qt8698d218/qt8698d218.pdfinfo:doi/10.5070/D330564441articleDermatology Online Journalvol 30, iss 5oai:escholarship.org:ark:/13030/qt48h4z9412024-11-07T08:54:22Zqt48h4z941Botryomycosis associated with retained hair piece and accompanying ethnic hair considerationsConner, AnnaMusiek, AmyBarnes, EthanSingh, NupurNahmias, Zachary2024-01-01botryomycosishaircarehairpieceapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/48h4z941https://escholarship.org/content/qt48h4z941/qt48h4z941.pdfinfo:doi/10.5070/D330564440articleDermatology Online Journalvol 30, iss 5oai:escholarship.org:ark:/13030/qt65t472k02024-11-07T08:54:21Zqt65t472k0A cross-sectional analysis of insurance acceptance among Mohs micrographic surgeons in New York CityRoster, KatieIslam, SumaiyaFeroz, FarhhaFabre, ShelcieIslam, ZahidulCline, AbigailLipner, Shari R2024-01-01insuranceMohsMedicaidMedicaresurgeryapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/65t472k0https://escholarship.org/content/qt65t472k0/qt65t472k0.pdfinfo:doi/10.5070/D330564439articleDermatology Online Journalvol 30, iss 5oai:escholarship.org:ark:/13030/qt3xq3v2cs2024-11-07T08:54:19Zqt3xq3v2csThe use of dupilumab for the treatment of alopecia areataAli, ImanNelson, Emelie EPhan, BrandyKulkarni, VedaMcGee, ChristinaCao, EmilyRashid, Rashid M2024-01-01alopeciadupilumabdupixentapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3xq3v2cshttps://escholarship.org/content/qt3xq3v2cs/qt3xq3v2cs.pdfinfo:doi/10.5070/D330564438articleDermatology Online Journalvol 30, iss 5oai:escholarship.org:ark:/13030/qt7dc487ks2024-11-07T08:54:18Zqt7dc487ksFungating mass on the breast of a male patientBray, Jeremy KDai, ChristinaSokumbi, Olayemi2024-01-01Breast cancer is one of the most common malignancies that can lead to cutaneous metastasis. Dermatopathologists often play an important role in the diagnosis of breast cancer metastasis to the skin. Rarely, dermatopathologists render a histopathologic diagnosis of primary breast cancer. We discuss a 51-year-old man with metastatic breast adenocarcinoma who presented after admission to the intensive care unit in the setting of altered mental status and critical anemia. Examination revealed a 14cmx12cm ulcerated, fungating tumor occupying the left breast. A four mm punch biopsy from the mass showed cords of atypical cells infiltrating the mid-to-deep dermis positive for CK7, GATA3, ER and PR. CK20, P40, p63, and TTF1 stains were negative. HER2/NEU immunoperoxidase stain was negative. CA15-3 was elevated at 75U/ml. Taken together, he was diagnosed with primary left breast ductal adenocarcinoma, grade two with subsequent visceral metastases to the bones, lymph nodes, and lungs. Although male breast cancer makes up less than 1% of all breast cancers, its incidence has been increasing worldwide. Recognition of the unique clinical and histologic findings of primary breast carcinoma is important to avoid delay in the diagnosis and initiation of appropriate treatment.breast carcinomaimmunohistochemistrymalignancymetastasisoncologytumorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7dc487kshttps://escholarship.org/content/qt7dc487ks/qt7dc487ks.pdfinfo:doi/10.5070/D330564436articleDermatology Online Journalvol 30, iss 5oai:escholarship.org:ark:/13030/qt3gp0z1082024-11-07T08:54:18Zqt3gp0z108Implementation of the atopic dermatitis yardstick via the electronic medical record: a pilot study to improve clinical documentation and patient educationGreenzaid, Jonathan DPixley, Jessica NKelly, Katherine AFeldman, Steven RStrowd, Lindsay C2024-01-01educationeczemainformaticstechnologyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3gp0z108https://escholarship.org/content/qt3gp0z108/qt3gp0z108.pdfinfo:doi/10.5070/D330564437articleDermatology Online Journalvol 30, iss 5oai:escholarship.org:ark:/13030/qt3wq625cb2024-11-07T08:54:17Zqt3wq625cbLactation anaphylaxis: report of a rare case with recurrent postpartum anaphylaxisHida, YasutoshiTakahagi, ShunsukeIwawaki, AyakaIshii, KaoriMyogo, Kayo2024-01-01Lactation anaphylaxis is extremely rare and has been scarcely reported in the literature. Breast feeding and/or milk expression immediately induces life-threatening anaphylactic reactions, including generalized urticaria, angioedema, respiratory symptoms, and hypotension. Six English-language case reports have described the clinical course in detail. The present report describes a case involving a 24-year-old woman with no history of allergic reactions or anaphylaxis who experienced anaphylactic reactions three times immediately after milk expression. Lactation anaphylaxis was suspected when a detailed medical history revealed lactation-related recurrent anaphylactic symptoms. The authors prescribed bromocriptine to stop lactation and switched her to formula feeding, which resulted in no further anaphylactic episodes. Based on a review of the relevant literature, this report describes the characteristics of lactation anaphylaxis and possible management strategies. The pathogenesis of lactation anaphylaxis has been inferred from various experimental results.breastfeedinglactation anaphylaxismast cellmammary glandtryptaseapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3wq625cbhttps://escholarship.org/content/qt3wq625cb/qt3wq625cb.pdfinfo:doi/10.5070/D330564435articleDermatology Online Journalvol 30, iss 5oai:escholarship.org:ark:/13030/qt6gz709d12024-11-07T08:54:16Zqt6gz709d1Skin necrosis following digital wart intralesional injection of cantharidinArango, Sebastian DWeir, Tristan BMiller, Andrew JOsterman, Meredith N2024-01-01A right-hand-dominant female presented 5 weeks following a right middle finger intralesional cantharidin injection for a common wart by a dermatologist. The patient experienced progressive stiffness, blistering, swelling, pain, and ultimately, full-thickness skin necrosis surrounding the injection site. Careful debridement followed by a full-thickness skin graft was performed with no evidence of involvement of the germinal matrix or terminal extensor tendon. At the 7-month postoperative mark, the patient's graft exhibited favorable healing and improved functionality that did not require further follow-up. Intralesional injection of cantharidin solutions for digital warts leads to progressive skin necrosis. Our case required prompt debridement and defect coverage. Involvement of the underlying anatomical structures was also a concern. Dermatologists and hand surgeons should be familiar with this complication as intralesional cantharidin injections are contraindicated.cantharidinhandinjectionintralesionalnecrosiswartapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6gz709d1https://escholarship.org/content/qt6gz709d1/qt6gz709d1.pdfinfo:doi/10.5070/D330564434articleDermatology Online Journalvol 30, iss 5oai:escholarship.org:ark:/13030/qt92m5p62m2024-11-07T08:54:15Zqt92m5p62mRecurrent aseptic abscesses resulting in superficial pyoderma gangrenosum-like ulcers in a patient with granulomatosis with polyangiitisYamamoto, Toshiyuki2024-01-01Patients with granulomatosis with polyangiitis occasionally present with cutaneous manifestations, which are important clues for the early diagnosis. Although pyoderma gangrenosum-like ulcers are rarely observed, a unique case with unusual clinical features is presented herein. A 75-year-old woman with positive proteinase 3-antineutrophil cytoplasmic antibody (PR3-ANCA) repeatedly developed aseptic abscesses on the abdomen, buttock, lower legs, and forearms. Histopathological features of biopsy taken from ulcers showed necrotizing granulomatous inflammation with multinucleated giant cells without leukocytoclastic vasculitis. The present case was initially diagnosed as limited granulomatosis with polyangiitis without renal and lung involvement. However, two years later, she died of cerebral hemorrhage.aseptic abscesspolyangiitispyoderma gangrenosumWegener granulomatosisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/92m5p62mhttps://escholarship.org/content/qt92m5p62m/qt92m5p62m.pdfinfo:doi/10.5070/D330564432articleDermatology Online Journalvol 30, iss 5oai:escholarship.org:ark:/13030/qt1zx3669h2024-11-07T08:54:15Zqt1zx3669hDiagnosis of perianal pyramidal protrusion in infantsMargulies, ShaeWelborn, MacartneyVincek, Vladimir2024-01-01Infantile perianal pyramidal protrusion is characterized by a light pink to skin-colored soft tissue protrusion that is often midline and anterior [A1]to the anus. It most commonly occurs in young females and is relatively asymptomatic. Although biopsies are not routinely done, histopathology is relatively nonspecific and can appear similar to an acrochordon. The differential diagnosis is broad and clinical misdiagnosis as condyloma can lead to unnecessary accusations of child abuse. We report a case of perianal pyramidal protrusion that was originally biopsied owing to concern of condyloma acuminatum or molluscum. This case raises awareness of this diagnosis to help avoid unnecessary procedures and prevent emotional distress that could come for families with an inaccurate diagnosis of condyloma in young children.infantilePPPperianalpyramidal protrusionapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1zx3669hhttps://escholarship.org/content/qt1zx3669h/qt1zx3669h.pdfinfo:doi/10.5070/D330564433articleDermatology Online Journalvol 30, iss 5oai:escholarship.org:ark:/13030/qt03h7f5462024-11-07T08:54:14Zqt03h7f546Idiopathic gingival papillokeratosis with crypt formation: an exclusive entity in the young population?Salinas-Munoz, MacarenaAitken-Saavedra, JuanMaturana-Ramirez, Andrea2024-01-01Idiopathic gingival papillokeratosis with crypt formation (IGPC) is a new and a very rare benign entity, clinically characterized by white-yellowish plaques with papillary architecture located in the upper labial gingiva of adolescent patients. The condition generally exhibits a bilateral symmetrical distribution and is asymptomatic. We report two new cases, one with a classic presentation and the other in an older individual. Through these case reports, we describe and highlight the key clinical and histopathological features associated with IGPC for greater understanding and knowledge by general dentists, oral pathologists, and dermatologists.crypt formationfibromatosisgingivalidiopathicinterdentalpapillapapillokeratosisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/03h7f546https://escholarship.org/content/qt03h7f546/qt03h7f546.pdfinfo:doi/10.5070/D330564431articleDermatology Online Journalvol 30, iss 5oai:escholarship.org:ark:/13030/qt8v94f6ks2024-11-07T08:54:13Zqt8v94f6ksTreatment of disseminated granuloma annulare with pulse therapy upadacitinibTrees, AlannaSmithem, CassiBialick, MallorieKabigting, Filamer2024-01-01Granuloma annulare (GA) is an idiopathic inflammatory skin condition with a chronic and unpredictable course. Although localized GA is usually cleared with topical or systemic corticosteroids, generalized GA is often difficult to treat owing to the lack of treatment options and recurrence with treatment. Recent evidence has helped to elucidate the etiology behind GA, with growing confirmation for the use of JAK inhibitors as a possible treatment for GA. We present a 61-year-old woman with recalcitrant GA who responded successfully to pulse therapy upadacitinib, a JAK1 inhibitor. Our findings demonstrate the utility of this alternative and practical treatment strategy that may reduce the cumulative toxicity of upadacitinib and optimize its risk/benefit ratio.granuloma annulareinhibitorJanus kinaseJAK-STATupadacitinibapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8v94f6kshttps://escholarship.org/content/qt8v94f6ks/qt8v94f6ks.pdfinfo:doi/10.5070/D330564430articleDermatology Online Journalvol 30, iss 5oai:escholarship.org:ark:/13030/qt7t19r3gx2024-11-07T08:54:13Zqt7t19r3gxPseudoxanthoma elasticum-like papillary dermal elastolysis; A report of two cases and a literature reviewMurshidi, RandBani Hamad, SalsabielaAl-Tarawneh, Awad2024-01-01Pseudoxanthoma elasticum-like papillary dermal elastolysis is a rare, benign, acquired, gradually-developing chronic elastic tissue disorder that almost exclusively affects post-menopausal women. It is essential to recognize this disease as it mimics the inherited pseudoxanthoma clinically. The pathophysiology behind this disease is multifactorial; it includes intrinsic skin aging, ultraviolet radiation exposure, and genetic components. We report two patients with pseudoxanthoma elasticum-papillary dermal elastolysis diagnosis based on clinicopathologic correlation in two post-menopausal women who presented with multiple asymptomatic papules over the neck that developed gradually without systemic involvement, and were managed conservatively. We also discuss this disease's clinical, dermoscopic, and histopathologic features.elastic tissueelastolysisfibroelastic papulosisfibroelastolytic disorderapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7t19r3gxhttps://escholarship.org/content/qt7t19r3gx/qt7t19r3gx.pdfinfo:doi/10.5070/D330564429articleDermatology Online Journalvol 30, iss 5oai:escholarship.org:ark:/13030/qt8g94r7fr2024-11-07T08:54:12Zqt8g94r7frCutaneous protothecosis: a new case and review of Brazilian patientsAguinaga, FelipeCarranza, KatherineAzulay, VitoriaZarco, Olga MilenaQuintella, Danielle CarvalhoCuzzi, Tullia2024-01-01Protothecosis is a rare but emerging infectious disease, caused by algae from the genus Prototheca. It presents predominantly as cutaneous lesions and poses a diagnostic challenge owing to its diverse clinical presentation. Typically, it occurs in exposed areas of the skin, associated with trauma. Diagnosis relies mainly on histopathology and culture. This article presents an elderly diabetic woman with cutaneous protothecosis from Rio de Janeiro, Brazil. We emphasize clinical features, histopathology, and successful treatment with itraconazole, along with a brief review of the 12 previously reported cases from Brazil.algaeitraconazoleProtothecaprotothecosisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8g94r7frhttps://escholarship.org/content/qt8g94r7fr/qt8g94r7fr.pdfinfo:doi/10.5070/D330564428articleDermatology Online Journalvol 30, iss 5oai:escholarship.org:ark:/13030/qt9107p3v42024-11-07T08:54:11Zqt9107p3v4Bevacizumab-induced subungual hemorrhageOwen, Jacob JLong, SloanMullinax, KimberlyGriffin, John2024-01-01Exudative (wet) age-related macular degeneration can be treated with the vascular endothelial growth factor (VEGF)-inhibiting monoclonal antibody bevacizumab. Currently, bevacizumab therapy is associated with known skin-related side effects, such as rash, mucosal hemorrhage, and hemorrhagic ulcers. While subungual "splinter" hemorrhage is a documented side effect of VEGF receptor antagonists and Raf protein inhibitors, there are no prior reports of bevacizumab-induced subungual hemorrhage to the best of our knowledge. Thus, we present the case of a 71-year-old female diagnosed with bilateral age-related macular degeneration, who, during six months of intravitreal bevacizumab treatment, began noticing fingernail discoloration, described as similar to that of a bruise. Given our patient's history of bevacizumab therapy and the documented reports of bevacizumab-associated mucosal and ulcerative hemorrhage, we hypothesize that the discoloration and hemorrhage are likely unreported adverse effects associated with bevacizumab therapy.BevacizumabMacular degenerationSubungual hemorrhageapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9107p3v4https://escholarship.org/content/qt9107p3v4/qt9107p3v4.pdfinfo:doi/10.5070/D330564427articleDermatology Online Journalvol 30, iss 5oai:escholarship.org:ark:/13030/qt63g8q4h62024-11-07T08:54:11Zqt63g8q4h6Personalized melanoma grading system: a presentation of a patient with four melanomas detected over two decades with evolving whole-body imaging and artificial intelligence systemsDrugge, RhettNaqo, XhuljetaDedej, SabinaGirnyk, GalynaNaqo, JonaDrugge, FrankVolpicelli, Elgida2024-01-01Melanoma is a life-threatening tumor that significantly impacts individuals' health and society worldwide. Therefore, its diagnostic tools must be revolutionized, representing the most remarkable human efforts toward successful management. This retrospective study includes the multidimensional analysis of five melanomas in a man in our clinic including whole-body photography, dermatoscopy, artificial intelligence system, genetic test, and the final histopathological conclusion. The correlation between findings in each diagnostic step is discussed. The value of the melanoma grading system will be the application in high-risk lesions to make the right management decision.artificial intelligencedermatoscopygrading systemmelanomaMelanoscan(r)trackingphotographywhole-bodyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/63g8q4h6https://escholarship.org/content/qt63g8q4h6/qt63g8q4h6.pdfinfo:doi/10.5070/D330564426articleDermatology Online Journalvol 30, iss 5oai:escholarship.org:ark:/13030/qt4600x40s2024-11-07T08:54:10Zqt4600x40sRural access to dermatology services: a call to actionBrumbaugh, BethanyLally, JagBrodell, Robert2024-01-01This commentary underscores the urgent issue of limited access to dermatologic care in rural areas, leading to adverse health outcomes. With only 10% of dermatologists practicing in rural America, the "rural mortality penalty" contributes to escalating morbidity and mortality. Disparities in dermatologist distribution, particularly in minority-majority counties with lower incomes, worsen health inequities. Despite these challenges, initiatives such as pipeline programs, rural university offices, rural dermatology residency tracks, teledermatology, and Project ECHO (a collaborative model of medical education and care) are promising. This commentary stresses the need for academic dermatologists to recruit more rural medical students and train more residents with a rural upbringing. This predicts future practice in such communities. Immediate action to address the widening rural dermatology gap is needed. The formation of the Rural Access to Dermatology Society, with its first meeting in the spring of 2024 at the annual meeting of the American Academy of Dermatology, is a key part of this process.accesscarehealth systemsmedical educationrural dermatologyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4600x40shttps://escholarship.org/content/qt4600x40s/qt4600x40s.pdfinfo:doi/10.5070/D330564425articleDermatology Online Journalvol 30, iss 5oai:escholarship.org:ark:/13030/qt20z0r37h2024-11-07T08:54:09Zqt20z0r37hLight-based therapies in the treatment of alopeciaOh, Christina SKarim, MariaKlein, Elizabeth JYin, LuGutierrez, DanielShapiro, JerrySicco, Kristen Lo2024-01-01All types of alopecia, including androgenetic alopecia, alopecia areata, and lichen planopilaris/frontal fibrosing alopecia, affect over half of men and women. Though a common dermatological experience, many patients with visible hair loss report significant psychological and social distress and, consequently seek treatment. Current existing therapeutic regimens have proven to be efficacious, though may result in various adverse effects and require lifelong use. Laser and light-based therapies have been emerging in the current literature as a safe and alternative treatment, but their utilization for treating alopecia is poorly understood. This review evaluates the existing evidence regarding the use of lasers in the treatment of various forms of alopecia. Overall, there has been promising evidence for potential alopecia treatment efficacy: low-level light therapy for androgenetic alopecia, fractional laser for androgenetic alopecia, and excimer laser for alopecia areata.alopeciaexcimerfractionallaserlight therapyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/20z0r37hhttps://escholarship.org/content/qt20z0r37h/qt20z0r37h.pdfinfo:doi/10.5070/D330564423articleDermatology Online Journalvol 30, iss 5oai:escholarship.org:ark:/13030/qt0pv3832w2024-11-07T08:54:09Zqt0pv3832wExploring opposing arguments in the call for randomized controlled trials to demonstrate benefit of Mohs micrographic surgery for cutaneous melanomaVidal, Nahid Y.O'Hern, KeeganSteen, AaronCarley, SamaAhn, Ji Won2024-01-01Importance: The call for robust randomized clinical trials (RCTs) comparing Mohs micrographic surgery (MMS) with wide local excision for treatment of melanoma has stymied the development of guidelines for MMS despite growing evidence of benefit. This commentary explores the controversy by detailing opposing arguments, reviewing the relevant evidence supporting the use of MMS for early-stage melanoma, and discussing the role that RCTs may play in development of national guidelines for surgical treatment options for melanoma. Randomized clinical trials are considered the gold standard of clinical research, but there are no such trials currently to support MMS for melanoma. However, there is a growing literature base of retrospective and prospective cohorts and meta-analyses consistently demonstrating the efficacy and cost-effectiveness of MMS for melanoma. The dearth of clear consensus guidelines has contributed to confusion by referring specialties, controversy across specialties managing melanoma, and inequality in access. Recognizing that this is an ongoing area of discussion within dermatologic surgery, we explore opposing arguments with regard to the demand for RCT data to support dermatologic surgery practices.clinical trialcutaneous melanomaMohs micrographic surgeryopposing argumentsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0pv3832whttps://escholarship.org/content/qt0pv3832w/qt0pv3832w.pdfinfo:doi/10.5070/D330564424articleDermatology Online Journalvol 30, iss 5oai:escholarship.org:ark:/13030/qt3w76g7w62024-11-07T08:54:08Zqt3w76g7w6Addressing the cardiovascular implications of acanthosis nigricans: what a dermatologist needs to knowEggiman, EvanFeldman, SteveArd, JamyPatel, Priya2024-01-01Background: Acanthosis nigricans (AN) is a dermatologic skin condition that is often overlooked in its role as an indicator of underlying cardiovascular disorders. Recognizing the importance of AN beyond its cosmetic concerns is crucial for improving patient outcomes. Objective: Provide a review of AN and what every dermatologist should know of its underlying cardiovascular risk. Methods: A literature search through PubMed was performed. Terms used were "Acanthosis Nigricans," "hyperinsulinemia," "cardiovascular disease," "diabetes," "insulin resistance,". Further articles were found using source materials from included references. Inclusion criteria involved studies showing the association between AN and cardiovascular risks, with a specific focus on obesity and insulin resistance. Results: Acanthosis nigricans increases risks of obesity and insulin resistance as individuals with AN exhibited a 2.6-fold higher likelihood of insulin resistance, independent of other factors. Acanthosis nigricans surpassed other risk factors in classifying individuals at risk for type two diabetes and cardiovascular disease. Conclusions: Recognizing the association of AN with cardiovascular disease provides an opportunity for early intervention, focusing on weight management and underlying metabolic disorders to improve both cosmetic concerns and cardiovascular health. Dermatologists should consider AN as a signal that prompts referral for a thorough assessment for associated metabolic diseases.acanthosis nigricanscardiovascular diseaseleptin insulin resistanceobesitysurgeryapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3w76g7w6https://escholarship.org/content/qt3w76g7w6/qt3w76g7w6.pdfinfo:doi/10.5070/D330564422articleDermatology Online Journalvol 30, iss 5oai:escholarship.org:ark:/13030/qt2p13j13g2024-09-21T09:55:36Zqt2p13j13gPosition Title: Assistant Project ScientistDepartment of Dermatology, University of California, Davis School of Medicine2024-01-01jobsscientistrecruitmentresearchacademicsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2p13j13ghttps://escholarship.org/content/qt2p13j13g/qt2p13j13g.pdfinfo:doi/10.5070/D330464126articleDermatology Online Journalvol 30, iss 4oai:escholarship.org:ark:/13030/qt0869k2jd2024-09-21T09:55:36Zqt0869k2jdPosition Title: Academic DermatologistDepartment of Dermatology, University of California, Davis School of Medicine2024-01-01The 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, or 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 activity.Additionally, based on the qualifications and experience a candidate may be considered for the departmental directorships.The appointments may be made up to 100%.jobsdermatologistrecruitmentacademicsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0869k2jdhttps://escholarship.org/content/qt0869k2jd/qt0869k2jd.pdfinfo:doi/10.5070/D330464125articleDermatology Online Journalvol 30, iss 4oai:escholarship.org:ark:/13030/qt7118z86n2024-09-21T09:55:35Zqt7118z86nBalancing beneficence and autonomy: The dilemma of unsolicited medical advice in dermatologyVerma, Kritin KKoch, Ryan SShalabi, Mojahed MKParekh, Palak K2024-01-01adviceautonomybeneficenceunsolicitedapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7118z86nhttps://escholarship.org/content/qt7118z86n/qt7118z86n.pdfinfo:doi/10.5070/D330464124articleDermatology Online Journalvol 30, iss 4oai:escholarship.org:ark:/13030/qt6pv5v8wg2024-09-21T09:55:34Zqt6pv5v8wgSupravenous and perivenous distribution of a benign pigmented purpuric eruptionMatsudate, Yoshihiro2024-01-01dermatosispigmentedpurpuricsegmentalsuperficialveinapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6pv5v8wghttps://escholarship.org/content/qt6pv5v8wg/qt6pv5v8wg.pdfinfo:doi/10.5070/D330464123articleDermatology Online Journalvol 30, iss 4oai:escholarship.org:ark:/13030/qt9w59969t2024-09-21T09:55:33Zqt9w59969tUpdates in the prevention of glucocorticoid-induced adverse effectsCunningham, CallieLimmer, AllisonKivelevitch, Dario2024-01-01autoimmunecorticosteroidgeneral dermatologyglucocorticoidguidelinesmedicalPneumocystis jirovecipneumonia prophylaxisrheumatologyvaccinationsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9w59969thttps://escholarship.org/content/qt9w59969t/qt9w59969t.pdfinfo:doi/10.5070/D330464122articleDermatology Online Journalvol 30, iss 4oai:escholarship.org:ark:/13030/qt1v80h6mr2024-09-21T09:55:32Zqt1v80h6mrOrange palpebral spots on bilateral upper eyelidsHackley, MadisonBrownstone, NicholasSun, ChristinaHsu, Sylvia2024-01-01discolorationorangepalpebral spotsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1v80h6mrhttps://escholarship.org/content/qt1v80h6mr/qt1v80h6mr.pdfinfo:doi/10.5070/D330464121articleDermatology Online Journalvol 30, iss 4oai:escholarship.org:ark:/13030/qt2gt3w04c2024-09-21T09:55:31Zqt2gt3w04cSuccessful treatment of psoriasis and lichen planus with tildrakizumabRomero-Jimenez, BelenGruber-Velasco, FernandoAxpe-Gil, CatalinaBarros-Eyzaguirre, Maria JesusRoman-Sainz, JorgeImbernon-Moya, Adrian2024-01-01interleukin-23lichen-planuspsoriasistildrakizumabapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2gt3w04chttps://escholarship.org/content/qt2gt3w04c/qt2gt3w04c.pdfinfo:doi/10.5070/D330464120articleDermatology Online Journalvol 30, iss 4oai:escholarship.org:ark:/13030/qt03q0z4002024-09-21T09:55:31Zqt03q0z400Pyoderma gangrenosum after breast reduction surgeryLee, EudoraLim, SubinElliott, ErikaCobos, Gabriela A2024-01-01dermatologyneutrophilic dermatosispost surgicalpyoderma gangrenosumapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/03q0z400https://escholarship.org/content/qt03q0z400/qt03q0z400.pdfinfo:doi/10.5070/D330464119articleDermatology Online Journalvol 30, iss 4oai:escholarship.org:ark:/13030/qt6cx8r2q22024-09-21T09:55:30Zqt6cx8r2q2Outcomes and approaches to program signaling during the 2021-2022 dermatology residency application cycleWilliams, Georgia ERinderknecht, Fatuma-Ayaan BLee, MelissaBailey, Kandice CNovack, Danielle EWorswick, Scott DRosenblatt, Adena ERosman, Ilana SAhmed, Ammar M2024-01-01dermatologyeducationmatchresidencypreference signalingprogramsupplemental applicationapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6cx8r2q2https://escholarship.org/content/qt6cx8r2q2/qt6cx8r2q2.pdfinfo:doi/10.5070/D330464118articleDermatology Online Journalvol 30, iss 4oai:escholarship.org:ark:/13030/qt1pt6x8jw2024-09-21T09:55:29Zqt1pt6x8jwDiffuse face and ear hypertrichosis caused by 5% topical minoxidil in an adult woman with spontaneous resolutionAlkhayal, Fares AAlkinani, Ali A2024-01-01Minoxidil is a vasodilator medication known for its ability to promote hair growth. Although it was first introduced as an oral drug to treat hypertension, minoxidil was observed to have the important side-effect of increasing hair growth. This led to the development of a topical formulation as a 2% concentration solution for the treatment of female androgenic alopecia (AGA) and 5% for treating male AGA, which is considered as a first line U.S. Food and Drug Administration (FDA)-approved treatment for AGA in addition to oral 5-alpha-reductase inhibitor (finasteride). The mechanism by which minoxidil promotes hair growth is not fully understood but can be related to increasing blood flow owing to its vasodilator effects. Androgenic alopecia is characterized by the gradual conversion of terminal hairs into vellus hairs. Alterations in the hair cycle include reduced duration of the anagen phase and increased duration of the telogen phase, resulting in shorter hairs and eventual balding. Side effects of topical minoxidil include irritant and allergic contact dermatitis, pruritus, and facial hypertrichosis, which are more often seen with the use of 5% solutions rather than 2%. Herein, we report a 24-year-old woman who developed severe ear and face hypertrichosis after using a topical 5% minoxidil solution. She later had spontaneous resolution of her hypertrichosis three months after stopping it.facehypertrichosisminoxidiltopicalapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1pt6x8jwhttps://escholarship.org/content/qt1pt6x8jw/qt1pt6x8jw.pdfinfo:doi/10.5070/D330464117articleDermatology Online Journalvol 30, iss 4oai:escholarship.org:ark:/13030/qt4g42s80z2024-09-21T09:55:28Zqt4g42s80zA rapidly-growing friable nodule on the cheekLeeolou, Melissa CYoung, Peter ATicknor, Iesha LLai, JinpingPaniagua, Ricardo TBurns, Robert L2024-01-01Atypical fibroxanthoma and pleomorphic dermal sarcoma are on a spectrum of cutaneous tumors that present as ulcerated lesions in older adults. We present an 84-year-old man with pleomorphic dermal sarcoma, initially presenting as a bleeding lesion of the cheek that progressed to an eroded nodule.atypical fibroxanthomadermal sarcomaneoplasmpleomorphicspindle cellundifferentiatedapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4g42s80zhttps://escholarship.org/content/qt4g42s80z/qt4g42s80z.pdfinfo:doi/10.5070/D330464116articleDermatology Online Journalvol 30, iss 4oai:escholarship.org:ark:/13030/qt1f07n0sk2024-09-21T09:55:27Zqt1f07n0skFolliculotropic and syringotropic mycosis fungoides mimicking basal cell carcinomaQuarshie, ClaudiaDeClerck, BrittneyHu, Jenny C2024-01-01Mycosis fungoides (MF) is characterized by a clonal proliferation of skin-homing mature T cells with special predilection for involving the epidermis. Folliculotropic and syringotropic MF typically present with erythematous papules, patches, and plaques, with punctate accentuation that is folliculocentric in the former. We report a 67-year-old woman, with an extensive history of allergic contact dermatitis, who was referred to the Mohs surgery clinic with a large pink plaque extending from the nasal bridge to the right upper medial cheek concerning for basal cell carcinoma. An outside punch biopsy showed benign basaloid follicular neoplasm. The patient was found to also have indurated erythematous plaques of the bilateral upper arms and erythematous scaly patches of bilateral arms and legs, abdomen, lateral trunk, buttocks, and groin. Owing to concern for possible cutaneous lymphoma, punch biopsies were performed which revealed the diagnosis of folliculotropic and syringotropic MF. Of note, folliculotropic and syringotropic MF are often, but not uniformly, characterized by a more aggressive disease course. This case highlights the importance of a high index of suspicion and awareness of all clinical and histopathologic pitfalls to avoid misdiagnosis of MF.folliculotropicmycosis fungoidessyringotropicapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1f07n0skhttps://escholarship.org/content/qt1f07n0sk/qt1f07n0sk.pdfinfo:doi/10.5070/D330464115articleDermatology Online Journalvol 30, iss 4oai:escholarship.org:ark:/13030/qt4c51q4fb2024-09-21T09:55:26Zqt4c51q4fbCutaneous ulcers in sarcoidosisAlsatti, HanadiBalkhy, AtheelAlmahdi, Bashaer HAbualola, Amal H2024-01-01Sarcoidosis is a disease characterized by immunological granuloma formation in various organs. Cutaneous manifestations occur in about 25% of patients with rare cases showing ulcerative sarcoidosis, that can be debilitating if not treated promptly. This article presents a patient with isolated ulcerative sarcoidosis and reviews existing literature. A 44-year-old woman presented with a non-healing ulcer on her right gluteal area. A skin biopsy confirmed sarcoidosis with non-necrotizing granulomas. Systemic involvement of sarcoidosis was ruled out. Treatment involved topical corticosteroids and intralesional corticosteroid injections, resulting in complete healing. This case emphasizes the importance of considering ulcerative sarcoidosis in non-healing wounds and the efficacy of corticosteroid treatment.cutaneousLofgren syndromesarcoidosisulcersapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4c51q4fbhttps://escholarship.org/content/qt4c51q4fb/qt4c51q4fb.pdfinfo:doi/10.5070/D330464113articleDermatology Online Journalvol 30, iss 4oai:escholarship.org:ark:/13030/qt2vf2h3vm2024-09-21T09:55:26Zqt2vf2h3vmMilia within resolving bullous pemphigoid lesionsAlturkistani, RahafAlshareef, AlhusainAlghamdi, YaraAlzaidi, ReemaAsiry, SaeedAlraddadi, Ali2024-01-01Bullous pemphigoid is an autoimmune blistering disease that is characterized by pruritus, cutaneous urticarial plaques, and tense bullae, with mucosal involvement. On histopathology, a subepidermal blister is predominantly evident with eosinophilic inflammatory infiltrates in the upper dermis. In a few bullous dermatoses, milia can manifest at the scar of blistering lesions or in non-lesional skin. Milia are classically associated with epidermolysis bullosa acquisita, porphyria cutanea tarda, and mucous membrane pemphigoid. We report a case of bullous pemphigoid with milia manifesting within healing blistering lesions.bullousbullosa acquisitaepidermolysismiliapemphigoidpemphigusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2vf2h3vmhttps://escholarship.org/content/qt2vf2h3vm/qt2vf2h3vm.pdfinfo:doi/10.5070/D330464114articleDermatology Online Journalvol 30, iss 4oai:escholarship.org:ark:/13030/qt67p062p22024-09-21T09:55:25Zqt67p062p2Zosteriform mycosis fungoides: case report of progression to tumor stage and review of the literatureHida, YasutoshiIwawaki, AyakaFujii, YoshiyukiOsaki, Kyosuke2024-01-01Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma, although it has many clinicopathological variants. Zosteriform MF is an extremely rare variant characterized by dermatomal distribution. To date, only six patients with zosteriform MF have been reported. We report a 57-year-old man with tumor-stage zosteriform MF localized on the left T4, T7-8, and bilateral L4 dermatomes for seven years after the first visit. Local skin-target therapy radiotherapy effectively led to complete remission, which was maintained with a combination of oral etretinate (30mg/day) and narrow-band ultraviolet B phototherapy. No other reports exist of zosteriform MF occurring in multiple dermatomes. We reviewed the literature to add to our understanding of the nature of rare variants of MF and discuss therapeutic options for zosteriform MF.dermatomeherpes zostermycosis fungoidesradiotherapyzosteriformapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/67p062p2https://escholarship.org/content/qt67p062p2/qt67p062p2.pdfinfo:doi/10.5070/D330464112articleDermatology Online Journalvol 30, iss 4oai:escholarship.org:ark:/13030/qt9tx0h8d02024-09-21T09:55:24Zqt9tx0h8d0Teriflunomide-related development of inverse psoriasis and worsening of pre-existing plaque psoriasisMueller, KylePei, SusanKuraitis, Drew2024-01-01Leflunomide can be used in management of psoriatic disease. Leflunomide's active metabolite, teriflunomide, is used in the treatment of multiple sclerosis and has unexpectedly been rarely reported to induce pustular psoriasis. In this report, we present a patient with multiple sclerosis who developed inverse psoriasis after starting teriflunomide.adverse eventdrug-induceddrug reactioninverse psoriasisleflunomidepsoriasis vulgaristeriflunomideapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9tx0h8d0https://escholarship.org/content/qt9tx0h8d0/qt9tx0h8d0.pdfinfo:doi/10.5070/D330464111articleDermatology Online Journalvol 30, iss 4oai:escholarship.org:ark:/13030/qt04q6t1vz2024-09-21T09:55:24Zqt04q6t1vzA case presentation of widespread macular amyloidosis associated with dual hepatitis B and hepatitis C infectionMuhaidat, JihanBa-Shammakh, Saleh AHaj-Freej, Hasn MAbdullah Al, Enas2024-01-01Macular amyloidosis is a variant of primary localized cutaneous amyloidosis in which amyloid protein is believed to be derived from keratinocytes. The care of this variant generally focuses on addressing the associated symptoms without the need to assess for underlying disease. However, an increasing number of cases of primary localized cutaneous amyloidosis have been reported in association with systemic diseases, particularly autoimmune diseases. A few cases of biphasic primary localized cutaneous amyloidosis have been reported in association with chronic hepatitis C infection. Herein, we report an unusual patient, a 38-year-old man with widespread macular amyloidosis concurrently presenting with dual hepatitis B virus and hepatitis C virus infections. Collecting similar cases can further validate this uncommon association.hepatitismacular amyloidosisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/04q6t1vzhttps://escholarship.org/content/qt04q6t1vz/qt04q6t1vz.pdfinfo:doi/10.5070/D330464110articleDermatology Online Journalvol 30, iss 4oai:escholarship.org:ark:/13030/qt0d05c5p02024-09-21T09:55:23Zqt0d05c5p0Annular secondary syphilis with HIV coinfection that resembles other dermatosesPradipta, Nabila KirttiSusetiati, Devi ArtamiNurmastuti, HafidzahDanarti, RetnoPudjiati, Satiti Retno2024-01-01Syphilis is a sexually transmitted infection with manifestations that can mimic other diseases, leading to misdiagnosis. Annular syphilis is a rare atypical secondary syphilitic lesion that seldomly involves the face. Human immunodeficiency virus (HIV) coinfection can increasingly lead to atypical manifestations of syphilis and complicate the diagnosis. Herein, we describe a 29-year-old man with a diagnosis of annular secondary syphilis and HIV coinfection. He had clinical manifestations of annular erythematous papules and plaques with white scales at the edges, distributed and scattered on the face, neck, and upper back. The skin lesions went undetected on several visits and were misdiagnosed owing to similarities with other dermatoses. Serological examination showed positive Treponema pallidum particle agglutination assay and venereal disease research laboratory test titer 1/512, confirming syphilis infection. Results from the histopathological examination supported the diagnosis of secondary syphilis. Positive anti-HIV rapid test results indicated concurrent HIV infection. He was treated for syphilis and given antiretroviral therapy, and showed a good response as demonstrated by improvement of the lesions and serological titers. This case highlights the importance of recognizing the possibility of annular secondary syphilis and HIV coinfection which can have atypical manifestations.annular syphilisatypicalsecondaryapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0d05c5p0https://escholarship.org/content/qt0d05c5p0/qt0d05c5p0.pdfinfo:doi/10.5070/D330464109articleDermatology Online Journalvol 30, iss 4oai:escholarship.org:ark:/13030/qt3gz5j64v2024-09-21T09:55:22Zqt3gz5j64vFibroelastolytic papulosis: two cases of disease spectrum variantsIngrassia, Jenne PLee, NariWang, HongbeiGottesman, SilvijaShah, Pooja R2024-01-01Fibroelastolytic papulosis (FEP) is an acquired cutaneous disorder of elastin that encompasses both white fibrous papulosis of the neck (WFPN) and pseudoxanthoma elasticum (PXE)-like papillary dermal elastolysis (PDE). Although FEP is a benign acquired disorder, it shares overlapping clinical features with pseudoxanthoma elasticum (PXE), a genetic disorder with systemic manifestations. We report two cases of FEP, including the WFPN and PXE-like PDE variants, in elderly women. In one case, a woman in her 70s with hyperlipidemia and chronic kidney disease presented with white-to-yellow, smooth, monomorphic papules coalescing into plaques on the posterior neck and bilateral antecubital fossa. A punch biopsy and elastic stain revealed a loss of elastic fibers in the papillary dermis. Based on these findings, we diagnosed our patient with PXE-like PDE. In another case, a woman in her 60s with no significant medical history similarly presented with skin-colored, smooth monomorphic papules on the posterior and anterior neck. A punch biopsy was also performed and an elastic stain showed a loss of elastic fibers in the papillary dermis, confirming the diagnosis of WFPN. Although rare, FEP is an important entity for dermatologists to recognize and differentiate from PXE given the potential for systemic complications in PXE.dermatopathologyelasticumelastinfibroelastolyticfibrousgeneticsneckpapulosispseudoxanthomawhiteFibroelastolytic papulosispseudoxanthoma elasticum-like papillary dermal elastolysiswhite fibrous papulosis of the neckapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3gz5j64vhttps://escholarship.org/content/qt3gz5j64v/qt3gz5j64v.pdfinfo:doi/10.5070/D330464108articleDermatology Online Journalvol 30, iss 4oai:escholarship.org:ark:/13030/qt5zb6w7b52024-09-21T09:55:21Zqt5zb6w7b5Nivolumab-induced hidradenitis suppurativa: a case reportLamberg, OliviaPandher, KaranMatthews, Natalie H2024-01-01We present a 44-year-old man with metastatic clear cell renal cell cancer undergoing treatment with nivolumab immunotherapy. Three months post-initiation, he developed symmetric recurrent nodules and boils in intertriginous areas, diagnosed as stage II hidradenitis suppurativa of the groin and gluteal cleft. The progressive course, lesion symmetry and location, worsening with nivolumab infusions, and biopsy findings supported the diagnosis. Hidradenitis suppurativa pathogenesis involves immune dysregulation marked by elevated IL17 and neutrophil-dominated inflammation [1]. Immune checkpoint inhibitors, including anti-PD1 agents like nivolumab, are linked to immune-related adverse events related to widespread T cell activation, potentially increasing IL17 signaling associated with HS [2,3]. Clinicians should be aware of, and observant for anti-PD1-induced HS, a rare immune-related adverse event, in patients undergoing immune checkpoint inhibitor therapy.adverse eventantibodyhidradenitis suppurativaimmune dysregulationimmunotherapynivolumabPD1application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5zb6w7b5https://escholarship.org/content/qt5zb6w7b5/qt5zb6w7b5.pdfinfo:doi/10.5070/D330464106articleDermatology Online Journalvol 30, iss 4oai:escholarship.org:ark:/13030/qt1kc730f82024-09-21T09:55:21Zqt1kc730f8Comparative dermatology--pavement paws: frictional dermatosis in puppies analogous to pool toesCohen, Philip R2024-01-01Dogs are susceptible to a diverse spectrum of dermatologic conditions, several of these skin disorders are analogous to dermatologic conditions occurring in humans. Pool toes appears on the plantar surface of the feet and toes; it is an aquatic pool-associated frictional dermatosis that results from repeated rubbing of the feet and toes against the rough cement at the bottom of the pool or its border. A frictional dermatosis that can develop on the uncalloused paw pads of puppies, resulting from repeated rubbing of the paws against ambient temperature, not heated, paved road is pavement paws. Neither pool toes nor pavement paws result from contact with a hot surface; these dermatoses are distinctive from beach feet, a thermal-associated superficial burn to the skin resulting from the hot temperature of the sand that contacts that the plantar feet and toes. In conclusion, similar to pool toes, the pathogenesis of pavement paws is a frictional dermatosis that can develop on the uncallused paw pads of puppies resulting from repeated rubbing of the paws against ambient temperature, not heated, pavement.beachcaninedermatosisdogfeetfrictionalpavementpawspoolpuppiespuppytoesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1kc730f8https://escholarship.org/content/qt1kc730f8/qt1kc730f8.pdfinfo:doi/10.5070/D330464105articleDermatology Online Journalvol 30, iss 4oai:escholarship.org:ark:/13030/qt8tt0c9412024-09-21T09:55:20Zqt8tt0c941Evaluating the effectiveness of ChatGPT4 in the diagnosis and workup of dermatologic conditionsGreif, CharlotteMpunga, NdanziaKoopman, Irene VPye, AllisonHivnor, Chad MOwen, Joshua L2024-01-01ChatGPT is a publicly available chatbot released by OpenAI. Its usefulness in responding to medical questions has been assessed in several specialties, but there is limited literature in dermatology. This study seeks to understand how well ChatGPT4 can provide accurate diagnoses and appropriate workup suggestions for clinical vignettes describing common dermatologic conditions. Ten vignettes were input into ChatGPT4 representing presentations of common dermatologic conditions, written from the perspective of a physician not board-certified in dermatology. ChatGPT4 was asked to identify the top five most likely diagnoses and its recommended workup for each vignette. Responses were assessed quantitatively by calculating the percentage of correct diagnoses, with accurate diagnoses defined by three board-certified dermatologists, and qualitatively using Likert scales describing the accuracy of diagnoses and appropriateness of workups scored by eleven board-certified dermatologists. Overall, 52% of ChatGPT4's diagnoses were accurate and 62% of its recommended workup suggestions were deemed completely correct by board-certified dermatologists. ChatGPT4 was better at recommending an appropriate workup than identifying accurate diagnoses across vignettes. ChatGPT4 was able to accurately diagnose and workup common dermatologic conditions in slightly more than half of cases. ChatGPT4 was better at determining an appropriate workup than an accurate diagnosis.Keywords: artificial intelligence, ChatGPT, dermatology, diagnosis, OpenAI, workupartificial intelligenceChatGPTdermatologydiagnosisOpenAIworkupapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8tt0c941https://escholarship.org/content/qt8tt0c941/qt8tt0c941.pdfinfo:doi/10.5070/D330464104articleDermatology Online Journalvol 30, iss 4oai:escholarship.org:ark:/13030/qt6d1930nz2024-07-05T11:16:00Zqt6d1930nzInverse psoriasis on pre-existing hidradenitis suppurativa lesions: Reply to "A case series of tumor necrosis factor inhibitor-induced psoriasis in patients with hidradenitis suppurativa"Baskurt, DefneDogan, Pelin ErtopMericoz, Cisel AydinDemirkesen, CuyanVural, Secil2024-01-01hidradenitis suppurativainflammationpsoriasisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6d1930nzhttps://escholarship.org/content/qt6d1930nz/qt6d1930nz.pdfinfo:doi/10.5070/D330363884articleDermatology Online Journalvol 30, iss 3oai:escholarship.org:ark:/13030/qt1f48k9rz2024-07-05T11:15:59Zqt1f48k9rzKoebner phenomenon related to chest binding in a transgender man with psoriasisAguinaga, FelipeCeccarelli, Miguel ALora-Barraza, Leonardo2024-01-01chest bindingKoebnerphenomenonpsoriasistransgendertransmasculineapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1f48k9rzhttps://escholarship.org/content/qt1f48k9rz/qt1f48k9rz.pdfinfo:doi/10.5070/D330363883articleDermatology Online Journalvol 30, iss 3oai:escholarship.org:ark:/13030/qt4293k9jw2024-07-05T11:15:57Zqt4293k9jwMorphea-like lesions after treatment with ustekinumabShaffer, Brett RZaino, MalloryBowers, Nathan LHunter, DinaFeldman, Steven R2024-01-01application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4293k9jwhttps://escholarship.org/content/qt4293k9jw/qt4293k9jw.pdfinfo:doi/10.5070/D330363882articleDermatology Online Journalvol 30, iss 3oai:escholarship.org:ark:/13030/qt26h8m1bg2024-07-05T11:15:56Zqt26h8m1bgSevere cutaneous drug reaction associated with enfortumab vedotinCabanillas-Cabral, Adolfo ATerron, Angel Santos-BrizRodriguez-Conde, SergioCanueto-Alvarez, JavierConde-Ferreiros, Alberto2024-01-01advancedadverse reactioncancercutaneousenfortumab vedotinurothelialapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/26h8m1bghttps://escholarship.org/content/qt26h8m1bg/qt26h8m1bg.pdfinfo:doi/10.5070/D330363880articleDermatology Online Journalvol 30, iss 3oai:escholarship.org:ark:/13030/qt1vs9c5n52024-07-05T11:15:54Zqt1vs9c5n5Patient photographs taken without instructions are of sufficient quality for clinical decision-making in teledermatologyLiu, Jennifer YLohman, Mary EKlufas, DanielFassett, MarlysAmerson, ErinTwigg, AmandaLeslie, KieronKhodosh, Rita2024-01-01dermatologyphotographyteledermatologytelemedicineapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1vs9c5n5https://escholarship.org/content/qt1vs9c5n5/qt1vs9c5n5.pdfinfo:doi/10.5070/D330363877articleDermatology Online Journalvol 30, iss 3oai:escholarship.org:ark:/13030/qt3mq7m0qv2024-07-05T11:15:52Zqt3mq7m0qvPatient satisfaction and outcomes within a free dermatology clinic implemented at an academic medical centerHughes, Julia RMcCollum, BrookeMoody, RyleeTaha, Isra NShaikh, SaniyaKremer, MichaelChaudhry, Sofia B2024-01-01accessbarriersdermatologydisparitiesdiversityfree clinichealthhealthcareMedicaidunderserveduninsuredapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3mq7m0qvhttps://escholarship.org/content/qt3mq7m0qv/qt3mq7m0qv.pdfinfo:doi/10.5070/D330363876articleDermatology Online Journalvol 30, iss 3oai:escholarship.org:ark:/13030/qt788754352024-07-05T11:15:51Zqt78875435Sensitive detection of quality of life impact with a hidradenitis suppurativa specific measureKelly, Katherine ASingh, RohanSenthilnathan, AditiPichardo, Rita OFeldman, Steven R2024-01-01quality of lifehidradenitis suppurativapsychosocialapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/78875435https://escholarship.org/content/qt78875435/qt78875435.pdfinfo:doi/10.5070/D330363875articleDermatology Online Journalvol 30, iss 3oai:escholarship.org:ark:/13030/qt9mn6d4nm2024-07-05T11:15:49Zqt9mn6d4nmComparison of potential contact allergens in best-selling adult and baby cleansersGalamgam, JaydenNoveir, Sasan DCheng, Carol E2024-01-01are that the contents of this article are their own original unpublished findings. Title: Comparison of potential contact allergens in best-selling adult and baby cleansers Authors: Jayden Galamgam1 MD, Sasan D Noveir2 BA, Carol E Cheng1 MD Affiliations: 1Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA, 2 David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA Corresponding Author: Jayden Galamgam MD, Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, Email: jgalamgam@mednet.ucla.eduallergencleansersdermatitispediatricsapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9mn6d4nmhttps://escholarship.org/content/qt9mn6d4nm/qt9mn6d4nm.pdfinfo:doi/10.5070/D330363874articleDermatology Online Journalvol 30, iss 3oai:escholarship.org:ark:/13030/qt15s2z4kp2024-07-05T11:15:48Zqt15s2z4kpPyogenic granuloma of the scalp arising from a retained bullet fragment after a contralateral skull-penetrating gunshot woundTicknor, Iesha LYoung, Peter AZacher, Natasha CBae, Gordon H2024-01-01Pyogenic granulomas are benign lesions commonly found on the skin and mucosal surfaces. Although the etiology of pyogenic granuloma is not well understood, some reports have suggested that PG may be caused by impaired wound healing following tissue injury. Rare cases of pyogenic granulomas in the setting of local foreign body have been reported in the literature. Although foreign body reactions have not been identified as a cause of pyogenic granuloma, these reports evidence the need to further investigate this association. We present a 33-year-old man who presented with a pyogenic granuloma on the scalp six years after a contralateral skull-penetrating gunshot wound that resulted in retained bullet fragments.foreign bodygranulomagunshotpyogenicwoundapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/15s2z4kphttps://escholarship.org/content/qt15s2z4kp/qt15s2z4kp.pdfinfo:doi/10.5070/D330363873articleDermatology Online Journalvol 30, iss 3oai:escholarship.org:ark:/13030/qt7fc419q12024-07-05T11:15:46Zqt7fc419q1Chronic ulcer in a patient with essential thrombocythemia taking hydroxyureaMaloney, NolanNovoa, RobertoYeh, Jennifer E2024-01-01Chronic skin ulcers in patients with suspected pyoderma gangrenosum can, on closer inspection and further workup, have a different cause. Recognition of key features on clinical examination such as the presence of atrophie blanche is key to avoid misdiagnosis of pyoderma gangrenosum and its subsequent treatment with high-dose corticosteroids and other immunosuppressive medications.atrophie blanchelivedoid vasculopathyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7fc419q1https://escholarship.org/content/qt7fc419q1/qt7fc419q1.pdfinfo:doi/10.5070/D330363872articleDermatology Online Journalvol 30, iss 3oai:escholarship.org:ark:/13030/qt6bh993qx2024-07-05T11:15:44Zqt6bh993qxCutis verticis gyrata in a patient with acromegaly: an unusual case and review of literatureAchach, OssamaAssarrar, ImaneLoukili, Mohamed AymaneRouf, SihamLatrech, Hanane2024-01-01Acromegaly is a rare systemic syndrome induced by the overproduction of growth hormone (GH) and insulin-like growth factor type one (IGF1). It is responsible for changes in the skeletal and soft tissue systems and it almost always occurs because of a pituitary adenoma. Amongst the skin complications related to acromegaly, cutis verticis gyrate (CVG) is occasionally found. It is a skin condition characterized by excessive growth of the skin of the scalp, resulting in furrows and folds. Only a few cases of this uncommon association have been reported in the literature. The present clinical case illustrates typical CVG associated with acromegaly. Imaging revealed a pituitary macroadenoma lesion and hormonal evaluation revealed elevated IGF1 and hypopituitarism. The patient underwent a transsphenoidal resection of the pituitary adenoma and the histopathological examination confirmed the diagnosis. The diagnosis of CVG is clinical, so radiologic assessments are generally not necessary. The management of acromegaly associated with CVG depends on controlling the serum levels of GH and IGF1. In some cases, specific injections or surgery can be used to minimize CVG.acromegalyadenomacutisgrowth hormonepituitaryrareverticis gyrateapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6bh993qxhttps://escholarship.org/content/qt6bh993qx/qt6bh993qx.pdfinfo:doi/10.5070/D330363871articleDermatology Online Journalvol 30, iss 3oai:escholarship.org:ark:/13030/qt352987hd2024-07-05T11:15:42Zqt352987hdAcute generalized exanthematous pustulosis triggered by COVID-19Amoedo, PatriciaCerejeira, AndreCoelho, Ana RitaNogueira, Ana CristinaAzevedo, Filomena2024-01-01Acute generalized exanthematous pustulosis is a severe adverse skin reaction, usually caused by drugs, but in rare cases it can be associated with infections. Several cases related to COVID-19 have been reported, however, almost all were drug-related. Here we report a case of acute generalized exanthematous pustulosis associated with COVID-19 in a previously healthy 64-year-old woman, with no culprit drugs.acuteCOVID-19exanthematousgeneralizedpustulosisSARS-CoV-2application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/352987hdhttps://escholarship.org/content/qt352987hd/qt352987hd.pdfinfo:doi/10.5070/D330363870articleDermatology Online Journalvol 30, iss 3oai:escholarship.org:ark:/13030/qt9g99s8gt2024-07-05T11:15:41Zqt9g99s8gtBlau syndrome-the skin as a warning signMorgan, Mariana Aparecida Pasade Oliveira, Rafaela MouraGoncalves, Alice AndradeTopan, Larissa Habib Mendonca GoisBandeira, MarciaAbagge, Kerstin Taniguchide Carvalho, Vania Oliveira2024-01-01Blau syndrome is an autosomal dominant chronic inflammatory disease, which may begin with skin manifestations in the first months of life, alerting physicians to the diagnosis. This case reports a patient diagnosed jointly by pediatric dermatology and rheumatology consultants at two years of age.arthritisautoinflammatoryBlauearlygranulomatousmonogenicmutationNOD2rheumatoidsyndromeapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9g99s8gthttps://escholarship.org/content/qt9g99s8gt/qt9g99s8gt.pdfinfo:doi/10.5070/D330363869articleDermatology Online Journalvol 30, iss 3oai:escholarship.org:ark:/13030/qt27v5m4232024-07-05T11:15:40Zqt27v5m423Erythema multiforme-like papules after COVID vaccine administrationDaly, Theodore JSmith, Gregory TMcClain, Steve A2024-01-01A unique dermatopathology incident arose after administration of the mRNA-1273 SARS-CoV-2 (Moderna) vaccine. Specifically, a transient purpuric interface dermatitis occurred 5 days post-second vaccine with the presentation of erythematous papules with erythema multiforme-type findings. A patient developed purpuric interface dermatitis with micro-vesiculation post-vaccination which ultimately resolved without sequelae.COVID-19interface dermatitismicro-vesiculationpurpuricvaccine reactionapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/27v5m423https://escholarship.org/content/qt27v5m423/qt27v5m423.pdfinfo:doi/10.5070/D330363868articleDermatology Online Journalvol 30, iss 3oai:escholarship.org:ark:/13030/qt68w450nc2024-07-05T11:15:39Zqt68w450ncThe use of systemic corticosteroids in debilitating sycosis barbae, sycosis barbae fulminansKrivda, Kathleen ROkoro, Uzoamaka JLogemann, Nicholas F2024-01-01Submitted as: (mark with X) X_Case Report _Case Presentation _Photo Vignette _Letter Authors declare that the contents of this article are their own original unpublished findings. Title: The use of systemic corticosteroids in debilitating sycosis barbae, sycosis barbae fulminans Authors: Kathleen R Krivda MD, Uzoamaka J Okoro MD, Nicholas F Logemann DO Affiliations: Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, Bethesda, Maryland, USA Corresponding Author: Kathleen Krivda MD, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda MD 20889, Tel: 240-751-3823, Email: kathleenkrivda@gmail.com Abstract (no more than 200 words):barbaefulminanspseudofolliculitissycosisvulgarisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/68w450nchttps://escholarship.org/content/qt68w450nc/qt68w450nc.pdfinfo:doi/10.5070/D330363867articleDermatology Online Journalvol 30, iss 3oai:escholarship.org:ark:/13030/qt4gt3p5xx2024-07-05T11:15:38Zqt4gt3p5xxPossible new defining presentation of mosaic tetrasomy 9p: multiple and recurrent pilomatrixomaWang, Jonathan WBehnam, RetaPorto, Dennis A2024-01-01Tetrasomy 9p is a rare genetic syndrome resulting from two additional copies of the short arm of chromosome 9. Symptoms often present in the form of congenital abnormalities including cognitive disabilities, growth retardation, abnormal earlobes, congenital heart disease, and dysmorphia of the skull and face. Current literature suggests patients with tetrasomy 9p may exhibit any combination of these symptoms or, in rare instances, none at all. Although karyotyping, chromosomal microarray, and galactose-1-phosphate uridyltransferase activity analyses are the definitive diagnostic methods used, there remains a need for more robust clinical recognition in cases of mild phenotypic expression. Herein, we present a rare case of mosaic tetrasomy 9p in a long-term survival patient with multiple and recurrent pilomatrixomas, rare benign growths more commonly found in individuals under the age of 20. To our knowledge, only two previous reports have noted concurrent tetrasomy 9p with pilomatrixomas. We are the first to identify this phenotype in an adult tetrasomy 9p patient. Dermatopathology evaluation was conducted to verify our diagnoses. Our aim is to present a unique, additional case suggesting multiple pilomatrixomas as a new defining clinical presentation of mosaic tetrasomy 9p and to review the literature underlying the genetic changes associated with this syndrome.geneticmosaicismpilomatrixomastetrasomy 9papplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4gt3p5xxhttps://escholarship.org/content/qt4gt3p5xx/qt4gt3p5xx.pdfinfo:doi/10.5070/D330363866articleDermatology Online Journalvol 30, iss 3oai:escholarship.org:ark:/13030/qt23b749xs2024-07-05T11:15:37Zqt23b749xsExclusive extragenital lichen sclerosis in a child presenting in a lichen planus distributionMurshidi, RandAlSamhori, Jehad FerasAlSamhouri, Abdel Rahman FerasHamad, Salsabiela BaniAbdaljaleel, MaramAlShammas, Faris2024-01-01Lichen sclerosus (LS) is a chronic inflammatory dermatosis primarily affecting the genitalia, commonly characterized by pearly-white papules and plaques. Although predominantly affecting females, LS can manifest across all age groups, with a bimodal distribution observed in prepubescent girls and postmenopausal women. This case report presents an unusual instance of exclusive extragenital LS in a 10-year-old girl, showcasing hyperpigmented patches and wrinkled plaques resembling lichen planus on her forearms and lower legs. Histopathological analysis confirmed LS, revealing distinctive epidermal changes and lymphocytic infiltrates. The absence of mucosal involvement and unique clinical presentation differentiated this case from typical LS manifestations. Treatment with topical clobetasol propionate demonstrated significant improvement in pruritus. Extragenital LS is infrequent, particularly among children, and its diagnosis necessitates a comprehensive clinicopathological correlation. The reported case contributes valuable insights into this uncommon variant, emphasizing the importance of accurate diagnosis and tailored treatment strategies. Additionally, it highlights the efficacy of high-potency topical corticosteroids in managing this condition.corticosteroidhyperpigmented patcheslichen planuspediatric dermatologysclerosustopicalapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/23b749xshttps://escholarship.org/content/qt23b749xs/qt23b749xs.pdfinfo:doi/10.5070/D330363865articleDermatology Online Journalvol 30, iss 3oai:escholarship.org:ark:/13030/qt40h397j32024-07-05T11:15:35Zqt40h397j3Recalcitrant multi-variant lichen planus successfully treated with oral baricitinib and topical ruxolitinib creamMin, MildredDulai, Ajay SSivamani, Raja K2024-01-01Lichen planus is a chronic auto-inflammatory disease that primarily affects mucocutaneous regions. There are many variants of lichen planus including cutaneous, oral, nail, follicular, and erosive forms. Without any disease-specific treatment options, multi-variant lichen planus can be a challenging disease to manage. We present a 61-year-old woman with multivariant lichen planus that was refractory to numerous systemic and topical therapies. Subsequently, her cutaneous and vulvovaginal lesions improved with the use of oral baricitinib and the erosive oral lesions improved with topical ruxolitinib.baricitinibJanus kinaselichen planusruxolitinibapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/40h397j3https://escholarship.org/content/qt40h397j3/qt40h397j3.pdfinfo:doi/10.5070/D330363864articleDermatology Online Journalvol 30, iss 3oai:escholarship.org:ark:/13030/qt0d5696722024-07-05T11:15:34Zqt0d569672Improving patient retention of medical information: lessons from the contact dermatitis clinicLi-Wang, JenniferKatta, Rajani2024-01-01Medical communication skills are widely recognized as important, especially for situations in which providers must present complex and detailed information. Although much research focuses on how providers can improve their delivery of medical information, an equally important part of communication is supporting patient retention of the information. We present several methods to improve patient retention of medical information that we have found successful in an allergic contact dermatitis clinic. Some recommendations address information transfer (follow effective structure, teach to different learning styles, provide written instructions, employ the teach-back method). Other methods are effective, focusing on the patient's emotional, social, and relational needs (include storytelling, metaphor, and analogy, allay negative emotions, listen deeply/know your patient). This list is not exhaustive, but we have found these methods effective when counseling patients with allergic contact dermatitis. Patient retention of medical information is an important part of effective health care, benefits both the provider and the patient, and is applicable to every medical practice.communicationcounselingdermatitisretentionapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0d569672https://escholarship.org/content/qt0d569672/qt0d569672.pdfinfo:doi/10.5070/D330363863articleDermatology Online Journalvol 30, iss 3oai:escholarship.org:ark:/13030/qt34k4b6sq2024-07-05T11:15:33Zqt34k4b6sqA practical classification scale for the dermatology management of individuals with skin of color: the colorimetric scale for skin of colorCohen, Philip RDiMarco, Michelle AGeller, Rachel LDarrisaw, Lora A2024-01-01A simple and rapid method that is not based on race and ethnicity for classifying people with skin of color is of paramount importance in dermatology. The currently used Fitzpatrick classification of sun-reactive skin types is inadequate. Newer scales that have been used in immigration surveys and sociology studies are not applicable in the office setting. A new, non-racial and non-ethnic, colorimetric scale for skin of color has recently been proposed that is simple to perform. The scale has five colors: very light beige (skin color type 1), light brown (skin color type 2), medium brown (skin color type 3), dark brown (skin color type 4) and very dark brown (skin color type 5); an individual with white skin, such as in albinism, would have a skin color type 0 in this classification. In conclusion, the colorimetric scale enables the rapid classification of individuals with skin of color and allows for accurate assessment of skin cancer risk, more appropriate management of cosmetic dermatologic procedures and aesthetic devices, and enhanced ability for focused counseling regarding hair products, skin care interventions, and color-targeted makeup based on the person's skin tone.aestheticblackchemicalclassificationclinicalcolorcolorimetriccosmeticdermatologydyschromiaethnicevaluationFitzpatrickMonklasermanagementmicroneedlingpeelracialscalescarscarringskintherapytreatmentwhiteapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/34k4b6sqhttps://escholarship.org/content/qt34k4b6sq/qt34k4b6sq.pdfinfo:doi/10.5070/D330363862articleDermatology Online Journalvol 30, iss 3oai:escholarship.org:ark:/13030/qt0p2997ts2024-07-05T11:15:32Zqt0p2997tsAcne vulgaris in black pediatric patients: clinical presentation, treatment patterns, and unique needsJordan, Kristiana MFamisan, Demi OMyer, Summer NFine, JeffreyRen, YunyiTartar, Danielle M2024-01-01Acne vulgaris is a common dermatological diagnosis observed in pediatric patients with skin of color, often resulting in scarring, keloid formation, and post-inflammatory hyperpigmentation, significantly impacting their quality of life. This exploratory retrospective chart review included 77 black pediatric patients seen at a tertiary care center for acne vulgaris between 2018 and 2023. We analyzed demographics, acne descriptors, and treatment modalities. The most common acne morphology was comedonal acne (83.6%), with 71% of the patients being female. Significant age differences were observed particularly for acne at the chin and overall face. Treatment regimens commonly prescribed included combinations of adapalene and benzoyl peroxide (22%), topical antibiotics, tretinoin, and benzoyl peroxide (34%). Given the higher risk of sequelae for patients with darker skin, it is crucial to address their unique treatment needs. This study highlights the distinctive characteristics of acne in black pediatric patients and calls for further research to enhance our understanding and treatment of this population. Limitations include the lack of direct patient interactions and reliance on chart data. Further studies are needed to compare acne presentation in skin of color of other populations, refining our knowledge of acne clinical presentation, complications, and treatment modalities for diverse patient populations.acnepediatricspigmentationskin of colorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0p2997tshttps://escholarship.org/content/qt0p2997ts/qt0p2997ts.pdfinfo:doi/10.5070/D330363861articleDermatology Online Journalvol 30, iss 3oai:escholarship.org:ark:/13030/qt2d59584j2024-06-02T10:31:36Zqt2d59584jCorrigendum: Spindle cell lipoma: a rare case report on the halluxLiu, Caroline CSchulman, Joshua MDahle, Sara EAlley, Shelby M2024-01-01The original article was published on February 15, 2024 and corrected on April 15, 2024.The revised version of the article corrects Figure 2. The changes appear in the revised online PDF copy of this article.application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2d59584jhttps://escholarship.org/content/qt2d59584j/qt2d59584j.pdfinfo:doi/10.5070/D330263602articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt38j570g92024-06-02T10:31:35Zqt38j570g9Non-adherent dressings to make skin flaps stickDokic, YelenaAlkul, SuzannaShimizu, IkueRanario, Jennifer Song2024-01-01dermatologic surgeryflapsMohs surgeryresident educationsurgical trainingapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/38j570g9https://escholarship.org/content/qt38j570g9/qt38j570g9.pdfinfo:doi/10.5070/D330263597articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt6bs863zb2024-06-02T10:31:34Zqt6bs863zbPatient and provider-directed adjunct diagnostic tools in the detection of skin cancerWei, GraceKontzias, ChristinaHaidari, WasimFeldman, Steven RAhn, Christine2024-01-01detectiondiagnosisnon-invasiveskin cancerapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6bs863zbhttps://escholarship.org/content/qt6bs863zb/qt6bs863zb.pdfinfo:doi/10.5070/D330263596articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt1906k01h2024-06-02T10:31:32Zqt1906k01hA patient with acute-type adult T-cell leukemia/lymphoma that rapidly progressed after Helicobacter pylori eradication therapyMatsudate, YoshihiroSaeki, Kyosuke2024-01-01cutaneousHelicobacter pyloridrug hypersensitivityHTLV-1 infectionsT-cell lymphomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1906k01hhttps://escholarship.org/content/qt1906k01h/qt1906k01h.pdfinfo:doi/10.5070/D330263595articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt6df9w0xw2024-06-02T10:31:30Zqt6df9w0xwNodular hidradenoma: clinical, dermoscopic, and histopathological featuresCorreia, Catarinade Vasconcelos, PedroSoares-de-Almeida, Luis2024-01-01Nodular hidradenoma is an infrequent benign tumor originating from the proximal portion of the sweat glands, most commonly associated with the apocrine glands. Owing to its variable clinical presentation, correctly diagnosing nodular hidradenoma can be challenging, with several potential conditions in the differential diagnosis to consider. This article presents a healthy 52-year-old woman with an atypical location of nodular hidradenoma, highlighting the critical role of integrating clinical, dermoscopic, and histopathological characteristics for an accurate diagnosis. We discuss the clinical features, dermoscopic findings, histological examination, differential diagnosis, and treatment options for nodular hidradenoma, emphasizing the importance of surgical intervention in preventing potential malignant transformation.adnexalneoplasmsskin appendagesweat glandtubular adenomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/6df9w0xwhttps://escholarship.org/content/qt6df9w0xw/qt6df9w0xw.pdfinfo:doi/10.5070/D330263594articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt8k9712wz2024-06-02T10:31:29Zqt8k9712wzA rare case of meloxicam-induced pseudoporphyriaBenandi, KatherineSieving, DevonWolf, Kristin2024-01-01Drug-induced pseudoporphyria is commonly linked to nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen, oxaprozin, ketoprofen, and ibuprofen. The NSAID meloxicam is not a commonly reported inciting agent. We report a case of meloxicam-induced pseudoporphyria in a 55-year-old woman with a past medical history of hypertension, hyperlipidemia, gastroesophageal reflux disease, and osteoarthritis. She presented to the clinic with tense and denuded bullae on her dorsal feet, which was diagnosed as pseudoporphyria after further workup. Upon evaluating the patient's medication history, meloxicam was identified as the most likely inciting agent. The patient's condition resolved with the discontinuation of this medication. Our findings can help dermatologists effectively diagnose and treat meloxicam-induced pseudoporphyria in patients with similar cases.meloxicamNSAIDSphotosensitive rashpseudoporphyriaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8k9712wzhttps://escholarship.org/content/qt8k9712wz/qt8k9712wz.pdfinfo:doi/10.5070/D330263593articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt7ht317nm2024-06-02T10:31:28Zqt7ht317nmPorokeratosis on the lip: A Case SeriesWescott, Raquel MHeaphy, Michael R2024-01-01Porokeratosis is a skin condition that involves the formation of plaques, characterized by a hyperkeratotic ridge with an atrophic center. There is a histological presence of a cornoid lamella, which is a parakeratotic column that traverses through the stratum corneum. The plaques are mostly benign but have the potential to become squamous cell carcinomas if left untreated. Porokeratosis lesions typically occur on the extremities, but they can develop anywhere. The occurrence of porokeratosis on the lip is exceedingly rare. We report three cases of porokeratosis on the lip. Each incidence was treated with cryotherapy, which was unsuccessful in two. One of these two patients did not elect for topical treatment and is being monitored for lesion changes. The second patient was successfully treated via shave biopsy. The third patient was lost to follow-up post-cryotherapy.cornoidcryotherapylamellaelipporokeratosisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7ht317nmhttps://escholarship.org/content/qt7ht317nm/qt7ht317nm.pdfinfo:doi/10.5070/D330263592articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt8c4955qh2024-06-02T10:31:27Zqt8c4955qhRefractory chronic spontaneous urticaria after heterologous COVID-19 booster vaccinationTomaras, Miranda CristaDouglas, Leah MichelleSchmidt, Rosa MichelleBloomquist, Maria SuzanneDiwan, Abdul HafeezKim, Soo Jung2024-01-01Chronic spontaneous urticaria (CSU) involves recurrent, pruritic wheals lasting more than 6 weeks in response to various etiologies, including unknown causality. Though most cutaneous reactions to the COVID-19 vaccine series are self-limited and of short duration, more complex presentations including chronic spontaneous urticaria have been described. To the best of our knowledge, this is the first report of chronic spontaneous urticaria following heterologous mRNA COVID-19 booster vaccination that includes vaccination with both forms of the mRNA vaccine. Our patient received Pfizer-BioNTech for the primary series and Moderna for the booster. After failing several therapies, our patient's urticaria was refractory even to omalizumab. The source for chronic spontaneous urticaria development in our patient may be related to the unique humoral response elicited by receipt of a different mRNA vaccine manufacturer.COVID-19mRNA vaccineomalizumaburticariaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8c4955qhhttps://escholarship.org/content/qt8c4955qh/qt8c4955qh.pdfinfo:doi/10.5070/D330263591articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt51f5f0x92024-06-02T10:31:25Zqt51f5f0x9Angiosarcoma: hiding in plain sightNguyen, Tue FBambekova, Pavela GHivnor, Chad MSiddiqui, Huma AOwen, Joshua L2024-01-01Angiosarcoma is a rare, aggressive soft-tissue sarcoma of endothelial origin that necessitates early recognition, diagnosis, and treatment. The most commonly reported presentation consists of violaceous patches and plaques on the head and neck of elderly white men, with fewer reports affecting patients with Skin of Color. Most cases of angiosarcoma are idiopathic and tend to recur locally with early metastasis, conferring a poor prognosis. We report a case of an 83-year-old Fitzpatrick skin type IV man who presented with a large violaceous-to-black mamillated plaque on the frontotemporal scalp that was clinically highly suggestive of cutaneous angiosarcoma. However, unrevealing histopathology complicated our diagnostic process and delayed management. Immunohistochemistry was invaluable in determining the diagnosis of angiosarcoma. Our case highlights the aggressive nature of cutaneous angiosarcoma, necessitating close clinicopathologic correlation to confirm the diagnosis and initiate treatment.cutaneous angiosarcomadermatooncologydermatopathologymedical dermatologyskin of colorapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/51f5f0x9https://escholarship.org/content/qt51f5f0x9/qt51f5f0x9.pdfinfo:doi/10.5070/D330263590articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt72g038qm2024-06-02T10:31:24Zqt72g038qmThe rope sign, a typical and yet infrequent clueGarcia-Rodriguez, VictorArandes-Marcocci, JorgeFernandez-Figueras, MTSalleras-Redonnet, Montse2024-01-01Cutaneous granulomatous reactions are diverse, both from the clinical and the pathological perspective. Most underlying pathophysiological aspects remain elusive. Interstitial granulomatous dermatitis and palisaded neutrophilic and granulomatous dermatitis have been claimed to be reactions to systemic disorders, such as infectious, inflammatory, or neoplastic conditions. Recently, the overarching term "reactive granulomatous dermatitis" has been coined to unify both entities. We herein report two cases of reactive granulomatous dermatitis presenting with the widely known, albeit infrequent "rope sign" and provide clinicopathological correlation. The two patients included a 53-year-old woman with enlarging erythematous plaques and underlying palpable cords on both sides of trunk near axillae (rope sign), and a 51-year-old woman with personal history of rheumatoid arthritis and a palpable cord on the left aspect of the trunk. Pathological findings were compatible with reactive granulomatous dermatitis in both cases. In conclusion, the rope sign represents a strikingly infrequent but decisive diagnostic clue of reactive granulomatous dermatitis.diagnosisgranulomatous dermatitisinterstitialrope signapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/72g038qmhttps://escholarship.org/content/qt72g038qm/qt72g038qm.pdfinfo:doi/10.5070/D330263589articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt03t6528c2024-06-02T10:31:23Zqt03t6528cA case of melanoma in situ of the central forehead repair by V-Y advancement flap and Burow graftDiamond, CarrieLeigh, RebekahRundle, ChandlerFlynn, M SethStamey, Christopher2024-01-01Large defects on the face after Mohs surgery have posed significant reconstructive challenges. A 90-year-old man presented with melanoma in situ of the central forehead, which resulted in a 4.5cmx4.3cm defect after multiple stages of Mohs surgery. Although different approaches for forehead repair with nasal root involvement are possible, we demonstrate that the V-Y advancement flap and subsequent Burrow graft for nasal root repair represents a viable closure technique for large circular defects of the central forehead.Burow graftin situmelanomaMohs surgeryreconstructionV-Y advancementapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/03t6528chttps://escholarship.org/content/qt03t6528c/qt03t6528c.pdfinfo:doi/10.5070/D330263588articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt96w1r65m2024-06-02T10:31:22Zqt96w1r65mDrug-Induced dermatomyositis following COVID-19 vaccinationHerron, ElliottPowell, DouglasFlorell, Scott RHansen, Christopher2024-01-01Dermatomyositis (DM) is a multi-organ idiopathic inflammatory myopathy that presents with proximal symmetric muscle weakness accompanied by characteristic cutaneous findings. Most individuals present with skin manifestations prior to muscle involvement and its course can involve the blood vessels, joints, esophagus, and lungs and can be paraneoplastic, making a malignancy assessment imperative. Although its etiology is unknown, type I interferon appears to be a component in evoking the characteristic inflammatory response and patients with DM often have an increase in type I inducible genes. Suspected triggers for DM are environmental factors, drugs, viral infections, and vaccines. The association of DM with vaccination poses a new conundrum within the medical community as people continue to get vaccinated and boosted with SARS-CoV2 vaccines, though it is worth noting that the most common challenges arose as type I hypersensitivity reactions and new onset autoimmune disorders are rare. Presented here is a 53-year-old man who was diagnosed with DM after receiving the second dose of the Pfizer vaccine. His case highlights the importance of the potential onset of autoimmune diseases following the COVID-19 vaccine, a phenomenon that clinicians should be aware of as the discourse concerning the pandemic continues.COVID-19dermatomyositisdrug inducedSARS-CoV-2vaccine induced dermatomyositisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/96w1r65mhttps://escholarship.org/content/qt96w1r65m/qt96w1r65m.pdfinfo:doi/10.5070/D330263587articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt5h0532w22024-06-02T10:31:20Zqt5h0532w2Localized pemphigus vulgaris on scalp: an atypical presentation.Lapena-Casado, AlejandroAlcantara-Gonzalez, JavierGarcia-Garcia, MarPerna-Monroy, CristianConcellon-Donate, Maria-AntoniaCapusan, Tania-Marusia2024-01-01We present two middle-aged patients with pruritic, crusted scalp erosions. Skin biopsy showed epidermal acantholysis with IgG and C3 intercellular deposits on direct immunofluorescence, leading to the diagnosis of localized pemphigus vulgaris. Resolution of the lesions without relapse occurred after low doses of oral prednisone and intralesional triamcinolone acetonide.pemphigusscalpvulgarisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5h0532w2https://escholarship.org/content/qt5h0532w2/qt5h0532w2.pdfinfo:doi/10.5070/D330263586articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt2484d0582024-06-02T10:31:19Zqt2484d058Extragenital lichen sclerosus et atrophicus-morphea overlap as an initial presentation of genital lichen sclerosusGordon, Emily RAdeuyan, OluwaseyiFahmy, Lauren MSchreidah, Celine MTrager, Megan HLapolla, Brigit AHusain, SameeraGeskin, Larisa J2024-01-01Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory disorder, most often characterized by atrophic skin plaques located on female genitalia. Infrequently, LSA may present extragenitally; however, much is unknown about the temporal relationship between genital and extragenital LSA. Morphea, also known as localized scleroderma, is a rare inflammatory skin condition characterized by sclerotic plaques. Investigators debate whether LSA and morphea exist on the same spectrum of disease, with LSA representing a superficial variant of morphea involving genitalia, or if they are distinct but coincidental entities. Although researchers have described LSA and morphea occurring in different locations on the same patient, few reports describe LSA and morphea occurring in the same lesion and in the inguinal folds. Herein, we report a case of a 62-year-old woman with extragenital LSA-morphea overlap in the inguinal folds, who three months later developed genital LSA. Extragenital LSA-morphea in the same plaque, with no signs of genital lesions on initial exam, with later development of genital LSA, is especially uncommon. The temporal progression of extragenital LSA-morphea overlap to genital LSA over a three-month period is an important contribution to the literature, as the temporal relationship between extragenital and genital LSA is not previously discussed.extragenitallichen sclerosus et atrophicusmorpheaoverlaptemporalapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2484d058https://escholarship.org/content/qt2484d058/qt2484d058.pdfinfo:doi/10.5070/D330263585articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt0p40q6cr2024-06-02T10:31:18Zqt0p40q6crAn atypical presentation of human monkeypox infection with clinicopathologic correlationColon, JessicaMcNamara, Stephanie AGrubbs, HaileyGupta, AnmolHenehan, MasonBrazen, BrettRajabi-Estarabadi, AliNousari, Carlos H2024-01-01There is growing evidence to support new modes of transmission for human monkeypox infection. As these methods are being explored, this report delineates the day-to-day clinical sequelae following the initial exposure in an HIV-positive man who had sexual intercourse with another man days preceding his infection. We describe atypical cutaneous manifestations involving widespread erythematous pustules with preceding anogenital ulcerations and concomitant bilateral inguinal lymphadenopathy. Clinicopathologic correlation is used to assist in the workup and establishing the diagnosis. Our case supports others reported in the literature that suggest sexual contact as a means of transmission. More research is needed that investigates the presence of infection in both men and women, including those who could act as carriers, to elucidate other pathways in this evolving yet evasive viral disease.atypicalgenital ulcersHIVlymphadenopathymonkeypoxMpoxperianal ulcerssexual transmissionapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0p40q6crhttps://escholarship.org/content/qt0p40q6cr/qt0p40q6cr.pdfinfo:doi/10.5070/D330263584articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt8ch4w0c32024-06-02T10:31:17Zqt8ch4w0c3Generalized Hailey-Hailey disease associated with c.2395C>T ATP2C1 gene mutation and fatal outcome.Brown, Isabelle DPariser, Robert J2024-01-01Hailey-Hailey disease (HHD) is a rare, autosomal dominant genodermatosis caused by a mutation of the ATP2C1 gene and presenting as an erosive dermatosis, particularly in the intertriginous areas. Generalized HHD is a rare variant. We present a case of widespread, recalcitrant HHD in a middle-aged woman with a fatal outcome. No other underlying dermatosis was identified, with the possible exception of drug sensitivity to carbamazepine. Diagnosis of HHD was confirmed by histology and genetic studies which showed a c.2395C>T mutation in the ATP2C1 gene. Concurrent pemphigus was excluded. Cases of generalized HHD are extremely rare and present a challenge in diagnosis and management. Increased awareness of this severe clinical variant is needed to improve quality of care for patients with this form of HHD.acantholysisgenodermatosisHailey-Haileypemphigusapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/8ch4w0c3https://escholarship.org/content/qt8ch4w0c3/qt8ch4w0c3.pdfinfo:doi/10.5070/D330263583articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt152511772024-06-02T10:31:16Zqt15251177Febrile ulceronecrotic Mucha-Habermann disease - a case and treatment reviewMoutinho-Pereira, SaraBeires, FranciscaSantos, Joana dosRelvas, MariaRamos, Leonor CastendoRamos, Sara CastendoMedeiros, TeresaGreenfield, HelenaRamos, Sara AugustaAndrade, Pedro2024-01-01Febrile ulceronecrotic Mucha-Habermann disease is a rare and severe variant of pityriasis lichenoides, characterized by sudden onset of generalized ulceronecrotic papules that rapidly coalesce into ulcers associated with high fever. Systemic manifestations such as intravascular disseminated coagulation and pulmonary, cardiac, gastrointestinal, and central nervous system involvement are common. Treatment is based on oral corticosteroids, immunosuppressive drugs such as methotrexate, and general supportive treatment. The present case describes a stepwise approach to a patient with Mucha-Habermann disease with insufficient response to methotrexate.dermatologyMucha-Habermannpityriasis lichenoidesPLEVAulceronecroticapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/15251177https://escholarship.org/content/qt15251177/qt15251177.pdfinfo:doi/10.5070/D330263582articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt3q47v0xj2024-06-02T10:31:15Zqt3q47v0xjErythema elevatum diutinum in a patient with well-controlled Crohn diseaseMcKenna, BrianBlechman, AdamGru, AlejandroFlowers, R Hal2024-01-01Erythema elevatum diutinum is a rare, chronic cutaneous leukocytoclastic vasculitis, with prominent fibrosis at its later stage. In this article, we report a case of erythema elevatum diutinum in a 23-year-old woman with well-controlled Crohn disease. To our knowledge, erythema elevatum diutinum has been reported in only three other cases of Crohn disease, in which eruptions of erythema elevatum diutinum were associated with features of active Crohn. Our patient was in clinical remission at the time of erythema elevatum diutinum onset, making this report significant not only for its uncommon presentation, but more importantly, to aid readers. diagnosis and clinical management of similar cases.Crohn diseaseerythema elevatum diutinuminflammatory bowelleukocytoclastic vasculitisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/3q47v0xjhttps://escholarship.org/content/qt3q47v0xj/qt3q47v0xj.pdfinfo:doi/10.5070/D330263581articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt4dn4k1872024-06-02T10:31:14Zqt4dn4k187Acrokeratosis paraneoplastica (Basex syndrome) with trachyonychia preceding the diagnosis of squamous cell carcinoma of the lungGioe, ReedMathien, AugustKuraitis, Drew2024-01-01Acrokeratosis paraneoplastica (Basex syndrome) is a rare paraneoplastic condition hallmarked by psoriasiform lesion development on acral surfaces, most often related to an underlying squamous cell carcinoma. Patients may also present with nail plate changes. Successful management of this condition can be accomplished by treating the underlying malignancy.acrokeratosis paraneoplasticabazex syndromecancerlungmalignancyparaneoplasiaparaneoplasticpsoriasiformapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4dn4k187https://escholarship.org/content/qt4dn4k187/qt4dn4k187.pdfinfo:doi/10.5070/D330263580articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt9tx7p5jj2024-06-02T10:31:13Zqt9tx7p5jjCutaneous mucormycosis infection owing to Rhizomucor variabilis presenting as recurrent lower limb ulceration and cellulitis in a diabetic patientMonteiro, Amelia YutingMin, Aaron WeiSee, Joyce SiongPan, Jiun Yit2024-01-01Primary cutaneous mucormycosis is caused by environmental fungi and may complicate leg ulcers or traumatic wounds even in immunocompetent individuals. This case report highlights recurrent lower limb ulcers and cellulitis in a patient with type two diabetes mellitus, which was unresponsive to conventional antibiotic treatment. Histopathology revealed the diagnosis of cutaneous mucormycosis, and fungal cultures identified Rhizopus variabilis as the causative organism. Initial courses of oral azole antifungals yielded only partial response and he eventually required more aggressive treatment with i.v. amphotericin B and oral posaconazole. Good treatment outcomes for this condition require a high index of clinical suspicion, early histopathological and microbiological diagnosis, targeted systemic antifungal therapy, and surgical debridement if necessary.cutaneousdiabetesimmunocompetentmucormycosisRhizopus variabilisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9tx7p5jjhttps://escholarship.org/content/qt9tx7p5jj/qt9tx7p5jj.pdfinfo:doi/10.5070/D330263579articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt56c4t18r2024-06-02T10:31:12Zqt56c4t18rDisseminated tuberculosis in an immunocompetent 15-year-old adolescentMartins, Ezequias BDuraes, Sandra MBVilte, Remberto MCVCarvalho, Fabiana Rdos Santos, Thaina BBatzner, Clarissa Nda Silva, Natalia CZFerreira, Laura CRonchini, Karla ROMVallim, Marcela TMMcBenedict, BillyMalta, Luis MarceloPinheiro, Patricia YM2024-01-01Tuberculosis is one of the oldest known diseases and it remains one of the main causes of morbidity and mortality, especially in developing countries. It is associated with social inequalities and affects different age groups. Tuberculosis in children and adolescents should be considered a sentinel event, since it is linked to a recent infection through contact with bacilliferous adults. We report an immunocompetent 15-year-old adolescent with tuberculosis, exhibiting pulmonary, osteoarticular, and cutaneous involvement. Conventional treatment with tuberculostatic drugs for a year had satisfactory results without sequelae.adolescentdisseminatedimmunocompetentMycobacterium tuberculosistuberculosisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/56c4t18rhttps://escholarship.org/content/qt56c4t18r/qt56c4t18r.pdfinfo:doi/10.5070/D330263578articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt7n65z50g2024-06-02T10:31:11Zqt7n65z50gSquamoid eccrine ductal carcinoma: clinical, histological and immunohistochemical featuresChan, Cynthia XSriharan, AravindhanLeBlanc, Robert EGuill, Marshall AGlass, Jonathan SMomtahen, Shabnam2024-01-01Squamoid eccrine ductal carcinoma (SEDC) is a cutaneous adnexal malignancy that is histologically challenging to distinguish from squamous cell carcinoma. We report three cases of this rare entity and review the present literature regarding clinical, histological, and immunohistochemical features. Patients presented with a single nodule or plaque lesion on their back and temple. The shave biopsies for Patient A and C were interpreted as SEDC. Patient B's initial shave biopsy was interpreted as probable surface of squamous cell carcinoma, and subsequent excision revealed SEDC. Ductal differentiation was confirmed by positive expression of epithelial membrane antigen and carcinoembryonic antigen immunostains in all three patients. Review of the 67 previously reported cases emphasizes the importance of diagnosing SEDC accurately and promptly given its potential for distant metastasis and mortality. Perineural or lymphatic invasion is associated with higher rate of recurrence or metastasis. There should be high pathologic suspicion for SEDC in an elderly patient presenting with a palpable lesion, even if located outside of the head and neck area, particularly when there is suggestion of ductal differentiation in a sample of a squamous neoplasm.adnexal carcinomaductal differentiationeccrinesquamoid neoplasmapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7n65z50ghttps://escholarship.org/content/qt7n65z50g/qt7n65z50g.pdfinfo:doi/10.5070/D330263577articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt07r8081k2024-06-02T10:31:10Zqt07r8081kImproving pediatric atopic dermatitis care in the emergency department and primary care setting: a collaborative quality improvement pilot projectPaladichuk, HanaShivaprakash, NandithaHaller, Courtney NDiaz, Lucia ZWilkinson, MatthewLevy, Moise LIyer, Sujit2024-01-01Emergency department visits and healthcare expenditures for pediatric atopic dermatitis have been increasing over the last two decades. There is a paucity of replicable quality improvement initiatives addressed at educating primary care and emergency medicine clinicians on this condition. The goal of this initiative was to improve clinician knowledge and comfort in the diagnosis and management of pediatric atopic dermatitis and superinfection. Clinicians were recruited via email from academic and community settings in Travis County, Texas, in 2020. They were sent a pre-intervention survey, a series of three quizzes, and a post-intervention survey. After each quiz, participants received performance feedback and various forms of multimodal education. Differences between the first and final quiz scores and clinician confidence levels were analyzed for statistical significance. Fifty-six clinicians completed the intervention. The average overall and treatment-specific scores increased significantly by 10% and 37%, respectively. Further, confidence levels improved significantly in the majority of clinicians. Clinician qualitative feedback revealed high satisfaction. Results from this educational quality improvement project have demonstrated that this is an effective and replicable resource for educating clinicians who manage pediatric atopic dermatitis in the emergency department and outpatient setting.clinicianeczemaeducationpediatricapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/07r8081khttps://escholarship.org/content/qt07r8081k/qt07r8081k.pdfinfo:doi/10.5070/D330263576articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt952871q52024-06-02T10:31:09Zqt952871q5Merkel cell carcinoma associated with TNF inhibitor therapy: a systematic review of case reportsAlmashali, MohammedAlotaibi, Manar AShadid, Asem2024-01-01A rare neuroendocrine skin cancer called Merkel cell carcinoma (MCC) primarily affects elderly people. The objective of this study is to comprehensively review the impact of immunosuppressive medications, particularly TNF inhibitors, on the emergence of MCC. Methods: PubMed, Web of Science, Science Direct, and Cochrane Library were searched. Study articles were screened by title and abstract at Rayyan Qatar Computing Research Institute, then a full-text assessment was implemented. Results: A total of eight case reports with 9 patients were included. Of the total population, seven were women and only two were men. Their age ranged from 31 to 73 years. More than half the population (5 cases) were being treated for rheumatoid arthritis. All received TNF inhibitors that were associated with the induction of MCC. Conclusion: We found that it is essential for physicians to explain potential cancer risks to patients before starting long-term immunosuppressive therapy and to conduct routine checks for MCC and other side effects. TNF inhibitors (infliximab, adalimumab, etanercept, and golimumab) were all associated with MCC development. Women constituted the majority of cases and most were elderly.autoimmunecarcinomainhibitorsMerkel cellreviewsystematicTNFaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/952871q5https://escholarship.org/content/qt952871q5/qt952871q5.pdfinfo:doi/10.5070/D330263575articleDermatology Online Journalvol 30, iss 2oai:escholarship.org:ark:/13030/qt1q91h62d2024-05-03T18:21:47Zqt1q91h62dErythema 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/1q91h62dhttps://escholarship.org/content/qt1q91h62d/qt1q91h62d.pdfinfo:doi/10.5070/D330163304articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt51w7973d2024-05-03T18:21:46Zqt51w7973dElectronic 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/51w7973dhttps://escholarship.org/content/qt51w7973d/qt51w7973d.pdfinfo:doi/10.5070/D330163303articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt8x71108d2024-05-03T18:21:45Zqt8x71108dJellyfish 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/8x71108dhttps://escholarship.org/content/qt8x71108d/qt8x71108d.pdfinfo:doi/10.5070/D330163302articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt2fj887j52024-05-03T18:21:44Zqt2fj887j5Three 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/2fj887j5https://escholarship.org/content/qt2fj887j5/qt2fj887j5.pdfinfo:doi/10.5070/D330163301articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt3pr6235s2024-05-03T18:21:42Zqt3pr6235sArtificial 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/3pr6235shttps://escholarship.org/content/qt3pr6235s/qt3pr6235s.pdfinfo:doi/10.5070/D330163300articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt1qk2138z2024-05-03T18:21:41Zqt1qk2138zAdvancing 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/1qk2138zhttps://escholarship.org/content/qt1qk2138z/qt1qk2138z.pdfinfo:doi/10.5070/D330163299articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt83r9c4qv2024-05-03T18:21:40Zqt83r9c4qvOsteonecrosis 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/83r9c4qvhttps://escholarship.org/content/qt83r9c4qv/qt83r9c4qv.pdfinfo:doi/10.5070/D330163297articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt846053fq2024-05-03T18:21:39Zqt846053fqMilia 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/846053fqhttps://escholarship.org/content/qt846053fq/qt846053fq.pdfinfo:doi/10.5070/D330163296articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt0gt361tg2024-05-03T18:21:38Zqt0gt361tgCongenital 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/0gt361tghttps://escholarship.org/content/qt0gt361tg/qt0gt361tg.pdfinfo:doi/10.5070/D330163295articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt57q552jp2024-05-03T18:21:37Zqt57q552jpStevens-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/57q552jphttps://escholarship.org/content/qt57q552jp/qt57q552jp.pdfinfo:doi/10.5070/D330163294articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt43w6t0pz2024-05-03T18:21:35Zqt43w6t0pzVerrucous 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/43w6t0pzhttps://escholarship.org/content/qt43w6t0pz/qt43w6t0pz.pdfinfo:doi/10.5070/D330163293articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt6nd6w2f52024-05-03T18:21:34Zqt6nd6w2f5Fast 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/6nd6w2f5https://escholarship.org/content/qt6nd6w2f5/qt6nd6w2f5.pdfinfo:doi/10.5070/D330163292articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt1wr1d18m2024-05-03T18:21:33Zqt1wr1d18mMultiple juvenile xanthogranulomaGarcia-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/1wr1d18mhttps://escholarship.org/content/qt1wr1d18m/qt1wr1d18m.pdfinfo:doi/10.5070/D330163291articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt9q97x41f2024-05-03T18:21:32Zqt9q97x41fPatients 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/9q97x41fhttps://escholarship.org/content/qt9q97x41f/qt9q97x41f.pdfinfo:doi/10.5070/D330163287articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt7sr3b07h2024-05-03T18:21:32Zqt7sr3b07hSpindle 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/7sr3b07hhttps://escholarship.org/content/qt7sr3b07h/qt7sr3b07h.pdfinfo:doi/10.5070/D330163290articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt3z30h45r2024-05-03T18:21:30Zqt3z30h45rInfliximab-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/3z30h45rhttps://escholarship.org/content/qt3z30h45r/qt3z30h45r.pdfinfo:doi/10.5070/D330163286articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt5836f5db2024-05-03T18:21:29Zqt5836f5dbBasal 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/5836f5dbhttps://escholarship.org/content/qt5836f5db/qt5836f5db.pdfinfo:doi/10.5070/D330163285articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt45n0r4h12024-05-03T18:21:28Zqt45n0r4h1Successful 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/45n0r4h1https://escholarship.org/content/qt45n0r4h1/qt45n0r4h1.pdfinfo:doi/10.5070/D330163284articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt40k8c3jk2024-05-03T18:21:27Zqt40k8c3jkRetronychia: 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/40k8c3jkhttps://escholarship.org/content/qt40k8c3jk/qt40k8c3jk.pdfinfo:doi/10.5070/D330163282articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt0vj409562024-05-03T18:21:27Zqt0vj40956A 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/0vj40956https://escholarship.org/content/qt0vj40956/qt0vj40956.pdfinfo:doi/10.5070/D330163283articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt26b4s0sh2024-05-03T18:21:26Zqt26b4s0shClinical 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/26b4s0shhttps://escholarship.org/content/qt26b4s0sh/qt26b4s0sh.pdfinfo:doi/10.5070/D330163281articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt0k50k8732024-05-03T18:21:25Zqt0k50k873Clinical 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/0k50k873https://escholarship.org/content/qt0k50k873/qt0k50k873.pdfinfo:doi/10.5070/D330163280articleDermatology Online Journalvol 30, iss 1oai:escholarship.org:ark:/13030/qt0vh549nr2024-01-24T11:43:35Zqt0vh549nrSpontaneous, 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/0vh549nrhttps://escholarship.org/content/qt0vh549nr/qt0vh549nr.pdfinfo:doi/10.5070/D329663008articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt8hf3h0812024-01-24T11:43:33Zqt8hf3h081Provider 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/8hf3h081https://escholarship.org/content/qt8hf3h081/qt8hf3h081.pdfinfo:doi/10.5070/D329663007articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt8d68f7tc2024-01-24T11:43:31Zqt8d68f7tcActinic 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/8d68f7tchttps://escholarship.org/content/qt8d68f7tc/qt8d68f7tc.pdfinfo:doi/10.5070/D329663006articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt9px8n48q2024-01-24T11:43:29Zqt9px8n48qPainful 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/9px8n48qhttps://escholarship.org/content/qt9px8n48q/qt9px8n48q.pdfinfo:doi/10.5070/D329663005articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt1kj3x7x72024-01-24T11:43:28Zqt1kj3x7x7A 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/1kj3x7x7https://escholarship.org/content/qt1kj3x7x7/qt1kj3x7x7.pdfinfo:doi/10.5070/D329663004articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt9dz0x4q52024-01-24T11:43:26Zqt9dz0x4q5Is 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/9dz0x4q5https://escholarship.org/content/qt9dz0x4q5/qt9dz0x4q5.pdfinfo:doi/10.5070/D329663003articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt35g1j48f2024-01-24T11:43:24Zqt35g1j48fSymptomatic 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/35g1j48fhttps://escholarship.org/content/qt35g1j48f/qt35g1j48f.pdfinfo:doi/10.5070/D329663002articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt8jg938302024-01-24T11:43:23Zqt8jg93830Cutaneous 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/8jg93830https://escholarship.org/content/qt8jg93830/qt8jg93830.pdfinfo:doi/10.5070/D329663001articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt77f7z8082024-01-24T11:43:21Zqt77f7z808Recurrence 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/77f7z808https://escholarship.org/content/qt77f7z808/qt77f7z808.pdfinfo:doi/10.5070/D329663000articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt1h2913p12024-01-24T11:43:20Zqt1h2913p1A 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/1h2913p1https://escholarship.org/content/qt1h2913p1/qt1h2913p1.pdfinfo:doi/10.5070/D329662999articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt88z197dr2024-01-24T11:43:18Zqt88z197drLinear 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/88z197drhttps://escholarship.org/content/qt88z197dr/qt88z197dr.pdfinfo:doi/10.5070/D329662998articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt0tq7m2sz2024-01-24T11:43:17Zqt0tq7m2szLupus 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/0tq7m2szhttps://escholarship.org/content/qt0tq7m2sz/qt0tq7m2sz.pdfinfo:doi/10.5070/D329662997articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt3f95d3hj2024-01-24T11:43:15Zqt3f95d3hjLetterer-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/3f95d3hjhttps://escholarship.org/content/qt3f95d3hj/qt3f95d3hj.pdfinfo:doi/10.5070/D329662996articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt2v9044942024-01-24T11:43:14Zqt2v904494Linear 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/2v904494https://escholarship.org/content/qt2v904494/qt2v904494.pdfinfo:doi/10.5070/D329662995articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt2fn9d2tr2024-01-24T11:43:12Zqt2fn9d2trPediatric 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/2fn9d2trhttps://escholarship.org/content/qt2fn9d2tr/qt2fn9d2tr.pdfinfo:doi/10.5070/D329662994articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt277908hf2024-01-24T11:43:10Zqt277908hfCutaneous 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/277908hfhttps://escholarship.org/content/qt277908hf/qt277908hf.pdfinfo:doi/10.5070/D329662993articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt2863x96n2024-01-24T11:43:09Zqt2863x96nDisseminated 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/2863x96nhttps://escholarship.org/content/qt2863x96n/qt2863x96n.pdfinfo:doi/10.5070/D329662992articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt693825g72024-01-24T11:43:08Zqt693825g7When 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/693825g7https://escholarship.org/content/qt693825g7/qt693825g7.pdfinfo:doi/10.5070/D329662991articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt1f85k8q32024-01-24T11:43:06Zqt1f85k8q3ChatGPT 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/1f85k8q3https://escholarship.org/content/qt1f85k8q3/qt1f85k8q3.pdfinfo:doi/10.5070/D329662990articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt7mh056g62024-01-24T11:43:05Zqt7mh056g6Implementation 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/7mh056g6https://escholarship.org/content/qt7mh056g6/qt7mh056g6.pdfinfo:doi/10.5070/D329662989articleDermatology Online Journalvol 29, iss 6oai:escholarship.org:ark:/13030/qt10q117sn2023-11-03T09:46:29Zqt10q117snWe 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/10q117snhttps://escholarship.org/content/qt10q117sn/qt10q117sn.pdfinfo:doi/10.5070/D329562422articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt8wj331h22023-11-03T09:46:28Zqt8wj331h2COVID-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/8wj331h2https://escholarship.org/content/qt8wj331h2/qt8wj331h2.pdfinfo:doi/10.5070/D329562421articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt952731x62023-11-03T09:46:26Zqt952731x6Associations 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/952731x6https://escholarship.org/content/qt952731x6/qt952731x6.pdfinfo:doi/10.5070/D329562420articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt8n41c4s52023-11-03T09:46:25Zqt8n41c4s5The 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/8n41c4s5https://escholarship.org/content/qt8n41c4s5/qt8n41c4s5.pdfinfo:doi/10.5070/D329562419articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt1n60m7t42023-11-03T09:46:23Zqt1n60m7t4Prescription 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/1n60m7t4https://escholarship.org/content/qt1n60m7t4/qt1n60m7t4.pdfinfo:doi/10.5070/D329562418articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt0739t59r2023-11-03T09:46:22Zqt0739t59rUnderemphasis 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/0739t59rhttps://escholarship.org/content/qt0739t59r/qt0739t59r.pdfinfo:doi/10.5070/D329562416articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt3k93d1ft2023-11-03T09:46:21Zqt3k93d1ftAssessment 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/3k93d1fthttps://escholarship.org/content/qt3k93d1ft/qt3k93d1ft.pdfinfo:doi/10.5070/D329562415articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt0c0377tx2023-11-03T09:46:20Zqt0c0377txLivedoid 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/0c0377txhttps://escholarship.org/content/qt0c0377tx/qt0c0377tx.pdfinfo:doi/10.5070/D329562414articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt6631v7vv2023-11-03T09:46:19Zqt6631v7vvFicus 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/6631v7vvhttps://escholarship.org/content/qt6631v7vv/qt6631v7vv.pdfinfo:doi/10.5070/D329562413articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt9r81m80n2023-11-03T09:46:17Zqt9r81m80nErythematous 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/9r81m80nhttps://escholarship.org/content/qt9r81m80n/qt9r81m80n.pdfinfo:doi/10.5070/D329562412articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt7cf9b9wd2023-11-03T09:46:16Zqt7cf9b9wdRed 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/7cf9b9wdhttps://escholarship.org/content/qt7cf9b9wd/qt7cf9b9wd.pdfinfo:doi/10.5070/D329562411articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt81j436wv2023-11-03T09:46:15Zqt81j436wvAn 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/81j436wvhttps://escholarship.org/content/qt81j436wv/qt81j436wv.pdfinfo:doi/10.5070/D329562410articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt3xx728nk2023-11-03T09:46:14Zqt3xx728nkCutaneous 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/3xx728nkhttps://escholarship.org/content/qt3xx728nk/qt3xx728nk.pdfinfo:doi/10.5070/D329562409articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt2pk4t34w2023-11-03T09:46:13Zqt2pk4t34wErythema 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/2pk4t34whttps://escholarship.org/content/qt2pk4t34w/qt2pk4t34w.pdfinfo:doi/10.5070/D329562408articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt3v78n67p2023-11-03T09:46:12Zqt3v78n67pA 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/3v78n67phttps://escholarship.org/content/qt3v78n67p/qt3v78n67p.pdfinfo:doi/10.5070/D329562407articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt64j2q2102023-11-03T09:46:11Zqt64j2q210A 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/64j2q210https://escholarship.org/content/qt64j2q210/qt64j2q210.pdfinfo:doi/10.5070/D329562406articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt6c07c81q2023-11-03T09:46:10Zqt6c07c81qExacerbation 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/6c07c81qhttps://escholarship.org/content/qt6c07c81q/qt6c07c81q.pdfinfo:doi/10.5070/D329562405articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt1k43w2tc2023-11-03T09:46:09Zqt1k43w2tcGeneralized 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/1k43w2tchttps://escholarship.org/content/qt1k43w2tc/qt1k43w2tc.pdfinfo:doi/10.5070/D329562404articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt1335h4q12023-11-03T09:46:08Zqt1335h4q1Two 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/1335h4q1https://escholarship.org/content/qt1335h4q1/qt1335h4q1.pdfinfo:doi/10.5070/D329562403articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt0hm4w7hz2023-11-03T09:46:07Zqt0hm4w7hzSecondary 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/0hm4w7hzhttps://escholarship.org/content/qt0hm4w7hz/qt0hm4w7hz.pdfinfo:doi/10.5070/D329562402articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt59n0n0d62023-11-03T09:46:06Zqt59n0n0d6Anti-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/59n0n0d6https://escholarship.org/content/qt59n0n0d6/qt59n0n0d6.pdfinfo:doi/10.5070/D329562401articleDermatology Online Journalvol 29, iss 5oai:escholarship.org:ark:/13030/qt0vk376bp2023-09-08T12:48:26Zqt0vk376bpTache 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/0vk376bphttps://escholarship.org/content/qt0vk376bp/qt0vk376bp.pdfinfo:doi/10.5070/D329461918articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt0j14g1mv2023-09-08T12:48:22Zqt0j14g1mvBullous 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/0j14g1mvhttps://escholarship.org/content/qt0j14g1mv/qt0j14g1mv.pdfinfo:doi/10.5070/D329461917articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt6nc6x9xr2023-09-08T12:48:19Zqt6nc6x9xrMethotrexate-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/6nc6x9xrhttps://escholarship.org/content/qt6nc6x9xr/qt6nc6x9xr.pdfinfo:doi/10.5070/D329461916articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt2577x0fx2023-09-08T12:48:18Zqt2577x0fxDermatology 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/2577x0fxhttps://escholarship.org/content/qt2577x0fx/qt2577x0fx.pdfinfo:doi/10.5070/D329461915articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt26d180dw2023-09-08T12:48:17Zqt26d180dwDocument 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/26d180dwhttps://escholarship.org/content/qt26d180dw/qt26d180dw.pdfinfo:doi/10.5070/D329461914articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt9f28w3f52023-09-08T12:48:16Zqt9f28w3f5Update 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/9f28w3f5https://escholarship.org/content/qt9f28w3f5/qt9f28w3f5.pdfinfo:doi/10.5070/D329461913articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt5bh3v1pn2023-09-08T12:48:11Zqt5bh3v1pnIncreased 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/5bh3v1pnhttps://escholarship.org/content/qt5bh3v1pn/qt5bh3v1pn.pdfinfo:doi/10.5070/D329461912articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt6234s1wb2023-09-08T12:48:09Zqt6234s1wbCutaneous 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/6234s1wbhttps://escholarship.org/content/qt6234s1wb/qt6234s1wb.pdfinfo:doi/10.5070/D329461911articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt79c0z5m82023-09-08T12:48:06Zqt79c0z5m8Dynamic 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/79c0z5m8https://escholarship.org/content/qt79c0z5m8/qt79c0z5m8.pdfinfo:doi/10.5070/D329461910articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt58b0n1dp2023-09-08T12:48:03Zqt58b0n1dpSubepidermal 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/58b0n1dphttps://escholarship.org/content/qt58b0n1dp/qt58b0n1dp.pdfinfo:doi/10.5070/D329461909articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt3bc2f1s22023-09-08T12:48:02Zqt3bc2f1s2Erosive 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/3bc2f1s2https://escholarship.org/content/qt3bc2f1s2/qt3bc2f1s2.pdfinfo:doi/10.5070/D329461908articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt6d4477s22023-09-08T12:48:00Zqt6d4477s2Invisible 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/6d4477s2https://escholarship.org/content/qt6d4477s2/qt6d4477s2.pdfinfo:doi/10.5070/D329461907articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt5z24g1qc2023-09-08T12:47:57Zqt5z24g1qcCutaneous 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/5z24g1qchttps://escholarship.org/content/qt5z24g1qc/qt5z24g1qc.pdfinfo:doi/10.5070/D329461906articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt33b6c24c2023-09-08T12:47:54Zqt33b6c24cLenalidomide-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/33b6c24chttps://escholarship.org/content/qt33b6c24c/qt33b6c24c.pdfinfo:doi/10.5070/D329461905articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt7cz368pz2023-09-08T12:47:52Zqt7cz368pzNeutrophilic 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/7cz368pzhttps://escholarship.org/content/qt7cz368pz/qt7cz368pz.pdfinfo:doi/10.5070/D329461904articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt0382v0g92023-09-08T12:47:50Zqt0382v0g9Sickle 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/0382v0g9https://escholarship.org/content/qt0382v0g9/qt0382v0g9.pdfinfo:doi/10.5070/D329461903articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt9m98s49f2023-09-08T12:47:48Zqt9m98s49fA 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/9m98s49fhttps://escholarship.org/content/qt9m98s49f/qt9m98s49f.pdfinfo:doi/10.5070/D329461862articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt5mq5z39h2023-09-08T12:47:47Zqt5mq5z39hLow 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/5mq5z39hhttps://escholarship.org/content/qt5mq5z39h/qt5mq5z39h.pdfinfo:doi/10.5070/D329461861articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt4qv771072023-09-08T12:47:46Zqt4qv77107A 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/4qv77107https://escholarship.org/content/qt4qv77107/qt4qv77107.pdfinfo:doi/10.5070/D329461860articleDermatology Online Journalvol 29, iss 4oai:escholarship.org:ark:/13030/qt24s0n3vw2023-07-17T11:45:47Zqt24s0n3vwPosition 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/24s0n3vwhttps://escholarship.org/content/qt24s0n3vw/qt24s0n3vw.pdfinfo:doi/10.5070/D329361444articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt71h6f05c2023-07-17T11:45:45Zqt71h6f05cAmicrobial 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/71h6f05chttps://escholarship.org/content/qt71h6f05c/qt71h6f05c.pdfinfo:doi/10.5070/D329361443articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt2jt8n9xn2023-07-17T11:45:44Zqt2jt8n9xnTattoo-associated Sweet syndromeCohen, Philip R2023-01-01black tattoocontactcytokinedermatitisdermatosishennaneutrophilicparaphenyenediaminepigmentSweetsyndromewomanapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2jt8n9xnhttps://escholarship.org/content/qt2jt8n9xn/qt2jt8n9xn.pdfinfo:doi/10.5070/D329361442articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt0hs897p22023-07-17T11:45:43Zqt0hs897p2Periocular Demodex folliculorum folliculitisChiriac, AncaWollina, Uwe2023-01-01Demodexfolliculitisperiocullarapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/0hs897p2https://escholarship.org/content/qt0hs897p2/qt0hs897p2.pdfinfo:doi/10.5070/D329361441articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt72m857v82023-07-17T11:45:42Zqt72m857v8Congenital 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/72m857v8https://escholarship.org/content/qt72m857v8/qt72m857v8.pdfinfo:doi/10.5070/D329361440articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt9zz9v05q2023-07-17T11:45:40Zqt9zz9v05qOcular 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/9zz9v05qhttps://escholarship.org/content/qt9zz9v05q/qt9zz9v05q.pdfinfo:doi/10.5070/D329361439articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt8xz080cs2023-07-17T11:45:39Zqt8xz080csEffects 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/8xz080cshttps://escholarship.org/content/qt8xz080cs/qt8xz080cs.pdfinfo:doi/10.5070/D329361438articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt3mw5v82z2023-07-17T11:45:38Zqt3mw5v82zBarriers 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/3mw5v82zhttps://escholarship.org/content/qt3mw5v82z/qt3mw5v82z.pdfinfo:doi/10.5070/D329361437articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt2c11z02s2023-07-17T11:45:37Zqt2c11z02sPatient 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/2c11z02shttps://escholarship.org/content/qt2c11z02s/qt2c11z02s.pdfinfo:doi/10.5070/D329361436articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt5dx0t4rr2023-07-17T11:45:35Zqt5dx0t4rrMacrolides for the treatment of bullous pemphigoidZou, HenryDaveluy, Steven2023-01-01Keywords: bullous pemphigoidclarithromycincytokineerythromycininterleukinmacrolidesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5dx0t4rrhttps://escholarship.org/content/qt5dx0t4rr/qt5dx0t4rr.pdfinfo:doi/10.5070/D329361435articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt9jm0x1rq2023-07-17T11:45:34Zqt9jm0x1rqPaclitaxel-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/9jm0x1rqhttps://escholarship.org/content/qt9jm0x1rq/qt9jm0x1rq.pdfinfo:doi/10.5070/D329361434articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt39j2n4b12023-07-17T11:45:33Zqt39j2n4b1Successful 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/39j2n4b1https://escholarship.org/content/qt39j2n4b1/qt39j2n4b1.pdfinfo:doi/10.5070/D329361433articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt9hq354w12023-07-17T11:45:32Zqt9hq354w1Localized 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/9hq354w1https://escholarship.org/content/qt9hq354w1/qt9hq354w1.pdfinfo:doi/10.5070/D329361432articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt6bc931cj2023-07-17T11:45:31Zqt6bc931cjMultiple 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/6bc931cjhttps://escholarship.org/content/qt6bc931cj/qt6bc931cj.pdfinfo:doi/10.5070/D329361431articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt40h7p1pn2023-07-17T11:45:30Zqt40h7p1pnSmokeless 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/40h7p1pnhttps://escholarship.org/content/qt40h7p1pn/qt40h7p1pn.pdfinfo:doi/10.5070/D329361430articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt47s2q8zk2023-07-17T11:45:28Zqt47s2q8zkCutaneous 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/47s2q8zkhttps://escholarship.org/content/qt47s2q8zk/qt47s2q8zk.pdfinfo:doi/10.5070/D329361429articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt00g297qh2023-07-17T11:45:26Zqt00g297qhCytokeratin-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/00g297qhhttps://escholarship.org/content/qt00g297qh/qt00g297qh.pdfinfo:doi/10.5070/D329361428articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt1wq2s9j92023-07-17T11:45:25Zqt1wq2s9j9Usefulness 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/1wq2s9j9https://escholarship.org/content/qt1wq2s9j9/qt1wq2s9j9.pdfinfo:doi/10.5070/D329361427articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt8625q85m2023-07-17T11:45:24Zqt8625q85mDiffuse 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/8625q85mhttps://escholarship.org/content/qt8625q85m/qt8625q85m.pdfinfo:doi/10.5070/D329361426articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt8kq929qx2023-07-17T11:45:23Zqt8kq929qxA 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/8kq929qxhttps://escholarship.org/content/qt8kq929qx/qt8kq929qx.pdfinfo:doi/10.5070/D329361425articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt9gt192c82023-07-17T11:45:21Zqt9gt192c8Workforce 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/9gt192c8https://escholarship.org/content/qt9gt192c8/qt9gt192c8.pdfinfo:doi/10.5070/D329361424articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt7r30085b2023-07-17T11:45:20Zqt7r30085bBiosimilars 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/7r30085bhttps://escholarship.org/content/qt7r30085b/qt7r30085b.pdfinfo:doi/10.5070/D329361423articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt9jn4p23h2023-07-17T11:45:19Zqt9jn4p23hNon-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/9jn4p23hhttps://escholarship.org/content/qt9jn4p23h/qt9jn4p23h.pdfinfo:doi/10.5070/D329361422articleDermatology Online Journalvol 29, iss 3oai:escholarship.org:ark:/13030/qt6n9400vw2023-05-03T11:59:49Zqt6n9400vwPosition 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/6n9400vwhttps://escholarship.org/content/qt6n9400vw/qt6n9400vw.pdfinfo:doi/10.5070/D329260786articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt7gs957r72023-05-03T11:59:48Zqt7gs957r7Cutaneous 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/7gs957r7https://escholarship.org/content/qt7gs957r7/qt7gs957r7.pdfinfo:doi/10.5070/D329260785articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt1ws7x0982023-05-03T11:59:46Zqt1ws7x098Skin 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/1ws7x098https://escholarship.org/content/qt1ws7x098/qt1ws7x098.pdfinfo:doi/10.5070/D329260784articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt93f5p3fv2023-05-03T11:59:45Zqt93f5p3fvSkin 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/93f5p3fvhttps://escholarship.org/content/qt93f5p3fv/qt93f5p3fv.pdfinfo:doi/10.5070/D329260783articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt8pk3858h2023-05-03T11:59:43Zqt8pk3858hTumor 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/8pk3858hhttps://escholarship.org/content/qt8pk3858h/qt8pk3858h.pdfinfo:doi/10.5070/D329260782articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt374497cm2023-05-03T11:59:41Zqt374497cmImprovement 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/374497cmhttps://escholarship.org/content/qt374497cm/qt374497cm.pdfinfo:doi/10.5070/D329260781articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt042406782023-05-03T11:59:40Zqt04240678Out 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/04240678https://escholarship.org/content/qt04240678/qt04240678.pdfinfo:doi/10.5070/D329260780articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt4bb5s2bm2023-05-03T11:59:38Zqt4bb5s2bmLichen 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/4bb5s2bmhttps://escholarship.org/content/qt4bb5s2bm/qt4bb5s2bm.pdfinfo:doi/10.5070/D329260779articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt7xc3n6xv2023-05-03T11:59:36Zqt7xc3n6xvA 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/7xc3n6xvhttps://escholarship.org/content/qt7xc3n6xv/qt7xc3n6xv.pdfinfo:doi/10.5070/D329260778articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt2h80d70f2023-05-03T11:59:35Zqt2h80d70fPost-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/2h80d70fhttps://escholarship.org/content/qt2h80d70f/qt2h80d70f.pdfinfo:doi/10.5070/D329260777articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt1mt6j9tb2023-05-03T11:59:33Zqt1mt6j9tbA 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/1mt6j9tbhttps://escholarship.org/content/qt1mt6j9tb/qt1mt6j9tb.pdfinfo:doi/10.5070/D329260776articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt3pr3g15x2023-05-03T11:59:31Zqt3pr3g15xCutaneous 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/3pr3g15xhttps://escholarship.org/content/qt3pr3g15x/qt3pr3g15x.pdfinfo:doi/10.5070/D329260775articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt0sg646zv2023-05-03T11:59:29Zqt0sg646zvMycobacterium 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/0sg646zvhttps://escholarship.org/content/qt0sg646zv/qt0sg646zv.pdfinfo:doi/10.5070/D329260774articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt6fs5n7c32023-05-03T11:59:28Zqt6fs5n7c3Amyopathic 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/6fs5n7c3https://escholarship.org/content/qt6fs5n7c3/qt6fs5n7c3.pdfinfo:doi/10.5070/D329260773articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt925005wh2023-05-03T11:59:27Zqt925005whCutaneous 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/925005whhttps://escholarship.org/content/qt925005wh/qt925005wh.pdfinfo:doi/10.5070/D329260772articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt5x52n3tg2023-05-03T11:59:25Zqt5x52n3tgNodular 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/5x52n3tghttps://escholarship.org/content/qt5x52n3tg/qt5x52n3tg.pdfinfo:doi/10.5070/D329260771articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt0h81f7mg2023-05-03T11:59:24Zqt0h81f7mgAn 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/0h81f7mghttps://escholarship.org/content/qt0h81f7mg/qt0h81f7mg.pdfinfo:doi/10.5070/D329260770articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt59n531fv2023-05-03T11:59:23Zqt59n531fvWidespread 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/59n531fvhttps://escholarship.org/content/qt59n531fv/qt59n531fv.pdfinfo:doi/10.5070/D329260769articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt02g0p03p2023-05-03T11:59:21Zqt02g0p03pParaneoplastic 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/02g0p03phttps://escholarship.org/content/qt02g0p03p/qt02g0p03p.pdfinfo:doi/10.5070/D329260768articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt78w4s27r2023-05-03T11:59:20Zqt78w4s27rBilateral 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/78w4s27rhttps://escholarship.org/content/qt78w4s27r/qt78w4s27r.pdfinfo:doi/10.5070/D329260767articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt06t5877g2023-05-03T11:59:19Zqt06t5877gArtificial 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/06t5877ghttps://escholarship.org/content/qt06t5877g/qt06t5877g.pdfinfo:doi/10.5070/D329260766articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt4gw9m6vd2023-05-03T11:59:18Zqt4gw9m6vdThe 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/4gw9m6vdhttps://escholarship.org/content/qt4gw9m6vd/qt4gw9m6vd.pdfinfo:doi/10.5070/D329260765articleDermatology Online Journalvol 29, iss 2oai:escholarship.org:ark:/13030/qt62x4n5pz2023-02-28T09:01:35Zqt62x4n5pzInstagram 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/62x4n5pzhttps://escholarship.org/content/qt62x4n5pz/qt62x4n5pz.pdfinfo:doi/10.5070/D329160228articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt9t23911n2023-02-28T09:01:34Zqt9t23911nHerpetic 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/9t23911nhttps://escholarship.org/content/qt9t23911n/qt9t23911n.pdfinfo:doi/10.5070/D329160227articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt3qh1q6zz2023-02-28T09:01:34Zqt3qh1q6zzDoes 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/3qh1q6zzhttps://escholarship.org/content/qt3qh1q6zz/qt3qh1q6zz.pdfinfo:doi/10.5070/D329160226articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt78g924ks2023-02-28T09:01:33Zqt78g924ksCapecitabine-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/78g924kshttps://escholarship.org/content/qt78g924ks/qt78g924ks.pdfinfo:doi/10.5070/D329160225articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt7hd7j8wm2023-02-28T09:01:32Zqt7hd7j8wmJAK 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/7hd7j8wmhttps://escholarship.org/content/qt7hd7j8wm/qt7hd7j8wm.pdfinfo:doi/10.5070/D329160224articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt77b745bb2023-02-28T09:01:31Zqt77b745bbDermatology 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/77b745bbhttps://escholarship.org/content/qt77b745bb/qt77b745bb.pdfinfo:doi/10.5070/D329160223articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt1016c4g52023-02-28T09:01:30Zqt1016c4g5Social 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/1016c4g5https://escholarship.org/content/qt1016c4g5/qt1016c4g5.pdfinfo:doi/10.5070/D329160222articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt1820m79x2023-02-28T09:01:29Zqt1820m79xDelayed 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/1820m79xhttps://escholarship.org/content/qt1820m79x/qt1820m79x.pdfinfo:doi/10.5070/D329160221articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt9081j00w2023-02-28T09:01:28Zqt9081j00wBullous 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/9081j00whttps://escholarship.org/content/qt9081j00w/qt9081j00w.pdfinfo:doi/10.5070/D329160220articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt3m8478pb2023-02-28T09:01:27Zqt3m8478pbReddish-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/3m8478pbhttps://escholarship.org/content/qt3m8478pb/qt3m8478pb.pdfinfo:doi/10.5070/D329160219articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt2bj244212023-02-28T09:01:26Zqt2bj24421Sneddon-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/2bj24421https://escholarship.org/content/qt2bj24421/qt2bj24421.pdfinfo:doi/10.5070/D329160218articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt4s94w5dr2023-02-28T09:01:25Zqt4s94w5drVarenicline-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/4s94w5drhttps://escholarship.org/content/qt4s94w5dr/qt4s94w5dr.pdfinfo:doi/10.5070/D329160217articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt4cd5c9bf2023-02-28T09:01:24Zqt4cd5c9bfMyxoid 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/4cd5c9bfhttps://escholarship.org/content/qt4cd5c9bf/qt4cd5c9bf.pdfinfo:doi/10.5070/D329160216articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt89n6g1hh2023-02-28T09:01:23Zqt89n6g1hhAtezolizumab-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/89n6g1hhhttps://escholarship.org/content/qt89n6g1hh/qt89n6g1hh.pdfinfo:doi/10.5070/D329160215articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt1jm0674r2023-02-28T09:01:22Zqt1jm0674rA 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/1jm0674rhttps://escholarship.org/content/qt1jm0674r/qt1jm0674r.pdfinfo:doi/10.5070/D329160214articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt5c13t4s42023-02-28T09:01:21Zqt5c13t4s4A 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/5c13t4s4https://escholarship.org/content/qt5c13t4s4/qt5c13t4s4.pdfinfo:doi/10.5070/D329160213articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt0tz012ps2023-02-28T09:01:20Zqt0tz012psEpstein-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/0tz012pshttps://escholarship.org/content/qt0tz012ps/qt0tz012ps.pdfinfo:doi/10.5070/D329160212articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt8133412b2023-02-28T09:01:18Zqt8133412bNovel 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/8133412bhttps://escholarship.org/content/qt8133412b/qt8133412b.pdfinfo:doi/10.5070/D329160211articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt82f9d5w62023-02-28T09:01:17Zqt82f9d5w6A 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/82f9d5w6https://escholarship.org/content/qt82f9d5w6/qt82f9d5w6.pdfinfo:doi/10.5070/D329160210articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt3217m2vn2023-02-28T09:01:15Zqt3217m2vnNirmatrelvir-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/3217m2vnhttps://escholarship.org/content/qt3217m2vn/qt3217m2vn.pdfinfo:doi/10.5070/D329160209articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt7p03c5xg2023-02-28T09:01:13Zqt7p03c5xgGeospatial 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/7p03c5xghttps://escholarship.org/content/qt7p03c5xg/qt7p03c5xg.pdfinfo:doi/10.5070/D329160208articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt7sp2m4442023-02-28T09:01:12Zqt7sp2m444Differences 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/7sp2m444https://escholarship.org/content/qt7sp2m444/qt7sp2m444.pdfinfo:doi/10.5070/D329160207articleDermatology Online Journalvol 29, iss 1oai:escholarship.org:ark:/13030/qt0fr2c39r2022-12-29T10:32:15Zqt0fr2c39rAnalysis 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/0fr2c39rhttps://escholarship.org/content/qt0fr2c39r/qt0fr2c39r.pdfinfo:doi/10.5070/D328659738articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt0d99b75p2022-12-29T10:32:14Zqt0d99b75pPerception 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/0d99b75phttps://escholarship.org/content/qt0d99b75p/qt0d99b75p.pdfinfo:doi/10.5070/D328659737articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt9jf534xz2022-12-29T10:32:13Zqt9jf534xzOptimizing 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/9jf534xzhttps://escholarship.org/content/qt9jf534xz/qt9jf534xz.pdfinfo:doi/10.5070/D328659736articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt8438j9np2022-12-29T10:32:11Zqt8438j9npSharps 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/8438j9nphttps://escholarship.org/content/qt8438j9np/qt8438j9np.pdfinfo:doi/10.5070/D328659735articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt2vm3d29w2022-12-29T10:32:10Zqt2vm3d29wChatbot 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/2vm3d29whttps://escholarship.org/content/qt2vm3d29w/qt2vm3d29w.pdfinfo:doi/10.5070/D328659734articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt0zp9w2hx2022-12-29T10:32:09Zqt0zp9w2hxA 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/0zp9w2hxhttps://escholarship.org/content/qt0zp9w2hx/qt0zp9w2hx.pdfinfo:doi/10.5070/D328659732articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt34k2h53t2022-12-29T10:32:07Zqt34k2h53tRapid 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/34k2h53thttps://escholarship.org/content/qt34k2h53t/qt34k2h53t.pdfinfo:doi/10.5070/D328659731articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt2dk6v1252022-12-29T10:32:06Zqt2dk6v125Cerebriform 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/2dk6v125https://escholarship.org/content/qt2dk6v125/qt2dk6v125.pdfinfo:doi/10.5070/D328659730articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt5dp8418s2022-12-29T10:32:04Zqt5dp8418sLarge, 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/5dp8418shttps://escholarship.org/content/qt5dp8418s/qt5dp8418s.pdfinfo:doi/10.5070/D328659729articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt1645n2t22022-12-29T10:32:03Zqt1645n2t2Hemosiderotic (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/1645n2t2https://escholarship.org/content/qt1645n2t2/qt1645n2t2.pdfinfo:doi/10.5070/D328659728articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt9gd5m8p52022-12-29T10:32:01Zqt9gd5m8p5Bleeding 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/9gd5m8p5https://escholarship.org/content/qt9gd5m8p5/qt9gd5m8p5.pdfinfo:doi/10.5070/D328659727articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt0bk4f4tf2022-12-29T10:32:00Zqt0bk4f4tfPyoderma 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/0bk4f4tfhttps://escholarship.org/content/qt0bk4f4tf/qt0bk4f4tf.pdfinfo:doi/10.5070/D328659742articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt4nm6593v2022-12-29T10:31:59Zqt4nm6593vA 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/4nm6593vhttps://escholarship.org/content/qt4nm6593v/qt4nm6593v.pdfinfo:doi/10.5070/D328659741articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt0ts6k2mk2022-12-29T10:31:58Zqt0ts6k2mkHitchhiking 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/0ts6k2mkhttps://escholarship.org/content/qt0ts6k2mk/qt0ts6k2mk.pdfinfo:doi/10.5070/D328659740articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt0hp3h4ft2022-12-29T10:31:57Zqt0hp3h4ftAn 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/0hp3h4fthttps://escholarship.org/content/qt0hp3h4ft/qt0hp3h4ft.pdfinfo:doi/10.5070/D328659739articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt5cz2h04b2022-12-29T10:31:56Zqt5cz2h04bPrimary 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/5cz2h04bhttps://escholarship.org/content/qt5cz2h04b/qt5cz2h04b.pdfinfo:doi/10.5070/D328659726articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt29b1f3np2022-12-29T10:31:55Zqt29b1f3npAcne 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/29b1f3nphttps://escholarship.org/content/qt29b1f3np/qt29b1f3np.pdfinfo:doi/10.5070/D328659725articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt3k3243zj2022-12-29T10:31:54Zqt3k3243zjTrichodysplasia 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/3k3243zjhttps://escholarship.org/content/qt3k3243zj/qt3k3243zj.pdfinfo:doi/10.5070/D328659724articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt8kb4f1352022-12-29T10:31:53Zqt8kb4f135Importance 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/8kb4f135https://escholarship.org/content/qt8kb4f135/qt8kb4f135.pdfinfo:doi/10.5070/D328659723articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt6xs8q91c2022-12-29T10:31:53Zqt6xs8q91cCharacteristics 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/6xs8q91chttps://escholarship.org/content/qt6xs8q91c/qt6xs8q91c.pdfinfo:doi/10.5070/D328659719articleDermatology Online Journalvol 28, iss 6oai:escholarship.org:ark:/13030/qt564612w52022-11-02T16:08:31Zqt564612w5Lichen 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/564612w5https://escholarship.org/content/qt564612w5/qt564612w5.pdfinfo:doi/10.5070/D328559254articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt2s07d47r2022-11-02T16:08:30Zqt2s07d47rA 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/2s07d47rhttps://escholarship.org/content/qt2s07d47r/qt2s07d47r.pdfinfo:doi/10.5070/D328559253articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt6wj347f52022-11-02T16:08:29Zqt6wj347f5Pathological 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/6wj347f5https://escholarship.org/content/qt6wj347f5/qt6wj347f5.pdfinfo:doi/10.5070/D328559252articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt7g82d93h2022-11-02T16:08:28Zqt7g82d93hAcute 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/7g82d93hhttps://escholarship.org/content/qt7g82d93h/qt7g82d93h.pdfinfo:doi/10.5070/D328559261articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt9jk6c3rc2022-11-02T16:08:27Zqt9jk6c3rcEpidemiology 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/9jk6c3rchttps://escholarship.org/content/qt9jk6c3rc/qt9jk6c3rc.pdfinfo:doi/10.5070/D328559251articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt2p99p9zm2022-11-02T16:08:26Zqt2p99p9zmA 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/2p99p9zmhttps://escholarship.org/content/qt2p99p9zm/qt2p99p9zm.pdfinfo:doi/10.5070/D328559250articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt14x0d1sv2022-11-02T16:08:25Zqt14x0d1svLinear 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/14x0d1svhttps://escholarship.org/content/qt14x0d1sv/qt14x0d1sv.pdfinfo:doi/10.5070/D328559270articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt51m6r9md2022-11-02T16:08:23Zqt51m6r9mdSmall 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/51m6r9mdhttps://escholarship.org/content/qt51m6r9md/qt51m6r9md.pdfinfo:doi/10.5070/D328559249articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt27v8j30n2022-11-02T16:08:22Zqt27v8j30nTelangiectasias 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/27v8j30nhttps://escholarship.org/content/qt27v8j30n/qt27v8j30n.pdfinfo:doi/10.5070/D328559248articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt18n0q7zx2022-11-02T16:08:21Zqt18n0q7zxTreating 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/18n0q7zxhttps://escholarship.org/content/qt18n0q7zx/qt18n0q7zx.pdfinfo:doi/10.5070/D328559247articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt3251n6032022-11-02T16:08:19Zqt3251n603Leukocytoclastic 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/3251n603https://escholarship.org/content/qt3251n603/qt3251n603.pdfinfo:doi/10.5070/D328559246articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt154310bh2022-11-02T16:08:18Zqt154310bhQuestions 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/154310bhhttps://escholarship.org/content/qt154310bh/qt154310bh.pdfinfo:doi/10.5070/D328559245articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt4wq003hp2022-11-02T16:08:17Zqt4wq003hpCutaneous 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/4wq003hphttps://escholarship.org/content/qt4wq003hp/qt4wq003hp.pdfinfo:doi/10.5070/D328559244articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt89m5c60z2022-11-02T16:08:16Zqt89m5c60zMultiple 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/89m5c60zhttps://escholarship.org/content/qt89m5c60z/qt89m5c60z.pdfinfo:doi/10.5070/D328559259articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt8566q1s62022-11-02T16:08:15Zqt8566q1s6Epidermolytic 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/8566q1s6https://escholarship.org/content/qt8566q1s6/qt8566q1s6.pdfinfo:doi/10.5070/D328559243articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt53x207tm2022-11-02T16:08:14Zqt53x207tmHerpes 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/53x207tmhttps://escholarship.org/content/qt53x207tm/qt53x207tm.pdfinfo:doi/10.5070/D328559242articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt9zz2c3072022-11-02T16:08:13Zqt9zz2c307Limited 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/9zz2c307https://escholarship.org/content/qt9zz2c307/qt9zz2c307.pdfinfo:doi/10.5070/D328559241articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt57x5s3zt2022-11-02T16:08:12Zqt57x5s3ztDermatology 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/57x5s3zthttps://escholarship.org/content/qt57x5s3zt/qt57x5s3zt.pdfinfo:doi/10.5070/D328559260articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt5v56r9wh2022-11-02T16:08:11Zqt5v56r9whWhole 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/5v56r9whhttps://escholarship.org/content/qt5v56r9wh/qt5v56r9wh.pdfinfo:doi/10.5070/D328559240articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt85h7m5312022-11-02T16:08:10Zqt85h7m531The 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/85h7m531https://escholarship.org/content/qt85h7m531/qt85h7m531.pdfinfo:doi/10.5070/D328559239articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt6cs8c3m62022-11-02T16:08:09Zqt6cs8c3m6Efficacy 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/6cs8c3m6https://escholarship.org/content/qt6cs8c3m6/qt6cs8c3m6.pdfinfo:doi/10.5070/D328559238articleDermatology Online Journalvol 28, iss 5oai:escholarship.org:ark:/13030/qt9pq4b97k2022-09-04T21:13:13Zqt9pq4b97kThe 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/9pq4b97khttps://escholarship.org/content/qt9pq4b97k/qt9pq4b97k.pdfinfo:doi/10.5070/D328458537articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt1kv748f22022-09-04T21:13:12Zqt1kv748f2Surgical 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/1kv748f2https://escholarship.org/content/qt1kv748f2/qt1kv748f2.pdfinfo:doi/10.5070/D328458536articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt7gc3k55c2022-09-04T21:13:11Zqt7gc3k55cTreatment 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/7gc3k55chttps://escholarship.org/content/qt7gc3k55c/qt7gc3k55c.pdfinfo:doi/10.5070/D328458534articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt7jm714k12022-09-04T21:13:10Zqt7jm714k1Herpes 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/7jm714k1https://escholarship.org/content/qt7jm714k1/qt7jm714k1.pdfinfo:doi/10.5070/D328458533articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt77m782vs2022-09-04T21:13:10Zqt77m782vsDrug 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/77m782vshttps://escholarship.org/content/qt77m782vs/qt77m782vs.pdfinfo:doi/10.5070/D328458532articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt98q9474t2022-09-04T21:13:09Zqt98q9474tModified 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/98q9474thttps://escholarship.org/content/qt98q9474t/qt98q9474t.pdfinfo:doi/10.5070/D328458530articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt91n125fg2022-09-04T21:13:07Zqt91n125fg"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/91n125fghttps://escholarship.org/content/qt91n125fg/qt91n125fg.pdfinfo:doi/10.5070/D328458529articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt5f19f26k2022-09-04T21:13:06Zqt5f19f26kImiquimod-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/5f19f26khttps://escholarship.org/content/qt5f19f26k/qt5f19f26k.pdfinfo:doi/10.5070/D328458526articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt0zb2c2d42022-09-04T21:13:06Zqt0zb2c2d4Successful 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/0zb2c2d4https://escholarship.org/content/qt0zb2c2d4/qt0zb2c2d4.pdfinfo:doi/10.5070/D328458527articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt7qg9190f2022-09-04T21:13:04Zqt7qg9190fA 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/7qg9190fhttps://escholarship.org/content/qt7qg9190f/qt7qg9190f.pdfinfo:doi/10.5070/D328458525articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt29j7573d2022-09-04T21:13:04Zqt29j7573dAngioimmunoblastic 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/29j7573dhttps://escholarship.org/content/qt29j7573d/qt29j7573d.pdfinfo:doi/10.5070/D328458523articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt66w875t52022-09-04T21:13:03Zqt66w875t5Blastic 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/66w875t5https://escholarship.org/content/qt66w875t5/qt66w875t5.pdfinfo:doi/10.5070/D328458522articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt3s82x7dh2022-09-04T21:13:02Zqt3s82x7dhAnnular 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/3s82x7dhhttps://escholarship.org/content/qt3s82x7dh/qt3s82x7dh.pdfinfo:doi/10.5070/D328458521articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt3277d6t22022-09-04T21:13:01Zqt3277d6t2Werner 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/3277d6t2https://escholarship.org/content/qt3277d6t2/qt3277d6t2.pdfinfo:doi/10.5070/D328458520articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt2nk7k0pk2022-09-04T21:13:00Zqt2nk7k0pkPityriasis 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/2nk7k0pkhttps://escholarship.org/content/qt2nk7k0pk/qt2nk7k0pk.pdfinfo:doi/10.5070/D328458518articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt8qz544vz2022-09-04T21:12:59Zqt8qz544vzAnti-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/8qz544vzhttps://escholarship.org/content/qt8qz544vz/qt8qz544vz.pdfinfo:doi/10.5070/D328458517articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt5cc5c8xw2022-09-04T21:12:58Zqt5cc5c8xwNoninflammatory 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/5cc5c8xwhttps://escholarship.org/content/qt5cc5c8xw/qt5cc5c8xw.pdfinfo:doi/10.5070/D328458515articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt7qr987b02022-09-04T21:12:57Zqt7qr987b0A 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/7qr987b0https://escholarship.org/content/qt7qr987b0/qt7qr987b0.pdfinfo:doi/10.5070/D328458513articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt6zj648262022-09-04T21:12:56Zqt6zj64826Characteristics 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/6zj64826https://escholarship.org/content/qt6zj64826/qt6zj64826.pdfinfo:doi/10.5070/D328458511articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt1fm0m3652022-09-04T21:12:55Zqt1fm0m365Treatment 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/1fm0m365https://escholarship.org/content/qt1fm0m365/qt1fm0m365.pdfinfo:doi/10.5070/D328458503articleDermatology Online Journalvol 28, iss 4oai:escholarship.org:ark:/13030/qt6md761402022-06-23T16:07:54Zqt6md76140The 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/6md76140https://escholarship.org/content/qt6md76140/qt6md76140.pdfinfo:doi/10.5070/D328357797articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt52k6561d2022-06-23T16:07:52Zqt52k6561dClassic 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/52k6561dhttps://escholarship.org/content/qt52k6561d/qt52k6561d.pdfinfo:doi/10.5070/D328357796articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt0gq7d56b2022-06-23T16:07:52Zqt0gq7d56bUtility 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/0gq7d56bhttps://escholarship.org/content/qt0gq7d56b/qt0gq7d56b.pdfinfo:doi/10.5070/D328357798articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt7mz2564g2022-06-23T16:07:51Zqt7mz2564gToward 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/7mz2564ghttps://escholarship.org/content/qt7mz2564g/qt7mz2564g.pdfinfo:doi/10.5070/D328357799articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt8vv4m2gj2022-06-23T16:07:49Zqt8vv4m2gjUse 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/8vv4m2gjhttps://escholarship.org/content/qt8vv4m2gj/qt8vv4m2gj.pdfinfo:doi/10.5070/D328357795articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt1gd4v5zh2022-06-23T16:07:48Zqt1gd4v5zhEducational 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/1gd4v5zhhttps://escholarship.org/content/qt1gd4v5zh/qt1gd4v5zh.pdfinfo:doi/10.5070/D328357842articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt4h15t5cg2022-06-23T16:07:47Zqt4h15t5cgPost 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/4h15t5cghttps://escholarship.org/content/qt4h15t5cg/qt4h15t5cg.pdfinfo:doi/10.5070/D328357794articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt4wr7d49s2022-06-23T16:07:46Zqt4wr7d49sAssociation 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/4wr7d49shttps://escholarship.org/content/qt4wr7d49s/qt4wr7d49s.pdfinfo:doi/10.5070/D328357792articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt18k4p0dp2022-06-23T16:07:45Zqt18k4p0dpDiverse 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/18k4p0dphttps://escholarship.org/content/qt18k4p0dp/qt18k4p0dp.pdfinfo:doi/10.5070/D328357791articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt9vz206xw2022-06-23T16:07:43Zqt9vz206xwCalciphylaxis: utility of skin biopsy within a diagnostic algorithmKwapnoski, ZacharyBrassard, Alain2022-01-01algorithmbiopsycalciphylaxisclinicaldiagnosticapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/9vz206xwhttps://escholarship.org/content/qt9vz206xw/qt9vz206xw.pdfinfo:doi/10.5070/D328357790articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt8792b7v32022-06-23T16:07:42Zqt8792b7v3Pruritic 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/8792b7v3https://escholarship.org/content/qt8792b7v3/qt8792b7v3.pdfinfo:doi/10.5070/D328357789articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt3nk1v9jc2022-06-23T16:07:40Zqt3nk1v9jcSecondary 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/3nk1v9jchttps://escholarship.org/content/qt3nk1v9jc/qt3nk1v9jc.pdfinfo:doi/10.5070/D328357788articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt1sd2q9f22022-06-23T16:07:39Zqt1sd2q9f2Localized 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/1sd2q9f2https://escholarship.org/content/qt1sd2q9f2/qt1sd2q9f2.pdfinfo:doi/10.5070/D328357787articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt4p50g0xq2022-06-23T16:07:38Zqt4p50g0xqSquamous 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/4p50g0xqhttps://escholarship.org/content/qt4p50g0xq/qt4p50g0xq.pdfinfo:doi/10.5070/D328357786articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt8g28912s2022-06-23T16:07:37Zqt8g28912sMilia 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/8g28912shttps://escholarship.org/content/qt8g28912s/qt8g28912s.pdfinfo:doi/10.5070/D328357785articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt9cn102hk2022-06-23T16:07:36Zqt9cn102hkLucio 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/9cn102hkhttps://escholarship.org/content/qt9cn102hk/qt9cn102hk.pdfinfo:doi/10.5070/D328357784articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt8pt9t1k72022-06-23T16:07:35Zqt8pt9t1k7Total 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/8pt9t1k7https://escholarship.org/content/qt8pt9t1k7/qt8pt9t1k7.pdfinfo:doi/10.5070/D328357782articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt6pv8d2802022-06-23T16:07:35Zqt6pv8d280A 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/6pv8d280https://escholarship.org/content/qt6pv8d280/qt6pv8d280.pdfinfo:doi/10.5070/D328357783articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt7qx2k0w42022-06-23T16:07:34Zqt7qx2k0w4Innovation 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/7qx2k0w4https://escholarship.org/content/qt7qx2k0w4/qt7qx2k0w4.pdfinfo:doi/10.5070/D328357781articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt8jv7r1q52022-06-23T16:07:33Zqt8jv7r1q5Understanding 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/8jv7r1q5https://escholarship.org/content/qt8jv7r1q5/qt8jv7r1q5.pdfinfo:doi/10.5070/D328357780articleDermatology Online Journalvol 28, iss 3oai:escholarship.org:ark:/13030/qt3kc392p92022-05-15T18:03:54Zqt3kc392p9Position 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/3kc392p9https://escholarship.org/content/qt3kc392p9/qt3kc392p9.pdfinfo:doi/10.5070/D328257411articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt60j6f1zn2022-05-15T18:03:53Zqt60j6f1znOn 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/60j6f1znhttps://escholarship.org/content/qt60j6f1zn/qt60j6f1zn.pdfinfo:doi/10.5070/D328257410articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt4gr0601w2022-05-15T18:03:52Zqt4gr0601wPsoriasis, 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/4gr0601whttps://escholarship.org/content/qt4gr0601w/qt4gr0601w.pdfinfo:doi/10.5070/D328257409articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt1zf1t8g72022-05-15T18:03:51Zqt1zf1t8g7Improving 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/1zf1t8g7https://escholarship.org/content/qt1zf1t8g7/qt1zf1t8g7.pdfinfo:doi/10.5070/D328257408articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt1nk5g5w92022-05-15T18:03:50Zqt1nk5g5w9Survey 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/1nk5g5w9https://escholarship.org/content/qt1nk5g5w9/qt1nk5g5w9.pdfinfo:doi/10.5070/D328257407articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt2qw5f63b2022-05-15T18:03:49Zqt2qw5f63bNon-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/2qw5f63bhttps://escholarship.org/content/qt2qw5f63b/qt2qw5f63b.pdfinfo:doi/10.5070/D328257406articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt4t49f41z2022-05-15T18:03:48Zqt4t49f41zBeyond 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/4t49f41zhttps://escholarship.org/content/qt4t49f41z/qt4t49f41z.pdfinfo:doi/10.5070/D328257405articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt6553c5ps2022-05-15T18:03:47Zqt6553c5psAdvanced 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/6553c5pshttps://escholarship.org/content/qt6553c5ps/qt6553c5ps.pdfinfo:doi/10.5070/D328257404articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt0s56t9gm2022-05-15T18:03:46Zqt0s56t9gmDegenerative 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/0s56t9gmhttps://escholarship.org/content/qt0s56t9gm/qt0s56t9gm.pdfinfo:doi/10.5070/D328257403articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt9kc732n12022-05-15T18:03:45Zqt9kc732n1Acroangiodermatitis 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/9kc732n1https://escholarship.org/content/qt9kc732n1/qt9kc732n1.pdfinfo:doi/10.5070/D328257400articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt5sr475s02022-05-15T18:03:44Zqt5sr475s0Interstitial 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/5sr475s0https://escholarship.org/content/qt5sr475s0/qt5sr475s0.pdfinfo:doi/10.5070/D328257399articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt6qr6c5jb2022-05-15T18:03:43Zqt6qr6c5jbCutaneous 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/6qr6c5jbhttps://escholarship.org/content/qt6qr6c5jb/qt6qr6c5jb.pdfinfo:doi/10.5070/D328257402articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt88f861dc2022-05-15T18:03:42Zqt88f861dcA 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/88f861dchttps://escholarship.org/content/qt88f861dc/qt88f861dc.pdfinfo:doi/10.5070/D328257397articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt8gg6693r2022-05-15T18:03:41Zqt8gg6693rA 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/8gg6693rhttps://escholarship.org/content/qt8gg6693r/qt8gg6693r.pdfinfo:doi/10.5070/D328257396articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt5f65w32k2022-05-15T18:03:40Zqt5f65w32kMyopericytoma 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/5f65w32khttps://escholarship.org/content/qt5f65w32k/qt5f65w32k.pdfinfo:doi/10.5070/D328257395articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt3df5f83z2022-05-15T18:03:39Zqt3df5f83zCD4/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/3df5f83zhttps://escholarship.org/content/qt3df5f83z/qt3df5f83z.pdfinfo:doi/10.5070/D328257394articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt8zk543482022-05-15T18:03:38Zqt8zk54348Sexual 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/8zk54348https://escholarship.org/content/qt8zk54348/qt8zk54348.pdfinfo:doi/10.5070/D328257393articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt9j53k98k2022-05-15T18:03:37Zqt9j53k98kImpact 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/9j53k98khttps://escholarship.org/content/qt9j53k98k/qt9j53k98k.pdfinfo:doi/10.5070/D328257391articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt7dh0k1xr2022-05-15T18:03:37Zqt7dh0k1xrSubscription-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/7dh0k1xrhttps://escholarship.org/content/qt7dh0k1xr/qt7dh0k1xr.pdfinfo:doi/10.5070/D328257392articleDermatology Online Journalvol 28, iss 2oai:escholarship.org:ark:/13030/qt3p96v4mp2022-04-22T17:16:34Zqt3p96v4mpPPE 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/3p96v4mphttps://escholarship.org/content/qt3p96v4mp/qt3p96v4mp.pdfinfo:doi/10.5070/D328157074articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt6c73g6zb2022-04-22T17:16:33Zqt6c73g6zbMelanoma 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/6c73g6zbhttps://escholarship.org/content/qt6c73g6zb/qt6c73g6zb.pdfinfo:doi/10.5070/D328157073articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt6f18k6zq2022-04-22T17:16:32Zqt6f18k6zqCurettage 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/6f18k6zqhttps://escholarship.org/content/qt6f18k6zq/qt6f18k6zq.pdfinfo:doi/10.5070/D328157072articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt3sx049jm2022-04-22T17:16:31Zqt3sx049jmConjunctival 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/3sx049jmhttps://escholarship.org/content/qt3sx049jm/qt3sx049jm.pdfinfo:doi/10.5070/D328157075articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt05z8g6c72022-04-22T17:16:29Zqt05z8g6c7Cutaneous 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/05z8g6c7https://escholarship.org/content/qt05z8g6c7/qt05z8g6c7.pdfinfo:doi/10.5070/D328157071articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt2m7847qv2022-04-22T17:16:28Zqt2m7847qvSocial 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/2m7847qvhttps://escholarship.org/content/qt2m7847qv/qt2m7847qv.pdfinfo:doi/10.5070/D328157070articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt66x3q5bz2022-04-22T17:16:26Zqt66x3q5bzUndesirable 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/66x3q5bzhttps://escholarship.org/content/qt66x3q5bz/qt66x3q5bz.pdfinfo:doi/10.5070/D328157067articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt18d5v7hw2022-04-22T17:16:26Zqt18d5v7hwPublic 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/18d5v7hwhttps://escholarship.org/content/qt18d5v7hw/qt18d5v7hw.pdfinfo:doi/10.5070/D328157068articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt68f641rr2022-04-22T17:16:25Zqt68f641rrBasal 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/68f641rrhttps://escholarship.org/content/qt68f641rr/qt68f641rr.pdfinfo:doi/10.5070/D328157066articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt3r6133hv2022-04-22T17:16:23Zqt3r6133hvAn 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/3r6133hvhttps://escholarship.org/content/qt3r6133hv/qt3r6133hv.pdfinfo:doi/10.5070/D328157065articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt8g76064d2022-04-22T17:16:22Zqt8g76064dFixed 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/8g76064dhttps://escholarship.org/content/qt8g76064d/qt8g76064d.pdfinfo:doi/10.5070/D328157064articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt5pg0k0p02022-04-22T17:16:21Zqt5pg0k0p0A 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/5pg0k0p0https://escholarship.org/content/qt5pg0k0p0/qt5pg0k0p0.pdfinfo:doi/10.5070/D328157063articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt37f1t16d2022-04-22T17:16:20Zqt37f1t16dEarly 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/37f1t16dhttps://escholarship.org/content/qt37f1t16d/qt37f1t16d.pdfinfo:doi/10.5070/D328157062articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt3149s14c2022-04-22T17:16:19Zqt3149s14cLichenoid 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/3149s14chttps://escholarship.org/content/qt3149s14c/qt3149s14c.pdfinfo:doi/10.5070/D328157061articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt3wv549wb2022-04-22T17:16:18Zqt3wv549wbToxic 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/3wv549wbhttps://escholarship.org/content/qt3wv549wb/qt3wv549wb.pdfinfo:doi/10.5070/D328157060articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt75k7b00v2022-04-22T17:16:17Zqt75k7b00vComplete 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/75k7b00vhttps://escholarship.org/content/qt75k7b00v/qt75k7b00v.pdfinfo:doi/10.5070/D328157059articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt73p005z52022-04-22T17:16:16Zqt73p005z5Cutaneous 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/73p005z5https://escholarship.org/content/qt73p005z5/qt73p005z5.pdfinfo:doi/10.5070/D328157058articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt2q30p2jt2022-04-22T17:16:15Zqt2q30p2jtTeledermatology 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/2q30p2jthttps://escholarship.org/content/qt2q30p2jt/qt2q30p2jt.pdfinfo:doi/10.5070/D328157057articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt9kr0342z2022-04-22T17:16:14Zqt9kr0342zClinical 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/9kr0342zhttps://escholarship.org/content/qt9kr0342z/qt9kr0342z.pdfinfo:doi/10.5070/D328157055articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt3h12w6572022-04-22T17:16:14Zqt3h12w657Ethnic 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/3h12w657https://escholarship.org/content/qt3h12w657/qt3h12w657.pdfinfo:doi/10.5070/D328157056articleDermatology Online Journalvol 28, iss 1oai:escholarship.org:ark:/13030/qt710572t72022-03-20T16:43:19Zqt710572t7Lichen 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/710572t7https://escholarship.org/content/qt710572t7/qt710572t7.pdfinfo:doi/10.5070/D3271055635articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt1pm738wt2022-03-20T16:43:19Zqt1pm738wtDiagnostic 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/1pm738wthttps://escholarship.org/content/qt1pm738wt/qt1pm738wt.pdfinfo:doi/10.5070/D3271055634articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt4ft1b5f92022-03-20T16:43:18Zqt4ft1b5f9Distribution 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/4ft1b5f9https://escholarship.org/content/qt4ft1b5f9/qt4ft1b5f9.pdfinfo:doi/10.5070/D3271055633articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt2pn9n8tz2022-03-20T16:43:17Zqt2pn9n8tzThe 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/2pn9n8tzhttps://escholarship.org/content/qt2pn9n8tz/qt2pn9n8tz.pdfinfo:doi/10.5070/D3271055632articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt7b0782452022-03-20T16:43:16Zqt7b078245Alopecia 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/7b078245https://escholarship.org/content/qt7b078245/qt7b078245.pdfinfo:doi/10.5070/D3271055631articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt1vh950z92022-03-20T16:43:15Zqt1vh950z9Cat-associated zoonotic conditionsCohen, Philip R2021-01-01application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1vh950z9https://escholarship.org/content/qt1vh950z9/qt1vh950z9.pdfinfo:doi/10.5070/D3271055630articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt1198z48x2022-03-20T16:43:13Zqt1198z48xClinical 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/1198z48xhttps://escholarship.org/content/qt1198z48x/qt1198z48x.pdfinfo:doi/10.5070/D3271055629articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt7rx6d9jx2022-03-20T16:43:12Zqt7rx6d9jxSolitary 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/7rx6d9jxhttps://escholarship.org/content/qt7rx6d9jx/qt7rx6d9jx.pdfinfo:doi/10.5070/D3271055628articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt8jb5h6b32022-03-20T16:43:11Zqt8jb5h6b3Concurrent 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/8jb5h6b3https://escholarship.org/content/qt8jb5h6b3/qt8jb5h6b3.pdfinfo:doi/10.5070/D3271055627articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt3g67z4mj2022-03-20T16:43:10Zqt3g67z4mjPrimary 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/3g67z4mjhttps://escholarship.org/content/qt3g67z4mj/qt3g67z4mj.pdfinfo:doi/10.5070/D3271055626articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt2pp519wn2022-03-20T16:43:09Zqt2pp519wnCalciphylaxis: 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/2pp519wnhttps://escholarship.org/content/qt2pp519wn/qt2pp519wn.pdfinfo:doi/10.5070/D3271055696articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt3571n0832022-03-20T16:43:08Zqt3571n083Pediatric 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/3571n083https://escholarship.org/content/qt3571n083/qt3571n083.pdfinfo:doi/10.5070/D3271055622articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt76x4h9x22022-03-20T16:43:07Zqt76x4h9x2How 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/76x4h9x2https://escholarship.org/content/qt76x4h9x2/qt76x4h9x2.pdfinfo:doi/10.5070/D3271055620articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt57b984r42022-03-20T16:43:06Zqt57b984r4Telogen 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/57b984r4https://escholarship.org/content/qt57b984r4/qt57b984r4.pdfinfo:doi/10.5070/D3271055619articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt7pr1g45g2022-03-20T16:43:05Zqt7pr1g45gDeterminants 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/7pr1g45ghttps://escholarship.org/content/qt7pr1g45g/qt7pr1g45g.pdfinfo:doi/10.5070/D3271055618articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt5tw6x51z2022-03-20T16:43:04Zqt5tw6x51zThe 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/5tw6x51zhttps://escholarship.org/content/qt5tw6x51z/qt5tw6x51z.pdfinfo:doi/10.5070/D3271055615articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt2rm294722022-03-20T16:43:03Zqt2rm29472Evaluation 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/2rm29472https://escholarship.org/content/qt2rm29472/qt2rm29472.pdfinfo:doi/10.5070/D3271055614articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt8x39p1xz2022-03-20T16:43:02Zqt8x39p1xzInnovations 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/8x39p1xzhttps://escholarship.org/content/qt8x39p1xz/qt8x39p1xz.pdfinfo:doi/10.5070/D3271055695articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt4vx6g4hf2022-03-20T16:43:02Zqt4vx6g4hfDermatologists 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/4vx6g4hfhttps://escholarship.org/content/qt4vx6g4hf/qt4vx6g4hf.pdfinfo:doi/10.5070/D3271055613articleDermatology Online Journalvol 27, iss 10oai:escholarship.org:ark:/13030/qt5dj4j2jd2022-03-16T11:54:35Zqt5dj4j2jdPosition 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/5dj4j2jdhttps://escholarship.org/content/qt5dj4j2jd/qt5dj4j2jd.pdfinfo:doi/10.5070/D3271256720articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt4wm8004g2022-03-16T11:54:34Zqt4wm8004gPalbociclib-induced IgA vasculitisPatel, Payal MKelm, Ryan CAmber, Kyle T2021-01-01application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/4wm8004ghttps://escholarship.org/content/qt4wm8004g/qt4wm8004g.pdfinfo:doi/10.5070/D3271256719articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt2x39m6q82022-03-16T11:54:32Zqt2x39m6q8Reconstruction 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/2x39m6q8https://escholarship.org/content/qt2x39m6q8/qt2x39m6q8.pdfinfo:doi/10.5070/D3271256718articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt26m5p0m52022-03-16T11:54:31Zqt26m5p0m5The 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/26m5p0m5https://escholarship.org/content/qt26m5p0m5/qt26m5p0m5.pdfinfo:doi/10.5070/D3271256717articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt7qk8p1zz2022-03-16T11:54:29Zqt7qk8p1zzA 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/7qk8p1zzhttps://escholarship.org/content/qt7qk8p1zz/qt7qk8p1zz.pdfinfo:doi/10.5070/D3271256715articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt3dr0g30c2022-03-16T11:54:29Zqt3dr0g30cUnilateral 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/3dr0g30chttps://escholarship.org/content/qt3dr0g30c/qt3dr0g30c.pdfinfo:doi/10.5070/D3271256716articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt87m0h96c2022-03-16T11:54:27Zqt87m0h96cLaugier-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/87m0h96chttps://escholarship.org/content/qt87m0h96c/qt87m0h96c.pdfinfo:doi/10.5070/D3271256714articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt3p94v1xm2022-03-16T11:54:25Zqt3p94v1xmDelayed-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/3p94v1xmhttps://escholarship.org/content/qt3p94v1xm/qt3p94v1xm.pdfinfo:doi/10.5070/D3271256713articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt41j8k3hd2022-03-16T11:54:24Zqt41j8k3hdErythema 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/41j8k3hdhttps://escholarship.org/content/qt41j8k3hd/qt41j8k3hd.pdfinfo:doi/10.5070/D3271256712articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt2rt5p3jj2022-03-16T11:54:23Zqt2rt5p3jjAtypical 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/2rt5p3jjhttps://escholarship.org/content/qt2rt5p3jj/qt2rt5p3jj.pdfinfo:doi/10.5070/D3271256711articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt5tw5t4t32022-03-16T11:54:22Zqt5tw5t4t3An 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/5tw5t4t3https://escholarship.org/content/qt5tw5t4t3/qt5tw5t4t3.pdfinfo:doi/10.5070/D3271256710articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt43h117d42022-03-16T11:54:21Zqt43h117d4Prurigo 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/43h117d4https://escholarship.org/content/qt43h117d4/qt43h117d4.pdfinfo:doi/10.5070/D3271256709articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt7mz3x55z2022-03-16T11:54:20Zqt7mz3x55zPhotodermatitis 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/7mz3x55zhttps://escholarship.org/content/qt7mz3x55z/qt7mz3x55z.pdfinfo:doi/10.5070/D3271256708articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt5cg2s0k92022-03-16T11:54:19Zqt5cg2s0k9Sclerosing 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/5cg2s0k9https://escholarship.org/content/qt5cg2s0k9/qt5cg2s0k9.pdfinfo:doi/10.5070/D3271256707articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt3t55g37q2022-03-16T11:54:18Zqt3t55g37qAn 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/3t55g37qhttps://escholarship.org/content/qt3t55g37q/qt3t55g37q.pdfinfo:doi/10.5070/D3271256706articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt6xz7j1bd2022-03-16T11:54:16Zqt6xz7j1bdPostauricular 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/6xz7j1bdhttps://escholarship.org/content/qt6xz7j1bd/qt6xz7j1bd.pdfinfo:doi/10.5070/D3271256705articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt5mt9v5r82022-03-16T11:54:16Zqt5mt9v5r8Reactive 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/5mt9v5r8https://escholarship.org/content/qt5mt9v5r8/qt5mt9v5r8.pdfinfo:doi/10.5070/D3271256704articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt88v4z4jr2022-03-16T11:54:14Zqt88v4z4jrCutaneous 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/88v4z4jrhttps://escholarship.org/content/qt88v4z4jr/qt88v4z4jr.pdfinfo:doi/10.5070/D3271256702articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt73q2w7v92022-03-16T11:54:14Zqt73q2w7v9Extranodal 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/73q2w7v9https://escholarship.org/content/qt73q2w7v9/qt73q2w7v9.pdfinfo:doi/10.5070/D3271256701articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt2cv8s2hw2022-03-16T11:54:13Zqt2cv8s2hwPrimary 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/2cv8s2hwhttps://escholarship.org/content/qt2cv8s2hw/qt2cv8s2hw.pdfinfo:doi/10.5070/D3271256703articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt9k26d06b2022-03-16T11:54:12Zqt9k26d06bDermatology 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/9k26d06bhttps://escholarship.org/content/qt9k26d06b/qt9k26d06b.pdfinfo:doi/10.5070/D3271256721articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt6pt405g12022-03-16T11:54:11Zqt6pt405g1The 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/6pt405g1https://escholarship.org/content/qt6pt405g1/qt6pt405g1.pdfinfo:doi/10.5070/D3271256700articleDermatology Online Journalvol 27, iss 12oai:escholarship.org:ark:/13030/qt7t5478m52022-03-10T06:36:17Zqt7t5478m5Position 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/7t5478m5https://escholarship.org/content/qt7t5478m5/qt7t5478m5.pdfinfo:doi/10.5070/D3271156102articleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt5xm4g4rp2022-03-10T06:36:16Zqt5xm4g4rpAsymptomatic large lingual thyroidNamazi, Mohammad RKetabi, Yasaman2021-01-01application/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/5xm4g4rphttps://escholarship.org/content/qt5xm4g4rp/qt5xm4g4rp.pdfinfo:doi/10.5070/D3271156101articleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt72c0v1pz2022-03-10T06:36:15Zqt72c0v1pzTik Tok tylomaBarry, Kelly KHawryluk, Elena B2021-01-01calluscalloustylomaapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/72c0v1pzhttps://escholarship.org/content/qt72c0v1pz/qt72c0v1pz.pdfinfo:doi/10.5070/D3271156100articleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt7pk5q1w32022-03-10T06:36:14Zqt7pk5q1w3Etodolac-induced erythrodermaSeara, VeraCosta-Fernandes, SoniaDuarte, MariaMaia, Lilian2021-01-01desquamationerythrodermaexfoliative dermatitisapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/7pk5q1w3https://escholarship.org/content/qt7pk5q1w3/qt7pk5q1w3.pdfinfo:doi/10.5070/D3271156099articleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt3ht1640b2022-03-10T06:36:13Zqt3ht1640bVancomycin-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/3ht1640bhttps://escholarship.org/content/qt3ht1640b/qt3ht1640b.pdfinfo:doi/10.5070/D3271156098articleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt4d21j0jt2022-03-10T06:36:12Zqt4d21j0jtCrusted 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/4d21j0jthttps://escholarship.org/content/qt4d21j0jt/qt4d21j0jt.pdfinfo:doi/10.5070/D3271156097articleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt7zp4b9zs2022-03-10T06:36:11Zqt7zp4b9zsAn 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/7zp4b9zshttps://escholarship.org/content/qt7zp4b9zs/qt7zp4b9zs.pdfinfo:doi/10.5070/D3271156096articleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt4h74480z2022-03-10T06:36:10Zqt4h74480zAtopic 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/4h74480zhttps://escholarship.org/content/qt4h74480z/qt4h74480z.pdfinfo:doi/10.5070/D3271156095articleDermatology Online Journalvol 27, iss 11oai:escholarship.org:ark:/13030/qt5tr5s0vm2022-03-10T06:36:08Zqt5tr5s0vmCharacteristics 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/5tr5s0vmhttps://escholarship.org/content/qt5tr5s0vm/qt5tr5s0vm.pdfinfo:doi/10.5070/D3271156094articleDermatology Online Journalvol 27, iss 11oclc_dc:doj:500:4471:eyJmaXJzdCI6NTAwLCJiZWZvcmUiOiIyMDI2LTA1LTEyVDA2OjMwOjI1KzAwOjAwIiwiYWZ0ZXIiOiIyMDExLTAzLTE4VDE0OjMyOjQyKzAwOjAwIiwiaW5jbHVkZSI6WyJQVUJMSVNIRUQiLCJFTUJBUkdPRUQiXSwib3JkZXIiOiJVUERBVEVEX0RFU0MiLCJsYXN0SUQiOiJxdDV0cjVzMHZtIiwibGFzdERhdGUiOiIyMDIyLTAzLTEwVDA2OjM2OjA4KzAwOjAwIn0