Autosensitization dermatitis, or Id reaction, is a cutaneous phenomenon in which an acute secondary dermatitis develops at a location distant from a primary inflammatory focus due to excess circulation of cytokines. Autosensitization frequently results from cases of infection, and multiple infectious organisms including bacteria, viruses, parasites, and fungi have been shown to cause reactions at sites distant to the infection. Many cutaneous morphologies have been reported in Id reactions. There...
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Introduction: Several studies have shown an association between psoriasis and hepatitis C virus infection. To assess this relationship, we have evaluated the frequency of psoriasis among a population of patients receiving treatment for hepatitis C infection.
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Erythema annulare centrifugum (EAC), a figurate erythema, can present as a reactive process and may herald the development, or signify the presence, of internal malignancy. As this eruption can appear prior to diagnosis of such malignancies, it is important to consider this in the differential diagnosis for a patient presenting with EAC. We present the case of a 58-year-old Caucasian woman with a 7-year history of chronic pruritic, erythematous, annular, scaly plaques of the upper and lower extremities...
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Introduction: Poromas are rare benign tumors arising from the intraepidermal portion of the sweat duct. We present a case of multiple eccrine poromas arising in a patient with natural killer T-cell (NK-T) lymphoma after being treated with chemotherapy and radiotherapy.
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Introduction: Ustekinumab, an interleukin-12/23 inhibitor, is approved for the treatment of moderate-to-severe plaque psoriasis in the US and EU. In phase 3 studies, the efficacy of ustekinumab has been demonstrated based on significant improvements in Psoriasis Area and Severity Index (PASI) responses compared with placebo, and in others head to head trials. For almost a decade, an improvement of 75% in PASI score from baseline (PASI 75) has been accepted as a clinically meaningful reduction in...
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Background: Acquired dermal macular hyperpigmentation (ADMH) is a hypernym which includes disorders previously described as lichen planus pigmentosus, Riehl melanosis, pigmented contact dermatitis and erythema dyschromicum perstans. Dermal pigmentation area and severity score (DPASI), is a recently proposed scoring system for ADMH. Briefly, the scoring system involves dividing face and neck into 6 different segments. In each segment, the disease severity is assessed by dermatoscopic and multiplied...
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Background: Melanoma is the most common skin cancer in patients under 20 years. Staging procedures typically follow those in adults; however little is known about utilization of sentinel lymph node biopsy (SLNB) and predictors of positive sentinel nodes. We aimed to assess SLNB utilization and factors affecting SLN positivity in a pediatric melanoma cohort.
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Introduction: Biosimilar medicines are highly similar to the originator biological drugs and both considered not to have any clinically meaningful difference in structure, pharmacokinetics, quality, safety or efficacy.
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Background: Lichenoid purpura (LP) is a variant of pigmented purpuric dermatosis (PPD) that is characterized by rust macules or papules mainly on the legs and histologically by a dense, band-like dermal inflammatory cell infiltrate with extravasated red blood cells. Recent data suggests that LP may be a precursor of mycosis fungoides (MF), with similar histologic features. Medium-dose ultraviolet A-1 (UVA-1) is an effective treatment option for MF. From this perspective, medium-dose UVA-1 phototherapy...
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Dermatofibroma protuberans (DFSP) is an uncommon, locally aggressive cutaneous soft tissue sarcoma of low-intermediate malignancy that favors young adults. It usually presents as an asymptomatic, indurated, skin-colored plaque that enlarges over a period of months to years. Histologically, it is characterized by its capacity to infiltrate the dermis and subcutaneous tissue in the form of peripheral tentacle-like projections. This feature justifies a high rate of local recurrence, while the rate of...
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Background: Postherpetic neuralgia (PHN) is a neuropathic pain syndrome persisting or resuming after resolution of the herpes zoster (HZ) inflammatory rash. There is no consensus on best treatment, options for which are primarily pharmacologic and aimed at pain management
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Background: Ultraviolet A1(UVA1) phototherapy has been used to treat many inflammatory dermatoses. Studies have originated from Europe and the United States but few studies have been conducted in Asian populations.
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Background: Poziotinib is a potent, orally available, EGFR and HER2 exon 20-selective tyrosine kinase inhibitor used to treat nonsmall cell lung cancer (NSCLC). During a Phase 2 clinical trial of poziotinib, a high incidence of cutaneous reactions were reported in treated patients. Up to 55% of patients received a dose reduction in response to adverse events, most commonly from skin reaction and diarrhea.
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A 68-year-old lady with a history of C1 esterase inhibitor deficiency and hypothyroidism presented to our center with a 2-year history of multiple superficial ulcers at various sites, including: both arms, back, abdomen, thighs, and buttocks. She denied any history of trauma to these areas. On first presentation, the ulcers appeared infected and she was treated with oral antibiotics according to microbiological sensitivities. Due to minimal improvement, a punch biopsy was taken from a right forearm...
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William’s syndrome is a well-defined genetic disorder due to a microdeletion on chromosome 7. It is most commonly characterized by cardiovascular defects, electrolyte abnormalities, and abnormal facies. Cutaneous manifestations of this syndrome are uncommonly discussed in the literature, and its possible association with various basal cell carcinoma syndromes is even less well established. Specifically, the hereditary basal cell carcinoma syndromes that have a well-established genetic basis—nevoid...
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Introduction: The effect of withdrawal and retreatment with the selective JAK-1 inhibitor, upadacitinib (UPA), was evaluated during the 32-week pre-specified interim analysis from the 88-week phase 2b trial in patients with atopic dermatitis (AD).
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Introduction: Atopic dermatitis (AD) is a chronic, inflammatory and pruritic skin disease, with a prevalence of 1-3% of the adult population. Usually begins in early childhood, progresses with a recurrent course before disappearing at puberty, and may persist to adulthood or present de novo during this period. It is frequently associated with elevated levels of serum IgE, individual or family history of type I allergies, allergic rhinitis and asthma. The therapeutic approach in adult AD patients...
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Background/Context: Socioeconomic status (SES) is defined as an individual’s social or economic standing. It includes measures on income, education, occupation, location of residence or housing. Studies have found a link between lower SES and less access to health care. Furthermore, there is emerging data on the role of SES in dermatologic conditions.
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Objective: VOYAGE 2, a Phase 3, double-blind, placebo- and active-comparator-controlled study, evaluated efficacy and safety of guselkumab (GUS) in patients with moderate to severe plaque psoriasis (PsO). Significant improvement in health-related quality of life (HRQOL) and work productivity was observed in patients treated with GUS vs placebo (PBO) and adalimumab (ADA) at Weeks (Wks) 16 and 24, respectively. This analysis reports results from Wks 48-156.
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Dermal melanocytoses are distinct melanocytic lesions characterized by a blue-gray discoloration of large portions of the skin. During embryogenesis, melanocytes are found diffusely throughout the dermis. By the end of gestation, these melanocytes have migrated to the dermoepidermal junction. Defect in migration of pigmented neural crest cells result in deep melanin in the skin and associated tyndall effect, appearing clinically as dermal melanocytoses. Subtypes include a wide variety of congenital...
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Background: Dermatological toxicities (lichenoid, immune-bullous, vitiligo, acantholytic, granulomatous, panniculitis etc.) to programmed cell death receptor 1 (PD-1) inhibition are reported in 30-40% of patients. Here we present a patient with sarcoidal granulomas and septal panniculitis on pembrolizumab.
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Introduction: Risankizumab (RZB) is a humanized IgG1 monoclonal antibody that selectively inhibits the p19 subunit of interleukin-23 (IL-23), a cytokine that participates in the development and maintenance of psoriatic lesions. We report on the impact of prior therapies on the long-term efficacy of RZB compared with ustekinumab (UST) in patients with moderate-to-severe plaque psoriasis using integrated data from 2 studies.
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Background: Lichen planopilaris (LPP) is a common form of primary scarring alopecia. The striking scalp morphology in LPP leading to follicular destruction and scarring has been extensively studied. Reports of body hair involviment in LPP are scant. Extra-scalp LPP has been majorly reported in association with its rare variants, which are frontal fibrosing alopecia (FFA) and Graham-Little-Piccardi-Lassueur Syndrome (GLPLS). Few reports have described the histopathological features of extra-scalp...
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Introduction: Over 75% of dermatologists are projected to face malpractice litigation, with an average indemnity payment of $238,145.00. Although over 1 in 110 American residents are incarcerated, limited information exists regarding malpractice litigation in the setting of dermatologic healthcare for the incarcerated population. The goal of this study was to describe the characteristics of federal prison malpractice cases involving dermatologists.
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Pembrolizumab is a programmed cell death inhibitor (PD-1) licensed to treat metastatic malignant melanoma amongst other malignancies. It is a monoclonal antibody which binds the PD-1 receptor and triggers an immunological response to malignant cells. Immunological skin reactions are increasingly documented and include lichen planus, lupus-like reaction, vitiligo and bullous pemphigoid. In our center we have treated 298 patients with pembrolizumab for various malignancies including melanoma. We report...
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Background: Ozenoxacin is a nonfluorinated quinolone that has been recently approved by the FDA for the topical treatment of impetigo due to Staphylococcus aureus or Streptococcus pyogenes in adult and pediatric patients 2 months of age and older.
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Background: Due to the fear of needle, needle-free injection devices powered by air/gas have been developed and used as a transdermal drug delivery system. But, they were not widely used because of pain and slow speed (20∼40 shots/min). Thus the needs for painless and speedy nonneedle injection devices has been increased.
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Introduction: Chondroid syringoma or mixed tumor is a benign rare cutaneous variant of pleomorphic adenoma (being the tumor that most frequently affects the salivary glands). Chondroid syringoma presents as a slow growing, painless, nodular lesion most commonly located on the head and neck. It can be classified as eccrine or apocrine tumor according to its pathological characteristics. The diagnosis of chondroid syringomas is based on clinical and histopathological findings and the treatment is surgical...
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