Dermatology online journal最新文献

Excision of skin cancer may involve a closure that can substantially increase the total cost of care. Dermatologist-specific factors may predict closure billing. The objective was to identify characteristics that predict higher-than-expected closure costs following skin cancer excision. The study included general dermatologists who performed malignant excisions and closures in the 2022 United States Medicare population. K-means clustering was performed on each dermatologist's cost difference and their mean size of malignant excisions. Dermatologist characteristics were compared between clusters and effect sizes were calculated to ensure substantial magnitudes of difference. Compared with dermatologists in low-cost clusters, dermatologists in high-cost clusters had higher office visit levels of service (P<0.0001) and practiced in postal codes with higher household incomes (P<0.0001), lower social deprivation scores (P<0.0001), and more urban areas (P<0.0001). For only small excision sizes, the high-cost cluster had more female dermatologists (P<0.0001). General dermatologists who billed for office visits at higher levels or practiced in more urban and affluent areas had higher skin cancer excision closure costs. The dermatologist practice patterns described here may help inform strategies to reduce the cost of surgical care for skin cancer.

Primary cutaneous follicle center lymphoma rarely presents as macular alopecia and is typically characterized by solitary papules and nodules on the head, neck, and trunk. We report a 24-year-old woman with frontal alopecia that clinically resembled frontal fibrosing alopecia but was ultimately diagnosed as primary cutaneous follicle center lymphoma. The patient presented with pronounced alopecia over the left frontal scalp superimposed on milder bitemporal alopecia and intermittent symptoms of scalp irritation. Histopathologic examination of a scalp biopsy revealed a nodular lymphocytic infiltrate with irregular germinal centers localized to the adventitial dermis of the eccrine coil and the interadnexal interstitium. Immunophenotyping confirmed B-cell clonality, with findings consistent with primary cutaneous follicle center lymphoma. This case highlights the importance of biopsy in atypical alopecia presentations, as histologic findings were pivotal in diagnosing primary cutaneous follicle center lymphoma with concurrent frontal fibrosing alopecia features.

Basal cell nevus syndrome (Gorlin syndrome) is a rare genetic condition characterized by multiple basal cell carcinomas, often arising before age 20.  Most cases result from a mutation in the patched 1 gene-part of the sonic hedgehog pathway. Rarely, this condition is related to a suppressor of fused gene mutation, which occurs downstream from Smoothened, and is unresponsive to Smoothened inhibitors including vismodegib and sonidegib. Notably, basal cell nevus syndrome, secondary to a suppressor of fused gene mutation, is associated with a higher incidence of childhood medulloblastoma with implications for the patient and offspring.  A 72-year-old man with pearly papules coalescing into plaques across the nose and cheeks presented. The lesions had appeared as a teenager, and the patient reported his sister had similar lesions. Five biopsies, reviewed by three dermatopathologists, were consistent with basal cell carcinoma. Genetic testing was negative for patched 1 and patched 2 mutations but positive for a heterozygous suppressor of fused mutation. Patients with basal cell nevus syndrome should be treated with surgical excision, counseled on sun protection, screened and monitored for complications, and treated with vismodegib (if associated with patched 1 mutation) or itraconazole (if associated with suppressor of fused mutation).

Longevity refers to living a longer and healthier life than the average.  Many dermatologists are characterized by not only longevity, but also superaging.  The American Academy of Dermatology published the obituaries of 57 colleagues; 89% (51 of the 57 dermatologists) of the dermatologists were older than 80 years of age when they died.  It is remarkable that so many dermatologists live so long.  We propose that the longevity observed in dermatologists may not only be merely the result of chance.  We hypothesize that dermatologist longevity is the result of the genetic predisposition, lifestyle (such as healthy diets, exercise, and rest), and specific career characteristics.

There are deficiencies in preclinical dermatology education: only 12% of medical schools in the United States offer a dedicated preclinical curriculum. Students could use free artificial intelligence as an alternative to other expensive resources to prepare for United States Medical Licensing Examination board examinations. ChatGPT was prompted to generate a dermatology curriculum including lecture outlines, disease pathology, histology, pharmacology, and practice questions based on the United States Medical Licensing Examination Step 1 content outline. The result was analyzed for completeness, accuracy, and quality. ChatGPT created a dermatology curriculum with 8 topics: introduction, infectious disorders, inflammatory disorders, neoplasms, integumentary disorders, pathology/histology, pharmacology, and clinical case studies. The curriculum included placeholders for the visual learning components rather than incorporating clinical images. The clinical vignettes included were incomplete and not detailed. Artificial intelligence can provide accessible, personalized, and cost-effective resources for preclinical medical students learning dermatology. This has the potential to impact inequalities among medical schools in dermatology education. However, generated curriculums need to be evaluated by dermatology educators to ensure accuracy and quality.

Atopic dermatitis is a chronic, itch-inducing inflammatory skin condition that significantly affects quality of life. Abrocitinib, an oral medication that selectively inhibits Janus kinase 1, targets inflammatory pathways involved in the disease. All Janus kinase inhibitors approved by the United States Food and Drug Administration for inflammatory conditions carry boxed warnings for serious infections, mortality, malignancy, major adverse cardiovascular events, and thrombosis. A panel of eight dermatologists met to evaluate the safety of abrocitinib and the impact of Janus kinase selectivity on side effects. A literature search of PubMed, Scopus, and Google Scholar identified 246 English-language studies, of which 36 met inclusion. These were reviewed by the panel prior to a roundtable discussion. Using a modified Delphi method, the panel developed 10 consensus statements and assigned a strength of recommendation to each: seven statements were rated "A," one "B," and two "C." Abrocitinib provides rapid itch relief for people with moderate-to-severe atopic dermatitis. It shows greater selectivity for Janus kinase 1 than other treatments and higher efficacy than biologic therapies. Its safety profile is similar to other Janus kinase 1 inhibitors, with low risk of serious infections and a rate of cardiovascular events and thrombosis comparable to placebo.

Inflammatory 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.

Osteoma 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.

An 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.