Dermatology online journal最新文献

A 44-year-old woman with type II diabetes mellitus presented with an 8-month history of a painful, ulcerating rash at the area of insulin injection of her left lower abdomen. Topical antibiotics, topical corticosteroids, oral antibiotics, and supportive wound care provided no relief. A similar eruption developed on the right abdomen when she switched injection sites. Wedge biopsy of the violaceous, reticular plaque demonstrated a central dermal scar with surrounding lobular and linear collections of small blood vessels, consistent with reactive angioendotheliomatosis. This condition typically occurs secondary to an underlying systemic disease, but we believe hers was a side effect related to trauma from insulin injection or secondary to an insulin additive hypersensitivity. The patient was switched to a glucagon-like peptide-1 agonist, active lesions were treated with topical timolol 0.5% ophthalmic solution, and oral propranolol was started with upward titration. She continues to see improvement in pain and has not developed any new ulcerations at other sites on the body.

Bullous pemphigoid is a chronic autoimmune blistering disease typically presenting as non-specific pruritis following by the development of vesicles and bullae. A variety of medications and comorbid medical conditions have been associated with bullous pemphigoid. Herein, we present a case describing a potential novel association between immunoglobulin A nephropathy and bullous pemphigoid.

Hidradenitis suppurativa is a chronic inflammatory skin disorder characterized by painful recurring pustules, nodules, abscesses, and sinus tract formation. Secondary lymphedema associated with hidradenitis suppurativa is an uncommon but severe condition, often resulting in significant morbidity. Although the exact link between lymphedema and chronic hidradenitis suppurativa is not fully understood, the chronic inflammatory process with scarring is a likely an important factor. Herein, we reported a 52-year-old man with untreated chronic hidradenitis suppurativa, nonalcoholic fatty liver disease-related cirrhosis, and secondary massive scrotal lymphedema, complicated by cellulitis and sepsis. Despite appropriate treatment, the patient's condition deteriorated and he unfortunately passed away two weeks after hospitalization. Additionally, we reviewed the literature on hidradenitis suppurativa-associated lymphedema, analyzing data from 51 patients. The majority were men with long-standing severe hidradenitis suppurativa. Surgical intervention was identified as the most commonly effective treatment modality, offering substantial improvements in function and appearance. However, some patients experienced postsurgery adverse events. In conclusion, this report highlights the importance of early detection and management of hidradenitis suppurativa and its complications to prevent patients' significant morbidity.

Epithelial sheath neuroma is a cutaneous tumor presenting as an erythematous and often painful lesion on the skin of the back. We report a 74-year-old woman with a 7mm epithelial sheath neuroma located on the right upper central back. The initial clinical impression was a basal cell carcinoma and histopathologically, the tumor mimicked a carcinoma with perineural invasion. She had no prior trauma or surgeries at the surgical site. She reported experiencing pain at the site of the tumor. Pain is a symptom of more than half of the reported epithelial sheath neuroma cases. The papule was excised, and there has been no recurrence at the surgical site. We report the unusual occurrence of this very uncommon neoplasm, a tumor that might be inadvertently confused with an aggressive squamous cell carcinoma.

Morphea is an uncommon inflammatory disorder characterized by progressive sclerosis of the skin and soft tissues. We describe the novel occurrence of generalized morphea profunda arising in close temporal association with the COVID-19 messenger ribonucleic acid vaccination series. An 80-year-old man presented with numerous areas of firm, tight skin across his trunk and extremities with associated itching and burning. He denied characteristic symptoms of systemic sclerosis. Physical examination revealed numerous indurated plaques, some with porcelain-white or sclerotic yellow centers, on the bilateral dorsal forearms, anterior waistline, and bilateral legs. There was no evidence of sclerodactyly or inflammatory arthritis. Punch biopsies showed thickened collagen bundles in the reticular dermis, diminished periadnexal fat, and a perivascular and interstitial mononuclear cell infiltrate. The hyalinizing fibrosing reaction extended into the fat and was manifested by notable expansion of the interlobular septa of the fat by dense collagen. He was started on oral methotrexate with significant improvement in symptoms and lesion induration at 14-month follow-up. This case report provides further insight into the potential dermatologic adverse events associated with COVID-19 messenger ribonucleic acid vaccination. Further investigation is needed to determine any predisposing patient-specific intrinsic factors, unrecognized pathophysiologic mechanisms, and approximate incidence of such adverse events.

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.