Dermatology online journal最新文献

Enchondromas 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.

Janus 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.

Personal 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.

Given 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.

Drug-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.

Skin 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.

Comprehensive 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.

Blue 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.