Taylor E Gladys, Tae-Hwan Kim, C. Beatty, S. Choudhary
Granuloma annulare (GA) is a common, noninfectious granulomatous skin condition that usually presents in its localized form, characterized by flesh-colored to erythematous papules coalescing into annular plaques without scale, commonly on the dorsal hands. Lesions can be pruritic and often resolve without treatment in two years. However, the generalized form of GA has a lower incidence and presents with similar morphology, but with >10 lesions in a widespread distribution. Generalized GA is known to be more symptomatic, longer-lasting, and recalcitrant to treatment. The diagnosis is made based on clinicopathological correlation with palisading granulomas around degenerated collagen in the dermis, mucin, and infiltrative lymphocytes and histiocytes. Treatment remains challenging as evidence is limited to case reports, case series, and a few retrospective studies. Here we present the case of a 59-year-old Caucasian female with pruritic rash that began on her abdomen and spread to her extremities over two months. Biopsy revealed superficial histiocytic infiltrates palisading around eosinophilic areas of altered collagen, multiple multinucleate giant cells with elastophagocytosis and lymphohistiocytic perivascular infiltrates, and mucin in the dermis on colloidal iron staining. Overall, this was consistent with generalized GA. The patient was started on a combination of low dose naltrexone (LDN) and psoralen and ultraviolet A (PUVA) therapy. At a five-month follow up visit, she demonstrated near complete resolution of symptoms without any serious adverse effects.
{"title":"Case of Generalized Granuloma Annulare Treated with Low Dose Naltrexone + PUVA","authors":"Taylor E Gladys, Tae-Hwan Kim, C. Beatty, S. Choudhary","doi":"10.25251/skin.7.4.12","DOIUrl":"https://doi.org/10.25251/skin.7.4.12","url":null,"abstract":"Granuloma annulare (GA) is a common, noninfectious granulomatous skin condition that usually presents in its localized form, characterized by flesh-colored to erythematous papules coalescing into annular plaques without scale, commonly on the dorsal hands. Lesions can be pruritic and often resolve without treatment in two years. However, the generalized form of GA has a lower incidence and presents with similar morphology, but with >10 lesions in a widespread distribution. Generalized GA is known to be more symptomatic, longer-lasting, and recalcitrant to treatment. The diagnosis is made based on clinicopathological correlation with palisading granulomas around degenerated collagen in the dermis, mucin, and infiltrative lymphocytes and histiocytes. Treatment remains challenging as evidence is limited to case reports, case series, and a few retrospective studies. Here we present the case of a 59-year-old Caucasian female with pruritic rash that began on her abdomen and spread to her extremities over two months. Biopsy revealed superficial histiocytic infiltrates palisading around eosinophilic areas of altered collagen, multiple multinucleate giant cells with elastophagocytosis and lymphohistiocytic perivascular infiltrates, and mucin in the dermis on colloidal iron staining. Overall, this was consistent with generalized GA. The patient was started on a combination of low dose naltrexone (LDN) and psoralen and ultraviolet A (PUVA) therapy. At a five-month follow up visit, she demonstrated near complete resolution of symptoms without any serious adverse effects.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43631299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this report, we describe a case of a healthy 67-year-old female with rapidly growing red nodules on the scalp that demonstrated histological features of benign epithelioid hemangioma on multiple instances yet behaved clinically as a malignant angiosarcoma. Despite multiple rounds of resection, radiation, and chemotherapy, the patient ultimately succumbed from her widely metastatic disease. Diagnosis of vascular neoplasms, including the spectrum of low-grade epithelioid hemangioma, intermediate-grade epithelioid hemangioendothelioma, and high-grade angiosarcoma remains challenging due to overlapping clinical and histopathological features. This report is presented to highlight the need for clinicians to interpret histopathology, whether benign or malignant, in the context of clinical observation as the clinical course may not always match the biopsy.
{"title":"Malignant Angiosarcoma Masquerading as Benign Epithelioid Hemangioma","authors":"K. Daftary, J. Brieva, R. Chovatiya","doi":"10.25251/skin.7.4.11","DOIUrl":"https://doi.org/10.25251/skin.7.4.11","url":null,"abstract":"In this report, we describe a case of a healthy 67-year-old female with rapidly growing red nodules on the scalp that demonstrated histological features of benign epithelioid hemangioma on multiple instances yet behaved clinically as a malignant angiosarcoma. Despite multiple rounds of resection, radiation, and chemotherapy, the patient ultimately succumbed from her widely metastatic disease. Diagnosis of vascular neoplasms, including the spectrum of low-grade epithelioid hemangioma, intermediate-grade epithelioid hemangioendothelioma, and high-grade angiosarcoma remains challenging due to overlapping clinical and histopathological features. This report is presented to highlight the need for clinicians to interpret histopathology, whether benign or malignant, in the context of clinical observation as the clinical course may not always match the biopsy.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46994182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-17DOI: 10.25251/skin.7.supp.219
M. Gooderham, L. Spelman, S. Imafuku, M. Romanelli, J. Merola, A. Armstrong, E. Colston, Subhashish Banerjee, T. Scharnitz, A. Blauvelt
Introduction: Deucravacitinib, an oral, selective, allosteric tyrosine kinase 2 inhibitor, is approved in the US and other countries for the treatment of adults with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy. In the POETYK PSO-1 (NCT03624127) and PSO-2 (NCT03611751) trials, deucravacitinib was superior to placebo and apremilast in patients with moderate to severe plaque psoriasis. This analysis evaluated deucravacitinib efficacy by baseline characteristics. Methods: Efficacy endpoints, including ≥75% reduction from baseline in Psoriasis Area and Severity Index (PASI 75) and static Physician’s Global Assessment score of 0 (clear) or 1 (almost clear) (sPGA 0/1), were evaluated at Week 24 by baseline subgroups including weight, sex, and PASI in the pooled PSO-1 and PSO-2 population, and at Week 52 in PSO-1 patients who received continuous deucravacitinib treatment from Day 1. Results: In the pooled PSO-1 and PSO-2 population, deucravacitinib (n=843) was more efficacious than apremilast (n=422) at Week 24 across subgroups defined by baseline weight (<90 kg: PASI 75, 69.8% vs 43.8%, sPGA 0/1, 60.2% vs 34.2%; ≥90 kg: PASI 75, 55.4% vs 31.5%, sPGA 0/1, 45.9% vs 25.6%), sex (male: PASI 75, 59.3% vs 33.7%, sPGA 0/1, 49.6% vs 24.7%; female: PASI 75, 70.4% vs 45.2%, sPGA 0/1, 60.9% vs 39.4%), and PASI (≤20: PASI 75, 61.6% vs 38.6%, sPGA 0/1, 53.5% vs 32.4%; >20: PASI 75, 64.7% vs 37.0%, sPGA 0/1: 53.2% vs 27.1%). Consistent efficacy was observed through Week 52 in patients who received continuous deucravacitinib treatment in PSO-1 (n=332), regardless of baseline characteristics. Conclusion: Deucravacitinib demonstrated consistent efficacy for up to 52 weeks regardless of baseline characteristics in patients with moderate to severe plaque psoriasis. Acknowledgments This study was sponsored by Bristol Myers Squibb Writing and editorial assistance was provided by Liz Rockstein, PhD, of Peloton Advantage, LLC, an OPEN Health company, funded by Bristol Myers Squibb
{"title":"Deucravacitinib, an Oral, Selective, Allosteric Tyrosine Kinase 2 Inhibitor, in Moderate to Severe Plaque Psoriasis: Efficacy by Baseline Demographic and Disease Characteristics in the Phase 3 POETYK PSO-1 and PSO-2 Trials","authors":"M. Gooderham, L. Spelman, S. Imafuku, M. Romanelli, J. Merola, A. Armstrong, E. Colston, Subhashish Banerjee, T. Scharnitz, A. Blauvelt","doi":"10.25251/skin.7.supp.219","DOIUrl":"https://doi.org/10.25251/skin.7.supp.219","url":null,"abstract":"Introduction: Deucravacitinib, an oral, selective, allosteric tyrosine kinase 2 inhibitor, is approved in the US and other countries for the treatment of adults with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy. In the POETYK PSO-1 (NCT03624127) and PSO-2 (NCT03611751) trials, deucravacitinib was superior to placebo and apremilast in patients with moderate to severe plaque psoriasis. This analysis evaluated deucravacitinib efficacy by baseline characteristics. \u0000Methods: Efficacy endpoints, including ≥75% reduction from baseline in Psoriasis Area and Severity Index (PASI 75) and static Physician’s Global Assessment score of 0 (clear) or 1 (almost clear) (sPGA 0/1), were evaluated at Week 24 by baseline subgroups including weight, sex, and PASI in the pooled PSO-1 and PSO-2 population, and at Week 52 in PSO-1 patients who received continuous deucravacitinib treatment from Day 1. \u0000Results: In the pooled PSO-1 and PSO-2 population, deucravacitinib (n=843) was more efficacious than apremilast (n=422) at Week 24 across subgroups defined by baseline weight (<90 kg: PASI 75, 69.8% vs 43.8%, sPGA 0/1, 60.2% vs 34.2%; ≥90 kg: PASI 75, 55.4% vs 31.5%, sPGA 0/1, 45.9% vs 25.6%), sex (male: PASI 75, 59.3% vs 33.7%, sPGA 0/1, 49.6% vs 24.7%; female: PASI 75, 70.4% vs 45.2%, sPGA 0/1, 60.9% vs 39.4%), and PASI (≤20: PASI 75, 61.6% vs 38.6%, sPGA 0/1, 53.5% vs 32.4%; >20: PASI 75, 64.7% vs 37.0%, sPGA 0/1: 53.2% vs 27.1%). Consistent efficacy was observed through Week 52 in patients who received continuous deucravacitinib treatment in PSO-1 (n=332), regardless of baseline characteristics. \u0000Conclusion: Deucravacitinib demonstrated consistent efficacy for up to 52 weeks regardless of baseline characteristics in patients with moderate to severe plaque psoriasis. \u0000 \u0000Acknowledgments \u0000 \u0000This study was sponsored by Bristol Myers Squibb \u0000Writing and editorial assistance was provided by Liz Rockstein, PhD, of Peloton Advantage, LLC, an OPEN Health company, funded by Bristol Myers Squibb \u0000","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47848370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carlie Reeves, L. Falcone, Collen J Beatty, V. Kazlouskaya, Joseph C English Iii
A 67-year-old woman was evaluated for a worsening asymptomatic rash located on her torso, back, and legs. She denied any chills or fevers, and reported feeling otherwise well. Clinically, large brownish, slightly atrophic plaques were seen on the torso suggestive of either morphea or a granulomatous condition. Histopathologic examination revealed an increase in interstitial histiocytes infiltrating between altered collagen fibers, palisaded granulomas with increased mucin, suggestive of granuloma annulare (GA), as well as dermal sclerosis, perineural infiltrates with plasma cells and diminished CD34 counts, that are more typical for localized scleroderma/morphea. Morphea and patch-type GA may be indistinguishable clinically and share some histopathological features. This case demonstrates similarities between these conditions and features of both conditions in the same patient.
{"title":"Patch-Type Granuloma Annulare with Clinical and Histological Features of Morphea: A True Overlap?","authors":"Carlie Reeves, L. Falcone, Collen J Beatty, V. Kazlouskaya, Joseph C English Iii","doi":"10.25251/skin.7.4.23","DOIUrl":"https://doi.org/10.25251/skin.7.4.23","url":null,"abstract":"A 67-year-old woman was evaluated for a worsening asymptomatic rash located on her torso, back, and legs. She denied any chills or fevers, and reported feeling otherwise well. Clinically, large brownish, slightly atrophic plaques were seen on the torso suggestive of either morphea or a granulomatous condition. Histopathologic examination revealed an increase in interstitial histiocytes infiltrating between altered collagen fibers, palisaded granulomas with increased mucin, suggestive of granuloma annulare (GA), as well as dermal sclerosis, perineural infiltrates with plasma cells and diminished CD34 counts, that are more typical for localized scleroderma/morphea. Morphea and patch-type GA may be indistinguishable clinically and share some histopathological features. This case demonstrates similarities between these conditions and features of both conditions in the same patient.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48051196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Erik Jaklitsch, A. Mizes, F. Sanchez, Ana Romero, Katherin Bonilla, A. James
Erythema annulare centrifugum (EAC) is a reactive inflammatory dermatosis characterized by multiple, pruritic annular plaques that often resolve spontaneously. EAC is putatively caused by hypersensitivity to medications, foods, infections, malignancies, stress, and arthropod bites; however, in many cases, a participating factor is not identified. We present a pregnant woman who was diagnosed with EAC seen by our dermatology team during a short-term brigade in Tegucigalpa, Honduras.
{"title":"Rare Case of Early Pregnancy-Associated Erythema Annulare Centrifugum in a Low-Resource Setting","authors":"Erik Jaklitsch, A. Mizes, F. Sanchez, Ana Romero, Katherin Bonilla, A. James","doi":"10.25251/skin.7.4.18","DOIUrl":"https://doi.org/10.25251/skin.7.4.18","url":null,"abstract":"Erythema annulare centrifugum (EAC) is a reactive inflammatory dermatosis characterized by multiple, pruritic annular plaques that often resolve spontaneously. EAC is putatively caused by hypersensitivity to medications, foods, infections, malignancies, stress, and arthropod bites; however, in many cases, a participating factor is not identified. We present a pregnant woman who was diagnosed with EAC seen by our dermatology team during a short-term brigade in Tegucigalpa, Honduras.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44765206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Inequities in dermatologic health outcomes translate to worsened clinical outcomes for minority groups. For example, despite a lower incidence of skin cancer overall, African Americans are diagnosed at later stages with greater degrees of lymph node involvement. This has been shown to lead to disproportionate mortality when compared to lighter skinned individuals. Medical education materials contain a significantly lower percentage of skin of color (SOC) images than of lighter skin and research has indicated lower diagnostic accuracy of dermatologic conditions in darker skin by U.S. medical students. The objective of this study was to explore U.S. resident dermatologists’ ability to accurately identify skin pathology among SOC patients verus lighter skin to potentially identify gaps in training that may contribute to this disproportionate morbidity and mortality. Methods: A cross-sectional electronic REDCap survey open to all U.S. dermatology residents asked participants their basic demographics (e.g., level of training, racial and ethnic identity) and program characteristics (e.g., geographical location, proportion of patients by Fitzpatrick type, presence of a dedicated SOC clinic). This data was correlated with participant visual diagnostic accuracy on a 22-item multiple choice quiz (images selected by a senior academic dermatologist) of characteristic nonmalignant and malignant conditions in lighter skin and SOC. Results: Residents preferentially misdiagnosed malignant lesions in SOC over lighter skin (p <.0001) and preferentially misdiagnosed malignant lesions in SOC over nonmalignant lesions in SOC (p <.001). None of the residents’ basic demographic or program characteristic variables had significant relationships with any assessment of performance. Conclusion: Dermatologists should maintain a high clinical suspicion for malignant conditions in patients with darker skin types, given that these lesions are the most preferentially misdiagnosed and the fact that these lesions carry higher risks for morbidity and mortality. Dermatology residency programs should instill efforts to emphasize correct detection of malignant lesions amongst those with skin of color.
{"title":"Understanding the Factors Associated with US Dermatology Resident Trainees' Diagnostic Confidence and Skill for Skin of Color Pathology","authors":"A. Jeanfreau, K. Beiter, D. Hilton","doi":"10.25251/skin.7.4.3","DOIUrl":"https://doi.org/10.25251/skin.7.4.3","url":null,"abstract":"Background: Inequities in dermatologic health outcomes translate to worsened clinical outcomes for minority groups. For example, despite a lower incidence of skin cancer overall, African Americans are diagnosed at later stages with greater degrees of lymph node involvement. This has been shown to lead to disproportionate mortality when compared to lighter skinned individuals. Medical education materials contain a significantly lower percentage of skin of color (SOC) images than of lighter skin and research has indicated lower diagnostic accuracy of dermatologic conditions in darker skin by U.S. medical students. The objective of this study was to explore U.S. resident dermatologists’ ability to accurately identify skin pathology among SOC patients verus lighter skin to potentially identify gaps in training that may contribute to this disproportionate morbidity and mortality.\u0000Methods: A cross-sectional electronic REDCap survey open to all U.S. dermatology residents asked participants their basic demographics (e.g., level of training, racial and ethnic identity) and program characteristics (e.g., geographical location, proportion of patients by Fitzpatrick type, presence of a dedicated SOC clinic). This data was correlated with participant visual diagnostic accuracy on a 22-item multiple choice quiz (images selected by a senior academic dermatologist) of characteristic nonmalignant and malignant conditions in lighter skin and SOC.\u0000Results: Residents preferentially misdiagnosed malignant lesions in SOC over lighter skin (p <.0001) and preferentially misdiagnosed malignant lesions in SOC over nonmalignant lesions in SOC (p <.001). None of the residents’ basic demographic or program characteristic variables had significant relationships with any assessment of performance.\u0000Conclusion: Dermatologists should maintain a high clinical suspicion for malignant conditions in patients with darker skin types, given that these lesions are the most preferentially misdiagnosed and the fact that these lesions carry higher risks for morbidity and mortality. Dermatology residency programs should instill efforts to emphasize correct detection of malignant lesions amongst those with skin of color. ","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44491219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Vesiculobullous Erythema Migrans with Central Necrosis","authors":"Julian Stashower, A. Wills, B. Zlotoff","doi":"10.25251/skin.7.4.20","DOIUrl":"https://doi.org/10.25251/skin.7.4.20","url":null,"abstract":"N/A - not required for this submission type","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43417301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rekha Gurunatham Ponnurangam, S. Ramasamy, Sridhar Venu, Jayakalyani Vijayananth
Background: Acne vulgaris is a chronic inflammatory disease of pilosebaceous unit, which has a variable course, with acute or insidious onset, relapses and recurrences. It is one of the commonest disease of patients attending the dermatology clinic. Tetracyclines are the most common oral antibiotic prescribed for acne vulgaris. Aims: Our study aims to compare the efficacy of topical 2.5% Benzoyl peroxide gel (BPO) with oral Doxycycline versus topical 2.5% Benzoyl peroxide gel with oral Lymecycline in the treatment of acne vulgaris. Methods: The study included 100 patients with acne vulgaris divided into two groups of 50 each. Group A were treated with topical 2.5% Benzoyl peroxide gel once daily application at night and capsule Doxycycline 100mg twice a day and Group B were treated with topical 2.5% Benzoyl Peroxide gel once daily application at night and capsule Lymecycline 408 mg once a day for 12 weeks. The primary assessment was done using Indian Association of Acne (IAA) grading at baseline and then every fortnight till 12 weeks. Patients were followed up for another 12 weeks after completion of the study. Results: The gradewise distribution of acne based upon IAA grading among both the groups were compared. Chi square test and p value for all 3 grades of acne at baseline, 2week, 4 week, 6 week, 8 week, 10 week, 12 week showed statistical improvement among patients in group B at 2, 8 and 10 weeks with p value being 0.01,0.01 and 0.007 respectively. Conclusions: From our study it is evident that Lymecycline is superior to Doxycycline, with much statistical significance among moderate to severe acne.
{"title":"A Randomised Controlled Study of Topical Benzoyl Peroixde with Oral Doxycycline Versus Topical Benzoyl Peroxide with Oral Lymecycline in Acne Vulgaris","authors":"Rekha Gurunatham Ponnurangam, S. Ramasamy, Sridhar Venu, Jayakalyani Vijayananth","doi":"10.25251/skin.7.4.2","DOIUrl":"https://doi.org/10.25251/skin.7.4.2","url":null,"abstract":"Background: Acne vulgaris is a chronic inflammatory disease of pilosebaceous unit, which has a variable course, with acute or insidious onset, relapses and recurrences. It is one of the commonest disease of patients attending the dermatology clinic. Tetracyclines are the most common oral antibiotic prescribed for acne vulgaris.\u0000Aims: Our study aims to compare the efficacy of topical 2.5% Benzoyl peroxide gel (BPO) with oral Doxycycline versus topical 2.5% Benzoyl peroxide gel with oral Lymecycline in the treatment of acne vulgaris.\u0000Methods: The study included 100 patients with acne vulgaris divided into two groups of 50 each. Group A were treated with topical 2.5% Benzoyl peroxide gel once daily application at night and capsule Doxycycline 100mg twice a day and Group B were treated with topical 2.5% Benzoyl Peroxide gel once daily application at night and capsule Lymecycline 408 mg once a day for 12 weeks. The primary assessment was done using Indian Association of Acne (IAA) grading at baseline and then every fortnight till 12 weeks. Patients were followed up for another 12 weeks after completion of the study.\u0000Results: The gradewise distribution of acne based upon IAA grading among both the groups were compared. Chi square test and p value for all 3 grades of acne at baseline, 2week, 4 week, 6 week, 8 week, 10 week, 12 week showed statistical improvement among patients in group B at 2, 8 and 10 weeks with p value being 0.01,0.01 and 0.007 respectively.\u0000Conclusions: From our study it is evident that Lymecycline is superior to Doxycycline, with much statistical significance among moderate to severe acne.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43478405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"History in The Making: The Transformative Impact of TikTok on Dermatology","authors":"K. Sparling","doi":"10.25251/skin.7.4.25","DOIUrl":"https://doi.org/10.25251/skin.7.4.25","url":null,"abstract":"<jats:p>N/A</jats:p>","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42709343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Among HIV-positive patients, co-infection with syphilis is estimated to be as high as 20%. The diagnosis of syphilis is often missed due to its asymptomatic nature during its primary stages. A 68-year-old HIV-positive male presented with perianal lesions to his primary care physician twice. He was then referred to two different specialists before a proper physical exam was conducted after which he was diagnosed with otosyphilis and neurosyphilis. Physicians should have a higher index of clinical suspicion for syphilis in HIV-positive patients to allow for prompt diagnosis given the propensity of these patients to develop more severe neurological and ophthalmologic manifestations. This case highlights the importance of a thorough skin exam by a primary care physician when examining patients to allow for an earlier and accurate diagnosis and thus avoiding unnecessary referrals to specialists.
{"title":"Syphilis in HIV Positive Individuals and the Importance of a Skin Exam: A Case Report","authors":"Aditi Chokshi, Amaurys Diaz","doi":"10.25251/skin.7.4.14","DOIUrl":"https://doi.org/10.25251/skin.7.4.14","url":null,"abstract":"Among HIV-positive patients, co-infection with syphilis is estimated to be as high as 20%. The diagnosis of syphilis is often missed due to its asymptomatic nature during its primary stages. A 68-year-old HIV-positive male presented with perianal lesions to his primary care physician twice. He was then referred to two different specialists before a proper physical exam was conducted after which he was diagnosed with otosyphilis and neurosyphilis. Physicians should have a higher index of clinical suspicion for syphilis in HIV-positive patients to allow for prompt diagnosis given the propensity of these patients to develop more severe neurological and ophthalmologic manifestations. This case highlights the importance of a thorough skin exam by a primary care physician when examining patients to allow for an earlier and accurate diagnosis and thus avoiding unnecessary referrals to specialists.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41890453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：