Pub Date : 2023-07-17DOI: 10.25251/skin.7.supp.227
Z. Draelos, E. Tanghetti, L. Stein Gold, L. Kircik, N. Bhatia, J. Zeichner, Jeffrey Sugarman
Introduction: IDP-126 polymeric mesh gel (clindamycin phosphate 1.2%/benzoyl peroxide [BPO] 3.1%/adapalene 0.15%) is the first triple-combination, fixed-dose topical acne product in development and it addresses major acne pathophysiological processes. IDP-126 demonstrated superior efficacy to vehicle and component dyads, with good safety/tolerability in a phase 2 study of participants with moderate-to-severe acne. The objectives of this study were to assess dermal irritation/sensitization and safety of IDP-126 gel in two phase 1 studies and to compare irritancy of IDP-126 gel and commercially available BPO 2.5%/adapalene 0.3% gel in one phase 1 study of healthy participants. Methods: Two phase 1, randomized, evaluator-blinded, within-participant, dermal safety studies enrolled healthy participants aged ≥18 years (N=234, repeat insult patch test [RIPT]; N=45, cumulative irritation patch test [CIPT]). Patches were applied to the upper back multiple times over 6-8 weeks (RIPT) or every 24 hours for 21 days (CIPT). Patches contained: IDP-126 gel, vehicle gel, saline 0.9% (RIPT/CIPT), sodium lauryl sulfate (SLS) 0.5% (CIPT), or branded BPO 2.5%/adapalene 0.3% gel (CIPT). Participants in each study received all treatments. Endpoints comprised sensitization potential (RIPT), mean cumulative/total irritation scores, and treatment-emergent adverse events (TEAEs). Results: Overall, irritation with IDP-126 was moderate and not clinically significant. CIPT: IDP-126 was “moderately irritating” (mean score: 1.29), which was significantly less irritating than BPO/adapalene (1.96; P<0.001), statistically similar to SLS (1.17), and more irritating than saline or vehicle (~0.30; P<0.001). RIPT: no participants had investigator-confirmed sensitization to any treatments. In both studies, no TEAEs were related to treatment. Conclusions: In two phase 1 studies, fixed-dose, triple-combination clindamycin phosphate 1.2%/ BPO 3.1%/adapalene 0.15% polymeric mesh gel had moderate irritancy and no confirmed sensitization in healthy participants. Additionally, IDP-126 demonstrated significantly less irritation versus commercially available, branded BPO 2.5%/adapalene 0.3% gel. IDP-126 demonstrated good safety/tolerability, mirroring the phase 2 study results. Funding: Ortho Dermatologics
{"title":"Dermal Irritation, Sensitization, and Safety of Fixed-Dose Triple-Combination Clindamycin Phosphate 1.2%/Benzoyl Peroxide 3.1%/Adapalene 0.15% Gel in Healthy Participants","authors":"Z. Draelos, E. Tanghetti, L. Stein Gold, L. Kircik, N. Bhatia, J. Zeichner, Jeffrey Sugarman","doi":"10.25251/skin.7.supp.227","DOIUrl":"https://doi.org/10.25251/skin.7.supp.227","url":null,"abstract":"Introduction: IDP-126 polymeric mesh gel (clindamycin phosphate 1.2%/benzoyl peroxide [BPO] 3.1%/adapalene 0.15%) is the first triple-combination, fixed-dose topical acne product in development and it addresses major acne pathophysiological processes. IDP-126 demonstrated superior efficacy to vehicle and component dyads, with good safety/tolerability in a phase 2 study of participants with moderate-to-severe acne. The objectives of this study were to assess dermal irritation/sensitization and safety of IDP-126 gel in two phase 1 studies and to compare irritancy of IDP-126 gel and commercially available BPO 2.5%/adapalene 0.3% gel in one phase 1 study of healthy participants. \u0000Methods: Two phase 1, randomized, evaluator-blinded, within-participant, dermal safety studies enrolled healthy participants aged ≥18 years (N=234, repeat insult patch test [RIPT]; N=45, cumulative irritation patch test [CIPT]). Patches were applied to the upper back multiple times over 6-8 weeks (RIPT) or every 24 hours for 21 days (CIPT). Patches contained: IDP-126 gel, vehicle gel, saline 0.9% (RIPT/CIPT), sodium lauryl sulfate (SLS) 0.5% (CIPT), or branded BPO 2.5%/adapalene 0.3% gel (CIPT). Participants in each study received all treatments. Endpoints comprised sensitization potential (RIPT), mean cumulative/total irritation scores, and treatment-emergent adverse events (TEAEs). \u0000Results: Overall, irritation with IDP-126 was moderate and not clinically significant. CIPT: IDP-126 was “moderately irritating” (mean score: 1.29), which was significantly less irritating than BPO/adapalene (1.96; P<0.001), statistically similar to SLS (1.17), and more irritating than saline or vehicle (~0.30; P<0.001). RIPT: no participants had investigator-confirmed sensitization to any treatments. In both studies, no TEAEs were related to treatment. \u0000Conclusions: In two phase 1 studies, fixed-dose, triple-combination clindamycin phosphate 1.2%/ BPO 3.1%/adapalene 0.15% polymeric mesh gel had moderate irritancy and no confirmed sensitization in healthy participants. Additionally, IDP-126 demonstrated significantly less irritation versus commercially available, branded BPO 2.5%/adapalene 0.3% gel. IDP-126 demonstrated good safety/tolerability, mirroring the phase 2 study results. \u0000 \u0000Funding: Ortho Dermatologics","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":"46852793","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}
Here we report a case of dermatofibrosarcoma protuberans (DFSP) that presented originally to the emergency department with chief complaint of ‘chest pain arising from a chest wall mass’. This case is unique for multiple reasons including the fact that the DFSP caused this patient severe pain that radiated from the site of the mass to the patient’s back. The lesion originated from a traumatic scar that the patient had obtained following a car accident two years prior to presentation. In addition, the DFSP was significantly larger in size than what has typically been reported in the literature. This case illustrates that DFSP has the potential to present with multiple atypical features.
{"title":"A Case of a Large, Painful Dermatofibrosarcoma Protuberans Arising from a Traumatic Scar","authors":"D. Fischer, Graham H Litchman","doi":"10.25251/skin.7.3.16","DOIUrl":"https://doi.org/10.25251/skin.7.3.16","url":null,"abstract":"Here we report a case of dermatofibrosarcoma protuberans (DFSP) that presented originally to the emergency department with chief complaint of ‘chest pain arising from a chest wall mass’. This case is unique for multiple reasons including the fact that the DFSP caused this patient severe pain that radiated from the site of the mass to the patient’s back. The lesion originated from a traumatic scar that the patient had obtained following a car accident two years prior to presentation. In addition, the DFSP was significantly larger in size than what has typically been reported in the literature. This case illustrates that DFSP has the potential to present with multiple atypical features.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43789049","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 : 2023-05-20DOI: 10.25251/skin.7.supp.208
E. Graber, H. Baldwin, A. Alexis, J. D. Del Rosso, R. Fried, J. Harper, Adelaide Hebert, L. Kircik, E. Rieder, L. Stein Gold, Siva Narayanan, V. Koscielny, I. Kasujee
Objective: Evaluate patient self-perceived AV symptoms and impact of AV on emotional/social functioning and ADL, among AV patients in community practices across the U.S. Methods: Single-arm, prospective cohort study (PROSES: NCT04820673) was conducted with moderate-to-severe non-nodular AV patients >9yrs who were prescribed sarecycline in real-world U.S community practices. Validated ASIS questionnaire (with Signs and Impact (emotional & social) domains) and an Expert Panel Questionnaire (EPQ; emotional functioning (items 1-4), social functioning (items 5-7), and ADL (items 8-11)) were completed by patients (>12yrs) and caregivers (for patients 9-11yrs) at baseline and week-12. All items were scored on five-point adjectival response scale (score: 0 (never/not at all) – 4 (all the time/very much/extremely)); a higher ASIS domain score indicate severe symptoms or negative impact of AV. ASIS domain scores and proportion of patients reporting score=2/3/4 (moderate to high burden/impact or parent understanding (EPQ10)) for EPQ items at baseline were analyzed. Results: A total of 253 AV patients completed the study (pediatric: 39.92%; female: 66.40%; moderate AV: 86.56%; severe AV: 13.44%). At baseline, patients reported moderate AV burden in most domains, as depicted by the following domain score: signs: 1.96, impact: 2.06, emotional impact subdomain: 2.43; social impact subdomain: 0.98. From EPQ items, proportion of patients reporting score=2/3/4 (moderate to severe burden) at baseline were: patients’ mood/anger (EPQ1) – 56.13%; worries about AV worsening (EPQ2) – 79.45%; thinking about acne (EPQ3) – 84.19%; level of acne worries (EPQ4) – 72.73; patients’ social media/’selfie’ activity (EPQ5) – 51.38%; impact on real-life plans (EPQ6) – 44.66%; efforts to hide AV (EPQ7) – 72.73%; picked-on/judged due to AV (EPQ8) – 26.88%; ability to reach future goals (EPQ9) – 27.27%; sleep impact (EPQ11) – 27.67%; parent understanding of AV concerns (for patients<18yrs; EPQ10) – 84.16%. Conclusion: Moderate to severe AV burden/impact was observed in this prospective cohort of AV patients in the U.S. Emotional impact and social impact of AV were especially more pronounced among the AV population.
{"title":"Acne symptoms and impact of acne on social functioning, emotional functioning, and activities of daily living (ADL) among patients with moderate to severe non-nodular Acne Vulgaris (AV) in community practices across the U.S","authors":"E. Graber, H. Baldwin, A. Alexis, J. D. Del Rosso, R. Fried, J. Harper, Adelaide Hebert, L. Kircik, E. Rieder, L. Stein Gold, Siva Narayanan, V. Koscielny, I. Kasujee","doi":"10.25251/skin.7.supp.208","DOIUrl":"https://doi.org/10.25251/skin.7.supp.208","url":null,"abstract":"Objective: Evaluate patient self-perceived AV symptoms and impact of AV on emotional/social functioning and ADL, among AV patients in community practices across the U.S. Methods: Single-arm, prospective cohort study (PROSES: NCT04820673) was conducted with moderate-to-severe non-nodular AV patients >9yrs who were prescribed sarecycline in real-world U.S community practices. Validated ASIS questionnaire (with Signs and Impact (emotional & social) domains) and an Expert Panel Questionnaire (EPQ; emotional functioning (items 1-4), social functioning (items 5-7), and ADL (items 8-11)) were completed by patients (>12yrs) and caregivers (for patients 9-11yrs) at baseline and week-12. All items were scored on five-point adjectival response scale (score: 0 (never/not at all) – 4 (all the time/very much/extremely)); a higher ASIS domain score indicate severe symptoms or negative impact of AV. ASIS domain scores and proportion of patients reporting score=2/3/4 (moderate to high burden/impact or parent understanding (EPQ10)) for EPQ items at baseline were analyzed. Results: A total of 253 AV patients completed the study (pediatric: 39.92%; female: 66.40%; moderate AV: 86.56%; severe AV: 13.44%). At baseline, patients reported moderate AV burden in most domains, as depicted by the following domain score: signs: 1.96, impact: 2.06, emotional impact subdomain: 2.43; social impact subdomain: 0.98. From EPQ items, proportion of patients reporting score=2/3/4 (moderate to severe burden) at baseline were: patients’ mood/anger (EPQ1) – 56.13%; worries about AV worsening (EPQ2) – 79.45%; thinking about acne (EPQ3) – 84.19%; level of acne worries (EPQ4) – 72.73; patients’ social media/’selfie’ activity (EPQ5) – 51.38%; impact on real-life plans (EPQ6) – 44.66%; efforts to hide AV (EPQ7) – 72.73%; picked-on/judged due to AV (EPQ8) – 26.88%; ability to reach future goals (EPQ9) – 27.27%; sleep impact (EPQ11) – 27.67%; parent understanding of AV concerns (for patients<18yrs; EPQ10) – 84.16%. Conclusion: Moderate to severe AV burden/impact was observed in this prospective cohort of AV patients in the U.S. Emotional impact and social impact of AV were especially more pronounced among the AV population.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41496159","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 : 2023-05-20DOI: 10.25251/skin.7.supp.214
J. Plaza, Sarah I. Estrada, B. Russell, J. Siegel, Jason Rogers, J. Wilkinson, S. Kurley, M. Goldberg, K. Motaparthi
Background: Histopathological examination is adequate for most melanocytic neoplasms; however, there is a subset of lesions that are difficult to diagnose. The 23- and 35-gene expression profile (GEP) tests deliver results of suggestive of benign neoplasm, suggestive of malignant neoplasm, or intermediate (cannot exclude malignancy). They are intended to provide clinicians with objective results to be interpreted in the context of clinical, laboratory, and histopathological features to achieve a definitive diagnosis. Both GEPs are stand-alone tests that are independently validated and clinically available. Greater than 99% benign or malignant reporting is achieved clinically when the 23-GEP test is processed first, and if an intermediate result or test failure occurs, the 35-GEP is utilized. Methods: The performance of the 23- and 35-GEP tests using this methodology was tested on unequivocal cases from a variety of subtypes (101 benign, 249 malignant). Lesions were included if 2/3 dermatopathologist diagnoses were concordant. Subtype designation was determined by the dermatopathologist that submitted the lesion for the study. Results: The overall accuracy metrics in this cohort were 96.0% sensitivity and 87.8% specificity. The results demonstrated 100% sensitivity in several melanoma subtypes including acral lentiginous (n=15), desmoplastic (n=20), melanoma in situ (n=16), and nevoid (n=16). Other melanoma subtypes showed sensitivity metrics of: lentigo maligna, 96.7% (n=31); nodular, 95.1% (n=81); superficial spreading, 97.7% (n=42); and spitzoid, 85.0% (n=20). Subtypes of benign nevi showed a specificity of: blue, 96.7% (n=30); compound, 85.7% (n=42); junctional, 77.8% (n=18); and Spitz, 100% (n=7). Conclusions: Overall, we demonstrate that use of the 23- and 35-GEP diagnostic test workflow results in high accuracy across many subtypes of benign and malignant melanocytic neoplasms. Financial Disclosures: JAP has served as a consultant for Castle Biosciences, Inc. SIE is a consultant and shareholder of Castle Biosciences, Inc. BHR, JJS, JHR, JKW, SJK, and MSG are employee shareholders of Castle Biosciences, Inc. KM has served as a consultant and investigator for studies supported by Castle Biosciences, Inc. This study was supported by Castle Biosciences, Inc.
{"title":"Subtype performance of the ancillary diagnostic 23- and 35-gene expression profile (GEP) tests for difficult-to-diagnose melanocytic lesions","authors":"J. Plaza, Sarah I. Estrada, B. Russell, J. Siegel, Jason Rogers, J. Wilkinson, S. Kurley, M. Goldberg, K. Motaparthi","doi":"10.25251/skin.7.supp.214","DOIUrl":"https://doi.org/10.25251/skin.7.supp.214","url":null,"abstract":"Background: Histopathological examination is adequate for most melanocytic neoplasms; however, there is a subset of lesions that are difficult to diagnose. The 23- and 35-gene expression profile (GEP) tests deliver results of suggestive of benign neoplasm, suggestive of malignant neoplasm, or intermediate (cannot exclude malignancy). They are intended to provide clinicians with objective results to be interpreted in the context of clinical, laboratory, and histopathological features to achieve a definitive diagnosis. Both GEPs are stand-alone tests that are independently validated and clinically available. Greater than 99% benign or malignant reporting is achieved clinically when the 23-GEP test is processed first, and if an intermediate result or test failure occurs, the 35-GEP is utilized. \u0000Methods: The performance of the 23- and 35-GEP tests using this methodology was tested on unequivocal cases from a variety of subtypes (101 benign, 249 malignant). Lesions were included if 2/3 dermatopathologist diagnoses were concordant. Subtype designation was determined by the dermatopathologist that submitted the lesion for the study. \u0000Results: The overall accuracy metrics in this cohort were 96.0% sensitivity and 87.8% specificity. The results demonstrated 100% sensitivity in several melanoma subtypes including acral lentiginous (n=15), desmoplastic (n=20), melanoma in situ (n=16), and nevoid (n=16). Other melanoma subtypes showed sensitivity metrics of: lentigo maligna, 96.7% (n=31); nodular, 95.1% (n=81); superficial spreading, 97.7% (n=42); and spitzoid, 85.0% (n=20). Subtypes of benign nevi showed a specificity of: blue, 96.7% (n=30); compound, 85.7% (n=42); junctional, 77.8% (n=18); and Spitz, 100% (n=7). \u0000Conclusions: Overall, we demonstrate that use of the 23- and 35-GEP diagnostic test workflow results in high accuracy across many subtypes of benign and malignant melanocytic neoplasms. \u0000Financial Disclosures: JAP has served as a consultant for Castle Biosciences, Inc. SIE is a consultant and shareholder of Castle Biosciences, Inc. BHR, JJS, JHR, JKW, SJK, and MSG are employee shareholders of Castle Biosciences, Inc. KM has served as a consultant and investigator for studies supported by Castle Biosciences, Inc. This study was supported by Castle Biosciences, Inc.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43446754","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}
A previously healthy woman in her 40s presented to the dermatology clinic with a 1-year history of a tender, draining, enlarging mass on the left buttock. Physical examination revealed an extensively indurated hyperpigmented nodule with numerous overlying clustered exophytic verrucous papules on the L medial buttock (see figure 1). Initial skin biopsy of verrucous lesions was notable for lymphangioma with overlying condyloma, D2-40 positive. MRI abdomen and pelvis with contrast demonstrated a left gluteal enhancing subcutaneous soft tissue mass, 10.3 x 8.2 x 8.8 cm in size, overlying and involving the left gluteus maximus, along with satellite nodules present in the medial gluteus maximus and paraspinal muscles, with bilateral pelvic and inguinal adenopathy. Excisional deep tissue biopsy revealed a diagnosis of a high-grade, multifocal spindle and undifferentiated pleomorphic sarcoma. The patient subsequently underwent 4 cycles of neoadjuvant chemotherapy AIM (doxorubicin, iphosphamide, MESNA), followed by radical resection of the left gluteal region, with positive margins, followed by repeat surgical resection and reconstruction with left-sided latissimus dorsi myocutaneous free flap. The patient has now completed radiation therapy. Soft tissue sarcoma is a heterogeneous group of rare malignancies of mesenchymal origin, that represents 0.8% of all adult cancers. Prognostic factors associated with poor outcome include high histologic grade, large tumor size, presence of metastases, and unresectability1. Herein, we report a novel case of high-grade soft-tissue undifferentiated pleomorphic sarcoma, masquerading as acquired lymphangioma circumscriptum (ALC), as noted on initial skin biopsy of grouped flesh-colored verrucous papules overlying an indurated tender mass. ALC is a lymphatic malformation occurring as sequela to any process which interrupts previously normal lymphatic drainage. As such, subcutaneous lymphatic cisterns are unable to drain completely into the general lymphatic system, resulting in lymphatic dilation and subsequent development of vesicular and papular lesions on the trunk, extremities, and anogenital areas.2 ALC can mimic common infectious growths including molluscum contagiosum and condyloma accuminata, and accordingly be mismanaged. Etiologic causes of ALC including malignancy, and has previously been reported in the setting of cervical carcinoma, vulvar carcinoma, endometrial carcinoma, Hodgkin lymphoma, rhabdomyosarcoma, rectal carcinoma, melanoma, and high-grade penile dysplasia2,3,4. Other etiologic causes can include surgery, trauma, radiation therapy, chronic inflammatory conditions including hidradenitis suppurativa, and inflammatory bowel disease. To date, acquired lymphangioma circumscriptum has not been reported in the setting of underlying high-grade pleomorphic soft tissue sarcoma. As such, clinical presence of grouped frogspawn-like or verrucous papules, in an area of tender induration or lymphedema, should
一位40多岁的健康女性在皮肤科诊所就诊，她有一年的左臀压痛、引流、增大肿块的病史。体格检查显示，L内侧臀部有一个广泛硬结的色素沉着结节，上面有许多成簇的外生疣状丘疹（见图1）。疣状病变的初次皮肤活检以淋巴管瘤伴尖锐湿疣为显著，D2-40阳性。MRI腹部和骨盆对比显示，左侧臀大肌增强皮下软组织肿块，大小为10.3 x 8.2 x 8.8 cm，覆盖并累及左侧臀大肌肉，臀大肌内侧和棘旁肌存在卫星结节，伴有双侧骨盆和腹股沟腺病。切除深层组织活检显示诊断为高级别、多灶梭形和未分化多形性肉瘤。患者随后接受了4个周期的新辅助化疗AIM（阿霉素、异丙酰胺、MESNA），然后对左侧臀肌区域进行根治性切除，切缘为正，然后重复手术切除并用左侧背阔肌肌皮瓣重建。病人现在已经完成了放射治疗。软组织肉瘤是一组罕见的间充质恶性肿瘤，占所有成人癌症的0.8%。与不良预后相关的预后因素包括组织学分级高、肿瘤大小大、存在转移和不可切除1。在此，我们报告了一例新的高级软组织未分化多形性肉瘤，伪装为获得性局限性淋巴管瘤（ALC），如在硬结性压痛块上的肉色疣状丘疹的初次皮肤活检中所述。ALC是一种淋巴畸形，是任何中断先前正常淋巴引流的过程的后遗症。因此，皮下淋巴池无法完全排入一般淋巴系统，导致淋巴扩张，随后在躯干、四肢和肛门生殖器区域形成水泡和丘疹病变。2 ALC可以模仿常见的感染性生长，包括传染性软体动物和尖锐湿疣，因此管理不当。ALC的病因包括恶性肿瘤，以前曾报道过宫颈癌、外阴癌、子宫内膜癌、霍奇金淋巴瘤、横纹肌肉瘤、直肠癌、黑色素瘤和高级别阴茎发育不良2，3，4。其他病因可能包括手术、创伤、放射治疗、慢性炎症性疾病（包括化脓性汗炎）和炎症性肠病。到目前为止，获得性局限性淋巴管瘤在潜在的高度多形性软组织肉瘤中还没有报道。因此，在压痛硬结或淋巴水肿区域，临床上出现成群的蛙状或疣状丘疹，应促使进行检查，以排除潜在的恶性病因，因为新发的ALC可能掩盖了潜在的恶性。
{"title":"High-grade Undifferentiated Pleomorphic Sarcoma Presenting as Acquired Lymphangioma Circumscriptum","authors":"P. Rambhia, S. D’Angelo, P. Shah","doi":"10.25251/skin.7.3.20","DOIUrl":"https://doi.org/10.25251/skin.7.3.20","url":null,"abstract":"A previously healthy woman in her 40s presented to the dermatology clinic with a 1-year history of a tender, draining, enlarging mass on the left buttock. Physical examination revealed an extensively indurated hyperpigmented nodule with numerous overlying clustered exophytic verrucous papules on the L medial buttock (see figure 1). Initial skin biopsy of verrucous lesions was notable for lymphangioma with overlying condyloma, D2-40 positive. MRI abdomen and pelvis with contrast demonstrated a left gluteal enhancing subcutaneous soft tissue mass, 10.3 x 8.2 x 8.8 cm in size, overlying and involving the left gluteus maximus, along with satellite nodules present in the medial gluteus maximus and paraspinal muscles, with bilateral pelvic and inguinal adenopathy. Excisional deep tissue biopsy revealed a diagnosis of a high-grade, multifocal spindle and undifferentiated pleomorphic sarcoma. The patient subsequently underwent 4 cycles of neoadjuvant chemotherapy AIM (doxorubicin, iphosphamide, MESNA), followed by radical resection of the left gluteal region, with positive margins, followed by repeat surgical resection and reconstruction with left-sided latissimus dorsi myocutaneous free flap. The patient has now completed radiation therapy. \u0000Soft tissue sarcoma is a heterogeneous group of rare malignancies of mesenchymal origin, that represents 0.8% of all adult cancers. Prognostic factors associated with poor outcome include high histologic grade, large tumor size, presence of metastases, and unresectability1. Herein, we report a novel case of high-grade soft-tissue undifferentiated pleomorphic sarcoma, masquerading as acquired lymphangioma circumscriptum (ALC), as noted on initial skin biopsy of grouped flesh-colored verrucous papules overlying an indurated tender mass. ALC is a lymphatic malformation occurring as sequela to any process which interrupts previously normal lymphatic drainage. As such, subcutaneous lymphatic cisterns are unable to drain completely into the general lymphatic system, resulting in lymphatic dilation and subsequent development of vesicular and papular lesions on the trunk, extremities, and anogenital areas.2 ALC can mimic common infectious growths including molluscum contagiosum and condyloma accuminata, and accordingly be mismanaged. Etiologic causes of ALC including malignancy, and has previously been reported in the setting of cervical carcinoma, vulvar carcinoma, endometrial carcinoma, Hodgkin lymphoma, rhabdomyosarcoma, rectal carcinoma, melanoma, and high-grade penile dysplasia2,3,4. Other etiologic causes can include surgery, trauma, radiation therapy, chronic inflammatory conditions including hidradenitis suppurativa, and inflammatory bowel disease. \u0000 To date, acquired lymphangioma circumscriptum has not been reported in the setting of underlying high-grade pleomorphic soft tissue sarcoma. As such, clinical presence of grouped frogspawn-like or verrucous papules, in an area of tender induration or lymphedema, should ","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45151527","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}
This case report highlights the successful treatment of refractory atopic dermatitis (AD) in an immunosuppressed patient using dupilumab, a biologic agent that selectively targets cytokines crucial in the pathogenesis of AD. The patient had a history of failed treatment with numerous topical and systemic immunomodulating agents, including corticosteroids and immunosuppressive drugs for organ transplant. Dupilumab treatment resulted in significant improvement of symptoms, including reduced pruritus, and ultimately achieved disease control. Importantly, the patient experienced no adverse effects apart from one COVID-19 infection over three years of co-administration of dupilumab with immunosuppressive transplant rejection treatment. The safety of dupilumab in immunocompromised and transplant patients has been a concern, but studies have shown its safety and efficacy in these patient populations. This case highlights the potential for dupilumab as a safe and effective treatment option for patients with severe AD who are immunocompromised or have undergone solid organ transplantation.
{"title":"Treatment of Severe Recalcitrant Atopic Dermatitis with Dupilumab in a Kidney Transplant Patient","authors":"Vivian Li, Sophie Guenin, M. Lebwohl","doi":"10.25251/skin.7.3.10","DOIUrl":"https://doi.org/10.25251/skin.7.3.10","url":null,"abstract":"This case report highlights the successful treatment of refractory atopic dermatitis (AD) in an immunosuppressed patient using dupilumab, a biologic agent that selectively targets cytokines crucial in the pathogenesis of AD. The patient had a history of failed treatment with numerous topical and systemic immunomodulating agents, including corticosteroids and immunosuppressive drugs for organ transplant. Dupilumab treatment resulted in significant improvement of symptoms, including reduced pruritus, and ultimately achieved disease control. Importantly, the patient experienced no adverse effects apart from one COVID-19 infection over three years of co-administration of dupilumab with immunosuppressive transplant rejection treatment. The safety of dupilumab in immunocompromised and transplant patients has been a concern, but studies have shown its safety and efficacy in these patient populations. This case highlights the potential for dupilumab as a safe and effective treatment option for patients with severe AD who are immunocompromised or have undergone solid organ transplantation. \u0000 ","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46221145","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}
Alan G. Mulholland, Brandon Tang, S. Shumak, Linda Zhou
Disseminated varicella-zoster virus (VZV) infection has devastating impacts on patients’ quality of life, with increasing morbidity and mortality. Thus, it is imperative that a diagnosis be made early. This case description illustrates a unique and dramatic presentation of disseminated VZV infection with important clinical implications.
{"title":"Disseminated Varicella-zoster Virus Infection in an Immunocompetent Host","authors":"Alan G. Mulholland, Brandon Tang, S. Shumak, Linda Zhou","doi":"10.25251/skin.7.3.19","DOIUrl":"https://doi.org/10.25251/skin.7.3.19","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000Disseminated varicella-zoster virus (VZV) infection has devastating impacts on patients’ quality of life, with increasing morbidity and mortality. Thus, it is imperative that a diagnosis be made early. This case description illustrates a unique and dramatic presentation of disseminated VZV infection with important clinical implications. \u0000 \u0000 \u0000 \u0000","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46110110","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 : 2023-05-20DOI: 10.25251/skin.7.supp.204
L. Stein Gold, A. Pinter, M. Augustin
{"title":"Efficacy and Safety of Calcipotriene/Betamethasone Dipropionate Cream for the Treatment of Plaque Psoriasis Evaluated from Pooled Phase 3 Data","authors":"L. Stein Gold, A. Pinter, M. Augustin","doi":"10.25251/skin.7.supp.204","DOIUrl":"https://doi.org/10.25251/skin.7.supp.204","url":null,"abstract":"","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42212448","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}
D. Zakria, A. Armstrong, B. Berman, J. D. Del Rosso, M. Lebwohl, T. Schlesinger, D. Rigel
Background: Actinic keratosis (AK) is one of the most common dermatologic diagnoses. While there are several treatment options, many topical therapies have poor adherence due to duration of treatment and local skin reactions (LSRs). Objective: To review the available literature on the most commonly used patient-administered field-directed therapies for AK and create consensus statements on the role of medication adherence in improving AK outcomes. Methods: A literature search of PubMed was completed for English-language original research articles reporting efficacy, safety, and tolerability data for 5-FU, diclofenac gel, imiquimod cream, and tirbanibulin. Once the articles were selected, they were distributed to a panel consisting of seven dermatologists with extensive expertise in managing AKs. Each panelist reviewed the articles and assigned them a level of evidence based on Strength of Recommendation Taxonomy (SORT) criteria. The panelists then met to review and discuss the studies and created consensus statements on the management of AKs and the importance of medication compliance. A modified Delphi process was used to approve the adoption of each statement. Results: The literature search produced 1,326 articles that met search criteria. After screening these articles for relevance and applying the inclusion criteria, 17 articles were chosen to be reviewed by the panel and assigned a level of evidence based on SORT criteria. The panel then created six consensus statements that received a unanimous vote for adoption. Conclusion: While there are several options for the treatment of AK, there is little consensus on a standard of care. Clearance rates for the most common topical field therapies vary significantly but are also difficult to directly compare due to differences in methodology for measuring and assessing outcomes. Overall, it is clear that an efficacious, tolerable, and convenient treatment for AKs is critical to optimal adherence and management and, given the results of recent studies, tirbanibulin may be the best topical option for meeting these criteria.
{"title":"The Importance of Medication Adherence in the Treatment of Actinic Keratosis: An Expert Consensus Panel","authors":"D. Zakria, A. Armstrong, B. Berman, J. D. Del Rosso, M. Lebwohl, T. Schlesinger, D. Rigel","doi":"10.25251/skin.7.3.1","DOIUrl":"https://doi.org/10.25251/skin.7.3.1","url":null,"abstract":"Background: Actinic keratosis (AK) is one of the most common dermatologic diagnoses. While there are several treatment options, many topical therapies have poor adherence due to duration of treatment and local skin reactions (LSRs). \u0000Objective: To review the available literature on the most commonly used patient-administered field-directed therapies for AK and create consensus statements on the role of medication adherence in improving AK outcomes. \u0000Methods: A literature search of PubMed was completed for English-language original research articles reporting efficacy, safety, and tolerability data for 5-FU, diclofenac gel, imiquimod cream, and tirbanibulin. Once the articles were selected, they were distributed to a panel consisting of seven dermatologists with extensive expertise in managing AKs. Each panelist reviewed the articles and assigned them a level of evidence based on Strength of Recommendation Taxonomy (SORT) criteria. The panelists then met to review and discuss the studies and created consensus statements on the management of AKs and the importance of medication compliance. A modified Delphi process was used to approve the adoption of each statement. \u0000Results: The literature search produced 1,326 articles that met search criteria. After screening these articles for relevance and applying the inclusion criteria, 17 articles were chosen to be reviewed by the panel and assigned a level of evidence based on SORT criteria. The panel then created six consensus statements that received a unanimous vote for adoption. \u0000Conclusion: While there are several options for the treatment of AK, there is little consensus on a standard of care. Clearance rates for the most common topical field therapies vary significantly but are also difficult to directly compare due to differences in methodology for measuring and assessing outcomes. Overall, it is clear that an efficacious, tolerable, and convenient treatment for AKs is critical to optimal adherence and management and, given the results of recent studies, tirbanibulin may be the best topical option for meeting these criteria.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47135119","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}
Natalie Garcia, Charlotte Mcrae, Abigail O. Smith, L. Graham
Leukemia Cutis (LC) is a rare extramedullary cutaneous manifestation of leukemia that varies in terms of clinical presentation, leukemia type, and timing of presentation in relation to systemic leukemia. LC typically presents following diagnosis of systemic leukemia and during an active flare or relapse. An estimated 3.7% of patients with Acute Myeloid Leukemia (AML) develop LC. A 61-year-old male with poorly controlled HIV presented with a rash that began one month prior on his cheek as a red papule, which he believed was an ingrown hair. On exam, pink and yellow firm papules and nodules covered his entire body surface except the groin and axilla. One nodule held a peau d’orange appearance. The rash was overall asymptomatic, and he reported only increased fatigue. His CD4 count and viral load were 136 and 330,000 respectively. One punch biopsy revealed negative cultures for fungus, bacteria, and acid-fast bacilli. Two biopsies sent for pathologic evaluation revealed AML of the skin. Bone marrow biopsy confirmed AML. Clinically the presentation of LC is nonspecific, and systemic symptoms rarely appear in conjunction with LC. High clinical suspicion and histopathologic examination are necessary for diagnosis of LC.
{"title":"Leukemia Cutis as the Presenting Sign of Acute Myeloid Leukemia in an HIV+ patient","authors":"Natalie Garcia, Charlotte Mcrae, Abigail O. Smith, L. Graham","doi":"10.25251/skin.7.3.11","DOIUrl":"https://doi.org/10.25251/skin.7.3.11","url":null,"abstract":"Leukemia Cutis (LC) is a rare extramedullary cutaneous manifestation of leukemia that varies in terms of clinical presentation, leukemia type, and timing of presentation in relation to systemic leukemia. LC typically presents following diagnosis of systemic leukemia and during an active flare or relapse. An estimated 3.7% of patients with Acute Myeloid Leukemia (AML) develop LC. A 61-year-old male with poorly controlled HIV presented with a rash that began one month prior on his cheek as a red papule, which he believed was an ingrown hair. On exam, pink and yellow firm papules and nodules covered his entire body surface except the groin and axilla. One nodule held a peau d’orange appearance. The rash was overall asymptomatic, and he reported only increased fatigue. His CD4 count and viral load were 136 and 330,000 respectively. One punch biopsy revealed negative cultures for fungus, bacteria, and acid-fast bacilli. Two biopsies sent for pathologic evaluation revealed AML of the skin. Bone marrow biopsy confirmed AML. Clinically the presentation of LC is nonspecific, and systemic symptoms rarely appear in conjunction with LC. High clinical suspicion and histopathologic examination are necessary for diagnosis of LC.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42259324","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}
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