A 53-year-old woman presented with an eruption on her face and body for 2 weeks that had developed first on the face before spreading to the trunk and extremities. There was burning with sunlight exposure. Her medical conditions included diabetes mellitus, vitamin D deficiency, and hyperlipidemia. Her treatment for the past 4 years included metformin, saxagliptin, atorvastatin, vitamin B12, vitamin D, lansoprazole, and aspirin. Because atorvastatin did not control her lipids, fenofibrate was prescribed. At 3 months, she developed photodermatitis on the sun-exposed areas of her skin and also on sun-covered areas of the chest and back. Examination showed facial erythematous scaly plaques and multiple scaly annular erythematous plaques on her trunk and extremities (Figure 1). Methylprednisolone aceponate ointment, pimecrolimus ointment 0.1%, and sunblock were prescribed. Her facial eruption was only minimally lessened, while the dermatitis worsened on the trunk, arms, and legs.
A 64-year-old man participated in a 13.1-mile half marathon in San Diego, CA on April 23, 2023. The ambient temperature when he started the race was 54°F, which increased to 64°F on his completing the race 3 hours and 58 minutes later. Both of his hands and their digits started swelling after the first hour of running. They progressively became larger during the remainder of the race; a positive fist sign developed and the patient could not close his hands into a fist (Figure 1). Neither pruritus, swelling at any other site, nor angioedema was reported.
The 73-year-old non-Hispanic, African-American man with a history of renal cell carcinoma (RCC), status post-nephrectomy receiving Lenvatinib, and metastatic disease, for which he also had received nivolumab for 13½ months. An itchy eruption appeared one month after the discontinuation of nivolumab and after the beginning of axitinib therapy. Physical examination revealed pink-violaceous scaly plaques, some with trailing scales on the anterior aspect of the trunk (Figure 1), a slight erosion on the hard palate, and hypopigmentation on the hands and legs. A punch biopsy revealed spongiotic and interface dermatitis, suggesting a drug eruption. The patient was treated with triamcinolone 0.1% ointment and prednisone 60 mg, with resolution of the eruption. Because the treating oncologist was concerned that the dermatitis was caused by axitinib, the patient was switched to tivozanib; however, the patient developed a new bullous eruption two months after starting tivozanib. Physical examination revealed small papules on the hands, pink patches on the trunk, and small round crusts and tense lesions on the arms (Figure 1).
ZelsuvmiTM (berdazimer) topical gel has been approved recently for the treatment of molluscum contagiosum (MC) in patients aged ≥1 year. In three phase 3, randomized, double-blind, vehicle-controlled trials of similar design, berdazimer was investigated for the treatment of MC. Berdazimer or vehicle was applied once daily on MC lesions until complete lesion clearance was observed or for up to 12 weeks. Berdazimer demonstrated higher efficacy in achieving the primary outcome at week 12 (Trial 1, berdazimer: 32.4% [144/444] and vehicle: 19.7% [88/447]; Trial 2, berdazimer: 30% [71/237] and vehicle: 20.3% [24/118]; and Trial 3, berdazimer: 26% [61/236] and vehicle: 22% [28/126]), compared to vehicle. Common adverse events were the mild to moderate reactions, including application site pain, dermatitis, exfoliation, erythema, pruritus, and lesions.
Various specific and nonspecific dermatologic abnormalities are observed in chronic kidney disease (CKD). Dermatologic manifestations are observed at all stages of CKD and these increase with increasing duration and severity of the renal disease. Most of the studies in the literature have focussed mainly on dermatologic manifestations associated with dialysis and end-stage renal disease. We conducted a cross-sectional study to determine the prevalence, patterns, and risk factors of dermatologic disorders in CKD patients irrespective of clinical stage or status of dialysis.
As the presurgical size and anatomic location of non-melanoma skin cancer correlates to the complexity of Mohs micrographic surgery (MMS), patients are frequently asked to self-report their preoperative tumor size to aid in efficient scheduling and triage. We aimed to assess the accuracy of patient's self-reported lesion measurements prior to MMS by comparing patient's estimates of lesion size to the measurements taken by a Mohs surgeon. We conducted a retrospective chart review of 1,000 patients who underwent MMS and self-reported their lesion size at a preoperative telehealth visit. The patients reported their lesion size in one dimension (1D)/two dimensions (2D) or using a pencil eraser as a size reference. Patients demonstrated excellent reliability (intra-class correlation coefficient [ICC]: 0.916) while reporting their lesion size in two dimensions, and moderate reliability (ICC: 0.644) while reporting their lesion size in one dimension. Patients had slight agreement (κ = 0.178) with the surgeon's preoperative measurement while using a pencil eraser as a size reference. Dermatology practices must be encouraged to utilize telehealth to obtain presurgical size estimates from patients using 1D or 2D size measurements. By utilizing presurgical size estimates, surgeons can better triage and schedule patients to provide appropriate anticipatory guidance to patients and their caretakers.
A 63-year-old man, with no past medical history, presented with an asymptomatic, progressively evolving polypoid lesion for 2 years in the left ciliary region. Physical examination revealed an exophytic tumor lesion of firm consistency and lobulated surface, with regular and well-defined borders. It measured 2 cm in diameter, and had a brownish-violet coloration with whitish areas (Figure 1).
Pyoderma gangrenosum (PG) is the second most common skin manifestation reported in patients with inflammatory bowel disease (IBD). We performed a single-institution, retrospective study to summarize the clinical features and examine effective treatment regimens and outcomes of PG in IBD patients. We identified 45 patients who presented to our institute between January 1, 2002 and December 31, 2021 with the following criteria: (1) diagnosed with an active PG (ICD9: 686.01, ICD10: L88) during the specified period, (2) aged at least 18 years at the time of diagnosis, (3) had the diagnosis of IBD, and (4) documented treatment regimens/outcomes. In our cohort, 56% of the patients had PG at the site of stoma. Intralesional and oral steroids were the most utilized therapies for peristomal PG (PPG) and non-peristomal PG (NPPG) in 60% and 62% of the patients, respectively. The bowel manifestations were under control at the time of PG diagnosis in 76% of PPG patients, compared to 43% of NPPG patients. Our findings demonstrated that PPG in IBD patients could be managed locally with intralesional steroids only, as the bowel manifestations of PPG patients tend to be under control, compared to those of NPPG patients.
A 39-year-old woman presented to the dermatology department in January 2022 with a 3-week history of a progressively enlarging and intensely pruritic erythematous annular nodule on her left hand. The lesion started as a small blister, which was initially presumed to be a flare up of her pompholyx dermatitis. On her physician's advice, she applied clobetasol propionate ointment twice daily for 5 days; however the blister continued to increase in size until it burst, revealing raw inflamed skin. As the patch continued to increase in size, she was prescribed oral ciprofloxacin 500 mg twice a day for 5 days; however, the constantly weeping lesion grew to around 3 cm in diameter. The associated pruritus also became intense, without any response to regular antihistamines and ice application and disturbing patient's sleep. She also applied regular povidone iodine dressings but without any effect. Apart from pompholyx dermatitis, her medical history was significant for hypermobile Ehlers Danlos syndrome type 3 (hEDS).
A Caucasian woman in her twenties having asymptomatic papules on the hands for the past 6 months was referred by rheumatology for a skin biopsy. The patient had presented to rheumatologist for arthralgia. On physical examination, multiple, dull red, 2-5-mm papules were observed on her dorsal fingers, with most in the periungual regions. No papules or nodules were discovered on the mucosal membranes or other areas of her skin. Given the presence of characteristic "coral beads" along the periungual regions, the clinical diagnosis of multicentric reticulohistiocytosis (MRH) was rendered. A 4-mm punch biopsy revealed histiocytes with eosinophilic, homogenous, and finely granular "ground glass" cytoplasm.
Mycosis fungoides (MF) is a neoplasm of the immune system. It is a cutaneous lymphoma originating in the peripheral epidermotropic T-cells, specifically the memory T-cells (CD45RO+). The etiology of MF is indefinite, but various factors, such as genetic and epigenetic abnormalities, environmental and occupational exposure to chemicals, infections, and cytokines (interleukin [IL]-2, IL-4, etc.), play a vital role. Pityriasis lichenoides (PL), such as MF, is a rare subtype that is presented with skin lesions similar to that of PL.
Normal human life expectancy has increased; hence, growing interest in the field of skin quality is observed. Peels are common medical devices that stimulate new skin growth and improve texture. Injectable hyaluronic acid (HA)-based products act by replacing fragmented collagen. HA skin boosting is a new technique that is able to reduce aging indicators. The aim of this study was to evaluate the efficacy and safety of a multi-acid superficial peel combined with an HA skin booster to improve quality of the skin. We conducted a prospective study with patients presenting hyperpigmentation, skin dryness, loss of elasticity, or fine lines. The participants were required to apply either peel or booster treatment during an attack phase and during the followed maintenance phase. Subjective and objective evaluations were performed to assess clinical outcomes (i.e., skin hydration, firmness, and brightness). A total of 16 subjects participated in the study. We observed a higher satisfaction at the end of the treatment, compared to the baseline, for each of the three skin qualities (P < 0.0001). Similarly, analysis of physicians' global assessment scores demonstrated that physicians detected higher scores at the end of the study, compared to the baseline (P < 0.0001). Our study demonstrated the synergistic effect of a multi-acid superficial peel combined with HA skin boosting to improve skin appearance.
A 15-year-old African-American man (Fitzpatrick skin type V) presented to the outpatient dermatology clinic with a large, verrucous, exophytic mass measuring 3.5 × 2.3 cm on the right lateral side of the posterior flank (Figure 1). The lesion had been increasing in size for several years. His mother had refused a shave excision when he was 9 years old. He also had atopic dermatitis, acanthosis nigricans, and benign melanocytic nevi. He was obese with borderline hypercholesterolemia.
