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).

This Dermatopathology Diagnosis in our print edition is eligible for 1 self-assessment credit for Maintenance of Certification from the American Board of Dermatology (ABD). After completing this activity, diplomates can visit the ABD website (http://www.abderm.org) to self-report the credits under the activity title "Cutis Dermatopathology Diagnosis." You may report the credit after each activity is completed or after accumulating multiple credits.

Patients undergoing cancer treatment experience a multitude of skin, hair, and nail adverse events, prompting them to use non-evidence-based and often restrictive over-the-counter (OTC) recommendations to alleviate their symptoms. Comprehensively assessing evidence-based OTC modalities is crucial to enable cancer patients to comfortably resume their lives post-treatment and integrate clinically sound practices into their self-care routines. Perform a systematic review and assessment of evidence-based OTC skin, hair, and nail care recommendations for adult patients undergoing cancer treatment. PubMed, Cochrane, Embase, and Medline databases were searched in March 2023 to identify English articles addressing OTC skin, hair, and nail care recommendations for adult patients before, during, and after cancer chemotherapy or radiation therapy (RT). Quality was assessed with Oxford Centre for Evidence Based Medicine criteria. 2192 unique articles were screened, of which 77 met inclusion criteria consisting of 54 randomized controlled trials (RCT), 8 non-randomized controlled cohorts, 1 non-randomized controlled clinical trial, 3 controlled prospective cohorts, 4 prospective cohorts, 2 controlled clinical trials, 1 prospective comparative study, 2 case reports, and 2 case series discussing 9322 patients. An additional article outside of our database search was included for a total of 78 articles. OTC skin care treatments with the best quality of evidence included moisturizing creams. Our review revealed a paucity of evidence-based hair and nail care practices. This systematic review serves to highlight the efficacy of diverse OTC skin, hair, and nail care recommendations for adult cancer patients while encouraging further clinical trials to establish evidence-based management guidelines.

A 24-year-old man presented to our dermatology clinic with a painful lesion on the right buccal cheek of 4 months’ duration that had not changed in size or appearance. He had a history of Crohn disease that was being treated with 6-mercaptopurine and infliximab. He underwent jaw surgery 7 years prior for correction of an underbite, followed by subsequent surgery to remove the hardware 1 year after the initial procedure. He experienced recurring skin abscesses following the initial jaw surgery roughly once a year that were treated with bedside incision and drainage procedures in the emergency department followed by trimethoprim-sulfamethoxazole with complete resolution; however, treatment with mupi-rocin ointment 2%, trimethoprim-sulfamethoxazole, and azithromycin did not provide symptomatic relief or resolution for the current lesion. Physical examination revealed a 4-cm ulceration with actively draining serosanguineous discharge. Two punch biopsies were performed; 48-hour bacterial and fungal cultures, as well as Giemsa, acid-fast bacilli, and periodic acid–Schiff staining were negative.

The golden age has passed for antibiotic discovery, and while some antibiotics are currently in various phases of clinical trials in the United States, many pharmaceutical companies have abandoned antibiotic research. With the need for antibiotics, we should expand our horizon for therapeutic mining and can look toward understudied sources such as ice cores. Ice cores contain microorganisms and genetic material that have been frozen in time for thousands of years. The antibiotics used by these organisms are encoded in their genomes, which can be unlocked, identified, and characterized with modern advances in molecular biology, genetic sequencing, various computational approaches, and established natural product discovery pipelines. While synthetic biology can be used in natural product discovery approaches, synthetic biology and bioengineering efforts can also be leveraged in the selection and biodesign of increased compound yields, potency, and stability. Here, we provide the perspective that ice cores can be a source of novel antibiotic compounds and that the tools of synthetic biology can be used to design better antimicrobials.

The prevalence and cost of wounds pose a challenge to patients as well as the healthcare system. Wounds can involve multiple tissue types and, in some cases, become chronic and difficult to treat. Comorbidities may also decrease the rate of tissue regeneration and complicate healing. Currently, treatment relies on optimizing healing factors rather than administering effective targeted therapies. Owing to their enormous diversity in structure and function, peptides are among the most prevalent and biologically important class of compounds and have been investigated for their wound healing bioactivities. A class of these peptides, called cyclic peptides, confer stability and improved pharmacokinetics, and are an ideal source of wound healing therapeutics. This review provides an overview of cyclic peptides that have been shown to promote wound healing in various tissues and in model organisms. In addition, we describe cytoprotective cyclic peptides that mitigate ischemic reperfusion injuries. Advantages and challenges in harnessing the healing potential for cyclic peptides from a clinical perspective are also discussed. Cyclic peptides are a potentially attractive category of wound healing compounds and more research in this field could not only rely on design as mimetics but also encompass de novo approaches as well.

The human gut microbiome harbors hundreds of bacterial species with diverse biochemical capabilities. Dozens of drugs have been shown to be metabolized by single isolates from the gut microbiome, but the extent of this phenomenon is rarely explored in the context of microbial communities. Here, we develop a quantitative experimental framework for mapping the ability of the human gut microbiome to metabolize small molecule drugs: Microbiome-Derived Metabolism (MDM)-Screen. Included are a batch culturing system for sustained growth of subject-specific gut microbial communities, an ex vivo drug metabolism screen, and targeted and untargeted functional metagenomic screens to identify microbiome-encoded genes responsible for specific metabolic events. Our framework identifies novel drug-microbiome interactions that vary between individuals and demonstrates how the gut microbiome might be used in drug development and personalized medicine.