Perineurioma is a benign peripheral nerve sheath tumor. Several subtypes have been described, including plexiform, reticular, and sclerosing. The reticular variant has been previously described as having a net or lace-like growth pattern consisting of large anastomosing cords of spindle-shaped cells. We report a case of an 11-year-old male who presented with a 2-year history of a slowly enlarging, tan-white lesion on the finger. Microscopically, the lesion consisted of cells with ovoid nuclei and delicate, elongate cytoplasmic processes, arranged in a microreticular pattern. The lesional cells were markedly positive for epithelial membrane antigen and claudin-1. Based on these features and the unusual morphology, the case was called a microreticular perineuroma. The patient underwent complete excision of the lesion with no recurrence 9 months after follow-up. To our knowledge, this is the first reported case of this morphologic variant. Awareness of this entity is important to avoid inappropriate management.

Abstract: Podophyllotoxin (PPT) is used to treat condylomata acuminata and works by destabilizing microtubules within epithelial cells, leading to mitotic arrest in metaphase. PPT-induced changes to the epidermis can cause histological findings mimicking dysplasia. Here, we present a case of vulvar condyloma acuminatum treated with PPT, showing ballooning degeneration, necrotic keratinocytes, and mitotic figures. PPT-treated skin may resemble dysplasia or squamous cell carcinoma in situ due to dyskeratosis and frequent mitoses; however, the synchronicity of mitotic figures in early phases of mitosis, as well as the absence of cellular pleomorphism and atypical mitotic figures, allows for distinction from malignancy. This case demonstrates the importance of understanding the histological changes caused by PPT to prevent misdiagnosis and potential overtreatment.

Background Cutaneous histopathologic diagnoses in children often differ from those in adults. Depending on practice setting, these specimens may be evaluated by dermatopathologists or pediatric pathologists. We sought to determine whether comfort level with pediatric dermatopathology is associated with prior training, pediatric dermatopathology exposure during fellowship, career duration, or specimen subtype. Methods We surveyed dermatopathologists and pediatric pathologists practicing in the United States. Training and practice variables were evaluated by multivariable regression for association with comfort level. Results Of the 156 respondents, 72% were dermatopathologists (response rate 11.6%) and 28% were pediatric pathologists (response rate 9.3%). Dermatopathologists reported higher comfort overall (P < .001); this was also true for inflammatory dermatoses and melanocytic neoplasms (P < .001). Thirty-four percent and 75% of dermatopathologists and pediatric pathologists, respectively, reported lower comfort with pediatric skin specimens than their usual cases. Pediatric pathologists were 28% more likely to refer these cases to colleagues. Among dermatopathologists, dermatology-trained were more comfortable than pathology-trained colleagues interpreting inflammatory dermatoses (P < .001). Conclusions Pathologists' comfort with pediatric dermatopathology varied significantly based upon prior training, career duration, and specimen subtype. These results suggest opportunities for improving education in this domain.

The rapid spread of coronavirus disease 2019 (COVID-19) around the globe has necessitated implementation of social distancing measures to slow disease dissemination and conserve personal protective equipment. These actions have changed how we live and work. The COVID-19 pandemic has challenged our mission to teach the next generation of dermatologists. In this moment, we have been dealt new obstacles, which demand flexible solutions. We wish to share our experiences with continuing residency education on a virtual platform. During this international disaster, some may ask, why bother with education? Physicians from a variety of specialties, including dermatology trainees, are contributing to front-line patient care in COVID-19 hot spots.1Sengupta S. 'With virus surge, dermatologists and orthopedists are drafted for the E.R.' New York Times.https://www.nytimes.com/2020/04/03/nyregion/new-york-coronavirus-doctors.htmlDate: 2020Date accessed: April 7, 2020Google Scholar In places where there is not an immediate demand for dermatologists to serve alongside our colleagues in acute patient care, education can continue and may serve as a way to maintain normalcy. The duration of this pandemic is unknown, and delays in reengineering education may result in long-lasting deficits in resident training. Virtual education can also establish a sense of camaraderie and connection when many are experiencing social isolation. Recent technologies have made virtual resident education accessible to all training programs. High-quality camera technologies and high-speed Internet have made group-meeting software a feasible replacement for traditional learning experiences (Table I). We have sought to ensure that these technologies supplement rather than distract from the fundamental goals of our teaching, which are to help trainees gain knowledge, improve critical thinking, and facilitate dialogue among residents and attending physicians. Our basic and clinical science lectures, grand rounds conferences, and image sessions are now broadcast live and recorded for future viewing with Microsoft Teams (a Health Insurance Portability and Accountability Act–compliant platform, Microsoft, Redmond, WA). Dermatopathology lectures, delivered throughout the week, are taught with live-broadcast sessions; with self-paced review of glass slides, whole scanned slides, and photomicrographs, followed by instructor-led review; and with live streaming at the microscope with an attending dermatopathologist. Overall, we have increased lectures and conferences to supplement the loss of direct patient care caused by postponement of nonurgent visits and procedures.Table IAdvantages and disadvantages of digital platforms for medical educationAdvantages of digital formatDisadvantages of digital formatAllows social distancing necessary during pandemicLack of inherent aspects of interactivity during live encountersConvenience of access obviating commute to site of live sessionPotential for distraction during lecture by primary speakerReal-time virtual visits allow faculty to witness trainee-patient interactions and provide feedback for improvementPotential for technical limitations/interruptions (eg, faulty connections)Potential for greater number of participantsLimitations on hands-on activities (eg, suturing skills sessions)Potential for economy (eg, obviates travel expense for imported guest speakers)Hacking by malevolent sourcesAutomatic archival of presented material and contentUse of archived material for review and improvementAllows chats during lecture of primary speaker Open table in a new tab As we have transitioned patient care to teledermatology, we have maintained resident involvement in outpatient visits and inpatient consultation services despite physical separation. Teledermatology has been shown to be an effective, efficient way of treating and triaging patients.2Zakaria A. Maurer T. Su G. Amerson E. Impact of teledermatology on the accessibility and efficiency of dermatology care in an urban safety-net hospital: a pre-post analysis.J Am Acad Dermatol. 2019; 81: 1446-1452Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar However, formal teledermatology curricula are lacking.3Wanat C. Newman S. Finney K.M. Kovarik C.L. Lee I. Teledermatology education: current use of teledermatology in US residency programs.J Grad Med Educ. 2016; 8: 286-287Crossref PubMed Scopus (31) Google Scholar We have taken this opportunity to revitalize our teledermatology education, beginning with incorporation of the American Academy of Dermatology teledermatology curriculum. Residents also receive individual feedback about patients they care for via teledermatology. In outpatient clinics, residents primarily treat patients through the use of the EPIC electronic medical record and the BlueJeans videotelephony platform for live-interactive teledermatology. On inpatient services, we use both store-and-forward teledermatology and live-interactive interfaces as needed. In-person visits with patients are reserved for high-acuity cases that require direct evaluation. Challenges presented by COVID-19 have highlighted our collective resilience and creativity. Meaningful learning is not easy, and the present circumstances have transformed us into new learners as both our residents and attending physicians have adapted to novel ways of education and of caring for patients.

Dermatologic TherapyVolume 33, Issue 6 e13834 LETTER Acute generalized exanthematous pustulosis induced by empiric hydroxychloroquine for presumed COVID-19 Tyler Enos, Corresponding Author Tyler Enos [email protected] orcid.org/0000-0002-9212-3977 Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA Correspondence Tyler Enos, Department of Dermatology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9069. Email: [email protected]Search for more papers by this authorHaneol S. Jeong, Haneol S. Jeong Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USASearch for more papers by this authorTravis Vandergriff, Travis Vandergriff Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USASearch for more papers by this authorHeidi T. Jacobe, Heidi T. Jacobe Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USASearch for more papers by this authorBenjamin F. Chong, Benjamin F. Chong Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USASearch for more papers by this author Tyler Enos, Corresponding Author Tyler Enos [email protected] orcid.org/0000-0002-9212-3977 Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA Correspondence Tyler Enos, Department of Dermatology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9069. Email: [email protected]Search for more papers by this authorHaneol S. Jeong, Haneol S. Jeong Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USASearch for more papers by this authorTravis Vandergriff, Travis Vandergriff Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USASearch for more papers by this authorHeidi T. Jacobe, Heidi T. Jacobe Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USASearch for more papers by this authorBenjamin F. Chong, Benjamin F. Chong Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USASearch for more papers by this author First published: 15 June 2020 https://doi.org/10.1111/dth.13834Citations: 11Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume33, Issue6November/December 2020e13834 RelatedInformation

Elastosis perforans serpiginosa (EPS) is a rare condition, commonly grouped with other perforating dermatoses, in which dermal elastic fibers are transepidermally extruded. It is classically described on the head, neck, and flexural sites and is composed of keratotic papules arranged in annular and arcuate arrays. We report a case of extensive EPS in a man with Down syndrome, successfully treated with acitretin, a secondgeneration oral retinoid. A 23-year-old man with Down syndrome presented for evaluation of an eruption present for 10 years. He reported moderate pruritus, and his family was concerned about the rash being contagious and socially isolating. Prior unsuccessful treatments included triamcinolone 0.1% ointment and several courses of oral antibiotics. He had numerous erythematous, keratotic papules in a serpiginous configuration on the right neck, thighs, and lower legs (Fig. 1a). Skin biopsies showed an acanthotic distorted epidermis, with clumps of coiled and fragmented elastic fibers in the superficial dermis and within small channels in the epidermis (Fig. 1b). Verhoeff-Van Gieson stain highlighted elastic fibers undergoing transepidermal elimination (Fig. 1c). A diagnosis of EPS was made. Given the duration and widespread nature of the eruption, the patient and family desired systemic treatment. Figure 1 (a) Patient’s leg prior to treatment. (b) Hematoxylin-eosin stained punch biopsy from the leg demonstrating acanthosis with a keratotic plug and extrusion of material noted at the base (original magnification 94). (c) Verhoeff-Van Gieson stain highlighting elastic fibers perpendicularly oriented within the epidermis (original magnification 940)

The dressing material of a wound plays a key role since bacteria can live in the bandage and keep re-infecting the wound, thus a bandage is needed that blocks biofilm in the bandage. Using an in vivo wound biofilm model, we examined the effectiveness of an organo-selenium (OS)-coated polyester dressing to inhibit the growth of bacteria in a wound. Staphylococcus aureus (as well as MRSA, Methicillin resistant Staph aureus), Stenotrophomonas maltophilia, Enterococcus faecalis, Staphylococcus epidermidis, and Pseudomonas aeruginosa were chosen for the wound infection study. All the bacteria were enumerated in the wound dressing and in the wound tissue under the dressing. Using colony-forming unit (CFU) assays, over 7 logs of inhibition (100%) was found for all the bacterial strains on the material of the OS-coated wound dressing and in the tissue under that dressing. Confocal laser scanning microscopy along with IVIS spectrum in vivo imaging confirmed the CFU results. Thus, the dressing acts as a reservoir for a biofilm, which causes wound infection. The same results were obtained after soaking the dressing in PBS at 37 °C for three months before use. These results suggest that an OS coating on polyester dressing is both effective and durable in blocking wound infection.

The authors declare no potential conflict of interest.

A 61-year-old woman with inflammatory bowel disease and ankylosing spondylitis, treated with infliximab infusions, presented with a several-year history of episodic red eyes and periorbital rash. Three years ago, she underwent patch testing that was reportedly positive for gold and lanolin. The patient continued wearing gold jewelry but avoided wool alcohol products, with resolution of symptoms. However, several weeks before presentation, she again had conjunctival injection and pruritus that progressed to involve the periorbital skin. Repeated oral prednisone tapers resulted in moderate improvement of eye redness only. A month before presentation, she discontinued use of contact lenses, antihistamine eye drops, sunscreen, and cosmetics but continued to use shea butter on the face. She had seen an ophthalmologist who advised her to avoid gold, discontinue ophthalmic solutions, and apply only petrolatum to the skin. She was then seen at our dermatology clinic, where patch testing was performed with the North American Contact Dermatitis Group 80 series (Chemotechnique) and her personal cosmetic products and eye drops. Tominimize the potential of infliximabmasking patch test results, we conducted the procedure at a time point most distal to her next infliximab infusion. Patch testing revealed a single positive reaction, to Alaway eye drops, which contained ketotifen, benzalkonium chloride, and glycerin. Pertinent negative reactions included lanolin, gold, and benzalkonium chloride, as well as her other ophthalmic products, including contact lens solutions. Since avoiding Alaway eye drops, she has remained symptom-free. The positive reaction to Alaway eye drops, coupled with a negative reaction to benzalkonium chloride, led us to conclude that ketotifen in the eye drops was the relevant causative agent. The progression of her symptoms from conjunctivitis to periorbital dermatitis plus resolution of the eruption after avoidance of the offending eye drops validates this conclusion. For more definitive patch testing, we requested a sample of ketotifen used by Alaway's manufacturer, but the company refused. Ketotifen is a recognized contact sensitizer, with 9 previous cases reported. One retrospective review of 49 patients from Japan with documented sensitivity to ophthalmic drops found 8 cases due to products containing ketotifen fumarate, although only 6 confirmed causality with patch testing. Aschenbeck and Warshaw documented the first case of allergic contact dermatitis due to ketotifencontaining eye drops in North America. Smets et al reported a case of isolated conjunctivitis without involvement of surrounding skin due to ketotifen, and Niizeki et al described a case of bilateral periorbital erythema without eye involvement. Ketotifen has both antihistaminic and mast cell–stabilizing properties. It is available over-the-counter in topical ophthalmic form in the United States for allergic conjunctivitis, and the oral form is available in a limited number of countries for asthma. In our patient, previous positive testing to lanolin and gold were historical confounders that delayed correct management, especially because neither gold nor lanolin was a suitable cause of the initial conjunctivitis.

Congenital infantile fibrosarcoma ( CIFS ) is a rare neoplasm of infancy that occurs most frequently in the extremities, and when presenting in the skin, may sometimes resemble infantile hemangiomas or other vascular lesions. Clinically, these tumors differ from hemangiomas in the time of onset, morphology, and growth pattern and must be evaluated histologically for definitive diagnosis. We describe an infant with a neoplasm involving the distal left forearm initially presumed to be a vascular lesion after evaluation by two separate ultrasound studies. He presented at seven weeks of life with a multinodular lesion that had enlarged significantly since birth, and the skin biopsy revealed a fibrosarcoma. This case highlights an unusual cutaneous presentation of CIFS , which varies in appearance from the previous 12 cases reported in the literature. We review the clinical manifestations of these congenital masses and emphasize early diagnosis for conservative therapy and improved prognosis.

BackgroundThe utility of brentuximab vedotin (BV) in CD30(+) systemic lymphomas is established, however evidence for treating primary cutaneous lymphoma remains limited. This study aimed to evaluate BV in treating CD30(+) transformed mycosis fungoides (MF) and primary cutaneous anaplastic large cell lymphoma (PC-ALCL). MethodsA literature review was conducted, and we analyzed data from published trials and case reports obtained via search of Ovid-MEDLINE (R) and PubMed databases. The search yielded 372 reports, and 10 publications met inclusion criteria. Sixty-one patients with CD30(+) transformed MF and seven with PC-ALCL were included. ResultsMean age at BV initiation was 60.8years (67 - PC-ALCL; 60.1 - MF), and 4.1 therapies were attempted prior to BV (3.1 - PC-ALCL; 4.2 - MF). The overall response rate was 67.7% (100% - PC-ALCL; 63.9% - MF), with 16.2% of patients experiencing complete response (100% - PC-ALCL; 6.6% - MF). Mean time to clinical response was 5.3 and 9.3weeks for PC-ALCL and MF, respectively. Mean response duration for patients with PC-ALCL was 7.6 and 7.8months for MF. Peripheral neuropathy (57.2%) and fatigue (35.6%) were the most commonly reported adverse effects. ConclusionsThis analysis summates the current evidence regarding the use of BV in treating CD30(+) MF and PC-ALCL. Preliminary results indicate that BV is effective for CD30(+) CTCL, however additional studies with larger sample sizes are necessary. The study provides clinicians with the clinical context in which BV may be appropriate as well as information regarding therapeutic expectations and outcomes.

Biofilm formation in wounds is a serious problem which inhibits proper wound healing. One possible contributor to biofilm formation in a wound is the bacteria growing within the overlying bandage. To test this mechanism, we used bandages that contained a coating of organo-selenium that was covalently attached to the bandage. We tested the ability of this coating to kill bacteria on the bandage and in the underlying tissue. The bandage material was tested with both lab strains and clinical isolates of Staphylococcus aureus, Pseudomonas aeruginosa and Staphylococcus epidermidis. It was found that the organo-selenium coated bandage showed inhibition, of biofilm formation on the bandage in vitro (7–8 logs), with all the different bacteria tested, at selenium concentrations in the coating of less than 1.0%. These coatings were found to remain stable for over one month in aqueous solution, 15 min in boiling water, and over 6 years at room temperature. The bandages were also tested on a mouse wound model where the bacteria were injected between the bandage and the wound. Not only did the selenium bandage inhibit biofilm formation in the bandage, but it also inhibited biofilm formation in the wound tissue. Since selenium does not leave the bandage, this would appear to support the idea that a major player in wound biofilm formation is bacteria which grows in the overlying bandage.

Oral bacteria, including Streptococcus mutans and Streptococcus salivarius, contribute to tooth decay and plaque formation; therefore, it is essential to develop strategies to prevent dental caries and plaque formation. We recently showed that organo-selenium compounds covalently attached to different biomaterials inhibited bacterial biofilms. Our current study investigates the efficacy of an organo-selenium dental sealant (SeLECT-Defense(TM) sealant) in inhibiting S. mutans and S. salivarius biofilm formation in vitro. The organo-selenium was synthesized and covalently attached to dental sealant material via standard polymer chemistry. By colony-forming unit (CFU) assay and confocal microscopy, SeLECT-Defense(TM) sealant was found to completely inhibit the development of S. mutans and S. salivarius biofilms. To assess the durability of the anti-biofilm effect, we soaked the SeLECT-Defense(TM) sealant in PBS for 2 mos at 37°C and found that the biofilm-inhibitory effect was not diminished after soaking. To determine if organo-selenium inhibits bacterial growth under the sealant, we placed SeLECT-Defense sealant over a lawn of S. mutans. In contrast to a control sealant, SeLECT-Defense(TM) sealant completely inhibited the growth of S. mutans. These results suggest that the inhibitory effect of SeLECT-Defense(TM) sealant against S. mutans and S. salivarius biofilms is very effective and durable.