Addendum to: Eruption as a clinical manifestation of COVID-19: Photographs of a patient
We recently described a case of a 26-year-old patient with presumptive coronavirus disease 2019 (COVID-19) who presented with a facial eruption that had a distinctly violaceous color typical of pernio.1 We now report that, 2 months after the onset of signs and clinical manifestations, the patient underwent a COVID-19 antibody assay and it was positive, thus confirming the presumptive clinical diagnosis of COVID-19. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - June 12, 2020 Category: Dermatology Authors: Leonard J. Hoenig, Frederick A. Pereira Tags: COVID-19: Important Updates and Developments Source Type: research
Introducing special cutaneous “sign” tribute to health care workers managing new coronavirus disease 2019 (COVID-19)
The novel coronavirus disease 2019 (COVID-19) pandemic is an unresolved global issue at present. We read the article “COVID-19 pandemic and the skin - what should dermatologists know?” with great interest. The contribution describes various skin problems related to personal protective equipment and personal hygiene.1,2 (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - May 19, 2020 Category: Dermatology Authors: Ajith P. Kannangara Tags: Correspondence Source Type: research
Reply: Introducing special cutaneous “sign” tribute to health care workers managing new coronavirus disease 2019 (COVID-19)
Subsequent to our initial publication on coronavirus disease 2019 (COVID-19) infection and the skin, the pandemic has evolved with nearly 1,600,000 new cases and over 93,000 deaths since the beginning of April 2020,1 with these numbers increasing daily. In China, 3,300 health care workers have been infected with the virus, whereas the number in Italy has escalated to 2,600 so far. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - May 19, 2020 Category: Dermatology Authors: Razvigor Darlenski, Nikolai Tsankov Tags: Correspondence Source Type: research
The pathophysiology of pityriasis alba: Time-dependent histologic changes
Although pityriasis alba is a common dermatologic condition, its pathogenesis is poorly understood, and there are many discrepancies in the literature. To assess the effect of the duration of disease on the histologic findings, a search of cases labeled “pityriasis alba” was performed on any cases submitted to our dermatopathology laboratory. Of 179 cases of pityriasis alba, five cases identified the duration of the disease, when the biopsy was taken. A biopsy for a lesion of only 1-month duration demonstrated groups of large, prominent melanoc ytes heaped up upon one another. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - May 1, 2020 Category: Dermatology Authors: Katrice M. Karanfilian, Sara Behbahani, Muriel W. Lambert, Albert Alhatem, Joseph Masessa, Jose Espinal-Mariotte, Robert A. Schwartz, W. Clark Lambert Tags: Comment and Controversy Source Type: research
Rituximab in autoimmune pemphigoid diseases: Indications, optimized regimens, and practice gaps
Rituximab is a monoclonal antibody targeting CD20 on B cells with proven efficacy for pemphigus vulgaris, now an FDA-approved indication. Other autoimmune bullous diseases can be challenging to treat and have significant associated morbidity and mortality, but data supporting the use of rituximab in pemphigoid group diseases remain limited. Although rituximab demonstrates efficacy for clinical improvement and remission in pemphigoid, concern for adverse events may also limit the use of this medication. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - May 1, 2020 Category: Dermatology Authors: Renee M. Thomas, Alysha Colon, Kiran Motaparthi Tags: Investigational Rounds Source Type: research
The Ubangi misnomer
Lip plates are a form of body modification practiced today by several tribes in Africa and Amazonia. In 1930, the American people were introduced to lip plates in a most spectacular fashion, when the Ringling Bros. and Barnum& Bailey Circus brought in 13 Congolese natives to star as the newest attraction in their sideshow. The Congolese women wore huge lip plates, a result of cultural lip piercing with progressive lip stretching by wooden pegs and plates.The Congolese exhibit was publicized throughout the country as the “Ubangi Savages,” a made-up name selected from an African map, because it had an exotic ...
Source: Clinics in Dermatology - May 1, 2020 Category: Dermatology Authors: Leonard J. Hoenig Tags: Reflections on dermatology: past present, and future Source Type: research
Reply to “How I learned to stop worrying and love machine learning” by Mattessich et al
Mattessich et al1 have presented a very concise yet powerful message arguing why machine learning (ML) should be embraced as the future of dermatology. Autonomous artificial intelligence (AI) has become ubiquitous in today ’s society, from self-driving cars to the spam filter in our e-mail, and medicine is no exception. ML is a field of computational science that involves models that can be trained to make predictions and take actions when confronted with new information. There are numerous applications of ML in med icine, from reading medical images to robot-assisted surgery. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - May 1, 2020 Category: Dermatology Authors: Shawn Shih, Amor Khachemoune Tags: Correspondence Source Type: research
Blemished noses in the art of three masters: Ghirlandaio, Rembrandt, and Warhol
Blemished noses are portrayed in the paintings of such noted artists as Ghirlandaio, Rembrandt, and Andy Warhol. Sometimes, the deformity results from a skin disorder such as rhinophyma as in Ghirlandaio ’s An Old Man and his Grandson or a saddle nose deformity from congenital syphilis as in Rembrandt’s Portrait of Gerard de Lairesse. Andy Warhol’s Before and After portrays a large nose before and after cosmetic surgery. This contribution explores some of the lessons that can be learned, both artistically and medically, from these famous works of art. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - May 1, 2020 Category: Dermatology Authors: Taha Osman Mohammed, Shahzeb Hassan, Noor Hamideh, Ali Mahmoud, Michael A. Waugh, Gerd Plewig, Lawrence Charles Parish, Leonard J. Hoenig Tags: Reflections on Dermatology: Past Present, and Future Source Type: research
Managing dermatology patients who prefer “all natural” treatments
Dermatology patients are expressing a growing interest in complementary and alternative medicine (CAM) and natural treatment options for management of dermatologic conditions. Counseling on the optimal integration of CAM with conventional therapeutic approaches can be daunting for practitioners who do not feel well-versed in these modalities. A productive conversation between the clinician and patient seeking natural treatments should address the appropriate role and scope of CAM in a therapeutic plan, which is best suited for use as maintenance therapy or to augment traditional pharmaceutical or procedural interventions. ...
Source: Clinics in Dermatology - May 1, 2020 Category: Dermatology Authors: Aunna Pourang, Aleksi J. Hendricks, Vivian Y. Shi Tags: Dermatology Disquisitions and Other Essays Source Type: research
Dermatologists in the Wild West, 1870-1900: The early pioneers from the Mississippi River to the Pacific Coast
During the Wild West era of American history (approximately 1870-1900), at least 53 dermatologists settled between the Mississippi River and the Pacific Coast. In 1870, two dermatologists began their practice in the city of St Louis, Missouri (William Augustus Hardaway and Solomon Claiborne Martin, Sr) and one dermatologist started his practice in San Francisco, California (George J. Bucknall). By 1900, 50 more dermatologists had settled in 19 cities located in the American West (Tables 1,2). There, they established practices, initiated academic programs, and pioneered dermatology as a medical specialty in the western Unit...
Source: Clinics in Dermatology - May 1, 2020 Category: Dermatology Authors: Leonard J. Hoenig, Lawrence Charles Parish Tags: Reflections on Dermatology: Past, Present, and Future Source Type: research
Factors contributing to burnout in dermatologists
Physician burnout is associated with increased medical errors, lower patient satisfaction, and decreased professional work effort. Although rates of burnout are lower in dermatology than in other specialties, the prevalence is still high and increasing. Burnout affects both personal and patient care. It is important to consider factors and ways to combat this phenomenon to prevent deterioration. To achieve this, a comprehensive understanding of the causes contributing to burnout in dermatology is crucial. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - May 1, 2020 Category: Dermatology Authors: Alysha Colon, Ryan Gillihan, Kiran Motaparthi Source Type: research
The corporatization of care in academic dermatology
Concern over the corporatization of medicine has existed since the late 1800s and continues to grow today in the face of large-scale mergers, vertical integration of health care services, and private equity (PE) investment in dermatology practices. Although academic departments have traditionally been viewed as exempt from Corporate Practice of Medicine (CPOM) laws, they face the same health care landscape and cultural pressures as private and PE-backed practices, as well as some unique financial challenges. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - May 1, 2020 Category: Dermatology Authors: Madeline E. DeWane, Eliot Mostow, Jane M. Grant-Kels Tags: Academic dermatology corporatization Source Type: research
The corporatization of dermatopathology
has long preceded that of dermatology and has been driven by federal legislation and economic influences. Although the Clinical Laboratory Improvement Amendments and the Stark Law limited physician-owned laboratories, loopholes via the Safe Harbor Exemptions outlined in the Anti-Kickback Statute allowed corporate laboratories to flourish through relationships built by health information technology donations. The rise of corporatization has had widespread effects on the fields of dermatopathology and dermatology, resulting in reduced numbers of dermatology-trained dermatopathologists and decreased caseloads in academic ins...
Source: Clinics in Dermatology - May 1, 2020 Category: Dermatology Authors: Erica B. Lee, Jane M. Grant-Kels, Kiran Motaparthi Tags: Dermatopathology corporatization Source Type: research
Why dermatology is the second least diverse specialty in medicine: How did we get here?
Dermatology is currently the second least diverse medical specialty, after orthopedic surgery, with only a minority of physicians identifying as underrepresented in medicine (UIM). To diversify our specialty, our understanding and recognition of multifactorial barriers to inclusivity such as financial barriers, lack of mentorship, and the implicit bias against minorities UIM is critical. With collaborative efforts by national dermatology organizations, dermatology residency programs, and medical schools to increase the presence of UIM dermatology physicians in the US health care, this important issue continues to receive t...
Source: Clinics in Dermatology - May 1, 2020 Category: Dermatology Authors: Sophia Akhiyat, Leah Cardwell, Olayemi Sokumbi Source Type: research
Dermatology leadership and a top-down approach to increasing diversity
The reasons underlying the lack of diversity within dermatology can be broadly categorized into lack of mentorship, decreased awareness of the specialty during medical school, socioeconomic barriers associated with the application process, and implicit bias during resident selection. This contribution examines the need for diversity in medicine and provides insight into the reasons behind the low number of underrepresented minority residents in dermatology. Leadership strategies that may help increase diversity in the field are also reviewed. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - May 1, 2020 Category: Dermatology Authors: Marjorie E. Monta ñez-Wiscovich, Xiomara Brioso Rubio, Abel Torres Source Type: research
The evolution of private equity in dermatology
The first known entry of private equity (PE) in the clinical dermatology space was over a decade ago. There are now in excess of 30 PE-backed dermatology groups (PEGs) with a vision for dermatology. Many use the management services organization, which allows PE firms to circumvent corporate practice of medicine laws, align cooperative physicians, and set the foundation for PEG evolution. PEGs may have different characteristics depending on their stage of evolution; however, as they mature through the stages, they become increasingly similar to each other. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - May 1, 2020 Category: Dermatology Authors: Sailesh Konda, Joseph Francis Source Type: research
Dermatology resident perspectives on practice ownership structures and private equity-backed group practices
Recently, dermatology group practice ownership structures have changed, as private equity (PE) consolidates independent dermatology practices to create larger groups. Currently, little is known about how dermatology residents perceive practice ownership structures, including those that are owned by PE. One hundred thirty-seven residents from 32 dermatology residency programs responded to a 21-question anonymous survey. Approximately 65% of residents in this study were not open to working for PE-backed practices, and their negative perceptions of how PE influences quality of care, long-term salary, and physician autonomy we...
Source: Clinics in Dermatology - May 1, 2020 Category: Dermatology Authors: Taylor Novice, David Portney, Milad Eshaq Source Type: research
Common patterns of corporate dermatology billing abuses in Medicare data sets
Advances in technology have brought about significant changes in the way physicians ’ encounters are viewed. Patient charts once existed only in medical offices and hospital basements with medical billing done manually. Technologic changes have created new methods and expectations for oversight of the physician’s practice. This contribution examines the effects of data transpar ency on dermatology. Medicare has also responded with new requirements for quality reporting. The ability to recreate clinical encounters from freely available and physician-identifiable claims data has led to lawsuits, investigations by...
Source: Clinics in Dermatology - May 1, 2020 Category: Dermatology Authors: Joseph K. Francis Source Type: research
Wellness, burnout, and the dermatologist: Fundamentals for practice longevity
Physician wellness is a critical component of any effective health care system, as physicians serve essential roles as diagnosticians, surgeons, and leaders in medical care. Physician burnout, defined as a combination of the presence of emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment, is an increasingly recognized problem in the US health care system, as rates of burnout among physicians are on the rise, now exceeding 50%. To date, few studies have examined the impact of burnout on dermatologists specifically, but existing studies evaluating physicians collectively have shed light...
Source: Clinics in Dermatology - May 1, 2020 Category: Dermatology Authors: Drew J.B. Kurtzman Source Type: research
The heightened focus on wellness in dermatology residency education
Dermatology residents and dermatology faculty members experience stress in the workplace, placing them at risk for burnout. As a profession, dermatologists have one of the fastest growing rates of burnout clinical manifestations across all specialties. The Accreditation Council for Graduate Medical Education has revised its program requirements for residency programs to include greater emphasis on actions to promote wellness. Examples of actions to promote wellness that are used currently in dermatology and other residency and medical education settings are explored. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - May 1, 2020 Category: Dermatology Authors: Erik J. Stratman, Eileen Anthony, Zoe E. Stratman, Michael J. Schulein Source Type: research
Hot button topics: Corporate influence, diversity, and wellness in dermatology
“Private equity.” “Diversity.” “Burnout.” Seemingly ubiquitous in the current dermatology literature, these terms may elicit strong reactions from readers. Rather than avoid these hot button topics in favor of comfort, this issue of Clinics in Dermatology seeks to encourage a healthy dis cussion of corporate influence, diversity, and wellness in dermatology. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - May 1, 2020 Category: Dermatology Authors: Kiran Motaparthi Tags: Commentary Source Type: research
From East to West: Effects of the globalization of cultural practices
Throughout the world, the marks and assimilation of traditional sociocultural values into popular, mainstream culture have become the new norm: from wedding ceremonial tradition, such as mehndi and bindi, to cosmetic hair removal, such as threading, have gained popularity among Western countries. The boundaries of dermatology practice also extend beyond the countries ’ borders. The knowledge regarding common cultural practices from East to West may help clinicians in the increasing globalized practice of dermatology. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - May 1, 2020 Category: Dermatology Authors: Melissa Laughter, Sahitya Priya Cherukuri, Mayra B.C. Maymone, Neelam A. Vashi Tags: Dermatologic Disquisitions and Other Essays Source Type: research
Along came a spider: Medicine ’s most famous spider eponyms
Spiders have long been admired for the beauty of their webs. They are celebrated in popular culture as well as in medical eponyms. This contribution provides the historical background for three spider-related eponyms: nevus araneus (spider angioma), arachnodactyly, and the arachnoid mater. Nevus araneus was first named and described by Sir Erasmus Wilson in 1842. Arachnodactyly was described in 1896 by Antoine Marfan using the term pattes d ’araignée, which means spider legs. In 1902, Emile Charles Achard proposed the term arachnodactyly for this clinical finding. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - March 1, 2020 Category: Dermatology Authors: Leonard J. Hoenig Tags: Reflections on Dermatology: Past, Present, and Future Edited by Leonard J. Hoenig, MD Source Type: research
Platelet-rich plasma for facial rejuvenation: An early examination
Platelet-rich plasma (PRP) has become a popular and trendy treatment in dermatology for various skin ailments, most notably for acne scars, traumatic scars, hair regrowth, and cutaneous rejuvenation. Although PRP has been utilized in the world of orthopedics for many years, its recent entry into dermatology has been wrought with controversy, especially as some have marketed it to consumers as a type of cure-all; however, the studies behind PRP treatment, especially for cutaneous rejuvenation, are currently limited, while we await additional larger studies. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - March 1, 2020 Category: Dermatology Authors: Elizabeth Schoenberg, Georgette Hattier, Jordan V Wang, Nazanin Saedi Tags: Comment and Controversy Source Type: research
Daniel Turner (1667-1740)
is credited with having written the first book in English on the diagnosis and treatment of skin disease. In De Morbis Cutaneis, Turner distinguishes two types of skin conditions: those that affect the inside of the body but are symptomatic on the surface, and those that are of an outward origin. Turner also underlines the necessity for prophylaxis against venereal diseases. Turner ’s book Syphilis. A Practical Dissertation on the Venereal Disease contains the first description of the “condum,” a word that derives from the Latin condio, condo and means “to preserve.” Turner should be remember...
Source: Clinics in Dermatology - March 1, 2020 Category: Dermatology Authors: Andrzej Grzybowski, Piotr Kanclerz, Lawrence Charles Parish Tags: Caretaker of the Skin Source Type: research
Charcoal: An ancient material with a new face
Activated charcoal has become popular in the cosmetic industry and is found in a variety of products, including facial cleansers and soaps. For centuries, charcoal has been used as an antidote for poisonings, but now companies claim that charcoal-containing products can treat acne, dandruff, and others; however, clinical evidence does not support these claims. Patients should be counseled that the use of activated charcoal is generally safe but advised that there is a lack of evidence to support its exfoliative or anti-aging abilities. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - March 1, 2020 Category: Dermatology Authors: Nelson Sanchez, Rachel Fayne, Brandon Burroway Tags: Reflections on Dermatology: Past, Present, and Future Source Type: research
Cutaneous manifestations associated with HIV infections: A great imitator
HIV is associated with an increased incidence of mucocutaneous disorders, with the overwhelming majority of HIV-infected individuals being afflicted with skin diseases during the course of the infection. Skin diseases in HIV patients are rarely fatal, but they have a significant effect on the quality of life. The immunologic stage of the infection and the use of highly active antiretroviral therapy (HAART) are the main elements that determine the spectrum of the mucocutaneous involvement. Many skin diseases may occur simultaneously in HIV patients, and the course of these diseases may or may not be different than it is in ...
Source: Clinics in Dermatology - March 1, 2020 Category: Dermatology Authors: Ayse Serap Karadag, Ömer Faruk Elmas, İlknur Kıvanç Altunay Source Type: research
Commentary: Great imitators in dermatology: II
Some diseases, whether in diagnosing them or for their response or lack of response to treatment, continue to be astonishing. This remains so, despite the fact that technology has greatly improved, that we can reach information more quickly, and that we have many more resources now than we had even a decade ago. Even with all of these changes and advances, there are conditions and therapeutic considerations that continue to be challenging —hence, great imitators. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - March 1, 2020 Category: Dermatology Authors: Ayse Serap Karadag Source Type: research
Contact dermatitis: A great imitator
Contact dermatitis (CD) refers to a group of cutaneous diseases caused by contact with allergens or irritants. It is characterized by different stages of an eczematous eruption and has the ability to mimic a wide variety of dermatologic conditions, including inflammatory dermatitis, infectious conditions, cutaneous lymphoma, drug eruptions, and nutritional deficiencies. Irritant CD and allergic CD are the two main presentations of the disease. The diagnosis is based on a detailed history, physical examination, and patch testing, if necessary. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - March 1, 2020 Category: Dermatology Authors: Ömer Faruk Elmas, Necmettin Akdeniz, Mustafa Atasoy, Ayse Serap Karadag Source Type: research
Cutaneous metastases: A great imitator
Neoplastic cells originating from a primary cancer can uncommonly spread to the skin, where they suggest a poor prognosis for the patient. In women, melanoma, breast, ovarian, oral cavity, and lung are the most common primary sources; in men, melanoma, lung, colon, and squamous cell carcinoma of the head and neck predominate. The classic presentation of cutaneous metastases is a firm, painless, flesh-colored to an erythematous dermal nodule (or nodules); however, several other presentations, including inflammatory, cicatricial, and bullous lesions, have been reported. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - March 1, 2020 Category: Dermatology Authors: Joanna Jaros, Samantha Hunt, Eucabeth Mose, Olivia Lai, Maria Tsoukas Source Type: research
Drug eruptions: Great imitators
Drug eruptions are among the great masqueraders that sometimes cause diagnostic challenges in clinical practice. Pharmacologic agents may induce skin changes, sharing the same pathophysiologic mechanisms of specific dermatoses, or inducing drug eruptions with different pathologic mechanisms that have similar clinical presentations. The former conditions are usually called drug-induced skin diseases, whereas the latter conditions are termed “dermatosis–like drug eruptions.” Both types are great imitators in dermatologic practice and can be easily misdiagnosed as other diseases or lead to unrecognized causa...
Source: Clinics in Dermatology - March 1, 2020 Category: Dermatology Authors: Chia-Yu Chu Source Type: research
Drug eruptions associated with tumor therapy: Great imitators
We describe drug eruptions that may be associated with different therapies by class: antimetabolite chemotherapeutics, genotoxic agents, spindle inhibitors, signal transduction inhibitors, and immunotherapies. Methotrexate is most often associated with mucocutaneous reactions, alkylating antimetabolite agents with hyperpigmentation, and platinum antimetabolite agents with type I IgE-mediated hypersensitivity reactions. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - March 1, 2020 Category: Dermatology Authors: Catherine Ludwig, Vivien Goh, Jeffrey Rajkumar, Jeremiah Au, Maria Tsoukas Source Type: research
Langerhans cell histiocytosis: A great imitator
Langerhans cell histiocytosis (LCH) is an uncommon but serious inflammatory neoplasia that affects many organs, including the skin. Though uncommon, it should remain high on a clinician ’s differential diagnosis in treatment-resistant cases of conditions, such as seborrheic dermatitis, diaper dermatitis, arthropod bites, and many more. A thorough history nd physical examination for each patient can aid in the diagnosis; however, if clinically suspicious for LCH, a punch biopsy sh ould be performed. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - March 1, 2020 Category: Dermatology Authors: Kayla St. Claire, Ryan Bunney, Kurt A. Ashack, Michelle Bain, Marylee Braniecki, Maria M. Tsoukas Source Type: research
Cutaneous leishmaniasis: A great imitator
Cutaneous leishmaniasis (CL) is called “the great imitator,” because it can mimic almost all types of dermatoses. This similarity may sometimes lead to misdiagnosis, resulting in inappropriate treatment and morbidities. Atypical forms occur due to the interaction between parasitic factors and the host immune response. Secondary infec tion or mistreatment of CL can also alter the natural course, resulting in bizarre and misdiagnosed cases. Atypical leishmaniasis should be considered in longstanding and painless lesions that may simulate erysipelas, dermatitis, verruca, herpes zoster, paronychia, and sporotrichos...
Source: Clinics in Dermatology - March 1, 2020 Category: Dermatology Authors: Mehmet Salih Gurel, Burak Tekin, Soner Uzun Source Type: research
Cutaneous nocardiosis: A great imitator
Nocardiosis is caused by Gram-positive aerobic bacilli of the Nocardia genus, which are saprophytes living in the soil. It is a rare and opportunist disease with a localized or disseminated infection. When occurring in patients who are immunocompromised, involvement is usually systemic, most commonly represented by pulmonary disease. It can also be acquired through direct inoculation, entailing primary skin and subcutaneous tissue infections, frequently presenting as a localized nodular process. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - March 1, 2020 Category: Dermatology Authors: Marcia Ramos-e-Silva, Roberta Sim ão Lopes, Beatriz Moritz Trope Source Type: research
Sclerodermalike syndromes: Great imitators
Sclerodermalike syndromes (SLSs) comprise diseases with mucin deposition (eg, scleromyxedema, scleredema), with eosinophilia (eg, eosinophilic fasciitis), metabolic or biochemical abnormalities (eg, nephrogenic systemic fibrosis), or endocrine disorders (eg, POEMS syndrome, or polyneuropathy, organomegaly, endocrinopathy, monoclonal lymphoproliferative disorder, and hypothyroidism). Chronic graft-versus-host disease may also show sclerodermalike skin changes. Inherited progeria syndromes with early aging (eg, Werner syndrome) and a heterogeneous group of hereditary disorders with either skin thickening (eg, stiff skin synd...
Source: Clinics in Dermatology - March 1, 2020 Category: Dermatology Authors: Cec ília Varjú, Gábor Kumánovics, László Czirják, Marco Matucci-Cerinic, Tünde Minier Source Type: research
The trustworthiness and transparency in clinical practice guidelines versus the ongoing damaging power of direct and indirect conflict of interest
With the increasing costs of health care, clinical practice guidelines (CPGs) have gained a crucial role in standardizing care, protecting health resources, and assuring their accurate distribution by improving health outcomes. Influencing the outcome of a guideline (by one of the authors, members of the specialty board, or an influential member of the specialty) could result in inappropriate expense to the health care system and profits to investors of the medications/tests/devices that were recommended. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - March 1, 2020 Category: Dermatology Authors: Erisa Alia, Jane M. Grant-Kels Tags: Comment and Controversy Source Type: research
Personal reflections on mentorship as a pathway toward sustaining a joyful dermatologic practice: Part I: Influential mentors during training and early career
The greatest mentors model career paths that are personally fulfilling and intellectually stimulating, provide tangible guidance and boundless encouragement to help mentees discern and achieve their goals, and inspire self-confidence in mentees that translate to success in a variety of areas, including patient care, education, research, and overall life purpose. Mentorship is a readily available resource to all of us and embodies many of the qualities that initially attracted us to the medical profession. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - January 1, 2020 Category: Dermatology Authors: David A. Wetter Tags: Clinics in Dermatology: Contemporary Dermatology Source Type: research
On the mound with melanoma: The Jim Umbricht story
Jim Umbricht (1930-1964) was a Major League baseball pitcher for the Pittsburgh Pirates and Houston Astros (formerly Houston Colt .45s). In 1963, he was diagnosed with stage III malignant melanoma which presented with a right leg pigmented skin lesion and right groin lymphadenopathy. Umbricht was treated at MD Anderson Cancer Center and Tumor Institute in Houston with the relatively new therapeutic modality of isolated limb perfusion. He was able to resume pitching 2 months after the surgery and played the remainder of the baseball season. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - January 1, 2020 Category: Dermatology Authors: Leonard J. Hoenig Tags: Reflections on dermatology: Past, present, and future Source Type: research
The rash that becomes purpuric, petechial, hemorrhagic, or ecchymotic
Hemorrhagic rashes are observed in a wide variety of conditions, ranging from harmless to life-threatening. This review offers a stepwise approach, which helps limit the possible differential diagnoses based on the clinical manifestations and the clinical picture. The most common and most important conditions, including infectious, coagulation and embolic disorders, vasculitides, and vasculopathies, are briefly reviewed focusing on morphology. Dermatologists often need to distinguish among infectious, reactive, or autoimmune etiologies of the rash and determine if the condition is dangerous or even life-threatening in orde...
Source: Clinics in Dermatology - January 1, 2020 Category: Dermatology Authors: Dimitar Antonov, Jivko Kamarashev, Jana Kazandjieva, Teodora Neykova, Nikolai Tsankov Source Type: research
The rash that presents as a vesiculobullous eruption
We present the most typical clinical clues and offer simplified algorithms to the clinical diagnosis of skin conditions with vesicles and bullae. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - January 1, 2020 Category: Dermatology Authors: Ivan Bogdanov, Razvigor Darlenski, Evgeniya Hristakieva, Karen Manuelyan Source Type: research
Dermatoscopy in life-threatening and severe acute rashes
A prompt recognition of life-threatening and severe acute rashes is of utmost importance to start an appropriate therapy as soon as possible. Consequently, clinicians often must rely only on clinical data to make a diagnosis because some diagnostic procedures may take a relatively long time to be performed (eg, histologic examination, microbiologic tests). In this scenario, dermatoscopy may be useful as an auxiliary tool to support the diagnosis by highlighting subclinical features. We have provided an up-to-date overview on the use of dermatoscopic assessment in life-threatening and severe acute dermatoses, including eryt...
Source: Clinics in Dermatology - January 1, 2020 Category: Dermatology Authors: Enzo Errichetti, Giuseppe Stinco Source Type: research
The life-threatening eruption in HIV and immunosuppression
Immunosuppressed patients frequently have skin diseases of mild to moderate intensity. Diagnosis as well as treatment should be performed early to avoid important complications for these patients. Skin eruptions are among these problems. Life-threatening eruptions in HIV and other types of immunosuppression range from acute retroviral syndrome to drug eruptions; immune reconstitution inflammatory syndrome; infection by virus, protozoan, bacteria, or fungi; inflammatory and immune dermatoses; and neoplasia. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - January 1, 2020 Category: Dermatology Authors: Marcia Ramos-e-Silva, Pedro Secchin, Beatriz Trope Source Type: research
The life-threatening eruptions of immune checkpoint inhibitor therapy
Immune checkpoint inhibitors (ICPi) have emerged as a new frontier of cancer therapy. Although monoclonal antibodies to cytotoxic T-lymphocyte associated protein 4 (CTLA-4), programmed cell death 1 (PD-1), and programmed cell death ligand 1 (PD-L1) have revolutionized oncologic management, these agents may result in a spectrum of immune-related adverse events (irAE) of which dermatologic toxicities are among the most frequent. Prompt recognition and management of irAE is essential for dermatologists caring for the expanding population of cancer patients exposed to these drugs. (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - January 1, 2020 Category: Dermatology Authors: Emily L Coleman, Brianna Olamiju, Jonathan S Leventhal Source Type: research
Eruptions in life-threatening rheumatologic diseases
Dermatologic changes occur in a variety of rheumatic diseases. Skin can be the initial site of involvement, thus providing important clues for an accurate diagnosis based on cutaneous findings. Dermatologic findings can also be an indicator of systemic involvement and prognostic outcome; however, many connective tissue disorders have a wide variety of cutaneous manifestations, with significant overlap between different diseases. These skin signs often precede systemic clinical manifestations. Careful attention to characteristic dermatologic findings in Beh çet’s disease, systemic lupus erythematosus, rheumatoi...
Source: Clinics in Dermatology - January 1, 2020 Category: Dermatology Authors: Burhan Engin, Ay şegül Sevim, Seher Küçükoğlu Cesur, Yalçın Tüzün Source Type: research
The rash that presents as a red swollen face
We present in detail the main clinical presentations, diagnostic tests, and management of some of the most severe conditions that can frequently present as a red and swollen face: acute or recurrent angioedema, mast cell-driven or bradykinin-mediated angioedema, nonhereditary and hereditary angioedema, allergic or photoallergic facial contact dermatitis, contact urticaria, severe adverse drug reactions (particularly drug reaction with eosinophilia and systemic symptoms [DRESS]), skin infections (erysipelas, cellulitis, necrotizing fasciitis), and autoimmune diseases (dermatomyositis). (Source: Clinics in Dermatology)
Source: Clinics in Dermatology - January 1, 2020 Category: Dermatology Authors: Mariana Batista, Margarida Gon çalo Source Type: research