Clinical interventions aimed at expanding access to dermatologic care
In the United States access to healthcare continues to be a major issue. Although "top down" public policy approaches hold promise for expanding access, a lack of political consensus has hindered progress. A review of the literature was conducted to investigate the efficacy of clinical interventions aimed at expanding access to care from the "bottom up." The greatest improvements in access to care over the past decade have harnessed teledermatology, shared care, appointment scheduling strategies, and team-based care. Optimization of these approaches will require additional population-based, dermatology-...
Source: Dermatology Online Journal - April 14, 2021 Category: Dermatology Source Type: research

Characteristics of patients seen at a dermatology free clinic, 2017-2020: a retrospective chart review
(Source: Dermatology Online Journal)
Source: Dermatology Online Journal - April 12, 2021 Category: Dermatology Source Type: research

Microsatellitosis in Merkel cell carcinoma: a staging quandary
(Source: Dermatology Online Journal)
Source: Dermatology Online Journal - April 12, 2021 Category: Dermatology Source Type: research

A virtual faculty exchange program enhances dermatology resident education in the COVID-19 era: a survey study
One of the many consequences of the COVID-19 pandemic was the cancelation of the 2020 American Academy of Dermatology Annual Meeting. This conference historically features lectures from world-renowned experts in all areas of dermatology, thus providing an important educational experience for dermatology residents. We hypothesized that the cancellation of this meeting produced a substantial educational loss for dermatology residents. To mitigate this impact, we developed a virtual faculty exchange program and surveyed dermatology residents' perspectives on its implementation. All participating residents found the virtual fa...
Source: Dermatology Online Journal - April 12, 2021 Category: Dermatology Source Type: research

Localized bullous pemphigoid after knee replacement surgery
We present a 57-year-old woman who presented with pruritic tense bullae overlying the surgical scar from a knee replacement 6 months prior on her anterior right knee. This case illustrates the potential for localized BP to be triggered by surgical procedures. (Source: Dermatology Online Journal)
Source: Dermatology Online Journal - April 12, 2021 Category: Dermatology Source Type: research

Nivolumab-associated Stevens-Johnson syndrome in a patient with lung cancer
Nivolumab is a fully human immunoglobulin G4 immune checkpoint inhibitor antibody approved for use in the treatment of several malignancies such as lung cancer. Cutaneous reactions to checkpoint inhibitors are frequent, appearing in approximately 40% of patients. Although most of the reactions are well tolerated, these drugs can lead to severe cutaneous adverse reactions, but a quick recognition of the symptoms can significantly decrease their mortality. In this case report, we describe a patient with metastatic squamous lung cell carcinoma suffering from nivolumab-induced Stevens-Johnson syndrome with severe skin denudati...
Source: Dermatology Online Journal - April 12, 2021 Category: Dermatology Source Type: research

Circumscribed palmar hypokeratosis successfully treated with cryotherapy
(Source: Dermatology Online Journal)
Source: Dermatology Online Journal - April 12, 2021 Category: Dermatology Source Type: research

Multicentric reticulohistiocytosis masquerading as cutaneous connective tissue disease
Multicentric reticulohistiocytosis (MRH) is a rare type of non-Langerhans cell histiocytosis characterized by coral-toned papules with predilection for dorsal surfaces in addition to severe arthropathy. It sometimes proves difficult to differentiate these joint and skin findings clinically from certain rheumatologic diseases, primarily dermatomyositis. Herein, we present an 82-year-old woman who presented with the clinical findings described above and was subsequently diagnosed with MRH after biopsy and review of relevant clinical history. Because about 25% of patients diagnosed with MRH have an underlying occult malignanc...
Source: Dermatology Online Journal - April 12, 2021 Category: Dermatology Source Type: research

Cutaneous calciphylaxis of the glans penis presenting as a gangrenous ulceration
We report a 67-year-old man with calciphylaxis revealed by an unusual necrotic ulcer of the glans penis.... (Source: Dermatology Online Journal)
Source: Dermatology Online Journal - April 12, 2021 Category: Dermatology Source Type: research

A survey of osteopathic physician and student authorship in the dermatology literature
(Source: Dermatology Online Journal)
Source: Dermatology Online Journal - April 12, 2021 Category: Dermatology Source Type: research

Keratoacanthoma centrifugum marginatum
(KCM) is an uncommon variant of keratoacanthoma. Keratoacanthoma centrifugum marginatums are most commonly seen on sun-exposed surfaces and present with progressive peripheral expansion and raised, hyperkeratotic borders. Central clearing with atrophy and lack of spontaneous clearance are other key clinical characteristics. The majority of cases are benign with a low risk of metastasis. The size of such growths is variable with reported cases ranging from 5.0cm ×5.0cm to as large as 20.0cm×14.0cm. Treatment options include surgical excision, oral retinoids, and intralesional chemotherapeutics such as methotrex...
Source: Dermatology Online Journal - April 12, 2021 Category: Dermatology Source Type: research

Symmetric facial macules in an Asian woman
Hori nevus, also known as acquired bilateral nevus of Ota-like macules, is a form of dermal melanocytosis found most commonly in women of East Asian heritage. It presents as discrete brown macules on the bilateral cheeks which later coalesce into confluent grey-brown macules and small patches. Herein, we report a classic case of Hori nevus and discuss the histologic findings and differential diagnosis. We also review the proposed pathophysiology, genetic considerations, and treatment options. (Source: Dermatology Online Journal)
Source: Dermatology Online Journal - April 12, 2021 Category: Dermatology Source Type: research

Scleredema diabeticorum in a patient: un uncommon etiology of restrictive lung pattern Escleredema diabeticorum en un paciente: una etiolog ía infrecuente de patrón restrictivo pulmonar
We report a man with a history of poorly controlled diabetes presenting with extensive scleredema adultorum of the trunk in a "cuirasse" pattern associated with restrictive lung disease. Cutaneous ultrasonography revealed a marked thickening of the dermis as well as various echogenic spots in the dermis. Cutaneous hardness secondary to scleredema may cause limited mobility. Therefore, respiratory manifestations may be associated and assessed, mainly in cases of extensive scleredema involving trunk and shoulders. Moreover, cutaneous ultrasonography may be useful to monitor the evolution of scleredema and confirm t...
Source: Dermatology Online Journal - April 12, 2021 Category: Dermatology Source Type: research

Stewart-Treves syndrome: a diagnosis to keep in mind
(Source: Dermatology Online Journal)
Source: Dermatology Online Journal - April 12, 2021 Category: Dermatology Source Type: research

Dermatitis artefacta
(Source: Dermatology Online Journal)
Source: Dermatology Online Journal - April 12, 2021 Category: Dermatology Source Type: research

Syringocystadenoma papilliferum of the scalp
We present a 50-year old woman with a pink-orange plaque and nodule on the scalp, consistent with syringocystadenoma papilliferum that arose within a nevus sebaceus. (Source: Dermatology Online Journal)
Source: Dermatology Online Journal - April 12, 2021 Category: Dermatology Source Type: research

Reactive angioendotheliomatosis associated with antiphospholipid syndrome
Reactive angioendotheliomatosis (RAE) is an uncommon, benign, antiproliferative condition associated with systemic diseases that may cause occlusion or inflammation of the vascular lumina. A link between antiphospholipid syndrome (APS) and RAE has been reported a few times in the literature. Herein, we present a unique case of RAE diagnosed in a patient with primary APS who was well-managed on warfarin and rituximab with no recent thrombotic events. As RAE can precede or follow a diagnosis of APS, the presence of the condition indicates a need to workup for APS and to ensure those with the condition are adequately anticoag...
Source: Dermatology Online Journal - April 12, 2021 Category: Dermatology Source Type: research

Multifocal pyoderma gangrenosum secondary to subclinical diverticulitis: case report and brief literature review
Pyoderma gangrenosum is characteristically associated with inflammatory bowel disease. However, the association between this neutrophilic dermatosis and diverticular disease is scarcely mentioned in the literature. Diverticulitis should be included in the differential diagnosis in patients with pyoderma gangrenosum and gastrointestinal complaints, or even in asymptomatic patients, particularly in the elderly. Misdiagnosis can lead to inadequate treatments and serious complications. (Source: Dermatology Online Journal)
Source: Dermatology Online Journal - April 12, 2021 Category: Dermatology Source Type: research

How the COVID-19 pandemic is affecting graduating dermatology residents and fellows
(Source: Dermatology Online Journal)
Source: Dermatology Online Journal - April 12, 2021 Category: Dermatology Source Type: research

Ectopic extramammary Paget disease in thoracic location
We report the first Latin American confirmed case, to our knowledge, of primary E-EMPD in a 55-year-old man with a 1-year history of asymptomatic thoracic plaque. (Source: Dermatology Online Journal)
Source: Dermatology Online Journal - April 12, 2021 Category: Dermatology Source Type: research

Patient safety in dermatology: a ten-year update
Objective: We update and expand our 2010 article in this journal, Patient safety in dermatology: A review of the literature [4][DH1]. Methods: PubMed at the National Center for Biotechnology Information (NCBI), United States National Library of Medicine (NLM) was searched September 2019 for English language articles published between 2009 and 2019 concerning patient safety and medical error in dermatology. Potentially relevant articles and communications were critically evaluated by the authors with selected references from 2020 added to include specific topics: medication errors, diagnostic errors including telemedicine, ...
Source: Dermatology Online Journal - April 12, 2021 Category: Dermatology Source Type: research

Cutaneous metastasis of a hypopharyngeal squamous cell carcinoma-unusual presentation
Cutaneous metastasis are uncommon and account for only 2% of all skin cancers, but are extremely rare in hypopharyngeal carcinomas. Although often associated with advanced cancer, cutaneous metastasis can be the first indication of relapse or treatment failure. Additionally, the clinical presentation is widely variable, which can make an early diagnosis difficult. New skin lesions should be evaluated in cancer patients to rule out metastases. Herein, we present a patient with an unusual cutaneous metastasis as the first sign of recurrence of a hypopharyngeal carcinoma. (Source: Dermatology Online Journal)
Source: Dermatology Online Journal - April 12, 2021 Category: Dermatology Source Type: research

Erosive pustular dermatosis of the scalp induced by gefitinib: case and review of the literature
We report a patient with erosive pustular dermatosis of the scalp, a neutrophil-mediated skin disease presenting with sterile pustules evolving into erosions and crusts on the scalp, during treatment with the EGFR inhibitor gefitinib for lung cancer. A literature review of the drug-induced cases of this rare entity is provided. (Source: Dermatology Online Journal)
Source: Dermatology Online Journal - March 11, 2021 Category: Dermatology Source Type: research

Generalized milia-like calcinosis cutis in a child with Down syndrome: dermoscopic features
(Source: Dermatology Online Journal)
Source: Dermatology Online Journal - March 8, 2021 Category: Dermatology Source Type: research

CARES Act provider relief fund aid to dermatologists in response to coronavirus disease 2019 (COVID-19)
(Source: Dermatology Online Journal)
Source: Dermatology Online Journal - March 8, 2021 Category: Dermatology Source Type: research

Free open access data sources for dermatology researchers
Free open access data sources are a valuable tool for dermatology researchers and may uncover crucial information about dermatological diseases and delivery of dermatological care. This short review discusses six open access data sources including: National Health and Nutrition Examination Survey (NHANES), National Health Interview Survey (NHIS), National Survey of Children's Health (NSCH), National Ambulatory Medical Care Survey (NAMCS)/National Hospital Ambulatory Medical Care Survey (NHAMCS), Centers for Medicare and Medicaid Services (CMS), and Gene Expression Omnibus (GEO). We explain the role of each data source in d...
Source: Dermatology Online Journal - March 8, 2021 Category: Dermatology Source Type: research

Targetoid lesions in a patient with systemic lupus erythematosus
Rowell Syndrome is a rare presentation of lupus erythematosus manifesting as an eruption of erythema multiforme-like papules and plaques with immunological findings of positive rheumatoid factor, speckled antinuclear antibodies, and/or anti-Ro/La antibodies. This case highlights the unusual and highly debated presentation of Rowell Syndrome in a 66-year-old woman with newly-appearing erythematous, targetoid plaques in the setting of previously diagnosed systemic lupus erythematosus. Skin biopsy revealed histological features of full-thickness epidermal necrosis with focal sub-epidermal separation and a superficial perivasc...
Source: Dermatology Online Journal - March 8, 2021 Category: Dermatology Source Type: research

Vulvar edema: diagnostic clue to Crohn disease
Vulvar lesions are clinically challenging for physicians because the differential diagnosis may include many entities. Vulvar edema is one of the most frequent symptoms and is normally attributed to a local cause. Herein, we present a case report of vulvar Crohn disease (VCD) in a 9-year-old girl, in which skin lesions preceded the systemic gastrointestinal symptoms. Both clinical features and histopathological findings guided us to an early Crohn disease (CD) diagnosis. Dermatologists often have the opportunity to detect systemic diseases at early stages. A good knowledge of the CD skin manifestations could lead to an ear...
Source: Dermatology Online Journal - March 8, 2021 Category: Dermatology Source Type: research

Generalized epidermolytic ichthyosis with palmoplantar hyperkeratosis
We present a 2-year-old girl who presented with erythematous and thick scaling skin. Her condition began at birth as multiple flaccid blisters that would easily break into erosions. There was no history of similar condition nor consanguinity within her family. Skin examination revealed diffuse erythematous skin covered with thick scales and erosion, predominantly on her face, extremities, palms, and soles. The skin histopathology examination showed diffuse parakeratosis with vacuolar and granular degeneration within granular and spinous layers along the epidermis. She was diagnosed with generalized... (Source: Dermatology Online Journal)
Source: Dermatology Online Journal - March 8, 2021 Category: Dermatology Source Type: research

Basal cell carcinoma associated with non-neoplastic cutaneous conditions: a comprehensive review
Basal cell carcinoma (BCC) can be a component of a collision tumor in which the skin cancer is present at the same cutaneous site as either a benign tumor or a malignant neoplasm. However, BCC can also concurrently occur at the same skin location as a non-neoplastic cutaneous condition. These include autoimmune diseases (vitiligo), cutaneous disorders (Darier disease), dermal conditions (granuloma faciale), dermal depositions (amyloid, calcinosis cutis, cutaneous focal mucinosis, osteoma cutis, and tattoo), dermatitis, miscellaneous conditions (rhinophyma, sarcoidal reaction, and varicose veins), scars, surgical sites, sys...
Source: Dermatology Online Journal - March 8, 2021 Category: Dermatology Source Type: research

Hidradenitis suppurativa patient perspectives during the COVID-19 pandemic
(Source: Dermatology Online Journal)
Source: Dermatology Online Journal - March 8, 2021 Category: Dermatology Source Type: research

The use of Goeckerman therapy in managing erythrodermic psoriasis resistant to multiple medications
Erythrodermic psoriasis is a relatively rare, more dangerous inflammatory variant of psoriasis associated with high morbidity and mortality. It can be exceptionally challenging to manage, defeating even the most experienced dermatologist's arsenal of treatment strategies. Goeckerman therapy, a regimen of ultraviolet B phototherapy and crude coal tar, has demonstrable efficacy in severe and recalcitrant plaque-type psoriasis. However, its utility in erythrodermic psoriasis has not been explored within the dermatology literature. Herein, we present a patient with a long-standing history of erythrodermic psoriasis refractory ...
Source: Dermatology Online Journal - March 8, 2021 Category: Dermatology Source Type: research

Progressive nodular histiocytosis: an unusual disorder
We report here a novel case of PNH with dermoscopic description and post-surgical outcome. Our patient presented with pruritic papules and nodules with progression over two years. Dermoscopic examination of large lesions showed multiple telangiectases without ulceration. There was no mucosal involvement. Histopathological analysis of a papule showed a dermal infiltrate composed of histiocytes and many Touton giant cells; a nodule revealed a dermis occupied by spindle cells arranged in a storiform pattern. The nodules were resected and the largest surgical defect, on the forehead, was corrected with A-T advancement flap. Th...
Source: Dermatology Online Journal - March 8, 2021 Category: Dermatology Source Type: research

Response of pruritic scrotal epidermolytic acanthomas to pimecrolimus 1% cream
We describe the first reported case of pruritic scrotal EA successfully treated with topical pimecrolimus. (Source: Dermatology Online Journal)
Source: Dermatology Online Journal - March 8, 2021 Category: Dermatology Source Type: research

Loose anagen syndrome in one identical twin girl
We present a 2-year-old girl with LAS type B whose identical twin sister was unaffected. The diagnosis was confirmed with a painless hair pull test proven to contain anagen hairs with ruffled cuticles on trichoscopy, preventing the need for unnecessary referrals and diagnostic tests. (Source: Dermatology Online Journal)
Source: Dermatology Online Journal - March 8, 2021 Category: Dermatology Source Type: research

Epidermodysplasia verruciformis: report of two patients with autosomal dominant inheritance
Epidermodysplasia verruciformis is a rare genodermatosis associated with mutations in the EVER1/TMC6 and EVER2/TMC8 genes. The inheritance is considered to be autosomal recessive, but reports suggesting an autosomal dominant inheritance indicate disease genetic heterogeneity. Its onset occurs in early childhood and presents as a combination of pityriasis versicolor-like, flat wart-like and seborrheic keratosis-like lesions, with a potential for malignant transformation, mainly squamous cell carcinoma. (Source: Dermatology Online Journal)
Source: Dermatology Online Journal - March 8, 2021 Category: Dermatology Source Type: research

Rosacea videos on social media: A comparison of accuracy, quality, and viewer engagement
Background: Little is known regarding the accuracy, quality, and viewer engagement of video-based online education. Objective: To assess the accuracy, quality, viewer engagement, and viewer experience of rosacea videos on social media. Methods: Reviewers searched "rosacea" and examined videos on YouTube in September 2018. Videos were categorized by source: 1) Healthcare sources: university/professional organizations, industry, and individuals that were healthcare professionals, and 2) Non-healthcare sources: lay media and individuals that were not healthcare professionals. Video accuracy was measured using the Dy...
Source: Dermatology Online Journal - March 8, 2021 Category: Dermatology Source Type: research

Psychodermatology fellowship: is it time?
The fields of dermatology and psychiatry have overlap in the patient populations and diseases they treat. However, there are not currently fellowship opportunities for dermatologists or psychiatrists specifically interested in gaining expertise in psychodermatology. We discuss the logistics of a one-year psychodermatology fellowship, open to residents after completing either dermatology or psychiatry residencies, and the potential benefits that it could bring to both dermatology and psychiatry training programs across the county. (Source: Dermatology Online Journal)
Source: Dermatology Online Journal - March 8, 2021 Category: Dermatology Source Type: research

Surgical instrument disinfection during the era of COVID-19
(Source: Dermatology Online Journal)
Source: Dermatology Online Journal - March 8, 2021 Category: Dermatology Source Type: research

Assessing the effects of topical cannabidiol in patients with atopic dermatitis
(Source: Dermatology Online Journal)
Source: Dermatology Online Journal - March 8, 2021 Category: Dermatology Source Type: research

Inflammatory tinea faciei accompanying multiple annular erythema and facial edema related to Microsporum canis
(Source: Dermatology Online Journal)
Source: Dermatology Online Journal - March 8, 2021 Category: Dermatology Source Type: research

Assessing the utility of the decoy effect on biologic treatment preference
Background: Many patients struggle with choosing and adhering to biologics. Psychological approaches (e.g. decoy effect) may impact patients' choices when selecting a biologic. Objective: Assess whether decoy options influence choice between injectable treatment options. Methods: Following IRB approval, 750 subjects>18 years were recruited through MTurk. Subjects were randomized in a 1:1:1 ratio into the following groups: 1) baseline comparison between a more effective, weekly injection and a less effective, every-three-month injection; 2) baseline with a decoy inferior to the weekly injection; 3) baseline with a decoy ...
Source: Dermatology Online Journal - March 8, 2021 Category: Dermatology Source Type: research

Orf progressiva: giant progressive and destructive infections in the immunocompromised
We present a 43-year-old male ranch owner with a history of renal transplantation who contracted an orf infection from his lamb. The infection recurred despite attempts at debridement, but achieved near complete resolution after treatment with imiquimod and valacyclovir. The histologic findings of orf progressiva are identical to the early stages of classic orf infection and are characterized by epithelial hyperplasia, intracytoplasmic eosinophilic inclusions, and an edematous, vascular dermis. There is no standard treatment for orf progressiva. Surgical excision has frequently resulted... (Source: Dermatology Online Journal)
Source: Dermatology Online Journal - February 5, 2021 Category: Dermatology Source Type: research

Erythematous papules on the penis as first manifestation of metastatic prostate adenocarcinoma
We report a 70-year-old man with asymptomatic reddish papules on the glans penis that histologically showed metastases of prostate adenocarcinoma. He had a medical history of a stage IV undifferentiated prostate adenocarcinoma that was currently being treated with chemotherapy. The medical history of advanced stage prostate adenocarcinoma associated with the clinical and pathological findings confirmed the diagnosis of penile metastatic prostate adenocarcinoma. This is an example of the relevance of a thorough history combined with histopathological and immunohistochemical correlation which allowed the diagnosis of a penil...
Source: Dermatology Online Journal - February 3, 2021 Category: Dermatology Source Type: research

Two cases of mycosis fungoides diagnosed after treatment non-response to dupilumab
(Source: Dermatology Online Journal)
Source: Dermatology Online Journal - February 3, 2021 Category: Dermatology Source Type: research

BRAF L597K mutation: an opportunity to treat
The outcomes of patients with metastatic melanoma (MM) have significantly improved after the introduction of BRAF-specific inhibitors. Herein is reported a patient with MM and non-V600-BRAF mutation who responded to iBRAF/iMEK therapy. In July 2014, a 63-year-old man presented with a 4.1mm-thick V600E-BRAF wild type melanoma on the back. Metastases were identified in one sentinel node and two of 11 subsequently excised lymph nodes, with no signs of distant metastatic disease. In September 2017, lung metastasis was observed and pembrolizumab was started. Progressive disease was apparent at cycle 10 and therapy was switched ...
Source: Dermatology Online Journal - February 3, 2021 Category: Dermatology Source Type: research

Epidermolytic hyperkeratosis of the vulva
Vulvar epidermolytic hyperkeratosis is a benign entity that mimics other malignant and inflammatory vulvar dermatoses clinically and histologically requiring careful clinical pathologic correlation for diagnosis. (Source: Dermatology Online Journal)
Source: Dermatology Online Journal - February 3, 2021 Category: Dermatology Source Type: research

Lupus miliaris disseminatus faciei with complete response to isotretinoin
Lupus miliaris disseminatus faciei is an uncommon type of granulomatous rosacea characterized by a papular eruption in the central regions of the face. A 43-year-old woman presented with an asymptomatic papular eruption on the face that had developed over a period of five months. Physical examination revealed multiple, small, reddish-brown papules, distributed symmetrically on the central area of the face. A biopsy was taken, showing dermal epithelioid cell granulomas with central necrosis and surrounding lymphocytic infiltrate with multinucleate giant cells. No foreign bodies were found in granulomas and no mycobacterial ...
Source: Dermatology Online Journal - February 3, 2021 Category: Dermatology Source Type: research

Pyoderma gangrenosum associated with levamisole-adulterated cocaine in a c-ANCA positive patient
We present a 52-year-old woman with chronic maxillary sinusitis and cocaine use disorder presenting with a two-week history of painful ulcers on bilateral lower extremities, each with a purulent base and undermined, violaceous borders. Urine toxicology was positive for cocaine and serologic... (Source: Dermatology Online Journal)
Source: Dermatology Online Journal - February 3, 2021 Category: Dermatology Source Type: research

An unusual case of pyogenic granuloma-like Kaposi sarcoma
We report an elderly, immunocompetent man with pyogenic granuloma-like Kaposi sarcoma, which was clinically consistent with a pyogenic granuloma and possessed histological findings consistent with Kaposi sarcoma and pyogenic granuloma. (Source: Dermatology Online Journal)
Source: Dermatology Online Journal - February 3, 2021 Category: Dermatology Source Type: research