Association between psoriasis and cardiometabolic comorbidities in a racially and ethnically diverse low-income primary care population.

Psoriasis is associated with cardiometabolic comorbidities, including obesity, diabetes, hyperlipidaemia and hypertension. Many studies that established these associations originated from primarily White and/or relatively affluent populations. To evaluate whether there is a differential risk for cardiometabolic comorbidities in racial/ethnic minorities, we performed a cross-sectional analysis comparing cardiometabolic comorbidities between those with and without psoriasis in a racially and ethnically diverse population of 56 987 low-income patients, stratified by race/ethnicity, and assessed whether race/ethnicity acts as an effect modifier for cardiometabolic comorbidities. We found that psoriasis was statistically significantly associated with obesity, diabetes, hyperlipidaemia and hypertension. The association of psoriasis with comorbidities did not differ significantly by race/ethnicity; thus, we did not find evidence of effect modification. However, our diverse, low-income population had an extremely high baseline prevalence of cardiometabolic comorbidities compared with previous populations studied. Our results suggest education and intervention regarding modifiable risk factors are particularly important among vulnerable populations.

Patient Perspectives on Social Risk Screening and Documentation in a Dermatology Clinic.

Importance: Providing person-centered dermatologic care includes consideration of social risk factors, such as housing instability and unreliable transportation, that may affect clinical management. Patients' perspectives on social risk screening and documentation in dermatology clinics have not yet been evaluated. Objective: To understand patients' perspectives on social risk screening and documentation in a dermatology clinic. Design, Setting, and Participants: This mixed-methods study used a survey and semistructured interviews and was conducted in a general dermatology clinic at a large urban public hospital. Patients at the clinic were eligible to complete the survey if they were 18 years or older; able to speak and read English, Spanish, or Cantonese; and comfortable using a computer tablet. Survey participants who preferred to use English were eligible for interviews. The survey included social risk screening questions, measures of acceptability, and questions on social risk factors associated with patient acceptability. Semistructured interviews were conducted to explore attitudes and beliefs about social risk screening and documentation. Survey and interview findings were integrated during data analysis through development of themes and joint display. Data were analyzed from December 2021 to April 2023. Main Outcomes and Measures: There were 2 outcome measures of acceptability: appropriateness of screening in a dermatology clinic and comfort with documentation of social risk in the electronic health record (EHR). Results: A total of 135 participants (including 73 males [54.1%]) answered both measures of acceptability in the survey. Of these participants, 116 (85.9%) reported that social risk screening in their dermatology clinic was very or somewhat appropriate and 85 (63.0%) reported being completely or somewhat comfortable with having their social risks documented in the EHR. Themes that were developed from surveys and interviews were the (1) role of interpersonal factors in willingness to disclose social risks, (2) implications of institutional trust for willingness to disclose and comfort with documentation, and (3) relevance of screening in a dermatology clinic. Conclusions and Relevance: Results of this study showed that most participants found social risk screening to be appropriate in a dermatology clinic, although a smaller proportion of participants were comfortable with EHR documentation of their social risks. Optimizing patients' trust in their physicians and the medical system, while addressing privacy and discrimination concerns, may help facilitate disclosure of social risks.

Management of Neovaginal Secretions After Salvage Gender Affirming Right-Colon Vaginoplasty Using Glycopyrrolate.

Purpose: We report a novel case of a transgender woman who experienced excess mucosal secretion leading to symptomatic skin irritation after her colonic vaginoplasty successfully treated with glycopyrrolate. Methods: This is a case report of a 47-year-old transgender woman with symptomatic excess mucosal secretion and skin irritation from colonic vaginoplasty, and we describe her treatment course and responses. Patient consent was obtained for publication. Results: The patient's chronic neovaginal discharge improved with glycopyrrolate. Conclusions: Anticholinergic drugs may be helpful in treating patients who experience chronic neovaginal discharge following colonic vaginoplasty.

15-Year Diversity Trends Among Dermatology Resident Trainees Compared With Other Specialties.

This cross-sectional study examines racial and ethnic diversity trends among dermatology resident trainees and applicants compared with other specialties.

Treatment modalities in brachioradial pruritis: a systematic review.

INTRODUCTION: Brachioradial pruritis is a rare dysesthesia syndrome that is known to negatively impact quality of life. No consensus exists regarding optimal treatment strategies. METHODS: We searched MEDLINE, EMBASE, and the Cochrane Collaboration Clinical Trials Registry from 1966 to 2021 for studies using the title word "brachioradial pruritis" with no language restriction. One author (A.Z.) screened and performed full article reviews of all randomized clinical trials, cohort studies, case-control studies, case reports, and case series describing treatment outcomes among patients with brachioradial pruritis. RESULTS: We identified 239 potential articles with a final set of 45 articles meeting inclusion criteria. Only a single randomized clinical trial was identified, finding no significant benefit of topical capsaicin cream. Treatment modalities with the greatest number of reported successful therapeutic trials include gabapentin and tricyclic antidepressants. In patients with confirmed cervical spine disease, spine-directed therapies such as epidural injections were found to be beneficial. Case reports and small case series describing less-common treatments were also identified. DISCUSSION: The literature is overall limited with the greatest support for gabapentin, pregabalin, tricyclic antidepressants, and spine-directed therapies in appropriate patients with brachioradial pruritis. Future randomized clinical trials are needed to compare the relative effectiveness of available treatments.

Cystic Neutrophilic Granulomatous Mastitis Regression with the Tumor Necrosis Factor-α Inhibitor, Adalimumab.

Idiopathic granulomatous mastitis (IGM) is a rare, benign, inflammatory breast disease that primarily affects parous women within a period of five years post-partum. Cystic neutrophilic granulomatous mastitis (CNGM) is clinically identical to IGM, but histopathology demonstrates distinct central lipid vacuoles rimmed by neutrophils with an outer cuff of epithelioid histiocytes/granulomas, with inconsistent presence of Coryneform bacteria within the vacuoles. There is no consensus on the treatment for either IGM or CNGM, which may be managed surgically with wide local excision or mastectomy or medically with antibiotics, steroids, and steroid-sparing immunosuppressive agents. We present a 30-year-old woman with plaque psoriasis and CNGM whose breast symptoms resolved after treatment with the tumor necrosis factor alpha (TNF-α) inhibitor adalimumab, which has not previously been described as a treatment option for CNGM.

Incidence and Characteristics of Delayed Injection Site Reaction to the mRNA-1273 Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Vaccine (Moderna) in a Cohort of Hospital Employees.

BACKGROUND: mRNA SARS-CoV-2 vaccines are administered to 2 million individuals per day in the United States under US Food and Drug Administration emergency use authorization. METHODS: Observational cohort study of hospital employees who received their first SARS-CoV-2 mRNA vaccination between 14 December 2020 and 8 January 2021, including employees who reported onset of an injection site reaction ≥48 hours after administration of their first or second dose to an employee hotline. RESULTS: Thirteen female employees who received the mRNA-1273 vaccine (Moderna) during the first 3 weeks of the SARS-CoV-2 vaccine rollout at San Francisco General Hospital reported a pruritic rash at the injection site appearing 3 -9 days after receipt of their initial dose. Five had milder or similar reactions with earlier onset after the second dose. One additional female employee reported this delayed reaction only after the second dose. None reported serious adverse events or had symptoms severe enough to seek medical attention. These cases represented 1.1% of the 1275 female employees who received their first mRNA-1273 dose and 2.0% of the 557 who were aged 31 -45 years during this initial vaccine rollout. None of 675 males who initiated mRNA-1273 or 3612 employees of any sex who initiated BNT162b (Pfizer) vaccination during this period reported delayed-onset reactions. CONCLUSIONS: These results suggest that delayed-onset, injection site pruritic rashes after mRNA-1273 SARS-CoV-2 vaccine administration, lasting up to 1 week, occur commonly in females, do not lead to serious sequela, and should not deter receipt of the second vaccine dose.

Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases.

BACKGROUND: Cutaneous reactions after messenger RNA (mRNA)-based COVID-19 vaccines have been reported but are not well characterized. OBJECTIVE: To evaluate the morphology and timing of cutaneous reactions after mRNA COVID-19 vaccines. METHODS: A provider-facing registry-based study collected cases of cutaneous manifestations after COVID-19 vaccination. RESULTS: From December 2020 to February 2021, we recorded 414 cutaneous reactions to mRNA COVID-19 vaccines from Moderna (83%) and Pfizer (17%). Delayed large local reactions were most common, followed by local injection site reactions, urticarial eruptions, and morbilliform eruptions. Forty-three percent of patients with first-dose reactions experienced second-dose recurrence. Additional less common reactions included pernio/chilblains, cosmetic filler reactions, zoster, herpes simplex flares, and pityriasis rosea-like reactions. LIMITATIONS: Registry analysis does not measure incidence. Morphologic misclassification is possible. CONCLUSIONS: We report a spectrum of cutaneous reactions after mRNA COVID-19 vaccines. We observed some dermatologic reactions to Moderna and Pfizer vaccines that mimicked SARS-CoV-2 infection itself, such as pernio/chilblains. Most patients with first-dose reactions did not have a second-dose reaction and serious adverse events did not develop in any of the patients in the registry after the first or second dose. Our data support that cutaneous reactions to COVID-19 vaccination are generally minor and self-limited, and should not discourage vaccination.

Impact of Teledermatology Program on Dermatology Resident Experience and Education.

Background: Despite many dermatology residency programs establishing teledermatology programs, few studies have analyzed its impact on resident education. Introduction: We evaluated the University of California, San Francisco School of Medicine teledermatology program at the Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG). We sought to evaluate resident perspectives on teledermatology and quantify its effects on the number of cases evaluated. Materials and Methods: Each week, dermatology residents triage new teledermatology referrals under the supervision of a dermatology attending. We anonymously surveyed dermatology residents and recent graduates who participated in teledermatology and evaluated responses through inductive thematic analysis. We also used administrative records to compare the productivity ratio (cases evaluated per hour) in clinic versus in teledermatology from June to December 2017. Results: Fifteen out of 21 (71%) potential respondents completed the survey. Five primary content areas emerged through the analysis, with teledermatology providing high caseload, a low-stress learning environment, and opportunities to consider a broad differential diagnoses while developing visual diagnostic and triaging skills. Residents had a productivity ratio of 4.55 (680.7 patients/149.7 h) in dermatology clinic versus 11.49 (299.7 patients/26.1 h) in teledermatology sessions. Discussion: Our thematic analysis to identify the most valued components of teledermatology is novel and can aid the design of teledermatology programs in other settings. We also found that residents evaluated twice the number of patient cases per unit time, with the implication that teledermatology can catalyze the development of visual morphology abilities. Conclusions: Teledermatology is viewed positively by dermatology residents and enables efficient case review by residents.