Vesicular Eruption Secondary to Bites by Larval Amblyomma americanum.

Tick-borne illness is an increasingly concerning cause of human infectious disease. Not only do ticks transmit disease, but their bites also may cause impressive local reactions. This report highlights a case of a widespread vesicular eruption secondary to bites by larval Amblyomma americanum sustained by a 58-year-old woman. This case posed a diagnostic challenge because of the unusually large number and wide distribution of bites as well as the subsequent vesicular reaction that ensued. It is necessary for dermatologists in tick-endemic areas to keep tick bites in the differential when evaluating vesicular eruptions. In addition, it is important for dermatologists to be aware of the tick species in their area.

Methotrexate-Induced Cutaneous Ulcers: A Rare Side Effect.

Methotrexate is often prescribed for the treatment of autoimmune conditions. There are many well-known side effects of methotrexate, a lesser known side effect is methotrexate-induced cutaneous ulceration. Only eight cases have been reported in the literature. Here we report a ninth case report of methotrexate-induced cutaneous ulceration in a 73-year-old female who had recently had her methotrexate dose increased for her seronegative rheumatoid arthritis. She presented to the emergency department with painful ulcerative nodules on her hands. In addition, laboratory evaluation found her to be pancytopenic. Methotrexate was discontinued and patient was given a dose of leucovorin. Within a couple weeks of methotrexate discontinuation, the ulcers resolved. Our case in addition to a review of the literature suggests that methotrexate-induced cutaneous ulceration may be an indication of life-threatening pancytopenia.

Skin Cancer Prevention and Screening Behaviors among Agricultural Workers: A Survey of the Attendees of the Sioux Falls Farm Show.

INTRODUCTION: Agricultural workers are at a higher risk for skin cancer due to excessive amounts of sun exposure, poor sun safety practices, and limited access to healthcare. This study aimed to assess skin cancer history, sun protection practices, and skin cancer surveillance measures among Midwestern agricultural workers. METHODS: Individuals that attended the 2020 Sioux Falls Farm Show were asked to complete a 12-question survey on sun exposure, sun protective practices, and skin cancer surveillance. Survey responses were aggregated and analyzed using Microsoft Excel. RESULTS: A total of 99 individuals participated in the study, of which 70 identified as agricultural workers. Most individuals reported working outdoors eight to 10 hours daily for 10-12 months of the year. Most participants reported poor sun protection habits, such as limited sunscreen and limited wide-brimmed hat use. A large number of participants reported they had previously received a professional skin check, although 33 percent reported never examining their own skin for suspicious lesions. CONCLUSIONS: Midwestern agricultural workers present a unique population that could benefit from improved skin cancer prevention. Opportunities for improvement include education of skin cancer preventative measures using platforms that are likely to reach rural agricultural workers and education regarding skin self-examinations. This study identified high risk factors of this population including substantial sun exposure, poor sun protection, and minimal self-skin examinations. Our findings may help guide future methods to increase skin cancer education, prevention, and surveillance in agricultural workers.

Skin Cancer Education in the Rural Salon.

INTRODUCTION: Due to an increase in the incidence of skin cancer and a shortage of primary care and specialty physicians in rural areas, creative public health strategies must be employed to address disparities in skin cancer education, prevention, and detection. METHODS: Hair salons in eastern South Dakota communities with populations less than 15,000 were visited in-person by medical student facilitators. Hair professionals at these locations completed pre-survey assessments for baseline self-assessed comfort with detecting suspicious skin lesions and with educating patrons on skin cancer prevention strategies. Their likelihood to both alert patrons of suspicious skin lesions and encourage them to have their lesion evaluated by a physician was also assessed. A 20-minute educational PowerPoint presentation was given. Final assessment was evaluated with a post-presentation survey. RESULTS: Self-assessed hair professional comfort with identifying suspicious skin lesions was higher in post-survey results, in addition, the educational presentation increased comfort with sharing skin cancer prevention information with patrons. Hair professionals also reported increased likelihood that they would alert patrons to suspect skin lesions. Also, hair professionals reported increased likelihood that they would encourage patrons to seek medical care for their concerning lesions. CONCLUSIONS: Hair professionals may act as lay skin cancer educators in rural salons. Educational programs for hair professionals can increase their comfort with detecting lesions suspicious for skin cancer, increase their comfort with sharing skin protection information with patrons, and increase their likelihood of both alerting their patrons about suspicious skin lesions and encouraging their patrons to have their suspicious lesions evaluated.