Dissecting cellulitis of the scalp associated with peripheral and axial spondyloarthritis: report of a case and review of the literature.

Dissecting cellulitis of the scalp (DCS) is a rare, primary neutrophilic cicatricial alopecia of unknown etiology. The disease follows a chronic, relapsing, and remitting course which may ultimately lead to scar formation and alopecia. The association of seronegative peripheral and/or axial spondyloarthritis in patients with hidradenitis suppurativa (HS) and acne conglobata (AC) is well established. However, the occurrence of spondyloarthropathy in patients with either isolated or combined DCS is relatively rare and therefore underrecognized by clinicians. We report a patient with DCS with inflammatory peripheral arthritis and asymptomatic radiographic sacroiliitis. Using PubMed, Ovid, and Google scholar, we searched for case reports of inflammatory arthritis in HS, AC, and DCS in the English literature from 1982 to present. We identified 12 patients with DCS who had associated spondyloarthropathy with adequate clinical details for a systematic analysis. We outline key clinical features, radiographic findings, and treatment utilized for these patients. Seronegative axial and peripheral spondyloarthritis may occur in the setting of isolated DCS as well with concomitant HS and AC. The inflammatory arthritis often develops during acute flares of the cutaneous disease. Choosing optimal drug therapy may be challenging. Current options include anti-TNF-α medications, which have been reported to be effective for both the cutaneous lesions and the associated spondyloarthritis. The complex pathophysiology of the conditions that comprise the follicular occlusion triad warrants further research into the potential role of additional biologic agents.

Pine tar callus: A mimicker of a melanocytic lesion.

We report a case of acral pigmented lesions due to pine tar, a common compound used on baseball bats to improve grip, deposition. The patient presented with an acute concern for a new melanocytic lesion, and dermoscopy revealed large brown globules, not typical of melanocytic neoplasms. We propose that the coupling of dermoscopy and a thorough clinical history of exogenous exposures in similar clinical presentations can provide reassurance in evaluating atypical appearing pigmented lesions.

Management of Persistent Pruritus and Lichenoid Reaction Secondary to Nivolumab With Narrowband Ultraviolet B Phototherapy.

Immune checkpoint inhibitors targeting the programmed cell death receptor 1 (PD-1) are increasingly used to treat several malignancies, with the most common adverse event being cutaneous toxicity. We report the case of a 68-years-old man with stage IV non-small cell lung cancer treated with nivolumab who developed a pruritic, lichenoid eruption refractory to treatment with topical or systemic steroids, who was started on narrow band ultraviolet B therapy which resolved the reaction.

Sun Protection Behaviors in Head Start and Other Early Childhood Education Programs in Illinois.

Importance: Sun safety attitudes developed in early childhood can reduce lifetime UV radiation exposure and the risk of skin cancer. Objective: To assess the current policies, practices, and attitudes among caregivers regarding sun protection in children aged 2 to 6 years. Design, Setting, and Participants: A survey of 202 administrators or managers and teachers of Illinois Head Start/Early Head Start (HS/EHS) and day care centers was conducted from July 3 through 21, 2017. Organizations were randomly selected from 4 lists of urban, suburban, town, and rural locations and stratified to ensure population-based proportional representation of the Illinois population vulnerable to UV exposure. Program administrators or managers participated in a 5- to 10-minute telephone interview that assessed importance of health and sun protection behaviors, program practices, and demographic characteristics. Data analysis was conducted August 2, 2017. Main Outcomes and Measures: Outcomes included attitudes toward the importance of health behaviors in comparison with sun protective behaviors, reported use of sun protection (seeking shade, scheduling outdoor activities, sun protective clothing, and sunscreen practices), and sunburn prevalence. Results: Respondents (from 102 HS/EHS programs with 52% boys overall and a mean [SD] child age of 2.5 [0.5] y and 100 day care programs with 49% boys and age of 2.3 [0.4] y) stated that the 3 most important habits were good nutrition (66 [64.7%] HS/EHS, 71 [71.0%] day care), adequate exercise (41 [40.2%] HS/EHS, 55 [55.0%] day care), and brushing teeth (35 [34.3%] HS/EHS, 38 [38.0 %] day care). Scheduling outdoor activities to avoid peak sun intensity was performed less by HS/EHS programs (46 [45.1%]) in comparison with day care programs (71 [71.0%]; P < .001). Sunscreen was provided for students in 109 programs, but 84 (77.1%) did not allow children to apply sunscreen themselves. Half of the programs (100 of 202 [50.0%]) used spray sunscreen to avoid unnecessarily touching children. Most programs did not report any children having sunburns (129 [63.9%]) and followed heat index guidelines (114 [56.4%]). Conclusions and Relevance: Administrators and teachers did not identify sun safety as one of the most important health habits. While spray sunscreen was used frequently, avoiding spraying sunscreen directly on a child's face, which may get it into the child's eyes, was not done. The heat index was widely used to determine outdoor playtime. Adopting UV index policies could help prevent sunburns in early spring when the heat index is low but UV index is high. Dermatologists may assume responsibility for educating the administrators about the danger of spraying sunscreen into a child's face and the advantage of using the UV index to determine when sun protection is needed.

Methodology for a mixed-methods multi-country study to assess recognition of and response to maternal and newborn illness.

BACKGROUND: Although maternal and newborn mortality have decreased 44 and 46% respectively between 1990 and 2015, achievement of ambitious Sustainable Development Goal targets requires accelerated progress. Mortality reduction requires a renewed focus on the continuum of maternal and newborn care from the household to the health facility. Although barriers to accessing skilled care are documented for specific contexts, there is a lack of systematic evidence on how women and families identify maternal and newborn illness and make decisions and subsequent care-seeking patterns. The focus of this multi-country study was to identify and describe illness recognition, decision-making, and care-seeking patterns across various contexts among women and newborns who survived and died to ultimately inform programmatic priorities moving forward. METHODS: This study was conducted in seven countries-Ethiopia, Tanzania, Uganda, Nigeria, India, Indonesia, and Nepal. Mixed-methods were utilized including event narratives (group interviews), in-depth interviews (IDIs), focus group discussions (FDGs), rapid facility assessments, and secondary analyses of existing program data. A common protocol and tools were developed in collaboration with study teams and adapted for each site, as needed. Sample size was a minimum of five cases of each type (e.g., perceived postpartum hemorrhage, maternal death, newborn illness, and newborn death) for each study site, with a total of 84 perceived PPH, 45 maternal deaths, 83 newborn illness, 55 newborn deaths, 64 IDIs/FGDs, and 99 health facility assessments across all sites. Analysis included coding within and across cases, identifying broad themes on recognition of illness, decision-making, and patterns of care seeking, and corresponding contextual factors. Technical support was provided throughout the process for capacity building, quality assurance, and consistency across sites. CONCLUSION: This study provides rigorous evidence on how women and families recognize and respond to maternal and newborn illness. By using a common methodology and tools, findings not only were site-specific but also allow for comparison across contexts.