Novel approaches in the treatment of Hansen's disease (Leprosy): a case series of multidrug therapy of monthly rifampin, moxifloxacin, and minocycline (RMM) in the United States.

The World Health Organization (WHO) recommends multidrug therapy (MDT) for the treatment of paucibacillary and multibacillary forms of leprosy, also known as Hansen's disease (HD). MDT combinations of dapsone, rifampin, and clofazimine have reduced the prevalence of the disease but are not without adverse effects impacting regimen adherence. Hence, an urgent need exists to consider alternative MDT regimens with an improved safety profile that promotes treatment adherence. Herein, we described a case series of 10 patients with HD (nine patients with multibacillary leprosy and one with pure neural leprosy) treated with monthly rifampin, moxifloxacin, and minocycline (RMM). The United States National Hansen's Disease Program (NHDP) diagnosed and treated patients across US institutions. All patients received a regimen of 12-24 months of RMM. We reviewed the clinical outcomes, adherence, rate of completion, and adverse events of patients treated with monthly RMM from January 2019 to August 2022. Nine patients had multibacillary leprosy, with some having type-2 reactions. One patient had pure neural leprosy with a reversal reaction. In this case series, we identified that all patients completed the RMM regimen without treatment interruptions. None of the patients experienced any skin hyperpigmentation or any significant side effects. All patients tolerated the monthly RMM regimen with rapid improvement of skin lesions and without logistic hurdles. Based on previous clinical evidence and the results of this case series, the NHDP and other programs should consider the RMM regimen as first-line therapy.

Pediatric teledermatology--a survey of current use.

Demand for pediatric dermatologic care far exceeds the supply of pediatric dermatologists. Teledermatology has been proposed as a solution to improve access to care, however, data regarding teledermatology use for pediatric patients are lacking. Surveys assessing use and experience with teledermatology were administered to pediatric dermatologists attending the 2006 Society for Pediatric Dermatology Annual Meeting and to programs offering teledermatology identified in the American Telemedicine Association's 2003 Teledermatology Survey. Over half of the 76 pediatric dermatologists responding to the survey had previous experience with teledermatology and nearly half currently use some form of teledermatology. For most, this represents nonreimbursed, store-and-forward consultations. Respondents noted that teledermatology allows more accurate triage of dermatology patients, decreases travel and outpatient clinic visits, and provides an avenue for ongoing support and education for primary care physicians. While difficulties exist, overcoming obstacles to the use of pediatric teledermatology and reimbursement for such services could improve access to expert pediatric dermatologic care.

Neutrophilic panniculitis in infancy: a cutaneous manifestation of juvenile rheumatoid arthritis.

Neutrophilic panniculitis is rare and is classified as a panniculitic member of the neutrophilic dermatoses spectrum. In affected patients, an underlying systemic disease, such as myelodysplasia, is often present. We describe an infant with juvenile rheumatoid arthritis who developed neutrophilic panniculitis. Neutrophilic panniculitis clinically mimics other panniculitides and biopsy specimen can be diagnostic. Identification of this entity can aid the diagnosis of the underlying systemic process.

An overview of cutaneous mosaicism.

Cutaneous mosaicism is a poorly understood but relatively common dermatological finding. This paper reviews basic concepts of mosaicism as well as common and rare mosaic skin disorders.

Common sports-related dermatologic infections.

All athletes have an increased risk of cutaneous infections. In both team and individual sports the skin is exposed to a range of infectious organisms. While effective therapies exist, preventive measures can decrease outbreaks of most sports-related dermatologic infections. This article highlights common dermatologic infections of the athlete, their prevention and treatment.

Teledermatology in Missouri and beyond.

The practice of teledermatology has grown considerably in rural and frontier areas where access barriers exist. Live-interactive and store-and-forward modalities are used, either alone or in combination (hybrid model). Research has shown that the diagnoses made and management recommended during teledermatology interactions are in concordance with in-person diagnosis and treatment. Many patients worldwide have limited access to expert dermatological care and the current technology is increasingly offering access for these patients.

Multiple triangular lunula unguis: a specific finding for the nail-patella syndrome.

In this case presentation recognition of multiple triangular lunula unguis led to the diagnosis of the rare nail-patella syndrome (NPS). A single triangular lunula may be traumatic in origin, but multiple, with apex pointing toward the free edge of the nail, must be considered part of the NPS especially when combined with absence of the distal interphalangeal joint creases.

"Free-floating" desmosomes in lipoid proteinosis: an inherent defect in keratinocyte adhesion?

The classic features of lipoid proteinosis - beadlike papules and hoarseness - result from the accumulation of hyaline material in the mucocutaneous dermis. However, the characteristic manifestation in children - erosive, crusted lesions that lead to scarring - is rarely discussed and poorly understood. Lipoid proteinosis results from mutations in extracellular matrix protein 1, but the function of this protein is largely unknown. We performed ultrastructural studies on lesional epidermis, cultured monolayer keratinocytes, and raft keratinocyte cultures from blistering lesions of a child with lipoid proteinosis. All sections showed the dissociation of relatively intact desmosomes from keratinocytes, with desmosomes that were "free-floating" in the intercellular spaces or attached by thin strands to the cell membrane. These changes were present in serial sections of both tissue and cultured keratinocytes, suggesting this observation to be an inherent feature of keratinocytes devoid of extracellular matrix protein 1, rather than an artifact. Although additional patients should be studied, the diminished appearance of the inner dense plaque - the region of attachment of keratin intermediate filaments to desmosomal proteins - provides preliminary evidence that extracellular matrix protein 1 may participate in attaching keratin intermediate filaments to desmosomal region protein(s).

Cutaneous findings in congenital disorders of glycosylation: the hanging fat sign.

The congenital disorders of glycosylation are a group of rare metabolic disorders with predominantly neurologic findings. Some variants of this disorder also exhibit cutaneous manifestations. We report a patient with a congenital disorder of glycosylation type Ia, the most common form, with emphasis on the cutaneous findings of this type, and summarize the cutaneous findings in the other forms of the disorder.

Acquired raised bands of infancy: association with amniotic bands.

Raised limb bands are a recently described disorder characterized by skin-colored linear plaques typically located on the extremities of affected children. Various etiologies for their development have been proposed, including amniotic bands. We report a child with extensive raised bands of the trunk and extremities and documented amniotic bands in utero. We propose altering the name of this entity to reflect the wider potential distribution of the lesions. The presence of documented amniotic bands and other sequelae typical for the amniotic band sequence in this patient strongly implicates amniotic bands or related pathology in the formation of acquired raised bands of infancy.