ABSTRACT
Hidradenitis suppurativa (HS) is a painful, disfiguring, chronic inflammatory disease affecting the axillary, inframammary, and groin regions. Black Americans are disproportionately affected by HS. Structural barriers may be responsible for a lack of better prevention and management. This paper discusses possible reasons that may lead to a more severe presentation and barriers to treatment. Moseley I, Ragi SD, Handler MZ. racial disparities in the treatment of hidradenitis suppurativa: an analysis of data from the National Ambulatory Medical Care Survey. J Drugs Dermatol. 2023;22(7):692-694. doi:10.36849/JDD.6803.
Subject(s)
Hidradenitis Suppurativa , Humans , Hidradenitis Suppurativa/therapy , Hidradenitis Suppurativa/drug therapy , Black or African American , Health Care Surveys , Groin , PainSubject(s)
Biopsy/economics , Biopsy/standards , Skin Neoplasms/pathology , Adult , Female , Humans , Quality ControlABSTRACT
Patients with skin conditions may apply or consume a wide variety of "remedies" with a similarly wide range of effects that may alter the clinical and/or dermatologic presentations of the lesion. Dermatologists or other clinicians should probe for this and carefully document such treatment, as well as any treatment administered by a health care professional or any other person. The dermatopathologist, however, cannot assume that this has been done or done successfully, and therefore must be on constant alert to recognize the effects of such "remedies."
Subject(s)
Diagnostic Errors , Self Care/adverse effects , Skin Diseases/pathology , Adult , Female , Humans , Male , Middle AgedABSTRACT
Erythema ab igne (EAI) is a persistent, chronic skin condition resulting from prolonged exposure to infrared radiation, experienced as heat. Once associated with traditional warming sources like wood burning stoves or open fires, modern, infrared exposure originates also from newer sources like laptops and heating pads and may be creating a rebound of EAI. The epidemiology may be different too, with younger patients than previously seen. Localized EAI over an area of pain in the abdomen or lower back can be a sign of an underlying disorder, including cancer. Prognosis of EAI is good, with removal of the heat source resulting in complete remission. In chronic cases in which premalignant cutaneous dysplasia has resulted, additional treatments may be necessary including topical retinoids, 5-fluorouracil cream, and laser treatments. Rarely, cancers such as squamous cell carcinoma, Merkel cell carcinoma, and cutaneous marginal zone B cell lymphoma have been associated with longstanding EAI.
Subject(s)
Erythema/etiology , Hot Temperature/adverse effects , Infrared Rays/adverse effects , Precancerous Conditions/etiology , Skin Neoplasms/etiology , Abdomen , Back , Chronic Disease , Erythema/therapy , Humans , Prognosis , Technology , ThighABSTRACT
BACKGROUND: No studies have examined the use of topical ingenol mebutate for improvement of photoaged skin. OBJECTIVE: To evaluate clinical results of ingenol mebutate gel applied to photoaged skin and to quantify improvement at 7, 30, and 60 days after application. MATERIALS AND METHODS: Twenty-five subjects were enrolled in the study. Picato (ingenol mebutate) (LEO Pharma, Parsippany, NJ) gel was applied to an area with a known actinic keratosis daily for 3 days. Subjects self-evaluated and were investigator evaluated on 6 characteristics on Days 7, 30, and 60 using an objective scale. The scale evaluated actinic keratosis, overall skin appearance, wrinkling, dyschromia, erythema, and texture. The subjects were also evaluated using the Griffiths' Photonumeric Photoaging Scale for overall improvement. RESULTS: Twenty-two subjects completed the clinical study and demonstrated statistically significant improvement by Day 60 in actinic keratosis, overall skin appearance, wrinkling, dyschromia, erythema, and texture (p < .05). CONCLUSION: Topical ingenol mebutate 0.015% gel produces cosmetic improvement of photoaged skin within 60 days of application.
Subject(s)
Dermatologic Agents/administration & dosage , Diterpenes/administration & dosage , Keratosis, Actinic/drug therapy , Skin Aging/drug effects , Aged , Dermatologic Agents/adverse effects , Diterpenes/adverse effects , Female , Gels , Humans , Male , Middle Aged , Prospective Studies , Skin Aging/radiation effectsABSTRACT
Squamous cell carcinoma (SCC) of the scalp has increased prevalence in older patients and often presents later in life. Mohs micrographic surgery remains the most effective treatment in most cases. Delayed presentation may result in localized bony invasion or distant metastases. We present a case of an elderly woman presenting with extension of SCC into the parietal bone of the skull.
Subject(s)
Carcinoma, Squamous Cell/pathology , Head and Neck Neoplasms/pathology , Parietal Bone/pathology , Scalp , Skin Neoplasms/pathology , Aged, 80 and over , Carcinoma, Squamous Cell/surgery , Female , Head and Neck Neoplasms/surgery , Humans , Mohs Surgery , Neoplasm Invasiveness , Parietal Bone/diagnostic imaging , Positron Emission Tomography Computed Tomography , Skin Neoplasms/surgerySubject(s)
Antineoplastic Agents/therapeutic use , Fluorouracil/therapeutic use , Imiquimod/therapeutic use , Immunosuppression Therapy/adverse effects , Organ Transplantation/adverse effects , Skin Neoplasms/prevention & control , Chemoprevention , Humans , Immunosuppression Therapy/methods , Retinoids/therapeutic use , Skin Neoplasms/etiologySubject(s)
Carcinoma, Basal Cell/therapy , Carcinoma, Squamous Cell/therapy , Immunosuppression Therapy/adverse effects , Immunosuppressive Agents/adverse effects , Organ Transplantation/adverse effects , Skin Neoplasms/therapy , Carcinoma, Basal Cell/etiology , Carcinoma, Squamous Cell/etiology , Humans , Skin Neoplasms/etiologySubject(s)
Carcinoma, Merkel Cell/diagnosis , Immunohistochemistry , Lung Neoplasms/pathology , Skin Neoplasms/diagnosis , Aged , Carcinoma, Merkel Cell/metabolism , Carcinoma, Merkel Cell/secondary , Humans , Keratin-20/metabolism , Lung Neoplasms/secondary , Male , Skin Neoplasms/metabolism , Skin Neoplasms/pathology , Specimen Handling , Staining and Labeling , Time FactorsABSTRACT
BACKGROUND: Lasers and noncoherent intense pulse light sources effectively treat vascular lesions. Intense pulsed light (IPL), a nonablative treatment for photorejuvenation, uses a flashlamp which emits noncoherent light between 400 and 1400 nm. The light may be filtered to target a specific chromophore. The pulsed dye laser (PDL), at 595 nm, has been the historical standard of care in the treatment of facial erythema. We sought to determine whether IPL may be used in lieu of PDL in reducing facial erythema. OBJECTIVES: To determine whether IPL may be used to treat facial erythema with equal efficacy as PDL used at nonpurpuric settings. METHODS: Prospective investigation of a cohort of 15 subjects with unwanted bilateral facial erythema. Subjects presented for two treatments with an IPL (BBL™ BroadBand Light; Sciton, Palo Alto, CA) to one half of the face and PDL (Cynergy™; Cynosure, Westford, MA) to the other half. RESULTS: Patients with facial erythema may be successfully treated with IPL or PDL. CONCLUSIONS: Intense pulsed light and pulsed dye laser with nonpurpuric settings were equally effective in reducing facial erythema.
Subject(s)
Erythema/therapy , Facial Dermatoses/therapy , Intense Pulsed Light Therapy , Lasers, Dye/therapeutic use , Female , Humans , Male , Middle Aged , Prospective Studies , Single-Blind MethodSubject(s)
Coloring Agents , Dermatofibrosarcoma/pathology , Histiocytoma, Benign Fibrous/pathology , Skin Neoplasms/pathology , Antigens, CD34/metabolism , Biomarkers/analysis , Biopsy, Needle , Diagnosis, Differential , Factor XIIIa/metabolism , Female , Humans , Immunohistochemistry , Male , Middle Aged , Risk Assessment , Sensitivity and Specificity , Staining and LabelingABSTRACT
Porphyrias are a group of intriguing genetic diseases of the heme pathway, of which porphyria cutanea tarda (PCT) is the most common. Resulting from a defect in enzymes in the porphyria pathway, PCT has been linked to several conditions. Recent studies have demonstrated a change in thinking regarding the human immunodeficiency virus (HIV) and development of PCT. The exacerbation of PCT with contraction of HIV is now believed to result from coinfection from the hepatitis C virus (HCV). Blistering of sun-exposed skin, a classic presenting sign of PCT, is not exclusive to the condition. Cutaneous findings must also trigger physicians to consider additional types of porphyrias, such as variegate porphyria. The diagnosis of pseudoporphyria, which does not result from enzymatic absence, must be considered in patients with photosensitivity and cutaneous bullae. Recent health food trends, such as chlorophyll, have been linked to pseudoporphyria. PCT is a serious condition in which accurate diagnosis is necessary for appropriate management.
Subject(s)
Disease Progression , Porphyria Cutanea Tarda/diagnosis , Porphyria Cutanea Tarda/enzymology , Diagnosis, Differential , Heme/biosynthesis , Humans , Porphyria Cutanea Tarda/genetics , Porphyria Cutanea Tarda/therapy , Porphyrias, Hepatic/diagnosis , Risk FactorsABSTRACT
Hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome is a rare genetic disorder that predisposes individuals to multiple cutaneous leiomyomas, renal cell carcinomas, and in women, uterine leiomyomas. Also known as Reed syndrome, it is caused by a germline heterozygous mutation of the fumarate hydratase tumor suppressor gene. HLRCC is associated with significant morbidity because of pain from cutaneous and uterine leiomyomas, the cutaneous pain often of unique character. Although genetic testing is currently considered the criterion standard to diagnose HLRCC, newer immunohistochemistry markers may provide rapid and cost effective alternatives to genetic testing. Because of the potentially aggressive nature of renal cell carcinomas that develop as early as in childhood, close annual cancer surveillance is desirable in individuals with HLRCC. In this review, we offer an update and an approach to the diagnosis, management, and renal cancer surveillance in HLRCC.
Subject(s)
Leiomyomatosis/diagnosis , Leiomyomatosis/therapy , Neoplastic Syndromes, Hereditary/diagnosis , Neoplastic Syndromes, Hereditary/therapy , Skin Neoplasms/diagnosis , Skin Neoplasms/therapy , Uterine Neoplasms/diagnosis , Uterine Neoplasms/therapy , Algorithms , HumansABSTRACT
Onychomadesis is the proximal separation of the nail plate from the nail matrix due to a temporary cessation of nail growth. It can occur in children of all ages including neonates. Diagnosis is made clinically through palpation and inspection of the nail plate. Physicians should consider underlying associations. A review of the patient's history for any viral illnesses 1 to 2 months prior to nail changes often will help identify the causative disease. Onychomadesis typically is mild and self-limited. There is no specific treatment, but a conservative approach to management is recommended with treatment of any underlying causes and supportive care. Spontaneous nail regrowth usually occurs within 12 weeks and may occur faster in children. In this article, causes of onychomadesis are described, including the connection between hand-foot-and-mouth disease (HFMD) and onychomadesis. We also explore several theories of possible mechanisms for onychomadesis; however, the precise mechanism remains unclear and further investigation is needed.
Subject(s)
Hand, Foot and Mouth Disease/complications , Nail Diseases/diagnosis , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Nail Diseases/etiology , Nail Diseases/pathology , Time FactorsABSTRACT
Since the beginning of the twenty-first century, there has been a rapid rise in the number of cases of chikungunya. Initially limited to islands of the southwestern Indian Ocean, the virus has spread across Africa and into the islands of the Caribbean. Cutaneous symptoms include a morbilliform eruption, hyperpigmented macules, and aphthae-like ulcers. Patients often also experience fever and joint pain. We review the methods for diagnosis, treatment, and prevention of this increasingly prevalent virus now emerging more commonly in Europe and North America.