Perioperative Anxiety Associated With Mohs Micrographic Surgery: A Survey-Based Study.

BACKGROUND: Mohs micrographic surgery (MMS)-associated anxiety is an important issue that remains poorly discussed. Identifying risk factors for MMS-associated anxiety will better equip physicians to manage patients' preoperative anxiety and result in improved patient satisfaction and outcomes. OBJECTIVE: This study aims in identification of risk factors that may play a role in MMS-associated anxiety among patients with nonmelanoma skin cancer. METHODS: A cross-sectional case series was conducted among MMS patients collect information on patient demographics and surgical locations and to measure perioperative anxiety and quality of life (QoL). In addition, adjusted linear and logistic regression analyses were performed to identify potential risk factors that predict MMS-associated anxiety. RESULTS: Significant increases in perioperative anxiety were associated with the eyelid area compared with the noneyelid facial area and nonfacial area ( p ≤ .05). Patients with graduate degrees exhibited less anxiety compared with ones who received less education ( p ≤ .05). Higher perioperative anxiety was associated with a greater impact on QoL ( p ≤ .05). CONCLUSION: This study identified that surgical location and the patient's educational level are 2 critical predicting factors for perioperative anxiety. Furthermore, perioperative anxiety could negatively affect a patient's quality of life and warrants further investigation into effective management.

Ketogenic Diet-induced Prurigo Pigmentosa (the "Keto Rash"): A Case Report and Literature Review.

Prurigo pigmentosa (PP) is a rare inflammatory dermatosis of unknown etiology that primarily affects adolescents and young adults. It is typically characterized by a pruritic eruption of erythematous papules on the trunk and neck that evolves into reticulate hyperpigmentation upon resolution of the inflammatory phase of the rash. It has been associated with various triggers, including the metabolic state of ketosis. Interestingly, the recent increase in popularity of the ketogenic diet for weight loss has led to an increased number of PP cases reported in the literature. We present a case of PP in a 21-year-old Hispanic man, which erupted during strict adherence to a ketogenic diet. We conducted a literature review and identified 19 other cases of PP related to ketogenic diet. While PP has historically been reported primarily in Asia, we found cases occurring in patients of Middle Eastern, Caucasian, Hispanic, Asian, and African descent. On average, the rash presented 31 days after initiating the diet and subsided 18 days after diet cessation. Most cases were treated with an oral tetracycline and resolved with residual hyperpigmentation. We present this information to highlight the increasing association of PP with the ketogenic diet so that early diagnosis and treatment and optimal patient outcomes may be achieved. Dermatologists should be aware of the timing of rash onset and resolution in relation to the diet.

Development of Periungual Pyogenic Granuloma with Associated Paronychia Following Isotretinoin Therapy: A Case Report and a Review of the Literature.

The development of periungual pyogenic granulomas while taking the oral acne drug isotretinoin is a known yet uncommon and potentially severe side effect of the oral vitamin A derivative. Previous reports have detailed the development of pyogenic granulomas most commonly arising at sites of previous acne lesions as well as both subungual and periungual locations, with associated paronychia, bleeding, and discomfort. This is thought to arise as a result of the nail bed's fragility and propensity toward spicule formation brought on by the proliferative action of isotretinoin. Here, we report a case of periungual pyogenic granuloma with associated paronychia in a patient taking oral isotretinoin. A review of the pathogenesis and available treatment modalities based on the current literature is provided.

Ice pack-induced perniosis: a rare and underrecognized association.

Perniosis, or chilblain, is characterized by skin lesions that occur as an abnormal reaction to exposure to cold and damp conditions. It can present as an idiopathic dermatosis or in association with an underlying connective tissue or autoimmune disease. Differentiation by histopathologic examination is controversial. Herein, we report a unique case of a 73-year-old woman who developed acquired perniosis on the buttocks from the use of ice packs to treat chronic low back pain.

A rare case of primary cutaneous diffuse large B-cell lymphoma, leg type.

Primary cutaneous diffuse large B-cell lymphoma, leg type (DLBCLLT) is a rare, intermediately aggressive form of primary cutaneous B-cell lymphoma (CBCL) that is characterized by the presence of large round cells on histopathology. Clinically, patients present with red-brown nodules on the distal legs. The prognosis is less favorable than other types of CBCLs, with a 5-year survival rate of 50%. We present a case of primary cutaneous DLBCLLT in a 74-year-old woman. A comprehensive review of cutaneous T-cell lymphoma and CBCL also is provided, along with a discussion of the T-cell and B-cell forms of pseudolymphoma.