ABSTRACT
BACKGROUND: Adequate sun protection practices in chronically immunosuppressed patients can minimize the burden of the most common type of skin cancer in this population. In addition, early recognition of skin cancer by patients can lead to decreased morbidity, and possibly mortality from the disease. Nevertheless, there are significant gaps in the knowledge of sun protection measures and early recognition of skin cancer. OBJECTIVE: The aim of this study is to determine the risk factors of solid organ transplant recipients (SOTRs) for developing skin cancer and their sun exposure education and behavior post-transplantation. MATERIALS AND METHODS: This study evaluates the responses of 107 SOTRs on their outlooks and beliefs of sunscreen usage, skin cancer, and sun exposure knowledge. RESULTS: Our study identified several significant risk factors for the development of actinic keratosis or keratinocyte carcinoma in SOTRs including history of sunburn before age 18, blue eyes, history of tanning bed use, performing monthly skin exams, ability to identify precancerous skin lesions, and history of previous skin examinations. CONCLUSION: A patient-centered approach needs to be used to properly educate patients on effective ways to reduce excessive sun exposure. Regular skin examinations, and patients continued education are necessary components in reducing the burden of skin cancer in SOTRs.
Subject(s)
Organ Transplantation , Skin Neoplasms , Sunburn , Humans , Adolescent , Eye Color , Skin Neoplasms/etiology , Skin Neoplasms/prevention & control , Skin Neoplasms/epidemiology , Sunburn/prevention & control , Sunscreening Agents/therapeutic use , Transplant Recipients , Organ Transplantation/adverse effects , Health Knowledge, Attitudes, PracticeABSTRACT
Epidermolytic acanthomas (EA) are uncommon benign tumors clinically presenting as single to multiple papules. Histologically, EA display hyperkeratosis, hypergranulosis, acanthosis, and epidermal degeneration-also known as epidermolytic hyperkeratosis (EH). EA may be misdiagnosed as condyloma both clinically and histopathologically when located on the genitalia. Thus, this diagnosis carries a significant psychological burden and must remain in the differential when initially considering genital warts. We utilize the case of a 62-year old female referred to dermatology for a 5-year history of multiple pruritic and hypopigmented vulvar papules-misdiagnosed as genital warts-to highlight the impact of differentiating EA from genital warts. This patient was initially misdiagnosed with common genital warts at her gynecologist's office and treated unsuccessfully for years. A shave biopsy was performed and histology revealed EH, consistent with EA.
ABSTRACT
The coronavirus disease 2019 (COVID-19) global pandemic has required dermatology residency programs to convert their learning environment largely to a virtual setting. The impromptu reliance on online lectures, videoconference didactics, and other digital educational resources during this time is welcomed by today's millennial generation of medical trainees and coincides with their learning preferences. Although hands-on direct patient care experiences are currently limited due to reservation of in-office visits for urgent care only, resident participation in teledermatology has permitted them to continue gaining valuable clinical training and may allow for enhanced evaluation of their performance in the future. Given the shown benefits of telemedicine and student preferences for online learning, incorporating these virtual technologies into the curriculum will be essential to advancing dermatology residency education.
Subject(s)
COVID-19/prevention & control , Dermatology/education , Internship and Residency/methods , Telemedicine , Humans , Internet , Learning , SARS-CoV-2 , VideoconferencingSubject(s)
Carcinoma, Basal Cell/diagnostic imaging , Carcinoma, Squamous Cell/diagnostic imaging , Mohs Surgery , Skin Neoplasms/diagnostic imaging , Carcinoma, Basal Cell/pathology , Carcinoma, Basal Cell/surgery , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/surgery , Frozen Sections , Humans , Image Processing, Computer-Assisted , Intraoperative Period , Microscopy , Observer Variation , Referral and Consultation , Reproducibility of Results , Skin Neoplasms/pathology , Skin Neoplasms/surgerySubject(s)
Eczema/etiology , Malnutrition/complications , Adult , Female , Gastric Bypass/adverse effects , HumansABSTRACT
Autoimmune bullous dermatoses are defined by autoantibodies directed against adhesion proteins in the epidermis or basement membrane zone, resulting in blister formation on the skin and mucosa. Diagnosis depends on lesional biopsy for histopathology and perilesional biopsy for direct immunofluorescence. Additional diagnostic methods include indirect immunofluorescence, enzyme-linked immunosorbent assay, and immunoblot (Western blot), which may be selected in specific clinical scenarios due to improved sensitivity and/or specificity. This contribution reviews the available evidence supporting the use of each method to provide a practical reference for clinicians when diagnosing autoimmune bullous disorders. Techniques and cost are reviewed, and newer diagnostic techniques with potential for clinical application are.
Subject(s)
Autoimmune Diseases/diagnosis , Skin Diseases, Vesiculobullous/diagnosis , Autoantibodies/analysis , Autoimmune Diseases/pathology , Biomarkers/analysis , Blotting, Western , Enzyme-Linked Immunosorbent Assay , Epidermis/metabolism , Fluorescent Antibody Technique, Indirect , Humans , Skin Diseases, Vesiculobullous/pathologyABSTRACT
Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by relapsing eczematous rash with severe pruritus and recurrent infection. Topical emollients and immune-modulators (e.g., corticosteroids and calcineurin inhibitor) are first-line therapies for acute flares. In severe refractory cases, systemic immunosuppression may be required. Increased incidence of AD has been documented in heart-transplant children who receive their transplant or thymectomy before the age of 1 year. The treatment of these patients remains a conundrum for dermatologists. We present a case report of a chronically immunosuppressed transplant patient with severe AD treated with dupilumab and in remission for over 2 years with minimal side effects. We will also discuss impact of transplant immunosuppression in the pathogenesis of AD.
Subject(s)
Antibodies, Monoclonal, Humanized/administration & dosage , Dermatitis, Atopic/drug therapy , Dermatologic Agents/administration & dosage , Heart Transplantation , Adolescent , Antibodies, Monoclonal, Humanized/adverse effects , Antibodies, Monoclonal, Humanized/pharmacology , Dermatitis, Atopic/immunology , Dermatologic Agents/adverse effects , Dermatologic Agents/pharmacology , Humans , Male , Th2 Cells/immunologyABSTRACT
Vitiligo is an acquired disorder of pigmentation characterized by the development of white macules and patches on the skin. Although multiple theories have been proposed to understand the underlying pathophysiology behind the pigment loss, the exact etiology remains unknown. Vitiligo universalis is an extremely rare variant that causes nearly complete depigmentation of the entire body surface. Treatment is challenging, especially when pigment loss is generalized and diffuse. We present a unique case of a patient with vitiligo universalis that had remained untreated and stable for >20 years until she developed repigmentation shortly after initiation of dialysis.
ABSTRACT
Prolidase deficiency is a rare autosomal recessive disorder characterized by cutaneous ulcers, facial dysmorphism, recurrent infections, and intellectual disability. We report a unique case of a 6-year-old boy with prolidase deficiency and Crohn's disease who presented with lower extremity ulcers. Cutaneous ulcers due to prolidase deficiency are historically resistant to treatment, and we report success with the novel use of topical tacrolimus.
Subject(s)
Calcineurin Inhibitors/therapeutic use , Leg Ulcer/drug therapy , Prolidase Deficiency/complications , Tacrolimus/therapeutic use , Administration, Topical , Child , Humans , Leg Ulcer/genetics , Male , OintmentsSubject(s)
Erythema Multiforme/diagnosis , Lupus Erythematosus, Cutaneous/diagnosis , Adult , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , SyndromeABSTRACT
Background: Currently, dermatology residency training requires minimal experience in cosmetic procedures which can be achieved through observation. Objective: To assess education in and expectations for cosmetic procedures during dermatology residency. Materials and Methods: A 20-question survey was electronically distributed to 138 Accreditation Council for Graduate Medical Education-accredited dermatology residency training programs. Results: One hundred fifty surveys were returned. While 74 percent of the responding residents reported plans to integrate cosmetic procedures into their future practice, only 36 percent felt adequately trained. Forty-eight percent of residents received one or less didactic lectures annually. Over 95 percent of residents felt that a more formal curriculum in cosmetic procedures would benefit residency education. Conclusion: There appears to be insufficient didactic and clinical training in cosmetic procedures during dermatology residency to meet resident expectations and future practice habits.
ABSTRACT
BACKGROUND: Solid organ transplant recipients (SOTRs) are at an increased risk of epithelial malignancies, mainly squamous cell carcinoma, and its precursor lesions such as actinic keratoses, warts, and porokeratosis, which may respond to retinoid therapy. OBJECTIVE: To review the published evidence on the efficacy and safety of topical and systemic retinoids for the treatment and prophylaxis of malignant and premalignant conditions that mostly afflict SOTRs. MATERIALS AND METHODS: Systematic review of the literature to summarize the level of evidence and grade of recommendation for retinoid therapy with emphasis in the SOTR population. RESULTS: Acitretin has the highest strength of recommendation (Grade A) for prophylaxis of nonmelanoma skin cancer (NMSC) and treatment and prophylaxis of actinic keratoses in SOTR. In nonimmunosuppressed patients, acitretin and isotretinoin have a Grade B recommendation for treatment of recalcitrant warts. Topical retinoids have not shown efficacy in preventing NMSC in immunocompetent patients. CONCLUSION: Retinoids constitute a highly efficacious alternative for the management of the most common conditions that affect SOTRs. Acitretin has the most robust evidence for chemoprophylaxis in SOTRs. Knowledge about the specific indications and expected side effects of topical and systemic retinoids may help optimize their therapeutic potential.