Efficacy of 785-nm Picosecond Titanium Sapphire Laser for Treatment of Brown Nevus of Ota Lesions in FST II-V: A Retrospective Analysis.

BACKGROUND: Nevus of Ota (NOTA) is a dermal melanocytosis acquired in early childhood or pregnancy. Given their color variability, NOTA often require a combination of wavelengths for successful treatment. Quality-switched lasers have consistently shown efficacy in targeting dermal pigment, while picosecond lasers (PSLs) are an emerging technology for pigmentary disorders. OBJECTIVE: To further elucidate its efficacy, the authors conducted a retrospective review of 17 patients with NOTA treated with a 785-nm PSL for brown NOTA lesions between 2021 and 2023. MATERIALS AND METHODS: The primary end point analyzed clinical improvement based on before and after photography reviewed by 3 board-certified dermatologists using a five-point visual analog scale. RESULTS: Seventeen patients of Fitzpatrick skin types (FSTs) II to V, ranging from ages 14 to 38 years, were included in this study. Patients were treated for an average of 3.2 sessions in 2 to 3-month intervals. Visual analog scale scores demonstrated a mean clearance of 51% to 75%. No pigmentary alterations were noted. CONCLUSION: Because NOTA is common in higher FSTs, the authors believe that the 785-nm PSL is an excellent treatment option for brown NOTA in these skin types. This study highlights the need for further investigation to determine optimal treatment parameters for the color-based laser treatment approach for NOTA.

The diagnostic difficulties of juvenile vulvar pemphigoid.

Mucous membrane pemphigoid is a rare autoimmune disease affecting mucosal surfaces. Pediatric cases are exceptionally rare, one subtype being vulvar pemphigoid. Juvenile vulvar pemphigoid can be challenging to diagnose due to its rarity and subtle initial symptoms. We present a case of an 8-year-old girl successfully diagnosed early in the disease course via histopathology, and immunofluorescence. Detecting MMP can be complex due to variations in epitope binding typically not included in commercial ELISA assays, necessitating comprehensive workup. Missed diagnosis may lead to progression to systemic involvement with severe consequences; thus, timely diagnosis and treatment are crucial.

Resolution of painful trichodysplasia spinulosa with topical cidofovir: case report.

Purpose: Trichodysplasia spinulosa (TS) is a rare, disfiguring skin condition which presents with widespread asymptomatic or pruritic, skin-colored papules with white protruding keratin spiculations in immunocompromised individuals. Due to its rarity, there is little data to guide treatment decisions. The purpose of this article is to report a case of TS that completely resolved after treatment with topical cidofovir.Materials and methods: A 19-year-old immunosuppressed female presented with widespread painful, itchy bumps on the nose and face. Upon examination, there were erythematous papules with hyperkeratinized spicules affecting the central face. Biopsy of the lesions was consistent with TS which was confirmed via PCR analysis. The tenderness of this patient's eruption was highly atypical for TS. Once daily topical application of compounded 1% cidofovir cream was prescribed.Results: The patient's symptoms resolved completely after 4 weeks of therapy with topical cidofovir 1% cream, without reduction of immunosuppression.Conclusions: Topical cidofovir 1% cream may be a valuable treatment for this rare disease.

Painful Foot Lesions: A Case Report.

Hand-foot skin reaction (HFSR) is a documented cutaneous adverse reaction to tyrosine kinase inhibitor (TKI) chemotherapy. Cutaneous toxicities such as HFSR can be debilitating and may result in serious complications; however, continued chemotherapy is desirable to optimize the patient's odds of survival and tumor remission. We present a case of a 66-year-old male, with a history of metastatic renal clear cell carcinoma, who was diagnosed with grade 3 HFSR triggered by axitinib, a tyrosine kinase inhibitor. Our patient was able to expeditiously resume chemotherapy after temporary cessation of axitinib with concurrent application of topical steroids and keratolytics. Expedient return to life-prolonging chemotherapy is of great importance for patients with advanced malignancies; therefore, accurate diagnosis and prompt identification of the offending medication are critical to the management of this entity. We aim to increase the awareness of tyrosine kinase inhibitor-induced HFSR and review the diagnosis and current guidelines for management.

Effects of Blue Light on the Skin and Its Therapeutic Uses: Photodynamic Therapy and Beyond.

BACKGROUND: Blue light is the most energetic portion of the visible light spectrum. Recent awareness of its ubiquity and potential has led to greater developments in therapeutic uses. OBJECTIVE: Provide up-to-date information on the effects of blue light on the skin, with a focus on the benefits and its place in therapeutic modalities within dermatology. MATERIALS AND METHODS: A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for articles related to blue light's effect on the skin and therapeutic modalities using blue light. This search resulted in 223 unique results with 60 articles selected for review. RESULTS: Therapeutic modalities using blue light have been proven to be effective as a monotherapy or component of a comprehensive treatment plan for common dermatologic diseases such as actinic keratosis, acne, cutaneous infections, and psoriasis, and early reports support its use in disseminated superficial actinic porokeratosis and actinic cheilitis. CONCLUSION: The benefits and treatment applications of blue light have proven effective in multiple forms and uses. In the correct setting, blue light can be a useful tool to the practicing dermatologist for many common and sometimes refractory skin diseases while remaining low-risk and convenient. Further standardization and monitoring should be pursued to determine the most appropriate use.

Patient willingness to receive full-body skin exams based on the sex and/or gender and training level of provider: a survey study.

Full-body skin examinations (FBSEs) involve examination of the patient's skin from head to toe, and may be uncomfortable for some patients. While many patients prefer same-sex providers for pelvic, genital and rectal exams, desire for same-sex providers for FBSEs is not well characterized. This may be further magnified when FBSE is performed by medical trainees. We surveyed 566 subjects using Amazon Mechanical Turk (AMT), an online crowdsourcing platform, to assess the public's willingness to receive FBSEs based on the sex and/or gender and the level of training of the healthcare provider (HCP). The overall willingness by all respondents to undergo FBSE performed by a dermatologist, dermatology resident and medical student was 84.3%, 77.5% and 65.7%, respectively, if the HCP was the same sex/gender, compared with 60.6%, 54.8% and 45.7% if the HCP was a different sex/gender (P < 0.001). In our cohort, unwillingness for FBSEs was greater if the patient was female, if the HCP was a different gender/sex from the patient and if the HCP was a medical student.

Gianotti-crosti syndrome in the setting of recent coronavirus disease-19 infection.

Since the onset of the COVID-19 pandemic, the growing body of literature has largely focused on the adult population. Reported symptoms among children appear to be consistent with those in adults, including fever, respiratory symptoms, and gastrointestinal symptoms, though children may experience an overall milder disease course. Viral exanthems with possible association to COVID-19 have been reported in pediatric patients. We describe a 10-month-old boy with Gianotti-Crosti syndrome in the setting of recent SARS-CoV-2 RT-PCR positive testing to increase physician awareness and add to the collection of cutaneous manifestations of COVID-19.

Hyperkeratosis of the left cheek.

A 66-year-old man with a recent history of herpes zoster in the second division of the trigeminal nerve presented with hyperkeratotic plaques along his left cheek and temple. A shave biopsy was found to be consistent with postherpetic hyperkeratosis. This case represents a unique presentation of Wolf's postherpetic isotopic response: a new skin disorder emerging at the site of a previously healed herpetic, predominantly zoster, infection. We aim to increase awareness of an unusual complication of herpes zoster and the importance of appropriate vaccination to help protect patients from these potential postinfection effects.

Pembrolizumab-induced Myositis in the Setting of Metastatic Melanoma: An Increasingly Common Phenomenon.

Pembrolizumab, an anti-programmed cell death protein 1 (PD-1) antibody, has demonstrated efficacy in treating metastatic melanoma. However, a handful of case reports have been published reporting autoimmune phenomena weeks after administration of the first dose of this immunomodulator. Although immunotherapy complications are not well known among dermatologists, they should be cognizant of this association between anti-programmed cell death protein 1 immunotherapy and autoimmune symptomology, since pembrolizumab has become a common therapy for metastatic melanoma. Here, the author presents a case of a patient with metastatic melanoma and a family history of autoimmune disease who presented with myositis in the weeks after receiving pembrolizumab.

The case of the magenta woman (DRESS syndrome).

Drug reaction with eosinophilia and systemic symptoms, otherwise known as DRESS syndrome, is a rare, potentially life-threatening drug-induced hypersensitivity reaction that primarily involves a widespread skin rash, fever, hematological abnormalities, lymphadenopathy, and organ injury. Anti-epileptics, sulfonamides, and allopurinol are the most common triggers, but other offending medications have been reported in the literature. Vancomycin has been increasingly reported over the past 5 years, with 26 cases reported to date. Here we describe a case of a 44-year-old woman who presented with a cutaneous drug reaction with single-organ damage to the kidneys, likely triggered by 1 month treatment of osteomyelitis with intravenous vancomycin. The patient's clinical picture was initially consistent with recurring red-man syndrome that eventually became persistent after failing treatment with infusion rate reduction and diphenhydramine. This case highlights the need for a detailed review of medications taken within 2 months of the onset of the rash, as well as the importance of being cognizant of medications that incite multiple drug reactions.

Kaposi Sarcoma of the Medial Foot in an MSM, HIV-Negative Man: A Fifth Clinical Variant.

Kaposi sarcoma (KS) is a low-grade vascular neoplasm with four well-documented clinical types: classic, African (endemic), acquired immunodeficiency syndrome (AIDS)-associated (epidemic), and iatrogenic, as well as a fifth recently described variant, men having sex with men (MSM) without human immunodeficiency virus (HIV) infection. Often distinguishable on clinical exam, KS lesions are typically found on the skin and mucosa of immunocompromised individuals, though numerous published reports have demonstrated the ability of KS to present in immunocompetent individuals. Here, we present the case of a 66-year-old, HIV-negative MSM with violaceous, non-blanching macules and patches of the medial foot referred to dermatology by his primary care physician. Histopathologic analysis revealed Kaposi sarcoma. Although this patient engaged in same-sex sexual behaviors, his HIV-negative status and otherwise lack of immunocompromise would deter many clinicians from suspecting a diagnosis of KS. Despite therapy, disease prognosis is often dependent upon stage at diagnosis. Therefore, it is important that every clinician understand the cutaneous findings associated with KS and be aware of the higher rates of KS even in HIV-seronegative MSM to facilitate prompt diagnosis and immediate treatment of this high-risk population.

Discovery of IgG4 Anti-Gliadin Autoantibody as a Potential Biomarker of Psoriasis Using an Autoantigen Array.

PURPOSE: Psoriasis is a complex immunological skin disease. However, whether humoral autoimmunity is involved in the pathogenesis of psoriasis remains unclear. The aim is to determine if there are autoantibodies associated with disease activity of psoriasis. EXPERIMENTAL DESIGN: A novel autoantigen array harboring 75 antigens is developed to discover autoantibodies in the serum of psoriasis patients (N = 12) compared to healthy controls (N = 12). Validation studies are performed in a larger cohort of psoriasis patients (N = 73) and healthy controls (N = 75) together with atopic dermatitis as disease controls (N = 10). RESULTS: The screening results demonstrate that immunoglobulin G4 (IgG4) anti-gliadin autoantibodies are significantly elevated in the serum of psoriasis patients, compared to healthy controls. Receiver operating characteristic (ROC) analysis indicates that IgG4 anti-gliadin autoantibody levels can clearly discriminate psoriasis patients from healthy controls with an AUC of 0.98 (p < 0.001). Also, IgG4 anti-gliadin autoantibody can reflect disease severity with the psoriasis area severity index score in a subpopulation of psoriasis patients. CONCLUSIONS AND CLINICAL RELEVANCE: These results suggest that IgG4 anti-gliadin autoantibody may be a disease marker of psoriasis, and it may be useful in clinical diagnostics and disease monitoring of psoriasis. CLINICAL RELEVANCE: This work represents a relatively comprehensive screening of autoantibodies, that is, IgG4 autoantibodies in psoriasis using an in-house autoantigen array. This novel proteomic platform may be useful in clinical screening of IgG type or IgG4 subtype autoantibodies in psoriasis patients for disease monitoring or drug responses. Particularly, IgG4 anti-gliadin autoantibody, as a new potential disease marker of psoriasis, may be useful in clinical diagnostics or prognostics of related immunological disorders.