High-frequency photoacoustic and ultrasound imaging for skin evaluation: Pilot study for the assessment of a chemical burn.

Skin architecture and its underlying vascular structure could be used to assess the health status of skin. A non-invasive, high resolution and deep imaging modality able to visualize skin subcutaneous layers and vasculature structures could be useful for determining and characterizing skin disease and trauma. In this study, a multispectral high-frequency, linear array-based photoacoustic/ultrasound (PAUS) probe is developed and implemented for the imaging of rat skin in vivo. The study seeks to demonstrate the probe capabilities for visualizing the skin and its underlying structures, and for monitoring changes in skin structure and composition during a 5-day course of a chemical burn. We analayze composition of lipids, water, oxy-hemoglobin, and deoxy-hemoglobin (for determination of oxygen saturation) in the skin tissue. The study successfully demonstrated the high-frequency PAUS imaging probe was able to provide 3D images of the rat skin architecture, underlying vasculature structures, and oxygen saturation, water, lipids and total hemoglobin.

Photoacoustic imaging for cutaneous melanoma assessment: a comprehensive review.

Significance: Cutaneous melanoma (CM) has a high morbidity and mortality rate, but it can be cured if the primary lesion is detected and treated at an early stage. Imaging techniques such as photoacoustic (PA) imaging (PAI) have been studied and implemented to aid in the detection and diagnosis of CM. Aim: Provide an overview of different PAI systems and applications for the study of CM, including the determination of tumor depth/thickness, cancer-related angiogenesis, metastases to lymph nodes, circulating tumor cells (CTCs), virtual histology, and studies using exogenous contrast agents. Approach: A systematic review and classification of different PAI configurations was conducted based on their specific applications for melanoma detection. This review encompasses animal and preclinical studies, offering insights into the future potential of PAI in melanoma diagnosis in the clinic. Results: PAI holds great clinical potential as a noninvasive technique for melanoma detection and disease management. PA microscopy has predominantly been used to image and study angiogenesis surrounding tumors and provide information on tumor characteristics. Additionally, PA tomography, with its increased penetration depth, has demonstrated its ability to assess melanoma thickness. Both modalities have shown promise in detecting metastases to lymph nodes and CTCs, and an all-optical implementation has been developed to perform virtual histology analyses. Animal and human studies have successfully shown the capability of PAI to detect, visualize, classify, and stage CM. Conclusions: PAI is a promising technique for assessing the status of the skin without a surgical procedure. The capability of the modality to image microvasculature, visualize tumor boundaries, detect metastases in lymph nodes, perform fast and label-free histology, and identify CTCs could aid in the early diagnosis and classification of CM, including determination of metastatic status. In addition, it could be useful for monitoring treatment efficacy noninvasively.

Hidradenitis suppurativa perspectives during the COVID-19 pandemic.

The COVID-19 pandemic created a new set of challenges regarding the care of patients with hidradenitis suppurativa (HS). Access to safe, timely medical care and the use of immunosuppressive therapy were central topics of concern for patients and providers. In addition, the incidence and severity of SARS-CoV-2 infection in patients with HS were critical to examine during the evolving pandemic and to provide recommendations for patients for makinginformed decisions about their disease and its management. Another consideration of the COVID-19 pandemic was the role of the internet to connect individuals with HS with each other and experts in the field. This is a unique contribution that collectively examines the perspectives of HS medical care and support during the COVID-19 pandemic.

Annular skin lesions in infancy.

Annular skin lesions have a unique morphology, and the dramatic appearance of these skin eruptions in infants can cause concern for parents and clinicians. Annular lesions appearing during infancy (defined here as birth to 1 year of age) lend to a broad differential, ranging from benign cutaneous disorders to severe systemic diseases. This review summarizes the pathogenesis, clinical and histopathologic findings, and management options of possible etiologies for annular skin lesions in infants, including annular erythema of infancy, neonatal lupus erythematosus, dermatophyte infections, hemorrhagic edema of infancy, and urticaria multiforme.

Atypical ulcers: a stepwise approach for clinicians.

Chronic ulcers are associated with significant morbidity and mortality. Typical ulcers are due to venous insufficiency, diabetes, ischemia, pressure, and lymphedema. A chronic ulcer that does not respond to standard therapies should be reevaluated for potential atypical etiologies. Atypical ulcers are less common and more difficult to diagnose due to a wide range of possible etiologies, including inflammatory (autoimmune), neoplastic, vasculopathy, hematologic, infectious, drug-induced, or external. No standardized approach to the management of complex atypical ulcers exists. In this review, a stepwise approach to atypical ulcers is proposed with the aim of assisting physicians in their identification and diagnosis. If perfusion is adequate and there are no signs of infection, then the authors recommend obtaining an ulcer biopsy for microbiologic, DIF, and histopathologic evaluation as the criterion standard for diagnosis. Laboratory testing, including an autoimmune panel, a hypercoagulable panel, and an infectious diseases panel, can further aid in diagnosis. Atypical ulcers often require multidisciplinary care, with input from specialists in rheumatology, dermatology, infectious diseases, wound care, vascular surgery, hematology, and oncology. Effective communication within the health care team is essential for accurate diagnosis and management of atypical ulcers. Active dialogue between providers can improve consult efficiency and ultimately lower the cost of care.

Pediatric Hospitalizations for Atopic Dermatitis in the United States; Characteristics Associated with the Atopic Triad.

Atopic dermatitis (AD) is one of the most common skin disorders in pediatric patients. Many patients with AD also have asthma and/or allergic rhinitis; when combined, these constitute the atopic triad.1 This study characterized US pediatric patients hospitalized with a primary diagnosis of AD or Eczema (AD-E) and determined characteristics associated with the coexistence of additional diagnoses in the triad. A retrospective analysis was performed, including a multivariate logistic regression model, with data from the 2012 to 2017 National Inpatient Sample. Patients that met the inclusion criteria (N = 901) consisted predominantly of toddlers of male gender and white race. Further, 40% belonged to a household of the lowest quartile annual income and 64% were covered by Medicare/Medicaid. Mean length of stay and total charges were significantly higher for patients with AD-E plus asthma and/or allergic rhinitis when compared to patients with AD-E alone. On multivariate analysis, age and sex were significantly associated with the presence of additional atopic conditions. The mid-childhood group had the highest likelihood compared to infants, and girls had a lower likelihood compared to boys. Understanding characteristics associated with additional atopic conditions in children with AD-E as well as healthcare disparities in this population may yield early intervention, enhanced care, and improved resource allocation.

Annular skin lesions in infancy.

Annular skin lesions have a unique morphology, and the dramatic appearance of these skin eruptions in infants can cause concern for parents and clinicians. Annular lesions appearing during infancy (defined here as birth to 1 year of age) lend to a broad differential, ranging from benign cutaneous disorders to severe systemic diseases. This review summarizes the pathogenesis, clinical and histopathologic findings, and management options of possible etiologies for annular skin lesions in infants, including annular erythema of infancy, neonatal lupus erythematosus, dermatophyte infections, hemorrhagic edema of infancy, and urticaria multiforme.

Balancing medical education in aesthetics: Review and debate.

The demand for minimally invasive cosmetic procedures is rising, and the public and other physicians deem dermatologists as top providers of these services. Given these expectations, dermatologic residency training must equip resident physician trainees to care for the growing population of patients with aesthetic concerns. As it stands, formal hands-on cosmetic dermatology training in residency is lacking specific structure. Educational, cultural, time, and monetary barriers exist, among others, which restrict residents from attaining proficiency in cosmetic dermatology procedures prior to graduation. This may adversely impact patient safety and deter graduates from offering aesthetic procedures. The standardization of core residency competencies in minimally invasive cosmetic procedures is fundamental to guarantee patient safety and satisfaction while ensuring practitioner competence. The balance between these elements is essential for optimal patient care. We review and debate modifying and strengthening the current curriculum requirements while presenting means to overcome barriers.

Primary Tumor Location Predicts Survival in Melanoma: A Retrospective Cohort Study of 239,257 Melanoma Patients.

The link between primary tumor location and overall survival in melanoma has been studied in the past, but its associated population and prognostic significance is less understood. The purpose of this study was to characterize melanoma demographics and disease-specific survival (DSS) in relation to primary tumor site. Data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program were retrospectively analyzed; from 1973 to 2015, 239,257 patients diagnosed with cutaneous melanoma were included in the study and separated into three cohorts based on primary tumor site. The effect of primary location on melanoma survival was evaluated using Cox proportional hazards models. Tumors were predominantly localized and had a depth of ≤1 mm. Patients diagnosed with tumors originating in the upper and lower extremities had significantly increased DSS probability compared to those of the head and neck. Characteristics, including woman sex, married or widowed status, treated on the Pacific coast, and increasing year of diagnosis, were associated with greater DSS. Conversely, non-white or Hispanic origin, higher age at diagnosis, tumors with increased depth, or nodular or acral melanoma histology were associated with lower DSS. Primary tumor site is a significant predictive factor of DSS in cutaneous melanoma along with additional characteristics supported in our study.

Rescuing medical education in times of COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic has caused widespread disruptions in various sectors of medicine, including medical education. Although the necessary focus has been on patient care and public safety and the long-lasting impact of COVID-19 remains to be determined, the impact on medical education warrants further attention and action. While it seems minuscule compared with the toll the global pandemic has caused worldwide, the impact on medical education, including graduate medical education, carries the potential to alter career progression and outcomes. We have assessed the effects of COVID-19 on dermatology clinics, residency education, and medical education, exploring recommendations and actions taken by governing bodies and offering additional suggestions of our own.

Dysregulated microRNA expression in IL-4 transgenic mice, an animal model of atopic dermatitis.

IL-4 plays an important role in the pathogenesis of atopic dermatitis (AD). Previously we showed that the expression of genes in chemotaxis, angiogenesis, inflammation and barrier functions is dysregulated in IL-4 transgenic (Tg) mice, a well-characterized AD mouse model. In this study, we aim to study differential expression of microRNAs in IL-4 Tg mice. As compared with wild-type mice, we found that 10 and 79 microRNAs are dysregulated in the skin of IL-4 mice before and after the onset of skin lesions, respectively. Bioinformatic analysis and previous reports show that these dysregulated microRNAs may be involved in the NF-κB, TLRs, IL-4/IL-13, MAPK and other pathways. We also found that miR-139-5p and miR-196b-3p are significantly up-regulated in the peripheral blood of IL-4 Tg mice. Taken together, our data have identified many dysregulated microRNAs in IL-4 Tg mice, which may play important roles in AD pathogenesis and pathophysiology.

Gene Co-expression Networks Identifies Common Hub Genes Between Cutaneous Sarcoidosis and Discoid Lupus Erythematosus.

In this study we analyzed gene co-expression networks of three immune-related skin diseases: cutaneous sarcoidosis (CS), discoid lupus erythematosus (DLE), and psoriasis. We propose that investigation of gene co-expression networks may provide insights into underlying disease mechanisms. Microarray expression data from two cohorts of patients with CS, DLE, or psoriasis skin lesions were analyzed. We applied weighted gene correlation network analysis (WGCNA) to construct gene-gene similarity networks and cluster genes into modules based on similar expression profiles. A module of interest that was preserved between datasets and corresponded with case/control status was identified. This module was related to immune activation, specifically leukocyte activation, and was significantly increased in both CS lesions and DLE lesions compared to their respective controls. Protein-protein interaction (PPI) networks constructed for this module revealed seven common hub genes between CS lesions and DLE lesions: TLR1, ITGAL, TNFRSF1B, CD86, SPI1, BTK, and IL10RA. Common hub genes were highly upregulated in CS lesions and DLE lesions compared to their respective controls in a differential expression analysis. Our results indicate common gene expression patterns in the immune processes of CS and DLE, which may have indications for future therapeutic targets and serve as Th1-mediated disease biomarkers. Additionally, we identified hub genes unique to CS and DLE, which can help differentiate these diseases from one another and may serve as unique therapeutic targets and biomarkers. Notably, we find common gene expression patterns in the immune processes of CS and DLE through utilization of WGCNA.

Dermatologist transitions: Academics into private practices and vice versa.

National experience demonstrates that most physicians will undergo a job change within the first few years of practice. Due to shifting payment models, personal preferences, and financial burden, among other factors, job transitions between private practice and academic medicine are expected. With the rising shortage of dermatologists and an increase in demand for dermatologic services, this particular topic is salient due to the impact on patient care, graduate medical education, and advances in research and medicine. The balance between these elements is fundamental for the future of dermatologic education and care. We address the challenges faced by dermatologists in both the academic and private practice settings, while offering insight into the motivations and barriers in the transition between the two.