Multiethnic training in residency: a survey of dermatology residents.

Individuals with skin of color make up the majority of the world's population and a rapidly expanding section of the US population. Future dermatologists must be knowledgeable about dermatologic conditions presenting in patients of various ethnic backgrounds. A 10-question survey was emailed to 109 dermatology residency programs to assess if dermatologists in-training feel that their residency curriculum sufficiently gives them exposure to and education on patients with skin of color. Forty-three residents completed the survey from 5 regions of the United States. Resident responses differed by region. Residents from areas with less diversity were more likely to agree that dedicated skin of color clinics and rotations are important to gain competency compared to residents from areas with more diversity.

Lactate and Immunosuppression in Sepsis.

Serum lactate levels are traditionally interpreted as a marker of tissue hypoxia and often used clinically as an indicator of severity and outcome of sepsis/septic shock. Interestingly, recent studies involving the effects of tumor-derived lactate suggest that lactate itself may have an immunosuppressive effect in its local environment. This finding adds to the recent advances in immunometabolism that shed light on the importance of metabolism and metabolic intermediates in the regulation of innate immune and inflammatory responses in sepsis. In this article, we summarize recent studies, showing that the activation of immune cells requires aerobic glycolytic metabolism and that lactate produced by aerobic glycolysis may play an immunosuppressive role in sepsis.

Cyclosporine-induced Erythromelalgia.

Erythromelalgia is a neurovascular disorder which causes pain, swelling, erythema, and warmth of the distal extremities. Primary disease is due to a genetic mutation in the SCN9A gene, but secondary erythromelalgia can be the consequence of a variety of underlying etiologies, including drug and toxin exposures. The disease is rare, occurring in only 1.3 out of every 100,000 in the United States, and symptoms can vary significantly in severity and presentation. Therefore, it can be difficult to recognize the disorder, identify the source, and promptly treat the condition. We report a reversible cause of erythromelalgia induced by the use of oral cyclosporine. This correlation is poorly documented in literature, with limited accounts identifying an association between erythromelalgia and cyclosporine. As drug-induced erythromelalgia represents a reversible cause of disease, physicians should obtain a detailed medication history during the diagnostic workup, specifically inquiring about the use of cyclosporine.