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.

Is Morgellons an organic disease? structural and functional abnormalities implicated in the pathophysiology of delusional infestation.

Little is known about the pathophysiology of delusional infestation (DI), a psychodermatologic condition in which patients have a fixed, false belief of being infested with parasites or inanimate material in their skin, despite lack of objective evidence. Because some delusional states, such as schizophrenia and psychotic state in bipolar disorder have been found to be associated with brain structural and functional abnormalities, a literature review was conducted to summarize available data on structural and functional abnormalities that are found to be associated with DI. A review of the literature found cases of brain imaging studies in patients with primary DI, as well as patients with secondary DI. Accumulating evidence from the studies reviewed suggests that dysfunction of the fronto-striato-thalamo-parietal network may explain how delusions manifest in DI and suggest that DI has an organic etiology. Abnormalities in the striato-thalamo-parietal network may cause false sensations of infestation through dysfunction in visuo-tactile regulation, whereas abnormalities in the frontal region may impair judgement. Delusional infestation patients also exhibit increased activation of brain structures implicated in itch processing. Furthermore, patients at high risk for cerebrovascular disease who present with secondary DI may benefit from brain imaging studies to rule out brain ischemic insult.

The Kirby-Xiao Intraoral Injection Technique: A Novel Method to Improve Perioral Cosmesis with Hyaluronic Acid Filler-A Review.

Perioral cosmesis is an important component of facial aesthetics. The perioral region is prone to revealing signs of aging due to repetitive movements and various environmental factors. While it is well established that perioral aesthetics can be effectively treated with hyaluronic acid dermal filler, there is limited published data available on injection techniques specifically designed for perioral rejuvenation. In this article, we review the perioral anatomy and current percutaneous filler injection techniques for perioral cosmesis. We then present a novel intraoral filler injection approach to improve perioral aesthetics with minimal downtime and high patient satisfaction.

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.

FLT3 mutation incidence and timing of origin in a population case series of pediatric leukemia.

BACKGROUND: Mutations in FLT3 result in activated tyrosine kinase activity, cell growth stimulation, and a poor prognosis among various subtypes of leukemia. The causes and timing of the mutations are not currently known. We evaluated the prevalence and timing of origin of FLT3 mutations in a population series of childhood leukemia patients from Northern California. METHODS: We screened and sequenced FLT3 mutations (point mutations and internal tandem duplications, ITDs) among 517 childhood leukemia patients, and assessed whether these mutations occurred before or after birth using sensitive "backtracking" methods. RESULTS: We determined a mutation prevalence of 9 of 73 acute myeloid leukemias (AMLs, 12%) and 9 of 441 acute lymphocytic leukemias (ALLs, 2%). Among AMLs, FLT3 mutations were more common in older patients, and among ALLs, FLT3 mutations were more common in patients with high hyperdiploidy (3.7%) than those without this cytogenetic feature (1.4%). Five FLT3 ITDs, one deletion mutation, and 3 point mutations were assessed for their presence in neonatal Guthrie spots using sensitive real-time PCR techniques, and no patients were found to harbor FLT3 mutations at birth. CONCLUSIONS: FLT3 mutations were not common in our population-based patient series in California, and patients who harbor FLT3 mutations most likely acquire them after they are born.