Mycosis Fungoides Palmaris et Plantaris Mimicking "Dyshidrotic Eczema": A Case Report.

Mycosis fungoides palmaris et plantaris (MFPP) is a rare variant of mycosis fungoides (MF), a type of cutaneous T-cell lymphoma. MFPP primarily affects the palms and soles of the feet and is often misdiagnosed as dyshidrotic eczema due to its similar clinical presentation. This case report presents a middle-aged woman with MFPP whose initial presentation was mistaken for dyshidrotic eczema. Despite treatment with topical corticosteroids, the patient's lesions persisted, prompting further investigations that led to the diagnosis of MFPP. The patient was initiated on betamethasone dipropionate ointment and hydroxyzine for pruritus management, with a pivotal referral to oncology for comprehensive evaluation. This case highlights the importance of considering MFPP in the differential diagnosis of persistent eczematous lesions on the palms and soles, especially when treatment with topical corticosteroids is ineffective. J Drugs Dermatol. 2024;23(7):569-570.     doi:10.36849/JDD.8474.

Metastatic Merkel Cell Carcinoma After Simultaneous Pancreas-Kidney Transplantation: Fatal Outcomes.

Merkel cell carcinoma (MCC) is a rare, highly aggressive cutaneous malignancy. Immunosuppression increases the risk of MCC and is associated with poor prognosis. Organ transplant recipients (OTR) have worse overall survival (OS) than patients with immunosuppression due to other causes. Treating MCC after organ transplantation is challenging, as checkpoint inhibitor immunotherapy, the standard of care for treating MCC, increases the risk of transplant rejection. This paper reviews the cases of two simultaneous pancreas-kidney transplant (SPKT) recipients with MCC and explores the role of immunosuppression in the development of MCC. Immunosuppression was discontinued and checkpoint inhibitor therapy was initiated in the first patient and considered by the second patient. In both cases, treatment failed, and the patients died shortly after developing metastatic MCC. These cases illustrate the need for improved multidisciplinary treatment regimens for MCC in OTRs. J Drugs Dermatol. 2024;23(5):376-377.     doi:10.36849/JDD.8234  .

Checkpoint Inhibitor-Induced Neurotoxicity in a Case of Metastatic Melanoma.

Checkpoint inhibitors (CPIs) are increasingly being used in the treatment of malignant melanoma. While showing promise in metastatic melanoma treatment, CPIs are associated with immune-related adverse events in various organ systems. Among these events, checkpoint inhibitor-induced neurotoxicity stands out as a particularly rare yet diagnostically challenging and potentially life-threatening occurrence. We report a unique case of checkpoint inhibitor-induced neurotoxicity in a patient with metastatic melanoma directly after beginning treatment with checkpoint inhibitor encorafenib. The patient presented with an unclear clinical course, with features of Guillain-Barré syndrome, myasthenia gravis, and brainstem encephalitis.  We followed a recently established management algorithm for checkpoint inhibitor-induced neurotoxicity with positive outcomes. This case report highlights the importance of recognizing checkpoint inhibitor-induced neurotoxicity as a potential adverse effect of CPIs when treating metastatic melanoma. J Drugs Dermatol. 2023;22(12):e25-e27.     doi:10.36849/JDD.7991e.

Epidemiology of Chronic Dermatologic Conditions in Skin of Color.

Across the board, common dermatologic conditions disproportionately affect patients of color. While the causes of these disparities have been tied to the environment, societal structure, access to care, health literacy, and biological factors, there is limited understanding of the extent and impact of dermatologic healthcare inequity. This study provides a resource on the epidemiology of common dermatologic diseases across racial lines and points out current lapses in scientific understanding of the disparate impact of certain conditions. This study will review epidemiological data on atopic dermatitis (AD), adult acne, pseudofolliculitis, dermatophytosis, psoriasis, vitiligo, melasma, hyperpigmentation, keloids, hidradenitis suppurativa (HS), basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. J Drugs Dermatol. 2023;22(11):e21-e23    doi:10.36849/JDD.7131e.

Scarring and Dyschromias in Fitzpatrick Skin Type IV-VI: A Review of Dermatologic Treatment Protocols.

IMPORTANCE: Managing chronic conditions is an essential aspect of dermatologic care, especially regarding the resolution of inflammatory dermatologic disease and recovery of skin lesions. Short-term complications of healing include infection, edema, dehiscence, hematoma formation, and tissue necrosis. At the same time, longer-term sequelae may consist of scarring and scar widening, hypertrophic scars, keloids, and pigmentary changes. This review will focus on dermatologic complications of chronic wound healing in patients with Fitzpatrick skin type (FPS) IV-VI or skin of color (SOC), with an emphasis on hypertrophy/scarring and dyschromias. It will focus on current treatment protocols and the potential complications specific to patients with FPS IV-VI. OBSERVATIONS: There are multiple complications of wound healing that are more prevalent in SOC, including dyschromias and hypertrophic scarring. These complications are challenging to treat, and current protocols are not without complications and side effects that must be considered when offering therapy to patients with FPS IV-VI. CONCLUSIONS AND RELEVANCE: When treating pigmentary and scarring disorders in patients with skin types FPS IV-VI, it is essential to implement a stepwise approach to management that is conscious of the side effect profile of current interventions. J Drugs Dermatol. 2023;22(7): doi:10.36849/JDD.7253.

Assessing Implicit Bias in Dermatology.

BACKGROUND: Patients with skin of color (SOC), defined as Fitzpatrick skin types IV to VI, and of varying ethnicities are under-represented in dermatology. This includes practitioners, trainees, dermatologic teaching materials, and clinical studies.  Methods: Online survey study to assess dermatologists’ perceptions that could impact patient care. Participants were screened for providers that spent ≥80% of their time in direct patient care; managed ≥100 unique patients per month; and had ≥20% aesthetic patients. RESULTS: A total of 220 dermatologists participated; 50 with SOC, 152 non-SOC, and 18 other. SOC dermatologists had a more diverse patient population by racial/ethnic background, but there was no difference in proportion of patients by Fitzpatrick skin phototype categories. While race/ethnicity is not considered a primary factor in clinical decision making, Fitzpatrick skin type is for many dermatologists. Most dermatologists agree that more diversity in medical training for dermatologic conditions would be beneficial. Dermatologists report that adding before and after photos of different skin types in educational materials and increasing training on cultural competency are likely to be the most effective strategies for improvement. CONCLUSIONS: Although racial/ethnic diversity shows differences based on location of practice and the race of dermatologists, diversity of skin type based on Fitzpatrick scale is virtually identical across practices, illustrating the challenge of categorizing patients by this scale alone. Beer J, Downie J, Noguiera A, et al. Assessing implicit bias in dermatology. J Drugs Dermatol. 2023;22(7):635-640. doi:10.36849/JDD.7435.

Pityriasis Alba in Pediatric Patients With Skin of Color.

As we continue to work toward a more equitable future of medicine, it is necessary to recognize the needs distinct to pediatric dermatology to decrease health disparities that affect this patient population. Currently, there is very little research investigating the predominate risk factors and management of pityriasis alba in children with skin of color. Herein, we discuss existing literature on pityriasis alba in children with skin of color, as well as the research and educational needs in this area. J Drugs Dermatol. 2023;22(4)    doi:10.36849/JDD.7221 Citation: Hyun Choi S, Beer J, Bourgeois J, et al. Pityriasis alba in pediatric patients with skin of color. J Drugs Dermatol. 2023;22(4):417-418. doi:10.36849/JDD.7221.

Scarring and Dyschromias in Fitzpatrick Skin Type IV-VI: A Review of Dermatologic Treatment Protocols.

IMPORTANCE: Managing chronic conditions is an essential aspect of dermatologic care, especially regarding the resolution of inflammatory dermatologic disease and recovery of skin lesions. Short-term complications of healing include infection, edema, dehiscence, hematoma formation, and tissue necrosis. At the same time, longer-term sequelae may consist of scarring and scar widening, hypertrophic scars, keloids, and pigmentary changes. This review will focus on dermatologic complications of chronic wound healing in patients with Fitzpatrick skin type (FPS) IV-VI or skin of color (SOC), with an emphasis on hypertrophy/scarring and dyschromias. It will focus on current treatment protocols and the potential complications specific to patients with FPS IV-VI.  Observations: There are multiple complications of wound healing that are more prevalent in SOC, including dyschromias and hypertrophic scarring. These complications are challenging to treat, and current protocols are not without complications and side effects that must be considered when offering therapy to patients with FPS IV-VI.  Conclusions and Relevance: When treating pigmentary and scarring disorders in patients with skin types FPS IV-VI, it is essential to implement a stepwise approach to management that is conscious of the side effect profile of current interventions. J Drugs Dermatol. 2023;22(3):288-296. doi:10.36849/JDD.7253.

Climate change and the displaced person: how vectors and climate are changing the landscape of infectious diseases among displaced and migrant populations.

BACKGROUND: As the climate crisis grows, so does the global burden of displacement. Displacement, whether a direct or indirect consequence of natural disaster, can lead to dire health sequelae. Skin health is no exception to this, with dermatologic disease being a leading concern reported by those who care for displaced persons. Health professionals who provide dermatologic care for displaced persons benefit from understanding how climate change impacts the global profile of infectious agents. METHODS: This review was performed using PubMed and Google Scholar. Search terms included climate change, displaced person, internally displaced person, and refugee, as well as searches of infectious disease dermatology and the specific diseases of interest. Case reports, case series, reviews, and original research articles were included in this review. Non-English studies were not included. RESULTS: In this manuscript several key infectious agents were identified, and we discuss the skin manifestations and impact of climate change on cutaneous leishmaniasis, dengue, chikungunya, zika, malaria, pediculosis, cutaneous larva migrans, cholera, and varicella zoster. CONCLUSIONS: Climate change plays a significant role in the challenges faced by displaced persons, including their skin health. Among the many consequences of climate change is its altering of the ecological profile of infectious agents and vectors that impact displaced persons. Being familiar with this impact can improve dermatologic care for this vulnerable population.

Addressing Disparities in Melanoma Recognition in Skin of Color.

Melanoma is the third most common skin malignancy across all racial groups in the United States.1 While non-Hispanic white patients comprise the overwhelming majority of cases, morbidity and mortality remain disproportionately higher in minority populations.

Mycosis Fungoides: Awareness in Skin of Color.

Over the past decade, what is known about skin of color in the field of dermatology has gained an increasing amount of attention among both clinicians and the general public. Recent efforts have continued to shed light on the role of skin color in health disparities and the development of actionable strategies to improve outcomes for patients of color. While research has largely focused on conditions such as atopic dermatitis, psoriasis, and skin cancer, uncommon dermatologic conditions have been less emphasized in skin of color discussions thus far.

Diversity in Academic Dermatology.

The American Medical Association recently declared racism to be a public health threat. It declared that “Racism negatively impacts and exacerbates the health inequities among historically marginalized communities”.1 The New England Journal of Medicine echoed this declaration in a recent article that included goals for making medicine more diverse by transforming “the ranks of institutional research leadership, faculty, trainees, and staff to reflect the demographic diversity of the communities their organizations serve.”2 The article also calls for more transparent selection criteria for choosing leaders in medicine. Necessary changes are articulated and provide a pathway towards more equality in medicine. One subspecialty in the field of medicine (dermatology) lacks the type of diversity one would expect from physicians who study the skin. Although the problem has been discussed for years, it has yet to be rectified. J Drugs Dermatol. 2022;21(5):674-676. doi:10.36849/JDD.6899.

The clinical utility of teledermoscopy in the era of telemedicine.

Teledermoscopy is a novel diagnostic tool for the prevention, diagnosis, and treatment of skin disease when direct visualization of lesions is difficult. It is an economically viable option that can complement telehealth visits and that providers can utilize to identify melanocytic lesions and optimize care with diagnostic accuracy comparable to face-to-face (FTF) diagnosis. Teledermoscopy is invaluable in monitoring chronic conditions that require frequent follow-up and treatment optimization. Inclusion of clinical and dermoscopic images has been shown to improve the diagnostic accuracy of teledermatology services, thereby reducing healthcare costs. Teledermoscopy is also non-discriminatory, as diagnostic accuracy is similar in lighter and darker skin types. It has been shown to improve patient access to specialty services and reduce the number of "no-shows" at FTF clinics and length of surgery waiting times. Mobile teledermoscopy is user-friendly, feasible, and economically viable, as inexpensive mobile dermatoscopes have emerged on the market to reduce consumer out-of-pocket costs. Research is limited on teledermoscopy's utility in diagnosing pre-cancerous and cancerous skin lesions in adults, particularly complex pigmented lesions. Further research is recommended to investigate the role of dermoscopic expertise and artificial intelligence on the evaluation of teledermoscopic images.

Teledermatology: current indications and considerations for future use.

Telemedicine is one of the most consequential technologies in modern healthcare. In certain situations, it allows for the delivery of care with high quality and minimal difficulty. This is particularly true in dermatology, in which many dermatological conditions can be treated remotely. The burden on dermatology patients has been greatly reduced for certain pathologies due to telemedicine. Health care providers also achieve improved job satisfaction following the convenience of meeting their patients. This paper details select dermatological conditions, and subsequently divides them into those treatable by telemedicine appointments, and those requiring face to face appointments.