A confounding clinically aggressive case of necrotizing granulomatous and suppurative dermatitis.

Superficial granulomatous pyoderma gangrenosum is a rare, superficial, vegetating form of pyoderma gangrenosum that tends to occur as a single lesion, most commonly on the trunk. Herein, we report a clinically confounding case of disseminated superficial granulomatous pyoderma gangrenosum in a patient with a 5-year history of painful and chronic ulcerations of the bilateral upper extremities and face in a sun exposed distribution. This was a diagnostically challenging case due to the treatment-refractory nature of our patient's skin lesions and the atypical clinical and histologic presentations encountered. We review our clinical decision process and acknowledge other entities that were considered during the clinical course of this case. Additionally, we discuss the lack of responsiveness to various treatment options with eventual successful clearance of this patient's active skin disease with initiation of adalimumab.

A Case of Neonatal Myeloid Sarcoma.

Here we describe a cutaneous neonatal myeloid sarcoma (MS) case with a subsequent diagnosis of acute myeloid leukemia (AML) seven days later. Cytogenetic studies were unusual demonstrating a triple copy of KAT6A abnormality and complex 8;14;22 translocation involving the 8p11.2 region. MS may be the initial finding suggesting associated AML; therefore, the diagnosis of cutaneous MS may allow for expeditious evaluation/treatment of such leukemic disorders.

Draize human repeat insult patch test (HRIPT): Seven decades of pitfalls and progress.

Allergic contact dermatitis, a Type IV delayed hypersensitivity reaction, can result in dermatologic signs/symptoms for patients/workers. The likelihood of this phenomenon has been estimated/predicted for numerous chemicals/drugs by animal model and human patch testing protocols developed over the last century. Karl Landsteiner initiated testing with guinea pig studies; further studies based on his initial concept were in continual development. John Draize extended Landsteiner's guinea pig studies (which led to development of blood transfusions) to a human assay documenting irritant and allergic contact dermatitis potential - for drugs, chemicals, mixtures and products. We performed a literature search of major Draize derived protocols of the human repeat insult patch test (HRIPT). Our results reveal minor and major differences between protocols and lack of international standardization. Key clarification and principles post-Draize modified and improved usefulness of the HRIPT. Without a standard method of performing the HRIPT, it is problematic to generalize results of studies summarized here. Furthermore, we suggest a potential standardization procedure/protocol combining the work of the most satisfactory HRIPT methods. As the HRIPT constitutes a key parameter in current quantitative risk assessment for chemicals/drugs, such standardization should aid potential prediction of allergic contact dermatitis potential.

Percutaneous absorption of chemicals from fabric (textile).

Percutaneous penetration of chemicals from clothing can result in both acute and chronic toxicities. Although personal protective equipment composed of nonwoven material can provide thorough protection, it is often uncomfortable under normal occupational conditions. Certain everyday textiles are often utilized as protective clothing due to their cost, comfort, and convenience. Although common textiles may cover most skin, certain regions remain exposed by such outfits. The body areas covered by the fabric are at risk for fabric permeation and percutaneous penetration of chemical, either immediately or over time, dependent on the fabric composition and the characteristics of the chemical used. in vitro and in vivo publications studied percutaneous penetration of chemicals from contaminated fabric and show that everyday textiles are superior to bare skin. The increased protection offered can be attributed to properties of the fabric such as weave, thickness, fabric finish, absorbency, and the overall barrier provided. Although common textiles do offer some protection, they remain inferior to nonwoven personal protective equipment. Much remains unknown regarding percutaneous penetration and protection offered by everyday textiles.

Skin Cancer Prevention and Screening Behaviors among Agricultural Workers: A Survey of the Attendees of the Sioux Falls Farm Show.

INTRODUCTION: Agricultural workers are at a higher risk for skin cancer due to excessive amounts of sun exposure, poor sun safety practices, and limited access to healthcare. This study aimed to assess skin cancer history, sun protection practices, and skin cancer surveillance measures among Midwestern agricultural workers. METHODS: Individuals that attended the 2020 Sioux Falls Farm Show were asked to complete a 12-question survey on sun exposure, sun protective practices, and skin cancer surveillance. Survey responses were aggregated and analyzed using Microsoft Excel. RESULTS: A total of 99 individuals participated in the study, of which 70 identified as agricultural workers. Most individuals reported working outdoors eight to 10 hours daily for 10-12 months of the year. Most participants reported poor sun protection habits, such as limited sunscreen and limited wide-brimmed hat use. A large number of participants reported they had previously received a professional skin check, although 33 percent reported never examining their own skin for suspicious lesions. CONCLUSIONS: Midwestern agricultural workers present a unique population that could benefit from improved skin cancer prevention. Opportunities for improvement include education of skin cancer preventative measures using platforms that are likely to reach rural agricultural workers and education regarding skin self-examinations. This study identified high risk factors of this population including substantial sun exposure, poor sun protection, and minimal self-skin examinations. Our findings may help guide future methods to increase skin cancer education, prevention, and surveillance in agricultural workers.

Incorporation of Women's Health Maintenance Screening in the USD Coyote Clinic.

INTRODUCTION: The Coyote Clinic is a student-run clinic that provides free services to Sioux Falls residents without insurance. It has not historically provided routine women's health screenings. The project addressed this lack of preventative care. We aimed to increase the percentage of female patients that are up to date on Papanicolaou (Pap) smears, mammograms, and human papillomavirus (HPV) vaccines through the implementation of screening questions. METHODS: A screening questionnaire was created and asked to female patients between the ages of 18-65 about the dates and results of their last Pap smear, mammogram, and the administration of any HPV vaccine. RESULTS: 27 patients answered the questions. Fifty-two percent were Caucasian, 26 percent Hispanic, 15 percent African American, and 7 percent Middle Eastern. Two patients were eligible for HPV vaccination: one had not received the vaccination and the other was unknown. All 27 women were eligible for Pap smears. Seventy-six percent had normal results, 19 percent were unsure of their results, and 5 percent had abnormal results. Eight patients were eligible for mammograms: five were up to date, two were tested in the last three years, and one had an unknown test date. CONCLUSIONS: The majority of eligible female patients were up to date on Pap smears and mammograms. The health maintenance questionnaire was a valuable resource for patient care, patient health literacy, and medical student education.

Effects of anatomical location on in vivo percutaneous penetration in man.

PURPOSE: Percutaneous penetration in man is affected by several factors: chemical properties, skin anatomy variables, and environmental conditions can all modify the quantity of chemical that penetrates through the skin barrier. The amount of chemical or drug that penetrates the cutaneous barrier must be considered due to the local and systemic absorption that may occur. Regional variation in percutaneous absorption is an additional factor to recognize when analysing chemical percutaneous penetration. Although it has been studied that certain anatomic sites allow for increased absorption, there is limited literature regarding in vivo data in man. This overview catalogues and analyses studies performed in man to quantify chemical permeation at varying anatomical locations. We also review what is known about the pharmacokinetics of Food and Drug Administration approved medication patches and semisolids and the regional variation in absorption that they may display. This research work aims to create an updated, concise overview of the pertinent studies available regarding percutaneous penetration and regional variability. MATERIALS AND METHODS: We searched PubMed, Web of Science, Google Scholar and the United States Food and Drug Administration's online database for approved transdermal delivery systems from January 1965 to March 2020, with the search words: percutaneous absorption, regional variation, anatomical location, along with extensive bibliographical review. We further utilized the prior listed search engines to search for published data pertaining to regional differences in percutaneous absorption for each of the FDA-approved medications. If no publication was found, we utilized the Summary Basis of Approval documents for each medication to determine patch application site pharmacokinetics. RESULTS: Several chemical containing gels and solutions were tested for regional variability. Chemical characteristics and body site location were determinants in absorption. In general, the head, neck and genitalia contamination resulted in greatest absorption, whereas trunk, back, and thighs resulted in less absorption. Most of the FDA-approved transdermal delivery patch medications are efficacious at more than one body location, allowing for greater patient convenience when choosing patch location. CONCLUSIONS: Regional variability in chemical and drug absorption is of clinical and pharmacological significance. More studies determining in vivo percutaneous absorption in man are necessary to further understand the role of regional variation, the mechanisms involved, and how to derive reliable formulas for extrapolating flux from one anatomic site to the next, often required for risk assessments.

In vivo modeling of docosahexaenoic acid and eicosapentaenoic acid-mediated inhibition of both platelet function and accumulation in arterial thrombi.

Omega-3 polyunsaturated fatty acids (n-3 PUFAs) are associated with a variety of cellular alterations that mitigate cardiovascular disease. However, pinpointing the positive therapeutic effects is challenging due to inconsistent clinical trial results and overly simplistic in vitro studies. Here we aimed to develop realistic models of n-3 PUFA effects on platelet function so that preclinical results can better align with and predict clinical outcomes. Human platelets incubated with the n-3 PUFAs docosahexaenoic acid and eicosapentaenoic acid were stimulated with agonist combinations mirroring distinct regions of a growing thrombus. Platelet responses were then monitored in a number of ex-vivo functional assays. Furthermore, intravital microscopy was used to monitor arterial thrombosis and fibrin deposition in mice fed an n-3 PUFA-enriched diet. We found that n-3 PUFA treatment had minimal effects on many basic ex-vivo measures of platelet function using agonist combinations. However, n-3 PUFA treatment delayed platelet-derived thrombin generation in both humans and mice. This impaired thrombin production paralleled a reduced platelet accumulation within thrombi formed in either small arterioles or larger arteries of mice fed an n-3 PUFA-enriched diet, without impacting P-selectin exposure. Despite an apparent lack of robust effects in many ex-vivo assays of platelet function, increased exposure to n-3 PUFAs reduces platelet-mediated thrombin generation and attenuates elements of thrombus formation. These data support the cardioprotective value of-3 PUFAs and strongly suggest that they modify elements of platelet function in vivo.