Commonly prescribed medications associated with alopecia.

BACKGROUND: The diagnosis and treatment of medication-associated alopecia often challenges patients and physicians. While numerous studies on the topic exist, limited information on the strength and magnitude of these studies exists. OBJECTIVES: We investigated the most commonly prescribed medications with high levels of evidence to support associations with alopecia. METHODS: A list of most commonly prescribed medications was compiled using the "Top 100 Prescriptions, Sales" (Intercontinental Marketing Services) and "Top 200 Names Searched" (RxList.com). PubMed, Embase, and Web of Science were searched for "generic drug name" AND "alopecia" and "generic drug name" AND "hair loss." Two reviewers independently reviewed articles for drug, study type and level of evidence, and number of alopecia cases. RESULTS: A total of 192 unique drugs were investigated, with 110 yielding positive search results. Of these, 13 were associated with alopecia in studies with strong levels of evidence (adalimumab, infliximab, budesonide, interferon ß-1α, tacrolimus, enoxaparin, zoster vaccine, lamotrigine, docetaxel, capecitabine, erlotinib, imatinib, and bortezomib). LIMITATIONS: Only full-length articles available in the English language were included. The methodology used relied on lists of drugs based on their sales rather than number of prescriptions, which likely overrepresented expensive drugs. CONCLUSIONS: Few studies with high levels of evidence have been conducted on the topic of medication-associated alopecia. The mechanisms of hair loss must be further identified to provide effective management.

Concominant bullous pemphigoid and cutaneous Crohn disease.

We report a case of new-onset bullous pemphigoid manifesting concurrently with cutaneous Crohn disease in a 58-year-old woman. Cutaneous Crohn disease is an extraintestinal manifestation of Crohn disease characterized by non-specific plaques or nodules. Bullous pemphigoid, a sub-epidermal autoimmune blistering disorder, has been observed in the setting of inflammatory bowel disease. The patient presented with recurrent bullae on the abdomen, thighs, and buttocks of 1 year's duration. She was not on any immunosuppressive therapies and had been treated with infliximab and azathioprine for her Crohn disease, which were discontinued 8 years before the blistering commenced. Punch biopsy of lesional skin showed a sub-epidermal blister with eosinophils. Sarcoidal and tuberculoid granulomas were present in the dermis. Direct immunofluorescence revealed linear 2+ IgG and 3+ C3 along the basement membrane. Indirect immunofluorescence was positive for BP180 and BP230 antibodies. These findings support the diagnosis of bullous pemphigoid with concomitant cutaneous Crohn disease. Both bullous pemphigoid and Crohn disease have been associated with an altered T-cell response. The similarities in the pathogenesis of the underlying inflammatory milieu suggest a possible etiopathogenic connection. This is believed to be the first report of cutaneous Crohn disease presenting simultaneously with bullous pemphigoid on histopathological examination.

Gender differences in melanoma prognostic factors.

BACKGROUND: Although previous studies identify gender differences in melanoma, limited research on the phenomenon exists. METHODS: In this retrospective chart review, 1,156 adults diagnosed with melanoma, between 2006-2016, at the University of Colorado were included. Breslow depth, mitotic rate, ulceration status, and location were extracted from charts between March and August 2016. Cochran-Armitage trend tests and cumulative logistic regression were used to examine the association between gender and Breslow depth, univariately and after adjusting for potential confounders. RESULTS: In univariate analysis, males were significantly more likely to present with lesions with higher Breslow depths (p for trend=0.005). In models adjusted for age, melanoma subtype, and location, males were marginally more likely to present with lesions with higher Breslow depths (cumulative OR: 1.261, 95% CI: 0.988-1.611, p=0.060). Males were also marginally more likely to present with lesions with higher mitotic rates, after further adjustments for all other prognostic factors (cumulative OR: 1.244, 95% CI: 0.979-1.580, p=0.074). LIMITATIONS: This was a retrospective single-institution study. CONCLUSION: Differences in mitotic rates among melanomas in males versus females, even after adjustments for all other prognostic factors, suggests that biological differences may contribute to the female prognosis advantage.

Orf Virus Infection in Humans: A Review With a Focus on Advances in Diagnosis and Treatment.

Ecthyma contagiosum, also called contagious pustular dermatosis, is a zoonotic disease caused by the orf virus (OrfV). As a member of the poxviridae family and parapoxvirus genus, this dermatotropic virus has developed an array of mechanisms by which to evade the host immune system in both humans and animals. The ubiquitousness of this pathogen in sheep, goats, and deer has led to the development of orf in diverse areas around the world. Human disease occurs via direct contact with infected animals or fomites. Rarely, human-to-human transmission has been reported. The disease progresses through six clinically distinct dermatologic stages and lesions usually heal in three to six weeks without scarring. Farmers, veterinarians, and hunters represent high-risk groups, as their repeated contact with livestock and wild animals predisposes them to infection. With an increasing number of cattle, livestock, and wild animals being kept as pets, human orf may become more prevalent in the future. Taken with the lack of a widely accepted and successful antiviral treatment regimen, this demonstrates the importance of conducting additional research to further elucidate the pathogenic effects of the OrfV in humans. J Drugs Dermatol. 2017;16(7):684-689.

Multiple miliary osteoma cutis of the face associated with Albright hereditary osteodystrophy in the setting of acne vulgaris: a case report.

Osteoma cutis is a condition characterized by theformation of bone within the skin. Such aberrantossification of the skin and subcutaneous tissue isconsidered primary when it arises in the absence ofunderlying tissue damage or a preceding cutaneouslesion. Conversely, secondary osteoma cutis occurswhen skin ossification is the result of a pre-existingskin lesion, trauma, or inflammatory process [1,2].Although rare, primary osteoma cutis has beenassociated with a number of different geneticdisorders. Albright hereditary osteodystrophy (AHO),a condition first described in 1942 by Fuller Albright,is an autosomal dominant metabolic disorder causedby a mutation in the GNAS1 gene [3]. This disease isassociated with a variety of phenotypic traits includingcutaneous ossification, short stature, brachydactyly,obesity, and mental retardation. It should be notedthat brachydactyly is the most specific feature of AHO[4]. However, owing to variable expressivity individualsmay present only with a subset of these symptoms [5,6]. The cutaneous ossification observed in patientswith AHO may be seen in infancy or early childhoodand is sometimes the earliest presenting symptom.Nonetheless, because clinical features of AHO canbe seen in the absence of metabolic derangements(i.e. normal serum calcium, phosphorus, and PTHlevels) an early diagnosis is often missed and delayedfor many years. Herein, we present a case of miliaryosteoma cutis of the face in a 68 year-old woman withphenotypic features of AHO and laboratory studiesconsistent with type 1a PHP.

Greater distance to an academic medical center is associated with poorer melanoma prognostic factors: The University of Colorado Experience.

INTRODUCTION: Numerous studies report a correlation between distance to diagnostic provider in an academic medical center and poorer prognosis ofdisease. Limited research on this topic exists with respect to melanoma. METHODS: This was a retrospective chart review of 1,463 adults (≥18 years) initially diagnosed with melanoma between 2006-2016. Associations between distance traveled and Breslow depth and presence of metastatic disease were assessed via cumulative and binary logistic regression models, adjusting for patient and tumor characteristics. RESULTS: Subjects traveling ≥50 miles had 58% greater odds of having an increased Breslow depth than those traveling less than that distance (OR: 1.58; 95% CI: 1.24-2.01; p<0.0001), and had four times the odds of presenting with metastatic disease (OR: 4.04; 95% CI: 3.00-5.46; p<0.0001). DISCUSSION: We highlight the correlation between increased distance to our academic medical center with greater Breslow depths and the presence ofmetastatic disease at presentation. CONCLUSION: Future studies assessing other factors and regional differences that limit access to diagnosis might help improve screening efforts to prevent poorer prognosis for patients in these areas.

A rare case of dermatofibrosarcoma protuberans of the forefoot.

Dermatofibrosarcoma protuberans is an extremely rare, potentially malignant tumor type that usually presents on the trunk or proximal extremities. The clinical presentation includes a gradually enlarging painless plaque-like or nodular lesion of the skin with surrounding red to blue discoloration. The diagnosis is based on clinical presentation, computed tomography or magnetic resonance imaging, and biopsy with histologic analysis. An early and timely diagnosis improves chances of complete surgical resection thus improving prognosis. Herein, we present a rare case of dermatofibrosarcoma protuberans with the hopes that its addition to the literature will aid in the earlier recognition of future patients and help prevent this potentially curable disease from becoming deadly.