The Clinical Learning Environment Review as a model for impactful self-directed quality control initiatives in Clinical Practice.

The Clinical Learning Environment Review (CLER) program was designed to assess the learning environment in residencies and fellowships accredited by the Accreditation Council for Graduate Medical Education (ACGME). The program's focus is preventing harm to patients. This effort was purposely separated from the residency survey process so that training programs would be open to identifying and preventing errors without fear of jeopardizing their accreditation status. In our dermatology residency program, we established a resident-centered project for quality assessment/quality improvement (QA/QI). We identified areas of potential patient harm, designed methods to quantifiably assess the problems, and developed focused and cost-effective initiatives to improve patient safety. A new initiative was presented at each monthly faculty meeting. This project jump-started QA/QI efforts in our department and has improved patient safety. Our QA/QI project also has enhanced resident/faculty communication and provided trainees with experience in designing QA/QI efforts. It could serve as a model for postresidency efforts to prevent patient harm.

Gaucher Disease Type 2 Presenting with Collodion Membrane and Blueberry Muffin Lesions.

Collodion membrane is most closely associated with forms of autosomal recessive congenital ichthyosis, but the differential diagnosis includes many other less common etiologies. Herein we present a case of Gaucher disease (GD) type 2 in a neonate presenting with collodion membrane in addition to blueberry muffin lesions. The clinical presentation and etiology of GD and the differential diagnoses for collodion membrane and blueberry muffin lesions are briefly reviewed.

Chemotherapy-associated tongue hyperpigmentation and blue lunula.

Combination chemotherapy is associated with cutaneous and mucosal side effects. Antineoplastic agents have been associated with mucosal and nail pigmentation. We describe a 16-year-old Saudi Arabian girl with combination chemotherapy-associated black tongue hyperpigmentation and blue lunula. The diagnosis of drug-associated pigmentary changes is based on correlating the onset of the clinical observations with the temporal initiation of the patient's chemotherapy agents. Spontaneous fading of antineoplastic therapy-induced tongue or nail dyschromia may subsequently occur following discontinuation of the causative drug.

Radiation port dermatophytosis: tinea corporis occurring at the site of irradiated skin.

Radiation port dermatophytosis is the occurrence of tinea corporis within the area of radiation therapy delivery. A 68-year-old man, while receiving proton beam radiation for adenocarcinoma of the prostate, developed a dermatophyte infection in the area of the radiotherapy port. Including this patient, 4 patients with radiation port dermatophytosis have been reported in the world literature. The epidemiology, clinical manifestations, histopathology, diagnosis, pathogenesis, and treatment of this condition are discussed. The diagnosis of radiation port dermatophytosis may be missed because it is misinterpreted as radiation-induced dermatitis. Thus, it is possible that radiation port dermatophytosis may be more prevalent in patients receiving radiation therapy.