Rapid-onset ulcerative hand nodule.

Was this an infectious abscess, or something less common?

Racial and Ethnic Disparities Among US Academic Dermatology Leadership and Its Influence on Resident Diversity.

BACKGROUND: Diversity in medicine improves mentorship and patient care. However, dermatology is one of the least diverse specialties. We analyzed the racial distributions across leadership positions at academic dermatology programs and explored potential influences on resident racial/ethnic composition.  Methods: A list of ACGME-accredited dermatology programs was obtained. Residency program websites, hospital websites, and publicly available data were used to ascertain race and ethnicity of academic dermatology leadership and residents. SAS version 9.4 was used to calculate descriptive statistics and associations between racial/ethnic composition of dermatologists in leadership positions and residents.  Results: URM individuals were significantly underrepresented across both leadership (6.9%) and resident (12.0%) positions. No statistically significant correlation was found between the percent of URM leadership and URM residents.  Conclusion: Diversity among the US population, medical students, dermatology trainees, and faculty are not reflected in departmental leadership in academic dermatology. This may influence URM recruitment into the field, retention of URM faculty and residents, and mentorship opportunities for URM dermatologists interested in leadership positions. Efforts are needed to improve disparities in representation across leadership roles in academic dermatology.  Fritsche M, Singh P, Zhou S, et al. Racial and ethnic disparities among US Academic Dermatology Leadership and its influence on resident diversity. J Drugs Dermatol. 2023;22(7):653-656. doi:10.36849/JDD.7114.

Bone Wax as a Physical Hemostatic Agent.

Achieving hemostasis in cutaneous surgery on bony or irregular surfaces can be challenging; typical pressure dressings that act by mechanical occlusion with petrolatum gauze can be inadequate. We offer the use of bone wax as a practical hemostatic agent that can be (1) molded to provide ideal occlusion and pressure without adhering to wound surfaces and (2) painlessly and simply removed.

Cohort study assessing the predictive value of a research year vs additional degree in dermatology.

Taking a gap year to obtain an additional degree or for research is becoming increasingly popular among medical students pursuing dermatology to bolster residency application competitiveness. The purpose of this study was to determine whether doing so influences future academic achievement and career trajectory. A list of dermatologists who achieved board certification in 2010 was obtained from the American Board of Dermatology. Information regarding additional post-graduate degrees, research years, fellowship specialization, practice setting, publication number, and H-index were obtained using publicly available data. Additional degrees were associated with higher research productivity, higher H-index, and practicing at teaching hospitals while taking a research year was only associated with a higher H-index. This data can be used to further inform medical students wishing to achieve high levels of research productivity and careers at teaching institutions and residency programs wishing to recruit such applicants.

Skin of Color in Dermatology: Analysis of Content and Engagement on TikTok.

IMPORTANCE: There is an existing disparity in the ability for patients with skin of color to access reliable, evidence-based care via social media. OBJECTIVES: To analyze the intention, creators, and engagement of skin of color content posted on TikTok. DESIGN: Cross-sectional epidemiologic study analyzing the content of 43 search terms related to skin of color. SETTING: Population-based. PARTICIPANTS: The accounts linked to the top 3 posts associated with each search term when sorted by both relevance and number of likes based on the TikTok algorithm. EXPOSURES: N/A. MAIN OUTCOME MEASURES: The number of views, likes, comments, and shares. RESULTS: Dermatologists fall behind other TikTok creators with regard to producing popular skin of color content on TikTok. Conclusion and Results: Dermatologists have the opportunity to help combat the spread of misinformation by generating educational posts and making reliable content more available for skin of color patients. J Drugs Dermatol. 2022;21(7):718-722. doi:10.36849/JDD.6784.

Smooth Versus Textured Tissue Expander Breast Reconstruction: Complications and Efficacy.

INTRODUCTION: Ongoing recognition of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and its link with textured devices has brought a paradigm shift in prosthetic-based breast reconstruction. Many institutions no longer offer textured expansion devices for staged reconstruction. However, there is a paucity of data regarding the efficacy of smooth tissue expanders (TE). We hypothesized that the time to final reconstruction and complication profile between smooth and textured TEs would be similar in breast reconstruction patients. METHODS: A retrospective chart review was performed of all patients who underwent TE breast reconstruction during a 6-year period at the Penn State Hershey Medical Center. Rates of complications treated nonoperatively and those requiring reoperation were assessed. Mechanical complications, including expander malposition and rupture, were evaluated. Time to final breast reconstruction was quantified. Mixed-effects logistic regression and linear regression models, as appropriate, were used to compare textured to smooth TEs. Patient characteristics and anatomic plane placement were adjusted for in all analyses of outcomes. RESULTS: Data were collected on 389 patients, encompassing 140 smooth and 604 textured TEs. Textured devices had an increased incidence of complications treated nonsurgically (16.7% vs 10.7%; P = 0.14). However, smooth TEs had an increased incidence of reoperation (12.1% vs 7.6%; P = 0.06). Most noteworthy was that although smooth TEs had a 40-fold increase in malposition (13.6% vs 0.3%; P < 0.001), no reoperation for this complication was warranted. Further, the time to final reconstruction was comparable between the 2 devices (textured expanders: 221 days and smooth expanders: 234 days; P = 0.15). CONCLUSIONS: Staged, implant-based reconstruction is the most common surgical approach to recreate the breast mound following mastectomy. Textured TEs were the cornerstone to this approach. Unfortunately, the association between textured devices and BIA-ALCL now mandates an alternative. We postulated that smooth expanders would compare favorably for breast reconstruction. Although our study suggests that smooth TEs suffer more malposition, this has a negligible impact on the reconstructive timeline. Thus, smooth TEs may prove beneficial when considering the risk of BIA-ALCL associated with textured devices.

Damage in hidradenitis suppurativa: a narrative review emphasizing the need for a novel outcome measure.

Cutaneous damage caused by hidradenitis suppurativa (HS) is an important contributor to disease burden, independent of active lesions. Outcome measures used to specifically assess damage are becoming commonplace in the assessment of inflammatory diseases. However, no standardized method for assessing HS damage currently exists. The purpose of this study was to review outcome measures in HS that include constructs of both active disease and damage, review damage-specific instruments used in other inflammatory and destructive diseases, and review instruments used to assess scars of various aetiologies. This ultimately provides insight into how attributes of different tools can be applied to develop an outcome measure specific to HS damage. What is already known about this topic? Hidradenitis suppurativa (HS) is a chronic, relapsing, inflammatory skin condition, which causes consequent cutaneous damage and scarring. Damage caused by HS is highly prevalent and an important contributor to its morbidity. Damage is an important component of inflammatory diseases that has proven its utility in a number of outcome measures; however, no standardized method for assessing HS damage currently exists. What does this study add? This narrative review assesses outcome measures used to measure damage in other inflammatory and destructive diseases. Instruments used to assess damage in other diseases can provide a starting point for the development of a damage outcome measure for HS.

Biomechanical Comparison of Fibertape Device Repair Techniques of Ligamentous Lisfranc Injury in a Cadaveric Model.

BACKGROUND: Lisfranc ligamentous injuries are complex, and their treatment, along with the preferred method of fixation, is controversial. Implementing a flexible synthetic augmentation device (fibertape) has been described as an alternative to traditional screw fixation. This biomechanical study evaluated two fibertape devices with interference screw fixation: InternalBrace, and InternalBrace with supplementary intercuneiform stabilization. METHODS: The diastasis and relative angular displacement between bones were measured at three midfoot joints in the Lisfranc articulation. Measurements were obtained for the pre-injured, injured, and post-fixation stages under static loading. Specimens then underwent stepwise increases in cyclic loading performed at 1 Hz and 100 cycles, at 100 N ground reaction force intervals from 500 to 1200 N to simulate postoperative loading, and then up to 1800 N to simulate high loads. Failure of fixation was defined as diastasis greater than 2 millimeters at the second-metatarsal - medial-cuneiform joint. RESULTS: InternalBrace specimens demonstrated failures in 3 of 9 (33%) specimens at cyclic loads of 1000 N. Conversely, InternalBrace with Supplementary Limb specimens had 1 failure at 1200 N. The difference in diastasis at the second metatarsal-medial cuneiform joint was statistically significant between the two groups at higher loads of 1600N (p = 0.019) and 1800N (p = 0.029). CONCLUSION: The use of InternalBrace for ligamentous Lisfranc injuries appears to provide a biomechanically viable alternative for withstanding early postoperative protected weight bearing. Furthermore, the use of a supplementary limb in addition to the InternalBrace fibertape fixation method appears to enhance its biomechanical efficacy.

Novel FEMASK-score, a histopathologic assessment for destructive Charcot neuropathic arthropathy, reveals intraneural vasculopathy and correlates with progression and best treatment.

BACKGROUND: Charcot neuropathic arthropathy is a debilitating, rapidly destructive degenerative joint disease that occurs in diabetic, neuropathic midfoot. Clinicoradiologic assessment for Charcot neuropathic arthropathy previously relied on Eichenholtz stage. There is limited histopathologic data on this entity. We wanted to independently develop a histopathologic scoring system for Charcot neuropathic arthropathy. DESIGN: Retrieval of surgical pathology midfoot specimens from Charcot patients (2012-2019) were analyzed to evaluate joint soft tissue and bone. Considering progression from large (≥half 40× hpf) to small (