An Atypical Presentation of Mpox Transmitted Between Transgender Men Through Oral Sex.

ABSTRACT: The current multicountry outbreak of mpox in 2022 is the first occurrence of widespread transmission in nonendemic countries. Prior cases in the United States involved exposure through foreign travel or direct contact with infected rodents. Reports of the current outbreak have predominately described spread through sexual encounters between cis-gender men who have sex with men. We report a unique case of mpox in which the transmission occurred through oral sex between 2 transgender men, with a short incubation period and progressive asynchronous emergence of lesions. Continued analysis of transmission routes and awareness will improve timely prevention, diagnosis and treatment.

Epidemiologic Analysis of Chilblains Cohorts Before and During the COVID-19 Pandemic.

Importance: Beginning in March 2020, case reports and case series linked the COVID-19 pandemic with an increased occurrence of chilblains, but this association has not been evaluated in an epidemiologic study. Objective: To assess whether a correlation exists between COVID-19 incidence and chilblains incidence. Design, Setting, and Participants: A retrospective cohort study was conducted within the Kaiser Permanente Northern California system from January 1, 2016, to December 31, 2020; health plan members of all ages were included. Exposure: COVID-19 incidence in 207 location-months, representing 23 geographic locations in northern California across 9 months. Main Outcome and Measures: Chilblains incidence was the main outcome. The association of chilblains incidence with COVID-19 incidence across the 207 location-months was measured using the Spearman rank correlation coefficient. Results: Of 780 patients with chilblains reported during the pandemic, 464 were female (59.5%); mean (SD) age was 36.8 (21.8) years. COVID-19 incidence was correlated with chilblains incidence at 207 location-months (Spearman coefficient 0.18; P = .01). However, only 17 of 456 (3.7%) patients with chilblains tested during the pandemic were positive for SARS-CoV-2, and only 9 of 456 (2.0%) were positive for SARS-CoV-2 within 6 weeks of the chilblains diagnosis. Test results of 1 of 97 (1.0%) patients were positive for SARS-CoV-2 IgG antibodies. Latinx patients were disproportionately affected by COVID-19 but not by chilblains. Conclusions and Relevance: This cohort study found that in northern California, the incidence of chilblains increased during the pandemic but was correlated weakly with the incidence of COVID-19 across 207 location-months. These findings may have resulted from a causal role of COVID-19, increased care-seeking by patients with chilblains during the pandemic, or changes in behavior during shelter in place.

Interactive Session for Residents and Medical Students on Dermatologic Care for Lesbian, Gay, Bisexual, Transgender, and Queer Patients.

Introduction: Despite increasing emphasis on LGBTQ health in medical education, evidence-based training on LGBTQ patient care in dermatology is lacking. We designed an interactive online didactic session on dermatologic care of LGBTQ patients for medical students and dermatology residents. Methods: Session content was based on continuing medical education articles and incorporated preexisting LGBTQ-inclusive policies, environments, and videos. We implemented the session via a web-based videoconferencing platform as part of a preexisting resident lecture series. We began with a 90-minute lecture on LGBTQ health care disparities and dermatologists' roles, best practices for providing inclusive care, and dermatologic health concerns and screening recommendations in LGBTQ populations. To solidify knowledge and promote practice of learned skills, a 30-minute interactive role-playing session followed where participants acted as observer, patient, or provider in three distinct clinical scenarios pertaining to dermatologic care of LGBTQ patients. Participants completed baseline and follow-up surveys, which included a psychometrically validated clinical skills scale and an ad hoc knowledge assessment. Results: Baseline and follow-up scores from the clinical skills scale increased overall (0.7; 95% CI, 0.5-0.9; p < .001), in self-reported clinical preparedness (1.1; 95% CI, 0.5-1.6; p = .001), and in basic knowledge (0.8; 95% CI, 0.3-1.4; p = .003). Discussion: An online interactive didactive session on dermatological care of LGBTQ patients increased participants' clinical preparedness and basic knowledge. Implementation of similar sessions at other institutions can improve gaps in preparing residents and medical students in dermatological care of LGBTQ patients.

Anogenital Dermatitis in Men Who Have Sex with Men.

Evaluation of anogenital dermatitis requires a detailed history, including a sexual history. Men who have sex with men have different risk of certain infectious causes compared with men who have sex with women. Infectious causes of balanitis and anal dermatitis are easily treatable once identified. Irritant contact dermatitis is a common cause of balanitis, and avoidance of irritants, including decreased soap washing, helps many patients improve. Detailed histories of the personal products used by the patient and partner(s), including soaps, lotions, perfumes, lubricants, condoms, topical medications, hygiene sprays, personal wipes, and laundry detergent, may reveal possible irritants or contact allergens.

Cutaneous manifestations of COVID-19: a systematic review and analysis of individual patient-level data.

Distinctive patterns in the cutaneous manifestations of COVID-19 have been recently reported. We conducted a systematic review to identify case reports and case series characterizing cutaneous manifestations of confirmed COVID-19. Key demographic and clinical data from each case were extracted and analyzed. The primary outcome measure was risk factor analysis of skin related outcomes for severe COVID-19 disease. Seventy-one case reports and series comprising 144 cases of cutaneous involvement in COVID-19 were included. The most frequently occurring morphologies were: morbilliform (30.6%), varicelliform (18.8%), urticarial (13.2%), chilblains-like (12.5%), and acro-ischemic (9%). The median age of patients was 51 years (mean: 45.9, range: 0 to 91). Patients with chilblains-like eruptions had lower frequencies of extracutaneous COVID-19 symptoms (5/18, 27.8%, P<0.05) and were less likely to have severe COVID-19 disease (2/18, 11%, 95% CI 1.4% to 34.7%, P=0.02). Patients with livedoid and acro-ischemic morphologies had severe COVID-19 more frequently than those with other morphologies (17/21, 81%, 95% CI 58.0% to 94.5%, P<0.0001). The most frequently observed cutaneous manifestations of COVID-19 (morbilliform, varicelliform, and urticarial) are well-described patterns of viral exanthems. However, chilblains-like, livedoid, and acro-ischemic morphologies are not traditionally associated with viral infections and were significantly associated with severity of COVID-19 disease.

Palmoplantar keratoderma with progressive gingivitis and recurrent pyodermas.

Papillon-Lefèvre syndrome (PLS) is a rare inherited palmoplantar keratoderma (PPK) that is associated with progressive gingivitis and recurrent pyodermas. We present a case exhibiting classic features of this autosomal-recessive condition and review the current understanding of its pathophysiology, diagnosis, and treatment. Additionally, a review of pertinent transgredient PPKs is undertaken, with key and distinguishing features of each syndrome highlighted.

White epidermal nevi at birth in a patient with tuberous sclerosis.

We report a neonate who presented at birth with multiple, scattered, white macerated plaques. Punch biopsy confirmed epidermal nevi. At 3 months of age the patient presented with infantile spasms and, after full evaluation, was diagnosed with tuberous sclerosis complex (TSC). We suggest that physicians consider TSC in a neonate with epidermal nevi inconsistent with any described epidermal nevus syndrome.

A pilot study describing knowledge and practices in the health care of men who have sex with men by U.S. Air Force primary care providers.

BACKGROUND: The Centers for Disease Control and Prevention (CDC) recommends annual sexually transmitted infection (STI) screening in men who have sex with men (MSM) that is unique to this patient population. The goal of this study is to establish whether U.S. Air Force (USAF) providers are familiar with these guidelines and determine if USAF providers offer these tests appropriately. METHODS: A survey designed to determine primary care provider knowledge and practices in MSM health care was disseminated via e-mail to 124 primary care providers at 3 separate USAF medical facilities in Northern California from September 15 to 30, 2011. FINDINGS: There was a 46% response rate. 15% of respondents correctly identified all CDC-recommended STI screens. 42% stated that they did not know the CDC screening guidelines. 51% did not screen male patients for MSM activity in the past year. 81% of respondents had not offered the full complement of MSM STI screening in the past year. CONCLUSION: The majority of USAF primary care providers surveyed were not familiar with CDC-recommended annual screening tests for STIs in MSM, and they did not screen for MSM activity or offer MSM STI screening tests regularly. Further studies across the Department of Defense are needed to corroborate the findings of this study.

Clinic teaching made easy: a prospective study of the American Academy of Dermatology core curriculum in primary care learners.

BACKGROUND: Dermatology instruction for primary care learners is limited, and the American Academy of Dermatology (AAD) has developed a new core curriculum for dermatology. OBJECTIVE: This study sought to prospectively evaluate short-term knowledge acquisition and long-term knowledge retention after using the AAD core curriculum during a clinical dermatology clerkship. METHODS: Resident physicians and physician assistant students performing clerkships at military dermatology clinics were given access to the AAD core curriculum teaching modules before their public availability. Knowledge acquisition was measured with pretests and posttests, and a follow-up quiz was given up to a year after the dermatology rotation to assess knowledge retention. RESULTS: In all, 82 primary care learners met inclusion criteria. Knowledge improved significantly from pretest to posttest (60.1 vs 77.4, P < .01). Of the 10 factors evaluated, only high use of the World Wide Web site was significantly associated with improved posttest scores (70.8 vs 82.2, P = .003). Long-term follow-up scores available from 38 participants were only slightly lower than their posttest scores (70.5 vs 78.9, P < .01) at a median time of 6.8 months after the clerkship. Students found the online modules clear, engaging, and worth their time and preferred them to other teaching methods such as textbook reading and lectures. LIMITATIONS: The nonrandomized study was voluntary, so individual performance may be influenced by selection bias. CONCLUSION: The more learners used the online curriculum, the better they scored on the posttest. This demonstrates the efficacy of the AAD core curriculum in teaching its goals and objectives for primary care learners performing a dermatology clerkship.

Serum lidocaine levels and cutaneous side effects after application of 23% lidocaine 7% tetracaine ointment to the face.

BACKGROUND: Few published studies have analyzed serum lidocaine levels and individual patient characteristics affecting metabolism after application of compounded topical anesthetics. OBJECTIVE: To measure serum lidocaine levels during and cutaneous side effects after standardized application of 23% lidocaine/7% tetracaine compounded anesthetic to the face of healthy volunteers. METHODS AND MATERIALS: Fifty-two volunteers were enrolled, and compounded 23% lidocaine/7% tetracaine ointment was applied to their faces for 2 hours. Lidocaine levels were determined every 30 minutes during application and for 2 hours after removal. Follow-up telephone calls 3 days later assessed cutaneous side effects. RESULTS: Median peak lidocaine level was 1.15 µg/mL, and the highest peak lidocaine level in an individual was 3.4 µg/mL. Higher serum lidocaine levels were found in men (p < .01), nonwhite volunteers (p = .02), and those with larger facial surface area (p = .04). Age and body mass index did not affect lidocaine levels. Irritant contact dermatitis was common, resulting in hyperpigmentation in some patients. CONCLUSION: Facial surface area, male sex, and nonwhite ethnicity were associated with higher serum lidocaine levels after topical application of lidocaine. Compounded anesthetics containing lidocaine should be used with caution under the direct supervision of a physician.