Acquired Immunodeficiency Syndrome (AIDS)-Related Kaposi's Sarcoma in Conjunction With Methicillin-Resistant Staphylococcus aureus (MRSA) and May-Thurner Syndrome.

A 34-year-old male with a history of peripheral vascular disease and multifactorial anemia presented with red blotches on his face, trunk, and extremities, multiple large bumps prominent on the lower extremities that burst at times with yellow pus and blood, swelling in the ankles, extremely dry feet, a chronic ulcer on the foot, and a dry, flaky, and irritated left middle finger. The patient was human immunodeficiency virus (HIV) positive, viral load undetectable. Endovenous laser ablation therapy was performed to correct venous insufficiency. A balloon was placed in the common iliac vein to treat May-Thurner syndrome. The bumps on the lower extremities were biopsied and found to be Kaposi's sarcoma (KS) and were removed by both wide excisions and shave removals, and further treatment with doxorubicin was performed successfully. The foot ulcer was found to be positive for methicillin-resistant Staphylococcus aureus (MRSA) and was treated with sulfamethoxazole-trimethoprim, metronidazole, and a chlorhexidine topical liquid. The patient noted that the treatments on his leg were working very well, and he was clearing up.

Vitiligo and Prostate Cancer Correlation.

A 72-year-old male with a history of systemic hypertension, asthma, chronic obstructive pulmonary disease (COPD), and hyperlipidemia presents with diffuse patches of cutaneous depigmentation. A shave biopsy of different regions of depigmented skin indicated vitiligo. The patient was prescribed Opzelura (ruxolitinib) 1.5% topical cream as well as tacrolimus 0.1% topical ointment for vitiligo. He also had a history of prostate cancer. A prostate biopsy revealed three sites of prostatic adenocarcinoma with a Gleason score of 6 and a Prostate Imaging-Reporting and Data System (PI-RADS) score of 2. The patient remained in active surveillance for prostate cancer without treatment, due to its low severity. A subsequent biopsy five years later revealed a decrease in prostate cancer prevalence, with cancer present in only one core and at a lower severity. The purpose of this case presentation is to discuss possible links between vitiligo and prostate cancer, as well as their shared mechanisms and pathways.

Somatic BRCA Mutation in Metastatic Breast Cancer.

A 65-year-old female with a history of multicentric invasive ductal breast carcinoma with lobular features and prior mastectomy presented with a chief complaint of two new raised mildly erythematous lesions on the right upper arm. The lesions were visualized during examination, and the patient noted no symptoms associated with them. Tangential shave biopsies were obtained for each lesion and were sent to the lab for testing. Both lesions were found to be metastatic breast carcinoma. Wide local excisions were performed on each site. The patient followed up with radiation therapy and was prescribed Faslodex and Ibrance. FoundationOne testing on the lesions revealed BRCA2 loss in the tumor, and germline DNA testing was performed in light of this. The test yielded negative results for harmful BRCA1 and 2 mutations. The patient was treated with Lynparza (olaparib), and two years following the start of this medication has had no additional recurrences.

Inhibition of Clostridium difficile and Antibiotic-Resistant Subtypes by Compound RNW03.

Clostridium difficile infection is mainly the result of antibiotic usage which disturbs the normal microbial flora. Antibiotic-resistant strains of C. difficile have emerged which have limited the number of therapeutic options. We sought to determine if compound RNW03, a broad spectrum anti-microbial formula, would be effective in inhibiting C. difficile and its antibiotic-resistant subtypes. Compound RNW03 was titrated and added to standard concentrations of C. difficile. The wells were incubated in an anaerobic chamber for 48 hours followed by a cell count. Compound RNW03 proved to be effective in preventing the growth of seven different C. difficile strains, including those that were antibiotic-resistant strains in dilutions of 32- to 64-fold.

Levamisole-Induced Necrosis and Vasculitis.

A 56 year-old Caucasian man with a past medical history (PMH) of cytopenia and a positive antinuclear antibody (ANA) presented to the dermatology office due to painful discoloration of the ears (Figure 1) and a "rash" on the upper portion of his right arm (Figure 2) which had initially subsided but later worsened. Punch biopsies of the right ear and right arm lesions were performed at the initial visit. (SKINmed. 2021;19:-0).

Familial Angiofibrohistiocytic Hamartoma Syndrome.

A 27-year-old Hispanic man presented with multiple papules and nodules measuring up to 10 cm in diameter. These lesions were widespread (Figure 1), but not on mucosal epithelium. At birth, the patient had had multiple hypopigmented macules that had progressed to papules and nodules over time. Dermatoscopic examination of these papules and nodules showed prominent capillaries. New lesions were constantly developing but were slow-growing. Other family members had similar lesions, including the patient's three brothers, father, paternal aunt, and a 3-year-old niece (daughter of the 2nd eldest brother), although not as extensively as in this patient. The paternal grandparents were not affected (Figure 2). As the patient had been raised in rural Mexico with limited financial resources, access to health care was limited, so the condition had been left undiagnosed and untreated for most of the patient's life.

Tau Protein in Oral Mucosa and Cognitive State: A Cross-sectional Study.

Neurodegenerative diseases are characterized by the presence of abnormal aggregates of proteins in brain tissue. Among them, the presence of aggregates of phosphorylated Tau protein (p-Tau) is the hallmark of Alzheimer's disease (AD) and other major neurodegenerative disorders such as corticobasal degeneration and frontotemporal dementia among others. Although Tau protein has previously been assumed to be exclusive to the central nervous system, it is also found in peripheral tissues. The purpose of this study was to determine whether there is a differential Tau expression in oral mucosa cells according to cognitive impairment. Eighty-one subjects were enrolled in the study and classified per Mini-Mental State Examination test score into control, mild cognitive impairment (MCI), and severe cognitive impairment (SCI) groups. Immunocytochemistry and immunofluorescence revealed the presence of Tau and four p-Tau forms in the cytoplasm and nucleus of oral mucosa cells. More positivity was present in subjects with cognitive impairment than in control subjects, both in the nucleus and cytoplasm, in a speckle pattern. The mRNA expression of Tau by quantitative real-time polymerase chain reaction was higher in SCI as compared with the control group (P < 0.01). A significantly higher percentage of immunopositive cells in the SCI group was found via flow cytometry in comparison to controls and the MCI group (P < 0.01). These findings demonstrate the higher presence of p-Tau and Tau transcript in the oral mucosa of cognitively impaired subjects when compared with healthy subjects. The feasibility of p-Tau quantification by flow cytometry supports the prospective analysis of oral mucosa as a support tool for screening of proteinopathies in cognitively impaired patients.

The Presence of Alpha-Synuclein in Skin from Melanoma and Patients with Parkinson's Disease.

BACKGROUND: The misfolding and prion-like propagation of the protein α-synuclein (α-syn) is the leading molecular signature in Parkinson's disease (PD). There is a significant coincidence of PD and melanoma that may suggest a shared pathophysiology. This study compared the presence of α-syn in neural crest-derived tissues, such as nevi, melanoma, skin tags, and skin biopsies from patients with PD and healthy controls. METHODS: Biopsies from participants with PD were obtained from patients from a tertiary referral center for dermatology and neurology in Mexico and a private dermatopathology center in Florida between January 2015 and March 2016. Biopsies from 7 patients with melanoma, 15 with nevi, 9 with skin tags, 8 with PD, and 9 skin biopsies from healthy volunteers were analyzed for immunohistochemical determination of α-syn and tyrosinase. All analyses were performed by pathologists who were blinded with respect to the clinical diagnosis. RESULTS: In healthy controls, positive α-syn status was restricted to scattered cells in the basal layer of the epidermis and accounted for 1 ± 0.8% of the analyzed area. In patients with PD, there was increased staining for α-syn PD (3.3 ± 2.3%), with a higher percentage of positive cells in nevi (7.7 ± 5.5%) and melanoma (13.6 ± 3.5%). There was no increased staining in skin tags compared with healthy controls. CONCLUSION: Patients with PD and melanoma have increased staining for α-syn in their skin. The authors propose that neurons and melanocytes, both derived from neuroectodermal cells, may share protein synthesis and regulation pathways that become dysfunctional in PD and melanoma.

Geriatric dermatology review: Major changes in skin function in older patients and their contribution to common clinical challenges.

There is a paucity of data to guide evidence-based treatment decisions in managing older dermatologic patients, in part because of the frequent exclusion of older adults from clinical trials. Hence, we provide a comprehensive review of important conditions in geriatric dermatology, or "dermatogeriatrics." It is our hope the field of "dermatogeriatrics" will become more evidence-based and recognized as a field in its own right so that we can better meet the needs of our growing numbers of older patients, now and in the future.

Geriatric dermatology: Part I. Geriatric pharmacology for the dermatologist.

Issues related to prescribing dermatologic drugs in the elderly are less recognized than age-related skin findings. This is related in part to the lack of a standardized residency training curriculum in geriatric dermatology. As the number of elderly patients rises in the United States, drug-related iatrogenic complications will become increasingly important. This review discusses age-related changes in pharmacokinetics and pharmacodynamics of common dermatologic drugs. These changes include volume of distribution, renal function, liver toxicity from interactions of commonly prescribed drugs, and medications that can decompensate cognition in the older patient population. We outline seven prescribing principles related to older dermatology patients, including useful strategies to reduce polypharmacy and improve drug adherence, using an evidence-based approach whenever possible.

Geriatric dermatology: Part II. Risk factors and cutaneous signs of elder mistreatment for the dermatologist.

Cutaneous signs may be the most visible hint of elder mistreatment. Dermatologists are in a unique position to recognize and report physical abuse and neglect in the older patient population. In this review, we describe the scope and impact, risk factors, cutaneous signs, and appropriate responses to suspected elder mistreatment. There is a critical need for additional evidence to inform clinical practice in the field of elder abuse and neglect. Recognition and reporting of suspected elder mistreatment by the dermatologist can be life-saving for the older patient.

Dermatologic presentation of omphalomesenteric duct remnant.

A 6-month-old girl was presented to the clinic by her parents for evaluation of a skin lesion on the umbilicus present since birth (Figure). The infant's parents were concerned mainly because of its appearance, and they related that the child was essentially asymptomatic. There was no history of trauma to the area, and the parents denied any complications during delivery. The lesion appeared as a violaceous polypoid papule in the umbilical depression. A biopsy was performed and sent for histologic evaluation. The dermatopathology report revealed the presence of ectopic intestinal mucosa consistent with omphalomesenteric duct remnant. We fully discussed the situation with the parents and referred the child to a pediatric surgeon for complete evaluation and removal of any ectopic tissue.

Past and future: porphyria and porphyrins.

Porphyria is a compelling disease--disrupted enzyme pathways, heightened sensitivities, and a fascinating history tied in with tales of Dracula. This review discusses the history, pathophysiology, classification, and treatment of porphyria. It further discusses the way in which research on the etiologies of the various porphyrias has led to the development of porphyrin-based photodynamic therapy, which shows great promise in targeted therapy for a variety of serious pathologies.

Eczematous diseases of the geriatric population.

Geriatric patients must endure many medical challenges within and from without the integumental system. Clinicians should be comprehensive in treatment and thorough in investigation of any and all dermatologic concerns. Many of these concerns begin with an eczematous lesion and the differential is broad. Knowledge of the structure and anatomy of the skin, and how time and external forces combine with internal processes to manifest lesional findings, is the key. The dermatologist may have to sift through the entire dermatologic differential each and every time he or she encounters a lesion with eczematous characteristics. Complete examination of patients and careful attention to their history is the best starting point to help patients achieve the most quality from life and the least morbidity from disease.

Scabies and pediculosis.

Although scabies and pediculosis are difficult and widespread problems, there are many effective treatments available. Dermatologists play a major role in educating the public in prevention and diagnosis. Although patients are more aware and well informed of the infections because of the Internet and other sources, practitioners are often the most important source of information and treatment in helping to eradicate this worldwide problem.

Cutaneous manifestations of endocrine-metabolic disease and nutritional deficiency in the elderly.

This article explores cutaneous manifestations of endocrine-metabolic disease and nutritional deficiency in the elderly. Topics covered include the following: diabetes mellitus, thyroid disorders, adrenal dysfunction, pituitary disorders, parathyroid disease, nutritional deficiencies, menopause, and HIV.

Skin cancer in elderly patients.

The role of the dermatologist who provides care to the geriatric patient assumes the care for the integument system. The ability to diagnose and treat cancerous lesions effectively with special care given to the needs of the geriatric patient is considered indispensable. The clinician should accept the responsibility of skin cancers and obtain biopsies with empathy and care.

Cutaneous oncologic and cosmetic surgery in geriatric patients.

A wide array of surgical procedures is available to geriatric patients. These interventions can enhance the appearance of patients and facilitate the removal of skin cancers. Pre-existing medical conditions of geriatric patients must be considered comprehensively when selecting and performing cutaneous surgical procedures. Many older patients suffer from a variety of diseases and take a variety of medications and herbal supplements to ameliorate the consequences of such diseases. In general, skin surgery can be performed safely on even very old patients, provided precautions are followed. The biopsychosocial well-being and essence of patients must also be addressed when performing dermatologic surgery. If patients are treated holistically and comprehensively, their surgical experience can be enhanced and their health and appearance improved.