Reactive Keratoacanthoma Following Treatment with 5-Fluorouracil.

Keratoacanthoma (KA) is an epidermal cell tumor with a central keratin plug known to be a variant of keratinocyte carcinoma (KC). KAs typically arise from ultraviolet (UV)-damaged skin and thus are particularly prevalent on extremities. KAs can also be a consequence of local skin trauma. 5-fluorouracil (5-FU) is a topical therapy used to treat early KC, as well as actinic keratoses (AKs). In this paper, we describe the unique cases of two elderly female patients who were treated with 5-FU for AKs of the lower extremities but developed severe inflammatory reactions and reactive KAs to the topical therapy.

Ros-NET: A deep convolutional neural network for automatic identification of rosacea lesions.

BACKGROUND: Rosacea is one of the most common cutaneous disorder characterized primarily by facial flushing, erythema, papules, pustules, telangiectases, and nasal swelling. Diagnosis of rosacea is principally done by a physical examination and a consistent patient history. However, qualitative human assessment is often subjective and suffers from a relatively high intra- and inter-observer variability in evaluating patient outcomes. MATERIALS AND METHODS: To overcome these problems, we propose a quantitative and reproducible computer-aided diagnosis system, Ros-NET, which integrates information from different image scales and resolutions in order to identify rosacea lesions. This involves adaption of Inception-ResNet-v2 and ResNet-101 to extract rosacea features from facial images. Additionally, we propose to refine the detection results by means of facial-landmarks-based zones (ie, anthropometric landmarks) as regions of interest (ROI), which focus on typical areas of rosacea occurrence on a face. RESULTS: Using a leave-one-patient-out cross-validation scheme, the weighted average Dice coefficients, in percentages, across all patients (N = 41) with 256 × 256 image patches are 89.8 ± 2.6% and 87.8 ± 2.4% with Inception-ResNet-v2 and ResNet-101, respectively. CONCLUSION: The findings from this study support that pre-trained networks trained via transfer learning can be beneficial in identifying rosacea lesions. Our future work will involve expanding the work to a larger database of cases with varying degrees of disease characteristics.

A Retrospective Analysis Comparing the New Standardized Letter of Recommendation in Dermatology with the Classic Narrative Letter of Recommendation.

Background: In an effort to avoid numerous problems associated with narrative letters of recommendation, a dermatology standardized letter of recommendation was utilized in the 2014-2015 resident application cycle. Objective: A comparison of the standardized letter of recommendation and narrative letters of recommendation from a single institution and application cycle to determine if the standardized letter of recommendation met its original goals of efficiency, applicant stratification, and validity. Methods: Eight dermatologists assessed all standardized letters of recommendation/narrative letters of recommendation pairs received during the 2014-2015 application cycle. Five readers repeated the analysis two months later. Each letter of recommendation was evaluated based on a seven question survey. Letter analysis and survey completion for each letter was timed. Results: Compared to the narrative letters of recommendation, the standardized letter of recommendation is easier to interpret (p<0.0001), has less exaggeration of applicants' positive traits (p<0.001), and has higher inter-rater and intrarater reliability for determining applicant traits including personality, reliability, work-ethic, and global score. Standardized letters of recommendation are also faster to interpret (p<0.0001) and provide more information about the writer's background or writer-applicant relationship than narrative letters of recommendation (p<0.001). Limitations: This study was completed at a single institution. Conclusions: The standardized letter of recommendation appears to be meeting its initial goals of 1) efficiency, 2) applicant stratification, and 3) validity. (J Clin Aesthet Dermatol. 2016;9(9):36-2.).

Dermatoses of pregnancy.

The dermatoses of pregnancy represent a distinct heterogenous group of cutaneous disorders that can impact the health of the pregnant woman and potentially the fetus. The current classification of pregnancy-specific cutaneous disorders is reviewed, along with important clinical features. Advances in management of these disorders, along with fetal implications, are discussed. The diagnosis of these disorders is challenging, but important clinical features can aid in diagnosis. There have been important advances in the management of these disorders and better understanding of potential fetal risks. Early recognition is critical for appropriate care.

Graft-versus-host disease-associated angiomatosis: a clinicopathologically distinct entity.

BACKGROUND: Chronic graft-versus-host disease (GVHD) may present with various cutaneous manifestations. Isolated case reports describe eruptive angiomas in this setting. OBJECTIVE: We sought to provide a clinical and pathologic description of vascular proliferations in patients with GVHD. METHODS: Cases of documented GVHD associated with vascular proliferations were collected from the National Institutes of Health, Ohio State University, and MD Anderson Cancer Center. RESULTS: Eleven patients with a diagnosis of GVHD who developed vascular proliferations were identified. All patients manifested sclerotic type chronic GVHD of the skin. Vascular lesions were first documented a median of 44 months after transplantation and occurred primarily on the lower extremities or trunk. Histopathology revealed anastomosing networks of thin-walled vascular proliferations in a vague lobular growth pattern, with overlying epidermal acanthosis, peripheral collarette, ulceration, and disorganized fibroblast-rich and fibrotic stroma. Improvement was noted in 1 patient treated with propranolol and sirolimus and 1 patient with electrocautery. LIMITATIONS: Given the retrospective nature of the study, the overall incidence of vascular lesions in patients with GVHD is unknown. Histopathology was present for review on only 3 of 11 patients. CONCLUSION: The phenomenon of vascular lesions appears to be relatively specific for sclerotic type chronic GVHD when compared with other fibrosing diseases. We propose the term "graft-versus-host disease-associated angiomatosis" to describe this entity.

Layered closure versus buried sutures and adhesive strips for cheek defect repair after cutaneous malignancy excision.

BACKGROUND: Primary closure of surgical defects after excision of cutaneous malignancies has been traditionally accomplished with layered closure. OBJECTIVE: We sought to compare the cosmetic outcome of cheek defects repaired with layered closure versus buried sutures and adhesive strips. METHODS: In all, 38 patients underwent excision of a cutaneous malignancy on the cheek by primary excision or Mohs micrographic surgery. Patients were prospectively randomized to receive layered closure to one half of the repair and buried sutures with adhesive strip closure for the other half of the repair. Follow-up assessment was performed by a blinded evaluator using a visual analog scale. RESULTS: There were no differences in scar contour, erythema, or overall cosmesis between closure types. LIMITATIONS: All study participants were Caucasian, with a mean age of 68 years, limiting generalizability of results. CONCLUSION: Layered closure does not have a cosmetic advantage over buried sutures and adhesive strips for the primary repair of cheek defects.

A review of bioactive materials and chronic wounds.

An increasing number of bioactive materials are indicated for the treatment of chronic lower extremity ulcers. They are promising adjuncts to standard therapy. When used in conjunction with standard therapy for venous leg ulcers and diabetic foot ulcers, bioactive materials may increase the likelihood and rate of healing. This review compares commonly available bioactive materials indicated for chronic wound healing and provides an overview of the relevant Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes for these products.