Axillary Granular Parakeratosis.

We describe a case of an 85-year-old Caucasian female who presented to the dermatology clinic with pruritic, scaly hyperpigmented papules and plaques with surrounding erythema in the left axilla. Based on the history and physical examination, there was concern for possible varicella zoster infection, and the patient was started on valacyclovir 1000 mg three times daily for seven days. A shave biopsy was taken from the left axilla to confirm a diagnosis. Microscopic examination revealed compact hyperparakeratosis with keratohyalin granules throughout the parakeratotic stratum corneum as well as admixed eosinophils within the stratum corneum. The epidermis was acanthotic with irregular hyperplasia of the rete ridges. These microscopic findings supported a diagnosis of axillary granular parakeratosis, a benign skin condition caused by a defect in epidermal differentiation. Granular parakeratosis is seemingly rare but is felt to be an underreported condition. It is important for clinicians to be aware of the disease in order to correctly identify the lesions and reassure patients of its benign nature and provide appropriate treatment recommendations.

Skin Cancer Prevention and Screening Behaviors among Agricultural Workers: A Survey of the Attendees of the Sioux Falls Farm Show.

INTRODUCTION: Agricultural workers are at a higher risk for skin cancer due to excessive amounts of sun exposure, poor sun safety practices, and limited access to healthcare. This study aimed to assess skin cancer history, sun protection practices, and skin cancer surveillance measures among Midwestern agricultural workers. METHODS: Individuals that attended the 2020 Sioux Falls Farm Show were asked to complete a 12-question survey on sun exposure, sun protective practices, and skin cancer surveillance. Survey responses were aggregated and analyzed using Microsoft Excel. RESULTS: A total of 99 individuals participated in the study, of which 70 identified as agricultural workers. Most individuals reported working outdoors eight to 10 hours daily for 10-12 months of the year. Most participants reported poor sun protection habits, such as limited sunscreen and limited wide-brimmed hat use. A large number of participants reported they had previously received a professional skin check, although 33 percent reported never examining their own skin for suspicious lesions. CONCLUSIONS: Midwestern agricultural workers present a unique population that could benefit from improved skin cancer prevention. Opportunities for improvement include education of skin cancer preventative measures using platforms that are likely to reach rural agricultural workers and education regarding skin self-examinations. This study identified high risk factors of this population including substantial sun exposure, poor sun protection, and minimal self-skin examinations. Our findings may help guide future methods to increase skin cancer education, prevention, and surveillance in agricultural workers.

Cutaneous nocardiosis in an immunocompromised patient.

We describe a case of a 79-year-old man with chronic lymphocytic leukemia (CLL) who presented with ataxia; falls; vision loss; and numerous mobile erythematous nodules on the chin, neck, scalp, and trunk. Computed tomography of the head and chest revealed cavitary lesions in the brain and lungs. Clinically, the skin nodules were believed to represent an infectious process. Two punch biopsies were obtained, which revealed an unremarkable epidermis with a mixed inflammatory infiltrate with abscess formation in the dermis. Gram stain highlighted gram-positive branching bacterial organisms. Similar organisms were identified in a bronchoalveolar lavage specimen. Cultures from skin and blood were positive for Nocardia. Our case serves as a reminder to clinicians and pathologists to keep a broad differential diagnosis when dealing with infectious diseases in immunocompromised patients.

A Biopsychosocial Approach to Pain Management.

INTRODUCTION: The goal of this project was to implement a biopsychosocial approach to pain management and measure the effects on patient perception of pain. It was hypothesized that the intervention would positively impact patients' perception of pain. METHODS: A validated survey, the Revised American Pain Society Patient Outcome Questionnaire, was administered to patients on the day of discharge from Avera McKennan Hospital Orthopedics Unit 2-East and 2-West following total joint replacement. Prior to data collection, 2-East was renovated to create more welcoming and comfortable patient rooms. Pre-intervention data was gathered April through June of 2017. In July, a four-hour staff training session on alternative comfort measures and pain medication administration took place. Post-intervention data was gathered July through September of 2017. Data was analyzed via Microsoft Office Excel using t-test and chi-square analyses. RESULTS: Statistically significant improvement was seen on 2-East in pain severity and relief, least amount of pain reported, use of non-medicine methods, and impact of pain on sleep, activities, and negative emotions. Analysis of 2-East and 2-West combined revealed a decrease in overall pain, medication side effects, and impact of pain on sleep, activity, and negative emotions, although not statistically significant. In addition, there was an increase in helpfulness of information, ability to participate in decisions about pain management, and use of nonpharmacologic strategies, although not statistically significant. CONCLUSIONS: The study found outcomes consistent with the hypothesis, although not all results were statistically significant. The complementary use of nonpharmacologic interventions shows promise for improving patient experiences post-surgery. However, more research would be necessary to recommend the widespread implementation of these techniques.