Risk factors and prevention strategies for cutaneous squamous cell carcinoma in transplant recipients.

It has been well established that organ transplant recipients (OTRs) are at an increased risk of skin cancer. Studies vary on the exact degree of this risk, but it is likely somewhere between 60 and 100 times more likely that an OTR patient will develop skin cancer. The management of skin cancer burden in OTRs requires a multidisciplinary approach with the transplant team, dermatologists, and oncology. In many major hospital systems, there are dedicated transplant dermatology clinics that allow for specialized and more frequent screenings of this high-risk population. Here we discuss the pathogenesis, presentation, and treatment options used by dermatologists to prevent and treat commonly found skin cancers in this vulnerable population.

Neuropathic ulcers: a focused review.

Neuropathic ulcers or diabetic foot ulcers are preventable ulcers associated with diabetes mellitus. These ulcers occur in the setting of unrecognized trauma, peripheral neuropathy, and foot deformities; however, they are often complicated by peripheral arterial disease and infection. Approximately 15% of individuals with a neuropathic ulcer require limb amputation as a result of infection. Not only are neuropathic ulcers a burden to the patient but also to the economy. The cost of diabetic foot ulcer care is approximately $1.38 billion per year. This makes neuropathic ulcers an important therapeutic target. This review presents the pathophysiology, clinical presentation, evaluation, management, and prevention of neuropathic ulcers.

Axillary manifestations of dermatologic diseases: a focused review.

Many dermatologic conditions affect the axillae; however, identification is often difficult due to similar clinical presentations. The axillae are unique due to their increased humidity, as well as their high density of hair follicles and sweat glands. Furthermore, they are a site of increased friction due to the presence of closely opposing skin surfaces. In addition to the axillae being involved with common skin diseases affecting other body surface areas, these unique factors also predispose the axillae to less common skin manifestations. This review categorizes the various conditions based on their inflammatory or infectious etiology and describes each condition based on their predominant characteristics, such as lesion type and color, methods of diagnosis, and treatment. Overall, the goal of this review is to provide a broad differential of conditions affecting the axillae so that conditions can be differentiated from one another and treated effectively.

Acne treatment: analysis of acne-related social media posts and the impact on patient care.

Many patients use social media as a source of medical information on dermatologic diseases. Social media offers accessible methods of communicating with physicians, other patients, and pharmacies. The information gathered through social media posts has the potential to influence patients' views of their conditions and treatment options, though the source often is unknown. This systematic review examined the content and source of social media posts identified using the search terms acne and treatment across all social media platforms available through a commercial social media data aggregating software (Crimson Hexagon) from May 2008 to May 2016. The goal of this study was to identify sources of acne-related social media posts to determine communication trends to gain a better understanding of the potential impact social media may have on patient care.

Review of the Etiopathogenesis and Management Options of Chondrodermatitis Nodularis Chronica Helicis.

Chondrodermatits nodularis chronica helicis (CNCH), first described by Max Winkler in 1915, presents as a sore nodule on the helix or antihelix of the external ear. In this paper, we review the etiopathogenesis and management options of CNCH. This condition has a multifactorial etiology; however, sustained pressure from sleeping on one side is the favored theory. Currently, there are many surgical and non-surgical methods of treating CNCH. Most practitioners recommend conservative measures first in their patients, such as pressure-relieving prostheses, prior to surgical treatment. Surgery is the gold standard of therapy with cartilage and wedge excisions yielding recurrence rates of about 10%. Carbon dioxide laser and photodynamic therapy are newer treatment modalities for CNCH, yet they have recurrence rates similar to conservative therapy. In conclusion, due to the high rates of CNCH recurrence, wedge resection is the suggested treatment for CNCH after conservative measures fail.

Developing a Continuous Quality Improvement Assessment Using a Patient-Centered Approach in Optimizing Systemic Lupus Erythematosus Disease Control.

Systemic lupus erythematosus (SLE) is a multi-organ, autoimmune disease in which patients lose self-tolerance and develop immune complexes which deposit systemically causing multi-organ damage and inflammation. Patients often experience unpredictable flares of symptoms with poorly identified triggers. Literature suggests exogenous exposures may contribute to flares in symptoms. An online pilot survey was marketed globally through social media to self-reported SLE patients with the goal to identify specific subpopulations who are susceptible to disease state changes based on analyzed exogenous factors. The pilot survey was promoted for two weeks, 80 respondents fully completed the survey and were included in statistical analysis. Descriptive statistical analysis was performed on de-identified patient surveys and compared to previous literature studies reporting known or theorized triggers in the SLE disease state. The pilot survey identified similar exogenous triggers compared to previous literature, including antibiotics, increasing beef intake, and metal implants. The goal of the pilot survey is to utilize similar questions to develop a detailed internet-based patient interactive form that can be edited and time stamped as a method to promote continuous quality improvement assessments. The ultimate objective of the platform is to interact with SLE patients from across the globe longitudinally to optimize disease control and improve quality of care by allowing them to avoid harmful triggers.

Differentiation of Lung Cancer, Empyema, and Abscess Through the Investigation of a Dry Cough.

An acute dry cough results commonly from bronchitis or pneumonia. When a patient presents with signs of infection, respiratory crackles, and a positive chest radiograph, the diagnosis of pneumonia is more common. Antibiotic failure in a patient being treated for community-acquired pneumonia requires further investigation through chest computed tomography. If a lung mass is found on chest computed tomography, lung empyema, abscess, and cancer need to be included on the differential and managed aggressively. This report describes a 55-year-old Caucasian male, with a history of obesity, recovered alcoholism, hypercholesterolemia, and hypertension, presenting with an acute dry cough in the primary care setting. The patient developed signs of infection and was found to have a lung mass on chest computed tomography. Treatment with piperacillin-tazobactam and chest tube placement did not resolve the mass, so treatment with thoracotomy and lobectomy was required. It was determined through surgical investigation that the patient, despite having no risk factors, developed a lung abscess. Lung abscesses rarely form in healthy middle-aged individuals making it an unlikely cause of the patient's presenting symptom, dry cough. The patient cleared his infection with proper management and only suffered minor complications of mild pneumoperitoneum and pneumothorax during his hospitalization.

A Review of Colorectal Cancer Detection Modalities, Stool DNA, and Fecal Immunochemistry Testing in Adults Over the Age of 50.

Colorectal cancer (CRC) is the third leading cause of cancer death in the United States. Recently, more focus has been placed on developing effective screening tools to detect the presence of both precancerous and cancerous lesions present in the colon and rectum. Colonoscopy has been well established as the gold standard of the colon and rectal cancer screening. However, not all patients are willing to undergo a colonoscopy due to the procedure's invasive nature. Non-invasive screening methods have been developed to appeal to patients who refuse colonoscopy. Fecal occult blood tests have long been used by physicians, in addition to colonoscopy, in an effort to screen for CRC. New screening methods, such as fecal immunochemical test (FIT) and stool DNA (sDNA) testing, have been developed as a more sensitive screening measure to attempt to accurately screen patients who have precancerous or cancerous colorectal lesions. This article compares CRC screening techniques through literature review in order to determine which tests offer the most sensitive detection of CRC and precancerous lesions in average-risk adults over the age of 50 years old. Through this review, it can be seen that sDNA is more sensitive than FIT in detecting all stages of CRC, as well as precancerous lesions.