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Dermatology Online Journal

Samantha Witta, Andrea Bershow, Ronda S Farah, Brian Berg, Noah Goldfarb
A 66-year-old man presented with a grayish 1mm macule on the left cheek. Dermatoscopic examination revealed annular-granular structures partially surrounding a single follicular ostium. Histopathologic examination demonstrated atypical, confluent single melanocytes at the basal layer with nesting, crowding, and upward migration descending along the hair follicle, consistent with the diagnosis of lentigo maligna (LM). This case presents evidence in support of the Schiffner progression model for LMs, starting with asymmetric pigmented follicular openings composed of annular-granular structures, which later coalesce into gray to dark black/brown streaks, and then form pseudo-networks or rhomboidal structures...
September 15, 2018: Dermatology Online Journal
Aastha Gupta, Pooja Arora, Purnima Malhotra, Kabir Sardana
Fixed drug eruption is a delayed type hypersensitivity reaction to a drug seen most frequently with antibiotics such as tetracyclines, sulfonamides, and NSAIDs such as naproxen and ibuprofen. Although H1-antihistamines rarely elicit cutaneous adverse effects, there have been a few reports in the literature implicating them in causing fixed drug eruption, particularly the piperazine derivatives (hydroxyzine, cetirizine, levocetirizine), and loratadine. However, cutaneous drug reactions with the alkylamine derivatives like pheniramine maleate are extremely uncommon and fixed drug eruptions have not been reported with any of the alkylamine antihistamines to date...
August 23, 2018: Dermatology Online Journal
Yunyoung Claire Chang, Ali Al-Haseni, Jag Bhawan, Sahni Debjani
Metastatic squamous cell carcinoma (SCC) to the skin can be distinguished histologically from primary cutaneous squamous cell carcinoma as, unlike the latter, it is typically separated from the normal overlying squamous epithelium. Rare cases have been reported of cutaneous metastases of SCC that demonstrate continuity with the overlying benign squamous epithelium, termed "epidermotropic cutaneous metastases of SCC." We report the first case of epidermotropic cutaneous metastases of SCC originating from primary esophageal SCC with a review of the literature on this rare histological phenomenon...
August 23, 2018: Dermatology Online Journal
Jennifer R DiBiagio, Tia Pyle, Justin J Green
We discuss imiquimod associated with non-application site mucosal reactions and two of our own clinical cases. In one of our patients, erosive cheilitis developed in a young boy after using topical imiquimod 5% cream for 5 nights weekly on bilateral cheeks, chin, and near vermillion border for molluscum contagiosum. The case is discussed with concerns for imiquimod use in molluscum contagiosum when used near mucosal surfaces.
August 23, 2018: Dermatology Online Journal
Michael A Cardis, Alison R Huppmann, Anna Yasmine Kirkorian
Fibrous hamartoma of infancy (FHI) is a benign mesenchymal tumor of young children. It has a broad clinical differential diagnosis and is often clinically confused for vascular and malignant soft tissue neoplasms. Recognition of the unique histologic features of FHI, a triphasic population of mature adipose tissue, mature fibrous tissue, and immature mesenchymal tissue, will ensure the correct diagnosis. In this report we present a case of this rare entity, including the associated clinical, radiologic, and histologic findings...
July 26, 2018: Dermatology Online Journal
Juliane P Araujo, Jacqueline Cruz, Jefferson X Oliveira, Alan M Canto
In some cases of dentofacial deformities such as vertical maxillary excess, administration of botulinum toxin has been used as an effective minimally invasive technique to improve the aesthetic disorder of gummy smile. This article presents a case of a woman with excessive gingival exhibition during the smile related to vertical maxillary excess and hyperactive upper lip elevator muscles. This patient was treated using botulinum toxin type A (BT) to camouflage the deformity and improve her facial aesthetic...
July 15, 2018: Dermatology Online Journal
James V Twede, Mark C Patterson, Mike L Anderson
We report an atypical case of an epidermoid cyst associated with a skull defect to emphasize the diagnostic utility of bedside ultrasonography for the evaluation of subcutaneous scalp nodules. A 24-year-old woman presented with what appeared to be a benign cyst on the right parietal scalp. The cyst was first noticed one year prior to presentation and caused only mild irritation. Upon excision of the cyst, a notable calvarial defect was found in the frontoparietal bone and surgical excision was suspended. Head and brain imaging was performed confirming the calvarial defect with mild mass effect on the brain...
July 15, 2018: Dermatology Online Journal
Luis J Borda, Joshua S Mervis, Paolo Romanelli, Hadar Lev-Tov
Clear cell acanthoma (CCA) is a rare, benign cutaneous condition most often seen on the lower extremities. Lesions are of variable morphology and have been described as polypoid, pigmented, giant, and cystic lesions. Although no racial or gender predilection has been reported, CCA on the breast is a very rare finding that has been observed mainly in young Korean women. Herein, we describe a case of CCA of the areola in an elderly woman with metastatic renal cell carcinoma. Physical exam revealed a pink plaque with central erosions on the left areola...
July 15, 2018: Dermatology Online Journal
Daniel Clayton Morse, Jaime Tschen
We report a case of a slowly growing papule on the nasal bridge of an elderly woman. Histopathological findings revealed a very unusual type of folliculosebaceous cystic hamartoma with a retiform and primitive epithelial proliferation associated with the stromal component. Folliculosebaceous cystic hamartoma is an uncommon lesion that involves a cystically dilated follicle embedded in a stroma of distinct mesenchymal tissue. Because folliculosebaceous cystic hamartoma is a rare and clinically indistinct lesion, clinical photographs of the lesion are not widely available...
July 15, 2018: Dermatology Online Journal
M Costa-Silva, F Osorio, A Pedrosa, P Santos, F Azevedo
Porocarcinoma (PC) is a malignant neoplasm arising from the intraepidermal ductal portion of the sweat gland duct. Lichen planopilaris (LPP) is a not so rare variant of cutaneous lichen planus (LP) with a preferential involvement of hair follicles, consisting of a chronic lymphocytic inflammation, leading to cicatricial alopecia. A 42-year-old woman, recently diagnosed with HIV infection, was referred to our clinic because of an alopecic patch of 6 years' duration. In the upper region of the alopecia a 1.5cm nodule was noticed, which the patient stated had started growing soon after the appearance of the hair loss...
July 15, 2018: Dermatology Online Journal
Tatyana Yetto, Carrick Burns
Linear IgA bullous dermatosis is a rare bullous disease in children and adults that can be associated with autoimmune conditions, malignancies, infections, or medication exposure. The definitive diagnosis relies on the biopsy. A 58-year-old man presented to our clinic with a pruritic vesicular and bullous eruption. Histology showed the classic findings of a subepidermal blister with neutrophilic infiltrate and linear IgA deposition along the dermal-epidermal junction. Upon further evaluation, he was diagnosed with ulcerative proctitis...
July 15, 2018: Dermatology Online Journal
Jacqueline Jones, Jason D Marquart, Nicholas F Logemann, Daniel R DiBlasi
Lichen striatus is a rare inflammatory dermatosis that follows the lines of Blaschko. This paper discusses an unusual presentation of lichen striatus following hepatitis B vaccination and reviews the literature of vaccine-induced lichen striatus.
July 15, 2018: Dermatology Online Journal
Evan Darwin, Paolo Romanelli, Hadar Lev-Tov
Multiple Sclerosis (MS) is a chronic autoimmune disease that presents with a wide variety of sensory and motor deficiencies. New medications targeting B cells have been approved to treat MS, but the side effect profile has not been widely explored. Herein, we report a case of drug-induced psoriasiform dermatitis following ocrelizumab treatment. Physicians should be cognizant of this possible side effect in patients receiving treatment for MS.
July 15, 2018: Dermatology Online Journal
Erik Petersen, Kory Lee, Chen Yao, Richard Jahan-Tigh, Valencia Thomas
The subculture of bodybuilding is rife with people willing to do whatever is necessary to achieve the perfect physique. One particularly concerning behavior is the injection of site-enhancing-oils (SEO) into lagging muscle groups to achieve instant size and symmetry. The typical SEO is a combination of lidocaine, alcohol, and oil; it is rarely, if ever, administered by a qualified professional. As a result, there are a variety of potential complications that can manifest in the skin and other organ systems...
July 15, 2018: Dermatology Online Journal
Trissa M Connors, Alejandro Restrepo, Harry Dao
Photosensitive drug reactions resulting in hyperpigmentation occur when there is an accumulation in the skin of melanin, heavy metals, or the drug itself. Herein we describe an immunocompromised orthotopic liver transplant patient with levofloxacin-induced hyperpigmentation with iron deposition. To identify the causal agent, consideration was given to medications the patient had taken long-term, as well as medications introduced more recently before the event. Levofloxacin and posaconzole emerged as the most likely culprit drugs, neither of which have a strong history in the literature of being associated with photosensitive hyperpigmentation...
July 15, 2018: Dermatology Online Journal
Francesca Cortini, Barbara Marinelli, Manuela Seia, Agostino Seresini, Alessandra Bassotti
Classic Ehlers-Danlos syndrome (cEDS) is characterized by skin hyperelasticity, joint hypermobility, increased tendency to bruise, and abnormal scarring. Mutations in type V collagen, a regulator of type I collagen fibrillogenesis, underlie this type of EDS. In this article we report a genetic and clinical analysis of an Italian family that carried missense mutation c.934 C>T (p.R312C) in the COL1A1 gene. Literature review showed an association between this missense mutation and vascular complications...
July 15, 2018: Dermatology Online Journal
Karlyn E Pollack, Mary Margaret B Noland
Lucien Marie Pautrier was a skilled dermatologist whose work led to the creation of numerous manuscripts within the field of dermatology. His name, though, most often lends itself to a histopathological finding that was not his own discovery. For years, the origin of the term "pautrier microabscess" was thought to be the result of a misattribution by Louis H. Winer at the 66th annual meeting of the American Dermatological Association in 1946. However, a recently reported citing of the term in a 1932 article has led to speculation that the term could, in fact, have been first coined at a meeting of the New York Society of Dermatology in 1927...
July 15, 2018: Dermatology Online Journal
M Cameron, J Tan, C McLellan, A I O'Neil, A Reed, C Henderin, R P Dellavalle, S Boyal
INTRODUCTION: Despite proven benefits in other medical specialties, there is a paucity of patient decision aids (PDAs) in dermatology. The present study developed online PDAs for acne and psoriasis, incorporating iterative patient and physician feedback, in accordance with International Patient Decision Aid Standards (IPDAS). DESIGN AND METHOD: Content was adapted from clinical practice guidelines and primary research and formatted for an 8th grade reading level...
July 15, 2018: Dermatology Online Journal
Julie Iacullo, Elaine Kunzler, Harib H Ezaldein, Jeffrey F Scott
The role of biologic therapies in the field of dermatology continues to evolve as newer drugs and biosimilars are introduced to the U.S. market. Prescribing patterns and expenditures regarding biologic drugs are not well described. To address this knowledge gap, a retrospective review was conducted using the Medicare Provider Utilization and Payment Data: Part D Prescriber dataset between January 1st, 2013 and December 31st, 2015. The primary outcome was claims per provider per calendar year. Secondary outcomes included drug cost, shared cost per dermatologist, and practice location...
July 15, 2018: Dermatology Online Journal
Dema T Alniemi, Alyssa Fischer, Laura A Greene, Joseph C Pierson
Ipilimumab is an immune-modulating drug that is being used today for various cancers including metastatic malignant melanoma. Owing to its mechanism of action, several adverse events have been reported, including some affecting skin. In this work, we report a novel display of multiple ipilimumab-associated halo lichenoid reactions surrounding benign nevi during treatment of metastatic melanoma. A patient underwent treatment with ipilimumab for treatment of stage IIIC melanoma at our center and was monitored for progress and adverse events throughout treatment...
July 15, 2018: Dermatology Online Journal
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