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Takahashi A, Hattori S, Sakai E, Yang L, Katayama I, Fujimoto M, Wataya-Kaneda M. Distribution of shagreen patches and fibrous cephalic plaques in patients with tuberous sclerosis complex: A retrospective cohort study. J Am Acad Dermatol 2024; 90:849-852. [PMID: 38104779 DOI: 10.1016/j.jaad.2023.11.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 10/10/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Aya Takahashi
- Department of Dermatology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Satoshi Hattori
- Department of Biomedical Statistics, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan; Institute for Open and Transdisciplinary Research Initiative, Osaka University, Suita, Osaka, Japan
| | - Ena Sakai
- Department of Biomedical Statistics, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Lingli Yang
- Department of Dermatology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Ichiro Katayama
- Department of Dermatology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Mari Wataya-Kaneda
- Department of Dermatology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan; Division of Health Science, Department of Neurocutaneous Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
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2
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Nagarajan AK, Manoharan K, Moozhiyil S. Segmental Collagenoma in Tuberous Sclerosis - Think Beyond the Skin: A Rare Case Report. Indian J Dermatol 2023; 68:123. [PMID: 37151256 PMCID: PMC10162764 DOI: 10.4103/ijd.ijd_1038_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Collagenomas are connective tissue nevi characterized by an imbalance in the distribution and amount of collagen in the extracellular matrix. Shagreen patch, a collagenoma of tuberous sclerosis, is a classical finding in this genodermatosis (Tuberous Sclerosis). Though the prototypical lesion is a shagreen patch, some individuals manifest only small collagenomas, and these can hinder a diagnosis of tuberous sclerosis and thus mask underlying systemic involvement as was seen in this case we have reported, wherein a 22-year-old male presented with segmental collagenomas over the face and calcified subependymal nodules of the brain on further investigation.
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Affiliation(s)
- Ashok Kumar Nagarajan
- From the Department of DVL, Sree Balaji Medical College and Hospital, Chromepet, Chennai, Tamil Nadu, India
| | - Krishnaswamy Manoharan
- From the Department of DVL, Sree Balaji Medical College and Hospital, Chromepet, Chennai, Tamil Nadu, India
| | - Shreya Moozhiyil
- From the Department of DVL, Sree Balaji Medical College and Hospital, Chromepet, Chennai, Tamil Nadu, India
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3
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Tiplica GS, Fritz K, Butacu AI, Ungureanu L, Sălăvăstru CM. Gutartige nichtmelanozytäre Hauttumoren bei Syndromen. Hautarzt 2022; 73:114-126. [DOI: 10.1007/s00105-022-04947-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 12/24/2022]
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4
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Histological Patterns of Skin Lesions in Tuberous Sclerosis Complex: A Panorama. Dermatopathology (Basel) 2021; 8:236-252. [PMID: 34287284 PMCID: PMC8293214 DOI: 10.3390/dermatopathology8030029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/17/2022] Open
Abstract
Tuberous Sclerosis Complex (TSC) is a multisystem genetic disease characterized by cutaneous and extracutaneous hamartomas. The diagnosis is based on the association of major and minor criteria, defined by a consensus conference updated in 2012. The clinical examination of the skin is crucial because seven diagnostic criteria are dermatological: four major (hypomelanotic macules, angiofibroma or fibrous cephalic plaques, ungual fibromas, shagreen patches) and three minor criteria (confetti skin lesions, dental enamel pits, intraoral fibromas). Skin biopsy is commonly performed to assert the diagnosis of TSC when the clinical aspect is atypical. Histopathology of TSC cutaneous lesions have been poorly reported until now. In this article, we review the histologic features described in the literature and share our experience of TSC skin biopsies in our pediatric hospital specialized in genetic disorders. Both hypomelanotic lesions and cutaneous hamartomas (angiofibroma/fibrous cephalic plaques, ungual fibromas, shagreen patches) are discussed, including the recent entity called folliculocystic and collagen hamartoma, with a special emphasis on helpful clues for TSC in such lesions.
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Dash S, Palit A, Mitra S, Behera B. Multidermatomal Zosteriform Collagenoma: A Rare Case Report with Dermoscopic Findings and Review of Literature. Indian Dermatol Online J 2021; 12:447-450. [PMID: 34211915 PMCID: PMC8202495 DOI: 10.4103/idoj.idoj_335_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/04/2020] [Accepted: 08/22/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Siddhartha Dash
- Department of Dermatology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Aparna Palit
- Department of Dermatology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Suvradeep Mitra
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Biswanath Behera
- Department of Dermatology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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6
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Savell AS, Norton K, Heaphy MR. Folliculocystic and Collagen Hamartoma: A Subset of Fibrous Cephalic Plaque. Cureus 2021; 13:e14987. [PMID: 34131532 PMCID: PMC8195546 DOI: 10.7759/cureus.14987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Tuberous sclerosis complex is known to cause a variety of cutaneous hamartomas, most commonly hypomelanotic macules, angiofibromas, shagreen patches, and fibrous cephalic plaques. In recent years, a new cutaneous hamartoma that bears physical and histological resemblance to fibrous cephalic plaque has been proposed called folliculocystic and collagen hamartoma. The primary difference between the two diagnoses is the histologic presence of infundibular cysts in the latter. However, some authors have called into question if the two diagnoses are truly distinct. In this case report, we present a patient with tuberous sclerosis complex and fibrous cephalic plaque with infundibular cysts and propose that the presence of cysts should be incorporated into the possible histologic features of fibrous cephalic plaque.
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Affiliation(s)
- Anita S Savell
- Dermatology, University of Nevada Reno School of Medicine, Reno, USA
| | - Kyle Norton
- Dermatology, University of Nevada Reno School of Medicine, Reno, USA
| | - Michael R Heaphy
- Dermatopathology, Skin Cancer and Dermatology Institute, Reno, USA.,Dermatology, University of Nevada Reno School of Medicine, Reno, USA
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7
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Cartron AM, Buccine D, Treichel AM, Lee CR, Moss J, Darling TN. Miliary fibromas in tuberous sclerosis complex. J Eur Acad Dermatol Venereol 2021; 35:1226-1229. [PMID: 33565654 DOI: 10.1111/jdv.17161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is a hamartoma syndrome characterized by multiple skin lesions, such as angiofibromas, shagreen patch and miliary fibromas (MiF). OBJECTIVE To determine the clinical and histological features of MiF. METHODS A retrospective analysis was conducted on 133 adults with TSC. Photography was used to characterize the appearance and location of MiF. Histological features in five skin samples from four individuals were evaluated by a board-certified dermatopathologist. RESULTS MiF were observed in 19 of 133 (14%) individuals with TSC. MiF were 1- to 3-mm skin-coloured, sessile papules scattered on the back and rarely buttocks or thighs. Most were scattered in a bilaterally symmetric distribution, but others were asymmetric or associated with a shagreen patch. Histological features of MiF included expansion of the papillary and periadnexal dermis with variable hamartomatous abnormalities involving adjacent epithelial components. CONCLUSIONS MiF are distinct from other cutaneous lesions in TSC such as shagreen patches and angiofibromas. Recognition of this entity is important in defining the spectrum of TSC disease and reassuring individuals with TSC that these lesions are benign.
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Affiliation(s)
- A M Cartron
- Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.,Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - D Buccine
- Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - A M Treichel
- Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.,Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - C R Lee
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - J Moss
- Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - T N Darling
- Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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8
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Zhang B, Zhang X, Xing H, Ma L. Multiple hypomelanotic macules in an infant cannot be ignored. Pediatr Investig 2020; 4:301-302. [PMID: 33376960 PMCID: PMC7768292 DOI: 10.1002/ped4.12235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Bin Zhang
- Department of DermatologyBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Xin Zhang
- Heart CenterBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Huan Xing
- Department of DermatologyBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Lin Ma
- Department of DermatologyBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
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Abstract
OPINION STATEMENT Oncologists should be able to discern the salient clinical features of the most common germline mutations that give rise to neuroendocrine tumors. Astute recognition of an index patient affected by a hereditary syndrome can lead to a "tip-of-the-iceberg" phenomenon whereby their entire kindred can then be proactively monitored and managed potentially with substantial reduction of morbidity and mortality. Through careful history-taking, as well as thoughtful assimilation of findings from the physical exam, biochemical laboratories, scans, and pathology reports, the clinician can spot phenotypic clues that distinguish these familial patterns from sporadic cases of tumorigenesis.
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10
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Kirk CW, Donnelly DE, Hardy R, Shepherd CW, Morrison PJ. Natural history of a fibrous cephalic plaque and sustained eight decade follow-up in an 80 year old with tuberous sclerosis complex type 2. THE ULSTER MEDICAL JOURNAL 2020; 89:14-16. [PMID: 32218621 PMCID: PMC7027183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/08/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Fibrous cephalic plaques (FCP) are a characteristic manifestation of tuberous sclerosis complex (TSC) and occur in one third of cases. Their natural history and long term course is unknown, as is the outcome of long term follow-up of TSC cases in old age. PHENOTYPE AND METHODS We describe an 80 year old with TSC due to a c.2784dupC TSC2 mutation, who was diagnosed in infancy with an FCP and was regularly followed up at the TSC clinic over 8 decades with regular epilepsy treatment and renal monitoring. RESULTS Regular clinical photography and clinical records document the plaque at different ages. The FCP naturally resolved at 74 years. Facial angiofibromas also faded with time in the last decade. His epilepsy and renal abnormalities remained under control with careful surveillance and monitoring. DISCUSSION Natural aging in the eighth decade causes progressive laxity of collagen and leads to natural resolution of FCPs. This novel finding with a unique 80 year follow up yields valuable insights into the aging changes within FCPs and facial angiofibromas as the pathways linking facial angiofibromas and FCP's through the TGF-β1 pathway are now being elucidated. CONCLUSION We present a clinical odyssey showing the natural progression and history of FCPs in TSC and comment on the mechanistic pathways allowing potential interventions in this disfiguring condition. TSC cases can be successfully managed and complications - particularly in the brain and kidney, can be avoided over an entire lifetime. This is encouraging for long term prospects for patients with TSC.
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Affiliation(s)
- Claire W Kirk
- Department of Genetic Medicine, Belfast Health and Social Care Trust, Belfast BT9 7AB, UK
| | - Deirdre E Donnelly
- Department of Genetic Medicine, Belfast Health and Social Care Trust, Belfast BT9 7AB, UK,Centre for Cancer Research and Cell Biology, Queens University Belfast, BT9 7AE, UK
| | - Rachel Hardy
- Department of Genetic Medicine, Belfast Health and Social Care Trust, Belfast BT9 7AB, UK
| | - Charles W Shepherd
- Department of Genetic Medicine, Belfast Health and Social Care Trust, Belfast BT9 7AB, UK
| | - Patrick J Morrison
- Department of Genetic Medicine, Belfast Health and Social Care Trust, Belfast BT9 7AB, UK,Centre for Cancer Research and Cell Biology, Queens University Belfast, BT9 7AE, UK,Correspondence to: Prof P Morrison CBE, MD, DSc. Consultant in Genetic Medicine, Regional Genetics Centre, A Floor, Belfast HSC Trust, Belfast, BT9 7AB, UK. E-mail:
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Affiliation(s)
- Qiong Wu
- Department of Dermatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hongxiao Chen
- Department of Dermatology, Linyi People’s Hospital, Linyi, China
| | - Dirk M. Elston
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston
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12
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Abstract
The rare case of an eyelid lesion comprised of hamartomatous dermal collagen, known as a collagenoma, is presented. Collagenomas may be sporadically acquired, or inherited as part of numerous autosomal dominant syndromes. In the appropriate clinical context, their diagnosis should prompt a thorough review of systems, systemic examination, and inquiry into family history, to assess for underlying autosomal dominant syndromes. Recognition of collagenomas may thus allow diagnosis of inherited syndromes, allowing patients to obtain appropriate genetic counseling, as well as screening and treatment of associated systemic pathology.
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13
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Bishnoi A, De D, Vinay K, Vishwajeet V, Saikia UN. A large shagreen patch with overlying verrucous epidermal naevus: a curious case of colocalization. Clin Exp Dermatol 2018; 44:218-220. [PMID: 29893016 DOI: 10.1111/ced.13681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2018] [Indexed: 11/30/2022]
Affiliation(s)
- A Bishnoi
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - D De
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - K Vinay
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - V Vishwajeet
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - U N Saikia
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
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Oyerinde O, Buccine D, Treichel A, Hong C, Lee CCR, Moss J, Darling TN. Fibrous cephalic plaques in tuberous sclerosis complex. J Am Acad Dermatol 2017; 78:717-724. [PMID: 29258863 DOI: 10.1016/j.jaad.2017.12.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/01/2017] [Accepted: 12/10/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Fibrous cephalic plaques (FCPs) stereotypically develop on the forehead of patients with tuberous sclerosis complex (TSC). They constitute a major feature for TSC diagnosis and may present before other TSC-related cutaneous hamartomas. OBJECTIVE To describe the clinical characteristics of FCPs in TSC. METHODS A total of 113 patients with TSC were enrolled in an observational cohort study. Retrospective analysis of medical records and skin photography was performed. FCPs were categorized by anatomic location and size. RESULTS FCPs were observed in 36% of patients (41 of 113). Of 62 total lesions, 58% were 1 to less than 5 cm, 13% were 5 cm or larger, and 29% were of unknown size mostly because of prior excision. The distribution of lesions was 39% on the forehead, 27% on the face (nonforehead), 3% on the neck, and 31% on the scalp. Fourteen patients had similar lesions less than 1 cm in diameter. Histopathologically, FCPs displayed dermal collagenosis, decreased elastic fibers, and features of angiofibromas or fibrofolliculomas. LIMITATIONS Men were under-represented because the cohort was enriched for patients with TSC with lymphangioleiomyomatosis, which occurs in adult women. CONCLUSION Two-fifths of FCPs presented on the forehead, with most of the remainder in other locations on the face and scalp. Better recognition of these lesions may lead to earlier diagnosis of TSC.
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Affiliation(s)
- Oyetewa Oyerinde
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Danielle Buccine
- Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Alison Treichel
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Claire Hong
- Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Chyi-Chia Richard Lee
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Joel Moss
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Thomas N Darling
- Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
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Kaplan L, Kazlouskaya V, Ugorji R, Heilman E, Siegel DM, Glick SA. Folliculocystic and collagen hamartoma of tuberous sclerosis: A new case in a female patient and review of literature. J Cutan Pathol 2017; 45:67-70. [DOI: 10.1111/cup.13056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 09/26/2017] [Accepted: 10/05/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Laura Kaplan
- Department of Dermatology; SUNY Downstate Medical Center; Brooklyn New York
| | | | - Rex Ugorji
- Department of Dermatology; SUNY Downstate Medical Center; Brooklyn New York
| | - Edward Heilman
- Department of Dermatology; SUNY Downstate Medical Center; Brooklyn New York
| | - Daniel M. Siegel
- Department of Dermatology; SUNY Downstate Medical Center; Brooklyn New York
| | - Sharon A. Glick
- Department of Dermatology; SUNY Downstate Medical Center; Brooklyn New York
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