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Pach JJ, Nelson CA, Leventhal JS. Characterizing skin and soft tissue infections in patients with cancer on systemic oncologic therapy: A single institution retrospective analysis from the outpatient and inpatient oncodermatology service. JAAD Int 2024; 15:21-23. [PMID: 38371669 PMCID: PMC10869938 DOI: 10.1016/j.jdin.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Affiliation(s)
- Jolanta J Pach
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Caroline A Nelson
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
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2
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Wei BM, Fox LP, Kaffenberger BH, Korman AM, Micheletti RG, Mostaghimi A, Noe MH, Rosenbach M, Shinkai K, Kwah JH, Phillips EJ, Bolognia JL, Damsky W, Nelson CA. Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. Part II diagnosis and management. J Am Acad Dermatol 2024; 90:911-926. [PMID: 37516356 DOI: 10.1016/j.jaad.2023.02.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/11/2023] [Accepted: 02/17/2023] [Indexed: 07/31/2023]
Abstract
Drug-induced hypersensitivity syndrome, also known as drug reaction with eosinophilia and systemic symptoms, is a severe cutaneous adverse reaction characterized by an exanthem, fever, and hematologic and visceral organ involvement. The differential diagnosis includes other cutaneous adverse reactions, infections, inflammatory and autoimmune diseases, and neoplastic disorders. Three sets of diagnostic criteria have been proposed; however, consensus is lacking. The cornerstone of management is immediate discontinuation of the suspected drug culprit. Systemic corticosteroids remain first-line therapy, but the literature on steroid-sparing agents is expanding. Longitudinal evaluation for sequelae is recommended. Adjunctive tests for risk stratification and drug culprit identification remain under investigation. Part II of this continuing medical education activity begins by exploring the differential diagnosis and diagnosis of drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms and concludes with an evidence-based overview of evaluation and treatment.
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Affiliation(s)
- Brian M Wei
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Lindy P Fox
- Department of Dermatology, University of California, San Francisco, California
| | | | - Abraham M Korman
- Department of Dermatology, The Ohio State University, Columbus, Ohio
| | - Robert G Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Arash Mostaghimi
- Department of Dermatology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Megan H Noe
- Department of Dermatology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kanade Shinkai
- Department of Dermatology, University of California, San Francisco, California
| | - Jason H Kwah
- Department of Medicine, Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, New Haven, Connecticut
| | - Elizabeth J Phillips
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jean L Bolognia
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - William Damsky
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Caroline A Nelson
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut.
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3
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Wei BM, Fox LP, Kaffenberger BH, Korman AM, Micheletti RG, Mostaghimi A, Noe MH, Rosenbach M, Shinkai K, Kwah JH, Phillips EJ, Bolognia JL, Damsky W, Nelson CA. Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. Part I. Epidemiology, pathogenesis, clinicopathological features, and prognosis. J Am Acad Dermatol 2024; 90:885-908. [PMID: 37516359 DOI: 10.1016/j.jaad.2023.02.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/11/2023] [Accepted: 02/26/2023] [Indexed: 07/31/2023]
Abstract
Drug-induced hypersensitivity syndrome (DiHS), also known as drug reaction with eosinophilia and systemic symptoms (DRESS), is a severe cutaneous adverse reaction (SCAR) characterized by an exanthem, fever, and hematologic and visceral organ involvement. Anticonvulsants, antibiotics, and allopurinol are the most common triggers. The pathogenesis involves a complex interplay between drugs, viruses, and the immune system primarily mediated by T-cells. DiHS/DRESS typically presents with a morbilliform eruption 2-6 weeks after drug exposure, and is associated with significant morbidity, mortality, and risk of relapse. Long-term sequelae primarily relate to organ dysfunction and autoimmune diseases. Part I of this continuing medical education activity on DiHS/DRESS provides an update on epidemiology, novel insights into pathogenesis, and a description of clinicopathological features and prognosis.
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Affiliation(s)
- Brian M Wei
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Lindy P Fox
- Department of Dermatology, University of California, San Francisco, California
| | | | - Abraham M Korman
- Department of Dermatology, The Ohio State University, Columbus, Ohio
| | - Robert G Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Arash Mostaghimi
- Department of Dermatology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Megan H Noe
- Department of Dermatology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kanade Shinkai
- Department of Dermatology, University of California, San Francisco, California
| | - Jason H Kwah
- Department of Medicine, Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, New Haven, Connecticut
| | - Elizabeth J Phillips
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jean L Bolognia
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - William Damsky
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut; Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Caroline A Nelson
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut.
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4
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Chen ST, Semenov YR, Alloo A, Bach DQ, Betof Warner A, Bougrine A, Burton L, Cappelli LC, Castells M, Cohen J, Dewan AK, Fadden R, Guggina L, Hegde A, Huang V, Johnson DB, Kaffenberger B, Kroshinsky D, Kwatra S, Kwong B, Lacouture ME, Larocca C, Leventhal J, Markova A, McDunn J, Mooradian MJ, Naidoo J, Choi J, Nambudiri V, Nelson CA, Patel AB, Pimkina J, Rine J, Rubin KM, Sauder M, Shaigany S, Shariff A, Sullivan RJ, Zubiri L, Reynolds KL, LeBoeuf NR. Defining D-irAEs: consensus-based disease definitions for the diagnosis of dermatologic adverse events from immune checkpoint inhibitor therapy. J Immunother Cancer 2024; 12:e007675. [PMID: 38599660 PMCID: PMC11015215 DOI: 10.1136/jitc-2023-007675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 04/12/2024] Open
Abstract
With an increasing number of patients eligible for immune checkpoint inhibitors, the incidence of immune-related adverse events (irAEs) is on the rise. Dermatologic immune-related adverse events (D-irAEs) are the most common and earliest to manifest, often with important downstream consequences for the patient. Current guidelines lack clarity in terms of diagnostic criteria for D-irAEs. The goal of this project is to better define D-irAE for the purposes of identification, diagnosis, and future study of this important group of diseases.The objectives of this project were to develop consensus guidance for an approach to D-irAEs including disease definitions and severity grading. Knowing that consensus among oncologists, dermatologists, and irAE subspecialists would be critical for usability, we formed a Dermatologic irAE Disease Definition Panel. The panel was composed of 34 experts, including oncologists, dermatologists, a rheumatologist, and an allergist/immunologist from 22 institutions across the USA and internationally. A modified Delphi consensus process was used, with two rounds of anonymous ratings by panelists and two virtual meetings to discuss areas of controversy. Panelists rated content for usability, appropriateness, and accuracy on 9-point scales in electronic surveys and provided free text comments. A working group aggregated survey responses and incorporated them into revised definitions. Consensus was based on numeric ratings using the RAND/UCLA Appropriateness Method with prespecified definitions.Following revisions based on panelist feedback, all items received consensus in the second round of ratings. Consensus definitions were achieved for 10 core D-irAE diagnoses: ICI-vitiligo, ICI-lichen planus, ICI-psoriasis, ICI-exanthem, ICI-bullous pemphigoid, ICI-Grover's, ICI-eczematous, ICI-eruptive atypical squamous proliferation, ICI-pruritus without rash, and ICI-erosive mucocutaneous. A standard evaluation for D-irAE was also found to reach consensus, with disease-specific exceptions detailed when necessary. Each disorder's description includes further details on disease subtypes, symptoms, supportive exam findings, and three levels of diagnostic certainty (definite, probable, and possible).These consensus-driven disease definitions standardize D-irAE classification in a useable framework for multiple disciplines and will be the foundation for future work. Given consensus on their accuracy and usability from a representative panel group, we anticipate that they can be used broadly across clinical and research settings.
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Affiliation(s)
- Steven T Chen
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Mass General Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Yevgeniy R Semenov
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Allireza Alloo
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Daniel Q Bach
- Department of Dermatology, Cedars Sinai, Los Angeles, California, USA
| | | | - Amina Bougrine
- Department of Dermatology, Université de Montréal, Montreal, Quebec, Canada
| | | | - Laura C Cappelli
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mariana Castells
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Justine Cohen
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medical Oncology, Centers for Cutaneous and Melanoma Oncology, Dana-Farber Cancer Insititute, Boston, MA, USA
| | - Anna K Dewan
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Lauren Guggina
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Victor Huang
- Department of Dermatology, University of California Davis, Davis, California, USA
| | | | - Benjamin Kaffenberger
- Department of Dermatology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniela Kroshinsky
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Shawn Kwatra
- Johns Hopkins Department of Dermatology, Baltimore, Maryland, USA
| | - Bernice Kwong
- Stanford University School of Medicine, Stanford, UK
| | - Mario E Lacouture
- MSKCC, New York, New York, USA
- NYU Langone Health, New York, New York, USA
| | - Cecilia Larocca
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jonathan Leventhal
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Alina Markova
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jon McDunn
- Project Data Sphere ®, Morrisville, North Carolina, USA
| | - Meghan J Mooradian
- Mass General Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jarushka Naidoo
- Johns Hopkins University, The Bloomberg-Kimmel Institute for Cancer Immunotherapy, Baltimore, Maryland, USA
| | - Jennifer Choi
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vinod Nambudiri
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Caroline A Nelson
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Anisha B Patel
- Department of Dermatology, Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Julia Pimkina
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | | | - Maxwell Sauder
- DIvision of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Sheila Shaigany
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Afreen Shariff
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Ryan J Sullivan
- Mass General Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Leyre Zubiri
- Mass General Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kerry L Reynolds
- Mass General Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nicole R LeBoeuf
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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5
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Hashemi DA, Nelson CA, Nyberg M, Das M, Rosenbach M. Evaluation of potential instruments for quantifying necrobiosis lipoidica severity via physician evaluation and patient-reported outcomes. J Am Acad Dermatol 2023; 89:1305-1306. [PMID: 37633461 DOI: 10.1016/j.jaad.2023.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 07/02/2023] [Accepted: 08/01/2023] [Indexed: 08/28/2023]
Affiliation(s)
- David A Hashemi
- Harvard Combined Dermatology Residency Training Program, Harvard Medical School, Boston, Massachusetts
| | - Caroline A Nelson
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | | | - Maya Das
- Processa Pharmaceuticals, Hanover, Maryland
| | - Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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Waters M, Dobry A, Le ST, Shinkai K, Beachkofsky TM, Davis MDP, Dominguez AR, Kroshinsky D, Markova A, Micheletti RG, Mostaghimi A, Pasieka HB, Rosenbach M, Seminario-Vidal L, Trinidad J, Albrecht J, Altman EM, Arakaki R, Ardern-Jones M, Bridges AG, Cardones AR, Chadha AA, Chen JK, Chen ST, Cheng K, Daveluy S, DeNiro KL, Harp J, Keller JJ, King B, Korman AM, Lowenstein EJ, Luxenberg E, Mancuso JB, Mauskar MM, Milam P, Motaparthi K, Nelson CA, Nguyen CV, Nutan F, Ortega-Loayza AG, Patel T, Rahnama-Moghadam S, Rekhtman S, Rojek NW, Sarihan M, Shaigany S, Sharma TR, Shearer SM, Shields BE, Strowd LC, Tartar DM, Thomas C, Wanat KA, Walls AC, Zaba LC, Ziemer CM, Maverakis E, Kaffenberger BH. Development of a Skin-Directed Scoring System for Stevens-Johnson Syndrome and Epidermal Necrolysis: A Delphi Consensus Exercise. JAMA Dermatol 2023; 159:772-777. [PMID: 37256599 PMCID: PMC10838134 DOI: 10.1001/jamadermatol.2023.1347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Importance Scoring systems for Stevens-Johnson syndrome and epidermal necrolysis (EN) only estimate patient prognosis and are weighted toward comorbidities and systemic features; morphologic terminology for EN lesions is inconsistent. Objectives To establish consensus among expert dermatologists on EN terminology, morphologic progression, and most-affected sites, and to build a framework for developing a skin-directed scoring system for EN. Evidence Review A Delphi consensus using the RAND/UCLA appropriateness criteria was initiated with a core group from the Society of Dermatology Hospitalists to establish agreement on the optimal design for an EN cutaneous scoring instrument, terminology, morphologic traits, and sites of involvement. Findings In round 1, the 54 participating dermatology hospitalists reached consensus on all 49 statements (30 appropriate, 3 inappropriate, 16 uncertain). In round 2, they agreed on another 15 statements (8 appropriate, 7 uncertain). There was consistent agreement on the need for a skin-specific instrument; on the most-often affected skin sites (head and neck, chest, upper back, ocular mucosa, oral mucosa); and that blanching erythema, dusky erythema, targetoid erythema, vesicles/bullae, desquamation, and erosions comprise the morphologic traits of EN and can be consistently differentiated. Conclusions and Relevance This consensus exercise confirmed the need for an EN skin-directed scoring system, nomenclature, and differentiation of specific morphologic traits, and identified the sites most affected. It also established a baseline consensus for a standardized EN instrument with consistent terminology.
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Affiliation(s)
- Margo Waters
- The Ohio State University College of Medicine, Columbus
| | - Allison Dobry
- Department of Dermatology, University of California, San Francisco
| | - Stephanie T Le
- Department of Dermatology, University of California, Davis
| | - Kanade Shinkai
- Department of Dermatology, University of California, San Francisco
| | | | - Mark D P Davis
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Arturo R Dominguez
- Departments of Internal Medicine and Dermatology, University of Texas Southwestern Medical Center, Dallas
| | | | - Alina Markova
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert G Micheletti
- Department of Dermatology and Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Helena B Pasieka
- Departments of Dermatology, Uniformed Services University, Bethesda, Maryland
- The Burn Center, MedStar Washington Hospital Center, Washington, DC
| | - Misha Rosenbach
- Department of Dermatology and Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - John Trinidad
- Department of Dermatology, Massachusetts General Hospital, Boston
| | - Joerg Albrecht
- Department of Medicine, Division of Dermatology, Cook County Health, Chicago, Illinois
| | - Emily M Altman
- Department of Dermatology, University of New Mexico Health Sciences Center, Albuquerque
| | - Ryan Arakaki
- Department of Dermatology, University of California, San Francisco
| | | | - Alina G Bridges
- Departments of Dermatology and Anatomic Pathology, Donald and Barbara Zucker School for Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Adela R Cardones
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Angad A Chadha
- Section of Dermatology, University of Chicago, Chicago, Illinois
| | - Jennifer K Chen
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Steven T Chen
- Department of Dermatology, Massachusetts General Hospital, Boston
| | - Kyle Cheng
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Steven Daveluy
- Department of Dermatology, Wayne State University School of Medicine, Detroit, Michigan
| | | | - Joanna Harp
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Jesse J Keller
- Department of Dermatology, Oregon Health and Science University, Portland
| | - Brett King
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Abraham M Korman
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus
| | - Eve J Lowenstein
- Department of Dermatology, SUNY Downstate Medical Center and Kings County Medical Center, Oceanside, New York
| | - Erin Luxenberg
- Department of Dermatology, Hennepin Healthcare, Minneapolis, Minnesota
| | | | - Melissa M Mauskar
- Departments of Internal Medicine and Dermatology, University of Texas Southwestern Medical Center, Dallas
| | - Philip Milam
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville
| | - Caroline A Nelson
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Cuong V Nguyen
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Fnu Nutan
- Department of Dermatology, Virginia Commonwealth University Medical Center, Richmond
| | | | - Tejesh Patel
- Department of Dermatology, University of Tennessee Health Science Center, Memphis
| | | | - Sergey Rekhtman
- Departments of Dermatology and Anatomic Pathology, Donald and Barbara Zucker School for Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Nathan W Rojek
- Department of Dermatology, University of California, Irvine
| | - Mansi Sarihan
- Department of Dermatology, Valleywise Health-Creighton University, University of Arizona, Mayo Clinic, Phoenix, Arizona
| | - Sheila Shaigany
- Departments of Dermatology and Anatomic Pathology, Donald and Barbara Zucker School for Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Timmie R Sharma
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sabrina M Shearer
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Bridget E Shields
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Lindsay C Strowd
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Cristina Thomas
- Departments of Internal Medicine and Dermatology, University of Texas Southwestern Medical Center, Dallas
| | - Karolyn A Wanat
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Andrew C Walls
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lisa C Zaba
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Carolyn M Ziemer
- Department of Dermatology, University of North Carolina Chapel Hill, Chapel Hill
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Ji-Xu A, Liakos W, Merleev A, Brüggen MC, Nelson CA. Assessing the Discriminatory Ability of Diagnostic Criteria for Ulcerative Pyoderma Gangrenosum and Its Mimickers. JAMA Dermatol 2023; 159:337-338. [PMID: 36652229 PMCID: PMC9857708 DOI: 10.1001/jamadermatol.2022.5978] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This comparative effectiveness research study assesses the discriminatory ability of diagnostic criteria for pyoderma gangrenosum.
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Affiliation(s)
- Antonio Ji-Xu
- Department of Dermatology, University of California, Davis, Sacramento
| | - William Liakos
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Alexander Merleev
- Department of Dermatology, University of California, Davis, Sacramento
| | - Marie-Charlotte Brüggen
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Swiss Institute for Allergy Research, Davos, Switzerland
| | - Caroline A. Nelson
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
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8
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Kim SR, Ko CJ, Nelson CA, Ramachandran S, Gehlhausen JR. Random skin biopsies for diagnosis of intravascular large B-cell lymphoma: Retrospective analysis of 31 biopsies from a US dermatology inpatient consultative service with literature review. J Am Acad Dermatol 2023; 88:714-716. [PMID: 36152693 DOI: 10.1016/j.jaad.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/29/2022] [Accepted: 09/13/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Sa Rang Kim
- Department of Dermatology, Yale University, New Haven, Connecticut
| | - Christine J Ko
- Department of Dermatology, Yale University, New Haven, Connecticut; Department of Pathology, Yale University, New Haven, Connecticut
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9
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Bhattacharya S, Basu S, Sheng E, Murphy C, Wei J, Kersh AE, Nelson CA, Bryer JS, Ashchyan HA, Steele K, Forrestel A, Seykora JT, Micheletti RG, James WD, Rosenbach M, Leung TH. Identification of a neutrophil-specific PIK3R1 mutation facilitates targeted treatment in a patient with Sweet syndrome. J Clin Invest 2023; 133:162137. [PMID: 36355435 PMCID: PMC9797331 DOI: 10.1172/jci162137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/26/2022] [Indexed: 11/12/2022] Open
Abstract
BackgroundAcute febrile neutrophilic dermatosis (Sweet syndrome) is a potentially fatal multiorgan inflammatory disease characterized by fever, leukocytosis, and a rash with a neutrophilic infiltrate. The disease pathophysiology remains elusive, and current dogma suggests that Sweet syndrome is a process of reactivity to an unknown antigen. Corticosteroids and steroid-sparing agents remain frontline therapies, but refractory cases pose a clinical challenge.MethodsA 51-year-old woman with multiorgan Sweet syndrome developed serious corticosteroid-related side effects and was refractory to steroid-sparing agents. Blood counts, liver enzymes, and skin histopathology supported the diagnosis. Whole-genome sequencing, transcriptomic profiling, and cellular assays of the patient's skin and neutrophils were performed.ResultsWe identified elevated IL-1 signaling in lesional Sweet syndrome skin caused by a PIK3R1 gain-of-function mutation specifically found in neutrophils. This mutation increased neutrophil migration toward IL-1β and neutrophil respiratory burst. Targeted treatment of the patient with an IL-1 receptor 1 antagonist resulted in a dramatic therapeutic response and enabled a tapering off of corticosteroids.ConclusionDysregulated PI3K/AKT signaling is the first signaling pathway linked to Sweet syndrome and suggests that this syndrome may be caused by acquired mutations that modulate neutrophil function. Moreover, integration of molecular data across multiple levels identified a distinct subtype within a heterogeneous disease that resulted in a rational and successful clinical intervention. Future patients will benefit from efforts to identify potential mutations. The ability to directly interrogate the diseased skin allows this method to be generalizable to other inflammatory diseases and demonstrates a potential personalized medicine approach for patients with clinically challenging disease.Funding SourcesBerstein Foundation, NIH, Veterans Affairs (VA) Administration, Moseley Foundation, and H.T. Leung Foundation.
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Affiliation(s)
- Shreya Bhattacharya
- Dermatology Department, Perelman School of Medicine, University of Pennsylvania; Philadelphia, Pennsylvania, USA
| | - Sayon Basu
- Dermatology Department, Perelman School of Medicine, University of Pennsylvania; Philadelphia, Pennsylvania, USA
| | - Emily Sheng
- Dermatology Department, Perelman School of Medicine, University of Pennsylvania; Philadelphia, Pennsylvania, USA
| | - Christina Murphy
- Dermatology Department, Perelman School of Medicine, University of Pennsylvania; Philadelphia, Pennsylvania, USA
| | - Jenny Wei
- Dermatology Department, Perelman School of Medicine, University of Pennsylvania; Philadelphia, Pennsylvania, USA
| | - Anna E. Kersh
- Dermatology Department, Perelman School of Medicine, University of Pennsylvania; Philadelphia, Pennsylvania, USA
| | - Caroline A. Nelson
- Dermatology Department, Perelman School of Medicine, University of Pennsylvania; Philadelphia, Pennsylvania, USA
| | - Joshua S. Bryer
- Dermatology Department, Perelman School of Medicine, University of Pennsylvania; Philadelphia, Pennsylvania, USA
| | - Hovik A. Ashchyan
- Dermatology Department, Perelman School of Medicine, University of Pennsylvania; Philadelphia, Pennsylvania, USA
| | - Katherine Steele
- Dermatology Department, Perelman School of Medicine, University of Pennsylvania; Philadelphia, Pennsylvania, USA
| | - Amy Forrestel
- Dermatology Department, Perelman School of Medicine, University of Pennsylvania; Philadelphia, Pennsylvania, USA
| | - John T. Seykora
- Dermatology Department, Perelman School of Medicine, University of Pennsylvania; Philadelphia, Pennsylvania, USA
| | - Robert G. Micheletti
- Dermatology Department, Perelman School of Medicine, University of Pennsylvania; Philadelphia, Pennsylvania, USA
| | - William D. James
- Dermatology Department, Perelman School of Medicine, University of Pennsylvania; Philadelphia, Pennsylvania, USA
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Misha Rosenbach
- Dermatology Department, Perelman School of Medicine, University of Pennsylvania; Philadelphia, Pennsylvania, USA
| | - Thomas H. Leung
- Dermatology Department, Perelman School of Medicine, University of Pennsylvania; Philadelphia, Pennsylvania, USA
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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10
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Pimentel MA, Li MM, Noe MH, Latour E, Seminario-Vidal L, Greiling T, Shinkai K, Hamilton A, Alavi A, Bolognia JL, Cowen EW, Dominguez A, Fernandez AP, Fivenson D, Huang WW, Madigan LM, Mauskar M, Means AD, Nelson CA, Patsatsi A, Pugliese D, Rojek NW, Rosenbach M, Smith GP, Swerlick RA, Heffernan MP, Mostaghimi A, Ortega-Loayza AG. Features that define clinical severity of ulcerative pyoderma gangrenosum: a Delphi consensus study of experts and patients on behalf of the US Medical Dermatology Society. Br J Dermatol 2022; 188:566-568. [PMID: 36746554 DOI: 10.1093/bjd/ljac137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/09/2022] [Accepted: 12/17/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Matthew A Pimentel
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | | | | | | | | | - Teri Greiling
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
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11
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Nelson CA, Singer S, Chen T, Puleo AE, Lian CG, Wei EX, Giobbie-Hurder A, Mostaghimi A, LeBoeuf NR. Reply to: "Comment on 'Bullous pemphigoid after anti-PD-1 therapy: A retrospective case-control study evaluating impact on tumor response and survival outcomes'". J Am Acad Dermatol 2022; 87:e245-e248. [PMID: 32417422 DOI: 10.1016/j.jaad.2020.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Caroline A Nelson
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Cutaneous Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Sean Singer
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tianqi Chen
- Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ashleigh Eberly Puleo
- Department of Cutaneous Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Christine G Lian
- Program in Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Erin X Wei
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anita Giobbie-Hurder
- Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nicole R LeBoeuf
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Cutaneous Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
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12
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Nelson CA, Singer S, Chen T, Puleo AE, Lian CG, Wei EX, Giobbie-Hurder A, Mostaghimi A, LeBoeuf NR. Bullous pemphigoid after anti-programmed death-1 therapy: A retrospective case-control study evaluating impact on tumor response and survival outcomes. J Am Acad Dermatol 2022; 87:1400-1402. [PMID: 31931083 DOI: 10.1016/j.jaad.2019.12.068] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/26/2019] [Accepted: 12/22/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Caroline A Nelson
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Cutaneous Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Sean Singer
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tianqi Chen
- Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ashleigh Eberly Puleo
- Department of Cutaneous Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Christine G Lian
- Program in Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Erin X Wei
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anita Giobbie-Hurder
- Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nicole R LeBoeuf
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Cutaneous Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
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13
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Belzer A, Rosenbach M, Parker ER, Barbieri JS, Nelson CA. Reducing the carbon footprint of travel to an international dermatology conference: a case study of the Medical Dermatology Society's Carbon Footprint Program. Int J Dermatol 2022. [DOI: 10.1111/ijd.16497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/14/2022] [Accepted: 10/26/2022] [Indexed: 11/15/2022]
Affiliation(s)
| | - Misha Rosenbach
- Department of Dermatology Perelman School of Medicine at the University of Pennsylvania Philadelphia PA USA
| | - Eva R. Parker
- Department of Dermatology, Center for Biomedical Ethics and Society Vanderbilt University Medical Center Nashville TN USA
| | - John S. Barbieri
- Department of Dermatology, Brigham and Women's Hospital Harvard Medical School Boston MA USA
| | - Caroline A. Nelson
- Department of Dermatology Yale University School of Medicine New Haven CT USA
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14
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Choi R, Garritano J, Laird M, Johnston M, Tkachenko E, Damsky W, Little AJ, McNiff J, Girardi M, Nelson CA. Treatment of toxic epidermal necrolysis and concurrent COVID-19-associated hyperinflammatory syndrome with systemic corticosteroids and etanercept. JAAD Case Rep 2022; 29:139-141. [PMID: 36160836 PMCID: PMC9485430 DOI: 10.1016/j.jdcr.2022.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Rachel Choi
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - James Garritano
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Mary Laird
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Margaret Johnston
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Elizabeth Tkachenko
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - William Damsky
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Alicia J. Little
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Jennifer McNiff
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Michael Girardi
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Caroline A. Nelson
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
- Correspondence to: Caroline A. Nelson, MD, Assistant Professor, Department of Dermatology, Director, Inpatient Dermatology, Yale University School of Medicine, 15 York St, New Haven, CT 06510.
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15
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Belzer A, Weiss E, Etaee F, Bunick CG, Damsky W, Nelson CA. Stenotrophomonas maltophilia, a Pathogen of Increasing Relevance to Dermatologists: A Case Report and Review of the Literature. Antibiotics (Basel) 2022; 11:antibiotics11101398. [PMID: 36290055 PMCID: PMC9598652 DOI: 10.3390/antibiotics11101398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/08/2022] [Accepted: 10/09/2022] [Indexed: 12/01/2022] Open
Abstract
Stenotrophomonas maltophilia is a Gram-negative bacillus that causes skin and soft tissue infections (SSTI), as well as bacteremia, pneumonia, and urinary tract infections. S. maltophilia infections are typically nosocomial and are often transmitted through water sources. Although historically described in immunocompromised hosts, S. maltophilia prevalence is increasing in both immunocompromised and immunocompetent populations. In light of high morbidity and mortality, it is critical that dermatologists are aware of this organism because of the limited options for therapy. Here, we describe a case of a S. maltophilia abscess with bacteremia in a patient with chronic lymphocytic leukemia and aplastic anemia that was successfully treated with trimethoprim-sulfamethoxazole. We also review the current standard of care and propose an algorithm for the treatment of S. maltophilia infection.
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Affiliation(s)
| | - Emma Weiss
- Department of Dermatology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Farshid Etaee
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Christopher G. Bunick
- Department of Dermatology, Yale School of Medicine, New Haven, CT 06510, USA
- Program in Translational Biomedicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - William Damsky
- Department of Dermatology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Caroline A. Nelson
- Department of Dermatology, Yale School of Medicine, New Haven, CT 06510, USA
- Correspondence:
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16
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Richardson H, Taylor J, Kane-Grade F, Powell L, Bosquet Enlow M, Nelson CA. Corrigendum to "Preferential responses to faces in superior temporal and medial prefrontal cortex in three-year-old children" [Dev. Cogn. Neurosci. 50 (2021) 100984]. Dev Cogn Neurosci 2022:101155. [PMID: 36175322 DOI: 10.1016/j.dcn.2022.101155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- H Richardson
- Department of Pediatrics, Boston Children's Hospital, United States; Department of Pediatrics, Harvard Medical School, United States; School of Philosophy, Psychology and Language Sciences, University of Edinburgh, United Kingdom.
| | - J Taylor
- Department of Pediatrics, Boston Children's Hospital, United States; Department of Pediatrics, Harvard Medical School, United States
| | - F Kane-Grade
- Department of Pediatrics, Boston Children's Hospital, United States; Department of Pediatrics, Harvard Medical School, United States; Institute of Child Development, University of Minnesota, United States
| | - L Powell
- Department of Psychology, University of California San Diego, United States
| | - M Bosquet Enlow
- Department of Psychiatry, Boston Children's Hospital, United States; Department of Psychiatry, Harvard Medical School, United States
| | - C A Nelson
- Department of Pediatrics, Boston Children's Hospital, United States; Department of Pediatrics, Harvard Medical School, United States; Graduate School of Education, Harvard University, United States.
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17
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Briggs N, Wei BM, Ahuja C, Baker C, Foppiano Palacios C, Lee E, O’Grady N, Singanamala S, Singh K, Bandaranayake TD, Cohen JM, Damsky W, Davis MW, Mejia R, Nelson CA, Topal JE, Azar MM. Mucocutaneous Leishmaniasis in a Pregnant Immigrant. Open Forum Infect Dis 2022; 9:ofac360. [PMID: 35928503 PMCID: PMC9345408 DOI: 10.1093/ofid/ofac360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/20/2022] [Indexed: 01/05/2023] Open
Abstract
Cutaneous leishmaniasis is a parasitic infection that causes significant maternal morbidity, and even fetal mortality, during pregnancy, yet there are limited therapeutic options. Here, we report a case of leishmaniasis in a pregnant immigrant with exuberant mucocutaneous lesions with favorable response to liposomal amphotericin B.
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Affiliation(s)
- Neima Briggs
- Correspondence: Neima Briggs, MD, PhD, Yale School of Medicine, PO Box 208022, New Haven, CT 06520-8022, USA ()
| | - Brian M Wei
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Chaarushi Ahuja
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Catherine Baker
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Carlo Foppiano Palacios
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Emily Lee
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Niamh O’Grady
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Santhi Singanamala
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Katelyn Singh
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Thilinie D Bandaranayake
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jeffrey M Cohen
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - William Damsky
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, Connecticut, USA
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Matthew W Davis
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Rojelio Mejia
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Caroline A Nelson
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Jeffrey E Topal
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Marwan M Azar
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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18
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Said JT, Liu M, Talia J, Singer SB, Semenov YR, Wei EX, Mostaghimi A, Nelson CA, Giobbie-Hurder A, LeBoeuf NR. Risk Factors for the Development of Bullous Pemphigoid in US Patients Receiving Immune Checkpoint Inhibitors. JAMA Dermatol 2022; 158:552-557. [PMID: 35416925 PMCID: PMC9008562 DOI: 10.1001/jamadermatol.2022.0354] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance De novo bullous pemphigoid (BP) is a rare immune-mediated adverse event from immune checkpoint inhibitors (ICIs) that can necessitate permanent discontinuation of the anticancer therapy, but the risk factors for developing this toxic effect are unknown. Objective To compare potential risk factors for BP in patients treated with ICIs who did and did not develop BP. Design, Setting, and Participants This cohort and nested propensity score-matched case-control study was conducted at the Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Massachusetts General Hospital. All patients at these facilities with de novo BP after ICI treatment were compared with all patients on the cancer registry who were treated with ICIs between October 1, 2014, and December 31, 2020. Patients with incomplete or blinded data regarding the ICI agent or total cycles were excluded. Exposures In the cohort, assessed potential risk factors included age at ICI introduction, sex, ICI molecular target, and cancer type, which were then used as matching variables. In the propensity score-matched case-control analysis, risk factors assessed included sex, race and ethnicity, cancer stage, metastasis sites, idiopathic BP comorbidities, pre-ICI vaccination, radiation history, body mass index, and derived neutrophil-to-lymphocyte ratio. Main Outcomes and Measures Diagnosis of BP at any point after ICI treatment, confirmed by direct immunofluorescence, indirect immunofluorescence, autoantibody serologies, or diagnostic consensus among study board-certified dermatologists. Odds ratios (ORs) and 95% CIs were calculated for all risk factors. In the secondary analysis, best overall responses to ICIs between cases and controls were compared by Fisher exact test. Results Among 5636 patients treated with ICIs at Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Massachusetts General Hospital during the study period, 35 (0.6%; median [IQR] age, 72.8 [13.4] years; 71.4% [25] male patients) developed BP. In a multivariate logistic regression model that assessed 2955 patients with complete data in the cancer registry, age 70 years or older (OR, 2.32; 95% CI, 1.19-4.59; P = .01), having melanoma (OR, 3.21; 95% CI, 1.51-6.58; P < .003), and having nonmelanoma skin cancer (OR, 8.32; 95% CI, 2.81-21.13; P < .001) were significantly associated with developing BP. In the nested 1:2 case-control comparison of all 35 cases to 70 propensity score-matched controls, a complete or partial response on initial restaging imaging was a risk factor for BP development (OR, 3.37; 95% CI, 1.35-9.30; P = .01). Bullous pemphigoid cases also more frequently exhibited overall tumor response to ICIs than matched controls (29 of 35 [82.9%] vs 43 of 70 [61.4%]; P = .03). Conclusions and Relevance In this cohort study, age 70 years or older and skin cancer were associated with increased risk of developing ICI-associated BP. Given the association of BP with improved initial and best overall tumor responses, early identification and toxic effect-directed treatment should be prioritized, especially in individuals at risk for developing de novo BP.
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Affiliation(s)
- Jordan T. Said
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - Mofei Liu
- Division of Biostatistics, Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jordan Talia
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Sean B. Singer
- Harvard Medical School, Boston, Massachusetts,Department of Dermatology, Massachusetts General Hospital, Boston
| | - Yevgeniy R. Semenov
- Harvard Medical School, Boston, Massachusetts,Department of Dermatology, Massachusetts General Hospital, Boston
| | - Erin X. Wei
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - Caroline A. Nelson
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Anita Giobbie-Hurder
- Division of Biostatistics, Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nicole R. LeBoeuf
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts,Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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19
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Sun Q, Asch S, Bayart C, Bayliss SJ, Benjamin L, Bruckner A, DiGiovanna JJ, Fleckman P, Funk T, Lucky A, Nelson CA, Newell B, Polcari I, Teng J, Williams ML, Gan G, Deng Y, Paller AS, Choate KA. Development and Initial Validation of a Novel System to Assess Ichthyosis Severity. JAMA Dermatol 2022; 158:359-365. [PMID: 35171201 PMCID: PMC8851366 DOI: 10.1001/jamadermatol.2021.5917] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE A comprehensive, user-friendly system to assess global ichthyosis disease burden is imperative to improving the care of patients with ichthyosis, identifying appropriate participants for clinical trials, and quantifying treatment outcomes. To our knowledge, there is currently no validated scale to objectively and systematically measure ichthyosis severity across the entire body. OBJECTIVE To create and evaluate a comprehensive and user-friendly instrument to measure total body ichthyosis severity in adults and children. DESIGN, SETTING, PARTICIPANTS In this qualitative study, ichthyosis experts participated in the content development of the Ichthyosis Scoring System (ISS). The body was divided into 10 regions, and Likert scales (0-4) were created to quantify scale and erythema, with extensive descriptors and photographic standards. An 83-image teaching set was created from photographs of participants with ichthyosis. Two cohorts of dermatologists (11 total) independently scored all test photographs twice to evaluate interrater and intrarater reliabilities. Participants were enrolled worldwide from referral centers and patient advocacy groups. Participants of all ages, races, and ethnicities were included in the creation of ISS, and dermatologists with varying experience and areas of expertise participated as raters to evaluate the ISS. The study was conducted from 2019 to 2021, and the data were analyzed in 2021. MAIN OUTCOMES AND MEASURES Intraclass correlation coefficients determined overall reliabilities. RESULTS Across both cohorts of 11 dermatologists in total, the intraclass correlation coefficients for total, scale and erythema scores were greater than 0.90 (95% CI, 0.77-0.97), greater than 0.91 (95% CI, 0.79-0.98), and greater than 0.88 (95% CI, 0.72-0.97), respectively. Most body sites exhibited moderate to good interrater reliabilities for scale and erythema. Intrarater reliabilities were good to excellent. CONCLUSIONS AND RELEVANCE The results of this qualitative study demonstrate reproducibility and suggest that the ISS is a reliable system to measure global ichthyosis severity in adults and children.
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Affiliation(s)
- Qisi Sun
- Departments of Dermatology, Pathology and Genetics, Yale University School of Medicine, New Haven, Connecticut
| | - Sarah Asch
- Department of Dermatology, HealthPartners and Park Nicollet Medical Groups, St Paul, Minnesota
| | - Cheryl Bayart
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Susan J. Bayliss
- Division of Dermatology, Washington University School of Medicine, St Louis, Missouri
| | - Latanya Benjamin
- Department of Integrated Medical Science, Florida Atlantic University, Boca Raton
| | - Anna Bruckner
- Departments of Dermatology and Pediatrics, University of Colorado School of Medicine, Aurora,Deputy Editor, JAMA Dermatology
| | - John J. DiGiovanna
- Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Philip Fleckman
- Department of Medicine, Division of Dermatology, University of Washington, Seattle
| | - Tracy Funk
- Department of Dermatology, Oregon Health & Science University, Portland
| | - Anne Lucky
- Department of Dermatology, University of Cincinnati Medical Center, Cincinnati, Ohio,Department of Dermatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Caroline A. Nelson
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Brandon Newell
- Department of Pediatrics, Division of Dermatology, Children’s Mercy Hospital, Kansas City, Missouri
| | - Ingrid Polcari
- Department of Dermatology, University of Minnesota, Minneapolis
| | - Joyce Teng
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Mary L. Williams
- Departments of Dermatology and Pediatrics, University of California, San Francisco
| | - Geliang Gan
- Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Yanhong Deng
- Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Amy S. Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Keith A. Choate
- Departments of Dermatology, Pathology and Genetics, Yale University School of Medicine, New Haven, Connecticut
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20
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Weiss EH, Ko CJ, Leung TH, Micheletti RG, Mostaghimi A, Ramachandran SM, Rosenbach M, Nelson CA. Neutrophilic Dermatoses: a Clinical Update. Curr Derm Rep 2022; 11:89-102. [PMID: 35310367 PMCID: PMC8924564 DOI: 10.1007/s13671-022-00355-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 11/13/2022]
Abstract
Purpose of Review Neutrophilic dermatoses are defined by the presence of a sterile neutrophilic infiltrate on histopathology. This review focuses on the pathogenesis, epidemiology, clinicopathological features, diagnosis, and management of four disorders: Sweet syndrome, pyoderma gangrenosum, Behçet syndrome, and neutrophilic eccrine hidradenitis. Recent Findings Recent studies have provided insight into the complex pathogenesis of neutrophilic dermatoses. Evidence supports an intricate interplay of abnormal neutrophil function and inflammasome activation, malignant transformation into dermal infiltrating neutrophils, and genetic predisposition. Summary Neutrophilic dermatoses have diverse cutaneous and extracutaneous manifestations and may be associated with significant morbidity and mortality. Common underlying associations include infectious, inflammatory, and neoplastic disorders, as well as drug reactions. Emerging diagnostic and therapeutic frameworks identify an expanding role for biologic and targeted anti-inflammatory therapies.
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21
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Creadore A, Desai S, Alloo A, Dewan AK, Bakhtiar M, Cruz-Diaz C, Femia A, Fox L, Katz KL, Micheletti R, Nelson CA, Ortega-Loayza AG, Patrinely JR, Plovanich M, Rosenbach M, Shaigany S, Shields BE, Saleh JZ, Sharif-Sidi Z, Shinkai K, Smith J, Su C, Wanat KA, Wieser JK, Wright S, Noe MH, Mostaghimi A. Clinical Characteristics, Disease Course, and Outcomes of Patients With Acute Generalized Exanthematous Pustulosis in the US. JAMA Dermatol 2022; 158:176-183. [PMID: 34985493 PMCID: PMC8733866 DOI: 10.1001/jamadermatol.2021.5390] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Acute generalized exanthematous pustulosis (AGEP) is a rare, severe cutaneous adverse reaction associated with systemic complications. Currently available data are largely limited to small retrospective case series. Objective To describe the clinical characteristics, disease course, and outcomes of a heterogeneous group of patients with AGEP across the US. Design, Setting, and Participants A retrospective review of a case series of patients was conducted from January 1, 2000, through July 31, 2020. All 340 included cases throughout 10 academic health systems in the US were scored retrospectively using the EuroSCAR scoring system, and patients with a score corresponding to probable or definite AGEP and aged 18 years or older were included. Main Outcomes and Measures Patient demographic characteristics, clinical course, suspected causative agent, treatment, and short- and long-term outcomes. Results Most of the 340 included patients were women (214 [62.9%]), White (206 [60.6%]), and non-Hispanic (239 [70.3%]); mean (SD) age was 57.8 (17.4) years. A total of 154 of 310 patients (49.7%) had a temperature greater than or equal to 38.0 °C that lasted for a median of 2 (IQR, 1-4) days. Of 309 patients, 263 (85.1%) developed absolute neutrophilia and 161 patients (52.1%) developed either absolute or relative eosinophilia. Suspected causes of AGEP were medications (291 [85.6%]), intravenous contrast agents (7 [2.1%]), infection (3 [0.9%]), or unknown (39 [11.5%]). In 151 cases in which a single medication was identified, 63 (41.7%) were β-lactam antimicrobials, 51 (33.8%) were non-β-lactam antimicrobials, 9 (6.0%) were anticonvulsants, and 5 (3.3%) were calcium channel blockers. The median time from medication initiation to AGEP start date was 3 (IQR, 1-9) days. Twenty-five of 298 patients (8.4%) had an acute elevation of aspartate aminotransferase and alanine aminotransferase levels, with a peak at 6 (IQR, 3-9) days. Twenty-five of 319 patients (7.8%) experienced acute kidney insufficiency, with the median time to peak creatinine level being 4 (IQR, 2-5) days after the AGEP start date. Treatments included topical corticosteroids (277 [81.5%], either alone or in combination), systemic corticosteroids (109 [32.1%]), cyclosporine (10 [2.9%]), or supportive care only (36 [10.6%]). All-cause mortality within 30 days was 3.5% (n = 12), none of which was suspected to be due to AGEP. Conclusions and Relevance This retrospective case series evaluation of 340 patients, the largest known study cohort to date, suggests that AGEP onset is acute, is usually triggered by recent exposure to an antimicrobial, may be associated with liver or kidney complications in a minority of patients, and that discontinuation of the triggering treatment may lead to improvement or resolution.
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Affiliation(s)
- Andrew Creadore
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts ,Student, Boston University School of Medicine, Boston, Massachusetts
| | - Sheena Desai
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts ,Student, Tufts University School of Medicine, Boston, Massachusetts
| | - Allireza Alloo
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Anna K. Dewan
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mina Bakhtiar
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Carla Cruz-Diaz
- Department of Dermatology, University of California, San Francisco,Assistant Section Editor, JAMA Dermatology
| | - Alisa Femia
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York
| | - Lindy Fox
- Department of Dermatology, University of California, San Francisco
| | - Kimberly L. Katz
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Robert Micheletti
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia,Images in Dermatology Editor, JAMA Dermatology
| | - Caroline A. Nelson
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | | | - J. Randall Patrinely
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Molly Plovanich
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
| | - Misha Rosenbach
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia,Editorial Board member, JAMA Dermatology
| | - Sheila Shaigany
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York,Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York
| | - Bridget E. Shields
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia,Assistant Section Editor, JAMA Dermatology,Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Jamal Z. Saleh
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | | | - Kanade Shinkai
- Department of Dermatology, University of California, San Francisco,Chief Editor, JAMA Dermatology
| | - Jacob Smith
- Department of Dermatology, Oregon Health and Science University, Portland
| | - Chang Su
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Karolyn A. Wanat
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Jill K. Wieser
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
| | - Shari Wright
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Megan H. Noe
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts ,Associate Editor, JAMA Dermatology
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22
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Noe MH, Wan MT, Mostaghimi A, Gelfand JM, Agnihothri R, Armstrong AW, Bhutani T, Bridges A, Brownstone N, Butt M, Duffin KPC, Carr C, Creadore A, DeNiro KL, Desai S, Dominguez AR, Duffy EK, Fairley JA, Femia A, Gudjonsson JE, Kaffenberger JA, Katz KL, Kirby JS, Le ST, Martinez E, Maverakis E, Myers B, Naik HB, Nelson CA, Ortega-Loayza AG, Plovanich ME, Rangel LK, Ravi V, Reddy VD, Saleh JZ, Sandhu JK, Shakshouk H, Shields BE, Sharif-Sidi Z, Smith J, Steahr A, Toussi A, Wanat KA, Wang B, Wei BM, Weinhammer A, Worswick SD, Yang A. Evaluation of a Case Series of Patients With Palmoplantar Pustulosis in the United States. JAMA Dermatol 2021; 158:68-72. [PMID: 34878495 DOI: 10.1001/jamadermatol.2021.4635] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Palmoplantar pustulosis (PPP) is a is a chronic, orphan disease with limited epidemiological data. Objective To describe the clinical characteristics, treatments, longitudinal disease course, and health care utilization in adults with PPP across the US. Design, Setting, and Participants This retrospective, longitudinal case series from 20 academic dermatology practices in the US included a consecutive sample of 197 adults who met the European Rare and Severe Psoriasis Expert Network consensus definition for PPP between January 1, 2007, and December 31, 2018. Data analysis was performed June 2020 to December 2020. Main Outcomes and Measures The primary outcome was to describe the patient characteristics, associated medical comorbidities, treatment patterns, complications, and PPP-specific health care utilization. Results Of 197 patients, 145 (73.6%) were female, and the mean (SD) age at presentation was 53.0 (12.6) years, with a mean (SD) follow-up time of 22.1 (28.0) months. On initial presentation, 95 (48.2%) patients reported skin pain, and 39 (19.8%) reported difficulty using hands and/or feet. Seventy patients (35.5%) were treated with systemic treatments, and use of more than 20 different systemic therapies was reported. In patients with at least 6 months of follow-up (n = 128), a median (IQR) of 3.7 (4-10) dermatology visits per year were reported; 24 (18.8%) patients had 5 or more visits during the study period. Conclusions and Relevance In this case series, PPP was associated with persistent symptoms, continued health care utilization, and a lack of consensus regarding effective treatments, emphasizing the unmet medical need in this population. Additional research is necessary to understand treatment response in these patients.
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Affiliation(s)
- Megan H Noe
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marilyn T Wan
- Department of Internal Medicine, Memorial Hospital West, Pembroke Pines, Florida
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | - Ritesh Agnihothri
- Department of Dermatology, University of Rochester, School of Medicine & Dentistry, Rochester, New York
| | - April W Armstrong
- Department of Dermatology, Keck Hospital of USC, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Tina Bhutani
- Department of Dermatology, UCSF Medical Center, University of California San Francisco School of Medicine
| | - Alina Bridges
- Department of Dermatology, Mayo Clinic Graduate School of Education, Rochester, Minnesota.,Richfield Laboratory of Dermatopathology, Dermpath Diagnostics, Cincinnati, Ohio
| | - Nicholas Brownstone
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco
| | - Melissa Butt
- Department of Dermatology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | | | | | - Andrew Creadore
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Katherine L DeNiro
- Division of Dermatology, Department of Medicine, University of Washington, Seattle
| | - Sheena Desai
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
| | - Arturo R Dominguez
- Departments of Dermatology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Emily K Duffy
- Division of Dermatology, Department of Medicine, University of Washington, Seattle
| | - Janet A Fairley
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City
| | - Alisa Femia
- Ronald O. Perelman Department of Dermatology, NYU Langone Hospitals, New York University Grossman School of Medicine, New York, New York
| | | | | | - Kimberly L Katz
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Stephanie T Le
- Department of Dermatology, University of California, Davis School of Medicine, Sacramento
| | | | - Emanual Maverakis
- Department of Dermatology, University of California, Davis School of Medicine, Sacramento
| | - Bridget Myers
- University of California San Francisco School of Medicine
| | - Haley B Naik
- Department of Dermatology, UCSF Medical Center, University of California San Francisco School of Medicine
| | - Caroline A Nelson
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University School of Medicine, Portland
| | - Molly E Plovanich
- Department of Dermatology, University of Rochester, School of Medicine & Dentistry, Rochester, New York
| | - Lauren K Rangel
- Ronald O. Perelman Department of Dermatology, NYU Langone Hospitals, New York University Grossman School of Medicine, New York, New York
| | - Vignesh Ravi
- Department of Dermatology, Keck Hospital of USC, University of Southern California Keck School of Medicine, Los Angeles, California
| | | | - Jamal Z Saleh
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Jeena K Sandhu
- Department of Dermatology, Keck Hospital of USC, University of Southern California Keck School of Medicine, Los Angeles, California.,Division of Dermatology, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
| | - Hadir Shakshouk
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Bridget E Shields
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin, Madison
| | | | - Jacob Smith
- Oregon Health and Science University School of Medicine, Portland
| | - Amanda Steahr
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City
| | - Atrin Toussi
- Department of Dermatology, University of California, Davis School of Medicine, Sacramento
| | - Karolyn A Wanat
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Bo Wang
- Department of Dermatology, University of Michigan, Ann Arbor
| | - Brian M Wei
- Yale School of Medicine, New Haven, Connecticut
| | - Annika Weinhammer
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Scott D Worswick
- Department of Dermatology, Keck Hospital of USC, University of Southern California Keck School of Medicine, Los Angeles, California
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23
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Nelson CA, Tomayko MM. Targeting the FcRn: A Novel Approach to the Treatment of Pemphigus. J Invest Dermatol 2021; 141:2777-2780. [PMID: 34565557 DOI: 10.1016/j.jid.2021.06.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 06/13/2021] [Accepted: 06/15/2021] [Indexed: 11/16/2022]
Abstract
Pemphigus is a debilitating autoimmune blistering disorder mediated by IgG autoantibodies to desmosomal cadherins that requires novel steroid-sparing therapies. In this phase 1b/2 trial reported by Werth et al. (2021), the FcRn inhibitor ALXN1840 induced rapid and sustained clinical improvement in patients with chronic, active, refractory pemphigus. FcRn inhibition is a promising new approach to the treatment of pemphigus and other autoantibody-mediated autoimmune disorders.
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Affiliation(s)
- Caroline A Nelson
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mary M Tomayko
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA; Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA.
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24
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Affiliation(s)
- Nelson Ugwu
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Anjela Galan
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut.,Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Caroline A Nelson
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
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25
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Nelson CA, Pachauri S, Balk R, Miller J, Theunis R, Ko JM, Kovarik CL. Dermatologists' Perspectives on Artificial Intelligence and Augmented Intelligence - A Cross-sectional Survey. JAMA Dermatol 2021; 157:871-874. [PMID: 34037674 DOI: 10.1001/jamadermatol.2021.1685] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Caroline A Nelson
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | | | - Rosie Balk
- American Academy of Dermatology, Rosemont, Illinois
| | | | | | - Justin M Ko
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, California
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Internal Medicine, Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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26
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Fathy R, Nelson CA, Barbieri JS. Combating climate change in the clinic: Cost-effective strategies to decrease the carbon footprint of outpatient dermatologic practice. Int J Womens Dermatol 2021; 7:107-111. [PMID: 33537400 PMCID: PMC7838240 DOI: 10.1016/j.ijwd.2020.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 11/28/2022] Open
Abstract
There have been numerous studies highlighting the negative impact that climate change has already had and is expected to continue to have on patients and their health. Notably, the health care industry has been identified as a major contributor to the global carbon footprint, highlighting a major opportunity for practitioners to intervene. However, the large majority of the literature on strategies to reduce health care’s contribution to climate change focuses solely on the inpatient setting. We review a variety of strategies for clinicians in the outpatient setting to adjust their practices to combat climate change. Summarizing the best evidence from other industries and translating recommendations from the literature on inpatient practice, we identify a wide range of opportunities for intervention, many of which are easy to implement and cost-effective. These general strategies to reduce both the carbon footprint and monthly operating costs of an outpatient clinic should be of interest to any practicing physician, both dermatologists and nondermatologists.
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Affiliation(s)
- Ramie Fathy
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Caroline A Nelson
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.,Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
| | - John S Barbieri
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
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27
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Bui AT, Singer S, Tkachenko E, Sharma P, Nelson CA, LeBoeuf NR, Mostaghimi A. 15995 Geographic disparities in access to scalp cooling for the prevention of chemotherapy-induced alopecia in the United States. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Nelson CA, Pérez-Chada LM, Creadore A, Li SJ, Lo K, Manjaly P, Pournamdari AB, Tkachenko E, Barbieri JS, Ko JM, Menon AV, Hartman RI, Mostaghimi A. Patient Perspectives on the Use of Artificial Intelligence for Skin Cancer Screening: A Qualitative Study. JAMA Dermatol 2020; 156:501-512. [PMID: 32159733 PMCID: PMC7066525 DOI: 10.1001/jamadermatol.2019.5014] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/07/2020] [Indexed: 12/27/2022]
Abstract
Importance The use of artificial intelligence (AI) is expanding throughout the field of medicine. In dermatology, researchers are evaluating the potential for direct-to-patient and clinician decision-support AI tools to classify skin lesions. Although AI is poised to change how patients engage in health care, patient perspectives remain poorly understood. Objective To explore how patients conceptualize AI and perceive the use of AI for skin cancer screening. Design, Setting, and Participants A qualitative study using a grounded theory approach to semistructured interview analysis was conducted in general dermatology clinics at the Brigham and Women's Hospital and melanoma clinics at the Dana-Farber Cancer Institute. Forty-eight patients were enrolled. Each interview was independently coded by 2 researchers with interrater reliability measurement; reconciled codes were used to assess code frequency. The study was conducted from May 6 to July 8, 2019. Main Outcomes and Measures Artificial intelligence concept, perceived benefits and risks of AI, strengths and weaknesses of AI, AI implementation, response to conflict between human and AI clinical decision-making, and recommendation for or against AI. Results Of 48 patients enrolled, 26 participants (54%) were women; mean (SD) age was 53.3 (21.7) years. Sixteen patients (33%) had a history of melanoma, 16 patients (33%) had a history of nonmelanoma skin cancer only, and 16 patients (33%) had no history of skin cancer. Twenty-four patients were interviewed about a direct-to-patient AI tool and 24 patients were interviewed about a clinician decision-support AI tool. Interrater reliability ratings for the 2 coding teams were κ = 0.94 and κ = 0.89. Patients primarily conceptualized AI in terms of cognition. Increased diagnostic speed (29 participants [60%]) and health care access (29 [60%]) were the most commonly perceived benefits of AI for skin cancer screening; increased patient anxiety was the most commonly perceived risk (19 [40%]). Patients perceived both more accurate diagnosis (33 [69%]) and less accurate diagnosis (41 [85%]) to be the greatest strength and weakness of AI, respectively. The dominant theme that emerged was the importance of symbiosis between humans and AI (45 [94%]). Seeking biopsy was the most common response to conflict between human and AI clinical decision-making (32 [67%]). Overall, 36 patients (75%) would recommend AI to family members and friends. Conclusions and Relevance In this qualitative study, patients appeared to be receptive to the use of AI for skin cancer screening if implemented in a manner that preserves the integrity of the human physician-patient relationship.
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Affiliation(s)
- Caroline A. Nelson
- Yale School of Medicine, Department of Dermatology, New Haven, Connecticut
| | - Lourdes Maria Pérez-Chada
- Harvard Medical School, Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Andrew Creadore
- Harvard Medical School, Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
- Medical student, Boston University School of Medicine, Boston, Massachusetts
| | - Sara Jiayang Li
- Harvard Medical School, Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kelly Lo
- Harvard Medical School, Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Priya Manjaly
- Harvard Medical School, Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
- Medical student, Boston University School of Medicine, Boston, Massachusetts
| | - Ashley Bahareh Pournamdari
- Harvard Medical School, Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
- Medical student, School of Medicine, University of California, San Francisco
| | - Elizabeth Tkachenko
- Harvard Medical School, Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
- Medical student, University of Massachusetts Medical School, Worcester
| | - John S. Barbieri
- Perelman School of Medicine at the University of Pennsylvania, Department of Dermatology, Philadelphia
| | - Justin M. Ko
- Stanford University School of Medicine, Department of Dermatology, Palo Alto, California
| | - Alka V. Menon
- Department of Sociology, Yale University, New Haven, Connecticut
| | - Rebecca Ivy Hartman
- Harvard Medical School, Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Dermatology, Veterans Affairs Integrated Service Network 1, Jamaica Plain, Massachusetts
| | - Arash Mostaghimi
- Harvard Medical School, Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
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29
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Bui ATN, Nelson CA, Lian CG, Canales AL, LeBoeuf NR. Eosinophilic fasciitis induced by nivolumab therapy managed without treatment interruption or systemic immunosuppression. JAAD Case Rep 2020; 6:693-696. [PMID: 32715051 PMCID: PMC7369459 DOI: 10.1016/j.jdcr.2020.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Caroline A Nelson
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Christine G Lian
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Alvaro Laga Canales
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nicole R LeBoeuf
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Cutaneous Oncology, Department of Dermatology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
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30
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Perkins S, Cohen JM, Nelson CA, Bunick CG. Teledermatology in the era of COVID-19: Experience of an academic department of dermatology. J Am Acad Dermatol 2020; 83:e43-e44. [PMID: 32305442 PMCID: PMC7162755 DOI: 10.1016/j.jaad.2020.04.048] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Sara Perkins
- Department of Dermatology, Yale University, New Haven, Connecticut.
| | - Jeffrey M Cohen
- Department of Dermatology, Yale University, New Haven, Connecticut
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Nelson CA, Zhong CS, Hashemi DA, Ashchyan HJ, Brown-Joel Z, Noe MH, Imadojemu S, Micheletti RG, Vleugels RA, Wanat KA, Rosenbach M, Mostaghimi A. A Multicenter Cross-Sectional Study and Systematic Review of Necrobiotic Xanthogranuloma With Proposed Diagnostic Criteria. JAMA Dermatol 2020; 156:270-279. [PMID: 31940000 PMCID: PMC6990734 DOI: 10.1001/jamadermatol.2019.4221] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/07/2019] [Indexed: 11/14/2022]
Abstract
Importance Necrobiotic xanthogranuloma (NXG) is a non-Langerhans cell histiocytosis classically associated with paraproteinemia attributable to plasma-cell dyscrasias or lymphoproliferative disorders. Despite the morbidity of NXG, the literature is limited to case reports and small studies, and diagnostic criteria are lacking. Objective To evaluate the characteristics of NXG and propose diagnostic criteria. Design, Setting, and Participants This multicenter cross-sectional study was conducted at tertiary academic referral centers and followed by a systematic review and a consensus exercise. The multicenter cohort included patients with NXG diagnosed at the Brigham and Women's and Massachusetts General Hospitals (2000-2018), the University of Iowa Hospitals and Clinics (2000-2018), and the University of Pennsylvania Health System (2008-2018). The systematic review was conducted in 2018 and included patients with NXG identified in the Cochrane, Ovid EMBASE, PubMed, and Web of Science databases. The consensus exercise was conducted by 8 board-certified dermatologists to identify diagnostic criteria. Main Outcomes and Measures Demographic factors, comorbidities, clinical features, and treatment response. Results Of 235 included patients with NXG (34 from the multicenter cohort and 201 from the systematic review results), the mean (SD) age at presentation was 61.6 (14.2) years; 147 (62.6%) were female. Paraproteinemia was detected in 193 patients (82.1%), most often IgG-κ (117 patients [50.0%]). A malignant condition was detected in 59 patients (25.1%), most often multiple myeloma (33 patients [14.0%]). The overall rate of paraproteinemia and/or a malignant condition was 83.8% (197 patients). In the multicenter cohort, evolution of paraproteinemia into multiple myeloma was observed up to 5.7 years (median [range], 2.4 [0.1-5.7] years) after NXG presentation. Cutaneous lesions consisted of papules, plaques, and/or nodules, typically yellow or orange in color (113 of 187 [60.4%]) with a periorbital distribution (130 of 219 [59.3%]). The eye was the leading site of extracutaneous involvement (34 of 235 [14.5%]). In the multicenter cohort, intravenous immunoglobulin had the best treatment response rate (9 of 9 patients [100%]), followed by antimalarial drugs (4 of 5 patients [80%]), intralesional triamcinolone (6 of 8 patients [75%]), surgery (3 of 4 patients [75%]), chemotherapy (8 of 12 patients [67%]), and lenalidomide or thalidomide (5 of 8 patients [63%]). The consensus exercise yielded 2 major criteria, which were (1) clinical and (2) histopathological features consistent with NXG, and 2 minor criteria, consisting of (1) paraproteinemia, plasma-cell dyscrasia, and/or other associated lymphoproliferative disorder and (2) periorbital distribution of cutaneous lesions. In the absence of foreign body, infection, or another identifiable cause, fulfillment of both major and at least 1 minor criterion were proposed to establish the diagnosis of NXG. Conclusions and Relevance Necrobiotic xanthogranuloma is a multisystem disorder associated with paraproteinemia and malignant conditions. The proposed diagnostic criteria may advance clinical research and should be validated.
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Affiliation(s)
- Caroline A. Nelson
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - David A. Hashemi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Hovik J. Ashchyan
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Zoe Brown-Joel
- University of Iowa Carver College of Medicine, Iowa City
| | - Megan H. Noe
- Perelman School of Medicine at the University of Pennsylvania, Department of Dermatology, Philadelphia
| | - Sotonye Imadojemu
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert G. Micheletti
- Perelman School of Medicine at the University of Pennsylvania, Department of Dermatology, Philadelphia
- Perelman School of Medicine at the University of Pennsylvania, Department of Medicine, Philadelphia
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Karolyn A. Wanat
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City
| | - Misha Rosenbach
- Perelman School of Medicine at the University of Pennsylvania, Department of Dermatology, Philadelphia
- Perelman School of Medicine at the University of Pennsylvania, Department of Medicine, Philadelphia
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Hashemi DA, Brown-Joel ZO, Tkachenko E, Nelson CA, Noe MH, Imadojemu S, Vleugels RA, Mostaghimi A, Wanat KA, Rosenbach M. Clinical Features and Comorbidities of Patients With Necrobiosis Lipoidica With or Without Diabetes. JAMA Dermatol 2020; 155:455-459. [PMID: 30785603 DOI: 10.1001/jamadermatol.2018.5635] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Necrobiosis lipoidica (NL) is a rare granulomatous condition. Current knowledge of its key features is based on a limited number of studies and case reports, leading to wide variability in the characterization of its defining features, with limited comparison of patients with or without diabetes. Objective To evaluate the epidemiologic characteristics, clinical features, and disease associations of NL in patients with or without type 1 or 2 diabetes. Design, Setting, and Participants This multicenter retrospective review included 236 patients aged 15 to 84 years who were evaluated and received a diagnosis of NL at the University of Pennsylvania Health System between January 1, 2008, and July 15, 2018; University of Iowa Hospitals and Clinics between January 1, 2000, and June 15, 2018; and Brigham and Women's Hospital and Massachusetts General Hospital between January 1, 2000, and February 15, 2018. Main Outcomes and Measures Patient demographics, clinical features, medical comorbidities, and biopsy status. Results Of the 236 patients with NL, 200 were women and 36 were men, and 182 were white, with a median age at presentation of 50.0 years (interquartile range, 33.0-59.0 years). The diagnosis was biopsy proven in 156 patients (66.1%). Of the 230 patients with location specified, 225 (97.8%) had NL on the lower legs. A total of 138 patients with NL (58.5%; 95% CI, 52.7%-65.3%) had diabetes. The median hemoglobin A1c for patients with diabetes was 8.00% (interquartile range, 6.68%-9.50%) (to convert hemoglobin A1c to proportion of total hemoglobin, multiply by 0.01). Patients with diabetes were significantly younger than patients without diabetes (median age, 45.0 vs 52.0 years; P = .005), and slightly less likely to be female (112 of 138 [81.2%] vs 87 of 96 [90.6%]; P = .046), but lesion characteristics were otherwise comparable. Other notable comorbidities included obesity in 95 of 184 patients (51.6%; 95% CI, 44.4%-58.9%), hypertension in 104 of 230 patients (45.2%), dyslipidemia in 98 of 225 patients (43.6%), and thyroid disease in 56 of 229 patients (24.5%). Conclusions and Relevance This study of NL supports its associations with diabetes as well as obesity, hypertension, dyslipidemia, and thyroid disease. Younger age and female sex were observed more frequently in patients with diabetes. Otherwise, NL lesions in patients with or without diabetes shared many clinical features, suggesting that risk factors outside of elevated blood glucose may play an important role in the disease. Future studies should evaluate these associations with the goal of further elucidating NL's underlying pathophysiologic characteristics.
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Affiliation(s)
- David A Hashemi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | | | - Caroline A Nelson
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Megan H Noe
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Sotonye Imadojemu
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Karolyn A Wanat
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City
| | - Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Cobos GA, Nelson CA, Alsarheed A, LaChance A, Laga AC, LeBoeuf N, Vleugels RA. Capecitabine-Related Eruption Mimicking Dermatomyositis in 2 Patients With Metastatic Breast Cancer. JAMA Dermatol 2020; 156:103-104. [PMID: 31693064 DOI: 10.1001/jamadermatol.2019.3162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Gabriela A Cobos
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Caroline A Nelson
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Abeer Alsarheed
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Avery LaChance
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alvaro C Laga
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nicole LeBoeuf
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Center for Cutaneous Oncology, Department of Dermatology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Key Words
- BP, bullous pemphigoid
- BP180, anti–bullous pemphigoid 180
- BP230, anti–bullous pemphigoid 230
- DIF, direct immunofluorescence
- ELISA, enzyme-linked immunosorbent assay
- ICI, immune checkpoint inhibitor
- IIF, indirect immunofluorescence
- Ig, immunoglobulin
- NBP, nonbullous pemphigoid
- PD-1
- PD-1, programmed cell death 1
- bullous pemphigoid
- immune checkpoint inhibitor
- immune-related adverse event
- nonbullous pemphigoid
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Affiliation(s)
- Sean Singer
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Caroline A Nelson
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Center for Cutaneous Oncology, Department of Dermatology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Christian G Lian
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna K Dewan
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nicole R LeBoeuf
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Center for Cutaneous Oncology, Department of Dermatology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
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Ashchyan HJ, Butler DC, Nelson CA, Noe MH, Tsiaras WG, Lockwood SJ, James WD, Micheletti RG, Rosenbach M, Mostaghimi A. The Association of Age With Clinical Presentation and Comorbidities of Pyoderma Gangrenosum. JAMA Dermatol 2019; 154:409-413. [PMID: 29450453 DOI: 10.1001/jamadermatol.2017.5978] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Importance Pyoderma gangrenosum is an inflammatory neutrophilic dermatosis. Current knowledge of this rare disease is limited owing to a lack of validated diagnostic criteria and large population studies. Objective To evaluate the association of age with the clinical presentation and comorbidities of pyoderma gangrenosum. Design, Setting, and Participants This was a multicenter retrospective cohort study performed at tertiary academic referral centers in urban settings. Adults (≥18 years) who were evaluated and diagnosed as having pyoderma gangrenosum at the Brigham and Women's and Massachusetts General Hospitals from 2000 to 2015 and the University of Pennsylvania Health System from 2006 to 2016 were included. Main Outcomes and Measures Patient demographics, clinical features, medical comorbidities, and treatment. Results Of the 356 validated cases of pyoderma gangrenosum included in the study, 267 (75%) were women and 284 (84.8%) were white. The mean (SD) age at presentation was 51.6 (17.7) years. Pathergy was recorded in 100 patients (28.1%). A total of 238 patients (66.9%) had associated medical comorbidities: inflammatory bowel disease in 146 patients (41.0%); inflammatory arthritis in 73 patients (20.5%); solid organ malignant neoplasms in 23 patients (6.5%); hematologic malignant neoplasms in 21 patients (5.9%); and hematologic disorders, specifically monoclonal gammopathy of undetermined significance, myelodysplastic syndrome, and polycythemia vera in 17 patients (4.8%). When stratified by age, pathergy was more common in patients 65 years or older (36.3% vs 24.3%; P = .02). Inflammatory bowel disease was the only medical comorbidity that was more common in patients younger than 65 years (47.7% vs 26.6%; P < .001), while a number of medical comorbidities were more common in those 65 years or older, including rheumatoid arthritis (13.3% vs 6.2%; P = .03), ankylosing spondylitis (1.8% vs 0%; P = .04), solid organ malignant neoplasms (13.3% vs 3.3%; P < .001), hematologic malignant neoplasms (9.7% vs 4.1%; P = .04), and the aforementioned hematologic disorders (10.6% vs 2.1%; P < .001). Conclusions and Relevance Although clinical presentation in this large cohort was similar between different age groups, disease associations varied by age. The findings of this study may allow for a more focused, age-specific evaluation of patients with pyoderma gangrenosum.
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Affiliation(s)
- Hovik J Ashchyan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Daniel C Butler
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Caroline A Nelson
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Megan H Noe
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - William G Tsiaras
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephen J Lockwood
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - William D James
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Robert G Micheletti
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Charny JW, Nelson CA, Mochel M, Pugliese DJ. Ascending erythematous nodules on the arm. Cutis 2018; 102:E15-E17. [PMID: 30657810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Jacob W Charny
- Department of Dermatology, University of Illinois at Chicago College of Medicine, USA
| | - Caroline A Nelson
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Mark Mochel
- Department of Pathology, Virginia Commonwealth University Health System, Richmond, USA
| | - Douglas J Pugliese
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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Gatica-Torres M, Nelson CA, Lipoff JB, Miller CJ, Rubin AI. Nail clipping with onychomycosis and surprise clue to the diagnosis of nail unit melanoma. J Cutan Pathol 2018; 45:803-806. [DOI: 10.1111/cup.13333] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Michelle Gatica-Torres
- Department of Dermatology; Albert Einstein College of Medicine/Montefiore Medical Center; Bronx New York USA
| | - Caroline A. Nelson
- Department of Dermatology; Perelman School of Medicine at the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - Jules B. Lipoff
- Department of Dermatology; Perelman School of Medicine at the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - Christopher J. Miller
- Department of Dermatology; Perelman School of Medicine at the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - Adam I. Rubin
- Department of Dermatology; Perelman School of Medicine at the University of Pennsylvania; Philadelphia Pennsylvania USA
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Nelson CA, Kovarik CL, Barbieri JS. Human-computer symbiosis: enhancing dermatologic care while preserving the art of healing. Int J Dermatol 2018; 57:1015-1016. [PMID: 29873395 DOI: 10.1111/ijd.14071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 04/27/2018] [Accepted: 05/16/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Caroline A Nelson
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - John S Barbieri
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Ashchyan HJ, Nelson CA, Stephen S, James WD, Micheletti RG, Rosenbach M. Neutrophilic dermatoses: Pyoderma gangrenosum and other bowel- and arthritis-associated neutrophilic dermatoses. J Am Acad Dermatol 2018; 79:1009-1022. [PMID: 29653213 DOI: 10.1016/j.jaad.2017.11.063] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/06/2017] [Accepted: 11/08/2017] [Indexed: 01/27/2023]
Abstract
Neutrophilic dermatoses are a heterogeneous group of inflammatory skin disorders that present with unique clinical features but are unified by the presence of a sterile, predominantly neutrophilic infiltrate on histopathology. The morphology of cutaneous lesions associated with these disorders is heterogeneous, which renders diagnosis challenging. Moreover, a thorough evaluation is required to exclude diseases that mimic these disorders and to diagnose potential associated infectious, inflammatory, and neoplastic processes. While some neutrophilic dermatoses may resolve spontaneously, most require treatment to achieve remission. Delays in diagnosis and treatment can lead to significant patient morbidity and even mortality. Therapeutic modalities range from systemic corticosteroids to novel biologic agents, and the treatment literature is rapidly expanding. The second article in this continuing medical education series reviews the epidemiology, clinical characteristics, histopathologic features, diagnosis, and management of pyoderma gangrenosum as well as bowel-associated dermatosis-arthritis syndrome and the arthritis-associated neutrophilic dermatoses rheumatoid neutrophilic dermatitis and adult Still disease.
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Affiliation(s)
- Hovik J Ashchyan
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Caroline A Nelson
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sasha Stephen
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William D James
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert G Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Nelson CA, Stephen S, Ashchyan HJ, James WD, Micheletti RG, Rosenbach M. Neutrophilic dermatoses: Pathogenesis, Sweet syndrome, neutrophilic eccrine hidradenitis, and Behçet disease. J Am Acad Dermatol 2018; 79:987-1006. [PMID: 29653210 DOI: 10.1016/j.jaad.2017.11.064] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/06/2017] [Accepted: 11/08/2017] [Indexed: 12/24/2022]
Abstract
Neutrophilic dermatoses are a heterogeneous group of inflammatory skin disorders that present with unique clinical features but are unified by the presence of a sterile, predominantly neutrophilic infiltrate on histopathology. The morphology of cutaneous lesions associated with these disorders is heterogeneous, which renders diagnosis challenging. Moreover, a thorough evaluation is required to exclude diseases that mimic these disorders and to diagnose potential associated infectious, inflammatory, and neoplastic processes. While some neutrophilic dermatoses may resolve spontaneously, most require treatment to achieve remission. Delays in diagnosis and treatment can lead to significant patient morbidity and even mortality. Therapeutic modalities range from systemic corticosteroids to novel biologic agents, and the treatment literature is rapidly expanding. The first article in this continuing medical education series explores the pathogenesis of neutrophilic dermatoses and reviews the epidemiology, clinical and histopathologic features, diagnosis, and management of Sweet syndrome, neutrophilic eccrine hidradenitis, and Behçet disease.
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Affiliation(s)
- Caroline A Nelson
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sasha Stephen
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hovik J Ashchyan
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William D James
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert G Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Nelson CA, Elder DE, Elenitsas R, Weir M. Conjunctivitis, mucosal erosions, and moist cutaneous plaques. JAAD Case Rep 2018; 4:117-119. [PMID: 29349113 PMCID: PMC5767905 DOI: 10.1016/j.jdcr.2017.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Caroline A Nelson
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David E Elder
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rosalie Elenitsas
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michelle Weir
- Department of Medicine, Section of Dermatology, Pritzker School of Medicine at the University of Chicago, Chicago, Illinois
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Nelson CA, Noe MH, McMahon CM, Gowda A, Wu B, Ashchyan HJ, Perl AE, James WD, Micheletti RG, Rosenbach M. Sweet syndrome in patients with and without malignancy: A retrospective analysis of 83 patients from a tertiary academic referral center. J Am Acad Dermatol 2017; 78:303-309.e4. [PMID: 29107342 DOI: 10.1016/j.jaad.2017.09.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 08/25/2017] [Accepted: 09/04/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Sweet syndrome is a neutrophilic dermatosis that may be categorized into classic, malignancy-associated, and drug-induced subtypes. Few studies have systematically analyzed this rare disorder. OBJECTIVE To describe the clinicopathologic characteristics and treatment of Sweet syndrome and identify characteristics associated with concurrent malignancy. METHODS We retrospectively reviewed patients with Sweet syndrome at the University of Pennsylvania from 2005 to 2015. RESULTS We identified 83 patients (mean age, 57 years; 51% male) with Sweet syndrome: 30% with the classic form, 44% with the malignancy-associated form, 24% with the drug-induced form in the setting of malignancy, and 2% with the drug-induced form. Acute myeloid leukemia was the most common malignancy (in 24 of 83 patients [29%]). Filgrastim was the most common medication (used in 8 of 83 patients [10%]). Leukopenia (P < .001), anemia (P = .002), thrombocytopenia (P < .001), absence of arthralgia (P < .001), and histiocytoid or subcutaneous histopathology (P = .024) were associated with malignancy (χ2 test). LIMITATIONS This was a retrospective study that represents patients from a single tertiary academic referral center, which may limit its generalizability to other settings. CONCLUSION When caring for patients with Sweet syndrome, dermatologists should be aware of the potential association of leukopenia, anemia, thrombocytopenia, absence of arthralgia, and histiocytoid or subcutaneous histopathology with malignancy.
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Affiliation(s)
- Caroline A Nelson
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Megan H Noe
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christine M McMahon
- Department of Medicine, Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Asha Gowda
- University of Toledo College of Medicine, Toledo, Ohio
| | - Benedict Wu
- Department of Medicine, Drexel College of Medicine, Philadelphia, Pennsylvania
| | - Hovik J Ashchyan
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander E Perl
- Department of Medicine, Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - William D James
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert G Micheletti
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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Paniagua-Avila MA, Messenger E, Nelson CA, Calgua E, Barg FK, Bream KW, Compher C, Dean AJ, Martinez-Siekavizza S, Puac-Polanco V, Richmond TS, Roth RR, Branas CC. The Guatemala-Penn Partners: An Innovative Inter-Institutional Model for Scientific Capacity-Building, Healthcare Education, and Public Health. Front Public Health 2017; 5:70. [PMID: 28443274 PMCID: PMC5385342 DOI: 10.3389/fpubh.2017.00070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/20/2017] [Indexed: 12/02/2022] Open
Abstract
Population health outcomes are directly related to robust public health programs, access to basic health services, and a well-trained health-care workforce. Effective health services need to systematically identify solutions, scientifically test these solutions, and share generated knowledge. The World Health Organization (WHO)’s Global Healthcare Workforce Alliance states that the capacity to perform research is an essential factor for well-functioning public health systems. Low- and middle-income countries have greater health-care worker shortages and lower research capacity than higher-income countries. International global health partnerships between higher-income countries and low-middle-income countries aim to directly address such inequalities through capacity building, a process by which human and institutional resources are strengthened and developed, allowing them to perform high-level functions, solve complex problems, and achieve important objectives. The Guatemala–Penn Partners (GPP) is a collaboration among academic centers in Guatemala and the University of Pennsylvania (Penn), in Philadelphia, Pennsylvania that echoes the vision of the WHO’s Global Healthcare Workforce Alliance. This article describes the historical development and present organization of the GPP according to its three guiding principles: university-to-university connections, dual autonomies with locally led capacity building, and mutually beneficial exchanges. It describes the GPP activities within the domains of science, health-care education, and public health, emphasizing implementation factors, such as sustainability and scalability, in relation to the guiding principles. Successes and limitations of this innovative model are also analyzed in the hope that the lessons learned may be applied to similar partnerships across the globe.
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Affiliation(s)
- Maria Alejandra Paniagua-Avila
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,School of Medicine, Universidad Francisco Marroquín, Guatemala City, Guatemala
| | - Elizabeth Messenger
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Caroline A Nelson
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Erwin Calgua
- School of Medicine, Universidad San Carlos de Guatemala, Guatemala City, Guatemala.,Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Frances K Barg
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kent W Bream
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Office of Global Health and the Provost's Office of the University of Pennsylvania, Philadelphia, PA, USA
| | - Charlene Compher
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
| | - Anthony J Dean
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Victor Puac-Polanco
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Therese S Richmond
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
| | - Rudolf R Roth
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Charles C Branas
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Barbieri JS, Nelson CA, Bream KD, Kovarik CL. Primary care providers' perceptions of mobile store-and-forward teledermatology. Dermatol Online J 2015; 21:13030/qt2jt0h05w. [PMID: 26437165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 08/14/2015] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION Although teledermatology offers promise as a tool to increase access to care, adoption has been limited. Understanding the perspectives and experiences of key stakeholders, such as primary care providers (PCPs) and patients, is important to identify opportunities to reduce barriers to adoption and to improve teledermatology programs. Although many studies have examined patients' experiences and satisfaction with teledermatology, few have examined referring PCPs' perspectives. OBJECTIVE To identify PCPs' perceptions on the strengths and limitations of teledermatology in order to identify opportunities to improve teledermatology programs. METHODS We distributed an anonymous, web-based survey to 30 PCPs involved in a two-year study evaluating a mobile app-based teledermatology platform. RESULTS 100% (18/18) agreed or strongly agreed that teledermatology increases access to dermatologic care, improves patient care, and is acceptable to patients. 100% (18/18) agreed or strongly agreed that teledermatology provides educational benefit to the PCP. Only 6% (1/18) agreed that teledermatology increases medical liability and 11% (2/18) agreed that it increases risk of a breach in privacy or confidentiality. CONCLUSIONS Our findings highlight that PCPs are highly satisfied with mobile app-based, store-and-forward teledermatology and that they believe teledermatology offers synergistic educational benefit. We hope these results will help guide the development of teledermatology programs to increase access to timely, cost-effective care.
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Affiliation(s)
- John S Barbieri
- Perelman School of Medicine at the University of Pennsylvania
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Nelson CA, Wanat KA, Roth RR, James WD, Kovarik CL, Takeshita J. Teledermatology as pedagogy: diagnostic and management concordance between resident and attending dermatologists. J Am Acad Dermatol 2015; 72:555-7. [PMID: 25687312 DOI: 10.1016/j.jaad.2014.11.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 11/05/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Caroline A Nelson
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Karolyn A Wanat
- Department of Dermatology, Carver College of Medicine at the University of Iowa, Iowa City
| | - Rudolf R Roth
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - William D James
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Junko Takeshita
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
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Barbieri JS, Nelson CA, Bream KD, Kovarik CL. Primary care providers' perceptions of mobile store-and-forward teledermatology. Dermatol Online J 2015. [DOI: 10.5070/d3218028436] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Nelson CA, Kovarik CL, Morssink CB. Tele-leprology: a literature review of applications of telemedicine and tele-education to leprosy. LEPROSY REV 2014; 85:250-261. [PMID: 25675649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Global efforts to eliminate leprosy have brought about a steep decline in prevalence; however, new cases are continually detected. Without early diagnosis and appropriate management, these individuals are at risk of disability, disfigurement, and social stigma. Telemedicine and tele-education are increasingly utilised strategies to maintain access to expert healthcare for leprosy patients scattered in low-accessibility areas. However, an overview of tele-leprology, the application of these strategies specifically to leprosy, is currently unavailable. This review provides such an overview and discusses future directions for research and implementation.
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Nelson CA, Frosch Z, Lapin J, Kogan JR. Facilitating the clerkship transition through near-peer-led 'student reports'. Med Educ 2014; 48:532-3. [PMID: 24712951 DOI: 10.1111/medu.12459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Barbieri JS, Nelson CA, James WD, Margolis DJ, Littman-Quinn R, Kovarik CL, Rosenbach M. The Reliability of Teledermatology to Triage Inpatient Dermatology Consultations. JAMA Dermatol 2014; 150:419-24. [DOI: 10.1001/jamadermatol.2013.9517] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- John S. Barbieri
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Caroline A. Nelson
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - William D. James
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania , Philadelphia
| | - David J. Margolis
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia2Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania , Philadelphia3Department of Epidemiology and Biostatistics, Perelman School of Medicine a
| | - Ryan Littman-Quinn
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania , Philadelphia
| | - Carrie L. Kovarik
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania , Philadelphia
| | - Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania , Philadelphia
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Head MJ, Nelson CA, Siu KC. Multi-degree of freedom joystick for virtual reality simulation. J Med Eng Technol 2013; 37:475-83. [PMID: 24079814 DOI: 10.3109/03091902.2013.831492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
A modular control interface and simulated virtual reality environment were designed and created in order to determine how the kinematic architecture of a control interface affects minimally invasive surgery training. A user is able to selectively determine the kinematic configuration of an input device (number, type and location of degrees of freedom) for a specific surgical simulation through the use of modular joints and constraint components. Furthermore, passive locking was designed and implemented through the use of inflated latex tubing around rotational joints in order to allow a user to step away from a simulation without unwanted tool motion. It is believed that these features will facilitate improved simulation of a variety of surgical procedures and, thus, improve surgical skills training.
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Affiliation(s)
- M J Head
- Department of Mechanical and Materials Engineering, University of Nebraska- Lincoln , Lincoln, NE , USA
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