Subcorneal Pustular Dermatosis Following SARS-CoV-2 Infection

Subcorneal pustular dermatosis (SPD), also called Sneddon-Wilkinson disease, is a rare, relapsing pustular dermatosis.1 SPD has been associated with multiple myeloma, IgA Gammopathy, pyoderma gangrenosum and certain autoimmune diseases.2 However, SPD occurrence following SARS-COV-2 has not yet been reported. Herein, we report a case of SPD occurring after SARS-CoV-2 infection in a 52-year-old male. We hypothesize that the occurrence of SPD shortly following SARS-CoV-2 infection suggests the viral illness may have precipitated onset of SPD, and the patient may remain at risk for future flares of disease despite appropriate treatment and current remission status.

Specialties with Few Underrepresented Applicants Lack Diversity Information on Residency Websites

INTRODUCTION

With the advent of virtual interviews and the increasing accessibility of internet resources, students increasingly rely on program websites for residency application decisions. In this cross-sectional study, we evaluated the presence of diversity or inclusion information in the least diverse US specialties' residency program websites, including dermatology, orthopedic surgery, otolaryngology, plastic surgery, and urology residency programs.

METHODS

Two authors independently reviewed each Accreditation Council for Graduate Medical Education-accredited non-military US residency program website and ranked the websites' diversity and inclusion information using six pre-determined criteria based on previous studies in the literature.

RESULTS

This study reveals that more than half of residency programs of each specialty met zero of the diversity and inclusion information criteria.

CONCLUSIONS

Residency program websites in the least diverse specialties are lacking important information for prospective applicants that may help signal programs' commitment to inclusivity and attract a diverse candidate pool.

Understanding melanoma in situ: Lentigo maligna surgical treatment terminology and guideline adherence, a targeted review

BACKGROUND

Malignant melanoma in-situ, lentigo maligna (MMIS-LM) can be successfully treated with several different surgical techniques; however, the literature is inconsistent in defining them.

OBJECTIVE

To comprehensively define and describe the national guideline recommended surgical techniques used to treat MMIS-LM to help clarify and standardize this terminology to ensure compliance with the guidelines.

METHODS

A targeted literature review was performed from 1990 to 2022 focusing on articles that discussed the national guideline recommended surgical techniques of wide local excision, Mohs micrographic surgery (MMS), modified Mohs surgery, and staged excision/Slow-Mohs for MMIS-LM, as well as the related methods of tissue processing. National Comprehensive Cancer Network and American Academy of Dermatology guidelines were reviewed to identify how the techniques need to be employed to be compliant with guideline recommendations.

RESULTS

We describe the various surgical and tissue processing techniques and discuss advantages and disadvantages of each.

LIMITATIONS

This paper was styled as a narrative review defining and clarifying terminology and technique and does not investigate these topics more broadly.

CONCLUSION

Understanding the methodology and terminology for these surgical procedures and tissue processing methods is critical so that both general dermatologists and surgeons can employ these techniques effectively for optimal patient care.

Skin of Color in Preclinical Medical Education: A Cross-Institutional Comparison and A Call to Action

Disease presentations can vary between different skin phototypes, at times requiring distinct management and therapies. Medical education curricula have yet to be updated to better reflect and address the dermatologic needs of an increasingly diverse population. The objective of this study was to determine if the preclinical dermatology curriculum at 3 US medical schools provided adequate representation of skin of color patients in their didactic presentation slides. Three US medical schools-all members of the American Medical Association (AMA) Accelerating Change in Medical Education consortium-were included in the study. The institutions were a blend of private and public schools located across different geographic boundaries. The main outcome measures included the proportion of total skin of color photographs for each institution, the number of priority conditions for skin of color patients, and the discussion of differences between skin types. The results strongly suggested that skin of color is underrepresented in the preclinical dermatology curriculum at all 3 institutions. Efforts should be made to increase images and discussion of skin of color in preclinical didactics.

Subungual Nail Erythrasma Presenting as Melanonychia: A Rare Finding

Nail pathology may reflect a wide array of localized and systemic dermatological conditions. Certain nail findings such as melanonychia can create diagnostic challenges even to nail experts. We report a case of a 78-year-old man who presented with melanonychia of the great toe. Nail clipping showed focal melanin deposition, and dermoscopy demonstrated a region of localized erythema in the lunula concerning for possible melanocytic neoplasm. Subsequent nail biopsy showed numerous vertically oriented filamentous bacteria and coccobacilli within the nail plate consistent with a diagnosis of subungual nail erythrasma. Nail erythrasma is a rare entity. Additionally, this case highlights a new clinical presentation of nail erythrasma as melanonychia.

Use of mobility ratios to estimate binding constants of ligands to proteins in affinity capillary electrophoresis

This work evaluates the use of mobility ratios (M) to estimate binding constants of proteins to ligands using affinity capillary electrophoresis (ACE). This concept is demonstrated using two model systems: vancomycin (Van) from Streptomyces orientalis and carbonic anhydrase B (CAB, EC 4.2.1.1). A plot of change in M (deltaM) over the concentration of ligand [L] versus deltaM yields a more useful representation of the Scatchard plot in capillary electrophoresis (CE) than traditional plots of the change in mobility delta mu over [L] versus delta mu in a wide set of circumstances, especially when comparing electropherograms obtained in the presence of substantial variations in electroosmotic flow. Altering the voltage and/or capillary length of the CE system produced only small variations in M, but much larger changes in the more standard measures of migration used by the mu form of analysis. The use of M in the Scatchard analysis offers a new approach to estimating binding constants of ligands to proteins using ACE.