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Understanding Borealpox virus: an update for clinicians following the first mortality. Int J Dermatol 2024. [PMID: 38703183 DOI: 10.1111/ijd.17218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 05/06/2024]
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2
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Histopathology and radiologic imaging for the confirmation of calciphylaxis in a diverse population: A retrospective cohort study. J Am Acad Dermatol 2024:S0190-9622(24)00503-6. [PMID: 38513831 DOI: 10.1016/j.jaad.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/22/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
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3
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IgA vasculitis and malignancy: A systematic review. J Eur Acad Dermatol Venereol 2024; 38:e41-e44. [PMID: 37561328 DOI: 10.1111/jdv.19411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023]
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4
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Efficacy and safety of repository corticotropin injection for refractory cutaneous dermatomyositis: a prospective, open-label study. Rheumatology (Oxford) 2023:kead595. [PMID: 37941470 DOI: 10.1093/rheumatology/kead595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/19/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVES Cutaneous dermatomyositis (DM) is often refractory to multiple medications. Repository corticotropin injection (RCI) is FDA-approved for DM, but little is known about its efficacy and safety for treating cutaneous DM. We conducted a prospective, open-label trial assessing efficacy and safety of RCI for treating refractory cutaneous DM. METHODS DM patients with moderate-to-severe cutaneous activity [Cutaneous Dermatomyositis Disease Area and Severity Index activity (CDASI-A)] >14 despite prior treatment with ≥2 systemic agents were enrolled. Patients were initiated on 80 u RCI twice weekly for 6 months. Primary outcomes included significant decreases in CDASI-A and Physician's Global Assessment (PGA) scores at 6 months. RESULTS Of nineteen patients enrolled, fifteen patients (11 females, 4 males) with DM (7 classic, 8 amyopathic) completed 6 months of RCI treatment. Patients were treated with a median 3.0 systemic medications prior to enrolment and were taking a median of 2.0 systemic medications at enrolment. Median baseline CDASI-A score was 19.0 and median PGA activity score was 2.5/10. For patient-reported outcomes, baseline median patient global skin score (PtGSS) was 3.0/10 and median dermatology life quality index (DLQI) score was 7.0/10. At 6 months, there were statistically significant improvements in CDASI-A scores (median= 10.0), PGA scores (median= 0.8/10), PtGSS scores (median= 7.0) and DLQI scores (median= 2.0), among others. Adverse effects were mild. CONCLUSIONS RCI treatment resulted in statistically significant and clinically meaningful improvement in cutaneous DM activity and quality of life. Our results suggest RCI is an effective, safe, and well-tolerated treatment for patients with refractory cutaneous dermatomyositis. CLINICAL TRIAL REGISTRATION This clinical trial was registered with ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT01906372).
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Sweet Syndrome Associated with Active Inflammatory Bowel Disease: A Case Series of a Rare Extra-intestinal Manifestation. Dig Dis Sci 2023; 68:3562-3568. [PMID: 37402983 PMCID: PMC10921822 DOI: 10.1007/s10620-023-07983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/22/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Cutaneous extra-intestinal manifestations (EIM) occur in up to 20% of patients with IBD. Information about Sweet syndrome (SS)'s clinical course as a rare cutaneous EIM in IBD is limited to case reports. We present the largest retrospective cohort on the occurrence and management of SS in IBD. STUDY Electronic medical records and paper charts since 1980 were retrospectively reviewed at a large quaternary medical center to identify all adult IBD patients with histopathology-proven SS. Patient characteristics and clinical outcomes were evaluated. RESULTS 25 IBD patients with SS were identified; 3 patients were assessed to have AZA-induced SS. The majority of SS patients were female. Median age at diagnosis was 47 years (IQR 33-54 years) and SS appeared at a median of 6.4 years after IBD diagnosis. IBD patients with SS had a high rate of complicated IBD phenotypes (75% extensive colitis in UC and 73% stricturing or penetrating disease in CD, with 100% colonic involvement), as well as frequent co-occurring EIMs (60%). SS correlated with global IBD disease activity. Corticosteroids were an effective therapy for SS in IBD. Recurrence rate of SS was 36%. CONCLUSION Contrary to previous case reports, SS was a cutaneous EIM occurring late after diagnosis of IBD in our cohort, with occurrences paralleling global IBD disease activity. Although AZA-induced and IBD-associated SS were both effectively treated with corticosteroids, distinguishing them is relevant for future IBD treatment strategies.
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Skin ulcerations caused by xylazine: A less-known entity. J Am Acad Dermatol 2023:S0190-9622(23)00594-7. [PMID: 37054812 DOI: 10.1016/j.jaad.2023.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/29/2023] [Accepted: 04/02/2023] [Indexed: 04/15/2023]
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Reef safe sunscreens: A call to action. J Eur Acad Dermatol Venereol 2023; 37:e314-e315. [PMID: 36394366 DOI: 10.1111/jdv.18763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022]
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8
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Update for dermatologists on monkeypox: An emerging health problem in the world. Indian J Dermatol Venereol Leprol 2023; 89:326-331. [PMID: 36999170 DOI: 10.25259/ijdvl_673_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/01/2022] [Indexed: 02/05/2023]
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9
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Distinguishing monkeypox from its mimickers. J Med Virol 2023; 95:e28523. [PMID: 36695517 DOI: 10.1002/jmv.28523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/11/2022] [Accepted: 01/22/2023] [Indexed: 01/26/2023]
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10
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Clinical considerations in pediatric cases of monkeypox. J Am Acad Dermatol 2023; 88:e91-e92. [PMID: 36113613 PMCID: PMC9677527 DOI: 10.1016/j.jaad.2022.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 01/31/2023]
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11
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Pentoxifylline in dermatology. J Cosmet Dermatol 2023; 22:410-417. [PMID: 36208009 DOI: 10.1111/jocd.15445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/03/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pentoxifylline was initially marketed for use in patients with intermittent claudication due to chronic occlusive arterial disease of the extremities but has since been shown to have several off-label uses in dermatology. AIMS The aim of this review is to increase awareness of the several applications of pentoxifylline in the field of dermatology. METHODS A comprehensive PubMed search was conducted in May 2022 using the following phrases "dermatology" AND "pentoxifylline." Our search period spanned 34 years from 1988 to 2022. All available literature was reviewed. Reference lists of identified articles were included. Studies were excluded if they were not in English and if the study was out of scope. Eighty-one articles were included in this review. RESULTS Pentoxifylline has been used to treat various dermatological conditions including peripheral vascular disease, vasculitis and vasculopathies, chilblains, pigmented purpuric dermatosis, granuloma annulare, necrobiosis, keloids, lichen sclerosis et atrophicus, scars, radiation-induced fibrosis, vitiligo, alopecia areata, leishmaniasis, and leprosy. CONCLUSIONS Pentoxifylline's use in dermatology is growing. However, there are limited larger studies and randomized control trials on the use of pentoxifylline in dermatology and more investigation is needed to evaluate its use for many dermatologic conditions. Pentoxifylline's unique mechanism of action as well as its good tolerability, cost-effectiveness, and minimal drug interactions make it a convenient primary or adjunctive option in many dermatological conditions.
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Tranexamic acid in melasma: A focused review on drug administration routes. J Cosmet Dermatol 2023; 22:1197-1206. [PMID: 36606378 DOI: 10.1111/jocd.15589] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/30/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Melasma is a disorder of hyperpigmentation and vascularization often found in women between the ages of 20 and 40. The pathogenesis is unknown, but melasma often occurs in sun-exposed areas of the face, forearms, and back. Risk factors include family history, increased estrogen/progesterone, certain medications, and UV exposure. Melasma is typically treated with topical hydroquinone (HQ); however, it is often refractory to treatment. Tranexamic acid (TXA) is a plasmin inhibitor used off-label in the treatment of melasma. TXA can be administered orally, topically, or intralesionally. AIMS The purpose of this review is to characterize the wide variety of TXA delivery methods for melasma treatment and the efficacy of these methods compared with traditional treatments. PATIENTS/METHODS A comprehensive PubMed and Embase search was conducted in May 2022 using the phrases tranexamic acid and melasma. Forty-six articles were included in this review. RESULTS Oral, intralesional, and topical TXA is safe and effective treatments for melasma. They have been studied in a variety of randomized controlled trials and have been compared with several traditional treatments. Overall, MASI scores in patients using TXA in any form improved. CONCLUSIONS Oral TXA was found to be the most effective, especially in cases of refractory melasma; however, it caused GI upset and menstrual irregularities in many patients. The pro-thrombotic nature of this drug must be considered before safely prescribing to patients. Intralesional injections and microneedling with topical TXA were found to be effective alternatives to oral treatment. Lastly, topical TXA alone was found to be the least effective method but can be combined with other cosmeceuticals to improve outcomes. Topical TXA was also found to be better tolerated than hydroquinone, a traditional topical melasma treatment.
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Diagnostic considerations in suspected cases of monkeypox. J Am Acad Dermatol 2023; 88:e53-e55. [PMID: 36167184 PMCID: PMC9534272 DOI: 10.1016/j.jaad.2022.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 12/02/2022]
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Reply to "Routine Re-screening for Latent Tuberculosis Has Low Utility in Patients With Chronic Immune-Mediated Inflammatory Diseases Treated With Biologics: A Single Center Retrospective Cohort Study". J Am Acad Dermatol 2022; 87:1437-1438. [PMID: 35995087 DOI: 10.1016/j.jaad.2022.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022]
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New diagnosis of systemic lupus erythematosus after COVID-19 vaccination: A case report and review of literature. JAAD Case Rep 2022; 30:30-34. [PMID: 36246778 PMCID: PMC9550275 DOI: 10.1016/j.jdcr.2022.09.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Reply to "Comment on 'Current outbreak of monkeypox: essentials for the dermatologist'". J Am Acad Dermatol 2022; 87:e229-e230. [PMID: 36030985 PMCID: PMC9533925 DOI: 10.1016/j.jaad.2022.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 12/04/2022]
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Painful Perianal Rash in an HIV-Positive Individual. JAAD Case Rep 2022; 31:115-117. [DOI: 10.1016/j.jdcr.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 11/24/2022] Open
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Current outbreak of monkeypox: Essentials for the dermatologist. J Am Acad Dermatol 2022; 87:e171-e174. [PMID: 35753551 PMCID: PMC9528187 DOI: 10.1016/j.jaad.2022.06.1170] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/04/2022] [Accepted: 06/18/2022] [Indexed: 01/17/2023]
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Acute onset psychosis-the diagnosis lies in your 'hands'. Bipolar Disord 2022; 24:762-763. [PMID: 36064205 DOI: 10.1111/bdi.13253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Routine rescreening for latent tuberculosis has low utility in patients with chronic immune-mediated inflammatory diseases treated with biologics: A single-center, retrospective cohort study. J Am Acad Dermatol 2022; 87:841-843. [PMID: 35597388 PMCID: PMC10022868 DOI: 10.1016/j.jaad.2022.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 11/19/2022]
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Meyerson Phenomenon in a Nevus Simplex. Indian Dermatol Online J 2022; 14:133. [PMID: 36776181 PMCID: PMC9910544 DOI: 10.4103/idoj.idoj_302_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/23/2022] [Accepted: 06/30/2022] [Indexed: 12/31/2022] Open
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Abstract
BACKGROUND AND AIMS Sweet syndrome [SS] is a dermatological condition associated with both inflammatory bowel disease [IBD] and azathioprine use. We performed a systematic review to better delineate clinical characteristics and outcomes of SS in IBD patients. METHODS Peer-reviewed, full-text journal publications from inception to April 2020 in English language and adult subjects with IBD were included. Skin biopsy was required as SS gold-standard diagnosis. Azathioprine-associated SS required recent azathioprine introduction or recurrence of SS after azathioprine re-challenge. RESULTS We included 89 publications with 95 patients [mean age of SS diagnosis: 44 years; 59% female; 20 with azathioprine-associated SS and 75 without]. SS was diagnosed prior to IBD in 5.3%, at time of IBD diagnosis in 29.5% and after diagnosis in 64.2%. In total, 91% of patients with SS had known colonic involvement and the majority [76%] had active IBD at diagnosis; 22% had additional extra-intestinal manifestations. Successful therapies for SS included corticosteroids [90.5%], anti-tumour necrosis factor [TNF]-α inhibitor therapy [14.8%] and azathioprine [11.6%]. Azathioprine-associated SS was distinct, with 85% male patients, mean age of SS diagnosis of 50 years and a lower likelihood to be prescribed corticosteroids for treatment [75% vs 94.7% of non-azathioprine-associated SS, p = 0.008]. All patients with azathioprine-associated SS improved with medication cessation and developed recurrence after re-challenge. CONCLUSIONS SS may precede or occur with IBD diagnosis in almost one-third of cases. Azathioprine and IBD-associated SS present and behave distinctly, especially with regard to gender, age at diagnosis and recurrence risk. Corticosteroids and TNF-α inhibitors have demonstrated efficacy in treating SS in IBD.
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Dermatomyositis and malignancy: should all patients with dermatomyositis undergo malignancy screening? ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:432. [PMID: 33842653 PMCID: PMC8033297 DOI: 10.21037/atm-20-5215] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Dermatomyositis is an autoimmune disease that occurs in association with underlying malignancy in a subset of patients. Given this association, diagnosis of dermatomyositis typically triggers malignancy screening. Although various malignancy screening protocols have been proposed, none have been extensively studied or taken into account prevalence of dermatomyositis-associated malignancies. We utilized peer-reviewed manuscripts identified by a Medline search from May 2000 to April 2020 to present a focused review concerning the association between dermatomyositis and malignancy, and controversies related to screening for malignancies most commonly occurring in dermatomyositis patients. This information was then synthesized to propose a rational strategy for approaching malignancy screening in dermatomyositis patients. Our review supports that risk of malignancy in dermatomyositis patients is well-established. However, the subset of dermatomyositis patients in whom the benefits of malignancy screening outweigh the risks of harm is unknown. Additionally, an evidence-based malignancy screening protocol for dermatomyositis patients that optimizes the risk:benefit ratio does not exist. Given the clear harms that can result, we propose that shared decision-making strategies be implemented to determine whether pursuit of malignancy screening conforms with dermatomyositis patients’ desires and values. Physicians should be clear about potential risks and benefits of malignancy screening, and discuss clinical and serologic features present that may suggest/refute underlying malignancy during conversations aimed at shared decision-making. Research is greatly needed to determine which dermatomyositis patients warrant malignancy screening, which tests should be performed, and the intensity with which they should be ordered. Only after such work is done can malignancy screening in dermatomyositis patients be considered to have high value.
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AB008. Utility of repeat latent tuberculosis testing in patients with immune-mediated diseases taking biologics. ANNALS OF TRANSLATIONAL MEDICINE 2021. [PMCID: PMC8033305 DOI: 10.21037/atm.2021.ab008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Guidelines for repeat latent tuberculosis infection (LTBI) testing while on biologics are not clearly defined. The CDC and U.S. Preventive Services Task Force recommend routine serial LTBI screening in high-risk patients, such as those on immunosuppressive medications. Furthermore, recommendations for annual LTBI screening in patients on biologics have been incorporated into the Medicare Merit-Based Incentive Payment Systems and will impact physician reimbursement. However, little evidence supports that this practice is clinically valuable and/or cost-effective in patients on biologics. To evaluate the utility of serial LTBI screening in patients taking biologics and to identify risk factors in patients who convert from negative to positive QuantiFERON TB test (QFT) results while on biologics. Methods We retrospectively reviewed QFT results in patients treated with biologics for chronic immune-mediated inflammatory/autoimmune conditions (IMIDs) at a single, tertiary care center from 2007–2019. For each patient included in our study, detailed clinical information from their medical records was collected. Results We identified 5,212 patients who had IMIDs and >1 repeat QFT result after starting biologic therapy. The most common IMID diagnoses were inflammatory bowel disease (30%), rheumatoid arthritis (28%) and psoriatic disease (24%). The majority of patients had all negative QFTs (87.5%), whereas 172 patients (3.3%) had >1 positive QFT. Amongst patients with positive QFTs, 61/172 patients (35%) converted from a negative to a positive QFT after biologic therapy initiation. Of these 61 patients, only 28 patients were eventually treated for LTBI. Fourteen of the 28 patients treated for LTBI had documented risk factors for TB exposure, such as travel to endemic TB areas and/or exposure to individuals with TB. Only one case of active TB was diagnosed. Conclusions This represents the largest single-institution study evaluating rates of QFT test positivity conversion in patients taking biologics. Repeat LTBI testing in patients taking biologics revealed a low rate of conversion (1.17%). Our results suggest clinical utility and cost-effectiveness of repeat LTBI screening in patients on biologics may be more valuable if not performed routinely, but driven by a focused review of TB exposure risk factors in each patient.
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A Refractory Blistering Eruption in a Young Woman With a Positive Antinuclear Antibody. J Clin Rheumatol 2021; 27:e62-e63. [PMID: 31609816 DOI: 10.1097/rhu.0000000000001188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Large-cell variant of Merkel cell carcinoma with clear-cell change. J Cutan Pathol 2020; 47:1-5. [PMID: 31840299 DOI: 10.1111/cup.13583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/18/2019] [Accepted: 09/25/2019] [Indexed: 11/29/2022]
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17244 Utility of repeated latent tuberculosis testing in psoriatic disease patients taking biologics. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17417 Risk factors and impact of conversion to an indeterminate interferon-gamma release assay result in patients receiving biologics. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Family history of psoriasis, psychological stressors, and tobacco use are associated with the development of tumor necrosis factor-α inhibitor-induced psoriasis: A case-control study. J Am Acad Dermatol 2020; 83:1599-1605. [PMID: 32592879 DOI: 10.1016/j.jaad.2020.06.081] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 06/13/2020] [Accepted: 06/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Tumor necrosis factor-α inhibitor-induced psoriasis (TNFI psoriasis) is a paradoxical reaction characterized by development of a psoriasiform rash that mimics psoriasis vulgaris. Temporal onset variability and low incidence rates suggest that underlying risk factors or outside triggers have a role in TNFI psoriasis initiation. OBJECTIVES We aimed to identify underlying risk factors and outside triggers associated with TNFI psoriasis onset. METHODS This case-control study included 97 patients at a tertiary care center between 2003 and 2013 who developed TNFI psoriasis. Ninety-seven control patients were matched to age, sex, disease, TNF-α inhibitor, and length of time on treatment before TNFI psoriasis onset. Patient medical records were reviewed ≥6 months immediately preceding TNFI psoriasis onset (similar equivalent time point for matched controls) for information about potential risk factors and outside factors categorized as: (1) serologic abnormalities, (2) acute events, and (3) social factors. RESULTS Compared with those of matched controls, odds ratios (ORs) were significantly higher in the TNFI psoriasis group for psoriasis family history (OR, 16.0) and acute psychological stressors (OR, 3.14) and marginally associated with tobacco use (OR, 1.76). CONCLUSIONS Our results suggest that psoriasis family history, psychological stressors, and tobacco use might be risk factors for developing TNFI psoriasis. Performing detailed patient histories when considering TNFI therapy may be useful in identifying patients at risk for TNFI-psoriasis.
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Patch-type granuloma annulare: An institution-based study of 23 cases. J Cutan Pathol 2020; 47:785-793. [PMID: 32279342 DOI: 10.1111/cup.13707] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/23/2020] [Accepted: 04/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Granuloma annulare (GA) is a skin disorder of uncertain etiology. Patch (type) GA is an uncommon variant of GA with a paucity of data characterizing it. We describe the features of 23 cases of patch GA. METHODS The archives of dermatopathology were searched for cases of patch GA. The clinical history and morphology for each patient were reviewed. Only cases with patch clinical morphology were included. The clinical and histopathologic features were assessed including the pattern of granulomatous inflammation and presence of other inflammatory cell types. RESULTS Most patients were female (19/23) with erythematous patches on the trunk and proximal extremities. The most common clinical differential diagnosis included mycosis fungoides (MF), morphea and contact dermatitis. Dyslipidemia was the most common comorbidity (30%), followed by diabetes (15%) and hypertension (15%). Histopathologic features included interstitial lymphocytes and histiocytes with dermal mucin. Two cases showed focal palisaded granulomas. Eosinophils and plasma cells were present in 1/3 of cases. CONCLUSION Patch GA is an uncommon GA variant with an interstitial granulomatous histopathologic pattern that predominantly affects women over 50. It can mimic interstitial MF and early morphea both clinically and histopathologically. Awareness of this GA variant can help prevent misdiagnosis and inappropriate treatment for these patients.
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Safety of trimethoprim-sulfamethoxazole for Pneumocystis jirovecii pneumonia prophylaxis in patients taking methotrexate. J Am Acad Dermatol 2020; 84:166-168. [PMID: 32320772 DOI: 10.1016/j.jaad.2020.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
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Reply to: "Evidence-based guidelines for tuberculosis screening before biologic treatment initiation". J Am Acad Dermatol 2020; 83:e27-e28. [PMID: 32222450 DOI: 10.1016/j.jaad.2020.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 03/17/2020] [Indexed: 11/19/2022]
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Conversion to positive latent tuberculosis infection status is low in patients with hidradenitis suppurativa taking biologic medications. J Am Acad Dermatol 2020; 83:246-248. [PMID: 31940465 DOI: 10.1016/j.jaad.2020.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/27/2019] [Accepted: 01/08/2020] [Indexed: 11/15/2022]
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Diagnoses of hospitalized patients with skin abnormalities prompting biopsy by consulting dermatologists: A 3-year review from a tertiary care center. J Cutan Pathol 2019; 47:346-356. [PMID: 31845375 PMCID: PMC9291190 DOI: 10.1111/cup.13628] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 12/25/2022]
Abstract
Background Dermatologists play an important role in diagnosing and managing hospitalized patients with cutaneous abnormalities. Skin biopsies remain an indispensable tool for aiding dermatologists in accurate diagnosis and treatment. We aimed to determine the range of conditions, and the most common conditions, prompting skin biopsy by dermatology hospital consultation (HCON) services to aid in evaluation of hospitalized patients. Methods All hospitalized patients seen by a single tertiary care center dermatology HCON service between 2015 and 2018 who had associated skin biopsies were identified. Histologic features and clinical diagnoses of each patient were classified into 13 histologic reaction pattern categories. Results Eight hundred and thirty one inpatients evaluated by our dermatology HCON service had 914 skin biopsies. The most frequent diagnostic categories prompting biopsy were vasculopathic (17.6%), interface dermatitis (16.5%), infectious (12.6%), and spongiotic dermatitis (10.9%). The most frequent diagnostic categories included drug reaction (13.2%), leukocytoclastic vasculitis (8.5%), skin cancer (5.4%), graft‐vs‐host disease (3.5%), connective tissue disease (3.3%), and calciphylaxis (3.0%). Conclusion Our study suggests a variety of serious diseases affecting inpatients prompts biopsy by dermatology consultation services. Educational curricula for dermatology and pathology residents, fellows, and staff designed with these data may enhance knowledge that improves the quality of inpatient dermatology care.
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Utility of repeat latent tuberculosis testing with the Quanti
FERON
‐
TB
Gold test in patients with psoriasis treated with tumour necrosis factor‐α inhibitors at a single U.S. institution. Br J Dermatol 2019; 182:800-802. [DOI: 10.1111/bjd.18461] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Disseminated discoid lupus erythematosus mimicking Degos disease. Australas J Dermatol 2019; 61:e114-e116. [PMID: 31429927 DOI: 10.1111/ajd.13139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Erosive pustular dermatosis of the scalp associated with Sirolimus. J Eur Acad Dermatol Venereol 2019; 34:e15-e16. [PMID: 31403723 DOI: 10.1111/jdv.15860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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SAT-270 Results from the Chronic Kidney Disease Observational Database (CKDOD), India. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Abstract
Vitiligo is an acquired disorder of skin pigmentation that produces significant psychological impact especially in those with skin of color. Narrow-band ultraviolet B (NB-UVB) therapy, which was first used in vitiligo in 1997 by Westerhof and Nieuweboer-Krobotova, has emerged as one of the safest and most effective therapy for this dermatosis. The light source used for NB-UVB phototherapy is the TL-01 lamp, and the most common model of the NB-UVB phototherapy device is the upright in-office booth or chamber which has 24-48 such lamps. In recent years, there have been several advances in the understanding of the mechanism of action of NB-UVB and the use of combination treatments, many of which increase the efficacy of NB-UVB. In 2017, the Vitiligo Working Group made vital recommendations on the dosage, frequency, and safety of NB-UVB in vitiligo. Furthermore, home phototherapy devices are gaining popularity as they lead to an improved patient compliance. There is still need for large multicenter randomized controlled trials to assess benefits of home phototherapy in vitiligo and studies investigating additional benefits of phototherapy following surgical therapy.
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Update on calciphylaxis etiopathogenesis, diagnosis, and management. Cutis 2018; 102:395-400. [PMID: 30657805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Calciphylaxis is a rare painful skin condition classically seen in patients with end-stage renal disease (ESRD), particularly those on chronic dialysis; however, it also has been increasingly reported in patients with normal renal function. Calciphylaxis is associated with high mortality rates, and excruciating pain and nonhealing ulcers often lead to recurrent hospitalizations and infectious complications. It is critical for dermatologists to recognize the clinical features of calciphylaxis to ensure accurate and timely diagnosis and proper management. In this article, we provide an update on calciphylaxis etiopathogenesis, diagnosis, and management, and we highlight the challenges faced in managing this potentially fatal condition.
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Majocchi Granuloma of the Breast: A Rare Clinical Entity. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Primary cutaneous angioplasmocellular hyperplasia. Dermatol Online J 2016; 22:13030/qt79j5831h. [PMID: 27617459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/18/2016] [Indexed: 06/06/2023] Open
Abstract
Angioplasmocellular hyperplasia is a rare clinical condition with blood vessel proliferation and a reactive plasma cell infiltrate. To the best of our knowledge fewer than 20 cases of cutaneous angioplasmocellular hyperplasia have been published in English literature. We report a case of a 65-year-old man who presented with a long standing asymptomatic flesh colored ulcerated nodule on the back. Histopathological examination revealed a dermal vascular proliferation with polyclonal plasma cell infiltration. A diagnosis of angioplasmocellular hyperplasia was established. This entity is rare and we would like to emphasize the importance of clinico-pathological correlation to differentiate it from various other conditions of cutaneous plasma cell infiltration.
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Majocchi Granuloma of the Breast: A Rare Clinical Entity. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:610-2. [PMID: 27032569 DOI: 10.1016/j.ad.2016.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 02/05/2016] [Accepted: 02/13/2016] [Indexed: 10/22/2022] Open
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Primary cutaneous angioplasmocellular hyperplasia. Dermatol Online J 2016. [DOI: 10.5070/d3224030654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Idiopathic Acquired Leukonychia Totalis of the Fingernails in a Child Treated Successfully with Zinc and Amino Acid Supplementation. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2014.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Scaly erythematous perineal dermatitis in twins. Clin Pediatr (Phila) 2015; 54:192-3. [PMID: 25034353 DOI: 10.1177/0009922814543326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Loose anagen hair syndrome in a child. INDIAN JOURNAL OF PAEDIATRIC DERMATOLOGY 2015. [DOI: 10.4103/2319-7250.149428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Acquired lymphangioma circumscriptum of the vulva in a twin pregnancy. J Eur Acad Dermatol Venereol 2014; 30:147-9. [DOI: 10.1111/jdv.12640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Keloidal plaque in a patient with pulmonary tuberculosis: A rare morphological variant of tuberculosis verrucosa cutis. Int J Mycobacteriol 2014; 3:214-6. [PMID: 26786491 DOI: 10.1016/j.ijmyco.2014.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022] Open
Abstract
Tuberculosis verrucosa cutis (TVC), also known as warty tuberculosis, anatomist's wart or prosector's wart is characterized by the presence of verrucous plaque-like lesions, resulting from direct inoculation of the causative organism into the skin of a previously infected patient. A 59-year-old man presented with a hyperpigmented plaque on the chest wall which closely mimicked a keloid. He was a case of sputum-positive pulmonary tuberculosis and had repeatedly been applying early morning saliva on the lesion as a part of the indigenous practices for quick healing. There was further progression of the lesion with discharge from several sites. A smear for acid fast bacilli was positive from the discharge and growth on Lowenstein Jensen medium revealed growth of Mycobacterium tuberculosis. Biopsy was compatible with TVC and the patient was started on 6months anti-tubercular therapy. However, the plaque continued to persist with continuing discharge from multiple openings which necessitated surgical intervention, finally leading to near complete resolution of the plaque of TVC.
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