1
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Harrison I, Patel B, Kunzler E, Walker A, Missall T, Motaparthi K. Dermatopathologist accuracy in classifying angioinvasive fungal infections using virtual microscopy. J Cutan Pathol 2024; 51:387-392. [PMID: 38366893 DOI: 10.1111/cup.14596] [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: 07/26/2023] [Revised: 12/28/2023] [Accepted: 01/28/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Due to perceived difficulty in the categorization of angioinvasive fungal infections based on histopathology, variation exists in dermatopathology reporting. METHODS This study characterized the diagnosis of angioinvasive fungal infections by light microscopy at a single academic institution over an 11-year period. Subsequently, the accuracy of blinded reclassification by virtual microscopy was measured. RESULTS Seventy-six specimens with hematoxylin-eosin slides were obtained from 33 patients. The mean diagnostic accuracy of dermatopathologists in differentiating mucormycosis, hyalohyphomycosis, and phaeohyphomycosis based on blinded reclassification via virtual microscopy was 74%, with a range of 65%-91%. CONCLUSIONS While there was a range in diagnostic accuracy, the highest score of 91% and the identification of common sources of error suggest that histopathologic categorization of angioinvasive fungal infections can frequently be performed. However, accurate identification is not always possible given common pitfalls in diagnosis. In addition, standardized and clinically useful reporting should be considered.
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Affiliation(s)
- Iris Harrison
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Basil Patel
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Elaine Kunzler
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Addie Walker
- Department of Pathology and Laboratory Medicine, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Tricia Missall
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
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2
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Diaz MJ, Haq Z, Tran JT, Abdi P, Motaparthi K, Grant-Kels JM, Montanez-Wiscovich ME. Psoriasis and non-Hodgkin's lymphoma in a diverse sample of U.S. adults: a propensity matched case-control study. J Am Acad Dermatol 2024:S0190-9622(24)00440-7. [PMID: 38452818 DOI: 10.1016/j.jaad.2024.02.040] [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: 10/19/2023] [Revised: 01/26/2024] [Accepted: 02/24/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Michael J Diaz
- College of Medicine, University of Florida, Gainesville, Florida.
| | - Zaim Haq
- School of Medicine, Brown University, Providence, Rhode Island
| | - Jasmine T Tran
- School of Medicine, Indiana University, Indianapolis, Indiana
| | - Parsa Abdi
- Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida, Gainesville, Florida
| | - Jane M Grant-Kels
- Department of Dermatology, University of Florida, Gainesville, Florida; Department of Dermatology, University of Connecticut, Farmington, Connecticut
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3
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Diaz MJ, Liu V, Forouzandeh M, Motaparthi K. Type III cryoglobulinemia associated with monoclonal gammopathy of uncertain significance and presenting with retiform purpura. JAAD Case Rep 2024; 44:34-37. [PMID: 38292579 PMCID: PMC10824683 DOI: 10.1016/j.jdcr.2023.11.002] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Affiliation(s)
- Michael J. Diaz
- University of Florida College of Medicine, Gainesville, Florida
| | - Vivian Liu
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
| | - Mahtab Forouzandeh
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
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4
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Kovacevic J, Samia AM, Shah A, Motaparthi K. Herpes zoster ophthalmicus. Clin Dermatol 2024:S0738-081X(24)00007-5. [PMID: 38281688 DOI: 10.1016/j.clindermatol.2024.01.007] [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: 01/30/2024]
Abstract
Herpes zoster ophthalmicus (HZO) occurs when latent varicella zoster virus reactivates in the ophthalmic division of the fifth cranial nerve (CNV1). HZO commonly affects older and immunocompromised patients. This disease is considered an ophthalmic emergency due to the wide range of associated ocular symptoms, including severe chronic pain and vision loss. HZO is typically a clinical diagnosis due to its classic presentation of a unilateral vesicular eruption in the dermatomes corresponding to CNV1. Timely treatment is imperative to minimize ocular morbidity in HZO, given that ocular involvement is present in 50% of affected patients.
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Affiliation(s)
- Jasmina Kovacevic
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Arthur Mark Samia
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Ankit Shah
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA.
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5
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Farahbakhsh N, Bhatia A, Graves M, Mishra V, Motaparthi K. Effectiveness of a leadership conference for chief residents in dermatology. Clin Dermatol 2024; 42:96-99. [PMID: 38042438 DOI: 10.1016/j.clindermatol.2023.11.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
The position of chief resident involves increased leadership, mentorship, and management responsibilities. There is no standardized procedure in which dermatology chief residents are trained and prepared for their final year of residency. In 2008, an annual Dermatology Chief Academy conference was initiated in which incoming chief residents were given formal leadership training for their new role. At the 2020 conference, residents completed a survey regarding their expectations and experience of this conference. After the conference, residents felt significantly better prepared for their new role as chief residents, handling conflicts, and effective leadership. A formal leadership conference for incoming chief residents is vital for improving the success of a residency program.
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Affiliation(s)
- Navid Farahbakhsh
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Ashish Bhatia
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Graves
- Division of Dermatology, University of Texas Dell Medical School, Austin, Texas, USA
| | | | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA.
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6
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Wasuwanich P, Kumari J, So JM, Egerman RS, Wen TS, Motaparthi K. Pregnancies complicated by Stevens-Johnson syndrome and toxic epidermal necrolysis: a nationwide study. Arch Dermatol Res 2023; 316:34. [PMID: 38079002 DOI: 10.1007/s00403-023-02784-2] [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: 08/18/2023] [Revised: 10/28/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Paul Wasuwanich
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Jaya Kumari
- Jinnah Sindh Medical University, Karachi, Pakistan
| | - Joshua M So
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Robert S Egerman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Tony S Wen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, 4037 NW 86 Terrace, 4Th Floor, Room 4123 Springhill, Gainesville, FL, 32606, USA.
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7
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Wasuwanich P, So JM, Chakrala TS, Chen J, Motaparthi K. Epidemiology of Stevens-Johnson syndrome and toxic epidermal necrolysis in the United States and factors predictive of outcome. JAAD Int 2023; 13:17-25. [PMID: 37575514 PMCID: PMC10413346 DOI: 10.1016/j.jdin.2023.06.014] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/15/2023] Open
Abstract
Background Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS-TEN overlap syndrome are rare severe cutaneous adverse reactions associated with high mortality. Objectives To estimate incidence and describe trends of SJS/TEN hospitalizations in the United States and to describe the clinical, demographic, and geographic characteristics of affected patients and risk factors for mortality. Methods We utilized hospitalization data from the 2010 to 2020 National Inpatient Sample. SJS, SJS-TEN overlap syndrome, and TEN were identified by International Classification of Diseases, 9th Revision and International Classification of Diseases, 10th Revision codes and analyzed by logistic regression. Results We identified 51,040 hospitalizations involving SJS/TEN. Amog those, 37,283 (73.0%) were for SJS only, 7818 (15.3%) were for SJS-TEN overlap syndrome, and 7160 (14.0%) were for TEN only. Overall, SJS/TEN hospitalization rates declined over time, 2010 to 2020 (P < .05). Mortality rates of the SJS group, SJS-TEN overlap syndrome group, and TEN group were 5.4%, 14.4%, and 15.3%, respectively. Increasing age, chronic kidney disease, pneumonia, sepsis, and malignant neoplasm were all significantly associated with increased odds of mortality (P < .05). Non-Hispanic White racial/ethnic identification was associated with decreased odds of mortality (P < .05). Limitations Lack of standardization for diagnostic criteria. Conclusions Risk factors identified in this study lay the groundwork for improvement in SJS/TEN mortality prediction scoring.
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Affiliation(s)
- Paul Wasuwanich
- University of Florida College of Medicine, Gainesville, Florida
| | - Joshua M. So
- University of Florida College of Medicine, Gainesville, Florida
| | - Teja S. Chakrala
- Department of Internal Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Jinghua Chen
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, Florida
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
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8
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Smith KN, Welborn M, Monir RL, Motaparthi K, Schoch JJ. Pediatric pyoderma gangrenosum associated with leukocyte adhesion deficiency type 1: A case report and review of the literature. Pediatr Dermatol 2023; 40:1086-1090. [PMID: 37002583 DOI: 10.1111/pde.15292] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/26/2023] [Indexed: 06/19/2023]
Abstract
Pyoderma gangrenosum is a rare neutrophilic dermatosis characterized by painful skin ulcers with necrotic, undermined margins. In severe cases, particularly in pediatric patients, work-up for an associated autoimmune, inflammatory, malignant, or genetic disorder should be considered based on the clinical presentation. We report a unique case of pediatric pyoderma gangrenosum with a leukemoid reaction, secondary to an autosomal recessive leukocyte adhesion deficiency type 1.
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Affiliation(s)
- Kristin N Smith
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Macartney Welborn
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Reesa L Monir
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jennifer J Schoch
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
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9
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Margulies S, Rechdan M, Gao H, Motaparthi K. Analysis of Internal Dermatology Matches Following the COVID-19 Pandemic. Cutis 2023; 112:229-231. [PMID: 38091443 DOI: 10.12788/cutis.0891] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Dermatology has long been recognized as a highly competitive field within medicine, with extremely limited spots available for aspiring dermatologists to secure residencies across the United States. We sought to evaluate the trends and factors influencing the match process in dermatology residencies, particularly given the changes brought on by the COVID-19 pandemic. Using data from publicly available match lists and regional categorizations, we studied the rates of internal and regional matches for dermatology applicants in the postpandemic era (2022-2023) compared with prepandemic statistics. Overall, the research sheds light on the evolving dynamics of dermatology residency matching in response to pandemic-induced changes and applicant preferences.
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Affiliation(s)
- Shae Margulies
- University of Florida, Gainesville. Dr. Margulies is from the Department of Medicine, College of Medicine; Michaela Rechdan is from the College of Medicine; Dr. Gao is from the Department of Biostatistics; and Dr. Motaparthi is from the Department of Dermatology
| | - Michaela Rechdan
- University of Florida, Gainesville. Dr. Margulies is from the Department of Medicine, College of Medicine; Michaela Rechdan is from the College of Medicine; Dr. Gao is from the Department of Biostatistics; and Dr. Motaparthi is from the Department of Dermatology
| | - Hanzhi Gao
- University of Florida, Gainesville. Dr. Margulies is from the Department of Medicine, College of Medicine; Michaela Rechdan is from the College of Medicine; Dr. Gao is from the Department of Biostatistics; and Dr. Motaparthi is from the Department of Dermatology
| | - Kiran Motaparthi
- University of Florida, Gainesville. Dr. Margulies is from the Department of Medicine, College of Medicine; Michaela Rechdan is from the College of Medicine; Dr. Gao is from the Department of Biostatistics; and Dr. Motaparthi is from the Department of Dermatology
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10
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Krishingner GA, Forouzandeh M, Rodríguez JA, Ashouri K, Motaparthi K, Whiles BB. Successful Management of Angioinvasive Deep Fungal Infections of the Penis: A Multidisciplinary Approach with Intraoperative Frozen Margins. Am J Case Rep 2023; 24:e939971. [PMID: 37782653 PMCID: PMC10556538 DOI: 10.12659/ajcr.939971] [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: 02/21/2023] [Revised: 08/16/2023] [Accepted: 06/15/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Mucormycosis, a cause of opportunistic infections in immunocompromised patients, is rarely identified in the penis. The literature often describes drastic surgical interventions or rapid patient demise, with scant mention of surgical management specifics. The objective of this report is to detail our experience with this unique infection and highlight the utility of intraoperative frozen margins during surgical management. CASE REPORT Herein, we describe successful treatment of a 55-year-old man with biopsy-proven B-cell acute lymphoblastic leukemia (B-ALL) undergoing Hyper-CVAD (Cyclophosphamide, Vincristine, Adriamycin, and Dexamethasone) therapy who initially presented with an asymptomatic violaceous lesion of the penis. Differential diagnoses ranged from infectious, vasculogenic, and pharmacologic in nature. Ultimately, a punch biopsy tissue culture confirmed angioinvasive fungal infection with Rhizopus and Fusarium species. Initial debridement combined with intravenous antifungal therapy was unsuccessful. However, partial penectomy with use of intraoperative frozen margins, a 5-week course of antifungal therapy, and continued B-ALL treatment allowed effective and lasting resolution of the infection, with partial penile preservation. CONCLUSIONS This case supports a multidisciplinary approach as the primary treatment for penile angioinvasive fungal infections. This includes treatment of the underlying immunocompromising condition, appropriate intravenous antifungal therapy, and urgent operative debridement. This report highlights the importance of utilizing intraoperative frozen sections to ensure negative margins and to optimize overall tissue sparing in this anatomically sensitive area.
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Affiliation(s)
| | | | - José A. Rodríguez
- Department of Infectious Disease, University of Florida, Gainesville, FL, USA
| | - Kenan Ashouri
- Department of Urology, University of Florida, Gainesville, FL, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida, Gainesville, FL, USA
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11
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Livingston T, Samia A, Motaparthi K, Montanez-Wiscovich ME. A case of follicular psoriasis mimicking pityriasis rubra pilaris: a diagnostic dilemma. Int J Dermatol 2023; 62:e526-e528. [PMID: 37212586 DOI: 10.1111/ijd.16719] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/07/2023] [Accepted: 05/04/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Torie Livingston
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Arthur Samia
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL, USA
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12
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Hammond AM, Chung M, Motaparthi K, Saikaly SK. Athena: Specialty Certificate Examination case for infectious disease. Clin Exp Dermatol 2023; 48:1196-1197. [PMID: 37379582 DOI: 10.1093/ced/llad217] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/23/2023] [Accepted: 06/19/2023] [Indexed: 06/30/2023]
Abstract
A 63-year-old man presented with an extensive pruritic and painful rash on his arm that had gradually progressed over 8 years after pricking his wrist on a bush, despite treatment with antifungals and antibiotics. Physical examination showed numerous erythematous, coalescing verrucous plaques in a sporotrichoid distribution on the arm with crust and scale. We discuss further tests, diagnosis and treatment.
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Affiliation(s)
| | - Michael Chung
- Department of Dermatology, University of Florida, Gainesville, FL, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida, Gainesville, FL, USA
| | - Sami K Saikaly
- Department of Dermatology, University of Florida, Gainesville, FL, USA
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13
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Tvedten E, Nambudiri V, Mathes E, Daveluy SD, Murina A, Motaparthi K. Results From the First Annual Association of Professors of Dermatology Program Directors Survey. Cutis 2023; 112:116-119. [PMID: 37903396 DOI: 10.12788/cutis.0854] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
The first annual Association of Professors of Dermatology (APD) program director (PD) survey was distributed in November 2022 and included 53 respondents from individual Accreditation Council for Graduate Medical Education (ACGME) programs. This survey included 137 in-depth questions to identify similarities and differences among programs regarding 12 broad categories: program characteristics; PD demographics; impact of the COVID-19 pandemic on residency training; available resources; quality improvement; clinical instruction; didactic instruction; research content; diversity, equity, and inclusion; wellness; evaluation systems; and graduation outcomes of postgraduate year (PGY) 4 residents. The survey provided preliminary insight to similarities and differences between programs, such as varying academic time and research resources, while also challenging norms seen in areas of diversity, equity, and inclusion. As future surveys are optimized to obtain greater response rates, these metrics can be captured in a centralized database accessible to PDs to reflect trends and identify strengths and weaknesses of dermatology residency programs.
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Affiliation(s)
- Erika Tvedten
- Dr. Tvedten is from the Department of Dermatology, Cooper University Hospital, Camden, New Jersey. Dr. Nambudiri is from the Department of Dermatology and Internal Medicine, Harvard Medical School, Boston, Massachusetts. Dr. Mathes is from the Department of Dermatology, University of California, San Francisco. Dr. Daveluy is from the Department of Dermatology, Wayne State University School of Medicine, Detroit, Michigan.Dr. Murina is from the Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana. Dr. Motaparthi is from the Department of Dermatology, University of Florida College of Medicine, Gainesville
| | - Vinod Nambudiri
- Dr. Tvedten is from the Department of Dermatology, Cooper University Hospital, Camden, New Jersey. Dr. Nambudiri is from the Department of Dermatology and Internal Medicine, Harvard Medical School, Boston, Massachusetts. Dr. Mathes is from the Department of Dermatology, University of California, San Francisco. Dr. Daveluy is from the Department of Dermatology, Wayne State University School of Medicine, Detroit, Michigan.Dr. Murina is from the Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana. Dr. Motaparthi is from the Department of Dermatology, University of Florida College of Medicine, Gainesville
| | - Erin Mathes
- Dr. Tvedten is from the Department of Dermatology, Cooper University Hospital, Camden, New Jersey. Dr. Nambudiri is from the Department of Dermatology and Internal Medicine, Harvard Medical School, Boston, Massachusetts. Dr. Mathes is from the Department of Dermatology, University of California, San Francisco. Dr. Daveluy is from the Department of Dermatology, Wayne State University School of Medicine, Detroit, Michigan.Dr. Murina is from the Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana. Dr. Motaparthi is from the Department of Dermatology, University of Florida College of Medicine, Gainesville
| | - Steven D Daveluy
- Dr. Tvedten is from the Department of Dermatology, Cooper University Hospital, Camden, New Jersey. Dr. Nambudiri is from the Department of Dermatology and Internal Medicine, Harvard Medical School, Boston, Massachusetts. Dr. Mathes is from the Department of Dermatology, University of California, San Francisco. Dr. Daveluy is from the Department of Dermatology, Wayne State University School of Medicine, Detroit, Michigan.Dr. Murina is from the Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana. Dr. Motaparthi is from the Department of Dermatology, University of Florida College of Medicine, Gainesville
| | - Andrea Murina
- Dr. Tvedten is from the Department of Dermatology, Cooper University Hospital, Camden, New Jersey. Dr. Nambudiri is from the Department of Dermatology and Internal Medicine, Harvard Medical School, Boston, Massachusetts. Dr. Mathes is from the Department of Dermatology, University of California, San Francisco. Dr. Daveluy is from the Department of Dermatology, Wayne State University School of Medicine, Detroit, Michigan.Dr. Murina is from the Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana. Dr. Motaparthi is from the Department of Dermatology, University of Florida College of Medicine, Gainesville
| | - Kiran Motaparthi
- Dr. Tvedten is from the Department of Dermatology, Cooper University Hospital, Camden, New Jersey. Dr. Nambudiri is from the Department of Dermatology and Internal Medicine, Harvard Medical School, Boston, Massachusetts. Dr. Mathes is from the Department of Dermatology, University of California, San Francisco. Dr. Daveluy is from the Department of Dermatology, Wayne State University School of Medicine, Detroit, Michigan.Dr. Murina is from the Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana. Dr. Motaparthi is from the Department of Dermatology, University of Florida College of Medicine, Gainesville
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14
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Harrison I, Forouzandeh M, Motaparthi K. Chronic Ulcer on the Tongue as a Manifestation of Histoplasmosis During Anti-tumor Necrosis Factor-Alpha (TNF-⍺) Inhibitor Therapy for Psoriasis. Cureus 2023; 15:e45217. [PMID: 37720115 PMCID: PMC10500618 DOI: 10.7759/cureus.45217] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 09/19/2023] Open
Abstract
Anti-tumor necrosis factor-alpha (TNF-⍺) inhibitors are commonly used in the treatment of inflammatory conditions such as psoriasis. However, these agents lead to increased susceptibility to infections. We report a patient with reactivation of latent histoplasmosis six months after starting an anti-TNF-⍺ inhibitor for the treatment of psoriasis. Dermatologists should be aware of the risks associated with initiating therapy and maintain a low threshold of suspicion for this infection in patients on anti-TNF-⍺ inhibitors presenting with oral ulcers.
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Affiliation(s)
- Iris Harrison
- Department of Dermatology, University of Florida College of Medicine, Gainesville, USA
| | - Mahtab Forouzandeh
- Department of Dermatology, University of Florida College of Medicine, Gainesville, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, USA
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15
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Li H, Farahbakhsh N, Forouzandeh M, Baskaran N, Motaparthi K. Mpox and herpes simplex virus type 2 coinfection in a patient with HIV. Clin Dermatol 2023; 41:655-656. [PMID: 37806409 DOI: 10.1016/j.clindermatol.2023.10.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Affiliation(s)
- Han Li
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Navid Farahbakhsh
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Mahtab Forouzandeh
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Naveen Baskaran
- Division of Hospital Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA.
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Li H, Maddy A, Patel BM, DeClerck BK, Kasim J, Wanat KA, Motaparthi K. Hypertrophic verrucous mpox as a sign of disease progression. JAAD Case Rep 2023; 38:38-40. [PMID: 37600736 PMCID: PMC10433278 DOI: 10.1016/j.jdcr.2023.04.031] [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: 08/22/2023] Open
Affiliation(s)
- Han Li
- University of Florida College of Medicine, Gainesville, Florida
| | - Austin Maddy
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
| | - Basil M. Patel
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
| | - Brittney K. DeClerck
- Department of Dermatology, Keck School of Medicine of University of South California, Los Angeles, California
| | - Jesse Kasim
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Karolyn A. Wanat
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
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17
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Olsen E, Svoboda SA, Saikaly SK, Missall TA, Motaparthi K. Delayed Onset of Bullous Pemphigoid Secondary to Nivolumab. Cureus 2023; 15:e43230. [PMID: 37692698 PMCID: PMC10491457 DOI: 10.7759/cureus.43230] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
The increasing use of immune checkpoint inhibitors, such as nivolumab, a programmed cell death protein 1 (PD-1) inhibitor, for advanced neoplastic disease has revealed significant cutaneous immune-related adverse effects. Herein, we report a case of bullous pemphigoid (BP) secondary to nivolumab therapy for recurrent metastatic oropharyngeal squamous cell carcinoma. In this patient, the time to development of BP was three years, which represents the most delayed onset of BP secondary to a PD-1 inhibitor that has been reported in the literature. Symptoms were initially controlled on low-dose oral prednisone but recurred after two years. The patient was subsequently treated with a several-month taper of high-dose oral prednisone, during which he was able to resume nivolumab without recurrence of skin lesions. Although immune checkpoint inhibitor-induced BP remains rare, physicians should be aware of this serious cutaneous immune-related adverse event as the use of this drug class continues to expand.
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Affiliation(s)
- Eric Olsen
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, USA
| | - Steven A Svoboda
- Department of Dermatology, University of Florida, Gainesville, USA
| | - Sami K Saikaly
- Department of Dermatology, University of Florida, Gainesville, USA
| | - Tricia A Missall
- Department of Dermatology, University of Florida, Gainesville, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida, Gainesville, USA
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18
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Li H, Baskaran N, Kariyawasam V, Motaparthi K. Perianal ulcer and proctocolitis in an immunocompromised patient. JAAD Case Rep 2023; 37:71-73. [PMID: 37492431 PMCID: PMC10363660 DOI: 10.1016/j.jdcr.2023.05.008] [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: 07/27/2023] Open
Affiliation(s)
- Han Li
- University of Florida College of Medicine, Gainesville, Florida
| | - Naveen Baskaran
- Division of Hospital Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Vidhu Kariyawasam
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
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19
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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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20
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Malik AM, Welborn M, Gao H, Motaparthi K. Self-directed virtual educational strategies for dermatopathology: A prospective comparison of Instagram-based static images to whole slide images. J Cutan Pathol 2023. [PMID: 37272167 DOI: 10.1111/cup.14472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/05/2023] [Accepted: 05/16/2023] [Indexed: 06/06/2023]
Affiliation(s)
- Ali M Malik
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Macartney Welborn
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Hanzhi Gao
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
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21
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Lee D, Waseh S, Motaparthi K, Hsu S. Rowell Syndrome in a Middle-Aged Woman: A Case Report. Cureus 2023; 15:e39631. [PMID: 37388608 PMCID: PMC10305509 DOI: 10.7759/cureus.39631] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/01/2023] Open
Abstract
Rowell syndrome (RS) is characterized by the presentation of lupus erythematosus (LE) with erythema multiforme (EM)-like lesions. It is thought to display a characteristic serologic pattern consisting of a "speckled-type" antinuclear antibody (ANA), positive anti-Ro/SSA or anti-La/SSB, or positive rheumatoid factor (RF). We report the case of a patient with subacute cutaneous lupus erythematosus (SCLE) who presented with EM-like lesions responsive to oral corticosteroids.
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Affiliation(s)
- Diane Lee
- Dermatology, Temple University Hospital, Philadelphia, USA
| | - Shayan Waseh
- Dermatology, Temple University Hospital, Philadelphia, USA
| | | | - Sylvia Hsu
- Dermatology, Temple University Hospital, Philadelphia, USA
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22
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Fletcher D, Patel S, Motaparthi K. Successful Treatment of Linear IgA Disease and Ulcerative Colitis With Sulfasalazine. Cureus 2023; 15:e37210. [PMID: 37168182 PMCID: PMC10166405 DOI: 10.7759/cureus.37210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 04/08/2023] Open
Abstract
Linear IgA disease (LAD) is an uncommon autoimmune blistering disease that has been associated with medications, malignancy, and other autoimmune diseases, such as ulcerative colitis (UC). In this case report, a patient with a history of UC developed characteristic LAD lesions. While dapsone is considered first-line therapy for LAD, the treatment team opted for an underutilized, plausibly less toxic, and more simplified treatment regimen with sulfasalazine, successfully utilizing the two distinct actions of sulfasalazine's components - sulfapyridine and 5-aminosalicylate (5-ASA) - to concurrently treat both the LAD and UC symptoms. The authors discuss the pathophysiology of LAD and UC and expound on the mechanistic theory of their association. Additionally, the pharmacodynamics of sulfasalazine and considerations of its side effect profile are examined.
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23
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Zhai L, Motaparthi K. Building successful culture, mission, and vision in dermatology. Clin Dermatol 2023; 41:234-239. [PMID: 37423263 DOI: 10.1016/j.clindermatol.2023.06.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Building a successful culture in academic dermatology is necessary now more than ever, but this problem is compounded by the shortage of dermatologists, especially academicians. This dearth of academic dermatologists raises questions about who will train future generations of physicians and who will drive innovative research to advance the field and improve patient care. Recruitment and retention of dermatologists in academia faces steep challenges posed by increasing demands within academic medicine and the draw of the private sector. It is important to address barriers to a career in academia. Efforts should be focused on modifiable aspects of dermatology residency experiences to promote a career in academic dermatology. Of equal importance is the retention of faculty already in academia because midcareer shifts from academic settings to private practice can result in a significant leadership gap.
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Affiliation(s)
- Lisa Zhai
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA.
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24
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Vincek V, Vause A, Harrison A, Krutchik M, Miller R, Motaparthi K. A case report of granulomatous lymphomatoid papulosis. Dermatol Online J 2023; 29. [PMID: 37040910 DOI: 10.5070/d329160213] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 02/27/2023] Open
Abstract
Lymphomatoid papulosis is a chronic CD30-positive cutaneous lymphoproliferative disorder that is characterized by recurring red-brown necrotic papules. It exhibits a wide spectrum of histopathologic findings and is often associated with cutaneous T-cell lymphomas. Six different histological subtypes have been classified by the WHO, but there is limited understanding regarding rare histopathologic variants. We describe a 51-year-old man who presented with recurring, necrotic papules for 6 years that progressed to involve the face, scalp, trunk, axilla, and scrotum. Histopathology demonstrated sarcoidal granulomas, along with a CD30-positive T cell infiltrate which demonstrated clonality by T cell receptor gamma gene rearrangement. A diagnosis of lymphomatoid papulosis associated with granulomas was established based on the clinical and histopathologic presentation. The clinical understanding of granulomatous lymphomatoid papulosis is limited in the available literature and more awareness of this histopathologic variant is required for accurate classification of this disorder.
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Affiliation(s)
- Vladimir Vincek
- Department of Dermatology, College of Medicine, University of Florida, Gainesville, Florida, USA.
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25
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Hammond A, Covey S, Guo W, Gregory S, Bender NR, Motaparthi K, Walker A. Impact of alternative histopathology protocols in the dermatopathology laboratory: A prospective quality improvement study. J Cutan Pathol 2023; 50:466-470. [PMID: 36749118 DOI: 10.1111/cup.14400] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/06/2023] [Accepted: 01/29/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Histopathology protocols for processing dermatopathology specimens vary among laboratories. OBJECTIVE To determine an optimal histopathology protocol to minimize cost and turnaround time (TAT) for biopsy specimens in a dermatopathology laboratory. METHODS A prospective, 4-month study compared the mean cost and TAT of producing one versus two initial H&E slides, and zero versus three unstained slides that could be used for frequently used special or immunohistochemical (IHC) stains. RESULTS For all cases, cost was lower for one versus two initial H&E slides, with an insignificant increase in TAT. Producing three vs zero unstained slides incurred higher cost, with no reduction in TAT. In a subset of cases in which frequently used special or IHC stains were performed, cost and TAT were optimized by producing one initial H&E and three unstained slides. CONCLUSION A protocol of one initial H&E slide and zero unstained slides optimizes cost and TAT in our dermatopathology laboratory. Pigmented lesions and inflammatory dermatoses may benefit from the addition of unstained slides. Further study is needed to quantify this benefit and evaluate for other cases for which an alternative protocol is advantageous.
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Affiliation(s)
- Alexander Hammond
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Sarah Covey
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Wanru Guo
- Department of Biostatistics, University of Florida College of Public Health, Gainesville, Florida, USA
| | - Scott Gregory
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | | | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Addie Walker
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
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26
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Monir RL, Motaparthi K, Schoch JJ. Red-brown papules in a 13-month-old. Pediatr Dermatol 2023; 40:201-203. [PMID: 36670500 DOI: 10.1111/pde.15137] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/30/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Reesa L Monir
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jennifer J Schoch
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
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27
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Mukosera GT, Ibraheim MK, Lee MP, Elston D, Singh R, Ho J, Motaparthi K, Ahn CS, Lee BA, Gardner JM, Ferringer T, Elsensohn A. From Scope to Screen: A Collection of Online Dermatopathology Resources for Residents and Fellows. JAAD Int 2023; 12:12-14. [DOI: 10.1016/j.jdin.2022.12.007] [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: 01/31/2023] Open
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28
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McGaugh S, Chakrala T, Prakash R, Motaparthi K. Acute inflammatory edema in the setting of bilateral lung transplantation. JAAD Case Rep 2022; 32:32-34. [PMID: 36624810 PMCID: PMC9823116 DOI: 10.1016/j.jdcr.2022.11.029] [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: 12/12/2022] Open
Affiliation(s)
- Scott McGaugh
- University of Florida College of Medicine, Gainesville, Florida
| | - Teja Chakrala
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Roshni Prakash
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida, Gainesville, Florida
- Correspondence to: Kiran Motaparthi, MD, Department of Dermatology, University of Florida, 4037 NW 86 Terrace, 4th Floor, Gainesville, FL 32606.
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29
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Gilkey T, Hammond A, Gurnani P, Forouzandeh M, Hsu S, Motaparthi K. Subtype transition from pemphigus vulgaris to pemphigus foliaceus. JAAD Case Rep 2022; 31:31-34. [DOI: 10.1016/j.jdcr.2022.10.036] [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: 11/11/2022] Open
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30
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Motaparthi K, Edgar L, Aughenbaugh WD, Bruckner AL, Leone A, Mathes EF, Murina A, Rapini RP, Rubenstein D, Wysong A, Stratman EJ. Milestones 2.0: An advancement in competency-based assessment for dermatology. Clin Dermatol 2022; 40:776-781. [PMID: 35988761 DOI: 10.1016/j.clindermatol.2022.08.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In 2013, Next Accreditation System and Milestones became the competency-based assessment framework required for all specialties accredited by the Accreditation Council for Graduate Medical Education. Dermatology residency programs implemented Milestones 1.0 in the 2013-2014 academic year. The Accreditation Council for Graduate Medical Education committed to review and revise Milestones 1.0 within 3 to 5 years. Subsequently, feedback from key stakeholders influenced the goals for revision, including reducing complexity, enhancing community engagement, and providing additional resources for programs. In 2019, the Dermatology Milestones 2.0 work group streamlined the specialty-specific patient care and medical knowledge subcompetencies. The harmonized milestones allowed for greater uniformity across specialties in systems-based practice, practice-based learning and improvement, professionalism, and interpersonal communication and skills. The work group developed a supplemental guide with specialty-specific context to help program directors, clinical competency committee members, and other faculty understand individual milestones. Dermatology Milestones 2.0 reduces the number of subcompetencies from 28 to 21. Milestones 2.0 represents an advancement in competency-based assessment for dermatology. The first year of reporting for Dermatology Milestones 2.0 is 2021.
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Affiliation(s)
- Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA.
| | - Laura Edgar
- Accreditation Council for Graduate Medical Education, Chicago, Illinois, USA
| | - William D Aughenbaugh
- Department of Dermatology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Anna L Bruckner
- Departments of Dermatology and Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Alexa Leone
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Erin F Mathes
- Department of Dermatology, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Andrea Murina
- Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Ronald P Rapini
- Department of Dermatology, University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas, USA
| | - David Rubenstein
- United States Army Medical Department Center and Medical Service Corps, Texas State University School of Health Administration, San Marcos, Texas, USA
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center College of Medicine, Omaha, Nebraska, USA
| | - Erik J Stratman
- Department of Dermatology, Marshfield Clinic Health System, Marshfield, Wisconsin, USA
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31
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Farahbakhsh N, Della Porta A, Monir RL, Guo W, Grant-Kels JM, Motaparthi K. Training dermatology residents in dermatoscopy: A case control lecture series assessment. Clin Dermatol 2022; 40:782-787. [PMID: 35948236 DOI: 10.1016/j.clindermatol.2022.08.003] [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: 12/15/2022]
Abstract
Lack of standardized dermatoscopy training limits confidence and accuracy. We assessed the effect of a dermatoscopy lecture series on the diagnostic accuracy of dermatology residents' biopsies. Additionally, we evaluated resident comfort with and knowledge of dermatoscopy before and after the curriculum. Twelve dermatology residents were enrolled in a 5-month dedicated dermatoscopy curriculum. To assess knowledge of and comfort with dermatoscopy, residents were given a 50-question assessment and 21-question survey before and after the curriculum. Change in diagnostic accuracy was assessed by comparing the suspected clinical diagnosis to the final histopathologic diagnosis of lesions biopsied by residents before and after the course. Upon completion of the curriculum, residents felt significantly more comfortable performing dermatoscopy (P = .002) and using dermatoscopy to identify melanocytic nevi (P = .037) and melanomas (invasive and in situ) (P = .012). Postgraduate year 2 residents also showed significantly improved diagnostic accuracy after the training course (odds ratio, 1.33; 95% confidence interval, 1.06-1.67; P = .013). Our study was limited by a small sample size of 12 residents from a single academic institution. A formal dermatoscopy course can effectively improve dermatology residents' knowledge, confidence, and diagnostic accuracy when using dermatoscopy.
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Affiliation(s)
- Navid Farahbakhsh
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | | | - Reesa L Monir
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Wanru Guo
- Department of Biostatistics, University of Florida College of Public Health and Health Professions, Gainesville, Florida, USA
| | - Jane M Grant-Kels
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA.
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Zhai L, Motaparthi K. Building successful culture, mission, and vision in dermatology. Clin Dermatol 2022; 40:796-801. [PMID: 35987297 DOI: 10.1016/j.clindermatol.2022.08.011] [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: 12/15/2022]
Abstract
Building a successful culture in academic dermatology is necessary now more than ever, which is compounded by the shortage of dermatologists, especially academicians. This dearth of academic dermatologists raises questions concerning who will train future generations of physicians and who will drive innovative research to advance the field and improve patient care. Recruitment and retention of dermatologists in academia faces steep challenges posed by increasing demands within academic medicine and the draw of the private sector. It is important to address barriers to a career in academia. Efforts should be focused on modifiable aspects of dermatology residency experiences to promote a career in academic dermatology. Of equal importance is the retention of faculty already in academia because midcareer shifts from academic settings to private practice can result in a significant leadership gap.
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Affiliation(s)
- Lisa Zhai
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA.
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Kreher MA, Ahn J, Werbel T, Motaparthi K. Subcutaneous panniculitis-like T-cell lymphoma after COVID-19 vaccination. JAAD Case Rep 2022; 28:18-20. [PMID: 35966352 PMCID: PMC9364717 DOI: 10.1016/j.jdcr.2022.08.006] [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: 11/26/2022] Open
Affiliation(s)
| | - John Ahn
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
| | - Tyler Werbel
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
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Tvedten EJ, Turnbull JP, Guo W, Motaparthi K. Attitudes Toward Allopathic and Osteopathic Candidates in the Dermatologic Residency Application Process. Clin Dermatol 2022:S0738-081X(22)00128-6. [DOI: 10.1016/j.clindermatol.2022.10.002] [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: 11/30/2022]
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Gitin A, Patel SP, Weatherall A, Vincek V, Motaparthi K. Xanthomatous cutaneous Rosai-Dorfman disease with overlapping features of IgG4-related disease. JAAD Case Rep 2022; 29:134-138. [PMID: 36262360 PMCID: PMC9574542 DOI: 10.1016/j.jdcr.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Margulies S, Patel SP, Motaparthi K. Ulceronecrotic rash in an immunocompetent individual. JAAD Case Rep 2022; 27:29-31. [PMID: 35990229 PMCID: PMC9389133 DOI: 10.1016/j.jdcr.2022.06.029] [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: 11/25/2022] Open
Affiliation(s)
- Shae Margulies
- University of Florida College of Medicine, Gainesville, Florida
| | - Sagar P Patel
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
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Blumstein AJ, Patel S, Motaparthi K. Chronic superficial ulcers on the trunk. JAAD Case Rep 2022; 27:121-123. [PMID: 36042972 PMCID: PMC9420335 DOI: 10.1016/j.jdcr.2022.07.023] [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: 11/18/2022] Open
Affiliation(s)
| | | | - Kiran Motaparthi
- Correspondence to: Kiran Motaparthi, MD, Department of Dermatology, University of Florida College of Medicine, 4037 NW 86 Terrace, 4th Floor, Gainesville, FL 32606.
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Cravero K, Chung M, Motaparthi K, Saikaly SK. Nonpruritic hypopigmented macules on an immunocompromised patient. JAAD Case Rep 2022; 27:143-146. [PMID: 36046807 PMCID: PMC9421168 DOI: 10.1016/j.jdcr.2022.07.021] [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: 12/02/2022] Open
Affiliation(s)
- Karen Cravero
- College of Medicine, University of Florida, Gainesville, Florida
| | - Michael Chung
- Department of Dermatology, University of Florida, Gainesville, Florida
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida, Gainesville, Florida
| | - Sami K Saikaly
- Department of Dermatology, University of Florida, Gainesville, Florida
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Hsu S, Lee JB, Motaparthi K. The Jack-in-the-Box Sign: A Diagnostic Sign for Palisaded Encapsulated Neuroma. Skinmed 2022; 20:302. [PMID: 35976022] [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: 06/15/2023]
Affiliation(s)
- Sylvia Hsu
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, PA;
| | - Jason B Lee
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL
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Gitin A, Porta AD, Bisbee E, Braunlich K, Motaparthi K. Anti-laminin 332 mucous membrane pemphigoid in a young woman treated with rituximab. Dermatol Online J 2022; 28. [DOI: 10.5070/d328458517] [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] [Received: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 11/08/2022] Open
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Wells A, Harmel A, Smith KN, Beers P, Qiu Y, Datta S, Schoch JJ, De Benedetto A, Longo I, Motaparthi K. Impact of Skin Biopsy and Clinical-Pathologic Correlation in Dermatology Inpatient Consults. Cureus 2022; 14:e28534. [PMID: 36185900 PMCID: PMC9517953 DOI: 10.7759/cureus.28534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background While studies of hospital dermatology have demonstrated diagnostic discordance between primary teams and dermatology consultants, little is known about the impact of biopsy and clinical-pathologic correlation (CPC) in consultation. This study compares biopsy performance based on diagnostic discordance and evaluates the impact of CPC on the diagnosis. Methods This was a retrospective review of 376 dermatologic consultations at a single academic medical center between July 1, 2017, and June 27, 2018. Results Biopsy was significantly less likely to be performed when the diagnosis by the referring primary team was unspecified (p < 0.001). In 24 percent of cases, the diagnosis based on histopathology alone differed from the diagnosis reached by formal CPC consensus review with either potential or significant impact on management. Conclusion Dermatologists who perform inpatient consultations and rely on hospital-based pathology services may consider a consensus review for CPC. Requests to perform a biopsy may be interpreted as a request for diagnostic assistance rather than pressure to perform a procedure.
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Prakash R, Chakrala T, McGaugh S, Saikaly S, Motaparthi K. LB974 Blastomycosis-like pyoderma: A diagnosis of correlation. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.997] [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: 10/17/2022]
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Cravero K, Maddy AJ, Motaparthi K. Digital ulcers as presenting symptom of secondary antiphospholipid syndrome. JAAD Case Rep 2022; 29:1-5. [PMID: 36186414 PMCID: PMC9519777 DOI: 10.1016/j.jdcr.2022.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Zaladonis AG, Lee JB, Hsu S, Motaparthi K. Facial Discoid Dermatosis: What Is It? Skinmed 2022; 20:174-176. [PMID: 35779021] [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: 06/15/2023]
Affiliation(s)
- Angela G Zaladonis
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, PA
| | - Jason B Lee
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Sylvia Hsu
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, PA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL;
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Margulies S, Werbel T, Missall T, Motaparthi K. Diffuse blistering rash with ocular involvement. JAAD Case Rep 2022; 23:90-92. [PMID: 35495965 PMCID: PMC9046949 DOI: 10.1016/j.jdcr.2022.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Tvedten E, Marion T, Motaparthi K. Necrotic Plaques on the Ears of a Patient With COVID-19. JAMA Dermatol 2022; 158:579-580. [PMID: 35416915 DOI: 10.1001/jamadermatol.2022.0745] [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: 11/14/2022]
Affiliation(s)
- Erika Tvedten
- Michigan State University College of Osteopathic Medicine, East Lansing
| | - Tyler Marion
- Department of Dermatology, University of Florida College of Medicine, Gainesville
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville
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Motaparthi K, Hsu S. Probabilities, uncertainty, and cognitive bias in clinical diagnosis. Am J Obstet Gynecol 2022; 226:593. [PMID: 34757003 DOI: 10.1016/j.ajog.2021.10.030] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | - Sylvia Hsu
- Lewis Katz School of Medicine, Temple University, 3401 North Broad St., Ste B500, Philadelphia, PA 19140.
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Smith KN, Bisbee EL, Kallis PJ, Satcher KG, Schoch J, Fraitag S, Vincek V, Motaparthi K. Erythroderma in a neonate. JAAD Case Rep 2022; 21:97-100. [PMID: 35198711 PMCID: PMC8850577 DOI: 10.1016/j.jdcr.2021.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Bryan J, Skopis PK, Saikaly SK, Nguyen K, Motaparthi K. Letter to the Editor: Comparing Cases of Type I cryoglobulinemia with histopathologic findings of vasculitis. JAAD Case Rep 2022; 23:160-161. [PMID: 35519798 PMCID: PMC9062339 DOI: 10.1016/j.jdcr.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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