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Jain S, Pyle HJ, Evans JC, Gao W, Mauskar MM. Cutaneous manifestations of systemic methotrexate toxicity. JAAD Int 2024; 15:179-181. [PMID: 38651037 PMCID: PMC11033189 DOI: 10.1016/j.jdin.2024.02.013] [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: 04/25/2024] Open
Affiliation(s)
- Shivani Jain
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hunter J. Pyle
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jessica C. Evans
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Whitney Gao
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Melissa M. Mauskar
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
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2
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Rivera S, Dehner K, Flood A, Dykstra C, Mauskar MM, DeMaria AL. Adverse healthcare experiences are correlated with increased time to diagnosis in women with vulvar inflammatory dermatoses: a retrospective cohort survey. Br J Dermatol 2024; 190:761-762. [PMID: 38170454 DOI: 10.1093/bjd/ljae003] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/18/2023] [Accepted: 02/05/2024] [Indexed: 01/05/2024]
Abstract
This retrospective cohort survey of over 300 women examined diagnostic delay in vulvar dermatoses compared with nonvulvar control conditions (e.g. psoriasis or atopic dermatitis). Adverse healthcare experiences (e.g. uncertainty of which provider to consult, embarrassment in talking to providers) occurred more often for participants with vulvar disease and were significantly correlated with increased time to diagnosis in this group, which was not the case in control conditions. The findings suggest opportunities to improve care for people with vulvar disease.
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Affiliation(s)
| | | | - Anna Flood
- Indiana University School of Medicine, Indianapolis, IN
| | - Chandler Dykstra
- Marian University College of Osteopathic Medicine, Indianapolis, IN, USA
| | - Melissa M Mauskar
- Department of Dermatology
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Andrea L DeMaria
- Department of Public Health, Purdue University, West Lafayette, IN
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3
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AbdelHameid D, Wang L, Mauskar MM, Dominguez AR, Thomas C. Sepsis-like features in hidradenitis suppurativa flares requiring admission: A retrospective cohort study. J Am Acad Dermatol 2024:S0190-9622(24)00386-4. [PMID: 38395228 DOI: 10.1016/j.jaad.2024.02.022] [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: 09/18/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024]
Affiliation(s)
- Duaa AbdelHameid
- Department of Dermatology, University of Texas Southwestern Medical Center
| | - Laura Wang
- Department of Dermatology, University of Texas Southwestern Medical Center
| | - Melissa M Mauskar
- Department of Dermatology, University of Texas Southwestern Medical Center
| | - Arturo R Dominguez
- Department of Dermatology, University of Texas Southwestern Medical Center; Department of Internal Medicine, University of Texas Southwestern Medical Center
| | - Cristina Thomas
- Department of Dermatology, University of Texas Southwestern Medical Center; Department of Internal Medicine, University of Texas Southwestern Medical Center.
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4
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Pyle HJ, Evans JC, Artami M, Raj P, Sridharan S, Arana C, Eckert KM, McDonald JG, Harris-Tryon TA, Mauskar MM. Assessment of the Cutaneous Hormone Landscapes and Microbiomes in Vulvar Lichen Sclerosus. J Invest Dermatol 2024:S0022-202X(24)00111-8. [PMID: 38368928 DOI: 10.1016/j.jid.2024.01.027] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/24/2024] [Accepted: 01/31/2024] [Indexed: 02/20/2024]
Abstract
Vulvar lichen sclerosus (VLS) is a progressive skin disease of unknown etiology. In this longitudinal case-control exploratory study, we evaluated the hormonal and microbial landscapes in 18 postmenopausal women (mean [SD] age: 64.4 [8.4]) with vulvar lichen sclerosus and controls. We reevaluated the VLS patients after 10-14 weeks of daily topical Class I steroid. We found that groin cutaneous estrone was lower in vulvar lichen sclerosus versus controls (-22.33, 95% CI -36.96 to -7.70; P = 0.006); cutaneous progesterone was higher (5.73, 95% CI 3.74 to 7.73; P< 0.0001). Forehead 11-deoxycortisol (-0.24, 95% CI -0.42 to -0.06; P = 0.01) and testosterone (-7.22, 95% CI -12.83 to -1.62; P = 0.02) were lower in disease. With treatment, cutaneous estrone (-7.88, 95% CI -44.07 to 28.31; P = 0.62), progesterone (2.02, 95% CI -2.08 to 6.11; P = 0.29), and 11-deoxycortisol (-0.13, 95% CI -0.32 to 0.05; P = 0.15) normalized; testosterone remained suppressed (-7.41, 95% CI -13.38 to -1.43; P = 0.02). 16S rRNA V1-V3 and ITS1 amplicon sequencing revealed bacterial and fungal microbiome alterations in disease. Findings suggest that cutaneous sex hormone and bacterial microbiome alterations may be associated with VLS in postmenopausal women.
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Affiliation(s)
- Hunter J Pyle
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA
| | - Jessica C Evans
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA
| | - Methinee Artami
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA
| | - Prithvi Raj
- Department of Immunology, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA
| | - Srisha Sridharan
- Department of Immunology, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA
| | - Carlos Arana
- Department of Immunology, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA
| | - Kaitlyn M Eckert
- Center for Human Nutrition, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA; Department of Molecular Genetics, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA
| | - Jeffrey G McDonald
- Center for Human Nutrition, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA; Department of Molecular Genetics, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA
| | - Tamia A Harris-Tryon
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA; Department of Immunology, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA.
| | - Melissa M Mauskar
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA; Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA.
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5
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Foster JA, Freeland D, Mauskar MM. Geriatric Genital Dermatology. J Am Med Dir Assoc 2024; 25:351-355. [PMID: 38191124 DOI: 10.1016/j.jamda.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024]
Abstract
As women age, hormonal changes set the stage for a variety of vulvovaginal pathologies. Health care providers in long-term care facilities should be able to recognize and treat these conditions, especially because residents may be unable to communicate their discomfort. The objective of this article is to highlight the major vulvovaginal conditions affecting older women and provide up-to-date information on treatment for providers in long-term care facilities.
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Affiliation(s)
- Jennifer A Foster
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Deborah Freeland
- Division of Geriatric Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Melissa M Mauskar
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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6
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Pyle HJ, Dominguez AR, Mauskar MM, Thomas C. Stevens-Johnson syndrome/toxic epidermal necrolysis predictive models are not effective when applied by non-dermatologists: A single-institution prospective study. Skin Health Dis 2023; 3:e292. [PMID: 38047266 PMCID: PMC10690703 DOI: 10.1002/ski2.292] [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] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Affiliation(s)
- Hunter J. Pyle
- Department of DermatologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Arturo R. Dominguez
- Department of DermatologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Melissa M. Mauskar
- Department of DermatologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Obstetrics and GynecologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Cristina Thomas
- Department of DermatologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
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Pyle HJ, Evans JC, Vandergriff TW, Mauskar MM. Vulvar Lichen Sclerosus Clinical Severity Scales and Histopathologic Correlation: A Case Series. Am J Dermatopathol 2023; 45:588-592. [PMID: 37462209 DOI: 10.1097/dad.0000000000002471] [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: 07/20/2023]
Abstract
ABSTRACT Several vulvar lichen sclerosus (VLS) clinical severity scales have recently been proposed. In this prospective case series, we characterized histopathology in the context of clinical severity in 6 treatment-naïve postmenopausal patients with VLS. The Vulvar Quality of Life Index (VQLI) and an adaptation of the 2018 International Society for the Study of Vulvovaginal Disease Delphi consensus VLS severity score were administered. Vulvar skin punch biopsies were obtained to measure inflammatory density, constituent inflammatory cells, thickness of the stratum corneum and other epidermal layers, dermal edema, and dermal sclerosis. Clinicopathologic correlations were assessed. Two cases demonstrated sparse inflammatory densities, 1 case demonstrated patchy and nodular inflammatory density, 1 case demonstrated dense lichenoid inflammatory density, and 2 cases demonstrated dense lichenoid and epitheliotropic inflammatory densities. Those patients who reported severe pruritus demonstrated the greatest lymphocytic inflammatory densities on histopathological examination. Both cases of ulceration or erosion were associated with severe VQLI scores. Severe VQLI scores were also associated with trends for higher average thickness of the epidermal layers and of dermal sclerosis. Altogether, histopathologic grading of biopsy sites may reflect clinical severity in patients with VLS.
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Affiliation(s)
- Hunter J Pyle
- Departments of Dermatology; Pathology; and Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
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8
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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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Griffith CF, Young PA, Froman RL, Vasquez R, Mauskar MM. Patient satisfaction with dermatologists, resident physicians, and physician assistants: a multi-year cross-sectional study in an academic medical center. Dermatol Online J 2023; 29. [PMID: 37591276 DOI: 10.5070/d329361436] [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: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 08/19/2023] Open
Affiliation(s)
- Cynthia F Griffith
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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10
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Pyle HJ, Shedd CM, Begovic J, Thomas C, Vandergriff TW, Mauskar MM, Dominguez AR. Complications and Histopathological Findings of Image-Guided Core Needle Biopsy in Diagnosis of Cutaneous Calciphylaxis. Am J Dermatopathol 2023; 45:414-417. [PMID: 37073994 DOI: 10.1097/dad.0000000000002426] [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: 04/20/2023]
Affiliation(s)
- Hunter J Pyle
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Christine M Shedd
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jovan Begovic
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Cristina Thomas
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Travis W Vandergriff
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX; and
| | - Melissa M Mauskar
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Arturo R Dominguez
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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O’Brian M, Rose EK, Mauskar MM, Dominguez AR. Sudden Conjunctivitis, Lymphopenia, and Rash Combined With Hemodynamic Changes (SCoRCH) After Trimethoprim-Sulfamethoxazole Use: A Case Series Study of a Hypersensitivity Reaction. JAMA Dermatol 2023; 159:73-78. [PMID: 36350597 PMCID: PMC9647562 DOI: 10.1001/jamadermatol.2022.4657] [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: 05/20/2022] [Accepted: 09/05/2022] [Indexed: 11/11/2022]
Abstract
Importance Trimethoprim-sulfamethoxazole (TMP-SMX) hypersensitivity reaction, ranging from circulatory shock to aseptic meningitis and respiratory failure, is a potentially life-threatening condition with dermatologic relevance. Objective To describe the mucocutaneous findings and clinical features of TMP-SMX hypersensitivity reaction. Design, Setting, and Participants This was a retrospective case series study of 7 patients who developed a characteristic rash, hemodynamic changes, and end-organ dysfunction after treatment with TMP-SMX at a large university hospital system during January 2013 to March 2022. Exposures Treatment with TMP-SMX within 2 weeks of the reaction. Main Outcome and Measures Descriptions of the condition, including the demographic information of the affected population, the reaction timeline, and mucocutaneous and clinical features. Results The cohort comprised 7 patients (median [range] age, 20 [15-66] years; 4 female and 3 male). The most common mucocutaneous findings were generalized sunburn-like erythema without scale, conjunctivitis, and mild facial and acral edema. Three patients had previous exposure to TMP-SMX and developed symptoms in 1 day or less, while those without prior exposure presented from 4 to 11 days after drug initiation. Among the 7 patients, 6 had fever, 7 had hypotension, and 7 had tachycardia. All patients had lymphopenia and evidence of end-organ dysfunction with either kidney or liver involvement. Median (range) time to resolution was 72 (48-96) hours. Conclusions and Relevance This retrospective case series indicates that SCoRCH (sudden conjunctivitis, lymphopenia, and rash combined with hemodynamic changes) should be considered in the differential diagnosis of patients presenting with acute generalized sunburn-like erythema, conjunctivitis, systemic symptoms, and hemodynamic changes in the setting of recent TMP-SMX use.
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Affiliation(s)
- Madeleine O’Brian
- University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center, Dallas
| | - Elysha K. Rose
- University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center, Dallas
| | - Melissa M. Mauskar
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas
| | - Arturo R. Dominguez
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
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12
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Qian J, Li JN, Rose EK, Vandergriff T, Khosama L, Beg MS, Mauskar MM, Wang RC. Fibroblast growth factor receptor inhibitor therapy induced calcinosis cutis treated with sodium thiosulfate. JAAD Case Rep 2022; 31:128-132. [PMID: 36583143 PMCID: PMC9792732 DOI: 10.1016/j.jdcr.2022.10.040] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Justin Qian
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas
| | - Jeffrey N. Li
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas
| | - Elysha K. Rose
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas
| | - Travis Vandergriff
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas
| | - Leticia Khosama
- Division of Hematology/Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Muhammad S. Beg
- Division of Hematology/Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Melissa M. Mauskar
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas
| | - Richard C. Wang
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas,Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, Texas,Correspondence to: Richard C. Wang, MD, PhD, Department of Dermatology, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, Suite 400, Dallas, TX 75390 @richintuition
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13
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Pyle HJ, Mauskar MM, Dominguez AR. Cytomegalovirus vulvar ulceration in patient without HIV-AIDS. Am J Obstet Gynecol 2022; 227:769. [PMID: 35926649 DOI: 10.1016/j.ajog.2022.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/29/2022] [Accepted: 07/25/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Hunter J Pyle
- Departments of Dermatology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Melissa M Mauskar
- Departments of Dermatology, The University of Texas Southwestern Medical Center, Dallas, TX; Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Arturo R Dominguez
- Departments of Dermatology, The University of Texas Southwestern Medical Center, Dallas, TX; Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX.
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14
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Sattler S, Elsensohn AN, Mauskar MM, Kraus CN. Plasma cell vulvitis: A systematic review. Int J Womens Dermatol 2022; 7:756-762. [PMID: 35028377 PMCID: PMC8714578 DOI: 10.1016/j.ijwd.2021.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background Plasma cell vulvitis (PCV) is an inflammatory vulvar dermatosis that is not well characterized. Diagnosis is often delayed, and the condition can be refractory to treatment. To date, there are no systematic reviews on this topic. Objective This study aimed to provide a systematic review of PCV, including epidemiologic, clinical, and histopathologic findings, as well as associated comorbidities and treatment options. Methods A primary literature search was conducted using the PubMed, Ovid Medline, Cochrane, and CINAHL databases. Results Fifty-three publications with 196 patients (mean age: 55.3 ± 14.5 years) were included. The majority of studies were case reports and case series. Common symptoms included burning/stinging (52%), dyspareunia (44%), and pruritus (41%). Common findings included erythema (84%), glistening/shiny appearance (29%), well-demarcated lesions (25%), and erosions (22%). Common anatomic sites were the labia minora (45%), introitus (31%), and periurethral (19%). Fifty-three percent of patients had a solitary lesion. Common histologic findings were a predominant plasma cell infiltrate (88%), presence of other inflammatory cells (55%), hemosiderin/siderophages (46%), and epidermal atrophy (43%). Topical corticosteroids (64%) and tacrolimus ointment (13%) were the most frequent treatment modalities. In most reports, previous treatments were tried, and there was a diagnostic delay. Conclusion PCV is likely underrecognized and should be considered in patients with erythema of the mucous and modified mucous membranes, symptoms of burning or stinging, and a predominant plasma cell infiltrate on histopathology. First-line therapy should begin with high-potency topical corticosteroids, with the most evidence for clobetasol 0.05% or tacrolimus 0.1% ointment. Prospective studies are needed to further characterize this condition and to develop treatment guidelines.
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Affiliation(s)
| | | | - Melissa M Mauskar
- University of Texas Southwestern Medical Center, Department of Dermatology, Dallas, Texas
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15
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Affiliation(s)
| | - Robin Granberry
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Audrey Rutherford
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Melissa M. Mauskar
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
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16
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Shah KM, Silverman RA, Mauskar MM. A child with epidermolytic ichthyosis, generalized erythema, and erosions. Pediatr Dermatol 2022; 39:128-129. [PMID: 35106818 DOI: 10.1111/pde.14880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kishan M Shah
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robert A Silverman
- Department of Pediatrics, Georgetown University, Washington, District of Columbia, USA
| | - Melissa M Mauskar
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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17
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Mauskar MM. Recognition and diagnosis of vulvar dermatoses. Case Rep Womens Health 2021; 32:e00344. [PMID: 34386354 PMCID: PMC8342896 DOI: 10.1016/j.crwh.2021.e00344] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Melissa M Mauskar
- Departments of Dermatology and Obstetrics and Gynecology, University of Texas Southwestern Medical Center, United States of America
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18
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Affiliation(s)
- Khang D. Nguyen
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tyler Enos
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Travis Vandergriff
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rebecca Vasquez
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ponciano D. Cruz
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Heidi T. Jacobe
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Melissa M. Mauskar
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
- Correspondence to: Melissa M. Mauskar, MD, 5323 Harry Hines Blvd, Dallas, TX 75390-9069.
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19
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Wang AL, Lospinoso DJ, Mauskar MM. Wiping Away Cellulitis: A Case of Factitious Disorder. Cutis 2021; 107:E29-E30. [PMID: 34314328 DOI: 10.12788/cutis.0300] [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: 11/20/2022]
Affiliation(s)
- Allison L Wang
- Dr. Wang is from the Division of Dermatology, Cook County Health, Chicago, Illinois. Dr. Lospinoso is from San Antonio Uniformed Services Health Education Consortium, Texas. Dr. Mauskar is from the Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
| | - Danielle J Lospinoso
- Dr. Wang is from the Division of Dermatology, Cook County Health, Chicago, Illinois. Dr. Lospinoso is from San Antonio Uniformed Services Health Education Consortium, Texas. Dr. Mauskar is from the Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
| | - Melissa M Mauskar
- Dr. Wang is from the Division of Dermatology, Cook County Health, Chicago, Illinois. Dr. Lospinoso is from San Antonio Uniformed Services Health Education Consortium, Texas. Dr. Mauskar is from the Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
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20
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Treichel AM, Teske N, Vandergriff T, Dominguez A, Mauskar MM, Nguyen KD. Kikuchi disease with cutaneous involvement complicated by features of hemophagocytic lymphohistiocytosis. J Cutan Pathol 2021; 48:343-346. [PMID: 33470433 DOI: 10.1111/cup.13720] [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: 01/28/2020] [Revised: 04/12/2020] [Accepted: 04/20/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Alison M Treichel
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Noelle Teske
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Travis Vandergriff
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Arturo Dominguez
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Melissa M Mauskar
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Khang D Nguyen
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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21
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Pineider J, Weon J, West L, Nanes B, Vandergriff T, Mauskar MM. Cutaneous polyarteritis nodosa with clinical features of pyoderma gangrenosum. JAAD Case Rep 2020; 6:1291-1293. [PMID: 33294567 PMCID: PMC7701038 DOI: 10.1016/j.jdcr.2020.09.001] [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: 11/21/2022] Open
Affiliation(s)
| | - Jenny Weon
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lindsey West
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Benjamin Nanes
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Travis Vandergriff
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Melissa M Mauskar
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
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22
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Mauskar MM, Marathe K, Venkatesan A, Schlosser BJ, Edwards L. Vulvar diseases. J Am Acad Dermatol 2020; 82:1287-1298. [DOI: 10.1016/j.jaad.2019.10.077] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 09/26/2019] [Accepted: 10/03/2019] [Indexed: 11/25/2022]
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23
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Prasad S, Mauskar MM. A catastrophic vulvar ulcer. Am J Obstet Gynecol 2020; 222:276-277. [PMID: 31233709 DOI: 10.1016/j.ajog.2019.06.038] [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: 05/29/2019] [Accepted: 06/17/2019] [Indexed: 11/27/2022]
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24
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Mauskar MM, Marathe K, Venkatesan A, Schlosser BJ, Edwards L. Vulvar diseases: Approach to the patient. J Am Acad Dermatol 2019; 82:1277-1284. [PMID: 31712174 DOI: 10.1016/j.jaad.2019.07.115] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 07/18/2018] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 10/25/2022]
Abstract
Patients with vulvar dermatoses often delay seeking medical treatment because of anxiety and embarrassment. Moreover, women frequently self-treat with various home remedies and see multiple clinicians before presenting to a dermatologist. Despite serving as the primary providers for patients with vulvovaginal symptoms, gynecologists typically receive limited training in the causes and management of these conditions. Dermatologists are experts in the evaluation and management of cutaneous disease and should be the caretakers of all skin, including the genitalia. Vulvar disorders are underrecognized by dermatologists for numerous reasons: inadequate training, lack of comfort with both interview and examination techniques, and unfamiliarity with normal anatomic variations. The first article in this continuing medical education series on vulvar dermatoses reviews the fundamentals, approach, and techniques that can be used to ensure a successful visit for both patient and provider.
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Affiliation(s)
- Melissa M Mauskar
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Kalyani Marathe
- Department of Dermatology, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio; Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio
| | - Aruna Venkatesan
- Department of Dermatology, Stanford University, Stanford, California; Division of Dermatology, Santa Clara Valley Medical Center, San Jose, California
| | - Bethanee J Schlosser
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Libby Edwards
- Department of Dermatology, University of North Carolina, Charlotte, North Carolina; Division of Dermatology, Carolinas Medical Center and Southeast Vulvar Clinic, Charlotte, North Carolina
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25
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O'Brien KF, Bradley SE, Mitchell CM, Cardis MA, Mauskar MM, Pasieka HB. Vulvovaginal manifestations in Stevens-Johnson syndrome and toxic epidermal necrolysis: Prevention and treatment. J Am Acad Dermatol 2019; 85:523-528. [PMID: 31437544 DOI: 10.1016/j.jaad.2019.08.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 08/06/2019] [Accepted: 08/10/2019] [Indexed: 11/29/2022]
Abstract
The prevalence of acute vulvovaginal involvement in toxic epidermal necrolysis can be as high as 70%; up to 28% of female patients will also develop chronic vulvovaginal sequelae. There is little consensus regarding prevention and treatment of the gynecologic sequelae of both Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). We review acute and chronic sequelae, including erosions, scar formation, chronic skin changes, urethral complications, adenosis, malignant transformation, vulvodynia, and dyspareunia. We provide comprehensive recommendations for acute and long-term vulvovaginal care in adult and pediatric SJS/TEN patients. Treatment should include an ultrapotent topical steroid, followed by a nonirritating barrier cream applied to vulvar and perineal lesions. A steroid should be used intravaginally along with vaginal dilation in all adults (but should be avoided in prepubertal adolescents) with vaginal involvement. Menstrual suppression should be considered in all reproductive age patients until vulvovaginal lesions have healed. Last, referrals for pelvic floor physical therapy and to surgical subspecialties should be offered on a case-by-case basis. This guide summarizes the current available literature combined with expert opinion of both dermatologists and gynecologists who treat a high volume of SJS/TEN patients.
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Affiliation(s)
| | - Sarah E Bradley
- Department of Obstetrics, MedStar Washington Hospital Center, Washington, DC; Department of Gynecology, MedStar Washington Hospital Center, Washington, DC
| | - Caroline M Mitchell
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael A Cardis
- Department of Dermatology, MedStar Washington Hospital Center, Washington, DC
| | - Melissa M Mauskar
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas; Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Texas
| | - Helena B Pasieka
- Georgetown University School of Medicine, Washington, DC; Department of Dermatology, MedStar Washington Hospital Center, Washington, DC.
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27
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Wang AL, Rainwater YB, Mauskar MM. Bullous eruption in 2 brothers. Cutis 2018; 101:169-178. [PMID: 29718021] [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: 06/08/2023]
Affiliation(s)
- Allison L Wang
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas, USA
| | | | - Melissa M Mauskar
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas, USA
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28
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Affiliation(s)
- Mary E Anderson
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Adnan Mir
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
| | - Melissa M Mauskar
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
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29
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Blankenship DW, Nymeyer H, Mauskar MM. Cutaneous Ulcers Secondary to Cytomegalovirus and Herpes Simplex Virus in an Immunocompromised Patient. Am J Med Sci 2017; 353:e3. [DOI: 10.1016/j.amjms.2016.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 11/08/2016] [Accepted: 11/14/2016] [Indexed: 11/28/2022]
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30
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Malviya N, Rainwater YB, Vandergriff T, Mauskar MM. Cutaneous extranodal NK/T-cell lymphoma mimicking cellulitis an HIV positive patient without lymphopenia. J Cutan Pathol 2016; 44:296-299. [PMID: 28035700 DOI: 10.1111/cup.12885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 07/13/2016] [Revised: 12/15/2016] [Accepted: 12/26/2016] [Indexed: 12/25/2022]
Abstract
We present the case of a 28-year-old male with a history of human immunodeficiency virus (HIV) with a 1-month history of a steadily enlarging, firm painful lesion on the right posterior shoulder. The patient was initially treated for cellulitis given his clinical picture. Histopathologic examination revealed an angiocentric and dermal proliferation of markedly atypical lymphoid cells with numerous mitoses and apoptotic bodies along with broad zones of necrosis. Biopsy revealed the presentation to be consistent with NK/T-cell lymphoma. The cutaneous lesions from NK/T-cell lymphoma can often be initially mistaken for cellulitis, therefore this malignancy should be included on the differential in a patient HIV/acquired immune deficiency syndrome (AIDS).
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Affiliation(s)
- Neeta Malviya
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yevgeniya B Rainwater
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Travis Vandergriff
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Melissa M Mauskar
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
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31
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Kraus C, Dugan EM, Mauskar MM. Cutaneous horn on the penis. J Am Acad Dermatol 2016; 75:e127-e128. [PMID: 27646751 DOI: 10.1016/j.jaad.2015.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/19/2015] [Accepted: 12/11/2015] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Melissa M Mauskar
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas.
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32
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Affiliation(s)
- Melissa M Mauskar
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
| | - Dominique C Pichard
- Department of Dermatology, Children's National Health System, Washington, DC
| | - Scott A Norton
- Department of Dermatology, Children's National Health System, Washington, DC
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