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Schmeusser B, Borchers C, Travers JB, Borchers S, Trevino J, Rubin M, Donnelly H, Kellawan K, Carpenter L, Bahl S, Rohan C, Muennich E, Guenthner S, Hahn H, Rkein A, Darst M, Mousdicas N, Cates E, Sunar U, Bihl T. Inter- and Intra-physician variation in quantifying actinic keratosis skin photodamage. J Clin Investig Dermatol 2020; 8:4. [PMID: 33088904 PMCID: PMC7575200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We investigated the variations in physician evaluation of skin photodamage based on a published photodamage scale. Of interest is the utility of a 10-level scale ranging from none and mild photodamage to actinic keratosis (AK). The dorsal forearms of 55 adult subjects with various amounts of photodamage were considered. Each forearm was independently evaluated by 15 board-certified dermatologists according to the Global Assessment Severity Scale ranging from 0 (less severe) to 9 (the most progressed stage of skin damage). Dermatologists rated the levels of photodamage based upon the photographs in blinded fashion. Results show substantial disagreement amongst the dermatologists on the severity of photodamage. Our results indicate that ratings could be more consistent if using a scale of less levels (5-levels or 3-levels). Ultimately, clinicians can use this knowledge to provide better interpretation of inter-rater evaluations and provide more reliable assessment and frequent monitoring of high-risk populations.
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Affiliation(s)
- Benjamin Schmeusser
- Department of Pharmacology & Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH, 45435, USA
| | - Christina Borchers
- Department of Pharmacology & Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH, 45435, USA
| | - Jeffrey B. Travers
- Department of Pharmacology & Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH, 45435, USA
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH, 45435, USA
- Dayton Veterans Administration Medical Center, Dayton, OH, 45428, USA
| | - Samia Borchers
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH, 45435, USA
| | - Julian Trevino
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH, 45435, USA
| | - Max Rubin
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH, 45435, USA
| | - Heidi Donnelly
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH, 45435, USA
| | - Karl Kellawan
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH, 45435, USA
| | - Lydia Carpenter
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH, 45435, USA
| | - Shalini Bahl
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH, 45435, USA
| | - Craig Rohan
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH, 45435, USA
| | - Elizabeth Muennich
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH, 45435, USA
| | | | - Holly Hahn
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH, 45435, USA
| | - Ali Rkein
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH, 45435, USA
| | - Marc Darst
- Charlotte Dermatology, Charlotte, NC 28277, USA
| | - Nico Mousdicas
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, 46202, USA
| | - Elizabeth Cates
- Department of Pharmacology & Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH, 45435, USA
| | - Ulas Sunar
- Department of Biomedical, Industrial & Human Factors Engineering, Wright State University, Dayton, OH, 45435, USA
| | - Trevor Bihl
- Department of Pharmacology & Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH, 45435, USA
- Department of Biomedical, Industrial & Human Factors Engineering, Wright State University, Dayton, OH, 45435, USA
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Travers JB, Poon C, Bihl T, Rinehart B, Borchers C, Rohrbach DJ, Borchers S, Trevino J, Rubin M, Donnelly H, Kellawan K, Carpenter L, Bahl S, Rohan C, Muennich E, Guenthner S, Hahn H, Rkein A, Darst M, Mousdicas N, Cates E, Sunar U. Quantifying skin photodamage with spatial frequency domain imaging: statistical results. Biomed Opt Express 2019; 10:4676-4683. [PMID: 31565518 PMCID: PMC6757479 DOI: 10.1364/boe.10.004676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 06/10/2023]
Abstract
We investigated the change in optical properties and vascular parameters to characterize skin tissue from mild photodamage to actinic keratosis (AK) with comparison to a published photodamage scale. Multi-wavelength spatial frequency domain imaging (SFDI) measurements were performed on the dorsal forearms of 55 adult subjects with various amounts of photodamage. Dermatologists rated the levels of photodamage based upon the photographs in blinded fashion to allow comparison with SFDI data. For characterization of statistical data, we used artificial neural networks. Our results indicate that optical and vascular parameters can be used to quantify photodamage and can discriminate between the stages as low, medium, and high grades, with the best performance of ∼70%, ∼76% and 80% for characterization of low- medium- and high-grade lesions, respectively. Ultimately, clinicians can use this noninvasive approach for risk assessment and frequent monitoring of high-risk populations.
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Affiliation(s)
- Jeffrey B. Travers
- Department of Pharmacology & Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
- Dayton Veterans Administration Medical Center, Dayton, OH 45428, USA
| | - Chien Poon
- Department of Biomedical, Industrial & Human Factors Engineering, Wright State University, Dayton, OH 45435, USA
| | - Trevor Bihl
- Department of Pharmacology & Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
- Department of Biomedical, Industrial & Human Factors Engineering, Wright State University, Dayton, OH 45435, USA
| | - Benjamin Rinehart
- Department of Biomedical, Industrial & Human Factors Engineering, Wright State University, Dayton, OH 45435, USA
| | - Christina Borchers
- Department of Pharmacology & Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| | - Daniel J. Rohrbach
- Department of Biomedical, Industrial & Human Factors Engineering, Wright State University, Dayton, OH 45435, USA
| | - Samia Borchers
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| | - Julian Trevino
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| | - Max Rubin
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| | - Heidi Donnelly
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| | - Karl Kellawan
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| | - Lydia Carpenter
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| | - Shalini Bahl
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| | - Craig Rohan
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| | - Elizabeth Muennich
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| | | | - Holly Hahn
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| | - Ali Rkein
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| | - Marc Darst
- Charlotte Dermatology, Charlotte, NC 28277, USA
| | - Nico Mousdicas
- Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA
| | - Elizabeth Cates
- Department of Pharmacology & Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| | - Ulas Sunar
- Department of Biomedical, Industrial & Human Factors Engineering, Wright State University, Dayton, OH 45435, USA
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Ocana JA, Bell MC, Heskett JB, Baker WH, Mousdicas N, Turner MJ. Treatment of estrogen-induced dermatitis with omalizumab. JAAD Case Rep 2019; 5:481-483. [PMID: 31193571 PMCID: PMC6536736 DOI: 10.1016/j.jdcr.2019.03.007] [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: 11/03/2022] Open
Affiliation(s)
- Jesus A Ocana
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Maria C Bell
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Jordan B Heskett
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana
| | - William H Baker
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Nico Mousdicas
- Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Matthew J Turner
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana.,Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
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Kandula P, Elosiebo R, Mousdicas N. Plantar ulcerative lichen planus: rapid improvement with a novel triple-therapy approach. Cutis 2018; 102:131-135. [PMID: 30235362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Ulcerative lichen planus (ULP) is a rare variant of lichen planus that is characterized by chronic, painful, and disabling ulcerations. Ulcerative lichen planus has been known to be resistant to many treatments, and therapeutic interventions often involve use of aggressive immunosuppressive medications without satisfactory remission of symptoms. We present the case of a 56-year-old man with an 8-year history of painful ulcerations on the right plantar foot as well as a large ulceration of the left lateral tongue. Biopsy confirmed a suspected diagnosis of plantar ULP. The patient developed marked clinical improvement of the cutaneous and oral mucosal lesions with oral and topical steroids, topical tacrolimus, and oral doxycycline after only 4 weeks of treatment. It is important for dermatologists to be aware of the potential diagnosis of plantar ULP, especially in the evaluation of chronic treatment-resistant ulcers that often have been previously misdiagnosed. We introduce this novel therapeutic regimen as a rapidly effective and relatively safe alternative to conventional immunosuppressive agents for long-term management of plantar ULP.
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Affiliation(s)
- Prasanthi Kandula
- Division of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Raven Elosiebo
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, USA
| | - Nico Mousdicas
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, USA
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Vissing M, Wilson C, Mousdicas N, Ali S. Discrete and Coalescing Pustules Masking Severe Recalcitrant Rosacea Due to Demodex. Integr Med (Encinitas) 2017; 16:58-62. [PMID: 30936806 PMCID: PMC6438092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
CONTEXT Rosacea is a frequent and often easily treatable condition in dermatological practice. The clinical manifestations of rosacea are hypothesized to be the result of a dysregulation of the innate immune system. The roles played by outside factors, such as the presence of Demodex or localized immunosuppression in the pathogenesis of rosacea, are under considerable debate. OBJECTIVE The current study intended to examine the contribution of immunosuppression to a case of recalcitrant rosacea and the effects of nutritional status in the resolution of the skin disease. DESIGN The research team designed a case study. SETTING The study took place at the dermatology clinic of the Department of Dermatology at Indiana University (Indianapolis, IN, USA). PARTICIPANT The participant was a 36-y-old male patient at the clinic with a recalcitrant dermatosis of the face and neck. This patient's disease had persisted despite multiple standard treatments for facial dermatitis, rosacea, and granulomatous rosacea with a high Demodex burden. INTERVENTION The intervention included a tapering course of cyclosporin, 3 mg of ivermectin daily for 3 wk, 500 mg daily of ascorbic acid, 1000 units daily of cholecalciferol, and green smoothies. OUTCOME MEASURES The study measured the patient's levels of immunoglobulin M (IgM), 25 hydroxyvitamin D, and ascorbic acid. RESULTS The testing showed isolated IgM deficiency and low levels of 25 hydroxyvitamin D and ascorbic acid. The rash resolved following the tapering course of cyclosporin and vitamin repletion through supplements and dietary alteration. CONCLUSIONS The case was one with multiple confounding variables: (1) the presence of Demodex, (2) iatrogenic immunosuppression due to prolonged systemic and topical steroid use, and (3) vitamin deficiency. The case demonstrates the multifactorial pathogenesis of a recalcitrant dermatosis of the face and neck, and the research team encourages providers to consider a holistic approach when patients do not respond to standard medical therapy.
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Affiliation(s)
- Megan Vissing
- Corresponding author: Megan Vissing, MD E-mail address:
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Jacob SE, McGowan M, Silverberg NB, Pelletier JL, Fonacier L, Mousdicas N, Powell D, Scheman A, Goldenberg A. Pediatric Contact Dermatitis Registry Data on Contact Allergy in Children With Atopic Dermatitis. JAMA Dermatol 2017; 153:765-770. [PMID: 28241280 PMCID: PMC5817590 DOI: 10.1001/jamadermatol.2016.6136] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [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: 11/16/2016] [Accepted: 12/22/2016] [Indexed: 01/20/2023]
Abstract
Importance Atopic dermatitis (AD) and allergic contact dermatitis (ACD) have a dynamic relationship not yet fully understood. Investigation has been limited thus far by a paucity of data on the overlap of these disorders in pediatric patients. Objective To use data from the Pediatric Contact Dermatitis Registry to elucidate the associations and sensitizations among patients with concomitant AD and ACD. Design, Setting, and Participants This retrospective case review examined 1142 patch test cases of children younger than 18 years, who were registered between January 1, 2015, and December 31, 2015, by 84 health care providers (physicians, nurse practitioners, physician assistants) from across the United States. Data were gathered electronically from multidisciplinary providers within outpatient clinics throughout the United States on pediatric patients (ages 0-18 years). Exposures All participants were patch-tested to assess sensitizations to various allergens; history of AD was noted by the patch-testing providers. Main Outcomes and Measures Primary outcomes were sensitization rates to various patch-tested allergens. Results A total of 1142 patients were evaluated: 189 boys (34.2%) and 363 girls (65.8%) in the AD group and 198 boys (36.1%) and 350 girls (63.9%) in the non-AD group (data on gender identification were missing for 17 patients). Compared with those without AD, patch-tested patients with AD were 1.3 years younger (10.5 vs 11.8 years; P < .001) and had longer history of dermatitis (3.5 vs 1.8 years; P < .001). Patch-tested patients designated as Asian or African American were more likely to have concurrent AD (odds ratio [OR], 1.92; 95% CI, 1.20-3.10; P = .008; and OR, 4.09; 95% CI, 2.70-6.20; P <.001, respectively). Patients with AD with generalized distribution were the most likely to be patch tested (OR, 4.68; 95% CI, 3.50-6.30; P < .001). Patients with AD had different reaction profiles than those without AD, with increased frequency of reactions to cocamidopropyl betaine, wool alcohol, lanolin, tixocortol pivalate, and parthenolide. Patients with AD were also noted to have lower frequency of reaction to methylisothiazolinone, cobalt, and potassium dichromate. Conclusions and Relevance Children with AD showed significant reaction patterns to allergens notable for their use in skin care preparations. This study adds to the current understanding of AD in ACD, and the continued need to investigate the interplay between these disease processes to optimize care for pediatric patients with these conditions.
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Affiliation(s)
- Sharon E. Jacob
- Department of Dermatology, Loma Linda University, Loma Linda, California
| | - Maria McGowan
- Department of Internal Medicine, Loma Linda University, Loma Linda, California
| | - Nanette B. Silverberg
- Departments of Dermatology and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Janice L. Pelletier
- Department of Pediatric Dermatology, Eastern Maine Medical Center, Bangor
- University of Vermont School of Medicine, Burlington
| | - Luz Fonacier
- Department of Allery Immunology, State University of New York at Stony Brook, Stony Brook
- Department of Allery Immunology, Winthrop University Hospital, Mineola, New York
| | - Nico Mousdicas
- Department of Dermatology, Indiana University Health, Indianapolis
| | - Doug Powell
- Department of Dermatology, University of Utah, Salt Lake City
| | - Andrew Scheman
- Clinical Dermatology, Northwestern University, Chicago, Illinois
| | - Alina Goldenberg
- Department of Dermatology, University of California–San Diego, San Diego
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Affiliation(s)
- R. Bednarek
- Department of Dermatology; Geisinger Medical Center; Danville PA USA
| | - S. Warren
- Department of Dermatology; Division of Dermatopathology; Indiana University School of Medicine; Indianapolis IN USA
| | - N. Mousdicas
- Department of Pathology; Division of Dermatopathology; Indiana University School of Medicine; Indianapolis IN USA
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Ezra N, Jourabchi N, Mousdicas N. Voriconazole-Induced Subacute Cutaneous Lupus Erythematosus in an Adult With Aspergillosis. Skinmed 2016; 14:461-463. [PMID: 28031137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 59-year-old man was treated with voriconazole for chronic invasive aspergillosis and who subsequently developed subacute cutaneous lupus erythematosus (SCLE). The patient presented with a 6-week history of multiple erythematous papulosquamous lesions on his chest, upper and lower extremities, and back (Figure 1). They were nonpruritic and nonpainful. He was afebrile and otherwise well. He had no history of extensive sun exposure prior to the appearance of the eruption. He had been taking voriconazole for about 3 months prior to the onset of lesions. He denied any family history of connective tissue disease.
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Affiliation(s)
- Navid Ezra
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN;
| | - Natanel Jourabchi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nico Mousdicas
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN
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Veerkamp P, Mousdicas N, Bednarek R. Rosacea Fulminans Precipitated by Acute Stress: A Case Report Describing an Integrative Approach for a Patient Reluctant to Use Isotretinoin. Integr Med (Encinitas) 2016; 15:32-35. [PMID: 28223895 PMCID: PMC5312834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
CONTEXT Rosacea fulminans is a rare skin disorder with a multifactorial etiology. Stress is one of the common precipitating factors of this condition but is not often targeted in treatment. Isotretinoin is considered part of the first-line therapy for this condition but, in cases where its use is restricted, other therapeutic interventions as part of an integrative approach may be effective. PATIENT CONCERNS A 38-y-old female presented with rosacea fulminans brought on by an acutely stressful event. After multiple failed therapies, she experienced resolution of her symptoms with a combination of systemic corticosteroids, antibiotics, diet modification, and stress reduction, with the treatment of stress playing a significant role. CONCLUSIONS Stress management and diet modification are key adjunctive therapies in the treatment of rosacea fulminans and need to be addressed more often in treatment. In cases where patients are reluctant or unable to take isotretinoin, an integrative approach may be effective in achieving symptomatic improvement.
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Ward RE, Veerula VL, Ezra N, Travers JB, Mousdicas N. Multilevel symmetric neuropathic pruritus (MSNP) presenting as recalcitrant “generalized” pruritus. J Am Acad Dermatol 2016; 75:774-781. [DOI: 10.1016/j.jaad.2016.05.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 05/11/2016] [Accepted: 05/19/2016] [Indexed: 11/29/2022]
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Isaacs MJ, Strausburg MB, Mousdicas N. Pediatric Positional Sitting Dermatitis: A New Form of Pediatric Contact Dermatitis. Pediatr Dermatol 2016; 33:e226-7. [PMID: 27040019 DOI: 10.1111/pde.12858] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We report on four pediatric patients who presented with localized dermatitis in areas subject to repetitive friction due to their sitting positions. We propose that the cause of the eruption was irritant contact dermatitis due to frequently sitting in a crossed-leg sitting position, an entity for which we have coined the term pediatric positional sitting dermatitis (PPSD). The goal of this report is to raise clinicians' awareness of PPSD, which to our knowledge has not been previously described, and to discuss management of these patients.
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Affiliation(s)
- Michael J Isaacs
- Department of Dermatology, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Matthew B Strausburg
- Department of Dermatology, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Nico Mousdicas
- Department of Dermatology, School of Medicine, Indiana University, Indianapolis, Indiana
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Strausburg M, Linos K, Staser K, Mousdicas N. Dowling-Degos disease co-presenting with Darier disease. Clin Exp Dermatol 2015; 41:410-2. [DOI: 10.1111/ced.12790] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2015] [Indexed: 11/29/2022]
Affiliation(s)
- M. Strausburg
- Department of Dermatology; Indiana University School of Medicine; Indianapolis IN USA
| | - K. Linos
- Department of Pathology/Dermatopathology; Indiana University School of Medicine; Indianapolis IN USA
| | - K. Staser
- Department of Dermatology; Indiana University School of Medicine; Indianapolis IN USA
| | - N. Mousdicas
- Department of Dermatology; Indiana University School of Medicine; Indianapolis IN USA
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Liszewski W, Vogt K, Kuhar M, Mousdicas N, Magel G. Tortoiseshell-like plaque on the right flank. J Am Acad Dermatol 2015. [DOI: 10.1016/j.jaad.2014.10.015] [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: 11/25/2022]
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Bednarek R, Ezra N, Toubin Y, Linos K, Mousdicas N. Eruptive disseminated porokeratosis associated with corticosteroid-induced immunosuppression. Clin Exp Dermatol 2015; 40:753-6. [PMID: 25800103 DOI: 10.1111/ced.12636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2014] [Indexed: 11/29/2022]
Abstract
Eruptive disseminated porokeratosis (EDP) is a disease that presents clinically with sudden onset of erythematous papules and plaques, with a ridge-like border histologically represented by a cornoid lamella. We report a case of EDP occurring in a 39-year-old woman 3 days after completion of a 2-week course of oral corticosteroid therapy for an acute asthma exacerbation. The patient was treated with emollients and sun protection. Unlike the more chronic disseminated superficial (actinic) porokeratosis, EDP secondary to immunosuppression from corticosteroid therapy has very rarely been reported in the dermatological literature.
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Affiliation(s)
- R Bednarek
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - N Ezra
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Y Toubin
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - K Linos
- Department of Pathology, Division of Dermatopathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - N Mousdicas
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, USA
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Streicher JL, Sheehan MP, Armstrong AB, Mousdicas N. Cutaneous manifestation of α₁-antitrypsin deficiency: panniculitis absent on biopsy. Cutis 2014; 93:303-306. [PMID: 24999642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Patients with α₁-antitrypsin (AAT) deficiency may develop cutaneous manifestations of the disorder that histologically appear as panniculitis. Algorithms consistently emphasize measuring AAT levels when both clinical and histological features of deficiency are present; however, the patient's medical history and a physical examination alone can be extremely helpful in guiding the physician to the diagnosis of AAT deficiency. We describe a patient who presented with the classic clinical findings of AAT deficiency-associated panniculitis with surprising absence of panniculitis on repeated deep incisional biopsies. We propose a triad of classic findings that should alert the clinician to check the patient's serum AAT levels, even in the absence of panniculitis on histologic evaluation. Consideration of this clinical triad may prevent delays in the diagnosis of AAT deficiency, as early lesions may not yet demonstrate subcutaneous fat involvement.
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Affiliation(s)
- Jenna L Streicher
- Department of Dermatology, Indiana University School of Medicine, 550 N University Blvd, Ste 3240, Indianapolis, IN 46202, USA.
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Affiliation(s)
- Ha K Do
- Department of Dermatology, Indiana University, 545 Barnhill Drive-EH 139, Indianapolis, IN 46202.
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Travers JB, Spandau DF, Lewis DA, Machado C, Kingsley M, Mousdicas N, Somani AK. Fibroblast senescence and squamous cell carcinoma: how wounding therapies could be protective. Dermatol Surg 2013; 39:967-73. [PMID: 23437969 DOI: 10.1111/dsu.12138] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Squamous cell carcinoma (SCC), which has one of the highest incidences of all cancers in the United States, is an age-dependent disease, with the majority of these cancers diagnosed in people age 70 and older. Recent findings have led to a new hypothesis on the pathogenesis of SCC. OBJECTIVES To evaluate the potential of preventive therapies to reduce the incidence of SCC in at-risk geriatric patients. MATERIALS AND METHODS Survey of current literature on wounding therapies to prevent SCCs. RESULTS This new hypothesis of SCC photocarcinogenesis states that senescent fibroblasts accumulate in the dermis, resulting in a reduction in dermal insulin-like growth factor-1 (IGF-1) expression. This lack of IGF-1 expression sensitizes epidermal keratinocytes to fail to suppress ultraviolet light B (UVB)-induced mutations, leading to increased proclivity to photocarcinogenesis. Recent evidence suggests that dermal wounding therapies, specifically dermabrasion and fractionated laser resurfacing, can decrease the proportion of senescent dermal fibroblasts, increase dermal IGF-1 expression, and correct the inappropriate UVB response found in geriatric skin, protecting geriatric keratinocytes from UVB-induced SCC initiation. CONCLUSIONS In this review, we will discuss the translation of pioneering basic science results implicating commonly used dermal fibroblast rejuvenation procedures as preventative treatments for SCC.
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Affiliation(s)
- Jeffrey B Travers
- Department of Dermatology, Indiana University, Indianapolis, Indiana 46202, USA.
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Travers JB, Kozman A, Yao Y, Ming W, Yao W, Turner MJ, Kaplan MH, Mousdicas N, Haggstrom AN, Saha C. Treatment outcomes of secondarily impetiginized pediatric atopic dermatitis lesions and the role of oral antibiotics. Pediatr Dermatol 2012; 29:289-96. [PMID: 22150395 PMCID: PMC3310266 DOI: 10.1111/j.1525-1470.2011.01661.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Patients with atopic dermatitis (AD) are predisposed to infection with Staphylococcus aureus, which worsens their skin disease; it has been postulated that the lack of antimicrobial peptides due to aberrant allergic inflammation in skin with AD could mediate this enhanced bacterial susceptibility. We sought to characterize the amounts of S. aureus and biological products found in infected AD lesions and whether treatment with topical corticosteroids and oral cephalexin as the only antimicrobial improved outcomes. Fifty-nine children with clinically and S. aureus-positive impetiginized lesions of AD were enrolled in this study. A lesion was graded clinically using the Eczema Area and Severity Index, and wash fluid was obtained from the lesion for quantitative bacterial culture and antibiotic sensitivities and measurement of bacterial products and cytokines. Subjects were re-evaluated 2 weeks after treatment. Improvement in the clinical and inflammatory characteristics of impetiginized lesions were noted, even in the 15% of lesions infected with Methicillin-resistant S. aureus (MRSA). In a subgroup of subjects whose lesions did not contain S. aureus 2 weeks after initiating treatment, beta-defensin levels were higher at both visits than in normal skin. Treatment of uncomplicated impetiginized pediatric AD with topical corticosteroids and cephalexin results in significant clinical improvement, even in subjects infected with MRSA. We propose that the inhibition of abnormal inflammation by the treatment regimen, resulting in the high levels of defensins, is involved in the improvement of AD and that systemic antibiotics do not appear to be necessary in secondary impetiginized AD.
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Affiliation(s)
- Jeffrey B Travers
- Department of Dermatology, Indiana University School of Medicine, 550 N. University Blvd., suite 3240, Indianapolis, IN 46202, Indiana, USA.
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Yao Y, Kozman A, Al-Hassani M, Saha CK, Yi Q, Yao W, Mousdicas N, Kaplan MH, Travers JB. Identification of staphylococcal protein A in infected atopic dermatitis lesions. J Invest Dermatol 2010; 130:2502-4. [PMID: 20520625 DOI: 10.1038/jid.2010.154] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Travers JB, Kozman A, Mousdicas N, Saha C, Landis M, Al-Hassani M, Yao W, Yao Y, Hyatt AM, Sheehan MP, Haggstrom AN, Kaplan MH. Infected atopic dermatitis lesions contain pharmacologic amounts of lipoteichoic acid. J Allergy Clin Immunol 2009; 125:146-52.e1-2. [PMID: 19962742 DOI: 10.1016/j.jaci.2009.09.052] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 09/19/2009] [Accepted: 09/23/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Bacterial infection with Staphylococcus aureus is a known trigger for worsening of atopic dermatitis (AD); the exact mechanisms by which bacterial infection worsens dermatitis are unknown. OBJECTIVE We sought to characterize the amounts of the biologically active bacterial lipoprotein lipoteichoic acid (LTA) in infected AD lesions. METHODS Eighty-nine children with clinically impetiginized lesions of AD were enrolled in this study. A lesion was graded clinically by using the Eczema Area and Severity Index (EASI), wash fluid obtained from the lesion for quantitative bacterial culture, and measurement of LTA and cytokines. The staphylococcal isolate was tested for antibiotic susceptibilities. The patients were treated with a regimen that included topical corticosteroids and systemic antibiotics, and the lesion was reanalyzed after 2 weeks. RESULTS S aureus was identified in 79 of 89 children enrolled in the study. The bacterial colony-forming unit (CFU) counts correlated with the EASI lesional score (P = .04). LTA levels as high as 9.8 mug/mL were measured in the wash fluid samples, and the amounts correlated with the lesional EASI scores (P = .01) and S aureus CFU (P < .001). Approximately 30% of clinically impetiginized AD lesions contained greater than 1 mug/mL LTA, amounts that exert effects on various cell types in vitro. Moreover, injection of skin tissue ex vivo with amounts of LTA found in AD lesions resulted in epidermal cytokine gene expression. CONCLUSION Pharmacologic levels of LTA are found in many infected atopic dermatitis lesions.
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Affiliation(s)
- Jeffrey B Travers
- Department of Dermatology, Indiana University School of Medicine, 702 Barnhill Drive, Indianapolis, IN 46202, USA.
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Sehra S, Tuana FMB, Holbreich M, Mousdicas N, Tepper RS, Chang CH, Travers JB, Kaplan MH. Scratching the surface: towards understanding the pathogenesis of atopic dermatitis. Crit Rev Immunol 2008; 28:15-43. [PMID: 18298382 DOI: 10.1615/critrevimmunol.v28.i1.20] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease with a steadily increasing prevalence affecting 10%-20% of infants and 1%-3% of adults globally. It is often the first clinical manifestation of atopic disease preceding asthma and allergic rhinitis. At least half of the children with AD develop some other form of atopic disease later in life. The pathogenesis of AD involves a complex interplay of factors, including genetic predisposition due to altered immune or skin barrier function, interactions with the environment, and infectious triggers of inflammation. In this review, we summarize the recent advances in understanding the contribution of different factors in the pathophysiology of AD in human and animal model systems. These insights provide new therapeutic potential for the treatment of human AD.
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Affiliation(s)
- Sarita Sehra
- Department of Pediatrics and HB Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Sheehan M, Huddleston H, Mousdicas N. Picture of the month. Chronic bullous dermatosis of childhood. Arch Pediatr Adolesc Med 2008; 162:581-582. [PMID: 18524750 DOI: 10.1001/archpedi.162.6.581] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Michael Sheehan
- Department of Dermatology, Indiana University School of Medicine, Indianapolis 46202, USA
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Sehra S, Tuana FMB, Holbreich M, Mousdicas N, Kaplan MH, Travers JB. Clinical correlations of recent developments in the pathogenesis of atopic dermatitis. An Bras Dermatol 2008. [DOI: 10.1590/s0365-05962008000100009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Atopic dermatitis is a chronic inflammatory skin disease with a steadily increasing prevalence affecting 10-20 of infants and 1-3 of adults globally. It is often the first clinical manifestation of atopic disease preceding asthma and allergic rhinitis. Probably half of the children with atopic dermatitis develop some other form of atopic disease later in life. The pathogenesis involves a complex interplay of factors including genetic predisposition due to altered immune or skin barrier function, interactions with the environment such as food and allergen exposures, and infectious triggers of inflammation. In this review, we summarize the recent advances in understanding the contribution of different factors in the pathophysiology of atopic dermatitis and how insights provide new therapeutic potential for its treatment.
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Affiliation(s)
- Sarita Sehra
- Center for Pediatric Research, United States of America
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Allen KJ, Davis CL, Billings SD, Mousdicas N. Recalcitrant papulopustular rosacea in an immunocompetent patient responding to combination therapy with oral ivermectin and topical permethrin. Cutis 2007; 80:149-151. [PMID: 17944176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A 68-year-old healthy man presented with papulopustular rosacea (PPR) recalcitrant to multiple therapies, including permethrin cream 5%. Histologic examination detected the presence of chronic folliculitis and numerous Demodex organisms. A diagnosis of rosacealike demodicidosis was rendered, and the patient was treated with oral ivermectin and permethrin cream 5%, resulting in resolution of the folliculitis. Demodex infestation should be considered in any patient with rosacealike dermatitis resistant to conventional rosacea therapies. If infestation is demonstrated in these patients, oral ivermectin in combination with topical permethrin is a safe and effective therapeutic option.
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Affiliation(s)
- Kattie J Allen
- Indiana University School of Medicine, Indianapolis 46202, USA
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Affiliation(s)
- Ernest Lee
- Indiana University School of Medicine, Indianapolis, USA
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Zhang Q, Mousdicas N, Yi Q, Al-Hassani M, Billings SD, Perkins SM, Howard KM, Ishii S, Shimizu T, Travers JB. Staphylococcal lipoteichoic acid inhibits delayed-type hypersensitivity reactions via the platelet-activating factor receptor. J Clin Invest 2005; 115:2855-61. [PMID: 16184199 PMCID: PMC1224300 DOI: 10.1172/jci25429] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2005] [Accepted: 07/12/2005] [Indexed: 01/17/2023] Open
Abstract
Staphylococcus aureus infections are known triggers for skin inflammation and can modulate immune responses. The present studies used model systems consisting of platelet-activating factor receptor-positive and -negative (PAF-R-positive and -negative) cells and PAF-R-deficient mice to demonstrate that staphylococcal lipoteichoic acid (LTA), a constituent of Gram-positive bacteria cell walls, acts as a PAF-R agonist. We show that LTA stimulates an immediate intracellular Ca2+ flux only in PAF-R-positive cells. Intradermal injections of LTA and the PAF-R agonist 1-hexadecyl-2-N-methylcarbamoyl glycerophosphocholine (CPAF) induced cutaneous inflammation in wild-type but not PAF-R-deficient mice. Systemic exposure to LTA or CPAF inhibited delayed-type hypersensitivity (DTH) reactions to the chemical dinitrofluorobenzene only in PAF-R-expressing mice. The inhibition of DTH reactions was abrogated by the addition of neutralizing antibodies to IL-10. Finally, we measured levels of LTA that were adequate to stimulate PAF-R in vitro on the skin of subjects with infected atopic dermatitis. Based on these studies, we propose that LTA exerts immunomodulatory effects via the PAF-R through production of the Th2 cytokine IL-10. These findings show a novel mechanism by which staphylococcal infections can inhibit Th1 reactions and thus worsen Th2 skin diseases, such as atopic dermatitis.
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MESH Headings
- Animals
- Calcium/immunology
- Cell Line
- Dermatitis, Atopic/immunology
- Dermatitis, Atopic/microbiology
- Dermatitis, Atopic/pathology
- Dinitrofluorobenzene/adverse effects
- Drug Hypersensitivity/immunology
- Drug Hypersensitivity/pathology
- Drug Synergism
- Humans
- Hypersensitivity, Delayed/chemically induced
- Hypersensitivity, Delayed/immunology
- Hypersensitivity, Delayed/pathology
- Inflammation/chemically induced
- Inflammation/immunology
- Inflammation/pathology
- Interleukin-10/immunology
- Lipopolysaccharides/administration & dosage
- Lipopolysaccharides/chemistry
- Mice
- Mice, Knockout
- Platelet Activating Factor/administration & dosage
- Platelet Activating Factor/analogs & derivatives
- Platelet Membrane Glycoproteins/agonists
- Platelet Membrane Glycoproteins/deficiency
- Platelet Membrane Glycoproteins/immunology
- Receptors, G-Protein-Coupled/agonists
- Receptors, G-Protein-Coupled/deficiency
- Receptors, G-Protein-Coupled/immunology
- Skin/immunology
- Skin/pathology
- Staphylococcal Infections/immunology
- Staphylococcal Infections/pathology
- Staphylococcus aureus/chemistry
- Staphylococcus aureus/immunology
- Teichoic Acids/administration & dosage
- Teichoic Acids/chemistry
- Th1 Cells/immunology
- Th1 Cells/pathology
- Th2 Cells/immunology
- Th2 Cells/pathology
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Affiliation(s)
- Qiwei Zhang
- Department of Dermatology, H.B. Wells Center for Pedoatric Research, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
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Mousdicas N, Saxe N. Fish-tank granuloma. The first reported case in South Africa. S Afr Med J 1987; 71:321-2. [PMID: 3563758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The first case of infection with the non-tuberculous mycobacterium, Mycobacterium marinum, in South Africa is reported. Of special interest was the linear nodular (sporotrichoid) appearance.
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