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Tworig J, Morrie R, Bistrong K, Somaiya RD, Hsu S, Liang J, Cornejo K, Feller MB. Differential expression analysis identifies candidate synaptogenic molecules for wiring direction-selective circuits in the retina. J Neurosci 2024:e1461232024. [PMID: 38514178 DOI: 10.1523/jneurosci.1461-23.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 02/16/2024] [Accepted: 02/22/2024] [Indexed: 03/23/2024] Open
Abstract
An organizational feature of neural circuits is the specificity of synaptic connections. A striking example is the direction-selective (DS) circuit of the retina. There are multiple subtypes of DS retinal ganglion cells (DSGCs) that prefer motion along one of 4 preferred directions. This computation is mediated by selective wiring of a single inhibitory interneuron, the starburst amacrine cell (SAC), with each DSGC subtype preferentially receiving input from a subset of SAC processes. We hypothesize that the molecular basis of this wiring is mediated in part by unique expression profiles of DSGC subtypes. To test this, we first performed paired recordings from isolated mouse retina of both sexes to determine that postnatal day 10 (P10) represents the age at which asymmetric synapses form. Second, we performed RNA-sequencing and differential expression analysis on isolated P10 ON-OFF DSGCs tuned for either nasal or ventral motion and identified candidates which may promote direction-specific wiring. We then used a conditional knockout strategy to test the role of one candidate, the secreted synaptic organizer cerebellin-4 (Cbln4), in the development of DS tuning. Using two-photon calcium imaging, we observed a small deficit in directional tuning among ventral-preferring DSGCs lacking Cbln4, though whole-cell voltage clamp recordings did not identify a significant change in inhibitory inputs. This suggests that Cbln4 does not function primarily via a cell-autonomous mechanism to instruct wiring of DS circuits. Nevertheless, our transcriptomic analysis identified unique candidate factors for gaining insights into the molecular mechanisms that instruct wiring specificity in the DS circuit.Significance Statement By performing mRNA transcriptome analysis on three populations of direction-selective ganglion cells - two preferring horizontal motion and one preferring vertical motion - we identified differentially expressed candidate molecules potentially involved in cell subtype-specific synaptogenesis within this circuit. We tested the role of one differentially expressed candidate, Cbln4, enriched in ventral-preferring DSGCs. Using a targeted knockout approach, the deletion of Cbln4 led to a small reduction in direction-selective tuning while maintaining dendritic morphology and normal strength and asymmetry of inhibitory synaptic transmission. Overall, we have shown that this approach can be used to identify interesting candidate molecules, and future functional studies are required to reveal the mechanisms by which these candidates influence synaptic wiring within specific circuits.
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Affiliation(s)
- J Tworig
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA 94720
| | - R Morrie
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA 94720
| | - K Bistrong
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA 94720
| | - R D Somaiya
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA 94720
| | - S Hsu
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA 94720
| | - J Liang
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA 94720
| | - K Cornejo
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA 94720
| | - M B Feller
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA 94720
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA 94720
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2
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James WA, Rosenberg AL, Wu JJ, Hsu S, Armstrong A, Wallace EB, Lee LW, Merola J, Schwartzman S, Gladman D, Liu C, Koo J, Hawkes JE, Reddy S, Prussick R, Yamauchi P, Lewitt M, Soung J, Weinberg J, Lebwohl M, Glick B, Kircik L, Desai S, Feldman SR, Zaino ML. Executive Summary: From the Medical Board of the National Psoriasis Foundation: Perioperative management of immunomodulatory agents in patients with psoriasis and psoriatic arthritis. J Am Acad Dermatol 2024:S0190-9622(24)00497-3. [PMID: 38499181 DOI: 10.1016/j.jaad.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 02/06/2024] [Accepted: 03/05/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Warren A James
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Angela L Rosenberg
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jashin J Wu
- Department of Dermatology, University of Miami Miller School of Medicine
| | - Sylvia Hsu
- Temple University School of Medicine, Philadelphia, Pennsylvania
| | | | | | - Lara Wine Lee
- Medical University of South Carolina, Charleston, South Carolina
| | - Joseph Merola
- Brigham and Women's Hospital Harvard Medical School, Boston, Massachusetts
| | | | | | - Clive Liu
- Bellevue Dermatology, Bellevue, Washington
| | - John Koo
- University of California, San Francisco Medical Center, San Francisco, California
| | | | - Soumya Reddy
- NYU Grossman School of Medicine, New York, New York
| | - Ron Prussick
- Washington Dermatology Center, Frederick, Maryland
| | - Paul Yamauchi
- Dermatology Institute & Skin Care Center Santa Monica, California
| | | | | | | | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina;; Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina;; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina;; Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mallory L Zaino
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina;.
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3
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Hackley M, Thampy D, Waseh S, Feldman SR, Blauvelt A, Weinberg JM, Schwartzman S, Liao W, Prussick R, Cohen JM, Hsu S. Increased risk of severe generalized pustular psoriasis due to tuberculosis screening delay for spesolimab initiation. J Am Acad Dermatol 2024; 90:408-410. [PMID: 37821053 DOI: 10.1016/j.jaad.2023.09.078] [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: 07/28/2023] [Revised: 09/24/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Madison Hackley
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Daphne Thampy
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Shayan Waseh
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Steven R Feldman
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | - Jeffrey M Weinberg
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sergio Schwartzman
- Hospital for Special Surgery, New York Prsebyterian Hospital, Weill Cornell Medical Center, New York, New York
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Ronald Prussick
- Department of Dermatology, George Washington University, Washington, DC
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Sylvia Hsu
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania.
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4
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Awh KC, Hsu S. Do We Need to Monitor for Graves' Disease After a Diagnosis of Pemphigoid Gestationis? Cureus 2023; 15:e48972. [PMID: 38106729 PMCID: PMC10725743 DOI: 10.7759/cureus.48972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
Pemphigoid gestationis (PG) is a rare autoimmune bullous disease that occurs during pregnancy or the postpartum period. PG has been associated with an increased risk of Graves' disease possibly due to shared genetic factors and immune system fluctuations during pregnancy. However, the evidence supporting the association between PG and Graves' disease is mixed. Although dermatologists are cautioned to watch for Graves' disease in patients with a history of PG, this guidance is based on a single cohort where most patients were diagnosed with Graves' disease prior to PG onset. Recent data failed to find an association between Graves' disease and PG but did not capture the lifetime risk of Graves' disease in these patients. Future studies could focus on long-term follow-up of females with PG, shedding light on the lifetime risk profiles of these patients.
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Affiliation(s)
| | - Sylvia Hsu
- Dermatology, Temple University Hospital, Philadelphia, USA
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5
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Parker JJ, Waseh S, Hsu S. The hairy sole sign. JAAD Case Rep 2023; 41:102-103. [PMID: 37920701 PMCID: PMC10618611 DOI: 10.1016/j.jdcr.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Affiliation(s)
- Jennifer J. Parker
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Shayan Waseh
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Sylvia Hsu
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
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6
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Hackley M, Loesch A, Brownstone N, Hsu S. Commentary: Successful treatment of refractory palmoplantar pustular psoriasis with apremilast: a case series. Front Med (Lausanne) 2023; 10:1283313. [PMID: 38020107 PMCID: PMC10646758 DOI: 10.3389/fmed.2023.1283313] [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: 08/25/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Madison Hackley
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Amanda Loesch
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | | | - Sylvia Hsu
- Temple University Health System, Inc., Philadelphia, PA, United States
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7
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Ku ECY, Hsu S, Banker R, Healy E, Chen AM, Harris JP. Pre- and Post-Treatment Patient-Reported Financial Toxicity in Head and Neck Cancer: Identifying Influential Factors and Clinical Significance. Int J Radiat Oncol Biol Phys 2023; 117:e241-e242. [PMID: 37784951 DOI: 10.1016/j.ijrobp.2023.06.1170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Head and neck cancer patients are at high-risk for financial stress due to the often complex, time-consuming, and expensive treatments that can impact physical function and quality of life. It is important to identify factors that affect financial toxicity early on in treatment and to help mitigate their effects. The goals of this study are to assess patient-reported financial toxicity prior to and after completion of radiation therapy (RT) and to uncover any interactions with socioeconomic factors, quality of life, treatment satisfaction, and treatment adherence. MATERIALS/METHODS A total of 80 patients who were evaluated for RT to the head and neck region between July 2021 and December 2022 and had completed surveys prior to the initiation of RT were included. Surveys included the FACIT-COST and FACIT-TS-G. Patient clinical information and demographics were collected. Linear regression was used to evaluate categorical variables and Pearson correlation was used to evaluate continuous variables and their associations with COST. RESULTS The median pre-RT COST was 29.5 (range 4-44) with lower scores indicating worse financial toxicity. The majority of patients were white (69%), non-Hispanic (75%), and English-speaking (75%). 65% had Medicare, 14% had Medicaid, and 21% had other insurance. 60 of 80 (75%) patients ultimately underwent RT at our institution. 34 (57%) missed at least one day of scheduled RT fractions and 11 (14%) patients had G-tubes placed. Lower COST was associated with decreased age, thyroid primary disease, advanced stage, metastatic disease, Medicaid insurance, Hispanic ethnicity, unemployment, and G-tube placement. Higher COST was associated with cutaneous primary disease and ability to speak English, while Medicare insurance trended toward significance. 18 of 80 patients (23%) completed follow-up surveys post-RT and 9 reported a decrease in COST. At baseline, the standard deviation of the COST was 10.6. Effect size was defined as the number of standard deviation change. Mean decrease in COST was 9.4 (effect size of 89%). Mean FACT-TS-G was lower, indicating decreased treatment satisfaction, for these patients as compared to those that had the same or increased COST compared to baseline, (17.4 vs. 22.7, p < 0.01). There were more missed RT days, 4 vs. 1, and G-tube placements, 2 vs. 0, in those with decreased COST as well. CONCLUSION Worse baseline financial toxicity was associated with younger age, advanced stage, metastatic disease, Medicaid insurance, unemployment, and G-tube placement. Those that reported worsened financial toxicity after RT reported worse treatment satisfaction and had more missed RT days and G-tube placements. These findings support work to better understand financial toxicity as it may predict those at higher risk of missing treatments, particularly crucial considering prolonged RT duration is linked to poorer outcomes. Future efforts will focus on automating early referrals to case managers and social work services for these patients.
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Affiliation(s)
- E C Y Ku
- Department of Radiation Oncology, University of California - Irvine, Orange, CA
| | - S Hsu
- Department of Radiation Oncology, University of California - Irvine, Orange, CA
| | - R Banker
- Department of Hematology/Oncology, University of California Irvine - Orange, CA, Orange, CA
| | - E Healy
- Department of Radiation Oncology, University of California - Irvine, Orange, CA
| | - A M Chen
- Department of Radiation Oncology, University of California - Irvine, Orange, CA
| | - J P Harris
- Department of Radiation Oncology, University of California - Irvine, Orange, CA
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8
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Harris JP, Hsu S, Ku ECY, Nagasaka M, Kuo JV, Healy E. Severity of Financial Toxicity for Patients Receiving Palliative Radiation Therapy. Int J Radiat Oncol Biol Phys 2023; 117:e234-e235. [PMID: 37784933 DOI: 10.1016/j.ijrobp.2023.06.1153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Patients receiving palliative radiotherapy (RT) are often at their most vulnerable state, but the impact of financial toxicity on their health and quality of life (QOL) is not well-described. We set out to determine the degree of financial toxicity in a population undergoing palliative RT. MATERIALS/METHODS A review of patients referred for palliative RT at our site was conducted. Financial toxicity was determined with COST-FACIT, and previously suggested grading cutoffs were used. Additional patient-reported outcome (PRO) instruments included the EORTC overall health and quality of life questions and the FACIT-TS-G (treatment satisfaction). Multiple imputations by chained equations using predictive mean matching were used for incomplete responses. Spearman's rank correlation coefficient, Kruskal-Wallis testing, and linear regressions were used to measure associations. RESULTS A total of 53 patients were identified who had completed PRO surveys between May 2021 and December 2022. Median COST was 25 (range 0-44), with lower scores indicating greater financial toxicity. 49% reported grade 0 financial toxicity (COST ≥26), 32% had grade 1 financial toxicity (COST 14-25), 19% had grade 2 financial toxicity (COST 1-13), and 6% had grade 3 financial toxicity (COST = 0). Overall, cancer caused financial hardship among 45%. Higher COST was moderately associated with higher overall health (rho = 0.36, p = 0.02) and weakly associated with higher QOL (rho = 0.28, p = 0.07). From a demographic standpoint, median area family income from census tract data was $98,598 (range $32,303-$190,833), and higher income was associated with higher COST (rho = 0.47, p<0.001). Having Medicare (beta = 13.8, p = 0.003) or private (beta = 13.5, p = 0.001) coverage (rather than Medicaid) were associated with less financial toxicity, whereas having an underrepresented minority background (beta = -13.2, p<0.001), or having a non-English language preference (rho = 0.40, p = 0.003) were associated with greater financial toxicity. Median time from diagnosis was 12.9 mo, and 40% of patients had ≥2 prior systemic therapies. The median RT dose was 25 Gy (range 4-45 Gy). The most common irradiated sites included spine (24%), non-spine bones (21%), brain (18%), and lung/mediastinum (18%). COST was not associated with number of prior systemic therapies (p = 0.31), RT dose (p = 0.83), RT technique (p = 0.86), or treatment satisfaction (p = 0.34). Median follow up was 8.0 months, and median 6-month survival was 83% (95% CI 73%-95%). Inferior OS was associated with more prior systemic therapies (HR 3.43, p = 0.03), but not with COST (HR 1.01, p = 0.67). CONCLUSION Financial toxicity was seen in approximately half of patients receiving palliative RT. Patient-reported overall health, Medicaid coverage, and area income correlated well with financial toxicity, but the investigated clinical characteristics did not. This supports the hypothesis that financial toxicity is common and a unique factor that should be measured in cancer patients.
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Affiliation(s)
- J P Harris
- Department of Radiation Oncology, University of California - Irvine, Orange, CA
| | - S Hsu
- Department of Radiation Oncology, University of California - Irvine, Orange, CA
| | - E C Y Ku
- Department of Radiation Oncology, University of California - Irvine, Orange, CA
| | - M Nagasaka
- Division of Hematology and Oncology, University of California - Irvine, Orange, CA
| | - J V Kuo
- Department of Radiation Oncology, University of California - Irvine, Orange, CA
| | - E Healy
- Department of Radiation Oncology, University of California - Irvine, Orange, CA
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9
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Tekmen V, Cochrane M, Kim J, Hsu S, Rees A. Topical Tacrolimus and Alcohol-Induced Facial Flushing: A Case Report and Literature Review. Cureus 2023; 15:e46744. [PMID: 38021509 PMCID: PMC10631569 DOI: 10.7759/cureus.46744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 12/01/2023] Open
Abstract
Flush reactions can be incited by various factors including inherent mutation, drugs, and diseases. A medication that is commonly used in dermatology but less associated with alcohol-induced facial flushing is topical tacrolimus. We present the case of a 44-year-old man experiencing this phenomenon on a distant, non-application site and a review of cases published in the literature.
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Affiliation(s)
- Volkan Tekmen
- Dermatology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Mikayla Cochrane
- Dermatology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Joyce Kim
- Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, USA
| | - Sylvia Hsu
- Dermatology, Temple University Hospital, Philadelphia, USA
| | - Adam Rees
- Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, USA
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10
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Loesch A, Brownstone ND, Hsu S. Tinea Capitis Mimicking Alopecia Areata. Skinmed 2023; 21:277-278. [PMID: 37771022] [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: 09/30/2023]
Affiliation(s)
- Amanda Loesch
- The Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, PA
| | - Nicholas D Brownstone
- The Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, PA
| | - Sylvia Hsu
- The Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, PA;
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11
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Tran T, Katz L, Hsu S. Microneedling in Clinical Practice. Skinmed 2023; 21:300. [PMID: 37771030] [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: 09/30/2023]
Affiliation(s)
- Theresa Tran
- School of Medicine at Temple University, Philadelphia, PA;
| | - Lewis Katz
- School of Medicine at Temple University, Philadelphia, PA
| | - Sylvia Hsu
- Department of Darmatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA;
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12
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Hackley M, Brownstone ND, Hsu S. Diagnosing Monkeypox: The "Doughnut Pustule" Debunked. Skinmed 2023; 21:190-191. [PMID: 37634104] [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: 08/28/2023]
Affiliation(s)
- Madison Hackley
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, PA
| | - Nicholas D Brownstone
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, PA
| | - Sylvia Hsu
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, PA;
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13
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Bowden A, Ekeh O, Brownstone ND, Hsu S. Acneiform Eruption Secondary to Over-the-Counter Vitamin B12. Cureus 2023; 15:e43275. [PMID: 37692729 PMCID: PMC10492573 DOI: 10.7759/cureus.43275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Treating an acneiform eruption requires the discovery of its etiology. Often, the removal of the offending agent can lead to the resolution of the eruption, resulting in an excellent prognosis. Herein, we present a rare case of a vitamin B12-induced acneiform eruption occurring in a 68-year-old female due to an over-the-counter supplement.
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Affiliation(s)
- Acacia Bowden
- Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, USA
| | - Odera Ekeh
- Dermatology, Cooper Medical School of Rowan University, Camden, USA
| | | | - Sylvia Hsu
- Dermatology, Temple University Hospital, Philadelphia, USA
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14
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Masood M, Brownstone ND, Agarwala SN, Jin A, Hsu S. Diffuse Annular Plaques in an Infant. Cutis 2023; 112:E12-E14. [PMID: 37820337 DOI: 10.12788/cutis.0846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- Mavra Masood
- Dr. Masood is from the Department of Internal Medicine, Lankenau Medical Center, Wynnewood, Pennsylvania. Drs. Brownstone, Agarwala, Jin, and Hsu are from the Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Nicholas D Brownstone
- Dr. Masood is from the Department of Internal Medicine, Lankenau Medical Center, Wynnewood, Pennsylvania. Drs. Brownstone, Agarwala, Jin, and Hsu are from the Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Saira N Agarwala
- Dr. Masood is from the Department of Internal Medicine, Lankenau Medical Center, Wynnewood, Pennsylvania. Drs. Brownstone, Agarwala, Jin, and Hsu are from the Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Annie Jin
- Dr. Masood is from the Department of Internal Medicine, Lankenau Medical Center, Wynnewood, Pennsylvania. Drs. Brownstone, Agarwala, Jin, and Hsu are from the Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Sylvia Hsu
- Dr. Masood is from the Department of Internal Medicine, Lankenau Medical Center, Wynnewood, Pennsylvania. Drs. Brownstone, Agarwala, Jin, and Hsu are from the Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
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15
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Lee D, Waseh S, Motaparthi K, Hsu S. Rowell Syndrome in a Middle-Aged Woman: A Case Report. Cureus 2023; 15:e39631. [PMID: 37388608 PMCID: PMC10305509 DOI: 10.7759/cureus.39631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/01/2023] Open
Abstract
Rowell syndrome (RS) is characterized by the presentation of lupus erythematosus (LE) with erythema multiforme (EM)-like lesions. It is thought to display a characteristic serologic pattern consisting of a "speckled-type" antinuclear antibody (ANA), positive anti-Ro/SSA or anti-La/SSB, or positive rheumatoid factor (RF). We report the case of a patient with subacute cutaneous lupus erythematosus (SCLE) who presented with EM-like lesions responsive to oral corticosteroids.
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Affiliation(s)
- Diane Lee
- Dermatology, Temple University Hospital, Philadelphia, USA
| | - Shayan Waseh
- Dermatology, Temple University Hospital, Philadelphia, USA
| | | | - Sylvia Hsu
- Dermatology, Temple University Hospital, Philadelphia, USA
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16
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Raman J, Jin A, Parker JJ, Vickers CM, Proca DM, Hsu S, Lee JB. Multiple fibrofolliculomas within a fibrous cephalic plaque in a patient with tuberous sclerosis. JAAD Case Rep 2023; 34:36-39. [PMID: 36941874 PMCID: PMC10023931 DOI: 10.1016/j.jdcr.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Affiliation(s)
- Justin Raman
- College of Medicine, University of Florida, Gainesville, Florida
| | - Annie Jin
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
- Correspondence to: Annie Jin, MD, Department of Dermatology, Temple University Lewis Katz School of Medicine, 3401 North Broad St, Ste. B500, Philadelphia, PA 19140.
| | - Jennifer J. Parker
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Conor M. Vickers
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Daniela M. Proca
- Department of Pathology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Sylvia Hsu
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Jason B. Lee
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
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Szymanski M, Mirza K, De Jonge N, Schmidt T, Brahmbhatt D, Billia F, Hsu S, MacGowan G, Jakovljevic D, Agostoni P, Trombara F, Jorde U, Rochlani Y, Vandersmissen K, Reiss N, Russell S, Meyns B, Gustafsson F. Prognostic Value of Repeated Peak Oxygen Uptake Measurements in LVAD Patients - Follow Up on PRO-VAD Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1644] [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: 04/05/2023] Open
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18
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Mehta A, Goldberg J, Bagchi P, Marboe C, Shah K, Najjar S, Hsu S, Rodrigo M, Jang M, Cochrane A, Tchoukina I, Kong H, Lohmar B, Mcnair E, Valantine H, Agbor-Enoh S, Berry G, Shah P. Cell-Free DNA Enhances Pathologist Interrater Reliability at the Assessment of Acute Rejection on Endomyocardial Biopsy, on Behalf of the GRAfT Investigators. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1524] [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: 04/05/2023] Open
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Grewal J, Bortner B, Gregoski M, Cook D, Britt A, Hajj J, Rofael M, Sheidu M, Montovano M, Mehta M, Hajduczok A, Rajapreyar I, Brailovski Y, Genuardi M, Kanwar M, Atluri P, Lander M, Shah P, Hsu S, Kilic A, Houston B, Tedford R. Validation of the Heartmate 3 Risk Score in a Real World Patient Cohort. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1590] [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: 04/05/2023] Open
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20
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Goldberg J, deFilippi C, Lockhart C, McNair E, Sinha S, Kong H, Najjar S, Lohmar B, Tchoukina I, Shah K, Feller E, Hsu S, Rodrigo M, Jang M, Marboe C, Berry G, Valantine H, Agbor-Enoh S, Shah P. Dysregulated Circulating Proteins in Cellular and Antibody-Mediated Rejection, on Behalf of the Graft Investigators. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.146] [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: 04/05/2023] Open
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21
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Szymanski M, Mirza K, De Jonge N, Schmidt T, Brahmbhatt D, Billia F, Hsu S, MacGowan G, Jakovljevic D, Agostoni P, Trombara F, Jorde U, Rochlani Y, Vandersmissen K, Reiss N, Russell S, Meyns B, Gustafsson F. Improvement in Peak Oxygen Uptake During First Year of Mechanical Circulatory Support in End-Stage Heart Failure Patients - Follow Up on PRO-VAD Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.780] [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: 04/05/2023] Open
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22
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Jin A, McLarney BD, Hsu S, Lee JB. Granulomatous secondary syphilis: Another diagnostic pitfall for the dermatopathologist. J Cutan Pathol 2023; 50:209-212. [PMID: 36437794 DOI: 10.1111/cup.14370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 11/29/2022]
Abstract
Syphilis is growing ever more prevalent in the United States with its incidence rising every year. Dermatopathologists need to maintain a high index of suspicion to avoid delayed diagnosis of this treatable disease. Accordingly, it is imperative to be aware of its myriad of presentations-including secondary syphilis with granulomatous inflammation. Most cases show aggregations of epithelioid histiocytes associated with plasma cells. Other patterns include an interstitial granuloma-annulare-like pattern, sarcoidal, and tuberculoid pattern. Immunohistochemical stains for Treponema pallidum may be negative, especially in late secondary or tertiary syphilis. We present a case of nodular secondary syphilis with granulomatous inflammation with negative T. pallidum staining.
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Affiliation(s)
- Annie Jin
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
| | - Brett D McLarney
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sylvia Hsu
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jason B Lee
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Ohanenye C, Brownstone ND, Huang S, Lee JB, Hsu S. Lichen Sclerosus of the Lip. Cureus 2023; 15:e35234. [PMID: 36968933 PMCID: PMC10033245 DOI: 10.7759/cureus.35234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 02/22/2023] Open
Abstract
In this case report, we outline a case of a 36-year-old woman who presented to the dermatology clinic with a history of a hypopigmented macule on her lip. After conducting hepatitis C antibody testing and a shave biopsy, the patient was diagnosed with lichen sclerosus. Because of the increased risk for squamous cell carcinoma, she underwent an anogenital exam, where no lesions were found.
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Wiese D, Stroup AM, Shevchenko A, Hsu S, Henry KA. Disparities in Cutaneous T-Cell Lymphoma Incidence by Race/Ethnicity and Area-Based Socioeconomic Status. Int J Environ Res Public Health 2023; 20:3578. [PMID: 36834276 PMCID: PMC9960518 DOI: 10.3390/ijerph20043578] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/11/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Cutaneous T-cell lymphoma (CTCL) is a rare type of extranodal non-Hodgkin lymphoma (NHL). This study uses population-based data from the New Jersey (NJ) State Cancer Registry to examine geographic variation in CTCL incidence and evaluates whether CTCL risk varies by race/ethnicity and census tract socioeconomic status (SES). The study included 1163 cases diagnosed in NJ between 2006 and 2014. Geographic variation and possible clustering of high CTCL rates were assessed using Bayesian geo-additive models. The associations between CTCL risk and race/ethnicity and census tract SES, measured as median household income, were examined using Poisson regression. CTCL incidence varied across NJ, but there were no statistically significant geographic clusters. After adjustment for age, sex, and race/ethnicity, the relative risk (RR) of CTCL was significantly higher (RR = 1.47, 95% confidence interval: 1.22-1.78) in the highest income quartile than in the lowest. The interactions between race/ethnicity and SES indicated that the income gradients by RR were evident in all groups. Compared to non-Hispanic White individuals in low-income tracts, CTCL risk was higher among non-Hispanic White individuals in high-income tracts and among non-Hispanic Black individuals in tracts of all income levels. Our findings suggest racial disparities and a strong socioeconomic gradient with higher CTCL risk among cases living in census tracts with higher income compared to those living in lower-income tracts.
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Affiliation(s)
- Daniel Wiese
- Department of Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA 30144, USA
- Department of Geography and Urban Studies, Temple University, Philadelphia, PA 19122, USA
| | - Antoinette M. Stroup
- New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, NJ 08608, USA
- Rutgers Cancer Institute of New Jersey, Rutgers Biomedical and Health Sciences, New Brunswick, NJ 08901, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA
| | - Alina Shevchenko
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
| | - Sylvia Hsu
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
| | - Kevin A. Henry
- Department of Geography and Urban Studies, Temple University, Philadelphia, PA 19122, USA
- Division of Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, PA 19115, USA
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Park JS, Saeidian AH, Youssefian L, Hsu S, Vahidnezhad H, Uitto J. Acquired ichthyosis, asteatotic dermatitis or xerosis? An update on pathoetiology and drug-induced associations. J Eur Acad Dermatol Venereol 2023; 37:47-56. [PMID: 36165597 DOI: 10.1111/jdv.18608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/14/2022] [Indexed: 12/15/2022]
Abstract
Acquired ichthyosis (AI) is a relatively rare cutaneous entity characterized by transient, generalized scaling and pruritus in the absence of family history of ichthyosis or atopic disease. The hyperkeratosis in AI can range from the mild, white-to-brown scaling resembling that in ichthyosis vulgaris (IV) to the more prominent dark brown scaling phenotype, similar to that found in lamellar ichthyosis. The disease can wax and wane in relation to endogenous and/or exogenous factors. Histopathology of AI is similar to that found in IV. AI is usually of cosmetic concern to patients but can, in some cases, reflect the presence of more serious conditions, including malignancies, autoimmune diseases or metabolic disorders. In some cases, AI can be an adverse effect of a medication or the cutaneous symptom of a toxic exposure. Other conditions, such as severe xerosis or eczema, can present with clinical findings similar to AI, making diagnosis a challenge. Furthermore, cases of AI are sporadic throughout the literature and have been documented across a wide variety of medical settings distinct from dermatology, which often contribute to misdiagnosis of this disease. Definitive management requires prompt identification and treatment of the inciting factors combined with conservative therapies, which can include topical emollients, keratolytics, retinoids or corticosteroids, and in rare cases, oral retinoids.
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Affiliation(s)
- Jason S Park
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Amir H Saeidian
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Leila Youssefian
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sylvia Hsu
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
| | - Hassan Vahidnezhad
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jouni Uitto
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Forman JL, Brownstone ND, Hsu S. A trailing Scale that Is Not Erythema Annulare Centrifugum. Skinmed 2023; 21:38-39. [PMID: 36987826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Affiliation(s)
- Jessica L Forman
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, PA
| | - Nicholas D Brownstone
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, PA
| | - Sylvia Hsu
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, PA;
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Tran TN, Huang S, Hsu S. The Need for Unified Consensus on Wound Care Management in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Skinmed 2023; 21:7-11. [PMID: 36987820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Affiliation(s)
- Theresa N Tran
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, PA
| | - Simo Huang
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, PA
| | - Sylvia Hsu
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, PA;
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28
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Markeson CD, Brownstone ND, Sun CW, Hsu S. Targetoid Lesions, but the Diagnosis Is Not Erythema Multiforme. Skinmed 2023; 21:107-109. [PMID: 37158350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Christopher D Markeson
- Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Nicholas D Brownstone
- Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Christina W Sun
- Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Sylvia Hsu
- Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA;
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Gilkey T, Hammond A, Gurnani P, Forouzandeh M, Hsu S, Motaparthi K. Subtype transition from pemphigus vulgaris to pemphigus foliaceus. JAAD Case Rep 2022; 31:31-34. [DOI: 10.1016/j.jdcr.2022.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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30
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Hsu S, Stevens D, Sajjad F, Salapatek A. ONSET OF ACTION OF AZELASTINE HCL NASAL SPRAY 0.15% EVALUATED IN AN ENVIRONMENTAL EXPOSURE CHAMBER. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Annular bullous dermatoses represent an etiologically diverse group of cutaneous phenomena that present with a figurate morphology in association with vesicles and bullae. This group of diverse conditions consists of bullous pemphigoid; pemphigoid gestationis; epidermolysis bullosa simplex, Dowling-Meara type; linear immunoglobulin A bullous dermatosis; chronic bullous disease of childhood; anti-p200 pemphigoid; subcorneal pustular dermatosis; and immunoglobulin A pemphigus. Astute examination of clinical, histopathologic, and serologic features is crucial in distinguishing these bullous dermatoses. We review the clinical presentation, pathophysiology, histopathology, and treatments for each bullous annular disease to aid physicians in their recognition, diagnosis, and management.
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Affiliation(s)
- Morgan Sussman
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Lisa Zhai
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Alexandra Morquette
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Simo Huang
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
| | - Sylvia Hsu
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
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Hsu S, Lee JB, Motaparthi K. The Jack-in-the-Box Sign: A Diagnostic Sign for Palisaded Encapsulated Neuroma. Skinmed 2022; 20:302. [PMID: 35976022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Sylvia Hsu
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, PA;
| | - Jason B Lee
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL
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O'Brien MA, Hsu S, Shevchenko A, Quartey A. Dupilumab Failure in Treating Dermatomyositis-Associated Pruritus. Cureus 2022; 14:e28270. [PMID: 36158442 PMCID: PMC9491795 DOI: 10.7759/cureus.28270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/29/2022] Open
Abstract
Dermatomyositis (DM) is a multisystem inflammatory condition with diverse cutaneous and systemic symptoms. Both muscle and skin involvement are common and can occur simultaneously or sequentially, or individuals can have muscle- or skin-limited disease. Skin involvement in DM can be extensive, and pruritus is one of the most problematic symptoms for the patient. Its pathophysiology is poorly understood, making management challenging for clinicians. A limited number of therapeutic agents target pruritus in DM, adding another challenge for clinicians. Previous case reports suggest dupilumab as a treatment for pruritus in DM. However, our patient experienced no relief. Our patient’s failure of dupilumab suggests that its targets, interleukin (IL)-4 and IL-13, do not play a significant role in the pruritus of DM. It is possible that targeting other small molecules in inflammatory pathways could greatly alleviate pruritus for individuals with DM. Further studies need to be conducted to extrapolate the mechanism of pruritus in DM so that individuals with DM can find more significant relief.
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McLarney BD, Parker JJ, Hsu S. Large café-au-lait spots on a 5-year-old boy. JAAD Case Rep 2022; 28:127-129. [PMID: 36159720 PMCID: PMC9494035 DOI: 10.1016/j.jdcr.2022.08.025] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
| | | | - Sylvia Hsu
- Correspondence to: Sylvia Hsu, MD, Department of Dermatology, Temple University Lewis Katz School of Medicine, 3401 N Broad St, Ste B500, Philadelphia, PA 19140.
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McLarney BD, Huang S, Hsu S. Peristomal granulation tissue mimicking peristomal pyoderma gangrenosum in the context of urine-diverting ostomies. JAAD Case Rep 2022; 29:33-36. [PMID: 36186406 PMCID: PMC9522867 DOI: 10.1016/j.jdcr.2022.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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36
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Zaladonis AG, Lee JB, Hsu S, Motaparthi K. Facial Discoid Dermatosis: What Is It? Skinmed 2022; 20:174-176. [PMID: 35779021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Angela G Zaladonis
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, PA
| | - Jason B Lee
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Sylvia Hsu
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, PA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL;
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Bagel J, Nguyen TQ, Lima H, Jain N, Pariser DM, Hsu S, Yosipovitch G, Zhang H, Chao J, Bansal S, Chen Z, Richman D, Korotzer A, Ardeleanu M. Baseline Demographics and Severity and Burden of Atopic Dermatitis in Adult Patients Initiating Dupilumab Treatment in a Real-World Registry (PROSE). Dermatol Ther (Heidelb) 2022; 12:1417-1430. [PMID: 35590038 PMCID: PMC9209562 DOI: 10.1007/s13555-022-00742-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Dupilumab was initially approved in 2017 as the first biologic therapy for atopic dermatitis (AD). We characterized adults with AD initiating dupilumab in a real-world setting in the USA/Canada. Methods PROSE is an ongoing, longitudinal, prospective, observational, multicenter registry of patients with AD initiating dupilumab per country-specific prescribing information. We report baseline data (day of first dupilumab injection) for patients enrolled from April 2018 through July 2019. Results Among 315 patients (mean age 42.5 years, 55.2% female), the median AD duration was 17.0 years; 65.4% reported a history of type 2 inflammatory comorbidities (e.g., allergic rhinitis, asthma), and 93.3% reported treatment(s) for AD in the previous year, including topical corticosteroids (90.8%), systemic corticosteroids (36.2%), and nonsteroidal systemic therapies (14.0%). In total, 89.2% had an Overall Disease Severity score of 3 (moderate) or 4 (severe). Other mean disease severity scores included the following: Eczema Area and Severity Index 16.9 (range 0–72), body surface area affected 26.8%, Patient-Oriented Eczema Measure 18.5 (range 0–28), Dermatology Life Quality Index 12.7 (range 0–30), and pruritus Numerical Rating Scale score 6.9 (range 0–10). Conclusion Patients initiating dupilumab have longstanding moderate-to-severe AD with significant disease burden and frequent type 2 comorbidities. ClinicalTrials.gov Identifier NCT03428646. Video Abstract (MP4 23,650 kb)
Supplementary Information The online version contains supplementary material available at 10.1007/s13555-022-00742-w.
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Affiliation(s)
- Jerry Bagel
- Eczema Treatment Center of New Jersey, East Windsor, NJ, USA
| | | | - Hermenio Lima
- Leader Research and the Division of Dermatology, McMaster University, Hamilton, ON, Canada
| | - Neal Jain
- Arizona Allergy and Immunology Research, Gilbert, AZ, USA
| | - David M Pariser
- The Department of Dermatology, Eastern Virginia Medical School and Virginia Clinical Research Inc., Norfolk, VA, USA
| | - Sylvia Hsu
- The Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, The Miami Itch Center, University of Miami, Miami, FL, USA
| | - Haixin Zhang
- Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Jingdong Chao
- Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Shikha Bansal
- Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Zhen Chen
- Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | | | - Andrew Korotzer
- Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA.
| | - Marius Ardeleanu
- Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
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38
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Lopez CG, Huang S, Hsu S. Keratosis Pilaris in an Ovarian Cancer Patient Treated with Bevacizumab and Doxorubicin. Skinmed 2022; 20:139-140. [PMID: 35532769] [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: 06/14/2023]
Affiliation(s)
- Christina G Lopez
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, PA;
| | - Simo Huang
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, PA
| | - Sylvia Hsu
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, PA
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39
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Bon A, Gerhard E, Mathew J, Kong H, Jang M, Henry L, Lee B, Hsu S, Shah K, Tchoukina I, Sterling S, Rodrigo M, Najjar S, Marboe C, Berry G, Valantine H, Shah P, Agbor-Enoh S. Cell-Free DNA to Distinguish High Risk Donor Specific Antibodies in Heart Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1209] [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: 11/24/2022] Open
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40
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Scheel P, Tsou B, Kauffman M, Drakos S, Weller A, Sharma K, Kilic A, Hsu S. Right Ventricle Pressure-Volume Analysis During LVAD Explant Evaluation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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41
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Shah P, Agbor-Enoh S, Bagchi P, deFilippi C, Mercado A, Diao G, Morales D, Shah K, Najjar S, Feller E, Hsu S, Rodrigo M, Lewsey S, Jang M, Marboe C, Berry G, Khush K, Valantine H. Circulating microRNA Biomarkers in Cellular and Antibody-Mediated Heart Transplant Rejection. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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42
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Jani V, Aslam M, Salazar IC, Kass D, Hsu S. Unsupervised Machine Learning to Identify and Target Myofilament Mechanisms of Clinical RV Dysfunction in HFrEF. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.356] [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: 11/26/2022] Open
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43
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Motaparthi K, Hsu S. Probabilities, uncertainty, and cognitive bias in clinical diagnosis. Am J Obstet Gynecol 2022; 226:593. [PMID: 34757003 DOI: 10.1016/j.ajog.2021.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | - Sylvia Hsu
- Lewis Katz School of Medicine, Temple University, 3401 North Broad St., Ste B500, Philadelphia, PA 19140.
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Pastore LM, Sun CW, Hsu S. Erythropoietic Protoporphyria: You May Not Have Seen It, but It May Have Seen You. Cureus 2022; 14:e23253. [PMID: 35449677 PMCID: PMC9012550 DOI: 10.7759/cureus.23253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/05/2022] Open
Abstract
Erythropoietic protoporphyria is a rare skin condition that commonly presents in childhood. We report a case of a 35-year-old Hispanic male with a history of sun sensitivity, presenting with complaints of immediate burning and itching of the skin on his face and upper extremities upon sun exposure. On examination, there was minimal face erythema and calluses over the knuckles. Laboratory workup demonstrated substantially increased protoporphyrin (over 10 times the upper limit of normal) along with elevated liver enzyme levels. Liver biopsy confirmed stage 4 cirrhosis. Our patient’s cutaneous manifestations were the primary complaint that led to the diagnosis of his terminal hepatic illness. We recommend screening for erythropoietic protoporphyria in patients who present with a life-long history of non-blistering, burning and itching of the skin, which begins immediately upon sun exposure.
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Jin A, Zaladonis AG, Hsu S. Considering a Biologic: What's a Clinician to Do? Screening and Laboratory Monitoring for Biologic Therapies in the Treatment of Psoriasis. Skinmed 2022; 20:14-17. [PMID: 35435820] [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: 06/14/2023]
Abstract
Biologic therapies have revolutionized the treatment of psoriasis; however, these immunomodulatory therapies may increase the risk of reactivation of latent and chronic infections. Tumor necrosis factor alpha (TNF-α) inhibitors, in particular, have been associated with the increased risk of reactivation of tuberculosis (TB) in patients with latent TB, as well as hepatitis B virus (HBV), in patients with chronic HBV infections. Currently, baseline TB tests are the only screening tests supported with strong evidence. High-grade evidence for HBV screening tests is lacking; however, these tests are sometimes performed in clinical practice. We describe current recommendations for screening tests prior to the initiation of biologic therapy.
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Affiliation(s)
- Annie Jin
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA;
| | - Angela G Zaladonis
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Sylvia Hsu
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
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Hopkins CR, Ren V, Grover R, Cockerell C, Hsu S. When Bullous Pemphigoid Is Not Bullous Pemphigoid: The Importance of Going Beyond Direct Immunofluorescence. Cureus 2022; 14:e22201. [PMID: 35308677 PMCID: PMC8925621 DOI: 10.7759/cureus.22201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 11/16/2022] Open
Abstract
Bullous pemphigoid (BP) is the most common autoimmune bullous disease, but rarer forms of pemphigoid may appear identical to BP on routine histopathology and direct immunofluorescence (DIF). Here, we present the case of a 60-year-old man, who was initially thought to have BP, with supportive findings on routine histopathology and DIF. However, prominent oral involvement and cutaneous lesions refractory to conventional treatment suggested an alternate diagnosis. Further workup was performed, including indirect immunofluorescence (IIF) on salt-split skin, which showed binding of antibodies to the dermal floor rather than to the blister roof, and enzyme-linked immunosorbent assay for pemphigus and pemphigoid antibodies. With these additional tests, we concluded that the patient does not have BP but rather anti-p200 pemphigoid, anti-p105 pemphigoid, or a yet undiscovered form of pemphigoid. We reached a presumptive diagnosis of anti-p200 pemphigoid, as it is the most common pemphigoid with serum antibodies to the dermal floor of human salt-split skin by IIF. This case demonstrates that suspicion for other autoimmune bullous diseases in cases of treatment-refractory and clinically aberrant BP is essential. A limited workup may lead to a missed diagnosis and ultimately less efficient disease management.
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Huang S, Hsu S, Motaparthi K. Vesiculobullous Diseases. Medicina (B Aires) 2022; 58:medicina58020186. [PMID: 35208511 PMCID: PMC8876315 DOI: 10.3390/medicina58020186] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 11/16/2022] Open
Abstract
A diverse range of inflammatory dermatoses are characterized by vesicles or bullae [...]
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Affiliation(s)
- Simo Huang
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; (S.H.); (S.H.)
| | - Sylvia Hsu
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; (S.H.); (S.H.)
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL 32606, USA
- Correspondence:
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Hsu JI, Hsu S. Chronic Urticaria. Skinmed 2022; 20:364-366. [PMID: 36314621] [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: 04/14/2023]
Abstract
• A thorough history and physical examination are vital for accurate diagnosis of chronic urticaria.• Extended laboratory tests rarely yield clinically significant or actionable findings, and hence are not recommended.• Most patients experience symptomatic relief following treatment with H1 antihistamines, omalizumab, or cyclosporine, with eventual spontaneous remission.
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Affiliation(s)
| | - Sylvia Hsu
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, PA;
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Hsu JI, Hsu S. Chronic Urticaria. Skinmed 2022; 20:364-366. [PMID: 36314703] [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: 04/14/2023]
Abstract
• A thorough history and physical examination are vital for accurate diagnosis of chronic urticaria.• Extended laboratory tests rarely yield clinically significant or actionable findings, and hence are not recommended.• Most patients experience symptomatic relief following treatment with H1 antihistamines, omalizumab, or cyclosporine, with eventual spontaneous remission.
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Affiliation(s)
| | - Sylvia Hsu
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, PA;
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Menter A, Van Voorhees AS, Hsu S. Pustular Psoriasis: A Narrative Review of Recent Developments in Pathophysiology and Therapeutic Options. Dermatol Ther (Heidelb) 2021; 11:1917-1929. [PMID: 34626330 PMCID: PMC8611132 DOI: 10.1007/s13555-021-00612-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 07/28/2021] [Indexed: 12/13/2022] Open
Abstract
Pustular psoriasis is an unusual form of psoriasis that frequently presents clinical challenges for dermatologists. The condition presents with pustules on an erythematous background and has two distinct subtypes: localized disease on the palms and soles, called palmoplantar pustulosis (PPP), and generalized pustular psoriasis (GPP). The involvement of the fingers, toes, and nails is defined as a separate localized variant, acrodermatitis continua of Hallopeau, and is now thought to be a subset of PPP. The rarity of pustular psoriasis frequently makes the correct diagnosis problematic. In addition, treatment is limited by a relative lack of evidence-based therapeutic options. Current management is often based on existing therapies for standard plaque psoriasis. However, there remains a need for treatments with high, sustained efficacy and a rapid onset of action in pustular psoriasis. Recent advances in understanding of the pathogenesis of pustular psoriasis have provided insights into potential therapies. Treatment of pustular psoriasis is generally determined by the extent and severity of disease, and recent years have seen an increasing use of newer agents, including biologic therapies. Current classes of biologic therapies with US Food and Drug Administration and European Medicines Agency approval for treatment of moderate-to-severe plaque psoriasis in the USA (and elsewhere) include tumor necrosis factor alpha inhibitors (adalimumab, certolizumab pegol, etanercept, infliximab), interleukin (IL)-17 inhibitors (brodalumab, ixekizumab, secukinumab), an IL-12/23 inhibitor (ustekinumab), and IL-23 inhibitors (guselkumab, risankizumab, tildrakizumab). Recently, specific inhibitors of the IL-36 pathway have been evaluated in GPP and PPP, including spesolimab, an IL-36 receptor inhibitor which has shown promising results in GPP. The emerging drugs for pustular psoriasis offer the possibility of rapid and effective treatment with lower toxicities than existing therapies. Further research into agents acting on the IL-36 pathway and other targeted therapies has the potential to transform the future treatment of patients with pustular psoriasis. This article reviews the clinical features of PPP and GPP, and current understanding of the genetics and immunopathology of these conditions; it also provides an update on emerging treatments. Pustular psoriasis is a skin condition where people develop small pus-filled blisters on their skin. Pustular psoriasis may affect certain areas of the body, such as the palms and/or the soles. This is called palmoplantar pustulosis (PPP for short). Another type of pustular psoriasis can affect most of the body called generalized pustular psoriasis (GPP for short). Not many people have PPP or GPP. Around 5–12 in every 10,000 people worldwide develop PPP. GPP is even rarer, affecting only 2–7 out of every 1 million people. In addition to being relatively uncommon, these conditions are challenging to treat. This article aims to help doctors who treat skin conditions (dermatologists) to identify and treat people with pustular psoriasis. Currently there is no standard treatment for GPP and PPP in the USA or Europe, but several medicines are approved for treatment of GPP in Japan. Doctors often use treatments that have been shown to work in plaque psoriasis, which is the most common type of psoriasis, to treat people with GPP and PPP. Traditional treatments for PPP and GPP are often not effective. Researchers are working on developing new effective treatments for pustular psoriasis that may work more rapidly and have fewer side effects. These are expected to be available in the next few years.
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Affiliation(s)
- Alan Menter
- Department of Dermatology, Baylor Scott & White University, 3900 Junius Street, Suite 145, Dallas, TX 75246 USA
| | | | - Sylvia Hsu
- Department of Dermatology, Temple University School of Medicine, Philadelphia, PA USA
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