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Sepsis-like features in hidradenitis suppurativa flares requiring admission: A retrospective cohort study. J Am Acad Dermatol 2024:S0190-9622(24)00386-4. [PMID: 38395228 DOI: 10.1016/j.jaad.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024]
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Stevens-Johnson syndrome/toxic epidermal necrolysis predictive models are not effective when applied by non-dermatologists: A single-institution prospective study. SKIN HEALTH AND DISEASE 2023; 3:e292. [PMID: 38047266 PMCID: PMC10690703 DOI: 10.1002/ski2.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
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3
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Evaluating awareness of skin cancer in skin of color organ transplant recipients. Arch Dermatol Res 2023; 315:2669-2677. [PMID: 35871186 DOI: 10.1007/s00403-022-02371-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 06/13/2022] [Accepted: 07/02/2022] [Indexed: 11/02/2022]
Abstract
Organ transplant recipients are at high risk for skin cancer. Currently, more than half of the transplant waiting list is composed of skin of color patients. Skin cancer in skin of color is associated with higher morbidity and mortality and has a different clinical presentation and risk factors. Yet, skin cancer prevention resources and efforts are primarily focused on non-skin of color patients. A cross-sectional pilot survey was administered to assess and compare skin cancer attitudes, behaviors, and knowledge especially risk factors and features specific to skin of color between skin of color and non-skin of color organ transplant recipients. Patients from a patient list obtained from the University of Texas Southwestern Medical Center organ transplant center were randomized on Excel and contacted by phone with the choice to participate by phone or online. 219 of 403 patients completed the survey. Skin of color organ transplant recipients was significantly more likely to never practice recommended skin cancer preventative behaviors (p = 0.002, 0.006, 0.02), to hold a lower perceived self-risk (p = 0.02), to worry less about getting skin cancer (p = 0.003), and to have false perceptions about risk factors (p = 0.001, 0.005) in either univariable or multivariable analysis. However, they were more likely (38%, p = 0.02) to recognize human papillomavirus as a risk factor. The knowledge gaps identified can guide the development of skin cancer educational resources that are more comprehensive and relevant to skin of color recipients. This can lead to better outcomes and reduce racial health disparities.
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Implementation and evaluation of a store-and-forward teledermatology workflow in a United States safety-net hospital urgent care emergency center: A retrospective cohort study. JAAD Int 2023; 12:112-120. [PMID: 37409319 PMCID: PMC10319336 DOI: 10.1016/j.jdin.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 07/07/2023] Open
Abstract
Background Teledermatology (TD) is an important method for increasing access to care in outpatient settings. However, less is known regarding its use in emergency/urgent care centers. Objective To evaluate the effect of TD on urgent care emergency center (UCEC) dwell time and postencounter utilization. Study type and methods This retrospective cohort study evaluated patients in a safety-net hospital (Parkland Health, Dallas, Texas, USA) UCEC, who (1) received a TD consult in 2018, (2) were referred to dermatology clinic in 2017, or (3) were referred to dermatology clinic in 2018 without a TD consult. Results We evaluated 2024 patients from 2017 to 2018. Of the 973 referred to dermatology clinic in 2018, 332 (34%) received TD consultations. Mean dwell time for patients receiving TD was longer versus the 2017 cohort (303 vs 204 minutes, respectively). Patients receiving TD consultation with inflammatory skin conditions had lower odds of dermatology clinic visits compared with those that did not (odds ratio, 0.5; 95% CI, 0.3-0.8). Teledermatology was not associated with differences in repeat UCEC utilization. Limitations Single institution study and inability to account for differences in patient complexity. Conclusion TD increases dwell time in a safety-net hospital's UCEC but can reduce dermatology clinic utilization for patients with inflammatory skin conditions.
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Atypical Adult-onset Still's disease with flagellate morphology in a patient with skin of color. JAAD Case Rep 2023; 37:54-57. [PMID: 37492429 PMCID: PMC10363657 DOI: 10.1016/j.jdcr.2023.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
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Development of a Skin-Directed Scoring System for Stevens-Johnson Syndrome and Epidermal Necrolysis: A Delphi Consensus Exercise. JAMA Dermatol 2023; 159:772-777. [PMID: 37256599 PMCID: PMC10838134 DOI: 10.1001/jamadermatol.2023.1347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Importance Scoring systems for Stevens-Johnson syndrome and epidermal necrolysis (EN) only estimate patient prognosis and are weighted toward comorbidities and systemic features; morphologic terminology for EN lesions is inconsistent. Objectives To establish consensus among expert dermatologists on EN terminology, morphologic progression, and most-affected sites, and to build a framework for developing a skin-directed scoring system for EN. Evidence Review A Delphi consensus using the RAND/UCLA appropriateness criteria was initiated with a core group from the Society of Dermatology Hospitalists to establish agreement on the optimal design for an EN cutaneous scoring instrument, terminology, morphologic traits, and sites of involvement. Findings In round 1, the 54 participating dermatology hospitalists reached consensus on all 49 statements (30 appropriate, 3 inappropriate, 16 uncertain). In round 2, they agreed on another 15 statements (8 appropriate, 7 uncertain). There was consistent agreement on the need for a skin-specific instrument; on the most-often affected skin sites (head and neck, chest, upper back, ocular mucosa, oral mucosa); and that blanching erythema, dusky erythema, targetoid erythema, vesicles/bullae, desquamation, and erosions comprise the morphologic traits of EN and can be consistently differentiated. Conclusions and Relevance This consensus exercise confirmed the need for an EN skin-directed scoring system, nomenclature, and differentiation of specific morphologic traits, and identified the sites most affected. It also established a baseline consensus for a standardized EN instrument with consistent terminology.
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Acute graft-versus-host disease after double lung transplant confirmed by short tandem repeat analysis to identify donor chimerism in the skin. JAAD Case Rep 2023; 36:24-27. [PMID: 37361400 PMCID: PMC10285118 DOI: 10.1016/j.jdcr.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
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Complications and Histopathological Findings of Image-Guided Core Needle Biopsy in Diagnosis of Cutaneous Calciphylaxis. Am J Dermatopathol 2023; 45:414-417. [PMID: 37073994 DOI: 10.1097/dad.0000000000002426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
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Severe Mpox Infections in People With Uncontrolled Human Immunodeficiency Virus. Clin Infect Dis 2023; 76:1843-1846. [PMID: 36718662 DOI: 10.1093/cid/ciad052] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 02/01/2023] Open
Abstract
In the current mpox outbreak, infections are usually self-limited. We describe 3 patients with uncontrolled HIV and mpox infections lasting months, causing debilitating lesions, complications, and death, despite initiating anti-mpox and antiretroviral therapy. Delayed treatment of mpox with antiviral agents may contribute to poor outcomes in severely immunocompromised patients.
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Cutaneous Angiosarcoma. JAMA Dermatol 2023; 159:332. [PMID: 36652219 DOI: 10.1001/jamadermatol.2022.5446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This case report describes a large, purpuric plaque involving most of the right face with associated periorbital swelling but without ulceration.
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Efficacy of a lay community health worker (promotoras de salud) program to improve adherence to emollients in Spanish-speaking Latin American pediatric patients in the United States with atopic dermatitis: A randomized, controlled, evaluator-blinded study. Pediatr Dermatol 2023; 40:69-77. [PMID: 36263875 DOI: 10.1111/pde.15148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/10/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Latin American patients in the United States experience significant health disparities. Community health workers (promotoras de salud) reduce disparities by providing culturally appropriate education. While educational interventions have been studied in atopic dermatitis (AD), a chronic dermatologic condition affecting children, none have evaluated the use of promotoras in Spanish-speaking pediatric patients in the United States. OBJECTIVE To create and evaluate a promotora-led education program for Spanish-speaking caregivers of Latin American, pediatric patients with AD through a randomized, controlled, evaluator-blinded study. METHODS Children with moderate/severe AD (n = 48) were recruited from the pediatric dermatology clinic at Children's Health℠ in Dallas, TX and randomized to receive clinic education (n = 26) or clinic education plus promotora home visits (n = 22). The primary outcome was overall adherence to topical emollients over the 12-week study, quantified by MEMSCap™ devices; several secondary endpoints were evaluated. RESULTS Intention-to-treat analysis revealed a trend toward increased overall adherence to emollients over the 12-week study period in promotora (median [interquartile range, IQR]: 43% [26%-61%]) versus non-promotora (median [IQR]: 20% [11%-49%]) (p = .09) groups. SCORAD, AD knowledge, and Spanish-language Parental Quality of Life Questionnaire for AD (Sp-PIQoL-AD) improved in both groups, although there was no statistically significant difference between groups. There was a trend toward increased AD knowledge at Week 4 (p = .06) in the promotora group. CONCLUSIONS A promotora-led educational intervention is a promising approach in increasing caregiver medication adherence in pediatric, Latin American patients with AD in the United States. Further research using creative and culturally appropriate strategies to increase medication adherence is necessary to reduce health disparities in other racial and ethnic minority populations in the United States.
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Sudden Conjunctivitis, Lymphopenia, and Rash Combined With Hemodynamic Changes (SCoRCH) After Trimethoprim-Sulfamethoxazole Use: A Case Series Study of a Hypersensitivity Reaction. JAMA Dermatol 2023; 159:73-78. [PMID: 36350597 PMCID: PMC9647562 DOI: 10.1001/jamadermatol.2022.4657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/05/2022] [Indexed: 11/11/2022]
Abstract
Importance Trimethoprim-sulfamethoxazole (TMP-SMX) hypersensitivity reaction, ranging from circulatory shock to aseptic meningitis and respiratory failure, is a potentially life-threatening condition with dermatologic relevance. Objective To describe the mucocutaneous findings and clinical features of TMP-SMX hypersensitivity reaction. Design, Setting, and Participants This was a retrospective case series study of 7 patients who developed a characteristic rash, hemodynamic changes, and end-organ dysfunction after treatment with TMP-SMX at a large university hospital system during January 2013 to March 2022. Exposures Treatment with TMP-SMX within 2 weeks of the reaction. Main Outcome and Measures Descriptions of the condition, including the demographic information of the affected population, the reaction timeline, and mucocutaneous and clinical features. Results The cohort comprised 7 patients (median [range] age, 20 [15-66] years; 4 female and 3 male). The most common mucocutaneous findings were generalized sunburn-like erythema without scale, conjunctivitis, and mild facial and acral edema. Three patients had previous exposure to TMP-SMX and developed symptoms in 1 day or less, while those without prior exposure presented from 4 to 11 days after drug initiation. Among the 7 patients, 6 had fever, 7 had hypotension, and 7 had tachycardia. All patients had lymphopenia and evidence of end-organ dysfunction with either kidney or liver involvement. Median (range) time to resolution was 72 (48-96) hours. Conclusions and Relevance This retrospective case series indicates that SCoRCH (sudden conjunctivitis, lymphopenia, and rash combined with hemodynamic changes) should be considered in the differential diagnosis of patients presenting with acute generalized sunburn-like erythema, conjunctivitis, systemic symptoms, and hemodynamic changes in the setting of recent TMP-SMX use.
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Cytomegalovirus vulvar ulceration in patient without HIV-AIDS. Am J Obstet Gynecol 2022; 227:769. [PMID: 35926649 DOI: 10.1016/j.ajog.2022.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/29/2022] [Accepted: 07/25/2022] [Indexed: 11/28/2022]
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Successful treatment of recalcitrant mucous membrane pemphigoid with multisystem involvement with baricitinib and methotrexate. JAAD Case Rep 2022; 27:67-69. [PMID: 35990232 PMCID: PMC9388867 DOI: 10.1016/j.jdcr.2022.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Utility of Direct Immunofluorescence using buccal mucosal biopsies in those with suspected isolated Ocular Mucous Membrane Pemphigoid. Ophthalmology 2022; 129:1171-1176. [DOI: 10.1016/j.ophtha.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/19/2022] [Accepted: 06/02/2022] [Indexed: 10/18/2022] Open
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Evaluating the impact of a community health worker (Promotora de Salud) program on attitudes and beliefs regarding atopic dermatitis among Spanish-speaking Latin-American caregivers. Pediatr Dermatol 2022; 39:182-186. [PMID: 35178737 DOI: 10.1111/pde.14917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 12/22/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Community health workers (CHWs), or promotora de salud, have an important role in healthcare education and advocacy in the Latin American community. We aimed to determine the impact of a promotora de salud program on attitudes and beliefs regarding AD management among Latin American caregivers of pediatric patients with atopic dermatitis. METHODS This is a sub-study of an ongoing randomized, investigator-blinded, placebo-controlled trial. Mann-Whitney U tests compared questionnaire responses in the standard education group to the promotora group. RESULTS Caregivers in the promotora group were more likely to state that they knew how to apply wet wraps and use bleach (sodium hypochlorite) baths at 1 month (wet wraps p = .027, bleach baths p = .005) and 3 months (wet wraps p = .005, bleach baths p < .001) demonstrating greater self-efficacy, defined as an individual's belief in their capacity to execute a certain behavior to achieve a desired outcome, compared with the standard education group. CONCLUSIONS Culturally competent and language concordant educational interventions may improve confidence in utilizing wet wraps and bleach baths among Latin-American caregivers of children with atopic dermatitis, which may improve AD outcomes in the Latin-American community.
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Abstract
Importance Palmoplantar pustulosis (PPP) is a is a chronic, orphan disease with limited epidemiological data. Objective To describe the clinical characteristics, treatments, longitudinal disease course, and health care utilization in adults with PPP across the US. Design, Setting, and Participants This retrospective, longitudinal case series from 20 academic dermatology practices in the US included a consecutive sample of 197 adults who met the European Rare and Severe Psoriasis Expert Network consensus definition for PPP between January 1, 2007, and December 31, 2018. Data analysis was performed June 2020 to December 2020. Main Outcomes and Measures The primary outcome was to describe the patient characteristics, associated medical comorbidities, treatment patterns, complications, and PPP-specific health care utilization. Results Of 197 patients, 145 (73.6%) were female, and the mean (SD) age at presentation was 53.0 (12.6) years, with a mean (SD) follow-up time of 22.1 (28.0) months. On initial presentation, 95 (48.2%) patients reported skin pain, and 39 (19.8%) reported difficulty using hands and/or feet. Seventy patients (35.5%) were treated with systemic treatments, and use of more than 20 different systemic therapies was reported. In patients with at least 6 months of follow-up (n = 128), a median (IQR) of 3.7 (4-10) dermatology visits per year were reported; 24 (18.8%) patients had 5 or more visits during the study period. Conclusions and Relevance In this case series, PPP was associated with persistent symptoms, continued health care utilization, and a lack of consensus regarding effective treatments, emphasizing the unmet medical need in this population. Additional research is necessary to understand treatment response in these patients.
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Novel Treatments for Chronic Erythema Multiforme Inform Translational Science and Disease Pathogenesis. JAMA Dermatol 2021; 157:1411-1413. [PMID: 34757395 DOI: 10.1001/jamadermatol.2021.4082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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A severe presentation of acute generalized exanthematous pustulosis with non-infectious circulatory shock in an adolescent. Pediatr Dermatol 2021; 38:1267-1271. [PMID: 34272752 DOI: 10.1111/pde.14704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We present a severe case of acute generalized exanthematous pustulosis (AGEP) secondary to trimethoprim-sulfamethoxazole complicated by non-infectious circulatory shock in a 16-year-old boy. Hemodynamic instability has been reported as a complication of AGEP in adults, but is rarely observed in pediatric patients. The patient we present demonstrated characteristic cutaneous findings of AGEP including isolated non-follicular, sterile pustules on a background of erythema with involvement at intertriginous areas and subsequently developed non-infectious circulatory shock. This case expands the spectrum of possible clinical presentations for AGEP in pediatric patients.
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Cutaneous Carcinomatous Arteriopathy and Retiform Purpura Secondary to Metastatic Penile Carcinoma. Cutis 2021; 108:E3-E5. [PMID: 34397362 DOI: 10.12788/cutis.0304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Supportive care in the acute phase of Stevens-Johnson syndrome and toxic epidermal necrolysis: an international, multidisciplinary Delphi-based consensus. Br J Dermatol 2021; 185:616-626. [PMID: 33657677 DOI: 10.1111/bjd.19893] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Supportive care is the cornerstone of management of adult and paediatric Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). However, consensus on the modalities of supportive care is lacking. OBJECTIVES Our aim in this international multicentric Delphi exercise was to establish a multidisciplinary expert consensus to standardize recommendations regarding supportive care in the acute phase of SJS/TEN. METHODS Participants were sent a survey via the online tool SurveyMonkey, consisting of 103 statements organized into 11 topics: multidisciplinary team composition, suspect drug management, infection prevention, fluid resuscitation and prevention of hypothermia, nutritional support, pain and psychological distress management, management of acute respiratory failure, local skincare, ophthalmological management, management of other mucosa, and additional measures. Participants evaluated the level of appropriateness of each statement on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate). The results were analysed according to the RAND/UCLA Appropriateness Method. RESULTS Forty-five participants from 13 countries (on three continents) participated. After the first round, a consensus was obtained for 82.5% of the 103 initially proposed statements. After the second round, a final consensus was obtained for 102 statements. CONCLUSIONS We have reached an international Delphi-based consensus on best supportive care practice for SJS/TEN. Our expert consensus should help guide physicians in treating patients with SJS/TEN and thereby improve short-term prognosis and the risk of sequelae.
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Validation of two predictive models designed to aid clinicians in identifying Stevens-Johnson syndrome/toxic epidermal necrolysis: A single institution retrospective review. J Am Acad Dermatol 2021; 86:960-962. [PMID: 33819535 DOI: 10.1016/j.jaad.2021.03.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/05/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
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Erythroderma and Annular Pustular Plaques. JAAD Case Rep 2021; 9:105-106. [PMID: 33778143 PMCID: PMC7982451 DOI: 10.1016/j.jdcr.2020.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Evaluation of the effect of store-and-forward teledermatology on in-person health care system utilization in a safety-net public health and hospital system. J Am Acad Dermatol 2021; 85:1026-1028. [PMID: 33482252 DOI: 10.1016/j.jaad.2020.12.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 12/16/2020] [Accepted: 12/29/2020] [Indexed: 11/18/2022]
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Implications of increasing publication trends in dermatology on individuals from disadvantaged backgrounds and those without a home dermatology program. J Am Acad Dermatol 2020; 84:e109-e110. [PMID: 33038470 DOI: 10.1016/j.jaad.2020.08.136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
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Rapid Screening of Invasive Fungal Infections in the Hospital Setting Using the (1,3)-β-D-glucan Assay. Cutis 2020; 106:33-34;36. [DOI: 10.12788/cutis.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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New Debates Surrounding the Histopathological Findings of Calciphylaxis-Do These Give Us New Insights Into Pathogenesis of the Disease? JAMA Dermatol 2020; 155:773-775. [PMID: 31116348 DOI: 10.1001/jamadermatol.2019.0051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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A survey-based study of diagnostic and treatment concordance in standardized cases of cellulitis and pseudocellulitis via teledermatology. J Am Acad Dermatol 2020; 82:1221-1223. [DOI: 10.1016/j.jaad.2019.09.084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
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Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults. J Am Acad Dermatol 2020; 82:1553-1567. [PMID: 32151629 DOI: 10.1016/j.jaad.2020.02.066] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/04/2020] [Accepted: 02/26/2020] [Indexed: 12/14/2022]
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions with high morbidity and mortality. Supportive care management of SJS/TEN is highly variable. A systematic review of the literature was performed by dermatologists, ophthalmologists, intensivists, and gynecologists with expertise in SJS/TEN to generate statements for supportive care guideline development. Members of the Society of Dermatology Hospitalists with expertise in SJS/TEN were invited to participate in a modified, online Delphi-consensus. Participants were administered 9-point Likert scale questionnaires regarding 135 statements. The RAND/UCLA Appropriateness Method was used to evaluate and select proposed statements for guideline inclusion; statements with median ratings of 6.5 to 9 and a disagreement index of ≤1 were included in the guideline. For the final round, the guidelines were appraised by all of the participants. Included are an evidence-based discussion and recommendations for hospital setting and care team, wound care, ocular care, oral care, urogenital care, pain management, infection surveillance, fluid and electrolyte management, nutrition and stress ulcer prophylaxis, airway management, and anticoagulation in adult patients with SJS/TEN.
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Violaceous nodules in an HIV-positive man. Dermatol Online J 2020; 26:13030/qt1b42h7nt. [PMID: 32239893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023] Open
Abstract
Plasmablastic lymphoma (PBL) is a rare and aggressive malignancy associated with immunosuppression and the oncogenic effects of the Epstein-Barr virus (EBV). We present an HIV-positive man with PBL that presented as ulcers and violaceous exophytic nodules on the legs. The clinical features, histologic appearance, and differential diagnosis of this malignancy are briefly reviewed.
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Edema and Ulceration of the Lower Extremities-All That's Red Is Not Infection: A Teachable Moment. JAMA Intern Med 2018; 178:277-278. [PMID: 29228067 DOI: 10.1001/jamainternmed.2017.7194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Bedside diagnostics in dermatology: Parasitic and noninfectious diseases. J Am Acad Dermatol 2017; 77:221-230. [PMID: 28711083 DOI: 10.1016/j.jaad.2016.06.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/29/2016] [Accepted: 06/17/2016] [Indexed: 10/19/2022]
Abstract
In addition to aiding the diagnosis of viral, bacterial, and fungal diseases, mineral oil preparation, Tzanck smear, and other techniques can be used to diagnose parasitic infections, neonatal pustular dermatoses, blistering diseases, Stevens-Johnson syndrome, and a plethora of other benign and malignant conditions, including granulomatous diseases and tumors. In many cases, these techniques are specific, reliable, and easy to perform and interpret. In others, a certain amount of training and expertise are required. In the proper clinical scenario, these tests are rapid, economical, and compare favorably with other diagnostic methods.
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Bedside diagnostics in dermatology: Viral, bacterial, and fungal infections. J Am Acad Dermatol 2017; 77:197-218. [PMID: 28711082 DOI: 10.1016/j.jaad.2016.06.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/29/2016] [Accepted: 06/02/2016] [Indexed: 02/08/2023]
Abstract
Viral, bacterial, and fungal infections are frequently encountered in clinical practice, resulting in numerous cutaneous manifestations. Although diagnosis of these infections has changed over time because of technological advancements, such as polymerase chain reaction, bedside diagnostic techniques still play an important role in diagnosis and management, enabling rapid and low-cost diagnosis and implementation of appropriate therapies. This 2-part article will review both common and infrequent uses of bedside diagnostic techniques that dermatologists can incorporate into daily practice. This article examines the utility of bedside tests for the diagnosis of viral, bacterial, and fungal infections. The second article in this series reviews the use of bedside diagnostics for parasitic and noninfectious disorders.
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Creation of an Internal Teledermatology Store-and-Forward System in an Existing Electronic Health Record: A Pilot Study in a Safety-Net Public Health and Hospital System. JAMA Dermatol 2017; 153:644-650. [PMID: 28423156 DOI: 10.1001/jamadermatol.2017.0204] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance External store-and-forward (SAF) teledermatology systems operate separately from the primary health record and have many limitations, including care fragmentation, inadequate communication among clinicians, and privacy and security concerns, among others. Development of internal SAF workflows within existing electronic health records (EHRs) should be the standard for large health care organizations for delivering high-quality dermatologic care, improving access, and capturing other telemedicine benchmark data. Epic EHR software (Epic Systems Corporation) is currently one of the most widely used EHR system in the United States, and development of a successful SAF workflow within it is needed. Objectives To develop an SAF teledermatology workflow within the Epic system, the existing EHR system of Parkland Health and Hospital System (Dallas, Texas), assess its effectiveness in improving access to care, and validate its reliability; and to evaluate the system's ability to capture meaningful outcomes. Design, Setting, and Participants Electronic consults were independently evaluated by 2 board-certified dermatologists, who provided diagnoses and treatment plans to primary care physicians (PCPs). Results were compared with in-person referrals from May to December 2013 from the same clinic (a community outpatient clinic in a safety-net public hospital system). Patients were those 18 years or older with dermatologic complaints who would have otherwise been referred to dermatology clinic. Main Outcomes and Measures Median time to evaluation; percentage of patients evaluated by a dermatologist through either teledermatology or in-person compared with the previous year. Results Seventy-nine teledermatology consults were placed by 6 PCPs from an outpatient clinic between May and December 2014; 57 (74%) were female and their mean (SD) age was 47.0 (12.4) years. Teledermatology reduced median time to evaluation from 70.0 days (interquartile range [IQR], 33.25-83.0 days) to 0.5 days (IQR, 0.172-0.94 days) and median time to treatment from 73.5 to 3.0 days compared with in-person dermatology visits. Overall, a greater percentage of patients (120 of 144 [83.3%]) were evaluated by a dermatologist through either teledermatology or in-person during the 2014 study period compared with the previous year (111 of 173 [64.2%]). Primary care physicians followed management recommendations 93% of the time. Conclusions and Relevance Epic-based SAF teledermatology can improve access to dermatologic care in a public safety-net hospital setting. We hope that the system will serve as a model for other health care organizations wanting to create SAF teledermatology workflows within the Epic EHR system.
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Bullae and Atypical Target Lesions in a Young Woman. JAMA Dermatol 2017; 153:461-462. [PMID: 28002547 DOI: 10.1001/jamadermatol.2016.4809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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A diffuse desquamative rash in an elderly male. Int J Dermatol 2017; 56:e170-e172. [PMID: 28251610 DOI: 10.1111/ijd.13558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/15/2016] [Accepted: 01/04/2017] [Indexed: 12/01/2022]
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Purple Crusted Nodules in a Patient With End-stage Liver Disease. JAMA Dermatol 2016; 152:941-2. [PMID: 27120337 DOI: 10.1001/jamadermatol.2016.0935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Calciphylaxis: Controversies in Pathogenesis, Diagnosis and Treatment. Am J Med Sci 2016; 351:217-27. [DOI: 10.1016/j.amjms.2015.11.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 09/22/2015] [Indexed: 10/22/2022]
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Pyoderma gangrenosum (PG) associated with levamisole-adulterated cocaine: Clinical, serologic, and histopathologic findings in a cohort of patients. J Am Acad Dermatol 2016; 74:892-8. [PMID: 26785804 DOI: 10.1016/j.jaad.2015.11.040] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 11/26/2015] [Accepted: 11/30/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recently, isolated reports of pyoderma gangrenosum (PG) secondary to levamisole-contaminated cocaine have been described, with similar serologic findings to the vasculopathic presentation. OBJECTIVE We sought to describe clinical, histopathological, and serologic findings in 8 patients with PG associated with levamisole-contaminated cocaine. METHODS Eight consecutive patients presenting with this disease spanning the period from 2011 to 2015 were included for the cohort. Observed variables included: lesion distribution, morphology, serologic titers, and histopathologic evaluation for vasculitis and vasculopathy. RESULTS All patients reported cocaine exposure prior to the onset of lesions resembling PG. Lesions appeared primarily on the upper (6 of 8 patients) and lower (all 8 patients) extremities. Most patients demonstrated elevated titers for p-ANCA and antiphospholipid antibodies, and a diffuse dermal infiltrate dominated by neutrophils was seen in all biopsy specimens. Lesions improved or remained stable with conservative management or short courses of steroids, and recurrence was only noted on re-exposure to adulterated cocaine. LIMITATIONS The study is limited by sample size. CONCLUSIONS PG may occur after exposure to levamisole-adulterated cocaine. Clinical and histopathological findings resemble those seen in conventional forms of PG, whereas serologic findings mirror those seen in other levamisole-associated vasculopathic or vasculitic eruptions. Cocaine avoidance represents a cornerstone of management in these patients.
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Disseminated Candida tropicalis presenting with Ecthyma-Gangrenosum-like Lesions. Dermatol Online J 2016; 22:13030/qt7vg4n68j. [PMID: 26990472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 01/15/2016] [Indexed: 06/05/2023] Open
Abstract
Disseminated candidiasis in immunosuppressed patients has been classically associated with an erythematous papular eruption, however more severe presentations are possible. We present a patient who developed disseminated Candida tropicalis that presented with hemorrhagic bullae that progressed to large necrotic ulcers.
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Disseminated Candida tropicalis presenting with Ecthyma-Gangrenosum-like Lesions. Dermatol Online J 2016. [DOI: 10.5070/d3221029790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Purpura fulminans in the setting of Escherichia coli septicemia. Cutis 2015; 96:E3-E4. [PMID: 26761941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Systemic lupus erythematosus in a patient with PTEN hamartoma tumour syndrome. Br J Dermatol 2015; 170:990-2. [PMID: 24641667 DOI: 10.1111/bjd.12767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Change in arterial intima-media thickness: is it an appropriate surrogate for cardiovascular risk in psoriasis patients treated with tumor necrosis factor-alpha inhibitors? J Am Acad Dermatol 2014; 71:388-9. [PMID: 25037785 DOI: 10.1016/j.jaad.2014.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 02/16/2014] [Indexed: 11/30/2022]
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Primary cutaneous zygomycosis secondary to minor trauma in an immunocompromised pediatric patient: a case report. Dermatol Online J 2014; 20:13030/qt4r2455h9. [PMID: 24945642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 06/13/2014] [Indexed: 06/03/2023] Open
Abstract
Zygomycosis is an opportunistic infection generally found in immunocompromised individuals. Herein we present a pediatric patient with primary cutaneous mucormycosis that developed at a site of trauma. Diagnosis and treatment are discussed.
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Primary cutaneous zygomycosis secondary to minor trauma in an immunocompromised pediatric patient: a case report. Dermatol Online J 2014. [DOI: 10.5070/d3206022864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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