Dermatology Online Journal is an open-access, refereed publication intended to meet reference and education needs of the international dermatology community since 1995. Dermatology Online Journal is supported by the Department of Dermatology UC Davis, and by the Northern California Veterans Administration.
Volume 29, Issue 2, 2023
Children and adolescents with chronic cutaneous conditions are at risk of experiencing adverse psychosocial effects such as anxiety, depression, and loneliness. The well-being of these children's families may also be impacted by their child's condition. It is important for the quality of life of patients and their families to better understand the psychosocial impact caused by pediatric dermatologic conditions and interventions that help mitigate these effects. This review summarizes the psychological impact of the common pediatric dermatological disorders, vitiligo, psoriasis, and alopecia areata, on children and their caregivers. Studies examining quality of life, psychiatric conditions, and other measures of psychosocial impact in children and caregivers, as well as those evaluating the effectiveness of interventions aimed at addressing psychosocial effects, were included. This review highlights the increased risk that children with these conditions have in experiencing adverse psychosocial effects including quality of life impairment, psychological pathology, and social stigmatization. In addition, the specific risk factors within this population that are associated with increased negative effect such as age and severity of disease are discussed. This review demonstrates a need for increased support of these patients and their families and additional research on the effectiveness of current interventions.
Artificial intelligence in medicine - dermatology compared to other medical specialties in FDA-cleared software as medical device
Artificial intelligence (AI) and machine learning (ML) have occupied the center stage in healthcare as research groups and institutions investigate their capabilities and risks. Dermatology is often cited as one of the medical specialties most ripe for disruption with AI technology due to the heavy incorporation of visual information into clinical decisions and treatments. Although the literature on AI in dermatology is rapidly growing, there has been a noticeable absence of mature AI solutions utilized by dermatology departments or patients. This commentary provides insight into the regulatory challenges facing AI solutions for the specialty of dermatology and the unique considerations that should be factored into AI development and deployment.
Eccrine angiomatous hamartoma is an uncommon, benign clinical entity constituting a nodular proliferation of eccrine glands and vascular structures localized to the dermis that typically present as unilateral, flesh-colored, erythematous, or violaceous papules on the extremities. These hamartomas may be associated with pain, hyperhidrosis, joint deformity, or functional impairment depending on the severity of the disease process. We present a case of bilaterally symmetric, asymptomatic eccrine angiomatous hamartomas involving all proximal interphalangeal joints of both hands. To date, there are only four prior cases of bilaterally symmetric eccrine angiomatous hamartomas reported in the literature, suggesting that the distribution experienced by our patient may represent a previously undescribed syndrome.
Dermatomyositis (DM) is a systemic autoimmune disorder characterized by proximal myopathy and dermatological findings. Approximately 15-30% of DM cases emerge as a paraneoplastic syndrome caused by a concomitant malignancy. Although more rare, in cancer patients DM has also been reported as a possible result of toxicity of some antineoplastic agents, such as taxanes and monoclonal antibodies. Herein, we report a 35-year-old woman with metastatic breast cancer who presented with skin lesions after initiation of paclitaxel and anti-HER2 agents. Clinical, laboratory, and histological findings were consistent with the diagnosis of DM.
Without prompt diagnosis and treatment, patients with Lyme disease may develop life threatening multi-organ system complications. As such, we discuss the key diagnostic features of the condition along with patient-specific suggested treatment protocols. Additionally, Lyme disease is reportedly expanding to regions that were previously not impacted, key epidemiological features are outlined. We discuss a patient with severe Lyme disease who presented with widespread cutaneous involvement and atypical pathologic findings within an uncharacteristic geographic region. Erythematous, annular patches and plaques with dusky-to-clear centers were initially observed on the right thigh and later extended to the trunk and bilateral lower extremities. The diagnosis of Lyme disease was made clinically and confirmed with western blot testing that was positive for IgM antibodies. The patient additionally had a history of rheumatoid arthritis, for which he discontinued treatment prior to the current presentation with Lyme disease. During follow up visits, the patient noted lower extremity joint pain. Due to the overlapping clinical features of post-Lyme arthritis and rheumatoid arthritis, key differences are outlined to prevent misdiagnosis. Data revealing trends in the geographic distribution of the disease and possible need for increased surveillance and prevention strategies within previously unaffected areas are discussed.
Proliferative verrucous leukoplakia (PVL) is a rare, aggressive form of oral leukoplakia with a substantial risk of malignant transformation. The slowly progressive course and the lack of a single defining histopathologic characteristic for PVL make this entity a diagnostic challenge. We report on a patient who presented with a 7-year history of worsening oral lesions.
Nodular lymphangitis, also known as lymphocutaneous syndrome or sporotrichoid lymphangitis, presents with inflammatory nodules along the lymphatic vessels, typically involving the upper or lower extremities. Although the most common cause of nodular lymphangitis is infection due to Sporothrix schenckii, Nocardia brasiliensis, Mycobacterium marinum, or Leishmania braziliensis, it is important for clinicians to be aware of methicillin-resistant Staphylococcus aureus as a rare cause of nodular lymphangitis and perform gram stain, bacterial culture, and antibiotic sensitivity profiles when appropriate. History of recent travel or exposures, incubation time, presence of systemic symptoms, and presence of ulceration, suppuration, or drainage can serve as diagnostic clues, but microbiological tissue cultures and histopathologic studies confirm the diagnosis. Herein, we present a case of nodular lymphangitis caused by methicillin-resistant Staphylococcus aureus (MRSA); tissue culture and antibiotic sensitivities were used to guide treatment.
A 75-year-old man with a three-year history of metastatic lung adenocarcinoma was diagnosed with cutaneous lymphangitic carcinomatosa of unique morphology. He was admitted to our hospital for right neck swelling, erythema, and failure to thrive. Skin examination demonstrated an indurated, thickened, firm, hyperpigmented plaque extending from the right neck and chest to the right ear, cheek, and eyelids. Skin biopsy demonstrated poorly differentiated adenocarcinoma, morphologically consistent with metastasis from the patient's known pulmonary adenocarcinoma and showed dermal invasion, perineural invasion, and involvement of dermal lymphatics. The diagnosis was an atypical presentation of cutaneous lymphangitis carcinomatosa from metastatic lung adenocarcinoma. This case presentation affirms that cutaneous lymphangitis carcinomatosa has a variety of atypical presentations, so physicians must maintain a high index of suspicion when evaluating cutaneous lesions in patients with known or suspected internal malignancy.
Dermatomyositis is an inflammatory myopathy involving the skin that typically affects patients between 40-60 years of age and is more likely to be diagnosed in women. Around 10-20% of dermatomyositis cases present with subclinical or absent muscle involvement, termed "clinically amyopathic." Presence of anti-transcription intermediary factor 1? (TIF1?) antibodies is an important indicator of underlying malignancy. We present a patient with anti-TIF1? positive amyopathic dermatomyositis associated with bilateral breast cancer. The patient was safely treated with trastuzumab for breast cancer and intravenous immunoglobulin for dermatomyositis.
Mycobacterium marinum is a nontuberculous mycobacterium capable of causing skin and soft tissue infections. Most infections are associated with skin trauma and contact with contaminated water in fish tanks, pools, or infected fish. The incubation period is about 21 days but can be prolonged up to 9 months before the onset of symptoms. We report a patient with cutaneous Mycobacterium marinum infection with a non-pruritic erythematous plaque on his right wrist for three months. A history of exposure to contaminated freshwater two years prior was the only exposure that could be determined. Treatment with oral ciprofloxacin combined with clarithromycin produced a good outcome.
Cutaneous mucormycosis is a rapidly advancing fungal infection that most commonly occurs due to airborne spread or direct inoculation and requires early detection and prompt treatment for optimal survival. Major risk factors include diabetes, transplantations, malignancies, surgical procedures, and HIV. Diagnostic criteria are based on microscopy and culture. We present an immunocompromised patient with cutaneous mucormycosis that developed in a peristomal ulcer following a hemicolectomy procedure. Histopathologic evaluation was indicative of mucormycosis. Intravenous posaconazole treatment was initiated, but unfortunately, the patient's condition deteriorated and he passed away.
Herein, we present a patient with a lipidized fibrous histiocytoma, an underrecognized variant of dermatofibroma (cutaneous fibrous histiocytoma). Our patient presented with a nodule on the ankle that showed foamy histiocytes and hyalinized collagen bundles on histology. This case highlights a classic presentation and features of lipidized fibrous histiocytoma, raising further awareness of this distinctive variant of dermatofibroma that should be distinguished from xanthoma and xanthogranuloma.
Wolf isotopic response describes the onset of a new dermatosis at the site of a previous, healed dermatosis, which is usually a herpes zoster infection. Fibroelastolytic papulosis is a poorly understood elastolytic condition defined by a loss of elastic fibers specific to the papillary dermis. The present report describes a case of fibroelastolytic papulosis with onset following herpes zoster infection. This association provides new evidence for an immunopathogenic origin for fibroelastolytic papulosis and further supports current theories of the pathogenesis of Wolf isotopic response.
Herpes zoster is caused by reactivation of the latent varicella zoster virus and often occurs in immunocompromised individuals. We describe a rare case of an immunocompetent patient with herpes zoster triggered by Shingrix, a non-live vaccine designed to protect against herpes zoster. Although herpes zoster has been described as a reaction to vaccinations before, to our knowledge this is the first report of herpes zoster triggered by a varicella zoster vaccine.
Secukinumab and ixekizumab are IL17A inhibitors most commonly used to treat psoriasis. Common side effects include upper respiratory tract infections, injection site reactions, and mucocutaneous candidiasis. Recently, these medications have been reported to trigger lichen planus and lichenoid reactions have also been reported as an emerging side effect of biologics, especially tumor necrosis factor inhibitors. Herein, we report a patient with lichen planus that appeared after initiation of secukinumab for the treatment of psoriasis.
The University of California, Davis, School of Medicine, the Department of Dermatology is currently recruiting for a full-time basic research position in the series of Ladder rank or In-Residence at the Assistant, Associate or Full Professor rank. Appointees to this position will be predominantly engaged in research, but also participate in teaching and engage in University and public service. This position may be 100% tenure track or a 50/50 appointment, in which case the position will be 50% tenure track and 50% In Residence. Professor In-Residence titles are intended to be used for individuals supported by non-State funds.
The successful candidate will be expected to excel at student teaching and inclusive mentoring, write and submit research proposals to government agencies to secure additional funding and will be expected to spend a minimum of 70% effort in research. Candidates shall have the ability to adhere to University policies and procedures and to work cooperatively and collegially within a diverse environment.