Drug hypersensitivity syndrome or DRESS (drug reaction with eosinophilia and systemic symptoms) is a severe reaction with an estimated mortality of 10%. Antibacillary drugs are rarely incriminated. A 28-year-old patient...Drug hypersensitivity syndrome or DRESS (drug reaction with eosinophilia and systemic symptoms) is a severe reaction with an estimated mortality of 10%. Antibacillary drugs are rarely incriminated. A 28-year-old patient with tubercular miliaria who developed antibacillary-induced DRESS is presented. The dermatological lesions appeared four weeks after the beginning of the antitubercular treatment. The diagnosis of DRESS was made when all the Registry of Severe Toxidermia (RegiSCAR) criteria were present. The treatment was stopped and the patient was put on symptomatic treatment under supervision in the intensive care unit, with progressive improvement. Substitution with second-line antituberculosis drugs was necessary and was done with caution. DRESS with antituberculosis drugs is rare and its management is not codified.
Lichen planus pigmentosus (LPP) is recognized as a rare variant of lichen planus, characterized by dermal hyperpigmentation. Specifically, a particular intertriginous variant of LPP is known as lichen planus pigmentosus...Lichen planus pigmentosus (LPP) is recognized as a rare variant of lichen planus, characterized by dermal hyperpigmentation. Specifically, a particular intertriginous variant of LPP is known as lichen planus pigmentosus inversus (LPPI). In our case, the patient presented with symmetric, hyperpigmented dark brown patches mainly in axillary areas, closely resembling the features of acanthosis nigricans (AN). The differential diagnosis considered included LPPI, AN, post-inflammatory hyperpigmentation related to contact dermatitis, symmetrical drug-related intertriginous and flexural exanthema, fixed drug eruption, and erythema dyschromicum perstans (EDP). Histopathological examination revealed the absence of hyperkeratosis and papillomatosis, typically associated with AN. Dermoscopy revealed diffuse brownish hue along with dots and globules of inconsistent size, which suggests dermal pigmentary incontinence and the likelihood of LPPI. This case illustrates the challenge in differentiating LPPI from similar flexural hyperpigmentation disorders based on the comprehensive approach including thorough history taking, clinical manifestations, histopathological analysis, and dermoscopic examination.
A 68-year-old woman with a history of seizures on cenobamate presented with an itchy rash all over her body. The rash started about one month prior to her presentation to the dermatology clinic. The rash was initially tr...A 68-year-old woman with a history of seizures on cenobamate presented with an itchy rash all over her body. The rash started about one month prior to her presentation to the dermatology clinic. The rash was initially treated with topical triamcinolone with improvement at one-month follow-up. However, four months later the rash flared and there was concern that cenobamate was the cause. Biopsy was performed showing vacuolar interface dermatitis with atrophy, suggestive of subacute lupus erythematosus. Blood work revealed positive antinuclear antibody, anti-ribonucleoprotein antibody, Sjogren Anti-SS-A and positive histone antibody. Given the worsening rash, positive labs, and cenobamate as the only changed drug several months before initial onset, she was diagnosed with drug-induced subacute cutaneous lupus erythematous and her cenobamate was discontinued. To the best of your knowledge, this is the first reported case of a medication in the carbamate family leading to drug induced subacute cutaneous lupus erythematosus.
We present a patient with human immunodeficiency virus who developed multiple painful lesions that previously in the past had speciated as Cryptococcus neoformans cutaneously, and in the lung. Despite induction therapy f...We present a patient with human immunodeficiency virus who developed multiple painful lesions that previously in the past had speciated as Cryptococcus neoformans cutaneously, and in the lung. Despite induction therapy for presumed re-infection, the patient did not improve so a biopsy was performed and this was speciated as Mycobacterium avium complex, with final diagnosis being disseminated Mycobacterium avium complex. This case highlights the importance of considering a broad differential diagnosis for any new lesions regardless of prior culture data.
Blastomyces dermatitidis is a dimorphic fungus that can disseminate in the immunocompetent and immunodeficient. Many infected patients display heterogenous cutaneous findings, making it one of dermatology's great clinica...Blastomyces dermatitidis is a dimorphic fungus that can disseminate in the immunocompetent and immunodeficient. Many infected patients display heterogenous cutaneous findings, making it one of dermatology's great clinical mimics. Cases presenting as single lesions are often mistaken for neoplasms or other infections. We report a patient with diabetes mellitus who presented to the emergency department with a two-month history of an ulcerated jawline nodule. Treatment with incision/drainage and doxycycline for presumed bacterial abscess was unsuccessful. Upon re-presentation 10 days later, biopsy and fungal culture of the tumor confirmed infection with B. dermatitidis. Chest computed tomography revealed disease dissemination. Halfway through a 6-month course of itraconazole, cutaneous and pulmonary findings were notably improved. Diabetes is an emerging risk factor for dissemination that likely contributed to the severity in our case. Early biopsy can prevent potentially life-threatening treatment delays, highlighting the need for blastomycosis to be considered in the differential diagnosis of non-healing wounds.
Acquired reactive perforating collagenosis is an uncommon disorder that present as keratotic plugs on the skin owing to transepidermal perforation of dermal connective tissue. Etiology is unclear, although the condition...Acquired reactive perforating collagenosis is an uncommon disorder that present as keratotic plugs on the skin owing to transepidermal perforation of dermal connective tissue. Etiology is unclear, although the condition has been associated with renal disease, diabetes, and HIV. It can frequently be misdiagnosed and lead to significant impact on quality of life, particularly in patients with skin of color. Herein, we present an skin of color patient with this condition who experienced severe pruritus over years before receiving a definitive diagnosis. Clobetasol improved her condition and quality of life over several months.
Bullous systemic lupus erythematosus (SLE) is a rare cutaneous manifestation of SLE characterized by sudden vesiculobullous eruptions. Herpes zoster infection may lead to rapid bullae development in patients with known b...Bullous systemic lupus erythematosus (SLE) is a rare cutaneous manifestation of SLE characterized by sudden vesiculobullous eruptions. Herpes zoster infection may lead to rapid bullae development in patients with known bullous SLE. Herein, we describe a case of rapid development of bullous herpes zoster in a patient with bullous SLE. Patients with SLE and lupus nephritis exhibit an increased risk for herpes zoster infection. Bullous herpes zoster has been described in a previous patient with SLE and lupus nephritis. The current case illustrates that the presence of bullous SLE may have precipitated the development of bullous variant herpes zoster, as blisters leading to breakages in the skin increase risk for superinfection by viral pathogens. The current case highlights the importance of monitoring for skin changes in patients with SLE and maintaining a low threshold for infectious workup. Furthermore, it is important to recognize that the presence of bullae in SLE may confuse the diagnosis of bullous herpes zoster, leading to delays in diagnosis and management. Given high rates of morbidity and mortality in disseminated herpes zoster infection, the emergence of bullae in patients with SLE should raise a high index of suspicion for herpes zoster infection and prompt systemic workup.
Enfortumab vedotin (EV) is a monoclonal antibody drug conjugate composed of antibody against nectin-4 and linked to the microtubule inhibitor monomethyl auristatin E that is used to treat metastatic urothelial carcinoma....Enfortumab vedotin (EV) is a monoclonal antibody drug conjugate composed of antibody against nectin-4 and linked to the microtubule inhibitor monomethyl auristatin E that is used to treat metastatic urothelial carcinoma. Enfortumab vedotin-associated cutaneous adverse events are common and are clinically diverse, ranging from papulosquamous eruption to vesiculobullous eruptions such as Stevens-Johnson syndrome/toxic epidermal necrolysis and erythema multiforme-like eruption with vesiculobullae. Despite clinically diverse appearance, histopathology of EV-associated cutaneous adverse reactions often demonstrates interface dermatitis. We present the clinical and histopathologic features in a unique case of EV-associated widespread vesiculobullous eruption initially concerning for disseminated herpetic infection in a patient undergoing treatment of metastatic urothelial carcinoma with EV and pembrolizumab.
The growing demand for dermatologic services and shortage of dermatologic providers sets the stage for favorable market conditions to open a private dermatology practice. However, business-related education in medicine i...The growing demand for dermatologic services and shortage of dermatologic providers sets the stage for favorable market conditions to open a private dermatology practice. However, business-related education in medicine is lacking and the concept of starting a new practice may be daunting for dermatologists in any stage of training. We describe key components of starting a private dermatology practice. Topics include strategies to build a business plan, find a location, explore financial options, structure a legal framework, and incorporate branding and marketing.
Climate change poses an increasing threat to human health, with well-documented impacts on dermatologic conditions. However, the U.S. healthcare sector is paradoxically a significant contributor to climate change-worseni...Climate change poses an increasing threat to human health, with well-documented impacts on dermatologic conditions. However, the U.S. healthcare sector is paradoxically a significant contributor to climate change-worsening greenhouse gas emissions. To address this negative externality, calls to action to decarbonize healthcare delivery have spurred research and initiatives around improving the environmental sustainability of medicine. Published sustainability recommendations for dermatologic practices have addressed themes such as renewable energy, single-use disposable materials, regulated medical waste, and clinician advocacy. Our current commentary provides an analysis of the potential of existing recommendations and outlines additional, novel, and actionable interventions. We highlight recently released decarbonization resources and regulatory changes. We emphasize the importance of reassessing procedure kits, minimizing medication waste, and implementing green procurement policies. We also address nuances in promoting environmentally-conscious transit, maximizing the efficient use of technology, supporting alternatives to single-use items, leveraging resources for patient education, assessing appropriate use of carbon credits, and bolstering community climate resilience.
Topical treatment with glucocorticosteroids is a mainstay therapy for many dermatologic conditions. Though efficacious in many, topical therapies often fail to achieve desired positive results in clinical practice. SKIN-...Topical treatment with glucocorticosteroids is a mainstay therapy for many dermatologic conditions. Though efficacious in many, topical therapies often fail to achieve desired positive results in clinical practice. SKIN-CAP spray (Cheminova Laboratories International SA, Madrid, Spain), a product containing activated zinc pyrithione, and subsequently found to have contained clobetasol, provided unprecedented clearing of psoriasis even when ultra-high potency topical glucocorticosteroids had failed. A PubMed for terms related to corticosteroids, topical therapy, patient adherence, and SKIN-CAP spray was performed. Articles from 1997 to 2023 were included in the review of SKIN-CAP spray. In this review, we report the background of SKIN-CAP as well as studies that were performed in an attempt to explain its perceived high efficacy. The remarkable efficacy that occurred with SKIN-CAP over other delivery systems for high potency topical corticosteroids was initially speculated to be a consequence of an interaction between the zinc pyrithione and the clobetasol. However, no synergistic efficacy was identified, and there was no greater drug delivery. Better adherence to the SKIN-CAP product may explain the efficacy. The SKIN-CAP story provides insights into the need for healthy skepticism, the importance of treatment adherence, and ways to encourage better adherence to topical medications.
Superficial leiomyosarcoma is a rare malignancy of muscular origin arising in the skin and soft tissues. Although wide local excision is the standard of care for these tumors, Mohs micrographic surgery is a promising tre...Superficial leiomyosarcoma is a rare malignancy of muscular origin arising in the skin and soft tissues. Although wide local excision is the standard of care for these tumors, Mohs micrographic surgery is a promising treatment option as it provides for optimal margin control. The object of this systematic review is to examine the efficacy of micrographic surgery in the management of superficial leiomyosarcoma. A literature search was conducted using the PubMed/Medline and Cochrane databases; 14 studies representing 66 patients were included. Analysis demonstrated a notably low rate of recurrence (1.5%) and metastasis (0.0%) in tumors treated with micrographic surgery, contrasting with increased rates of recurrence and metastasis in tumors treated with wide local excision. These data may be influenced by a shortage of subcutaneous leiomyosarcoma in the included patients, as subcutaneous tumors are more likely to recur and metastasize. Further research is warranted to determine the value of Mohs micrographic surgery in treating superficial leiomyosarcoma and specifically, the subcutaneous variant.
Cantharidin, a natural toxin produced by the blister beetle, is a topical agent that induces acantholysis of the epidermis, breaking down desmosome plaques through the release of serine proteases. Cantharidin is availabl...Cantharidin, a natural toxin produced by the blister beetle, is a topical agent that induces acantholysis of the epidermis, breaking down desmosome plaques through the release of serine proteases. Cantharidin is available in three liquid forms: Ycanth (0.7%), Canthacur (0.7%), and Canthacur PS (1% cantharidin, 30% salicylic acid, 2% podophyllotoxin). Ycanth is used to treat molluscum contagiosum (MC). Canthacur is routinely used to treat a variety of dermatologic conditions including MC, plantar warts, and common warts, whereas Canthacur PS is a more potent formulation indicated for treatment of plantar warts only. The objective of this review is to highlight the efficacy, safety, and diverse use of topical cantharidin in the treatment of various skin conditions. Conditions in which treatment with topical cantharidin yielded a good-to-excellent response include MC, plantar warts, and common warts. Topical cantharidin treatment of anogenital warts yielded mixed results. None of the indications reviewed herein yielded a poor response to topical cantharidin. Overall, topical cantharidin resulted in a good-to-excellent clinical response in several conditions with mild and transient adverse events. The results of this review suggest the safe and efficacious use of topical cantharidin in the field of dermatology and highlight the potential for future use.
_Case Presentation X Photo Vignette _Letter Authors declare that the contents of this article are their own original unpublished findings. Title: Metastatic lung cancer mimicking varicella-zoster virus Authors: Katherine..._Case Presentation X Photo Vignette _Letter Authors declare that the contents of this article are their own original unpublished findings. Title: Metastatic lung cancer mimicking varicella-zoster virus Authors: Katherine Snow1 BA, Rylee Moody1 MD, Michael Kremer2 MD, Sofia Chaudhry2 MD Affiliations: 1Saint Louis University, School of Medicine, St. Louis, Missouri, USA, 2SSM Health Saint Louis University Hospital, Department of Dermatology, St. Louis, Missouri, USA Corresponding Author: Katherine Snow, 1008 South Spring Avenue, St. Louis, MO 63110, Tel: 314-617-2660, Email: katherine.snow@health.slu.edu Abstract: Cutaneous metastases from lung adenocarcinoma are rare and usually signify advanced disease with a poor prognosis. This case describes a 63-year-old woman with stage IV lung adenocarcinoma who presented with a painful, initially unilateral, rash on her breast. The clinical appearance of erythematous plaques with vesiculo-papules suggested disseminated herpes zoster, leading to the initiation of intravenous acyclovir. However, histopathology revealed atypical epithelial cells consistent with cutaneous metastasis from the primary lung carcinoma. Although cutaneous metastases from lung cancer typically present as nodules, zosteriform skin metastases are extremely rare. This case is a unique instance of bilateral zosteriform skin metastases from lung carcinoma, underscoring the importance of considering cutaneous metastasis in patients with atypical skin lesions and underlying malignancy. Early recognition and accurate diagnosis are crucial for patient management and prognosis.
Dystrophic calcinosis cutis is the aberrant deposition of insoluble calcium in cutaneous tissue generally secondary to inflammatory connective tissue disease. Although calcinosis cutis is commonly seen in juvenile dermat...Dystrophic calcinosis cutis is the aberrant deposition of insoluble calcium in cutaneous tissue generally secondary to inflammatory connective tissue disease. Although calcinosis cutis is commonly seen in juvenile dermatomyositis, it is a relatively rare occurrence in adult disease. Herein, we discuss an 82-year-old woman with extensive history of dermatomyositis of the scalp who presented with new-onset calcinosis cutis of the scalp.