Giant Hemosiderotic Adenodermatofibroma: A Case Report and Review of the Literature.

ABSTRACT: Adenodermatofibromas are an extremely rare subtype of dermatofibroma (DF) characterized by a dermal proliferation of spindle-shaped fibroblasts and histocytes, dilated glandular structures with apocrine secretion, and prominent vascular proliferation, with or without hemosiderotic features. We describe a recent extraordinary case of a hemosiderotic adenodermatofibroma in a 25-year-old female. We review histologic findings and theories behind etiology, as well as review the spectrum of clinical presentations for this lesion. We also discuss imaging findings that may make identification of these entities challenging.

A Review of Antithrombotic Agents in Dermatologic Surgery and Context for a Practical Approach, With Cardiology and Pharmacologic Input.

Dermatologic surgeons are encountering more patients on antithrombotic agents. There are no established consensus guidelines for managing antithrombotic agents in the perioperative period. We provide an updated overview of antithrombotic agents in dermatologic surgery and management of such agents in the perioperative period with additional unique perspectives from cardiology and pharmacy. A literature search of PubMed and Google Scholar was performed to review the English-language medical literature. The landscape of antithrombotic therapy is changing with a notable rise in the use of direct oral anticoagulants (DOACs.) While no consensus guidelines exist, most studies recommend continuing antithrombotic therapy in the perioperative period with appropriate lab monitoring, when applicable. However, recent data suggest it is safe to hold DOACs in the perioperative period. As antithrombotic therapy evolves, the dermatologic surgeon needs to remain current with the most recent available data. Where data are limited, a multidisciplinary approach to managing these agents in the perioperative period is essential. J Drugs Dermatol. 2023;22(5): doi:10.36849/JDD.7456.

Successful Use of Percutaneous Dissolvable Sutures During COVID-19 Pandemic: A Retrospective Review.

BACKGROUND: The COVID-19 pandemic has had dramatic effects on all fields of medicine, including an effort to limit in-person visits. Within dermatologic surgery, one strategy is to close surgical incisions using percutaneous absorbable sutures. To the authors' knowledge, there are no large studies comparing changes in suture preferences and subsequent outcomes during the pandemic. OBJECTIVE: To assess changes in suture preference and frequency of post-operative complications for percutaneous absorbable and non-absorbable sutures during the pandemic. METHODS: A retrospective review of 1358 Mohs surgeries completed at the Cleveland Clinic during a 2-month period prior to COVID-19 and a matched 2-month period during the pandemic. RESULTS: Sutures were used to close 1103 cases. Significantly more closures were performed with percutaneous absorbable sutures during COVID-19 (87.6%, 39.6%; P < .0001). There was no significant difference in the frequency of post-operative complications between suture materials (P = .48). The use of absorbable sutures were associated with a significantly higher frequency of suture hypersensitivity reaction (P = .020) but significantly lower frequency of infection (P = .021) and wound dehiscence (P < .0001). CONCLUSIONS: Suture preference shifted towards absorbable sutures during the COVID-19 pandemic. Percutaneous absorbable sutures offered a formidable alternative to non-absorbable sutures and could reduce in-person follow-up visits without increasing post-operative complications.

Can Sunscreens Harm Coral Reefs? Addressing Environmental Concerns and Offering Practical Recommendations.

The crucial role sunscreen plays in preventing sunburns, photoaging, and skin cancer is unquestionable, and as a result, it is incumbent upon dermatologists to influence patients to appropriately use sunscreens. In addition to explaining the benefits of sunscreen use and how to properly use sunscreen, dermatologists must also address possible barriers or concerns that patients may have regarding sunscreen. One concern that has gained increasing media attention in the recent years has been the environmental impact of sunscreens, especially the impact on coral reefs. There is strong evidence that some sunscreen ingredients, especially oxybenzone, are harmful to corals if the concentration in water is high. In some situations, primarily related to the number of swimmers and the geography of the shoreline, concentrations of oxybenzone far exceed the levels shown to be harmful to corals. As advocates for our patients' skin health, we need to be prepared to address this issue when asked, so that patients do not forgo sunscreen use in an effort to protect corals. This article will review evidence regarding the effects of sunscreen ingredients on corals and will provide practical guidance for counseling patients on how to select sunscreens that minimize the potential for harm to coral reefs.

A Patient-Narrative Video Approach to Teaching Fibromyalgia.

INTRODUCTION: Although fibromyalgia is one of the most common and clinically important rheumatologic entities, physicians frequently report that their training fails to prepare them to manage this disease. Many medical schools devote insufficient time and attention to the subject of fibromyalgia, resulting in training gaps that can manifest as failures of both knowledge and empathy. There is a need for evidence-based, time-efficient methods for teaching this important subject. We have developed a narrative-driven video presentation for clerkship students and sought to evaluate its impact on fibromyalgia-related knowledge and attitudes. METHODS: Fibromyalgia: A Patient's Perspective (FPP), a 13-minute video, was presented to third-year medical students (N = 54). Surveys of knowledge and attitudes were collected before and after the video. Composite scores, as well as Knowledge and Attitudes subscales, were computed, and paired t tests were used to compare pre/post means for these scales, as well as for individual questions. Mann-Whitney U and Kruskal-Wallis tests were used to identify correlations between survey scores and student sex and specialty of interest. RESULTS: Between pre-experience and post-experience surveys, there were statistically significant differences for 11 of 15 questions (73%). The composite score increased from 3.8 (SD = 0.44) to 4.2 (SD = 0.47) (P < .0001). Knowledge and Attitude subscale scores also increased, from 4.0 (SD = 0.5) to 4.38 (SD = 0.5) (P < .0001) and 3.6 (SD = 0.5) to 3.93 (SD = 0.5) (P < .0001), respectively. Students reported favorable impressions of the video, with 87% agreeing that the video was helpful to learners and 79% disagreeing that a lecture would be preferable to the video. No differences in scores by sex or intended specialty were observed. CONCLUSION: The FPP video demonstrates promise as a tool for enhancing both knowledge of and positive, empathic attitudes toward fibromyalgia in medical learners. It may serve as a useful resource for educators looking to further develop their clinical pain management curricula.