Psoriasiform Pemphigus Foliaceus in an African American Female: An Important Clinical Manifestation.

A 50-year-old African-American woman presented to the dermatology clinic with a pruritic eruption of 3 years' duration. On clinical examination, the patient had well-demarcated, pink, atrophic plaques and superficial erosions over the inframammary folds and mid-chest. She also had well-demarcated, hyperpigmented, hyperkeratotic scaly plaques over the abdomen, suprapubic region, elbows, knees, and back with sporadic small superficial blisters. A punch biopsy of the right abdomen was performed and revealed psoriasiform epidermal hyperplasia, focal parakeratosis, and acantholysis throughout the superficial spinous and granular layers. Only a sparse inflammatory infiltrate was present in the underlying dermis. Clinical and histological findings supported the diagnosis of pemphigus foliaceus (PF), but psoriasis was included in the differential diagnosis due to the presence of discrete plaques with an erythematous border. We hypothesize that patients with psoriasiform presentations of PF may be misdiagnosed with plaque psoriasis. It is important to distinguish between PF and psoriasis as there is evidence that ultraviolet light, a common treatment for psoriasis, may exacerbate PF. We document and highlight this atypical psoriasiform presentation of PF in a patient with skin of color to raise awareness and improve diagnosis and outcomes.

J Drugs Dermatol. 2018;17(4):471-473.

Application of mobile teledermatology for skin cancer screening.

BACKGROUND: With advancements in mobile technology, cellular phone-based store-and-forward teledermatology may be applied to skin cancer screening. OBJECTIVE: We sought to determine diagnostic and management concordance between in-person and teledermatology evaluations for patients at skin cancer screening whose clinical images and history were transmitted through mobile phones. METHODS: A total of 86 patients with 137 skin lesions presented to a skin cancer screening event in California. These patients' clinical history and skin images were captured by a software-enabled mobile phone. Patients were assessed separately by an in-person dermatologist and a teledermatologist, who evaluated the mobile phone-transmitted history and images. Diagnostic and management concordance was determined between the in-person and teledermatology evaluations. RESULTS: The primary categorical diagnostic concordance was 82% between the in-person dermatologist and the teledermatologist (95% confidence interval 0.73-0.89), with a Kappa coefficient of 0.62 indicating good agreement. The aggregated diagnostic concordance between the in-person dermatologist and the teledermatologist was 62% (95% confidence interval 0.51-0.71), with Kappa coefficient of 0.60 indicating good agreement. Management concordance between the in-person dermatologist and the teledermatologist was 81% (95% confidence interval 0.72-0.88), with a Kappa coefficient of 0.57, which indicates moderate agreement between the dermatologists. Multivariate analysis showed that older age and presentation of atypical nevus were significantly associated with disagreement in diagnosis between the teledermatologist and in-person dermatologist, after adjusting for other factors. LIMITATIONS: Dermatoscopic images were not captured via mobile phones, which might improve diagnostic accuracy. CONCLUSION: Mobile teledermatology using cellular phones is an innovative and convenient modality of providing dermatologic consultations for skin cancer screening.

Merkel cell carcinoma: treatment with bleomycin.

Merkel cell carcinoma is the second most deadly form of skin cancer after melanoma, with a mortality rate of as high as 35 percent. It usually occurs as a deep red or purple dome-shaped tumor on sun-exposed skin of elderly people. Transplant recipients or AIDS patients have a higher incidence of this tumor than normal individuals. There is an association of a polyoma virus with this tumor that may explain the increased incidence in immunosuppression. Surgery, followed by radiation therapy is the standard of treatment. Sentinel node dissection is recommended because this tumor metastasizes often. Chemotherapy, such as is used for oat cell carcinoma of the lung, is advised for metastatic disease. However, systemic chemotherapy protocols have not been overly successful. We have treated four cases of stage-I Merkel cell carcinoma with surgery followed by intralesional bleomycin and have followed these cases for up to five years with no evidence of recurrence or metastasis. One case had radiation post operatively but the tumor recurred. Intralesional bleomycin caused complete regression of this tumor with minimal scarring and long term cure. Bleomycin, besides being a potent chemotherapy agent, has direct antiviral effects that may explain why this drug is so effective in treating Merkel cell carcinoma.

Imiquimod 5% cream following curettage without electrodesiccation for basal cell carcinoma: preliminary report.

BACKGROUND: Using more than one therapeutic approach in the treatment of basal cell carcinomas (BCCs) has the potential to enhance cure rates. MATERIALS AND METHODS: In this study, 57 nodular and superficial BCCs were curetted without electrodesiccation. One week later, imiquimod 5% cream therapy was initiated once daily 5 times per week for 6 weeks. At 1-year follow-up, 0 of 57 BCCs (0%) had clinical recurrences. Cosmetic results were very good to excellent. CONCLUSION: Combination therapy with imiquimod 5% cream followed by curettage represents an effective method for treating BCCs with a high cure rate.