A Case Report of Sebaceous Filaments.

This report details a case of a 16-year-old African American girl who presented with a two-year history of white spicules on her face without associated symptoms, including pruritus or pain. On physical examination, there were many 1-2 mm discreet white to yellow filamentous spicules on the mid and lower face. Histopathology scrapings showed cornified cells and calcification consistent with sebaceous filaments. Sebaceous filaments are a rare condition that presents as white-to-yellow spicules distributed in highly sebaceous areas on the face. It is caused by sebum accumulation and cornified keratinocytes surrounding hair follicles, resulting in visible excretions. Treatment of sebaceous filaments is targeted at reducing the size of sebaceous glands which subsequently decreases excretions and improves skin appearance. Despite low incidence, sebaceous filaments are likely under-reported. It is important for dermatologists to recognize and treat sebaceous filaments in patients who present with this condition to improve their appearance and quality of life. The present patient was successfully treated with topical tretinoin.

An unusual presentation of pigmented purpuric lichenoid dermatitis.

Pigmented purpuric lichenoid dermatitis (PPLD) is a rare subtype of pigmented purpuric dermatosis, which classically presents with a mixture of lichenoid papules and patches on the bilateral lower extremities. Herein, we describe an unusual case of a 47-year-old man with PPLD who presented with 1-3mm discrete papules without the presence of larger patches. The diagnosis of PPLD should be considered for patients presenting with bilateral symmetric discrete papules on the legs.

Learning Experiences in LGBT Health During Dermatology Residency.

Approximately 4.5% of adults in the United States identify as members of the lesbian, gay, bisexual, transgender (LGBT) community, and this population has a variety of health care disparities. Dermatologists have the potential to greatly impact the health of this community, but learning experiences in dermatology residency are lacking. In this study, we investigated LGBT education in dermatologic residency from the residents' perspective and assessed preparedness of dermatology residents to care for this community. An online survey was distributed to current US dermatology residents through program coordinator and program director listserves and postings on dermatology social media groups. Descriptive statistics and a Kruskal-Wallis rank test were used for analysis. There were 114 respondents. This study demonstrated that many dermatology residents are not effectively taught LGBT health topics and feel unprepared to treat this community. Most dermatology residents desired increased training. Further research is needed to determine the best strategies for increasing LGBT learning experiences in dermatology residency programs.

Interstitial granuloma annulare triggered by Lyme disease.

Granuloma annulare is a non-infectious granulomatous skin condition with multiple different associations. We present a case of a man in his 60s with a three-week history of progressive targetoid plaques on his arms, legs, and trunk. Skin biopsy demonstrated interstitial granuloma annulare. Additional testing revealed IgM antibodies to Borrelia burgdorferi on western blot suggesting interstitial granuloma annulare was precipitated by the recent infection. Lyme disease is an uncommonly reported association with interstitial granuloma annulare.

The role of enhanced plantar-surface sensory feedback on lower limb EMG during planned gait termination.

Purpose/aim of the study: Generation of smooth movement relies on the central nervous system (CNS) having information from the visual, vestibular and somatosensory systems to effectively execute motor behaviour. Recently, cutaneous afferent inputs have been linked to lower leg motorneuron pools, resulting in a growing interest of adding texture to the plantar foot sole interface as a novel method to facilitate cutaneous feedback. The aim of this study was to characterize the changes in magnitude and temporal organization of muscle activity, and to investigate motor output changes from enhanced tactile feedback during perturbed gait termination.Materials and methods: Thirty young adults experienced an unpredictable platform perturbation when completing planned gait termination. The study manipulated two experimental variables: 1) direction of platform tilt (anterior, posterior, medial, lateral), and 2) foot sensory facilitation (non-facilitated, facilitated). Upper and lower leg EMG onset, cessation time and integrated EMG (iEMG) were measured in addition to common gait parameters (walking velocity, step length, step width).Results: Gait termination over a textured surface resulted in significantly earlier upper leg EMG onset times and modified iEMG of rectus femoris, vastus medialis and biceps femoris muscles.Conclusions: Results of this study suggest that the addition of cutaneous feedback under the plantar-surface of the foot increases the ability to generate an earlier muscle response, consequently improving response ability to an unexpected perturbation. Secondly, enhanced tactile feedback appears to inform the CNS of the magnitude of the threat to the balance control system, providing additional insight into how the CNS uses enhanced tactile feedback during a gait termination task.