RESUMEN
ABSTRACT: The current multicountry outbreak of mpox in 2022 is the first occurrence of widespread transmission in nonendemic countries. Prior cases in the United States involved exposure through foreign travel or direct contact with infected rodents. Reports of the current outbreak have predominately described spread through sexual encounters between cis-gender men who have sex with men. We report a unique case of mpox in which the transmission occurred through oral sex between 2 transgender men, with a short incubation period and progressive asynchronous emergence of lesions. Continued analysis of transmission routes and awareness will improve timely prevention, diagnosis and treatment.
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Mpox , Minorías Sexuales y de Género , Personas Transgénero , Humanos , Masculino , Homosexualidad Masculina , Brotes de EnfermedadesAsunto(s)
COVID-19 , Eritema Pernio , Vacunas contra la COVID-19 , Humanos , Interferón-alfa , SARS-CoV-2RESUMEN
Importance: Beginning in March 2020, case reports and case series linked the COVID-19 pandemic with an increased occurrence of chilblains, but this association has not been evaluated in an epidemiologic study. Objective: To assess whether a correlation exists between COVID-19 incidence and chilblains incidence. Design, Setting, and Participants: A retrospective cohort study was conducted within the Kaiser Permanente Northern California system from January 1, 2016, to December 31, 2020; health plan members of all ages were included. Exposure: COVID-19 incidence in 207 location-months, representing 23 geographic locations in northern California across 9 months. Main Outcome and Measures: Chilblains incidence was the main outcome. The association of chilblains incidence with COVID-19 incidence across the 207 location-months was measured using the Spearman rank correlation coefficient. Results: Of 780 patients with chilblains reported during the pandemic, 464 were female (59.5%); mean (SD) age was 36.8 (21.8) years. COVID-19 incidence was correlated with chilblains incidence at 207 location-months (Spearman coefficient 0.18; P = .01). However, only 17 of 456 (3.7%) patients with chilblains tested during the pandemic were positive for SARS-CoV-2, and only 9 of 456 (2.0%) were positive for SARS-CoV-2 within 6 weeks of the chilblains diagnosis. Test results of 1 of 97 (1.0%) patients were positive for SARS-CoV-2 IgG antibodies. Latinx patients were disproportionately affected by COVID-19 but not by chilblains. Conclusions and Relevance: This cohort study found that in northern California, the incidence of chilblains increased during the pandemic but was correlated weakly with the incidence of COVID-19 across 207 location-months. These findings may have resulted from a causal role of COVID-19, increased care-seeking by patients with chilblains during the pandemic, or changes in behavior during shelter in place.
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COVID-19/epidemiología , Eritema Pernio/epidemiología , Adolescente , Adulto , COVID-19/complicaciones , COVID-19/diagnóstico , California/epidemiología , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenAsunto(s)
Acné Vulgar/epidemiología , Índice de Masa Corporal , Sobrepeso/epidemiología , Obesidad Infantil/epidemiología , Acné Vulgar/diagnóstico , Adolescente , California/epidemiología , Niño , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Sobrepeso/diagnóstico , Obesidad Infantil/diagnóstico , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
Evaluation of anogenital dermatitis requires a detailed history, including a sexual history. Men who have sex with men have different risk of certain infectious causes compared with men who have sex with women. Infectious causes of balanitis and anal dermatitis are easily treatable once identified. Irritant contact dermatitis is a common cause of balanitis, and avoidance of irritants, including decreased soap washing, helps many patients improve. Detailed histories of the personal products used by the patient and partner(s), including soaps, lotions, perfumes, lubricants, condoms, topical medications, hygiene sprays, personal wipes, and laundry detergent, may reveal possible irritants or contact allergens.
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Enfermedades del Ano/terapia , Dermatitis Alérgica por Contacto/terapia , Dermatitis Irritante/terapia , Enfermedades de los Genitales Masculinos/terapia , Minorías Sexuales y de Género , Enfermedades de Transmisión Sexual/terapia , Enfermedades del Ano/diagnóstico , Condones/efectos adversos , Dermatitis/diagnóstico , Dermatitis/terapia , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/etiología , Dermatitis Irritante/diagnóstico , Dermatitis Irritante/etiología , Enfermedades de los Genitales Masculinos/diagnóstico , Humanos , Lubricantes/efectos adversos , Lubricantes/química , Masculino , Enfermedades de Transmisión Sexual/diagnóstico , Jabones/efectos adversos , Jabones/químicaRESUMEN
Distinctive patterns in the cutaneous manifestations of COVID-19 have been recently reported. We conducted a systematic review to identify case reports and case series characterizing cutaneous manifestations of confirmed COVID-19. Key demographic and clinical data from each case were extracted and analyzed. The primary outcome measure was risk factor analysis of skin related outcomes for severe COVID-19 disease. Seventy-one case reports and series comprising 144 cases of cutaneous involvement in COVID-19 were included. The most frequently occurring morphologies were: morbilliform (30.6%), varicelliform (18.8%), urticarial (13.2%), chilblains-like (12.5%), and acro-ischemic (9%). The median age of patients was 51 years (mean: 45.9, range: 0 to 91). Patients with chilblains-like eruptions had lower frequencies of extracutaneous COVID-19 symptoms (5/18, 27.8%, P<0.05) and were less likely to have severe COVID-19 disease (2/18, 11%, 95% CI 1.4% to 34.7%, P=0.02). Patients with livedoid and acro-ischemic morphologies had severe COVID-19 more frequently than those with other morphologies (17/21, 81%, 95% CI 58.0% to 94.5%, P<0.0001). The most frequently observed cutaneous manifestations of COVID-19 (morbilliform, varicelliform, and urticarial) are well-described patterns of viral exanthems. However, chilblains-like, livedoid, and acro-ischemic morphologies are not traditionally associated with viral infections and were significantly associated with severity of COVID-19 disease.
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COVID-19/complicaciones , SARS-CoV-2 , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Factores de Riesgo , Enfermedades Cutáneas Virales/epidemiología , Enfermedades Cutáneas Virales/etiología , Adulto JovenRESUMEN
Papillon-Lefèvre syndrome (PLS) is a rare inherited palmoplantar keratoderma (PPK) that is associated with progressive gingivitis and recurrent pyodermas. We present a case exhibiting classic features of this autosomal-recessive condition and review the current understanding of its pathophysiology, diagnosis, and treatment. Additionally, a review of pertinent transgredient PPKs is undertaken, with key and distinguishing features of each syndrome highlighted.
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Gingivitis/etiología , Enfermedad de Papillon-Lefevre/fisiopatología , Piodermia/etiología , Adulto , Catepsina C/genética , Progresión de la Enfermedad , Femenino , Gingivitis/tratamiento farmacológico , Gingivitis/patología , Humanos , Mutación , Enfermedad de Papillon-Lefevre/tratamiento farmacológico , Enfermedad de Papillon-Lefevre/genética , Piodermia/patología , RecurrenciaAsunto(s)
Enfermedades de la Piel/patología , Adolescente , Femenino , Humanos , Extremidad SuperiorRESUMEN
We report a neonate who presented at birth with multiple, scattered, white macerated plaques. Punch biopsy confirmed epidermal nevi. At 3 months of age the patient presented with infantile spasms and, after full evaluation, was diagnosed with tuberous sclerosis complex (TSC). We suggest that physicians consider TSC in a neonate with epidermal nevi inconsistent with any described epidermal nevus syndrome.
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Neoplasias Cutáneas/etiología , Neoplasias Cutáneas/patología , Esclerosis Tuberosa/complicaciones , Esclerosis Tuberosa/patología , Humanos , Recién Nacido , Masculino , Nevo/etiología , Nevo/patologíaRESUMEN
BACKGROUND: Dermatology instruction for primary care learners is limited, and the American Academy of Dermatology (AAD) has developed a new core curriculum for dermatology. OBJECTIVE: This study sought to prospectively evaluate short-term knowledge acquisition and long-term knowledge retention after using the AAD core curriculum during a clinical dermatology clerkship. METHODS: Resident physicians and physician assistant students performing clerkships at military dermatology clinics were given access to the AAD core curriculum teaching modules before their public availability. Knowledge acquisition was measured with pretests and posttests, and a follow-up quiz was given up to a year after the dermatology rotation to assess knowledge retention. RESULTS: In all, 82 primary care learners met inclusion criteria. Knowledge improved significantly from pretest to posttest (60.1 vs 77.4, P < .01). Of the 10 factors evaluated, only high use of the World Wide Web site was significantly associated with improved posttest scores (70.8 vs 82.2, P = .003). Long-term follow-up scores available from 38 participants were only slightly lower than their posttest scores (70.5 vs 78.9, P < .01) at a median time of 6.8 months after the clerkship. Students found the online modules clear, engaging, and worth their time and preferred them to other teaching methods such as textbook reading and lectures. LIMITATIONS: The nonrandomized study was voluntary, so individual performance may be influenced by selection bias. CONCLUSION: The more learners used the online curriculum, the better they scored on the posttest. This demonstrates the efficacy of the AAD core curriculum in teaching its goals and objectives for primary care learners performing a dermatology clerkship.
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Competencia Clínica , Curriculum , Dermatología/educación , Medicina Familiar y Comunitaria/educación , Internet , Adulto , Instrucción por Computador/métodos , Educación de Postgrado en Medicina , Educación de Pregrado en Medicina , Evaluación Educacional , Femenino , Humanos , Internado y Residencia , Aprendizaje , Masculino , Atención Primaria de Salud , Estudios Prospectivos , Sociedades Médicas , Estados UnidosRESUMEN
BACKGROUND: Few published studies have analyzed serum lidocaine levels and individual patient characteristics affecting metabolism after application of compounded topical anesthetics. OBJECTIVE: To measure serum lidocaine levels during and cutaneous side effects after standardized application of 23% lidocaine/7% tetracaine compounded anesthetic to the face of healthy volunteers. METHODS AND MATERIALS: Fifty-two volunteers were enrolled, and compounded 23% lidocaine/7% tetracaine ointment was applied to their faces for 2 hours. Lidocaine levels were determined every 30 minutes during application and for 2 hours after removal. Follow-up telephone calls 3 days later assessed cutaneous side effects. RESULTS: Median peak lidocaine level was 1.15 µg/mL, and the highest peak lidocaine level in an individual was 3.4 µg/mL. Higher serum lidocaine levels were found in men (p < .01), nonwhite volunteers (p = .02), and those with larger facial surface area (p = .04). Age and body mass index did not affect lidocaine levels. Irritant contact dermatitis was common, resulting in hyperpigmentation in some patients. CONCLUSION: Facial surface area, male sex, and nonwhite ethnicity were associated with higher serum lidocaine levels after topical application of lidocaine. Compounded anesthetics containing lidocaine should be used with caution under the direct supervision of a physician.
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Anestésicos Locales/efectos adversos , Anestésicos Locales/sangre , Erupciones por Medicamentos/etiología , Cara/anatomía & histología , Lidocaína/efectos adversos , Lidocaína/sangre , Tetracaína/efectos adversos , Adulto , Anestésicos Locales/administración & dosificación , Superficie Corporal , Dermatitis por Contacto/etiología , Combinación de Medicamentos , Femenino , Humanos , Hiperpigmentación/inducido químicamente , Lidocaína/administración & dosificación , Masculino , Persona de Mediana Edad , Bases Oleosas , Grupos Raciales , Factores Sexuales , Tetracaína/administración & dosificación , Adulto JovenRESUMEN
BACKGROUND: Few published articles focus on undergraduate dermatology education. OBJECTIVE: To quantify the amount and type of dermatology instruction for medical students and to rank specific diseases by the expectations of learners. METHODS: Electronic surveys were sent via e-mail to 109 dermatology residency programs as well as to 33 medical schools without dermatology programs. RESULTS: Responses were received from 64% of dermatology residency programs. Half of the responding institutions require 10 or fewer hours of dermatology instruction, and 8% require no dermatology instruction. Seventy-five percent or more of the responding dermatologists expected medical students to learn to diagnose or treat 33 skin diseases after completing a clinical dermatology rotation. LIMITATIONS: Surveys were sent only to academic institutions. CONCLUSIONS: Dermatology educators expect medical students to learn to diagnose or treat common skin diseases, but little time is designated for this in most medical schools. The aggregate opinions of dermatology educators may be used to prioritize future curricula.