Clinical and laboratory factors associated with wound healing in patients with pyoderma gangrenosum: a retrospective study.

INTRODUCTION: Pyoderma gangrenosum (PG) is a rare, chronic, inflammatory, and ulcerative condition that often affects the lower extremities. Laboratory markers such as neutrophil-to-lymphocyte ratio, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level may have prognostic utility in the management of ulcerative or inflammatory conditions. OBJECTIVE: This exploratory analysis investigated the relationship between readily available clinical factors and target ulcer healing within 6 months from the first visit. METHODS: Two logistic regression models were fit-one focused on ESR as a primary predictor adjusted for age and hemoglobin level, and the other focused on CRP level adjusted for body mass index (BMI) and smoking history. RESULTS: The odds of wound healing at 6 months for patients with abnormal CRP was 0.19 times the odds of healing (95% CI, 0.03-0.77) for those with normal CRP (<10 mg/L), after accounting for BMI and smoking. Similarly, after accounting for age and hemoglobin, those with high ESR experienced 2.81 times the odds of healing (95% CI, 0.69-14.58) at 6 months compared with patients with normal ESR. CONCLUSIONS: After adjustment, an increased CRP level was associated with lower odds of healing; however, further research is warranted to investigate its prognostic utility. The relationship between ESR and odds of healing should be interpreted with caution because the wide 95% CI for the adjusted odds ratio reflects marked uncertainty in the estimate. This research brief may inform investigations into inflammatory markers as possible prognostic markers for wound healing in patients with PG.

Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions with high morbidity and mortality. Supportive care management of SJS/TEN is highly variable. A systematic review of the literature was performed by dermatologists, ophthalmologists, intensivists, and gynecologists with expertise in SJS/TEN to generate statements for supportive care guideline development. Members of the Society of Dermatology Hospitalists with expertise in SJS/TEN were invited to participate in a modified, online Delphi-consensus. Participants were administered 9-point Likert scale questionnaires regarding 135 statements. The RAND/UCLA Appropriateness Method was used to evaluate and select proposed statements for guideline inclusion; statements with median ratings of 6.5 to 9 and a disagreement index of ≤1 were included in the guideline. For the final round, the guidelines were appraised by all of the participants. Included are an evidence-based discussion and recommendations for hospital setting and care team, wound care, ocular care, oral care, urogenital care, pain management, infection surveillance, fluid and electrolyte management, nutrition and stress ulcer prophylaxis, airway management, and anticoagulation in adult patients with SJS/TEN.

Effect of in-office samples on dermatologists' prescribing habits: a retrospective review.

The relationship between physicians and pharmaceutical companies has caused the medical community to question the degree to which pharmaceutical interactions and incentives can influence physicians' prescribing habits. Our study aimed to analyze whether a change in institutional policy that restricted the availability of in-office samples for patients resulted in any measurable change in the prescribing habits of faculty physicians in the Department of Dermatology and Cutaneous Surgery at the University of South Florida (USF)(Tampa, Florida). Medical records were retrospectively reviewed for common dermatology diagnoses-acne vulgaris, atopic dermatitis, onychomycosis, psoriasis, and rosacea-before and after the pharmaceutical policy changes, and the prescribed medications were recorded. These medications were then categorized as brand name, generic, and over-the-counter (OTC). Statistical analysis using a mixed effects ordinal logistic regression model accounting for baseline patient characteristics was conducted to determine if a difference in prescribing habits occurred.

Characterisation and diagnosis of ulcers in inpatient dermatology consultation services: A multi-centre study.

Accurate and prompt diagnosis of skin ulcers is critical to optimise management; however, studies in hospitalised patients are limited. This retrospective review of dermatologic consultations included 272 inpatients with skin ulcers between July 2015 and July 2018 in four U.S. academic hospitals. The median age was 54 years and 45% were male. In 49.3% of the patients, skin ulcers were considered the primary reason for admission. Ulcers of 62% were chronic and 49.6% were located on the lower extremities. Pyoderma gangrenosum (17.3%), infection (12.5%), and exogenous causes (11.8%) were the leading aetiologies; 12% remained diagnostically inconclusive after consultation. Diagnostic agreements pre-dermatology and post-dermatology consult ranged from 0.104 (n = 77, 95% CI 0.051-0.194) to 0.553 (n = 76, 95% CI 0.440-0.659), indicating poor-modest agreement. This study highlights the diagnostic complexity and relative incidences of skin ulcers in the inpatient setting.

Diagnosis and Management of Cutaneous B-Cell Lymphomas.

Primary cutaneous B-cell lymphomas are a group of diseases with indolent and aggressive behavior. The goal of the initial workup is to evaluate for systemic involvement, provide adequate staging, and guide therapy. Histopathological studies are a critical part of the workup for classification of these lymphomas because they are similar to their nodal counterparts. There are limited data for treatment guidelines, and thus, therapy differs among institutions. Overall, localized therapies are preferred for indolent types and chemotherapy or immunotherapy for the aggressive forms.

Annular Lichenoid Dermatitis of Youth: A Chronic Case Managed Using Pimecrolimus.

Annular lichenoid dermatitis of youth, first described in 2003, is a rare and occasionally chronic skin disease. We report a case of annular lichenoid dermatitis of youth relapsing over the course of 5 years successfully treated and maintained with topical pimecrolimus cream.