Severe atopic dermatitis in a 21-month-old boy successfully treated with dupilumab.

While dupilumab has emerged as a novel targeted systemic treatment for severe AD, efficacy and safety-based data in young children are limited. We discuss the case of a 21-month-old child with severe recalcitrant atopic dermatitis successfully treated with dupilumab.

A guide to curettage and cautery in the management of skin lesions.

BACKGROUND: Curettage and cautery is a procedure used for treatment of low-risk skin malignancies and pre-cancerous lesions. Given good lesion selection and technique, high cure rates and good cosmesis are routine for this quick, simple and cost-effective operation. OBJECTIVE: The purpose of this article is to review and summarise the steps in managing carefully selected cutaneous lesions with curettage and cautery. DISCUSSION: This article will address lesion selection, technique, efficacy, complications and how to incorporate curettage into daily practice.

Recognising skin manifestations of rheumatological disease.

BACKGROUND: An understanding of skin conditions associated with rheumatic diseases ensures accurate diagnosis and management. Cutaneous manifestations of rheumatological disease are legion. OBJECTIVE: The aim of this article is to increase clinician familiarity with the dermatological manifestations of rheumatic conditions to enable accurate diagnosis and effective management. DISCUSSION: This article will address the skin manifestations of lupus erythematosus, rheumatoid arthritis, psoriatic arthritis, dermatomyositis and scleroderma, including their implications in diagnosis, prognosis and treatment.

Genital premalignant and malignant diseases: a retrospective study of male genital skin biopsies.

BACKGROUND: Genital skin malignancies are a rare entity encountered by clinicians that may result in significant morbidity and mortality. Lack of familiarity or expertise in this area among clinicians can delay appropriate management of these conditions and may result in disease progression. METHODS: We performed a retrospective descriptive cohort study of male patients who received a genital skin biopsy reported by one major dermatopathology laboratory between January 2017 and December 2018 with a histological diagnosis of a premalignant or malignant condition. Patient age, type of clinician, clinical notes, genital site, type of biopsy performed, and histopathological diagnosis were evaluated. RESULTS: Of the 1525 male genital skin biopsies available for analysis, 5% (74/1525) were premalignant or malignant diseases. These included penile intraepithelial neoplasia (PeIN) (42/74, 57%), followed by invasive squamous cell carcinoma (SCC) (11/74, 15%), Bowenoid papulosis (BP) (9/74, 12%), basal cell carcinoma (8/74, 11%), malignant melanoma (2/74, 2.7%), extramammary Paget's (1/74, 1.4%), and metastatic cutaneous deposits (1/74, 1.4%). PeIN and BP most commonly affected the penile shaft ([18/42] 43% and [4/9] 44%, respectively), invasive SCCs most commonly affected the glans penis (4/11, 36%), and all BCCs (8/8, 100%) were located on the scrotum. Invasive SCCs were most biopsied by urologists, BP was most biopsied by dermatologists, and PeINs and BCCs were most biopsied by general practitioners. CONCLUSIONS: A variety of genital malignancy types were found in males. A greater understanding of male genital premalignant and malignant conditions may help guide education and further research in this area.

Pathologically oriented descriptive study of male genital circumcisions across medical and surgical specialties.

BACKGROUND: Circumcision is one of the most frequently performed procedure by clinicians, yet its role and indication in clinical practice lacks consensus and remains unclear. We sought to evaluate a collection of male circumcisions to determine the range of indications, histopathological diagnoses, and type of clinicians associated with circumcision. METHODS: We performed a retrospective descriptive cohort study of male patients who received a circumcision reported by one major dermatopathology laboratory between January 2017 and December 2018. Data were extracted from the histological report of the pathologist for each case. Patient age, type of clinician, clinical notes, and histopathological diagnosis were evaluated. RESULTS: "/> A total of 406 circumcisions were identified. The median age for circumcision was 36 (IQR 16-61). Boys less than 18 years of age made up 24% (98/406). Histological diagnoses included normal (43/406, 11%), nonspecific inflammation (82/406, 20%), inflammatory conditions (264/406, 65%), infections (9/406, 2.2%), benign neoplasms (5/406, 1.0%), and scar tissue (3/406, 0.7%). The most common diagnosis was balanitis xerotica obliterans (226/406, 56%). Rarely, genital infections and neoplastic lesions were identified. Circumcisions were performed by urologists (289/406, 71.2%), general practitioners (76/406, 18.7%), general surgeons (32/406, 8%), pediatric surgeons (5/406, 1%), and dermatologists (4/406, 1%). The main indications for circumcision were phimosis (110/202, 54%), suspected lichen sclerosus (28/202, 14%), and balanitis (15/202, 7%). CONCLUSION: Circumcision was performed for a broad range of genital dermatoses across various medical and surgical specialties. Few studies have described these observations. We discuss the common pathological conditions leading to circumcision and its role in diagnosis and treatment.

A Survey on Knowledge Gaps in Assessment and Management of Severe Drug Hypersensitivity Reactions: Multicenter Cross-Sectional Study of Australian Health Care Providers.

Severe drug hypersensitivity reactions (DHRs) are often encountered by health care professionals (HCPs). We evaluated knowledge of doctors and pharmacists in the assessment and management of severe DHRs using a structured questionnaire. A cross-sectional study was conducted in 4 metropolitan hospital networks in Melbourne, Australia. A 13-question, scenario-based multiple-choice questionnaire to assess specific knowledge domains in drug hypersensitivity syndrome recognition, causality attribution, cross-reactivity patterns, appropriate diagnostic tests, and therapy was administered to HCPs of various vocation and specialty groups. Data were analyzed according to profession, self-reported experience, and preparedness in managing severe DHRs. Two hundred thirty-eight participants (45.0% senior doctors, 24.4% junior doctors, and 30.7% pharmacists) across a range of subspecialties achieved an overall median score of 7 (IQR, 5-8)-overall 55.6% correct responses to all questions-with senior doctors outperforming junior doctors and pharmacists (P < .001). The best performance by all participants was in DHR syndrome recognition (60.9%), and the poorest was in diagnostics/therapy (52.0%). HCP group and experience level were significantly associated with better performance in the knowledge domains of cross-reactivity and diagnostics/therapy (P = .003 and < .001, respectively), but not in the domains of syndrome recognition and causality attribution (P > .05). Levels of self-reported preparedness in DHR management were not associated with performance rates in any of the knowledge domains. This study demonstrated significant knowledge gaps in the recognition and management of severe drug hypersensitivity reactions. Targeted multidisciplinary education of staff caring for these patients is needed to improve knowledge gaps.

Metastatic Crohn's disease in a boy presenting with genital swelling.

Cutaneous manifestations of Crohn's disease are uncommon and occasionally can affect the genitals with varying symptomatology. When cutaneous features precede or occur in the absence of GI symptoms, this condition may remain undiagnosed. We report the case of a 14-year-old boy who presented for evaluation of persistent penile edema with clinicopathological features consistent with a diagnosis of genital metastatic Crohn's disease, successfully treated with infliximab.

Review of non-invasive body contouring devices for fat reduction, skin tightening and muscle definition.

Non-invasive body contouring is a rapidly growing field in cosmetic dermatology. Non-invasive contouring devices improve the body's appearance through the removal of excess adipose tissue, particularly in areas in which fat persists despite optimal diet and exercise routine. The technology can also be used for skin tightening. This article reviews the five FDA-approved non-invasive body contouring modalities: cryolipolysis, laser, high-intensity focused electromagnetic field, radiofrequency and high-intensity focused ultrasound. These devices have emerged as a popular alternative to surgical body contouring due to their efficacy, favourable safety profile, minimal recovery time and reduced cost. Although they do not achieve the same results as liposuction, they are an attractive alternative for patients who do not want the risks or costs associated with surgery. When used appropriately and correctly, these devices have demonstrated excellent clinical efficacy and safety.

Disseminated cutaneous-only histoplasmosis in a patient with AIDS.

Histoplasmosis is an opportunistic fungal infection that occurs predominantly in immunocompromised patients. Cutaneous lesions in histoplasmosis are rare and typically occur in the absence of extra-cutaneous manifestations. We present a rare case of disseminated cutaneous-only histoplasmosis in a patient with recently diagnosed AIDS.

Acute otitis media in children presenting to the emergency department: Is it diagnosed and managed appropriately?

AIM: To describe the diagnostic and management practice in children with acute otitis media (AOM) presenting to the emergency department (ED) and compare diagnosis and management against existing guidelines. METHODS: We performed a retrospective descriptive cohort study of patients ≤15 years of age who presented to two EDs in Southeast Queensland between January 2016 and June 2017 with an ED diagnosis of AOM. Likelihood of diagnosis was based on medical records and classified as likely, possible or unlikely using paediatric practice guidelines. Appropriateness of antibiotics prescription was classified using the National Antibiotic Prescribing Survey, which takes into account adherence to the Australian Therapeutic Guidelines. Each medical record was extracted by two blinded reviewers, and discrepancies were resolved by consensus or arbitration. RESULTS: Of the 305 patients included for analysis, 87% had a likely or possible diagnosis of AOM. Otalgia was the presenting complaint in 75%. Standard otoscopy was the routine method for tympanic membrane visualisation, and 70% had abnormal tympanic membrane findings. Almost two-thirds (62%) of all children were prescribed antibiotics. Antibiotic appropriateness could be ascertained for 286 patients (94%). A total of 39% received inappropriate antibiotic management for AOM. The majority of patients received analgesia in the form of paracetamol and/or ibuprofen. CONCLUSIONS: ED clinicians make the diagnosis of AOM fairly accurately, although better assessment of the tympanic membrane by tympanometry and/or pneumatic otoscopy may improve accuracy. More than one-third of patients are prescribed antibiotics inappropriately. Our data can inform knowledge translation and education strategies to ensure the correct evidence-based management of this condition.