Recurrence of Metastatic Crohn's Disease after Surgical Resection.

A 36-year-old woman presented to the emergency department with a 1-day history of purulent perianal and vulvar discharge. She had a 25-year history of Crohn's disease (CD), and 13 years prior had received a total colectomy with end ileostomy. She had vulvar biopsies 5 years prior to presentation, demonstrating noncaseating granulomas consistent with metastatic Crohn's disease (MCD). Throughout the course of her disease, she had a failed treatment with adalimumab, certolizumab, methotrexate, and 6-mercaptopurine. She had received a radical vulvectomy 1 year prior to presenting to control recurrent vulvar abscesses and MCD while receiving monthly subcutaneous infliximab 10 mg/kg body weight. Dermatology was consulted at presentation, and the physical examination revealed tender, linear ulcerations with a granulated appearance and depigmentation on the natal cleft and vulva (Figures 1 and 2). Computerized tomography (CT) scan of the abdomen and pelvis indicated thickening of soft tissue without evidence of abscesses, fluid collection, or fistulae. Given the distribution and morphology of lesions with a history of biopsy-proven MCD, the patient was diagnosed with a flare of MCD.

Examination of the Utility of Cysteamine in the Treatment of Melasma: Current Perspectives.

Melasma is a chronic cutaneous condition that not only affects the appearance of patients but also has an immense psychosocial impact on patient quality of life. Although many treatment options are currently available, there is no single universal treatment regimen that works for all patients. Significant attention has been recently focused on the development and use of topical treatments that can lighten the dark patches associated with melasma. One such ingredient that has received growing attention in recent years is cysteamine. It works through several mechanisms to influence the melanogenesis pathway. This commentary reviews the information on this topical ingredient and offers relevant clinical insights.

Role of Cica (Centella asiatica) in Skincare Formulations: Examination of a Popular Ingredient.

Skincare products containing ingredients derived from Centella asiatica, more commonly known as Cica, have become popular as anti-aging remedies, moisturizers, anti-inflammatory drugs, and in treating scars, wounds, and atopic dermatitis, among other skin conditions.1-7 Cica has been used in homeopathy for centuries to treat a variety of ailments.2,6 Due to the many purported benefits of its skincare formulations, we examined the mechanisms of cica and reviewed the existing literature in order to shed more light on its role in dermatology. (SKINmed. 2022;20:94-96).

Growing role for arnica in cosmetic dermatology: Lose the bruise.

This commentary examines the utility of arnica in cosmetic dermatology. For many years, arnica has been used to reduce the morbidity associated with various procedures, including surgeries and treatments with lasers and other energy-based devices. Arnica is a traditional homeopathic remedy that can reduce post-procedural edema and bruising. Although it has been used clinically by many physicians and is widely and readily available to patients, the available data is limited and often conflicting. We reviewed the relevant information on arnica and offer our own insights into its use in order to shed more light on its periprocedural utility.

Reactive granulomatous dermatitis associated with ovarian cancer and a review of its role as a harbinger for malignancy.

Reactive granulomatous dermatitis (RGD) is a rare dermatosis with a variety of cutaneous manifestations unified by a dermal granulomatous infiltrate on histology. Rheumatoid arthritis and autoimmune disease are classic associations, but an increasing number of cases have been attributed to covert malignancy. Only 41 cases of paraneoplastic RGD have been documented to our knowledge and we present an additional case that manifested eight months prior to the diagnosis of ovarian cancer and clinically mimicked morphea. Histopathologic examination identifying palisaded CD68+ cells and collagen degeneration are helpful in diagnosing this entity which may mimic a host of other cutaneous processes, including metastatic disease. Cancer-directed therapies have been successful in clearing paraneoplastic RGD with or without the addition of corticosteroids, as RGD severity may be driven by the underlying malignancy. This case highlights the importance of utilizing histopathology to confirm the diagnosis given its nonspecific clinical findings, as well as the importance of considering malignancy and metastatic disease in patients diagnosed with RGD regardless of their cancer history.