Part II: Cutaneous manifestations of peripheral vascular disease.

In this Part 2 of a 2-part continuing medical education series, we review the epidemiology of peripheral vascular disease, its association with cutaneous symptoms, and the diagnosis and evaluation of cutaneous features of vascular disorders. As peripheral vascular disease becomes more prevalent globally, it is essential for dermatologists to become competent at accurately recognizing and diagnosing cutaneous manifestations and directing individuals to receive appropriate care and treatment.

Part I: Cutaneous manifestations of cardiovascular disease.

In this part 1 of a 2-part continuing medical education series, we review the epidemiology and pathophysiology of cardiovascular disease, its association with cutaneous symptoms, and the diagnosis and evaluation of cutaneous features of cardiovascular syndromes, including infective endocarditis, acute rheumatic fever, Kawasaki disease, cholesterol embolization syndrome, lipid disorders, cardiac amyloidosis, and cardiac myxomas. As the incidence and prevalence of cardiovascular diseases increase, dermatologists play an essential role in recognizing the cutaneous manifestations of cardiovascular diseases in order to appropriately connect patients with follow-up care.

Impact of Direct-to-Consumer Advertising of Cosmetic Procedures on Consumers.

BACKGROUND: Direct-to-consumer (DTC) advertising is a prominent type of health care communication. OBJECTIVE: This study aims to determine the impact of DTC advertisements on consumer opinion. METHODS: A total of 203 participants were recruited from dermatology clinics at an urban academic center. Participants viewed 2 cosmetically oriented DTC advertisements, and prequestionnaires and postquestionnaires were administered to assess consumer opinion. RESULTS: Postquestionnaire data highlight a 18.8% and 24.6% increase in participants reporting using commercials as an information source (p < .001) and seeking out additional medical knowledge (p < .001), respectively. After watching the advertisements, there was a 14.4% increase in participants who believed advertisements facilitate better discussions between patients and physicians (p < .001) and a 33% increase in patients reporting they would discuss the procedures with their doctors (p < .001). Of the participants, 60% believed the advertisements did not provide enough information about the possible risks of the product and 39.4% believed a physician was not required to perform cosmetic procedures. CONCLUSION: Direct-to-consumer advertisements instill meaningful information to patients and promote patient-physician communication. They also seem to exaggerate the benefits while making the procedures seem simple and without risks, suggesting trained medical professionals are not needed for administration.

Effects of the COVID-19 Pandemic On Patient Social Media Use and Acceptance of Cosmetic Procedures.

Objective: We sought to explore facets of social media usage and the effect of the COVID-19 pandemic on the acceptance of cosmetic procedures. Methods: At an outpatient dermatology clinic from October 2019 to June 2022, 175 subjects who were English and Spanish speaking and aged 18 years or older were recruited. Participants completed a questionnaire including demographic information, social media usage, perceptions of cosmetic procedures, and desire to have a cosmetic procedure. Results were grouped into a pre-COVID-19 pandemic group and post-COVID-19 pandemic group due to a natural experiment that arose. Data were analyzed to ascertain the effect of social media usage and other factors that impact desire to undergo a cosmetic procedure between patients before and after the COVID-19 pandemic. Results: Factors resulting in differences in desire to have a cosmetic procedure included using photo editing applications (p=0.002), following celebrities and influencers on social media (p<0.001), and following social media accounts showing cosmetic results (p=0.013). There was a statistically significant change in number of participants that: followed social media accounts showing results of cosmetic procedures (pre-COVID: 31.9%, post-COVID: 50.6%, p=0.036); had thought about having a cosmetic procedure done (pre-COVID: 63.8%, post-COVID: 86.4%, p<0.001); had discussed cosmetic procedures with a physician, dermatologist, or other professional (pre-COVID: 43.6%, post-COVID: 67.9%, p=0.001); and believed that a cosmetic procedure would help their self-esteem (pre-COVID: 47.9%, post-COVID: 77.8%, p<0.001). Limitations: Limitations of this study include response bias, recall bias, and single institution study design, limiting generalizability. Conclusion: Our findings suggest that time spent on social media and use of photo-editing applications significantly contributes to desire to undergo a cosmetic procedure and contributed to the rise of cosmetic consultations during the COVID-19 pandemic.

Exogenous Ochronosis: Characterizing a Rare Disorder in Skin of Color.

Exogenous ochronosis is a rare dyschromia that primarily impacts those with skin of color. It is characterized by blue-black pigmentation and is associated with the long-term application of skin-lightening creams containing hydroquinone. Commonly confused with other dyschromias, the use of skin lightening topicals can cause paradoxical skin darkening in patients with known exogenous ochronosis. This is highly distressing to patients, often worsening the underlying dyschromia and making treatment more difficult. A 10-year retrospective analysis was conducted that revealed 25 patients with exogenous ochronosis. The average patient used a skin lightening cream for 9.2 years, with exogenous ochronosis most commonly arising on the cheeks (68%), forehead (24%), and temples (20%). Furthermore, this study identified that patients with exogenous ochronosis may respond well to treatment with Q-switched Alexandrite laser and microneedling. The incidence of exogenous ochronosis is likely to increase as demographics shift and access to a wide range of over-the-counter topicals becomes more available, both in the United States and worldwide. Therefore, it is imperative to better characterize exogenous ochronosis to identify best treatment practices for all patients.

Consumer Preferences of Topical Vitamin C Products: A Comparative Study.

Hyperpigmentation disorders greatly impact the quality of life of many patients. Vitamin C and ascorbic acid derivatives are commonly used as topical agents to reduce the effect of facial dyschromia. The market for vitamin C topicals has greatly increased, but with little oversight, resulting in a wide variety of products with regard to purity and efficacy. In this study, we conducted an analysis of the most highly rated vitamin C-containing compounds on Amazon and Sephora. It was found that consumers for both retailers prioritized efficacy and cosmetic elegance in their rating of products. Additionally, consumers displayed no preference among vitamin C derivatives in the products available to them. This study highlights the diverse vitamin C formulations currently available as well as consumer preferences, emphasizing the importance of fully reviewing all products patients are utilizing to better counsel on treatment regimens.

Pityriasis Lichenoides et Varioliformis Acuta as a Complication of COVID-19 Infection.

Pityriasis lichenoides is an acute and/or chronic skin disease associated with recurrent erythematous papules that self-resolve. While its etiology is unknown, preceding viral infection may play a role. We present an atypical case of a 40-year-old woman with pityriasis lichenoides et varioliformis acuta as a complication of a COVID-19 infection.

Tinted Sunscreens: Consumer Preferences Based on Light, Medium, and Dark Skin Tones.

Visible light (VL) has been shown to increase tyrosinase activity and induce immediate erythema in light-skinned individuals and long-lasting pigmentation in dark-skinned individuals. Tinted sunscreens (TSs) formulated with iron oxides (IOs) and/or pigmentary titanium dioxide (PTD) provide functional and cosmetic benefits and are a safe, effective, and convenient way to protect against both UV and high-energy VL. We conducted an analysis of over-the-counter TSs with the objective of investigating the factors that influence consumer preference when choosing TS depending on underlying skin tone. Descriptive data for each product were collected from an online supplier that provides reviewer information. The top 10 most helpful reviews were analyzed and coded by a consensus qualitative coding scheme, which included positive and negative descriptors in 5 major categories. Most products provided only one color shade, and tone incompatibility was the most commonly cited negative feature, with the vast majority of these comments being from consumers of dark skin tones. Top recommended products corresponded with increased shade options, indicating the dearth of shade diversity in products to be a potential area of improvement in tinted sunscreen options.

A Case of an Inflammatory Myofibroblastic Tumor Mimicking Appendicitis.

Inflammatory myofibroblastic tumors (IMTs) are rare tumors that have been described only in a few cases in the literature. IMTs are mesenchymal neoplasms that typically affect children and young adults. The most common anatomical locations are the abdominopelvic region, lung, and retroperitoneum, but any site may be involved. Given that there are no clinical or radiographic characteristics specific to IMTs, the diagnosis is made by pathology. We report on a young woman presenting with an acute appendicitis-like clinical picture due to an IMT located in the ascending colon to raise awareness of this rare, but possible presentation.

A Case of Laryngeal Tuberculosis Mimicking Lymphoma.

The incidence of laryngeal tuberculosis has steadily increased due to rising prevalence of HIV infection, immunosuppressive diseases and treatments, and the emergence of multidrug-resistant organisms and atypical mycobacteria. We report on a woman with a unique presentation of laryngeal tuberculosis mimicking lymphoma to remind clinicians that the diagnosis of laryngeal tuberculosis merits awareness and that delay in diagnosis poses a serious threat to the patient due to delayed treatment and further complications.

Impact of Social Media on Skin Cancer Prevention.

Despite the increasing prevalence of social media usage in health care contexts, its impact on skin cancer prevention and awareness has not been largely investigated. We conducted a review of literature on this topic with the objective of summarizing and analyzing the role of social media in skin cancer and sun damage awareness and to identify the uses, benefits, and limitations of different social media platforms on skin cancer prevention. In today's technological society, it is critical to understand and study the best form of communication. Specific platforms like Instagram, Twitter, Facebook, YouTube, and TikTok vary in originators of material, target demographics, messaging strategies, and reliability of information with regards to skin cancer, sun, and indoor tanning damage. Our results demonstrate that social media interventions have shown promise in skin cancer prevention and continue to escalate by the day. Dermatologists should keep pace with the latest dermatological content on social media and examine its evolution to target the right audience with the proper messages. Further research is needed to evaluate the effectiveness and true impact of social media on meaningful and lasting behavior change for skin cancer prevention.

Skin-Lightening Products: Consumer Preferences and Costs.

Disorders of skin hyperpigmentation have an appreciable impact on quality of life, carrying social and cultural importance that influences widespread consumer demand for cosmetic lightening products. We sought to investigate product factors that may influence consumer preference when choosing an over-the-counter cream for skin-lightening purposes. The keyword "lightening cream" was searched in the "Beauty and Personal Care category" of online retailer Amazon.com. The top fifth percentile of products was determined by filtering the search results for a minimum of four out of five stars from customer reviews, and then further filtered by products with over 100 reviews. Number of reviews, rating, price per unit, vehicle, application instructions, ingredients, and review attributes were evaluated. Over 2,900 products were catalogued as "lightening cream" on Amazon.com. There were 40 products rated >4 stars and >100 reviews, constituting the top 1.34% of entries. Tocopheryl was present in 58% of the top 40 products, ascorbic acid in 40%, and niacinamide in 20%. Notably, 22.5% of the top 40 products contained no known skin-lightening ingredient. There was a moderate positive correlation (R2=0.378) between price and consumer rating, with kojic acid being the most expensive per ounce ($24.89) and salicylic acid being the most highly rated (4.54 stars; $15.00/oz). This study provides insight on the factors influencing the choice, preferences, and satisfaction of consumer that sought Amazon for the purchase of lightening products.

Trends in Use of Prescription Skin Lightening Creams.

The desire for an even skin tone pervades all cultures and regions of the world. Uniform skin color is considered a sign of beauty and youth. Pigmentation abnormalities can arise idiopathically with genetic predetermination, with injury and environmental exposures, and with advancing age, and can, therefore, be distressing to patients, leading them to seek a variety of treatments with professional assistance. In this short report, we describe the trends in the use of prescription lightening creams, particularly in patients with darker skin types residing in the US. Amongst 404 participants, skin hyperpigmentation had a moderate effect on patients' quality of life, and the most common diagnosis associated with the use of a prescription product was melasma (60.8%). The most common agent prescribed was hydroquinone (62.9%), followed by triple combination cream (31.4%). It is the dermatologist's duty to gauge the effect of the pigmentation disease on patients' life in order to counsel, tailor, and decide on the most appropriate treatment option.

Risk Factors for and Time to Recurrence of Symptomatic Malignant Pleural Effusion in Patients With Metastatic Non-Small Cell Lung Cancer with EGFR or ALK Mutations.

BACKGROUND: The main goal of management in patients with non-small cell lung cancer (NSCLC) and malignant pleural effusion (MPE) is palliation. Patients with MPE and actionable mutations, because their disease is expected to respond quickly and markedly to targeted therapy, are less likely than those without actionable mutations to receive definitive MPE management. Whether such management is indicated in these patients is unclear. RESEARCH QUESTIONS: What is the time to ipsilateral MPE recurrence requiring intervention in patients with metastatic NSCLC by mutation status? What are the risk factors for MPE recurrence? STUDY DESIGN AND METHODS: Retrospective cohort study of consecutive patients who underwent initial thoracentesis for MPE. We used a Fine-Gray subdistribution hazard model to calculate the time to ipsilateral MPE recurrence requiring intervention within 100 days of initial thoracentesis and to identify variables associated with time to pleural fluid recurrence. RESULTS: A total of 396 patients, comprising 295 (74.5%) without and 101 (25.5%) with actionable mutations, were included. Most patients with actionable mutations (90%) were receiving targeted treatment within 30 days of initial thoracentesis. On univariate analysis, patients with actionable mutations showed a significantly higher hazard of MPE recurrence. On multivariate analysis, this difference was not significant. Larger pleural effusion size on chest radiography (P < .001), higher pleural fluid lactate dehydrogenase (P < .001), and positive cytologic examination results (P = .008) were associated with an increased hazard of recurrence. INTERPRETATION: Our findings indicate that patients with actionable mutations have a similar risk of MPE recurrence when compared with patients without mutations and would benefit from a similar definitive management approach to MPE.

Invasive Thymoma with Right Upper Lobe Endobronchial Lesion and Autoimmune Enteropathy.

Thymomas are slow-growing neoplasia arising from the epithelial cells of the thymus that usually present with respiratory symptoms, superior vena cava syndrome, or parathymic syndromes. Approximately 30% of thymomas develop myasthenia gravis. An additional 5% of patients with thymomas have other systemic syndromes, including rheumatoid arthritis, thyroiditis, red cell aplasia, systemic lupus erythematosus, and Cushing syndrome. Rarely, patients can present with diarrhea due to thymoma-associated autoimmune gastrointestinal pathologies that include Good syndrome (acquired hypogammaglobulinemia), thymoma- associated multiorgan autoimmunity, and autoimmune enteropathy. We present an uncommon and interesting case of an invasive metastatic thymoma with right upper lobe endobronchial lesion and autoimmune enteropathy in a 27-year-old female. The novelty of this case lay in the findings of extensive metastatic thymoma with right upper lobe endobronchial disease and autoimmune diarrhea.