RESUMO
Acne vulgaris is a common dermatological diagnosis observed in pediatric patients with skin of color, often resulting in scarring, keloid formation, and post-inflammatory hyperpigmentation, significantly impacting their quality of life. This exploratory retrospective chart review included 77 black pediatric patients seen at a tertiary care center for acne vulgaris between 2018 and 2023. We analyzed demographics, acne descriptors, and treatment modalities. The most common acne morphology was comedonal acne (83.6%), with 71% of the patients being female. Significant age differences were observed particularly for acne at the chin and overall face. Treatment regimens commonly prescribed included combinations of adapalene and benzoyl peroxide (22%), topical antibiotics, tretinoin, and benzoyl peroxide (34%). Given the higher risk of sequelae for patients with darker skin, it is crucial to address their unique treatment needs. This study highlights the distinctive characteristics of acne in black pediatric patients and calls for further research to enhance our understanding and treatment of this population. Limitations include the lack of direct patient interactions and reliance on chart data. Further studies are needed to compare acne presentation in skin of color of other populations, refining our knowledge of acne clinical presentation, complications, and treatment modalities for diverse patient populations.
Assuntos
Acne Vulgar , Antibacterianos , Negro ou Afro-Americano , Fármacos Dermatológicos , Humanos , Acne Vulgar/tratamento farmacológico , Feminino , Criança , Masculino , Estudos Retrospectivos , Adolescente , Fármacos Dermatológicos/uso terapêutico , Antibacterianos/uso terapêutico , Peróxido de Benzoíla/uso terapêutico , Tretinoína/uso terapêutico , Fatores EtáriosRESUMO
Tumor necrosis factor (TNF) inhibitors may paradoxically induce pustular eruptions, most of which are classified as pustular psoriasis. Amicrobial pustulosis of the folds (APF) is a much rarer entity that was recently recognized to occur in the setting of chronic anti-TNF therapy and inflammatory bowel disease, with 12 existing cases in the literature. Amicrobial pustulosis of the folds is a neutrophilic dermatosis characterized by aseptic pustules involving the major and minor skin folds, genital regions, and scalp. Herein, we report an additional case of paradoxical APF induced by chronic infliximab therapy in a patient with Crohn disease.
Assuntos
Doença de Crohn , Infliximab , Humanos , Infliximab/efeitos adversos , Infliximab/uso terapêutico , Doença de Crohn/tratamento farmacológico , Doença de Crohn/complicações , Adulto , Dermatopatias Vesiculobolhosas/induzido quimicamente , Dermatopatias Vesiculobolhosas/patologia , Masculino , Feminino , Fator de Necrose Tumoral alfa/antagonistas & inibidoresAssuntos
Ceratodermia Palmar e Plantar , Leucemia Mieloide Aguda , Síndromes Paraneoplásicas , Humanos , Leucemia Mieloide Aguda/complicações , Ceratodermia Palmar e Plantar/etiologia , Ceratodermia Palmar e Plantar/diagnóstico , Síndromes Paraneoplásicas/diagnóstico , Eczema/etiologia , Eczema/diagnóstico , Masculino , Pessoa de Meia-Idade , FemininoRESUMO
Background: Nipple-areolar complex (NAC) conditions affect reproductive-age women, yet it is not known how care of NAC complaints is distributed among medical specialties. There is a need to characterize all NAC conditions, including their treatment and the care team involved in their clinical management, of nonlactating and lactating patients to determine care gaps. Materials and Methods: This was a retrospective cohort study of reproductive-age females who presented to a large tertiary health system with an NAC complaint between 2015 and 2020. Data about the symptoms, diagnosis, specialty providing care, diagnostic considerations, and treatments were collected. Results: Nipple pain, dermatitis, and thrush were the most common diagnoses among 407 encounters (215 patients). Lactating patients represented half (204, 50%) of the study sample. Benign breast conditions like obstructed ductal openings, accessory nipples, nipple growth, inverted nipples, and chronic and bacterial infections represented a third of all encounters. Primary care physicians (167, 41%) and obstetricians (105, 26%) provided most of the care and referred a third and quarter of patients, respectively, to another provider. Conclusion: The care of patients with NAC complaints is not limited to obstetricians. Internal medicine, family medicine, emergency medicine, and obstetrician-gynecology, dermatology, and surgery resident physicians should receive training in benign breast conditions and clinical lactation.
Assuntos
Doenças Mamárias , Mamoplastia , Mamilos , Feminino , Humanos , Doenças Mamárias/diagnóstico , Doenças Mamárias/terapia , Lactação , Estudos Retrospectivos , AdultoRESUMO
Myxedema is a rare, cutaneous complication of autoimmune thyroid diseases that most often affects the anterior shins. Herein, we report a patient with a history of Graves disease and Hashimoto thyroiditis who presented with boggy, alopecic patches associated with scalp pruritus. Punch biopsies from these lesions showed increased interstitial mucin in the reticular dermis, consistent with localized myxedema. This report showcases a rare presentation of localized myxedema of the scalp, highlighting the diverse cutaneous manifestations of autoimmune thyroid diseases.
Assuntos
Doença de Graves , Doença de Hashimoto , Mixedema , Humanos , Couro Cabeludo , Mixedema/complicações , Alopecia , Biópsia , Doença de Graves/complicações , Doença de Hashimoto/complicaçõesAssuntos
Neoplasias da Mama , Dermatite , Mamoplastia , Humanos , Feminino , Mamilos , Estudos RetrospectivosRESUMO
African tick bite fever, resulting from Rickettsia africae inoculation, is endemic in sub-Saharan Africa. We present a United States traveler with African tick bite fever 5 days after she returned from a mission trip to Zimbabwe. The patient exhibited symptomatic hypotension in addition to more typical findings, including fever, fatigue, and a necrotic eschar. The diagnosis was supported by histopathological findings and the patient's symptoms rapidly resolved with oral doxycycline therapy. We believe this case represents the first African tick bite fever diagnosis associated with symptomatic hypotension. This case additionally serves as a reminder of the importance of evaluating patient travel history.
Assuntos
Hipotensão , Infecções por Rickettsia , Rickettsiose do Grupo da Febre Maculosa , Doenças Transmitidas por Carrapatos , Feminino , Humanos , Infecções por Rickettsia/diagnóstico , Infecções por Rickettsia/tratamento farmacológico , Infecções por Rickettsia/epidemiologia , Doenças Transmitidas por Carrapatos/diagnóstico , Doenças Transmitidas por Carrapatos/epidemiologia , Doenças Transmitidas por Carrapatos/microbiologia , Rickettsiose do Grupo da Febre Maculosa/complicações , Doxiciclina/uso terapêutico , Viagem , Hipotensão/complicaçõesRESUMO
We present a 65-year-old woman who developed a diffuse pruritic papular eruption after receiving induction chemotherapy with daunorubicin and cytarabine for newly diagnosed acute myelomonocytic leukemia. The rash improved clinically with triamcinolone treatment and chemotherapy was allowed to continue. This case adds to the growing literature of transient acantholytic dermatosis development in the setting of anti-cancer therapy and emphasizes the importance of clinicopathologic correlation in cutaneous eruptions in cancer patients.
Assuntos
Exantema , Leucemia Mieloide Aguda , Feminino , Humanos , Criança , Idoso , Citarabina , Daunorrubicina/efeitos adversos , Quimioterapia de Indução/efeitos adversos , Leucemia Mieloide Aguda/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Prurido/tratamento farmacológico , Triancinolona/uso terapêuticoRESUMO
BACKGROUND: Juvenile dermatomyositis (JDM) is the most common inflammatory myopathy in the pediatric population and can represent a medical emergency. However, many features of JDM remain poorly understood, disease presentation is highly variable, and predictors of disease course have yet to be identified. METHODS: This retrospective chart review included 47 JDM patients seen at a tertiary care center over a 20-year period. Characteristics such as demographics, clinical signs and symptoms, antibody positivity, dermatopathology features, and treatments were recorded. RESULTS: All patients had evidence of cutaneous involvement, whereas 88.4% experienced muscle weakness. Constitutional symptoms and dysphagia were commonly present. The most frequent cutaneous findings were Gottron papules, heliotrope rash, and nailfold changes. Anti-TIF1? was the most prevalent myositis-specific autoantibody. Management involved systemic corticosteroids in nearly all cases. Strikingly, the dermatology department was only involved in the care of four in every ten (19/47) patients. CONCLUSIONS: Prompt recognition of the strikingly reproducible skin findings present in JDM can improve disease outcomes in this population. This study highlights the need for increased education of such pathognomonic findings as well as more multidisciplinary care. In particular, a dermatologist should be involved in the care of patients presenting with muscle weakness and skin changes.
Assuntos
Dermatomiosite , Miosite , Humanos , Criança , Dermatomiosite/patologia , Centros de Atenção Terciária , Estudos Retrospectivos , Debilidade MuscularRESUMO
Undermining is thought to improve wound outcomes; however, randomized controlled data regarding its efficacy are lacking in humans. The objective of this randomized clinical trial was to determine whether undermining low to moderate tension wounds improves scar cosmesis compared to wound closure without undermining. Fifty-four patients, 18 years or older, undergoing primary linear closure of a cutaneous defect with predicted postoperative closure length of ≥ 3 cm on any anatomic site were screened. Four patients were excluded, 50 patients were enrolled, and 48 patients were seen in follow-up. Wounds were divided in half and one side was randomized to receive either no undermining or 2 cm of undermining. The other side received the unselected intervention. Three months, patients and 2 masked observers evaluated each scar using the Patient and Observer Scar Assessment Scale (POSAS). A total of 50 patients [mean (SD) age, 67.6 (11.5) years; 31 (64.6%) male; 48 (100%) white] were enrolled in the study. The mean (SD) sum of the POSAS observer component scores was 12.0 (6.05) for the undermined side and 11.1 (4.68) for the non-undermined side (P = .60). No statistically significant difference was found in the mean (SD) sum of the patient component for the POSAS score between the undermined side [15.9 (9.07)] and the non-undermined side [13.33 (6.20)] at 3 months. For wounds under low to moderate perceived tension, no statistically significant differences in scar outcome or total complications were noted between undermined wound halves and non-undermined halves.Trail Registry: Clinical trials.gov Identifier NCT02289859. https://clinicaltrials.gov/ct2/show/NCT02289859 .
Assuntos
Cicatriz , Lesões dos Tecidos Moles , Idoso , Cicatriz/etiologia , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Feminino , Humanos , Masculino , Pele/patologia , Lesões dos Tecidos Moles/complicações , Técnicas de Sutura/efeitos adversos , Resultado do Tratamento , CicatrizaçãoRESUMO
We present a patient with anti-MDA5 negative, anti-Ku positive clinically amyopathic dermatomyositis (CADM). A 61-year-old woman presented with a chief complaint of a 20-year history of a pruritic rash that was active on her face, chest, hands, legs, and back. A mildly scaly, erythematous, photo-distributed eruption along with slightly violaceous, scaly papules accentuated on the wrist, metacarpophalangeal joints, proximal interphalangeal and distal interphalangeal joints. Antibody profile was significant for positive ANA and anti-dsDNA, elevated anti-TIF-1gamma (RDL)/p155, and weakly positive anti Ku. Biopsy was consistent with dermatomyositis. Melanoma differentiation-associated gene 5 antibody (anti-MDA-5) has been identified as the most commonly associated autoantibody found in CADM and is associated with poor prognosis and a biomarker for the diagnosis of rapidly progressive interstitial lung disease. To our knowledge, our patient is the first case of negative anti-MDA-5 and anti-Ku positive CADM.
Assuntos
Autoanticorpos/sangue , Doenças Autoimunes/diagnóstico , Dermatomiosite/imunologia , Helicase IFIH1 Induzida por Interferon/imunologia , Autoantígeno Ku/imunologia , Dermatomiosite/tratamento farmacológico , Dermatomiosite/patologia , Feminino , Humanos , Metotrexato/uso terapêutico , Pessoa de Meia-IdadeAssuntos
Povo Asiático/estatística & dados numéricos , Dermatologia/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Dermatopatias/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Instituições de Assistência Ambulatorial/estatística & dados numéricos , California/epidemiologia , Criança , China/etnologia , Eczema/epidemiologia , Eczema/terapia , Feminino , Humanos , Renda/estatística & dados numéricos , Idioma , Masculino , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Dermatopatias/etnologia , Dermatopatias/terapia , Viagem/estatística & dados numéricos , Adulto JovemAssuntos
Dermatomiosite/diagnóstico , Anticorpos Antinucleares/análise , California , Dermatomiosite/complicações , Dermatomiosite/etiologia , Dermatomiosite/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Estudos Retrospectivos , Centros de Atenção TerciáriaRESUMO
Iatrogenic vascular occlusion secondary to filler injection, such as with hyaluronic acid, is a known but rare, entity. It typically occurs in the setting of facial cosmetic procedures but has also been described in the setting of osteoarthritis. We present a patient with ankle osteoarthritis who developed an asymmetric, reticular, livedoid eruption after intraarticular injection with hyaluronic acid. She was diagnosed with livedo racemosa secondary to vascular occlusion and placed on low molecular weight heparin. Later, a transition to low-dose daily aspirin maintained the improvement.
Assuntos
Ácido Hialurônico/efeitos adversos , Osteoartrite/tratamento farmacológico , Dermatopatias Vasculares/induzido quimicamente , Idoso , Articulação do Tornozelo , Arteriopatias Oclusivas/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Ácido Hialurônico/administração & dosagem , Injeções Intra-Articulares , Livedo Reticular/diagnóstico , Dermatopatias Vasculares/diagnósticoRESUMO
Porokeratosis ptychotropica is a rare and commonly misdiagnosed subtype of porokeratosis involving the body folds. We present a 53-year-old man with systemic mastocytosis who presented with a pruritic, verrucous plaque in the gluteal fold that showed multiple cornoid lamellae on histopathologic evaluation, diagnostic of porokeratosis ptychotropica. Various treatments have been reported, including topical corticosteroids, retinoids, vitamin D analogs, calcineurin inhibitors, imiquimod, phototherapy, cryotherapy, or ablative laser therapy, but recurrences are common.
Assuntos
Nádegas/patologia , Mastocitose Sistêmica/complicações , Poroceratose/patologia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Poroceratose/diagnóstico , Poroceratose/etiologiaRESUMO
Eosinophilic fasciitis is a rare connective tissue disorder characterized by inflammation of the fascia that leads to painful, indurated skin. Because of its variable clinical presentation and overlap with conditions, such as morphea, the diagnosis of eosinophilic fasciitis can be challenging and relies on clinical presentation, histopathologic and laboratory analysis, and response to therapy. Herein, we present an unusual, solitary, isolated plaque with pathologic features and response to therapy most consistent with eosinophilic fasciitis.