Trichodysplasia spinulosa: a presentation of polyomavirus infection in immunosuppressed patients.

Trichodysplasia spinulosa (TS) is a rare skin condition that occurs mainly in immunosuppressed patients. Although initially postulated to be an adverse effect of immunosuppressants, TS-associated polyomavirus (TSPyV) has since been isolated from TS lesions and is now considered to be the causative agent. Trichodysplasia spinulosa presents with folliculocentric papules with protruding keratin spines, most commonly on the central face. Trichodysplasia spinulosa can be diagnosed clinically, but the diagnosis can be confirmed with histopathological examination. Histological findings include the presence of hyperproliferating inner root sheath cells containing large eosinophilic trichohyaline granules. Polymerase chain reaction (PCR) can also be used to detect and quantify TSPyV viral load. Owing to the paucity of reports in the literature, TS is frequently misdiagnosed and there is no high-quality evidence to guide management. Herein, we present a renal transplant recipient with TS that did not respond to topical imiquimod but improved upon treatment with valganciclovir and reduction of the mycophenolate mofetil dose. Our case highlights the inverse relationship between immune status and disease progression in this condition.

Social media (SoMe) enhances exposure of dermatology articles.

Social media (SoMe) refers to a variety of virtual platforms used to enhance sharing of information. To evaluate the influence of SoMe with regards to views and downloads of published dermatology articles, we conducted a retrospective study from July 2020-March 2021 examining articles published on Instagram and Twitter under Dermatology Online Journal (DOJ) accounts and compared these with type-matched and issue-matched articles that were not posted on social media. During this time period, 163 total articles of the three types used for social media (Case Report, Case Presentation, and Photo Vignette) were published in DOJ and 15 were promoted via SoMe. Utilization of SoMe demonstrated a significant (P<0.0001) positive effect with regards to both views (175.5±16.4) and downloads (31.5±4.0) over matched articles not published on SoMe. Similar trends illustrating the positive effect of SoMe on readership have been previously observed in the field of dermatology as well as other medical specialties. Most direct accessions to articles arrived via Instagram rather than Twitter, diverging from previous studies on SoMe use in medical journals. Social media, in particular Instagram, can be a successful platform to enhance the exposure of peer-reviewed medical information.

Current biological therapies for use in HIV-positive patients with psoriasis: case report of gesulkumab used and review.

BACKGROUND: Psoriasis in human immunodeficiency virus (HIV)-positive patients may be severe. Physicians may be tentative to use biologics in HIV-infected patients. OBJECTIVE: We present an HIV-positive patient with psoriasis who was treated with guselkumab. This paper aims to investigate the safety, efficacy, and tolerability of biologic therapies for HIV-positive patients with psoriasis. METHODS: A systematic PubMed review of articles dating between 2000-2018 containing key words psoriasis AND HIV, and psoriatic AND HIV combined with several approved biologic therapies. The review generated 15 articles containing 27 cases of HIV-positive patients treated with etanercept, infliximab, adalimumab, or ustekinumab for their psoriasis. RESULTS: The majority of cases reported excellent clinical responses, limited adverse events, and well tolerated treatment. CD4 count and viral loads were stable throughout treatment. Similar safety and efficacy were seen in the illustrative case report. Available literature is limited to case reports or case series and could be subject to publication bias of successful cases. Many reports lack quantifiable data and report results based on clinical judgement. No randomized, controlled trials evaluate biologic treatment for psoriasis in HIV-positive patients. CONCLUSIONS: The findings suggest that biologic therapy is an efficacious, safe, and tolerable treatment for most patients with moderate-to-severe psoriasis in HIV-positive patients.

Ustekinumab to target granulomatous dermatitis in recalcitrant ulcerative necrobiosis lipoidica: case report and proposed mechanism.

We present a 42-year-old woman with no history of diabetes or glucose intolerance who had a 5-year history of ulcerative necrobiosis lipoidica (NL). Despite failure of multiple medications, she experienced clearing of her ulcers after her treatment was changed to ustekinumab. We discuss our patient's disease course and elaborate upon mechanistic reasons for her improvement related to ustekinumab therapy.

100% Complete response rate in patients with cutaneous metastatic melanoma treated with intralesional interleukin (IL)-2, imiquimod, and topical retinoid combination therapy: results of a case series.

BACKGROUND: Patients with cutaneous melanoma metastases have experienced excellent responses to intralesional interleukin (IL)-2. This has led to its recent inclusion into the US National Comprehensive Cancer Network guidelines for management of cutaneous melanoma metastases. Despite this, intralesional IL-2 has not been highlighted in the US literature nor have US physicians adopted it. OBJECTIVE: We sought to evaluate the effectiveness of intralesional IL-2 combined with topical imiquimod and retinoid for treatment of cutaneous metastatic melanoma. METHODS: A retrospective case series of 11 patients with cutaneous metastatic melanoma were treated with intralesional IL-2 combined with topical imiquimod and retinoid. RESULTS: A 100% complete local response rate with long-term follow-up (average of 24 months) was seen in all 11 patients treated with this proposed regimen. Biopsy specimens of treated sites confirmed absence of malignant cells. The most common treatment-related adverse event was rigors. LIMITATIONS: Small number of patients, retrospective review of charts, and lack of a comparison group were limitations. CONCLUSION: Intralesional IL-2 administered concomitantly with topical imiquimod and a retinoid cream is a promising therapeutic option for managing cutaneous melanoma metastases. The regimen was well tolerated and should be considered as a reasonable alternative to surgical excision.

Trigeminal trophic syndrome: report of 3 cases affecting the scalp.

Trigeminal trophic syndrome (TTS) is a rare condition that results from a prior injury to the sensory distribution of the trigeminal nerve. Patients typically respond to the altered sensation with self-mutilation, most often of the nasal ala. We describe 3 patients with TTS who presented with self-induced ulcerations primarily involving the scalp. Two patients developed delusions of parasitosis (DOP) based on the resulting symptoms of TTS, which is a unique association. Trigeminal trophic syndrome may occur at extranasal sites and in any branch of the trigeminal nerve. The condition should be considered when ulcers are encountered in this nerve distribution. Symptoms such as formication may mimic DOP. Trigeminal trophic syndrome may be differentiated from DOP by the restriction of symptoms and ulcerations to the distribution of the trigeminal nerve.