Acquired progressive kinking of the hair in an elderly woman: a case report.

Acquired progressive kinking of the hair (APK) is a rare disorder that presents at any age and is infrequently presented in the literature. This diagnosis has been used to describe similar hair changes, though there are significant differences in presentation, population, and individual clinical features. Histologic analysis of hair shafts aids in diagnosis owing to commonly reported features such as irregular twisting, bending, and grooving of hair shafts with polygonal shapes on cross-section. We present a case with classic histologic features in an unusual patient to highlight this rare condition. Additional cases and studies are necessary to evaluate etiology, differentiate subsets of APK, and develop both treatment and prevention strategies.

Merkel Cell Carcinoma Therapeutic Update.

OPINION STATEMENT: Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine tumor of the skin. Early-stage disease can be cured with surgical resection and radiotherapy (RT). Sentinel lymph node biopsy (SLNB) is an important staging tool, as a microscopic MCC is frequently identified. Adjuvant RT to the primary excision site and regional lymph node bed may improve locoregional control. However, newer studies confirm that patients with biopsy-negative sentinel lymph nodes may not benefit from regional RT. Advanced MCC currently lacks a highly effective treatment as responses to chemotherapy are not durable. Recent work suggests that immunotherapy targeting the programmed cell death receptor 1/programmed cell death ligand 1 (PD-1/PD-L1) checkpoint holds great promise in treating advanced MCC and may provide durable responses in a portion of patients. At the same time, high-throughput sequencing studies have demonstrated significant differences in the mutational profiles of tumors with and without the Merkel cell polyomavirus (MCV). An important secondary endpoint in the ongoing immunotherapy trials for MCC will be determining if there is a response difference between the virus-positive MCC tumors that typically lack a large mutational burden and the virus-negative tumors that have a large number of somatic mutations and predicted tumor neoantigens. Interestingly, sequencing studies have failed to identify a highly recurrent activated driver pathway in the majority of MCC tumors. This may explain why targeted therapies can demonstrate exceptional responses in case reports but fail when treating all comers with MCC. Ultimately, a precision medicine approach may be more appropriate for treating MCC, where identified driver mutations are used to direct targeted therapies. At a minimum, stratifying patients in future clinical trials based on tumor viral status should be considered as virus-negative tumors are more likely to harbor activating driver mutations.

Sebaceous carcinoma on the abdomen in an African-American male patient.

Sebaceous carcinoma is a rare, aggressive cutaneous tumor most commonly involving the head and neck, especially the periorbital area. It has been associated with Muir-Torre syndrome, human papillomavirus infection, and radiotherapy. This case report describes an unusual clinical presentation of a large sebaceous carcinoma on the abdomen of an African-American male patient who was successfully treated with Mohs micrographic surgery. The case is reported due to the unusual location of the lesion on the abdomen and the rare occurrence of this tumor type in an African-American male.

Asteatotic eczema in hypoesthetic skin: a case series.

IMPORTANCE: Asteatotic eczema (eczema craquelé, xerotic eczema) occurs most frequently in areas of dehydrated skin, most often during the winter months when decreased humidity results in increased water loss from the stratum corneum. We present 5 cases in which asteatotic eczema was found outside of its normal distribution, within desensitized skin and scars. OBSERVATIONS: Five patients with a history of trauma and scar formation presented with erythematous, dry plaques with fine crackling involving hypoesthetic skin. Each of the 5 patients had classic asteatotic eczema skin findings, the only commonality being hypoesthesia. Borders of the hypoesthetic skin were identified using light touch and compared with the regions affected by asteatotic eczema. In all cases, the skin affected by asteatotic eczema was within the hypoesthetic areas. CONCLUSIONS AND RELEVANCE: Asteatotic eczema developing on skin with altered sensation is an underreported condition. Prompt recognition and treatment may lead to a more efficient patient encounter and alleviate unnecessary patient stress.

Patterns and perceptions of supplement use by U.S. Marines deployed to Afghanistan.

Dietary supplements are implicated in an increasing number of minor and serious adverse events, including death. A series of adverse events in deployed Marines using multiple supplements prompted medical officers to investigate the prevalence of supplement use among Marines stationed on Camp Leatherneck, Afghanistan. The investigators developed a survey to identify the types of supplements used, patterns of supplement use, reasons for taking supplements, perceived benefits from using supplements, and self-reported adverse effects. Marines were invited to complete an anonymous 17-question survey while visiting recreational and athletic facilities. A total of 329 active duty Marines completed the survey. The prevalence of supplement use was 72% for males and 42% for females (p = 0.009). Of the 12% of Marines reporting side effects, 79% were taking multiple supplements and 89% were using stimulants. Deployment was significantly associated with new supplement use (p < 0.001). Of users, 81% noted an improvement in physical performance. The majority of deployed Marines use multiple dietary supplements and perceive a high benefit. Given the high prevalence of supplement use and recent deaths associated with supplement use, recommendations are needed to guide the use of certain supplements by U.S. Marines in the deployed environment.