Lupus erythematosus-specific bullous lesions.

Lupus erythematosus (LE)-specific bullous lesions are often difficult to distinguish from other bullous diseases presenting in patients with systemic lupus erythematosus. Herein, we describe a 49-year-old woman with systemic lupus erythematosus with recurrent tense bullae on the forearms. Clinical, histopathologic, and serologic findings led to the diagnosis of LE-specific bullous lesions. We also summarize the diagnostic clues for distinguishing LE-specific bullous lesions, bullous systemic lupus erythematosus, and erythema multiforme-like lesions in LE (Rowell syndrome).

Dermatopathologist accuracy in classifying angioinvasive fungal infections using virtual microscopy.

BACKGROUND: Due to perceived difficulty in the categorization of angioinvasive fungal infections based on histopathology, variation exists in dermatopathology reporting. METHODS: This study characterized the diagnosis of angioinvasive fungal infections by light microscopy at a single academic institution over an 11-year period. Subsequently, the accuracy of blinded reclassification by virtual microscopy was measured. RESULTS: Seventy-six specimens with hematoxylin-eosin slides were obtained from 33 patients. The mean diagnostic accuracy of dermatopathologists in differentiating mucormycosis, hyalohyphomycosis, and phaeohyphomycosis based on blinded reclassification via virtual microscopy was 74%, with a range of 65%-91%. CONCLUSIONS: While there was a range in diagnostic accuracy, the highest score of 91% and the identification of common sources of error suggest that histopathologic categorization of angioinvasive fungal infections can frequently be performed. However, accurate identification is not always possible given common pitfalls in diagnosis. In addition, standardized and clinically useful reporting should be considered.

Herpes zoster ophthalmicus.

Herpes zoster ophthalmicus (HZO) occurs when latent varicella zoster virus reactivates in the ophthalmic division of the fifth cranial nerve (CNV1). HZO commonly affects older and immunocompromised patients. This disease is considered an ophthalmic emergency due to the wide range of associated ocular symptoms, including severe chronic pain and vision loss. HZO is typically a clinical diagnosis due to its classic presentation of a unilateral vesicular eruption in the dermatomes corresponding to CNV1. Timely treatment is imperative to minimize ocular morbidity in HZO, given that ocular involvement is present in 50% of affected patients.

Effectiveness of a leadership conference for chief residents in dermatology.

The position of chief resident involves increased leadership, mentorship, and management responsibilities. There is no standardized procedure in which dermatology chief residents are trained and prepared for their final year of residency. In 2008, an annual Dermatology Chief Academy conference was initiated in which incoming chief residents were given formal leadership training for their new role. At the 2020 conference, residents completed a survey regarding their expectations and experience of this conference. After the conference, residents felt significantly better prepared for their new role as chief residents, handling conflicts, and effective leadership. A formal leadership conference for incoming chief residents is vital for improving the success of a residency program.

Analysis of Internal Dermatology Matches Following the COVID-19 Pandemic.

Dermatology has long been recognized as a highly competitive field within medicine, with extremely limited spots available for aspiring dermatologists to secure residencies across the United States. We sought to evaluate the trends and factors influencing the match process in dermatology residencies, particularly given the changes brought on by the COVID-19 pandemic. Using data from publicly available match lists and regional categorizations, we studied the rates of internal and regional matches for dermatology applicants in the postpandemic era (2022-2023) compared with prepandemic statistics. Overall, the research sheds light on the evolving dynamics of dermatology residency matching in response to pandemic-induced changes and applicant preferences.

Results From the First Annual Association of Professors of Dermatology Program Directors Survey.

The first annual Association of Professors of Dermatology (APD) program director (PD) survey was distributed in November 2022 and included 53 respondents from individual Accreditation Council for Graduate Medical Education (ACGME) programs. This survey included 137 in-depth questions to identify similarities and differences among programs regarding 12 broad categories: program characteristics; PD demographics; impact of the COVID-19 pandemic on residency training; available resources; quality improvement; clinical instruction; didactic instruction; research content; diversity, equity, and inclusion; wellness; evaluation systems; and graduation outcomes of postgraduate year (PGY) 4 residents. The survey provided preliminary insight to similarities and differences between programs, such as varying academic time and research resources, while also challenging norms seen in areas of diversity, equity, and inclusion. As future surveys are optimized to obtain greater response rates, these metrics can be captured in a centralized database accessible to PDs to reflect trends and identify strengths and weaknesses of dermatology residency programs.

Successful Management of Angioinvasive Deep Fungal Infections of the Penis: A Multidisciplinary Approach with Intraoperative Frozen Margins.

BACKGROUND Mucormycosis, a cause of opportunistic infections in immunocompromised patients, is rarely identified in the penis. The literature often describes drastic surgical interventions or rapid patient demise, with scant mention of surgical management specifics. The objective of this report is to detail our experience with this unique infection and highlight the utility of intraoperative frozen margins during surgical management. CASE REPORT Herein, we describe successful treatment of a 55-year-old man with biopsy-proven B-cell acute lymphoblastic leukemia (B-ALL) undergoing Hyper-CVAD (Cyclophosphamide, Vincristine, Adriamycin, and Dexamethasone) therapy who initially presented with an asymptomatic violaceous lesion of the penis. Differential diagnoses ranged from infectious, vasculogenic, and pharmacologic in nature. Ultimately, a punch biopsy tissue culture confirmed angioinvasive fungal infection with Rhizopus and Fusarium species. Initial debridement combined with intravenous antifungal therapy was unsuccessful. However, partial penectomy with use of intraoperative frozen margins, a 5-week course of antifungal therapy, and continued B-ALL treatment allowed effective and lasting resolution of the infection, with partial penile preservation. CONCLUSIONS This case supports a multidisciplinary approach as the primary treatment for penile angioinvasive fungal infections. This includes treatment of the underlying immunocompromising condition, appropriate intravenous antifungal therapy, and urgent operative debridement. This report highlights the importance of utilizing intraoperative frozen sections to ensure negative margins and to optimize overall tissue sparing in this anatomically sensitive area.

Chronic Ulcer on the Tongue as a Manifestation of Histoplasmosis During Anti-tumor Necrosis Factor-Alpha (TNF-⍺) Inhibitor Therapy for Psoriasis.

Anti-tumor necrosis factor-alpha (TNF-⍺) inhibitors are commonly used in the treatment of inflammatory conditions such as psoriasis. However, these agents lead to increased susceptibility to infections. We report a patient with reactivation of latent histoplasmosis six months after starting an anti-TNF-⍺ inhibitor for the treatment of psoriasis. Dermatologists should be aware of the risks associated with initiating therapy and maintain a low threshold of suspicion for this infection in patients on anti-TNF-⍺ inhibitors presenting with oral ulcers.

Delayed Onset of Bullous Pemphigoid Secondary to Nivolumab.

The increasing use of immune checkpoint inhibitors, such as nivolumab, a programmed cell death protein 1 (PD-1) inhibitor, for advanced neoplastic disease has revealed significant cutaneous immune-related adverse effects. Herein, we report a case of bullous pemphigoid (BP) secondary to nivolumab therapy for recurrent metastatic oropharyngeal squamous cell carcinoma. In this patient, the time to development of BP was three years, which represents the most delayed onset of BP secondary to a PD-1 inhibitor that has been reported in the literature. Symptoms were initially controlled on low-dose oral prednisone but recurred after two years. The patient was subsequently treated with a several-month taper of high-dose oral prednisone, during which he was able to resume nivolumab without recurrence of skin lesions. Although immune checkpoint inhibitor-induced BP remains rare, physicians should be aware of this serious cutaneous immune-related adverse event as the use of this drug class continues to expand.

Epidemiology of Stevens-Johnson syndrome and toxic epidermal necrolysis in the United States and factors predictive of outcome.

Background: Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS-TEN overlap syndrome are rare severe cutaneous adverse reactions associated with high mortality. Objectives: To estimate incidence and describe trends of SJS/TEN hospitalizations in the United States and to describe the clinical, demographic, and geographic characteristics of affected patients and risk factors for mortality. Methods: We utilized hospitalization data from the 2010 to 2020 National Inpatient Sample. SJS, SJS-TEN overlap syndrome, and TEN were identified by International Classification of Diseases, 9th Revision and International Classification of Diseases, 10th Revision codes and analyzed by logistic regression. Results: We identified 51,040 hospitalizations involving SJS/TEN. Amog those, 37,283 (73.0%) were for SJS only, 7818 (15.3%) were for SJS-TEN overlap syndrome, and 7160 (14.0%) were for TEN only. Overall, SJS/TEN hospitalization rates declined over time, 2010 to 2020 (P < .05). Mortality rates of the SJS group, SJS-TEN overlap syndrome group, and TEN group were 5.4%, 14.4%, and 15.3%, respectively. Increasing age, chronic kidney disease, pneumonia, sepsis, and malignant neoplasm were all significantly associated with increased odds of mortality (P < .05). Non-Hispanic White racial/ethnic identification was associated with decreased odds of mortality (P < .05). Limitations: Lack of standardization for diagnostic criteria. Conclusions: Risk factors identified in this study lay the groundwork for improvement in SJS/TEN mortality prediction scoring.

Building successful culture, mission, and vision in dermatology.

Building a successful culture in academic dermatology is necessary now more than ever, but this problem is compounded by the shortage of dermatologists, especially academicians. This dearth of academic dermatologists raises questions about who will train future generations of physicians and who will drive innovative research to advance the field and improve patient care. Recruitment and retention of dermatologists in academia faces steep challenges posed by increasing demands within academic medicine and the draw of the private sector. It is important to address barriers to a career in academia. Efforts should be focused on modifiable aspects of dermatology residency experiences to promote a career in academic dermatology. Of equal importance is the retention of faculty already in academia because midcareer shifts from academic settings to private practice can result in a significant leadership gap.

Rowell Syndrome in a Middle-Aged Woman: A Case Report.

Rowell syndrome (RS) is characterized by the presentation of lupus erythematosus (LE) with erythema multiforme (EM)-like lesions. It is thought to display a characteristic serologic pattern consisting of a "speckled-type" antinuclear antibody (ANA), positive anti-Ro/SSA or anti-La/SSB, or positive rheumatoid factor (RF). We report the case of a patient with subacute cutaneous lupus erythematosus (SCLE) who presented with EM-like lesions responsive to oral corticosteroids.