Targetoid lesions in a patient with systemic lupus erythematosus.

Rowell Syndrome is a rare presentation of lupus erythematosus manifesting as an eruption of erythema multiforme-like papules and plaques with immunological findings of positive rheumatoid factor, speckled antinuclear antibodies, and/or anti-Ro/La antibodies. This case highlights the unusual and highly debated presentation of Rowell Syndrome in a 66-year-old woman with newly-appearing erythematous, targetoid plaques in the setting of previously diagnosed systemic lupus erythematosus. Skin biopsy revealed histological features of full-thickness epidermal necrosis with focal sub-epidermal separation and a superficial perivascular lymphocytic infiltrate interpreted to favor Rowell Syndrome given her clinical history and presentation. Although no standard treatment exists, a prednisone taper and topical corticosteroids proved effective initially, with complete resolution at six months on mycophenolate mofetil and belimumab.

An expert panel consensus on opioid-prescribing guidelines for dermatologic procedures.

BACKGROUND: Opioid overprescribing is a major contributor to the opioid crisis. The lack of procedure-specific guidelines contributes to the vast differences in prescribing practices. OBJECTIVE: To create opioid-prescribing consensus guidelines for common dermatologic procedures. METHODS: We used a 4-step modified Delphi method to conduct a systematic discussion among a panel of dermatologists in the fields of general dermatology, dermatologic surgery, and cosmetics/phlebology to develop opioid prescribing guidelines for some of the most common dermatologic procedural scenarios. Guidelines were developed for opioid-naive patients undergoing routine procedures. Opioid tablets were defined as oxycodone 5-mg oral equivalents. RESULTS: Postoperative pain after most uncomplicated procedures (76%) can be adequately managed with acetaminophen and/or ibuprofen. Group consensus identified no specific dermatologic scenario that routinely requires more than 15 oxycodone 5-mg oral equivalents to manage postoperative pain. Group consensus found that 23% of the procedural scenarios routinely require 1 to 10 opioid tablets, and only 1 routinely requires 1 to 15 opioid tablets. LIMITATIONS: These recommendations are based on expert consensus in lieu of quality evidence-based outcomes research. These recommendations must be individualized to accommodate patients' comorbidities. CONCLUSIONS: Procedure-specific opioid prescribing guidelines may serve as a foundation to produce effective and responsible postoperative pain management strategies after dermatologic interventions.

Pulsed dye laser repurposed: Treatment of refractory molluscum contagiosum in renal transplant patient.

We present a case of a 15-year-old girl with an allogenic renal transplant secondary to chronic glomerulonephritis of unknown etiology who presented with treatment refractory molluscum contagiosum of the lower extremities and perineum. Treatment of mollusca with pulsed dye laser resulted in a clinically significant and sustained response. To our knowledge, this is the first report of a successful treatment of molluscum contagiosum with pulsed dye laser in the setting of a renal transplant.

Histiocytoid Sweet's Syndrome in the Setting of Myelodysplastic Syndrome.

Acute febrile neutrophilic dermatosis, or Sweet's syndrome, is characterized by tender, edematous papules and plaques, favoring the upper extremities and the head and neck regions. The classic variant of Sweet's syndrome involves a predominantly neutrophilic dermal infiltrate on histopathology. However, histiocytoid Sweet's syndrome has been noted to have a primary histiocytoid mononuclear infiltrate and is typically found in patients with malignancies such as myelodysplasia. This case report discusses the treatment of histiocytoid Sweet's syndrome in an immunocompromised patient with a recent history of Mycobacterium avium complex infection and latent tuberculosis in the setting of myelodysplastic syndrome.

Perifollicular Melanocyte Regeneration in Bullous Pemphigoid.

Bullous pemphigoid (BP) is an autoimmune skin disorder that causes fluid-filled blisters to appear on various body parts, often preceded by urticaria and pruritis. This case report describes the perifollicular melanocyte regeneration within diseased areas in a skin of color patient with BP. By reviewing the various pathologies that can result in melanocyte destruction and the basic science of melanocyte regeneration, we can better identify and explain this phenomenon to patients and lead to earlier diagnoses. Furthermore, due to the lack of published information on skin conditions in skin of color patients, this report can assist in raising awareness of an atypical BP presentation in the dermatological community.

Multiple cutaneous nodules presenting as metastatic squamous cell carcinoma of the esophagus.

A 62-year-old man with weight loss and dysphagia developed 3 cutaneous nodules. Fine needle aspirate of one of the nodules identified squamous cell carcinoma, which was found to be a metastasis from esophageal cancer.

If At First You Don't Succeed, Trikafta Again.

Adverse reactions, including severe cutaneous reactions, to cystic fibrosis transmembrane conductance regulator (CFTR) modulators have been described in the literature. Herein we present a drug eruption in response to elexacaftor/tezcaftor/ivacaftor (brand name, Trikafta) in a 7-year-old male with cystic fibrosis, followed by desensitization and successful continuation. A review of the literature outlining similar cases is provided. Attempting to mitigate and manage drug reactions to CFTR modulators is essential because they represent vital and irreplaceable therapies for individuals with cystic fibrosis (CF).

Spin in Abstracts of Systematic Reviews and Meta-analyses of Melanoma Therapies: Cross-sectional Analysis.

BACKGROUND: Spin is defined as the misrepresentation of a study's results, which may lead to misperceptions or misinterpretation of the findings. Spin has previously been found in randomized controlled trials and systematic reviews of acne vulgaris treatments and treatments of various nondermatological conditions. OBJECTIVE: The purpose of this study was to quantify the presence of spin in abstracts of systematic reviews and meta-analyses of melanoma therapies and identify any related secondary characteristics of these articles. METHODS: We used a cross-sectional approach on June 2, 2020, to search the MEDLINE and Embase databases from their inception. To meet inclusion criteria, a study was required to be a systematic review or meta-analysis pertaining to the treatment of melanoma in human subjects, and reported in English. We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) definition of systematic reviews and meta-analyses. Data were extracted in a masked, duplicate fashion. We conducted a powered bivariate linear regression and calculated odds ratios for each study characteristic. RESULTS: A total of 200 systematic reviews met the inclusion criteria. We identified spin in 38% (n=76) of the abstracts. The most common type of spin found was type 3 (selective reporting of or overemphasis on efficacy outcomes or analysis favoring the beneficial effect of the experimental intervention), occurring 40 times; the least common was type 2 (title claims or suggests a beneficial effect of the experimental intervention not supported by the findings), which was not present in any included abstracts. We found that abstracts pertaining to pharmacologic interventions were 3.84 times more likely to contain spin. The likelihood of an article containing spin has decreased annually (adjusted odds ratio 0.91, 95% CI 0.84-0.99). No significant correlation between funding source or other study characteristics and the presence of spin was identified. CONCLUSIONS: We have found that spin is fairly common in the abstracts of systematic reviews of melanoma treatments, but the prevalence of spin in these abstracts has been declining from 1992-2020.

Treatment of Trichilemmomas With Topical Sirolimus.

This case report describes a woman in her 60s flesh-colored papules that were localized to the central face and a lobular downgrowth of cells with clear, expanded, faintly glassy cytoplasm.