Mycosis Fungoides Palmaris et Plantaris Mimicking "Dyshidrotic Eczema": A Case Report.

Mycosis fungoides palmaris et plantaris (MFPP) is a rare variant of mycosis fungoides (MF), a type of cutaneous T-cell lymphoma. MFPP primarily affects the palms and soles of the feet and is often misdiagnosed as dyshidrotic eczema due to its similar clinical presentation. This case report presents a middle-aged woman with MFPP whose initial presentation was mistaken for dyshidrotic eczema. Despite treatment with topical corticosteroids, the patient's lesions persisted, prompting further investigations that led to the diagnosis of MFPP. The patient was initiated on betamethasone dipropionate ointment and hydroxyzine for pruritus management, with a pivotal referral to oncology for comprehensive evaluation. This case highlights the importance of considering MFPP in the differential diagnosis of persistent eczematous lesions on the palms and soles, especially when treatment with topical corticosteroids is ineffective. J Drugs Dermatol. 2024;23(7):569-570.     doi:10.36849/JDD.8474.

Metastatic Merkel Cell Carcinoma After Simultaneous Pancreas-Kidney Transplantation: Fatal Outcomes.

Merkel cell carcinoma (MCC) is a rare, highly aggressive cutaneous malignancy. Immunosuppression increases the risk of MCC and is associated with poor prognosis. Organ transplant recipients (OTR) have worse overall survival (OS) than patients with immunosuppression due to other causes. Treating MCC after organ transplantation is challenging, as checkpoint inhibitor immunotherapy, the standard of care for treating MCC, increases the risk of transplant rejection. This paper reviews the cases of two simultaneous pancreas-kidney transplant (SPKT) recipients with MCC and explores the role of immunosuppression in the development of MCC. Immunosuppression was discontinued and checkpoint inhibitor therapy was initiated in the first patient and considered by the second patient. In both cases, treatment failed, and the patients died shortly after developing metastatic MCC. These cases illustrate the need for improved multidisciplinary treatment regimens for MCC in OTRs. J Drugs Dermatol. 2024;23(5):376-377.     doi:10.36849/JDD.8234  .

Scarring and Dyschromias in Fitzpatrick Skin Type IV-VI: A Review of Dermatologic Treatment Protocols.

IMPORTANCE: Managing chronic conditions is an essential aspect of dermatologic care, especially regarding the resolution of inflammatory dermatologic disease and recovery of skin lesions. Short-term complications of healing include infection, edema, dehiscence, hematoma formation, and tissue necrosis. At the same time, longer-term sequelae may consist of scarring and scar widening, hypertrophic scars, keloids, and pigmentary changes. This review will focus on dermatologic complications of chronic wound healing in patients with Fitzpatrick skin type (FPS) IV-VI or skin of color (SOC), with an emphasis on hypertrophy/scarring and dyschromias. It will focus on current treatment protocols and the potential complications specific to patients with FPS IV-VI. OBSERVATIONS: There are multiple complications of wound healing that are more prevalent in SOC, including dyschromias and hypertrophic scarring. These complications are challenging to treat, and current protocols are not without complications and side effects that must be considered when offering therapy to patients with FPS IV-VI. CONCLUSIONS AND RELEVANCE: When treating pigmentary and scarring disorders in patients with skin types FPS IV-VI, it is essential to implement a stepwise approach to management that is conscious of the side effect profile of current interventions. J Drugs Dermatol. 2023;22(7): doi:10.36849/JDD.7253.

Scarring and Dyschromias in Fitzpatrick Skin Type IV-VI: A Review of Dermatologic Treatment Protocols.

IMPORTANCE: Managing chronic conditions is an essential aspect of dermatologic care, especially regarding the resolution of inflammatory dermatologic disease and recovery of skin lesions. Short-term complications of healing include infection, edema, dehiscence, hematoma formation, and tissue necrosis. At the same time, longer-term sequelae may consist of scarring and scar widening, hypertrophic scars, keloids, and pigmentary changes. This review will focus on dermatologic complications of chronic wound healing in patients with Fitzpatrick skin type (FPS) IV-VI or skin of color (SOC), with an emphasis on hypertrophy/scarring and dyschromias. It will focus on current treatment protocols and the potential complications specific to patients with FPS IV-VI.  Observations: There are multiple complications of wound healing that are more prevalent in SOC, including dyschromias and hypertrophic scarring. These complications are challenging to treat, and current protocols are not without complications and side effects that must be considered when offering therapy to patients with FPS IV-VI.  Conclusions and Relevance: When treating pigmentary and scarring disorders in patients with skin types FPS IV-VI, it is essential to implement a stepwise approach to management that is conscious of the side effect profile of current interventions. J Drugs Dermatol. 2023;22(3):288-296. doi:10.36849/JDD.7253.

Checkpoint Inhibitor-Induced Neurotoxicity in a Case of Metastatic Melanoma.

Checkpoint inhibitors (CPIs) are increasingly being used in the treatment of malignant melanoma. While showing promise in metastatic melanoma treatment, CPIs are associated with immune-related adverse events in various organ systems. Among these events, checkpoint inhibitor-induced neurotoxicity stands out as a particularly rare yet diagnostically challenging and potentially life-threatening occurrence. We report a unique case of checkpoint inhibitor-induced neurotoxicity in a patient with metastatic melanoma directly after beginning treatment with checkpoint inhibitor encorafenib. The patient presented with an unclear clinical course, with features of Guillain-Barré syndrome, myasthenia gravis, and brainstem encephalitis.  We followed a recently established management algorithm for checkpoint inhibitor-induced neurotoxicity with positive outcomes. This case report highlights the importance of recognizing checkpoint inhibitor-induced neurotoxicity as a potential adverse effect of CPIs when treating metastatic melanoma. J Drugs Dermatol. 2023;22(12):e25-e27.     doi:10.36849/JDD.7991e.

Epidemiology of Chronic Dermatologic Conditions in Skin of Color.

Across the board, common dermatologic conditions disproportionately affect patients of color. While the causes of these disparities have been tied to the environment, societal structure, access to care, health literacy, and biological factors, there is limited understanding of the extent and impact of dermatologic healthcare inequity. This study provides a resource on the epidemiology of common dermatologic diseases across racial lines and points out current lapses in scientific understanding of the disparate impact of certain conditions. This study will review epidemiological data on atopic dermatitis (AD), adult acne, pseudofolliculitis, dermatophytosis, psoriasis, vitiligo, melasma, hyperpigmentation, keloids, hidradenitis suppurativa (HS), basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. J Drugs Dermatol. 2023;22(11):e21-e23    doi:10.36849/JDD.7131e.

Assessing Implicit Bias in Dermatology.

BACKGROUND: Patients with skin of color (SOC), defined as Fitzpatrick skin types IV to VI, and of varying ethnicities are under-represented in dermatology. This includes practitioners, trainees, dermatologic teaching materials, and clinical studies.  Methods: Online survey study to assess dermatologists’ perceptions that could impact patient care. Participants were screened for providers that spent ≥80% of their time in direct patient care; managed ≥100 unique patients per month; and had ≥20% aesthetic patients. RESULTS: A total of 220 dermatologists participated; 50 with SOC, 152 non-SOC, and 18 other. SOC dermatologists had a more diverse patient population by racial/ethnic background, but there was no difference in proportion of patients by Fitzpatrick skin phototype categories. While race/ethnicity is not considered a primary factor in clinical decision making, Fitzpatrick skin type is for many dermatologists. Most dermatologists agree that more diversity in medical training for dermatologic conditions would be beneficial. Dermatologists report that adding before and after photos of different skin types in educational materials and increasing training on cultural competency are likely to be the most effective strategies for improvement. CONCLUSIONS: Although racial/ethnic diversity shows differences based on location of practice and the race of dermatologists, diversity of skin type based on Fitzpatrick scale is virtually identical across practices, illustrating the challenge of categorizing patients by this scale alone. Beer J, Downie J, Noguiera A, et al. Assessing implicit bias in dermatology. J Drugs Dermatol. 2023;22(7):635-640. doi:10.36849/JDD.7435.

Pityriasis Alba in Pediatric Patients With Skin of Color.

As we continue to work toward a more equitable future of medicine, it is necessary to recognize the needs distinct to pediatric dermatology to decrease health disparities that affect this patient population. Currently, there is very little research investigating the predominate risk factors and management of pityriasis alba in children with skin of color. Herein, we discuss existing literature on pityriasis alba in children with skin of color, as well as the research and educational needs in this area. J Drugs Dermatol. 2023;22(4)    doi:10.36849/JDD.7221 Citation: Hyun Choi S, Beer J, Bourgeois J, et al. Pityriasis alba in pediatric patients with skin of color. J Drugs Dermatol. 2023;22(4):417-418. doi:10.36849/JDD.7221.

Addressing Disparities in Melanoma Recognition in Skin of Color.

Melanoma is the third most common skin malignancy across all racial groups in the United States.1 While non-Hispanic white patients comprise the overwhelming majority of cases, morbidity and mortality remain disproportionately higher in minority populations.

Diversity in Academic Dermatology.

The American Medical Association recently declared racism to be a public health threat. It declared that “Racism negatively impacts and exacerbates the health inequities among historically marginalized communities”.1 The New England Journal of Medicine echoed this declaration in a recent article that included goals for making medicine more diverse by transforming “the ranks of institutional research leadership, faculty, trainees, and staff to reflect the demographic diversity of the communities their organizations serve.”2 The article also calls for more transparent selection criteria for choosing leaders in medicine. Necessary changes are articulated and provide a pathway towards more equality in medicine. One subspecialty in the field of medicine (dermatology) lacks the type of diversity one would expect from physicians who study the skin. Although the problem has been discussed for years, it has yet to be rectified. J Drugs Dermatol. 2022;21(5):674-676. doi:10.36849/JDD.6899.

Mycosis Fungoides: Awareness in Skin of Color.

Over the past decade, what is known about skin of color in the field of dermatology has gained an increasing amount of attention among both clinicians and the general public. Recent efforts have continued to shed light on the role of skin color in health disparities and the development of actionable strategies to improve outcomes for patients of color. While research has largely focused on conditions such as atopic dermatitis, psoriasis, and skin cancer, uncommon dermatologic conditions have been less emphasized in skin of color discussions thus far.

The clinical utility of teledermoscopy in the era of telemedicine.

Teledermoscopy is a novel diagnostic tool for the prevention, diagnosis, and treatment of skin disease when direct visualization of lesions is difficult. It is an economically viable option that can complement telehealth visits and that providers can utilize to identify melanocytic lesions and optimize care with diagnostic accuracy comparable to face-to-face (FTF) diagnosis. Teledermoscopy is invaluable in monitoring chronic conditions that require frequent follow-up and treatment optimization. Inclusion of clinical and dermoscopic images has been shown to improve the diagnostic accuracy of teledermatology services, thereby reducing healthcare costs. Teledermoscopy is also non-discriminatory, as diagnostic accuracy is similar in lighter and darker skin types. It has been shown to improve patient access to specialty services and reduce the number of "no-shows" at FTF clinics and length of surgery waiting times. Mobile teledermoscopy is user-friendly, feasible, and economically viable, as inexpensive mobile dermatoscopes have emerged on the market to reduce consumer out-of-pocket costs. Research is limited on teledermoscopy's utility in diagnosing pre-cancerous and cancerous skin lesions in adults, particularly complex pigmented lesions. Further research is recommended to investigate the role of dermoscopic expertise and artificial intelligence on the evaluation of teledermoscopic images.

Grover Disease Associated With Chemotherapy: Review of Potential Pathophysiology, Current Treatments, and Future Directions.

INTRODUCTION: Transient acantholytic dermatosis has been frequently reported in patients with malignancies. While paraneoplastic cases have rarely been reported, most eruptions occur in the setting of chemotherapeutic agents. Management is based on limited data and primarily with topical steroids and topical emollients. A subset of patients exhibits recalcitrant disease and require alternate therapeutic approachesMethods: This systematic review consisted of identifying records in PubMed using the medical subject headings (MeSH) terms “chemotherapy” AND “Grover”, “chemotherapy” AND “Grover’s”, “cancer” AND “Grover”, “cancer” AND “Grover’s”, “malignancy” AND “Grover”, “malignancy” AND “Grover’s”, as well as a free text search for “Grover” OR “Grover’s” OR “Grover disease” OR “Grovers disease” OR “Grover’s disease” OR “transient acantholytic dermatosis” OR “transient acantholytic” to identify case reports, case series, systematic reviews, review articles, meta-analyses, clinical trials, brief commentaries, and original articles. The titles and abstracts of all results were reviewed. Full texts of relevant results were then read in their entirety and applicability was determined. RESULTS: Overall, Grover disease has rarely been reported in the setting of malignancy. When it occurs, it is generally in the setting of chemotherapy use. Chemotherapy-associated Grover disease is reported most frequently in association with cytotoxic chemotherapies, followed by small molecule inhibitors. The first line treatment for this complication is the use of topical agents. When these provide inadequate relief, alternate therapies have been rarely reported, with novel treatments proposed based on the type of chemotherapy agent and its mechanism of action. CONCLUSIONS: Chemotherapy-associated Grover disease is an uncommon complication of cancer treatment. While most cases of chemotherapy-associated Grover disease can be treated with topical steroids and topical emollients, certain cases require a more specialized approach. This could include adjuvant adjuvant therapies, or novel treatments that are directly related to the mechanism of action of the chemotherapy involved. J Drugs Dermatol. 2020;19(11):1056-1064. doi:10.36849/JDD.2020.5648.

Teledermatology: Improving Access or Widening Healthcare Disparities?

Teledermatology, the form of telemedicine directed toward dermatology patients, is one of the earliest technological innovations that advanced remote medical care. Developed in 1995, teledermatology was established with the mission of increasing healthcare access among patients in rural geographic locations who had limited access to specialist care.1.

Effectiveness of Pediatric Teledermatology.

Initial studies of teledermatology in pediatric populations indicated that many of the problems experienced in adult virtual visits were even more apparent when treating children. Specifically, it was noted that the difficulty in obtaining medical history and participation of the pediatric patients provided additional challenges in evaluation.1 Direct-to-consumer models have highlighted many of these challenges as well as a general lack of continuity of care previously seen in pediatric teledermatology. Addressing these challenges may be accomplished by further involving parents in the teledermatology workflow.

Persistent Agminated CD30+ Lymphoproliferative Disorder.

Lymphomatoid papulosis (LyP) is a chronic skin condition, characterized by recurrent eruptions of papules and nodules with or without central necrosis that spontaneously resolve. This condition was originally described by Macaulay in 1968 as a self-healing rhythmical paradoxical eruption that was clinically benign yet histologically malignant.1 Clinically, it is defined by papules that wax and wane, are generally less than 1cm in diameter, and heal spontaneously after 6­8 weeks with subsequent scarring.2

Topical kinase inhibitors induce regression of cutaneous squamous cell carcinoma.

Actinic keratoses (AKs) and squamous cell carcinoma in situ (SCCIS) are precursor lesions for cutaneous squamous cell carcinoma (cSCC), the second most common form of cancer. Current topical therapies for AKs and SCCIS promote skin inflammation to eradicate lesions and do not directly target the biological mechanisms driving growth. We hypothesized that topical small molecule inhibitors targeting kinases promoting keratinocyte growth in AKs and SCCIS could induce regression of these lesions with less inflammation. To test this hypothesis, we determined the efficacy of topical dasatinib, 5-fluorouracil and BEZ-235 in inducing regression of cSCCs in the K14-Fyn Y528 transgenic mouse model. Topical dasatinib induced regression of cSCC with less inflammation, no ulceration and no mortality compared to 5-fluorouracil. Topical BEZ-235 induced cSCC regression similar to dasatinib without erythema or ulceration. These data indicate that topical small molecule kinase inhibitors targeting drivers of AK/SCCIS/cSCC growth represent a promising therapeutic approach to treat these common skin lesions.

Perioral Rejuvenation: A Prospective, Quantitative Dynamic Three-Dimensional Analysis of a Dual Modality Treatment.

BACKGROUND: The perioral region is the most dynamic anatomic area of the face and subject to complex and dramatic changes during aging. Successful treatment for perioral rejuvenation has yet to be identified, and prior studies have reported only subjective outcomes. OBJECTIVES: The purpose of this study was to utilize our validated dynamic 3-dimensional imaging technology to determine whether conservative neuromodulation combined with hyaluronic acid filler volumization can decrease perioral strain and increase volume with significant patient satisfaction. METHODS: An IRB-approved prospective study of a dual modality treatment for perioral rhytids was performed on females with perioral aging who had not had prior facial treatment within the past year. Eighteen (18) units of Dysport were injected into the upper and lower orbicularis oris and 1 cc of Restylane Silk was injected in volume-depleted perioral regions in each patient. Each patient underwent imaging with digital image correlation (DIC) and completed the FACE-Q survey prior to injection and at 14 days and 90 days postinjection. RESULTS: Thirty-two female patients were recruited. A significant reduction in perioral strain was observed at both day 14 and day 90. This was concomitant with a significant increase in perioral volume at day 14 that at 90 days was significantly retained in the marionette lines. Further, there was a significant improvement in patient satisfaction with overall facial appearance at day 14 that was maintained at 90 days. CONCLUSIONS: Conservative neuromodulation and hyaluronic acid filler volumization of the perioral region produces a significant reduction in strain correlating with high patient satisfaction, even at 90 days. This dual modality treatment is effective in rejuvenating the perioral region, and its future optimization will provide greater therapeutic options for this anatomically complex area.