Methotrexate-Induced Epidermal Necrosis.

A 79-year-old woman with psoriasis presented to the emergency department with new-onset eruptions on the trunk, extremities, and oral mucosa for 8-9 days. For psoriasis, she had been taking 15 mg of methotrexate weekly for over 18 years, and had discontinued folic acid a few months prior to this.

Drug-Induced Alopecia Areata From Upadacitinib.

This case report describes an unexpected occurrence of alopecia areata (AA) in a 55-year-old woman undergoing treatment with upadacitinib for atopic dermatitis. This patient developed AA approximately one year into her upadacitinib treatment for atopic dermatitis. This case highlights possible upadacitinib-induced AA, which has not been reported in the literature. Not only does this case demonstrate the typical timeline for drug-induced alopecia, but it also raises questions about whether upadacitinib can cause drug-induced alopecia.

Triad of Thyroid Ophthalmopathy, Dermopathy, and Acropachy.

A 40-year-old African-American man was referred to our dermatology clinic for management of his long-standing thyroid dermopathy. The patient was diagnosed with hyperthyroidism at the age of 20, and was treated with radioactive iodine I-131 but subsequently lost to follow-up. He had not consulted physicians again until the age of 30. Then he presented with severe thyroid eye disease, significant weight gain, hypothy-roidism, and painful leg swelling. Levothyroxine was initiated, which stabilized his thyroid levels but had no effect on his exophthalmos and leg swelling.

Facial Dermatitis Herpetiformis.

A 34-year-old African-American woman with a past medical history of human immunodeficiency virus (HIV) and hypertension presented to the clinic with a blister that was appearing about once a month on her nose or cheeks over the past 8 months. The blister was occasionally pru- ritic and would resolve spontaneously. At the time of presentation, the patient had only post-inflammatory hyperpigmentation on her nasal dorsum. The patient had photos of the blister on her phone to show what it originally looked like (Figure 1).

Full Guidelines-From the Medical Board of the National Psoriasis Foundation: Perioperative management of systemic immunomodulatory agents in patients with psoriasis and psoriatic arthritis.

BACKGROUND: Systemic immunomodulatory agents are indicated in the treatment of moderate-to-severe plaque psoriasis and psoriatic arthritis. Perioperative use of these medications may increase the risk of surgical site infection (SSI) and complication. OBJECTIVE: To evaluate the risk of SSI and complication in patients with chronic autoimmune inflammatory disease receiving immunomodulatory agents (tumor necrosis factor-alfa [TNF-α] inhibitors, interleukin [IL] 12/23 inhibitor, IL-17 inhibitors, IL-23 inhibitors, cytotoxic T-lymphocyte-associated antigen-4 costimulator, phosphodiesterase-4 inhibitor, Janus kinase inhibitors, tyrosine kinase 2 inhibitor, cyclosporine (CsA), and methotrexate [MTX]) undergoing surgery. METHODS: We performed a search of the MEDLINE PubMed database of patients with chronic autoimmune inflammatory disease on immune therapy undergoing surgery. RESULTS: We examined 48 new or previously unreviewed studies; the majority were retrospective studies in patients with rheumatoid arthritis and inflammatory bowel disease. CONCLUSION: For low-risk procedures, TNF-α inhibitors, IL-17 inhibitors, IL-23 inhibitors, ustekinumab, abatacept, MTX, CsA, and apremilast can safely be continued. For intermediate- and high-risk surgery, MTX, CsA, apremilast, abatacept, IL-17 inhibitors, IL-23 inhibitors, and ustekinumab are likely safe to continue; however, a case-by-case approach is advised. Acitretin can be continued for any surgery. There is insufficient evidence to make firm recommendations on tofacitinib, upadacitinib, and deucravacitinib.

Interdigital Toe Web Space Erythrasma in a Young Child: A Case Report.

Erythrasma is a common superficial skin infection in adults. However, there is a paucity of reported cases in the pediatric population. Here we report a case of interdigital pedal erythrasma presenting in a four-year-old child as itchy, scaly maceration.

A Case Report of Sebaceous Filaments.

This report details a case of a 16-year-old African American girl who presented with a two-year history of white spicules on her face without associated symptoms, including pruritus or pain. On physical examination, there were many 1-2 mm discreet white to yellow filamentous spicules on the mid and lower face. Histopathology scrapings showed cornified cells and calcification consistent with sebaceous filaments. Sebaceous filaments are a rare condition that presents as white-to-yellow spicules distributed in highly sebaceous areas on the face. It is caused by sebum accumulation and cornified keratinocytes surrounding hair follicles, resulting in visible excretions. Treatment of sebaceous filaments is targeted at reducing the size of sebaceous glands which subsequently decreases excretions and improves skin appearance. Despite low incidence, sebaceous filaments are likely under-reported. It is important for dermatologists to recognize and treat sebaceous filaments in patients who present with this condition to improve their appearance and quality of life. The present patient was successfully treated with topical tretinoin.

Do We Need to Monitor for Graves' Disease After a Diagnosis of Pemphigoid Gestationis?

Pemphigoid gestationis (PG) is a rare autoimmune bullous disease that occurs during pregnancy or the postpartum period. PG has been associated with an increased risk of Graves' disease possibly due to shared genetic factors and immune system fluctuations during pregnancy. However, the evidence supporting the association between PG and Graves' disease is mixed. Although dermatologists are cautioned to watch for Graves' disease in patients with a history of PG, this guidance is based on a single cohort where most patients were diagnosed with Graves' disease prior to PG onset. Recent data failed to find an association between Graves' disease and PG but did not capture the lifetime risk of Graves' disease in these patients. Future studies could focus on long-term follow-up of females with PG, shedding light on the lifetime risk profiles of these patients.

Topical Tacrolimus and Alcohol-Induced Facial Flushing: A Case Report and Literature Review.

Flush reactions can be incited by various factors including inherent mutation, drugs, and diseases. A medication that is commonly used in dermatology but less associated with alcohol-induced facial flushing is topical tacrolimus. We present the case of a 44-year-old man experiencing this phenomenon on a distant, non-application site and a review of cases published in the literature.

Acneiform Eruption Secondary to Over-the-Counter Vitamin B12.

Treating an acneiform eruption requires the discovery of its etiology. Often, the removal of the offending agent can lead to the resolution of the eruption, resulting in an excellent prognosis. Herein, we present a rare case of a vitamin B12-induced acneiform eruption occurring in a 68-year-old female due to an over-the-counter supplement.