CD123 immunohistochemistry for plasmacytoid dendritic cells is useful in the diagnosis of scarring alopecia.

BACKGROUND: Distinguishing types of lymphocytic scarring alopecia is often difficult because of the overlapping features. Recently, the presence of plasmacytoid dendritic cells (PDCs) in cutaneous lupus erythematosus (LE) was demonstrated and further shown to help distinguish lupus from other dermatoses.1-6 This study aims to determine if the presence and distribution of PDCs can aid in the diagnosis of scarring alopecia. METHODS: Cases of scarring alopecia due to chronic cutaneous lupus erythematosus (CCLE), lichen planopilaris (LPP) and central centrifugal cicatricial alopecia (CCCA) were examined histopathologically. A total of 45 total biopsies were evaluated and CD123 immunohistochemistry was performed on all samples. The relative percentage of PDCs, the presence of clusters and the distribution of CD123+ cells were noted. RESULTS: PDCs comprised a greater percentage of the infiltrate and were arranged in clusters in cases of CCLE vs. LPP or CCCA. In CCLE, the location of PDCs was perivascular, perifollicular, perieccrine and/or at the follicular junction. In LPP and CCCA, PDCs were mainly arranged as single, interstitial cells. CONCLUSIONS: Our findings suggest that the presence and arrangement of CD123+ PDCs may assist in the diagnosis of scarring alopecia. We anticipate this will be of value in diagnosing challenging cases of highly inflammatory scarring alopecia.

Epidermolysis bullosa nevus in a patient with recessive dystrophic epidermolysis bullosa: a case report.

We present a case of a 6-year-old girl with recessive dystrophic epidermolysis bullosa (EB) who presented with a large pigmented lesion clinically concerning for melanoma. After histological examination and fluorescent in situ hybridization analysis, diagnosis of EB nevus was performed. EB nevi are benign melanocytic neoplasms with histological findings similar to recurrent nevi occurring in all types of EB. They often mimic melanoma clinically, dermatoscopically, and histopathologically. The ability to recognize an EB nevus is essential for appropriate management of the patient. Unnecessary surgical excision in patients with already high-risk EB should be avoided. Close monitoring of these lesions is recommended because no cases of transformation to melanoma have been described.

Correlation of USMLE Step 1 scores with performance on dermatology in-training examinations.

BACKGROUND: Although United States Medical Licensing Examination (USMLE) Step 1 was not designed to predict resident performance, scores are used to compare residency applicants. Multiple studies have displayed a significant correlation among Step 1 scores, in-training examination (ITE) scores, and board passage, although no such studies have been performed in dermatology. OBJECTIVE: The purpose of this study is to determine if this correlation exists in dermatology, and how much of the variability in ITE scores is a result of differences in Step 1 scores. This study also seeks to determine if it is appropriate to individualize expectations for resident ITE performance. METHODS: This project received institutional review board exemption. From 5 dermatology residency programs (86 residents), we collected Step 1 and ITE scores for each of the 3 years of dermatology residency, and recorded passage/failure on boards. Bivariate Pearson correlation analysis was used to assess correlation between USMLE and ITE scores. Ordinary least squares regression was computed to determine how much USMLE scores contribute to ITE variability. RESULTS: USMLE and ITE score correlations were highly significant (P < .001). Correlation coefficients with USMLE were: 0.467, 0.541, and 0.527 for ITE in years 1, 2, and 3, respectively. Variability in ITE scores caused by differences in USMLE scores were: ITE first-year residency = 21.8%, ITE second-year residency = 29.3%, and ITE third-year residency = 27.8%. LIMITATIONS: This study had a relatively small sample size, with data from only 5 programs. CONCLUSIONS: There is a moderate correlation between USMLE and ITE scores, with USMLE scores explaining ∼26% of the variability in ITE scores.

Cutaneous rosai-dorfman disease persisting after surgical excision: report of a case treated with acitretin.

OBJECTIVE: Cutaneous Rosai-Dorfman disease is rare, and there is a lack of literature on clinical evidence for treatment options. The objective of this report is to illustrate that acitretin may be effective in treating cutaneous Rosai-Dorfman disease. DESIGN: A patient with cutaneous Rosai-Dorfman disease refractory to antibiotics, steroids, and surgical excision was treated with acitretin for a period of four months and was closely monitored for improvement in the lesion. SETTING: This was a patient in the authors' medical dermatology clinic. PARTICIPANTS: A single patient was involved. RESULTS: The patient had continuous improvement in her cutaneous Rosai-Dorfman disease throughout a four-month treatment course with softening of the plaque and decreased erythema. She chose to discontinue treatment after four months due to hair loss with acitretin. CONCLUSION: Cutaneous Rosai-Dorfman disease is a rare, benign, generally self-limited, lymphoproliferative disease of unknown etiology. It typically occurs as histiocyte-rich inflammatory infiltrates, manifesting as red papules and plaques in older women, without predilection for site. Treatment is usually unnecessary, unless the lesions persist and are bothersome to the patient or cause functional deficits. Treatments are based on case reports and include surgery, radiation, and medical options. Our experience with a patient with a case of cutaneous Rosai-Dorfman disease persisting after surgical excision demonstrates that acitretin may be an effective therapeutic option for cutaneous Rosai-Dorfman disease.