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ABSTRACT: Lichen linear planus is a rare variant of lichen planus that appears as pruritic, polygonal, purple papules in a blaschkoid distribution. This review critically assesses all reported cases of linear lichen planus (LLP) for proposed etiology, clinical and histologic traits, treatment options, and recurrence. A PubMed search from inception through March 2023, followed by article screening and full-text review, identified 51 unique cases of LLP. Data from each case including the sex of the patient, anatomic distribution of lesions, biopsy results, proposed etiology, treatment, and recurrence were recorded. LLP did not show a significant gender or age predilection, most frequently presented unilaterally with pruritus, and involved numerous anatomic regions. Various triggers including metal implants, vaccinations, infections, malignancy, and pregnancy were identified. The most common histopathologic descriptions included band-like lymphocytic or lichenoid infiltrate, basal liquefactive, vacuolar degeneration, hypergranulosis, hyperkeratosis, civatte or colloid bodies, melanin incontinence, and orthokeratosis. Treatment options, duration of treatment, and recurrence rate of LLP lesions were variable. Although LLP is rare, dermatologists should be aware of this presentation and appropriate diagnostic and treatment options because swift diagnosis can reduce patient morbidity.
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Liquen Plano , Humanos , Liquen Plano/patología , Femenino , Masculino , Persona de Mediana Edad , Adulto , Recurrencia , AncianoRESUMEN
Premature graying of hair (PGH) is a multifactorial condition defined by the graying of hair before the age of 20 in Caucasians and before the age of 30 in African Americans. Although the etiology remains unknown, it has been associated with genetic predisposition, oxidative stress, nutritional deficiencies, and autoimmune diseases. Current treatment options are limited but can include anti-inflammatory medications, vitamins, and hair colorants for symptom control. In this report, we present a case of premature graying in a 32-year-old male, onset at age 15, exhibiting a distinctive fractal pattern. This case represents a unique instance of PGH characterized by an unusual pattern, necessitating further investigation into potential etiological factors and underlying pathophysiological mechanisms.
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INTRODUCTION: Smartwatches have proven life-saving in medical specialties such as cardiology. Smartwatches actively warn us of arrhythmia risk and loud noise exposure. However, dermatologic health metrics are rarely monitored, and users are never alerted of potential skin health issues. Furthermore, the role of these devices within dermatology has not been evaluated in the literature. This study aims to analyze the current data points monitored by smartwatches and discuss potential adaptations to support dermatologic patient education and improve clinical management. Methods: The top three smartwatches per global market share were identified and analyzed to determine the health data points they monitor and the alerts they provide. These data points were grouped and compared based on their corresponding body systems. Results: Cardiovascular health comprises the highest percentage of data points collected with an average of 41% while dermatologic health averaged only 11%. Conclusion: Dermatology is grossly underrepresented in current smartwatch devices. There is an important need to expand the dermatologic health metrics tracked by adapting existing smartwatch technology. From proactive cancer prevention to disease-specific reactive interventions, smartwatches can play a significant role in improving dermatological health and reducing healthcare costs.
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Epidermal inclusion cysts (EICs) are benign masses that often develop on the face, scalp, neck, and back. Typically, EICs occur secondary to acne or obstructed hair follicles. However, the development of multiple EICs is associated with various syndromes and invasive procedures. Despite their relatively benign nature, a small percentage of EICs have been found to undergo malignant transformation. The complete excision of EICs is essential for their definitive treatment because of their ability to rupture, causing pain and infection. We present the first reported case of a patient without a history of acne, axillary surgery, or genetic syndromes who presented with multiple, painless, bilateral axillary EICs.
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Spiny keratoderma is a rare skin condition that presents on the palmar and plantar surfaces of the hands and/or feet. This condition is difficult to appreciate under ambient lighting but can be both physically and emotionally distressing to patients. Furthermore, because of the association with various neoplasms and systemic diseases, timely diagnosis and appropriate follow-up is of importance. We evaluate a case of spiny keratoderma in a patient with recently diagnosed hypothyroidism and emphasize the importance of proper lighting during a dermatology-focused physical examination. The patient's palmar lesions were only appreciable under LED light and with physical examination. A biopsy of the lesions confirmed the diagnosis of spiny keratoderma.
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Queratodermia Palmoplantar , Neoplasias , Enfermedades de la Tiroides , Humanos , Queratodermia Palmoplantar/etiología , Queratodermia Palmoplantar/complicaciones , Piel/patología , Neoplasias/complicacionesRESUMEN
We present a case of a diffuse, vascular eruption localized to the left thigh and left abdomen in an otherwise apparently healthy 63-year-old male. The patient reported that the eruption was not bothersome and had been present for as long as he could remember. Due to its benign appearance in nature, the patient declined a biopsy or further follow-up. While reports of diffuse vascular eruptions have been associated with many genetic diseases, this case offers an example of a diffuse vascular eruption in a healthy patient. Further research is needed to understand the potential genetic or environmental factors contributing to the development of such lesions in healthy patients.
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We evaluate the rare case of a patient who presented with generalized, non-pruritic lichen amyloidosis. There are three reported cases of generalized and non-pruritic lichen amyloidosis. The lichen amyloidosis subtype of primary localized cutaneous amyloidosis is characterized by keratinocyte-derived amyloid deposition in the papillary dermis, classically presenting as pruritic, hyperpigmented macules coalescing into plaques on the lower extremities. While the pathogenesis is likely multifactorial, chronic scratching has been proposed as an inciting factor. The patient's type of lichen amyloidosis challenges the proposed etiology of chronic scratching leading to amyloid deposition.
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Unwanted diffusion of pigment past the original margins of a tattoo, termed "tattoo blowout," appears as a blurred rim classically surrounding the original tattoo borders. The darkened skin is visibly noted within hours to days following the tattooing procedure. Although this complication is not largely covered in literature, in prior cases, blowout has been shown to occur in areas of thin skin such as the dorsum of the foot. We present a rare presentation of tattoo blowout in a possible gravity-dependent pattern of pigment migration, occurring years after tattoo application. This atypical presentation highlights the knowledge gap that exists in the medical literature surrounding the mechanism of tattoo blowout and reinforces that physicians should be aware of these potentially poor aesthetic outcomes.
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Pressure ulcers form when skin is compressed against a bony prominence, often in the context of prolonged supine or prone-based care. Hospitalized, bedridden patients are at the highest risk of this complication, especially when preventative measures like regular rotational bed treatment are not employed. In this case report, we present a rare case of a COVID-19-related facial pressure ulcer that occurred in the context of regular rotational bed treatment. The lesion was managed by wound care and allowed to heal by secondary intention. Ultimately, we hope that this manuscript will raise awareness for this atypical ulcer location, especially as prone-position treatment approaches take hold.
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Linear lichen planus (LLP), also known as blaschkolinear or blaschkoid lichen planus, is a rare subtype of lichen planus that presents along the lines of Blaschko. While LLP has been associated with vaccinations, neoplasms, medications, and successive pregnancies, we present a case of LLP following a primary pregnancy. A 29-year-old G1P1 female presented to dermatology for the evaluation of an intensely pruritic, whorled rash confined to her left lower leg that appeared shortly after the birth of her first child. A biopsy of the lesion and subsequent histopathology confirmed the diagnosis of LLP. The patient was treated with topical steroids with minimal response to therapy and declined further treatment.
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Spiny keratoderma (SpK) is a rare skin condition characterized by spine-like papules on the palms and soles. The condition is identified under several names such as "music box spine keratosis" and "palmoplantar filiform hyperkeratosis," creating ambiguity in the diagnostic and histopathologic features of the disease. In this study, we reviewed 84 cases of SpK to examine patient demographics, medical history, clinical and histopathological descriptions, and sporadic versus hereditary onset. Notably, the most used histopathological terms were "parakeratosis" and "hypogranulosis," and the most used clinical terms were "spine" and "hyperpigmented." The average age at presentation was 60.1 years with the majority of cases in males. Only 29.8% of cases were associated with a family history of SpK and underlying malignancies were present in 28.6% of cases. This review investigates the frequency of histopathologic and clinical terms used to describe SpK to provide insight into the clinical and histopathological characteristics of this rarely reported condition.
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Queratodermia Palmoplantar , Queratosis Actínica , Paraqueratosis , Masculino , Humanos , Persona de Mediana Edad , Queratodermia Palmoplantar/diagnóstico , Piel/patología , Paraqueratosis/patología , Queratosis Actínica/patologíaAsunto(s)
COVID-19 , Instituciones de Atención Ambulatoria , COVID-19/epidemiología , Humanos , Pandemias , SARS-CoV-2RESUMEN
Alopecia is typically viewed as a localized process, and comorbidities are not usually analyzed. The authors examine the prevalence of vitamin D deficiency among patients attending an alopecia clinic during a 3-month period. The data showed that 79% of patients had vitamin D deficiency, and the average value of low vitamin D was 19.1 mg/mL in patients. Vitamin D levels have not been examined extensively in skin disorders, and it is not clear whether vitamin D levels are correlative or causative in alopecia. The co-occurrence of both findings at such a dramatic level suggests the need for evaluation of this laboratory value in the alopecia population.
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Alopecia/epidemiología , Deficiencia de Vitamina D/epidemiología , Vitamina D/sangre , Adulto , Anciano , Alopecia Areata/epidemiología , Instituciones de Atención Ambulatoria , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Deficiencia de Vitamina D/sangre , Adulto JovenAsunto(s)
Doxorrubicina/análogos & derivados , Neoplasias Endometriales/tratamiento farmacológico , Exantema/inducido químicamente , Síndrome Mano-Pie/etiología , Neoplasias Pulmonares/tratamiento farmacológico , Doxorrubicina/efectos adversos , Femenino , Humanos , Persona de Mediana Edad , Polietilenglicoles/efectos adversosRESUMEN
Hair transplants were developed and championed by dermatologists. However, dermatology literature has few contributions from within our specialty. In this manuscript, we present our evaluation of a specific graft harvesting approach for hair transplants referred to as Follicular unit extraction (FUE). In particular, we sought to evaluate the rate of harvest attempts that did not produce an actual hair folliclular unit graft.
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Folículo Piloso/trasplante , Robótica , Recolección de Tejidos y Órganos/métodos , Alopecia/cirugía , Humanos , Cuero Cabelludo/cirugía , Trasplante Autólogo/métodosRESUMEN
Alopecia affects many individuals worldwide. Owing to the large role that hair loss plays in self-image and self-confidence, an increasing number of these men and women seek options for hair restoration. Major considerations and sources of hesitation for strip surgical restoration are the visible linear scar, prolonged downtime, and other expected side effects of invasive procedures. These problems can be circumvented by smaller harvest approaches. However, the traditional punch harvest, which produces no linear scar, does leave patients with an often-unsatisfactory "doll hair" appearance. Follicular Unit Extraction (FUE) is a minimally invasive surgical procedure that utilizes a punch device to harvest occipital follicular units that are later transplanted in areas of loss to restore hair growth. FUE captures the benefit of multiple available restoration techniques and avoids the disadvantages of traditional strip surgery. A number of variations on the procedure are currently in practice and many more exciting advances are underway.