Hydroxychloroquine-Induced Nonthrombocytopenic Purpura: A Case Series.

Hydroxychloroquine (HCQ) is a disease-modifying anti-rheumatic medication for the treatment of various autoimmune conditions. A rare side effect of HCQ is thrombotic thrombocytopenic purpura (TTP). We present two cases of patients who developed purpura that did not meet TTP criteria following treatment with HCQ. While the etiology of HCQ-associated TTP is poorly understood, we propose a spectrum of manifestations related to HCQ, ranging from benign purpura to TTP. As multiple factors contribute to the disease, we believe that HCQ may act as a "second hit" in patients with genetic susceptibility, which also influences the variability in the severity of disease manifestations. J Drugs Dermatol. 2024;23(5):e124.     doi:10.36849/JDD.7781e.

Rituximab for linear immunoglobulin A bullous dermatosis.

Linear immunoglobulin A bullous dermatosis (LABD) is an idiopathic or drug-induced vesiculobullous disease typically managed with dapsone or colchicine. We report a case of LABD successfully treated with rituximab in a patient who was intolerant to first-line therapies and recalcitrant to typical immunosuppressants. The patient was initially started on prednisone and mycophenolate mofetil which resulted in minimal response and disease progression. Improvement was seen after two infusions of rituximab 1000 mg at 2 weeks apart with planned maintenance therapy.

Management Options for Linear Immunoglobulin A (IgA) Bullous Dermatosis: A Literature Review.

Linear immunoglobulin A (IgA) bullous dermatosis (LABD) is an autoimmune condition with various triggers. Because of the lack of randomized controlled trials on LABD treatment, management options are mostly anecdotal. This paper provides a comprehensive review of treatment options from a literature review of reported treatments to arm clinicians with a guideline for the management of LABD in both pediatric and adult patients as well as those recalcitrant to first-line therapy (dapsone and steroids). We additionally illustrate an algorithm to use for the management of LABD to aid clinicians when faced with unique patient circumstances.

Pediatric Verrucous Psoriasis: A Case Report in a Pediatric Patient and Discussion of the Literature.

Verrucous psoriasis (VP) is a rare histologic variant of psoriasis. To date, fewer than 40 cases have been reported, with pediatric cases representing an exceedingly small fraction. Treatment options are limited, and the disease is often refractory to conventional methods. Herein, we report a case of VP in an adolescent male which previously failed biologic and systemic therapy with adalimumab and acitretin, respectively, ultimately responding with great success to ixekizumab in combination with topical corticosteroids. J Drugs Dermatol. 2022;21(8):891-893. doi:10.36849/JDD.6626R1.

Successful Treatment of Palmoplantar Pustulosis With Apremilast.

Palmoplantar pustulosis (PPP) is a chronic, debilitating autoimmune skin disease characterized by the presence of recurrent neutrophilic pustules on acral surfaces. Although similarities exist, PPP is currently regarded as a distinct pathologic entity from palmoplantar psoriasis.1.

Kaposi Sarcoma of the Face Not Associated with Acquired Immunodeficiency Syndrome: A Case Report and Review of the Literature.

Kaposi sarcoma (KS) is an angioproliferative vascular neoplasm characterized by the proliferation of endothelial cells that is typically seen in patients with acquired immunodeficiency syndrome (AIDS). There are four major subtypes of KS: classic, African endemic, iatrogenic, and AIDS-associated KS. In rare circumstances, a patient might present with KS that does not fit into any of the four major subtypes and has no identifiable predisposing factors. This case report and review of the literature is presented to serve as a reminder to practitioners to suspect the unexpected when considering cystic or vascular-type lesions on the head and neck.

Smartphones: dermatologic impact of the digital age.

As smartphones continue to gain popularity, skin changes to the fifth digit caused by extended use of these devices will become more prevalent. A 20-item survey was designed to assess smartphone use and skin changes that may be associated with smartphone use. This study is an initial step in uncovering a possible phenomenon of smartphone use affecting the digits, namely the fifth digit.

Advanced Presentation of Homeopathically treated Giant Melanoma: A Case Report.

We report the case of a 47-year-old woman who presented to the emergency department with a 9.7cm × 8.3cm melanoma on her foot, which impeded her ability to walk. The patient had been treating the fungating mass with black salve after seeking treatment from a homeopathic physician when first noticing a mole increasing in size several years previously. Additionally, we examine published reports of giant melanoma in the literature and investigate the possible maleficence of black salve treatment.

An Excellent Response to Tofacitinib in a Pediatric Alopecia Patient: A Case Report and Review.

KD is an 8 year-old male patient who presented to our clinic in December 2016 with a history of patchy hair loss for many months duration that was worsening. KD's past medical history was notable for atopic dermatitis, and a positive family history of autoimmune thyroid disease. Upon examination he had well circumscribed areas of hair loss throughout his scalp, with exclamation mark hairs seen on dermoscopy. Eyebrows and eyelashes were intact, no epidermal changes of scale or erythema were noted on the scalp and no palpable lymph nodes were present. He was diagnosed with alopecia areata at this time and was treated with Clobetasol 0.05% solution QHS as well as Kenalog 2.5 mg/ml injections to the areas of hair loss. Patient followed up two months later with worsening of his alopecia at a rapid pace, presenting now with hair loss of the entire scalp and loss of the eyebrows. He was diagnosed with progression to alopecia universalis at that time, with a corresponding SALT (Severity of Alopecia Tool) score of 100. Both KD and his mother stated the hair loss was causing much distress in the patient's life both at school and at home. After a thorough discussion of treatment alternatives to include continued topical high dose steroids, intralesional injections, high dose oral methylprednisolone, topical irritation with anthralin, topical immunotherapy with diphenylcyclopropenone (DPCP) or squaric acid dibutylester (SADBE) and systemic immunosuppressives, both the mother, patient and clinician agreed to try tofacitinib 5 mg twice daily with continued usage of topical steroids. Patient and his family was counseled about support groups, and local meetings to ease the mental distress associated with this condition. After baseline labs were obtained and reported within normal limits, to include CBC, CMP, thyroid studies, lipids and Quanitferon gold, KD was started on tofacitinib 5 mg BID. Labs were repeated one month later, and 3 months ongoing thereafter. At KD's 3 month follow up, after starting tofacitinib 5 mg twice daily, KD showed complete regrowth of the eyebrows with minimal hair growth of the posterior occiput (Figure 1 a-d). At KD's 6 month follow up he had 100% regrowth of eyebrows and complete scalp regrowth, resulting in a SALT score of 0 (Figure 2). KD reported no side effects until month 6, after full hair regrowth, when patient started to report mild headaches. Drug holiday was offered but the patients family chose to discontinue treatment at this time as they were concerned side effects were secondary to medication usage. Unfortunately, patient was lost to follow-up after the discontinuation of treatment. From previous case reports we can postulate that his alopecia returned to baseline after discontinuation of tofacitinib. KD had an incredible response to treatment, as has been reported previously in literature of adolescents using these novel therapies. This is the youngest patient ever reported to be successfully treated with oral tofacitinib 5 mg twice daily for alopecia and its variants. J Drugs Dermatol. 2018;17(8):914-917.

Perspectives in cosmetic dermatology: What is in front of the mirror?

Managing patient expectations can be a difficult task and is one that cosmetic dermatologists frequently encounter. Misinformation and unrealistic expectations can oftentimes exist regarding cosmetic procedures and their results. These misconceptions can result in patient dissatisfaction and frustration on the physician's behalf. This case report underscores the importance of utilizing what is arguably the most basic and ancient tool in the office, the mirror. There are many different facets to the patient encounter and a variety of devices at the physician's disposal. Proper use of this valuable tool can improve communication, elucidate patient concerns, and reflect the focus on the patient. These can ultimately lead to improved procedure outcome and patient satisfaction.

Locally Advanced Basal Cell Carcinoma: Two Severe Case Presentations and Review.

Basal cell carcinoma (BCC) is a common skin malignancy comprising 80% of non-melanoma skin cancers.1 Over 2.8 million cases are estimated to be diagnosed in the United States alone each year. Advanced BCCs are comprised of BCCs that have metastasized to local or distant lymph nodes or organs, or locally invasive BCCs that are extensive and infiltrate vital structures such as eyes, nose, or brain. Advanced BCC tumors represent roughly 1-10% of BCCs today. Two severe case presentations and treatment options will be discussed in this case report series and review.

J Drugs Dermatol. 2018;17(3):358-362.

Safety Considerations and Monitoring in Patients Treated with Systemic Medications for Acne.

Acne vulgaris, a disorder of the pilosebaceous unit, is one of the most commonly encountered conditions in dermatology practice. Effective treatment of acne vulgaris is important in that it can prevent psychosocial distress and physical scarring. Systemic therapeutic options are available for moderate to severe acne. It is imperative that the safe and effective treatment revolves around the health care provider's familiarity of side effects of various treatments. In this article, the side effects and monitoring guide for the most commonly prescribed systemic agents for acne vulgaris are reviewed.

Osteopathic medicine and the practice of dermatology: history and current status. An overview of the American Osteopathic College of Dermatology, an affiliate specialty college of the American Osteopathic Association.

As the unified training body for osteopathic physicians specializing in dermatology, the American Osteopathic College of Dermatology (AOCD) sponsors 18 dermatology residency programs that integrate academic training (focusing on the core of basic medical sciences) with clinical instruction (emphasizing specialized diagnostic and laboratory techniques and the high-level performance of all dermatologic and surgical procedures) to engender the ability to provide superior, specialized dermatologic care. The board of directors of the American Academy of Dermatology (AAD) recommended passage of a bylaws amendment establishing a category of osteopathic fellow for those osteopathic physicians who are certified by the American Osteopathic Board of Dermatology; however, the AAD membership failed to adopt the amendment by the required two-thirds majority. Constitutional bylaws of both societies stress the importance of the goal of unification and representation of the specialty of dermatology. Continued rapprochement appears to be in the best interest of the AAD and AOCD and may well enhance our efforts to deal with the challenges that face dermatology and medical practice in the 21st century.