Vaccine Toes Are the New COVID Toes.

Introduction: Pernio-like lesions were reported as dermatologic manifestations of COVID-19 as early as May of 2020. Since mRNA COVID-19 vaccines were introduced in December 2020, 9 reports of vaccine-associated pernio-like lesions have been presented in the medical literature. Case Presentation: A male in his 60s developed pernio-like lesions on the bilateral toes approximately 1 week after receiving the second dose of the Pfizer-BioNTech COVID-19 mRNA vaccine. His symptoms resolved in 6 weeks. Conclusion: The rising number of reports of pernio-like lesions associated with COVID-19 vaccination underlines the importance of the pathophysiological state of the vaccinated patient and how it relates to dermatological manifestations. Pernio-like lesions are thought to represent a robust host immune antiviral response related to production of interferon-1 in the setting of primary infection; incidences occurring after vaccination further support this theory. Unfortunately, media-generated reports of such reactions have the potential to inflame distrust and fear of the vaccine among the general public. Given the previous media interest in reporting pernio-like lesions with primary COVID-19 infection, it is reasonable to expect overrepresentation of pernio-like lesions with vaccination. There appears to be a general increase in patient distrust of evidence-based medicine and thus "COVID toes" represent an important intersection at which the clinician can capture the patient's trust by providing education and counseling.

Clinical interventions aimed at expanding access to dermatologic care.

In the United States access to healthcare continues to be a major issue. Although "top down" public policy approaches hold promise for expanding access, a lack of political consensus has hindered progress. A review of the literature was conducted to investigate the efficacy of clinical interventions aimed at expanding access to care from the "bottom up." The greatest improvements in access to care over the past decade have harnessed teledermatology, shared care, appointment scheduling strategies, and team-based care. Optimization of these approaches will require additional population-based, dermatology-specific research. It is clear that dermatologists, using a "bottom up approach," can significantly expand access to care in their communities in a manner that is economically viable and maintains quality of care and patient satisfaction.

Lupus nephritis in a transgender woman on cross-sex hormone therapy: a case for the role of oestrogen in systemic lupus erythematosus.

We present the case of a 22-year-old African American transgender women (male to female), who was admitted for fatigue, abdominal pain and lower extremity edema and was diagnosed with systemic lupus erythematosus (SLE) and lupus nephritis. Treatment with high-dose steroids and mycophenolate mofetil helped resolve her symptoms. She has remained off oestrogen therapy since admission and has not experienced any major complications. It is important to consider therapy outcomes in this specific patient population. A review of four other cases of transgender women on cross-sex hormone therapy who were diagnosed with lupus is also presented.

What's eating you? blister beetles revisited.

Blister beetles are a group of insects that include the Meloidae, Oedemeridae, and Staphylinidae families. The most well-known family, Meloidae, has more than 200 species known for causing a blistering dermatitis in humans by emitting the substance cantharidin, which has been pharmacologically used as a vesicant and can cause deleterious effects if ingested. Most recently, blister beetles have been studied for their anticancer properties.

The spectrum of histopathologic findings in pemphigoid: Avoiding diagnostic pitfalls.

BACKGROUND: Bullous pemphigoid (BP) is an autoimmune vesiculobullous dermatitis that primarily affects the elderly and presents with tense, fluid-filled blisters. The histological hallmark on routine hematoxylin & eosin (H&E)-stained specimens is a subepidermal blister with luminal eosinophils. However, there are histologic variants than can produce diagnostic confusion. METHODS: All immunofluorescence reports from an independent certified dermatopathology laboratory (2006-2015) were inspected, and those with findings consistent with an autoimmune subepidermal blistering process were selected. Seventy-seven cases were identified, and the corresponding H&E-stained specimens were reviewed by two dermatopathologists who tabulated the histopathologic findings. RESULTS: Just over half of biopsies showed subepidermal clefting (54%). The histologic variants included: urticarial or eczematous findings (17%), partial or complete re-epithelialization (28%), and epidermal necrosis (7%). CONCLUSION: While re-epithelialization of subepidermal blisters is a commonly accepted phenomenon, there are no published data demonstrating its incidence. Because only half of the biopsies showed the classic subepidermal blister, it is important to be aware of the spectrum of histopathologic findings that occur in this disease. Specifically, the presence of an intraepidermal blister and/or epidermal necrosis on routine H&E-stained specimens does not preclude the diagnosis of pemphigoid.