ABSTRACT
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.
Subject(s)
Graves Ophthalmopathy , Humans , Male , Adult , Graves Ophthalmopathy/diagnosis , Hyperthyroidism/diagnosis , Hyperthyroidism/complicationsABSTRACT
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).
Subject(s)
Dermatitis Herpetiformis , Facial Dermatoses , Humans , Female , Adult , Dermatitis Herpetiformis/diagnosis , Dermatitis Herpetiformis/pathology , Facial Dermatoses/diagnosis , Facial Dermatoses/pathologyABSTRACT
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.
Subject(s)
Arthritis, Psoriatic , Methotrexate , Psoriasis , Humans , Arthritis, Psoriatic/drug therapy , Psoriasis/drug therapy , Psoriasis/immunology , Methotrexate/therapeutic use , Perioperative Care/methods , Thalidomide/therapeutic use , Thalidomide/analogs & derivatives , Thalidomide/adverse effects , Surgical Wound Infection/prevention & control , Surgical Wound Infection/epidemiology , Piperidines/therapeutic use , Cyclosporine/therapeutic use , Phosphodiesterase 4 Inhibitors/therapeutic use , Phosphodiesterase 4 Inhibitors/adverse effects , Ustekinumab/therapeutic use , Ustekinumab/adverse effects , Immunomodulating Agents/therapeutic use , Abatacept/therapeutic use , Abatacept/adverse effects , Janus Kinase Inhibitors/therapeutic use , Janus Kinase Inhibitors/adverse effects , Pyrroles/therapeutic use , Pyrroles/adverse effects , Pyrimidines/therapeutic use , Pyrimidines/adverse effectsSubject(s)
Psoriasis , Tuberculosis , Humans , Psoriasis/diagnosis , Psoriasis/etiology , Antibodies, Monoclonal, Humanized , Chronic Disease , Acute DiseaseABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
Subject(s)
Alopecia Areata , Tinea Capitis , Humans , Alopecia Areata/diagnosis , Tinea Capitis/diagnosis , AlopeciaABSTRACT
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.
ABSTRACT
Rowell syndrome (RS) is characterized by the presentation of lupus erythematosus (LE) with erythema multiforme (EM)-like lesions. It is thought to display a characteristic serologic pattern consisting of a "speckled-type" antinuclear antibody (ANA), positive anti-Ro/SSA or anti-La/SSB, or positive rheumatoid factor (RF). We report the case of a patient with subacute cutaneous lupus erythematosus (SCLE) who presented with EM-like lesions responsive to oral corticosteroids.