Shiitake Dermatitis and Potential Implications for Military Readiness.

Shiitake flagellate dermatitis is an intensely pruritic erythematous or violaceous eruption marked by "whip-like" linear streaks consisting of papules or plaques following the ingestion of undercooked shiitake mushrooms (Lentinula edodes). Most commonly localized on the trunk and upper limbs, the characteristic pattern of the rash is associated with the consumption of lentinan, a thermolabile toxin found within the mushroom, as well as a broad range of other dermatological conditions, including dermatomyositis, adult-onset Still's disease, and reactions to medications such as bleomycin. In this case report, we present a 24year-old active duty service member who presented to the clinic for the evaluation of a flagellate erythematous eruption on his abdomen, back, and extremities. As U.S. forces pivot to operating in austere and resource-limited settings in the Pacific, recognizing the spectrum of diagnoses encompassed by flagellate erythema is important for maintaining operational readiness and differentiating self-limited cutaneous manifestations from more serious underlying conditions associated with this finding.

Epidermolysis Bullosa Acquisita: A Case Report.

BACKGROUND Epidermolysis bullosa acquisita is a rare, subepithelial bullous disorder, which is distinguished from other autoimmune blistering diseases by the production of antibodies against type VII collagen. CASE REPORT Here, we describe the case of a 79-year-old male resident of the Northern Mariana Islands who presented to the clinic with multiple blistering skin lesions. CONCLUSIONS The primary focus of treatment is to prevent disease progression and serious complications of scarring (including blindness and respiratory obstruction) by avoiding physical trauma and suppressing the immune systems with agents, including corticosteroids, colchicine, dapsone, methotrexate, and cyclophosphamide. Successful treatment of the condition should involve a multidisciplinary team of medical professionals with regular monthly follow-ups during periods of active disease.

Prediction of postoperative pain after Mohs micrographic surgery with 2 validated pain anxiety scales.

BACKGROUND: Anxiety toward pain has been shown in several studies to increase postoperative pain after surgical procedures. This anxiety can be measured by several validated questionnaires, the Pain Catastrophizing Scale (PCS) and the Pain Anxiety Symptoms Scale (PASS). Higher scores on these scales correlate with increased pain after surgery, but this has not yet been demonstrated in dermatologic surgery. OBJECTIVE: To assess whether pain anxiety will predict postoperative pain after Mohs micrographic surgery (MMS). MATERIALS AND METHODS: Patients at 2 private Mohs practices were recruited to fill out 2 pain questionnaires, the PCS and the PASS. Their postoperative pain was assessed after MMS. RESULTS: Three hundred fifty-six patients completed the study. Overall, most patients experienced little postoperative pain after Mohs surgery. However, for people with high anxiety toward pain, they also experienced statistically significant greater postoperative pain. Other factors that contributed to greater postoperative pain included female gender and lower extremity location. Second intention healing had lower pain than other repair types. CONCLUSION: This study shows that postoperative pain is affected by pain anxiety, even in dermatologic surgery. However, most patients still had very little discomfort after surgery, further supporting MMS as an effective and safe procedure with relatively few postoperative problems.

The undervaluation of evaluation and management professional services: the lasting impact of current procedural terminology code deficiencies on physician payment.

The Resource-Based Relative Value Scale (RBRVS) is fundamentally undermined by the following foundational errors: (1) The full range of office-based evaluation and management (E/M) activities are not captured by the Current Procedural Terminology (CPT) code choices, (2) it places relatively high values on procedural services, (3) there is no measure of intensity for complex outpatient E/M care, and (4) its maintenance and update have been delegated to select professional societies. Limitations imposed on the development of the RBRVS dating back to the early 1980s have not been corrected. The repertoire of codes for physician office-based E/M work must be expanded to create a new topology of choices with new outpatient code families with discrete service code levels, such as comprehensive outpatient consultation care, comprehensive outpatient primary care, and limited outpatient consultation care. Service code relative values must be based on representative samples and reliable survey data, draw from the broader literature on work intensity, and be developed with accountable and representative professional engagement.