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1.
Dermatol Surg ; 47(8): 1093-1097, 2021 08 01.
Article in English | MEDLINE | ID: mdl-33988555

ABSTRACT

BACKGROUND: Patients use social media to find information about cosmetic procedures, yet dermatologists historically lack a social media presence. Misleading information from nonexperts is potentially harmful. OBJECTIVE: To identify the top influencers posting about nonsurgical cosmetic procedures on Instagram, verify their credentials, and analyze their content to empower dermatologists to effectively join the online conversation, combat harmful misinformation, and preserve the expertise and influence of board-certified dermatologists. METHODS AND MATERIALS: Using the Klear marketing platform, Instagram influencers with more than 50,000 followers were identified. Influence rating, top posts, and other metrics were extracted using proprietary algorithms. RESULTS: Ninety nine influencers were identified. Of the top 10, 70% were board-certified plastic surgeons. Physicians not board-certified in a core cosmetic specialty had the highest influencer rating and number of followers. The most popular posts were of before and after photographs and personal posts. CONCLUSION: Dermatologists may be able to increase their Instagram footprint by posting frequently, especially of before and after and personal photographs, using hashtags, Instagram live and Instagram television, and Instagram stories. It is important for the dermatology community to find a way to ethically navigate social media to have a seat at the table and meet patients where they are.


Subject(s)
Cosmetic Techniques/statistics & numerical data , Dermatologists/statistics & numerical data , Information Dissemination/methods , Marketing of Health Services/statistics & numerical data , Social Media/statistics & numerical data , Adult , Cosmetic Techniques/economics , Dermatologists/economics , Female , Humans , Male , Social Media/economics , Young Adult
2.
Pediatr Dermatol ; 38(3): 585-590, 2021 May.
Article in English | MEDLINE | ID: mdl-33742460

ABSTRACT

BACKGROUND: In their early phase, infantile hemangiomas (IH) can sometimes be difficult to differentiate from port-wine birthmarks (PWB). Until recently, inexpensive diagnostic tools have not been readily available. OBJECTIVE: To determine the diagnostic utility of widely available colorimetric technology when differentiating PWB from IH in photographs of infants less than 3 months old. METHODS: Multi-center, retrospective analysis of RGB (red, green, and blue) and HSL (hue, saturation, lightness) values collected using electronic colorimeters from images of clinically confirmed untreated IH or PWB. Subgroup analysis of flat vascular birthmarks was subsequently performed. RESULTS: Images of 119 IH (specifically, 45 flat IH) and 59 PWB were identified. PWB had significantly (P < .001) higher RGB values of all primary colors, most notably for blue and green (mean difference: >50), irrespective of thickness. RGB or RGB with HSL values had an excellent accuracy (90%), sensitivity (92%), specificity (98%), and positive predictive value (98%) when discriminating PWB from flat IH. IH could be distinctly clustered from PWB when combining their RGB with HSL values. CONCLUSION: Electronic colorimeters with emphasis on blue and green values, are able to differentiate PWB from IH, irrespective of thickness, with a high degree of accuracy. A larger scale evaluation is now required.


Subject(s)
Hemangioma, Capillary , Pigmentation Disorders , Port-Wine Stain , Humans , Infant , Pilot Projects , Port-Wine Stain/diagnosis , Retrospective Studies
3.
J Am Acad Dermatol ; 85(2): 523-528, 2021 Aug.
Article in English | MEDLINE | ID: mdl-31437544

ABSTRACT

The prevalence of acute vulvovaginal involvement in toxic epidermal necrolysis can be as high as 70%; up to 28% of female patients will also develop chronic vulvovaginal sequelae. There is little consensus regarding prevention and treatment of the gynecologic sequelae of both Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). We review acute and chronic sequelae, including erosions, scar formation, chronic skin changes, urethral complications, adenosis, malignant transformation, vulvodynia, and dyspareunia. We provide comprehensive recommendations for acute and long-term vulvovaginal care in adult and pediatric SJS/TEN patients. Treatment should include an ultrapotent topical steroid, followed by a nonirritating barrier cream applied to vulvar and perineal lesions. A steroid should be used intravaginally along with vaginal dilation in all adults (but should be avoided in prepubertal adolescents) with vaginal involvement. Menstrual suppression should be considered in all reproductive age patients until vulvovaginal lesions have healed. Last, referrals for pelvic floor physical therapy and to surgical subspecialties should be offered on a case-by-case basis. This guide summarizes the current available literature combined with expert opinion of both dermatologists and gynecologists who treat a high volume of SJS/TEN patients.


Subject(s)
Stevens-Johnson Syndrome/complications , Vaginal Diseases/etiology , Vaginal Diseases/therapy , Vulvar Diseases/etiology , Vulvar Diseases/therapy , Female , Humans , Practice Guidelines as Topic , Stevens-Johnson Syndrome/diagnosis , Vaginal Diseases/prevention & control , Vulvar Diseases/prevention & control
4.
J Lasers Med Sci ; 11(4): 395-404, 2020.
Article in English | MEDLINE | ID: mdl-33425289

ABSTRACT

Introduction: Darier disease (DD) is a chronic disease with high morbidity and limited treatment options. Laser efficacy in the treatment of DD remains understudied. Methods: A literature search conducted between 07/21/2017 and 05/05/2018 identified all original cases of DD treated with laser therapy. Results: Outcomes from 24 patients were reviewed, 22 patients were identified in the literature and 2 cases are included from our institution. Five types of lasers were identified [CO2 laser, Er:YAG laser, pulse dye laser [PDL], diode laser, erbium-doped fiber laser], with CO2 (46%) and PDL (42%) being the most common. Seventy-nine percent of patients were treated with more than one procedure (average, 3 procedures). The estimated body surface treated with each session ranged from 5%-50%. The most common adverse events came from CO2 and Er:YAG lasers and included dyspigmentation, pain, and post-laser erythema and edema. The time to response (mode, 1 month) was only reported in half of the studies. Conclusion: Laser treatments appear to be a promising alternative to standardized therapies in DD.

5.
J Drugs Dermatol ; 18(10): 1049-1052, 2019 Oct 01.
Article in English | MEDLINE | ID: mdl-31603634

ABSTRACT

Drug re-exposure resulting in Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) is a rare phenomenon and has scarcely been reported. With an aging population, polypharmacy, and a lack of a unified electronic medical record, standard recommendations to prevent or minimize the risk of re-exposure are necessary. We identified five patients, with diagnosis confirmed SJS/TEN, and determined the clinical characteristics and contributing risk factors leading to re-exposure. Polypharmacy, multiple prescribers, advanced age, medical illiteracy, retention of discontinued medications and self-prescribing all contributed to re-exposure in this cohort of patients. This case series demonstrates the potentially deadly effect of drug re-exposure, and the need for both streamlined and integrated medication allergy documentation systems. J Drugs Dermatol. 2019;18(10):1049-1052.


Subject(s)
Medical History Taking , Medication Reconciliation , Stevens-Johnson Syndrome/prevention & control , Aged , Aged, 80 and over , Cohort Studies , Female , Humans , Male , Middle Aged , Retreatment/adverse effects , Risk Factors , Severity of Illness Index , Stevens-Johnson Syndrome/diagnosis , Stevens-Johnson Syndrome/etiology , Young Adult
6.
J Drugs Dermatol ; 18(8): 828-830, 2019 Aug 01.
Article in English | MEDLINE | ID: mdl-31424716

ABSTRACT

A 56-year-old Caucasian male with a history of chronic plaque psoriasis, primary sclerosing cholangitis status-post liver transplant on tacrolimus, and ulcerative colitis on infliximab developed a progressive erythematous eruption with associated fatigue, anorexia, myalgias, and arthralgias. On two separate occasions, his skin biopsy demonstrated a lichenoid interface dermatitis (LID). Despite multiple courses of oral prednisone, topical steroids, and a short course of hydroxychloroquine, his symptoms continued to relapse and remit. When a temporal association between increasing his infliximab dose and the global progression of his disease was identified, he was ultimately diagnosed with a TNF-α inhibitor-induced psoriasis flare. Despite the patient's long-standing history of psoriasis, a plausible psoriasis rebound reaction after systemic steroids was not strongly considered in light of his histopathology. Though lichenoid interface dermatitis is a commonly reported histologic finding in patients on TNF-α inhibitors, it has scarcely been reported in patients with psoriasiform eruptions clinically.


Subject(s)
Drug Eruptions/diagnosis , Infliximab/adverse effects , Lichenoid Eruptions/diagnosis , Psoriasis/drug therapy , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Biopsy , Diagnosis, Differential , Drug Eruptions/etiology , Drug Eruptions/pathology , Humans , Lichenoid Eruptions/pathology , Male , Middle Aged , Psoriasis/diagnosis , Skin/drug effects , Skin/pathology , Symptom Flare Up
7.
Pediatr Dermatol ; 36(4): 550-551, 2019 Jul.
Article in English | MEDLINE | ID: mdl-30931535

ABSTRACT

A 10-year-old girl, suspected 2 days prior to have streptococcal pharyngitis, presented with diffuse erythema, tense bullae, Nikolsky-positive desquamation, as well as ulcerations of her oral and genital mucosa. She denied recent travel, sick contacts, or preceding and concurrent use of medications, including over-the-counter and herbal supplements. A comprehensive viral polymerase chain reaction (PCR) panel, Mycoplasma pneumoniae PCR and IgM, streptococcal molecular antigen test, urine culture, blood culture, and rheumatologic serologies were negative. Based on the patient's clinical presentation and biopsy results, she was diagnosed with idiopathic toxic epidermal necrolysis.


Subject(s)
Pharyngitis/diagnosis , Stevens-Johnson Syndrome/etiology , Stevens-Johnson Syndrome/pathology , Streptococcal Infections/physiopathology , Adolescent , Biopsy, Needle , Female , Follow-Up Studies , Humans , Immunohistochemistry , Pharyngitis/microbiology , Severity of Illness Index , Stevens-Johnson Syndrome/therapy , Time Factors
8.
J Am Acad Dermatol ; 80(2): 493-499, 2019 Feb.
Article in English | MEDLINE | ID: mdl-30293898

ABSTRACT

BACKGROUND: The proliferative phase of infantile hemangiomas (IHs) is usually complete by 9 months of life. Late growth beyond age 3 years is rarely reported. OBJECTIVE: To describe the demographic and clinic characteristics of a cohort of patients with late growth of IH, defined as growth in a patient >3 years of age. METHODS: A multicenter, retrospective cohort study. RESULTS: In total, 59 patients, 85% of which were female, met the inclusion criteria. The mean first episode of late growth was 4.3 (range 3-8.5) years. Head and neck location (55/59; 93%) and presence of deep hemangioma (52/59; 88%) were common characteristics. Posterior fossa malformations, hemangiomas, arterial anomalies, cardiac defects, eye abnormalities (PHACE) syndrome was noted in 20 of 38 (53%) children with segmental facial IH. Systemic therapy (corticosteroid or ß-blocker) was given during infancy in 58 of 59 (98%) and 24 of 59 (41%) received systemic therapy (ß-blockers) for late IH growth. LIMITATIONS: The retrospective nature and ascertainment by investigator recall are limitations of the study. CONCLUSION: Late IH growth can occur in children after 3 years of age. Risk factors include head and neck location, segmental morphology, and involvement of deep dermal/subcutaneous tissues.


Subject(s)
Hemangioma, Capillary/diagnosis , Hemangioma, Capillary/therapy , Skin Neoplasms/diagnosis , Skin Neoplasms/therapy , Adrenal Cortex Hormones/therapeutic use , Age Factors , Child , Child, Preschool , Cohort Studies , Disease Progression , Female , Follow-Up Studies , Hemangioma, Capillary/congenital , Humans , Laser Therapy/methods , Male , Propranolol/therapeutic use , Retrospective Studies , Risk Assessment , Severity of Illness Index , Skin Neoplasms/congenital , Time Factors , Treatment Outcome , United States
10.
Pediatr Dermatol ; 35(3): e196-e197, 2018 May.
Article in English | MEDLINE | ID: mdl-29574945

ABSTRACT

A 12-year-old Hispanic boy with chronic atopic dermatitis and cushingoid features presented to our institution. He was being treated with an unknown quantity of oral prednisolone 15 mg/5 mL, equivalent to 70 mg/m2 /d of oral prednisone, purchased over the counter in El Salvador. Systemic corticosteroids are not recommended for chronic therapy of atopic dermatitis because of their significant adverse effects. Foreign-sourced pharmaceuticals account for almost half of the drugs consumed in the United States, which means that, to protect our patients, medical providers must inquire about and report unsafe medications deemed legal outside the United States to the Food and Drug Administration.


Subject(s)
Cushing Syndrome/chemically induced , Glucocorticoids/adverse effects , Prednisolone/adverse effects , Prednisone/adverse effects , Child , Cushing Syndrome/diagnosis , Dermatitis, Atopic/drug therapy , Humans , Male , Prednisolone/administration & dosage , Prednisone/administration & dosage
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