Multiple Eruptive Keratoacanthomas Secondary to Nivolumab Immunotherapy.

Immune checkpoint inhibitors are increasingly being utilized for the treatment of advanced neoplastic disease and have been associated with wide-ranging cutaneous adverse effects. Though exceedingly rare, eruptive keratoacanthomas have been associated with the use of immune checkpoint inhibitors such as pembrolizumab and nivolumab, whose molecular target is the programmed cell death protein 1. Herein, we detail a case of numerous eruptive keratoacanthomas arising in a patient one month after initiation of nivolumab for recurrent metastatic oropharyngeal squamous cell carcinoma. Treatment with multiple rounds of intralesional corticosteroids and a several-month course of oral acitretin resulted in partial improvement. Subsequent treatment with intralesional 5-fluorouracil demonstrated near-complete resolution of the keratoacanthomas without discontinuation of nivolumab. Although eruptive keratoacanthomas secondary to immune checkpoint inhibitors are exceptionally rare, physicians should be aware of this cutaneous adverse effect as their use becomes more widespread.

Delayed Onset of Bullous Pemphigoid Secondary to Nivolumab.

The increasing use of immune checkpoint inhibitors, such as nivolumab, a programmed cell death protein 1 (PD-1) inhibitor, for advanced neoplastic disease has revealed significant cutaneous immune-related adverse effects. Herein, we report a case of bullous pemphigoid (BP) secondary to nivolumab therapy for recurrent metastatic oropharyngeal squamous cell carcinoma. In this patient, the time to development of BP was three years, which represents the most delayed onset of BP secondary to a PD-1 inhibitor that has been reported in the literature. Symptoms were initially controlled on low-dose oral prednisone but recurred after two years. The patient was subsequently treated with a several-month taper of high-dose oral prednisone, during which he was able to resume nivolumab without recurrence of skin lesions. Although immune checkpoint inhibitor-induced BP remains rare, physicians should be aware of this serious cutaneous immune-related adverse event as the use of this drug class continues to expand.

Benign Familial Pemphigus in Skin of Color.

This case report describes friable erythematous plaques on the neck, inguinal folds, buttocks, bilateral axillae, and bilateral antecubital fossae.

Ethics training in dermatology residency programs: A survey of dermatology residency program directors and assistant/associate program directors.

Professionalism, defined as a demonstrated adherence to professional and ethical principles, is one of the six core competencies of dermatology graduate medical education. We sought to assess the current educational landscape for ethics training in dermatology residency programs by surveying dermatology residency program directors and assistant/associate program directors. A sixteen-question survey was designed and distributed to dermatology program directors and assistant/associate program directors via an email list. The estimated response rate was 43.17%. Most (54.55%) dermatology residency programs did not have an ethics curriculum. Among programs with an ethics curriculum, about three-fourths were implemented in the past ten years. The most common settings for teaching ethics were "formal didactics" (31.91%) and "ad hoc during clinical encounters and other clinical settings" (27.66%). Cited barriers to implementing and/or maintaining an ethics curriculum were "lack of time" (30.10%), "lack of faculty with expertise in ethics" (24.27%), and "lack of useful resources" (20.39%). Despite requirements for ethics training, most dermatology residency programs did not report having an ethics curriculum. This study's results highlight the need for an increased emphasis on ethics training in US dermatology residency programs.

The Association of Academic Cosmetic Dermatology: improving cosmetic dermatology education through collaboration, research, and advocacy.

Cosmetic and laser procedures are increasingly popular among patients and are skills in which dermatologists are regarded as well trained. Most dermatology residents intend to incorporate cosmetic procedures into their practice and prefer to learn such procedures during residency through direct patient care. However, there are notable challenges in optimizing how residents are trained in cosmetic and laser dermatology. To address these barriers and elevate the practice of cosmetic dermatology in academic medicine, the Association of Academic Cosmetic Dermatology (AACD) was founded in 2021 as the lead professional society for dermatologists who direct the education of resident trainees in cosmetic and laser dermatology. The AACD, a group of board-certified dermatologists who teach cosmetic and laser dermatology to residents, aims to improve cosmetic dermatology education through collaboration, research, and advocacy.

Needs and Gaps in Resident Trainee Education, Clinical Patient Care, and Clinical Research in Cosmetic Dermatology: Position Statement of the Association of Academic Cosmetic Dermatology.

Cosmetic dermatology is a key subspecialty of academic dermatology. As such, academic centers are expected to demonstrate excellence in the teaching of cosmetic dermatology skills to trainees, the clinical delivery of cosmetic dermatology services to patients, and the performance of clinical research that advances knowledge and uncovers new therapies in cosmetic dermatology. The Association of Academic Cosmetic Dermatology (AACD), a newly formed medical professional society, includes as its principal aims the support of all of these areas. AACD is comprised of group of board-certified dermatologists who teach cosmetic and laser dermatology at US dermatology residency programs. An expert panel constituted by the AACD recently convened a workshop to review gaps pertaining to academic cosmetic dermatology. This panel considered needs and potential corrective initiatives in three domains: resident education, patient experience, and clinical research. The work of the panel was used to develop a roadmap, which was adopted by consensus, and which will serve to guide the AACD moving forward.

A case of topical imiquimod induced fatigue.

Topical imiquimod is used for a variety of common dermatologic lesions, including melanoma in-situ. As an immunomodulator, it is relatively well tolerated with minimal side effects, including scaling, erythema, and edema. Here we present a rare systemic adverse effect, where our patient experienced debilitating severe fatigue when applying imiquimod to a single lesion. Clinicians should be mindful of this side effect and counsel patients appropriately.

Use of Potent Topical Corticosteroids (TCS) for Hypergranulation Tissue (HGT) in Pediatric Patients.

Hypergranulation is a common complication of wound healing that dermatologists encounter and is characterized by excess granulation tissue, which results in delayed healing and reepithelialization. Though many treatment options have been presented in the literature, less invasive and irritating treatment regimens are often preferred in the pediatric population. Here we present a case of a 14-year-old female with hypergranulation tissue (HGT) of the scalp that was successfully treated with topical corticosteroids (TCS). Additionally, a literature review was conducted to determine the prevalence of topical corticosteroid use for HGT in the pediatric population. Although not first line, TCS should be considered as a non-invasive and painless treatment for HGT in the pediatric population.