Vaccinating Providers for HPV Due to Transmission Risk in Ablative Dermatology Procedures.

Prior research has shown that surgical plume released in ablative procedures poses significant health risks to providers. For dermatologists, the possibility of oropharyngeal human papillomavirus (HPV) inoculation from inhalation of viral particles released in smoke has been previously documented. Despite this, there are limited guidelines of health and safety protocols for physicians performing electrodesiccation or laser surgery and many providers are still not vaccinated against HPV. Due to the occupational risk of autoinoculation, we recommend that all dermatologists be vaccinated against HPV.

Lip Reconstruction After Mohs Micrographic Surgery: A Guide on Flaps.

The lips are commonly affected by skin cancer because of increased sun exposure over time. Even with early detection, many of these skin cancers require surgical removal with subsequent reconstruction. Mohs micrographic surgery is the preferred method of treatment for nonmelanoma skin cancers of the lip, as it has the lowest recurrence rates and allows for the maximum preservation of healthy tissue. After surgery, the remaining lip defect often requires reconstruction with skin grafts or a local cutaneous or myocutaneous flap. There are several local flap reconstruction options available, and some may be used in combination for more complex defects. We provide a succinct review of commonly utilized flaps and outline their indications, risks, and benefits.

Pediatric pulse dose corticosteroid therapy dosing and administration in the treatment of alopecia areata: A review of literature.

BACKGROUND: The use of pulse dose corticosteroid therapy (PDCT) in children for treatment of alopecia areata (AA) has been reported, but dosing regimens are not well-established. We aim to evaluate the available literature regarding the utilization and various dosing regimens of PDCT, as well as associated side effects, in the treatment of AA in children. METHODS: We performed a systematic review of studies describing the use of PDCT for the treatment of AA in children. RESULTS: Eight relevant studies were identified, five of which administered the treatment intravenously (IV) and three of which administered the treatment orally. Protocols with IV administration included two studies which used IV dexamethasone at 1.5 mg/kg/day for 1-3 days monthly for a maximum of 12 cycles and three studies used IV methylprednisolone 8-30 mg/kg/day for 1-3 days monthly for a maximum of 3-10 cycles. The three protocols with oral administration included variable doses of prednisolone at variable intervals and cycle lengths, betamethasone and dexamethasone at a prednisolone equivalent of 5 mg/kg, and methylprednisolone 15 mg/kg for 3 days bimonthly for 12 cycles. In these studies, PDCT was generally well-tolerated and resulted in improvement of the AA. CONCLUSION: PDCT was found to be well-tolerated with few serious side effects reported. It appears to be beneficial early in disease course, especially for those with multifocal AA.

Dermatologic Management of Hidradenitis Suppurativa and Impact on Pregnancy and Breastfeeding.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that most commonly affects women of childbearing age. The symptoms of the disease are managed with a multitude of topical and systemic medications. The course of HS changes during pregnancy, and some women can experience postpartum flares. Thus, it is important to be aware of how pregnancy may alter the treatment plan for women and impact their choice to breastfeed. The following review summarizes medical management for HS and its safety during pregnancy and breastfeeding.

Clinical recommendations to address dermatologic healthcare disparities in sexual and gender minority patients: a review.

BACKGROUND: In the United States, an estimated 4.5% of the population identifies as a sexual or gender minority (SGM). Efforts are underway to address this population's healthcare disparities. [A1] Objective: This review aims to highlight dermatologist's role in treating SGM patients, raise awareness about SGM-related stigma, and identify clinical interventions to improve SGM care. METHODS: Articles were selected by review of literature from PubMed's database from 2000-2020. RESULTS: The first intervention outlines methods to educate the healthcare team on the terminology used by the SGM community and how HIV epidemiology is a distinct topic through separate trainings. The second intervention emphasizes better communication with SGM patients in routine discussions, including the proper elicitation of a sexual history by avoiding heteronormative questioning. The last intervention discusses enhancing this population's clinical experience by updating clinical intake forms to include a fill-in-the-blank for patients' pronouns, refraining from gender-specific bathrooms, and advertising commitment to SGM care online. CONCLUSION: Our review article highlights a dermatologist's integral role in SGM care. The review emphasizes three distinct intervention areas that aim to destigmatize sexual/gender identity in the workplace, promote cultural humility, and improve the therapeutic alliance between SGM patients with dermatologists.

Calciphylaxis After Kidney Transplant.

Calciphylaxis is an uncommon disease that presents with painful ulceration and necrosis of the skin secondary to small vessel calcification and microvascular occlusion. Calciphylaxis carries a poor prognosis as the nonhealing wounds provide a port of entry for pathogens, predisposing these patients to infection and sepsis. Ulcers caused by calciphylaxis are most commonly seen in patients with end-stage renal disease (ESRD) but can also present in patients with normal electrolytes and kidney function. We report a case of a 42-year-old woman with a 10-year history of ESRD who developed rapidly progressing calciphylaxis in her legs and hand, starting three months after successful kidney transplantation. The relationship between kidney transplantation and calciphylaxis remains unclear. There are a handful of cases in which calciphylaxis has been treated by successful kidney transplant, however, other cases have been reported in which calciphylaxis developed after kidney transplantation.

Bullous hemorrhagic lichen sclerosus of the breast: a report of two cases and review of the literature.

Lichen sclerosus (LS) is a chronic dermatologic condition characterized by atrophic porcelain-appearing plaques that can cause intense discomfort and eventually lead to destruction of local architecture. Lichen sclerosus most commonly arises in the anogenital area, but up to 20% of cases can present on extragenital skin. Rarely, LS can also present with hemorrhage and bullae; the mechanism by which this occurs is unknown. We report two cases of bullous hemorrhagic LS of the breast arising in 66-year-old and 77-year-old women. Bullous hemorrhagic LS of the breast is exceedingly rare, with few reported cases, and presents a diagnostic challenge to clinicians.

Progressive Tightening of Pulley Sutures for Primary Repair of Large Scalp Wounds.

Scalp defects greater than 2 cm in diameter are not usually amenable to primary closure and require local tissue rearrangement, grafting, tissue expansion, or prolonged second intention healing. Scalp flap reconstruction is a significant undertaking that requires elevation of a total flap surface area that is 3-6 times the size of the defect, often involves profuse bleeding, and can be challenging to perform without conscious sedation or general anesthesia. Anticoagulated and medically complex patients pose additional challenges and limit options for treatment. The pulley suture uses the mechanical advantage of the pulley to distribute tension across a wound and is useful in areas of high tension such as scalp wounds. For scalp wounds greater than 2 cm, pulley sutures are placed along the length of the wound. An assistant exerts equal tension on the pulley sutures, and the surgeon sequentially ties the sutures. The sutures are tightened and retied weekly until complete scalp closure is achieved. The pulley sutures can be used for rapid primary closure of scalp wounds up to 2.5-3.0 cm in diameter under local anesthesia. For scalp wounds larger than 3 cm, we have also found that pulley sutures can be progressively tightened yielding additional tissue expansion every week. Scalp wounds greater than 3.0 cm can be easily closed via primary repair and weekly tightening of pulley sutures without the need for flap reconstruction, traditional tissue expander placement, or second intention healing.