Cutis marmorata telangiectatica congenita successfully treated with intense pulsed light and pulse dyed laser therapy: a case report.

Cutis marmorata telangiectatica congenita (CMTC) is a rare vascular disorder characterized by blue-purple reticulated patches and plaques that can be localized or generalized. Associated skin atrophy and soft tissue hypoplasia is common while ulceration is relatively uncommon. As CMTC is exceedingly rare and spontaneous remission in childhood can occur in mild cases, evidence for treatment of severe, refractory disease is limited. We present the case of a four-year-old female with CMTC and associated painful, recalcitrant ulcers successfully treated with a combination of pulsed dye laser and intense pulsed light therapy.

Don't forget these 5 things when treating hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a common dermatologic condition in which chronic and recurrent inflammation affects the pilosebaceous unit and can lead to permanent disfigurement with scars and sinus tracts. Multimodal individualized treatment typically is required to address the medical, surgical, and psychosocial needs of affected patients. This article discusses several aspects of HS treatment that often are overlooked: educating patients about disease pathophysiology, counseling on smoking cessation, offering laser hair removal, planning for flares, and considering childbearing status.

Challenges of treating primary psychiatric disease in dermatology.

Psychiatric disorders are common among dermatology patients. They may be secondary to skin disease but also can be the primary cause of cutaneous concerns. Because patients with primary psychiatric disorders who present to dermatology often refuse referral to mental health providers, dermatologists are challenged with management of various psychiatric conditions, such as delusional infestation and trichotillomania. Effective, evidence-based treatments are available for psychodermatologic disorders, and dermatologists should be comfortable with their implementation.

Surgical dermatoethics for the trainee.

Proficiency in performing dermatologic procedures is obtained by practice, and residents practice with real patients. The imperative of training new generations of dermatologists must be achieved while patient autonomy is respected and the highest standards of patient safety are upheld. This article examines ethical considerations that are inherent to the training process in procedural dermatology, including disclosing training status, informing patients of experience level with a particular procedure, and the need for graded responsibility under appropriate supervision.

Pemetrexed-Induced Pseudocellulitis Reaction With Eosinophilic Infiltrate on Skin Biopsy.

Peripheral edema with painful erythema is an increasingly recognized but poorly understood cutaneous adverse reaction to the antifolate agent pemetrexed. It is frequently misdiagnosed as cellulitis, and when it occurs, it is often dose-limiting. The authors report the case of a patient with preexisting lower extremity edema who developed extensive painful, bilateral erythema 5 days after administration of pemetrexed. An eosinophil-rich dermal inflammatory infiltrate was noted histologically. The authors review previously reported cases of pemetrexed-induced pseudocellulitis and discuss possible pathophysiology.

Dermatology Interest Groups in Medical Schools.

Involvement in a Dermatology Interest Group (DIG) allows students to learn about dermatology, partake in service projects, get involved in research, and ask questions about the application process for residency programs. In this article, we review the activities and member involvement of DIGs from 11 medical schools. To our knowledge, this is the first descriptive analysis of DIGs across the United States. This comparison of DIGs is not only potentially helpful for medical schools interested in establishing a DIG, but it also offers insight into how previously established DIGs could improve and have a greater impact both in individual medical schools and in the community at-large.

Influences of age, tongue region, and chorda tympani nerve sectioning on signal detection measures of lingual taste sensitivity.

Although the ability to taste is critical for ingestion, nutrition, and quality of life, a clear understanding of the influences of age, sex, and chorda tympani (CT) resection on taste function in different regions of the anterior tongue is generally lacking. In this study we employed criterion-free signal detection analysis to assess electric and chemical taste function on multiple tongue regions in normal individuals varying in age and sex and in patients with unilateral CT resections. The subjects were 33 healthy volunteers, ranging from 18 to 87 years of age, and 9 persons, 27 to 77 years of age, with unilateral CT lesions. The influences of age, sex, tongue region, and chorda tympani resections on signal detection sensitivity (d') and response bias (ß) measures was assessed in 16 tongue regions to weak electric currents and solutions of sucrose, sodium chloride, and caffeine. Significant age-related decrements in d' were found for sucrose (p=0.012), sodium chloride (p=0.002), caffeine (p=0.006), and electric current (EC) (p=0.0001). Significant posterior to anterior, and medial to lateral, gradients of increasing performance were present for most stimuli. ß was larger on the anterior than the posterior tongue for the electrical stimulus in the youngest subjects, whereas the opposite was true for sucrose in the oldest subjects. No sex differences were apparent. d' was depressed ipsilateral to the CT lesion side to varying degrees in all tongue regions, with the weakest influences occurring on the medial and anterior tongue. CT did not meaningfully influence ß. This study is the first to employ signal detection analysis to assess the regional sensitivity of the tongue to chemical and electrical stimuli. It clearly demonstrates that tongue regions differ from one another in terms of their age-related sensitivity and their susceptibility to CT lesions.

Optimizing reliability and sensitivity of Semmes-Weinstein monofilaments for establishing point tactile thresholds.

Semmes-Weinstein monofilaments (SWM) are widely used to assess tactile point pressure sensitivity. However, the reliability of SWMs has been questioned, standardization of stimulus presentation procedures is lacking, and the sensitivity measure is commonly confounded by the response criterion. This study sought to assess the reliability of two versions of a forced-choice single staircase SWM test with the goal of optimizing test reliability with a minimum number of test trials. Test-retest and intra-test reliability coefficients for SWM threshold values from the plantar halluces of 24 normal subjects were obtained using two versions of a forced-choice single-staircase procedure. One version followed a two-down one-up rule (2D) and the other a three-down one-up rule (3D). The 3D procedure was significantly more reliable than the 2D procedure for all sequential combinations of reversal pairs. A total of four 3D reversal pairs (i.e., eight reversals) were sufficient to achieve test-retest and intra-test reliability coefficients>0.90. High reliability with the minimum number of trials was obtained by calculating the threshold as the mean of eight reversals (test-retest r=0.93, p<0.001; Sessions 1 and 2 intra-test rs=0.87 and 0.92; ps<0.001). Identical median detection thresholds were noted for the two repeated test sessions (5.1g/mm(2)). The threshold values correlated with subject age despite the small range of ages tested, suggesting high sensitivity (Sessions 1 and 2 rs=0.61 and 0.63, ps<0.001). This study demonstrates that SWMs provide highly reliable and sensitive point pressure thresholds with very few trials when an appropriate psychophysical paradigm is employed. The brief forced-choice procedure described herein could serve as a basis for standardizing SWM stimulus presentation methods.