RESUMEN
Disorders of hyperpigmentation are common and, depending on the extent and location of involvement, can affect the quality of life and pose a significant psychologic burden for patients. Given the similarities in presentation of the various causes of hyperpigmentation, it is often difficult to elucidate the etiology of these conditions, which is important to guide management. Furthermore, certain disorders, such as lichen planus pigmentosus and ashy dermatosis, have similar clinical and/or histologic presentations, and their classification as distinct entities has been debated upon, leading to additional confusion. In this review, the authors selected commonly encountered disorders of hyperpigmentation of the skin, subdivided into epidermal, dermal, or mixed epidermal-dermal disorders based on the location of pigment deposition, along with disorders of hyperpigmentation of the mucosa and nails. Melanocytic nevi, genetic disorders, and systemic causes of hyperpigmentation were largely excluded and considered to be outside the scope of this review. We discussed the pathogenesis of hyperpigmentation as well as the clinical and histologic features of these conditions, along with challenges encountered in their diagnosis and classification. The second article in this 2-part continuing medical education series focuses on the medical and procedural treatments of hyperpigmentation.
Asunto(s)
Hiperpigmentación , Liquen Plano , Neoplasias Cutáneas , Humanos , Calidad de Vida , Hiperpigmentación/diagnóstico , Hiperpigmentación/etiología , Hiperpigmentación/terapia , Piel/patología , Liquen Plano/complicaciones , Neoplasias Cutáneas/patologíaRESUMEN
Key challenges in the management of pigmentary disorders such as melasma and postinflammatory hyperpigmentation are their resistance to treatment, tendency to recur after treatment, and the risk of exacerbating hyperpigmentation with many treatment modalities. The second article in this 2-part continuing medical education series on pigmentary disorders focuses on the evidence behind medical and procedural treatments of dyschromias, including photoprotection, topical lightening agents, oral agents, chemical peels, and laser therapy.
Asunto(s)
Quimioexfoliación , Hiperpigmentación , Terapia por Láser , Terapia por Luz de Baja Intensidad , Melanosis , Humanos , Hiperpigmentación/terapia , Hiperpigmentación/prevención & control , Melanosis/terapia , Resultado del TratamientoRESUMEN
BACKGROUND: Insurance, racial, and socioeconomic health disparities continue to pose significant challenges for access to dermatologic care. Studies applying teledermatology to increase access to underinsured individuals and ethnic minorities are limited. OBJECTIVE: To determine how the implementation of a teledermatology program affects access to health care and patient outcomes. METHODS: A cross-sectional evaluation was performed of all ambulatory dermatology referrals and electronic dermatology consultations (eConsults) at Ohio State University within a 25-month period. RESULTS: Compared with ambulatory referrals, eConsults served more nonwhite patients (612 of 1698 [36.0%] vs 4040 of 16,073 [25.1%]; P < .001) and more Medicaid enrollees (459 of 1698 patients [27.0%] vs 3266 of 16,073 [20.3%]; P < .001). In addition, ambulatory referral patients were significantly less likely to attend their scheduled appointment compared with eConsult patients, as either "no-shows" (246 of 2526 [9.7%] vs 3 of 62 [4.8%]) or cancellations (742 of 2526 [29.4%] vs 8 of 62 [12.9%]; P = .003). There were fewer median days to extirpation for eConsult patients compared with ambulatory referral patients (interquartile range; 80.7 ± 79.8 vs 116.9 ± 86.6 days; P = .004). CONCLUSION: Integrating dermatologic care through a telemedicine system can result in improved access for underserved patients through improved efficiency outcomes.
Asunto(s)
Dermatología/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Hospitales Universitarios/estadística & datos numéricos , Consulta Remota/estadística & datos numéricos , Enfermedades de la Piel/diagnóstico , Adulto , Citas y Horarios , Estudios Transversales , Dermatología/métodos , Dermatología/organización & administración , Femenino , Implementación de Plan de Salud , Accesibilidad a los Servicios de Salud/organización & administración , Disparidades en Atención de Salud/estadística & datos numéricos , Hospitales Universitarios/organización & administración , Humanos , Masculino , Persona de Mediana Edad , Ohio , Evaluación de Programas y Proyectos de Salud , Consulta Remota/organización & administración , Estudios Retrospectivos , Enfermedades de la Piel/terapia , Factores Socioeconómicos , Poblaciones Vulnerables/estadística & datos numéricosRESUMEN
Immunosuppression following organ transplantation is a known risk factor for the development of lymphoproliferative disorders. Mycosis fungoides, a rare entity in pediatric patients, has seldom been reported as a post-transplant lymphoproliferative disorder. We report a case of folliculotropic mycosis fungoides in a pediatric patient following liver transplantation that was initially diagnosed as tinea capitis.
Asunto(s)
Micosis Fungoide/diagnóstico , Neoplasias Cutáneas/diagnóstico , Tiña del Cuero Cabelludo/diagnóstico , Niño , Diagnóstico Diferencial , Humanos , Trasplante de Hígado/efectos adversos , Masculino , Micosis Fungoide/etiología , Neoplasias Cutáneas/etiologíaAsunto(s)
Antibacterianos/efectos adversos , Cladribina/administración & dosificación , Erupciones por Medicamentos/etiología , Leucemia de Células Pilosas/tratamiento farmacológico , Pentostatina/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Antibacterianos/uso terapéutico , Antineoplásicos/administración & dosificación , Estudios de Cohortes , Erupciones por Medicamentos/epidemiología , Interacciones Farmacológicas , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Leucemia de Células Pilosas/patología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estudios Retrospectivos , Medición de RiesgoAsunto(s)
Antineoplásicos/efectos adversos , Erupciones por Medicamentos/epidemiología , Leucemia de Células Pilosas/tratamiento farmacológico , Adulto , Anciano , Cladribina/efectos adversos , Estudios de Cohortes , Citarabina/efectos adversos , Erupciones por Medicamentos/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pentostatina/efectos adversos , Adulto JovenRESUMEN
Objective: We aimed to analyze the reformatted standard letter of recommendation (SLOR) for dermatology residents to examine trends in grading and content based on the positions of the letter writers, their backgrounds, and their relationship with the applicant, as well as to evaluate the SLOR's ability to discriminate applicants. Design: This was a retrospective characterization study of dermatology SLORs from the 2016-17 application cycle. Setting: We examined SLORs received by The Ohio State University, the University of Oklahoma, and Hofstra University Northwell Health dermatology residency programs. Participants: We included dermatology residency applicants and their letter writers from the 2016-17 application cycle. Results: A total of 141 SLORs were analyzed from 115 applicants. SLORs demonstrated grade inflation from letter writers of all backgrounds. Ratings for research potential and inquisitive nature were significantly lower than ratings for other categories. Letter writers with limited clinical and research contact graded applicants significantly lower than did writers who had more extensive contact. Word boxes were underutilized. Conclusion: The dermatology SLOR is useful in differentiating applicants, and ratings correlate with the relationships that letter writers have with their applicants. Residency programs should be aware of these findings when evaluating letters of recommendation for applicants.
RESUMEN
Background: New-onset dermatitis in the elderly can be attributed to a variety of disease processes. We defined new-onset dermatitis in which the etiology is attributed solely to age-related processes as "dermatitis of immune senescence"-a diagnosis of exclusion based on clinical presentation and further diagnostic testing. Objective: Retrospective cohort of elderly patients with new-onset dermatitis to examine the differences in demographics, work-up, and treatments between patients with dermatitis of immune senescence and those patients ultimately given more specific diagnoses. Methods: Four hundred and thirty-three patients aged 60 years and older with new-onset dermatitis from 2011 to 2016 at Ohio State University were identified by chart review and categorized as "dermatitis of immune senescence" or "alternate diagnosis" based on patch testing, biopsy, and physician documentation. Results: In this subset of patients, 10.2 percent (44/433) underwent patch testing and 16.2 percent (70/433) underwent biopsy. Furthermore, 86.4 percent of patients who underwent patch testing (38/44) and 57.1 percent who underwent biopsy (40/70) were given a more specific diagnosis following their test. Use of intramuscular steroids (p<.001), oral steroids (p=.004), and antihistamines (p=.002) were significantly higher in the alternate diagnosis group. Conclusion: The low rate of patch testing and biopsy and the high rate of diagnosis change post-procedure demonstrate an underutilization of diagnostic testing in this population.
Asunto(s)
Dermatología/educación , Internado y Residencia , Dermatólogos , Humanos , Selección de PersonalRESUMEN
Dsk5 mice have a gain of function in the epidermal growth factor receptor (EGFR), caused by a point mutation in the kinase domain. We analyzed the effect of this mutation on liver size, histology, and composition. We found that the livers of 12-wk-old male Dsk5 heterozygotes (+/Dsk5) were 62% heavier compared with those of wild-type controls (+/+). The livers of the +/Dsk5 mice compared with +/+ mice had larger hepatocytes with prominent, polyploid nuclei and showed modestly increased cell proliferation indices in both hepatocytes and nonparenchymal cells. An analysis of total protein, DNA, and RNA (expressed relative to liver weight) revealed no differences between the mutant and wild-type mice. However, the livers of the +/Dsk5 mice had more cholesterol but less phospholipid and fatty acid. Circulating cholesterol levels were twice as high in adult male +/Dsk5 mice but not in postweaned young male or female mice. The elevated total plasma cholesterol resulted mainly from an increase in low-density lipoprotein (LDL). The +/Dsk5 adult mouse liver expressed markedly reduced protein levels of LDL receptor, no change in proprotein convertase subtilisin/kexin type 9, and a markedly increased fatty acid synthase and 3-hydroxy-3-methyl-glutaryl-CoA reductase. Increased expression of transcription factors associated with enhanced cholesterol synthesis was also observed. Together, these findings suggest that the EGFR may play a regulatory role in hepatocyte proliferation and lipid metabolism in adult male mice, explaining why elevated levels of EGF or EGF-like peptides have been positively correlated to increased cholesterol levels in human studies.