Squamous cell carcinoma arising in an epidermal inclusion cyst.

Squamous cell carcinoma (SCC) arising from an epidermal inclusion cyst (EIC) is uncommon. We present a case of a 70-year-old man with a scalp nodule with persistent discharge that was resected based on the clinical impression of an EIC. Histopathologic exam showed an infundibular EIC with an epidermal type of squamous epithelium; however, some of the cyst lining and lumen was replaced by squamous proliferation with malignant features. There are 56 cases of SCC arising in EICs reported in the English literature. Though suspected EICs are commonly benign, a thorough pathologic evaluation is required to rule out malignancy.

A tale of three common nipple diseases.

Paget's disease of the nipple is a rare breast carcinoma of the nipple-areola complex and is often associated with an underlying in situ or invasive carcinoma. It clinically presents as a thickened, erythematous, weeping or crusted lesion with irregular borders. Paget's cells invading the epidermis are the hallmark histopathologic feature, and cytokeratin 7 staining is positive in nearly all cases. However, the diagnosis of Paget's disease may be delayed or missed in favor of clinically similar benign nipple processes such as nipple adenoma and nipple dermatitis. We present a case of Paget's disease of the nipple in a 73-year-old woman with a brief review of other common nipple diseases.

The clinical evolution of lichen planus pemphigoides.

Lichen planus pemphigoides (LPP) is a rare autoimmune subepidermal blistering disease characterized by lichenoid and bullous lesions. LPP is generally thought to be idiopathic, possibly related to medication or malignancy, or potentially the result of long-standing lichenoid inflammation damaging the basement membrane zone leading to epitope spreading. The histological appearance of lichenoid and bullous lesions in LPP resembles findings of lichen planus and bullous pemphigoid, respectively. We present a case of LPP in a 64-year-old woman with a brief historical review of the establishment of LPP as a separate disease entity and a discussion of similarities and differences of LPP with other lichenoid and blistering dermatoses.

Transfollicular elimination of sebaceous glands in a patient with disseminate and recurrent infundibulofolliculitis.

Disseminate and recurrent infundibulofolliculitis (DRIF) is a rare form of folliculitis characterized by multiple papules widely distributed on the trunk and extremities. We present a 37-year-old man with confirmed DRIF complicated by transfollicular elimination of the sebaceous unit, an additional finding of DRIF that has rarely been reported.

COVID-19 and dermatological personal protective equipment considerations.

Cutaneous injury and irritation among health care workers has substantially risen during the COVID-19 pandemic. In a field already laden with skin-induced injury and irritation due to high levels of handwashing and glove wearing, increases have been reported in handwashing-induced xerosis, irritant dermatitis, and contact dermatitis from N95 respirators and other surgical masks. Masks, goggles, face shields, and gloves all potentially create abrasions from long hours of use, leading to itching, pain, and aggravation of underlying skin conditions. Personal protective equipment (PPE)-related skin injury can be serious, and the American Academy of Dermatology has released recommendations on preventing and treating occupationally induced dermatologic conditions during the COVID-19 pandemic. These are reviewed and discussed in conjunction with overarching guidelines for mitigating the spread of the virus.

PPE decontamination to overcome PPE shortage in rural area during pandemic.

Despite remarkable developments in healthcare, the world was not ready to stop the spread of the novel COVID-19 pandemic almost a century after the great influenza pandemic. The explosive increase in the number of patients stalled the healthcare system, and the first and apparent issue was the shortage of personal protective equipment (PPE). Our group established a system using a hydrogen peroxide vaporization method to decontaminate and reuse N95 respirators for healthcare workers. The system decontaminated over 12,000 units of PPE to cover institutions in West Texas. This service provided support at the most needed time during the pandemic.

Development of Terry's nails after a gastrointestinal bleed.

Terry's nails are characterized by white opacification of the nails with effacement of the lunula and distal sparing. Described originally in 1954 by Dr. Richard Terry as a common fingernail abnormality in patients with hepatic cirrhosis, Terry's nails are now a known sequelae of other conditions such as congestive heart failure, chronic kidney disease, diabetes mellitus, and malnutrition. Often all nails of the hands are affected. Treatment of the underlying disease may result in resolution. We present a case of a 77-year-old man who developed Terry's nails following an acute gastrointestinal bleed and subsequent hemorrhagic shock. The development of Terry's nails after a gastrointestinal bleed has not been previously reported.