Common contact allergens implicated in frontal fibrosing alopecia found in over-the-counter hair growth serums and solutions.

Background: Frontal fibrosing alopecia (FFA) is a form of lichen planopilaris with an undetermined etiopathogenesis, predominantly affecting women. There is conflicting evidence as to whether contact allergens may play a role in the underlying etiology or progression of FFA. Objective: The aim of this study is to find the most common products that patients search for online, identify contact allergens present in these advertised over-the-counter hair products, and suggest their role in the development or exacerbation of FFA. Methods: We reviewed current research on this topic and then investigated common allergens found in over-the-counter hair products commonly used for hair regrowth. Results: FFA's exact etiopathogenesis remains vastly unknown, however, current literature has reported an association between inflammatory skin conditions and FFA. Limitations: The lack of published data on the function of contact allergens in FFA placed restrictions on our study. Conclusion: A survey-based analysis with a larger cohort is needed to further interpret the relationship between product use and FFA presentation based on contact allergens. More research on possible etiopathogenesis and the relationship between contact dermatitis and FFA may prevent further progression of a patient's disease, leading to an improvement in their quality of life.

Relapsing Polychondritis in a Patient With Rheumatoid Arthritis: Improved With Pentoxifylline.

Relapsing polychondritis (RP) is a rare autoimmune condition that involves the recurrent inflammation of cartilage throughout the body, with a predilection for auricular and nasal cartilage. Given its rarity and diverse clinical presentations, RP is frequently misdiagnosed or left untreated, which can lead to significant morbidity and mortality. When it is correctly diagnosed, there are no standardized guidelines on the treatment of RP to date. Management of this disease requires a multidisciplinary approach, and about 30% of patients with RP have other autoimmune disorders, further complicating the approach to targeted treatment. Biologic agents (including TNF inhibitors) are commonly used. We present a compelling case of a 46-year-old female with rheumatoid arthritis (well-controlled on adalimumab) and hypothyroidism who presented to the dermatology clinic with recurrent episodes of painful, swollen, and erythematous ears, leading to a clinical diagnosis of relapsing polychondritis. Off-label use of oral pentoxifylline, along with topical corticosteroids, led to significant improvement in her symptoms. Dermatologists play an important role in the diagnosis of this rare disorder, as skin manifestations may be the initial presenting sign of RP. Further research into potentially effective treatments is needed. Timely identification and management of RP may prevent the progression of cartilage destruction, thus improving patients' long-term prognosis and overall quality of life.

Cutaneous carcinosarcoma: a rare diagnosis.

Carcinosarcoma is a rare malignant tumor that is a combination of carcinoma (cancer of epithelial tissue) and sarcoma (cancer of mesenchymal tissue). In practice, it is more common to have either carcinoma or sarcoma individually, but it is novel to have a combination of the two; as a result, few cases have been reported. Carcinosarcoma typically occurs in visceral organs and is rare in the skin. We present the case of a 68-year-old man with a lesion on his left zygomatic cheek that was revealed to be a biphasic malignant neoplasm. Multiple stains provided evidence of both epithelial and mesenchymal components within the lesion. Treatment for such a diagnosis typically involves a combination of wide local excision or plastic surgery for reconstruction purposes, both of which were used with this patient. This case describes the identification of cutaneous carcinosarcoma using immunohistochemical tests and emphasizes the uniqueness of such a diagnosis that requires early attention and appropriate selective treatment.

Development of Retroperitoneal Abscess Following Routine Injection of Triamcinolone for Musculoskeletal Pain.

Glucocorticoid intramuscular injections are a quick, routine procedure done in an outpatient setting to relieve musculoskeletal pain quickly. However, despite being a low-risk procedure it can lead to local infections, including abscess and skin necrosis, and even more rarely, bacteraemia and multi-organ failure. In this case, we present a healthy, immunocompetent woman in her 40s diagnosed with a retroperitoneal abscess due to methicillin-resistant Staphylococcus aureus after an intramuscular injection of triamcinolone. LEARNING POINTS: Injections of glucocorticoids are commonly used in medical practice to alleviate musculoskeletal pain in addition to oral non-steroidal anti-inflammatory agents.Complications of injections include abscess formation, skin necrosis and sepsis, typically from Staphylococcus aureus or other skin colonisers.It should be understood that there are risks associated with injections regardless of age or co-morbidities, so these risks should be discussed with the patient in depth before administration.

Drug-induced neutrophilic lobular panniculitis secondary to BRAF and MEK inhibitor used for treatment of low-grade glioma and its management.

An 8-year-old boy presented with his mother for evaluation of an erythematous rash 3 weeks after the start of dual BRAF-MEK inhibition with dabrafenib and trametinib for treatment of progression of low-grade glioma. Panniculitis has been reported as a rare adverse cutaneous event induced by BRAF inhibitors, MEK inhibitors, and the combined dual BRAF-MEK therapy. Based on the patient's history, clinical presentation, and histopathological findings, a diagnosis of drug-induced neutrophilic panniculitis was made. This case describes neutrophilic panniculitis as a potential cutaneous manifestation of dual BRAF-MEK inhibitor therapy and describes the management of such side effects. Neutrophilic panniculitis is a relatively rare manifestation, characterized by neutrophilic inflammation in the subcutaneous tissue. Additionally, this case serves as a reminder to consider the cutaneous side effects of such therapies, given that MEK and BRAF inhibitors are increasingly used to treat primary brain tumors in the pediatric population. Routine inspection and early management may improve patients' quality of life and enable continuation of anticancer therapy.

​​Longitudinal Erythronychia Secondary to a Wooden Splinter.

Longitudinal erythronychia (LE) is a term for red streaks in the nail which can be caused by a range of diseases. The specific type of longitudinal erythronychia can correlate with certain associated conditions making it important to properly categorize when discovered. A 71-year-old Hispanic male presented to the clinic with a type 1A LE associated with subungual keratosis that had been asymptomatic for approximately 12 months. The patient denied injury, pain, cold sensitivity, or cosmetic distress. The working diagnosis was squamous cell carcinoma in situ (SCCIS) vs. onychopapilloma or glomus tumor. A 4mm punch biopsy from the distal nail matrix was performed, and dermatopathology revealed that the LE was secondary to a wooden splinter. After a literature review, it was discovered that this is the first confirmed case of LE secondary to a splinter. Future providers should keep splinters as a potential differential diagnosis, especially as they evaluate LE, but ultimately all suspicious type IA lesions should be biopsied to rule out potential insidious pathologies, such as SCCIS and malignant melanoma.

Inverse pityriasis rosea secondary to COVID-19 vaccination.

A 56-year-old woman presented for evaluation of a pruritic rash with associated body aches, fever, and chills that first appeared about 1 week after Johnson and Johnson COVID-19 vaccination. The rash initially presented as one lesion on her left breast that then spread to her face and groin. Based on clinical presentation, dermoscopic findings, and histopathological examination, a diagnosis of inverse pityriasis rosea was made. Although the exact pathogenesis of pityriasis rosea remains unknown, current evidence suggests that the inflammatory reaction to infectious agents, vaccines, certain drugs, or reactivation of herpesvirus 6 and 7 are possible etiologies.