A Case of Perifollicular Macular Amyloidosis.

Macular amyloidosis is a common type of primary localized cutaneous amyloidosis. We present a case report of a 74-year-old patient with no significant past medical history who was evaluated for dark macules and pruritus for over a year. On exam, follicular-based brown macules on the upper and lower back, bilateral shoulders, and bilateral dorsal upper arms were noted. The morphology and distribution of follicular-based macules was unusual, so the differential included follicular lichen planus, follicular eczema, and macular amyloidosis. Punch biopsy showed deposits of eosinophilic fibrillary material along with pigmentary incontinence in the papillary dermis, consistent with macular amyloidosis. Additionally, there was some trapping of the adnexal structures with atrophy of the periadnexal fat in the reticular dermis. In macular amyloidosis keratin, intermediate filaments such as cytokeratin serve as the amyloid precursors which deposit in the superficial dermis. Characteristically, macular amyloidosis presents as hyperpigmented macules or patches, often in a "rippled" linear pattern. This case highlights a rare presentation of macular amyloidosis because of the atypical follicular involvement and emphasizes the variety of presentations for localized cutaneous amyloidosis. Additionally, new treatment options such as Janus Kinase inhibitors and their potential role in the pathological pathway are discussed.

Online dermatology curriculum experiences among US dermatology residents and faculty.

Many dermatology residency programs adapted to the COVID-19 pandemic by transitioning to online teaching methods. This may impact the quality of education and the satisfaction of residents. Dermatology faculty and residents nationwide were surveyed regarding their experiences with the novel online curricula. A total of 65 individuals representing at least 20 ACGME-accredited dermatology programs responded. Many programs implemented a predominantly online curriculum (78%). Most participants reported that both clinical dermatology and dermatopathology were online during the pandemic's peak (90%). Among those who had experienced a live curriculum prior to the pandemic, 49% reported that a virtual curriculum had similar effectiveness, whereas 36% deemed it less effective. Open-ended questions suggested that disadvantages of a virtual curricula included too many distractions, lack of human features, and less spontaneous feedback. They also suggested advantages to an online curriculum included flexibility and more opportunities to hear from guest speakers. Dissatisfaction before the curriculum change was the same as after (7%), suggesting that the educational experience was not worsened. Failing to adjust the curriculum to residents' needs can contribute to lower satisfaction and inadequate education. The variation of responses signifies the importance of seeking sufficient feedback from residents to meet their educational needs.

Skin Cancer Education Interventions for Primary Care Providers: A Scoping Review.

Primary care physicians (PCPs) are often the first line of defense against skin cancers. Despite this, many PCPs do not receive a comprehensive training in skin conditions. Educational interventions aimed at skin cancer screening instruction for PCPs offer an opportunity to detect skin cancer at earlier stages and subsequent improved morbidity and mortality. A scoping review was conducted to collect data about previously reported skin cancer screening interventions for PCPs. A structured literature search found 51 studies describing 37 unique educational interventions. Curriculum elements utilized by the interventions were divided into categories that would facilitate comparison including curriculum components, delivery format, delivery timing, and outcome measures. The interventions varied widely in design, including literature-based interventions, live teaching sessions, and online courses with durations ranging from 5 min to 24 months. While several interventions demonstrated improvements in skin cancer knowledge and competency by written exams, only a few revealed positive clinical practice changes by biopsy review or referral analysis. Examining successful interventions could aid in developing a skin cancer detection curriculum for PCPs that can produce positive clinical practice and population-based changes in the management of skin cancer.

Evaluating skin of color education in dermatology residency programs: data from a national survey.

A dearth of skin of color (SOC) education exists among dermatology residency programs despite the increasingly diverse United States population; a 2008 study reported that 52% of dermatology residency programs had didactic sessions or lectures focusing on diseases in SOC. In the last decade, no new studies have examined the state of residency SOC education. In this study, dermatology residents across the United States were surveyed anonymously about SOC education at their residency program, satisfaction with SOC education, opinions on improving SOC education, and perspective on cultural competence. Of the 125 respondents, 63.2% reported their program provides SOC-related didactics; 44.0% had a rotation where residents primarily saw patients with SOC, although only 11.2% had a dedicated SOC rotation. While more than 60% of residents reported being satisfied or very satisfied with their SOC education, residents' satisfaction with their knowledge of diseases primarily seen in SOC was lowest (56.8%) of all categories. Thematic analysis revealed four major themes for improvement of SOC education, including curricular reform, clinical exposure, emphasizing determinants of health, and opportunities to learn from faculty with diverse interests and expertise about SOC. These findings highlight unique opportunities for dermatologists to enhance SOC education and care for patients of all backgrounds.

Assessing dermatology resident confidence in caring for patients with skin of color.

Many dermatology residency programs lack sufficient didactics and experiences with patients with skin of color (SOC). This may impact resident confidence with this patient population, which may affect patient satisfaction and perceptions of care. Dermatology residents nationwide were surveyed to determine their confidence in care of patients with SOC and white skin across several dimensions, including detailing morphology, making diagnostic and therapeutic decisions, tailoring treatment recommendations, and detecting suspicious lesions. A total of 125 dermatology residents representing 46 programs (of 119, 39%) responded. Resident confidence was significantly lower across all categories measured regarding caring for patients with SOC compared with patients with white skin (P <.001). After multivariate analysis adjusting for demographic and residency program characteristics, confidence in caring for patients with SOC remained significantly lower. Residents in programs with SOC education (i.e., SOC didactics, SOC clinical rotation) reported significantly higher confidence in one or more aspects of SOC care compared with residents in programs without such curricula. A deficiency in SOC education may contribute to the lower resident confidence observed. Integrating only one type of SOC education into residents' curricula, although helpful, may not sufficiently enhance confidence across all dimensions of care. A multifaceted approach is needed.

Granular cell tumor: importance of histopathology in determining malignant potential.

Granular cell tumors (GCTs), sometimes called Abrikossoff tumors, are rare and typically benign soft tissue tumors. Malignant GCTs, which are even rarer than benign GCTs, can occur and must be detected early given their high mortality rate. Distinguishing between benign and malignant GCTs is difficult clinically; however, histologic evaluation plays an essential role in this endeavor.

Upcoming topical TRPV1 anti-pruritic compounds.

Transient receptor potential vanilloid type 1 (TRPV1) is found on sensory neurons, keratinocytes, sebocytes, and dendritic cells. Activated TRPV1 channels are believed to help propagate the itch sensation. Therefore, there has been great interest in targeting TRPV1 to treat pruritus. Since oral formulations aimed at TRPV1 have led to adverse effects such as hyperthermia, there has been emphasis on developing novel topical agents. Several companies are investigating topical TRPV1 anti-pruritic compounds and the initial data has been very promising. These drugs have the potential to be important treatment options for the management of itch. This paper reviews topical products in current development for pruritus that target TRPV1 channels.

Linezolid as a treatment option for cutaneous non-tuberculous mycobacterial infections.

Cutaneous non-tuberculous mycobacterial (NTM) infections have rapidly increased in incidence in recent years. Currently there is no standard treatment and the variable and nonspecific ways in which cutaneous NTM infection presents makes it a therapeutic and diagnostic challenge. We describe a 67-year-old immunocompetent woman with cutaneous NTM infection after she recently underwent a root canal procedure. Although the species was not identified and she was unable to tolerate multiple antibiotics, she ultimately responded well to three months of treatment with linezolid. Given that cutaneous NTM infection can present in immunocompetent patients and that the incidence is rising, it is important for clinicians to maintain a high index of clinical suspicion, especially in patients with a recent history of surgery, trauma, or cosmetic procedures. Linezolid has coverage against non-tuberculous mycobacteria and is an effective therapeutic option for cutaneous NTM cases in which identification to the species level is not possible or when adverse effects limit therapeutic options.

Acrokeratoelastoidosis: is there an association between asthma and sporadic cases in children?

Acrokeratoelastoidosis (AKE) is a rare, benign papular keratoderma that presents as keratotic papules on the lateral margins of the palms and soles. It is most commonly inherited in an autosomal dominant fashion, although sporadic cases are also described. We present a sporadic case of AKE in an 11-year-old girl with a past medical history significant for asthma. On literature review, we found three other cases presenting in children with a past medical history of asthma. We suggest a possible association between asthma and sporadic cases of AKE in children. Current understanding of the pathophysiology of AKE and its associated risk factors is limited and no effective treatment exists. Awareness of a possible association with asthma and atopy, careful history recording in young patients presenting with sporadic cases of AKE, and further research may help to delineate the likelihood of an association between AKE and asthma or atopy. Developing a better understanding of the associated factors that may contribute to the disease process may help guide more effective, targeted treatments in the future.

Hydroxyurea-induced hyperpigmentation with iron deposition.

Hydroxyurea is a chemotherapeutic agent that is used in the treatment of various hematological diseases including chronic myelogenous leukemia, polycythemia vera, and sickle cell anemia. Hydroxyurea is also used to treat psoriasis. Drug-induced hyperpigmentation is a known cutaneous side effect of hydroxyurea along with xerosis, dermal ulcers, and dermatomyositis-like eruptions. Hyperpigmentation has been observed in the oral mucosa, nails, and in a generalized or a diffuse pattern. The mechanism of hyperpigmentation related to hydroxyurea is believed to be correlated with increased melanin. Classically, clinical types of diffuse hyperpigmentation owing to iron deposition in the dermis have been associated with minocycline and not with hydroxyurea. We report a novel case in which hydroxyurea hyperpigmentation is associated with iron deposition.

A toxic epidermal necrolysis-like presentation of linear IgA bullous dermatosis treated with dapsone.

Linear IgA bullous dermatosis is a rare autoimmune vesiculobullous disease characterized by linear deposition of IgA along the basement membrane zone. It is classically idiopathic, but may also arise secondary to drug exposure. A heterogeneous spectrum of clinical features has been described, including a rare, morbid variant mimicking toxic epidermal necrolysis. Herein, we present a case of vancomycin-induced linear IgA bullous dermatosis that manifested clinically as toxic epidermal necrolysis and resolved with dapsone therapy.