Dermatology's role in the fight against human trafficking: A report from the AAD Ad Hoc Task Force and call to action.

While the majority of American Academy of Dermatology members have some broad awareness of human trafficking, most are not aware of it in their communities or of the skin signs that could prompt identification of those being exploited, and have requested educational resources to assist patients affected by trafficking. The American Academy of Dermatology Ad Hoc Task Force on Dermatologic Resources for the Intervention and Prevention of Human Trafficking has been working to develop relevant resources, including an online toolkit on the American Academy of Dermatology website: https://www.aad.org/member/clinical-quality/clinical-care/human-trafficking.

Combatting professional burnout through creative writing.

Physician burnout is becoming an increasing problem. In fact, nearly half of all physicians feel completely depleted, to the point where one in seven has contemplated suicide. Causes for burnout development include: administrative overload, regulatory restrictions, loss of autonomy or control, workplace issues, decreased access to medicines for patients, and electronic medical records. On the opposite end of this spectrum is physician fulfillment. Creative writing can be a therapeutic method of self-fulfillment. This may provide not only focused relief from burnout but also another possible avenue for success for multitalented people such as physicians.

Evidence-based best practice advice for patients treated with systemic immunosuppressants in relation to COVID-19.

The emergence of the COVID-19 pandemic has led to significant uncertainty among physicians and patients about the safety of immunosuppressive medications used for the management of dermatologic conditions. We review available data on commonly used immunosuppressants and their effect on viral infections beyond COVID-19. Notably, the effect of some immunosuppressants on viruses related to SARS-CoV2, including SARS and MERS, has been previously investigated. In the absence of data on the effect of immunosuppressants on COVID-19, these data could be used to make clinical decisions on initiation and continuation of immunosuppressive medications during this pandemic. In summary, we recommend considering the discontinuation of oral Janus kinase (JAK) inhibitors and prednisone; considering the delay of rituximab infusion; and suggesting the careful continuation of cyclosporine, mycophenolate, azathioprine, methotrexate, and biologics in patients currently benefitting from such treatments.

Widespread Skin Necrosis Secondary to Gemcitabine Therapy.

Gemcitabine, a pyrimidine nucleoside analogue, is an oncologic agent used in the treatment of cutaneous T-cell lymphoma (CTCL). Common dermatologic reactions associated with gemcitabine include alopecia, mild skin rash, and mucositis but skin necrosis is exceptional. Herein we present an unusual case of widespread skin necrosis mimicking toxic epidermal necrolysis in a 45-year-old woman receiving gemcitabine therapy for stage IIIA cutaneous T-cell lymphoma. This is the first reported case of a TEN-like reaction subsequent to gemcitabine treatment. J Drugs Dermatol. 2018;17(5):582-585.

A comparative study of epidermal tight junction proteins in a dog model of atopic dermatitis.

BACKGROUND: Tight junctions (TJ) are important for skin barrier function and could be relevant in modulating allergen penetration in atopic dermatitis (AD). Humans with AD have been described to have decreased expressions of some TJ proteins in the skin. HYPOTHESIS/OBJECTIVES: This study aimed to investigate TJ protein expression using an experimental AD model in dogs. METHODS: Skin biopsies from six atopic (nonlesional skin) and five normal beagle dogs were stained for TJ proteins [zonula occludens 1 (ZO-1), occludin, claudin-1] by immunohistochemistry. Staining intensity was evaluated both objectively using imaging software and subjectively. Six images/sections were randomized and blindly scored by six investigators for intensity, distribution, integrity and staining pattern. RESULTS: The intensity of ZO-1 was significantly decreased in the atopic group objectively (P = 0.010) and subjectively (P = 0.002) relative to the normal group. Occludin was decreased significantly subjectively (P = 0.027) but not objectively. Claudin was not significantly different between groups by either quantification. Additionally, only ZO-1 demonstrated a significantly patchier staining pattern in the atopic group. There was no consistent staining pattern in this study. CONCLUSIONS AND CLINICAL IMPORTANCE: ZO-1 and occludin, which have not been described to be associated with the development of AD in humans, could play a role in this atopic dog model. Further investigation on the expression and modulation of TJ proteins and their clinical relevance is needed.