Antibiotics for acne vulgaris: using instagram to seek insight into the patient perspective.

OBJECTIVES: Monitoring of public social media posts is an underutilized method to understand patients' perspectives regarding their condition and treatment. We investigated information shared by Instagram users of oral and topical antibiotics for treatment of acne vulgaris. MATERIAL AND METHODS: We performed a retrospective observational study of public Instagram posts assigned common hashtags to denote the use of antibiotics therapy for acne over nearly eight years. RESULTS: Dissatisfaction was more prevalent among users of oral antibiotics (25.6%) compared to users of topical antibiotics (9.8%), and negative tone among this group was most commonly due to lack of improvement in skin appearance. Reported side effects paralleled known side effects for oral and topical antibiotics. CONCLUSIONS: Instagram may have utility in elucidating patient behavior and attitudes. Dermatologists should increase their social media presence in order to disqualify any incorrect information endorsed in 'popular' or commonly viewed posts.

Clinical and histologic presentation of pediatric reactive granulomatous dermatitis.

OBJECTIVE: To characterize the clinical and histologic presentation of reactive granulomatous dermatitis (RGD) in the pediatric population. METHODS: In this multicenter retrospective chart review, 7 pediatric patients with biopsy-proven RGD were identified. Photographs, histology reports, and clinical course were reviewed to discover patterns in demographics, comorbid conditions, autoimmune sequelae, drug exposures, infections, morphology, and histologic features. RESULTS: Overall, 7 patients were included and analyzed. Most were female and Hispanic. All presented with a similar dermatologic phenotype previously described in the adult literature including macular erythema and annular, pink to violaceous, edematous papules and plaques, often involving proximal extremities and extensor joints. All biopsies demonstrated variable collagen alteration and a perivascular interstitial infiltrate of histiocytes with or without mucin. Neutrophils or karyorrhexic debris were present in 4/7 of the biopsies, and eosinophils were occasionally seen (2/7 cases). In all cases, RGD was associated with active SLE or led to a new diagnosis, and initiation of systemic treatment improved cutaneous disease. CONCLUSIONS: Pediatric RGD was more common in female patients and ethnic minorities, and strongly associated with SLE. Clinical and histologic presentations were consistent across all cases with only minor variations, suggesting that recognition and confirmation might be expedited by familiarity with these dominant patterns. Diagnosis of RGD in pediatric patients should prompt screening for SLE.

A review of N-acetylcysteine in the treatment of grooming disorders.

BACKGROUND: Pathologic grooming disorders can lead to clinically significant distress and functional impairment. Studies on treatment of these disorders with selective serotonin reuptake inhibitors (SSRIs) and anticonvulsants have led to inconsistent findings. N-acetylcysteine (NAC) has shown promise in treatment of obsessive-compulsive and related disorders. The objective of this article is to perform an updated review of NAC in the treatment of grooming disorders. METHODS: PubMed was searched from inception to October 2017 to identify literature on the use of NAC in the management of trichotillomania, onychophagia, and pathological skin picking. Case reports, case series, and randomized controlled trials were included. Data on study design, dosing regimens, comorbidities, concurrent treatment, and side effects were extracted from the included articles. RESULTS: Fifteen articles were included in this review, which consisted of 10 case reports, one case series, and four randomized controlled trials. Dosing of oral NAC ranged from 450 to 2,400 mg per day, and treatment periods lasted from 1 to 8 months. Side effects were uncommon, mild, and usually gastrointestinal in nature, with severe aggression reported in one child. CONCLUSIONS: While there are multiple reports of the safety and efficacy of NAC in the treatment of grooming disorders, there are currently few randomized controlled trials on this topic, and more research is needed to develop a formal treatment algorithm. While current data should be considered very preliminary, case reports have demonstrated mostly positive results and a lack of significant side effects. A trial of NAC may be a viable option for pathologic grooming disorders, especially in patients who have failed prior psychologic or pharmacologic treatment.

Social media in dermatology: clinical relevance, academic value, and trends across platforms.

Social media encompasses multiple sites for online communication that reach a large proportion of the global population. While the increase in number of publications investigating dermatology content on social media has paralleled the growth of social media in the past decade, there has not yet been an extensive review of past literature on this topic. Our objective is to summarize and analyze publications on the role of social media within the field of dermatology. Social media is frequently used by patients to solicit advice related to cutaneous concerns and even when seeking out a dermatologist, but it is underutilized among both clinicians marketing their practices and academicians collaborating with colleagues in the field. Social media has the potential to advance instruction for trainees in dermatology and facilitate new research methods. Patient-centered perspectives and advocacy groups have a larger presence overall on social media platforms than stakeholders in academic dermatology. Furthermore, specific platforms like Facebook, YouTube, and Twitter vary in originators of material, messaging strategies, and reliability of information with regards to certain dermatologic conditions and behaviors.

The chick chorioallantoic membrane (CAM) as a versatile patient-derived xenograft (PDX) platform for precision medicine and preclinical research.

Patient-derived xenografts (PDX) are an increasingly valuable tool in oncology, providing biologically faithful models of many different cancer types, and potential platforms for the development of precision oncology approaches. However, PDX have primarily been established in immunodeficient rodent models, with accompanying cost and efficiency constraints that pose barriers to more widespread adoption. The chicken egg chorioallantoic membrane (CAM) is an alternative in vivo PDX model. We provide here a comprehensive review of studies that grafted primary human tissue, as opposed to cell lines, onto the CAM. Twenty publications met our criteria of having inoculated patient-derived tumor tissue onto the CAM. Successful engraftment has been reported for over a dozen tumor subtypes, supporting the appropriateness of the CAM as a PDX platform. Resemblance of xenografts to the original patient tumor, increased vascularity of the CAM following engraftment, and micrometastasis into the chick mesenchyme were frequently reported. Application of standard or experimental cancer therapies to xenografts has also been undertaken, with the discovery of both synergistic drug effects and positive associations between the assay and clinical outcome. The CAM provides opportunities for RNA and DNA based sequencing of patient tumors, and the ability to efficiently (in 5-10 days) test multiple targeted therapies on fragments derived from the same tumor. While routine use of the CAM-based PDX model would benefit from a more-complete understanding of the stromal environment of CAM xenografts and interaction with the developing avian immune system, current literature supports the model's potential as an efficient, scalable precision medicine platform.