Phytophotodermatitis due to a Citrus-Based Hand Sanitizer: A Case Report.

Phytophotodermatitis, a cutaneous reaction caused by direct contact with photosensitive substances in plants and subsequent exposure to ultraviolet light, is commonly caused by psoralens in plants, including citrus fruits. We describe a case of phytophotodermatitis caused by a hand sanitizer containing a blood orange (Citrus sinensis) extract. To our knowledge, this is the first reported case of phytophotodermatitis caused by a hand sanitizer. A 41-year-old woman presented with a 2-week history of pruritic cutaneous eruptions on her right thigh. Approximately 24 hours prior to the onset of her symptoms, she applied a new citrus-based hand sanitizer. Immediately after applying the hand sanitizer, her right thigh was exposed to sunlight for approximately 5 hours. Extracts from oranges are used in many cosmetics, including perfumes and fragrances. With the increased use of hand sanitizers during the coronavirus disease 2019 pandemic, physicians should note that phytophotodermatitis due to scented hand sanitizers may occur more frequently.

How to Save a Limb: Identification of Pyoderma Gangrenosum.

We report the case of a 67-year-old woman with a painful expanding ulcer on the left leg of 2 months' duration that initially was diagnosed as a skin and soft tissue infection (SSTI) with plans for surgical debridement. Upon dermatologic consultation, surgery was canceled due to the possible diagnosis of pyoderma gangrenosum (PG) and risk of pathergy. Notable features of this patient included a history of inflammatory bowel disease (IBD), poor response to antibiotics, chronicity, lack of signs of sepsis, potential complications of surgical intervention, and ultimately a response to immunosuppressive agents.

Revisiting the Rintala advancement flap for nasal tip reconstruction.

The approach to nasal reconstruction is based on the nature of the defect and the donor tissue. The Rintala flap, first described by Rintala and Asko-Slejavaara, is a surgical technique used to close midline nasal defects. It is a simple, one-stage procedure and is most effective for defects ranging from 1.5 to 2.5 centimeters. In addition, the Rintala flap is an excellent tissue match and maintains the natural contour of the nose. Other flaps employed in nasal defect closure include the paramedian forehead flap and the Rieger flap. The authors discuss the Rintala flap technique and utility with comparison to alternative flaps used for nasal reconstruction.

DRESS syndrome associated with influenza virus.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a potentially life-threatening drug-induced reaction. Though the most common clinical manifestations are eosinophilia, fever, rash, and lymphadenopathy, patients can also present with severe organ dysfunction. The pathogenesis of DRESS syndrome is only currently partially understood, though it is known that DRESS syndrome is commonly associated with infection or viral reactivation; specifically, human herpes viruses 6 and 7 and Epstein-Barr virus have been implicated in the pathogenesis. We present the first case of DRESS syndrome in the context of serology-proven influenza virus.

Multiple flat-topped scaly violaceous papules.

Epidermodysplasia verruciformis (EV) is an autosomal recessive genodermatosis characterized by susceptibility to beta-genus human papillomavirus (HPV) infection. Owing to TMC6/EVER1 and TMC8/EVER2 mutations that lead to abnormal transmembrane channels in the endoplasmic reticulum involved in immunological pathways, keratinocytes cannot combat infection from non-pathogenic HPV strains. Mutations involving RHOH, MST-1, CORO1A, and IL-7 have also been associated with EV in patients without TMC6 or TMC8 mutations. We highlight a 27-year-old man with multiple violaceous flat-topped papules with scale and irregular borders distributed on his chest, extremities, abdomen, and back. The striking physical examination and the subsequent biopsy findings of enlarged nests of cells in the granular and spinous layers with blue-gray cytoplasm and keratohyaline granules confirmed the diagnosis. We conclude with a brief discussion on the differential diagnosis, which includes confluent and reticulated papillomatosis, Darier disease, and disseminated superficial actinic porokeratosis.

Pustular DRESS Syndrome Secondary to Hydroxychloroquine With EBV Reactivation

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) or drug-induced hypersensitivity (DIHS) is a rare and feared complication of frequently used medications such as anticonvulsants, sulfonamides, and allopurinol. To date, no reports of hydroxychloroquine-induced pustular DRESS syndrome have been associated with Epstein-Barr virus (EBV) reactivation nor imitated other cutaneous adverse drug reactions as in our patient. Observation: A 56-year-old female presented with a diffuse cutaneous eruption involving the face, trunk, extremities, and palms approximately two weeks after the initiation of hydroxychloroquine therapy for a suspected Sjögren's-like process with inflammatory cervical lymphadenopathy. Skin examination demonstrated diffuse erythematous and edematous papules and pustules on her dorsal and volar hands and fingers, arms, legs, chest, abdomen, back, scalp, and face. In many areas, lesions coalesced into plaques with overlying pustules, scale, and crust. Additional notable exam findings included centralized facial edema, edema of the hands, and cervical lymphadenopathy. Laboratory workup revealed leukocytosis, peripheral eosinophilia, elevated transaminases, and a negative autoimmune workup; however, serology demonstrated EBV reactivation. Histologic assessment displayed a spongiotic dermatitis with eosinophils, superficial perivascular dermatitis, as well as corneal, subcorneal, and intraepidermal neutrophilic microabscesses, mimicking acute generalized exanthematous pustulosis or pustular psoriasis, even though clinical evaluation suggested DRESS syndrome. Conclusion: To our knowledge, this is the first reported case of hydroxychloroquine-induced pustular DRESS syndrome in the context of EBV reactivation. Given hydroxychloroquine's immunomodulatory function and association with other cutaneous manifestations, our patient represents a significant diagnostic challenge. Therefore, this case highlights the importance of knowledge regarding overlapping features, histologically and clinically, among acute generalized exanthematous pustulosis, pustular psoriasis, and DRESS syndrome. J Drugs Dermatol. 2019;18(2):207-209.

Review of Socioeconomic Disparities in Lower Extremity Amputations: A Continuing Healthcare Problem in the United States.

Lower extremity amputation is one of the most unfortunate, yet preventable, consequences of uncontrolled lower limb ischemia occurring secondary to diabetes mellitus or peripheral arterial disease. In the United States, racial and socioeconomic disparities are associated with significant differences seen in the incidence and type or level of lower extremity amputation among patients. Due to shifting demographics and the uncertain state of healthcare coverage, lower extremity amputation rates are only projected to increase in the future. Given the potential societal and individual costs associated with the loss of a limb, this review seeks to summarize the recent findings on disparities in the identification, treatments offered, and outcomes of lower limb ischemia in order to elucidate potential interventions at the practitioner and policy levels.

Platelet-rich plasma for androgenic alopecia treatment: A comprehensive review.

Androgenic alopecia (AGA) is a chronic, progressive condition affecting millions of individuals worldwide. Treatment modalities for AGA are limited and our understanding of the pathophysiology underlying the disease is still developing. Platelet-rich plasma (PRP), an autologous collection of concentrated platelets and their respective growth factors, has demonstrated efficacy in limiting AGA. The current understanding of AGA pathogenesis is summarized, including our current understanding regarding androgens, inflammation, and arrector pili muscle loss. Furthermore, the molecular pathways induced by PRP in the context of AGA are discussed to ascertain how PRP can prevent disease progression. Well-designed studies investigating the effect of PRP on AGA patients to provide insight on how PRP should be used to achieve consistent clinical results are also presented. Future investigations should focus on elucidating a unifying theory to connect the currently disparate avenues of AGA pathogenesis. PRP clinical trials should be based on standardized treatment protocols to establish generalizable results.

Exfoliative Cheilitis as a Manifestation of Factitial Cheilitis.

Factitial cheilitis is a rare diagnosis of exclusion that occurs most frequently in young women with a history of anxiety disorders and recent psychosocial stressors. It presents as continuous keratinaceous build-up, crusting, and desquamation of the lips, consistent with exfoliative cheilitis. Affected areas can progress to superinfection with Staphylococcus aureus or Candida albicans. We report a case of a 23-year-old woman who presented with diffuse hyperkeratosis of the upper and lower lips that was initially suspected to be allergic or irritant contact dermatitis based on clinical examination. Clinical and histologic correlation of two separate biopsies plus a negative infectious workup led to the consideration of a factitial etiology. Through open and direct communication between the patient and the provider, the appropriate diagnosis was discerned. Referral for the psychiatric symptoms as well as management of the same resulted in complete resolution of her lip findings. This case highlights the importance of considering factitial cheilitis as the etiology of exfoliative cheilitis, especially in the presence of concomitant psychiatric disorders.

Sister Mary Joseph Nodule as a Cutaneous Manifestation of Metastatic Appendiceal Adenocarcinoma: Case Report and Literature Review.

Sister Mary Joseph nodule (SMJN) is an uncommon pattern of superficial periumbilical tumor metastasis, with the primary tumor most commonly associated with gynecological or gastrointestinal origins. This manifestation can represent extensive tumor development from any of the intra-abdominal or pelvic structures. Therefore, SMJN carries a poor prognosis, with a two-year survival rate of only 13.5 percent regardless of the etiology of primary cancer. In this case, a 67-year-old man with metastatic mucinous adenocarcinoma of the appendix involving the umbilicus presenting more than five years after the initial cancer diagnosis is reported. The features of patients with metastatic appendiceal carcinoma presenting as SMJN are also reviewed. With the inclusion of our patient, there are six patients who have documented SMJN due to appendiceal carcinoma: two men, two women, and two patients without demographic data. The patients ranged from the ages of 31 to 68 years, with a median age of 56.5 years at cancer diagnosis and 59 years at SMJN diagnosis. In 75 percent of the cases, SMJN was the initial clinical manifestation of a previously unsuspected appendiceal carcinoma and presented clinically one to seven months (median of five months) before the pathologic confirmation of the metastatic appendiceal carcinoma. The likelihood of SMJN presenting as the initial clinical feature of appendiceal cancer may increase in patients with extensive intraperitoneal metastasis in the form of pseudomyxoma peritonei or carcinomatosis. Therefore, the observation of a solitary umbilical nodule should prompt an investigation for an underlying primary neoplasm, as the prognosis after tumor metastasis to the umbilicus is poor.

Solitary Palmar Keratoacanthoma: Case Report.

Keratoacanthoma (KA) is a squamous neoplasm exhibiting a triphasic growth pattern involving rapid growth, stabilization, and eventual spontaneous resolution. Historically, keratoacanthomas were thought to originate on hair-bearing skin or sun-exposed surfaces. However, recent reports demonstrate that they can occur on the mucous membranes, subungual regions, and palms and soles. We report a 74-year-old man who developed a KA on the left palmar surface after minor trauma, for which he underwent Mohs' micrographic surgery. A literature review for the terms: keratoacanthoma, palm, palmar, volar, plantar, and sole resulted in only four reported cases of solitary or giant KA of the palms and soles; excluding our patient, all of the cases occurred on the plantar foot. A number of reports describe palmar KA in the context of multiple lesions occurring simultaneously. However, to our knowledge, our patient represents the first reported case of a solitary palmar KA in the literature. The features of follicular and non-follicular keratoacanthomas (KAs) and their association with trauma are discussed.

Sex differences in stroke: Review of current knowledge and evidence.

Stroke is a leading cause of death among women in the United States, and women are more affected by stroke than men. With women living longer than men, women experience not only a higher incidence of stroke but also more negative outcomes. Despite its lethal impact and high morbidity rate, the road from innovative bench research to improved clinical outcomes has been slow. This review explores the differential physiology, epidemiology, and clinical presentation of stroke between men and women, as well as the current status of laboratory and clinical data.