Industry Payments Comparison Between Female and Male Mohs Surgeons From 2015 to 2021.

BACKGROUND: There are limited data on female Mohs surgeon industry relationships. OBJECTIVE: To evaluate industry payment activity between female and male Mohs surgeons. MATERIALS AND METHODS: A retrospective review of the U.S. Centers for Medicare and Medicaid Services open payments data was performed between 2015 and 2021 for Mohs surgeons in the United States. Gender, academic affiliation, practice region, annual total payment, cumulative payment, and industry payment type was collected. RESULTS: Male Mohs surgeons received higher mean total payments than female Mohs surgeons ( p = .04), which persisted when data were stratified based on industry payment type and practice region. Both genders had similar median total payments ( p = .4). Females in academic practice received higher mean total payments than those in private practice. Females experienced a significant lower mean total payment compared with males in the South ( p = .03). CONCLUSION: High total payments received by male Mohs surgeons skewed the data, which is supported by a significant mean total payment difference despite a similar median total payment distribution. Female Mohs surgeons receiving the top payments may address this mean payment difference. Females seem to have higher payments if they practice in the Northeast and are in academics. Further studies are needed to evaluate this payment gap.

An Open-Label, Prospective, Pilot Study of Hypertonic Saline for Hidradenitis Suppurativa.

BACKGROUND: Hidradenitis suppurativa (HS) fistulas are likely to persist without surgical intervention. Hypertonic saline (HTS), a venous sclerosant, disrupts the endothelial lining leading to occlusion and fibrosis when used for venous insufficiency. OBJECTIVE: To evaluate the efficacy and tolerability of HTS sclerotherapy for HS fistulas. METHODS AND MATERIALS: This Institutional review board-approved, nonrandomized, clinical trial included adult patients with a diagnosis of HS and at least one confirmed HS fistula who underwent HTS injections into their fistulas every two weeks followed by a 4-week follow-up period. The study was performed from 2016 to 2019 at two academic outpatient dermatology clinics in Boston, MA. Primary outcomes were physician-assessed improvement of HS fistula characteristics between final and baseline visits and physician-assessed HS improvement during course of study. RESULTS: Overall, 21 patients participated. Physician-assessed overall HS improvement was significant between Visits 2 and 3 (p = .036). Drainage (p = .035), erythema (p = .008), and swelling (p = .025) demonstrated statistically significant improvement from baseline to final visit. Dermatology life quality index scores significantly improved from baseline to Visit 2 (p = .0005), Visit 3 (p = .0008), and final visit (p = .011). Numeric rating scale stinging scores increased with sclerosant volume. CONCLUSION: This study demonstrated physician-reported and patient-reported improvement in fistulas following serial HTS injections. HTS injections were well tolerated.

Pityriasis Lichenoides et Varioliformis Acuta as a Complication of COVID-19 Infection.

Pityriasis lichenoides is an acute and/or chronic skin disease associated with recurrent erythematous papules that self-resolve. While its etiology is unknown, preceding viral infection may play a role. We present an atypical case of a 40-year-old woman with pityriasis lichenoides et varioliformis acuta as a complication of a COVID-19 infection.

Yin and Yang of skin microbiota in "swimmer acne".

Cutibacterium acnes (C. acnes) is an organism implicated in the pathogenesis of acne. Despite regular immersion in antimicrobial chlorine, adolescent swimmers suffer from acne and tend to be resistant to standard therapies. Given the presence of Pseudomonas within swimming facilities, we hypothesized that "swimmer acne" is potentially driven by a different microbial mechanism. In this study, we aimed to examine the microbial dynamics of C. acnes and Pseudomonadaceae, a family of gram-negative bacteria (includes Pseudomonas aeruginosa), in swimmers and its potential contribution to the pathogenesis of acne in this population. Using fluorescence photography that measures the Coproporphyrin III (CPIII), we quantitated an absolute abundance of C. acnes present on the face of each participant pre- and post-swimming. In addition, 16S rRNA gene sequencing was utilized to assess relative abundance of the skin microbiota on each participant pre- and post-swimming. 16 swimmers (8 girls and 8 boys) completed the study. Seven had acne on the face. The CPIII fluorescence levels decreased for all swimmers after 1 h of swimming (p-value <0.001). In contrast, the relative abundance of C. acnes remained unchanged, while that of Pseudomonadaceae increased after swimming (p-value =0.027). Comparing the relative abundances of Pseudomonadaceae before swimming, there was a significant increase in variance from the mean in acne group as compared to no acne group (p-value <0.001). Taken together, we conclude that the skin dysbiosis resulting from repeated decolonization and colonization of C. acnes and Pseudomonadaceae, respectively, can potentially be associated with the pathogenesis of acne in swimmers.

Effects of swimming on facial sebum in adolescents.

Swimmers often complain of dry skin, consistent with decreased skin sebum levels, and yet may also have acne, which is commonly related to elevated sebum levels. Sixteen adolescent swimmers with and without acne were enrolled to examine two markers of facial sebum levels before and after 1 hour of swimming. Swimmers with acne did not have significant decreases in their sebum levels or shine measurements after swimming, whereas swimmers without acne did. Overall, swimming may remove superficial sebum more than follicular sebum and therefore leave swimmers subject to both dry skin and acne simultaneously.

Methotrexate shows benefit in a subset of patients with severe hidradenitis suppurativa.

BACKGROUND: Methotrexate is an immunomodulatory therapy that may offer benefit to patients with hidradenitis suppurativa (HS). Despite its theoretical advantages, there is a paucity of available data regarding long-term methotrexate use in patients with HS. OBJECTIVE: This study aimed to assess whether methotrexate treatment leads to improvement in HS disease severity. METHODS: We conducted an institutional review board-approved, single-center, retrospective chart review of patients with HS who were treated with methotrexate between 2000 and 2018. Primary outcome measurements included the HS Physician's Global Assessment (HS PGA), Hurley staging, abscess count, fistula count, and inflammatory nodule count. RESULTS: A total of 29 patients were identified; 14 were excluded for reasons including never starting methotrexate and missing follow-up data. For remaining patients (n = 15), the average cumulative dose of methotrexate was 520.1 mg (range, 30-1665 mg) and the average length of treatment was 11.7 months (range, 1-38 months). Patients taking methotrexate as a primary therapy had a higher cumulative dose and length of treatment (520.13 mg; 14.6 months) compared with those taking biologics concomitantly (468.44 mg; 9.1 months). Patients using methotrexate as primary therapy demonstrated nonsignificant reductions in HS PGA, inflammatory nodule count, and abscess count. Patients on concomitant biologic therapy failed to demonstrate any change in HS PGA, inflammatory nodule count, and abscess count. LIMITATIONS: Limitations of the study include its retrospective nature, small sample size, length of time on methotrexate between groups, and homogeneity of the patient population. CONCLUSION: Methotrexate may represent an effective treatment option in older patients with lower body mass indices but fails to offer benefit in patients taking concurrent biologic therapy.

Biologic therapies for the treatment of hidradenitis suppurativa.

Introduction: Hidradenitis suppurativa (HS) is a chronic skin disorder characterized by inflammatory nodules, abscesses, and fistulae. Patients tend to present in young adulthood and are predominantly female. The pathogenesis of HS involves apopilosebaceous gland follicle occlusion and affected areas often occur where this type of gland predominates. Treatment selection depends on HS severity, which is included in different scoring systems. In recent years, biological therapies have been evaluated and used with increasing frequency in moderate-to-severe HS disease.Areas covered: This review focuses on biological therapies for HS as assessed in case reports, case series, and clinical trials. The efficacy, hidradenitis suppurativa scoring systems, and long-term results of these therapies are discussed depending on the studies' endpoints.Expert opinion: Adalimumab is currently the only FDA-approved HS biological therapy. Some patients do not experience treatment efficacy with adalimumab at 40 mg/week, which may result in increasing the dose or seeking other treatments. Infliximab is the next line of HS treatment with demonstrated efficacy. Other biological therapies being studied have demonstrated efficacy in small patient groups, but lack study power. Further studies may provide answers to seeking treatment options for patients who fail to improve on current standard HS treatment.

Apocrine adenocarcinoma of the eyelid: case report and literature review on management.

Apocrine adenocarcinoma of the eyelid is a rare sweat gland cancer. It is predominant in older adults and has increased prevalence in males. Management is based on recommendations from reported cases and their outcomes. Surgical excision is considered effective in apocrine adenocarcinoma of the eyelid. We report the case of a 58-year-old woman with apocrine adenocarcinoma located on her left upper eyelid. Excisional biopsy demonstrated focal apocrine secretion in a basaloid nest proliferation. The patient had no recurrence at four months. Our case provides insight into the workup and management of eyelid apocrine adenocarcinoma. Furthermore, we discuss key management recommendations according to previous authors' experiences with eyelid apocrine adenocarcinoma.

Fibro-osseous pseudotumor on the hyponychium of the great toe.

Fibro-osseous pseudotumor of the toe is a benign soft tissue tumor that is predominant in the young adult population. Although the etiology is unknown, a history of trauma has been reported to precede tumor development. The differential diagnosis includes myositis ossificans, extraskeletal osteosarcoma, and pyogenic granuloma. Once removed, the tumor typically has no recurrence. Surgical excision is the treatment of choice. We present a patient with fibro-osseous pseudotumor of the great toe, which had no recurrence following excision.

The Development of Psoriasis Over a Silicone Granuloma: Case Report and Postulated Mechanism of Pathogenesis.

Liquid silicone injections are used for soft tissue augmentation and have the potential to cause adverse effects. A 60-year-old woman who developed a psoriatic lesion over a silicone granuloma is reported. The clinical, dermatoscopic, and histological findings were characteristic of psoriasis. The patient was started on hydroxychloroquine for the treatment of the granuloma without any subsequent development of new psoriatic lesions. The presentation of psoriasis associated with a silicone granuloma in an immunocompetent patient is unique. The sequence of events is another example of a dermatosis occurring in an immunocompromised cutaneous district.

Adult-onset papular purpuric gloves and socks syndrome.

Papular purpuric gloves and socks syndrome (PPGSS) is a self-limited exanthem that presents as painful or pruritic edema, erythema, petechiae, and purpura of the palms and soles with occasional extension to the dorsal hands and feet. The majority of PPGSS cases reported in the literature are associated with parvovirus B19 and occur in children and young adults. In a recent literature search, there were 11 PPGSS cases in adults with none reporting Epstein-Barr virus (EBV) as a viral etiology. However, there have been PPGSS cases related to EBV in children. We report the case of a 72-year-old man with PPGSS associated with Epstein-Barr virus. This case report serves as a reminder that PPGSS can present not only in the setting of pediatric and young adult parvovirus B19 infection, but also in immunocompetent adults with other viral infections.

Delusional infestation in psychodermatology.

Delusional infestation (DI), also known as delusional parasitosis, consists of a patient's strong belief that he or she is infested with a nonliving substance or living organism despite lack of medical evidence to support this belief. The most commonly reported sources of infestation include insects, fibrous strands, worms, and scabies. DI is predominantly seen in women and older patients. This disorder has a variable course and prognosis in patients. DI can be a primary psychiatric problem, or secondary to underlying medical conditions or other psychiatric disorders. It has been proposed that DI presents along a spectrum that includes four categories: overvalued concern of infestation, somatoform preoccupation, delusional state, and terminal delusional state. Management depends on the patient's category at presentation. The diagnostic approach for DI involves a thorough evaluation that can rule out medical conditions that underlie the patient's symptoms. This includes obtaining a detailed history, physical exam, and ordering laboratory tests. Treatment for primary DI includes both first and second-generation antipsychotics. Secondary DI treatment depends on the etiology. The prognosis of patients with DI is difficult to predict due to various factors including level of insight, underlying psychiatric conditions, and medication adherence. It is important for the physician to maintain a therapeutic relationship with the patient in order to properly address the patient's concerns.

Multiple eccrine spiradenomas in a zosteriform pattern.

Eccrine spiradenoma (ES) typically presents as a solitary tender lesion. Multiple ES is a rare variant of ES and can present in a segmental, linear, blaschkoid, or zosteriform pattern. The etiology of multiple ES is unknown, but several theories have been suggested including a multipotent stem cell origin. We report the case of a 30-year-old woman with multiple painful ES in a zosteriform pattern on the mid-back and abdomen. Skin biopsy of a representative lesion demonstrated a circumscribed tumor nodule encapsulated by a fibrous capsule with diffuse dense basophilic proliferation located in the dermis. The lesions were then excised on two separate sessions without recurrence.