Cosmetic Dermatology Training During Residency: Outcomes of a Resident-Reported Survey.

BACKGROUND: As the demand for cosmetic treatments increases, it is important for dermatology residents to be educated about and achieve proficiency in dermatologic cosmetic procedures. OBJECTIVE: To assess dermatology residents' educational exposure to cosmetic dermatology. MATERIALS AND METHODS: An anonymous 18-question survey was sent electronically to 1,266 dermatology residents requesting information about cosmetic dermatology training during residency. RESULTS: Two hundred sixty-eight residents responded to the survey (21% response rate). Most residents receive didactic instruction (94%) and hands-on training (91%) on cosmetic dermatology topics during residency. Survey participants in residency programs perceived as supportive of cosmetic dermatology training are more frequently provided lectures (70% vs 31%, p < .001) and procedural training (100% vs 69%, p < .001) in cosmetic dermatology as compared to residents in unsupportive programs. Eighty-nine percent of respondents reported hands-on training as the most effective method for developing proficiency in cosmetic procedures. CONCLUSION: Providing safe and competent patient care should serve as the impetus for expanding cosmetic dermatology education and training for residents.

Preferential secretion of inducible HSP70 by vitiligo melanocytes under stress.

Inducible HSP70 (HSP70i) chaperones peptides from stressed cells, protecting them from apoptosis. Upon extracellular release, HSP70i serves an adjuvant function, enhancing immune responses to bound peptides. We questioned whether HSP70i differentially protects control and vitiligo melanocytes from stress and subsequent immune responses. We compared expression of HSP70i in skin samples, evaluated the viability of primary vitiligo and control melanocytes exposed to bleaching phenols, and measured secreted HSP70i. We determined whether HSP70i traffics to melanosomes to contact immunogenic proteins by cell fractionation, western blotting, electron microscopy, and confocal microscopy. Viability of vitiligo and control melanocytes was equally affected under stress. However, vitiligo melanocytes secreted increased amounts of HSP70i in response to MBEH, corroborating with aberrant HSP70i expression in patient skin. Intracellular HSP70i colocalized with melanosomes, and more so in response to MBEH in vitiligo melanocytes. Thus, whereas either agent is cytotoxic to melanocytes, MBEH preferentially induces immune responses to melanocytes.

Painful parotid hypertrophy with bulimia: a report of medical management.

In eating disorders, such as bulimia nervosa, body image disturbance often extends beyond the realm of weight and shape into the dermatologic spectrum. While commonly associated conditions due to binging and self-induced vomiting include cutaneous entities (e.g., Russell's sign, acne, alopecia and hypertrichosis) and oral pathologies (e.g., enamel erosion, caries and mild parotid hypertrophy), a rare but troubling manifestation is disfiguring parotid enlargement (sialoadenomegaly). This article presents a case of painful sialoadenomegaly associated with hyperamylasemia in a bulimic patient successfully managed with pilocarpine.

A case of recurrent pseudolymphomatous folliculitis: A mimic of cutaneous lymphoma.

Pseudolymphomatous folliculitis is a rare entity. We present a 62-year-old man with a recurrent solitary nodule on his nose requiring multiple excisions. Microscopic examination of the excisions showed a dense lymphocytic infiltrate containing numerous histiocytes and S100+, CD1a+ dendritic cells that surrounded and infiltrated hypertrophic hair follicles. Diffuse sheets of CD3+ T cells and nodular clusters of CD20+ B cells were also seen. There was normal reactive pattern of follicular centers. Light chain restriction was not detected. T-cell receptor and immunoglobulin heavy chain gene rearrangements by polymerase chain reaction revealed negative findings. A diagnosis of pseudolymphomatous folliculitis was made based on the hypertrophic hair follicles, periadnexal S100+ and CD1a+ dendritic cells, and negative clonal gene rearrangement study findings. This case of recurrent pseudolymphomatous folliculitis is instructive because of the resemblance to cutaneous lymphomas and cutaneous lymphoid hyperplasias, and the need for correct diagnosis to avoid overtreatment of this indolent condition.

Primary cutaneous coccidioidomycosis.

Primary cutaneous coccidioidomycosis is usually secondary to laboratory or autopsy inoculation, but can result from trauma in endemic areas. We describe an unusual case of primary inoculation cutaneous coccidioidomycosis occurring in an immunocompetent woman in a nonendemic area. The clinical features, diagnostic tests, and therapy of this extremely rare disease are reviewed.