Oral Prescription Management.

The treatment of atopic dermatitis (AD) with oral treatments has been limited in the past due to the increased risk of adverse effects associated with oral agents. However, in recent years, a shift toward the minimization of adverse effects has been explored. Although existing treatment options like oral corticosteroids and Immunosuppressive therapies have been utilized for acute flare-ups of AD, their long-term use is limited by adverse effects and the need for lab monitoring. New systemic treatment options such as Janus kinase (JAK) inhibitors are emerging as a promising therapy, due to their quick onset and antipruritic features. However, the black box warning associated with this medication class requires careful selection of appropriate candidates and patient education despite early favorable safety profiles seen in AD trials. Discussion of other oral agents, like antibiotics and antihistamines, and their role in AD management are also clarified.

Interstitial granulomatous dermatitis and granulomatous arteritis in the setting of PD-1 inhibitor therapy for metastatic melanoma.

Checkpoint inhibition has become an important target in the management of malignant melanoma. As anti-CTLA4 inhibitors and anti-PD1 antibodies are increasingly utilized, reports of immune-related adverse events (IRAEs) are becoming more frequent. Common noted cutaneous IRAEs are morbilliform, lichenoid, bullous, granulomatous, psoriasiform, and eczematous eruptions. We report a case of interstitial granulomatous dermatitis and granulomatous arteritis in the setting of nivolumab (anti-PD1) monotherapy for metastatic melanoma. There are many different causes for granulomatous vasculitis, such as herpes virus infection, lymphoproliferative disorders, systemic vasculitis, and inflammatory bowel disease. This report adds to the growing literature on granulomatous IRAEs due to checkpoint inhibition.

Disseminated intravascular coagulation: A devastating systemic disorder of special concern with COVID-19.

Disseminated intravascular coagulation (DIC) is linked with severe COVID-19, prompting considerable concern. DIC can be a devastating systemic disorder. It is often markedly manifest on the skin as acrocyanosis or as petechiae and purpura with progression to hemorrhagic bullae. Subcutaneous hematomas may occur, as may thrombotic findings including necrosis and gangrene. The most common cause is infection, with special emphasis now on COVID-19. We have reviewed the medical literature under the search terms "Disseminated intravascular coagulation" and "consumption coagulopathy" for the past two decades in the English language using Medline and Google Scholar to update special concerns and considerations, focusing on those with COVID-19. Skin findings with DIC may be prominent. The severity of cutaneous lesions often correlates with the gravity of systemic disease. DIC is most effectively treated by addressing the underlying cause and resuscitating the patient using supportive measures. It is pivotal to recognize and treat DIC early, before deadly complications, such as multiple organ failure, arise.

Occult Patient Intervention Leading to Misleading Histopathology.

Patients with skin conditions may apply or consume a wide variety of "remedies" with a similarly wide range of effects that may alter the clinical and/or dermatologic presentations of the lesion. Dermatologists or other clinicians should probe for this and carefully document such treatment, as well as any treatment administered by a health care professional or any other person. The dermatopathologist, however, cannot assume that this has been done or done successfully, and therefore must be on constant alert to recognize the effects of such "remedies."

Superficial spreading melanoma: an analysis of 97 702 cases using the SEER database.

Superficial spreading melanoma (SSM) is the most common type of melanoma. Large, population-based studies analyzing the incidence and survival of SSM are limited. This retrospective study was designed to evaluate demographic factors influencing the incidence and survival of SSM using a national population-based database. The United States National Cancer Institute's Surveillance, Epidemiology, and End Results registry was used to calculate incidence and disease-specific survival trends for SSM between 1973 and 2012. Patient data were stratified according to age, sex, race, ulceration, thickness, and stage. Of 97 702 patients, 52.66% were men, 94.93% were white, and 38.92% had a primary lesion on the trunk. The overall incidence is 5.987/100 000 and is increasing with an annual percentage change (APC) of 1.42%. Incidence increases with age, peaking at 70-79 years. Men (6.68/100 00, APC: 1.78) had a significantly higher incidence than women (5.565/100 000, APC: 1.10). A total of 79.16% of SSM are less than or equal to 1 mm and 92.32% are nonulcerated. The overall 5-year survival is 95.30% and is increasing steadily. Women (hazard ratio: 0.54), 'other' races (hazard ratio: 0.30), those with local disease, those with thin tumors, and those without ulceration had higher survival than their counterparts (P<0.0001). The incidence of this predominantly thin melanoma subtype is on the rise, creating enhanced concern. Primary and secondary prevention techniques should consider the mortality associated with thin melanoma.