Recurrent aphthous stomatitis: A comprehensive review and recommendations on therapeutic options.

Recurrent aphthous stomatitis (RAS) is a common chronic disease in the oral mucosa that affects about 20% of the population. It is characterized by solitary or multiple, recurrent, small ulcers with erythematous haloes and yellow/gray floors. RAS can be managed through a wide variety of preventative measures and therapies, intending to reduce ulcer pain, stimulate ulcer healing, and/or prevent ulcer recurrence. First-line treatment options include topical medications in the form of corticosteroids (triamcinolone acetonide), anti-inflammatory drugs (amlexanox), antibiotics (doxycycline), and antiseptics (lidocaine). In more severe cases of RAS where local treatment is insufficient, systemic drugs in the form of corticosteroids (prednisone), immunomodulatory drugs (thalidomide), and antibiotics/antimicrobials (clofazimine) can prove effective. This review will summarize current treatment options for RAS with discussion of prevention, topical measures, natural treatments, systemic therapies, and new potential therapies. Furthermore, this review will provide recommendations on therapeutic options for RAS based on disease severity and patient circumstances.

Treatment of calcinosis cutis associated with autoimmune connective tissue diseases.

Calcinosis cutis is a condition that is commonly associated with autoimmune connective tissue diseases. It is characterized by the deposition of insoluble calcium salts in the skin and subcutaneous tissue, which can cause pain, impair function, and have significant impacts on quality of life. Calcinosis cutis is difficult to manage because there is no generally accepted treatment: evidence supporting treatments is mostly comprised of case reports and case series, sometimes yielding mixed findings. Both pharmacologic and procedural interventions have been proposed to improve calcinosis cutis, and each may be suited to different clinical scenarios. This review summarizes current treatment options for calcinosis cutis, with discussion of recommendations based on patient-specific factors and disease severity.

Evaluating the research productivity of academic dermatologists based on the NIH-supported relative citation ratio.

The National Institutes of Health (NIH) recently developed an article-level metric called the relative citation ratio (RCR). It improves upon prior metrics such as the h-index in that it is field-normalized, allowing for more accurate comparisons of author productivity between fields. The RCR is also a more accurate metric for evaluating early-career stage investigators. We sought to provide benchmark RCR data of academic dermatologists and examine how factors such as gender, degrees, and academic rank impact RCR scores. Academic dermatologists were indexed using the NIH iCite database. Gender, additional degrees, academic rank, total number of publications, mean RCR, and weighted RCR were collected for each dermatologist. Mean and weighted RCR scores were compared by gender, degrees, and academic rank, with P values based on multiple linear regression. 1899 dermatology faculty members were included in the analysis. Academic dermatologists had a median mean RCR of 1.12 (interquartile range/IQR 0.65-1.73) and a median weighted RCR of 18.89 (IQR 4.67-62.18). Full professorship as well as Doctor of Philosophy acquisition were associated with an increase in mean and weighted RCR scores. Male gender was associated with an increase in weighted RCR scores. Interestingly, male and female academic dermatologists along with assistant and associate professors had similar mean RCR scores. Limitations of the study include the inability to differentiate dermatologists with the same name. The iCite website also only includes PubMed-listed articles from 1995 to 2021. Overall, academic dermatologists have a median mean RCR value greater than the NIH benchmark value of 1.00, suggesting that their publications are more impactful compared to those published by the general scientific community. The benchmark data from this study may prove useful for self-evaluation and also grant, hiring, and promotional decisions.

Intralesional cidofovir for the management of refractory cutaneous verrucae: a review of applications and opportunities.

Viral warts - manifestations of cutaneous infection by human papilloma virus - can be a significant physical and emotional burden for patients when common treatments fail, particularly for individuals who are immunocompromised or with multiple lesions. Cidofovir, an antiviral agent typically used for the treatment of cytomegalovirus infection, has emerged as an alternative treatment option for viral warts when administered topically or intralesionally. In this review, we highlight the scientific rationale, published evidence, and practical clinical uses of intralesional cidofovir for the management of cutaneous warts as well as ongoing questions requiring further research and exploration of this emerging therapy for refractory verrucae.

Adherence of dermatology home page websites to accessibility guidelines for persons with disabilities.

Patients with disabilities utilize accommodations or assistive technologies to access content from healthcare websites, but not all websites are built accessibly. We sought to evaluate the accessibility of dermatology home page websites from the 3 largest hospitals in each state of the United States (n = 150) using evaluation tools SortSite 6.42.924.0 and the Web Accessibility Evaluation Tool (WAVE). Of 150 hospitals evaluated, 128 (85%) were teaching hospitals and 48 (32%) were from the southern United States. The average numbers of contrast errors and all other errors detected by WAVE were 13.6 and 8.9, respectively. The mean number of Level A, AA and AAA issues detected per WCAG 2.1 guidelines were 5.7, 1.5, and 2.5, respectively. There were no significant differences in any accessibility metrics between teaching and non-teaching hospitals. Overall, dermatology home page websites have an average of 6 failures to meet the baseline A criteria of WCAG 2.1 and no websites were completely adherent to standards. The mean elements of contrast errors, other errors, alerts, and structural elements issues were all greater in the dermatology websites than in a federal public health website in a global analysis. Inaccessible dermatology websites present a significant barrier for patients to schedule and receive dermatologic care at hospitals nationally and may result in adverse outcomes for this underserved population. Dermatologic care teams and web developers must prioritize improving the accessibility of their websites to benefit all patients.

Clinicopathologic features of ecthyma gangrenosum: a single integrated health system cohort.

Ecthyma gangrenosum is an uncommon cutaneous eruption that can initially present with painless macules, which rapidly evolve into necrotic ulcers. This study sought to characterize clinicopathologic features of ecthyma gangrenosum from a single integrated health system. Our cohort consisted of 82 individuals diagnosed with ecthyma gangrenosum. Lesions were most commonly found in the lower extremities (55%) and the truncal region (20%). A wide variety of fungal and bacterial etiologies were found among our cohort. The majority of patients with EG were immunocompromised (79%) and 38% of patients also experienced sepsis. The mortality rate seen in our cohort was approximately 34%. No statistical differences in mortality outcome due to EG related complications were seen between pathogen etiology, and distribution or location of lesions. Patients who were septic or immunocompromised died more frequently than non-septic or immunocompetent patients, suggesting poorer prognosis.