Skin and Connective Tissue Diseases Commons^™

Actinic Granuloma Complicated By Secondary Syphilis: A Case Report, Kevin H. Nguyen, Christopher M. Wong, Ethan Q. Nguyen

HCA Healthcare Journal of Medicine

Introduction

Actinic granuloma (AG) is a rare skin eruption thought to result from a sun-induced inflammatory response attracting giant cells, which are large, multinucleated, and inflammatory, to form granulomas and degrade surrounding elastic material. Clinically, lesions begin on sun-exposed skin as pink papules and nodules that coalesce into demarcated annular plaques with a hypopigmented center. Histologically, actinic elastosis surrounds the outer annulus ring, with histiocytes and giant cells within the raised border, and the innermost central zone is filled with minimal to absent elastic fibers.

Case Presentation

We present a middle-aged female with a pruritic eruption of diffuse erythematous macules …

Management Of Keloid-Associated Pruritus With Topical Crisaborole 2% Ointment: A Case Report, Daniel A. Nguyen, Elizabeth Thai Ms, Stephen E. Weis

HCA Healthcare Journal of Medicine

Introduction

The pathophysiology of keloid formation is poorly understood, and current treatments, including intralesional corticosteroids, cryotherapy, and surgery, are often associated with high resistance to treatment and recurrence. The multifactorial pathogenesis of keloid formation suggests that aberrant inflammatory cytokine signaling associated with keratinocyte dysregulation may contribute to keloid-associated pruritus.

Case Presentation

In this paper, we report 2 cases of keloid-associated pruritus that were successfully treated with topical crisaborole 2% ointment, a phosphodiesterase 4 (PDE4) inhibitor. Both patients had previously undergone multiple unsuccessful treatments before being treated with crisaborole 2% ointment. In both cases, the patients experienced complete relief of pruritus …

Presentations Of Cutaneous Disease In Various Skin Pigmentations: Porokeratosis, Henry Lim, Christopher M. Wong, Christian J. Scheufele, Daniel A. Nguyen, Michael Carletti, Stephen E. Weis

HCA Healthcare Journal of Medicine

Porokeratosis was first described in 1893. It is a relatively rare disorder with over 9 subtypes. Lesions are clinically characterized as well-demarcated, erythematous papules (raised, <1 cm) or plaques (raised, >1 cm), with an atrophic center, and raised scaly border. Porokeratosis is an important diagnosis to identify because it may undergo malignant transformation and mimics many commonly encountered diagnoses. These commonly mimicked diagnoses include squamous cell carcinoma, tinea corporis, nummular dermatitis, and psoriasis vulgaris, to name a few. The clinical images in this review focus on identifying porokeratosis along the full spectrum of skin tones.

Presentations Of Cutaneous Disease In Various Skin Pigmentations: Chronic Atopic Dermatitis, Cecilia Nguyen, Jordan Thompson, Daniel A. Nguyen, Christopher M. Wong, Christian J. Scheufele, Michael Carletti, Stephen E. Weis

HCA Healthcare Journal of Medicine

Atopic dermatitis is a chronic inflammatory skin disorder classically affecting flexural areas of the body. It is present in children and adults, including those with darker skin pigmentation. Chronic lesions are hyperpigmented plaques that are dry, cracked, and/or scaly often with lichenification. Differential diagnoses include psoriasis, seborrheic dermatitis, ichthyosis, and pityriasis rosea. This article will showcase clinical images with varying presentations of chronic atopic dermatitis in a range of age groups and skin colors according to the Fitzpatrick scale.

Presentations Of Cutaneous Disease In Various Skin Pigmentations: Seborrheic Dermatitis, Christian J. Scheufele, Christopher M. Wong, Daniel A. Nguyen Do, Pharmd, Michael Carletti, Stephen E. Weis

HCA Healthcare Journal of Medicine

Seborrheic dermatitis is a common dermatologic disease affecting patients of all ages, ethnicities, and skin pigmentations. The rash often affects the scalp, ears, and central face. The underlying skin pigmentation of the individual may affect how this disease presents. We present several cases of seborrheic dermatitis in individuals of varying ages, genders, and skin pigmentations.

An Unusual Presentation Of Tapinarof-Induced Folliculitis, Ysabelle Martinez, Christian J. Scheufele, Christopher Wong, Stephen E. Weis

North Texas GME Research Forum 2024

Introduction: Tapinarof 1% cream is a novel non-steroidal topical medication recently FDA-approved for plaque psoriasis. Tapinarof’s non-steroidal mechanism allow for longer treatment periods without topical corticosteroid side effects e.g. skin atrophy, hypopigmentation, telangiectasias, and striae. Adverse events identified during pivotal trials may not be completely defined before widespread clinical use. This case reports a new presentation of folliculitis with tapinarof use. Case Presentation: A 25-year-old female with trisomy-21 presented for a rash on her left lower leg. The eruption began one year earlier. The eruption was not associated with pruritus, joint pain or nail changes. A clinical diagnosis of …

Retrospective Review Of Adverse Events After Treatment Of Non-Melanoma Skin Cancer With Image-Guided Superficial Radiation Therapy, Marshall Hall, Henry Lim, Jason Pham, Alyssa Forsyth, Wenqin Du

North Texas GME Research Forum 2024

No abstract provided.

Crusted Scabies: A Case Report, Marshall Hall, Philip Oh, Michael Carletti, Stephen E. Weis

North Texas GME Research Forum 2024

Introduction: Scabies is a parasitic dermatologic condition that often presents as an extremely pruritic rash. A rare and highly contagious variant of scabies is crusted scabies, formerly known as Norwegian scabies. Crusted scabies presents with hyperkeratotic papules and plaques, most commonly on the palms and soles. Due to the variety of presentations seen in scabies, it can be difficult to diagnose. Case presentation: Case 1: An 89-year-old male with a history of dementia, anxiety, and benign prostatic hyperplasia presented with a 2-month history of a generalized pruritic rash. He lived in a memory care center. The physical exam showed an …

Presentations Of Cutaneous Disease In Various Skin Pigmentations: Steroid Atrophy, Marshall Hall, Ysabelle Martinez, Wenqin Du, Christian Scheufele, Christopher M. Wong

North Texas GME Research Forum 2024

Introduction: Topical steroids are commonly prescribed first-line medications for various inflammatory and autoimmune dermatologic conditions. Their widespread use raises the importance of proper use. Topical steroids have well-known side effects including skin atrophy, redness, striae, and telangiectasias. These side effects have not been well documented in patients of various skin tones. Primary care clinicians must recognize topical steroid side effects and their appearance in various skin tones. This paper will focus on representing skin atrophy, the most common steroid side effect, in a variety of Fitzpatrick skin types. Case Presentation: We present a series of images illustrating skin atrophy …

Geometric Favre-Racouchot Syndrome Following Image-Guided Superficial Radiation Therapy, Marshall Hall, Cecilia Nguyen, Christian Scheufele, Christopher M. Wong, Stephen E. Weis

North Texas GME Research Forum 2024

Introduction: Favre-Racouchot Syndrome is a cutaneous disease characterized by nodules, cysts, and comedones located in sun-exposed areas of the face. It is most commonly found on the bilateral temporal and periorbital skin. Favre-Racouchot Syndrome is most associated with chronic sun exposure. It occurs more commonly in cigarette smokers. It has been rarely associated with radiation therapy. It has not been reported after image-guided superficial radiation therapy or in a geometric pattern. Case presentation: We present the first two recorded cases of Favre-Racouchot Syndrome occurring in the setting of image-guided superficial radiation therapy. Both patients presented with well-demarcated geometric plaques with …

Presentations Of Cutaneous Disease In Various Skin Pigmentations: Tinea Corporis, Navya Peddireddy, Braden Van Alfen, Christian Scheufele, Marshall Hall, Christopher M. Wong

North Texas GME Research Forum 2024

Introduction: Tinea corporis, a superficial fungal skin infection, typically manifests as pruritic annular erythematous scaly plaques with central clearing. This condition can involve every body region. Here we present tinea corporis across various skin pigmentations. The goal of this presentation is to highlight distinctions and similarities in light, medium, and dark skin tones, using the Fitzpatrick scale for stratification of skin types. We hope this can aid primary care clinicians in early recognition of this common condition. Case Presentation: We present a series of cases illustrating the diverse manifestations of tinea corporis across different Fitzpatrick skin types. In Figure 2, …

Bilateral Corticosteroid Atrophy Mimicking Morphea En Coup De Sabre: A Case Report, Christopher M. Wong, Jade Pool, Rafael Do Valle, Cassandra Kenny, Dustin V. Wilkes

North Texas GME Research Forum 2024

Introduction: Corticosteroids affect numerous downstream cytokines to exert anti-inflammatory and immunosuppressive effects. Intralesional corticosteroid injection provides several advantages, including bypassing the stratum corneum to deliver a higher concentration of drug locally, while reducing systemic exposure. Intralesional corticosteroids are used in a variety of dermatologic conditions, and suboccipital steroid injection has been described as a novel treatment for cluster headaches. Case Presentation: A 52-year-old Caucasian female presented to the outpatient dermatologic clinic with indented skin lesions on the scalp and forehead for six weeks. The indentation started on her left frontal scalp and spread down gradually to her forehead and temple. …

Improving Lesion Diameter Reporting On Skin Biopsy Requisition Forms: A Quality Improvement Project, Christopher Wong, Christian Scheufele, Marshall Hall, Henry Lim, Daniel A. Nguyen

North Texas GME Research Forum 2024

Background: Skin biopsy requisition forms (SBRFs) are the primary communication tool between dermatologists and dermatopathologists. Diameters of biopsied skin lesions are frequently omitted on SBRFs. This quality improvement project aimed to increase the rate of reporting diameters of neoplasms on SBRFs from an academic dermatology outpatient clinic to greater than 65% within three years. Methods: The Plan-Do-Study-Act model was utilized. An initial audit was performed for SBRFs of biopsies obtained between July 1, 2021, and February 4, 2022 (“Cycle 1”). On February 4, 2022, the authors discussed societal guidelines for lesion diameter reporting on SBRFs (“Intervention A”). Cycle 2 prospectively …

In Tint Condition: Analysis Of Actice Ingredients In Popular Tinted Moisturizers And Facial Sunscreens, Nadia El-Hamdi, Peyton Harris, Sloan Long, Sheeva Shahinfar, Palak Parekh

Gulf Coast Division GME Research Symposium 2024

No abstract provided.

Cytochrome P450 Alterations In A Patient Treated With Guselkumab For Moderate-Severe Plaque Psoriasis, Michelle Militello, Sarah Ferrer-Bruker

South Atlantic Division GME Research Day 2024

No abstract provided.

Facial Angiosarcoma Masquerading As Rosacea, Rachel Murray, Danielle Glinka, Juan Rosario-Collazo, Karthik Krishnamurthy

South Atlantic Division GME Research Day 2024

No abstract provided.

A Rare Case Of Epithelioid Hemangioendothelioma In A Teenager, Layal Antoury, Sarah Ferrer Bruker, Karthik Krishnamurthy

South Atlantic Division GME Research Day 2024

No abstract provided.

Resolved Peristomal Erosive Papulonodular Dermatitis Mimicking Nevoid Hyperkeratosis Of The Nipple And Areola, Christa M. Tomc, Daniel A. Nguyen, Joseph S. Susa, Stephen E. Weis

HCA Healthcare Journal of Medicine

Introduction

Nevoid hyperkeratosis of the nipple and areola (NHKNA) is a rare cutaneous entity with a distinct clinical and histological presentation. The type II form of this condition can result from various dermatoses, such as irritant contact dermatitis. Erosive papulonodular dermatitis is a chronic irritant dermatitis that often occurs in areas of occlusion and maceration, such as peristomal skin. Pseudoverrucous papules and nodules are a variant of erosive papulonodular dermatitis and have a non-specific histologic pattern of reactive hyperplasia.

Case Presentation

We present a case of a patient with resolved peristomal erosive papulonodular dermatitis who presented status-post ileostomy reversal with …

Death Due To Drug Reaction With Eosinophilia And Systemic Symptoms (Dress) Syndrome: A Case Report, Samantha P. Sternad, Jane Pangburn, Chad Johnston, David Rowe

HCA Healthcare Journal of Medicine

Background

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening, multi-organ adverse drug reaction with an incidence of 1 in 1000 to 1 in 10 000 highrisk drug exposures.

Case Presentation

An elderly female presented to the hospital with progressive weakness and a diffuse erythematous macular rash covering most of her body that started 3 days prior. Over the next 3 days, the patient quickly deteriorated, developing disorientation with acute onset left-sided weakness, leukocytosis, thrombocytopenia, eosinophilia, liver and kidney failure, and hypoxia. Clinical and histological changes supported the diagnosis of DRESS syndrome caused by intravenous (IV) ampicillin …

Presentations Of Tumor Recurrence Of Non-Melanoma Skin Cancer After Treatment With Low-Energy Superficial Radiation Therapy, Marshall Hall, Henry Lim, Christian Scheufele, Christopher M. Wong, Daniel A. Nguyen, Michael Carletti, Stephen Weis

North Texas GME Research Forum 2023

Background: Basal cell carcinoma and squamous cell carcinoma are the most common types of non-melanoma skin cancers.1 Superficial radiation therapy (SRT) is a treatment modality that utilizes low-energy x-rays to disrupt cell mitosis.2 While this technique has been used for over a century, it has recently gained favor in clinical practice.3,4 This method of treatment offers favorable outcomes and advantages for select patients. Although the incidence of cancer recurrence after superficial radiation therapy is low, relatively little is known regarding predictive patterns. The frequency and timing of cancer recurrence is not well defined using SRT delivered technology with an image-guided …

Retrospective Review Of Adverse Events Following Treatment Of Non-Melanoma Skin Cancer With Low-Energy Superficial Radiation Therapy, Marshall Hall, Henry Lim, Christian Scheufele, Christopher Wong, Daniel A. Nguyen, Michael Carletti, Stephen Weis

North Texas GME Research Forum 2023

Background: Basal cell carcinoma and squamous cell carcinoma are the most common types of non-melanoma skin cancer.1 Superficial radiation therapy (SRT) is a treatment modality that utilizes low-energy x-rays to disrupt cell mitosis directly and indirectly.2 This method of treatment offers advantages for select patients. While this technique has been utilized for over a century, it has recently begun to gain favor in clinical practice.1,3 Although SRT has shown favorable outcomes with a low risk of complications, it still poses a risk for adverse events.1,3,4 The frequency and severity of adverse events are not well-defined with SRT delivered technology with …

Lesion Size Inclusion On Dermatopathology Requisition Forms: A Quality Improvement Project, Christopher M. Wong, Henry Lim, Christian Scheufele, Daniel A. Nguyen, Ashleigh E. Hermann, Michael Carletti, Stephen Weis

North Texas GME Research Forum 2023

Introduction: Dermatopathology requisition forms (RFs) are a critical communication tool between dermatologists and dermatopathologists. Including detailed information on RFs improves the diagnostic accuracy of the consulting dermatopathologist. However, the diameter of the biopsied lesion is often omitted on RFs. This study aimed to increase the rate of reporting lesion diameters on RFs from an academic outpatient dermatology clinic to greater than 65% through education, reinforcement, and evaluation. Methods: This quality improvement project retrospectively and prospectively analyzed the inclusion rate of lesion diameters on dermatopathology RFs from a single institution. In Phase 1, data was collected from all skin biopsies performed …

A Challenging Mimicker: Uncovering Hypopigmented Mycosis Fungoides From Common Benign Dermatoses, Paola Torres-Laboy, Rachel Dykes, Michelle Foley, Karthik Krishnamurthy

South Atlantic Division GME Research Day 2023

No abstract provided.

A Case Of Aquagenic And Cholinergic Urticaria, Marilian A. Canals Rivera, Kyle Rauch, Amanda Brenner, Victoria Charry

South Atlantic Division GME Research Day 2023

No abstract provided.

Blastic Plasmacytoid Dendritic Cell Neoplasm, Jacquelyn Medina, Adam Chahine, Courtney Bernett, Karthik Krishnamurthy

South Atlantic Division GME Research Day 2023

No abstract provided.

Puzzling Painful Cutaneous Nodules: A Sign To Dig Deeper, Preetha Kamath, Angelia Stepien, Brandon Beal, Courtney Bernett, Karthik Krishnamurthy

South Atlantic Division GME Research Day 2023

No abstract provided.

The Importance Of Recognizing The Many Facets Of Crohn’S Disease, Alexander Howell, Rachel Murray, Ann Church, Karthik Krishnamurthy

South Atlantic Division GME Research Day 2023

No abstract provided.

A Rare Case Of Demodicosis Following Treatment Of Oral Fluconazole, Joshua Bezecny, Emily Bolton, Matthew H. Taylor, Elizabeth G. Berry

Continental, MidAmerica, & Mountain Divisions GME Research Day 2023

No abstract provided.

Skin Of Color Representation On Wikipedia, William Kim, Sophia Wolfe, Caterina Zagona-Prizio, Robert P. Dallavalle, Natasha Fazel, Ryan Spilman

Continental, MidAmerica, & Mountain Divisions GME Research Day 2023

No abstract provided.

Slow Mohs For Sebaceous Carcinoma Of The Scalp, Heather Kopecky, Angela Rosenburg, Brett Thomas, Richard Miller

West Florida Division GME Research Day 2023

No abstract provided.