Dermatology Commons^™

The Importance Of A Broad Differential Diagnosis: Hepatitis C Virus Associated Cryoglobulinemic Vasculitis, Shadi Jafari-Esfahani, Christine E. Loftis, Juan Naranjo, Emilia Dulgheru

Research Symposium

Introduction: Mixed cryoglobulinemia syndrome (MCS) is a systemic inflammatory syndrome affecting small-medium sized vessels due to the presence of type II or III cryoglobulins in the serum. MSC can manifest as systemic vasculitis with symptoms varying from weakness, arthralgia, palpable purpura, peripheral neuropathy, and renal involvement. The most common cause of MCS includes lymphoproliferative disorders, autoimmune diseases and viral infections, with hepatitis C virus (HCV) being the most common etiology.

Case Presentation: A 60-year-old lady was referred to our office for evaluation of rheumatoid arthritis. She reported history of bilateral thumb pain, bilateral knee pain associated with episodes of swelling, …

Patchy Alopecia In A Young Adult With A Generalized Rash, Oscar Rodrigo Zamudio Herrera, Nevin Varghese

Research Symposium

Background: Syphilis is a sexually transmitted infection that has been increasing in the United States. The prevalence of syphilis rose by 6.8% during 2019-to 2020. Secondary syphilis typically presents with a generalized maculopapular rash on palms and soles, however, can also have subtle dermatological findings such as alopecia. Syphilitic alopecia is an atypical manifestation of secondary syphilis, seen in 2.9 to 7% of the cases.

Case presentation: An 18-year-old Hispanic male presented to the clinic after noticing patchy loss of hair on the scalp for 2 weeks and one week of generalized non pruritic rash. His past medical history was …

Malignancy Or Dermatophyte Infection? The Challenges In Evaluation Of Chronic Diffuse Rashes, Margi Nayak, Humaira Bibi, Anthony Cimmino, Xuan Ouyang, Jonathan Fairley

Research Day

Introduction: The purpose of our case presentation is to help understand the use of diagnostic studies in differentiating diffuse rashes with potentially underlying malignant etiology from infectious etiology.

A 40 y.o. F with a past medical history significant for anemia presented to the ED with painful rashes that had been getting worse for over 1 year. She mentioned that initially the rash began on her arm around the time when her 2 dogs were being treated for fungal infection and then it started spreading to her chest, back, upper extremities, lower extremities, abdomen, and genital areas as well. She described …

Case Series Of Common Skin Lesions Encountered In Elderly Cadavers: A Dermatopathology Analysis, Tamryn L. Van Der Horn, Brigitte L. Cochran, Savita Arya

Research Day

INTRODUCTION: Gaining hands-on experience in both dermatology and pathology is a common barrier that prevents first and second year medical students from refining skills that are not later taught until residency. This prompted a study to develop gross differential diagnostic skills and how to analyze histopathology slides to diagnose common skin lesions to refine skills in both clinical and histology presentation for medical students.

METHODS: A case series was designed to examine multiple shave biopsies on all abnormal skin lesions observed from nine cadavers used for the first-year medical students gross anatomy lab during the year 2022-2023. Biopsies were stained …

The Clinical Definition And Characterization Of Field Of Cancerization In Patients With Actinic Keratoses, Stuti Prajapati, Christina Kontzias, Mallory Zaino, Steven Feldman

Rowan-Virtua Research Day

Introduction: Chronic UV radiation affects the entire area of skin exposed, leading to visible actinic keratoses (AK) and subclinical changes in the surrounding skin. AKs are hyperkeratotic lesions, with a 0.025-16% risk of transforming into squamous cell carcinoma (SCC).1 Cellular atypia around AKs is the field of cancerization (FOC). Topical AK therapies can treat the FOC, while destructive treatments address visible lesions. FDA-approved products may be approved for field sizes up to 25 cm2.1,2

Objective: To characterize the FOC and assess the correlation between the FOC and number of AKs.

Methods: 100 patients with AKs were recruited. FOC was defined …

Barriers To Dermatological Care In Patients Who Received Extensive Mohs Surgery - An In-Depth Qualitative Analysis, Stuti Prajapati, Mallory Zaino, Christina Kontzias, Laura Doerfler, Steven R. Feldman

Rowan-Virtua Research Day

Background: Dermatological care needs to be accessible for the elderly, but they face prominent challenges contributing to delays in diagnosis and treatment. Prolonged management of may lead to widespread cutaneous malignancies, necessitating extensive Mohs surgery.

Objective: To identify areas for early intervention in the geriatric population who have undergone extensive Mohs surgery.

Methods: We performed a qualitative study on 10 patients 65 years and older (68-91) from Atrium Health Wake Forest Baptist dermatology clinics between December 2022 and February 2023, who had extensive Mohs surgery (3 or more layers removed).

Results: Three major areas for potential intervention for cutaneous carcinoma …

Case Report And Brief Review: A Case Of Erythema Ab Igne Due To A Space Heater, Adam Kandil, James Espinosa, Alan Lucerna, James Lee, Robin Lahr

Rowan-Virtua Research Day

A 35 year old male presented to the Emergency Department (ED) with a rash of his left lateral lower leg of a 2 months duration. The patient had been using an electric space heater and the affected area was the closest part of his body to the heater. A diagnosis of erythema ab igne was made. Here we discuss erythema ab igne in reference to the medical history of the diagnosis, pathophysiology, modern causative heat sources such as laptop computers and treatment.

New Onset Lichen Planus And Back Pain Leading To Discovery Of A Peri Aortic Abscess, Monica Diep, Wayne Tamaska, Philip Carhart, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Back pain is a common chief complaint in the emergency department. With the differential ranging from musculoskeletal pain to cauda equina, there are a plethora of diagnoses. Differentiating between benign back pain and back pain that warrants further evaluation and even possible emergent surgical intervention is often a challenge in the acute setting. In this case report, a strange combination of all new symptoms including lichen planus, fevers, chills and atraumatic back pain lead to the eerie and very unexpected diagnosis of a peri-aortic abscess.

Dorsal Wrist Impingement Syndrome Pain After Ganglion Cyst Removal – A Case Report, Sidharth Sahni, Joseph Fares, Natty Jumreornvong, Arpun Shah, Mariam Zakhary

Rowan-Virtua Research Day

A ganglion cyst is a benign fluid-filled sac that develops idiopathically on the dorsal aspect of the wrist by the joint capsule or tendon sheath. It is diagnosed clinically, with MRI and ultrasound used for confirmation. Treatment includes immobilization, aspiration, hydrossection, steroid or hyaluronidase injection, and surgery. Although uncommon, Dorsal Ganglion Cysts (DGC) can lead to Dorsal Wrist Impingement (DWI) syndrome. This syndrome is caused by a thickening of the wrist capsule from overuse, injury, or repetitive procedures. This thickness leads to capsule pinching commonly by the extensor carpi radialis brevis (ECRB) tendon during wrist extension and tenderness by the …

Case Report: Facial Mask-Induced Acne ("Maskne"), Gabriel Meister, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

A 42 year old male health care worker presented with complaints of severe mask related acne vulgaris predominately to the cheeks, chin and nose Here we present the case of a N95 and surgical facial mask use has been a requirement for many occupations during the Covid-19 pandemic. Patient states their current position requires use of an N95 respirator to be worn throughout their shift which can range from 9-14 hours, 6 days per week. Extended daily use of such masks may lead to changes in the skin which can induce irritation and precipitate infection.

Case Report: Nosocomial Digital Eczema From Surface Cleansing Bleach, James Espinosa, Umar Sannoh, Alan Lucerna

Rowan-Virtua Research Day

We report the case of a healthcare provider who developed hand eczema, predominantly on the first digit and thumb of the right hand, in association with contact with the surface of a desk and mouse pad at work. The eczema abated on days off and was exacerbated within hours of work. The diagnosis was made of hand eczema from surface cleaning bleach. It was noted that several other healthcare providers had developed similar symptoms. The patient's eczema was confirmed by a dermatologist and was successfully treated with topical triamcinolone and emollient cream to the affected areas. Prevention by adhesive strip …

Treatment Of Bullous Pemphigoid With Dupilumab: A Case Report, Margaret C. Hurley, Jocelynn F. Dillon, Harold J. Milstein

Research Day

Introduction: Bullous Pemphigoid (BP) is an autoimmune blistering condition that results from formation of autoantibodies against basement membrane hemidesmosome proteins, specifically BP180 and BP230. Classic BP presents as pruritic, tense blisters on the trunk and extremities, most commonly in the elderly. BP’s pathophysiology involves IL4/IL5/IL13 and eosinophils. Dupilumab is an IgG monoclonal antibody targeted at the IL4-α receptor that works to attenuate the IL4/IL13 pathway involved in T2 differentiation. Dupilumab has clinical applications for T2 mediated disease and shows promise in the therapy of BP.

Case Description: We report a case of an 83-year-old Asian male who presented in the …