Dermatology Commons^™

The Impact Of Intralesional 5-Fluorouracil In The Treatment Of Keloid Scars, Madeline Derham

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Background

- The American Academy of Dermatology (AAD) defines a keloid scar as a type of raised scar extending past the initial area of injury¹

- Approximately 10% of the general population affected - significant risk factors include +family history, darker skin tones, mechanism of injury (burn, surgical)³

- Symptom presentation: pain, pruritus, burning, increased sensitivity³

- Varying existing treatment methods with high resistance and recurrence rates leading to no agreed upon standard approach⁵

• Most widely adopted method currently : intralesional (ILS) steroid ^injection5

Leser-Trélat Sign As A Marker For Underlying Pancreatic Cancer, Kalpit Modi, Richard Chen, Layla Abubshait

Einstein Health Papers

Case Presentation: Early diagnosis and rapid treatment of cancer is essential for good clinical outcomes for patients. In this case, an 85-year-old man presented with failure to thrive and was noted to have rapid-onset, multiple seborrheic keratoses (Leser-Trélat sign) on his chest and back. He was ultimately diagnosed with pancreatic cancer using computed tomography.

Discussion: Leser-Trélat sign is a rare cutaneous marker for underlying malignancy. Identification of this sign can help guide diagnostic imaging and lab work to identify an occult internal malignancy, resulting in more rapid diagnosis, earlier treatment, and potentially better clinical outcomes.

Application Of Teaching Regarding Injury Appearance In Darker Pigmented Skin Patients: A Quality Improvement Project, Tiffany Akiba

DNP Projects

Significance and Background: The skin is the largest organ of our body, and skin injury prevention begins with accurately inspecting skin. Current practices stress on looking for any signs of redness which often signify that the skin is possibly injured or compromised. However, darker skin tones do not appear red when injured. Assessing for redness is a practice that is suited better for lighter skin tones.

Purpose: Provide education to providers on current skin assessment practices of darker skin tones.

Methods: The IHI Model of Improvement was used for this project, and the Plan-Do-Study-Act cycle was used to test for …

Understanding The Factors Associated With Us Dermatology Resident Trainees’ Diagnostic Confidence And Skill For Skin Of Color Pathology, Alissa Jeanfreau, Kaylin Beiter, Deborah Hilton

School of Medicine Faculty Publications

Background: Inequities in dermatologic health outcomes translate to worsened clinical outcomes for minority groups. For example, despite a lower incidence of skin cancer overall, African Americans are diagnosed at later stages with greater degrees of lymph node involvement. This has been shown to lead to disproportionate mortality when compared to lighter skinned individuals. Medical education materials contain a significantly lower percentage of skin of color (SOC) images than of lighter skin and research has indicated lower diagnostic accuracy of dermatologic conditions in darker skin by U.S. medical students. The objective of this study was to explore U.S. resident dermatologists’ ability …

Phenotype And Genotype Heterogeneity Of Pla2g6-Associated Neurodegeneration In A Cohort Of Pediatric And Adult Patients, Ali Zare Dehnavi, Maryam Bemanalizadeh, Seyyed Mohammad Kahani, Mahmoud Reza Ashrafi, Mohammad Rohani, Mehran Beiraghi Toosi, Morteza Heidari, Sareh Hosseinpour, Behnam Amini, Shaghayegh Zokaei, Zahra Rezaei, Hajar Aryan, Man Amanat, Hassan Vahidnezhad, Pouria Mohammadi, Masoud Garshasbi, Ali Reza Tavasoli

Department of Dermatology and Cutaneous Biology Faculty Papers

BACKGROUND: Phospholipase-associated neurodegeneration (PLAN) caused by mutations in the PLA2G6 gene is a rare neurodegenerative disorder that presents with four sub-groups. Infantile neuroaxonal dystrophy (INAD) and PLA2G6-related dystonia-parkinsonism are the main two subtypes. In this cohort, we reviewed clinical, imaging, and genetic features of 25 adult and pediatric patients harboring variants in the PLA2G6.

METHODS: An extensive review of the patients' data was carried out. Infantile Neuroaxonal Dystrophy Rating Scale (INAD-RS) was used for evaluating the severity and progression of INAD patients. Whole-exome sequencing was used to determine the disease's underlying etiology followed by co-segregation analysis using Sanger sequencing. In …

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 …

Therapy Selection For Tinea Corporis And Cruris With Commorbidity: 3 Case Series, Yefta Yefta, Dwi Retno Adi Winarni, Agnes Sri Siswati

Journal of General - Procedural Dermatology & Venereology Indonesia

Background: Dermatophytosis is a superficial (skin, hair and nails) fungal infection caused by dermatophyte group fungi (Trichophyton, Epidermophyton and Microsporum). Immunocompromised conditions cause fungal infections to become more widespread and require consideration of therapy.

Case Illustration: This case series represented three cases of tinea corporis and tinea cruris in patients with comorbidities. The first case was tinea corporis and tinea cruris in a patient with congestive heart failure with oral terbinafine therapy. The second case was tinea corporis and tinea cruris in a patient with bilateral fourth degree hydronephrosis with oral griseofulvin therapy. The third case was tinea …

Lucio Phenomenon In Pregnancy: A Histopathology Review, Siti Efrida Fiqnasyani, Triasari Oktavriana,, Ervina Rosmarwati, Dita Eka Novriana, Ambar Mudigdo

Journal of General - Procedural Dermatology & Venereology Indonesia

Background: Lucio phenomenon (LP) is a reaction occurring in lepromatous, non-nodular, diffuse leprosypatients who have not received multidrug therapy (MDT). The diagnosis of LP are based on clinical features and supported by histopathological examination. This report was conducted to establish a diagnosis of LP byhistopathological examination, considering that cases of LP in pregnancy are quite rare so that clinicians can be more precise.

Case: A 35-year-old pregnant woman complained of extensive ulcers on her hand and legs. Madarosis, saddle nose, and earlobes were found A slit skin smear examination showed a bacterial index of +4 and a morphological …

An Overview Of Risk Factors For Androgenetic Alopecia Among Women At Pasar Ambacang, Kuranji, Padang, Lidya Aprilia Sugma, Satya Wydya Yenny, Roslaili Rasyid

Journal of General - Procedural Dermatology & Venereology Indonesia

Background: Androgenetic alopecia (AGA) is a patterned hair loss due to chronic and progressive miniaturization of hair follicles. Hair represents femininity and self-confidence in women. Therefore, AGA may affect the quality of life and psychology in women. This study aims to describe the risk factors for AGA in women living in Pasar Ambacang Sub-district, Kuranji District, Padang City.

Method: This was a descriptive, cross-sectional study that included 40 women with AGA. Interviews with subjects were conducted. This study was approved by the Health Research Ethics Committee at Universitas Andalas (252/UN.16.2/KEPK-FK/2021)

Results: AGA was mostly found on patients …

Scientometric Evaluation Of The Global Research In Acne Disease, Aida Khakimova, Oleg Zolotarev, Engin Senel

Journal of General - Procedural Dermatology & Venereology Indonesia

Background: Although acne is one of the most common diseases, medical literature lacks a scientometric analysis relevant to this disorder. In the present study we aimed to perform a scientometric evaluation of literature related to acne.

Methods: Publications were identified by searching for the term «acne» in PubMed. Papers from different countries were then identified by using the Advanced Search Builder. The indicators for evaluating of the absolute and relative increase in number of articles were proposed.

Results: Dynamic publication of activity is compared according to our proposed indicator - The Average Relative Growth Rate. After 1945 …

Challenges In Diagnosing Staphylococcal Scalded Skin Syndrome In Children With Kwashiorkor: A Case Report, Christie Hamdali, Sondang Sirait, Adria Rusvita, Bawono Bhakti

Journal of General - Procedural Dermatology & Venereology Indonesia

Staphylococcal scalded skin syndrome (SSSS) is a type of exfoliating skin disease with high incidence in children. This condition can cause serious morbidity and even mortality with certain comorbid diseases such as malnutrition. Malnutrition could mask the diagnosis of SSSS because of its similarity to numerous differential diagnoses. Accuracy of clinical diagnosis is then essential to determine the proper initial management. This case report presents a 6-month-old male baby with staphylococcal scalded skin syndrome and kwashiorkor. The patient presented with complaints of multiple erythematous plaques and widespread vesicular lesions that subsequently ruptured, resulting in erosions. Physical examination revealed edema, coarse …

The Effect Of Topical Oatmeal (Avena Sativa) On Hydration-Related Skin Disorders: A Systematic Review, Karenina Novani Sugondo, Melyawati Hermawan

Journal of General - Procedural Dermatology & Venereology Indonesia

Background: In recent years, interest in developing cosmetics and beauty products based on natural ingredients has increased. The addition of herbal extracts to products could improve the effectiveness of therapy. One of the natural ingredients that can be found is oatmeal. Oatmeal has been used for a long time and has been approved by the U.S. Food and Drug Administration as a skin protective agent since 2003. This study aims to systematically review the literature to determine the effect of topical oatmeal (Avena sativa) on hydration-related skin disorders.

Methods: A total of 9,538 studies were found in the database sources …

The Effectivity Of Ultrasound-Guided Platelet-Rich Plasma Perineural Injection In Improving Leprosy Sensory Peripheral Neuropathy, Herwinda Brahmanti, Arif Widiatmoko, Dhelya Widasmara, Diane Tantia Sari, Shahdevi Nandar Kurniawan, Widodo Mardi Santoso, Ristiawan Muji Laksono, Abdul Gofur

Journal of General - Procedural Dermatology & Venereology Indonesia

Background: Sensory nerve damage is the earliest leprosy sign which can lead to disability. Previous studies showed that autologous platelet-rich plasma (PRP) perineural blind injection can stimulate leprosy sensory nerve regeneration. Our study provided a safer and more accurate PRP agent delivery method through ultrasound-guided injection and was the first to compare PRP versus standard neuropathy treatment, the neurotropic vitamin. This study aimed to determine the effectiveness of combination therapy of ultrasound-guided PRP perineural injection and oral vitamin B complex compared to single oral vitamin B complex in sensory peripheral neuropathy of posterior tibial nerve in leprosy patients.

Zosteriform Cutaneous Metastases From A Carcinoma Mammae, Kharisma Yuliasis Widiasri, Ayu Wikan Sayekti, Novian Febiyanto, Elliana Wahyuanggradewi, Jeffrey Giantoro, Satiti Retno Pudjiati, Hanggoro Tri Rinonce, Agnes Sri Siswati

Journal of General - Procedural Dermatology & Venereology Indonesia

Background: Cutaneous metastases were reported in 18.6-26.5% of breast cancer patients. Zosteriform cutaneous metastasis is an unusual and rare morphological variant. Clinicians, especially dermatovenereologists, should consider dermatomal cutaneous metastases in oncology patients aside from herpes zoster, which is common in this population.

Case Illustration: A 62-year-old woman presented with clustered papules and vesicles with an erythematous base, sometimes painful, on the right side of the chest in T5-T7 dermatomal distribution of 1-month duration. She had undergone a radical mastectomy for breast carcinoma and had been receiving chemoradiotherapy, which was completed in March 2018. A diagnosis of zosteriform cutaneous …

Recalcitrant Cutaneous Mastocytosis Treated With Genetically Informed Targeted Therapy: A Case Report, Laura Gleason, Volkan Tekmen, Alexa Cohen, Safiyyah Bhatti, Burcu Beksac, Jisun Cha, Pierluigi Porcu, Neda Nikbakht

Department of Dermatology and Cutaneous Biology Faculty Papers

Introduction:

Mastocytosis, a clonal proliferation of mast cells commonly involving the skin and bone marrow, has a varied clinical presentation ranging from cutaneous lesions to systemic disease. Cutaneous mastocytosis is managed symptomatically, but systemic mastocytosis is treated with targeted therapy against the mutated receptor tyrosine kinase c-KIT, the pathogenic driver of mastocytosis. However, there are no guidelines for the treatment of cutaneous mastocytosis refractory to symptomatic management.

We herein report a method to select genetically informed therapy for symptomatic and recalcitrant cutaneous mastocytosis.

Case presentation:

We performed a mutational analysis of dermal mast cells after enrichment by laser capture in …

Kinetics Of Wound Development And Healing Suggests A Skin-Stabilizing Effect Of Allogeneic Abcb5+ Mesenchymal Stromal Cell Treatment In Recessive Dystrophic Epidermolysis Bullosa, Elke Niebergall-Roth, Kathrin Dieter, Cristina Daniele, Silvia Fluhr, Maria Khokhrina, Ines Silva, Christoph Ganss, Markus H. Frank, Mark A. Kluth

Research outputs 2022 to 2026

Recessive dystrophic epidermolysis (RDEB) is a rare, inherited, and currently incurable skin blistering disorder characterized by cyclically recurring wounds coexisting with chronic non-healing wounds. In a recent clinical trial, three intravenous infusions of skin-derived ABCB5+ mesenchymal stromal cells (MSCs) to 14 patients with RDEB improved the healing of wounds that were present at baseline. Since in RDEB even minor mechanical forces perpetually provoke the development of new or recurrent wounds, a post-hoc analysis of patient photographs was performed to specifically assess the effects of ABCB5+ MSCs on new or recurrent wounds by evaluating 174 wounds that occurred after baseline. During …

Clinical Presentation And Management Of Chromoblastomycosis: A Case Report And Review, Lacey Falgout, Deborah Hilton

School of Medicine Faculty Publications

No abstract provided.

Changes In Nascent Chromatin Structure Regulate Activation Of The Pro-Fibrotic Transcriptome And Myofibroblast Emergence In Organ Fibrosis, Morgan D. Basta, Svetlana Petruk, Ross Summer, Joel Rosenbloom, Peter J. Wermuth, Edward J. Macarak, Alex V. Levin, Alexander Mazo, Janice L. Walker

Department of Biochemistry and Molecular Biology Faculty Papers

Cell reprogramming to a myofibroblast responsible for the pathological accumulation of extracellular matrix is fundamental to the onset of fibrosis. Here, we explored how condensed chromatin structure marked by H3K72me3 becomes modified to allow for activation of repressed genes to drive emergence of myofibroblasts. In the early stages of myofibroblast precursor cell differentiation, we discovered that H3K27me3 demethylase enzymes UTX/KDM6B creates a delay in the accumulation of H3K27me3 on nascent DNA revealing a period of decondensed chromatin structure. This period of decondensed nascent chromatin structure allows for binding of pro-fibrotic transcription factor, Myocardin-related transcription factor A (MRTF-A) to nascent DNA. …

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 …

Maintenance Of Chronicity Signatures In Fibroblasts Isolated From Recessive Dystrophic Epidermolysis Bullosa Chronic Wound Dressings Under Culture Conditions, Cristian De Gregorio, Evelyng Catalán, Gabriel Garrido, Pilar Morandé, Jimena Castillo Bennett, Catalina Muñoz, Glenda Cofré, Ya-Lin Huang, Bárbara Cuadra, Paola Murgas, Margarita Calvo, Fernando Altermatt, María Joao Yubero, Francis Palisson, Andrew P. South, Marcelo Ezquer, Ignacia Fuentes

Department of Dermatology and Cutaneous Biology Faculty Papers

BACKGROUND: Recessive Dystrophic Epidermolysis Bullosa (RDEB) is a rare inherited skin disease caused by variants in the COL7A1 gene, coding for type VII collagen (C7), an important component of anchoring fibrils in the basement membrane of the epidermis. RDEB patients suffer from skin fragility starting with blister formation and evolving into chronic wounds, inflammation and skin fibrosis, with a high risk of developing aggressive skin carcinomas. Restricted therapeutic options are limited by the lack of in vitro models of defective wound healing in RDEB patients.

RESULTS: In order to explore a more efficient, non-invasive in vitro model for RDEB studies, …

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: 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 …

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.

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 …

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.

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 …

Introduction Of Probiotics To Improve Eczema Symptoms In Children In One Pediatric Primary Care Practice: A Quality Improvement Project, Christie Potter

Doctor of Nursing Practice Scholarly Projects

Background: There is emerging interest in alternative approaches to treating children with eczema because there is currently no allopathic cure. Non-pharmacological approaches are regarded as generally safe, well tolerated, and cost effective. Eczema is a chronic, relapsing inflammatory, itchy skin condition that adversely affects quality of life in many individuals, including children. Eczema interferes with sleep, leads to secondary skin infections, and causes intractable itching. Topical steroids are the current standard of practice in treating patients but, evidence suggests that they can cause unwanted side effects and can lead to serious systemic reactions. The purpose of this quality improvement project …