Dermatology Commons^™

The Curious Case Of A Painful Leg Ulcer, Jay R Patel, Rubi Montejano, Christina Hopkins, Hanna Siatecka, Theodore Rosen

Faculty, Staff and Students Publications

Sickle cell disease is a condition that can involve numerous organ systems secondary to vascular occlusion. Herein, we present a case of a 21-year-old male with sickle cell disease requiring long-term hydroxyurea therapy. Upon migrating to the United States from Yemen, the patient developed a rapidly progressive, exquisitely painful ulcer on his right lower extremity. Given his country of origin, a broad differential, including select infectious diseases, was essential. Moreover, establishing the unequivocally correct diagnosis was crucial to determine proper and safe therapy. Ultimately, a lesional biopsy demonstrated numerous sickled red blood cells occluding blood vessels, leading to the diagnosis …

Clinical Efficacy Of 5-Fluorouracil And Bleomycin In Dermatology, Suyeon Kim, Yu Ri Woo, Sang Hyun Cho, Jeong Deuk Lee, Hei Sung Kim

Faculty, Staff and Student Publications

Bleomycin and 5-fluorouracil (5-FU) are widely used in various dermatological disorders. Both drugs are well-recognized as antineoplastic drugs and exert their effect by blocking the cell cycle. Topical and intralesional formulations are available and have been studied in both non-neoplastic and cancerous lesions. However, data comparing the effect of bleomycin and 5-FU in the dermatological disorders are limited. This review outlines the action mechanisms of both drugs and compares their clinical efficacies in a wide range of dermatologic diseases including hypertrophic scar, wart, skin cancer, vascular malformation, hemangioma, and vitiligo, and discusses the overall safety of the drugs. Intralesional bleomycin …

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. …

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.

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

South Atlantic Division GME Research Day 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.

A Unique Case Of Darier's Disease With Perioral Cutaneous Cobblestoning Treated With Dupilumab, Sara Holt, Sherlyn Saju, Richard Miller

West Florida Division GME Research Day 2024

No abstract provided.

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.

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: Tinea Corporis, Navya Peddireddy, Braden Van Alfen, Christian Scheufele, Marshall Hall, Christopher M. Wong, Stephen Weis

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, …

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

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: 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 …

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

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 …

Rapid Response To Sirolimus In Patients With Pik3ca-Related Overgrowth Spectrum, Jessica R Nye, Jackson C Green, Michael Talanker, Jose Barrera, Kate Richardson, Neethu M Menon, Adelaide A Hebert, Matthew R Greives, Autumn A Atkinson

Faculty, Staff and Student Publications

PIK3CA-related overgrowth spectrum (PROS) is an umbrella term used to unify a heterogenous group of vascular overgrowth disorders by a shared genetic cause. Given that patients with PROS have a known, or likely, gene mutation in the PI3K/AKT/mTOR cascade, we hypothesize they experience a rapid response to inhibitors of this pathway, including sirolimus. In the following case series, we describe 3 patients with PROS and their response to sirolimus therapy. Despite their unique clinical presentations, insight into the genetic origin of their vascular overgrowth allowed for their successful treatment with the same medication.

Item Generation In The Development Of A Questionnaire For Predicting Multidrug Therapy Compliance In Leprosy, Yulia Siskawati, Sali Rahadi Asih, Aria Kekalih, Sri Linuwih Menaldi, Herqutanto Herqutanto, Kusmarinah Bramono

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Lengthy therapeutic regimens in leprosy are prone to defaults, contributing to more antibiotic-resistant Mycobacterium. Intervening patients’ medical habits midway would be more complicated than understanding their perception of undergoing such regimens in advance. We study the factors considered relevant to leprosy patients’ compliance to construct a novel self-reporting questionnaire that can predict the patients’ adherence before initiating multidrug therapy.

Methods: According to the Delphi methods, we conducted three rounds of interviews with twenty-three respondents from various backgrounds, including dermatologists, government officials, healthcare workers, and patients with leprosy, to infer the associated factors of the included items. Each …

Ai’S Next Frontier — Dermatology? How It May Help Close The Health Gap For Dark-Skinned Patients, Gretchen B. Smail

Capstones

This project examines how engineers are creating artificial intelligence systems to help with dermatology diagnosis. Researchers believe that these systems can help close the health care gap in lower income and Black and brown communities, but dermatologists of color worry that these systems are not being trained to recognize skin conditions on patients of color.

Metformin: A Potential Treatment For Acne, Hidradenitis Suppurativa And Rosacea, Minah Cho, Yu Ri Woo, Sang Hyun Cho, Jeong Deuk Lee, Hei Sung Kim

Faculty, Staff and Student Publications

Metformin is a widely used drug for treatment of diabetes mellitus, due to its safety and efficacy. In addition to its role as an antidiabetic drug, numerous beneficial effects of metformin have enabled its use in various diseases. Considering the anti-androgenic, anti-angiogenic, anti-fibrotic and antioxidant properties of metformin, it may have the potential to improve chronic inflammatory skin diseases. However, further evidence is needed to confirm the efficacy of metformin in dermatological conditions, This review focuses on exploring the therapeutic targets of metformin in acne vulgaris, hidradenitis suppurativa and rosacea, by studying their pathogeneses.

Chromoblastomycosis Presenting As A Solitary Lesion In A Non-Endemic Region, Yelena Dokic, Gordana Verstovsek, Theodore Rosen

Faculty, Staff and Students Publications

Chromoblastomycosis is a neglected tropical disease typically found in endemic tropical and subtropical regions. Herein, we discuss a rare case of a 55-year-old man in Texas who presented with an exophytic papule on the forearm, diagnosed to have chromoblastomycosis by shave biopsy and subsequent histopathological analysis. Treatment options for chromoblastomycosis include long-term oral antifungal therapy with itraconazole, physical modalities such as heat therapy in conjunction with oral antifungals, and surgical interventions such as cryosurgery or surgical excision.

Differentiating Desquamating Skin Lesions: A Case Of Methotrexate Epidermal Necrosis, Sahifah Ansari, Dina H Zamil, Edgar Rodriguez, Carly Dunn, Soo Jung Kim

Faculty, Staff and Students Publications

Desquamating skin lesions are a non-specific finding that requires urgent evaluation given the life-threatening severity of one of the potential causes, Stevens-Johnson syndrome (SJS). Methotrexate toxicity, also known in its cutaneous form as methotrexate epidermal necrosis (MEN), is another entity that presents similarly to SJS and is described here in a patient with increased risk due to his age, chronic kidney disease, and increased dose of methotrexate. His diagnosis was complicated by other historical risk factors, including antibiotic use, but was eventually elucidated when he was noted to have bone marrow suppression. Given the pathophysiology of SJS, a T-cell mediated …

Skin Barrier Function: The Interplay Of Physical, Chemical, And Immunologic Properties, Paola Baker, Christina Huang, Rakan Radi, Samara B Moll, Emmanuela Jules, Jack L Arbiser

Student Papers, Posters & Projects

An intact barrier function of the skin is important in maintaining skin health. The regulation of the skin barrier depends on a multitude of molecular and immunological signaling pathways. By examining the regulation of a healthy skin barrier, including maintenance of the acid mantle and appropriate levels of ceramides, dermatologists can better formulate solutions to address issues that are related to a disrupted skin barrier. Conversely, by understanding specific skin barrier disruptions that are associated with specific conditions, such as atopic dermatitis or psoriasis, the development of new compounds could target signaling pathways to provide more effective relief for patients. …

Durability Of Near-Complete Skin Clearance In Patients With Psoriasis Using Systemic Biologic Therapies: Real-World Evidence From The Corevitas Psoriasis Registry, Robert R Mclean, Adam P Sima, Silky Beaty, Eric A Jones, Thomas Eckmann, Robert Low, Laura Mcclung, Rebecca L Spitzer, Jeffrey Stark, April Armstrong

Faculty, Staff and Student Publications

INTRODUCTION: Near-complete skin clearance has become a rapidly achievable treatment goal for patients with psoriasis receiving systemic biologic therapies. However, real-world evidence for durability of near-complete skin clearance and risk factors associated with loss of near-complete skin clearance is limited.

METHODS: This study described durability of near-complete skin clearance (≥ 90% improvement in Psoriasis Area and Severity Index from initiation; PASI90) and identified clinical factors or patient characteristics associated with loss of PASI90 among patients with psoriasis from the CorEvitas Psoriasis Registry (April 2015-August 2021). Included patients had PASI > 5 at biologic initiation and achieved PASI90 at approximately 6 months …

Giant Renal Cell Carcinoma In A Patient With Ipsilateral Lower Limb Hypertrophic Lichen Planus; Case Report And Literature Review, Silvia Popescu, Dumitru Peța, Zoltan Janos Kövér, Dumitru Toma, Ioan-Teodor Cristea, Mihaela Anca Popescu, Oana-Denisa Bălălău, Romina-Marina Sima, Gabriel-Petre Gorecki, Călin Giurcăneanu

Journal of Mind and Medical Sciences

Renal cell carcinoma is the most common type of primary urogenital cancer, usually resistant to radiotherapy and chemotherapy. Hypertrophic lichen planus is an inflammatory dermatosis characterized by the presence of papulosquamous and intensely pruritic lesions. The association of these two conditions is unusual, being reported in the specialized literature only in a few rare cases with the onset of lichenoid lesions after patients have undergone various forms of treatment. The case of a 62-year-old male patient who was admitted for severe abdominal pain due to a giant renal tumor associated with a hypertrophic plaque located on the anterior part of …

Ccdc50 Promotes Tumor Growth Through Regulation Of Lysosome Homeostasis, Penghui Jia, Tian Tian, Zibo Li, Yicheng Wang, Yuxin Lin, Weijie Zeng, Yu Ye, Miao He, Xiangrong Ni, Ji'an Pan, Xiaonan Dong, Jian Huang, Chun-Mei Li, Deyin Guo, Panpan Hou

Faculty, Staff and Student Publications

The maintenance of lysosome homeostasis is crucial for cell growth. Lysosome-dependent degradation and metabolism sustain tumor cell survival. Here, we demonstrate that CCDC50 serves as a lysophagy receptor, promoting tumor progression and invasion by controlling lysosomal integrity and renewal. CCDC50 monitors lysosomal damage, recognizes galectin-3 and K63-linked polyubiquitination on damaged lysosomes, and specifically targets them for autophagy-dependent degradation. CCDC50 deficiency causes the accumulation of ruptured lysosomes, impaired autophagic flux, and superfluous reactive oxygen species, consequently leading to cell death and tumor suppression. CCDC50 expression is associated with malignancy, progression to metastasis, and poor overall survival in human melanoma. Targeting CCDC50 …

Garetosmab In Fibrodysplasia Ossificans Progressiva: A Randomized, Double-Blind, Placebo-Controlled Phase 2 Trial, Maja Di Rocco, Eduardo Forleo-Neto, Robert J Pignolo, Richard Keen, Philippe Orcel, Thomas Funck-Brentano, Christian Roux, Sami Kolta, Annalisa Madeo, Judith S Bubbear, Jacek Tabarkiewicz, Małgorzata Szczepanek, Javier Bachiller-Corral, Angela M Cheung, Kathryn M Dahir, Esmée Botman, Pieter G Raijmakers, Mona Al Mukaddam, Lianne Tile, Cynthia Portal-Celhay, Neena Sarkar, Peijie Hou, Bret J Musser, Anita Boyapati, Kusha Mohammadi, Scott J Mellis, Andrew J Rankin, Aris N Economides, Dinko Gonzalez Trotter, Gary A Herman, Sarah J O'Meara, Richard Delgizzi, David M Weinreich, George D Yancopoulos, E Marelise W Eekhoff, Frederick S Kaplan

Faculty, Staff and Student Publications

Fibrodysplasia ossificans progressiva (FOP) is a rare disease characterized by heterotopic ossification (HO) in connective tissues and painful flare-ups. In the phase 2 LUMINA-1 trial, adult patients with FOP were randomized to garetosmab, an activin A-blocking antibody (n = 20) or placebo (n = 24) in period 1 (28 weeks), followed by an open-label period 2 (28 weeks; n = 43). The primary end points were safety and for period 1, the activity and size of HO lesions. All patients experienced at least one treatment-emergent adverse event during period 1, notably epistaxis, madarosis and skin abscesses. Five deaths …

Gut Microbiome In Patients With Early-Stage And Late-Stage Melanoma, Russell G Witt, Samuel H Cass, Tiffaney Tran, Ashish Damania, Emelie E Nelson, Elizabeth Sirmans, Elizabeth M Burton, Manoj Chelvanambi, Sarah Johnson, Hussein A Tawbi, Jeffrey E Gershenwald, Michael A Davies, Christine Spencer, Aditya Mishra, Matthew C Wong, Nadim J Ajami, Christine B Peterson, Carrie R Daniel, Jennifer A Wargo, Jennifer L Mcquade, Kelly C Nelson

Faculty, Staff and Student Publications

IMPORTANCE: The gut microbiome modulates the immune system and responses to immunotherapy in patients with late-stage melanoma. It is unknown whether fecal microbiota profiles differ between healthy individuals and patients with melanoma or if microbiota profiles differ among patients with different stages of melanoma. Defining gut microbiota profiles in individuals without melanoma and those with early-stage and late-stage melanoma may reveal features associated with disease progression.

OBJECTIVE: To characterize and compare gut microbiota profiles between healthy volunteers and patients with melanoma and between patients with early-stage and late-stage melanoma.

DESIGN, SETTING, AND PARTICIPANTS: This single-site case-control study took place at …

An Unusual Presentation Of Pigmented Purpuric Lichenoid Dermatitis, Christine De Antonis, Jordan T. Hyde, Jason B. Lee, Sylvia Hsu

Department of Dermatology and Cutaneous Biology Faculty Papers

Pigmented purpuric lichenoid dermatitis (PPLD) is a rare subtype of pigmented purpuric dermatosis, which classically presents with a mixture of lichenoid papules and patches on the bilateral lower extremities. Herein, we describe an unusual case of a 47-year-old man with PPLD who presented with 1-3mm discrete papules without the presence of larger patches. The diagnosis of PPLD should be considered for patients presenting with bilateral symmetric discrete papules on the legs.

Cutaneous Dermal Metastasis Of Inflammatory Breast Carcinoma Mimicking Granuloma Annulare, Vikram Shaw, Jay Patel, Hanna Siatecka, Omid Jalali

Faculty, Staff and Students Publications

Breast cancer can present as a wide range of cutaneous lesions at the time of diagnosis or months to years after a known diagnosis of breast cancer. Cutaneous sequela of breast cancer, including metastasis, have a diverse range of clinical appearances. Here, we describe the case of a 59-year-old female with stage IV metastatic inflammatory breast carcinoma presenting with a chronic worsening rash on her anterior chest wall. Biopsy results demonstrated metastatic carcinoma cells within the dermal lymphatics, consistent with primary breast cancer. To our knowledge, based on a thorough review of the literature, no previous case reports detailing cutaneous …

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, …