Dermatology Commons^™

Trends In Dermatologic Biologic Prescribing: A Medicare Part D Public Use File Analysis From 2018 To 2023., Cathleen V D'Angelo, Patricia Wilberger, Chase Merritt, Joshua Burshtein, Dawn Merritt

Ambulatory and Primary Care Articles

No abstract provided.

Seasonal And Geographic Trends In Photodynamic Therapy And Cryosurgery Use In The United States: A Cross-Sectional Study From 2015-2022., Dawn Merritt, Jon Lyons, Mouna Mikati, Christian Geils, Todd Schlesinger

Ambulatory and Primary Care Articles

BACKGROUND: Photodynamic therapy (PDT) is an effective field treatment for actinic keratoses (AKs). It is an ideal option for patients who prefer a minimally invasive procedure conveniently administered in their physician's office. Anecdotal clinician insights suggest that it may not be used at the same rate year-round.

OBJECTIVE: This study investigates whether PDT and cryosurgery usage is affected by season and geographic location in the United States.

METHODS: The data source is an aggregate of closed and open United States medical procedural claims (

RESULTS: PDT utilization is affected by season and geographic location. Procedural claims peak during cooler months …

Ex Vivo Assessment Of Keratinocytic Carcinomas Using A Fast Mid-Infrared Probe., Maria G Vazquez De Vasquez, Rebecca C Bradley, Charles L Hitchcock, Angela S Casey, Austin Cusick, James V Coe, Ronald Siegle

Ambulatory and Primary Care Articles

A fast mid-infrared spectral probe was used to record infrared (IR) spectra of fresh skin tissue removed from patients with biopsy-proven keratinocytic cancer (KC) during Mohs surgery. A 150-patient library of IR spectral data was obtained to see if KC on the epidermal side (outside) of tissue samples can be differentiated from adjacent nonmalignant tissue and normal skin. A linear support vector machine model minimized overtraining predicting the contributions to decisions at each step in the spectrum. Training with an equal cost for KC and nontumor cases samples demonstrated a KC sensitivity of 93% ± 5% and specificity 82% ± …

Correction: A Comprehensive Narrative Review Of The Challenges Surrounding Cutaneous Scc., Sarah C Beach, Austin S Cusick, Aaron S Farberg, Shannon C Trotter

Ambulatory and Primary Care Articles

No abstract provided.

Leukoplakia: An Uncommon Presentation Of Acute Febrile Neutrophilic Dermatosis (Sweet Syndrome)., Suchita Sampath, Bryce Delong, Sahil Kapur, Matthew J Franklin

Ambulatory and Primary Care Articles

No abstract provided.

Dermatology Match Disparities: Analyzing Osteopathic Vs. Allopathic Student Outcomes Post-Acgme/Aoa Single Accreditation System (2020-2024)., Leo Wan, Karandeep Bawa, Aileen Park, Haaris Kadri, Austin Cusick, Shannon C Trotter

Medical Education Articles

CONTEXT: Dermatology remains one of the most competitive medical specialties, with successful candidates often demonstrating outstanding academic performance, extensive research experience, and strong letters of recommendation. The integration of the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) into a single accreditation system in 2020 was intended to streamline residency training, but it has raised concerns about how Doctor of Osteopathic Medicine (DO) applicants will perform in dermatology residency match.

OBJECTIVES: This study examines the differences in DO and MD match rates following the single graduate medical education (GME) accreditation system, focusing on the match …

Mycobacterium Genavense-Induced Spindle Cell Pseudotumor Presenting With Symptoms Of Giant Cell Arteritis., Britney Le, Guilherme Kuceki, Jamie Zussman

Ambulatory and Primary Care Articles

No abstract provided.

Disseminated Herpes Zoster Encephalitis Induced By Low-Dose Corticosteroids., Natalie Soliman, Britney Le, Kelly M Kimball, Dawn Merritt

Ambulatory and Primary Care Articles

No abstract provided.

A Comprehensive Narrative Review Of The Challenges Surrounding Cutaneous Scc., Sarah C Beach, Austin S Cusick, Aaron S Farberg, Shannon C Trotter

Ambulatory and Primary Care Articles

Cutaneous squamous cell carcinoma (cSCC) is the second most common nonmelanoma skin cancer (NMSC) and is predominantly found in the head and neck region. With an annual increase in NMSC diagnoses, cSCC presents significant diagnostic and therapeutic challenges. This review discusses the many risk factors for the development of cSCC, outlines the criteria for defining high-risk cSCC, and examines treatment approaches of these tumors based on risk stratification. While most cSCCs are treatable with surgical excision, approximately 5% metastasize, with head and neck cSCC showing poor prognosis once metastasis occurs. High-risk cSCCs, which are more likely to recur or metastasize, …

Telogen Effluvium And Anesthesia Considerations: A Case Report., Elizabeth Johnson-Gray, Samantha A Currier, Hanen Fernandez, Matt Brown, Matthias Franzen

Ambulatory and Primary Care Articles

Telogen effluvium is a form of non-scarring hair loss characterized by premature shedding of hair. Pathophysiologically, telogen effluvium occurs when a significant number of hair follicles prematurely enter the telogen phase, resulting in excessive shedding. The exact mechanism is unclear, but it is believed to involve alterations in the hair follicle's growth cycle, possibly mediated by illness, infection, major surgery, low protein intake, or hormonal changes. Some medications can also be linked to this disease, such as beta blockers, carbamazepine, and vitamin A. When affected hairs are in the resting phase, noticeable hair shedding occurs. Our patient was a 61-year-old …

Enhanced Hair Regrowth With Five Monthly Sessions Of Minoxidil-Dutasteride-Copper Peptides Tattooing For Androgenetic Alopecia Assessed By Artificial Intelligence And Blinded Evaluators., Guilherme Kuceki, Austin J Coppinger, Sara D Ragi, Luke S Johnson, Andy Goren, Luiza L Kalil, Pablo Cirino, Carlos G Wambier

Ambulatory and Primary Care Articles

No abstract provided.

A Case Of Peristomal Pyoderma Gangrenosum With Histological Features Of Pseudoxanthoma Elasticum., Kelly M Kimball, Matthew J Franklin

Ambulatory and Primary Care Articles

No abstract provided.

Petechiae And A Persistent Violaceous Nodule: A Presentation Of Blastic Plasmacytoid Dendritic Cell Neoplasm To Dermatology., Madison Anzelc, Christina Druskovich, Austin Cusick, Matthew Franklin

Ambulatory and Primary Care Articles

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, highly aggressive CD4+ CD56+ hematopoietic malignancy. The cutaneous presentation is variable but often includes violaceous nodules. We present a rare case of BPDCN, which featured dermatological findings consisting of erythematous macules, petechiae, purpura, and a violaceous nodule. A skin biopsy and peripheral blood smear supported a diagnosis of BPDCN. With BPDCN favoring cutaneous involvement, we urge dermatologists to be aware of the possibility of a BPDCN diagnosis in patients who present with purpuric nodules and petechial skin findings, especially when it is not easily explainable by another pathology or medication.

Concurrent Varicella-Zoster Virus Reactivation And Recurrent Herpes Simplex Virus Infection In The C2 Dermatome With Varicella-Zoster Virus Encephalitis: A Case Report And Review Of The Literature., Morgan A Hatlovic, Madison Anzelc, Matthew Franklin

Ambulatory and Primary Care Articles

Herpes simplex virus (HSV) and varicella-zoster virus (VZV) are common viruses that are present in the general population. However, it is uncommon for both viruses to coincide at the same time and location. These viruses infect the nervous system to establish latency and have been associated with neurological disorders. We discuss a case of co-occurring VZV reactivation and recurrent HSV infection with subsequent VZV encephalitis following an insult to the neurologic system.

Treatment Of Recalcitrant Hailey-Hailey Disease With Naltrexone And Dupilumab: A Report Of Two Cases., Breanna Santoso, Rachel Krevh, Alexa Israeli, Austin Cusick, Dawn Merritt, Michael Holsinger

Ambulatory and Primary Care Articles

This report presents two cases of patients with long-standing, treatment-resistant Hailey-Hailey disease (HHD) who experienced significant symptom relief through a combination therapy of oral naltrexone and dupilumab injections. The therapeutic potential of targeting the Th2 pathway and Ca

An Atypical Facial Eruption In Skin Of Color: A Rare Presentation Of Histiocytoid Sweet Syndrome., Brittany Ehlert, Lauren Shegos, Matthew Franklin, Kaila Buckley, Jaimie Rodger

Ambulatory and Primary Care Articles

No abstract provided.

Use Of Interleukin-12/23 Inhibitor For The Management Of Acne Fulminans., Hannah Gier, Alexa Israeli, Austin Cusick, Dawn Merritt

Ambulatory and Primary Care Articles

Acne fulminans (AF) is a rare disorder marked by severe eruptions of inflamed nodules, hemorrhagic crusts, and ulcers accompanied by systemic symptoms and often laboratory abnormalities. Commonly affecting adolescent males with pre-existing acne, AF has been associated with isotretinoin therapy and elevated testosterone levels. With unknown pathogenesis, lesions frequently involve the trunk and face and are managed standardly with corticosteroids and isotretinoin. Uncontrolled or recurrent cases pose challenges due to prolonged high-dose corticosteroid use with increased scarring. In this study, we present a case of AF in a 17-year-old male unresponsive to corticosteroid and isotretinoin therapy, successfully treated with ustekinumab, …

Use Of Interleukin-12/23 Inhibitor For The Management Of Acne Fulminans., Hannah Gier, Alexa Israeli, Austin Cusick, Dawn Merritt

Ambulatory and Primary Care Articles

Acne fulminans (AF) is a rare disorder marked by severe eruptions of inflamed nodules, hemorrhagic crusts, and ulcers accompanied by systemic symptoms and often laboratory abnormalities. Commonly affecting adolescent males with pre-existing acne, AF has been associated with isotretinoin therapy and elevated testosterone levels. With unknown pathogenesis, lesions frequently involve the trunk and face and are managed standardly with corticosteroids and isotretinoin. Uncontrolled or recurrent cases pose challenges due to prolonged high-dose corticosteroid use with increased scarring. In this study, we present a case of AF in a 17-year-old male unresponsive to corticosteroid and isotretinoin therapy, successfully treated with ustekinumab, …

Cutaneous Graft-Versus-Host Disease Within Chronic Photodamaged Skin: A Case Series Demonstrating Role For Topical 5-Fluorouracil., Ashley N Gray, Christina Avila, Catherine G Chung, Lucia Seminario-Vidal, Alice Mims, Brittany Dulmage, Karilyn Larkin, Hannah Choe, Samantha Jaglowski, Sumithira Vasu, Benjamin H Kaffenberger

Ambulatory and Primary Care Articles

No abstract provided.

Adult Female With A Painful And Pruritic Lower Extremity Skin Lesion., Chase Silvers, Christopher Lloyd

Ambulatory and Primary Care Articles

No abstract provided.

Trigeminal Trophic Syndrome In A Pediatric Patient With Diffuse Intrinsic Pontine Glioma., Ezra Hoover, Ryan Jay, Patricia Witman

Ambulatory and Primary Care Articles

A 13-year-old girl with a history of diffuse intrinsic pontine glioma (DIPG) suffered from progressively worsening facial ulcerations secondary to paresthesia-induced self-excoriation. She was diagnosed with trigeminal trophic syndrome (TTS) induced by DIPG and struggled to heal her lesions in the background of this excoriation disorder. A multidisciplinary approach that included mood disorder management with sertraline and amitriptyline helped diminish paresthesia, improve her quality of life, and promote healing of the ulcers despite the progression of her DIPG. This case highlights the multifactorial complexity of TTS in pediatric patients and the need for successful management strategies.

The Impact Of Global Health Disparities On Atopic Dermatitis In Displaced Populations: Narrowing The Health Equity Gap For Patients With Skin Of Color., Sami Jelousi, Divya Sharma, Andrew Alexis, Jenny E Murase

Ambulatory and Primary Care Articles

Atopic dermatitis (AD) is a relatively common inflammatory skin disease marked by eczematous lesions and pruritus often leading to significant morbidity and quality of life impairment for those affected. Recent studies have shown that patients with skin of color (SOC) carry a larger disease burden than patients of European descent. In the USA, these disparities are partly due to structural, environmental, and interpersonal racism. From a global perspective, there is a paucity of research on the burden of atopic dermatitis and other inflammatory skin diseases experienced by the record numbers of refugees, migrants, and asylum seekers around the world. Although …

Acute Generalized Exanthematous Pustulosis: A Painful And Pruritic Presentation Of Pustulosis Following Pharmacotherapy For Pharyngeal Phlegmon., Chase Silvers, John Casey

Ambulatory and Primary Care Articles

Acute generalized exanthematous pustulosis (AGEP) is primarily a drug-induced skin eruption, which typically presents within two days of starting an offending medication; it is often self-limiting with spontaneous resolution within two weeks upon medication cessation. We report the case of a patient who presented with generalized desquamation, characteristic pustules, and several morbilliform rashes on the body surface in association with recent amoxicillin-clavulanic acid exposure. This was associated with significant pruritus, which was the associated chief complaint. A multimodal approach to symptomatic management with topical corticosteroids, barrier ointments, oral antihistamines, and analgesics was required, in addition to the cessation of the …

Brooke-Spiegler Syndrome: Familial Cylindromatosis, A Rare Variant Of A Rare Familial Syndrome., Harsh Patel, William Naber, Austin Cusick, Craig Oser

Ambulatory and Primary Care Articles

Brooke-Spiegler Syndrome (BSS) is a rare autosomal dominant familial disorder resulting in dermatologic neoplasms of copious nodular appendages. Here, we report a case of Familial Cylindromatosis (FC), a subtype of BSS, in a patient with the largest cylindroma of 7.4 × 5.6 × 3.8 cm on the scalp. The patient had undiagnosed cylindromas growing for 36 years at presentation; however, he did not seek out healthcare evaluation. Excision and pathologic investigation of three large masses from different body sites determined a shared phenotype of cylindromas. Subsequent evaluation of the patient's son separately, after primary patient excision, confirmed cylindroma development as …

Acne Severity And Sleep Quality In Adults., Kory P Schrom, Sayeeda Ahsanuddin, Michelle Baechtold, Raghav Tripathi, Amy Ramser, Elma Baron

Ambulatory and Primary Care Articles

Poor sleep quality is extremely prevalent, with about one third of adults in the USA obtaining less than the recommended amount of sleep. In addition, poor sleep quality has been linked to an increased risk of many conditions, including diabetes, hypertension, psychiatric conditions, and overall all-cause mortality. Research has shown that sleep disturbance does impact skin disease, although many details of this relationship are still unclear. The goal of this study is to determine if there is a relationship between acne severity and sleep quality in adults. Forty subjects with acne were recruited from dermatology clinics in Cleveland, OH, to …

Perforating Granuloma Annulare Appearing As A Psoriasiform Lesion., Benjamin M Witkoff, Nedyalko N Ivanov, Shannon C Trotter

Ambulatory and Primary Care Articles

We present a 54-year-old Caucasian female with a history of diabetes mellitus, multiple sclerosis, and ulcerative colitis who presented with nail dystrophy, polyarthralgia in her hands and hips, myalgia, proximal myopathy, dactylitis, and psoriasiform-appearing progressive, painful plaques on the dorsal aspect of her hands. Histologic examination of the lesion from the left index finger revealed an interstitial and necrobiotic granulomatous dermatitis with connective tissue mucin deposition associated with a perivascular lymphoid infiltrate. Additionally, there was focal transepidermal elimination of the necrobiotic material. She was diagnosed with perforating granuloma annulare (PGA). We are unaware of any other cases of PGA in …