Dermatology Commons^™

Cold-Sensitive Acral Hand Lesions, Avery H. Seward, Jocelyn H. Larocque

Department of Medicine Faculty Publications

[Case description] An otherwise healthy woman in her 60s presented with a 2-year history of a persistent, itchy, and tender rash on the dorsal hands. The rash fluctuated in severity with the seasons, worsening during the colder months. The patient denied joint pain and fatigue, or lesions elsewhere.

Examination revealed partially blanchable violaceous plaques on the dorsal hands with partial sparing of the proximal and distal interphalangeal joints (Fig 1). A few punctate, crusted erosions and purpuric macules were present on the dorsal and volar distal phalanges (Figs 2 and 3).

Enlarging Fingertip Nodule Mimicking A Pyogenic Granuloma In A Man In His 60'S, Avery H. Seward, Jocelyn H. Larocque, Stephen M. Hughes

Department of Medicine Faculty Publications

[Case presentation] A man in his 60's with a history of hypertension, hyperlipidemia, and resected colon cancer in remission presented with a 4-month history of an enlarging nodule on the right fourth fingertip. The patient recalled having a splinter removed from the same site a few weeks prior to the development of the lesion. The lesion was initially diagnosed by an orthopaedist as a pyogenic granuloma (Figure 1a), and the patient was advised to apply table salt to the area several times daily. However, the lesion continued to enlarge over 3 months with occasional bleeding and mild tenderness. Physical examination …

Educational Case: Hidradenitis Suppurativa, Ryan C. Saal, Linnea Lackstrom Westerkam, Cristo A. Carrasco Mendoza, Paul B. George, Christopher J. Sayed

Department of Medicine Faculty Publications

[Introduction] The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see https://doi.org/10.1016/j.acpath.2023.100086.1¹

Objective SK1.1: Pathophysiology of changes in the skin. Describe the pathophysiologic basis for changes in the color, surface texture, swelling, temperature, and sensitivity of skin.

Competency 2: Organ system pathology, Topic: Skin (SK); Learning Goal 1: …

Dual Clinical Presentation Of A Birthmark: A Quiz, Avery H. Seward, Jacqueline E. Leyrer, Sarah H. Carlock

Department of Medicine Faculty Publications

[Introduction] A man in his early 30s presented with a longstanding birthmark on the lift thigh that was first noticed at age 12. As a teenager, the lesion was treated with a CO2 laser at an outside institution; however, the lesion continued to slowly enlarge over the past several years. The patient reported recurrent irritation and swelling from a construction safety harness with occasional bleeding and frequent bruising. Recently, the area became inflamed, prompting an ER visit, where the patient was evaluated for cellulitis, underwent a normal ultrasound and was placed on cephalexin 500 gm twice daily for 10 days.

T-Cells May Represent A Novel Biomarker For Female Pattern Hair Loss, Juan Marrero Berrios, Iain Noel Encarnacion, Noelle Desir, Aman Prasad, Matthew Hedberg, Susan Taylor, John T. Seykora

Department of Medicine Faculty Publications

[Introduction] Androgenetic alopecia (AGA) is a common non-scarring alopecia classically attributed to androgen sensitivity and genetics. Histopathologic studies have identified perifollicular and perivascular lymphocytic and histiocytic infiltrates, through the composition and clinical relevance of this infiltrate have not been fully characterized.¹ Our study aims to address this gap through detailed quantitative immunohistochemical characterization (IHC) of the inflammatory infiltrate in female patients with AGA compared to telogen effluvium (TE), a non-inflammatory control.

Drug-Induced Lichen Planus Associated With Ocrelizumab, Avery Seward, John D. Strickley, Jeffrey P. Callen

Department of Medicine Faculty Publications

This case report highlights recurrent cutaneous lichen planus as a rare adverse effect of ocrelizumab, with flares occurring after each infusion and improving with prophylactic prednisone. Recognizing this association may help clinicians diagnose and manage similar cases while allowing patients to continue an otherwise effective therapy.

Directional Association Between Irritable Bowel Syndrome And Dermatological Disease: A Large-Scale Retrospective Study, Alex Y. Liu, Naomi T. Matsuno, Houston Nelson, David Johnson, David Pariser

Department of Medicine Faculty Publications

Background/Objectives: Microbial dysbiosis is implicated with a pathogenic role in both irritable bowel syndrome (IBS) and several dermatological conditions. Yet, few studies have assessed a potential overlapping epidemiologic association. We aimed to assess the 1-year prevalence of common dermatologic conditions following an initial IBS diagnosis and to evaluate the reverse association using reciprocal analyses. Methods: We conducted a retrospective study using TriNetX. Patients aged 18–50 with no history of inflammatory bowel disease, celiac disease, or infectious intestinal disease were matched 1:1 to healthy controls by demographics and comorbidities. The primary outcome was the prevalence of acne vulgaris, psoriasis, …

Visit Complexity Differs Between Scarring And Nonscarring Alopecia: A 5-Year Dataderm Analysis, Ian Noel Encarnacion, Noelle Desir, Nicholas Schell, Apoorva Mehta, Temitayo Ogunleye, Susan Taylor

Department of Medicine Faculty Publications

[Introduction] Accurate coding is a critical component of dermatologic practice, influencing reimbursement and documentation of clinical complexity. Although alopecia has significant psychosocial and financial burdens, Current Procedural Terminology (CPT) coding patterns in alopecia management remain largely understudied. Our population-level study using the American Academy of Dermatology's DataDerm clinical registry¹ evaluates alopecia CPT coding trends, pre-2021 and post-2021 evaluation and management (E/M) CPT coding updates,² aiming to inform coding practices and visit complexity, which have significant reimbursement implications.

Persistent Peristomal Pain Due To An Exposed Cutaneous Nerve, Iain Noel Encarnacion, Kaylin Beiter, Natasha Hakkal, Emily Hejazi, Paul Hernandez, Melissa Laughter, Shannon Nugent, Samir Thaker, Xiaowei Xu, Misha Rosenbach

Department of Medicine Faculty Publications

[Introduction]

Case description

A 25-year-old woman with a history of ulcerative colitis treated with multiple abdominal surgeries complicated by peristomal pyoderma gangrenosum (PPG) presented with severe peristomal pain and ulceration. Treatment course was complicated; disease control was achieved via combination infliximab 10 mg/kg every 4 weeks, corticosteroids (topical triamcinolone 0.1% ointment, intralesional 10 mg/ml injections, and oral prednisone 30 mg daily with a gradual taper), and cyclosporine 125 mg tapering by 25 mg every 3 weeks, ultimately tapered to infliximab monotherapy.

Insurance Disparities In Hidradenitis Suppurativa: A Comprehensive Review Of Demographics, Outcomes, And Access To Care, Alim Osman, Alexandra R. Nigro, Michael C. Povelaitis, Marc Z. Handler

Department of Medicine Faculty Publications

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that disproportionately affects women, African Americans, and individuals of biracial descent. It is associated with substantial physical and psychiatric morbidity, reducing quality of life.

Objective: This review analyzed disparities in treatment outcomes, disease progression, and healthcare access among HS patients based on insurance type.

Methods: Using PRISMA guidelines, a comprehensive literature search identified 7 studies meeting inclusion criteria. Owing to data heterogeneity, studies were qualitatively analyzed.

Results: Findings consistently demonstrated that Medicaid patients experienced worse outcomes than those with private insurance or Medicare. Medicaid patients had higher rates of comorbid …

International Myositis Assessment And Clinical Studies Guidelines For Risk-Based Cancer Screening: An External Validation In Patients With Dermatomyositis Seen At A Metropolitan Academic Center, Isabel Silva, Jasper Dayanan, Alexandra Nigro, Capriana Jiang, Ma Georgina Erfe, Trixie Rivera, Saakshi Khattri

Department of Medicine Faculty Publications

Objective

Dermatomyositis (DM) is an idiopathic inflammatory myopathy (IIM) characterized by muscle weakness, skin findings, and increased malignancy risk. Cancer risk is greatest in the three years before or after DM onset, termed paraneoplastic DM. The International Myositis Assessment and Clinical Studies Group (IMACS) set forth evidence-based guidelines for risk stratification and cancer screenings for newly diagnosed patients with IIM. '

Methods

We retrospectively reviewed the records of 413 patients with a known diagnosis of DM or clinically amyopathic DM at the Mount Sinai Health System (2019-2024). Demographics, clinical findings, laboratory results, myositis autoantibody panels, and cancer screening or diagnosis …

When Unilateral Leg Swelling Is Not Deep Vein Thrombosis: A Case Of Disseminated Kaposi Sarcoma Revealing Advanced Human Immunodeficiency Virus, Ahmed Ismail, Zachary Wilson, Thomas Currow, Michael Dileonardo, Carsten Kirby

Department of Medicine Faculty Publications

Kaposi sarcoma (KS) is an acquired immunodeficiency syndrome (AIDS)-defining malignancy that can involve the skin, lymph nodes, and visceral organs in patients with advanced human immunodeficiency virus (HIV). We report the case of a 35-year-old man with no known prior medical history who presented to the charity care clinic complaining of recurrent thrush and two weeks of progressive right lower extremity swelling. His physical examination revealed painful, pruritic violaceous papules and plaques over the proximal right thigh that had been present for one week. He was referred to the emergency department (ED) for further workup. Venous duplex ultrasonography was negative …

A Linear Presentation Of Cutaneous Rosai Dorfman Disease, Emily Sheetz, Ryan C. Saal, Molly K. Smith, Rachel Chikowski Byrd

Department of Medicine Faculty Publications

[Case description] A 53-year-old female with type II diabetes and hypertension presented to the dermatology clinic with a 3-month history of an asymptomatic linear eruption along the right knee that extended distally along the shin. Initial biopsy showed an atypical lymphohistiocytic infiltrate (Fig 1), which was found to be polyclonal. At her 3-month follow up visit, the eruption demonstrated significant clinical progression with numerous indurated papules and papulonodules, some of which were tender, along the right knee and pretibial surface (Fig 2). No improvement was noted with topical triamcinolone prescribed at her initial visit.