Dermatology Commons^™

Pyemotes Herfsi Dermatitis: A Case Of 17 Year Itch, Christina E. Borchers, Taylor Schaetzle, Samia Borchers

Dermatology Faculty Publications

No abstract provided.

The Effects Of An Interprofessional Education Video On Dermatologists’ Understanding Of The Role Of The Dermatology Certified Nurse Practitioner, Danielle Elaine Spelich

Doctoral Projects

Dermatology-certified nurse practitioners (DCNPs) have validated knowledge of a dermatology core curriculum and have at least 3,000 hours of formal or informal dermatology training (Dermatology Nurse Practitioner Certification Board [DNPCB], n.d.a). With their standardized education and training, DCNPs are meeting the benchmarks set out by dermatologists. Subsequently, DCNPs have become the new gold standard for dermatology advanced practice registered nurses (APRNs).

However, there is no mention of DCNPs by the American Academy of Dermatology (American Academy of Dermatology [AAD], 2022), and personal experience with dermatologists is that they lack knowledge about DCNPs. This lack of knowledge could create an impasse …

Clinical And Pathological Characteristics And Outcomes Among Patients With Subcutaneous Panniculitis-Like T-Cell Lymphoma And Related Adipotropic Lymphoproliferative Disorders, Joan Guitart, Aaron R Mangold, Maria Estela Martinez-Escala, Christina J Walker, Nneka I Comfere, Mellissa Pulitzer, Kerri E Rieger, Carlos A Torres-Cabala, Laura B Pincus, Erica S Kumar, Erica Bo Kyung Wang, Katherine E Park, Maria L Espinosa, Madeleine Duvic, Youn H Kim, Steven Horwitz

Faculty, Staff and Student Publications

IMPORTANCE: There is a knowledge gap about subcutaneous panniculitis-like T-cell lymphoma (SPTCL) owing to its rarity and diagnostic difficulty, resulting in an absence of well-documented large case series published to date.

OBJECTIVE: To generate consensus knowledge by a joint multi-institutional review of SPTCL and related conditions.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective clinical and pathological review included cases initially diagnosed as SPTCL at 6 large US academic centers. All cases were reviewed by a group of pathologists, dermatologists, and oncologists with expertise in cutaneous lymphomas. Through a process of group consensus applying defined clinical and pathological diagnostic criteria, the cohort …

Effect Of Roflumilast Cream Vs Vehicle Cream On Chronic Plaque Psoriasis: The Dermis-1 And Dermis-2 Randomized Clinical Trials, Mark G Lebwohl, Leon H Kircik, Angela Y Moore, Linda Stein Gold, Zoe D Draelos, Melinda J Gooderham, Kim A Papp, Jerry Bagel, Neal Bhatia, James Q Del Rosso, Laura K Ferris, Lawrence J Green, Adelaide A Hebert, Terry Jones, Steven E Kempers, David M Pariser, Paul S Yamauchi, Matthew Zirwas, Lorne Albrecht, Alim R Devani, Mark Lomaga, Amy Feng, Scott Snyder, Patrick Burnett, Robert C Higham, David R Berk

Faculty, Staff and Student Publications

IMPORTANCE: Once-daily roflumilast cream, 0.3%, a potent phosphodiesterase 4 inhibitor, demonstrated efficacy and was well tolerated in a phase 2b trial of patients with psoriasis.

OBJECTIVE: To evaluate the efficacy of roflumilast cream, 0.3%, applied once daily for 8 weeks in 2 trials of patients with plaque psoriasis.

DESIGN, SETTING, AND PARTICIPANTS: Two phase 3, randomized, double-blind, controlled, multicenter trials (DERMIS-1 [trial 1; n = 439] and DERMIS-2 [trial 2; n = 442]) were conducted at 40 centers (trial 1) and 39 centers (trial 2) in the US and Canada between December 9, 2019, and November 16, 2020, and between …

Pleomorphic Dermal Sarcoma Of The Scalp: Review Of Management And Distinguishing Features From Atypical Fibroxanthoma, Alexa J Cohen, Sahithi Talasila, Bojan Lazarevic, Laura Gleason, Viral Patel, Neda Nikbakht

Department of Dermatology and Cutaneous Biology Faculty Papers

No abstract provided.

Social Media Impact Of Articles Published By Dermatology Residents During Medical School: Cross-Sectional Study, Austin Huang, Harrison Zhu, Kelvin Zhou, R Parker Kirby, Nina Dasari, Gianmarco A Calderara, Kathryn Cordova, Ryan Sorensen, Anshul Bhatnagar, Soo Jung Kim

Faculty, Staff and Students Publications

BACKGROUND: The Altmetric score (AS) is a novel measure of publication impact that is calculated by the number of mentions across various social media websites. This method may have advantages over traditional bibliometrics in the context of research by medical students.

OBJECTIVE: This study aimed to determine whether dermatology matriculants who graduated from higher-ranked medical schools published more articles with greater impact (ie, a higher AS) than those from lower-ranked institutions.

METHODS: A PubMed search for articles published by dermatology residents who started medical school in 2020 was conducted. Demographic information and Altmetric data were collected, and medical schools were …

Dermatologic Manifestations Of Rheumatic Disease: Cutaneous Manifestations Of Sarcoidosis, Sarah Shapiro, Sindhuja Koppu, Mavra Masood, Beth Rubinstein, Huzaefah Syed

Open Textbooks and Course Materials

This OER is a part of the Dermatologic Manifestations of Rheumatic Disease project, which provides overviews of the identification, diagnosis, and workup for different rheumatologic diseases, with a focus on providing examples from persons of color (POC). This work seeks to fill gaps and exclusionary practices in medical education practices and resources and diagnostic frameworks in regards to skin of color. This lack of representation bodes significant repercussions on the ability of future physicians to deliver equitable care for an increasingly diverse US population. Each module consists of a similar Powerpoint format, which includes key objectives, hypothetical disease cases, an …

Cell-Intrinsic Melanin Fails To Protect Melanocytes From Ultraviolet-Mutagenesis In The Absence Of Epidermal Melanin, Tirzah J. Weiss, Emma R. Crawford, Valentina Posada, Hafeez Rahman, Tong Liu, Brandon M. Murphy, Tiffany E. Arnold, Shannon Gray, Zhexuan Hu, Rebecca C. Hennessey, Lianbo Yu, John August D'Orazio, Craig J. Burd, Jonathan H. Zippin, Douglas Grossman, Christin E. Burd

Markey Cancer Center Faculty Publications

Melanin is a free-radical scavenger, antioxidant, and broadband absorber of ultraviolet (UV) radiation which protects the skin from environmental carcinogenesis. However, melanin synthesis and UV-induced reactive melanin species are also implicated in melanocyte genotoxicity. Here, we attempted to reconcile these disparate functions of melanin using a UVB- sensitive, NRAS-mutant mouse model, TpN. We crossed TpN mice heterozygous for an inactivating mutation in Tyrosinase to produce albino and black littermates on a C57BL/6J background. These animals were then exposed to a single UVB dose on postnatal day three when keratinocytes in the skin have yet to be melanized. Approximately one-third (35%) …

Efficacy And Safety Of Topical Hypericin Photodynamic Therapy For Early-Stage Cutaneous T-Cell Lymphoma (Mycosis Fungoides): The Flash Phase 3 Randomized Clinical Trial, Ellen J Kim, Aaron R Mangold, Jennifer A Desimone, Henry K Wong, Lucia Seminario-Vidal, Joan Guitart, James Appel, Larisa Geskin, Edward Lain, Neil J Korman, Nathalie Zeitouni, Neda Nikbakht, Kenneth Dawes, Oleg Akilov, Joi Carter, Michi Shinohara, Timothy M Kuzel, Warren Piette, Neal Bhatia, Amy Musiek, David Pariser, Youn H Kim, Dirk Elston, Erin Boh, Madeleine Duvic, Auris Huen, Theresa Pacheco, Jeffrey P Zwerner, Seung Tae Lee, Michael Girardi, Christiane Querfeld, Kimberly Bohjanen, Elise Olsen, Gary S Wood, Adam Rumage, Oreola Donini, Andrea Haulenbeek, Christopher J Schaber, Richard Straube, Christopher Pullion, Alain H Rook, Brian Poligone

Faculty, Staff and Student Publications

IMPORTANCE: Given that mycosis fungoides-cutaneous T-cell lymphoma (MF/CTCL) is chronic, there is a need for additional therapies with minimal short- and long-term adverse effects. Topical synthetic hypericin ointment, 0.25%, activated with visible light is a novel, nonmutagenic photodynamic therapy (PDT).

OBJECTIVES: To determine the efficacy and safety of topical synthetic hypericin ointment, 0.25%, activated with visible light as a nonmutagenic PDT in early-stage MF/CTCL.

DESIGN, SETTINGS, AND PARTICIPANTS: This was a multicenter, placebo-controlled, double-blinded, phase 3 randomized clinical trial (FLASH study) conducted from December 2015 to November 2020 at 39 academic and community-based US medical centers. Participants were adults (≥18 …

The Effect Of Body Mass Index On Therapeutic Response To Bacterial Vaginosis In Pregnancy, Kevin P Lee, Misha V Koshelev, D3code Team, Omar Pacha

Faculty, Staff and Student Publications

No abstract provided.

A Case Of Perifollicular Macular Amyloidosis, Imran T Baig, Jamael L Thomas, Misha V Koshelev

Faculty, Staff and Student Publications

Macular amyloidosis is a common type of primary localized cutaneous amyloidosis. We present a case report of a 74-year-old patient with no significant past medical history who was evaluated for dark macules and pruritus for over a year. On exam, follicular-based brown macules on the upper and lower back, bilateral shoulders, and bilateral dorsal upper arms were noted. The morphology and distribution of follicular-based macules was unusual, so the differential included follicular lichen planus, follicular eczema, and macular amyloidosis. Punch biopsy showed deposits of eosinophilic fibrillary material along with pigmentary incontinence in the papillary dermis, consistent with macular amyloidosis. Additionally, …

Acyclovir-Resistant Anogenital Herpes Simplex Virus In An Hiv Patient With Pseudoepitheliomatous Hyperplasia Resembling Squamous Cell Carcinoma, Jean Elizze M. Charles, Stephen E. Weis, Gregory A. Hosler

HCA Healthcare Journal of Medicine

Background

Herpes simplex virus (HSV) is a common infection. However, it may present atypically when patients are immunocompromised, such as with slowly expanding, long-lasting ulcerative or hypertrophic lesions. The histopathologic finding of pseudoepitheliomatous hyperplasia (PEH) can occur in a variety of situations where there is chronic inflammation and can be seen in patients with chronic HSV. Atypical presentations of HSV, particularly hypertrophic lesions with histopathologic findings of PEH, can be misinterpreted as squamous cell carcinoma, create difficulty in diagnosis and hinder appropriate treatment.

Case Description

We report a case of a 59-year-old female with a past medical history of human …

Development And Validation Of A Simple Model To Predict The Risk Of Nonmelanoma Skin Cancer On Screening Total Body Skin Examination, Rebecca Hartman, Yun Xue, Ryan Karmouta, Elizabeth Tkachenko, Sara J. Li, David G. Li, Cara Joyce, Arash Mostaghimi

Biostatistics Collaborative Core: Faculty Publications and Other Works

Objective. There is insufficient evidence to generate skin cancer screening guidelines at the population level, resulting in arbitrary variation in patient selection for screening skin examinations. This study was aimed at developing an easy-to-use predictive model of nonmelanoma skin cancer (NMSC) risk on screening total body skin examination (TBSE).

Methods. This epidemiologic assessment utilized data from a prospective, multicenter international study from primarily academic outpatient dermatology clinics. Potential predictors of NMSC on screening TBSE were identified and used to generate a multivariable model that was converted into a point-based scoring system. The performance characteristics of the model were validated in …

Collagen Vii Maintains Proteostasis In Dermal Fibroblasts By Scaffolding Tango1 Cargo, Qingqing Cao, Grace Tartaglia, Michael Alexander, Pyung Hung Park, Shiv Poojan, Mehdi Farshchian, Ignacia Fuentes, Mei Chen, John . A. Mcgrath, Francis Palisson, Julio Salas-Alanis, Andrew P. South

Department of Dermatology and Cutaneous Biology Faculty Papers

Lack of type VII collagen (C7) disrupts cellular proteostasis yet the mechanism remains undescribed. By studying the relationship between C7 and the extracellular matrix (ECM)-associated proteins thrombospondin-1 (TSP1), type XII collagen (C12) and tissue transglutaminase (TGM2) in primary human dermal fibroblasts from multiple donors with or without the genetic disease recessive dystrophic epidermolysis bullosa (RDEB) (n=31), we demonstrate that secretion of each of these proteins is increased in the presence of C7. In dermal fibroblasts isolated from patients with RDEB, where C7 is absent or defective, association with the COPII outer coat protein SEC31 and ultimately secretion of each of …

Advances In Management And Therapeutics Of Cutaneous Basal Cell Carcinoma, Olivia M Chen, Keemberly Kim, Chelsea Steele, Kelly M Wilmas, Nader Aboul-Fettouh, Carrick Burns, Hung Quoc Doan, Sirunya Silapunt, Michael R Migden

Faculty, Staff and Student Publications

Basal cell carcinoma (BCC), the most common cancer in humans, is a malignant neoplasm of cells derived from the basal layer of the epidermis. Tumor characteristics such as histologic subtype, primary versus recurrent tumor, anatomic location, size, and patient attributes determine the risk level and acceptable treatment options. Surgical options offer histologic confirmation of tumor clearance. Standard excision provides post-treatment histologic assessment, while Mohs micrographic surgery (MMS) provides complete margin assessment intraoperatively. Additional treatment options may be employed in the correct clinical context. Small and low-risk BCCs, broad field cancerization, locally-advanced disease, metastatic disease, cosmetic concerns, or morbidity with surgical …

Reporting Of Mycetoma Cases From Skin And Soft Tissue Biopsies Over A Period Of Ten Years: A Single Center Report And Literature Review From Pakistan, Mohammad Zeeshan, Saira Fatima, Joveria Farooqi, Kauser Jabeen, Arsalan Ahmed, Afreen Haq, Muhammad Omer Arif, Afia Zafar

Department of Pathology and Laboratory Medicine

Background: Mycetoma is an important neglected tropical disease associated with debilitation, disfigurement and death if not diagnosed and treated adequately. In Pakistan, mycetoma cases have frequently been diagnosed in histopathology and microbiology laboratories. However, there is scarcity of published data from this country. Therefore, the objectives of this study were to evaluate the frequency and type of mycetoma reported in skin and soft tissue biopsies from a single center over 10 years and review of published literature from Pakistan.
Method: This descriptive observational retrospective study was conducted at the Aga Khan University Hospital laboratory, Karachi, Pakistan. Laboratory data from 2009-2018 …

Advances In Cutaneous Squamous Cell Carcinoma Management, Carrick Burns, Shelby Kubicki, Quoc-Bao Nguyen, Nader Aboul-Fettouh, Kelly M Wilmas, Olivia M Chen, Hung Quoc Doan, Sirunya Silapunt, Michael R Migden

Faculty, Staff and Student Publications

cSCC is increasing in prevalence due to increased lifespans and improvements in survival for conditions that increase the risk of cSCC. The absolute mortality of cSCC exceeds melanoma in the United States and approaches that of melanoma worldwide. This review presents significant changes in the management of cSCC, focusing on improvements in risk stratification, new treatment options, optimization of existing treatments, and prevention strategies. One major breakthrough in cSCC treatment is the advent of immune checkpoint inhibitors (ICIs) targeting programmed cell death protein 1 (PD-1) and programmed death-ligand 1 (PD-L1), which have ushered in a renaissance in the treatment of …

Urticarial Rash In A Patient With Alpha-Gal Syndrome Caused By Subcutaneous Heparin At Prophylactic Dosing: A Case Report, Russell G. Behmer, Randolph S. Thomas, Hani T. Jarawan

Journal of Maine Medical Center

Introduction: We report a patient with a history of red meat allergy, or alpha-gal syndrome, who had an urticarial rash after exposure to unfractionated heparin at a dose typically used for prophylaxis of deep venous thrombosis. Although anaphylactic reactions have been reported with systemic intravenous heparin, we believe this case is the first report of an immunoglobulin E–mediated reaction to subcutaneous heparin at prophylactic dosing.

Clinical Findings: An 85-year-old male had a 3-year history of red meat allergy and was intolerant of pork and beef. He developed an immunoglobulin E–mediated allergic reaction to subcutaneous heparin at a dose of 5000 …

Pruritic Annular Erythematous Eruption After Receiving The Covid-19 Vaccine, Devon E. Cross, James Garritano, Amanda E. Zubek, Alicia J. Little

COVID-19 Papers, Posters, and Presentations

No abstract provided.

Evaluation Of Residual Antibacterial Effects On Canine Skin Surface And Hairs Following Treatment With Five Commercial Mousse Products Against Staphylococcus Pseudintermedius In Vitro, Chi-Yen Wu

LSU Master's Theses

Topical products are essential treatments for canine superficial bacterial folliculitis. However, studies for commercial products typically evaluate antibacterial effects on hairs rather than the skin surface. In addition, the interference from the hair length has not been evaluated in these studies. Therefore, the study objective for this study was to evaluate the residual antibacterial effects of five mousse products, (1) 2% chlorhexidine and 2% miconazole, (2) 0.05% phytosphingosine, (3) 2% salicylic acid and 10% ethyl lactate, (4) 3% chlorhexidine and 0.5% climbazole, and (5) 2% chlorhexidine and 1% ketoconazole on both the skin surface and hairs in both short- and …

Elevated Serum Levels Of Interleukin-15 In Pemphigus Vulgaris Patients: A Potential Therapeutic Target, Maedeh Kheirodin, Zohreh Tehranchinia, Yasaman Ketabi, Soheil Tavakolpour, Sahar Dadkhahfar, Masoomeh Faghankani, Hassan Vahidnezhad, Nikoo Mozafari

Department of Dermatology and Cutaneous Biology Faculty Papers

Introduction: Pemphigus vulgaris (PV) is a rare autoimmune disease that causes painful blistering. Interleukin-15 (IL-15) as a member of the immunoregulatory cytokines family is associated with the development of the chronic inflammatory or autoimmune disease. There is not much information available in the literature on the exact role IL-15 plays in PV. Objectives: The goal of this study was to evaluate the serum levels of IL-15 in patients with PV and assess the association of IL-15 with anti-desmoglein antibodies and the severity of the disease. Methods: Fifty-three individuals affected with active PV and 38 age- and gender-matched healthy controls were …

Finding The Right Scope: Dermoscopy For Primary Care, Peggy Cyr, Elizabeth Seiverling

MaineHealth Maine Medical Center

Background

• Primary care physicians (PCPs) frequently address skin concerns and perform clinical skin examinations1

• For PCPs, the use of dermoscopy has been shown to increase the sensitivity for skin cancer diagnosis compared to unassisted examinations2,3

• Prior to this study, no formal consensus existed on the fundamental knowledge and skills that PCPs should have with respect to dermoscopy

Objectives

• To develop an expert opinion consensus statement on 2 proficiency standards for PCPs using dermoscopy

Impact Of Dermoscopy Training For Pcps On Nnb To Detect Melanoma, Madeline Prentiss, Kathryn Stevens, Henry Stoddard, Peggy Cyr, Laura Houk, Hadjh Ahrns, Elizabeth Seiverling

MaineHealth Maine Medical Center

The goal of this project was to analyze the impact of dermoscopy training on the number of melanocytic nevi needed to biopsy (NNB) to detect a melanoma in the primary care setting .

Pediatric Dermatology Econsult Program With Dermoscopy: Sub Analysis Of Infantile Hemangiomas, Peggy R. Cyr, Madeline Prentiss, Hadjh Ahrns, Abby Markham, Elizabeth V Seiverling

MaineHealth Maine Medical Center

Here we present an analysis of pediatric dermatology eConsults with emphasis on dermoscopy utilization and the impact on eConsult on infantile hemangiomas (IH) management.

Skin Cancer Education Interventions For Primary Care Providers: A Scoping Review, Ashley E Brown, Maleka Najmi, Taylor Duke, Daniel A Grabell, Misha V Koshelev, Kelly C Nelson

Faculty, Staff and Student Publications

Primary care physicians (PCPs) are often the first line of defense against skin cancers. Despite this, many PCPs do not receive a comprehensive training in skin conditions. Educational interventions aimed at skin cancer screening instruction for PCPs offer an opportunity to detect skin cancer at earlier stages and subsequent improved morbidity and mortality. A scoping review was conducted to collect data about previously reported skin cancer screening interventions for PCPs. A structured literature search found 51 studies describing 37 unique educational interventions. Curriculum elements utilized by the interventions were divided into categories that would facilitate comparison including curriculum components, delivery …

The 2-Methoxymethyl Modification Of P -Phenylenediamine Reduces The Sensitization Risk For Hairdressers To Hair Dyes-An Occupational Hand Exposure-Based Risk Assessment, Emanuele Marco Gargano, Brunhilde Blömeke, Anthony Gaspari, Carsten Goebel

Department of Dermatology and Cutaneous Biology Faculty Papers

Background: Allergic contact dermatitis involving the hands is a common occupational skin disease for hairdressers and the potent sensitizers p -phenylenediamine (PPD) and toluene-2,5-diamine (PTD) are associated with the development of occupational allergic contact dermatitis.

Objective: The aim of the study was to analyze whether the use of the moderate sensitizer 2-methoxymethyl-PPD (ME-PPD) in professional hair dyes is a suitable tool to reduce the occupational contact allergy risk for hairdressers.

Methods: Hand exposure of hairdressers (N = 11) to ME-PPD was analyzed under routine hair coloring conditions in commercial salons. By accounting for wet work and uneven hand exposure, the …

Delayed Diagnosis Of Klippel-Trénaunay Syndrome In A 23-Year-Old African American Male, Daniel A. Nguyen, Pranav Patel, Stephen E. Weis

HCA Healthcare Journal of Medicine

Klippel-Trénaunay syndrome is a rare genetic disorder that typically presents as a triad of symptoms consisting of venous malformations (varicosities), capillary malformations (port-wine stain), and limb overgrowth. We followed a 23-year-old African American male with a past medical history of peripheral vascular disease, who was visiting the dermatology clinic for a persistent skin lesion on his thigh. During physical examinations, we noted a subtle port-wine stain on his right leg, right leg hypertrophy, and peripheral vascular disease. Skin findings were difficult to observe on his darker skin tone, Fitzpatrick skin type VI, which may have led to the delayed diagnosis …

Presentations Of Cutaneous Disease In Various Skin Pigmentations: Cutaneous Abscesses, Christopher M. Wong, Christian J. Scheufele, Sandhya Bodapati, Daniel A. Nguyen, Ashleigh E. Hermann, Jean Elizze M. Charles, Michael Carletti, Stephen E. Weis

HCA Healthcare Journal of Medicine

Cutaneous abscesses are collections of pus resulting from skin and soft tissue bacterial infections. They clinically exhibit the four cardinal inflammatory signs of pain, warmth, swelling, and erythema. In patients with darkly pigmented skin, classically-associated erythema may be challenging to appreciate and can lead to missed or delayed diagnosis. We compare abscess presentations in different skin types. Recognition of varying presentations of cutaneous abscesses in diverse skin colors will help clinicians utilize additional clues to identify and diagnose this entity correctly.

Presentations Of Cutaneous Disease In Various Skin Pigmentations: Inverse Psoriasis, Daniel A. Nguyen, Henry Lim, Christopher M. Wong, Christian J. Scheufele, Ashleigh E. Hermann, Jean Elizze M. Charles, Michael Carletti, Stephen E. Weis

HCA Healthcare Journal of Medicine

Inverse psoriasis is a clinical variant of psoriasis involving flexural or intertriginous areas of the body. Inverse psoriasis may be present in 3 to 36% of psoriasis patients. Lesions are clinically characterized as smooth, well-demarcated, erythematous plaques (raised, >1 cm) without the typical silvery scales of classic psoriasis. Differential diagnosis includes tinea infection, candidiasis, seborrheic dermatitis, or bacterial streptococcal infection. The clinical images in this review focus on identifying inverse psoriasis along the full spectrum of skin tones.

Presentations Of Cutaneous Disease In Various Skin Pigmentations: Plaque Psoriasis, Ashleigh E. Hermann, Daniel A. Nguyen, Christopher M. Wong, Christian J. Scheufele, Michael Carletti, Stephen E. Weis

HCA Healthcare Journal of Medicine

Recent studies estimate that more than 8 million Americans have psoriasis. The prevalence of psoriasis in African Americans is 1.5% compared to 3.6% of Caucasians. Psoriasis is likely to be underdiagnosed among African Americans and other individuals with darker pigmented skin due to variations in clinical presentation in addition to disease distribution and severity. We present images of psoriasis vulgaris in a variety of Fitzpatrick skin types. Differences in the biology of skin pigmentation may explain the clinical masking of erythema in darker-skinned individuals. Recognition of this important difference will help clinicians utilize additional clues to identify and diagnose this …