Dermatology Commons^™

Janus Kinase (Jak) Inhibitors: A New Frontier In The Treatment Of Vitiligo, Catherine F. Alapatt, Amanda Greenspan, Mohammad Fardos

Rowan-Virtua Research Day

Up to 70 million people worldwide suffer from vitiligo, an autoimmune disease characterized by the destruction of melanin. Current treatment options vary in efficacy. The disease manifests clinically as white circular macules of depigmentation seen primarily on the face and appendages.1 The pathophysiology of vitiligo is multifactorial and still being studied. One proposed mechanism behind the pathophysiology of vitiligo involves the upregulation of interferon gamma (IFN-γ) with downstream effects on JAK/STAT pathways resulting in CXCL10 transcription.1,2 Here we discuss Ruxolitinib, a topical JAK inhibitor, that recently passed its clinical trial phase, and Ritlecitinib, an oral JAK inhibitor which is currently …

Updates To Acne Vulgaris Treatment: A Review Of A Topical Androgen Receptor Inhibitor, Catherine F. Alapatt, Klaudia Matanaj

Rowan-Virtua Research Day

Acne Vulgaris is an inflammatory skin disorder that is common among adolescents and young adults. Acne is defined as a chronic inflammatory dermatosis which consists of open comedones (blackheads), closed comedones (whiteheads) and inflammatory lesions.1 There are many ways to combat acne, one of which is to stop the effects of androgens on androgen receptors. Here we will review Clascoterone, a medication approved for the treatment of acne. Clascoterone is the first topical medication to target the hormonal pathogenesis of acne. It was approved by the FDA in 2020 and is effective in treatment of acne vulgaris in patients 12 …

Waiting For A Cure: Factors Influencing Melanoma Treatment Delays, Lisa Huang, David Rubin, Lothar Vidal, Jordan Riser, Christopher Jones, Samantha Hiester

Rowan-Virtua Research Day

Melanoma, with a five-year survival rate of 94% in early-stage diagnosis, drops significantly when diagnosed at later stages, making identifying barriers to timely treatment crucial. This literature review examines factors influencing melanoma treatment wait times and their impact on patient outcomes. Elderly, male, and Medicare patients, along with those with higher Breslow thickness and severe melanoma stages, experienced longer wait times. Patients receiving intervention within 30 days had better survival rates. Lack of knowledge and misconceptions about melanoma contribute to delayed care, particularly in communities with lower incidence rates. Black patients faced longer waits from diagnosis to surgery, indicating disparities. …

Rosarugosides A And D From Osa Rugosa Flower Buds: Their Potential Anti-Skin-Aging Effects Intnf-Α-Induced Human Dermal Fibroblasts, Kang Sub Kim, So-Ri Son, Yea Jung Choi, Yejin Kim, Si-Young Ahn, Dae Sik Jang, Sullim Lee

Faculty, Staff and Student Publications

This present study investigated the anti-skin-aging properties of Rosa rugosa. Initially, phenolic compounds were isolated from a hot water extract of Rosa rugosa's flower buds. Through repeated chromatography (column chromatography, MPLC, and prep HPLC), we identified nine phenolic compounds (1-9), including a previously undescribed depside, rosarugoside D (1). The chemical structure of 1 was elucidated via NMR, HR-MS, UV, and hydrolysis. Next, in order to identify bioactive compounds that are effective against TNF-α-induced NHDF cells, we measured intracellular ROS production in samples treated with each of the isolated compounds (1- …

Trichotillomania Case Report, Kimberly Kluglein, David F. Lo, Don D. Shamilov

Rowan-Virtua Research Day

Trichotillomania is a psycho-dermatologic disorder involving self-inflicted hair loss through pulling. Often complicated by anxiety and depression. Multifactorial etiology and limited evidence-based treatment options makes management difficult. Treatment approaches include a combination of pharmacotherapy, CBT, HRT, and ACT. Case presentation involves a 24-year-old female, diagnosed with treatment-resistant trichotillomania who achieved remission and hair regrowth through mindset reframing, physical barriers, and community support. Novel approaches focusing on mindset and community support can yield positive outcomes.

Sunscreen Cost And Its Effect On Skin Cancer In Low-Income Communities: A Systemic Review, John Sauer

Rowan-Virtua Research Day

This research examines the pivotal connection between sunscreen affordability and its impact on skin cancer prevalence, especially in low-income communities. Despite universal dermatological recommendations for daily sunscreen use, stringent criteria contribute to elevated prices, averaging around $10 for a 6 oz unit. This financial strain is compounded for families adhering to recommended application rates, leading to significant economic burdens. Outdoor laborers, less likely to follow guidelines, face heightened risks. Government programs' excluding sunscreen costs further exacerbate challenges for low-income communities, contributing to increased skin cancer incidence. This review aims to establish a correlation between sunscreen cost and skin cancer rates, …

Metastatic Osteosarcoma Involving The Skin: A Systematic Review Of Patient Demographics, Clinical Characteristics, And Treatment Outcomes, Sarah Fried, Ameen Suhrawardy, Rafey Rehman, Malik Al-Jamal, Drew Moore, Darius Mehregan

Posters

Skeletal osteosarcomas - most common primary malignant bone tumor1 and commonly metastasize to:

• Lungs (95%)2 •

Other bones (50%)2 •

Kidneys (12%)2 •

Rarely to the skin3

Extraskeletal osteosarcomas (ESOS) – soft tissue tumors that may also metastasize to the skin4,5,6

Value in gathering data on this rare phenomenon:

• Informs biology and dermatologic care of patients suffering from this cancer.

This systematic review characterizes metastatic osteosarcomas involving the skin.

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.

The Role Of Radiotherapy In The Complex Treatment Of Mycosis Fungoides; A Case Report, Laura Florentina Rebegea, Claudia-Elena Pavel, Nadejda Corobcean, Ana Maria Ilie, Dorel Firescu, Madalin Guliciuc, Elena Niculet, Mihaela Dumitru, Daniela Mihalache, Flavius Bulgaru, Roxana-Andreea Rahnea-Nita

Journal of Mind and Medical Sciences

Introduction. Mycosis fungoides (MF) is the most common form of primary cutaneous T-cell lymphoma. Radiotherapy induces excellent response rates in the treatment of localized or extensive lesions of MF, both as monotherapy and as part of a multidisciplinary treatment. Total skin irradiation with electrons or protons is available in a limited number of medical centers and is mainly used in patients with extensive MF. Case presentation. It is presented the case of a 47-year-old patient who developed erythematous papules and plaques on the chest, upper limbs, face and scalp, initially diagnosed as chronic eczema and treated with systemic corticotherapy, antihistamines …

Actinic Granuloma Complicated By Secondary Syphilis: A Case Report, Kevin H. Nguyen, Christopher M. Wong, Ethan Q. Nguyen

HCA Healthcare Journal of Medicine

Introduction

Actinic granuloma (AG) is a rare skin eruption thought to result from a sun-induced inflammatory response attracting giant cells, which are large, multinucleated, and inflammatory, to form granulomas and degrade surrounding elastic material. Clinically, lesions begin on sun-exposed skin as pink papules and nodules that coalesce into demarcated annular plaques with a hypopigmented center. Histologically, actinic elastosis surrounds the outer annulus ring, with histiocytes and giant cells within the raised border, and the innermost central zone is filled with minimal to absent elastic fibers.

Case Presentation

We present a middle-aged female with a pruritic eruption of diffuse erythematous macules …

Management Of Keloid-Associated Pruritus With Topical Crisaborole 2% Ointment: A Case Report, Daniel A. Nguyen, Elizabeth Thai Ms, Stephen E. Weis

HCA Healthcare Journal of Medicine

Introduction

The pathophysiology of keloid formation is poorly understood, and current treatments, including intralesional corticosteroids, cryotherapy, and surgery, are often associated with high resistance to treatment and recurrence. The multifactorial pathogenesis of keloid formation suggests that aberrant inflammatory cytokine signaling associated with keratinocyte dysregulation may contribute to keloid-associated pruritus.

Case Presentation

In this paper, we report 2 cases of keloid-associated pruritus that were successfully treated with topical crisaborole 2% ointment, a phosphodiesterase 4 (PDE4) inhibitor. Both patients had previously undergone multiple unsuccessful treatments before being treated with crisaborole 2% ointment. In both cases, the patients experienced complete relief of pruritus …

Presentations Of Cutaneous Disease In Various Skin Pigmentations: Porokeratosis, Henry Lim, Christopher M. Wong, Christian J. Scheufele, Daniel A. Nguyen, Michael Carletti, Stephen E. Weis

HCA Healthcare Journal of Medicine

Porokeratosis was first described in 1893. It is a relatively rare disorder with over 9 subtypes. Lesions are clinically characterized as well-demarcated, erythematous papules (raised, <1 cm) or plaques (raised, >1 cm), with an atrophic center, and raised scaly border. Porokeratosis is an important diagnosis to identify because it may undergo malignant transformation and mimics many commonly encountered diagnoses. These commonly mimicked diagnoses include squamous cell carcinoma, tinea corporis, nummular dermatitis, and psoriasis vulgaris, to name a few. The clinical images in this review focus on identifying porokeratosis along the full spectrum of skin tones.

Presentations Of Cutaneous Disease In Various Skin Pigmentations: Chronic Atopic Dermatitis, Cecilia Nguyen, Jordan Thompson, Daniel A. Nguyen, Christopher M. Wong, Christian J. Scheufele, Michael Carletti, Stephen E. Weis

HCA Healthcare Journal of Medicine

Atopic dermatitis is a chronic inflammatory skin disorder classically affecting flexural areas of the body. It is present in children and adults, including those with darker skin pigmentation. Chronic lesions are hyperpigmented plaques that are dry, cracked, and/or scaly often with lichenification. Differential diagnoses include psoriasis, seborrheic dermatitis, ichthyosis, and pityriasis rosea. This article will showcase clinical images with varying presentations of chronic atopic dermatitis in a range of age groups and skin colors according to the Fitzpatrick scale.

Presentations Of Cutaneous Disease In Various Skin Pigmentations: Seborrheic Dermatitis, Christian J. Scheufele, Christopher M. Wong, Daniel A. Nguyen Do, Pharmd, Michael Carletti, Stephen E. Weis

HCA Healthcare Journal of Medicine

Seborrheic dermatitis is a common dermatologic disease affecting patients of all ages, ethnicities, and skin pigmentations. The rash often affects the scalp, ears, and central face. The underlying skin pigmentation of the individual may affect how this disease presents. We present several cases of seborrheic dermatitis in individuals of varying ages, genders, and skin pigmentations.

Expanding Global Health Dermatology Leadership: Launching The Gloderm International Mentorship Program, Alexis G. Strahan, Olivia M. Davies, Lucía T. Fernández, Inena Wa Inena Gaylord, Yared Getachew Mekonnen, Marlous L. Grijsen, Jose E. Ollague, Doriane Sabushimike, Luisa Polo Silveira, Toby Maurer, Roni P. Dodiuk-Gad, Archana Singal, Henry W. Lim, Arpita Bhose, Janet E. Lubov, Shivani Jain, Morvarid Zehtab, Tom Allison, Maud Guerin, Wendemagegn Enbiale, Wingfield Rehmus, Karolyn A. Wanat, L Claire Fuller, Elizabeth Bailey, Esther E. Freeman

School of Medicine Faculty Publications

No abstract provided.

Geographic Distribution Of Melanoma Cases In Maine: Identifying Vulnerable Counties For Targeted Intervention, Joshua R. Parbs, Madeline Prentiss, Calla Hladky, Henry Stoddard, Kathryn Stevens, Elizabeth V. Seiverling, Peggy Cyr

Journal of Maine Medical Center

Introduction: Maine has the twelfth highest incidence of melanoma in the United States. The purpose of this study was to determine which Maine counties were the most impacted by melanoma through the use of geographical methods. Identification of counties with the highest prevalence of melanoma will help in targeting future training and public health interventions.

Methods: All melanoma cases (n=5,340) reported to the Maine CDC Cancer Registry from 2013 to 2018 were sorted by pathologic T stage. Data were sorted by county and population-adjusted. Population data and provider data came from Area Health Resource Files. County and zip-code maps were …

Regimen For Accelerated Propranolol Initial Dosing (Rapid), Charles Y. Huang, Marissa J. Perman, Albert C. Yan

Student Papers, Posters & Projects

BACKGROUND: Infantile hemangiomas are common vascular tumors in children. Propranolol has proven effective in treating infantile hemangiomas and while generally safe, has potential risk for more serious side effects of hypoglycemia, hypotension, bradycardia, bronchospasm, and cardiovascular or respiratory compromise. Current prescribing guidelines recommend initiating propranolol doses at 1 mg/kg/day, with up-titration to 2 mg/kg/day. This study aims to compare the incidence of adverse events in infants and children treated with propranolol initiated at 1 mg/kg/day versus being initiated directly at 2 mg/kg/day.

METHODS: A retrospective cohort study was conducted using medical records of patients receiving propranolol therapy for infantile hemangiomas …

Inter-Institutional Analysis Of Skin Of Color Representation In Dermatological Lecture Content At Md And Do Medical Schools, Oluwafunke Oluwatosin Ogunremi, Blake Fredericksen, John Komas, Sana Ismail, Siri Knutsen-Larson Md, Valeriy Kozmenko Md, Afia Albin Do

Aesculapius Journal (Health Sciences & Medicine)

The purpose of this study was to analyze the lecture materials provided in medical schools through a diversity lens. Skin pathologies manifest distinctively on various shades of skin and physicians must be equipped with the proper knowledge to identify and diagnose these conditions accurately and promptly. For most medical students, images in prominent textbooks and lecture slides are their first encounter with disease presentations. Therefore, it is important to analyze the diversity of skin tones in the content that is being delivered. Specifically, the use of images featuring darker skin tones compared to those depicting lighter skin tones. This study …

Playing It Sun Safe: A Quality Improvement Project, Sarah P. Tarr, Kathryn K. Dambrino, R. David Phillippi, Ashley Karpinos

DNP Projects

Background: Athletes who play outdoor sports have multiple risk factors for the development of skin cancer. Literature highlights the need for the use of evidence-based strategies to improve the knowledge and utilization of sun protection practices in this high-risk population. Methods: Playing it Sun Safe was a multifaceted skin cancer prevention initiative implemented in a population of collegiate soccer athletes in collaboration with a university athletic department and campus health clinic. Evidence-based interventions were designed through application of the Health Belief Model (HBM) and were implemented using the Institute for Healthcare Improvement (IHI) quality improvement framework. Purpose: The two-fold aim …

Surgical Intervention For Diffuse Dermal Angiomatosis Of The Breast, Caroline E. Savoie, Bethany S. Acosta, Harley J. Davis, G. William Poche

School of Medicine Faculty Publications

No abstract provided.

Neonatal Onset Multisystem Inflammatory Disease Presenting As An Urticarial Rash In A Newborn, Irene Chern, Dana Toib

Tower Health Research Day

No abstract provided.

Hiding In Plain Sight; Dermatologic Manifestation Of A Systemic Disease, Christopher Ignatz, David Young Do, Brian Chwiecko Md

Tower Health Research Day

No abstract provided.

Multicenter Study Of Long-Term Outcomes And Quality Of Life In Phace Syndrome After Age 10., Mitchell Braun, Ilona J. Frieden, Dawn H. Siegel, Elizabeth George, Christopher P. Hess, Christine K. Fox, Sarah L. Chamlin, Beth A. Drolet, Denise Metry, Elena Pope, Julie Powell, Kristen Holland, Caden Ulschmid, Marilyn G. Liang, Kelly K. Barry, Tina Ho, Chantal Cotter, Eulalia Baselga, David Bosquez, Surabhi Neerendranath Jain, Jordan K. Bui, Irene Lara-Corrales, Tracy Funk, Alison Small, Wenelia Baghoomian, Albert C. Yan, James R. Treat, Griffin Stockton Hogrogian, Charles Huang, Anita Haggstrom, Mary List, Catherine C. Mccuaig, Victoria Barrio, Anthony J. Mancini, Leslie P. Lawley, Kerrie Grunnet-Satcher, Kimberly A. Horii, Brandon D. Newell, Amy J. Nopper, Maria C. Garzon, Margaret E. Scollan, Erin F. Mathes

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: To characterize long-term outcomes of PHACE syndrome.

STUDY DESIGN: Multicenter study with cross-sectional interviews and chart review of individuals with definite PHACE syndrome ≥10 years of age. Data from charts were collected across multiple PHACE-related topics. Data not available in charts were collected from patients directly. Likert scales were used to assess the impact of specific findings. Patient-Reported Outcomes Measurement Information System (PROMIS) scales were used to assess quality of life domains.

RESULTS: A total of 104/153 (68%) individuals contacted participated in the study at a median of 14 years of age (range 10-77 years). There were infantile hemangioma …

Resolution Of Metastatic Cutaneous Crohn's Disease With Upadacitinib Monotherapy, Kevin M Burningham, Kritin K Verma, Anisha B Patel, Stephen K Tyring

Faculty, Staff and Student Publications

No abstract provided.

Scurvy In An Adolescent: A Case Report, Tony Du, Abhay Kulkarni

Faculty, Staff and Students Publications

Scurvy is a rare condition characterized by a deficiency in dietary vitamin C. Historically a disease taught in the context of long ocean voyages with limited vitamin intake, it is now rare in developed nations. The classical physical exam findings include gingival bleeding, perifollicular hemorrhages, and corkscrew hairs. We discuss the case of a 15-year-old female with scurvy whose initial presentation suggested more common diagnoses seen in the emergency department setting. Her course was complicated by a prior history of anorexia nervosa and a restrictive diet that lacked necessary vitamins. Once the patient's dietary habits were identified, a detailed physical …

Risk Of Developing Hypertension In Atopic Dermatitis Patients Receiving Long-Term And Low-Dose Cyclosporine: A Nationwide Population-Based Cohort Study, Yu Ri Woo, Arum Choi, Seo Won Song, Suyeun Kim, Sang Wook Son, Sang Hyun Cho, Sukil Kim, Jung Eun Kim

Faculty, Staff and Student Publications

BACKGROUND: Cyclosporine (CS) is a first-line immunosuppressive agent used to manage moderate to severe atopic dermatitis (AD). To date, the risk of developing hypertension associated with the long-term use of low-dose CS in AD patients is understudied.

OBJECTIVE: To determine the cumulative dose-dependent effect of CS on the risk of developing hypertension in patients with AD.

METHODS: A nationwide population-based retrospective cohort with 1,844,009 AD patients was built from the Korean National Health Insurance System database from 2005 to 2009. A Cox proportional-hazard regression analysis was performed according to patients' CS treatment history adjusted for potential confounders.

RESULTS: Current use …

Development Of Ige-Mediated Food Allergies In Children With History Of Food Protein-Induced Allergic Proctocolitis: A Series Of Five Cases, Kim L. Tran, Elizabeth L. Wisner, George M. Jeha, Luke A. Wall

School of Medicine Faculty Publications

Food protein-induced allergic proctocolitis (FPIAP) is a non-IgE-mediated allergic condition that presents with hematochezia in otherwise healthy infants. It is most commonly induced by cow's milk protein via breast milk or formula. The prognosis for FPIAP is generally considered favorable with most infants achieving symptomatic resolution after diet modification. Most infants go on to tolerate the offending foods by 1–3 years of age. Over 8 years at our institution, five patients were identified and noted to have FPIAP to cow's milk during infancy with subsequent development of IgE-mediated allergic reaction to cow's milk and other foods. All five cases developed …

The Koolungar Moorditj Healthy Skin Project: Elder And Community Led Resources Strengthen Aboriginal Voice For Skin Health, Bernadette M. Ricciardo, Jacinta Walton, Noel Nannup, Dale Tilbrook, Heather-Lynn Kessaris, Carol Michie, Brad Farrant, Roni Forrest, Annette Garlett, Joanne Hill, Larissa Jones, Natasha Kickett, Sally Smith, Delys Walton, Taleah Ugle, Nadia Rind, Richelle Douglas, Jodie Ingrey, Brenda Carter, Ainslie Poore, Ingrid Amgarth-Duff, Hannah Thomas, Prasad S. Kumarasinghe, Jonathan R. Carapetis, Asha C. Bowen

Journal of the Australian Indigenous HealthInfoNet

In partnership with local Aboriginal Community Controlled Health Organisations, the Elder-led co-designed Koolungar Moorditj Healthy Skin project is guided by principles of reciprocity, capacity building, respect, and community involvement. Through this work, the team of Elders, community members, clinicians and research staff have gained insight into the skin health needs of urban-living Aboriginal koolungar (children); and having identified a lack of targeted and culturally appropriate health literacy and health promotion resources on moorditj (strong) skin, prioritised development of community-created healthy skin resources. Community members self-appointed to Aboriginal Community Advisory Groups (CAG) on Whadjuk (Perth) …

Development Of Solitary Keratoacanthoma From A Cutaneous Wart, Joshua M. Ninan, Veronica Salazar

Research Symposium

Background: Common cutaneous warts, referred to in medicine as verrucae vulgaris, are proliferative lesions caused by human papillomavirus. These lesions are mostly benign and usually resolve without incident, except in the case of the patient mentioned in this report. Our patient developed a solitary keratoacanthoma, currently accepted as a clinical variant of squamous cell carcinoma, as a result of several risk factors and traumatic exposure. The current literature does not have an established association of HPV with solitary keratoacanthomas. This case report explores the presentation and pathogenesis of solitary keratoacanthomas within the setting of HPV.

Case Presentation: 48-year-old Caucasian female …

Cutaneous Ulcerations As The Presenting Sign Of Acute Aortic Occlusion, Odera Ekeh, Zoe I. Smith, Justin J. Green

Cooper Medical School of Rowan University Departmental Research

This is a report of a case of acute aortic occlusion (AAO) in a 46-year-old woman who presented with confluent and coalescing punched-out ulcerations on the bilateral medial buttocks and abdominal ulcerations. This case highlights how AAO, although rare, should be considered in patients with cardiovascular risk factors presenting with acute lower extremity pain and new-onset cutaneous ulcerations of the perineum and/or abdomen.