Dermatology Commons^™

Kinetics Of Wound Development And Healing Suggests A Skin-Stabilizing Effect Of Allogeneic Abcb5+ Mesenchymal Stromal Cell Treatment In Recessive Dystrophic Epidermolysis Bullosa, Elke Niebergall-Roth, Kathrin Dieter, Cristina Daniele, Silvia Fluhr, Maria Khokhrina, Ines Silva, Christoph Ganss, Markus H. Frank, Mark A. Kluth

Research outputs 2022 to 2026

Recessive dystrophic epidermolysis (RDEB) is a rare, inherited, and currently incurable skin blistering disorder characterized by cyclically recurring wounds coexisting with chronic non-healing wounds. In a recent clinical trial, three intravenous infusions of skin-derived ABCB5+ mesenchymal stromal cells (MSCs) to 14 patients with RDEB improved the healing of wounds that were present at baseline. Since in RDEB even minor mechanical forces perpetually provoke the development of new or recurrent wounds, a post-hoc analysis of patient photographs was performed to specifically assess the effects of ABCB5+ MSCs on new or recurrent wounds by evaluating 174 wounds that occurred after baseline. During …

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.

Hemorrhagic Herpes Zoster Duplex Unilateralis In A Patient Taking Clopidogrel, Austinn C Miller, Anthony Thompson, Alexzandra Mattia, Laurie A Temiz, Susuana Adjei, Stephen K Tyring

Faculty, Staff and Student Publications

No abstract provided.

Clinical Presentation And Management Of Chromoblastomycosis: A Case Report And Review, Lacey Falgout, Deborah Hilton

School of Medicine Faculty Publications

No abstract provided.

Changes In Nascent Chromatin Structure Regulate Activation Of The Pro-Fibrotic Transcriptome And Myofibroblast Emergence In Organ Fibrosis, Morgan D. Basta, Svetlana Petruk, Ross Summer, Joel Rosenbloom, Peter J. Wermuth, Edward J. Macarak, Alex V. Levin, Alexander Mazo, Janice L. Walker

Department of Biochemistry and Molecular Biology Faculty Papers

Cell reprogramming to a myofibroblast responsible for the pathological accumulation of extracellular matrix is fundamental to the onset of fibrosis. Here, we explored how condensed chromatin structure marked by H3K72me3 becomes modified to allow for activation of repressed genes to drive emergence of myofibroblasts. In the early stages of myofibroblast precursor cell differentiation, we discovered that H3K27me3 demethylase enzymes UTX/KDM6B creates a delay in the accumulation of H3K27me3 on nascent DNA revealing a period of decondensed chromatin structure. This period of decondensed nascent chromatin structure allows for binding of pro-fibrotic transcription factor, Myocardin-related transcription factor A (MRTF-A) to nascent DNA. …

Topical Administration Of An Apoptosis Inducer Mitigates Bleomycin-Induced Skin Fibrosis, Md Nurul Huda, Edgar A Borrego, Cristina D Guerena, Armando Varela-Ramirez, Renato J Aguilera, Christine M Hamadani, Eden E L Tanner, Abu Zayed Md Badruddoza, Sandeep K Agarwal, Md Nurunnabi

Faculty, Staff and Students Publications

Pathological fibrosis is distinguished from physiological wound healing by persistent myofibroblast activation, suggesting that therapies that induce myofibroblast apoptosis selectively could prevent progression and potentially reverse the established fibrosis, such as for scleroderma (a heterogeneous autoimmune disease characterized by multiorgan fibrosis). Navitoclax (NAVI) is a BCL-2/BCL-xL inhibitor with antifibrotic properties and has been investigated as a potential therapeutic for fibrosis. NAVI makes myofibroblasts particularly vulnerable to apoptosis. However, despite NAVI's significant potency, clinical translation of BCL-2 inhibitors, NAVI in this case, is hindered due to the risk of thrombocytopenia. Therefore, in this work, we utilized a newly developed ionic liquid …

Malignancy Or Dermatophyte Infection? The Challenges In Evaluation Of Chronic Diffuse Rashes, Margi Nayak, Humaira Bibi, Anthony Cimmino, Xuan Ouyang, Jonathan Fairley

Research Day

Introduction: The purpose of our case presentation is to help understand the use of diagnostic studies in differentiating diffuse rashes with potentially underlying malignant etiology from infectious etiology.

A 40 y.o. F with a past medical history significant for anemia presented to the ED with painful rashes that had been getting worse for over 1 year. She mentioned that initially the rash began on her arm around the time when her 2 dogs were being treated for fungal infection and then it started spreading to her chest, back, upper extremities, lower extremities, abdomen, and genital areas as well. She described …

Maintenance Of Chronicity Signatures In Fibroblasts Isolated From Recessive Dystrophic Epidermolysis Bullosa Chronic Wound Dressings Under Culture Conditions, Cristian De Gregorio, Evelyng Catalán, Gabriel Garrido, Pilar Morandé, Jimena Castillo Bennett, Catalina Muñoz, Glenda Cofré, Ya-Lin Huang, Bárbara Cuadra, Paola Murgas, Margarita Calvo, Fernando Altermatt, María Joao Yubero, Francis Palisson, Andrew P. South, Marcelo Ezquer, Ignacia Fuentes

Department of Dermatology and Cutaneous Biology Faculty Papers

BACKGROUND: Recessive Dystrophic Epidermolysis Bullosa (RDEB) is a rare inherited skin disease caused by variants in the COL7A1 gene, coding for type VII collagen (C7), an important component of anchoring fibrils in the basement membrane of the epidermis. RDEB patients suffer from skin fragility starting with blister formation and evolving into chronic wounds, inflammation and skin fibrosis, with a high risk of developing aggressive skin carcinomas. Restricted therapeutic options are limited by the lack of in vitro models of defective wound healing in RDEB patients.

RESULTS: In order to explore a more efficient, non-invasive in vitro model for RDEB studies, …

Case Series Of Common Skin Lesions Encountered In Elderly Cadavers: A Dermatopathology Analysis, Tamryn L. Van Der Horn, Brigitte L. Cochran, Savita Arya

Research Day

INTRODUCTION: Gaining hands-on experience in both dermatology and pathology is a common barrier that prevents first and second year medical students from refining skills that are not later taught until residency. This prompted a study to develop gross differential diagnostic skills and how to analyze histopathology slides to diagnose common skin lesions to refine skills in both clinical and histology presentation for medical students.

METHODS: A case series was designed to examine multiple shave biopsies on all abnormal skin lesions observed from nine cadavers used for the first-year medical students gross anatomy lab during the year 2022-2023. Biopsies were stained …

Case Report: Nosocomial Digital Eczema From Surface Cleansing Bleach, James Espinosa, Umar Sannoh, Alan Lucerna

Rowan-Virtua Research Day

We report the case of a healthcare provider who developed hand eczema, predominantly on the first digit and thumb of the right hand, in association with contact with the surface of a desk and mouse pad at work. The eczema abated on days off and was exacerbated within hours of work. The diagnosis was made of hand eczema from surface cleaning bleach. It was noted that several other healthcare providers had developed similar symptoms. The patient's eczema was confirmed by a dermatologist and was successfully treated with topical triamcinolone and emollient cream to the affected areas. Prevention by adhesive strip …

Dorsal Wrist Impingement Syndrome Pain After Ganglion Cyst Removal – A Case Report, Sidharth Sahni, Joseph Fares, Natty Jumreornvong, Arpun Shah, Mariam Zakhary

Rowan-Virtua Research Day

A ganglion cyst is a benign fluid-filled sac that develops idiopathically on the dorsal aspect of the wrist by the joint capsule or tendon sheath. It is diagnosed clinically, with MRI and ultrasound used for confirmation. Treatment includes immobilization, aspiration, hydrossection, steroid or hyaluronidase injection, and surgery. Although uncommon, Dorsal Ganglion Cysts (DGC) can lead to Dorsal Wrist Impingement (DWI) syndrome. This syndrome is caused by a thickening of the wrist capsule from overuse, injury, or repetitive procedures. This thickness leads to capsule pinching commonly by the extensor carpi radialis brevis (ECRB) tendon during wrist extension and tenderness by the …

The Clinical Definition And Characterization Of Field Of Cancerization In Patients With Actinic Keratoses, Stuti Prajapati, Christina Kontzias, Mallory Zaino, Steven Feldman

Rowan-Virtua Research Day

Introduction: Chronic UV radiation affects the entire area of skin exposed, leading to visible actinic keratoses (AK) and subclinical changes in the surrounding skin. AKs are hyperkeratotic lesions, with a 0.025-16% risk of transforming into squamous cell carcinoma (SCC).1 Cellular atypia around AKs is the field of cancerization (FOC). Topical AK therapies can treat the FOC, while destructive treatments address visible lesions. FDA-approved products may be approved for field sizes up to 25 cm2.1,2

Objective: To characterize the FOC and assess the correlation between the FOC and number of AKs.

Methods: 100 patients with AKs were recruited. FOC was defined …

Barriers To Dermatological Care In Patients Who Received Extensive Mohs Surgery - An In-Depth Qualitative Analysis, Stuti Prajapati, Mallory Zaino, Christina Kontzias, Laura Doerfler, Steven R. Feldman

Rowan-Virtua Research Day

Background: Dermatological care needs to be accessible for the elderly, but they face prominent challenges contributing to delays in diagnosis and treatment. Prolonged management of may lead to widespread cutaneous malignancies, necessitating extensive Mohs surgery.

Objective: To identify areas for early intervention in the geriatric population who have undergone extensive Mohs surgery.

Methods: We performed a qualitative study on 10 patients 65 years and older (68-91) from Atrium Health Wake Forest Baptist dermatology clinics between December 2022 and February 2023, who had extensive Mohs surgery (3 or more layers removed).

Results: Three major areas for potential intervention for cutaneous carcinoma …

Case Report: Facial Mask-Induced Acne ("Maskne"), Gabriel Meister, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

A 42 year old male health care worker presented with complaints of severe mask related acne vulgaris predominately to the cheeks, chin and nose Here we present the case of a N95 and surgical facial mask use has been a requirement for many occupations during the Covid-19 pandemic. Patient states their current position requires use of an N95 respirator to be worn throughout their shift which can range from 9-14 hours, 6 days per week. Extended daily use of such masks may lead to changes in the skin which can induce irritation and precipitate infection.

Case Report And Brief Review: A Case Of Erythema Ab Igne Due To A Space Heater, Adam Kandil, James Espinosa, Alan Lucerna, James Lee, Robin Lahr

Rowan-Virtua Research Day

A 35 year old male presented to the Emergency Department (ED) with a rash of his left lateral lower leg of a 2 months duration. The patient had been using an electric space heater and the affected area was the closest part of his body to the heater. A diagnosis of erythema ab igne was made. Here we discuss erythema ab igne in reference to the medical history of the diagnosis, pathophysiology, modern causative heat sources such as laptop computers and treatment.

New Onset Lichen Planus And Back Pain Leading To Discovery Of A Peri Aortic Abscess, Monica Diep, Wayne Tamaska, Philip Carhart, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Back pain is a common chief complaint in the emergency department. With the differential ranging from musculoskeletal pain to cauda equina, there are a plethora of diagnoses. Differentiating between benign back pain and back pain that warrants further evaluation and even possible emergent surgical intervention is often a challenge in the acute setting. In this case report, a strange combination of all new symptoms including lichen planus, fevers, chills and atraumatic back pain lead to the eerie and very unexpected diagnosis of a peri-aortic abscess.

Treatment Of Bullous Pemphigoid With Dupilumab: A Case Report, Margaret C. Hurley, Jocelynn F. Dillon, Harold J. Milstein

Research Day

Introduction: Bullous Pemphigoid (BP) is an autoimmune blistering condition that results from formation of autoantibodies against basement membrane hemidesmosome proteins, specifically BP180 and BP230. Classic BP presents as pruritic, tense blisters on the trunk and extremities, most commonly in the elderly. BP’s pathophysiology involves IL4/IL5/IL13 and eosinophils. Dupilumab is an IgG monoclonal antibody targeted at the IL4-α receptor that works to attenuate the IL4/IL13 pathway involved in T2 differentiation. Dupilumab has clinical applications for T2 mediated disease and shows promise in the therapy of BP.

Case Description: We report a case of an 83-year-old Asian male who presented in the …

Introduction Of Probiotics To Improve Eczema Symptoms In Children In One Pediatric Primary Care Practice: A Quality Improvement Project, Christie Potter

Doctor of Nursing Practice Scholarly Projects

Background: There is emerging interest in alternative approaches to treating children with eczema because there is currently no allopathic cure. Non-pharmacological approaches are regarded as generally safe, well tolerated, and cost effective. Eczema is a chronic, relapsing inflammatory, itchy skin condition that adversely affects quality of life in many individuals, including children. Eczema interferes with sleep, leads to secondary skin infections, and causes intractable itching. Topical steroids are the current standard of practice in treating patients but, evidence suggests that they can cause unwanted side effects and can lead to serious systemic reactions. The purpose of this quality improvement project …

Adipocytes And Innate Immunity In Systemic Sclerosis, Nancy Wareing

Dissertations and Theses (Open Access)

Systemic sclerosis (SSc; scleroderma) is a chronic systemic autoimmune and connective tissue disorder characterized by vasculopathy, autoimmune phenomena, and widespread fibrosis. Skin thickening and tightening is the cardinal feature of SSc and is responsible, in part, for the considerable morbidity of this disease. There are currently no targeted treatments for skin manifestations in SSc, primarily due to our fragmented understanding of its pathophysiologic mechanisms. In PART I, we report a previously unappreciated link between aberrant expression of the developmental gene sine oculis homeobox homolog 1 (SIX1) in skin-associated adipocytes in SSc skin and the early loss of dermal white adipose …

Complete Clearance Of Pustular Psoriasis After A Single Dose Of Risankizumab, Ashleigh E. Hermann, Stephen E. Weis

HCA Healthcare Journal of Medicine

Introduction

Psoriasis is a chronic, multifactorial, inflammatory skin disease with several subtypes, including pustular psoriasis. Pustular psoriasis is characterized by pustules forming lakes of pus on the skin. Pro-inflammatory pathways, such as the interleukin (IL)-17/IL-23 axis, have been shown to play a significant role in the pathogenesis of psoriasis. Biologic therapies directed towards these pro-inflammatory pathways have effectively treated plaque psoriasis, but fewer treatments have shown similar efficacy for pustular psoriasis.

Case Presentation

We present a 45-year-old Black female who presented to the dermatology clinic with generalized pustular psoriasis affecting approximately 70% of her body surface area. She also noted …

Accidental Extravasation Of Mitomycin C Into The Subcutaneous Tissue, Johnathon Chung, Brooke Walterscheid, Jose Lopez-Vera, Hytham Rashid, Mike K. Liang

HCA Healthcare Journal of Medicine

Introduction

Mitomycin C (MMC) is a common chemotherapeutic agent used to treat a variety of solid tumors. Cutaneous adverse events are rare, but MMC is a known vesicant reported to cause tissue necrosis and sloughing, erythema, and ulceration if incorrectly infused into the subcutaneous tissue. Definitive treatment of extravasation injuries due to MMC depends on the severity of the cutaneous manifestation, which includes stopping the infusion, removing the catheter, or possible debridement.

Case Presentation

We present the case of a 70-year-old female with extensive soft-tissue injury secondary to extravasation of MMC that required hospital admission and surgical intervention to remove …

Death Due To Drug Reaction With Eosinophilia And Systemic Symptoms (Dress) Syndrome: A Case Report, Samantha P. Sternad, Jane Pangburn, Chad Johnston, David Rowe

HCA Healthcare Journal of Medicine

Background

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening, multi-organ adverse drug reaction with an incidence of 1 in 1000 to 1 in 10 000 highrisk drug exposures.

Case Presentation

An elderly female presented to the hospital with progressive weakness and a diffuse erythematous macular rash covering most of her body that started 3 days prior. Over the next 3 days, the patient quickly deteriorated, developing disorientation with acute onset left-sided weakness, leukocytosis, thrombocytopenia, eosinophilia, liver and kidney failure, and hypoxia. Clinical and histological changes supported the diagnosis of DRESS syndrome caused by intravenous (IV) ampicillin …

Eruptive Lentigines Confined To Resolving Psoriatic Plaques Following Treatment With Guselkumab, Jacob R. Kilgore Md, James C. Curry, Shane E. Cook Md

Marshall Journal of Medicine

Eruptive lentigines in the area of resolving psoriatic plaques has been well documented in the literature following successful treatment with multiple therapies. This is historically associated with light treatment but has been expanded to include other therapies such as anti-tumor necrosis factor therapies and, more recently, some biologics⁵. Guselkumab (Tremfya) is an IgG1λ monoclonal antibody used in the treatment of plaque psoriasis with only one case of eruptive lentigines confined to resolving psoriatic plaques (ELRP) noted as a side effect. We present the second such case of ELRP associated with successful treatment of plaque psoriasis with Guselkumab, as …

Retrospective Review Of Adverse Events Following Treatment Of Non-Melanoma Skin Cancer With Low-Energy Superficial Radiation Therapy, Marshall Hall, Henry Lim, Christian Scheufele, Christopher Wong, Daniel A. Nguyen, Michael Carletti, Stephen Weis

North Texas GME Research Forum 2023

Background: Basal cell carcinoma and squamous cell carcinoma are the most common types of non-melanoma skin cancer.1 Superficial radiation therapy (SRT) is a treatment modality that utilizes low-energy x-rays to disrupt cell mitosis directly and indirectly.2 This method of treatment offers advantages for select patients. While this technique has been utilized for over a century, it has recently begun to gain favor in clinical practice.1,3 Although SRT has shown favorable outcomes with a low risk of complications, it still poses a risk for adverse events.1,3,4 The frequency and severity of adverse events are not well-defined with SRT delivered technology with …

Presentations Of Tumor Recurrence Of Non-Melanoma Skin Cancer After Treatment With Low-Energy Superficial Radiation Therapy, Marshall Hall, Henry Lim, Christian Scheufele, Christopher M. Wong, Daniel A. Nguyen, Michael Carletti, Stephen Weis

North Texas GME Research Forum 2023

Background: Basal cell carcinoma and squamous cell carcinoma are the most common types of non-melanoma skin cancers.1 Superficial radiation therapy (SRT) is a treatment modality that utilizes low-energy x-rays to disrupt cell mitosis.2 While this technique has been used for over a century, it has recently gained favor in clinical practice.3,4 This method of treatment offers favorable outcomes and advantages for select patients. Although the incidence of cancer recurrence after superficial radiation therapy is low, relatively little is known regarding predictive patterns. The frequency and timing of cancer recurrence is not well defined using SRT delivered technology with an image-guided …

An Innovative Model For Graduate Medical Education Faculty Development Through Physician In Training Delivery, Daniel A. Nguyen, Christopher Wong, Christian Scheufele, Michael Carletti, Stephen Weis

North Texas GME Research Forum 2023

BACKGROUND/INTRODUCTION: Faculty development is an important component for ACGME accreditation of residency programs. 1-3 There are multiple strategies for faculty development with methods including workshops, lunch-ins, and online modules. 10-12 Having successful approaches to develop faculty has lead to self-reported improvement in teaching and clinical skills, intrapersonal and interpersonal growth with faculty given more positive ratings by learners. 8,9 Beyond the individual faculty, there can be system wide cultural shifts supportive of scholarly teaching. 10 Delivering content that is convenient and valuable to the faculty can be challenging. 3,4 If resident physicians can deliver effective convenient faculty development programs then …

Lesion Size Inclusion On Dermatopathology Requisition Forms: A Quality Improvement Project, Christopher M. Wong, Henry Lim, Christian Scheufele, Daniel A. Nguyen, Ashleigh E. Hermann, Michael Carletti, Stephen Weis

North Texas GME Research Forum 2023

Introduction: Dermatopathology requisition forms (RFs) are a critical communication tool between dermatologists and dermatopathologists. Including detailed information on RFs improves the diagnostic accuracy of the consulting dermatopathologist. However, the diameter of the biopsied lesion is often omitted on RFs. This study aimed to increase the rate of reporting lesion diameters on RFs from an academic outpatient dermatology clinic to greater than 65% through education, reinforcement, and evaluation. Methods: This quality improvement project retrospectively and prospectively analyzed the inclusion rate of lesion diameters on dermatopathology RFs from a single institution. In Phase 1, data was collected from all skin biopsies performed …

Blastic Plasmacytoid Dendritic Cell Neoplasm, Jacquelyn Medina, Adam Chahine, Courtney Bernett, Karthik Krishnamurthy

South Atlantic Division GME Research Day 2023

No abstract provided.

A Case Of Aquagenic And Cholinergic Urticaria, Marilian A. Canals Rivera, Kyle Rauch, Amanda Brenner, Victoria Charry

South Atlantic Division GME Research Day 2023

No abstract provided.