Dermatology Commons^™

Man With An Itchy Back, Katherine Schaffer, Nevin Adamski, Brittany Ambrose, Kathleen Anderson

Department of Emergency Medicine Faculty Publications

[First paragraph] A 61-year old man with no significant past medical history presented with painful bug bites on his lower back 1 day after a 1.5-week-long visit to Africa. He noticed bug bites on his lower back 3 days ago; since then, they have increased in size and become more painful. He was prescribed doxycycline at urgent care earlier that morning and had taken 1 dose. He is taking prophylactic medications for malaria and has had no fever at home. Vital signs, exquisitely tender papular lesions with a central punctum and surrounding erythema in the bilateral paralumbar regions.

Assessment Of Primary Malignancy Risk Following Initiation Of Biologic Therapy In Psoriasis Patients, Chunghwan Ro, Ana Ormaza Vera, Waleed Adawi, Alexander Yap, Clinton W. Enos

Department Dermatology Faculty Publications

Limited evidence exists regarding the long-term oncologic safety of biologic therapies, particularly interleukin (IL)-17 inhibitors (IL-17i) and IL-23i, in the management of psoriasis. This propensity-score-matched retrospective-cohort study assessed the risk of developing a primary malignancy within 10-years following exposure to an FDA-approved biologic among psoriasis patients compared to biologic-naïve controls. After propensity-score-matching, 32,230 biologic-exposed patients were further grouped into cohorts of tumor necrosis factor inhibitors (TNFi, n=16,011), IL-23i (n=5,604), IL-12/23i (n=3,856), and IL-17i (n=5,467). During a 10-year period, TNFi-treated patients had a reduced risk of developing any primary malignancy compared to biologic-naïve psoriasis patients [HR 0.80(0.73-0.87)]. Similarly, a lower incidence …

Irritable Bowel Syndrome Risk In Acne Patients: Implications For Dermatologic Care, Alex Y. Liu, Ana Ormaza Vera, Clinton W. Enos

Department Dermatology Faculty Publications

[Practice points]

• Clinicians should consider monitoring for early signs of irritable bowel syndrome (IBS) in adult patients with acne to facilitate prompt diagnosis and intervention.
• Clinicians should remain judicious when prescribing antibiotics for acne management to minimize potential disruptions to the gut microbiota and the risk for IBS.
• Isotretinoin may serve as a safer alternative to antibiotics in patients with acne, particularly those with gastrointestinal concerns.

Decoding Tattoo And Permanent Makeup Pigments: Linking Physicochemical Properties To Absorption, Distribution, Metabolism, And Elimination Profiles Using Quantitative Structure-Activity Relationship (Qsar)-Based New Approach Methodologies (Nams), Girija Bansod, Ajay Vikram Singh, Preeti Bhardwaj, Tulika Rai, Sweta Vijay Nakhale, Amruta Shelar, Rajendra Patil, Peter Laux, Andreas Luch, Christopher J. Osgood, Michael W. Stacey

Biological Sciences Faculty Publications

The safety and quality of tattoo and permanent makeup (PMU) pigments are subject to increased scrutiny due to their potential to cause adverse effects like anaphylaxis, photoallergic responses, and long-term toxicity. These undesirable reactions governed by their chemical structure possess varied physicochemical properties and absorption, distribution, metabolism, and elimination (ADME) characteristics. These properties control the pigment behavior during application, stability, and interaction with human tissue. The correlation between these physicochemical characteristics and ADME parameters of tattoo/PMU pigments remain under-explored despite the current advances in toxicology. Our study aims to address and bridge the gap by leveraging open-access QSAR computational toxicology …

The Quality-Of-Life Benefits And Risk Of Isotretinoin (Accutane) In Acne Treatment: A Systematic Review, Noelia Valencia Zuniga

Honors Undergraduate Theses

Acne vulgaris is a prevalent dermatological condition, particularly affecting adolescents and young adults. While often treated as a cosmetic issue, acne can significantly impair a patient's mental health and overall quality of life (QoL). Isotretinoin, commonly known as Accutane, is widely regarded as the most effective treatment for severe and persistent acne. However, its use is controversial due to a range of potential side effects, including psychiatric symptoms, teratogenicity, and other systemic complications. To better understand the risk-benefit profile of isotretinoin in acne treatment, we conducted a systematic review, focusing on the QoL benefits and risks associated with its use. …

Efficacy And Safety Of Once-Daily Roflumilast Cream 005% In Pediatric Patients Aged 2-5 Years With Mild-To-Moderate Atopic Dermatitis (Integument-Ped): A Phase 3 Randomized Controlled Trial, Lawrence F Eichenfield, Rocco Serrao, Vimal H Prajapati, John C Browning, Lisa Swanson, Tracy Funk, Mercedes E Gonzalez, Adelaide A Hebert, Mark Lee, Mark Boguniewicz, Eric L Simpson, Melissa S Seal, David Krupa, Diane Hanna, Scott Snyder, Patrick Burnett, David H Chu, Erin Almaraz, Robert C Higham, David R Berk

Faculty, Staff and Student Publications

Background/objectives: Efficacy and safety of roflumilast cream 0.15% were demonstrated in patients aged ≥ 6 years with atopic dermatitis (AD) in two Phase 3 trials. This Phase 3 parallel-group, double-blind trial (INTEGUMENT-PED; NCT04845620) compared the efficacy and safety of roflumilast cream 0.05% and a vehicle in patients aged 2-5 years with AD.

Methods: Patients aged 2-5 years with mild-to-moderate AD were treated with once-daily roflumilast cream 0.05% or vehicle for 4 weeks. The primary efficacy endpoint was Validated Investigator Global Assessment for AD (vIGA-AD) Success (0 [Clear] or 1 [Almost Clear] plus ≥ 2-grade improvement from baseline) at Week …

Unveiling The Mystery: Paraneoplastic Syndrome Masquerading As Skin Thickening, Megan Schermerhorn, Md, Quian Leng, Atish Dey

Books, Presentations, Posters, Etc.

Introduction: Systemic sclerosis is a rare autoimmune disorder defined by skin thickening in the distal digits and is frequently accompanied by inflammatory arthritis. There are known mimics of systemic sclerosis, which present with similar sclerosis of the skin. Palmar fasciitis and polyarthritis syndrome (PFPAS) is a rare paraneoplastic syndrome that presents with progressive flexion contractures of the hands, inflammatory fasciitis, fibrosis, and generalized inflammatory arthritis. PFPAS is most associated with ovarian adenocarcinoma, and rarely associated with pancreatic adenocarcinoma. Early recognition of this rare syndrome was critical in identifying an asymptomatic pancreatic adenocarcinoma. Case Description: 58-year-old woman with osteoarthritis of multiple …

Comparison Of The Efficacy Of Topical Cetirizine 1% Versus Topical Minoxidil 5% Solution In Treatment Of Male Androgenetic Alopecia, Hadeer Samy Abd-Elfattah, Bothaina Mahrous Ghanem, Farid Abd-Elreheim Badria, Mohammed Samir Sultan

Mansoura Medical Journal

Background: Androgenetic alopecia (AGA) is a common form of non-scaring hair loss characterized by extensive miniaturization of scalp hair follicles. Minoxidil is a standard topical treatment. Cetirizine, an antihistamine with anti-inflammatory properties, may be beneficial by modulating prostaglandins—specifically by inhibiting PGD2 and promoting PGE2, both of which have essential roles in hair cycle regulation. Aim: To compare the efficacy and safety of topical cetirizine 1% versus minoxidil 5% in treating male AGA. Patients and Methods: Forty male patients were randomly allocated in this randomized controlled study to receive topical cetirizine 1% or minoxidil 5%. Clinical photographs and dermoscopic evaluations were …

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.

Cutaneous Cytomegalovirus In Mixed Serostatus Kidney Transplant Patient, Dominic Finan, Vaibhav Garg, Lucjan Lang, Tricia Royer, Katherine Belden, Sherry Yang

Department of Dermatology and Cutaneous Biology Faculty Papers

Cutaneous cytomegalovirus infection is a rare but serious complication in solid organ transplant recipients. We present a 47-year-old male kidney transplant recipient with a chronic, nonhealing right lower extremity ulcer. Initial biopsies revealed septic vasculopathy, leading to treatment with sodium thiosulfate and antibiotics for suspected calciphylaxis. Despite regular wound care, the ulcer continued to worsen. After completing 6 months of cytomegalovirus prophylaxis, surveillance viral levels remained undetectable, but the ulcer progressed considerably. Worsening severity prompted hospitalization, during which cytomegalovirus viremia was detected, and an ulcer biopsy confirmed cytomegalovirus inclusion bodies. Antiviral therapy was reinitiated, resulting in rapid and sustained wound …

Apocrine Breast Cancer With Psammoma Bodies In A Male Patient, Alena Bashinskaya, Eric W. Baum, Michael B. Morgan

HCA Healthcare Journal of Medicine

Introduction

While male breast carcinoma is a relatively uncommon occurrence, its incidence is on the rise, potentially attributed to sporadic pathophysiological mechanisms, primarily involving hormonal imbalances. Invasive apocrine carcinoma represents a small fraction of global breast malignancies, with limited instances reported among male patients in the literature. The clinical presentation of an apocrine breast carcinoma closely resembles that of other breast cancer subtypes, as it is most often described as a solitary ulcerative nodular lesion occupying a retro-areolar region of the breast. Herein, we describe a novel case of an apocrine male breast carcinoma metastasizing to the skin, given that …

Clinical Variant Of Serpentine Supravenous Hyperpigmentation Following Subcutaneous Bortezomib Injection, Madelyn Richards, Stephen E. Weis

HCA Healthcare Journal of Medicine

Introduction

Bortezomib is a reversible proteasome inhibitor that is a first-line chemotherapeutic agent for multiple myeloma. Bortezomib can be administered intravenously or subcutaneously with similar efficacy. Subcutaneous administration has fewer side effects. Many cutaneous reactions have been associated with bortezomib treatment. These include morbilliform exanthems, erythematous nodules and papules, leukocytoclastic vasculitis, Sweet syndrome, and rarely Stevens-Johnson Syndrome.

Case Presentation

This paper reports the occurrence of serpentine supravenous hyperpigmentation (SSH) after subcutaneous administration of bortezomib. SSH is a rare, characteristic cutaneous reaction that has been reported following intravenous administration of chemotherapeutic agents. Intravenous administration of bortezomib rarely results in documented cases …

Port-Wine Stain Treatment With 577-Nm Laser: Treatment Outcomes Of Superficial Versus Deep Lesions, Yulia Siskawati

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Port-wine stains (PWS), or capillary malformations (CM), are congenital vascular anomalies characterized by gradual enlargement of the superficial cutaneous vascular plexus, leading to low-flow malformations in the skin. Laser therapy remains the preferred treatment for PWS. The 577-nm vascular laser system is particularly suited for treating cutaneous vascular disorders. This study evaluates the efficacy of the 577-nm vascular laser for both superficial and deep PWS lesions.

Case Illustration: Three adult patients, all aged over 17 years old, were treated with the 577-nm laser. In the first case with deeper PWS, four treatment sessions resulted in flattening of hypertrophic areas, …

Onycholysis In An Elderly Woman: Proposal For Treatment With Coix Seed Extract Administration, Yasuhiro Horiuchi

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: The exact etiology of onycholysis, which is characterized by the painless separation of the nail from the nail bed, remains unclear. Currently, there are no established effective treatments for this condition. Coix seed extract (C-S extract), a traditional Chinese medicine, is recognized for its various biological properties.

Case Illustration: This report describes a case of onycholysis affecting the left index finger of a 62-year-old female patient, with initial symptoms appearing three months prior. Despite ongoing internal administration of C-S extract, the patient experienced a recurrence of onycholysis on both the index finger and pinky finger of the left hand …

Systemic Antibiotic Selection In Skin And Soft Tissue Infections, Shafira Anindya Purnawan, Windy Keumala Budianti, Sandra Widaty

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Antibiotics are used in daily practice. To properly select antibiotics, it is important to pay attention to the definitive diagnosis, class of antibiotic, dose, interval, route of administration, and exact duration of use.

Discussion: The World Health Organization (WHO) categorizes antibiotics into three groups: Access, Watch, and Reserve—known as the AWaRe classification—to help guide appropriate usage and combat antibiotic resistance. The Gyssens flowchart serves as a valuable tool for clinicians to qualitatively evaluate antibiotic utilization. In skin and soft tissue infections (SSTIs), treatment strategies are tailored according to the characteristics of the infection, including purulence, necrosis, and overall severity. …

Non–Invasive Vulvovaginal Rejuvenation: A Review, Jesryn Dhillon, Nelva Karmila Jusuf

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Non–invasive vulvovaginal rejuvenation is a promising option for women who want to restore the appearance and function of the vagina. Vaginal atrophy and vulvovaginal laxity are caused by several circumstances, including ageing, menopause, delivery, and others. Until now, non–invasive vulvovaginal rejuvenation has not been medically indicated, but it is estimated to be the focus of cosmetic dermatology in the future.

Discussion: Non–invasive vulvovaginal rejuvenation can be divided into two methods: using energy-based devices and injectables. Carbon dioxide, Erbium:YAG laser and radiofrequency are the commonly used energy-based devices. Injectables most frequently used are hyaluronic acid and platelet–rich plasma. Some additional …

Drug-Induced Hypersensitivity Syndrome With Liver Injury Due To Phenytoin: A Case Report, Lorettha Wijaya, Stella Adevita, Steven Alvianto, Yoseveline Christiani, Alius Cahyadi, Raesa Yolanda

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Drug-induced hypersensitivity syndrome (DIHS) is a rare and severe systemic drug reaction characterized by skin involvement, internal organ complications, and hematologic disorders. Management of this condition is challenging due to its wide range of cutaneous manifestations and 10% mortality rate.

Case Illustration: A 52-year-old male presented with widespread redness throughout his body with a prior history of regular phenytoin consumption. The rash continued to spread despite the patient’s abrupt discontinuation of the suspected medication. He was diagnosed with atypical DIHS according to J-SCAR criteria and was given high-dose corticosteroid. Drastic clinical improvement was observed after nine days of therapy, …

Bowen’S Disease Mimicking Lichen Simplex Chronicus In A 56-Year-Old Filipino Man: A Case Report, Cynthia Angela Karim, Elisabeth Ryan, Reynaldo Ugalde

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Bowen's disease (BD) is a chronic skin condition presenting clinically as erythematous plaques with scales on sun-exposed areas. BD is generally regarded as a squamous cell carcinoma (SCC) in situ. In contrast, lichen simplex chronicus (LSC), also known as neurodermatitis, is a chronic skin disorder characterized by extreme pruritus. In LSC, lichenified plaques form primarily on accessible body parts due to repeated scratching or rubbing.

Case Illustration: A 56-year-old male presented with a solitary chronic plaque with a central ulcer and erosions on his left upper thigh. Dermoscopy findings were glomerular vessels and a scaly surface, which are …

Comparison Of Quality Of Life, Anxiety, And Depression Levels Based On Acne Vulgaris Severity, Annisaul Husna, Satya Wydya Yenny, Desmawati Desmawati, Gardenia Akhyar, Masrul Masrul, Yulistini Yulistini

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Acne vulgaris is a chronic inflammation of the pilosebaceous unit. Although acne vulgaris is not fatal, it can cause psychological effects. This study aimed to compare the quality of life, anxiety, and depression levels based on the severity of acne vulgaris among medical students at Andalas University.

Methods: This was an observational-analytic study with a cross-sectional design. It was conducted from May to June 2023. The population included the third-grade students of the Medical Study Program of the Faculty of Medicine, Andalas University, who had acne vulgaris. The respondents were 70 people, recruited with consecutive sampling techniques. This research …

Dermoscopy And 30% Potassium Hydroxide Direct Examination As Diagnostic Tools For Distal Lateral Subungual Onychomycosis, Evangelina Lumban Gaol, Eliza Miranda, Sondang Pandjaitan Sirait

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Culture and histopathological examination are gold standards for diagnosing onychomycosis. However, these examinations are subject to several limitations. Dermoscopy has the potential to become a promising diagnostic tool for onychomycosis. Direct examination of potassium hydroxide (KOH) also has advantages similar to dermoscopy. Knowing the accuracy of both examinations can help clinical decision-making. Our objectives are to assess the diagnostic value of dermoscopy, KOH examination, and their combination for distal lateral subungual onychomycosis compared to culture or histopathology.

Methods: This was a cross-sectional diagnostic study of nails with suspected distal lateral subungual onychomycosis. Sixty nails were included in this study. …