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General Purpose: To raise awareness regarding the clinical presentations of patients with pseudoporphyria., Target Audience: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care., Learning Objectives/outcomes: After participating in this educational activity, the participant will:1. Describe the clinical presentation of pseudoporphyria.2. Identify the differential diagnoses of blistering lesions on hands and feet.3. Outline the management options for patients with porphyria., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: When angiosarcoma, a rare and aggressive tumor of the soft tissue, develops in the setting of chronic lymphedema, it is referred to as Stewart-Treves syndrome. It is usually seen in chronic lymphedema of the upper limbs postmastectomy. Angiosarcoma developing in the lower limb in the setting of chronic lymphedema is rare and has a poor outcome. The presentation of angiosarcoma can vary, ranging from a bleeding papule to a plaque or a subcutaneous mass, which can later progress to ulceration or necrosis. Treatment for Stewart-Treves syndrome is aggressive because of its poor prognosis and usually requires a multidisciplinary approach of surgery, radiation, and chemotherapy. Several theories have been put forth to explain the mechanism of Stewart-Treves syndrome, but it remains ambiguous. The current literature regarding angiosarcoma developing in the setting of chronic lymphedema in the lower limb is limited to single case reports. Herein, the authors report a series of six cases of biopsy-proven angiosarcoma in the setting of lower extremity lymphedema. Providers should include angiosarcoma in the differential diagnosis of ulcerative or vascular tumors arising in the context of lower extremity lymphedema., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

General Purpose: To review a practical and scientifically sound application of the wound bed preparation model for communities without ideal resources., Target Audience: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care., Learning Objectives/outcomes: After participating in this educational activity, the participant will:1. Summarize issues related to wound assessment.2. Identify a class of drugs for the treatment of type II diabetes mellitus that has been shown to improve glycemia, nephroprotection, and cardiovascular outcomes.3. Synthesize strategies for wound management, including treatment in resource-limited settings.4. Specify the target time for edge advancement in chronic, healable wounds., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To review the literature on cutaneous reactions to the influenza vaccine in adults., Data Sources: Authors systematically searched three databases: PubMed, MEDLINE, and EMBASE., Study Selection: Case reports published between January 1, 1995 and December 31, 2020 that described a cutaneous reaction to any brand of the influenza vaccine in adults were included. Exclusion criteria included having the wrong study design, pediatric cases, publication prior to 1995, and lack of cutaneous reaction to the vaccine., Data Extraction: A total of 232 articles were identified. After duplicate removal, title and abstract screening, and full-text screening, 29 studies were included in the final review. Data extracted included patient sex, age, type of influenza vaccine received, time from vaccine administration to cutaneous reaction, duration of cutaneous reaction, description of cutaneous reactions, treatments used, and the outcome (eg, resolution, reoccurrence, complications)., Data Synthesis: The mean age of participants was 43.7 years (range, 19-82 years), and 60% were women (n = 18). The most frequent cutaneous reaction that occurred following influenza vaccination included erythematous macules/papules/plaques (n = 17 [56.7%]), vasculitic and purpuric rashes (n = 5 [16.7%]), and maculopapular (morbilliform) rashes (n = 3 [10.0%]). All patients received treatment, and 96.7% (n = 29) of the cutaneous manifestations were resolved. Most studies did not report any further complications upon follow-up., Conclusions: Understanding and identifying the relationship between the influenza vaccine and possible cutaneous manifestations can help providers predict and anticipate these adverse effects., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

General Purpose: To provide comprehensive information about breast ulcers to facilitate accurate diagnosis and treatment of these lesions., Target Audience: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care., Learning Objectives/outcomes: After participating in this educational activity, the participant will:1. Differentiate common wound complications after mastectomy.2. Identify the clinical manifestations of various types of breast ulcers.3. Explain appropriate pharmacologic and nonpharmacologic treatment options for various types of breast ulcers., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Pityriasis rubra pilaris (PRP) is a rare, chronic papulosquamous disorder that presents with scaling plaques, palmoplantar keratoderma, and keratotic follicular papules. Typically, there are distinctive unaffected areas referred to as "islands of sparing." Pityriasis rubra pilaris has been associated with various immunodeficient states and malignancies.The authors conducted a literature review using MEDLINE, PubMed, and Google Scholar, documenting all known cases of PRP associated with malignancy; 15 cases were found in the literature. They also present the case of a 49-year-old White man who, prior to referral to dermatology, was seen in urgent care for widespread pruritic rash. Physical examination in the dermatology clinic revealed confluent, scaly erythematous papules coalescing into plaques with island of sparing involving the trunk and upper and lower extremities. Bilateral palms and soles showed hyperkeratosis with fissuring. He was diagnosed with PRP after punch biopsy and began a new course of topical corticosteroid therapy. Hematology was consulted because of abnormal complete blood count results, and he was subsequently diagnosed with chronic lymphoid leukemia.Treatment of PRP is largely based on clinical experience and may involve corticosteroids, immunomodulators, or biologic therapy. The relationship between PRP and malignancy is unknown. Current theories postulate it may be driven by tumor production of functional peptides or antigen cross-reactivity between cancer cells and the skin. This is the second reported case of PRP as a manifestation of leukemia, and the first of chronic lymphoid leukemia. Although not yet understood, the documented relationship between PRP and malignancy prompts screening for cancer in all patients with new-onset PRP., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To synthesize the available evidence on the prevalence and odds for anxiety and depression in adults with pyoderma gangrenosum (PG)., Data Sources: Observational studies examining anxiety and depression in adults with PG were systematically searched using the MEDLINE, EMBASE, PsycINFO, and CINAHL databases from the inception of each database to March 11, 2020., Study Selection: Two authors independently screened references based on predetermined eligibility criteria., Data Extraction: Of the 244 articles identified, three met the eligibility criteria. Relevant data were extracted from included studies, and methodological quality was evaluated independently by two authors using the modified Newcastle-Ottawa Scale., Data Synthesis: Three observational studies comprising 183 participants with PG met the inclusion criteria. Estimated rates of depression in adults with PG ranged from 10% to 23%. None of the studies measured rates of anxiety., Conclusions: The current systematic review suggests that depression is a common psychological comorbidity in adults with PG. Additional research is required to further assess the psychological comorbidities in this population., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

General Purpose: To present the 2021 update of the Wound Bed Preparation paradigm., Target Audience: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care., Learning Objectives/outcomes: After participating in this educational activity, the participant will: 1. Apply wound assessment strategies. 2. Identify patient concerns about wound care. 3. Select management options for healable, nonhealable, and maintenance wounds., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

General Purpose: To discuss the pathogenesis and clinical features of wounds caused by microthrombi formation under the following categories of systemic diseases: cold-related and immune-complex deposition diseases, coagulopathies, abnormalities in red blood cell structure, emboli, and vasospasm., Target Audience: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care., Learning Objectives/outcomes: After participating in this educational activity, the participant should be better able to:1. Recall the etiology, risk factors, and pathophysiology of the various types of microthrombotic wounds.2. Describe the clinical manifestations and treatment of the various types of microthrombotic wounds., Abstract: Typical wounds such as diabetic foot ulcers, venous leg ulcers, pressure ulcers, and arterial ulcers are responsible for more than 70% of chronic wounds. Atypical wounds have broad differential diagnoses and can sometimes develop as a combination of different conditions. Regardless of the etiology, impaired blood circulation is characteristic of all chronic and acute wounds. Chronic wounds associated with microthrombi formation are an important group of atypical wounds commonly linked to an underlying systemic disease. In this perspective article, the pathogenesis and clinical features of wounds caused by microthrombi formation are discussed under the following categories of systemic diseases: cold-related and immune-complex deposition diseases, coagulopathies, abnormalities in red blood cell structure, emboli, and vasospasm.

General Purpose: To provide information about pyoderma gangrenosum (PG), including pathophysiology, diagnostic criteria, and treatment., Target Audience: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care., Learning Objectives/outcomes: After participating in this educational activity, the participant should be better able to: ABSTRACT: Pyoderma gangrenosum (PG) is an uncommon cutaneous disease, presenting with recurrent painful ulcerations most commonly on the lower extremities. The diagnosis is made according to a typical presentation, skin lesion morphology, skin biopsy, histopathology, and the exclusion of other etiologies. Classically, PG presents with painful ulcers with well-defined violaceous borders; other variants including bullous, pustular, and vegetative/granulomatous can also occur. Treatment of PG involves a combination of topical and systemic anti-inflammatory and immunosuppressive medications, wound care, antimicrobial agents for secondary infections, and treatment of the underlying etiology. This article is a continuing education review of the literature with a focus on the clinical application of the pathophysiology, diagnosis, and treatment of this challenging disease.

Purpose: To provide information from a literature review about the prevention, recognition, and treatment for contact dermatitis., Target Audience: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care., Objectives: After participating in this educational activity, the participant should be better able to:1. Identify signs and symptoms of and diagnostic measures for contact dermatitis.2. Identify causes and risks for contact dermatitis.3. Select appropriate treatment for contact dermatitis and its prevention., Abstract: Contact dermatitis to wound care products is a common, often neglected problem. A review was conducted to identify articles relevant to contact dermatitis.A PubMed English-language literature review was conducted for appropriate articles published between January 2000 and December 2015.Contact dermatitis is both irritant (80% of cases) or allergic (20% of cases). Frequent use of potential contact allergens and impaired barrier function of the skin can lead to rising sensitization in patients with chronic wounds. Common known allergens to avoid in wound care patients include fragrances, colophony, lanolin, and topical antibiotics.Clinicians should be cognizant of the allergens in wound care products and the potential for sensitization. All medical devices, including wound dressings, adhesives, and bandages, should be labeled with their complete ingredients, and manufacturers should be encouraged to remove common allergens from wound care products, including topical creams, ointments, and dressings.

Hidradenitis suppurativa (HS) is a chronic inflammatory disorder of the intertriginous area. Patients with HS have several challenges to their quality of life and activities of everyday living, including malodor, purulent discharge, and discomfort. There is often a delay in diagnosis and appropriate treatment. The need for cosmetically acceptable local treatments and dressing application makes this disease an important challenge for wound care specialists. The choice of optimal treatment varies depending on the disease severity, expert knowledge, the availability of an interprofessional team, and patient factors.

Purpose: To provide information about the etiology, diagnostic evaluations, and clinical features of hidradenitis suppurativa (HS)., Target Audience: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care., Objectives: After participating in this educational activity, the participant should be better able to:1. Identify the prevalence, pathophysiology, and risk factors associated with HS.2. Describe diagnostic evaluations, staging, and comorbid disorders associated with HS. Hidradenitis Suppurativa (HS) is a recurrent inflammatory follicular disease that commonly affects the apocrine-bearing skin. The aim of this continuing education article is to review the pathogenesis and clinical presentations of HS. The spectrum of clinical presentations ranges from subcutaneous nodules to draining sinus and fistula. The pathogenesis of HS remains unknown.

Erythroderma is a condition caused by several etiologies that result in red inflamed skin on 90% or more of the body surface. To optimize the diagnosis and management of the erythrodermic patient, healthcare professionals should be familiar with the underlying etiologies and treatment modalities. Patients with erythroderma require immediate attention as they may face a variety of medical complications. Early detection and effective management of these complications significantly reduce mortality and morbidity of this potential dermatologic emergency. This review highlights the underlying common diagnoses, assessment, and management of the patient with erythroderma.

Purpose: The purpose of this learning activity is to provide information about the etiology and treatment of atrophie blanche., Target Audience: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care., Objectives: After participating in this educational activity, the participant should be better able to:1. Discuss the pathophysiology of atrophie blanche.2. Explore treatment options for livedoid vasculopathy., Abstract: Atrophie blanche (AB) is a porcelain-white scar that may be seen at the base of a healed ulcer or in association with livedoid vasculopathy (LV). The term AB originally had been used synonymously with LV, whereas LV is a noninflammatory thrombotic condition presenting as either a primary or secondary event (often associated with coagulation).

Primary and metastatic malignancies may occasionally mimic or coexist with cutaneous fungal infections. The authors report 3 cases of cancers that were initially presumed to be cutaneous fungal infections. Dermatologists should maintain a low threshold for skin biopsy in patients with persistent or refractory fungal infections.

Care of people with diabetic foot ulcers requires a systematic approach following the wound bed preparation paradigm and the existing best practice recommendations. The purpose of this article is to summarize key evidence and recommendations regarding prevention and management of diabetic foot ulcers that can be translated into practice.

Purpose: To enhance the learner's competence with knowledge of the clinical variants and management of psoriasis., Target Audience: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care., Objectives: After participating in this educational activity, the participant should be better able to:1. Demonstrate knowledge of the types, symptoms, and diagnostic testing of psoriasis.2. Apply knowledge of psoriasis treatment to patient care scenarios., Abstract: Psoriasis is an inflammatory skin condition that is associated with various comorbidities. To the wound care physician, the Koebner phenomenon is of importance, as any superficial trauma can induce psoriasis. Particularly, periwound and joints are particularly susceptible to flare-ups of this condition. This review highlights the epidemiology and treatment of psoriasis.

Martorell hypertensive ischemic leg ulcer represents rapidly progressive and extremely painful ulcers that are frequently underdiagnosed. These occur most commonly on the lateral-dorsal calf and are associated with hypertension and diabetes. This article will synthesize a review of the literature for the accurate diagnosis and treatment of this painful debilitating condition.

People with diabetes mellitus will develop lower-limb complications, such as neuropathy, peripheral vascular disease, foot ulcers, and lower-leg amputations. Resources to control elevated hemoglobin A1c and blood pressure, along with the standardized approach using the 60-second tool (2012), can detect the high-risk diabetic foot and help prevent complications.

Sickle cell disease is a genetic disorder of hemoglobin synthesis leading to a deformation of the red blood cell. This disorder is associated with painful, slow-to-heal leg ulcers. This article discusses the wound bed preparation paradigm as a guide to the treatment of sickle cell-associated leg ulcers.

Purpose: To enhance the learner's competence with knowledge of hand dermatitis., Target Audience: : This continuing education activity is intended for physicians and nurses with an interest in skin and wound care., Objectives: After participating in this educational activity, the participant should be better able to: 1. Demonstrate knowledge of the pathophysiology and assessment of, and diagnostic testing for, hand dermatitis. 2. Apply knowledge of hand dermatitis to patient care scenarios for treatment recommendations and patient education. Hand dermatitis is a common disorder with different clinical presentations. Contact (irritant and allergic) dermatitis is the most common subtype with atopic dermatitis and dyshidrotic eczema as common differential diagnoses. The exact diagnosis and differential diagnoses (psoriasis, fungal infections) are important for specific investigations and treatment plans.

Purpose: To enhance the learner's competence with knowledge of biopsy techniques and when to perform biopsies on specific chronic wounds., Target Audience: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care., Objectives: After participating in this educational activity, the participant should be better able to: 1. Distinguish between different types of chronic wounds that require biopsies. 2. Apply knowledge of biopsy techniques to obtain quality results. 3. Analyze various types of chronic wounds to determine the appropriate type of biopsy needed.

Purpose: To provide the practitioner with current information on the most common nail disorders., Target Audience: This continuing education activity is intended for physicians and nurses with an interest in wound care and related disorders., Objectives: After reading this article and taking this test, the reader should be able to: 1. Describe the structures that compose the nail apparatus. 2. Identify the most common nail disorders, including etiology and treatment.