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Nail matricectomy is indicated in the management of painful onychodystrophies, including recalcitrant onychocryptosis, onychogryphosis, onychauxis, and refractory onychomycosis. Although many matricectomy methods have been described, with phenolization being the best studied, no one method has clearly emerged as superior. We present a series of 14 patients who underwent a total of 18 matricectomies with either phenolization or electrodessication (ED) in a private dermatology office, and describe a simple and effective variation of the ED technique using a modified hyfrecator tip. A video demonstration of this technique is included. We also describe ED matricectomy in the context of a review of the literature, ascertaining recurrence rates, complication rates, healing time, and patient satisfaction. The nuances of technique specifics (such as the use of adjunct methods and antibiotics), as well as outcome predictors and measurements have been highlighted. We found ED to be comparable to other forms of matricectomy, with the advantages of ease of use, minimal complications, and good satisfaction rates.

Background The McGill Faculty of Medicine implemented a new undergraduate medical curriculum in 2013 with additional preclinical lectures in dermatology. At the time of writing, no Canadian prospective study has been published on undergraduate dermatology training in the context of a complete curricular renewal. Objectives Our study was designed to determine the impact of increasing preclinical teaching in dermatology on medical students’ diagnostic accuracy and learning retention of common dermatoses encountered in primary care. Methods A standardized questionnaire was administered to the Classes of 2015, 2016, 2017, and 2018 in 6 versions for a total of 6 times over their 4 years of training. Each version featured 10 photographs of common dermatoses encountered in primary care. Students were invited to participate anonymously and on a voluntary basis. Results A small absolute, but statistically significant difference, of 3% was detected in the fourth and final year of training between the old curriculum (average score = 70%, standard deviation = 15%) and the new curriculum (average score = 73%, standard deviation = 15%), P = .03. Furthermore, the Class of 2018’s performance improved year by year over the entire 4 years of the new curriculum. Conclusions Additional preclinical lectures in dermatology do improve medical students’ diagnostic accuracy of common dermatoses encountered in primary care. Furthermore, they do retain their learning throughout the preclinical and clerkship years.

Background: Clustering of patients with cutaneous T-cell lymphoma (CTCL) was reported in several jurisdictions around the world. This rare cancer is known to affect spouses and in some cases multiple members of the same family. These combined results suggest the existence of external disease triggers/promoters. We recently conducted the first comprehensive analysis of CTCL incidence and mortality in Canada, which revealed case clustering in several regions. Objectives: To extend our previous analysis on CTCL incidence across Canada and to provide all the collected data on CTCL patient incidence in Canada during the period of 1992 to 2010. Methods: Clinical parameters for patients with CTCL in Canada were analyzed using 2 independent population-based cancer registries: Canadian Cancer Registry and Le Registre Québécois du Cancer. The CTCL incidence rates were examined on different geographical levels, including provinces/territories, cities, and forward sortation areas. Results: Our findings further corroborate our earlier observations of higher CTCL incidence in Newfoundland and Labrador, maritime provinces (Nova Scotia and New Brunswick), and prairie provinces (Manitoba and Saskatchewan). Also, most cities with high CTCL incidence were located in these provinces. Extensive mapping of high-incidence postal codes supports case clustering in a number of communities that are located in the proximity of industrial centres and seaports. Conclusions: Detailed analysis of CTCL incidence in Canada is critical to fully understand the burden of this disease in our country, to begin the search for a possible external trigger for this lymphoma, and to reform how health care resources are distributed throughout the country to better serve Canadian patients with CTCL.

Although familial aggregation of lymphoproliferative disorders has been described, heredity has not been implicated in the etiology of primary cutaneous B-cell lymphomas (PCBCL). We report herein the first case of 2 young monozygotic twins with PCBCL. The first twin was an 18-year-old woman when she presented with multiple skin nodules on the thorax and head. Histology showed an atypical small B-cell proliferation, consistent with primary cutaneous marginal zone lymphoma (PCMZL). Molecular genetics studies demonstrated B-cell clonality. Seven years later, the second twin developed her first lesion that was histologically similar to that of her twin. She subsequently developed other clinically similar lesions. Histology was consistent with PCMZL and showed B-cell clonality. Occurrence of PCBCL in these monozygotic twins raises the possibility of a genetic risk factor. Further study of such rare cases may offer valuable insights into the molecular basis of the etiology and pathogenesis of this unusual disorder.

Background: Bullous lupus erythematosus is a rare disease that is extremely rare in childhood (with only seven previous reports) and difficult to control. Objective: Herein is presented the youngest patient reported with this condition, and a novel, safe, and effective treatment regimen is described. Methods: Through study, perseverance, serendipity, and creativity, a safe and effective regimen was developed. Results: The combination of mycophenolate mofetil and erythromycin (plus sun protection) was found to be efficacious. Conclusion: It is proposed that the two medications act synergistically, with the “antibiotic” acting as a antiinflammatory agent, but at a different point in the inflammatory cascade than mycophenolate mofetil. This suggests the approach of using common, inexpensive, and benign antibiotics to potentiate, and perhaps decrease the use of, immunomodulatory agents in autoimmune and autoinflammatory diseases.

Background: Nonattendance at scheduled appointments is a major problem. Previous studies have shown rates between 17 and 31%. Most US studies found the type of payer to be the greatest determinant of attendance rates. Objectives: This study examines the no-show rate in a private dermatology practice under a single universal payer model, including the effects of old versus new patient, gender, day of the week, month, and weather. Results: The overall rate of nonattendance was lower than in all previous studies (7.79%), with the only statistically significant variable being established versus new patients. Limitations: Certain demographic data investigated in previous studies (eg, age, socioeconomic status) were not assessable. Data are from a single office. Conclusion: The no-show rate in a single universal payer, private practice model is low, especially for established patients.

Background: Lichen planopilaris (LPP) is believed to be a follicular variant of lichen planus that affects pilosebaceous units, mainly of the scalp. An extremely rare variant of LPP is a linear form, which follows the lines of Blaschko. Of the five previously documented cases of linear LPP, all were limited to the face. Objective: We report the case of a 34-year-old male who presented with a nonpruritic eruption on the trunk consisting of erythematous, keratotic, folliculocentric papules following Blaschko's lines. Results: Biopsy revealed lichenoid and interface dermatitis involving the basilar epidermis and hair follicles, as well as apoptotic keratinocytes, consistent with LPP. Conclusion: This represents the first documented case of LPP, following the Blaschko's lines, in a nonfacial distribution.