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Photosensitizing drug reactions are cutaneous eruptions that occur after exposure to ultraviolet radiation in patients using photosensitizing medications. The reactions can be broadly classified into phototoxic and photoallergic, with the former being much more common and well documented. There is an extensive list of photosensitizing medications, especially in the case of phototoxicity. The most common are amiodarone, chlorpromazine, doxycycline, hydrochlorothiazide, nalidixic acid, naproxen, piroxicam, tetracycline, thioridazine, vemurafenib, and voriconazole. Most of the medications implicated in photosensitivity share an action spectrum within the ultraviolet A range. Distinguishing between phototoxicity and photoallergy can be difficult, because some clinical overlap exists between the two disorders. It is often done based on pathogenesis, clinical presentation, and diagnosis. Management is similar for both types of reactions, with the gold standard being prevention. This review provides an overview of the photosensitizing drug reactions and highlights the similarities and differences between phototoxicity and photoallergy, as well as other photosensitizing drug reactions in the phototoxicity family including lichenoid reactions and pseudoporphyria. [ABSTRACT FROM AUTHOR]

Background While immunosuppressive therapy for acute graft-versus-host disease (aGVHD) advances, viral reactivation has been found to be an increasingly common complication in these patients. Dermatologists may often be consulted on inpatient services for evaluation. Objective We investigated the literature for the role of viral infections in aGVHD and review the current evidence regarding management. Methods Articles in the public domain regarding aGVHD, cytomegalovirus, Epstein–Barr virus, varicella zoster virus, hepatitis viruses, parvovirus B19, and respiratory viruses were included. Results Dermatologic findings vary between different viral antigens, and some infections may be a marker for the development of aGVHD or worsen prognosis. Limitations The heterogeneous cohorts of the studies reviewed often preclude direct comparison between results. Conclusion The relationship between viral reactivation and aGVHD may be bidirectional and is worthy of further exploration. Additional studies are needed to determine appropriate prophylaxis and treatment. [ABSTRACT FROM AUTHOR]

Background: Erythema multiforme (EM), an acute dermatologic condition frequently encountered in the Emergency Department, classically presents with a targetoid rash. We reviewed all recent EM cases seen at the LAC-USC County Hospital in order to ascertain the proportion of Herpes associated EM (HAEM) cases and to inform the diagnostic workup of these patients.Methods: ICD-9 and ICD-10 codes were used to extract a list of EM cases at our institution from 2013 to 2019. Two non-blinded abstractors screened records to confirm an EM diagnosis and entered patient data utilizing a standardized data abstraction form. Cohen's kappa statistic was used to measure inter-rater reliability on various variables. Kappa (κ) values ranged from 0.803 to 1.0.Results: 70 pediatric and 56 adult EM patients were included in the study. A likely etiology was ascribed to 63% of pediatric and adult EM cases. Pediatric EM was most commonly attributed to upper respiratory infection (URI) (n = 23; 33%), Mycoplasma pneumoniae infection (n = 5; 7%), and medications (n = 4; 6%). Adult EM was most commonly attributed to HSV infection (n = 11; 20%), medications (n = 5; 9%), URIs (n = 4; 7%), and other infections (n = 4; 7%).Conclusion: HSV-1/2 serologic testing should be considered in most EM patients to potentially prevent repeated ED visits. In EM cases not clearly attributable to herpes or drug exposure, physicians can consider further workup: Mycoplasma serology, nasal PCR, and a respiratory viral panel in pediatric patients. Identification of an etiologic cause may suggest a different treatment approach and prevent mislabeling of medication allergies in patient charts. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has accelerated discussions about reforms needed in the dermatology residency application process. We sought to evaluate the perspectives of dermatology program directors (PDs) and applicants regarding changes implemented during the 2020-2021 application cycle and measure support for potential reforms. Two online surveys were distributed to PDs and applicants who participated in the 2020-2021 dermatology residency match. Responses were collected from a total of 79 PDs (73.8% response rate, 83.5% complete responses) and 232 applicants (83.6% complete responses). The top 3 reforms supported by PDs were application caps (89.4% in favor), interview caps (86.4% in favor), and token preference signaling (81.8% in favor). The top 3 reforms supported by applicants were coordinated interview invite release (89.7% in favor), national webinars with PDs and/or faculty to discuss the application process (86.6% in favor), and formalized mentorship programs with PDs and/or faculty (78.4% in favor). This study was limited by the inability to capture responses from more dermatology applicants, possibly affecting the generalizability of the results. We identified broad support for multiple proposed reforms to the dermatology residency application process, particularly to improve the efficiency of application review and strengthen communication between programs and applicants. [ABSTRACT FROM AUTHOR]