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Background Methotrexate is an immunomodulatory therapy that may offer benefit to patients with hidradenitis suppurativa (HS). Despite its theoretical advantages, there is a paucity of available data regarding long-term methotrexate use in patients with HS. Objective This study aimed to assess whether methotrexate treatment leads to improvement in HS disease severity. Methods We conducted an institutional review board–approved, single-center, retrospective chart review of patients with HS who were treated with methotrexate between 2000 and 2018. Primary outcome measurements included the HS Physician's Global Assessment (HS PGA), Hurley staging, abscess count, fistula count, and inflammatory nodule count. Results A total of 29 patients were identified; 14 were excluded for reasons including never starting methotrexate and missing follow-up data. For remaining patients (n = 15), the average cumulative dose of methotrexate was 520.1 mg (range, 30–1665 mg) and the average length of treatment was 11.7 months (range, 1–38 months). Patients taking methotrexate as a primary therapy had a higher cumulative dose and length of treatment (520.13 mg; 14.6 months) compared with those taking biologics concomitantly (468.44 mg; 9.1 months). Patients using methotrexate as primary therapy demonstrated nonsignificant reductions in HS PGA, inflammatory nodule count, and abscess count. Patients on concomitant biologic therapy failed to demonstrate any change in HS PGA, inflammatory nodule count, and abscess count. Limitations Limitations of the study include its retrospective nature, small sample size, length of time on methotrexate between groups, and homogeneity of the patient population. Conclusion Methotrexate may represent an effective treatment option in older patients with lower body mass indices but fails to offer benefit in patients taking concurrent biologic therapy.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by inflammatory nodules, abscesses, and fistulae. Severe disease is frequently treated with adalimumab or infliximab, but limited research and insurance coverage confine treatment options. Often, aggressive multifaceted therapeutic regimens fail in severe cases. The Janus kinase (JAK) inhibitor, tofacitinib, acts through the JAK-STAT pathway, suppressing inflammatory cytokines implicated in HS pathogenesis, such as interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α.1 JAK inhibitors may benefit HS patients who lack response to targeted biologic therapy. We report on 2 patients with a rare, recalcitrant, ulcerating HS phenotype who, despite not responding to numerous treatments, including biologics (Table I), exhibited prolonged response to a tofacitinib multimodal regimen. Table I Baseline patient characteristics

The utilization of robotic platforms for general surgery procedures such as hernia repair is growing rapidly in the United States. A limited amount of data are available evaluating operative outcomes in comparison to standard laparoscopic surgery. We completed a retrospective review comparing robotic and laparoscopic ventral hernia repair to provide safety and outcomes data to help design a future prospective trial design. A retrospective review of 215 patients undergoing ventral hernia repair (142 robotic and 73 laparoscopic) was completed at two large academic centers. Primary outcome measure evaluated was recurrence. Secondary outcomes included incidence of primary fascial closure, and surgical site occurrences. Propensity for treatment match comparison demonstrated that robotic repair was associated with a decreased incidence of recurrence (2.1 versus 4.2%, p

Introduction: Hidradenitis suppurativa (HS) is a chronic skin disorder characterized by inflammatory nodules, abscesses, and fistulae. Patients tend to present in young adulthood and are predominan...

Apocrine adenocarcinoma of the eyelid is a rare sweat gland cancer. It is predominant in older adults and has increased prevalence in males. Management is based on recommendations from reported cases and their outcomes. Surgical excision is considered effective in apocrine adenocarcinoma of the eyelid. We report the case of a 58-year-old woman with apocrine adenocarcinoma located on her left upper eyelid. Excisional biopsy demonstrated focal apocrine secretion in a basaloid nest proliferation. The patient had no recurrence at four months. Our case provides insight into the workup and management of eyelid apocrine adenocarcinoma. Furthermore, we discuss key management recommendations according to previous authors' experiences with eyelid apocrine adenocarcinoma.

Fibro-osseous pseudotumor of the toe is a benign soft tissue tumor that is predominant in the young adult population. Although the etiology is unknown, a history of trauma has been reported to precede tumor development. The differential diagnosis includes myositis ossificans, extraskeletal osteosarcoma, and pyogenic granuloma. Once removed, the tumor typically has no recurrence. Surgical excision is the treatment of choice. We present a patient with fibro-osseous pseudotumor of the great toe, which had no recurrence following excision.

Liquid silicone injections are used for soft tissue augmentation and have the potential to cause adverse effects. A 60-year-old woman who developed a psoriatic lesion over a silicone granuloma is reported. The clinical, dermatoscopic, and histological findings were characteristic of psoriasis. The patient was started on hydroxychloroquine for the treatment of the granuloma without any subsequent development of new psoriatic lesions. The presentation of psoriasis associated with a silicone granuloma in an immunocompetent patient is unique. The sequence of events is another example of a dermatosis occurring in an immunocompromised cutaneous district.

Delusional infestation (DI), also known as delusional parasitosis, consists of a patient's strong belief that he or she is infested with a nonliving substance or living organism despite lack of medical evidence to support this belief. The most commonly reported sources of infestation include insects, fibrous strands, worms, and scabies. DI is predominantly seen in women and older patients. This disorder has a variable course and prognosis in patients. DI can be a primary psychiatric problem, or secondary to underlying medical conditions or other psychiatric disorders. It has been proposed that DI presents along a spectrum that includes four categories: overvalued concern of infestation, somatoform preoccupation, delusional state, and terminal delusional state. Management depends on the patient's category at presentation. The diagnostic approach for DI involves a thorough evaluation that can rule out medical conditions that underlie the patient's symptoms. This includes obtaining a detailed history, physical exam, and ordering laboratory tests. Treatment for primary DI includes both first and second-generation antipsychotics. Secondary DI treatment depends on the etiology. The prognosis of patients with DI is difficult to predict due to various factors including level of insight, underlying psychiatric conditions, and medication adherence. It is important for the physician to maintain a therapeutic relationship with the patient in order to properly address the patient's concerns.

Papular purpuric gloves and socks syndrome (PPGSS) is a self-limited exanthem that presents as painful or pruritic edema, erythema, petechiae, and purpura of the palms and soles with occasional extension to the dorsal hands and feet. The majority of PPGSS cases reported in the literature are associated with parvovirus B19 and occur in children and young adults. In a recent literature search, there were 11 PPGSS cases in adults with none reporting Epstein-Barr virus (EBV) as a viral etiology. However, there have been PPGSS cases related to EBV in children. We report the case of a 72-year-old man with PPGSS associated with Epstein-Barr virus. This case report serves as a reminder that PPGSS can present not only in the setting of pediatric and young adult parvovirus B19 infection, but also in immunocompetent adults with other viral infections.

Eccrine spiradenoma (ES) typically presents as a solitary tender lesion. Multiple ES is a rare variant of ES and can present in a segmental, linear, blaschkoid, or zosteriform pattern. The etiology of multiple ES is unknown, but several theories have been suggested including a multipotent stem cell origin. We report the case of a 30-year-old woman with multiple painful ES in a zosteriform pattern on the mid-back and abdomen. Skin biopsy of a representative lesion demonstrated a circumscribed tumor nodule encapsulated by a fibrous capsule with diffuse dense basophilic proliferation located in the dermis. The lesions were then excised on two separate sessions without recurrence.