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Background Calciphylaxis is a rare disorder characterized by skin necrosis caused by calcium deposition within vessels, thrombosis, and subsequent tissue ischemia. Penile involvement may rarely occur. Objective To identify risk factors, diagnosis, management, and mortality of patients with penile calciphylaxis. Methods A retrospective medical record review was conducted of 16 patients with penile calciphylaxis treated at 2 large urban tertiary care centers between January 2001 and December 2019. A control group of 44 male patients with nonpenile calciphylaxis at the same institution was included. Results The median survival of patients with penile calciphylaxis was 3.8 months (interquartile range, 27.0 months). Mortality was 50% at 3 months and 62.5% at 6 months for penile calciphylaxis, and 13.6% at 3 months and 29.5% at 6 months for controls (P = .008). Patients with penile calciphylaxis were less likely to be obese (P = .04) but more likely to have hyperparathyroidism (P = .0003) and end-stage renal disease (P = .049). Limitations Retrospective study design and small sample size. Conclusions This study further defines the disease course of penile calciphylaxis, which has high mortality. Imaging may be used to aid diagnosis. Risk factors include end-stage renal disease, hyperparathyroidism, and normal body mass index.

Cellulitis is an infection of the skin and skin-associated structures with many clinical mimickers known collectively as pseudocellulitis. Dermatology or infectious disease consultation is considered the gold standard for diagnosis. We evaluated a prospective cohort of adult patients presenting to the emergency department (ED) with concern for lower extremity cellulitis who received dermatology consultation with conferral of a final diagnosis. Possible risk factors independently associated with cellulitis diagnosis (P.1) were included in a logistic regression model for prediction of cellulitis diagnosis. Factors having odds ratios with a confidence interval excluding 1 were identified as significant independent predictors. The study identified factors that should be considered in evaluation of patients with suspected uncomplicated lower extremity cellulitis.

Biologic agents may predispose patients to skin and soft tissue infections (SSTIs). Guidelines recommend discontinuing the agent preoperatively; the true risk of infection is unclear.To assess the incidence of SSTIs in patients receiving biologic agents for all clinical indications. A secondary aim was to assess those undergoing surgery to determine postoperative SSTI risk.A retrospective medical record review was conducted at 2 urban tertiary care hospitals. Biologic agent use ranged from June 2013 to June 2018. Data were extracted on biologic agent injections, surgical procedures, and patient characteristics.Hypertension, former smoking, and corticosteroid use were significantly associated with SSTI risk (P .05). There was no increased SSTI risk among biologic agents (P = .49). Biologic therapy with concomitant corticosteroid use increased risk of SSTI (P = .0049). There was no difference in postoperative SSTI risk in patients who stopped biologic therapy before surgery and those who did not.This study is limited by its retrospective design.There was no increased risk of either postoperative or nonperioperative SSTI risk among biologic agents. Concomitant corticosteroid use increased SSTI risk. Current guidelines regarding stopping biologic agents before surgery warrant re-evaluation, because there was no difference in SSTI risk in patients who did so.

Background Patient outcomes are improved when dermatologists provide inpatient consultations. Inpatient access to dermatologists is limited, illustrating an opportunity to use teledermatology. Little is known about the ability of dermatologists to accurately diagnose disease and manage inpatients with teledermatology, particularly when using nondermatologist-generated clinical data. Methods This prospective study assessed the ability of teledermatology to diagnose disease and manage 41 dermatology consultations from a large urban tertiary care center, using internal medicine referral documentation and photographs. Twenty-seven dermatology hospitalists were surveyed. Interrater agreement was assessed by the κ statistic. Results There was substantial agreement between in-person and teledermatology assessment of the diagnosis with differential diagnosis (median κ = 0.83), substantial agreement in laboratory evaluation decisions (median κ = 0.67), almost perfect agreement in imaging decisions (median κ = 1.0), and moderate agreement in biopsy decisions (median κ = 0.43). There was almost perfect agreement in treatment (median κ = 1.0), but no agreement in follow-up planning (median κ = 0.0). There was no association between raw photograph quality and the primary plus differential diagnosis or primary diagnosis alone. Limitations Selection bias and single-center nature. Conclusions Teledermatology may be effective in the inpatient setting, with concordant diagnosis, evaluation, and management decisions.

Drug eruptions in children are common but in general less studied than their adult counterparts. Aside from having significant impact on the child's health and quality of life, these reactions can limit what medications the patient can receive in the future. Familiarity with pediatric drug eruptions is important for accurate diagnosis and to prevent future recurrence or ineffective therapy. Our current understanding of how drug reactions differ mechanistically between children and adults is poor. There are multiple factors that could be contributing to the differing incidence, presentation, and treatment modalities offered to pediatric versus adult patients. For many of these cutaneous drug reactions, the treatment regime is not standardized, being based primarily on case reports. Although not comprehensive, this review highlights common pediatric drug eruption patterns and discuss diagnostic mimickers. Five cutaneous adverse drug reactions in the pediatric population are presented: morbilliform (exanthematous) eruptions, urticarial eruptions, serum sickness-like reactions, fixed drug eruptions, and DRESS syndrome. Clinical features, diagnostic workup, and management are discussed with an emphasis on the pediatric population.

Cutaneous manifestations have been associated with COVID-19 infection and their significance in hospitalized patients remains unclear. This study catalogues the exanthems observed in hospitalized COVID-19 patients to determine prevalence and inform clinicians in devising diagnostic and management strategies.

BACKGROUND Patients of color are disproportionately impacted by vitiligo. Access to treatment depends greatly on insurance coverage. We, therefore, assessed current vitiligo treatment coverage policies across major United States health insurers to determine current patterns and coverage gaps for vitiligo. METHODS The study surveyed 15 commercial health care insurers, 50 BlueCross BlueShield (BCBS) plans, Medicare, Medicaid, and Veterans Affairs. Information on treatment coverage for vitiligo, specifically pimecrolimus and tacrolimus, excimer laser therapy, PUVA, and narrow-band (nb)UVB, was collected via an online review of insurance policy documents, confirmed with phone calls to organization representatives, or via a survey of Medicaid providers, and state Medicaid directors. RESULTS Of 17 organizations with regional or national coverage policies, 12% did not cover topical calcineurin inhibitors, 56% did not cover nbUVB phototherapy, 53% did not cover PUVA phototherapy, and 41% did not cover laser therapy. For BCBS, pimecrolimus and tacrolimus were not covered in 39% and 35% of states, respectively. NbUVB and PUVA therapy were not covered in 20% and 10% of states, respectively. Excimer laser therapy was not covered in 82% of states. Out of 32 states with accessible Medicaid information, 11 did not cover topicals, 5 did not cover nbUVB, 4 did not cover PUVA, and 7 did not cover laser. Two commonly cited reasons for coverage denial were that the treatment indication was considered cosmetic, and certain therapies are not FDA-approved. CONCLUSIONS There is inequity in the distribution of health among vitiligo patients given current patterns of insurance coverage for treatment, which may have disproportionate impact on patients of color.

Cellulitis is an infection of the skin and skin-associated structures sometimes presenting with purulence, defined by generation of pus.1 Purulent infections can further be complicated by cutaneous abscess, a walled collection of pus in the subcutaneous space. Research on paediatric cellulitis is limited, and antimicrobial treatment widely varies even among paediatric infectious disease providers with some studies suggesting overuse of broad antibiotic coverage.2-4 Methicillin-resistant Staphylococcus aureus (MRSA) infection in paediatric cellulitis can be challenging to diagnose and treat with appropriate antibiotic coverage. Nasal swabs are a polymerase chain reaction assay screening for the presence of MRSA that typically result within 24 hours, much faster than traditional microbial culture with sensitivities.5 This study assesses the performance of nasal swabs for predicting MRSA infections in our institution.

Background Calciphylaxis is an ischemic vasculopathy with high morbidity and mortality. Early and accurate diagnosis is critical to management of calciphylaxis. Clinical mimickers may contribute to delayed or misdiagnosis. Objective To assess the rate and risk factors for misdiagnosis and to identify clinical mimickers of calciphylaxis. Methods A retrospective medical record review was conducted of patients with calciphylaxis at a large urban tertiary care hospital between 2006 and 2018. Results Of 119 patients diagnosed with calciphylaxis, 73.1% were initially misdiagnosed. Of patients not initially misdiagnosed, median time to diagnosis from initial presentation was 4.5 days (interquartile range, 1.0-23.3), compared to 33 days (interquartile range, 13.0-68.8) in patients who were initially misdiagnosed (P = .0002). The most common misdiagnoses were cellulitis (31.0%), unspecified skin infection (8.0%), and peripheral vascular disease (6.9%). Patients who were misdiagnosed frequently received at least 1 course of antibiotics. Patients with end-stage renal disease were less likely to be misdiagnosed than those without this disease (P = .001). Limitations Single-center, retrospective study. Conclusions Understanding the risk factors for misdiagnosis of calciphylaxis is an opportunity for further education concerning this rare disease.

Background Calciphylaxis is a rare thrombotic vasculopathy characterized by high morbidity and mortality. There is a paucity of studies examining longitudinal outcomes. Objective To assess mortality, days spent in the hospital, and amputations in patients with calciphylaxis. Methods A retrospective medical record review was conducted in 145 patients diagnosed with calciphylaxis at an urban tertiary care hospital from January 2006 to December 2018. Results Six-month mortality was 37.2%, and 1-year mortality was 44.1%. Patients with nephrogenic calciphylaxis had worse survival than those with nonnephrogenic calciphylaxis (P = .007). This difference in survival disappeared when limiting mortality to deaths due to calciphylaxis. Age (P = .003) and end-stage renal disease (P = .01) were risk factors associated with 1-year mortality. Diabetes mellitus was associated with greater total hospitalization days (coefficient, 1.1; 95% confidence interval, 1.01-1.4); bedside debridement was associated with fewer hospitalization days (coefficient, 0.8; 95% confidence interval, 0.7-0.9). Amputations were not associated with any of the examined risk factors. The use of warfarin followed by a transition to nonwarfarin anticoagulation was associated with decreased hazard of death (P = .01). Limitations Retrospective nature. Conclusions Calciphylaxis remains a complex, heterogeneous disease. Mortality is lower in patients with nonnephrogenic disease. These findings may be incorporated during discussions regarding the goals of care to facilitate informed shared decision making.

● Calciphylaxis is a serious disorder with high morbidity and mortality and no approved therapy. Intralesional sodium thiosulfate (ILSTS) has not been well-studied as a treatment modality. ● This retrospective study identifies ILSTS as a potentially effective treatment option for calciphylaxis with few adverse effects.

Background: Cutaneous manifestations have been associated with COVID-19 infection and their clinical significance in hospitalized patients remains unclear Methods: A retrospective chart review of 1216 patients older than 18 years of age hospitalized with laboratory-confirmed SARS-CoV-2 infection from March 12, 2020 to May 31, 2020 at a large urban academic medical center A keyword search query of patient records combined with manual chart review by at least two dermatologists identified a study group having cutaneous manifestations concurrent with COVID-19 infection, specifically between 14 days prior to admission and up to discharge Results: 122 patients with 195 skin lesions concurrent with COVID-19 hospitalization were identified Dermatology reviewers evaluated clinical photographs for 116 lesions (59 5%) and inpatient dermatology consultations for 42 lesions (21 5%) The most common cutaneous findings in patients with COVID-19 hospitalization were pressure injuries (n=118;60 5%) and morbilliform eruptions (n=33;16 9%) A very small number of patients (0 6%;n=7/1216) had exanthems occurring within 2 weeks of COVID-19 symptom onset The majority of exanthems developed within 14 days of exposure to possible culprit drugs and beyond the 14-day window of COVID-19 symptom onset, making viral association unlikely Conclusion: Skin lesions concurrent with COVID-19 hospitalization were most frequently linked to hospitalization-related factors, such as pressure injuries or drug-related exanthems, rather than due to novel pathologies related to SARS-CoV-2 itself

Background: The World Health Organization recommends healthcare providers wear personal protective equipment (PPE) to prevent COVID-19 infection There are no universally accepted recommendations for PPE usage by healthcare providers when caring for asymptomatic patients who can transmit infection Objective: To survey PPE usage across medical dermatology practices and assess provider concern for COVID-19 transmission in the workplace Methods: An anonymous survey was distributed via e-mail to dermatologists with membership in the Society for Dermatology Hospitalists and the Association of Professors in Dermatology Questions pertained to use and perception of PPE in outpatient encounters The survey remained open for 6 weeks and reached a predetermined target response number of 50-100 dermatologists among 429 recipients Results: 88 dermatologists completed the survey (20 5%) and the majority practice in an outpatient clinic (80 7%) When caring for patients, most practices officially recommended utilizing a surgical mask (95 5%) and face shield (52 3%) Though a minority of practices recommended an N95 respirator (9 1%) or gloves (29 5%), a larger fraction of dermatologists self-reported using an N95 respirator (26 1%) and/or gloves (43 2%) 35 2% of dermatologists supplemented practice-provided PPE by providing personally obtained PPE, and 18 2% of dermatologists felt their institution did not adequately address their perceived risk of contracting COVID-19 42 0% of physicians perceived their risk of contracting COVID-19 at work to be moderate or high Conclusion: An appreciable fraction of dermatologists perceived their COVID-19 infection risk to be medium or high, and some dermatologists are taking supplemental safety measures This study calls attention to the level of provider-perceived risk and highlights opportunities to address provider concerns regarding COVID-19 transmission