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3. A prospective cohort study comparing the performance of interferon gamma release assays in autoimmune skin diseases

Author

Rebecca G. Gaffney, Christina E. Bax, Emily Keyes, Victoria P. Werth, Robert Borucki, Steffan W. Schulz, Rui Feng, Josef Symon S. Concha, Joyce Okawa, D. Yan, Adarsh Ravishankar, Rebecca L Krain, and Lisa Pappas-Taffer

Subjects
Oncology, medicine.medical_specialty, business.industry, MEDLINE, Dermatology, Skin Diseases, Autoimmune Diseases, Interferon-gamma, Latent Tuberculosis, Internal medicine, Humans, Medicine, Interferon gamma, Prospective Studies, business, Prospective cohort study, Interferon-gamma Release Tests, medicine.drug
Published
2022
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4. Environmental triggers of dermatomyositis: a narrative review

Author

Christina E. Bax, Lisa Pappas-Taffer, Adarsh Ravishankar, Victoria P. Werth, and Spandana Maddukuri

Subjects
030203 arthritis & rheumatology, Autoimmune disease, Hepatitis, Exacerbation, biology, business.industry, Parvovirus, General Medicine, Dermatomyositis, biology.organism_classification, medicine.disease, Virus, Vaccination, Pathogenesis, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Immunology, Medicine, Review Article on Rheumatologic Skin Disease, business
Abstract

Dermatomyositis (DM) is an autoimmune disease that affects the skin, lungs, and muscle. Although the pathogenesis of DM is not completely understood, several environmental triggers have been linked to DM onset or flare. This article specifically examines the effects of herbal supplements, drugs, infections, ultraviolet (UV) radiation, and environmental pollutants on the onset or exacerbation of DM. Herbal supplements such as Spirulina platensis, Aphanizomenon flos-aquae, Chlorella, Echinacea, and Alfalfa have been implicated and are frequently used in health foods. Medications such as hydroxyurea, TNF-α inhibitors, immune checkpoint inhibitors (ICI), and penicillamine, as well as certain viral infections, such as parvovirus B19, coxsackie virus, polyomavirus, Epstein-Barr virus (EBV), hepatitis, influenza, and human immunodeficiency viruses (HIV) have been associated with DM onset. Bacterial infections and vaccinations have also been linked to the development of DM. Additional environmental factors, including UV radiation and air pollutants, such as silica, biological/mineral dust, and particulate air matter from vehicle and industrial emissions, may also play a role in DM pathogenesis. Overall, there is general agreement that an autoimmune attack of the skin, muscle, and lungs in DM can be triggered by various environmental factors and warrants further investigation.

Published
2021

7. Evaluation of the Effectiveness and Tolerability of Mycophenolate Mofetil and Mycophenolic Acid for the Treatment of Morphea

Author

Emile Latour, Jeffrey Zhao, Marleigh J. Stern, Nicole Leung, Elaine Kunzler, Elizabeth Tkachenko, Lisa Pappas-Taffer, Shivani Sharma, Anne E. Laumann, Ruth Ann Vleugels, Nicole Fett, Kelly Lo, Adela R. Cardones, Smriti Prasad, Megan Arthur, Jeong Min Yu, Stephanie Florez-Pollack, Heidi Jacobe, Daniel Knabel, Alisa N. Femia, Rebecca G. Gaffney, Jacob Houser, and Anthony P. Fernandez

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Pansclerotic Morphea, Dermatology, Mycophenolate, Gastroenterology, Mycophenolic acid, Cohort Studies, 030207 dermatology & venereal diseases, 03 medical and health sciences, Scleroderma, Localized, Young Adult, 0302 clinical medicine, Interquartile range, Adrenal Cortex Hormones, Internal medicine, medicine, Humans, Child, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Correction, Hydroxychloroquine, Middle Aged, Mycophenolic Acid, medicine.disease, Regimen, Methotrexate, Treatment Outcome, Tolerability, 030220 oncology & carcinogenesis, Child, Preschool, Female, business, Morphea, Immunosuppressive Agents, medicine.drug
Abstract

Importance First-line systemic therapy for morphea includes methotrexate with or without systemic corticosteroids. When this regimen is ineffective, not tolerated, or contraindicated, a trial of mycophenolate mofetil (MMF) or mycophenolic acid (MPA)—referred to herein asmycophenolate—is recommended; however, evidence to support this recommendation remains weak. Objective To evaluate the effectiveness and tolerability of mycophenolate for the treatment of morphea. Design, Setting, and Participants A retrospective cohort study was conducted from January 1, 1999, to December 31, 2018, among 77 patients with morphea from 8 institutions who were treated with mycophenolate. Main Outcomes and Measures The primary outcome was morphea disease activity, severity, and response at 0, 3 to 6, and 9 to 12 months of mycophenolate treatment. A secondary outcome was whether mycophenolate was a well-tolerated treatment of morphea. Results There were 61 female patients (79%) and 16 male patients (21%) in the study, with a median age at disease onset of 36 years (interquartile range, 16-53 years) and median diagnostic delay of 8 months (interquartile range, 4-14 months). Generalized morphea (37 [48%]), pansclerotic morphea (12 [16%]), and linear morphea of the trunk and/or extremities (9 [12%]) were the most common subtypes of morphea identified. Forty-one patients (53%) had an associated functional impairment, and 49 patients (64%) had severe disease. Twelve patients received initial treatment with mycophenolate as monotherapy or combination therapy and 65 patients received mycophenolate after prior treatment was ineffective (50 of 65 [77%]) or poorly tolerated (21 of 65 [32%]). Treatments prior to mycophenolate included methotrexate (48 of 65 [74%]), systemic corticosteroids (42 of 65 [65%]), hydroxychloroquine (20 of 65 [31%]), and/or phototherapy (14 of 65 [22%]). After 3 to 6 months of mycophenolate treatment, 66 of 73 patients had stable (n = 22) or improved (n = 44) disease. After 9 to 12 months of treatment, 47 of 54 patients had stable (n = 14) or improved (n = 33) disease. Twenty-seven patients (35%) achieved disease remission at completion of the study. Treatments received in conjunction with mycophenolate were frequent. Mycophenolate was well tolerated. Gastrointestinal adverse effects were the most common (24 [31%]); cytopenia (3 [4%]) and infection (2 [3%]) occurred less frequently. Conclusions and Relevance This study suggests that mycophenolate is a well-tolerated and beneficial treatment of recalcitrant, severe morphea.

Published
2020

8. Systemic sclerosis: Current concepts of skin and systemic manifestations

Author

Victoria P. Werth, David R. Pearson, and Lisa Pappas-Taffer

Subjects
medicine.medical_specialty, Localized Therapy, Dermatology, Systemic therapy, Scleroderma, Fingers, Calcinosis cutis, Scleroderma, Localized, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Terminology as Topic, Skin Ulcer, medicine, Humans, Telangiectasis, Autoantibodies, 030203 arthritis & rheumatology, Scleroderma, Systemic, business.industry, Pruritus, Calcinosis, Treatment options, Raynaud Disease, medicine.disease, Connective tissue disease, Risk stratification, Observational study, business, Pigmentation Disorders
Abstract

Systemic sclerosis is an uncommon autoimmune connective tissue disease with multiorgan system involvement and significant associated morbidity and mortality. Cutaneous signs and clinical manifestations are of particular importance, as they may be recognized before systemic manifestations, allowing earlier risk stratification into the limited and diffuse cutaneous subtypes, as well as earlier initiation of treatment. Important cutaneous manifestations include Raynaud's phenomenon, digital ulcers, cutaneous sclerosis, calcinosis cutis, telangiectasias, pruritus, and dyspigmentation. Despite investigation of a wide variety of treatments, no FDA-approved pharmacologic therapies exist for systemic sclerosis, and data from high-quality studies are limited. In the following review, we will discuss skin-directed therapies. Although there is evidence to support specific treatments for Raynaud's phenomenon, digital ulcers, and cutaneous sclerosis, there are limited rigorous studies evaluating the treatment of other cutaneous signs and clinical manifestations. Additional randomized-controlled trials and large observational studies are necessary to develop future evidence-based treatment options.

Published
2018
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10. Contributors

Author

James L. Abbruzzese, Omar Abdel-Wahab, Ghassan K. Abou-Alfa, Janet L. Abrahm, Jeffrey S. Abrams, Jeremy S. Abramson, Dara L. Aisner, Michelle Alonso-Basanta, Jesus Anampa, Megan E. Anderson, Emmanuel S. Antonarakis, Richard Aplenc, Frederick R. Appelbaum, Luiz H. Araujo, Ammar Asban, Edward Ashwood, Farrukh T. Awan, Juliet L. Aylward, Arjun V. Balar, Courtney J. Balentine, Stefan K. Barta, Nancy Bartlett, Karen Basen-Engquist, Lynda Kwon Beaupin, Ross S. Berkowitz, Donald A. Berry, Therese Bevers, John F. Boggess, Julie R. Brahmer, Janet Brown, Karen Brown, Powel Brown, Ilene Browner, Paul A. Bunn, William R. Burns, John C. Byrd, Karen Cadoo, David P. Carbone, H. Ballentine Carter, Jorge J. Castillo, Alfred E. Chang, Eric Chang, Stephen J. Chanock, Claudia I. Chapuy, Vikash P. Chauhan, Herbert Chen, Ronald C. Chen, Nai-Kong V. Cheung, Jennifer H. Choe, Michaele C. Christian, Paul M. Cinciripini, Michael F. Clarke, Robert E. Coleman, Robert L. Coleman, Adriana M. Coletta, Jerry M. Collins, Jean M. Connors, Michael Cools, Kevin R. Coombes, Jorge Cortes, Mauro W. Costa, Anne Covey, Kenneth H. Cowan, Christopher H. Crane, Jeffrey Crawford, Kristy Crooks, Daniel J. Culkin, Brian G. Czito, Piero Dalerba, Josep Dalmau, Mai Dang, Michael D'Angelica, Kurtis D. Davies, Myrtle Davis, Nicolas Dea, Ana De Jesus-Acosta, Angelo M. DeMarzo, Theodore L. DeWeese, Maximilian Diehn, Subba R. Digumarthy, Angela Dispenzieri, Khanh T. Do, Konstantin Dobrenkov, Jeffrey S. Dome, James H. Doroshow, Jay F. Dorsey, Marianne Dubard-Gault, Steven G. DuBois, Dan G. Duda, Malcolm Dunlop, Linda R. Duska, Madeleine Duvic, Imane El Dika, Hashem El-Serag, Jeffrey M. Engelmann, David S. Ettinger, Lola A. Fashoyin-Aje, Eric R. Fearon, James M. Ford, Wilbur A. Franklin, Phoebe E. Freer, Boris Freidlin, Alison G. Freifeld, Terence W. Friedlander, Debra L. Friedman, Arian F. Fuller, Lorenzo Galluzzi, Mark C. Gebhardt, Daniel J. George, Mark B. Geyer, Amato J. Giaccia, Mark R. Gilbert, Whitney Goldner, Donald P. Goldstein, Annekathryn Goodman, Karyn A. Goodman, Kathleen Gordon, Laura Graeff-Armas, Alexander J. Greenstein, Stuart A. Grossman, Stephan Grupp, Arjun Gupta, Irfanullah Haider, Missak Haigentz, John D. Hainsworth, Benjamin E. Haithcock, Christopher L. Hallemeier, Samir Hanash, Aphrothiti J. Hanrahan, James Harding, Michael R. Harrison, Muneer G. Hasham, Ernest Hawk, Jonathan Hayman, Jonathan E. Heinlen, N. Lynn Henry, Joseph Herman, Brian P. Hobbs, Ingunn Holen, Leora Horn, Neil S. Horowitz, Steven M. Horwitz, Odette Houghton, Scott C. Howard, Clifford A. Hudis, Stephen P. Hunger, Arti Hurria, David H. Ilson, Annie Im, Gopa Iyer, Elizabeth M. Jaffee, Reshma Jagsi, Rakesh K. Jain, William Jarnagin, Aminah Jatoi, Anuja Jhingran, David H. Johnson, Brian Johnston, Patrick G. Johnston, Kevin D. Judy, Lisa A. Kachnic, Orit Kaidar-Person, Sanjeeva Kalva, Deborah Y. Kamin, Hagop Kantarjian, Giorgos Karakousis, Maher Karam-Hage, Nadine M. Kaskas, Michael B. Kastan, Nora Katabi, Daniel R. Kaul, Scott R. Kelley, Nancy Kemeny, Erin E. Kent, Oliver Kepp, Simon Khagi, Joshua E. Kilgore, D. Nathan Kim, Bette K. Kleinschmidt-DeMasters, Edward L. Korn, Guido Kroemer, Geoffrey Y. Ku, Shivaani Kummar, Bonnie Ky, Daniel A. Laheru, Paul F. Lambert, Mark Lawler, Jennifer G. Le-Rademacher, John Y.K. Lee, Nancy Y. Lee, Susanna L. Lee, Jonathan E. Leeman, Andreas Linkermann, Jinsong Liu, Simon Lo, Jason W. Locasale, Charles L. Loprinzi, Maeve Lowery, Emmy Ludwig, Matthew A. Lunning, Robert A. Lustig, Mitchell Machtay, Crystal Mackall, David A. Mahvi, David M. Mahvi, Amit Maity, Neil Majithia, Marcos Malumbres, Karen Colbert Maresso, John D. Martin, Koji Matsuo, Natalie H. Matthews, Lauren Mauro, R. Samuel Mayer, Worta McCaskill-Stevens, Megan A. McNamara, Neha Mehta-Shah, Robert E. Merritt, Matthew I. Milowsky, Lori M. Minasian, Tara C. Mitchell, Demytra Mitsis, Michelle Mollica, Margaret Mooney, Farah Moustafa, Lida Nabati, Jarushka Naidoo, Amol Narang, Heidi Nelson, William G. Nelson, Suzanne Nesbit, Mark Niglas, Tracey O'Connor, Kenneth Offit, Mihaela Onciu, Eileen M. O’Reilly, Elaine A. Ostrander, Lisa Pappas-Taffer, Drew Pardoll, Jae H. Park, Anery Patel, Anish J. Patel, Steven R. Patierno, Steven Z. Pavletic, Peter C. Phillips, Miriam D. Post, Amy A. Pruitt, Christiane Querfeld, Vance A. Rabius, S. Vincent Rajkumar, Mohammad O. Ramadan, Erinn B. Rankin, Sushanth Reddy, Michael A. Reid, Scott Reznik, Tina Rizack, Jason D. Robinson, Leslie Robinson-Bostom, Carlos Rodriguez-Galindo, Paul B. Romesser, Steven T. Rosen, Myrna R. Rosenfeld, Nadia Rosenthal, Meredith Ross, Julia H. Rowland, Anthony H. Russell, Michael S. Sabel, Arjun Sahgal, Ryan D. Salinas, Erin E. Salo-Mullen, Manuel Salto-Tellez, Sydney M. Sanderson, John T. Sandlund, Victor M. Santana, Michelle Savage, Eric C. Schreiber, Lynn Schuchter, Liora Schultz, Michael V. Seiden, Morgan M. Sellers, Payal D. Shah, Jinru Shia, Konstantin Shilo, Eric Small, Angela B. Smith, Stephen N. Snow, David B. Solit, Anil K. Sood, Enrique Soto-Perez-de-Celis, Joseph A. Sparano, Vladimir S. Spiegelman, Sheri L. Spunt, Zsofia K. Stadler, David P. Steensma, Richard M. Stone, Steven Kent Stranne, Kelly Stratton, Bill Sugden, Andrew M. Swanson, Martin S. Tallman, James E. Talmadge, David T. Teachey, Catalina V. Teba, Ayalew Tefferi, Bin Tean Teh, Joyce M.C. Teng, Joel E. Tepper, Premal H. Thaker, Aaron P. Thrift, Arthur-Quan Tran, Grace Triska, Donald Trump, Kenneth Tsai, Chia-Lin Tseng, Diane Tseng, Sandra Van Schaeybroeck, Brian A. Van Tine, Erin R. Vanness, Gauri Varadhachary, Marileila Varella-Garcia, Richard L. Wahl, Michael F. Walsh, Thomas Wang, Jared Weiss, Irving L. Weissman, Shannon N. Westin, Jeffrey D. White, Richard Wilson, Richard J. Wong, Gary S. Wood, Yaohui G. Xu, Meng Xu-Welliver, Shlomit Yust-Katz, Timothy Zagar, Elaine M. Zeman, Tian Zhang, and James A. Zwiebel

Published
2020
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12. Autoimmune Connective Tissue Diseases

Author

Daisy Danielle Yan and Lisa Pappas-Taffer

Subjects
Pregnancy, Fetus, medicine.medical_specialty, Lupus erythematosus, Systemic lupus erythematosus, business.industry, food and beverages, Connective tissue, Context (language use), Dermatomyositis, medicine.disease, Connective tissue disease, Dermatology, medicine.anatomical_structure, medicine, business
Abstract

Autoimmune connective tissue diseases (CTDs), including lupus, dermatomyositis, and others, are dermatological and systemic diseases which can be affected by and can affect pregnancy. There are no consensus guidelines for treating cutaneous CTDs in pregnancy, and many of the CTDs have not been studied in the context of pregnancy due to their rarity. Dermatomyositis tends to stabilize or improve during pregnancy and flare post-partum. Cutaneous lupus can flare during pregnancy, but pre-conception disease control reduces risks in pregnancy. In CTDs, the amount of disease activity mirrors risks to the fetus, with disease control for 6 months prior to conception being an indicator for favorable outcomes.

Published
2020
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14. The incidence of herpes zoster in cutaneous lupus erythematosus (CLE), dermatomyositis (DM), pemphigus vulgaris (PV), and bullous pemphigoid (BP)

Author

Lisa Pappas-Taffer, Rui Feng, Elizabeth S. Robinson, Victoria P. Werth, and Aimee S. Payne

Subjects
Adult, Male, medicine.medical_specialty, Comorbidity, Dermatology, Herpes Zoster, Dermatomyositis, 03 medical and health sciences, 0302 clinical medicine, Pemphigoid, Bullous, Lupus Erythematosus, Cutaneous, medicine, Humans, 030212 general & internal medicine, Aged, Retrospective Studies, Aged, 80 and over, Philadelphia, 030203 arthritis & rheumatology, Autoimmune disease, integumentary system, business.industry, Incidence, Incidence (epidemiology), fungi, Pemphigus vulgaris, Retrospective cohort study, Middle Aged, medicine.disease, Case-Control Studies, Cutaneous Lupus Erythematosus, Female, Bullous pemphigoid, business, Pemphigus, Shingles
Abstract

Background Herpes zoster is a common condition that causes significant morbidity. Objective This study determined the incidence of zoster in patients with cutaneous lupus erythematosus (CLE), dermatomyositis (DM), pemphigus vulgaris (PV), and bullous pemphigoid (BP). Methods In this retrospective cohort study the electronic medical records of 186 patients with CLE, 103 with DM, 83 with PV, 44 with BP, and 152 healthy control patients were reviewed to confirm positive diagnoses of zoster. Results The incidence of zoster per 1000 person-years was 29.4 in CLE, 55.4 in DM, 18.6 in PV, 10.2 in BP, and 3.9 in healthy control subjects. The mean age (SD) in years was 46.1 (14.9) for CLE, 52.2 (14.5) for DM, 51.8 (13.5) for PV, 71.44 (11.8) for BP, and 48.2 (18.2) for healthy control subjects. The incidence of zoster was significantly higher in the CLE ( P = .0177) and DM ( P = .0070) groups than the healthy control subjects, all of whom were of a similar mean age. Limitations The limitations of this study are the sample size, referral bias, and retrospective nature. Conclusion The incidence of zoster in patients with CLE and, particularly, DM was significantly higher than that of the healthy control subjects.

Published
2016
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15. Acute and recurrent facial pustulosis: a unique clinical entity?

Author

Lisa Pappas-Taffer, Anthony K. Guzman, William D. James, and Dirk M. Elston

Subjects
030201 allergy, Pediatrics, medicine.medical_specialty, Erythema, business.industry, Folliculitis, Dermatology, medicine.disease, Pustulosis, Chin, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Infectious Diseases, medicine.anatomical_structure, Female patient, medicine, Forehead, Referral center, medicine.symptom, business
Abstract

We report a series of three patients encountered in a tertiary referral center that share a rare constellation of clinical and histopathologic findings. In each case, a healthy female patient reported recurrent episodes of rapidly-appearing, tightly-clustered, fine pustules on a background of light erythema involving the chin, forehead, cheeks, and neck (Figure 1). These episodic eruptions, which occurred approximately 4-6 episodes per year, were associated with mild pruritus, and relapsed and remitted within 5 days without therapeutic intervention. This article is protected by copyright. All rights reserved.

Published
2017
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16. Effect of long-term treatment with tumour necrosis factor-α inhibitors on single-dose ultraviolet-induced changes in human skin

Author

Lynne Taylor, Elizabeth S. Robinson, Jordan C. Achtman, Rui Feng, J.L. Nevas, Majid Zeidi, Robert Mitrani, Jamie Langenhan, Joyce Okawa, Meena R. Sharma, Victoria P. Werth, Lisa Pappas-Taffer, E. Privette, Hee Joo Kim, and C. Calianno

Subjects
Male, 0301 basic medicine, 030103 biophysics, Long term treatment, Necrosis, Ultraviolet Rays, Dermatitis, Human skin, Dermatology, Article, Etanercept, 03 medical and health sciences, Text mining, medicine, Humans, Aged, Skin, Tumor Necrosis Factor-alpha, business.industry, Adalimumab, Middle Aged, Infliximab, 030104 developmental biology, Cancer research, Collagen, medicine.symptom, business
Published
2017
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18. Developing classification criteria for skin-predominant dermatomyositis: the Delphi process

Author

Rachel, Abuav, Rohit, Aggarwal, Nidhi, Avashia-Khemka, Jeffrey, P Callen, Adela Rambi, G Cardones, Sarah, S Chisolm, Benjamin, F Chong, Lorinda, Chung, Jennie, T Clarke, M Kari Connolly, Melissa, Costner, Megan, Curran, Lyubomir, Dourmishev, Lisa, A Drage, Alisa, N Femia, Anthony, P Fernandez, Nicole, Fett, Galen, Foulke, Andrew, G Franks Jr, Anna, Haemel, Yasuhito, Hamaguchi, Christopher, B Hansen, Sotonye, Imadojemu, Khor Jia Ker, Hee Joo Kim, Drew Jb Kurtzman, Christina, Lam, Anne, E Laumann, Julie, Lin, Jeffery, D Mailhot, Simon, J Meggitt, Robert, G Micheletti, Sei-Ichiro, Motegi, Yoshinao, Muro, Elizabeth, O'Brien, Lisa, Pappas-Taffer, Taraneh, Paravar, Parodi, Aurora, David, R Pearson, Joanie, Pinard, Sarika, Ramachandran, Lisa, G Rider, Misha, Rosenbach, Richard, D Sontheimer, Michael, Sticherling, Cristián Andrés Vera Kellet, Ruth Ann Vleugels, David, A Wetter, and Yukie, Yamaguchi

Published
2019

19. Pityriasis rubra pilaris: A study evaluating patient quality of life in 2 populations

Author

Ruth Ann Vleugels, A. Brooke Eastham, Stephanie W. Liu, Elizabeth Tkachenko, Lisa Pappas-Taffer, Cara Joyce, Alisa N. Femia, and Misha Rosenbach

Subjects
Male, medicine.medical_specialty, business.industry, Alopecia, Dermatology, Middle Aged, medicine.disease, Arthralgia, Self-Help Groups, Quality of life (healthcare), Keratoderma, Palmoplantar, Surveys and Questionnaires, Pityriasis Rubra Pilaris, medicine, Quality of Life, Humans, Pityriasis rubra pilaris, Female, business, Aged
Published
2018

21. List of Contributors

Author

Anthony Abdullah, Michael Abrouk, Tashmeeta Ahad, Imtiaz Ahmed, Anwar Al Hammadi, Caroline Allen, Amer Ali Almohssen, Wisam Alwan, Mahreen Ameen, Sadegh Amini, Bryan E. Anderson, Grant J. Anhalt, Donald J. Baker, Harini Rajgopal Bala, Julia Baltz, David Banach, Cedric C. Banfield, Robert Baran, Ajoy Bardhan, Melissa C. Barkham, Ysabel M. Bello, Emma Benton, Wilma F. Bergfeld, Eric Berkowitz, Brian Berman, Jeffrey D. Bernhard, Daniel Bernstein, John Berth-Jones, Chinmoy Bhate, Bhavnit K. Bhatia, Jonathan E. Blume, Nevianna Bordet, Catherine Borysiewicz, Gary J. Brauner, Robert T. Brodell, Marc D. Brown, Robert M. Burd, Anne E. Burdick, Niraj Butala, Jeffrey P. Callen, Ivan D. Camacho, Helena Camasmie, Daniel Caplivski, Mitchell S. Cappell, Genevieve A. Casey, Lawrence S. Chan, Loi-Yuen Chan, Jennifer K. Chen, Chen 'Mary' Chen, Nicole Yi Zhen Chiang, Anthony J. Chiaravalloti, Fiona J. Child, Anthony C. Chu, Timothy H. Clayton, Steven R. Cohen, Elizabeth A. Cooper, Susan M. Cooper, Nick Collier, Christina M. Correnti, Ian H. Coulson, M. Laurin Council, Shawn E. Cowper, Nicholas M. Craven, Daniel Creamer, Ponciano D. Cruz, Carrie Ann R. Cusack, Adam Daunton, Mark D.P. Davis, Robert S. Dawe, David P. D’Cruz, David de Berker, Danielle M. DeHoratius, Min Deng, Seemal R. Desai, Georgina Devlin, John J. DiGiovanna, Alexander Doctoroff, Roni P. Dodiuk-Gad, Dawn Z. Eichenfield, Lawrence F. Eichenfield, Drore Eisen, Ure Eke, Dirk M. Elston, Patrick O.M. Emanuel, Clinton W. Enos, Shaheen H. Ensanyat, Anna F. Falabella, Aaron S. Farberg, Lawrence S. Feigenbaum, Kristen Heins Fernandez, Nicole Fett, Andrew Y. Finlay, Bahar F. Firoz, Elnaz F. Firoz, James E. Fitzpatrick, Amy E. Flischel, Kelly A. Foley, Derek Freedman, Georgina A. Fremlin, Richard Fried, Philip Friedlander, Adam Friedman, Amy K. Forrestel, Brian S. Fuchs, Joanna E. Gach, Anjela Galan, Jaya Ganesh, Amit Garg, Lauren Geller, Carlo M. Gelmetti, Elizabeth Ghazi, Sneha Ghunawat, Leonard H. Goldberg, Mark J.D. Goodfield, Marsha L. Gordon, Asha Gowda, Daniel A. Grabell, Matthew Grant, Clive E.H. Grattan, Malcolm W. Greaves, Justin J. Green, Christopher E.M. Griffiths, Charles A. Gropper, Anna L. Grossberg, Aditya K. Gupta, Ali S. Hadi, Suhail M. Hadi, Iris A. Hagans, Bethany R. Hairston, Analisa Vincent Halpern, Caroline Halverstam, Natasha Harper, Matthew J. Harries, John Harris, Shannon Harrison, Michael M. Hatch, Adrian H.M. Heagerty, Adelaide A. Hebert, Stephen E. Helms, Camile L. Hexsel, Doris M. Hexsel, Warren R. Heymann, Elisabeth M. Higgins, Claire L. Higgins, Whitney A. High, Herbert Hönigsmann, Marcelo G. Horenstein, George J. Hruza, Andrea Hui, Ran Huo, Sally H. Ibbotson, Sherrif F. Ibrahim, Andrew Ilchyshyn, Dina Ismail, Stefania Jablonska, Heidi T. Jacobe, William D. James, Aysha Javed, Gregor B.E. Jemec, Graham A. Johnston, Stephen K. Jones, Jacqueline M. Junkins-Hopkins, Jessica Kaffenberger, Kelly R. Kane, Antonios Kanelleas, Ayşe Serap Karadağ, Laura Karas, Ruwani P. Katugampola, Bruce E. Katz, Roselyn Kellen, Murtaza Khan, Hooman Khorasani, Ellen J. Kim, Hee J. Kim, Brian Kirby, Joslyn S. Kirby, Rachel S. Klein, Kate Kleydman, Dimitra Koch, John J. Kohorst, John Y.M. Koo, Sandra A. Kopp, Neil J. Korman, Carrie Kovarik, Kenneth H. Kraemer, Bernice R. Krafchik, Karthik Krishnamurthy, Knut Kvernebo, Charlene Lam, Peter C. Lambert, James A.A. Langtry, Amir A. Larian, Cecilia A. Larocca, E. Frances Lawlor, Clifford M. Lawrence, Mark G. Lebwohl, Oscar Lebwohl, Julia S. Lehman, Tabi A. Leslie, Stuart R. Lessin, Jacob O. Levitt, Fiona M. Lewis, Maryam Liaqat, Kristina J. Liu, Michael P. Loosemore, Thomas A. Luger, Omar Lupi, Boris D. Lushniak, Calum C. Lyon, Andrea D. Maderal, Bassel H. Mahmoud, Slawomir Majewski, Richard B. Mallett, Steven M. Manders, Ranon Mann, Yasaman Mansouri, David J. Margolis, Orit Markowitz, Alexander Marsland, Agustin Martin-Clavijo, Daniela Martinez, Catalina Matiz, Marcus Maurer, Kevin McKerrow, Nekma Meah, Giuseppe Micali, Robert G. Micheletti, Leslie G. Millard, James E. Miller, Jillian W. Wong Millsop, Daniel Mimouni, Ginat W. Mirowski, Sultan A. Mirza, Sonja Molin, Adisbeth Morales-Burgos, Warwick L. Morison, Cato Mørk, Colin A. Morton, Richard J. Motley, Megan Mowbray, Eavan G. Muldoon, Anna E. Muncaster, George J. Murakawa, Jenny E. Murase, Michele E. Murdoch, Adam S. Nabatian, Mio Nakamura, Rajani Nalluri, Zeena Y. Nawas, Glen R. Needham, Glenn C. Newell, Julia Newton-Bishop, Adam V. Nguyen, Rosemary L. Nixon, Jack C. O’Brien, Stephanie Ogden, Suzanne M. Olbricht, Sally Jane O’Shea, Cindy E. Owen, Michael Pan, Lisa Pappas-Taffer, Jennifer L. Parish, Lawrence Charles Parish, Michael Payette, Gary L. Peck, Sandra Pena, Jarad Peranteau, Frederick A. Pereira, William Perkins, Clifford S. Perlis, Robert G. Phelps, Tania J. Phillips, Maureen B. Poh-Fitzpatrick, Miriam Keltz Pomeranz, Samantha R. Pop, Pierluigi Porcu, James B. Powell, Lori D. Prok, Tia M. Pyle, Surod Qazaz, Vikram Rajkomar, Rabia S. Rashid, Mehdi Rashighi, Ravi Ratnavel, Christie G. Regula, Michael Renzi, Jean Revuz, Rachel V. Reynolds, Elisabeth Richard, Gabriele Richard, Darrell S. Rigel, Wanda Sonia Robles, Megan Rogge, Alain H. Rook, Jamie R. Manning, Ted Rosen, Misha Rosenbach, David Rosenfeld, Christopher Rowland Payne, Adam I. Rubin, Courtney Rubin, Malcolm H.A. Rustin, Thomas Ruzicka, Sara Samimi, Lawrence A. Schachner, Noah Scheinfeld, Bethanee J. Schlosser, Rhonda E. Schnur, Robert A. Schwartz, Matthew J. Scorer, Bryan A. Selkin, Jamie Seymour, Christine M. Shaver, Christopher R. Shea, Neil H. Shear, Tang Ngee Shim, Hiroshi Shimizu, Julia Siegel, Elisha Singer, Maral Kibarian Skelsey, Chris Sladden, Michael Sladden, Janellen Smith, Joanne E. Smucker, Najwa Somani, Lacy L. Sommer, Mary Sommerlad, Christine Soon, Jennifer A. Sopkovich, Nicholas A. Soter, James M. Spencer, Richard C.D. Staughton, Jane C. Sterling, Cord Sunderkötter, Saleem M. Taibjee, Deborah Tamura, Eunice Tan, William Y-M. Tang, Lynsey Taylor, Bruce H. Thiers, Lucy J. Thomas, Cody R. Thornton, Anne-Marie Tobin, Rochelle R. Torgerson, Antonella Tosti, Fragkiski Tsatsou, Yukiko Tsuji-Abe, William F.G. Tucker, Stephen K. Tyring, Jeremy Udkoff, Robin H. Unger, Walter P. Unger, Sarah Utz, Martha C. Valbuena, Peter van de Kerkhof, Abby S. Van Voorhees, Ramya Vangipuram, David Veitch, Vanessa Venning, Sarah G. Versteeg, Martha Viera, Carmela C. Vittorio, Ruth Ann Vleugels, Gorav N. Wali, Joanna Wallengren, Joy Wan, Karolyn A. Wanat, Gabriele Weichert, Anja K. Weidmann, Jeffrey M. Weinberg, Victoria P. Werth, Lucile E. White, Adam H. Wiener, Jonathan K. Wilkin, Nathaniel K. Wilkin, Jason Williams, Niall Wilson, Karen Wiss, Joseph A. Witkowski, Lauren E. Wiznia, Henry K. Wong, Junie Li Chun Wong, Andrew L. Wright, Cooper C. Wriston, Benedict C. Wu, Adam Wulkan, Andrea L. Zaenglein, Irshad Zaki, Joshua A. Zeichner, Tian Hao Zhu, John J. Zone, Christos C. Zouboulis, and Torstein Zuberbeir

Published
2018
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23. Toxic Erythema of Chemotherapy

Author

Lisa Pappas-Taffer

Subjects
Chemotherapy, medicine.medical_specialty, integumentary system, business.industry, medicine.medical_treatment, Toxic erythema, Neutrophilic eccrine hidradenitis, Medicine, Cytotoxic chemotherapy, business, medicine.disease, Dermatology, Syringometaplasia
Abstract

Toxic erythema of chemotherapy (TEC) is an umbrella category of overlapping cutaneous reactions to cytotoxic chemotherapy agents, including: hand-foot syndrome (HFS), eccrine squamous syringometaplasia (ESS); some include neutrophilic eccrine hidradenitis (NEH) under this overarching term (the authors feel that NEH has some distinguishing features and is discussed separately).

Published
2018
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24. Parental leave in dermatology residency: Ethical considerations

Author

Jules B. Lipoff, Jenna M. Peart, Lisa Pappas-Taffer, and Rachel S. Klein

Subjects
medicine.medical_specialty, Attitude of Health Personnel, Conflict of Interest, business.industry, Policy making, Decision Making, Conflict of interest, Internship and Residency, Dermatology, Parental Leave, Pregnancy, Family medicine, Humans, Medicine, Female, Parental leave, Policy Making, business
Published
2015
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25. The Cutaneous Side Effects of Selective BRAF Inhibitors and Anti-CTLA4 Agents: the Growing Role of the Dermatologist in the Management of Patients with Metastatic Melanoma

Author

Emily Y. Chu, Lisa Pappas-Taffer, and Misha Rosenbach

Subjects
medicine.medical_specialty, integumentary system, business.industry, Melanoma, Dabrafenib, Dermatology, Vitiligo, Alopecia areata, medicine.disease, Keratosis Pilaris, Morbilliform, Seborrheic dermatitis, medicine, skin and connective tissue diseases, Vemurafenib, business, medicine.drug
Abstract

Two new drugs—vemurafenib, a selective BRAF inhibitor (BRAFi), and ipilimumab, an anti-CTLA4 monoclonal antibody—were approved by the FDA in 2011 and have demonstrated a survival benefit in the treatment of metastatic melanoma. Cutaneous side effects are common with both medication classes, occurring in up to 92 % of patients treated with BRAFis, and up to 69 % of patients treated with anti-CTLA4 therapy. Cutaneous eruptions associated with BRAFis include benign and malignant squamous and melanocytic proliferations, photosensitivity, morbilliform eruptions, diffuse keratosis pilaris, Grover’s disease, seborrheic dermatitis, panniculitis, hand-foot skin reaction, epidermal cysts, and hair changes. Dermatologic findings associated with anti-CTLA4 agents include morbilliform eruptions, hair depigmentation, vitiligo, and alopecia areata. Given the array of skin eruptions occurring in melanoma patients receiving these agents, the role of the dermatologist in monitoring and treating these patients is paramount.

Published
2013
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26. A cross-sectional survey of voriconazole prescribers: Assessing current practice and knowledge of cutaneous side effects

Author

Peter B. Chansky, Karolyn A. Wanat, Robert G. Micheletti, Misha Rosenbach, and Lisa Pappas-Taffer

Subjects
Male, medicine.medical_specialty, Antifungal Agents, Skin Neoplasms, Attitude of Health Personnel, Cross-sectional study, Dermatology, Risk Assessment, 01 natural sciences, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, 0103 physical sciences, medicine, Humans, Practice Patterns, Physicians', Intensive care medicine, Voriconazole, 010304 chemical physics, business.industry, Incidence, Prognosis, Drug Utilization, Cross-Sectional Studies, Current practice, Female, Drug Eruptions, business, medicine.drug
Published
2017
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27. Acquired port-wine stain with superimposed eczema following penetrating abdominal trauma

Author

Jamie, Langenhan, Roberto A, Novoa, and Lisa, Pappas-Taffer

Subjects
Diagnosis, Differential, Male, Adolescent, Port-Wine Stain, Anti-Inflammatory Agents, Eczema, Humans, Abdominal Injuries, Wounds, Stab, Administration, Cutaneous, Triamcinolone
Abstract

Port-wine stains (PWSs), or capillary malformations, are common congenital lesions, but acquired lesions rarely present in the setting of trauma. We present the case of an 18-year-old man who developed a PWS and associated localized eczema following penetrating trauma to the left abdomen. The diagnoses were confirmed on biopsy. The patient's eczema improved with topical steroids. Magnetic resonance imaging of PWSs is recommended in order to rule out deeper arteriovenous malformations. More research is needed to elucidate the connection between PWS pathophysiology and the development of eczema.

Published
2016

28. Contributors

Author

James L. Abbruzzese, Ghassan K. Abou-Alfa, Janet L. Abrahm, Jeffrey S. Abrams, Dara L. Aisner, Shaheen Alanee, Steven R. Alberts, Michelle Alonso-Basanta, Megan E. Anderson, Emmanuel S. Antonarakis, Frederick R. Appelbaum, Jonathan B. Ashman, Juliet L. Aylward, Ali A. Baaj, Arjun V. Balar, Lodovico Balducci, Nancy L. Bartlett, Qaiser Bashir, Lynda Kwon Beaupin, Al B. Benson, Ross Stuart Berkowitz, Donald A. Berry, Therese B. Bevers, John F. Boggess, Leif-Erik Bohman, Michael J. Borowitz, Jeff Boyd, Julie R. Brahmer, Joanna M. Brell, Karen Brown, Powel H. Brown, Paul A. Bunn, John C. Byrd, Dario Campana, David P. Carbone, H. Ballentine Carter, Jorge J. Castillo, Manpreet K. Chadha, Richard Champlin, Alfred E. Chang, Stephen J. Chanock, Vikash P. Chauhan, Herbert Chen, Ronald C. Chen, Nai-Kong V. Cheung, Michaele C. Christian, Paul M. Cinciripini, Michael F. Clarke, Anthony J. Cmelak, Robert E. Coleman, Jerry M. Collins, Kevin R. Coombes, Jorge Cortes, Mauro W. Costa, Anne Covey, Kenneth H. Cowan, Daniel J. Culkin, Brian G. Czito, Piero Dalerba, Josep Dalmau, Michael D'Angelica, Nancy E. Davidson, Theodore L. DeWeese, Mark Dickson, Maximilian Diehn, Subba R. Digumarthy, Angela Dispenzieri, Susan M. Domchek, Jeffrey S. Dome, John H. Donohue, James H. Doroshow, Jay F. Dorsey, Laura Doyon, Ronny Drapkin, Dan G. Duda, Linda R. Duska, Rosana Eisenberg, Mario A. Eisenberger, Janine Erler, Lola A. Fashoyin-Aje, Eric R. Fearon, Leslie A. Fecher, Joseph M. Flynn, James M. Ford, Patrick M. Forde, Arlene A. Forastiere, Laura P. Forsythe, Kelley V. Foyil, Wilbur A. Franklin, Alison G. Freifeld, Terence W. Friedlander, Debra L. Friedman, Arlan F. Fuller, Lorenzo Galluzzi, Tara C. Gangadhar, Marileila Varella Garcia, Mark C. Gebhardt, Amato J. Giaccia, Mark R. Gilbert, David Gius, John Glaspy, Ziya L. Gokaslan, Donald Peter Goldstein, Anne Kathryn Goodman, Karyn A. Goodman, Adrian Greenstein, Alexander Greenstein, Ellen R. Gritz, Thomas G. Gross, Stuart A. Grossman, Roy M. Gulick, Leonard L. Gunderson, Barrett G. Haik, John D. Hainsworth, Benjamin E. Haithcock, Christopher L. Hallemeier, Aphrothiti J. Hanrahan, Ernest T. Hawk, Jonathan E. Heinlen, Lee J. Helman, Joseph M. Herman, H. William Higgins, Alan L. Ho, Ingunn Holen, Andrew B. Hollander, Leora Horn, Scott C. Howard, Fumito Ito, Gopa Iyer, Elaine S. Jaffe, Elizabeth M. Jaffee, Rakesh K. Jain, William Jarnagin, Dawn E. Jaroszewski, Aminah Jatoi, Juan C. Jaume, Anuja Jhingran, David H. Johnson, Brian Johnston, Patrick G. Johnston, Lee W. Jones, Kevin D. Judy, Lisa A. Kachnic, Deborah Y. Kamin, Hagop Kantarjian, Giorgos Karakousis, Maher Karam-Hage, Zeynel A. Karcioglu, Norbert Kased, Michael B. Kastan, Stuart Katz, Eric Kauffman, Daniel R. Kaul, Ronan Kelly, Nancy Kemeny, Thomas W. Kensler, Erin E. Kent, Oliver Kepp, Joshua E. Kilgore, Ellen Kim, Katherine N. Kimmelshue, Lawrence Kleinberg, Boris Kobrinsky, Guido Kroemer, Shivaani Kummar, Daniel A. Laheru, Paul F. Lambert, Janessa Laskin, Mark Lawler, Jack Lee, John Y.K. Lee, Kachiu Lee, Nancy Y. Lee, Susanna I. Lee, Renato Lenzi, Allen S. Lichter, Allan Lipton, Charles L. Loprinzi, Paula Loughlin, Maeve Lowery, Sam J. Lubner, Emmy Ludwig, Robert A. Lustig, Mitchell Machtay, Lukasz Macyszyn, David M. Mahvi, Amit Maity, Robert G. Maki, Marcos Malumbres, John C. Mansour, Pierre P. Massion, Karen Colbert Maresso, Lauren A. Mauro, R. Samuel Mayer, Haggi Mazeh, Beryl McCormick, Charles J. McDonald, Steven Meranze, Chris J. Miller, Matthew I. Milowsky, Bruce Minsky, Margaret Mooney, Mark Morgan, A. Ross Morton, Anthony J. Murgo, Lida Nabati, William G. Nelson, Suzanne Nesbit, John E. Niederhuber, Ariela Noy, Tracey O'Connor, Kenneth Offit, Mihaela Onciu, Eileen M. O'Reilly, Elaine A. Ostrander, Joel Palefsky, Lisa Pappas-Taffer, Drew Pardoll, Jae H. Park, Peter C. Phillips, Roberto Pili, Peter A. Pinto, Miriam D. Post, Amy A. Pruitt, Ching-Hon Pui, Joe Bill Putnam, Christiane Querfeld, Martin N. Raber, Vance Rabius, Soroush Rais-Bahrami, S. Vincent Rajkumar, R. Lor Randall, Erinn B. Rankin, Nadeem Riaz, R. Taylor Ripley, Tina Rizack, Clifford G. Robinson, Jason D. Robinson, Leslie Robinson-Bostom, Carlos Rodriguez-Galindo, Ronald Rodriguez, Paul B. Romesser, Mark J. Roschewski, Steven T. Rosen, Myrna R. Rosenfeld, Nadia Rosenthal, Julia H. Rowland, James L. Rubenstein, Paul G. Rubinstein, Valerie W. Rusch, Anthony H. Russell, Charles J. Ryan, Virgilio Sacchini, Manuel Salto-Tellez, John T. Sandlund, Victor M. Santana, David F. Schneider, Kasmintan A. Schrader, Eric C. Schreiber, Lynn M. Schuchter, Daniel M. Sciubba, Michael V. Seiden, Ravi Sharaf, Neelesh Sharma, Karen L. Sherman, Jinru Shia, Kostandinos Sideras, Elin R. Sigurdson, Eric J. Small, Angela Smith, Penny K. Sneed, Stephen N. Snow, David B. Solit, James L. Speyer, Vladimir Spiegelman, Dempsey S. Springfield, Sheri L. Spunt, David P. Steensma, Elizabeth Stier, Thomas E. Stinchcombe, Richard M. Stone, Steven Kent Stranne, Michael B. Streiff, Paul T. Strickland, Bill Sugden, Martin S. Tallman, James E. Talmadge, Ayalew Tefferi, Joyce M.C. Teng, Joel E. Tepper, Kensei Tobinai, Joseph E. Tomaszewski, Frank Torti, Donald L. Trump, Kunihiro Tsukasaki, Sandra Van Schaeybroeck, Erin Vanness, Gauri R. Varadhachary, James Vardiman, Robert Vonderheide, Richard L. Wahl, Jean S. Wang, Toshiki Watanabe, Irving L. Weissman, Jeffrey D. White, Richard Wilson, Wyndham H. Wilson, Antonio C. Wolff, Richard J. Wong, Gary S. Wood, George Xu, Yaohui Gloria Xu, Stephen Yang, John Yee, Shlomit Yust-Katz, Timothy M. Zagar, Amer M. Zeidan, Elaine M. Zeman, Longzhen Zhang, Haoyi Zheng, and James A. Zwiebel

Published
2014
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29. Dermatologic Toxicities of Anticancer Therapy

Author

Lisa Pappas-Taffer, H. William Higgins, Kachiu Lee, Charles J. McDonald, and Leslie Robinson-Bostom

Subjects
Radiation therapy, Human disease, integumentary system, business.industry, medicine.medical_treatment, Medicine, Drug dosages, Drug reaction, Pharmacology, Cytotoxic chemotherapy, Adverse effect, business
Abstract

As with other pharmacologic agents used in the treatment of human disease, the administration of anticancer drugs often results in toxic adverse effects to the skin, hair, and nails. Toxic drug reactions in the skin may occur as idiosyncratic or allergic drug reactions at ordinary therapeutic drug dosages or in a dose-dependent manner. In general, three classes of anticancer agents have unique dermatologic toxicities: cytotoxic chemotherapy, radiation therapy, and targeted anticancer therapy.

Published
2014
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31. Direct-to-Consumer Advertising of Prescription Medications: Misguided 'Autonomy' in the Information Age

Author

Lisa Pappas-Taffer and Alexander Miller

Subjects
Direct-to-consumer advertising, Information Age, Drug advertising, business.industry, media_common.quotation_subject, education, Advertising, Public relations, Management research, Medicine, Medical prescription, business, Autonomy, media_common, Mass media
Abstract

Practicing physicians can expect an average of ten specific drug requests per week from patients. Many of these requests stem from direct-to-consumer drug advertising (DTCDA) [Findlay S (2000) Prescription drugs and mass media advertising. National Institute of Health Care Management Research, Washington, DC] which has rapidly increased over the past decade. This rise significantly impacts the physician-patient encounter. This chapter highlights ethical conflicts that can arise in the era of DTCDA. The chapter reviews the basic concepts of DTCDA, evaluates current data in the literature regarding its impact on the physician-patient relationship, and provides recommendations for responding to such requests in an ethical manner.

Published
2011
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32. Sporotrichoid Eruption in a Patient After Lung Transplantation

Author

Michelle Scott, Karolyn A. Wanat, and Lisa Pappas-Taffer

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Osteomyelitis, Physical examination, Nodule (medicine), Dermatology, medicine.disease, Surgery, Subcutaneous nodule, Biopsy, medicine, Lung transplantation, medicine.symptom, Abscess, business, Myositis
Abstract

Aman inhis 50spresentedwith purple nodules onhis left arm.He hadundergone lung transplantation for end-stage chronic obstructive pulmonary disease 3months before presentation andwas takingprednisone,mycophenolatemofetil, and tacrolimus.Healsohad ahistoryof thalassemiaminor requiringblood transfusions andhad most recently received a transfusion 1 week before our evaluation. The day after his transfusion, he noted swelling at the intravenous catheter insertion site and subsequently developed a painful nodule.Over thenextweek,hedevelopedascendingerythemawithmultiple tender nodules extending from his left dorsal hand to his upper arm. He denied fevers,malaise, and other systemic symptoms. Physical examination revealed a purple, pustular nodule on the left dorsal hand with a palpable, erythematous cord extending up his arm (Figure, A). He had additional purple, superficial nodules tracking along the cord with deeper subcutaneous nodules proximally (Figure, B). He had no regional lymphadenopathy. Computed tomography of the lungs showed no evidence of infection. Magnetic resonance imaging of the left arm revealed soft-tissue swelling and subcutaneous nodules but no abscess, myositis, or osteomyelitis. A punch biopsy was performed (Figure, C). What is your diagnosis?

Published
2014
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