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Background: Dermatologic toxicity is a very common immune-related adverse event (irAE) for patients with melanoma who are receiving immune checkpoint inhibitor therapy (ICI). Concurrent skin infection, such as in the case of pityriasis versicolor reported here, can mimic and/or exacerbate dermatologic toxicity from irAE.Case Presentation: A 58-year-old Caucasian man with a history of pityriasis versicolor infection and metastatic melanoma received ICI therapy. He developed progressively worsening pruritic maculopapular lesions 22 weeks into his treatment that ultimately covered 40% of his body. He was diagnosed with dermatologic toxicity due to ICI therapy with concurrent pityriasis versicolor. He was initially started on topical steroid and topical antifungal cream but achieved minimum improvement. His treatment was then escalated to oral prednisone, but it only achieved modest control of his dermatitis. All subsequent attempts to wean him from oral prednisone resulted in worsening of his dermatitis. Eventually he was started on oral fluconazole in combination with prednisone, which led to rapid resolution of his dermatitis.Conclusion: We report a case of dermatological toxicity due to an irAE with concurrent pityriasis versicolor. The steroid treatment for irAE was likely exacerbating the underlying fungal infection, and the fungal infection was in term mimicking the symptoms of irAE. This patient's severe dermatitis was only brought under control after receiving a more potent antifungal therapy in combination with a steroid. It is vital to look beyond the irAE when managing dermatitis in patients receiving ICI therapy. [ABSTRACT FROM AUTHOR]

The article discusses a case study of a 7-week-old girl child with congenital syphilis that mimicked neonatal lupus. It is said that syphilis' clinical and histologic patterns can mimic other dermatoses. Given their overlapping clinical, histologic and serologic features, there is a potential to misdiagnose congenital syphilis as neonatal lupus erythematosus.

Onychocytic matricoma is a newly described matrical tumor of the nail unit that clinically presents with localized thickening of the nail plate and melanonychia and represents a benign acanthoma of onychocytes. Onychocytic matricoma can be classified according to its histopathologic type (acanthotic, papillomatous or keratogenous with retarded maturation) and pigmentation (pigmented, melanocytic or non-pigmented). However, there are no published reports of non-pigmented onychocytic matricoma. We report a case of hypopigmented onychocytic matricoma that presented with a thickened nail plate, xanthonychia and histopathologic features of acanthosis, prekeratogenous zone and keratogenous zone cells forming pseudosquamous eddies, and minimal pigmentation with Fontana staining. We also provide detailed clinical, intraoperative and histopathologic correlations of this rare tumor. Both clinicians and dermatopathologists should be aware that onychocytic matricoma can present with xanthonychia, thickening of the nail plate and mimic an onychomatricoma. [ABSTRACT FROM AUTHOR]

Background: Following the initial diagnosis of a marginal zone or follicle center lymphoma on skin biopsy, patients undergo staging to determine the extent of disease. Objective: We sought to characterize the frequency that these patients were found to have a systemic nodal disease upon work-up as well as the impact of imaging on disease management. Methods: We conducted a retrospective chart review of patients presenting with a working diagnosis of PCMZL or PCFCL treated at The Ohio State University from 1990 to 2022. Data collected included: patient history, progress notes, virtual encounters, laboratory results, presentation features, imaging, and pathology. Biomarkers included ANA, SSA/SSB, BCL6 and H. Pylori labs, bone marrow biopsies, positive imaging, and need of systemic medication and mortality. Results: 71 patients with suspected PCMZL and PCFCL were identified. 66 of 71 patients underwent imaging. Of this group, 12 patients (9 with suspected PCFCL and 3 with suspected PCMZL) demonstrated lymphadenopathy on imaging. Of these 12 patients, 5 underwent biopsy of suspected lymph nodes, and 3 had biopsy-proven nodal involvement and received systemic therapy. Of the remaining 7 patients with evidence of lymphadenopathy on imaging, 4 were thought to have reactive lymph nodes, and 3 were treated empirically with systemic chemotherapy due to the extent or progression of their disease. Of patients with imaging negative for lymphadenopathy, 3 of 52 (5.8%) patients with received systemic treatment, while 49 of 52 patients (94.2%) received localized treatment. Limitations: Most of the relationships between this data were correlational and patients selected for this study were limited to a single institution. Conclusion: Prospective study of the role of imaging without subsequent lymph biopsy to direct treatment decisions is warranted. [ABSTRACT FROM AUTHOR]

Allogeneic hematopoietic stem cell transplantation (allo‐HSCT) is a potentially curative treatment option for patients with refractory cutaneous T‐cell lymphoma (CTCL) through replacement of the bone marrow responsible for lymphoma cells and possibly induction of a graft‐versus‐lymphoma effect. However, allo‐HSCT is not always curative; relapse of CTCL occurs in about half of patients post‐transplant. Treatment of relapsed CTCL after allo‐HSCT is challenging because post‐transplant patients are at high risk of graft‐versus‐host disease, and this condition may be precipitated or exacerbated by standard CTCL therapies. The benefit of each potential therapy must therefore be weighed against its risk of graft versus host disease (GVHD). In this article, we review the management of relapsed CTCL after allo‐HSCT. We begin with an exemplative patient whose relapsed Sezary syndrome was successfully treated without development of GVHD. We also report high‐throughput T‐cell receptor sequencing data obtained during the patient's disease relapse and remission. We then review general guidelines for management of relapsed CTCL and summarize all reported cases and outcomes of relapsed CTCL after transplant. We conclude by reviewing the current CTCL therapies and their risk of GVHD. [ABSTRACT FROM AUTHOR]

Basal cell carcinoma (BCC) is highly curable by surgical excision or radiation. In rare cases, BCC can be locally destructive or difficult to surgically remove. Hedgehog inhibition (HHI) with vismodegib or sonidegib induces a 50–60% response rate. Long-term toxicity includes muscle spasms and weight loss leading to dose decreases. This retrospective chart review also investigates the impact of CoQ10 and calcium supplementation in patients treated with HHI drugs at a single academic medical center from 2012 to 2022. We reviewed the charts of adult patients diagnosed with locally advanced or metastatic BCC treated with vismodegib or sonidegib primarily for progression-free survival (PFS). Secondary objectives included overall survival, BCC-specific survival, time to and reasons for discontinuation, overall response rate, safety and tolerability, use of CoQ10 and calcium supplements, and insurance coverage. Of 55 patients assessable for outcome, 34 (61.8%) had an overall clinical benefit, with 25 (45.4%) having a complete response and 9 (16.3%) a partial response. Stable disease was seen in 14 (25.4%) and 7 (12.7%) progressed. Of the 34 patients who responded to treatment, 9 recurred. Patients who were rechallenged with HHI could respond again. The median overall BCC-specific survival rate at 5 years is 89%. Dose reductions or discontinuations for vismodegib and sonidegib occurred in 59% versus 24% of cases, or 30% versus 9% of cases, respectively. With CoQ10 and calcium supplementation, only 17% required a dose reduction versus 42% without. HHI is highly effective for treating advanced BCC but may require dosing decreases. Sonidegib was better tolerated than vismodegib. CoQ10 and calcium supplementation can effectively prevent muscle spasms. [ABSTRACT FROM AUTHOR]

Of the 22 patients without preexisting skin disease, the most common diagnoses were drug eruption ( I n i = 11), contact dermatitis ( I n i = 2), and Sezary syndrome ( I n i = 2). Dear Editor, Erythroderma is characterized by erythema of greater than 80-90% of the skin surface.1,2 While preexisting dermatoses are the most commonly implicated causes, other etiologies include infections, malignancies, and drug reactions.1,3 Unclassified cases are deemed idiopathic.3 In this cross-sectional study, we evaluated the etiologies, hospital courses, and outcomes of patients with erythroderma. In conclusion, our study found that preexisting dermatoses, most often psoriasis, were responsible for erythroderma in about half of patients. [Extracted from the article]

Background: Current understanding of the etiology, natural history, and outcomes of acute generalized exanthematous pustulosis (AGEP) has been limited, with most available studies consisting of small or heterogenous cohorts. Objectives: The aim of this study was to further characterize associated factors and disease outcomes of AGEP. Methods: A cross-sectional study design was employed with formal inclusion and causality criteria. Patients were identified from an inpatient database at an academic medical center, including 65 patients with AGEP and a control group of 61 patients with non-severe cutaneous adverse reactions. Results: Increased age and body mass index (BMI) were associated with higher risk of AGEP (p < 0.001). Length of stay was longer for both the overall AGEP cohort (13.1 days) and a subcohort with a primary discharge diagnosis of AGEP (9.7 days) compared with the control group (3.6 days) [p < 0.001]. Patients with AGEP were more likely to be discharged to a long-term care facility compared with control patients (p < 0.001). Conclusions: AGEP was associated with longer length of hospitalization, higher rates of discharge to long-term care facilities, and higher mortality compared with non-severe cutaneous adverse drug reaction (SCAR) medication reactions. Future research should examine the association between morbid obesity and this particular drug reaction, and the possibility of decreasing hospitalization length given the relatively low risk of mortality among patients with AGEP. [ABSTRACT FROM AUTHOR]

Dear Editor, Up to one-third of hospitalized patients have significant skin findings.[1] While inpatient dermatology consultations allow for efficient, accurate diagnosis and treatment,[1] access to these services is often limited outside of academic institutions.[2] Even when dermatology consultations are available, suspected skin cancers are commonly deferred for outpatient evaluation and management. We found 82 consults placed to evaluate these incidental lesions from 2011 to 2017, with 41 involving inpatient biopsies and 22 referrals for outpatient biopsy; 19 cases were excluded as the biopsy or need for biopsy was declined after evaluation (Table 1). Nine out of 16 patients who received outpatient biopsies of malignant lesions initiated treatment compared to 26 out of 29 patients who had inpatient biopsies (Table 2). [Extracted from the article]

Cellulitis is a common dermatologic indication for hospitalization in the United States, resulting in approximately 650,000 admissions and costing $3.7 billion annually.1 However, the cellulitis diagnosis may be overused in the inpatient setting due to a lack of readily available dermatologic expertise.2 It is important to identify and understand this possible phenomenon because misdiagnosed cellulitis treated with unnecessary antibiotics can lead to kidney injury, nosocomial infections, and drug reactions.3 To this end, we assessed whether the availability of dermatology training programs was associated with the number of cellulitis diagnoses rendered at a given hospital. As exposure to inpatient consultations is a required part of ACGME-accredited dermatology residency programs, we aimed to compare hospitals in Ohio where dermatologic consultations may be informal or unavailable to those with dermatologic residency programs. Impact of dermatology and teledermatology consultations for patients admitted with cellulitis: a pilot study. [Extracted from the article]