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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]

Acne keloidalis nuchae (AKN) is a condition that involves chronic inflammation of the hair follicles on the occipital scalp and posterior neck that often progresses to keloid-like plaques. AKN has most commonly been reported to affect postpubertal males of African descent. The cause of AKN has not been definitively described; however, it is likely an inflammatory response to trauma or infection of the scalp. AKN is associated with chronic scalp folliculitis, hidradenitis suppurativa, folliculitis decalvans, acne mechanica, keratosis follicularis spinulosa decalvans, cutis verticis gyrata, metabolic syndrome, acanthosis nigricans, and hypothyroidism. Treatment for AKN begins with topicals, antibiotics, and intralesional steroid injections. Refractory cases are treated with laser and surgery. Isotretinoin, cryotherapy, phototherapy, electrosection, and radiotherapy have also been effective in treating AKN but are less commonly used. In this review, we describe the existing understanding of AKN with a focus on comorbid conditions and available treatment options. [ABSTRACT FROM AUTHOR]

Background: Granuloma annulare (GA), a benign inflammatory skin disease, is considered a Th1‐type delayed hypersensitivity reaction. Localized GA is likely to resolve spontaneously, whereas disseminated GA (DGA) may persist for decades and can be resistant to treatment. Biologics including TNF‐α inhibitors have been proposed and utilized as salvage therapy for GA and other related diseases, interstitial granulomatous dermatitis (IGD), and actinic granuloma (AG). Methods: A systematic review was conducted using the combination of search terms "granuloma annulare," "interstitial granulomatous dermatitis," or "actinic granuloma" and either "biologics," "etanercept," "adalimumab," "infliximab," "ustekinumab," "ixekizumab," "secukinumab," "guselkumab," "golimumab," "brodalumab," "tildrakizumab," or "certolizumab" from the years 1970–2017. Results: Review of the literature revealed that 79.3% of the patients with GA, IGD, or AG who had been treated with demonstrated TNF‐α inhibitor therapy a clinical response. Conclusions: TNF‐α inhibitor therapy has been used to treat chronic GA, IGD, and AG that involved extensive body surface areas. However, the literature is limited to case series lacking control groups. Randomized, controlled trials are required to establish evidence‐based treatment of GA and related cutaneous, granulomatous conditions. [ABSTRACT FROM AUTHOR]

A 68-year-old female with a history of chronic lymphocytic leukemia (CLL) presented with an extensive purpuric patch on her left forearm. She had been treated with acalabrutinib for 5 months, and her white blood cell count had risen to 147 K/μl. Laboratory tests showed a platelet count of 152 K/μl and a hematocrit of 34.9%. A punch biopsy revealed vaso-occlusive changes and thrombotic vasculopathy. The patient's purpura resolved 6 weeks after discontinuing acalabrutinib. This case highlights the cutaneous manifestations of acalabrutinib toxicity and the need for monitoring and guidance for patients on BTK inhibitors. [Extracted from the article]

Systemic sclerosis and morphea are connective tissue diseases characterized by tightening, thickening, and hardening of the skin, leading to significant morbidity. Unfortunately, current treatment options have limited efficacy for many patients. Cutaneous manifestations of these diseases arise from excess collagen deposition and fibrosis in the skin, through pathogenic mechanisms which have yet to be extensively detailed at the causal immune and cellular levels. Research elucidating the mechanism of action of retinoic acid on collagen production in the skin and case series highlighting the success of retinoic acid on the skin manifestations of systemic sclerosis and on morphea demonstrate its promise as a treatment. Herein they will briefly review the treatment options for both systemic sclerosis and morphea, and will discuss the potential of retinoic acid as a therapy and the supporting evidence from the literature, highlighting the previously published basic science and clinical studies investigating the role of retinoic acid in the treatment of sclerotic skin diseases. [ABSTRACT FROM AUTHOR]

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous reactions that are medication-induced in most instances. While the clinical manifestations of SJS and TEN are well-defined, the optimal treatment for these disorders is not. Case reports have shown benefit with the use of a variety of agents including tumor necrosis factor-alpha inhibitors and cyclophosphamide, whereas thalidomide was associated with an increased mortality. Plasmapheresis and cyclosporine have also demonstrated efficacy anecdotally, albeit with an even smaller number of cases in the literature. Most of the reporting has focused on the use of systemic corticosteroids and intravenous immunoglobulin (IVIG) for these severe reactions. The majority of studies analyzing the use of IVIG in the treatment of SJS/TEN show a benefit, though more recent series cast doubt upon this conclusion. The results of these studies are summarized in this present review study. [ABSTRACT FROM AUTHOR]

As our understanding of the role of UV in causing skin cancer continues to expand, researchers and clinicians must continue to remain up to date on the various means by which UV exposure can be quantified. The purpose of this article was to review the current methods used to measure lifetime exposure to UV and to summarize the strengths and weaknesses of each of these approaches. Thus we include here a review of research articles that deal with questionnaire reliability and physical examination. We also review more technologically advanced techniques used to measure chronic UV exposure; these include microtopography, histology, gene studies and spectroscopy. Both the utility of using a specific measurement technique and the accuracy of particular techniques are explored. Finally, we touch upon the results of articles that link UV exposure to skin cancer and what this means for the future of UV-induced skin cancer research. [ABSTRACT FROM AUTHOR]

Dear Editor, Pityriasis rubra pilaris (PRP) is a rare papulosquamous condition that is comorbid with depression in 15-20% of cases.[[1], [3]] A survey of 85 patients with PRP showed that PRP was associated with a worse quality of life (QoL) than other common dermatological conditions.[4] Despite this, there are scarce data on the burden of and characteristics associated with psychiatric symptoms and QoL in PRP. Overall, 87-6% of participants reported PRP-related depression symptoms, 21-4% PRP-related anxiety symptoms and 7-3% PRP-related suicidal ideation over the previous 2 weeks. Characterizing disease features and other medical diagnoses in patients with pityriasis rubra pilaris. [Extracted from the article]

Primary retroperitoneal melanoma is a very rare extracutaneous presentation of melanoma. In this case report, we present a 65-year-old female with unilateral lower extremity edema secondary to occlusion of iliac vessels by a primary retroperitoneal melanoma tumor. We also review the findings in other cases previously described in the literature. [ABSTRACT FROM AUTHOR]

In this case report, we detail the case of a young adult with a recurrent case of Reactive Infectious Mucocutaneous Eruption (RIME) in the setting of Sars-COV-2 infection, the second time this has been reported in the literature. We review the more common causes of RIME, including Chlamydophila pneumoniae, metapneumovirus, parainfluenza, rhinovirus, enterovirus, and influenza; and we discuss patient characteristics in other reported cases of RIME secondary to COVID-19 and the features of recurrent RIME seen in patients reported in the literature. Our patient had the characteristic severe mucosal involvement seen with RIME, and was treated with supportive care alone and experienced rapid improvement in symptoms. [ABSTRACT FROM AUTHOR]

The article describes the cases of four patients who developed alopecia after they were treated with dupilumab for atopic dermatitis. The patients underwent scalp biopsies to determine their conditions. They were also diagnosed with sebaceous gland atrophy, apoptotic keratinocytes, and a plasma cell infiltrate in the dermis with marked spongiosis.

This article discusses the cutaneous adverse effects induced by tebentafusp, a recently approved immunotherapy agent, in patients with metastatic uveal melanoma. The study presents a case series of six patients who experienced cutaneous adverse reactions after receiving tebentafusp treatment. The most common reaction was pruritus, which was well-controlled with antihistamines in some patients but required more extensive treatment regimens in others. Severe reactions were managed with high-potency steroid wet wraps and aprepitant. The article emphasizes the need for further research on the range of adverse cutaneous reactions to tebentafusp and highlights the importance of recognizing and treating these effects. [Extracted from the article]

The article discusses the case of an 80-year-old man with a history of Immunoglobulin A (IgA) monoclonal gammopathy, who presented with a ulcerative lesion on his right knee. and was diagnosed with pyoderma gangrenosum based on negative tissue cultures, characteristic pain, and clinical appearance. Topics discussed include common presentation of pyoderma gangrenosum as inflammatory nodule or pustule that enlarges and ulcerates, and wound exacerbated by mechanical or chemical trauma.

Background: Bullous pemphigoid (BP) is a rare autoimmune blistering condition characterized by antibodies to the structural proteins BP1 and BP2 at the dermal-epidermal junction. The link between BP and malignancy remains unclear. Due to the rarity of the disease, there have been few studies with small sample sizes characterizing the association between BP and malignancy. Objectives: There were two main goals of this retrospective cohort study: (1) to look at the associated risk of malignancy in patients with BP compared to controls and (2) to compare the rates of malignancy in two separate hospitals with differing patient populations. Method: We reviewed the medical records of 99 patients diagnosed with BP observed between 2014 and 2019. 66 patients were from Keck Hospital and 33 were from Los Angeles County/University of Southern California (LAC/USC) Hospital. Each patient was age- and sex-matched to a control from the same hospital. Results: Malignancies occurred in 26 BP patients and 29 controls. 7 of the BP patients from LAC/USC Hospital (21.2%) and 19 patients from Keck Hospital (28.8%) had malignancies. Conclusions: Overall, we did not find an increased risk of malignancy in BP patients compared to controls, nor did we find a statistically differing rate of malignancy in BP patients from various socioeconomic and ethnic backgrounds. [ABSTRACT FROM AUTHOR]

Pityriasis rubra pilaris (PRP) is a rare, difficult to treat papulosquamous disorder that responds variably to retinoids and immunosuppression. Successful use of biologics for treating PRP has been described in the literature by case reports and a limited number of case series. To provide additional data, we retrospectively analyzed cases of PRP treated with biologics at our institution. We identified seven patients with a clear diagnosis of PRP treated with adalimumab, etanercept, and/or ustekinumab at our institution from January 1, 2014 to April 1, 2017. Six of seven patients had type I, adult acquired PRP, and one had type V atypical juvenile PRP. In response to tumor necrosis factor (TNF)-α inhibition, two patients had marked responses (>75% improvement in involved body surface area), while three patients failed to show any improvement on a TNF-α inhibitor. In two cases of PRP refractory to TNF-α inhibition, ustekinumab resulted in a partial response (<75% improvement) in one patient and no response in the other. Compared to other published data, our cohort was substantially more resistant to treatment with biologics, a finding which may provide valuable perspective for dermatologists managing refractory PRP in the future. [ABSTRACT FROM AUTHOR]

Pityriasis rubra pilaris represents a group of familial and acquired disorders of cornification that affect both adult and pediatric patients. Treatment options are difficult to assess through clinical trials, given the rarity of the disorder and its tendency for spontaneous remission. Case reports and case series are therefore the primary means of assessment. Because of the heterogeneity of the disease, there is no universal approach to treatment, and multiple agents may need to be trialed to achieve disease control. At present, topicals are used for most pediatric patients, though monotherapy with topicals is only effective for less severe disease. Despite concerns over their side-effect profiles, oral retinoids are generally accepted as a first-line systemic therapy. However, interleukin-17 inhibitors and ustekinumab, an interleukin-12 and interleukin-23 inhibitor, may soon become first-line systemic treatment as well, given their efficacy and relative safety in trials thus far. Ustekinumab, in particular, is emerging as a first-line agent for patients with pityriasis rubra pilaris with CARD14 gene variations. When these therapies fail, second-line and adjunctive therapies to consider include tumor necrosis factor-alpha inhibitors, methotrexate, and phototherapy. However, further investigation is necessary to assess the safety and efficacy of many of these agents in juvenile pityriasis rubra pilaris. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 67-year-old Caucasian male with acute myelogenous leukemia, nausea, and vomiting. Physical examination the patient is done which revealed cutaneous Graft-Versus-Host Disease (GVHD) and toxic epidermal necrolysis (TEN) diseases. The patient who was hematopoietic stem cell transplant recipient is treated with elafin.

Recurrence of DRESS syndrome is poorly characterized, and dermatologists must be prepared to predict, identify, and manage patients after treatment of the initial presentation. In this study, a primary literature search was conducted using PubMed, capturing all articles recording cases of DRESS syndrome recurrence. Forty-two articles were included for review comprising a total of 60 patients. The average age of patients was 46.3 years and time to recurrence was 123 days. Recurrent episodes presented more frequently with a higher fever and eosinophil absolute peak. Relapse was most often attributed to the introduction of a new medication (n = 18). Of the 17 cases in which outcome data were available, the survival rate of those experiencing recurrence was 71%. Viral reactivation with HHV-6 and organ involvement of the liver were frequently recorded complications. In essence, viral reactivation, severe internal organ involvement, and hematological abnormalities all portended a poorer prognosis in those experiencing DRESS syndrome recurrence. An adequate course of treatment should be maintained until clinical and laboratory parameters normalize, with a slow taper to minimize the likelihood of relapse in those most at risk. [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]

In this case study, we present a safe and novel treatment for a patient with soft tissue hand disability caused by severe and chronic lupus and cutis laxa ( CL). This patient was a woman in her 50s with a 20-year history of systemic lupus erythematous ( SLE) and multiple sclerosis who developed hand disability because of the drastic loss of firmness in her soft tissue, extending from the dermis down to the ligaments. The likely cause was CL with SLE synovitis, exacerbated by corticosteroid tapering. Fractional photothermolysis ( FP) LASER ( Fraxel DUAL 1550/1927; Solta Medical) therapy profoundly alleviated her joint locking in addition to improving the firmness of the overlying skin to reverse her hand disability. This case illustrates a novel approach to CL hand treatment and the profound impact the treatment had on the patient's disabled hand. FP therapy is quick and safe, and its medical application to skin and joints should be further explored. [ABSTRACT FROM AUTHOR]

Drug reaction and eosinophilia with systemic symptoms (DRESS), also known as drug‐induced hypersensitivity syndrome (DIHS), shares features with hemophagocytic lymphohistiocytosis (HLH), most notably fever, rash, and internal organ involvement. However, there is increasing recognition of drug‐induced (secondary) HLH and biopsy‐proven hemophagocytosis in DRESS, suggesting that HLH and DRESS not only overlap but also may be diseases on the same spectrum of immune dysfunction. To characterize existing literature on HLH/DRESS overlap, we queried the PubMed/MEDLINE database for 23 cases of HLH‐DRESS codiagnosis. Average time‐to‐onset of rash after exposure to inciting drug was 2.7 weeks. Fourteen cases (61%) clinically worsened despite initial therapy, prompting a workup with diagnosis of HLH on average 2.3 weeks after diagnosing DRESS. Nine cases met HLH diagnostic criteria and had a RegiSCAR score ≥4. Nine cases met one set of criteria with a presentation suggestive of the other. Five cases met neither criteria. A patient presenting with fever, generalized rash, bicytopenia, and internal organ involvement after drug exposure was most predictive of meeting diagnostic criteria for both HLH and DRESS. Treatment was highly variable, although most initiated systemic corticosteroids with/without IVIG, plasmapheresis, or etoposide. Patients with poor outcomes in this review were treated using steroid monotherapy and had viral reactivation. Dermatologists should consider the possibility of HLH in any patient presenting with fever, rash, internal organ involvement, and cytopenia. Additional studies will be necessary to further characterize HLH and DRESS overlap and determine optimal management. [ABSTRACT FROM AUTHOR]

Coccidioides immitis (and Coccidioides posadasii) are endemic fungi of the southwestern United States and northern Mexico. Uncomplicated, symptomatic Coccidioides infection most commonly causes a self-limited pneumonia; however, immunocompromised patients can manifest severe pneumonia with an additional risk of dissemination to bone, joints, soft tissues, and in the most severe cases, the central nervous system. In 2020, clinicians were challenged with a previously unseen volume of acute respiratory complaints as a result of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. We present a patient with respiratory failure secondary to SARS-CoV-2 who experienced prolonged hypoxia and neurologic deterioration, eventually leading to a diagnosis of occult disseminated coccidiomycosis involving meningitis, miliary-pattern pneumonia, and cutaneous lesions. [ABSTRACT FROM AUTHOR]

Tyrosine kinase inhibitors are a class of targeted anticancer drugs that inhibit cancer cell proliferation by inactivating proteins involved in signal transduction cascades. Various cutaneous adverse events have been observed after tyrosine kinase inhibitor administration, including Sweet syndrome. We queried the PubMed database to identify 14 cases of Sweet syndrome thought to be secondary to tyrosine kinase inhibitors. Tyrosine kinase inhibitor‐induced Sweet syndrome had a median of 2 months latency following drug administration. All cases but one had morphologic features classic for Sweet syndrome (erythematous and tender papules, plaques, or nodules). All cases also had classic histopathologic findings (dermal neutrophilic infiltrate without vasculitis or necrosis). Using diagnostic criteria for drug‐induced Sweet syndrome and the Naranjo Drug Reaction Probability Scale for a drug‐induced cutaneous eruption, we found that six cases favored a drug‐induced etiology over malignancy, two cases favored a malignancy‐associated Sweet syndrome, and the remaining eight met drug‐induced Sweet syndrome criteria but had low Naranjo scores. Nine cases resulted in medication discontinuation, while five cases continued anticancer therapy and were treated only with corticosteroids with quick resolution of skin lesions. Dermatologists should be aware of this adverse cutaneous reaction to tyrosine kinase inhibitors and should treat on a case‐by‐case basis, though limited evidence in this review suggests that oncologic therapy may safely be continued with prompt corticosteroid treatment. [ABSTRACT FROM AUTHOR]

Checkpoint inhibitors are a new class of drugs that enhance the immune system's intrinsic ability to destroy tumor cells by blocking signaling through the programmed cell death (PD‐1) receptor, its ligand (PD‐L1), and the cytotoxic T‐lymphocyte‐associated antigen 4 (CTLA‐4). The resulting increase in immunologic activity is responsible for a variety of adverse cutaneous reactions, which sometimes include neutrophilic dermatoses. We queried the PubMed database for existing cases of checkpoint inhibitors causing neutrophilic dermatoses. The literature search identified four cases of Sweet syndrome, four cases of pustular eruptions, two cases of pyoderma gangrenosum, and one case of bullous lupus erythematosus secondary to checkpoint inhibitors. All neutrophilic dermatoses were treated with topical or systemic steroids and most (9 of 11) completely resolved. Dermatologists should be aware of these rare, adverse cutaneous reactions to checkpoint inhibitors and how to approach their treatment, especially as their use increases. [ABSTRACT FROM AUTHOR]

The use of checkpoint inhibitors for treatment of advanced malignancies is increasing. Rashes, pruritus, and more rarely, reactions resembling Stevens‐Johnsons syndrome (SJS) or toxic epidermal necrolysis (TEN) may occur secondary to checkpoint inhibitors. To characterize existing literature on these reports, we queried the PubMed/MEDLINE database for cases of SJS or TEN associated with checkpoint inhibitors. We identified 18 cases of SJS or TEN‐like reactions to checkpoint inhibitors in the literature. There were 12 cases of SJS‐like rashes with median time to onset of 5.6 weeks (average of 8.9 weeks), of which five were delayed to week 8 or later from checkpoint inhibitor initiation. The five TEN‐like reactions had a median time to onset of 4 weeks (average of 5.38 weeks), of which two were delayed to week 6 or later. SJS/TEN‐like reactions to nivolumab (seven cases) had median onset time of 3 weeks, whereas five cases secondary to pembrolizumab had median onset time of 11 weeks. Seven cases in this study described prodromal rashes, which varied from localized papular rashes to generalized morbilliform rashes, prior to evolution into SJS or TEN‐like patterns. SJS‐like patterns generally improved well on systemic treatment/supportive care and no cases of death were identified, but mortality occurred in three of five patients with TEN‐like reactions. Dermatologists should consider the possibility for unique features of SJS/TEN in response to checkpoint inhibitors. Additional studies will be necessary to further characterize SJS/TEN‐like eruptions on checkpoint inhibitors and determine the optimal management of these cases. [ABSTRACT FROM AUTHOR]

The article presents case study of a 34-year-old male and 59 year-old female who were diagnosed with dermatomyositis (DM) which was been treated with low-dose naltrexone. It mentions that DM involves systemic corticosteroids and other steroid-sparing agents, including methotrexate, mycophenolate mofetil, and intravenous immunoglobulin (IVIG).

HIV infection and rheumatic skin diseases (RSSs) are both states of immune dysregulation. HIV infection, antiretroviral therapy (ART), and immune reconstitution inflammatory syndrome are factors that may favour or prevent the development of RSS in people living with HIV/AIDS (PLWHA).1,2 However, the population-level data are scarce. Although the association between other systemic diseases and HIV/AIDS is well established,4,5 there is a lack of large studies investigating RSSs in HIV/AIDS. [Extracted from the article]

Abstract: A 10‐year‐old girl with a history of blastic plasmacytoid dendritic cell neoplasm, a rare malignancy in children, presented with recurrent skin eruptions beginning while on maintenance chemotherapy, including mildly pruritic skin‐colored plaques, tender indurated nodules, and violaceous bound‐down plaques. This case highlights an unusual presentation of relapsed blastic plasmacytoid dendritic cell neoplasm on chemotherapy, with skin lesions providing important clues to the progression of systemic disease. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 36-year-old female with necrotic plaque on the calf and thigh following a liver transplant at age 25 for cryptogenic cirrhosis, leading to end stage renal disease. Topics include why the patient was diagnosed with polyarteritis nodosa (PAN), the criteria for diagnosing PAN set by the American College of Rheumatology, and a suggestion that the patient's initial cirrhotic liver could have been the first manifestation of PAN.

Large difficult to heal ulcers of various etiologies carry a high morbidity and mortality rate. Becaplermin is a recombinant platelet-derived growth factor approved for treatment of diabetic ulcers. In this two-case series, we report the use of becaplermin in the treatment of ulcers due to (i) calciphylaxis, an often fatal condition resulting from systemic calcification and thrombosis of vessels and (ii) pyoderma gangrenosum (PG), a neutrophilic dermatosis. We also report that topical collagenase worsened PG ulcers, consistent with pathergy. Becaplermin can be used to help treat ulcers resulting from calciphylaxis and PG. These encouraging results lend support for the utilization of becaplermin in the treatment of nondiabetic chronic ulcers of various etiologies. [ABSTRACT FROM AUTHOR]

Cellular neurothekeoma is a rare cutaneous tumor that occurs more frequently in women. A 68-year-old female with a history of left nasal alar basal cell carcinoma and Guillain-Barré syndrome presented to the clinic with a 3-mm firm skin-colored papule with scattered telangiectasias. Histopathologic examination with immunochemistry of the lesion was consistent with cellular neurothekeoma. It stained positive for microphthalmia transcription factor and NKI-C3 and negative for HMB-45 and S-100. The lesion was excised with 3-mm margins, and no recurrence was noted within 1 year of follow-up. We present a case of cellular neurothekeoma in a patient with a history of Guillain-Barré syndrome as well as a review of the literature. Our case report is unique in that no prior association has been found in the literature between cellular neurothekeoma and Guillain-Barré syndrome. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Pityriasis rubra pilaris (PRP) is a papulosquamous disorder that sometimes fails to respond favorably to oral retinoids or methotrexate (Klein, Landthaler, & Karrer, [2]). For the most treatment-refractory patients who reported attempting three different classes of biologics (TNF- , IL-12/23, and IL-17 blockade), only one of eight patients completely failed to show any improvement. [Extracted from the article]

Toxic shock syndrome (TSS) can sometimes mimic Steven Johnsons syndrome/toxic epidermal necrolysis (SJS/TEN). Tumor necrosis factor (TNF) alpha is thought to play a role in the pathogenesis of both TSS and SJS/TEN. Etanercept, a TNF‐alpha inhibitor has been recently shown to treat and decrease mortality of SJS/TEN. We report a 51‐year‐old female with history of SJS presenting with painful skin and bullae 2 days following cystoscopy with botulinum toxin injection into the bladder. Due to initial concern for SJS/TEN, the patient was treated with 50 mg of subcutaneous etanercept. Punch biopsies were not consistent with SJS, and the patient fulfilled five out of five criteria for a confirmed case of TSS. The patient ultimately had a favorable outcome despite etanercept treatment. Ultimately, TNF‐alpha antagonists are an emerging therapy to treat SJS/TEN, and are unlikely to worsen TSS prognosis. Given that etanercept can be used to successfully treat SJS/TEN and TNF‐alpha levels are elevated in TSS, if a dermatologist chooses to treat TEN with etanercept, consideration of TSS on the differential should not necessarily exclude etanercept as a reasonable treatment option. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 52-year-old, with rheumatoid arthritis associated-interstitial lung disease (RA-ILD), who was presented with fever post-bilateral lung transplant with treatment included rituximab, plasmapheresis and antithymocyte globulin.

The article describes the case of woman with breast cancer that presented with a purpuric plaque over her neck diagnosed as telangiectatic metastatic breast carcinoma (TMBC). It presents the findings from the histopathologic examination and immunohistochemistry. The percentages of patients with cases of skin metastases from breast carcinoma are offered. Also discusses is the differentiation of TMBC from other cutaneous lesions.