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SOC Manuscripts

Psoriasiform Pemphigus Foliaceus in an African American Female: An Important Clinical Manifestation

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Source: J Drugs Dermatol. 2018;17(4):471-473

Evan Austin BS, Jillian W. Millsop MD, Haines Ely MD, Jared Jagdeo MD MS and Joshua M. Schulman MD

A 50-year-old African-American woman presented to the dermatology clinic with a pruritic eruption of 3 years’ duration. On clinical examination, the patient had well-demarcated, pink, atrophic plaques and superficial erosions over the inframammary folds and mid-chest. She also had well-demarcated, hyperpigmented, hyperkeratotic scaly plaques over the abdomen, suprapubic region, elbows, knees, and back with sporadic small superficial blisters. A punch biopsy of the right abdomen was performed and revealed psoriasiform epidermal hyperplasia, focal parakeratosis, and acantholysis throughout the superficial spinous and granular layers. Only a sparse inflammatory infiltrate was present in the underlying dermis. Clinical and histological findings supported the diagnosis of pemphigus foliaceus (PF), but psoriasis was included in the differential diagnosis due to the presence of discrete plaques with an erythematous border. We hypothesize that patients with psoriasiform presentations of PF may be misdiagnosed with plaque psoriasis. It is important to distinguish between PF and psoriasis as there is evidence that ultraviolet light, a common treatment for psoriasis, may exacerbate PF. We document and highlight this atypical psoriasiform presentation of PF in a patient with skin of color to raise awareness and improve diagnosis and outcomes.

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alopecia lichen Planus pigmentosus

Frontal Fibrosing Alopecia and Concomitant Lichen Planus Pigmentosus: A Case Series of Seven African American Women

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The association of frontal fibrosing alopecia (FFA) and lichen planus pigmentosus (LPPigm) is rare. Prior reports suggest that FFA and LPPigm are on the same spectrum of disease, and a diagnosis of LPPigm may predict the future development of FFA. We aim to further characterize the association between FFA and LPPigm by reviewing the clinical cases of seven African American women. Seven patients with FFA were diagnosed clinically by recession of frontotemporal hairline and confirmed by histopathologic examination showing lymphocyte-mediated cicatricial alopecia. LPPigm was diagnosed by clinical evaluation alone based on the characteristic morphology, color, and distribution of the lesions. It is difficult to distinguish whether halted progression of FFA was due to the success of the treatment regimen or spontaneous stabilization of disease over time. Our case series supports the theory that FFA and LPPigm likely exist on the same spectrum of disease. Our observations demonstrate a likely positive correlation between FFA and LPPigm.

Prior studies suggested that LPPigm may be a herald sign for FFA, predicting the future onset of frontotemporal hair loss, though there has been at least one reported case of an individual simultaneously developing FFA and LPPigm. Our results do not support the hypothesis that LPPigm is a herald sign for FFA, but do support the theory that FFA and LPPigm likely exist on the same disease spectrum. Our findings parallel that of another case series which noted that there was no obvious trend pertaining to order of FFA and LPPigm development (Figure 1). A patient with one variant of lichen planus, either FFA or LPPigm, is likely at a higher risk to develop another variant of lichen planus. FFA patients with Fitzpatrick skin type III-V may be more likely to develop LPPigm because this condition commonly presents in darker skin types. Although few studies have previously reported on FFA with concomitant LPPigm, none of these studies specifically focused on the manifestation of this phenomenon in African American women. This is particularly worth investigating, as LPPigm, when it occurs, has a strong predilection for darker skin types, and FFA is most commonly found in women.

Source: J Drugs Dermatol. 2018;17(4):397-400.

Laura N. Uwakwe MD, Leah A. Cardwell MD, Emily H. Dothard MD, Bernice I. Baroudi BS, and Amy J. McMichael MD

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Successful Treatment of Keloid With Fractionated Carbon Dioxide (CO2) Laser and Laser-Assisted Drug Delivery of Triamcinolone Acetonide Ointment in an African-American Man

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Source: J Drugs Dermatol. 2017;16(9):925-927.

Ekaterina Kraeva MD, Derek Ho MD, and Jared Jagdeo MD MS

Keloids are fibrous growths that occur as a result of abnormal response to dermal injury. Keloids are cosmetically disfiguring and may impair function, often resulting in decreased patient quality-of-life. Treatment of keloids remains challenging, and rate of recurrence is high. We present a case of a 39-year-old African-American man (Fitzpatrick VI) with a 10-year history of keloid, who was successfully treated with eight sessions of fractionated carbon dioxide (CO2) laser immediately followed by laser-assisted drug delivery (LADD) of topical triamcinolone acetonide (TAC) ointment and review the medical literature on fractionated CO2 laser treatment of keloids. To the best of our knowledge, this is the first report of successful treatment of a keloid using combination therapy of fractionated CO2 laser and LADD with topical TAC ointment in an African-American man (Fitzpatrick VI) with excellent cosmetic results sustained at 22 months post-treatment. We believe that this combination treatment modality may be safe and efficacious for keloids in skin of color (Fitzpatrick IV-VI) and other patients. This case highlights the ability of laser surgeons to safely use fractionated CO2 lasers in patients of all skin colors.

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Microneedling in All Skin Types: A Review

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Source: J Drugs Dermatol. 2017;16(4):308-314.

Lauren Meshkov Bonati MD, Gorana Kuka Epstein MD, and Tamara Lazic Strugar MD

Microneedling procedures are growing in popularity for a wide variety of skin conditions. This paper comprehensively reviews the medical literature regarding skin needling efficacy and safety in all skin types and in multiple dermatologic conditions. A PubMed literature search was conducted in all languages without restriction and bibliographies of relevant articles reviewed. Search terms included: “microneedling,” “percutaneous collagen induction,” “needling,” “skin needling,” and “dermaroller.” Microneedling is most commonly used for acne scars and cosmetic rejuvenation, however, treatment benefit has also been seen in varicella scars, burn scars, keloids, acne, alopecia, and periorbital melanosis, and has improved flap and graft survival, and enhanced transdermal delivery of topical products. Side effects were mild and self-limited, with few reports of post-inflammatory hyperpigmentation, and isolated reports of tram tracking, facial allergic granuloma, and systemic hypersensitivity.

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Quality of Life in a Vitiligo Support Group

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Source: J Drugs Dermatol. 2017;16(4):344-350.

Saba Zabetian MD, Gordon Jacobson MS, Henry W. Lim MD, Melody J. Eide MD, and Richard H. Huggins MD

BACKGROUND: No study has examined the impact of vitiligo support group membership on vitiligo patient quality of life (QoL).

OBJECTIVE: We sought to examine the QoL impact of vitiligo support groups by comparing QoL and associated patient characteristics between vitiligo patients who are and are not members of a vitiligo support group.

METHODS: Members of a Henry Ford Hospital-sponsored, Southeast Michigan Vitiligo Support Group were compared to non-member vitiligo patients recruited from a previous study cohort.17 Eligible patients were asked to complete the Dermatology Life Quality Index (DLQI) and a study-specific questionnaire designed to collect relevant patient characteristics.

RESULTS: The mean DLQI scores for the support group members and non-members were similar (7.1 ± 5.4 and 6.0 ± 6.5, respectively; P-value 0.2), despite the support group members reporting more severe overall disease and increased disease severity in exposed portions of the body. The African-American: Caucasian ratio and the prevalence of unemployment were both significantly higher among the support group participants. Limitations: Small sample size may have limited the study’s ability to demonstrate the differences between the support group participants and the controls.

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