Alessandra Haskin

A new drug with a nasty bite: A case of krokodil-induced skin necrosis in an intravenous drug user

Krokodil is a commonly used street name for desomorphine, an injectable opioid derivative that is associated with severe dermatologic effects. We report a case of a woman who had extensive ulcerations after a single use of this narcotic. To our knowledge, this is the first case report of the cutaneous manifestations of krokodil use in the dermatologic literature.

Patterns of antimicrobial resistance in lesions of hidradenitis suppurativa

Background: Antibiotic therapy is commonly used to treat hidradenitis suppurativa (HS). Although concern for antibiotic resistance exists, data examining the association between antibiotics and antimicrobial resistance in HS lesions are limited. Objective: We sought to determine the frequency of antimicrobial resistance in HS lesions from patients on antibiotic therapy. Methodology: A cross‐sectional analysis was conducted on 239 patients with HS seen at the Johns Hopkins Medical Institutions from 2010 through 2015. Results: Patients using topical clindamycin were more likely to grow clindamycin‐resistant Staphylococcus aureus compared with patients using no antibiotics (63% vs 17%; P = .03). Patients taking ciprofloxacin were more likely to grow ciprofloxacin‐resistant methicillin‐resistant S aureus compared with patients using no antibiotics (100% vs 10%; P = .045). Patients taking trimethoprim/sulfamethoxazole were more likely to grow trimethoprim/sulfamethoxazole‐resistant Proteus species compared with patients using no antibiotics (88% vs 0%; P < .001). No significant antimicrobial resistance was observed with tetracyclines or oral clindamycin. Limitations: Data on disease characteristics and antimicrobial susceptibilities for certain bacteria were limited. Conclusions: Antibiotic therapy for HS treatment may be inducing antibiotic resistance. These findings highlight the importance of stewardship in antibiotic therapy for HS and raise questions regarding the balance of antibiotic use versus potential harms associated with antibiotic resistance.

Understanding patient experiences with scarring alopecia: a qualitative study with management implications

Abstract Introduction: Alopecia can have a significant negative impact on patient’s lives. The objective of this study is to describe some of the emotional and psychological challenges that affect women with scarring alopecia (SA). Methods: A qualitative study design was used with open-ended, individual interviews with 10 women with biopsy-proven SA. Interviews were audio-taped, transcribed verbatim and analyzed thematically using ATLAS.ti analysis software. Results: Four overarching major themes (with several subthemes) emerged including the following: the negative emotional impact of SA, difficulties with concealing hair loss, negative experiences with diagnosis/management, and the importance of support from others. Patients reported that many of these issues were under-emphasized during doctor visits. Conclusion: Analysis of patient responses indicated that patients with SA contend with significant emotional and psychological sequelae of their diagnosis.

Ethnic Hair Care Products

The multibillion dollar market for black hair care and styling products is constantly growing and changing. These products are tailored to satisfy the unique hair care needs of black consumers (and others with curly hair) and are often located in a separate section of the cosmetics aisle in retail stores and pharmacies. This section will discuss the use of hair oils, butters, and various styling aids commonly used by those with tightly curled hair. It is important that dermatologists become aware of these frequently used hair care and styling aids, and understand how they affect the hair.

Thermal Modifications of Ethnic Hair

The application of heat to straighten and style hair is often a major component in the hair care routine for women of all races. This chapter will discuss the chemical changes that occur with thermal straightening, the process behind it, frequently used thermal styling tools, and resultant heat-induced hair damage associated with this hairstyling practice. This chapter will also include a discussion of keratin straightening treatments and the controversies surrounding the safety of these products.

Scarring Alopecias Related to Hairstyling Practices

Over time, traumatic hairstyling practices can lead to both scarring and nonscarring forms of alopecia. In scarring alopecia, fibrous scar tissue replaces hair follicles, resulting in permanent hair loss. In nonscarring alopecia, such as traction and chemically related alopecias, hair regrowth is possible. However, repeated trauma can lead to permanent, scarring hair loss. Additionally, hair styling practices can exacerbate existing alopecia. Understanding the role hair care practices play in the development of hair loss is critical to management of these conditions.

Ethnic Hairstyling Practices and Hair Prostheses II: Wigs, Weaves, and Other Extensions

Hairstyles vary significantly across ethnic populations and are often thought of as an expression of personal style and a celebration of cultural heritage. This chapter provides an overview of the wide variety of hairstyles and hair prostheses most commonly used in the black community as well as the potential harmful effects associated with them. It also includes a brief discussion of camouflage techniques for patients with hair loss.

Chemical Modifications of Ethnic Hair

Hair is one of the few physical features that can be easily altered in its shape, color, and length. This chapter will discuss some of the methods used to esthetically modify the appearance of hair, with an emphasis on chemical processes commonly used in ethnic communities. This includes detailed descriptions of the processes involved in chemical relaxation, texturizing, and hair coloring, in addition to the potential deleterious effects of these chemical modifications.

Breaking the cycle of hair breakage: pearls for the management of acquired trichorrhexis nodosa

Abstract Acquired trichorrhexis nodosa (TN) is a common cause of hair loss for patients of all ethnicities. It is especially prevalent in black patients with tightly curled hair types and can present unique diagnostic and therapeutic challenges due to structural differences in these hair types and the combination of various hair care and styling practices that contribute to hair damage. While scalp biopsies can help rule out other etiologies of hair loss, there is a paucity of histologic findings in acquired TN, making this primarily a clinical diagnosis. Instead of more traditional prescription based therapies, the management of this form of hair loss emphasizes protecting the hair shaft and minimizing further damage through the development of a healthy hair care regimen. This involves appropriate selection and use of cleansing products and conditioning agents that help protect the hair from the insults of daily grooming. This paper will review the current literature on acquired TN and will provide guidelines and recommendations for management by reviewing the different types of cleansing and conditioning products that can be used to prevent and/or halt the progression of hair breakage.

Reply to: “Commentary on ‘A new drug with a nasty bite: A case of krokodil-induced skin necrosis in an intravenous drug user’”

To the Editor: I thank the authors for their reply to our article. Levamisole, an adulterant most commonly found in cocaine, can be associated with skin vasculitis resulting in ulcerating lesions.1, 2 The most common cutaneous findings are characteristic purpuric lesions, including retiform purpura or palpable purpura, which often occur in conjunction with leukocytoclastic vasculitis. These lesions favor acral surfaces such as the helical rim or fingertips and are often antineutrophil cytoplasmic antibody positive.1, 2 On the contrary, large ulcerations on the forearms would be an unusual presentation for levamisole toxicity, especially in the absence of more classic findings as noted above. In cases such as these, physical examination is important, and cutaneous findings must be emphasized. The patient only had involvement where she directly injected the substance, another finding that is unusual for levamisole, which often affects areas distal to areas of injection owing to systemic activity without antineutrophil cytoplasmic antibody positivity. Finally, the patient voluntarily reported purchasing krokodil immediately before the ulcerations occurred. I caution against the authors sentiment of completely excluding patient history, especially when clinical findings support the history provided. We believe that doctors should continue to exercise vigilance and keep krokodil on their differential of possibilities in cases of large ulcerations in patients with a history of intravenous drug use.