Audrey A. Jacobsen

Posaconazole Substitution for Voriconazole-Associated Phototoxic Effects.

Posaconazole Substitution for VoriconazoleAssociated Phototoxic Effects Voriconazole is used for long-term prophylaxis or treatment of fungal infections. Voriconazole-induced phototoxic effects and photocarcinogenesis is an independent risk factor for squamous cell carcinoma (SCC) development in organ transplant recipients.1 An alternative for patients at risk for cutaneous cancer has not been well studied. We describe a patient with voriconazole-induced photocarcinogenesis whose symptoms and tumor count improved after substitution with posaconazole.

Practical management of the adverse effects of Hedgehog pathway inhibitor therapy for basal cell carcinoma

REFERENCES 1. Piette EW, Rosenbach M. Granuloma annulare: pathogenesis, disease associations and triggers, and therapeutic options. J Am Acad Dermatol. 2016;75:467-479. 2. Piette EW, Rosenbach M. Granuloma annulare: clinical and histologic variants, epidemiology, and genetics. J Am Acad Dermatol. 2016;75:457-465. 3. Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and trends in diabetes among adults in the United States, 1988-2012. JAMA. 2015;314:1021-1029. 4. Goff DC Jr, Bertoni AG, Kramer H, et al. Dyslipidemia prevalence, treatment, and control in the Multi-Ethnic Study of Atherosclerosis (MESA): gender, ethnicity, and coronary artery calcium. Circulation. 2006;113:647-656. 5. Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002;87:489-499.

Hypertension prevalence: an examination of urban and rural Haiti

Abstract Background With the burden of disease shifting from communicable to non-communicable diseases, hypertension is rising as a major health concern in developing nations. Absence of data for surveillance and effect of non-communicable diseases restrict the ability of stakeholders to respond effectively. We aim to estimate the prevalence of hypertension in Haiti and analyse differences in hypertensive status among urban and rural location, age, and sex. Methods We reviewed medical charts at two Haitian clinics: one in the urban city of Port-au-Prince and one in the rural village of Marmont in the Central Plateau, and recorded age, sex, weight, blood pressure, location of patient (urban vs rural), and present treatments and which specific medications. Participants included all non-pregnant outpatients older than 25 years who visited the clinics at least once between Jan 1, 2011. and June 15, 2013. 1019 patients were included in the study; 520 from Port-au-Prince and 490 from Marmont. Findings The overall prevalence of hypertension was 34·4% (n=351, 95% CI 31·8–37·8); with a prevalence of 31·6% (n=167, 95% CI 27·6–35·3) in Port-au-Prince and a prevalence of 37·6% (n=184, 95% CI 34·5–40·9) and Marmont. Younger participants had lower rates of hypertension than did older participants. Patients aged 25–34 years had a hypertension prevalence of 12·0% (n=41), aged 35–44 years of 23·8% (n=51), aged 45–54 years of 46·9% (n=91), aged 55–64 years of 58·6% (n=65), and aged older than 65 years of 65·6% (n=103). No observable differences were noted between locations within the same age group. When sex was compared, 34·7% (n=227) of women and 34·0% (n=124) of men were hypertensive. Women in the rural location had a significantly higher prevalence (39·0%, n=122) of hypertension than women in the urban location (30·8%, n=105, p=0·028). Of 351 total hypertensive participants, only 54·1% (n=190) showed any evidence of being prescribed antihypertensives in their chart. Interpretation This study suggests that hypertension is a major health problem in Haiti. Interventions are needed to address the proper management of hypertensive patients through medications and follow-ups, particularly in rural hypertensive women. Further research needs to be done to confirm the increased hypertension prevalence in rural locations in Haiti and to explore the causes of the differing hypertension prevalence in populations by location and sex. Funding Global Health Scholar Award from the Department of Public Health Sciences at University of Miami.

Predisposing Factors for Onychomycosis

Onychomycosis is the most prevalent nail disease with a significant burden on quality of life. Age is the principal non-modifiable risk factor for onychomycosis development. Medical conditions such as diabetes, HIV infection, immunosuppressed states, concurrent tinea pedis, and peripheral artery disease increase the risk for onychomycosis. Physical and environmental factors that increase risk include obesity, certain athletic activities, and possibly smoking.

Nodular Cutaneous Amyloidoma of the Extremity Secondary to Chronic Granulomatous Inflammation in Setting of Sarcoidosis

Soft tissue amyloidoma is a rare condition that presents primarily in the abdomen and/or mediastinum and more uncommonly on the extremities. Soft tissue amyloidomas on the extremities have been associated with chronic inflammation, particularly when accompanied by AA‐type amyloid deposition as seen in local trauma, surgery, hypertension and diabetes. To our knowledge, this is the first reported case of nodular cutaneous amyloidoma in the setting of systemic and cutaneous sarcoidosis. A 65‐year‐old woman presented with an asymptomatic subcutaneous nodule above her left lateral malleolus. Histopathology of the lesion showed an inconspicuous epidermis with amorphous eosinophilic material deposited in masses within the entire dermis. Congo red and crystal violet stains were positive. Based on the clinical and pathologic findings she was diagnosed with nodular cutaneous amyloidoma. We hypothesize that this process developed secondary to the chronic granulomatous inflammation of sarcoidosis.

Black and Hispanic Caregivers’ Behaviors, Motivations, and Barriers to Sun Protection in Children Aged 4 to 12 Years in Miami, Florida

Black and Hispanic Caregivers’ Behaviors, Motivations, and Barriers to Sun Protection in Children Aged 4 to 12 Years in Miami, Florida Major shortcomings in efforts to prevent skin cancer in minority communities include increased incidence of melanoma and higher rates of mortality.1 Culture, socioeconomic factors, knowledge and awareness of skin cancer, and perceived risk may account for these disparities.2 Limited studies of sun protective practices in caregivers of black and Hispanic children exist.3,4 We compare black, Hispanic white, and non-Hispanic white caregivers’ behaviors, motivations, and barriers to sun protection in children aged 4 to 12 years in Miami, Florida. This information is imperative to understanding family-based factors that can lead to lifelong, habitual sun safety behaviors.

Applying the community health worker model in dermatology: a curriculum for skin cancer prevention education training

Incidence of skin cancer is rising in Hispanic populations and minorities often have more advanced disease and experience higher mortality rates. Community health worker (CHW) programs to promote primary and secondary prevention show promise for many diseases, but an adequate training program in skin cancer prevention is not documented. We present a model for CHW specialty certification in skin cancer prevention for underserved, Hispanic communities.

Dermatologic Surgery Needs in Low-Income, Uninsured, and Minority Communities.

Uninsured, immigrant, and minority populations are underrepresented in dermatologic services including skin cancer. The index patient in our series is illustrative: in 2010, aHaitianman presentedwith a fungating tumor on his foot, which we diagnosed as melanoma before his death. His case prompted the initiation of a program at a large nonprofit clinic to advance dermatology services,with an emphasis on surgical care, to local underserved communities. This permitted us to successfully treat underserved patients, as illustrated by more than two-year survival of a second patient who presented with a fungating acral melanoma (Figure 1).