Christopher J. Sayed

Incidental finding of cutaneous meningeal heterotopia in aplasia cutis congenita

Aplasia cutis congenita and cutaneous meningeal heterotopia are both rare congenital conditions that most commonly occur on the scalp and may appear clinically and histologically similar. A subtype of aplasia cutis congenita, membranous aplasia cutis congenita, and cutaneous meningeal heterotopia are both proposed to result from neural tube closure errors. However, neither non‐membranous nor membranous aplasia cutis congenita are known to occur together with cutaneous meningeal heterotopia in the same lesion. We report the incidental finding of cutaneous meningeal heterotopia within a lesion of aplasia cutis congenita.

The performance of telescoping fat pad biopsies for detecting systemic amyloidosis: a four and a half year retrospective analysis and brief review of the fine needle aspiration literature.

Systemic amyloidosis has historically been diagnosed by organ biopsy and Congo red staining, with reported sensitivities that exceed 90%. The abdominal fat pad fine needle aspiration (FNA), introduced in the 1970s, carries sensitivity estimates largely derived from studies with deficiencies. Patient follow‐up is often unclear and proportionally low numbers of patients are verified as true negatives. Issues in other studies include only testing verified systemic amyloidosis cases. The telescoping fat pad biopsy (TFPB) is used as an alternative to FNA and is similarly carried out quickly with low morbidity. Although the two methods would seem to be comparable intuitively, this has not been established because sensitivity data for the TFPB method is scarce to non‐existent. The charts of 58 consecutive patients who underwent TFPB screening for amyloidosis in a single hospital from August of 2010 to January 2015 were examined. All six TFPB positive patients were determined to be true positives. Eight TFPB negative patients were concurrently determined to have systemic amyloidosis by other methods – organ biopsy (7) and mass spectrometry (1) resulting in a 43% sensitivity. The remaining patients were categorized into 25 true negatives and 18 that were indeterminate based on clinical course and other biopsy results.

Hemorrhagic bullae of the oral mucosa

ABH: angina bullosa hemorrhagica H&E: hematoxylin-eosin INTRODUCTION Angina bullosa hemorrhagica (ABH) is a rare benign disorder characterized by sudden onset of painless, blood-filled, blisters of the oral cavity that quickly expand and rupture spontaneously within 24 to 48 hours. First reported in 1967, ABH has been noted under other diagnostic terms including recurrent or traumatic oral hemophlyctenosis and benign hemorrhagic bullous stomatitis. Localization of blisters is usually restricted to the soft palate, yet the buccal mucosa, tongue, and lips may also be involved. Associated symptoms have been noted in some cases, including hoarseness and blood-tinged sialorrhea. Blisters tend to heal without scarring. Most cases occur in adults, ages 50 to 70, with no differentiation in incidence between men or women. Because it is infrequently encountered in the clinical setting and sparsely reported in the dermatologic literature, its recognition and diagnosis make it challenging for providers. We report a recent case of ABH in a middle-aged man with idiopathic thrombocytopenia, including its emergent presentation and relevant histopathology.

Implementation of an Outcomes-Based Curriculum for Dermatology Clerkships and Initial Positive Perceptions from Faculty and Students

REFERENCES 1. Maurer M, Abuzakouk M, B erard F, et al. The burden of chronic spontaneous urticaria is substantial: real-world evidence from ASSURE-CSU. Allergy. 2017;72:2005-2016. 2. Institute for Health Metrics and Evaluation (IHME). GBD Compare. Seattle, WA: IHME, University of Washington; 2016. Available from: http://vizhub.healthdata.org/gbd-compare. 3. Karimkhani C, Dellavalle RP, Coffeng LE, et al. Global skin disease morbidity and mortality: an update from the Global Burden of Disease study 2013. JAMA Dermatol. 2017;153: 406-412. 4. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease study 2010. Lancet. 2012;380:2163-2196. 5. B€ uy€ uk€ ozt€ urk S, GelincikA, Demirt€ urkM, Kocaturk E, Colako glu B, Dal M. Omalizumab markedly improves urticaria activity scores and quality of life scores in chronic spontaneous urticaria patients: a real life survey. J Dermatol. 2012;39:439-442.

Squamous cell carcinoma arising in a chronic perineal wound in a patient with long-standing cutaneous Crohn's disease

CD: Crohn’s disease HS: hidradenitis suppurativa SCC: squamous cell carcinoma TNF: tumor necrosis factor INTRODUCTION Cutaneous squamous cell carcinoma (SCC) is an invasive, malignant tumor with metastatic potential. This tumor can arise from various precursor lesions, including ulcers, actinic keratoses, and leukoplakia. A Marjolin ulcer is an aggressive malignancy of the skin, most commonly SCC, arising in chronic wounds or scars. Transformation from a chronic wound to SCC is rare and slow with an unknown pathogenesis, although proposed mechanisms include nonspecific or chronic antigenic stimulation. Malignantly transformed wounds are challenging to differentiate from primary chronic ulcers, so having a high suspicion for SCC and diagnosis in a timely manner is key. Clinically, it is important to monitor for changes in wound appearance and perform histologic evaluation early. Chronic osteomyelitis is the clinical condition most frequently associated with Marjolin ulcers, with other common etiologies being trauma, burns, and diabetes. Although cases of SCC developing in the setting of chronic hidradenitis suppurativa (HS) or Crohn’s disease (CD) have been described in the literature, SCC may be regarded as a rare complication of these diseases. We present a patient with chronic cutaneous CD that worsened focally on the gluteal cleft and perineum that then became refractory to multiple immunosuppressive therapies, including biologics and cyclosporine. After months of failed treatment, she was found to have SCC, and ultimately passed away approximately 18 months later.

Infestations in the Geriatric Patient

Purpose of ReviewThis article seeks to review the common infestations plaguing the geriatric population including scabies, lice, and bed bugs as incidence is on the rise in this growing population. These infestations can be debilitating, embarrassing, and burdensome to patients. We discuss classic clinical presentations, diagnostic features, first-line treatment, and management of each.Recent FindingsA special focus is included on scabies infestations as its incidence is rapidly increasing, and unique considerations are given to the geriatric population regarding management and treatment. Furthermore, increased reports of post-scabetic pruritus pose a treatment conundrum to providers.SummaryWe hope our review of common geriatric infestations including scabies, lice, and bed bugs better equips primary physicians to diagnose, treat, and manage complications following treatment.

Bruising and Hemorrhagic Vesicles on the Tongue.

Awoman inher 70swith recently diagnoseddiastolic heart failurewas admitted forworsening dyspnea. Her medical history was notable for hypertension and oral lichen planus. Over theprevious2 to3months, thepatient also reportedeasybruisingwithminor trauma and erosions on the lateral tongue. Findings fromphysical examination revealedperioral andperiorbital purpura, someof which she attributed to friction from her nasal cannula (Figure, A). Hemorrhagic vesicles and petechiaewere distributed over the lateral tongue (Figure, B) and buccalmucosa. Additional petechiaeandpurpurawerenotedonher lowerextremities, including inguinal fold, thigh, and crura. Laboratory values were notable for elevated serum troponin I levels of 0.144 ng/mL (to convert to micrograms per liter, multiply by 1), probrain natriuretic propeptide (BNP) levels of 14 000 pg/mL (to convert to nanograms per liter, multiply by 1), and proteinuria with hyaline casts. Biopsy specimens for histological analysis were obtained from the lower extremity petechia (Figure, C) and abdominal fat pad (Figure, D). Quiz at jamadermatology.com Photograph of hemorrhagic purpura A Photograph of hemorrhagic vesicles B

Psoriasis-Like Lesions and Skin Reactions

The clinical identification and classification of anti-TNF therapy-associated dermatological side effects present an increasing clinical challenge for gastroenterologists treating patients with inflam