Connie R. Shi

Sex and leadership in academic dermatology: A nationwide survey

REFERENCES 1. Torensma B, Thomassen I, van Velzen M, In ’t Veld BA. Pain experience and perception in the obese subject systematic review (revised version). Obes Surg. 2016;26: 631-639. 2. Karayiannakis AJ, Syrigos KN, Zbar A, et al. The effect of vertical banded gastroplasty on glucose-induced beta-endorphin response. J Surg Res. 1998;80:123-128. 3. Kukkar A, Bali A, Singh N, Jaggi AS. Implications and mechanism of action of gabapentin in neuropathic pain. Arch Pharm Res. 2013;36:237-251. 4. Mandviwala T, Khalid U, Deswal A. Obesity and cardiovascular disease: a risk factor or a risk marker? Curr Atheroscler Rep. 2016; 18:21.

Co-teaching: applications in medical education

Coteaching is an instructional method whereby two educators share the planning, delivery and assessment of instruction, as well as the physical space of educational delivery. 1 Originally developed as a teaching method to supplement student learning in the special education and general education settings, 1,2 coteaching is a versatile teaching strategy that can be adapted to a variety of settings and learning needs, as illustrated by Cook and Friend ’ s fi ve proposed models of coteaching (Table 1 ). 1

Unilateral, localized bullous pemphigoid in a patient with chronic venous stasis

Bullous pemphigoid (BP) is a systemic, autoimmune bullous disease that classically presents as widespread urticarial plaques or tense bullae. Localized variants of BP are rare with approximately 100 cases reported. We present a unique case of unilateral, localized BP in the setting of venous stasis.

Teaching & Learning Tips 6: The flipped classroom

Challenge: The “flipped classroom” is a pedagogical model in which instructional materials are delivered to learners outside of class, reserving class time for application of new principles with peers and instructors. Active learning has forever been an elusive ideal in medical education, but the flipped class model is relatively new to medical education. What is the evidence for the “flipped classroom,” and how can these techniques be applied to the teaching of dermatology to trainees at all stages of their medical careers?

Teaching and Learning Tips 12: Peer observation of teaching

Challenge: How can clinical teachers continually improve their teaching skills? In addition to student feedback, peer and expert opinion can also provide valuable formative and evaluative feedback to guide self‐improvement efforts. Here, we discuss ways to structure peer observation of teaching in dermatological settings and offer tips on how to optimize the learning experience for both the educator and peer observer.

Pediatric Cutaneous Graft Versus Host Disease: A Review

BACKGROUND Graft versus host disease (GVHD) is a significant complication following hematopoietic stem cell transplantation in the pediatric population. The most common clinical manifestation of GVHD is in the skin. This article will present a review of key concepts related to pediatric cutaneous GVHD, including pathophysiology, clinical epidemiology, diagnosis, and treatment options. OBJECTIVE GVHD is an immune-mediated process characterized by an inflammatory immune response in acute GVHD and mixed inflammatory and fibrotic states in chronic GVHD. The clinical presentations of cutaneous GVHD are heterogeneous. METHOD Acute cutaneous GVHD classically presents as an erythematous morbilliform eruption appearing within a few weeks after transplantation. Chronic cutaneous GVHD may manifest as poikiloderma, lichenoid lesions, or sclerodermatous changes. The sclerodermatous form of cutaneous GVHD is associated with substantial long-term morbidity, including joint contractures, myalgias, and mobility restriction. RESULTS First-line pharmacologic treatment options typically include corticosteroids and in some cases, calcineurin inhibitors. Biologics and immunotherapies are an active area of investigation for GVHD that is refractory to corticosteroid treatment. Non-pharmacologic treatment options that have shown benefit for cutaneous GVHD include extracorporeal photopheresis and phototherapy. CONCLUSION Accurate diagnosis and treatment of cutaneous GVHD is essential to preventing and alleviating the long-term sequelae and morbidity associated with this condition.

Imatinib-induced psoriasiform eruption in a patient with chronic myeloid leukemia

A 32-year-old woman with chronic myeloid leukemia (CML) presented for evaluation of a new diffuse cutaneous eruption that developed within one month of initiating therapy with imatinib mesylate at 400 mg daily. The patient endorsed associated pruritus and scaling of the scalp. Notably, the rash improved during a one-week trial off of imatinib and recurred when imatinib was re-initiated. Her only other medication was dexlansoprazole for chronic gastro-esophageal reflux disease. The patient reported no prior personal or family history of skin disease. She achieved a complete hematological response to imatinib for her CML, which she continued to take. Physical examination revealed multiple well-demarcated, thin pinkto-violaceous plaques with hyperkeratotic white scale distributed symmetrically over the dorsal hands (Image 1), bilateral elbows, bilateral lower extremities, and posterior neck, along with scaling and crusting of the scalp and the conchal bowls. Her clinical presentation was consistent with a psoriasiform eruption and the temporal relationship of rash onset with initiation of imatinib was consistent with an imatinib-induced psoriasiform eruption. The patient was treated with topical clobetasol ointment twice daily for two weeks, followed by triamcinolone ointment twice daily for two weeks, while continuing on imatinib for her CML. The lesions demonstrated marked resolution within three weeks of topical therapy. Tyrosine kinase inhibitors such as imatinib mesylate, nilotinib, and dasatinib are associated with a range of cutaneous adverse effects. Cutaneous reactions to imatinib occur in up to 69% of patients, with the most common being superficial edema and erythematous maculopapular rash. Less commonly, hypoand hyper-pigmentation, lichenoid eruptions, psoriasis and psoriasiform eruptions, pityriasis rosea-like rashes, and Stevens–Johnson syndrome can result, among others. It is thought that cutaneous reactions to imatinib are dose-dependent, as these adverse IMAGE 1 Pink-to-violaceous plaques with hyperkeratotic white scale symmetrically distributed on the (A) dorsal hands and (B) palmar hands and wrists

Widespread psoriasis flare following influenza vaccination

Article history: Received 8 May 2017 Received in revised form 17 June 2017 Accepted 21 June 2017 Available online xxxx

Research Techniques Made Simple: Cost-Effectiveness Analysis

Cost-effectiveness analysis (CEA) is a research method used to determine the clinical benefit-to-cost ratio of a given intervention. CEA offers a standardized means of comparing cost-effectiveness among interventions. Changes in quality-adjusted life-years, disability-adjusted life-years, or survival and mortality are some of the common clinical benefit measures incorporated into CEA. Because accounting for all associated costs and benefits of an intervention is complex and potentially introduces uncertainty into the analysis, sensitivity analyses can be performed to test the analytic model under varying conditions. CEA informs the identification of high-value clinical practices and can be used to evaluate preventative, diagnostic, and therapeutic interventions in dermatology.

Erythematous Rash Following Hematopoietic Stem Cell Transplantation

A 66-year-old man with newly diagnosed multiple myeloma underwent autologous hematopoietic stem cell transplantation (HSCT). On posttransplant day 10, he developed fever (38.4°C). He was started on empirical treatment with cefepime; however, his fevers persisted despite antibiotic therapy. On posttransplant day 14 he developed new-onset pruritic, confluent, erythematous, blanching morbilliform macules and papules on his trunk and extremities (Figure, left). Review of systems was notable for diarrhea and a 6-pound weight gain since transplantation and negative for headache, cough, shortness of breath, or abdominal pain. Onexamination,therewasnolymphadenopathyorhepatosplenomegaly.Thepatient’sheart rate was 100/min, blood pressure was 106/68 mm Hg, and he occasionally experienced mild hypoxiato94%onambientair.Resultsofabasicmetabolicpanelwerenormal,withabloodurea nitrogenlevelof10mg/dL(3.57mmol/L)andcreatininelevelof0.7mg/dL(61.88μmol/L).White blood cell (WBC) count was 7300/μL, and absolute neutrophil count (ANC) was 5480/μL. Neutrophil recovery occurred beginning on posttransplant day 10, with WBC count of 700/μL and ANC of 532/μL on posttransplant day 10, correlating with the onset of the patient’s fevers. Platelet count was 48 × 103/μL, and hemoglobin was 8.2 g/dL. Results of liver function tests were normal. Blood, urine, sputum, and respiratory viral cultures were negative. Tests for cytomegalovirus, Epstein-Barr virus, human herpesvirus-6, adenovirus, parvovirus, cryptococcal antigen, aspergillus galactomannan antigen, β-glucan, and Clostridium difficile were negative. Chest computed tomography demonstrated multifocal ground-glass and consolidative pulmonary opacities (Figure, right). Computed tomography of the abdomen was unremarkable. A skin punch biopsy demonstrated subtle vacuolar change; rare epidermal dyskeratosis, including within a hair follicle; and superficial perivascular mononuclear cell infiltrate with occasional eosinophils.