Corey Georgesen

The development, evidence, and current use of ATX-101 for the treatment of submental fat

ATX‐101 (deoxycholic acid) is the first pharmaceutical therapy approved by the FDA for the reduction in submental fat. Deoxycholic acid is an endogenous secondary bile acid that normally solubilizes dietary fat, contributing to its breakdown and absorption within the gut. This article reviews the identification of deoxycholic acid as a lipolytic agent, and the mechanism of action, pharmacokinetics, and pharmacodynamics of ATX‐101. In addition to phase I/II trials, four Phase III clinical trials have evaluated safety and efficacy of ATX‐101. These studies helped establish the appropriate dosage, administration techniques, warnings, and side effects of ATX‐101. ATX‐101 is effective in treating submental fat. Adverse events, although common, are mild and transient.

Orofacial granulomatosis and erythema multiforme in an adolescent with Crohn's disease

The cutaneous manifestations of Crohns disease are myriad. A 15‐year‐old girl presented with recurrent lip swelling and eventual development of diarrhea and targetoid macules on the palms, feet, and back. She was finally diagnosed with Crohns disease in the setting of a clinical presentation and histopathology consistent with orofacial granulomatosis and erythema multiforme. We review the literature and summarize reported occurrences of these cutaneous diseases in children with Crohns disease.

Surgical smoke: Risk assessment and mitigation strategies

Background: Although many dermatologic surgeons are aware of the risks of surgical smoke, many do not use hazard reduction strategies. Objective: To identify the infectious, inhalational, chemical, and mutagenic risks of surgical smoke in dermatologic procedures and suggest evidence‐based hazard reduction strategies. Methods: A review of articles indexed for MEDLINE on PubMed using the keywords surgical smoke, dermatology, surgical mask, respirator, smoke evacuator, and guidelines in 13 combinations was performed by using Preferred Reporting Items for Systematic Reviews and Meta‐Analyses protocols. The review included data from 45 articles from the dermatology, surgery, infectious disease, obstetrics, and cancer biology literature. Results: There are risks associated with surgical smoke, and although some dermatologists are aware of these risks, many are not using hazard reduction strategies such as smoke evacuators and surgical masks. Limitations: Most of the data regarding the hazards of surgical smoke and methods for smoke safety are derived from in vitro and in vivo studies in nonhumans, as well as from resources outside of the dermatology literature. Conclusion: Standardized guidelines for surgical smoke safety should be implemented in the dermatology community and residency curriculum.

A generalized fixed drug eruption associated with mycophenolate

Mycophenolate is a reversible inhibitor of inosine monophosphate dehydrogenase, which plays an important role in the production of DNA. This drug is commonly used in several autoimmune and inflammatory conditions, including connective tissue diseases, immunobullous disease, and atopic dermatitis, and in the setting of organ transplantation. Mycophenolate is considered first-line therapy in many patients because of its relatively minimal side effect profile when compared with other immunosuppressive agents. Most common side effects include diarrhea, gastrointestinal distress, peripheral edema, and high blood pressure. Less common side effects include pancytopenias and risk of infection.1 Given the overall prevalence of mycophenolate use, we present a rare case of a generalized fixed drug eruption caused by mycophenolate.

Streptococcal-induced Kawasaki disease of the psoriasiform phenotype in a young adult

A 22-year-old male presented with 5 days of fever, malaise, nonbloody diarrhea, and dry cough. This was accompanied by an erythematous rash involving his trunk and arms. He had unprotected sexual intercourse 2 weeks prior and a remote history of cocaine and marijuana use but denied any sick contacts or tick bites. His past medical history includes asthma. Physical examination demonstrated sinus tachycardia, highgrade fevers (40 degrees Celsius), unilateral cervical lymphadenopathy, tender hepatomegaly, facial edema, a sharply demarcated macular and papular erythematous rash with fine scaling (Fig. 1a), and limbus-sparing conjunctivitis (Fig. 1b). Initial laboratory tests showed a neutrophil-predominant leukocytosis (23.5 9 10 cells per liter), mild transaminitis, elevated erythrocyte sedimentation rate (58 millimeters per hour), and Creactive protein (16.85 milligrams per deciliter). Urine studies showed a sterile pyuria. He was admitted for intravenous fluids and started on vancomycin and piperacillin-tazobactam, but the tachycardia and fevers persisted, and he experienced rapidly worsening dyspnea requiring 50% supplemental oxygen. In addition, his hands and feet became markedly edematous and subsequently desquamated (Fig. 1c,d), accompanied by cracking of the lips with hyperemia of the tongue. Anti-streptolysin O titers (292 International Units per milliliter [IU/ml]; normal reference range 0–135 IU/ml) and anti-Dnase titers (386 Units per milliliter [U/ml]; normal reference range 0–260 U/ ml) were elevated. Additional infectious, rheumatologic, and immunologic studies were normal. A transthoracic echocardiogram demonstrated mildly reduced ejection fraction without coronary artery abnormalities. Computed tomography scan of the chest showed peri-bronchovascular ground glass opacities. A skin biopsy exhibited discontiguous foci of lenticular-shaped neutrophil-imbued parakeratosis with attendant granular cell layer diminution, features reminiscent of guttate psoriasis (Fig. 2). With other etiologies having been excluded, a diagnosis of Kawasaki disease was made. The patient received 2 g/kg IVIG in addition to aspirin 1 g every 6 hours. Over the ensuing 2 days, the patient’s fevers defervesced, he was weaned off oxygen, and the rash faded with superficial desquamation. To date, he has not experienced coronary complications.