James H. Keeling

New World and Old World Leishmania Infections: A Practical Review.

Leishmaniasis is a parasitic infection endemic to more than 90 countries worldwide. As travel to endemic areas increases, dermatologists need to keep this entity in the differential for any chronic skin lesion in persons who may have had a possible exposure for any duration. It can be difficult to diagnose because manifestations are varied and sometimes subclinical. This article discusses the current state of epidemiology, pathogenesis, clinical presentation, diagnosis, and treatment options. A special focus is placed on cutaneous manifestations and their treatment.

Outcomes of melanoma in recipients of solid organ transplant

BACKGROUNDnThere is concern that the immunologic tumor malignant melanoma (MM) may have worse outcomes in immunosuppressed hosts than in the general population.nnnOBJECTIVEnWe sought to describe outcomes of MM in immunosuppressed solid organ transplant recipients and compare them with the general population.nnnMETHODSnWe conducted a retrospective review of medical charts and pathology slides of cases of MM and solid organ transplantation between 1978 and 2007, with comparison of outcomes.nnnRESULTSnIn all, 48 MMs were identified in 43 transplant recipients. No patient with MM before transplant receipt had melanoma recurrence, subsequent metastasis, or death caused by melanoma. Of patients with MM diagnosed after transplantation, metastases developed in 3 patients, and two patients died of melanoma.nnnLIMITATIONSnRetrospective review and low number of cases are limitations.nnnCONCLUSIONSnOutcomes of MM in immunosuppressed transplant recipients appeared similar to those in prognostically matched nonimmunosuppressed hosts. The small number of cases limited statistical comparisons.

Trends in patch-test results and allergen changes in the standard series: A Mayo Clinic 5-year retrospective review (January 1, 2006, to December 31, 2010)

BACKGROUNDnPatch testing is essential for identification of culprits causing allergic contact dermatitis.nnnOBJECTIVEnWe sought to identify trends and allergen changes in our standard series during 2006 to 2010, compared with our previous report (2001-2005).nnnMETHODSnWe conducted a retrospective review of patch-test results.nnnRESULTSnA total of 3115 patients were tested with a mean of 73.0 allergens. Since our prior report, 8xa0allergens were added to the standard series; 14 were deleted. Significantly higher rates of allergic positive reaction were documented for carba mix, 3%, and Disperse Orange 3, 1%. Rates were lower for 10 allergens: neomycin sulfate, 20%; gold sodium thiosulfate, 0.5%; hexahydro-1,3,5-tris(2-hydroxyethyl)triazine, 1%; disperse blue 124, 1%; disperse blue 106, 1%; diazolidinyl urea, 1%; hexylresorcinol, 0.25%; diazolidinyl urea, 1% aqueous; 2-bromo-2-nitropropane-1,3-diol, 0.25%; and lidocaine, 5%. Many final patch-test readings for many allergens were categorized as mild reactions (erythema only). Overall allergenicity and irritancy rates declined significantly since our prior report. Results were generally comparable with those in a North American Contact Dermatitis Group report from 2005 to 2006.nnnLIMITATIONSnThis was a retrospective study; there is a lack of long-term follow-up.nnnCONCLUSIONSnSince our previous report, our standard series composition has changed, and overall rates of allergenicity and irritancy have decreased. Notably, many final patch-test readings showed mild reactions.

Periorbital edema as the presenting sign of dermatomyositis

Background Periorbital edema can occur in dermatomyositis, which is characterized by symmetric macular erythema, Gottrons papules, Gottrons sign, periungual telangiectasia, heliotrope rash, and poikilodermatous macules on the shoulders, arms, or upper back (shawl sign).

Cutaneous Microsphaeropsis arundinis infection initially interpreted as squamous cell carcinoma

The fungal class Coelomycetes is increasingly recognized as a major cause of opportunistic soft tissue infections. Such infections are classified as phaeohyphomycoses (dematiaceous fungal infections characterized by pigmented hyphae). Fungal organisms within the genus Microsphaeropsis are included in this class. Two case reports of soft tissue infections caused by Microsphaeropsis arundinis have been reported in Australia; but there are no published reports of infections with this organism in patients in the United States. We report a case of cutaneous M. arundinis initially diagnosed as squamous cell carcinoma in an immunosuppressed patient.

Results of patch testing in 10 patients with peristomal dermatitis.

BACKGROUNDnPeristomal dermatitis is a common problem in patients with ostomies that is a source of considerable morbidity. Irritant contact dermatitis is most common, but allergic contact dermatitis can also occur. Because of the lack of published reports on patch testing for this indication, we undertook a retrospective study of patch testing results in patients with suspected peristomal allergic contact dermatitis.nnnOBJECTIVEnWe sought to describe our patch testing experience with patients referred with peristomal dermatitis.nnnMETHODSnThis was a retrospective review of medical records of patients with ostomies and peristomal dermatitis who underwent patch testing in the Mayo Clinic Departments of Dermatology in Jacksonville, FL; Rochester, MN; and Scottsdale, AZ, during a 10-year period (2000-2010).nnnRESULTSnTen patients with peristomal dermatitis were referred for patch testing (6 in Minnesota, 2 in Florida, and 2 in Arizona). Patients were patch tested to the materials used in their stoma devices, to the standard series, and in some cases to supplemental series. All 10 had at least one allergic patch test reaction, most commonly to stoma paste (3 of 10 patients).nnnLIMITATIONSnRetrospective nature of study via chart review is a limitation.nnnCONCLUSIONnPatch testing is a useful tool for identification of allergens in patients with peristomal dermatitis.

Patch test results may vary depending on where testing is performed: a comparison of patch test results from three geographically distinct sites in the USA

Backgroundu2002 Do patch test results vary from one part of the USA to another? Few reports directly compare the results of patch testing across centers within the USA.

THE DERMATOLOGIST IN MILITARY OPERATIONS

The military dermatologist has a specific and significant role in military operations--in time of war as well as in peace. Many dermatologists are unfamiliar with the impact that our specialty and cutaneous disease has upon the ability of the military to fulfill the missions, duties, and responsibilities assigned by our government. This article highlights a few of the recent or ongoing types of military operations in which our specialty plays a prominent part.

In vitro analysis of lymphocytes: markers and functions.

Current dermatologic literature is becoming replete with articles elucidating current concepts in the pathophysiology of lymphocytic diseases. Much of this knowledge emanates from the increasingly sophisticated and complex methods of identifying lymphocytes. No longer does it suffice to know that B lymphocytes or T lymphocytes are present, but rather the key information involves knowing what subsets of these cells are present and/or their functional status. The reader attempting to assimilate all this information is thus confronted with an overwhelming, as well as frequently changing, array of analytic methods. This paper is presented as a review of thinking, principles, and methods employed in research on lymphocytic disease.