Navid Ezra

The beak sign: a clinical clue to airborne contact dermatitis.

1. Warshaw E. Contact dermatitis conundrums. American Contact Dermatitis Society 24th Annual Meeting. Miami Beach, FL: American Contact Dermatitis Society; 2013. 2. Bruze M. Thoughts on standardization of multicenter patch test studies. American Contact Dermatitis Society 24th Annual Meeting. Miami Beach, FL: American Contact Dermatitis Society; 2013. 3. Bruze M, Isaksson M, Gruveberger B, et al. Recommendation of appropriate amounts of petrolatum to be applied at patch testing. Contact Dermatitis 2007;56:281Y285. 4. Jaimes JP, Liu A, Bhardwaj SS, et al. Optimizing reproducibility for clinical studies involving patch testing and application of topical preparations. Dermatitis 2006;63:284Y288. 5. Engfeldt M, Gruveberger B, Isaksson M, et al. Comparison of three different techniques for application of water solutions to Finn chambers. Contact Dermatitis 2010;63:284Y288.

The microsecond 1064 nm Nd:YAG laser as an adjunct to improving surgical scars following Mohs micrographic surgery.

Background: Scarring following skin surgery is an unavoidable certainty. Scars resulting from Mohs Micrographic Surgery (MMS) can cause both cosmetic and functional problems. Various lasers have been used to treat scars, but the role of the microsecond pulsed 1064 nanometer neodymium-doped yttrium aluminum garnet (1064 nm Nd:YAG) in treating surgical scars is not well-defined. Objective: We aim to examine the clinical application of the 1064 nm Nd:YAG laser in improving surgical scars. Methods: Ten patients who were unhappy with cosmetic or functional outcomes of their surgical scars following MMS were treated with 1–3 sessions of the 1064 nm Nd:YAG laser to improve their scars. Therapy completion was determined by patient satisfaction with the appearance of their scars and/or resolution of any contractures that formed following surgery. Results: All ten patients were pleased with the improved appearance of their scars. Four patients saw complete resolution of an ectropion or eclabium that formed secondary to scar contractures from MMS. The side effects of laser treatments were limited to 1–2 hours of erythema, and there were no incidences of adverse effects or recurrence of contractures. Conclusion: Our clinical experience with the 1064 nm Nd:YAG laser provides promising data on improving appearance of and functionality from post-surgical scars.

Dermatologic Signs and Symptoms of Substance Abuse

Various substances of abuse are known to cause specific cutaneous manifestations. In this review, we highlight the cutaneous manifestations associated with the use of cocaine, heroin, marijuana, methamphetamine, alcohol, and anabolic steroids. Cutaneous signs of tanning addiction are also discussed, as tanning bed use is a particularly relevant and growing problem in Dermatology. We also provide examples of general signs of drug abuse, including stigmata of injection drug use, vascular complications, and infectious complications. This review aims to make clinicians more aware of these signs in order to better recognize substance abuse disorders and guide effective treatment.

Eruptive disseminated porokeratosis associated with corticosteroid-induced immunosuppression

Eruptive disseminated porokeratosis (EDP) is a disease that presents clinically with sudden onset of erythematous papules and plaques, with a ridge‐like border histologically represented by a cornoid lamella. We report a case of EDP occurring in a 39‐year‐old woman 3 days after completion of a 2‐week course of oral corticosteroid therapy for an acute asthma exacerbation. The patient was treated with emollients and sun protection. Unlike the more chronic disseminated superficial (actinic) porokeratosis, EDP secondary to immunosuppression from corticosteroid therapy has very rarely been reported in the dermatological literature.

Topical Keratolytics for a Case of Porokeratotic Eccrine Ostial and Dermal Duct Nevus

Porokeratotic Eccrine Ostial and Dermal Duct Nevus (PEODDN) is a rare disorder of keratinization characterized by the presence of cornoid lamellae and association with eccrine sweat ducts. These lesions are usually benign and asymptomatic, so treatment is often for cosmetic purposes. Current therapies for PEODDN are either insufficient or impractical. We present a case of PEODDN treated with topical tretinoin 0.05% cream and 5-fluorouracil 5% cream with the hopes of providing an efficacious, financially relevant, and well-tolerated treatment regime for PEODDN. The combination of topical tretinoin and 5-fluorouracil did not provide substantial improvement in the lesions of a patient treated with this therapy for 6 weeks, and further studies are needed to identify an efficacious treatment for PEODDN that is both well-tolerated and economically feasible for patients with this condition.

Litigation arising from the use of soft-tissue fillers in the United States.

E., Peacock, E. A., Keele, B. J., and Kingsley M. (2015). Litigation arising from the use of soft-tissue fillers in the United States. Journal of the American Academy of Dermatology 73(4), 702-704.

Drug-Induced Acneiform Eruptions

Acne vulgaris is a polymorphic inflammatory skin disease, clinically characterized by mixture of comedones, superficial and deep inflamed papules, pustules, and nodules. It is a chronic inflammation of the pilosebaceous unit. Acneiform drug eruptions are a monomorphic inflammatory skin disease lacking comedones with lesions typically in the same stage. This type of drug eruption has an abrupt onset and is often associated with various medications (Table 54.1). The pathogenesis of acneiform drug eruptions is poorly understood; documented evidence when available will be presented under the specific drug categories in this chapter.

Successful use of the microsecond 1,064-nm Nd: YAG laser as a novel treatment for surgical scar contractures on free margins.

Scar contractures are a common complication after cutaneous surgery. Contractures that occur at free margins on patients after Mohs micrographic surgery (MMS) can be especially troublesome and can lead to cosmetic issues anddeformities such as an ectropionor eclabium. These deformities can lead to functional problems and must be treated to prevent further complications. This 4-patient case series looks at a noninvasive and nondebilitating treatment for surgical contractures. The aim of this study was to evaluate the safety and efficacy of treatment of surgical scar contractures on free margins with the microsecond-pulsed 1,064-nm neodymium-doped yttrium aluminum garnet (1,064-nm Nd:YAG) laser.

Estrogen dermatitis presenting as gyrate erythema treated with leuprolide.

A 37-year-old woman presented with a 20-year history of an extremely pruritic and, at times, painful symmetrical gyrate erythema with a trailing scale involving the central chest expanding centrifugally over the medial aspect of both breasts. The dermatosis would predictably fluctuate in extent and intensity with each menstrual cycle (Fig. 1). The gyrate erythema would arise the day after completion of the menstrual period, and the extent and severity would peak around midcycle. Thereafter, the raised erythematous edge and trailing scale would subside considerably and become asymptomatic until after the next menstrual period. As her clinical features strongly suggested hypersensitivity to female sex hormones, an intradermal skin test to establish the diagnosis of estrogen dermatitis was performed using the following protocol. An EpiPen and injectable diphenhydramine were made available before proceeding with testing. Two hormonal products (conjugated estrogen 25-mg vial and medroxyprogesterone of 150-mg/mLsuspension)were diluted to a concentrationof 1mg/mL, and 0.1 mL (100 mcg) injected intradermally to different locations, as well as histamine and normal saline positive and negative controls, respectively. Immediate results were read for 15 minutes. In cases where no wheal or flare is seen, patch testing can then proceed with 48and 96-hour readings per protocol. The intradermal skin test in this patient conducted on the flexural forearms showed reactivity to estrogen and positive control at 15 minutes. Negative control and progesterone showed no reaction. The patient was treated with the gonadotropin releasing hormone analogue leuprolide as an 11.25-mg injection every 3 months. If gonadotropin releasing hormone is administered in a continuous manner, such as is achieved with leuprolide treatment, then the function of the pituitary gland is suppressed, decreasing folliclestimulating hormone and luteinizing hormone secretion and ultimately decreasing sex hormone production. Following a single dose of leuprolide, her dermatosis improved after 3 days, demonstrating a quicker resolution than her natural disease course, and remained clear thereafter. No severe long-term side effects of leuprolide have been reported in the literature using an equivalent dose to 3.75 mg monthly. The patient only reported mild hot flashes after the initial dose. Because of preexisting dyspareunia and symptomatic fibroids, however, the patient underwent hysterectomy and oophorectomy after her third dose of leuprolide, representing the definitive treatment of estrogen dermatitis. To the best of our knowledge, this is the first case of estrogen dermatitis documented in the literature to develop in the period immediately after the end of menses, as most cases show onset before the start of menses.2 When correlating the course of our Figure 1. Clinical presentation of estrogen dermatitis. A, Gyrate erythema manifesting as an erythematous lichenified scaly annular plaque on the central chest. B, Complete clearance after leuprolide treatment.