Nooshin Brinster

Alopecia areata: An appraisal of new treatment approaches and overview of current therapies

Many therapies are available for the treatment of alopecia areata, including topical, systemic, and injectable modalities. However, these treatment methods produce variable clinical outcomes and there are no currently available treatments that induce and sustain remission. When making management decisions, clinicians must first stratify patients into pediatric versus adult populations. Disease severity should then be determined (limited vs extensive) before deciding the final course of therapy. The second article in this continuing medical education series describes the evidence supporting new treatment methods, among them Janus kinase inhibitors. We evaluate the evidence concerning the efficacy, side effects, and durability of these medications. An overview of conventional therapy is also provided with new insights gleaned from recent studies. Finally, future promising therapeutic options that have not yet been fully evaluated will also be presented.

Alopecia areata: Disease characteristics, clinical evaluation, and new perspectives on pathogenesis

Alopecia areata (AA) is a common, inflammatory, nonscarring type of hair loss. Significant variations in the clinical presentation of AA have been observed, ranging from small, well-circumscribed patches of hair loss to a complete absence of body and scalp hair. Patients affected by AA encompass all age groups, sexes, and ethnicities, and may experience frustration with the unpredictable nature of their disease for which there is currently no definitive treatment. The cause of AA remains incompletely understood, though it is believed to result-at least in part-from a loss of immune privilege in the hair follicle, autoimmune-mediated hair follicle destruction, and the upregulation of inflammatory pathways. Patients with AA frequently experience marked impairment in psychological well-being, self-esteem, and may be more likely to suffer from psychiatric comorbidities. Part one of this two-part continuing medical education series describes the epidemiology, clinical evaluation, prognosis, and recent advancements in the understanding of the pathogenesis of AA.

Unique Presentation of Orf Virus Infection in a Thermal-Burn Patient After Receiving an Autologous Skin Graft

We describe a burn patient who developed skin lesions on her skin-graft harvest and skin-graft recipient (burn) sites. Orf virus infection was confirmed by a combination of diagnostic assays, including molecular tests, immunohistochemical analysis, pathologic analysis, and electron microscopy. DNA sequence analysis grouped this orf virus isolate among isolates from India. Although no definitive source of infection was determined from this case, this is the first reported case of orf virus infection in a skin graft harvest. Skin graft recipients with exposures to animals may be at risk for this viral infection.

Systemic lupus erythematosus and antineutrophilic cytoplasmic antibody-associated vasculitis overlap syndrome complicated by subarachnoid hemorrhage: case-based review

Systemic lupus erythematosus (SLE) and antineutrophil cytoplasmic antibody-associated vasculitis (AAV) overlap syndrome is an inflammatory disorder with a mixed presentation that is characterized by clinical features of both SLE and AAV. Although renal disease predominates, any organ system in the body may be affected. Neurologic manifestation in patients with SLE–AAV overlap syndrome is rare and has only been previously documented as cerebral ischemia. We report a patient with SLE–AAV overlap syndrome diagnosed based on clinical, serologic and biopsy-proven histologic findings who presented with subarachnoid hemorrhage (SAH) secondary to ruptured right anterior cerebral artery aneurysm. To the authors’ knowledge, this is the first reported case of SLE–AAV overlap syndrome diagnosed in a patient with a SAH due to an intracranial aneurysm. Neurologic involvement in patients with SLE–AAV overlap syndrome is uncommon and has not been well-studied. Clinicians who encounter patients with neurologic signs that present with symptoms and a serologic profile that correspond to both SLE and AAV criteria, should consider the association between SLE–AAV overlap syndrome and a hemorrhagic stroke, specifically SAH.

Calciphylaxis with Pseudoxanthoma Elasticum-like Changes: A Case Series

Calciphylaxis and pseudoxanthoma elasticum (PXE) are rare, clinically distinct disorders that share a common feature of cutaneous calcification and that vary widely in their cutaneous presentation.

Cold panniculitis: Adverse cutaneous effect of whole-body cryotherapy

WBC: whole-body cryotherapy INTRODUCTION Whole-body cryotherapy (WBC) involves exposure to extremely cold air (below -1108C) in an enclosed space for several minutes. It has been increasingly used in recent years as a treatment for muscle soreness after exercise, with many claiming it also has widespread cosmetic benefits. However WBC does not have US Food and Drug Administration approval. In addition, a 2015 Cochrane review determined there is insufficient evidence to support the claims of its benefits or safety. Here we report a case of cold panniculitis that occurred after exposure to WBC.

Superficial granulomatous pyoderma of the leg improved after conservative management with Unna boot and intralesional steroid injections

INTRODUCTION Superficial granulomatous pyoderma (SGP) is a rare condition that some regard as a variant of pyoderma gangrenosum (PG) given their clinical similarities; however, SGP is distinct in its cutaneous presentation, histology, lack of underlying disease, and prognosis. Treatment options have ranged from oral antibiotics to oral and intralesional steroids, immunomodulatory agents, and intravenous immunoglobulin (IVIG), among others. We describe a case of long-standing SGP that responded to conservative management with Unna boot and intralesional steroid injections.

Systemic lupus erythematosus and antineutrophil cytoplasmic antibody–associated vasculitis: An emerging overlap syndrome with cutaneous manifestations

AAV: antineutrophil cytoplasmic antibodyeassociated vasculitis ACR: American College of Rheumatology ANA: antinuclear antibody ANCA: antineutrophil cytoplasmic antibody anti-MPO: antimyeloperoxidase MCTD: mixed connective tissue disease p-ANCA: perinuclear antineutrophil cytoplasmic antibody RNP: ribonucleoprotein SLE/AAV: systemic lupus erythematosus antineutrophil cytoplasmic antibodyeassociated vasculitis overlap syndrome INTRODUCTION Systemic lupus erythematosus and antineutrophil cytoplasmic antibody (ANCA)eassociated vasculitis (SLE/AAV) overlap syndrome is a rare disease originally described in 2008. With only a few reports in the literature, this condition is characterized by aggressive crescentic glomerulonephritis, arthritis, cutaneous involvement, and both antinuclear antibody (ANA) and ANCA. Dermatologic manifestations are common and may occur at initial presentation. Although skin lesions may vary in morphology, the most commonly reported include cutaneous nodules and ecchymoses. Few reports have characterized the cutaneous findings seen in this disorder. We report a young woman with SLE/ AAV overlap syndrome who presented with a macular eruption and histopathology findings demonstrating interface dermatitis.

Genital ulcers in an immunocompromised man

A 72-year-old man with a history of type 2 diabetes, renal transplant, long-term immunosuppression with prednisone and tacrolimus, and a recent diagnosis of posttransplant lymphoproliferative disorder, presented with a 2-week history of worsening headaches and blurry vision. Physical examination was notable for a left facial droop and 4 genital ulcerations: 2 on the left medial thigh and 2 on the left lateral scrotum. The ulcerations had well-defined pink raised borders and a thin yellowmembrane overlying the base (Fig 1). Results of a punch biopsy are shown (Fig 2).

Tick bite mimicking indeterminate cell histiocytosis

Ticks are a well‐known vector for viral, bacterial, and rickettsial infections, many of which are accompanied by cutaneous eruptions, but the bite itself can induce a spectrum of inflammatory reactions, including foreign body granuloma, tick bite alopecia, and cutaneous lymphoid hyperplasia. We describe the development of an indeterminate cell histiocytic infiltrate at the site of a tick bite. Although the etiology of intermediate cell histiocytosis is not well understood, this case raises the possibility that such infiltrates may represent an inflammatory reaction in some patients.