Nordau Kanigsberg

Alopecia Areata following Adalimumab

Background: Alopecia areata is a nonscarring hair loss characterized by well-circumscribed patchy areas, most often on the scalp. The inflammatory cytokine tumor necrosis factor alpha (TNF-α), has been connected with the development of alopecia areata in vivo; thus, the TNF-α inhibitors have been cited as possible treatments for this autoimmune condition. Objective: We report a case of alopecia areata that developed in a 52-year-old woman who was recently started on adalimumab for treatment of her psoriatic arthritis. Results: We discuss the previously published cases in the literature linking alopecia areata to TNF-α inhibitor administration. Our case is the first report of a new-onset alopecia areata following adalimumab. Conclusions: Even though TNF-α is implicated in causing alopecia areata, TNF-α inhibitors have paradoxically been associated with new cases of alopecia areata. It is possible that TNF-α may not be involved in the pathogenesis of alopecia areata, as in vitro studies have suggested.

Cutis Marmorata Telangiectatica Congenita and Neonatal Lupus

Abstract:  Cutis marmorata telangiectatica congenita is an uncommon congenital vascular anomaly that is characterized by persistent, reticulated, violaceous pigmentation. We describe a female infant with vascular lesions consistent with this entity who was born to a mother with previously diagnosed systemic lupus erythematosus. Antinuclear antibodies and anti‐Ro/SSA antibodies were detected in both mother and infant, supporting a diagnosis of neonatal lupus. This presentation is consistent with the rarely reported association between neonatal lupus and cutis marmorata telangiectatica congenita that suggests the latter is part of the cutaneous spectrum of the former. A thorough maternal history and laboratory investigations should be considered for infants with cutis marmorata telangiectatica congenita and their mothers in order to rule out the presence of an underlying autoimmune disease.

The Effectiveness of Written Action Plans in Atopic Dermatitis.

Atopic dermatitis (AD) is a chronic dermatosis requiring a stepwise and dynamic approach to management. The use of written action plans has been shown to improve outcomes in other chronic diseases that require a similar incremental approach. A systematic review was performed to evaluate the effect of a written eczema action plan (EAP) in AD management and to identify characteristics of effective action plans in children with eczema. Only two trials were identified as eligible, which highlights the need for more research on EAPs.

Becker nevus on the lower limb: case report and review of the literature.

Background: Becker nevus is a hamartoma with brown hyperpigmentation and hypertrichosis that usually affects young males. It has a predilection for the upper half of the trunk and proximal upper extremity. Objective: This is a case report of a 38-year-old male with a Becker nevus without hypertrichosis on the lower limb and a review of the literature. Results: Including our case report, 12 cases of Becker nevus on the lower limb were identified in the English literature (8 males and 4 females). It has never been reported below the knee. In males, the lesion was not associated with other anomalies, and all but two showed hypertrichosis (six of eight). In 50% (two of four) of women, it was associated with localized lipoatrophy. In one woman, it presented without hypertrichosis. Conclusion: The presence of Becker nevi on the lower limb is unusual, and hypertrichosis is not always a feature. Larger studies are required to look into the true prevalence of this presentation and its prognostic value as a marker for other anomalies.

Canaries in the Mineshaft: The Dermatology Workforce Shortage in Eastern Ontario

Background: The number of dermatology residency positions in Canada has not reflected the growing workforce shortage. Until 2005, all dermatology residents at the University of Ottawa were committed to return to their funding area at the completion of their training. This has left Eastern Ontario with a critical shortage of dermatologists. Objective: To survey dermatologists practicing in Eastern Ontario to understand the basis of the workforce shortage and outlook for the future. Methods: Mailed surveys sent in 1999, 2003, and 2006 to all dermatologists in Eastern Ontario requesting demographic information, workload data, and future career plans. Results: There was a 100% response rate in each survey year. Between 1999 and 2006, the total number of practicing dermatologists decreased from 26 to 23, whereas the average age increased from 51.4 to 57.4 years. The waiting time to see new and returning patients increased, from 5.8 to 18.5 weeks and 4.9 to 11.8 weeks, respectively. Ten of the 23 dermatologists practicing in 2006 plan to retire within the next 5 years. Conclusions: The inadequate supply of dermatologists in Eastern Ontario will increasingly threaten patient care. This emphasizes the need for additional funding for dermatology training positions, continued mentorship, and improved dermatology training for nondermatologists.

Dynaclose Tape: A Practical Alternative to Punch Biopsy Site Closure

Background: A punch biopsy is a common therapeutic and diagnostic procedure that is routinely performed by dermatologists. A thin cylinder of tissue is removed with a biopsy punch, which creates a full-thickness wound. Sutures are used for primary closure as part of standard practice and are removed in follow-up 5 to 14 days later. The biopsy site heals with a small linear scar. In the past, punch biopsies were often left to heal by secondary intention, but given the extended healing time, this has fallen out of practice among dermatologists. Objective: The purpose of this case report is to introduce a new quick and cost-effective approach to accelerate secondary intention healing following punch biopsies in busy dermatology clinics. Results/Conclusion: We present a case where Dynaclose tape (Canica Design Inc, Almonte, ON) was used as an alternative to sutures for biopsy site closure. Dynaclose tape is a strip with adhesive ends and a clear center composed of silicone elastomer. The silicone elastomer promotes wound closure by pulling the opposing margins together. The tape maintains excellent adhesion and follows the natural shape of the skin to maximize patient comfort and mobility.

Actinic superficial folliculitis in a 29-year-old man.

Background: Since actinic superficial follicultis was first described in 1985, only three further cases have been published. The characteristics of this disease are monomorphous, superficial, follicular pustules that appear on the back, upper chest, and shoulders annually after the first sun exposure of the year. The lesions resolve on their own within 10 days. Recurrence occurs under similar conditions after a latency period of at least 4 weeks. Methods: A 29-year-old man presented to our clinic with a 5-year history of an intermittent follicular rash. These eruptions occurred on his back and chest only when he was exposed to the sun, with his shirt off. They developed 24 to 36 hours after the first sun exposure of the year and resolved spontaneously after 5 to 7 days. Photographs of the affected area were impressive, with follicular pustules grouped along his left flank. Conclusion: According to our literature search, this is the sixth reported case of actinic superficial folliculitis. This is the first case in which provocative phototesting was done. We review the clinical and pathologic attributes of actinic superficial folliculitis.

Incidence of cutaneous malignant melanoma in the Ottawa region: 1996 to 2006.

Background: The incidence rates of invasive primary cutaneous malignant melanoma in Canada have shown a gradual tapering in recent years, after decades of increases. This trend suggests that the incidence of melanoma in Canada is stabilizing; however, knowledge of the recent trend for both in situ and invasive tumors was lacking. Objective: The purpose of this study was to examine the temporal trend of both in situ and invasive melanoma within the Ottawa region over a 10-year period. Methods: The histopathology of cutaneous melanomas diagnosed in the Ottawa region was obtained for the years 1996, 2001, and 2006 from the main diagnostic centers servicing the area; however, not all melanomas have been accounted for. All rates are expressed per 100,000 population per year. Results: Melanoma incidence decreased between 1996 and 2001 (–3.83) and increased between 2001 and 2006 (+7.46; p ≤ .05). This increase is mainly attributable to in situ melanoma (+5.49; p ≤ .05). There has been no statistically significant change in invasive melanoma. Conclusions: Invasive melanoma incidence in the Ottawa region remained stable, whereas in situ melanoma incidence increased.

Pediatric Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Halted by Etanercept

We report a case of an 11-year-old female with Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) overlap, most likely triggered by sulfamethoxazole-trimethoprim, who was treated with the combination of methylprednisolone, cyclosporine, and etanercept. Her condition stabilized and her skin involvement did not progress after the addition of etanercept. To our knowledge, this is the first report of etanercept for pediatric SJS/TEN.

Differential diagnosis of a pink nodule with a blue globule

the Division of Dermatology, Department of Medicine, niversity of Ottawa, and the School of Medicine, Queen’s niversity, Kingston. ing sources: None. anigsberg serves in an advisory role for Pierre Fabre and has ceived honoraria for his work. This role is unrelated to the ork presented here. All other authors have no conflicts of terest to declare. Reprint requests: Jennifer Beecker, MD, Division of Dermatology, Department of Medicine, University of Ottawa, The Ottawa Hospital Civic Campus, Ground Floor East, Rm 13, 737 Parkdale Ave, Ottawa, Ontario K1Y. E-mail: jbeecker@ottawahospital.on.ca. J Am Acad Dermatol 2014;71:e191-3. 0190-9622/