Tanya Greywal

Terra firma-forme dermatosis: A report of ten individuals with Duncan's dirty dermatosis and literature review.

Background: Terra-firma forme dermatosis, also known as Duncan’s dirty dermatosis, is a benign skin condition that presents as dirt-like plaques in patients of all ages. Purpose: We describe a series of ten patients that presented with terra-firma forme dermatosis. Methods and Materials: We reviewed PubMed for the following terms: dermatosis, Duncan’s dirty dermatosis, isopropyl alcohol, terra firma, and terra firma-forme dermatosis. We also reviewed papers containing these terms and their references. Results: The diagnosis of terra firma-forme dermatosis was confirmed in all patients who had complete resolution of each lesion after the application of 70% isopropyl alcohol. Conclusions: Terra-firma forme dermatosis is easily diagnosed and treated with 70% isopropyl alcohol. It is important to recognize this benign dermatologic condition since it can be confused with other cutaneous disorders. Therefore, in order to avoid unnecessary referrals, biopsies, blood tests, and medications, we suggest a trial of wiping the skin lesion with 70% isopropyl alcohol pads when the diagnosis of terra-firma forme dermatosis is considered.

Evidence-based recommendations for the management of acne fulminans and its variants

Background Acne fulminans (AF) is a severe variant of inflammatory acne. It typically manifests as an explosive worsening and ulceration of skin lesions, and can be associated with systemic symptoms. However, there is a paucity of evidence‐based information and no clear guidelines concerning the classification and treatment of AF. Objective To better define the spectrum of AF and its variants, devise optimal therapeutic approaches, and identify areas of future research. Methods A panel of physicians with expertise in severe acne vulgaris was convened after a comprehensive literature review of severe acne variants. Priority topics were reviewed and presented by each panelist at a 5‐hour conference. Following review of the audiotape and scribed notes from the conference, surveys were utilized to address points of controversy and to clarify consensus recommendations. Results Appropriate clinical case presentations and consensus survey questions were utilized to create final recommendations based on both the literature and the expert consensus. Limitations Limited evidenced‐based data and prospective studies in the literature concerning the treatment of AF is available. Conclusion These guidelines better characterize AF and provide health care practitioners approaches to the classification, treatment, and prevention of AF and its variants. Abbreviations used: AF: acne fulminans; AF‐SS: acne fulminans with systemic symptoms; AF‐WOSS: acne fulminans without systemic symptoms; ICP: intracranial pressure; IIAF‐SS: isotretinoin‐induced acne fulminans with systemic symptoms; IIAF‐WOSS: isotretinoin‐induced acne fulminans without systemic symptoms; IL‐1: interleukin 1; PAPA: pyogenic arthritis, pyoderma gangrenosum, and acne; PAPASH: pyogenic arthritis, pyoderma gangrenosum, acne, and hidranitis suppurative; PASH: pyoderma gangrenosum, acne, and hidranitis suppurative; PTCS: pseudotumor cerebri syndrome; SAPHO: synovitis, acne, pustulosis, hyperostosis, and osteitis.

Squamous Cell Carcinoma In Situ Upstaged to Invasive Squamous Cell Carcinoma: A 5-Year, Single Institution Retrospective Review.

BACKGROUND Shave biopsy may not be able to accurately distinguish squamous cell carcinoma in situ (SCCIS) from invasive squamous cell carcinoma (SCC). Information on the incidence of biopsy-proven SCCIS upstaged to SCC after a more complete histologic examination is limited. OBJECTIVE To determine the incidence and clinical risk factors associated with upstaging the biopsy diagnosis of SCCIS into invasive SCC based on findings during Mohs micrographic surgery (MMS). METHODS All MMS cases of SCCIS performed between March 2007 and February 2012 were identified, MMS operative notes were examined, and invasive dermal components were confirmed by the MMS slide review. Upstaged SCCIS was defined as biopsy-diagnosed SCCIS subsequently found to be an invasive SCC during MMS. RESULTS From 566 cases with the preoperative diagnosis of SCCIS, 92 (16.3%) cases were SCCIS upstaged to SCC. Location of ears, nose, lips, and eyelids, preoperative diameter >10 mm, and biopsy report mentioning a transected base were significant predictors of upstaged SCCIS. CONCLUSION Considering the possibility that over 16% of SCCIS may be truly invasive SCC, biopsy-proven SCCIS should be treated adequately with margin-assessed treatment modalities such as surgical excision or Mohs surgery when indicated.

A Slowly Enlarging Tumor on a Child's Leg

A 9-year-old boy from Mexico with no significant medical history presented for evaluation of a slowly enlarging, exophytic tumor on his right posterior lower leg. The lesion had appeared 5 years earlier, after a trauma to the area. The lesion was not pruritic or tender, but it had been intermittently bleeding. The mother reported the boy to be developing and ambulating normally. She denied he had any other skin lesions. Upon presentation, the tumor had received no treatment; no imaging studies were performed. A review of systems was negative for fever, weight loss, and pain. Physical examination revealed a large (6.5 cm 9 9 cm) malodorous, exophytic, verrucous, firm, nontender tumor on the posterior calf of the right lower leg (Fig. 1). What is the diagnosis?

Speckled lentiginous nevus: A rare presentation associated with motor neuropathy and muscular atrophy in a child

Speckled lentiginous nevus syndrome has been described in individuals with a speckled lentiginous nevus with rare associated neurologic deficits. Because speckled lentiginous nevus syndrome almost always affects adults, it is not typically considered when evaluating children. We present the first reported case of speckled lentiginous nevus syndrome presenting in a young child with muscle atrophy and motor deficits affecting muscles along the same distribution as the speckled lentiginous nevus.

Pediatric dermatology procedures and pearls: Multimodal revision of earlobe keloids

Keloid scars are benign proliferations of fibrous tissue and collagen that usually occur in response to cutaneous injury. Many treatment modalities have been described in the literature, with variable rates of recurrence and no clear consensus. Keloids remain a therapeutic challenge to patients and physicians alike. Herein we describe a novel technique for treating recurrent earlobe keloids in an outpatient setting with multimodal therapy including shave removal followed immediately by ablative fractional laser resurfacing (AFR) and laser‐assisted delivery (LAD) of corticosteroids.