2. Venous thromboembolism in patients with
pemphigus: A cohort study
Yael Anne Leshem, MD Lihi Atzmony, MD, Israel
Dudkiewicz, MD, Emmilia Hodak, MD, Daniel Mimouni,
MD
August 2017 Volume 77, Issue 2, Pages 256–260
3. Objective
Possibility of venous
thromboembolism as a cause of
morbidity/mortality in pemphigus
patients
5. Results
10 patients (6%) had a VTE, with a median
of 4 months time from the diagnosis
5 were DVT, 4 were PE, 1 had both
6. Conclusion and practice
VTE is not rare in patients with pemphigus
To possibly screen for it through physical
exam/coagulation profile during visits in
the first year of diagnosis
7. Association between bullous pemphigoid
and psoriasis: A case-control study
Khalaf Kridin, MD, Reuven Bergman, MD
August 2017Volume 77, Issue 2, Pages 370–372
8. Methods
study consisted of 287 patients newly
diagnosed with BP between 2000 and 2015
and 1373 age-, sex-, and ethnicity-
matched control subjects
10. Possible explanations
may be due to the antigenicity of the
basement membrane in psoriasis patients
being altered at a younger age,
stimulating antibasement membrane
autoantibody formation and BP
development earlier in life.
11. Conclusion and practice
There exists a significant association
between BP and Psoriasis
To add the possibility of BP in the DDx of
any patient, especially elderly, with
psoriasis that has presented with
unexplained blistering, urticarial lesions
or chronic pruritus.
12. Therapeutic Pearl : Liquid nitrogen
cryotherapy in the treatment of chronic,
unresponsive nodular scabies
Vijay Zawar, MD, DNB, DVD, FRCP
(Edin), Manoj Pawar, MD
Skin Disease Centre, Nashik, India
August 2017Volume 77, Issue 2,
Pages e43–e44
13. Challenge
Nodular scabies can lead to chronic pruritic prurigo
nodularis-like lesions , even after successful treatment
of scabies
Possibly explained as a hypersensitivity reactions to
particles of mites
14. Proposed solution
LNT for 2 cycles of 10 seconds to each
lesion
Followed by azithromycin 500mg OD
treatment for 3 days with topical
mupirocin until lesions heal
16. August CME : Bedside
Diagnostics in Dermatology
Robert G. Micheletti, Arturo R.
Dominguez, MD, Karolyn A. Wanat, MD
Excellent 2 part series of articles
17. Therapeutic pearl: Fractional carbon
dioxide laser in combination with topical
corticosteroid: An innovative treatment for
hypertrophic lichen planus
Imran Majid, MD
CUTIS Institute of Dermatology, Srinagar, Jammu and
Kashmir, India
September 2017 Volume 77, Issue 3, Pages e67–e68
19. Solution
fractional CO2 laser at 4-week intervals at
a fluence of around 60 J/cm2
topical clobetasol gel twice daily
between the laser sessions
20. Results
Excellent results are obtained with
complete or near-complete
clearance after 3 or 4 sessions
In the photo, circled lesion was
treated with combination treatment
and right sided lesion with topical
clobetasol alone
21. Multiple and repeated sampling increases
the sensitivity of direct
immunofluorescence testing for the
diagnosis of mucous membrane pemphigoid
Julia Marie Nitz, Detlef Zillikens, MD
Department of Dermatology, University of Lübeck,
Lübeck, German
October 2017 Volume 77, Issue 4, Pages 700–705.e3
22. Background
MMP has been known to have a low
sensitivity of DIF positivity when
compared to BP and PV
24. Methods
Reviewed the DIF results of 136
patients who were immunologically
confirmed to have MMP
25. Results
85% of patients who had more than one
biopsy sent for DIF at the initial workup
showed positive DIF compared to 69% of
patients who had only one sample
95% of patients showed positive DIF when
subsequent work-ups were done
26. Conclusions and practice
More than one samples give a higher rate
of positive DIF in the diagnosis of MMP
Whenever considering a diagnosis of MMP,
consider sending more than one biopsy
sample
27. Effect of voriconazole on risk of
nonmelanoma skin cancer after
hematopoietic cell transplantation
Presented at the 58th American Society of
Hematology Annual Meeting and
Exposition, San Diego, CA; December 2-4,
2016.
Lawrence F. Kuklinski, BA, Shufeng Li, MS,
Margaret R. Karagas, PhD, Wen-Kai Weng,
MD, Bernice Y. Kwong, MD
October 2017 Volume 77, Issue 4, Pages 706–712
29. Methods
Retrospective review of 1220 patients
who had allogenic HSCT and 1418 patients
who had undergone autologous HSCT
30. Results
Voriconazole showed an increased
incidence of NMSC in patients who had
undergone allogenic HSCT (1.82 hazard
ratio) but DID NOT show an increased risk
in those who had autologous HSCT
31. Conclusion and practice
Voriconazole, which had already been
shown in the past to increase risk of SSC
in solid organ transplant recipients, has
been shown to increase risk of NMSC in
patients undergoing Allogenic HSCT
32. Research Letter : Human papilloma virus
expression in immunocompetent patients
with actinic keratosis: A case series
Caterina Dianzani, MD, PhD, Francesca Paolini, PhD,
Claudio Conforti, MD, Elisabetta Riva, PhD, Emanuela
Beninati, MD, Aldo Venuti, MD, PhD
October 2017 Volume 77, Issue 4, Pages 770–772
33. Methods
Fresh samples from 40 patients with AK
were tested for HPV DNA using PCR
Samples from AK’s and healthy skin were
tested from each patient
34. Results
88.8% of AK lesions showed positivity for
HPV vs. 62% of healthy skin
Most common HPV serotype were 36 and
107
36. Research letter: Prevalence of
clinical signs of activity in Vitiligo
patients
Nader Aboul-Fettouh, BS, Jorge
Hinojosa, BA, Andrea Tovar-Garza, MD,
Amit G. Pandya
Department of Dermatology, University
of Texas Southwestern Medical Center,
Dallas, Texas
October 2017 Volume 77, Issue 4, Pages 774–775
37. Objectives
To assess the prevalence of three well
established signs of disease activity in
vitiligo patients
- Confetti lesions (black arrow)
- Trichrome lesions (white arrow)
- Koebner phenomenon
39. Conclusion and practive
Majority of patients who had active
vitiligo showed at least one of the three
markers of disease activity
Highly encouraged to examine all vitiligo
patients for these three markers
40. Clinical pearl : Use of Wood's lamp to
diagnose progressive macular
hypomelanosis
Rachel T. Pflederer, MD, John Paul
Wuennenberg, BA, Caitlyn Foote, MD,
Daniel Aires, MD, JD, Anand Rajpara, MD
October 2017 Volume 77, Issue 4, Pages e99–e100
41. Background and challenge
Progressive macular hypermelanosis is a condition
presenting with multiple hypopigmented macules all
over the trunk
Very commonly misdiagnosed as PIH or P.versicolor
42. Solution
Woods lamp examination
shows characteristic
punctate orange-red
follicular fluorescence
Likely arises due to p.acnes,
which is thought to be the
cause of the condition
43. Conclusion and practice
Use woods lamp examination in patients
which persistent lesions of PIH and
P.versicolor
Treatment of PMH is topical clindamycin
or topical benzoyl peroxide +/- NBUVB
44. Therapeutic pearl : “Two-step
phototherapy” for treatment-resistant
psoriasis on the lower extremities
aleb Jeon, BS, Mio Nakamura, MD
Department of Dermatology, University of California–
San Francisco, San Francisco, California
October 2017 Volume 77, Issue 4, Page e101
45. Challenge
Psoriasis on the distal lower extremities is
notoriously treatment-resistant
Dose of phototherapy from the middle of
the light bulb is much higher than the top
and bottom
47. Step 1
Patient stands on a stool and is exposed
to phototherapy, then the patient steps
off the stool and receives regular
phototherapy
Face and genitalia to be covered
48. Step 2
Patient steps on stool again and receives
phototherapy to the lower extremeties
while the rest of the body is covered
49. Results
Higher rates of patients treated with this
form of phototherapy responded
compared to regular phototherapy
50. Therapeutic pearl: Recognizing and
overcoming phototherapy-induced
initiation burn
Caleb Jeon, BS, Mio Nakamura, MD
Department of Dermatology, University
of California, San Francisco, California
October 2017 Volume 77, Issue 4, Page e103
51. Challenge
‘’initiation burns’’ are fairly commonly
encountered in clinical practice
Patients tend to refuse further
phototherapy
52. Solution
Abrubt treatment of pruritic and
‘’burned’’ areas with topical steroids
Resumption of treatment with
phototherapy at extremely low doses and
slower increment of dose each time
53. Suggested dosing protocol for a patient with initiation burn
Type of UV Initial dose, mJ/cm2
Subsequent dose
increments, mJ/cm2
Narrowband UV-B 30 10-30
Broadband UV-B 5 5-10
Psoralen + UV-A 0.25 0.5
54. Risk of malignancy with systemic psoriasis
treatment in the Psoriasis Longitudinal
Assessment Registry
David Fiorentino, MD, Vincent Ho, MD,
Mark G. Lebwohl, MD, Luiz Leite, MD,
Lori Hopkins, PharmD, Claudia Galindo,
MD, Kavitha Goyal, MD, Wayne
Langholff, PhD, Steven Fakharzadeh,
MD, PhD, Bhaskar Srivastava, MD, PhD,
Richard G. Langley, MD
Mount Sinai, NY, USA
November 2017 Volume 77, Issue 5, Pages 845–854.e5
55. Objective
Evaluation of the impact of Systemic
Treatment for psoriasis on the risk of
malignancy
To determine if the increase risk of
malignancy in psoriasis is related to the
disease itself or the immunosuppression
related to the systemic treatment
56. Methods
Prospective case-control study of 12090
patients with psoriasis
Compared MTX, anti TNF and
Ustekinumab
Divided each into three groups: 0-3
months on treatment, 3-12 months on
treatment, and more than 12 months of
treatment
57. Results
252 malignancies identified (excluding
NMSC)
Most common malignancies were (highest
to lowest): breast, prostate, lung,
melanoma, lymphoma
MTX and Ustekinumab were not
associated with higher risk of malignancy
Long term (>12 months) of treatment with
Anti TNF agents was associated with
increased risk (odds ratio 1.34)
58. Conclusion and practice
Long term treatment with Anti-TNF
agents for psoriasis appears to be
associated with higher risk of cancer
59. Folate and phototherapy: What should we
inform our patients?
Myron Zhang, MD, Gregory Goyert, MD,
Henry W. Lim
November 2017Volume 77, Issue 5, Pages 958–964
60. Objectives
Ultraviolet (UV) degradation of folate has
been studied in vitro and in vivo
To review effects on folate blood levels in
patients undergoing phototherapy and
provide adequate recommendation for
women of childbearing age
61. Methods
PubMed was searched for in vivo studies
comparing folate levels before and after
phototherapy.
Studies on folate levels with
sun,UVA,UVB,PUVA exposure from 1946 to
2016 were included
62. Results
No evidence of reduced folate levels after
UVA or Sun exposure
Exposure to NBUVB phototherapy at > 40
J/cm2 cumulatively and >2 J/cm2 per
treatment was associated with 19-27%
decrease in folate levels
Lower doses of NBUVB have not been
associated with decreased folate levels
63. Conclusion and practice
Since many pregnancies are unplanned
and low folate levels are associated with
NTD’s, it is recommended that women of
childbearing age to receive daily folate
supplementation for the duration of the
phototherapy
