Blue Papules in a Child: Family History Might Prevent Diagnostic Tears.

A healthy 14-month-old boy presented with firm and grouped blue papules in the right mid area of the back and the right peri-anal area (Figure 1). The lesions first appeared when the boy was a 6- or 9-month old, gradually increasing in number to a total of six lesions. The child was delivered full-term with no complications, had no medical issues, and no personal or family history of gastrointestinal bleeding or anemia.

Acquired Lymphangiectasia in the Setting of a Gastrointestinal Stromal Tumor.

A 53-year-old woman presented for a skin cancer screening and was found to have scattered violaceous papulovesicles on the right buttock and right lower aspect of the abdomen. These lesions had been increasing in number for 3 years. The patient denied pain or pruritis at the site of lesions and denied any systemic fi ndings.

Human Papillomavirus and Genital Warts: A Review of the Evidence for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines.

To provide updates for the 2015 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines on human papillomavirus (HPV) and anogenital warts (AGWs), a review of the literature was conducted in key topic areas: (1) epidemiology and burden of disease; (2) transmission and natural history; (3) diagnosis and management of AGWs; (4) occupational exposure of healthcare workers; (5) anal cancer screening among men who have sex with men (MSM); and (6) HPV vaccine recommendations. Most sexually active persons will have detectable HPV at least once in their lifetime; 14 million persons are infected annually, and 79 million persons have prevalent infection. HPV is transmitted frequently between partners; more frequent transmission has been reported from females to males than from males to females.

Scabies and Bacterial Superinfection among American Samoan Children, 2011-2012.

Background: Scabies, a highly pruritic and contagious mite infestation of the skin, is endemic among tropical regions and causes a substantial proportion of skin disease among lower-income countries. Delayed treatment can lead to bacterial superinfection, and treatment of close contacts is necessary to prevent reinfestation. We describe scabies incidence and superinfection among children in American Samoa (AS) to support scabies control recommendations.

Acute rheumatic fever and rheumatic heart disease among children--American Samoa, 2011-2012.

Acute rheumatic fever is a nonsuppurative, immune-mediated consequence of group A streptococcal pharyngitis (strep throat). Recurrent or severe acute rheumatic fever can cause permanent cardiac valve damage and rheumatic heart disease, which increases the risk for cardiac conditions (e.g.

Congenital syphilis investigation processes and timing in Louisiana.

Background: Congenital syphilis (CS) is a potentially life-threatening yet preventable infection. State and local public health jurisdictions conduct investigations of possible CS cases to determine case status and to inform public health prevention efforts. These investigations occur when jurisdictions receive positive syphilis test results from pregnant women or from infants.

Prevaccine era human papillomavirus types 6, 11, 16 and 18 seropositivity in the U.S.A., National Health and Nutrition Examination Surveys, 2003-2006.

Background: A vaccine is available to prevent human papillomavirus (HPV) 6, 11, 16 and 18; in the prevaccine era, seropositivity to vaccine types is a measure of natural exposure.

Methods: We describe HPV seropositivity in the USA among 14-59-year-olds using the 2003-2006 National Health and Nutrition Examination Surveys.

Results: Seropositivity to HPV 6, 11, 16 and 18 was 17.

Coxsackievirus A6-induced hand-foot-mouth disease.

Importance: Hand-foot-mouth disease (HFMD) is an acute, self-limited, highly contagious viral illness that commonly affects children younger than 5 years. It is most typically caused by enterovirus 71 or coxsackievirus A16 and results in asymptomatic infection or mild disease. Immunocompetent adults are rarely affected.

Expedited partner therapy in federally qualified health centers--New York City, 2012.

Background: Management of patients' sex partners is a critical element of sexually transmitted disease (STD) control. Expedited partner therapy (EPT), a practice in which patients deliver medication or a prescription directly to their partners, is one option for partner management. As of 2009, New York State law specifically allows EPT for chlamydial infection.

Prevalence of circumcision among men and boys aged 14 to 59 years in the United States, National Health and Nutrition Examination Surveys 2005-2010.

Background: In 2009, an estimated 3590 new heterosexually acquired HIV infections occurred in males in the United States. Three randomized controlled trials demonstrated that male circumcision decreased a man's risk for HIV acquisition through heterosexual sex. We describe circumcision prevalence in US males and determine circumcision prevalence among males potentially at increased risk for heterosexually acquired HIV infection.

Challenges in congenital syphilis surveillance: how are congenital syphilis investigations classified?

Background: Congenital syphilis is a serious, preventable, and nationally notifiable disease. Despite the existence of a surveillance case definition, congenital syphilis is sometimes classified differently using an algorithm on the Centers for Disease Control and Prevention's case reporting form.

Methods: We reviewed Louisiana's congenital syphilis electronic reporting system for investigations of infants born from January 2010 to October 2011, abstracted data required for classification, and applied the surveillance definition and the algorithm.

Improvement in peripheral blood disease burden in patients with Sézary syndrome and leukemic mycosis fungoides after total skin electron beam therapy.

Background: There is a paucity of effective therapies for patients with Sézary syndrome and advanced mycosis fungoides with peripheral blood involvement. Total skin electron beam (TSEB) radiation therapy is an extremely effective skin-directed therapy for these patients, but, until recently, it was thought not to signifcantly affect the peripheral blood malignant T-cell population.

Objective: We conducted this study to determine if TSEB has therapeutic effect on the peripheral blood in patients with advanced mycosis fungoides and Sézary syndrome.

Hospitalization cost of congenital syphilis diagnosis from insurance claims data in the United States.

We analyzed medical insurance claims data (2005-2009) to determine the hospitalization costs of newborns with congenital syphilis (CS) diagnoses. We found 44 admission claims with CS diagnosis. The excess cost per case of CS (in 2009 US dollars) was estimated at $9969 (95% confidence interval, $5702-$16,769).

High clinical response rate of Sezary syndrome to immunomodulatory therapies: prognostic markers of response.

Objectives: To quantify response rates of Sézary syndrome (SS) to multimodality immunomodulatory therapy and to identify the important prognostic parameters that affect overall response to treatment.

Design: Retrospective cohort study.

Setting: Cutaneous T-cell lymphoma clinic at The Hospital at the University of Pennsylvania.

Donor-derived Strongyloides stercoralis infections in renal transplant recipients.

Background: Donor-derived Strongyloides stercoralis infection occurs rarely after transplantation, and the risk factors are not well understood. We present cases of two renal allograft recipients who developed Strongyloides hyperinfection syndrome after receipt of organs from a common deceased donor who received high-dose steroids as part of a preconditioning regimen.

Methods: The two renal transplant patients who developed Strongyloides hyperinfection syndrome are reported in case study format with review of the literature.

Validity assessment of the cutaneous T-cell lymphoma severity index to predict prognosis in advanced mycosis fungoides/Sézary syndrome.

Background: There is a need for standardized quantitative disease assessment measures in mycosis fungoides/Sézary syndrome. In 2005, a cutaneous T-cell lymphoma (CTCL)-severity index (SI) that not only measures disease extent (on a scale of 0-75) independent of the classic TNM(B) staging system but can also be used to estimate individual 5-year survival (SR5) was reported.

Objective: We sought to assess the generalizability of the CTCL-SI/SR5 equation (SR5 equation) to predict prognosis in our cohort of patients with advanced mycosis fungoides/Sézary syndrome (n = 50, photopheresis service, 1984-2001).

Dermatology in Botswana: The American Academy of Dermatology's Resident International Grant.

In 2008, the American Academy of Dermatology began sponsoring North American dermatology residents to travel to Botswana in sub-Saharan Africa and spend 4 to 6 weeks working with the Botswana-UPenn Partnership, the Baylor International Pediatrics AIDS Initiative, Princess Marina Hospital, and surrounding smaller district hospitals. During their time in Botswana, the residents staff the busy outpatient dermatology clinic and see adult and pediatric inpatients at Princess Marina Hospital in Gaborone, the capital city. The residents also travel to 4 rural hospitals to provide clinical services to patient and education to local health care providers.

Cutaneous toxicities of antiretroviral therapy for HIV: part II. Nonnucleoside reverse transcriptase inhibitors, entry and fusion inhibitors, integrase inhibitors, and immune reconstitution syndrome.

Cutaneous manifestations of antiretroviral medications for HIV are common and potentially dangerous conditions encountered by dermatologists. Part II of this two-part series on the cutaneous effects of antiretroviral medications for HIV will discuss the four most recent classes of medications that have been developed and immune reconstitution syndrome--an important diagnostic consideration when evaluating a dermatologic patient who is taking antiretroviral medications.