Acral Myxoinflammatory Fibroblastic Sarcoma: Report of a Case and Treatment with Mohs Micrographic Surgery.

Acral myxoinflammatory fibroblastic sarcoma (AMFS) represents a low-grade sarcoma with a high rate of local recurrence that commonly affects the distal extremities. The lesion often presents as a painless mass in the hands or feet. There is no formal standardized treatment protocol for this tumor, but wide surgical excision, with or without adjuvant radiation therapy, is the conventional treatment.

Prolonged Periorbicular Edema After Injection of Hyaluronic Acid for Nasojugal Groove Correction.

The injection of hyaluronic acid (HA), a naturally occurring biopolymer, is a common cosmetic procedure. Despite their efficacy and growing adaptation by the medical community, HA fillers occasionally give rise to adverse events. Adverse events from HA fillers range from temporary, such as edema and erythema, to more long-term effects, including granulomas or, in rare cases, sequelae from vascular occlusion.

Pernio as the presenting sign of blast crisis in acute lymphoblastic leukemia.

A previously healthy 5-year-old girl presented with acute onset of blue toes and red spots on the nose and fingers. The striking nature of these lesions, along with the finding of submandibular lymphadenopathy, prompted further evaluation. Laboratory findings were remarkable for anemia, high transaminase levels, and high blast count.

First report of mesalamine (5-aminosalicylic acid) as the causative agent in a case of acute generalized exanthamous pustulosis.

Acute generalized exanthamous pustulosis (AGEP)is a rare eruption of non-follicular sterile pustuleson a diffuse background of erythema and edema,commonly associated with fever and leukocytosis.Antibiotics are implicated in most cases; however,other drugs have been reported to cause AGEP. Wereport a case of a 73-year-old man with a historyof ulcerative colitis who presented with a diffusepustular rash, renal failure, elevated liver functiontests, and leukocytosis with neutrophilia.

A Review of Local Anesthetics: Minimizing Risk and Side Effects in Cutaneous Surgery.

Background: The specialty of dermatology relies heavily on local anesthesia for diagnosis and management of skin disease. The appropriate selection, preparation, administration, and monitoring of these medications affect surgical outcome and patient safety and satisfaction.

Objective: To perform a comprehensive literature review of the side effects and risks associated with local anesthetics used in cutaneous surgery.

Resident guide to advocacy in dermatology.

Many opportunities exist for residents to get involved in advocacy in dermatology, from national to grassroots levels. Residents also should be aware of opportunities to get involved in patient advocacy and become familiar with the myriad of patient advocacy groups that exist. These groups offer support and education for patients and initiate research efforts for specific dermatologic conditions that provide support for patients beyond what can be offered during a standard office visit.

Enhancing dermatology education: resident presentation opportunities.

Dermatology residency is a time to maximize educational experiences, which include opportunities to attend academic meetings and present research and clinical cases. In this article, resident presentation opportunities at major academic dermatology meetings are reviewed.

Calciphylaxis: a case series and the role of radiology in diagnosis.

Background: Calciphylaxis is a syndrome of vascular calcification most commonly affecting patients with end-stage renal disease (ESRD) on hemodialysis. Because of its high mortality rate, early diagnosis and treatment are necessary. Although diagnosis is usually based on skin biopsy, histopathology is often nonspecific.

Scattered atypical melanocytes with hyperchromatic nuclei in the nail matrix: diagnostic clue for early subungual melanoma in situ.

Background: The lack of highly specific clinical and histopathological criteria has contributed to the delay in diagnosis of subungual melanoma in situ in its early stages.

Methods: Eighteen cases of subungual melanoma in situ, the largest series reported to date, were analyzed to characterize the clinical and histopathological findings of early stages of subungual melanoma in situ along with five cases of nail matrix nevus and five cases of subungual lentigo serving as histologic control.

Results: Clinically, longitudinal melanonychia was present in all 18 cases of subungual melanoma in situ, consisting of irregular dark brown to black streaks within a brown background with (11 cases) or without Hutchinson's sign.

The Value of the Black Box Warning in Dermatology.

Boxed, or "black box" warnings are issued by the United States Food and Drug Administration (US FDA) as a means to label drugs associated with serious adverse events. However, there is no clear metric to determine how and when the boxed warning is applied. Inconsistencies in the review process, language, timing, and dissemination of these warnings impact dermatologists and their patients.

Minimize that "pinch and burn": tips and tricks to reduce injection pain with local anesthetics.

Local anesthetics are commonly utilized in the practice of dermatology. Minimizing local anesthetic injection pain can be beneficial to both physicians and patients. Easily implemented techniques that reduce injection pain of intralesional local anesthetics are reviewed.

Fellowships after dermatology residency: the traditional and beyond.

Postresidency fellowship training options exist for graduating dermatology residents. Formal subspecialty fellowship programs are offered in dermatopathology, pediatric dermatology, micrographic surgery and dermatologic oncology (procedural dermatology), and cosmetic dermatologic surgery. There also are a number of fellowships offered at certain institutions for those interested in more specific subspecialties or academia.

Clinical course of segmental vitiligo: a retrospective study of eighty-seven patients.

Background: Vitiligo is an acquired disorder characterized by a progressive loss of melanocytes, which is difficult to manage and has an unknown prognosis. The subtype of segmental vitiligo (SV) has been established but it has not been adequately characterized.

Objective: To collect long-term follow-up data for evaluating the clinical course of SV.

Use of psychotropic drugs in dermatology: unique perspectives of a dermatologist and a psychiatrist.

Psychocutaneous morbidity is commonly found in dermatologic practice. Patients generally refuse referral to psychiatry, and dermatologists cannot always provide psychotherapeutic support. By establishing an alliance with these patients and with working knowledge of the common psychotherapeutic agents used in dermatology, these patients can be managed comfortably by the clinician.

Brighter eyes: combined upper cheek and tear trough augmentation: a systematic approach utilizing two complementary hyaluronic acid fillers.

Non-surgical rejuvenation of the periorbital-cheek complex can be effectively and safely accomplished using a combination of two hyaluronic acid (HA) fillers with distinct viscosities. We present a series of 21 patients with mild to moderate tear trough deformities who were treated with concomitant injection of two dermal fillers (Restylane® and Perlane®). Procedural technique entailed micro-depot injections of the finer viscosity HA into the sub-muscular plane along the orbital rim followed by manual massage.

Effective treatment of etanercept and phototherapy-resistant psoriasis using the excimer laser.

Treatment of moderate-to-severe plaque psoriasis often requires the use of phototherapy or systemic therapy, which includes immunosuppressants, retinoids, and biologic agents. Although biologic use is becoming increasingly popular, it is not uncommon for patients to experience treatment failure. We describe a patient who had a suboptimal response to etanercept monotherapy after twelve weeks of induction dosing (50 mg twice weekly), as well as to a combination of etanercept (50 mg once weekly-maintenance dosing) and narrowband ultraviolet B (NB-UVB) phototherapy three times weekly for an additional twelve weeks.

Clomiphene citrate is safe and effective for long-term management of hypogonadism.

Objective: To assess the efficacy and safety of long-term clomiphene citrate (CC) therapy in symptomatic patients with hypogonadism (HG).

Patients And Methods: Serum T, oestradiol and luteinizing hormone (LH) were measured in patients who were treated with CC for over 12 months. Additionally, bone densitometry (BD) results were collected for all patients.

Long-term etanercept use for severe generalized psoriasis in an HIV-infected individual: a case study.

The treatment options for psoriasis in HIV-infected individuals are limited due to the immunosuppressive nature of the therapeutic modalities and the patient's immunocompromised state. Etanercept has been shown to be safe and effective in the non-HIV psoriasis population with nearly 20 years of experience. However, there is limited data on the safety of etanercept use in the HIV patient population.