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Competing Interests: None disclosed.

In countries other than the United States, the BCG vaccine is typically used as a method for preventing childhood tuberculosis; in the United States, the BCG vaccine has gained popularity as a speculated therapy for autoimmune and inflammatory disorders. Research suggests that the vaccine can train the innate immune response, thereby improving symptoms of disorders such as diabetes and fibromyalgia. However, the potential side effects associated with the use of this vaccine are not totally innocuous. Although 95% of recipients should expect common skin complications after administration of the BCG vaccine, other more serious cutaneous sequelae may occur. Potential cutaneous side effects associated with vaccine use can include fistulation, abscess formation, and even ulceration. This brief report highlights a patient in whom cutaneous tuberculosis developed, specifically tuberculous chancre, secondary to receiving the BCG vaccine as a possible treatment for fibromyalgia. After undergoing surgical debulking of the tumor, the patient subsequently received the standard of care to the wound base and was started on 6 months of isoniazid monotherapy. Cutaneous tuberculosis is exceedingly rare, and the chancre variant accounts for only about 1% of diagnosed cases. Although common in pediatric populations, the chancre variant of cutaneous tuberculosis is not typically seen in adult populations, most likely because the BCG vaccine is often administered to children to prevent childhood tuberculosis. As use of the BCG vaccine in adults becomes more prevalent to potentially treat or mitigate certain disorders, it is imperative that health care providers recognize the potentially severe side effects associated with its use.

Background The internet has had an enormous influence on the field of medicine. In this regard, Statista, a market and consumer data company, estimated in 2019 that more than half the world's population (>four billion people) were active internet users. Accessing the World Wide Web has become the second nature for most. In the medical field, many patients look to the internet for information regarding certain procedures. The purpose of this study, therefore, was to assess the readability level of more than 492 online sources with information on a wide array of interventional pain procedures. Objective The aim is to determine the readability of online patient educational materials for interventional pain procedures. Study design This is a retrospective review. Methods We downloaded and reformatted to plain text 492 internet-based patient educational materials for 17 different interventional pain procedures. Plain text was processed using Readability Studio (Oleander Software Ltd., Vandalia, Ohio, USA), which employs 10 quantitative readability scales that are widely used and accepted in the medical literature. Results The software determined the average reading level (or grade level) of the 492 online sources we examined to be 12.1, with a range of 10.9 to 13. Limitations Google is not the only online search engine patients utilize for information, and the top links for each search could change over time. Also, some patients prefer videos rather than text to learn about their disease and treatment options. Finally, depending on their provider, the links that patients are directed to may be significantly more or less readable. Conclusions The average American adult reads at the eighth grade level. The National Institutes of Health and the American Medical Association have recommended education materials be made available at the third to seventh grade level. Our analysis shows patient educational materials found online for interventional pain procedures to be overly technical, with an average reading level (or grade level) of 12.1., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Kamath et al.)

Skin cancer is a major public health problem. Unfortunately, individuals who lack health insurance have lower skin cancer screening rates compared to insured individual and, therefore, have a higher risk of more advanced cancer diagnoses. Student-run health clinics may be the answer to this dilemma. Student-run health clinics can not only help by providing essential dermatologic services to the general population, both insured and uninsured, but also provide early exposure to dermatology education for medical students.