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Granulomatosis with polyangiitis (GPA) and rheumatoid arthritis (RA) have shared features including vasculitis, ocular inflammation, interstitial lung disease, and arthritis but existing evidence indicates they are distinct conditions. Interestingly, the co-existence of GPA and RA has been described in the literature. Herein, we report two cases of GPA developing in patients with underlying RA and examine the relationship between the two conditions. Two cases of GPA that developed in patients with preexisting RA are described in detail. Additionally, PubMed was searched for articles in English showing an association of RA and GPA using keywords “rheumatoid arthritis, and vasculitis, and Wegener’s, and ANCA, and granulomatosis polyangiitis.” In addition to our two cases of RA and GPA overlap, 14 reports were identified in PubMed library from 1970 to 2020. Most of the cases were females (14/16, 88%), and had RA as the initial diagnosis (15/16, 94%). The mean age of RA diagnosis was 45.5 years, the mean age of GPA diagnosis was 52 years and the mean interval between both diagnoses was 101 months. Cyclophosphamide and steroid therapy were used in most of the cases. There are numerous reports of GPA and RA overlap in the literature. GPA should be considered in the differential diagnosis when vasculitis develops in patients with RA.

The incidence of psoriasis (PsO) increased between 1970 to 2000 in the United States (U.S).1 Therapies for moderate-to-severe PsO and psoriatic arthritis (PsA) have experienced advances due to biologic agents' introduction in the early 2000s.2 We aim to study longitudinal trends of PsO hospitalizations in the last 2 decades in the U.S, following biologic agents' introduction. Data was obtained from the National Inpatient Sample (NIS) database, the largest hospitalization database in the U.S. NIS is a nationally representative stratified sample of 20% of all hospitalizations in the US. We performed a 21-year longitudinal trend analysis of NIS 1998-2018.

Bleomycin is a useful treatment option for recalcitrant verrucae. Several different methods of bleomycin delivery have been described, including intralesional injection, intralesional injection combined with laser, microneedling, multiple puncture and adhesive tape. We reviewed the literature to evaluate the various methods of bleomycin administration to treat warts, including the different doses, instruments and procedures used. Intralesional injection (cure rate ranged from 67.8 - 99.23%) and topical bleomycin with multipuncture or microneedling methods (63.6 to 100%) were found to be effective in the treatment of warts. Overall, pain is significantly less with microneedling and multipuncture techniques compared with intralesional injection. Bleomycin injection combined with pulsed dye laser, electroporation, or by other methods, such as, microneedle patches or adhesive tape do not seem to be more beneficial than bleomycin administered by intralesional injection, multipuncture or microneedling techniques. This article is protected by copyright. All rights reserved.

Carotenemia is a condition characterized by yellow-orange discoloration of the skin usually secondary to excessive ingestion of foods rich in carotene. It occurs in the absence of yellow discoloration of the sclera. Carotenemia is a benign condition; hence, further diagnostic testing is unnecessary. We present a case of carotenemia secondary to excessive ingestion of papaya and mango.

Introduction: Hidradenitis suppurativa (HS) or acne inversa is a chronic, inflammatory, recurrent, debilitating skin disease. There have been studies linking HS to metabolic syndrome [1]. However, there is a scarcity of studies on metabolic and endocrine co-morbidities of hospitalized HS patients. This study aims to compare the prevalence of metabolic and endocrine co-morbidities in hospitalized HS patients to hospitalized non-HS patients. Methods: Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 Database. NIS is the largest inpatient hospitalization database in the United States. The NIS was searched for hospitalizations for adult patients aged 18 years or above with a principal or secondary diagnosis of HS and those without any diagnosis of HS. Chi-square test was used to compare the prevalence of common metabolic and endocrine comorbidities between HS and non-HS hospitalized patients. Co-morbidities were obtained from secondary diagnoses. We used ICD-10 codes to obtain HS hospitalizations and co-morbidities. STATA, version 16 was used for analysis. Results: There were over 71 million discharges in the combined 2016 and 2017 NIS database. Out of which, 40,275 hospitalizations had a diagnosis of HS. HS hospitalizations had higher prevalence of type 2 diabetes (33.1% vs 24.5%, p Conclusion: Hospitalized HS patients have a higher prevalence of type 1 & 2 diabetes mellitus and obesity compared to hospitalized non-HS patients. An interdisciplinary approach involving the endocrinologist, dermatologist, and hospitalist may be needed to optimally manage these co-morbidities in hospitalized HS patients. References 1. Ergun T. Hidradenitis suppurativa and the metabolic syndrome. Clin Dermatol. 2018;36(1):41–47. doi:10.1016/j.clindermatol.2017.09.007