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Patch testing while taking systemic immunosuppressants is sometimes unavoidable. Methotrexate (MTX) is the immunosuppressant currently considered least likely to negatively impact patch testing.The aim of the study was to characterize a cohort of patients patch tested while taking MTX.This is a retrospective review of patients patch tested at the University of North Carolina Dermatology in Chapel Hill, North Carolina, from 2010 to 2019, comparing patch test results of patients taking MTX with those of a control group.An overall 52.8% positivity rate (356/674) was observed. Sixty two of 674 patients were patch tested while taking MTX, with a 46.8% positivity rate (29/62) compared with 53.4% (327/612) in the control group. The control group experienced 975 reactions, including 637 1+ reactions, 291 2+ reactions, and 47 3+ reactions. The MTX group experienced 50 reactions, including thirty-two 1+ reactions, fourteen 2+ reactions, and four 3+ reactions. The difference between the distributions was not statistically significant. Mean weekly MTX dose was 15.6 mg, whereas mean total accumulated dose was 251.6 mg. There was no statistically significant difference between weekly dose and total accumulated dose in patients with positive or negative results.In our cohort, MTX had no discernible effect on patch test results, supporting use during patch testing with minimal false-negative risk.

Background Solar lentigines are benign keratinocytic proliferations resulting from prolonged and cumulative sun exposure. The newer photoselective lasers have become the mainstay of treatment. However, cryosurgery and trichloroacetic acid (TCA) solution are cost-effective alternatives in the treatment of solar lentigines. Methods Twenty-five patients with multiple solar lentigines over the dorsa of their hands were included. Each hand was treated randomly with either 30% TCA solution or liquid nitrogen spray. The efficacy of treatment was evaluated at 8 weeks. Results Cryosurgery was more likely to produce significant lightening of the lentigines than 30% TCA solution (P

Background The rate of human immunodeficiency virus (HIV) infection in women of reproductive age has increased dramatically in the last decade. The effects of pregnancy on the prevalence of cutaneous diseases in this group is unclear. Objectives To compare the prevalence of cutaneous diseases in healthy pregnant women, HIV-positive pregnant women, and HIV-positive nonpregnant women. Methods Fifty HIV-positive pregnant women and 52 HIV-positive nonpregnant women were compared with a control group of 50 HIV-negative pregnant women for the prevalence of cutaneous diseases. Results The prevalence of cutaneous diseases was higher (65%) in the HIV-positive nonpregnant group than in the HIV-positive pregnant group (42%) or the control group (28%). Infectious diseases were more frequent in the HIV-positive nonpregnant group. Conclusions Pregnancy does not seem to increase the prevalence of cutaneous diseases that occur during the course of HIV disease.

Background: Controversy still exists as to whether dermatophytic skin infection is truly more common in patients with diabetes. Objective: The purpose of this study was to determine the true prevalence of dermatophytosis in diabetic patients as compared with a control population. Methods: One hundred consecutive diabetic patients were examined for evidence of fungal disease of the skin and compared with nondiabetic, nonimmunocompromised patients. Potassium hydroxide preparation and fungal cultures were obtained from all suspect lesions. Results: Thirty-one percent of the diabetic population had culture-proven fungal infections compared with 33% of the control group. The organism most commonly isolated was Trichophyton rubrum in both groups, and the feet were the most common site of infection. Candida albicans was more prevalent in the control group, affecting the nails in particular (24% vs 15% in the diabetic patients). Conclusion: This study shows that there does not seem to be an increased prevalence of dermatophytosis in diabetic patients as compared with a control, nondiabetic patient.

Background. Recent data have supported an autoimmune etiology of vitiligo. Genetic factors also seem to play an important role in this disorder. The purpose of this study was to determine the presence and frequency of organ-specific autoantibodies in vitiligo patients and their relatives. Methods. Twenty patients with vitiligo and two first or second degree relatives of each patient were interviewed and their sera analyzed for the presence of antithyroglobulin (ATg), antithyroid microsomal (ATM), antiparietal cell (APC), and antiadrenal (AAd) autoantibodies. The sera of 20 normal patients were used as control. Results. A significantly increased frequency of ATg, ATM, and APC antibodies was found in vitiligo patients when compared to normal controls. First and second degree relatives had significantly increased frequencies of ATg and ATM. A high incidence of autoimmune/endocrine diseases was found in the patients' relatives, including a 25% prevalence of vitiligo. Conclusions. These findings not only support an autoimmune etiology for vitiligo, but also highlight the strong genetic contribution to this pigmentary disorder.

The purpose of this study was to evaluate the prevalence of dermatologic problems among patients with chronic renal failure (CRF) undergoing hemodialysis or peritoneal dialysis. One-hundred and two patients with CRF were examined for the presence of cutaneous alterations. All patients examined had at least one cutaneous lesion. The most prevalent findings were alterations in the cutaneous pigmentation. Of particular interest was an increased prevalence of hyperpigmented macules on the palms and soles. Other manifestations, seen particularly in the hemodialysis group, included the half-and-half nail, pruritus, and keratotic pits of the palms and soles. Infectious processes were more prevalent in the group undergoing peritoneal dialysis. This study showed that all patients with CRF have some type of cutaneous alteration and that the type of dialysis could have some influence upon the incidence of these changes.

Tender erythematous nodules and plaques developed on the abdomen and legs of two women, 45 and 48 years of age, with hyperparathyroidism as a result of chronic renal failure caused by polycystic kidney disease, The histopathologic findings of these lesions were characterized by a calcifying panniculitis. Laboratory tests disclosed normal calcium levels and hyperphosphatemia with an elevated level of calcium phosphate product. Calciphylaxis appeared to be the mechanism of soft tissue calcification in these patients.