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Introduction Mycosis fungoides (MF) is the most frequent subtype of primary cutaneous T cell lymphomas (pCTCL). The diagnosis may be particularly difficult in the early stages as well as in atypical and rare clinical presentations. Furthermore, MF may simulate a large variety of common dermatologic disorders and patterns, both histopathologically and clinically. Methods A literature search was performed to provide a comprehensive update on the rare and atypical MF manifestations as well as the dermatoses and dermatological patterns that could be imitated by MF. Results A total of 114 publications were found describing a series of different dermatoses and dermatological patterns mimicked by MF, as well as some particular localizations of MF lesions and dermatoses that occur in preexisting MF lesions. Conclusions The number of dermatoses that can be imitated by MF is ever-increasing. Patients with common dermatologic conditions that prove to be treatment refractory should be biopsied without delay, and sequentially as necessary, to prevent delay in diagnosis and progression of disease. Clinicopathologic correlation is the best way of diagnosis.

Side effects of nutritional supplements, Edited by F. Anselmo, M.S. Driscoll Where on earth did the copy editor decide to do this?Abstract Vitamin and mineral supplement consumption is widespread. They are taken for a variety of conditions, including dermatologic disorders. Although consumers often assume these supplements are safe, excessive consumption of supplements may have deleterious effects. Such vitamin supplements include vitamin A, niacin, biotin, vitamin D, and vitamin E, and specific mineral supplements include zinc, copper, and iron. These supplements may have a number of potential adverse effects.

Significant androgenetic hair loss occurs in men older than 50 years, and in women it occurs in many who are perimenopausal, menopausal, and postmenopausal. By age 60 years, it is estimated that 80% of women experience hair loss. Other nonandrogenetic forms of hair loss occur due to various dermatologic disorders as well as systemic disorders. Children may also experience significant hair loss, often due to genetic abnormalities and incidences of trauma. In this article the author discusses a combination approach to hair loss for men, women, and children.

Fecal microbiota transplant and dermatologic disorders: A retrospective cohort study assessing the gut microbiome’s role in skin disease

Patients with gender dysphoria (transgender people), receiving gender-affirming hormone therapy and/or surgical treatment, often face specific skin conditions. Dermatological lesions can result in higher rates of body image dissatisfaction, gender dysphoria, anxiety, depression, and suicidal ideation among transgender patients. The article provides a review of commonly observed skin conditions induced by gender-affirming therapy (acne vulgaris, hypertrophic and keloid scars, pseudofolliculitis barbae, melasma), their clinical manifestation, and current treatment strategies.

Topical sirolimus has become a crucial treatment option for many dermatologic disorders. Because an FDA-approved topical formulation is not commercially available, sirolimus creams, ointments, and gels are professionally prepared by compounding pharmacies. Also, the topical use of a commercially available sirolimus solution approved for oral administration is described regularly. To better guide providers in their decision-making when topical sirolimus is being considered, this article highlights the substantial pharmaceutical and clinical differences between commercial oral solution and compounded preparations specifically designed for topical therapy.

Pregnancy can influence the course of a number of dermatologic disorders. Interestingly, these disorders can also influence pregnancy outcomes negatively, due to a variety of underlying pathogenic mechanisms. These outcomes may range from low fetal birth weight, preterm birth, and miscarriages to perineal lacerations complicating deliveries. Our review highlights the impact that papulosquamous disorders may have on pregnancy and their course throughout pregnancy. We chose papulosquamous disorders due to their relatively high prevalence worldwide compared to other dermatologic disorders. This review also sheds light on any gaps in the literature relevant to this topic that should be addressed.

Glucocorticoid-induced osteoporosis (GIOP) is a frequently encountered and serious side effect of glucocorticoid use. Bone loss leading to an increased risk for fracture occurs early in the use of glucocorticoids, yet patients at risk for this complication are often undertreated. All physicians prescribing glucocorticoids should therefore be familiar with a basic approach to anticipating and preventing GIOP when starting patients on glucocorticoid therapy. This manuscript and its case vignettes are designed to help dermatologists assess and manage bone health to prevent GIOP in patients receiving glucocorticoid therapy.

Food allergy evaluation for dermatologic disorders is warranted when Type 1 allergy is suspected, and includes skin prick testing (SPT) or measurement of specific immunoglobulin E (IgE) levels. The utility of these tests for identifying triggers is improved with clinical correlation, especially for contact urticaria, and protein contact dermatitis, which are mixed mechanism diseases. In atopic dermatitis (AD), patients are at risk for development of food allergy, and screening with SPT or IgE may be considered in severe AD, especially to guide early food introduction. Management of food-related AD exacerbations should focus on modifications in skincare before evaluating for allergy.

Skin as the largest organ, is influenced by wide variety of environmental and external factors. In addition many internal diseases can involve skin. Oral cavity and skin have close contact with each other Like skin which has contact with various external factors, oral cavity and its contents also has touch with different chemical agents, enzymes and diverse microorganisms. Oral lesions of dermatologic disorders need an exact attention because these oral lesions may be the sole and first presentation of skin diseases and the presence of these lesions may affect the quality of patient’s life and nourishment Although oral mucus membrane and skin are in direct continuity with each other ,but different condition of oral cavity causes specific characters and functions. Various infectious agents and different dermatologic disorders cause oral lesions and the most prevalent of these are candida infection and lichen planus. Many oral lesions are treated without specific and exact diagnosis by physician and symptoms like pain and pricking sensation and others are managed. so increasing diagnostic and therapeutic knowledge of these lesion is necessary. So we explain the oral lesion of common dermatologic disorders in this article in order to facilitate diagnosis and prevention of progression of these disorder that some may be dangerous.

Several popular Shakespearean characters are dramatically portrayed on stage with striking physical appearances caused by medical and dermatologic disorders. Shakespeare's colorful portrayal of their maladies not only helps to entertain audiences but also serves to define the characters' personalities and behavior. Shakespeare himself emphasizes this point in his play Richard III, in which the notorious English king states that his evil nature is a direct result of his hideous spinal deformity. This contribution discusses four other famous Shakespearean characters: Bardolph, who appears to be suffering from rosacea; the Witches of Macbeth, who have beards; Juliet, who has green sickness (chlorosis); and Falstaff, who is morbidly obese. In all of these cases, their skin disorders and medical maladies serve to highlight their underlying nature.

Patients suffering from dermatologic disorders experience significant psychological/psychiatric burden. Accumulating data, especially on alopecia areata, show the bidirectional association between hair loss and the psychological/psychiatric disease. Hair loss in a primary psychological/psychiatric condition results from hair pulling and other manipulation that are forms of stress or anxiety relief rituals. The bidirectional connection between alopecia areata (AA) and psychological/psychiatric factors has recently gotten a lot of attention. Stress is considered a very common cause of telogen effluvium (TE), which often develops after major life events such as mourning or divorce. The stress and emotional burden of chemotherapy-induced alopecia prompts some patients to choose less effective chemotherapeutic agents in hopes of avoiding hair loss as a side effect. Hair loss can result from various causes and take different shapes and forms. It was previously thought that one of the causes of hair loss is a preexistent psychological/psychiatric illness.

Background:The skin is the largest organ in the body and has aesthetic significance. The presence of any skin lesion or skin disease might be associated with psychosocial morbidity and negative impact on the quality of life. Objectives:To determine the level and degree of adjustment to psychosocial morbidity associated with the presence of dermatological conditions and assessing the quality of life of affected adults. Methods:Data were collected from 189 new patients attending the Dermatology Clinic at the Federal Medical Centre, Abeokuta, Nigeria using systematic random sampling. The validated Adjustment to Chronic Skin (ACS) diseases questionnaire and Finlay’s Dermatology Life Quality Index (DLQI) questionnaire were the research instruments. Results:The respondents consisted of 80 males (42.3%) and 109 females (57.7%) with a mean age of 36.3± 15.3 years. The least adjustment to skin-related psychosocial morbidity (49.7%) was observed with the helplessness scale. The mean score on the DQoL was 9.9 ± 6.2 and over half of the respondents (53.9%) reported moderate to an extremely large negative effect on their quality of life. Conclusion:The presence of dermatological conditions impact negatively on the quality of life and the least adjustment to skin-related psychosocial morbidity was experienced on the helplessness scale. Dermatology practitioners should acquire psychological evaluation and/or counselling skills to provide holistic care.

ObjectiveTo explore the types and frequency of dermatologic disorders routinely encountered by community pharmacists in Lebanon, identify their educational preparedness and confidence, reasons for referrals to dermatologists and their attitude toward the potential pharmacist role in the treatment of dermatologic disorders.MethodsA cross-sectional descriptive study was conducted between June and October 2017. It involved the use of a self-administered questionnaire, distributed to a randomly selected sample of 500 community pharmacists from all Lebanese districts.Key findingsA total of 456 pharmacists completed the questionnaire. Sixty-four per cent of participants had received a dermatology course at university and 38.7% had undertaken some form of postgraduate education in dermatology. Pharmacists believed that the most commonly encountered disorders were sunburn (22.6%) and acne (15.6%) during spring/summer and skin dryness (18.8%) followed by head lice (13.1%) during autumn/winter. Additionally, more than half of respondents reported that skin-related advice requests were 6–15% of the total advice offered to patients. Sixty-four per cent were confident or extremely confident in advising patients with dermatological complaints. Pharmacists ranked ‘unsure of diagnosis’ as the most common reason for patient referral to dermatologists. Pharmacists who received postgraduate dermatology training had higher self-reported confidence in tackling skin diseases and their treatments (P < 0.05).ConclusionsOur study revealed that community pharmacists in Lebanon commonly encounter a limited number of dermatologic disorders and the majority believed that they can confidently advise and manage patients. Nonetheless, they admitted a gap in their dermatology education at both undergraduate and postgraduate levels.

Ingenol mebutate (IM) is a novel drug currently only FDA-approved for the treatment of actinic keratosis. However, it has been extensively used off-label to treat multiple other skin disorders. In recent years, literature has emerged providing evidence for IMrsquo;s use as treatment for dermatologic disorders beyond actinic keratosis, including squamous cell carcinoma in situ. Here, we report a case series in which topical 0.05% ingenol mebutate was used to treat squamous cell carcinoma in situ, with five of six patients demonstrating successful results. J Drugs Dermatol. 2021;20(2):169-171. doi:10.36849/JDD.5602.

Ethnopharmacological relevance In China, shi hu (stems of Dendrobium chrysotoxum Lindl, D. fimbriatum Hook. D. huoshanense Z.Z. Tang & S.J. Cheng, or D. nobile Lindl) and tie pi shi hu (stems of D. officinale Kimura et Migo) are famous traditional medicines and are listed in the Chinese Pharmacopoeia. However, the leaves of these Dendrobium plants are largely discarded. Aim of the study To better utilize Dendrobium leaves, we summarize their traditional uses, chemical constituents, pharmacological activities, and toxicological effects. Materials and methods “Orchidaceae”, “Dendrobium”, “leaf”, “traditional use”, and “ethnobotany” were used as search terms to screen the literature. Cited references were collected between 1960 and 2020 from the Web of Science, China National Knowledge Internet (CNKI), SciFinder, and Google Scholar, primarily in English and Chinese. Results Traditional uses of leaves from 16 Dendrobium species were identified in the literature. The major uses of Dendrobium leaves include treatments for dermatologic disorders, metabolic syndromes, nervous system disorders, and musculoskeletal system disorders. More than 50 chemical compounds have been identified in the leaves of 10 Dendrobium species, which primarily include flavonoids, bibenzyls, coumarins, N-containing compounds, and polysaccharides. Antihyperlipidemia, antihypertensive, antihyperuricemia, anti-inflammatory, antimicrobial, antioxidant, cytotoxic and antitumor, hepatoprotective, immunomodulatory, lipase-inhibitory, and/or tyrosinase-inhibitory activities have been reported for the leaves of six Dendrobium species. D. officinale leaves have been shown to exhibit no reproductive toxicity against male rats, while D. speciosum Sm. leaves have been observed to exhibit slight genotoxicity in an in vitro study. Among Dendrobium species, D. officinale leaves are the most widely studied. Conclusions D. officinale leaves represent a good example of the utilization of leaf resources of the Dendrobium genus. In the future, more extensive research for the development of Dendrobium leaves is needed.

Dermatologic disorders such as atopic dermatitis arise from genetic and environmental causes and are complex and multifactorial in nature. Among possible risk factors, aberrant immunological reactions are one of the leading etiologies. Immunosuppressive agents including topical steroids are common treatments for these disorders. Despite their reliability in clinical settings, topical steroids display side effects, typified by skin thinning. Accordingly, there is a need for alternate effective and well-tolerated therapies. As part of our efforts to investigate new immunomodulators, we have developed a series of JAK inhibitors, which incorporate novel three-dimensional spiro motifs and unexpectedly possess both excellent physicochemical properties and antidermatitis efficacy in the animal models. One of these compounds, JTE-052 (ent-60), also known as delgocitinib, has been shown to be effective and well-tolerated in human clinical trials and has recently been approved in Japan for the treatment of atopic dermatitis as the first drug among Janus kinase inhibitors.

Double filtration plasmapheresis (DFPP) is a semi-selective blood purification modality derived from the plasma exchange (PE) modality. In the DFPP treatment, two types of filters with different pore sizes are used: a plasma separator and a plasma component separator. Blood is separated into plasma and blood cells using a plasma separator. The separated plasma is fractionated into large and small molecular weight components by a plasma component separator. Large molecular weight components, including pathogenic substances, are discarded. Small molecular weight components, including valuable substances such as albumin, are returned to the patient. The advantage of DFPP is that the volume of replacement fluid can be significantly reduced compared to PE. By selecting the optimal pore size model for the plasma component separator, DFPP can be applied to various disorders. The clinical applications of DFPP are reviewed based on recent articles on metabolic disorders, organ transplants, rheumatic disorders, neurological disorders, and dermatologic disorders.

Ingenol mebutate (IM) is a novel drug that was developed for the treatment of actinic keratosis (AK). The drug works by a dual mechanism of action -- a rapid induction of cell death by necrosis along with a delayed neutrophil-mediated cellular cytotoxicity response.¹ Currently, IM is available as a 0.015% or 0.05% topical gel and has only been FDA-approved for the treatment of actinic keratosis. However, IM has also been extensively used off-label, and found to be efficacious in the treatment of multiple other skin disorders. In this review, we discuss the current literature that provides evidence for the successful use of ingenol mebutate as treatment for dermatologic disorders beyond actinic keratosis. J Drugs Dermatol. 2020;19(2)156-161. doi:10.36849/JDD.2020.4731

Some systemically used drugs in managing dermatologic disorders have associated severe side effects, of which eye involvement is very significant. There are various mechanisms for these drugs to cause damage to the eye. The damage to the eye can be acute as in Stevens–Johnson syndrome or chronic as with chloroquine and hydroxychloroquine toxicity. Knowledge about these drugs and information about the mechanisms and types of damage to the eye are essential. It is also important to understand the monitoring mechanisms to diagnose early and limit the damage. Newer investigative tools, especially the imaging techniques help us to diagnose the adverse effects at an early stage. All these issues are discussed in brief here.

Schamberg's disease is one of the pigmented purpuric dermatoses (PPD). PPD encompass a large and heterogeneous group of dermatologic disorders featuring purpuric lesions often located on the lower limbs. The various forms of PPD are notoriously known to be resistant to treatment. Fractional photothermolysis has been described as a successful and safe method to induce dermal remodeling. We report three patients with Schamberg's disease who were successfully treated with 4 monthly sessions of fractional non-ablative 1540 nm erbium:glass laser, with resolution of their purpuric pigmented rash lasting up to 9 months after the last treatment session.

There is an increased prevalence of psychiatric symptoms in dermatologic disorders. However, these are often underrecognized and undertreated contributing to suboptimal adherence and therapeutic outcomes. A working knowledge of psychotropic medications and their use in dermatology is essential for comprehensive management of psychodermatological conditions. The present review provides a framework for use of psychotropic agents in dermatological settings and is intended to serve as a ready reckoner for the dermatologist. We initially review the general considerations involved in prescribing psychotropic agents in skin conditions. Next, we discuss individual classes of psychotropic agents such as anti-depressants, mood stabilizers, antipsychotics, and anxiolytics focusing on preferred agents while prescribing. Finally, we discuss the common adverse cutaneous reactions reported with psychotropic agents.

Building upon the knowledge garnered from investigations utilizing traditional culturing methods, advances in sequencing technologies have catalyzed a revolution in studying human-associated microbes: bacteria, fungi and viruses. Skin microbiome research in healthy individuals and patients with dermatologic disorders has provided insights into the complexity and biogeography of human skin microbes. The continual developments in sequencing and analyses will provide increasingly sophisticated tools to interrogate human-associated microbes, ultimately to improve our understanding of health and disease.

The association between psychiatric and dermatologic disorders has been well characterized in the present literature with estimates of up to 40% of dermatology patients having concomitant psychiatric problems that are often related to their skin condition. Here, we present our experience regarding the implementation of a psychodermatology clinic in Detroit, Michigan. The most commonly referred conditions were delusions of parasitosis, neurotic excoriations, and isotretinoin initiation for patients with a history of psychiatric conditions. Seventy-three percent of referred patients were female. By creating a monthly clinic for patients who are diagnosed with skin conditions and associated psychiatric disorders or psychological symptoms, we are able to meet the needs of these patients with a synergistic relationship between health care providers.

Retinoids have been tried in a wide array of dermatologic disorders due to their broad effects on cutaneous and systemic physiology and the elucidated anti-inflammatory and immune effects. Apart from the few established indications, retinoids have several novel uses, ranging from cutaneous malignancies to photoaging. Retinoids have myriad effects on the physiologic processes in skin and other organ systems. The clinical uses for this drug even though unapproved are increasing in dermatology and beyond. Apart from the relatively few approved indications, the rest though still await validation. Translational research has suggested that overexpression of tumor suppressor p53, a pro-apoptotic transcription factor, may also help explain retinoic acid's teratogenic effects. As retinoids are believed to be involved in the Hox signaling pathways that are crucial in the development of the pharyngeal arches, it is the derivatives of the pharyngeal arches that are often affected by excess retinoic acid exposure during pregnancy.

Background Holistic dermatology focuses on treating the human body as a whole and implementing lifestyle changes to enhance the treatment and prognosis of skin disease. Understanding the interplay between modifiable lifestyle factors and patients' dermatologic health will help physicians better inform patients on self-care methods to mitigate the burden of their skin disease(s). Objective To review the current scientific literature on the relationship between modifiable lifestyle factors and the dermatologic outcome of skin disorders. Methods A systematic literature search on PubMed, Cochrane, and Web of Science was conducted to identify research articles examining the relationship between dermatology and 6 major categories of modifiable lifestyle factors: diet, sleep, exercise, stress, alcohol, and smoking. Results A substantial amount of evidence supports the relationship between modifiable lifestyle factors and dermatologic outcomes. There were the most studies on diet, stress, alcohol, and smoking, but all lifestyle factors were supported by some degree of scientific evidence. Conclusion All modifiable lifestyle factors explored in this review play a critical role in modulating the onset and progression of skin disease. We anticipate more research studies in the future and an increasing integration of holistic dermatology into patient care.

Objective: Acquired reactive perforating collagenosis is an uncommon skin disease that belongs to a group of dermatologic disorders characterized by transepidermal elimination of dermal material. It is highly associated with systemic disease, primarily diabetes mellitus and dialysis-dependent chronic renal failure.Methods: A 70-year-old female with 20 years of poorly controlled type 2 diabetes mellitus presented with a 6-month history of multiple pruritic erythematous papules and nodules with central hyperkeratosis, involving her right dorsal arm. Histologic examination was consistent with acquired reactive perforating collagenosis. In addition to topical treatment of the disease, the patient was referred to endocrinology for appropriate management of her underlying diabetes mellitus.Results: Ideal treatment should involve both the endocrinologist and dermatologist. Control of the underlying systemic disease, in this case diabetes, as well topical or systemic medications can both help to improve this condition. Our patient re-established care with her endocrinologist who adjusted her medication regimen, resulting in improved hemoglobin A1c values. Our patient additionally benefited from topical betamethasone cream, ammonium lactate, and pimecrolimus application. The combined therapy led to resolution of her pruritic rash.Conclusion: This case highlights the importance of the skin exam by the endocrinologist, as he or she plays a unique role in identifying this rare and difficult-to-treat dermatologic disease. Early detection and prompt referral to a dermatologist are crucial in preventing progression of disease, treating the disease, and improving the patient's quality of life.Abbreviation: ARPC = acquired reactive perforating collagenosis

Pregnancy dermatoses describe a set of extremely pruritic dermatologic disorders that uniquely present in the gestational period. Those who care for pregnant women are left to try to differentiate these conditions. They are pruritic urticarial papules and plaques of pregnancy (PUPPP), pemphigoid gestationis, atopic eruption of pregnancy, and intrahepatic cholestasis of pregnancy. While the most common of these, atopic eruption of pregnancy and PUPPP, are benign, self-limiting diseases that have no implications for the fetus, pemphigoid gestationis and intrahepatic cholestasis of pregnancy both pose a risk to the fetus and are associated with adverse outcomes. A clinician’s ability to distinguish these conditions can impact both the mother and the fetus.