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Hintergrund: Das lepidische Adenokarzinom stellt ein histologisches Muster des nicht kleinzelligen Lungenkrebses dar, der charakteristischerweise in der Peripherie der Lunge entsteht und sich entlang der bereits bestehenden Alveolarwände ausbreitet. Nicht invasive und invasive Varianten des lepidischen Adenokarzinoms sind abhängig von der Zerstörung des Parenchyms, der Gefäß- oder Pleurainvasion. Die prädominant lepidischen Lungenmalignome gelten als langsam wachsend mit seltener Metastasierung und ausgezeichneter Prognose. Die Klassifizierung der Weltgesundheitsorganisation (WHO) für maligne Lungenerkrankungen basiert auf molekularen und histopathologischen Befunden. Die CT-Befunde weisen meist Milchglasmerkmale auf, die häufig fälschlicherweise für eine entzündliche oder infektiöse Ätiologie gehalten werden. Diese Tumore sind in der Regel chirurgisch resezierbar und mit einer besseren Überlebensrate verbunden, da sie nur selten Knoten bilden und extrathorakale Manifestationen aufweisen. In seltenen Fällen weisen diese Tumore eine diffuse Lungenbeteiligung auf, die trotz fehlender Nodal- und Fernmetastasen mit schlechteren Ergebnissen einhergeht. Präsentation des Falles: Eine 63-jährige kaukasische, sportliche, immunkompetente Frau stellte sich mit 2 Monaten fortschreitender Kurzatmigkeit, Müdigkeit, Appetitlosigkeit und 6,8 kg Gewichtsverlust vor. In der Anamnese fanden sich lediglich ein gut eingestellter Bluthochdruck und eine Hypothyreose. Das Kontrast-Computertomographie-Angiogramm und die Positronenemissionstomographie zeigten diffuse hypermetabolische interstitielle und Luftraum-Anomalien der Lunge ohne Lymphadenopathie (oder Fernbeteiligung) zusätzlich zu einem rechten Hydropneumothorax und einem linken Pleuraerguss. Die grundlegenden Labortests waren unauffällig, und umfangreiche Tests auf Bakterien und Pilze waren negativ. Anschließend wurden eine Bronchoskopie und eine videounterstützte thorakoskopische Operation durchgeführt. Die Zytologie der Pleuraflüssigkeit, die Lungen- und Pleurabiopsien ergaben ein positives Ergebnis für ein lepidisches Adenokarzinom mit einer Expression von 2% des Programmed Death Ligand 1 und ein Genomtest ein positives Ergebnis für eine PTEN-Gen-Deletion. Vor Aufnahme der Behandlung war die Patientin am Tag 15 des Krankenhausaufenthalts verstorben. Schlussfolgerung: Wir stellen einen seltenen Fall eines prädominant lepidischen Adenokarzinoms mit ausgedehnter bilateraler aerogener Ausbreitung ohne lymphatische Invasion bei einer gesunden Patientin mit geringem Risiko vor. Diese Falldarstellung könnte die Kenntnisse über die unterschiedlichen Verhaltensmuster von prädominant lepidischen Adenokarzinomen erweitern.

The safe management of allergic skin disorders during pregnancy is essential to maternal and fetal health. Poorly controlled allergic skin disease affects the health of mother and child. This article reviews the disease course and treatment of atopic dermatitis, chronic urticaria, and allergic contact dermatitis in pregnancy. It focuses on topical and systemic therapies in the context of pregnancy and breastfeeding. Because disease activity may vary in pregnancy, prescription stewardship is imperative; a balance among disease control, minimum effective dosing, and medication safety profiles should be maintained. Secondary complications and risks to maternal or infant health should also be avoided.

Despite a common CD4+ T-cell precursor, helper T (Th) 1 and 2 lymphocytes affect different immunologic responses, including cellular and humoral pathways, respectively. Th1 cells stimulate the activation of type 1 macrophages, IgG/immunoglobulin M production, and cytokine release (eg, interferon gamma [IFN-γ], interleukin 2) to respond to intracellular pathogens. In contrast, Th2 cells target extracellular pathogens, leading to increases in immunoglobulin E and proliferation of eosinophils, basophils, B lymphocytes, type 2 macrophages, and mast cells through the actions of interleukin 4 (IL-4), interleukin 5, interleukin 13 (IL-13), and interleukin 31.1 Th17 cells are important for host defense against extracellular bacteria and fungi, as well as injury, and are thought to be key drivers of autoimmune diseases. Th17 cells produce interleukin 17A, interleukin 17F, interleukin 22, and C-C motif chemokine ligand 20 and are characterized by neutrophil and macrophage recruitment. The Th2 cytokine, IL-4, has been shown to inhibit Th17 development.2 Dupilumab (Dupixent, Regeneron Pharmaceuticals and Sanofi Genzyme), a fully human monoclonal (IgG4) antibody, inhibits the signaling of IL-4/13 by blocking the shared receptor subunit, IL-4 receptor α. Dupilumab is an effective treatment for a number of Th2-driven conditions, including atopic dermatitis (AD), asthma, and chronic rhinosinusitis with nasal polyposis. Multiple sclerosis (MS) is an inflammatory disease of the central nervous system, which is characterized by multifocal demyelination and neuroaxonal degeneration, where the immune system is skewed toward Th1/Th17 axes.3 Interestingly, epidemiologic studies have suggested that a history of allergic diseases may confer some protection from MS.4 We report a temporal association of relapsing-remitting MS flareup and dupilumab treatment for AD. We provide a potential mechanism by which dupilumab leads to Th2 suppression with secondary Th1/17 dysregulation.

Highlights • Mucorales known to cause opportunistic infections in immunocompromised hosts. • This is the 2nd reported case of cutaneous mucormycosis in a patient on ibrutinib. • Amphotericin B is typical 1st line therapy. • We report successful completion of treatment of cutaneous mucormycosis with posaconazole., Background Mucorales is a zygomycete fungi known to cause opportunistic infections in immunosuppressed hosts. Spores may be inhaled, causing rhinocerebral or pulmonary infections, or gastrointestinal infections if swallowed. Less often, cutaneous mucormycosis develops after inoculation via broken skin. Presentation A 72-year old male on ibrutinib and prednisone for chronic lymphocytic leukemia (CLL) presented with localized, right forearm cutaneous mucormycosis at the site of a dog-scratch sustained three weeks prior. The patient failed to respond to cephalexin as an outpatient, prompting biopsy showing ribbon-like pseudo septate hyphae and possible vascular invasion suggestive of Mucorales. Treatment course included liposomal amphotericin B 5 mg/kg IV every 24 h for ten days followed by a 90-day course of posaconazole 300 mg daily after general surgery consultation was sought. Conclusion We outline the second reported case of localized cutaneous mucormycosis arising in the setting of ibrutinib use. Because the combination of immunosuppressed states, ibrutinib and skin trauma may serve as a nidus for mucormycosis, practitioners should be vigilant of thorough skin evaluations in these patients and appropriate anti-fungal treatment. Although amphotericin B has been well studied as first line therapy, oral posaconazole has been shown as an efficacious second-line treatment.

Background: Nipple discomfort inhibits breastfeeding goals, particularly between 0 and 8 weeks postpartum (PP), and yet the specific dermatologic entities that contribute to nipple soreness have not been clearly delineated. Moreover, there remains a lack of evidence-based guidelines for nipple symptoms and skin diseases. Methods: A survey was distributed to 6-8-week PP women, 18-50 years of age, with an intent to exclusively or partially breastfeed ("at the breast" or "pump"). The study aimed to characterize nipple skin symptoms (pain and itching) and lesions (eczema, redness, cuts, or wounds) and any association between these nipple problems and past dermatologic history, breastfeeding outcomes, and the ability to meet her breastfeeding goals. Results: Findings paralleled Centers for Disease Control and Prevention (CDC) statistics with a 25% decline in breastfeeding rates between birth, 86.3% (189), and 6-8 weeks PP, 64.5% (145). By 6-8 weeks PP, exclusive "formula" and "exclusive feeding at the breast" showed the largest increase (+16.4%) and decrease (-22.9%), respectively. Although no significant difference was found in comparison of nipple problems to feeding methods or skin history, women who reported pumping or PP redness/eczema had higher odds ratios of a change in feeding practice, history of eczema, and sensitive skin. Strong pumping intentions were also associated with the highest risk of unmet breastfeeding goals. Conclusion: Regardless of feeding method, product, or provider use, PP nipple problems predominantly arose between 1 and 3 weeks PP. Clinical Trial Registration number 201901737.

Background Psychocutaneous disorders are often attributed to stimulant medications, yet this relationship has never been fully elucidated. Literature on psychocutaneous disorders largely focuses on clinical presentation and treatment rather than disease etiology or exacerbation. Objective To determine whether patients presenting with psychocutaneous disorders display high rates of stimulant use and psychiatric comorbidity. Methods We undertook a retrospective cohort study of patients with psychocutaneous disorders presenting to a single center. It was hypothesized that these patients would have high rates of stimulant use and psychiatric comorbidity. Following analysis of baseline demographics, the patients were assigned to 1 of 2 groups: those with a psychotic disorder and those with a neurotic disorder. Results Sixty percent of the patients (n = 317) with psychocutaneous disease had recently used a stimulant and more than 80% (270 of 317) carried an additional psychiatric diagnosis. The neurotic disorder group (n = 237) was younger and had higher rates of stimulant use. The psychotic disorder group (n = 80) had higher rates of psychosis, medical comorbidity, and illicit stimulant drug use. Limitations The predominantly Caucasian population may limit generalizability of findings as may the retrospective nature. Conclusions Patients with psychocutaneous disease have high rates of stimulant use and most have at least 1 psychiatric comorbidity.

This review provides an overview of the principal stages of wound healing, the populations of endogenous and therapeutic stem cells, applications of stem cells in specific types of wounds, and current approaches of stem cell delivery for tissue regeneration. New uses of progenitor stem cells have been developed for the treatment of wounds. Stem cells improve wound healing through both local and paracrine effects. Stem cell populations of therapeutic utility include embryonic stem cells, induced pluripotent stem cells, adult bone marrow and adipose-derived mesenchymal stem cells, as well as stem cells from skin, cord blood, and extra fetal tissue. Induced pluripotent stem cells mitigate many of the ethical and immunogenic concerns related to use of embryonically derived stem cells. Skin, the largest organ in the human body, serves as a protective barrier for mammals. Both aging and disease contribute to loss of skin barrier function, which can result in consequences such as chronic wounds. Recent advances in many types of stem cell therapy may revolutionize treatment of difficult wounds. Optimal techniques for obtaining and delivering stem cells are still being refined.