124 results on '"Lindy P. Fox"'
Search Results
2. Nonuremic calciphylaxis manifesting with diffuse dermal angiomatosis
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Francine T. Castillo, BS, Divya Seth, MD, MPH, Ritesh Agnihothri, MD, Lindy P. Fox, MD, Jeffrey P. North, MD, and Anna K. Haemel, MD
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diffuse dermal angiomatosis ,nonuremic calciphylaxis ,Dermatology ,RL1-803 - Published
- 2022
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3. Cutaneous Clinico-Pathological Findings in three COVID-19-Positive Patients Observed in the Metropolitan Area of Milan, Italy
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Raffaele Gianotti, Stefano Veraldi, Sebastiano Recalcati, Marco Cusini, Massimo Ghislanzoni, Francesca Boggio, and Lindy P. Fox
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covid-19 ,italy ,Dermatology ,RL1-803 - Abstract
Abstract is missing (Short communication)
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- 2020
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4. Successful treatment of mucous membrane pemphigoid with bortezomib
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Lina Saeed, BS, Timothy H. Schmidt, MD, PhD, Lianne S. Gensler, MD, Andrew J. Gross, MD, Lindy P. Fox, MD, Tiffany C. Scharschmidt, MD, Karin Gaensler, MD, Haley Naik, MD, Michael A. Rosenblum, MD, PhD, and Kanade Shinkai, MD, PhD
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autoimmune blistering disease ,bortezomib ,mucous membrane pemphigoid ,Dermatology ,RL1-803 - Published
- 2018
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- View/download PDF
5. A dermatologic assessment of 101 mpox (monkeypox) cases from 13 countries during the 2022 outbreak: Skin lesion morphology, clinical course, and scarring
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Sonya Prasad, Cristina Galvan Casas, Alexis G. Strahan, L. Claire Fuller, Klint Peebles, Andrea Carugno, Kieron S. Leslie, Joanna L. Harp, Teodora Pumnea, Devon E. McMahon, Misha Rosenbach, Janet E. Lubov, Geoffrey Chen, Lindy P. Fox, Allen McMillen, Henry W. Lim, Alexander J. Stratigos, Terrence A. Cronin, Mark D. Kaufmann, George J. Hruza, Lars E. French, Esther E. Freeman, Prasad, S, Casas, C, Strahan, A, Fuller, L, Peebles, K, Carugno, A, Leslie, K, Harp, J, Pumnea, T, Mcmahon, D, Rosenbach, M, Lubov, J, Chen, G, Fox, L, Mcmillen, A, Lim, H, Stratigos, A, Cronin, T, Kaufmann, M, Hruza, G, French, L, and Freeman, E
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medical dermatology ,mpox ,immunocompromised ,general dermatology ,international health ,infectious disease ,vaccine ,viru ,skin lesion ,global health ,monkeypox ,viral infection ,Dermatology - Abstract
Background: In the 2022 mpox (monkeypox) outbreak, 79,000 global cases have been reported. Yet, limited dermatologic data have been published regarding lesion morphology and progression. Objective: The objective of this study was to characterize skin lesion morphology, symptomatology, and outcomes of mpox infection over time. Methods: The American Academy of Dermatology/International League of Dermatological Societies Dermatology COVID-19, Mpox, and Emerging Infections Registry captured deidentified patient cases of mpox entered by health care professionals. Results: From August 4 to November 13, 2022, 101 cases from 13 countries were entered, primarily by dermatologists (92%). Thirty-nine percent had fewer than 5 lesions. In 54% of cases, skin lesions were the first sign of infection. In the first 1-5 days of infection, papules (36%), vesicles (17%), and pustules (20%) predominated. By days 6-10, pustules (36%) were most common, followed by erosions/ulcers (27%) and crusts/scabs (24%). Crusts/scabs were the predominant morphology after day 11. Ten cases of morbilliform rash were reported. Scarring occurred in 13% of the cases. Limitations: Registry-reported data cannot address incidence. There is a potential reporting bias from the predilection to report cases with greater clinical severity. Discussion: These findings highlight differences in skin findings compared to historical outbreaks, notably the presence of skin lesions prior to systemic symptoms and low overall lesion counts. Scarring emerged as a major possible sequela.
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- 2023
6. Mpox first skin lesion location: a reflection of mode of transmission?
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Lubov, J, Strahan, A, Prasad, S, Galvan Casas, C, Claire Fuller, L, Peebles, K, Carugno, A, Leslie, K, Harp, J, Pumnea, T, Mcmahon, D, Rosenbach, M, Chen, G, Fox, L, Mcmillen, A, Lim, H, Stratigos, A, A Cronin, T, Kaufmann, M, Hruza, G, French, L, E. Freeman., E, Janet E. Lubov, Alexis Strahan, Sonya Prasad, Cristina Galvan Casas, L. Claire Fuller, Klint Peebles, Andrea Carugno, Kieron S. Leslie, Joanna L. Harp, Teodora Pumnea, Devon E. McMahon, Misha Rosenbach, Geoffrey Chen, Lindy P. Fox, Allen McMillen, Henry W. Lim, Alexander J. Stratigos, Terrence A Cronin, Mark D. Kaufmann, George J. Hruza, Lars E. French, Esther E. Freeman., Lubov, J, Strahan, A, Prasad, S, Galvan Casas, C, Claire Fuller, L, Peebles, K, Carugno, A, Leslie, K, Harp, J, Pumnea, T, Mcmahon, D, Rosenbach, M, Chen, G, Fox, L, Mcmillen, A, Lim, H, Stratigos, A, A Cronin, T, Kaufmann, M, Hruza, G, French, L, E. Freeman., E, Janet E. Lubov, Alexis Strahan, Sonya Prasad, Cristina Galvan Casas, L. Claire Fuller, Klint Peebles, Andrea Carugno, Kieron S. Leslie, Joanna L. Harp, Teodora Pumnea, Devon E. McMahon, Misha Rosenbach, Geoffrey Chen, Lindy P. Fox, Allen McMillen, Henry W. Lim, Alexander J. Stratigos, Terrence A Cronin, Mark D. Kaufmann, George J. Hruza, Lars E. French, and Esther E. Freeman.
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- 2023
7. Mpox in persons living with HIV: results from an international dermatologic registry
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Strahan, A, Lubov, J, Prasad, S, Galvan Casas, C, Claire Fuller, L, Peebles, K, Carugno, A, Leslie, K, Harp, J, Pumnea, T, Mcmahon, D, Rosenbach, M, Chen, G, Fox, L, Mcmillen, A, Lim, H, Stratigos, A, A Cronin, T, Kaufmann, M, Hruza, G, French, L, Freeman, E, Alexis Strahan, Janet Lubov, Sonya Prasad, Cristina Galvan Casas, L. Claire Fuller, Klint Peebles, Andrea Carugno, Kieron S. Leslie, Joanna L. Harp, Teodora Pumnea, Devon E. McMahon, Misha Rosenbach, Geoffrey Chen, Lindy P. Fox, Allen McMillen, Henry W. Lim, Alexander J. Stratigos, Terrence A Cronin, Mark D. Kaufmann, George J. Hruza, Lars E. French, Esther E. Freeman, Strahan, A, Lubov, J, Prasad, S, Galvan Casas, C, Claire Fuller, L, Peebles, K, Carugno, A, Leslie, K, Harp, J, Pumnea, T, Mcmahon, D, Rosenbach, M, Chen, G, Fox, L, Mcmillen, A, Lim, H, Stratigos, A, A Cronin, T, Kaufmann, M, Hruza, G, French, L, Freeman, E, Alexis Strahan, Janet Lubov, Sonya Prasad, Cristina Galvan Casas, L. Claire Fuller, Klint Peebles, Andrea Carugno, Kieron S. Leslie, Joanna L. Harp, Teodora Pumnea, Devon E. McMahon, Misha Rosenbach, Geoffrey Chen, Lindy P. Fox, Allen McMillen, Henry W. Lim, Alexander J. Stratigos, Terrence A Cronin, Mark D. Kaufmann, George J. Hruza, Lars E. French, and Esther E. Freeman
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- 2023
8. Association of Body Lice Infestation With Hemoglobin Values in Hospitalized Dermatology Patients
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Nora Rudd, Adam Zakaria, Michael A. Kohn, Erin H. Amerson, Lindy P. Fox, Eleni Linos, and Aileen Y. Chang
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Hemoglobins ,Pediculus ,Research Letter ,Animals ,Humans ,Dermatology ,Lice Infestations - Abstract
This retrospective study examines the association of lice infestation with iron-deficiency anemia and risk factors such as homelessness and physical disability.
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- 2023
9. The impact of the American Academy of Dermatology/International League of Dermatological Societies COVID-19 registry during the pandemic: 2500 cases across 72 countries
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Alexis G. Strahan, Janet E. Lubov, Sonya Prasad, Lindy P. Fox, Devon E. McMahon, Rhea Singh, Misha Rosenbach, Seemal R. Desai, Henry W. Lim, Bruce H. Thiers, George J. Hruza, Lars E. French, and Esther E. Freeman
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Dermatology - Published
- 2023
10. Association of society of dermatology hospitalist institutions with improved outcomes in Medicare beneficiaries hospitalized for skin disease
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Pranav Puri, Benjamin D. Pollock, Miranda Yousif, Puneet K. Bhullar, Blake W. Boudreaux, Lindy P. Fox, Misha Rosenbach, Mark R. Pittelkow, and Aaron R. Mangold
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Dermatology - Published
- 2023
11. Toxic epidermal necrolysis-like toxic erythema of chemotherapy: 2 illustrative cases
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Ryan Arakaki, Lindy P. Fox, Daniel M. Klufas, Anna Haemel, Sally Y. Tan, Alyson A. Endicott, Eric Dean Merrill, Angela Lu, and Philip E. LeBoit
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medicine.medical_specialty ,medicine.medical_treatment ,Case Report ,TEN - Toxic epidermal necrolysis ,Dermatology ,paraneoplastic pemphigus ,Stevens-Johnson syndrome ,CLS, capillary leak syndrome ,CLs upper limits ,toxic epidermal necrolysis ,capillary leak syndrome ,Acute graft versus host disease ,aGVHD, acute graft-versus-host disease ,medicine ,TEN, toxic epidermal necrolysis ,toxic erythema of chemotherapy ,Chemotherapy ,business.industry ,acute graft-versus-host disease ,PNP, paraneoplastic pemphigus ,TEC, toxic erythema of chemotherapy ,medicine.disease ,Toxic epidermal necrolysis ,IVIG, intravenous immunoglobulin ,Paraneoplastic pemphigus ,drug reactions ,RL1-803 ,oncology ,Toxic erythema ,business ,Capillary Leak Syndrome - Published
- 2021
12. Skin reactions to COVID-19 vaccines: An American Academy of Dermatology/International League of Dermatological Societies registry update on reaction location and COVID vaccine type
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Kimberly G. Blumenthal, Lindy P. Fox, Ramie Fathy, Lars E. French, Anisha Tyagi, Esther E. Freeman, George J. Hruza, Qisi Sun, Devon E. McMahon, and Rhea Singh
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2019-20 coronavirus outbreak ,Skin reaction ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Medicine ,Dermatology ,business ,Virology - Published
- 2022
13. Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases
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Kimberly G. Blumenthal, Anisha Tyagi, Jules B. Lipoff, Henry W. Lim, Lindy P. Fox, Devon E. McMahon, Danna Moustafa, Seemal R. Desai, Lars E. French, Erin Amerson, Bruce H. Thiers, Esther E. Freeman, George J. Hruza, and Misha Rosenbach
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Adult ,Male ,medicine.medical_specialty ,COVID-19 Vaccines ,mRNA ,Dermatology ,registry ,Global Health ,Article ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Pfizer ,vaccine ,medicine ,Humans ,Registries ,Erythema multiforme ,Chilblains ,Adverse effect ,SARS-CoV-2 ,business.industry ,public health ,COVID-19 ,Middle Aged ,medicine.disease ,Morbilliform ,Vaccination ,Delayed hypersensitivity ,Moderna ,030220 oncology & carcinogenesis ,Pityriasis rosea ,Female ,Drug Eruptions ,business ,Shingles - Abstract
Background Cutaneous reactions after messenger RNA (mRNA)-based COVID-19 vaccines have been reported but are not well characterized. Objective To evaluate the morphology and timing of cutaneous reactions after mRNA COVID-19 vaccines. Methods A provider-facing registry-based study collected cases of cutaneous manifestations after COVID-19 vaccination. Results From December 2020 to February 2021, we recorded 414 cutaneous reactions to mRNA COVID-19 vaccines from Moderna (83%) and Pfizer (17%). Delayed large local reactions were most common, followed by local injection site reactions, urticarial eruptions, and morbilliform eruptions. Forty-three percent of patients with first-dose reactions experienced second-dose recurrence. Additional less common reactions included pernio/chilblains, cosmetic filler reactions, zoster, herpes simplex flares, and pityriasis rosea-like reactions. Limitations Registry analysis does not measure incidence. Morphologic misclassification is possible. Conclusions We report a spectrum of cutaneous reactions after mRNA COVID-19 vaccines. We observed some dermatologic reactions to Moderna and Pfizer vaccines that mimicked SARS-CoV-2 infection itself, such as pernio/chilblains. Most patients with first-dose reactions did not have a second-dose reaction and serious adverse events did not develop in any of the patients in the registry after the first or second dose. Our data support that cutaneous reactions to COVID-19 vaccination are generally minor and self-limited, and should not discourage vaccination.
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- 2021
14. The spectrum of COVID-19–associated dermatologic manifestations: An international registry of 716 patients from 31 countries
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Henry W. Lim, Lindy P. Fox, Junko Takeshita, Carrie L. Kovarik, Bruce H. Thiers, Devon E. McMahon, Esther E. Freeman, George J. Hruza, Lars E. French, Seemal R. Desai, Jules B. Lipoff, Misha Rosenbach, and Joanna Harp
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Critically ill ,Hospitalized patients ,business.industry ,Incidence (epidemiology) ,MACULAR ERYTHEMA ,Dermatology ,Morbilliform ,Pathophysiology ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Purpura ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,In patient ,medicine.symptom ,business ,Mild disease ,Skin Findings - Abstract
Background Coronavirus disease 2019 (COVID-19) has associated cutaneous manifestations. Objective To characterize the diversity of cutaneous manifestations of COVID-19 and facilitate understanding of the underlying pathophysiology. Methods Case series from an international registry from the American Academy of Dermatology and International League of Dermatological Societies. Results The registry collected 716 cases of new-onset dermatologic symptoms in patients with confirmed/suspected COVID-19. Of the 171 patients in the registry with laboratory-confirmed COVID-19, the most common morphologies were morbilliform (22%), pernio-like (18%), urticarial (16%), macular erythema (13%), vesicular (11%), papulosquamous (9.9%), and retiform purpura (6.4%). Pernio-like lesions were common in patients with mild disease, whereas retiform purpura presented exclusively in ill, hospitalized patients. Limitations We cannot estimate incidence or prevalence. Confirmation bias is possible. Conclusions This study highlights the array of cutaneous manifestations associated with COVID-19. Many morphologies were nonspecific, whereas others may provide insight into potential immune or inflammatory pathways in COVID-19 pathophysiology.
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- 2020
15. Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults
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Cody Calhoun, Benjamin H. Kaffenberger, Stephen J. Malachowski, Lindsay C. Strowd, Alex G. Ortega-Loayza, Scott Worswick, Alisa N. Femia, Victoria R. Sharon, Anisha Guda, Rebecca B. Saunderson, Juliana Eljure-Téllez, Cindy E. Owen, Karolyn A. Wanat, Caroline M. Mitchell, Arturo R. Dominguez, Lindy P. Fox, Elizabeth N. Ergen, Hajirah N. Saeed, Samantha Venkatesh, Swapna S Shanbhag, Jonathan Cotliar, Robert G. Micheletti, David A. Wetter, James Sun, Mark D. P. Davis, Steven T. Chen, Katherine L. DeNiro, Daniela Kroshinsky, Melissa M. Mauskar, Thomas M. Beachkofsky, Adela R. Cardones, Helena B. Pasieka, Alina G. Bridges, James Chodosh, Lucia Seminario-Vidal, Alina Markova, Sahand Rahnama-Moghadam, and Arash Mostaghimi
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Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Dermatology ,Likert scale ,law.invention ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Wound care ,0302 clinical medicine ,law ,medicine ,Humans ,business.industry ,Stevens johnson ,Guideline ,Pain management ,medicine.disease ,Intensive care unit ,Toxic epidermal necrolysis ,stomatognathic diseases ,Stevens-Johnson Syndrome ,030220 oncology & carcinogenesis ,Airway management ,business - Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions with high morbidity and mortality. Supportive care management of SJS/TEN is highly variable. A systematic review of the literature was performed by dermatologists, ophthalmologists, intensivists, and gynecologists with expertise in SJS/TEN to generate statements for supportive care guideline development. Members of the Society of Dermatology Hospitalists with expertise in SJS/TEN were invited to participate in a modified, online Delphi-consensus. Participants were administered 9-point Likert scale questionnaires regarding 135 statements. The RAND/UCLA Appropriateness Method was used to evaluate and select proposed statements for guideline inclusion; statements with median ratings of 6.5 to 9 and a disagreement index of ≤1 were included in the guideline. For the final round, the guidelines were appraised by all of the participants. Included are an evidence-based discussion and recommendations for hospital setting and care team, wound care, ocular care, oral care, urogenital care, pain management, infection surveillance, fluid and electrolyte management, nutrition and stress ulcer prophylaxis, airway management, and anticoagulation in adult patients with SJS/TEN.
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- 2020
16. Varicella‐zoster and herpes simplex virus reactivation post‐COVID‐19 vaccination: a review of 40 cases in an International Dermatology Registry
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Lars E. French, Grace Chamberlin, Henry W. Lim, Lindy P. Fox, Jules B. Lipoff, Devon E. McMahon, Harry L. Greenberg, Cynthia Lee, Anisha Tyagi, Marlys S. Fassett, Esther E. Freeman, George J. Hruza, Misha Rosenbach, Seemal R. Desai, Kimberly G. Blumenthal, Bruce H. Thiers, and Ramie Fathy
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Herpesvirus 3, Human ,2019-20 coronavirus outbreak ,COVID-19 Vaccines ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,Dermatology ,medicine.disease_cause ,Herpes Zoster ,Letters To The Editor ,Chickenpox ,Humans ,Simplexvirus ,Medicine ,Registries ,Letter to the Editor ,SARS-CoV-2 ,business.industry ,Vaccination ,COVID-19 ,Herpes Simplex ,medicine.disease ,Virology ,Infectious Diseases ,Herpes simplex virus ,business ,Shingles - Published
- 2021
17. Clinical and Pathologic Correlation of Cutaneous COVID-19 Vaccine Reactions including V-REPP: A Registry Based Study
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Jules B. Lipoff, Bruce H. Thiers, Esther E. Freeman, Seemal R. Desai, Devon E. McMahon, George J. Hruza, Kimberly G. Blumenthal, Lars E. French, Ramie Fathy, Rosalynn M. Nazarian, William Damsky, Henry W. Lim, Carrie L. Kovarik, Lindy P. Fox, Grace Chamberlin, Anisha Tyagi, and Misha Rosenbach
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bullous pemphigoid ,pityriasis rosea ,registry ,Stevens-Johnson syndrome ,papular ,chilblains ,mRNA-1273 ,Zoster ,urticaria ,erythromelalgia ,AZD1222 ,vaccine ,Erythema multiforme ,Registries ,dermatopathology ,medicine.diagnostic_test ,lichen planus ,Pityriasis ,psoriasis ,dermatology ,Moderna ,Dermatopathology ,morbilliform ,medicine.medical_specialty ,Ad26.COV2.S ,COVID-19 Vaccines ,Johnson & Johnson Janssen ,Oxford-AstraZeneca ,Skin Diseases ,Article ,Biopsy ,medicine ,Humans ,pernio ,Chilblains ,dermal hypersensitivity reaction ,delayed large local ,business.industry ,SARS-CoV-2 ,erythema multiforme ,COVID-19 ,Exanthema ,medicine.disease ,Dermatology ,papulosquamous ,Skin biopsy ,Pityriasis rosea ,Histopathology ,pathology ,Pfizer-BioNTech ,BNT162b2 ,business - Abstract
Background Cutaneous reactions after COVID-19 vaccination have been commonly reported; however, histopathologic features and clinical correlations have not been well characterized. Methods We evaluated for a history of skin biopsy all reports of reactions associated with COVID-19 vaccination identified in an international registry. When histopathology reports were available, we categorized them by reaction patterns. Results Of 803 vaccine reactions reported, 58 (7%) cases had biopsy reports available for review. The most common histopathologic reaction pattern was spongiotic dermatitis, which clinically ranged from robust papules with overlying crust, to pityriasis rosea-like eruptions, to pink papules with fine scale. We propose the acronym “V-REPP” (vaccine-related eruption of papules and plaques) for this spectrum. Other clinical patterns included bullous pemphigoid-like (n = 12), dermal hypersensitivity (n = 4), herpes zoster (n = 4), lichen planus-like (n = 4), pernio (n = 3), urticarial (n = 2), neutrophilic dermatosis (n = 2), leukocytoclastic vasculitis (n = 2), morbilliform (n = 2), delayed large local reactions (n = 2), erythromelalgia (n = 1), and other (n = 5). Limitations Cases in which histopathology was available represented a minority of registry entries. Analysis of registry data cannot measure incidence. Conclusion Clinical and histopathologic correlation allowed for categorization of cutaneous reactions to the COVID-19 vaccine. We propose defining a subset of vaccine-related eruption of papules and plaques, as well as 12 other patterns, following COVID-19 vaccination.
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- 2021
18. 32700 Association between body lice infestation and decreased hemoglobin values
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Nora Rudd, Adam Zakaria, Michael A. Kohn, Erin H. Amerson, Lindy P. Fox, Eleni Linos, and Aileen Y. Chang
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Dermatology - Published
- 2022
19. Evaluating the potential cost savings from inpatient dermatology consultations
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Lindy P. Fox, Marcus Wiggins, Aaron R. Mangold, Mark R. Pittelkow, Benjamin D. Pollock, Miranda Yousif, Misha Rosenbach, and Pranav Puri
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Inpatients ,business.industry ,Remote Consultation ,MEDLINE ,Value based payment ,Dermatology ,medicine.disease ,Cost savings ,Infectious Diseases ,Cost Savings ,Financial modeling ,Medicine ,Humans ,Medical emergency ,business ,Referral and Consultation - Published
- 2021
20. Characterization of dermatological diagnoses among hospitalized patients experiencing homelessness
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Lindy P. Fox, Penelope Kim-Lim, Adam Zakaria, Aileen Y. Chang, and Erin Amerson
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Adult ,Male ,medicine.medical_specialty ,Dermatology ,Disease ,Skin infection ,Skin Diseases ,Article ,Odds ,Venous stasis ,Internal medicine ,Psoriasis ,Medicine ,Humans ,Medical diagnosis ,Aged ,business.industry ,Seborrhoeic dermatitis ,Odds ratio ,Middle Aged ,medicine.disease ,Hospitalization ,Cross-Sectional Studies ,Ill-Housed Persons ,Female ,San Francisco ,business - Abstract
While previous studies have characterized the types of dermatological disease among people experiencing homelessness (PEH) in the outpatient setting, dermatological disease among hospitalized PEH has never been evaluated. Therefore, we performed a cross-sectional analysis of hospitalized patients who received dermatology consultations at two San Francisco hospitals between March 2018 and March 2020 and compared the odds of diagnostic categories between PEH and patients with stable housing. In both unadjusted and adjusted analyses, PEH had significantly higher odds of bacterial skin infections [adjusted odds ratio (aOR) = 2.29, 95% CI 1.46-3.61], ectoparasitic disease (aOR = 9.43, 95% CI 3.79-23.47), psoriasis or seborrhoeic dermatitis (aOR = 2.50, 95% CI 1.43-4.36) and venous stasis or lymphoedema (aOR = 2.54, 95% CI 1.23-5.27) and significantly lower odds of drug reactions (aOR = 0.34, 95% CI 0.18-0.67). Overall, these findings highlight the unique dermatological challenges among hospitalized PEH and suggest potential strategies to facilitate equitable dermatology care delivery.
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- 2021
21. Subepidermal blistering eruptions, including bullous pemphigoid, following COVID-19 vaccination
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Noel Turner, Lindy P. Fox, Devon E. McMahon, Ramie Fathy, Monica N. Valentin, Mary M. Tomayko, Ohara Aivaz, Tena Rallis, William Damsky, and Esther E. Freeman
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2019-20 coronavirus outbreak ,medicine.medical_specialty ,Pemphigoid ,Subepidermal blistering ,COVID-19 Vaccines ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Immunology ,Vaccination ,Disease Management ,medicine.disease ,Dermatology ,Disease susceptibility ,Blister ,Correspondence ,Pemphigoid, Bullous ,Immunology and Allergy ,Medicine ,Humans ,Bullous pemphigoid ,Disease Susceptibility ,business - Published
- 2021
22. Acute inflammatory edema: A mimicker of cellulitis in critically ill patients
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Laura B. Pincus, Elizabeth M. Marchionne, Lindy P. Fox, Timothy H. McCalmont, and Philip E. LeBoit
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Male ,medicine.medical_specialty ,Critical Illness ,Volume overload ,Connective tissue ,Dermatitis ,Inflammation ,Dermatology ,law.invention ,Diagnosis, Differential ,Pathogenesis ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Body Water ,law ,Abdomen ,medicine ,Edema ,Humans ,Aged ,business.industry ,Cellulitis ,Middle Aged ,medicine.disease ,Intensive care unit ,Lymphatic system ,medicine.anatomical_structure ,Thigh ,030220 oncology & carcinogenesis ,Acute Disease ,Female ,medicine.symptom ,business - Abstract
Background Inpatient dermatology consultations for treatment-refractory or atypical cellulitis are common. In critically ill patients, differentiating cellulitis from its mimickers can be challenging. Objective We describe acute inflammatory edema, a likely underrecognized variant of pseudocellulitis. Methods We reviewed the charts of 15 patients with this diagnosis, seen by the inpatient dermatology consultation service at the University of California at San Francisco between 2009 and 2017. Results The cohort consisted of 9 women and 6 men with an age range of 52-73 years. Acute inflammatory edema presents as bilateral, erythematous, and edematous plaques, most commonly involving the thighs and lower abdomen, sparing areas of increased pressure on the skin. There is a predilection for patients with high body mass index and those with clinical or quantitative findings of fluid overload. Conclusion We propose a 3-part pathogenesis of acute inflammatory edema: 1) acute-onset volume overload 2) in patients with impaired lymphatic return 3) leads to dermal edema, microtears in connective tissue, and an influx of inflammation.
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- 2019
23. Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Multicenter Retrospective Study of 377 Adult Patients from the United States
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Raj Patel, Sandeep S. Saluja, Caroline Yang, Robert G. Micheletti, Megan H. Noe, Adela R. Cardones, Sasha Stephen, Lindy P. Fox, Mark D.P. Davis, Scott Worswick, Jennifer Boggs, Alba Posligua, Daniel D. Miller, Jessica St. John, Monica Rani, Misha Rosenbach, Ronald Hamrick, Arash Mostaghimi, Arturo R. Dominguez, Baran Ho, Bernice Y. Kwong, Lauren C. Hughey, Maria Aleshin, Kanade Shinkai, Erika M. Summers, Larry M. Jones, David J. Margolis, Zelma Chiesa-Fuxench, Daniela Kroshinsky, Benjamin H. Kaffenberger, Karolyn A. Wanat, Jonathan Cotliar, Amy Musiek, Natalie Sun, Victoria R. Sharon, Joel M. Gelfand, Shayna Gordon, Nicole Strickland, Jennifer K. Chen, Ashwin Agarwal, Kimball Jade Kindley, David A. Wetter, and Alex G. Ortega-Loayza
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Adult ,Male ,medicine.medical_specialty ,Critical Care ,Sulfamethoxazole ,Dermatology ,Biochemistry ,Trimethoprim ,Cohort Studies ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,Adrenal Cortex Hormones ,Internal medicine ,Intensive care ,medicine ,Humans ,Molecular Biology ,Survival analysis ,Aged ,Retrospective Studies ,business.industry ,Immunoglobulins, Intravenous ,Retrospective cohort study ,Cell Biology ,Middle Aged ,medicine.disease ,Survival Analysis ,United States ,Toxic epidermal necrolysis ,Standardized mortality ratio ,Stevens-Johnson Syndrome ,030220 oncology & carcinogenesis ,Female ,business ,Cohort study ,medicine.drug - Abstract
Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare, severe mucocutaneous reaction with few large cohorts reported. This multicenter retrospective study included patients with SJS/TEN seen by inpatient consultative dermatologists at 18 academic medical centers in the United States. A total of 377 adult patients with SJS/TEN between January 1, 2000 and June 1, 2015 were entered, including 260 of 377 (69%) from 2010 onward. The most frequent cause of SJS/TEN was medication reaction in 338 of 377 (89.7%), most often to trimethoprim/sulfamethoxazole (89/338; 26.3%). Most patients were managed in an intensive care (100/368; 27.2%) or burn unit (151/368; 41.0%). Most received pharmacologic therapy (266/376; 70.7%) versus supportive care alone (110/376; 29.3%)-typically corticosteroids (113/266; 42.5%), intravenous immunoglobulin (94/266; 35.3%), or both therapies (54/266; 20.3%). Based on day 1 SCORTEN predicted mortality, approximately 78 in-hospital deaths were expected (77.7/368; 21%), but the observed mortality of 54 patients (54/368; 14.7%) was significantly lower (standardized mortality ratio = 0.70; 95% confidence interval = 0.58-0.79). Stratified by therapy received, the standardized mortality ratio was lowest among those receiving both steroids and intravenous immunoglobulin (standardized mortality ratio = 0.52; 95% confidence interval 0.21-0.79). This large cohort provides contemporary information regarding US patients with SJS/TEN. Mortality, although substantial, was significantly lower than predicted. Although the precise role of pharmacotherapy remains unclear, co-administration of corticosteroids and intravenous immunoglobulin, among other therapies, may warrant further study.
- Published
- 2018
24. Predictors of postdischarge follow-up attendance among hospitalized dermatology patients: Disparities and potential interventions
- Author
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Penelope Kim-Lim, Adam Zakaria, Ryan Arakaki, Aileen Y. Chang, Lindy P. Fox, and Erin Amerson
- Subjects
medicine.medical_specialty ,Quality management ,Patients ,business.industry ,Psychological intervention ,Attendance ,Aftercare ,Dermatology ,Health equity ,Patient Discharge ,Underserved Population ,Family medicine ,Medicine ,Humans ,Continuity of care ,business ,Follow-Up Studies - Published
- 2021
25. Cold and COVID: recurrent pernio during the COVID-19 pandemic
- Author
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Henry W. Lim, Jules B. Lipoff, Lindy P. Fox, Misha Rosenbach, Devon E. McMahon, Seemal R. Desai, Esther E. Freeman, George J. Hruza, Lars E. French, and Marlys S. Fassett
- Subjects
Skin manifestations ,medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,SARS-CoV-2 ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,COVID-19 ,Dermatology ,medicine.disease ,Chilblains ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Pandemic ,medicine ,Research Letter ,Humans ,business ,Pandemics - Abstract
Pernio is a commonly reported cutaneous manifestation of SARS‐CoV‐2 infection.1 Our international registry of COVID‐19 dermatologic manifestations has collected 1,176 total cases of COVID‐19 skin manifestations, including 619 cases of pernio in suspected or confirmed COVID‐19 patients.1 Most patients with new‐onset pernio were entered into the registry after the first pandemic wave (79% in March‐May 2020). Starting in September 2020, the registry received reports of a subset of these patients who developed recurrent pernio in the following months.
- Published
- 2021
26. Timing of PCR and antibody testing in patients with COVID-19–associated dermatologic manifestations
- Author
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Esther E. Freeman, George J. Hruza, Lindy P. Fox, Jules B. Lipoff, Lars E. French, Marlys S. Fassett, and Devon E. McMahon
- Subjects
2019-20 coronavirus outbreak ,Time Factors ,biology ,Coronavirus disease 2019 (COVID-19) ,business.industry ,SARS-CoV-2 ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,public health ,MEDLINE ,COVID-19 ,Dermatology ,registry ,Virology ,Skin Diseases ,Article ,chilblains ,COVID-19 Nucleic Acid Testing ,biology.protein ,Medicine ,Humans ,In patient ,pernio ,Antibody ,business - Published
- 2021
- Full Text
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27. Emerging Evidence of the Direct Association Between COVID-19 And Chilblains-Reply
- Author
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Esther E. Freeman, Lindy P. Fox, Devon E. McMahon, UCL - SSS/IREC/PNEU - Pôle de Pneumologie, ORL et Dermatologie, and UCL - (SLuc) Service de dermatologie
- Subjects
2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,SARS-CoV-2 ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Biopsy ,MEDLINE ,COVID-19 ,Dermatology ,medicine.disease ,Virology ,Chilblains ,Medicine ,Humans ,business ,Pandemics ,Skin - Abstract
In Reply We thank Freeman et al for their comment in reference to our recently published article in JAMA Dermatology. The authors rightly point out the limitations of this study in 31 patients with regard to early antibody testing and the imperfect sensitivities and specificities of these tests. However, we later reported updated data, including an additional 23 patients with chilblains.
- Published
- 2021
28. Long COVID in the skin: a registry analysis of COVID-19 dermatological duration
- Author
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Devon E. McMahon, Misha Rosenbach, Henry W. Lim, Lindy P. Fox, Lars French, Seemal Desai, Jules B. Lipoff, Jason G. Cyster, Antonia E. Gallman, Marlys S. Fassett, Esther E. Freeman, and George J. Hruza
- Subjects
2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,SARS-CoV-2 ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Comment ,MEDLINE ,COVID-19 ,Chilblains ,Infectious Diseases ,Post-Acute COVID-19 Syndrome ,Internal medicine ,Medicine ,Humans ,Duration (project management) ,Young adult ,business - Published
- 2021
29. The Ethics of Inpatient Consultative Dermatology
- Author
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Lauren M. Madigan and Lindy P. Fox
- Subjects
medicine.medical_specialty ,Inpatient care ,business.industry ,Hospitalized patients ,media_common.quotation_subject ,education ,Beneficence ,Specialty ,Subspecialty ,Collegiality ,Dermatology ,Medicine ,Justice (ethics) ,business ,Autonomy ,media_common - Abstract
There is a significant burden of skin disease among hospitalized patients and it is our ethical responsibility, as a specialty, to address this need. Performing inpatient care exposes consulting dermatologists to ethical considerations that parallel those of other hospital-based providers and challenges consultants to juggle moral standards of patient autonomy, collegiality, nonmaleficence, beneficence and justice in allocation of care. As inpatient consultative dermatology grows as a subspecialty, it is paramount that providers consider their ethical obligations and the specific vulnerabilities of this patient population.
- Published
- 2021
30. Association Between Homelessness and Group A Streptococcus Skin and Soft Tissue Infections Among Hospitalized Dermatology Consult Patients
- Author
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Adam Zakaria, Katrina Abuabara, John Szumowski, Penelope Kim-Lim, Lindy P. Fox, Erin H. Amerson, and Aileen Y. Chang
- Subjects
Streptococcus pyogenes ,Soft Tissue Infections ,Streptococcal Infections ,Ill-Housed Persons ,Research Letter ,Humans ,Dermatology ,Skin - Abstract
This cross-sectional study examines the rates of group A Streptococcus skin and soft tissue infections among persons experiencing homelessness.
- Published
- 2022
31. Response to: 'Comment on ‘The spectrum of COVID-19-associated dermatologic manifestations: An international registry of 716 patients from 31 countries’'
- Author
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Lindy P. Fox, Devon E. McMahon, Esther E. Freeman, and Seemal R. Desai
- Subjects
2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,vesicular ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,macular erythema ,Dermatology ,registry ,COVID toes ,Skin Diseases ,Article ,Global health ,medicine ,Humans ,pernio ,Registries ,urticarial ,SARS-CoV-2 ,business.industry ,Public health ,public health ,COVID-19 ,MACULAR ERYTHEMA ,Morbilliform ,retiform purpura ,morbilliform ,business - Published
- 2021
32. JAAD Consultative Dermatology-Relaunched
- Author
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Lucia Seminario-Vidal, Lindy P. Fox, Dirk M. Elston, and Jane M. Grant-Kels
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,MEDLINE ,Dermatology ,Periodicals as Topic ,business ,Editorial Policies ,Societies, Medical - Published
- 2020
33. Pernio-like skin lesions associated with COVID-19: A case series of 318 patients from 8 countries
- Author
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Lindy P. Fox, Esther E. Freeman, George J. Hruza, Junko Takeshita, Jules B. Lipoff, Devon E. McMahon, Bruce H. Thiers, Misha Rosenbach, Carrie L. Kovarik, and Lars E. French
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Coronavirus disease 2019 (COVID-19) ,Adolescent ,Pneumonia, Viral ,Dermatology ,Severity of Illness Index ,Skin Diseases ,Article ,chilblains ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Betacoronavirus ,Young Adult ,0302 clinical medicine ,COVID-19 Testing ,Bias ,Interquartile range ,Severity of illness ,medicine ,Humans ,Registries ,pernio ,Young adult ,Chilblains ,Pandemics ,business.industry ,Clinical Laboratory Techniques ,Foot ,SARS-CoV-2 ,Public health ,public health ,COVID-19 ,Middle Aged ,medicine.disease ,Hand ,Infectious disease (medical specialty) ,030220 oncology & carcinogenesis ,Female ,business ,Coronavirus Infections ,Foot (unit) - Abstract
Background Increasing evidence suggests pernio-like lesions are cutaneous manifestations of coronavirus infectious disease 2019 (COVID-19). Objective To describe clinical and pathologic findings of pernio-like lesions in patients with confirmed or suspected COVID-19. Methods An international dermatology registry was circulated to health care providers worldwide through the American Academy of Dermatology, International League of Dermatologic Societies, and other organizations. Results We documented 505 patients with dermatologic manifestations associated with COVID-19, including 318 (63%) with pernio-like lesions. Patients with pernio-like lesions were generally young and healthy, with relatively mild COVID-19. Of 318 patients with confirmed or suspected COVID-19 by providers, 23 (7%) were laboratory-confirmed COVID-19 positive, and 20 others (6%) were close contacts of patients with confirmed COVID-19. Given current testing criteria, many patients lacked COVID-19 testing access. For 55% of patients, pernio-like lesions were their only symptom. In patients with other COVID-19 symptoms, pernio-like lesions typically appeared after other symptoms. Pernio-like lesions lasted a median of 14 days (interquartile range, 10-21 days). Limitations A case series cannot estimate population-level incidence or prevalence. In addition, there may be confirmation bias in reporting. We cannot exclude an epiphenomenon. Conclusions Pernio-like skin changes of the feet and hands, without another explanation, may suggest COVID-19 infection and should prompt confirmatory testing.
- Published
- 2020
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34. The American Academy of Dermatology COVID-19 registry: Crowdsourcing dermatology in the age of COVID-19
- Author
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Esther E. Freeman, George J. Hruza, Junko Takeshita, Lindy P. Fox, Devon E. McMahon, Bruce H. Thiers, Misha Rosenbach, Matthew Fitzgerald, and Lars E. French
- Subjects
medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,International Cooperation ,Pneumonia, Viral ,Dermatology ,Crowdsourcing ,Skin Diseases ,Betacoronavirus ,Pandemic ,Medicine ,Humans ,Registries ,Pandemics ,Societies, Medical ,biology ,business.industry ,SARS-CoV-2 ,Academies and Institutes ,COVID-19 ,biology.organism_classification ,United States ,Family medicine ,business ,Coronavirus Infections - Published
- 2020
- Full Text
- View/download PDF
35. Timing of PCR and Antibody Testing in Patients with COVID-19 associated dermatologic manifestations
- Author
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Marlys S. Fassett, Lindy P. Fox, Devon E. McMahon, and Esther E. Freeman
- Subjects
medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,biology ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Assay sensitivity ,medicine.disease ,Laboratory results ,Dermatology ,medicine ,biology.protein ,In patient ,Viral shedding ,Antibody ,business ,Chilblains - Abstract
A recent study from Spain noted 40 patients with chilblain-like lesions in suspected COVID-19.1 None tested PCR positive for SARS-CoV-2, but 30% had detectable antibodies. The rapid increase in chilblain/pernio-like cases during the COVID-19 pandemic is likely SARS-CoV-2-associated. The relationship between skin symptom onset and COVID-19 PCR/antibody test timing, however, remains uncharacterized.We established an international registry for cutaneous manifestations of COVID-19.2, 3 Providers reported time between dermatologic symptom onset and positive/negative COVID-19 laboratory results, when available.From 8 April-30 June, 2020, 906 laboratory-confirmed or suspected COVID-19 cases with dermatologic manifestations were reported, 534 of which were chilblains/pernio.3 Among PCR-tested patients, 57%(n=208) overall and 15%(n=23) of chilblains/pernio cases were PCR-positive. Antibody positivity was 37%(n=39) overall and 19%(n=15) for chilblains/pernio.We evaluated 163 patients with timing information on PCR and/or antibody testing (Table 1). For patients with suspected COVID-19 and any cutaneous manifestation, PCR-positive testing occurred median 6 (IQR 1-14) days after dermatologic symptoms started while PCR-negative testing occurred median 14 (IQR 7-24) days later. For patients with pernio/chilblains, PCR-positivity was noted 8 (IQR 5-14) days after symptoms and negativity median 14 (IQR 7-28) days later. Antibody testing (IgM or IgG) was positive median 30 (IQR 19-39) days after symptom onset for all dermatologic manifestations and 27 (IQR 24-33) days after chilblains/pernio onset.Like Hubiche et al, our data highlight the low frequency of SARS-CoV-2 PCR+ testing in COVID-19 patients with cutaneous manifestations. Positive predictive values for COVID-19 PCR are influenced by viral shedding kinetics, which are difficult to assess in non-respiratory presentations.4 Our data reveal that early PCR testing is more likely to be positive than later testing, even when date-of-onset is defined by cutaneous manifestations rather than systemic symptoms.Most COVID-19 antibody data are from systemically-ill patients; the kinetics of antibody production in mild-to-moderate COVID-19 infections remain unclear.5 Here, positive antibodies resulted median 30 days from disease onset, beyond the frequently used 14-21 day testing window. In outpatients with true infection, many factors influence the likelihood of a positive antibody result: antibody production, test availability, assay sensitivity, and timing of care-seeking in relation to symptom-onset. These variables influence our interpretation of individual test results and our understanding of the association between pernio and COVID-19.More population-level testing data is necessary to optimize diagnostic test timing. Positive identification of COVID-19 in minimally-symptomatic patients, including patients with skin findings, is critical to the public health effort.
- Published
- 2020
- Full Text
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36. Navigating Immunosuppression in a Pandemic: A Guide for the Dermatologist from the COVID Task Force of the Medical Dermatology Society and Society of Dermatology Hospitalists
- Author
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Steven T. Chen, Lindy P. Fox, Misha Rosenbach, Joanna Harp, Michi M. Shinohara, Vinod E. Nambudiri, Joseph F. Merola, Helena B. Pasieka, Robert G. Micheletti, Milan J. Anadkat, and Omid Zahedi Niaki
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Advisory Committees ,Clinical Decision-Making ,Pneumonia, Viral ,immunosuppressive therapy ,Context (language use) ,autoimmune disease ,Disease ,Dermatology ,Skin Diseases ,Article ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Betacoronavirus ,0302 clinical medicine ,Pandemic ,medicine ,Humans ,Intensive care medicine ,Pandemics ,Societies, Medical ,Immunosuppression Therapy ,immunosuppression ,business.industry ,SARS-CoV-2 ,Risk of infection ,COVID-19 ,Immunosuppression ,medicine.disease ,Symptom Flare Up ,medical dermatology ,Harm ,Hospitalists ,030220 oncology & carcinogenesis ,Relative risk ,Practice Guidelines as Topic ,Middle East respiratory syndrome ,Interdisciplinary Communication ,Disease Susceptibility ,business ,Coronavirus Infections ,dermatology-rheumatology ,Decision Making, Shared ,Dermatologists - Abstract
Dermatologists treating immune-mediated skin disease must now contend with the uncertainties associated with immunosuppressive use in the context of the SARS-CoV-2 pandemic. Though the risk of infection with many commonly used immunosuppressive agents remains low, direct data evaluating the safety of such agents in COVID-19 are scarce. This article reviews and offers guidance based upon currently available safety data, and the most recent COVID-19 outcome data, in patients with immune-mediated dermatologic disease. The interdisciplinary panel of experts emphasize a stepwise, shared decision-making approach in the management of immunosuppressive therapy. The goal of this article is to help providers minimize the risk of disease flares while simultaneously minimizing the risk of iatrogenic harm during an evolving pandemic., This article adds to the limited literature on COVID-19 and immunosuppression. It provides expert opinion based on existing drug safety data and recent COVID-19 outcome data in patients with immune-mediated dermatologic disorders. • The goal is to facilitate management of immunosuppressive drugs and minimize potential for harm in this patient population.
- Published
- 2020
37. Cutaneous Clinico-Pathological Findings in three COVID-19-Positive Patients Observed in the Metropolitan Area of Milan, Italy
- Author
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Lindy P. Fox, Massimo Ghislanzoni, Sebastiano Recalcati, Marco Cusini, Raffaele Gianotti, Francesca Boggio, and Stefano Veraldi
- Subjects
Male ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Pneumonia, Viral ,Dermatology ,Betacoronavirus ,italy ,Pandemic ,lcsh:Dermatology ,Medicine ,Humans ,Skin pathology ,Pandemics ,Skin ,Aged, 80 and over ,Hardware_MEMORYSTRUCTURES ,biology ,business.industry ,SARS-CoV-2 ,COVID-19 ,General Medicine ,lcsh:RL1-803 ,Middle Aged ,biology.organism_classification ,Metropolitan area ,Virology ,Erythema ,Clinico pathological ,Female ,business ,Coronavirus Infections - Abstract
is missing (Short communication)
- Published
- 2020
38. Development and Validation of a Risk Prediction Model for In-Hospital Mortality Among Patients With Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis-ABCD-10
- Author
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Arturo R. Dominguez, Amy Musiek, Joel M. Gelfand, David J. Margolis, Jonathan Cotliar, Jennifer K. Chen, Misha Rosenbach, Alex G. Ortega-Loayza, Karolyn A. Wanat, Robert G. Micheletti, Scott Worswick, Daniel D. Miller, Lauren C. Hughey, David A. Wetter, Megan H. Noe, Rebecca A. Hubbard, Adela R. Cardones, Mark D.P. Davis, Benjamin H. Kaffenberger, Victoria R. Sharon, Kanade Shinkai, Daniela Kroshinsky, Bernice Y. Kwong, Lindy P. Fox, Arash Mostaghimi, and Erika M. Summers
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Dermatology ,Severity of Illness Index ,Cohort Studies ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Severity of illness ,Medicine ,Humans ,Hospital Mortality ,Dialysis ,Aged ,Body surface area ,business.industry ,Odds ratio ,Middle Aged ,Models, Theoretical ,medicine.disease ,Prognosis ,Toxic epidermal necrolysis ,United States ,030220 oncology & carcinogenesis ,Stevens-Johnson Syndrome ,Cohort ,Female ,Hemodialysis ,business ,Cohort study - Abstract
Importance Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a spectrum of severe mucocutaneous drug reaction associated with significant morbidity and mortality. A previously developed SJS/TEN-specific severity-of-illness model (Score of Toxic Epidermal Necrolysis [SCORTEN]) has been reported to overestimate and underestimate SJS/TEN-related in-hospital mortality in various populations. Objective To derive a risk prediction model for in-hospital mortality among patients with SJS/TEN and to compare prognostic accuracy with the SCORTEN model in a multi-institutional cohort of patients in the United States. Design, Setting, and Participants Data from a multicenter cohort of patients 18 years and older treated for SJS/TEN between January 1, 2000, and June 1, 2015, were obtained from inpatient consult databases and electronic medical record systems at 18 medical centers in the United States as part of the Society for Dermatology Hospitalists. A risk model was derived based on data from 370 of these patients. Model discrimination (calculated as area under the receiver operating characteristic curve [AUC]) and calibration (calculated as predicted vs observed mortality, and examined using the Hosmer-Lemeshow goodness-of-fit statistic) were assessed, and the predictive accuracy was compared with that of SCORTEN. All analysis took place between December 2016 and April 2018. Main Outcomes and Measures In-hospital mortality. Results Among 370 patients (mean [SD] age 49.0 [19.1] years; 195 [52.7%] women), 54 (15.14%) did not survive to hospital discharge. Five covariates, measured at the time of admission, were independent predictors of in-hospital mortality: age in years (odds ratio [OR], 1.05; 95% CI, 1.02-1.07), body surface area (BSA) in percentage of epidermal detachment (OR, 1.02; 95% CI, 1.01-1.04), serum bicarbonate level below 20 mmol/L (OR, 2.90; 95% CI, 1.43-5.88), active cancer (OR, 4.40; 95% CI, 1.82-10.61), and dialysis prior to admission (OR, 15.94; 95% CI, 3.38-66.30). A severity-of-illness score was calculated by taking the sum of 1 point each for age 50 years or older, epidermal detachment greater than 10% of BSA, and serum bicarbonate level below 20 mmol/L; 2 points for the presence of active cancer; and 3 points for dialysis prior to admission. The score was named ABCD-10 (age, bicarbonate, cancer, dialysis, 10% BSA). The ABCD-10 model showed good discrimination (AUC, 0.816; 95% CI, 0.759-0.872) and calibration (Hosmer-Lemeshow goodness of fit test, P = .30). For SCORTEN, on admission, the AUC was 0.827 (95% CI, 0.774-0.879) and was not significantly different from that of the ABCD-10 model (P = .72). Conclusions and Relevance In this cohort of patients with SJS/TEN, ABCD-10 accurately predicted in-hospital mortality, with discrimination that was not significantly different from SCORTEN. Additional research is needed to validate ABCD-10 in other populations. Future use of a new mortality prediction model may provide improved prognostic information for contemporary patients, including those enrolled in observational studies and therapeutic trials.
- Published
- 2020
39. Effect of Topical Brimonidine on Alcohol-Induced Flushing in Asian Individuals: A Randomized Clinical Trial
- Author
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Isaac M. Neuhaus, Lindy P. Fox, Kanade Shinkai, Siegrid S. Yu, Roy C. Grekin, Christine Aroyan, Sarah T. Arron, Brian Lu, Daniel Tan, Wesley Y. Yu, and Kieron S. Leslie
- Subjects
Adult ,Male ,medicine.medical_specialty ,Erythema ,Alcohol Drinking ,Psychological intervention ,Dermatology ,Placebo ,Administration, Cutaneous ,Alcohol-induced flushing ,law.invention ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Randomized controlled trial ,Asian People ,Double-Blind Method ,law ,Internal medicine ,Flushing ,Medicine ,Humans ,Prospective Studies ,Ethanol ,business.industry ,Brimonidine ,Brief Report ,Distress ,030220 oncology & carcinogenesis ,Brimonidine Tartrate ,Female ,medicine.symptom ,business ,Psychosocial ,Gels ,medicine.drug - Abstract
IMPORTANCE: Alcohol flushing syndrome (AFS, also known as Asian glow and Asian flush) affects 20% to 47% of East Asians and causes significant psychosocial distress. There are no approved treatments for this condition. OBJECTIVE: To determine whether brimonidine gel, 0.33%, decreases facial erythema in patients with AFS after consumption of alcohol. DESIGN, SETTING, AND PARTICIPANTS: In this randomized clinical trial, 20 healthy volunteers of East Asian descent with a self-reported history of AFS were recruited between April 2018 and March 2019. INTERVENTIONS: Participants were randomized to application of brimonidine gel to either the left or right half of their face. Placebo control was applied to the opposite side. After 30 minutes, participants ingested alcohol. MAIN OUTCOMES AND MEASURES: Outcomes were specified before data collection. The difference in erythema between the treated and placebo side of each participant’s face was measured 60 minutes after drug application (primary outcome) and at 90 and 120 minutes after drug application (secondary outcomes). Participants were asked to rate their likelihood of using the medication again and their likelihood of recommending the medication to a friend on a scale of 0 to 10. RESULTS: The mean (SD) age of the 20 individuals enrolled in the study was 30.5 (8.4) years, and there were 10 women (50%). There was a significant difference in erythema at 60 minutes after drug application as measured by the difference in Clinician Erythema Assessment score (2.1; 95% CI, 1.5-2.71; P
- Published
- 2019
40. LB742 Predictors of post-discharge follow-up attendance among hospitalized dermatology patients
- Author
-
Kanade Shinkai, Lindy P. Fox, Aileen Y. Chang, Ryan Arakaki, Erin Amerson, Penelope Kim-Lim, Adam Zakaria, and Anna Haemel
- Subjects
medicine.medical_specialty ,business.industry ,Emergency medicine ,medicine ,Attendance ,Cell Biology ,Dermatology ,business ,Molecular Biology ,Biochemistry ,Post-discharge follow-up - Published
- 2021
41. LB737 Lack of stable housing as a risk factor for group A streptococcal skin and soft tissue infection among hospitalized adult patients
- Author
-
Penelope Kim-Lim, Adam Zakaria, Lindy P. Fox, Erin Amerson, Katrina Abuabara, and Aileen Y. Chang
- Subjects
medicine.medical_specialty ,Adult patients ,business.industry ,Internal medicine ,Medicine ,Soft tissue infection ,Cell Biology ,Dermatology ,Risk factor ,business ,Molecular Biology ,Biochemistry ,Group A - Published
- 2021
42. Updates in the Approach to the Patient with Purpura
- Author
-
Lindy P. Fox and Ryan Arakaki
- Subjects
030203 arthritis & rheumatology ,Pathology ,medicine.medical_specialty ,business.industry ,Dermatology ,Malignancy ,medicine.disease ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Purpura ,0302 clinical medicine ,hemic and lymphatic diseases ,medicine ,medicine.symptom ,Differential diagnosis ,business ,Vasculitis ,Palpable purpura - Abstract
This review aims to provide an updated clinical framework for how to approach the patient with a purpuric eruption. The approach outlined within is focused on the identification of the primary cutaneous morphology from which one can then generate a focused differential diagnosis and initiate an appropriate workup. The primary morphologies of purpura include petechiae, macular purpura, palpable purpura, and retiform purpura. Each of these morphologies is associated with a specific underlying pathophysiology. Identifying the morphology and pathophysiology that is present is especially important in purpuric eruptions as they may be associated with underlying systemic illness such as malignancy, infection, vasculitis, or autoimmune disease. The approach to purpura starts with identifying the suspected primary cutaneous morphology. This allows the clinician to generate a hypothesis regarding the pathophysiology causing a patient’s eruption. Based on the pathophysiology that is suspected, a differential diagnosis can be generated and an appropriate workup can be initiated. This is especially important in purpuric eruptions as they can be a manifestation of many types of internal diseases.
- Published
- 2017
43. SCIENTIFIC ABSTRACTS - 17th Annual Las Vegas Dermatology Seminar
- Author
-
Iris Ahronowitz and Lindy P. Fox
- Subjects
Erythema nodosum ,Pemphigoid ,medicine.medical_specialty ,Linear IgA bullous dermatosis ,Lupus erythematosus ,integumentary system ,business.industry ,Dermatology ,medicine.disease ,Pemphigus ,stomatognathic system ,immune system diseases ,medicine ,Pseudolymphoma ,Surgery ,skin and connective tissue diseases ,Vasculitis ,business ,Pyoderma gangrenosum - Abstract
A variety of common dermatoses are known to have drug-induced variants. This article discusses the clinical presentation, time frames, reported culprit medications, pathophysiology and management of drug-induced lupus, cutaneous vasculitis, pemphigus, pemphigoid, linear IgA bullous dermatosis, Sweet's syndrome, erythema nodosum, pyoderma gangrenosum, pseudolymphoma, lichen planus, and psoriasis.
- Published
- 2016
44. Retiform purpura: Workup and therapeutic considerations in select conditions
- Author
-
Lindy P. Fox, Joanna Harp, and Corey Georgesen
- Subjects
medicine.medical_specialty ,Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis ,Dermatology ,Skin Diseases, Vascular ,Catastrophic antiphospholipid syndrome ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,immune system diseases ,Risk Factors ,hemic and lymphatic diseases ,medicine ,Humans ,Purpura ,Disseminated intravascular coagulation ,Calciphylaxis ,business.industry ,Systemic Vasculitis ,medicine.disease ,Cryoglobulinemia ,030220 oncology & carcinogenesis ,Etiology ,medicine.symptom ,Vasculitis ,Microscopic polyangiitis ,business ,Purpura fulminans - Abstract
In this article we focus on updates in select etiologies of retiform purpura. These causes of retiform purpura, in addition to bacterial or fungal sepsis, disseminated intravascular coagulation, purpura fulminans, and catastrophic antiphospholipid syndrome, are important diagnoses with potential for morbidity and mortality. Important aspects in the pathophysiology, patient demographics and risk factors, updates in the diagnostic workup, histopathology, and treatment of these specific conditions are discussed.
- Published
- 2019
45. Retiform purpura: A diagnostic approach
- Author
-
Lindy P. Fox, Corey Georgesen, and Joanna Harp
- Subjects
Pathology ,medicine.medical_specialty ,Biopsy ,Thrombotic thrombocytopenic purpura ,Ischemia ,Dermatology ,Skin Diseases, Vascular ,Diagnosis, Differential ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,hemic and lymphatic diseases ,medicine ,Humans ,Medical History Taking ,Physical Examination ,Purpura ,Disseminated intravascular coagulation ,business.industry ,Clinical Laboratory Techniques ,medicine.disease ,030220 oncology & carcinogenesis ,Differential diagnosis ,medicine.symptom ,Vasculitis ,business - Abstract
Retiform purpura is a specific morphology within the spectrum of reticulate eruptions of vascular origin. It develops when blood vessels serving the skin are compromised resulting in downstream cutaneous ischemia, purpura, and necrosis. Identifying retiform purpura is important particularly in the acutely ill patient. It may elucidate the underlying diagnosis, provide prognostic information, and suggest a treatment approach. The differential diagnosis of retiform purpura is vast, reflecting the myriad conditions that can lead to cutaneous vessel wall damage or lumen occlusion. In this article, we give an overview of the differential diagnosis of this cutaneous morphology, provide an approach to workup, and highlight updates in treatment of some of the more common conditions that manifest as retiform purpura.
- Published
- 2019
46. Dermatology hospitalist fellowships: present and future
- Author
-
Lindy P. Fox and Natalie Z Sun
- Subjects
medicine.medical_specialty ,Inpatient care ,Hospitalized patients ,business.industry ,Dermatology ,Hospital Medicine ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Hospitalists ,030220 oncology & carcinogenesis ,Humans ,Medicine ,Surgery ,Direct consequence ,Curriculum ,Fellowships and Scholarships ,business - Abstract
The question of what makes a successful dermatology hospitalist has risen to the forefront due to the rapidly increasing number of these providers. Inpatient dermatology fellowships have formed as a direct consequence. Though mostly in their infancy, these programs have primary or secondary goals to train providers in the dermatologic care of the hospitalized patient. This article presents a brief synopsis of the history of traditional hospitalist fellowships and extrapolates these findings to existing hospitalist dermatology fellowships. As more of these programs arise, these fellowships are poised to revolutionize dermatologic inpatient care from a systems perspective.
- Published
- 2017
47. Where are we now with inpatient consultative dermatology?: Assessing the value and evolution of this subspecialty over the past decade
- Author
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Lauren M. Madigan and Lindy P. Fox
- Subjects
Value (ethics) ,medicine.medical_specialty ,Inpatients ,business.industry ,Value based care ,Diagnosis-related group ,Dermatology ,Subspecialty ,Skin Diseases ,United States ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Hospitalists ,030220 oncology & carcinogenesis ,Health care ,Outcome Assessment, Health Care ,medicine ,Humans ,business ,Referral and Consultation ,Forecasting ,Specialization - Abstract
The importance of inpatient consultative dermatology is often underrecognized and undervalued. A significant need exists because the burden of skin disease in the hospital is great and expertise regarding the recognition and management of uncommon and severe skin disorders is limited outside the field. In response to this need, the concept of a dermatology hospitalist was defined and the Society for Dermatology Hospitalists was created in 2009. Over the past decade, the subspecialty has developed and fostered both research and education. Data now exist demonstrating the value of inpatient dermatology services not only to patients but also to payors and health care systems. Future needs include strategies to improve access to expertise and additional efforts to establish our field as an indispensable and enduring component of hospital-based care.
- Published
- 2018
48. Vancomycin-associated drug-induced hypersensitivity syndrome
- Author
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Lindy P. Fox and Lauren M. Madigan
- Subjects
Adult ,Male ,medicine.medical_specialty ,Dermatology ,Risk Assessment ,Drug reaction with eosinophilia and systemic symptoms ,Drug Administration Schedule ,Academic institution ,Cohort Studies ,030207 dermatology & venereal diseases ,03 medical and health sciences ,chemistry.chemical_compound ,Young Adult ,0302 clinical medicine ,Sex Factors ,Vancomycin ,Eosinophilia ,medicine ,Drug-induced hypersensitivity syndrome ,Prevalence ,Humans ,Aged ,Retrospective Studies ,Creatinine ,Acute interstitial nephritis ,Academic Medical Centers ,Dose-Response Relationship, Drug ,business.industry ,Incidence (epidemiology) ,Age Factors ,Small sample ,Middle Aged ,medicine.disease ,Prognosis ,United States ,chemistry ,030220 oncology & carcinogenesis ,Drug Hypersensitivity Syndrome ,Female ,business ,medicine.drug - Abstract
Background Although hypersensitivity reactions are well characterized for certain medications, vancomycin-associated drug-induced hypersensitivity syndrome (DIHS), or drug reaction with eosinophilia and systemic symptoms (DRESS), has yet to be defined. Objective To better define the clinical phenotype of vancomycin-associated DIHS. Methods A retrospective case series was conducted over an 8-year period at a single, academic institution. A total of 29 cases of DIHS/DRESS were identified, of which 4 were attributed to vancomycin. A literature review was performed; it identified 28 additional cases of vancomycin-induced DIHS. Vancomycin-associated acute interstitial nephritis was also reviewed to detect additional, previously uncharacterized cases of systemic hypersensitivity. The review yielded 11 additional cases. Results In this literature review and retrospective series, the incidence of renal dysfunction among vancomycin-induced cases (75% and 68% of cases in the series and literature, respectively) was notably higher than the overall reported incidence in DIHS (10%-40%). The degree of renal impairment was also significantly increased in the retrospective series (a median 4.98-fold change in baseline creatinine level vs a 2.25-fold increase in non–vancomycin-associated cases [P = .011]). Limitations The principal limitation of this study is the small sample size. Other notable limitations include the retrospective nature of the study and absence of confirmatory renal biopsies. Conclusion Although the current understanding of DIHS/DRESS is imperfect, our findings suggest that vancomycin-induced cases present with a unique phenotype characterized by a higher burden of renal involvement.
- Published
- 2018
49. Successful treatment of mucous membrane pemphigoid with bortezomib
- Author
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Lianne S. Gensler, Haley B. Naik, Tiffany C. Scharschmidt, Timothy H. Schmidt, Lindy P. Fox, Lina Saeed, Karin M.L. Gaensler, Kanade Shinkai, Michael Rosenblum, and Andrew J. Gross
- Subjects
bullous pemphigoid ,medicine.medical_specialty ,Mucocutaneous zone ,BP, bullous pemphigoid ,Dermatology ,Matrix metalloproteinase ,MMP, mucous membrane pemphigoid ,Article ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,BP ,mucous membrane pemphigoid ,medicine ,lcsh:Dermatology ,skin and connective tissue diseases ,BP - Bullous pemphigoid ,integumentary system ,MMP ,business.industry ,Bortezomib ,bortezomib ,lcsh:RL1-803 ,medicine.disease ,autoimmune blistering disease ,Mucous membrane pemphigoid ,030221 ophthalmology & optometry ,Proteasome inhibitor ,Bullous pemphigoid ,business ,medicine.drug - Abstract
Mucous membrane pemphigoid (MMP) is a rare, autoantibody-mediated disease characterized by mucocutaneous blistering including oral, ocular, laryngeal, and skin involvement. Treating MMP is challenging, with few effective therapies available. We report successful treatment of a patient with treatment-refractory MMP with the proteasome inhibitor, bortezomib.
- Published
- 2018
50. Inpatient dermatology consultation aids diagnosis of cellulitis among hospitalized patients: A multi-institutional analysis
- Author
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Lauren C. Hughey, Lauren Strazzula, Daniela Kroshinsky, Lindy P. Fox, Jonathan Cotliar, Kanade Shinkai, and Sarah N. Gee
- Subjects
Male ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Hospitalized patients ,Incidence (epidemiology) ,Cellulitis ,Physical examination ,Dermatology ,Middle Aged ,medicine.disease ,Tertiary care ,Hospitalization ,Humans ,Medicine ,Female ,In patient ,Risk factor ,business ,AIDS diagnosis ,Retrospective Studies - Abstract
Background Given its nonspecific physical examination findings, accurately distinguishing cellulitis from a cellulitis mimicker (pseudocellulitis) is challenging. Objective We sought to investigate the national incidence of cellulitis misdiagnosis among inpatients. Methods We conducted a retrospective review of inpatient dermatology consultations at Massachusetts General Hospital, University of Alabama at Birmingham Medical Center, University of California Los Angeles Medical Center, and University of California San Francisco Medical Center in 2008. All consults requested for the evaluation of cellulitis were included. The primary outcomes were determining the incidence of cellulitis misdiagnosis, evaluating the prevalence of associated risk factors, and identifying common pseudocellulitides. Results Of the 1430 inpatient dermatology consultations conducted in 2008, 74 (5.17%) were requested for the evaluation of cellulitis. In all, 55 (74.32%) patients evaluated for cellulitis were given a diagnosis of pseudocellulitis. There was no statistically significant difference in the rate of misdiagnosis across institutions ( P = .12). Patient demographics and associated risk factor prevalence did not statistically vary in patients given a diagnosis of cellulitis versus those with pseudocellulitis ( P > .05). Limitations This study was unable to evaluate all patients admitted with cellulitis and was conducted at tertiary care centers, which may affect the generalizability of the results. Conclusions Cellulitis is commonly misdiagnosed in the inpatient setting. Involving dermatologists may improve diagnostic accuracy and decrease unnecessary antibiotic use.
- Published
- 2015
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