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Actinic keratoses (AKs) are frequently treated in the U.S., impacting an estimated 40 million people in 2004 and costing over $1 billion annually. AKs are a major public health concern because of their high prevalence, substantial cost, and potential for malignant transformation to keratinocyte carcinoma (KC). In this analysis, predictors of AK count were explored using pre-randomization baseline data from two large randomized trials of veterans with multiple prior KCs (n=932 and n=1131). Multivariate analyses were conducted to elucidate associations between AK count and several demographic and health related factors. In both trials, greater baseline AK count on the face/ears was strongly associated (p≤0.01) with older age, lower latitude, male sex, greater sun sensitivity, previous 5-FU use, and a higher number of prior invasive SCCs, but was not associated with number of prior BCCs. Additionally, mean baseline AK count was higher on the left side of the face/ear compared to the right, which may be explained by increased UV radiation to the left side while driving. Risk factors for actinic keratoses in a high-risk population are particularly important as actinic keratoses in this group are more likely to progress to keratinocyte carcinoma. Recognizing predictors of AK count in individuals at high risk for KC may help providers tailor AK prevention and treatment efforts. This may in turn lower the risk of KC—perhaps a more important goal—as the keratinocytic dysplasia that gives rise to malignancy, and sometimes appears as an AK, is what actually threatens patient health.

An 84-year-old woman presented with 5 days of a pruritic skin eruption that formed arciform and linear patterns. She was diagnosed with flagellate shiitake mushroom dermatitis related to shiitake mushroom consumption the day prior symptom onset.

Keloids are benign growths characterized by excessive collagen formation. The treatment of keloid scars remains a challenging clinical dilemma for both patients and providers. Intralesional cryosurgery has emerged as a safe and effective new treatment by destroying the hypertrophic scar tissue with minimal damage to the skin surface. [ABSTRACT FROM AUTHOR]

The article presents a case study of a two-month-old girl with a rash on the forehead and scalp developed at age of two weeks and worsened. The mother of the patient reported a normal vagina delivery with mild hyperbilirubinemia. The patient was diagnosed with neonatal lupus erythematosus (NLE). It discusses microscopic findings, differential diagnosis, and treatment of NLE, highlighting the importance of monitoring pregnant antibody-positive mother for the risk of passing autoimmune disease.

A 51-year-old man with a 3-year history of exogenous testosterone pellet injections to the left buttock presented for routine skin examination. While the patient reported recurrent drainage from the site of testosterone replacement therapy (TRT) injections, he continued to receive repeated implantations every 6 months. On physical examination, a 12-mm irregular, brown macule was identified within a poorly demarcated, ecchymotic, and fluctuant subcutaneous plaque on the left buttock with a sinus tract draining serosanguinous fluid. The pigmented lesion was biopsied, revealing malignant melanoma in situ ; hence, a wide local excision was scheduled. During the procedure, necrotic subcutaneous fat was observed surrounding the site of biopsy, and a region measuring 18 cm 2 approximately was debrided and submitted for pathologic evaluation. Histopathologic examination revealed a diffused subcutaneous granulomatous infiltrate with septal and lobular panniculitis and fat necrosis as well as peripherally palisading histiocytes and hemosiderin deposition (Figures 1A and B). Similar findings were observed in another specimen from the same segment of debrided tissue, compatible with granulomatous panniculitis. Periodic acid-Schiff (PAS), Gram's, and acid-fast bacilli (AFB) stains revealed no microorganisms. During surgical exploration, six foreign bodies were discovered and identified as undissolved testosterone pellets. The patient was referred to a wound care center, but ultimately lost to follow-up.

An 81-year-old man presented to the clinic with a 2.1 cm firm, skin-colored subcutaneous tumor on the left upper arm (Figure 1). The lesion arose at the site of a past smallpox vaccination and had been slowly enlarging for approximately 4 years. The differential diagnosis included sympastic leiomyoma, and a variety of desmoplastic spindle cell lesions such as desmoplastic melanoma, cutaneous spindle cell carcinoma, and desmoplastic leiomyosarcoma. Punch biopsy and immunohistochemical staining revealed positive spindle cells for desmin and caldesmon (Figures 2 and 3). Immunostain for p53 was also strongly and uniformly positive. Owing to poor circumscription on histopathology, symplastic leiomyosarcoma was ruled out. Demoplastic melanoma was also excluded due to positive immunoreaction to muscle markers (desmin and caldesmon) and negative S-100 staining. Additionally, cutaneous spinde cell carcinoma was also ruled out due to negative p63 and cytokeratin staining. Ultimately, clinicopathologic correlation favored a diagnosis of desmoplastic leiomyosarcoma. Staged excisions were performed to eradicate the lesion.

A 60-year-old Caucasian woman with a 15-year smoking history presented with new, asymptomatic, pink lesions that gradually appeared over a period of 6 weeks. Physical examination revealed erythematous annular and nummular plaques on her upper and lower extremities, chest, and abdomen (Figure 1A and 1B). A shave biopsy from the right thigh revealed focal areas of necrobiotic collagen in the superficial portion of the dermis, surrounded by histiocytes, multinucleated giant cells, and lymphocytes, consistent with granuloma annulare (GA) (Figure 2). 1 .

A 52-year-old man with Fitzpatrick type V skin presented for evaluation of a photodistributed eruption of unknown origin. The patient reported a 20-year history of the dermatitis, with worsening severity during the past 6 years. He had required one hospital admission with intravenous methylprednisolone and two extended courses of oral prednisone (starting dose of 60 mg/d). He complained of pruritus and swelling localized to the sun-exposed areas of the forearms, face, and neck, with notable sparing of photoprotected areas of his skin. He denied new medications, and a systemic review of systems was noncontributory.

The human circadian clock ensures that biochemical and physiological processes occur at the optimal time of day. In addition to a central pacemaker in the body, recent evidence suggests that peripheral mammalian tissues also possess autonomous circadian oscillators, which are regulated by genes linked to distinct tissue-specific functions. The skin is situated in a position naturally exposed to diurnal environmental changes. The skin's chronobiological functioning influences skin aging, cell repair and development of skin cancers, as well as optimal timing of drug delivery to the skin. An understanding of circadian skin-related functions and the impact of their disruption allow clinicians to improve therapeutic decision-making and maximize the effectiveness of prescribed treatments.

Background: Patients with moderate to severe psoriasis may not respond adequately to single systemic agent and may require combination systemic therapy., Objective: To evaluate the prevalence, indications, and response to combination systemic therapy with ustekinumab for psoriasis in a tertiary referral center., Methods: This retrospective study comprised 102 psoriasis patients treated with ustekinumab at a single tertiary care center. Data was collected pertaining to history of psoriasis, past and current therapies including use of concomitant psoriasis agents, response to therapy, and side effects while on ustekinumab., Results: Twenty-two of 102 (22%) patients were identified as receiving combination systemic treatment involving ustekinumab and at least one additional agent. The most common indication for combination therapy was psoriatic arthritis (35%), followed by bridging therapy (26%), inadequate psoriasis control (13%), prevention of non-melanoma skin cancers (17%), and control of palmoplantar disease (9%). Methotrexate was the additional agent in 12 patients, cyclosporine in 7 patients, acitretin in 5 patients, and 1 patient received a second biologic agent, first etanercept and then adalimumab. Overall, the reduction in body surface area (BSA) was 80% for patients on combination therapy. For those patients on combination therapy for psoriatic arthritis, 75% had resolution or stabilization of their symptoms. Only one patient, receiving cyclosporine, discontinued combination therapy due to adverse side effects., Conclusion: Combination systemic therapy with ustekinumab can be effective and well tolerated for patients who cannot be adequately treated with ustekinumab alone.