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Acne keloidalis nuchae (AKN) correctly termed “folliculitis keloidalis”, is an unusual form of chronic folliculitis and cicatricial alopecia that affects nape of neck. AKN can lead to significant scarring with tumor like masses and alopecia. Treatment in chronic cases is challenging with recurrence being common. Several modalities are being tried with variable success. We aim to report our experience with multimodality surgical approach. Five patients of chronic AKN refractory to intralesional steroids were treated between 2015 - 2018 with (1) excision and primary closure or (2) punch excision followed by healing with secondary intention or (3) intralesional cryotherapy, based on lesion morphology, site and extent . All patients also underwent long-pulsed (LP) neodymium-doped yttrium aluminum garnet (Nd:YAG)laser hair removal for the affected part with an aim to prevent new lesions from developing in the surrounding area. Patients were followed at regular intervals till 6 months. 100% patients were satisfied with the treatment outcome. They showed 80%–90% overall reduction in lesions with satisfactory cosmetic outcome. Complete removal of follicles leads to least chance of local recurrence. Surgical excision remains the most effective modality of management. In case of lesions <5 mm, punch excision can be gratifying. Cryotherapy is useful where excision and primary closure is not feasible. Hair removal lasers can prevent new lesions in the sorrounding area. Combined multimodality approach tailored to the type of lesions gives maximal result with a better cosmetic outcome. [ABSTRACT FROM AUTHOR]

The article discusses a case study on acneiform eruptions, a type of skin disease, on the face caused due to inhaling steroids and mentions the need to use topical medications in treating the disease.

The article discusses soft tissue neoplasm lipomas in the adipose tissue and most common in mesenchymal tissue. It examines the asymptomatic swelling on the left forehead of a fifty-eight-year-old male leading to an epidermoid cyst and lipoma diagnosis and a plan of using local anesthesia for surgical excision with the dissection of the frontalis muscle. It suggests the importance of differential diagnosis for proper patient care as to subcutaneous forehead nodules being common.

Background: Laser therapy has emerged as an innovative approach for managing various nail conditions, offering precise targeting, minimal invasiveness, and favorable safety profiles. This review analyzes the literature on laser therapy for nail indications, encompassing onychomycosis, nail psoriasis, nail warts, ingrown toenails, onychodystrophy, nail pigmentation disorders, and nail tumors., Methods: PubMed and Google Scholar databases were searched to identify articles on laser therapy using specific key terms related to nail conditions (e.g., onychomycosis, nail psoriasis). Relevant articles were shortlisted based on laser treatment in nail disorders, its mechanisms of action, research outcomes, and clinical applications., Results: Nd: YAG or CO 2 lasers showed efficacy in onychomycosis by targeting fungal cells. Studies suggest that laser treatments offer comparable results to traditional therapies, often enhancing outcomes when combined with topical agents such as calcipotriol/betamethasone in nail psoriasis. For nail warts, ingrown toenails, onychodystrophy, and nail pigmentation disorders, lasers provide alternative or adjunctive therapies, achieving positive outcomes lesion clearance and symptom improvement. Conclusion: This review underscores the transformative potential of laser therapy in nail disorder management, providing clinicians with innovative treatment alternatives. Nevertheless, further studies are needed to refine protocols, evaluate long-term outcomes and explore its application in specific conditions such as nail tumors., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Indian Dermatology Online Journal.)

To our knowledge, this is a unique report of intraoperative magnetic resonance imaging (iMRI) of an intracranial cottonoid. The current literature describes images of cottonoids as a post-operative finding in the setting of an unintentionally retained foreign body; however, the iMRI images we present are important as the use of iMRI in the resection of complex tumors and epilepsy foci increases. This series of images was obtained during a craniotomy for tumor resection of a patient with dysembryoplastic neuroepithelial tumor. To determine both the degree of tumor resection and the amount of residual tumor, cottonoids were left in our patient's resection cavity and underwent iMRI. The ability to distinguish cottonoids in these images is important for intraoperative localization of resection margins and to prevent the retention of cottonoids., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: The optimal extent of resection of craniopharyngiomas to minimize the long-term risks of hypothalamic and endocrine dysfunction (obesity and panhypopituitarism) in children remains uncertain. The purpose of this study was to report long-term outcomes of pediatric patients with craniopharyngioma undergoing surgical treatment and to study rates of endocrinological and hypothalamic dysfunction in association with extent of resection., Methods: This retrospective study was performed in a cohort of children who underwent resection for craniopharyngioma at Children's of Alabama between 1990 and 2020. The primary outcome was hypothalamic dysfunction defined as a 0.5 increase in body mass index (BMI) Z-score and as a BMI > 2 SDs with or without psychiatric disturbances. Univariable analysis was performed using ANOVA, Wilcoxon rank-sum test, Pearson's chi-square test, and Fisher's exact test as appropriate. Missing data on the primary outcome were handled via multiple imputations. Relative risks were estimated using a multivariable generalized linear model with a priori variables selected using a modified Poisson regression approach with robust error variance to estimate risk ratios., Results: The cohort includes 39 patients (24 girls and 15 boys; age range 1 month-16 years) who underwent resection of craniopharyngioma at the authors' center between 1990 and 2020. The preoperative goal of treatment was cyst decompression (CD) in 5, subtotal resection (STR) in 13, and gross-total resection (GTR) in 21 patients. The median long-term follow-up after surgery was 8.11 years (average 8.21, range 0.4-24.33 years). Univariate analysis demonstrated a statistically significant increase in hypothalamic dysfunction in patients undergoing GTR when compared to those undergoing STR or CD at 1 month postoperatively (p = 0.006) and 6-11 months postoperatively (p = 0.010), but with this difference not persisting beyond 1 year. Multivariable analysis showed patients older than 10 years at time of surgery to be the most affected and at highest risk of developing significant hypothalamic dysfunction. There was no significant difference in pituitary or neurological function between the STR/CD and GTR groups at 12-24 months or at most recent follow-up. There was no significant difference in BMI Z-scores between the STR/CD and GTR groups at 6-12 months or at most recent follow-up., Conclusions: Both STR and GTR of craniopharyngioma were associated with significant endocrinological sequelae after 1 year. These potential complications should be discussed with patients and their families, and postoperative protocols should include early nutritional and endocrinological interventions with endocrinologist consultation.

Abstract: Nociceptive and pruriceptive neurons in the dorsal root ganglia (DRG) convey sensations of pain and itch to the spinal cord, respectively. One subtype of mature DRG neurons, comprising 6% to 8% of neurons in the ganglia, is responsible for sensing mediators of acute itch and atopic dermatitis, including the cytokine IL-31. How itch-sensitive (pruriceptive) neurons are specified is unclear. Here, we show that transmembrane protein 184B (TMEM184B), a protein with roles in axon degeneration and nerve terminal maintenance, is required for the expression of a large cohort of itch receptors, including those for interleukin 31 (IL-31), leukotriene C4, and histamine. Male and female mice lacking TMEM184B show reduced responses to IL-31 but maintain normal responses to pain and mechanical force, indicating a specific behavioral defect in IL-31-induced pruriception. Calcium imaging experiments indicate that a reduction in IL-31-induced calcium entry is a likely contributor to this phenotype. We identified an early failure of proper Wnt-dependent transcriptional signatures and signaling components in Tmem184b mutant mice that may explain the improper DRG neuronal subtype specification. Accordingly, lentiviral re-expression of TMEM184B in mutant embryonic neurons restores Wnt signatures. Together, these data demonstrate that TMEM184B promotes adult somatosensation through developmental Wnt signaling and promotion of proper pruriceptive gene expression. Our data illuminate a new key regulatory step in the processes controlling the establishment of diversity in the somatosensory system., (Copyright © 2021 International Association for the Study of Pain.)

A nonverbal 3-year-old male with a complex past medical history was referred to pediatric neurosurgery for evaluation of Chiari I malformation. A full clinical evaluation suggested that the "Chiari" was a secondary change caused by craniocerebral disproportion that was the result of delayed pan-sutural craniosynostosis. Given his unknown cause of craniosynostosis, whole-exome sequencing (WES) was performed. WES revealed a de novo, somatic mosaic variant in the KAT6A gene. This report discusses importance of keeping a broad differential in the setting of referral for Chiari I malformation and presents a unique case of craniosynostosis. Additionally, it emphasizes the value of utilizing genetic testing for complex craniofacial cases with unknown causes to provide clinical answers and guide clinical management., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Ear keloids are benign, fibrous proliferations due to excessive collagen synthesis and deposition. It is a popular practice to pierce earlobes for decorative earrings and adornment; this might trigger the keloid process. Although there are varied treatment modalities, it is unsatisfactory and has always been a challenge. The aim is to evaluate the efficacy of surgical treatment with intralesional therapy in auricular keloids., Methods: We included 30 patients with 45 keloids over the ear. Patients were evaluated (including detailed history, complete physical and local examination), and photographs and written informed consent were taken. They were treated with: excision and closure, intralesional and/or surface cryotherapy, ablative laser, intralesional steroids, and 5-fluorouracil. Excision and closure, and intralesional cryotherapy were done under local anesthesia. Closure was done after intramarginal excision with or without raising auto flaps, followed by intraoperative intralesional steroids to margins. Recurrence was assessed at 3 weeks, 3 months, 6 months, and 1 year., Results: The age group of patients ranged from 14 to 57 years. A total of 32 out of 45 (71.1%) keloids were excised and were combined with intraoperative and postoperative intralesional steroid injection, with sessions depending on the patient's response. Eight (17.7%) and five (11.1%) keloids were treated using intralesional cryotherapy and only intralesional steroids, respectively. A total of 16.6% of patients had recurrence with one patient having recurrence of bilateral earlobes keloid., Conclusion: Keloidectomy with intraoperative and postoperative intralesional steroid injections has been very effective in the treatment of ear keloids. Different treatment modalities act synergistically, but excision surgery gives good results as it aims at maintaining ear architecture., (© 2021 the International Society of Dermatology.)

The voltage-gated sodium NaV1.7 channel, critical for sensing pain, has been actively targeted by drug developers; however, there are currently no effective and safe therapies targeting NaV1.7. Here, we tested whether a different approach, indirect NaV1.7 regulation, could have antinociceptive effects in preclinical models. We found that preventing addition of small ubiquitin-like modifier (SUMO) on the NaV1.7-interacting cytosolic collapsin response mediator protein 2 (CRMP2) blocked NaV1.7 functions and had antinociceptive effects in rodents. In silico targeting of the SUMOylation site in CRMP2 (Lys374) identified >200 hits, of which compound 194 exhibited selective in vitro and ex vivo NaV1.7 engagement. Orally administered 194 was not only antinociceptive in preclinical models of acute and chronic pain but also demonstrated synergy alongside other analgesics—without eliciting addiction, rewarding properties, or neurotoxicity. Analgesia conferred by 194 was opioid receptor dependent. Our results demonstrate that 194 is a first-in-class protein-protein inhibitor that capitalizes on CRMP2-NaV1.7 regulation to deliver safe analgesia in rodents.

Precision medicine requires the translation of basic biological understanding to medical insights, mainly applied to characterization of each unique patient. In many clinical settings, this requires tools that can be broadly used to identify pathology and risks. Patients often present to the intensive care unit with broad phenotypes, including multiple organ dysfunction syndrome (MODS) resulting from infection, trauma, or other disease processes. Etiology and outcomes are unique to individuals, making it difficult to cohort patients with MODS, but presenting a prime target for testing/developing tools for precision medicine. Using multitime point whole blood (cellular/acellular) total transcriptomics in 27 patients, we highlight the promise of simultaneously mapping viral/bacterial load, cell composition, tissue damage biomarkers, balance between syndromic biology versus environmental response, and unique biological insights in each patient using a single platform measurement. Integration of a transcriptome workflow yielded unexpected insights into the complex interplay between host genetics and viral/bacterial specific mechanisms, highlighted by a unique case of virally induced genetics (VIG) within one of these 27 patients. The power of RNA-Seq to study unique patient biology while investigating environmental contributions can be a critical tool moving forward for translational sciences applied to precision medicine.

Background: Type 1 Chiari malformation (CM-I) has been historically defined by cerebellar tonsillar position (TP) greater than 3-5 mm below the foramen magnum (FM). Often, the radiographic findings are highly variable, which may influence the clinical course and patient outcome. In this study, we evaluate the inter-operator reliability (reproducibility) of MRI-based measurement of TP in CM-I patients and healthy controls., Methods: Thirty-three T2-weighted MRI sets were obtained for 23 CM-I patients (11 symptomatic and 12 asymptomatic) and 10 healthy controls. TP inferior to the FM was measured in the mid-sagittal plane by seven expert operators with reference to McRae's line. Overall agreement between the operators was quantified by intraclass correlation coefficient (ICC)., Results: The mean and standard deviation of cerebellar TP measurements for asymptomatic (CM-Ia) and symptomatic (CM-Is) patients in mid-sagittal plane was 6.38 ± 2.19 and 9.57 ± 2.63 mm, respectively. TP measurements for healthy controls was 0.48 ± 2.88 mm. The average range of TP measurements for all data sets analyzed was 7.7 mm. Overall operator agreement for TP measurements was relatively high with an ICC of 0.83., Conclusion: The results demonstrated a large average range (7.7 mm) of measurements among the seven expert operators and support that, if economically feasible, two radiologists should make independent measurements before radiologic diagnosis of CM-I and surgery is contemplated. In the future, an objective diagnostic parameter for CM-I that utilizes automated algorithms and results in smaller inter-operator variation may improve patient selection.

Lipoid proteinosis (LP) is a rare autosomal-recessive genodermatosis, characterized by the deposition of amorphous hyaline-like material in different parts of the body, especially the skin and mucous membranes. Disfiguring lesions predominantly affect the facial appearance. No curative therapy and treatment options limited to symptomatic approaches are available. Facial disfigurement in this disease may have a huge negative effect on the patients' psychology and quality of life. With this regard, the patients may benefit very much from the treatments that enhance their cosmetic outlook. We present a 19-year-old female patient with LP who came to us seeking treatment for her facial lesions. She was treated with a combination regimen of fractional carbon dioxide and non-ablative radio frequency with good clinical and aesthetic outcome., Competing Interests: There are no conflicts of interest.

OBJECTIVE Endoscopic third ventriculostomy with choroid plexus cauterization for the treatment of neonatal and infant hydrocephalus has gained popularity in the past decade. Identifying treatment failure is critically important. Results of a pilot study of 2 novel imaging markers seen on fast-sequence T2-weighted axial MRI showed potential clinical utility. However, the reliability of multiple raters detecting these markers must be established before a multicenter validation study can be performed. METHODS Two sets of de-identified single-shot T2-weighted turbo spin-echo axial images were prepared from scans of patients before and after they underwent endoscopic third ventriculostomy with choroid plexus cauterization between March 2013 and January 2016. The first set showed the lateral and third ventricles for visualization of turbulent CSF dynamics, and the second set showed the lateral ventricular atria for choroid plexus glomus detection. Three raters (Group 1) received written instructions before evaluating each image set once and then again 1 week later. Another 8 raters (Group 2) evaluated both image sets after oral instruction and group training on a pretest image set. Fleiss' kappa coefficients with 95% CIs were calculated for intrarater and interrater reliability in Group 1 and interrater reliability in Group 2. RESULTS Intrarater reliability kappa coefficients for Group 1 were ≥ 0.74 for turbulence and ≥ 0.80 for choroid plexus; their interrater kappa coefficients at the initial assessment were 0.50 (95% CI 0.37-0.62) and 0.56 (95% CI 0.43-0.69), respectively. The Group 2 interrater kappa scores were 0.82 (95% CI 0.78-0.86) for turbulence and 0.62 (95% CI 0.58-0.66) for choroid plexus. CONCLUSIONS With minimal training, intrarater reliability on visualization of turbulence and the choroid plexus was substantial, but interrater reliability was only moderate. After modestly increasing training, interrater reliability improved to near perfect and to substantial reliability for visualization of turbulence and choroid plexus, respectively. Given adequately trained observers, a multicenter investigation into the validity and potential clinical utility of the imaging markers seems feasible.