157 results on '"Robert G, Micheletti"'
Search Results
2. Updates in SJS/TEN: collaboration, innovation, and community
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Madeline E. Marks, Ramya Krishna Botta, Riichiro Abe, Thomas M. Beachkofsky, Isabelle Boothman, Bruce C. Carleton, Wen-Hung Chung, Ricardo R. Cibotti, Roni P. Dodiuk-Gad, Christian Grimstein, Akito Hasegawa, Jay H. Hoofnagle, Shuen-Iu Hung, Benjamin Kaffenberger, Daniela Kroshinsky, Rannakoe J. Lehloenya, Michelle Martin-Pozo, Robert G. Micheletti, Maja Mockenhaupt, Keisuke Nagao, Suman Pakala, Amy Palubinsky, Helena B. Pasieka, Jonathan Peter, Munir Pirmohamed, Melissa Reyes, Hajirah N. Saeed, Jeffery Shupp, Chonlaphat Sukasem, Jhih Yu Syu, Mayumi Ueta, Li Zhou, Wan-Chun Chang, Patrice Becker, Teresa Bellon, Kemberlee Bonnet, Gianpiero Cavalleri, James Chodosh, Anna K. Dewan, Arturo Dominguez, Xinzhong Dong, Elena Ezhkova, Esther Fuchs, Jennifer Goldman, Sonia Himed, Simon Mallal, Alina Markova, Kerry McCawley, Allison E. Norton, David Ostrov, Michael Phan, Arthur Sanford, David Schlundt, Daniel Schneider, Neil Shear, Kanade Shinkai, Eric Tkaczyk, Jason A. Trubiano, Simona Volpi, Charles S. Bouchard, Sherrie J. Divito, and Elizabeth J. Phillips
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Stevens-Johnson Syndrome ,Toxic Epidermal Necrolysis ,severe adverse cutaneous drug reactions ,HLA genotyping ,pharmacogenomics ,body surface area ,Medicine (General) ,R5-920 - Abstract
Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) is a predominantly drug-induced disease, with a mortality rate of 15–20%, that engages the expertise of multiple disciplines: dermatology, allergy, immunology, clinical pharmacology, burn surgery, ophthalmology, urogynecology, and psychiatry. SJS/TEN has an incidence of 1–5/million persons per year in the United States, with even higher rates globally. One of the challenges of SJS/TEN has been developing the research infrastructure and coordination to answer questions capable of transforming clinical care and leading to improved patient outcomes. SJS/TEN 2021, the third research meeting of its kind, was held as a virtual meeting on August 28–29, 2021. The meeting brought together 428 international scientists, in addition to a community of 140 SJS/TEN survivors and family members. The goal of the meeting was to brainstorm strategies to support the continued growth of an international SJS/TEN research network, bridging science and the community. The community workshop section of the meeting focused on eight primary themes: mental health, eye care, SJS/TEN in children, non-drug induced SJS/TEN, long-term health complications, new advances in mechanisms and basic science, managing long-term scarring, considerations for skin of color, and COVID-19 vaccines. The meeting featured several important updates and identified areas of unmet research and clinical need that will be highlighted in this white paper.
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- 2023
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3. Physical and mental health impact of Stevens-Johnson syndrome/toxic epidermal necrolysis and post-hospital discharge care: Identifying practice gaps
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Alexandra J. Coromilas, MD, Sherrie J. Divito, MD, PhD, Elizabeth J. Phillips, MD, and Robert G. Micheletti, MD
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drug hypersensitivity ,long term health sequelae ,postdischarge care ,severe cutaneous adverse drug reaction ,Stevens-Johnson syndrome ,toxic epidermal necrolysis ,Dermatology ,RL1-803 - Published
- 2023
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4. Identification of a neutrophil-specific PIK3R1 mutation facilitates targeted treatment in a patient with Sweet syndrome
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Shreya Bhattacharya, Sayon Basu, Emily Sheng, Christina Murphy, Jenny Wei, Anna E. Kersh, Caroline A. Nelson, Joshua S. Bryer, Hovik A. Ashchyan, Katherine Steele, Amy Forrestel, John T. Seykora, Robert G. Micheletti, William D. James, Misha Rosenbach, and Thomas H. Leung
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Dermatology ,Inflammation ,Medicine - Abstract
Background Acute febrile neutrophilic dermatosis (Sweet syndrome) is a potentially fatal multiorgan inflammatory disease characterized by fever, leukocytosis, and a rash with a neutrophilic infiltrate. The disease pathophysiology remains elusive, and current dogma suggests that Sweet syndrome is a process of reactivity to an unknown antigen. Corticosteroids and steroid-sparing agents remain frontline therapies, but refractory cases pose a clinical challenge.Methods A 51-year-old woman with multiorgan Sweet syndrome developed serious corticosteroid-related side effects and was refractory to steroid-sparing agents. Blood counts, liver enzymes, and skin histopathology supported the diagnosis. Whole-genome sequencing, transcriptomic profiling, and cellular assays of the patient’s skin and neutrophils were performed.Results We identified elevated IL-1 signaling in lesional Sweet syndrome skin caused by a PIK3R1 gain-of-function mutation specifically found in neutrophils. This mutation increased neutrophil migration toward IL-1β and neutrophil respiratory burst. Targeted treatment of the patient with an IL-1 receptor 1 antagonist resulted in a dramatic therapeutic response and enabled a tapering off of corticosteroids.Conclusion Dysregulated PI3K/AKT signaling is the first signaling pathway linked to Sweet syndrome and suggests that this syndrome may be caused by acquired mutations that modulate neutrophil function. Moreover, integration of molecular data across multiple levels identified a distinct subtype within a heterogeneous disease that resulted in a rational and successful clinical intervention. Future patients will benefit from efforts to identify potential mutations. The ability to directly interrogate the diseased skin allows this method to be generalizable to other inflammatory diseases and demonstrates a potential personalized medicine approach for patients with clinically challenging disease.Funding Sources Berstein Foundation, NIH, Veterans Affairs (VA) Administration, Moseley Foundation, and H.T. Leung Foundation.
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- 2023
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5. Penicillin allergy evaluation in hospitalized patients with hematologic malignancy
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Vima M. Patel, Brian Chu, Keith W. Hamilton, Cassandra Bellamy, Christina Harker, Joshua S. Bryer, Bridget Shields, Rebecca L. Hirsh, Olajumoke O. Fadugba, and Robert G. Micheletti
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Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - Abstract
A penicillin allergy testing service (PATS) assessed penicillin allergy in patients with hematologic malignancies; 17 patients who met criteria had negative skin testing. Patients who underwent penicillin challenge passed and were delabeled. Of delabeled patients, 87% received and tolerated β-lactams during follow-up. Providers found the PATS valuable.
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- 2023
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6. Corticosteroid use in chronic dermatologic disorders and osteoporosis
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Beatrice C. Lupsa, MD, Karl L. Insogna, MD, Robert G. Micheletti, MD, and Avrom Caplan, MD
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Glucocorticoid-induced osteoporosis ,osteoporosis ,women's health ,bone health ,DXA scan ,FRAX score ,Dermatology ,RL1-803 - Abstract
Glucocorticoid-induced osteoporosis (GIOP) is a frequently encountered and serious side effect of glucocorticoid use. Bone loss leading to an increased risk for fracture occurs early in the use of glucocorticoids, yet patients at risk for this complication are often undertreated. All physicians prescribing glucocorticoids should therefore be familiar with a basic approach to anticipating and preventing GIOP when starting patients on glucocorticoid therapy. This manuscript and its case vignettes are designed to help dermatologists assess and manage bone health to prevent GIOP in patients receiving glucocorticoid therapy.
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- 2021
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7. Treatment of cutaneous vasculitis
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Robert G. Micheletti
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vasculitis ,cutaneous vasculitis ,treatment ,management ,skin ,Medicine (General) ,R5-920 - Abstract
Cutaneous vasculitis encompasses a spectrum of disease states, with varied morphology, severity, and potential for systemic involvement. Even vasculitis which is skin-limited can have a significant quality-of-life impact, necessitating treatment. This manuscript summarizes the available evidence for management of various types of skin-limited vasculitis and provides a proposed therapeutic ladder based on published studies and expert opinion.
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- 2022
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8. Protocol for a randomized multicenter study for isolated skin vasculitis (ARAMIS) comparing the efficacy of three drugs: azathioprine, colchicine, and dapsone
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Robert G. Micheletti, Christian Pagnoux, Roy N. Tamura, Peter C. Grayson, Carol A. McAlear, Renee Borchin, Jeffrey P. Krischer, Peter A. Merkel, and for the Vasculitis Clinical Research Consortium
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Skin vasculitis ,Azathioprine ,Colchicine ,Dapsone ,Sequential multiple assignment randomized trial ,Medicine (General) ,R5-920 - Abstract
Abstract Background Skin-limited forms of vasculitis, while lacking systemic manifestations, can persist or recur indefinitely, cause pain, itch, or ulceration, and be complicated by infection or scarring. High-quality evidence on how to treat these conditions is lacking. The aim of this comparative effectiveness study is to determine the optimal management of patients with chronic skin-limited vasculitis. Methods ARAMIS is a multicenter, sequential, multiple assignment randomized trial with an enrichment design (SMARTER) aimed at comparing the efficacy of three drugs—azathioprine, colchicine, and dapsone—commonly used to treat various forms of isolated skin vasculitis. ARAMIS will enroll patients with isolated cutaneous small or medium vessel vasculitis, including cutaneous small vessel vasculitis, immunoglobulin A (IgA) vasculitis (skin-limited Henoch-Schönlein purpura), and cutaneous polyarteritis nodosa. Patients not responding to the initial assigned therapy will be re-randomized to one of the remaining two study drugs (Stage 2). Those with intolerance or contraindication to a study drug can be randomized directly into Stage 2. Target enrollment is 90 participants, recruited from international centers affiliated with the Vasculitis Clinical Research Consortium. The number of patients enrolled directly into Stage 2 of the study will be capped at 10% of the total recruitment target. The primary study endpoint is the proportion of participants from the pooled study stages with a response to therapy at month 6, according to the study definition. Discussion ARAMIS will help identify effective agents for skin-limited forms of vasculitis, an understudied group of diseases. The SMARTER design may serve as an example for future trials in rare diseases. Trial registration ClinicalTrials.gov : NCT02939573 . Registered on 18 October 2016.
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- 2020
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9. Factors associated with disease-specific life impact in patients with hidradenitis suppurativa: results from the Global VOICE project
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Amit Garg, Sahil Rawal, Oleg Akilov, Afsaneh Alavi, Christine Ardon, Falk G Bechara, Arnon D Cohen, Steven R Cohen, Steven Daveluy, Véronique del Marmol, Maïa Delage, Solveig Esmann, Shani Fisher, Evangelos J Giamarellos-Bourboulis, Amelia Glowaczewska, Noah Goldfarb, Elena Gonzalez Brant, Øystein Grimstad, Sandra Guilbault, Iltefat Hamzavi, Rosalind Hughes, John R Ingram, Gregor B E Jemec, Qiang Ju, Naomi Kappe, Brian Kirby, Joslyn S Kirby, Michelle A Lowes, Lukasz Matusiak, Stella Micha, Robert G Micheletti, Angela P Miller, Dagfinn Moseng, Haley B Naik, Aude Nassif, Georgios Nikolakis, So Yeon Paek, Jose Carlos Pascual, Errol Prens, Barry Resnik, Hassan Riad, Christopher Sayed, Saxon D Smith, Yssra Soliman, Jacek C Szepietowski, Jerry Tan, Linnea Thorlacius, Thrasyvoulos Tzellos, Hessel H van der Zee, Bente Villumsen, Lanqi Wang, Christos C Zouboulis, and Andrew Strunk
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Dermatology - Abstract
Patients with hidradenitis suppurativa experience significant life impact related to their disease. Younger age, Black race, high BMI, active smoking, flares, depression, anxiety, high comorbidity burden, disability, and difficult access to a dermatologist adversely influence life impact related to having hidradenitis suppurativa. Attention to these factors, particularly modifiable ones, may reduce overall impact of disease.
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- 2023
10. Strategies for Effective Management of Hidradenitis Suppurativa in the Hospital Setting
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Alexandra Coromilas and Robert G. Micheletti
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Dermatology - Published
- 2022
11. Development of a Skin-Directed Scoring System for Stevens-Johnson Syndrome and Epidermal Necrolysis
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Margo Waters, Allison Dobry, Stephanie T. Le, Kanade Shinkai, Thomas M. Beachkofsky, Mark D. P. Davis, Arturo R. Dominguez, Daniela Kroshinsky, Alina Markova, Robert G. Micheletti, Arash Mostaghimi, Helena B. Pasieka, Misha Rosenbach, Lucia Seminario-Vidal, John Trinidad, Joerg Albrecht, Emily M. Altman, Ryan Arakaki, Michael Arden-Jones, Alina G. Bridges, Adela R. Cardones, Angad A. Chadha, Jennifer K. Chen, Steven T. Chen, Kyle Cheng, Steven Daveluy, Katherine L. DeNiro, Joanna Harp, Jesse J. Keller, Brett King, Abraham M. Korman, Eve J. Lowenstein, Erin Luxenberg, Jennifer Brescoll Mancuso, Melissa M. Mauskar, Philip Milam, Kiran Motaparthi, Caroline A. Nelson, Cuong V. Nguyen, Fnu Nutan, Alex G. Ortega-Loayza, Tejesh Patel, Sahand Rahnama-Moghadam, Sergey Rekhtman, Nathan W. Rojek, Mansi Sarihan, Sheila Shaigany, Timmie R. Sharma, Sabrina M. Shearer, Bridget E. Shields, Lindsay C. Strowd, Danielle M. Tartar, Cristina Thomas, Karolyn A. Wanat, Andrew C. Walls, Lisa C. Zaba, Carolyn M. Ziemer, Emanual Maverakis, and Benjamin H. Kaffenberger
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Dermatology - Abstract
ImportanceScoring systems for Stevens-Johnson syndrome and epidermal necrolysis (EN) only estimate patient prognosis and are weighted toward comorbidities and systemic features; morphologic terminology for EN lesions is inconsistent.ObjectivesTo establish consensus among expert dermatologists on EN terminology, morphologic progression, and most-affected sites, and to build a framework for developing a skin-directed scoring system for EN.Evidence ReviewA Delphi consensus using the RAND/UCLA appropriateness criteria was initiated with a core group from the Society of Dermatology Hospitalists to establish agreement on the optimal design for an EN cutaneous scoring instrument, terminology, morphologic traits, and sites of involvement.FindingsIn round 1, the 54 participating dermatology hospitalists reached consensus on all 49 statements (30 appropriate, 3 inappropriate, 16 uncertain). In round 2, they agreed on another 15 statements (8 appropriate, 7 uncertain). There was consistent agreement on the need for a skin-specific instrument; on the most-often affected skin sites (head and neck, chest, upper back, ocular mucosa, oral mucosa); and that blanching erythema, dusky erythema, targetoid erythema, vesicles/bullae, desquamation, and erosions comprise the morphologic traits of EN and can be consistently differentiated.Conclusions and RelevanceThis consensus exercise confirmed the need for an EN skin-directed scoring system, nomenclature, and differentiation of specific morphologic traits, and identified the sites most affected. It also established a baseline consensus for a standardized EN instrument with consistent terminology.
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- 2023
12. Epidemiology and diagnostic classification of adults presenting with an initial episode of leukocytoclastic vasculitis: a multicenter review of 440 patients
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Andrew C. Walls, Adam Faletsky, Brian Chu, Robert G. Micheletti, and Arash Mostaghimi
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Dermatology - Published
- 2023
13. Delayed diagnosis of DRESS syndrome in a patient with skin of color
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Eric L Bean, Daniel J Lewis, Michelle A Weir, and Robert G Micheletti
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Dermatology ,General Medicine - Published
- 2023
14. Identification of a neutrophil-specific PIK3R1 mutation facilitates targeted treatment in a patient with Sweet syndrome
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Shreya Bhattacharya, Sayon Basu, Emily Sheng, Christina Murphy, Jenny Wei, Anna E. Kersh, Caroline A. Nelson, Joshua S. Bryer, Hovik A. Ashchyan, Katherine Steele, Amy Forrestel, John T. Seykora, Robert G. Micheletti, William D. James, Misha Rosenbach, and Thomas H. Leung
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General Medicine - Abstract
Acute febrile neutrophilic dermatosis (Sweet syndrome) is a potentially fatal multiorgan inflammatory disease characterized by fever, leukocytosis, and a rash with a neutrophilic infiltrate. Disease pathophysiology remains elusive, and current dogma suggests Sweet syndrome is a "reactive" process to an unknown antigen. Corticosteroids and steroid-sparing agents remain front-line therapies, but refractory cases pose a clinical challenge.A 51-year-old woman with multiorgan Sweet syndrome developed serious corticosteroid-related side effects and was refractory to steroid-sparing agents. Blood counts, liver enzymes, and skin histopathology supported the diagnosis. Whole genome sequencing, transcriptomic profiling, and cellular assays of patient's skin and neutrophils were performed.We identified elevated IL-1 signaling in lesional Sweet syndrome skin caused by a PIK3R1 gain-of-function mutation specifically found in neutrophils. This mutation increased neutrophil migration towards IL-1β and neutrophil respiratory burst. Targeted treatment with an IL-1R1 antagonist in the patient resulted in a dramatic therapeutic response and enabled tapering of corticosteroids.Dysregulated PI3K-AKT signaling is the first signaling pathway linked to Sweet syndrome and suggests Sweet syndrome may be caused by acquired mutations that modulate neutrophil function. Moreover, integration of molecular data across multiple levels identified a distinct subtype within a heterogenous disease that resulted in a rational and successful clinical intervention. Future cases will benefit from efforts to identify potential mutations. The ability to directly interrogate diseased skin allows this method to be generalizable to other inflammatory diseases and demonstrates a potential personalized medicine approach for challenging patients.FUNDING Berstein Foundation, NIH, VA, Moseley Foundation, and H.T. Leung Foundation.
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- 2022
15. Supportive care in the acute phase of Stevens-Johnson syndrome and toxic epidermal necrolysis
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Neil H. Shear, P. Joly, Alain Brassard, P. Wolkenstein, Kanade Shinkai, L. S. Vidal, K. Zaghbib, C. Salavastru, J. Newman, A. Colin, J.N. Bouwes Bavinck, N. Hama, Arturo R. Dominguez, J. T. Schulz, Roni P. Dodiuk-Gad, Lars E. French, Emanual Michael Maverakis, D. Meyersburg, Chia-Yu Chu, K. Pallesen, M. C. Brüggen, R. Le Floch, Robert G. Micheletti, E. Bequignon, B. Milpied, Tetsuo Shiohara, Benjamin H. Kaffenberger, Paolo Romanelli, C. Bodemer, S. L. Chua, Arash Mostaghimi, E. Howard, Elizabeth J. Phillips, Annamari Ranki, Mirjam Nägeli, R. Sheridan, J. Gueudry, S. Ingen-Housz-Oro, Barbara Horváth, A. Toussi, Amy S. Paller, Jonathan Cotliar, Anette Bygum, Danielle M. Tartar, N. de Prost, Robert S. Stern, S. Walsh, Wen-Hung Chung, Scott Worswick, Riichiro Abe, M. Arden-Jones, Megan H. Noe, C. Moss, George-Sorin Tiplica, E. Brezinova, B. Didona, S. T. Le, Hôpital Henri Mondor, Epidémiosurveillance de protozooses à transmission alimentaire et vectorielle (ESCAPE), Université de Reims Champagne-Ardenne (URCA)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Agence nationale de sécurité sanitaire de l'alimentation, de l'environnement et du travail (ANSES), Epidemiology in Dermatology and Evaluation in Therapeutics (EpiDermE), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), HUS Inflammation Center, Department of Dermatology, Allergology and Venereology, Helsinki University Hospital Area, University of Helsinki, Translational Immunology Groningen (TRIGR), Agence nationale de sécurité sanitaire de l'alimentation, de l'environnement et du travail (ANSES)-Université de Rouen Normandie (UNIROUEN), and Normandie Université (NU)-Normandie Université (NU)-Université de Reims Champagne-Ardenne (URCA)
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Adult ,medicine.medical_specialty ,Consensus ,education ,MEDLINE ,Dermatology ,Phase (combat) ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Multidisciplinary approach ,Humans ,Medicine ,Infection control ,Child ,Retrospective Studies ,computer.programming_language ,Modalities ,business.industry ,Research ,Stevens johnson ,16. Peace & justice ,medicine.disease ,Toxic epidermal necrolysis ,3. Good health ,Stevens-Johnson Syndrome ,3121 General medicine, internal medicine and other clinical medicine ,Family medicine ,business ,computer ,[SDV.MHEP.DERM]Life Sciences [q-bio]/Human health and pathology/Dermatology ,Delphi - Abstract
Background Supportive care is the cornerstone of management of adult and paediatric Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). However, consensus on the modalities of supportive care is lacking.Objectives Our aim in this international multicentric Delphi exercise was to establish a multidisciplinary expert consensus to standardize recommendations regarding supportive care in the acute phase of SJS/TEN.Methods Participants were sent a survey via the online tool SurveyMonkey, consisting of 103 statements organized into 11 topics: multidisciplinary team composition, suspect drug management, infection prevention, fluid resuscitation and prevention of hypothermia, nutritional support, pain and psychological distress management, management of acute respiratory failure, local skincare, ophthalmological management, management of other mucosa, and additional measures. Participants evaluated the level of appropriateness of each statement on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate). The results were analysed according to the RAND/UCLA Appropriateness Method.Results Forty-five participants from 13 countries (on three continents) participated. After the first round, a consensus was obtained for 82.5% of the 103 initially proposed statements. After the second round, a final consensus was obtained for 102 statements.Conclusions We have reached an international Delphi-based consensus on best supportive care practice for SJS/TEN. Our expert consensus should help guide physicians in treating patients with SJS/TEN and thereby improve short-term prognosis and the risk of sequelae.
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- 2021
16. Systemic Interventions for Treatment of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: Summary of a Cochrane Review
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Megan H. Noe and Robert G. Micheletti
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Dermatology - Abstract
Clinical QuestionWhat are the effects of systemic therapies for Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN)?Bottom LineThere is limited high-quality evidence to support the use of systemic immunomodulatory therapies to decrease mortality rates in SJS/TEN.
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- 2022
17. Cutaneous Small Vessel Vasculitis: A Practical Guide to Diagnosis and Management
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Robert G, Micheletti
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Cutaneous vasculitis may be a cutaneous manifestation of systemic vasculitis, a skin-limited variant of systemic vasculitis, or a type of single-organ vasculitis limited to the skin. Careful evaluation is necessary to distinguish these possibilities, differentiate skin-limited from systemic disease, and identify important underlying conditions, if present. Appropriate management depends on disease type and severity. In the case of cutaneous small vessel vasculitis (CSVV), treatment is primarily based on case reports and expert opinion, using a range of immunomodulatory or immunosuppressive therapies. This manuscript presents a systematic and stepwise approach to the evaluation of patients presenting with cutaneous vasculitis, as well as the management of those diagnosed with CSVV, using best available evidence. Studies relevant to the classification, evaluation, and management of skin vasculitis are ongoing.
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- 2022
18. Use of teledermatology by dermatology hospitalists is effective in the diagnosis and management of inpatient disease
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Carolyn Ziemer, Misha Rosenbach, Scott Worswick, Joseph C. Pierson, Lindsay C. Strowd, Daniela Kroshinsky, Joseph C. Kvedar, Victoria R. Sharon, Karolyn A. Wanat, Anar Mikailov, Andrew C. Walls, Philip Song, Allireza Alloo, Alina G. Bridges, Melissa M. Mauskar, David A. Wetter, Mark D.P. Davis, Jesse J. Keller, Alisa N. Femia, Bernice Y. Kwong, Emily D. Nguyen, Yevgeniy Balagula, Joanna Harp, Benjamin H. Kaffenberger, Robert G. Micheletti, Edward W. Cowen, Kristina J. Liu, Ryan Karmouta, Zachary Schwager, Arash Mostaghimi, Alina Markova, Ryan Arakaki, Lucia Seminario-Vidal, Colleen K. Gabel, and Guohai Zhou
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Selection bias ,Telemedicine ,medicine.medical_specialty ,Teledermatology ,business.industry ,media_common.quotation_subject ,Dermatology ,Disease ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Inter-rater reliability ,0302 clinical medicine ,Interquartile range ,030220 oncology & carcinogenesis ,Medicine ,Differential diagnosis ,business ,Prospective cohort study ,media_common - Abstract
Background Patient outcomes are improved when dermatologists provide inpatient consultations. Inpatient access to dermatologists is limited, illustrating an opportunity to use teledermatology. Little is known about the ability of dermatologists to accurately diagnose disease and manage inpatients with teledermatology, particularly when using nondermatologist-generated clinical data. Methods This prospective study assessed the ability of teledermatology to diagnose disease and manage 41 dermatology consultations from a large urban tertiary care center, using internal medicine referral documentation and photographs. Twenty-seven dermatology hospitalists were surveyed. Interrater agreement was assessed by the κ statistic. Results There was substantial agreement between in-person and teledermatology assessment of the diagnosis with differential diagnosis (median κ = 0.83), substantial agreement in laboratory evaluation decisions (median κ = 0.67), almost perfect agreement in imaging decisions (median κ = 1.0), and moderate agreement in biopsy decisions (median κ = 0.43). There was almost perfect agreement in treatment (median κ = 1.0), but no agreement in follow-up planning (median κ = 0.0). There was no association between raw photograph quality and the primary plus differential diagnosis or primary diagnosis alone. Limitations Selection bias and single-center nature. Conclusions Teledermatology may be effective in the inpatient setting, with concordant diagnosis, evaluation, and management decisions.
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- 2021
19. Is There a Role for Therapeutic Drug Monitoring in Patients with Hidradenitis Suppurativa on Tumor Necrosis Factor-α Inhibitors?
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Robert G. Micheletti, Michelle A. Lowes, Tasnim Abdalla, Afsaneh Alavi, A. Hillary Steinhart, and Nirmal Kaur
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Oncology ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Context (language use) ,Dermatology ,General Medicine ,medicine.disease ,Inflammatory bowel disease ,Infliximab ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,Therapeutic drug monitoring ,Internal medicine ,medicine ,Adalimumab ,Tumor necrosis factor alpha ,Hidradenitis suppurativa ,business ,medicine.drug - Abstract
Tumor necrosis factor-α inhibitors, adalimumab and infliximab, are at the forefront of biologic therapy for the management of moderate-to-severe hidradenitis suppurativa, with adalimumab as currently the only approved medication for this condition. In treating patients, primary or secondary lack of response (also termed suboptimal response) is a major burden for both patients and healthcare systems and is a challenge with biologics in part owing to the development of anti-drug antibodies following treatment. To overcome this, therapeutic drug monitoring may be conducted proactively or reactively to a patient's suboptimal response guided by measurements of trough serum drug concentrations and levels of anti-drug antibodies. While strong evidence to support the utility of therapeutic drug monitoring exists in patients with inflammatory bowel disease, current information is limited in the context of hidradenitis suppurativa. We sought to summarize the available evidence and to present the role of therapeutic drug monitoring and other dose optimization strategies in improving clinical response in patients with hidradenitis suppurativa treated with tumor necrosis factor-α inhibitors.
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- 2021
20. Diagnosis and management of Stevens-Johnson syndrome/toxic epidermal necrolysis
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Robert G. Micheletti and Megan H. Noe
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Antigens, Differentiation, T-Lymphocyte ,Keratinocytes ,medicine.medical_specialty ,Fas Ligand Protein ,Apoptosis ,Dermatology ,Disease ,CD8-Positive T-Lymphocytes ,Malignancy ,medicine.disease_cause ,law.invention ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Anti-Infective Agents ,Risk Factors ,law ,Neoplasms ,medicine ,Genetic predisposition ,Humans ,Genetic Predisposition to Disease ,Granulysin ,Adverse effect ,030203 arthritis & rheumatology ,Perforin ,Tumor Necrosis Factor-alpha ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,Immune dysregulation ,medicine.disease ,Intensive care unit ,Toxic epidermal necrolysis ,Killer Cells, Natural ,stomatognathic diseases ,Immune System Diseases ,Stevens-Johnson Syndrome ,Anticonvulsants ,business - Abstract
Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare, immunologically mediated cutaneous adverse reaction characterized by mucous membrane and epidermal detachment, with a mortality ranging from 15% to 25%. Risk factors for the development of SJS/TEN include immune dysregulation, active malignancy, and genetic predisposition. Medications are the most common cause, particularly antimicrobials, antiepileptics, allopurinol, and nonsteroidal anti-inflammatory medications. Drug-specific CD8 T-cells and natural killer cells are thought to be the major inducers of keratinocyte apoptosis via release of soluble cytotoxic mediators, including Fas ligand, perforin/granzyme, tumor necrosis factor, and granulysin. When SJS/TEN is suspected clinically, appropriate therapy should be instituted without delay. All patients should be managed initially in an intensive care unit or burn unit under a multidisciplinary team of physicians experienced in the care of patients with SJS/TEN. Available data support the use of various pharmacologic agents to halt disease progression and improve outcomes, but no single drug has been found to be superior or beneficial for all patients. Future research should focus on developing a better understanding of the genetic susceptibility and immunopathophysiology of the disease, as well as novel diagnostic and therapeutic targets to improve patient outcomes.
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- 2020
21. A novel combination ('CHAP') regimen for management of livedoid vasculopathy in 12 patients
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Alexandra J. Coromilas and Robert G. Micheletti
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Dermatology - Published
- 2022
22. Neutrophilic Dermatoses: a Clinical Update
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Emma H. Weiss, Christine J. Ko, Thomas H. Leung, Robert G. Micheletti, Arash Mostaghimi, Sarika M. Ramachandran, Misha Rosenbach, and Caroline A. Nelson
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Dermatology - Abstract
Neutrophilic dermatoses are defined by the presence of a sterile neutrophilic infiltrate on histopathology. This review focuses on the pathogenesis, epidemiology, clinicopathological features, diagnosis, and management of four disorders: Sweet syndrome, pyoderma gangrenosum, Behçet syndrome, and neutrophilic eccrine hidradenitis.Recent studies have provided insight into the complex pathogenesis of neutrophilic dermatoses. Evidence supports an intricate interplay of abnormal neutrophil function and inflammasome activation, malignant transformation into dermal infiltrating neutrophils, and genetic predisposition.Neutrophilic dermatoses have diverse cutaneous and extracutaneous manifestations and may be associated with significant morbidity and mortality. Common underlying associations include infectious, inflammatory, and neoplastic disorders, as well as drug reactions. Emerging diagnostic and therapeutic frameworks identify an expanding role for biologic and targeted anti-inflammatory therapies.
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- 2022
23. Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults
- Author
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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
- Subjects
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.
- Published
- 2020
24. Retrospective review of drug‐induced Stevens‐Johnson syndrome and toxic epidermal necrolysis cases at a pediatric tertiary care institution
- Author
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Robert G. Micheletti, Elana Putterman, Leslie Castelo-Soccio, Cathryn Sibbald, and James R. Treat
- Subjects
Male ,Drug-induced Stevens-Johnson syndrome ,medicine.medical_specialty ,Adolescent ,medicine.drug_class ,Antibiotics ,Population ,Dermatology ,Tertiary care ,Etanercept ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Child ,education ,Retrospective Studies ,education.field_of_study ,Retrospective review ,Tertiary Healthcare ,business.industry ,Immunoglobulins, Intravenous ,medicine.disease ,Toxic epidermal necrolysis ,Child, Preschool ,Stevens-Johnson Syndrome ,030220 oncology & carcinogenesis ,North America ,Pediatrics, Perinatology and Child Health ,Corticosteroid ,Female ,business ,medicine.drug - Abstract
Background/objectives Stevens-Johnson syndrome and toxic epidermal necrolysis represent important sources of potential mortality and morbidity in children. There is a need for more clinical data in this population to determine whether specific treatments preferentially improve outcomes. Methods This was a single-center retrospective review of children admitted with drug-induced Stevens-Johnson syndrome, toxic epidermal necrolysis or Stevens-Johnson syndrome/toxic epidermal necrolysis overlap at a tertiary care pediatric institution in North America from 2008 to 2018. Patients without a dermatology assessment and diagnosis were excluded. Demographic, clinical, and treatment information were abstracted and reviewed for all included patients. Results Sixteen patients were identified, 43% female (7/16), with a mean age at presentation of 10.4 ± 5.2 years. Antibiotics were implicated in 56.3% of patients (9/16) and anticonvulsants in 31.3% (5/16). Sulfamethoxazole-trimethoprim was the triggering antibiotic in 31.3% of patients. The majority of patients were treated with intravenous immunoglobulin alone (50%, 8/16) or intravenous immunoglobulin with steroids (25%, 4/16). Etanercept was added to intravenous immunoglobulin and corticosteroid in a 2-year-old patient, resulting in clinical stabilization and halting of epidermolysis. No patients died. Clinical sequelae were noted in five patients, including ocular complications (n = 4), labial adhesions (n = 1), and persistent skin dyspigmentation (n = 3). Conclusions Our results highlight that sulfamethoxazole-trimethoprim is an important cause of Stevens-Johnson syndrome-toxic epidermal necrolysis in children. Mortality was reassuringly low, but ocular sequelae were an important cause of morbidity. More data are needed to help determine whether specific treatments including etanercept may provide mortality or morbidity benefit in pediatric populations.
- Published
- 2020
25. Low-dose methotrexate as rescue therapy in patients with hidradenitis suppurativa and pyoderma gangrenosum developing human antichimeric antibodies to infliximab: A retrospective chart review
- Author
-
Leo L. Wang and Robert G. Micheletti
- Subjects
Adult ,Male ,medicine.medical_specialty ,MEDLINE ,Dermatology ,Low dose methotrexate ,Human antichimeric ,Chart review ,medicine ,Humans ,In patient ,Hidradenitis suppurativa ,Aged ,Retrospective Studies ,business.industry ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Infliximab ,Pyoderma Gangrenosum ,Hidradenitis Suppurativa ,Methotrexate ,Antibody Formation ,Female ,business ,Pyoderma gangrenosum - Published
- 2020
26. Evaluating patients' unmet needs in hidradenitis suppurativa: Results from the Global Survey Of Impact and Healthcare Needs (VOICE) Project
- Author
-
Hessel H. van der Zee, Maïa Delage, Oleg E. Akilov, Hassan Riad, José C. Pascual, Brian Kirby, Angie Parks Miller, Qiang Ju, Solveig Esmann, Robert G. Micheletti, Erica Neuren, Dagfinn Moseng, Øystein Grimstad, L. Thorlacius, Yssra Soliman, Lanqi Wang, Haley B. Naik, Georgios Nikolakis, Amelia Głowaczewska, Noah Goldfarb, Iltefat H. Hamzavi, Gregor B.E. Jemec, Shani Fisher, Errol P. Prens, Jacek C Szepietowski, Joslyn S. Kirby, Evangelos J. Giamarellos-Bourboulis, Steven Daveluy, Denny Cha, Jerry Tan, So Yeon Paek, Falk G. Bechara, Saxon D Smith, Véronique Del Marmol, Steven R. Cohen, Andrew Strunk, Michelle A. Lowes, Christine B. Ardon, Lukasz Matusiak, Amit Garg, John R. Ingram, Christos C. Zouboulis, Christopher Sayed, Afsaneh Alavi, Christina Avgoustou, Thrasyvoulos Tzellos, B. Villumsen, Naomi Kappe, Arnon D. Cohen, Elena Gonzalez Brant, S. Guilbault, R. Hughes, Aude Nassif, Barry I. Resnik, Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Centre Médical de l'Institut Pasteur, Institut Pasteur [Paris], Medizinische Hochschule Brandenburg Theodor Fontane / Brandenburg Medical School Theodor-Fontane (MHB Theodor Fontane), Windsor Clinical Research Inc [Windsor, Ontario, Canada], Hofstra University [Hempstead], Centre Médical de l'Institut Pasteur (CMIP), and Institut Pasteur [Paris] (IP)
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,diagnosis ,[SDV]Life Sciences [q-bio] ,comorbid conditions ,unmet needs ,Dermatology ,Disease ,Unmet needs ,Young Adult ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,life impact ,Health care ,medicine ,Humans ,pain ,Hidradenitis suppurativa ,Prospective Studies ,care ,ComputingMilieux_MISCELLANEOUS ,treatment ,Global VOICE, acne inversa, care, comorbid conditions, diagnosis, hidradenitis suppurativa, life impact, pain, patient, symptoms, treatment, unmet needs ,business.industry ,hidradenitis suppurativa ,Emergency department ,Middle Aged ,medicine.disease ,Hidradenitis Suppurativa ,3. Good health ,Global VOICE ,Mood disorders ,Health Care Surveys ,030220 oncology & carcinogenesis ,Family medicine ,Needs assessment ,acne inversa ,symptoms ,Female ,patient ,business ,Needs Assessment ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,[SDV.MHEP.DERM]Life Sciences [q-bio]/Human health and pathology/Dermatology - Abstract
Background: A needs assessment for patients with hidradenitis suppurativa (HS) will support advancements in multidisciplinary care, treatment, research, advocacy, and philanthropy. Objective: To evaluate unmet needs from the perspective of HS patients. Methods: Prospective multinational survey of patients between October 2017 and July 2018. Results: Before receiving a formal HS diagnosis, 63.7% (n = 827) of patients visited a physician >= 5 times. Mean delay in diagnosis was 10.2 6 8.9 years. Patients experienced flare daily, weekly, or monthly in 23.0%, 29.8%, and 31.1%, respectively. Most (61.4% [n = 798]) rated recent HS-related pain as moderate or higher, and 4.5% described recent pain to be the worst possible. Access to dermatology was rated as difficult by 37.0% (n = 481). Patients reported visiting the emergency department and hospital >= 5 times for symptoms in 18.3% and 12.5%, respectively. An extreme impact on life was reported by 43.3% (n = 563), and 14.5% were disabled due to disease. Patients reported a high frequency of comorbidities, most commonly mood disorders. Patients were dissatisfied with medical or procedural treatments in 45.9% and 34.6%, respectively. Limitations: Data were self-reported. Patients with more severe disease may have been selected. Conclusion: HS patients have identified several critical unmet needs that will require stakeholder collaboration to meaningfully address.
- Published
- 2020
27. Contributors
- Author
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Afsaneh Alavi, Maria Aleshin, Falk G. Bechara, Richard G. Bennett, Ron Birnbaum, Nicholas Brownstone, Connor R. Buechler, Angel Shree' Byrd, Alexandra P. Charrow, Emily F. Cole, Erin K. Collier, Steven D. Daveluy, Jennifer M. Fernandez, John W. Frew, Amit Garg, Ralph George, Stephanie R. Goldberg, Noah Goldfarb, Sandra Guilbault, Iltefat H. Hamzavi, Paul G. Hazen, Marsha Henderson, Aleksi J. Hendricks, Jennifer L. Hsiao, Tarannum Jaleel, Lydia J. Johnson, Olivier Join-Lambert, Michelle L. Kerns, Alexa B. Kimball, Joslyn S. Kirby, Indermeet Kohli, Joi Lenczowski, Hadar Lev-Tov, Wilson Liao, Michelle A. Lowes, Alexis B. Lyons, Neeta Malviya, Robert G. Micheletti, Peyton C. Morss-Walton, Bridget Myers, Haley B. Naik, Shanthi Narla, Aude Nassif, Tien Viet Nguyen, Georgios Nikolakis, Elizabeth O'Brien, Lauren A.V. Orenstein, Angie Parks-Miller, Zarine S. Patel, Martina L. Porter, Kyla N. Price, Mayur Ramesh, Barry I. Resnik, Monica Rosales Santillan, Muskaan Sachdeva, Daniela P. Sanchez, Kevin T. Savage, Chris Sayed, Monica Shah, Rob Leland Shaver, Vivian Y. Shi, Jan M. Smogorzewski, Farah Succaria, Ryan M. Svoboda, Alyssa M. Thompson, Aristeidis G. Vaiopoulos, Surya A. Veerabagu, Joseph R. Walsh, Maximillian A. Weigelt, Ximena Wortsman, and Christos C. Zouboulis
- Published
- 2022
28. Vasculitis
- Author
-
Robert G. Micheletti and Peter A. Merkel
- Published
- 2022
29. Low utility of radiologic imaging in evaluating cutaneous small-vessel vasculitis: A multi-institutional retrospective study
- Author
-
Ryan S. Din, Peter B. Chansky, Jean-Phillip Okhovat, Andrew C. Walls, Arash Mostaghimi, and Robert G. Micheletti
- Subjects
Adult ,Diagnostic Imaging ,Male ,Vasculitis ,medicine.medical_specialty ,business.industry ,Microcirculation ,Retrospective cohort study ,Dermatology ,Middle Aged ,Skin Diseases, Vascular ,medicine.disease ,Radiography ,Small vessel vasculitis ,Humans ,Medicine ,Female ,Radiology ,business ,Cutaneous small-vessel vasculitis ,Aged ,Retrospective Studies - Published
- 2021
30. Long-term sequelae from Stevens-Johnson syndrome/toxic epidermal necrolysis in a large retrospective cohort
- Author
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Megan H. Noe, Robert G. Micheletti, and Leo L. Wang
- Subjects
Adult ,Male ,medicine.medical_specialty ,business.industry ,MEDLINE ,Retrospective cohort study ,Stevens johnson ,Dermatology ,Middle Aged ,medicine.disease ,United States ,Toxic epidermal necrolysis ,Young Adult ,Stevens-Johnson Syndrome ,Disease Progression ,medicine ,Humans ,Female ,Survivors ,business ,Retrospective Studies - Published
- 2021
31. Prevalence of Leukopenia and Associated Outcomes in Patients With Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis
- Author
-
Leo L, Wang, Megan H, Noe, and Robert G, Micheletti
- Subjects
Stevens-Johnson Syndrome ,Prevalence ,Humans ,Leukopenia ,Dermatology ,Thrombocytopenia - Abstract
This case series compares the factors, comorbidities, and complications associated with leukopenia between patients with and without leukopenia on hospital admission.
- Published
- 2022
32. Medical management of Stevens-Johnson syndrome/toxic epidermal necrolysis among North American dermatologists
- Author
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Jane J. Han, Andrew Creadore, Megan H. Noe, Arash Mostaghimi, Lucia Seminario-Vidal, and Robert G. Micheletti
- Subjects
medicine.medical_specialty ,business.industry ,Racial Groups ,Stevens johnson ,Dermatology ,medicine.disease ,Toxic epidermal necrolysis ,Stevens-Johnson Syndrome ,North America ,medicine ,Humans ,business ,Dermatologists - Published
- 2021
33. Corticosteroid use in chronic dermatologic disorders and osteoporosis
- Author
-
Avrom Caplan, Beatrice Lupsa, Robert G. Micheletti, and Karl L. Insogna
- Subjects
medicine.medical_specialty ,bisphosphonate ,chronic corticosteroid therapy ,Side effect ,Osteoporosis ,Dermatology ,Article ,DXA scan ,FRAX score ,medicine ,In patient ,bone health ,Intensive care medicine ,Dermatologic disorders ,Glucocorticoid-induced osteoporosis ,business.industry ,medicine.disease ,women's health ,osteoporosis ,Glucocorticoid therapy ,RL1-803 ,Corticosteroid use ,Complication ,business ,Glucocorticoid ,hormones, hormone substitutes, and hormone antagonists ,medicine.drug - Abstract
Glucocorticoid-induced osteoporosis (GIOP) is a frequently encountered and serious side effect of glucocorticoid use. Bone loss leading to an increased risk for fracture occurs early in the use of glucocorticoids, yet patients at risk for this complication are often undertreated. All physicians prescribing glucocorticoids should therefore be familiar with a basic approach to anticipating and preventing GIOP when starting patients on glucocorticoid therapy. This manuscript and its case vignettes are designed to help dermatologists assess and manage bone health to prevent GIOP in patients receiving glucocorticoid therapy.
- Published
- 2021
34. Long-term Physical and Psychological Outcomes of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis
- Author
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Fnu Nutan, Adam Vaudreuil, Shawna Nicole Huckell, Sara A Kullberg, Robert G. Micheletti, Rachit Gupta, Daniela Kroshinsky, Melissa Hoffman, Sara Hylwa-Deufel, Vartan Pahalyants, Jesse J. Keller, Karen J. Lee, Edgar Martinez, Kerry Hennessy, John Trinidad, Peter B. Chansky, Michelle A. Boettler, Montana Osler, Arturo R. Dominguez, Eden Lake, Lindsey M. Voller, William Murphy, Kathryn Michels, Tejesh Patel, Arjun R. Bashyam, Nicole A. Karikari, Blanca Estupinan, Lindsay C. Strowd, Lucia Seminario-Vidal, Nayanika Challa, and Arash Mostaghimi
- Subjects
Adult ,Pediatrics ,medicine.medical_specialty ,Psychological intervention ,Dermatology ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Medicine ,Humans ,Physical Examination ,Depression (differential diagnoses) ,Retrospective Studies ,Response rate (survey) ,business.industry ,Brief Report ,Mouth Mucosa ,Middle Aged ,medicine.disease ,Mental health ,Toxic epidermal necrolysis ,030220 oncology & carcinogenesis ,Stevens-Johnson Syndrome ,Quality of Life ,Anxiety ,Female ,medicine.symptom ,business ,Patient education - Abstract
Importance Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is known to cause multiple end-organ complications in its acute phase, but less is known about the long-term association with patients' mental health and quality of life. Objective To examine the chronic physical and psychological sequelae affecting patients with SJS/TEN. Design, setting, and participants A survey study conducted at 11 academic health centers in the US evaluated 121 adults diagnosed with SJS/TEN by inpatient consultive dermatologists between January 1, 2009, and September 30, 2019. Interventions Patients completed a survey that included the following validated questionnaires: Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Primary Care Post-Traumatic Stress Disorder Screen (PC-PTSD), and the 12-item Short Form Health Survey (SF-12). The survey also included questions created by the study team regarding fear, patient education, and long-term sequelae relevant to SJS/TEN. Main outcomes and measures Primary outcome measures were the percentage of patients reporting long-term physical sequelae; the percentage of patients with positive results on PHQ-9, GAD-7, and PC-PTSD screening; and the numeric score on the SF-12 (score of 50 defined as average physical and mental well-being). Results A total of 121 individuals (73 women [60.3%]; mean [SD] age, 52.5 [17.1] years) completed the survey (response rate, 29.2%). The most common long-term physical sequelae reported were cutaneous problems (102 of 121 [84.3%]), ocular problems (72 of 121 [59.5%]), and oral mucosal problems (61 of 120 [50.8%]). A total of 53.3% (64 of 120) of the respondents had results indicating depression on the PHQ-9, 43.3% (52 of 120) showed signs of anxiety on the GAD-7, and 19.5% had results indicating PTSD on the PC-PTSD. The mean (SD) SF-12 Physical Component Summary score was 42.4 (22.8), and the mean Mental Component Summary score was 46.1 (20.9). A total of 28.2% (33 of 117) of the respondents were unable to work, 68.1% (81 of 119) were fearful of taking new medications, and 30.0% (36 of 120) avoided taking prescribed medications for a diagnosed medical condition. Conclusions and relevance This survey study found that long-term physical sequelae, depression, and anxiety appear to be common in patients with SJS/TEN, with implications for health and well-being. Improved awareness of these complications may assist health professionals in offering medical care, counseling, and support to patients with SJS/TEN.
- Published
- 2021
35. A survey-based study of diagnostic and treatment concordance in standardized cases of cellulitis and pseudocellulitis via teledermatology
- Author
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Robert G. Micheletti, Jesse J. Keller, Michi M. Shinohara, Arturo R. Dominguez, Daniel Li, Sabrina Newman, Daniela Kroshinsky, Tejesh Patel, Kanade Shinkai, Benjamin H. Kaffenberger, Sahand Rahnama-Moghadam, Arash Mostaghimi, Adam B. Raff, Lucia Seminario, Abraham M. Korman, Alisa N. Femia, Megan H. Noe, Adela R. Cardones, and Misha Rosenbach
- Subjects
medicine.medical_specialty ,Teledermatology ,medicine.diagnostic_test ,business.industry ,Biopsy ,Remote Consultation ,Concordance ,MEDLINE ,Cellulitis ,Dermatology ,medicine.disease ,Anti-Bacterial Agents ,Diagnosis, Differential ,Patient Admission ,Surveys and Questionnaires ,Humans ,Medicine ,Diagnostic Errors ,business ,Skin pathology ,Skin - Published
- 2020
36. Hidradenitis suppurativa encounters in a national electronic health record database notable for low dermatology utilization, infrequent biologic prescriptions, and frequent opiate prescriptions
- Author
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Megan H. Noe, Robert G. Micheletti, Mackenzie R. Wehner, David J. Margolis, Haley B. Naik, and Eleni Linos
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Databases, Factual ,Cross-sectional study ,MEDLINE ,Dermatology ,Drug Prescriptions ,Article ,Young Adult ,Electronic health record ,Electronic Health Records ,Humans ,Medicine ,Hidradenitis suppurativa ,Young adult ,Medical prescription ,Child ,Biological Products ,business.industry ,Opiate Alkaloids ,Infant, Newborn ,Infant ,Middle Aged ,Patient Acceptance of Health Care ,medicine.disease ,United States ,Hidradenitis Suppurativa ,Cross-Sectional Studies ,Child, Preschool ,Family medicine ,Female ,business - Published
- 2020
37. Timing of mucocutaneous symptoms and medication discontinuation in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis in the United States
- Author
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Arash Mostaghimi, Robert G. Micheletti, and Megan H. Noe
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Mucocutaneous zone ,MEDLINE ,Dermatology ,Cohort Studies ,Humans ,Medicine ,Aged ,Retrospective Studies ,Withholding Treatment ,business.industry ,Retrospective cohort study ,Stevens johnson ,Middle Aged ,medicine.disease ,United States ,Toxic epidermal necrolysis ,Stevens-Johnson Syndrome ,Female ,business ,Medication Discontinuation ,Cohort study - Published
- 2019
38. North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations
- Author
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Alexa B. Kimball, Alain Brassard, Yves Poulin, Tara Jaleel, Dennis P. Orgill, Robert G. Micheletti, Paul G. Hazen, Craig N. Burkhart, Angela Miller, Alice B. Gottlieb, Joslyn S. Kirby, Christopher Sayed, Michelle A. Lowes, Daniel B. Eisen, Karen Crowell, Afsaneh Alavi, Raed Alhusayen, Iltefat H. Hamzavi, Haley B. Naik, and Ali Alikhan
- Subjects
medicine.medical_specialty ,MEDLINE ,Disease ,Dermatology ,law.invention ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Randomized controlled trial ,law ,Health care ,medicine ,Adalimumab ,Hidradenitis suppurativa ,Intensive care medicine ,Surgical approach ,business.industry ,Dermatology Life Quality Index ,Guideline ,Evidence-based medicine ,medicine.disease ,Comorbidity ,Infliximab ,030220 oncology & carcinogenesis ,business ,medicine.drug - Abstract
Hidradenitis suppurativa is a severe and debilitating dermatologic disease. Clinical management is challenging and consists of both medical and surgical approaches, which must often be combined for best outcomes. Therapeutic approaches have evolved rapidly in the last decade and include the use of topical therapies, systemic antibiotics, hormonal therapies, and a wide range of immunomodulating medications. An evidence-based guideline is presented to support health care practitioners as they select optimal medical management strategies and is reviewed in this second part of the management guidelines. A therapeutic algorithm informed by the evidence available at the time of the review is provided.
- Published
- 2019
39. Adverse drug reaction causality assessment tools for drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis: room for improvement
- Author
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Chun-Wei Lu, Munir Pirmohamed, Neil H. Shear, Brian R Lee, Jeffery P. Struewing, David J. Margolis, Jennifer L. Goldman, Wolfram Hoetzenecker, Chun-Bing Chen, Robert G. Micheletti, Wen-Hung Chung, and Sally Usdin Yasuda
- Subjects
Drug-induced Stevens-Johnson syndrome ,medicine.medical_specialty ,Pediatrics ,Pharmacology toxicology ,Risk Assessment ,030226 pharmacology & pharmacy ,Pharmacovigilance ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Correct name ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Probability ,Pharmacology ,business.industry ,Reproducibility of Results ,General Medicine ,medicine.disease ,Causality ,Dermatology ,Toxic epidermal necrolysis ,Stevens-Johnson Syndrome ,business ,Algorithms ,Adverse drug reaction - Abstract
Establishment of causality between drug exposure and adverse drug reactions (ADR) is challenging even for serious ADRs such as Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Several causality assessment tools (CAT) exist, but the reliability and validity of such tools is variable. The objective of this study was to compare the reliability and validity of existing ADR CATs on SJS/TEN cases.Seven investigators completed three CAT (ALDEN, Naranjo, Liverpool) for 10 SJS/TEN cases. Each CAT categorized the causality of 30 potential drugs as definite/very probable, probable, possible, or doubtful/unlikely. An additional reviewer provided expert opinion by designating the implicated drug(s) for each case. A Kappa score was generated to compare CAT responses both by method (reliability of all 7 reviewers, by CATs) and by reviewer (reliability of the 3 CAT, by reviewer). A c statistic was calculated to assess validity.Inter-rater reliability by CAT was poor to fair: ALDEN 0.22, Naranjo 0.11, and Liverpool 0.12. Reliability was highest when causality classification was definite/very probable (0.16-0.41). Similarly, intra-rater reliability by reviewer was poor. When comparing the validity of the overall CAT to expert reviewer, area under the curve was highest for ALDEN (c statistic 0.65) as compared to Liverpool (0.55) or Naranjo (0.54).Available CAT have poor reliability and validity for drug-induced SJS/TEN. Due to the importance of determining ADR causality for research, industry, and regulatory purposes, development of an enhanced tool that can incorporate data from immunological testing and pharmacogenetic results may strengthen CAT usefulness and applicability for drug-induced SJS/TEN.
- Published
- 2019
40. Proceeding report of the Second Symposium on Hidradenitis Suppurativa Advances (SHSA) 2017
- Author
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Jenny Hsaio, John W. Frew, Ximena Wortsman, Michelle A. Lowes, Aude Nassif, Barry I. Resnik, Marc Bourcier, Richard G. Bennett, Steven Daveluy, Hadar Lev-Tov, Falk G. Bechara, Gregory S. Schultz, Erin Martinez, Jerry Tan, Aamir Siddiqui, Christopher Sayed, Lauren K. Hoffman, Vincent Piguet, Zarine S. Patel, Amit Garg, Robert G. Micheletti, Ricardo Cibotti, Joslyn S. Kirby, Afsaneh Alavi, Cynthia L. Nicholson, Eran Shavit, Iltefat H. Hamzavi, Angie Parks-Miller, Haley B. Naik, Mayur Ramesh, University of Toronto, Ruhr University Bochum (RUB), University of California [Los Angeles] (UCLA), University of California, Université de Sherbrooke (UdeS), Centre Médical de l'Institut Pasteur, Institut Pasteur [Paris], University of Western Ontario (UWO), Rockefeller University [New York], University of California (UC), Centre Médical de l'Institut Pasteur (CMIP), and Institut Pasteur [Paris] (IP)
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Mindfulness ,[SDV]Life Sciences [q-bio] ,education ,Dermatology ,Disease ,Biochemistry ,Article ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Epidemiology ,Medicine ,Hidradenitis suppurativa ,symposium ,Molecular Biology ,business.industry ,hidradenitis suppurativa ,medicine.disease ,3. Good health ,030104 developmental biology ,Family medicine ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,[SDV.MHEP.DERM]Life Sciences [q-bio]/Human health and pathology/Dermatology - Abstract
The 3rd Annual Symposium on Hidradenitis Suppurativa Advances (SHSA) took place on 12-14 October 2018 at the Women's College Hospital in Toronto, Ontario, Canada. This symposium was a joint meeting of the Hidradenitis Suppurativa Foundation (HSF) founded in the USA and the Canadian Hidradenitis Suppurativa Foundation (CHSF). This cross-disciplinary meeting with experts from around the world was an opportunity to discuss the most recent advances in the study of hidradenitis suppurativa pathogenesis, epidemiology, classification, scoring systems, radiologic diagnosis, treatment approaches and psychologic assessment. Two special sessions this year were HS as a systemic disease and HS management guidelines. There were focused workshops on wound healing and ultrasound. There were two sessions primarily for patients and their families in the HS School programme: One workshop focused on mindfulness, and the second involved discussion among clinicians and patients about various disease aspects and the latest management. To facilitate networking between clinical and research experts and those early in their career, a mentoring breakfast was held.
- Published
- 2019
41. Dermatologic support for oncology: Quantifying the consultative services received by hospitalized oncology patients
- Author
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Robert J. Smith, Misha Rosenbach, Robert G. Micheletti, and Melissa Hoffman
- Subjects
Oncology ,Inpatients ,education.field_of_study ,medicine.medical_specialty ,business.industry ,Population ,Dermatology ,Hospitalization ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Neoplasms ,030220 oncology & carcinogenesis ,Internal medicine ,Hospital admission ,Humans ,Medicine ,Oncology patients ,education ,business ,Referral and Consultation ,Retrospective Studies - Abstract
Hospitalized oncology patients often require multidisciplinary care. Inpatient consultative dermatologists can provide expertise in the management of cutaneous complications that patients with cancer may experience. The goal of this study was to quantify the types of consults received by hospitalized oncology patients to better understand the utilization of dermatology consults in this population. Hospital billing codes were used to identify inpatient oncology patients and the types of consults they received at a single quaternary care hospital center. Between July 1, 2015, and January 31, 2020, 14,175 patients were admitted to an oncology service for more than 24 hours, and 5,243 (37%) of these patients received at least 1 consultation during their hospital admission. These patients received a total of 10,492 consults from 101 different services. Dermatology had the fifth-highest number of consults (n = 623; 5.9%). Among patients receiving consults, 608 (11.6%) received inpatient dermatology consults. Infectious disease was the service with the most consults (n = 1,485; 14.2%) and was also the service most commonly co-consulted with dermatology (n = 262; 42.1%). The inpatient consultative dermatology service is highly utilized among hospitalized oncology patients, suggesting that expertise in dermatologic care is valued by oncology teams.
- Published
- 2021
42. Corrigendum to ‘SJS/TEN 2019: From science to translation’ [J. Dermatol. Sci. 98/1 (2020) 2–12]
- Author
-
Sonia Whyte-Croasdaile, Ricardo Cibotti, Alfonso Iovieno, Cristina Olteanu, Jessica Weintraub, Bruce Carleton, Mayumi Ueta, Jonathan Peter, Mahyar Etminan, Jean McCawley, Cynthia Sung, Wan-Chun Chang, Sherrie J. Divito, Maja Mockenhaupt, Julienne Jagdeo, Rannakoe J. Lehloenya, Simona Volpi, Hyon K. Choi, Neil H. Shear, Lisa M. Wheatley, Hajirah N. Saeed, Hongsheng Wang, Michael R. Ardern-Jones, Robyn Lim, Christine Shieh, Diane Forbes, Charles S. Bouchard, Agnieszka K. Biala, Elizabeth J. Phillips, Robert G. Micheletti, Zhao-Qing Wang, Shuen-Iu Hung, Wen-Hung Chung, Chia Ling Hsieh, Karen Dewar, Sophie Le Pallec, Nicole Chapman, Jason A Trubiano, Michael J. Rieder, James H. Holmes, Ulrike Dehaeck, Wanpen Anderson, Chen Wan, Mee Kum Kim, Galen E.B. Wright, Munir Pirmohamed, Angie Lowe, Teresa Bellón, Sonia N. Yeung, Katie Niemeyer, Julie McCawley, Sheng-Ying Tsou, Gianpiero L. Cavalleri, Sabine Straus, Elyse A. Hope, Chonlaphat Sukasem, Thomas M. Beachkofsky, Li Zhou, Michael A. Norcross, Cindy Whale, Paul Anderson, Jennifer L. Goldman, Mario E. Lacouture, Esther Fuchs, Douglas Oboh, Riichiro Abe, Kristina B. Williams, James Chodosh, David M. Koelle, and Helena B. Pasieka
- Subjects
Published Erratum ,Political science ,MEDLINE ,media_common.cataloged_instance ,Library science ,Regret ,Dermatology ,European union ,Molecular Biology ,Biochemistry ,media_common - Abstract
The authors regret not all contributing authors correctly acknowledged funding. Jonathan Peter’s IMARI-Africa project (AFRISCAR) is part of the EDCTP2 programme supported by the European Union (grant number TMA2017SF-1981 ). The authors would like to apologise for any inconvenience caused.
- Published
- 2021
43. Neutrophilic dermatoses
- Author
-
Sasha Stephen, Caroline A. Nelson, Hovik J. Ashchyan, Robert G. Micheletti, Misha Rosenbach, and William D. James
- Subjects
030203 arthritis & rheumatology ,medicine.medical_specialty ,business.industry ,Bowel-associated dermatosis–arthritis syndrome ,Sweet Syndrome ,Neutrophilic eccrine hidradenitis ,Arthritis ,Still Disease ,Behcet's disease ,Dermatology ,medicine.disease ,Inflammatory bowel disease ,Pathogenesis ,Rheumatoid neutrophilic dermatitis ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Epidemiology ,medicine ,Rheumatoid factor ,Histopathology ,business ,Pyoderma gangrenosum - Abstract
Neutrophilic dermatoses are a heterogeneous group of inflammatory skin disorders that present with unique clinical features but are unified by the presence of a sterile, predominantly neutrophilic infiltrate on histopathology. The morphology of cutaneous lesions associated with these disorders is heterogeneous, which renders diagnosis challenging. Moreover, a thorough evaluation is required to exclude diseases that mimic these disorders and to diagnose potential associated infectious, inflammatory, and neoplastic processes. While some neutrophilic dermatoses may resolve spontaneously, most require treatment to achieve remission. Delays in diagnosis and treatment can lead to significant patient morbidity and even mortality. Therapeutic modalities range from systemic corticosteroids to novel biologic agents, and the treatment literature is rapidly expanding. The second article in this continuing medical education series reviews the epidemiology, clinical characteristics, histopathologic features, diagnosis, and management of pyoderma gangrenosum as well as bowel-associated dermatosis-arthritis syndrome and the arthritis-associated neutrophilic dermatoses rheumatoid neutrophilic dermatitis and adult Still disease.
- Published
- 2018
44. Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Multicenter Retrospective Study of 377 Adult Patients from the United States
- Author
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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
- Subjects
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
45. Cutaneous Manifestations of COVID-19: Characteristics, Pathogenesis, and the Role of Dermatology in the Pandemic
- Author
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Mariam Alam, Misha Rosenbach, Joanna Harp, William Lewis, Robert G. Micheletti, and Katherine Steele
- Subjects
Male ,medicine.medical_specialty ,Urticaria ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Dermatology ,Disease ,Severity of Illness Index ,Skin Diseases ,Pathogenesis ,030207 dermatology & venereal diseases ,03 medical and health sciences ,COVID-19 Testing ,0302 clinical medicine ,Pandemic ,Humans ,Medicine ,030212 general & internal medicine ,Purpura ,Skin ,business.industry ,COVID-19 ,Exanthema ,Morbilliform ,Pathophysiology ,body regions ,Skin Diseases, Viral ,Female ,medicine.symptom ,business - Abstract
Cutaneous manifestations of COVID-19-SARS-CoV-2-are common and varied. Morbilliform, vesicular, and urticarial eruptions may be nonspecific initial features of the disease. Chilblainlike lesions on the fingers or toes typically occur as part of a resolution phase, signifying a milder course, whereas livedoid lesions and retiform purpura are associated with coaguloapthy and more severe disease. Additionally, a severe Kawasaki-like multisystem inflammatory syndrome rarely is seen in children. This diverse range of cutaneous manifestations in COVID-19 reflects a spectrum of host immunologic responses to SARS-CoV-2 and may inform disease pathophysiology.
- Published
- 2021
46. Advances in cutaneous vasculitis research and clinical care
- Author
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Avrom Caplan and Robert G. Micheletti
- Subjects
030203 arthritis & rheumatology ,medicine.medical_specialty ,Systemic disease ,business.industry ,medicine.medical_treatment ,Translational research ,General Medicine ,Disease ,medicine.disease ,Targeted therapy ,03 medical and health sciences ,0302 clinical medicine ,Multicenter trial ,medicine ,Review Article on Rheumatologic Skin Disease ,030212 general & internal medicine ,Clinical care ,Disease management (health) ,Vasculitis ,business ,Intensive care medicine - Abstract
Vasculitis is characterized by inflammation and destruction of blood vessels, resulting in downstream ischemic tissue damage. Diagnosis of vasculitis is a careful exercise in clinical-pathologic correlation, depending upon the clinical manifestations, organs involved, the size of affected blood vessels, imaging, and laboratory findings. While some vasculitis subtypes may be confined to the skin, serious internal organ involvement or underlying disease states may also occur. Accordingly, the skin plays an important role in the diagnostic process and may be prognostically important in some cases, signifying more severe systemic disease. The skin also provides opportunities for tissue-based translational research, improving understanding of disease pathophysiology. Dermatologists, therefore, play a critical role in evaluating vasculitis and helping to advance vasculitis clinical care and research. Recent updates in vasculitis nomenclature and terminology, evidence-based diagnosis, pathogenesis, and investigations of targeted therapies are changing vasculitis research and leading to fundamental shifts in disease management. Treatment advances favoring evidence-based and targeted, rather than broadly immunosuppressive, therapies are in development, while a multicenter trial for skin-limited vasculitis is ongoing. Collaborative multidisciplinary research networks are key to current and future advances in vasculitis research. In this review, we describe recent developments in vasculitis clinical care and research, starting with a discussion of efforts to develop diagnostic and classification criteria, followed by updates on the evaluation and treatment of vasculitis.
- Published
- 2021
47. Pregnancy in Hidradenitis Suppurativa-Patient Perspectives and Practice Gaps
- Author
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Ademide A Adelekun, Robert G. Micheletti, Natalie M. Villa, and Jennifer L. Hsiao
- Subjects
Adult ,medicine.medical_specialty ,MEDLINE ,Dermatology ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Pregnancy ,Surveys and Questionnaires ,Practice Gaps ,medicine ,Research Letter ,Childbirth ,Humans ,Hidradenitis suppurativa ,Reproductive health ,business.industry ,Survey research ,medicine.disease ,Professional Practice Gaps ,Hidradenitis Suppurativa ,Pregnancy Complications ,030220 oncology & carcinogenesis ,Family medicine ,Female ,business - Abstract
This survey study reports on patients’ concerns about the implications of hidradenitis suppurativa for sexual and reproductive health, heritability of the condition, and pregnancy and childbirth as well as the inadequate information and support from clinicians.
- Published
- 2021
48. Is There a Role for Therapeutic Drug Monitoring in Patients with Hidradenitis Suppurativa on Tumor Necrosis Factor-α Inhibitors?
- Author
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Tasnim, Abdalla, Michelle A, Lowes, Nirmal, Kaur, Robert G, Micheletti, A Hillary, Steinhart, and Afsaneh, Alavi
- Subjects
Biological Factors ,Treatment Outcome ,Crohn Disease ,Tumor Necrosis Factor-alpha ,Adalimumab ,Humans ,Psoriasis ,Drug Monitoring ,Infliximab ,Hidradenitis Suppurativa - Abstract
Tumor necrosis factor-α inhibitors, adalimumab and infliximab, are at the forefront of biologic therapy for the management of moderate-to-severe hidradenitis suppurativa, with adalimumab as currently the only approved medication for this condition. In treating patients, primary or secondary lack of response (also termed suboptimal response) is a major burden for both patients and healthcare systems and is a challenge with biologics in part owing to the development of anti-drug antibodies following treatment. To overcome this, therapeutic drug monitoring may be conducted proactively or reactively to a patient's suboptimal response guided by measurements of trough serum drug concentrations and levels of anti-drug antibodies. While strong evidence to support the utility of therapeutic drug monitoring exists in patients with inflammatory bowel disease, current information is limited in the context of hidradenitis suppurativa. We sought to summarize the available evidence and to present the role of therapeutic drug monitoring and other dose optimization strategies in improving clinical response in patients with hidradenitis suppurativa treated with tumor necrosis factor-α inhibitors.
- Published
- 2021
49. Comorbidity screening in hidradenitis suppurativa: Evidence-based recommendations from the US and Canadian Hidradenitis Suppurativa Foundations
- Author
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Steven Daveluy, Janice Lester, Mark G. Kirchhof, Andrew Strunk, Neeta Malviya, Amit Garg, Joslyn S. Kirby, Tarannum Jaleel, Michelle A. Lowes, Iltefat H. Hamzavi, Ali Alikhan, Lauren A.V. Orenstein, Robert G. Micheletti, Haley B. Naik, Vincent Piguet, Raed Alhusayen, Wayne Gulliver, Alexa B. Kimball, Shari Wright, Christopher Sayed, Jerry Tan, Afsaneh Alavi, Isabelle Delorme, Hadar Lev-Tov, and Noah Goldfarb
- Subjects
obesity ,Disease ,Comorbidity ,Cardiovascular ,030207 dermatology & venereal diseases ,0302 clinical medicine ,cardiovascular disease ,2.1 Biological and endogenous factors ,Hidradenitis suppurativa ,guidelines ,dissecting cellulitis of the scalp ,Metabolic Syndrome ,education.field_of_study ,spondyloarthritis ,Health Services ,pilonidal disease ,Polycystic ovary ,Pyoderma Gangrenosum ,Hidradenitis Suppurativa ,Crohn's disease ,sexual dysfunction ,030220 oncology & carcinogenesis ,depression ,diabetes mellitus ,Female ,medicine.symptom ,dermatologist ,medicine.medical_specialty ,Canada ,down syndrome ,hypertension ,Clinical Sciences ,Population ,substance use ,herpes zoster ,lymphoma ,Dermatology ,metabolic syndrome ,smoking ,03 medical and health sciences ,inflammatory bowel disease ,Clinical Research ,Internal medicine ,medicine ,Humans ,education ,acne ,generalized anxiety disorder ,suicide ,ulcerative colitis ,business.industry ,screening ,Prevention ,Dermatology & Venereal Diseases ,dyslipidemia ,hidradenitis suppurativa ,Odds ratio ,Evidence-based medicine ,systemic ,medicine.disease ,Sexual dysfunction ,polycystic ovary syndrome ,North America ,Digestive Diseases ,business - Abstract
Background Hidradenitis suppurativa (HS) is associated with comorbidities that contribute to poor health, impaired life quality, and mortality risk. Objective To provide evidence-based screening recommendations for comorbidities linked to HS. Methods Systematic reviews were performed to summarize evidence on the prevalence and incidence of 30 comorbidities in patients with HS relative to the general population. The screening recommendation for each comorbidity was informed by the consistency and quality of existing studies, disease prevalence, and magnitude of association, as well as benefits, harms, and feasibility of screening. The level of evidence and strength of corresponding screening recommendation were graded by using the Strength of Recommendation Taxonomy (SORT) criteria. Results Screening is recommended for the following comorbidities: acne, dissecting cellulitis of the scalp, pilonidal disease, pyoderma gangrenosum, depression, generalized anxiety disorder, suicide, smoking, substance use disorder, polycystic ovary syndrome, obesity, dyslipidemia, diabetes mellitus, metabolic syndrome, hypertension, cardiovascular disease, inflammatory bowel disease, spondyloarthritis, and sexual dysfunction. It is also recommended to screen patients with Down syndrome for HS. The decision to screen for specific comorbidities may vary with patient risk factors. The role of the dermatologist in screening varies according to comorbidity. Limitations Screening recommendations represent one component of a comprehensive care strategy. Conclusions Dermatologists should support screening efforts to identify comorbid conditions in HS.
- Published
- 2020
50. Nutritional dermatoses in the hospitalized patient
- Author
-
Melissa, Hoffman, Robert G, Micheletti, and Bridget E, Shields
- Subjects
Risk Factors ,Malnutrition ,Humans ,Skin Diseases - Abstract
Cutaneous disease may be the first manifestation of an underlying nutritional deficiency, highlighting the importance of early recognition by dermatologists. Undernutrition occurs when there is an imbalance between nutrient intake and metabolic demand. Many hospitalized patients are in catabolic states due to chronic illness, infection, malabsorption, or medication. These patients are at an increased risk for undernutrition and therefore associated cutaneous disease. This review details the risk factors for nutritional deficiency, illustrates the presentations of cutaneous disease, reviews diagnostic workups, and provides suggestions for supplementation in the undernourished patient.
- Published
- 2020
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