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Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory disorder, most often characterized by atrophic skin plaques located on female genitalia. Infrequently, LSA may present extragenitally; however, much is unknown about the temporal relationship between genital and extragenital LSA. Morphea, also known as localized scleroderma, is a rare inflammatory skin condition characterized by sclerotic plaques. Investigators debate whether LSA and morphea exist on the same spectrum of disease, with LSA representing a superficial variant of morphea involving genitalia, or if they are distinct but coincidental entities. Although researchers have described LSA and morphea occurring in different locations on the same patient, few reports describe LSA and morphea occurring in the same lesion and in the inguinal folds. Herein, we report a case of a 62-year-old woman with extragenital LSA-morphea overlap in the inguinal folds, who three months later developed genital LSA. Extragenital LSA-morphea in the same plaque, with no signs of genital lesions on initial exam, with later development of genital LSA, is especially uncommon. The temporal progression of extragenital LSA-morphea overlap to genital LSA over a three-month period is an important contribution to the literature, as the temporal relationship between extragenital and genital LSA is not previously discussed.

Tebentafusp is a bispecific protein that recently underwent FDA approval for the treatment of metastatic uveal melanoma that functions by redirecting cytotoxic T cells to glycoprotein-100, a protein highly expressed in melanoma. Although clinical trials have demonstrated that rashes are common in the first few days of treatment, little is known about skin reactions that develop later in the treatment course. Herein, we describe a type IV hypersensitivity reaction and vitiligo-like depigmentation that developed six weeks into treatment and discuss the possible mechanisms underlying these reactions. The type IV hypersensitivity reaction resolved without intervention within seven weeks of onset, suggesting that tebentafusp can be safely continued in select patients who develop this cutaneous reaction.

Monoclonal Gammopathy of Undetermined Significance (MGUS) is a clonal plasma cell disorder that is considered preneoplastic, asymptomatic, and only requiring observation. However, MGUS may result in cutaneous complications, which are poorly understood, causing treatment delays and patient suffering. We present 30 patients with cutaneous findings associated with MGUS, characterizing clinical presentations, isoforms, treatments, and outcomes. These included: MGUS-associated 'rashes' (pruritic eczematous rashes), reactive and mucin-depositional conditions (pyoderma gangrenosum, scleromyxedema), M-protein-related deposition disorders (POEMS syndrome, Waldenstrom macroglobulinemia), and cutaneous lymphomas. Twelve of 30 (40%) patients received multiple myeloma drugs (MMDs). Eleven (92%) patients improved, and those not receiving MMDs rarely improved, suggesting that MMDs have efficacy for cutaneous manifestations of MGUS. Therefore, trialing MMDs may be warranted for patients with MGUS not responding to other therapies. Moreover, evaluation for monoclonal gammopathy in elderly patients with intractable pruritus or other chronic skin conditions that are non-responsive to skin-directed therapies should be considered. [ABSTRACT FROM AUTHOR]

Individual reports described lymphoproliferative disorders (LPDs) after COVID-19 vaccination; however, the relationship between cases is unexamined. We aim to determine if there are cases of cutaneous LPDs associated with COVID-19 vaccination and their outcomes. We present a review of world literature, vaccine registries, and two unreported cases of LPDs after COVID-19 vaccination. Review of the medical literature, VAERS, and our two cases reveal predominance of Pfizer-BioNTech vaccine, younger patients, and males. All cases resulted in favorable outcomes. Approximately 84% of cases demonstrated CD30+ positivity in their skin biopsies, suggesting that an antigenic trigger may lead to a type IV adaptive immune response, with clonal expansion of CD30+ T-cells and subsequent oncogenic mutational hits eventuating in transient LPDs. LPDs after COVID-19 vaccination appear in the context of the same vaccines (proportionally to their global market shares), share clinical and pathological findings, and have indolent, self-limited character. [ABSTRACT FROM AUTHOR]

Background: Recent studies have evaluated Alzheimer's disease (AD) associated with cerebrovascular and cardiovascular risk factors. Stroke history mediates association between late‐onset AD and cardiovascular disease risk factors (Tosto et al., 2016). Our research investigated stroke as a potential moderator between polygenic risk score (PRS) and Alzheimer's disease. Method: Participants were enrolled in the multi‐ethnic Washington Heights‐Inwood Columbia Aging Project (WHICAP). 653 non‐Hispanic white and 2285 Caribbean Hispanic participants were included based on GWAS data and stroke status (self‐reported history of stroke or MRI‐visualized stroke). A concordance analysis assessed stroke group agreement. PRS from GWAS statistics was calculated for both populations. Following calculation of moderators by stroke status on population‐specific PRS, binomial logistic regression models were conducted. Model outcome was Alzheimer's disease, which incorporated four diagnoses: Pure Alzheimer's disease, Probable Alzheimer's disease with Stroke, Alzheimer's disease with Parkinsonism, and Atypical Alzheimer's disease. Another set of models was conducted for the Caribbean Hispanic population towards a general outcome of Alzheimer's disease alone. Result: Concordance analyses among all 4987 WHICAP participants showed Cohen's kappa of ‐0.033 and p of 0.001* (p* < 0.05), indicating no concordance between self‐reported and MRI‐visualized stroke groups; this is consistent with observation by Reitz et al., 2009. Within the Caribbean Hispanic population, MRI‐visualized stroke models for Alzheimer's disease (four types) showed moderator significance (p of 0.002*, 0.007*, and 0.001* for Models 1, 2, 3 respectively) and MRI‐visualized stroke models towards generalized Alzheimer's disease showed moderator significance (p of 0.152, 0.041*, and 0.020* for Models 1, 2, 3 respectively). Conclusion: Stroke is likely to be an important moderator of PRS and Alzheimer's disease risk in MRI‐visualized stroke models, while a self‐reported history of stroke was not related. [ABSTRACT FROM AUTHOR]