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To date, only twenty cases of cutaneous legionellosis have been reported. Cutaneous legionellosis has heterogeneous manifestations including abscesses, nodules, and cellulitis. The detection of most cutaneous Legionella species requires specific diagnostic cultures and assays. Herein, we report a case of cutaneous legionella in a hematopoietic cell transplantation recipient with culture-negative nodules unresponsive to empiric antibiotics. We also discuss the varied morphology of cutaneous legionellosis and important diagnostic considerations.

Hidradenitis suppurativa (HS) is a chronic, inflammatory, debilitating disease of unknown etiology. HS can occur in people of all ethnicities and ages, and affects approximately 3-4% of the United States. To date, few studies have specifically examined the race prevalence of HS; further epidemiological research is needed to identify specific trends among HS and its racial predilections. At our center, 1.3% of African-American patients were seen for HS, compared to 18% of Caucasian patients (plt;0.05), and the percent ratio of African-American versus Caucasian patients with HS was 7.22:1. Our number ratio of African-American patients versus Caucasian patients with HS was 1.19:1. Studies performed at Henry Ford Medical Center and University of Pittsburgh report ratios of 1.64:1 and 1.98:1 respectively. These data support study trends suggesting HS is more common among patients of African-American descent. A large, population-based study across the United States is needed to better assess the associations between ethnicity and HS. Examining this patient population has the potential to improve our understanding of HS pathophysiology, and will enable clinicians to better manage patients with this disease.

Introduction: Treatment goals depend on individual definitions of “treatment success” and tend to differ between patients and physicians. Patients who do not meet their own treatment goals, but do meet provider definitions of well-controlled disease, may be inappropriately placed on stable treatment regimens.Methods: Patients with psoriasis on stable treatment regimens were queried about perceptions of disease control, improvement level, overall treatment satisfaction, and consideration for trying new treatments. Response ratings were tabulated to assess treatment type and satisfaction level associations, and patient feedback was analyzed to assess reasons for new treatment consideration.Results: The majority of patients (59%) considered “well-controlled” by their dermatologist were not satisfied with their current regimen. The majority of patients (66%) considered “well-controlled” by their dermatologist would consider trying new medications. Patients on topical treatments were significantly less...

Background: Hidradenitis suppurativa (HS) is a debilitating chronic disease that leads to inflammation and abscess formation in the involved skin, along with a malodorous discharge. Pain is a considerable aspect of HS and significantly impacts quality of life. In addition, HS is significantly associated with depression. A better understanding of contributing factors to depression and pain in patients with HS can identify opportunities to improve care for patients. Objective: To identify factors that contribute to depression and chronic pain in patients with HS. Methods: This is a retrospective chart review of 283 patients seen at dermatology clinics of an academic health center for HS from July 2012 to December 2015. The association between HS and depression and chronic pain was assessed in multivariate models using logistic regression analyses. Results: Patients with a greater number of areas of involvement were more likely to have both chronic pain and depression. Limitations: This is a single-center retrospective chart review with a limited sample size. Conclusion: This study suggests that the extent of disease rather than severity plays a role in reducing the quality of life in HS patients.

Background: Though psoriasis is chronic and recurring, current options can help many patients achieve good disease control.New treatments could provide greater improvement in objective disease, but it is not clear that there is room for improving subjective outcomes, particularly for patients who are already “well-controlled.”Objective: To analyze treatment satisfaction of well-controlled patients with psoriasis in two patient populations of very different disease severity.Methods: Patients with well-controlled psoriasis on topicals (mild psoriasis) only or on biologics (moderate-to-severe psoriasis) were queried by telephone about perceptions of disease control, improvement level, overall treatment satisfaction, and consideration for trying new treatments. Satisfaction scores and feedback were analyzed to assess treatment type and satisfaction level associations.Results: The majority of patients, regardless of disease severity, would consider trying new treatments for psoriasis, though patients with mild psoriasis were less satisfied with their disease control, level of improvement, and overall treatment. Patient feedback revealed widespread treatment dissatisfaction, non-adherence, and inconvenience.Limitations: The patient population was from one university setting.Conclusion: 16% of patients with psoriasis meet study definition for “well-controlled” disease. Less than 20% of these well- controlled patients with psoriasis are satisfied with their current level of control and clearance and would not consider trying new treatments, suggesting the majority of well-controlled patients, regardless of disease severity, still have unmet needs. Strongerpatient-physician communication may contribute to patient-based, comprehensive care in concordance with a health system that isheaded towards financial incentives for better patient satisfaction.

Psoriasis is closely associated with cardiovascular comorbidities. Poor adherence can affect both psoriasis outcomes and the effectiveness of treatment for cardiovascular comorbidities. We discuss a case of psoriasis medication nonadherence resulting in admission to the dermatology inpatient service for erythrodermic psoriasis. Administration of the patient's prescribed home antihypertensive regimen on admission resulted in a severe hypotension requiring transfer to the medical intensive care unit (ICU). This case illustrates the role of poor adherence in an erythrodermic flare of psoriasis; this case also illustrates how new-onset regimented adherence, in a formerly nonadherent patient, may result in life-threatening iatrogenic disease.