Publications by authors named "Benjamin F Chong"

51 Publications

SnapshotDx Quiz: June 2021.

J Invest Dermatol 2021 Jun;141(6):e65-e70

Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas, USA. Electronic address:

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http://dx.doi.org/10.1016/j.jid.2021.03.004DOI Listing
June 2021

Elevated serum levels of C-X-C motif chemokine ligand 10 can distinguish systemic lupus erythematosus patients from cutaneous lupus erythematosus patients.

J Am Acad Dermatol 2021 Apr 18. Epub 2021 Apr 18.

Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2021.04.032DOI Listing
April 2021

The CLASI, a validated tool for the evaluation of skin disease in lupus erythematosus: a narrative review.

Ann Transl Med 2021 Mar;9(5):431

Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.

Cutaneous lupus erythematosus (CLE) can present with or without features of systemic lupus erythematosus (SLE), with estimates of the incidence of isolated skin disease almost equaling the incidence of those with systemic disease. However, despite the impact CLE has on a patient's quality of life (QoL), there has been no US Food and Drug Administration (FDA) approved treatment for the disease in the past 50 years. In addition, patients with skin predominant LE are often excluded from clinical SLE trials. In the rare trials that include patients with skin predominant LE, disease activity and progression in the skin are often difficult to evaluate using multi-organ outcome measures. The need for new therapies for CLE and the lack of focus on skin outcomes has led to the development of the Cutaneous Lupus Disease Area and Severity Index (CLASI), a validated organ-specific outcome measure that is not only responsive to change in disease activity and damage but also correlated to changes in a patient's QoL. This paper will emphasize the extensive validation studies performed in developing the CLASI, as well as the importance of clinical trials using the CLASI to address the need for improved therapies for patients with lupus skin manifestations.
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http://dx.doi.org/10.21037/atm-20-5048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8033342PMC
March 2021

Role of biomarkers in the diagnosis and prognosis of patients with cutaneous lupus erythematosus.

Ann Transl Med 2021 Mar;9(5):429

Department of Dermatology, University of Texas at Southwestern Medical Center, Dallas, TX, USA.

Cutaneous lupus erythematosus (CLE) is a connective tissue disease with varying presentations, and clinical sequelae including itching, dyspigmentation, and scarring. CLE can occur as its own entity or in conjunction with systemic disease, known as systemic lupus erythematosus (SLE). Because CLE is clinically diverse, identification of a biomarker may help not only facilitate early diagnosis and management but also identify individuals at risk for poor prognosis and development of SLE. While potential biomarkers in SLE have been extensively studied, few biomarkers for CLE have been identified and incorporated into clinical practice. Anti-SS-A antibody is a commonly used biomarker for diagnosis of subacute CLE patients. Type I interferon-related proteins such as MxA and guanylate binding protein-1 (GBP-1) and chemokines such as CXCR3, CXCL9, and CXCL10 have been identified as biomarkers that may support diagnosis and track disease activity. First-line oral treatment for CLE currently consists of anti-malarials such as hydroxychloroquine (HCQ), chloroquine (CQ), and quinacrine (QC). Studies have found that an increased myeloid dendritic cell population with higher TNF-α expression may be predictive of poor treatment response to HCQ in CLE patients. Autoantibodies against nuclear antigens (e.g., anti-double-stranded DNA and anti-Smith antibodies) and elevated erythrocyte sedimentation rate have been more commonly found in CLE patients progressing to SLE than those who have not. This review aims to summarize previous and emerging biomarkers for CLE patients.
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http://dx.doi.org/10.21037/atm-20-5232DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8033322PMC
March 2021

SnapshotDx Quiz: February 2021.

J Invest Dermatol 2021 Feb;141(2):e15-e19

Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. Electronic address:

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http://dx.doi.org/10.1016/j.jid.2020.11.013DOI Listing
February 2021

Evaluation of the effect of store-and-forward teledermatology on in-person health care system utilization in a safety-net public health and hospital system.

J Am Acad Dermatol 2021 Jan 19. Epub 2021 Jan 19.

Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.12.088DOI Listing
January 2021

Factors associated with quality of life in cutaneous lupus erythematosus using the Revised Wilson and Cleary Model.

Lupus 2020 Nov 3;29(13):1691-1703. Epub 2020 Sep 3.

Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Objectives: The purpose of this study was to characterize the impact of cutaneous lupus erythematosus (CLE) in adults and identify the clinical and non-clinical factors associated with quality of life (QoL), using the Revised Wilson and Cleary Model.

Methods: 101 patients diagnosed with CLE were included in this cross-sectional study. QoL was measured with the Cutaneous Lupus Erythematosus Quality of Life (CLEQoL) scale and disease activity and damage with the Cutaneous Lupus Activity and Severity Index (CLASI). Patient demographics, clinical, and disease characteristics were also collected. Descriptive statistics were calculated, and multiple regression was employed to determine significant (p < 0.05) predictors of overall QoL. Data were analyzed using SPSS v24.

Results: The overall regression QoL model was significantly different from zero, (F = 24.96; df = 14, 76; p = <0.001). Disease activity (β = 0.13), pain (β = 0.13), fatigue (β = 0.24), body image (β = 0.62), and side effects (β = -0.13) were significant predictors of overall QoL while controlling for other predictor variables. Patients who experienced higher levels of disease activity, fatigue severity, pain levels, and greater degree of body dissatisfaction had significantly poorer QoL. Fewer side effects experienced from CLE medications were significantly associated with higher QoL.

Conclusions: Study findings support the considerable burden associated with CLE. Several modifiable variables such as pain, fatigue, body image, and disease activity were associated with QoL. Therefore, interventions that incorporate these variables may reduce negative impacts on QoL life and improve health outcomes in CLE patients. Furthermore, given the chronic and recurring nature of the condition, strategies focused on improving QoL are needed for this vulnerable population.
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http://dx.doi.org/10.1177/0961203320951842DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641991PMC
November 2020

Creation and Validation of Classification Criteria for Discoid Lupus Erythematosus.

JAMA Dermatol 2020 08;156(8):901-906

Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Importance: Classification criteria are the standardized definitions that are used to enroll uniform cohorts for research studies. They emphasize high specificity and are distinct from diagnostic criteria. No universally recognized classification criteria currently exist for discoid lupus erythematosus (DLE), which has led to problematic heterogeneity in observational and interventional clinical studies across the field.

Objective: To create and validate classification criteria for DLE using 12 previously defined candidate criteria items.

Design, Setting, And Participants: For this diagnostic study, candidate criteria items were prospectively applied by dermatologists and dermatopathologists at clinical visits of patients with DLE or a condition that could be confused for DLE, termed a DLE mimicker, at academic dermatology practices across the United States, Poland, Japan, and South Korea. Data were collected from December 1, 2017, to February 1, 2019, and analyzed from March 1 to September 19, 2019.

Main Outcomes And Measures: Clinical features among these 2 groups were calculated and compared with χ2 or Fisher exact tests. Candidate models were identified using best subsets logistic regression analysis. Improvement tests, fit statistics, and discrimination were considered to choose a final model.

Results: Nine sites contributed 215 patients, 15 of whom had missing or incomplete data. The final model for DLE classification criteria includes only clinical variables: atrophic scarring (3 points), location in the conchal bowl (2 points), preference for the head and neck (2 points), dyspigmentation (1 point), follicular hyperkeratosis and/or plugging (1 point), and erythematous to violaceous in color (1 point), with an area under the receiving operating characteristic curve of 0.91 (95% CI, 0.87-0.95). A score of at least 5 points yields a sensitivity of 84.1% and a specificity of 75.9% in the classification of DLE, with increasing scores yielding higher specificity.

Conclusions And Relevance: These findings provide the initial validation of classification criteria for DLE for use in observational and clinical trials.
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http://dx.doi.org/10.1001/jamadermatol.2020.1698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301299PMC
August 2020

Acute generalized exanthematous pustulosis induced by empiric hydroxychloroquine for presumed COVID-19.

Dermatol Ther 2020 Nov 8;33(6):e13834. Epub 2020 Jul 8.

Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

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http://dx.doi.org/10.1111/dth.13834DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7323399PMC
November 2020

Worsening skin damage in patients with cutaneous lupus erythematosus may predict development of systemic lupus erythematosus.

J Am Acad Dermatol 2021 Feb 11;84(2):538-540. Epub 2020 May 11.

Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.05.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735818PMC
February 2021

Robust measurement of clinical improvement in patients with cutaneous lupus erythematosus.

Lupus Sci Med 2020 27;7(1):e000364. Epub 2020 Jan 27.

Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Objective: The severity and disease course of cutaneous lupus erythematosus (CLE) are highly variable. Consequently, outcome measures for CLE clinical improvement are heterogeneous, complicating treatment decisions and therapeutic development. This study characterises CLE outcome measures and identifies the influence of clinical improvement thresholds on strengths of associations with patient demographic and clinical factors.

Methods: In this pilot cohort study, multivariable models identified factors associated with CLE activity and skin damage improvement, defined as relative decreases in Cutaneous Lupus Activity and Severity Index (CLASI) activity (CLASI-A) and damage (CLASI-D) scores, over ranges of response thresholds.

Results: 66 patients with 119 visit-pairs were included in the CLASI-A analysis. 74 patients with 177 visit-pairs were included in the CLASI-D analysis. Factors associated with CLE activity and damage improvement depended on the response threshold. Some associations were stronger at more stringent thresholds, including subacute CLE predominance with increased likelihood of CLASI-A improvement (=0.73; 50% reduction: OR 1.724 (95% CI 0.537 to 5.536); 75%: 5.67 (95% CI 1.56 to 20.5)) and African-American race with decreased likelihood of CLASI-D improvement (=0.80; 20%: 0.40 (95% CI 0.17 to 0.93); 40%: 0.25 (95% CI 0.08 to 0.82)). Other associations were stable across multiple thresholds, including older age of CLE development with increased likelihood of CLASI-A improvement (=0.25; 50%: 1.05 (95% CI 1.01 to 1.09]; 75%: 1.05 (95% CI 1.00 to 1.10)) and higher initial disease activity with decreased likelihood of CLASI-D improvement (=0.55; 20%: 0.91 (95% CI 0.84 to 0.98); 40%: 0.88 (95% CI 0.79 to 0.97)).

Conclusions: Examining a range of CLASI threshold outcomes can comprehensively characterise changes in disease course in patients with CLE. Insufficiently stringent thresholds may fail to distinguish meaningful clinical change from natural fluctuation in disease activity.
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http://dx.doi.org/10.1136/lupus-2019-000364DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008708PMC
May 2021

Principal components analysis as a tool to identify lesional skin patterns in cutaneous lupus erythematosus.

J Am Acad Dermatol 2020 Sep 12;83(3):922-924. Epub 2020 Jan 12.

Department of Dermatology, University of Texas Southwestern Medical Center, Dallas. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.01.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354201PMC
September 2020

Study of Anti-Malarials in Incomplete Lupus Erythematosus (SMILE): study protocol for a randomized controlled trial.

Trials 2018 Dec 20;19(1):694. Epub 2018 Dec 20.

University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.

Background: Onset of systemic lupus erythematosus (SLE) is preceded by a preclinical phase characterized by expression of autoantibodies and nonspecific clinical symptoms. Hydroxychloroquine is a treatment for lupus that is widely used based on longstanding experience and a very good safety profile. Existing data suggest that treatment with hydroxychloroquine may postpone the onset of disease. However, prospective studies that prove and quantify the efficacy of hydroxychloroquine in the preclinical phase of lupus have not been done. This study will test the hypothesis that early hydroxychloroquine use can prevent accumulation of clinical abnormalities and modify immune responses that define SLE.

Methods: A randomized, double-blind, placebo-controlled trial of hydroxychloroquine vs placebo will be conducted. Participants will have incomplete lupus erythematosus as defined by the presence of antinuclear antibody (ANA) positivity at a titer of 1:80 or greater, as well as one or two additional criteria from the 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria. The age range will be 15-45 years and the treatment phase will be 96 weeks. The primary endpoint will be the increase in the number of features of SLE defined by the 2012 SLICC classification schema. Secondary outcomes will include the proportion of participants who transition to a classification of SLE as defined by SLICC criteria.

Discussion: A major challenge for improving therapies in patients with SLE is early detection of disease. The ANA test that is widely used to screen for SLE has low specificity and interpretation of its significance is challenging. The Study of Anti-Malarials in Incomplete Lupus Erythematosus (SMILE) trial will provide insights into the appropriate target population for intervention, and will assess whether hydroxychloroquine can slow progression as measured by the accumulation of criteria. Ophthalmologic safety in this population will be assessed. The study will investigate candidate biomarkers that will guide treatment decisions and will accumulate a specimen biobank that will be available to the lupus research community for further in-depth mechanistic studies. This trial is a first step toward testing the feasibility of disease prevention strategies in SLE.

Trial Registration: ClinicalTrials.gov, NCT 03030118 . Registered on 24 January 2017.
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http://dx.doi.org/10.1186/s13063-018-3076-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6302430PMC
December 2018

Outcomes associated with shorter wait times at a county hospital outpatient dermatology clinic.

Cutis 2018 09;102(3):159-160

Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, and Parkland Health and Hospital System, Dallas, USA.

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September 2018

Mock Recruitment for the Study of Antimalarials in an Incomplete Lupus Erythematosus Trial.

Arthritis Care Res (Hoboken) 2019 11;71(11):1425-1429

Penn State College of Medicine, Hershey, Pennsylvania.

Objective: Recruitment to randomized clinical trials is expensive and often falls short of goals, limiting achievement of measurable outcomes. To prepare for a trial in patients with incomplete forms of lupus, a mock recruitment protocol was carried out at 4 proposed study sites. The objective was to determine levels of interest in patients and to uncover potential barriers to enrollment.

Methods: After obtaining institutional review board approval, study coordinators approached individuals who generally fit proposed criteria for the trial. A standardized script was followed in a structured interview. Levels of interest were determined and any reasons for concerns were collected with an open-ended format.

Results: A total of 45 subjects were interviewed, of which 73% expressed an interest in the trial, and 64% said they were likely to enroll. Concerns of those who were not interested included risk of hydroxychloroquine, desire not to receive placebo, and lack of time for participation.

Conclusion: The mock recruitment suggests that the trial will be attractive to suitable patients. The concerns raised support other data indicating that provision of information is crucial to achieving enrollment goals. Mock recruitment of potential investigators should be considered also to address referral concerns.
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http://dx.doi.org/10.1002/acr.23802DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6487234PMC
November 2019

Expansion of Myeloid-Derived Suppressor Cells in the Peripheral Blood and Lesional Skin of Cutaneous Lupus Patients.

J Invest Dermatol 2019 02 6;139(2):478-481. Epub 2018 Oct 6.

University of Texas Southwestern Medical Center, Department of Dermatology, Dallas, Texas, USA. Electronic address:

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http://dx.doi.org/10.1016/j.jid.2018.08.023DOI Listing
February 2019

Natural history of disease activity and damage in patients with cutaneous lupus erythematosus.

J Am Acad Dermatol 2018 Dec 30;79(6):1053-1060.e3. Epub 2018 Jun 30.

Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania; Medical Research, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania. Electronic address:

Background: Long-term studies characterizing disease course of cutaneous lupus erythematosus (CLE) patients on standard-of-care treatments are lacking.

Objective: We characterized and compared disease course of CLE patients using Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI).

Methods: In total, 83 CLE patients with CLASI scores collected from ≥3 study visits within 2 years had disease activity and damage trends calculated by average change scores (ACS). Trends were classified as improved (ACS ≤-3), worsened (ACS ≥3), or stable (-3 < ACS < 3). Linear regression models compared CLASI trends between groups.

Results: Most patients (72.73%) with initial CLASI activity (CLASI-A) scores >9 (N = 33) had improved disease activity versus 14.00% of those with initial CLASI-A scores ≤9 (N = 50). Linear regression analyses showed significant improvement in CLASI-A scores in patients of minority races (P < .05), with baseline CLASI-A scores >9 (P < .0001), baseline CLASI damage (CLASI-D) scores ≥10 (P = .0001), and CLE disease duration ≤1 year (P = .01). Of 28 patients with baseline CLASI-D scores ≥10, 35.71% had improvements in damage, while 5.26% of patients with initial CLASI-D scores of 5-9 (N = 19) and 0% with initial CLASI-D scores <5 (N = 36) (P = .0005) had improvements.

Limitations: Limitations include small sample size.

Conclusion: Baseline CLASI-A score >9, minority race, and short disease duration predict CLE disease activity improvement. A baseline CLASI-D score ≥10 is associated with disease damage improvement.
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http://dx.doi.org/10.1016/j.jaad.2018.06.040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234101PMC
December 2018

Ulcerative livedoid vasculopathy responding to clopidogrel.

JAAD Case Rep 2018 Mar 3;4(2):203-205. Epub 2018 Feb 3.

University of Texas Southwestern Medical Center, Dallas, Texas.

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http://dx.doi.org/10.1016/j.jdcr.2017.09.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5993557PMC
March 2018

Autoimmune Diseases in Patients With Cutaneous Lupus Erythematosus.

JAMA Dermatol 2018 06;154(6):712-716

Department of Dermatology, University of Texas Southwestern Medical Center, Dallas.

Importance: Increased rates of autoimmune conditions have been reported in association with systemic lupus erythematosus (SLE). Little is known about coexisting autoimmune conditions in patients with cutaneous lupus erythematosus (CLE) without SLE.

Objective: To determine the prevalence and risk factors of having coexisting autoimmune conditions in patients with CLE.

Design, Setting, And Participants: This cross-sectional study was performed from November 2008 to February 2017 at the University of Texas Southwestern Medical Center (UTSW) and Parkland Health and Hospital System, Dallas, Texas. Participants were identified through the UTSW Cutaneous Lupus Registry. All participants had a dermatologist-confirmed diagnosis of CLE using clinicopathological correlation. Exclusion criteria included age younger than 18 years, and meeting at least 4 American College of Rheumatology diagnostic criteria for SLE. Participants with CLE and without concomitant autoimmune diseases were compared by demographic and disease characteristics.

Main Outcomes And Measures: The primary and secondary outcomes were presence of coexisting autoimmune condition(s) and individual autoimmune diseases, respectively. Predictor variables significantly associated with coexisting autoimmune diseases were identified by univariate and multivariable logistic regression analyses.

Results: Among the 285 participants initially screened, 129 participants with CLE were included (102 [79.1%] female; median age, 49 years [interquartile range, 38.3-57.1 years]). Coexisting autoimmune conditions were found in 23 (17.8%). Autoimmune thyroid disease had the highest frequency at 4.7% (n = 6). Multivariable logistic regression analyses showed that patients with CLE who were white (odds ratio [OR], 2.88; 95% CI, 1.00-8.29; P = .0498), never smokers (OR, 3.28; 95% CI, 1.14-9.39; P = .03), had family history of autoimmune disease (OR, 3.54; 95% CI, 1.21-10.39; P = .02), and history of positive antinuclear antibody test result (OR, 4.87; 95% CI, 1.69-14.03; P = .003) had a significant association with having coexisting autoimmune conditions.

Conclusions And Relevance: This study suggests that patients with CLE without concurrent SLE can have increased rates of coexisting autoimmune conditions. Collecting a thorough review of systems can prompt clinicians to pursue further testing and evaluation by other specialists. Future studies investigating development of coexisting autoimmune conditions over time in the CLE population are necessary to confirm these findings.
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http://dx.doi.org/10.1001/jamadermatol.2018.0616DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145644PMC
June 2018

SnapshotDx Quiz: June 2018.

J Invest Dermatol 2018 06;138(6):e43

Department of Dermatology, University of Texas Southwestern Medical Center. Electronic address:

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http://dx.doi.org/10.1016/j.jid.2018.04.008DOI Listing
June 2018

Differential glucose requirement in skin homeostasis and injury identifies a therapeutic target for psoriasis.

Nat Med 2018 05 16;24(5):617-627. Epub 2018 Apr 16.

Department of Dermatology, UT Southwestern Medical Center, Dallas, TX, USA.

Proliferating cells, compared with quiescent cells, are more dependent on glucose for their growth. Although glucose transport in keratinocytes is mediated largely by the Glut1 facilitative transporter, we found that keratinocyte-specific ablation of Glut1 did not compromise mouse skin development and homeostasis. Ex vivo metabolic profiling revealed altered sphingolipid, hexose, amino acid, and nucleotide metabolism in Glut1-deficient keratinocytes, thus suggesting metabolic adaptation. However, cultured Glut1-deficient keratinocytes displayed metabolic and oxidative stress and impaired proliferation. Similarly, Glut1 deficiency impaired in vivo keratinocyte proliferation and migration within wounded or UV-damaged mouse skin. Notably, both genetic and pharmacological Glut1 inactivation decreased hyperplasia in mouse models of psoriasis-like disease. Topical application of a Glut1 inhibitor also decreased inflammation in these models. Glut1 inhibition decreased the expression of pathology-associated genes in human psoriatic skin organoids. Thus, Glut1 is selectively required for injury- and inflammation-associated keratinocyte proliferation, and its inhibition offers a novel treatment strategy for psoriasis.
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http://dx.doi.org/10.1038/s41591-018-0003-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6095711PMC
May 2018

SnapshotDx Quiz: February 2018.

J Invest Dermatol 2018 02;138(2):e19

Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address:

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http://dx.doi.org/10.1016/j.jid.2017.12.007DOI Listing
February 2018

Not Just Skin Deep: Systemic Disease Involvement in Patients With Cutaneous Lupus.

J Investig Dermatol Symp Proc 2017 10;18(2):S69-S74

Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. Electronic address:

Cutaneous lupus erythematosus, specifically discoid lupus erythematosus, disproportionately affects those with skin of color and may result in greater dyspigmentation and scarring in darker skin types. In this article, we review investigations relevant to cutaneous lupus patients with skin of color at University of Texas Southwestern Medical Center, associations and risk of progression to systemic lupus, and recommendations for monitoring for systemic disease spread. Between 5% and 25% of patients with cutaneous lupus can develop systemic lupus. If they progress to systemic disease, patients often develop mild systemic disease with primarily mucocutaneous and musculoskeletal manifestations. Patients with cutaneous lupus should be followed up closely to monitor for systemic disease involvement. The University of Texas Southwestern Cutaneous Lupus Erythematosus Registry, of which almost two thirds of participants are those with skin of color, is a part of an ongoing effort to better understand the pathophysiologic mechanisms of CLE and to identify prognostic indicators of risk of progression to systemic lupus.
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http://dx.doi.org/10.1016/j.jisp.2016.09.001DOI Listing
October 2017

Creation of an Internal Teledermatology Store-and-Forward System in an Existing Electronic Health Record: A Pilot Study in a Safety-Net Public Health and Hospital System.

JAMA Dermatol 2017 07;153(7):644-650

Division of Information Technology, Parkland Health and Hospital Systems, Dallas, Texas5Departments of Dermatology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas.

Importance: External store-and-forward (SAF) teledermatology systems operate separately from the primary health record and have many limitations, including care fragmentation, inadequate communication among clinicians, and privacy and security concerns, among others. Development of internal SAF workflows within existing electronic health records (EHRs) should be the standard for large health care organizations for delivering high-quality dermatologic care, improving access, and capturing other telemedicine benchmark data. Epic EHR software (Epic Systems Corporation) is currently one of the most widely used EHR system in the United States, and development of a successful SAF workflow within it is needed.

Objectives: To develop an SAF teledermatology workflow within the Epic system, the existing EHR system of Parkland Health and Hospital System (Dallas, Texas), assess its effectiveness in improving access to care, and validate its reliability; and to evaluate the system's ability to capture meaningful outcomes.

Design, Setting, And Participants: Electronic consults were independently evaluated by 2 board-certified dermatologists, who provided diagnoses and treatment plans to primary care physicians (PCPs). Results were compared with in-person referrals from May to December 2013 from the same clinic (a community outpatient clinic in a safety-net public hospital system). Patients were those 18 years or older with dermatologic complaints who would have otherwise been referred to dermatology clinic.

Main Outcomes And Measures: Median time to evaluation; percentage of patients evaluated by a dermatologist through either teledermatology or in-person compared with the previous year.

Results: Seventy-nine teledermatology consults were placed by 6 PCPs from an outpatient clinic between May and December 2014; 57 (74%) were female and their mean (SD) age was 47.0 (12.4) years. Teledermatology reduced median time to evaluation from 70.0 days (interquartile range [IQR], 33.25-83.0 days) to 0.5 days (IQR, 0.172-0.94 days) and median time to treatment from 73.5 to 3.0 days compared with in-person dermatology visits. Overall, a greater percentage of patients (120 of 144 [83.3%]) were evaluated by a dermatologist through either teledermatology or in-person during the 2014 study period compared with the previous year (111 of 173 [64.2%]). Primary care physicians followed management recommendations 93% of the time.

Conclusions And Relevance: Epic-based SAF teledermatology can improve access to dermatologic care in a public safety-net hospital setting. We hope that the system will serve as a model for other health care organizations wanting to create SAF teledermatology workflows within the Epic EHR system.
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http://dx.doi.org/10.1001/jamadermatol.2017.0204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5817461PMC
July 2017

Changes in T cell and B cell composition in discoid lupus erythematosus skin at different stages.

J Dermatol Sci 2017 Mar 5;85(3):247-249. Epub 2016 Dec 5.

University of Texas Southwestern Medical Center Department of Dermatology, Dallas, TX, USA. Electronic address:

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http://dx.doi.org/10.1016/j.jdermsci.2016.12.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5316357PMC
March 2017

Reducing outpatient dermatology clinic wait times in a safety net health system in Dallas, Texas.

J Am Acad Dermatol 2016 Sep;75(3):631-632

Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2016.04.043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5444080PMC
September 2016