Publications by authors named "Caroline Halverstam"

16 Publications

  • Page 1 of 1

Bullous drug eruption after second dose of mRNA-1273 (Moderna) COVID-19 vaccine: Case report.

J Infect Public Health 2021 Jul 8. Epub 2021 Jul 8.

Icahn School of Medicine at Mount Sinai/NYC Health + Hospitals Queens, NY, USA. Electronic address:

Background: In December 2020, Moderna released the mRNA-1273 vaccine. The most common side effects are headache, muscle pain, redness, swelling, and tenderness at the injection site. In addition, there have been dermatological adverse events, such as hypersensitivity reactions. Although rare, various bullous eruptions have been described following vaccination. Bullous pemphigoid has been reported to occur most often after receipt of influenza and the diphtheria-tetanus-pertussis vaccine. To the best of our knowledge, there have been no reports of bullous drug eruptions resulting from mRNA vaccines.

Case Summary: A 66-years-old obese Guyanese male presented with a bullous rash following receipt of a commercial COVID-19 mRNA vaccine. He received the first dose uneventfully. However, within 24 h of receiving the second dose, he developed fever, myalgias, and malaise accompanied by a painful blistering rash of his torso, arms, and legs. His fever and myalgias improved after 24 h, but his painful rash did not, and five days after the initial symptoms, he presented to the hospital. There were many violaceous, poorly demarcated patches on his trunk, arms, and thighs on examination, many of which had large flaccid bullae within, and a few areas on his buttocks, posterior shoulder, and scrotum were eroded. The exam was also significant for lower extremity muscle tenderness, stiffness with preserved strength. A skin biopsy showed epidermal necrosis and sparse perivascular dermatitis concerning Stevens-Johnson syndrome or erythema multiforme. However, in the absence of mucous membrane involvement or targetoid lesions, the diagnosis of an extensive bullous fixed drug eruption was made.

Conclusion: This case illustrates that the bullae eruption occurred as a result of receiving the Moderna vaccination.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jiph.2021.06.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8264280PMC
July 2021

Telogen effluvium, Beau lines, and acral peeling associated with COVID-19 infection.

JAAD Case Rep 2021 Jul 6;13:138-140. Epub 2021 Jun 6.

Division of Dermatology, Albert Einstein College of Medicine, Bronx, New York.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jdcr.2021.05.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8180346PMC
July 2021

Telogen effluvium: a sequela of COVID-19.

Int J Dermatol 2021 Jan 23;60(1):122-124. Epub 2020 Nov 23.

Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ijd.15313DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753411PMC
January 2021

Current Status of Dermatologic Education in US Medical Schools.

JAMA Dermatol 2020 04;156(4):468-470

Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamadermatol.2020.0006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7142379PMC
April 2020

Time-series analysis of National Residency Matching Program data for the dermatology match in the United States.

J Am Acad Dermatol 2020 Jul 9;83(1):210-213. Epub 2019 Aug 9.

Department of Dermatology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaad.2019.08.004DOI Listing
July 2020

Prolonged Serum Alanine Aminotransferase Elevation Associated with Isotretinoin Administration.

Case Reports Hepatol 2019 17;2019:9270827. Epub 2019 Jul 17.

Marion Bessin Liver Research Center, Division of Hepatology, Albert Einstein College of Medicine and Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY 10461, USA.

Isotretinoin is a highly effective oral retinoid derivative for severe forms of acne. Despite its high margin of safety, isotretinoin carries a risk of teratogenicity and mild to massive elevations of serum cholesterol and triglyceride levels, as well as infrequent transaminitis. Liver dysfunction induced by isotretinoin is rare but it poses a management dilemma. We describe a 16-year-old male in whom alanine aminotransferase (ALT) rose from a baseline of 13 to 288 U/L after 20 weeks of treatment with 1.0-1.4 mg/kg of oral isotretinoin daily. Though the patient remained asymptomatic, ALT levels did not return to normal limits for approximately 8 months after discontinuation of therapy, an observation that has not been documented in the literature. When oral isotretinoin was readministered for intractable facial acne 3 years later, liver enzymes remained normal throughout the course of therapy. Although the pathogenesis and prognosis of retinoid-induced hepatotoxicity are unknown, this case illustrates that isotretinoin may be safely readministered after normalization of liver function tests.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2019/9270827DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6662412PMC
July 2019

A National Survey of Medical Coding and Billing Training in United States Dermatology Residency Programs.

J Drugs Dermatol 2018 Jun;17(6):678-682

Background: Due to frequent changes in medical coding systems, billing for outpatient visits through Evaluation and Management (E & M) services has become increasingly complicated. As a result, physicians often bill improperly, costing the United States health care system billions of dollars annually. Despite the importance of proper documentation, medical coding and billing is largely ignored during residency training.

Objective: Assess the exposure to and quality of medical coding and billing training in dermatology residency programs.

Methods: A questionnaire was distributed to dermatology programs in the United States consisting of questions pertaining to didactic education for, experience with, and resident knowledge of medical coding and billing.

Results: 138/443 dermatology residents participated (31.2% response rate). 79% of residents reported receiving some type of formal training. Nearly 89% reported personally billing patient visits to some degree, with 41.3% billing for 100% of outpatient visits. Over 75% of residents were able to answer basic billing questions and 70% correctly billed a patient visit when given a complex clinical scenario. Despite these results, only 37% of residents reported feeling confident in their billing abilities. Lastly, 94.9% of respondents believed medical coding and billing should be integrated into dermatology training curriculums.

Conclusions: The majority of dermatology residents have opportunities to learn medical coding and billing through didactics and clinical experiences. Many residents were able to answer correctly questions that tested their basic knowledge of E&M coding. These results are encouraging and reflect the recognition of the importance of medical coding and billing training during residency. J Drugs Dermatol. 2018;17(6):678-682.
View Article and Find Full Text PDF

Download full-text PDF

Source
June 2018

Discovering Black Soap: A Survey on the Attitudes and Practices of Black Soap Users.

J Clin Aesthet Dermatol 2017 Jul 1;10(7):18-22. Epub 2017 Jul 1.

Dr. Lin is with Wlliam Carey University College of Osteopathic Medicine in Hattiesburg, Mississippi.

The purpose of this study was to discover the general attitudes and practices of black soap users with regard to amelioration of various dermatologic conditions. This was a prospective questionnaire-based study with a sample size of 100 black soap users. Outpatient dermatology clinics of Montefiore Medical Center and other Albert Einstein affiliated dermatology clinics in Bronx, New York. One hundred subjects who have used black soap were recruited. The participants evaluated and reported their attitudes and applications of black soap. Data on sociodemographic prevalence and user satisfactions of black soap were collected and analyzed. The age distribution of participants was uniform among the specified age categories: 1) 18 to 29 years; 2) 30 to 39 years, 3) 40 to 49 yesars, and 4) 50 years and older. The sex distribution favored women, comprising 74 percent of those surveyed. A significant number of participants were born in either Africa (23%) or the Caribbean (19%). Black soap usage was applied to mitigate many dermatologic conditions, including acne (23%), dark spots (20%), razor bumps (13%), eczema (7%), and fine lines (4%). The most popular usage was for overall skin care (70%). The vast majority of users found black soap helpful for their skin condition (51% very satisfied, and 40% somewhat satisfied). The survey results indicate widespread usage and satisfaction with black soap for reduction in symptoms of various dermatologic conditions. Further investigations are warranted to discover active ingredients present in black soap that may unveil future therapeutic options for various dermatologic conditions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5605219PMC
July 2017

Acquired Epidermodysplasia Verruciformis and Its Relationship to Immunosuppressive Therapy: Report of a Case and Review of the Literature.

J Drugs Dermatol 2017 Jul;16(7):701-704

Introduction: Epidermodysplasia verruciformis (EV) is a rare inherited dermatosis characterized by increased susceptibility to human papilloma virus infection. Acquired EV occurs in patients with compromised cell-mediated immunity, such as patients with HIV and transplant recipients. Optimal management of acquired EV has not yet been established, as cases are rare and are due to a variety of underlying conditions. Additionally, no distinctions have been made between different immunosuppressive medications and their respective link to EV.

Methods And Results: We report a patient with systemic lupus erythematosus who developed EV while on azathioprine and prednisone. The patient's lesions resolved completely after she was switched from azathioprine to mycophenolate mofetil. Her lesions recurred when her immunosuppressive regimen was again changed from mycophenolate mofetil to methotrexate. A review of the literature revealed azathioprine to be related to other cases of acquired EV.

Discussion: This case indicates a possible link between specific immunosuppressive drugs and the development of EV, allowing for new EV treatment considerations. In this case and previous cases, azathioprine is indicated as being particularly linked with the development of EV, while mycophenolate mofetil may be an immunosuppressive option that is less likely to induce EV in patients predisposed to this condition. J Drugs Dermatol. 2017;16(7):701-704.
View Article and Find Full Text PDF

Download full-text PDF

Source
July 2017

Diagnosis and management of cold urticaria.

Cutis 2016 Jan;97(1):59-62

Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, USA.

Cold urticaria is a physical urticaria characterized by a localized or systemic eruption of papules upon exposure of the skin to cold air, liquids, and/or objects. In some cases, angioedema and anaphylaxis also may occur. The symptoms of cold urticaria can have a negative impact on patients' quality of life. Second-generation H1 antihistamines are the first line of treatment in cold urticaria; however, patients who are unresponsive to initial treatment with H1 antihistamines may require further management options. Avoidance of cold exposure is the most effective prophylactic measure. In mild to moderate cases, the primary goal of therapy is to improve the patient's quality of life. In more severe cases, treatment measures to protect the patient's airway, breathing, and circulation may be necessary. We report the case of a 23-year-old man with cold urticaria who was refractory to initial therapy with H1 antihistamines. A review of the literature also is provided.
View Article and Find Full Text PDF

Download full-text PDF

Source
January 2016

Stiff skin syndrome in a newborn infant.

Int J Dermatol 2013 Aug 24;52(8):993-5. Epub 2012 Sep 24.

Department of Dermatology, Mount Sinai School of Medicine, New York, NY 10029, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1365-4632.2012.05478.xDOI Listing
August 2013

Nonstandard and off-label therapies for psoriasis.

Clin Dermatol 2008 Sep-Oct;26(5):546-53

Department of Dermatology, Mount Sinai School of Medicine, Box 1048, New York, NY 10029-6574, USA.

Although most psoriasis patients respond to standard therapies, many circumstances warrant the use of nonstandard or off-label treatments. For instance, patients with treatment-resistant psoriasis or those who have had multiple adverse effects to other therapies may be good candidates for off-label treatments. Similarly, patients with unusual and hard-to-treat forms of psoriasis such as pustular psoriasis and palmoplantar psoriasis or specific comorbidities may benefit from certain nonstandard therapies. Drugs that may be used as alternatives to standard therapies include mycophenolate mofetil, tacrolimus or pimecrolimus, isotretinoin, colchicine, sulfasalazine, paclitaxel, dapsone, azathioprine, and hydroxyurea. Other unconventional therapies include climatotherapy at the Dead Sea and grenz ray therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clindermatol.2007.10.023DOI Listing
January 2009

Cushing syndrome from percutaneous absorption of 1% hydrocortisone ointment in Netherton syndrome.

Pediatr Dermatol 2007 Jan-Feb;24(1):42-5

Departments of Internal Medicine (Dermatology) and Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.

Netherton syndrome is a congenital skin disease associated with decreased skin barrier function and increased percutaneous absorption. We report an 11-year-old boy with Netherton syndrome who developed Cushing syndrome after application of 1% hydrocortisone ointment to his entire body for more than 1 year. This presentation illustrates that even low-potency steroid ointments should be used with caution in Netherton syndrome and warns about the use of long-term topical medications with potential systemic side effects when used in large quantities in any chronic skin disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1525-1470.2007.00331.xDOI Listing
May 2007

Lack of significant skeletal changes after long-term, low-dose retinoid therapy: case report and review of the literature.

J Cutan Med Surg 2006 Nov-Dec;10(6):291-9

Department of Dermatology, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.

Background: Long-term systemic retinoid therapy has been associated with skeletal side effects. There have been reports of diffuse idiopathic skeletal hyperostosis (DISH) syndrome, calcification of ligaments, and osteoporosis, as well as premature fusion of epiphyses and modeling abnormalities of long bones, occurring in patients on chronic high-dose isotretinoin, etretinate, and acitretin therapy. Low-dose acitretin has been used for many years as monotherapy or in combination with other systemic therapies for psoriasis. Evidence to date suggests that the frequency of symptomatic bony effects is quite low in these patients.

Objective: To present the radiologic findings of a patient on long-term, low-dose acitretin and etretinate and to review the literature on the radiologic evidence of skeletal side effects during retinoid therapy.

Methods: Case report and literature search.

Results: A patient on low-dose acitretin had no significant radiologic abnormalities associated with retinoid use after 9 years of treatment. A review of the literature revealed conflicting reports on the incidence of radiologic abnormalities in patients on retinoid treatment.

Conclusion: The evidence to date does not substantiate a clear link between radiologic skeletal abnormalities and long-term, low-dose acitretin or etretinate therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2310/7750.2006.00065DOI Listing
March 2007
-->