Publications by authors named "Juliana Berk-Krauss"

13 Publications

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The underrepresentation of "COVID toes" in skin of color: An example of racial bias or evidence of a tenuous disease association?

J Am Acad Dermatol 2021 02 17;84(2):e91-e92. Epub 2020 Nov 17.

Department of Dermatology, Coney Island Medical Center, Brooklyn, New York; Department of Dermatology, Woodhull Medical Center, Brooklyn, New York; Department of Dermatology, Cumberland Medical Center, Brooklyn, New York. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.11.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7831723PMC
February 2021

New Systematic Therapies and Trends in Cutaneous Melanoma Deaths Among US Whites, 1986-2016.

Am J Public Health 2020 05 19;110(5):731-733. Epub 2020 Mar 19.

Juliana Berk-Krauss is with The State University of New York Downstate Medical Center, Brooklyn. Juliana Berk-Krauss, Jennifer A. Stein, and David Polsky are with The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY. Jeffrey Weber is with the Department of Medicine, New York University School of Medicine. Jennifer A. Stein, Jeffrey Weber, and David Polsky are with The Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, NYU Langone Health, New York. Alan C. Geller is with the Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA.

To determine the effect of new therapies and trends toward reduced mortality rates of melanoma. We reviewed melanoma incidence and mortality among Whites (the group most affected by melanoma) in 9 US Surveillance, Epidemiology, and End Results registry areas that recorded data between 1986 and 2016. From 1986 to 2013, overall mortality rates increased by 7.5%. Beginning in 2011, the US Food and Drug Administration approved 10 new treatments for metastatic melanoma. From 2013 to 2016, overall mortality decreased by 17.9% (annual percent change [APC] = -6.2%; 95% confidence interval [CI] = -8.7%, -3.7%) with sharp declines among men aged 50 years or older (APC = -8.3%; 95% CI = -12.2%, -4.1%) starting in 2014. This recent, multiyear decline is the largest and most sustained improvement in melanoma mortality ever observed and is unprecedented in cancer medicine. The introduction of new therapies for metastatic melanoma was associated with a significant reduction in population-level mortality. Future research should focus on developing even more effective treatments, identifying biomarkers to select patients most likely to benefit, and renewing emphasis on public health approaches to reduce the number of patients with advanced disease.
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http://dx.doi.org/10.2105/AJPH.2020.305567DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144422PMC
May 2020

Botulinum toxin for treatment of Raynaud phenomenon in CREST syndrome.

Dermatol Online J 2018 Dec 15;24(12). Epub 2018 Dec 15.

The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York Yale University School of Medicine, New Haven, Connecticut.

Calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia (CREST) syndrome is a form of a rare, clinical subtype of systemic sclerosis, known as limited systemic sclerosis. Limited systemic sclerosis, including CREST syndrome, manifests as fibrotic skin changes restricted to the hands and face, with vascular, musculoskeletal, and visceral involvement. We present a case of a 75-year-old woman with a longstanding history of CREST syndrome complicated by a digital ulceration and persistent pain associated with recalcitrant Raynaud phenomenon. After failing a number of first-line pharmacologic therapies such as diltiazem, sildenafil, and topical nitropaste, the patient was started on a trial of botulinum toxin for the left second digit, with 10 unit injections into both webspaces for a total of 20 units. Following injection, the patient reported no further baseline pain in the affected finger and an over fifty-percent improvement in discomfort with manipulation of the digit at a follow-up time of one week. The ulceration started healing within the following three weeks. This result was maintained at a follow-up time of six weeks.
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December 2018

In Reply to Lenchus.

Acad Med 2018 04;93(4):520

Fourth-year medical student, Yale School of Medicine, New Haven, Connecticut; ORCID: http://orcid.org/0000-0003-4594-9570. Internal medicine resident, Brigham and Women's Hospital, Boston, Massachusetts. Fourth-year medical student, Yale School of Medicine, New Haven, Connecticut. Fourth-year medical student, Yale School of Medicine, New Haven, Connecticut; ORCID: https://orcid.org/0000-0002-2972-3697. Fourth-year medical student, Yale School of Medicine, New Haven, Connecticut; ORCID: http://orcid.org/0000-0001-9642-9589.

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http://dx.doi.org/10.1097/ACM.0000000000002132DOI Listing
April 2018

Comparison of Dermatologist Density Between Urban and Rural Counties in the United States.

JAMA Dermatol 2018 11;154(11):1265-1271

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York.

Importance: As the US population continues to increase and age, there is an unmet need for dermatologic care; therefore, it is important to identify and understand the characteristics and patterns of the dermatologist workforce.

Objective: To analyze the longitudinal dermatologist density and urban-rural disparities using a standardized classification scheme.

Design, Setting, And Participants: This study analyzed county-level data for 1995 to 2013 from the Area Health Resources File to evaluate the longitudinal trends and demographic and environmental factors associated with the geographic distribution of dermatologists.

Main Outcomes And Measures: Active US dermatologist and physician density.

Results: In this study of nationwide data on dermatologists, dermatologist density increased by 21% from 3.02 per 100 000 people to 3.65 per 100 000 people from 1995 to 2013; the gap between the density of dermatologists in urban and other areas increased from 2.63 to 3.06 in nonmetropolitan areas and from 3.41 to 4.03 in rural areas. The ratio of dermatologists older than 55 years to younger than 55 years increased 75% in nonmetropolitan and rural areas (from 0.32 to 0.56) and 170% in metropolitan areas (from 0.34 to 0.93). Dermatologists tended to be located in well-resourced, urban communities.

Conclusions And Relevance: Our findings suggest that substantial disparities in the geographic distribution of dermatologists exist and have been increasing with time. Correcting the workforce disparity is important for patient care.
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http://dx.doi.org/10.1001/jamadermatol.2018.3022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6248119PMC
November 2018

Melanoma risk after in vitro fertilization: A review of the literature.

J Am Acad Dermatol 2018 Dec 25;79(6):1133-1140.e3. Epub 2018 Jul 25.

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York. Electronic address:

Background: The role of female sex hormones in the pathogenesis of malignant melanoma (MM) remains controversial. Although melanocytes appear to be hormonally responsive, the effect of estrogen on MM cells is less clear. Available clinical data does not consistently demonstrate that increased endogenous hormones from pregnancy or increased exogenous hormones from oral contraceptive pills and hormone replacement affect MM prevalence and outcome.

Objective: We sought to examine potential associations between in vitro fertilization (IVF) and melanoma.

Methods: A literature review was conducted. Primary outcomes were reported as associations between IVF and melanoma risk compared with the general population. Secondary outcomes included associations stratified by type of IVF regimen and subgroup, such as parous versus nulliparous patients.

Results: Eleven studies met our inclusion criteria. Five studies found no increased risk for MM among IVF users compared with the general population. Two studies found an increase in MM in clomiphene users, and 4 studies found an increase in MM among patients who were gravid or parous either before or after IVF.

Conclusion: The reviewed studies do not reveal consistent patterns of association between IVF and MM among all infertile women. However, the data indicates a potential increased risk for MM in ever-parous patients treated with IVF. High-quality studies including a large number of MM cases that control for well-established MM risk factors are needed to adequately assess the relationship between IVF and MM, particularly among ever-parous women.
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http://dx.doi.org/10.1016/j.jaad.2018.07.022DOI Listing
December 2018

Bullous disorders associated with anti-PD-1 and anti-PD-L1 therapy: A retrospective analysis evaluating the clinical and histopathologic features, frequency, and impact on cancer therapy.

J Am Acad Dermatol 2018 Dec 17;79(6):1081-1088. Epub 2018 Jul 17.

Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut. Electronic address:

Background: Bullous disorders associated with anti-programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) therapy are increasingly reported and may pose distinct therapeutic challenges. Their frequency and impact on cancer therapy are not well established.

Objective: To evaluate the clinical and histopathologic findings, frequency, and impact on cancer therapy of bullous eruptions due to anti-PD-1/PD-L1 therapy.

Methods: We retrospectively reviewed the medical records of patients evaluated by the oncodermatology clinic and consultative service of Yale New Haven Hospital from 2016 to 2018.

Results: We identified 9 of 853 patients who developed bullous eruptions (∼1%) that were treated with an-PD-1/PD-L1 therapy at our institution during the study period: 7 presented with bullous pemphigoid, 1 presented with bullous lichenoid dermatitis, and 1 presented with linear IgA bullous dermatosis in the context of vancomycin therapy. In all, 8 patients required systemic steroids, 5 required maintenance therapy, and 8 required interruption of immunotherapy. All 9 patients had an initial positive tumor response or stable disease, but 4 went on to develop disease progression.

Limitations: This was a retrospective study from a single tertiary care center.

Conclusions: Bullous disorders developed in approximately 1% of patients treated with anti-PD-1/PD-L1 therapy at our institution and frequently resulted in interruption of immune therapy and management with systemic corticosteroids and occasionally steroid-sparing agents.
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http://dx.doi.org/10.1016/j.jaad.2018.07.008DOI Listing
December 2018

Pregnancy and Melanoma: Recommendations for Clinical Scenarios.

Int J Womens Dermatol 2018 Jun 1;4(2):113-115. Epub 2018 Mar 1.

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY.

Managing pregnant patients with a history of melanoma or with a melanoma diagnosis can be daunting and confusing for dermatologists. We present three clinical scenarios that raise questions about the safety of pregnancy in patients with a history of melanoma, skin biopsies during pregnancy, and excisions and sentinel lymph node biopsies during pregnancy. Our recommendations incorporate the most up-to-date clinical data to help guide clinicians when faced with pigmented lesions and melanoma in a pregnant patient.
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http://dx.doi.org/10.1016/j.ijwd.2017.11.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986258PMC
June 2018

In Reply to Fisher.

Acad Med 2018 02;93(2):153

Fourth-year medical student, Yale School of Medicine, New Haven, Connecticut; ORCID: http://orcid.org/0000-0003-4594-9570; e-mail: Internal medicine resident, Brigham and Women's Hospital, Boston, Massachusetts. Fourth-year medical student, Yale School of Medicine, New Haven, Connecticut. Sixth-year MD/PhD student, Yale School of Medicine, New Haven, Connecticut; ORCID: http://orcid.org/0000-0002-4306-5061. Fourth-year medical student, Yale School of Medicine, New Haven, Connecticut. Fourth-year medical student, Yale School of Medicine, New Haven, Connecticut. Fourth-year medical student, Yale School of Medicine, New Haven, Connecticut; ORCID: http://orcid.org/0000-0001-9642-9589.

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http://dx.doi.org/10.1097/ACM.0000000000002056DOI Listing
February 2018

An immunosuppressed man with an isolated necrotic plaque on the chest.

JAAD Case Rep 2018 Mar 12;4(2):114-116. Epub 2018 Jan 12.

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jdcr.2017.02.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5767909PMC
March 2018

What's in a Name-Dermoscopy vs Dermatoscopy.

JAMA Dermatol 2017 12;153(12):1235

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York.

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http://dx.doi.org/10.1001/jamadermatol.2017.3905DOI Listing
December 2017

Mole Mapping for Management of Pigmented Skin Lesions.

Dermatol Clin 2017 Oct 7;35(4):439-445. Epub 2017 Aug 7.

The Ronald O. Perelman Department of Dermatology, NYU School of Medicine, 240 East 38th Street, 11th Floor, New York, NY 10016, USA.

Identifying new or changing melanocytic lesions, particularly in patients with numerous or atypical nevi, can be challenging. Total-body photography and sequential digital dermoscopy imaging, together known as digital follow-up, are 2 prominent forms of noninvasive imaging technology used in mole mapping that have been found to improve diagnostic accuracy, detect earlier-stage melanomas, and reduce costs. Digital follow-up, in combination with direct-to-consumer applications and teledermatology, is already revolutionizing the ways in which physicians and patients participate in melanoma surveillance and will likely continue to enhance early detection efforts.
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http://dx.doi.org/10.1016/j.det.2017.06.004DOI Listing
October 2017

No Time for Silence: An Urgent Need for Political Activism Among the Medical Community.

Acad Med 2017 09;92(9):1231-1233

E. Levinsohn is a fourth-year medical student, Yale School of Medicine, New Haven, Connecticut. K. Weisenthal is a fourth-year medical student, Yale School of Medicine, New Haven, Connecticut. P. Wang is a fifth-year medical student, Yale School of Medicine, New Haven, Connecticut. A. Shahu is a fourth-year medical student, Yale School of Medicine, New Haven, Connecticut. M. Meizlish is a fifth-year MD-PhD student, Yale School of Medicine, New Haven, Connecticut. T. Robledo-Gil is a fourth-year medical student, Yale School of Medicine, New Haven, Connecticut. E. Duffy is a fourth-year medical student, Yale School of Medicine, New Haven, Connecticut. S. Fox is a second-year medical student, Yale School of Medicine, New Haven, Connecticut. J. Berk-Krauss is a fourth-year medical student, Yale School of Medicine, New Haven, Connecticut.

Despite being a major stakeholder in the U.S. health care system, the medical community has remained relatively mute in the debate over the future of the Patient Protection and Affordable Care Act (ACA). If the ACA were repealed, tens of millions of Americans would be in danger of losing their insurance, resulting in a significant increase in mortality. Because misinformation about the ACA is rampant, it is imperative that health care providers explain to the public what exactly the ACA is and how repeal will affect patients. Traditionally, many in the medical community have abstained from political advocacy for multiple reasons, including compromising the doctor-patient relationship, financial incentives, lack of experience with activism due to an absence of training in that area, and fear of political retaliation. Encouragingly, there are indications that the medical community is beginning to become more vocal. Medical students are one example, having formed a grassroots response to repeal. However, students need more guidance and support from experienced mentors to most effectively serve as patient advocates. This is no time for silence: On this life-or-death issue, the medical community cannot afford to remain mute.
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http://dx.doi.org/10.1097/ACM.0000000000001724DOI Listing
September 2017