Publications by authors named "Misha Rosenbach"

180 Publications

Dermatologic Support for Oncology: Quantifying the consultative services received by hospitalized oncology patients.

J Am Acad Dermatol 2021 May 2. Epub 2021 May 2.

Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA. Electronic address:

Dermatology was the fifth most utilized consultative service by Oncology when compared to the 101 other inpatient consultative services. Patients receiving dermatology consults had longer lengths of stay. Previous work has demonstrated the impact of dermatology consultations, showing that dermatology consults changed the final diagnosis in 71% of consult requests, and another tudy demonstrated that 23% of dermatology consultations came from the primary hematology or bone marrow transplant services. The volume of consults requested for dermatology suggests that inpatient dermatologic expertise is valued by oncology teams.
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http://dx.doi.org/10.1016/j.jaad.2021.04.088DOI Listing
May 2021

Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases.

J Am Acad Dermatol 2021 Apr 7. Epub 2021 Apr 7.

Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts. Electronic address:

Background: Cutaneous reactions after messenger RNA (mRNA)-based COVID-19 vaccines have been reported but are not well characterized.

Objective: To evaluate the morphology and timing of cutaneous reactions after mRNA COVID-19 vaccines.

Methods: A provider-facing registry-based study collected cases of cutaneous manifestations after COVID-19 vaccination.

Results: From December 2020 to February 2021, we recorded 414 cutaneous reactions to mRNA COVID-19 vaccines from Moderna (83%) and Pfizer (17%). Delayed large local reactions were most common, followed by local injection site reactions, urticarial eruptions, and morbilliform eruptions. Forty-three percent of patients with first-dose reactions experienced second-dose recurrence. Additional less common reactions included pernio/chilblains, cosmetic filler reactions, zoster, herpes simplex flares, and pityriasis rosea-like reactions.

Limitations: Registry analysis does not measure incidence. Morphologic misclassification is possible.

Conclusions: We report a spectrum of cutaneous reactions after mRNA COVID-19 vaccines. We observed some dermatologic reactions to Moderna and Pfizer vaccines that mimicked SARS-CoV-2 infection itself, such as pernio/chilblains. Most patients with first-dose reactions did not have a second-dose reaction and serious adverse events did not develop in any of the patients in the registry after the first or second dose. Our data support that cutaneous reactions to COVID-19 vaccination are generally minor and self-limited, and should not discourage vaccination.
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http://dx.doi.org/10.1016/j.jaad.2021.03.092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024548PMC
April 2021

Treatment of cutaneous sarcoidosis with tofacitinib 2% ointment and extra virgin olive oil.

JAAD Case Rep 2021 Mar 25;9:1-3. Epub 2020 Dec 25.

Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1016/j.jdcr.2020.12.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868739PMC
March 2021

Climate change & dermatology - a special issue for a special topic.

Int J Womens Dermatol 2021 Jan 3;7(1):1-2. Epub 2020 Dec 3.

Clinical Professor of Dermatology and Pediatrics, University of California San Francisco, San Francisco, CA, United States.

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http://dx.doi.org/10.1016/j.ijwd.2020.12.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7838323PMC
January 2021

Long COVID in the skin: a registry analysis of COVID-19 dermatological duration.

Lancet Infect Dis 2021 03 15;21(3):313-314. Epub 2021 Jan 15.

Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA. Electronic address:

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http://dx.doi.org/10.1016/S1473-3099(20)30986-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836995PMC
March 2021

Grover Disease Associated With Chemotherapy: Review of Potential Pathophysiology, Current Treatments, and Future Directions.

J Drugs Dermatol 2020 Nov;19(11):1056-1064

Introduction: Transient acantholytic dermatosis has been frequently reported in patients with malignancies. While paraneoplastic cases have rarely been reported, most eruptions occur in the setting of chemotherapeutic agents. Management is based on limited data and primarily with topical steroids and topical emollients. A subset of patients exhibits recalcitrant disease and require alternate therapeutic approachesMethods: This systematic review consisted of identifying records in PubMed using the medical subject headings (MeSH) terms “chemotherapy” AND “Grover”, “chemotherapy” AND “Grover’s”, “cancer” AND “Grover”, “cancer” AND “Grover’s”, “malignancy” AND “Grover”, “malignancy” AND “Grover’s”, as well as a free text search for “Grover” OR “Grover’s” OR “Grover disease” OR “Grovers disease” OR “Grover’s disease” OR “transient acantholytic dermatosis” OR “transient acantholytic” to identify case reports, case series, systematic reviews, review articles, meta-analyses, clinical trials, brief commentaries, and original articles. The titles and abstracts of all results were reviewed. Full texts of relevant results were then read in their entirety and applicability was determined.

Results: Overall, Grover disease has rarely been reported in the setting of malignancy. When it occurs, it is generally in the setting of chemotherapy use. Chemotherapy-associated Grover disease is reported most frequently in association with cytotoxic chemotherapies, followed by small molecule inhibitors. The first line treatment for this complication is the use of topical agents. When these provide inadequate relief, alternate therapies have been rarely reported, with novel treatments proposed based on the type of chemotherapy agent and its mechanism of action.

Conclusions: Chemotherapy-associated Grover disease is an uncommon complication of cancer treatment. While most cases of chemotherapy-associated Grover disease can be treated with topical steroids and topical emollients, certain cases require a more specialized approach. This could include adjuvant adjuvant therapies, or novel treatments that are directly related to the mechanism of action of the chemotherapy involved. J Drugs Dermatol. 2020;19(11):1056-1064. doi:10.36849/JDD.2020.5648.
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http://dx.doi.org/10.36849/JDD.2020.5648DOI Listing
November 2020

Generalized granuloma annulare: A widespread response to limited application of compounded 2% topical tofacitinib.

JAAD Case Rep 2020 Oct 8;6(10):1113-1115. Epub 2020 Aug 8.

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

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http://dx.doi.org/10.1016/j.jdcr.2020.07.054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7519269PMC
October 2020

Oral Granulomatous Disease.

Dermatol Clin 2020 Oct;38(4):429-439

Department of Dermatology, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA.

Granulomatous diseases are chronic inflammatory disorders whose pathogenesis is triggered by an array of infectious and noninfectious agents, and may be localized or a manifestation of systemic, disseminated disease. As in the skin, oral manifestations of granulomatous inflammation are often nonspecific in their clinical appearance. Thus, in the absence of overt foreign material or a recognizable infectious agent, identifying the underlying cause of the inflammation can be challenging. This article highlights various conditions known to induce granulomatous inflammation within the oral soft tissues.
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http://dx.doi.org/10.1016/j.det.2020.05.004DOI Listing
October 2020

Climate Change and Inpatient Dermatology.

Curr Dermatol Rep 2020 Aug 22:1-9. Epub 2020 Aug 22.

Department of Dermatology, University of Pennsylvania, 7th Floor Perelman Center for Advanced Medicine, South Pavilion, 3400 Civic Center Blvd, Philadelphia, PA 19104 USA.

Purpose Of Review: Climate change represents a major existential threat facing the global community, and it has already begun to affect human health in a multitude of ways. This review highlights and discusses the implications that climate change has already had and is expected to have for inpatient dermatologists.

Recent Findings: There are a variety of conditions affected by climate changes. The distribution and frequencies of infectious diseases and their vectors are changing in line with variations in climate conditions. Increased temperatures have already been associated with exacerbation of existing skin conditions, such as atopic dermatitis, and recent evidence suggests that higher temperatures will also magnify the effects of harmful ultraviolet radiation. Extreme weather events that result from climate change are followed by an array of dermatologic conditions that may be unusual for the given location. Inpatient dermatologists should be prepared to manage these potentially unfamiliar dermatologic consequences of climate change.

Summary: Climate change will have widespread effects on the medical field, and inpatient dermatologists will be faced with their own unique set of challenges and practice variations. Practitioners should be familiar with the ongoing and predicted effects of climate change in their locations so that they can readily identify and treat associated conditions, and they should adjust their practice to reduce their carbon footprint and serve as a model for patients to do the same.
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http://dx.doi.org/10.1007/s13671-020-00310-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442546PMC
August 2020

Activation of TRPA1 nociceptor promotes systemic adult mammalian skin regeneration.

Sci Immunol 2020 08;5(50)

Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.

Adult mammalian wounds, with rare exception, heal with fibrotic scars that severely disrupt tissue architecture and function. Regenerative medicine seeks methods to avoid scar formation and restore the original tissue structures. We show in three adult mouse models that pharmacologic activation of the nociceptor TRPA1 on cutaneous sensory neurons reduces scar formation and can also promote tissue regeneration. Local activation of TRPA1 induces tissue regeneration on distant untreated areas of injury, demonstrating a systemic effect. Activated TRPA1 stimulates local production of interleukin-23 (IL-23) by dermal dendritic cells, leading to activation of circulating dermal IL-17-producing γδ T cells. Genetic ablation of TRPA1, IL-23, dermal dendritic cells, or γδ T cells prevents TRPA1-mediated tissue regeneration. These results reveal a cutaneous neuroimmune-regeneration cascade triggered by topical TRPA1 activators that promotes adult mammalian tissue regeneration, presenting a new avenue for research and development of therapies for wounds and scars.
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http://dx.doi.org/10.1126/sciimmunol.aba5683DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7703669PMC
August 2020

Climate change and dermatology: An introduction to a special topic, for this special issue.

Int J Womens Dermatol 2021 Jan 19;7(1):3-7. Epub 2020 Aug 19.

Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, United States.

Anthropogenic global climate change is a well-documented phenomenon that has led to average global temperatures climbing to approximately 1 °C above preindustrial (1850-1900) levels, with even higher regional deviations in some areas and significantly increased average warming in densely populated urban centers. In 2018, the United Nations Intergovernmental Panel on Climate Change set a threshold of 1.5 °C of average warming (above the preindustrial baseline), beyond which our planet will become significantly less hospitable to human life. However, adverse human health impacts are already occurring due to current levels of global climate change, as summarized by publications such as 's annual "Countdown on Health and Climate Change," initiated in 2016. The human health impacts of climate change are truly cross-disciplinary, with nearly every medical specialty either already facing or set to face effects. The field of dermatology is not immune to these risks. This special issue of the is dedicated to the cross section of dermatology and climate change. This initial article will serve as an overview to introduce readers to the topic and to lay the groundwork for the rest of the issue. We are delighted to work with the Women's Dermatological Society and welcome their support for this dedicated issue. Herein, you will read from up-and-coming stars in the field and established experts, including articles on the following key areas: infectious diseases, environmentally friendly office practices, sunscreens and the environment, refugee health, heat-related illness, the effect of air pollution on the skin, the impact of climate change on pediatric dermatology, implications for skin cancer, and skin issues related to flooding and extreme weather events.
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http://dx.doi.org/10.1016/j.ijwd.2020.08.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7435281PMC
January 2021

Approaching the dermatology residency application process during a pandemic.

J Am Acad Dermatol 2020 11 21;83(5):e351-e352. Epub 2020 Jul 21.

Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1016/j.jaad.2020.07.066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7371582PMC
November 2020

The spectrum of COVID-19-associated dermatologic manifestations: An international registry of 716 patients from 31 countries.

J Am Acad Dermatol 2020 Oct 2;83(4):1118-1129. Epub 2020 Jul 2.

Department of Dermatology, University of California San Francisco, San Francisco, California.

Background: Coronavirus disease 2019 (COVID-19) has associated cutaneous manifestations.

Objective: To characterize the diversity of cutaneous manifestations of COVID-19 and facilitate understanding of the underlying pathophysiology.

Methods: Case series from an international registry from the American Academy of Dermatology and International League of Dermatological Societies.

Results: The registry collected 716 cases of new-onset dermatologic symptoms in patients with confirmed/suspected COVID-19. Of the 171 patients in the registry with laboratory-confirmed COVID-19, the most common morphologies were morbilliform (22%), pernio-like (18%), urticarial (16%), macular erythema (13%), vesicular (11%), papulosquamous (9.9%), and retiform purpura (6.4%). Pernio-like lesions were common in patients with mild disease, whereas retiform purpura presented exclusively in ill, hospitalized patients.

Limitations: We cannot estimate incidence or prevalence. Confirmation bias is possible.

Conclusions: This study highlights the array of cutaneous manifestations associated with COVID-19. Many morphologies were nonspecific, whereas others may provide insight into potential immune or inflammatory pathways in COVID-19 pathophysiology.
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http://dx.doi.org/10.1016/j.jaad.2020.06.1016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7331510PMC
October 2020

Cutaneous Sarcoidosis.

Semin Respir Crit Care Med 2020 10 27;41(5):689-699. Epub 2020 Jun 27.

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

Sarcoidosis is a chronic, multisystem, inflammatory disorder of unknown etiology that is characterized by noncaseating granulomas that impair normal organ functioning. Sarcoidosis predominantly affects the lungs, but the skin is often cited as the second most frequently involved organ. Cutaneous manifestations of sarcoidosis are highly variable and ongoing research seeks to better understand the relationship between clinical morphology and disease prognosis. Skin findings in patients with sarcoidosis can be "specific," in which sarcoidal granulomas infiltrate the skin, or they can represent a "nonspecific" reactive inflammatory process, as is seen in calcinosis cutis and erythema nodosum. Cutaneous sarcoidosis can be the initial presenting sign or develop later in the course of the disease. In some patients, the skin will be the most involved and impactful organ system and will drive therapy. In other cases, the skin will be an incidental or minor finding, but may be easily accessible for biopsy to confirm the diagnosis. There are many potential therapies for sarcoidosis, though no one therapy is universally effective.
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http://dx.doi.org/10.1055/s-0040-1713130DOI Listing
October 2020

Navigating immunosuppression in a pandemic: A guide for the dermatologist from the COVID Task Force of the Medical Dermatology Society and Society of Dermatology Hospitalists.

J Am Acad Dermatol 2020 Oct 19;83(4):1150-1159. Epub 2020 Jun 19.

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

Dermatologists treating immune-mediated skin disease must now contend with the uncertainties associated with immunosuppressive use in the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Although the risk of infection with many commonly used immunosuppressive agents remains low, direct data evaluating the safety of such agents in coronavirus disease 2019 (COVID-19) are scarce. This article reviews and offers guidance based on currently available safety data and the most recent COVID-19 outcome data in patients with immune-mediated dermatologic disease. The interdisciplinary panel of experts emphasizes a stepwise, shared decision-making approach in the management of immunosuppressive therapy. The goal of this article is to help providers minimize the risk of disease flares while simultaneously minimizing the risk of iatrogenic harm during an evolving pandemic.
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http://dx.doi.org/10.1016/j.jaad.2020.06.051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303642PMC
October 2020

Cutaneous Adverse Events in Newly Approved FDA Non-cancer Drugs: A Systematic Review.

Drugs R D 2020 Sep;20(3):171-187

Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 2012 Kenny Road, Rm 232, Columbus, OH, 43212, USA.

The prevalence of cutaneous adverse events attributable to newly approved anti-cancer drugs has been well reviewed in the dermatologic literature. In contrast, over 75% of US Food and Drug Administration approvals in the past 5 years have been for non-cancer drugs and indications. This represents multiple other categories of approved medications associated with cutaneous adverse reactions. To investigate the cutaneous adverse events associated with these potentially neglected medications, a systematic review was conducted. Two hundred and forty-one medications approved by the Food and Drug Administration between 2013 and 2018 were reviewed and 180 non-oncologic drugs were identified. The prescribing information for each medication was reviewed for the presence of cutaneous adverse events and a supplemental literature search was performed to better characterize any adverse events outlined within the prescribing information. Most reactions were classified as morbilliform, macular, popular, or maculopapular. Fortunately, only a few severe cutaneous adverse reactions were reported, namely in benznidazole, cannabidiol, and sofosbuvir. This review summarizes available data drawn from clinical trials and case reports involving cutaneous adverse events from the 21 non-oncologic medications associated with cutaneous adverse events.
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http://dx.doi.org/10.1007/s40268-020-00311-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7419407PMC
September 2020

Pernio-like skin lesions associated with COVID-19: A case series of 318 patients from 8 countries.

J Am Acad Dermatol 2020 08 30;83(2):486-492. Epub 2020 May 30.

Department of Dermatology, University of California, San Francisco, California.

Background: Increasing evidence suggests pernio-like lesions are cutaneous manifestations of coronavirus infectious disease 2019 (COVID-19).

Objective: To describe clinical and pathologic findings of pernio-like lesions in patients with confirmed or suspected COVID-19.

Methods: An international dermatology registry was circulated to health care providers worldwide through the American Academy of Dermatology, International League of Dermatologic Societies, and other organizations.

Results: We documented 505 patients with dermatologic manifestations associated with COVID-19, including 318 (63%) with pernio-like lesions. Patients with pernio-like lesions were generally young and healthy, with relatively mild COVID-19. Of 318 patients with confirmed or suspected COVID-19 by providers, 23 (7%) were laboratory-confirmed COVID-19 positive, and 20 others (6%) were close contacts of patients with confirmed COVID-19. Given current testing criteria, many patients lacked COVID-19 testing access. For 55% of patients, pernio-like lesions were their only symptom. In patients with other COVID-19 symptoms, pernio-like lesions typically appeared after other symptoms. Pernio-like lesions lasted a median of 14 days (interquartile range, 10-21 days).

Limitations: A case series cannot estimate population-level incidence or prevalence. In addition, there may be confirmation bias in reporting. We cannot exclude an epiphenomenon.

Conclusions: Pernio-like skin changes of the feet and hands, without another explanation, may suggest COVID-19 infection and should prompt confirmatory testing.
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http://dx.doi.org/10.1016/j.jaad.2020.05.109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7260509PMC
August 2020

Dermatomal necrotizing infundibular crystalline folliculitis following herpes zoster in a patient on PD-1 inhibitor therapy.

J Cutan Pathol 2020 Jun;47(6):501-505

Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1111/cup.13653DOI Listing
June 2020

Use of teledermatology by dermatology hospitalists is effective in the diagnosis and management of inpatient disease.

J Am Acad Dermatol 2021 Jun 7;84(6):1547-1553. Epub 2020 May 7.

Department of Dermatology, Mayo Clinic, Rochester, Minnesota.

Background: Patient outcomes are improved when dermatologists provide inpatient consultations. Inpatient access to dermatologists is limited, illustrating an opportunity to use teledermatology. Little is known about the ability of dermatologists to accurately diagnose disease and manage inpatients with teledermatology, particularly when using nondermatologist-generated clinical data.

Methods: This prospective study assessed the ability of teledermatology to diagnose disease and manage 41 dermatology consultations from a large urban tertiary care center, using internal medicine referral documentation and photographs. Twenty-seven dermatology hospitalists were surveyed. Interrater agreement was assessed by the κ statistic.

Results: There was substantial agreement between in-person and teledermatology assessment of the diagnosis with differential diagnosis (median κ = 0.83), substantial agreement in laboratory evaluation decisions (median κ = 0.67), almost perfect agreement in imaging decisions (median κ = 1.0), and moderate agreement in biopsy decisions (median κ = 0.43). There was almost perfect agreement in treatment (median κ = 1.0), but no agreement in follow-up planning (median κ = 0.0). There was no association between raw photograph quality and the primary plus differential diagnosis or primary diagnosis alone.

Limitations: Selection bias and single-center nature.

Conclusions: Teledermatology may be effective in the inpatient setting, with concordant diagnosis, evaluation, and management decisions.
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http://dx.doi.org/10.1016/j.jaad.2020.04.171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204758PMC
June 2021

A prospective comparison of cutaneous sarcoidosis disease response to immunomodulatory and immunosuppressive therapies.

J Am Acad Dermatol 2020 Jun 7;82(6):1546-1548. Epub 2020 Mar 7.

Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.02.070DOI Listing
June 2020

Unbearable wearables.

Dermatol Online J 2019 Dec 15;25(12). Epub 2019 Dec 15.

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

As wearable devices play an increasing role in the management of health and disease, adverse skin reactions to wearables have become more common. However, the management of allergic contact dermatitis is challenging and new treatment options more compatible with wearable devices are needed. In a 40-year-old woman with contact dermatitis to a continuous glucose monitoring device, topical clobetasol propionate 0.05% spray proved to be an effective treatment that was compatible with the application of adhesive wearables. This case demonstrates that spray formulations of topical steroids are a good option for the treatment of dermatitis under wearable devices such as continuous glucose monitors or ostomy appliance.
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December 2019

Successful treatment of refractory tumor necrosis factor inhibitor-induced palmoplantar pustulosis with tofacitinib: Report of case.

JAAD Case Rep 2020 Feb 22;6(2):115-118. Epub 2020 Jan 22.

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

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http://dx.doi.org/10.1016/j.jdcr.2019.12.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6992880PMC
February 2020

A Multicenter Cross-Sectional Study and Systematic Review of Necrobiotic Xanthogranuloma With Proposed Diagnostic Criteria.

JAMA Dermatol 2020 03;156(3):270-279

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

Importance: Necrobiotic xanthogranuloma (NXG) is a non-Langerhans cell histiocytosis classically associated with paraproteinemia attributable to plasma-cell dyscrasias or lymphoproliferative disorders. Despite the morbidity of NXG, the literature is limited to case reports and small studies, and diagnostic criteria are lacking.

Objective: To evaluate the characteristics of NXG and propose diagnostic criteria.

Design, Setting, And Participants: This multicenter cross-sectional study was conducted at tertiary academic referral centers and followed by a systematic review and a consensus exercise. The multicenter cohort included patients with NXG diagnosed at the Brigham and Women's and Massachusetts General Hospitals (2000-2018), the University of Iowa Hospitals and Clinics (2000-2018), and the University of Pennsylvania Health System (2008-2018). The systematic review was conducted in 2018 and included patients with NXG identified in the Cochrane, Ovid EMBASE, PubMed, and Web of Science databases. The consensus exercise was conducted by 8 board-certified dermatologists to identify diagnostic criteria.

Main Outcomes And Measures: Demographic factors, comorbidities, clinical features, and treatment response.

Results: Of 235 included patients with NXG (34 from the multicenter cohort and 201 from the systematic review results), the mean (SD) age at presentation was 61.6 (14.2) years; 147 (62.6%) were female. Paraproteinemia was detected in 193 patients (82.1%), most often IgG-κ (117 patients [50.0%]). A malignant condition was detected in 59 patients (25.1%), most often multiple myeloma (33 patients [14.0%]). The overall rate of paraproteinemia and/or a malignant condition was 83.8% (197 patients). In the multicenter cohort, evolution of paraproteinemia into multiple myeloma was observed up to 5.7 years (median [range], 2.4 [0.1-5.7] years) after NXG presentation. Cutaneous lesions consisted of papules, plaques, and/or nodules, typically yellow or orange in color (113 of 187 [60.4%]) with a periorbital distribution (130 of 219 [59.3%]). The eye was the leading site of extracutaneous involvement (34 of 235 [14.5%]). In the multicenter cohort, intravenous immunoglobulin had the best treatment response rate (9 of 9 patients [100%]), followed by antimalarial drugs (4 of 5 patients [80%]), intralesional triamcinolone (6 of 8 patients [75%]), surgery (3 of 4 patients [75%]), chemotherapy (8 of 12 patients [67%]), and lenalidomide or thalidomide (5 of 8 patients [63%]). The consensus exercise yielded 2 major criteria, which were (1) clinical and (2) histopathological features consistent with NXG, and 2 minor criteria, consisting of (1) paraproteinemia, plasma-cell dyscrasia, and/or other associated lymphoproliferative disorder and (2) periorbital distribution of cutaneous lesions. In the absence of foreign body, infection, or another identifiable cause, fulfillment of both major and at least 1 minor criterion were proposed to establish the diagnosis of NXG.

Conclusions And Relevance: Necrobiotic xanthogranuloma is a multisystem disorder associated with paraproteinemia and malignant conditions. The proposed diagnostic criteria may advance clinical research and should be validated.
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http://dx.doi.org/10.1001/jamadermatol.2019.4221DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6990734PMC
March 2020

A hydralazine-induced triumvirate: Lupus, cutaneous vasculitis, and cryptococcoid Sweet syndrome.

JAAD Case Rep 2019 Nov 31;5(11):1006-1009. Epub 2019 Oct 31.

Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1016/j.jdcr.2019.08.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6838470PMC
November 2019

A photo-distributed papulopustular eruption and multiple squamous cell carcinomas in a patient on ruxolitinib.

JAAD Case Rep 2019 Oct 22;5(10):895-897. Epub 2019 Oct 22.

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

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http://dx.doi.org/10.1016/j.jdcr.2019.06.038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6818392PMC
October 2019

Draining dorsal hand pustules, nodules, and ulcers in a patient with immunosuppression.

JAAD Case Rep 2019 Oct 24;5(10):846-848. Epub 2019 Sep 24.

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

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http://dx.doi.org/10.1016/j.jdcr.2019.06.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6804474PMC
October 2019