Publications by authors named "Nicole M Fett"

16 Publications

  • Page 1 of 1

Corrugated Purple Plaque on the Left Cheek: Answer.

Am J Dermatopathol 2021 May;43(5):386-387

Department of Dermatology, Oregon Health & Science University, Portland, OR.

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http://dx.doi.org/10.1097/DAD.0000000000001682DOI Listing
May 2021

A virtual faculty exchange program enhances dermatology resident education in the COVID-19 era: a survey study.

Dermatol Online J 2021 Mar 15;27(3). Epub 2021 Mar 15.

Department of Dermatology, University of California Irvine, Irvine, CA.

One of the many consequences of the COVID-19 pandemic was the cancelation of the 2020 American Academy of Dermatology Annual Meeting. This conference historically features lectures from world-renowned experts in all areas of dermatology, thus providing an important educational experience for dermatology residents. We hypothesized that the cancellation of this meeting produced a substantial educational loss for dermatology residents. To mitigate this impact, we developed a virtual faculty exchange program and surveyed dermatology residents' perspectives on its implementation. All participating residents found the virtual faculty exchange useful and would recommend it to other residents/programs. Moreover, all residents wanted to participate in more faculty exchange sessions as well as incorporate them throughout the academic year. Additionally, this educational program eliminated the potential cost of >$15,000 in flights and >24 metric tons of carbon emissions. This virtual faculty exchange program is a viable tool to enhance dermatology resident education in the COVID-19 era.
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March 2021

Corrugated Purple-Black Plaque on the Left Cheek: Challenge.

Am J Dermatopathol 2021 May;43(5):e54

Department of Dermatology, Oregon Health & Science University, Portland, OR.

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http://dx.doi.org/10.1097/DAD.0000000000001681DOI Listing
May 2021

Characteristics of patients with celiac disease and connective tissue disease overlap.

Int J Dermatol 2020 Aug 25;59(8):e309-e312. Epub 2020 Apr 25.

Department of Dermatology, Oregon Health and Science University, Portland, OR, USA.

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http://dx.doi.org/10.1111/ijd.14892DOI Listing
August 2020

Evaluation of the Effectiveness and Tolerability of Mycophenolate Mofetil and Mycophenolic Acid for the Treatment of Morphea.

JAMA Dermatol 2020 05;156(5):521-528

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

Importance: First-line systemic therapy for morphea includes methotrexate with or without systemic corticosteroids. When this regimen is ineffective, not tolerated, or contraindicated, a trial of mycophenolate mofetil (MMF) or mycophenolic acid (MPA)-referred to herein as mycophenolate-is recommended; however, evidence to support this recommendation remains weak.

Objective: To evaluate the effectiveness and tolerability of mycophenolate for the treatment of morphea.

Design, Setting, And Participants: A retrospective cohort study was conducted from January 1, 1999, to December 31, 2018, among 77 patients with morphea from 8 institutions who were treated with mycophenolate.

Main Outcomes And Measures: The primary outcome was morphea disease activity, severity, and response at 0, 3 to 6, and 9 to 12 months of mycophenolate treatment. A secondary outcome was whether mycophenolate was a well-tolerated treatment of morphea.

Results: There were 61 female patients (79%) and 16 male patients (21%) in the study, with a median age at disease onset of 36 years (interquartile range, 16-53 years) and median diagnostic delay of 8 months (interquartile range, 4-14 months). Generalized morphea (37 [48%]), pansclerotic morphea (12 [16%]), and linear morphea of the trunk and/or extremities (9 [12%]) were the most common subtypes of morphea identified. Forty-one patients (53%) had an associated functional impairment, and 49 patients (64%) had severe disease. Twelve patients received initial treatment with mycophenolate as monotherapy or combination therapy and 65 patients received mycophenolate after prior treatment was ineffective (50 of 65 [77%]) or poorly tolerated (21 of 65 [32%]). Treatments prior to mycophenolate included methotrexate (48 of 65 [74%]), systemic corticosteroids (42 of 65 [65%]), hydroxychloroquine (20 of 65 [31%]), and/or phototherapy (14 of 65 [22%]). After 3 to 6 months of mycophenolate treatment, 66 of 73 patients had stable (n = 22) or improved (n = 44) disease. After 9 to 12 months of treatment, 47 of 54 patients had stable (n = 14) or improved (n = 33) disease. Twenty-seven patients (35%) achieved disease remission at completion of the study. Treatments received in conjunction with mycophenolate were frequent. Mycophenolate was well tolerated. Gastrointestinal adverse effects were the most common (24 [31%]); cytopenia (3 [4%]) and infection (2 [3%]) occurred less frequently.

Conclusions And Relevance: This study suggests that mycophenolate is a well-tolerated and beneficial treatment of recalcitrant, severe morphea.
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http://dx.doi.org/10.1001/jamadermatol.2020.0035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7113833PMC
May 2020

Perioperative management of pyoderma gangrenosum.

J Am Acad Dermatol 2020 Aug 9;83(2):369-374. Epub 2020 Jan 9.

Department of Dermatology, Oregon Health & Science University, Center for Health & Healing, Portland, Oregon. Electronic address:

Pyoderma gangrenosum (PG) classically presents with an acute inflammatory stage, characterized by rapid evolution of painful ulcerations. The pathergy associated with PG lesions complicates disease management. Although PG is commonly treated with immunosuppression, some patients have refractory noninflammatory ulcers. In this subpopulation, there are case reports of successful surgical treatment. However, there is no consensus on optimal perioperative treatment for patients with PG undergoing surgery of any kind, PG related or otherwise. Therefore, we conducted a comprehensive literature review describing perioperative management practices and risk factors that may predict response to surgical intervention. We identified 126 cases of surgical intervention in patients with active PG; among these, only 16.7% experienced postoperative disease progression. No perioperative treatments or clinical risk factors were identified as statistically significant predictors of disease recurrence. Although limited by case series design and publication bias, this study is a valuable means of hypothesis generation for this rare condition.
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http://dx.doi.org/10.1016/j.jaad.2020.01.002DOI Listing
August 2020

Dermatology in the Diagnosis of Noncutaneous Malignancy: Paraneoplastic Diseases.

Dermatol Clin 2019 Oct 10;37(4):537-544. Epub 2019 Jul 10.

Oregon Health & Science University, 3303 Southwest Bond Avenue CH16D, Portland, OR 97239, USA.

It is important to recognize paraneoplastic dermatoses because they allow the practitioner to begin an early, directed workup to detect an underlying malignant neoplasm. In this review, several paraneoplastic dermatoses are outlined using existing data to detail each one's association with underlying malignancy, demographics, prognosis, and treatment considerations.
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http://dx.doi.org/10.1016/j.det.2019.05.011DOI Listing
October 2019

Clinical factors influencing the response to intravenous immunoglobulin treatment in cases of treatment-resistant pyoderma gangrenosum.

J Dermatolog Treat 2020 Nov 6;31(7):723-726. Epub 2019 May 6.

Department of Dermatology, Oregon Health & Science University, Center for Health & Healing, Portland, OR, USA.

Pyoderma gangrenosum (PG) is a neutrophilic disorder which classically presents as chronic, painful ulcers on the lower extremities. There is evidence supporting a potential role for intravenous immunoglobulin (IVIG) as adjuvant therapy for treatment-resistant cases; however, it is unclear which patients will most benefit from this modality of treatment - an especially important consideration given the cost per infusion ($5000-$10,000). Thus, we sought to identify the clinical characteristics of patients with refractory PG lesions who demonstrated complete healing when IVIG was incorporated into the therapeutic plan. We performed a literature search of PubMed/MEDLINE and Embase using the keywords 'pyoderma gangrenosum' and 'IVIG'. We also added four institutional cases. Descriptive statistics were used to analyze the data. Significance was set at  < .05. We discovered a total of 45 cases. Twenty-three patients with treatment-resistant PG had complete healing, 22 had partial or unhealed PG ulcers. Patients with one ulcer were 4.1 (95% CI: 1.1-18.5) times more likely to achieve complete healing than patients with more than one ulcer, when IVIG was added ( = .041). There is increased efficacy of IVIG as a treatment for patients with a solitary treatment-resistant PG lesion compared to patients with multiple refractory lesions.
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http://dx.doi.org/10.1080/09546634.2019.1606888DOI Listing
November 2020

Quinacrine-Associated Punctate Palmar Keratoderma.

J Clin Rheumatol 2021 Mar;27(2):e47-e49

Department of Dermatology Oregon Health & Science University Portland, OR

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http://dx.doi.org/10.1097/RHU.0000000000000849DOI Listing
March 2021

Practice and Educational Gaps in Lupus, Dermatomyositis, and Morphea.

Dermatol Clin 2016 Jul;34(3):243-50

Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Department of Dermatology, Perelman Center for Advanced Medicine, University of Pennsylvania School of Medicine, Suite 1-330A, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA. Electronic address:

Patients with skin-predominant lupus erythematosus, dermatomyositis, and morphea should be evaluated, treated, and followed by dermatologists who can take primary responsibility for their care. Many academic centers have specialized centers with dermatologists who care for these patients. Patients with skin-predominant lupus erythematosus should be followed regularly with laboratory tests to detect significant systemic disease. Antibody tests can help determine the risks for individual patients. Patients with morphea rarely progress to systemic disease, but therapies can be helpful in treating and preventing progression of disease.
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http://dx.doi.org/10.1016/j.det.2016.02.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5514844PMC
July 2016

Morphea (localized scleroderma).

Authors:
Nicole M Fett

JAMA Dermatol 2013 Sep;149(9):1124

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http://dx.doi.org/10.1001/jamadermatol.2013.5079DOI Listing
September 2013

Familial urticaria pigmentosa: report of a family and review of the role of KIT mutations.

Am J Dermatopathol 2013 Feb;35(1):113-6

Department of Dermatology, Philadelphia VA Medical Center, Philadelphia, PA, USA.

Cutaneous mastocytosis is a rare clinically heterogeneous disorder characterized by mast cell infiltration. Mastocytosis affects both children and adults and has been reported to occur in families. Recent data suggest that mutations in the c-kit proto-oncogene are causative of mastocytosis not only in adults but in children and familial cases as well; however, mutation analysis other than D816V is not widely available, making detection of causative mutations problematic. We present the case of a 33-year-old man with a 30-year history of persistent urticaria pigmentosa and his 2 affected children. Sequencing of KIT exons 8, 10, 11, and 17 was carried out on a skin biopsy specimen and mucosal swabs of the incident case and was negative for known KIT mutations. Additional work-up was deferred by the family. Presentation of this familial case of urticaria pigmentosa demonstrates the complexity of genetic evaluation in clinical settings. It suggests that mutations other than those reported in exons 8, 10, 11, and 17 may also result in familial mastocytosis. Presentation of this case also allows for review of the mechanism of action of causative KIT mutations and the recent literature supporting KIT mutations in childhood and familial mastocytosis.
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http://dx.doi.org/10.1097/DAD.0b013e31826330bfDOI Listing
February 2013

Morphea: evidence-based recommendations for treatment.

Authors:
Nicole M Fett

Indian J Dermatol Venereol Leprol 2012 Mar-Apr;78(2):135-41

Department of Dermatology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.

Morphea is a rare fibrosing disorder of the skin. Evidence-based treatment strategies in morphea are lacking. This review summarizes the available data on morphea treatment and provides therapeutic strategies based on morphea subtypes. The Cochrane Library, Medline and Embase from inception until May of 2011 were searched using the key words "morphea" and "morphea treatment." Reference lists of the resultant articles, as well as relevant reviews, were also searched. This review focuses on randomized controlled trials, prospective interventional trials without controls and retrospective reviews with greater than five subjects.
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http://dx.doi.org/10.4103/0378-6323.93628DOI Listing
July 2012

Evaluation of reliability, validity, and responsiveness of the CDASI and the CAT-BM.

J Invest Dermatol 2012 Apr 5;132(4):1117-24. Epub 2012 Jan 5.

Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA.

To properly evaluate therapies for cutaneous dermatomyositis (DM), it is essential to administer an outcome instrument that is reliable, valid, and responsive to clinical change, particularly when measuring disease activity. The purpose of this study was to compare two skin severity DM outcome measures, the Cutaneous Disease and Activity Severity Index (CDASI) and the Cutaneous Assessment Tool-Binary Method (CAT-BM), with the Physician Global Assessment (PGA) as the "gold standard". Ten dermatologists evaluated 14 patients with DM using the CDASI, CAT-BM, and PGA scales. Inter- and intra-rater reliability, validity, responsiveness, and completion time were compared for each outcome instrument. Responsiveness was assessed from a different study population, where one physician evaluated 35 patients with 110 visits. The CDASI was found to have a higher inter- and intra-rater reliability. Regarding construct validity, both the CDASI and the CAT-BM were significant predictors of the PGA scales. The CDASI had the best responsiveness among the three outcome instruments examined. The CDASI had a statistically longer completion time than the CAT-BM by about 1.5 minutes. The small patient population may limit the external validity of the findings observed. The CDASI is a better clinical tool to assess skin severity in DM.
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http://dx.doi.org/10.1038/jid.2011.440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3752293PMC
April 2012

Adult T-cell leukemia/lymphoma in a patient from Romania: a case report and review of the literature.

J Cutan Pathol 2008 Oct 9;35 Suppl 1:32-7. Epub 2008 Jun 9.

Department of Dermatology, University of Wisconsin and Veterans Affairs Medical Center, Madison, WI 53715, USA.

Adult T-cell leukemia/lymphoma (ATLL) is a rare malignancy caused by human T-cell leukemia virus-1. ATLL is endemic to Japan, and to date, there are only four case reports of patients from Romania who have developed ATLL. Here, we describe a woman living in Madison, Wisconsin, originally from Romania, who presented with an atypical papulosquamous eruption and was ultimately diagnosed with smoldering ATLL. Narrow-band ultraviolet-B (UV-B) therapy and mid-potency topical steroids resulted in skin clearing for approximately 5 months after diagnosis; however, she subsequently relapsed with disease refractory to both narrow band UV-B and psoralen plus ultraviolet A (PUV-A), progressed to acute ATLL and expired secondary to complications.
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http://dx.doi.org/10.1111/j.1600-0560.2007.00962.xDOI Listing
October 2008