Publications by authors named "Philip R Cohen"

445 Publications

Subungual Calcification and Nail Dystrophy: A Case of a Man With Subungual Calcinosis Cutis and an Associated Split Nail Plate.

Cureus 2021 Sep 3;13(9):e17695. Epub 2021 Sep 3.

Dermatology, University of California, Davis Medical Center, Sacramento, USA.

A dystrophic nail is an alteration of the physical appearance and structural properties of the nail from its shape, color, and texture, which can result from multiple etiologies. Calcinosis cutis is a condition that refers to the calcium deposition in the skin and underlying tissue. A 55-year-old man who presented with a split right thumbnail associated with subungual calcinosis cutis affecting the same digit for a duration of nine years is described. He did not recall trauma to the affected area. Microscopic evaluation of the tissue specimen obtained following a biopsy of the affected digit's nail matrix showed foci of calcium in the dermis. The correlation of his clinical presentation and biopsy findings established a diagnosis of subungual calcinosis cutis. Subungual calcification has been observed in several clinical settings. In addition to subungual calcinosis cutis, it has been noted as a normal finding in elderly individuals. In addition, it has been observed in patients with scleroderma or following trauma to the site. Less commonly, subungual calcification can be associated with idiopathic conditions: calcifying aponeurotic fibroma, digital calcinosis circumscripta, subepidermal calcified nodule, and calcified subungual epidermoid inclusion.
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http://dx.doi.org/10.7759/cureus.17695DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8489657PMC
September 2021

Verruca Vulgaris Occurring on a Tattoo: Case Report and Review of Tattoo-Associated Human Papillomavirus Infections.

Authors:
Philip R Cohen

Cureus 2021 Aug 30;13(8):e17575. Epub 2021 Aug 30.

Dermatology, University of California, Davis Medical Center, Sacramento, USA.

Cutaneous infections can occur on tattoos. Tattoo-associated viral infections can be caused by human papillomavirus. A verruca vulgaris developed on the tattoo of a 44-year-old woman; the viral lesion appeared 21 years after she received the tattoo and had been increasing in size during the prior five years. Biopsy of the lesion not only confirmed the diagnosis but also removed most of the wart; the patient declined any additional treatment. In addition to verruca vulgaris (27 individuals), verruca plana (14 individuals) and human immunodeficiency virus-associated acquired epidermodysplasia verruciformis (two men) are human papillomavirus lesions that have been observed to occur on tattoos. The latency period from receiving the tattoo to the appearance of the wart has ranged from one month to 21 years; the median duration was 21 months for verruca vulgaris and 24 months for verruca plana. The warts most frequently appeared in the dark, usually black, inked areas of the tattoo; indeed, it has been postulated that the ink created a cutaneous immunocompromised district that enhanced the opportunity for the viral lesions to occur in the tattoo. The use of contaminated instruments or ink during tattoo inoculation is the most likely etiology for the development of a wart on a tattoo. However, other potential mechanisms for human papillomavirus to occur on a tattoo include transmission of the virus from the tattoo artist's ungloved hand or saliva, a preexisting (albeit unrecognized) human papillomavirus lesion adjacent to or at the site of the tattoo, and postinoculation acquisition of the verruca at the site of the tattoo. Topical retinoid or imiquimod, used as a single agent, was not effective in the treatment of the warts. Some of the patients who were treated with cryotherapy using liquid nitrogen did not achieve any improvement of their viral lesions. However, other patients observed resolution of most or all their warts when cryotherapy with liquid nitrogen, either as monotherapy or followed by topical application of 5% imiquimod cream, was used; yet, following treatment, these individuals experienced mild distortion of their tattoo and/or hypopigmentation. Curettage and squaric acid dibutyl ester contact immunotherapy were both successful approaches to the management of tattoo-associated warts. In addition, warts were efficaciously managed with either photodynamic therapy or treatment with an ablative erbium:yttrium aluminum garnet (YAG) laser followed by topical application of 5% imiquimod cream.
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http://dx.doi.org/10.7759/cureus.17575DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8481100PMC
August 2021

Comment on "Becker nevus syndrome: A 2020 update".

Authors:
Philip R Cohen

J Am Acad Dermatol 2021 Sep 14. Epub 2021 Sep 14.

Touro University California College of Osteopathic Medicine, Vallejo, California; Department of Dermatology, University of California Davis, Sacramento, California. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2021.08.057DOI Listing
September 2021

Thalidomide-Then and Now: Case Report of a Woman With Thalidomide Embryopathy and Review of Current Thalidomide Uses.

Cureus 2021 Aug 10;13(8):e17070. Epub 2021 Aug 10.

Dermatology, University of California, Davis Medical Center, Sacramento, USA.

Thalidomide was initially developed as a sedative; subsequently, its use was expanded to treat morning sickness in pregnant women. However, it was later discovered to be a teratogenic drug that was associated with embryopathy in women. A woman is described who was exposed to thalidomide in utero. She had several stigmata of thalidomide embryopathy. Although treatment of nausea and anxiety in pregnant women with thalidomide was discontinued in 1961, the drug has been found to be a useful agent for the management of several systemic conditions and dermatological disorders. Whether the treatment with thalidomide shall be incorporated in the therapeutic regime for patients with severe coronavirus disease 2019 (COVID-19) infection remains to be determined.
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http://dx.doi.org/10.7759/cureus.17070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8428198PMC
August 2021

A Woman With Solar Urticaria and Heat Urticaria: A Unique Presentation of an Individual With Multiple Physical Urticarias.

Cureus 2021 Aug 6;13(8):e16950. Epub 2021 Aug 6.

Dermatology, San Diego Family Dermatology, National City, USA.

Urticaria is a common group of dermatologic disorders characterized by hives. Solar urticaria and heat urticaria are two rare types of chronic inducible urticarias. Solar urticaria is triggered by exposure to sunlight or ultraviolet radiation. Heat urticaria is triggered by exposure or contact with a heat stimulus. A 63-year-old woman is described who has both solar urticaria and heat urticaria and the features of these chronic inducible urticarias are reviewed. The woman presented with urticarial lesions that appeared both after exposure to the sun and after cooking at a stove. Additional history revealed she was previously diagnosed with diabetes, hypertension, and thyroid disease. After sun exposure, a punch biopsy of both the affected skin, as well as the normal-appearing skin, was done. Correlation of the clinical history, cutaneous examination, and biopsy examination confirmed the diagnosis of solar urticaria. Treatment of the patient's urticarias included histamine 1 (H1) and histamine 2 (H2) antihistamines. Her symptoms resolved and did not recur provided that she took the medication as prescribed. Management of chronic urticaria includes not only treatment of the current episode but also prevention of future recurring urticarial lesions. In addition to antihistamines, treatment may include omalizumab (Xolair®) injections for persistent urticaria.
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http://dx.doi.org/10.7759/cureus.16950DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8418825PMC
August 2021

Novel somatic alterations in unicentric and idiopathic multicentric Castleman disease.

Eur J Haematol 2021 Aug 24. Epub 2021 Aug 24.

Division of Hematology and Oncology, Department of Medicine, Center for Personalized Cancer Therapy, University of California San Diego, La Jolla, California, USA.

Objectives: Castleman disease (CD) is a heterogeneous group of disorders involving systemic inflammation and lymphoproliferation. Recently, clonal mutations have been identified in unicentric CD (UCD) and idiopathic multicentric CD (iMCD), suggesting a potential underlying neoplastic process.

Methods: Patients with UCD or iMCD with next generation sequencing (NGS) data on tissue DNA and/or circulating tumor DNA (ctDNA) were included.

Results: Five patients were included, 4 with iMCD and 1 with UCD. Four patients (80%) were women; median age was 40 years. Three of five patients (60%) had ≥1 clonal mutation detected on biopsy among the genes included in the panel. One patient with iMCD had a 14q32-1p35 rearrangement and a der(1)dup(1)(q42q21)del(1)(q42) (1q21 being IL-6R locus) on karyotype. This patient also had a NF1 K2459fs alteration on ctDNA (0.3%). Another patient with iMCD had a KDM5C Q836* mutation, and one patient with UCD had a TNS3-ALK fusion but no ALK expression by immunohistochemistry.

Conclusions: We report 4 novel somatic alterations found in patients with UCD or iMCD. The 1q21 locus contains IL-6R, and duplication of this locus may increase IL-6 expression. These findings suggest that a clonal process may be responsible for the inflammatory phenotype in some patients with UCD and iMCD.
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http://dx.doi.org/10.1111/ejh.13702DOI Listing
August 2021

Verruciform Acral-Associated (Vacas) Xanthoma: Case Report and Review.

Cureus 2021 Jul 22;13(7):e16569. Epub 2021 Jul 22.

Dermatology, San Diego Family Dermatology, National City, USA.

Verrucous xanthoma is a benign histiocytic lesion of macrophage derivation. We describe a woman with a non-mucosal verruciform xanthoma located on her right thumb and review the features of patients with verruciform acral-associated xanthoma. A 69-year-old woman presented with a lesion on her right thumb of eight years duration that had been previously treated with liquid nitrogen cryotherapy without resolution. An initial biopsy was consistent with the surface of a callous. A second biopsy demonstrated a verruciform xanthoma. The patient elected to apply lactic acid 12% twice daily and pare the lesion with a pumice stone once weekly; this resulted in flattening of the xanthoma-associated hyperkeratosis. Acral verruciform xanthoma has, albeit rarely, been described on the hands and feet of individuals. Including the patient in this report, six individuals have been reported with verrucous xanthoma on the hands and 12 individuals have been reported with a verrucous xanthoma on the feet. Verruciform xanthoma most commonly occurs on the oral mucosa. Genital lesions are also a frequent site. Acral-distributed verruciform xanthoma is rare; we propose that a verruciform xanthoma that occurs on acral sites be referred to as a verruciform acral-associated (Vacas) xanthoma.
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http://dx.doi.org/10.7759/cureus.16569DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8378300PMC
July 2021

Sofosbuvir-Velpatasvir (Epclusa)-Associated Photosensitivity in a Hepatitis C Patient: Case Report and Review of Photosensitivity to Hepatitis C Antiviral Agents.

Cureus 2021 Jul 19;13(7):e16496. Epub 2021 Jul 19.

Dermatology, San Diego Family Dermatology, National City, USA.

Hepatitis C is a ribonucleic acid (RNA) virus, and its presence in individuals was previously considered to be a chronic condition. However, recent therapeutic advances with virus-directed treatment have resulted in a significant increase in cure rates as demonstrated by an absence of virus on repeat testing. Currently, several individual and combination antiviral therapies are available for the treatment of hepatitis C virus infection. However, each of the hepatitis C antiviral agents is associated with potential adverse skin effects whose incidence varies depending on the agent used for treatment. The cutaneous reactions, including photosensitivity, usually resolve once the antiviral treatment is completed. In this report, we discuss the case of a chronic hepatitis C patient who developed sofosbuvir-velpatasvir (Epclusa)-associated toxicity, while receiving the antiviral therapy. The 57-year-old man developed cutaneous phototoxicity when he started treatment with the drug. The adverse skin reaction promptly resolved once the treatment was completed. Clinicians who manage patients being treated with antiviral agents for hepatitis C infection should consider counseling these individuals regarding photoprotection including avoidance of sun exposure, daily sunscreen use, and wearing photoprotective clothing.
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http://dx.doi.org/10.7759/cureus.16496DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8373598PMC
July 2021

Social media (SoMe) enhances exposure of dermatology articles.

Dermatol Online J 2021 07 15;27(7). Epub 2021 Jul 15.

Department of Dermatology, University of California Davis, Sacramento, CA Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.

Social media (SoMe) refers to a variety of virtual platforms used to enhance sharing of information. To evaluate the influence of SoMe with regards to views and downloads of published dermatology articles, we conducted a retrospective study from July 2020-March 2021 examining articles published on Instagram and Twitter under Dermatology Online Journal (DOJ) accounts and compared these with type-matched and issue-matched articles that were not posted on social media. During this time period, 163 total articles of the three types used for social media (Case Report, Case Presentation, and Photo Vignette) were published in DOJ and 15 were promoted via SoMe. Utilization of SoMe demonstrated a significant (P<0.0001) positive effect with regards to both views (175.5±16.4) and downloads (31.5±4.0) over matched articles not published on SoMe. Similar trends illustrating the positive effect of SoMe on readership have been previously observed in the field of dermatology as well as other medical specialties. Most direct accessions to articles arrived via Instagram rather than Twitter, diverging from previous studies on SoMe use in medical journals. Social media, in particular Instagram, can be a successful platform to enhance the exposure of peer-reviewed medical information.
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http://dx.doi.org/10.5070/D327754361DOI Listing
July 2021

Incidental Clear Cell Syringoma of the Scalp in a Patient With Lichen Planopilaris.

Cureus 2021 Jun 30;13(6):e16064. Epub 2021 Jun 30.

Dermatology, San Diego Family Dermatology, National City, USA.

Syringomas are benign neoplasms of eccrine ducts; glycogen accumulation in the tumor cell cytoplasm results in a clear cell variant of syringoma. Syringoma and syringomatous proliferations (secondary to alteration of the eccrine sweat ducts) have been observed, albeit uncommonly, as an incidental finding in areas of alopecia on the scalp. A 71-year-old woman with scalp hair loss caused by lichen planopilaris had subclinical clear cell syringoma discovered as an incidental observation on evaluation of the biopsy specimen from an area of hair loss. Including our patient, scalp alopecia-associated syringoma or syringomatous proliferation has been described in a 47-year-old man and 16 women. The women ranged in age from 33 years to 83 years (median, 57 years). The duration of alopecia ranged from six months to 22 years; almost half of the patients (three of seven) had hair loss for 20 or more years. The frontal scalp was the most common location of alopecia; the parietal scalp and the entire scalp with diffuse hair loss were also frequent sites. Prior to biopsy, female pattern alopecia was the most common clinical diagnosis; lichen planopilaris and scarring alopecia were also frequent diagnoses. After the biopsy, pseudopelade was the most common diagnosis; lichen planopilaris and female pattern alopecia were also frequently observed. The pathogenesis of incidental syringomas and syringomatous proliferation in areas of scalp hair loss is postulated to be secondary to subclinical alopecia-related reactive changes.
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http://dx.doi.org/10.7759/cureus.16064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8323619PMC
June 2021

Parrot Beak Nail: Case Report and Review of Parrot Beak Nail Dystrophy.

Cureus 2021 Jun 27;13(6):e15974. Epub 2021 Jun 27.

Dermatology, San Diego Family Dermatology, National City, USA.

Parrot beak nail dystrophy is an excessive forward curvature of the nail plate that can affect both fingernails and toenails. Few cases have been reported since its original description in 1971; however, the incidence is estimated to be 2.5% in healthy individuals. Although the pathogenesis has not yet been established, parrot beak nail has been associated with chronic crack cocaine use, congenital bone or soft tissue abnormalities, other nail dystrophies, peripheral neuropathy, systemic sclerosis, and trauma to the nail. We describe an 86-year-old man with dementia and neuropathy who presented with an unperceived parrot beak nail of his left fourth toenail and concurrent onycholysis of his left great toenail. He had stopped visits with his podiatrist for nail care, which fostered the growth of these nail dystrophies. Our patient's parrot beak nail was successfully treated with nail clipping and regular nail maintenance to prevent its recurrence. The associated conditions, etiologies, and treatment of parrot beak nails are discussed.
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http://dx.doi.org/10.7759/cureus.15974DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8316624PMC
June 2021

Genital Rejuvenation of Scrotal and Vulvar Angiokeratomas: Laser Therapy of Scrotum and Vulva Lesions.

Skinmed 2021 1;19(3):216-218. Epub 2021 Jun 1.

San Diego Family Dermatology, National City, CA.

Genital rejuvenation requires medical and procedural treatments that can improve the morphology or aesthetics of the scrotum and vagina. Angiokeratomas are benign vascular lesions that my occur on the penis, scrotum, and vulva. These lesions can be of either cosmetic concern or medical significance if they bleed. Laser therapy can be successfully utilized for the treatment of genital angiokeratomas in men and women.
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http://dx.doi.org/DOI Listing
June 2021

Bariatric Surgery-Induced Telogen Effluvium (Bar SITE): Case Report and a Review of Hair Loss Following Weight Loss Surgery.

Cureus 2021 Apr 21;13(4):e14617. Epub 2021 Apr 21.

Dermatology, San Diego Family Dermatology, National City, USA.

Bariatric surgery is a potential modality for the management of obesity. Bariatric patients may experience skin disorders and hair loss postoperatively. A 24-year-old woman with polycystic ovarian syndrome-associated obesity successfully underwent bariatric surgery. Within seven weeks after surgery, she developed diffuse and progressive hair loss, characteristic of telogen effluvium. Alopecia following bariatric surgery may be acute in onset, occurring within the first three months and often associated with telogen effluvium. In addition, bariatric surgery postoperative hair loss may be the result of nutritional deficiencies; in this setting, it is often chronic in onset, occurring six months after surgery. Also, hair loss in bariatric patients may be multifactorial in etiology. We introduced an acronym to facilitate the description of patients who experience bariatric surgery-induced telogen effluvium: Bar SITE.
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http://dx.doi.org/10.7759/cureus.14617DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144077PMC
April 2021

Atrophic Dermatofibroma: A Unique Dermatofibroma Variant.

Cureus 2021 Apr 19;13(4):e14570. Epub 2021 Apr 19.

Dermatology, San Diego Family Dermatology, National City, USA.

Dermatofibromas are benign skin tumors with several variants, including the rare, uncommonly described atrophic dermatofibroma. To the best of our knowledge, there are currently 105 reported cases of atrophic dermatofibromas in the literature. This variant typically presents as a flat or depressed macule whose color can range from brown to white to red; in contrast to classic dermatofibromas that typically occur on the legs, atrophic dermatofibromas have a tendency to occur on the upper back and arms. An atrophic dermatofibroma can be clinically diagnosed; however, given the broad spectrum of clinical features of this lesion, a biopsy may be required. Characteristic pathologic features include epidermal acanthosis, basilar hyperpigmentation, fibroblast hyperplasia, and decreased or absent elastic fibers within the lesion. The pathogenesis of this lesion is not yet fully understood; however, it has been postulated that the loss of elastic fibers plays a key role in its development and characteristic atrophic appearance. We present the cases of two men with biopsy-confirmed atrophic dermatofibromas: a 47-year-old man with a pigmented macule on the right upper back and a 68-year-old man with an erythematous patch on the left posterolateral shoulder. The clinical and pathologic features of atrophic dermatofibromas are also summarized.
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http://dx.doi.org/10.7759/cureus.14570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136451PMC
April 2021

Topical Steroid-Induced Perioral Dermatitis (TOP STRIPED): Case Report of a Man Who Developed Topical Steroid-Induced Rosacea-Like Dermatitis (TOP SIDE RED).

Cureus 2021 Apr 12;13(4):e14443. Epub 2021 Apr 12.

Dermatology, San Diego Family Dermatology, National City, USA.

The long-term use of topical corticosteroids can result in rosacea-like dermatitis or facial perioral dermatitis. The case of a 54-year-old man is described who developed topical corticosteroid-induced perioral dermatitis (TOP STRIPED), and the features of topical corticosteroid-induced rosacea-like dermatitis are reviewed. The man presented with a painful erythematous facial eruption. Additional history revealed that he had been applying a high-potency topical corticosteroid twice daily to the affected area. Correlation of the clinical history and cutaneous examination established a diagnosis of topical corticosteroid-induced rosacea-like dermatitis (TOP SIDE RED). Treatment of the patient's TOP SIDE RED included not only discontinuing the high-potency corticosteroid but also initiating topical and oral antibiotics. In addition, a low-potency topical corticosteroid and metronidazole gel were also applied to the affected area. His facial rash resolved within three months and has not recurred. TOP STRIPED, also referred to as TOP SIDE RED, is an adverse side effect associated with the use of high-potency topical corticosteroids to the face. Management includes discontinuing the corticosteroid. Additional treatment may include a low-potency topical corticosteroid, antibiotics (systemic or topical or both), and/or topical calcineurin inhibitors, such as tacrolimus or pimecrolimus.
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http://dx.doi.org/10.7759/cureus.14443DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8115187PMC
April 2021

Fungal Melanonychia as a Solitary Black Linear Vertical Nail Plate Streak: Case Report and Literature Review of Candida-Associated Longitudinal Melanonychia Striata.

Cureus 2021 Apr 1;13(4):e14248. Epub 2021 Apr 1.

Pain Management/Palliative Care, Scripps Memorial Hospital, La Jolla, USA.

Longitudinal melanonychia striata, presenting as a black linear vertical band of the nail plate, can be caused by pigmented lesions and non-pigmented etiologies. A fungal infection of the nail plate, also referred to as onychomycosis or tinea unguim, can result from dermatophytes, non-dermatophyte molds, and . Albeit rare, -associated fungal melanonychia can present as a longitudinal black nail plate streak. The case of a 79-year-old man who developed a solitary linear black streak on his right fourth fingernail after a prior history of recent trauma to the digit's nail folds is described; the fungal culture grew . Including our patient, -associated longitudinal melanonychia striata has been described in four women and two men ranging in age from 40 to 79 years (median, 70 years) at diagnosis. The black streak, present from one month to one year (median, seven months), affected either a hand digit (five patients) or the great toe (one patient). Fungal organisms were visualized on either a potassium hydroxide preparation (one patient), pathologic evaluation of a nail plate specimen (three patients), or both (one patient). Culture grew (two patients), (two patients), (one patient), and (one patient). All of the patients experienced clinical improvement after treatment. Topical treatment (5% amorolfine hydrochloride nail lacquer for two patients or modified Castellani paint and 1% clotrimazole cream for one man) or oral itraconazole (either as monotherapy for two women or combined with 5% amorolfine hydrochloride nail lacquer for one woman) was successfully used. Although the clinical presentation of fungal melanonychia can mimic subungual melanoma when it appears as a solitary black linear vertical nail plate streak, investigative studies--such as a potassium hydroxide preparation, nail plate pathology, nail matrix biopsy, and/or fungal culture--can be used to establish the diagnosis of -associated longitudinal melanonychia striata and exclude the diagnosis of a pigmented melanocytic tumor.
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http://dx.doi.org/10.7759/cureus.14248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8093122PMC
April 2021

Chronic Lymphocytic Leukemia in Neurofibromatosis Type 1 Patients: Case Report and Literature Review of a Rare Occurrence.

Authors:
Philip R Cohen

Cureus 2021 Apr 2;13(4):e14258. Epub 2021 Apr 2.

Dermatology, San Diego Family Dermatology, National City, USA.

Neurofibromatosis type 1 (NF1) is an autosomal dominant genodermatosis that may also occur as the result of a spontaneous mutation. The diagnosis can be established by the presence of two of the seven National Institutes of Health (NIH) diagnostic criteria; several dermatologic manifestations are NIH criteria used to establish the diagnosis: axillary and inguinal freckling, café-au-lait macules, and neurofibromas. Mucosal evaluation of the eyes may detect a fourth criteria: pigmented iris hamartomas (Lisch nodules). The remaining NIH criteria include optic path glioma, distinctive osseus lesions, and a positive family history of the condition. A breast cancer 2 (BRCA2) positive woman with NF1 and chronic lymphocytic leukemia is described. Patients with NF1 have an increased lifetime risk to develop breast cancer, gastrointestinal stromal tumor, malignant glioma, malignant peripheral nerve sheath tumor, and rhabdomyosarcoma. Chronic lymphocytic leukemia occurring in NF1 patients is rare; including my female patient reported in this paper, chronic lymphocytic leukemia has only been reported in three individuals with NF1--two women and one man. The man and the other woman presented with advanced chronic lymphocytic leukemia and treatment with antineoplastic therapy at diagnosis; the man achieved clinical remission and the woman passed away from complications associated with therapy-refractory progression of her leukemia. My female patient required treatment 41 months after diagnosis and had a good clinical response; she has been without significant disease progression for 34 months. Similar to NF1, breast cancer 1 (BRCA1) and BRCA2 mutations are associated with an increased lifetime risk of developing cancer--particularly breast and ovarian carcinoma. An increased risk of chronic lymphocytic leukemia has also been demonstrated in patients with mutations of either BRCA1 or BRCA2. Also, albeit uncommon, either BRCA1 or BRCA2 mutation has been detected in women with NF1 who develop breast cancer. In conclusion, the development of chronic lymphocytic leukemia in NF1 patients may be coincidental and not associated with the underlying genodermatosis; however, the occurrence of chronic lymphocytic leukemia in my patient with NF1, in part, may be related to her BRCA2 positivity.
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http://dx.doi.org/10.7759/cureus.14258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088774PMC
April 2021

Dyshidrosiform Bullous Pemphigoid.

Authors:
Philip R Cohen

Medicina (Kaunas) 2021 Apr 20;57(4). Epub 2021 Apr 20.

San Diego Family Dermatology, National City, CA 91950, USA.

Dyshidrosiform bullous pemphigoid is a variant of bullous pemphigoid. At least 84 patients with dyshidrosiform bullous pemphigoid have been described. Dyshidrosiform bullous pemphigoid usually presents with pruritic blisters in elderly individuals; the hemorrhagic or purpuric lesions on the palms and soles can be the only manifestation of the disease. However, bullae may concurrently or subsequently appear on other areas of the patient's body. Patients typically improve after the diagnosis is established and treatment is initiated. The mainstay of therapy is systemic corticosteroids, with or without topical corticosteroids, and systemic dapsone or immunosuppressants. Drug-related or nickel-induced dyshidrosiform bullous pemphigoid improves after stopping the associated agent; however, systemic therapy has also been required to achieve resolution of the blisters. Similar to classic bullous pemphigoid, neurologic conditions and psychiatric disorders have been observed in dyshidrosiform bullous pemphigoid patients. The new onset of recurrent or persistent blisters on the palms, soles, or both of an elderly individual should prompt the clinician to consider the diagnosis of dyshidrosiform bullous pemphigoid.
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http://dx.doi.org/10.3390/medicina57040398DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8074754PMC
April 2021

Tumor Lysis Syndrome: Introduction of a Cutaneous Variant and a New Classification System.

Cureus 2021 Mar 11;13(3):e13816. Epub 2021 Mar 11.

Center for Personalized Cancer Therapy, University of California San Diego Moores Cancer Center, La Jolla, USA.

Tumor lysis syndrome, an oncological emergency, is characterized by laboratory parameters such as hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia, as well as renal injury with an elevated creatinine. Tumor lysis syndrome is seen in patients with aggressive malignancies and high tumor burden. More frequently, it occurs in individuals with hematologic malignancies such as high-grade lymphomas (such as Burkitt lymphoma) and leukemia (such as acute lymphocytic leukemia). It also, albeit less commonly, can be seen in patients with widespread solid tumors that are rapidly proliferating and are markedly sensitivity to antineoplastic therapy. Tumor lysis syndrome is usually preceded by cancer-directed therapy; however, the syndrome can present spontaneously prior to the individual receiving malignancy-directed treatment. We reported a man with metastatic salivary duct carcinoma who had cutaneous metastases that presented as carcinoma hemorrhagiectoides. Microscopic examination demonstrated that the metastatic tumor cells had infiltrated and replaced the entire dermis. After the patient received his first dose of antineoplastic therapy, he had an excellent response and the cutaneous metastases developed into ulcers; we hypothesize that most of the dermis, which had been replaced by tumor cells, disappeared as a result of the therapeutic response, and the overlying epidermis became necrotic and shed, leaving an ulcer. His dramatic response to treatment prompted us to propose a new classification of tumor lysis syndrome, which should include the systemic form of the condition as well as the new variant: cutaneous tumor lysis syndrome. We anticipate that, with improvement in targeted therapies, there may be an increase in therapy-associated cutaneous tumor lysis syndrome.
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http://dx.doi.org/10.7759/cureus.13816DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8038896PMC
March 2021

Basal cell carcinoma associated with non-neoplastic cutaneous conditions: a comprehensive review.

Authors:
Philip R Cohen

Dermatol Online J 2021 Feb 15;27(2). Epub 2021 Feb 15.

San Diego Family Dermatology, National City, CA Touro University California College of Osteopathic Medicine, Vallejo, CA.

Basal cell carcinoma (BCC) can be a component of a collision tumor in which the skin cancer is present at the same cutaneous site as either a benign tumor or a malignant neoplasm. However, BCC can also concurrently occur at the same skin location as a non-neoplastic cutaneous condition. These include autoimmune diseases (vitiligo), cutaneous disorders (Darier disease), dermal conditions (granuloma faciale), dermal depositions (amyloid, calcinosis cutis, cutaneous focal mucinosis, osteoma cutis, and tattoo), dermatitis, miscellaneous conditions (rhinophyma, sarcoidal reaction, and varicose veins), scars, surgical sites, systemic diseases (sarcoidosis), systemic infections (leischmaniasis, leprosy and lupus vulgaris), and ulcers. The relationship between the BCC and the coexisting non-neoplastic condition may be coincidental or possibly related to the development of the BCC; alternatively, the development of the BCC may be unrelated to the coexisting non-neoplastic conditions and secondary to either a Koebner isomorphic response or a Wolf isotopic response in an immunocompromised district of skin. This paper reviews several of the case reports and studies that describe the association of BCC with these non-neoplastic cutaneous conditions.
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February 2021

Second primary malignancies in patients with melanoma in situ: Insights from the surveillance, epidemiology, and end results program.

Cancer Epidemiol 2021 06 24;72:101932. Epub 2021 Mar 24.

University of Colorado School of Medicine, Department of Medical Oncology, Aurora, CO, USA; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA.

Background: Melanoma in situ (MIS) is among the most frequently diagnosed cancers in the United States. Emerging data suggest that MIS is associated with an increased risk of developing a second primary malignancy (SPM).

Objectives: To determine trends in MIS-associated SPMs and identify MIS-specific features that increase SPM risk.

Methods: In this retrospective population-based study, we identified 90,075 patients who were diagnosed with MIS between 1973 and 2015 from the Surveillance, Epidemiology, and End Results database. The risk of developing an SPM among these individuals was compared to individuals without a diagnosis of MIS. The risk of developing an SPM among patients with a diagnosis of MIS was also increased over time.

Results: Patients with a diagnosis of MIS had an increased relative risk (RR) of developing an SPM as compared to the general population with an identical age, sex, race, and follow-up period. The RR of a metachronous malignancy in MIS patients also increased over time, as follows: 1.16 (95 % CI: 1.07-1.26), 1.19 (95 % CI: 1.14-1.23), 1.30 (95 % CI: 1.27-1.33), and 1.52 (95 % CI: 1.49-1.56) in 1973-1982, 1983-1992, 1993-2002, and 2003-2015, respectively (P < 0.05). In addition, there was a direct correlation between the number of MIS lesions and SPM risk; ≥1, ≥2, and ≥3 tumors portended a 1.5-2, 2-3, and 4-5-fold increased risk of developing an SPM, respectively.

Conclusions: MIS is associated with an increased risk of developing an SPM and therefore individuals with a history of MIS may benefit from close medical surveillance.
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http://dx.doi.org/10.1016/j.canep.2021.101932DOI Listing
June 2021

Adult Acquired Buried Penis: A Hidden Problem in Obese Men.

Authors:
Philip R Cohen

Cureus 2021 Feb 1;13(2):e13067. Epub 2021 Feb 1.

Dermatology, San Diego Family Dermatology, National City, USA.

Buried penis is a condition where the penis is hidden by abdominal or suprapubic skin or fat. In adult men, buried penis occurs as an acquired condition most commonly caused by morbid obesity. The clinical characteristics of three obese men with adult acquired buried penis are described and the associated features of the buried penis are reviewed. In addition to morbid obesity, a buried penis can result from other etiologies, such as hidradenitis suppurativa, iatrogenic causes such as elective surgeries, infections, lichen sclerosus, penoscrotal lymphedema, and traumatic events. Lower urinary tract symptoms, such as voiding, and post-voiding problems are the most common presenting complaints; however, bacterial and fungal infections, phimosis, psychological issues, and sexual dysfunction, are also buried penis-related symptoms. The evaluation of a man with adult acquired buried penis begins with a detailed history for condition-related symptoms. Examination of the patient, both standing and supine with an attempt to demonstrate the penis using digital compression of the surrounding skin and fat, should be performed to determine the extent of the problem and whether comorbid conditions-such as infection and lichen sclerosus-are present. Both buried penis and lichen sclerosus can predispose to the development of penile squamous cell carcinoma; the diagnosis of this tumor can be delayed in men with adult acquired buried penis since an adequate penile examination is difficult or impossible. A multidisciplinary approach-including surgeons, primary care physician, registered dietitian nutritionist, and psychiatrist-should be considered for a patient with a buried penis. The surgical management is individualized and based on not only the extent of the problem but also whether an associated condition, such as urethral stricture, is present. Most patients are pleased with the functional and aesthetic outcome following surgery.
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http://dx.doi.org/10.7759/cureus.13067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932830PMC
February 2021

Ectopic Hidradenitis Suppurativa: Case Report and Review of Literature.

Cureus 2021 Jan 28;13(1):e12966. Epub 2021 Jan 28.

Dermatology, San Diego Family Dermatology, National City, USA.

Hidradenitis suppurativa is a chronic, recurrent follicular-based inflammatory condition classically occurring in apocrine-rich areas; commonly affected areas include the anogenital, axillary, inframammary, and inguinal regions. Infrequently, hidradenitis suppurativa can occur in locations where apocrine glands are scant or absent; in this setting, it has been referred to as ectopic hidradenitis suppurativa. The case of a 59-year-old man with ectopic hidradenitis suppurativa on his right posterior thigh is described. The postulated pathogenesis, treatment modalities, and various reported locations of ectopic hidradenitis suppurativa are reviewed.
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http://dx.doi.org/10.7759/cureus.12966DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920219PMC
January 2021

Therapeutic and Cosmetic Uses of Cannabis: Cannabinoids for Acne Treatment and Skin -Rejuvenation.

Authors:
Philip R Cohen

Skinmed 2021 1;19(1):45-47. Epub 2021 Feb 1.

From the San Diego Family Dermatology, National City, CA.

Cannabinoids can be endogenous (endocannabinoids), plant-derived (phytocannabinoids), or synthesized (synthetic cannabinoids). They are being used for the management of several medical conditions. Laboratory and preliminary clinical studies suggest that topical cannabinoids may be beneficial for the treatment of acne and for skin rejuvenation. (. 2021;19:-0).
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http://dx.doi.org/DOI Listing
October 2021

Laser-Induced Chrysiasis: A Unique Adverse Event Associated With Q-Switched Lasers.

Am J Clin Dermatol 2021 03 27;22(2):289-290. Epub 2021 Feb 27.

Division of Dermatology, Scripps Clinic, San Diego, CA, USA.

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http://dx.doi.org/10.1007/s40257-021-00588-6DOI Listing
March 2021

Basal Cell Carcinoma With Calcification: Case Report of Calcifying Basal Cell Carcinoma and Review of Calcinosis Cutis Associated With Basal Cell Carcinoma.

Cureus 2021 Jan 15;13(1):e12721. Epub 2021 Jan 15.

Dermatology, San Diego Family Dermatology, National City, USA.

Basal cell carcinoma is the most common cutaneous neoplasm. Calcinosis cutis is the deposition of calcium within the dermis. An 80-year-old man presented with a pearly nodule on his left nasal ala; a shave biopsy confirmed the diagnosis of a nodular basal cell carcinoma with calcinosis cutis, which was removed with Mohs micrographic surgery. The incidence of basal cell carcinoma with calcinosis cutis as well as the classification, identification, and potential origin of calcium deposits in basal cell carcinoma are discussed. Basal cell carcinoma can be associated with calcinosis cutis; indeed, calcifying basal cell carcinoma has a calculated incidence of 14%. There are five categories of calcification in basal cell carcinoma. In addition, calcification observed in cancer-free initial sections of a suspected basal cell carcinoma may be a diagnostic clue that a neoplasm is present in deeper sections of the tissue specimen. Although nodular basal cell carcinoma has the greatest incidence (37%) of calcium deposition, infiltrative (29%) and micronodular (27%) basal cell carcinomas are also frequently associated with calcification; therefore, the presence of calcifying basal cell carcinoma may indicate a more aggressive tumor subtype. Basal cell carcinoma may also be suspected in the differential diagnosis of a superficial breast neoplasm in which calcification is observed in the dermis; in this situation, mammography has been an effective diagnostic approach for identifying the basal cell carcinoma with calcification. The pathogenesis of calcification in basal cell carcinoma remains to be definitively established; however, calcium-binding proteins found in poorly differentiated keratinocytes may contribute to the etiology of basal cell carcinoma with calcification. The treatment of basal cell carcinomas with calcinosis cutis is similar to that of non-calcifying basal cell carcinomas; it is based upon the histologic subtype, the size, and the location of the tumor.
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http://dx.doi.org/10.7759/cureus.12721DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883528PMC
January 2021

Red Dot Basal Cell Carcinoma: Literature Review of a Unique Clinical Subtype of Basal Cell Carcinoma.

Dermatol Ther (Heidelb) 2021 Apr 15;11(2):401-413. Epub 2021 Feb 15.

San Diego Family Dermatology, National City, CA, USA.

Red dot basal cell carcinoma is a distinctive clinical subtype of basal cell carcinoma. It has been reported in eight individuals with a male to female ratio of 1:1; and the patients' ages ranged from 50 to 74 years. All patients had prior history of actinic keratoses and basal cell carcinoma. In addition, some patients also had prior squamous cell carcinoma, malignant melanoma, and/or dysplastic nevus. The tumor was usually of recent onset, asymptomatic, and on sun-exposed skin. It was most commonly located on the nose (five patients); other sites were the upper lip, the mid back, or thigh-each in one patient. The red dot basal cell carcinoma was solitary and small-usually 4 mm or less in diameter. It typically presented as a red macule or papule; however, it sometimes appeared as a flesh-colored or pink to light-red papule with a bright-red central area. Microscopic features showed basaloid tumor cells (arranged as either nodular aggregates or superficial buds or both). In the central portion of the lesion, there was a proliferation of erythrocyte-containing vascular spaces between the epidermis and the neoplasm. The basal cell carcinoma pathology subtype was either nodular and superficial (three patients), nodular (two patients), or superficial (one patient). The clinical differential diagnosis of red dot basal cell carcinoma included not only benign vascular lesions (such as hemangioma and telangiectasia) but also inflammatory conditions and adnexal tumors. Other basaloid cell neoplasms were in the pathologic differential diagnosis. The pathogenesis of red dot basal cell carcinoma is similar to that of other basal cell carcinoma clinical subtypes. Mohs surgery is the treatment of choice for red dot basal cell carcinomas. Red dot basal cell carcinoma has two categories of biologic behavior based on the ratio of the postoperative wound size as compared with the size of the preoperative tumor: nonaggressive (for which the ratio was 5:1 or less for three patients) and aggressive (for which the ratio was greater than 12:1 for three patients). There was no recurrence of the red dot basal cell carcinoma after treatment. In conclusion, the incidence of red dot basal cell carcinoma-a unique morphologic variant of basal cell carcinoma-may be higher than suggested by the number of reported patients with this basal cell carcinoma subtype.
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http://dx.doi.org/10.1007/s13555-021-00496-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8018996PMC
April 2021

Cutaneous Metastatic Cancer: Carcinoma Hemorrhagiectoides Presenting as the Shield Sign.

Cureus 2021 Jan 11;13(1):e12627. Epub 2021 Jan 11.

Center for Personalized Cancer Therapy, University of California San Diego Moores Cancer Center, La Jolla, USA.

Cutaneous metastases can be either the initial presentation of an unsuspected internal neoplasm in a cancer-free individual, or the harbinger of recurrent malignancy in an oncology patient who had achieved remission of his cancer, or a sign of progressive disease in a cancer patient who is currently receiving antineoplastic treatment. The cutaneous presentation of skin metastases is pleomorphic and can mimic not only benign conditions and tumors of the skin but also infections and inflammation of the skin. Carcinoma erysipelatoides, carcinoma hemorrhagiectoides, and carcinoma telangiectoides are the three subtypes of inflammatory cutaneous metastatic cancer. The former masquerades as a cutaneous streptococcal infection whereas the latter mimics idiopathic telangiectasias. In contrast, the morphology of carcinoma hemorrhagiectoides is distinctive: it appears similar in shape to a medieval knight's shield and its presence is referred to as a positive shield sign. To the best of our knowledge, carcinoma hemorrhagiectoides has been reported in four oncology patients whose skin metastases presented with the shield sign: two men with salivary duct carcinoma and two women with breast cancer. In conclusion, the shield sign may not only be a pathognomonic clinical feature of carcinoma hemorrhagiectoides but also reflect a common genomic aberration of these metastatic tumors.
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http://dx.doi.org/10.7759/cureus.12627DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872488PMC
January 2021

Bilateral Postprocedural Rhinitis After Intravenous Sedation With Supplemental Nasal Oxygen (PRAISE SNOG) After Cataract Surgery.

Cureus 2021 Jan 3;13(1):e12452. Epub 2021 Jan 3.

Center for Personalized Cancer Therapy, University of California San Diego Moores Cancer Center, La Jolla, USA.

Rhinitis is classified as allergic or nonallergic. It presents with nasal congestion, nasal pruritus, posterior nasal drainage, rhinorrhea, and/or sneezing. During short procedures, nasal cannula administration of supplemental oxygen may be utilized to prevent hypoxia. Postprocedural rhinitis after intravenous sedation with supplemental nasal oxygen (PRAISE SNOG) - a noninflammatory variant of nonallergic rhinitis - has been observed in colonoscopy patients. Symptoms (sneezing and/or rhinorrhea with or without tearing) typically begin during emergence from sedation and persist for hours to days before resolving. A 66-year-old woman developed bilateral PRAISE SNOG following cataract extraction; her bilateral symptoms of nasal pruritus, rhinorrhea, and sneezing began immediately after awakening from sedation and spontaneously resolved within 24 hours. Mucosal irritation by the nasal cannula prongs that deliver the oxygen is a postulated pathogenesis for postprocedural rhinitis. Modification of the nasal prong composition (by using a soft silicon-based material), placement (by insertion prior to the induction of sedation and by not impinging on the nasal mucosa), and length (by trimming from 10 to two millimeters) are possible actions that might be initiated in order to prevent PRAISE SNOG.
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http://dx.doi.org/10.7759/cureus.12452DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853694PMC
January 2021

Concurrent Scleredema and Pyoderma Gangrenosum: Case Report and Review of Comorbid Conditions.

Cureus 2020 Dec 20;12(12):e12188. Epub 2020 Dec 20.

Dermatology, San Diego Family Dermatology, National City, USA.

Scleredema is a connective tissue disorder that presents as diffuse induration of skin, most often involving the upper body. Scleredema can be associated with prior infection, monoclonal gammopathy, and diabetes mellitus. Pyoderma gangrenosum is a neutrophilic dermatosis that presents as an ulcer with violaceous borders. Pyoderma gangrenosum can be idiopathic or associated with various conditions. A 66-year-old man with a 20-year history of scleredema diabeticorum presented with idiopathic pyoderma gangrenosum in the affected area of scleredema on his neck. His pyoderma gangrenosum resolved after treatment with topical and intralesional corticosteroids. Diseases associated with scleredema, pyoderma gangrenosum or both are reviewed.
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http://dx.doi.org/10.7759/cureus.12188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815298PMC
December 2020
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