Publications by authors named "Rachel Kornik"

16 Publications

  • Page 1 of 1

Diagnosis and Management of Vulvovaginal Lichen Planus.

Obstet Gynecol Surv 2020 Oct;75(10):624-635

Professor, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA.

Importance: Genital lichen planus is a debilitating disorder that lacks definitive recommendations regarding diagnosis and treatment.

Objective: The aim of this study was to present best practices from available evidence for the diagnosis and treatment of genital lichen planus.

Evidence Acquisition: We conducted a narrative review of the literature on genital lichen planus by searching PubMed using the following search terms: "vulvar lichen planus" OR (vulvar diseases[mesh] OR vulva[mesh]) AND lichen planus[mesh] OR vulvar[ti] AND "lichen planus"[ti]. We included all languages and years in the search.

Results: The search resulted in 273 citations that we reviewed for relevancy and selected 60 as the foundation for this review that focuses on genital sites. Diagnosis can be made without biopsy, and when a biopsy is taken, the pathologic findings may be nonspecific. Topical ultrapotent corticosteroids are most commonly used as first-line treatment of genital lichen planus.

Conclusions And Relevance: When patients present with genital lichen planus, a complete review of systems and a thorough physical examination should be performed because of the prevalence of extragenital sites. Treatment of genital disease should start with a topical, ultrapotent steroid, and follow-up visits should occur to ensure improvement and to monitor for adverse drug reactions and malignancy.
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http://dx.doi.org/10.1097/OGX.0000000000000834DOI Listing
October 2020

Adequacy of dermatology and ob-gyn graduate medical education for inflammatory vulvovaginal skin disease: A nationwide needs assessment survey.

Int J Womens Dermatol 2020 Jun 22;6(3):182-185. Epub 2020 Feb 22.

Department of Dermatology, University of Wisconsin, Madison, WI, United States.

Background: Many patients with inflammatory vulvovaginal skin diseases, such as lichen planus and lichen sclerosus, experience a delay in diagnosis and lack of appropriate treatment. Unfortunately, patients experience significant morbidity with these conditions.

Objective: The aim of this study was to assess the adequacy of training in vulvar dermatoses for dermatology and obstetrics-gynecology residents (in the United States), with a secondary goal of identifying the most ideal modality to broadly reach these residents with high quality instruction.

Methods: We created a survey with questions relating to attitudes about training in vulvovaginal disease, quantity of current education on the subject, and opinions on ways to improve training. The survey was distributed to obstetrics-gynecology and dermatology residents and program directors nationwide.

Results: Most respondents reported that training was not adequate in this area and that additional education was needed.

Conclusion: We propose that online, interactive, case-based learning modules, created by vulvovaginal experts, could help improve graduate medical education and lead to better patient outcomes.
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http://dx.doi.org/10.1016/j.ijwd.2020.01.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330429PMC
June 2020

septic vasculitis.

JAAD Case Rep 2020 May 30;6(5):422-425. Epub 2020 Apr 30.

Warren Alpert Medical School of Brown University, Providence, Rhode Island.

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http://dx.doi.org/10.1016/j.jdcr.2020.02.043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7200184PMC
May 2020

Vulvar basal cell carcinoma in a patient with long-standing lichen sclerosus.

JAAD Case Rep 2019 Jan 9;5(1):69-71. Epub 2018 Dec 9.

Department of Dermatology, The University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

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http://dx.doi.org/10.1016/j.jdcr.2018.07.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6290116PMC
January 2019

Allergic Contact Dermatitis of the Vulva.

Dermatitis 2018 Sep/Oct;29(5):233-243

Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison.

Allergic contact dermatitis is an important diagnostic consideration in the evaluation of patients presenting with vulvar complaints. The high prevalence of contact sensitization in the vulvar region is likely multifactorial. We review the extant literature regarding key predisposing factors in the pathogenesis of vulvar allergic contact dermatitis, as well as the most commonly implicated allergens as identified by a number of retrospective studies and case series. On the basis of our findings, we provide diagnostic and therapeutic recommendations for practicing clinicians.
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http://dx.doi.org/10.1097/DER.0000000000000339DOI Listing
January 2019

Patch Testing in Vulvar Allergic Contact Dermatitis.

Dermatitis 2018 Mar/Apr;29(2):95-96

Department of Dermatology, University of California, San Francisco University of Michigan Medical School, Ann Arbor Department of Dermatology, University of California, San Francisco Department of Dermatology, University of Wisconsin, Madison Department of Dermatology, University of California, San

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http://dx.doi.org/10.1097/DER.0000000000000345DOI Listing
October 2018

Vulvovaginal Graft-Versus-Host Disease.

Obstet Gynecol Clin North Am 2017 Sep;44(3):475-492

UCSF School of Medicine, 505 Parnassus Avenue, San Francisco, CA 94143, USA.

Vulvovaginal chronic graft-versus-host disease (cGVHD) is an underrecognized complication of stem cell transplantation. Early recognition may prevent severe sequelae. Genital involvement is associated with oral, ocular, and skin manifestations. Treatment includes topical immunosuppression, dilator use, and adjuvant topical estrogen. Clinical and histologic features may mimic other inflammatory vulvar conditions. In the right clinical context, these findings are diagnostic of chronic GVHD. Female recipients of allo-hematopoietic stem cell transplantation (HCT) are at higher risk of condylomas, cervical dysplasia, and neoplasia. The National Institutes of Health publishes guidelines for the diagnosis, grading, management, and supportive care for HCT patients by organ system.
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http://dx.doi.org/10.1016/j.ogc.2017.05.007DOI Listing
September 2017

Warfarin-Associated Nonuremic Calciphylaxis.

JAMA Dermatol 2017 03;153(3):309-314

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

Importance: Classic calciphylaxis associated with renal failure is a life-threatening disease. Warfarin-associated calciphylaxis without renal injury has been described, but whether it is a subset of classic calciphylaxis or a different entity remains unknown. We describe 1 case of warfarin-associated calciphylaxis, present data from 2 others from our institution, and review all cases of warfarin-associated calciphylaxis available in the literature. Our review indicates that warfarin-associated calciphylaxis is clinically and pathophysiologically distinct from classic calciphylaxis.

Objective: To review warfarin-associated calciphylaxis and determine its relationship to classic calciphylaxis.

Design, Setting, And Participants: We searched MEDLINE and Ovid without language or date restrictions for case reports of calciphylaxis from the inpatient setting using the terms "calciphylaxis and warfarin," "non-uremic calciphylaxis," and "nonuremic calciphylaxis." We defined nonuremic calciphylaxis as a histopathologic diagnosis of calciphylaxis without severe kidney disease (serum creatinine level >3 mg/dL; glomerular filtration rate <15 mL/min; acute kidney injury requiring dialysis; and renal transplantation).

Exposures: Each patient had been exposed to warfarin before the onset of calciphylaxis.

Main Outcomes And Measures: Patient data were abstracted from published reports. Original patient medical records were requested and reviewed when possible.

Results: We identified 18 patients with nonuremic calciphylaxis, 15 from the literature, and 3 from our institution. Patients were predominantly female (15 of 18 [83%]) with ages ranging from 19 to 86 years. Duration of warfarin therapy prior to calciphylaxis onset averaged 32 months. Lesions were usually located below the knees (in 12 of 18 [67%]). No cases reported elevated calcium-phosphate products (0 of 17 [0%]). Calcifications were most often noted in the tunica media (n = 8 [44%]) or in the vessel lumen and tunica intima (n = 7 [39%]). The most common treatments included substitution of heparin or low-molecular weight heparin for warfarin (n = 13 [72%]), intravenous sodium thiosulfate (n = 9 [50%]), and hyperbaric oxygen (n = 3 [17%]). The survival rate on hospital discharge was remarkably high, with 15 cases (83%) reporting full recovery and 3 cases ending in death.

Conclusions And Relevance: Warfarin-associated calciphylaxis is distinct from classic calciphylaxis in pathogenesis, course, and, particularly, outcome. This finding should influence clinical management of the disease and informs targeted treatment of the disease.
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http://dx.doi.org/10.1001/jamadermatol.2016.4821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5703198PMC
March 2017

Asymptomatic Cobblestoned Plaques on the Soles.

JAMA Dermatol 2017 01;153(1):79-80

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

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http://dx.doi.org/10.1001/jamadermatol.2016.3433DOI Listing
January 2017

Diabetes insipidus, bone lesions, and new-onset red-brown papules in a 42-year-old man.

J Am Acad Dermatol 2013 Jun 1;68(6):1034-8. Epub 2013 Mar 1.

Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.

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http://dx.doi.org/10.1016/j.jaad.2013.01.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3657338PMC
June 2013

Dermatofibrosarcoma protuberans in children: an update on the diagnosis and treatment.

Pediatr Dermatol 2012 Nov-Dec;29(6):707-13. Epub 2012 Jul 11.

Department of Dermatology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin 53715, USA.

Dermatofibrosarcoma protuberans (DFSP) is a fibrohistiocytic tumor of low grade malignant potential. Although rare, pediatric cases pose a particular challenge in diagnosis and management. In children, the clinical appearance may be heterogeneous and a high index of suspicion is necessary to avoid delays in diagnosis which can lead to further morbidity. Histologic examination, often with the use of appropriate immunostains, is necessary for diagnosis. Advances in the understanding of the molecular genetics of DFSP have led to further diagnostic and therapeutic modalities. DFSP is thought to result from a translocation between platelet-derived growth factor beta (PDGFB, 22q13.1) and type 1 collagen (COL1A1, 17q21≈22) leading to a fusion protein (PDGFB) which stimulates the PDGF receptor. Detection of this translocation in tissue via PCR or fluorescence in situ hybridization (FISH) can be helpful in difficult cases. While surgery with wide local excision or Mohs micrographic surgery is the mainstay of treatment, the use of targeted therapy with imatanib mesylate shows promise in large or unresectable tumors. Knowledge of the clinical features, histology, genetics, and treatment options is important for successful management of these tumors.
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http://dx.doi.org/10.1111/j.1525-1470.2012.01767.xDOI Listing
September 2013

Patch-testing North American lip dermatitis patients: data from the North American Contact Dermatitis Group, 2001 to 2004.

Dermatitis 2008 Jul-Aug;19(4):202-8

Dartmouth Medical School, Hanover, NH, USA.

Background: The most common differential diagnoses for patients presenting with lip dermatitis or inflammation include atopic, allergic, and irritant contact dermatitis. Patch testing can be performed to identify the allergic contact conditions.

Objective: To report North American Contact Dermatitis Group (NACDG) patch-test results of patients who presented for patch testing with only lip involvement from 2001 to 2004. Patient characteristics, allergen frequencies, relevance, final diagnoses, and relevant allergic sources not in the NACDG screening series were evaluated.

Methods: The NACDG 2001-2004 database was used to select patients presenting with only lip involvement.

Results: Of 10,061 patients tested, 2% (n = 196) had lips as the sole involved site. Most (84.2%) were women. After patch testing, 38.3% (n = 75) were diagnosed with allergic contact cheilitis. Fragrance mix, Myroxilon pereirae, and nickel were the most common relevant allergens. Of 75 patients, 27 (36%) had relevant positive patch-test reactions to items not on the NACDG series; lipstick and cosmetics were the predominant sources.

Conclusions: Patch testing is valuable in the evaluation and identification of contact allergy in patients referred for lip dermatitis. The use of supplementary allergens based on history and exposure is important in the identification of additional relevant allergens. Over a third of patients with contact allergy had other factors, such as irritant dermatitis, considered relevant to their condition.
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September 2008

Nickel.

Dermatitis 2008 Jan-Feb;19(1):3-8

Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.

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June 2008

The perfect time to be stressed: a differential modulation of human memory by stress applied in the morning or in the afternoon.

Prog Neuropsychopharmacol Biol Psychiatry 2005 Dec 17;29(8):1281-8. Epub 2005 Oct 17.

Laboratory of Human Stress Research, Douglas Hospital Research Centre, Frank B. Common Pavilion, 6875 LaSalle Blvd, Verdun, Québec, Canada, H4H 1R3.

We measured the effects of a stressful experience on memory for emotionally arousing and neutral material learned after exposure to a stressor which induces a significant increase in corticosteroid stress hormones. Because memory performance can be influenced by circadian changes in corticosteroid levels, subjects were tested either in the morning or in the afternoon. Nineteen healthy men (9 in the morning group and 10 in the afternoon group) were submitted to a psychological stress task before viewing a story composed of emotionally negative and neutral segments, while another 20 healthy males (10 in the morning group and 10 in the afternoon group) viewed the story without being exposed to the psychological stressor. Salivary cortisol levels were measured before and after the stressor. Memory performance was assessed by a one week post learning delayed recall. Results show that stress-induced increases in salivary cortisol levels impaired delayed free recall of emotionally arousing material in the morning group, but not in the afternoon group. There was no effect of stress on memory for neutral material. Altogether, these findings suggest that stressing participants in the morning, at a time of high circulating levels of corticosteroids, over stimulated the corticosteroid receptors in the brain, impairing declarative memory for emotionally arousing material unrelated to the stressor. These findings suggest that the experimental context, i.e., time of day at which the experiment occurs, the nature of the to-be-remembered material (remembering the stressful event itself or material unrelated to the stressor) and the valence of the to-be-remembered material (emotionally arousing vs. neutral), modulates the effects of stress on human declarative memory.
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http://dx.doi.org/10.1016/j.pnpbp.2005.08.012DOI Listing
December 2005

Motivation influences the underestimation of cumulative risk.

Pers Soc Psychol Bull 2005 Nov;31(11):1511-23

Department of Psychology, McGill University, Montreal, Quebec, Canada H3A 1B1.

Past research has shown that people typically underestimate the cumulative risk of events. This effect has mainly been interpreted as resulting from the use of cognitive heuristics and judgment strategies, such as availability or anchoring and adjustment. The authors suggest that motivational processes can be an additional force in the generation of cumulative risk estimates. Using an experimental design, Study 1 shows that people underestimate the cumulative risk of infection with sexually transmitted diseases of appealing prospective sexual partners by using risk-irrelevant information for their judgment. Using a correlational design, Study 2 demonstrates that people underestimate the cumulative risk of being infected with a sexually transmitted disease and that commitment to the present partner is directly related to a low cumulative risk estimate as well as indirectly through its effect on the perceived risk of the present partner. Together, the two studies demonstrate that motivation influences the underestimation of cumulative risk.
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http://dx.doi.org/10.1177/0146167205276864DOI Listing
November 2005