Faculty Bibliography

Methotrexate is historically recognized as an effective treatment of pemphigus but its utility as a single or alternate steroid-sparing agent was not recognized in recent consensus recommendations in pemphigus management. We aimed to evaluate the efficacy and safety of a treatment course for pemphigus that involves methotrexate as a single or steroid-sparing agent. In a retrospective cohort study, we examined patients with pemphigus vulgaris or pemphigus foliaceus who were on ≥3 months of methotrexate therapy. Efficacy and safety were evaluated by established pemphigus disease endpoints. Of the 34 patients who met inclusion criteria, 25 (73.5%) were on glucocorticoids at time of methotrexate initiation (median follow-up: 5.4 years; median time on methotrexate: 3.7 years). An appreciable proportion achieved disease control (91.2%), with some achieving clinical remission off all systemic therapies (23.5%). For patients on glucocorticoids, median time to control was 42 days, median time to minimal steroid dose tapering (5 mg prednisone) was 161 days, and median time to complete steroid tapering was 308 days. For patients on methotrexate as a single agent, median time to control was 119 days. Among all patients, relapse commonly occurred (88.2%). At last follow-up, 26.5% were managed on topical therapies alone and 11.8% required systemic steroid therapy. Methotrexate was largely tolerated with a low incidence of adverse events leading to treatment discontinuation (2.9%). Methotrexate has the potential to be an effective and well-tolerated option for patients and may be considered for use as an alternate single or steroid-sparing agent for pemphigus.

Drug discovery and development (DDD) is an interdisciplinary enterprise that spans the translational continuum. Despite DDD's importance, formal training within medical and biomedical schools is lacking. In this tutorial, we outline the current educational landscape in DDD and the growing educational need in this area. Lastly, we describe the Health Innovations and Therapeutics concentration as an example of how to design and implement an educational program in DDD.

Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory disease characterized by tender, erythematous, indurated breast plaques with associated edema, drainage, and scar formation.1 IGM is often mistaken for breast carcinoma or infectious mastitis.1,2 Histopathology readily distinguishes IGM from breast carcinoma, as the primary finding in IGM is granulomas centered around mammary lobules.3 Nevertheless, differentiating IGM from bacterial mastitis and other mimickers, such as atypical mycobacterial infections or sarcoidosis, can be more difficult.4 Herein, we report the largest case series of concurrent IGM and erythema nodosum (EN)

Vulvar dermatoses are common, potentially debilitating conditions that can be seen by a variety of medical specialists. Lichenoid vulvar diseases, namely lichen sclerosus (LS), lichen planus (LP), and lichen simplex chronicus (LSC), can all negatively impact patients' quality of life and LS and LP also have an association with squamous cell carcinoma. It is essential that dermatologists are familiar with the unique features of each of these conditions to ensure the appropriate management and follow up. Herein, we provide an update on the epidemiology, clinical presentation, histopathology, and treatment of patients with vulvar LS, LP, and LSC.

Postirradiation morphea (PIM) is a rare and potentially disabling cutaneous complication of radiotherapy, affecting approximately 2 in every 1000 patients treated with radiotherapy. Only 67 cases are reported in the literature to date, and treatment data is reported in only roughly half of cases. The objective of this retrospective cohort study was to characterize the nature and treatment of patients with PIM. Using two medical record databases at New York University, we reviewed all charts with ICD-9 code 701.0 to identify all patients with PIM at a large tertiary care center from 2007 to 2015. Nine patients with PIM were identified. All were female and had a history of radiotherapy for breast cancer. Mean age of onset was 58 years. Where data were available, 40% (n = 2) developed PIM within 1 year of first radiation exposure, 40% (n= 2) within 1-5 years, and 20% (n =1) after 5 years. Sixty seven percent (n = 6) had PIM extending beyond the irradiation field to sites including the contralateral breast, abdomen, back, groin, and extremities. Fifty-six percent (n = 5) were asymptomatic, 33% (n = 3) had pruritus, and 11% (n = 1) had pain. One patient had a history of radiation dermatitis. None had a history of connective tissue disease. All were referred to a dermatologist. Where treatment data were available, all (n = 8) were treated with topical agents including dapsone, corticosteroids, calcipotriol, azeilaic acid, and tacrolimus. Only 1 patient had substantial improvement with topical therapy alone (dapsone); the remainder had no or partial improvement. The majority of patients (n=5) required systemic agents including methotrexate, etanercept, doxycycline, colchicine, calcitriol, pentoxifylline, and/or phototherapy. MTX, although only utilized in 2 patients, led to substantial improvement in both. Overall, PIM was treatment refractory with 50% (n = 4) of patients requiring trials of three or more treatment regimens and the majority (n = 5) requiring treatment for greater than six months. In conclusion, this study represents the largest PIM cohort since 1989 and the largest study to date to report on PIM therapy. This study highlights the recalcitrant and potentially chronic nature of PIM, as well as the diverse nature of PIM in terms of symptoms, latency period from radiotherapy, and areas of involvement. Additional study is needed to further characterize PIM