Faculty Bibliography

BACKGROUND:Differentiating scarring and nonscarring alopecia poses a diagnostic dilemma for clinicians, with histopathology used to distinguish. The extent to which dermatologists are able to clinically classify alopecia has not been evaluated. METHODS:A retrospective study of pathology reports on 458 patients was used to calculate a kappa coefficient to correlate clinical presence of scarring or nonscarring alopecia to histopathologic presence of scarring or nonscarring. A multivariate analysis was performed to assess for associations with scarring. RESULTS:The kappa correlation coefficient was 0.59 (P < 0.0001), indicating moderate agreement and varied by race and sex. There were 15 times higher odds of making the clinical diagnosis of scarring alopecia (OR 14.64 95% CI [8.64-24.18]; P < 0.001), and this increased with age. CONCLUSIONS:These results suggest that clinical exam is moderately reliable in distinguishing between scarring and nonscarring alopecia. Our results highlight the need for education and diagnostic schemata for evaluation of alopecia based on gender and in skin of color.

Hidradenitis suppurativa (HS) is a chronic and debilitating inflammatory skin disease that disproportionately affects women of childbearing age. Yet, little has been written about the impact of pregnancy on the natural history of HS. It has been postulated that apocrine-gland activity diminishes in pregnancy, accounting for symptom remission.

Actinomycetomas are soft tissue bacterial infections that are in the differential for unusual masses of the extremities. Typical infectious agents include Actinomyces and Nocardia and are treated with long-term antibiotics. We report a rare case of Gordonia actinomycetoma that was misdiagnosed as Nocardia and subsequently required surgical excision in addition to antibiotic therapy.

Hidradenitis suppurativa is a debilitating inflammatory skin disease with a chronic course and often disappointing response to treatment. Though a minority of persons (20%) reports symptom remission during pregnancy, the vast majority experiences no relief (72%), and few experience clinical deterioration (8%). Disease flares are also observed post-partum. The pathophysiological basis for pregnancy-associated fluctuations in clinical status is currently unknown. Because most women with HS require ongoing management throughout pregnancy, it is important to evaluate the suitability and safety of current treatment options for pregnant women. The following review will outline current management strategies for HS and their compatibility with pregnancy and lactation.