Faculty Bibliography

The vulvar dermatologic examination is a crucial component of gynecologic and dermatologic practice, requiring a thorough understanding of normal anatomy and physiologic variations, and common pathologic conditions. This review outlines key elements of the history-taking process, including demographic factors, symptoms, product use, and relevant medical history, which help guide diagnostic evaluation. A structured approach to distinguishing normal anatomic variations from disease is emphasized, including the identification of physiological changes across the lifespan and common benign lesions that may mimic pathology. Proper vulvar hygiene and personal care habits play a significant role in maintaining vulvar health and preventing irritant or allergic reactions. We review evidence-based recommendations on cleansing practices, product selection, and environmental factors that contribute to vulvar irritation, as well as common allergens and irritants implicated in contact dermatitis. In addition, we discuss the indications for vulvar biopsy, emphasizing its role in distinguishing benign inflammatory conditions from premalignant or malignant processes. Specific biopsy techniques and procedural considerations are highlighted to ensure accurate histopathologic diagnosis and optimal patient outcomes. This guide provides clinicians with a practical framework for evaluating the vulva, integrating history-taking, physical examination, patient education, and diagnostic interventions to improve care for individuals presenting with vulvar complaints.

Combined oral contraceptives (COC) decrease androgen levels by inhibiting androgen production and increasing sex hormone binding globulin. COC can therefore be used in the treatment of androgen-mediated dermatologic conditions. Hormonal contraceptives may also contribute to some dermatologic diseases through interactions with estrogen and/or progesterone receptors. In part two of this continuing medical education article, we discuss evidence regarding the mechanism and efficacy of hormonal contraceptives as therapeutics for acne, hirsutism, and hair loss, and review potential dermatologic SE of hormonal contraceptives to guide dermatologists in utilizing this therapy in their practices.

The skin synthesizes hormones and expresses hormone receptors. Androgens are steroid hormones that interact with the skin and play a role in the development of acne, hirsutism, and hair loss. Estrogens and progestogens are steroid hormones found in the skin that may affect sebum production and hair growth by lowering androgen levels, as well as incompletely understood interactions with the skin's structures. Thus, oral contraceptive pills (OCPs) containing estrogen and progestogen have potential benefits in treating conditions commonly seen by dermatologists. In part 1 of this continuing medical education article (CME), we discuss the effects of androgens, estrogens, and progestogens on the skin and hair and characterize available hormonal oral contraceptives, their routes of administration, hormonal compositions, and potential adverse effects. This two-part CME is intended to serve as a guide to dermatologists for both selecting among OCPs and further understanding their interactions with the skin and hair.

BACKGROUND:HPV is a prevalent sexually transmitted infection (STI) associated with malignancies and condyloma acuminata (CA), with significant healthcare costs. Despite vaccine availability, vaccination rates remain low, highlighting the need for effective interventions to increase uptake. OBJECTIVE:To improve HPV vaccination rates among eligible individuals at a safety-net dermatology STI clinic. METHODS:A multiphase quality improvement program aimed to improve HPV education and vaccination rates was implemented in a dermatology STI clinic. The cohort included 175 patients with CA between August 2019 and December 2022. HPV vaccine education and immunization rates were measured. RESULTS:While counseling/education rates were high, vaccination initiation rates remained low before the onset of in-office HPV vaccine. In-office HPV vaccine administration demonstrated a 175% increase in vaccine initiation (p < 0.01). LIMITATIONS/CONCLUSIONS:This study had a relatively small sample size and was conducted in an urban, safety-net hospital; results may not be generalizable to smaller or rural practices. CONCLUSION/CONCLUSIONS:This quality improvement initiative successfully increased HPV vaccination rates at a safety-net dermatology STI clinic, demonstrating that in-office, same day vaccination for HPV was critical for the success. Our study highlights an effective approach toward improving vaccination rates for HPV and is a model for vaccine delivery.

OBJECTIVE/UNASSIGNED:This review aims to consolidate available evidence, identify research gaps, and advocate for a more informed approach to the management of pityriasis rosea in pregnant individuals. DATA SOURCES/UNASSIGNED:PubMed, Web of Science, and Directory of Open Access Journals were systematically searched based on the keywords "pityriasis rosea," "pityriasis circinate," "roseola annulate," "herpes tonsurans maculosus," "herald patch," and "pregnancy" on January 25, 2024 for publications between 1950 to 2024. STUDY SELECTION/UNASSIGNED:Studies containing outcomes data for pregnant patients with established PR were included. Studies must have been written or translated into English and published in a peer-reviewed journal. Studies which did not pertain to PR in the setting of pregnancy were excluded, as screened by two reviewers. Responses, general informational reviews, and letters to the editor without novel data were also excluded. RESULTS/UNASSIGNED:Eleven relevant articles were identified, encompassing data from 177 patients. Overall, 81% of patients had favorable outcomes while 19% experienced unfavorable outcomes. PR onset before 15 weeks gestation was associated with a higher rate of unfavorable outcomes (41%), including a 27% rate of spontaneous abortion (SA). Conversely, PR onset after 15 weeks had a lower unfavorable outcome rate (21%), and no instances of SA. CONCLUSION/UNASSIGNED:Conflicting data exists regarding the impact of PR on pregnancy outcomes. However, PR onset within the first 15 weeks, widespread lesions, constitutional symptoms, and higher human herpesvirus 6 viral loads may increase the risk of unfavorable outcomes such as SA. Close follow-up and consideration of antiviral treatment are recommended for high-risk patients.