Barber Knowledge and Recommendations Regarding Pseudofolliculitis Barbae and Acne Keloidalis Nuchae in an Urban Setting [Letter]
Association of keloids with systemic medical conditions: a retrospective analysis [Letter]
Patient satisfaction with different treatment modalities for vitiligo [Letter]
Assessing the use of methotrexate as an alternate therapy for pemphigus vulgaris and pemphigus foliaceus
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 â‰¥3â€‰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: 5.4â€‰years; median time on methotrexate: 3.7â€‰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 42â€‰days, median time to minimal steroid dose tapering (5Â mg prednisone) was 161â€‰days, and median time to complete steroid tapering was 308â€‰days. For patients on methotrexate as a single agent, median time to control was 119â€‰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.
Response to Ranpariya et al.'s "Direct-to-consumer teledermatology platforms may have inherent conflicts of interest." [Letter]
Enlarging alopecic patch in an African American woman with central centrifugal cicatricial alopecia: A case of concomitant tinea incognito [Case Report]
Dermatologists' knowledge of dermoscopic features in hair and nail disorders [Letter]
Revisiting Solitary Pedunculated Lipofibromas
OBJECTIVES/OBJECTIVE:Pedunculated lipofibromas are soft, compressible, skin-colored nodules that typically present as an acquired solitary lesion, predominantly located on the buttocks and thighs. We aimed to differentiate between pedunculated lipofibromas and nevus lipomatosus superficialis. Although benign, this may be important as treatment options vary. METHODS:We describe 3 cases of solitary pedunculated lipofibromas occurring in older, obese adults that required clinicopathologic correlation for the correct diagnosis. RESULTS:The histopathologic features of pedunculated lipofibromas include a broad-based lesion with aggregates of mature adipocytes extending upwards into the dermis without an associated inflammatory infiltrate. The primary histopathologic differential diagnoses include fibroepithelial polyps with adipocytes and nevus lipomatosus superficialis, which is more frequently found in children or young adults and is typically characterized clinically by multiple lesions with a cerebriform to verrucoid surface. CONCLUSIONS:While the precise relationship between pedunculated lipofibromas and nevus lipomatosus is still unknown, we propose using pedunculated lipofibroma as a more specific clinical term to refer to solitary pedunculated or broad-based fatty lesions with a smooth surface that occur in older patients and in a wide anatomic distribution.
Comparing the clinical differences in white and black women with frontal fibrosing alopecia [Letter]
Evaluating the Contributions of Dermatologists in the Management of Systemic Sclerosis: A Retrospective Analysis [Letter]
Systemic Sclerosis (SSc) is an autoimmune condition characterized by cutaneous sclerosis and the potential for internal organ involvement.1 Given the multisystem nature of SSc, multiple disciplines are often involved in its management. However, while the skin is affected in more than 90% of patients,2 dermatologists are variably involved in the management of SSc, potentially first evaluating patients only late in the disease course, or at times not at all.