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Chronic lymphocytic leukemia and the skin: implications for the dermatologist

Fried, Lauren J; Criscito, Maressa C; Stevenson, Mary L; Pomeranz, Miriam K
B-cell chronic lymphocytic leukemia (CLL) is the most prevalent leukemia in the United States, and its diagnosis can have many dermatologic implications. For one, the cutaneous manifestations of CLL include several entities, most notably leukemia cutis, eosinophilic dermatosis of hematologic malignancy, and a heightened risk of skin infections. Additionally, CLL patients are at an increased risk of secondary malignancies, most commonly of the skin. Furthermore, a number of commonly utilized treatments for CLL have cutaneous implications which should be considered in the interdisciplinary management of CLL patients. In this review, we will provide an update on the diverse cutaneous manifestations of CLL and CLL-directed therapies in order to help guide dermatologic management of this increasingly prevalent patient population.
PMID: 33951189
ISSN: 1365-4632
CID: 4897992

Vulvovaginal Pyoderma Gangrenosum in a Patient Treated With Ocrelizumab for Multiple Sclerosis

Breneman, Alyssa N; Eber, Ariel E; Haque, Hoosna; Levine, Libby; Askanase, Anca; Riley, Claire S; Pomeranz, Miriam Keltz; Hassan, Dahlia; Mancebo, Silvia E; Polin, Melanie; Melamed, Alexander; Bordone, Lindsey A; Rosser, Mary; Gockley, Allison; Gallitano, Stephanie M
PMID: 35256568
ISSN: 1526-0976
CID: 5200202

Art of prevention: The importance of dermatologic care when using aromatase inhibitors

Behbahani, Sara; Geisler, Amaris; Kolla, Avani; Dreker, Margaret Rush; Kaunitz, Genevieve; Pomeranz, Miriam K
As of January 2021, there are more than 3.8 million women in the United States with a history of breast cancer. The current standard of care for breast cancer involves surgical resection, radiation therapy, adjuvant endocrine therapy, and/or adjuvant chemotherapy. Aromatase inhibitors (AIs) are the gold standard for endocrine therapy in postmenopausal women. Dermatologic adverse events (dAEs) associated with AIs are rare but have been reported in the literature. Commonly reported dAEs include unspecified rash, pruritus, alopecia, vulvovaginal atrophy, vasculitis, and autoimmune/connective tissue disorders. Appropriate preventative strategies and careful management considerations have the potential to optimize the comprehensive care of patients with cancer and improve quality of life. Furthermore, prevention of dAEs can lead to a reduction in cancer treatment interruptions and discontinuations. Herein, we characterize dAEs of AIs and discuss preventative management to reduce the incidence of AI therapy interruption.
PMID: 35028380
ISSN: 2352-6475
CID: 5119112

Purpura Fulminans Induced by Vibrio vulnificus [Letter]

Akoh, Christine C; Singh, Gaurav; Lederhandler, Margo; Kim, Randie H; Pomeranz, Miriam Keltz
PMID: 35100541
ISSN: 2326-6929
CID: 5153372

28226 Aromatase inhibitor-induced dermatologic adverse effects: A systematic review [Meeting Abstract]

Behbahani, S; Geisler, A; Kaunitz, G; Pomeranz, M K
Background: Aromatase inhibitors (AIs) are the mainstay of adjuvant endocrine therapy in the management of estrogen receptor-positive breast cancer in postmenopausal women. Dermatology-related adverse events (AEs) (including the skin, hair, nails, and mucosal surfaces) associated with AIs are rare but have been reported in the literature. However, to date, no systematic reviews have been performed to analyze the characteristics of patients and types of dermatology-related AEs developed as a result of AI use.
Method(s): A comprehensive electronic literature research of published articles was conducted in the following databases: MEDLINE (Ovid), Scopus (Elsevier), Cochrane (Wiley), and Web of Science (Clarivate Analytics). Controlled vocabulary, MeSH, subject headings, and keywords were used with the search strategy. Two independent reviewers examined the titles and abstracts of all articles. The search identified 322 articles for title and abstract review. Review articles, other systematic reviews, and studies where AIs were used in combination with other treatments were excluded. Forty-nine articles met inclusion criteria.
Result(s): Our study analyzed AI usage in 5296 patients. The median age of patients on AI therapy was 64. The most commonly used AI was anastrozole (39%) followed by letrozole (36%) and exemestane (17%). Onset of dermatology-related AEs ranged from 2 days to 9 months. Commonly reported side effects included unspecified rash, pruritis, alopecia, vaginal dryness, dermatitis, and various autoimmune and connective tissue disease reactions.
Conclusion(s): While dermatology-related AEs are rare after AI use, our study shows that there may be a considerable proportion of patients experiencing dermatology-related AEs.
ISSN: 0190-9622
CID: 4977382

Benign "lumps and bumps" of the vulva: A review

Sally, Rachel; Shaw, Katharina S; Pomeranz, Miriam Keltz
Vulvar dermatology represents a challenge for many providers. Given that the vulva is both a gynecologic and dermatologic organ, patients with cutaneous lesions involving the vulva may present to primary care, gynecology, or dermatology. Particularly within dermatology, the vulva remains understudied, which can lead to anxiety among providers regarding appropriate next steps in the diagnosis and management of vulvar lesions. Thus, the purpose of this review is to highlight commonly encountered anatomic variants and benign neoplasms of the vulva, distinguish them from key pathologic mimickers, and provide guidance to practicing dermatologists on what may constitute normal vulvar variations.
PMID: 34621949
ISSN: 2352-6475
CID: 5067792

Autoimmune and dermatologic conditions associated with lichen sclerosus

Bieber, Amy Kalowitz; Steuer, Alexa B; Melnick, Laura E; Wong, Priscilla W; Pomeranz, Miriam Keltz
PMID: 32777320
ISSN: 1097-6787
CID: 4873572

Viral Venereal Diseases of the Skin

Karagounis, Theodora K; Pomeranz, Miriam K
Viral venereal diseases remain difficult to treat. Human papilloma virus (HPV) and herpes simplex virus (HSV) are two common viral venereal diseases. HPV infections are characterized by anogenital warts and less commonly by premalignant or malignant lesions. HSV infections classically present as grouped vesicles on an erythematous base with associated burning or pain; however, immunosuppressed patients may have atypical presentations with nodular or ulcerative lesions. This review discusses the epidemiology, diagnosis, and management of anogenital HPV and HSV infections with an emphasis on treatment modalities for the practicing dermatologist. Diagnosis of these diseases typically relies on clinical assessment, although multiple diagnostic techniques can be utilized and are recommended when diagnosis is uncertain or evaluating an individual with increased risk of malignancy. Management of HPV and HSV infections involves appropriate counseling, screening, and multiple treatment techniques. Particularly for HPV infections, a practitioner may need to use a combination of techniques to achieve the desired outcome.
PMID: 34008162
ISSN: 1179-1888
CID: 4878702

Melanoma in situ and invasive melanoma of the vulva: An analysis of the National Cancer Database

Behbahani, Sara; Malerba, Stefano; Warren, Christopher J; Pomeranz, Miriam K; Samie, Faramarz H
PMID: 32950551
ISSN: 1097-6787
CID: 4798362

Dermatologic sequelae of breast cancer: From disease, surgery, and radiation

Milam, Emily C; Rangel, Lauren K; Pomeranz, Miriam K
The care of breast cancer patients is important to dermatologists. Breast cancer's initial presentation, clinical progression, and its associated treatments can result in a variety of cutaneous complications. Dermatologists may be the first to identify a breast cancer diagnosis, as a subset of patients first present with direct extension of an underlying tumor or with a cutaneous metastasis. The surgical treatment of breast cancer also begets a variety of skin sequelae, including postoperative lymphedema, soft tissue infections, seromas, pyoderma gangrenosum, and scarring disorders. Moreover, breast cancer radiation treatment commonly results in skin changes, which can range from mild and temporary dermatoses to chronic and disfiguring skin ulceration, fibrosis, and necrosis. Radiation may also precipitate secondary malignancies, such as angiosarcoma, as well as rarer dermatologic diseases, such as radiation-induced morphea, lichen planus, and postirradiation pseudosclerodermatous panniculitis. Finally, breast cancer is also associated with an array of paraneoplastic phenomena, including Sweet's syndrome and the rarer intralymphatic histiocytosis. Herein, we review the dermatological manifestations of breast cancer, including conditions associated with its presentation, progression, and treatment sequelae. Chemotherapy-induced cutaneous side effects are beyond the scope of this review. This article provides a comprehensive review for dermatologist to be able to identify, diagnose, and manage breast cancer patients from initial presentation to treatment monitoring and subsequent follow-up.
PMID: 33226140
ISSN: 1365-4632
CID: 4734702