Faculty Bibliography

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.
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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.

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.

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.

Background/UNASSIGNED:Vulvar lichen sclerosus (LS) is a chronic dermatosis for which the true prevalence is not well established. LS remains an underrecognized and undertreated disease, and treatment patterns and differences among various specialties that care for patients with LS are largely unknown. Objective/UNASSIGNED:This study sought to determine the prevalence of diagnosed vulvar LS, demographic characteristics, and diagnostic and treatment patterns in the United States. Methods/UNASSIGNED:A database comprising >21.7 million women with commercial insurance in the United States was analyzed, and the largest cohort of patients with LS in the United States to date was identified. Results/UNASSIGNED:We found that obstetricians/gynecologists are diagnosing and managing approximately half of women with LS, and regardless of specialty, the majority of providers are appropriately prescribing high-potency topical steroids. Conclusion/UNASSIGNED:Our results suggest that LS may truly be underrecognized and underdiagnosed, especially in younger women.

Vulvar malignancies represent a serious gynecologic health concern, especially given the increasing incidence over the past several decades. Squamous cell carcinoma and melanoma are common subtypes, although other neoplasms such as basal cell carcinoma and Paget's disease of the vulva may be seen. Many vulvar cancers are initially misdiagnosed as inflammatory conditions, delaying diagnosis and worsening prognosis. It is essential that dermatologists are familiar with characteristic findings for each malignancy in order to ensure appropriate diagnosis and management. Herein, we review the unique epidemiologic and clinical characteristics of each major vulvar malignancy, as well as discuss their respective prognoses and current management recommendations.