Faculty Bibliography

Masculinizing hormonal treatment in transgender men has the potential to increase the level of androgens at end organs, including the pilosebaceous unit. Androgen-induced sebocyte growth and differentiation, sebum production, and infundibular keratinization may underlie the development of acne vulgaris among patients receiving this therapy. Despite the incidence of treatment-related acne and the unique considerations in treating transgender men, studies addressing this topic among this patient population are limited. Generally, standard guidelines for the treatment of acne can be followed in treating these patients; however, several medical, social, and psychologic factors should be considered. The aim of this article is to familiarize dermatologists with the sensitivities and challenges of treating acne in transgender male individuals.

BACKGROUND:The role of female sex hormones in the pathogenesis of malignant melanoma (MM) remains controversial. While melanocytes appear to be hormonally responsive, the effect of estrogen on MM cells is less clear. Available clinical data does not consistently demonstrate that increased endogenous hormones from pregnancy, or increased exogenous hormones from oral contraceptive pills and hormone replacement, impact MM prevalence and outcome. OBJECTIVE:We sought to examine potential associations between in vitro fertilization (IVF) and melanoma. METHODS:A literature review was conducted. Primary outcomes were reported as associations between IVF and melanoma risk, as compared to the general population. Secondary outcomes included associations stratified by type of IVF regimen and subgroup, such as parous versus nulliparous patients. RESULTS:Eleven studies met our inclusion criteria. Five studies found no increased risk of MM among IVF users as compared to the general population. Two studies found an increase in MM in clomiphene users. Four studies found an increase in MM among patients who were gravid or parous either before or after IVF. CONCLUSIONS:The reviewed studies do not reveal consistent patterns of association between IVF and MM among all infertile women. However, the data indicates that there may be an increased risk of MM in ever-parous patients treated with IVF. High-quality studies, which include a large number of MM cases and control for well-established MM risk factors, are needed to adequately assess the relationship between IVF and MM, particularly among ever-parous women.

Iodinated contrast (IC) often is overlooked as a cause of delayed drug reactions. As a result, patients may continue to be readministered these agents, experiencing preventable morbidity. We report an illustrative case of a delayed cutaneous reaction to IC and review the literature on the epidemiology and management of this underrecognized phenomenon.

Anetoderma is a rare benign elastolytic disorder that is characterized by focal loss of elastin fibers on histopathology and is often recalcitrant to treatment. We present a case of a patient with a 20-year history of pruritic and painful hyperpigmented atrophic papules clustered on the neck, axillae, inframammary folds, and right medial thigh. Although the histopathologyof her axillary lesions was consistent with anetoderma, her clinical presentation is unusual given the extent of involvement, reported pain and pruritus, and sharp demarcation of the distribution. The diagnosticuncertainty of this case led to added difficulty in management of a disease that is already notoriously difficult to treat and may significantly impact patient's quality of life.

Throughout pregnancy, the body undergoes a variety of physiologic changes. The cutaneous findings can be most noticeable and often worrisome to both physicians and patients. Obstetricians and dermatologists must be able to differentiate between changes that are benign and those that may be pathologic. Most physicians recognize benign changes that are commonly described in literature such as hyperpigmentation, melasma, striae gravidarum, and telogen effluvium; however, they may be unaware of changes that tend to be less frequently discussed. This comprehensive review provides a broad overview of the physiologic cutaneous changes that occur during pregnancy as described in the literature over the past 10 years.